PSY1022 WEEK 5 ABNORM 1 Flashcards
DEMONIC MODEL
View of mental illness in which odd behaviour, hearing voices, or talking to oneself was attributed to evil spirits infesting the body.
MEDICAL MODEL
View of mental illness as due to a physical disorder requiring treatment.
ASYLUM
Institution for people with mental illnesses created in the 15th century.
“Bedlam” comes from Bethlehem, the name of an insane asylum in London in the Middle Ages.
MORAL TREATMENT
Approach to mental illness calling for dignity, kindness, and respect for those with mental illness. Dorothea Dix (America) and Phillippe Pinel (France)
DE INSTITUTIONALIZATION
1960s and 1970s government policy that focused on releasing hospital psychiatric patients into the community and closing mental hospitals.
Both good and bad. Many people then had no care at all. Homeless.
PSYCHOPATHOLOGY
Mental illness.
Often studied using a failure analysis approach. Examining breakdowns to understand healthy functioning.
MENTAL DISORDER CRITERIA (WHAT IS ABNORMAL?)
- Statistical rarity - but not all uncommon things are bad and not all mental illness is uncommon.
- Subjective distress - often bad, but sometimes feel good (like manic phase of bipolar)
- Impairment - Most interfere with people’s ability to function. But other things that aren’t mental illness also interfere (like laziness)
- Societal disapproval - can be a factor. But not everything we disapprove of is a mental disorder (like racism)
- Biological dysfunction - some yes (schizophrenia), some no (phobias)
FAMILY RESEMBLANCE VIEW
According to this view mental disorders don’t all have one thing in common. They are similar, but there are differences (like in a family).
CHLORPROMAZINE
One of the first drugs used in mental hospitals. Provided some relief from symptoms of schizophrenia and other disorders marked by a loss of contact with reality.
PSYCHIATRIC DIAGNOSES ACROSS CULTURES
Certain conditions are culture bound, or specific to one or more societies.
Koro - parts of Asia. Patients believe their penis is retreating into their abdomen.
Amok - parts of Asia and Africa. Intense sadness followed by uncontrolled behaivour and unprovoked attacks on people and animals. “Running amok”
CULTURAL UNIVERSALITY
Many mental disorders, especially those that are severe, appear to exist in most and perhaps all cultures.
MISCONCEPTION: PSYCHIATRIC DIAGNOSIS IS JUST PIGEONHOLING.
We deprive people of their uniqueness, and imply that all people in the same category are alike in all important respects.
No - a diagnosis implies they are alike in at least one important respect. People are very different. Can also make communication easier, especially between mental health professionals.
MISCONCEPTION: PSYCHIATRIC DIAGNOSES ARE UNRELIABLE.
Interrater reliability is usually high. But lower for personality disorders.
MISCONCEPTION: PSYCHIATRIC DIAGNOSES ARE INVALID
Don’t provide us with any new information. Just labels for behaviour we don’t like.
No - can predict behaviour and performance. Though some pop psychology labels are just that.
MISCONCEPTION: PSYCHIATRIC DIAGNOSES STIGMATISE PEOPLE
Psychiatric diagnoses exert powerful negative effects on people’s perceptions and behaviour.
No - there is some stigma, but the effect of the labels only lasts so long.
LABELING THEORISTS
Scholars who argue that psychiatric diagnoses exert powerful negative effects on people’s perceptions and behaviours.
DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM)
Diagnostic system containing the American Psychiatric Association (APA) criteria for mental disorders.
Book says DSM-IV (2000), but DSM-V is out now.
Problems: comorbitity, categorical model.
Biosocialpyscho approach.
Designed to improve communication. 1844.
DSM-IV 17 major categories, 200 subcategories. DSM-V has 21.
PREVALENCE
Percentage of people within a population who have a specific mental disorder.
AXIS
Dimension of functioning.
- life stressors, associated mental conditions, etc.
1 - major disorders (depression, etc.) Diagnosis of a category.
2- personality disorders and mental retardation
3 - medical conditions
4 - pyschosocial stressors
5 - global assessment (referral, hospitalisation, etc)
In DSM-V 1 to 3 are combined.
COMORBIDITY
Co-occurance of two or more diagnoses within the same person (eg. depression and anxiety)
CATEGORICAL MODEL
Model in which a mental disorder differs from normal functioning in kind rather than degree. Eg. someone has major depression, or they don’t.
DIMENSIONAL MODEL
Model in which a mental disorder differs from normal functioning in degree rather than kind. People fall on a continuum. Eg. different degrees of depression.
MENTAL ILLNESS AND VIOLENCE
Myth that people with mental illness are at a greatly heightened risk of violence.
Fact is that overwhelming majority are not physically aggressive.
But people with substance abuse ARE.
INSANITY DEFENSE
Legal defense proposing that people shouldn’t be held legally responsible for their actions if they weren’t of “sound mind” when committing them.
INVOLUNTARY COMMITMENT
Procedure of placing some people with mental illnesses in a psychiatric hospital or other facility based on their potential danger to themselves or others, or their inability to care for themselves.
MAJOR DEPRESSIVE EPISODE
State in which a person experiences a lingering depressed mood or diminished interest in pleasurable activities, along with symptoms that include weight loss and sleep difficulties. Retarded or agitated motor function. Self blame.
2 weeks.
MAJOR DEPRESSIVE DISORDER
Chronic or recurrent state in which a person experiences a lingering depressed mood or diminished interest in pleasurable activities, along with symptoms that include weight loss and sleep difficulties.
16% of people experience this. Women are twice as likely as men. Recurrent. Average person with major depression has 5 to 6 episodes in a lifetime.
Unipolar.
MANIC EPISODE
Markedly inflated self-esteem or grandiosity, greatly decreased need for sleep, much more talkative than usual, racing thoughts, distractability, increased activity level or agitation,
and excessive involvement in pleasurable activities that can cause problems (like reckless driving or excessive spending).
Positive and negative symptoms.
BIPOLAR DISORDER I
Presence of one or more manic episodes. Formerly called manic-depressive disorder.
Equal in men and women.
90% of people who have had one manic episode will have another.
More than half the time a major depressive episode preceeds a manic episode.
Most genetically influenced of all mental disorders. Heritability may be as high as 85%.
Stress can trigger a switch between states. Some suggestion of biological link. Sometimes triggered by positive events.
BIPOLAR DISORDER II
Patients must experience at least one episode of major depression and one hypomanic episode.
DYSTHYMIC DISORDER
Low-level depression of at least two years’ duration; feelings of inadequacy, sadness, low energy, poor appetite, decreased pleasure and productivity, and hopelessness.
HYPOMANIC EPISODE
A less intense and disruptive version of a manic episode; feelings of elation, grouchiness or irritability, distractability, and talkativeness.
CYCLOTHYMIC DISORDER
Moods alternate between numerous periods of hypomanic symptoms and numerous periods of depressive symptoms. Cycles up and down. Increases the risk of developing bipolar disorder.
POSTPARTUM DEPRESSION
A depressive episode that occurs within a month after childbirth. As many as 15% of women develop postpartum depression. A much more serious condition is post partum psychosis. One or two in 1000. Hallucinations to kill the infant, or delusions it is possessed by an evil spirit.
SEASONAL AFFECTIVE DISORDER
Depressive episodes that display a seasonal pattern, most commonly beginning in autumn or winter and improving in spring. There must be two consecutive years in which the episode appears on a seasonal basis. Symptoms often include weight gain, lack of energy, carbohydrate craving, and excessive sleep.
COGNITIVE MODEL OF DEPRESSION
Theory that depression is caused by negative beliefs and expectations.
Aaron Beck.
BEHAVIORAL MODEL OF DEPRESSION
Proposes that depression results from a low rate of response-contingent positive reinforcement.
Cognitive triad: negative views of oneself, the world, and the future. Negative schemas. Originate in early experiences of loss, failure, and rejection.
Cognitive distortions.
DEPRESSIVE REALISM
Individuals with mild depression actually have a more accurate view of circumstances.
But depressed people are also less attentive to reality.
LEARNED HELPLESSNESS
Tendency to feel helpless in the face of events we can’t control.
Martin Seligman, experiments with dogs.
People with depression attribute failure to internal factors, and success to external factors.
BIOLOGY IN DEPRESSION?
Twin studies suggest genes exert a moderate effect on the risk of major depression.
Stress-sensitive gene? More research needed.
Low level of norepinephrine and diminshed neurogenesis.
Many patients have problems with the brain’s reward and stress-response systems. Decreased dopamine.
SUICIDE
Major depression and bipolar disorder at higher risk of suicide than most other disorders.
Bipolar 15 times more likely than general population.
Also some anxiety disorders and substance abuse.
People are only acutely suicidal for a short window of time, so intervention is critical.
12 to 13 people out of 100, 000 commit suicide.
3 times as many man as women.
MAJOR SUICIDE RISK FACTORS
Depression Hopelessness Substance abuse Schizophrenia Homosexuality (social stigma) Unemployment Chronic, painful, or disfiguring illness Recent loss of a loved one (death or divorce) Family history of suicide Personality disorders Anxiety disorders Old age, especially in men Recent discharge from a hospital.
SCHIZOPHRENIA
Severe disorder of thought and emotion associated with a loss of contact with reality.
NOT always multiple personalities, rather one personality that is shattered.
Delusions. Hallucinations, usually auditory. Disorganised speech.
Twice as likely to relapse if relatives display highly expressed emotion (criticism, etc).
DELUSIONS
Strongly held, fixed belief that has no basis in reality. Commonly involve the theme of persecution.
PSYCHOTIC SYMPTOM
Psychological problem reflecting serious distortions in reality.
HALLUCINATIONS
Sensory perception that occurs in the absence of an external stimulus. Can be auditory, olfactory, gustatory, tactile, or visual.
Visual hallucinations, especially in the absence of auditory hallucinations, are usually signs of organic (medical) disorder or substance abuse.
DISORGANISED SPEECH
Symptom of schizophrenia. Results from thought disorder. Usual associations between two words, such as mother-child, are weakened or highly unusual in schizophrenics.
Can become so bad it is called “word salad”
PARANOID TYPE OF SCHIZOPHRENIA
Prominent delusions or auditory hallucinations. Generally persecutory or grandiose, but often combined and organised around a central theme.
Ability to think, reason, and express feelings (outside of the delusion) may not be impaired.
Function at a higher level than other types of schizophrenia.
DISORGANISED TYPE OF SCHIZOPHRENIA
Disorganised speech and behaviour, as well as flat or inappropriate affect, such as unpredictable giggling. Delusions and hallucinations, if present, are not well organised into a single theme and are often short-lived.
CATATONIC TYPE OF SCHIZOPHRENIA
One or more catatonic symptoms. Can harm themselves or others when they are in a stupor and are immobile or when they are extremely excited and agitated. Malnutrition, exhaustion, and self inflicted injuries are possible.
CATATONIC SYMPTOM
Motor problem, including extreme resistance to complying with simple suggestions, holding the body in bizarre or rigid postures, or curling up in a fetal position.
BIOLOGICAL CAUSES OF SCHIZOPHRENIA
- Brain abnormalities. Typically central ventricles are enlarged. Suggests brain deterioration. Grey matter loss.
- Increased size of sulci.
- Decreased size of temporal lobes, activation of the amygdala and hippocampus, basal ganglia, and symmetry of the brain’s hemispheres.
- Hypofrontality. Front lobes less active when engaged in demanding mental tasks.
- Dopamine pathways.
- Genetic links.
DIATHESIS-STRESS MODEL
Perspective proposing that mental disorders are a joint product of genetic vulnerability, called a diathesis, and stressors that trigger this vulnerability.
Idea that 10% of people are predisposed to schizophrenia. Have schizotypal personality disorder.
- social withdrawal, thought and movement abnormalities, learning and memory deficits, elevated neuroticism, temporal lobe abnormalities, impaired attention, eye movement disturbances when tracking moving objects.
But most people with a vulnerability do not develop schizophrenia.
POSITIVE SYMPTOMS OF SCHIZOPHRENIA
Symptoms ADDED to what normal people experience. Delusions, hallucinations, disordered thoughts and speech, etc.
NEGATIVE SYMPTOMS OF SCHIZOPHRENIA
Symptoms SUBTRACTED from what normal people experience. Deficits of emotional or thought responses, lack of motivation, inability to experience pleasure, etc.
SYMPTOM
Any characteristic of a person’s actions, thoughts, or feelings that could be a potential indicator of a mental disorder.
SYNDROME
A constellation of interrelated symptoms manifested by a given individual.
- must involve distress or impaired functioning
- the source must be located within the person
- can’t be purely explained as an effect of poverty, prejudice, or social forces.
MULTIPLE CAUSATION
Predisposing causes
Precipitating causes
Maintaining causes
PREDISPOSING CAUSES
Those well in place before the onset of the disorder that make the person susceptible to the disorder.
PRECIPITATING CAUSES
Immediate events in one’s life that bring on the disorder.
MAINTAINING CAUSES
The consequences of a disorder that help to keep it going once it begins.
MOOD
A prolonged state that alters a person’s thoughts and behaviours.
Two main categories of mood disorders in DSM-IV:
- major depressive
- bi polar
DSM-V has many more.
TWO MAJOR DISTINCTIONS BETWEEN DEPRESSION AND ANXIETY
- Anxiety tends to be coupled with physiological arousal and hyper vigilance.
- Depression tends to entail an absence of pleasure and sense of hopelessness.
