Week 9 Flashcards
Psychological Disorders - Middle Ages
Middle ages
► Possession by demons
► Exorcism of evil spirits thought responsible for mental illness
► Trephination: drilling holes into skull to let out demons
Psychological Disorders - Bedlam
Bedlam
► St Mary of Bethlehem Priory, England, founded in 1247
► Operated for five centuries as institution for mentally ill
► Gentry would pay to admission to watch the antics of the mad
Psychological Disorders - Changing Views
Changing views…
► an illness, but mental rather than physical
► People like Phillipe Pinel and William Tuke ushered in a more humane approach to the treatment of the mentally ill
Process of Diagnosis
The clinical interview ► Current symptoms ► History of symptoms ► Impact of symptoms on functioning ► Hypothesis testing Collateral information ► Family members, friends, GPs, teachers, etc. Psychometric assessment (e.g., Beck’s Depression Inventory, Alcohol Use Disorders Identification Test, Depression, Anxiety, and Stress Scale)
Mental Disorder
A syndrome (group of associated features) that is characterized by clinically significant disturbance in an individual’s cognitions, emotion, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning
Not mental disorders
It is not:
► An expectable or culturally approved response to a common stressor
► Socially deviant behaviour or conflicts that are primarily between the individual and society (e.g. criminality), unless the deviance/conflict results from a dysfunction in the individual
Why classify abnormal behaviour ?
- Assists communication
- Assists research
- Assists understanding of causality
- Assists treatment selection
- Facilitates comparisons across time and geographic areas
Disorders classified by
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM)
► DSM (1952) | DSM-II (1968) | DSM-III (1980) | DSM-III-R (1987) | DSM-IV (1994) | DSM-IV-TR (2000) | DSM-5 (2013)
World Health Organization: International Classification of Diseases (ICD)
Diagnostic Categories
Anxiety disorders | Mood disorders | Schizophrenia | Obsessive-compulsive disorders | Personality disorders | Dissociative disorders | Eating disorders | Trauma-related disorders | Conduct disorders | Substance-related disorders | Somatic symptom disorders
Criticism of classifying behaviour
Categories versus dimensions ► DSM-5 has introduced a dimensional approach that allows clinicians to rate disorders along a continuum of severity - Pejorative labels/terminology - Danger of self-fulfilment - Reliability
Prevalence
Proportion of people in a defined population who have the condition at a specified point in time (or during a period of time)
► e.g., How many Australian adults would currently meet criteria for a Major Depressive Disorder?
Incidence
Frequency of new cases identified during a specified period of time
► e.g., The number of new cases of Major Depressive Disorder diagnosed in Australian adults in 2015
Comorbidity
Co-occurrence of disorders
Anxiety Disorders
Characterised by feelings of excessive fear, anxiety, and related behavioural disturbances
► Out of proportion to environmental threats
Generalised Anxiety Disorders (GAD)
- Persistent and excessive anxiety and worry about a number of events or activities (for at least 6 months)
- Perseverative, negative thinking about things that can go wrong
- Accompanied by symptoms such as restlessness, difficulty concentrating, muscle tension, irritability
Panic Disorders - Anxiety
- Recurrent attacks of overwhelming anxiety and intense fear that usually occur suddenly and unexpectedly
- Often leads to avoidance of precipitating conditions
Can develop agoraphobia
► Fear of being in places from which escape might be difficult or help might not be available in the event of embarrassing or incapacitating symptoms
Panic Attacks - Anxiety
Panic attack: abrupt surge of intense fear or intense discomfort that reaches a peak within minutes
► Heart palpitations, pounding heart, or accelerated heart rate
► Trembling or shaking
► Feelings of choking
► Nausea or abdominal distress
► Feeling dizzy, unsteady, lightheaded, or faint
► Chill or heat sensations
► Fear of losing control, “going crazy”, or dying
Specific Phobia - Anxiety
- Persistent irrational fear or anxiety about a specific object, activity, or situation (e.g. spiders, heights, flying, receiving an injection)
- Avoidance of situations
- Treated with exposure therapy
Social Anxiety Disorder
► Marked fear or anxiety about social situations (fear of possible scrutiny or negative evaluation)
► Frequently concerned about others noticing anxiety symptoms
- Treated with exposure therapy
Anxiety Aetiology - Biological
BIOLOGICAL - Biological preparedness (evolutionary) - Neurochemistry ► Low levels of GABA (gamma-Aminobutyric acid) ► Low levels of serotonin
Anxiety Twin Studies - Biological
Twin studies and family studies show moderate genetic predisposition to anxiety disorders
► MZ twins: If one twin has an anxiety disorder, 35% chance other twin will have an anxiety disorder
► DZ twins: If one twin has an anxiety disorder, 15% chance other twin will have an anxiety disorder
Anxiety Aetiology - Environmental
ENVIRONMENTAL
- Diathesis-stress hypothesis
- Genetic factors place an individual at risk…BUT… environmental stress factors must impinge in order for the potential risk to manifest itself
- Severe stressors
- Negative life events
Anxiety Aetiology - Cognitive
COGNITIVE
Overestimate likelihood or nature of threat
► Perceive ambiguous situations as threatening, and focus excessive attention on perceived threats
- Underestimate ability to cope with threat
- Selective recall of threat information
‘Vicious Cycle’ of Anxiety
►Trigger –>
Cognition | Behaviours | Physical Symptoms
Mood Disorders
Characterised by disturbance in emotion or mood
Major Depressive Disorder - Mood Disorders
- Persistent depressed mood and anhedonia
- Other symptoms: disturbances in appetite, sleep, energy level, concentration, feelings of worthlessness, suicidal thoughts/attempts
- Symptoms present most of the day, nearly every day, for a minimum of 2 weeks
- Major depressive episodes are often recurrent
Persistent Depressive Disorder - Mood Disorders
- Also known as dysthymia
- Chronically depressed mood that occurs for most of the day, more days than not, for at least 2 years
Seasonal Affective Disorder - Mood Disorders
- A depressive syndrome that occurs during a particular season
- Characterised by mood and behaviour changes with regular seasonal climatic variation
Bipolar Disorder - Mood Disorders
- Experience both emotional “poles” of depression and mania
Manic episode:
Abnormally elevated or expansive mood, excessive happiness and euphoria in combination with several additional symptoms: grandiosity, decreased sleep, racing thoughts, constant need to speak, psychomotor agitation, excessive involvement in pleasurable activities
Mood Disorder Aetiology - Biological
BIOLOGICAL
Neurochemistry
► Serotonin (low -> depression, high -> mania)
► Noradrenaline (low -> depression, high -> mania)
Mood Disorders Twin Studies - Biological
Twin studies
► MZ twins: if one twin has an mood disorder, 65% chance other twin will have an mood disorder
► DZ twins: if one twin has an mood disorder, 15% chance other twin will have an mood disorder
Mood Disorders Aetiology - Cognitive
Negative triad: Negative views about self, world, and future
Cognitive distortions:
► Automatic/implicit processing of positive and neutral information in negative way
► Memory bias for sad events
- Learned helplessness, pessimistic attribution style
- Rumination
Mood Disorders Aetiology - Environmental
ENVIRONMENTAL
- Diathesis-stress hypothesis
- Severe stressors
- Negative life events
- Early childhood and family environment– disruptive, hostile, negative
- Social isolation, lack of intimate relationships
Schizophrenia
Schizophrenia involves disturbances in nearly every dimension of human psychology – thought, perception, behaviour, language, communication, emotion
Schizophrenia - Positive Symptoms
Excesses, presence of abnormal features
► Hallucinations, delusions
► Loosening of associations, disordered thought/speech
► Inappropriate emotions, bizarre behaviour
Schizophrenia - Negative Symptoms
Deficits, absence of normal features ► Flat/blunted affect ► Lack of motivation, apathy ► Social withdrawal ► Intellectual impairment (e.g., impoverished thought)
Schizophrenia - Hallucinations
► Perceptual experiences (e.g., visual, auditory, tactile)
► Either gross distortion of perceptual input OR Occur in absence of real, external stimulus
► Auditory hallucinations (e.g., hearing voices) – most common
Schizophrenia - Delusions
False beliefs that are maintained even though they clearly are out of touch with reality
Schizophrenia - Delusions associated belief
Persecution Reference Grandeur Identity Guilt Control
Persecution - Schizophrenia
Belief that others are persecuting, spying on, or trying to harm them
Reference - Schizophrenia
Belief that objects, events, or other people have particular significance to them
Grandeur - Schizophrenia
Belief that they have great power, knowledge, or talent
Identity - Schizophrenia
Belief that they are someone else (e.g., Jesus Christ, the Queen)
Guilt - Schizophrenia
Belief that they have committed a terrible sin
Control - Schizophrenia
Belief that their thoughts and behaviours are being controlled by external forces
Loosening of Associations - Schizophrenia
Tendency for conscious thought to move along associative lines rather than to be controlled, logical, and purposeful
► Reflected in speech
Disorganised speech:
► Loosening of associations
► Word salad
Deterioration of adaptive behaviour e.g. social, occupational, personal hygiene
Schizophrenia Aetiology - Biological
BIOLOGICAL
Neurochemistry
► Excessive dopamine
Schizophrenia Twin Studies - Biological
Twin studies
► MZ twins: if one twin has schizophrenia, 48% chance other twin will have schizophrenia
► DZ twins: if one twin has schizophrenia, 17% chance other twin will have schizophrenia
Schizophrenia Aetiology - Environmental
ENVIRONMENTAL
- Diathesis-stress hypothesis
- Birth complications, viruses, malnutrition
- Stressful life events (in combination with emotional reactivity)
- Expressed emotion within family
► Highly critical/hostile attitudes
► Emotionally over-involved/intrusive family members
- Child abuse
*look up image
Obsessive Compulsive Disorders
Obsessions:
Intrusive, repeated, distressing thoughts, ideas or urges
Compulsions:
Repetitive behaviours or mental acts the person feels forced to carry out (usually to reduce anxiety associated with obsessions)
OCD main types
► Checking
► Contamination
► Hoarding
► Intrusive thoughts
Personality Disorders
- An enduring maladaptive pattern of thought, feeling, and behaviour
- The pattern is inflexible & stable, pervasive across situations
- The pattern causes clinically significant disturbance / impairment in social, occupational, or other important areas of functioning
- The pattern is traceable back at least to adolescence or early adulthood
Paranoid PD
suspicious, mistrusts loyalties, reluctant to confide, bears grudges, perceives attacks on reputation
Borderline PD
instability in relationships, poor sense of identity,poor affect regulation; impulsivity; recurrent suicidal/self-harm
Antisocial PD
disregard for rights of others; deceitfulness; lack of remorse/empathy; reckless disregard for safety; law violations
Narcissistic PD
grandiose, self-important, arrogant, entitled, lacks empathy/interest in others, envious, interpersonally exploitative
Dependent PD
submissive, clingy, excessive need to be taken care of, feels helpless when alone, desperately seeks relationships
Dissociative Disorders
- Characterised by disruptions in consciousness, memory, sense of identity, or perception
- Associated with amnesia
Dissociative Identity Disorder
- Colloquially known as multiple personality disorder
- At least two distinct personalities exist within same person
- Generally reflect history of trauma/abuse
Anorexia Nervosa
- Refusal to maintain body weight at minimally normal weight for age & height (< 85% expected weight)
- Intense fear of gaining weight, even though underweight
- Distorted body image
- Food restriction, excessive exercise, vomiting
- Health implications (e.g., brittle bones, heart attack, death)
Bulimia Nervosa
Binge-and-purge syndrome
