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