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Psychological Disorders

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  1. Perspectives of Psychological Disorders
  1. Introduction
  • Abnormal psychology (psychopathology): scientific study of mental illness, study the origins of symptoms, developmental course, as well as how to treat and how to prevent mental illness
  • Mental illness is more common than people think
  • 26% of people surveyed said they had experienced mental illness within the past year
  • 46% said they had experienced mental illness up to this point in their life
  • 60-70% of people with mental illness do not get help
  • Why people don’t get help:
  • No money
  • Ignorance
  • Living in rural areas where help is not available
  • Stigma behind mental illness
  • Beware of MSS (Medical Student Syndrome)
  • Students becoming hyper vigilant about their own symptoms, relating them to disorders they’re studying
  1. Defining Psychological Disorders
  • Criteria
  • Statistical infrequency (CAREFUL: just because something is statistically infrequent, doesn’t mean it’s abnormal)
  • Behaviour must be deviant (different than the norms and rules of a specific culture)
  • Distressing (the individual is not distressed about their condition)
  • Behaviour has to be dysfunctional (harmful to the individual, or to others  usually disruptive)
  1. Understanding Psychological Disorders
  • The why?
  • 3 Perspectives:
  1. The Demonic Model
  • People who genuinely believe there is something possessing them, not their mind afflicting them
  1. Medical Perspective:
  • Renaissance period
  • People started to diagnose mental illness
  • Believed all symptoms were physiologically and biologically based
  • Practices included: Blood Letting (draining 40% of someone’s blood), Scaring the Sickness out (throwing people into snake pits)
  • Pinel (a director of science in France)
  • Fought for the rights of these mentally ill patients who were being treated terribly
  • Promoted moral and ethical treatment of mentally sick people
  • Syphilis (if left untreated, can cause severe mental disorders)
  • A physical disease that causes mental diseases solidified the medical perspective
  • Today:
  • Diagnose symptoms
  • Use therapy
  • Cure the disease
  1. The Bio-Psycho-Social Perspective
  • Nature and Nurture are examined
  • Genes are examined
  • Physiological and biological factors are taken into account
  • Social and Cultural aspects are also examined
  • Anorexia is only found in cultures who worship the skinny female body
  • Koro (specific to southeast Asia) is an anxiety disorder that causes males to believe their penis will jab into their own abdomens, killing them
  1. Classifying Disorders
  • Medical professionals need a single system that can organize and sort everything pertaining to certain disorders
  • This system is the DSM-IV-TR
  • It organizes, and categorizes info
  • Lists symptoms
  • Lists criteria that must be met in order to diagnose a mental illness
  • Describes the course of an illness
  • DOES NOT provide explanations as to why people have certain diseases
  • DOES NOT provide treatment options

  • The categories are reliable
  • A mentally ill patient goes to different hospitals with the same story, leads to a good probability that the medical professionals will agree on a certain disorder
  • It clearly lists the observable behaviours that must be present in order to be diagnosed
  • Always will be in a state of evolution and devolution (meaning the book is always being revised to ensure accuracy)
  • “It takes a village” to revise the DSM (over 60 organizations are involved in the revision of this book)
  • Criticism
  • The DSM might be culturally biased
  • It categorizes but does not talk about dimensions in these categories
  • The DSM has too many categories
  1. Labeling Psychological Disorders
  • Labels encourage stigma
  • They have biasing power
  • Self-fulfilling prophecy
  • When we label people, they may end up behaving in line with the label
  • Benefits of labels
  • They facilitate communication and research
  • Myth Busting!
  • Mentally ill people DO NOT look bizarre
  • Personal weakness
  • People ARE NOT often dangerous (some are but not all mentally ill people are dangerous)
  • People ARE ABLE to fully recover (contrary to the belief that many do not recover)
  • Some people ARE successful (contrary to conception that mentally ill people have no work, low wages, etc.)
  1. Anxiety Disorders
  1. Introduction
  • Anxiety is normal
  • Anxiety is adaptive
  • Anxiety can become maladaptive
  • Different types of anxiety disorders
  1. Generalized Anxiety Disorders (GAD)
  • Global, overwhelming, persistent, relentless anxiety
  • People who have it are anxious about anything, everything, and nothing
  1. Phobias
  • Very common
  • Focused
  • Typically irrational
  • Can be disruptive and incapacitating
  • Example is Agoraphobia (people who are terrified of being in a public place and not being able to get help if they need it)
  • Shyness is common but social phobia is an extreme
  • Social phobia is people being absolutely terrified of certain public situations
  1. Obsessive Compulsive Disorder
  • Lives are dominated and controlled by obsessions and compulsions
  • Obsessions are thoughts that are unwanted, uncontrollable, intrusive, and repetitive
  • Compulsions are behaviours that a person feels compelled and driven to perform over and over again
  1. Post-Traumatic Stress Disorder
  • Their nervous systems are easily aroused
  • They are easily startled
  1. A - Biological Factors
  • Genes play a big role
  • Natural Selection (we are biologically predisposed to fear the things our ancestors feared)
  • Brain:
  • Amygdala
  • OCD is linked to high levels of activity in the frontal lobes, the caudate nucleus, and the anterior cingulate nuclei
  • OCD is linked to low levels of serotonin
  • GAD are linked to low levels of serotonin and GABA (a neuron that tells other neurons not to fire)

B – Psychological Factors

  • Faulty thinking (people are hyper-vigilant in finding sources of threats rather than safety)
  • Maladaptive learning (much of our fears and anxieties are learned through conditioning, observation, modeling)
  • Fear Conditioning – we will learn to associate a new stimulus with danger and threat
  • Stimulus Generalization (Fear) – your fear is going to extend to stimuli similar to the condition stimulus – EX) one dog bites you, you become afraid of all dogs
  • Reinforcement – a positive effect occurs, and continues to feed the fear that you have
  • Observational Learning – observe the people around you and if they fear certain things, you may end up fearing those things as well

C – Socio-Cultural Factors

  • EX) Taijin Kyofusho – “Social Phobia” specific to Japan
  • Fear of embarrassing others, not oneself

   

  3) Mood Disorders

  1. Major Depressive Disorder
  • Extreme form of sadness
  • Sleep difficulty
  • Physical slowness or agitation
  • Feelings of worthlessness
  1. Dysthymic Disorder
  • Double depression (someone who has this disorder and sometimes go into a major depressive disorder)
  1. Bipolar Disorder
  • People who experience mood disorders at both ends of the continuum
  • Symptoms (Manic):
  • Increased energy
  • Excessive euphoria
  • Over-talkative
  • Self esteem is super inflated
  • Sex drive goes up
  • Diagnosis
  • 1 week or more + 3 or more symptoms
  • Cyclothymic Disorder
  • A form of bipolar disorder (it’s bipolar’s little brother)

  1. 1 - The Biological Perspective
  • The Brain:
  • Loss of gray matter linked to depression
  • Frontal lobes and hippocampus are smaller in these individuals
  • Low levels of activity in left frontal lobe, high levels of activity in right frontal lobe
  • Amygdala tends to be hyperactive in people who are depressed
  • Neurotransmitters:
  • Low levels of dopamine, serotonin, norepinephrine, glutamate (excitatory neurotransmitter)
  • Hormonal system
  • The system linked and associated with the fight or flight response tends to be overactive in people with depression
  • Evolutionary perspective
  • Moderate depression can be adaptive
  • Nature’s way of saying “stop and unwind”
  • Mania:
  • Linked and associated with high levels of norepinephrine and glutamate

2 – The Social Cognitive Perspective

  • Environmental factors
  • Disorder of thinking
  • “Cognitive Triad” – people are depressed because they think poorly of themselves, the world, and the future
  • Pessimistic explanatory style
  • Negative event explained over:
  • Internal dimensions
  • Stable dimensions
  • Global dimensions
  • Positive event explained over:
  • External dimensions
  • Unstable dimensions
  • Specific dimensions
  • Reciprocal determinism between thoughts and mood
  1. The Vicious Cycle of Depression
  • Brain Chemisty <-> Cognition
  • Cognition <-> Mood
  • Brain Chemisty <-> Mood

  • Stressful experience  Negative explanatory style  Depressed mood  Cognitive and behavioural changes
  1. Depression Cont.
  • Most common disorder is depression
  • Women are twice as likely to have depression
  • It can be self-terminating
  • Depression is on the rise and is occurring earlier than ever before

4) Schizophrenia

  1. Intro
  • Huge variations
  • Loss of touch with reality
  • “Cancer” of mental illness
  • Profound changes
  • 1/100 men get it earlier and worse
  1. Positive Symptoms (Symptoms that are prevalent)
  • Delusions (false beliefs)
  • Hallucinations (perceptions without sensations
  • Disorganized speech (quarter/half sentences – don’t finish their thoughts) “word salad” is random words strung together and sufferers think they’ve created a sentence
  • Catatonia people who suffer this stay in one physical position and can’t get out of it
  • Disorganized behaviours (ineffective or inappropriate at times)
  • Disorganized emotions
  • Disorganized thinking (difficulty separating fact from fiction)
  • Attention (everywhere, all over the place, “ADD” of sorts)

Negative Symptoms (Symptoms that provide the absence of)

  • Flat affect (no matter what is said to them, an uninterested reaction occurs, i.e. “flat”
  • Speech becomes very slow and very monotonous – extreme cases people end up with Alogia (speech is almost absent)
  • Abolition (absence of motivation)
  • Attention deficits
  1. Subtypes of Schizophrenia
  1. Type 1 (Reactive) Schizophrenia
  • Positive symptoms
  • Acute onset (develops quickly)
  • Good prognosis
  • Favourable response to medication

  1. Type 2 (Process) Schizophrenia
  • Negative symptoms
  • Chronic (develops slowly)
  • Prognosis is poor
  • Poor response to medication
  • Men get it more often  don’t know why

  1. Understanding Schizophrenia
  1. Genetic Factors
  • No relative with schizophrenia – 1/100 chance to get it yourself
  • Relative with schizophrenia – 1/10 chance to get it yourself
  • 1 in 2 chance of identical twin having it, if other does
  • Adoption studies show that an adoptive child with no schizophrenia, with adoptive parents that have it, risk is still 1/100
  • Chromosomes 6, 7, 13, 22 show abnormalities that are linked and associated with schizophrenia
  • Genes that have an effect:
  • GRM3
  • GAD1
  • SNP4
  • DISC1
  • Some people with schizophrenia tend to have chunks of DNA that are missing – others have chunks added to their existing DNA
  • HERV-W (a retrovirus) believed to be associated with schizophrenia
  • Over 25% of schizophrenia are linked with the father’s age (men in their 40’s/50’s are 3x more likely to give their children schizophrenia, than 20 year olds)
  1. Environmental Factors
  • Complications at birth increase risk for schizo
  • If the mother gets pregnant during famine/starvation – increases risk for child having shcizo
  • Low birth weight linked/associated with a number of negative outcomes INCLUDING risk for schizo – stronger for boys than for girls
  • If mom takes painkillers during pregnancy, it increases the risk of schizo by 5x
  • Women with herpes, their children 5x more likely to get schizo
  • Influenza during 2nd trimester – children 2x likely to get schizo
  • Influenza during 1st trimester – children 7x likely to get schizo
  • Head injury before age of 10 increases risk for schizo
  • Smoking marijuana can lead to increased risk (if smoked before the age of 18)
  • See interactions D.5
  1. Brain Abnormalities
  • Link between abnormal neurotransmitters and schizo
  • Increased dopamine activity is linked and associated with positive symptoms
  • Decreased dopamine activity is linked with negative symptoms
  • Decreased glutamate levels lead to negative symptoms
  • Abnormal interactions between dopamine and glutamate can lead to schizo
  • GABA abnormalities can lead to higher chance of schizo
  • Structure/function of brain (some cases of schizo linked with):
  • Enlarged ventricles
  • Smaller frontal lopes
  • Smaller hippocampus
  • Abnormal connections between frontal lobes and hippocampus
  • Orientations of neurons in hippocampus are abnormal (normal setup is parallel orientations – abnormal they are crossed)
  • Inappropriate connections in utero (the inappropriate connections between neurons occur in the womb)
  • White matter in the brain (healthy teens developed normally after 5 years – early onset schizo teens developed abnormally) the slower the development of white matter, the more symptoms suffered
  • Loss of gray matter (healthy teens developed normally, schizo teens had a lot of destroyed tissue)
  1. Psychological Factors
  • There is no single psychological factor we can link to schizophrenia on it’s own
  • We can find psychological factors interacting with other factors though
  1. Interactions
  • All in the family
  • Expressed emotions:
  • The extent to which family members use criticism and hostility to deal with issues
  • Over involvement, etc.
  • If cured schizo patients return to families who are high in expressed emotions, 60-75% of them relapse
  • Nature & Nurture:
  • Adopted children were recruited to participate in a study – some had bio moms with schizo, some didn’t
  • Expectation is that children with moms who have schizo have a higher chance of getting it – children with bio moms who have schizo, that were raised in healthy adoptive homes severely decreased their risk for schizo
  • Children who were raised in “broken” homes had a higher risk to develop it (both cases of bio moms with/without schizo)
  • A combination of factors (for the first time ever):
  • Show that being exposed to a viral infection
    + having chronic and severe stress
     show a serious increase for risk of schizo
  • GOOD NEWS
  • 25% of people get one episode, but then move on from it
  • Another 25% get re-occurring episodes but can move on from it
  • BAD NEWS
  • 50% of people have it chronically and are in/out of hospitals constantly

5) Personality Disorders

  1. Introduction
  • Typical ways of thinking, believing, feeling are inflexible, rigid, maladaptive, dysfunctional
  • Organized into 3 clusters:
  1. Anxious/Fearful Behaviours
  • Example – “Withdrawn avoidant personality disorder”
  • People that yearn for interpersonal relationships, but avoid them like the plague
  • These people tend to have strong feelings of being inadequate
  1. Odd or Eccentric Behaviours
  • Example – “Schizoid personality disorder”
  • People who suffer have pervasive detachment from the social world
  • No interest in interpersonal relationships – including family members and sexual intimacy
  • Very casual interactions with people
  • Usually are loners, emotionally flat and cold, seem to be indifferent to both praise and criticism
  1. Dramatic, emotional, erratic, or impulsive behaviours
  • Histrionic Personality Disorder
  • Emotional expressions are overly dramatized/exaggerated - “Drama Queens”
  • Self-centered
  • Behaviour/appearance inappropriate in terms of seduction/sexiness
  • Low tolerance for frustration
  • Insecure and shallow
  • Narcissistic Personality Disorder
  • Inflated sense of self importance
  • No one else has the qualities they possess
  • Super self-absorbed
  • Difficulty feeling any concern for others
  • Disregard other people’s feelings
  • Excessive need for admiration
  • Boastful and pretentious
  • Borderline Personality Disorder
  • Mostly women have it
  • Main characteristic is instability (mood/emotions)
  • Self image is unstable
  • Tend to seek lots of attention from others
  • Very common for them to have bouts of rage and anger
  • Have pervasive feelings of emptiness
  • Terrified of abandonment and feeling alone
  • Very self-destructive
  • Self mutilation
  • Suicide attempts
  • Reckless behaviours (gambling, sexual promiscuousness)
  • People with this disorder tend to have a destructive attachment – abusive/neglectful caregivers
  • Areas of the brain that determine the intensity of negative emotions are HYPERACTIVE
  • Areas we use to control some random stuff are underactive
  • Antisocial Personality Disorder
  • 6% of male population are diagnosed, 1% of female population are diagnosed
  • PERVASIVE pattern of manipulating, exploiting, disregarding or violating the rights of others
  • Behaviours are often criminal
  • No conscience, empathy, passion, guilt, etc.
  • They fear very little
  • They see people as mere objects
  • All serial killers are psychopaths, not all psychopaths are serial killers
  • Seems to be a genetic component to be a psychopath BUT there are also environmental factors that come into play as well
  • Some studies seem to indicate that it’s an interaction between nature and nurture that is linked with psychopathy
  • Genetic deficiencies + Maltreatment = Increased Risk for Psychopathy

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