Chapter 14
Psychological Disorders
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Abnormal Behavior
Historical aspects of mental disorders
The medical model What is abnormal behavior?
– 3 criteria• Deviant• Maladaptive • Causing personal distress
A continuum of normal/abnormal
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Prevalence, Causes, and Course
Epidemiology Prevalence - % of population that displays the
disorder during a specific period Lifetime prevalence – Diagnosis Etiology – causes Prognosis
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Psychodiagnosis: The Classification of Disorders
American Psychiatric Association – published first taxonomy in 1952
Diagnostic and Statistical Manual of Mental Disorders – 4th ed. (DSM - IV)
Multiaxial system 5 axes or dimensions
– Axis I – Clinical Syndromes– Axis II – Personality Disorders or Mental Retardation– Axis III – General Medical Conditions– Axis IV – Psychosocial and Environmental Problems– Axis V – Global Assessment of Functioning
Example Figure DSM V – to be published in 2011-12
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Fig. 14-3, p. 555Figure 14.3 – DSM-IV overview
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Example multiaxial evaluation
The DSM multiaxial system
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Axis I Clinical Syndromes and Axis II Personality Disorders
Anxiety Disorders – Somatoform Disorders – Dissociative Disorders – Mood Disorders – Schizophrenic Disorders – Eating Disorders –
Axis II – Personality Disorders –
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Clinical Syndromes: Anxiety Disorders
Generalized anxiety disorder– “free-floating anxiety”
Phobic disorder– Specific focus of fear
Panic disorder and agoraphobia (definition issue)– Physical symptoms of anxiety/leading to agoraphobia
Obsessive compulsive disorder– Obsessions– Compulsions
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Etiology of Anxiety Disorders
Biological factors – – Genetic predisposition, anxiety sensitivity– GABA circuits in the brain
Conditioning and learning– Acquired through classical conditioning or observational
learning – – Maintained through operant conditioning
Cognitive factors– Judgments of perceived threat –
Personality– Neuroticism
Stress – – A precipitator
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Clinical Syndromes: Somatoform Disorders
Somatization Disorder Conversion Disorder – Figure Hypochondriasis
– Etiology• Reactive autonomic nervous system
• Personality factors
• Cognitive factors
• The sick role
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Clinical Syndromes: Dissociative Disorders
Dissociative amnesia Dissociative fugue Dissociative identity disorder
– Etiology• severe emotional trauma during childhood
– Controversy• Media creation?
• Sybil
• Repressed memories
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Clinical Syndromes: Mood Disorders
Major depressive disorder– Dysthymic disorder
Bipolar disorder (manic-depressive disorder)– Cyclothymic disorder
Etiology– Age of onset – – Genetic vulnerability – – Neurochemical factors– Cognitive factors – negative thinking – – Interpersonal roots– Precipitating stress
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Clinical Syndromes: Schizophrenia
General symptoms– Delusions and irrational thought– Deterioration of adaptive behavior -
avolition– Hallucinations – any modality but
usually auditory– Disturbed emotions – 66%
Prognostic factor– Gradual onset– Sudden onset
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Subtyping of Schizophrenia
4 subtypes– Paranoid type – most
common subtype - John Nash
– Catatonic type– Disorganized type– Undifferentiated type
New model for classification– Positive vs. negative
symptoms
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Etiology of Schizophrenia
Genetic vulnerability – Neurochemical factors – Dopamine hypothesis – Structural abnormalities of the brain – prefrontal lobe
and ventricles – The neurodevelopmental hypothesis – Expressed emotion – Precipitating stress – stress-vulnerability model –
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– Genetic vulnerability - schizophrenia
Table of ContentsThe dopamine hypothesis as an explanation for schizophrenia
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Neurological Changes in Schizophrenia
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– Neurodevelopment hypothesis of schizophrenia
– Expressed emotion and relapse rates in schizophrenia
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The stress-vulnerability model of schizophrenia
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Personality Disorders
Next slide– description and male/female percents Anxious-fearful cluster
– Avoidant, dependent, obsessive-compulsive
Dramatic-impulsive cluster– Histrionic, narcissistic, borderline, antisocial
Odd-eccentric cluster– Schizoid, schizotypal, paranoid
Etiology– Genetic predispositions, inadequate socialization in
dysfunctional families
Prognosis
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Psychological Disorders and the Law
Insanity– M’naghten rule– The insanity defense –– perception versus actual cases
Involuntary commitment – varies by states– danger to self– danger to others– in need of treatment
Culture and pathology –
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John Hinkley, Jr. – assassination attempt of President Reagan in 1981
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Eating Disorders –
Issues of weight – Anorexia nervosa
– Criteria and subtypes: restrictive and binge/purge Bulimia nervosa Binge eating History and prevalence
– Age onset – Etiology
– Genetics– Personality – perfectionism– Cultural issues - “perfect” body type and digital photograph– Family role– Cognitive factors
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Age of anorexia nervous in the United States – Lucas et al. (1991)
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