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Chapter 14

Chapter 14. Psychological Disorders. 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. Prevalence, Causes, and Course. Epidemiology

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Chapter 14

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  1. Chapter 14 Psychological Disorders

  2. 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

  3. Prevalence, Causes, and Course • Epidemiology • Prevalence - % of population that displays the disorder during a specific period • Lifetime prevalence – • Diagnosis • Etiology – causes • Prognosis

  4. 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

  5. Figure 14.3 – DSM-IV overview Fig. 14-3, p. 555

  6. The DSM multiaxial system Example multiaxial evaluation

  7. 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 –

  8. 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

  9. 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

  10. Clinical Syndromes: Somatoform Disorders • Somatization Disorder • Conversion Disorder – Figure • Hypochondriasis • Etiology • Reactive autonomic nervous system • Personality factors • Cognitive factors • The sick role

  11. Clinical Syndromes: Dissociative Disorders • Dissociative amnesia • Dissociative fugue • Dissociative identity disorder • Etiology • severe emotional trauma during childhood • Controversy • Media creation? • Sybil • Repressed memories

  12. 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

  13. 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

  14. 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

  15. 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 –

  16. – Genetic vulnerability - schizophrenia

  17. The dopamine hypothesis as an explanation for schizophrenia

  18. Neurological Changes in Schizophrenia

  19. – Neurodevelopment hypothesis of schizophrenia – Expressed emotion and relapse rates in schizophrenia

  20. The stress-vulnerability model of schizophrenia

  21. 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

  22. 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 –

  23. John Hinkley, Jr. – assassination attempt of President Reagan in 1981

  24. 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

  25. Age of anorexia nervous in the United States – Lucas et al. (1991)

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