Psychological Disorders

Psychological Disorders Chapter 16

DSM-IV-TR • DSM – Diagnostic and Statistical Manual of Mental Disorders (4th Edition, Text Revision) • Book that contains: • Characteristics that define each disorder • Additional features that are usually present • How to distinguish this disorder from others • List of symptoms that must be present (diagnostic criteria) • NOS – Not Otherwise Specified

DSM-IV-TR • Axis I - clinical disorders, including major mental disorders, (typically what we think the diagnosis is) • Axis II – long standing personality disorders, maladaptive traits, and mental retardation • Axis III – physical disorders, general medical conditions (that will impact Axis I, II) • Axis IV – current stress level, environmental factors • Axis V – Global Assessment of Functioning

SIGNS VS. SYMPTOMS • Signs – any features, feelings, noticed by someone that is NOT the client (What the psychologist would notice) • Symptoms – any features, feelings, noticed and reported by the patient client (What the client usually comes in about) • Malingering – pretending to have symptoms that you do not actually have

Disorders Diagnosed in Infancy, Childhood, or Adolescence • Onset must be before age 18 • Cannot function in daily life as a ‘normal’ person of that age • impairments in social interaction, impairments in communication, restricted interests and repetitive behavior

Disorders Diagnosed in Infancy, Childhood, or Adolescence • Mental Retardation (Axis II) – Diagnostic Criteria • IQ is below 70 • Two or more are below what is expected for the person’s age: 1) Communication, 2) Caring for self, 3) Safety, 4) Working, 5) Relating to Others, 6) Living at home, 7) Health, 8) Using Free Time, 9) Academic Functioning, 10) Directing Self, 11) Using Community Resources • Begins before age 18

Disorders Diagnosed in Infancy, Childhood, or Adolescence • Mental Retardation – IQ is below 70

IQ RANGECLASSIFICATION 144 & up Genius 130-144 Gifted 115-129 Above Average 100-114 Higher Average 85-99 Lower Average 70-84 Below Average 50/55-70 Mild Mental Retardation 35/40-50/55 Moderate M.R. 20/25-35/40 Severe M.R. Below 20/25 Profound M.R.

Disorders Diagnosed in Infancy, Childhood, or Adolescence • Autism - impairments in social interaction, impairments in communication, restricted interests and repetitive behavior • Behavior is noticed before age of 2 or 3

Disorders Diagnosed in Infancy, Childhood, or Adolescence • Autism – Diagnostic Criteria • Two or more of the following – 1) Deficient social interaction via nonverbal behaviors, i.e., eye contact, facial expression, body posture, and gestures; 2) Inappropriate peer relationships; 3) Absence of sharing achievements, interests or pleasure; 4) Absence of social or emotional reciprocity

Disorders Diagnosed in Infancy, Childhood, or Adolescence • One or more of the following: 1) Delayed or absent development of spoken language without compensation through gestures; 2) Unable to begin or sustain conversation (of those who can speak); 3) Repetitive, stereotyped or idiosyncratic language; 4) social imitative play or spontaneous, make-believe play is absent.

Disorders Diagnosed in Infancy, Childhood, or Adolescence • One or more of the following: 1) Intense preoccupation with stereotyped and restricted interests, i.e., spinning things; 2) Routines or rituals with no apparent function; 3) Repetitive or stereotyped mannerisms, i.e., hand flapping; 4) Absorbed with parts of objects • Lack one or more before the age of three: 1) Social interaction; 2) Language used in social communication; 3) Play that is imaginative and symbolic

APPLIED BEHAVIOR ANALYSIS • http://www.youtube.com/watch?v=im04U9Be4mA • http://www.youtube.com/watch?v=wTTvTweONQQ&feature=related

DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE • Asperger’s Disorder – high functioning Autism – IQ is more normal, behavior is more normal, but social interactions are still not quite there

DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE • (A )Qualitative impairment in social interaction, as manifested by at least two of the following: • marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction • failure to develop peer relationships appropriate to developmental level • a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) • lack of social or emotional reciprocity.

DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE • (B)Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: • encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus • apparently inflexible adherence to specific, non-functional routines or rituals • stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) • persistent preoccupation with parts of objects

DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE • Oppositional Defiant Disorder - ongoing pattern of disobedient, hostile and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior

DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE • A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:  (1) often loses temper  (2) often argues with adults  (3) often actively defies or refuses to comply with adults' requests or rules  (4) often deliberately annoys people  (5) often blames others for his or her mistakes or misbehavior  (6) is often touchy or easily annoyed by others  (7) is often angry and resentful  (8) is often spiteful or vindictive • Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.

DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE • Conduct Disorder - repetitive behavior wherein the rights of others or social norms are violated – takes place in childhood and/or adolescence; goes beyond normal rebellion

DISORDERS DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE • Conduct Disorder – Diagnostic Criteria • A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months: Aggression to people and animals (1) often bullies, threatens, or intimidates others  (2) often initiates physical fights  (3) has used a weapon that can cause serious physical harm to others (e.g., abat, brick, broken bottle, knife, gun)  (4) has been physically cruel to people  (5) has been physically cruel to animals  (6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)  (7) has forced someone into sexual activity

Destruction of property (8) has deliberately engaged in fire setting with the intention of causing serious damage  (9) has deliberately destroyed others' property (other than by fire setting)Deceitfulness or theft (10) has broken into someone else's house, building, or car  (11) often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others)  (12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery) Serious violations of rules (13) often stays out at night despite parental prohibitions, beginning before age 13 years  (14) has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)  (15) is often truant from school, beginning before age 13 years

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. • C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder. Specify type based on age at onset: (Childhood or Adolescence)

Substance Related Disorders • Drug Addiction – both psychological (you think you need it) and physiological addictions (your body needs it, and needs more) • Tolerance – the body gets used to a certain amount of drugs so it needs more and more and more and more (this is true even of something like Advil) • Dependence • Abuse • Intoxication • Withdrawal

Schizophrenia & Psychotic Disorders • thought processes are not based on reality, and are expressed in different ways • Symptoms – • Positive – Delusions, hallucinations (things added) • Negative - flat affect (things taken away) • Symptoms not due to other medical conditions/drug use

Schizophrenia & Psychotic Disorders • Subtypes: • Paranoid – delusions, auditory hallucinations (hearing voices) • Catatonic – remain motionless in unusual positions (waxy flexibility) • Disorganized – inappropriate emotions, laughing for no reason • Undifferentiated – criteria for schizophrenia is met, but not paranoid, catatonic, or disorganized • Residual – still have a few symptoms of schizophrenia, but no more delusions/ hallucinations

Schizophrenia & Psychotic Disorders • Diagnostic Criteria A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated): (1) delusions (2) hallucinations (3) disorganized speech (e.g., frequent derailment or incoherence) (4) grossly disorganized or catatonic behavior (5) negative symptoms, i.e., affective flattening, alogia, or avolition

Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other. • B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).

C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal(start) or residual (end) symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

Catatonic Schizophrenia • A type of Schizophrenia in which the clinical picture is dominated by at least two of the following: • (1) motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor (2) excessive motor activity (that is apparently purposeless and not influenced by external stimuli) (3) extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism (4) peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing (5) echolalia or echopraxia

Disorganized Schizophrenia • A type of Schizophrenia in which the following criteria are met: • A. All of the following are prominent: • (1) disorganized speech (2) disorganized behavior (3) flat or inappropriate affect • B. The criteria are not met for Catatonic Type.

Paranoid Schizophrenia • A type of Schizophrenia in which the following criteria are met: • A. Preoccupation with one or more delusions or frequent auditory hallucinations. • B. None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect.

Residual Schizophrenia • A type of Schizophrenia in which the following criteria are met: • A. Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. • B. There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia, present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

Undifferentiated Schizophrenia • A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type.

Schizophrenia & Psychotic Disorders • Schizoaffective Disorder • A. An uninterrupted period of illness during which, at some time, there is either a Major Depressive Episode, a Manic Episode, or a Mixed Episode concurrent with symptoms that meet Criterion A for Schizophrenia. Note: The Major Depressive Episode must include Criterion A1: depressed mood. • B. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms. • C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.

SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS*** • Schizoaffective Disorder – a combination of delusions/hallucinations (schizophrenia) with mood changes (bipolar)

Mood Disorders • Manic Episode – lasts a week, with at least three of the following symptoms: (1) inflated self-esteem or grandiosity(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep) (3) more talkative than usual or pressure to keep talking (4) flight of ideas or subjective experience that thoughts are racing(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) (6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation(7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) • These symptoms must be severe enough to make functioning in society impossible and may run the risk of hospitalization

MOOD DISORDERS*** • Hypomanic Episode – displays the same symptoms of a manic episode EXCEPT, it lasts around 4 days (instead of a week) and the person is still able to function properly in society • Depressive episode – for two weeks includes (at least five) symptoms such as depressed mood, loss of interest, weight gain/loss, insomnia/hypersomnia, restlessness, feelings of worthlessness, feelings of guilt, inability to concentrate, thoughts of death

MOOD DISORDERS*** • Bipolar I – your basic bipolar the most people have heard of; presence of manic (or hypomanic) episodes and depressive episodes; usually stay in each episode for a significant amount of time before switching (not just mood swings) • Bipolar II – bipolar without the presence of a manic episode (only hypomanic and major depressive)

MOOD DISORDERS*** • Major Depressive Disorder – a reoccurrence of at least two major depressive episodes within two months • Dysthymic Disorder – (Eeyore) for at least two years, displaying depressed symptoms more often than not (hopelessness, not eating, low self-esteem, low energy, etc.); NO manic/hypomanic/major depressive episodes – this is low grade depression

MOOD DISORDERS • Dysthymic DisorderA. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year. • B. Presence, while depressed, of two (or more) of the following: • (1) poor appetite or overeating (2) Insomnia or Hypersomnia(3) low energy or fatigue (4) low self-esteem (5) poor concentration or difficulty making decisions (6) feelings of hopelessness

C. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time. • D. No Major Depressive Episode has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In Partial Remission. Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode. • E. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.

MOOD DISORDERS*** • Cyclothymic – low grade bipolar; no manic episodes (only hypomanic) and no major depressive (more like dysthymic); symptoms must be present for at least 2 years with no longer than 2 months without symptoms • Seasonal Affective Disorder – depression when it is cold/dark out (winter); treated with fluorescent light (tanning bed)

MOOD DISORDERS • Major Depressive DisorderA. Presence of two or more Major Depressive Episodes. functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations. • Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode. • Major Depressive Episode:. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous

MOOD DISORDERS • Major Depressive Episode(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood. (2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) (3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. (4) Insomnia or Hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) (6) fatigue or loss of energy nearly every day (7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) (8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) (9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

MOOD DISORDERS • Cyclothymic Disorder • A. For at least 2 years, the presence of numerous periods with hypomanic symptoms (see p. 338) and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode. Note: In children and adolescents, the duration must be at least 1 year. • B. During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time.

C. No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance. Note: After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes (in which case both Bipolar I Disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed).

MOOD DISORDERS*** • Bipolar I • Diagnosis of this Bipolar Disorder requires at least one Manic episode, but there may be episodes of Hypomania or Major Depression as well. (This diagnosis conforms to the classic concept of manic depressive illness.)

MOOD DISORDERS • Manic EpisodeA. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary). • B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree: • (1) inflated self-esteem or grandiosity(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep) (3) more talkative than usual or pressure to keep talking (4) flight of ideas or subjective experience that thoughts are racing(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) (6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation(7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) • C. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

ANXIETY DISORDERS*** • Anxiety – a vague, generalized feeling that one is in danger • Anxiety disorders are usually irrational and causes inability to function properly in society

Psychological Disorders