Psychological Disorders

1. Psychological Disorders

2. What is Abnormal Behavior? • Unusualness • Social Deviance • Emotional Distress • Maladaptive Behavior • Dangerousness • Faulty Perception of Reality • Hallucinations • Delusions

3. Mental or Psychological Disorder • Any behavior or emotional state that causes a person to suffer, is self-destructive; seriously impairs the person’s ability to work or get along with others; or endangers others or the community.

4. Insanity • Legal term that depends on whether the person is aware of the consequences of behavior and is able to control it.

5. Culture-Bound Syndrome • Psychological disorders found only among specific cultural groups.

6. Culture-Bound Syndrome • Dhat Syndrome • Intense fear of losing semen (India). • Ataque de Nervios • Uncontrollable shouting, crying, trembling, and verbal or physical aggression. Prevalent among women (Latin America). • Brain Fag • Difficulties in concentration, memory & thinking among HS & college students in responses to the challenges of schooling ( West Africa). • Koro • Intense anxiety that the sexual organs will recede into the body and possibly cause death (Malaysia). • Amok • Brooding followed by violent outburst; often precipitated by an insult; seems to be prevalent only among men (Malaysia).

7. Culture-Bound Syndrome • Ghost Sickness • Preoccupation with death and the dead, with bad dreams, fainting, appetite loss, fear, & hallucinations (Native Americans). • Pibloktoq • Episodes of extreme excitement of up to 30 minutes, during which the individual behaves irrationally or violently (Artic Inuit Communities). • Qi-gong psychotic reaction • Short episode of mental symptoms after engaging in the Chinese folk practice of qi-gong, or “exercise of vital energy” (China). • Tajin kyofusho • Intense fear that the body, its parts, or its functions displease, embarrass, or are offensive to others (Japan). • Zar • Belief in possession by a spirit, causing shouting, laughing, head banging, weeping & withdrawal (North Africa & Middle East).

8. Models of Abnormal Behavior • Early Beliefs • Medical Model • Psychological Models • Sociocultural Model • Biopsychosocial Model

9. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) • The “bible” of psychological and psychiatric diagnosis. • Primary aim of the DSM is descriptive • provide clear criteria for diagnostic categories.

10. Advantages of the DSM • When used correctly it improves the reliability of the diagnosis making it more accurate. • Creates uniformity among clinicians • Correct labeling of the disorder may help people identify the source of their condition that may lead to proper treatment.

11. Limitations of the DSM • May foster over diagnosis. • May increase risk of creating self-fulfilling prophecies. • Label will follow the individual. • May confuse serious mental disorders with normal problems. • Diagnoses reflect prevailing attitudes and prejudice. • Create illusion of universality.

13. Multiaxial Assessment Axis I: Clinical Disorders Other conditions that may be a focus of clinical attention Axis II: Personality Disorders Mental Retardation Axis III: General medical conditions Axis IV: Social and environmental stressors Axis V: Global assessment of overall functioning

14. DSM-IV –TR (Axis I) • Disorders first diagnosed in Infancy, childhood, or adolescence • Delirium, dementia, and amnesic and other cognitive disorders • Substance related disorders • Schizophrenia and other psychotic disorders • Anxiety disorders • Somatoform disorders • Fastidious disorders • Dissociative disorders • Sexual and gender identity disorders • Eating disorders • Sleep disorders • Impulse control disorders • Adjustment disorders • Other conditions that may be a focus of clinical attention

15. DSM-IV –TR (Axis II) • Mental Retardation • Personality Disorders

16. Disorders First Diagnosed in Infancy, Childhood, or Adolescence • Learning disorders (Learning disabilities) • Pervasive developmental disorders • Autism, Asperger's Disorders, etc. • Attention-deficit and disruptive disorders • ADHD, Conduct Disorder, Oppositional Defiant Disorder, Disruptive Behavior Disorder, etc. • Feeding & eating disorders of infancy or early childhood • Pica, Rumination Disorders, etc. • Tic disorders • Tourette’s Disorder, Chronic Motor or Vocal Tic Disorder, etc. • Elimination disorders • Encopresis, Enuresis, etc. • Other disorders of infancy, childhood or adolescence

17. Delirium, Dementia, Amnestic and other Cognitive Disorders • Delirium • Acute and relatively sudden decline in attention-focus, perception, and cognition. Delirium is not the same as dementia, though it commonly occurs in demented patients. • Dementia • Progressive decline in cognitive function due to damage or disease in the body beyond what might be expected from normal aging. Although dementia is far more common in the geriatric population, it may occur in any stage of adulthood. • Amnestic Disorders

18. Schizophrenia • A psychosis or mental condition involving distorted perceptions of reality and an inability to function in most aspects of life. • Severity and duration of symptoms vary. • Onset can be abrupt or gradual. • Prognosis is unpredictable when onset is gradual.

19. Schizophrenia and other Psychotic Disorders • Schizophrenia • Paranoid Type • Disorganized Type • Catatonic Type • Undifferentiated Type • Residual Type • Schizophrenic Disorder • Schizoaffective Disorder • Delusional Disorders • Erotomanic Type • Grandiose Type • Jealous Type • Persecutory Type • Somatic Type • Mixed Type • Shared psychotic disorders (Folie a Deux) • Other

20. Symptoms of Schizophrenia • Active or positive symptoms • Delusions--false beliefs about reality • Hallucinations and heightened sensory awareness • visual, auditory, olfactory, gustatory, tactile, etc. • Disorganized, incoherent speech--illogical jumble of ideas • Grossly disorganized and inappropriate behavior ranging from childlike silliness to violent agitation • Negative symptoms • Loss of motivation • Poverty of speech--brief, empty replies reflecting diminished though • Emotional flatness--unresponsive facial expressions, poor eye contact, diminished emotionality • Tend to occur before and last after positive symptoms

21. Origins of Schizophrenia Biological factors • Genetic predispositions • Risk of schizophrenia for general population is 1-2 % • Risk is about 50 % if identical twin has schizophrenia • Risk is 12 % for people with one schizophrenic parent • Risk is 35-46 % for people with two schizophrenic parents • No specific genes for schizophrenia have been identified • Structural brain abnormalities • May have decreased brain weight, reduced volume in specific brain areas, or reduced number of neurons in certain brain areas • May have enlarged ventricles • More likely to have abnormalities in the thalamus • Antipsychotic medications might affect the brain • Neurotransmitter abnormalities • Schizophrenics may have low levels of serotonin and high levels of dopamine activity • Prenatal abnormalities • Damage to fetal brain may increase likelihood of schizophrenia • Severe malnutrition during pregnancy • Infectious viruses, such as influenza, especially during second trimester of gestation

22. Anxiety Disorder • Panic Disorder • Phobic Disorders • Obsessive-Compulsive Disorder (OCD) • Post-traumatic stress Disorders (PTSD) • Acute Stress Disorder • Generalized Anxiety Disorder • Substance Induced Anxiety Disorder • Others

23. Panic Disorder • Characterized by sudden attacks of intense fear, with feelings of impending doom. • Symptoms • Heart palpitations, dizziness, and faintness. • Often related to stress, prolonged emotion, or traumatic experiences. • Are not uncommon; whether it develops into a disorder depends on how the bodily reactions are interpreted. • Culture influences the particular symptoms.

24. Phobias • Unrealistic fear of a specific situation, activity, or object. • Social phobia • Persistent, irrational fear of situations in which one will be observed by others. • Agoraphobia • Fear of being alone in a public place from which escape might be difficult or help unavailable. • The most disabling phobia--most common phobia for which people seek treatment. • May begin with panic attacks--sudden onset of intense fear, then avoiding situations that might provoke another attack.

25. Obsessive Compulsive Disorders • Obsessions • Recurrent, persistent, unwished-for thoughts. • May be frightening or repugnant. • Compulsions • Repetitive, ritualized behaviors that the person feels must be carried out to avoid disaster. • People feel a lack of control over the compulsion. • Common compulsions include repeated hand washing, counting, touching, and checking things. • Most OCD sufferers do not enjoy the rituals and realize the behavior is senseless, but if they try to break off the ritual, they feel mounting anxiety. • Several parts of the brain are overactive in OCD sufferers, resulting in the person experiencing a constant state of danger.

26. Posttraumatic Stress Disorder (PTSD) • Can occur as a result of uncontrollable and unpredictable danger such as rape, war, or natural disasters. • Symptoms • Reliving the trauma in thoughts or dreams • “Psychic numbing” • Increased physiological arousal • Reaction may be immediate or delayed with PTSD • Symptoms of PTSD may recur for 10 years or more

27. Generalized Anxiety Disorder • Symptoms • Continuous, uncontrollable anxiety or worry • Feelings of foreboding and dread • Restlessness, difficulty concentrating, irritability, and jitteriness • Duration of at least 6 months • Predisposing factors • Physiological tendency • Unpredictable environment in childhood

28. MOOD DISORDERS • Depressive Disorders • Major Depressive Disorders • Dysthymic Disorders • Bipolar Disorders • Bipolar I Disorder • Bipolar II Disorder • Cyclothymic Disorder • Substance Induced Mood Disorder • Postpartum Onset

29. Major Depressive Disorder • Disrupts ordinary functioning for at least six months. • Symptoms: emotional, cognitive & behavioral changes. • Emotional • Feelings of despair and hopelessness. • Loss of pleasure in usual activities. • Thoughts of death or suicide. • Cognitive • Exaggerate minor failings, discount positive events, interpret things that go wrong as evidence that nothing will ever go right. • Low self-esteem, losses interpreted as sign of personal failure. • Memory and concentration difficulties. • Behavioral • Unable to do everyday activities (e.g., takes tremendous effort to get up and get dressed). • May stop eating or overeat, have difficulty falling asleep or staying asleep, feel tired all the time.

30. Bipolar Disorder • Depression alternates with mania • Bipolar I • One or more manic episodes. • Bipolar II • One or more depressive episodes with at least one hypomanic episode

31. Manic Episode • A distinct period of abnormally and persistently elevated , expansive or irritable mood lasting at least 1 week. • Inflated self esteem or grandiosity • Decrease need for sleep • More talkative • Distractibility • Excessive involvement in pleasurable activities

32. Origins of Mood Disorders Biological Explanations • Focus on genetics and brain chemistry • Low norepinephrine and/or serotonin levels implicated in depression • Mania may be caused by excessive production of norepinephrine • Drugs help to bring the levels of neurotransmitter into balance • Brain scans show reduced frontal lobe activity in depressed people

33. Other Explanations for Depression • Social explanations--focus on stressful conditions of people’s lives • Marriage and employment associated with lower rates of depression. • In women, having more children is associated with higher rates of depression • A history of exposure to violence is related to depression • Attachment explanations--focus on disturbed relationships and separations and a history of insecure attachments • Disruption of a primary relationship most often sets off a depressive episode • Cognitive explanations--propose that depression results from particular habits of thinking and interpreting events • Learned helplessness theory held that people become depressed when their efforts to avoid pain or control the environment fail--however, not all depressed people have actually experienced failure • “Ruminating response style” may also lead to longer, more intense periods of depression • Women more likely to adopt this style than men

34. Somatoform Disorders • Somatization Disorder • Conversion Disorder • Pain Disorder • Hypochondriasis • Body Dysmorphic Disorder • Others

35. Dissociative Disorders • Dissociative Amnesia • Dissociative Fugue • Dissociative Identity Disorder • Others

36. Sexual Disorder • Sexual Dysfunctions • Male erectile disorder • Premature ejaculation • Female orgasmic disorder • Hypoactive sexual desire • others • Paraphilias • Exhibitionism • Fetishism • Frotteurism • Pedophilia • Voyeurism • Sexual masochism • Sexual sadism • others I

37. Eating Disorders • Anorexia Nervosa • Bulimia Nervosa

38. Sleep Disorders • Dyssomnia • Insomnia • Hypersomnia • Narcolepsy • other • Parasomnia • Nightmare disorders • Sleep terror disorder • Sleepwalking disorder • other

39. Impulse Control Disorders • Intermittent Explosive Disorders • Kleptomania • Pyromania • Pathological Gambling • Trichotillomania • Other

40. Axis IIPersonality Disorder • Paranoid Personality Disorder • Antisocial Personality Disorder • Borderline Personality Disorder • Histrionic Personality Disorder • Narcissistic Personality Disorder • Avoidant Personality Disorder • Dependent Personality Disorder • Other

41. Axis IVPsychosocial & Environmental Problems • Problems with primary support group • Problems related to social environment • Educational problems • Occupational problems • Housing problems • Economic problems • Problems with accese to heath care • Legal problems • Other psychosocial problems

42. Axis VGlobal Assessment of Functioning Scale (GAF) • 100 Superior functioning • 90 Minimal symptoms • 80 Transient symptoms • 70 Mild symptoms • 60 Moderate symptoms • 50 Serious symptoms • 40 Some impairment of reality • 30 Serious impairment • 20 Dangerous symptoms • 10 Extremely severe & dangerous symptoms