Chapter 14 Psychological Disorders

What’s Abnormal • Thomas Szasz – Szasz suggests that abnormal behavior is a deviance from social norms – There is no mental illness.

Abnormal Behavior • What is abnormal behavior? – 3 criteria – F 14.2 • Deviant • Maladaptive • Causing personal distress

• A continuum of normal/ abnormal

Prevalence, Causes, and Course

• Epidemiology • Prevalence - % of population that displays the disorder during a specific period • Lifetime prevalence – F 14.5 • Diagnosis • Etiology – causes • Prognosis

Psychodiagnosis: The Classification of Disorders

• American Psychiatric Association – published first taxonomy in 1952 • Diagnostic and Statistical Manual of Mental Disorders – 5th ed. (DSM - V) • Multiaxial system • 5 axes or dimensions – F 14.3

– 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

• See Example in Figure 14.4 • DSM V – to be published in 2011-12

The DSM multiaxial system An Example of a multiaxial evaluation

Axis I Clinical Syndromes and Axis II Personality Disorders

Axis I • Anxiety Disorders – p. 577 • Somatoform Disorders – p. 582 • Dissociative Disorders – p. 584 • Mood Disorders – p. 586 • Schizophrenic Disorders – p. 592 Axis II – • Personality Disorders – p. 598

Clinical Syndromes: Anxiety Disorders • Generalized anxiety disorder – “free-floating anxiety”

• Phobic disorder – Specific focus of fear. Many people are fearful of some insects but it does not affect their routine activities. Phobic fears affect functioning.

• Panic disorder and agoraphobia – Physical symptoms of anxiety/leading to agoraphobia

• Obsessive compulsive disorder – Obsessions (thoughts) – Compulsions (actions/rituals)

How Common are Phobias

Etiology of Anxiety Disorders

• Biological factors – – Genetic predisposition, anxiety sensitivity – E.g. GABA or Serotonin 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 – A precipitator

Clinical Syndromes: Somatoform Disorders

• Somatization Disorder • Conversion Disorder – Figure 14.11 • Hypochondriasis – Etiology • • • •

Reactive autonomic nervous system Personality factors Cognitive factors The sick role

Clinical Syndromes: Dissociative Disorders

• Dissociative amnesia • Dissociative fugue • Dissociative identity disorder – Etiology • severe emotional trauma during childhood

– Controversy • Media creation? • Sybil • Repressed memories

Clinical Syndromes: Mood Disorders

• Figure 14.12 and Table 14.1 • Major depressive disorder – Dysthymic disorder

• Bipolar disorder (manic-depressive disorder) – Cyclothymic disorder

• Etiology – – – – – –

Age of onset – F 14.13 Genetic vulnerability – F 14.14 Neurochemical factors-F 14.15 Cognitive factors – negative thinking – F 14.16 Interpersonal roots Precipitating stress

Depression and its Affect on Family

Clinical Syndromes: Schizophrenia

• General symptoms – Delusions and irrational thought – Deterioration of adaptive behavior – Hallucinations – any modality but usually auditory – Disturbed emotions – 66%

• Prognostic factor – Gradual onset – Sudden onset

Subtyping of Schizophrenia

• 4 subtypes – Paranoid type – most common subtype - John Nash – Catatonic type – Disorganized type – Undifferentiated type

Etiology of Schizophrenia

• Genetic vulnerability – F 14.10 • Neurochemical factors – Dopamine hypothesis – F 14.21 • Structural abnormalities of the brain – prefrontal lobe and ventricles – F 14.20 • The neurodevelopmental hypothesis – F 14.21 • Expressed emotion – F 14.22

Figure 14.18 – Genetic vulnerability schizophrenia

Neurological Changes in Schizophrenia

Figure 14.21 – Neurodevelopment hypothesis of schizophrenia

Figure 14.22 – Expressed emotion and relapse rates in schizophrenia

The stress-vulnerability model of schizophrenia

Personality Disorders • See next slide for description and male/female percents of incidence • 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

Psychological Disorders and the Law

• Insanity – M’naghten rule (a person is unable to distinguish right from wrong)

• Involuntary commitment – varies by states – danger to self – danger to others – in need of treatment