Psychology timed test on 4.1st 8:30 am, PDT

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Defining Mental Disorders: What Is Abnormal?

Mental disorder: Persistent disturbance or dysfunction in behavior, thoughts, or emotions that causes significant distress or impairment.

Culture and Pathology

Cultural variations (relativism/universalism)

Culture-bound disorders

Koro

Windigo

What is the Medical Model and Diagnosis?

Medical model: Abnormal psychological experiences are conceptualized as diseases, like physical illnesses, have biological and environmental causes, defined symptoms, and possible cures.

Diagnosis: A determination of there is a disease present.

Prevalence, Causes, and Course

Epidemiology

Prevalence

Lifetime prevalence

Diagnosis

Etiology

Prognosis

Comorbid

Classifying Disorders: The DSM

Diagnostic and Statistical Manual of Mental Disorders (DSM-5): Describes 22 major categories containing more than 200 different mental disorders

22 chapters lists specific criteria that must be met for diagnosis for each disorder

Provides section devoted to cultural considerations in diagnosis of mental disorders

Alternative Diagnostic Systems (ICD 10, Research Domain Criteria Project = RDoc)

Main DSM–5 Categories of Mental Disorders

Neurodevelopmental Disorders	These are conditions that begin early in development and cause significant impairments in functioning, such as intellectual disability (formerly called “mental retardation”), autism spectrum disorder, and attention-deficit/hyperactivity disorder.
Schizophrenia Spectrum and Other Psychotic Disorders	This is a group of disorders characterized by major disturbances in perception, thought, language, emotion, and behavior.
Bipolar and Related Disorders	These disorders include major fluctuations in mood—from mania to depression—and also can include psychotic experiences, which is why they are placed between the psychotic and depressive disorders in DSM–5.
Depressive Disorders	These are conditions characterized by extreme and persistent periods of depressed mood.
Anxiety Disorders	These are disorders characterized by excessive fear and anxiety that are extreme enough to impair a person’s functioning, such as panic disorder, generalized anxiety disorder, and specific phobia.
Obsessive-Compulsive and Related Disorders	These are conditions characterized by the presence of obsessive thinking followed by compulsive behavior in response to that thinking.
Trauma- and Stressor-Related Disorders	These are disorders that develop in response to a traumatic event, such as posttraumatic stress disorder.
Dissociative Disorders	These are conditions characterized by disruptions or discontinuity in consciousness, memory, or identity, such as dissociative identity disorder (formerly called “multiple personality disorder”).
Somatic Symptom and Related Disorders	These are conditions in which a person experiences bodily symptoms (e.g., pain, fatigue) associated with significant distress or impairment.
Feeding and Eating Disorders	These are problems with eating that impair health or functioning, such as anorexia nervosa and bulimia nervosa.

Main DSM–5 Categories of Mental Disorders

Elimination Disorders	These involve inappropriate elimination of urine or feces (e.g., bed-wetting).
Sleep–Wake Disorders	These are problems with the sleep–wake cycle, such as insomnia, narcolepsy, and sleep apnea.
Sexual Dysfunctions	These are problems related to unsatisfactory sexual activity, such as erectile disorder and premature ejaculation.
Gender Dysphoria	This is a single disorder characterized by incongruence between a person’s experienced/expressed gender and assigned gender.
Disruptive, Impulse-Control, and Conduct Disorders	These are conditions involving problems controlling emotions and behaviors, such as conduct disorder, intermittent explosive disorder, and kleptomania.
Substance-Related and Addictive Disorders	This collection of disorders involves persistent use of substances or some other behavior (e.g., gambling) despite the fact that it leads to significant problems.
Neurocognitive Disorders	These are disorders of thinking caused by conditions such as Alzheimer’s disease or traumatic brain injury.
Personality Disorders	These are enduring patterns of thinking, feeling, and behaving that lead to significant life problems.
Paraphilic Disorders	These are conditions characterized by inappropriate sexual activity, such as pedophilic disorder.
Other Mental Disorders	This is a residual category for conditions that do not fit into one of the above categories but are associated with significant distress or impairment, such as an unspecified mental disorder due to a medical condition.
Medication-Induced Movement Disorders and Other Adverse Effects of Medication	These are problems with physical movement (e.g., tremors, rigidity) that are caused by medication.

What Are the Disadvantages/Advantages of Labeling?

Disadvantage: Stigmas are likely attached to labeling people with psychological disorders.

Roughly 60% of sufferers do not seek treatment.

Education does not dispel the stigma.

May result in unnecessary incarceration

May lead to low self-esteem

Advantages: Peace of mind, treatment

Therapists: Who Provides Treatment?

Psychiatrists

Clinical psychologists (Ph.D. and PSY.D.)

Psychological associates (M.A.)

Counselling psychologists

Clinical social workers

Psychiatric nurses

Counsellors

The Elements of the Treatment Process

Treatments: How Many Types are There?

3 Main Categories

Insight therapies

“Talk therapy”

Behaviour therapies

Changing overt behaviour

Biomedical therapies

Biological functioning interventions

Clients: Who Seeks Therapy?

Most common presenting problems

Anxiety and depression

Long delays until treatment is sought

Stigmatization

Insight Therapies: Client-Centred Therapy

Carl Rogers

Goal: restructure self-concept to better correspond to reality

Therapeutic climate

Genuineness

Unconditional positive regard

Empathy

Therapeutic Process

Clarification

Emotion focused therapy

Therapies Inspired By Positive Psychology

Well-being therapy

Self acceptance

Purpose in life

Autonomy

Personal growth

Positive psychotherapy

Biomedical Therapies

Physiological intervention to reduce psychological symptoms.

Assumption: Disorder is partly or wholly caused by biological malfunctioning.

Three major categories: Anti-anxiety, anti-psychotic, antidepressant. (Mood stabilizer in different category).

Anxiety Disorders

Anxiety disorder: Class of mental disorder in which anxiety is the predominant feature

Anxiety can be adaptive or maladaptive, when it is disproportionate to real threats and challenges.

Significant comorbidity between anxiety and depression

Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders (Six Types)

1. Generalized anxiety disorder

“Free-floating anxiety”

2. Specific Phobias

Specific focus of fear (e.g., water, flying, snakes, holes).

3. Social Anxiety

Leaving the house, public speaking, crowds, small talk

4. Panic disorder and agoraphobia

Physical symptoms of anxiety/leading to agoraphobia

5. Obsessive-compulsive disorder (not listed in the anxiety disorder category although anxiety a central feature).

Obsessions

Compulsions

6. Post-traumatic stress disorder (PTSD)

Etiology of Anxiety and Anxiety-Related Disorders

Biological factors

Genetic predisposition, anxiety sensitivity

GABA circuits in the brain (nature’s tranquilizer)

Conditioning and learning

Acquired through classical conditioning or observational learning

Maintained through operant conditioning

Cognitive factors

Judgments of perceived threat

Stress

A precipitator

Generalized Anxiety Disorder

Anxiety related to chronic worry

Not tied to any specific issue

The feeling of restlessness, anxiousness and excessive worry.

Interfere with daily living (eating, sleeping, relationships).

Treatment: CBT + anti-depressants, or Xanax (benzodiazepine).

Phobic Disorders

Phobic disorders: Disorders characterized by marked, persistent, and excessive fear and avoidance of specific objects, activities, or situations

Specific phobia: Disorder that involves an irrational fear of a particular object or situation that markedly interferes with an individual’s ability to function: Animals, natural environment, situations, blood injections and injury, other phobias

Social phobia: Disorder that involves an irrational fear of being publicly humiliated or embarrassed

Phobias can also be classically conditioned.

Behaviour Therapies for Phobias

B.F. Skinner and colleagues

Goal: unlearning maladaptive behaviours and learning adaptive ones

Systematic Desensitization – Joseph Wolpe

Classical conditioning

Anxiety hierarchy

Aversion therapy

Alcoholism, sexual deviance, smoking, etc.

Social skills training

Modelling

Behavioural rehearsal

Panic Disorder

Panic disorder: A type of anxiety disorder causes repeated, unexpected attacks of intense fear and fear of another attack.

Approximately 4% of the Canadians will experience a panic attack in their lifetime.

Usually during period intense stress. Women 2X more likely than are men. ¾ have at least one other physical or mental illness like diabetes or depression. Family history.

Agoraphobia: Specific phobia involving a fear of public places.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD): An anxiety disorder in which repetitive, intrusive, thoughts (obsessions) and ritualistic behaviors (compulsions) designed to fend off those thoughts interfere significantly with an individual’s functioning

Classified separately from anxiety disorders because the disorder is believed to have distinct cause via different neural circuitry

Roughly 2% of the population suffers

Moderate heritability

Treatments for Anxiety Disorders

Depends on the specific anxiety.

Relief of symptoms (e.g., tension, nervousness).

Antianxiety Medications – Xanax (which is a benzodiazepine), Buspar (not a benzo) + CBT

Anti-depressants + CBT

How anti-anxiety meds work: Relief of tension, nervousness.

Posttraumatic Stress Disorder: Troubles after a Trauma

Posttraumatic stress disorder (PTSD): Disorder characterized by chronic physiological arousal, recurrent unwanted thoughts or images of the trauma, and avoidance of things that call the traumatic event to mind.

Brain imaging techniques: Identified important neural correlates: Heightened amygdala activity; decreased medial prefrontal cortex activity; smaller hippocampus (preexisting condition)

Treatment: Anti-depressants (Paxil, Zoloft, Prozac) + CBT.

Depressive and Bipolar Disorders

Major depressive disorder

Dysthymic disorder

Bipolar disorder (manic-depressive disorder)

Cyclothymic disorder

Etiology

Genetic vulnerability

Neurochemical factors

Cognitive factors

Hormonal

Interpersonal roots

Concussions

Precipitating stress

Treatment of Major Depressive Disorder

Serotonin Reuptake Inhibitors: Prozac, Paxil, Zoloft. New drug: esketamine (taken with SSRI) + talk therapy.

How SSRI’s work: Increase serotonin in the brain. (SSRIs blocks the reabsorption (reuptake) of serotonin into neurons. Increased levels of serotonin improves transmission of messages between neurons. Called ‘selective’ because they mainly affect serotonin, not other neurotransmitters.

Electroconvulsive therapy.

Cognitive-Behavioural Therapy

Goal: to change the way clients think to treat depression, anxiety disorders, OCD, PTSD *often alongside medication).

Self-instructional training

Detect and recognize negative thoughts

Reality testing

Kinship with behaviour therapy

Aaron Beck

Early pioneer in cognitive therapy (change one’s thinking)

Bipolar Disorder

Bipolar disorder: Unstable emotional condition characterized by cycles of abnormal, persistent high mood (mania) and low mood (depression)

Lifetime risk is about 2.5%; no gender differences

Rapid cycling bipolar disorder for about 10%

*Highest heritability of all disorders: 40-70% for identical twins

Stressful life experiences often precede episodes.

Predicted increase in bipolar symptoms over time associated with neuroticism and conscientiousness

Biomedical Treatments for Bipolar Disorders

The depression is treated the same way major depressive disorder is: Talk therapy, anti-depressants such as SSRI’s (e.g., Prozac, Paxil, Zoloft (these are brand names). New drug called esketamine taken with SSRI creates new neural pathways

Manic: Mood-stabilizers: Valporate and lithium (also control hallucinations). Valporate may decrease episodes of mania and like lithium reduces hallucinations.

Disorders of Childhood, Adolescence and Adulthood

The most common and well-known disorder:

Attention deficit/hyperactivity disorder (ADHD): Persistent pattern of severe problems with inattention and/or hyperactivity or impulsiveness that cause significant impairments in functioning.

Behaviors experienced for at least 6 months in at least 2 settings; ability to perform at school or home impaired; present before age 12.

1.1 million Canadian adults have ADHD. (1,795,734009 people

aged 5-19 worldwide). (129 million children).

Brain imaging studies structural and functional abnormalities

Drug treatment effective

Biomedical Therapies For ADHD

ADHD and ADD: Ritalin, Adderall are not time-released but Vyvanse and Concert are time released. (These are brand names).

How Do They Work? Dopamine and norepinephrine play a role in attention and executive functioning.

Ritalin is a CNS stimulant (speeds up brain activity) by decreasing dopamine reuptake—more in brain.

Vyvanse and Adderall are amphetamines and increase the release of dopamine and norepinephrine.