The psychological disorders

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Joella Glenn
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1 The psychological disorders Defining abnormal Statistical infrequency Normal distribution; the normal curve Violation of norms Culture bound syndromes Personal distress Some disorders do not involve distress e.g., psychopathy Disability or dysfunction Impairment in some important area of life Unexpectedness Responses that are unexpected given the situation Current diagnostic system Diagnostic and statistical manual of mental disorders: American Psychiatric Association First published in 1952; the first DMSs were very theoretically-driven, primarily psychodynamic DSM-II in 1968 DSM-III in 1980 Homosexuality was removed as a disorder per se Ego dystonic homosexuality remained as a diagnosis 1

2 DSM-III-R in 1987 Ego dystonic homosexuality removed Substance abuse disorders diagnoses greatly expanded DSM-IV in 1994 DSM-IV-TR in 2000 Text revision; no diagnoses or diagnostic criteria changed Brings research evidence up to date More information relevant to ethnic and cultural issues Diagnostic system Axis I Usually the focus of treatment All diagnostic categories, except personality disorders and mental retardation Axis II Personality disorders Mental retardation Axis III General medical conditions Axis IV Psychosocial and environmental conditions Axis V Current level of functioning Diagnostic categories Axis I Disorders usually first diagnosed infancy, childhood, or adolescence Substance-related disorders Schizophrenia Mood disorders Anxiety disorders Somatoform disorders Factitious disorders Dissociative disorders Sexual and gender identity disorders Eating disorders Sleep disorders Impulse control disorders not elsewhere classified Adjustment disorders 2

3 Diagnostic categories Axis II and III Axis II Personality disorders Mental retardation Axis III General medical conditions Diagnostic categories Axis IV and Axis V Axis IV Support group Social environment Educational Occupational Housing Economic Access to health care services Interaction with the legal system/crime Other problems Axis V Scale: = superior functioning 50 = moderate impairment 10 = severe impairment; e.g., persistent danger of hurting self or others Other diagnostic (or not) issues Abnormal dangerous Personality disorders Substance use disorders Insanity not a psychological term or concept Only a legal term; psychologists do not determine insanity; juries and judges do One can be mentally ill but not insane, e.g., Jeffrey Dahmer Competence Does the person understand and can aid in his/her own defense Does the person understand the risks and benefits of a medical treatment; does the person understand the consequences of refusing treatment? Persons who are competent have the right to self-determination 3

4 schizophrenia Characterized by major disturbances in several areas Thought, e.g., delusions Perception, e.g., hallucinations Emotion, e.g., flat or inappropriate affect Behavior, e.g., catatonia Positive symptoms Excesses or distortions; something that is there that shouldn t be Disorganized speech, also referred to as formal thought disorder Loose associations Clang associations Word salad Hallucinations: sensory experiences in the absence of stimulation from the environment Primarily auditory Can be a single voice or several voices Command hallucinations are the most dangerous Positive symptoms, continued Delusions: beliefs held contrary to reality not limited to those with schizophrenia persons with mania or severe depression may also be delusional, but not as bizarre Unwilling recipient of bodily sensations imposed by an external agent, e.g., x-rays Thought insertion Thought broadcast Thoughts being stolen Feelings being controlled by an external source Behavior is being controlled by an external source Personalization 4

5 Negative symptoms Behavioral deficits: i.e., absence of things that should be present Avolition lack of energy and absence of interest Alogia a negative thought disorder characterized by poverty of speech and/or poverty of content of speech Anhedonia the inability to experience pleasure lack of interest in recreation activities, failure to develop close relationships with others, lack of interest in self Flat affect no stimulus can elicit an emotional response Asociality severe impairment in social relationships Positive versus Negative positive More acute Periods of normal functioning Higher functioning More responsive to treatment Less impairment Better prognosis negative Chronic Few if any, periods of normalcy Lower functioning Impaired intellectual functioning Poor prognosis Other symptoms Catatonia Catatonic immobility Waxy flexibility cogwheeling Inappropriate affect Emotional responses are out of context 5

6 history Kraepelin and Bleuler, two european psychiatrists labeled it dementia praecox Dementia not appropriate; Bleuler renamed it schizophrenia in 1908 US clinicians tended to diagnose it whenever hallucinations or delusions were present Patients were diagnosed whom we now recognize as having certain personality disorders Patients were diagnosed with schizophrenia whom we now recognize as having a mood disorder categories Disorganized Inappropriate affect Shifts of emotion Speech is disorganized Behavior is disorganized Neglects self care Catatonic Immobility Wild excitement Paranoid Delusional thoughts are predominant Delusions of persecution Grandiose Delusional jealousy Ideas of reference etiology Twin studies Concordance rates for identical twins is 44% Fraternal twins: 12% Negative has a stronger genetic component than positive symptoms Adoption studies 6

7 Biochemical factors The dopamine hypothesis Brain injury to prefrontal cortex Dopamine underactive negative Sxs Release of mesolimbic dopamine from inhibitory control positive Sxs Evidence exists for serotonin and glutamate The brain MRI studies have shown reductions in gray matter in the prefrontal cortex Low metabolic rates in the prefrontal cortex Damage to brain that occurs in utero? Interaction between brain damage and brain development; dopamine peaks during adolescence treatment Shock and psychosurgery Drug therapy Antipsychotics Extrapyramidal side effects: tremors, shuffling gait, drooling; dyskinesia Tardive dysnkinesia Mood stabilizers Milieu therapy Social learning therapy Medication management 7

Schizophrenia and Other Psychotic Disorders

Schizophrenia and Other Psychotic Disorders Chapter 14 This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display,