week 11: abnormal psychology

What is abnormal psychology?

A brand of psychology concerned with unusual patterns of behaviour, emotion and thought

what is on being sane in insane places

8 mentally sound undercover pseudopatients travelled to 12 hospitals and faked a single symptom, claiming to hear supernatural voices etc.

Were admitted into the institution and confined for substantial periods despite no longer reporting hallucinations after admission

hospital staff often misinterpret their behaviours to fit within the context of the psychiatric treatment eg, taking notes while studying the environment = engaging in writing behaviour

remission

implies that mental problems were not being seen as curable illnesses and diagnosis of mental disorder in remission did not mean that you were now sane → having auditory illusions for once in your lifetime is enough for psychiatry to label you for the rest of your life, highlighting the dangerous effect of stigma in psychological disorders

what is the modern definition of psychological disorder?

a psychological dysfunction within an individual associated with distress or impairment in functioning and a response that is not typical, deviant or culturally expected

atypical or deviant

Something is considered abnormal because it occurs infrequently; it deviates from the average eg, washing hands 100 times a day due to fear of contamination

why does “deviating from the average” not work well as a definition for psychological disorder?

some deviation is obviously not a disorder and many people are far from the average in their behaviour but few would be considered disordered, can even call them talented or ecentric

personal distress

When a person is extremely upset, distressed, or suffers from a condition eg, suffering due to fear of germs

psychological dysfunction

When’s a person ability to work and live is clearly, often measurably impaired eg, fear of germs causes a person to stay home all day

psychological influences causing psychological disorder

When stress, trauma, learned helplessness, mood-related perceptions and memories increase likelihood of developing psychological problems eg, physical or sexual abuse in childhood

biological influences causing psychological disorder

evolution, individual genes, brain structure and chemistry eg, abnormal transmission or depletion of certain neurotransmitters → 17% different genes that seem to be expressed with various anxiety disorders

socio-cultural influences that cause psychological disorder

roles, expectations, definitions of normality and disorder → some behaviours are considered acceptable in one society but might be labelled abnormal in another eg, extreme hyperactivity considered abnormal in developed countries based in cities, but less likely to be a problem in predominantly agricultural society

what are anxiety disorders?

psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety.

anxiety

negative mood state caused by apprehension about the future, not pleasant but is adaptive and important in moderate amounts as it allows us to be future-oriented and helps us avoid dangerous situations

obsessive-compulsive disorder

characterized by unwanted repetitive thoughts, which become obsessions → sometimes accompanied by actions, which become compulsions

what are obsessions

repetitive and persistent thoughts, images or uges

what are compulsions

Repetitive behaviours in response to an obsession, aimed to reduce the distress triggered by the obsession or to prevent a feared event

what are the diagnostic criteria of OCD?

1. presence of obsession, compulsions or both

2. Obessions and compulsions are time consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

3. OCD symptoms are not attributable to the physiological effects of a substance

4. The disturbance is not better explained by other mental disorder

what is the best therapy for old?

exposure therapy with response prevention → to demonstrate that nothing catastrophic will occur if these compulsions are not met

usage of cognitive intervention to help patients reinterpret their thoughts and images

what is generalised anxiety disorder?

continually tense and apprehensive, experiencing unfocused, negative, and out-of-control feelings → intensity, duration, or frequency of the anxiety and worry is out of proportion to the actual likelihood or impact of the anticipated event

→ anxiety affects trouble working, maintaining social relationships or enjoying life

what are the diagnostic criteria

1. excessive anxiety and worry, occurring more days than not to at least 6 months, about a number of events or activities

2. The individual finds it difficult to control the worry

3. The anxiety and worry associated with 3 or more symptoms : Restlessness, Being easily fatigued, Difficult concentrating, Irritability, Muscle Tension, Sleep disturbance

4. Cause clinically significant distress or impairment in social,

   occupational, or other important areas of functioning

5. The disturbance is not better explained by another mental

   disorder

what are regulators for generalised anxiety disorder

Benzodiazepines (minor tranquilizers)

Cognitive-behavioural treatment: patients evoke the worry process during therapy sessions and confront anxiety-provoking images and thoughts head-on

what are panic disorders

Recurrent unexpected panic attacks: an abrupt surge of intense fear or intense discomfort that reaches a peak within minute

more than one unexpected panic attack for which there is no obvious cue or trigger

what are diagnostic criteria for panic disorder?

1. Recurrent unexpected panic attacks

2. At least one attack has been followed by 1 month of persistent concern or worry about additional panic attack or a significant maladaptive change in behaviour related to the attacks

3. The disturbance is not attributable to medical condition or other mental disorder

what are panic attacks?

an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur

what are the symptoms of panic attacks

1. accelerated heart rate

2. sweating

3. trembling

4. sensations of shortness of breath

5. feelings of choking

6. chest pain

7. nausea

8. feeling dizze

9. chills or heat sensations

10. numbness sensations

11. derealisation

12. fear of dying

13. fear of losing control

what are the possible treatments for panic disorder?

Focus on teaching patients to control breathing and learning to relax, as a stressful experience may increase the frequency of panic attacks over the next three months

Helping patient experience sweating and increased heart rate in a controlled setting, showing that they need not lead to a full-scale panic attack

what is specific phobia

persistent, irrational fears of specific objects, activities or situations that markedly interferes with an individual’s ability to function

The degree of the fear makes it irrational and leads to extreme destress in the presence of the feared object

what are the diagnostic criteria for specific phobia?

1. Marked fear or anxiety about a specific object or situation

2. The phobic object or situation always provokes immediate

   fear or anxiety

3. The phobic object or situation is actively avoided or endured

   with intense fear or anxiety

4. The fear is out of proportion to the actual danger posed by

   the specific object or situation and to the sociocultural context

5. The fear is persistent, typically lasting for 6 months or

   more

6. The fear causes clinically significant distress or impairment

   in social, occupational, or other important areas of

   functioning

7. The disturbance is not better explained by the symptoms of

   another mental disorder

what is a type of therapy for phobia?

systematic desensitisation

what is systematic desensitisation?

A type of exposure therapy that associates a relaxed state of mind with gradually increasing anxiety-inducing stimuli

what are the three steps of systematic desensitisation?

1. anxiety hierachy

2. Learning coping mechanism

3. pairing the stimuli on the hierachy

what is anxiety hierarchy?

The patient creates a fear hierarchy starting at stimuli that create the least anxiety, building up in stages to the greatest anxiety-provoking stimuli

what is learning coping mechanism?

patients are taught appropriate coping and relaxation techniques as a mean to control their fear

what is pairing the stimuli on the hierarchy?

patients are presented with increasingly unpleasant levels of the feared stimuli, from lowest to highest, while utilizing the relaxation technique

what are mood disorders?

characterised by emotional extremes and challenges in regulating mood eg, depressive disorders and bipolar disorders

what is major depressive disorder

characterized by a persistent feeling of sadness or a lack of happiness/ interest in outside stimuli for prolonged periods of time

people with depression report aan average number to sad experiences but few experiences, and tend to report inability to even imagine anything that would make them happy

what is the diagnosis for major depressive disorder?

1. depressed mood of loss of interest of pleasure present during the same 2-week period and represent a change in previous functioning

2. depressed mood most of the day, nearly every day

3. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

4. significant weight loss

5. insomnia or hypersomnia nearly every day

6. psychomotor agitation or retardation nearly every day

7. fatigue or loss of energy nearly every day

8. Diminished ability to think or concentrate, nearly every day

9. Feeling of worthlessness

10. Recurrent thought of death or recurrent suicidal ideation

11. The symptoms cause clinically significant distress or

    impairment in social, occupational, or other important areas

12. The episode is not attributable to the physiological effects of a

    substance or to another medical condition

what is a treatment option for depression?

antidepressants like selective serotonin reuptake inhibitors

cognitive therapy via cognitive restructuring

combined treatment provides a better treatment outcome

what is cognitive restructuring?

1. Identifying a situation that leads to maladaptive thoughts

2. examining the thoughts by determining what is true and not true about them

3. developing an alternative and more balanced thought

What is electroconvulsive therapy?

sending a brief electrical current though the brain of an anesthetised patient

possibility for why it works: could increase level of serotonin, blocks stress hormones, and promotes neurogenesis in the hippocampus

what is bipolar disorder

a condition in which someone alternates between the hopelessness and lethargy of depression and the overexcited state of mania

tendency of manic episodes to alternate with major depressive episodes

mania

a mood disorder marked by a hyperactive, wildly optimistic state, constantly active, inhibited and often irritable

engaged in risky behaviours like reckless driving, gambling, overspending etc.

what are the diagnostic criteria for bipolar 1 disorder?