Chapters 15 and 16

The big kahuna

Psychopathology

The study of psychological disorders, including symptoms and treatment

Psychological disorders

A condition characterized by abnormal thoughts, feelings, and behaviors

Cultural expectations

Social norms vary between cultures (violating cultural norms is not enough for a diagnosis)

Dysfunction

Occurs when internal mechanisms breakdown and cannot preform its normal function

Harmful dysfunction (Wakefield 1992)

Dysfunction that leads to negative consequences, judged by the individuals cultural

Diagnosis DSM 5

Appropriately identifying and labeling a set of defined symptoms.

Classifications of DSM 5

• Diagnostic features

• Diagnostic criteria

• Prevalence

Comorbidity

The co-occurrence of two disorders

ICD

International classification of diseases, frequently used for clinical diagnosis

Supernatural perspective

Psychological disorders attributed to a force beyond scientific understanding

Dancing mania

Epidemic in Western Europe in which people would dance for days or weeks screaming of terrible visions

Biological factors in disorders

Genetic factors, chemical imbalances and brain abnormalities

Diathesis Stress model

A diagnostic model that proposes a disorder may develop when an underlying vulnerability is coupled with a precipitating event

Anxiety disorders

A mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities

Agoraphobia

Characterized by intense anxiety, fear and avoidance of situations where it would be difficult to leave

Rachman 1977

Fear acquisition composed of 3 main components. Classical conditioning, vicarious learning and verbal transmission

Social anxiety

Characterized by extreme and persistent anxiety and avoidance of social situations

Safety behaviors

Mental or behavioral acts that reduce anxiety in situations

Panic disorder

Recurrent and unexpected panic attacks along with at least a month of consistency

Panic attack

A period of extreme fear or discomfort that develops abruptly and reaches a peak in 10 min

Panic attack symptoms

Dizzy, unsteady, lightheaded, shortness of breath, chest palpitations and accelerated heart rate

Generalized anxiety disorder

A relatively continuous state of excessive, uncontrollable worry and apprehension

OCD

Involves obsessions and compulsions. intrusive completion urges (obsessions) need to engage in repetitive behaviors or mental acts (compulsions)

PTSD

A disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event.

PTSD symptoms

Symptoms occur for at least one month. Feeling detached from others, flashbacks, persistently negative emotional states.

Depressive disorders

intense and persistent sadness is the main feature

Mania

extreme elation and agitation is the main feature

Manic episode

a distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased activity in energy

Major depressive disorder

Depressed mood most of the day, nearly every day. Loss of interest and pleasure in usual activities

Symptoms

Weight loss or weight gain, Difficulty falling asleep, Psychomotor agitation

Subtypes of depression

Seasonal pattern, Postpartum depression and Persistent depressive disorder (dysthymia)

Bipolar disorder

A disorder associated with episodes of mood swings ranging from depressive lows to manic highs.

Bipolar is often comorbid with

anxiety disorder and substance abuse disorder

Risk factors of Bipolar disorder

People are more prone to stop using medication. Medication seeks to balance mood, since it is normal for moods to fluctuate. Many people who enjoy the manic side because of the heightened mania.

Biological factors in bipolar disorder

Elevated levels of cortisol Cortisol activates the amygdala and deactivates the prefrontal cortex (disturbances connected to depression).

Aron Beck

Theorized that depression- prone people possess mental predispositions to think about most things in a negative way (depressive schemas)

Depressive schemas

contain themes of loss failure rejection worthlessness and inadequacy

Hopelessness theory

cognitive theory of depression proposing that a style of thinking that perceives negative life events as having stable and global causes leads to a sense of hopelessness and then to depression

Rumination

repetitive and passive focus on the fact that one is depressed and dwelling on depressed symptoms, rather than distracting one’s self from the symptoms or attempting to address them in an active, problem-solving manner.

Suicide risk factors and precursors

• Substance abuse problems, previous suicide attempts, access to lethal means in which to act, serotonin dysfunction.

withdrawal from social social relationships, feeling like a burden, engaging in reckless and risk taking behaviors.

Schizophrenia

A disorder that affects a person's ability to think, feel, and behave clearly.

Schizophrenia symptoms

Hallucinations, paranoid delusions, grandiose delusions, somatic delusions, disorganized thinking, disorganized or abnormal motor behavior, catatonic behaviors

Negative symptoms of schizophrenia

Avolition – lack of motivation to engage in self-initiated and meaningful activity.

Alogia– reduced speech output.

Asociality – social withdrawal.

Anhedonia – inability to experience pleasure.

Dissociative amnesia

inability to recall important person

Dissociative fugue

individual suddenly wanders away from home, experiences confusion about their identity and is some cases may adopt a new identity

Depersonalization/derealization disorder

characterized by recurring episodes of depersonalization, derealization or both

Depersonalization

feelings of “unreality or detachment form , or unfamiliarity with one's whole self or from aspects of the self”

Derealization

a sense of “unreality or detachment or unfamiliarity with the world be it individuals, inanimate objects or all surroundings”

Dissociative identity disorder

individual exhibits two or more separate personalities or identities

Involves memory gaps for the time during which another identity is in charge

Cluster A (personality disorder)

1. Paranoid personality disorder

2. Schizoid personality disorder

3. Schizotypal personality disorder

Cluster B (personality disorders)

1. Antisocial personality disorder

2. Histrionic personality disorder - characteristics of being overly dramatic

3. Narcissistic personality disorder - overinflated sense of self. Extremely vindictive

4. Borderline personality disorder

Cluster C (personality disorders)

1. Avoidant personality disorder

2. Dependent personality disorder -

3. Obsessive compulsive disorder

Borderline personality disorder

A mental disorder characterized by unstable moods, behavior, and relationships.

Antisocial personality disorder

characterized by complete lack of regard for other people's rights or feelings

Avoidant personality disorder

A disorder characterized by social discomfort and avoidance of interpersonal contact.

ADHD

constant pattern of inattention and/or hyperactive and impulsive behavior that interferes with normal functioning

Innatention

• Difficulty sustaining attention

• Failure to follow instructions

• Disorganization

• Lack of attention to detail

Hyperactivity

• Excessive movement

• Interrupting and intruding on others

• Blurting out responses before questions have been completed

• Difficulty waiting ones turn

Autism spectrum disorder

Deficits in social interaction - turn head difficulty maintaining conversation

Repetitive patterns of behavior or interests

Past treatment - exorcism

involving incantation and prayers said over the individuals body by a priest/ religious figure

Past treatment - trephining

a hole made in the skill to release spirits from the body this often leads to death

Asylums

The first institutions for the specific purpose of housing people with psychological disorders

Philippe pinel (late 1700s)

French physician

Argued for more humane treatment of the mentally  ill

Dorothea DIx (19 century)

Social reformer who became an advocate the indigent insane

Electroshock treatment (now called electroconvulsive therapy)

involves brief application of electric stimulus to produce a generalized secure. We still use this but it is much more controlled.

Deinstitutionalization

the closing of large asylums, by providing for people to stay in their communities and be treated locally.

Involuntary treatment

Therapy that is not the individual's choice

Voluntary treatment

The person chooses to attend therapy to obtain relief from symptoms

Sources of psychological treatment

community mental health centers, private or community practitioners, school counselors, school psychologists or school social works group therapy.

Psychodynamic psychotherapy

Talk therapy based on belief that the unconscious and childhood conflicts impact behavior

Play therapy

Psychoanalytic therapy wherein interaction with toys is used instead of talk; used in child therapy

Behavior therapy

Principles of learning applied to change undesirable behavior

Cognitive therapy

Awareness of cognitive process helps patients eliminate thought patterns that lead to distress

Humanistic therapy

Increase self-awareness and acceptance through focus on conscious thoughts

Free association

patient relaxes and then says whatever comes to mind at the moment.

Dream analysis

therapist interprets the underlying meaning of dreams.

Transference

patient transfers all the positive or negative emotions associated with their other relationships to the psychoanalyst

Psychoanalysis today

psychodynamic psychotherapy - talk therapy based on belief that the unconscious and childhood conflicts impact behavior

Behavior Therapy

Conditioning principles are applied to recondition clients and change their behavior.

Counterconditioning

Client learns a new response to a stimulus that has previously elicited an undesirable behavior. Includes aversive conditioning and exposure therapy.

Aversive conditioning

uses an unpleasant stimulus to stop an undesirable behavior.

Antabuse

substance that causes negative side effects such as vomiting when combined with alcohol has been used effectively to treat alcoholism

Exposure therapy

seeks to change the response to a conditioned stimulus.

Mary Cover Jones

Developed the first type of exposure therapy.

Jones’ Study (1924):

Aimed to replace Peter’s fear of rabbits with a conditioned response of relaxation.

•Repeatedly exposed Peter to a rabbit, while he was eating a snack (in a relaxed state).

•Rabbit started in a cage on the other side of the room and over several days was gradually moved closer to Peter while he ate his snack.

•After 2 months, Peter was able to pet the rabbit while eating his snack.

Joseph Wolpe (1958)

Refined Jones’s techniques and developed the version of exposure therapy used today.

Systematic desensitization

type of exposure therapy wherein a calm and pleasant state is gradually associated with increasing levels of anxiety-inducing stimuli.

Virtual reality exposure therapy

uses a stimulation to help conquer fears when it’s too impractical, expensive or embarrassing to recreate anxiety-inducing situations.

Applied behavior analysis

operant conditioning technique designed to reinforce positive behaviors and punish unwanted behaviors.

Token economy

used in controlled settings such as psychiatric hospitals

Individuals are reinforced for desired behaviors with tokens that can be exchanged for items and privileges

Overgeneralization

taking a small situation and making it huge

Polarized thinking

seeing things in absolutes

Rational-Emotive Therapy (RET)

one of the first forms of cognitive-behavioral therapy, founded by Albert Ellis.

Cognitive-behavioral therapy (CBT)

works to change cognitive distortions and self-defeating behaviors. (Aims to change both how people think and how they act).

Psychotropic medications

medications used to treat psychological disorders.

Antipsychotics

treat positive psychotic symptoms such as hallucinations, delusions, and paranoia by blocking dopamine.

Atypical antipsychotics

treat the negative symptoms of schizophrenia such as withdrawal and apathy, by targeting both dopamine and serotonin receptors.

Anti-depressants

alter levels of serotonin and norepinephrine.

Anti-anxiety agents

depress central nervous system activation.

Mood stabilizers

treat episodes of mania as well as depression (Bipolar disorder).