Chapter 15

Mental Disorder

A disturbance in thinking, emotion, or behavior that causes a person to suffer, is self-destructive, seriously impairs a person’s ability to work or get along with others.

Mental Illness:

Mental, behavioral or emotional disorder … resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities (National Institute of Mental Health)

Psychological Disorders

( collection of symptoms) marked by a “clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior.”(APA, 2013)

Diathesis-Stress Model

emphasizes how individual vulnerabilities interact with external stresses or circumstances to produce specific mental disorders (genetic predisposition | environmental)

International Classification of Mental Disorders (ICD)

The International Classification of Diseases (ICD), specifically the section dedicated to mental disorders, is a globally recognized standard for diagnosing and classifying mental health conditions,

➢ ICD is used globally for disease monitoring, public health surveillance, and more. 

➢The DSM is produced by the American Psychiatric Association, while the ICD is produced by the World Health Organization (WHO)

Autism

Pervasive social communication and social interaction challenges and 

➢Presence of restricted repetitive behavior, interests, or activities

spectrum disorder

is a disorder or group of disorders whose symptoms are on a continuum.

✰Clinical features show up differently and vary in intensity.

A diagnosis of schizophrenia spectrum disorder involves at least two of the following symptoms over a period of 6 months:

 Delusions [“fixed beliefs that are not amenable to change in light of conflicting evidence]

✳  Hallucinations [ a false sensory perception that feels real despite the absence of an external stimulus]

✳  disorganized speech

✳  disorganized behavior or catatonic behavior

✳  negative symptoms

At least one of these symptoms needs to be delusions, hallucinations, or disorganized speech.

Schizophrenia Spectrum Disorder

 a disorder characterized by delusions, hallucinations, disorganized and incoherent speech, inappropriate behavior, and cognitive impairment 

A fragmented condition — disturbances/breakdown in selective attention

Positive Symptoms [excesses]/ behaviors are present

→ Hallucinations

→ Bizarre delusions; Delusions of persecution and grandeur —inflated sense of self-importance, power

→ Disorganized speech

→ Disorganized thinking

→ Grossly disorganized motor Behavior or catatonia — unresponsiveness or hyperactivity / agitated behavior

Word salad – jumbled ideas that make no sense

Negative Symptoms [deficits]/ actions or feelings are absent

→ Avolition [ profound inability to act]

→ Blunted/flat affect

→Lose motivation to take care of themselves 

→ Anhedonia

dopamine hypothesis

an excess or dysregulation of dopamine in certain brain regions, particularly the mesolimbic pathway, is associated with the positive symptoms (like hallucinations and delusions) of the disorder.

Major Depressive Disorder

Characterized by severely depressed mood and/or inability to experience pleasure

5 symptoms — 2 weeks
 *Depressed Mood

➢ *Diminished interest or pleasure

➢ Significant weight change/ change in appetite

➢ Insomnia/hypersomnia

➢ Psychomotor agitation

➢ Fatigue loss of energy

➢ Feelings of worthlessness or excessive/inappropriate guilt

➢ Diminished ability to think / concentrate/indecisiveness

➢ Recurrent thoughts of death

Persistent  Depressive Disorder

Characterized by chronic, low-grade, depressed or irritable mood.

Low self-esteem

➢Feelings of hopelessness

➢ Poor appetite or overeating

➢ Insomnia/hypersomnia

➢ Low energy/fatigue

➢ Poor concentration/difficulty making decisions

Bipolar disorder

Manic Episode:  A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day 

Core Symptoms (DSM 5 — 3 or more)

➢Inflated self-esteem or grandiosity.

➢Decreased need for sleep (feels rested after 3 hours).

➢Pressured speech (more talkative than usual).

➢Flight of ideas or racing thoughts.

➢High distractibility.

➢Increased goal-directed activity (social, work, school) or psychomotor agitation.

➢Excessive involvement in high-risk activities (e.g., spending sprees, sexual indiscretions).

Bipolar I

diagnosis based more on manic episodes than depression [manic episode 7 days]

Bipolar II

less extreme [hypomania] [manic episode < 4 days]

Generalized Anxiety Disorder

Chronic excessive worry; produces a sense of loss of control 

Diffuse and always present.

Majority of days for 6 months

The anxiety and worry are associated with three or more of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months).

1. Restlessness or feeling keyed up or on edge

2. Being easily fatigued

3. Difficulty concentrating or mind going blank

4. Irritability

5. Muscle tension

   1. Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

Panic Disorder

A discrete period of intense fear or discomfort, in which four or more of the following symptoms developed abruptly and reached a peak within 10 minutes:

• Palpitations, pounding heart, or accelerated heart rate

• Sweating

• Trembling or shaking

• Sensations of shortness of breath or smothering

• Feeling of choking

• Chest pain or discomfort

• Nausea or abdominal distress

• Feeling dizzy, unsteady, lightheaded, or faint

• Fear of dying

Recurrent and unexpected panic attacks (see below)≥1 attack has been followed by 1 month or more of 1 or more of the following

Persistent concern about additional attacks

Worry about the implications of the attack or its consequences

A significant change in behavior related to the attacks

ttempts to avoid all situations that might trigger a panic attack can lead to Agoraphobia — involves fearing and avoiding places or situations that might cause panic and feelings of being trapped, helpless or embarrassed

Social anxiety disorde

 DSM: Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).

Obsessive-Compulsive Disorder (OCD)

Disorder characterized by repetitive intrusive thoughts [obsessions] and ritualistic behaviors [compulsions]

Obsessions (repetitive thoughts)

Concern with dirt, germs, or toxins

Something terrible happening (fire, death, illness)

Symmetry, order, or exactness

Compulsions (repetitive behaviors)

Excessive hand washing, bathing, toothbrushing, or grooming

Repeating rituals (in/out of a door, up/down from a chair)

Checking doors, locks, appliances, car brakes, homework

→ Prefrontal cortex cognitive rigidity; abnormally high activity in the circuitry involving habitual behavior