PSYCH 101 Chap 15: Psychological Disorders

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Mental Disorders in Canada

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Mental Disorders in Canada

1/5 Canadians have a mental disorder

affects everyone, leading cause of disability in Canada
$51 billion/year, direct(doctor, hospitals) and indirect (not going to work because child is sick) costs

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Psychopathology

multi-component definition: (ASDMDB)

  • a-typical, statistically rare

  • socially unacceptable (behaviours not typically acceptable, ex going through trash, disheveled, broken glasses)

  • behaviour causes distress to person or others (may/may not have lack of insight towards one’s own health)

  • maladaptive - behaviours harmful/non-productive (ex. suicidal)

  • often product of distorted cognition (may not be aware or becomes aware then changes, ex. FBI after them)

  • biological dysfunction (strong biological underpinning may require medication)

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Models of Psychopathology

models of maladjustment form basis, concerned with assessment, treatment, and prevention (DSCPHEMB)

  1. Demonic: middle ages, illness from the devil and evil spirits inhabiting the body, exorcisms to get demons out, bloodletting

  2. Medical-Biological: physiological abnormality that explains everything, assumes can be diagnosed, treated, and cured

  3. Psychodynamic: Freud, results from anxiety from unresolved conflicts, engaging in too many defense mechanisms, stuck in one psychosexual stage

  4. Humanistic: individual uniqueness and decision making, assumes maladjustment occurs when needs are not met, doesn’t look at more severe conditions

  5. Behavioural: learned through selective reinforcement punishment (ex. if touch wall 3 times when come into a room, anxiety reduces, so reinforced to do it every time)

  6. Cognitive: engage in both prosocial and maladjusted behaviours because of their thoughts (ex. low mood, thoughts associated with those is negative about self, so related to developing of depressive symptoms)

  7. Sociocultural: family, community, and society, maladjustment in context of those things (ex. parent with anxiety behaviour, so excessive worry about being near insects, so child picks up that behaviours after observing)

  8. Evolutionary: may be expressions of behaviour that would once have been normal in history, to protect ourselves

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Best Approach/Model

(Psychopathology)

an eclectic approach choosing the model that seems to fit the problem

a biopsychosocial approach combines biology, psychology, and social factors

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3 Main Considerations about Mental Illness

most people do recover from mental illness

few people with mental illness are violent

most people with mental illness bear their pain privately

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Misconceptions about Mental Illness

psychiatric diagnosis is nothing more than pigeonholing (labelling);

are unreliable;

are invalid;

stigmatize people

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Diagnostic and Statistical Manual of Mental Disorders (DSM)

DSM-5 TR(text revision) is the most recent

published by American Psychiatric Association

manual to help guide diagnosis, a system for diagnosing maladjusted behaviour

takes into consideration if it’s malingering (fake symptoms), there is a physical cause (substance use, thyroid issues, etc.), culture rates, gender, etc.

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Criticisms of DSM-5

validity; doesn’t always follow Robin & Guze’s 3 stage way/criteria for validity

high level of comorbidity - 2 or more disorders are present at the same time (anxiety + depression)

reliance on categorical rather than dimension model of psychopathology: “have it or don’t”, no in between

vulnerable to political and social influences (homosexuality was originally in there, gender dysphoria still is (trans/nonbinary))

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Multiaxial

(DSM)

DSM-5 no longer multiaxial (CIGPEG)

I. Clinical disorders

II. Personality disorders (harder to treat) + intellectual development disorders (problems with functioning, less then 70 IQ)

III. General medical conditions

IV. Psychosocial or environmental problems

V. Global assessment of functioning (GAF) (1-100 of functioning ability)

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Generalized Anxiety Disorder (GAD)

(Types of Anxiety)

continuous anxiety, about multiple things, for at least 6 months

  • physiological symptoms, concentration difficulty, fatigue, usually trouble sleeping, etc

    • ex. laying down for bed, thinking about boss looking at you, maybe multiple times, see computer screen not about work, maybe he thinks you never work, etc, etc, → can’t sleep, not awake next day, affect performace

  • 3% of population, 1/3 develop after major stressor

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Panic Disorder

(Types of Anxiety)

repeated, unexpected panic attacks, out of the blue, usually not triggered

ex. in shower all of a sudden start sweating, heart race, can’t breathe

symptoms: heart palpitations, sweating, dizziness, choking, sitting/pressure on chest, derealization, nausea, cold or hot

can develop concern about happening again, they persist → change in personal behaviour in attempt to avoid them

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Agoraphobia

(Types of Anxiety)

fear and avoidance of being alone in a place in which escape may be difficult or embarrassing

symptoms: hyperventilation, extreme tension, cognitive disorganization

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Social Anxiety Disorder

(Types of Anxiety)

fear of and desire to avoid situations where one might be scrutinized by others, both positive and negative evaluations

avoidance and impairment

ex. don’t go in big groups, don’t date, no family gatherings

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Specific Phobias

(Types of Anxiety)

persistent and irrational fear of particular object or situation, and avoiding it which is impairing, excessive concerns about that thing

ex. blood phobia, needle phobia, claustrophobia

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Obsessive-Compulsive Disorder (OCD)

(Types of Anxiety)

2 components:

  • obsessions: persistent and uncontrollable thoughts (anxiety provoking) + irrational beliefs

  • compulsions: actions, compulsive rituals that interfere with daily life → reduce tension/anxiety

severity associated with time spent on compulsions, aware of it but not able to stop

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Explanations for Anxiety Disorders

(COLAB)

learning models focus on acquiring fears via classical conditioning, then maintaining them through operant conditioning, ex. this brought relief last time, so do it again

observing, ex. parent avoid insects, so kids pick up on excessive worrying/avoidance

catastrophic thinking, ex. “it’s really windy, there’s got to be a tornado because there was a tornado near here once”

anxiety sensitivity - aware of bodily changes that could mean something is wrong, ex. heart racing, “something is wrong, what is it?”

biological - genetics

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OCD Perspectives

Freud: believed OCD originated from difficulties in the anal stage of development where they learn to control themselves (if stuck, become controlling of other things

Learning theorists: order in a person’s environment reduces uncertainty/anxiety, thus reinforces

Biopsychologists: genetic component to OCD, leading to a drug treatment

learning component, neurochemicals, genetic components

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Covid Stress Syndrome

Dr. Asmundson (UoRegina), Dr. Taylor (UBC)

longitudinal study, population-based, sample of Canadians + Americans, administered 3 times, multi-faceted

5 aspects: (DSPTC)

  1. danger + contamination fears

  2. socio-economic consequences

  3. xenophobia (of foreigners that may be carrying infection)

  4. traumatic stress syndrome (some people more concerned about getting covid than experiencing death)

  5. compulsive checking + reassurance seeking

Covid Stress Scales assess these, 12 language translations

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Major Depression Disorder

12% prevalence rate

must have at least 5 of 9 symptoms, including depressed mood or loss of interest/pleasure

symptoms must be present for at least 2 weeks and represent change from previous functioning, cause clinically significant distress or impairment

first episode prior to age 40, after one episode, more likely to have another, average length is 6 months to 1 year

1.3 million Canadians affected each year, women 2x more likely to be diagnosed (reaching out, symptom/presentation difference, hormonal changes, victimization)

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Symptoms of Major Depression Disorder

At least 5: (ACEND DIAL) or (CAD DENIAL)

  • *depressed mood

  • *loss of interest and pleasure in usual activities

  • insomnia (can be not getting to sleep, not staying asleep, not able to wake up early)

  • shift in activity level (lethargic or agitated)

  • poor appetite + weight loss, or increased + weight gain

  • loss of energy, fatigue

  • negative self-concept, self-reproach/blame, worthlessness, guilt

  • complaints or evidence of difficulty in concentrating (slowed thinking, indecisiveness)

  • reccurrent thoughts of death or suicide (not just fear of death, but serious considerations/plans)

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Causes of Major Depression Disorder

Biological theories: both genetics + neurotransmitters underlie

  • monoamine theory- results from deficiencies of monoamines or inefficient receptors (serotonin, norepinephrine, dopamine)

Cognitive theories:

  • Beck:

    1. Negative Triad - depressed people have negative views of themselves, environment, and future

    2. Negative schemas - negative way to evaluate things
    3. Cognitive Distortions - supports 1^ and 2^, certain ways of thinking about things, “negative glasses”, Black and white (all good/bad), ignoring positive

  • Learned helplessness: Seligman, no control in situations, so give up

Biopsychosocial Model:

  • vulnerability: person’s diminished ability to deal with life events (biological, genetic predisposition)

  • the more vulnerable, the more likely to develop, but still need environment/stress to initiate depression

  • diathesis-stress model: link between vulnerability and stress, with high vulnerability, only need small environmental change to trigger

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Learned Helplessness

(Theories of Major Depression Disorder)

behaviour of giving up or not responding when exposed to negative consequences which they feel they have no control over

Seligman suggested people’s beliefs about the causes of failure (attributions) determines whether they will become depressed

if we think “my fault or someone else’s”, more likely to develop → Internally attributed

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Bipolar Disorder

2 extremes:

  • depression - major depressive episode

  • mania - rapid speech, inflated self-esteem (extremely brilliant), impulsiveness (little thought/care for consequences), euphoria (limited touch with reality), decreased need for sleep (days on end)

equally common in men/women, 1-2% of population, strong genetic component

Bipolar II only goes up into hypo-mania then depressive, no full mania

<p>2 extremes:</p><ul><li><p><u>depression</u> - major depressive episode</p></li><li><p><u>mania</u> - rapid speech, inflated self-esteem (extremely brilliant), impulsiveness (little thought/care for consequences), euphoria (limited touch with reality), decreased need for sleep (days on end)</p></li></ul><p>equally common in men/women, 1-2% of population, strong genetic component</p><p>Bipolar II only goes up into hypo-mania then depressive, no full mania</p>
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Dissociative Disorders

characterized by: sudden, temporary, alteration in consciousness, identity, behaviour, and/or memory

Includes:

  • Dissociative amnesia - sudden and extensive inability to recall important personal info

    • Dissociative fugue (not in DSM-5) - suddenly leave home/work and assumes new identity

  • Dissociative Identity Disorder (DID) (previously Multiple Personality Disorder) - existence of 2 or more distinct personality or ego states with different ways of interacting, idea that once had a traumatic physical/sexual abuse experience (often caregiver) and can’t escape, so creates ego states to cope

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Schizophrenia

affects 1% of the population, lack of reality testing (what real is), deterioration of social + cognitive functioning, inability to meet life demands

(+)Positive symptoms: don’t occur those without, but do in those with schizophrenia, adds to the presentation, ex. delusions, hallucinations

(-)Negative symptoms: normally occur, but not in those with schizophrenia, absent from presentation, ex. flat affect (saying “I’m very scared” but no visible change)

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Schizophrenia Characteristics

Delusions: incorrect beliefs, ex. “I am god”, “I am being stalked by the FBI”

Hallucinations: compelling perceptual experiences without any actual physical stimulations

  • across all modalities: visual, auditory (most common), tactile, olfactory (smell), gustatory (taste)

Distortions in emotional expression: (FAID)

  • inappropriate affect - emotional response not appropriate in the circumstance, ex. laugh at a death

  • flat affect - ex. saying “I’m very scared” but no visible change

  • ambivalent affect - showing wide range of emotions in a brief period

  • disorganized thinking/speech - onto new topics constantly or “word salad”, words strung together

First sign: non-specific symptoms of anxiety, mood difficulties, isolation, difficulty maintaining logical thought and coherent conversation (prodromal period/phase)

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Causes of Schizophrenia

most theorists adopt diathesis-stress model

  1. genetic or biological vulnerability underlies schizophrenia

  2. life stress interacts with vulnerability to produce schizophrenia

Biological:

  • brain abnormalities - enlarged ventricles, increased sulci size, hypofrontality

  • neurotransmitter dysfunction - dopamine and serotonin

  • genetic - 48% concordance with monozygotic twins

No Environmental:

  • “schizophrenia mother” (parents confusing children, difficulty communicating, or give inconsistent messages) is a myth

<p>most theorists adopt <strong><u>diathesis-stress model</u></strong></p><ol><li><p>genetic or biological vulnerability underlies schizophrenia</p></li><li><p>life stress interacts with vulnerability to produce schizophrenia</p></li></ol><p>Biological: </p><ul><li><p>brain abnormalities - enlarged ventricles, increased sulci size, hypofrontality</p></li><li><p>neurotransmitter dysfunction - dopamine and serotonin</p></li><li><p>genetic - 48% concordance with monozygotic twins</p></li></ul><p>No Environmental:</p><ul><li><p>“schizophrenia mother” (parents confusing children, difficulty communicating, or give inconsistent messages) is a <u>myth</u></p></li></ul>
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Personality Disorders

described people with long-standing, inflexible, maladaptive behaviours that cause stress and social/occupational difficulties

(BAD PHAN)

  1. Paranoid personality disorder

    • pervasive pattern of odd/eccentric behaviour, distrust/suspicion of others

  2. Borderline personality disorder

    • instability in mood, identity, impulse control, often high self-destructive, trouble with relationships, mainly women, ~2% of population

  3. Histrionic personality disorder

    • emotionality, attention seeking by exaggerating situations in their lives

  4. Narcissistic personality disorder

    • grandiosity, need for admiration, lack of empathy, exaggerated sense of self-importance

  5. Antisocial personality disorder

    • disregard for and violation of right of others, impulsivity, self-centered

  6. Avoidant personality disorder

    • social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation

  7. Dependent personality disorder

    • need to be taken care of, submissiveness and clinging behaviours, fears of separation

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Violence and Mental Disorders

most are not violent, delusions and manic phase of Bipolar Disorder may have greater risk

more likely to be danger to themselves, suicide

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Warning Signs for Suicide

  • depression

  • verbal statements like “You’d be better off without me”

  • expressions of hopelessness and helplessness

  • daring and risk-taking behaviour that is atypcial

  • personality changes like withdrawal, aggression, moodiness

  • giving away prized possessions

  • lack of interest in the future

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