Psychological Disorders

Psychological Disorders

Overview of Mental Health

  • Mental health is a continuum rather than a fixed state.

  • Psychopathology:

    • Characterized by subjective discomfort, unhappiness, anxiety, depression, emotional distress, and social nonconformity.

  • Abnormal Behavior:

    • Defined as maladaptive behavior.

    • Must be evaluated in situational context.

  • DSM:

    • Diagnostic and Statistical Manual (DSM) is a key resource for diagnosing mental disorders.

Case Analysis of Abnormality

  • Different levels of anxiety and their categorization as abnormal are depicted in context:

    • Extremely Low - Low - Moderate - High - Extremely High levels of anxiety.

Levels of Functioning

Table 14.1 Levels of Functioning Scale

  • 100: Superior functioning in a wide range of activities; no symptoms.

  • 90: Absent or minimal symptoms; functioning well in all areas with no more than everyday problems.

  • 80: No more than slight impairment in relationships, work, or school.

  • 70: Some mild symptoms or difficulty with relationships; moderate symptoms or moderate problems with relationships, work, or school.

  • 60: Serious symptoms or serious impairments in relationships, work, or school.

  • 50: Impairment in grasp of reality or communication.

  • 40: Behavior considerably affected by delusions or hallucinations; unable to function in almost all areas.

  • 30: Some danger to self or others; minimal personal hygiene; communication grossly impaired.

  • 20: Persistent danger of severely hurting self or others; inability to maintain hygiene; serious suicidal acts.

Examples of Levels of Functioning

  • 100: Life's problems never get out of hand.

  • 90: Person sought for positive qualities.

  • 80: Mild anxiety before exams; occasional family arguments.

  • 70: Difficulty concentrating post-argument; falling behind in school.

  • 60: Depressed mood; mild insomnia; truancy and theft behavior.

  • 50: Blunted emotions; evasive speech; occasional panic attacks.

  • 40: Suicidal thoughts; obsessional rituals; unable to keep a job.

  • 30: Illogical speech; grossly inappropriate actions; preoccupation with suicide.

  • 20: Tentative suicide attempts; violent behavior; incoherence.

DSM-IV-TR Major Categories of Disorders

Table 14.2 Major DSM-IV-TR Categories

  • Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence:

    • Mental Retardation: Example: Mild mental retardation.

    • Learning disorders: Example: Reading disorder.

    • Motor skills disorder: Example: Developmental coordination disorder.

    • Communication disorders: Example: Stuttering.

    • Pervasive developmental disorders: Example: Autistic disorder.

    • Attention-deficit and disruptive behavior disorders: Example: Attention-deficit/hyperactivity disorder.

    • Feeding and eating disorders of Infancy or early childhood: Example: Pica (eating inedible substances).

    • Tic disorders: Example: Tourette's disorder.

    • Elimination disorders: Example: Enuresis (bedwetting).

    • Other disorders of Infancy, childhood, or adolescence: Example: Separation anxiety disorder.

  • Delirium, Dementia, Amnestic, and Other Cognitive Disorders:

    • Delirium: Example: Delirium due to a general medical condition.

    • Dementia: Example: Dementia of the Alzheimer's type.

    • Amnestic disorders: Example: Amnestic disorder due to a general medical condition.

  • Mental Disorders Due to a General Medical Condition Not Elsewhere Classified:

  • Substance-Related Disorders: Example: Cocaine use disorders.

  • Schizophrenia and Other Psychotic Disorders:

    • Schizophrenia: Example: Schizophrenia, paranoid type.

    • Schizophreniform disorder.

    • Schizoaffective disorder.

    • Delusional disorder: Example: Delusional disorder, grandiose type.

    • Brief psychotic disorder.

    • Shared psychotic disorder (folie à deux)

    • Psychotic disorder due to a general medical condition.

    • Substance-induced psychotic disorder.

    • Psychotic disorder not otherwise specified.

  • Mood Disorders:

    • Depressive disorders: Example: Major depressive disorder.

    • Bipolar disorders: Example: Bipolar I disorder.

    • Mood disorder due to a general medical condition.

    • Substance-induced mood disorder.

    • Mood disorder not otherwise specified.

  • Anxiety Disorders: Example: Panic disorder.

  • Somatoform Disorders: Example: Conversion disorder.

  • Factitious Disorders: Example: Factitious disorder.

  • Dissociative Disorders: Example: Dissociative identity disorder.

  • Sexual and Gender Identity Disorders:

    • Sexual dysfunctions: Example: Sexual arousal disorders.

    • Paraphilias: Example: Voyeurism.

    • Sexual disorder not otherwise specified.

    • Gender Identity disorders: Example: Gender Identity disorder.

  • Eating Disorders: Example: Anorexia nervosa.

  • Sleep Disorders:

    • Primary sleep disorders.

    • Dyssomnias: Example: Primary insomnia.

    • Parasomnias: Example: Sleep terror disorder.

    • Sleep disorders related to another mental disorder: Example: Insomnia related to posttraumatic stress disorder.

    • Other sleep disorders: Example: Substance-induced sleep disorder.

  • Impulse Control Disorders Not Elsewhere Classified: Example: Kleptomania.

  • Adjustment Disorders: Example: Adjustment disorder.

  • Personality Disorders: Example: Antisocial personality disorder.

Selected Categories and Symptoms of Psychopathology

Table 14.3 Selected Categories

  • Psychotic Disorders:

    • Primary Symptom: Loss of contact with reality.

    • Typical Signs of Trouble:

    • Hallucinations, hearing or seeing things that aren't there.

    • Delusions, fears of being pursued.

    • Examples: Schizophrenia, schizoaffective disorder.

  • Mood Disorders:

    • Primary Symptom: Mania or depression.

    • Typical Signs of Trouble: Feelings of extreme sadness or excessive energy.

  • Anxiety Disorders:

    • Primary Symptom: High anxiety or behavioral distortions based on anxiety.

    • Typical Signs of Trouble: Attacks of panic, fear, or compulsive behavior.

  • Somatoform Disorders:

    • Primary Symptom: Bodily complaints without a physical basis.

    • Typical Signs of Trouble: Complaints of being ill when a doctor finds no evidence thereof.

  • Dissociative Disorders:

    • Primary Symptom: Amnesia, feelings of unreality, or multiple identities.

    • Typical Signs of Trouble: Gaps in memory and depersonalization experiences.

  • Personality Disorders:

    • Primary Symptom: Unhealthy personality patterns.

    • Typical Signs of Trouble: Pattern of interpersonal difficulties such as impulsiveness or seeking attention artificially.

  • Sexual and Gender Identity Disorders:

    • Primary Symptom: Disturbed gender identity and/or deviant sexual behavior.

  • Substance-Related Disorders:

    • Primary Symptom: Disturbances due to drug abuse or dependence.

Specific Disorders

Substance-Related Disorders

  • Characterized by patterns of excessive consumption and dependency on substances:

    • Includes illegal drugs and prescription drugs.

  • Examples: Cocaine use disorder, alcohol use disorder.

Somatoform Disorders

  • Defined by the presence of physical symptoms without a clear medical cause:

    • Examples may include experiencing pain with no identifiable medical source or hyper-fixation on health.

Personality Disorders

  • Define deeply ingrained maladaptive personality patterns.

  • Categories and Examples:

    • Moderate Impairment:

    • Dependent: Lacks confidence, extremely dependent.

    • Histrionic: Dramatic, exaggerated emotions for attention.

    • Narcissistic: Overestimation of self-worth and need for admiration.

    • Antisocial: Lack of guilt or remorse, aggression, deceit.

    • High Impairment:

    • Obsessive-Compulsive: Perfectionism, control, rigidity.

    • Schizoid: Emotional detachment, inability to form close relationships.

    • Avoidant: Social discomfort, fear of evaluation.

    • Severe Impairment:

    • Borderline: Erratic self-image, extreme sensitivity to rejection.

    • Paranoid: Distrust, viewing others with suspicion.

    • Schizotypal: Odd behavior, bizarre thoughts.

Anxiety Disorders

  • Defined by excessive worry and fear that limits the person's ability to function.

  • Different types include:

    • Generalized anxiety disorder (chronic worry).

    • Panic disorder (with/without agoraphobia).

    • Phobias (specific and social).

    • Obsessive-Compulsive disorder.

  • Each category involves various treatment approaches such as therapy, medication, etc.

Table 14.6 Anxiety Disorders

  • Type of Disorder

    • Generalized anxiety disorder

    • Typical Signs: Worrying excessively for at least 6 months.

    • Panic disorder (without agoraphobia)

    • Typical Signs: Sudden panic attacks.

    • Panic disorder (with agoraphobia)

    • Typical Signs: Fear of public settings due to panic attacks.

    • Specific phobia

    • Typical Signs: Intense fear linked to specific objects or situations.

    • Social phobia

    • Typical Signs: Anxiety in social settings.

    • Obsessive-Compulsive disorder

    • Typical Signs: Thoughts compelling repetitive actions.

    • Acute stress disorder

    • Typical Signs: Less than a month of emotional aftermath from trauma.

    • Posttraumatic stress disorder (PTSD)

    • Typical Signs: More than a month of emotional effects from trauma.

Psychosis and Schizophrenia

Psychosis

  • Defined as a loss of contact with reality:

    • Symptoms include hallucinations, delusions, disturbed emotions and communication, and personality disintegration.

    • Positive symptoms include added behavior such as hallucinations; negative symptoms involve deficits in functioning.

  • Causes:

    • Medical conditions, drug use, or mental health disorders such as schizophrenia.

Schizophrenia

  • Major types of schizophrenia previously defined (now less emphasized due to modern classifications):

    • Types include disorganized, catatonic, paranoid, and undifferentiated categories.

  • Key Contributors:

    • Hereditary factors, environmental factors, age of onset, brain structure differences, treatment approaches.

Table 14.4 Warning Signs of Psychotic Disorders and Major Mood Disorders

  • Expressions of bizarre thoughts, withdrawal from relationships, bizarre perceptions (hearing voices), extreme anxiety or sadness, and destructive behaviors are indicators of disorders.

Genetic Risk Factors for Schizophrenia

  • Vulnerability expressed through familial connections, with risk percentages increasing based on familial closeness (identical twins having ~50% risk).

  • Proven Statistics:

    • General population to Identical twins: 0% to 50% risk of developing schizophrenia.

Stress-Vulnerability Model

  • Describes how both genetic vulnerabilities and environmental stress contribute to mental disorders.

  • Graphical representation may show vulnerability and stress levels correlating with psychopathology severity.

Brain Activity and Schizophrenia

  • Studies depict notable differences in brain activity between individuals with and without schizophrenia.

  • Notably, ventricle enlargement in patients may indicate brain deterioration or structural changes associated with the disorder.

Mood Disorders

  • Depression:

    • Characterized by a low mood, low motivation, poor concentration, sleep disruptions, and suicidal ideation.

  • Mania:

    • Agitation, racing thoughts, unrealistic self-expectations, reduced sleep needs, inflated self-esteem, and risk-prone behaviors are typical symptoms.

Types of Mood Disorders
Table 14.5 DSM-IV-TR Classification of Mood Disorders

  • Depressive Disorders:

    • Major depressive disorder

    • Extreme emotional depression lasting at least 2 weeks.

    • Dysthymic disorder

    • Moderately depressed mood lasting 2 years.

  • Bipolar Disorders:

    • Bipolar I disorder

    • Characterized by extreme mania and depression.

    • Bipolar II disorder:

    • Cyclothymic disorder

    • Involves ups and downs for at least 2 years.

Indicators of Trouble

  • Extreme sadness or worthlessness, inability to feel pleasure, racing thoughts during manic phases are key indicators of manic episodes and depressive phases.

  • Graphical evidence may show disruptions in sleep cycles in those struggling with depression.

Treatment for Mood Disorders

  • Bipolar Disorder:

    • Pharmacological treatments include Lithium, mood stabilizers, and atypical antipsychotics.

  • Depression:

    • Therapeutic options range from therapies to antidepressant medications or ECT (Electroconvulsive Therapy).

Summary

  • Understanding the complex nature of mental health disorders, including their diagnostic criteria and symptoms, informs treatment approaches and enhances the clinical management of psychological disorders.