Mar 16 - Mental disorders

Mental disorders

  • mental illness was not always considered mental or illness

  • 5000 B.C Egypt - idea that mental illness were evil spirits → released by trephining

  • 1140 B.C China

  • 500 B.C Greece → Pythagoras suggest disease o the mind

  • 15th century Europe → insane set adrift on ship of fools

  • 1700 → medical model

  • 1840 England → 1st insanity defence fr attempted murder

  • 1900 Charcot Freud → notion of psychogenic problem

Perspectives

  • medical

  • Psychodynamic

  • Humanistic

  • Cognitive behavioural

  • Sociocultural

→ different ethologies, prognoses, and treatment

Classifying disorders

  • need for taxonomy

    • Scientific

    • Practical

    • Symptoms → syndrome

    • Ex) disorganized thinking, withdrawal, hallucinations → schizophrenia

  • Until mid 1970s classified as either

    • Neurosis; anxiety ex) phobia → still in touch with reality

    • Psychosis; thought disturbance ex) schizophrenia

  • Early classifications by cause, shift to observable symptoms, DSM5 - TR is latest version

Psychological disorders

  • anxiety disorders

    • Generalized

    • Phonic

    • OCD

    • PTSD

  • Somatic symptom disorders

  • Dissociative disorders

    • Amnesia

    • Fugue

    • Multiple personality

  • Mood disorders

    • Depression

    • Bipolar

  • Schizophrenic disorders

  • Personality disorders

  • Notes* unbiased? Reliable? Valid? → rosenhan “on being sane in insane places”

    • Rosen Han and 7 others admitted → each pseudo patient said they heard voices → they were otherwise normal → all admitted, most as schizophrenic - not a single staff member detected deception → normal behaviour taken as symptom → discharge was 19 days (max time was 52 days) → diagnosis = schizophrenia remission

Mood disorders

  • characterized by disturbance in mood (affect) rather than thought

  • High = mania and low = depression

  • Unipolar or major depression

  • Patient experiences only the despair of depression

  • 10% men and 20% women

  • Bipolar → patient swings from one extreme to another (1%) →about ten episodes of each state during life → untreated and each phase can last months

    • Rapid cycler (20%) → 4 o more swings per year but some people shift daily

    • Mania is problem? → mild is not BUT jumps from one thing to another, unable to sit still, jumps from unbounded elation to intense irritation → endless talk, no inhibitions, grand plans, insomnia, ceaseless torrent of activity, sedation → Clifford beers

  • Major depression → polar opposite, patient appear utterly dejected, hopeless, worthless → hallucinations → loss of appetite, sleep disturbance, fatigue little if any interest in se, suicide

    • Risk of suicide is low while patient is in worst depression → apathy → ris. Increases as patient comes out f depression, rates are highest on weekend leaves and shortly after discharge

  • Etiology

    • Genetic; bipolar

    • Egeland → gene disorder in Amish population → 63% dev. Bipolar

  • Biochemical

    • Switch in bipolar not related to external circumstances → probable inherited

    • Depressed people have shortage of norepinephrine, serotonin, dopamine - NE drops drunk depression and increases during mania

  • Monoamine theory

    • NE, serotonin, dopamine → success of tricycles and MaO inhibitors

Psychodynamic perspectives a

  • Feelings of anger toward aren’t who abandoned you

  • Anger directed inward resulting in guilt and self loathing

Learning perceptive

  • Lewison → loss of rewards

  • Seligmann → learned helplessness

  • Is hopelessness the cause of depression

  • Most cognitive theorists see mood as effect rather than cause

Cognitive perspective

  • Beck’s theory → patient has negative cognitive triad → intense negative beliefs about self, future and external world

  • Interpretations follow schema → maximize bad thing as and minimize good things

  • Derived rom unfortunate experience in early life → schema becomes self fulfilling

The cycle of depression

  1. Stressful experience

  2. Negative explanatory style (“im the problem”)

  3. Depressed mood

  4. Cognitive and behavioural changes (dont even try to feel better)

  5. Repeat ^

  • Attributional style → abramson and seligman → what rally matters is how individuals attributes negative events → a style of internal, global al and stable

Schizophrenia

  • splitting of mental processes (attention, perception, emotion, motivation, thought) NOT splitting into different personalities

  • Worldwide about 1%, North America 1-2 % during life → suggest 740,000 Canadians hav

  • Diagnostic and statistical manual definition → cognitive or perceptual distortion, social or occupation dissociation, duration (6 months), not another disorder

  • Subtypes

    • Catatonic; excessive sometimes violent activity or mute unmoving state

    • Paranoid; delusions of grandeur

    • Disorganized; incoherent speech, odd affect, delusions hallucinations,

    • Undifferentiated

    • Type 1; positive symptoms ex) delusions, hallucinations

    • Type 2; negative symptoms ex) flat affect

    • Actions, feelings, thoughts all related together \→ withdrawing from social interactions and poor self care → sometimes increases activity and rarely strange postures (catatonic)

  • Feelings

    • Flat affect → no emotion

    • Inappropriate affect → wrong emotion

  • Thoughts

    • Delusions are false beliefs that are held in the face of compelling evidence to the contrary ex) David is the lord of the domain

    • Delusions of grandeur

    • Thought broadcasting, though insertion.

    • Hallucinations are false sensory perceptions ex) Kevin the sleep bunnies talked about him

    • Posey and losch … hear things that arnt there

    • Formal thought disorders; breakdowns in the form or pattern of logical thinking → parasitical and overinclusion ex) Paul have a happy and fruitful year

Cause of schizophrenia

  • Predisposition → genetic biochemical neurological

  • Stress; arum, social

  • DISC 1 → protein that guides

Stress

  • incidence of schizophrenia is much higher (9x) in as aeas

  • Family enviornment → more conflict with parents of schizos → more negative reactions to child

  • Expressed emotions → discharged patients more likely to relapse if family members were critical