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DISORDERS

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ABNORMAL BEHAVIOR

Historical aspects of mental disorders The medical model What is abnormal behavior? 3 criteria

Deviant Maladaptive Causing personal distress

A continuum of normal/abnormal

PREVALENCE, CAUSES, AND COURSE

Epidemiology Prevalence - % of population that displays the

disorder during a specific period Lifetime prevalence Diagnosis Etiology – causes Prognosis

PSYCHODIAGNOSIS: THE CLASSIFICATION OF DISORDERS

American Psychiatric Association – published first taxonomy in 1952

Diagnostic and Statistical Manual of Mental Disorders – 4th ed. (DSM - IV)

Multiaxial system 5 axes or dimensions – F 14.3 Axis I – Clinical Syndromes Axis II – Personality Disorders or Mental Retardation

Axis III – General Medical Conditions Axis IV – Psychosocial and Environmental Problems Axis V – Global Assessment of Functioning DSM V – to be published in 2011-12

Figure 14.4 – Example multiaxial evaluation

TWO MAJOR CLASSIFICATIONS IN THE DSM

N E U R O T I C D I S O R D E R S

Distressing but one can still function in society and act rationally.

P S Y C H O T I C D I S O R D E R S

Person loses contact with reality, experiences distorted perceptions.

AXIS I CLINICAL SYNDROMES AND AXIS II PERSONALITY DISORDERS

Anxiety Disorders Somatoform Disorders Dissociative Disorders Mood Disorders Schizophrenic Disorders Eating Disorders Axis II – Personality Disorders

CLINICAL SYNDROMES: ANXIETY DISORDERS

Generalized anxiety disorder “free-floating anxiety” Phobic disorder Specific focus of fear Panic disorder and agoraphobia Physical symptoms of anxiety/leading to agoraphobia Obsessive compulsive disorder Obsessions Compulsions

ETIOLOGY OF ANXIETY DISORDERS

Biological factors Genetic predisposition, anxiety sensitivity GABA circuits in the brain Conditioning and learning Acquired through classical conditioning or observational

learning Maintained through operant conditioning Cognitive factors Judgments of perceived threat Personality Neuroticism Stress A precipitator

CLINICAL SYNDROMES: SOMATOFORM DISORDERS

Somatization Disorder Conversion Disorder Hypochondriasis Etiology

Reactive autonomic nervous system Personality factors Cognitive factors The sick role

CLINICAL SYNDROMES: DISSOCIATIVE DISORDERS

Dissociative amnesia Dissociative fugue Dissociative identity disorder Etiology

severe emotional trauma during childhood Controversy

Media creation? Sybil Repressed memories

CLINICAL SYNDROMES: MOOD DISORDERS

Major depressive disorder Dysthymic disorder Bipolar disorder (manic-depressive disorder) Cyclothymic disorder EtiologyAge of onset – F 14.12Genetic vulnerability – F 14.14Neurochemical factorsCognitive factors – negative thinking – F 14.15, F 14.16

Interpersonal rootsPrecipitating stress

CLINICAL SYNDROMES: SCHIZOPHRENIA General symptoms Delusions and irrational thought Deterioration of adaptive behavior - avolition Hallucinations – any modality but usually auditory

Disturbed emotions – 66%

Prognostic factor Gradual onset Sudden onset

SUBTYPING OF SCHIZOPHRENIA

4 subtypes Paranoid type Catatonic type Disorganized type Undifferentiated type

New model for classification Positive vs. negative symptoms

ETIOLOGY OF SCHIZOPHRENIA

Genetic vulnerability Neurochemical factors – Dopamine hypothesis Structural abnormalities of the brain – prefrontal

lobe and ventricles The neurodevelopmental hypothesis Expressed emotion Precipitating stress – stress-vulnerability model

Figure 14.19 The dopamine hypothesis as an explanation for schizophrenia

NEUROLOGICAL CHANGES IN SCHIZOPHRENIA

Figure 14.21 – Neurodevelopment hypothesis of schizophrenia

Figure 14.22 – Expressed emotion and relapse rates in schizophrenia

Slide 33 – The stress-vulnerability model of schizophrenia

PERSONALITY DISORDERS

Anxious-fearful cluster Avoidant, dependent, obsessive-compulsive Dramatic-impulsive cluster Histrionic, narcissistic, borderline, antisocial Odd-eccentric cluster Schizoid, schizotypal, paranoid Etiology Genetic predispositions, inadequate socialization in

dysfunctional families Prognosis

PSYCHOLOGICAL DISORDERS AND THE LAW Insanity M’naghten rule The insanity defense Involuntary commitment – varies by states danger to self danger to others in need of treatment Culture and pathology

EATING DISORDERS

Issues of weight Anorexia nervosa Criteria and subtypes: restrictive and binge/purge Bulimia nervosa Binge eating History and prevalence Age onset Etiology Genetics Personality – perfectionism Cultural issues - “perfect” body type and digital photograph Family role Cognitive factors

Figure 14.25 - Age of anorexia nervous in the United States – Lucas et al. (1991)