Clinical Disorders PDF

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Unit 8: Clinical Psychology – Modules 65 - 73

Module 65 – Introduction to Psychological Disorders

Psychological disorders used to be thought to be due to the presence of evil spirits in the brain. This person had holes bored in their skull to release these evil spirits!

Psychological Disorder: a syndrome marked by a clinically significant disturbance in an individual’s cognition, emotion regulation or behaviour (APA, 2013) Disturbed or dysfunctional behaviours:  

Are maladaptive – they interfere with normal day-to-day life Distress often accompanies dysfunctional behaviour

Understanding Psychological Disorders The Medical Model: psychological disorders have physical causes that can be diagnosed, treated, and in most cases, cured, often through treatment in a hospital Phillippe Pinel (1745 – 1826) played an important role in classifying disorders as illnesses:   

Devoted his life to helping the mentally ill Madness is not a demon possession but a sickness of the mind caused by severe stress and inhumane conditions Treatment included treating patients with gentleness and talking to them

Unit 8: Clinical Psychology – Modules 65 - 73

The Biopsychosocial Approach  

Behaviour arises from an interaction of nature and nurture Many disorders are culture bound e.g. anorexia nervosa and bulimia nervosa occur mainly in western cultures

Classifying Psychological Disorders Aims:    

to describe a disorder predict its future course imply appropriate treatment stimulate research into its causes.

Physicians and mental health workers use the detailed ‘diagnostic criteria and codes’ in the DSM-5 to guide medical diagnoses and define who is eligible for treatments, including medication. DSM-5: the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; a widely used system for classifying psychological disorders (2013); defines disorders according to symptoms not causes Some diagnostic labels have changed in the new DSM-5:  

Autism and Asperger’s syndrome are no longer included: now autism spectrum disorder Mental retardation is now intellectual disability

New categories:  

Hoarding disorder Binge-eating disorder

Some new categories are controversial: 

Disruptive mood dysregulation disorder: children’s disorder for children that exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year

Unit 8: Clinical Psychology – Modules 65 - 73

Why do you think this is controversial? turns temper tantrums into a disorder – leading to overmedication



Labeling Psychological Disorders - Should We Label? The Rosenhan Study The Power of Labels: David Rosenhan (1973) and seven others entered a hospital complained that they were hearing voices. When questioned they all answered questions truthfully. All eight people despite being normal were misdiagnosed with disorders. When their normal lives were analyzed clinicians ‘discovered’ the causes of their disorders, even though their symptoms had disappeared.  

Labels bias perception Labels can change reality: if a teacher is told a student is gifted they may act in ways that elicit that very behaviour from a student

Labels can be good: 

 

Allow health professionals to communicate about cases, comprehend underlying causes, and to discern effective treatment programs Inform patient self-understandings Useful in research that explores the causes and treatments of disordered behavior

Rates of Psychological Disorders 

The incidence of serious psychological disorder has been doubly high among those below the poverty line

Unit 8: Clinical Psychology – Modules 65 - 73

Unit 8: Clinical Psychology – Modules 65 - 73

Module 66: Anxiety Disorders, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder

Anxiety Disorders: psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviours that reduce anxiety Generalized anxiety disorder: an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal (persistent: 6 months or more) Affected people (often women):     

are often unable to identify, and therefore are unable to treat, the cause of the anxiety worry continuously, often jittery, agitated and sleep deprived, difficulty concentrating have other symptoms: depression, high blood pressure were often maltreated or inhibited as children are often young (by the age of 50 becomes relatively rare as emotions tend to mellow)

Panic disorder: an anxiety disorder marked by unpredictable, minutes-long, episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations. Often followed by worry over a possible next attack.  

Affects 1 in 75 people Smoking doubles the chance of this disorder Dan Harris: https://youtu.be/_qo4uPxhUzU

Phobias: an anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object, activity or situation.

Unit 8: Clinical Psychology – Modules 65 - 73

Some common and uncommon specific fears:

Social Anxiety Disorder (formally called social phobia): shyness taken to the extreme; intense fear of being scrutinized by others, avoid social situations or will sweat or tremble when doing so. Agoraphobia: fear or avoidance of situations, such as crowds or wide open places, where one has felt loss of control and panic Two other disorders involve anxiety, though the DSM – 5 now classifies them separately: Obsessive-compulsive disorder: a disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions) 

Obsessive thoughts and compulsive behaviours become a disorder when they persistently interfere with everyday living and cause distress Howie Mandel: https://youtu.be/dSZNnz9SM4g Ted-ed: https://youtu.be/DhlRgwdDc-E

Posttraumatic stress disorder: a disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia that lingers for four weeks or more after a traumatic experience Ted-ed: https://youtu.be/b_n9qegR7C4 Why?   

Memories exist to protect us in the future The greater one’s emotional distress during a trauma, the higher the risk for posttraumatic symptoms May be genetically predisposed

Unit 8: Clinical Psychology – Modules 65 - 73



Limbic system floods the body with stress hormones again and again as images of the traumatic experience erupt into consciousness

Posttraumatic growth: positive psychological changes as a result of struggling with extremely challenging circumstances and life crises; greater appreciation for life after a traumatic event Understanding Anxiety Disorders The Learning Perspective:

How does stimulus generalization relate to the development of phobias? 

If a person is attacked by a fierce dog they may develop a fear of all dogs

How does reinforcement help maintain our phobias and compulsions after they arise?  

Avoiding a feared situation will reduce anxiety, reinforcing the phobic behaviour If washing your hands relieves feelings of anxiety, you will wash your hands again to relieve anxiety

How might we learn fear through observational learning? 

Young children may learn their fears from their parents

n 

our interpretations and irrational beliefs can also cause feelings of anxiety e.g. a pounding heart might become a sign of a heart attack; an unreturned phone call might signal the end of a friendship

The Biological Perspective Natural Selection: we are biologically prepared to fear threats faced by our ancestors Genes: influence disorders by regulating neurotransmitters (serotonin and glutamate) Brain: over-arousal of brain areas involved in impulse control and habitual behaviours

Unit 8: Clinical Psychology – Modules 65 - 73

Unit 8: Clinical Psychology – Modules 65 - 73

Module 67: Mood Disorders Psychological disorders characterized by emotional extremes Major depressive disorder – prolonged hopelessness and lethargy  occurs when at least 5 signs of depression last two or more weeks, at least one symptom must be either a depressed mood, or loss of interest or pleasure These symptoms must cause near-daily distress or impairment and are not attributable to substance use or another medical or mental illness

Dysthymia (persistent depressive disorder): experiencing a mildly depressed mood more often than not for more than 2 years and at least 2 of the following symptoms:      

problems regulating appetite problems regulating sleep low energy low self-esteem difficulty concentrating and making decisions feeling of hopelessness

Unit 8: Clinical Psychology – Modules 65 - 73

Bipolar Disorder (formerly manic-depressive disorder) – alternating between depression and mania (an overexcited, hyperactive state wildly optimistic) Watch Margaret Trudeau talk about her diagnosis with bipolar disorder (this is a really good talk): https://www.bnnbloomberg.ca/canada/video/margaret-trudeau-speaks-onher-battle-with-mental-health~1599347

Ted-ed: https://youtu.be/RrWBhVlD1H8 Understanding Mood Disorders Genetic     

The risk of major depressive disorder and bipolar disorder increases if you have a parent/sibling with the disorder Severe depression associated with smaller than normal frontal lobes Hippocampus damage due to stress Decreased norepinephrine associated with depression, overabundance associated with mania Seratonin levels

Social-Cognitive Perspective

  

Negative thoughts and moods interact Explanatory style Collectivist vs. individualistic cultures

After a negative experience a depression prone person may respond with a negative explanatory style. Remember locus of control?

Unit 8: Clinical Psychology – Modules 65 - 73

Depression’s Vicious Cycle 

A cognitive therapist will try to break this cycle:

Unit 8: Clinical Psychology – Modules 65 - 73

Module 68: Schizophrenia “a split mind” Schizophrenia is a type of psychosis: a psychological disorder in which a person loses contact with reality, experiencing irrational ideas and distorted perceptions. Schizophrenia: A psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished or inappropriate emotional expression.  

 

Delusions: false beliefs, often of persecution or grandeur, that may accompany psychotic disorders – false thoughts Hallucinations: false sensory experience, such as seeing something in the absence of an external visual stimuli; most often auditory Disorganized thoughts may result from a breakdown in selective attention. Diminished and inappropriate emotions - Flat affect: emotionless state

- Difficulty reading emotions - Inappropriate motor behaviour (e.g. rocking) - Catatonia: may remain motionless for hours Onset and Development of Schizophrenia  Typically strikes as young people are maturing into adulthood (some as young as 12), 1 in 100 equally in males and females  Symptoms can vary: Negative symptoms: absence of appropriate behaviour (e.g. toneless voice, expressionless face etc.) Positive symptoms: presence of inappropriate behaviour (e.g. inappropriate emotions, hallucinations etc.)

Unit 8: Clinical Psychology – Modules 65 - 73

Onset can vary: Chronic (process) schizophrenia: slow developing, recovery is doubtful, usually negative symptoms Acute (reactive) schizophrenia: rapidly developing, often follows a stressful event, recovery is likely, usually positive symptoms Brain Abnormalities: Dopamine:  Excessive dopamine receptors; creating positive symptoms How might we treat this? Some patients who take medication for Schizophrenia will develop Parkinson’s-like symptoms (Parkinson’s is due to a lack of dopamine channels in the brain) Abnormal Brain Activity and Anatomy  Chronic schizophrenia: abnormally low brain activity in the frontal lobe  Unsynchronized neural firing  Increased activity in the amygdala: paranoia  Increased activity in the thalamus: hallucinations  Smaller than normal areas of the brain: cortex, corpus callosum, thalamus Risk Factors:  Low birth weight  Maternal diabetes  Older paternal age  Oxygen deprivation during delivery  Conception during famine  Mid-pregnancy viral infection

Unit 8: Clinical Psychology – Modules 65 - 73

Genetic Factors:

Watch: A Tale of Mental Illness: Elyn Saks - https://youtu.be/f6CILJA110Y Anderson Cooper tries a Schizophrenia simulator: https://youtu.be/yL9UJVtgPZY

Unit 8: Clinical Psychology – Modules 65 - 73

Module 69: Other Disorders Somatic Symptom and Related Disorders – ‘medically unexplained illnesses’ Somatic symptom disorder: a psychological disorder in which the symptoms take a somatic (bodily) form without an apparent physical cause Conversion disorder: a disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found (also called functional neurological symptom disorder) e.g. anxiety converted into a physical symptom Illness anxiety disorder: a disorder in which a person interprets normal physical sensations as symptoms of a disease (hypochondriasis) Dissociative Disorders: disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts and feelings; sudden loss of memory or change in identity often in response to stress Dissociative Identity Disorder (DID): a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. Formerly called multiple personality disorder https://youtu.be/F_jXviG7mpI Dissociative Amnesia: patients suffer a complete loss of identity, often brought on by trauma Dissociative Fugue: sufferer travels to a new location and assumes a new identity Crash Course: https://youtu.be/uxktavpRdzU

Unit 8: Clinical Psychology – Modules 65 - 73

Eating Disorders Anorexia nervosa: disorder in which a person maintains a starvation diet despite being significantly underweight Bulimia nervosa: disorder in which a person alternates binge eating with purging, excessive exercise or fasting Binge-eating disorder: significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging or fasting of bulimia Personality Disorders: disorders characterized by inflexible and enduring behaviour patterns that impair social functioning Three clusters of personality disorders based on three characteristics 1. Anxiety: e.g. avoidant personality disorder 2. Eccentric or odd behaviour: e.g. schizoid personality disorder, 3. Dramatic or impulsive behaviour: e.g. attention getting – histrionic personality disorder or self-focussed narcissistic personality disorder Antisocial Personality Disorder: a personality disorder in which a person (usually a man) exhibits a lack of conscience for wrongdoing, even towards friends and family members. May be aggressive and ruthless or a clever con artist. (sociopath or psychopath) Characteristics of antisocial personality disorder:        

Superficial charm and high intelligence Poise, rationality, absence of neurotic anxiety Lack of a sense of personal responsibility Untruthfulness, insincerity, callousness, manipulative Antisocial behaviour without regret or shame Poor judgement and failure to learn from experience Inability to establish lasting, close relationships Lack of insight into personal motivations

Narcissism - Ted Ed: https://youtu.be/arJLy3hX1E8 Crash Course Personality Disorders: https://youtu.be/4E1JiDFxFGk

Unit 8: Clinical Psychology – Modules 65 - 73

Unit 8: Clinical Psychology – Modules 65 - 73

Unit 8: Clinical Psychology – Modules 65 - 73

Unit 8: Clinical Psychology – Modules 65 - 73...