Psychological Disorder 1 and 2 PDF

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What is Abnormality? The four D’s Deviance, distress, dysfunction and danger - Deviance Refers to having thoughts, emotions and behaviour that fall far outside of the standards of what others are doing. [remember, differing from the norms of the group is not sufficient to qualify for a psychological disorder. - Distress Intense negative feelings such as anxiety, sadness, or despair due to behaviour may be indicative of psychological disorder. There are some exceptions, a person without distress is not necessarily psychologically healthy. E.g. bipolar patients in the manic phase often feel extremely elated and larger than life- certainly not distressed. Patients with antisocial personality disorder are also known to feel no remorse when caught causing harm to other people. - Dysfunction The behaviour that tends to interfere with the person’s ability to function on day to day life. They can no longer go to work or run a household. Behaviours that are dysfunctional are often described as “maladaptive” because they prevent a person from adjusting in new environment. There are exceptions to this abnormality as well. E.g. a person on a hunger strike as a means of protest voluntarily chose to stop function. - Danger Either to oneself or to another. This can be clear and obvious - a person engaging in a risky behaviour that leads to drug addiction or engaging in violence towards others. Just like other abnormalities, this case also has exceptions E.g. athletes who participate in extreme sports or sedentary office workers that eat unhealthy food are also necessarily mentally unhealthy. Classifying disorders The DSM A proper diagnosis is aided by guidelines from a book called the diagnostic and spastically Manual, also known as DSM. - one of the main functions of the DSM is to categorize and describe mental disorders so that clinicians have a common set of criteria for applying a diagnostic label to the symptoms of their patients. - The DSM allows researchers to talk to each other about mental disorders using a common language.

History - 1st edition - 1952, DSM has undergone many revisions and reflects changing perceptions, attitudes and scientific approaches. - New case studies and research emerge, previously unrecognized disorders have been added, such as hoarding disorder which is now included in DSM-5. At the same time, some previously recognized disorders have been removed, such as homosexuality, which hasn’t been included since DSM-II. - Beyond adding and removing disorders, revisions often seek to organize the DSM in a way that best facilitates effective diagnosis and treatment. DSM-5 began the shift from a categorical classification model, to a dimensional classification model. Categorical classification model - one in which the classified items differ from each other in kind. E.g. consider classifying height - in this classification individuals might be either short or tall. - categories are defined by rigid boundaries and a person can belong to only one specific kind of category. Dimensional classification model - Because psychological disorders are more fluid than rigid boundaries assigned by categories an alternative is to use a model in which items differ from a variety of degrees in a spectrum. That is the dimensional classification model. - E.g. variety of heights within a spectrum from tall to short. - A dimensional classification model better describes psychological disorders which can often overlap in symptoms , risk factors and underlying causes. - E.g. Autism, Asperger syndrome and Childhood disintegrative disorder were consolidated into one single label of Autism Spectrum Disorder - commonly known as ASD. Critics of DSM-5 - Even after 60 years of revision DSM-5 is not a finished product. - Critics still argue that DSM-5 still represents a categorical model. - This has negative implications for treatment. In the worst case scenario, subclinical cases of disorder that cause severe impairment but do not qualify for the diagnosis of a psychological disorder may go untreated. - Comorbidity - DSM-5 - critics for the high degree of comorbidity among many of its diagnoses. It is common for a person to be diagnosed with multiple disorders but it’s also possible that our diagnostics criteria simply overlaps too much. - If psychological disorders are frequently comorbid with each other, is it possible that our classification system is missing the bigger picture? - E.g. Patients diagnosed with anxiety disorders also often present with symptoms of major depression and this comorbidity complicates matters when trying to diagnose and treat a patient as a whole. Epidemiology Refers to study of the distribution of health-related states and disorders within a population. Psychopathology is a key part of this.

Pschological disorders often differ based on sex and culture. E.g. in collectivist cultures like Japan, people suffering from social anxiety typically fear offending others in social situations, whereas in individualist cultures like Canada these patients usually fear self-embarrassment. Prognosis Epidemiology also includes information like the typical prognosis, which is the probable course of an illness. - An acute prognosis is a short-lasting with sudden onset. E.g. heart attack - acute onset and require immediate treatment. - In contrast, chronic disorders are long-lasting and develop overtime. - Lastly, episodic prognoses have recurrent phases, separated by periods of normal functioning. This is a typical condition like a major depressive disorder. Prevalence The prevalence of a disorder is the % of a population that exhibits that disorder during a specific time period. To estimate prevalence, researchers select random samples from the entire population they want to describe. Prevalence —> number of people in the sample with characteristic of interest/total number in the sample. [divided] Point prevalence - measured at a specific instance in time. [However, consider that many psychological disorders are episodic, or go into remission. Importantly, this means that a person who does not display symptoms at this exact moment, may have displayed symptoms of a particular disorder at some point in the past.] Annual prevalence - disorder includes anyone who has the disorder or has had the disorder within the past year. Lifetime prevalence - includes anyone who has the disorder or has had the disorder within their lifetime. Cherry picking The unethical process of selecting the number that best support a position is called cherry picking. E.g. point prevalence - 0.5%, annual - 4% and lifetime 99.8%. Annual prevalence % most likely to be used for statistical presentation - cherry picking. Symptomatology The collection of behaviours, thoughts or feelings that may be a potential indicator of a specific psychological disorder. - understanding the set of symptoms that characterize a disorder is the first step a clinician must take to eventually provide effective treatment.

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This process is complicated by heterogeneity: the same psychological disorder often presents with different symptoms in varying degrees of severity, in different patients.

Depression Case: John suffering from major depressive disorder. - John lost his job as a head engineer when the plant he was working at shut down. It was his first, serious position and he now feels ungrounded. Instead of searching for a new job, however, John slipped into a routine where he spends most of his time indoors eating junk food and watching TV. Despite wanting to get back to work, he has trouble concentrating and making decisions, leaving him feeling hopeless about his future prospects. He also finds it worrying that he no longer enjoys sports or his normal hobbies. As a result of all this, his mind becomes filled with negative thoughts about failing both himself and his family. John displays most of the symptoms of a person with Unipolar Depression, also called Major Depressive disorder. - depression can be present in less severe form and not all symptoms have to be present for a clinician to make a diagnosis. - Episodic of Major Depression are recurrent, but if left untreated, can last several months. In between episodes, a person usually returns to normal functioning. - But due to risk of person’s social and physical well -being in some cases, risk of suicide; it is advisable to not leave depression untreated. Generalized Anxiety Disorder Case: Dana reports being easily fatigued, and complains of sweaty palms, heart palpitations, and difficulty concentrating. - Furthermore, she notes that she constantly worries about the health of her parents, her role as a ‘good mother’, and if her coworkers like her. Dana knows that her concerns are somewhat irrational but this does little to ease her apprehension. Over the past couple years Dana has had few social contacts because of her nervous symptoms, and on occasion has felt the need to leave work when the symptoms become unbearable. Dana’s family is largely unaware of her discomfort because she feels the need to appear ‘perfect’. Anxiety is a familiar feeling we experienced; such as fear, tension and distress. - People suffering from anxiety often suffer from intense, prolonged fear, tension and distress that can feel overwhelming and interferes with their relationships and the daily tasks of living. - A person with Generalized Anxiety Disorder feels repeatedly worried about what most people would consider minor things like normal life events and routines activities. - Being constantly worried = very negative impact on your physical health. People with GAD always feel tense which can lead to dizziness, sleep problems, muscle tension, headaches, fatigue, sometimes even nausea. They have difficulty concentrating and can often feel irritable. Schizophrenia

It is hard to find specific symptoms that are shared by all persons with this diagnosis. Instead, patients often have a combination of different types of symptoms. - Most symptoms can be described as positive or negative. - Positive symptoms: usually describes an excess of normal function, like hallucinations and delusions. - Hallucinations - perceptions of things that are not really there. Most common hallucinations are auditory where a person hears voices saying negative things in their head, or speaking to them from parts of their body. - Delusion - an irrational belief. Common delusions include believing that one is being persecuted by others or that one’s thoughts are being manipulated. - People also have disorganized thinking; underlying inability to think in a logical manner. - Disorganized motor behaviour may involve dramatic reductions in movement, classified as catatonic stupor. Conversely, there may be repeated, frantic motor movements that seem to have no purpose at all. This state is called catatonic excitement. - Negative symptoms: a loss of normal function, as in loss of speech or loss of pleasure from eating. - A person may become less interested in people and real world events, more concentrated with internal ideas and fantasies. - This may lead to estranged relationships and increased neglect of one’s personal appearance. - Person’s emotional response may also change. Clinicians use word affect to refer to emotional responsiveness. - A person with flat or blunted affect shows very little emotional response. - A patient with inappropriate affect shows emotional reactions that are inappropriate to the situation. - The distinction between positive and negative symptoms can be useful in helping clinicians understand the prognosis or trajectory of the illness over time. - Complicating matters - a patient with schizophrenia may experience only some of these symptoms and the severity of symptoms varies widely from case to case. Disorder 2 DSM- only describes a pattern of symptoms and does not offer an explanation for the disorder or suggest a treatment method. For us to be able to treat disorder, we need to gain a better understanding of what causes them. Etiology The cause, or set of causes of a disorder. Complexity if Etiology

Etiology of psychology is not well understood. For any given disorder , there are several potential causes ad ulti-le unique causes may operate simultaneously. The Biological Model Also known as the medical or disease model, assumes that a psychological disorder results from malfunction in the brain. It usually points to genetics, atypical neurotransmitter activity, or abnormal brain structures. Genetics Twins studies provide insights into genetic etiology. If 2 tee wins share a trait, they have concordance. Heritability of a specific disorder can be estimated by the concordance rates of identical and fraternal twins, as they vary in the % genotype they share. Identical twins > fraternal twins: share a specific disorder then genetic plays larger role Twins studies have implicated large genetic components in schizophrenia, depression and anxiety disorder. Studies are done to find genes that are responsible for genetic disorders. The studies can be contradictory and inconclusive. Neurotransmitters Abnormal levels of neurotransmitter activity in the brain seems to be linked with psychological disorders. E.g. depressed patients - low leaves of dopamine and norepinephrine activity. Serotonin and GABA are often implicated in the etiology of depression and anxiety. Brain structure Other scientists take a holistic approach, they analyze abnormalities in the brain structures of patients with psychological disorders. E.g. anxiety patients - hyperactive amygdalae. Correlation does not = causation. It is possible that these people were anxious which way they had hyperactive amygdalae not the other way around. The Environmental Model...