Transcript Medical criterion

Chapter 6 Mental Disorder
Cao Fenglin
Section 1
Mental Disorder : An Introduction
1. Definition of mental disorder
◆Mental disorder refers to the abnormality
of mental process and personality, such as
perception , thought , memory , intellect ,
attention , emotion , will , behavior etc.
Mental health
2. Criteria of judgment
◆ Experience criterion (Subjective distress)
◆ Statistical criterion (Deviation from statistical norms)
◆ Medical criterion
◆ Social adaptation criterion (Deviation from social norms)
◆ Time criterion (Length of time)
◆ Dysfunction
Experience criterion
◆ A person has a mental disorder if they experience
personal distress. Mental disorder may be defined
as abnormal if it creates subjective distress.
(For example, a hallmark of mood and anxiety
disorders is heightened subjective distress.)
◆Observer’S experience
Problem (Cont)
• Not all distressed individuals are mentally ill .
• Some mentally ill individuals do not show distress
(psychopaths).
Statistical deviance
• A person has a mental disorder when their
behaviour, ability, or experience is significantly
different from average.
• Abnormal behavior is often infrequent.
Mental disorder as statistical deviance (Cont)
Problem (Cont)
• We want to use the term disorder to describe some
conditions that are statistically infrequent.
• “positive” deviations are not distinguished from “negative”
deviations
• Not all unusual behavior is considered abnormal.
(e.g., superior athletic, musical, or intellectual ability)
Medical criterion
The medical criterion proposes that mental disorders
have a biological basis, can be classified into discrete
categories, and are analogous to physical disease.
• Symptoms: Signs of a disorder
• Diagnosis: To distinguish one from another
• Etiology: Cause
• Prognosis: The likely course of the disorder
Medical criterion (Cont)
• To think of abnormal behavior as a disease, such
as “mental illness” “psychological disorder”
• Rise of medical model brought improvement in
treatment
• Viewed with more sympathy, less fear
Problems:
• Labelling
Mental disorder as deviation from social norms
• A person has a mental disorder if they have
experiences and exhibit behaviours that are
inconsistent with the norms and values of
society of a given culture.
• Examples:
– Behaviour that is harmful to oneself or
others
– Poor reality contact
– Inappropriate emotional reactions
– Erratic behaviour
Homosexuality was defined as a disorder in
previous DSM Manuals
Problem (Cont)
• The violation of norms explicitly makes abnormality a
relative concept.
• Social norms may change which behaviors are deemed
abnormal. E.g., Homosexuality was once classified as a
mental disorder in the DSM (up till 1973).
• Criminals and prostitutes violate social norms, but would not
necessarily fall within the context of abnormal psychology.
Dysfunction
• Does the behavior impair an individual’s ability to
function in life (work, personal relationships)?
(E.g., internet addiction)
Problem (Cont)
• Some individuals with a DSM diagnosis, live
functional lives (e.g., transvestites).
3. Causal factors of mental disorder
(1) Biological factors
◆Genetic vulnerabilities
◆Biochemistry (neurotransmitter and hormonal
imbalances) : dopamine, 5-hydroxyl tryptamine and
norepinephrine.
◆Physical disease: Infection, toxicosis, various
metabolic block etc.
(2) Psychological factors
• Acute mental trauma
• Enduring mental trauma
(3)Social factors
◆politics, economy, religion , culture , ethics
morality , customs, habits , family environment
and interpersonal relationship.
4. Classification
◆Phenomenology classification
(1) cognition disorder
(2) emotion disorder
(3) will and behavior disorder
(4) conscious disorder
◆Psychiatric classification
(1)ICD-10 (International Classification of Disease, the tenth
version )
(2)CCMD-Ⅲ ( Chinese Classification of Mental Disorder and
Diagnostic Criteria, the third version )
(3)DSM-Ⅳ (Diagnostic and Statistical Manual, the forth version)
Section 2
Anxiety Disorder
1.Definition of anxiety
◆Anxiety is an uncomfortable feeling that occurs
in response to the fear of being hurt or losing
something valued.
◆Anxiety is a common human emotion.
The morbidity of anxiety disorder is about 15%.
The female overtakes the male.
Adaptation functions of anxiety
◆The first one is signal function.
◆The second one is to mobilize body and regulate
behavior.
◆The third one is learning and accumulating
experience.
Normal Anxiety
“Disordered” or “Maladaptive”
Experience of Anxiety or Fear
“Normal” or “Adaptive”
Experience of Anxiety or
Fear
Symptoms of anxiety
(1) Mood of tension and worry
(2) Mental symptoms
(3) Physical symptoms
• Worry constantly about yesterday's mistakes,
tomorrow’s problems.
• Worry about family, finances, work, personal
illness more than others.
• May see muscle tension, poor concentration,
irritability, sleep disturbance, feeling on edge.
video
A case:
◆Hazel was walking down a street near her home
one day when she suddenly felt flooded with intense
and frightening physical symptoms. Her whole body
tightened up, she began sweating and her heart was
racing, she felt dizzy and disoriented.
◆She thought, “I must be having a heart attack! I
can’t stand this! Something terrible is happening! I’m
going to die.” Hazel just stood frozen in the middle of
the street until an onlooker stopped to help her.
◆Physiological/somatic symptoms
Heart racing
Sweating
Tense muscles
◆ Cognitive Symptoms
Often exaggerated beliefs
◆ Behavioral Symptoms
Freezing
◆ Emotional Symptoms
Sense of dread and terror
2. Classification
(1) Reality anxiety (objectivity anxiety)
◆Reality anxiety is fear of real-world events.
◆The cause of this anxiety is usually easily identified.
For example, a person might fear receiving a dog bite
when they are near a dog.
◆The most common way of reducing this anxiety is
to avoid the threatening object.
(2 ) Id anxiety (neurotic anxiety)
Neurotic anxiety is the unconscious worry that
we will lose control of the id's urges, resulting
in punishment for inappropriate behavior.
◆" free-floating anxiety"
◆phobia
◆panic response
(3) Moral anxiety
◆Moral anxiety involves a fear of violating our own
moral principles.
◆In order to deal with this anxiety, Freud believed
that defense mechanisms helped shield the ego from
the conflicts created by the id, superego, and reality.
3. Causal factors and psychology theory
◆A precise cause of anxiety disorder is not
known, but researches have identified a variety
of biological, psychological, social,and cultural
factors.
(1) Biology mechanism
◆Research shows that anxiety disorder tends to
run in families, so a genetic link may be involved.
◆AD is associated with irregular levels of
neurotransmitters in the brain , such as
norepinephrine and serotonin.
◆Specific medical conditions, such as an overactive
thyroid gland, also can produce anxiety and its
symptoms. Anxiety disorder also occurs more
frequently in people with chronic conditions such as
diabetes or high blood pressure.
◆Anxiety is coordinated partly by a small organ deep
inside the brain called the amygdala. The amygdala is
involved in stress, fear, anxiety.
The Limbic System
(2) Psychosocial mechanism
◆Traumatic events in early life can make a person
vulnerable to anxiety disorders.
◆Parenting style, family environment and culture
may also influence whether a person is susceptible
to developing AD.
4. Mental intervention of anxiety disorder
• Precaution
• Drug treatment
• Psychological treatment
Relaxation method
Biofeedback training
Cognitive behavioral therapy
Section 3
Depressive disorder
1. Definition
◆ Depressive disorder is mental illness
characterized by a profound and persistent
feeling of sadness or despair ..., accompanied
with anxiety, body malaise and sleep disorder.
There are four main types of symptoms
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Mood
Cognitive
Motivational
Somatic (Bodily)
video
Characteristic symptoms(in detail)
◆feelings of hopelessness, pessimism
◆insomnia, early-morning awakening, or oversleeping
◆appetite and/or weight loss
◆decreased energy, fatigue, being“ slowed down”
◆loss of interest or pleasure in hobbies and activities that
were once enjoyed, including sex
◆feelings of guilt, worthlessness, helplessness
◆thoughts of death or suicide; suicide attempts
◆restlessness, irritability
◆persistent physical symptoms that do not respond to
treatment, such as headaches, digestive disorders, and
chronic pain
2. Causes of depression
◆Biological causes
Genetic factors
●Scientists believe genetic factors play a role in
some depressions.
● Recent genetic research also supports earlier
studies reporting family links in depression.
◆For example, if one identical twin suffers from
depression, the other twin has a 70 percent chance
of also having the illness.
◆Other studies that looked at the rate of depression
among adopted children supported this finding.
Depressive illnesses among adoptive family
members had little effect on a child's risk of
depression; however, the disorder was three times
more common among adopted children whose
biological relatives suffered depression.
Biochemical causes
◆The neurotransmitters believed to play a role in
mental functioning are serotonin (5-HT),
noradrenaline (NA), dopamine (DA) .
◆ When the normal balance of these
neurotransmitters is upset, depression may develop.
Hormones and the endocrine system
◆Abnormal functioning of the endocrine system may
cause abnormal levels of hormones to be present in
the body, potentially playing a role in the
development of depression.
◆Dysfunction of hypothalamic-pituitary-adrenal axis
◆Dysfunction of hypothalamic-pituitary-thyroid axis.
Brain structure and function
• MRI
• fMRI
• PET
Medical conditions
◆It is believed that those individuals with chronic
and/or very serious medical conditions may be at
increased risk of developing depression.
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Epilepsy
Diabetes
Stroke
Brain trauma
Parkinson's disease
Some cancers
Environmental situations
◆Many environmental factors may be linked to
depression, including stress, trauma, childhood
events.
Psychological/Cognitive factors
– Attributions are inferences we draw about causes
of events, others’ behavior, own behavior.
– Hopelessness theory of depression:
◆People who are depressed tend to make internal,
stable, global attributions for negative experiences
and external, unstable, and specific attributions for
positive experiences.
Maladaptive thoughts in depression
3.Mental intervention of depressive disorders
◆Most people with a depressive illness do not seek
treatment, — even those whose depression is extremely
severe— can be helped.
◆ There are now medications and psychosocial therapies
such as cognitive/behavioral, “talk,” or interpersonal
that ease the pain of depression.
Medications
• There are several types of antidepressant medications
used to treat depressive disorders.
• These include newer medications—chiefly the selective
serotonin reuptake inhibitors (SSRIs)—the tricyclics,
and the monoamine oxidase inhibitors (MAOIs).
• Hospitalization
• Supportive psychotherapy
• Cognitive therapy
Section 4
Personality Disorder
1. Definition
• An enduring pattern of inner experience and behavior
that deviates markedly from the expectations of the
individual’s culture, is pervasive and inflexible, has an
onset in adolescence or early adulthood, is stable over
time, and leads to distress or impairment.
2. Classification
• ICD-10 (International Classification of Disease,
tenth version )
There are eight personality disorders.
◆ Paranoid PD
– Suspicious, believes that other people will treat you
wrongly, insists on own rights.
◆ Schizoid PD
– Defective capacity in forming social relationships;
absence of warmth and tender feelings for others.
◆ Dissocial PD
– Chronically violating rights of others; failing to accept
social norms or sustain work behavior.
◆ Emotionally Unstable PD
(Explosive type,Borderline type,Aggressive type)
– Characterized by instability, impulsivity, recklessness,
explosiveness.
◆ Histrionic PD
– People who show exaggerated emotional expressions
and have an extremely strong longing for attention.
◆ Obsessive-Compulsive PD
– Preoccupied with organization, rules, schedules, lists;
extremely serious, formal; unable to express warm
emotions.
◆ Anxious, Avoidant PD
– Excessively sensitive to personal rejection,
humiliation; socially withdrawn in spite of desire for
acceptance from others.
◆ Dependent PD
–Not able to make day-to-day decisions. They are
afraid of being rejected or abandoned, and they put
aside their own wishes and needs, while doing what
others want.
3.Cause of personality disorders
◆A combination of personal history and biology
appears to play a role in most personality
disorders.
4. Mental Intervention
◆psychotherapy and medications.
-Psychodynamic psychotherapy, Cognitive
behavior therapy
-Medications may help alleviate these related
conditions, but they can't cure the underlying
disorder.
Section 5
Maladaptive Behavior
1.Alcohol dependence
★Concept
Alcohol dependence is a condition characterized by
the harmful consequences of repeated alcohol use, a
pattern of compulsive alcohol use, and (sometimes)
physiological dependence on alcohol (i.e., tolerance
and/or symptoms of withdrawal).
Four main features of alcohol dependence
• Physical dependence, with a characteristic withdrawal
syndrome that is relieved by more alcohol (e.g.,
morning drinking);
• Physiological tolerance, so that more and more
alcohol is needed to produce the desired effects;
• Difficulty in controlling how much alcohol is
consumed once drinking has begun;
• A craving for alcohol that can lead to relapse if one
tries to abstain.
Harmful to health
• School and job performance may suffer either
from hangovers or from actual intoxication on the
job or at school; child care or household
responsibilities may be neglected; and alcoholrelated absences may occur from school or job.
• Individuals with this disorder are at increased risk
for accidents, violence, and suicide.
Cause of alcohol dependence
• It is estimated that 40%-60% of the variance of risk is
explained by genetic influences.
• The risk for alcohol dependence is 3 to 4 times higher
in close relatives of people with alcohol dependence.
Intervention of alcohol dependence
• Behavior therapy
• Family therapy
VIDEO
2.Tobacco (Nicotine )addiction
★Concept
• Nicotine addiction is classified as nicotine use disorder
according to the DSM-IV-TR. The criteria for this diagnosis
include any 3 of the following within a 1-year time span:
– Tolerance to nicotine with decreased effect and increasing
dose to obtain same effect
– Withdrawal symptoms after cessation
– Smoking more than usual
– Persistent desire to smoke despite efforts to decrease intake
– Extensive time spent smoking or purchasing tobacco
– Postponing work, social, or recreational events in order to
smoke
– Continuing to smoke despite health hazards
Signs and symptoms
◆Individuals can't stop smoking. They have made one or
more serious, but unsuccessful attempts to stop.
◆They experience strong withdrawal symptoms when
they try to stop. Their attempts at stopping have caused
physical signs and symptoms of addiction, such as
craving for tobacco, anxiety, irritability, restlessness,
difficulty concentrating, headache, drowsiness, stomach
upset, even constipation or diarrhea.
◆They keep smoking despite health problems. Even
though they have developed problems with their lungs
or their heart, they haven't stopped or can't stop.
◆They give up social or recreational activities in order
to smoke. They may stop going to certain restaurants
or stop socializing with certain family members or
friends because they can't smoke in these situations.
Harmful to health
• Being addicted to tobacco brings smokers a
host of health problems. These effects include
damage to their lungs, heart and blood vessels.
Smokers have significantly higher rates of
heart disease, stroke and cancer. If you are a
smoker, you have:
• 22 times the risk of dying from lung cancer if male
• 12 times the risk of dying from lung cancer if
female
Intervention
• Health education
• Behavior training
• Cognitive-Behavioral therapy
• There are many ways to quit smoking, including
using medications and getting some sort of
counseling or support.
• The approved effective medications to help smokers
stop smoking fall into two categories — nicotine
replacement therapy and non-nicotine medications.
Any of these effective medications combined with
behavioral changes can double your chances of
quitting.
3.Drug dependence
★Concept
◆Drug dependence is used to describe continued
use of drugs, even when significant problems
related to their use have developed.
VIDEO
Symptoms
• Psychological addiction
• Physical addiction
• Tolerance
Classification
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Substances frequently abused include, but are
not limited to, the following:
alcohol
marijuana
hallucinogens
cocaine
amphetamines
opiates
Tranquilizer
Intervention
◆Detoxification and long-term follow-up management are
important features of successful treatment.
◆Long-term follow-up management usually includes
formalized group meetings and developmentally ageappropriate psychosocial support systems, as well as
continued medical supervision.
◆Individual and family psychotherapy are often
recommended to address the developmental, psychosocial,
and family issues that may have contributed to and
resulted from the development of a substance abuse
disorder.
4. Internet Addiction
◆Concept
Internet Addiction, also described as pathological
internet use, is defined by an individual’s inability
to control his or her use of the internet, which
eventually causes psychological, social, school,
and/or work difficulties in a person’s life.
Symptoms of internet addiction
Intense desire
Tolerance
Withdrawal
Behavior modification
Cognition distortions
Diagnosing internet addiction
• Young (1998) developed an eight-item Internet
Addiction Diagnostic Questionnaire (YDQ)
• Davis developed the Online Cognition Scale (OCS)
that measures problematic Internet use.
• Chou’S Questionnaire
• Chen’S Questionnaire
Mental intervention of internet addiction
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Practice The Opposite
External Stoppers
Setting Goals
Abstinence
Reminder Cards
Personal Inventory
Support Groups
Family Therapy