Transcript Psychological Disorders are - tcouchAPPsych

WARM UP
1.
Before we begin Abnormal Psych, what do you
hope to learn in this unit?
2.
Have you had any experience dealing with
psychological disorders – people connected to
you or any past reading on this topic?
3.
Prior to going on break next week, what goals do
you need to make new or recommit to?
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HISTORY OF UNDERSTANDING
PSYCHOLOGICAL DISORDERS
In Ancient times, disorders were thought to
have been caused by movements of the sun
and moon (lunacy is full moon) or by evil
spirits.
 Treatments for people with mental illness were
very inhumane even up until the mid 1900’s.
Patients were often chained like animals,
beaten, burned, castrated, etc.
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CONDITIONS FOR PSYCHOLOGICALLY DISABLED
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Ancient Greek Trephines
European Trephines
“released evil spirits.”
CONDITIONS FOR PSYCHOLOGICALLY DISABLED
CONDITIONS FOR PSYCHOLOGICALLY DISABLED
Forced sterilization of mentally ill in 19th and
early 20th century. Japan until 1950s.
 Nazis killed thousands of mentally ill as part
of their eugenics program.
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Better today? Yes, but not perfect.
MEDICAL MODEL IMPROVES CONDITIONS
Eventually the medical model came to
dominate understandings of mental illness.
 The medical model assumes diseases have
physical causes, can be diagnosed based on
their symptoms, can be treated, in most cases
cured.
 Assumption of medical model drastically
improved conditions in mental hospitals.
 BUT, the medical model can promote the myth
that disorders are brought on by single causes.
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HISTORICAL TREND OF
DEINSTITUTIONALIZATION
Starting in the 1950s and 1960s more and more
drugs began being used to “cure” psychological
disorders.
 Policy of deinstitutionalization --> patients were
removed from mental institutions to live in
family based or community based
environments.
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PSYCHOLOGICAL DISORDERS
PSYCHOLOGICAL BEHAVIORS RUN A CONTINUUM
FROM VERY MILD TO EXTREME. EVERYONE HAS
THESE BEHAVIORS TO ONE DEGREE OR ANOTHER. IT
IS NOT UNTIL A BEHAVIOR OR FEELING INTERFERES
WITH YOUR QUALITY OF LIFE THAT IT BECOMES A
DISORDER.
PSYCHOLOGICAL DISORDERS ARE:
Atypical (deviant)
Disturbing (distressing)
Maladaptive (dysfunctional)
Unjustifiable
What is “insane”?
Insanity is a legal definition, not a psychological one. The term of
insanity is applied to someone who is incapable of determining if an
act is wrong and cannot control their behavior.
The insanity defense is rarely used – just 0.9% of the time (9 times in
1000). The success rate is less than 20% of the time it is used.
People who are declared not guilty by reason of insanity generally
spend more time institutionalized than they would have been
imprisoned.
Being declared insane is not the same as being declared not
competent to stand trial – this simply means you are unable to
understand the charges against you and the proceedings of the
court (could apply to very young children, for example).
Defining Disorders
DSM IV - Diagnostic and statistical manual vol. 4.: describes
psychological disorders, without explaining the causes, predicts the
future course, and suggests treatments. It focuses on observable
behaviors to make diagnoses.
Categorizes 400+ disorders, in 17 categories.
Axis I: refers to clinical disorders which need clinical attention. Includes
most mental disorders
Ex: Depression, Schizophrenia, Phobia, etc.
Axis II: Includes personality disorders and mental retardation.
Ex: Antisocial, Narcissistic, Avoidant, etc.
Axis III: relates to physical conditions which may contribute to mental
illness. Ex: brain injury, cancer, HIV, etc.
Axis IV: relates to psycho-social events in a persons life which may
contribute to mental illness.
Ex: death of a loved one, divorce, new job, etc.
Axis V: relates to a rating clinician gives patient on how well they are
functioning in life presently and within the last year.
Advantages of Diagnosis and the DSM-IV
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Diagnosis can facilitate communication
Diagnosis can provide etiology (study of causation) clues
Diagnosis provides prognosis (likely outcome)
Diagnosis can give direction for treatment plans
Disadvantages of Diagnosis and the DSM-IV
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No clear line between normal and abnormal in many
cases
Reliability is still a problem (if 5 psychologists examine a
patient will they all come up with the same diagnosis?)
Diagnostic labels may take on a life of their own and are
hard to remove – LABELING THEORY – Rosenhan –
this can lead to self-fulfilling prophecy.
Diagnostic criteria for 313.81 Oppositional Defiant Disorder
Think of classes you have been in at West Meck. Have you ever met a
student who fit these critieria?
A. Four of the following are present in 6 months…
(1) often loses temper
(2) often argues with adults
(3) often actively defies or refuses to comply with adults' requests or rules
(4) often deliberately annoys people
(5) often blames others for his or her mistakes or misbehavior
(6) is often touchy or easily annoyed by others
(7) is often angry and resentful
(8) is often spiteful or vindictive
Note: Consider a criterion met only if the behavior occurs more frequently
than is typically observed in individuals of comparable age and
developmental level.
B. The disturbance in behavior causes clinically significant impairment in
social, academic, or occupational functioning.
Diagnostic criteria for 309.21 Separation Anxiety Disorder
Have you ever known a child or infant who fit three or more of these criteria?
(1) recurrent excessive distress when separation from home or major attachment
figures occurs or is anticipated
(2) persistent and excessive worry about losing, or about possible harm befalling,
major attachment figures
(3) persistent and excessive worry that an untoward event will lead to separation
from a major attachment figure (e.g., getting lost or being kidnapped)
(4) persistent reluctance or refusal to go to school or elsewhere because of fear of
separation
(5) persistently and excessively fearful or reluctant to be alone or without major
attachment figures at home or without significant adults in other settings
(6) persistent reluctance or refusal to go to sleep without being near a major
attachment figure or to sleep away from home
(7) repeated nightmares involving the theme of separation
(8) repeated complaints of physical symptoms (such as headaches, stomachaches,
nausea, or vomiting) when separation from major attachment figures occurs or is
anticipated
B. The duration of the disturbance is at least 4 weeks.
C. The onset is before age 18 years.
D. The disturbance causes clinically significant distress or impairment in social,
academic (occupational), or other important areas of functioning.
Diagnostic criteria for 305.90 Caffeine Intoxication
Have you ever experienced 5 or more of these after drinking 2-3 cups of coffee or
caffeine?
(1) restlessness
(2) nervousness
(3) excitement
(4) Insomnia
(5) flushed face
(6) diuresis
(7) gastrointestinal disturbance
(8) muscle twitching
(9) rambling flow of thought and speech
(10) tachycardia or cardiac arrhythmia
(11) periods of inexhaustibility
(12) psychomotor agitation
C. The symptoms in Criterion B cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
D. The symptoms are not due to a general medical condition and are not better accounted
for by another mental disorder (e.g., an Anxiety Disorder).
Rosenhan’s study – can you fake insanity?
Being Sane in Insane Places
http://www.youtube.com/watch?v=xAsqKCQDgmA
http://www.youtube.com/watch?v=FG4mOpQpmpw&feature=related
DAVID ROSENHAN TESTS POWER OF
LABELING AND ITS RELIABILITY
Describe Rosenhan’s study:
He had colleagues attempt to fake symptoms to get into
mental hospitals. Each pseudopatient told the hospitals they
had been hearing voices. Apart from that they told no lies
other than fake names, addresses, etc.
After being admitted, the fake patients acted completely
normal. Hospital staff failed to identify the fakers and
interpreted all of their normal behavior in terms of mental
illness. Ex: guy taking notes was said to have “writing
behavior” which seemed pathological.
What does this say about the impact of labeling?
Psychological Disorders: Causes
Are not usually caused by a single factor.
Bio-psycho-social school  most disorders
are caused by a biological predisposition,
physiological state, psychological dynamics,
and social circumstances.
Biological / genetic
predisposition
+
Stress
(environment)
= DISORDER
The diathesis-stress model
The model looks at the diathesis or genetic/biologic vulnerability
to a disorder/disease and the stress(or)s that may trigger it.
The diathesis-stress model uses the analogy of a "walking time
bomb" to help explain why, for example, not 100% of identical
twins both get schizophrenia. It also helps to explain why a large
percent of people in traumatic situations (post 911, rape, etc.)
never develop PTSD.
The model further talks about a balance -- the greater the
diathesis or predisposition, the less the stress required for the
disorder to "appear" and visa versa.
MOST MENTAL HEALTH PROFESSIONALS
ASSUME DISORDERS HAVE
INTERLOCKING CAUSES
Bio-Psycho-Social
Perspective:
assume biological,
psychological, and
socio-cultural
factors interact to
produce disorders.
Biological
(Evolution,
individual
genes, brain
structures
and chemistry)
Sociocultural
(Roles, expectations,
definition of normality
and disorder)
Psychological
(Stress, trauma,
learned helplessness,
mood-related perception
and memories)
KNOW WHAT CATEGORY ANY
DISORDER FITS INTO
Categories of Disorder:
1. Anxiety
2. Mood
3. Dissociative
4. Schizophrenia
5. Personality
6. Somatoform (Not in Book)
7. Facticious (Not in Book)
What about the DSM IV?
Is it useful or harmful?
DSM IV criticism
Diagnosis helps people