Psychological Disorders I PDF

PSYCHOLOGICAL DISORDERS I Taregh Shaban AIMS AND OBJECTIVES Aim: Ø To introduce the concept of abnormality Ø To develop a basic understanding of some of the most common mental health problems LEARNING OUTCOMES By the end of this lecture You’re able to distinguish between the most common anxiet...

PSYCHOLOGICAL DISORDERS I Taregh Shaban AIMS AND OBJECTIVES Aim: Ø To introduce the concept of abnormality Ø To develop a basic understanding of some of the most common mental health problems LEARNING OUTCOMES By the end of this lecture You’re able to distinguish between the most common anxiety disorder You can describe, in very broad terms, symptoms of GAD, Panic, simple phobia, OCD and depression Able to use two basic screening tools – one for GAD and one for depression.  THE CHALLENGE OF DEFINITION "What is normal for the spider is chaos for the fly." – Charles Addams Key Point: definitions of "abnormality“ are relative, limited and often overlapping  INDICATOR 1: STATISTICAL INFREQUENCY Abnormality defined by rare behaviours or characteristics, i.e., those behaviours or characteristics that are statistically infrequent or deviant from the mean. Williamson (2023) INDICATOR 2: DEVIATION FROM SOCIAL AND CULTURAL NORMS Behaviours that violate societal standards or rules, or deviate from them (Barlow & Durand, 2017). “Can anyone think of an example where a behaviour might be 'normal' in one culture but 'abnormal' in another?" INDICATOR 3: MALADAPTIVE BEHAVIOUR Abnormality defined by behaviours or actions that impair an individual's ability to function in daily life. American Psychiatric Association. (2013). INDICATOR 4: PERSONAL DISTRESS Explanation: Abnormality marked by personal suffering or distress. Quick Question: “can you think of examples where behaviour maybe accepted (or even valued) by society yet cause distress to an individual?"  A HOLISTIC VIEW - COMBINING INDICATORS Key Point: No single indicator is sufficient. In practice, professionals often combine these to arrive at a definition (or diagnostic criteria) of mental disorders (Nolen- Hoeksema, 2022). For example: The DSM-5 defines a mental disorder as “a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or development processes underlying mental functioning” (American Psychiatric Association, 2013, p. 20). DSM-5 also recognizes that mental disorders are often associated with significant distress or disability in key area of functioning such as social, occupational, or other activities. (Hooley et al (2021). It is also important to note the DSM-5 specifically excludes “culturally approved responses to common stressors” (American Psychiatric Association, 2013, p. 20), and “socially deviant behaviour” (American Psychiatric Association, 2013, p. 20) from mental disorder diagnoses. CONCLUSION AND EXTENSION ACTIVITY Conclusion: Infrequency, deviation from cultural norms, dysfunctionality, and personal distress are all potential indicators of abnormal behaviour (or psychopathology). Final comment: Although we have many indicators of abnormality, an ultimate definition still alludes us (Hooley at al. 2021). "Now, based on these definitions, can anyone think of a behaviour that might be challenging to categorize as 'normal’ or 'abnormal'?" DEFINING ABNORMALITY PERSPECTIVES ON MENTAL HEALTH PROBLEMS 1. Biological perspective – due to brain disorders 2. Psychoanalytic perspective – unconscious conflicts are key 3. Behavioural perspective – fears become conditioned 4. Cognitive perspective – maladaptive cognitive processes 5. Cultural/sociological perspective – social context 6. Vulnerability-stress model - Interaction between predisposition & stressful environmental conditions (need both to develop mental health problem)  THE BIO-PSYCHO-SOCIAL MODEL https://www.youtube.com/watch?v=bf0TZ5OzF5I&t=83s BIOMEDICAL MODEL  DEFINING ABNORMALITY CLASSIFYING MENTAL ILLNESS Good classification system aids diagnosis & treatment *ICD-11 International Classification of disease (WHO) * DSM-V diagnostic and statistical manual (American Psychiatric Association) https://www.youtube.com/watch?v=FxPXC8t- 2ls&list=PLaf8o4MVZXndtKtxJXvHOZRxxr2UcsQAs Neuroses – characterised by anxiety, unhappiness & maladaptive behaviour; but rarely serious enough to result in hospitalisation. Individual maintains ‘insight’ Psychoses – more serious mental disorders and this is where an individual does not have ‘insight’ COMMON MENTAL DISORDERS Dr Taregh Shaban  ANXIETY DISORDERS Anxiety only considered unhealthy when occurs in situations that most people can handle with little difficulty  F41.1 GENERALISED ANXIETY DISORDER (GAD) Called GAD because it often doesn’t have a particular trigger. A. A period of at least six months with prominent tension, worry and feelings of apprehension, about every-day events and problems. B. At least four symptoms out of the following list of items must be present, of which at least one from items (1) to (4). Autonomic arousal symptoms (1) Palpitations or pounding heart, or accelerated heart rate. (2) Sweating. (3) Trembling or shaking. (4) Dry mouth (not due to medication or dehydration).  GAD CONT. Symptoms concerning chest and abdomen (5) Difficulty breathing. (6) Feeling of choking. (7) Chest pain or discomfort. (8) Nausea or abdominal distress (e.g. churning in stomach). Symptoms concerning brain and mind (9) Feeling dizzy, unsteady, faint or light- headed. (10) Feelings that objects are unreal (derealization), or that one's self is distant or "not really here" (depersonalization). (11) Fear of losing control, going crazy, or passing out. (12) Fear of dying. General symptoms (13) Hot flushes or cold chills. (14) Numbness or tingling sensations. Symptoms of tension (15) Muscle tension or aches and pains. (16) Restlessness and inability to relax. (17) Feeling keyed up, or on edge, or of mental tension. (18) A sensation of a lump in the throat, or difficulty with swallowing. GAD CONT. Other non-specific symptoms: (19) Exaggerated response to minor surprises or being startled. (20) Difficulty in concentrating, or mind going blank, because of worrying or anxiety. (21) Persistent irritability. (22) Difficulty getting to sleep because of worrying. C. The disorder does not meet the criteria for panic disorder (F41.0), phobic anxiety disorders (F40.-), obsessive-compulsive disorder (F42.-) or hypochondriacal disorder (F45.2). D. Most commonly used exclusion criteria: not sustained by a physical disorder, such as hyperthyroidism, an organic mental disorder (F0) or psychoactive substance-related disorder (F1), such as excess consumption of amphetamine-like substances, or withdrawal from benzodiazepines GAD VIDEO https://www.youtube.com/watch?v=8jR9cehXrpE Note down all the symptoms you hear in this video#  F41.0 PANIC DISORDER A. Recurrent panic attacks, that are not consistently associated with a specific situation or object, and often occurring spontaneously (i.e. the episodes are unpredictable). The panic attacks are not associated with marked exertion or with exposure to dangerous or life-threatening situations. B. A panic attack is characterized by all of the following: (a) it is a discrete episode of intense fear or discomfort; (b) it starts abruptly; (c) it reaches a crescendo within a few minutes and lasts at least some minutes; (d) at least four symptoms must be present from the list below, one of which must be from items (1) to (4):  PANIC DISORDER Autonomic arousal symptoms (1) Palpitations or pounding heart, or accelerated heart rate. (2) Sweating. (3) Trembling or shaking. (4) Dry mouth (not due to medication or dehydration). PANIC DISORDER Symptoms concerning chest and abdomen :(5) Difficulty breathing. (6) Feeling of choking. (7) Chest pain or discomfort. (8) Nausea or abdominal distress (e.g. churning in stomach). Symptoms concerning brain and mind: (9) Feeling dizzy, unsteady, faint or light-headed. (10) Feelings that objects are unreal (derealization), or that one's self is distant or "not really here" (depersonalization) (11) Fear of losing control, going crazy, or passing out. (12) Fear of dying. General symptoms: (13) Hot flushes or cold chills. (14) Numbness or tingling sensations. IN GROUPS OF 3/4 In small groups discuss: What are the typical physical symptoms of agoraphobia? What emotions would you expect to see in agoraphobia? What thoughts/beliefs? What behaviours?  F40.0 AGORAPHOBIA A. Marked and consistently manifest fear in or avoidance of at least two of the following situations: (1) crowds; (2) public places; (3) travelling alone; (4) travelling away from home. B. Symptoms of anxiety in the feared situation at some time since the onset of the disorder, with at least two symptoms present together, on at least one occasion, from the list below, one of which must have been from items (1) to (4):  AGORAPHOBIA CONT. Autonomic arousal symptoms: (1) Palpitations or pounding heart, or accelerated heart rate. (2) Sweating. (3) Trembling or shaking. (4) Dry mouth (not due to medication or dehydration). Symptoms concerning chest and abdomen : (5) Difficulty breathing. (6) Feeling of choking. (7) Chest pain or discomfort. (8) Nausea or abdominal distress (e.g. churning in stomach). Symptoms concerning brain and mind : (9) Feeling dizzy, unsteady, faint or light-headed. (10) Feelings that objects are unreal (derealization), or that one's self is distant or "not really here" (depersonalization). (11) Fear of losing control, going crazy, or passing out. (12) Fear of dying. General symptoms (13) Hot flushes or cold chills. (14) Numbness or tingling sensations. C. Significant emotional distress due to the avoidance or the anxiety symptoms, and a recognition that these are excessive or unreasonable. D. Symptoms are restricted to or predominate in the feared situations or when thinking about them. IN GROUPS OF 3/4 In small groups discuss: What are the typical physical symptoms of social phobia? What emotions would you expect to see in social phobia? What thoughts/beliefs? What behaviours?  ICD 10 F40.1 SOCIAL PHOBIAS A. Either (1) or (2): (1) marked fear of being the focus of attention, or fear of behaving in a way that will be embarrassing or humiliating; (2) marked avoidance of being the focus of attention or situations in which there is fear of behaving in an embarrassing or humiliating way. These fears are manifested in social situations, such as eating or speaking in public; encountering known individuals in public; or entering or enduring small group situations, such as parties, meetings and classrooms.  SOCIAL PHOBIA CONT. B. At least two symptoms of anxiety in the feared situation at some time since the onset of the disorder, as defined in criterion B for F40.0 (Agoraphobia) and in addition one of the following symptoms: (1) Blushing. (2) Fear of vomiting. (3) Urgency or fear of micturition or defecation. C. Significant emotional distress due to the symptoms or to the avoidance. D. Recognition that the symptoms or the avoidance are excessive or unreasonable. E. Symptoms are restricted to or predominate in the feared situation or when thinking about it. IN GROUPS OF 3/4 In small groups discuss: What are the typical physical symptoms of specific phobia? What emotions would you expect to see in specific phobia? What thoughts/beliefs? What behaviours?  ICD 10 F40.2 SPECIFIC (ISOLATED) PHOBIAS A. Either (1) or (2): (1)marked fear of a specific object or situation not included in agoraphobia (F40.0) or social phobia (F40.1); (2)marked avoidance of such objects or situations. Among the most common objects or situations are animals, birds, insects, heights, thunder, flying, small enclosed spaces, sight of blood or injury, injections, dentists and hospitals.  SPECIFIC PHOBIA CONT. B. Symptoms of anxiety in the feared situation at some time since the onset of the disorder, as defined in criterion B for F40.0 (Agoraphobia). C. Significant emotional distress due to the symptoms or the avoidance, and a recognition that these are excessive or unreasonable. D. Symptoms are restricted to the feared situation, or when thinking about it. If desired, the specific phobias may be subdivided as follows: - animal type (e.g. insects, dogs) - nature-forces type (e.g. storms, water) - blood, injection and injury type - situational type (e.g. elevators, tunnels) - other type  F42 OBSESSIVE-COMPULSIVE DISORDER (OCD) A. Either obsessions or compulsions (or both), present on most days for a period of at least two weeks. B. Obsessions (thoughts, ideas or images) and compulsions (acts) share the following features, all of which must be present: (1) They are acknowledged as originating in the mind of the patient, and are not imposed by outside persons or influences. (2) They are repetitive and unpleasant, and at least one obsession or compulsion must be present that is acknowledged as excessive or unreasonable.  OCD CONT. (3) The subject tries to resist them (but if very long-standing, resistance to some obsessions or compulsions may be minimal). At least one obsession or compulsion must be present which is unsuccessfully resisted. (4) Carrying out the obsessive thought or compulsive act is not in itself pleasurable. (This should be distinguished from the temporary relief of tension or anxiety). C. The obsessions or compulsions cause distress or interfere with the subject's social or individual functioning, usually by wasting time. OCD VIDEO https://www.youtube.com/watch?v=ua9zr16jC1M 0-3.00 min  OBSESSIVE-COMPULSIVE DISORDER Lives dominated by repetitive acts (compulsions) or thoughts (obsessions) – central feature is over inflated sense of responsibility. Understanding obsessive-compulsive disorder Cognitive & behavioral theorists – those with obsessive-compulsive disorder appraise relatively harmless objects and situations as being more harmful than they are and that they are responsible for any harm that ensues. Rachman and Da Sliva (1978) May also have biological causes – possible deficiencies in serotonin – regulates primitive impulses  MOOD DISORDERS I Mood disorders divided into depressive disorders (one or more periods of depression) & bipolar disorders (person alternates between periods of depression & mania) Depression Depression becomes a disorder when the symptoms become so severe they interfere with normal functioning & continue for weeks at a time Women twice as likely to suffer depression as men https://www.youtube.com/watch?v=51vdnwrfsNA  SYMPTOMS OF DEPRESSION Requires 4 or more (of 10) symptoms present for at least 2 weeks. Symptoms must include ≥ 2 of: *Depressed mood *Anhedonia *Energy loss  Symptoms of depression (need 4 or more and as least 2 or more from those in bold) 1 Depressed mood 2 Loss of interest and enjoyment Reduced energy leading to: 3 Increased fatigability Diminished activity 4 Reduced concentration and attention 5 Reduced self-esteem and self confidence 6 Ideas of guilt and unworthiness 7 Bleak and pessimistic views of the future 8 Ideas or acts of: Self-harm Suicide 9 Disturbed sleep 10 Diminished appetite ACTIVITY Test each other of above symptoms Fill-in the PHQ 9  QUICK QUIZ WHICH OF THE FOLLOWING SYMPTOMS ARE SX OF DEPRESSION, WHICH ARE SYMPTOMS OF GAD AND WHICH ARE SX OF PANIC Shortness of breath or hyperventilation Feeling nervous, anxious, or Pessimism and Heart palpitations or a racing heart on edge hopelessness Chest pain or discomfort Not being able to stop or Restlessness and Trembling or shaking control worrying irritability Worrying too much about Choking feeling Anhedonia (loss of different things Feeling unreal or detached from Trouble relaxing pleasure in things) your surroundings Sweating Being so restless that it's Over eating or Nausea or upset stomach hard to sit still loss of appetite Feeling dizzy, light-headed, or Becoming easily annoyed or Suicidal ideation faint irritable Physical Numbness or tingling Feeling afraid as if something symptoms sensations awful might happen Hot or cold flashes Fear of dying, losing control, or going crazy Lecture 16 Psychological Disorders III  Learning Objectives Have an understanding of the more severe mental health problems experienced by adult patients namely: - Bipolar disorder - Schizophrenia - Personality disorders  Mood Disorders II Bipolar disorder Also known as manic depression – individuals alternate between depression & extreme elation Manic symptoms often change from joyful exuberance to hostile agitation & equally found in men & women Understanding mood disorders The biological perspective Tendency to develop mood disorders, especially bipolar disorders, appears to be inherited Structural & functional brain abnormalities could be precursors and causes of mood disorders or result of biochemical processes  Bipolar disorder - Note symptoms of Bipolar disorder - Note different types of Bipolar Disorder https://www.youtube.com/watch?v=YojXb-fLCeM 0- 3.45  Bipolar disorder Cont. Bipolar 1 Major low mood that least 2 weeks Major high that lasts at least 1 week or require hospitalisation Bipolar 2 Major low mood that lasts at lasts 2 weeks Hypomania (less severe highs than in bipolar 1) that last for at least a few days Cyclothymia Have milder lows and milder highs and they cycle for at least 2 years  What is Schizophrenia A summary by an expert https://www.youtube.com/watch?v=B4y2Wab43sQ  Characteristics of schizophrenia 1. Delusions - ‘Fixed false belief ’ – paranoia, delusion of grandeur, 2. Hallucinations (disturbances of perception) - both auditory & visual with visual less common (other sensory hallucinations rare) 3. Disorganised thought Incoherent speech; ideas jumbled together; 4. Disorganised behaviour: - e.g. Self neglect; difficulty planning and carrying out plans; sufferers sometimes exhibit bizarre motor activity; decreased ability to function – sufferers impaired in their ability to carry out daily routines of living. 5. Negative symptoms of schizophrenia - Loss of motivation; sitting down not doing anything; withdrawal from others Pair work: test each other on symptoms  Interview with schizophrenic patients? Patient 1 https://www.youtube.com/watch?v=iGH7hGkkMrU Patient 2 https://www.youtube.com/watch?v=wdr1YAtUSoA Schizophrenia  Schizophrenia Understanding schizophrenia The biological perspective Schizophrenia likely to have strong biological roots Two types of structural deficits in the brain – prefrontal cortex smaller & less active, and enlarged ventricles Also, problems in regulation of dopamine  Genetic factors implicated in schizophrenia Twin studies: - Twin studies have shown that the tendency for both monozygotic (identical) twins to develop schizophrenia is between 30-50% - The tendency for dizygotic (fraternal) twins to develop schizophrenia is about 15%. Adoption Studies: - One study (Kety et al., 1968) found that 13% of the biological relatives of the adoptees with schizophrenia also had schizophrenia - only 2% of the relatives of "normal" adoptees had schizophrenia  Non-genetic factors: These include: family stress, poor social interactions, infections or viruses at an early age, or trauma at an early age. Somehow the genetic makeup of individuals combines with nongenetic (environmental) factors seem t cause schizophrenia.  Personality Disorders Personality disorders Long-standing patterns of maladaptive behaviour. Personality traits become so inflexible & maladaptive that significantly impair individual’s ability to function  10 Types Personality Disorders Cluster A (Odd, bizarre, eccentric) Paranoid PD Schizoid PD Schizotypal PD  Types Personality Disorders continued Cluster B (Dramatic, erratic) Antisocial PD Borderline PD Histrionic PD Narcissistic PD  Types Personality Disorders Continued Cluster C (Anxious, fearful) Avoidant PD Dependent PD Obsessive-Compulsive PD  Antisocial personality disorder https://www.youtube.com/watch?v=tp8v4PUIr7o  Antisocial Personality Disorder The ICD code F60.2 is used to code Antisocial personality disorder ‘Antisocial personality disorder is characterized by a pervasive pattern of disregard for, or violation of, the rights of others. An impoverished moral sense or conscience is apparent, as well as a history of crime, legal problems, and/or impulsive and aggressive behavior.’  Borderline Personality disorder The ICD code F60.3 is used to code Borderline personality disorder ‘Borderline personality disorder (BPD) is a personality disorder. The essential features include a pattern of impulsivity and instability of behaviors, interpersonal relationships, and self-image. There may be uncontrollable anger and depression. The pattern is present by early adulthood and occurs across a variety of situations and contexts.’ https://www.youtube.com/watch?v=KSPhc2NJA2Q Need to learn the symptoms in the video  Dependent Personality Disorder The ICD code F60.7 is used to code Dependent personality disorder ‘Dependent personality disorder (DPD), formerly known as asthenic personality disorder, is a personality disorder that is characterized by a pervasive psychological dependence on other people. This personality disorder is a long-term (chronic) condition in which people depend on others to meet their emotional and physical needs, with only a minority achieving normal levels of independence.’ https://www.youtube.com/watch?v=-088JO3j7WQ Need to learn the symptoms in the video  Personality Disorders Understanding antisocial personality disorder Biological factors Genetic factors play a role in development of antisocial personality – twin studies confirm genetic component Psycho-Social factors Neglectful & hostile parents may contribute to disorder as do unmet emotional needs during childhood