Notes- PowerPoint Lecture 02 PDF

NOTES: [PowerPoint: Lecture 02.] QUICK LEARNING OBJECTIVES. Identify criteria for defining mental Identify common myths and disorders. misconceptions about suicide. Describe conceptions of diag...

NOTES: [PowerPoint: Lecture 02.] QUICK LEARNING OBJECTIVES. Identify criteria for defining mental Identify common myths and disorders. misconceptions about suicide. Describe conceptions of diagnoses across Identify the characteristics of borderline history and cultures. and psychopathic personality disorders. Identify common misconceptions about Explain the controversies surrounding psychiatric diagnoses and the strengths dissociative disorders and dissociative and limitations of the current diagnostic identity disorder. system. Recognize the characteristic symptoms of Describe structured clinical tests, such as schizophrenia. the MMPI, and their construction Explain how psychosocial, neural, methods. biochemical, and genetic influences create Describe the many ways people the vulnerability to schizophrenia. experience anxiety. Describe the symptoms and debate Identify the characteristics of different surrounding disorders diagnosed in mood disorders. childhood. Describe major explanations for depression and how life events can interact with the characteristics of the NOTES: [PowerPoint: Lecture 02.] 1  individual to produce depression symptoms. There are many conceptions of mental What is Mental Illness? illnesses, each with advantages and Psychopathology (mental illness) is often disadvantages: seen as a failure of adaptation to the Statistical rarity environment. Subjective distress The failure analysis approach tries to understand mental illness by examining Impairment breakdowns in functioning. Societal disapproval Mental disorders do not have a clear-cut Biological dysfunction definition. [ This implies the suspicion of a mental illness ] Abnormal behaviour: Deviant, maladaptive, or personally distressful behaviour over a relatively long period. What “Defines” a Mental Disorder? Statistical rarity Impairment (exams are disruptive) Biological dysfunction Genius or Disrupts your life – addiction, paranoia extraordinary Brain Laziness – yes, but… creativity – rare functioning, Procrastination – yes, but… neurotransmit Schizophrenia - rare Societal disapproval (be careful about what genetics, Depression - common environment you pathologize) Subjective distress (e.g., Family Thomas Szasz – “Mental illness is a anxiety, depression) resemblance myth” - society doesn’t approve Sometimes, it doesn’t (Horton?) view – bother the person. mental Homosexuality = “sexual disorders Mania, conduct deviation”/“disorder” until 1973 don’t all have disorder Racism, messiness, rudeness – not cool, one thing in but not mental illness common; rather, they share a loose set of features, and they all require some NOTES: [PowerPoint: Lecture 02.] 2  level of intervention. Historical Conceptions Demonic model: odd Medical model: mental illness as a physical disorder needing behaviours were the result treatment. of evil spirits inhabiting the Hippocrates’ “humours” (460-370 BC) body Blood, black bile, yellow bile, phlegm Trephination (found in Stone Age skulls) Treat with vomiting and leeches. Middle Ages The Renaissance Malleus Mallificarum People were housed in asylums – but these institutions were (1486): “How To often overcrowded and understaffed. Identify a Witch” Treatments were no better than before (bloodletting and Exorcisms and witch snake pits) hunts were common during this time. Modern Era The Mental Hygiene Movement (1700s-1800s) Deinstitutionalization: With advent of other medications, the policy was Reformers like Phillippe Pinel and Dorothea Dix enacted in the 1960s and 1970s. pushed for moral treatment. Government policy that focused on Calling for treating patients with dignity, closing mental hospitals and respect, and kindness releasing hospitalized psychiatric Still no effective treatments, though, so many patients into the community with continued to suffer with no relief. services and supports to be provided In the early 1950s, a drug was developed called by planned/promised, smaller, less chlorpromazine (Thorazine) isolating, and local community mental healthcare providers/centres. Moderately decreased symptoms of schizophrenia and similar problems Some patients returned to almost normal lives but tens of thousands Game changer for psychology and psychiatry. had no follow-up care and went off medications; governments saved a large amounts of money. NOTES: [PowerPoint: Lecture 02.] 3  [Often underfunded] Community mental health centres and halfway houses popped up and attempt/ed to help with this problem After 50+ years, one look around shows we’ve completely addressed and solved that failure—now, both everyone can get the help they need, Dorothea Dix. and everything is back to normal! Right? Right?!? Recent study indicating that 15% of all patients treated for mental disorders are homeless Psychiatric Diagnoses: An Psychiatric diagnoses are invalid. (Thomas Szasz) organized system of classification Sort of true ( labelling of behaviour not disorder), but for treatment and communication. still pretty good for prediction of a number of things. Misconceptions : (Not helpful: Internet d/o, road rage d/o, shopping Psychiatric diagnosis is nothing addiction = problematic behaviour) more than pigeonholing. Distinguishes and predicts (Helpful: Robins & Guze At least one aspect is the criteria) same, but all people, even Psychiatric diagnoses stigmatize people. with the same diagnosis, are different (never forget that Labels *can* be negative = “crazy” (Schizophrenic vs. people are unique, but there is person with schizophrenia or person living with something that is the “same” schizophrenia) for all of them) Again, yes and no (Rosenthal study) Psychiatric diagnoses are “empty, hollow, thud” — Admissions for unreliable. schizophrenia — avg stay 3 weeks! But all were High interrater around 0.8 discharged as “in remission” ;so, no long-term effects. except for the PDs … reliability The DSM-5 Diagnostic and Statistical Manual of Mental Disorders (DSM) is a system that contains the criteria for mental disorders (1952 – present) Currently on fifth edition, DSM-5. Has 18 different classes of disorders (see Brightspace) NOTES: [PowerPoint: Lecture 02.] 4  Contains diagnostic criteria and for each condition (A Buzzfeed quiz might not be your best bet for a Dx) decision rules. For example, 9 criteria for MDD, must meet 5 (4 of which are specific: fatigue, insomnia, prob. concentrating, significant wt. loss And depressed mood or diminished interest/pleasure in daily life or both Warns to “think organic” (rule out physical causes of symptoms first, e.g., hypothyroidism & hyperthyroidism) Contains information on prevalence = % of people in a population with a disorder Recognizes cultural norms. Diagnosis Across Cultures Robins and Guze Criteria for Validity Certain conditions are Distinguishes that diagnosis from other, similar diagnoses culture-bound Predicts performance on laboratory tests, including Koro involves personality measures, neurotransmitter levels, and brain- believing your genitals imaging findings are shrinking and Predicts family history of psychiatric disorders receding into your abdomen Predicts natural history (change over time) Amok is marked by Predicts treatment response episodes of intense sadness and brooding followed by uncontrolled behaviour and violence Taijin kyofushu is a fear of offending others by saying something offensive or giving off a terrible body odour Many severe mental disorders (schizophrenia, alcoholism, psychopathy) appear to NOTES: [PowerPoint: Lecture 02.] 5  be universal across cultures DSM Criticisms Not all diagnoses meet Robins and Guze criteria for validity (e.g., Mathematics Disorder) Not all criteria and decisions rules are based on scientific data (some are based on committee decisions) Is a normal grief reaction the same as clinical depression? Are we medicalizing normality? High level of comorbidity (2+ disorders at once, so it is something else?) Reliance on categorical model (disorder differs from normal functioning in kind rather than degree) rather than dimensional model (opposite; degree rather than kind) (pregnancy – easy: depression – hard Mental Illness and the Law Mental disorder defence: legal defence proposing that people shouldn’t be held legally responsible for their actions if they weren’t of “sound mind” when committing them Insanity defense requires people to not know: People can only be committed against their will if they: What they were doing Pose a clear and present threat to themselves or others at the time of crime or are so impaired they can’t care for themselves. What they were doing was wrong Less than 1% successful Involuntary commitment is a NOTES: [PowerPoint: Lecture 02.] 6  procedure for protecting us from certain people with mental disorders and protecting them from themselves Minnesota Multiphasic Personality Inventory (MMPI) Was used in the assessment of Considered to have good validity, can psychopathology and was developed using distinguish between disorders. empirical method. Can be interpreted manually or via a which was used to approach to building program. tests in which researchers begin with Problematic in that: two or more criterion groups and examine which items best distinguish Some overlap between scales them. Cannot be the sole basis of The test has low face validity. diagnosis which extents to which respondents can One scale alone does not predict an tell what the items are measuring illness Low face validity is thought to be an advantage because preticapants cannot “fake” responses. 567 true-false questions, 10 basic scales; Contains three validity scales designed to detect various types of distorted responses. L (Lie) detects impression management F (Frequency) detects malingering K (Correction) measures defensive responding. Anxiety Disorders Most anxieties are transient and can be adaptive. However, anxieties can also become excessive and inappropriate. One of the most prevalent and earliest onset of all classes of disorders. NOTES: [PowerPoint: Lecture 02.] 7  Inappropriate anxiety exists in other disorders and problems. Somatic symptom disorders are physical symptoms with psychological origins. Illness anxiety disorder is a preoccupation that you have a serious disease despite no evidence (Hypochondriasis). Generalized Anxiety Disorder Panic Disorder Continual feelings of worry, anxiety, Repeated, unexpected panic attacks, along physical tension, and irritability about with: many areas. Persistent concerns about future About 3% of the population; 1/3 develop attacks. it after major stressor or life change. A change in personal behaviour in an Springboard disorder for other anxiety attempt to avoid them. disorders. Panic attacks are brief, intense episodes Panic disorder or phobias. of extreme fear characterized by sweating, dizziness, lightheadedness, racing More prevalent in females and heartbeat, and feelings of impending death Caucasians. or going crazy. Can be associated with specific situations or come “out of the blue”. Phobias Posttraumatic Stress Disorder Intense fear of an object or situation that’s greatly out of proportion to its actual threat. Marked emotional disturbance after you Most common anxiety disorder, several forms: experience or witness a Agoraphobia: fear of being in a place or situation from severely stressful event which escape is difficult or embarrassing, or in which Symptoms include: help is unavailable in the event of a panic attack. Flashbacks and Social anxiety disorder (formerly social phobia): recurrent dreams intense fear of negative evaluation in social situations. Avoiding Specific phobia: intense fear of objects, places, or reminders of the situations that is greatly out of proportion to their actual trauma threat. Increased physiological arousal NOTES: [PowerPoint: Lecture 02.] 8  Obsessive-Compulsive Disorder Condition marked by repeated and lengthy (at least one hour per day) immersion in obsessions, compulsions, or both. Obsessions: persistent ideas, thoughts, or impulses that are unwanted and inappropriate and cause marked distress Distress is relieved by compulsions. repetitive behaviour or mental act performed to reduce or prevent stress. Explanations for Anxiety Disorders Learning models How a Social Anxiety Disorder might develop using focus on acquiring the learning model. fears via classical Socially awkward person. conditioning, then maintaining them Social rejection. through operant More shy and awkward. conditioning. Increased rejections. Can also learn Avoid Social Situations. fears by observing Negative Reinforcement. others or by Social Anxiety Disorder. hearing misinformation from others. Anxious people tend to think about the world in different ways from non-anxious people. Catastrophic thinking - predicting terrible events despite low probability Anxiety sensitivity – a fear of anxiety-related symptoms The negative misinterpretation of minor physical symptoms (I feel dizzy) along with over-interpretation (I am going to die) Panic Attack. Genetic and biological influences – twin studies show that many anxiety disorders are genetically influenced. We inherit high levels of neuroticism (high-strung & irritable) NOTES: [PowerPoint: Lecture 02.] 9  OCD – specific overactive genes related to transport of serotonin and glutamate. Malfunction of the caudate nucleus and frontal lobe. Can’t “let it go” or “shift gears”. Mood Disorders Over 20% of North Americans will experience a mood disorder. Major Depressive Disorder (MDD) is the most common, at 16% Average episode lasts 6 months to 1 year, most people experience 5-6 episodes. Can cause extreme functional impairment across all areas. More prevalent in females, most likely to develop in 30s. Features of a major depressive episode: Depressed mood or diminished interest in pleasurable activities, along with symptoms that include weight loss, sleep difficulties, fatigue, lack of concentration, and feelings of worthlessness. Depression symptoms can develop gradually or suddenly, but are often recurrent. Explanations for MDD Complex interplay of biological, psychological, and social influences Major life events, particularly the loss of something that is dearly valued, can set stage for depression Depression can create interpersonal problems, which cause lack of social support Major life events: stressful events that represent loss are closely tied to depression NOTES: [PowerPoint: Lecture 02.] 10  Interpersonal model: depressed people seek excessive reassurance which leads them to being disliked and rejected Behavioural model Depressed people have a lack of positive reinforcement, and this leads them to stop engaging in enjoyable behaviour (social skills issues) Beck’s cognitive model Depression is caused by negative beliefs and expectations about self, the future, and the world Learned helplessness Tendency to feel helpless in the face of events we can’t control People with depression attribute failure internally and have global, stable attributions Genes exert a moderate influence on MDD; role of serotonin, norepinephrine, and dopamine systems is suggested Bipolar Disorder Suicide Have both depressive and manic People with M D D and bipolar disorder are episodes at higher risk for suicide (x15 for B D) Elevated mood, lowered need for 11th leading cause of death in Canada and U sleep, high energy, talkativeness, S (3rd for children and adolescents) inflated self-esteem, impulsive Prediction is difficult due to lack of research irresponsible behaviour and low base rates Equally common in men and women Very heavily genetically influenced (~85%!) , but stressful life events can cause episode onset (whether negative or positive) Heritabilityis a measure of how well differences in people's genes account for differences in their traits.... In scientific terms, heritabilityis a statistical concept (represented as h²) that describes how much of the variation in a given trait can be attributed to genetic variation. NOTES: [PowerPoint: Lecture 02.] 11  Genes – dopamine (increased sensitivity) and serotonin receptors (decreased sensitivity) Increased activity in amygdala (associated with emotions), decreased activity in prefrontal cortex (associated with planning) Increased risk of suicide (as with major depression) Rate =15% higher than general population Personality Disorders Condition in which personality traits, appearing first in adolescence, are inflexible, stable, expressed in a wide variety of situations, and lead to distress or impairment. 10 listed in the DSM-5, but only a few have been well-researched. Borderline Psychopathic Personality Personality Disorder Condition marked by superficial charm, dishonesty, Marked by manipulativeness, self-centeredness, and risk taking instability in Overlaps with antisocial personality disorder mood, identity, and impulse Condition marked by a lengthy history of irresponsible and/or control, often illegal actions highly self- Primarily males, about 25% of the prison population qualifies. destructive. Causes are largely unknown, but may stem in part from a deficit in Mainly women, fear. about 2% of Without fear, punishment might be ineffective population. Behaviour is much more difficult to control as a result In relationships, Alternatively, people with the disorder may be perpetually under- alternate between aroused and experiencing stimulus hunger. worshipping and hating partners May explain high rates of risk-taking behaviour in this group. In sociobiological model, individuals with B P D overreact to stress and NOTES: [PowerPoint: Lecture 02.] 12  experience lifelong difficulties regulating their emotions. Personality Disorders (10 in the DSM). Not just “quirks” in personality; and should only be diagnosed when: Personality traits first appear by adolescence. Traits are inflexible, stable, and expressed in a wide variety of situations. Traits lead to distress or impairment. a. Odd/Eccentric Paranoid Schizoid Schizotypal b. Dramatic/Emotional/Erratic Borderline Narcissistic Antisocial Histrionic c. Anxious/Fearful Avoidant Dependent Obsessive-Compulsive Dissociative Disorders Involve disruptions in consciousness, memory, identity, or perception. NOTES: [PowerPoint: Lecture 02.] 13  Depersonalization disorder Feeling of detachment (like you’re observing yourself) Derealization disorder The external world seems unreal. Dissociative amnesia Inability to recall important personal information—most often related to a stressful experience—that can’t be explained by ordinary forgetfulness. Dissociative fugue Sudden, unexpected travel away from home or the workplace, accompanied by amnesia. Dissociative Identity Disorder Characterized by presence of two or more distinct identities (alters) Intriguing differences between alters shown, but could be easily explained in other ways Controversial: Strong debate over the posttraumatic and sociocognitive models of the disorder Post-traumatic Sociocognitive model – expectancies and beliefs from psychotherapy model – DID arises and cultural influences shape and maintain the disorder from a history of Most DID patients show no signs of the disorder before severe abuse during psychotherapy childhood Therapies increase the idea of multiples Up to 90% of patients with DID Link with fantasy-prone personality were abused as a 1976 = 79 documented cases / 1986 = 6000 documented cases child (physical Currently 100s of thousands of cases and/or sexual) ➡️ Dramatic increase in DID after the release of the best-selling book compartmentalization Sybil, which showcased a woman with 16 personalities However, Are therapists and the media “creating” DID patients? childhood abuse is not unique to DID A lot more abuse than DID. NOTES: [PowerPoint: Lecture 02.] 14  Schizophrenia: “split mind” Severe disorder of thought and emotion associated with a loss of contact with reality. Less than 1% of population, but over half of people in mental institutions. A hallmark symptom are delusions. Strongly held, fixed beliefs with no basis in reality. Symptoms include disturbances in attention, thinking, language, emotion, and relationships. Delusions and other psychotic symptoms reflect serious distortions in reality. Hallucinations are sensory perceptions that occur in the absence of external stimuli. Disorganized speech (word salad), echolalia (repeating speech) and catatonic symptoms also commonly occur. Motor problems, including extreme resistance to complying with simple suggestions, holding the body in bizarre or rigid postures, or curling up in a fetal position. Psychosocial factors play a role in schizophrenia, but only trigger it in persons with genetic vulnerabilities. NOTES: [PowerPoint: Lecture 02.] 15  Family members can influence whether patients relapse (expressed emotion). Number of brain abnormalities seen: Enlarged ventricles Increased sulci size Hypofrontalitiy Neurotransmitter differences also found, such as abnormalities in dopamine receptors. Dopamine, norepinephrine, glutamate, and serotonin systems are all disturbed. Highly genetically influenced disorder Diathesis-stress models proposes that it is the interaction between genetic vulnerability (diathesis) and stressors that triggers illness Early warning signs of schizophrenia vulnerability have been identified, including: Social withdrawal Thought and movement problems Lack of emotions Decreased eye contact Autistic Spectrum Disorders Attention-Deficit / Marked by severe deficits in language, social bonding, Hyperactivity Disorder and imagination. Primary problems include inattentive, impulsive, and Often accompanied by mental retardation. hyperactivity symptoms Dramatic increase in autism diagnoses from early Diagnosable in 3-7% of 1990s to today (1 in 150), but why? school children, more males Many have blamed M M R vaccines, starting with a ∶ than females (3 1) 1998 UK study. Related to numerous Study was later retracted by the journal that published functional problems in both it as flawed in several ways. children and adults NOTES: [PowerPoint: Lecture 02.] 16  Subsequent research has shown no link between Highly genetically influenced, vaccines and autism. can be successfully treated with stimulant medications Parents fell prey to an illusory correlation. What role might the typical They noticed symptoms after administering structure, methods, and vaccines, so the vaccines must have caused the environment of schools as a symptoms! learning environment be Increase is most likely due to changes in diagnostic playing? practices and CDA and ADA laws. More mild forms of autism (e.g. Asperger’s Syndrome) now included. NOTES: [PowerPoint: Lecture 02.] 17