Revision Notes in Psychiatry, 3rd Ed - PDF

REVISION NOTES IN PSYCHIATRY THIRD EDITION BASANT K. PURI ANNIE HALL ROGER HO REVISION NOTES IN PSYCHIATRY THIRD EDITION REVISION NOTES IN PSYCHIATRY THIRD EDITION BASANT K. PURI ANNIE HALL ROGER HO The authors acknowledge the following illustrators: Ms. Ja’naed Woods (for Chapter 1, “Descript...

REVISION NOTES IN PSYCHIATRY THIRD EDITION BASANT K. PURI ANNIE HALL ROGER HO REVISION NOTES IN PSYCHIATRY THIRD EDITION REVISION NOTES IN PSYCHIATRY THIRD EDITION BASANT K. PURI ANNIE HALL ROGER HO The authors acknowledge the following illustrators: Ms. Ja’naed Woods (for Chapter 1, “Descriptive Psychopathology”); Mr. Edwin Ng (for Chapter 7, “Cognitive Assessment and Neuropsychological Processes”); and Miss Anna Chua (for all other chapters). CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2014 by Basant K. Puri, Anne Hall and Roger Ho CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20130916 International Standard Book Number-13: 978-1-4441-7014-6 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents Preface..................................................................................................................................................................... lxxvii Authors..................................................................................................................................................................... lxxix Abbreviations........................................................................................................................................................... lxxxi Chapter 1 Descriptive Psychopathology....................................................................................................................1 1.1 Disorders of General Behaviour.....................................................................................................1 1.1.1 Underactivity.....................................................................................................................1 1.1.1.1 Stupor.................................................................................................................1 1.1.1.2 Depressive Retardation......................................................................................1 1.1.1.3 Obsessional Slowness........................................................................................1 1.1.2 Overactivity.......................................................................................................................1 1.1.2.1 Psychomotor Agitation......................................................................................1 1.1.2.2 Hyperkinesis......................................................................................................1 1.1.2.3 Somnambulism (Sleep Walking).......................................................................1 1.1.2.4 Compulsion (Compulsive Ritual)......................................................................1 1.1.2.5 Abnormal Posture and Movements...................................................................1 1.2 Disorders of Speech........................................................................................................................3 1.2.1 Disorders of Rate, Quantity, and Articulation..................................................................3 1.2.2 Disorders of the Form of Speech......................................................................................3 1.2.3 Disorders (Loosening) of Association (Formal Thought Disorder)..................................4 1.3 Disorders of Emotion......................................................................................................................4 1.3.1 Disorders of Affect............................................................................................................4 1.3.2 Disorders of Mood............................................................................................................4 1.3.3 Disorders Related to Anxiety............................................................................................5 1.4 Disorders of Thought Content........................................................................................................5 1.4.1 Preoccupations..................................................................................................................5 1.4.2 Obsessions.........................................................................................................................5 1.4.3 Phobias..............................................................................................................................5 1.5 Abnormal Beliefs and Interpretations of Events............................................................................6 1.5.1 Overvalued Ideas...............................................................................................................6 1.5.2 Delusions...........................................................................................................................6 1.5.3 Passivity Phenomenon.......................................................................................................6 1.5.4 Delusional Perception........................................................................................................7 1.6 Abnormal Experiences...................................................................................................................7 1.6.1 Sensory Distortions...........................................................................................................7 1.6.2 Sensory Deceptions...........................................................................................................7 1.6.2.1 Illusions..............................................................................................................7 1.6.2.2 Hallucinations....................................................................................................7 1.6.2.3 Pseudohallucinations (Coined by Kandinsky in 1885)......................................8 1.7 Disorders of Self-Awareness (Ego Disorders)................................................................................9 1.8 Cognitive Disorders........................................................................................................................9 1.8.1 Disorientation....................................................................................................................9 1.8.2 Disorders of Attention.......................................................................................................9 1.8.3 Disorders of Memory........................................................................................................9 1.8.4 Disorders of Intelligence.................................................................................................10 v vi Contents 1.8.5 Disorders of Consciousness.............................................................................................10 1.8.5.1 Levels of Consciousness..................................................................................10 1.8.5.2 Clouding of Consciousness..............................................................................10 1.8.5.3 Delirium...........................................................................................................10 1.8.5.4 Fugue...............................................................................................................10 1.8.5.5 Aphasias...........................................................................................................10 1.9 Dyslexia........................................................................................................................................10 1.10 Agraphia....................................................................................................................................... 11 1.11 Alexia........................................................................................................................................... 11 1.12 Acalculia....................................................................................................................................... 11 1.13 Apraxias and Agnosias................................................................................................................. 11 1.13.1 Apraxias.......................................................................................................................... 11 1.13.2 Agnosias and Disorders of Body Image..........................................................................12 Bibliography............................................................................................................................................15 Chapter 2 Classiication........................................................................................................................................... 17 2.1 History of Classiication Schemes................................................................................................ 17 2.1.1 Ancient Greeks................................................................................................................ 17 2.1.2 Ancient Romans.............................................................................................................. 17 2.1.3 Cullen.............................................................................................................................. 17 2.2 ICD............................................................................................................................................... 17 2.3 DSM.............................................................................................................................................. 17 2.4 ICD-10.......................................................................................................................................... 18 2.4.1 Organic, Including Symptomatic, Mental Disorders...................................................... 18 2.4.2 Schizophrenia, Schizotypal, and Delusional Disorders.................................................. 18 2.4.3 Mood (Affective) Disorders............................................................................................ 18 2.4.4 Neurotic, Stress-Related, and Somatoform Disorders.................................................... 18 2.4.5 Behavioural Syndromes Associated with Physiological Disturbances and Physical Factors............................................................................................................................. 18 2.4.6 Disorders of Adult Personality and Behaviour................................................................19 2.4.7 Mental Retardation..........................................................................................................19 2.4.8 Disorders of Psychological Development........................................................................19 2.4.9 Behavioural and Emotional Disorders with Onset Usually Occurring in Childhood and Adolescence............................................................................................19 2.5 DSM-IV-TR and DSM-5..............................................................................................................19 2.5.1 Axis I: Clinical Disorders; Other Conditions That May Be a Focus of Clinical Attention..........................................................................................................................19 2.5.1.1 DSM-IV-TR and DSM-5: Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence (Excluding Mental Retardation Which Is Diagnosed on Axis II).....................................................................................19 2.5.1.2 DSM-IV-TR and DSM-5: Delirium, Dementia, and Amnestic and Other Cognitive Disorders.........................................................................................20 2.5.1.3 DSM-IV-TR and DSM-5: Substance-Related Disorders.................................20 2.5.1.4 DSM-IV-TR and DSM-5: Schizophrenia and Other Psychotic Disorders.......21 2.5.1.5 DSM-IV-TR and DSM-5: Depressive Disorders..............................................22 2.5.1.6 DSM-IV-TR and DSM-5: Bipolar Disorders...................................................22 2.5.1.7 DSM-IV-TR and DSM-5: Anxiety Disorders..................................................22 2.5.1.8 DSM-IV-TR and DSM-5: Somatoform Disorders...........................................22 2.5.1.9 DSM-IV-TR and DSM-5: Factitious Disorders...............................................22 2.5.1.10 DSM-IV-TR and DSM-5: Sexual and Gender Identity Disorders...................22 Contents vii 2.5.1.11 DSM-IV-TR and DSM-5: Eating Disorders.....................................................23 2.5.1.12 DSM-IV-TR and DSM-5: Sleep Disorders......................................................23 2.5.1.13 DSM-IV-TR and DSM-5: Impulse-Control Disorders not Elsewhere Classiied..........................................................................................................23 2.5.1.14 Adjustment Disorders......................................................................................23 2.5.2 AXIS II: Personality Disorders; Mental Retardation......................................................23 2.5.2.1 Personality Disorders.......................................................................................23 2.5.2.2 Mental Retardation..........................................................................................24 2.5.3 Axis III: General Medical Conditions............................................................................24 2.5.4 Axis IV: Psychosocial and Environmental Problems.....................................................24 2.5.5 Axis V: Global Assessment of Functioning....................................................................24 Bibliography............................................................................................................................................24 Chapter 3 Basic Psychology.....................................................................................................................................25 3.1 Principles of Learning Theory.....................................................................................................25 3.1.1 Deinition of Learning.....................................................................................................25 3.1.2 Classical Conditioning....................................................................................................25 3.1.2.1 Deinition and Introduction.............................................................................25 3.1.2.2 Acquisition Stage.............................................................................................25 3.1.2.3 Delayed Conditioning......................................................................................25 3.1.2.4 Simultaneous Conditioning.............................................................................25 3.1.2.5 Trace Conditioning..........................................................................................25 3.1.2.6 Backward Conditioning...................................................................................25 3.1.2.7 Higher-Order Conditioning.............................................................................25 3.1.2.8 Extinction.........................................................................................................25 3.1.2.9 Generalization..................................................................................................26 3.1.2.10 Discrimination.................................................................................................26 3.1.2.11 Incubation........................................................................................................26 3.1.2.12 Stimulus Preparedness.....................................................................................26 3.1.2.13 Little Albert.....................................................................................................26 3.1.3 Operant Conditioning (Instrumental Learning)..............................................................26 3.1.3.1 Deinition and Introduction.............................................................................26 3.1.3.2 Trial-and-Error Learning/Behaviour...............................................................26 3.1.3.3 Law of Effect...................................................................................................26 3.1.3.4 Skinner Box.....................................................................................................26 3.1.4 Observational Learning (Vicarious Learning/Modelling).............................................26 3.1.4.1 Deinition and Introduction.............................................................................26 3.1.4.2 Bobo Doll Experiments...................................................................................27 3.1.4.3 Optimal Conditions for Observational Learning.............................................27 3.1.4.4 Steps Involved in the Modelling Process.........................................................27 3.1.5 Cognitive Learning.........................................................................................................27 3.1.5.1 Deinition.........................................................................................................27 3.1.5.2 Mechanisms.....................................................................................................27 3.1.5.3 Assimilation Theory........................................................................................27 3.1.6 Concepts of Extinction and Reinforcement in Explaining Behaviour............................28 3.1.6.1 Extinction.........................................................................................................28 3.1.6.2 Reinforcement..................................................................................................28 3.1.6.3 Punishment......................................................................................................28 3.1.6.4 Primary Reinforcement...................................................................................28 viii Contents 3.1.6.5 Secondary Reinforcement...............................................................................28 3.1.6.6 Schedules of Reinforcement............................................................................28 3.1.6.7 Motivation........................................................................................................28 3.1.7 Clinical Applications of Behavioural Treatments...........................................................28 3.1.7.1 Reciprocal Inhibition.......................................................................................28 3.1.7.2 Habituation......................................................................................................28 3.1.7.3 Chaining..........................................................................................................29 3.1.7.4 Shaping............................................................................................................29 3.1.7.5 Cueing..............................................................................................................29 3.1.7.6 Escape Conditioning........................................................................................30 3.1.7.7 Avoidance Conditioning..................................................................................30 3.1.7.8 Self-Control Therapy.......................................................................................30 3.1.7.9 Modelling Therapy.......................................................................................... 31 3.2 Phenomena of Visual and Auditory Perception........................................................................... 31 3.2.1 Perception........................................................................................................................ 31 3.2.1.1 Deinition......................................................................................................... 31 3.2.1.2 Absolute Threshold.......................................................................................... 31 3.2.1.3 Difference Threshold....................................................................................... 31 3.2.1.4 Weber’s Law.................................................................................................... 31 3.2.1.5 Fechner’s Law.................................................................................................. 31 3.2.1.6 Signal Detection Theory.................................................................................. 31 3.2.2 Perceptual Organization.................................................................................................. 31 3.2.2.1 Figure-Ground Differentiation........................................................................ 31 3.2.2.2 Object Constancy.............................................................................................32 3.2.2.3 Depth Perception.............................................................................................32 3.2.2.4 Perceptual Set..................................................................................................32 3.2.3 Relevance of Visual Perceptual Theory to Psychopathology..........................................32 3.2.3.1 Illusions............................................................................................................32 3.2.3.2 Hallucinations..................................................................................................33 3.2.3.3 Other Psychopathologies.................................................................................33 3.2.4 Development of Visual Perception..................................................................................33 3.2.5 Culturally Sanctioned Distress States.............................................................................33 3.2.5.1 Nocturnal Hallucinations in Ultra-Orthodox Jewish Israeli Men...................33 3.2.5.2 Isolated Sleep Paralysis with Visual Hallucinations among Nigerian Students.......34 3.2.5.3 Mu-Ghayeb......................................................................................................34 3.2.5.4 Auditory and Visual Hallucinations Related to Bereavement in the Caribbean.........................................................................................................34 3.3 Information Processing and Attention.........................................................................................34 3.3.1 Information Processing...................................................................................................34 3.3.1.1 Data-Driven Processing...................................................................................35 3.3.1.2 Conceptually Driven Processing.....................................................................35 3.3.2 Attention..........................................................................................................................35 3.4 Factors Affecting Memory...........................................................................................................35 3.4.1 Memory...........................................................................................................................35 3.4.1.1 Encoding/Registration.....................................................................................35 3.4.1.2 Storage.............................................................................................................35 3.4.1.3 Retrieval...........................................................................................................35 3.4.2 Inluences upon Memory.................................................................................................36 3.4.3 Optimal Conditions for Encoding, Storage, and Retrieval of Information.....................36 3.4.3.1 Encoding/Registration.....................................................................................36 3.4.3.2 Storage.............................................................................................................37 Contents ix 3.4.3.3 Retrieval...........................................................................................................37 3.4.4 Memory Information Processing....................................................................................37 3.4.4.1 Primary Working Memory Storage Capacity..................................................37 3.4.4.2 Principle of Chunking.....................................................................................39 3.4.4.3 Semantic Memory............................................................................................39 3.4.4.4 Episodic Memory.............................................................................................39 3.4.4.5 Skills Memory.................................................................................................39 3.4.4.6 Other Aspects of Long-Term/Secondary Memory..........................................39 3.4.5 Process of Forgetting and the Inluence of Emotional Factors on Retrieval...................39 3.4.5.1 Forgetting.........................................................................................................39 3.4.5.2 Theories of Forgetting.....................................................................................39 3.4.5.3 Inluence of Emotional Factors on Retrieval...................................................40 3.4.6 Processes of Interference, Schemata, and Elaboration...................................................40 3.4.6.1 Interference......................................................................................................40 3.4.6.2 Schemata..........................................................................................................40 3.4.6.3 Elaboration.......................................................................................................40 3.5 Factors Affecting Thought...........................................................................................................40 3.5.1 Relationship of Thought to Language.............................................................................40 3.5.1.1 Concepts..........................................................................................................40 3.5.1.2 Prototypes........................................................................................................ 41 3.5.2 Reasoning........................................................................................................................ 41 3.5.2.1 Deductive Reasoning....................................................................................... 41 3.5.2.2 Inductive Reasoning........................................................................................42 3.5.3 Problem-Solving Strategies.............................................................................................43 3.5.3.1 Alternative Representations.............................................................................43 3.5.3.2 Expertise..........................................................................................................43 3.5.3.3 Computer Simulation.......................................................................................43 3.5.4 Algorithms.......................................................................................................................43 3.5.5 Heuristics.........................................................................................................................43 3.6 Factors Affecting Personality.......................................................................................................44 3.6.1 Derivation of Nomothetic and Idiographic Theories......................................................44 3.6.2 Trait and State Approaches.............................................................................................44 3.6.3 Construct Theory............................................................................................................46 3.6.4 Humanist Approaches.....................................................................................................46 3.6.4.1 Roger’s Self Theory.........................................................................................47 3.6.4.2 Maslow.............................................................................................................47 3.6.5 Psychoanalytic Approaches.............................................................................................47 3.6.5.1 Freud’s Stages of Psychosexual Development.................................................47 3.6.5.2 Erikson’s Stages of Development....................................................................48 3.6.6 Situationist Approach......................................................................................................48 3.6.7 Interactionist Approach...................................................................................................48 3.6.8 Inventories.......................................................................................................................48 3.6.8.1 16PF.................................................................................................................48 3.6.8.2 MMPI...............................................................................................................48 3.6.8.3 CPI...................................................................................................................49 3.6.8.4 Other Inventories.............................................................................................50 3.6.8.5 Limitations.......................................................................................................50 3.6.9 Rating Scales...................................................................................................................50 3.6.9.1 SAP..................................................................................................................50 3.6.9.2 SCID II............................................................................................................50 3.6.9.3 SIDP.................................................................................................................50 x Contents 3.6.9.4 PAS..................................................................................................................50 3.6.9.5 PDE.................................................................................................................. 51 3.6.9.6 IPDE................................................................................................................ 51 3.6.10 Repertory Grid................................................................................................................ 51 3.6.11 Q-Sort Schedule.............................................................................................................. 51 3.7 Factors Affecting Motivation....................................................................................................... 51 3.7.1 Extrinsic Theories and Homeostasis............................................................................... 51 3.7.2 Hypothalamic Systems and Satiety................................................................................. 51 3.7.3 Intrinsic Theories............................................................................................................ 51 3.7.3.1 Optimal Arousal.............................................................................................. 51 3.7.3.2 Cognitive Dissonance...................................................................................... 51 3.7.3.3 Attitude-Discrepant Behaviour........................................................................52 3.7.3.4 Need for Achievement.....................................................................................52 3.7.4 Curiosity Drive................................................................................................................52 3.7.5 Maslow’s Hierarchy of Needs.........................................................................................52 3.8 Factors Affecting Emotion...........................................................................................................52 3.8.1 Types of Emotion............................................................................................................52 3.8.2 Components of Emotional Response..............................................................................52 3.8.3 James–Lange Theory......................................................................................................52 3.8.4 Cannon–Bard Theory......................................................................................................53 3.8.5 Schachter’s Cognitive Labelling Theory and Cognitive Appraisal.................................53 3.9 Stress.............................................................................................................................................53 3.9.1 Physiological and Psychological Aspects........................................................................53 3.9.2 Situational Factors...........................................................................................................53 3.9.2.1 Life Events.......................................................................................................53 3.9.3 Vulnerability and Invulnerability....................................................................................53 3.9.4 Coping Mechanisms........................................................................................................53 3.9.5 Learned Helplessness......................................................................................................53 3.9.6 Locus of Control..............................................................................................................54 References...............................................................................................................................................54 Chapter 4 Social Psychology....................................................................................................................................57 4.1 Attitudes and How They Are Affected........................................................................................57 4.1.1 Deinition.........................................................................................................................57 4.1.2 Components.....................................................................................................................57 4.1.3 Measurement...................................................................................................................57 4.1.3.1 Thurstone Scale...............................................................................................57 4.1.3.2 Likert Scale......................................................................................................57 4.1.3.3 Semantic Differential Scale.............................................................................57 4.1.4 Attitude Change...............................................................................................................57 4.1.5 Persuasive Communication.............................................................................................57 4.1.5.1 Communicator.................................................................................................57 4.1.5.2 Recipient..........................................................................................................58 4.1.5.3 Message...........................................................................................................58 4.1.6 Cognitive Consistency and Dissonance..........................................................................58 4.2 Self-Psychology............................................................................................................................58 4.2.1 Self-Concept....................................................................................................................58 4.2.1.1 Self-Esteem......................................................................................................58 4.2.1.2 Self-Image........................................................................................................58 Contents xi 4.2.2 Self-Perception Theory...................................................................................................58 4.3 Interpersonal Issues......................................................................................................................58 4.3.1 Interpersonal Attraction..................................................................................................58 4.3.2 Attribution Theory (Heider)............................................................................................59 4.3.2.1 Internal or Dispositional Attribution...............................................................59 4.3.2.2 External or Situational Attribution..................................................................59 4.3.2.3 Primary (Fundamental) Attribution Error.......................................................59 4.3.3 Theory of Mind...............................................................................................................59 4.4 Leadership, Social Inluence, Power, and Obedience..................................................................59 4.4.1 Leadership.......................................................................................................................59 4.4.2 Social Facilitation............................................................................................................59 4.4.3 Social Power....................................................................................................................59 4.4.4 Conformity......................................................................................................................59 4.4.5 Obedience to Authority...................................................................................................60 4.5 Phenomenon of Aggression..........................................................................................................60 4.5.1 Explanations....................................................................................................................60 4.5.1.1 Psychoanalytic.................................................................................................60 4.5.1.2 Social Learning Theory...................................................................................60 4.5.1.3 Operant Conditioning......................................................................................60 4.5.1.4 Ethology...........................................................................................................60 4.5.1.5 Frustration–Aggression Hypothesis................................................................60 4.5.1.6 Arousal............................................................................................................60 4.5.2 Inluence of Television....................................................................................................60 4.6 Concept of Altruism.....................................................................................................................60 Bibliography............................................................................................................................................ 61 Chapter 5 Human Growth and Development...........................................................................................................63 5.1 Conceptualizing Development.....................................................................................................63 5.1.1 Basic Concepts................................................................................................................63 5.1.2 Gene–Environment Interactions.....................................................................................63 5.1.3 Historical Models............................................................................................................63 5.2 Attachment and Bonding..............................................................................................................63 5.2.1 Attachment Theory.........................................................................................................63 5.2.2 Attachment Abnormalities..............................................................................................64 5.2.2.1 Insecure Attachment........................................................................................64 5.2.2.2 Avoidant Attachment.......................................................................................64 5.2.3 Separation Anxiety..........................................................................................................64 5.2.4 Acute Separation Reaction..............................................................................................64 5.2.5 Stranger Anxiety.............................................................................................................64 5.2.6 Maternal Deprivation......................................................................................................64 5.3 Family Relationships and Parenting Practise...............................................................................64 5.3.1 Child-Rearing Practise....................................................................................................64 5.3.2 Family Structure..............................................................................................................65 5.3.3 Ordinal Position in Family..............................................................................................65 5.3.4 Distorted Family Function..............................................................................................65 5.3.5 Impact of Bereavement....................................................................................................65 5.3.6 Impact of Parental Divorce.............................................................................................65 5.3.7 Impact of Intrafamilial Abuse.........................................................................................65 5.3.7.1 Sexual Abuse...................................................................................................65 xii Contents 5.3.7.2 Physical Abuse/Nonaccidental Injury.............................................................66 5.4 Temperament................................................................................................................................66 5.4.1 Individual Temperamental Differences...........................................................................66 5.4.2 Origins, Typologies, and Stability of Temperament.......................................................67 5.5 Piaget’s Model of Cognitive Development...................................................................................68 5.5.1 Sensorimotor Stage.........................................................................................................68 5.5.2 Preoperational Stage........................................................................................................68 5.5.3 Concrete Operational Stage.............................................................................................68 5.5.4 Formal Operational Stage...............................................................................................68 5.6 Language Development................................................................................................................69 5.6.1 Normal Childhood Development....................................................................................69 5.6.2 Environmental Inluences and Communicative Competence.........................................69 5.7 Moral Development......................................................................................................................69 5.7.1 Kohlberg’s Stage Theory.................................................................................................69 5.7.1.1 Preconventional Morality (Level I).................................................................69 5.7.1.2 Conventional Morality (Level II)....................................................................69 5.7.1.3 Postconventional Morality (Level III).............................................................69 5.7.2 Relationship to the Development of Social Perspective Taking......................................70 5.8 Development of Fears in Childhood and Adolescence................................................................70 5.8.1 Deinition.........................................................................................................................70 5.8.2 Development with Age....................................................................................................70 5.8.3 Possible Etiological and Maintenance Mechanisms.......................................................70 5.8.3.1 Unconscious Conlict.......................................................................................70 5.8.3.2 Learned Response............................................................................................70 5.8.3.3 Lack of Control................................................................................................70 5.9 Sexual Development.....................................................................................................................70 5.9.1 Sex Determination...........................................................................................................70 5.9.2 Changes at Puberty.........................................................................................................71 5.9.2.1 Physical Changes.............................................................................................71 5.9.2.2 Onset in Girls...................................................................................................71 5.9.2.3 Onset in Boys...................................................................................................71 5.9.2.4 Physiological Changes.....................................................................................71 5.9.3 Gender Identity................................................................................................................71 5.9.4 Gender/Sex Typing..........................................................................................................71 5.9.5 Gender Role.....................................................................................................................71 5.9.6 Sexual Behaviour............................................................................................................71 5.9.6.1 Sexual Drive....................................................................................................71 5.9.6.2 Childhood Sexuality........................................................................................72 5.9.6.3 Masturbation....................................................................................................72 5.9.7 Sexual Orientation...........................................................................................................72 5.9.7.1 Homosexuality.................................................................................................72 5.9.7.2 Modern Arguments in Favor of Biological Determinism...............................73 5.9.7.3 Arguments against Biological Determinism................................................... 74 5.10 Adolescence.................................................................................................................................. 74 5.10.1 Conlict with Parents and Authority................................................................................ 74 5.10.1.1 Cognitive Developmental Models.................................................................... 74 5.10.1.2 Erikson’s Stages of Psychosocial Development............................................... 74 5.10.1.3 Ethological and Sociobiological Models......................................................... 74 5.10.1.4 Social-Learning Theory.................................................................................. 74 5.10.1.5 Equity Theory.................................................................................................. 74 Contents xiii 5.10.1.6 Separation–Individuation................................................................................75 5.10.2 Affective Stability and ‘Turmoil’....................................................................................75 5.10.2.1 Anna Freud......................................................................................................75 5.10.2.2 Erikson.............................................................................................................75 5.10.2.3 Offer and Offer................................................................................................75 5.10.3 Normal and Abnormal Adolescent Development...........................................................75 5.10.3.1 Offer and Offer................................................................................................75 5.10.3.2 Block and Haan................................................................................................75 5.11 Adaptations in Adult Life.............................................................................................................76 5.11.1 Pairing.............................................................................................................................76 5.11.1.1 Homogamous Mate Selection..........................................................................76 5.11.1.2 Reinforcement Theory.....................................................................................76 5.11.1.3 Social Exchange Theory..................................................................................76 5.11.1.4 Equity Theory..................................................................................................76 5.11.1.5 Matching Hypothesis.......................................................................................76 5.11.1.6 Cultural Differences........................................................................................76 5.11.1.7 Cross-Cultural Constancies.............................................................................76 5.11.2 Parenting.........................................................................................................................76 5.11.3 Grief, Mourning, and Bereavement.................................................................................76 5.11.3.1 Deinitions........................................................................................................76 5.11.3.2 Normal Grief...................................................................................................77 5.11.3.3 Bereavement....................................................................................................77 5.11.3.4 Morbid Grief Reactions...................................................................................77 5.11.3.5 Differentiating between Bereavement and a Depressive Episode...................77 5.12 Normal Ageing............................................................................................................................77 5.12.1 Physical Aspects..............................................................................................................77 5.12.1.1 Health...............................................................................................................77 5.12.1.2 Cerebral Changes.............................................................................................77 5.12.2 Social Aspects.................................................................................................................78 5.12.2.1 Stereotyping.....................................................................................................78 5.12.2.2 Empty Nest Syndrome.....................................................................................78 5.12.3 Ego Integrity versus Despair...........................................................................................78 5.12.3.1 Ego Integrity....................................................................................................78 5.12.3.2 Despair.............................................................................................................78 5.12.4 Cognitive Aspects............................................................................................................78 5.13 Death and Dying...........................................................................................................................78 5.13.1 Deinitions.......................................................................................................................78 5.13.1.1 Timely Death...................................................................................................78 5.13.1.2 Untimely Death................................................................................................78 5.13.1.3 Unintended Death............................................................................................78 5.13.1.4 Intended Death.................................................................................................79 5.13.1.5 Subintended Death...........................................................................................79 5.13.2 Impending Death.............................................................................................................79 References...............................................................................................................................................79 Chapter 6 Description and Measurement.................................................................................................................83 6.1 Description...................................................................................................................................83 6.1.1 Types of Data...................................................................................................................83 6.1.1.1 Qualitative.......................................................................................................83 xiv Contents 6.1.1.2 Quantitative......................................................................................................83 6.1.2 Scales of Measurement....................................................................................................83 6.1.3 Sampling Methods..........................................................................................................83 6.1.3.1 Simple Random Sampling...............................................................................83 6.1.3.2 Systematic Sampling.......................................................................................83 6.1.4 Frequency Distributions..................................................................................................83 6.1.4.1 Frequency Distribution....................................................................................83 6.1.4.2 Frequency Table...............................................................................................83 6.1.4.3 Relative Frequency..........................................................................................83 6.1.4.4 Cumulative Frequency.....................................................................................83 6.1.4.5 Cumulative Frequency Table...........................................................................83 6.1.4.6 Cumulative Relative Frequency.......................................................................84 6.1.4.7 Cumulative Relative Frequency Table.............................................................84 6.1.5 Discrete Probability Distributions...................................................................................84 6.1.5.1 Bernoulli Trial.................................................................................................84 6.1.5.2 Bernoulli Distribution......................................................................................84 6.1.5.3 Binomial Distribution......................................................................................84 6.1.5.4 Poisson Distribution.........................................................................................84 6.1.6 Continuous Probability Distributions..............................................................................84 6.1.6.1 Normal Distribution.........................................................................................84 6.1.6.2 t Distribution....................................................................................................85 6.1.6.3 χ2 Distribution..................................................................................................85 6.1.6.4 F Distribution...................................................................................................86 6.1.7 Summary Statistics: Measures of Location.....................................................................86 6.1.7.1 Measures of Central Tendency........................................................................86 6.1.7.2 Quantiles..........................................................................................................86 6.1.8 Summary Statistics: Measures of Dispersion..................................................................86 6.1.8.1 Range...............................................................................................................86 6.1.8.2 Measures Relating to Quantiles.......................................................................86 6.1.8.3 Standard Deviation..........................................................................................86 6.1.8.4 Variance...........................................................................................................87 6.1.9 Graphs.............................................................................................................................87 6.1.9.1 Deinition.........................................................................................................87 6.1.9.2 Drawing Graphs...............................................................................................87 6.1.9.3 Linear Relationship..........................................................................................87 6.1.9.4 Power Law Relationship..................................................................................87 6.1.9.5 Exponential Relationship.................................................................................87 6.1.9.6 Other Relationships Involving Expressions.....................................................88 6.1.10 Outliers............................................................................................................................88 6.1.10.1 Measures of Central Tendency........................................................................88 6.1.10.2 Measures of Dispersion...................................................................................88 6.1.10.3 Correlation and Linear Regression..................................................................88 6.1.11 Stem-and-Leaf Plots........................................................................................................88 6.1.12 Boxplots (Box-and-Whisker Plots)..................................................................................88 6.1.13 Scatter Plot (Scattergrams, Scatter Diagrams, or Dot Graphs).......................................89 6.2 Principles of Measurement...........................................................................................................90 6.2.1 Interviews........................................................................................................................90 6.2.2 Self-Predictions...............................................................................................................90 6.2.3 Psychophysiological Techniques.....................................................................................90 6.2.4 Naturalistic Observations................................................................................................90 Contents xv 6.2.5 Scaling.............................................................................................................................90 6.2.6 Norm Referencing...........................................................................................................90 6.2.7 Criterion Referencing......................................................................................................90 6.3 Intelligence...................................................................................................................................90 6.3.1 Aptitude...........................................................................................................................90 6.3.2 Attainment.......................................................................................................................90 6.3.3 Components of Intelligence.............................................................................................90 6.3.4 Mental Age Scale............................................................................................................ 91 6.3.5 Intelligence Quotient....................................................................................................... 91 6.3.6 Wechsler Adult Intelligence Scale................................................................................... 91 6.3.7 Wechsler Intelligence Scale for Children: Revised......................................................... 91 6.3.8 Wechsler Preschool and Primary Scale of Intelligence.................................................. 91 6.3.9 Group Ability Tests......................................................................................................... 91 6.3.10 Nature–Nurture...............................................................................................................92 6.3.11 Cultural Inluences..........................................................................................................92 6.4 Techniques Used in Neuropsychological Assessment..................................................................92 6.4.1 Comprehensive Test Batteries.........................................................................................92 6.4.1.1 Halstead–Reitan Battery..................................................................................92 6.4.1.2 Luria–Nebraska Neuropsychological Battery.................................................92 6.4.1.3 Repeatable Battery for the Assessment of Neuropsychological Status...........93 6.4.2 Language Tests................................................................................................................93 6.4.2.1 Boston Diagnostic Aphasia Examination, 3rd Edition....................................93 6.4.2.2 Boston Naming Test.........................................................................................93 6.4.2.3 Graded Naming Test........................................................................................94 6.4.2.4 Token Test........................................................................................................94 6.4.2.5 Speed and Capacity of Language Processing Test..........................................94 6.4.3 Perception Tests...............................................................................................................94 6.4.3.1 Bender–Gestalt Test/Bender Visual Motor Gestalt Test.................................94 6.4.3.2 Visual Object and Space Perception Battery...................................................94 6.4.3.3 Behavioural Inattention Test............................................................................94 6.4.4 Memory Tests..................................................................................................................94 6.4.4.1 Benton Visual Retention Test..........................................................................94 6.4.4.2 Graham–Kendall Memory for Designs Test...................................................94 6.4.4.3 Rey–Osterrieth Test.........................................................................................94 6.4.4.4 Paired Associate Learning Tests.....................................................................95 6.4.4.5 Synonym Learning Test...................................................................................95 6.4.4.6 Object Learning Test.......................................................................................95 6.4.4.7 Rey Auditory Verbal Learning Test................................................................95 6.4.4.8 California Verbal Learning Test......................................................................95 6.4.4.9 Wechsler Memory Scale-IV............................................................................95 6.4.4.10 Rivermead Behavioural Memory Test.............................................................95 6.4.4.11 Adult Memory and Information Processing Battery.......................................95 6.4.5 Intelligence Tests.............................................................................................................96 6.4.5.1 WAIS and Similar Tests..................................................................................96 6.4.5.2 National Adult Reading Test............................................................................96 6.4.5.3 Raven’s Progressive Matrices..........................................................................96 6.4.6 Executive Function (Frontal Lobe) Tests........................................................................96 6.4.6.1 Stroop...............................................................................................................96 6.4.6.2 Verbal Fluency.................................................................................................96 6.4.6.3 Tower of London Test......................................................................................96 xvi Contents 6.4.6.4 Wisconsin Card Sort Test................................................................................96 6.4.6.5 Cognitive Estimates Test.................................................................................97 6.4.6.6 Six Elements Test.............................................................................................97 6.4.6.7 Multiple Errands Task.....................................................................................97 6.4.6.8 Trail Making Test............................................................................................97 6.4.7 Personality Tests..............................................................................................................97 6.4.7.1 Objective Tests.................................................................................................97 6.4.7.2 Projective Tests................................................................................................98 6.4.8 Dementia Tests and Related Tests...................................................................................98 6.4.8.1 Mini-Mental State Examination......................................................................98 6.4.8.2 Cambridge Neuropsychological Test Automated Battery...............................98 6.4.8.3 Gresham Ward Questionnaire.........................................................................98 6.4.8.4 Blessed’s Dementia Scale................................................................................99 6.4.8.5 Information–Memory–Concentration Test......................................................99 6.4.8.6 Geriatric Mental State Schedule......................................................................99 6.4.8.7 Cambridge Examination for Mental Disorders...............................................99 6.4.8.8 Crichton Geriatric Behaviour Rating Scale.....................................................99 6.4.8.9 Clifton Assessment Schedule..........................................................................99 6.4.8.10 Stockton Geriatric Rating Scale......................................................................99 6.4.8.11 Present Behavioural Examination...................................................................99 6.4.8.12 Manchester and Oxford Universities Scale for the Psychopathological Assessment of Dementia..................................................................................99 6.4.8.13 Sandoz Clinical Assessment............................................................................99 6.4.8.14 Vineland Social Maturity Scale.....................................................................100 6.4.8.15 Performance Test of Activities of Daily Living.............................................100 References.............................................................................................................................................100 Chapter 7 Cognitive Assessment and Neuropsychological Processes................................................................... 103 7.1 Memory...................................................................................................................................... 103 7.1.1 Sensory Memory........................................................................................................... 103 7.1.1.1 Short-Term Memory...................................................................................... 103 7.1.1.2 Explicit Memory............................................................................................ 103 7.1.1.3 Implicit Memory............................................................................................ 103 7.2 Amnesia...................................................................................................................................... 103 7.3 Language.................................................................................................................................... 103 7.3.1 Cerebral Dominance..................................................................................................... 103 7.3.1.1 Speech and Language Areas......................................................................... 103 7.3.1.2 Pathways........................................................................................................ 105 7.3.2 Dysphasias..................................................................................................................... 105 7.3.2.1 Receptive Dysphasia...................................................................................... 105 7.3.2.2 Expressive Dysphasia.................................................................................... 105 7.3.2.3 Conduction Dysphasia................................................................................... 105 7.3.2.4 Global Dysphasia........................................................................................... 105 7.3.3 Mutism........................................................................................................................... 105 7.4 Perception................................................................................................................................... 105 7.4.1 Visual Perception.......................................................................................................... 105 7.4.1.1 Other Agnosias..............................................................................................106 7.5 Dyslexia and Dysgraphia............................................................................................................107 7.5.1 Dyslexia.........................................................................................................................107 7.5.2 Dysgraphia....................................................................................................................107 Contents xvii 7.6 Alexia and Agraphia...................................................................................................................107 7.6.1 Alexia without Agraphia...............................................................................................107 7.6.2 Alexia with Agraphia....................................................................................................108 7.7 Apraxias......................................................................................................................................108 7.7.1 Acalculia and Anarithmetria.........................................................................................108 7.8 Frontal Lobe Functions..............................................................................................................109 7.8.1 Prefrontal Cortex...........................................................................................................109 7.8.2 Frontal Eye Fields..........................................................................................................109 7.8.3 Motor and Premotor Cortex.......................................................................................... 110 7.8.4 Broca’s Area.................................................................................................................. 110 7.8.5 Orbital Cortex................................................................................................................ 110 7.8.6 Frontal Lobe Lesions..................................................................................................... 110 7.8.7 Assessment of Temporal Lobe Functions..................................................................... 110 7.9 Left and Right Cerebral Hemispheres........................................................................................ 110 Bibliography.......................................................................................................................................... 114 Chapter 8 Social Sciences and Stigma................................................................................................................... 115 8.1 Descriptive Terms....................................................................................................................... 115 8.1.1 Social Class................................................................................................................... 115 8.1.1.1 Determinants................................................................................................. 115 8.1.1.2 Occupational Classiication........................................................................... 115 8.1.2 Socioeconomic Status................................................................................................... 115 8.1.3 Relevance to Psychiatric Disorder and Health-Care Delivery...................................... 115 8.1.3.1 Psychiatric Disorder....................................................................................... 115 8.1.3.2 Relationship between Social Class and Psychiatric Disorder....................... 115 8.1.3.3 Health-Care Delivery..................................................................................... 116 8.1.3.4 Pathways to Psychiatric Care......................................................................... 116 8.1.4 Black Report on Socioeconomic Inequalities in Health............................................... 116 8.1.4.1 Explanations.................................................................................................. 116 8.1.4.2 Changes after 10 Years.................................................................................. 116 8.2 Historical Sociological Theories................................................................................................ 117 8.2.1 Weber............................................................................................................................ 117 8.2.1.1 Bureaucracy................................................................................................... 117 8.2.1.2 Rationalization............................................................................................... 117 8.2.1.3 Religion.......................................................................................................... 117 8.2.2 Marx.............................................................................................................................. 117 8.2.2.1 Communism................................................................................................... 117 8.2.2.2 Crime............................................................................................................. 117 8.2.2.3 Religion.......................................................................................................... 117 8.2.3 Durkheim...................................................................................................................... 117 8.2.3.1 Anomie.......................................................................................................... 118 8.2.3.2 Suicide........................................................................................................... 118 8.2.4 Foucault......................................................................................................................... 118 8.2.4.1 Principles of Exclusion.................................................................................. 118 8.2.4.2 Sexuality........................................................................................................ 118 8.2.5 Parsons.......................................................................................................................... 118 8.2.6 Goffman........................................................................................................................ 118 8.2.7 Habermas...................................................................................................................... 118 8.3 Social Roles of Doctors and Illness............................................................................................ 119 8.3.1 Social Role.................................................................................................................... 119 xviii Contents 8.3.2 Social Role of Doctors.................................................................................................. 119 8.3.3 Sick Role........................................................................................................................ 119 8.3.3.1 Rights (Privileges)......................................................................................... 119 8.3.3.2 Obligations..................................................................................................... 119 8.3.4 Illness Behaviour........................................................................................................... 119 8.3.4.1 Stages............................................................................................................. 119 8.3.4.