Abnormal o Personal distress o Violation of social norms o Harmful dysfunction o Impairment Beliefs about disorders o Ancient Greeks The gods punished humans by causing madness Hippocrates suggested a link to the brain o Middle ages The Demonic Model possession by the devil Punishment for sin Witches o Renaissance Medical Model Asylums Moral treatment o The Modern Era 1950 s Dramatic change in treatment of mentally ill Deinstitutionalization Community mental health centers Culture Bound Disorders o Certain conditions are culture bound Remain poorly researched o May be variants of conditions in Western Culture E g social anxiety o Individualistic vs Collectivistic o Many mental disorders appear to be universal across cultures e g schizophrenia alcoholism Misconceptions o Psychiatric diagnosis is nothing more than pigeonholing o Psychiatric diagnoses are unreliable o Psychiatric diagnoses are invalid Robins and Guze criteria for validity o Psychiatric diagnoses stigmatize people Classification o Psychodynamic Diagnostic Manual PDM o DSM IV TR Diagnostic and Statistical Manual Multiaxial system Diagnostic criteria Warns to think organic Gives prevalence rates o DSM IV 5 Axes Clinical Syndromes Axis 1 o o o o Developmental Learning Attention Mood Anxiety most prevalent of all disorders 29 of us will meet criteria for an anxiety disorder at some point in our lives Average age of onset 11 years Generalized Anxiety Disorder Broad spectrum worry Feelings of impending negative events Many topics Physical symptoms GI problems ulcers headaches May be specific or nonspecific Arousal of sympathetic nervous system Panic Disorder Abrupt attacks of acute anxiety Panic Attacks o Repeated and unexpected Feels like a heart attack Fear of dying or going crazy May last minutes or hours Symptoms tend to peak in 10 min o Choking racing heart numbness nausea sweatiness shortness of breath Feeling like it s all in their head Some are associated with specific situations Can have with or without agoraphobia fear of being in a place or situation in which escape is difficult Misconception agoraphobia is a fear of crowds or public places Phobias Intense irrational sometimes debilitating fear of specific objects or situations Situation avoided or endured with great distress Agoraphobia Claustrophobia Social Phobia o Fear of public situations and scrutiny leading to embarrassment or humiliation Public speaking Eating in front of others Writing in front of others o Recognize fear as excessive or unreasonable o o o May lead to panic attack Avoidance Can be generalized if includes multiple situations OCD obsessive compulsive disorder If I don t do bad things will happen Obsessions recurrent persistent anxietyprovoking thoughts images experienced as intrusive causes marked distress o Have I locked the door are my hands clean Etc Compulsions ritualistic repetitive behaviors or mental acts that reduce the anxiety connected with obsessions Aimed at reducing distress o Ex Checking the doors washing hands counting etc PTSD post traumatic stress disorder PTSD Begins with a life threatening event Flashbacks reliving Intense fear Avoidance Nightmares Overall anxiety Defensiveness or aggression Mood Disorders Major depressive disorder low mood feeling down sad little interest or pleasure in normally enjoyable activities need at least one of these o Changes in sleep appetite feelings of hopelessness guilt worthlessness indecision psychomotor retardation agitation o Suicidal ideation o Far more prevalent in women Maybe report more Dysthymia less severe but longer lasting symptoms o low level depression o Persists for at least 2 years o Chronic depression Seasonal affective disorder depressive episode with a seasonal pattern o Most common in fall or winter o Must occur in 2 consecutive years o Light therapy Postpartum depression depressive episode occuring within a month of childbirth o Most often in women but can also affect men Bipolar disorder times of depression and times of mania o Manic phases euphoric mood energetic irritable pressured speech rapid flight of ideas little sleep grandiosity impulsive increase in goal directed activity o Depressed state lasts longer than manic states 3x o Mania lasts more than 7 days or requires hospitalization o Bipolar I mania o Bipolar II hypomania Difference is length o Severity o More depressive episodes and more intense in type II o Psychotic features o Hypomania at least 4 days o Equally common in men and women o Manic episodes often produce serious problems in social and occupational functioning o High comorbidity with substance and alcohol abuse o Spending sprees o One of the most genetically influenced mental disorders o Twin studies 85 heritability o Stressful life events increase in manic episodes Cyclothymia milder or subthreshold form of Bipolar Disorder o Numerous extreme mood disturbances o Alternating between periods of hypomania and mild or moderate depression o Short cycles Causes of Mood Disorders o Life events Loss of a close relationship Stressful life events Lack of social support o Interpersonal model Reassurance seeking Vicious cycle o Behavioral model Low rate of responsecontingent positive reinforcement Decrease in pleasurable activities further leads to less reinforcement o Cognitive model Cognitive triad negative views of self world and future These negative thought patterns are called negative schemas Negative spin on experiences Depressive realism research shows that individuals with mild depression actually have more accurate view of circumstances o Learned helplessness tendency to feel helpless in the face of events we can t control Can t account for all aspects of depression Attribute failure to internal as opposed to external factors Success due to external factors o Biological factors Moderate effect Variations in Serotonin transporter gene Low levels of neuropinephrine Decreased levels of dopamine Suicidality o Risk factors depression hopelessness impusivity o Precipitated by exit events o 3rd leading cause of death in college age students o 11th leading cause of death o Higher risk major depression and bipolar disorder o 15x higher for those with Bipolar than general population o 30 000 per year in the USA Probably underestimates true number because some reported as accidents o 25 attempts per completed suicide o Men who come in for treatment and that are older especially want to assess suicidality o Difficult to pinpoint predictors Would be