Psychological Disorders and Psychopathology Psychopathology Abnormal behavior a harmful dysfunction in which the behaviors deemed to be atypical disturbing maladaptive and unjustifiable o Deviant Does behavior conform to societal norms Changes over time Infrequency is a poor criteria Cultural relativism Distressful Maladaptive Does the behavior make you unhappy Does the behavior interfere with life Etiology of mental illness historical perspective o Possession by evil spirit or demons Mental illness Early treatment o Trephining Cutting or drilling a hole into the skull o Beatings o Bloodletting o Magnetic therapy o Submersion in hot or cold water o Spinning chair and centrifical force beds Etiology of mental illness medical model Emerged in 1800 s o Moral management Dr Phillippe Pinel o Proposes that it is useful to think of abnormal behavior as a disease and has become the main way of thinking about mental illness today o Very different from how mental illness used to be perceived o Introduced term s such as symptoms diagnosis etiology prognosis course treatment therapy remission cure relapse o Has brought much needed improvement to patient care Deinstitutionalization in the 60 s and 70 s o Kennedy was going for this o Introduction of psychotropic medications 1954 o 1960 500 000 people were confined to institutions o JFK s community mental health program o Comprehensive mental health bill in 1964 o Medicare and medicade 1966 o In 1986 100 000 in institutions o For every 20 public beds in 1955 only one bed existed in 2005 Current views on the etiology cause of mental illness focus on the o Diathesis stress model o Biopsychosocial model Female hysteria Faintness nervousness insomnia fluid retention heaviness in abdomen muscle spasm shortness of breath irritability loss of appetite for food and sex and a tendency to cause trouble Treatment included genital massage and paroxysm Prevalence 1 out of 5 adults and children require treatment in any given year o More recent surveys suggest it is closer to 1 out of 3 Electroconvulsive therapy ECT Epidemiology of Mental illness Data based on o ECA study in 1980 s o NCS study in early 1990 s Lifetime prevalence 40 Most prevalent disorders o Substance use disorders o Anxiety disorders o Mood disorders Classifying Psych Disorders Goal o Describe the disorder in terms of symptomology o Predict its future course o Imply appropriate treatments Facilitates communication and research WHO ICD 10 APA DMS IV R o First version in 1952 o Mental health people use this more than the other one o Latest version came out in 2000 DSM 5 May 18 2013 Multi axial system DSM IV TR o DSM has five axes or components Axis I criteria for diagnosing most disorders Axis II specific to personality disorders Axis III patients general medical condition Axis IV psychosocial and environmental problems Axis V global assessment of functioning Criticisms of the classification system The Myth of mental illness by Thomas Szasz 1960 illness o Called the problems in living o Results in derogatory labels and stigmas Stewart Page 77 room for rent study o Abnormal behavior usually involves a deviation from cultural norms rather than an o Trying to rent a room while telling them they just got released from a mental hospital Disorders Usually First Diagnosed in Infancy Childhood or Adolescence Pervasive Developmental Disorders o Deficits in intellectual functioning sensory response and communication o Autism Affects 4 out of 10 000 children 200 000 300 000 in the US 80 are male 5x more common in boys Most debilitating PDD Usually diagnosed by 30 months and always by three years old Impairment in Social interaction and communication Additional symptoms Distressed by change rigid infexable routines Throw tantrums and get upset with change Stereotyped and repetitive motor mannerisms hands finger legs whole body Intense preoccupation with a restricted range of interests Degree of impairment mild to severe Mental retardation is typical Some have an extraordinary talent in a particular area e g art music numbers idiot savant Ice box mother mothers who were cold aloof unengaging Unknown etiology Mothers with rubella in pregnancy Genetic links Vaccinations MMR Hormonal differences o Attention Deficit Hyperactive Disorder Inflammation of brain or lack of oxygen at birth Controversial diagnosis under over diagnosis Is it even a real disorder Neurological condition first identified in early 1900 s Affects 3 5 of school age children Boys diagnosed 3 5 times more than girls Tends to run in families 25 chance of parents also affected Most often diagnosed between ages 8 and 10 Thought to outgrow it but not always the case Affect 5 of adults Attentional symptoms Hyperactive symptoms Impulsive symptoms Symptoms must be present for six months or more Symptoms must cause impairment in 2 or more areas of functioning and be present before age seven Types inattentive hyperactive impulsive combined New type sluggish cognitive tempo Importanc of good assessment Etiology neurodevelopmental disorder Prenatal exposure to alcohol or cigarette smoke Birth trauma Postnatal exposure to toxins such as lead Genetics Head injury Diet Neurotransmitters such as dopamine and norepinephrine Infections Environmental factors poor parenting family dysfunction excessive TV and videogames Treatment Behavior modification Medication 70 80 respond o Stimulants such as Adderall Ritalin Cylert Concerta Focalin Vyvanse o Strattera o Wellbutrin o Depression a class of disorders characterized by emotional disturbances that cause significant distress and dysfunction common cold of psychological disorders Sadness vs major depressive disorder Prevalence Adults 5 10 lifetime 17 Children Preschoolers 1 school age 2 adolescent 5 9 Women twice as likely to become depressed compared to men Symptoms of depression Mood sad unhappy despairing Neurovegitative symptoms appetite sleep libido energy interest motivation attention and concentration Social isolation and withdraw Anhedonia lack of pleasure Low self esteem Helplessness and hopelessness Moodiness emotional liability Tearfulness Suicidal ideation Kids apathy irritable persistent sadness Often difficult to identify in kids Depression striking earlier and earlier Etiology of depression Genetics and or biology serotonin and norepinephrine Psychoanalytic Theory Learning Theory o We learn to be depressed Interpersonal theory Cognitive behavioral theory o Negative thoughts negative mood o