PSY 301 1st Edition Lecture 21 Outline of Last Lecture I Consciousness II Neural aspects of consciousness III Limited Processing Capacity IV Attention V Circadian Rhythm VI REM sleep VII Sleep Disorders VIII Stimulants and Hallucinogens Outline of Current Lecture I Psychological Disorder II Difficulties in Defining Disorders III Alternative Approaches to Psychopathology IV Classifying Mental Illnesses V Goals of DSM VI Comorbidity VII Schizophrenia VIII Social Symptoms IX Acute Schizophrenia X Chronic Schizophrenia Current Lecture Psychological disorder a constellation of cognitive emotional and behavioral symptoms that create distress disability dysfunction or danger Difficulties in Defining Disorders 1 major cultural differences in prevalence rates and how symptoms are expressed 2 changes over time in what is defined as a disorder 3 normal behaviors differ by reference group and situation 4 some definitions are specific to a context a e g insanity a legal not a psychological definition Alternative Approaches to Psychopathology 1 somatogenic a model that explains psychopathology on a physiological basis 2 psychogenic a model that explains psychopathology on a psychological basis 3 diathesis stress a model that distinguishes between the factors that create a risk for illness diathesis and those that turn the risk into a problem stress 4 multicausal models a model of psychopathology that adopts a biopsychosocial perspective in which biological psychological and social factors all contribute to mental illness Multiple diatheses and multiple stressors may exist for a particular person and a particular mental illness 1 somatogenic a model that explains psychopathology on a physiological basis 2 psychogenic a model that explains psychopathology on a psychological basis 3 diathesis stress a model that distinguishes between the factors that create a risk for illness diathesis and those that turn the risk into a problem stress 4 multicausal models a model of psychopathology that adopts a biopsychosocial perspective in which biological psychological and social factors all contribute to mental illness Multiple diatheses and multiple stressors may exist for a particular person and a particular mental illness Classifying Mental Illnesses Diagnosis is typically based on one of two classification schemes DSM IV Diagnostic Statistical Manual of mental Disorder 1 published by the American Psychiatric Association 1 primarily used in the US 2 used for almost all research International Classification of Diseases ICD 10 1 published by the World health Organization 2 used primarily in England Goals of DSM DSM a classification system that describes the features used to diagnose each recognized mental disorder describes 400 disorders and how the disorder can be distinguished from other similar problems 1 Involves disturbances in behavior thoughts or emotions 2 Causes significant distress or impairment 3 Stem from internal dysfunction biological and or psychological DSM a classification system that describes the features used to diagnose each recognized mental disorder describes 400 disorders and how the disorder can be distinguished from other similar problems 1 Involves disturbances in behavior thoughts or emotions 2 Causes significant distress or impairment 3 Stem from internal dysfunction biological and or psychological Comorbidity the co occurrence of two or more disorders in a single individual DSM Appendix disorders that only appear in certain cultures 1 e g adhat an Indian disorder involving severe anxiety over the discharge of semen shenjing shauir a Chinese disorder involving fatigue dizziness headaches ghost sickness a native American disorder involving a powerful preoccupation with death 2 Some disorders found in the main section of DSM also seem to be culture bound e g bulima seems to appear only in western culture or in cultures heavily exposed to the west Schizophrenia an umbrella term for a number of psychiatric disorders that involve disturbances in nearly every dimension including thought perception behavior language communication and emotion Lifetime prevalence about 1 1 varies greatly by country and area 2 seems to begin earlier in men 3 men seem to develop a more severe form of the disorder Wide range of associated symptoms 1 no patient shows all of them 2 how many are needed for diagnosis is a clinical judgment Primary symptoms involve a disturbance of thought perception and language Disorganized Thinking 1 loosening of associations conscious thought moves along associative lines 2 disorganized speech ideas shift rapidly and incoherently from one to another unrelated topic 3 impoverished thought lack of complex thought in response to environmental events 3 unusual word usage like clanging or neologisms Psychotic thinking involves a loss of contact with reality 1 hallucinations a false perceptual experience that has a compelling sense of being real despite the absence of external stimulation a hearing voices is most common 2 delusions a patently false belief system often bizarre and grandiose that is maintained in spite of its irrationality a persecution b control c grandeur Social symptoms 1 withdrawal from social contacts 2 socially inappropriate behavior 3 avolition lack of motivation or goal directed behaviors Affective emotional symptoms blunted or inappropriate emotions Motor symptoms bizarre restless or immobile motor behaviors catatonic Positive and Negative Symptoms Most useful division of symptoms is into positive and negative Positive an excess or distortion of normal functioning 1 two kinds of positive symptoms a disorganized inappropriate emotions disordered thoughts bizarre behavior b psychotic delusions hallucinations Negative a diminution or loss of normal functions 1 flat affect avolition catatonia withdrawal from relationships socially inappropriate behavior impoverished thought positive and negative symptoms seem to involve different neural circuits and to respond to different medications Most useful division of symptoms is into positive and negative Positive an excess or distortion of normal functioning 1 two kinds of positive symptoms a disorganized inappropriate emotions disordered thoughts bizarre behavior b psychotic delusions hallucinations Negative a diminution or loss of normal functions 1 flat affect avolition catatonia withdrawal from relationships socially inappropriate behavior impoverished thought positive and negative symptoms seem to involve
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