1
Q
What does the medical model propose and what are the criticisms?
A
- proposes that it is useful to think of abnormal behaviour as a disease
- Prior to the 18th century, most conceptions of abnormal behaviour were based on superstition (exorcisms, rituals, chants, etc) but the medical model brought improvements in the treatment of those who exhibited abnormal behaviour
- critics: pins potentially derogatory labels on people which promotes prejudice and prevents people from seeking help resulting in stress
- critics: Thomas Szasz asserts that illness only affects the physical body and not the mind and that abnormal behaviour are problems in living rather than medical problems
2
Q
What is diagnosis, etiology, and prognosis?
A
- Diagnosis: involves distinguishing one illness from another
- Etiology: refers to the apparent causation and developmental history of an illness
- Prognosis: a forecast about the probable course of an illness
3
Q
What is the criteria for abnormal behaviour?
A
- Deviance: their behaviour deviates from what their society/culture considers acceptable
- Maladaptive behaviour: their everyday adaptive behaviour is impaired (interfere with a person’s social or occupational functioning)
- Personal distress: an individual’s report of great personal distress. When they describe their subjective pain and suffering to friends, relatives, and mental health professionals
4
Q
How does diagnosis of mental disorders differ?
A
- diagnoses of psychological disorders involve value judgments; In evaluating physical diseases, people can usually agree that a malfunctioning heart or kidney is pathological, regardless of their personal values. However, judgments about mental illness reflect prevailing cultural values, social trends, and political forces, as well as scientific knowledge
- On occasion, everybody acts in deviant ways, thus, normality and abnormality exist on a continuum
5
Q
What are the stereotypes about psychological disorders?
A
- Psychological disorders are incurable; The vast majority of people who are diagnosed as mentally ill eventually improve and lead normal, productive lives. Even the most severe psychological disorders can be treated successfully.
- People with psychological disorders are often violent and dangerous; Only a modest association has been found between mental illness and violence- prone tendencies
- People with psychological disorders behave in bizarre ways and are very different from normal people: This is true only in a small minority of cases, usually involving relatively severe disorders. A classic study by David Rosenhan showed that even mental health professionals may have difficulty distinguishing normality from abnormality.
6
Q
What are the DSM-5 concerns?
A
- categorical approach: the assumption that people can reliably be placed in discontinuous (non-overlapping) diagnostic categories
- critics note that there is enormous overlap among various disorders’ symptoms, making the boundaries between diagnoses much fuzzier than would be ideal. Critics have also pointed out that people often qualify for more than one diagnosis. So it should be replaced by a dimensional approach (describe disorders in terms of how people score on a limited number of continuous dimensions). However, experts would have had to agree about which dimensions to assess and how to measure them
- concern related to the DSM has been its nearly exponential growth. The number of specific diagnoses in the DSM increased from 128 in the first edition to 541 in the current edition. Critics of the DSM argue that this approach “medicalizes” everyday problems and casts the stigma of pathology on normal self-control issues and could trivialize the concept of mental illness.
7
Q
What is the epidemiology and prevalence of psychological disorders?
A
- etemiology: the study of the distribution of mental or physical disorders in a population
- prevalence: refers to the percentage of a population that exhibits a disorder during a specified time period
- The most recent large-scale epidemiological study estimated the lifetime risk of a psychiatric disorder to be 51 percent
- Across all of North America, the most common types of psychological disorders are (1) substance use disorders, (2) anxiety disorders, and (3) depression.
- –>p560 for rest of stats
8
Q
What are anxiety disorders?
A
- a class of disorders marked by feelings of excessive apprehension and anxiety
- experience high levels of anxiety with disturbing regularity
- generalized anxiety disorder, specific phobia, panic disorder, and agoraphobia
- many people who develop one anxiety syndrome often suffer from another at some point in their lives
9
Q
What is generalized anxiety disorder?
A
- marked by a chronic, high level of anxiety that is not tied to any specific threat
- They hope that their worrying will help to ward off negative events
- They often dread decisions and brood over them endlessly. Their anxiety is commonly accompanied by physical symptoms such as trembling, muscle tension, diarrhea, dizziness, faintness, sweating, and heart palpitations
- tends to have a gradual onset and is seen more frequently in females than males
10
Q
What are specific phobias?
A
- a persistent and irrational fear of an object or situation that presents no realistic danger
- while some phobias are rare, other types of phobias are relatively common, including acrophobia (fear of heights), claustrophobia (fear of small, enclosed places), brontophobia (fear of storms), hydrophobia (fear of water), and various animal and insect phobias
- realize that their fears are irrational, but still are unable to calm themselves when confronted by a phobic object
- the lifetime prevalence of specific phobias is estimated to be around 10 percent; two- thirds of the victims are females
11
Q
What are panic disorders?
A
- characterized by recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly
- accompanied by physical symptoms of anxiety and are sometimes misinterpreted as heart attacks
- victims often become apprehensive and hypervigilant, wondering when their next panic attack will occur
- two-thirds of people who are diagnosed with panic disorder are female, and the onset of the disorder typically occurs during late adolescence or early adulthood
12
Q
What is agoraphobia?
A
- a fear of going out to public places
- People with panic disorder often become increasingly concerned about exhibiting panic in public, to the point where they are afraid to leave home
- although many will venture out if accompanied by a trusted companion
- it can co-exist with a variety of disorders and can vary in severity
13
Q
What is obsessive compulsive disorder?
A
- marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions)
- Obsessions sometimes centre on inflicting harm on others, personal failures, suicide, or sexual acts.
- Compulsions usually involve stereotyped rituals that temporarily relieve anxiety
- Specific types of obsessions tend to be associated with specific types of compulsions (ex. obsessions about contamination tend to be paired with cleaning compulsions)
- occur in roughly 2–3 percent of the population and is seen in males and females in roughly equal numbers
- While OCD is often seen as a unitary disorder, research by Laura Summerfeldt suggests that it may be a heterogeneous disorder; Four factors seemed to underlie the symptoms: obsessions and checking, symmetry and order, cleanliness and washing, and hoarding
14
Q
What is post-traumatic stress disorder?
A
- part of the trauma- and stressor-related disorders
- In some instances, PTSD does not surface until many months or years after a person’s expo- sure to severe stress
- Common symptoms of PTSD include re-experiencing the traumatic event in the form of nightmares and flashbacks, emotional numbing, alienation, problems in social relationships, an increased sense of vulnerability, and elevated levels of arousal, anxiety, anger, and guilt
- Individuals who have especially intense emotional reactions during or immediately after the traumatic event go on to show elevated vulnerability to PTSD
- Vulnerability seems to be greatest among people whose reactions are so intense that they report dissociative experiences
- 7–8 percent of people have suffered from PTSD at some point in their lives, with prevalence being higher among women than men
- The frequency and severity of post-traumatic symptoms usually decline gradually over time, but recovery tends to be gradual and in many cases, the symptoms never completely disappear
15
Q
What are concordance rates?
A
– indicates the percentage of twin pairs or other pairs of relatives who exhibit the same disorder
16
Q
What are the biological factors of anxiety disorders?
A
- The results of both twin studies and family studies suggest a moderate genetic predisposition to anxiety disorders
- Recent evidence suggests that a link may exist between anxiety disorders and neurochemical activity in the brain
- disturbances in the neural circuits using GABA may play a role in some types of anxiety disorders and abnormalities in neural circuits using serotonin have been implicated in obsessive-compulsive disorders
17
Q
How does conditioning contribute to anxiety disorders?
A
- anxiety responses may be acquired through classical conditioning and maintained through operant conditioning
- Once a fear is acquired through classical con- ditioning, the person may start avoiding the anxiety-producing stimulus. The avoidance response is negatively reinforced because it is followed by a reduction in anxiety. This process involves operant conditioning
- studies find that a substantial portion of people suffering from phobias can identify a traumatic conditioning experience that probably contributed to their anxiety disorder
- Criticisms of this approach: many people with phobias cannot recall or identify a traumatic conditioning experience that led to their phobia. Conversely, many people endure extremely traumatic experiences that should create a phobia but do not. Moreover, phobic fears can be acquired indirectly, by observing another’s fear response to a specific stimulus or by absorbing fear-inducing information
18
Q
How does preparedness contribute to anxiety disorders?
A
- Martin Seligman’s concept of preparedness: people are biologically prepared by their evolutionary history to acquire some fears much more easily than others
- people develop phobias of ancient sources of threat (e.g., snakes and spiders) much more readily than modern sources of threat (e.g., electrical out- lets or hot irons)
19
Q
What are the cognitive factors of anxiety disorders?
A
- the cognitive view holds that some people are prone to anxiety disor- ders because they see threat in every corner of their lives
- some people are more likely to suffer from problems with anxiety because they tend to (a) misinterpret harmless situations as threatening, (b) focus excessive attention on perceived threats, and (c) selectively recall information that seems threatening
- anxious and non-anxious subjects were asked to read 32 sentences that could be interpreted in either a threatening or a nonthreatening manner (ex. “The doctor examined little Emma’s growth”); the anxious participants interpreted the sentences in a threatening way more often than the non-anxious participants did
20
Q
How does stress contribute to anxiety disorders?
A
- Research has also demonstrated that types of anxiety disorders can be stress related
- For instance, patients with panic disorder had experienced a dramatic increase in stress in the month prior to the onset of their disorder and other studies found that stress levels are predictive of the severity of OCD patients’ symptoms
- numerous studies have linked early-life stress to an increased prevalence of anxiety disorders, dis- sociative disorders, depressive disorders, bipolar disorders, schizophrenic disorders, personality disorders, and eating disorders
21
Q
What are dissociative disorders?
A
- a class of disorders in which people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity
- includes dissociative amnesia, dissociative identity disorder, and depersonalization/derealization disorder
22
Q
What is dissociative amnesia?
A
- a sudden loss of memory for important personal information that is too extensive to be due to normal forgetting
- can occur for a single traumatic event or for an extended period of time surrounding the event
- In some cases, having forgotten their name, their family, where they live, and where they work, these people wander away from their home area, but remember matters unrelated to their identity, such as how to drive a car and how to do math
23
Q
What is dissociative identity disorder (DID)?
A
- a disruption of identity marked by the experience of two or more largely complete, and usually very different, personalities
- these individuals fail to integrate incongruent aspects of their personality into a normal, coherent whole
- The alternate personalities commonly display traits that are quite foreign to the original personality
- Transitions between identities often occur suddenly
- the various personalities generally report that they are unaware of each other, although objective measures of memory suggest otherwise
- seen more often in women than in men
- Starting in the 1970s, a dramatic increase was seen in the diagnosis of DID; theorists argue that a handful of clinicians have begun overdiagnosing the condition and that some clinicians unwittingly reinforce patients for progressively showing a seemingly exotic or exciting disorder
24
Q
What is the etiology of dissociative disorders?
A
- Dissociative amnesia is usually attributed to excessive stress, but little is known about why this extreme reaction to stress occurs in a tiny minority of people, but not in the vast majority who are subjected to similar stress.
- Some skeptical theorists believe that book and movie portrayals of dissociative identity disorder and reinforcement from their therapists make people with DID believe that independent entities within them are to blame for their peculiar behaviours, unpredictable moods, and ill-advised actions.
- Alternatively, many clinicians are convinced that dissociative identity disorder is an authentic disorder. They maintain that most cases of dissociative identity disorder are rooted in severe emotional trauma that occurred during childhood.
- However, little is known about the causes of dissociative identity disorder
25
What is major depressive disorder?
- - people show persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure
- - anhedonia; a diminished ability to experience pleasure
- - lack the energy or motivation to tackle the tasks of living, to the point where they often have trouble getting out of bed
- - Anxiety, irritability, and brooding are commonly observed
- - people who suffer from depression often exhibit other disorders as well
- - The average number of depressive episodes is five to six. The average length of these episodes is about five to seven months.
- - An earlier age of onset is associated with more recurrences, more severe symptoms, and a worse prognosis
- - Depression is associated with an elevated risk for a variety of physical health problems and increases mortality by about 50 percent
26
What is the gender gap in major depressive disorders?
- - Research indicates that the prevalence of depression is about twice as high in women as it is in men
- - A portion of the disparity may be the result of women’s elevated vulnerability to depression at certain points in their reproductive life cycle (postpartum and postmenopausal depression)
- - Susan Nolen-Hoeksema attributes a portion of the higher prevalence of depression among women to their experience of greater stress and adversity
- - Nolen-Hoeksema also believes that women have a greater tendency than men to ruminate about setbacks and problems`
27
What is bipolar disorder?
- - Bipolar I disorder (formerly known as manic- depressive disorder) is characterized by the experience of one or more manic episodes as well as periods of depression
- - One manic episode is sufficient to qualify for this diagnosis
- - In a manic episode, a person’s mood becomes elevated to the point of euphoria. The individual talks rapidly and shifts topics wildly, as his or her mind races at breakneck speed. Judgment is often impaired. Some people in manic periods gamble impulsively, spend money frantically, or become sexually reckless
- - In bipolar II disorder, individuals suffer from episodes of major depression along with hypomania in which their change in mood and behaviour is less severe than those seen in full mania
- - Although not rare, bipolar disorders are much less common than depressive disorders and is seen equally often in males and females (unlike depressive disorders)
- - Manic episodes typically last about four months while depressive episodes tend to last longer
- - The typical age of onset is in the late teens
28
What is cyclothymic disorder?
-- People are given a diagnosis of cyclothymic disorder when they exhibit chronic but relatively mild symptoms of bipolar disturbance
29
What postpartum depression?
- - a type of depression that sometimes occurs after childbirth (within four weeks) and can include both depression and mania
- - women residing in urban settings have higher rates of postpartum depression than women in other settings. It has also been found that immigrant women in Canada appear to have an even higher rate of postpartum depression than do Canadian-born women
30
What is seasonal affective disorder (SAD)?
- - a type of depression that follows a seasonal pattern, and postpartum depression, a type of depression that sometimes occurs after childbirth
- - For some individuals who experience either bipolar or major depressive disorder, their symptoms may show a regular relationship with the seasons of the year
- - more common in countries such as Canada, where there is less sunlight in the winter months with rates even higher among the Inuit in the Canadian Arctic
- - There are suggestions that the onset of SAD is related to melatonin production and circadian rhythms
- - One form of treatment for SAD is phototherapy, in which individuals suffering from SAD are exposed systematically to therapeutic light
31
What is the genetic etiology of depressive disorders?
-- The concordance rate for identical twins is much higher suggesting that heredity can create a predisposition to mood dysfunction. Environmental factors probably determine whether this predisposition is converted into an actual disorder
32
What are Neurochemical and Neuroanatomical etiology of depressive disorders?
- - Correlations have been found between mood disor- ders and abnormal levels of two neurotransmitters in the brain (norepinephrine and serotonin) although other neurotransmitter disturbances may also contribute
- - association between depression and reduced hippocampal volume, especially in the dentate gyrus of the hippocampus
- - the human brain continues to generate new neurons (neurogenesis) in adulthood, especially in the hippocampal formation; depression occurs when major life stress causes neurochemical reactions that suppress this neurogenesis, resulting in reduced hippocampal volume and antidepressant drugs are successful because they promote neurogenesis
33
What are the hormonal factors of depressive disorders?
- - Evidence suggests that overactivity along the HPA axis in response to stress can often play a role in the development of depression
- - depressed patients show elevated levels of cortisol, a key stress hormone produced by HPA activity
- - hormonal changes eventually have an impact in the brain, where they may be the trigger for the suppression of neurogenesis
34
What are the cognitive factors of depressive disorders?
- - Martin Seligman: learned helplessness—passive “giving up” behaviour produced by exposure to unavoidable aversive events
- - theory of learned helplessness asserts that the roots of depression lie in how people explain the setbacks and other negative events they experience
- - people who exhibit a pessimistic explanatory style are especially vulnerable to depression because they attribute their setbacks to their personal flaws instead of to situational factors and draw global, far-reaching conclusions about their personal inadequacies based on these setbacks
- - Susan Nolen-Hoeksema found that depressed people who ruminate about their depression remain depressed longer than those who try to distract themselves (women have a greater tendency to ruminate than men which explains the gender disparity)
- - Alloy and colleagues: assessed explanatory style in first-year college students who were not depressed. found that a negative explanatory style predicted vulnerability to depression, with major depression emerging in 17 percent of students who exhibited negative thinking, but only 1 percent of those who did not (after 2.5 years)
35
What are the interpersonal roots of depressive disorder?
- - According to behavioural approaches, inadequate social skills put people on the road to depressive disorders
- - research has found associations between poor social skills and depression
- - Another interpersonal factor is that depressed people tend to be depressing (irritable, pessimistic, complain a lot and aren’t particularly enjoyable companions)
- - As a consequence, they have fewer social supports which can increase vulnerability to depression
- - Evidence indicates that depressed people may gravitate to partners who view them unfavourably and hence reinforce their negative views of themselves
36
How are concussions related to depressive disorders?
- -Depression is a common feature of post-concussion syndrome
- - depression rates in head trauma patients are many times higher than in the general population and that depression can be long-lasting
- - brain scans showed that athletes who had suffered from concussions and depression, as compared to the other participants, showed “reduced activation in the dorsolateral prefrontal cortex and striatum and attenuated deactivation in medial frontal and temporal regions”. The results also indicated that depression levels correlated with the level of neural response in areas typically associated with depression, along with grey matter loss in those area
37
How does stress contribute to depressive disorders?
- - The evidence suggests the existence of a moderately strong link between stress and the onset of both major depression and bipolar disorder
- - However, not everyone who experiences stress develop mood disorders so one has to be vulnerable to developing mood disorders in the first place
- - Studies show that stress is less of a factor in triggering depression as episodes of depression accumulate over the years
38
What is schizophrenia?
- - a disorder marked by delusions, hallucinations, disorganized speech, negative symptoms (e.g., diminished emotional expression), and deterioration of adaptive behaviour
- - usually emerges during adolescence or early adulthood and 1% of population is affected
- - increased risk for suicide and for premature mortality from natural causes
39
What are the general symptoms of schizophrenia?
- - Delusions: false beliefs that are maintained even though they clearly are out of touch with reality (ex. thoughts are being injected into their minds against their will). Delusions of grandeur is when one thinks they are famous or important. Thinking becomes chaotic rather than logical and linear.
- - Deterioration of Adaptive Behaviour: deterioration in the quality of the person’s routine functioning in work, social relationships, and personal care (inability to get along with others or to function in the work world)
- - Hallucinations: sensory perceptions that occur in the absence of a real, external stimulus or are gross distortions of perceptual input. The most common being auditory hallucinations.
- - Disturbed Emotions: Some victims show a flattening of emotions (little emotional response). Others show inappropriate emotional responses or become emotionally volatile (acts of aggression)
40
What are the four subtypes of schizophrenia and why were they removed from the DSM-5?
1) Paranoid schizophrenia: dominated by delusions of persecution, along with delusions of grandeur
2) Catatonic schizophrenia: striking motor disturbances, ranging from the muscular rigidity seen in a withdrawn state called a catatonic stupor to random motor activity seen in a state of catatonic excitement
3) Disorganized schizophrenia: frequent incoherence, obvious deterioration in adaptive behaviour, and virtually complete social withdrawal
4) Undifferentiated schizophrenia: People who were clearly schizophrenic but who could not be placed into any of the three categories (mixtures of schizophrenic symptoms)
- - DSM-5 discarded the four subtypes because there were not meaningful differences between the classic subtypes in etiology, prognosis, or response to treatment. Also the catatonic and disorganized subtypes were rarely seen in contemporary clinical practice and that undifferentiated cases did not represent a subtype
41
What is the difference between negative and positive symptoms of schizophrenia?
- - Negative symptoms: behavioural deficits, such as flattened emotions, social withdrawal, apathy, impaired attention, poor grooming, lack of persistence at work or school, and poverty of speech
- - Positive symptoms: behavioural excesses or peculiarities, such as hallucinations, delusions, incoherent thought, agitation, bizarre behaviour, and wild flights of ideas
- - Most patients exhibit both types of symptoms, but vary in the degree
- - negative symptoms is associated with less effective social functioning and poorer overall treatment
42
What is the genetic etiology of schizophrenia?
- - in twin studies, concordance rates average around 48 percent for identical twins, in comparison with about 17 percent for fraternal twins
- - a child born to two schizophrenic parents has about a 46 percent probability of developing a schizophrenic disorder
43
What is the neurochemical etiology of schizophrenia?
- - dopamine hypothesis: increased dopamine synthesis and release in specific regions of the brain may be the crucial factor that triggers schizophrenic illness in vulnerable individuals
- - Recent research has suggested that marijuana use during adolescence may help precipitate schizophrenia in young people who have a genetic vulnerability to the disorder and an association between methamphetamine use and the emergence of schizophrenia
44
What are the structural abnormalities in the brains of schizophrenic patients?
- - reductions in both grey matter and white matter in specific brain regions
- - CT and MRI scans suggest an association between enlarged brain ventricles and schizophrenic disturbance. These enlarged ventricles are assumed to cause the degenerate of brain tissue
- - This structural deterioration could be a consequence of schizophrenia, or it could be a contributing cause of the illness
45
What is The Neurodevelopmental Hypothesis of schizophrenia?
- - This hypothesis suggests that sensitive phases of prenatal development or during birth can cause subtle neurological damage that elevates individuals’ vulnerability to schizophrenia
- - the sources of these neurological damages could be viral infection or malnutrition during prenatal development and on obstetrical complications during the birth process
- - inflammation thought to be the critical process that disrupts neural maturation
- - elevated incidence of schizophrenia in a group of people who were prenatally exposed to a severe famine
- - Other research has shown that schizophrenic patients are more likely than control subjects to have experienced obstetrical complications and physical anomolies when they were born
46
What is expressed emotion (EE) in schizophrenia?
- - the degree to which a relative of a schizophrenic patient displays highly critical or emotionally overinvolved attitudes toward the patient
- - After release from a hospital, people with schizophrenia who return to a family high in expressed emotion show relapse rates about three times that of patients who return to a family low in expressed emotion. This is probably because their families more sources of stress than sources of support.
47
How does stress contribute to schizophrenia?
- - High stress may then serve to precipitate a schizo- phrenic disorder in someone who is vulnerable
- - Research indicates that high stress can also trigger relapses in patients who have made progress toward recovery and patients who show strong emotional reactions are likely to have their symptoms exacerbated by stress
48
What are personality disorders?
- - a class of disorders marked by extreme, inflexible personality traits that cause subjective distress or impaired social and occupational functioning
- - generally become recognizable during adolescence or early adulthood
- - grouped into three related clusters:
1) anxious/ fearful,
2) odd/eccentric
3) dramatic/impulsive
49
What is antisocial personality disorder?
- - marked by impulsive, callous, manipulative, aggressive, and irresponsible behaviour
- - Since they haven’t accepted the social norms they violate, people with antisocial personalities rarely feel guilty about their transgressions (lack consciousness)
- - more frequently among males than females
- - rarely experience genuine affection for others, predatory and promiscuous, tolerate little frustration, and they pursue immediate gratification
- - antisocial personalities tend to begin their criminal careers at an early age, to commit offences at a relatively high rate, and to be versatile offenders. However, some others don't commit any criminal offences and hold high statuses in society.
50
What is borderline personality disorder?
- - marked by instability in social relationships, self-image, and emotional functioning
- - more common in females than males
- - turbulent interpersonal relationships marked by fears of abandonment, and fragile, unstable self-concepts, as their goals, values, opinions, and career plans shift suddenly
- - They tend to be intense, with frequent anger issues and poor control of their emotions.
- - prone to impulsive behaviour with an elevated risk for self-injurious behaviour and suicide
- - may vary somewhat in response to specific features of situations
51
What is narcissistic personality disorder?
- - marked by a grandiose sense of self-importance, a sense of entitlement, and an excessive need for attention and admiration
- - more common in males
- - Although they seem self-assured and confident, their self-esteem is actually quite fragile, leading them to fish for compliments and to be easily threatened by criticism
- - routinely complain that others do not appreciate their accomplishments or give them the respect they deserve
52
What is the etiology of personality disorders?
- - Given that personality disorders consist of extreme manifestations of personality traits, these disorders are also influenced by heredity, and the data from twin and family studies support this line of reasoning
- - Environmental factors; contributing factors to antisocial personality disorder include dysfunctional family systems; erratic discipline; parental neglect; and parental modelling of exploitive, amoral behaviour. In contrast, borderline personality disorder has been attributed primarily to a history of early trauma, including physical and sexual abuse
PSYCH1002
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