Mental Disorders

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Mental Disorders 
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Mental Disorder then
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Mental Disorder then
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Mental Disorder then
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Mental Disorder then
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Mental Disorder then
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Mental Disorders

• disturbances of an individuals behavioral or
  psychological functioning that are not culturally
  accepted and that lead to psychological distress,
  behavioral disability, and/or impaired overall
  functioning.

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MODELS OF MENTAL DISORDER

• PSYCHOLOGICAL MODEL
• SOCIOLOGICAL MODEL
• DIATHESIS- STRESS MODEL

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• Psychological model emphasizes psychological
  factors in the development of mental disorders
  learning i.e. phobias, cognition irrational
  beliefs i.e. depression, and unconscious
  forces.
• Sociological factors emphasizes external
  factors such as negative environments poverty,
  homelessness, unemployment, inferior education,
  and prejudice.
•  
• Diathesis-stress model mental disorders result
  from a predisposition for a given disorder
  (diathesis) and stressors in an individuals
  environment that tend to activate or stimulate
  the predisposition. (Example genetic factors,
  early traumatic experiences, personality traits
  predisposed an individual whether the
  individual experiences the disorder depends on
  their environment i.e. antisocial aggressive
  gene exposed to tumultuous environment
  inner-city, domestic abuse, etc).

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Assessment and Diagnosis of Mental Disorders
DSM-IV Diagnostic and Statistical Manual of
Mental Disorder IV
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• It is the official diagnostic tool used by
  psychologist.This manual help psychologist to
  describe and classify mental disorders. Major
  Diagnostic Categories page 539.
• The book describes diagnostic features- symptoms
  that must be present. It looks at variations in
  age, gender, culturally related features, some
  things that are normal in one culture are not
  abnormal in others (eg. incest African tribes).
  
• Disorders are classified along five axes Axis I
  clinical disorder, Axis II personality
  disorder/mental retardation, Axis III medical
  conditions, Axis IV- psychosocial or
  environmental conditions, and Axis V- GAF
  global assessment functioning.
•  
•  

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Limitation of the DSM-IV

• The manual is mainly descriptive doesnt
  attempt to explain.
• The manual also attaches labels to people and the
  person may then be perceived in terms of that
  label certain stigma associated.

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CLASSIFICATION OF MENTAL DISORDERS
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Disruptive Disorders
Childhood disorders involving poor impulse
control and interpersonal conflict

• 1. Oppositional defiant disorder 3 to 7)
• 2. Conduct disorder puberty.

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Oppositional defiant disorder

• The essential feature of ODD- a recurrent
  pattern of negativistic, defiant, disobedient,
  and hostile behavior toward authority figures
  that persists for at least 6 months.
• Usually start when children are young (ages 3 to
  7) and can lead to more serious disorder
  conduct disorder which begins somewhat later
  puberty.
•  

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Conduct disorder

• Involves more serious antisocial behaviors that
  go beyond throwing tantrums or disobeying rules.
  
• Here the child impedes on the basic rights of
  others and violates major age-appropriate
  societal norms or rules.
• Children are seen as being aggressive towards
  people and animals, destroying property, being
  deceitful and engaging in theft, violations of
  rules i.e. running away, staying out at night,
  truant from school.

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OTHER CHILDHOOD DISORDERS

• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Autism

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 Attention-Deficit/Hyperactivity Disorder
(ADHD)

• ADHD persistent pattern of inattention and/or
  hyperactivity that is more frequent and severe
  than is typically observed in individuals at a
  comparable level of development.
• Causes are both biological and psychological.
  Low birth weight, oxygen deprivation at birth,
  and alcohol or drug consumption. Psychological
  factors include parental intrusiveness or over
  stimulation parents who just cant seem to
  leave their infants alone.
• Treated with drugs Ritalin

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  Autism Pervasive Developmental Disorder

• Involve lifelong impairment in mental or physical
  functioning.
• The essential features of autism are the presence
  of
• abnormal or impaired development in social
  interaction dont use nonverbal behaviors such
  as eye contact and communication and
• a restricted repertoire of activity or interest
  repetitive pattern of behaviors.
• Children with this disorder seem to be
  preoccupied with themselves and to live in a
  private world.

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Feeding and Eating Disorders
Disturbances in eating behavior that involve
maladaptive and unhealthy efforts to control body
weight.
ANOREXIA NERVOSA
BULIMIA NERVOSA
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Anorexia Nervosa

• Excessive and intense fear of gaining weight
  coupled with refusal to maintain a normal body
  weight.
• More common in women than in men. Why?
  Sociological factors women feel pressure to
  live up to the images of beauty shown in the
  media. Psychological control family pressures

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• Bulimia
• Persons engage in recurrent episodes of binge
  eating eating huge amounts of food within short
  periods of time and then engage in some activity
  that will prevent them from gaining weight.
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• Usually women, and unlike anorexics, bulimics are
  of normal weight so it is harder to detect that
  something is wrong with them.
• Seem to have same sociological causes wanting
  to be thin as defined by society.

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Mood Disorders
disturbance in mood more prolonged more
extreme than is typical for most people

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1. Major Depressive Disorder 2. Bipolar Disorder
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Major Depressive Episode

• Persons suffering from depression should have
  five or more symptoms for at least 2 consecutive
  weeks.
• Symptoms include profound unhappiness most of the
  day, nearly every day diminished interest or
  pleasure in all, or almost all activities
  eating, sports, sex significant weight loss when
  not dieting or weight gain insomnia or
  hypersomnia fatigue or loss of energy
  psychomotor agitation or retardation (feeling of
  restlessness or being slowed down) recurrent
  thoughts of death, diminished ability to think or
  concentrate.

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• Bipolar Disorder
• Characterized by wide swings in mood between deep
  depression and mania.
• Causes biological and psychological.
  Depression runs in family this support the
  argument for biological causes.
• Research also shows that there seem to be some
  abnormality in brain biochemistry. It is found
  that levels of norepinephrine and serotonin are
  lower in the brains of those suffering from
  depression.
• They also found that these two neurotransmitters
  were higher in those suffering from mania

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• Psychological factors learned helplessness
  beliefs that outcomes of events are out of the
  control of the individual. One result in
  feelings of learned helplessness is depression.
•  
• Negative views about oneself also lead to
  feelings of depression. These persons possess
  negative self-schemas that is negative
  conceptions of their own traits, abilities, and
  behavior.

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Anxiety Disorders
Disorders characterized by fear or worry that is
more extreme and prolonged than is typical for
most people.

• Phobias
• Panic Disorder and Agoraphobia
• Obsessive-Compulsive Disorder (OCD)
• Posttraumatic Stress Disorder (PTSD)

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• a. Phobias excessive fear that causes intense
  emotional distress and impairs daily functioning.
  
• Most common phobia is social phobia persistent
  fear of social or performance situations in which
  embarrassment may occur.
• Exposure to the social or performance situation
  almost invariably provokes an immediate anxiety
  response, such as panic attack.
•  
• Causes Psychological factors learning
  classical conditioning.

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• b. Panic Disorder and Agoraphobia
• Panic attacks are what lead to a person being
  diagnosed with a panic disorder. Panic attacks
  are characterized by periodic, unexpected attacks
  of intense, terrifying anxiety. Some panic
  attacks occur due to specific situation.
• One such case is panic disorder that is
  associated with agoraphobia, or fear of
  situations from which escape might be difficult
  or in which help may not be available. Take the
  form of intense fear of open spaces, fear of
  being in public, fear of traveling or fear of
  having a panic attack while away from home.
• Claustrophobia fear of enclosed spaces

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• c. Obsessive-Compulsive Disorder
• Recurrent obsessions (thoughts) and compulsions
  (actions) that are severe enough to be time
  consuming or causes marked distress or
  significant impairment.
• Most common fear is those of dirt, germs, or
  touching infected people or objects, disgust over
  body waste or secretions. The compulsive actions
  include repetitive hand washing, checking doors,
  windows, water, and gas counting objects a
  precise number of times or repeating an action a
  specific number of times, and hoarding old mail,
  newspaper and other useless objects.

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• d. Posttraumatic Stress Disorder (PTSD)
• Disorder in which people persistently
  re-experience a traumatic event in their thoughts
  or dreams.
• Feel as if they are reliving the event from time
  to time.
• Persistently avoid stimuli associated with the
  traumatic event.
• Persistently experience 2 or more of the
  following symptoms of increased arousal such as
  difficulty falling or staying asleep/
  irritability or outbursts of anger, difficulty
  concentrating hypervigilance exaggerated
  startle response.

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Somatoform Disorders

• physical symptoms for which there is no apparent
  physical cause.
•  

• Hypochondriasis
• Munchausens syndrome
• Conversion disorder

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• a. Hypochondriasis
• Fear of having or the idea that one has a serious
  disease based on a misinterpretation of one or
  more bodily signs or symptoms.
• Even after assurance from their doctors they
  continue to worry. Many hypochondriacs are not
  faking they feel the pain and discomfort they
  report.
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• b. Munchausens syndrome
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• These persons are usually faking. Devote their
  lives to seeking and often obtaining costly
  and painful medical procedures they know they
  dont need.
• Why? Maybe to get attention. Persons run up
  medical bills that have to be paid by insurance.

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• c. Conversion disorder
• Persons actually experience physical problems
  such as motor deficits (paralysis) or sensory
  deficits (blindness). No medical conditions to
  account for deficits.
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• Causes Psychological factors focus on inner
  sensations they tend to perceive normal bodily
  sensations as being more intense and disturbing
  than most people. Tend to be highly negativistic
  low self-esteem.
• Sociological factors persons learn that they
  will get more attention and better treatment
  patients are reinforced.

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 Sexual Disorders
disturbance in the process that characterize the
sexual response cycle (attain orgasm, erections)
or by pain associated with sexual intercourse.

• Sexual desire disorder
• Sexual arousal disorder
• Orgasm disorder
• Pain disorder - Dyspareunia, Vaginismus

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OTHER SEXUALLY RELATED DISORDERS

• Paraphilias
• Gender Identity Disorders

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 Sexual Disorders

• Sexual dysfunction is characterized by a
  disturbance in the process that characterize the
  sexual response cycle (attain orgasm, erections)
  or by pain associated with sexual intercourse.
• Sexual desire disorder involves a lack of
  interest in sex or active aversion to sexual
  activity. Persons report that they rarely have
  sexual fantasies and that they avoid almost all
  sexual activity and this causes them distress.

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• Sexual arousal disorder involves the inability to
  attain or maintain an erection (male erectile
  disorder) or the absence of vaginal swelling and
  lubrication (female sexual arousal disorder).
• Orgasm disorder includes the delay or absence of
  orgasms in both sexes (female/male orgasmic
  disorder) and premature ejaculation (reaching
  orgasm too quickly) in males.

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Sexual pain disorders

• Dyspareunia genital pain that is associated
  with sexual intercourse in either males or
  females. Causes marked distress.
• Vaginismus recurrent or persistent involuntary
  spasm of the musculature of the outer third of
  the vagina that interferes with sexual
  intercourse. Causes marked distress.

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Paraphilias

• Recurrent and intense sexually arousing
  fantasies, sexual urges or behaviors generally
  involving
• nonhuman objects,
• the suffering or humiliation of oneself or ones
  partner, or
• children or other non-consenting persons that
  occurs over a period of at least 6 months. These
  things are necessary for sexual arousal.

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Gender Identity Disorders

• These persons feel that they were born with the
  wrong sexual identity.
• Identify with the opposite sex and show
  preference in cross-dressing. Many of these
  people undergo sex-change operations sexual
  organs are altered to resemble the other gender.
  
• People usually undergo years of hormonal therapy
  and counseling before the actual therapy.
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Personality Disorders
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• Extreme and inflexible patterns of perceiving,
  relating to, and thinking about the environment
  and oneself that are exhibited in a wide range of
  social and personal contexts.
• Most personality disorders are said to be
  ego-syntonic that means that they are in sync
  with the ego and not distressing to person
  experiencing the disorder.
• However, there are a few of the disorders that
  are ego-dystonic out-of-sync- with the ego and
  thus cause the person problems. These people
  will usually seek help as oppose to the former.

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Three clusters of Personality disorders
Pervasive and inflexible style of interpersonal
interaction which is problematic

• Odd and Eccentric
• Dramatic, Emotional, and Erratic
• Anxious and Fearful

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• Odd and Eccentric PD.
• Paranoid
• Schizoid
• Schizotypal
• Dramatic, Emotional, and Erratic PD
• Histrionic
• Narcissistic
• Antisocial
• Borderline
• Anxious and Fearful PD
• Avoidant
• Obsessive-Compulsive
• Dependent

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Odd and Eccentric PD.

• Paranoid PD pervasive distrust and
  suspiciousness of others believe that everyone
  is out to get them, deceive them or take
  advantage of them.
• Schizoid PD pervasive pattern of detachment
  from social relationships and a restricted range
  of expression of emotions in interpersonal
  settings lack basic social skills.
• Schizotypal pervasive pattern of social and
  interpersonal deficits marked by acute discomfort
  with, and reduced capacity for close
  relationships as well as by a cognitive and
  perceptual distortions and eccentricities of
  behavior (odd thinking and speech, odd beliefs,
  inappropriate or constricted affects).

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. Dramatic, Emotional, and Erratic PD

• Histrionic PD (drama queen) pervasive pattern
  of excessive emotionality and attention seeking.
  They want to be the center of attention, and they
  will do almost anything to attain this goal
  dress in unusual ways red cat suit with hot
  pink knee high boots excessive make-up. Seem
  confident on the surface, but these people really
  lack self-confidence and need approval and
  acceptance from others.
• Narcissistic PD pervasive pattern of
  grandiosity (in fantasy or behavior), need for
  admiration, and lack of empathy. Grandiose ideas
  about their own abilities these people think
  that they are exceptional and will react with
  anger if others dont recognize this.

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• Antisocial PD pervasive pattern of disregard
  for and violation of the rights of others.
  Demonstrate at least 3 or more of the following
  symptoms failure to conform to social norms
  with respect to lawful behaviors, deceitfulness
  as is indicated by repeated lying, impulsivity,
  irritability and aggressiveness, reckless regard
  for safety of self and others, consistent
  irresponsibility, and lack of remorse.

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• Borderline PD pervasive pattern of instability
  of interpersonal relationships, self-image and
  affect. (love/hate). Need at least 5 or more of
  the following symptoms frantic efforts to avoid
  real or imagined abandonment, unstable and
  intense interpersonal relationships alternating
  b/w extremes of idealization and devaluation,
  identity disturbance, impulsivity in at least 2
  areas (substance abuse, sex, reckless driving,
  binge eating), recurrent suicidal behavior or
  gestures or threats or self-mutilating, chronic
  feelings of emptiness, and inappropriate intense
  anger.

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Anxious and Fearful PD

• a. Avoidant PD pervasive pattern of social
  inhibition, feelings of inadequacy, and
  hypersensitivity to negative evaluation.
  Ego-dystonic these persons actually seek
  therapy they know that something is wrong and
  they want to change. These persons want friends,
  but they are afraid of being rejected they will
  take the chance if they are guaranteed not to be
  rejected see the difference with the schizoid
  they dont want friends.

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• b. Obsessive-Compulsive PD pervasive pattern of
  preoccupation with orderliness, perfectionism,
  and mental and interpersonal control at the
  expense of flexibility, openness and efficiency.
  Indicated by 4 or more f the following symptoms
  preoccupation with details, rules, lists and
  order, shows perfectionism that interferes with
  task completion, excessively devoted to work and
  productivity to the exclusion of leisure
  activities and friendships, unable to discard
  worn-out or worthless objects, reluctant to
  delegate tasks or work with others unless they
  submit to exactly his/her way of doing things,
  adopts miserly spending style, and shows rigidity
  and stubbornness.

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• c. Dependent PD pervasive and excessive need to
  be taken care of that leads to submissive and
  clinging behavior and fears of separation.
  Indicated by five or more of the following
  difficulty making everyday decisions w/o advice
  from others needs others to assume
  responsibility for most major areas of their
  lives has difficulty expressing disagreement
  with others b/c of fear of loss of support or
  approval difficulty initiating projects or doing
  things on their own feels uncomfortable or
  helpless when alone urgently seeks another
  relationship when one as ended preoccupied,
  unrealistically, with fears of being left to take
  care of self.

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  Schizophrenia
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• Described as the most devastating mental
  disorder.
• Fragmentation of basic psychological functions
  (attention, perception, thought, emotions, and
  behavior).
• Problems with adjusting to the demands of
  reality. Misperceive what is happening around
  them, often hearing and seeing things that arent
  there (hallucinations).
• Trouble paying attention to what is going on
  around them, thinking is often confused and
  disorganized that they cannot communicate
  w/others.
• Bizarre behavior and blunting emotions.

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Positive symptoms-adding something that is not
normally there.

• Delusions
• Hallucinations
• Disorganized speech
• Disorganized behaviors

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• Delusions are misinterpretations of normal events
  and experiences. 1) Delusion of persecution 2)
  Delusion of grandeur 3) Delusion of control.
  These are phasic meaning they come and go
  just like most of the positive symptoms.
• Hallucinations seeing and hearing things that
  arent really there. Usually voices telling them
  what to do.
• Disorganized speech word salad (jumbled words),
  frequent derailment (start with one thought and
  go off into another) or incoherence, create their
  own words. All this seems to stem from the fact
  the schizophrenics are easily distracted lack
  capacity for selective attention.
• Disorganized behaviors odd movements or strange
  gestures or no movement at all for long periods
  of time catatonia

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Negative symptoms absence of functions or
reactions that most persons show.

• Flat affect no emotion
• Avolition lack of motivation
• Alogia lack of speech

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• Negative symptoms absence of functions or
  reactions that most persons show.
• Flat affect no emotion stare off in space
  with a glazed look. When they do show emotion it
  is often times inappropriate may laugh at
  funerals and cry at birthday parties.
• Avolition lack of motivation or will persons
  may sit down doing nothing for hours.
• Alogia lack of speech may answer direct
  questions, but otherwise tend to remain silent
  w/drawn into private world.

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Onset and Course

• Chronic disorder last at least 6 months,
  generally begins in early 20. Equal among
  gender, although males have earlier onset than
  females.

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Five types of Schizophrenia

• Catatonic type at least 2 of the following
  motoric immobility catalepsy (including waxy
  flexibility) or stupor excessive motor activity
  (purposeless) extreme negativism (resistance to
  all instructions or maintenance of a rigid
  posture against attempts to be moved) or mutism
  echolalia (repetition or words) or echopraxia
  automatic imitation of movements.
• Disorganized type disorganized speech,
  disorganized behavior, flat or inappropriate
  affect.

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• Paranoid type preoccupation with one or more
  delusions (centered around the belief that others
  are out to get him) or frequent auditory
  hallucinations dont show disorganized speech or
  catatonic behavior or flat affect.
• Undifferentiated type meet all of Criteria 'A'
  symptoms delusions, hallucinations,
  disorganized speech, catatonic behavior, and flat
  affect, but dont meet the criteria for
  catatonic, disorganized or paranoid.
• Residual type waste-basket used when there
  has been at least one episode of schizophrenia,
  but the current clinical picture is w/o positive
  psychotic symptoms.

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Causes

• Genetic factors run in families twin studies.
  
• Biological factors brain dysfunction larger
  ventricles may produce abnormalities in the
  cerebral cortex. Reduced activity in the frontal
  lobes. (page 570).
• Biochemical factors neurotransmitters
  disturbance high levels of dopamine.
• Psychological factors families create
  environments that place their children at risk.
  Studies done on relapse shows - harsh criticism,
  hostility, and show too much concern with their
  problems.