Mental Disorders

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Mental Disorders 
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Definition

• 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.
• Mental disorders- THEN AND NOW
•  

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History

• CAUSES
• 1400s- moon influenced brain and induced madness
• Supernatural forces
• Possession of evil spirits
• Physical factors- brain damage, hereditary
• TREATMENT
• Asylums
• Exorcism
• Beaten
• Starved
• Rest, good food and drink and solitude
• Trephening

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MODERN MODELS OF MENTAL DISORDER

• PSYCHOLOGICAL MODEL
• SOCIOLOGICAL MODEL
• DIATHESIS- STRESS MODEL

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• Biological model- role of the nervous system in
  mental disorders. Seeks to understand such
  disorders in terms of malfunctions in portions of
  the brain, imbalance in various neurotransmitters
  and genetic factors
• Psychological model emphasizes psychological
  factors in the development of mental disorders
  for instance many psychologists believe that
  learning play a key role in many mental disorders
  .e.g. learning phobias
• Sociocultural factors emphasizes external
  factors such as negative environments poverty,
  homelessness, unemployment, inferior education,
  prejudice as potential causes of some mental
  disorders.
•  
• 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.

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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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CATEGORIES OF MENTAL DISORDERS
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1. Disruptive Disorder

• Divided into two categories
• 1. Oppositional defiant disorder
• 2. Conduct 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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 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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2. Feeding and Eating Disorders

• Disturbances in eating behavior that involve
  maladaptive and unhealthy efforts to control body
  weight.
• a. 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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• b. 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.
•  
• 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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  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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3. Mood Disorders

• Demonstration of swings in mood from very
  elated to very dejected. Although we have all
  felt some level of sadness or happiness persons
  suffering from a mood disorder have swings that
  are extreme, prolonged and impair daily
  functioning.
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What constitute the diagnosis of depression?

• 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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4. Anxiety Disorders
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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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6. Dissociative Disorders

• They involve profound losses of identity or
  memory, intense feelings of unreality, a sense of
  being depersonalized (i.e. separate from
  oneself), and uncertainty about ones own identity

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• a. Dissociative amnesia
• Individuals suddenly experience a loss of memory
  that does not stem from medical conditions or
  other mental disorders.
• Such losses can be localized, involving only a
  specific period of time, or generalized,
  involving memory for the persons entire life
• b. Dissociative Fugue
• An individual suddenly leaves home and travels to
  a new location where he or she has no memory of
  his or her previous life.

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• b. Dissociative Identity Disorder
• Also known as Multiple Personality Disorder in
  the past
• Involves a shattering pf personal identity into
  two- and often more- separate but coexisting
  personalities, each possessing different traits,
  behaviours, memories, and emotions
• Usually there is one host personality- the
  primary identity that is present most of the
  time, and one or more alters- alternative
  personalities that appear from time to time

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7. Somatoform Disorders

•  
• Involves experiencing physical symptoms for which
  there is no apparent physical cause.
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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
• Parent-child/Self-mutilation
• Disorder where patients pretend to have illness
  and therefore are subject to many medical tests
  and surgical procedures
• 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.

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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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 8. 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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9. 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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10. 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

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

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Odd and Eccentric PD.

• Paranoid PD pervasive distrust and
  suspiciousness of others
• 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, cognitive and perceptual distortions,
  and eccentric behaviour

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. Dramatic, Emotional, and Erratic PD

• Histrionic PD pervasive pattern of excessive
  emotionality and attention seeking.
• Narcissistic PD pervasive pattern of
  grandiosity in fantasy or behavior, need for
  admiration, and lack of empathy.
• Antisocial PD pervasive pattern of disregard
  for and violation of the rights of others.
  Deceitfulness, impulsivity, irritability, lack of
  remorse
• Borderline PD pervasive pattern of instability
  of interpersonal relationships, self-image and
  affect.

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Anxious and Fearful PD

• Avoidant PD pervasive pattern of social
  inhibition, feelings of inadequacy, and
  hypersensitivity to negative evaluation.
• Obsessive-Compulsive PD preoccupation with
  orderliness, perfectionism, and need for mental
  and interpersonal control at the expense of
  flexibility, openness and efficiency.
• Dependent PD pervasive and excessive need to be
  taken care of that leads to submissive and
  clinging behavior and fears of separation.

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  11. 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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• Characterized as having psychotic symptoms. The
  essential features of schizophrenia are a mixture
  of both positive and negative symptoms.
• Positive symptoms adding something that is not
  normally there. Include delusions,
  hallucinations, disordered thought processes, and
  disordered behavior.
• 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.

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• 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 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 for at least 6 months. For most people
  however it lasts for much longer and symptoms
  come and go.
• People with the disorder have period when they
  appear almost normal, and long periods when their
  symptoms are readily apparent
• Generally begins in early 20s. Equal among
  gender, although males have earlier onset than
  females.

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Five types of Schizophrenia

• Catatonic unusual patterns of motor activity,
  such as catalepsy or stupor excessive motor
  activity (purposeless) extreme negativism
  mutism speech disturbances such as echolalia
  (repetition or words) or echopraxia automatic
  imitation of movements.
• Disorganized disorganized speech, disorganized
  behavior, flat or inappropriate affect.
• Paranoid preoccupation with one or more sets of
  delusions, centered around the belief that others
  are out to get him

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• Undifferentiated many symptoms, including
  delusion, hallucination, incoherence
• Residual withdrawal, minimum affect, and
  absence of motivation occurs after prominent
  delusions and hallucinations are no longer present

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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.