"normal", vs. "abnormal"
- 4 criteria
- 1. Distress- emotional pain, difficult to function.
- 2. Impairment-can't function at an optimal or average level.
- 3. Risk to self of others- committing suicide or abusing others.
- 4.Socially/ Culturally unacceptable behaviors- yelling a dead person's name, looking for them in the middle of the night.
Prevalence of mental disorders in U.S.
21 % of Americans have experienced a mental disorder during the perceding year. A Life time prevalence of mental disorder = 32%.
co-existing psychiatric condition. 54% (just remember that number)
Medical Doctors (MDs) with advanced training in treating people with psychological disorders.
Trained in either type of doctoral program. Some counseling some normal development.
Issues of reliability of a diagnostic system.
A given diagnosis will be consistently applied to anyone showing a particular set of symptoms.
Issues of validity of a diagnostic system.
The diagnoses represent real and distinct clinical phenomena.
How DSM developed: theoretical assumption of the first edition. What year?
(1952)- Theoretical assumptions that emotional problems or "reactions" causes the disorders it described.
Definition of "mental disorder". (When it is clinically significant.)
Distress or disability, significant risk, Not acceptable behavior.
4 Assumptions of DSM.
- 1.Classification system based on medical model (patient)
- 2.Atheoretical Orientation -
- 3. Catergorical Approach
- 4. Multiaxial system- allows clients to be characterized in a multidemensional way.
behavior that involves distressing, unacceptable symptoms that are enduring and lack any physical basis. (not a modern term diagnostic term)
Various forms of behavior involving a loss of contact with reality, such as delusions (false beliefs) and hallucinations (false perceptions). (Not a formal diagnostic category, psychotic is retained in the DMS as a descriptive term.) NOT USED AS PART OF THE OFFICIAL NAMING SYSTEM.
Within the Categorical approach, the recent movement to the dimensional model.
There is difficulty of establishing clear boundaries between psychological conditions so they are considering adopting a dimensional model. (EX. MILD, MODERATE, SEVERE,.. etc..)
- Axis 1- Clinical disorders - collection of symptoms that constitute a particular abnormality.
- Axis 2- Personality Disorders + Mental Retardation- sets of disorders that represent enduring characteristics of an individual's personality or abilities.
- Axis 3- General Medical Condition- for documenting a client's mental conditions, keep in mind when developing a treatment plan.
- Axis 4- Psychosocial and Environmental Problems - documents events that may affect the diagnosis, treatment or outcome of a client's psychological disorder. (stressors) p. 48
- Axis 5- Global Assessment of Functioning (GAF) Scale- overall rating of psychological health.
Determining the best approach to treatment. (p. 60-61) and current idea of empirically-supported treatment (EST). GOALS
- Immediate Goals- addresses most processing needs at the moments.
- Short-term Goals- change in behavior, thinking and emotions.
- Long-term Goals- depply rooted alternative in relationships and personality.
Components of mental status examination.
- Obsession- unwanted thoughts.
- Overvalued idea- Thoughts that have an odd and absurd quality: not usually bizzare.
- Magical thinking- Connections between two non-related events, (Drying clothes causes disaster)
- Affect- an individual's outward expression of emotion. VS Mood- refers to a person's experience of emotion, the way a person feels inside.
- -Thought disorder in speech- incoherence, loosening of associations.
Fear VS Anxiety
- Fear- innate, almost biologically based alarm response to dangerous of life-threatening situation.
- Anxiety-is more future-oriented and global, referring to the state in which an individual is inordinately apprehensive, tense, and uneasy about the prospect of something terrible happening.
Symptoms of Anxiety disorder
incapacitated by chronic and intense feelings of anxiety, feelings so strong that they are unable to function. Anxiety becomes a matter on clinical concern when it reaches a day- to-day unable to function. enters maladaptive state (extreme physical and psychological reactions.) 28% of U.S.
Treatment of Anxiety Disorder
Psychotropic medications (Zoloft, BuSpar, Paxil, Effexor)
Somatoform disorders- How they were important in history?
- - include a variety of conditions in which psychological conflicts become translated into physical problems or complaints that cause distress or impairment in a person's life.
- (history)- ANNA O.
Charcot and his discovery though the use of hypnosis.
Used hypnosis to show that psychological factors played a role in the physical symptoms or hysteria.
Various somatoform disorders
- Somatization disorder- involves the expression of psychological issues through bodily problems that cannot be explained by any medical condition, or substance.
- -Body Dysmophic Disorder (BDD)- preoccupied, almost to point of being delusional, with the ideas that a part of their body is ugly or defective...
- -Hypochonriasis- believe or fear that they have a serious illness, when in fact they are merely experiencing normal bodily reactions.
Malingering and factitious disorders.
- Malingering- deliberately feigning the symptoms of physical illness or psychological disorder for an ulterior motive.
- -Factitious Disorder- people fake symptoms or disorders, not for the purpose of any particular gain but because of an inner need to maintain a sick role.
Munchausen Syndrome by Proxy
a person induces physical symptoms in another person who in under that individual's care. (baby video)
Primary and secondary gain in Somatoform disorders.
- Primary gain- the avoidance of burdensome responsibilities because one is "disabled".
- -Secondary gain- sympathy and attention the sick person receives from other people.
Psychological factors affecting medical conditions
includes situations in which psychological or behavioral factors have an adverse effect on a medical condition. (EX. Axis 1 disorders, psychological symptoms, personality traits, maladaptive health behaviors, stress-related physiological responses and less specific psychological factors.)
Stress and Stressors
- Stress- the unpleasant emotional reaction a person has when they perceive an event to be threatening.
- -Stressors- the event itself.
Types of Coping Strategies. (Problem vs. emotional focused)
- -Problem-focused strategies- taking care of the problem and overcoming the anxiety. These people find that simply making plans to deal with the problem makes them feel better than doing nothing.
- -Emotion-focused strategies- reduce the emotional distress that accompanies the problem.
Field of Psychoneuroimmunology.
Psychoneuroimmunology- the study of the connections among stress, nervous system functions and the immune system.
Mood States: Dysphoria and Euphoria
- Dysphoria- emotion of sadness.
- -Euphoria -emotion of elation.( more cheerful than average person)
Classification of mood disorders. LOOK IT UP
Types of depression (melancholy and seasonal pattern.)
- Melancholy- lose interest in most activities or find it difficult to react to events in their lives that would normally bring pleasure.
- -Seasonal pattern- develope a depressive episode at about the same time each year, usually about 2 months during the fall or winter, but then they return to normal functioning.
Issues with the referral of young children.
Some children just have temper tantrums, or disobey the rules. It is not a reason to think they have a disorder.
Mental Retardation: criteria for diagnosis
IQ below 70. 1% of population, more common in males.
The range of mental retardation.
From mild to Profound.
Common forms of mental retardation and their causes.
- Down Syndrome- caused by an extra twenty-third chromosome.
- -PKU- inability to utilize phenylalanine, which builds up in the body's tissues and blood, leading to severe neural damage.
- -Tay-Sacks- a metabolic disorder caused by the absence of a vital enzyme, which leads to the accumalation of lipid in nerve cells, leading to neural degeneration and early death, usually before the age of 5.
- -Fragile X- on X chromosome, severe forms of retardation (mostly in males).
Environmentally related mental retardation; Fetal Alchohol Syndrome and the oterh examples...
- 1. Prenatal Disease-
- 2. Difficult delivery
- 3. Premature birth
- 4. Prenatal substance abuse
- 5. Failure to thrive
Pervasive developmental disorders definition...
Conditions that begin in childhood and have a major impact on social and cognitive functioning; involving serious deficits in social interaction and communication skills, as well as odd behavior, interests, and activities.
Pervasive disorders. (Rett)
Rett's disorder- only in females, child develops normally until between 5 months to 4 years, then begins to show neurological and cognitive impairments,(deceleration of head growth, stereotyped movements of hand, a lack of bodily coordination, language impairments, and social withdrawal.
Pervasive disorders. (Disintegrative)
-develops normally for 2 years, but before age 10 starts to lose language and motor skills as well as other adaptive functions, including bowel and bladder control.
Pervasive disorders. (Asperger)
-maintain cognitive and language development but become severly impaired in social interaction.
Symptoms of Autism
- Apparent before age 3, usually in infancy.
- -Clinicians assign the diagnosis based on symptoms that fall in three groups:
- 1. Impaired social interaction.
- 2. Impaired communication.
- 3. Oddities of behavior, interests, and/or activities.
Theories about autism's source (heritability) & evidence for it.
- Patterns of family inheritance.
- - Concordance among identical twins.
- - Chromosomal abnormalities.
- - Structural brain abnormalities.
- - Functional brain abnormalities.
Interventions in mental retardation and autism- (mainstreaming)
Mainstreaming- (develope motor abilities, coordination, language usage, and social skills.) People with cognitive and physical disabilities are integrated with non-disabled individuals, they participate in ordinary school classrooms, where they are provided with assistance geared to their particular needs.
Interventions in mental retardation and autism- (Behavior modification techniques)
Behavior modification techniques- rewarding the child for good behavior
- inattentiveness and hyperactivity-impulsivity.
- -Causes- growing up in disturbed family environment, and biological factors.
- -Treatments-Medications (Ritalin), let them understand the disorder.
a condition characterized by the repetitive and persistent violation of the rights of other people
Oppositional defiance disorder
show a pattern of negative, hostile, and defiant behavior that results in significant family or school problems.
Separation Anxiety disorder (in general)
intense and inappropriate anxiety concerning separation from home or caregivers.