Mental Disorders

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Mental Disorders

• What is Abnormal?
• Schizophrenia
• Mood Disorders
• Anxiety Disorders
• Eating Disorders
• Personality Disorders

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Defining Abnormality

• Mental Disorder The presence of a constellation
  of cognitive, emotional, and behavioral symptoms
  that create distress and impairment. Involves
• Distress
• Disability
• Danger

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Taken Into Consideration
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Explaining Abnormality

• Diathesis-stress model Predisposition combined
  with specific factors trigger a mental disorder.
  
• Diathesis Predisposition
• Stress Specific factors

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Diagnosis Multiaxial assessment

• Diagnostic and Statistical Manual of Mental
  Disorders (1994).
• Axis I Clinical disorders
• Axis II Personality disorders/mental retardation
• Axis III General medical conditions
• Axis IV Psychosocial/environmental conditions
• Axis V Patients level of functioning
• GAF 0-100

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Schizophrenia

• Begins between late teens and mid-30s.
• 1
• Prodromal phase gradual development of signs and
  symptoms
• Complete recovery unlikely
• Waxes and wanes

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Diagnostic Criteria (DSM IV)

• Positive symptoms
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized behavior
• Negative symptoms
• Flat emotion
• Alogia (empty replies)
• Avolition (absence of goal directed behaviors)

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Types of Schizophrenia

• Paranoid type Delusions/hallucinations
• Persecution
• Grandeur
• Disorganized type Disorganized speech,
  behavior, and flat or inappropriate emotion
• Catatonic Motoric impairment or agitation

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Cause

• Dopamine hypothesis
• Genetics
• Prenatal pathogen (virus)
• Laboratory findings
• Brain structural abnormalities
• Abnormal cerebral blood flow
• Neuropsychological impairment
• Attention, abstract thinking, reaction time

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Mood Disorders Depression and Bipolar

• Major Depressive Disorder
• Most common disorder
• Women diagnosed 2-3 times more than men
• 30 attempt suicide (1/2 succeed)
• Is highly treatable

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Diagnostic Criteria For two weeks, experience.

• Depressed mood
• Diminished interest/pleasure
• Weight loss or gain
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Thoughts of death
• Fatigue, feeling worthless
• Concentration problems

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Cause

• Environmental stress
• Thinking style
• Becks cognitive triad
• Inflexible thinking/attributional style
• Neurotransmitter dysfunction
• Rule-out medical condition
• Seasonal changes
• Genetics

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Prognosis (1 year)
(APA Data, 1994)
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Bipolar Disorder

• A mood disorder marked by 1 episodes of either
  mania or hypomania. Types
• Bipolar I (mania probably depression)
• Bipolar II (hypomania depression)
• Affects .4 to 1.6
• First episode in men, manic
• Women, depression
• Treatment resistance due to medication side
  effects, loss of mania
• Suicide 10-15
• Strong genetic influence

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Bipolar Disorder

• Many can function fully between episodes
• May be psychotic (during mania)
• Duration/frequency of mood varies
• Average 4 episodes per 10 years
• Rapid cycling 4 in one year

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Anxiety Disorders
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Anxiety Disorders

• Obsessive-Compulsive Disorder (OCD)
• Recurrent and persistent thoughts, impulses,
  images.

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OCD (cont)

• Compulsions (repetitive behaviors or mental
  acts).

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OCD (cont)

• Compulsions are attempts to control anxiety
• Affects 2-3
• Realize its irrational
• May involve serotonin
• May be caused by loop of neural activity that
  occurs in caudate nucleus of basal ganglia.
• c.n. does not turn off recurrent thoughts

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Phobias

• Specific phobia Persistent fear that is
  excessive or unreasonable due to an object or
  situation
• Immediate response
• Social phobia Fear of social situations

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Post Traumatic Stress Disorder (PTSD)

• PTSD
• Experience, witness, or confronted with an event
  that involved actual or threatened death or
  serious injury
• Response of intense fear, helplessness, horror
• Recurring recollections, dreams
• Flashbacks or sense of reliving
• Intense distress from triggers
• reactivity

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Two other anxiety disorders

• Generalized anxiety disorder Excessive anxiety
  or worry about many events or activities.
• Panic disorder Recurrent panic attacks
• Heart races/fear heart attack
• Dizzy, shaking
• Feel like going crazy
• May include agoraphobia

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Eating Disorders

• Anorexia Nervosa Refusal to maintain a normal
  body weight and intense fear of becoming fat.
• Restricting Type
• Binge Eating/Purging Type
• Bulimia Nervosa Recurrent episodes of binge
  eating and compensation
• Purging type
• Nonpurging type

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Eating Disorder Facts

• Cultural pressures - thoughts?
• Can be lethal or lead to permanent damage
• Depression is common
• Thinking style
• Abstinence violation effect
• Binging/purging is addictive
• Genetic predisposition for anorexia
• 56 identical twins

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Personality Disorders (PD)

• There are three groupings, based upon clinical
  presentation.
• Cluster A (Odd, eccentric)
• Cluster B (Dramatic, emotional, erratic)
• Cluster C (Anxious or fearful)

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What does it mean to have a PD?

• Personality traits are enduring patterns of
  perceiving, relating to, and thinking about the
  environment and self.
• When these traits become inflexible and
  maladaptive, and cause impairment, there is a PD.

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Essential features

• Enduring pattern of inner experience and behavior
  that deviates from cultural expectations AND is
  dysfunctional. May involve
• Cognitive distortions
• Emotional impairment
• Impaired interpersonal functioning
• Impaired impulse control

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Essential features

• A PD is stable, of long duration, and onset can
  be traced back to at least adolescence or early
  adulthood. Is NOT due to
• Drugs or alcohol
• Another disorder
• Situational stress

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Personality Disorders

• Antisocial Personality Disorder
• Avoidant Personality Disorder
• Borderline Personality Disorder
• Dependent Personality Disorder
• Histrionic Personality Disorder
• Schizotypal Personality Disorder
• Narcissistic Personality Disorder

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Antisocial Personality Disorder

• Pervasive pattern of disregard for and violation
  of others rights since age 15 years, as
  indicated by
• Failing to conform to social norms and repeatedly
  breaking the law.
• Repeated lying, or conning others.
• Impulsivity
• Ex. Frequently change jobs, residences
• Irritability and aggressiveness
• Ex. Bar fights

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Antisocial symptoms (cont)

• Reckless disregard for others safety.
• Ex. Recurrent speeding tickets.
• Consistent irresponsibility.
• LACK OF REMORSE.
• Must be at least 18.
• Prevalence is 3 in males and 1 in females.
• 3-30 in clinical settings.

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Characteristics

• Must have history of conduct disorder before age
  15.
• May pursue illegal occupations.
• Manipulate to get money, sex, power.
• May neglect a child.
• Squander necessity money.
• Leave child w/another or just leave.
• May not feed, bathe, dress child properly.

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Characteristics

• May be charming.
• Is male prevalence due to emphasis on aggression?
• Associated with low SES urban settings.
• Protective survival strategy?
• May experience unpleasant feelings.
• Inability to tolerate boredom.
• Depressed mood.