CLINICAL CHARACTERISTICS OF DISORDERS

1
CLINICAL CHARACTERISTICS OF DISORDERS

• Clinical Characteristics
• Anxiety
• Affective
• Psychotic

• Explanations Treatments
• Biological
• Behavioural
• Cognitive

2
Clinical Characteristics

• Anxiety Phobia
• Affective Depression
• Psychotic Schizophrenia

3
Exam Style Questions

• January 2010
• Describe the characteristics of a psychotic
  disorder. (10)
• Evaluate difficulties when identifying
  characteristics of psychological disorders. (15)
• June 2013
• Describe the characteristics of one anxiety
  disorder. (10)
• To what extent is it valid to identify a disorder
  from a list of characteristic. (15)
• June 2014
• Outline the characteristics of an affective
  disorder. (10)
• Asses the reliability of identifying a disorder
  from a list of characteristics. (15)

4
DSM-IV
Affective (Mood) Anxiety Psychotic
Bipolar Unipolar Dysthamic Cyclothamic OCD Phobia PTSD GAD Paranoid Residual Undifferentiated Catatonic
5
DSM-IV Depression

• Essential feature of specific depression
• Depression is a low emotional state
  characterised by significant levels of sadness,
  lack of energy and poor self-worth, and feelings
  of guilt

6
(No Transcript)
7
Discussion Carousel Depression
Why do you think depression is known as the common cold of the mind?
How is clinical depression different to feeling down?
What are 3 symptoms you would associate with depression?
Why do you think twice as many women as men are depressed?
What could the individual do to alleviate their depression?
What do you think causes depression? List as many reasons as you can.
Do you think depression can be cured? If yes, suggest how.
8
Depression

• FACT SHEET

• CASE STUDY

• Definition
• Prevalence
• Symptoms
• Types of depression

• William
• Lewis
• Tim
• Kay

9
Diagnostic Criteria

• Under DSM-IVR, a diagnosis of depression requires
  the presence of a sad, depressed mood, plus 4
  (from 8) other criteria including the following
• Physical/behavioural Difficulty sleeping
• Cognitive symptoms Recurrent thoughts of
  death/suicide
• Motivational Loss of energy

10
KEY WORDS DEPRESSION KEY WORDS DEPRESSION
WORD DEFINITION
  Is a condition where the prevailing emotional mood is distorted or inappropriate to the circumstances.  
  Describes a medical condition characterised by severely elevated mood. Associated with bipolar disorder, where episodes of mania alternate with episodes of depression  
  An illness that involves the body, mood, and thoughts and that affects the way a person eats, sleeps, feels about himself or herself, and thinks about things. People with this disorder cannot merely 'pull themselves together' and get better.  
  As categorized by the DSM-IV, it is a form of mood disorder characterised by a variation of mood between a phase of manic or hypomanic elation, hyperactivity and hyper imagination, and a depressive phase of inhibition, slowness to conceive ideas and move, and anxiety or sadness.
  A mild mood disorder which is sometimes seen as more of a personality trait than an illness. Characterised by repetitive periods of mild depression followed by periods of normal or slightly elevated mood.  
  A form of the mood disorder of depression characterised by a lack of enjoyment/pleasure in life that continues for at least six months. It differs from clinical depression in the severity of the symptoms. While usually it does not prevent a person from functioning, it prevents full enjoyment of life. It also lasts much longer than an episode of major depression.  
  A major depressive episode that occurs without the manic phase.
11
SADGFACES

• S
• A
• D
• G
• F
• A
• C
• E
• S

• Sadness, anxiety, or empty feelings
• Decreased energy, fatigue, being slowed down
• Loss of interest or pleasure in activities that
  were once enjoyed, including sex
• Insomnia
• Feelings of helplessness/hopelessness
• Thoughts of death
• Difficulty concentrating
• Restlessness
• Chronic aches

12
Symptoms

• Sadness
• Appetite disturbances
• Delusions and hallucinations
• Guilt, worthlessness
• Fatigue/loss of energy
• Anhedonia (loss of pleasure)
• Catatonia
• Esteem low
• Sleep disturbances

13
DSM-IV Phobia

• Essential feature of specific phobia
• marked and persistent fear of clearly
  discernible, circumscribed objects or situations.

14
Discussion Carousel Phobia
What is phobia?    
List different types of phobia?
What are 3 symptoms you would associate with phobia?
What happens physiologically when someone has a panic attack? What could the individual do to reduce their anxiety levels?
What do you think causes phobia? List as many reasons as you can.
Do you think phobia can be cured? If yes, suggest how.
15
Phobia

• FACT SHEET

• CASE STUDY

• Definition
• Prevalence
• Symptoms
• Types of Phobia

• Mr L
• Gareth
• Rachel
• Rebekah
• Louisa

16
Phobia DSM-IV

• Marked and persistent fear that is excessive or
  unreasonable, cued by the presence or
  anticipation of a
• Specific object or situation (e.g., flying,
  heights, animals, receiving an injection, seeing
  blood).
• Exposure to the phobic stimulus almost invariably
  provokes an immediate anxiety response, which may
  take the form of a Panic Attack.
• The person recognizes that the fear is excessive
  or unreasonable.
• The phobic situation(s) is avoided or else is
  endured with intense anxiety or distress.
• The avoidance, anxious anticipation, or distress
  in the feared situation(s) interferes
  significantly with the person's normal routine,
  occupational (or academic) functioning, or social
  activities or relationships, or there is marked
  distress about having the phobia.
• Duration is at least 6 months.

17
PIESTRAPS

• P
• I
• E
• S
• T
• R
• A
• P
• S

18
PIESTRAPS

• Panic Attack
• Irrational
• Excessive
• Shortness of breath
• Terror
• Reaction
• Anxiety
• Persisted 6months
• Specific

19
DSM-IV Schizophrenia

• Under DSM-IVR, a diagnosis of schizophrenia
• requires 2 or more positive symptoms for a
• period of at least 1 month.

• Positive symptoms
• Auditory hallucinations
• Disorganised speech
• Negative symptoms
• Losing emotional response
• Inability to feel pleasure
• Lack of motivation
• Disorganisation

Schizophrenia is a serious mental disorder
characterised by profound disruption in cognition
and emotion
20
Discussion Carousel Schizophrenia
What is schizophrenia?
What are 3 symptoms you would associate with schizophrenia?
What do you think causes schizophrenia? List as many reasons as you can.
Do you think schizophrenia can be cured? If yes, suggest how.
21
Schizophrenia

• FACT SHEET

• CASE STUDY

• Definition
• Prevalence
• Symptoms
• Types of schizophrenia

• Carroll
• Norma
• Daniel

22
Schizophrenia

• TYPES

• SYMPTOMS

• Disorganised delusions, hallucinations,
  incoherent speech, and large mood swings
• Catatonic almost total immobility for hours at a
  time
• Paranoid delusions of various kinds
• Undifferentiated
• Residual mild symptoms

• Positive symptoms
• Delusions
• Auditory hallucinations
• Disorganised speech
• Thought disorder
• Negative symptoms
• Losing emotional response
• Inability to feel pleasure
• Lack of motivation
• Poverty of speech
• Disorganisation

23
(No Transcript)
24
CSSTABSHEAD

• C
• S
• S
• T
• A
• B
• S
• H
• E
• A
• D

25
CSSTABSHEAD

• Catatonia , Paranoid, Residual, Undifferentiated
• Speech disorganised
• Symptoms positive/negative
• Types
• Auditory hallucination
• Behaviour disorganised
• Split from reality
• Hallucination
• Emotional response impaired
• Absence/present
• Delusions

26
KEY WORDS SCHIZOPHRENIA KEY WORDS SCHIZOPHRENIA
WORD DEFINITION
  A severe psychotic disorder characterized by distortions of reality, disturbances of thought and language and withdrawal from social contact
    The addition of psychotic behaviours
  If someone has a persecution complex, they suffer from the feeling that other people are trying to harm them.
    the belief that you are more important or powerful than you really are
  Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions.
  Inability to carry a conversation short and sometimes disconnected replies to questions speaking
    The absence of normal behaviours
  Marked primarily by delusions that follow a theme, like persecution or grandeur. Auditory hallucinations may accompany a delusion and are, therefore, usually related to its theme. Symptoms common to other subtypes, like disorganized speech and flattened affect, are not usually prominent in episodes of paranoia, but anger, irritability, and extreme anxiety are. People suffering from these type of delusions become particularly preoccupied with them and may be especially prone to violence.
27
KEY WORDS SCHIZOPHRENIA KEY WORDS SCHIZOPHRENIA
WORD DEFINITION
  Marked by disorganized speech, behaviour, and flattened affect is particularly disruptive. Also known as hebephrenic schizophrenia often features fragmented speech and inappropriate or unexpected behaviour that does not reflect ideas expressed verbally. Strange mannerisms, gestures, and surprising behaviour are common. This type of schizophrenia typically causes significant dysfunction in daily life, self-care, and interaction with others, as well as notable thought disturbance and loss of goal-directed behaviour.
  A form of schizophrenia characterized by a tendency to remain in a fixed state for long periods the catatonia may give way to short periods of extreme excitement
    The type given to a lack of catatonia, paranoia, or disorganized speech.
  A type of schizophrenia that is diagnosed when positive symptoms like delusions, hallucinations, and grossly disorganized behaviour has disappeared. Negative symptoms remain and may be interrupted only briefly by mildly disorganized speech or strange behaviour. When delusions or hallucinations occur, even if infrequently, they are not serious enough to cause severe dysfunction.
    When someone believes something that is not true.
  When you see, hear, feel or smell something which does not exist, usually because you are ill or have taken a drug.
28
Exam Style Questions (ESQ)

• January 2010
• Describe the characteristics of a psychotic
  disorder. (10)
• Evaluate difficulties when identifying
  characteristics of psychological disorders. (15)
• June 2013
• Describe the characteristics of one anxiety
  disorder. (10)
• To what extent is it valid to identify a disorder
  from a list of characteristic. (15)
• June 2014
• Outline the characteristics of an affective
  disorder. (10)
• Asses the reliability of identifying a disorder
  from a list of characteristics. (15)

29
Diagnosis

• Purpose
• To identify groups of similar sufferers so that
  psychiatrists and psychologists may develop
  explanations and methods to help those groups
• Billing purposes. The government and many
  insurance companies require a diagnosis for
  payment
• Techniques
• Observation
• Interview
• Psychological tests (e.g. IQ tests)
• Brain scans

30
Exam Style Question

• Plan and prepare a response to the question
• January 2010
• Describe the characteristics of a psychotic
  disorder. (10)
• Evaluate difficulties when identifying
  characteristics of psychological disorders. (15)

31
b. Evaluate difficulties when identifying
characteristics of psychological disorders

1. Highly subjective
2. Method Self-Report
3. Overlap between disorders
4. Symptoms may not always be evident
5. Ethnocentricism
6. Gender Bias
7. Type 1 2 Error

32
Evaluate difficulties when identifying
characteristics of psychological disorders

1. Highly subjective - a lot of the descriptions of
   characteristic refer to "excessive" or
   "irrational", but these are subjective not
   objective descriptions. This could lead to poor
   validity and reliability.
2. Requires self-report from individuals who may not
   perceive their behaviour as abnormal or
   dysfunctional, or who may be prone to
   lying/disordered thoughts and social
   desirability. Validity is an issue here too.
3. Significant overlap between disorders e.g. loss
   of pleasure is a factor in depression and
   schizophrenia, whilst bipolar disorders and
   schizophrenia can feature delusions and
   disordered actions. Anxiety is also somewhat
   common amongst people who are depressed, due to
   feelings of worthlessness and pessimistic
   depressive thought patterns.
4. Symptoms may not always be evident in psychiatric
   evaluations such as loss of pleasure in daily
   activities, or disordered actions. Thus it's
   unobservable. However you do of course have the
   patient to recall these.

33

• 5. Ethnocentrism This questions the
  international validity of diagnoses. For example
  they may be biased to certain countries,
  certainly the DSM is an American invention by the
  APA and therefore may bring into play wrong
  diagnoses based on racism.
• 6. Gender bias Ford and Widiger (1989) raised
  the fundamental question of why those involved in
  diagnosing and classifying disorders are
  predominantly men, when those being diagnosed and
  treated are mainly women? The issue with this is
  that normal stereotypical gender roles might be
  incorrectly labelled as pathological. When
  presented with identical case histories (apart
  from gender - control), 354 psychologists
  diagnosed women mainly with histrionic
  personality disorder, whereas men were more
  likely to be diagnosed with anti-social
  personality disorder.
• 7. Type 1 and type 2 Errors Rosenhan's study
  brought psychiatrists type 2 errors to light
  (diagnosing someone with an illness when in fact
  they do not have one).
• Type 1 errors on the other hand consist of
  diagnosing a patient without an illness when in
  fact they do have one.
• Obviously Type 2 would be the safer option, to
  ensure extra tests and care is taken (just incase
  the patient really does need it), nevertheless it
  is a waste of time.

34
Exam Style Question

• Plan and prepare a response to the question
• June 2013
• Describe the characteristics of one anxiety
  disorder. (10)
• (B) To what extent is it valid to identify a
  disorder from a list of characteristic. (15)

35
b. To what extent is it valid to identify a
disorder from a list of characteristic. (15)

• Validity of diagnosis Does the person diagnosed
  have real symptoms with a real underlying cause?
  (the illness is not socially constructed, the
  person is not faking) Diagnoses may be consistent
  but what if they are wrong?
• Fundamental attribution error There is a
  tendency of practitioners of overemphasizing
  dispositional rather than situational causes of
  behaviour when diagnosing patients.
• Self-Fulfilling prophecy The labelling of
  patients with certain disorders may affect the
  practioners perceptions of them (compare with
  researcher bias), patients may act the label that
  has been given to them. The label itself may
  simplify a problem that is highly complex
• Insanity defense People may fake mental illness
  in order to avoid punishment
• Co-morbidity There are significant individual
  differences for mental disorders. An individual
  may have multiple mental disorders

36
Research Evidence

• Szaz 1967 Many disorders may be culturally
  constructed. If the biological causes of the
  mental disorder are known, the individual may be
  diagnosed with mental disorder (the mental
  illness criterion). If there is no biologically
  underlying cause of the disorder, it is better to
  claim that the individual has problems with
  living.
• Rosenhan's ( 1973) classic study shows this when
  nearly all psuedo-patients were incorrectly
  diagnosed with schizophrenia. 8 sane people could
  get admitted to mental hospitals merely by
  claiming to hear voices.
• Rosenhan (1973) When a teaching hospital was
  told to expect pseudo-patients, they suspected 41
  out of 193 genuine patients of being fakers.

37

• Temerline (1970) Clinically trained
  psychiatrists were influenced in their diagnosis
  by hearing the opinion of a respected authority.
  (expert influence). Participants watched a
  video-taped interview of a healthy individual.
  The authority claimed, even though the person
  only seemed to be neurotic (distress where
  behaviour is not outside social norms, patient
  has not lost touch with reality) he was actually
  psychotic (behaviour is outside social norms,
  loss of touch with reality)
• Chapman Chapman (1967) Beginning clinicians
  observed draw-a-person test drawing randomly
  paired (unknowingly to participants) with symptom
  statements of patients. Although the relationship
  between symptoms and drawings were absent,
  participants rated a high associative strength
  between symptom and drawing characteristics (e.g.
  paranoia and drawing big eyes)
• Lipton Simon (1985) 131 patients were randomly
  chosen at a New York hospital. Initially there
  were 89 patients diagnosed with schizophrenia,
  eventually only 16. Initially, there were 15
  diagnosed with depression, eventually there were
  50.

38
Exam Style Question

• Plan and prepare a response to the question
• Outline the characteristics of an affective
  disorder (10 marks)
• Asses the reliability of identifying a disorders
  from a list of characteristics (15 marks)

39
Asses the reliability of identifying a disorders
from a list of characteristics (15 marks)

• Reliability of diagnosis Will different
  diagnosticians using the same classification
  system arrive at the same diagnosis?
• The consistency of diagnoses. We would expect all
  psychiatrists to diagnose the same set of
  symptoms in the same way. The reliability of
  earlier systems for diagnosis, e.g. DSM-II, was
  very poor, but it has been improved in revisions
  of the systems, e.g. DSM-IV-TR.

40
Asses the reliability of identifying a disorders
from a list of characteristics (15 marks)

• Pedersen et al., (2001) researchers compared the
  consistency of diagnoses and found that 71 of
  psychiatrists agreed with the ICD-10 definition
  of depression when assessing 116 patients
  (inter-rater relibility).
• Beck (1962) Agreement between two psychiatrists
  on diagnosis for 153 patients was 54 . This was
  due to vague criteria for diagnosis and different
  ways of psychiatrists to gather information
• Cooper et. al. (1972) When shown the same video
  clips, New York psychiatrists are twice as likely
  to diagnose schizophrenia than London
  psychiatrists. London psychiatrists were twice as
  likely to diagnose mania or depression than New
  York psychiatrists
• Di Nardo (1993) Two clinicians separately
  diagnosed 267 people seeking treatment for
  anxiety and stress disorders. They found higher
  reliability for obsessive compulsive disorder but
  lower reliability for major depression

41
Conclusion

• There is a large amount of research supporting
  the view that the reliability and validity of
  diagnosis are poor. This is due to many reasons,
  e.g. a possible social construction of mental
  illness, poor diagnostic tools, the possibility
  of faking, social influence, errors in
  attribution by practitioners and labeling
• Ethnocentricism There are significant individual
  and cultural differences for the symptoms of
  mental disorders. An individual may have multiple
  mental disorders
• Ethical Issues A wrong diagnosis may lead to a
  social stigma.

42
Counter argument

• There are methodological problems with the
  studies on validity and reliability (researcher
  bias, generalisability, ecological validity).
• Revised diagnostic tools are higher in
  reliability than earlier versions, e.g.
  DSM-IV-TR.
• Many people do seek help voluntarily for
  disorders (which may mean that the disorder is
  valid).
• The reliability of diagnosis is high for some
  disorders, e.g. obsessive compulsive disorder.
• There are many similarities of disorders across
  cultures.
• Diagnostic systems do not classify people, but
  the disorders that they have.