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90 Cards in this Set
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Psychological disorders
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A harmful dysfunction in which behaviour is judged:
-atypical, disturbing, maladaptive, and unjustifiable. |
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Definition of behaviour as normal or abnormal over time and across cultures.
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-a routine behaviour in one culture may be regarded as disordered in another.
-homosexuality was dropped as abnormal in1973 by American Psychiatric Association. -nicotine dependence was added to the disorders. |
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WHO’s statistics on disorders (2001).
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450 million people worldwide suffer from psychological disorders.
-mental disorders account for 15.4% of the years of life lost due to death or disability worldwide. |
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Prevalence and cost of psychological disorders in Canada Statistics Canada (2003); Public Health Agency of Canada (2002).
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-cost of psychological disorders in 1993 = 7.331 billion
-in 1999, 1.5 million hospital days were due to admissions for different psychological disorders. -increase in hospital admissions for eating disorders by 34% between 1987-1999 for females age 15 and below. |
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Understanding psychological disorders:
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-possessed by demons.
-witches in league with devil. -victims of God’s punishment. |
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Perceived causes of abnormality
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-movements of sun or moon, lunacy--full moon, and evil spirits.
-ancient treatments included exorcisms, rituals and chants |
Consequences of a threatening behaviour
-people were caged like animals, beaten, burned, castrated, mutilated, and their blood was replaced with animal’s blood. |
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Pinel (1745-1826) opposed this brutal treatment
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madness was caused by severe stresses and inhumane conditions, not because of demons.
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Pinel proposed a moral treatment
-boosting patients’ morale and talking with them. -replacing brutality with gentleness. -isolation with activity and filth with clean air and sun. |
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Medical model
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abnormal behaviour has physical causes
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Definition of mental illness as psychopathology
-needs to be diagnosed on the basis of its symptoms and cured through therapy |
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A disease affects only the body, hence, no mental illness (Szasz,1990)
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-abnormal behaviour usually involves a deviation from social norms rather than an illness.
-deviations are ‘problems in living’ rather than medical problems |
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Medical model’s concepts in the treatment and study of abnormality
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diagnosis, aetiology, epidemiology, prevalence and prognosis
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Diagnosis.
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distinguishing one illness from another
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Aetiology
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causation and developmental history of an illness
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Epidemiology
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distribution of mental/physical disorders in a population
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Prevalence
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percentage of a population that exhibits a disorder during a specified time period
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Prognosis
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forecast about the probable course of an illness
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Bio-psycho-social perspective
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The biological, sociocultural, and psychological factors interact to produce psychological disorders
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Reasons for a psychological disorders
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-a growth blocking difficulty in the environment.
-person’s perception or interpretation of the events. -person’s bad habits and poor social skills |
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Definition and criteria in the diagnosis of abnormality
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(1) deviance,
(2) maladaptive behaviour (3) personal distress |
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Classifying psychological disorders
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Diagnostic and Statistical Manual of Mental Disorders (DSM) by American Psychiatric Association in1952.
-Fourth edition (DSM-IV) released in 1994 included improvements based on research. |
A current authoritative scheme for classifying psychological disorders is the DSM-IV-TR, updated as a 2000 ‘text revision’.
-progress in making psychodiagnosis reliable, valid, and scientific. |
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In 2010, the American Psychiatric Association released the first draft of the upcoming DSM-5, a revision to appear in 2013.
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Proposed changes to the diagnostic labels.
-mental retardation to become intellectual developmental disorder. -new proposed categories of disorders; hypersexual disorder, hoarding disorder, and binge-eating disorder. |
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Aim of the new DSM-5
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-to support the integration of psychiatric diagnoses into mainstream medical practice.
The eleventh edition of the World Health Organization’s International Classification of Diseases (ICD-11). -covers both medical and psychological disorders; expected in 2014. |
Goals of diagnostic classification.
-describe a disorder and predict its future course. -imply appropriate treatment and stimulate research into its causes. |
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DSM-IV:
Widely used scheme for classifying psychological disorders |
-DSM-IV was developed in coordination with ICD-10; WHO’s International Classification of diseases
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-DSM-IV is a multiaxial system of classification comprised of five separate dimensions or axes
-diagnosis of disorders is made on Axes I and II. -clinicians record most types of disorders on Axis I. -Axis II lists personality disorders or mental retardation People may receive diagnosis on both Axes I and II |
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Axis III
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patient’s physical disorders (general medical conditions).
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Axis IV of DSM-IV
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types of stresses experienced by the individual in the past year (psychosocial and environmental problems)
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Axis V of DSM-IV
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individual’s current level of adaptive functioning (social and occupational behaviour).
highest level of functioning in the past year. |
Increase in the number of disorder categories from 100 to 400 over the past 50 years
-chances of an adult to meet the criteria of a disorder has increased to 30%. |
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Culture specific disorders on DSM-IV.:
Anorexia nervosa and bulimia are found in the Western cultures. |
Susto is found in Latin America.
-sever anxiety, restlessness, fear of black magic, reflects soul loss. Latah is observed in women in Malaysia. -hysteria and echolalia. Fajin-kyofusho is found in Japan. -social anxiety with one’s appearance; readiness to blush and a fear of eye contact. |
Whakama is a New Zealand Maori construct.
-shame, self-abasement, feelings of inferiority, inadequacy, self-doubt, shyness, excessive modesty and withdrawal. Witiko is a disorder in Algonquin Indians in Canada. -individual is possessed by Witiko spirit, a man eating monster. -cannibalistic behaviour or suicide ideation to avoid acting on the cannibalistic urges. Koro is observed in Southeast Asian men. -impotence resulting from obsessive fear that penis is retracting. |
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Culture specific disorders on DSM-IV.:
Anorexia nervosa and bulimia are found in the Western cultures. Cont.. |
Sinking heart is a condition of distress in the Punjabi culture.
-physical sensations in the heart or chest. -caused by excessive heat, exhaustion, worry, or social failure. -resembles depression and cardiovascular disease. Amok is found in Malaysia, Philippines and Thailand. -sudden rage and homicidal aggression. -stress, sleep deprivation and social withdrawal. Pibloktoq is a type of Arctic hysteria found in Inuit. |
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Labelling psychological disorders:
Labels are helpful in diagnosis; involve value judgements on normal or abnormal behaviour |
The criteria of mental illness is not value-free as the criteria of physical illness.
-a malfunctioning heart or kidney is pathological regardless of the personal values. -judgements about mental illness reflect prevailing cultural values, social trends, and political forces, and scientific knowledge. -antonyms; normal–abnormal and mental health–mental illness divide people into two groups. |
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Distinction of normal from abnormal
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-everybody acts in deviant ways, displays some maladaptive behaviour, and experiences personal distress.
-labels create preconceptions that guide our perceptions and our interpretations. |
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Biasing power of diagnostic labels
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Test of clinical insight of mental health workers.
-pseudo-patients were sent to the hospitals who complained of ‘hearing voices’. -reported their life histories honestly. -exhibited no further symptoms. -only provided false personal information. |
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Most were diagnosed as ‘schizophrenics’ and were kept in the hospital for 2-3 weeks.
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-clinicians searched for early incidents in the life histories of these patients and hospital behaviour that confirmed the diagnosis.
-even the normal behaviours of the patients were misinterpreted as symptoms (e.g., taking notes). -when informed about this experiment, clinicians did not accept their blunders. |
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Labels stigmatize people
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A confederate called people in Toronto who were advertising furnished rooms for rent.
-when she asked if the room was available, the answer was yes. -when she said she was about to be released from a mental hospital, the answer was ¾ of the time no. -also no, when she said she was calling for her brother who was about to be released from the jail. |
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Influence of media on perceptions of disorders and stereotype formation
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-‘beautiful mind’(mathematician Nash’s portrayal).
-homicidal, freaks, violent criminals and alcoholics. -90% of mental patients are not dangerous. -anxious, depressed and socially withdrawn. |
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Measurement of psychological disorders:
Methods of assessing psychological disorders |
-open-ended and structured interviews.
-self-reports, observations, and questionnaires. -rating scales, and psychological tests. |
Problems of the techniques
-reliability and the validity of the instruments |
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Anxiety disorders:
Feelings of excessive apprehension and anxiety. |
Most of us feel anxiety on certain occasions.
-avoid eye contact. -avoid talking to someone (shyness). -anxious of public speaking. |
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Types of anxiety disorders.
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-Generalized anxiety disorder.
-Panic disorder and agoraphobia. -Phobic disorder. -Obsessive compulsive disorder. |
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Generalized anxiety disorder
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A chronic, high level of anxiety not tied to any specific threat.
-person is tense, apprehensive, and in a state of autonomic nervous system arousal. |
Symptoms of generalized anxiety disorder.
-dizziness, sweating palms, heart palpitations, and ringing in the ears. -unfocused, out of control and having negative feelings. -2/3 are women, who are tense and jittery, and worried about the happening of bad things. person cannot identify the cause of the anxiety. |
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Panic disorder and agoraphobia
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Sudden and recurring attacks of overwhelming anxiety.
-a minutes-long episode of intense dread. -experiencing terror and accompanying chest pain. -choking, or other frightening sensation. |
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Misperceived as a heart attack
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shortening of breath, heart palpitation ,dizziness, and trembling
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Agoraphobia is the fear of open or public places
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people avoid being outside of house, in a crowd, on a bus or on an elevator
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Phobic disorder.
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An individual’s anxiety has a specific focus.
-persistent and irrational fear of an object or situation that presents no realistic danger. -common phobias are of animals, insects, heights, blood or tunnels. -people with social phobia avoid potentially embarrassing social situations. |
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Obsessive-compulsive disorder.
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-Obsessions: thoughts that repeatedly intrude on one’s consciousness in a distressing way.
-Compulsions: actions that one feels forced to carry out. |
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Persistent obsession and compulsion interfere with normal living
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repeatedly checking one’s handbag for the keys
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Obsessions often centre on inflicting harm on others, personal failure, suicide, or sexual acts.
Post-traumatic stress disorder (PTSD) |
Triggered by a variety of traumatic events.
-rape or assault. -a severe automobile accident. -a natural disaster. -witnessing of someone’s death. |
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The greater one’s emotional distress during a trauma, the higher the risk for post-traumatic symptoms
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A sensitive limbic system seems to increase vulnerability.
-floods the body with stress hormones as images of the traumatic experience erupt into consciousness. -Brain scans of PTSD patients suffering memory flashbacks reveal aberrant and persistent right temporal lobe activation. |
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The role of genes shows that some PTSD symptoms may actually be genetically predisposed.
PTSD surface after months/years after a person’s exposure to severe stress |
Symptoms of PTSD.
-re-experiencing the traumatic event in the form of nightmares and flashback. -emotional numbing, alienation. -problems in social relations. -an increased sense of vulnerability. -Elevated arousal, anxiety, anger, and guilt. -risk for substance abuse, depression, and suicide attempts. |
PTSD symptoms usually decline gradually over time.
-recovery is gradual, symptoms never completely disappear. |
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Impressive survivor resiliency of those who do not develop PTSD
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-half of adults experience at least one traumatic event in their lifetime.
-about 1/10 women and 1/20 men develop PTSD |
-Suffering can lead to ‘benefit finding’ called post-traumatic growth.
-Struggle with challenging crises leads people later to report an increased appreciation for life. Suffering has transformative power. -compared with those unchallenged by any adversity, people who face some adversity -enjoy better mental health and well-being |
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Explaining anxiety disorders
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Psychoanalytic approach (Freud).
-repression of threatening impulses causes anxiety. |
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Biological and learning approaches:
The leaning approach. |
1. Fear conditioning
experience of unpredictable negative events that are beyond the control of the individual results in anxiety. 2. Stimulus generalization. a person attacked by a pit bull generalizes the fear to all the dogs. 3. Reinforcement. escaping the feared situation reduces anxiety. 4. Observational learning. learning of fear by observing others’ fears. |
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Mood disorders
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-Common cold of psychological disorders.
-Emotional disturbances of varied kinds that disrupt physical, perceptual, social, and thought processes. |
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Types of mood disorders
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1. major depressive disorder or unipolar disorder.
2. bipolar disorder (manic-depressive disorder). |
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Major depressive disorder (diagnosis)
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-two or more weeks of depressed mood; no apparent reason.
-feelings of worthlessness. -diminished interest or pleasure in most activities. |
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Depression increases in winter from 11% to 29% called seasonal affective disorder (SAD).
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Symptoms for major depression.
-feeling discouraged about the future. -dissatisfaction with one’s life. -isolated from others. -difficulty concentrating. -sleep disturbances. -weight loss/gain and loss of libido. -suicidal tendencies. -lack of energy/exhaustion. |
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Depression statistics by Canadian Health Agency (2002)
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-about 8% of Canadians endure a depressive disorder at some time in their lives.
-1% suffer from a bipolar disorder. -young Canadians and females are more vulnerable to depression. |
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Bipolar disorder (manic- depressive)
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Alternating between the hopelessness and lethargy of depression and the overexcited state of mania
-People return to the normal mood after a depressive episode |
Some people rebound to the manic episode.
-over talkative, overactive, elated, needs little sleep, sexually less inhibited, loud, undependable and hard to interrupt. Maladaptive symptoms of mania. -euphoric mood, hyperactivity and wild optimism. |
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Theories of depression
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Explanations of mood disorders.
-biological and social-cognitive perspectives. The biological perspective. -genetic predispositions and biochemical imbalances. |
Genetic influences.
-high risk of depressive disorder among the family members. -50% chances of depression in identical twins. -70% chances of bipolar disorder in identical twins. -20% chances among fraternal twins. Linkage analysis is used to identify genes involved in depression |
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Biochemical imbalances
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Neurotransmitters play a major role.
-norepinephrine is high during the manic but low during the depressive phase. -serotonin level is low during depression. |
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The social-cognitive perspective
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Psychological processes related to information processing are the cause of depression.
-negative thoughts influence biochemical processes that accentuate depressing thoughts, --e.g., ‘self-defeating beliefs’. -depressed people magnify bad events, minimize good ones. -have negative assumptions about themselves, the situations, and the future. -self defeating beliefs may arise from ‘learned helplessness’. |
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Gender differences in uncontrollable events
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35% of women and 16% of men feel overwhelmed by the new situation and the tasks
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Our attributions of failures and bad events explain depression
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Depressed attributional style
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Depressed people explain their setbacks in characteristic way along three dimensions.
-internal rather than external (it’s my fault). -stable rather than unstable (it will not change). -global rather than specific (it affects all of my life). |
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Schizophrenia
‘split mind’ |
Schizophrenic disorders are a class of disorders.
-delusions, hallucinations, disturbed emotions disorganized speech and deterioration of adaptive behaviour. -biobehaviorual disorder that is manifested in cognition (Heinrichs,2005). |
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Prevalence estimates by WHO (2002)
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1% of the world population suffer from schizophrenia; about 24 millions across the world.
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Symptoms of schizophrenia:
Delusions and irrational thoughts |
false beliefs, often of persecution or grandeur, that may accompany psychotic disorder
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Beliefs of schizophrenics
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-thoughts are controlled by some external force.
-thinking becomes chaotic rather than logical. -loosening of association; people shift topics in disjointed way. |
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Hallucinations
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Sensory perceptions that occur in the absence of a real, external stimulus; distortion of perceptual input
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The most common hallucinations are auditory.
-reporting of hearing voices of nonexistent or absent people talking to them. -voices provide an insulting commentary on the person’s behaviour. -voices may be argumentative or issue commands. |
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Emotional disturbances
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Normal emotional tone is disrupted.
-little emotional responsiveness called ‘blunted or flat affect’. -inappropriate emotional responses that do not relate to the situation or to what they are saying. |
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Deterioration of adaptive behaviour
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Deterioration in the quality of the person’s routine functioning.
-work, social relations, and personal care. -friends will often make remarks such as ‘Bush just isn’t himself anymore’. |
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Subtypes of schizophrenia
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Four types of schizophrenic disorders, and a category for people who do not fit into any of the first three categories.
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-Paranoid schizophrenia.
-Catatonic schizophrenia -Disorganized type. -Undifferentiated type. |
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-Paranoid schizophrenia.
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Dominated by delusions of persecution and delusions of grandeur.
-become suspicious of friends and relatives or may attribute the persecutions to mysterious, unknown persons. -believe, they are important people, frequently seeing themselves as great inventors or as famous religious or political leaders. |
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-Catatonic schizophrenia
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Marked by striking motor disturbances, ranging from muscular rigidity to random motor activity.
-some go into an extreme form of withdrawal known as ‘catatonic stupor’. -remain motionless and seem oblivious to the environment for long periods of time. -become hyperactive and incoherent called ‘catatonic excitement’. -some alternate between these dramatic extremes. |
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-Disorganized type.
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Severe deterioration of adaptive behaviour.
-emotional indifference and frequent incoherence. -virtually complete social withdrawal. -aimless babbling and giggling are common. -delusions often centre on bodily functions. |
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-Undifferentiated type.
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Schizophrenics who cannot be placed in any of the three categories.
-marked by idiosyncratic mixtures of schizophrenic symptoms and is fairly common. |
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Aetiology of schizophrenia
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-The aetiology of schizophrenia is like other disorders.
-Genetic vulnerability. -Heredity plays a role in the development of schizophrenia. -Twin studies on schizophrenia |
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Neurochemical factors
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Changes in the activity of neurotransmitters in the brain.
-excess dopamine activity is a possible cause of schizophrenia. drugs used in the treatment of schizophrenia dampen dopamine activity in the brain. abnormalities in neural circuits using ‘glutamate’ as a neurotransmitter may play a role in -schizophrenia. |
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Structural abnormalities in the brain.
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The cognitive deficits in information processing suggest that schizophrenia may be caused by neurological deficits
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Neurodevelopmental hypothesis
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-schizophrenia may be caused by disruptions in the normal maturational processes of the brain before or at birth.
-any form of abuse to the brain during prenatal development or during the birth causes neurological damage. -increases individual’s vulnerability to schizophrenia later in life. |
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The sources of abuse
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-viral infections and malnutrition.
-obstetrical complications during the birth. -greater risk of schizophrenia if exposure to flu epidemic during the fetal development (influenza in Finland during 1957). -children of mothers who suffered from influenza during pregnancy are also at greater risk. |
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Prenatal malnutrition increases risk of schizophrenia
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-a cohort prenatally exposed to a sever famine during the World War II in 1944-45 showed higher incidence of schizophrenia.
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Psychological factors
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Initial belief of some psychologists.
-no environmental causes of schizophrenia unless the person has some family history of schizophrenia. |
Stress plays a key role in triggering schizophrenic disorders.
-biological and psychological factors influence individual’s vulnerability to schizophrenia. -high stress may precipitate schizophrenia in someone who is vulnerable. |
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Personality disorders
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People with personality disorders display certain personality traits to an excessive degree and in rigid ways.
-undermines their adjustment, usually without anxiety, depression, or delusions. |
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Personality disorders emerge during late childhood or adolescence and continue throughout adulthood
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DSM IV lists ten personality disorders.
Antisocial personality disorder. -person violates the rights of others. -fails to accept social norms. -is unable to sustain consistent work behaviour. -exploitative and reckless (82% men, 18% women). |
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Avoidant personality disorder
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person is usually withdrawn and anxiously sensitive toward rejection (50% both).
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Schizoid personality disorder
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person is socially disengaged and shows eccentric behaviours (78% men, 22% women).
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Histrionic personality disorder.
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person displays shallow, attention-getting emotions and every effort to get others’ praise and reassurance (15% men, 85% women).
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Narcissistic personality disorder
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person exaggerates his/her own importance, has fantasies of success, and reacts to criticism with rage or shame (70% men, 30% women).
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Borderline personality disorder
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person has an unstable identity, Borderline personality disorder unstable relationships and unstable emotions (38% men, 62% women).
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Antisocial personality disorder has both biological and psychological causes.
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Antisocial personality disorder has both biological and psychological causes.
-twin and adoption studies indicate the role of biological factors in antisocial behaviour. -PET scans of murderers’ brains indicate low activity in their frontal lobe, which controls impulses. |
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Role of biological and social factors in criminality.
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-babies whose backgrounds were marked by both biological and social problems were twice as likely to be criminal offenders than those with either biological or social risks.
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Dissociative disorders
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Dissociation is incapacity to integrate one’s thoughts, feelings, or experiences into one’s consciousness.
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conscious awareness becomes separated from previous memories, thoughts, and feelings.
experience of a sudden loss of memory or change in identity |
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Dissociative identity disorder
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-person exhibits two or more distinct and alternating personalities.
-each personality has its own voice and mannerisms, and the original one typically denies any awareness of the other/s. |
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