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Introduction and history of mental illness abnormal behaviour Document Transcript

  • 1. 4/13/2013 1 13/04/2013 DR. Mohamed S. Khalil 1 Definitions of Abnormality INTRODUCTION TO ABNORMAL PSYCHOLOGY 13/04/2013 DR. Mohamed S. Khalil 2 Definitions of Abnormality • Today there are various definitions that are used by psychologists and people in general for defining abnormal behavior. • The biopsychosocial perspective affect the entire spectrum from diagnosis to treatment of the various disorders. • These definitions are not necessarily mutually exclusive. • Here are the six basic approaches
  • 2. 4/13/2013 2 13/04/2013 DR. Mohamed S. Khalil 3 Definitions of Abnormality • A) Statistical deviation: a significant deviation from the average/majority •B. Social norm violation: Breaking social "rules". rity. C. Maladaptive behavior D. Personal distress: E. Deviation from an ideal: F. Medical disorder • No one definition is the "correct" or the "best" definition. ..And each definition can certainly be challenged... 13/04/2013 DR. Mohamed S. Khalil 4 Psychological Models of Mental Illness • Psychoanalytic model • Behavioral model • Cognitive Model • Cognitive-behavioral Learning Models • Humanistic model • Social Models: The Individual In Context: Social Systems & Family Systems
  • 3. 4/13/2013 3 13/04/2013 DR. Mohamed S. Khalil 5 Classifying Psychopathology • Mental illness is classified today according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV), published by the American Psychiatric Association (1994). • The DSM uses a multiaxial or multidimensional approach to diagnosing because rarely do other factors in a person's life not impact their mental health. It assesses five dimensions as described below: 13/04/2013 DR. Mohamed S. Khalil 6 Classifying Psychopathology • Axis I: Clinical Syndromes • This is what we typically think of as the diagnosis (e.g., depression, schizophrenia, social phobia). • Pervasive Developmental disorders are also included in this axis. • Developmental disorders include autism and disorders which are typically first evident in childhood • Axis II: Personality Disorders& Mental Retardation • Personality disorders are clinical syndromes which have a more long lasting symptoms and encompass the individual's way of interacting with the world. They include Paranoid, Antisocial, and Borderline Personality Disorders.
  • 4. 4/13/2013 4 13/04/2013 DR. Mohamed S. Khalil 7 The DSM-IV AXIS • Axis III: Physical Conditions which play a role in the development, continuance, or exacerbation of Axis I and II Disorders • Physical conditions such as brain injury or HIV/AIDS that can result in symptoms of mental illness are included here. • Axis IV: Severity of Psychosocial Stressors • Events in a persons life, such as death of a loved one, starting a new job, college, unemployment, and even marriage can impact the disorders listed in Axis I and II. These events are both listed and rated for this axis. • Axis V: Highest Level of Functioning • On the final axis, the clinician rates the person's level of functioning both at the present time and the highest level within the previous year. This helps the clinician understand how the above four axes are affecting the person and what type of changes could be expected. 13/04/2013 DR. Mohamed S. Khalil 8 Psychiatric Disorders (AXIS-1) 1. AXIS(I) • 1.Delirium, Dementia, Amnestic, and Other Cognitive Disorders • The primary symptoms of these disorders include significant negative changes in the way a person thinks and/or remembers. All of these disorders have either a medical or substance related cause • 2. Mental Disorders Due to a Medical Condition • Like those above, all disorders in this category are directly related to a medical condition. If symptoms of anxiety, depression, etc are a direct result of a medical condition, this is the classification used.
  • 5. 4/13/2013 5 13/04/2013 DR. Mohamed S. Khalil 9 Psychiatric Disorders (AXIS-1)•3. Substance Related Disorders •There are two disorders listed in this category: Substance Abuse and Substance Dependence. •Both involve the ingestion of a substance (alcohol, drug, chemical) which alters either cognitions, emotions, or behavior. Abuse refers to the use of the substance to the point that it has a negative impact on the person's life. This can mean receiving a fine for drinking and driving, being arrested for public intoxication, missing work or school, getting into fights, or struggling with relationships because of the substance 13/04/2013 DR. Mohamed S. Khalil 10 Psychiatric Disorders (AXIS-1) • 3. Substance Related Disorders Dependence refers to what we typically think of as 'addicted.' This occurs when: 1. the use of the substance is increased in order to get the same effect because the person has developed a tolerance, 2. the substance is taken more frequently and in more dangerous situations such as drinking and driving, or 3. the person continues to take the substance despite negative results and/or the desire to quit, or 4. withdrawal symptoms are present when the substance is stopped, such as delirium tremors (DTs), amnesia, anxiety, headaches, etc.
  • 6. 4/13/2013 6 13/04/2013 DR. Mohamed S. Khalil 11 Psychiatric Disorders (AXIS-1) • 4. Schizophrenia and other Psychotic Disorders • The major symptom of these disorders is psychosis, or delusions and hallucinations. The major disorders include schizophrenia and schizoaffective disorder. • Schizophrenia is probably the most recognized term in the study of psychopathology, and it is probably the most misunderstood. First of all, it does not mean that the person has multiple personalities. The prefix 'schiz' does mean split, but it refers to a splitting from reality. 13/04/2013 DR. Mohamed S. Khalil 12 Psychiatric Disorders (AXIS-1) • 4. Schizophrenia and other Psychotic Disorders • The major symptom of these disorders is psychosis, or delusions and hallucinations. The major disorders include schizophrenia and schizoaffective disorder. • Schizophrenia is probably the most recognized term in the study of psychopathology, and it is probably the most misunderstood. First of all, it does not mean that the person has multiple personalities. The prefix 'schiz' does mean split, but it refers to a splitting from reality.
  • 7. 4/13/2013 7 13/04/2013 DR. Mohamed S. Khalil 13 Psychiatric Disorders (AXIS-1) • 4. Schizophrenia and other Psychotic Disorders • The major symptom of these disorders is psychosis, or delusions and hallucinations. The major disorders include schizophrenia and schizoaffective disorder. • Schizophrenia is probably the most recognized term in the study of psychopathology, and it is probably the most misunderstood. First of all, it does not mean that the person has multiple personalities. The prefix 'schiz' does mean split, but it refers to a splitting from reality. 13/04/2013 DR. Mohamed S. Khalil 14 Psychiatric Disorders (AXIS-1) • 4. Schizophrenia and other Psychotic Disorders • The predominant features of schizophrenia include hallucinations and delusions and disorganized speech and behavior, inappropriate affect, and volition. There is no known cure for schizophrenia and is without doubt the most debilitating of all the mental illnesses. • Schizoaffective Disorder is characterized by a combination of the psychotic symptoms such as in Schizophrenia and the mood symptoms common in Major Depression and/or Bipolar Disorder. The symptoms are typically not as severe although when combined together in this disorder, they can be quite debilitating as well.
  • 8. 4/13/2013 8 13/04/2013 DR. Mohamed S. Khalil 15 Schizophrenia • Diagnostic Criteria • Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated): • delusions • hallucinations • disorganized speech (e.g., frequent derailment or incoherence) • grossly disorganized or catatonic behaviour • negative symptoms (i.e., affective flattening,) 13/04/2013 DR. Mohamed S. Khalil 16 Schizophrenia • Schizophrenic Symptoms: Types • Positive symptoms: • active symptoms like hallucinations, delusions, incoherent speech, disorganized thinking. responds better to medications • Negative symptoms: • Lacks appropriate emotional experience • inappropriate, blunted/flat affect • Avolition: lacks volition and motivation to do things • Alogia: poverty of speech
  • 9. 4/13/2013 9 13/04/2013 DR. Mohamed S. Khalil 17 Delusional Disorder • There isn’t a single type of Delusional Disorder. There are a number of subtypes, but they share a major common feature. This is that the person has a non-bizarre delusion - a delusion that could occur in real life. • For example, a person that feels they are being followed or poisoned is non-bizarre, while a person who feels their parents are from mars is bizarre. 13/04/2013 DR. Mohamed S. Khalil 18 Delusional Disorder • The subtypes are • Erotomanic, in which the person believes that a person of usually higher status is in love with them; • Grandiose, which is delusions of inflated worth, power, knowledge, identity, or special relationships; • Jealous is that where they believe the sexual partner is unfaithful; • Persecutory by which they believe they or someone they are close to is being maltreated; • Somatic, in which they believe they have a physical problem, defect, or illness; or, the mixed type, in which more than one of the previous types is present.
  • 10. 4/13/2013 10 13/04/2013 DR. Mohamed S. Khalil 19 Psychiatric Disorders (AXIS-1) • 5. Mood Disorders • The disorders in this category include those where the primary symptom is a disturbance in mood. The disorders include: • Major Depression, • Dysthymic Disorder, • Bipolar Disorder, and • Cyclothymia. 13/04/2013 DR. Mohamed S. Khalil 20 Psychiatric Disorders (AXIS-1) • Major Depression (also known as depression or clinical depression) is characterized by depressed mood, diminished interest in activities previously enjoyed, weight disturbance, sleep disturbance, loss of energy, difficulty concentrating, and often includes feelings of hopelessness and thoughts of suicide. • Dysthymia is often considered a lesser, but more persistent form of depression. Many of the symptoms are similar except to a lesser degree. Also, dysthymia, as opposed to Major Depression is more steady rather than periods of normal feelings and extreme lows.
  • 11. 4/13/2013 11 13/04/2013 DR. Mohamed S. Khalil 21 Psychiatric Disorders (AXIS-1) • Bipolar Disorder (previously known as Manic- Depression) is characterized by periods of extreme highs (called mania) and extreme lows as in Major Depression. Bipolar Disorder is subtyped either I (extreme or hypermanic episodes) or II (moderate or hypomanic episodes). • Like Dysthymia and Major Depression, Cyclothymia is considered a lesser form of Bipolar Disorder. 13/04/2013 DR. Mohamed S. Khalil 22 Psychiatric Disorders (AXIS-1) • 6. Anxiety Disorders • Anxiety Disorders categorize a large number of disorders where the primary feature is abnormal or inappropriate anxiety. The disorders in this category include: • Panic Disorder, • Agoraphobia, • Specific Phobias, • Social Phobia, • Obsessive-Compulsive Disorder, • Posttraumatic Stress Disorder, and • Generalized Anxiety Disorder.
  • 12. 4/13/2013 12 13/04/2013 DR. Mohamed S. Khalil 23 • Panic Disorder is characterized by a series of panic attacks. A panic attack is an inappropriate intense feeling of fear or discomfort including many of the following symptoms: heart palpitations, trembling, shortness of breath, chest pain, dizziness. • These symptoms are so severe that the person may actually believe he or she is having a heart attack. In fact, many, if not most of the diagnoses of Panic Disorder are made by a physician in a hospital emergency room. Psychiatric Disorders (AXIS-1) 13/04/2013 DR. Mohamed S. Khalil 24 Psychiatric Disorders (AXIS-1) • Agoraphobia: It refers to a series of symptoms where the person fears, and often avoids, situations where escape or help might not be available, such as shopping centers, grocery stores, or other public place. • Agoraphobia is often a part of panic disorder if the panic attacks are severe enough to result in an avoidance of these types of places. • Specific or Simple Phobia and Social Phobia represents an intense fear and often an avoidance of a specific situation, person, place, or thing. To be diagnosed with a phobia, the person must have suffered significant negative consequences because of this fear and it must be disruptive to their everyday life.
  • 13. 4/13/2013 13 13/04/2013 DR. Mohamed S. Khalil 25 Psychiatric Disorders (AXIS-1) • Generalized Anxiety Disorder: • is diagnosed when a person has extreme anxiety in nearly every part of their life. It is not associated with just open places (as in agoraphobia), specific situations (as in specific phobia), or a traumatic event (as in PTSD). The anxiety must be significant enough to disrupt the person's everyday life for a diagnosis to be made. 13/04/2013 DR. Mohamed S. Khalil 26 Psychiatric Disorders (AXIS-1) • Obsessive-Compulsive Disorder is characterized by obsessions (thoughts which seem uncontrollable) and compulsions (behaviors which act to reduce the obsession). Most people think of compulsive hand washers or people with an intense fear of dirt or of being infected. These obsessions and compulsions are disruptive to the person's everyday life, with sometimes hours being spent each day repeating things which were completed successfully already such as checking, counting, cleaning, or bathing.
  • 14. 4/13/2013 14 13/04/2013 DR. Mohamed S. Khalil 27 • Posttraumatic Stress Disorder (PTSD) occurs only after a person is exposed to a traumatic event where their life or someone else's life is threatened. • The most common examples are war, natural disasters, major accidents, and severe child abuse. • Once exposed to an incident such as this, the disorder develops into an intense fear of related situations, avoidance of these situations, reoccurring nightmares, flashbacks, and heightened anxiety to the point that it significantly disrupts their everyday life. Psychiatric Disorders (AXIS-1) 13/04/2013 DR. Mohamed S. Khalil 28 Psychiatric Disorders (AXIS-1) • 7. Somatoform Disorders • Disorders in this category include those where the symptoms suggest a medical condition but where no medical condition can be found by a physician. Major disorders in this category include Somatization Disorder, Pain Disorder, Hypochondriasis. • Somatization Disorder refers to generalized or vague symptoms such as stomach aches, sexual pain, gastrointestinal problems, and neurological symptoms which have no found medical cause. • Pain Disorder refers to significant pain over an extended period of time without medical support. • Hypochondriasis is a disorder characterized by significant and persistent fear that one has a serious or life-threatening illness despite medical reassurance that this is not true.
  • 15. 4/13/2013 15 13/04/2013 DR. Mohamed S. Khalil 29 Psychiatric Disorders (AXIS-1) • 8. Factitious Disorder • Factitious Disorder is characterized by the intentionally produced or feigned symptoms in order to assume the 'sick role.‘ • These people will often ingest medication and/or toxins to produce symptoms and there is often a great secondary gain in being placed in the sick role and being either supported, taken care of, or otherwise shown pity and given special rights. 13/04/2013 DR. Mohamed S. Khalil 30 Psychiatric Disorders (AXIS-1) • 9. Dissociative Disorders • The main symptom cluster for dissociative disorders include a disruption in consciousness, memory, identity, or perception. In other words, one of these areas is not working correctly causing significant distress within the individual. The major diagnoses in this category include: • Dissociative Amnesia, • Dissociative Fugue, • Depersonalization Disorder, and • Dissociative Identity Disorder.
  • 16. 4/13/2013 16 13/04/2013 DR. Mohamed S. Khalil 31 • Dissociative Amnesia is characterized by memory gaps related to traumatic or stressful events which are too extreme to be accounted for by normal forgetting. A traumatic event is typically a precursor to this disorder and memory is often restored. • Dissociative Fugue represents an illness where an individual, after an extremely traumatic event, abruptly moves to a new location and assumes a new identity. This disorder is very rare and typically runs its course within a month. Psychiatric Disorders (AXIS-1) 13/04/2013 DR. Mohamed S. Khalil 32 Psychiatric Disorders (AXIS-1) • Dissociative Disorders • Depersonalization Disorder, occurring after an extreme stressor, includes feelings of unreality, that your body does not belong to you, or that you are constantly in a dreamlike state. • Dissociative Identity Disorder (DID) is most widely known as Multiple Personality Disorder or MPD. DID is the presence of two or more distinct personalities within an individual. • These personalities must each take control of the individual at varying times and there is typically a gap in memory between personalities or "alters." This disorder is quite rare and a significant trauma such as extended sexual abuse is usually the precursor.