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What is mental illness? • Psychological Disorders Chapter 13 The medical model • • • Thomas Szasz Criteria • • • • • Diagnostic and Statistical Manual of Mental Disorders DSM-IV Multiaxial • • • • • Axis I: Clinical Syndromes Axis II: Personality Disorders or Mental Retardation Axis III: Medical Conditions Axis IV: Social/Environment Problems Axis V: Global Assessment of Functioning Diagnosis, etiology, prognosis Deviance Maladaptive Personal distress • • Diagnostic and Statistical Manual of Mental Disorders DSM-IV Multiaxial • • • • • Axis I: Clinical Syndromes Axis II: Personality Disorders or Mental Retardation Axis III: Medical Conditions Axis IV: Social/Environment Problems Axis V: Global Assessment of Functioning Disorders • • • • • Anxiety Disorders Somatoform Disorders Mood Disorders Dissociative Disorders Schizophrenia Anxiety Disorders • • • • • Generalized anxiety disorder Phobic disorder Panic disorder/agoraphobia Obsessive-compulsive disorder Post-traumatic stress disorder DSM criteria for GAD 1. Excessive anxiety and worry (apprehensive expectation), occurring more DSM criteria for GAD (cont’d) 4. ! The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a panic attack (as in panic disorder), being embarrassed in public (as in social phobia), being contaminated (as in obsessive-compulsive disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatization disorder), or having a serious illness (as in hypochondriasis), and the anxiety and worry do not occur exclusively during posttraumatic stress disorder. days than not for at least six months, about a number of events or activities (such as work or school performance). 2. The person finds it difficult to control the worry. 3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children. 1. restlessness or feeling keyed up or on edge 2. being easily fatigued (difficulty concentrating or mind going blank) 3. irritability 4. muscle tension 5. sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) 6. excessive sweating 5. ! The anxiety, worry, or physical symptoms cause clinically significant distress Anxiety Disorders Phobias or impairment in social, occupational, or other important areas of functioning. 6. ! The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder. • • • • • • Generalized anxiety disorder Phobic disorder Panic disorder/agoraphobia Obsessive-compulsive disorder Post-traumatic stress disorder • • • Acrophobia • Fear of heights Claustrophobia • Fear of enclosed spaces Androphobia • Fear of men Agoraphobia • Fear of public places Anxiety Disorders • • • • • Generalized anxiety disorder Phobic disorder Panic disorder/agoraphobia Post-traumatic stress disorder Obsessive-compulsive disorder Somatoform Disorders • • • • OCD Compare to: Psychosomatic illness Conversion disorder Hypochondriasis Compare to: • • Malingering Factitious disorder (Munchausen syndrome) • The Sick Role Glove Anesthesia Somatoform Disorders • • • Compare to psychosomatic illness Conversion disorder Hypochondriasis • Compare to: • • • Malingering Factitious disorder (Munchausen syndrome) The Sick Role Mood Disorders • Major depressive disorder Depression Screening Test • Do you feel sad, blue, unhappy or “down in the dumps?” • • Do you feel that you lost interest in sex or experiencing sexual difficulties? Do you feel tired, having little energy, unable to concentrate? • • Do you feel uneasy, restless or irritable? Do you feel it takes you longer than before to make decisions or unable to concentrate? • Do you have trouble sleeping or eating (too little or too much)? • Do you feel inadequate, like a failure or that nobody likes you anymore? • Do you feel that you are not enjoying the activities you used to? • Do you feel guilty without a rational reason, or put yourself down? • Do you feel that things always go or will go wrong no matter how hard you try? Depression Bipolar Disorder • Formerly manic-depressive disorder Genetic Factors in Depression Cognitive Factors in Depression • • Seligman Learned helplessness • • • Interpersonal Factors in Depression Hopelessness theory Pessimistic explanatory style Rumination Suicide Dissociative Disorders • • • Dissociative amnesia Dissociative fugue Dissociative identity disorder • Schizophrenia Schizophrenia Genetics of Schizophrenia Types • • • • • • The Three Faces of Eve Paranoid Catatonic Disorganized Undifferentiated Tardive dyskinesia Positive vs. negative symptoms Neurodevelopmental Hypothesis Culture and disorders • • • Koro Windigo Anorexia nervosa