Download Chapter 6 Abnormal mental state and maladaptive behavior

Chapter 6 Abnormal mental state and maladaptive behavior
Section 1 Abnormal mental state : an overview
1.Definition of abnormal mental state
Abnormal mental state refers to the abnormality of mental process and
personality, such as perception, thought, memory, intellect, attention, emotion, will,
behavior etc.
Abnormal mental state is a mental condition that causes significant distress or
disability, is not merely an expectable response to a particular event, and is a
manifestation of mental dysfunction.
Maladaptive behavior is behavior that deviates from the norms of the society in
which it is enacted.
DSM-IV definition of mental disorder：A mental disorder is “conceptualized as a
clinically significant behavioural or psychological syndrome or pattern that occurs in
an individual and that is associated with present distress or disability or with a
significantly increased risk of suffering death, pain, disability, or an important loss of
freedom.” “The syndrome or pattern must not be merely an expectable and culturally
sanctioned response to a particular event, for example, the death of a loved one.” “It
must currently be considered a manifestation of a behavioural, psychological, or
biological dysfunction in the individual.”
2.Criteria of judgment
Personal distress (Subjective distress) criterion
Statistical criterion (Deviation from statistical norms)
Medical criterion
Social adaptation criterion (Deviation from social norms)
Time criterion (Length of time)
Dysfunction
2.1 Personal distress (subjective distress) criterion
A person has a mental disorder if they experience personal distress. Mental
disorder may be defined as abnormal if it creates subjective distress. (E.g., a hallmark
of mood and anxiety disorders is heightened subjective distress.)
Problem: Not all distressed individuals are mentally ill & some mentally ill
individuals do not show distress (psychopaths).
2.2 Statistical criterion (Deviation from statistical norms)
A person has a mental disorder when their behavior, ability, or experience is
significantly different from average. Abnormal behavior is often infrequent.
Problem: ①We want to use the term disorder to describe some conditions that
are statistically infrequent. ②“positive” deviations are not distinguished from
“negative” deviations. ③Not all unusual behavior is considered abnormal!!
(e.g.,
superior athletic, musical, or intellectual ability)
2.3 Medical criterion
The medical criterion proposes that mental disorders have a biological basis, can
be classified into discrete categories, and are analogous to physical disease.
Symptoms: Signs of a disorder
Diagnosis: To distinguish one from another
Etiology: Cause
Prognosis: The likely course of the disorder
The medical criterion thinks of abnormal behavior as a disease,“mental illness”
or “psychological disorder”. Rise of medical model brought improvement in treatment.
It is viewed with more sympathy, less fear.
Problems: ①Labelling ②Encourages passivity
2.4 Social adaptation criterion (Deviation from social norms)
A person has a mental disorder if they have experiences and exhibit behaviours
that are inconsistent with the norms and values of society of a given culture.
Examples:
Behaviour that is harmful to oneself or others
Poor reality contact
Inappropriate emotional reactions
Erratic behaviour
Problem: ①The violation of norms explicitly makes abnormality a relative
concept. ②Societal norms may change which behaviors are deemed abnormal. E.g.,
Homosexuality was once classified as a mental disorder in the DSM (up till 1973).
③Criminals and prostitutes violate social norms, but would not necessarily fall within
the context of abnormal psychology.
2.5 Dysfunction
Does the behavior impair an individual’s ability to function in life (work,
personal relationships)? (E.g., substance-use disorders)
Problem: Some individuals with a DSM diagnosis, live functional lives (e.g.,
transvestites).
3.Causal factors of mental disorder
3.1Biological factors
genetic vulnerabilities
Biochemistry (neurotransmitter and hormonal imbalances): dopamine, 5hydroxyltryptamine and norepinephrine.
Physical disease: infection , toxicosis , various metabolic block etc.
3.2 Psychological factors
Acute mental trauma
Enduring mental trauma
3.3 Social factors
Politics, economy, religion , culture , ethics morality , customs, habits , family
environment and Interpersonal relationship .
4. Classification
4.1 Phenomenology classification:
Cognition disorder
Emotion disorder
Will and behavior disorder
Conscious disorder
4.2 Psychiatric classification
ICD-10 (International Classification of Disease, the tenth version )
CCMD-Ⅲ ( Chinese Classification of Mental Disorder and Diagnostic Criteria,
the third version )
DSM-Ⅳ (Diagnostic and Statistical Manual, the forth version)
Section 2 Anxiety disorders
1. Definition of anxiety
Anxiety is an uncomfortable feeling that occurs in response to the fear of being
hurt or losing something valued. Anxiety is a common human emotion. The morbidity
of anxiety disorder is about 15%. The female overtakes the male.
Adaptation functions of anxiety: ①The first one is signal function. ②The second
one is to mobilize body and regulate behavior. ③The third one is learning and
accumulating experience.
Symptoms of anxiety: ①mood of tension and worry ②mental symptoms
③physical symptoms
Worry constantly about yesterday's mistakes, tomorrow’s problems.
Worry about family, finances, work, personal illness more than others.
May see muscle tension, poor concentration, irritability, sleep disturbance,
feeling on edge.
A case: Hazel was walking down a street near her home one day when she
suddenly felt flooded with intense and frightening physical symptoms. Her whole
body tightened up, she began sweating and her heart was racing, she felt dizzy and
disoriented.She thought, “I must be having a heart attack! I can’t stand this!
Something terrible is happening! I’m going to die.” Hazel just stood frozen in the
middle of the street until an onlooker stopped to help her.
Difference between fear and anxiety: ①Fear is a response to a perceived danger
or threat. ②Anxiety is the anticipation of a possible threat.
2. Classification
2.1 Reality anxiety (objectivity anxiety)
Reality anxiety is fear of real-world events. The cause of this anxiety is usually
easily identified. For example, a person might fear receiving a dog bite when they are
near a menacing dog. The most common way of reducing this anxiety is to avoid the
threatening object.
2.2 Id anxiety (neurotic anxiety)
Neurotic anxiety is the unconscious worry that we will lose control of the id's
urges, resulting in punishment for inappropriate behavior.
Free-floating anxiety
Phobia
Panic response
2.3 Moral anxiety
Moral anxiety involves a fear of violating our own moral principles. In order to
deal with this anxiety, Freud believed that defense mechanisms helped shield the ego
from the conflicts created by the id, superego, and reality.
3. Causal factors and psychology theory
A precise cause of anxiety disorder is not known, but researches have identified a
variety of experiential, biological, environmental, psychological and cultural factors.
3.1 Biology mechanism
Research shows that anxiety disorder tends to run in families, so a genetic link
may be involved. Anxiety disorder is associated with irregular levels of
neurotransmitters in the brain , such as norepinephrine and serotonin.
Specific medical conditions, such as an overactive thyroid gland, also can
produce anxiety and its symptoms. Anxiety disorder also occurs more frequently in
people with chronic conditions such as diabetes or high blood pressure.
Anxiety is coordinated partly by a small organ deep inside the brain called the
amygdala. The amygdala is involved in stress, fear, anxiety.
3.2 Psychology mechanism
Traumatic events in early life can make a person vulnerable to anxiety disorders.
Parenting style, family environment and culture may also influence whether a person
is susceptible to developing AD.
4. Mental intervention of anxiety disorder
Precaution
Drug treatment (anxiolytic)
Psychological treatment
Relaxation method
Meditation method
Biofeedback training
Cognitive behavioral therapy
Section 3 Depressive disorders
1.Definition
Depressive disorders or depression are mental illnesses characterized by a
profound and persistent feeling of sadness or despair ..., accompanied with anxiety,
body malaise and sleep disorder.
There are four main types of symptoms:
Mood
Cognitive
Motivational
Somatic (Bodily)
Characteristic symptoms:①feelings of hopelessness, pessimism ②insomnia,
early-morning awakening, or oversleeping ③appetite and/or weight loss ④decreased
energy, fatigue, being“ slowed down”⑤loss of interest or pleasure in hobbies and
activities
that were once enjoyed, including sex ⑥feelings of guilt, worthlessness,
helplessness ⑦thoughts of death or suicide; suicide attempts ⑧restlessness,
irritability ⑨persistent physical symptoms that do not respond to treatment, such as
headaches, digestive disorders, and chronic pain.
2.Causes of depression
2.1 Biological causes
Biological causes of clinical depression continue to be studied extensively. Great
progress has been made in the understanding of brain function, the influence of
neurotransmitters and hormones, and other biological processes, as well as how they
may relate to the development of depression.
2.1.1 Genetic factors
Scientists believe genetic factors play a role in some depressions. Researchers
are hopeful, for instance, that they are closing in on genetic markers for susceptibility
to depressive disorder.
Recent genetic research also supports earlier studies reporting family links in
depression. For example, if one identical twin suffers from depression, the other twin
has a 70 percent chance of also having the illness. Other studies that looked at the rate
of depression among adopted children supported this finding. Depressive illnesses
among adoptive family members had little effect on a child's risk of depression;
however, the disorder was three times more common among adopted children whose
biological relatives suffered depression.
2.1.2 Biochemical causes
Neurotransmitters are chemicals made by the nerve cells in the brain that send
messages back and forth across the space between the cells (synapse).
The neurotransmitters believed to play a role in mental functioning are serotonin
(5-HT), noradrenaline (NA), dopamine (DA) . When the normal balance of these
neurotransmitters is upset, depression, may develop.
2.1.3 Hormones and the endocrine system
Abnormal functioning of the endocrine system may cause abnormal levels of
hormones to be present in the body, potentially playing a role in the development of
depression.
Dysfunction of hypothalamic-pituitary-adrenal axis.
Dysfunction of hypothalamic-pituitary-thyroid axis.
Of those individuals who are clinically depressed, about one-half will have an
excess of a hormone in their blood called cortisol.
Other research concerning cortisol has shown that the timing of the release of
this hormone may be problematic in those who are depressed. People who are not
depressed tend to have secretions of cortisol at certain times of the day. Cortisol levels
are highest at approximately 8:00 a.m. and 4:00 p.m., and then lowest during the night.
This normal cycling of cortisol levels does not occur in some people who are
depressed. For instance, they might have a consistent level of cortisol all the time, or
highest amounts in the middle of the night.
Cortisol levels can be tested using something called a dexamethasone
suppression test (DST).
2.1.4 Medical conditions
It is believed that those individuals with chronic and/or very serious medical
conditions may be at increased risk of developing depression.
Some illnesses that have been known to cause symptoms of depression include:
Hypothyroidism
Hyperthyroidism
Hypoparathyroidism
Hyperparathyroidism
Epilepsy
Diabetes
Stroke
Brain trauma
Parkinson's disease
Some cancers
2.1.5 Environmental situations
Many environmental factors may be linked to depression, including stress,
trauma, childhood events.
Research continues to better understand the interaction of genes and environment,
and precisely what is inherited.
2.6 Psychological/Cognitive factors
Attributions are inferences we draw about causes of events, others’ behavior,
own behavior.
Hopelessness Theory of Depression: People who are depressed tend to make.
Internal, stable, global attributions for negative experiences and External,
unstable, and specific attributions for positive experiences.
3. Mental intervention of depressive disorders
Most people with a depressive illness do not seek treatment, —even those whose
depression is extremely severe—can be helped.
Thanks to years of fruitful research, there are now medications and psychosocial
therapies such as cognitive/behavioral, “talk,” or interpersonal therapies that ease the
pain of depression.
There are several types of antidepressant medications used to treat depressive
disorders. These include newer medications—chiefly the selective serotonin reuptake
inhibitors (SSRIs)—the tricyclics, and the monoamine oxidase inhibitors (MAOIs).
The SSRIs—and other newer medications that affect neurotransmitters such as
dopamine or norepinephrine—generally have fewer side effects than tricyclics.
How to help yourself if you are depressed ?
Set realistic goals in light of the depression and assume a reasonable amount of
responsibility.
Break large tasks into small ones, set some priorities, and do what you can as you
can.
Try to be with other people and to confide in someone; it is usually better than
being alone and secretive.
Participate in activities that may make you feel better.
Mild exercise, going to a movie, a ball game, or participating in religious, social,
or other activities may help.
Expect your mood to improve gradually, not immediately.
Feeling better
Take time
It is advisable to postpone important decisions until the depression has lifted.
Before deciding to make a significant transition—change jobs, get married or
divorced—discuss it with others who know you well and have a more objective view
of your situation.
People rarely "snap out of" a depression. But they can feel a little better
day-by-day.
Remember, positive thinking will replace the negative thinking that is part of the
depression and will disappear as your depression.
Let your family and friends help you.
Section 4 Personality disorder
1. Definition
An enduring pattern of inner experience and behavior that deviates markedly
from the expectations of the individual’s culture, is pervasive and inflexible, has an
onset in adolescence or early adulthood, is stable over time, and leads to distress or
impairment.
Personality disorders are long-term patterns of thoughts and behaviors that cause
serious problems with relationships and work.
People with personality disorders have difficulty dealing with everyday stresses
and problems. They often have stormy relationships with other people.
Marked by extreme, inflexible personality traits that cause subjective distress or
impaired social/occupational functioning.
Long-standing, inflexible ways of behaving
Usually emerge childhood/adolescence
Some are mild versions of more severe Axis I disorders
2. Classification
According
to
ICD-10
(International
Classification
of
Disease,
version ),there are eight personality disorders.
2.1 Paranoid
Shows pervasive and unwarranted suspiciousness and mistrust of others
Overly sensitive
Prone to jealousy.
2.2 Schizoid
Defective capacity in forming social relationships
Absence of warmth and tender feelings for others
2.3 Schizotypal
Social deficits and oddities of thinking
tenth
Perception and communication that resemble schizophrenia.
May see odd superstitious beliefs.
2.4 Histrionic
Overly dramatic
Tending to exaggerate expressions of emotion
Egocentric
Attention seeking
2.5 Borderline
Unstable self-image
Mood,
Interpersonal relationships
Impulsive
Unpredictable
2.6 Narcissistic
Grandiosely self-important
Preoccupied with success fantasies
Expecting special treatment
Lacking interpersonal empathy
2.7 Antisocial
Chronically violating rights of others
Failing to accept social norms or sustain work behavior
Exploitive,
2.8 Dependent
Excessively lacking in self-reliance and selfesteem
Passively allowing others to make all decisions, constantly subordinating own
needs to others
2.9 Avoidant
Excessively sensitive to personal rejection, humiliation
Socially withdrawn in spite of desire for acceptance from others
2.10 Obsessive-Compulsive
Preoccupied with organization, rules, schedules, lists
Extremely serious, formal
Unable to express warm emotions
3.Characteristic of personality disorders
Personality disorders emerged in children and adolescent, and is relative stability.
Personality disorders has confused indefinite mental feature and tensive
relationship, and couldn’t adapt to the social environment.
Besides
psychopathia,
personality
disorders doesn’t
have
morphologic
pathological change of nervous system.
Those who have personality disorders have clear consciousness, can forecast
behavioral consequence, and understand the evaluation criterion of his behavior
consequence from society, but have superficial view and motive.
4.Cause of personality disorders
A combination of personal history and biology appears to play a role in most
personality disorders.
Genetics play a significant — but not necessarily singular — role in the
development of schizotypal and paranoid personality disorders, which all are more
common in families with a history of schizophrenia. Heredity also contributes to the
development of obsessive-compulsive personality disorder.
A family history of antisocial personality disorder increases your risk of
developing the condition, but childhood trauma also has considerable influence.
Children with an alcoholic parent, or who have an abusive or chaotic home life, are at
increased risk of developing antisocial personality disorder.
Sexual abuse is a common risk factor for borderline personality disorder. People
with borderline personality disorder who report sexual abuse at a younger age —
younger than 13 years old — are also more likely to have post-traumatic stress
disorder. Heredity and childhood head injuries also may influence the development of
this disorder.
The causes of avoidant and dependent personality disorders have been minimally
studied and aren't yet well understood.
5. Mental intervention
A number of barriers make personality disorders among the most challenging
mental health conditions to treat. People with these conditions are likely to have
difficulty opening up to or retaining closeness with therapists. Perceived criticism
may cause them to react angrily and break off therapy. Those who seek treatment on
their own and who are motivated to stick with therapy over many years are the most
likely to succeed.
Treatment for most personality disorders is with a combination of therapy and
medications.
5.1 Psychodynamic psychotherapy
This approach entails talking about your condition and related issues with a
mental health professional. Psychotherapy can help people with personality disorders
recognize how they're responsible for the turmoil in their lives and learn healthier
ways of reacting to people and problems. Individual, group and family therapy can all
be helpful.
5.2 Cognitive behavior therapy
This form of psychological treatment involves actively retraining the way you
think about problems, which in turn improves your emotions and behaviors.
5.3 Dialectical behavior therapy
This type of cognitive behavior therapy focuses on coping skills — learning how
to take better control of behaviors and emotions with techniques such as mindfulness,
which helps you observe your feelings without reacting. It is most often used to treat
borderline personality disorder. Doctors are studying the effectiveness of this type of
therapy with all types of personality disorders.
5.4 Medications
People with personality disorders often experience serious mental and emotional
strain, causing additional mental health problems, such as depression, phobia and
panic. Medications may help alleviate these related conditions, but they can't cure the
underlying disorder. Therapy aimed at building new coping mechanisms must be the
cornerstone of treatment.
Section 5 Abnormal
behavior
1.Alcohol dependence
1.1 Concepts
Alcohol Dependence is a condition characterized by the harmful consequences of
repeated alcohol use, a pattern of compulsive alcohol use, and (sometimes)
physiological dependence on alcohol (i.e., tolerance and/or symptoms of withdrawal).
This disorder is only diagnosed when these behaviors become persistent and very
disabling or distressing.
1.2 Four main features of alcohol dependence
Physical dependence, with a characteristic withdrawal syndrome that is relieved
by more alcohol (e.g., morning drinking) or other drugs.
Physiological tolerance, so that more and more alcohol is needed to produce the
desired effects.
Difficulty in controlling how much alcohol is consumed once drinking has
begun.
A craving for alcohol that can lead to relapse if one tries to abstain.
1.3 Harmful to health
School and job performance may suffer either from hangovers or from actual
intoxication on the job or at school; child care or household responsibilities may be
neglected; and alcohol-related absences may occur from school or job.
Individuals with this disorder are at increased risk for accidents, violence, and
suicide.
1.4 Cause of alcohol dependence
Alcohol Dependence often has a familial pattern, and it is estimated that
40%-60% of the variance of risk is explained by genetic influences.
The risk for Alcohol Dependence is 3 to 4 times higher in close relatives of
people with alcohol dependence.
Most studies have found a significantly higher risk for Alcohol Dependence in
the monozygotic twin than in the dizygotic twin of a person with Alcohol
Dependence.
1.5 Intervention of alcohol dependence
Behavior therapy
Family therapy
2.Tobacco (Nicotine )addiction
2.1 Concepts
Nicotine addiction is classified as nicotine use disorder according to the
DSM-IV-TR. The criteria for this diagnosis include any 3 of the following within a
1-year time span:
Tolerance to nicotine with decreased effect and increasing dose to obtain
same effect
Withdrawal symptoms after cessation
Smoking more than usual
Persistent desire to smoke despite efforts to decrease intake
Extensive time spent smoking or purchasing tobacco
Postponing work, social, or recreational events in order to smoke
Continuing to smoke despite health hazards
2.2 Signs and symptoms
You can't stop smoking. You've made one or more serious, but unsuccessful,
attempts to stop.
You experience strong withdrawal symptoms when you try to stop. Your attempts
at stopping have caused physical signs and symptoms of addiction, such as craving for
tobacco, anxiety, irritability, restlessness, difficulty concentrating, headache,
drowsiness, stomach upset, even constipation or diarrhea.
You keep smoking despite health problems. Even though you've developed
problems with your lungs or your heart, you haven't stopped or can't stop.
You give up social or recreational activities in order to smoke. You may stop
going to certain restaurants or stop socializing with certain family members or friends
because you can't smoke in these situations.
2.3 Harmful to health
Being addicted to tobacco brings you a host of health problems related to the
substances in tobacco smoke. These effects include damage to your lungs, heart and
blood vessels. Smokers have significantly higher rates of heart disease, stroke and
cancer. If you are a smoker, you have:
22 times the risk of dying from lung cancer if male
12 times the risk of dying from lung cancer if female
10 times the risk of dying from bronchitis and emphysema
2 to 3 times the risk of heart disease
2 times the risk of stroke
2.4 Intervention
Health education
Behavior training
Cognitive-Behavioral therapy
There are many ways to quit smoking, including using medications and getting
some sort of counseling or support.
The approved effective medications to help you stop smoking fall into two
categories — nicotine replacement therapy and non-nicotine medications. Any of
these effective medications combined with behavioral changes can double your
chances of quitting.
3.Drug dependence
3.1 concepts
Drug dependence is used to describe continued use of drugs, even when
significant problems related to their use have developed.
Signs include an increased tolerance or need for increased amounts of substance
to attain the desired effect, withdrawal symptoms with decreased use, unsuccessful
efforts to decrease use, increased time spent in activities to obtain substances,
withdrawal from social and recreational activities, and continued use of substance
even with awareness of physical or psychological problems encountered by extent of
substance use.
3.2 Symptoms
Psychological addiction
Physical addiction
Tolerance
getting high on drugs or getting intoxicated (drunk) on a regular basis
lying, especially about how much they are using
avoiding friends and family members
giving up activities they used to enjoy such as sports or spending time with
non-using friends
talking a lot about using drugs
believing they need to use in order to have fun
pressuring others to use
getting in trouble with the law
taking risks, such as sexual risks or driving under the influence of a
substance
missing work due to substance use
depressed, hopeless, or suicidal feelings
3.3 Classification
Substances frequently abused include, but are not limited to, the following:
Alcohol
Marijuana
Hallucinogens
Cocaine
Amphetamines
Opiates
Anabolic steroids
Tranquilizer: alcohol, hypnotic
3.4 Intervention
Detoxification (if needed, based on the substance abused) and long-term
follow-up management are important features of successful treatment.
Long-term follow-up management usually includes formalized group meetings
and developmentally age-appropriate psychosocial support systems, as well as
continued medical supervision.
Individual and family psychotherapy are often recommended to address the
developmental, psychosocial, and family issues that may have contributed to and
resulted from the development of a substance abuse disorder.
4. Internet addiction
4.1 concepts
Internet Addiction, also described as pathological internet use, is defined by an
individual’s inability to control his or her use of the internet, which eventually causes
psychological, social, school, and/or work difficulties in a person’s life.
4.2 Theoretical model
Young ’s ACE model
Davis’ Cognitive-Behavioral Model
Grohol’s stage model
4.3 Symptoms of internet addiction
Intense desire
Tolerance
Withdrawal
Mood modification
Behavior modification
Cognition distortions
4.4 Diagnosing internet addiction
Young (1998) developed
an eight-item Internet Addiction Diagnostic
Questionnaire (YDQ) .
Davis developed the Online Cognition Scale (OCS) that measures problematic
Internet use.
Chou’S Questionnaire
Chen’S Questionnaire
4.5 Mental intervention of internet addiction
Practice The Opposite
External Stoppers
Setting Goals
Abstinence
Reminder Cards
Personal Inventory
Support Groups
Family Therapy