Download Major Depressive Episode

Abnormal Psychology
PSY 120
Prof. South
11/21/08
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What is abnormal?
Categories and Causes
Mood Disorders
Anxiety Disorders
Social Cognitive Theory
Approach to
personality that
suggests it is human
experiences
and interpretations of
these experiences,
that determine growth
and development of
personality
Social-Cognitive Perspective
Culture
 Kind of culture you
are from will greatly
affect your
personality
 different cultures
value different things
 If you have what the
culture values, life will
be less stressful
Defining Abnormal Behavior
A clinically significant behavioral
or psychological syndrome
with:
1. Present distress
2. Disability
3. An increased risk of suffering
pain, death, disability, or loss
of freedom
DSM-IV-TR
200+ diagnostic categories
Not included
1. Expected & culturally
sanctioned response
2. Deviant behavior
3. Conflicts between
individual & society
Difficulties in Diagnosis
• Is this person’s behavior abnormal?
– Example: A woman does not like to throw
away plastic bags and religiously cleans them
and stores them away. She has hundreds of
plastic bags but rarely uses them. She gets
very angry if anyone suggests she should get
rid of them.
Difficulties in Diagnosis
• If a relative or friend:
– No.
• If a stranger:
– Yes.
“Uncle George’s Pancakes Fallacy”
(Meehl, 1973)
• People tend to compare the patient’s
behavior to that of a friend or relative (e.g.,
good ole Uncle George)
– The assumption is: your friend or relative is
not mentally ill (because you couldn’t have
any crazy friends or relatives…)
– Proper conclusion is that your friend or
relative also evidences abnormal behaviors
The Five DSM-IV Axes
Axis I
Axis II
Axis III
Axis IV
Axis V
Most major disorders
Stable, enduring problems;
personality disorders
Medical conditions
Psychosocial
problems/stressors
Global clinician rating of
adaptive functioning
Axis I
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Mood Disorders
Anxiety Disorders
Substance-Related Disorders
Schizophrenia and Other Psychotic Disorders
Eating Disorders
Somatoform Disorders
Dissociative Disorders
Sexual and Gender Identity Disorders
Sleep Disorders
Impulsive-Control Disorders
Adjustment Disorders
Factitious Disorders
Delirium, Dementia, and Amnestic and other Cognitive Disorders
Axis II
• Disorders usually first diagnosed in
infancy, childhood, or adolescence
• Personality Disorders
Current System of Classification
• Disorders grouped together under broader categories
– E.g. Mood Disorders
• Depressive Disorders
– Depressive Disorder
– Dysthymic Disorder
– Depressive Disorder NOS
• Bipolar Disorders
– Bipolar I
– Bipolar II
– Cyclothymic Disorder
– Bipolar Disorder NOs
• To qualify for a diagnosis, meet certain number of criteria for each
disorder
• Thus, a “categorical” system of diagnosis
• Is this the best way?
Major Depression
1 or more Major
Depressive Episodes
Symptoms
Behavior
Affective
Cognitive
Physiological
Anhedonia
Episodic Course
Major Depressive Episode
(5 or more for 2 weeks)
#1. depressed mood most of day (sad, empty)
#2 loss of interest or pleasure
#3 weight
#4 sleep
#5 body
#6 fatigue
#7 worthless/ guilt
#8 thinking
#9 recurrent thoughts of death, suicide
Bipolar I Disorder
• Alternates between full manic episodes
and depressive episodes
• Average age of onset is 18 years, but can
begin in childhood
• Tends to be chronic
Bipolar II
• Alternates between depressive episodes
and hypomanic episodes
Manic Episode
Elevated, expansive, or irritable mood (>1
week), plus 3 or more of:
Grandiosity/inflated self-esteem
Decreased need for sleep
Pressured speech
Flight of ideas
Easily distracted to irrelevant stimuli
Increase in goal-directed activity
Excessive involvement in activities with
potential for harmful consequence
Mood Disorders Among Twins
Causes of Mood Disorders
Biological
Stress
Learned Helplessness
Social and Cultural
Cognitive Theory
Beck’s Cognitive Triad for Depression
An Integrative Model of Mood Disorders
Anxiety Disorders
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Panic Disorder
Agoraphobia
Specific Phobia
Social Phobia
Obsessive-Compulsive Disorder
Post-traumatic Stress Disorder
Acute Stress Disorder
Generalized Anxiety Disorder
Difference between
“Normal & Abnormal” Anxiety
Normal
–Everyone experiences
anxiety from time to time
–Often important to have low
to moderate levels of anxiety
for optimal performance
–A little anxiety motivates
you to “go the extra mile
Abnormal
– intense
anxiety where
there is no
danger
–Overwhelmed
with anxiety is
not adaptive
Generalized Anxiety Disorder
Defining Features
– Excessive uncontrollable worry about life events
– Strong, persistent anxiety
– Somatic symptoms
– Persists for 6 months or more
Panic Disorders
Episode in which intense anxiety &
physiological symptoms are suddenly
experienced… recurrent, unpredictable
Panic attack symptoms include:
–Shortness of breath
–Chest pain & discomfort
– heart palpitations
–Feeling of choking
–Numbness or tingling
–Chills or hot flushes
–Sweating
–Shaking
Panic
Misappraisal of what’s happening
–Catastrophic conclusion
• I feel flush, fast heart beat.. I must
be having a heart attack vs. I am a
little over excited today
Specific Phobias
Defining Features
– Extreme and irrational fear of specific
object/situation
– Interferes with one's ability to function
– Recognize fears are unreasonable, but avoids
phobic objects
Social Phobia
Defining Features
– Fear of being
scrutinized by
others
– Interferes with
functioning
– Avoids social
situations
Obsessive-Compulsive Disorder
• Recurrent obsessions and/or compulsions that are
severe enough to be time consuming or cause marked
distress and/or significant impairment.
• At some point, person has recognized that the
obsessions or compulsions are excessive or
unreasonable.
• Common: cleaning or checking rituals
Obsessions
#1 Violence is MOST
common theme
#2 Contamination, 2nd common
theme
– shaking hands
– touching a public door
knob
– or toilet
Compulsions
• Most common manifestations:
• Hand washing (cleaning)
• Checking behavior
• Counters & Perfectionists
Post Traumatic Stress Disorder
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WW II military gave greater recognition to
the condition they termed "shell shock“
(PTSD)
• PTSD follows a
traumatic event
• Symptoms:
Re-experiencing
Avoidance
Arousal
Summary of Anxiety Disorders
One of the largest domains of
psychopathology
From normal to disordered
– Multiple factors
– Fear & anxiety persist to nondangerous cues
– Significant distress
Addictive Disorders:
one of country’s major mental and
health problem
Substance Use Disorders
• Abuse
– Interference with ability to fulfill major role
obligations and/or legal difficulties associated
with use
• Dependence
– Pattern of use that results in tolerance,
withdrawal, and compulsive drug-taking
behavior
Types of psychoactive
substances
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Alcohol
Amphetamines
Caffeine
Marijuana/hashish
Cocaine
Hallucinogens
Inhalants
Nicotine
Opiates
Phencyclidine
Sedatives, hypnotics, anxiolytics
midbrain: nucleus accumbens
All drugs which
people become
dependent upon act
on the
“pleasure pathways”
internal reward
centers, made up of
dopamine-sensitive
neurons
Ethnic Differences
Rates of alcoholism among
Asian populations are lower
than among European
people
This fact may be related to a
mutant enzyme that leads to
hypersensitive reactions to
alcohol in Asians
Mental health resources
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Center for Counseling and Psychological Services (CAPS) – 494-6995.
Offices at PUSH and in Psychological Sciences Building.
Urgent care after hours at PUSH 494-1724.
Crisis Center 742-0244
Mental Health American of Tippecanoe County 742-1800,
http://www.mhalafayette.org/
NAMI West Central Indiana 423-6939, http://www.nami-wci.org/