RS2020 Foundation Psychology for Rehabilitation

Lecture 10: Psychological Disorders

2:30pm – 4:20pm, Thursday, 26th November 2020

via BB Ultra Collaborate

Benjamin K. Yee
BSc Hons (London), DPhil (Oxon), CPsychol (BPS)

RS2020 | 2020-11-26 | Lecture 10 1

 Why study psychological disorders?

Understanding better how our psychology normally works

by investigating how it may go wrong.
“To reverse engineer a definition of what normal is.”

To work out the mechanism (How?) underlying both normal

and abnormal psychology, identify the roles of nature and
nurture in the grand scheme of things.

To cure psychological disorders. To develop drug and

psychological treatments to alleviate suffering.
“To make miserable people less miserable.”

https://opentext.wsu.edu/abnormal-psych/chapter/module-1-what-is-abnormal-psychology/

RS2020 | 2020-11-12 | Lecture 10 2

Global Burden of Mental Health Disability

Becker & Kleinman (2013) NEJM

https://www.nejm.org/doi/full/10.1056/NEJMra1110827

RS2020 | 2020-11-12 | Lecture 10 3

What is Abnormal Behaviour?
Where / How do we start? “The one truth is that no matter what behavior we display,
if taken to the extreme*, it can become disordered”
*both directions of extremes: excessive and deficiency

If your next-door neighbor scrubs his front porch twice every day and spends
virtually all his time cleaning and recleaning his house, is he normal?
If your sister-in-law goes to one physician after another seeking treatment for
ailments that appear imaginary, is she psychologically healthy?
Weiten (pp.492)

The Three D’s of the conceptualization of abnormal behavior in DSM-5

While “no definition can capture all aspects of all disorders”, some aspects are relevant
when examining if some behaviors/conditions maybe “abnormal”

DYSFUNCTION (cognition, emotion regulation, or behavior)

DISTRESS
DEVIANCE from social and cultural norms

(DANGEROUSNESS to self and others, and the costliness to society.)

https://opentext.wsu.edu/abnormal-psych/chapter/module-1-what-is-abnormal-psychology/

RS2020 | 2020-11-12 | Lecture 10 4

DYSFUNCTION (“maladaptive behavior” / impairment)
“Clinically significant disturbance in an individual’s cognition, An employee who suddenly performs
emotion, or behavior that reflects a dysfunction in the psychological, poorly may be experiencing an
environmental demand leading to
biological, or developmental processes underlying mental stress and ineffective coping
functioning”. mechanisms.
Dysfunction as a barrier to well-being by reference to general Once the demand resolves itself,
expectation and the person’s past performance. performance should return to normal
according to this principle.

DISTRESS
When the person experiences a disabling condition “in social, Feeling anxious or sad, and
occupational, or other important activities”. The personal distress associated behaviours, are common
and normal.
can be psychological or physical.
Distress alone may not imply abnormal behavior. e.g., the loss of a
loved one can cause significant pain in a “normal” person.
Analogy: deformation of a perfectly normal rubber band.

DEVIANCE from...
Cultural norms as the “totality of socially transmitted behaviors, Cultural and social norms can change.
customs, values, technology, attitudes, beliefs, art, etc. that are Homosexuality was dropped from
DSM-II in 1973.
particular to a group, determines what is normal.” Caffeine intoxication but not
Social norms as “the stated and unstated rules of society”. addiction.
Some deviant behavior is not
necessarily negative, e.g., genius.
(DANGEROUSNESS) How about savant skills in people
Some may include this consideration, e.g. pedophilic disorder with autism?

https://opentext.wsu.edu/abnormal-psych/chapter/module-1-what-is-abnormal-psychology/

RS2020 | 2020-11-12 | Lecture 10 5

The (Bio) Medical Model is a set of procedures doctors are trained on, including complaint, history, examination,
diagnosis, tests, treatment, and prognosis (with or without treatment).
MM is based on certain assumptions about the causation and that diseases should be
treated. MM has guided biomedical research and advances, which have been very
successful by any account. However, this approach has its critics.

Application of MM to Psychological (Mental)

Disorders implies:
Mental disorders are approachable like physical diseases
DYSFUNCTION (maladaptive behavior /
and are explicable in terms of underlying biological
impairment)
mechanism.
“Clinically significant disturbance in an individual’s
Relevant pathological processes in the body (brain / cognition, emotion, or behavior that reflects a
nervous system) that cause the disorders dysfunction in the psychological, biological, or
(dysfunction, impairment, maladaptive behaviour). developmental processes underlying mental
Their resolution should lead to normalization. functioning”.
Treatment should target causative pathology.

MM (and DSM) assumes the existence of biological

causes even if we cannot be sure or could not specify the
pathological process in such terms now.
It also recognizes environmental, cultural factors, but
may often medicalize them, e.g., calling some abnormal
behaviour as mal-adaptation.

RS2020 | 2020-11-12 | Lecture 10 6

The MedicalModel contrasts with
Models of Disability (disability rights Viewing psychological problems (mental
movements), which recognize that one should not be
disabilities) as diseases implies treatment
disadvantaged by one's disability as one should not be
as resolution of the underlying
discriminated by skin colour.
dysfunctional biological, physiological
Disabled and abled persons have equal rights to a
states/processes.
happy, independent, productive, and meaningful life,
free from discrimination.

The Medical Model targets/looks for what's

The Disability Models will examine how society can do
"wrong" or abnormal within the person’s body,
to improve the life's of the disabled - given the
and tries to fix the person so that he/she
circumstances of the person.
returns (recover) to some society norms of
behaving and living.

Diseases as “anomalies” to be treated,

corrected, and casted away?

RS2020 | 2020-11-12 | Lecture 10 7

Classification of Mental Disorders

Provides a common language for communication about

the diagnosis of disorders and symptoms.

Provides a system for describing abnormal behaviour,

which is the first step towards identifying meaningful
differentiation, between categories of disorders. DSM (Diagnostic and Statistical manual
of Mental Disorders)
Previous versions of DSM have adopted a categorical
approach. Clinicians are required to determine if a given
disorder was present or not. Disorder A

Latest DSM-5 retains a categorical approach but also

incorporates a dimensional perspective. The integrative
Overlapping
approach permits severity assessment (e.g., addiction), symptoms Overlap
allows fuzzy boundary between normal and abnormal, and
regroups similar disorders into spectrum of disorders (e.g.,
autism, schizophrenia) along some continuums of behavior Disorder C
(dimensions) – as variations in the manifestation of Disorder B
essentially the same underlying dysfunction(s).

https://www.psychiatry.org/File%20Library/Psyc
hiatrists/Practice/DSM/APA_DSM-5-Integrated-
Approach.pdf

RS2020 | 2020-11-12 | Lecture 10 8

Disorder Category Short Description
A group of conditions that arise in the developmental period and include intellectual Categories of Disorders in
Neurodevelopmental disorders disability, communication disorders, autism spectrum disorder, motor disorders, and
ADHD current DSM-5
Disorders characterized by one or more of the following: delusions, hallucinations,
Schizophrenia Spectrum
disorganized thinking and speech, disorganized motor behavior, and negative symptoms
Characterized by mania or hypomania and possibly depressed mood; includes Bipolar I
Bipolar and Related
and II, cyclothymic disorder

Characterized by sad, empty, or irritable mood, as well as somatic and cognitive changes
Depressive
that affect functioning; includes major depressive and persistent depressive disorders

Characterized by excessive fear and anxiety and related behavioral disturbances; Includes
Growth of the number of mental
Anxiety
phobias, separation anxiety, panic attack, generalized anxiety disorder disorders, although some disorders
Obsessive-Compulsive
Characterized by obsessions and compulsions and includes OCD, hoarding, and body have also been dropped through
dysmorphic disorder
Characterized by exposure to a traumatic or stressful event; PTSD, acute stress disorder, the years.
Trauma- and Stressor- Related
and adjustment disorders
Characterized by a disruption or disturbance in memory, identity, emotion, perception, or
Dissociative behavior; dissociative identity disorder, dissociative amnesia, and
depersonalization/derealization disorder
Characterized by prominent somatic symptoms to include illness anxiety disorder
Somatic Symptom
somatic symptom disorder, and conversion disorder
Characterized by a persistent disturbance of eating or eating-related behavior to include
Feeding and Eating
bingeing and purging
Characterized by the inappropriate elimination of urine or feces; usually first diagnosed in
Elimination
childhood or adolescence
Characterized by sleep-wake complaints about the quality, timing, and amount of sleep;
Sleep-Wake
includes insomnia, sleep terrors, narcolepsy, and sleep apnea
Characterized by sexual difficulties and include premature ejaculation, female orgasmic
Sexual Dysfunctions
disorder, and erectile disorder
Characterized by distress associated with the incongruity between one’s experienced or
Gender Dysphoria
expressed gender and the gender assigned at birth

Characterized by problems in self-control of emotions and behavior and involve the

Disruptive, Impulse-Control,
violation of the rights of others and cause the individual to violate societal norms; Some disorders are revised,
Conduct
includes oppositional defiant disorder, antisocial personality disorder, kleptomania, etc.
combined with others, or being
Substance-Related and Addictive
Characterized by the continued use of a substance despite significant problems related to
its use
switched from one category to
Neurocognitive
Characterized by a decline in cognitive functioning over time and the NCD has not been another.
present since birth or early in life
Characterized by a pattern of stable traits which are inflexible, pervasive, and leads to
Personality
distress or impairment
Characterized by recurrent and intense sexual fantasies that can cause harm to the
Paraphilic
individual or others; includes exhibitionism, voyeurism, and sexual sadism More in RS3310
 Sibling Relation Disorder
A pattern of interaction among siblings that is
associated with significant impairment in
individual or family functioning or with
development of symptoms in one or more of
the siblings, or when a sibling relational
problem is affecting the course, prognosis, or
treatment of a sibling's mental or other
medical disorder.
https://www.abc.net.au/radionational/programs/archived/rnafternoo
ns/hoarding-a-national-disorder/6086108

“Hundreds of thousands of people with

hoarding disorder live in squalid conditions
around Australia.”

RS2020 | 2020-11-12 | Lecture 10 10

A few more words on DSM ...

DSM is the product of the medical model (MM). It

looks at the disorders as physical diseases to be
treated, and bases decision on evidence from
biological and neural sciences (as explicitly stated
as an objective in DSM 5).
Disorder A

DSM is a also manual per se. It guides the

diagnosis of disorders and differentiation of one Overlapping
disorder from another. As a tool, DSM is symptoms Overlap
subjectable to changes and revisions.

Demarcations & categories may be questioned, Disorder C

esp. when diagnosis primarily depends on Disorder B
identification of behavioural symptoms.

However, how are these decided? By whom? Are

social, political, economic forces at play?

RS2020 | 2020-11-12 | Lecture 10 11

Biopsychosocial (BPS) Model

The BPS model has allowed some reconciliation between the

two dominant conceptions (with different assumptions and
emphases) of mental disorders, traceable to the
Mind-Body Problem:

1) The biomedical view that mental disorders arise from faulty

biology, physiological, and physical structures of the body,
and
2) The view that emphasizes the psychological dimensions of
maladaptive patterns of thinking, feeling and acting and
relating (to others and society).

The BPS is a frequently adopted perspective for holistic health

https://en.wikipedia.org/wiki/Biopsychosocial_model
professions (e.g., nurses, social workers, counselors, OT, and
(Weiten, Sect 13.7) clinical psychologists), although the biomedical view remains
prominent.

RS2020 | 2020-11-12 | Lecture 10 12

The Antipsychiatry Movement
A broad-based movement (from psychiatrists, sociologist,
philosophers, historians, anthropologists) in the 60’s that
questioned/ challenged the legitimacy of standard psychiatric
theory and practice. 1960 R. D. Laing
(1927 – 1989)
Coined the term
“medical model” in 1
- psychiatry as an agent of social control

- electroconvulsive therapy
- lobectomy
- long-term involuntary hospitalization

- baleful influence of pharma industry (e.g., Daniel Carlat, Robert Whitaker)

lower Dx threshold (e.g., major depression/ADHD in DSM-5) 1960 Thomas Szasz
(1920-2012)
new disorders (e.g., attenuated psychosis in DSM-5)
- reliance on drug therapy
- questioning biological theories, neurochemical imbalance
(e.g., lack of biomarkers)

- domination of Western model

exporting its notion of (e.g., PTSD) and (e.g. anorexia) actual
mental illnesses 1961 Michel Foucault
(1926-1984)

RS2020 | 2020-11-12 | Lecture 10 13

David Rosenhan’s experiment (1973)

The Pseudopatient experiment

Healthy associates or "pseudopatients" gain
admission to 12 psychiatric hospitals by claiming to The non-existent impostor experiment
have experienced auditory hallucinations.
All were admitted and diagnosed with psychiatric Over a 3-month period.
disorders. Out of 193 patients, 41 were considered to be
After admission, the pseudopatients acted normally. impostors and 42 were considered suspects
Stayed for 7-52 days. All but one were diagnosed
with schizophrenia "in remission" before their
release. In reality, Rosenhan had sent no pseudopatients.

https://www.youtube.com/watch?v=j6bmZ8cVB4o
https://www.youtube.com/watch?v=D8OxdGV_7lo
> 2:55

“...any diagnostic process that lends itself too readily to massive errors of this sort
cannot be a very reliable one.“

“...diagnoses are often not useful or reliable, but we ... continued to use them. We
now know that we cannot distinguish insanity from sanity.”

RS2020 | 2020-11-12 | Lecture 10 14

More recent criticism the biological medical
model in psychiatry

“Biologic psychiatry has thus far failed to produce a comprehensive theoretical

model of any major psychiatric disorder, any tests that can be used in a clinic to
diagnose clearly defined major psychiatric disorders, or any guiding principle for
somatic treatments to replace the empirical use of medications.
Biologic knowledge is foundational to good psychiatry, but we believe that
misapprehension of its limitations is stunting the field from within and subjecting it
to manipulation from without by corporate and administrative interests that,
intentionally or not, strive to benefit from a falsely simplified and deterministic
formulation of mental illness and its treatment.”

Gardner and Kleinman (2019) N Engl J Med 381(18):1697-1699.

“…today one is hard-pressed to find anyone knowledgeable who believes that the so-called
biological revolution of the 1980s made good on most or even any of its therapeutic and
scientific promises.”

Harrington (2019) Mind fixers: psychiatry’s troubled search for the biology of mental illness. New York: Norton

RS2020 | 2020-11-12 | Lecture 10 15

Anxiety Disorder, OCD and PTSD (Weiten Section 14.2)

GAD (Generalized Anxiety Disorder)

“Generalized anxiety disorder is characterized by GAD symptoms may include:
excessive anxiety and worry about a variety of events Persistent worrying or anxiety about a number of areas that are out
or activities (e.g., work or school performance) that of proportion to the impact of the events.
occurs more days than not, for at least 6 months. Overthinking plans and solutions to all possible worst-case
outcomes.
Perceiving situations and events as threatening, even when they
People with generalized anxiety disorder find it aren’t difficulty handling uncertainty.
difficult to control their worry, which may cause Indecisiveness and fear of making the wrong decision.
impairment in social, occupational, or other areas of Inability to set aside or let go of a worry.
Inability to relax, feeling restless, and feeling keyed up or on edge.
functioning.” Difficulty concentrating, or the feeling that your mind "goes blank"

https://www.nimh.nih.gov/health/statistics/generalized-anxiety-disorder.shtml Physical signs and symptoms:

Fatigue
Trouble sleeping
Muscle tension or muscle aches
Trembling, feeling twitchy
Nervousness or being easily startled
Sweating
Nausea, diarrhea or irritable bowel syndrome
Lifetime prevalence of about 5% Irritability (mood & behaviour)

Twice in females as males

Concerns over increases in younger people. https://www.mayoclinic.org/diseases-conditions/generalized-
anxiety-disorder/symptoms-causes/syc-20360803

RS2020 | 2020-11-12 | Lecture 10 17

Anxiety Disorder, OCD and PTSD (Weiten Section 14.2)

Severity of anxiety reported in past year

(2001 – 2003 Data from US)

RS2020 | 2020-11-12 | Lecture 10 18

RS2020 | 2020-11-12 | Lecture 10 19
Anxiety Disorder, OCD and PTSD (Weiten Section 14.2)

Specific Phobia
An overwhelming and unreasonable fear of
objects or situations that pose little real
danger but provoke anxiety and avoidance.
Unlike the brief anxiety when giving a speech
or taking a test, specific phobias are long
lasting, cause intense physical and
https://www.youtube.com/watch?v=
psychological reactions. pM3G6kITdYk
Ailurophobia (fear of cats)
Arachnophobia (fear of spiders)

http://phobialist.com/
https://www.fearof.net/

RS2020 | 2020-11-12 | Lecture 10 20

Anxiety Disorder, OCD and PTSD (Weiten Section 14.2)

Specific Phobia

Agoraphobia Typical agoraphobia includes fear of:

Fear of places or situations that might cause
you to panic and make you feel trapped, - Leaving home alone
helpless or embarrassed. - Crowds or waiting in line
- Enclosed spaces, such as movie theaters, elevators or small
stores
Agoraphobia usually develops as a - Open spaces, such as parking lots, bridges or malls
complication of panic disorder. - Using public transportation, such as a bus, plane or train
Lifetime prevalence ~ 1.3%

Panic Disorder
Fear of places or situations that might cause Sudden attacks of extreme fear peaks within a few
you to panic and make you feel trapped, minutes and trigger intense physical symptoms
helpless or embarrassed. (panic attacks).

You might think that you're totally losing control,

having a heart attack or even dying.

Fear of another panic attack can lead to avoiding

similar circumstances or the place where it
occurred in an attempt to prevent future panic
attacks.

RS2020 | 2020-11-12 | Lecture 10 21

Anxiety Disorder, OCD and PTSD (Weiten Section 14.2)

Obsessive-Compulsive Disorder (OCD)

Ritualistic behaviour

OCD features unwanted thoughts and fears

(obsessions) that lead you to do repetitive
behaviors (compulsions), which interfere with
daily activities and cause significant distress.

You may try to ignore or stop your obsessions, but Checking behaviour Hand washing
that only increases your distress and anxiety.
Ultimately, you feel driven to perform compulsive
acts to try to ease your stress ... leading to more
ritualistic behavior. fed by excessive fed by an excessive
concerns that fear of getting
something bad to contaminated by
happen to germs.
themselves or
OCD was classified under anxiety disorders
others, whether
category but is now under Impulse Control intentionally or
Disorder (of DSM-5). not.
Hoarding
Disorder

RS2020 | 2020-11-12 | Lecture 10 22

Anxiety Disorder, OCD and PTSD (Weiten Section 14.2)

Post-traumatic Stress Disorder (PTSD)

Triggered by a terrifying event — either experiencing it
or witnessing it. Experience distressful flashbacks,
nightmares and severe anxiety, as well as
uncontrollable thoughts about the event.

7% life-time prevalence
“...first recognized as a disorder in the 1970s in the aftermath of
the Vietnam War, when a great many veterans were
Intrusive memories (resurrent, distressing, upsetting) traumatized by their combat experiences.”
Nightmare and dreasms, and reminders.

Avoidance of thinking, talking about, places, activities, people

related to the traumatic event.

Negative changes in thinking and mood

e.g., Negative thoughts about yourself, others or the world;
Hopelessness; blunt emotion; detached from family and friends

Changes in physical and emotional reactions

e.g., irritability, aggressive behavior, overwhelming guilt or
shame

https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-
disorder/symptoms-causes/syc-20355967

RS2020 | 2020-11-12 | Lecture 10 23

Anxiety Disorder, OCD and PTSD (Weiten Section 14.2)

Biological Factors
- Genetic
- Physiological (GABA, serotonin)
benzodiazepines
Conditioning and Learning [should be under cognitive]
- Learned fear through classical and instrumental conditioning
(Mowrer’s two –factor model)
- Preparedness (classical conditioning) of specific phobias
- Impaired extinction learning

Cognitive Factors
- Misinterpretation of situations
- Attention SSRI
- Biased/Selective recalls of threatening experience and information.
- Overthinking, maladaptive cognitive styles

Stress
- Stress is inextricably linked to fear/anxiety physiologically and psychologically
- Stress may precipitate panic attacks and/or exacerbate symptoms

RS2020 | 2020-11-12 | Lecture 10 24

Dissociative Disorders (Weiten Section 14.3)

Dissociative disorders involve problems with memory, Dissociative amnesia

identity, emotion, perception, behavior and sense of self. (confused wandering away from your life, known as
"dissociative fugue"

https://www.psychiatry.org/patients-families/dissociative-
disorders/what-are-dissociative-disorders
Dissociative identity disorder
formerly "multiple personality disorder"
... experiencing a disconnection and lack of continuity "Each identity may have a unique name, personal history
and characteristics, including obvious differences in voice,
between thoughts, memories, surroundings, actions and
gender, mannerisms and even such physical qualities as
identity. the need for eyeglasses."

People with dissociative disorders escape reality in ways usually associated with overwhelming
that are involuntary, unhealthy and cause dysfunction. experiences, traumatic events and/or abuse.
https://www.mayoclinic.org/diseases-conditions/dissociative-disorders/symptoms-causes/syc-20355215

Depersonalization-derealization disorder
Depersonalization - observing your actions, feelings,
thoughts and self from a distance as though watching a
movie
Derealization - Other people and things in one's
surronding feel detached and foggy or dreamlike, time
may be slowed down or sped up, and the world may seem
Rare conditions and little is known about their unreal.
etiology.

RS2020 | 2020-11-12 | Lecture 10 25

26
Major Depressive Disorder and Bipolar Disorder (Weiten Section 14.4)

Major Depressive Disorder (MDD)

A mood disorder characterized by “persistent feelings of
sadness and despair, and a loss of interest in previous
sources of pleasure*”.

*anhedonia — a diminished ability to experience pleasure.

- lifetime prevalence: 13-16 %

- females > males

Biploar Disorder (or Manic Depressive Disorder)

Is characterized by “extreme mood swings that include
emotional highs (mania or hypomania) and lows
(depression).
... mood swings may occur rarely or multiple times a year”.

- lifetime prevalence: 1%
- females ~ males

RS2020 | 2020-11-12 | Lecture 10 27

Major Depressive Disorder and Bipolar Disorder (Weiten Section 14.4)

Manic phases can be

quite a desirable state.

Impulsive gambling,
Frantic spending,
Sexual recklessness

Suicidal behaviour
“Suicide is defined as death
- Suicides and attempted suicides (25 : 1) resulting from intentional self-
- Depression accounts for 50-60% of completed suicides in US injurious behavior, associated
with any intent to die as a result
of the behavior.”
Posner et al. (2014)

RS2020 | 2020-11-12 | Lecture 10 28

 Bertolote (2014) Prevention of Suicidal Behaviors. In: Matthew Nock
(ed) The Oxford Handbook of Suicide and Self-injury. OUP

To teach "gatekeepers" the warning signs of a suicide crisis

and how to respond. Gatekeepers can include anyone who
is strategically positioned to recognize someone at risk of
suicide (e.g., parents, friends, neighbors, teachers, coaches,
caseworkers, police officers) through:
(1) Questioning intent regarding suicide,
(2) Persuading the person to seek and accept help,
(3) Referring the person to appropriate resources.

RS2020 | 2020-11-12 | Lecture 10 29

Major Depressive Disorder and Bipolar Disorder (Weiten Section 14.4)

Genetic Factors
- Polygenetic

Craddock (1999)
Neurochemical hypotheses
- Noradrenaline (catecholamine hypothesis)
- Serotonin (5HT)
- Neurotrophic factors (BDNF)

Brain mechanism
- Hippocampus atrophy, esp., neurogenesis in the hippocampus

Stress
- Release of Stress hormones (corticosteroids) following activation of the HPA (hypothalamic-pituitary
adrenocortical) axis
- Corticosteroids can disrupt hippocampal function and neurogenesis
- History of early life stress
- Not a trigger of depressive/manic episode (in contrast to schizophrenia)

RS2020 | 2020-11-12 | Lecture 10 30

Major Depressive Disorder and Bipolar Disorder (Weiten Section 14.4)

Cognitive Factors
- Learned Helplessness
Cognitive style acquired through learning.
A pessimistic style of attribution vulnerable to depression:
To attribute setbacks to personal flaws instead of situational
factors.
To draw global, far-reaching conclusions about personal
inadequacies based on such setbacks.
c.f. Learned optimism
Resilience against depression

- Renumeration (female > male)

Rumination fosters and amplifies depression by increasing
negative thinking, impairing problem solving, and undermining
social support.
?
- Poor social skills
Irritable, pessimistic, unpleasant,
Alienation of others by excessive reassurance seeking,

RS2020 | 2020-11-12 | Lecture 10 31

https://illustrationchronicles.com/Cute-Cats-and-Psychedelia-The-Tragic-Life-of-Louis-Wain

https://en.wikipedia.org/wiki/Louis_Wain

RS2020 | 2020-11-12 | Lecture 10 32

Schizophrenia (Psychotic Disorders) (Weiten Section 14.5)

Schizophrenia is a severe, debilitating condition, with Very costly to the person & society
~1% lifetime prevalence. It involves a disintegration of Emerges during adolescence or early
one’s persona. adulthood.
Long-term functional impairment.
Increased suicide risk and premature
It is the most common type of psychosis, which refers death.
to the inability to distinguish one’s own thoughts and
reality.
Negative symptoms involve
Schizophrenia also involves both psychotic (bizarre behavioral deficits, such as
thoughts and beliefs, perceptual abnormality) and flattened emotions,
other non-psychotic symptoms. social withdrawal, apathy,
impaired attention, poor
grooming, lack of persistence
Positive symptoms involve at work or school, and poverty
positive
behavioral excesses or negative of speech.
peculiarities, such as hallucinations, (psychotic)
+ some motor disturbances
delusions,
incoherent thought, agitation,
bizarre behavior, and wild flights of
ideas.
cognitive Emotional disturbances,
inappropriate and lack of
affect, social impairment

Distressful
Cognitive symptoms
Deficits in memory, attention, Work-related
deterioration
and executive function.

RS2020 | 2020-11-12 | Lecture 10 33

Schizophrenia (Psychotic Disorders) (Weiten Section 14.5)

Most notable Delusions

Positive / psychotic symptoms False beliefs that are maintained even though they
clearly are out of touch with reality.

Delusions of grandeur Other symptoms of “thought

Delusions of persecution disorder” often reflected in
Thought broadcast speech: loosening of association
Thought insertion and flight of ideas

Hallucination
Sensory perceptions in the absence of a real, external
stimulus or are gross distortions of perceptual input

Most common in the auditory domain in SZ, but can also be in

“hearing voices in my head” other modality (visual, touch).
The voices is often insulting and takes the form of running
commentary.

RS2020 | 2020-11-12 | Lecture 10 34

Schizophrenia (Psychotic Disorders) (Weiten Section 14.5)

Clear genetic contribution suggested by

concordance analysis between relatives.

The Genain
Quadruplets Sisters

Neurochemical factors:

Dopamine hypothesis
- hyperactivity of dopamine neurotransmission is
implicated, esp., positive symptoms

Cannabis (marijuana) use

- the tetrahydrocannabinol component in cannabis
linked to increased risk of schizophrenia.

RS2020 | 2020-11-12 | Lecture 10 35

Schizophrenia (Psychotic Disorders) (Weiten Section 14.5)

Neurodevelopment perspective of Family Dynamics / Upbringing

schizophrenia etiology Expressed emotion refers to highly
critical or emotionally
overinvolved attitudes toward by
Expressed
Stress family members
emotion

inflammatory events as being consistent with early

developmental defect

RS2020 | 2020-11-12 | Lecture 10 36

https://www.huffpost.com/entry/stephen-wiltshires-detailed-drawings_n_1260041
Autistic Spectrum Disorder (ASD) (Weiten Section 14.6)

ASD is a spectrum disorder (in DSM-5) of developmental origin (incl. Asperger’s syndrome)
- male dominant (~80%)
- polygenetic in the milder end of the spectrum
- higher risk in preterm babies
- diagnosed before 3 y.o. (<18 m.o)
Savant skills:
- rapid riase in 1990s memory, exceptional ability to read,
spell and write; art; music;
mechanical or spatial skill; numbers,
calendar calculation.

Stephen Wiltshire - The

Human Camera

https://www.youtube.co
m/watch?v=xcX-Nvm-wmE

Take no interest in Impaired language Learning difficulty, Inflexible behaviour,

interpersonal interaction. development Poor intellectual
development Anxiety prone with
Poor empathy, theory of mind rage, and tandrums

Poor peer relationship, and

bonding with parents/carers.

RS2020 | 2020-11-12 | Lecture 10 38

Autistic Spectrum Disorder (ASD) (Weiten Section 14.6)

Extreme male brain hypothesis

or the Empathizing–systemizing theory
by Simon Baron-Cohen

https://www.youtube.com/watch?v=crmDSDeCEp4

Larger brain and overgrowth?

Hypoconnectivity and Hyperconnectivity

DiMartino et al. (2014)

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Personality Disorders (Weiten Section 14.7)

Manifestation of extreme, inflexible personality traits can

cause subjective distress and impair social and occupational
functioning.
Examples:
12% lifetime prevalence
Dysfunctional family
systems, erratic discipline,
Factors that shape our personality relevant are obviously parental neglect; Antisocial
factors of PDs: Genetic, environment, early upbringing. Parental modeling of PD
exploitive, amoral
Personality is about individual differences esp. how people behavior
see themselves and each other.
PDs therefore naturally are closely related to
Early trauma, physical and Borderline
distress/dysfunctional within interpersonal interactions.
sexual abuse PD

DSM-5 includes 10 PDs, under 3 Clusters:

RS2020 | 2020-11-12 | Lecture 10 40

 Personality Disorders (Weiten Section 14.7)

Cluster A: Odd or Eccentric Cluster B: Dramatic, Emotional, Cluster C: Anxious or Fearful

Erratic or Impulsive
Paranoid Avoidant
“showing pervasive and unwarranted Antisocial “Sensitive to potential rejection,
suspiciousness and mistrust of people; “Violate the rights of others, not humiliation, or shame ➔
overly sensitive; prone to jealousy” accept social norms or not form Social withdrawn in spite of desire for
Schizotypal attachments to others, cannot sustain acceptance from others”
“showing social deficits and oddities consistent work behavior; Dependent
of thinking, perception, and irresponsible, exploitive and reckless” “Low self-reliance and self-esteem;
communication resembling Allowing others to make all decisions;
Borderline
schizophrenia” Subordinating own needs to others’ ”
“Unstable in self-image, mood, and
Schizoid interpersonal relationships; impulsive Obsessive-compulsive
“Deficiency in forming social and unpredictable” “Preoccupied with organization, rules,
relationships; absence of warm, schedules, lists, trivial details;
Histrionic
tender feelings for others” ➔ Extremely conventional, serious, and
“Overly dramatic; exaggerated
formal; Unable to express warm
expressions of emotion; egocentric,
emotions”
attention seeking”
Narcissistic
“Grandiosely self-important;
preoccupied with success fantasies;
expect special treatment; long for
appreciation; lack interpersonal
empathy”

Unfilled ➔ fragile self-esteem, in

contrast to the appearance of self- (formal) behavior expected in
assurance and confidence employment, incl. trust with co-
workers.

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Eating Disorders (Weiten Section 14.8)

The product of modern, affluent Western culture…

90%–95% anorexia nervosa and and bulimia nervosa cases are female
~60% of binge-eating disorder cases are female
Mostly affect young women (typical age of onset 14–18 for anorexia; 15–21 for bulimia.

Anorexia nervosa Bulimia nervosa Binge-eating disorder

intense fear of weight gain, Habitual out-of-control Distress-inducing eating
distorted body image ➔ overeating, followed binges, not accompanied by
refusal to maintain normal by unhealthy compensatory purging, fasting, excessive
weight, and use of dangerous efforts: self-induced exercise seen in bulimia.
measures to lose weight. vomiting, fasting, abuse of
laxatives and diuretics, and Frequently overweight
Half suffer from depression excessive exercise.
or anxiety. Self-indulgence associated with
Appear normal in weight stress.
More likely to seek help

Leading to amenorrhea (absence Leading to cardiac arrythmias, Less severe and life-threatening.
of menses), GI problems, low dental problems, metabolic
blood pressure, osteoporosis, deficiencies, and GI problems
metabolic disturbances, cardiac
arrest.
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End of Lecture 10