Abnormal Psychology, the science and treatment of psychological disorders by A. M. Kring, S. L. Johnson, G. C. Davison and J. M. Neale (thirteenth edition) – Book summary
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Dissociation refers to some aspect of emotion, memory or experience being inaccessible consciously. Depersonalization/derealization involves a form of dissociation involving detachment. The person feels removed from the sense of self and surroundings. The lifetime prevalence of depersonalization/derealization disorder is about 2.5%. The lifetime prevalence of dissociative amnesia is about 7.5%. The lifetime prevalence of dissociative identity disorder is about 1%-3%. Clinical profile depersonalization/derealization disorder:DepersonalizationDerealizationSymptoms are persistent OR recurrentReality testing remains intactSymptoms are not explained by substances, another dissociative disorder, another psychological disorder of a medical conditionThis disorder involves no disturbances of memory. It usually begins in adolescence and is usually triggered by stress. It is very comorbid with personality disorders, depression and anxiety disorders. Depersonalization refers to experiences of detachment from one’s mental processes or body (e.g: as in a dream). Derealization refers to experiences of unreality of surroundings. Clinical profile dissociative amnesia:Inability to remember important autobiographical information, usually of a traumatic or stressful nature, that is too extensive to be ordinary forgetfulnessThe amnesia is not explained by substances, or by other medical or psychological conditionsIt is dissociative fugue subtype IF the amnesia is associated with bewildered or purposeful wanderingThe amnesia usually disappears as suddenly as it began, with complete recovery and only a small chance of recurrence. Procedural memory remains intact during episodes of amnesia. Alcohol and medication can cause blackouts and potentially explain the amnesia. Dissociative amnesia and fugue are rare, even among people who have experienced intense trauma. People experiencing stress tend to...
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A psychological disorder is difficult to define. There is no consensus on the definition of a psychological disorder. A psychological disorder definition should include the following four characteristics:
Demonology refers to the doctrine that an evil being or spirit can dwell within a person and control his or her mind and body. People used to be treated very inhumane in asylums. They were chained and tortured. After this moral treatment started, humane treatment. This was abandoned later in 1800.
After the connection between syphilis and paralysis, biological bases were seen as the cause of psychological disorders. After the observation of mass hysteria, a more psychological approach was being taken. The cathartic method refers to treating psychological disorders by reliving an earlier emotional trauma and releasing emotional tension by expressing previously forgotten thoughts about the events. Transference refers to the person’s responses to his or her analyst that seem to reflect attitudes and ways of behaving toward important people in the person’s past. The collective unconscious is part of the unconsciousness that is common to all human beings and consists of archetypes, basic categories for conceptualizing the world.
Freud still has an influence on modern-day psychology in the following three assumptions: childhood experiences help shape adult personality (1), there are unconscious influences on behaviour (2) and the causes and purposes of human behaviour are not always obvious (3). Appraisals are part of cognitive therapy.
All behaviour is heritable to some degree, but genes do not operate in isolation from the environment. The environment shapes how our genes are expressed and our genes shape the environment. Genes are the carriers of genetic information. Gene expression is the expression of a gene to produce a protein. Psychopathology is polygenic, there is not a single gene that causes a disorder. Heritability refers to the extent to which variability in a particular behaviour in a population can be accounted for by genetic factors. Shared environment factors are factors that members of a family have in common. Nonshared environment factors are factors that are distinct among members of a family.
Behaviour genetics is the study of the degree to which genes and environmental factors influence behaviour. Molecular genetics seeks to identify particular genes and their functions. A genetic polymorphism refers to a difference in the DNA sequence on a gene that has occurred in a population. Single nucleotide polymorphisms refer to differences between people in a single nucleotide. A gene-environment interaction means that a given person’s sensitivity to an environmental event is influenced by genes. Epigenetics is the study of how the environment can alter gene expression.
The neuroscience paradigm holds that psychological disorders are linked to aberrant processes in the brain. Norepinephrine is a neurotransmitter that communicates with the sympathetic nervous system. It is involved in producing high states of arousal. An agonist is a drug that stimulates a particular neurotransmitter’s receptor. An antagonist is a drug that works on a neurotransmitter’s receptor to dampen the activity of that neurotransmitter.
Nerves converge and messages are integrated from different centres in nuclei. Pruning is the elimination of a number of synaptic connections. The hypothalamic-pituitary-adrenal (HPA) axis is central to the body’s response to stress. Psychoneuroimmunology studies how psychological factors influence the immune system. Natural immunity is the body’s first line of defence. It consists of cells attacking the invaders. Specific immunity involves cells that respond more slowly to infection. Cytokines are activated by the immune system during infection and help initiate bodily responses to infection such as fever.
The cognitive behavioural paradigm makes use of learning principles and cognitive science. Problem behaviour is reinforced by getting attention (1), escaping from tasks (2), generating sensory feedback (3) and gaining access to desirable things or situations (4). Maintaining the effect of treatment is difficult.
Behavioural activation (BA) therapy involves helping a person engage in tasks that provide an opportunity for positive reinforcement. Behaviour therapy minimizes the importance of thinking and feeling. Cognition is a term that groups together the mental processes of perceiving, recognizing, conceiving, judging and reasoning. Implicit memory refers to the idea that a person can, without being aware of it, be influenced by prior learning.
Cognitive behaviour therapy (CBT) incorporates theory and research on cognitive processes. Cognitive restructuring refers to changing a pattern of thought.
Emotions influence how we respond to problems and
.....read moreA correct diagnosis will allow the clinician to describe base rates, causes and treatment. Reliability and validity are the cornerstones of any diagnostic or assessment procedure. Reliability refers to the consistency of measurement. Validity refers to measuring what you want to measure. Alternate form reliability refers to the extent to which scores on two forms of the test are consistent. Criterion validity is evaluated by determining whether a measure is associated expectedly with some other measure. If both variables are being measured at the same time, it is concurrent validity.
The diagnostic and statistical manual of mental disorders (DSM) is the diagnostic system used by many mental health professionals. Specific diagnostic criteria (1) and extensively described characteristics of diagnosis (2) were added to the DSM-III and have been retained ever since.
There are some major changes of the DSM into the DSM-5:
There are some criticisms of the DSM:
Diagnosing someone can have the disadvantages of changing a person’s ability to function and stigmatize a person. Diagnosis can lead us to focus on the disorder and ignore important differences among people.
There are several methods in which psychological assessment can be obtained.
Mental health professionals can use formal and structures as well as informal and fewer structures clinical interviews for psychological assessment. In a clinical interview, the interviewer pays attention to how the respondent answers questions. Trust is imperative for psychological treatment. A structured interview can be
.....read moreClinical profile major depressive disorder:
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AND at least five symptoms: |
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It is an episodic disorder because symptoms tend to be present for a period of time and then clear. People with persistent depressive disorder are chronically depressed. Clinical profile:
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AND at least two of the following during that time: |
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The symptoms do not clear for more than 2 months at a time. Bipolar disorders are not present. Women are more likely than men to develop
.....read moreAnxiety disorders include fear and anxiety. Anxiety refers to apprehension over an anticipated problem. Fear is a reaction to immediate danger. Fear happens at the moment and anxiety involves a future threat. In all anxiety disorders, except for a panic disorder, the symptoms must persist for at least 6 months. The symptoms must persist for at least one month for a panic disorder.
Clinical profile-specific phobia (e.g: snakes, spiders, heights):
For AT LEAST 6 months: |
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The object of phobia may also elicit intense disgust. Specific phobias are highly comorbid.
Clinical profile social anxiety disorder:
For AT LEAST 6 months: |
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The social anxiety disorder can be about a specific social situation (e.g: speaking in public) and doesn’t necessarily include all social situations. Severe social anxiety is highly comorbid with depression and alcohol abuse. People with social anxiety can demonstrate aggressive and hostile behaviour in the face of potential social rejection.
Clinical profile panic disorder:
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Panic attacks are unrelated to specific situations.
Clinical profile panic attack:
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Obsessive-compulsive and related disorders are defined by repetitive thoughts and behaviours that are so extreme that they interfere with everyday life. Obsessions are repetitive thoughts and urges. Compulsions are repetitive behaviours or mental acts. Compulsions are often not seen as pleasurable by the patient. OCD begins before age 10 or in late adolescence/early adulthood.
Clinical profile Obsessive-compulsive disorder:
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Obsessions include: |
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Compulsions include: |
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Obsessions or compulsions are time-consuming (1 hour a day) or cause significant distress or impairment |
People with body dysmorphic disorder (BDD) are preoccupied with one or more imagined or exaggerated defects in their appearance. People with BDD find it very hard to stop thinking about their concerns. BDD is associated with suicide ideation. It typically begins in adolescence. If weight and body shape are the only concerns about appearance, it might fit the profile of an eating disorder better. Clinical profile body dysmorphic disorder:
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Dissociation refers to some aspect of emotion, memory or experience being inaccessible consciously. Depersonalization/derealization involves a form of dissociation involving detachment. The person feels removed from the sense of self and surroundings. The lifetime prevalence of depersonalization/derealization disorder is about 2.5%. The lifetime prevalence of dissociative amnesia is about 7.5%. The lifetime prevalence of dissociative identity disorder is about 1%-3%.
Clinical profile depersonalization/derealization disorder:
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This disorder involves no disturbances of memory. It usually begins in adolescence and is usually triggered by stress. It is very comorbid with personality disorders, depression and anxiety disorders. Depersonalization refers to experiences of detachment from one’s mental processes or body (e.g: as in a dream). Derealization refers to experiences of unreality of surroundings.
Clinical profile dissociative amnesia:
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The amnesia usually disappears as suddenly as it began, with complete recovery and only a small chance of recurrence. Procedural memory remains intact during episodes of amnesia. Alcohol and medication can cause blackouts and potentially explain the amnesia. Dissociative amnesia and fugue are rare, even among people who have experienced intense trauma. People experiencing stress tend to focus on the central features of the threatening situation and stop paying attention to peripheral features. People tend to remember emotionally relevant information more than neutral information surrounding an event. It is possible that extremely high levels of stress hormones could interfere with memory formation.
Clinical profile dissociative identity disorder:
MOOD DISORDERS
Disorder | Major depressive disorder (MDD) |
Symptoms |
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Time | 2 weeks |
Prevalence | 16% |
A psychological disorder is difficult to define. There is no consensus on the definition of a psychological disorder. A psychological disorder definition should include the following four characteristics:
Demonology refers to the doctrine that an evil being or spirit can dwell within a person and control his or her mind and body. People used to be treated very inhumane in asylums. They were chained and tortured. After this moral treatment started, humane treatment. This was abandoned later in 1800.
After the connection between syphilis and paralysis, biological bases were seen as the cause of psychological disorders. After the observation of mass hysteria, a more psychological approach was being taken. The cathartic method refers to treating psychological disorders by reliving an earlier emotional trauma and releasing emotional tension by expressing previously forgotten thoughts about the events. Transference refers to the person’s responses to his or her analyst that seem to reflect attitudes and ways of behaving toward important people in the person’s past. The collective unconscious is part of the unconsciousness that is common to all human beings and consists of archetypes, basic categories for conceptualizing the world.
Freud still has an influence on modern-day psychology in the following three assumptions: childhood experiences help shape adult personality (1), there are unconscious influences on behaviour (2) and the causes and purposes of human behaviour are not always obvious (3). Appraisals are part of cognitive therapy.
All behaviour is heritable to some degree, but genes do not operate in isolation from the environment. The environment shapes how our genes are expressed and our genes shape the environment. Genes are the carriers of genetic information. Gene expression is the expression of a gene to produce a protein. Psychopathology is polygenic, there is not a single gene that causes a disorder. Heritability refers to the extent to which variability in a particular behaviour in a population can be accounted for by genetic factors. Shared environment factors are factors that members of a family have in common. Nonshared environment factors are factors that are distinct among members of a family.
Behaviour genetics is the study of the degree to which genes and environmental factors influence behaviour. Molecular genetics seeks to identify particular genes and their functions. A genetic polymorphism refers to a difference in the DNA sequence on a gene that has occurred in a population. Single nucleotide polymorphisms refer to differences between people in a single nucleotide. A gene-environment interaction means that a given person’s sensitivity to an environmental event is influenced by genes. Epigenetics is the study of how the environment can alter gene expression.
The neuroscience paradigm holds that psychological disorders are linked to aberrant processes in the brain. Norepinephrine is a neurotransmitter that communicates with the sympathetic nervous system. It is involved in producing high states of arousal. An agonist is a drug that stimulates a particular neurotransmitter’s receptor. An antagonist is a drug that works on a neurotransmitter’s receptor to dampen the activity of that neurotransmitter.
Nerves converge and messages are integrated from different centres in nuclei. Pruning is the elimination of a number of synaptic connections. The hypothalamic-pituitary-adrenal (HPA) axis is central to the body’s response to stress. Psychoneuroimmunology studies how psychological factors influence the immune system. Natural immunity is the body’s first line of defence. It consists of cells attacking the invaders. Specific immunity involves cells that respond more slowly to infection. Cytokines are activated by the immune system during infection and help initiate bodily responses to infection such as fever.
The cognitive behavioural paradigm makes use of learning principles and cognitive science. Problem behaviour is reinforced by getting attention (1), escaping from tasks (2), generating sensory feedback (3) and gaining access to desirable things or situations (4). Maintaining the effect of treatment is difficult.
Behavioural activation (BA) therapy involves helping a person engage in tasks that provide an opportunity for positive reinforcement. Behaviour therapy minimizes the importance of thinking and feeling. Cognition is a term that groups together the mental processes of perceiving, recognizing, conceiving, judging and reasoning. Implicit memory refers to the idea that a person can, without being aware of it, be influenced by prior learning.
Cognitive behaviour therapy (CBT) incorporates theory and research on cognitive processes. Cognitive restructuring refers to changing a pattern of thought.
Emotions influence how we respond to problems and
.....read moreA correct diagnosis will allow the clinician to describe base rates, causes and treatment. Reliability and validity are the cornerstones of any diagnostic or assessment procedure. Reliability refers to the consistency of measurement. Validity refers to measuring what you want to measure. Alternate form reliability refers to the extent to which scores on two forms of the test are consistent. Criterion validity is evaluated by determining whether a measure is associated expectedly with some other measure. If both variables are being measured at the same time, it is concurrent validity.
The diagnostic and statistical manual of mental disorders (DSM) is the diagnostic system used by many mental health professionals. Specific diagnostic criteria (1) and extensively described characteristics of diagnosis (2) were added to the DSM-III and have been retained ever since.
There are some major changes of the DSM into the DSM-5:
There are some criticisms of the DSM:
Diagnosing someone can have the disadvantages of changing a person’s ability to function and stigmatize a person. Diagnosis can lead us to focus on the disorder and ignore important differences among people.
There are several methods in which psychological assessment can be obtained.
Mental health professionals can use formal and structures as well as informal and fewer structures clinical interviews for psychological assessment. In a clinical interview, the interviewer pays attention to how the respondent answers questions. Trust is imperative for psychological treatment. A structured interview can be
.....read moreThe goal of exploratory research is to disprove hypotheses, generate hypotheses and getting rich descriptions. Qualitative research is primarily exploratory research. The limitations of qualitative research are generalizability (1), causality (2) and biases (3). The solution to the problem of generalizability is using correlational studies. The solution to the problem of causality is conducting experiments and longitudinal studies.
The case study involves recording detailed information about one person at a time. One major pitfall of case studies is the bias of the theoretical framework. Correlational studies are used to study prevalence, risk factors and incidence. Limitations of correlational studies are the representativeness of samples and that confidence intervals are rarely given. There is always the possibility of a third-variable mediator in correlational studies.
There are several correlational methods for behaviour and molecular genetics:
Experiments are used to test causality. Internal validity is important for experiments and there is relatively low external validity. In analogue studies, the researcher attempts to emulate the conditions hypothesised to lead to abnormalities. Randomized controlled trials are studies in which clients are randomly assigned to receive active treatment or a comparison. Treatment outcome research addresses the question of whether the treatment works. A single-case experimental design is an experiment involving one person responding to manipulations of the independent variable. The reversal design or the ABAB design is one form of single-case experimental design:
A) Initial period (baseline)
B) Treatment
A) Reinstatement of conditions of baseline
B) Reintroduction of treatment
Clinical significance is defined by whether a relationship between variables is large enough to matter. The efficacy of treatment refers to whether the treatment works in the purest of conditions. The effectiveness of treatment refers to whether the treatment works in the real world.
Clinical profile major depressive disorder:
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AND at least five symptoms: |
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It is an episodic disorder because symptoms tend to be present for a period of time and then clear. People with persistent depressive disorder are chronically depressed. Clinical profile:
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AND at least two of the following during that time: |
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The symptoms do not clear for more than 2 months at a time. Bipolar disorders are not present. Women are more likely than men to develop
.....read moreAnxiety disorders include fear and anxiety. Anxiety refers to apprehension over an anticipated problem. Fear is a reaction to immediate danger. Fear happens at the moment and anxiety involves a future threat. In all anxiety disorders, except for a panic disorder, the symptoms must persist for at least 6 months. The symptoms must persist for at least one month for a panic disorder.
Clinical profile-specific phobia (e.g: snakes, spiders, heights):
For AT LEAST 6 months: |
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The object of phobia may also elicit intense disgust. Specific phobias are highly comorbid.
Clinical profile social anxiety disorder:
For AT LEAST 6 months: |
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The social anxiety disorder can be about a specific social situation (e.g: speaking in public) and doesn’t necessarily include all social situations. Severe social anxiety is highly comorbid with depression and alcohol abuse. People with social anxiety can demonstrate aggressive and hostile behaviour in the face of potential social rejection.
Clinical profile panic disorder:
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Panic attacks are unrelated to specific situations.
Clinical profile panic attack:
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Obsessive-compulsive and related disorders are defined by repetitive thoughts and behaviours that are so extreme that they interfere with everyday life. Obsessions are repetitive thoughts and urges. Compulsions are repetitive behaviours or mental acts. Compulsions are often not seen as pleasurable by the patient. OCD begins before age 10 or in late adolescence/early adulthood.
Clinical profile Obsessive-compulsive disorder:
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Obsessions include: |
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Compulsions include: |
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Obsessions or compulsions are time-consuming (1 hour a day) or cause significant distress or impairment |
People with body dysmorphic disorder (BDD) are preoccupied with one or more imagined or exaggerated defects in their appearance. People with BDD find it very hard to stop thinking about their concerns. BDD is associated with suicide ideation. It typically begins in adolescence. If weight and body shape are the only concerns about appearance, it might fit the profile of an eating disorder better. Clinical profile body dysmorphic disorder:
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Dissociation refers to some aspect of emotion, memory or experience being inaccessible consciously. Depersonalization/derealization involves a form of dissociation involving detachment. The person feels removed from the sense of self and surroundings. The lifetime prevalence of depersonalization/derealization disorder is about 2.5%. The lifetime prevalence of dissociative amnesia is about 7.5%. The lifetime prevalence of dissociative identity disorder is about 1%-3%.
Clinical profile depersonalization/derealization disorder:
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This disorder involves no disturbances of memory. It usually begins in adolescence and is usually triggered by stress. It is very comorbid with personality disorders, depression and anxiety disorders. Depersonalization refers to experiences of detachment from one’s mental processes or body (e.g: as in a dream). Derealization refers to experiences of unreality of surroundings.
Clinical profile dissociative amnesia:
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The amnesia usually disappears as suddenly as it began, with complete recovery and only a small chance of recurrence. Procedural memory remains intact during episodes of amnesia. Alcohol and medication can cause blackouts and potentially explain the amnesia. Dissociative amnesia and fugue are rare, even among people who have experienced intense trauma. People experiencing stress tend to focus on the central features of the threatening situation and stop paying attention to peripheral features. People tend to remember emotionally relevant information more than neutral information surrounding an event. It is possible that extremely high levels of stress hormones could interfere with memory formation.
Clinical profile dissociative identity disorder:
Psychosis is a disruption in the experience of reality or disruption of reality testing. Hallucinations are perception-like experiences which occur without an external stimulus and the most common hallucinations are auditory hallucinations. It is not uncommon, as children tend to experience audio-visual hallucinations but this tends to stop at the age of 12 or 13. Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence. They are deemed bizarre if they are implausible, not understandable from same-culture peers and do not derive from ordinary life. There are several types of delusions:
Schizophrenia includes positive, negative and disorganized symptoms. Positive symptoms consist of symptoms that make it difficult for a person to tell what is real and what is not. Negative symptoms consist of behavioural deficits in motivation, pleasure, social closeness and emotion expression. Disorganized symptoms refer to the lack of ability to organize behaviour and conform to community standards. Catatonic behaviour is extremely disorganized behaviour. There are several negative symptoms:
Other symptoms include jumping to conclusions (1), disrupted self-experience (2), neurocognitive difficulties (3) and anosognosia (4): reduced insight into the illness. The severity of symptoms can be assessed using the Positive and Negative Syndrome Scale (PANSS) and using the beads task. Neurocognitive deficits can be measured by measuring working memory.
There is a strong genetic component in schizophrenia. There are several risk factors for developing a psychosis: being a migrant (1), urbanization (2), social exclusion (3) and trauma (4). A psychosis can be traumatic. A sense of social exclusion can play an important role in developing psychosis.
The social defeat hypothesis states that social exclusion increases the risk of psychosis. The dopamine hypothesis states that schizophrenia is related to excess activity of dopamine. The dopamine neurons in the prefrontal cortex may be underactive, which leads to overactivity of dopamine in the rest of the brain.
The cognitive model of auditory hallucinations states that an intrusive thought occurs, which is misattributed to an external source.
.....read moreThe incentive sensitization theory states that drugs stimulate the dopamine system (reward system), which produces rewards in the form of pleasurable feelings. This leads to the dopamine system becoming sensitive to the drug, resulting in incentive salience. Cue sensitivity leads to wanting of the drug and a dissociation between wanting and liking the drug develops.
The general development process of a substance use disorder (SUD) follows the following pattern: a positive attitude towards the drug (1), experimentation with the drug (2), regular use of the drug (3), heavy use of the drug (4), dependence or abuse of the drug (5). After this, there is either maintenance of the disorder (6) or recovery with the chance of relapse (7).
Tolerance is indicated by larger doses of the substances being needed to produce the desired effects. Withdrawal refers to the negative physical and psychological effects that develop when a person stops taking the substance or reduces the amount of substance being taken. People with a substance use disorder value immediate rewards more than delayed rewards. It recruits different brain regions and it can be hypothesised that both brain regions compete with each other when trying to make a decision.
Drug | Effects |
Marijuana | Feeling relaxed and sociable, large shifts in emotion, dull attention, fragmented thoughts, impaired thought processes, the sense that time moves more slowly, bloodshot, itchy eyes, dry mouth, increased appetite, raised blood pressure |
Opiates | Euphoria, drowsiness, lack of coordination, increase in self-confidence, lack of worries and fear, relieve pain and induce sleep |
Stimulants | Increase alertness and motor activity, heightens wakefulness, inhibits intestinal functions, quickening of heart rate, increase in self-confidence, euphoria |
Hallucinogen | Alter a sense of time, hallucinations and anxiety |
Ecstasy | Enhances intimacy, improve |
Eating disorders are not very stable. There is a lot of movement between the disorders. People with anorexia nervosa choose a thin figure as their ideal and overestimate their own body size, but are fairly accurate at reporting their weight. Maintaining thinness is strongly linked to self-esteem in anorexia nervosa.
There are several biological consequences of anorexia nervosa: falling of blood pressure (1), slowing of heart rate (2), decline of bone mass (3), kidney and gastrointestinal problems (4), drying of the skin (5), brittle nails (6), change in hormone levels (7), alteration of electrolytes (e.g., potassium) (8), tiredness (9) and lanugo (10).
Lanugo is a fine, soft hair that develops on the body in people with anorexia nervosa. 50%-70% of the people with anorexia nervosa recover, but it takes ±6-7 years to recover. Severity ratings in anorexia nervosa are based on BMI.
Bulimia nervosa and binge-eating disorder include binge eating. A binge is most likely to occur after a negative social interaction. Maintaining normal weight is strongly linked to self-esteem in bulimia nervosa. Most people with bulimia nervosa were slightly overweight before the onset of the disorder and binge eating started during an episode of dieting.
There are several biological consequences of bulimia nervosa: potassium depletion (1), diarrhoea (2), irregularities in heartbeat (3), menstrual problems (4), ragged teeth (5), swollen salivary glands (6) and tearing of tissue in the stomach and throat (7). Close to 75% of the people with bulimia nervosa recover. There are several biological consequences of binge eating disorder, with most of them being a consequence of obesity: sleep problems (1), anxiety (2), depression (3), irritable bowel syndrome (4) and early onset of menstruation (5).
Eating disorders are highly heritable. The hypothalamus regulates the level of cortisol in the body and cortisol levels differ in people with anorexia nervosa, but these hormonal differences are most likely to occur because of self-starvation. Self-starvation and excessive exercise may also increase endogenous opioids, substances produced by the body that reduce pain sensations, enhance mood and suppress appetite. Endogenous opioids may positively reinforce the behaviour that maintains the disorder.
Serotonin promotes satiety and severe food intake restrictions could interfere with the serotonin system. Dopamine is linked to the pleasurable aspects of food that compel an animal to go after food. Restrained eaters may be more sensitive to food cues. People with anorexia nervosa and bulimia nervosa had a greater expression of the dopamine transporter gene DAT. Expression of DAT influences the release of a protein that regulates the reuptake of dopamine back into the synapse.
Perfectionism and a sense of personal inadequacy may lead a person to become especially concerned with appearance. Western culture emphasizes and reinforces the desirability of being thin more for women than for men. The objectification of women’s bodies exaggerates this effect. Body shame has a negative influence on eating disorders, as well as criticism
.....read moreSexual fantasies begin to qualify as abnormal when they begin to affect us or others in unwanted or harmful ways. Sexual dysfunctions are persistent disruptions in the ability to experience sexual arousal, desire, or orgasm, or as pain associated with intercourse. Paraphilic disorders are defined as persistent and troubling attractions to unusual sexual activities or objects. Sexual norms and behaviour change with time and culture. Gender dysphoria refers to the idea that one should be the opposite gender.
Men report thinking about sex, masturbating and desiring sex more often as well as desiring more sexual partners and having more partners. Women tend to be ashamed of any flaws in their appearance and this shame can interfere with sexual satisfaction. Sexuality is more closely tied to relationship status for women than for men. Men are more likely to think of their sexuality in terms of power.
Women are more likely to report symptoms of sexual dysfunction, but men are more likely to meet diagnostic criteria for paraphilic disorder. The sexual response cycle consists of four phases:
For women, there is a difference between biological arousal and subjective excitement.
SEXUAL DYSFUNCTIONS
There are three types of sexual dysfunctions. Sexual dysfunctions involving sexual desire, arousal and interest (1), orgasmic disorders (2) and a disorder involving sexual pain (3). All sexual dysfunction disorders must last at least 6 months. Sexual concerns that arise as a consequence of severe relationship distress (e.g: partner abuse) should not be diagnosed as sexual dysfunctions.
Clinical profile female sexual interest/arousal disorder:
Diminished, absent or reduced frequency of AT LEAST three of the following: |
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Whether the behaviour is seen as problematic depends on culture. Externalizing disorders are characterised by more outward-directed behaviours. Internalizing disorders are characterised by more inward-focused experiences and behaviours.
There are three sub-types of ADHD:
People with ADHD tend to have problems getting along with peers and establishing friendships. They show poor social skills (1), aggressive behaviour (2) and overestimate their social skills (3). The combined type is the most likely to develop conduct problems.
The heritability of ADHD is ±70-80%. They have smaller dopaminergic areas in the brain, there are differences in brain structure, connectivity and function and they exhibit less activation in frontal areas. Frontal areas are important for the inhibition of behaviour. Low birth-weight (1), maternal smoking (2), interaction with family (3) and family characteristics (parental psychopathology) (4) are factors that can impact the development and can maintain or exacerbate the symptoms of ADHD. Food additives may help maintain or exacerbate the symptoms.
There are two paths of conduct disorder:
The adolescence-limited conduct disorder could result from a difference in physical maturation and the opportunity to assume adult responsibilities. Deficits in brain regions that support emotion (empathy) (1), deficiency in moral awareness (2), social information processing deficits (3), autonomic nervous system abnormalities (4) and peer rejection (5) are risk factors for conduct disorder. Ambiguous cues are often misinterpreted as evidence of hostile intent. Neighbourhood and family factors play a role in whether children associate with deviant peers.
The prevalence of depression in school-age children under 13 is ±2-3% and rises to ±6-16% in adolescence. Genetics (1), significant interpersonal stressful live events (2)¸ rejection by parents, cognitive distortions and a negative attributional style are risk factors for depression in children. The attributional style becomes stable by adolescence. The benefits of CBT may not last long for children and the side-effects of medication may be extreme for children.
Separation anxiety disorder is characterized by constant worry that some harm will befall their parents or themselves when they are away from their parents. For children, in order to be diagnosed with anxiety disorders, the fear does not need to be considered irrational as children are unable to make this judgement.
The heritability of anxiety disorders is ±29-50%. Parental control (1), insecure attachment style in infancy (2), overprotectiveness of parents (3), emotion regulation problems (4) and high levels of behavioural inhibition (5) are risk factors for the development of anxiety disorders in children.
A specific learning disorder is a condition in which a person shows a problem in a specific area of academic, speech, language
.....read moreThe number of elderly in the society increases because of an increase in life expectancy due to improved medical care and prevention of disease and because of the baby boom from 1946 – 1970. Diagnosing mental disorders in the elderly is difficult, as mental health is tied to physical problems and it is thus difficult to distinguish between a normal age-related change in function and neurocognitive disorders.
There are differences in circadian rhythm (1), temperature levels (2), cortisol level (3), metabolism (4) and heart rate (5) over the course of the day in the elderly. There is a flattening of daily cycle (1), fewer hours of sleep (2), peak shifts to the morning (3) and increased need for naps (4) with normal ageing. This leads to a decrease in cognitive abilities, a shift in peak performance, decrease in memory consolidation and a higher risk of brain disorders.
A problem with medication for the elderly is that the elderly often experience multiple medical issues, they take a number of medications, their medication is not adjusted to their age, medications are often tested on the young and there is a lot of medication nonadherence.
Ageism is an irrational prejudice against old people and/or ageing. There are several biases about ageing or being old. This includes being lonely (1), focussing on poor health (2) and being unhappy (3). There is social selectivity in older people, a shift of attention from forming new social interactions to cultivating the few important social interactions and older people are better at emotion regulation.
Age effects are the consequences of being a certain chronological age. Cohort effects are the consequences of growing up during a particular time period. Time-of-measurement effects are the effects of testing people at a particular time in history (e.g: after a terror attack). Consequences of longitudinal studies include selective mortality.
The prevalence of mental disorders is lower in the elderly and this could be due to reporting bias, cohort effects and selective mortality in research, but it likely reflects better mental health due to growing out of symptoms and enhanced coping abilities.
Dementia is a descriptive term for the deterioration of cognitive abilities to the point that functioning becomes impaired. In frontotemporal dementia, there is rapid progression of the disease and memory is not severely impaired, but there is functional impairment of executive function (1), ability to inhibit behaviour (2), empathy (3) and there is hyperorality (4), compulsive or perseverative behaviour (5) and apathy (6). It is caused by a loss of neurons in the frontal and temporal regions of the brain.
In dementia with Lewy bodies (DLB), protein deposits called Lewy bodies form in the brain and cause cognitive decline. It often occurs in the context of Parkinson’s disease, but this is not necessary. It is likely to include visual hallucinations, fluctuating cognitive symptoms and intense dreams with movement and vocalizing. Vascular dementia is caused by cerebrovascular disease. The onset of dementia
.....read morePersonality refers to a combination of unique traits expressed in thoughts, behaviours, feelings and interpersonal functioning. It is relatively stable over time and over situations. Personality disorders are pervasive, persistent and pathological. It can be assessed using semi-structured interviews (1), file research (2), using observations (3) and using heteroanamnesis, asking someone close to the person. They are dimensional in nature and the prevalence of a personality disorder is ±10%. The prevalence of personality disorders in prisons is ±60-70%. There is high comorbidity between the personality clusters.
Psychopathic people have no shame, poverty of emotions and manipulate others for personal gain. They seem unable to learn from experience, are insensitive to threats and immune to anxiety that keeps most people from breaking the law. Boldness (1), meanness (2) and impulsivity (3) underly psychopathy.
Problems with dopamine systems are involved in cognitive problems. Problems with serotonin systems are involved in anger and impulse control. Problems with MAO systems are involved with aggression. A dysfunctional amygdala leads to either hyper-emotionality or hypo-emotionality. A lack of frontal cortical control leads to impulses.
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