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Psychopathology or Psychological Disorders. KING LEAR. Prevalence. Lifetime Rates by Gender. Diagnosis: A Necessary Step. Diagnosis Process of identifying and grouping mental disorders with similar symptoms

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Psychopathology or psychological disorders l.jpg

Psychopathology or Psychological Disorders

KING LEAR




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Diagnosis: A Necessary Step

  • Diagnosis

    • Process of identifying and grouping mental disorders with similar symptoms

  • DSM-IV American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (4th Edition)


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Advances in diagnosis and therapy are success stories for clinical psychology/ psychiatry

In 1955, 500,000 institutionalized for psychological disorders

Today: 65,000

But mental hygiene arrests continue to this day (suicide, squalor, starving)


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Major Affective Disorders clinical psychology/ psychiatry

“The mind is its own place, and of itself

Can make a Heaven of Hell, a Hell of Heaven”

- John Milton (Paradise Lost)


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Major Affective Disorders clinical psychology/ psychiatry


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What is Bipolar disorder? clinical psychology/ psychiatry


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Mood cycles clinical psychology/ psychiatry


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Creativity & Bipolar clinical psychology/ psychiatry


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Creativity & Mood Dysfunction clinical psychology/ psychiatry

Iowa Writer’s Workshop, Andreasen, 1987

Other studies find 30x normal incidence rate in writers, musicians

Why are they linked?


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Hans Christian Anderson clinical psychology/ psychiatry

Ludwig von Beethoven

Lord Byron

Charles Dickens

T. S. Eliot

Ralph Waldo Emerson

William Faukner

F. Scott Fitzgerald

Paul Gauguin

Vincent van Gogh

Ernest Hemingway

Michelangelo

Sylvia Plath

Edgar Allan Poe

Gordon Sumner (Sting)

Peter Tchaikovsky

Leo Tolstoy

Mark Twain

Virginia Woolf

Tennessee Williams

Famous Bipolar Artists

  • Creativity Connection

  • Emotional reactive (unfiltered life)

  • Disinhibited (loose associations)

  • Absorption (focus)

  • Intense creative episodes during hypomania


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Vicious Cycle of Depression clinical psychology/ psychiatry


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Twenty-one dimensions of depression: clinical psychology/ psychiatry

1. Sadness                              12. Social withdrawal

2. Pessimism                           13. Indecisiveness

3. Sense of failure                   14 Change in body image

4. Dissatisfaction                     15. Retardation

5. Guilt                                   16. Insomnia

6. Expectation of punishment    17. Fatigability

7. Dislike of self                       18. Loss of appetite

8. Self Accusation                    19. Loss of Weight

9. Suicidal ideation                   20. Somatic preoccupation

10. Episodes of crying              21. Low level of energy

11. Agitation

In past week including today:

0 = I do not feel sad

1= I feel sad

2= I am sad all the time and I can’t snap out of it

3= I am so sad that I can’t stand it

0-63 max score (30+ indicates severe depression)

Beck Depression Inventory (BDI)

Aaron Beck


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Treatment for Unipolar clinical psychology/ psychiatry


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Antidepressants clinical psychology/ psychiatry


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30,000 Americans each year clinical psychology/ psychiatry

Nearly 2x the homicide rate

8th leading cause of death,

3rd for teens

2 x above the world rate

- 16.7/100K Japan (1997)

- 11.9/100K USA (1997)

Females attempt 3x males, but males succeed 4x

60% successes with firearms

Since 1950, suicide rates in teens has tripled

Suicide

Myth of Sisyphus (Camus): “There is only one really serious philosophical question, and that is suicide”


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Suicide in Depression Cycle clinical psychology/ psychiatry


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Anxiety Disorders clinical psychology/ psychiatry


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Phobia clinical psychology/ psychiatry

Intense irrational fear of object or situation


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Obsessive-Compulsive Disorder (OCD) clinical psychology/ psychiatry

  • Obsessions: repetitive thoughts

    - germs, terrible events, symmetry & order

  • Compulsions: repetitive behaviors

    - grooming, rituals, checking locks, appliances


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Dissociative Identity Disorder clinical psychology/ psychiatry

  • Previously Multiple personality disorders (MPD)


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Schizophrenia clinical psychology/ psychiatry

“Split Mind”

Disorders involving gross distortions of thoughts and perceptions and by loss of contact with reality


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Scz – the Disorder of Science and Math clinical psychology/ psychiatry

Isaac Newton – suffered psychotic break

Albert Einstein – autistic traits, Scz son

John Nash Jr – chronic schizophrenia

Bertrand Russell

James Joyce’s daughter

Syd Barrett (of Pink Floyd)

Socrates (perhaps, or

temporal lobe epilepsy)


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Paranoid clinical psychology/ psychiatry: Delusions or hallucinations often include extreme suspiciousness and hostility

Disorganized: Exhibit signs of illogical thinking and speech

Catatonic: Exhibit extremes in motor behavior

Undifferentiated: Do not clearly fit into a type

Catatonia

Types of Schizophrenia


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Positive & Negative Symptoms clinical psychology/ psychiatry

  • Positive Sx: cognitive, emotional, and behavioral excesses.

    • hallucinations, delusions, thought disorders, and bizarre behaviors.

  • Negative Sx: cognitive, emotional, and behavioral deficits.

    • apathy, flattened affect, social withdrawal, inattention, and slowed speech or no speech.


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Schizophrenia rates clinical psychology/ psychiatry

  • 1% across all cultures, despite few offspring

  • Male = females, or slightly more males

  • More in jails than psychiatric hospitals

  • 50% never accept that they are ill

  • 90% go off meds once+ (relapse within 3y)

  • Nearly 100% smoke (self-stimulation)

  • Higher prevalence in lower socioeconomic class

  • 25% full remission, 50% recurrent relapses (living independently on meds or less autonomously in group homes), 25% permanently hospitalized

  • 40% attempt suicide, 10% succeed


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DSM-IV Criteria clinical psychology/ psychiatry

  • Delusions

  • Hallucinations

  • Speech changes

  • Motor symptoms

  • Mood symptoms

  • Cognitive symptoms

    Must show 2 of following for 6 months


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Delusions – incorrect clinical psychology/ psychiatryconclusions about perceptions

  • Peculiar beliefs, culturally based aliens, secret lovers, paranoia, grandiosity, thought insertion or broadcast, erotomania

  • Ideas of reference events has special personal meaning

  • Magical thinking control events from afar


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DSM-IV Criteria clinical psychology/ psychiatry

  • Delusions

  • Hallucinations

  • Speech changes

  • Motor symptoms

  • Mood symptoms

  • Cognitive symptoms

    Must show 2 of following for 6 months


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Hallucinations clinical psychology/ psychiatry– inaccurate perceptions

Most auditory; some visual, olfactory, tactile

  • Commanding voice of authority – God, historical figure, parent alive or dead

  • Derisive, insulting

  • Running commentary of life, feelings, thoughts


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DSM-IV Criteria clinical psychology/ psychiatry

  • Delusions

  • Hallucinations

  • Speech changes

  • Motor symptoms

  • Mood symptoms

  • Cognitive symptoms

    Must show 2 of following for 6 months


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Speech changes clinical psychology/ psychiatry

  • Mute vs pressured (“word salad”)

  • Insensitive to the informational needs of audience

  • Overall, a poverty of speech


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DSM-IV Criteria clinical psychology/ psychiatry

  • Delusions

  • Hallucinations

  • Speech changes

  • Motor symptoms

  • Mood symptoms

  • Cognitive symptoms

    Must show 2 of following for 6 months


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Motor symptoms clinical psychology/ psychiatry

  • Catatonia

  • Peculiar (e.g., strip naked to greet)

  • Bizarre gestures, grimaces

  • Stereotypies (rocking, flapping)

  • Violence to self, or family members


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DSM-IV Criteria clinical psychology/ psychiatry

  • Delusions

  • Hallucinations

  • Speech changes

  • Motor symptoms

  • Mood symptoms

  • Cognitive symptoms

    Must show 2 of following for 6 months


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Mood symptoms clinical psychology/ psychiatry

  • Blunted, inappropriate, or exaggerated

  • Flat affect, anhedonia, avolitional, vegetative

  • Suicidal


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DSM-IV Criteria clinical psychology/ psychiatry

  • Delusions

  • Hallucinations

  • Speech changes

  • Motor symptoms

  • Mood symptoms

  • Cognitive symptoms

    Must show 2 of following for 6 months


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Cognitive Symptoms clinical psychology/ psychiatry

  • Attention disorder

  • Loose associations (“knight’s move”)

  • Memory impairment

  • Executive functioning – serial, perseveration, monitoring


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Knight’s Move clinical psychology/ psychiatry


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Impaired Theory of Mind clinical psychology/ psychiatry

  • Failure to monitor

    • what different people can know

    • one’s own intentional actions

    • informational needs of others

    • one simply thought something

    • mental and physical distinctions


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Course of Onset (Warning signs) clinical psychology/ psychiatry

  • <7y: Failure to develop dominant hand early (55% autistics fail as well)

  • 8-12 y: interpersonal problems, poor emotional control, high IQ, sensitive

  • 12-16y: cognitive problems begin, underachievement, disorganized thoughts, poor emotional rapport, few friends

  • 17-20y: [prodomal or precursory] withdrawal, decreased grooming, altered school or work performance, delusions emerging, abuse hallucinogens like marijuana or LSD


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Genetic Component clinical psychology/ psychiatry

Risk of developing schizophrenia in one’s lifetime increases as genetic relatedness with a diagnosed schizophrenic increases.

Dopamine hypothesis


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