Mental Health Disorders: Bipolar Disorder, Personality Disorders, and Legal Issues - Prof., Study notes of Abnormal Psychology

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Cognitive Disorders Nature of Cognitive Disorders Perspectives on Cognitive Disorders Cognitive processes such as learning, memory, and consciousness are impaired Most develop later in life Three Classes of Cognitive Disorders Delirium – Often temporary confusion and disorientation Dementia – Degenerative condition marked by broad cognitive deterioration Amnestic disorders – Memory dysfunctions caused by disease, drugs, or toxins Delirium: An Overview Nature of Delirium Central features – impaired consciousness and cognition Impairments develop rapidly over several hours or days Examples include confusion, disorientation, attention, memory, and language deficits Facts and Statistics Affects 10% to 30% of persons in acute care facilities Most prevalent in older adults, AIDS patients, and medical patients Full recovery often occurs within several weeks Medical Conditions related to Delirium Medical Conditions Drug intoxication, poisons, withdrawal from drugs Infections, head injury, and several forms of brain trauma Sleep deprivation, immobility, isolation, and excessive stress DSM-IV subtypes of Delirium Delirium due to a general medical condition Substance-induced delirium Delirium due to multiple etiologies Delirium not otherwise specified Dementia: An Overview Nature of Dementia Gradual deterioration of brain functioning Affects judgement, memory, language, and advanced cognitive processes Dementia has many causes and may be reversible or irreversible Progression of Dementia: Initial stages Memory impairment, visuo-spatial skills deficits Agnosia – inability to recognize and name objects (most common symptoms) Facial agnosia – inability to recognize familiar faces Other symptoms – delusions, depression, agitation, aggression, and apathy Progression of Dementia: Later stages Cognitive functioning continues to deteriorate Person requires almost total support to carry out day-today activities Death results from inactivity combined with onset of other illnesses Dementia: Facts and Statistics Onset and Prevalence Can occur at any age, but most common in the elderly Affects 1% of those between 65-74 years of age Affects over 10% of persons 85 years and older 47% of adults over the age of 85 have dementia of the Alzheimer’s type Incidence of Dementia Affects 2.3% of those 75-79 years of age and 8.5% of persons 85 and older Rates of new cases appear to double with every 5 years of age Most Cognitive disorders result in progressive deterioration of functioning Few Treatments exist to reverse pattern of damage and resulting deficits Depression common Family support may be crucial Personality Disorders Personality Disorders: An Overview The nature of personality and personality disorders Enduring and relatively stable predispositions (ways of relating and thinking) Predispositions are inflexible and maladaptive, causing distress and/or impairment Coded on Axis II of the DSM-IV and DSM-IV-TR Not diagnosed until over 18 years old Categorical vs. Dimensional Views of personality disorders DSM-IV and DSM-IV-TR Personality Disorder Clusters Cluster A: Odd or eccentric cluster (paranoid, schizoid) Cluster B: Dramatic, emotional, erratic cluster (antisocial, borderline) Cluster C: Fearful or anxious (avoidant, obsessive-compulsive) Personality Disorders: Facts and Statistics Prevalence of Personality Disorders About 0.5% to 2.5% of the general population Rates are higher in inpatient and outpatient settings Origins and Course of Personality Disorders Thought to begin in childhood Tend to run a chronic course if untreated Co-Morbidity rates are high Gender Distribution and Gender bias in Diagnosis Gender bias exists in the diagnosis of personality disorders Cluster A: Paranoid Personality Disorder Overview and Clinical Features Pervasive and unjustified mistrust and suspicion The Causes Biological and psychological contributions are unclear May result from early learning that people and the world is a dangerous place Treatment options Few seek professional help on their own Treatment focuses on development of trust Cognitive therapy to counter negativistic thinking Lack good outcome studies showing that treatment is efficacious Cluster A: Schizoid Personality Disorder Overview and Clinical Features Pervasive pattern of detachment from social relationships Very limited range of emotion in interpersonal situations The Causes Etiology is unclear Preference for social isolation in schizoid personality resembles autism Treatment Options Few seek professional help on their own Focus on the value of interpersonal relationships, empathy, and social skills Treatment prognosis is generally poor Cluster A: Schizotypal Personality Disorder Overview and Clinical Features Behavior and dress is odd and unusual Most are socially isolated and may be highly suspicious of others Magical thinking, ideas of reference, and illusions are common Risk for developing schizophrenia is high in this group Many also meet criteria for major depression The Causes Schizoid personality – A phenotype of a schizophrenia genotype? Left hemisphere and more generalized brain deficits Treatment Options Main focus is on developing social skills Treatment also addresses comorbid depression Medical treatment is similar to that used for schizophrenia Treatment prognosis is generally poor Cluster B: Antisocial Personality Disorder Overview and Clinical Features Failure to comply with social norms and violation of the rights of others Irresponsible, impulsive, and deceitful Lack of conscience, empathy, and remorse Relation between Psychopathy and Antisocial Personality Disorder Relation between ASPD, Conduct Disorder, and Early Behavior Problems Many have early histories of behavioral problems, including conduct disorder Many come from families with inconsistent parental discipline and support Families often have histories of criminal and violent behavior Neurobiological Contributions and Treatment of Antisocial Personality Prevailing Neurobiological Theories Brain damage – Little support for this view Underarousal hypothesis – Cortical arousal is too low Treatment focuses on grandiosity, lack of empathy, unrealistic thinking Treatment may also address co-occurring depression Little evidence that treatment is effective Cluster C: Avoidant Personality Disorder Overview and Clinical Features Extreme sensitivity to the opinions of others Highly avoidant of most interpersonal relationships Are interpersonally anxious and fearful of rejection The Causes Numerous factors have been proposed Early Development – A difficult temperament produces early rejection Treatment Options Several well-controlled treatment outcome studies exist Treatment is similar to that used for social phobia Treatment targets include social skills and anxiety Cluster C: Dependent Personality Disorder Overview and Clinical Features Excessive reliance on others to make major and minor life decisions Unreasonable fear of abandonment Tendency to be clingy and submissive in interpersonal relationships The Causes Still largely unclear Linked to early disruptions in learning independence Treatment Options Research on treatment efficacy is lacking Therapy typically progresses gradually Treatment targets include skills that foster independence Cluster C: Obsessive-Compulsive Personality Disorder Overview and Clinical Features Excessive and rigid fixation on doing things the right way Tend to be highly perfectionistic, orderly, and emotionally shallow Obsessions and compulsions are rare The Causes Are largely unknown Treatment Options Data supporting treatment are limited Treatment may address fears related to the need for orderliness Other targets include rumination, procrastination, and feelings of inadequacy Legal and Ethical Issues Mental Health and the Legal System: An Overview A variety of legal and ethical issues exist in regard to mental health and abnormal psychology The nature of civil vs. criminal commitment Balancing ethical considerations vs. legal considerations The role of psychologists in legal matters Expert witnesses, forensic psychology Rights of patients and research subjects Practice standards and the changing face of mental health care Civil Commitment: Overview, Criteria, and Oversight Authority Civil Commitment Laws Address legal declaration of mental illness Address when a person can be placed in a hospital or institution for treatment Such laws and what constitutes mental illness vary by state “Mental illness” means a substantial disorder of thought, mood, perception, psychological orientation or memory that significantly impairs judgment, behavior, capacity to recognize reality or ability to meet the ordinary demands of life Dangerous to Self or Others: Central to Commitment Proceedings Assessing dangerous: The role of mental health professionals Knowns and unknowns about violence and mental illness Civil Commitment General Criteria for Civil Commitment Demonstrate that a person has a mental illness and need treatment (often exclude substance use/abuse) Show that the person is dangerous to self or others Bias based on gender, race/ethnicity Predicting groups with higher likelihood of dangerous behavior vs. predicting individual’s likelihood of dangerous behavior Establish a grave disability – inability to care for self Governmental Authority Over Civil Commitment Police power – protection of the health, welfare, and safety of society Parens patriae – state acts a surrogate parent Civil Commitment – Changes Supreme Court cases prohibit confinement of nondangerous person who is capable of surviving by self or with help of willing & responsibly family or friends More restrictive commitment laws may result in mentally ill being jailed for criminal offenses Deinstitutionalization movement led to increase in homelessness rate Of the 2.5-3.5 million homeless, 25-30% are mentally ill Lack of community mental health facilities to replace large inpatient hospitals