Abnormal Psychology Lecture Notes

3/29/99

One of Prof. Kandel’s students is now a psychiatrist and made the following comments:

• dreams are a feature of PTSD, which is an anxiety disorder - mild tranquilizers help, also can be treated with antidepressants because in any disorder, there will be some amounts of depression
• addictive disorders are part of a comorbid problem
• personality disorders are comorbid – part of the broader picture

Economics of psychiatry:

• In the 1980’s, HMOs emerged and curtailed the length of treatment time
• Psychiatrist feels that it has changed the practice of psychiatry
• Quick, inexpensive response to keep them away from the doctor
• psychiatrist started to work for Veterans Administration to preserve her practice; VA is free to veterans who cannot afford to pay – secondary gain if the government has to pay the patient
• in the beginning of psychoanalysis, Freud pointed out that treatment has to be paid for
• if you give someone a diagnosis, you relieve them of some responsibility

Video on Personality Disorders:

Schizoid Personality Disorder—

• female patient
• childhood was mostly a loner, not too many friends
• felt more loneliness when married than when she had been single, felt rejected and uncared for
• primarily stays at home, reads, writes, draws

Histrionic Personality Disorder—

• female patient elaborately dressed
• can’t get along with other women – feels that they snicker at her, snub her
• says that her sister has an inferiority complex
• can get along better with men – they make her feel happy inside
• feels that her husband doesn’t pay her enough attention
• feels that she doesn’t get to do the things that other women do

Video on Impulse Control/Pathological Gambling:

• male patient started gambling when he was 8 years old
• started to lie, cheat, swindle, couldn’t stop and people kept on bailing him out
• hit rock bottom at age 42 when he realized he could no longer easily get out of debt
• gambled on almost anything, almost ended up in jail
• felt good while the game was going on and felt relief after it was over because it got it out of his system
• no sex life: mistress was gambling

Video on Disorders of Infancy and Youth:

• described the typical developmental stages of infants
• at 11 weeks old, infant pushes up head and chest
• at 14 weeks, eyes follow object
• 4 months old, eyes guide the hand in reaching for an object, no interest in a hidden object
• 8 months old, looks for the hidden object

Video on Eating Disorders:

Anorexia—

• female didn’t feel that she was too thin, although she knew logically
• at one point, had a weight loss of 35% of her body weight
• in hospital because health was at risk
• took amphetamines to lose weight
• one summer, she just started to cut back on food and she kept on losing
• either binged and purged, used amphetamines, or cut back on food
• binges brought on something emotional that she could not handle
• fascinated with food and is a good cook for others

Bulimia—

• binges of long food eating episodes – meats, starches, desserts
• feels full, tired of eating and stops the binge
• uses laxatives 3 times a week, 20-30 laxatives
• has gone at most 1 week without laxatives and then begins the same cycle of bingeing and purging

- Binged on "forbidden foods" until she felt full and uncomfortable to make herself vomit

• started with a diet of 700 calories per day and fasting on the weekends
• lost 20 pounds, was sick, at one point, she was so hungry that she binged
• connection between depression and obsession with food

3/31/99

Mental Retardation and Autism

DSM IV: loss or deficiency in cognitive functioning as measured by an IQ test – significantly below the mean

• inability to function
• classified as IQ more than 2 standard deviations below the mean (a score of 68 or below)
• there is a debate as to whether the retarded population constitutes a different classification and should not be measured on the normal IQ curve
• profoundly retarded à can’t answer questions
• largely depends on what the person can do for themselves in terms of language development and vocabulary

Risk Factors for Retardation:

1. Lead poisoning in infants and adults
2. Down’s Syndrome – trisomy 21; increased chance with increased maternal age
3. PKU – insufficient protein
4. Nutritional deficiencies – prenatal and postnatal
5. Damage to nervous system as consequence of anoxia

• prone to cataracts and Alzheimer’s disease – lenses get their proteins when the embryo is formed – same for nervous system: non-renewable organs

PKU – phenylkenoturea à deficient in enzyme that metabolizes certain proteins

• if not controlled, produces severe mental retardation that is progressive

Video on Student with PKU:

• born without the enzyme
• low protein food diet that avoids beer, ice cream, pizza, pasta, chicken wings, cake
• dietary supplement is $15,000 a year and it is very important to be on the diet
• 1962 development of Guthrie bloodspot test for PKU
• phenylalanine level should be between 4 and 6 for PKU, hers is 22
• mentally, the build up acts as a blocker between neurons – feels that she can’t put all the pieces together
• political disorder: many insurances will not cover the costly treatment
• babies of mothers with PKU can have brain damage and heart problems if the mother’s disorder is not closely controlled
• it is genetic dominant

Video on Mental Retardation:

Congenital Rubella (mother had rubella)—

• withdrawal, patient is almost completely blind and deaf
• rubbing his eyes trying to stimulate some visual sense
• poor eye coordination and muscle control
• aide strokes his face to attempt to get a response

Lead Poisoning –

• general lowering of intellectual ability
• poor hand-eye coordination
• lack of attention
• poor language skills
• has trouble following directions
• 9 year old has trouble counting in order

Down’s Syndrome –

• severe mental retardation
• abnormal development: flattened skull, small, slanted eyes, small, flat nose, tongue protrusion, short fingers and toes (especially thumb)
• hypotonic musculature

Aphasia –

• language disorder
• patient does not speak
• has trouble following directions
• can recognize words and objects, but does not speak

Multiple Tics –

• jerking that is sometimes uncontrollable
• started in the 3^rd grade – around the time a horse kicked him in the face
• jerking of arms and legs
• father yells, making him nervous, which increases the tics