HISTORY OF ABNORMAL PSYHCOLOGY

Distress
Danger
Dysfunction
Deviance

- Cultural Relativism
- Mental Health Law – Risa Hontiveros = Dorothea Dix
- Benjamin Rush – blood letting
- Philip Pinel – moral and humanitarian movement
- William Tuke – york retreat house
- Wilhelm Griesinger – abnormal psychology is rooted to brain diseases
- Jean Charcot – hypnosis as treatment for hysteria
- Joseph Breuer – cathartic method
- George Engel –Bio Psychosocial paradigm in Psychopathology

Relapse – return of illness

Remission – improvement of condition

LEVELS OF NORMALITY
Auto-normal – “I believe I am normal”
Hetero-normal – “Others see me as normal”
Auto-pathological – “I believe I am ill”
Hetero-pathological – “Others see me as ill”

Ego syntonic – assumption that you are normal, in harmony with your self-concept
Ego dystonic – not in harmony with your self-concept, they know that there is something
wrong

LEVELS OF DISORDER
Sub-threshold – 1 or 2 requirements are not met.
Sub-syndromal – number of duration is lacking.
Sub-clinical – does not cause significant distress or impairment.

NEURODEVELOPMENTAL DISORDERS

SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS

HISTORY

I. EMIL KRAEPELIN

Continuous Symptoms – Dementia Praecox

Episodic Symptoms – Manic-Depressive Psychosis
II. EUGENE BLEULER – renamed Dementia Praecox to Schizophrenia
 4 A’s of Bleuler (4 fundamentals)

 Autistic Thinking and Behavior (withdrawn)

 Ambivalence
 Affect disturbances (emotion disturbances)
 Association disturbances (formal thought disorder)
III. KURT SCHNEIDER

11 Symptoms of Schizophrenia (Schneiderian First Rank Symptoms)

 Though Insertion
 Thought Withdrawal
 Thought Broadcast
 Made Volition
 Made Affect
 Made Impulse
 Auditory Hallucination: Voices discussing and arguing (3rd person)
 Auditory Hallucination: Voices giving running commentary
 Auditory Hallucination: Voices saying thoughts aloud (thought echo) (Echo de la
pensee) (Gedankenlautwerden)
 Somatic Passivity
 Delusional Perception

4 classified symptoms

 Positive Symptoms
o Delusions
o Hallucinations
 Negative Symptoms (refer to the later part)
 Disorganized Symptoms
o Disorganized Speech
o Disorganize Behavior
 Movement Symptoms
o Catatonia
1. Delusional Disorder
a. One or more delusions for 1 month or longer
b. Types: Erotomanic, Grandiose, Jealous, Persecutory, Somatic)
2. Brief Psychotic Disorder
a. D,H, DT/S, G at least 1 day but less than 1 month
3. Schizophreniform Disorder
a. D, H, DT/s, G, NS at least 1 month but less than 6 months
4. Schizophrenia
a. D, H, DT/s, NS at least for 6 months
b. Phases
i. Prodromal Phase
ii. Active/Acute Phase
iii. Residual Phase
5. Schizoaffective Disorder
a. Major mood episodes concurrent with Criterion of Schizophrenia
6. Substance/Medication-Induced Psychotic Disorder
 7. Psychotic disorder Due to Another Medical Condition
8. Catatonia

Psychotic Features (key features that define Psychotic Disorder)

1. Delusions (Beliefs) (can be bizarre or non-bizarre) (can be in motivational view or deficit

view)
a. Persecutory
b. Referential
c. Grandiose
d. Erotomanic
e. Nihilistic
f. Somatic
g. Thought withdrawal
h. Though insertion
i. Delusion of control
2. Hallucinations (Perceptions)(without external stimulus)
a. Can also occur while sleeping (hypnagogic) of waking-up (hypnopompic)
3. Disorganized Thinking (Speech)
a. Derailment (loose of associations)
b. Incoherence (world salad)
c. Tangentiaity
4. Grossly Disorganized or Abnormal Motor Behavior (including catatonia)
a. Catatonic behavior (decreased in reactivity of environment)
i. Negativism
ii. Mutism or stupor
b. Catatonic excitement
5. Negative Symptoms
a. Affective flattening Diminished emotional expression
b. Avolition (decrease on motivation or purposeful activities)
c. Alogia (decrease of speech)
d. Anhedonia (decrease of pleasure)
e. Asociality (decrease in social interactions)

BIPOLAR AND RELATED DISORDERS

 Mania
o At least 1 week (present most of the day)
o Sufficiently severe to cause mark impairment on areas of functioning
o Elevated, expansive, irritable, increased goal-directed activity or energy
o With psychotic features
 Hypomania
 o 4 consecutive days (present most of the day)
o Mood change is observable
o Not ever enough to cause mark impairment on areas of functioning
o If there are psychotic features, proceed to Manic.
 Major Depressive
o 2-week period
o Diminished interest, depressed moss, insomnia or hypersomnia, significant weight loss,
psychomotor agitation, fatigue and loss of energy, feelings of worthlessness or guilt,
diminished ability to think, recurrent thought of death (ideations, attempt, planning)
1. Bipolar I
a. Manic Episodes
b. Episodes of depression
2. Bipolar II
a. Hypomanic episode
b. Episode of depression
3. Cyclothymic Disorder
a. Less severe the BI and BII
b. That not meet the criteria of Hypomanic, and MD
c. May feel stable but noticeable fluctuations on mood.
d. 2 year period (1 year for children and adolescents)
e. Present at least half the time, and has not been without the symptoms for 2 months.
4. Substance/Medication Induced Bipolar and Related Disorder
a. In the clinical picture (findings, laboratory, physical exam)
b. Not in the course of delirium
5. Bipolar and Related Disorder Due to Another Medical Condition
a. In the clinical picture (findings, laboratory, physical exam)
b. Pathophysiologal
c. Not in the course of delirium
6. Unspecified Bipolar and Related Disorder

FEEDING AND EATING DISORDERS

1. Pica
a. Persistent eating of non-nutritive, non-food substance for at least 1 month.
2. Rumination Disorder
a. Repeated regurgitation for at least 1 month
3. Avoidant/Restrictive Food Intake Disorder (DSM IV “feeding disorder of infancy or early
childhood)
a. Lack of interest in eating
b. Nutritional deficiency
c. Significant weight loss
d. Dependence in oral supplement an enteral feeding
4. Anorexia Nervosa
a. Very low weight
b. Anxiety and fear of gaining wait
c. Distorted view of body
d. Underweight
 e. Coexist with perfectionism an depression
f. Types:
i. Restricting Type
ii. Binge – Purging Type (thru laxatives, diuretics, enemas, vomiting)
g. Engage in food rituals
h. REFEEDING SYNDROME – absorption of nutrients by the cells even in low levels
i. Bradycardia – slow heart rate (60 bpm)
j. Amenorrhea – normal menstruation stops
k. Causes – Genetic/Hereditary factors, environmental factors, Socio-cultural factors, media
(teen)
l. Treatment – careful weight gaining, psychotherapy (CBT) for anxiety and fear of weight
gain.
m. Comorbid – depression, OCD, and Anxiety
5. Bulimia Nervosa
a. Binge-eating and purging cycle
b. Normal weight or overweight
c. At least 1 week 3 months and most of the day.
d. Causes – onset adolescent, control over weight, fixation in eating, low self-esteem,
genetic
e. Setting unrealistic goals
f. Side Effects of Repeated Vomiting
i. ERODED ENAMEL (Teeth Erosion)
ii. Halitosis
iii. Sialadenosis (Swelling of paratoid gland)
iv. RUSSEL’S SIGNS (Swelling of hand joints because of self-induced vomiting)
v. MALLORY-WEISS SYNDROME (Gastrointestinal)
vi. Hematemesis (blood in vomit)
vii. Tachycardia (fast heart-rate 100 bpm)
g. Amenorrhea – normal menstruation stops
h. Comorbid – depression, OCD, and Anxiety
i. Treatment – SSRI (selective serotonin reuptake inhibitor), Psychotherapy (CBT) “new
relationship with the food”.
6. Binge-Eating Disorder
a. Binge-eating but not compensatory
b. Eating quickly
c. Eating alone out of embarrassment
d. Eating without being hungry
e. Eating until uncomfortably full
f. Feelings of guilt/depression/disgust after eating
g. Overweight

ANXIETY DISORDERS
ANXIETY – defined as apprehension over an anticipated problem.
FEAR – reaction to present or immediate danger. Normal and adaptive psychological response to
danger.
1. Separation Anxiety Disorder
a. Developmentally inappropriate and excessive fear or anxiety concerning separation
from attachment figures.
b. Fear, anxiety, avoidance persists and lasting at least 4 weeks for children and
adolescents and typically 6 months in adults.
c. 2 – 41 % present in children, mostly in girls
2. Selective Mutism
a. Consistent failure to speak out of social situations in which there is an expectation for
speaking.
b. Duration of disturbance is at least 1 month
c. Comorbid with shyness and social anxiety
3. Specific Phobia
a. Marked fear or anxiety about a specific object or situation.
b. Most common psychiatric disorder
c. Fear and anxiety is inappropriate and out of proportion
d. Fear, anxiety, avoidance persists and lasting for 6 months.
e. Phobic stimulus
i. Animal
ii. Natural Environment
iii. Blood-injection, injury or needles.
iv. Situational
v. Others
f. Sometimes develops following a traumatic event but most patients don’t remember the
specific reason.
g. Differential diagnosis with Agoraphobia: when to agoraphobic situations overlap,
Agoraphobia is much more warranted (e.g. “public transportation” and “crowds”). Fear of
not escaping is one god differential diagnosis.
4. Social Anxiety Disorder (Social Phobia)
a. High levels of fear, anxiety and avoidance in social situations.
b. Fear, anxiety, avoidance persists and lasting for 6 months
c. Fearful of being scrutinized, judged, or embarrassed (fear of showing anxiety symptoms
that will be negatively evaluated)
d. Out of proportion
5. Panic Disorder
a. PANIC ATTACKS – abrupt surge of intense fear or intense discomfort. Can happen from
a calm state or anxious state. Criteria should be 4/13 symptoms.
i. Includes depersonalization (feeling of being detached to oneself) and
derealization (feelings of unreality)
ii. Can be a specifier for other mental disorders such as Depressive Disorder,
PTSD and Substance Abuse.
b. Recurrent unexpected panic attacks.
c. Persistent concern or worry about additional panic attack or their consequences and
avoidant behavior and maladaptive changes for 1 month.
d. PSYCHOTHERAPY: CBT
i. Learn
ii. Monitor
iii. Breathing and Relaxation
iv. Change Beliefs
v. Exposure
 e. Antidepressants (SSRI)
f. Anti-anxiety (benzodiazepines)
g. Anti-seizure (if severe)
6. Agoraphobia
a. Marked fear or anxiety about two (or more) situations.
i. Public transportation
ii. Open spaces
iii. Enclosed spaces
iv. Standing in line or being in a crowd
v. Being outside of the home alone
b. The individual fear or avoid such situations because of thoughts that escaping might be
difficult or help might not be available in times of panic-like symptoms or embarrassing
situations. (fear of falling in the elderly, fear of incontinence)
c. The fear, anxiety, and avoidance are persistent for 6 months.
7. Generalized Anxiety Disorder
a. Excessive difficult to control worrying
8. Substance/Medication-Induced Anxiety Disorder
9. Anxiety Disorder Due to Another Medical Condition

TREATMENTS

 Psychotherapy: CBT
 Systematic Desensitization

PSYCHOLOGY OF SUICIDE

Passive Suicidal Ideation – without intentions

Active Suicidal Ideation – with intentions and active plans

PERFORM RISK ASSESSMENT

S – Sex
A – Age
D – Depression
P – Previous Attempt
E – Ethanol or other drugs
R – Rational thinking loss
S – Social support lacking
O – Organized plan
N – No spouse or partner
A – Availability of lethal means
S – Sickness or Illness
Emil Durkheim – French, sociologist
 son of a rabbi
 religion and moral consciousness
 group formation and cohesion
 research the rates of suicide
 “Suicide was a solitary act, the causes had significant links to various social factors”
SOCIAL FACTORS THAT INFLUENCE SUICIDE RATES
 Cohesiveness
 A person’s standing
 Religious, social and occupational standing
a. INTEGRATION – the level in which a person feels connected to or accepted by a group
or society.
b. REGULATION - the degree to which an individual’s actions and desires are being
controlled by his or her society e.g: RELIGION AFFILIATION, MARRIAGE, MILITARY,
TIMES OF PEACE AND WAR, ECONOMY, WEALTH, SEX, RACE

1. Suicide Talk
2. Giving away prized possessions
3. Changes on their will
4. Obtaining a weapon
5. Strange sleeping patterns
6. Low energy
7. Abusing drugs or alcohol
8. Low motivation for social life
9. Not participating in activities they love
10. Self-harm and Risky behavior
11. Emotional outburst
12. Body language
13. Past suicide attempts
14. Happiness and Calmness

Suicide rate = social fact

FOUR TYPES OF SUICIDE

EGOISTIC – gradual lowering of social cohesion. Too low social integration. Feels isolated, no
sense of belongingness, and helpless
ALTRUISTIC – strong social cohesion. Too high social integration. Greatly involved and concerned
in a group’s norms and goals and neglect their own needs and goals.
ANOMIC – too low degree of regulation. Life becomes meaningless and frustrated on setting goals.
Committed during times of stress and changes.
FATALISTIC – too high degree of regulation. Too much extreme rules and high expectations.
Feeling of losing one sense of self.