Unit XII Abnormal Psychology
Teaching Tips
PEPRSPECTIVES ON PSYCHOLOGICAL DISORDERS (Intro,
Defining, Classifying, and Understanding)
1.
2.
3.
4.
5.
Before reading the unit, have students form
groups of four or five and develop a definition
for “psychological disorder.” Instruct them to be
specific; identifying criteria they would apply to
draw the line between normality and
abnormality. Have each group report out
definition. Spend the next part of the session
considering the difficulty of defining the term.
End the session by sharing the following criteria:
atypical, disturbing, maladaptive, and
unjustifiable
Student Project, “Diagnosing a Star” from Bolt’s
Teacher’s Resource binder
Teacher—type up cultural connection bullets,
page 562 or research them
Students go to www.dsm5.org and review;
teacher present overview online using Jing or
Screencast-o-matic
Students should understand the current DSM-IVTR designations; See chart on page 566 and be
able to categorize information (Quiz?)
Critical Thinking
1. Read and engage with critical thinking
ADHD—Normal High Energy or Genuine
Disorder (Myers page 563)
2. Read and engage with “Insanity and
Responsibility” Myers page 569. How
would you draw the line between
sending disturbed criminals to prisons or
to mental hospitals? Would the person’s
history (for example, having suffered
child abuse) influence your decision?
Recall Beth Thomas, Child of Rage video.
6. See resource on DSM-IV-TR
http://www.behavenet.com/apa-diagnosticclassification-dsm-iv-tr
7. Discuss “labeling” and portrayal in society (for
example, Television shows, etc.)
ANXIETY DISORDERS (What are they; How do we explain 3. Recap Studies of Identical Twins (also,
them?)
repeat info from Personality section).
8. Various surveys from Martin Bolt can be used at
this point: Peen State Worry Questionnaire,
Identical twins are studied to show which
Taylor Manifest Anxiety Scale, The Posttraumatic
behaviors are genetically predisposed
Cognitions Inventory
9. Distinguish OCD from OCPD (Myers page 570)
and which ones are environmentally
10. Students find and discuss lists of most obscure
influenced.
phobias and most common phobias. Source:
http://phobialist.com/
11. Weird phobias site also:
Teaching Tips
http://www.nursingdegreeguide.org/2010/100weird-phobias-that-really-exist/
Critical Thinking
12. Most common phobias-http://psychology.about.com/od/phobias/p/co
mmonphobias.htm (Class activity using white
boards? Team names it just for fun)
SOMATOFORM DISORDERS (What are they?)
4. One contributor to Somatoform
13. Use Bolt (p.15) Lecture/Discussion Topic:
disorders may be Stress. See Unit 8B.
Factitious Disorder
14. Explain that Somatoform disorders are not as
commonly diagnosed as they used to be. The
proposed revisions to the DSM-V suggest
combining somatization disorder,
hypochondriasis, undifferentiated somatoform
disorder and pain disorder into a new category
entitled, “Complex Somatic Symptom disorder”
(CSSD). This new disorder would address several
issues: significant overlap now exists among the
present list of disorders, making them difficult to
diagnose consistently; treatments for the
current list of disorders is essentially the same;
the new combined diagnosis of CSSD seems
more valid and reliable for diagnostic purposes
than diagnosing the current list of disorders
separately
15. Other forms of Somatoform Disorders include:
Body dysmorphic disorder (preoccupation with
body defects); Pain disorder (complaints of
severe pain without any particular physical
condition; or, also called malingering);
somatization disorder (patients under 30 years
of age will exhibit a variety of unexplained
physical symptoms)
DISSOCIATIVE DISORDERS (What are they? Why are they 5. Point out that Dissociation is not the
controversial? How do we explain them?)
same as Psychosis. Dissociation involves
16. View Chris Sizemore’s story. Multiple
Personalities. Chris Sizemore is the inspiration
breaking away from the sense of self,
behind Three Faces of Eve, and gave early
either losing memory and identity or
visibility to the disorder known as dissociative
identity disorder.
adding personalities. Psychosis involves a
17. View Darker Side of Dissociative Disorder—
break with reality, believing things that
Kenneth Bianchi, “Hillside Strangler”
Teaching Tips
Critical Thinking
are untrue or having hallucinations about
things that are not there.
6. Discuss controversy surrounding DID as a
diagnosis. Note two additional types of
dissociative disorders: Dissociative
Amnesia (person forgets who they are
given some trauma) and Dissociative
Fugue (Patients suffer the identify loss as
in dissociative amnesia, but these
patients also travel away from home,
often showing up as a Jane Doe or John
Doe in another community far away.
MOOD DISORDERS What are they? What forms do they
take? How do explain the causes for them and why are
they on the rise in Western culture?
18. Divide students into groups and have them
create a continuum of the different types of
mood, with depression on one extreme and
mania on the other. Have them come up with at
least five different levels of mood between the
two extremes. Assess—could the groups come
to a consensus about what the different types of
mood were called? Why or why not? What were
the different names they came up with for each
type of mood?
7.
Bolt Lecture or Discussion topics:
Sadder-but-wiser effect (p.20); class
exercise, “Attributions for an
Overdrawn Checking Account;” “the
Body investment scale and selfmutilation” or the “Expanded
Revised Fcts on Suicide.”
8. Read suicide close-up, page 585
19. View 60 Minutes February 2012 segment on
causes of depression and the placebo effect.
Discuss. Listed in Haiku, plus source:
http://www.cbsnews.com/video/watch/?id=739
9362n&tag=contentMain;contentAux
SCHIZOPHRENIA (What patterns of behavior –i.e.,
thinking, perceiving, feeling, and behaving—characterize
9.
Be certain to distinguish “Positive”
Teaching Tips
schizophrenia? How do we explain it?)
20. Discuss Biological Bases of Schizophrenia
Critical Thinking
and “Negative” symptoms of
Schizophrenia: Positive symptoms
refer to those that are excessive or
21. Note—credit card required for free trial Access
a free online computer simulation available
through UC-Davis that simulates hallucinations
that people with schizophrenia might
experience. Students will need to set up a free
account with Second Life, the online virtual
world:
www.ucdmc.ucdavis.edu/ais/virtualhallucination
s/
22. View Yale series on Schizophrenia Paul Bloom
(Show segments in class; 1 hour long
approximately); he talks about the case of
“Sybil.” See source:
http://www.npr.org/2011/10/20/141514464/re
al-sybil-admits-multiple-personalities-were-fake
Real Sybil admits fake diagnosis.
PERSONALITY DISORDERS (What characteristics are
typical of personality disorder? Note the avoidant
personality disorder cluster, the schizoid personality
disorder cluster, the narcissistic personality disorder
cluster, the histrionic personality disorder cluster, and the
antisocial personality disorder. The last one is the most
heavily researched.
23. Regarding antisocial personality disorder—while
all serial killers are antisocial, not all those with
antisocial disorder are serial killers. Explore the
lives and crimes of best known serial killers: Ted
Bundy, Kenneth Bianchi (Hillside Strangler),
Jeffrey Dahmer, Aileen Wuornos (America’s only
known female serial killer)
24. See also, Dennis Rader (BTK killer) of Kansas.
Convicted in 2005 of killing 10 people over a 30
year period in Kansas. Source:
http://youtu.be/WMdqOswFmf0
25. Divide students into small groups and provide
them with case studies of people with different
personality disorders. After they read each case
in addition to normal behaviors.
Outlandish behavior such as
paranoid delusions, hallucinations,
and erratic emotions or behaviors
are typical of positive symptoms.
Negative symptoms refer to those
that are deficient or less than
normal behaviors. Flat affect, social
withdrawal and catatonia are
common negative symptoms.
10. Discuss biological, genetic causes of
11. The terms Psychopath and
Sociopath are synonymous. These
words are actually legal terms and
not used as psychological diagnoses.
12. Discuss what contribution genes
make to the development of
antisocial personality disorder. Key
located in Myers Appendix E.
Teaching Tips
Critical Thinking
study, have students decide which disorder is
described. Then have students come together to
see if they all agreed on the diagnosis. Students
may also come up with their own case studies to
see if other students can correctly diagnose the
disorders.
Rates of Psychological Disorders
26. See Myers chart page 599; about 26.2 percent
of people in the US report having some type of
mental illness; Shanghai reports the lowest rate
of disorders
27. As you read this material, avoid a self-diagnosis
Unit XIII Treatment of Psychological Disorders
Teaching Tips
THE PSYCHOLOGICAL
THERAPIES
Critical Thinking
EVALUATING THERAPIES
BIOMEDICAL THERAPIES
PREVENTING PSYCHOLOGICAL
DISORDERS
CLASS CASE STUDY ACTIVITY
Online resource for Case studies:
Annenberg Learner Series (Annenberg Foundation
2011)
http://www.abacon.com/carson/case/c
http://www.learner.org/resources/series60.html?pop=ye
ases.html
s&pid=786#
APPENDIX
Incidental Information--V codes identify conditions other than a disease or injury and are also
used to report significant factors that may influence present or future care. A V-code is not
necessarily a primary diagnosis. V-codes are very important for medical billing and managed
care operations as they have a strong influence on covered treatments.
According to the DSM-IV, V-codes are used as follows:



The problem is the focus of diagnosis or treatment and individual has no behavioral health
condition (e.g., a Partner Relational Problem in which neither partner has symptoms that meet
criteria for a behavioral health condition).
The individual has a behavioral health condition but it is unrelated to the presenting problem
(e.g., a Partner Relational Problem in which one of the partners has an incidental behavioral
health condition).
The individual has a behavioral health condition that is related to the presenting problem, but
the problem is sufficiently severe to warrant independent clinical attention (e.g., a Partner
Relational Problem sufficiently problematic to be a focus of treatment that is also associated
with Major Depressive Disorder in one of the partners).
DSM-IV V-Codes
V-Code
V15.81
V61.1
V61.20
V61.21
V61.8
V61.9
Diagnoses
Noncompliance With Treatment
Partner Relational Problem
Physical / Sexual Abuse of a Adult
Parent-Child Relational Problem
Child Neglect
Physical / Sexual Abuse of a Child
Sibling Relational Problem
Relational Problem Related to a Mental Disorder or General Medical
Condition
V62.2
V62.3
V62.4
V62.81
V62.82
V62.89
V65.2
V71.01
V71.02
V71.09
Occupational Problem
Academic Problem
Acculturation Problem
Relational Problems
Bereavement
Borderline Intellectual Functioning
Phase of Life Problem
Religious or Spiritual Problem
Malingering
Adult Antisocial Behavior
Child or Adolescent Antisocial Behavior
No Diagnosis or Condition on Axis I
No Diagnosis on Axis II
Catatonia
Source: Gale Encyclopedia of Medicine
Definition
Catatonia is a condition marked by changes in muscle tone or activity associated with a large number of
serious mental and physical illnesses. There are two distinct sets of symptoms that are characteristic of
this condition. In catatonic stupor the individual experiences a deficit of motor (movement) activity that
can render him/her motionless. Catatonic excitement, or excessive movement, is associated with violent
behavior directed toward oneself or others.
Features of catatonia may also be seen in Neuroleptic Malignant Syndrome (NMS) which is an
uncommon (but potentially lethal) reaction to some medications used to treat major mental illnesses. NMS
is considered a medical emergency since 25% of untreated cases result in death. Catatonia can also be
present in individuals suffering from a number of other physical and emotional conditions such as drug
intoxication, depression, and schizophrenia. It is most commonly associated with mood disorders.
Description
In catatonic stupor, motor activity may be reduced to zero. Individuals avoid bathing and grooming, make
little or no eye contact with others, may be mute and rigid, and initiate no social behaviors. In catatonic
excitement the individual is extremely hyperactive although the activity seems to have no purpose.
Violence toward him/herself or others may also be seen.
NMS is observed as a dangerous side effect associated with certain neuroleptic (antipsychotic) drugs
such as haloperidol (Haldol). It comes on suddenly and is characterized by stiffening of the muscles,
fever, confusion and heavy sweating.
Catatonia can also be categorized as intrinsic or extrinsic. If the condition has an identifiable cause, it is
designated as extrinsic. If no cause can be determined following physical examination, laboratory testing,
and history taking, the illness is considered to be intrinsic.
Causes and symptoms
The causes of catatonia are largely unknown although research indicates that brain structure and function
are altered in this condition. While this and other information point to a physical cause, none has yet been
proven. A variety of medical conditions also may lead to catatonia including head trauma,
cerebrovascular disease, encephalitis, and certain metabolic disorders. NMS is an adverse side effect of
certain antipsychotic drugs.
A variety of symptoms are associated with catatonia. Among the more common are echopraxia (imitation
of the gestures of others) and echolalia (parrot-like repetition of words spoken by others). Other signs and
symptoms include violence directed toward him/herself, the assumption of inappropriate posture,
selective mutism, negativism, facial grimaces, and animal-like noises.
Catatonic stupor is marked by immobility and a behavior known as cerea flexibilitas (waxy flexibility) in
which the individual can be made to assume bizarre (and sometimes painful) postures that they will
maintain for extended periods of time. The individual may become dehydrated and malnourished because
food and liquids are refused. In extreme situations such individuals must be fed through a tube. Catatonic
excitement is characterized by hyperactivity and violence; the individual may harm him/herself or others.
On rare occasions, isolation or restraint may be needed to ensure the individual's safety and the safety of
others.
Diagnosis
Recognition of catatonia is made on the basis of specific movement symptoms. These include odd ways
of walking such as walking on tiptoes or ritualistic pacing, and rarely, hopping and skipping. Repetitive
odd movements of the fingers or hands, as well as imitating the speech or movements of others also may
indicate that catatonia is present. There are no laboratory or other tests that can be used to positively
diagnose this condition, but medical and neurological tests are necessary to rule out underlying lesions or
disorders that may be causing the symptoms observed.
Treatment
Treatment of catatonia includes medications such as benzodiazipines (which are the preferred treatment)
and rarely barbiturates. Antipsychotic drugs may be appropriate in some cases, but often cause catatonia
to worsen. Electroconvulsive therapy may prove beneficial for clients who do not respond to medication. If
these approaches are unsuccessful, treatment will be redirected to attempts to control the signs and
symptoms of the illness.
Prognosis
Catatonia usually responds quickly to medication interventions.
Prevention
There is currently no known way to prevent catatonia because the cause has not yet been identified.
Research efforts continue to explore possible origins. Avoiding excessive use of neuroleptic drugs can
help minimize the risk of developing catatonic-like symptoms.
Resources
Books
Frisch, Noreen Cavan, and Lawrence E. Frisch. Psychiatric Mental Health Nursing. Albany, NY: Delmar
Publishers, 1998.
Key terms
Barbiturates — A group of medicines that slow breathing and lower the body temperature and blood
pressure. They can be habit forming and are now used chiefly for anesthesia.
Benzodiazipines — This group of medicines is used to help reduce anxiety (especially before surgery)
and to help people sleep.
Electroconvulsive therapy — This type of therapy is used to treat major depression and severe mental
illness that does not respond to medications. A measured dose of electricity is introduced into the brain in
order to produce a convulsion. Electroconvulsive therapy is safe and effective.
Mutism — The inability or refusal to speak.
Negativism — Behavior characterized by resistance, opposition, and refusal to cooperate with requests,
even the most reasonable ones.
Neuroleptic drugs — Antipsychotic drugs, including major tranquilizers, used in the treatment of
psychoses like schizophrenia.