PSY 35 – Abnormal Psychology
CHAPTER 8: EATING AND SLEEP-
WAKE DISORDERS
EATING DISORDERS
Bulimia Nervosa
› Out of control eating binges followed
by self-induced vomiting and use of
laxatives or others to purge food.
Anorexia Nervosa
› Nervous loss of appetite,persons
eats nothing and beyond minimal
amounts of food, causing weight
loss.
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Binge-eating Disorder (BED)
› Individual binge on food. They find
this distressing but don’t attempt to
expel food.
› Pica – 1 month, an eating disorder in
which a person eats things that are not
usually considered as a food.
› Rumination – repeatedly regurgitate
(swallow) their food effortlessly and
painlessly in a month
› Obesity - Not an official disorder in
DSM5 Measure by a Body-mass index
(BMI)>29.
SLEEP WAKE DISORDER
An Overview of Sleep-Wake Disorders
› Dyssomnias - difficulties in getting
enough sleep, problems with sleeping
when you want to & complaints about
the quality of sleep.
› Parasomnias - characterized by
abnormal behavioral or physiological
events that occur during sleep, such as
nightmares and sleepwalking.
PSY 35 – Abnormal Psychology
› The disorder interferes with daily
activities like driving or paying
attention in class.

Insomnia Disorder
› People are considered to have
insomnia if they have trouble falling
asleep at night (difficulty initiating
sleep), if they wake up frequently or
too early and can’t go back to sleep
(difficulty maintaining sleep), or even if
they sleep a reasonable number of
hours but are still not rested the next
day (non-restorative sleep).

Narcolepsy
› Sudden sleepiness that may occur
during daytime
› Some experience cataplexy, the
sudden loss of muscle tone

Hypersomnolence Disorders
› Involves sleeping too much (hyper
means “in great amount” or
“abnormal excess”).
›› People with hypersomnolence sleep
through the night and appear rested
upon awakening but still complain of
being excessively tired throughout the
day.

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PSY 35 – Abnormal Psychology
Circadian Rhythm Sleep Disorder
› Characterized by disturbed sleep
(either insomnia or excessive sleepiness
during the day) brought on by the
brain’s inability to synchronize its sleep
patterns with the current patterns of
day and night.
› Our biological clock is in the
suprachiasmatic nucleus in the
hypothalamus.
CHAPTER 9 : PHYSICAL DISORDER
AND HEALTH PSYCHOLOGY
► Nature of Stress
General Adaption Syndrome (GAS):
theory of stress response
› Phase 1 – Alarm response
› Phase 2 – Resistance
› Phase 3 – Exhaustion
GAS Model by Hans Selye describes
the process your body goes through
when you are exposed to any kind of
stress, positive or negative.
Self-Efficacy (Albert Bandura)
- the sense of control/confidence that
can help cope with challenges/stress.
CHAPTER 10 : SEXUAL
DYSFUNCTIONS, PARAPHILIC
DISORDERS, & GENDER DYSPHORIA
Erectile Dysfunction
› the recurrent inability to achieve an
erection, the inability to maintain an
adequate erection, and/or a noticeable
decrease in erectile rigidity during
partnered sexual activity.
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► Prevalence
› The prevalence of lifelong versus
acquired erectile disorder is unknown.
There is a strong age related increase in
both prevalence and incidence of
problems with erection, particularly
after age 50 years.
› Approximately 13%-21% of men ages
40-80 years complain of occasional
problems with erections. Approximately
2% of men younger than age 40-50
years complain of frequent problems
with erections, whereas 40%-50% of
men older than 60-70 years may have
significant problems with erections.
› About 20% of men fear erectile
problems on their first sexual
experience, whereas approximately 8%
experienced erectile problems that
hindered penetration during their first
sexual experience.
►Development and Course
› Erectile failure on first sexual attempt
has been found to be related to having
sex with a previously unknown partner,
concomitant use of drugs or alcohol,
not wanting to have sex, and peer
pressure.
Substance/Medication Induced
Sexual Disorder
› a condition in both men and women in
which patients have difficulties with
sexual desire, arousal, and/or orgasm
PSY 35 – Abnormal Psychology
due to a side effect of certain
medications (legal or illicit).
► Recording Procedures
› ICD-9-CM. The name of the
substance/medication-induced sexual
dysfunction begins with the
specific substance (e.g., alcohol,
fluoxetine) that is presumed to be
causing the sexual dysfunction. The
diagnostic code is selected from the
table included in the criteria set, which
is based on the drug class.
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› For substances that do not fit into any
of the classes (e.g., fluoxetine), the code
for "other substance" should be used;
and in cases in which a substance is
judged to be an etiological factor but
the specific class of substance is
unknown, the category "unknown
substance" should be used.
› The name of the disorder is followed
by the specification of onset (i.e.,
onset during intoxication, onset
during withdrawal, with onset after
medication use), followed by the
severity specifier (e.g., mild, moderate,
severe).
› Unlike the recording procedures for
ICD-10- CM, which combine the
substance-induced disorder and
substance use disorder into a single
code, for ICD-9-CM a separate
diagnostic code is given for the
substance use disorder.
› For example, in the case of erectile
dysfunction occurring during
intoxication in a man with a severe
alcohol use disorder, the diagnosis is
291.89 alcohol-induced sexual
dysfunction, with onset during
intoxication, moderate. An additional
diagnosis of 303.90 severe alcohol use
disorder is also given.
› When more than one substance is
judged to play a significant role in the
development of the sexual dysfunction,
each should be listed separately (e.g.,
292.89 cocaine-induced sexual
dysfunction with onset during
intoxication, moderate; 292.89
fluoxetine-induced sexual dysfunction,
with onset after medication use).
› ICD-10-CM. The name of the
substance/medication-induced sexual
dysfunction begins with the
specific substance (e.g., alcohol,
fluoxetine) that is presumed to be
causing the sexual dysfunction.
› The diagnostic code is selected from
the table included in the criteria set,
which is based on the drug class and
PSY 35 – Abnormal Psychology
presence or absence of a comorbid
substance use disorder.
► Diagnostic Features
› The major feature is a disturbance in
sexual function that has a temporal
relationship with substance/medication
initiation, dose increase, or substance/
medication discontinuation.
► Associated Features Supporting
Diagnosis
› Sexual dysfunctions can occur in
association with intoxication with the
following classes of substances: alcohol;
opioids; sedatives, hypnotics, or
anxiolytics; stimulants (including
cocaine); and other (or unknown)
substances.
› Sexual dysfunctions can occur in
association with withdrawal
from the following classes of
substances: alcohol; opioids;
sedatives, hypnotics, or anxiolytics;
and other (or unknown) substances.
› Medications that can induce sexual
dysfunctions include antidepressants,
antipsychotics, and hormonal
contraceptives. The most commonly
reported side effect of antidepressant
drugs is difficulty with orgasm or
ejaculation. Problems with desire and
erection are less frequent.
› Approximately 30% of sexual
complaints are clinically significant.
Certain agents, such as bupropion and
mirtazapine, appear not to be
associated with sexual side effects.
› The sexual problems associated with
antipsychotic drugs, including
problems with sexual desire, erection,
lubrication, ejaculation, or orgasm,
have occurred with typical as well as
atypical agents. However, problems are
less common with prolactin-sparing
antipsychotics than with agents that
cause significant prolactin elevation.
› Although the effects of mood
stabilizers on sexual function are
unclear, it is possible that lithium and
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anticonvulsants, with the possible
exception of lamotrigine, have adverse
effects on sexual desire.
› Problems with orgasm may occur
with gabapentin. Similarly, there may
be a higher prevalence of erectile and
orgasmic problems associated with
benzodiazepines. There have not been
such reports with buspirone.
› Many nonpsychiatric medications,
such as cardiovascular, cytotoxic,
gastrointestinal, and hormonal agents,
are associated with disturbances in
sexual function.
› Illicit substance use is associated with
decreased sexual desire, erectile
dysfunction, and difficulty reaching
orgasm. Sexual dysfunctions are also
seen in individuals receiving methadone
but are seldom reported by patients
receiving buprenophine. Chronic
alcohol abuse and chronic nicotine
abuse are associated with erectile
problems
► Prevalence
› The prevalence and the incidence of
substance/medication-induced sexual
dysfunction are unclear, likely because
of underreporting of treatment-
emergent sexual side effects. Data on
substance/ medication-induced sexual
dysfunction typically concern the effects
of antidepressant drugs.
› The prevalence of antidepressant-
induced sexual dysfunction varies in
part depending on the specific agent.
Approximately 25%-80% of individuals
taking monoamine oxidase inhibitors,
tricyclic antidepressants, serotonergic
antidepressants, and combined
serotonergic-adrenergic antidepressants
report sexual side effects.
› There are differences in the
incidence of sexual side effects between
some serotonergic and combined
adrenergic serotonergic
antidepressants, although it is unclear
if these differences are clinically
significant.
PSY 35 – Abnormal Psychology
› Approximately 50% of individuals
taking antipsychotic medications will
experience adverse sexual side effects,
including problems with sexual desire,
erection, lubrication, ejaculation, or
orgasm.
› The incidence of these side effects
among different antipsychotic agents is
unclear. Exact prevalence and
incidence of sexual dysfunctions among
users of nonpsychiatric medications
such as cardiovascular, cytotoxic,
gastrointestinal, and hormonal agents
are unknown.
› Elevated rates of sexual dysfunction
have been reported with methadone or
high-dose opioid drugs for pain. There
are increased rates of decreased sexual
desire, erectile dysfunction, and
difficulty reaching orgasm associated
with illicit substance use.
› The prevalence of sexual problems
appears related to chronic drug abuse
and appears higher in individuals who
abuse heroin (approximately 60%-70%)
than in individuals who abuse
amphetamines or 3,4-
methylenedioxymethamphetamine (i.e.,
MDMA, ecstasy).
› Elevated rates of sexual dysfunction
are also seen in individuals receiving
methadone but are seldom reported by
patients receiving buprenorphine.
› Chronic alcohol abuse and chronic
nicotine abuse are related to higher
rates of erectile problems.
► Development and Course
› The onset of antidepressant-induced
sexual dysfunction may be as early as 8
days after the agent is first taken.
Approximately 30% of individuals with
mild to moderate orgasm delay will
experience spontaneous remission of
the dysfunction within 6 months. In
some cases, serotonin reuptake
inhibitor-induced sexual dysfunction
may persist after the agent is
discontinued.
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› The time to onset of sexual
dysfunction after initiation of
antipsychotic drugs or drugs of abuse
is unknown. It is probable that the
adverse effects of nicotine and alcohol
may not appear until after years of use.
› Premature (early) ejaculation can
sometimes occur after cessation of
opioid use.
› There is some evidence that
disturbances in sexual function related
to substance/medication use increase
with age.
› Culture-Related Diagnostic Issues
› There may be an interaction among
cultural factors, the influence of
medications on sexual functioning, and
the response of the individual to those
changes.
› Gender-Related Diagnostic Issues
› Some gender differences in sexual side
effects may exist.
► Functional Consequences of
Substance/Medication-Induced Sexual
Dysfunction
› Medication-induced sexual
dysfunction may result in medication
noncompliance.
► Differential Diagnosis
› Non-substance/medication-induced
sexual dysfunctions. › Many mental
conditions, such as
depressive, bipolar, anxiety, and
psychotic disorders, are associated with
disturbances of sexual function. Thus,
differentiating a substance/medication-
induced sexual dysfunction from a
manifestation of the underlying mental
disorder can be quite difficult.
› The diagnosis is usually established if
a close relationship between
substance/medication initiation or
discontinuation is observed.
› A clear diagnosis can be established if
the problem occurs after substance
/medication initiation, dissipates with
substance/medication discontinuation,
PSY 35 – Abnormal Psychology
and recurs with introduction of the
same agent.
› Most substance/medication-induced
side effects occur shortly after initiation
or discontinuation. Sexual side effects
that only occur after chronic use of a
substance/ medication may be
extremely difficult to diagnose with
certainty.
Premature (Early) Ejaculation
Premature (early) ejaculation is
defined in DSM-5 as a persistent or
recurrent pattern of ejaculation
occurring during partnered sexual
activity within about one minute
following vaginal penetration and before
the individual wishes it.
► Diagnostic Features
› Premature (early) ejaculation is
manifested by ejaculation that occurs
prior to or shortly after vaginal
penetration,operationalized by an
individual's estimate of ejaculatory
latency (i.e., elapsed time before
ejaculation) after vaginal penetration.
Estimated and measured intravaginal
ejaculatory latencies are highly
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correlated as long as the ejaculatory
latency is of short duration; therefore,
self-reported estimates of ejaculatory
latency are sufficient for diagnostic
purposes.
› A 60-second intravaginal ejaculatory
latency time is an appropriate cutoff for
the diagnosis of lifelong premature
(early) ejaculation in heterosexual men.
› There are insufficient data to
determine if this duration criterion can
be applied to acquired premature (early)
ejaculation. The durational definition
may apply to males of varying sexual
orientations, since ejaculatory latencies
appear to be similar across men of
different sexual orientations and across
different sexual activities.
► Associated Features Supporting
Diagnosis
› Many males with premature (early)
ejaculation complain of a sense of lack
of control over ejaculation and report
apprehension about their anticipated
inability to delay ejaculation on future
sexual encounters.
› The following factors may be
relevant in the evaluation of any
sexual dysfunction:
1) partner factors (e.g., partner's
sexual problems, partner's health
status);
2) relationship factors (e.g., poor
communication, discrepancies in desire
for sexual activity);
3) individual vulnerability factors
(e.g., poor body image, history of sexual
or emotional abuse), psychiatric
comorbidity (e.g., depression, anxiety),
and stressors (e.g., job loss,
bereavement);
4) cultural/ religious factors (e.g.,
inhibitions related to prohibitions
against sexual activity; attitudes toward
sexuality); and
5) medical factors relevant to
prognosis, course, or treatment.
► Prevalence
PSY 35 – Abnormal Psychology
› Estimates of the prevalence of
premature (early) ejaculation vary
widely depending on the definition
utilized. Internationally, more than
20%-30% of men ages 18-70 years
report concern about how rapidly they
ejaculate.
› With the new definition of premature
(early) ejaculation (i.e., ejaculation
occurring within approximately 1 min.
of vaginal penetration), only l%-3% of
men would be diagnosed with the
disorder. Prevalence of premature
(early) ejaculation may increase w/age.
► Development and Course
› By definition, lifelong premature
(early) ejaculation starts during a
male's initial sexual experiences
and persists thereafter. Some men may
experience premature (early) ejaculation
during their initial sexual encounters
but gain ejaculatory control over time.
› It is the persistence of ejaculatory
problems for longer than 6 months
that determines the diagnosis of
premature (early) ejaculation. In
contrast, some men develop the
disorder after a period of having a
normal ejaculatory latency, known as
acquired premature (early)
ejaculation. There is far less known
about acquired premature (early)
ejaculation than about lifelong
premature (early) ejaculation.
› The acquired form likely has a later
onset, usually appearing during or
after the fourth decade of life.
› Lifelong is relatively stable throughout
life. Little is known about the course of
acquired premature (early) ejaculation.
› Reversal of medical conditions such as
hyperthyroidism and prostatitis appear
to restore ejaculatory latencies to
baseline values. Lifelong premature
(early) ejaculation begins with early
sexual experiences and persists
throughout an individual's life.
› In approximately 20% of men
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with premature (early) ejaculation,
ejaculatory latencies decrease further
with age. Age and relationship length
have been found to be negatively
associated with prevalence of
premature (early) ejaculation
► Risk and Prognostic Factors
› Temperamental. Premature (early)
ejaculation may be more common in
men with anxiety disorders, especially
social anxiety disorder (social phobia).
› Genetic and physiological. There is a
moderate genetic contribution to
lifelong premature (early) ejaculation.
Premature (early) ejaculation may be
associated with dopamine transporter
gene polymorphism or serotonin
transporter gene polymorphism.
› Thyroid disease, prostatitis, and drug
withdrawal are associated with
acquired premature (early) ejaculation.
› Positron emission tomography
measures of regional cerebral blood flow
during ejaculation have shown primary
activation in the mesocephalic
transition zone, including the ventral
tegmental area.
› Culture-Related Diagnostic issues
Perception of what constitutes a normal
ejaculatory latency is different in many
cultures. Measured ejaculatory
latencies may differ in some countries.
Such differences may be explained by
cultural or religious factors as well as
genetic differences between
populations.
› Gender-Reiated Diagnostic Issues
› Premature (early) ejaculation is a
sexual disorder in males. Males and
their sexual partners may differ in their
perception of what constitutes an
acceptable ejaculatory latency.
› There may be increasing concerns in
females about early ejaculation in their
sexual partners, which may reflect
changing societal attitudes concerning
female sexual activity.
PSY 35 – Abnormal Psychology
► Functional Consequences of
Premature (Early) Ejaculation
› A pattern of premature (early)
ejaculation may be associated with
decreased self-esteem, a sense of lack of
control, and adverse consequences for
partner relationships.
› It may also cause personal distress in
the sexual partner and decreased
sexual satisfaction in the sexual
partner. Ejaculation prior to
penetration may be associated with
difficulties in conception.
► Differential Diagnosis
› Substance/medication-induced
sexual dysfunction. When problems
with premature ejaculation are due
exclusively to substance use,
intoxication, or withdrawal, substance/
medication-induced sexual dysfunction
should be diagnosed Ejaculatory
concerns that do not meet diagnostic
criteria. › It is necessary to identify
males with normal ejaculatory latencies
who desire longer ejaculatory latencies
and males who have episodic
premature (early) ejaculation (e.g.,
during the first sexual encounter with a
new partner when a short ejaculatory
latency may be common or normative).
› Neither of these situations would
lead to a diagnosis of premature (early)
ejaculation, even though these
situations may be distressing to some
males
► Comorbidity
› Premature (early) ejaculation may be
associated with erectile problems. In
many cases, it may be difficult to
determine which difficulty preceded the
other.
› Lifelong premature (early)
ejaculation may be associated with
certain anxiety disorders.
› Acquired premature (early)
ejaculation may be associated with
prostatitis, thyroid disease, or drug
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withdrawal (e.g., during opioid
withdrawal).
CHAPTER 11 : SUBSTANCE
RELATED, ADDICTIVE, &
IMPULSECONTROL DISORDERS
› Substance use
consumption of alcohol or drugs.
› Substance dependence
› an addiction to alcohol or drug.
Substance abuse
› continuous use regardless of risk
► Types of Substances
CNS (DEPRESSANT)
› Downer of the brain
› Alcohol, Marijuana,
› Botique > Cup syrups, Penadril
CNS (STIMULANT)
› Shabu, Cocaine, Caffeine, Cannabis,
Cigarettes
►Destructive Disorders:
Gambling Disorder
› The uncontrollable urge to keep
gambling despite the toll it takes on
your life.
Gambling: the will to take the risk on
something you value in the hope of
getting something of even greater value.
► Diagnostic Criteria for Gambling
Disorder
› Persistent and recurrent problematic
gambling behavior leading to clinically
significant impairment of distress, as
indicated by the individual exhibiting
four (or more) of the following in a 12-
month period:
Specify current severity:
Mild: 4-5 criteria met
Moderate: 6-7 criteria met
Severe: 8-9 criteria met
►DSM-5 Criteria
› Needs to gamble with increasing
amounts of money in order to achieve
the desired excitement.
PSY 35 – Abnormal Psychology
› Is restless or irritable when attempting
to cut down or stop gambling.
› Has made repeated unsuccessful
efforts to control, cut back, or stop
gambling.
› Is often preoccupied with gambling
(e.g., having persistent thoughts of
reliving past gambling experiences,
handicapping or planning the next
venture, or thinking of ways to get
money with which to gamble).
› Often gambles when feeling distressed
After losing money gambling, often
returns another day to get even
(“chasing” one’s losses). Lies to conceal
the extent of involvement with
gambling.
› Has jeopardized or lost a significant
relationship, job, or educational or
career opportunity because of
gambling.
› Relies on others to provide money to
relieve desperate financial situations
caused by gambling.
Kleptomania
› An enigmatic condition in which crime
(theft) forms a part of its diagnostic
criteria. This involves repeatedly being
unable to resist urges to steal items
that you generally don't really need.
Pyromania
› A type of impulse control disorder that
is characterized by being unable to
resist starting fires.
To receive a pyromania diagnosis, the
DSM-5 criteria states that someone
must:
› purposefully set fires on more than
one occasion
› experience tension before setting fires
and a release after
› have an intense attraction to fire and
its paraphernalia
› derive pleasure from setting or seeing
fires
CHAPTER 12 : PERSONALITY
DISORDERS
3 clusters
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A- odd and eccentric, atypical
personality disorders; PSS
paranoid- suspiciousness, secretive,
jealous, argumentative,
shizoid - emotional aloofness or detach
shizotypal- odd thoughts and
perceptions; beliefs on magical
thinking, illusions, depersonalization
and derealization, socially isolated
B- Dramatic and erratic; ABHN
Antisocial- violation of rules and
disregard of feelings and norms
(psychopathy) personality syndrome;
absence of emotions
Borderline- impulsiveness and
unpredictability, uncertain self image,
unstable health and social relationship,
extreme mood swings
Histrionic- overly dramatic behavior,
emotions are excessive, sexually
provocstive behavior
Narcissistic- extreme selfishness,
egocentric, self centeredness,
grandiosity, thinks highly of
themselves, need for admiration and
approval of others
C- anxious and fearful
Avoidant - defined by aloofness,
extreme potential rejection by others
Dependent- allow others to decide for
them,
OCPD- pattern of thinking,
perfectionistic, hyper concern with
details n efficiency, conventional typical
and formal emotions
CHAPTER 13 : SCHIZOPHRENIA
SPECTRUM & OTHER PSYCHOTIC
DISORDERS
Schizophrenia is a startling disorder
characterized by a broad spectrum of
cognitive and emotional dysfunctions
including delusions and hallucinations,
disorganized speech and behavior, and
inappropriate emotions.
Symptoms may include:
PSY 35 – Abnormal Psychology
› Delusions - These are false beliefs
that are not based in reality. Delusions
occur in most people w/ schizophrenia.
› Hallucinations - These usually involve
seeing or hearing things that don't
exist. Yet for the person with
schizophrenia, they have the full force
and impact of a normal experience.
Hallucinations can be in any of the
senses, but hearing voices is the most
common hallucination.
► Symptoms of Schizophrenia
› Disorganized thinking (speech) -
Disorganized thinking is inferred from
disorganized speech. Effective
communication can be impaired, and
answers to questions may be partially
or completely unrelated.
› Extremely disorganized or abnormal
motor behaviour - This may show in a
number of ways, from childlike silliness
to unpredictable agitation. Behavior can
include resistance to instructions,
inappropriate or bizarre posture, a
complete lack of response, or useless
and excessive movement.
› Negative symptoms - This refers to
reduced or lack of ability to function
normally. The person may also lose
interest in everyday activities, socially
withdraw or lack the ability to
experience pleasure.
Delusions - belief on the contrary of
truth or real
Hallucinations - sensory events
► Different types of delusions:
1. Persecutory delusions – belief that
one is going to be harmed, harassed,
and so forth by an individual,
organization, or other group
2. Referential delusions – belief that
certain gestures, comments,
environmental cues, and so forth are
directed at oneself
3. Grandiose delusions – when an
individual believes that he or she has
exceptional abilities, wealth, or fame
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4. Erotomanic Delusions – when an
individual believes falsely that another
person is in love with him or her
5. Nihilistic delusions – involve the
conviction that a major catastrophe will
occur
6. Somatic delusions – focus on
preoccupations regarding health and
organ function
CHAPTER 14 :
NEURODEVELOPMENTAL DISORDER
Neurodevelopmental Disorders :
› Intellectual disability (intellectual
developmental disorder) is
characterized by deficits in general
mental abilities, such as reasoning,
problem solving, planning, abstract
thinking, judgment, academic
learning, and learning from experience.
› The communication disorders
include language disorder, speech
sound disorder, so cial (pragmatic)
communication disorder, and
childhood-onset fluency disorder
(stuttering). The first three disorders
are characterized by deficits in the
development and use of language,
speech, and social communication,
respectively.
› Autism spectrum disorder is
characterized by persistent deficits in
social communica tion and social
interaction across multiple contexts,
including deficits in social reciprocity,
nonverbal communicative behaviors
used for social interaction, and skills in
developing, maintaining, and
understanding
relationships.
› ADHD is a neurodevelopmental
disorder defined by impairing levels of
inattention, dis organization,
and/or hyperactivity-impulsivity.
› Specific Learning Disorders are
diagnosed when there are specific
deficits in an individual’s ability to
perceive or process information
efficiently and accurately.
PSY 35 – Abnormal Psychology
› Motor Disorders include
developmental coordination disorder,
stereotypic movementdisorder, and
tic disorders.
CHAPTER 15 : NEUROCOGNITIVE
DISORDER
Major or Mild Neurocognitive
Disorder due to AD (Alzheimer’s
Disease) also commonly referred to as
Alzheimer's Dementia, is a DSM-5
(Diagnostic and Statistical Manual of
Mental Disorders, fifth edition),
diagnosis assigned to individuals who
are experiencing cognitive deficits
directly related to the onset and
progression of Alzheimer's Dementia.
› Alzheimer's Dementia is neurological
disorder in which an individual
experiences progressive cognitive
dysfunction, due to the incursion of
beta amyloid plaques and
neurofibrillary tangles in cholinergic
neurons. The acetylcholine production
of the effected neurons decreases,
which is clinically manifested as
progressive memory loss, and
associated behavioral symptoms.
► Symptoms of Alzheimer's Disease
According to the DSM-5, there are
three Criterion for Alzheimer's
Disease:
A. The diagnostic criteria for major or
minor neurocognitive disorder is
fulfilled,
B. Insidious onset and gradual decline
of cognitive function in one or more
areas for mild neurocognitive disorder,
or two or more areas for major
neurocognitive disorder, and
C. The diagnostic criteria for either
possible or probable Alzheimer's
Dementia are fulfilled, as defined by the
following:
Presence of causal Alzheimer's
Dementia genetic mutation based on
family history or genetic testing.
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The following three indicators are
present:
1. Decline in memory or learning, and
one other cognitive area, based on
history or trials of neuropsychological
testing
2. Steady cognitive decline, without
periods of stability, and
3. No indicators of other psychological,
neurological, or medical problems
responsible for cognitive decline.
There are further specifiers for mild
neurocognitive disorder: Probable
Alzheimer's Dementia if symptom 1 is
present, and possible if symptom 1 is
absent, but symptoms 1, 2, and 3 are
present, and the cognitive dysfunction
cannot be attributed to another
medical, neurological, or mental disease
process, or the use of prescribed or
illicit substances (American Psychiatric
Association, 2013).
► Onset
› The DSM-5 notes that early onset of
Alzheimer's Disease can occur in the
fifties and sixties, with onset of
symptoms in the eighties and nineties
(American Psychiatric Association,
2013).
► Prevalence
› According to the DSM-5, the
prevalence of Alzheimer's Disease is 5-
10% in persons in their seventies, and
25% for those age 80 and over
(American Psychiatric Association,
2013).
► Risk Factors and Risk markers
› The DSM-5 indicates that risk factors
for Alzheimer's Disease are TBI
(Traumatic Brain Injury) and old age
› A correlation has been found between
size of living space and incidence of
Alzheimer's Disease. In an eight year
longitudinal study of n=1300 elderly
people with no indicators of dementia,
subjects who did not venture outside
PSY 35 – Abnormal Psychology
their immediate home were two times
more likely to have Alzheimer's Disease
› Speculation as to causality would be
the role of neuroplastic adaptation to
environmental stimuli- the greater the
amount of sensory stimuli exposure,
resulting a a larger pool of potential
memory storage and stimulation of the
hippocampi and the cholinergic system
involved in memory acquisition and
storage, the more resistant the brain is
to the development and progression of
Alzheimer's Disease.
› Disrupted sleep may be an early
warning indicator of Alzheimer's
Disease. Poorly maintained sleep, with
daytime fatigue and the need for
hypnotics is correlated with the onset of
› Alzheimer's Disease within two years
according to a study involving n=14,600
age 50 and up. It was noted the
strongest predictor of the onset of
Alzheimer's Disease was daytime
fatigue
› There has been a longstanding debate
about the role of aluminum (Al) in
Alzheimer's Disease, Al is an
established neurotoxin, but the causal
link between environmental aluminum
exposure and Alzheimer's Disease
remains inconclusive and controversial.
► Comorbidity
› The DSM-5 indicates that APD is
comorbid with multiple medical
problems. The comorbidity of
Alzheimer's Disease with Down's
Syndrome is 75% in individuals with
Down Syndrome over age 65.
► Treatment for Alzheimer's Disease
› The DSM-5 does not specify treatment
options for Alzheimer's Disease.
Detection of Cognitive impairment can
b detected by a protocol developed by
the Alzheimer's association for Medicare
annual wellness visits in a primary care
setting, for possible early detection of
AD There are a number of
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cholinesterase inhibitors which are
utilized to delay the progression of
Alzheimer's Disease.
› There have also been clinical trials
exploring the use of transdermal
nicotine to treat MCI, as it has been
established that nicotine binds to
nicotinic acetylcholine receptors, and is
responsible for facilitating memory
storage. There is currently no
pharmacological intervention which can
halt the progression. The delay of the
progression of the disorder can give an
individual with Alzheimer's Disease a
longer period of cognitive functioning,
and an opportunity to settle financial
and business matters, to say goodbye
to or make amends to family and
friends, and to enjoy a fuller quality of
life and retain independence as long as
possible, as well as delay financial and
emotional burdens on family The
impact of Alzheimer's Disease on family
members and caregivers is substantial,
with financial and emotional
considerations predominating. Family
therapy may be useful, particularly if
there has been a history of family strife,
and supportive, solution focused
counseling and psychoeducation may
be useful for the person with
Alzheimer's Disease as well as their
family and caregivers, to learn how to
best support the patient.
► Impact on Functioning
Alzheimer's Disease will have a
progressive major impact on most areas
of functioning. It is inexorable and
terminal. The degree of impact will
depend on what stage the disease
process is in:
Stage 1: No impairment- no detectable
cognitive impairment in an individual
with risk factors for Alzheimer's
Disease.
Stage 2: Very mild decline- subjective
experience of occasional aphasia or
STM (Short Term Memory) failure which
PSY 35 – Abnormal Psychology
cannot be objectively verified. This may
me MCI instead of Alzheimer's Disease.
Stage 3: Mild decline- objective
indicators of aphasia, STM impairment
including problems with name recall, or
concentration may be present.
Stage 4: Moderate decline- difficulty
with Short term, recall, inability to
perform serial seven's, impaired
episodic LTM (Long Term Memory)
recall, and difficulty successfully
completing multi-step tasks.
Stage 5: Moderately severe decline-
disoriented to time and place, difficulty
dressing appropriately for weather and
occasion, deeper episodic LTM deficits.
Stage 6: Severe decline- disoriented to
person, time, place, more profound
episodic LTM deficits, reversed sleep
pattern, loss of bladder and bowel
control, enhancement of previously
suppressed personality characteristics,
and paranoid delusions.
Stage 7: Very severe decline-
unresponsive, loss of motor control,
abnormal reflexes, difficulty swallowing,
death.
MCI (Mild Cognitive Impairment)
involves minor deficits in STM which do
not have a substantial impact on daily
functioning, can be compensated for
with organizational tools, There is
speculation MCI could represent an
early stage of Alzheimer's Disease.
►Differential Diagnosis
There are diagnostic rule-outs for
Alzheimer's Disease which the clinician
must consider, In the DSM -5,
disorders such as Major Depressive
Disorder, and other medical conditions
which impact cognitive clarity, such as
thyroid dysfunction.Other differential
diagnostic considerations according to
the DSM-5 and other sources are: CBD
(Cortical Basal Degeneration), CJD
(Creutzfeldt-Jakob Disease), DLB,
(Dementia with Lewy Bodies), FTD
(Frontotemporal Dementia) MND,
(Motor Neuron Disease), and PSP
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(Progressive Supranuclear Palsy).
Korsakoff's syndrome should be ruled
out based on history of alcohol use.
Poly-pharmacy, or more limited use of
certain prescribed or illicit mediation or
alcohol that can produce cognitive
deficits, such as benzodiazepines can
account for MCI. Isolation, loneliness,
and sensory deficits can all produce
effects which may resemble early stage
dementia.
Different types of neurocognitive
disordes:
Alzheimer’s disease
› Alzheimer’s disease is the most
common cause of neurocognitive
disorder. It affects between 60 and 80
percent of all people with dementia.
Alzheimer’s currently affects some 5.5
million people in the United States
(U.S.). Around 200,000 of these people
are under 65 years of age, with
younger-onset Alzhiemer’s.
› In the early stages, people with
Alzheimer’s may find it hard to
remember recent events, conversations,
and names of people. They may also
experience depression.
› In time, it becomes harder to
communicate, and judgment may
become impaired. The person may feel
disoriented and confused. Their
behavior could change, and physical
activities such as swallowing and
walking might become harder.
Creutzfeldt-Jakob disease
› This condition represents a number of
brain diseases that cause problems
throughout the body. They are thought
to be triggered by prion proteins. A
prion is neither a virus nor a
bacterium, but it can cause a disease.
Types of Creutzfeldt-Jakob
disease (CJD) include bovine
spongiform encephalopathy (BSE), or
“mad cow disease.” Symptoms
include rapid memory, behavior, and
movement changes. It is a rare and
fatal condition.
PSY 35 – Abnormal Psychology
Dementia with Lewy bodies
› The symptoms can resemble those of
Alzheimer’s disease, but there may also
be sleep disturbances, visual
hallucinations, and an unsteady
walking pattern.
› Lewy bodies are collections of protein
that develop inside nerve cells and
prevent them from functioning properly.
Frontotemporal dementia
› This condition can trigger changes in
how people behave and how they relate
to others. It can also cause problems
with language and movement.
› Frontotemporal dementia often
emerges around the age of 60 years,
but it can appear in people who are in
their 20s. It involves a loss of nerve
cells.
Parkinson’s disease
› Parkinson’s is a motor system
disorder. The hallmark signs include
trembling, especially tremor in the
hands. It can also involve depression
and behavioral changes.
› In the later stages, the individual may
have difficulty speaking and sleep
disturbances.
Huntington’s disease
› Huntington’s is a genetic disorder that
results from a defect on chromosome 4.
It can lead to mood changes, abnormal
movements, and depression.
› The person may experience an ongoing
decline in thinking and reasoning skills.
There could be slurred speech and
problems with coordination. It tends to
appear between the ages of 30 and 50
years.
Mixed dementia
› Mixed dementia means the condition
has more than one cause. Examples
include Lewy body dementia combined
with vascular dementia or Alzheimer’s
disease.
Normal pressure hydrocephalus
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› This happens when a buildup of
cerebrospinal fluid causes pressure in
the brain.
› Symptoms can include memory loss,
problems with movement, and the
inability to control urination. It can
happen at any age, but it is more
common among older people.
Vascular dementia
› Also known as post-stroke dementia,
this can happen after a stroke, when
there is bleeding or vessel blockage in
the brain. It affects a person’s thinking
and physical movements.
› According to the Alzheimer’s
Association, early symptoms
may include an inability to organize,
plan, or make decisions.
Wernicke-Korsakoff syndrome
› This can result from a chronic
deficiency of vitamin B1, or thiamine. It
is most common in those who
chronically abuse alcohol. The effects of
alcohol and a poor diet are likely to
contribute.
› The chief symptom is severely
impaired memory, including long-term
memory gaps, which the person may try
to fill in with incorrect versions of what
they think happened. This
unintentional lying is known as
confabulation.
CHAPTER 16 : MENTAL HEALTH
SERVICES: LEGAL AND ETHICAL
ISSUES
The concept of mens rea, or a “guilty
mind,” reflects the idea that a crime
generally must consist. of not only a
proscribed act but also a “mental
element” sufficient to warrant
punishment.
PSY 35 – Abnormal Psychology

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