Lecture 23: Description Of Psychopathology Flashcards
What is mental health?
A state of emotional and social well being
What is psychopathology?
It refers to problematic patterns of thought, feeling and behaviour
Disrupted functioning at home, work and in the person’s social life (of some duration)
Patterns that cause distress in the person or in others
Varies between and within cultures
What are mental health problems?
The wide range of emotional and behavioural abnormalities that affect people throughout their lives
What is a mental disorder?
A clinically recognisable set of symptoms and behaviours which usually need treatment to be alleviated (a serious departure from normal functioning)
What is the highest proportion of mental disorder in australia?
Schizophrenia and related disorders
Followed by affective (depressive disorders)
What is the mental disorder burden by age and disorder?
20 year olds have the highest burden of mental disorders.
The highest type of mental disorder is others, followed by schizophrenia
Who has the highest burden of disease?
People aged 80-100
How do we classify mental disorders?
Using a manual called the DSM-IV published by the american psychiatric association
This uses a multi-axial system of diagnosis.
The axes cover symptoms as well as medical conditions, stress and current level of function
WHO also publishes a manual of mental and physical disorders called the international classification of disorders. This is used by mental health services in UK and for coding by DHBs in NZ
What are the 5 different axis in the DSM-IV?
I- symptoms that cause distress or significantly impair social or occupational functioning
II- personality disorders and intellectual disability-chronic and enduring problems that impair interpersonal or occupational functioning
III- medical conditions that may be relevant to understanding or treating a psychological disorder
IV- psychosocial and environmental problems such as negative life events and interpersonal stressors that may affect the diagnosis, treatment and prognosis of psychological disorders
V- global assessment of functioning- the individual’s overall level of functioning in social, occupational and leisure activities
What are the major types of disorders?
Disorders of infancy, childhood and development, e.g. ASD, ADHD,
Disorders secondary to medical condition
Substance use disorders e,g, alcohol dependence
Mood disorders e,g, depression
Anxiety disorders e.g. Panic disorder
Psychotic disorders e,g, schizophrenia
Cognitive disorders e.g. Dementia
Personality disorders e.g. Borderline PD
What is formulation?
The processes of understanding why a person has developed a disorder or problems of a certain time, why these have not got better or worse and what may happen if unaddressed
What does formulation require?
Detailed info about the person, via an assessment
Requires the use of one or more theories (lenses)
What are the 5 P’s of formulation?
Predisposing factors (e,g, genetic) Precipitating factors Perpetuating factors Protective factors Prognosis
What are the major disorders of focus for this lecture?
Mood
Anxiety
Personality
Psychotic illnesses
What are mood disorders
These are characterised by a disturbance in emotion and mood.
A mood is an internal feeling or emotion which often influences behaviour and the individual’s perception of the world
Affect is the external expression of an emotional state
What is major depressive disorder?
This is a long term episode of intense sadness, loss of appetite and difficulty in sleeping
Prevalence is about 8-10%
Women are twice as likely to have major depression
What is dysthymia?
A less severe type of depression where symptoms are evident over longer time periods (2 years) but are not as debilitating as those of major depression
Prevalence up to 20%
What is bipolar disorder?
Alternating episodes of mania and depression
Mania: an excessive degree of happiness and a belief that the person can do anything
Lifetime risk is low (1.5%)
What are the theories of depression?
Biological and environmental
Cognitive theory
Psychodynamic
Systemic
What is the biological environmental theory of depression?
Biological and environmental factors contribute to depression.
Heritability is estimated at 30-40%
Reduced serotonin levels are evident in many patients
Often the onset of depression is Stress-related
What is the cognitive theory on depression?
CBT maintains that when people have negative experiences in their lives it may result in beliefs such as being “unloveable” or “inadequate” these thoughts can lead to psychological dysfuntion
What is the psychodynamic theory on depression?
Depression is due to Anxieties stemming from early parental relationships, and is managed using various developmentally linked psychological defenses, some conscious, some subconscious and unconscious psychic processes. This is much more complicated.
What is the systemic theory on depression?
Problems in the individual reflect issues in the structure of functioning of the whole family/system. E.g. A child may present with behavioiral problems due to parental marital conflict
What are anxiety disorders?
In anxiety disorders people experience frequent, intense and irrational anxiety or apprehension,
This is the Most frequently occurring category of mental disorder in the general population (10%)
Women are more likely to be afflicted.
There is a high rate of comorbidity with depression
What are the types of anxiety disorders?
Phobias- an irrational fear of an object or sotuation
Social phobia = fear of being in public situations e.g. Public speaking
Agoraphobia= fear of being in places or situations from which it might be difficult to escape e,g, shopping centre or lift
Panic disorders = intense attacks of fear and terror that are not justified by the situation
What is the aetiology of anxiety disorders?
Genetic vulnerability, early experience and stress may cause a mild panic attack.
Association of panic state with autonomic cues like quickened pulse, shortness of breath, sweaty palms etc. This results in learned alarm
This causes an anxious apprehension concerning learned alarms
An unpredictable panic attack can result. This can be triggered by experience of learned alarms, anxious thoughts or anxiety provoking stimuli
This in tern causes a low belief in self efficacy in dealing with panic and potentially triggering situations, and the development of avoidance behaviour and search for stimuli associated with safety.
What are other types of anxiety disorders?
Obsessive compulsive disorder
Post traumatic stress disorder
Eating disorders
What is OCD?
Recurrent obsessions and compulsions that cause severe distress and interfere with daily life
Obsessions- are persistent, irrational thoughts and ideals
Compulsions- are intentional behaviours, performed in response to an obsession
Anxiety levels increase if a person with OCD is prevented from performing their compulsions
What is post traumatic stress disorder?
Persistent re-experiencing of traumatic events through distressing recollections, dreams, flashbacks, with impact on concentration and hypervigilence.
There is a large cultural overlay in this diagnosis e.g. Wars, sexual assualt
What are eating disorders?
Examples include anorexia nervosa: loss of weight, abnormal cognitions and perceptions regarding weight and shape, loss of periods or delayed development. Medical complications
Bulmia nervosa: binge purge cycle
What is psychosis?
An umbrella term for a number of disorders involving disturbances in
Thought form and content- i.e. Loosening of associations and delusions
Perception- particularly hallucinations which can be auditory, but are predominantly visual
Language- disconnected ideas may even be word salad
Affect- emotion is often flat or absent
What is the shortest form of psychosis?
Brief psychotic disorder
What is the longest form of psychosis?
Schizophrenia
What are the symptoms of psychosis?
Positive: signal presence of something not usually there e.g. Modt apparent in the acute phase of the disease, including delusions, hallucinations, thought disorder
Negative: signal absence of function e.g. Lack of emotion, motivation, complex thought
Mood symptoms- depressed or elevated, ood
Cognitive symptoms- poor memory, concentration
What are hallucinations?
a perception experienced in external space in the absence of normal stimuli
What are delusions?
Fixed false velif, not amenable to reason and not in keeping with that person’s subculture
What are the major types of schizophrenia?
Paranoid Catatonic Disorganised Undifferentiated Resisual
What are the two models/hypothesis which form the biological basis of schizophrenia?
Diathesis-stress model
Dopamine hypothesis
What is the diathesis stress model?
Schizophrenia develops in people with an underlying biological vulnerability (diathesis) that is compounded by stress
What is the dopamine hypothesis?
Schizophrenia reflects elevated levels of dopamine in the brain.
Paranoid schizophrenia is induced by chronic treatment with amphetamine, a drug that releases dopamine
What is the genetic risk of schizophrenia?
This is quite high.
Those genetically above the threshold for schizophrenia do not require environmental risk
Those genetically near the threshold, only require a some environmental risk
Those just genetically at risk, will require slightly more environmental risk to reach the threshold for schizophrenia
However those with no genetic predispositions cannot cross the threshold for schizophrenia i,e, they will not get it
What are the neural atrophies in schizophrenia?
Neuron loss in brain results in a diminished volume of brain tissue
Enlarged ventricles are a common finding
What areas of the brain are affected by atrophy in schizophrenia?
Atrophy has been observed in the frontal, temporal and prefrontal cortex as well as tissue connecting to the limbic system which is involved in emotional regulation
What are personality disorders.
Chronic and severe disturbances that inhibit an individual’s capacity to manage close relationships and hence impacts on family, employment and life in general
Estimated prevalence: 10% in general population
What is borderline personality disorder?
This is a disorder marked by unstable interpersonal relationsjips, mood swings, interpersonal sensitivity, and a complex way of interacting in which others feel they act out of character
What is antisocial personality disorder?
Marked by irresponsible and socially disruptive behaviour- unusually behaviourally determined
