Psychopathology Flashcards
What is psychopathology?
Patterns of thought, felling or behaviour that disrupt a person’s functioning or wellbeing
Although some abnormal behaviour is universal, what is abnormal can depend on a person’s culture
Indicators of abnormality:
No single behaviour is sufficient in determining abnormality, but indicators include:
- subjective distress
- maladaptiveness
- statistical deviancy
- violation of standards of society
- social discomfort
- irrationality and unpredictability
- dangerousness
Decisions about abnormal behaviour involve judgements and are based on cultural values and expectations and change over time
Mental health and mental disorders: definitions
Mental health: state of emotional and social wellbeing
Mental health problems: emotional and behavioural abnormalities which impair functioning
Mental disorder: clinically recognisable symptoms that cause distress and impair functioning, generally requiring treatment
People who are most at risk for mental disorders:
- children and adolescents
- older people
- aboriginal and torres strait islanders
- those living in rural and remote areas
- homeless individuals
- incarcerated individuals
- culturally and linguistically diverse individuals
Historical accounts of mental disorders include:
- demonology, gods, magic (possession by evil spirits, perhaps punishment from god) –> treatment = exorcism
- hippocrates (mental disorders due to brain pathology and imbalance of blood, phlegm, bile, black bile) –> treatment = balance the four humours
- early chinese medicine (yin and yang) –> treatment = restore balance
- middle ages in europe (supernatural causes of mental illness) –> treatment = prayer, holy water, sanctified ointments, touching relics, mild forms of exorcisms
- renaissance period (scientific questioning re-emerged, very slowly replaced superstition) –> treatment = asylums, 16th century and onward
- philippe pinel (removed chains from inmates to test hypothesis that mentally ill patients should be treated with kindness)
- william tuke (established the york retreat)
Biological perspective of mental health
Genetic vulnerability:
- usually not one gene, almost always polygenic
- genotype-environment interactions (diathesis stress model)
Brain Dysfunction and neural plasticity:
- genetics –> neutral activity (–> +
Psychodynamic perspective on mental disorders:
- capacities in love, work and relation to reality is based on the level of disturbance (normal to neurotic, personality disordered, psychotic)
- the conscious (ego, super ego), preconscious (ego, super ego), unconscious (super-ego, ID)
New psychodynamic perspectives on mental disorders (object relations, interpersonal perspective, attachment theory)
Object relations: emphasises that interactions with real and imagined other people could give rise to inner conflicts
Interpersonal perspective: emphasises cultural and social forces rather than inner instincts as determinants of behaviour
Attachment theory: emphasises the importance of early with attachment relationships as laying the foundation for later functioning throughout life. Quality parental care is needed to develop secure attachment
Behavioural perspective –> why did it arise, what is central to this approach of learning?
- Arose as a reaction against the unscientific methods of psychoanalysis
- only observable behaviour and the stimuli reinforcing properties of it can serve as the basis for understanding behaviour
- Central to this approach is learning:
a) modification of behaviour as a consequence of experience
b) classical (Pavlovian) conditioning
c) instrumental (Operant) conditioning
Pavlovian Conditioning
Before conditioning: neutral stimulus –> no response
During conditioning: neutral stimulus –> unconditioned stimulus –> unconditioned response
After conditioning: neutral stimulus –> conditioned response
Operant conditioning
An individual makes an association between a particular behaviour and consequence –> i.e. there is a stimulus, and then a key relationship between the response and the reinforcer (e.g. a light goes off to let the rat know that if it pulls the lever, food will appear)
Cognitive behavioural perspective: how did it arise, why is it important, what are the key areas?
- arose as a reaction against radical behaviourism
- important to understand how thoughts and information processing can become distorted and lead to maladaptive emotions and behaviours
- self efficacy: the belief that one can achieve desired goals
- cognitive distortions: an exaggerated or irrational thought pattern involved in the onset and perpetuation of pscyhopathological states
- attentional bias: the tendency for people’s perception to be affected by their recurring thoughts at the time
Social perspective - what is likely to leave a person vulnerable to psychopathology?
Exposure to multiple uncontrollable and unpredictable frightening life events is likely to leave a person vulnerable to psychopathology.
- early life deprivation or trauma
- problems with caregivers
- marital discord and divorce
- low SES and unemployment
- maladaptive peer relationships
- prejudice and discrimination
This approach has highlighted the importance of environment and has contributed to the development of programs designed to improve the social conditions that lead to maladaptive behaviour.
What are the causes of psychopathology?
- biological influences
- behavioural influences
- emotional and cognitive influences
- social and interpersonal influences
- developmental influences
What does the diathesis stress model do?
The diathesis stress model posits that mental disorders develop from a genetic or biological predisposition for that illness combined with stressful conditions that play a precipitating or facilitating role.
Dopamine and serotonin
Dopamine plays a role in addiction + reward, whereas serotonin plays a role in anxiety and depression
Which theorists distinguish three broad classes of psychopathology that form a continuum of functioning, from the least to the most disturbed, and what are these classes?
Psychodynamic theorists distinguish psychopathology by neuroticism, personality, psychosis
What type of conditioning has been applied as an etiological model for anxiety?
Pavlovian fear conditioning
What has the behavioural perspective taught us?
That maladaptive behaviour is the result of learning
Difference between classification and diagnosis?
Classification is an overall overarching taxonomy of illness
The act of placing someone in a category of that system is a diagnosis.
Do disorders have known entities?
No, they can only be diagnosed by their symptoms, they have no known entities.
How does the DSM5 define mental disorders?
a syndrome characterised by clinically significant disturbance in an individual’s cognition, emotion regulation or behaviour that reflects a dysfunction in psychological, biological or developmental processes
What is the most important standard for the DSM5 criteria?
clinical utility for prognosis and treatment response
DSM5 guiding principles
- must be practical for use in clinical practice
- only create changes that are supported by empirical evidence
- try to maintain continuity with DSM4
- harmonise with ICD11
- aim to include cultural variations where possible
- reduce excessive use of not otherwise specified
DSM5 categories
- neurodevelopmental disorders
- schizopherna spectrum and other psychotic disorders
- bipolar and related disorders
- depressive disorders
- anxiety disorders
- obsessive compulsive and related disorders
- trauma and stressor-related disorders
- dissociative disorders
- somatic symptom and related disorders
- feeding and eating disorders
- elimination disorders
- sleep wake disorders
- sexual dysfunctions
- gender dysphoria
- disruptive, impulse control and conduct disorders
- substance related and addictive disorders
- neurocognitive disorders
- personality disorders
- paraphilic disorders
How does a classification system help clinicians?
Helps clinicians identify a client’s problems, formulate a plan for interventions, and help researchers search for new knowledge.
___ is the act of placing an individual into a category of a classification system
diagnosis
The DSM5 main goal is:
to have clinical utility
are disorders causes of behaviour
no
is psychopathology dimensional or categorical
dimensional
DSM pros
improved patient care, improved scientific study of psychopathology, facilitates communication, increased knowledge that mental disorders are burdensome
DSM cons
- highly heterogenous disorders
- lots of comorbidity (if people meet criteria for one disorder, they often meet criteria for another disorder)
- does not distinguish between normal psychological phenomena and psychopathology
- may cause or add to stigma
Major Depressive Disorder Criteria
- in order to be diagnosed with a major depressive disorder, people need to meet criteria A (a depressed mood most of the day OR mardely diminished interest in almost everything) and 4 other criteria (i.e. experiencing appetite losss / gain, insomnia or hypersomnia, agitation or retardation, fatigue or loss of energy, worthlessness, poor concentration)
- there needs to be a consistent, repetitive pattern of these symptoms
Diagnosing someone with Major Depressive Disorder (specifiers such as severity, type)
- MDD has a variety of specifiers that let other professionals know about the type of depression and its severity
- severity (mild, moderate, suvere, with psychotic features, in partial remission, in full remission)
- type: anxious distress, mixed features, melancholic features, mood-congruent psychotic features, mood-incongruent psychotic features, seasonal pattern, etc
Persistent Depressive Disorder (Dysthymia)
Criteria:
- MUST HAVE: depressed mood most of the day, more days than not - at least 2 years
- must have two or more of these symptoms: (poor appetite / overeating, insomnia / hypersomnia, fatigue/loss of energy, low self-esteem, poor concentration / indecisiveness, feelings of hopelessness)
- no manic or hypomanic episode ever
Prevalence of MDD and PDD
MDD:
- lifetime rates of 16%
PDD:
- lifetime rates of 6%
Suicide
- most people who die from suicide meet the criteria for a depressive disorder
- worldwide (15th leading cause of death), in Australia (13th leading cause of death)
- high income countries have higher rates of suicide than low and middle-income countries
Risk factors for suicide in Australian Youth
- being male
- living in rural and remote areas
- being Aboriginal
- having a mood disorder
- history of suicidal behaviour
- substance abuse
- stressful life events
- family history
- access to firearms
- school disengagement
- unemployment
Beck’s Cognitive Theory: why only certain people who experience negative life events go on to experience a mental disorder
Life event –> automatic thoughts + cognitive errors + core beliefs or schemas –> depression
Behavioural activation theory
- negative life events lead to environments characterised by excessive aversive stimuli
- people get rewarded less often for engaging in healthy behaviour, but are positively reinforced for engaging in depressed behaviour
- when someone has a depressed mood, they are likely to decrease activation levels
Empirically supported treatments:
Behavioural activation theory leads us to suggest we should use behavioural activation treatment (also easier and less costly)
Cognitive theory leads us to use cognitive therapy (likely leads to reduction in depression through behavioural means)
Interpersonal psychotherapy (the theory doesn’t have a lot of evidence, but the treatment does)
The first point of call might be to offer someone behavioural activation treatment, and then move through the other therapies based on the symptoms of that particular individual
Bipolar 1
- need to meet criteria for a manic episode
- a Major Depressive episode is not a requirement for bipolar 1, although very common
Bipolar 2
- need to meet criteria for a hypomanic episode and a major depressive episode
- major depressive episode is a requirement for bipolar 2
Distinguishing bipolar 1 and bipolar 2
- distinguished from each other in terms of duration and severity
- a hypomanic episode cannot “turn into” a manic episode until it reaches 7 days in duration and is accompanied by an increase in severity
Criteria for a (hypo)manic episode
- you need to have abnormally and persistently elevated, expansive, or irritable mood for at least 1 week (a hypomanic episode is 4 or more days)
- at least 3 of the following to a significant degree (inflated self esteem, decreased need for sleep, pressure to keep talking, flight of ideas / racing thoughts, distractibility, increase in goal-directed activity and excessive involvement in activities that have potentially negative consequences)
- marked impairment in social or occupational or requires hospitalisation for safety
Genetics of bipolar disorder
- family studies: 1st degree relatives (3-15%) compared to controls (0-1%), low risk of probands of unipolar depression
- twin studies: concordance (monozyogtic twins = 20-75%, non-identical twins = 0-8%)
- heritability estimated around 80%
Neurotransmitters and bipolar disorder
- when experiencing a manic episode = higher levels of norepinephrine
- when experiencing depressive episode = reduced levels of serotonin
Empirically supported treatments to bipolar disorder
- medications are recommended as the first treatment for bipolar disorder (mood stabilisers, antipsychotics)
- psychological adjuncts (family focused therapy, systematic care, psychoeducation)
Bipolar 1 and bipolar 2 are distinguished from each other in terms of
duration and severity
Anxiety disorders: specific phobias
- marked fear or anxiety about a specific object / situation
- exposure to the phobic stimulus almost always provokes immediate fear or anxiety
- the phobic object / situation is avoided or else is endured with intense fear
- the fear of anxiety is out of proportion to the actual danger posed
- the fear, anxiety, avoidance is persistent, typically lasts 6 months or more
- the anxiety, avoidance causes clinically significant distress or impairment in social occupational or other important areas of life
- not better accounted for by another mental disorders
Specifiers for specific phobia:
- animal
- natural environment
- blood, injection, injury
- situational
- other
The average person with SP fears 3 objects or situations
Lifetime prevalence = 12.5% (most common anxiety disorder)
Specific phobia: preparedness theory
- prevalent fears reflect a biological predisposition to fear objects and situations that ahve threatened humans throughout history
- mixed empirical findings
- we know that we can condition things to elevate a fear response
- people elicit similar fear reactions to biologically coded things that we should fear (like snakes), compared to guns
social anxiety disorder
- marked fear about social situations involving possible scrutiny by others
- fears will act in way that will be negatively evaluated, included showing anxiety symptoms
- social situations almsot always provoke fear / anxiety
- social situations are avoided or endured with intesne fear
- fear is out of proportion to actual threat
- this is persistent, typically more than 6 months
- fear not attributable to physiological effects of a substance or another medical conditions
social anxiety disorder prevalence
- 2nd most prevalent anxiety disorder
- 12.1% lifetime, 6.8% last year
transitory shyness –> shy personality –> non-generalised social phobia –> generalised social phobia –> avoidance personality disorder
Panic disorders
- categorised by recurrent unexpected panic attacks, including 4 of the following symptoms
(palpitations, sweating, trembling or shaking, sensations of shortness of breath, feelings of choking, chest pain, nausea or abdominal distress, feeling dizzy, chills, paraesthesia, derealization, fear of lowing control, fear of dying) - these symptoms have to peak within 10 minutes of onset
- at least one attack followed by 1 month of persistent concern / worry about panic attacks of their consequences, significant maladaptive change in behaviour related to attacks
- not attributable to physiological effects of a substance or another medical condition
panic disorder prevalence
- 12 month prevalence: adolescence and adults = 2-3%, children =
generalised anxiety disorder criteria
- excessive anxiety, occuring more days than not for at least 6 months about a number of events
- difficulty controlling worry
- anxiety associated with 3+ of following symptoms (restlessness, easily fatigues, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance)
- anxiety symptoms cause clinically significant distress
- not attributable to physiological effects of a substance or another medical condition
Empirically supported treatments for anxiety disorders
Specific phobia: exposure therapy
Social anxiety disorder: cognitive behavioural therapy
Panic disorder: cognitive behavioural therapy
Generalised anxiety disorder: cognitive behavioural therapy
Obsessive Compulsive Disorder
- presence of obsessions, compulsions or both (at least 95% of people meet criteria for both)
- obsessions = recurrent and persistent thoughts, urges, or images that are experienced at some time during the disturbance, as intrusive and unwanted (they are unrealistic), the individual attempts to ignore or supress such thoughts
- compulsions: repetitive behaviours or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly + the behaviours or mental acts are aimed at preventing or reducing anxiety or distress (these are not connected in a realistic way with what they are designed to prevent)
Empirically supported treatments for OCD
- exposure and response prevention (making sure they do not do that compulsive behaviour)
Post Traumatic Stress Disorder
Must meet criteria A:
- directly experiencing the events: includes war, threatened or actual sexual violence or physical assault, kidnapping, torture, etc
- witnessing in person the event described above as it occurred to others, as well as witnessing a medical catastrophe in one’s child
- learning that the traumatic event occurred to a close family member or friend - in cases of actual or threatened death
- experiencing repeated or extreme exposure to aversive details of the traumatic event
empirically supported treatments to PTSD
- trauma focused therapy (prolonged exposure, cognitive processing therapy)
- what works, but does not improve outcomes = EMDR
- what should never be done: psychological debriefing (ends up exposing people to trauma when they haven’t actually been exposed)
