Week 6 - Introduction to Mental Health Flashcards
What were the beliefs on mental illness during the ancient Greece period?
- Used to think mental illness was due to imbalance of bile/liquids
- Treatment method: Demonological (evil spirits and exorcisms)
In what century were asylums introduced?
15th century
What were the key points in history regarding clinical psychology, during the 20th century?
- Shift from biology to psychology; Emil Kraeplin as the founder of modern psychiatry
- Psychodynamics perspective (Freud)
- Humanistic perspective (Rogers)
- Behavioural perspective
- Cognitive perspective
What is the definition of mental health?
Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his/her community (WHO, 2021)
What are the factors influencing mental health?
- Social
- Psychological
- Biological
(based on the Biopsychosocial Model of Health)
Definition of stigma
Negative attitudes and beliefs, that usually come from inaccurate information
Definition of Psychopathology
Study of symptoms and development of psychological disorders
Definition of Psychological Disorder
Pattern of behavioral or psychological symptoms
Definition of Lifetime Prevalence
Likelihood of someone experiencing disorder at some point in their life
What is the DSM-5?
- A complete list of various disorders and the symptoms/criteria associated with it
- Lists 20 categories of disorders, and covers more than 300 disorders
- Published in 2013
What are the different ways to assess disorders?
- Unstructured interviews
- Structured interviews
- Projective tests
- Questionnaires
- Neuropsychological testing
Explain unstructured interviews
- Initially gather information concerning status individual
- Building rapport with client
- Identify areas of consideration for diagnosis
Explain structured interviews
- Uses similar questions across clients to provide consistency
- Questions are based on criteria taken from DSM-5
Give examples of projective tests
- Rorschach inkblot test
- Thematic apperception test
What are the pros of projective tests?
- Informal format; Allows greater flexibility in administration and less likely to prompt social desirability
- Potentially assess unconscious conflicts and desires
- Good for rapport building (non-threatening)
- Helps to generate hypotheses about diagnosis
- Adds to “larger picture” of overall assessment
What are the cons of projective tests?
- Reliability is questionable, even with scoring guide
- Not great at predicting behaviour long-term
- Does not always help in understanding behaviour
- Clinicians may pursue wrong avenue for diagnosis
Examples of questionnaires used to assess disorders
- Minnesota Multiphasic Personality Inventory MMPI)
- Beck Depression Inventory (BDI)
- Hamilton Depression Rating Scale (HDRS)
- Generalised Anxiety Disorder Assessment (GAD-7)
Examples of neuropsychological testing used to assess disorders
- Wechsler Adult Intelligence Scale (WAIS)
- Wechsler Intelligence Scale for Children (WISC)
- Wechsler Preschool and Primary Scale of Intelligence (WPSSI)
Explain the Wechsler Tests
- Used to assess general level of cognitive functioning
- IQ, verbal comprehension, perceptual reasoning, working memory, processing speed
What do diagnostic categories do?
- Describe patterns of experiences/behaviours that may be causing distress and/or be seen as difficult to understand
Explain Korsakoff’s Syndrome
- A memory disorder that results from vitamin B1 deficiency and is associated with alcoholism
- Ability to learn new information is impaired
What are the differences between psychiatric and physical diagnoses?
- There are not always physical tests for psychiatric diagnoses
- No firm evidence that mental distress is caused by biochemical imbalances, genes or the brain (except some, ex. dementia)
- Our brains are involved in everything we do but not always the cause of abnormal behaviour
- The theory that mental distress is best understood as a kind of physical illness (ex. diabetes, cancer) is not fully supported
What are the problems with the DSM?
- Over-reliance on ‘medical’ model
- Categories, not dimensions
- Some propose that it should have biological explanations and specific treatments included in it
- People often get more than one diagnosis (Shift categories over time)
- People can have ‘sub-threshold’ problems but experience more impairment than those who meet the full criteria
- Psychiatrists often do not agree on the diagnosis, particularly for common disorders like depression and anxiety
What did Regier et al. (1990) find about comorbidity and addiction?
- 37% of individuals with alcohol use disorder also have a psychiatric disorder
- 53% of individuals with drug use disorder also had a psychiatric disorder
- 29% of individuals with a psychiatric disorder also had a substance use disorder
What are the effects of the overlap between addiction and other disorders?
- Disruption of social or recreational activities
- Social or interpersonal problems
- Hazardous/risky situations
- Failure to fulfill work, school or home obligations
Why is comorbidity a problem?
- How do we know which comes first (chicken or egg Q)?
*If addiction is responsible for depression/anxiety due to withdrawal, then the treatment should focus on addiction
*If depression/anxiety is responsible for addiction (coping mechanism/self-medication), treatment should focus on depression/anxiety
*Basically, we have to address the root cause
Arguments for Diagnostic Categories
- Fundamental part of clinical psychology
- Helps identify useful inventories
- Validates the patient’s experiences
How do diagnostic categories help people?
Can help people to:
- Feel like their experiences “make sense”
- Feel less alone
- Feel worthy of (and ask for) help and care
- Feel less guilt or self-blame for their difficulties
- Feel hope for treatment and recovery
- Find a language to explain their difficulties to others
What are the possible problems with diagnostic categories?
- Some feel that diagnosis is a barrier to recovery (self-fulfilling prophecy)
- Diagnosis might make people feel ‘different’ and feel more alone/isolated
- Diagnosis may not capture experiences that have caused current difficulties
What are the issues with DSM?
- Includes some conditions that are too “normal” to be considered disorders
- Uses arbitrary cutoffs
- Gender bias
- Insufficient sensitivity to cultural diversity
What are the changes being considered to be made in DSM-5?
- Use of biological markers as diagnostic tools
- Rating of disorders/symptoms on a scale
- Dimensional approach toward a disorder
What are the new disorders rejected to be added into DSM-5?
- Attenuated psychosis syndrome
- Mixed anxiety-depressive disorder
- Internet gaming disorder
What disorders in DSM-5 were revised?
- Bereavement exclusion
- Autism Spectrum Disorder
- Attention-Deficit/Hyperactivity Disorder
(Increased age symptoms from 7 to 12, Min. number of symptoms in adults increased to 5) - Bulimia Nervosa
(Frequency of binge-eating reduced to once a week) - Anorexia Nervosa
(Reduction of less than 85% of the body weight) - Learning disabilities in math, reading and writing were combined as Specific Learning Disorder
- Obsessive Compulsive Disorder removed from Anxiety Disorders to a new category
Criticisms of DSM-5
- Many “work group” members quit midway
- Leaders of mental health organizations boycotted the DSM-5; Most vocal critic was Allen Frances (led the development of the previous DSM)
- Diagnostic overexpansion
- Transparency of the revision process
- Background of the DSM-5 authors
- Field trial problems (Testing of DSM-5 was not very unreliable)
- Price is quite high, despite it being required by students and practitioners and etc.
- Breadth of coverage
- Controversial cutoffs
- Cultural issues
- Gender bias
- Little input from practitioners
What did Allen Frances say about the DSM-5?
- Changes were unsafe and scientifically unsound
- Medical illnesses were diagnosed as somatic symptom disorder
- DSM-5 will mislabel normal people, promote diagnostic inflation, encourage inappropriate medication use
What are the strengths of the DSM-5?
- Emphasis on empirical research
- Use of explicit diagnostic criteria
- A degree of interclinician reliability
- A theoretical language
- Facilitated communications between researchers and clinicians
