Psych 2621 Chapter 1: Definitional and Historical Considerations, and Canada’s Mental Health System, Psych 2621 Chapter 2: Current Paradigms and Integrative Approaches, Psych 2621 Chapter 3: Clinical Assessment, Classification and Diagnosis, Psych 26…

What are the ABC's of psychopathology

Affect (feelings or emotions), behaviours, cognitions (thinking)

Psychopathology

Field concerned with the nature and development of abnormal things

Affect

Feelings in our body that let us know what is happening. If you are feeling anxious, you may notice that your heart is beating faster

Behaviours

The things we do. The feelings we have prompt us to engage in certain behaviours. If you are sweating a lot, you may add more clothes, which will make you warmer, but people won't see the sweat.

Cognitions

Your thought processes. Thinking.

Do affect, behaviour, and cognitions have to occur together?

No. for instance, You could have anxious affect, but not have behavior and cognition reflective of that anxiety.

Statistical infrequency

A behaviour that occurs rarely or infrequently. We may characterise it as being abnormal because it doesn't happen often

Abnormality is usually determined by the presence of several characteristics at one time such as

Statistical infrequency, violation of norms, personal suffering, disability or dysfunction, unexpectedness.

Examples of statistical infrequency

A 14 year old consistently wetting the bed. MR (IQ < 70) or most mental deficiencies

Statistical infrequency discussion point

Elite athletic ability is a statistical rarity, so too are intellectual delays and intellectual giftedness. We wouldn't necessarily consider elite athletic ability to be abnormal. Just because it does not fall within the normal distribution does not necessarily make it abnormal.

Violation of norms

A behaviour that defies or goes against social norms it either threatens or makes anxious those observing it. This is a definition of abnormal behaviour that is relative to one's culture/group.

Examples of violation of norms

Anti-social behaviour of the psychopath violates social norms and is threatening to others.

Violation of norms discussion point

Prostitution violates social norms but does this mean that someone would necessarily meet diagnostic criteria for a mental disorder?

Discussing depression and anxiety in terms of violation of norms

Depression and anxiety don't violate social norms. If this was the criteria we used, they wouldn't meet criteria for diagnosis.

Personal suffering

A behaviour that creates personal suffering, distress, or torment in the person. This criterion fits many of the forms of abnormality such as depression but some disorders do not necessarily involve distress.

Example of personal suffering

Psychopaths are often not distressed by their behaviour; however, the behaviour of psychopaths can impact others in a negative way.

Personal suffering discussion point

Hunger and childbirth cause distress, but is this abnormal?

Disability or dysfunction

A behaviour that causes impairment in some important area of life, e.g., work, personal relationships, or recreational activities

Examples of exceptions when it comes to disability or dysfunction

Being short if you want to be a professional basketball player. Transvestism is not necessarily a disability; however, it is currently diagnosed as a mental disorder if it distresses the person.

Disability or dysfunction discussion point

Why might transvestitism cause distress in some and not in others? Who are the people who are so distressed that they warrant a clinical diagnosis? If 2 men participated in transvestitism and one man's wife was supportive, then he wouldn't meet the criteria. If the other man's wife doesn't want him to do it, questions him, and he fears being reprimanded by her, then that could create disability or dysfunction

Unexpectedness

A surprising or out-of-proportion response to environmental stressors can be considered abnormal.

Example of unexpectedness

An anxiety disorder is diagnosed when the anxiety is unexpected and out of proportion to the situation.

Unexpectedness discussion point

Is it unexpected for a stunt driver, who wrecks a car, to then proceed to jump into another one to do the exact same thing again? Is this indicative of abnormal behaviour?

Is there an all encompassing definition of abnormal behaviour?

No one definition by itself yields a fully satisfactory definition of abnormal behaviour, but together they offer a useful framework for beginning to define abnormality.

When describing and labelling behaviour, it is important to...?

There is a need to be as objective as possible when describing and labelling it

How many practicing psychiatrists in Canada?

Approximately 3,600

How many psychologists and psychological associates in Canada?

Approximately 13,000

How many nurses specialise in the mental health area in Canada?

Approximately 11,000

How many social workers work in mental health in Canada?

Thousands

Who delivers most primary mental health care?

Most of the primary mental health care is delivered by general practitioners.

Clinical psychologists and Psychiatrists - What's the difference?

Psychiatrists are MDs. They are able to prescribe medication to their patients. They also learn how to diagnose and do interventions outside of drugs. Clinical psychologists are not medical doctors, instead they have either completed a PhD or PsyD. PhDs are generally more research focused, they conduct research and then pass it off to those who may use it. PsyD is a professional program, your goal isn't to do research, it is to learn about diagnosing and therapeutic intervention.

What are some similarities between psychiatrists and clinical psychologists?

They are able to diagnose mental health conditions. They have doctoral degrees (different kinds). They are able to do interventions outside of drugs

What are some differences between psychiatrists and clinical psychologists?

Psychiatrists are medical doctors who have completed med school. Clinical psychologists do not have medical training. Psychiatrists do undergrad, medschool, and then more training to become a certified psychiatrist. Clinical psychologists do an undergrad, graduate work, a masters, a PhD or PsyD, and a residency. Psychiatrists can prescribe medications to their patients. Clinical psychologists cannot prescribe medication to their clients, but can provide therapeutic interventions and diagnoses.

Pre-scientific inquiry: What were mental disorders believed to be caused by?

Events beyond the control of humankind that were regarded as supernatural. Similarly, behaviour that seemed outside individual control reflected the displeasure of the gods or possession by demons.

Demonology

The doctrine that an evil being, such as the devil, may dwell within a person and control his or her mind and body. Often involved exorcism

Trepanning

making a surgical opening in a living skull by some instrument. Used to treat epilepsy, headaches, and other psychological d/o attributed to demons. Common in Peru and Bolivia. 3 specimens found in British Columbia Aboriginal populations

What was trepanning used to treat?

Used to treat epilepsy, headaches, and other psychological d/o attributed to demons

Where was trepanning commonly found?

Common in eru and Bolivia. 3 specimens found in British Columbia Aboriginal populations

What were Hippocrates' big contributions?

Separated medicine from religion, magic, and superstition. Rejected belief that the gods sent physical diseases and mental disturbances as punishment. Insisted that illnesses had natural causes thus should be treated like other illnesses

Who was one of the earliest proponents of somatogenesis?

Hippocrates was one of the earliest proponents

Somatogenesis

soma = body, genesis = origin

Psychogenesis

Psyche = mind, genesis = origin

What were Hippocrates' mental classifications

Mania, melancholia, and phrenitis (or brain fever)

Hippocrates' humoral physiology

Hippocrates' treatments were an important advance. Mental health was viewed as dependent on a delicate balance among four humours, or fluids, of the body. Imbalances resulted in various mental health conditions

According to Hippocrates, what are some imbalances that result in various mental health conditions?

Blood = changeable temperament.

Black bile = melancholia.

Yellow bile = irritability and anxiousness.

Phlegm = sluggish and dullness

What mental health condition is blood associated with?

Changeable temperament

What mental health condition is black bile associated with?

Melancholia

What mental health condition is yellow bile associated with?

Irritability and anxiousness

What mental health condition is phlegm associated with?

Sluggishness and dullness

The dark ages and demonology

Churches gained in influence. Christian monasteries replaced physicians as healers and as authorities on mental disorder

How did Christian monasteries replace physicians as healers and as authorities on mental disorder?

By praying and touching them with religious relics. Concocting fantastic potions for them.

Why did people turn to demonology?

To explain disasters, leading to an obsession with the devil

People turned to demonology to explain disasters leading to an obsession with the devil

"Witches" were blamed and zealously persecuted

1484 Pope Innocent VIII exhorted European clergy to leave no stone unturned in the search for witches

Sent two Dominican monks to northern Germany as inquisitors who later issued the manual entitled the Malleus Maleficarum ("the witches hammer")

Early 13th century "lunacy" trials held in England

Trials conducted to protect the mentally ill. Judgment of insanity allowed Crown to become guardian of estate. Defendant's orientation, memory, intellect, daily life, and habits were at issue in the trial. Strange behaviour were explained as physical illness / injury

How was strange behaviour explained during the lunacy trials?

Strange behaviours were explained as physical illness / injury

Development of asylums

Until the end of the 15th century, very few mental hospitals in Europe. Leprosy gradually disappeared from Europe and Leprosariums were converted to asylums. Asylums took disturbed people and beggars. Had no specific regimen for their inmates but work

Who did asylums take in?

The slides say disturbed people and beggars, but as discussed in class, it's important to note that they were a place for anyone in society that the masses didn't want around. A place to put people so you don't have to look at them. This didn't only include those experiencing mental illnesses.

St. Mary of Bethlehem

Founded in 1243 in London, devoted solely to the confinement of the mentally ill. Conditions were deplorable. It became a tourist attraction. Viewing the violent patients considered entertainment

Bedlam

A descriptive term for a place or scene of wild uproar and confusion. Comes from the name of the asylum, St. Mary of Bethlehem

What were the conditions of St. Mary of Bethlehem?

The conditions were deplorable. Patients weren't treated for anything. It became a tourist attraction.

Philippe Pinel (1745-1826)

Is considered primary figure in movement for humanitarian treatment of the mentally ill in asylums

What did Philippe Pinel believe?

Believed patients should be treated with dignity

How did Philippe Pinel advocate for moral treatment of the mentally ill in asylums?

Jean-Baptiste Pussin and then Pinel literally removed the chains of the people imprisoned. Began to treat patients as sick rather than as beasts. Light and airy rooms replaced dungeons and walks around the grounds were allowed. Results? Some patients incarcerated for years were discharged.

When were the first asylums in Canada built?

The first asylums in Canada were built during the institution-building period prior to the First World War.

Who was the last Canadian province to open an asylum?

Alberta was the last province to open one

Dementia precox

(early term for schizophrenia). Thought chemical imbalance as the cause of schizophrenia

Manic-depressive psychosis

(now called bipolar disorder) Thought an irregularity in metabolism as the cause of manic-depressive psychosis

Emil Kraepelin

Created a classification system to establish the biological nature of mental illnesses. Noticed clustering of symptoms (syndrome) which were presumed to have an underlying physical cause

Kraepelin's two main groups of severe mental disease

Dementia precox and Manic-depressive psychosis

What did Krapelin's early classification system become?

His system became the basis for the present diagnostic categories

General paresis

characterized by steady physical and mental deterioration, delusions of grandeur and progressive paralysis from which there was no recovery

Germ theory of disease

established by Pasteur. Laid the groundwork for demonstrating the relation between syphilis and general paresis. Also helped establish a causal link between infection, destruction of brain areas, and a form of psychopathology

Brainwashing

LSD + ECT, being delivered subliminal messages in hope they could wipe away their troubled past. Dr. Cameron 1950s + 60s

Psychosurgery

(e.g., lobotomy) performed out of scientific curiosity, i.e., to see how it would change patients

What is the primary reason only ⅓ of an estimated 3 million Canadians living with depression seek help?

Social stigma surrounding depression is the primary reason

Self-stigma

The tendency to internalize mental health stigma and see oneself in more negative terms as a result of experiencing a psychological problem.

Common misconceptions/myths of mental illness

Unstable and dangerous. Examples such as Vincent Li are incredibly rare and often relate to under-treatment of serious symptoms. Cannot be "cured" or contribute to society

How many canadians would avoid socialising or marrying someone who is mentally ill?

~50% of Canadians would avoid those things

How many Canadians are afraid to even be around someone with a serious mental illness?

~27% are afraid of this

How many Canadians would decline to tell friends or co-workers about a family member suffering from mental illness?

~50% would decline to do this

How many Canadians wouldn't hire a doctor, lawyer, financial advisor, child-care provider, or a landscaper who has a mental illness?

Most Canadians would not do this

More positive and informed attitudes in regards to mental illness are found in

found among younger people, more educated people, people with training, and those with personal experience perhaps due to having a family member with some form of illness

How many Canadians believe anyone can suffer from a mental disorder?

90% of Canadians believe this

The goal of deinstitutionalisation

Goal was/is to shift care from psychiatric hospitals into the community

The process of rapid deinstitutionalisation occurred in which five provinces?

(Alberta, British Columbia, Ontario, Nova Scotia, and Saskatchewan).

The enthusiasm for deinstitutionalization was tempered by evidence that

Evidence that many discharged people lead lives of poverty in the community, with a significant number included among the homeless and the prison population

Transinstitutionalization

More care is now provided in psychiatric units of general hospitals rather than in psychiatric hospitals

What institutions are mentally ill people more likely to end up in?

When considering 2004-05 data, there are many more mentally ill people in jails and in prisons than in hospitals. 300% more patients with serious mental illness were incarcerated in jails and in prisons than in hospitals.

How much have rates of mental illness detected at intake in Canadian prisons altered?

These rates doubled from 1997 to 2008

Are men or women more likely to meet criteria for a mood or anxiety disorder?

Women were 1.5 times more likely than men to meet criteria

Are men or women more likely to meet criteria for substance dependence?

Men were 2.6 times more likely than women to meet criteria

Are eating attitude problems and agoraphobia more common among women or men?

These were 6 times and 5 times more common among women than men respectively.

People in what province(s) reported the most happiness and the least distress?

People in NL and PEI

What province(s) reported very high levels of self-esteem and mastery but the least happiness and most distress?

Quebec reported this pattern

How does annual income (70k + vs < 19k) affect risk od having a diagnosable mental disorder?

When compared with people with an annual income of $70,000 or more, people with less than $19,000 per year were 4,3 times more at risk of having

How does the burden of mental illness and addictions compare to the burden of other illnesses?

The burden of mental illness and addictions is 1.5 times greater than the combined burden of all cancers

Mental health conditions with the highest amount of burden

- Depression

- Bipolar disorder

- Alcohol use disorders

- Social phobia

- Schizophrenia

Romanow called mental health care

Referred to it as "the orphan child of medicare"

Romanow recommendations for improving mental healthcare

-Include some homecare services for case management and intervention services.

-Develop a national drug agency.

-Provide an emergency drug program to help those with severe mental illnesses (e.g., schizophrenia and bipolar disorder).

-Establish a program to support informal caregivers (e.g., friends, families) who assist the mentally ill in critical times.