psychopathology Exam 1

origin of the word psychopathology

Greek roots:

• psyche (mind or soul)

• pathos (suffering or painful memory)

• logia (structure of or study of)

7 indicators of abnormality

1. subjective distress

2. maladaptiveness

3. statistical deviancy

4. violation of the standards of society

5. social discomfort

6. irrationality and unpredictiability

7. dangerousness

Alternative to DSM

ICD-11

What classification system does the World Health Organization (WHO) use, and how is it different from the DSM?

• WHO uses the ICD-11

• similar disorders have different names

• used in many countries outside the US

• ICD code numbers (which are provided next to the diagnosis in the DSM) are also used in hospital settings in the US

concordance rates

The likelihood of twins [20-30%] or parent/child [10%] sharing a specific trait or disorder

Etiology

the origin of

Demonic possession vs schizophrenia Essay Question

who founded the biopsychosocial model

Erik Erikson

biopsychosocial model factors

• biological

• psychological

• social, etc

who founded the Diathesis-stress model

Emil Kraepelin

Emil Kraepelin’s two classifications of mental illness (became foundation for DSM and ICD)

• dementia praecox: now schizophrenia

• manic depressive psychosis: now bipolar disorder

Diathesis-stress model

• diathesis: predisposition/vulnerability: genetic, environmental, biological

• stress: the trigger

epidemiology

study of distribution of disease, disorders, and health related behaviors

prevalence

active cases in a period of time

point prevalence

estimated proportion of actual cases at a specific point in time

incidence

number of new cases over a period of time

lifetime prevalence of DSM-IV

• 46.4%

• almost ½ of americans had mental illness at one point

prevalence of major depressive dissorder

• 1 year = 6.7%

• Whole life = 16.6%

prevalence of alcohol abuse

• 1 year = 3.1%

• Whole life = 13.2%

Prevalence of those seriously impaired by mental disorder

• 1 year adults = 5.8%

• 1 year adolescents = 8.0%

• now 4.0% overall

comorbidty

• the presence of 2 or more disorders

• high in those with sever disorders

Important historical figures in psychotherapy

• Hippocrates

• Plato

• Paul of Aegina

• Paraclesus

• Emil Kraepelin

• Freud

• Schaeffer

• Crosson

• Willson

about Hippocrates

Hippocrates (350BC)

• father of medicine and 4 bodily humors/fluids = balanced/imbalanced

the 4 bodily humors/fluids

• sanguine (blood: warm/lazy)

• phlegmatic (phlem: calm/lonely)

• choleric (yellow bile: productive/angry)

• melancholic (black bile: analytical/depressed)

about Plato

Plato (4th century BC)

• philosopher, idealism vs materialism (dualism)

• dysfunction: overemphasis on flesh

about Homer

Homer (800 BC)

• humans are heavily influenced by the gods (the voices in our heads? Thought to be caused by gods, not we understand as our own internal thoughts)

psychopathology in the middle ages (500AD - 1500AD)

• often supernatural conotation

  • sin, demonic possession

  • treated by clergy, exorcism/prayer, bleeding, trephination

trephination

drilling hole in skull to release evil spirits

lobotomy

severing the connections in the prefrontal cortext

Paul of Aegina

Paul of Aegina (7th century AD)

• music = balancing the humors

about Paracelsus

Paracelsus (1493)

• wanted to revolutionize medicine: internal causes of dysfunction, related to astral influences (lunatic), alchemy

• “Man is no body. The heart, the spirit, is man. And this spirit is an entire star, out of which he is built. If therefore a man is perfect in his heart, nothing in the whole light of Nature is hidden from him.”

about asylums and figures important to them

asylums (popularized in 1600)

• a way to segregate the troublesome

• Phillipe Pinel

• Dorothea Dix

about Phillipe Pinel

Phillipe Pinel (1745-1826)

• behavioral causes (treated by “moral management”) = better results than mere isolation

about Dorothea Dix

Dorothea Dix (1802-1887)

• mental hygiene movement = increasingly humane treatment: “Man is not made better by being degraded”

about Emil Kraepelin

Emil Kraepelin (1856-1926)

• first legit classification of mental issues, “father of psychiatry”

Interventions into the 20th century

• shocks

• induced comas (narcosis)

• restraint/isolation

• sedation

• lobotomy

about Sigmund Freud

Freud (1856-1939)

• Disorder results from psychological (internal) issues/conflicts, resulting from traumatic (sexual) experiences, fragmenting the self (conscious/unconscious) = excavation

• Psychopathology of Everyday Life: e.g., accidents, forgetfulness (e.g., appointments), lateness, Freudian Slips, “keys”, wedding ring, train example, sexual determinism

• Certain thoughts/desires are unacceptable/emotionally painful and must be repressed to protect the ego; these are converted into symptoms (disorder/dysfunction) + E.g., Oedipus/Electra complex, castration anxiety, penis envy

Freud’s disorders/dysfunctions

• Oedipus/Electra complex: in love with mother/father

• castration anxiety: men fear that their father will castrate them in a fight for the mother

• penis envy: women are jealous of penis

Who is associated with “The Myth of Mental Illness?”

Thomas Szasz (1920-2012)

About Thomas Szasz

Thomas Szasz (1920-2012)

• Mental health issues are a vague construct and mostly iatrogenic (i.e., created by clinicians) and malingering (i.e., faking)

  • No objective evidence of disease: e.g., brain scans, blood test, diagnosis based only on observed behaviors

Modern Views of the 21st century

Compassion & Humanity: Carl Rogers

• Deinstitutionalization

• Multiculturalism

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• Etiology of disorders is eclectic next week:

• Psychological

• Neurological (brain/neurotransmitters)

• Behavioral

• Genetic

• Social

• Environmental

• Spiritual?

About John Dominic Crossan

Possession in the Bible had political meaning 

• demons = romans

About Schaeffer

• presbyterian theologian

• infinite person truth

• “True Truth”

• no such thing as perfect mental health (because we live in a broken world)

About Wilson

• Philosopher

• “New” existentialism: more optimistic, life-affirming

• Disorder = not living fully (Robot)

• Treatment = live more fully i.e., evoke peak experiences

Wilson’s terminology

• peak experience: become aware of something you took for granted

• automatism/auto pilot: cause to lose pleasure

• beam of interest

• peakers: large ready-energy tanks

• third world: world of pure meaning

Who is associated with the biopsychosocial model?

Erik Erikson

Factors of the biopsychosocial model

• biological

• psychological

• social

diathesis - stress model disorder =

• Diathesis (predisposition/vulnerability: genetic, environmental, biological)

• Stress (trigger: acute/chronic)

ego

• conscious level

• executive mediating between id impulses and superego inhibitions; testing reality; rational. Operates mainly at conscious level but also at preconscious

superego

• preconscious level

• Ideals and morals; striving for perfection; incorporated from parents; becoming a person’s conscience. Operates mostly at preconscious level

Id

• unconscious level

• basic impulses (sex and aggression); seeking immediate gratification; irrational and impulsive. operates at unconscious level

Freud’s psychosexual stages

• oral (birth-2): related to mouth/feeding

• anal (2-4): related to potty training

  • We get pleasure when we relieve ourselves

• phallic (4-7): recognition of anatomy (envy)

• latent (7-12): distributed, superego

• genital (12+): focus on sex

psychosexual fixations

“Fixation” at a stage = over/under-gratification = disorder

• oral = smoke cigs, nail biting

• anal = anal retentive (uptight/strict) (OCD) vs anal expulses

• phallic = penis envy and castration fear

• genital = sleeps around a lot vs asexual

attachment styles

• secure

  • warm, caring, trusting

• anxious

  • fear of abandonment, relationship insecurities

• avoidant

  • distant and withdrawn

• disorganized

  • lack of empathy

  • wants closeness but is fearful of others

Parenting styles

• authoritative

  • high warmth and high control

• authoritarian

  • low warmth and high control

• permissive

  • high warmth and low control

• neglectful

  • low warmth and low control

• abuse

divorce and remarriage outcomes from best to worst

• stay together (work on it)

• divorce: amicable

• stay together: acrimonious (angry/bitter)

• divorce: acrimonious

behaviorism

Psychology as a science should deal w observable: behavior

• Avoid any subjective/non-measurable terminology

operant conditioning

Reward/reinforcement + punishment: increase/decrease behavior, positive vs. negative

classical conditioning

An unconditioned stimulus (US) naturally and automatically triggers a response without any learning, such as food naturally causing salivation in a dog. A conditioned stimulus (CS) is a previously neutral stimulus that, after being paired with the unconditioned stimulus, becomes associated with it and elicits a learned response.

neobehaviorism

social/observation factors

• Observational learning: Albert Bandura (1925–2021)

• Modeling (bobo doll)

• Disorder = observation of dysfunction

• James Baldwin (1924–1987): "Children have never been very good at listening to their elders, but they have never failed to imitate them."

• Social factors = poor social support/relationships > Mental health issues

Aaron Beck

Aaron Beck/Albert Ellis: the importance of thoughts/cognition relative to mental health

objective test

explicit, easy to interpret/administer, lots of information in relatively brief time

projective test

less explicit, harder to “fake”, access info not obtained by simple yes/no, More fun/enjoyable for clinicians/clients. E.g., Thematic Apperception Test (TAT)

MMPI

• T/F, 1-2 hours

• Minnesota Multiphasic Personality Inventory

• Use for depression, schizophrenia, ADHD, etc.

Rorschach

a measure of “performance”, i.e., what do you put onto your environment? Schemas.

• Movement?, Color?, Card turning, Details?

• Responses compared to those w Schizophrenia, Depression, etc.

• Suicidal ideation

intelligence test

WAIS-IV, Standard Binet

• Wechsler Adult Intelligence Scales (WAIS-IV)

• Most common intelligence test

• Measures (g)/general intelligence, overall cognitive functioning

• Useful in diagnosis of learning disorders/intellectual disability, ADHD, autism spectrum disorder, Alzheimer’s

  • 10 main subtests

  • Approx 2 hours to administer

achievment tests

• Woodcock-Johnson

• Reading, writing, math

Learning disorder

discrepancy between intelligence and achievement

WAIS-IV Particulars (4 domains)

• Working Memory (WMI): e.g. digit span

• Perceptual Reasoning(PRI): e.g. block design

• Verbal Comprehension(VCI): e.g. information

• Processing Speed(PSI): e.g. symbol search

• Full-scale IQ (FSIQ): overall composite

• Mean = 100, standard deviation = 15

Multicultural Competence

consider norm/reference groups, MMPI in Utah…

the process of assessment

1. Interview

2. Testing

3. Scoring/Interpretation/Report-Writing

4. Feedback

Structured

follow script with predetermined questions

Unstructured

no script, flexible, more conversational

Reliability

do you get the same results over time (all things being the same)?

Validity

: is it actually testing what you want it to test?

Standardization

it has to be the same administration!

• Includes norm or reference group

• Necessary for comparison: E.g., if testing for depression, do you answer items same way as people who are depressed?

How do we get Cortisol?

Threatening sensory input > thalamus > prefrontal cortex AND amygdala > hypothalamus (SNS)

Hypothalamic-pituitary-adrenal system (HPA)

• Hypothalamus >

• corticotropin-releasing hormone (CRH) >

• Pituitary gland >

• Adrenocorticotropic hormone (ACTH) > + Adrenal cortex/adrenal gland >

• Glucocorticoids = cortisol, i.e., STRESS

stress/trauma Risk factor

Type A personality

Stress/trauma Resilience: predicted by

Biopsychosocial factors:

• Demographic predictors (gender, SES, age)

• The stressor: severity, chronicity, expectedness, control

• Stress hormone?

are those with stress more or less predictable?

more predictable (?)

criteria for PTSD

• Directly experiencing/witnessing a physically violent event/death

• Followed by 1-2 symptoms from 5 symptom categories

• 1+ month duration after the event

PTSD 5 symptom categories:

1. Intrusion (e.g., memories),

2. avoidance (e.g., people/settings/ reminders),

3. arousal (e.g., hypervigilance, irritability, overactive SNS),

4. negative cognition/affect (anxiety, depression, concentration) and

5. dissociation (e.g., flashbacks)

prevalence of PTSD

Relatively rare = lifetime prevalence: 6.8%; 12 month prevalence: 3-5%

criteria for acute stress disorder

PTSD symptoms except < 1 month duration

• Majority eventually meet PTSD criteria

criteria for adjustment disorder

clinically significant stress, beyond what would be expected, which develops within 3 months after a stressful event

• This is likely where you would fall if below the “violent” event threshold for PTSD (e.g., spouse left, lost job)

• Often less severe, mild depression/anxiety symptoms

theory behind PTSD

traumatic event has not actually been processed or “felt,” individual is “stuck” in the trauma (with all the physiological effects [fight or flight])

treatment for PTSD (EMDR)

exploring/feeling trauma, “exposure” = take it slow, going to the gym

• Eye Movement Desensitization and Reprocessing (EMDR)

• Medication: alpha agonists (guanfacine), beta-blockers (propranolol)

  • both calm autonomic sympathetic response: reduce effects of epinephrine (adrenaline) and norepinephrine