Lecture on Psychopathology + Chapter 15 and 16

Mental Disorder/Psychopathology

A persistent dysfunction in behavior, thoughts, or emotions that causes significant distress or impairment.

Medical Model

Approach that classifies abnormal mental experiences as illnesses that, like physical illnesses, have causes, symptoms, and cures.

Disorder

Common set of signs and symptoms

Disease

Known pathological process affecting the body

Diagnosis

Determination as to whether a disorder or disease is present

Critics of the Medical Model argue

1. Inappropriate to use subjective self-reports over physical tests of pathology

2. Falsely “medicalizes” normal human behavior

Diagnostic and Statistical Manual of Mental Disorders (DSM)

classification system that describes the symptoms used to diagnose each recognized mental disorder and indicates how the disorder can be distinguished from other, similar problems

Comorbidity

Co-occurence of two or more disorders in a single individual. >80% of individuals with a mental disorder report this. Significant comorbidity between anxiety and depression.

IDC

International Classification of Diseases — another classification system, similar to DSM but used internationally.

Cultural Syndromes

Groups of symptoms that tend to cluster together in specific cultures.

Cultural idioms of distress

Ways of talking about or expressing distress that can differ across cultures. 

Cultural explanations

Culturally recognized descriptions of what causes the symptoms, distress, or disorder. (Religious, spiritual)

Biopsychosocial perspective

Explains mental disorders as the result of interactions among biological (genetics), psychological, and social factors.

Diathesis-stress Model

A person may be predisposed to a mental disorder that remains unexpressed until triggered by stress.

Research Domain Criteria Project (RDoC)

new initiative that classifies mental disorders by revealing the basic processes that give rise to them.

Anxiety Disorder

Class of mental disorders where anxiety is the primary feature.

Phobic disorders

characterized by persistent and excessive fear/avoidance of specific activities, objects, situations. Individual recognizes fear is irrational.

Specific Phobia

irrational fear of a specific stimulus that markedly interferes with an individuals ability to function.

5 categories of Specific Phobias

Animals, Natural Environments (ex. heights), situations (ex. enclosed spaces), Blood/injections/injuries, Other phobias (choking, vomiting, loud noises)

Social Phobia

Irrational fear of being publicly humiliated/embarrassed. Usually emerges between early adolescence and adulthood. 4% of people qualify for a diagnosis at some point in their lives.

Preparedness Theory

People are instinctively predisposed to certain fears. (ex. snakes, spiders). Supported by studies of the heritability of phobias — identical twins are more likely to share phobias than fraternal.

Factors of vulnerability to phobias

Temperament (excessive shyness correlated to development of phobias), neurobiological factors (abnormalities in neurotransmitters like serotonin), high activity in amygdala

Role of environments developing phobias

Phobias can be classically conditioned. Ex. dog bite created association with dogs and pain, creating irrational fear of dogs. However studies show people with phobias are not more likely than people without to recall personal experiences with feared object. 

Panic Disorder

Sudden occurrence of multiple psychological and physical symptoms that contribute to a feeling of stark fear. DSM diagnostic criteria — individual experiences recurring attacks and have significant anxiety about another. Studies suggest these disorders may be hereditary.

Agoraphobia

Fear of public places

Panic attacks conceptualized as…

a “fear of fear” because people who experience them may be hypersensitive to physical signs of anxiety which they interpret as disastrous for their well-being,

Generalized Anxiety Disorder (GAD)

Chronic or excessive worrying accompanied by 3 or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, sleep disturbance. 6% of people in the US have GAD.

Biological explanations of GAD

neurotransmitter imbalance

Obsessive-compulsive Disorder (OCD)

Repetitive intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) designed to fend off thoughts interfering with an individuals ability to function. Anxiety plays a role as obsessive thoughts produce anxiety, and compulsive behaviors reduce it, but it is not classified as an anxiety disorder in DSM.

OCD and the Preparedness Theory

Obsessions are typically derived from concerns that can pose a real threat such as contamination/disease.

Key neural component of OCD

Abnormally high activity in the cortico-striato-cortical loop which connects cortex with the striatum and thalamus. 

Posttraumatic Stress Disorder (PTSD)

Chronic physiological arousal, recurrent unwanted thoughts or images of trauma, and avoidance of things that remind individual of trauma. Those with PTSD show heightened activity in amygdala (evaluation of threatening info, fear conditioning. decreased activity in prefrontal cortex, downregulation)

Hippocampal Volumes correlation with PTSD (war veterans and their identical twins)

Inherited smaller hippocampus size may make people sensitive to conditions that cause PTSD, but a smaller hippocampal was not caused by combat exposure.

Mood Disorders and the two forms

Mental disorders that have mood disturbance as their predominant feature. 2 forms: depression (unipolar depression) and bipolar disorder.

Major depressive disorder (unipolar depression, aka depression)

severely depressed mood/inability to experience pleasure that lasts 2 or more weeks and is accompanied by feelings of worthlessness, lethargy, sleep and appetite disturbance.

Persistent depressive disorder

same cognitive effects as depression but are less severe and last longer, at least 2 years.

Double depression

When both types of depression co-occur. Moderately depressed mood for at least 2 years with periods of major depression. 

Seasonal Affective Disorder

Recurrent depressive episodes in a seasonal pattern. Causes — poor weather and reduced exposure to light in the winter.

Heritability of Depression

Moderate. less severe depression has 35% heritability, where severe depression is 50%.

Parts of the brain that are different for depressed people

Increased activity in brain regions responsible for processing emotional information, and decreased activity in areas associated with cognitive control.

Cognitive model of depression

biases in how information is taken in, processed, and remembered lead to and maintain depression.

Helplessness Theory

Individuals who are prone to depression automatically attribute negative experiences to themselves (internal), not likely to change (stable), and widespread (global). 

Negative Schema (of people with depression)

characterized by…

• negative interpretations of information (gray glasses, not rose-tinted)

• Bias in attention (focusing on the negative things)

• memory (better recal of negative info)

Bipolar Disorder

condition characterized by cycles of abnormal and persistent high mood (mania, DSM states manic phase has to last at least 1 week) and low mood (depression). High rate of heritabilityl Research suggests that individuals with this disorder have higher creativity and intellectual ability, the energy that supplies mania helps people achieve.

Bipolar I Disorder

at least one depressive, then one manic episode

Bipolar II Disorder

Person experiences depressive episode along with a hypomanic episode, which is an elevated mood similar to mania but of lower intensity. 

Rapid cycling bipolar disorder

at least four mood episodes (manic/hypomanic, depressive) every year.

Polygenic

arising from the interaction of multiple genes that combine to create the symptoms of a disorder.

Pleiotropic Effects

one gene influences a person's susceptibility to multiple disorders. Ex. shared genetic vulnerability for bipolar disorder and schizophrenia — gene linked to compromised ability in filtering info and recognition memory and dopamine/serotonin transmission. 

Expressed emotion

a measure of how much hostility, criticism, emotional over involvement people communicate when talking about a family member with a mental disorder. High expressed emotion → higher likelihood of relapse

Schizophrenia

Psychotic disorder characterized by significant disruption of basic psychological processes, distorted perception of reality, altered/blunt emotion, disturbances in thought, motivation, and behavior.

Positive symptoms of schizophrenia

thoughts and behaviors developed in people with the disorder (ex. hallucinations, delusions)

Hallucinations

false perceptual experiences that seem very real. Auditory, visual, smell, ex. hearing voices.

Delusions

false beliefs, often bizarre, maintained despite being irrational

Negative Symptoms

things present before the disorder, but have now gone away. (ex. social withdrawal, apathy, poverty of speech)

Disorganized symptoms

disruptions or deficits in abilities of speech, movement, and cognition. Disorganized speech, grossly disorganized behavior, catatonic behavior. 

Disorganized speech

severe disruption of communication where ideas shift rapidly and incoherently between unrelated topics

Grossly disorganized behavior

Behavior that is inappropriate for the situation or ineffective in attaining goals, often w specific motor disturbances (ex. strange movements, rigid posture, childlike silliness, improper sexual behavior)

Catatonic Behavior

decrease in all movement or an increase in muscular rigidity and overactivity

Cognitive Symptoms

deficits in cognitive abilities, specifically in executive functioning, attention, and working memory, present in those with schizophrenia. The least noticeable symptoms bc they are much less bizarre and public.

Dopamine Hypothesis

Idea that schizophrenia involves an excess of dopamine.

Anatomical features of people with Schizophrenia

• Enlarged ventricles (hollow areas filled with fluid within the brain), suggesting a loss of brain-tissue mass.

• Progressive tissue loss beginning in the parietal lobe.

• Adolescents dramtically loose gray matter (more than normal pruning of the brain amount)

• Studies have shows family environment also play a role in the development and recovery of schizophrenia. 

Autism Spectrum Disorder (ASD)

Condition beginning in early childhood where individual shows persistent communication deficits, restricted and repetitive patterns of behaviors, interests, or activities.

Impaired capacity for empathizing, heightened ability for systemizing, greater activation in regions related to basic object perception

Attention deficit/hyperactivity disorder (ADHD)

persistent pattern of severe problems with inattention and/or hyperactivity or impulsiveness that cause significant impairments in functioning

3 criteria for DSM adhd diagnosis

predominantly inattentive symptoms, predominantly hyperactive/impulsive symptoms, or combined presentation.

Brain structural differences in people with ADHD

• smaller brain volumes

• abnormalities in frontosubcortical networks associated with attention and behavioral inhibition

Conduct Disorder

persistent pattern of behavior involving aggression to people/animals, destruction of property, deceitfulness or theft, serious rule violations.

Personality Disorders

enduring pattern of thinking, feeling, or relating to others or controlling impulses that are different from cultural expectations and cause distress.

3 clusters of 10 personality disorders

1. odd/eccentric

2. dramatic/erratic

3. anxious/inhibited

Odd/eccentric

paranoid, schizoid (extreme introversion), Schizotypal (peculiar speaking, dressing, beliefs, difficulty forming relationships)

Dramatic/erratic

antisocial, borderline (unstable moods), histrionic (attention seeking), narcissistic

Anxious/inhibted

Avoidant, dependent, obsessive-compulsive

Antisocial personality disorder (APD)

pervasive pattern of disregard for and violation of the rights of others that begins in childhood or early adolescence and continues into adulthood

adults w APD typically have history of conduct disorder.

Diagnostic signs of APD

illegal behavior, deception, impulsivity, physical aggression, recklessness, irresponsibility, lack or remorse

Suicide

Self-inflicted death

Suicide attempts

potentially harmful behavior with some intention of dying

Nonsuicidal self-injury (NSSI)

direct, deliberate destruction of body tissue in the absence of any intent to die