Clinical Psychology

concept creep

the expanding definitions of psychological concepts, leading to potential over-diagnosis or misinterpretation

umbrella concepts

encompass a wide range of mental health disorders and problems

mental health

a person's emotional, psychological, and social well-being, affecting how they think, feel, and act

wellbeing

a state of mental and emotional balance, characterized by positive functioning and the absence of distress - ability to cope with everyday stressors

dysfunction

a disruption in the normal functioning of the mind or body, often affecting daily life and relationships

psychopathology

the study of mental disorders and their symptoms, causes, and treatments

categorical

classification of mental disorders based on distinct criteria, often used in diagnostic systems like the DSM-5

dimensional

a perspective in psychology that views mental disorders as existing on a continuum, rather than in discrete categories

alternatives

cultural/spiritual models that offer treatment in a more appropriate way for certain cultures and practices

What are the pros and cons of categorical psychopathology?

• Better for clinical use

• Easier to convey and communicate

What are the pros and cons of dimensional psychopathology?

• Lack of boundaries between different disorders

• Better for monitoring and planning treatment that targets the specific symptoms

What are the DSM diagnostic groupings?

• Schizophrenia and other psychotic disorders

• Depressive disorders

• Anxiety disorders

• Dissociative disorders

How does a clinician diagnose someone with a mental health problem/disorder?

• Clinical interviews

• Text descriptions of symptoms

• Ruling out certain disorders

• Establishing boundaries between disorder and normal reaction to a life event

• Determine specific primary disorder, severity, sub-types and treatment options

presenting problem

client’s reason for therapy

predisposing factors

factors that occur earlier in life that increase susceptibility to mental health problems later in life e.g. genetic vulnerability

precipitating factors

the trigger/cause for mental health problems/disorders

perpetuating

factors that are able to maintain the negative mental state or problem over time

protective factors

factors that are able to maintain a positive state of wellbeing e.g. supportive friends and family

What are biological factors influencing wellbeing?

physical health, genetics etc

What are social factors affecting wellbeing?

Work, school, friends, culture and family

What are psychological factors affecting wellbeing?

Coping, beliefs, thoughts and social skills

Social and Emotional Model of Wellbeing

• Connection to mind

• Connection to body

• Connection to Country

• Connection to family and kinship

• Connection to community

• Connection to culture

What took place during the anti-psychiatry movement?

Thomas Szasz and J.D. Laing argued that mental health is a ‘myth’

What was the Mad Pride movement?

Social and political movement, not ashamed of mental health disorders, parallel to the LGBQTIA+ movement in the present

reflexivity

acknowledging that the clinical will bring a different worldview to your client with a specific set of biases and pre-conceived beliefs

culture

shared patterns of meaning within a particular social world

What were Cuneiform tests?

• Mention of ‘Gods’ causing mental health problems

• Offered spiritual/supernatural explanations for mental health

What did Hippocrates state about mental health?

• Rejected supernatural theories based on his observations of patients during war time

• First real ‘scientific’ explanation describing paranoia and hallucinations

• Hysteria was used as a gendered tool to silence women and suggest that their mental health was caused by a lack of fertility

homosexuality

treated as a ‘sin’ and ‘crime’ during the time of Darwinism as it defied social and cultural expectations of fertility

declassification

• Alfred Kinsley - demonstrated the increased prevalence of homosexual activity

• Evelyn Hooker - demonstrated the lack of association between homosexuality and psychiatric disorders

What occurred during the Stone Wall Riots - LGBQTIA+ movement?

• Psychiatrists were masked to disguise their homosexuality

• First organised display of rebellion

• Broader shift in psychiatry with the removal of homosexuality as a ‘psychiatric disorder’

culturally-bound syndromes

a cluster or group of symptoms within a specific cultural group, community or context

What did Indigenous psychologist Tracy Westerman say about culturally-bound syndromes?

• Often associated with a spiritual disconnect to the land after being forcibly removed

• Culturally ‘sanctioned’ treatments are important - going to Country and not forcing Western remedies onto Indigenous Australians

stigma

the widely held beliefs and attitudes towards people of a certain social group or characteristics

public stigma

negative stereotypes and beliefs within the public directed towards people with mental health disorders

structural stigma

laws, policies, systems and practices ‘ingrained’ within society’s rules that discriminates against mental illness

laws

legal rules limiting people with mental illness (especially in Australia)

policies

organisational requirements creating exclusion e.g. denied a job due to counselling in the past or present

systems

access pathways to seeking help often produce inequity

practices

procedures that discriminate in healthcare e.g. physical symptoms being treated over the actual mental health disorder associated with them

internalised stigma

internalising public and structural messages about mental illness, worsening mental wellbeing

What is Corrigan’s Paradox?

stigma may damage/energise a low self-esteem due to the absorption of these negative attitudes and messages about mental illness

stigma by association

affects close supporters (family/friends) with the negative attitudes extended to the carers which occurs within a collective culture more often than others

intersectional stigma

other parts/human attributes that can be stigmatised interacting with stigma surrounding mental illness e.g. racism and mental health - seeking support as a person of colour would be more difficult than for a white person to seek support for their mental illness

Is pity considered a good thing for stigma?

No, can be seen as condescending in many ways but extremely common public/societal sentiment towards severe mental health disorders

What are some ways to reduce stigma and discrimination towards mental illness?

• Increasing positive contact with people who struggle with their mental health

• Psychoeducation to improve carers and general public’s views around mental illness

• Modelling and encouraging those struggling to seek help

• Portraying mental illness in a way that is optimistic in movies/TV shows

• Disclosing mental illness without feeling ashamed

• Psychological therapies

mood

a pervasive and sustained ‘background’ emotional state

affect

the observable expression of emotion

mood disorders

a depression or elevation of mood as the primary disturbance

unipolar

having only a single direction or towards a single pole

bipolar

migrating between multiple different poles or mood extremes

mania

extremely happy or sad

hypomania

slightly elevated mood

euthymia

balanced mood that remains stable and calm

dysthymia

moderately depressed mood

depression

extremely sad

What are some DSM-5 symptoms of depression?

• Depressed mood

• Anhedonia

• Fatigue or low energy

• Feelings of worthlessness or inappropriate guilt

• Decreased concentration or indecisiveness

What are some DSM-5 specifiers of depressive episodes?

• Psychotic features - disconnect from reality

• Melancholic features - major depressive symptoms

• Catatonic features

• Anxious distress (depressed + on edge)

• Seasonal pattern - related to less availability of light

What is the DSM-5 criteria for major depressive disorder?

• Presence of major depressive episode

• Not better explained by another diagnosis

• No history of mania, hypomania or mixed episode unless influenced by another factor e.g. drugs or medical illness

How does epidemiology relate to mood disorders?

• Family history of MDD increases the risk between 1.5 to 3 times

• 20 to 25% of patients with medical comorbidity

• Often comorbid with 1 or more anxiety disorders

Which population is most at risk for depression?

Younger biological females aged between 16 and 25 years old

panic disorder

recurrent unexpected panic attacks, occurring at anytime

What are some of the symptoms of panic disorder?

• Palpitations

• Sweating

• Feelings of choking

• Nausea or abdominal distress

• Derealisation and depersonalisation - disconnect from reality and oneself

What is the DSM-5 criteria for panic disorder?

• The panic attacks have been followed by 1 month or more of persistent concern or worry

• Significant maladaptive change in behaviour

• Not attributed to a substance, medical condition or another mental disorder

What is the current epidemiology on panic disorder?

• 30 to 50% people affected will have agoraphobia

• 50 to 60% will have major lifetime depression

• 20 to 25% will struggle with substance abuse/dependence

What is the DSM-5 criteria for generalised anxiety disorder?

• Excessive anxiety and worry

• Individual finds it difficult to control the worry

• Anxiety and worry are associated with at least half of the symptoms:

  • Restlessness

  • Fatigue

  • Difficulty concentrating/mind blanks

  • Irritability

  • Muscle tension

  • Sleep disturbance

What is the current epidemiology for generalised anxiety disorder?

• 90% will have at least another lifetime disorder e.g. depression/anxiety

• 66% will have another current such disorder

Tripartite Model of Depression and Anxiety (Clark & Watson, 1991)

Attempts to explain why anxiety and depression can co-occur but also be distinguished as mental health disorders

negative affect

• Both anxiety and depression

• General distress and negative emotions

positive affect

low positive affect (anhedonia, lack of pleasure) specific to depression

anxious arousal

• Physical symptoms like tension, palpitations and sweating

• More specific to anxiety disorders

What is the HiTOP model for depression and anxiety?

• Sees them as two separate disorders that are co-occurring

• Treatment may focus on two distinct conditions

• Part of a shared internalising spectrum

What is the role of the HPA axis in depression and anxiety?

• Made up of the hypothalamus, pituitary gland and adrenal glands

• Regulates the body’s response to stress by controlling cortisol release

• Helps maintain homeostasis, inflammation and circadian rhythms

What is the effect of chronic stress?

Prolonged activation of the HPA axis, increasing cortisol levels

What is the effect of dysregulation?

Disrupts stress hormone balance and affects neurotransmitters

What is the effect of overactivation?

Heightens arousal and vigilance, increasing worry and fear responses

What is Beck’s Cognitive Model?

• Unhelpful automatic thoughts arise quickly in response to life events and feel true

• Maintains depression through biased patterns of thinking

• Negative view of self, world and future

psychosis

an umbrella to describe the concept of ‘being out of touch with reality’

symptom configuration

delusional beliefs that are either non-bizarre or bizarre delusions based on the evidence presented in reality

duration

more or less than 6 months

relative pervasiveness

the core disorder that is affecting the individual e.g. bipolar disorder or schizoaffective disorder

schizophrenia

a disruption in various aspects of perceiving, thinking, feeling and behaviour

positive symptoms

additive to normal experience

negative symptoms

deficit in normal function

hallucinations

a perception in the absence of environmental stimuli

delusions

a fixed and false belief that is not amenable to change in light of conflicting evidence

persecutory delusions

belief that others are spying on or planning to harm them

grandiose delusions

belief in having exceptional abilities or fame

erotomanic

belief that someone, often of higher status, is in love with them

somatic

false belief about body function or sensations

nihilistic

belief that oneself, others, or the world does not exist

referential

belief that ordinary events have special personal meaning

circumstantiality

speech is over-inclusive with detail, tends to wander off before returning to the original point

tangentiality

thoughts begin linearly but quickly veer off into unrelated areas without returning to the original point

loose associations

an apparent disconnection between one thought and the next

thought blocking

appears to lose train of thought while mid-sentence

flight of ideas

a combination of thought disorders, a disconnection between several different ideas/thoughts

neologism

coining of new terms with idiosyncratic meanings

perseveration and verbigeration

persistent repetition of a response to new and unrelated stimuli and persistent repetition of words or phrases

word salad

complete lack of meaningful connections between words