Adult Psychopathology

models of illness/disability

• moral model

• medical model

• social model

moral model of illness/disability

punishment for wrongdoing

more common in history but manifests in drug blame

medical model of illness/disability

biological cause

social model of illness/disability

lack of support/resources led to mental health issue

supernatural explanation for illness

illness = punishment for sin

treatment for supernatural explanation

exorcism and banishment

early biological explanations for illness

body/brain pathology, humor theorytre

treatment for early biological explanations of illness

bloodlifting and induced vomit

psychoanalytic explanations of illness - unifying theory

failed to adapt to environment

treatment for psychoanalytic explanations of illness

analysis via talk therapy

Pinel and Dorthea Dix

worked for humane treatment of patients in asylum

biological interventions in asylums

lobotomy, electroconvulsive therapy

psychoanalysis

founded by freud

psychodynamic theory

psychological issues result from unconscious forces and defense mechanisms that arise in response to them

psychoanalytic treatment

help recognize conflicts and origins to change patterns

why was the DSM made

WW2 brought need for standardized nomenclature for soldiers

2 categories in DSM1

neurosis: short term

personality disturbance: long term

antipsychiatry

moement against psychiatry

Thomas Szaz

antipsychiatry

wrote The Myth of Mental Illness

claimed mental illness was a reaction to an insane society and psychiatrists were mental police

David Rosenhan Study

team enters psychiatry hospitals reporting symptom of hearing voices then acted normal once admitted

observed effects that normal behavior was not flagged

deinstitutionalization

mass cut to mental hospitals in 1960s-80s

many were released into community with the idea that community treatment was better than institutionalization

homosexuality as a mental illness in DSM 1 and 2

fear of opposite sex caused by traumatic parent child relationship

medicalization

criticism from psychiatry: views of psychiatry as unscientific

ex: DSM3 with diagnosis on symptoms

psychological theories

idea that there is a lack of evidence fro psychoanalysis

developed by Aaron Back in 1960s

developed into CBT

modern diagnostic systems 2 categories

categorical: criteria for diagnosis separates into groups

dimensional: define symptoms on continuum of healthy to severe

example of a categorical diagnosis system

DSM and ICD (intl classification of diseases)

pros and cons of categorical diagnostic system

pros: easy to communicate, current healthcare structure

cons: heterogeneity, comorbidity, issue of validity, lack of diagnosis for some

comorbidity

having more than one disease

research domain criteria (RDoC)

dimensional diagnostic system made by natl institute of mental health to define dimensions suitable for research target

views mental health in terms of domains of human neurobehavioral functioning

hierarchal taxonomy of psychopathology (HiTOP)

dimensional diagnostic system that generates data driven framework to classify mental disorders

groups at different levels: symptoms, traits, spectra

aim to connect structure and fit current diagnoses into structure

pros and cons of dimensional diagnostic systems

pros: better alignment w evidence of continuum, captures fundamentals

cons: harder to communicate, incompatible w current healthcare system, less clarity on treatment

research process for DSM

identify disorder of interest

compare those w and w/o disorder

research process for RDoC

define domain of analysis

recruit those in domain

study processes on basic level

research process for HiTOP

define level of specificity and dimensions of interest

recruit range in specified domains

treatment process for DSM

clinical interview

diagnosis

treatment

treatment process for RDoC

test to determine extent of dysfunction in domains

treat to normalize

hypothetical

treatment process for HiTOP

clinical interview or self report

determine elevation on higher and lower order domains

broad to specific interventions to target elevated

core features of MD episode

anhedonia

low mood/sadness

anhedonia

inability to feel pleasure

diagnosis of MD episode

5 or more of symptoms given in DSM in same 2 wk period

change from previous function

anhedonia or sadness

MDD

has major depressive episode not better explained by psychosis-spectrum disorder

no manic/hypomanic epirose

minor depression

2-4 symptoms

similar life effects to 5-6 symptoms

persistent depressive disorder

depressed for most days for 2 yrs

2 or more symptoms and less than 2 months of no symptoms in 2 yr time period

MDD epidemiology

16% lifetime prevalence

more common in women, lower income and education, single/divorces

seasonal affective disorder

MDD with specifier of seasonal pattern

prevalence varies with distance from equator

treatment for seasonal affective disorder

melatonin or bright light therapy

MDD Etiology

HPSA axis dysfunction

overactive immune system

monoamine dysfunction

0.3-0.4 heritability

psychological risk: child adversity, negative life event, lack of social support, personality

Cognitive Theories of depression

Beck’s Theory

Hopelessness Theory

Rumination

Beck’s Theory of Depression

negative triad: negative biases about self, world, future leads to more negative feelings

hopelessness theory

attributions: explanations of why things occur, can be global vs specific and stable vs unstable

depression: stable, global attributions to negative events

rumination

tendency to dwell on sad things

reinforcement behavioral theory

decreased seeking of positive reward and increased focus on aversive effects

low reinforcement causes depression

behavioral activation (BA)

make patients do enjoyable things leads to feeling good and focus on positive feelings

interpersonal therapy

focus on relationship

biological treatments for depression

ect, repetitive TMS, DBS, vagus nerve stimulations

mania diagnosis

elevated/irritable mood

more activity and energy

symptoms present most of day almost every day

over 2 symptoms in DSM

manic vs hypomanic diagnosis

manic: 1 wk ore require hospitalization or include psychosis, significant distress/functional impairment

hypomanic: at least 4 days, clear change in function but no impairment or psychosis

bipolar I diagnosis

1+ manic episode

bipolar II diagnosis

1+ manic and 1+ depressive episode

cyclothymic disorder diagnosis

2+ yrs of hypomanic and depressive symptoms

must be present ½ or more of the time

<2 months w/o symptoms

no full episodes

heritability of bipolar

60-80%

comorbidity of bipolar with anxiety

2/3

etiology of bipolar

heightened reward sensitivity

sleep deprivation → hormone disregulation → neurotransmitter disregulation

treatment for bipolar

antidepressants are avoided bc leads to manic but can be used in balance w other meds

lithium

anticonvulsant

antipsychotic

psychoeducation

nonsuicidal self injury (NSSI)

harm w/o intent to die

suicide ideation

suicidal thoughts

can range from passive to active

psychological theories for suicide

burdensomeness and lack of belonging →ideation

problem solving deficit

hopelessness → ideation

impulsivity → attempt

acute suicide

close to attempting

anxiety disorder

maldaptively innaccurate assessment of danger

anxiety

anticipation for future threat

fear

response to current danger

most common type of psycological disorder

anxiety

influences of anxiety

2:1 female:male ratio

culture

heritability 0.5-0.6

link w depression

anxiety cycle

anxiety → avoidance → short term relief → long term anxiety growth

panic attack

elevated adrenaline response attacks that peak at less than 10 min with norepinephrine then PFC activates parasympathetic branch slowing heart rate

sudden intense terror and 4+ other symptoms

panic disorder diagnosis

recurrent panic attacks and fear of future attacks

change in behavior to avoid attacks

locus coeruleus

source of norepinephrine

located in brainstem

agoraphobia

fear of situations where it is hard to get help/escape

often comorbid w panic disorder

“fear of fear”

belief in agoraphobia abt consequence of anxiety

specific phobia

fear of specific things

social anxiety disorder

fear of social situations

core fear of negative evaluation

generalized anxiety disorder

anxiety in a multitude of situations

Obsessive Compulsive related disorder

heightened concern of a specific topic

behaviors to reduce distress

Body dismorphic disorder

concern of features and hiding/altering features

avoiding images

cannot be restricted to weight or body image bc that would be an ED

body focused repetitive behavior disorder (BFRB)

skin and hair imperfection

picks/pulls

have emotion regulation difficulty

hoarding disorder

need for objects

acquisition of many objects

hard to discard objects

cognitive and emotional factors

prevalence of OCD

1-3%

onset in adolescence

OCD and anxiety comorbidity

75%

thought action fusion

the thought of doing the thing invokes same reaction as actually doing it

pedophilia OCD

fear and worry of being a pedophile

etiology of OCD

basal ganglia affected

0.4-0.5 heritability

pediatric acute-onset neuropsychiatric syndrome or pediatric autoimmune neuropsychiatric disorder

associated w strep

causes OCD like symptoms suddenly

strep antibodies attack basal ganglia

symptoms sometimes disappear w strep but sometimes lasts and requires treatment

polygenic

involves many genes

cognitive behavioral model

cycle for OCD

intrusive thought → distress → failed suppression of though → compulsion → reduce distress temporarily → restart

treating OCD

exposure therapy: confront thought and don’t do response/compulsion

cognitive approach

mindfullness-based approaches

meds: antidepressants, second generation antipsychotics

deep TMS, DS, surgary

n-acetylcysteine (NAC)

helps treat BFRBs

habit reversal training

self monitoring and using a competing motor response

treats BFRBs

acute stress disorder

<1M after trauma

PTSD

>1M after trauma

trauma

actual/threatened death, serious injury, or sexual violence