PSYC 115 - Exam 1

psychopathology

Comorbidity

A patient simultaneously meets criteria for major depression, panic disorder, and alcohol use disorder.

Heterogeneity

Two people both meet criteria for major depression but share very few symptoms.

Categorical threshold

One person has four symptoms, another has five. They are otherwise alike, but only one gets the diagnosis.

Reification

“Why is Jordan withdrawn?” — “Because Jordan has depression.”

It happens when your mind takes a concept that you cannot see or touch and acts like it is a solid, concrete thing.

Categorical (DSM)

• Supports the yes/no decisions clinicians must make

• One shared word across professions and systems

• Fits existing coverage, legal, and records systems 

• Decades of research already organized this way

• Weak on: overlap, severity, arbitrary thresholds, variation inside a category

Dimensional (HiTOP)

• Represents severity as it actually varies

• Represents overlap instead of stacking diagnoses

• Reduces reliance on arbitrary diagnostic thresholds

• Closer to the observed structure of symptom data

• Weak on: usability, communication, infrastructure — “so what do we do Tuesday?

Supernatural

Cause is outside nature

Somatogenic

Cause is in the body, importance of general paresis

Psychogenic

Cause is psychological, importance of Freud

Diathesis/ Stress

• The vulnerability you bring (temperament, belief, family history)

+

• The event that arrives (loss, breakup, poverty)

Genetic

• Polygenic (many genes, tiny effects, no "gene for" a disorder)

• Heritability is a population statistic, never about one person.

• Gene–environment correlation (genes shape environments you seek)

• G×E interaction

• Epigenetics (experience changes gene expression, not DNA sequence)

Neuroscience

• Neuron and synapse processes (synthesis, storage, release, binding, termination/reuptake; SSRIs block serotonin reuptake).

• Serotonin (depression), dopamine (schizophrenia, mania, reward), GABA (anxiety, inhibitory), norepinephrine (anxiety, stress).

• Know “chemical imbalance" is too simple.

• Brain differences can be cause, consequence, or correlate.

• HPA axis —> chronic stress blunts the feedback loop via cortisol

• Brain structure and function, neurons and neurotransmitters, and the neuroendocrine system, plus a long, uncomfortable history of reading them too confidently

HPA Axis

Complex neuroendocrine system that controls the body's reaction to stress and regulates processes like digestion, immune function, mood, and energy storage

Behavioral and Cognitive

• Classical conditioning (US, UR, CS, CR)

• Generalization, discrimination, extinction (new learning, the basis of exposure therapy).

• Operant conditioning (positive/negative reinforcement and punishment; avoidance is negative reinforcement).

• Observational learning (Bandura). Cognition: attention, interpretation, belief

Emotion

• Behavior, physiology, and cognition components,

• Emotion (brief, specific) vs. mood (longer, diffuse) vs. affect (observable expression).

• Psychopathology comes from intensity/duration, regulation (rumination, avoidance, suppression), or mismatch to context

Culture

• Shapes how distress is expressed damaging contexts create vulnerability; discrimination acts as a chronic stressor.

• Relationships buffer stress and are sources of stress.

• Group membership is not the mechanism; social position changes exposures and resources.

Developmental

The same event means different things at age 4 vs. 40, given developmental processes involved.

Assessment

• The systematic collection and integration of information

• It has seven jobs: identify problems and strengths, understand context, generate and test hypotheses, diagnose when appropriate, plan treatment, assess risk, monitor change.

Reliability

Do we get the same answer across time, raters and situations?

Validity

Do we measure the intended thing?

Unstructured Interview

Flexible, less reliable

Structured Interview

SCID-5; most consistent

Semi-Structured Interview

Common in practice; balance of both

DSM-5-TR

American Psychiatric Association; mental disorders only

ICD-11

all health conditions; global standard, used internationally

Case study

Rich detail, rare phenomena, generates hypotheses. Cannot establish cause, rule out alternatives, show prevalence, or generalize.

Epidemiology

• Prevalence (how many have it now or during a period)

• Incidence (new cases during a period)

• Risk factor (predicts higher odds; not a cause).

Correlation

• Sign = direction, absolute value = strength (−.70 and +.70 are equally strong)

• r = 0 rules out a straight-line relationship, not a curved one

• Can't show cause because of the directionality problem (which came first?) and the third-variable problem (e.g., impulsivity driving both drinking and aggression).

Experiment

• Manipulate the IV, randomly assign, measure the DV.

• Random assignment spreads preexisting differences evenly. Use control conditions, placebos, and blinding.

Internal validity

Did the cause produce the effect here? maximum control

External validity

Does it hold elsewhere? maximum realism.

Efficacy

Works in a controlled trial

Effectiveness

Works in real clinics with comorbidity, big caseloads, missed sessions

Single-case experimental designs

Measure one person repeatedly while changing conditions

ABAB/ Withdrawal-reversal

Treatment off, on, off, on in an experiment

Multiple Baseline

• Start treatment at different times across settings

• For example, introducing a new intervention at home first, then at school later, and then at work. If the behavior improves each time treatment begins, that supports the idea that the treatment is working

• Use when withdrawal would be unsafe

Episode vs. Disorder

One is a unit while the other is the history

Major depressive episode

At least 5 of 9 symptoms, most of the day, nearly every day, for at least 2 weeks. At least one must be depressed mood or anhedonia. Four domains:

• Mood/reward: depressed mood, anhedonia

• Body/energy: sleep change, appetite/weight change, fatigue, psychomotor agitation or slowing

• Thinking: poor concentration or indecisiveness, worthlessness or excessive guilt

• Risk: recurrent thoughts of death, suicidal ideation, plan, or attempt

• Know these symptoms specifically, and be ready to tell me if a specific case fits the diagnostic criteria, as well as potential rule-outs (medical issue, grief)

MDD

One or more MDEs with no manic or hypomanic episode ever. Usually recurrent; discrete episodes with remission.

Persistent depressive disorder (PDD)

Depressed mood more days than not for 2+ years (1 year in youth), never symptom-free for more than 2 months.

Mania

• Activation, both abnormally elevated, expansive, or irritable mood and increased activity or energy

• Lasts at least 1 week (or any duration if hospitalized).

• Grandiosity

• Decreased need for sleep (not insomnia)

• Pressured speech, racing thoughts or flight of ideas, and distractibility,

• Increased goal-directed activity, risky behavior.

• Compare to the person's own baseline

Hypomania

at least 4 days, change observable by others, no marked impairment, no hospitalization, no psychosis.

Bipolar I

At least one manic episode, ever. An MDE is not required.

Bipolar II

• At least one hypomanic episode plus at least one MDE, and never mania

• Not "less serious": its depressive episodes can be prolonged and severe.

Causes of depression

No single cause; equifinality and multifinality 

• Genetic: Polygenic; no "depression gene." Bipolar high heritability.

• Biological: high cortisol, serotonin and norepinephrine, more active amygdala, less active prefrontal cortex, inflammation. Reward differs: dopamine and striatum lower in depression, higher in mania.

• Stress: life events trigger episodes; chronic strain and early adversity raise risk.

• Cognitive: Beck's negative triad (self, world, future) and schemas → biased processing → confirming conclusions. Hopelessness theory: attributing a negative event to stable and global causes → hopelessness → depression. Rumination is abstract and repetitive with no stopping point, unlike problem solving.

• Behavioral: withdrawal → less reward → lower mood → more withdrawal.

• Interpersonal: withdrawal and excessive reassurance-seeking strain relationships, which confirms the negative self-view. A belief that changes your behavior can arrange the world to confirm itself.

Treatment for Bipolar Disorders

Medication is foundational (lithium, anticonvulsants, antipsychotics)

Deviance

• Behavior, thoughts, and emotions that differ markedly from what society considered proper

• Statistical rarity is not dysfunction 

  • Genius, extraordinary altruism, and Olympic level training are all “deviant: 

• Rare is not the same thing as disordered

• Key question to ask yourself: 

  • Whose norms?

  • Measured by whom? 

  • And what happens to the person who answers differentl

Distress

• It is what usually brings a person to treatment, and because it is the one criterion that takes a person own of their life as evidence 

• It fails as a definition. It is indispensable as a clinical signal.

Distress without disorder

• Grief, heartbreak, the week before finals 

• Suffering is not by itself pathology – sometimes it is the appropriate response to your life

Disorder without distress

• Mania can feel wonderful, in antisocial personality disorder, the distress is reliably experienced by everyone except the person who has it

Dysfunction

• Impairment in key areas of living – work, relationships, self-care, and health

• The most workable and the closely to how clinicians actually think 

• The processes involved are largely outside the person's control, which is exactly why “just try harder” is not a treatment plan.

Danger

• Many people believe this is central. It is the weakest of the four 

• Most people with a mental disorder are not dangerous to anyone 

• People with serious mental illness are considerably more likely to be victims of violence than to be violent towards others 

• Yet it is the criterion the public believe in most– and the one that has justified the most confinement in this chapter's history. 

Hippocrates

• Mental disorders arise from natural causes (somatogenesis)— not supernatural ones.

• The brain is the central organ of intellectual activity, and mental disorders come from brain pathology

• On epilepsy — the “sacred disease”

What Hippocrates got right

• Classification

• The Hippocratic writings name three categories — mania, melancholia, and phrenitis (brain fever).

• Built from daily clinical observation and written records of patients.  Treatment: “do no harm” 

• Matched to the diagnosis, and attentive to environment — rest, diet, air, and place.

• Humane by the standards of any era, including ours.

What Hippocrates got wrong

• Believed that personality and mental illness were caused by an imbalance of four bodily fluids or humors.

• Blood was linked to being cheerful and optimistic (sanguine)

• Phlegm to being calm and relaxed (phlegmatic),

• Yellow bile to being dominant and quick-tempered (choleric)

• Black bile to being thoughtful but prone to sadness (melancholic)

Galen

• A follower of Hippocrates who synthesized, commented on, and transmitted the Hippocratic texts — largely why they survived at all.

• Split the causes of psychological illness in two: physical (head injury, adolescence, menstrual changes) and mental (shock, fear, love).

• Roman practice: keep the patient comfortable and the humors in equilibrium — baths, massage, physical therapy … and a great deal of bloodletting. 

Johann Weyer

• Spoke out against persecution of people accused of witchcraft.

• Among the first to describe the behavior of accused women as illness rather than sin.

• Arguably the first physician to specialize in mental disorders.

• Weyer was not missing evidence his contemporaries had. He was reading the same behavior and drawing a different conclusion—and the culture was not ready to hear it.

Benjamin Rush

• “father of American psychiatry.”

• He recommended drawing copious amounts of blood to relieve what he believed was pressure on the brain.

• The “Tranquilizer”: a restraint chair built to immobilize the head and body completely.

• He later championed more humane methods — the same man, in the same career.

Francisco Goya

Gives us a look inside the asylums 

Michel Foucault

The line between reason and unreason was not discovered. It was drawn — and confinement was how the Enlightenment enforced it.

Philippe Pinel

Argued that patients were sick people whose illness should be met with sympathy and kindness

Dorothea Dix

•  Credited with helping establish or expand dozens of public mental hospitals.

• A schoolteacher with no institutional power who lobbied legislature after legislature.

Elizabeth Packard

After her husband committed her to a mental hospital for disagreeing with him about religion, she worked hard to be released and after campaigning for laws requiring a hearing before commitment and for legal rights of married women.

General paresis and syphilis

• Syphilis — caused by Treponema pallidum, identified in 1905.

• It reaches the brain — Untreated, years later, the infection involves the central nervous system.

• General paresis — Progressive paralysis, and psychiatric symptoms including delusions of grandeur.

• A madness with a cause — At least one condition filling asylum wards had a specific, findable physical cause.

• And therefore — maybe they all work like this.

  • That inference powered a century of biological psychiatry, and it was extraordinarily productive.

  • The overgeneralization — that every psychiatric disorder would turn out to have one specific physical cause, waiting to be found — was not.

Galton

• Studied twins and debated nature vs. nurture.

• Observed that psychological disorders often run in families.

• Also a major advocate of eugenics (yuck!).

Franz Mesmer

• Believed the universe was filled with an invisible fluid — “animal magnetism” — and that illness followed when a person’s supply was blocked.

• He claimed a unique ability to redistribute it by trance and the laying on of hands.

Jean-Martin Charcot (1825–1893)

• Believed “hysteria” was neurological.

• Used hypnosis to induce and remove hysterical symptoms in front of an audience of physicians — turning a parlor trick into something that could be observed, repeated, and argued about.

Freud

• Freud’s specific theories have held up poorly under empirical scrutiny.

• But the core claim — that talking about your experience with a trained listener can relieve suffering — underlies every psychotherapy we will study, including the best-supported ones.

• In addition, ideas of transference and countertransference are used in psychotherapy today, as well as larger principles that the causes of psychological problems may not be obvious.

Serotonin

IMPLICATED IN: Depression, and mood regulation more broadly

Dopamine

IMPLICATED IN: Schizophrenia, mania, and reward and motivation

GABA

IMPLICATED IN: Anxiety. The main Inhibitory transmitter, it dampens nerve impulses

Norepinephrine

IMPLICATED IN: Anxiety and other stress-related disorders

Electroconvulsive Therapy (ECT)

An established, effective treatment for severe depression. Administered under anesthesia with muscle relaxation; a typical course is several sessions over weeks. Main adverse effect is memory disruption, usually around the treatment period.

Transcranial Magnetic Stimulation (TMS)

Non-invasive, non-convulsive stimulation delivered in outpatient sessions. Used primarily where antidepressant trials have not produced adequate response. No anesthesia required

Ketamine and Esketamine

Act on glutamatergic rather than monoamine systems, with characteristically rapid effects. Esketamine nasal spray is approved for treatment-resistant depression, delivered under monitoring in certified settings

Shared Biology for Mood Disorders

• Stress system (HPA Axis): stress leads to high cortisol which is linked with mood disorders

• Serotonin & Norepinephrine: mood regulation

• Amygdala: more active

• Prefrontal Cortex: less active

• Sleep & circadian: rhythms disrupted

• Immune: Inflammatory signaling

Where Mood Disorders differ Biologically

• Depression has lower dopamine and under striatum both apart of the rewards systems or center

• Bipolar has higher dopamine and over striatum

Stress and Context shared by both Mood Disorders

• Life events can trigger many depressive or manic episodes

• Chronic strain like poverty and caregiving

• Early adversity can raise lifetime risk

Where Mood Disorders differ in Diathesis/Stress

• Vulnerability: genes early adversity

• Stressor: loss, conflict, chronic strain

• Episode: when the load exceeds coping

Cognition in depressive episodes

• Negative triad: self, world, future

• Attention: drawn to negative cues

• Memory: negative, overgeneral recall

• Interpretation: ambiguity = rejection

• Rumination: repetitive, no next step

• Hopelessness: predicts persistence

Cognition where they differ

• Depression has a worthless self and hopless outlook

• When in manic phases, bipolar has grandiose self and inflated outlook

Beck’s cognitive model

• Self: “There is something wrong with me. I am not enough.”

• World: “Nothing works out. People are disappointed in me.”

• Future: “This is how it will stay. Nothing I do will change it.

=

• Schemas: Durable belief structures, often formed early

• Biased Processing: What gets noticed, remembered, and how ambiguity is read

• Conclusions that confirm the Schema: The belief now has evidence

Hopelessness theory

• Stable vs. unstable Will it last?

• Global vs. specific Does it spread? Generalize?

• Internal vs. external Is it me?

Behavior in Depressive Episodes

• Withdrawal: less social contact

• Reduced activity: fewer rewards

• Avoidance: relief now, cost later

• Routine: sleep, meals, exercise slip

• Lost reinforcement: lower mood

How Behavior in Mood Disorders Differ

• For depression, activity is withdrawn and risk taking is low

• For bipolar, (manic phases) activity is driven and risk-taking is high

Cognitive Behavioral Theory (CBT)

• Maladaptive interpretations, schemas, and the behaviors that follow from them.

• Tests beliefs against evidence rather than arguing with them

• Maps onto: the interpretation loop

Behavioral Activation (BA)

• Withdrawal and the loss of positive reinforcement.

• Rebuilds graded, planned contact with meaningful activity.

• Maps onto: the withdrawal loop

• Scheduled, graded re-contact with rewarding activity — chosen with the person, planned in advance.

• Acting BEFORE motivation returns: motivation follows engagement rather than preceding it.

• Attending to what happened afterward, so the activity gets to teach something.

Interpersonal Psychotherapy (IPT)

• Role transitions, interpersonal conflict, grief, and the relationship patterns surrounding the episode.

• Maps onto: the interpersonal loop

Antidepressants: Common current classes

• SSRIs and SNRIs

• decent efficacy rate

• More effective for more severe depression, not as much mild

• Combination therapy often beats either alone for moderate to severe depression; use shared decision-making.

Antidepressants: Older classes

MAO inhibitors and tricyclics, they are effective but with significant side-effect burdens.

Psychotherapy and Medication

Most effective treatment

Bipolar treatment

• Medication is important and necessary

• Mood stabilizers and selected antipsychotics are the backbone of treatment. – Lithium, anticonvulsants, antipsychotics

• Antidepressant use in bipolar disorder is a genuinely contested area and is approached cautiously.

Equifinality

• Different starting points or risk factors can lead to the same psychological disorder.

• Example: One person develops depression after childhood trauma, while another develops it due to chronic stress.

Multifinality

• The same starting point or risk factor can lead to different psychological outcomes

• Example: Two people experience childhood trauma, but one develops depression while the other develops anxiety