Week 1 Lecture 1 - Clinical Psychology

Mental illness

“A clinically diagnosable disorder that significantly interferes with an individual’s cognitive, emotional or social abilities.”

Dysfunction

A failure of an internal neurobiological or metal mechanism to perform its natural (evolved) function

Harm

This dysfunction results in harm judged by societal standards

Anxiety (dysfunction and harm)

Dysfunction: Dysregulated fear response in safe situations

Harm: Distress, avoidance, impaired functioning

Depression (dysfunction and harm)

Dysfunction: Malfunction in mood regulation mechanisms

Harm: Persistent sadness, loss of interest, daily impairment

Psychosis

Dysfunction: Failure in mechanisms distinguishing reality from internal thoughts

Harm: Hallucinations, delusions, significant functional decline

DSM-5 definition of mental disorder

Defines mental disorder as “a mental disorder is a syndrome characterised by clinically significant disturbance in an individuals’ c ignition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.”

What is not a mental disorder

“An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder”

Socially defiant behaviour (eg political, religious, sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results form a dysfunction in the individual, as described above”

Classification of mental disorders:

• Categorical

• Dimensional

• Alternative

Categorical

Divides psychological disorders into categories based on criteria sets with defining features

Eg. Mental disorder, no mental disorder

• Better clinical and administrative utility - clinicians are often required to make dichotomous decisions

• Easier communication

Dimensional

Degrees of psychopathological phenomena occur along continuums

Eg. Fewer signs and symptoms, less severe, less frequent, less impact on functioning and/or less distress → more signs and symptoms, more severe, more frequent, more impact on functioning and/or distress

• Closely model lack of sharp boundaries between disorders, between disorders and normality

• Have greater capacity to detect change, facilitate monitoring

• Can develop treatment-relevant symptom targets p not simply aiming at result ion of disorder (most treatments actually target symptoms, not disorders)

Alternative

Models that do not focus on the mental health and illness concepts

DSM-5-TR Diagnosis

Diagnosis will be made on the basis of:

• Clinical Interviews - clinician and client semi-/structured

• Text descriptions - in DSM covering how disorders present

• Diagnostic criteria - does presentation match checklist?

Currently presenting symptoms and severity - eg depressed mood

Rule out disorder due to general medical condition - eg. Due to hypothyroidism

Rule out disorder due to direct effects of a substance - eg. Alcohol induced

DSM-5 Diagnostic Approach

Establish boundary with no mental disorder

• Clinical Significance/Cultural Norms

• Eg bereavement vs clinically significant depression

Determine specific primary disorder(s)

• Multiple diagnoses possible

Add subtypes/specifiers

• Severity (mild moderate, severe - with or without psychotic features)

• Treatment relevant (poor insight, atypical, etc)

• Longitudinal course (with/without full inter-episode recovery, seasonal pattern)

Biopsychosocial Paradigm

The dominant model in modern clinical psychology and psychiatry

• Biological

• Psychological

• Social

Biological

• History of medical illness

• Family history of psychiatric illness

• Increased use of substances

• Cessation of exercise

• Malnutrition

• Ongoing substance use

• Current medication type and dosage subtherapeutic

• Medical health

• Physical health

• Neurochemistry

• Genetic vulnerability

• Immune/stress response

• Comorbidity

• Metabolic disorders

Psychological

• Lack of validation from parents

• Feels responsible for parents’ divorce

• Ongoing fear of abandonment

• Depressogenic cognitive style

• Internalisation of precipitating social factors

• Fear of abandonment activated

• Lack of adaptive psychological coping skills

• Untrusting of professional psychological supports

• Behavioural depression

• Seeks psychological coping skills out informally

• Enjoys basic mindfulness practice

• Self-esteem

• Attitudes/beliefs

• Perceptions

• Coping skills

• Temperament

• Social skills

Social & Environmental

• Parents divorced during childhood

• Difficulty integrating socially at school

• DUI and loss of license

• Loss of job

• Financial difficulty

• Difficulty in romantic relationship

• Separation from fiancée

• Living away from own home in mother’s care

• Friendship network involved in gambling, substance use, and online gaming

• Interpersonal support from family and friends

• Instrumental support from mother

• Professional mental health supports

• Peer group

• Work

• School

• Socio-economic status

• Culture

• Family circumstances

Psychoanalytic Paradigm

Freud believe the unconscious has a profound influence on what we do and how we feel in day-to-day life

• caused by unresolved childhood conflicts and repressed desires

• resolve and recover through gaining awareness of unconscious processes

Behavioural Paradigm

• Classical Conditioning

• Operant Conditioning

Classical conditioning

Associate an involuntary response and a stimulus

Operant Conditioning

Associate a voluntary behaviour and a consequence

Goals of behavioural interventions include:

• Interrupt and/or change maladaptive stimulus-response associations

• Reinforce adaptive behaviour

DSM-5 model

Sees as two separate disorders that are co-occurring (or ‘co-morbid)

• treatment might focus on two distinct conditions

Hierarchical Taxonomy of Psychopathology

Sees these as part of a shared internalising spectrum rather than two separate disorders

• Treatment could focus more on core emotional dysregulation rather than treating two distinct conditions

Non-medical perspective

Culture can influence Aboriginal and Torres Strait Islander people’s decisions about when and why they should seek health services, their acceptance of treatment, the likelihood of adherence to treatment, the likelihood of adherence to treatment and follow up, and the likely success of prevention and health promotion strategies…