Psychopathology Review

PSYCHOPATHOLOGY

MENTAL DISORDERS

• Defined as a persistent disturbance or dysfunction in behavior, thoughts, or emotions leading to significant distress or impairment.
• Impacts daily functioning
• Diagnosed primarily based on behavioral symptoms.
• DSM-5-TR: Current manual for diagnosing psychiatric illness.
• Prevalence:
  • ~12% of the global population experiences a mental disorder.
  • This rate is approximately 20% in North America.
  • Gender differences exist in certain disorders.
  • Many disorders manifest during adolescence or early adulthood.

THE DSM-V

• Lists criteria necessary for diagnosing mental disorders.
• About 50% of Americans will experience at least one mental disorder in their lifetime.
• Comorbidity: The co-occurrence of two or more disorders; approximately 80% of those with a mental disorder report comorbidity.
• Common disorders include anxiety, mood disorders, impulse-control, and substance abuse disorders.
• Cultural factors influence experiences and expressions of mental disorders.

THE MEDICAL MODEL

• Views abnormal psychological experiences as illnesses with biological and environmental causes, identifiable symptoms, and possible treatments.
  • Diagnosis: Establishes the illness type.
  • Signs: Objective indicators of a disorder.
  • Symptoms: Subjective reports of behaviors, thoughts, and emotions.

DANGERS OF LABELING

• Labels can lead to negative stigma, implying danger or harmfulness associated with mental disorders.
• Approximately 60% of individuals do not seek treatment due to stigma.
• Education alone may not effectively reduce stigma.
• Individuals with mental disorders are not statistically more violent than the general population.
• Stigmatization may impact self-perception, leading to feelings of helplessness, which can hinder recovery.
• Preferred terminology: "Individual with Schizophrenia" instead of "schizophrenic."

SCHIZOPHRENIA

• Characterized by:
  • Positive Symptoms: Hallucinations, delusions, disorganized thoughts/speech, excited motor behavior.
  • Negative Symptoms: Flat affect, anhedonia, emotional and motivational deficits.
  • Cognitive Symptoms: Memory issues, attention difficulties, impaired social cognition.

HERITABILITY OF SCHIZOPHRENIA

• Caused by both genetic and environmental factors, but no singular causative gene has been identified.
• Adoption Studies: Show that children adopted by non-biological parents have a higher incidence of schizophrenia if their biological parents had it.
• Twin Studies: Concordance rates are 50% for monozygotic twins and 17% for dizygotic twins indicating genetic influence.

FACTORS RELATED TO DIAGNOSIS

• Advanced paternal age, stress exposure, urban living (increased risk due to pollutants and overcrowding), prenatal stress, infections during pregnancy, and atypical prenatal conditions contribute to diagnosis likelihood.

BRAIN CHANGES IN SCHIZOPHRENIA

• Ventricular Changes: Enlarged lateral ventricles linked to loss of brain tissue.
• Cortical Abnormalities: Thinning of cortical gray matter, altered corpus callosum structure/function, hypofrontality (underactivity in frontal cortex linked to reduced synaptic density).

TREATMENT OF SCHIZOPHRENIA

• First Generation Antipsychotics: Dopamine antagonists that target D2 receptors, primarily alleviating positive symptoms (e.g., Chlorpromazine, Haloperidol). Side effects include motor dysfunction.
• Second Generation Antipsychotics: Aim to reduce motor side effects and target multiple neurotransmitter receptors (e.g., Clozapine, Risperidone). May contribute to weight gain.
• Cognitive Behavioral Therapy: Helps to manage stress and reduce symptom flare-ups.

FUTURE AREAS FOR RESEARCH

• Investigating substances like Phencyclidine (PCP) that induce schizophrenia-like symptoms; supports glutamate hypothesis focusing on neurotransmission issues in schizophrenia.

MOOD DISORDERS

• Depression: A persistent low mood and/or anhedonia lasting two weeks or more, often accompanied by feelings of worthlessness, lethargy, and disturbances in sleep and appetite.
• Prevalence: Affects over 7% of Americans annually; more common in women, particularly those above age 40.

INHERITANCE OF DEPRESSION

• Concordance Rates: ~40% for monozygotic twins and ~20% for dizygotic twins, indicating strong genetic links.
• No specific gene has been identified; depression likely results from complex gene-environment interactions.

BRAIN REGIONS AFFECTED BY DEPRESSION

• Increased activity in the amygdala and frontal lobes during emotional processing tasks but decreased activation in the parietal cortex and anterior cingulate cortex. Decreased hippocampal volume observed in studies.

TREATMENTS FOR DEPRESSION

• Electroconvulsive Therapy (ECT): Induces seizures by delivering electrical shocks; used as a last resort due to memory and physical side effects.
• Transcranial Magnetic Stimulation: Noninvasive method with fewer side effects than ECT.
• Deep Brain Stimulation: Combines electrical stimulation with psychosurgery for severe cases.

DRUG TREATMENT OPTIONS

• Monoamine Hypothesis: Depression linked to insufficient activity at monoamine synapses.
• Antidepressants:
  • For instance, MAOIs and tricyclic antidepressants enhance monoamine levels.
  • SSRIs (e.g., Prozac, Paxil) focus particularly on increasing serotonin availability.
  • SNRIs target both serotonin and norepinephrine reuptake inhibition.
  • Ketamine: Provides rapid relief as a glutamate receptor antagonist.

THERAPY

• Cognitive Behavioral Therapy (CBT): Effective for correcting negative thought patterns with lower relapse rates compared to SSRIs; beneficial when combined with medication.

GENDER DIFFERENCES IN MOOD DISORDERS

• Women are twice as likely to experience depression; possible reasons include help-seeking behaviors and hormonal differences.
• Postpartum depression is especially prevalent and often responds well to CBT.

SLEEP AND DEPRESSION

• Common difficulties with sleep onset and maintenance; reduction in stage 3 sleep noted with an increase in lighter sleep stages.

BIPOLAR DISORDER

• Characterized by alternating periods of mania and depression.
• Manic Episodes: Include symptoms like grandiosity, decreased need for sleep, and impulsivity.
• Similar neurological signatures to Schizophrenia with alterations in ventricle size and brain structure.
• Bipolar disorder has a hereditary component stemming from multiple genetic influences and environmental triggers.

TREATMENT FOR BIPOLAR DISORDER

• Lithium: Mainstay treatment with a narrow therapeutic window; monitored closely for efficacy and side effects.
• CBT: Helpful for managing symptoms.