Psychopathology Class 1 Notes - The Chicago School

Roadmap

  • Introductions
  • Syllabus
  • Why study psychopathology?
  • Do psychological disorders really exist?
  • Reliability
  • Validity

About the Classroom

  • Everyone is welcome; take space and contribute if comfortable
  • Be curious, respectful, and kind
  • Make space for others
  • If something said in class doesn’t sit right, discuss with the instructor (in class or outside)

Introductions

  • Our TA: Katherine Gouldin
  • prompts to share:
    • Where are you from?
    • Any prior graduate school?
    • Any clinical experience?
    • Any research experience?
    • Something notable from your summer?

Syllabus & Readings

  • Syllabus Review (no detailed content provided in transcript)
  • Homework for next week (9/2):
    • Complete auto attendance assignment by 8/27 (tomorrow)
    • Mullins-Sweatt, S. N., Lengel, G. J., & DeShong, H. L. (2016). The importance of considering clinical utility in the construction of a diagnostic manual. Annual Review of Clinical Psychology, 12, 133-155. https://doi.org/10.1146/annurev-clinpsy-021815-092954
    • Anglin, D. M., et al. (2021). From womb to neighborhood: A racial analysis of social determinants of psychosis in the United States. American Journal of Psychiatry, 178(7), 599-610. https://doi.org/10.1176/appi.ajp.2020.20071091
    • DSM-5-TR: Section I “DSM-5 Basics” (pages 5-29)

How to Study the Readings

  • Distinguish study from casual reading; connect to lecture
  • Re-read unclear parts of articles
  • Practice describing empiricial studies aloud (in your own words) to someone not in class so they can explain back to you:
    • participants, hypotheses, how hypotheses were evaluated, findings, conclusions, implications
  • For review articles, be able to explain the take-home points clearly to someone not in class
  • For chapters, attend to content discussed in lecture
  • Mastery: go through each article/chapter several times focusing on the most important points you could be asked about

Language Matters

  • Use considerate, person-first language:
    • "Some with an alcohol /substance use disorder" rather than "alcoholic" or "addict"
    • "Died by suicide" rather than "committed suicide"
  • Avoid overgeneralizing clinical terms:
    • "I'm so OCD"… not unless diagnosed
    • "This person is so narcissistic"… are they though?
  • Do not capitalize disorders or schools of therapy

Why Study Psychopathology?

  • It’s common
  • It has high impact
  • It can be costly
  • It’s relevant to normal behavior processes
  • It’s interesting!
  • Figure 1 (Past Year Prevalence of Any Mental Illness Among U.S. Adults, 2022) illustrates variability across groups (data courtesy of SAMHSA). The figure shows prevalence by sex, age, race/ethnicity, etc., with overall rates ranging across groups (exact group-specific values vary by category).

Do Psychological Disorders Really Exist?

  • Labeling Theory
  • Thomas Szasz, MD: symptoms were “problems in living”
  • Disorders are deviations from social norms, which vary across groups
  • Labels tend to become fixed and stigmatizing
  • People with less power in a culture are more vulnerable to these problems
  • Treatment may create problems rather than helping
  • However… cross-cultural study findings offer counterpoints to strict labeling explanations (cross-cultural data show some robust patterns that are not solely about social labeling)

20 MINUTE BREAK

RELIABILITY

  • Reliability is the consistency of a measurement
  • Notable early unreliability of psychiatric disorders
  • Improvement in reliability over time
  • Approaches to improve reliability: Operational criteria; Structured interviews

Example of Historical Reliability Issue

  • DSM-II (1968) described involutional melancholia (296.0) as a disorder marked by worry, anxiety, agitation, severe insomnia, guilt, somatic preoccupations, and possible delusional proportions
  • Diagnosis relied on distinguishing from manic depressive illness and psychotic depressive reaction via mood vs. reality testing distinctions
  • There was debate about whether this diagnosis was valid; guidance recommended not using it unless other affective disorders were ruled out

RELIABILITY (Continued)

  • Reliability and diagnostic validity are related but distinct concepts
  • Operational criteria and structured interviews contributed to improved reliability
  • Still, reliability does not guarantee validity of diagnoses

DSM-5-TR (2022) Criteria for Major Depressive Disorder

  • A. Five (or more) of the following symptoms have been present during the same 2\text{-}week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. NOTE: Do not include symptoms attributable to another medical condition.
    1) Depressed mood most of the day, nearly every day (as indicated by subjective report or observations by others; in children/adolescents, mood can be irritable)
    2) Markedly diminished interest or pleasure in almost all activities most of the day, nearly every day
    3) Significant weight loss when not dieting or weight gain, or decrease/increase in appetite nearly every day (in children, failure to gain expected weight)
    4) Insomnia or hypersomnia nearly every day
    5) Psychomotor agitation or retardation nearly every day (observable by others, not just subjective feelings of restlessness or being slowed down)
    6) Fatigue or loss of energy nearly every day
    7) Feelings of worthlessness or excessive or inappropriate guilt nearly every day (which may be delusional)
    8) Diminished ability to think or concentrate, or indecisiveness nearly every day
    9) Recurrent thoughts of death, suicidal ideation, a suicide attempt, or a specific plan for suicide
  • B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • C. The episode is not attributable to the direct physiological effects of a substance or to another medical condition
  • NOTE: Bereavement-related symptoms may resemble a depressive episode; clinical judgment is required to determine if a major depressive episode is present in the context of loss
  • D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders
  • E. There has never been a manic or hypomanic episode (note: this exclusion does not apply if manic-like or hypomanic-like episodes are substance-induced or due to a medical condition)
  • Specify: With anxious distress; With mixed features; With melancholic features

VALIDITY

  • Validity is the accuracy of a measurement
  • Are psychiatric disorders valid?
  • Robins & Guze (1970) framework for evaluating diagnostic validity:
    • Clinical description
    • Laboratory studies
    • Delimitation from other disorders
    • Follow-up study
    • Family study

FINAL THOUGHTS OR QUESTIONS?

  • Open questions and reflections to close the session