HE100A: Health Issues I Lecture 6: Mental Health
HE100A: Health Issues I
Lecture 6: Mental Health
© 2025 by Dr. Nicolas Rouleau, Ph.D., Waterloo, Ontario
History of Psychopathology
Interest in Psychopathology
Psychopathology has always intrigued humans.
In ancient civilizations, mental illness was perceived as a corruption of the soul, linking it to a debate between the heart and brain.
For most recorded history, those who violated societal norms were often subjected to exile, forced re-education, or execution.
Different cultures set the boundaries of acceptable thought and behavior.
The compassionate treatment of people categorized as "different" is a relatively modern concept.
Treatment of the Mentally Ill
Historically, individuals perceived as different were treated with cruelty rather than compassion.
Psychotic individuals were subjected to violent exorcisms or labeled as witches, leading to ramifications like being burned or drowned.
Violating societal norms could result in severe punishments, such as stoning or harsh torture for insurrection or non-compliance.
Any behavior or thought deviation posed a potential threat to societal stability and established order.
Ancient Understanding of Mental Health
Understanding of Brain's Role
Despite cruel treatments, ancient people were not ignorant; Egyptian physicians recognized the brain's significance in mental processes.
Ancient Greeks experimented with brain stimulation in individuals near death, demonstrating an early understanding of brain function.
Returnees from war with head injuries were observed to have permanent personality changes.
Treatment Techniques
Ancient treatments included the use of electric eels for ailments like headaches and depressive states referred to as "the blue devils."
Trepanation (drilling holes in the skull) was utilized to relieve intracranial pressure in prehistoric times.
Natural remedies such as traditional medicines and fermented fruits were used to "calm the nerves."
Honey and topical applications aided in treating head injuries.
Early forms of PTSD treatment for soldiers involved rotating them in and out of combat to prevent "shell shock."
Lobotomies, while intended to calm or correct abnormal behavior, had severe consequences.
Somatogenesis and Early Theories
Hippocrates' Contributions
Hippocrates (460-377 B.C.) rejected the idea that mental disturbances were divine punishment.
Somatogenesis: Referred to as “body-created”; emphasizes that mental functions and dysfunctions arise from the body.
He acknowledged brain pathology as a cause of behavioral and cognitive abnormalities and classified conditions like mania, melancholia, and phrenitis.
He believed personality traits were shaped by humoral differences, the balance of bodily fluids.
Cultural Beliefs in Abnormal Behavior
Later beliefs linked abnormal behavior with being a witch, divine oracle, prophet, or influenced by demons and jinns.
Historical Institutions for Mental Illness Treatment
Asylums and Their Development
With the rise of leprosy during the Crusades, specialized hospitals (Leprosariums) were established to quarantine the sick.
By the 1500s, following a decline in infections due to religious wars, hospitals were repurposed as asylums for the mentally ill.
Institutions became a collective holding for beggars and the mentally disturbed, addressing broader societal issues.
Moral Treatment Movement
Philippe Pinel (1745-1826) emerged as a key figure advocating for humane treatment in asylums.
He championed removing chains from patients and treating them as individuals suffering from illnesses rather than as beasts.
Physical environment improvements followed, moving away from dark, dungeon-like settings to more humane accommodations.
Pinel emphasized the idea that trauma and personal issues contributed to mental health declines, suggesting that compassion could aid recovery.
Development of Classification Systems
Early Empirical Classification
Thomas Sydenham (1624-1689): Advised for empirically driven diagnosis and classification of mental disorders.
Emil Kraepelin (1856-1926): Proposed a classification system based on the grouping of symptoms into syndromes with medical roots.
He identified two primary categories: dementia praecox (now known as schizophrenia) and manic-depressive psychosis (bipolar disorder), associating them with chemical imbalances and metabolic disorders.
Linking Disease to Bodily Etiologies
In the late 1700s, patients exhibited a syndrome called general paresis, characterized by mental deterioration and delusions, believed to be correlated with syphilis.
This connection was clarified following germ theory advancements.
Advancements in Statistical Measures
Statistical Tools in Mental Health
Statistics allowed for the quantification of differences in mental health assessments, moving beyond subjective judgments.
Population comparisons became essential in identifying abnormalities, enabling objective assessments in diverse situations, including military selections.
Changing Perspectives on Abnormality
Historical Misconceptions
Historically, being “different” was incorrectly equated to being “wrong.”
Phrenology, a pseudoscience, misused scientific methods to legitimize existing prejudices.
Modern Mental Health Attitudes
Current Understanding of Abnormal Behavior
Contemporary beliefs attribute abnormal behavior to both biological and psychological factors.
There is an emphasis on compassion and policies aimed at reducing stigma surrounding mental health.
Nonetheless, society still treats individuals with addictions as morally flawed rather than as affected by a disorder.
Misunderstandings persist around conditions such as depression, with advice to simply “get over it.”
Public perceptions reveal that 51% of Canadians believe psychiatric medications can cause harm, with only 46% supporting interventions for anxiety.
Defining Mental Disorders
Criteria for Defining Mental Disorders
Mental disorders: Cognitive or behavioral issues that meet two major criteria
Must be abnormal
Must negatively impact an individual’s well-being
Types of mental disorders include personality disorders, mood disorders, anxiety disorders, psychotic disorders, and substance abuse disorders.
Understanding Abnormality
Probability Density and Abnormality Research
Graphical representation of abnormality depicts statistical norms with z-scores illustrating the distribution of data.
Normality is conceived in statistical terms, leading to a view where mental health exists on a spectrum as opposed to clear categories.
Biological and Psychosocial Etiologies
Biological Factors of Mental Disorders
Encompass genetic disorders, toxic exposures, vascular issues, developmental disorders, traumas, and infections.
Psychosocial Factors
Include influences from family structures, learned behaviors, cultural context, beliefs, socialization challenges, deprivation, and emotional trauma.
Diagnostic Classification in Mental Health
Importance of Diagnosis
Diagnosis is the act of distinguishing an individual's behavior within DSM (Diagnostic and Statistical Manual) contexts.
DSM serves as a standard collection of classifications with specific criteria.
Diagnostic formulation is critical, encompassing unique details about the individual not solely limited to DSM criteria.
Both components shape effective treatment strategies.
Criteria for Normality and Change Over Time
Evolving Definitions of "Normal"
What is recognized as "normal" constantly shifts with evolving societal standards and scientific understanding (DSM-5).
Controversial Changes in Diagnoses
Recent classifications have expanded, such as
Bad temper classified as “disruptive mood dysregulation disorder”.
Grief pathologized as “depression”.
Increased likelihood of diagnosing anxiety disorders.
Inclusion of internet and sex addiction as disorders.
Minor forgetfulness now seen as “minor neurocognitive disorder”.
Shyness becoming a pathological condition.
Defining and Understanding Anxiety
What is Anxiety?
Anxiety is understood as a cognitive-emotional state tied to anticipating negative events, experienced through various physiological symptoms including:
Tension, worry, increased blood pressure, heart rate, sweating, trembling, and rumination.
It is noted that a minimal level of anxiety can serve motivational purposes; for example, inducing proactive behaviors to avoid threats (like completion of chores or confronting bullies).
Maladaptive behaviors, such as substance use or procrastination, can provide temporary relief from anxiety but may contribute to longer-term issues.
Distinguishing Anxiety from Fear
Anxiety:
Anticipatory and general.
Long-lasting, resistant to immediate solutions.
Fear:
Response to a specific, present threat.
Quick to emerge and dissipate in response to the stimulus.
Behavioral implications often involve avoidance and can result in further suffering through compulsive behaviors.
Rumination
Refers to the repetitive processing of distressing thoughts, resulting in over-analysis and obsessive thinking.
This cycle often perpetuates sadness, worry, and can increase susceptibility to depression.
Demographics of Anxiety Disorders
PTSD: Lifetime prevalence of 8%.
OCD: Lifetime prevalence of 2%.
Generalized Anxiety Disorder (GAD): Lifetime prevalence of 5%.
Social Phobia: Lifetime prevalence of 3-13%.
Agoraphobia: Lifetime prevalence of 1.5%.
Panic Disorders: Lifetime prevalence of 1-2%.
Relevant Brain Anatomy
Amygdala: A principal center for fear and anxiety processing.
Hypothalamic-Pituitary-Adrenal (HPA) axis: Activated during anxiety.
Hippocampus: Can inhibit the hypothalamus within the HPA axis during anxiety responses.
Prefrontal and Orbitofrontal Cortices: Serve as inhibitory regions preventing excessive limbic activation (
).
Effects of GAD-Mimetic Drugs
Examples of substances impacting anxiety include:
Alcohol (GABA-A receptor agonists)
Caffeine (adenosine receptor antagonists)
Stimulants (dopamine blockade)
Treatment Approaches for GAD
GAD Course and Treatment Options
Treatment examples include:
Anxiolytics (anti-epileptics)
Neurofeedback training
Cognitive-Behavioral Therapy (CBT)
Neurofeedback Process
Continuous visual and auditory feedback provided.
Brainwaves control actions on screen.
Results in learning and maintenance of desired brain activity.
Generalized Anxiety Disorder (GAD) Criteria
Characterized by excessive anxiety and worry occurring more days than not for 6 months about several events.
Difficulty in controlling the worry must be present, coupled with three or more symptoms:
Restlessness or feeling on edge.
Easily fatigued.
Difficulty concentrating.
Irritability.
Muscle tension.
Sleep disturbances.
Generalized Anxiety Disorder (GAD) Etiology
Linked to:
Dysfunction in the frontal lobe.
GABA insufficiency or reduced receptor binding (disinhibition).
Laboratory Findings may reflect:
Excessive sweating and nausea,
Exaggerated startle response,
Increased occurrences of Irritable Bowel Syndrome (IBS), headaches.
Women are at a greater risk.
Mood and Mood Disorders
What is Mood?
Mood is a cognitive state characterized along a dimension of positive and negative valence (good/bad or elevated/lowered).
Unlike temperament or personality, moods are transient under normal circumstances.
Influences on mood include behavior, physiological states, sleep patterns, stress levels, and time of day.
Mood disorders occur when affect becomes disordered, leading to persistent emotional disturbances.
Mood Disorders Defined
Present as significant disturbances, ranging from depression to elation associated with mania.
Symptoms often co-occur with panic attacks, substance abuse, sexual dysfunction, and personality disorders, manifesting behaviorally.
Prevalence of Mood Disorders Across Age Groups
Depression rates are variable according to age groups.
Children (<8 years): 1% depiction of depressive disorders.
Ages 8-13: 2.8% diagnosed.
Adolescents (14-18): 5.6% prevalence rate.
Adults: Approximately 7% prevalence.
Mood disorders more common in females (2:1 ratio compared to males).
Understanding Depression
Presenting as profound sadness, feelings of worthlessness, and guilt.
Symptoms may include withdrawal, loss of interest/pleasure, changes in sleep and appetite, exhaustion in maintaining daily practices.
Symptoms in children may manifest as somatic complaints, whereas older adults may exhibit memory loss.
Cultural variability influences symptom reports.
Defining Mania
Mania is characterized by heightened emotional states, often without basis.
Symptoms includes hyperactivity, talkativeness, distractibility, and grandiose plans.
Mania often does not emerge without episodes of depression and may include erratic speech patterns and behavior.
DSM Classification Related to Mood
Mood Episodes: Transient disturbances in mood states.
Depressive Disorders: Distinct episodes of decreased mood.
Bipolar Disorders: Oscillation between depressive and manic moods.
Other Mood Disorders: Spanning medical conditions or substance influences.
Diagnostic Criteria for Depressive Episodes
Must exhibit either a depressed mood or loss of interest (anhedonia).
Five or more symptoms must manifest over a two-week period, including:
Depressed mood,
Anhedonia,
Insomnia,
Psychomotor agitation or retardation,
Fatigue or lethargy,
Worthlessness or inappropriate guilt,
Concentration difficulties,
Recurring thoughts of death or suicidal ideation.
Symptoms must be observed by others and recurrent nearly every day.
Understanding Major Depressive Disorder (MDD) and Its Context
What Major Depression is Not
MDD is not a normal grief response; prolonged mourning (greater than two months) may present clinical significance.
It is not simply having a bad day since mood disturbances must be chronic.
MDD cannot be equated with transient sadness; it needs to stem from a consistent cause.
MDD is also not a reflection of drug use or withdrawal, which would require alternative treatments.
Prevalence of MDD
Estimated to affect approximately 7% of the population.
Lifetime risk of MDD is about 10-25% for women and 5-12% for men, unaffected by ethnicity, education, or income levels.
Individuals with a first-degree relative have an increased likelihood of developing MDD (1-3x more risk).
Suicidal Behavior and Ideation
Understanding Suicide
Suicide denotes the desire to cause one’s own death, typically associated with complex psychological stressors.
Signs of suicidal behavior include decreased frontal lobe activity and heightened limbic system activity.
Behavioral signs: social withdrawal, substance abuse, changes in appetite, and arrangements of possessions.
Cognitive-behavioral signs include expressions of hopelessness, sudden mood changes, and sleeping pattern variations.
Notably, men and women may take their lives in varying manners.
Suicidal Ideation
Ideation involves the fixation on suicide and considerations surrounding it.
Typically, individuals do not act on suicidal thoughts unless they reach stable or heightened mood states post-depressive periods.
Suicide rates peak in spring, often following winter months.
Self-harm
Acts of self-harm involve inflicting pain or damage onto oneself, including behaviors like cutting, self-asphyxiation, or substance abuse.
These acts may serve to release opioids for temporary relief or distraction.
Distinctions between self-harm and suicide are based on intention and completion of the act.
Cultural Perspectives on Suicide
Cultures have various stances on suicide, affecting its normalization within communities.
Expressions of suicidality differ culturally, including terms used to articulate distress (e.g., referencing physical pain).
Minority stress experiences illustrate the link between social disadvantage, discrimination, and acculturation experiences.
Individual perceptions of belonging play a role in one's mental health.
Risk Factor Model
Predisposing Factors: Underlying vulnerabilities such as psychological disorders, trauma, and loss.
Precipitating Factors: Acute stressors like job loss or relationship dissolution instigate crises.
Contributing Factors: Additional stressors that may amplify the other factors, including health issues and social isolation.
Protective Factors: Resilience and coping strategies that guard against suicidal ideation or behavior.
Constructs in Psychology
What is a Construct?
Constructs exist as cognitive phenomena in the human brain, such as anxiety, motivation, and intelligence.
They help understand cognitive functions but cannot be directly observed; instead, they are inferred through behaviors and experiences.
Construct validity encompasses different factors like face validity and predictive validity.
Defining Personality
Understanding Personality
Personality is characterized as a construct reflecting an individual's unique patterns of thought, emotion, and behavior.
Personality plays a significant role in predicting outcomes in career and relationships.
There are conscious and unconscious aspects of traits.
Measurement of Personality
Personality can be assessed through various methods:
Free association and dream analysis (psychoanalytic approach).
Projective tests and therapy sessions (psychodynamic approach).
Questionnaires and inventories (trait-based methods).
Observational studies in natural contexts (social-cognitive approach).
Inventories are often utilized in clinical settings for standardized assessments.
The Five Factor Model (FFM) of Personality
FFM Dimensions
Openness:
High: Curious, prefers variety.
Low: Practical, conventional, prefers routine.
Conscientiousness:
High: Dependable, organized.
Low: Careless, disorganized.
Extraversion:
High: Sociable, outgoing.
Low: Reserved, withdrawn.
Agreeableness:
High: Trusting, empathetic.
Low: Critical, cynical.
Neuroticism:
High: Anxious, irritable.
Low: Calm, stable.
Eysenck's Two-Dimensional Model
E-N Model Overview
Characterizes individuals based on emotional stability (neuroticism) and introversion/extroversion.
Unstable emotions correspond with neurotic behaviors, and stable emotions reflect traits like thoughtfulness and peace.
Also identifies behavioral patterns:
Sanguine (extroverted, calm).
Choleric (extroverted, touchy).
Phlegmatic (introverted, peaceful).
Melancholic (introverted, anxious).
Trait/Biological Perspective
Traits and Behavior
Traits represent stable, habitual patterns of behavior and thought influenced by genetics and brain structure.
Most humans categorize into defined groups based on their personality traits.
SNIPS and Personality
Single nucleotide polymorphisms (SNIPs) correlated with traits include:
SNAP25 on chromosome 20 linked to neuroticism.
CLOCK gene associated with agreeableness.
DYRK1A connected to conscientiousness.
Social-Cognitive Perspective
Interaction of Traits and Environment
Emphasizes how environmental factors can amplify or suppress innate traits.
Personality can also be context-dependent, changing according to social situations and experiences.
Reciprocal Determinism
Causative Interaction
Describes the two-way causal relationship between personality traits and environmental influences.
Individual choices and experiences shape personal behavior and emotional responses over time, influencing future actions.
Context-Dependency of Personality
Behavioral Variation by Context
Individuals behave differently based on situational contexts, exhibiting variability across social environments.
Despite underlying genetic traits, behaviors may change under differing conditions (e.g. intoxication or fatigue).
Personality Disorders
Understanding Personality Disorders
Represent a heterogeneous group of long-standing, pervasive, and inflexible behavioral patterns.
Pathological traits may be recognized only with consistent and inflexible presentations that impair functioning.
Criteria for Diagnosis
Three main criteria for distinguishing disordered personality:
Rigid and inflexible behavioral patterns that cannot adapt to context.
Patterns of self-defeating behavior resulting in harmful cycles.
Structural instability of self under stress.
DSM-5 Criteria for General Personality Disorder
Defining Characteristics
A: Enduring behavior patterns deviating markedly from cultural norms in areas of cognition, affectivity, interpersonal function, and impulse control.
B: Patterns are inflexible, pervasive in social situations.
C: Leads to clinically significant distress or impairment in crucial life areas.
D: Stability over time, tracing back to early adulthood.
E: Cannot be explained by another mental disorder.
F: Not attributable to physiological effects of substances or other medical conditions.
Clusters of Personality Disorders
Classification of Disorders
Disorders are grouped based on shared characteristics:
Odd/Eccentric Cluster: Characterized by behaviors typical of schizophrenia; includes paranoid, schizoid, and schizotypal personality disorders.
Dramatic/Erratic Cluster: Exhibits dramatic and erratic emotions; encompasses borderline, histrionic, narcissistic, and antisocial personality disorders.
Anxious/Fearful Cluster: Linked with anxiety disorders; includes avoidant, dependent, and obsessive-compulsive personality disorders.
Treatment Approaches for Personality Disorders
Therapeutic Techniques
Therapy must address various complexities as personality disorders can be deeply rooted and require adjustment of self-concept and identity.
Treatments might focus on resolving issues stemming from childhood (psychodynamic) or tackle specific behavioral problems (behavioral/cognitive approach).
Exploring the Nature of Reality
Subjective vs Objective Reality
Reality is understood as a baseline accessible to others, distinct from private experiences.
Humans generally share a consensus about reality, supporting standardized accounts of phenomena despite occasional disagreements.
Psychosis Defined
Understanding Psychosis
Psychosis is characterized by a disconnection from reality, affecting social interactions and daily functioning.
Symptoms typically include:
Disorganized speech, negative behavioral signs, hallucinations (perceptions of non-physical stimuli), and delusions (misinterpretations of reality).
Psychotic episodes can vary in duration and intensity.
First Episode Psychosis
Phases of Psychosis
Typically progresses through three phases:
Prodromal Phase: Subtle symptoms, including anxiety and sleep disturbances, lasting several months.
Acute Phase: Manifestation of positive symptoms like delusions and hallucinations.
Recovery Phase: Gradual reduction of symptoms; recovery can be variable if treated early to prevent subsequent episodes.
Schizophrenia and Its Spectrum
Schizophrenia Overview
Named for its characteristic “split” mind, schizophrenia manifests through disordered thought, emotion, and behavior causing social withdrawal and delusions.
Symptoms can lead to bizarre motor activity reflecting the disorder's complexity.
Cultural Representation:
Case study of The Joker (2019) illustrates schizophrenia features, with indicators like hallucinations, social withdrawal, inappropriate affect, and bizarre behaviors manifested vividly.
Identification of Schizophrenia Spectrum
Encompasses a range of psychotic disorders, including:
Schizophrenia, Schizophreniform Disorder, Schizoaffective Disorder, Delusional Disorder, Brief Psychotic Disorder, and Variations related to medical conditions or substance abuse.
Prevalence and Demographics
Schizophrenia is present in 0.3% to 1% of adolescents and adults, with a higher occurrence in males.
Childhood-onset schizophrenia has a prevalence of 0.2 to 0.4 per 10,000, lacking gender disparities unlike adult occurrences.
Diagnostic Criteria for Schizophrenia
Requires two or more characteristic symptoms for a significant portion of a one-month period, including:
Delusions
Hallucinations
Disorganized speech
Grossly disorganized behavior or catatonia
Negative symptoms
Must cause significant social or occupational dysfunction and last at least 6 months.
Delusional Disorders
Overview
Distinguished by the presence of non-bizarre delusions without significant hallucinations.
Characteristics of Delusions:
Must be realistically plausible (e.g., beliefs of being poisoned or followed).
Bizarre delusions are considered distinct and implausible (e.g. organ replacement without scars).
Prevalence of Delusional Disorders
Account for 1%-2% of psychiatric admissions, with a general population prevalence of approximately 0.03%.
Lifetime morbidity risk ranges from 0.05% to 1%.
It reflects the low prevalence of delusional disorders in society, with jealous types more common in men.
DSM Criteria for Delusional Disorder
Non-bizarre delusions of at least 1 month, excluding any criteria met for schizophrenia.
Functioning should not be markedly impaired beyond the impact of the delusion.
Mood episodes must be brief in relation to the delusional timeframe.
Types of Delusional Disorders
Grandiosity: Belief in one’s special talents or important relationships.
Jealous: Unfounded beliefs of infidelity from a partner.
Persecutory: Feelings of being harassed or conspired against.
Somatic: Concerns about bodily sensations or health that are unfounded.
Erotomanic: Belief that someone is deeply in love with the individual, typically idealizing the relationship outside sexual context.
Cultural Considerations
Determination whether beliefs are classified as delusions often considers cultural norms and acceptability.