PSYCH 105- Week 10

Mental Disorders

• Somatogenic Hypothesis

  • posits that mental illness stems from biological or physical causes like illness, genetic inheritance, brain damage, or imbalance, contrasting with the psychogenic theory which attributes mental illness to psychological factors

• Psychogenic Hypothesis

  • suggests that mental or emotional factors, rather than purely physical causes, are the primary drivers of mental illness or certain physical symptoms. It emphasizes the role of trauma, stress, cognitions, and distorted perceptions in the development of these conditions.

• Diathesis Stress Model

  • a psychological theory that aims to explain how mental health disorders develop. It proposes that a combination of genetic or biological predispositions (diathesis) and environmental stressors can lead to the onset of a disorder

• Mental Disorder

  • a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often causing significant distress or impairment in personal functioning.

Treatment

Historical Context of Mental Health Treatment

• Early treatments based on the belief mental disorders were caused by evil spirits.

  • Examples of early treatments included:

  • Trepanation: drilling holes in the skull.

  • A variety of methods to calm or expel demons: music, prayers, starvation, flogging.

Establishment of Asylums

• Asylums were founded throughout Europe in the 16th century.

  • These institutions housed:

  • Criminals, individuals with epilepsy, the poor, and people with severe mental illnesses.

  • The aim was to segregate these individuals from society.

  • Asylum conditions were often horrific, involving:

  • Filthy environments, the use of chains, and other abuses.

Reform Movements

• Gradual reforms began in mental health treatment.

  • French physician Philippe Pinel (1793): advocated for humane treatment, removing shackles, and engaging with patients.

  • William Tuke (York Retreat): emphasized reading, manual labor, and conversation for individuals with severe disorders.

  • Hartford Retreat in the US: focused on moral treatment in a caring environment.

Backslide in Treatment Approaches

• Industrialization and population pressures led to the rise of larger institutions offering custodial care instead of treatment.

• The eugenics movement emerged, regarding mental disorders as defects requiring institutionalization and sterilization.

Antipsychotic Medications and Deinstitutionalization

• Introduction of antipsychotic medications in the 1950s (e.g., Thorazine, Haldol): effective in reducing symptoms of schizophrenia.

  • Limitations included inefficacy for negative symptoms like flat affect.

  • Trends shifted, with reductions in hospitalization duration due to medication and community care initiatives:

  • 1963 Mental Retardation Facilities and Community Mental Health Centers Construction Act signed by President John F. Kennedy.

  • Example: Average hospital stay for schizophrenia reduced from long-term to about two months by the 1980s.

  • Despite deinstitutionalization, many people lacked adequate community support; high rates of homelessness and incarceration persist among those with mental illnesses.

Types of Psychotherapy

• Psychotherapy is a common treatment for various mental health problems.

  • Psychodynamic Therapy:

  • Focuses on gaining insight into unconscious thoughts and past experiences.

  • Developed from Freud's psychoanalysis, utilizing techniques like free association and dream analysis.

  • Existential and Humanistic Therapies:

  • Focus on individual potential, self-acceptance, and rational decision-making.

  • Carl Rogers' client-centered therapy emphasizes empathy, genuine therapeutic relationships, and active listening.

  • Behavioral Therapies:

  • Address negative behaviors through learning new, positive behaviors.

  • Techniques such as exposure therapy for anxiety are introduced, sometimes using virtual reality for gradual exposure.

  • Cognitive Behavioral Therapy (CBT):

  • Combines cognitive and behavioral approaches to change self-defeating thoughts and behaviors.

  • Involves structured sessions and practice of new skills.

  • Mindfulness:

  • Emphasizes nonjudgmental acceptance of thoughts and sensations.

  • Based on Buddhist practices to promote physical and mental relaxation.

Group Therapies

• Availability of group therapies for shared experiences.

  • Examples: Alcoholics Anonymous and other 12-step programs, couple and family therapy help foster community support.

Efficacy of Psychotherapy

• Common perceptions about therapy are generally positive but are subjective.

• Randomized controlled trials (RCTs) are the gold standard for measuring treatment efficacy.

  • Challenges include defining what constitutes a placebo in psychotherapy studies.

• Meta-analyses indicate CBT is among the most supported therapies for various disorders: depression, anxiety, PTSD, etc.

• Eclectic approaches may be utilized by therapists with consideration to individual patient needs.

Biomedical Treatments

• Antidepressants:

  • Two major classes: monoamine oxidase inhibitors and tricyclic antidepressants, which enhance norepinephrine and serotonin transmission.

  • SSRIs (e.g., Prozac) represent a newer class of antidepressants with fewer side effects.

• Mood Stabilizers:

  • Lithium effectively treats bipolar disorder but requires careful monitoring due to side effects and toxicity.

• Anxiolytics:

  • Prescribed for anxiety, benzodiazepines are effective but carry addiction risks.

Emerging Treatments

• Other treatment options not commonly used:

  • Electroconvulsive Therapy (ECT) for severe depression resistant to other treatments.

  • Repetitive transcranial magnetic stimulation (RTMS) and deep brain stimulation (DBS) as alternatives with fewer cognitive side effects.

Barriers and Disparities in Access

• Only about 40% of people with significant mental disorders in the US received treatment in the past year.

  • Barriers include insurance concerns, provider availability, and stigma.

• Disparities exist among different ethnic and socioeconomic groups in accessing mental health services, influenced by cultural perceptions of mental health.

Conclusion

• Mental health treatment has evolved significantly from historical practices to modern psychotherapy and biomedical approaches.

• Ongoing challenges include ensuring equitable access, treatment effectiveness, and understanding diverse patient needs.

• New technologies, such as apps and digital therapeutics, might reshape mental health care delivery in the future.