Psychopathology exam 1

Chapter 1:

Historical Context and Early Perspectives

1. Understanding the Historical Context

   • Evolution of mental health perspectives over time.

   • Importance of historical context in shaping current understanding of mental disorders.

2. Ancient Civilizations

   • Early descriptions and treatments of mental illness in Ancient Egypt, Greece, and Rome.

   • Hippocrates' theory of the four humors and its impact on early medical thought.

     • The theory of the four humors (blood, phlegm, yellow bile, black bile) suggested that mental illness resulted from imbalances in bodily fluids.

3. Middle Ages

   • Influence of religion and superstition on the perception of mental illness.

   • Practices like witch hunts and exorcisms as treatment methods.

     • Mental illness was often seen as a result of demonic possession or moral failing during this period.

4. Renaissance and Enlightenment

   • Shift towards scientific inquiry and observation.

   • Emergence of asylums and institutional care for the mentally ill.

     • This period marked the beginning of more humane treatment practices and the establishment of institutions for care.

The Rise of Psychiatry

1. 19th Century Psychiatry

   • Philippe Pinel and the moral treatment movement focusing on humane care.

     • Pinel advocated for the removal of chains from patients and emphasized the importance of compassionate care.

   • Dorothea Dix and the reform of mental health institutions in the United States.

     • Dix's efforts led to the establishment of state hospitals and improved conditions for the mentally ill.

2. Early 20th Century

   • Introduction of psychoanalysis by Sigmund Freud.

     • Freud's psychoanalysis emphasized the role of unconscious processes and early childhood experiences in mental illness.

   • Development of psychodynamic theories and therapeutic techniques.

     • Psychodynamic therapy aimed to explore and resolve unconscious conflicts through techniques like free association and dream analysis.

Mid-20th Century Advances

1. Behaviorism and Cognitive Approaches

   • B.F. Skinner's operant conditioning and behavior modification.

     • Skinner's work focused on the principles of reinforcement and punishment to shape behavior.

   • Albert Bandura's social learning theory and the Bobo doll experiment showcasing observational learning.

     • Bandura demonstrated that people can learn behaviors through observation and imitation.

2. Humanistic Psychology

   • Carl Rogers' client-centered therapy emphasizing empathy and unconditional positive regard.

     • Rogers' approach focused on creating a supportive therapeutic environment to facilitate personal growth.

   • Abraham Maslow's hierarchy of needs and the concept of self-actualization.

     • Maslow proposed that individuals must meet basic physiological and safety needs before achieving self-actualization.

Modern Approaches to Mental Health

1. Biopsychosocial Model

   • Integration of biological, psychological, and social factors in understanding mental illness.

     • The biopsychosocial model provides a comprehensive framework for understanding the multifaceted nature of mental disorders.

2. Cognitive-Behavioral Therapy (CBT)

   • Aaron Beck's cognitive therapy for depression.

     • Beck's cognitive therapy aimed to identify and change negative thought patterns contributing to depression.

   • Techniques for addressing dysfunctional thinking patterns and modifying behavior.

     • CBT combines cognitive and behavioral techniques to treat a range of mental health conditions.

Advances in Neuroscience

1. Neurotransmitters and Brain Function

   • Role of neurotransmitters like serotonin, dopamine, and GABA in mental disorders.

     • Imbalances in neurotransmitters can contribute to conditions like depression, anxiety, and schizophrenia.

   • Understanding brain regions is involved in mood, cognition, and behavior.

     • Research on brain function has identified specific areas (e.g., prefrontal cortex, amygdala) linked to mental health.

2. Brain Imaging Techniques

   • Use of MRI, fMRI, PET, and EEG in studying brain activity and structure.

     • Brain imaging allows researchers to visualize brain activity and identify abnormalities associated with mental disorders.

Genetics and Mental Health

1. Genetic Predispositions

   • Heritability of mental disorders and the influence of genetic factors.

     • Studies have shown that many mental health conditions have a genetic component, indicating a hereditary risk.

   • Interaction between genes and environmental factors in the development of mental illness.

     • Gene-environment interactions play a crucial role in the onset and progression of mental disorders.

2. Epigenetics

   • Influence of environmental factors on gene expression.

     • Epigenetic changes can alter gene expression without changing the DNA sequence, impacting mental health.

   • Role of epigenetic changes in shaping mental health outcomes.

     • Environmental factors like stress, diet, and trauma can lead to epigenetic modifications that affect mental health.

Psychopharmacology

1. Development of Psychotropic Medications

   • History and development of antipsychotics, antidepressants, and anxiolytics.

     • Psychotropic medications have revolutionized the treatment of mental disorders by targeting specific neurotransmitter systems.

   • Mechanisms of action and therapeutic effects of these medications.

     • Different classes of medications work by altering neurotransmitter activity to alleviate symptoms.

2. Challenges and Considerations

   • Side effects and long-term impact of psychotropic medications.

     • While effective, these medications can have side effects that require careful management.

   • Importance of personalized treatment approaches and monitoring.

     • Personalized medicine aims to tailor treatments based on individual differences in genetics and response.

Psychotherapy and Counseling

1. Various Therapeutic Modalities

   • Overview of psychodynamic, humanistic, cognitive-behavioral, and integrative therapies.

     • Different therapeutic approaches offer various techniques and perspectives for treating mental disorders.

2. Effectiveness of Psychotherapy

   • Evidence-based practices and outcome research supporting various therapies.

     • Research has shown that psychotherapy can be highly effective for a wide range of mental health issues.

   • Role of the therapeutic relationship in achieving successful treatment outcomes.

     • The quality of the therapist-client relationship is a critical factor in the effectiveness of therapy.

Sociocultural Perspectives

1. Cultural Influences on Mental Health

   • Impact of cultural beliefs, values, and practices on the perception and treatment of mental disorders.

     • Cultural context can shape how mental health symptoms are expressed and understood.

   • Importance of considering cultural context in assessment and intervention.

     • Culturally sensitive approaches are essential for accurate diagnosis and effective treatment.

2. Addressing Cultural Competence

   • Importance of culturally sensitive assessment and treatment approaches.

     • Mental health professionals must be aware of cultural differences to provide effective care.

   • Strategies for enhancing cultural competence among mental health professionals.

     • Training and education in cultural competence can improve service delivery and client outcomes.

Evolutionary Perspectives

1. Evolutionary Psychology

   • Understanding mental disorders from an evolutionary standpoint.

     • Evolutionary psychology explores how mental health conditions may have evolved as adaptive responses to environmental challenges.

   • Exploration of how certain mental health conditions may have evolved as adaptive responses.

     • Traits that were once beneficial for survival may contribute to mental disorders in modern contexts.

2. Psychopathology and Evolution

   • Examination of the adaptive and maladaptive aspects of behavior in the context of evolution.

     • Understanding the evolutionary basis of behavior can provide insights into the nature of mental health conditions.

   • Impact of evolutionary pressures on mental health and behavior.

     • Evolutionary perspectives highlight the role of natural selection in shaping psychological traits.

Integrative Models

1. Integrative Approaches to Treatment

   • Combining multiple therapeutic modalities for a holistic approach to mental health.

     • Integrative therapy leverages the strengths of different approaches to address complex and comorbid conditions.

2. Interdisciplinary Collaboration

   • Importance of collaboration between mental health professionals, medical practitioners, and researchers.

     • Key Point: Interdisciplinary teams can provide comprehensive and coordinated care for individuals with mental health needs.

   • Role of interdisciplinary teams in providing comprehensive care.

     • Key Point: Collaboration among professionals enhances the quality and effectiveness of treatment.

Future Directions in Mental Health

1. Advances in Technology

   • Impact of digital health tools, teletherapy, and virtual reality on mental health treatment.

     • Technology has the potential to improve access to care and enhance treatment effectiveness.

   • Potential for technology to enhance access to care and improve treatment outcomes.

     • Innovations in technology can address barriers to mental health services and offer new treatment

Biological Approaches

Chlorpromazine and its Impact (1952)

• Discovery: Calming effect of chlorpromazine discovered by a French naval surgeon.

• Use in Mental Disorders: Suggested for treating mental disorders, especially schizophrenia.

• Store Label: Thorazine.

• Impact: Reduced symptoms of schizophrenia and number of patients in mental hospitals.

• Side Effects: Early antipsychotics had problematic side effects; newer drugs have fewer.

Noninvasive Treatment Approaches

• Electroconvulsive Therapy (ECT): Effective for severe depression, improvements include reduced motor convulsions.

• Transcranial Magnetic Stimulation (TMS): Uses magnetic stimulation to disrupt brain activity, treats depression and other mental disorders.

Invasive Treatment Approaches

• Deep Brain Stimulation (DBS): Electrodes placed in the brain to change brain networks, used for motor disorders, OCD, and depression.

• Surgical Procedures: Small cuts using gamma rays for severe epilepsy, depression, or anxiety.

Combining Treatments

• Biological and Psychological Approaches: Effective when combined; for example, psychotherapy with lower levels of psychotropic medication is effective for schizophrenia.

Psychodynamic Perspectives

Evidence-Based Treatments (1950s-1960s)

• Evidence-Based Medicine: Term used in medical field.

• Empirically Based Treatments: Term in psychology for scientifically proven treatments.

• 21st Century Focus: Diversity and cultural competency in evidence-based care.

Freud's Contributions

• Observations: Focused on inner mental conflicts and their treatment through psychoanalysis.

• Techniques: Free association, examining resistance and transference.

Existential-Humanistic Perspectives

Human Growth and Positive Psychology

• Client-Centered Therapy (Carl Rogers): Emphasizes empathic understanding, unconditional positive regard, and genuineness.

Emotion-Focused Therapy (Leslie Greenberg)

• Role of Emotion: Central to self-experience and change.

• Three Phases: Bonding and awareness, evocation and exploration, transformation and generation of alternatives.

Mindfulness Techniques

Nonjudgmental Observing

• Benefits: Reduces stress and reactivity, promotes compassion and broadens attention.

• Research Findings: Effective for anxiety, depression, chronic pain, and stress.

Behavioral Perspectives

Skinner's Views on Behavior

• Behavior and Consequences: Focus on reinforcement and learned behaviors.

• Limitations: Ignored internal processes.

Observational Learning (Albert Bandura)

• Modeling: Humans imitate behaviors of others without reinforcement.

Cognitive Behavioral Therapy (CBT)

Cognitive Triad in CBT

• Negative View of Self, Experiences, and Future: Therapy focuses on modifying these thoughts.

• Unified Treatment Model: Addressing common underlying mechanisms of disorders.

Third Wave of CBT

• Integration of Techniques: Including mindfulness, ACT, and ABBT.

Evolutionary and Cultural Perspectives

Evolutionary Connection

• Close Connection with Environment: Allows for genetic changes.

• Historical Conceptions of Psychopathology: Examples from ancient Greece, Renaissance, and beyond.

Three Broad Perspectives in Psychological Treatment

• Psychodynamic, Existential-Humanistic, and Cognitive Behavioral: Developed independently and often in opposition.

Chapter 2:

Historical and New Perspectives

• Traditional Methods: Observation and interaction with individuals to understand disorders.

• Progress in Neurosciences: Brain imaging and genetics offer new perspectives.

• Objective Markers: Use of neuroscience research to find objective markers in diagnosis and treatment.

• Processes Described: Cognitive, emotional, and motor processes in health and illness.

Brain Anatomy and Function

• Basic Brain Terminology: Anterior, posterior, dorsal, ventral, medial, lateral.

• Lobes of the Brain: Frontal (planning, thinking), Parietal (sensory information, spatial processes), Occipital (visual processing), Temporal (hearing, language).

• Neuron Anatomy: Cell body, axon, dendrites, synapses.

• Action Potential: Electrical impulse in axon; influenced by axon width and myelin sheath.

• Neurotransmitters: Chemicals facilitating or inhibiting action potentials at synapses.

Major Neurotransmitters

• Acetylcholine: Involved in muscles and learning.

• Monoamines: Serotonin (mood, sleep), Dopamine (movement, reinforcement), Norepinephrine and Epinephrine (stress response).

• Amino Acids: Glutamate (excitatory), GABA (inhibitory), Glycine (inhibitory in spinal cord).

• Neuropeptides: Endorphins (pain reduction), Substance P (pain sensitivity), Neuropeptide Y (eating, metabolism).

• Gas Transmitters: Nitric oxide (regulates blood flow).

Gut Microbiome and Brain Imaging Techniques

• Gut Microbiome: Influences cognition, stress, and various disorders.

• EEG: Measures electrical activity in the brain.

• MEG: Measures magnetic fields from neuron activity.

• PET: Measures blood flow using radioactive tracers.

• fMRI: Measures blood oxygen levels to infer brain activity.

• DTI: Maps white matter connections in the brain.

EEG, Evoked Potentials, MEG, PET, and fMRI

• EEG: Amplitude, frequency, and oscillations (alpha, beta, theta, delta, gamma).

• Evoked Potentials (EPs): Event-related potentials showing cognitive processing.

• MEG: Precise spatial location of magnetic fields.

• PET: Measures cerebral blood flow and metabolic activity.

• fMRI: Maps changes in cortical blood flow during tasks.

Diffusion Tensor Imaging (DTI) and Brain Networks

• DTI: Visualizes white matter connections; used in studies of dementia and schizophrenia.

• Trade-Offs in Techniques: Temporal vs. spatial resolution in brain imaging.

• Neuroethics: Ethical considerations in accessing brain imaging data.

• Brain Networks: Default, Central Executive, Salience networks.

Neuronal Connections and Networks

• Small World Framework: Neurons form local hubs with short and long-distance connections.

• Brain Networks: Default (mind-wandering), Central Executive (cognitive tasks), Salience (monitoring critical changes).

• Psychopathology in Networks: Dysfunction in turning networks on/off in schizophrenia, ADHD, autism.

Genetics and Mental Disorders

• Historical Genetics: Mendel’s principles of heredity, genes on chromosomes.

• Gene Expression: Transcription (DNA to RNA), translation (RNA to proteins).

• Epigenetic Processes: Environmental influences on gene activity; histone modifications.

DNA, Gene Expression, and Epigenetics

• Structure of DNA: Nucleotides (A, G, T, C) in a double helix.

• Gene Expression: Influenced by environmental factors; can be passed to future generations.

• Classic Epigenetic Studies: Influence of nurturing behavior in rats on offspring’s stress response.

Paternal Influences and Genetic Research

• Paternal Influence: Father’s diet and behavior affecting offspring’s gene expression.

• Epigenetics in Mental Disorders: Addiction, depression, schizophrenia, bipolar disorder.

• Mitochondrial Inheritance: mtDNA passed from mother, involved in energy production and mental disorders.

Genome-Wide Association Studies (GWAS)

• GWAS: Analyzing SNPs to find genetic similarities in disorders.

• Polygenic Score: Predicting individual differences in traits.

• Gene Co-Expression: Studying gene networks influencing brain functions.

• Rare Gene Variants: Significant impact on disorders like schizophrenia and bipolar disorder.

Evolutionary Perspective on Psychopathology

• Evolutionary Questions: Universality, adaptive value, historical evidence, nature of psychopathology.

• Human Complexity: Reflection, imagination, cultural influence on behavior and thoughts.

• Basic Processes: Survival, sexuality, socialness, and their disturbance in psychopathology.

Critical Questions

• Critical Questions: Universality, adaptive value, historical evidence, nature, protection, modern interaction.

• Brain Networks: Default, Central Executive, Salience networks.

• Genetic and Evolutionary Themes: Genetic inheritance, epigenetics, mitochondrial DNA.

• Instinctual Processes: Survival, sexuality, socialness in understanding psychopathology.

Chapter 4:

Introduction to Clinical Work

• Overview of how people seek clinical help

  • Scheduled appointments

  • Emergency situations

• Role of a clinician: Making sense of presented information

• First task: Psychological Assessment

  • Gathering information to make clinical decisions

  • Hypotheses about symptom causes

Assessing Cultural Dimensions

• Increasing awareness over the past 40 years

• Understanding disorders in cultural context

• Cultural LENS: Influence on distress expression

Cultural Formulation Interview (CFI)

• Developed for DSM-5 and updated in DSM-5-TR

• Focus on five domains:

  1. Cultural Identity of the Individual

     • Ethnic, racial, or cultural identity

     • Connection to culture of origin

  2. Cultural Conceptualizations of Distress

     • Influence on disorder experience

     • Acceptance of symptoms

     • Willingness to seek help

  3. Psychosocial Stressors and Cultural Vulnerability

     • Variation by culture

     • Support from family and community

     • Influence of cultural elements

  4. Cultural Features of Clinician-Patient Relationship

     • Influence of cultural factors on interaction

     • Expectations of treatment

  5. Overall Cultural Assessment

     • Summarizing cultural influences

     • Incorporating treatment preferences

Importance of Cultural Context

• Enhancing validity of assessment and diagnosis

• 16 questions related to culture in CFI

Reliability and Validity in Psychopathology Assessment

• Importance of accurate assessment and classification

• Challenges:

  • Accuracy of information provided by the individual

  • Selecting appropriate assessment instruments

Reliability

• Consistency of measurement

• Types of reliability:

  • Internal Reliability: Consistency within an instrument

  • Test–Retest Reliability: Consistency over time

  • Alternate-Form Reliability: Consistency across different forms

  • Inter-Rater Reliability: Consistency across different observers

Validity

• Accuracy of measurement

• Types of validity:

  • Content Validity: Measuring all aspects of the phenomenon

Predictive Validity and Assessment Measures

Validity Types

• Predictive Validity

  • Predicting future cognitions, emotions, or actions

  • Example: IQ test predicting college performance

• Concurrent Validity

  • Showing similar results to established measures

• Construct Validity

  • Measuring what it is designed to measure

  • Avoiding sensitivity to unrelated factors

• Ecological Validity

  • Considering data beyond local context

  • Influence of cultural factors on data

Assessment Measures

• Different methods of assessing signs and symbols

  • Symptom questionnaires

  • Personality inventories

  • Projective techniques

  • Neuropsychological approaches

  • Neuroscience approaches

Symptom Questionnaires

• Importance of symptom reporting and comparison

• Example: Beck Depression Inventory (BDI)

  • 21-item questionnaire

  • Four-choice format

  • Useful for determining depressive symptoms and tracking changes

Personality Tests

• Understanding individual styles for relating to the world

• Relationship between personality styles and psychopathology

Minnesota Multiphasic Personality Inventory (MMPI)

• True–false assessment of personality traits

• Development and structure:

  • Large pool of items reduced to 504

  • Given to psychiatric inpatients and compared with non-patients

  • Differentiating mental disorders

MMPI Clinical Scales

• Hypochondriasis (Hs): Excessive concern with bodily symptoms

• Depression (D): Characteristics of depression

• Hysteria (Hy): Emotional manner of experiencing the world

• Psychopathic Deviate (Pd): Antisocial tendencies

• Masculinity–Femininity (Mf): Traditional gender roles

• Paranoia (Pa): Suspiciousness of others

• Psychasthenia (Pt): Excessive anxiety and obsessive behavior

• Schizophrenia (Sc): Bizarre thoughts and lack of reality contact

• Hypomania (Ma): High-energy states and poor judgment

• Social Introversion (Si): Social introversion and extraversion

MMPI Validity Scales

• Lie Scale (L): Detecting attempts to skew results

• Infrequency Scale (F): Items infrequently endorsed by the general population

• Defensiveness Scale (K): Identifying denial of psychological problems

• Additional scales for clinical and research purposes

MMPI Versions

• MMPI-2 (1989)

• MMPI-2-RC (2012)

  • Restructured clinical scales

• MMPI-3 (2020)

  • Normed on a better representation of the general population

  • 10 validity and 42 descriptive scales

  • Hierarchical structure: Emotional/Internalizing Dysfunction, Thought Dysfunction, Behavioral/Externalizing Dysfunction

Projective Tests

Introduction

• Definition: Assessment tests with ambiguous stimuli

• Examples: Inkblots, ambiguous drawings

• Purpose: Understanding mind dynamics based on Freud’s theories

Freud’s Theoretical Basis

• Primary process thought: Non-logical, associative thinking (e.g., dreams)

• Secondary process thought: Logical, organized thinking

• Techniques: Free association and dream analysis

Free Association

• Technique: Say whatever comes to mind while lying on a couch

• Role of therapist: Notice connections between thoughts and emotions

• Assumption: Patterns of responding emerge over time

Historical Development

• Introduction in early 1900s

• Focus on detecting primary process thought and motivational processes

• Potential for understanding cognitive networks

Well-Known Projective Techniques

• Rorschach Inkblots

  • Development by Herman Rorschach

  • Creation and interpretation of inkblots

  • Scoring systems: Exner system and Rorschach Performance Assessment System (R-PAS)

  • Issues: Reliability, validity, scientific debate

  • Current research: Neuroscience techniques

• Thematic Apperception Test (TAT)

  • Developed by Christiana Morgan and Henry Murray

  • Composition: 30 black-and-white drawings

  • Technique: Creating stories about the drawings

  • Purpose: Gaining insight into thoughts, emotions, motivations

  • Limitations: Reliability, validity, and formal diagnosis

Overall Perspective on Projective Techniques

• Debate and controversy

• Pros and cons presented by Frick et al. (2010)

Pros and Cons of Projective Tests

• Pros:

  • Less structured format allows flexibility

  • Assessment of unconscious drives, motivations, desires, and conflicts

  • Provides deeper understanding beyond behavioral patterns

  • Adds to overall assessment picture

  • Helps generate hypotheses regarding functioning

  • Nonthreatening and good for rapport building

  • Long and rich clinical tradition

• Cons:

  • Questionable reliability and interpretation related to clinician characteristics

  • Questionable validity in making diagnoses and predicting behavior

  • Erroneous avenues in testing and misplaced confidence in findings

  • Detracts from time spent collecting detailed, objective information

  • Decreases overall reliability of assessment battery

  • Techniques must continually evolve with knowledge base

Pros and Cons of Projective Tests and Neuropsychological Testing

Neuropsychological Testing

• Purpose: Assessing general cognitive functioning and brain functioning

• Common intelligence tests: Wechsler Adult Intelligence Scale (WAIS)

  • Verbal and performance tasks

• Specific neuropsychological tests: Memory, attention, reasoning, emotional processing, motor processes

Norms and Applications

• Establishment of norms through large-scale testing

• Identifying cognitive changes related to aging or neurocognitive disorders

Historical Development and Current Uses

• Initial development for assessing brain damage from accidents, strokes, war

• Current use: Delineating deficits in mental illness

Examples of Neuropsychological Tests

• Wisconsin Card Sorting Test (WCST)

  • Task: Sorting cards by shape, number, color

  • Application: Identifying frontal lobe damage, schizophrenia-related difficulties

• Continuous Performance Test (CPT)

  • Task: Responding to specific letters in a sequence

  • Application: Measuring attentional characteristics, ADHD-related difficulties

Case Study: Genain Sisters

• Study of monozygotic quadruplets with schizophrenia

• Long-term neuropsychological testing and findings

• Cognitive stability over lifetime despite schizophrenia

Using Neuroscience Techniques to Identify Mental Illness

Introduction

• Shift toward viewing mental illness as brain-related problems

• Various neuroscience approaches to describe psychopathology

Traditional Psychopathology

• Defined in terms of signs and symptoms

• Analysis based on client experiences and professional observations

Neuroscience Techniques

• Identifying markers associated with specific mental disorders

• Brain imaging techniques: MRI, fMRI, EEG, MEG

• Example findings: Differentiation in autism and bipolar disorder

Neuroscience and Symptom Diversity

• Variability in symptom presentation within disorders

• Gender differences in mental disorders

Potential Benefits

• Improved diagnostic procedures

• Understanding mechanisms of disorders

• Genetic research: Similarities between schizophrenia and bipolar disorder

• Following disorder progression using brain imaging

Debates on Diagnosis and Classification

• Emphasis on reliability of diagnosis

• Observable characteristics for defining disorders

• Role of DSM and ICD in diagnosis

Categorical Versus Dimensional Approaches

• Historical emphasis on categorical diagnosis

• New perspectives with genetics and neural networks

• Describing disorders both categorically and dimensionally

Comorbidity and Hierarchical Approaches

• Comorbidity: Presence of multiple disorders in an individual

• National Comorbidity Survey findings

• General vulnerability to psychopathology (p factor)

• Internalizing vs. externalizing disorders

• Identifying common factors for clusters

HiTOP Approach

• Hierarchical Taxonomy of Psychopathology (HiTOP) consortium

• Classification of signs and symptoms

• Key findings: Dimensional characterization, co-occurrence of signs, hierarchical organization

• Efforts to link RDoC and HiTOP approaches

Neuroscience Techniques in Diagnosis and Treatment of Mental Illness

Introduction

• Push for objective markers in diagnosis and treatment

• Various levels of analysis in neuroscience: brain imaging, genetics, biochemical processes, brain networks, behavior, experience

Processes Explored in Neuroscience

• Memory

  • Brain areas: hippocampus, brain networks, biochemical changes

  • Psychopathological conditions: amnesia, delusions

• Reward System

  • Brain structures: nucleus accumbens, dopamine increase

  • Influence of rewards: food, sex, power, drugs

  • Disorders: addiction, mania, depression, schizophrenia

Neuroscience Approaches in Treatment

• Classification and personalized treatment based on underlying brain processes

• Validating theoretical constructs with neuroscience

  • Example: Brain network processes and Freudian constructs

  • Example: Cognitive therapy vs. medication for depression

National Institute of Mental Health (NIMH) Objectives

• Four major objectives:

  1. Define pathophysiology from genes to behavior

  2. Map illness trajectory to preempt disability

  3. Develop personalized interventions

  4. Strengthen public health impact through dissemination and reducing disparities

Integration of Perspectives

• Combining genetics, neurons, neural networks with cognitive, emotional, and behavioral processes

• Research Domain Criteria (RDoC) approach by NIMH

Purposes of Classification (Blashfield and Draguns)

• Nomenclature: Naming disorders for communication

• Information retrieval: Allowing non-professionals to search for information

• Descriptive system: Summarizing behaviors, thoughts, emotions

• Predictive system: Knowing disorder course and effective treatments

• Theory of psychopathology: Understanding the disorder

Historical and Current Classification Systems

• Emphasis on reliability of diagnosis and observable characteristics

• International Classification of Diseases (ICD)

  • History and development

  • Current version: ICD-11, used in over 100 countries

  • Mental disorders described as narratives

• Diagnostic and Statistical Manual of Mental Disorders (DSM)

  • Origins and development

  • Emphasis on consistency and environmental stress

  • First version: DSM-I published in 1952

Evolution of the DSM and Classification Systems

DSM-I Classification System

• Two broad categories:

  1. Disorders with brain pathophysiologies (e.g., Huntington’s chorea, neurocognitive disorders)

  2. Disorders with environmental components

• Divided into psychosis, neurosis, and character disorders

DSM-II (1968)

• Alignment with ICD-8

• Increased ability to collect worldwide statistics on mental disorders

Changes Leading to DSM-III (1980)

• Greater precision in describing signs and symptoms

• Differentiating one disorder from another

• Use of experimental research to inform definitions

DSM-III Major Changes

• Focus on observable evidence

• Specific criteria for disorders

• Five-level system of axes:

  • Axis I: Psychopathological symptoms

  • Axis II: Personality or intellectual disability

  • Axis III: Medical disorders

  • Axis IV: Significant environmental factors

  • Axis V: Level of functioning and role impairment

DSM-IV (1994) and DSM-IV-TR (2000)

• Coordination with ICD-10

• Increased scientific evidence for diagnostic criteria

• Three-step process for developing criteria

• DSM-IV-TR: Expanded text information

DSM-5 (2013) and DSM-5-TR (2022)

• Expanded scientific basis of diagnosis

• Collaboration with NIMH

• Consideration of developmental issues, gaps, disability, neuroscience, nomenclature, cross-cultural issues, age, and gender issues

• Input from WHO for ICD-11

Dimensional Assessments and Spectrums in DSM-5

• Introduction of dimensional assessments

• Disorders viewed as spectra (e.g., autism spectrum disorder, bipolar disorder)

• Combination of dimensional and categorical definitions

Example: DSM-5-TR Diagnostic Criteria for Specific Phobia

• Detailed criteria including duration, intensity, and sociocultural context

Detailed Guidelines and Use of DSM-5-TR

Introduction

• Importance of a careful clinical history

• Understanding social, psychological, and biological factors

• Differentiating between mental disorder and cultural deviations

Context and Organization

• DSM-5-TR as a manual for organizing symptoms, not specifying treatments

• Dropping the multiaxial system from DSM-III and DSM-IV

  • Eliminating Axes III, IV, and V

  • No separate axis for personality disorders

Organization Based on Vulnerabilities and Symptom Characteristics

• Chapters organized by general categories (e.g., neurodevelopmental, emotional, somatic)

• Advances in brain imaging, genetics, and neurosciences suggesting similarities

Challenges and Usages of DSM-5-TR

• Used by mental health professionals, researchers, and legal system

• Different demands for understanding processes, defining treatment, and legal considerations

Psychological Assessment

• Gathering information for clinical decisions

• Clinical interview (mental status exam) organized into major assessment categories

• Structured Clinical Interview for DSM Disorders (SCID)

• Cultural Formulation Interview (CFI) to understand cultural context

Concerns About Reliability and Validity

• Reliability: Internal, test–retest, alternate-form, inter-rater reliability

• Validity: Content, predictive, concurrent, construct validity

Models of Assessment

• Symptom questionnaires, personality tests, projective tests, neuropsychological testing

• Neuroscience techniques: Brain imaging (MRI, fMRI, EEG, MEG)

• Identifying underlying markers and brain processes

Classification Systems

• Organizing diversity of mental disorders

• Emphasis on reliability of diagnosis and observable characteristics

• DSM and ICD as primary classification systems

• Changes in DSM-5 and DSM-5-TR: Dimensional assessments and spectrum-related disorders

• Placement of disorders based on vulnerabilities and symptoms

National Institute of Mental Health (NIMH) Program

• Research Domain Criteria (RDoC) to study, prevent, and treat mental disorders