Week 1 – Psychopathology & Diagnostic Systems (MPP502)

Definition: Study of mental disorders—their symptoms, causes, & treatments.
- Differs from general mental-health studies by emphasizing abnormal experiences over wellness/prevention.
Multidisciplinary Roots
- Clinical Psychology → how symptoms present & impair functioning.
- Psychiatry → medical/biological interventions.
- Neuroscience → neural & genetic underpinnings.
- Social Sciences → cultural, environmental, & systemic influences.

Ancient/Supernatural Models
- Mental illness = punishment or possession → exorcisms, rituals.
Hippocratic Somatic Model (\approx 400\,\text{BCE})
- Four-humor imbalance; shifted cause to the body.
Middle Ages (500-1500\,\text{CE})
- Moral failure/demonic framing → harsh punitive “treatments.”
Asylum Era (1600s-1800s)
- Large-scale institutionalisation; conditions often inhumane.
Modern Psychiatry (1900s\text{–Present})
- Psychoanalysis, behaviourism, cognitive science, neuroscience, & evidence-based care progressively refine diagnosis & treatment.

DSM-5-TR
- Symptom-cluster, mental-disorder–only focus.
- Historically criticised for weak cultural context; TR adds cultural notes.
ICD-11
- Includes physical & mental disorders; broader global adoption.
- Greater weight to psychosocial & contextual factors.

Categorical (DSM/ICD)
- Binary diagnosis based on symptom lists.
- Pros: Standardisation; research comparability; insurance & policy utility.
- Cons: Rigid cut-offs, limited severity gradation, minimal context.
Dimensional
- Traits on continua (e.g., anxiety intensity).
- Pros: Captures severity & sub-threshold distress; aligns with RDoC research.
- Being piloted for future manual revisions.

Practical Constraints: Limited time/data vs. Professional Mandate: Evidence-based accuracy.
Three Tiers of Information Gathering
- Screening → brief, broad snapshots.
- Testing → formal tools measuring traits/abilities/symptoms.
- Assessment → integrative synthesis (tests + interview + collateral).

Autism Spectrum Disorder (ASD)
- Social–communication deficits & restricted/repetitive behaviour; severity ranges from high support needs to independent living.
Attention-Deficit/Hyperactivity Disorder (ADHD)
- Inattention, hyperactivity, impulsivity; onset <12\,\text{yrs}; symptoms must impair daily life.
Intellectual Disability (ID)
- Deficits in reasoning/problem-solving \rightarrow impaired adaptive functioning (daily living, social participation).

Major Depressive Disorder (MDD)
- Persistent low mood, anhedonia, sleep/appetite change, fatigue, worthlessness, suicidal ideation lasting \ge 2\,\text{weeks}.
Bipolar Disorders
- Bipolar I → ≥1 manic episode (may include depression).
- Bipolar II → ≥1 hypomanic + ≥1 major-depressive episode.
- Mania = elevated/irritable mood, grandiosity, risky activity.

Generalised Anxiety Disorder (GAD)
- Excessive worry across domains; restlessness, tension, fatigue, concentration issues.
Panic Disorder
- Recurrent unexpected panic attacks (palpitations, dizziness, fear of dying) \rightarrow avoidance/fear of future attacks.
Social Anxiety Disorder
- Intense fear of social scrutiny, embarrassment, rejection.

Post-Traumatic Stress Disorder (PTSD)
- Intrusions, avoidance, negative mood/cognition, hyper-arousal persisting >1\,\text{month} post-trauma.
Acute Stress Disorder (ASD)
- Similar cluster lasting <1\,\text{month}.

Schizophrenia
- Hallucinations, delusions, disorganised speech/behaviour, negative symptoms lasting \ge 6\,\text{months}.
Schizoaffective Disorder
- Schizophrenia symptoms plus mood-episode features (depression or mania).

Borderline Personality Disorder (BPD)
- Affective instability, fear of abandonment, impulsivity, self-harm.
Antisocial Personality Disorder (ASPD)
- Rule violation, deceit, lack of empathy, manipulative conduct.

Comprehensive Data Collection
- Clinical interview, self-report scales, collateral info, medical history.
Manual Comparison
- Match symptom pattern to DSM-5-TR/ICD-11 criteria.
Rule-Outs
- Medical (e.g., hypothyroidism mimicking depression).
- Substance-induced presentations.
- Cultural/contextual frames (e.g., normative spiritual visions vs. psychosis).
Severity & Functional Impact
- Mild → distress w/o impairment.
- Moderate → work/relationship disruption.
- Severe → pervasive impairment.
Treatment Planning
- Diagnosis informs modality (e.g., CBT for anxiety; meds + therapy for severe depression).

Objectives
- Determine presence/severity of symptoms, functional impact, diagnostic fit, & recommend treatment.
Quality Principles
- Reliability → consistent results.
- Validity → measuring intended construct.
- Standardisation → uniform procedure ensures fairness.
- Cultural Sensitivity → adaptation for language, beliefs, context.

Unstructured
- Open-ended dialogue; flexible but lower inter-rater reliability.
Structured
- Pre-set questions (e.g., SCID-5); high reliability but rigid.
Semi-Structured
- Hybrid (e.g., MINI); balances thoroughness & flexibility; demands clinician skill.

Informed Consent: Clarify purpose, process, & data use.
Avoid Over-Diagnosis/Labeling: Recognise sub-clinical distress; monitor spectrum thinking.
Confidentiality & Data Security: Secure storage; share only with permission.
Cultural Competency: Interpret symptoms through client’s cultural lens; avoid pathologising culturally normative behaviours.