Psychopathology Notes

Psychopathology Overview

• Definition of Mental Disorders: Persistent disturbances in behavior, thoughts, or emotions that cause significant distress or impairment in daily functioning.

• Diagnosis: Based on behavioral symptoms rather than physiological measurements.

• Classification System: DSM-5 is the current standard for diagnosing mental disorders.

Prevalence of Mental Disorders

• Approximately 12% of individuals worldwide deal with mental disorders at any given time.

• In North America, this percentage is higher, approximately 20%.

• Gender Differences:

  • Depression and anxiety are more common in women.

  • Substance use disorders (e.g., alcohol use disorder) are more common in men.

Mental Disorder Statistics

• About 50% of Americans experience at least one mental disorder at some point.

• Roughly 80% report experiencing a comorbid disorder (another disorder alongside the first).

• Common comorbid disorders include:

  • Anxiety with mood disorders (e.g., depression).

  • Impulse control disorders with substance use disorders.

• Cultural Impacts: Cultural factors can influence how disorders are discussed and experienced.

Medical Model of Mental Disorders

• Examines mental disorders as illnesses with biological and environmental causes.

• Diagnosis: Based on signs (objectively observed indicators) and symptoms (subjective feelings reported by the individual).

Stigma and Treatment Seeking

• Negative stigma attached to mental disorders (e.g., labeled as dangerous) discourages individuals from seeking treatment.

• Approximately 60% do not seek treatment due to stigma.

• Importance of using person-first language, such as "individuals with schizophrenia" instead of "schizophrenic."

Schizophrenia

• Characteristics: Positive, negative, and cognitive symptoms.

• Positive Symptoms: Abnormal states gained (e.g., hallucinations, delusions, disorganized behavior).

• Negative Symptoms: Reduction in typical functioning (e.g., lack of emotional expression, anhedonia).

• Cognitive Symptoms: Difficulties in memory, attention, decision making, and social cognition.

Treatment for Schizophrenia

• Early 1900s: Treatment often included prefrontal lobotomies.

• 1950s: Introduction of the first drug, chlorpromazine, to eliminate positive symptoms.

• Typical Antipsychotics: D2 receptor antagonists lead to the Dopamine Hypothesis (excess dopamine causes schizophrenia).

• Long-term Risks: Risk of tardive dyskinesia from prolonged use of typical antipsychotics.

• Atypical Antipsychotics: More effective with fewer motor symptoms; affect different neurotransmitter systems (e.g., serotonin).

Brain Changes in Schizophrenia

• Ventricular Changes: Enlarged lateral ventricles correlated with the DISC1 gene in mouse models.

• Cortical Thinning: Related to synaptic changes in gray matter.

• Structural Changes: Changes in the corpus callosum, amygdala, and hippocampus observed in affected individuals.

Genetic Factors

• Heritability: Strong genetic link; higher risk in relatives of diagnosed individuals.

• Adoption Studies: Help disentangle environmental from genetic influences.

• Twin Studies: Higher concordance rates in monozygotic twins for schizophrenia compared to dizygotic twins.

Other Factors Impacting Schizophrenia

• Advanced Paternal Age: Increases risk for schizophrenia.

• Stress: Higher stress during life transitions (e.g., moving, starting college) can trigger episodes.

• Urban Living: Associated with higher risk due to environmental factors.

• Prenatal Stress: Infections during pregnancy can affect the likelihood of future diagnosis.

Depression

• Major Depressive Disorder: Characterized by persistent low mood, loss of interest, and changes in sleep and appetite.

• More common in women and older adults.

• Prevalence: 7% of Americans experience major depressive disorder each year.

Genetic Factors in Depression

• Concordance Rates: 40% in identical twins vs. 20% in fraternal twins.

• Likely a mix of genetic predisposition and environmental influences.

Treatment Options for Depression

• Electroconvulsive Therapy (ECT): Induces seizures to 'reset' brain activity; less common today.

• Repetitive Transcranial Magnetic Stimulation (rTMS): Alters neural activity without invasive procedures.

• Medication:

  • Monoamine oxidase inhibitors (MAOIs) prevent monoamine breakdown, leaving more in the synapse.

  • SSRIs block serotonin reuptake (e.g., Prozac).

  • SNRIs block reuptake of both serotonin and norepinephrine (e.g., Cymbalta).

• CBT is effective for breaking cycles of negative thinking and best combined with medication.