Psychopathology and Treatment

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Psychopathology and Treatment
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Definition

• Psychopathology
• Clinical term
• A disorder of the mind that interferes with
  everyday functioning
• Insanity
• Legal term
• Definition has changed over time
• Mental illness or defect decreased the
  individuals capacity to appreciate the
  criminality of their behavior or to conform to
  the law

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Diagnosis

• Emil Kraeplin (1883)
• First to propose a classification system for
  mental disorders
• Noticed that not all patients with mental illness
  suffered from the same disorder
• Noticed that certain symptoms tended to cluster
  together as a unique syndrome or disorder

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Diagnosis

• Categorical vs Dimensional Diagnosis?
• Categorical
• Set of symptoms that vary together
• Must meet minimum threshold (e.g., 4 or more
  symptoms out of 9), to have the disorder
• Dimensional
• May involve a set of symptoms
• Disorder varies in degree of severity (from
  non-existent to severe)

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Diagnosis

• Diagnostic and Statistical Manual of Mental
  Disorders IV
• Categorical diagnostic system
• Specifies sets of observable symptoms for each
  disorder
• Specifies criteria for having or not having the
  diagnosis
• Because symptoms of different disorders overlap,
  gives information for differential diagnosis

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Diagnosis
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Difficulties in Diagnosis

• Rosenhan (1973)
• 8 participants (pseudo-patients) approached 12
  different psychiatric hospitals
• All reported hearing voices saying thud,
  empty, and hollow
• Reported no history of psychiatric problems
• Reported no other symptoms
• All other information about past history was
  accurate
• Once in the hospital, stopped reporting symptom
  and behaved normally

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Difficulties in Diagnosis

• All 12 hospitals admitted the pseudo-patients
• All pseudo-patients were given the diagnosis of
  Schizophrenia
• Took between 7 and 52 days to be released
• All released with a diagnosis of Schizophrenia in
  Remission
• None of staff, but some of the patients, realized
  that the pseudo-patients were sane

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Determining Risk

• Risk for Self-Harm or Harm of Others
• Mental health professionals have legal
  responsibility to breach confidentiality if they
  determine that a patient is at risk for harming
  him/herself or someone else
• E.g., Tarasoff Case
• Problem ? determining potential for harm is
  difficult

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Causes of Mental Disorder

• Biological/Genetic
• Brain structure or neuronal defect
• Inherited predisposition
• Psychological
• Faulty defense mechanisms

• Social Factors
• Family Systems Model
• Sociocultural Model
• Cognitive Behavioral
• Classical/operant conditioning
• Modeling/Vicarious reinforcement

Treatment is based on the conceptualization of
the disorder
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Mood Disorders
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Mood Disorders

• Mood disorders reflect extreme emotions that
  affect our ability to function and perform
  everyday activities

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Mood Disorders

• Depressive Disorders (AKA unipolar depression) ?
  pervasive feelings of sadness
• Major Depression
• Dysthymia
• Bipolar Disorders ? radical fluctuations in mood
  from sad to elated or irritable
• Bipolar I ? Major Depression Mania
• Bipolar II ? Major Depression Hypomania
• Cyclothymia ? Dysthymia Hypomania

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Major Depression
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Symptoms

• Depressed mood most of the day, nearly every day
• Loss of interest/ pleasure in previously enjoyed
  activities
• Significant weight loss or gain (gt 5 of body
  weight)
• Insomnia/hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Impaired thinking/concentration
• Recurrent thoughts of death or of suicide

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Causes

• Genetic
• Twin, family, and adoption studies suggest a
  genetic component for depression
• Identical twins 4 X more likely to be concordant
  for depression than Fraternal twins
• Biological
• Low levels of norepinephrine ? depression
• Low levels of serotonin ? depression

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Causes

• Biological (continued)
• Circadian rhythms, particularly patterns of
  sleeping and waking, are associated with
  depression
• Seasonal Affective Disorder
• As amount of daylight decreases, level of
  depression increases

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Seasonal Affective Disorder
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Causes

• Social/Environmental
• More stressful events ? greater likelihood of
  developing depression
• Having a close friendship ? mitigates against the
  impact of stressful life events

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Causes

• Cognitive (A.T. Beck)
• Cognitive Triad
• Depressed people think about themselves, their
  situation, and the future in a negative manner
• Attributions
• Failures/misfortunes (internal causes) personal
  defects
• Successes (external causes) luck
• Errors in Logic
• Overgeneralizing based on single events
• Magnifying the seriousness of events
• Taking responsibility for bad events

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Causes

• Learned Helplessness (Seligman)
• People view themselves as unable to control the
  negative events in their lives
• Attribute negative events to personal defects
  stable and global
• People begin to feel helpless about the ability
  to make positive changes
• Theory based on animal research
• Animals placed in aversive situations that they
  could not escape ? passive and unresponsive

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Treatment

• Depressive Disorders

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Medication

• Early Antidepressants
• Monoamine Oxidase Inhibitors (MAOI)
• Effective for treating depression
• Highly toxic
• Tricyclic antidepressants
• Effective for treating depression
• Cause weight gain, sedation, sweating,
  constipation, heart palpitations, and dry mouth

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Medication

• Modern Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• e.g., Prozac, Lexapro, Paxil
• Increase serotonin levels by blocking reuptake
• Some also have norepinephrine effects
• Also effective for treating anxiety
• Atypical Antidepressants
• Bupropion ? fewer side effects than other
  antidepressants (no sexual side effects)

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Behavioral Therapies

• Cognitive Therapy
• People are depressed because of negative beliefs
  about themselves, their situation and the future
• Therapy focuses on helping clients
• Recognize when they are thinking negatively
• Identify the negative thoughts/beliefs
• Challenge the beliefs with more positive and
  adaptive thoughts and/or behavioral experiments

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Cognitive Therapy
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Personality Disorders
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Personality Disorder

• When an individual relates to the world in
  inflexible and maladaptive ways that is
  long-lasting and interferes with social,
  occupational or other functioning

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Types of Personality Disorders

• Cluster A ? Odd or Eccentric Behavior
• Paranoid
• Schizoid
• Schizotypal
• Cluster B ? Dramatic, emotional or erratic
  behavior
• Histrionic
• Narcissistic
• Borderline
• Antisocial
• Cluster C ? Anxious or Fearful Behavior
• Avoidant
• Dependent
• Obsessive-Compulsive

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Borderline Personality Disorder
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Symptoms
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Causes

• Genetics
• Unclear at present
• Often have families members with mood disorders
• Biological
• Low Serotonin ? depressed mood and impulsivity
• Social/Cultural
• 70-80 have history of physical or sexual abuse
  or other trauma
• Caretakers who were critical or rejecting
• Caretakers who fostered dependence

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Treatment

• Borderline Personality Disorder

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Behavioral

• Dialectical Behavior Therapy (DBT)
• Combines elements of behavioral, cognitive, and
  psychodynamic approaches
• Involves both group and individual therapy
  sessions
• Begins with a discussion of what is expected of
  the client and what can be expected of the
  therapist

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Dialectical Behavior Therapy

• Three Stages of Treatment
• Stage 1 ? extreme symptoms (i.e., self-injurious
  and suicidal behaviors) are replaced with more
  effective/acceptable coping strategies
• Stage 2 ? explore and address traumatic
  experiences
• Stage 3 ? works on development of self-respect
  and independent problem-solving
• learn to support and validate themselves rather
  than relying on others