Psychopathology 8 December 2015 Overview of Mental
Disorders
Conceptions and definitions Incidence, prevalence and causes Major
categories Relationship to personality theories Closing thoughts
Some Things to Consider
Psychopathologies have biological/medical and
psychological/experiential causes Complexity of causes and symptoms
complicates diagnoses and treatment Perceptions and stigmatization
can affect diagnosis and treatment seeking Mental Disorders Arent
from Evil Spirits
Early theory: Possession mental disorders Somatogenic hypothesis
(bodily) General paresis (Kraft-Ebing) Syphilis delusions,
depression, paralysis, and death Psychogenic hypothesis
(psychological) Hysteria (Charcot; Freud; Breuer) Paralysis or
emotional fits with no neurological damage Modern Views:
Diathesis-Stress Model
Predisposition (e.g., genetic) for disorder Stress Triggers
disorder Both diathesis (risk) and stress must be present for
disorder Modern Views: Multicausal Models
Expands diathesis-stress models Multiple diatheses E.g., genetics,
styles of thinking Multiple stresses E.g., relationship problems,
victim of a crime Biopsychosocial perspective All three can
contribute to mental disorders Diagnosis Guidelines: DSM-V
DSM-IV-TR ( ) DSM-V (2013-Present) Previously, 5 major axes
Clinical syndromes and disorders Personality disordersand mental
retardation Medical conditions Psychosocialand environmental
stressors Global assessment of functioning Revised, nonaxial
Biopsychosocial diagnosis and risk factors (Axes I-III)
Psychosocial and environmental stressors (Axis IV) Disability (Axis
V) Better aligned with international standards (WHO, ICD) Mental
Disorders are Functionally-Defined
Behavioral or psychological syndrome or pattern that occurs in a
person and that is associated with present distress (e.g., a
painful symptom) or disability (i.e., impairment in one or more
important areas of functioning) or with a significantly increased
risk of suffering death, pain, disability, or an important loss of
freedom. In addition, this syndrome or pattern must not be merely
an expectable and culturally sanctioned response to a particular
event, for example, the death of a loved one. Whatever its original
cause, it must currently be considered a manifestation of a
behavioral, psychological, or biological dysfunction in the
individual. DSM-IV-TR (American Psychiatric Association, 2000)
Functional Focus of Diagnosis
DSM focuses definitions of mental disorders on impaired function
within social/cultural context Biological/psychological symptoms of
distress E.g., chronic pain, hallucinations Disability E.g., motor
impairment or learning deficits Social/cultural context E.g.,
Crying, fear, and anger are culturally universal emotional
responses to death, but may be suppressed in Western cultures
(Parkes, Laungani, & Young, 2003) Mental Illness Is a Major
Social Issue
Each year, 1 in 5 American adults are or have been diagnosed with a
mental illness Not drug/alcohol-related Does not include ADHD,
autism spectrum disorder, schizophrenia or other psychotic
disorders Risk of Mental Illness Is Widespread
Point prevalence How many people live with a disorder at a given
time Lifetime prevalence How many people will experience a given
disorder at any point in life Lifetime prevalence among US adults =
46% Assessing Mental Disorders
Assessment is critical for understanding reasons for symptoms and
developing a treatment plan 3 primary methods of assessment
Clinical interviews Self-report measures Projective tests
Assessment: Clinical Interviews
Semistructured interview Specific sequence of questions to identify
certain diagnostic content Symptoms Patient report of physical or
mental condition Signs Clinicians observations of physical or
mental condition Assessment: Self-Report Measures
Inventory of items to target symptoms or profile patients Beck
Depression Inventory 21 items, specific to depression Minnesota
Multiphasic Personality Inventory (MMPI-2) 567 items, broad profile
of personality Methods of Assessment: Projective Tests
Projective test types Thematic Apperception Test (TAT) Rorschach
(inkblot) Test Meant to indirectly reveal unconscious wishes or
conflicts Though popular, weak correlations with mental health
Thought Question Considering biopsychosocial factors
Give one pro AND one con of labeling mental disorders Please, write
your name and section on slips Section Time TA Name A 9:30 AM Josh
C 11:30 AM Jing D Matthew E Sophie F 12:30 PM G 10:30 AM H 1:30 PM
Kevin I J 2:30 PM L 3:30 PM Muhammad M Charlotte N 6:30 PM Anna
Major Categories of Mental Disorders
Anxiety disorders Mood disorders Schizophrenia Other Axis I &
II disorders Anxiety: Coping with Intense Emotions
Characterized by feelings of intense distress or worry Disruptive
and unsuccessful attempts at coping with those feelings Phobias =
Fear + Avoidance
Specific phobias E.g., acrophobia (heights), claustrophobia
(enclosed places), arachnophobia (spiders) Social phobia (social
anxiety disorder) Avoidance may exacerbate psychological or
physical harm E.g., more extreme avoidance of related fears,
resorting to substance abuse dependence Panic Disorder As Physical
Anxiety
Panic attacks Sudden onset of terrifying bodily symptoms Labored
breathing Choking Dizziness Tingling hands & feet Sweating
Trembling Heart palpitations Chest pain Anxiety Can Be Continuous
& Pervasive
Phobias need a stimulus Panic attacks are not constant Generalized
Anxiety Disorder Visibly worried nearly all the time Anxiety is not
specific to any stimulus Physical symptoms (e.g., rapid heart rate,
irregular breathing, sweating) can accompany psychological symptoms
Obsessive-Compulsive Disorder (OCD)
Obsessions Recurrent, unwanted or disturbing thoughts Compulsions
Repetitive or ritualistic acts that may help cope with obsessions
OCD symptoms may defend against anxiety 3 minutes in the mind of
someone with OCD Acute and Post-Traumatic Stress Disorders
Triggered abruptly by identifiable, horrific event Dissociation
Numbness to traumatic event Reactions include intense, intrusive
recurrent nightmares and flashbacks Affects women and men equally,
with different causes Women: rape or assault Men: combat-related
Specific Differences in PTSD
Major clusters of symptoms persist >1 month Re-experience
Nightmares, flashbacks Arousal Difficulty sleeping, concentrating
Avoidance Avoid anything related to trauma 7% lifetime prevalence
More likely in women Roots of Anxiety Predisposition is
heritable
Meta-analysis of siblings Identical twins have higher chance of
having same diagnosis than fraternal twins or non-twins Hettema,
Neale, Kendler, 2011 Anxiety can be conditioned Classical
(Pavlovian) exposure to stimulus in context of fear or anxiety
Vicarious observing another persons anxiety Roots of Anxiety
Similar brain areas (amygdala, insula) are hyperactive (red) across
phobias, social anxiety, and PTSD Hypoactivation (blue) may be
related to blunted affect in PTSD Etkin & Wager, 2007 Mood:
Persistent Ups and/or Downs
Depression Extremely common lifetime prevalence 1 in 4 women, 1 in
10 men Global deficits or disruption in Affect (sadness, loss of
pleasure) Behavior (sleep, diet, bodily functions) Cognition
(attention, working memory) Severe symptoms persist for > 2
weeks Common in adolescence through middle adulthood, but not
specific to any age in life Mood: Persistent Ups and/or Downs
Bipolar Disorder Depressive & manic episodes (hours-months in
duration) Mania racing thoughts and speech, irritability or
euphoria, impaired judgment Hypomania Mania Acute/Psychotic Mania
Short-lived periods, particularly insidious progression Switching
doesnt always happen, but there can be mixed states (signs of both
depression and mania) Lifetime prevalence of 4%... Roots of Mood
Disorders
High concordance rate For bipolar disorder, 60% in twins (Kelsoe,
1997) Neurotransmitter response and/or reuptake have complex,
unclear effects on mood Norepinephrine, dopamine, serotonin
Personal experiences, environment, and social/cultural factors can
increase vulnerability to depression Family/job problems; low SES
neighborhood; social support structure; norms for expressing
emotion Developing Vulnerability to Mood Disorders
Negative cognitive schema (Beck) Automatic, negative
interpretations about self, future, world Explanatory style
(Peterson & Seligman) Internal, global, stable characterization
of bad experiences Since the above both predate depression, how
might personality be involved? Schizophrenia: The Split Mind
(Blueler)
Group of severe mental disorders Disturbance of thought,
withdrawal, inappropriate or flat emotions, delusions,
hallucinations Lifetime prevalence = 1% Commonly diagnosed in
adolescence or early adulthood; more often in men Signs and
Symptoms of Schizophrenia
Positive or negative symptoms based on presence or absence in
healthy people Cognitive symptoms reflect impaired attention,
working memory, inhibitory control, and even early sensory
processing Psychosis is a cognitive break from reality Bizarre
beliefs and perceptions Positive Symptoms of Schizophrenia
Not typically present in healthy individuals Delusions Systematized
false beliefs of grandeur or persecution (delusions of reference)
Hallucinations Sensory experience without actual external
stimulation Anderson Cooper tries a schizophrenia simulator
Disorganized behavior Strangely dressed, violent or nonsensical
behavior Negative Symptoms of Schizophrenia
Not typically absent or low in healthy individuals Flat affect
Little to no display of emotion Catatonic behavior Anhedonia No
interest in pleasurable activities Withdrawal Isolation from social
interactions Development of idiosyncratic thoughts and behavior
Genetics & Development in Schizophrenia
Risk increases with closer relations Potential developmental risk
factors Influenza exposure Brown et al., 2001 Maternal malnutrition
St. Clair et al, 2005 Oxygen deprivation Cannon et al., 2000 Neural
Bases of Schizophrenia
Dopamine Hypothesis Oversensitivity to dopamine Classic
antipsychotics block dopaminergic signaling Amphetamines increase
dopamine activity schizophrenia-like symptoms Neural Bases of
Schizophrenia
Enlarged ventricles Decreased white and gray matter volume Shenton
et al., 2001 Decreased gray matter in prefrontal cortex Impaired
executive control Poverty: Diathesis & Stress in
Schizophrenia
Prevalence in Chicago ( ) Low SES closer to center High incidence
High SES moving outward Low incidence Poverty increases
vulnerability to schizophrenia, schizophrenia increases
vulnerability to poverty Overview of Other Axis I & II
Disorders
Developmental Eating Dissociative Personality Developmental
Disorders
Autism Language deficits: late onset, pronoun difficulties Motor
impairments: peculiar repetitive actions Apparently have little
understanding of or interest in other peoples emotions or goals
Attention-deficit/hyperactivity disorder (ADHD) Impulsivity,
attentional deficits, behavioral problems Controversy in diagnosis
Development of prefrontal cortex is implicated Eating Disorders
Either may arise from genetic factors, as well as sociocultural
norms of attractiveness Anorexia nervosa Appear underweight
Preoccupation with food, eating, gaining weight Incredibly strict
dieting and/or exercise; purging Bulimia nervosa Appear normal
weight Binging and compensatory behavior Dissociative
Disorders
Psychological distancing to cope with ongoing traumatic or
distressing events Dissociative amnesia Sudden inability to
remember a period of life Dissociative fugue Wandering from home
for extended period of time Dissociative identity disorder (DID)
Creation of multiple personalities Personality Disorders
Some aspects of different personality dimensions can be socially or
culturally maladaptive The associated maladaptive behaviors and
cognitions can lead to distress or impairments Since personality is
relatively stable within an individual and across time, such issues
can then be pervasive and persistent 10 Types of Personality
Disorders
Paranoid Mistrust of others Schizoid Detachment from others
Schizotypal Discomfort with relationships; cognitive &
perceptual distortions; odd behavior Antisocial Disregard &
violation of others rights Borderline Impulsive behavior; unstable
relationships, self-concept, affect Histrionic Excessive
attention-seeking and emotionality Narcissistic Grandiose, lacks
empathy, attention- and validation-seeking Avoidant Social
inhibition & insecurity Dependent Excessive need to be cared
for Obsessive-Compulsive Preoccupation with order, cleanliness, and
control Take Home Messages There is a high prevalence of mental
illness
Mental illnesses have biological, psychological, and social
underpinnings Social factors can influence illnesses and their
characterization/stigmatization Complexity of mental illnesses
(e.g., symptoms, signs, comorbidity) make diagnosis and treatment
extremely challenging Some Thoughts before We Cover Treatment
1 in 5 people you see may live with a mental illness Consider how
biological, psychological, and social factors influence our
perceptions of people who live with mental illness How do these
factors guide our assessment and treatment? How do these factors
help or hinder the decision to seek treatment? Be compassionate!!!
Even though you see people every day, you may never know what its
like live a day in their mind
