Psychopathology and Treatment. Definition Psychopathology Psychopathology Clinical term Clinical term A disorder of the mind that interferes with everyday.

Psychopathology Psychopathology and and

TreatmentTreatment

DefinitionDefinition Psychopathology Psychopathology

Clinical termClinical term A disorder of the mind that interferes with everyday A disorder of the mind that interferes with everyday

functioningfunctioning InsanityInsanity

Legal termLegal term Definition has changed over timeDefinition has changed over time Mental illness or defect decreased the individual’s Mental illness or defect decreased the individual’s

capacity to appreciate the criminality of their capacity to appreciate the criminality of their behavior or to conform to the lawbehavior or to conform to the law

DiagnosisDiagnosis Emil Kraeplin (1883) Emil Kraeplin (1883)

First to propose a classification system for First to propose a classification system for mental disordersmental disorders

Noticed that not all patients with mental illness Noticed that not all patients with mental illness suffered from the same disordersuffered from the same disorder

Noticed that certain symptoms tended to cluster Noticed that certain symptoms tended to cluster together as a unique syndrome or disordertogether as a unique syndrome or disorder

DiagnosisDiagnosis Categorical vs Dimensional Diagnosis?Categorical vs Dimensional Diagnosis? Categorical Categorical

Set of symptoms that vary togetherSet of symptoms that vary together Must meet minimum threshold (e.g., 4 or more Must meet minimum threshold (e.g., 4 or more

symptoms out of 9), to have the disordersymptoms out of 9), to have the disorder DimensionalDimensional

May involve a set of symptomsMay involve a set of symptoms Disorder varies in degree of severity (from non-Disorder varies in degree of severity (from non-

existent to severe)existent to severe)

DiagnosisDiagnosis Diagnostic and Statistical Manual of Mental Diagnostic and Statistical Manual of Mental

Disorders IVDisorders IV Categorical diagnostic systemCategorical diagnostic system Specifies sets of observable symptoms for each Specifies sets of observable symptoms for each

disorderdisorder Specifies criteria for having or not having the Specifies criteria for having or not having the

diagnosisdiagnosis Because symptoms of different disorders overlap, Because symptoms of different disorders overlap,

gives information for differential diagnosis gives information for differential diagnosis

DiagnosisDiagnosis

Difficulties in DiagnosisDifficulties in Diagnosis Rosenhan (1973)Rosenhan (1973)

8 participants (pseudo-patients) approached 12 8 participants (pseudo-patients) approached 12 different psychiatric hospitals different psychiatric hospitals

All reported hearing voices saying “thud,” “empty,” All reported hearing voices saying “thud,” “empty,” and “hollow”and “hollow”

Reported no history of psychiatric problemsReported no history of psychiatric problems Reported no other symptomsReported no other symptoms All other information about past history was accurateAll other information about past history was accurate Once in the hospital, stopped reporting symptom and Once in the hospital, stopped reporting symptom and

behaved normallybehaved normally

Difficulties in DiagnosisDifficulties in Diagnosis All 12 hospitals admitted the pseudo-patientsAll 12 hospitals admitted the pseudo-patients All pseudo-patients were given the diagnosis All pseudo-patients were given the diagnosis

of Schizophreniaof Schizophrenia Took between 7 and 52 days to be releasedTook between 7 and 52 days to be released All released with a diagnosis of Schizophrenia All released with a diagnosis of Schizophrenia

in Remissionin Remission None of staff, but some of the patients, None of staff, but some of the patients,

realized that the pseudo-patients were “sane”realized that the pseudo-patients were “sane”

Determining RiskDetermining Risk Risk for Self-Harm or Harm of OthersRisk for Self-Harm or Harm of Others

Mental health professionals have legal Mental health professionals have legal responsibility to breach confidentiality if they responsibility to breach confidentiality if they determine that a patient is at risk for harming determine that a patient is at risk for harming him/herself or someone elsehim/herself or someone else

E.g., Tarasoff CaseE.g., Tarasoff Case

Problem Problem determining potential for harm is determining potential for harm is difficultdifficult

Causes of Mental DisorderCauses of Mental Disorder Biological/GeneticBiological/Genetic

Brain structure or Brain structure or neuronal defectneuronal defect

Inherited Inherited predispositionpredisposition

PsychologicalPsychological Faulty defense Faulty defense

mechanismsmechanisms

Social FactorsSocial Factors Family Systems ModelFamily Systems Model Sociocultural ModelSociocultural Model

Cognitive BehavioralCognitive Behavioral Classical/operant Classical/operant

conditioningconditioning Modeling/Vicarious Modeling/Vicarious

reinforcementreinforcement

Treatment is based on the conceptualization of the disorder

Anxiety DisordersAnxiety Disorders

Anxiety DisordersAnxiety Disorders Characterized by the experience of excessive anxiety Characterized by the experience of excessive anxiety

in the absence of true danger and avoidance behaviorin the absence of true danger and avoidance behavior

Anxiety is our built-in alarm system Anxiety is our built-in alarm system developed developed to warn us of a threat and give us the energy to to warn us of a threat and give us the energy to respond to the threatrespond to the threat

Excessive, chronic anxiety without identifiable Excessive, chronic anxiety without identifiable cause and that leads to avoidance of non-cause and that leads to avoidance of non-threatening stimuli is abnormalthreatening stimuli is abnormal

Anxiety DisordersAnxiety Disorders Phobic DisordersPhobic Disorders

Social PhobiaSocial Phobia Specific PhobiasSpecific Phobias

Generalized Anxiety DisorderGeneralized Anxiety Disorder Panic DisorderPanic Disorder

With or without agoraphobiaWith or without agoraphobia Obsessive Compulsive DisorderObsessive Compulsive Disorder Post-Traumatic Stress DisorderPost-Traumatic Stress Disorder

Panic Disorder with Panic Disorder with AgoraphobiaAgoraphobia

SymptomsSymptoms Panic DisorderPanic Disorder

Attacks of terror that are sudden, overwhelming, and Attacks of terror that are sudden, overwhelming, and unexpectedunexpected

Did not follow situation that naturally elicits anxiety or Did not follow situation that naturally elicits anxiety or in which the individual was the focus of other’s in which the individual was the focus of other’s attentionattention

Involves fear of dying, of going crazy, or losing controlInvolves fear of dying, of going crazy, or losing control With AgoraphobiaWith Agoraphobia

Fear of situations where escape might be difficult or Fear of situations where escape might be difficult or embarrassing or where help may be unavailable in the embarrassing or where help may be unavailable in the event of an attackevent of an attack

Individual avoids such situations, goes only if Individual avoids such situations, goes only if accompanied, or endures with significant discomfortaccompanied, or endures with significant discomfort

CausesCauses Biological/GeneticBiological/Genetic

Locus coeruleus is the area of the brain that Locus coeruleus is the area of the brain that perceives novelty perceives novelty serves as an alarm system serves as an alarm system

Abnormalities of the locus coeruleus result in Abnormalities of the locus coeruleus result in increased arousal of the central nervous systemincreased arousal of the central nervous system

Increased arousal of CNS Increased arousal of CNS increased sensitivity increased sensitivity to internal and external cues signaling threatto internal and external cues signaling threat

CausesCauses Cognitive BehavioralCognitive Behavioral

Symptoms of anxiety and panic are similar to Symptoms of anxiety and panic are similar to symptoms associated with heart attacksymptoms associated with heart attack

Panic-prone people monitor bodily sensations for Panic-prone people monitor bodily sensations for symptoms that might signal an attacksymptoms that might signal an attack

Presence of symptoms result in life-threatening Presence of symptoms result in life-threatening cognitions (catastrophizing)cognitions (catastrophizing)

Increased focus on bodily sensations + Increased focus on bodily sensations + catastrophizing catastrophizing spiking of anxiety or panic spiking of anxiety or panic

CausesCauses

W. W. Norton

CausesCauses Agoraphobia results from negative Agoraphobia results from negative

reinforcementreinforcement Individuals are fearful of having another panic Individuals are fearful of having another panic

attackattack Going to places where escape might be difficult or Going to places where escape might be difficult or

where it would be embarrassing to have an attack where it would be embarrassing to have an attack increased anxiety increased anxiety

Panic disordered individuals avoid such placesPanic disordered individuals avoid such places Avoidance Avoidance avoidance of fear/anxiety avoidance of fear/anxiety

increased avoidanceincreased avoidance

TreatmentTreatmentPanic Disorder with Panic Disorder with

AgoraphobiaAgoraphobia

MedicationMedication Anxiolytic medications or tranquilizersAnxiolytic medications or tranquilizers

Benzodiazepines (e.g., Valium; Klonapin)Benzodiazepines (e.g., Valium; Klonapin) Used for short-term treatment of anxietyUsed for short-term treatment of anxiety Reduce anxiety and promote relaxationReduce anxiety and promote relaxation High degree of addiction potentialHigh degree of addiction potential

Selective Serotonin Reuptake Inhibitors (SSRI)Selective Serotonin Reuptake Inhibitors (SSRI) Primarily for the treatment of depressionPrimarily for the treatment of depression Appear to have anxiolytic propertiesAppear to have anxiolytic properties Can be used for long-termCan be used for long-term Though not addictive, can have unpleasant side effectsThough not addictive, can have unpleasant side effects

Behavioral TherapyBehavioral Therapy Cognitive Behavioral TherapyCognitive Behavioral Therapy

Education about biological and learning bases of Education about biological and learning bases of panicpanic

Cognitive RestructuringCognitive Restructuring Identifying anxiety-producing thoughtsIdentifying anxiety-producing thoughts Challenging thoughts with accurate informationChallenging thoughts with accurate information Substituting calming and empowering thoughts for Substituting calming and empowering thoughts for

anxiety-producing thoughtsanxiety-producing thoughts

Behavioral TherapyBehavioral Therapy Cognitive Behavioral TherapyCognitive Behavioral Therapy

Relaxation trainingRelaxation training Diaphragmatic breathingDiaphragmatic breathing Progressive muscle relaxationProgressive muscle relaxation

Systematic desensitizationSystematic desensitization Imaginal exposureImaginal exposure In vivo exposureIn vivo exposure

Behavioral TherapyBehavioral Therapy Systematic DesensitizationSystematic Desensitization

Develop fear hierarchyDevelop fear hierarchy

Expose patient to feared stimuli on hierarchyExpose patient to feared stimuli on hierarchy Start with a low-fear stimulusStart with a low-fear stimulus Continue to expose to low-fear stimulus until fear Continue to expose to low-fear stimulus until fear

extinguishesextinguishes Move to slightly more feared stimulus only after lower-Move to slightly more feared stimulus only after lower-

feared stimulus is masteredfeared stimulus is mastered

Panic DisorderPanic DisorderExerciseExercise SymptomSymptom

SpinningSpinning Dizziness, faintnessDizziness, faintness

GaggingGagging ChokingChoking

JoggingJogging Increased heart rate, increased B/p, chest Increased heart rate, increased B/p, chest tightness, sweating, flushingtightness, sweating, flushing

PushupsPushups Chest tightness, arm tightnessChest tightness, arm tightness

Holding breathHolding breath Chest tightness, depersonalization, derealization, Chest tightness, depersonalization, derealization, suffocatingsuffocating

HyperventilatingHyperventilating Dizziness, disorientation, depersonalization Dizziness, disorientation, depersonalization derealizationderealization

Inhaling COInhaling CO22 Choking, suffocating, derealization, Choking, suffocating, derealization, depersonalizationdepersonalization

Mood DisordersMood Disorders

Mood DisordersMood Disorders Mood disorders reflect extreme Mood disorders reflect extreme

emotions that affect our ability to emotions that affect our ability to function and perform everyday function and perform everyday activitiesactivities

Mood DisordersMood Disorders Depressive DisordersDepressive Disorders (AKA unipolar (AKA unipolar

depression) depression) pervasive feelings of sadness pervasive feelings of sadness Major DepressionMajor Depression DysthymiaDysthymia

Bipolar DisordersBipolar Disorders radical fluctuations in radical fluctuations in mood from sad to elated or irritablemood from sad to elated or irritable Bipolar I Bipolar I Major Depression & Mania Major Depression & Mania Bipolar II Bipolar II Major Depression & Hypomania Major Depression & Hypomania Cyclothymia Cyclothymia Dysthymia & Hypomania Dysthymia & Hypomania

Major DepressionMajor Depression

SymptomsSymptoms Depressed mood most of the day, nearly every dayDepressed mood most of the day, nearly every day Loss of interest/ pleasure in previously enjoyed Loss of interest/ pleasure in previously enjoyed

activitiesactivities

Significant weight loss or gain (> 5% of body weight)Significant weight loss or gain (> 5% of body weight) Insomnia/hypersomniaInsomnia/hypersomnia Psychomotor agitation or retardationPsychomotor agitation or retardation Fatigue or loss of energyFatigue or loss of energy Feelings of worthlessness or guiltFeelings of worthlessness or guilt Impaired thinking/concentrationImpaired thinking/concentration Recurrent thoughts of death or of suicideRecurrent thoughts of death or of suicide

CausesCauses GeneticGenetic

Twin, family, and adoption studies suggest a Twin, family, and adoption studies suggest a genetic component for depressiongenetic component for depression

Identical twins 4 X more likely to be concordant Identical twins 4 X more likely to be concordant for depression than Fraternal twinsfor depression than Fraternal twins

BiologicalBiological Low levels of norepinephrine Low levels of norepinephrine depression depression Low levels of serotonin Low levels of serotonin depression depression

CausesCauses Biological (continued)Biological (continued)

Circadian rhythms, particularly patterns of Circadian rhythms, particularly patterns of sleeping and waking, are associated with sleeping and waking, are associated with depressiondepression

Seasonal Affective Disorder Seasonal Affective Disorder As amount of daylight decreases, level of As amount of daylight decreases, level of

depression increasesdepression increases

Seasonal Affective DisorderSeasonal Affective Disorder

CausesCauses Social/EnvironmentalSocial/Environmental

More stressful events More stressful events greater likelihood of greater likelihood of developing depressiondeveloping depression

Having a close Having a close friendship friendship mitigates mitigates against the impact of against the impact of stressful life eventsstressful life events

CausesCauses Cognitive (A.T. Beck)Cognitive (A.T. Beck)

Cognitive TriadCognitive Triad Depressed people think about themselves, their Depressed people think about themselves, their

situation, and the future in a negative mannersituation, and the future in a negative manner AttributionsAttributions

Failures/misfortunes = (internal causes) personal defectsFailures/misfortunes = (internal causes) personal defects Successes = (external causes) luckSuccesses = (external causes) luck

Errors in LogicErrors in Logic Overgeneralizing based on single eventsOvergeneralizing based on single events Magnifying the seriousness of eventsMagnifying the seriousness of events Taking responsibility for bad eventsTaking responsibility for bad events

CausesCauses Learned Helplessness (Seligman)Learned Helplessness (Seligman)

People view themselves as unable to control the People view themselves as unable to control the negative events in their livesnegative events in their lives

Attribute negative events to personal defects Attribute negative events to personal defects stable and globalstable and global

People begin to feel helpless about the ability to People begin to feel helpless about the ability to make positive changesmake positive changes

Theory based on animal researchTheory based on animal research Animals placed in aversive situations that they Animals placed in aversive situations that they

could not escape could not escape passive and unresponsive passive and unresponsive

TreatmentTreatment

Depressive DisordersDepressive Disorders

MedicationMedication Early AntidepressantsEarly Antidepressants

Monoamine Oxidase Inhibitors (MAOI)Monoamine Oxidase Inhibitors (MAOI) Effective for treating depressionEffective for treating depression Highly toxicHighly toxic

Tricyclic antidepressantsTricyclic antidepressants Effective for treating depressionEffective for treating depression Cause weight gain, sedation, sweating, Cause weight gain, sedation, sweating,

constipation, heart palpitations, and dry mouthconstipation, heart palpitations, and dry mouth

MedicationMedication Modern AntidepressantsModern Antidepressants

Selective Serotonin Reuptake Inhibitors (SSRIs)Selective Serotonin Reuptake Inhibitors (SSRIs) e.g., Prozac, Lexapro, Paxile.g., Prozac, Lexapro, Paxil Increase serotonin levels by blocking reuptakeIncrease serotonin levels by blocking reuptake Some also have norepinephrine effectsSome also have norepinephrine effects Also effective for treating anxietyAlso effective for treating anxiety

Atypical AntidepressantsAtypical Antidepressants Bupropion Bupropion fewer side effects than other fewer side effects than other

antidepressants (no sexual side effects)antidepressants (no sexual side effects)

Behavioral TherapiesBehavioral Therapies Cognitive TherapyCognitive Therapy

People are depressed because of negative beliefs People are depressed because of negative beliefs about themselves, their situation and the futureabout themselves, their situation and the future

Therapy focuses on helping clientsTherapy focuses on helping clients Recognize when they are thinking negativelyRecognize when they are thinking negatively Identify the negative thoughts/beliefsIdentify the negative thoughts/beliefs Challenge the beliefs with more positive and Challenge the beliefs with more positive and

adaptive thoughts and/or behavioral adaptive thoughts and/or behavioral experimentsexperiments

Cognitive TherapyCognitive Therapy

Psychotic DisordersPsychotic Disorders

Psychotic DisordersPsychotic Disorders Psychotic disorders are characterized Psychotic disorders are characterized

by disturbances in thoughts, by disturbances in thoughts, perceptions, consciousness, and perceptions, consciousness, and emotionsemotions

These disturbances lead to impaired These disturbances lead to impaired social, personal, and/or occupational social, personal, and/or occupational functioningfunctioning

SchizophreniaSchizophrenia

SymptomsSymptoms Positive Symptoms (excesses)Positive Symptoms (excesses)

Delusions Delusions false personal beliefs based on incorrect false personal beliefs based on incorrect inferences about realityinferences about reality

Hallucinations Hallucinations false sensory perceptions that are false sensory perceptions that are experienced w/o an external sourceexperienced w/o an external source

Loosening of associations Loosening of associations shift rapidly from one topic to shift rapidly from one topic to anotheranother

Negative Symptoms (deficits)Negative Symptoms (deficits) Socially isolated and withdrawnSocially isolated and withdrawn Fail to express emotion; speech is monotonicFail to express emotion; speech is monotonic

CausesCauses

TreatmentTreatment

SchizophreniaSchizophrenia

MedicationMedication Haldol (Haloperidal)Haldol (Haloperidal)

Reduces positive but not negative symptomsReduces positive but not negative symptoms Tardive DyskinesiaTardive Dyskinesia

involuntary movements of the lips, tongue, face, legs, or involuntary movements of the lips, tongue, face, legs, or other body partother body part

Irreversible once present (some medications control these Irreversible once present (some medications control these symptoms)symptoms)

ClozapineClozapine Reduces both positive and negative symptoms; Works for Reduces both positive and negative symptoms; Works for

unremitting schizophreniaunremitting schizophrenia Side EffectsSide Effects

Seizures, heart arrythmias, weight gain, Seizures, heart arrythmias, weight gain, Fatal reduction in WBC Fatal reduction in WBC frequent blood tests required frequent blood tests required

BehavioralBehavioral Social skills trainingSocial skills training

Recognizing social cuesRecognizing social cues Regulating affectRegulating affect Recognizing signs of relapseRecognizing signs of relapse

Self-care skillsSelf-care skills

Family therapyFamily therapy Family therapy can address family environment Family therapy can address family environment

factors that increase risk of relapsefactors that increase risk of relapse Expressed EmotionExpressed Emotion

Personality DisordersPersonality Disorders

Personality DisorderPersonality Disorder When an individual relates to the world in When an individual relates to the world in

inflexible and maladaptive ways that is long-inflexible and maladaptive ways that is long-lasting and interferes with social, occupational lasting and interferes with social, occupational or other functioningor other functioning

Types of Personality DisordersTypes of Personality Disorders Cluster A Cluster A Odd or Eccentric Behavior Odd or Eccentric Behavior

ParanoidParanoid Schizoid Schizoid SchizotypalSchizotypal

Cluster B Cluster B Dramatic, emotional or erratic behavior Dramatic, emotional or erratic behavior HistrionicHistrionic NarcissisticNarcissistic BorderlineBorderline AntisocialAntisocial

Cluster C Cluster C Anxious or Fearful Behavior Anxious or Fearful Behavior AvoidantAvoidant DependentDependent Obsessive-CompulsiveObsessive-Compulsive

Borderline Borderline Personality DisorderPersonality Disorder

SymptomsSymptoms

CausesCauses GeneticsGenetics

Unclear at presentUnclear at present Often have families members with mood disordersOften have families members with mood disorders

BiologicalBiological Low Serotonin Low Serotonin depressed mood and impulsivity depressed mood and impulsivity

Social/CulturalSocial/Cultural 70-80% have history of physical or sexual abuse or 70-80% have history of physical or sexual abuse or

other traumaother trauma Caretakers who were critical or rejectingCaretakers who were critical or rejecting Caretakers who fostered dependenceCaretakers who fostered dependence

TreatmentTreatment

Borderline Personality Borderline Personality DisorderDisorder

BehavioralBehavioral Dialectical Behavior Therapy (DBT)Dialectical Behavior Therapy (DBT)

Combines elements of behavioral, cognitive, and Combines elements of behavioral, cognitive, and psychodynamic approaches psychodynamic approaches

Involves both group and individual therapy Involves both group and individual therapy sessionssessions

Begins with a discussion of what is expected of the Begins with a discussion of what is expected of the client and what can be expected of the therapistclient and what can be expected of the therapist

Dialectical Behavior TherapyDialectical Behavior Therapy Three Stages of TreatmentThree Stages of Treatment

Stage 1 Stage 1 extreme symptoms (i.e., self-injurious and extreme symptoms (i.e., self-injurious and suicidal behaviors) are replaced with more suicidal behaviors) are replaced with more effective/acceptable coping strategieseffective/acceptable coping strategies

Stage 2 Stage 2 explore and address traumatic experiences explore and address traumatic experiences

Stage 3 Stage 3 works on development of self-respect and works on development of self-respect and independent problem-solvingindependent problem-solving

learn to support and validate themselves rather than learn to support and validate themselves rather than relying on othersrelying on others