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• Mental disorders involve significant issues in thinking, emotions, or behavior due to psychological, biological, or developmental factors, causing major distress or difficulty in daily activities
• Normal stress reactions or socially conflicting behaviors aren't considered mental disorders unless they result from individual dysfunction

Diagnosing Abnormal Behavior

• Abnormal behavior is diagnosed using an integrative approach
• This approach involves the following steps:
• Referral question
• Diagnosis
• Treatment
• Evaluation

Psychopathology

• It is the study of the nature (etiology), symptomatology (symptoms), development (how the disorder developed), and treatment of psychological disorders
• Challenges when studying psychopathology include:
• Maintaining objectivity
• Avoiding preconceived notions
• Reducing stigma

Defining Mental Disorders (The 4 D's)

• Psychological dysfunction
• Personal distress
• Disability or impairment
• Deviation or violation of social norms

The Diagnostic and Statistical Manual (DSM)

• It is a widely accepted system that classifies psychological problems based on behaviors
• These behaviors must:
• Fit a pattern
• Cause dysfunction or distress
• Last for a specific duration
• Not be explained by other disorders
• Unspecified: Many mental disorders share symptoms and exist on a spectrum with related disorders
• Other Specified: Significant depressive symptoms that don't meet all criteria for a major depressive episode
• Not Otherwise Specified: Depressive episodes with insufficient symptoms to fit specific diagnoses

Types of Diagnoses

• Underdiagnosis
• Misdiagnosis
• Overdiagnosis

Basics of the DSM-5

• It is more reliable than DSM-IV
• Ongoing research validates diagnoses
• Symptoms may overlap across disorders
• Offers clear diagnostic criteria, with additional dimensional measures when needed

Classifications within the DSM

• Categorical Classification includes thresholds
• Dimensional Classification includes degrees

Elements of a Diagnosis

• Diagnostic Criteria & Descriptors
• Diagnostic Criteria: Guidelines for making diagnoses
• Diagnostic Descriptors support diagnoses like differential diagnoses and detailed criteria

Subtypes and Specifiers

• Subtypes are mutually exclusive groups within a diagnosis indicated by "specify whether"
• Specifiers describe course, severity, and features indicated by "specify" or "specify if"

Clinical Case Formulation using the DSM

• Diagnoses require clinical judgment, not just symptom checklists
• Take cultural and social context into consideration
• Note that the DSM-5 doesn't cover all mental disorders

DSM-5 is Non-Axial

• DSM-IV axes I, II, and III combined
• Lists relevant medical conditions
• GAF was replaced by the World Health Organization Disability Assessment Schedule (WHODAS)

Axes used in the DSM-IV

• AXIS I- Needs clinical attention
• AXIS II - More enduring
• AXIS III - General medical attention; all equal
• AXIS IV - Environmentally influenced
• AXIS V - WHODAS

Principal Diagnosis and Reasons for Visit

• Principal Diagnosis refers to the in-patient admission reason
• Reason For Visit refers to out-patient medical services
• Provisional diagnosis involves strong presumption, and insufficient information
• Hallucinations involve the senses
• Delusions involve false beliefs

Organization of Disorders

• Arranged by developmental and lifespan considerations, starting with diagnoses that appear early in life
• Signs are physical manifestations and observable behavior
• Symptoms are intangible, psychological, and/or emotional issues
• Syndromes are a combination of signs and symptoms
• Diagnoses of common stress or loss are not a disorder if they are culturally approved

Diagnosis Considerations

• Diagnosis considerations must be explained if the client refuses treatment
• These considerations should have clinical utility
• Not every disorder needs treatment, but the diagnosis should consider:
• Symptom Severity
• Symptom Salience
• Patient's Distress
• Disability
• Risks & Benefits of Available Treatments

Elements of a Clinical Description

• Presents the client's problem
• Prevalence is the number of people in the population with the disorder
• Incidence is the number of new cases in a given period
• Onset of a disorder begins acutely or insidiously

Abnormal Behavior In Historical Context

• A psychological disorder is a psychological dysfunction within an individual, associated with distress or impairment and atypical responses, or are not culturally expected

The Case of Judy

• Judy, a 16-year-old, was referred to an anxiety disorders clinic due to frequent fainting episodes
• She was diagnosed with blood-injection-injury phobia, a severe and persistent fear of blood or injury, which can be disabling and impact career choices and health

Requirements for defining a Psychological Disorder

• Psychological dysfunction
• Distress or impairment
• Atypical Response
• Psychological Dysfunction occurs when there is a breakdown in cognitive, emotional, or behavioral functioning
• Distress or Impairment occurs when behavior is causing significant distress or impairment in daily activities
• Atypical or Not Culturally Expected occurs when uncommon behavior deviates from the cultural norm.

Acceptable Definitions of a Psychological Disorder

• Accepted definitions include behavioral, psychological, or biological dysfunction
• Can be unexpected in its cultural context, associated with distress or impairment in functioning, or increased risk of suffering, death, pain, or impairment
• A prototype matches a "typical" profile of a disorder, that experts agree with

The Science of Psychopathology

• It is the scientific study of psychological disorders
• Scientist-Practitioners are mental health professionals who adopt a scientific approach in their clinical work
• Aspects of the Scientist-Practitioner
• Consumer of Science: Enhancing practice
• Evaluator of Science: Assessing the effectiveness of practice
• Creator of Science: Conducting research to develop new, useful procedures

Three Categories for Studying Psychological Disorders

Clinical Description

• A unique combination of behaviors, thoughts, and feelings that characterize a specific disorder
• A presenting problem is a shorthand description of why the individual came to the clinic
• Prevalence is the number of people in the population who have the disorder
• Incidence is the number of new cases in a given period
• Sex Ratio is the percentage of males and females with the disorder and typical age of onset
• Two Different Courses describe the individual pattern of the disorder
• Chronic lasts a long time or a lifetime
• Episodic recovery in a few months with potential recurrence
• Time-limited improves without treatment in a short period
• A disorder may begin acutely or insidiously
• Acute Onset begins suddenly
• Insidious Onset develops gradually over time
• Prognosis is the anticipated course of the disorder

Causation (Etiology)

• Study of origins, including biological, psychological, and social factors
• Treatment & Outcome: Success of new treatments can hint at the nature and causes of the disorder

Approaches to the Scientific Study of Psychological Disorders

• Ph.D. in clinical and counseling psychology
• Psy.D. in clinical and counseling "doctors of psychology"
• RPsy is a Registered Psychologist
• RPm is a Registered Psychometrician
• M.D. is a Psychiatrist
• M.S.W. are psychiatric and non-psychiatric social workers
• MN/MSN are psychiatric nurses

Historical Conceptions of Abnormal Behavior

• Supernatural model
• Biological model
• Psychological model

The Supernatural Model

• The general population believed Demons and witches as a source of misfortune
• Treatments included:
• Exorcism
• Trephination

Stress and Melancholy

• Viewed as mental or emotional causes of stress with a natural cure
• This recognized mental depression and treated anxiety as illnesses

Symptoms from Depression

• Despair and lethargy associated with the sin of acedia (sloth) were associated with depression
• Treatments included:
• Rest, sleep, healthy and happy environment, baths, ointments, and potions.
• Nicholas Oresme:
• Bishop and philosopher and adviser to the king of France
• Suggested melancholy (depression) as the cause of some bizarre behaviors, rather than demons

The Mad King

• King Charles IV of France, had a mental breakdown triggered by stress from the Catholic Church's division
• Despite treatments, none were effective, and the king believed that sorcery was the cause of his suffering

Treatments for Possession

• Exorcism, confinement, beatings, and other forms of torture
• Hanging people over a pit of poisonous snakes
• Hydrotherapy: Dunking in Ice water
• Shock Therapy

Mass Hysteria

• A large-scale outbreaks of bizarre behavior that includes Emotion Contagion and Mob Psychology

Dark Ages

• Christian Monasteries replaced physicians as healers and authorities on mental disorders
• Monks cared for and prayed for the mentally ill by concocting potions

Persecution of Witches (13th Century Onwards)

• Witchcraft: Seen as a heresy and denial of God, often attributed to Satan. Many accused were mentally ill

Lunacy Trial (13th Century England)

• Municipal authorities took responsibility for mentally ill by assessing sanity based on behavior, memory, and habits
• Lunacy, was attributed to the misalignment of the moon and stars

Biological Tradition

• Hippocrates & Galen (The Hippocratic-Galenic Approach) suggested that psychological disorders are biologically caused and can be treated like other diseases

Humorol Theory

• Blood: Heart
• Black Bile: Spleen
• Yellow Bile: Liver
• Phlegm: Brain Disease resulted from imbalances in these bodily fluids causing depression

Scientific Aproach

• Based on the four basic qualities: heat, dryness, moisture, and cold
• Temperaments:
• Sanguine: Ruddy complexion; insomnia and delirium due to excessive blood
• Melancholic: Depression due to black bile
• Phlegmatic: Apathy, sluggishness, calm under stress
• Choleric: Hot-tempered

Treatments for Imbalances

• Bleeding/Bloodletting: Removing blood, often with leeches
• Induced Vomiting: Using tobacco and half-boiled cabbage

Chinese Medicine

• Yin: Cold, dark wind
• Yang: Warm, life-sustaining wind
• Methods for Restoring wind flow, including acupuncture

Somatic theories

• Hippocrates coined hysteria, learned from Egyptians
• Somatic Symptom Disorders that include paralysis and and blindness were physical symptoms without physical causes
• Theories surrounding a wandering uterus cures included marriage and vaginal fumigation

Advanced Syphilis

• Caused by a bacterial microorganism and often leads to delusions and bizarre behaviors
• Pychosis can also be hallicunations
• Linked to malaria

Biological Development

• Electric Shock & Brain Surgery where treatments for psychosis
• Insulin Shock Therapy: Developed by Manfred Sakel by inducing comas with high doses of insulin
• Benjamin Franklin: Discovered that mild electric shocks could cause brief convulsions and memory loss, potentially useful for depression
• Joseph von Meduna:
• Observed that schizophrenia was rare in epileptics, leading to the idea that induced seizures might treat schizophrenia.
• Ugo Cerletti & Lucio Bini: Developed electroconvulsive therapy (ECT) for depression

Emil Kraepelin (1856-1926)

• A founding figure in modern psychiatry, known for his work in diagnosis and classification of psychological disorders
• Distinguished between different disorders based on their:
• Symptoms
• Onset
• Course that suggests different causes for each

Psychological Tradition

• Was a strong psychosocial approach to mental disorders by treating patients normally and encourage social interaction

• In clinical contexts, relationships and attention are nurtured by emphasizing positive consequences for appropriate behavior while eliminating restraint and seclusion.

• The structure of the Mind

• Defense Mechanisms

• Psychosexual Stages of Development

• Later Developments

• Psychoanalytic Psychotherapy

The Behavioral Model

• Pavlov and classical conditioning
• Watson and the rise of behaviorism
• The beginnings of behavior therapy
• B.F. Skinner operant conditioning

Biological Approaches

• Limited understanding of the biological basis of mental illness
• Louis Pasteur (1860s) established germ theory, that links disease to microorganisms
• General Paresis is a degenerative disorder with psychological symptoms, linked to syphilis
• The discovery of the microorganism causing syphilis suggested other mental illnesses might have biological causes

Genetic Early Foundations

• Galton early foundtions that mental illness can likely be inherited through a genetic marker
• Behavioral genetics studies show that genetic input can affect behavioral differences

Early Medical Foundations

• Insulin-Coma Therapy (Manfred Sakel, 1927) where one induces coma
• Prefrontal Lobotomy surgical destruction of frontal lobe tracts, often leading to listlessness and cognitive impairments

Emil Kraepelin Early Foundations

• Pioneered classification of mental illness based on biological causes

Mesmer

• Treated hysteria with "animal magnetism"
• Known as an early practitioner of hypnosis (mesmerism)

Psychonalytic Theory

• Human behavior is determined by unconscious forces and is based on Conflicts due to these opposing forces The Structure of the Mind
  • The structure of Personality
  • The Mechanisms
  • The psychoanalytic theory

Neo-Theorist

   Jung, Carl, Karen Horney, Fromm
 - Focused on psychological development
 - emphasised social relationship and identity expression
- Focused on relationship
- proposed the unconscious
     Structure
      Defense Menhanisas
      Psychosexual stages of development
     - Techniques of Psychoanalysis

      Cognitive models

Biophsychosocial

• examine the sociocultural facts and give the psychological support
• There is no genetic expression or expression

Humanistic Models

• emphasizes personal freemo d
• the concious effort to make some personal lives (Carl Rogers, and Abraham Marlow) normalicty from the lending perspecive. Social congnitive normalies

Cognitive Models

• cognition has a wide perspective
• Information-processing models where the main focus is desruptions in information processing.

Social factors and social economics group

• The Socialcation models are where the greater social stress in the community is higher
• downward drift: Where problems tend to lead to a decline in social status

DSM-5 Disorders

-Neurodevelopmental, Anxiety, ocd, personality disorders, bi polar disorders, gender dysphoria, disruptive disorders, depressive disorders, and trauma disorders

• These disorders must all have functional imprariment, that cannot be expleained

Somatic Disorders

Dissacotion Dissorders

Functional Neurolictical

Factorous Disese