Defining Psychopathology
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Questions and Answers

What is the primary focus of psychodynamic therapies developed by Freud?

  • Current behavior and its observable outcomes
  • Unconscious drives and past experiences (correct)
  • Social media influences on behavior
  • Genetic factors in mental health

    • Which of the following is a potential outcome of deinstitutionalization?

  • Increase in homelessness (correct)
  • Decreased mental health issues among the population
  • More funding for mental health facilities
  • Better housing situations for former patients

    • What is a key rationale for multicultural psychology?

  • To eliminate all cultural influences on behavior
  • To promote the superiority of one culture over others
  • To ensure biased treatment for all individuals
  • To address diverse cultural influences on mental health (correct)

    • Which professional is responsible for diagnosing and treating mental disorders as a medical doctor?

    <p>Psychiatrist</p> Signup and view all the answers

    Which of the following is NOT listed as a possible contributor to recent declines in young people's mental health?

    <p>Increased opportunities for success</p> Signup and view all the answers

    What is a criticism of managed care in mental health treatments?

    <p>It focuses on cost-efficient and brief treatments</p> Signup and view all the answers

    What effect has the discussion of mental health diagnoses on social media had on stigma?

    <p>Decreased stigma regarding mental health labels</p> Signup and view all the answers

    Which of the following is NOT one of the 'four D's' used to define psychopathology?

    <p>Delusion</p> Signup and view all the answers

    What distinguishes eccentrics from individuals with mental disorders?

    <p>Eccentrics have unique traits but no distress, dysfunction, or danger.</p> Signup and view all the answers

    The humoral theory of mental health is based on balancing which of the following?

    <p>Bodily fluids</p> Signup and view all the answers

    What was a common factor in the asylums created during the Middle Ages?

    <p>Overcrowding and inhumane conditions.</p> Signup and view all the answers

    Which treatment emerged in the early 20th century that is considered a somatogenic intervention?

    <p>Electroconvulsive therapy</p> Signup and view all the answers

    How did Krafft-Ebing contribute to our understanding of general paresis?

    <p>He associated it with a syphilis infection.</p> Signup and view all the answers

    What was a primary focus of the moral treatment approach in the 19th century?

    <p>Providing humane and respectful care.</p> Signup and view all the answers

    What condition was historically associated with aspects of hysteria?

    <p>Extreme emotional instability.</p> Signup and view all the answers

    What is a primary disadvantage of clinical case studies in research methods?

    <p>Limited generalizability</p> Signup and view all the answers

    Which statement accurately reflects the limitations of correlational methods?

    <p>They cannot determine causation.</p> Signup and view all the answers

    What is the philosophical concern related to mental disorder classifications?

    <p>Subjectivity of diagnosis</p> Signup and view all the answers

    What does prevalence refer to in epidemiological studies?

    <p>The total number of existing cases at a given time</p> Signup and view all the answers

    Which of the following best describes the role of the Institutional Review Board (IRB)?

    <p>To ensure ethical research practices</p> Signup and view all the answers

    What challenge does informed consent often face in psychological research?

    <p>Participants’ complete understanding of all procedures</p> Signup and view all the answers

    In research methods, what is a characteristic of naturalistic experiments?

    <p>Conducted in real-world environments</p> Signup and view all the answers

    What is the risk associated with financial or personal biases in research?

    <p>They may compromise study outcomes</p> Signup and view all the answers

    What does the term 'etiology' refer to in the context of mental disorders?

    <p>The cause or origin of a disorder</p> Signup and view all the answers

    Which aspect of psychology emphasizes the importance of observable phenomena in diagnosis?

    <p>Phenotypic Diagnosis</p> Signup and view all the answers

    What is the primary advantage of psychodiagnosis?

    <p>It helps in guiding treatment decisions</p> Signup and view all the answers

    Which of the following best describes the concept of 'co-morbidity'?

    <p>The simultaneous presence of multiple disorders</p> Signup and view all the answers

    Which method is commonly used to interpret responses to ambiguous stimuli in psychological assessments?

    <p>Projective Tests</p> Signup and view all the answers

    What is one of the main disadvantages of psychodiagnosis?

    <p>It can stigmatize individuals</p> Signup and view all the answers

    What aspect of the DSM-5-TR includes information about symptom severity and cultural context?

    <p>Dimensional and Ancillary Information</p> Signup and view all the answers

    What is a possible explanation for the higher diagnosis rate of depression in females compared to males?

    <p>Hormonal differences may contribute to mood disorders.</p> Signup and view all the answers

    What characterizes persistent depressive disorder?

    <p>It includes episodes of major depressive disorder as a complication.</p> Signup and view all the answers

    What is a common feature of psychotic depression?

    <p>Presence of hallucinations or delusions.</p> Signup and view all the answers

    Which of the following therapies focuses on increasing patient engagement in positive activities?

    <p>Behavioral Activation</p> Signup and view all the answers

    Which alternative treatment for severe depression is known for providing rapid relief?

    <p>Ketamine treatment</p> Signup and view all the answers

    What is a common symptom of major depression classified as a neurovegetative sign?

    <p>Sleep issues</p> Signup and view all the answers

    What is a significant risk associated with the initial treatment phase for antidepressant medications?

    <p>Heightened risk of suicidality.</p> Signup and view all the answers

    Which of the following is NOT considered a characteristic of postpartum depression?

    <p>Mild mood swings</p> Signup and view all the answers

    What differentiates bipolar depression from major depression?

    <p>Bipolar depression includes manic or hypomanic episodes.</p> Signup and view all the answers

    What is a key difference between major depression and baby blues?

    <p>Duration of emotional symptoms</p> Signup and view all the answers

    What behavioral change is commonly associated with major depression?

    <p>Social withdrawal</p> Signup and view all the answers

    What is a potential psychological mechanism proposed in the psychodynamic account of major depression?

    <p>Unresolved grief</p> Signup and view all the answers

    How is the recurrence rate of major depression characterized?

    <p>High risk of recurrence after the first episode</p> Signup and view all the answers

    Which of the following factors is suggested to potentially contribute to postpartum depression?

    <p>Lack of support</p> Signup and view all the answers

    In terms of cultural specificity, which of the following is a noted consideration in understanding major depression?

    <p>Increased stigma in collectivist societies</p> Signup and view all the answers

    Which brain area is primarily responsible for processing fear and anxiety?

    <p>Amygdala</p> Signup and view all the answers

    What type of medication is commonly used for treating anxiety but carries a risk of dependence?

    <p>Benzodiazepines</p> Signup and view all the answers

    Which disorder is characterized by persistent, excessive worry across multiple areas of life?

    <p>Generalized Anxiety Disorder</p> Signup and view all the answers

    What is a common feature of Obsessive-Compulsive Disorder (OCD)?

    <p>Intrusive thoughts and repetitive behaviors</p> Signup and view all the answers

    Which treatment approach is often effective for Social Anxiety Disorder?

    <p>Cognitive Behavioral Therapy (CBT)</p> Signup and view all the answers

    Which of the following conditions can mimic symptoms of anxiety disorders?

    <p>Hyperthyroidism</p> Signup and view all the answers

    What aspect is vital in the diagnostic features of panic disorder?

    <p>Intense fear episodes with physical symptoms</p> Signup and view all the answers

    Which statement best describes the difference in methods used by men and women in suicide attempts?

    <p>Men typically employ violent methods, whereas women tend to use less violent methods.</p> Signup and view all the answers

    What is a primary protective factor against suicide?

    <p>Strong family and community connections.</p> Signup and view all the answers

    Among racial and ethnic groups in the U.S., which group has the highest suicide rate?

    <p>Non-Hispanic white Americans</p> Signup and view all the answers

    What major influence can lead to an increase in suicide rates following an individual's death?

    <p>High-profile media coverage of the event</p> Signup and view all the answers

    Which of the following is NOT identified as a leading risk factor for suicide?

    <p>High academic achievement</p> Signup and view all the answers

    Dichotomous thinking is characterized by what type of cognitive distortion?

    <p>Believing outcomes are either all good or all bad</p> Signup and view all the answers

    What role does social influence play in suicide risk within communities?

    <p>It can create suicide clusters among close-knit groups.</p> Signup and view all the answers

    Which of the following statements about crisis intervention is true?

    <p>It helps individuals make more constructive choices during a crisis.</p> Signup and view all the answers

    What is one significant impact of mental disorders on families?

    <p>They can cause disruptive dynamics within families.</p> Signup and view all the answers

    Why is it important to study mental disorders?

    <p>They can result in significant costs and stigma for sufferers.</p> Signup and view all the answers

    What is a consequence of untreated mental disorders that extends beyond the individual?

    <p>They can lead to lost lives due to accidents and suicide.</p> Signup and view all the answers

    What is a significant challenge associated with the prevalence of mental disorders?

    <p>They often lead to stigma and isolation.</p> Signup and view all the answers

    What is a common misconception about mental disorders?

    <p>They are a sign of personal weakness or failure.</p> Signup and view all the answers

    What is the lifetime prevalence percentage of Major Depression among U.S. adults?

    <p>20%</p> Signup and view all the answers

    How does the prevalence of Social Anxiety Disorder among U.S. adults compare with Generalized Anxiety Disorder?

    <p>Social Anxiety Disorder has a prevalence of 8%</p> Signup and view all the answers

    What impact did Covid-19 have on the prevalence of mental disorders among adults aged 18-25?

    <p>It increased the prevalence by 25-30%.</p> Signup and view all the answers

    Which disorder has the lowest one-year prevalence rate among the disorders listed?

    <p>Generalized Anxiety Disorder</p> Signup and view all the answers

    Which mental disorder has a lifetime prevalence of 18% among U.S. adults?

    <p>Substance Use Disorder</p> Signup and view all the answers

    How does the monism perspective influence the understanding of mental disorders?

    <p>Mental disorders are considered to be brain disorders relating to medical illnesses.</p> Signup and view all the answers

    What is the primary philosophical distinction between monism and dualism regarding mental disorders?

    <p>Monism states that physical and mental are the same, while dualism sees them as distinct.</p> Signup and view all the answers

    What implication does reductive materialism have on the treatment of mental disorders?

    <p>Medical treatments are crucial as mental disorders are seen as brain disorders.</p> Signup and view all the answers

    Which statement best reflects dualist philosophy regarding mental disorders?

    <p>It emphasizes that disorders of mental processes do not depend on physical brain conditions.</p> Signup and view all the answers

    Which of the following philosophies is associated with the idea that mental events can be fully explained by physiological mechanisms?

    <p>Reductive Materialism</p> Signup and view all the answers

    What does the term 'not guilty by reason of insanity' imply about a defendant's mental state at the time of the crime?

    <p>The defendant's mental disorder significantly impaired their judgment.</p> Signup and view all the answers

    Which of the following is NOT a criterion commonly used to define a mental disorder?

    <p>Dysphoria</p> Signup and view all the answers

    How does the phrase 'guilty but insane' affect the legal judgment of a defendant?

    <p>It acknowledges the presence of a mental disorder without affecting guilt.</p> Signup and view all the answers

    What underlying issue complicates the definition of 'mental disorder' according to societal perceptions?

    <p>The historical association with criminal behavior and sin.</p> Signup and view all the answers

    What common background influences people's conceptions of mental disorders?

    <p>Direct or indirect exposure to mental health situations.</p> Signup and view all the answers

    What is a potential risk associated with the use of antidepressants in bipolar disorder treatment?

    <p>Switching into mania or mixed states</p> Signup and view all the answers

    Which antipsychotic is noted for having the greatest antidepressant properties?

    <p>Latuda</p> Signup and view all the answers

    Which statement best reflects the relationship between creativity and bipolar disorder?

    <p>Historical figures with bipolar disorder frequently excelled in creative fields.</p> Signup and view all the answers

    What should be considered regarding the use of antidepressants during pregnancy?

    <p>They may have significant side effects for both mother and child.</p> Signup and view all the answers

    What is a common perspective among individuals with bipolar disorder regarding their condition?

    <p>Some might choose to retain it due to its complexities.</p> Signup and view all the answers

    What is a primary effect of lithium carbonate when used in treating bipolar disorder?

    <p>Strong antimanic action</p> Signup and view all the answers

    Which symptom is considered a sign of a mixed episode in bipolar disorder?

    <p>Both euphoria and suicidal ideation</p> Signup and view all the answers

    Which medication is preferred for chronic management of Bipolar I/II disorders?

    <p>Lamictal</p> Signup and view all the answers

    What is a common misconception about the treatment of bipolar disorder?

    <p>Mania and depression are completely opposite conditions</p> Signup and view all the answers

    What role does psychotherapy typically play in treating bipolar disorder?

    <p>Helps build medication compliance</p> Signup and view all the answers

    Which statement about suicidal ideation in bipolar disorder is true?

    <p>May emerge during mixed episodes</p> Signup and view all the answers

    Which treatment is considered effective for both mania and bipolar depressions?

    <p>Electroconvulsive therapy (ECT)</p> Signup and view all the answers

    What is a potential risk associated with long-term use of lithium carbonate?

    <p>Kidney toxicity</p> Signup and view all the answers

    Which characteristic is often observed in individuals during manic episodes?

    <p>Racing thoughts</p> Signup and view all the answers

    What distinguishes mixed episodes from other bipolar episodes?

    <p>Combining symptoms of both mania and depression</p> Signup and view all the answers

    Which of the following is a characteristic of Panic Disorder?

    <p>Involves apprehensiveness about further attacks</p> Signup and view all the answers

    What is the approximate one-year prevalence of Panic Disorder?

    <p>2 - 3%</p> Signup and view all the answers

    Which of the following is a common cognitive symptom of anxiety disorders?

    <p>Objectless fear or feeling of apprehensiveness</p> Signup and view all the answers

    What physiological symptom is commonly associated with acute anxiety?

    <p>Dry mouth and sweating</p> Signup and view all the answers

    Which of the following disorders is categorized under Major Obsessive-Compulsive and Related Disorders?

    <p>Body Dysmorphic Disorder</p> Signup and view all the answers

    Which of the following symptoms is NOT typically associated with anxiety disorders?

    <p>Muscle relaxation</p> Signup and view all the answers

    Which physical disorder can present symptoms that mimic anxiety disorders?

    <p>Hyperthyroidism</p> Signup and view all the answers

    What describes a panic attack within the context of anxiety disorders?

    <p>A brief and intense episode of fear</p> Signup and view all the answers

    What is the female to male ratio in the prevalence of Panic Disorder?

    <p>2:1</p> Signup and view all the answers

    Which symptom is often linked to heightened anxiety and is considered a form of hypervigilance?

    <p>Going blank or spacing out</p> Signup and view all the answers

    Which symptom is commonly associated with panic attacks?

    <p>Pounding heart</p> Signup and view all the answers

    What role does the locus coeruleus play in anxiety?

    <p>It activates the sympathetic nervous system.</p> Signup and view all the answers

    Which neurotransmitter has been shown to have a deficit in anxiety-prone individuals?

    <p>GABA</p> Signup and view all the answers

    What physiological response is triggered by the sympathetic nervous system during acute anxiety?

    <p>Increased blood flow to muscles</p> Signup and view all the answers

    What is a common fear experienced during a panic attack?

    <p>Fear of losing control</p> Signup and view all the answers

    Study Notes

    Defining Psychopathology

    • Four D's: Deviance, Distress, Dysfunction, Danger
    • Deviance: Behavior that is unusual or statistically rare
    • Distress: Emotional pain or suffering
    • Dysfunction: Interference with daily functioning
    • Danger: Potential harm to self or others
    • Eccentrics: Display unique behaviors without distress, dysfunction, or danger
    • Eccentrics are typically not classified as having mental disorders

    History and Early Approaches

    • Trephination: Ancient practice of drilling holes in the skull to release evil spirits.
    • Humoral Theory: Ancient Greek concept of balancing bodily fluids (blood, phlegm, black bile, yellow bile) to maintain mental health.
      • Sanguine (Blood): Associated with happiness and optimism
      • Choleric (Yellow Bile): Associated with anger and irritability.
      • Melancholic (Black Bile): Associated with sadness and depression
      • Phlegmatic (Phlegm): Associated with calmness and passivity
    • Asylums: Institutions for those with mental disorders, often overcrowded and inhumane.

    Emerging Perspectives

    • Demonological View: Belief that mental illness was caused by possession by evil spirits or demons.
    • Moral Treatment (19th Century): Advocated for humane and respectful treatment of patients (e.g., Philippe Pinel, Dorothea Dix).

    Early 20th Century Treatments

    • Electroconvulsive therapy, insulin coma therapy, and lobotomies were used to treat mental disorders.

    Shifting Understandings: Somatogenic and Psychogenic Views

    • Somatogenic View: Mental disorders have physical or biological origins.
      • Krafft-Ebing linked syphilis to general paresis (neuropsychiatric disorder).
      • Wagner-Jauregg treated general paresis with induced malaria to kill the syphilis bacteria.
    • Psychogenic View: Mental disorders arise from psychological factors.
      • Hysteria: Historically, a condition often associated with extreme emotional instability, attributed to psychological or “female” causes.
      • Mesmerism/Hypnotism: Early methods by Franz Mesmer influencing modern hypnosis.

    Modern Approaches

    • Psychodynamic Therapies: Focus on unconscious drives and past experiences affecting current behavior (developed by Freud).
    • Biological Views of Mental Disorders: Mental disorders are viewed as arising from genetic, neurochemical, or physiological factors.
    • Psychotropic Medications: Drugs developed to treat mental disorders (e.g., antidepressants, antipsychotics, anxiolytics).
    • Deinstitutionalization: Shift to community-based care.
      • Rationale: Humane treatment and cost savings.
      • Outcome: Rise in homelessness and insufficient care for some individuals.
    • Multicultural Psychology: Recognizes diverse cultural influences on mental health and seeks culturally competent care.

    Mental Health Professions

    • Direct patient care:
      • Psychiatrists (M.D.’s)
      • Clinical Psychologists (Ph.D.’s)
      • Social Workers (M.S.W.’s / D.S.W.’s)
      • Psychiatric Nurses (R.N.’s)
      • Marriage & Family Therapists (M.F.T.’s)
      • Psych Technicians
      • MH Intake Workers, Staff
      • Primary Care Practitioner M.D.’s (PCP’s)
      • Physician Assistants (P.A.’s)
      • Nurse Practitioners (N.P.’s)
    • Mental health researchers:
      • Psychiatrists
      • Clinical psychologists
      • Neuroscientists
      • Endocrinologists
      • Psychopharmacologists
      • Geneticists
      • Epidemiologists
      • Clinical trial managers
      • Biostatisticians

    Recent Decline in Young People's Mental Health

    • Possible Contributing Factors:
      • Social media use
      • Climate anxiety
      • Helicopter parenting
      • Education without competition
      • Pressure to attend college
      • Over-pathologizing normal feelings
      • Decreased stigma

    Managed Care

    • Insurance-based model focusing on cost-efficient, brief treatments.
    • Critics argue it can limit the quality of mental health care.

    Research Methods in Psychopathology

    • Clinical Case Studies (Case Histories)

      • Advantages: Provide detailed insights into rare cases
      • Disadvantages: Limited generalizability, potential for researcher bias

    • Correlational methods

      • Advantages: Identify relationships between variables; useful for large populations
      • Disadvantages: Cannot determine causation

    • Experimental methods

      • Advantages: Can establish causation; controlled conditions
      • Disadvantages: May lack real-world applicability

    Liabilities of Correlation in Clinical Studies

    • Correlation does not imply causation
    • Third variables may affect relationships

    Problems with Current Research Practices

    • WEIRD participants: Bias due to Western, Educated, Industrialized, Rich, Democratic samples
    • Biases and Conflicts of Interest: Financial or personal biases may affect study outcomes
    • Replication Issues: Difficulty reproducing findings across studies

    Types of Correlational Studies

    • Epidemiological (Cross-sectional): Analyze data from a specific point in time
    • Longitudinal (Developmental): Track changes over time

    Experimental Studies

    • Experimental/Control groups: Participants are assigned to either group to compare effects
    • Participant Assignment: Random assignment helps ensure equal groups
    • Blind (Masked) Designs: Participants and researchers are unaware of who is receiving the treatment to reduce bias
    • Experimenter Bias: The experimenter's expectations influencing results
    • Naturalistic Experiments: Observe real-world situations
    • Analogue Experiments: Simulate real-world conditions in a controlled setting
    • Single-Subject Experiments: Involves a single participant and measures changes over time

    Epidemiological Studies

    • Prevalence: Total number of cases within a population at a given time
    • Incidence: Number of new cases within a defined time period
    • Data Collection: Surveys, medical records, or registries
    • IRB (Institutional Review Board): Ensures ethical research practices
    • Basic Rights of Participants: Privacy, protection from harm, right to withdraw
    • Informed Consent Issues: Complexity and potential limitations in participant comprehension can be problematic.

    Assessment and Diagnosis

    • DSM-5-TR Conception of “Mental Disorder”
      • Clinically significant behavioral or psychological syndrome or pattern
      • Associated with:
        • Present distress: Like a painful symptom
        • Disability: Impairment in one or more important areas of function
        • Increased risk of suffering: death, pain, disability, or loss of freedom

    Philosophical Viewpoints and their Relevance for Different Conceptions of Mental Disorder

    • Monism: The world is made of one stuff
      • Can be either all mental or all physical
      • Reductive materialism: Mental events reduced to brain events; everything can be explained through physiological mechanisms
    • Dualism: The physical and mental worlds are separate domains
      • Mind is different from brain
      • World of mental and physical interact
        • Psychiatrists using psychopharmacology often act as monists
        • Psychotherapists often act as dualists

    Kraepelin’s View on Mental Disorder Nosology

    • Emphasized categorizing disorders based on symptoms and course
    • Card-sorting method: Used to group similar cases
    • Etiology: Cause
      • Family health issues, personal history, substance abuse, etc.
    • Course: Trajectory of the disorder over time
    • Prognosis: Outcome
    • Signs: Observable markers
      • Things you see in a patient (tics, tone of voice)
    • Symptoms: Patient reports
      • What the patient tells you
    • Syndrome: Signs + Symptoms
    • Disorder: Syndrome + Course
    • Disease: Disorder + Tissue Damage

    Relationship Between Nosology and Diagnosis

    • Nosology: Science or scheme of disease categorization and classification
    • Diagnosis: Act of assigning a nosological category to a patient
      • A person can have more than one diagnosis

    Phenotypic vs. Genotypic Diagnosis

    • Phenotypic Diagnosis: Based on observable symptoms
      • Signs, symptoms, course, outcome, response to treatment
    • Genotypic Diagnosis: Based on genetic markers
      • Causes (Genes, germs, tissue abnormalities)

    Endophenotypic Signs in Diagnosis

    • Endophenotypes: Markers that may indicate a genotypic disorder
      • Lab tests
      • Retinal scans for Alzheimer’s-type dementia
      • Cognitive tests
      • Tests of circadian rhythm instabilities (BPD)
      • “Subclinical” biomarkers
      • Behavioral tests

    Advantages and Disadvantages of Psychodiagnosis

    • Advantages:
      • Guides treatment
      • Facilitates communication among professionals
      • Establishes prospects for contagion or transmission
      • Legal reasons
      • Financial reasons (insurance payment)
      • Research
    • Disadvantages:
      • Risk of stigma
      • Over-pathologizing
      • Sacrifices the uniqueness of the individual
      • Diagnosis itself can have an impact on the patient
      • Can rigidify treatment

    Kinds of Information that Go Into a Psychodiagnosis

    • Symptoms
    • Signs
    • Course of illness
    • Age of onset
    • Family history
    • Recent events
    • Recent behavior
    • Psychological tests
    • Laboratory tests (e.g., neuroimaging, hormonal assays, genetic testing)
    • Response to treatment (prior or current)

    Clinical Interview: Kinds of Information Solicited or Observed (Signs and Symptoms)

    • Signs: Observable behaviors
    • Symptoms: Reported experiences
    • Duration: Approximately one hour; crucial for diagnosis
    • Information Collected:
      • Current and past symptoms
      • Personal and family history
      • Mental health treatments
    • Appearance: Attire, grooming, physical traits (e.g., skin tone, weight)
    • Behavior: Posture, mannerisms, spasms/tics
    • Speech: Articulation, tone
    • Consciousness: Alertness level
    • Mood/Attitude: Emotional state, general attitude (e.g., defiant, sincere)
    • Thought Patterns: Content, process (delusions, hallucinations)
    • Knowledge and Thinking: General facts, abstract reasoning
    • Social Judgment & Insight
    • Cognitive Functioning : Screened via tools like the MOCA

    Goals of a Clinical Interview

    • Assess suitability for psychotherapy
    • Identify need for referrals (psychiatrist, PCP, neurologist, etc.)

    Basic Diagnostic Concepts

    • Nosology: Classification system
    • Diagnosis: Identifying a specific disorder
    • Signs & Symptoms: Observable indicators and reported experiences
    • Syndromes: Group of symptoms typical of a disorder
    • Prognosis: Predicted outcome
    • Course of Illness: Pattern over time
    • Etiology: Cause or origin
    • Co-Morbidity: Co-occurrence of multiple disorders

    Cognitive Tasks Commonly Used in the Clinical Interview including how Montreal Cognitive Assessment is Used

    • Assess attention, memory, language
    • Montreal Cognitive Assessment (MOCA): Checks for cognitive impairment

    Clinical Tests

    • Projective Tests: Interpret responses to ambiguous stimuli (e.g., TAT, Rorschach)
    • Personality/Response Inventories: Structured self-reports (e.g., MMPI-2)

    Reliability/Validity of Diagnosis or Assessment

    • Reliability: Consistency of results
    • Validity: Accuracy in measuring intended constructs

    Overview of TAT and Rorschach Administration, Interpretation, and Value

    • TAT: Storytelling from images reveals underlying thoughts
    • Rorschach: Inkblot interpretation explores personality

    General Makeup of MMPI-2

    • Broad measure of personality traits
    • Designed to identify mental health issues

    Psychophysiological Tests & Polygraphy

    • Measures physical responses (e.g., heart rate) linked to mental states
    • Polygraph: Assesses stress responses

    Major Types of Brain Imaging

    • CT, MRI: Structural images
    • fMRI, PET: Functional activity

    IQ Testing and Use of IQ

    • Measures cognitive ability
    • Often used in neuropsychological assessments

    Neuropsychological Tests

    • Evaluate cognitive functions to identify brain impairments

    History, Development and Construction of DSM-5-TR – General Principles and Organization

    • Developed over time, structured by symptom clusters and functional impact.

    Dimensional and Ancillary Information in DSM-5-TR

    • Includes symptom severity, cultural context, and functional impact

    Evidence-Based Treatment Guidelines

    • Recommendations based on research for effective treatments

    Psychotherapy: General Effectiveness And Meta-Analysis

    • Shows general efficacy
    • Meta-analyses summarize broad therapy effects

    Common Factors in Effective Psychotherapy, and the “Rapprochement Movement.”

    • Includes therapeutic alliance, empathy, and rapport
    • Rapprochement integrates various therapy approaches

    Pharmacogenomics

    • Tailoring medication based on genetic factors

    Co-morbidity

    • Co-existence of multiple disorders in one person; complicates diagnosis and treatment

    Major Depression

    • Cognitive/Motivational vs. Neurovegetative Symptoms:
      • Cognitive: sadness, guilt, feelings of worthlessness, suicidal thoughts
      • Motivational: loss of pleasure (anhedonia)
      • Neurovegetative: weight changes, sleep issues, psychomotor changes, fatigue, difficulty concentrating
    • Not Due To: bereavement, normal loss reactions, or substances
    • Resulting Behavior: social withdrawal, isolation, and possible irritability (especially in teens and males)
    • Psychodynamic Account:
      • Cause: unconscious conflicts from early losses or unmet needs
      • Mechanisms: repressed anger turned inward, unresolved grief, dependency needs
      • Problems: empirical limitations, childhood focus, treatment issues
    • Post-partum Depression vs. "Baby Blues":
      • Baby Blues: common, affects 50-80% of new mothers, mild mood swings, irritability, sadness, anxiety, resolves within two weeks postpartum
      • Postpartum Depression: affects about 10-20% of mothers, more intense and lasting sadness, hopelessness, fatigue, possible suicidal thoughts, impaired bonding with the baby, persists for weeks to months if untreated
      • Etiologies: hormonal changes, previous depression history, stress, lack of support, potential genetic factors
    • Patterns of Occurrence:
      • Episodes: symptoms lasting at least two weeks, but can extend for months
      • Persistence: in some, depression symptoms remain chronic or long-lasting
      • Recurrence: high risk of future depressive episodes after one occurrence, especially if untreated, with around 50% experiencing recurrence within five years
    • Sex Ratios in Prevalence:
      • Females are diagnosed more often than men (2:1 ratio)
      • Possible Explanations: x-linked depression genes, PMS symptoms coinciding with surveys, quality of life differences, cognitive style
    • "Kindling" and Depression Risk:
      • History of previous depressive episodes serves as kindling, increasing the risk of future episodes.
    • Persistent Depressive Disorder ("Double Depression"):
      • Overlay of a Major Depressive Disorder episode on top of persistent depressive disorder
      • Individuals experience an even deeper depressive episode when they already struggle with a "baseline" level of depression
    • Psychotic Features in Severe Major Depression:
      • Severe depression may include hallucinations and delusions

    Psychotherapy for Major Depression

    • Cognitive Behavioral Therapy (CBT): targets negative thought patterns, proven effective
    • Interpersonal Therapy (IPT): focuses on relationship issues, evidence supports effectiveness
    • Behavioral Activation: increases engagement in positive activities, effective in lifting mood
    • Natural Remission:
      • Some depressive episodes resolve on their own, suggesting natural cycles
      • Informs theories of depression's episodic nature

    Problems with Psychogenic Theories

    • Overemphasis on psychological origins may overlook biological causes and limit treatment options

    "Third-Wave" Cognitive Behavioral Therapy

    • Acceptance and Commitment Therapy (ACT): encourages acceptance of thoughts
    • Mindfulness-Based Cognitive Therapy (MBCT): uses mindfulness to prevent relapse, both have evidence for effectiveness

    Brain Changes in Depression

    • Low BDNF, neurotransmitter imbalances, and neocortical disturbances
    • Antidepressants may normalize these changes

    Antidepressant Medications

    • Classes: SSRIs, SNRIs, MAOIs, tricyclics
    • Uses: depression, anxiety, OCD
    • Side Effects: vary by class, can include fatigue, nausea, and dry mouth
    • Precautions: care with dosage, side effects may impact treatment adherence
    • Relationship with Suicidality: initial treatment phase may raise suicide risk, close monitoring is essential

    Electroconvulsive Therapy (ECT)

    • Nature of Treatment: uses controlled electrical impulses to induce seizures
    • Effectiveness: high for severe depression, side effects may include memory loss

    Alternative Treatments

    • TMS (Transcranial Magnetic Stimulation): stimulates brain regions, "Stanford protocol" has promising results
    • VNS (Vagus Nerve Stimulation): uses a device to stimulate the vagus nerve
    • Ketamine: rapid relief for severe cases, used under careful supervision

    Comparative Effectiveness

    • For mild to moderate depression, both medications and psychotherapy can be effective
    • Severe cases may benefit more from medication

    Seasonal Affective Disorder (SAD)

    • SAD: depression occurring seasonally
    • Phototherapy: light therapy to improve mood, effective in many cases

    Other Disorders Associated with Depression

    • Anxiety disorders, OCD, PTSD, chronic pain

    Mania and Bipolar Disorder

    • Etiology Hypotheses:
      • Neurochemical imbalances (e.g., high dopamine or norepinephrine in mania)
      • Structural brain changes and dysfunction in emotional regulation circuits
    • Genetic Evidence: strong genetic component, close family history increases risk
    • Sex Ratio: equal prevalence in men and women, though women may have more depressive episodes
    • Signs and Symptoms:
      • Manic Episode: elevated mood, decreased need for sleep, rapid speech, impulsivity, grandiosity
      • Depressive Episode: symptoms similar to Major Depression, but with higher recurrence and intensity in Bipolar Disorder
    • Course and Prognosis:
      • Chronic condition with recurrent episodes, variable between individuals
      • Higher risk of suicide, lifelong management often required
    • Differences from Major Depression:
      • Bipolar depression includes manic or hypomanic episodes
      • Depressive episodes may be more severe in Bipolar Disorder

    Antimanic Medications (Mood Stabilizers)

    • Classes: Lithium, anticonvulsants, atypical antipsychotics
    • Side Effects: weight gain, tremor, kidney or thyroid effects, requires regular monitoring

    Pharmacogenomics

    • Genesight© Test: personalized treatment approach using genetic testing to guide medication choices

    Non-Medication Treatments

    • Psychotherapy (CBT, psychoeducation), lifestyle modifications, ECT for severe cases

    Pediatric Bipolar Disorder

    • Similar symptoms to adult Bipolar Disorder, but with more irritability, mood swings, and behavior issues

    Bipolar Disorder and Creativity

    • Higher rates of creativity observed in some individuals with bipolar or depressive tendencies

    Other Disorders Associated with Bipolar Disorder

    • Anxiety disorders, substance abuse, ADHD, personality disorders

    Suicide Rates

    • Men are more likely to die by suicide than women, despite women attempting suicide more often.
    • Men tend to use violent methods like shooting, stabbing, and hanging, while women use less violent methods like drug overdose.
    • Non-Hispanic white Americans have the highest suicide rates in the US, followed by American Indians.
    • Social media and internet use are likely contributing factors to the recent rise in suicide rates.

    Suicide Risk Factors

    • Stressful Events: Life challenges, trauma, and abuse can increase suicide risk.
    • Social Isolation: Lack of social connection and support is a significant risk factor.
    • Serious Illness: Chronic or terminal illness can contribute to suicidal thoughts.
    • Abusive or Repressive Environment: Living in a harmful environment heightens risk.
    • Occupational Stress: High-pressure jobs can lead to burnout and suicidal ideation.
    • Mood and Thought Changes: Hopelessness, dichotomous thinking (black-and-white thinking), and depression are linked to suicide risk.
    • Alcohol and Drug Use: Substance abuse can impair judgment and increase impulsivity.
    • Mental Disorders: Depression, anxiety, bipolar disorder, and schizophrenia are major risk factors for suicide.
    • Modeling: Witnessing or reading about suicide can increase suicidal behavior.

    Suicide Protective Factors

    • Social Support: Strong family and community connections provide a safety net.
    • Access to Care: Availability of mental health resources enables intervention.
    • Coping Skills: Effective problem-solving abilities help individuals manage stress.
    • Beliefs and Values: Religious or spiritual commitments can provide meaning and purpose.
    • Dependents: Responsibility towards loved ones or pets can offer a reason to live.
    • Future Orientation: Optimism and future plans create hope and motivation.
    • Therapeutic Relationship: Positive connections with mental health professionals offer support and guidance.

    Suicide Prevention

    • Suicide Prevention Programs: Aim to identify at-risk individuals and provide crisis intervention.
    • Crisis Intervention: Helps people reframe their situation, make better decisions, and overcome crisis.

    Contagiousness of Suicide

    • Media Influence: Sensationalized news reports about suicide can trigger copycat suicides.
    • Social Influence: Suicide clusters can occur within close-knit communities or groups.
    • Social Media Impact: Online platforms can amplify suicide-related content, increasing exposure.
    • Family/Friend Influence: Individuals with loved ones who have died by suicide are at higher risk.

    Anxiety Disorders

    • Nature of Clinical “Anxiety”: Persistent worry, restlessness, muscle tension, difficulty concentrating, and sleep disturbances are common symptoms.
    • Sociocultural Factors: Cultural attitudes, socioeconomic stress, and social expectations impact anxiety.
    • Brain Areas Involved: Amygdala and prefrontal cortex play roles in anxiety processing.
    • Neurotransmitters Involved: GABA and serotonin levels affect mood and anxiety regulation.
    • ANS Involvement: The "fight-or-flight" response triggers physiological symptoms like increased heart rate and sweating.
    • Physical Conditions Mimicking Anxiety: Hyperthyroidism, heart arrhythmias, asthma, and other medical conditions can present with anxiety-like symptoms.

    Anxiety Treatments

    • Medication: Benzodiazepines, SSRIs, and SNRIs are used to manage anxiety symptoms.
    • Caution: Benzodiazepines can be addictive and have side effects like drowsiness and nausea.

    Specific Anxiety Disorders

    • Generalized Anxiety Disorder (GAD): Persistent, excessive worry across multiple life areas.
    • Panic Disorder: Intense fear episodes with physical symptoms, often accompanied by heightened awareness of bodily sensations.
    • Derealization/Depersonalization: Experiencing feelings of detachment from reality or oneself.
    • Agoraphobia: Fear of situations where escape might be difficult, often triggered by panic attacks.
    • Social Anxiety Disorder: Intense fear of social situations due to fear of judgment.
    • Specific Phobias: Excessive, irrational fears of specific objects or situations.

    Obsessive-Compulsive Disorder (OCD)

    • Features: Obsessions (intrusive thoughts) and compulsions (repetitive behaviors).
    • Risk Factors: Family history, trauma, and brain structure abnormalities.
    • Brain Areas: Orbitofrontal cortex, anterior cingulate cortex, and striatum are involved in OCD.
    • Related Disorders: Hoarding disorder, body-focused repetitive behaviors (like hair-pulling or skin-picking), body dysmorphic disorder, and body integrity dysphoria.

    Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)

    • Often linked to OCD symptoms, especially after a streptococcal infection.

    Illness Anxiety Disorder (Hypochondriasis)

    • Similar to OCD spectrum, characterized by excessive worry about health and potential illness.

    Mental Disorders Prevalence

    • Mental disorders are common, about 20% of people experience a major depressive episode in their life
    • One year prevalence of major depression in the US is 10%
    • The prevalence of mental disorders in the US is significantly higher than pre-COVID levels
    • Mental health of young people has declined dramatically, especially for young females, LGBTQ individuals, and those who experienced sexual violence
    • These trends predate COVID but were worsened by COVID-related problems like social isolation
    • College mental health has declined steadily over the past decade
    • The number of college students seeking mental health treatment has increased 40% from 2009-2015
    • Student mental health is now the most pressing issue for college presidents

    History of Psychopathology

    • Early views of psychopathology involved biological theories, like humorism that attributed mental disorders to imbalances in bodily fluids
    • During the Middle Ages, mental illness was often attributed to demonic possession and witchcraft
    • Malleus Maleficarum, a book written in 1486, blamed women for witchcraft, stating that women were more prone to renounce faith and inflict vengeances through witchcraft
    • From the 1700s to the 1800s, mental illness was viewed as evolutionary regression, with mentally ill people being categorized as animals
    • Mentally ill people were housed in conditions similar to those of animals
    • Treatment during this period often involved restraint and confinement
    • In the late-1800s, the concept of “moral treatment” emerged, advocating for humane treatment and care for the mentally ill
    • Philippe Pinel, a French physician, is credited for unchaining patients and advocating for more compassionate care
    • The State Hospital era, from 1900-1960, saw the rise of large psychiatric institutions
    • Treatment during this time included controversial and often harmful practices
    • These practices included pyrotherapy, insulin coma therapy, metrazol shock therapy, electroconvulsive therapy (ECT), and prefrontal lobotomy
    • Thorazine (chlorpromazine), the first “major tranquilizer,” was synthesized in 1948, leading to the “Thorazine Era” in the 1950s and 1960s
    • This era marked a shift towards pharmacological treatment of mental disorders.

    Philosophical Assumptions of Mental Disorder

    • Mental disorders are complex and require a clear understanding of core philosophical assumptions.
    • Monism: World is made of one stuff.
      • Idealism: Everything is mental
      • Materialism: Everything is physical, including mind.
        • Reductive Materialism: Mental events are brain events.
    • Dualism: Mind and brain are separate.
      • Mental disorders are disorders of mental processes.

    Defining Mental Disorder

    • There is no universally accepted definition of mental disorder.
    • Defining criteria can be problematic:
      • Deviance: Statistical, moral, or cultural differences.
      • Distress: The individual's own distress or that of others.
      • Dysfunction: Impairment in normal functioning.
      • Danger: Risk to self or others.
    • Societal views influence how mental disorders are perceived and addressed.

    Prototypes of Mental Disorders

    • People have developed prototypes of mental disorders through:
      • Real-life experiences: Witnessing mental health services or interventions.
      • Indirect experiences: Exposure to books, films, or conversations.
      • Professional training: Studying classic cases and clinical experiences.

    DSM-5-TR: The Diagnostic Bible

    • The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) is the current standard for diagnosing mental disorders.
    • It defines a mental disorder as:
      • Clinically significant: A behavioral or psychological syndrome that causes distress or impairment.
      • Not a culturally sanctioned response: Must be abnormal and not a predictable reaction to an event.

    Diagnostic Terminology and Processes

    • Nosology: System of categorising and classifying diseases.
    • Diagnosis: Assigning a category to a patient.
    • Etiology: Cause of the disorder.
    • Course: Trajectory of the disorder.
    • Prognosis: Predicted outcome of the disorder.
    • Signs: Observable markers.
    • Symptoms: Patient-reported experiences.
    • Syndrome: Set of signs and symptoms.
    • Disorder: Syndrome with a specific course.
    • Disease: Disorder with additional tissue damage.

    Reasons for Diagnosis

    • Prognosis: Predicting course and outcome.
    • Treatment implications: Guiding treatment decisions.
    • Communication: Facilitating information exchange between professionals.
    • Legal reasons: Determining competence or insanity.
    • Financial reasons: Compensation for patients and treatment providers.
    • Research: Understanding and studying mental disorders.

    Problems Inherent in Diagnosis

    • Individuality: Focus on patterns can homogenize unique individuals.
    • Etiology: Diagnosis may inappropriately imply cause.
    • Treatment rigidity: Can limit treatment options.
    • Iatrogenic illness: Treatment itself can cause problems.
    • Stigmatization: Negative societal attitudes can lead to stigma.
    • Secondary gain: People may benefit from being labeled as mentally ill.

    Types of Diagnosis

    • Phenotypic: Based on observed signs and symptoms.
    • Genotypic: Identifies causes, like genes, germs, or tissue abnormalities.
    • Endophenotypic: Uses biomarkers or subclinical tests to identify underlying vulnerabilities.

    Components of Diagnosis

    • Symptoms: Patient-reported experiences.
    • Signs: Observable indicators.
    • Course of illness: Trajectory of the disorder.
    • Age of onset: When symptoms began.
    • Family history: Presence of similar disorders in family members.
    • Recent events: Significant life events that may have influenced the condition.
    • Recent behavior: Changes in behavior or mood.
    • Psychological tests: Provide additional insights into psychological functioning.
    • Laboratory tests: Include neuroimaging, hormonal assays, and genetic testing.
    • Response to treatment: Effectiveness of past treatments.

    Multifactorial Nature of Diagnosis

    • No single sign or symptom definitively identifies a mental disorder.
    • Diagnosis is based on a pattern of signs and symptoms, or a syndrome.

    General Points on Diagnoses

    • Diagnoses are informed guesses and can evolve over time.
    • Mental disorders frequently co-occur (comorbidity).
    • Z-codes: Used to document psychosocial factors that may influence treatment but are not diagnoses themselves.

    Clinical Assessment: The Foundation of Diagnosis

    • Clinical interview: Most valuable tool in diagnosis.
    • Goals of the clinical interview:
      • Assess readiness for psychotherapy.
      • Determine need for referrals:
        • Psychiatrist for medication.
        • Primary care physician for medical evaluation.
        • Neurologist for neurological testing.
        • Other professionals like social workers or vocational counselors.

    Anxiety

    • People with anxiety experience a variety of cognitive and physiological symptoms, including worry, apprehension, hypervigilance, sweating, muscle tension, and rapid heart rate.
    • Acute intense anxiety is called a “panic attack”.
    • Panic attacks occur in many anxiety disorders.

    Panic Attacks

    • Symptoms include palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, and fear of dying.
    • Panic attacks are often mistaken for heart attacks and can lead to emergency room visits.

    Fear, Anxiety, and the Brain

    • The amygdala plays a crucial role in registering the emotional aspects of situations, especially potential threats.
    • The locus coeruleus, involved in arousal, activates the neocortex and the hypothalamic-pituitary axis and autonomic nervous system.

    Autonomic Nervous System

    • The autonomic nervous system (ANS) is made up of the sympathetic and parasympathetic nervous systems.
    • The sympathetic nervous system is responsible for the "fight-or-flight" response, mobilizing the body for action in stressful situations.

    Anxiety and GABA

    • GABA (Gamma-Aminobutyric Acid) is a neurotransmitter that inhibits anxiety.
    • People prone to anxiety often have deficits in GABA.
    • Blocking GABA chemically increases anxiety.
    • Alcohol and many anti-anxiety medications bind to GABA receptor areas and mimic the effects of GABA.

    Anxiety Disorders

    • Anxiety disorders are among the most common psychiatric problems.
    • They show increasing prevalence in adolescents and young adults, especially during and after the COVID-19 pandemic.
    • Anxiety disorders tend to run in families and are frequently co-morbid with Major Depression and Stress disorders.
    • There is a shared “distress” inheritance between anxiety disorders and Major Depression.
    • Anxiety disorders increase the risk of alcoholism/drug abuse and "self-medication."

    DSM-5-TR Nosology of Anxiety and Obsessive-Compulsive Disorders

    • The DSM-5-TR classifies anxiety disorders into several categories:
      • Panic disorder
      • Agoraphobia
      • Generalized Anxiety Disorder
      • Separation Anxiety Disorder
      • Social Anxiety Disorder (Social Phobia)
      • Specific Phobias
    • Obsessive-Compulsive and Related Disorders are now a separate category:
      • Obsessive-Compulsive Disorder
      • Body Dysmorphic Disorder
      • Hoarding Disorder
      • Trichotillomania
      • Excoriation (Skin-Picking) Disorder

    Panic Disorder

    • Includes recurrent unexpected panic attacks, lasting several minutes at a time.
    • Individuals experience apprehension about future attacks and their consequences.
    • Avoidance behavior and disability often result from these fears.

    Facts about Panic Disorder

    • One-year and lifetime prevalences are about 2-3%.
    • Prevalence is higher in females than males (2:1 ratio).
    • It often develops during young adulthood.
    • There's an increased risk for individuals with a history of child abuse/neglect or mitral valve prolapse.
    • The course is typically chronic but waxing and waning.
    • It's often associated with other anxiety disorders and Substance Use Disorders.
    • There is a high rate of co-morbidity with Major Depression (up to 60%).
    • Most patients can identify major stressors in the months preceding their first panic attack.
    • These disorders share a common element of repetitive thoughts, behaviors, or urges.
    • They include:
      • Hoarding Disorder: Characterized by excessive accumulation and difficulty discarding possessions, leading to clutter and disruption of living space.
      • Body-Focused Repetitive Behaviors (Trichotillomania and Excoriation Disorder): Involve repetitive hair-pulling or skin picking, respectively.
      • Body Dysmorphic Disorder: Excessive preoccupation with perceived flaws in one's appearance, leading to compulsive behaviors like mirror checking and grooming.
      • Body Integrity Dysphoria: Strong desire to remove a part of one's body, with beliefs that a limb or other body part does not "belong."

    Additional Considerations

    • Several physical disorders can manifest as "anxiety disorders," including hyperthyroidism, adrenal tumors, inner ear disease, and angina pectoris.
    • These disorders should be carefully ruled out by a healthcare professional.

    PANDAS

    • Stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections.
    • Occurs in children developing strep throat or rash, who experience sudden onset of tic disorder or OCD symptoms, often related to handwashing and germophobia.
    • Usually resolves with antibiotic therapy.
    • PANDAS may provide insights into the mechanisms underlying OCD, suggesting potential roles for autoimmunity and neurotoxicity.

    First-Line OCD Treatments

    • Antidepressant therapy with serotonin-boosting medications (SSRI’s and tricyclics) is often prescribed.
    • Behavior Therapy techniques, such as thought-stopping and response prevention, are also employed.
    • Neurosurgery is considered for intractable cases and involves targeting pathways to/from the frontal lobes.
    • Techniques include deep brain stimulation (DBS), surgical cutting of pathways, and non-invasive destruction using methods like gamma knife surgery.
    • Newer, non-invasive approaches utilize focused ultrasound.

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    Description

    Explore the foundational elements of psychopathology, including the Four D's: Deviance, Distress, Dysfunction, and Danger. Learn about historical approaches such as Trephination and Humoral Theory, as well as the distinction between eccentrics and those with mental disorders.

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