Introduction to Psychopathology

• Introduction to Psychopathology

Medical Models/ Syndromes

• A syndrome is borrowed from medical models of illness and is taxonic.
• Medical models have evolved over time and acknowledge illness as multifactorial/multiply determined.
• Clinical Psychology is working to catch up with these models.

Definitions and Constructs of Mental Disorders

• A harmful dysfunction involves a dysfunction where an organ system performs contrary to its design.
• It means not importantly at the peak of its design.
• Understanding the function and design of the brain, personality, and emotions is presumed.

Lilienfeld Critique

• A critique is posed on what constitutes a 'natural function.'
• Natural selection depends on variability.
• Some disorders may represent adaptations, not maladaptations.

Widiger Proposal

• Mental disorders are constructs.

Diagnosis and Diagnostic Systems

• Description highlights critical features of a diagnosis.
• For schizophrenia, the important symptoms are identified.
• Prediction may tell something about course, treatment response, etiology.
• Theory provides a set of postulates about relationships of different elements to one another.
• Communication occurs between clinicians.

Five Criteria of Diagnosis and Classification (Robins and Guze)

• Clinical description requires the disorder to be characterized by a common set of symptoms that cluster together and are characteristic of it.
• Course suggests people with the disorder should follow a common trajectory and have a similar onset.
• Treatment response indicates that if a disorder is valid, most people will respond similarly to similar treatments.
• Family history: If the disorder runs in families, it speaks to the validity of a diagnosis.
• Laboratory studies look for biological and psychophysiological associations.

Limitations of a Classification System

• Loss of uniqueness: A diagnosis implies that common features are more important than the ways in which individuals vary.
• Difficulty of boundary cases: There is the question of what to do about people on the boundary and whether to arbitrarily decide which group they're more similar to.
• Procrustean beds: This refers to a Greek myth where an innkeeper had one-size beds and would cut people to fit if they didn't accommodate the bed size.

Categorical vs. Dimensional System

• Categorical system: Focuses on the presence/absence of a disorder, such as being anxious or not.
• Relies on categorical diagnoses for research and understanding, simplifying communication and treatment selection.
• In a dimensional model, everyone falls somewhere, requiring classification of everyone instead of a binary yes/no.
• Categories are better for clinical decision-making like hospitalization or treatment choices.

Dimensional System

• Ranks on a continuous quantitative dimension the degree to which a symptom is present, like anxiety on a scale of 1 to 10.
• Dimensional systems may better capture an individual's functioning and preserve more information.
• They offer greater reliability (inter-rater, test re-test).
• Cutoffs in categorical systems tend to magnify small differences.

DSM and Classification

• DSM-I was released in 1952. DSM-II in 1968. DSM-III in 1980.
• DSM-I and II featured few categories, no symptom requirements, and psychoanalysis dominated.

DSM-III (1980)

• It featured demands for a more biological, empirical approach.
• Inclusion criteria: It asks what symptoms and how many are needed.
• Duration criteria: It defines how long symptoms must be exhibited.
• Exclusion criteria: It determines what symptoms rule out a diagnosis.
• Multi-axial classification includes major clinical disorders, personality disorders, contributing medical conditions, psychosocial stressors, and a GAF score for severity.
• Introduced assumptions like symptoms are the most useful for assessment and nosology is based on behavior/symptoms.
• It shifts focus away from life history, emphasizing how a person presents and the locus of pathology in the individual.

DSM-IV (1994)

• It introduced "clinically significant distress or impairment in social, occupational, or other important areas of functioning" as criteria.

DSM-IV-TR (2000)

• It did not introduce new diagnoses but provided more information on each.
• It offered a broad definition of mental illness for the first time.

DSM-5 (2013)

• It removed the multi-axial system and introduced dimensional assessment criteria for some diagnoses.
• Some disorders were re-classified and others removed.
• DSM-1 to DSM-5 moved from 106 to 157 categories.

Challenges to a Categorical Classification System

• Heterogeneity means in theory anyone inside boundaries should look similar, but they don't.
• Comorbidity is the simultaneous or lifetime presentation of multiple illnesses and affects outcomes.
• If a person meets criteria for one disorder, 50% qualify for more than one; over their lifetime, 75%.

Why Does Comorbidity Exist?

• Chance: With a 20% chance of MDD and 20% chance of anxiety, there's a 4% chance of having both. Some comorbidity is just chance.

Comorbidity Greater than Chance

• Indicates a sampling bias where each disorder is associated with a chance of being treated.
• Individuals with more disorders are more likely to seek treatment, resulting in biased clinical samples.
• High rates of comorbidity are also found in community samples.

Problems with Diagnostic Criteria

• Many criterion sets overlap, with issues like suicidal ideation in multiple disorders.

Additional Challenges

• Poorly-drawn diagnostic boundaries lead to multiformity; comorbid disorders may reflect a third, independent disorder.

Causal Explanation

• One disorder can be a risk factor for another, like conduct disorder leading to substance use disorder. Shared etiological risk factors also contribute.

Alternative Approaches

• Dimensional/Hierarchal Models: Latent factors manifest in different ways; internalizing and externalizing disorders share variance.
• Hierarchal Taxonomy of Psychopathology: Complex models relate symptoms to understand the locus of disorder; relies on symptom presentation.

Research Domain Criteria (RDoC)

• Aims to identify domains within constructs that can be measured using various units of analysis.
• Domains include negative valence systems, positive valence systems, cognitive systems, systems for social processes, and arousal/regulatory systems.

Psychiatric Epidemiology

• It seeks to describe the frequency/distribution of traits and disorders in different populations.
• Prevalence: It measures the percentage of people in a population with a disorder at a specific time.
• Incidence: It quantifies the percentage of people who develop a disorder for the first time during a specific period.

Relative Prevalence Rates of Psychological Disorders

• The 1-year and lifetime prevalence rates and onset ages of major depression, persistent depressive disorder, bipolar disorder, anxiety disorders, panic disorder, OCD, social anxiety disorder, GAD, and PTSD are examined.
• College students attending college are typically coming in with less severe psychopathology.

Etiological Models

• Address attempts to comprehend how/why individuals become ill.

Environmental and Genetic Models

• Environmental causes are the learning experiences. Genetics has many forms that are heritable.
• Focus is on environmental learning experiences and Freudian theories like the "schizophrenogenic mother" or "refrigerator mother" concepts.
• Genes determine a range of possibilities but not necessarily where you land. Most genes are probabilistic.
• Psychopathology is most likely polygenic, influenced by many genes.

Diathesis-Stress Models

• States that only those who have both diathesis AND stress will develop psychopathology
• Explain early psychopathology on nature/nurture, emphasizing nature and nurture interact differently.
• Diathesis: a predisposition or vulnerability to developing psychopathology.

Vulnerability-Stress Correlations

• Often non-independent, involving stress generation, where people's interactions elicit excessive reassurance.
• "Scars" can act as vulnerabilities, shaping interactions and perceptions of stress.
• Stress influences the development of diathesis, altering interpretations of subsequent experiences. Important terms in etiology include:
• Equifinality: People get the disorder in different ways.
• Multifinality: Same risk factor results in many manifestations of psychopathology.

Research Methods in Psychopathology

• Longitudinal Designs: A design that follows the same people over an extended period of time.

Retrospective Studies

• Start with a group with disorder (e.g. schizophrenia) and ask about their past. Focus is on collecting data and determining what preceded the disorder.
• This heavily relying on self-report, but existing archival data like home videos can be used to identify early risk factors.

Follow-Up Studies

• Follow people who are in a first onset case over many years to see what happens throughout the course of their illness

High-Risk Studies

• Selects a group of people who do not have the disorder yet but who are thought to be at high risk
• It then follows them, but faces limitations like unrepresentative kids and problems with attrition.

Vulnerability Marker

• Very expensive methods: It precedes the disorder, is trait-like, correlated but has 2 persist, and is present in a high-risk population.

Sampling Issues

• Case Control vs. Cohort: Case Control compares people with disorder to those without, while Cohort follows a large sample.
• Patients vs. Community: Patient populations may not represent those in the community. Controls can involve healthy or psychiatric controls.

Genetic Epidemiology

• Family studies identify a proband, assess family members through interviews, and use informant reports.

Adoption Studies

• Compare rates of disorder in biological and adoptive families.
• Key designs include parent/adoptee as proband and cross-fostering.

Twin Studies

• Studies analyze monozygotic (identical) and dizygotic (fraternal) twins to contrast genetic and environmental influences.
• The ACE model is used which puts variants in genotypes.

Problems With Twin Studies

• MZ twins often sharing a placenta, receive treated more similarly and is not deterministic. Genes determine a range of outcomes

Gene-Environment Correlations (rGE)

• The environment is not independent of our genotype. Can be passive rGE or active (niche-picking).

Paradox of Intelliegence

• IQ is highly heritable but also malleable, influenced by the Flynn effect and environmental stimulation.

Heritability as function of Environment

• Heritability increases across development, varying by family affluence and neighborhood alcohol outlets.

Mod of Transmission

• Quantitative genetics includes single-gene and polygenic transmission.

Many Different gene variants

• Working in conjunction are what determine the phenotype may be a mixed transmission

Problems with single Gene

• Single gene has more prevalence, while psychological phenotypes likely controlled more gene May be modified by interactions

Missing Heritabilities

• Can be explained quantitively genetics explains very little
• Need to know where the remaining genetic can be predicted

Gene environment interaction

• Can be followed from childhood into adulthood
• Looks at the redundant study if the gene only predicts latent vulnerability

Etiology

• Ones short allele with risk increases with the environment
• effects of the gene is expressed with certain criteria

Epigenetics

• Regulation and expression of the genes that are expressed

Micheal Meaney

Environment impacts genes

Other explanations

Phenotypes that do not measure precisely not homogeneous

Genotypes-Endophentyes-Phenypes

Intermittently show phenotype

Anxiety disorders

• In the DSM-5, anxiety-related disorders are categorized into three distinct chapters: Anxiety disorders Obsessive-Compulsive and related disorders - OCD Trauma and stressor-related disorders - PTSD They follow sequentially on purpose to show that they can be correlated

HITOP

• Hierarchal Taxonomy of Psychopathology

Special populations

Fear that is over the top

Phobias

Not intense

GAD

• general anxiety in which cannot control worry

Worry

Also evidence that GAD try to control or suppress the worry Vicious cycle Inability to control worry increases sense of lack of control Increases intrusiveness of the thoughts Cycle perpetuates itself White Bear

Social Anxiety Disorders

D- The symptoms are constant