Mental Disorders Overview

Mental Disorders

• Definition: A persistent disturbance in behavior, thoughts, or emotions, causing significant distress or impairment.
• Medical Model: Abnormal psychological experiences are illnesses with biological and environmental causes, defined symptoms, and potential cures.
• Diagnosis: Clinicians assess signs (objective indicators) and symptoms (subjective reports) to determine the nature of a disorder. Robin Williams' symptoms, for example, included depressed mood and substance-related struggles, suggesting both depressive and substance-use disorders.
• Differing Terminologies:
  • Disorder: A common set of signs and symptoms.
  • Disease: A known pathological process affecting the body.
  • Diagnosis: A determination of whether a disorder or disease is present.
  • Prognosis: The likely course of a disease or ailment.
• DSM (Diagnostic and Statistical Manual of Mental Disorders): A classification system describing mental disorders' symptoms, distinguishing them from similar problems.
  • DSM-5-TR: Contains 22 major categories and over 200 mental disorders. High comorbidity (individuals reporting two or more disorders).
• Epidemiology: The study of the distribution and causes of health and disease. U.S. has the highest rate of mental disorders.
• Cultural Context: Culture influences how mental disorders are experienced, described, assessed, and treated. Cultural Formulation Interview (CFI) is used in assessments to understand how culture might influence a client's experience.
• Prognosis of Mental Disorders: Mental disorders often have a typical course over time, but the medical model is an oversimplification, and a single cause/cure is rarely the case.
• Biopsychosocial Model: Mental health/illness results from interactions among biological, psychological, and social factors.
  • Diathesis-stress model: Mental illness emerges from an individual's predisposition (diathesis) combined with a major stressor.
• DSM Evolution: DSM is not a rigid guide but rather a dictionary-like reference introducing new initiatives.
  • RDoC (Research Domain Criteria): Focuses on the processes behind disorders rather than surface symptoms, e.g., responsiveness to reward in addiction.
• Research on Addiction and Mental Disorders:
  • Variations in the DRD2 gene are linked to abnormalities in frontal-lobe and striatum connectivity, impulsiveness, and responsiveness to rewards.
• Stigma and Mental Health Treatment: Stigma often prevents individuals with mental disorders from seeking treatment (approximately 60% do not).
• Anxiety Disorders: Marked by anxiety as the predominant feature; often co-occur.
  • Phobic Disorders: Persistent excessive fear of specific objects, activities, or situations.
    • Specific Phobias: Defined by irrational fear of particular objects or situations. Categories include animals, natural environments (heights), situations (bridges), blood/injections/injury, and other (chocking, loud noises).
  • Panic Disorder: Characterized by multiple psychological/physiological panic attacks. Often includes agoraphobia.
  • Generalized Anxiety Disorder (GAD): Characterized by chronic, excessive, and often unrealistic worry. Risk factors include biological and psychological factors, with some hereditary component.
• Obsessive-Compulsive Disorder (OCD): Classified separately from anxiety disorders due to distinct causes and maintenance by differing neural pathways.
  • Obsessions and compulsions such as checking, ordering, etc. are common.
  • High heritability, approximately 50%, and strong genetic heritability of OCD traits has been found.
• Post-Traumatic Stress Disorder (PTSD): Characterized by chronic physiological arousal, intrusive thoughts/images, and avoidance of trauma reminders.
• Mood Disorders: Characterized primarily by mood disturbances.
  • Major Depressive Disorder (MDD): Characterized by severely depressed mood lasting at least two weeks and other symptoms like feelings of worthlessness, lethargy, sleep, and appetite changes.
    • Persistent Depressive Disorder: Similar to MDD, but symptoms are less severe and last longer (at least 2 years).
    • Seasonal Affective Disorder (SAD): Depression with a seasonal pattern, occurring usually in winter. Prevalence (approximately 18% of U.S. adults). Gender differences and Socioeconomic factors potentially play a role.
• Bipolar Disorder: Involves extreme shifts between manic (high mood) and depressive episodes.
  • Types: Bipolar I and II; Cyclothymic Disorder
• Schizophrenia: A psychotic disorder marked by distortions in reality. Symptoms include hallucinations, delusions, emotional disturbance, and disruptions in thought, motivation, and behavior.
• Autism Spectrum Disorder (ASD): Characterized by persistent communication deficits and restricted and repetitive behaviors.
• Attention-Deficit/Hyperactivity Disorder (ADHD): Characterized by inattention or hyperactivity/impulsivity.
• Conduct Disorder: Characterized by a persistent pattern of behavior violating others' rights. Includes aggression towards people/animals, property destruction, theft, etc.
• Personality Disorders (DSM-5-TR): Enduring patterns of thinking, feeling, or relating to others. Ten specific personality disorders are categorized into three clusters:
  • Odd/eccentric
  • Dramatic/erratic
  • Anxious/inhibited
• Antisocial Personality Disorder (APD): Characterized by disregard for rights of others; history of conduct disorder in childhood/adolescence.
• Suicide and Nonsuicidal Self-Injury (NSSI):
  • Suicide (intentional self-inflicted death).
  • NSSI (deliberate destruction of body tissue without intent to die). It's often used as a coping mechanism for emotional distress.
• Prevalence and Treatment: High percentages of individuals experience mental disorders (e.g., 46.4% lifetime prevalence; 26.2% lifetime). Common reasons for avoiding treatment include unawareness of needing it, self-reliance beliefs, or structural barriers (cost/availability).

Treatment Approaches

• Psychological treatments: Interaction with a clinician to change behavior and brain function.
• Biological treatments: Drugs, surgery, etc., used to directly affect brain function.
• Eclectic Psychotherapy: Combines various techniques from different approaches to meet client needs.
• Psychodynamic Psychotherapy: Explores childhood events for insight into psychological issues; emphasizes unconscious processes.
• Person-Centered Therapy: Focuses on the client's natural growth tendency, demonstrating empathy, congruence, and unconditional positive regard.
• Behavioral Therapy: Assumes disordered behavior is learned, treats it through conditioning (e.g., exposure therapies).
• Cognitive Therapy: Corrects distorted thoughts.
• Group Therapy: Multiple participants address individual issues in a group.
• Biological Treatments:
  • Psychopharmacology:
    • Antipsychotics: Block dopamine receptors (e.g., chlorpromazine).
    • Antianxiety: Enhance GABA effects (e.g., benzodiazepines).
    • Antidepressants: Increase serotonin and/or norepinephrine (e.g., SSRIs, SNRIs).
    • Mood stabilizers: Used to treat bipolar disorder (e.g., lithium).
• Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), Deep Brain Stimulation (DBS).
• Alternative Treatments: Natural supplements (e.g, Omega-3s) and phototherapy.

Treatment Considerations

• Placebo effect: Improvement due to belief in treatment.
• Natural Improvement: Worsening or improvement of symptoms due to time, unrelated to interventions.
• Ethical concerns in treatment include avoidance of iatrogenic illness (illness stemming from treatment); adherence to ethical standards and use of empirically-supported methods.