Psychological Disorders Lecture 1

Psychological Disorders: Definition and Historical Background

• A psychological disorder is a psychological dysfunction within an individual associated with distress or impairment in functioning and a response that is not typical or culturally expected.
• Aspects of its definition:
  • Deviance/Atypical: deviating from the majority, violating social norms, or being statistically infrequent or 'rare'.
  • Distress: experiencing emotional distress due to the behavior.
  • Dysfunction: not being able to perform in daily life; behavior interferes with daily/social/occupational functioning.

Historical Background of Psychological Disorders

• Ancient cultures believed that spirits controlled aspects of a person's behavior (The Supernatural Model).
• In ancient Greece and Rome, Hippocrates and Galen identified symptoms such as hallucinations, delusions, melancholia, hysteria, and mania.
• Middle Ages through the Renaissance: influence of the Roman Catholic Church, abnormal behavior was seen as the work of the devil/witchcraft.
• 14th to 17th century (Renaissance period): Johann Weyer and Paracelsus proposed that the movement of the moon and stars affects people's psychological functioning.
• 16th century: Emergence of asylums.
• 19th century (The Psychological Model): moral therapy characterized by:
  • Removal of patients from "warehouse" asylums into specialized facilities.
  • More humane method of treatment + positive psychological interventions.
  • Use of respect, kindness, religion, and vocation.

Key Figures in the History of Psychological Disorders

• Emil Kraepelin (1856-1926): German psychiatrist who developed a classification system for mental disorders and identified "Dementia praecox" (modern-day schizophrenia).
• Sigmund Freud (1856-1939): developed psychoanalysis, which includes:
  • The id, ego, and superego.
  • Defense mechanisms (denial, sublimation, projection, rationalization, repression, reaction formation, and displacement).
  • Psychosexual stages of development (oral, anal, phallic, latent, genital).
• Other key figures: Carl Jung, Alfred Adler, and Aaron Beck.

The Biological Model of Psychological Disorders

• Assumes that psychological disorders result from biological processes.
• Factors that contribute to psychological disorders:
  • Genetic/hereditary factors.
  • Epigenetics: ways in which the environment can change gene expression, which can be passed down to later generations.
  • Biological scarring.
  • Brain malfunctioning or structural abnormalities.
  • Viral infection theory.

Research Methods in Psychopathology

• The scientist-practitioner model: mental health professionals are consumers of science, evaluators of science, and creators of science.
• Questions driving the science of psychopathology:
  • What are the presentations of different disorders?
  • What leads to the development of a psychological disorder (etiology)?
  • How do we treat disorders effectively?
  • How can we prevent the development of psychological disorders?

Basic Components of Research

• Starts with a hypothesis or educated guess.
• Research design: a method to test hypotheses, including independent and dependent variables.
• Considerations in research design:
  • Internal validity: the extent to which you can be confident that the independent variable is causing the dependent variable to change.
  • External validity: how well the results relate to things outside your study.

Sta5s5cal Versus Clinical Significance

• Sta5s5cal significance: the probability of obtaining the observed effect by chance is small.
• Clinical significance: whether or not the difference was meaningful for those affected.

Research at the Cellular Level

• The nervous system consists of the central nervous system (brain and spinal cord) and peripheral nervous system (somatic nervous system and autonomic nervous system).
• The neuron: neurotransmitters, dendrites, soma, axon, and synapse.
• The brain stem, thalamus, hypothalamus, and limbic system.
• Neurohormones and neurotransmitters: chemical substances that relay electrical signals between neurons.

Gene5cs Research

• Phenotypes (observable characteristics) vs. genotypes (unique genetic makeup).
• Endophenotypes: genetic mechanisms that contribute to the underlying problems causing symptoms among people with psychological disorders.

Behavioral Gene5cs

• Approaches to the study of behavior that do not examine genes directly, but infer the action of genes and environment.
• Family studies: examining behavioral patterns or emotional traits in the context of the family.
• Adoption studies: identifying adoptees who have a particular behavioral pattern or psychological disorder and attempting to locate first-degree relatives who were raised in different family settings.

Research at the Individual and Group Levels

• Studying individual cases: case study method and single-case experimental designs.
• Research at the group level: correlational research, experimental research, and studying behavior over time.
• Studying behavior across cultures: cross-cultural research and epidemiology.Here are the study notes for the text:
• Assessment and Diagnosis of Psychological Disorders*
• Information Gathering: gather information on patient's current and past interpersonal and social history, including family makeup
  • Structured, Unstructured, or Semi-structured interviews
  • Example: Structured Clinical Interview for DSM Disorders (SCID)
• Psychological Tests*
• Projec5ve Tests: has roots in psychoanalytic tradition
  • Clients presented with ambiguous test stimuli and asked to make interpretations
  • Require high degree of inference in scoring and interpretation
• Objec5ve Tests: roots in empirical tradition
  • Require minimal clinical inference in scoring and interpretation
  • Examples: paper and pencil questionnaires, including tests of specific psychological symptoms and personality tests
    • Measures of specific psychological symptoms: Sample Self Report Psychological Scale; Beck Depression Inventory
    • Personality tests: self-report questionnaires that assess personal traits; Minnesota Multiphasic Personality Inventory
    • Intelligence tests: Intelligence Quotient; average IQ is 15, standard deviation is 15
      • Examples: Stanford-Binet Intelligence Scale, Wechsler Adult Intelligence Scale, Wechsler Intelligence Scale for Children (WISC-IV, 7-16 years)
• Neuropsychological Tests*
• Measure abilities in areas such as receptive and expressive language, attention and concentration, memory, motor skills, perceptual abilities, and learning and abstraction
• Goal: detect impairment in cognitive/motor/perceptual functioning using simple and complex tasks that measure skills in various domains
• Examples: Halstead-Reitan Neuropsychological Battery, Trail Making Test, Wisconsin Card Sorting Test (WCST), Bender Visual Motor Gestalt Test
• Behavioral Assessments*
• Func5onal Analysis: identify causal links between behavior and environment; has basis in behaviorist tradition
  • "ABC" Model of Functional Analysis
    • Antecedents: Thoughts?Emotions?, Environmental triggers (people, places?), Other vulnerability factors?
    • Behavior: Frequency?Duration?Intensity?
    • Consequences: what follows from the behavior? reactions from others? immediate and after effects?
• Self-Monitoring: patient records and observes their own behavior
• Behavioral Observation: measurement of behavior by a trained observer
• Behavioral Avoidance Tests: strategies used to assess avoidance behavior
• Psychophysiological Assessments*
• Electroencephalography (EEG): measuring electrical activity in the head related to the firing of a specific group of neurons reveals brain wave activity
• Electrodermal Activity (EDA): measuring skin conductance
• Biofeedback: levels of physiological responding, such as blood pressure readings, are fed back to the patient (provided on a continuous basis) by meters or gauges so that the patient can try to regulate these responses.
• Neuroimaging and Brain Structure*
• Imaging Brain Structure:
  • Computerized Axial Tomography (CAT or CT scan): utilizes X-rays – relatively noninvasive and has proved useful in identifying and locating abnormalities in the structure or shape of the brain
  • Magnetic Resonance Imaging (MRI): utilizes strong magnetic fields (better resolution than CT scan): allows the computer to view the brain in layers, which enables precise examination of the structure
• Images of Brain Functioning:
  • Functional MRI (fMRI): allow researchers to see the immediate response of the brain to a brief event, such as seeing a new face
  • Positron Emission Tomography (PET Scan): when parts of the brain become active, blood, oxygen, or glucose rushes to these areas of the brain, creating "hot spots" picked up by detectors – we can learn what parts of the brain are working and what parts are not### Other Psycho5c Disorders
• Brief psycho5c disorder: sudden onset of psycho5c symptoms that lasts for less than a month.
• Schizophreniform disorder: similar to schizophrenia, but symptoms last between 1 to 6 months, with less severity.
• Schizoaffective disorder: a combination of schizophrenia and a mood disorder, such as a major depressive episode, a manic episode, or a mixed episode.
• Delusional disorder: a persistent belief that is contrary to reality, without other characteristics of schizophrenia, and presence of non-bizarre delusions.
• Shared psycho5c disorder: two people sharing a delusional belief due to a close relationship with a delusional individual.

E5ology

• Biological:
  • Neurotransmitters: dopamine hypothesis suggests that excessive or deficient stimulation of specific dopamine receptors may play a role.
  • Genetics: neuroanatomy (structural and functional abnormalities in the brain).
• Gene-environment interaction:
  • Twin studies: 48% chance of having schizophrenia if one has an identical twin with schizophrenia, and 17% chance if one has a fraternal twin with schizophrenia.
  • Family studies: having a relative with schizophrenia increases the chance of having the same disorder.
  • The role of gene-environment interaction (e.g., Finland study).

E5ology (continued)

• Biological:
  • Viral theories and prenatal stressors: fetal exposure to viral infection, pregnancy complications, and delivery complications.
  • Synaptic pruning: a process in which weaker synaptic contacts in the brain are eliminated and stronger connections strengthened.
• Is schizophrenia a single disease entity?:
  • May be a group of 8 distinct disorders, each related to changes in specific clusters of genes (Arnedo et al., 2014).
  • Particular sets of symptoms are matched by distinct genetic profiles.

Stress and Family Influences

• Family influences:
  • Role of a “schizophrenogenic mother”?: a mother whose cold, dominant, and rejecting nature was thought to cause schizophrenia in her children.
  • Expressed emotion (EE): describes a family’s emotional involvement and critical attitudes.
  • People with schizophrenia living in high EE family are 3.7 times more likely to experience relapse compared to people living in low EE family.

Treatment of Schizophrenia

• Pharmacological:
  • Antipsychotics: a class of medications that block dopamine receptors.
  • Typical and atypical antipsychotics.
  • Common side effect of typical antipsychotics: tardive dyskinesia.
• Transcranial Magnetic Stimulation (TMS):
  • Goal: provide stimulation to a targeted area of the cerebral cortex to change brain activity.
  • Decreases the frequency of hallucinations (temporarily).
  • Does not reduce delusions.

Psychosocial Treatment

• Psychoeducation: both patient and family members are educated about the disorder.
• Social skills training.
• Independent Living Skills Program (UCLA).
• Vocational rehabilitation.
• CBT (used to reduce psychotic symptoms).
• Cognitive remediation therapy.
• Acceptance and Commitment Therapy (ACT):
  • Incorporates principles of mindfulness and acceptance to increase psychological flexibility.
  • Effective in reducing rate of rehospitalization and reducing “believability” of psychotic symptoms among patients with schizophrenia (Bach & Hayes, 2002).