IDAP - L1-5

Psychopathology

• Describes statistical, cultural, social, moral abnormalities
• Concerned with deviations in behavior and/or thinking that are negative for the individual or society
• Also deals with the nature and treatment of disorders

Deviance in Psychopathology

• Describes infrequency or extremity
• Behavior or thought patterns that violate norms
• Critiques:
  • Vague and narrow definition
  • Encompasses both positive and negative extremes
  • Does not account for context and rarity of behavior

Distress in Psychopathology

• Refers to negative emotions caused by behaviors or thought patterns
• Critiques:
  • Not always a sign of disorder
  • Can arise from life circumstances and specific events
  • Lack of awareness of discomfort or harm caused by behaviors or thought patterns

Disability/Dysfunction in Psychopathology

• Refers to impairments in important areas of life
• Includes inability to pursue goals, limitations in opportunities, effects on social and professional interactions, or damage to body, health, or relationships
• Critique:
  • Normal variation in abilities can limit people in the same way as psychopathological symptoms

DSM-V Definition of Disorder

• Occurs in the individual
• Involves significant difficulties in thinking, feeling, behaving
• Usually involves personal distress
• Involves dysfunction in psychological, developmental, and/or neurobiological processes
• Not a specific reaction to an event
• Not primarily the result of social deviance or conflict with society

History of Approaches to Psychopathology

• Supernatural approach (before medical model): behavior out of the ordinary was explained by possession, religious phenomena, etc.
• Biological approach (5th century BC): explained by an imbalance of "humours" (bodily fluids)
• Medical model (13th century AD): focused on theory and treatments

Key Figures in the Development of the Medical Model

• Benjamin Rush: studied physiological signs, causes, and treatments, including bloodletting
• Philippe Pinel: reformed Paris asylums by encouraging freedom and empathy
• Emil Kraepelin: focused on distinctions between disorders and developed modern classification system

Nosology, Pathogenesis, Syndromes, and Etiology

• Nosology: classification of disease
• Pathogenesis: classification of diseases by their cause
• Syndromes: classification of diseases by their symptoms and/or biomarkers
• Etiology: study of causation (pathogenesis)

Epidemiology and Disorder Classification

• Epidemiology: study of frequency and distribution of cases
• Prevalence: total number of cases at a specific time
• Lifetime prevalence: likelihood of an individual developing a condition
• Incidence: number of new cases in a certain time period
• Co-morbidity: likelihood of multiple distinct diagnoses occurring at the same time

Signs, Symptoms, Courses, and Treatment Responses

• Signs: measurable and objective abnormalities (e.g., biomarkers and response times)
• Symptoms: subjective experiences (e.g., mood or social changes)
• Courses: progression of signs and symptoms over time
• Treatment responses: effects of treatment on signs and symptoms

Biological and Psychological Approaches to Causation and Treatment

• Biological approach: seeks to explain psychopathology through physiological or nervous system abnormalities
• Psychological approach: includes psychoanalytical, behavioral, and cognitive-behavioral approaches
• Critiques of psychological approach:
  • Reductionist and neglects social, economic, and legal factors
  • Does not respond to talk therapy, and more intensive methods are necessary
  • Psychoanalytical approach lacks empirical support

Multi-Path Model

• Accounts for genetic, physiological, sociocultural, interpersonal, and psychological factors

Reliability and Validity

• Reliability: consistency of measurements (inter-rater, test-retest, alternate form, and internal consistency)
• Validity: degree to which a test measures what it aims to measure (content, construct, and discriminative)
• Critique of DSM: moderate reliability and validity issues

Schizophrenia

• Heterogenous disorder with many symptoms and unknown underlying cause
• Affects all aspects of life (e.g., mood, motivation, career, sociality, relationships)
• Prevalence: 1% lifetime prevalence, rare in childhood, with high co-morbidity rate
• History: Emil Kraepelin's dementia praecox, renamed schizophrenia by Eugen Bleuler

Symptom Clusters of Schizophrenia

• Positive symptoms: excessive or distorted perceptions/thoughts
• Negative symptoms: deficits in motivation, pleasure, sociality, expression, etc.
• Disorganized symptoms: problems in organizing thought, speech, or movement

Delusions and Perception in Schizophrenia

• Delusions: strong, firm beliefs not grounded in logic or reality
• Abnormal perception/hallucinations: cluster of symptoms affecting perception of the world

Treatment and Diagnosis of Schizophrenia

• DSM-V criteria: two or more symptoms, including delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, and negative symptoms
• Differential diagnoses: schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, delusional disorder, substance abuse disorder, and other medical disorders

Biological and Environmental Factors in Schizophrenia

• Genetic component: twin studies and family studies suggest a genetic contribution
• Dopamine hypothesis: excess dopamine in the nervous system contributes to manic and schizophrenic symptoms
• Serotonin, GABA, and glutamate: possible roles in schizophrenia
• Brain structure and function: differences in ventricles, prefrontal cortex, and temporal cortex

Psychological and Environmental Factors in Schizophrenia

• Life stress: high or chronic stress can contribute to the onset or relapse of symptoms
• Socioeconomic status: highest rates of schizophrenia found in urban, low-class areas
• Family factors: effectiveness of communication and warmth in the family can play a role in preventing relapse### Unipolar Depressive Disorders and Suicide
• 2% of outpatients and 4% of inpatients with unipolar depressive disorders will die by suicide
• In inpatients, the suicide rate is 7% for males and 1% for females
• About 60% of those who die by suicide have a mood disorder

Bipolar Disorders

• Bipolar I Disorder: involves at least one episode of mania over the lifetime, usually occurring with episodes of major depressive disorder (MDD)
• Bipolar II Disorder: involves at least one major depressive episode and at least one episode of hypomania, with no manic episodes
• Cyclothymia: involves frequent but mild depressive symptoms, alternating with mild symptoms of mania, with symptoms not meeting criteria for a major depressive or manic episode

DSM-V Criteria

• Cyclothymia: numerous periods of hypomanic symptoms and depressive symptoms, present for at least 2 years, causing significant distress or functional impairment
• Manic Episodes: distinctly elevated or irritable mood, abnormally increased activity or energy, and at least four other symptoms, present for at least 1 week, requiring hospitalization, or including psychosis
• Hypomanic Episodes: distinctly elevated or irritable mood, abnormally increased activity or energy, and at least four other symptoms, present for at least 4 days, observable to others, and without marked impairment in functioning

Prevalence of Bipolar Disorders

• Lifetime prevalence of bipolar I disorder: less than 1%
• Lifetime prevalence of bipolar II and cyclothymia: 1-4%
• Onset: before 25 years old in more than half of cases, equal in men and women, but women experience more depressive episodes
• About 2/3 of patients meet diagnostic criteria for an anxiety disorder

Genetics and Neurotransmitters

• Heritability: MDD: 0.37, bipolar disorders: 0.93
• Neurotransmitters: serotonin, norepinephrine, and dopamine suggested as contributors to symptoms, but evidence from neuroimaging is inconsistent

Functional Brain Abnormalities

• Abnormal activity in emotion and reward centers observed in neuroimaging
• Oversensitivity to emotional stimuli and difficulty regulating emotions linked to elevated activity in the amygdala
• Impaired response to rewarding stimuli and lack of motivation linked to diminished activity in the nucleus accumbens and striatum

Cortisol Dysregulation

• Hyperactive HPA axis during episodes of MDD
• Over-secretion of cortisol associated with depressive symptoms
• Cortisol awakening response predicts likelihood of developing MDD and recurrence

Role of Childhood Adversity and Negative Life Events

• Childhood trauma increases the chance of developing depression
• Negative life events, such as job loss and relationship breakdown, often precede the onset of depressive episodes or relapse

Role of Social Support and Neuroticism

• Social support from close family or friends can buffer against the effect of stressful events
• Neuroticism, a personality trait, predicts the onset of mood disorders and anxiety disorders

Cognitive Style and Theories

• Beck's Negative Triad: negative ideas about the self, the world, and the future underlie symptoms of depression
• Hopelessness Theory: belief that desirable outcomes will not occur and that the individual has no power to change this underlies depression
• Rumination Theory: tendency to dwell on sad experiences or thoughts increases the likelihood of depression

Treatment of MDD

• Four types of antidepressants: MAO inhibitors, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and serotonin norepinephrine reuptake inhibitors (SNRIs)
• Success rate: around 60% of patients respond to medication
• Three other biological treatments: unilateral electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and psychosurgery
• Three psychological treatments: interpersonal psychotherapy, cognitive therapy, and psychodynamic approaches
• Success rate: 60-80% of patients see an improvement in some area

Anxiety Disorders

• Fear vs. Anxiety: fear is an immediate reaction to fearful stimuli, while anxiety is a sense of worry in anticipation of a situation
• Five main anxiety disorders: specific phobia, social anxiety disorder, panic disorder, agoraphobia, and generalized anxiety disorder
• Prevalence: 28% of people will meet the clinical criteria for one over their lifetime
• Co-morbidity rate: 60% with MDD, 50% between anxiety disorders

Theories of Anxiety Disorders

• Fear Conditioning Theory: classical conditioning and operant conditioning contribute to the development of anxiety disorders
• Personality Theory: certain traits, such as behavioral inhibition and neuroticism, increase the likelihood of developing an anxiety disorder
• Cognitive Factors: attention to threat, intolerance to uncertainty, and perceived lack of control contribute to anxiety

Treatment of Anxiety Disorders

• Three main biological treatments: anxiolytics, including benzodiazepines, beta blockers, and antidepressants
• Three psychological treatments: relaxation therapy, cognitive behavioral therapy, and exposure and response prevention therapy

Obsessive-Compulsive Disorder (OCD)

• Two main symptoms: obsessions and compulsions
• Primary focuses of obsessions: contamination, responsibility for harm, sex/morality, violence, religion, and symmetry/order
• Primary focuses of compulsions: decontamination, checking, repeating routine activities, ordering/arranging, and mental rituals

Treatment of OCD

• Two main biological treatments: selective serotonin reuptake inhibitors (SSRIs) and antidepressants
• Two psychological treatments: exposure and response prevention therapy and cognitive behavioral therapy### Genetic Role in OCD and Related Disorders
• OCD, BDD, and HD have a heritability of 30-50%

Neurobiological Role in OCD and Related Disorders

• Fronto-striatal circuits are hyperactive in OCD and BDD, especially during symptom presentation
• These circuits are implicated in error detection and cognitive control
• Successful treatment normalizes activity in these areas

Psychological Factors in OCD

• Cognitive-behavioral model of obsessions and compulsions suggests operant conditioning causes behaviors
• Temporary anxiety reduction reinforces behaviors
• Thought suppression increases unwanted thoughts (e.g., white bear experiment)
• Thought-action fusion leads to moral equivalence between thinking and acting
• Yedasentience is the subjective feeling of knowing or completion
• Deficits in yedasentience lead to anxiety and failure to resolve anxiety

Biological Treatments for OCD

• Main treatment: antidepressants (tricyclics, SSRIs, SNRIs)
• Effective for both OCD and BDD
• Clomipramine (tricyclic) is especially effective for OCD

Other Biological Treatments for OCD

• Deep brain stimulation: a promising treatment for extreme, intervention-resistant cases
• Involves electrodes implanted in fronto-striatal circuits
• Psychosurgery: bilateral lesions to white matter tracts in the anterior cingulate cortex
• Only used when all other treatments fail and patient's life is in danger

Psychological Treatment for OCD

• Main treatment: exposure and response prevention (ERP) therapy
• Involves facing sources of fear and adapting to reduce fear response
• Uses an exposure hierarchy to eventually extinguish anxiety and prevent ritualistic responses
• ERP is more effective than clomipramine for OCD, but requires a lifetime commitment