Understanding Psychopathology

Overview of Psychopathology

• Psychopathology is the scientific study of mental illness, including understanding mental disorders, their causes, progression, symptoms, and classification.
• The field explores how abnormal behaviors indicate mental disorders and the resulting dysfunction or illness in individuals.

Historical Perspectives

• The understanding of mental illness has shifted from supernatural to natural explanations.
• Early civilizations, including Egyptians, Indians, and Greeks, contributed to understanding mental health.
• Karl Jaspers' 1913 publication, General Psychopathology, laid the foundation for modern psychopathology, emphasizing individual experiences of abnormal mental states.
• Ancient explanations often attributed abnormal behaviors to supernatural forces, with treatments like trephination and exorcism.
• Greco-Roman Era emphasized organic causes of mental illness, in particular brain pathology
• Middle Ages saw a resurgence of supernatural explanations, influenced by the Catholic Church.
• Renaissance Era brought humanism, promoting welfare and humane treatment of the mentally ill.
• The 18th and 19th centuries brought moral treatment and lunacy reform, which shifted emphasis from containment to providing care.

Key Historical Milestones

• Bethlehem Hospital (London) was an asylum by the 1400s, but became a public spectacle for the wealthy.
• Friends' Hospital (USA), founded in the early 1800s, was the first non-profit mental hospital run by lay staff following Quaker values.
• Jane Murphy's cross-cultural study in 1976 found shared disturbed behavior descriptors across cultures, highlighting the universality of psychopathology.

Defining Abnormal Behavior

• Defining abnormal behavior involves considering several criteria, each with limitations.
• The four main criteria include statistical rarity, social deviance, distress, and dysfunction.
• Statistical rarity refers to behaviors that are statistically rare in the population; however, not all rare behaviors are abnormal (e.g., high intelligence).
• Social deviance refers to behaviors violating societal norms and considered culturally abnormal; however, deviance varies across cultures and time periods (e.g. homosexuality).
• Distress involves significant emotional or psychological discomfort; positive experiences like mania may impair functioning without distress.
• Dysfunction refers to behaviors that interfere with daily life functioning (e.g., addiction), but disengagement from roles may reflect shifting priorities.
• Challenges in defining abnormal behavior stem from its complexity and context-dependence; some socially deviant behaviors are not mental illnesses (e.g., criminal behavior).
• Cultural relativism influences perceptions of abnormal behavior, leading to diagnostic differences across societies.
• Context dependence means what's considered abnormal can depend on cultural or historical settings.

Understanding Mental Illness

• A mental disorder is clinically significant if it causes distress or dysfunction.
• In Australia, 43.7% of individuals experience a mental disorder in their lifetime
• Mental illnesses contribute to reduced productivity, reduced life satisfaction, and increased mortality.
• Mental and substance use disorders are the fourth-largest contributor to disease burden in Australia.
• Mental and substance use disorders are the second-largest contributor (24%) to the non-fatal burden of disease in Australia, after musculoskeletal conditions (25%).
• An estimated 418 million DALYs were attributed to mental disorders in 2019, representing 16% of global DALYs.

Theoretical Models

• Understanding mental illness requires analyzing multiple contributing factors.
• The main theoretical models include biological, psychological, sociocultural, and diathesis-stress models.
• Biological models focus on genetics, brain function, and psychological factors.
• Psychological models encompass psychoanalysis, behavioral, and cognitive approaches.
• Sociocultural models examine cultural, social, and environmental influences.
• The Diathesis-stress model explains how biological vulnerabilities and stress can trigger mental illness.

The Biopsychosocial Model

• Developed in 1977 by George Engel, integrating biological, psychological, and sociocultural factors.
• Prior to this model, mental illness was largely understood from a biomedical perspective (brain chemistry, trauma and genetics).
• Engel broadened the model to include psychological factors (thoughts, feelings, coping mechanisms, learning, and memory) and social factors (cultural influences, relationships, social support, socioeconomic status).
• The model considers the interplay of these factors, rather than treating them as independent contributors.
• Hormone regulation illustrates biology's impact on psychology by influencing emotions and cognition.
• This model takes a holistic approach, considering multiple influences rather than a single cause.
• Emphasizes individual differences, and considers why similar illnesses can be experienced differently.
• The Biopsychosocial model is of clinical relevance, as it is used in therapy and medical.

Biological Model

• Focuses on brain function, genetics, and the nervous system.
• Developed with advancements in psychiatry and neuroscience
• Core assumptions maintain that abnormal behaviors result from biological dysfunction
  • Includes brain structures, neurotransmitters, or genetic mutations.
• Used in diagnosing and treating mental illness through biological means
  • Includes medications and brain imaging.

Genetics and Mental Illness

• Molecular genetics studies how DNA structures influence behavior.
• Behavioral genetics examines how genes are inherited and influence behavior
  • Down syndrome (Trisomy 21) is associated with behavioral changes (aggression, attention deficits), not typically inherited, abnormal cell division.
• Most mental illnesses are influenced by multiple genes rather than a single genetic factor.

Brain Trauma and Mental Health

• Traumatic Brain Injury (TBI) can cause damage to teh brain, leading to cognitive and emotional impairments.
• Mild TBI can cause confusion, dizziness and memory loss.
• Sever TBI can cause prolonged unconsciousness, speech impairment, and emotional dysregulation
• Types of brain damage
  • Localized Injury - affects specific brain areas for particular functions.
  • Diffuse Damage - Widespread damage (axon shearing from rapid head movement like a car accident).
  • Ischemic Brain Injury - Oxygen deprivation leading to neuronal death.

Neurotransmitters and Mental Health

• Neurotransmitters are chemical messengers that enable brain communication
• Hormones are released by endocrine glands, influencing emotions and behaviors
• Psychopharmacology studies how drugs alter brain chemistry
  • Examples of treatments that change brain chemistry; anxiolytics treat anxiety, antidepressants target depression, and mood stabilizers target bipolar disorder.

Emerging Biological Treatments

• Electroconvulsive therapy (ECT) is used for treatment-resistant depression.
• Deep Brain Stimulation (DBS) uses electrodes implanted in the brain to regulate activity
  • DBS used in Parkinson's and OCD
• Transcranial direct-current stimulation (tDCS) provides a non-invasive method to stimulate brain areas

Limitations of the Biological Model

• A reductionist approach overlooks psychological and environmental influences.
• Considerations for side effects and relapse due to medications having long-term consequences
• Difficult to determine if biological differences cause mental illness or result from it.

Psychological Models

• The psychonalysis Model suggests unconscious conflicts can cause mental illness
• Focuses on childhood experiences that shape adult life.
• Treatments for psychological disturbance include free association and dream analysis
  • Limitations : difficult to measure scientifically and time-consuming therapy.

Psychodynamic Models

• Are built on psychoanalysis but introduced measurable treatment.
• Key theories
  • Ego psychology focuses on the self's ability to adapt.
  • Object relations theory examines early attachments.
  • Attachment theory is how early relationships can shape behaviour.

Behavioral Models

• Argue that mental illness results from learning and conditioning.
• Classitical conditioning example: Little Albert conditioned to fear rats
• Operant conditioning (Skinner): behavior shaped by reward/punishments
  • Examples of behavioral therepies include: exposure therapy (used with phobias, PTSD), systematic desensitization to reduce anxiety step-by-step, aversion therapy to associate negative stimuli with unwanted behavior, and token economies to reward positive behavior.

Cognitive Models

• Albert Ellis' rational emotive behavioral therapy (REBT) states that thoughts shape emotions and behaviors
• Aaron Beck's cognitive therapy focuses on negative though patterns
  • Cognitive therapy identified three types of negative thinking: global ("I fail at everything"), stable ("I'll always be a failure"), and internal ("I failed because I'm not smart").
• Cognitive behavioral therapy (CBT) integrates behavioral approaches, effective for depression, anxiety, PTSD, and addiction.

Sociocultural Models

• Stresses that abnormal behavior is influenced by social, cultural, and environmental factors.
• Examines how family dynamics, socioeconomic status, and cultural values shape mental health.
• Sociocultural Theories
  • Theory of reasoned action (1960s) proposes that behaviours are influenced by attitudes, beliefs and social norms.
  • Theory of planned behaviour (1980s) adds perceived control, so the belief in ability to perform an action.
  • Attribution theory concerns how people interpret behaviour, as well as errors in attribution, fundamental error, and self-serving bias

Diathesis-Stress Model

• This model suggests that diathesis ( a predisposition) + stress (life event) = increased risk of mental illness.
  • Example A person with a genetic risk for depression might only develop it after experiencing trauma.

Clinical Assessment

• Clinical assessment is a systematic process in mental health to evaluating mental wellbeing functioning.
• Main purposes are to identify and diagnose health disorders, evaluate cognitive abilites, develop treatment plans, and conduct initial evaluations ( emergency situations).
• Key objects of the processes diagnoses, provides a case formulation, provides monitoring treatments and risks.
• Clinical interviews essential assessment tools include unstructured, structured, and common forms.
• Cultural competency stresses that it's important to consider one's's own culture when assessing someone's state.
• Scientist practitioner model is important.

Clinical Assessment Tools

• The Mini-Mental State Examination (MMSE) screens for cognitive decline.
• The Minnesota Multiphasic Personality Inventory (MMPI−2) assesses personality and psychological disorders. Projective tests assess thoughts and emotions.
• The Wechsler Abbreviated Scale of Intelligence (WASI) measures general cognitive ability. The Tower of London test evaluates planning and problem-solving skills.

Neuroimaging and Physiological Assessments

• Neuroimaging techniques help identify brain abnormalities.
• Common techniques
  • CAT Scan - Detects brain injuries, tumors, and strokes using X-rays
  • MRI - Detailed brain images using magnetic fields
  • fMRI - Measures brain activity through blood oxygen levels
  • PET scans - Tracks metabolic activity using radioactive tracers.
  • Electroencephalogram (EEG) - Useful for epilepsy, sleep disorders
• EEG brain wave frequencies
  • Delta Waves - occurs during deep sleep
  • Theta Waves - occurs during the state of drowsiness and light sleep
  • Alpha Waves - relaxed wakefullness
  • Beta Waves - active for thinking and problem solving
  • Gamma Waves - occurs during high-level cognitive processing

Clinical Diagnosis and Assessment

• Gathering of information involves the clinical interview, physical exam, refferals/ consultations, and evidence based assessments.
• Signs are the observable behaviors (mood, affect, sleeping).
• Symptoms are subjectively self reported.
• Clinicians combine sings and symptoms to make a diagnosis.

Diagnostic Classification Systems

• The International Classification of Diesease is a diagnostic tool that classifies the classification of dieseases- The classification is available internationally at no cost and includes a diagnoses of personality disorders.
• DMS5 is tool utilized and published by the APA that has the purposes to improve reliability to diagnose illnesses. Tool categorised into mental illness groups and uses a specific tool to refine what the criteria requires to diagnoses.
• Two types of errors possible when diagnosing: Types 1; when diagnoses is incorrectly given and Type 2; When diagnoses is not given and diagnoses is missed. Important to maintain sensitives and specifies when diagnosing.

Catagorical vs. Dimensions

• A catagorical classification has illnesses that can either be seen to present or not present but dimensional classifications has considers on a degree of symptoms- which ranges in presentation. Dimensions features assesses the degree of symptoms presented.
• There has shifted movement to considering DMS for dimensions in classification.

Emerging Frameworks

• Power, Threat, and Meaning - framework that views abnormal functioning in relation to the contexts.

Self-Care

• Self-care can improve overall well being.
• The APS stresses the important emotion of self-care due to work load.
• Models of self are important

Stress and Impact

• Stress is a response to the environment that impacts bodies physically or psychologically.
• Bodies can have distress or measure of psychological to monitor psychological distress which can measured with questionares.

Trauma

• Some types of trauma include acute, chronic, and complex. Some trauma can impact some more than others.
• Trauma in childhood versus. adulthood.

Self-care Readings

• Stress's effect on language
• Some ways that clinicians use specific language that affects patients