Wurundjeri People & Mental Health

Billiberlary's Walk

• A cultural interpretation of the landscape that provides an experience of connection to country for the Wurundjeri people
• The Wurundjeri people, from the Kulin Nation, have walked the grounds where the University of Melbourne now stands since time immemorial
• The whispers and songs of the Wurundjeri people are within the University of Melbourne's built environment

Learning Outcomes

• Contemporary and historical concepts of mental health and illness will be described and explained
• Psychological disorder will be named and described
• Different approaches to thinking about and classifying mental disorder will be compared, contrasted, and explained, including pros and cons
• Reasons why classifying mental disorder is difficult and complex will be described and explained
• Different models of psychopathology will be compared, contrasted, and explained, including pros and cons

Mental Health

• It is a state of mental well-being where people can cope with life's stresses, realize abilities, learn and work effectively, and contribute
• It supports individual and collective decision-making, relationship-building, and shaping the world
• Mental health is a fundamental human right, crucial for personal, community, and socio-economic advancement
• It is more than the absence of mental disorders
• Exists on a continuum experienced differently with varying degrees of difficulty and distress
• Mental health conditions can include mental disorders, psychosocial disabilities, and other states with distress, impaired functioning, or self-harm risk
• People with mental health conditions may have lower well-being, but this isn't always the case

Mental Illness

• The Australian Government, Department of Health and Aged Care defines it as a clinically diagnosable disorder
• It significantly interferes with an individual's cognitive, emotional, or social abilities

Mental Disorder (DSM-5-TR Definition)

• It is a syndrome with clinically significant disturbance in cognition, emotion regulation, or behavior
• It reflects dysfunction in psychological, biological, or developmental processes
• Mental disorders usually cause significant distress or disability in social, occupational, or other activities

What Is Not a Mental Disorder?

• An expectable or culturally approved response to a common stressor/loss, like the death of a loved one is not a mental disorder
• Socially deviant behavior (political, religious, or sexual) and conflicts between the individual and society are not mental disorders

Approaches to Classification Models

• Categorical: Divides disorders into categories based on criteria sets with defining features.
• Dimensional: Psychopathological phenomena occur along continuums.
• Alternative: Do not focus on mental health and illness concepts.

Categorical vs. Dimensional Classification

• Categorical classification offers better clinical and administrative utility when clinicians make dichotomous decisions, and enables easier communication
• Dimensional classification models the lack of sharp boundaries between disorders and normality, detects change, facilitates monitoring, and develops treatment-relevant symptom targets

Understanding Heterogeneity

• Life experiences differ and individuals have different levels of resilience or vulnerability
• A classification system helps determine who is experiencing a clinically significant psychological problem

Diagnostic Systems

• Diagnostic and Statistical Manual of Mental Disorders (DSM) guides practice
• International Statistical Classification of Diseases and Related Health Problems (ICD) guides administration

DSM-5-TR

• Primarily categorical (diagnoses), with dimensional components (symptom severity rating, chapter organization, and new models)

DSM-5-TR Diagnostic Groupings:

• Neurodevelopmental, schizophrenia spectrum and other psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive-compulsive and related disorders, trauma- and stressor-related disorders, dissociative disorders, somatic symptom and related disorders, feeding and eating disorders, elimination disorders.
• Furthermore, it also considers sleep-wake disorders, sexual dysfunctions, gender dysphoria, disruptive/impulse control and conduct disorders, substance-related and addictive disorders, neurocognitive disorders, personality disorders, paraphilic disorders, and other mental disorders.
• Focus on medication-induced movement disorders and other conditions that may need clinical attention.

DSM-5-TR Diagnosis

• Based on Clinical interviews, text descriptions and diagnostic criteria
• Takes into account presenting symptoms and severity, general medical condition, and potential substance-related causes

DSM5 Diagnostic Approach

• Establish boundary with no mental disorder
• Determine specific primary disorder(s) with multiple diagnoses possible
• Add subtypes/specifiers like severity, treatment relevance, and longitudinal course

Panic Disorder Diagnosis (DSM-5-TR)

• Panic disorder is diagnosed based on recurrent, unexpected panic attacks, where a panic attack involves an surge of intense fear or discomfort that peaks within minutes
• During this time, four or more symptoms occur, such as: palpitations, sweating, trembling, sensations of shortness of breath, feelings of choking, chest pain, nausea, feeling dizzy, chills or heat sensations, paresthesias, derealization, fear of losing control, and fear of dying
• At least one attack is followed by 1 month (or more) of persistent concern about additional panic attacks or a significant maladaptive change in behavior related to the attacks
• The disturbance is not attributable to the physiological effects of a substance or another medical condition
• The disturbance is not better explained by another mental disorder

Assessment Tools

• Semi-Structured Interview Example: Mental State Exam (MSE)
• Structured Clinical Interview for DSM-5-TR (SCID-5-TR)

Biopsychosocial Case Formulation

• Example provided using a 33-year old male named "S"

Biopsychosocial Paradigm

• Paradigm involves biological, psychological and social & environmental components

Models of psychopathology

• There are Psychoanalytic, Behavioural, and Cognitive Models

Sigmund Freud (1856-1939)

• Believed the unconscious has a profound influence
• Proposed psychopathology is as a result of unresolved childhood conflicts and repressed desires

Behavioral Paradigm (J.B. Watson, B.F. Skinner)

• Behavioral interventions aims to interrupt and/or change maladaptive stimulus-response associations, and to reinforce positive behaviors.

Cognitive Paradigm (Beck)

• The cognitive paradigm highlights how thoughts influence emotions and behavior.

Dimensional Models of Psychopathology:

• Uses HiTOP which has hierarchical taxonomy

DSM vs HiTOP

• A case of an individual, James, presents with symptoms of generalized anxiety disorder and major depressive disorder
• The DSM-5-TR would see those as two separate disorders with two distinct treatments
• HiTOP sees the disorders as a shred interalizing spectrum with a with treatment focused on core emotional dysregulation

Normative Statistical Models

• It focuses on data-informed developmental trajectories.
• A key question: Does a person deviate from statistically normative functioning?

Research Domain Criteria Model (RDoC)

• It Is not focused on signs and symptoms like DSM-5-TR
• Has a focus is transdiagnostic and on categorization based on underlying domains and dimensions
• The key points include dimensional approach, domains comprising several constructs representing aspects of biology, behaviour, experience, it has a neurobiological focus, and champions an empirical approach

Cultural Models: Australian First Nations Model of Social and Emotional Wellbeing

• Culture can influence decisions about health services, treatment acceptance, compliance, and prevention strategies
• Includes connection to country, spirit, body, culture, mind, family, and community.

Anti-Psychiatry Perspectives

• Thomas Szasz: Mental illness is a myth (e.g., no disease identified).
• J.D. Laing: Psychiatry inappropriately pathologizes human distress (e.g., schizophrenia symptoms are a normal response to adversity).
• Social theorists: Michel Foucault and Erving Goffman argue psychiatry enforces societal norms, stigmatizes, is coercive, pseudoscientific, and causes harm.

Cultural Models: Mad Pride

• A social and political movement grounded in protest and challenge
• Takes stances against stigma, discrimination, and historical psychiatric practices.
• Believes in pride in the self as a complex whole that incorporates experiences into identity
• Reclaims of pejorative terminology
• Parallels with LGBTIQA+ Pride movement

Alternative model: Power, Threat, Meaning Framework

• It does not treat psychopathology as a medical condition, it focuses on patterned responses to social, cultural, and psychological factors
• Emphasizes role of power, threat, and meaning in psychological distress
• Considers what has happened to you, how did it affect you?, what sense did you make of it?, and what did you have to