topic 6

Mental Health Overview

• Mental health is a state of well-being where individuals can reach their potential, handle life's pressures, work productively and contribute to society.
• Psychopathology is the study of mental disorders, encompassing their development, origin, and manifestations. It's synonymous with mental illness.
• Mental illness encompasses a wide range of conditions characterized by psychological dysfunction and abnormal behavior.

History of Mental Illness

• Craniotomy, dating back to 6500 BC, was an early practice used to treat mental illness. 
• Demonology, which viewed mental illness as a result of demonic possession, influenced earlier views on mental illness.
• In the Renaissance era, Hippocrates suggested that mental illness was related to an imbalance of bodily fluids, known as humors (blood, phlegm, yellow bile, and black bile). Medical practices of this time also included somatic treatments which sought to address mental illnesses through physical remedies.
• The Middle Ages saw a revival of demonic possession as an explanation for mental illness.
• The mental asylum era saw the development of institutions for individuals with mental illness, marked by harsh treatments. The Bethlem Royal Hospital, also known as Bedlam, was a London-based example of such establishments.
• The humanistic approach, championed by Pinel, advocated for more humane treatment of the mentally ill by removing harsh restraints and solitary confinement.

Definitions of Abnormality

• Statistical deviance refers to behavior or thoughts that are rare or uncommon in a population. All rare behavior isn't deemed abnormal.
• Social norm deviance refers to deviation from social and cultural norms; behaviors harmful to oneself or others might be classified as abnormal.
• Subjective discomfort is emotional distress (e.g., anxiety, depression) significantly impacting a person's functioning.
• Inability to function normally means a person struggles to adapt to typical life demands.

Causes of Mental Disorders

• Biological factors include genetics, brain chemistry, immune system, and physical health.
• Psychological Perspective factors involve psychological causes. This includes psychodynamic experiences (early childhood experiences), behavioral experiences (learned behaviours), and cognitive experiences (thinking and beliefs).
• Socio-cultural factors encompass societal influences, such as family, social, and cultural aspects.

Biopsychosocial Model

• This model recognizes that various factors – biological, social, and psychological – contribute to mental health and disorders. These factors continuously interact, influencing an individual.

Psychological Disorder Definition

• A syndrome is a collection of symptoms indicative of a mental disorder.
• Mental disorders reflect dysfunctions in thoughts, emotions, or behaviors.
• They are usually associated with substantial distress or impairment in social, occupational, or other important areas of functioning, though not socially deviating, religious, political, or sexual behaviors. These behaviors are only seen as disordered if they result from dysfunction.
• Not all responses to a loss or stress (e.g., a loved one's death) classify as a disorder.

Classification of Mental Disorders

• The DSM-5, published by the APA, and ICD-10, published by the WHO, are the most prevalent and widely used diagnostic tools for classifying mental disorders. 
• The DSM-5 incorporates a dimensional approach to classification, viewing disorders along a continuum, encompassing both present/absent and related characteristics.
• The numbers of disorders increase with succeeding revisions of the DSM, reflecting improved understanding and the complexity of mental health conditions.

Anxiety, Trauma & Stress Disorders

• Anxiety disorders involve excessive or unrealistic worry and fear, leading to dysfunctional behaviors.
• This category includes phobias (irrational fear of specific objects or situations), Social Anxiety Disorder (fear of social situations), panic disorder (recurrent panic attacks and worry), generalized anxiety disorder (excessive anxiety), and obsessive compulsive and related disorders.

Main Anxiety Disorders

• Phobias are persistent fears of particular situations or objects that affect a person's life.
• Social anxiety disorder involves intense fear of social situations and potential humiliation.
• Specific phobias focus on intense and unwarranted fear of specific stimuli such as enclosed spaces, certain animals, or heights.
• Agoraphobia is an intense fear of public places, with avoidance behavior.
• Other forms of anxiety disorders include panic disorder (sudden attacks of intense fear), generalized anxiety disorder (persistent and excessive worry), obsessive-compulsive disorder (obsessions and compulsions), and post-traumatic stress disorder (PTSD).

Mood Disorders

• Mood disorders involve significant mood disturbances, either elevated or depressed.
• This category includes depressive disorders (major depressive disorder) and bipolar disorders.

Main Mood Disorders

• Major Depressive Disorder (MDD): characterized by pervasive low mood, along with specific symptoms lasting at least two weeks.
• Bipolar Disorder I: one or more manic episodes, potentially with depressive episodes.
• Bipolar Disorder II: involves hypomanic episodes and depressive episodes, lacking the severity of full-blown manic episodes.

Causes of Mood Disorders

• Psychodynamic factors suggest depression ties to anger directed inward or repressed emotions.
• Behavioral factors indicate learned helplessness in mood disorders, resulting from a perceived lack of control over outcomes.
• Cognitive perspective implies depression emerges from distorted or negative thought patterns about oneself.
• Biological factors suggest chemical imbalances in the brain, including serotonin, norepinephrine, and dopamine, contributing to mood disorders.

Eating Disorders

• Eating disorders encompass persistent eating disturbances affecting physical health and social functioning.
• This classification includes anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Anorexia Nervosa

• Severe dietary restriction leads to significantly low body weight and a distorted image of one's physical appearance
• Characterized by a BMI less than 17

Bulimia Nervosa

• Recurrent episodes of binge eating followed by behaviors to prevent weight gain, such as self-induced vomiting or using laxatives.

Binge-Eating Disorder

• Recurrent binge eating episodes without the compensatory behaviors seen in bulimia nervosa.

Causes of Eating Disorders

• Psychodynamic factors often involve issues in parent-child relationships and ego deficiencies, and unresolved conflicts in early childhood.
• Behavioral factors include learned eating patterns and reinforcements that encourage disordered eating habits to obtain relief.
• Cognitive factors include distorted thinking around body image and self-worth, affecting one's beliefs and leading to disordered eating behaviors.
• Biological influences, including genetic predispositions, can influence an individual.
• Cultural factors like media portrayals of body image may influence the prevalence of disordered eating patterns.

Schizophrenia

• Schizophrenia is a severe brain disorder marked by distorted reality perceptions and abnormal behaviors, including hallucinations, disordered thinking (delusions), inappropriate emotional responses, and bizarre behaviors.

Schizophrenia Symptoms

• Delusions are false fixed beliefs, despite evidence to the contrary. Delusions can be persecutory or grandiose.
• Hallucinations are perceptions that aren't based on reality. Auditory (hearing voices) and visual hallucinations are common.
• Disorganized thinking is characterized by disordered speech patterns and difficulty expressing coherent thoughts. There are specific types of disorganized thinking, like derailment or incoherence.

• Disorganized or abnormal behaviors range from immobility to excessive movements to odd gestures.
• Negative symptoms involve diminished emotional expression, apathy, and lack of motivation.

Causes of Schizophrenia

• Biological: Chemical imbalances (e.g., dopamine, GABA), structural defects in the brain (frontal lobe), and genetic/hereditary factors correlate with schizophrenia. Prenatal factors, such as viral infections, may also play a role.
• Environmental: factors like stress, vulnerability, and environmental stressors may trigger or worsen symptoms in individuals predisposed to schizophrenia.

Personality Disorders

• Personality disorders are characterized by inflexible and enduring behavior patterns that significantly impair social and interpersonal functioning.
• They are persistent, pervasive, and problematic.
• Personality disorders are grouped into three clusters, based on their similarities and characteristics. This includes odd (Cluster A), dramatic or emotional (Cluster B), and anxious or fearful (Cluster C) personalities.

Antisocial Personality Disorder

• This involves a pervasive pattern of disregard for and violation of the rights of others.
• Common traits include lack of conscience and remorse, manipulation, deception, aggression, and impulsiveness.

Borderline Personality Disorder

• Marked by instability in moods, interpersonal relationships, self-image, and impulses.
• Self-injurious behavior (self-mutilation), unstable relationships, difficulty controlling anger, and impulsivity are common traits.

Causes of Personality Disorders

• Cognitive-Behavioral perspectives emphasize that personality disorders stem from learned behaviors and associated beliefs.
• Biological factors suggest genetic influences.
• Environmental factors consider negative influences of childhood.

Psychotherapy Approaches

• Insight therapies aim to increase self-awareness and understanding of thoughts, feelings, and behaviors. Psychoanalysis, humanistic therapies (e.g., person-centered therapy, Gestalt therapy), are examples of insight therapies.
• Action therapies focus on changing maladaptive behaviors. Techniques include behavioral therapies (classical and operant conditioning, exposure therapy, and systematic desensitization), and cognitive therapies.

Group Therapies

• Therapy conducted in small groups consisting of individuals with similar issues.
• Couples therapy aims to improve communication, solve conflicts, and enhance relationships within couples.
• Family therapy recognizes that one person's problems affect others in the family.
• Self-help groups provide a communal support system for addressing common issues.

Effectiveness of Psychotherapy

• Psychotherapy helps many individuals, with approximately 75% experiencing some benefit.
• Psychotherapy should be tailored to suit individual needs.
• Treatments are usually combined to maximize effectiveness in diverse and complex presentations of mental disorders.
• Psychotherapy may be delivered online as a convenience for clients, yet some clinical situations require in-person interaction for optimum outcomes.

Biomedical Therapies

• Biomedical therapies directly target the body's physiology, using medications or procedures.
• Psychopharmacology involves using specific drugs to treat mental disorders, including antipsychotics, antidepressants, anxiety medications, and mood stabilizers.
• Electroconvulsive therapy (ECT) is used to induce seizures as treatment for severe depression and treatment resistant disorders. 
• Psychosurgery is a surgical procedure used to treat severe and persistent disorders where other therapies are ineffective.

Emerging Therapies

• Repetitive TMS and tDCS are non-invasive brain stimulation techniques used to treat depression, schizophrenia, and other disorders.
• Deep brain stimulation involves surgically implanted devices to send electrical impulses to specific brain regions to treat various disorders including deep depression and OCD. 
• Virtual reality therapy is used to create simulated environments to expose an individual to feared events.