PB5 Psychopathology Exam Article Notes PDF

PB5: Psychopathology Exam Article Notes 1. Aaron Antonovsky 1996 “Salutogenisis” Salutogenisis = approaching health from the perspective of maintaining good health and wellbeing Human distress is that of an integrated organism & has both a...

PB5: Psychopathology Exam Article Notes 1. Aaron Antonovsky 1996 “Salutogenisis” Salutogenisis = approaching health from the perspective of maintaining good health and wellbeing Human distress is that of an integrated organism & has both a psychic and a somatic aspect ‘Down the stream’ focus - the disease care system on saving those already ill WHO = Health = optimal physical, mental and social wellbeing – not the absence of illness or pain The focus > health promotion in research and action on all persons wherever on the continuum o Importance of creating appropriate social conditions which facilitate health-promotive behaviour eg. day care facilities, access to health care, adequate incomes for nutrition & housing o Salutogenisis focus vs. the pathogenic orientation o A flaw in the health promotion concept is the sole focus on pathogens/ concern with risk factors Lifestyle Models o Consciously chosen behaviour o Social & cultural circumstances that condition / constrain behaviour o Community and individual measures that can develop lifestyles that enhance wellbeing o A list of risk factors that impact health Salutogenic Model = a continuum model= we are each situated along a healthy/disease continuum at a given time o A theory of health o Derives from studying the strengths / weaknesses of promotive, preventative, curative rehabilitative ideas and practices o Must relate to all aspects of a person or one faceted / pathogenic is poor care Sense of Coherence = movement towards health on a continuum, not culture-bound, what matters is that one has the life experiences that lead to strong SOC SOC= 1. Manageability: belief that resources to cope are available 2. Meaningfulness: wish to be motivated to cope) 3. Comprehensibility: belief the challenge is understood Participation in new activities will not dramatically change a SOC but can prevent/ lower damage or add strength o Strength of SOC shaped by: ▪ consistency ▪ under-load/ overload balance ▪ participation in socially valued decision-making ▪ type of work raised doing eg. chores, family structure ▪ input from other factors eg. gender, genetics, ethnicity… GRR (Generalised Resistance Resources) help the organism cope with life stressors of the human existence Further questions for research: o Further testing is needed eg. does SOC act as a buffer? o Is there a linear relationship to health and SOC o Does the significance of SOC vary with age? 2. Alan Frances , 2013 “PTSD: Hard to get right” Life has always been risky for humans; risks have an important survival value PTSD symptoms: o reliving the moment repeatedly o flashbacks can bring the event to life again during the day o nightmares during the night o any situation the resembles the event can trigger avoidance and terror o intrusive memories o triggers become less intense and terrifying over time o those who suffer more emotional troubles prior to the trauma are more likely to have longer more adverse reactions to it PTSD diagnosis: only when symptoms persist and cause significant disability – the more terrible the stress the longer it lasts, the more intense/ intimate the exposure the more helpless the person feels High suicide rate, the course of the disorder dependent on the person/ the context Horrors inflicted by humans cause worse symptoms than natural catastrophes Nonviolent disaster: divorce, job, romance/ financial disappointment does not cause PTSD Risks  o PTSD diagnosis is dependent on self-reporting o There is no objective test o People may downplay or exaggerate symptoms o PSTD rates depend on how the diagnosis is made and which country is surveyed – complex psychological / contextual factors influence symptoms o Underreporting harmful in the long run – avoidance of situations o The importance to be strong/brave overrides the healing power of admittance and reflection o Low investigation of PTSD from pharma companies, medication not yet proven to be effective Errors in diagnosis are common PTSD is missed when people suffer symptoms stoically and silently Over diagnosed when it’s a trigger for financial gain (eg. US veterans who can collect governmental benefits for their work-related trauma 3. Alan Frances, 2013 “Bipolar II” There is a challenge in diagnostics to differentiate appropriate treatment plans for those who show: o Cyclical lows alternating with highs > bipolar o Cyclical lows > unipolar depression Antidepressants help the lows but can cause o irritability o mood swings o increase cycles thereby worsening the course if the patient has bipolar disorder Mood-stabilisers: side effects/ risks are not worth the hassle for unipolar depression: o weight gain o diabetes o heart disease The goal is to balance the risks of taking the mood-stabilisers Mania: is unmistakable and unforgettable; provides a clear call to action of not prescribing anti- depressants without the safety net of a mood stabiliser o A supercharged thoughts / actions if irritable spends money uncontrollably o Acting inappropriately/impulsively o Being intrusively sexual o Needing little sleep Hypomanic: Periodic elevations in mood that are not aligned with the definition of mania, alternating with periods of depression – is the boundary between bipolar and unipolar depression A new category is called ‘hypomania’ = bipolar II to offer more accurate diagnosis and safer treatment Risks o Hypomanic patients can be classified with either but is patient dependant. o Anti-depressants that can trigger a manic episode o Mood stabilisers that are more harmful than helpful o No clear boundary between hypomania and feeling good o Pharmaceutical advertisements take advantage of the grey area of diagnosis – when is someone really happy, high or having a hypomanic episode? o It has led to over diagnosis & unipolar depressive patients being treated with unnecessary mood stabilising drugs o Bipolar may affect more of the population than schizophrenia, which is why the pharmaceuticals have a bigger interest in exploiting the new hypomanic category o Antipsychotic medication are riskier than mood stabilisers 4. Alan Frances, 2013 Werther Fever Creates Epidemics of Suicide 1774 Goethe wrote ‘Die Leiden des jungen Werters’ a story about unrequited love and romantic suicide. It became a popular culture phenomenon and influenced the way people spoke, dressed and their manners including copy-cat suicides Suicide Types: o Suicide Clusters (the Virgin suicides- film): people copy a celebrity/relative/ friend etc. o Group suicide (Kamikaze): in defense of a religion/ideal/ nation o Mass suicide: socially sanctioned to avoid a fate worse than death o Mass religious suicide: follow-the-leader behaviour o Protest suicide: the ultimate form of protest Natural selection weeds out suicidal DNA Guidelines for media reporting suicide and avoiding suicide No detailed how-to descriptions No promotion of fame suicide No suggestion that suicide is a rational choice No sensationalism 5. Mark Schechter et al (2019) Psychotherapy with suicidal patients: the integrative psychodynamic approach of the Boston Suicide Study Group Psychodynamic therapy with suicidal patients Focus on the internal experience Exploration of thoughts, fears, fantasies in a psychodynamic frame Accompanied by an empathic therapist Uses techniques from DBT (Dialectical Behavioural Therapy) MBT (Metallisation Based Treatment) CBT Developmental & social psychology Emphasis on Therapeutic alliance Unconscious Implicit relational processes Facilitating change long-term exploratory treatment Integrative approach Integrative psychodynamic treatment Treatment is individual and are overlapping Discussed separately with Pat. 1. Development of narrative identity - iterative engagement with therapist to re-construct a coherent narrative 2. Approach to patient in crisis - non judgemental, acceptance, validation & assess imminent risk 3. Focus on patient’s internal affective experience - a timeless sense of anxiety and annihilation, panic, terror 4. Instilling hope - provide a roadmap for patients in despair and feeling shame, hopeless and discouraged to a better way of life 5. Improving affect tolerance - DBT to help emotion regulation/ distress tolerance 6. Improving sense of continuity & coherence 7. Modification of ‘relational scripts’ - are co-constructed - the listener influences how/if the story is told, helps make meaning of experiences 8. Attention to conscious & unconscious beliefs and fantasies 9. Attention to Therapeutic alliance 10. Attention to Countertransference - beware of countertransference of hopelessness - supervision is helpful Suicidal Patients Harshly self-critical and have an expectation of negative interpersonal experiences that confirm this sense of ‘bad’ self Lack of continuity = lack of ability to link experiences/ roles/ beliefs into an integrated whole Self-attack Anxiety when considering the self positively Automatic avoidant defences - therapist must disrupt these defences Suicidal thoughts can be ‘self sustaining’ and help regulate affect in order to avoid suicide Beliefs/ fantasies can be wide-ranged and in contradiction with one another Not able to connect the dots of past experience and current despair Engagement with therapist Provide a secure environment to explore the internal subjective experience of the patient Instil hope by bearing the pain Help the patient discover/ develop a sense of agency The experience to mourn what is not possible Re-engage in relationships Learn to envision a life worth living  Should disrupt the unconscious relational scripts by behaving differently than expected - this can facilitate change Actively support patient in creating new relational experiences Elicit feedback that is discrepant with maladaptive core beliefs about self Ruptures in the relationship can be painful but also an important tool (only if patient is stable), when the alliance can be repaired to offer implicit relational learning & growth Strengths of the BPSM Highlights 1. Holistic Framework: o The BPSM is praised for broadening the scope of medical practice by integrating biological, psychological, and social factors. o It provides a more comprehensive understanding of health and illness compared to the reductionist biomedical model. 2. Focus on Psychosocial Determinants of Health: o The model draws attention to the role of psychosocial factors in health outcomes, such as stress, social relationships, and mental well-being. o It has facilitated research into conditions like chronic pain, where psychosocial factors play a significant role. 3. Utility in Organising and Communicating Information: o As a conceptual framework, the BPSM is useful for organising complex, multi-factorial information about health and illness. o It has become an effective teaching tool in medical and healthcare education, helping practitioners adopt a more patient-centered approach. 4. Promotes Patient-Centered Care: o The model encourages healthcare providers to view patients as whole persons, considering their psychological and social contexts alongside biological symptoms. o This approach fosters trust and improves the therapeutic relationship. 5. Applications in Difficult-to-Treat Conditions: o The BPSM has been particularly helpful in addressing conditions that do not fit neatly into the biomedical paradigm, such as: Chronic pain: Highlighting factors like fear-avoidance and stress, leading to more effective interventions. Spinal care: Focusing on psychosocial contributors to disability and pain. Overall Context While the article critiques the misuse and overextension of the BPSM, it recognizes its significant contributions as a tool for organizing and emphasizing the importance of psychosocial factors in health The author stresses that these strengths do not compensate for the model's lack of scientific rigor when applied as an explanatory or diagnostic framework Core Hypothesis Substance use is a way for individuals to self-medicate emotional distress or psychological challenges People with substance use disorders often have underlying psychiatric or emotional vulnerabilities Earlier views that substances directly alleviate distress were oversimplified. Emphasis of a more nuanced match between specific substances and the emotional/psychological needs of users Many substance users have unresolved trauma, difficulty regulating emotions, or personality vulnerabilities. Self-medication arises when traditional coping mechanisms fail Specific Substance Links Opioids are often used to manage rage, aggression, or feelings of powerlessness. Stimulants (e.g., cocaine) are associated with efforts to counteract low energy, depression, or lack of focus Alcohol and sedatives are linked to the suppression of anxiety and managing interpersonal tensions Clinical Implications Effective treatment must address the emotional and psychological drivers of substance use. Therapies should focus on emotional regulation, coping skills, and resolving underlying issues rather than just stopping substance use Applications in Psychiatry The hypothesis has influenced dual-diagnosis treatment approaches. Highlights the need for personalized care in substance use disorder management Criticism and Limitations Not all substance use aligns with self-medication (e.g., recreational or social use) The hypothesis does not fully explain why some individuals develop addictions while others do not 6. Henrik Walter, (2013) The third wave of biological psychiatry 1st Wave Biological psychiatry is in its ‘Third Wave’ -the multi-level approach to bio. psychiatry. ranging from genes to psychosocial mechanisms. The mental role is more dominant Walter Griesinger (1850’s) - important figure in the first wave of bio. psychiatry, “mental disorders are disorders of the brain” Trying to gain evidence for the connection between the mental and nervous system First links between neuropathology and mental disorder Zeitgeist: psychopathology in psychiatric was not believed to be so easily explained as only being due to organics disorders of the brain Kraeplin & Jaspers were famous opposers of the bio. approach Kraeplin laid the groundwork for the DSM Psychological models: psychoanalysis and behavioral approaches became popular 2nd Wave 2nd half of the 20th century due to the discovery of the component genetics plays in severe mental illnesses like schizophrenia 1949 the discovery that medications can improve symptoms of several mental health disorders Medications became a pillar in psychiatric treatment - contributing to the opening and disappearance of large mental asylums Neurochemical imbalance of neurotransmitters became the preferred model for explaining psychiatric models Discredited the most effective model against severe depression “electroconvulsive therapy” 3rd Wave Driven by methodological and technological development Neuroscience is one of the largest research fields 3rd wave triggers: molecular neuroscience 1997, one of the most prestigious fields: o 1. Neurobiological changes reflected in mental health differentiation is more complex than ever o 2. The birth of cognitive neuroscience and imaging - the study of information processing o fMRI (functional magnetic resonance imaging) a major research tool in psychiatry & psychology o this is a result of computational power and technological advances o interplay genetics, experience, environment in aetiology and neural explanation 7. Khantzian (1985) The Self-medication hypothesis of addictive disorders: focus on cocaine & heroin dependence Hypothesis Addiction arises as a coping mechanism for managing psychological distress or emotional challenges Substances are not randomly chosen Substances effects align with the specific emotional or psychological needs of the user The hypothesis reframes addiction as an adaptive, though ultimately maladaptive, response to emotional distress rather than a purely moral failing or hedonistic behaviour Heroin Dependence Heroin provides relief from overwhelming rage, aggression, or feelings of powerlessness It serves as a numbing agent, helping users manage unbearable emotions and internal chaos Focus on Cocaine Dependence Cocaine enhances self-esteem and provides energy, helping users counteract feelings of depression, inadequacy, or emotional emptiness A stimulant for those who feel depleted or incapable of sustaining emotional resilience Key Characteristics of Addictive Disorders  Users often suffer from underlying personality vulnerabilities or psychiatric conditions (e.g., trauma, depression, or anxiety) Addiction is an attempt to self-regulate emotions or psychological states that feel unmanageable Mechanisms of Self-Medication Substances provide temporary relief but ultimately exacerbate emotional instability This creates a vicious cycle where dependence develops as users increasingly rely on substances for coping Clinical Observations Khantzian based his insights on extensive clinical experience with patients struggling with heroin and cocaine addiction Patterns of substance use align with the emotional struggles and psychiatric profiles of users Treatment Implications Effective treatment must go beyond detoxification and address the emotional and psychological issues driving substance use Psychotherapy should focus on emotional regulation, understanding trauma, and developing healthier coping mechanisms 8. Skoglund et al. (2024)“Time after time: A failure to identify and support females with ADHD - a Swedish population register study! Women with ADHD may not be properly identified or supported Primary outcome was the age at ADHD index/diagnosis Secondary were psychiatric comorbidity, pharmacological treatment and health care utilisation before and after ADHD diagnosis. Females were older at ADHD diagnosis at a mean age of 23.5 while men were younger at an average age of 19.6. Females also showed higher rate of psychiatric comorbidity, pharmacological treatment and health care utilisation Females with ADHD receive diagnosis and treatment for ADHD approximately 4 years later than men Females have a higher burden of comorbidities with other psychiatric conditions and healthcare utilisation, even before ADHD diagnosis, than compared to males and females without ADHD To decrease risks and long term consequences new methodologies and treatments for earlier recognition of ADHD symptoms and diagnosis and further care is warranted. Population based, cross sectional cohort study. 85,330 individuals with ADHD who are/were residents of Stockholm between Jan 1, 2011 to Dec 31, 2021 Men generally display more of the stereotypical disruptive symptoms of ADHD so diagnosis tends to happen earlier, than with women who are less likely to present the stereotypical symptoms of ADHD This can also lead to misdiagnosis, treatment or medication not directed at ADHD, which explains the raised rate of healthcare utilisation Females exhibit typical ADHD symptoms like hyperactivity, impulsivity etc. but these are misinterpreted (such as Borderlines, Bipolar, anxiety disorder etc). This also explains why Females have a higher rate of therapeutical attention prior to diagnosis, E.g - ADHD symptoms aren't recognised right, they think its borderlines, so she gets treatment for borderlines, and only later finds out its ADHD Comorbidity Both sexes showed elevated rates of comorbidites with anxiety and mood disorders alongside their ADHD diagnosis Females have a higher rate than men for anxiety and mood disorders Men show higher rates of being on the autism spectrum, tourettes or tic disorders as comorbidities with ADHD The largest difference between females and male were the rates of eating disorders (F: 5.6% vs M: 0.6%) and personality disorders (F: 6.3% vs M: 2.1%) Women with ADHD have a higher rate of self harming behaviour than men Females have a higher rate of medical use, non ADHD meds, and that so these may suppress comorbidities like depression but not ADHD symptoms or vice versa, and so other comorbidities can evolve or develop Treatment pharmacological & psychotherapy Females prior to their diagnosis show higher rates of medication use, anticonvulsants (typical for epilepsy), neuroleptics, sedatives, hypnotics and psychoanaleptics Females with ADHD also show higher rates of seeking psychotherapeutic treatment, rates increase after diagnosis Females with ADHD also show higher rate of healthcare utilisation in other aspects, going to doctor etc than men, but both rates increase after diagnosis Females are often diagnosed with Inattentive ADHD, however paper claims that there is Whereas boys are very quickly stereotyped to have ADHD when exhibiting these behaviours so are quicker to get referral to ADHD test. 9. Thomas Fuchs et al. ‘More than just Description: Phenomenology and Psychotherapy Phenomenology: A subjective, lived experience of mental illness approach Understanding how individuals experience reality and self in mental illness Focuses on the patient's first person perspective, where, when, how, why. (This is directly from the slides) Contributions of Phenomenology: Phenomenology has gained much reputation in recent years for its more subjective approach. It helps us understand the subjective and intersubjective perspective of patient Phenomenology has developed in depth psychopathological assessment and diagnosis which prepare the ground for exploration in further assessment Semistructured phenomenology interviews enable us to further understand the disturbed view of the patient Assessment scales help approximate the phenomenological core of severe mental illnesses (fancy way of saying, where it comes from and how bad it is lol) Phenomenology relies on the pre-reflexive = unreflected, how they feel in the very moment, and the implicit (subjective view) rather than the explicit (explicit means: clearly explained, logical etc) awareness Atmospheres, existential feelings, and common sense which usually happen in the background come more to focus - allows for deeper view and understanding Phenomenology challenges the therapist to step out of the common sense and dive into the patient's own interpretation of the world Therapist gains insight into the patients worldview, how it challenges ones own, differentiates it from it, fits or rejects it > schizophrenics would have a much different worldview Sees social interactions and relationships in a perspective of empathy, personal resonance rather than cognitive exchange Phenomenology was seen as the opposite to psychoanalysis for a long time, sorry leo. - both have differentiating ideas of the role of the unconscious Phenomenology is the foundation for psychopathology and psychotherapy as a whole Provides an approach to capture the human experience in all its dimensions > self awareness to embodiment Offers a view in which a patients mental disorders is part of their living experiences /relations. (my god can you suck your own dick even harder) Therapy with phenomenological approach focuses on interactions and relations, empathy and changing behaviours and roles regarding relationships Focus on process between therapist and patient Phenomenological approach is not mandatory, thank god lol 10. Szasz et al. (1960) The Myth of Mental Illness (This text is from 1960 so personally i think he should shut up) Mental Illness as a Social Construct: Not a biological disease but a metaphor for "problems in living" Lacks objective biological markers like in physiological diagnostics Based on judgments about socially unacceptable behaviours or beliefs Distinction from Brain Diseases: mental illnesses = moral or social conflicts mislabeled as medical conditions brain diseases = observable neurological defects  Ethical and Social Control: Psychiatry = a tool for enforcing societal norms and controlling deviant behavior > defined by society This conflates ethical problems with medical ones Modern Mythology: Concept of mental illness compared to historical myths like witchcraft Functions as a socially acceptable way to explain and manage human struggles Masking deeper ethical and relational issues 11. Nierenberg et al. (2023) Diagnosis and Treatment of Bipolar Disorder Diagnosis of Bipolar Disorder Clinical Presentation: Characterized by mood episodes including manic, hypomanic, and depressive states Manic Episodes: Elevated mood, increased energy, decreased need for sleep, grandiosity, impulsivity, and risky behaviors Hypomanic Episodes: Similar to mania but less severe and does not cause significant functional impairment Depressive Episodes: Low mood, loss of interest in activities, fatigue, feelings of worthlessness, and suicidal ideation Diagnostic Criteria: Bipolar I (mania with or without depression) vs. Bipolar II (hypomania and depression) as per DSM-IV criteria Challenges in Diagnosis Misdiagnosis: Bipolar disorder often misdiagnosed as depression, particularly in patients presenting with depressive episodes alone Mood Fluctuations: Difficulty in distinguishing between mood swings due to bipolar disorder and other mood disorders or medical conditions Family History: A strong family history of bipolar disorder increases diagnostic accuracy Treatment of Bipolar Disorder Pharmacotherapy: ◦ Mood Stabilizers: Lithium is considered the gold standard for long-term management, especially in preventing both manic and depressive episodes ◦ Anticonvulsants: Valproate and lamotrigine used for mood stabilization ◦ Atypical Antipsychotics: Used in acute mania or as adjuncts for mood stabilization ◦ Antidepressants: May be used cautiously in combination with mood stabilizers, but risk of inducing mania exists Psychotherapy: Cognitive-behavioral therapy (CBT) and psychoeducation are key components of treatment to manage symptoms and improve medication adherence. Treatment Goals: To stabilize mood, prevent relapse, and improve functioning Considerations Long-Term Management: Requires a combination of pharmacological and non-pharmacological treatments Monitoring: Ongoing assessment of treatment response and side effects is crucial 12. Mark Ruffalo (2020) Major psychodynamic paradigms: A brief overview of ego psychology, object relations, self-psychology Psychodynamic / psychoanalytic theory used interchangeably = grouping of theoretical paradigms All believe an unconscious exists it motivates behaviour & causes Can cause emotional-psychological distress - Psychic determinism mental/ physical events can’t be separated from preceding events Therapist patient relationship and understanding transference Ego-psychology: Brenner/ Hartmann 1950s-60s - warring factions sexual/ aggressive drives & reactions by the superego/ consciousness ego makes compromises between drives, the consciousness and societal demands  defence mechanisms (repression, displacement, sublimation, anxiety) to manage clashing needs psychiatric symptoms result when defence mechanisms no longer work emphasis on psychosexual development Object relations 1930s -50s human relationships central in human psychology > bring great satisfaction/ disappointment focus on early experiences with parents, how they are internalised and replayed in life central: the development of a stable sense of self Kernberg: pioneering work on narcissistic & borderline personality disorder ideal treatment for people who have been failed by human relationships is an enduring human relationship Self psychology Suffering can stem from not being able to maintain a coherent sense of self have problems with self-esteem regulation Kohut: early problems with self-object function struggle with self-subject and others later in life helps to understand: depression, personality disorders, psychosomatic illness 13. Zaninottoa (2021) 4 Core concepts in psychiatric diagnosis Psychiatric diagnosis differs fundamentally from somatic medicine psychiatry incorporates a subjective element into both symptoms and behavioral signs subjectivity requires an approach centered on understanding rather than mere verification, prioritizing empathy and individual experience 1. Tightrope Walking (Karl Jaspers’): Balancing Understanding and Explanation Dual need for explaining (objective, scientific analysis) & understanding (subjective, empathic engagement) Key Idea: Psychiatric diagnosis requires “binocular vision, blending third-person empirical observation with first-person empathic understanding Challenge: clinicians must balance being emotionally attuned (engagement) without over-identifying (disengagement), combining empathy with critical reasoning. 2. Holistic Experience: The Role of Intuition and First Impressions Clinical intuition plays a critical role in the early stages of patient Interaction, drawing from the “atmospheric quality” of intersubjective experiences Praecox Feeling (H.C. Rümk): refelcts the psychiatrist’s intuitive sense of disconnection or bizarreness in schizophrenic patients Atmospheres: Immediate, preverbal perceptions (e.g., body language, gaze, tone) create an unconscious shared emotional space between clinician and patient Clinical Case: Despite prior assumptions of schizophrenia, a psychiatrist’s warm, intuitive connection with a patient led to a nuanced understanding beyond initial diagnoses 3. Co-Construction of Symptoms: A Shared Process Empathy’s Role: Diagnosis is collaborative between clinical and patient Edith Stein’s multidimensional model of empathy suggests three stages: 1. Recognizing the patient’s experiences as meaningful. 2. Using imagination to deepen understanding. 3. Forming a comprehensive view of the patient’s condition. Understanding Psychosis: clinicians can empathise with the underlying subjective disturbances, Example: A patient’s psychotic delusions about a past love were traced back to deeper emotional and biographical roots, such as unresolved trauma and idealized attachments 4. Evolving Typification: Diagnosis as a Dynamic Process Diagnosis evolves through the clinician’s ongoing relationship with the patient intuitive “typification” of their condition and refining it over time Ideal Types: clinicians use archetypes of disorders (e.g., schizophrenia, mania) as guides to identify relevant symptoms while avoiding rigid categorization Hermeneutic Circle: iterative process of refining diagnosis involves comparing initial impressions with emerging data and theoretical knowledge. Psychiatric diagnosis is a complex interplay of subjective and objective processes. The phenomenological approach emphasizes: Balancing intuition and critical analysis.  Building empathic, co-constructed understandings of symptoms. Refining diagnoses through ongoing engagement and reflection. This method promotes a deeper, patient-centered understanding, moving beyond rigid medical models to embrace the dynamic and interpersonal nature of psychiatry 14. Tryer (2015) Classification, assessment, prevalence, and effect of personality disorder Personality disorders (PDs) are highly prevalent across medical psychiatric settings They significantly affect interpersonal relationships, treatment outcomes, and broader societal costs PD’s misunderstood, stigmatized, and inadequately diagnosed Deemed untreatable or as diagnoses of exclusion Common Misconceptions: often labeled as core problem: challenges in defining what constitutes “disordered” Impact: PDs lead to increased mortality, including suicide Require recognition and intervention in all healthcare contexts Historical evolution of PD classification 1. Early History: Ancient descriptions linked personality to Hippocratic temperaments (e.g., choleric, melancholic 19th-century terms like moral insanity (Prichard) and psychopathic personalities (Schneider) shaped understanding 2. Modern Classifications: Personality disorders were formally classified with the development of systems like the ICD (1948) and DSM-III (1980) Schneider emphasized that individuals with PDs not only suffer themselves but also impose a burden on society Classification Systems 1. Traditional Systems (DSM-IV and ICD-10): Both use a categorical approach, dividing PDs into clusters (e.g., Cluster A: paranoid, schizoid; Cluster B: borderline, antisocial; Cluster C: avoidant, dependent). Problems: Overlapping and poorly validated categories Difficulties distinguishing PDs from normal personality variations and other mental illnesses High rates of comorbidity among different PD categories 2. Dimensional Models: Increasing evidence supports dimensional approaches PD’s on a spectrum of severity rather than categories For example, traits like emotional instability, impulsivity, and antagonism exist on a continuum from normal to pathological 3. Proposed Changes in ICD-11: Abolishes specific PD categories (e.g., borderline, antisocial). Focuses on: General PD diagnosis. Severity (mild, moderate, severe). Domain traits (e.g., detachment, disinhibition, negative affectivity) Recognizes that personality disorders can fluctuate over time and are not not necessarily lifelong Key Features of Personality Disorders Core Characteristics: Enduring patterns of maladaptive behavior, emotions, and cognition Impairments in interpersonal relationships and self-functioning. Onset typically in adolescence or early adulthood, but can fluctuate with time. Challenges in Diagnosis: No biological markers exist, and diagnosis relies heavily on clinical judgment Individuals with PDs often attribute their interpersonal issues to others rather than themselves Many cases go undiagnosed, leading to suboptimal care Prevalence of PDs General Population: estimated point prevalence: 4–15%, with slight variations based on culture  PDs are at least as common in men as in women More diagnoses in women (likely due to help-seeking behavior) High-Risk Populations: Around 50% of psychiatric outpatients and 25% of primary care patients meet PDs are especially prevalent in prisons (up to 66% of inmates). Impact and Implications of PDs Increased Morbidity and Mortality:mortality from physical illnesses (e.g., cardiovascular disease) contribute to poorer outcomes Effect on Treatment: PDs are associated with higher rates of suicide, self-harm, and premature lifestyle factors, such as smoking, substance use, and poor self-care, PDs often complicate the management of co-occurring mental and physical illness Recognizing PDs can improve outcomes by tailoring interventions and addressing underlying interpersonal dysfunction Economic and Social Costs: Severe PDs, especially those associated with self-harm or criminal behavior, place significant strain on healthcare and legal systems. Comorbidity with Other Disorders High Rates of Overlap: Individuals often meet criteria for multiple PDs or other mental health disorders (e.g., depression, anxiety) Clinical Challenge: Assessment of Personality Disorders Diagnostic Tools: Structured interviews (e.g., SCID-II) and self-report measures exist but are time-consuming and underused. Simplified screening tools, like the Standardized Assessment of Personality-Abbreviated Scale (SAPAS), show promise but risk overdiagnosis Barriers to Accurate Assessment: Complexity of criteria and reliance on inferential judgment Stigma surrounding PD diagnoses, which can discourage practitioners from pursuing them The Future: ICD-11 and Dimensional Diagnosis Simplified Diagnosis: Moves away from rigid categories toward assessing overall personality dysfunction and severity. Adds “personality difficulty” as a sub-threshold category, acknowledging milder but significant impairments Domain Traits in ICD-11: Negative Affectivity: Anxiety, self-loathing, emotional instability Disinhibition: Impulsivity, recklessness Detachment: Emotional withdrawal, lack of close relationships Dissocial Traits: Callousness, hostility Anankastia (unique to ICD-11): Perfectionism, inflexibility Clinical Utility: ICD-11’s approach encourages practical, flexible assessments, particularly in resource-limited settings Emphasizes that personality dysfunction can change over time, reducing stigma and promoting hope for recovery Conclusion The article advocates for a shift in how personality disorders are conceptualized and diagnosed Moving toward dimensional models, as proposed in ICD-11, can improve accuracy, reduce stigma, and better align diagnosis with clinical realities. By recognizing the fluctuating nature of personality dysfunction and emphasizing severity rather than fixed categories, the new approach has the potential to enhance treatment outcomes and reduce societal costs 15. S. Priebe (2016) A social paradigm in psychiatry - themes and perspectives Importance of social psychology and integrating individuals with mental disorders into social settings Under the umbrella term of “The social paradigm” Through a focus on the social aspect we would improve the outcomes for individuals with mental health issues The social paradigm: Focuses on the concept that social interactions heavily influence and shape mental health Highlights the interconnectedness of individual and social environment Highlights that social negative effects like: poverty, war, isolation, discrimination etc heavily affect a persons mental health negatively (We covered this a million times) - we sure did! Social aspect may have a larger impact than biology Historical development: the development of psychiatry and different paradigms has always focused on biological and medical aspects, before slowly the social aspects were considered Integration of the social paradigm and challenges: Further implementing the social paradigm would provide a deeper and more holistic view for patient treatment The importance of combining medical attention with social approaches He presents the challenge of a shift in paradigms in the established psychiatry world to be hard, and a lack of resources would hinder the adequate implementation of the paradigm Through an investigation into social factors into poverty, certain advancements or solutions can be found for these aspects Social psychology and a social approach is very important and helps us further understand the patients and what their dealing with, but especially medicine does not yet often consider variables such as this, and change is hard. (Boohoo). cry me a river … 16. Bruijiniks et al. (2000) The effects of 1x vs. 2x weekly sessions on psychotherapy outcomes in depressed patients Method: The study wanted to explore how different rates of both CBT and Interpersonal therapy would affect students. Pretty simple concepts, 200 students were assigned to one of 4 groups. The groups being CBT once a week, Twice a week, Interpersonal Therpay once a week, and twice a week Key findings: Individuals who received the two sessions of therapy a week had less depressive symptoms. (pretend youre shocked- its incredibly science almost wizzardy) Those who attended therapy twice a week also showed less likelihood to drop out of the experiment over the course of 16-24 weeks Those who had two sessions showed more improvement Conclusion: Individuals with depression who receive more therapy show faster improvement, more adherence to the therapy, and showed less symptoms of depression over the course of the study. (groundbreaking stuff here, more therapy is better, who woulda thunk it) i’m flabbergasted! And there is no difference between CBT or Interpersonal lol. 17. Hirota (2023) Autism Spectrum Disorder (ASD) Prevalence: ASD affects about 2.3% of children and 2.2% of adults globally The rise in diagnoses is due to better awareness and diagnostic methods Comorbiditities: People with ASD also have a higher rate of comorbid disorders such as depression, anxiety, sleep disorders (basically anyone with another disorder has a higher rate of having another, WHEN WILL IT END) Diagnosis: ASD is diagnosed based on two main criteria: ○ Deficits in social communication and interaction. ○ Restricted, repetitive behaviors. Early diagnosis (typically by age 2) is crucial for effective intervention Causes Genetic factors play a significant role, though environmental influences (e.g., prenatal toxins) may also contribute The exact cause remains unclear. (some people are autistic, get over it) (those dang vaccines)(stressed out helicopter- mom geriatric pregnancies.. Treatment: Behavioral therapies (e.g., Applied Behavior Analysis) are most effective for younger children. Educational programs and pharmacological treatments for specific symptoms (e.g., anxiety, irritability) can also help. Family involvement is essential for successful management Challenges: Early diagnosis can be difficult, especially for those with milder symptoms, Concerns about under diagnosis in certain populations (like girls). Autism is a spectrum and the severity and limitations of autism for an individual are unique to every person The text separates these areas into 3 levels needing support requiring substantial very much requiring substantial support (super creative on the level names here) Level 3 is the very much autistic meltdown rigid behaviour, socially unapproachable. (PMS me) Level 2 allows some flexibility both socially and existentially Level 1 some limitations but can process decently normal (You can decide where I and Matteo end on this list) Matteo and you are not even on the same list Outlook: With appropriate support, individuals with ASD can lead fulfilling lives they may face ongoing challenges in adulthood, particularly in areas like employment and social relationships Luma comments: The article is super extensive and detailed on essentially like every aspect of Autism I think the important aspects to take from this is the symptoms and signs in childhood which lead to diagnosis These being the no or little interest or development on a social level, and the need for routine or repetitive behaviour We’ve all seen examples of the super autistic mind 18. Bachmann (2024) Recognition and management of children and adolescents with conduct disorder: a real-world data study from four western countries Conduct Disorder (CD) is a common psychiatric condition among children and adolescents characterized by persistent patterns of behavior that violate social norms, rules, or the rights of others These behaviors include aggression, property destruction, theft, and deceit The prevalence of CD worldwide is estimated to be 2–4%, and it has significant clinical, social, and economic implications This study compares the recognition and management of CD across Denmark, Germany, Norway, and the USA, analyzing prevalence rates, comorbidities, treatment patterns, and healthcare utilization Key Findings 1. Prevalence of Conduct Disorder There is a 31-fold variation in the prevalence of diagnosed CD across the four countries: Denmark: 0.1%. Norway: 0.3%. USA: 1.1%. Germany: 3.1%. Possible reasons for this variation include Differences in healthcare systems: Scandinavian countries rely heavily on primary care and community services, which may not document formal CD diagnoses. Cultural differences in diagnosing and treating behavioral issues  Variability in clinical guidelines and diagnostic thresholds. 2. Psychiatric Comorbidities Comorbid psychiatric conditions are highly prevalent in individuals with CD, with rates ranging from 70% to 86%: ADHD is the most common comorbidity in all countries. Sex-based differences: Males: Higher rates of ADHD, tic disorders, and developmental disorders. Females: Higher rates of depression, anxiety, eating disorders, and personality disorders. Comorbid conditions exacerbate CD symptoms and complicate treatment. 3. Treatment Patterns: Psychopharmacological Treatment Medications are frequently prescribed for CD, despite limited evidence for their efficacy Antipsychotics are prescribed to 4–12% of CD patients (e.g., risperidone is most common). Psychostimulants are used to address ADHD comorbidities. German youths have the lowest rate of antipsychotic prescriptions compared to Scandinavian countries and the USA Hospitalization rates for CD patients vary Germany: 12.5% (highest rate, with the longest average stay of 22.3 days). Norway: 1.2% (lowest rate) Shorter hospital stays in the USA reflect systemic differences in healthcare structure Scandinavian countries utilize more community-based interventions, potentially reducing hospitalizations 4. Evidence-Based Interventions Parent Training Programs: Proven to be the most effective intervention for younger children with CD. Programs like Incredible Years and Triple P are more widely available in Scandinavian countries than in Germany or the USA. Psychosocial Interventions Multimodal approaches are recommended for older children and adolescents integrating individual therapy family support community services Reasons for Variations Healthcare System Differences: Scandinavian systems focus on primary care and community-level services, leading to fewer formal CD diagnoses in specialized services Germany relies heavily on inpatient care, which inflates diagnosis rates Cultural Factors Societal attitudes toward behavioral problems influence the likelihood of seeking and receiving formal diagnoses CD has significant long-term economic costs due to higher rates of criminal activity, homelessness, and healthcare utilization Early detection and intervention are cost-effective, reducing societal and healthcare burden Clinical Guidelines Germany has established guidelines for CD management, whereas Denmark and Norway lack formal national guidelines. Treatment Gaps Antipsychotics are used despite limited evidence, raising concerns about over-reliance on pharmacological solutions. Economic Impact of CD CD has significant long-term economy Strengths Cross-national comparisons using large, representative datasets Highlights differences in diagnosis and treatment across diverse healthcare systems Limitations Lack of data on the validity of CD diagnoses and the appropriateness of prescribed medications. No information on parent training programs, which are often funded outside health systems (e.g., social services). Socioeconomic and regional factors were not analyzed in detail 19. Lindström (2005) Salutogenesis Introduced 25 years ago by medical sociologist Aaron Antonovsky Shifts the focus in public health from preventing disease (pathogenesis) to promoting health by identifying and enhancing individuals’ resources forwell-being Is centered on the sense of coherence (SOC)—a concept that explains how people manage stress and stay health Salutogenesis, with its focus on resources, capacity, and sense of coherence, provides a transformative approach to health promotion By emphasizing what supports well-being rather than what causes illness, it fosters a dynamic, adaptable, and empowering perspective that can be applied across individual, group, and societal levels Key Concepts of Salutogenesis 1. Health as a Continuum Health is not binary (illness vs. health) but exists on a continuum ranging from total ill health (dis-ease) to total health (ease). Salutogenesis emphasizes moving individuals along this continuum toward better health, focusing on their capacity to cope with challenges 2. Sense of Coherence (SOC) SOC is a global orientation that reflects how people perceive and handle life. It has three core components: predictable, and meaningful meet challenges and are challenges rather than burdens Comprehensibility: The ability to understand life’s events as structured, Manageability: The belief that resources (internal or external) are available to Meaningfulness: A sense that life’s demands are worth investing energy in SOC acts as a buffer against stress Enabling individuals to navigate difficulties more effectively Develops throughout life, particularly during the early years, and is influenced by personal and environmental resources 3. General Resistance Resources (GRRs) GRRs are the personal, social, and environmental resources individuals use to maintain health, such as: Biological factors: Genetic resilience, physical health. Psychosocial factors: Intelligence, coping strategies, social support. Cultural factors: Religion, philosophy, or shared values. The key is not only having these resources but also the ability to utilize and re-utilize them effectively Applications 1. Public Health Salutogenesis offers a holistic framework for health promotion by emphasizing resources and strengths rather than risks and deficits. It aligns with the principles of the WHO Ottawa Charter for health promotion, encouraging empowerment and collaboration across disciplines. 2. Stress and Mental Health Salutogenesis is particularly effective in understanding how individuals remain healthy despite significant stress or adversity Linked to better mental health outcomes, including lower rates of anxiety and depression, and improved quality of life 3. Interventions and Practical Use SOC has been used to guide interventions in various contexts: Healthcare settings: Supervision of nurses, cancer care, and group interventions for environmental illnesses. Youth programs: Supporting at-risk children and adolescents through salutogenic approaches. Conflict resolution: Using SOC principles to foster understanding and cooperation in challenging situations Key Insights 1. Dynamic and Flexible: Salutogenesis is adaptable across disciplines and contexts It emphasizes lifelong development and adaptability 2. Focus on Resources The approach highlights people’s ability to identify and harness resources for their well-being, making it practical for diverse populations 3. Cross-Cultural Relevance The SOC concept has been applied in various cultural contexts, proving its universality and effectiveness in improving health outcomes Policy Implications Salutogenesis offers a unifying theoretical framework for health promotion, consolidating principles like empowerment and participation. It addresses one of the most pressing public health challenges: the impact of stress on mental health Integrating the salutogenic model into policies and interventions can enhance mental health promotion and resilience. 20. McIntyre (2020) Bipolar disorders Bipolar disorders (BDs) are chronic and severe mental health conditions Include BipolarI and Bipolar II These disorders significantly impair psychosocial functioning and reduce life expectancy by 10–20 years due to cardiovascular diseases and suicide Despite their complexity, advancements in understanding genetics, neurobiology, and treatment approaches continue to evolve Key Features of Bipolar Disorder 1. Types of Bipolar Disorders Bipolar I: Characterized by at least one manic episode, with or without depressive episodes. Bipolar II: Involves at least one hypomanic episode and one major depressive episode Bipolar II is associated with higher suicide risk compared to Bipolar I 2. Symptoms: Mania: Elevated mood, impulsivity, grandiosity, reduced need for sleep, and hyperactivity. Depression: Persistent sadness, fatigue, low motivation, and suicidal ideation. Mixed Features: Co-occurrence of manic and depressive symptoms. 3. Epidemiology Global lifetime prevalence: 0.6–1.0% for Bipolar I; 0.4–1.1% for Bipolar II Early Onset: Over 70% of cases present symptoms before age 25. Comorbidities 1. Psychiatric Comorbidities Anxiety disorders (70–90%) Substance use disorders (30–50%) ADHD (25–45%), Personality disorders (20–40%). 2. Medical Comorbidities High rates of cardiovascular disease, diabetes, obesity, and migraines. These comorbidities worsen outcomes and increase mortality Challenges in Diagnosis Delayed Diagnosis: many individuals remain undiagnosed for 6–10 years after symptom onset Misdiagnosis: Bipolar depression is often mistaken for unipolar depression or other disorders, leading to inappropriate treatments (e.g., antidepressant monotherapy, which may worsen symptoms Differential Diagnosis ADHD: Earlier onset, absence of mood episodes Borderline Personality Disorder: Rapid mood shifts linked to interpersonal stress, unlike the episodic nature of BD Screening tools, such as the Mood Disorders Questionnaire (MDQ), help identify BD in clinical settings Pathogenesis 1. Genetics Bipolar disorder has a heritability of 60–80%. Overlaps genetically with schizophrenia (Bipolar I) and major depressive disorder (Bipolar II) 2. Biological Mechanisms Impaired neuronal-glial plasticity, mitochondrial dysfunction, inflammation, and insulin signaling abnormalities contribute to BD 3. Neuroprogression Hypothesis: Repeated episodes may lead to progressive changes in brain structure and function, worsening cognitive and emotional outcomes 4. Trauma Childhood maltreatment increases the risk, severity, and complexity of BD presentations Treatment Approaches 1. Pharmacological Treatments Mood Stabilizers Lithium: Gold standard treatment with antimanic, antidepressant, and anti-suicide properties. Requires monitoring for side effects like kidney and thyroid dysfunction Valproate and carbamazepine: Effective for acute mania but limited evidence for long-term benefits. Lamotrigine: Effective in preventing depressive episodes but not mania Atypical Antipsychotics Effective in mania and bipolar depression (e.g., quetiapine, lurasidone, cariprazine) Effective in mania and bipolar depression (e.g., quetiapine, lurasidone, Side effects include weight gain, metabolic issues, and sedation. Antidepressants Controversial in BD due to risks of mood destabilization and treatment-emergent mania. Typically used adjunctively. Electroconvulsive Therapy (ECT) Highly effective for treatment-resistant depression and mania 2. Psychotherapy Cognitive Behavioral Therapy (CBT): Addresses negative thought patterns and improves emotional regulation. Family-Focused Therapy: Enhances family communication and support to reduce relapse rates. Interpersonal and Social Rhythm Therapy (IPSRT): Stabilizes daily routines to manage mood episodes. Psychoeducation: Increases patient awareness about BD and promotes treatment adherence. 3. Lifestyle and Adjunctive Interventions Exercise: Improves mood and overall functioning.  Sleep Hygiene: Addresses circadian rhythm disturbances. Dietary Interventions: Omega-3 fatty acids and anti-inflammatory diets show promise in adjunctive care. Prognosis and Outcomes 1. Course of Illness BD is highly recurrent, with patients spending significant time in depressive states Relapse rates are high, particularly without maintenance treatment 2. Cognitive Impairments Common in BD, particularly after repeated episodes. Impairments in memory, executive function, and attention affect quality of life. 3. Mortality Suicide risk is 15–20% in BD, with a lifetime attempt rate of 30–50%. Cardiovascular disease is the leading cause of premature death. Future Directions 1. Novel Treatments Ketamine and anti-inflammatory agents show promise for treatment-resistant bipolar depression stimulation technique Ongoing research into neurosteroids, gut microbiota modulation, and brain stimulation techniques 2. Integrated Care Addressing both psychiatric and medical comorbidities is essential for improving outcomes Greater focus on personalized, evidence-based treatments 3. Digital Health Smartphone apps and digital tools for monitoring symptoms and promoting self-management are emerging areas of interest 21. Overloser (2013) Understanding suicide risk: Identification of high risk groups during high risk times Suicide remains a complex public health challenge Requires a nuanced approach to assessment and prevention This study evaluates the factors that distinguish individuals who died by suicide (suicide completers) from those who died suddenly by other causes (e.g. accidents, natural causes) It integrates demographic factors, stressful life events, and psychiatric diagnoses to create a framework for identifying individuals at heightened suicide risk This study emphasizes the importance of integrating multiple domains—demographics, psychiatric conditions, and life events—into suicide risk assessments No single factor predicts suicide, the interaction between pre-existing vulnerabilities and acute stressors offers key insights into prevention strategies By addressing both long-term and immediate risks, mental health professionals can better identify and support individuals at high risk of suicide Key Factors in Suicide Risk Assessment 1. Demographics Suicide completers were significantly more likely to: Be Caucasian (86.5% vs. 72% in controls) Be male (78.4% vs. 68.1% in controls) Older individuals more at risk over younger adults Unmarried, divorced, seaparated, widowed, reduced emtional support Be unmarried (divorced, separated, or widowed), with marital instability linked to reduced emotional support. Older individuals (mid-50s to early 60s) had a higher risk compared to 2. Stressful Life Events Suicide completers were more likely to experience recent interpersonalconflicts (35.8% vs. 16.5%). Stressors included: Relationship problems (e.g., conflicts with spouses or significant others). Bereavement (7.4% vs. 3.1% in controls) Financial or occupational problems were common but not significantly  different from controls, possibly due to the universal nature of these stressors 3. Psychiatric Diagnoses Approximately 80-90% of suicide completers had a diagnosable psychiatric condition, with depressive disorders being the most common: Depression was present in 69.6% of suicide completers compared to 19.1% in controls Substance use disorders were present in 43.9% of suicide completers (vs. 30.5%). A history of prior suicide attempts was a strong predictor, with 68.9% of suicide completers having attempted suicide before Methodology The study used psychological autopsy, interviewing family members to gather data on the deceased’s mental health, life stressors, and personal history Compared 148 individuals who died by suicide to 257 individuals who died suddenly from non-suicidal causes Key Findings 1. Combination of Risk Factors Suicide risk increases when multiple domains (demographics, stressors, psychiatric diagnoses) interact Over half of suicide completers (53.4%) had risk factors in two or more domains 2. Psychiatric Diagnoses as Central Depression stood out as the strongest predictor of suicide risk. Substance use disorders and prior suicide attempts further increased vulnerability. 3.Stressful Life Events as Triggers Stressful life events often act as the immediate “breaking point” pushing individuals with pre-existing vulnerabilities into suicidal crises Implications for Prevention 1. Comprehensive Risk Assessments: Suicide prevention requires a holistic approach, assessing demographics, psychiatric history, and recent stressors Mental health professionals should focus on individuals with overlapping risk factors 2. Early Interventions Addressing mental health conditions, especially depression and substance abuse, is crucial Providing support during high-stress periods, such as after bereavement or interpersonal conflict, can reduce risk 3. Strengthening Social Support Marital or familial support plays a protective role Interventions should help individuals build and maintain healthy relationships 22. Northoff (2023) Overcoming the translational crisis of contemporary psychiatry- converging phenomenological and spatiotemporal psychopathology Psychiatry has made progress in fields such as genetics and neuroimaging There’s a “translational crisis”- the inability to translate scientific findings into practical diagnostic tools and therapies This crisis has two dimensions: Crisis of Mechanism: A lack of understanding of the neuro-computational mechanisms underlying psychiatric symptoms Crisis of Subjectivity: Insufficient integration of first-person subjective experiences into psychiatric models This combined approach highlights the spatiotemporal dynamics as a “common currency” between brain activity and subjective experience Offers innovative pathways for diagnosis and treatment Phenomenological Psychopathology (PP) = examines the subjective experience of space and time  Spatiotemporal Psychopathology (STPP) = links these subjective experiences to the brain’s spatiotemporal dynamics Spatial Dimension = subjective experience of space Phenomenological research has shown that psychiatric disorders significantly alter the experience of space By integrating PP and STPP, psychiatry can address both the crisis of subjectivity and the crisis of mechanism Neuro-computational mechanisms of space: disruptions in the brain’s network dynamics correlate with altered spatial experiences Temporal Dimension Subjective Experience of Time: time perception is also deeply affected in psychiatric disorders. Neuro-computational mechanisms of time The brain’s spontaneous activity creates an “inner time” that mirrors subjective temporal experiences 1. Schizophrenia (SZ) Fragmented spatial boundaries between self, body, and environment Patients report a blurring or merging of objects and people with themselves, leading to delusions, ego disturbances, and difficulty with social interactions Example: A patient feels objects “invading” their personal space or wall closing in on them. abnormalities in brain network dynamics, such as reduced functional connectivity in sensorimotor and higher-order regions This contributes to the blurring of spatial boundaries between the internal self and the external environment Neural activity shows imprecision in timing (e.g., disrupted synchronization in milliseconds), correlating with fragmented time perception Time is fragmented, disjointed blocks rather than a continuous flow May feel stuck Unable to integrate past and present 2. Major Depressive Disorder (MDD) Constricted spatial perception, where the environment feels distant, isolating, and inaccessible Patients often describe a gap or barrier between themselves and the world In MDD and BD, the brain’s functional organization shifts inward toward the default mode network, reflecting constricted or expanded spatial experiences Past and a sense of being trapped Time slows down and feels stagnant, often stuck in the past Example: A patient describes time as “petrified” and events as occurring in slow motion Slower neural activity in specific regions aligns with the perception of slowed or stagnant time 3. Bipolar Disorder (BD) Manic episodes expand spatial perception, making everything seem closer & more reachable, often accompanied by grandiosity and delusions Depressive episodes mirror MDD’s spatial constriction These differences in spatial experience can assist in differential diagnosis Manic episodes involve accelerated time perception, while depressive episodes resemble MDD’s stagnation 4. Anxiety Disorders (AD) Patients experience an overwhelming sense of future uncertainty, leading to heightened temporal unpredictability Reduced connectivity between brain regions responsible for prediction disrupts temporal certainty, reflecting patients’ sense of future unpredictability Key Recommendations 1. Clinical Applications PP’s insights into space and time disturbances can inform differential diagnoses Tools like the STEP scale (Scale for Space and Time Experience in Psychosis) quantitatively assess altered spatiotemporal experiences 2. Integrating Brain and Experience  Linking subjective experiences (e.g., fragmented time) with neural activity patterns can create biomarkers for psychiatric conditions Combining phenomenological and computational approaches may improve diagnostic precision and treatment strategies 23. Fusar-Poli (2022) The lived experience of psychosis: a bottom up review co-written by experts on experience and academics Bottom-up review of psychosis, developed collaboratively by individuals with lived experience and academic experts It focuses on subjective first-person accounts A comprehensive and nuanced understanding of psychosis across its clinical stages The study highlights the profound human and existential dimensions of psychosis, emphasizing the importance of co-created narratives in advancing psychiatric research and care Psychosis is not merely a clinical phenomenon but an intensely personal journey marked by struggle, resilience, and the quest for meaning Key Points Psychosis is one of the most complex and ineffable mental health experiences, challenging to communicate or understand. The study emphasizes phenomenology, centering the voices of individuals who’ve lived with psychosis to co-develop key themes and insights Methodology Analysis first-person narratives, literature, and qualitative data from global mental health organizations and workshops Collaborative workshops with individuals, families, and caregivers ensured themes aligned with lived realities Phenomenological methods enriched the themes, yielding a dynamic map of the psychotic experience. Lived Experiences Across Clinical Stages 1. Premorbid Stage (Before Symptoms) Core Themes: Loneliness, isolation, fragile “common sense” and a diminished sense of self Many individuals recall being shy, socially withdrawn, or feeling “odd” during childhood, linked to early signs of alienation and anxiety Loss of Common Sense: People experience a subtle disconnection from the natural flow of life, making everyday interactions cognitively effortful Early adverse experiences, such as bullying or family conflict, often amplify these feelings 2. Prodromal Stage (Early Warning Signs) Marked by a sense of heightened salience - everyday stimuli take on Exaggerated meaning, accompanied by paranoia or premonitions A pervasive feeling that something significant is about to happen (the “Trema” or stage-fright phase) Social withdrawal, hypervigilance, and emotional turmoil, with some individuals hiding their experiences out of fear or shame Disturbances in the sense of self, where individuals feel their identity is unstable or dissolving 3. First-Episode Stage (Onset of Psychosis) Relief and Revelation: Individuals often report a sense of clarity or resolution upon forming delusions, providing an explanation for their altered reality (e.g., the “aha moment” or “Apophany”) Self-referentiality intensifies: people feel the world revolves around them, leading to grandiose or persecutory delusions Loss of Agency: Experiences such as hallucinations or commanding voices Blur the boundaries between the self and the external world, this stage can feel chaotic, overwhelming, and isolating, accompanied by profound terror or guilt 4. Relapsing Stage Characterized by grief and loss: Mourning one’s pre-psychotic self, autonomy, and a sense of normalcy. Struggling with the stigma of being labeled mentally ill A dual awareness develops, as individuals feel split between the real world and lingering delusional thoughts The unpredictable nature of psychosis and uncertainty about the future are central concerns 5. Chronic Stage  Individuals often achieve greater acceptance of their condition and develop coping mechanisms May continue to grapple with persistent inner chaos, identity challenges, and social isolation. Recovery involves rebuilding meaning, reconnecting with the world, and finding purpose despite the disorder’s limitations The Recovery Journey Recovery is non-linear and highly individualized, requiring personal agency and supportive relationships It involves reclaiming identity: Reconciling past experiences with a new sense of self Social reintegration: Forming meaningful connections and reducing isolation Finding purpose: Moving toward goals and regaining hope Subjective Experiences of Treatment Inpatient Care Often traumatic, especially compulsory measures (e.g., restraint) Can also provide relief and safety during crises, offering a “respite” from external stressors Early Intervention Service: appreciated for their youth-friendly, recovery-focused approach, emphasizing partnership and human connection Medications and Psychological Treatments Mixed experiences: medications can alleviate distress Side effects A sense of dependency are common concerns Psychological interventions are valued for promoting understanding and empowerment 24. Gaebel (2019) Changes from ICD-10 to ICD- 11 and future directions in psychiatric classification The transition from ICD-10 to ICD-11 represents the most significant update to the International Classification of Diseases in decades This revision aims to improve the global applicability, clinical utility, and scientific validity of psychiatric classifications ICD-11 introduces several structural, diagnostic, and methodological changes, Greater dimensionality in some areas while maintaining the categorical approach for practical clinical use ICD-11 represents a significant step forward in psychiatric classification Emphasis on clinical utility and flexibility Dimensional elements enhance specificity Categorical framework ensures accessibility for clinicians worldwide Future revisions will likely build on this foundation by incorporating advances in neurobiology and dimensional psychiatry Key Changes in ICD-11 1. Chapter Structure The Mental, Behavioral, or Neurodevelopmental Disorders chapter now includes 21 disorder groupings, compared to 11 in ICD-10 Disorders previously grouped under childhood and adolescence (e.g., autism, ADHD) are integrated into broader categories, reflecting a lifespan perspective Sleep-wake disorders and conditions related to sexual health are now Separate chapters but cross-listed when relevant 2. New Diagnostic Categories Complex PTSD: Includes disturbances in affect regulation, negative self-concept, and relational difficulties alongside core PTSD features Prolonged Grief Disorder: Pathological grief persisting beyond cultural norms Gaming Disorder: Persistent gaming behavior impairing daily functioning. Compulsive Sexual Behavior Disorder: Failure to control intense sexual impulses Binge Eating Disorder and Avoidant/Restrictive Food Intake Disorder: better capture eating-related pathologies 3. Dimensional Approaches -ICD-11 integrates dimensional elements: Personality Disorders  ICD-11 replaces specific PD categories with a single diagnosis graded by severity (mild, moderate, severe) Optional trait qualifiers include negative affectivity, detachment, dissociality, disinhibition, and anankastia (=severe rigidity, control, perfectionism) Mood and Psychotic Disorders: disorders include qualifiers for symptom severity, specific symptoms, and course specifics (e.g., remission status) Schizophrenia: 6 symptom dimensions (e.g., positive, negative, cognitive) provide a detailed profile 4. Revised Diagnostic Criteria Diagnostic thresholds for some disorders were adjusted PTSD now requires three core symptoms (re-experiencing, avoidance, hyperarousal), leading to reduced prevalence estimates Revised criteria aim to differentiate disorders from normal variations in human functioning and prevent over-pathologization Field Studies and Evaluation 1. Reliability and Utility Field studies across 13 countries found ICD-11 to have higher interrater reliability than ICD-10 Clinicians rated the ICD-11 diagnostic guidelines as clear, user-friendly, and clinically relevant 2. Challenges in Implementation Some disorders (e.g., dysthymia, anxiety) showed moderate reliability, requiring further refinement. Concerns over cultural applicability and the complexity of new dimensional elements persist Future Directions in Psychiatric Classification Biologically Informed Nosology Efforts such as the Research Domain Criteria (RDoC) focus on linking mental disorders to underlying neurobiological processes (e.g., brain circuits, genetics) These frameworks are too complex for clinical use 2. Hierarchical Taxonomies The Hierarchical Taxonomy of Psychopathology (HiTOP) organizes symptoms into dimensions (e.g., internalizing, externalizing) Aim to address issues of comorbidity and overlap between disorders 3. Stepwise Diagnostic Models Stepwise approach for future ICD revisions: Initial categorical diagnoses for clarity and communication Additional dimensional assessments for detailed clinical and research use ICD-11 Strengths Greater emphasis on dimensionality improves precision Simplified personality disorder framework enhances usability New disorders reflect modern clinical realities (e.g., complex PTSD, gaming) Field studies suggest areas for improvement in reliability and cultural adaptation Limitations Clinical utility of HTOP limited The transition remains incremental ICD-11 is not a paradigm shift from ICD-10 25. Khanzian (1997) The Self medication hypothesis of addictive disorders: A reconsideration and recent applications Core Hypothesis Substance use is a way for individuals to self-medicate emotional distress or psychological challenges People with substance use disorders often have underlying psychiatric or emotional vulnerabilities Earlier views that substances directly alleviate distress were oversimplified. Emphasis of a more nuanced match between specific substances and the emotional/psychological needs of users Many substance users have unresolved trauma, difficulty regulating emotions, or personality vulnerabilities. Self-medication arises when traditional coping mechanisms fail Specific Substance Links  Opioids are often used to manage rage, aggression, or feelings of powerlessness. Stimulants (e.g., cocaine) are associated with efforts to counteract low energy, depression, or lack of focus Alcohol and sedatives are linked to the suppression of anxiety and managing interpersonal tensions Clinical Implications Effective treatment must address the emotional and psychological drivers of substance use. Therapies should focus on emotional regulation, coping skills, and resolving underlying issues rather than just stopping substance use Applications in Psychiatry The hypothesis has influenced dual-diagnosis treatment approaches Highlights the need for personalized care in substance use disorder management Criticism and Limitations Not all substance use aligns with self-medication (e.g., recreational or social use) The hypothesis does not fully explain why some individuals develop addictions while others do not NOT RELEVANT 26. Alex Roberts (2023) The bio-psycho-social model: its use and abuse George Engel (1977) > a response to the limitations of the biomedical model Aims to integrate biological, psychological, and social factors in understanding and treating illness. Widely adopted in medical practice and education, often referred to as the dominant model for health and disease. Core Crticisms The BPSM lacks scientific specificity and explanatory power It does not provide tools for defining diseases, distinguishing disease from non-disease, or establishing causal relationships The model is often misused as an explanatory framework, leading to speculative and unfounded conclusions Conceptual Issues: o The BPSM is too broad and vague, encompassing all possible factors without clear integration o Critics argue it is more a conceptual framework than a scientific model o Engel's own work relied on conflating "disease" with "illness," expanding the definition of disease without sufficient justification Researchers often misuse the BPSM, leading to "wayward discourse" characterised by: Concept Shifting: Blurring the lines between disease and illness to redefine conditions. Question Begging: Using assumptions about the BPSM’s validity to validate claims. Appeals to Authority: Citing the BPSM as proof without providing evidence. o Examples include studies on temporomandibular disorder (TMD) and irritable bowel syndrome (IBS), where symptoms are framed as diseases without validation. Consequences of Misuse: o Introduces conceptual instability in medical research, undermining progress. o Promotes medicalisation by labelling ambiguous conditions as diseases, potentially leading to unnecessary interventions. o Discourages revising or refining diagnostic constructs, resulting in stagnant and chaotic research paths. Potential Solutions: o Greater conceptual rigor is needed to avoid misuse of the BPSM.  o Researchers should recognise the BPSM as a framework for organising information, not a tool for generating causal claims or defining diseases. o The article highlights the strengths of the BPSM as a conceptual framework for addressing psychosocial determinants of health. However, it criticises its overuse and misrepresentation as a scientific model, urging a return to methodological rigor to avoid undermining medical research and practice. Strengths of the BPSM Highlights 1. Holistic Framework: o The BPSM is praised for broadening the scope of medical practice by integrating biological, psychological, and social factors. o It provides a more comprehensive understanding of health and illness compared to the reductionist biomedical model. 2. Focus on Psychosocial Determinants of Health: o The model draws attention to the role of psychosocial factors in health outcomes, such as stress, social relationships, and mental well-being. o It has facilitated research into conditions like chronic pain, where psychosocial factors play a significant role. 3. Utility in Organising and Communicating Information: o As a conceptual framework, the BPSM is useful for organising complex, multi-factorial information about health and illness. o It has become an effective teaching tool in medical and healthcare education, helping practitioners adopt a more patient-centered approach. 4. Promotes Patient-Centered Care: o The model encourages healthcare providers to view patients as whole persons, considering their psychological and social contexts alongside biological symptoms. o This approach fosters trust and improves the therapeutic relationship. 5. Applications in Difficult-to-Treat Conditions: o The BPSM has been particularly helpful in addressing conditions that do not fit neatly into the biomedical paradigm, such as: ▪ Chronic pain: Highlighting factors like fear-avoidance and stress, leading to more effective interventions. ▪ Spinal care: Focusing on psychosocial contributors to disability and pain. Overall Context: While the article critiques the misuse and overextension of the BPSM, it recognizes its significant contributions as a tool for organizing and emphasizing the importance of psychosocial factors in health. However, the author stresses that these strengths do not compensate for the model's lack of scientific rigor when applied as an explanatory or diagnostic framework.