Psychopathology Exam Notes 2024/2025 PDF

**PSYCHOPATHOLOGY EXAM NOTES** **2024/2025** **ICD- 10 Chapters** 1. F00 -09 Organic Disorders 2. F10 -19 Substance Induced Mental Disorders 3. F20 -- 29 Psychosis, Schizophrenia 4. F30 -39 Affective / Mood Disorders 5. F40 -49 Neurotic, stress-related and somatoform disorder 6. F50 -5...

**PSYCHOPATHOLOGY EXAM NOTES** **2024/2025** **ICD- 10 Chapters** 1. F00 -09 Organic Disorders 2. F10 -19 Substance Induced Mental Disorders 3. F20 -- 29 Psychosis, Schizophrenia 4. F30 -39 Affective / Mood Disorders 5. F40 -49 Neurotic, stress-related and somatoform disorder 6. F50 -59 Behavioral syndromes associated with physiological disturbances and physical factors (sleep, eating sexual etc.) 7. F60 - 69 Disorders of adult personality and behavior (not due to brain damage/disease, gender identity, sexual development and orientation 8. F70 -79 Mental retardation 9. F80 -89 Psychological development (speech/language, scholastic skills, pervasive dev. Disorders =autism spectrum) 10. F90 -99 Behavioral & emotional disorders with onset occurring in childhood/ adolescence 11. F99 Unspecified mental disorder **\ ** **Psychopathology Exam** **Article Notes** 1. **[Aaron Antonovsky 1996 "Salutogenisis"]** - A theory attempting to pave the way for the development of the field of salutogenisis - Human distress is that of an integrated organism and has both a psychic and a somatic aspect - Discusses the 'down the stream' focus of the disease care system on saving those already ill rather than approaching health from the perspective of maintaining good health and wellbeing - Successful promotion of health could have a major economic impact - Health WHO = optimal physical, mental and social wellbeing -- not the absence of illness or pain - Importance of creating appropriate social conditions which facilitate health-promotive behaviors eg. day care facilities, access to health care, adequate incomes for nutrition & housing - Lifestyle: - Consciously chosen behaviors - Social & cultural circumstances that condition / constrain behavior - Community and individual measures that can develop lifestyles that enhance wellbeing - A list of risk factors impact health - Salutogenic Model = a continuum model, derives from studying the strengths / weaknesses of promotive, preventative, curative rehabilitative ideas and practices- a theory of health, salutogenisis focus vs. the pathogenic orientation, we are each situated along a healthy/dis-ease continuum at a given time - 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 - Strength of SOC: shaped by consistency, underload-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... - Participation in new activities will not dramatically change a SOC but can prevent/ lower damage or add strength - GRR (Generalized Resistance Resources) help the organism cope with life stressors of the human existence - Manageability: belief that resources to cope are available - Meaningfulness: wish to be motivated to cope) - Comprehensibility: belief the challenge is understood - A flaw in the health promotion concept is the sole focus on pathogens/ concern with risk factors, if one is naturally healthy one has to merely reduce risk as much as possible - The focus is on health promotion both in research and action on all persons wherever on the continuum - Measurement tool -- a closed scale 29-item SOC 'Orientation to Life', shown to be true across cultures, feasible, reliable, valid for humans of all kind - Further testing is needed eg. does SOC act as a buffer? - Is there a linear relationship to health and SOC - Does the significance of SOC vary with age? 2. **[Alan Frances , 2013 "PTSD: Hard to get right"]** - Errors in diagnosis are common, PTSD is missed when people suffer symptoms stoically and silently, it is over diagnosed when it's a trigger for financial gain (US veterans who can collect governmental benefits for their work-related 'trauma') - Life has always been risky for humans; death has lurked in every corner since the beginning of humanity -- have an important survival value -- avoiding such risks in the future - PTSD symptoms: reliving the moment repeatedly, flashbacks can bring the event to life again during the day, nightmares during the night, any situation the resembles the event can trigger avoidance and terror - Most people: these intrusive memories, triggers become less intense and terrifying over time, 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 - PTSD diagnosis is dependent on self-reporting and there is no objective measure/test. - People may downplay or exaggerate symptoms, PSTD rates depend on how the diagnosis is made and which country is surveyed -- complex psychological / contextual factors influence symptoms - Underreporting harmful in the long run -- avoidance of situations, more rigid behavior developed, the importance to be strong/brave overrides the healing power of admittance and reflection - Low investigation of PTSD from pharma companies, medication not yet proven to be effective 3. **[Alan Frances, 2013 "Bipolar II"]** - There is a challenge in diagnostics to differentiate and define an appropriate treatment plan for those who show cyclical lows alternating with highs -- bipolar versus unipolar depression - **Antidepressants** help the lows but can cause *irritability, mood swings and increase* cycles thereby worsening the course if the patient has bipolar disorder - **Mood-stabilizers**: side effects are not worth the hassle for unipolar depression: weight gain, diabetes, heart disease - The goal is to balance the risks of taking the mood-stabilizers - **Mania:** is unmistakable and unforgettable *-- a supercharged thoughts / actions if irritable spends money uncontrollably, acting inappropriately/impulsively, being intrusively sexual, needing little sleep --* provides a clear call to action of not prescribing anti-depressants without the safety net of a mood stabilizer - **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 - **Challenge**: hypomanic patients can be classified with either but depending on the patient can either: - Be given anti-depressants that can trigger a manic episode - Be given mood stabilizers that are more harmful than helpful - So a new category is called 'hypomania' to offer more accurate diagnosis and safer treatment - No clear boundary between hypomania and feeling good - Pharmaceutical advertisements take advantage of the grey area of diagnosis -- when is someone really happy, high or having a hypomanic episode? - It has led to overdiagnosis, and unipolar depressive patients being treated with unnecessary mood stabilizing drugs - Bipolar may affect more of the population than schizophrenia, which is why the pharmaceuticals have a bigger interest in exploiting the new hypomanic category - Antipsychotic medication are riskier than mood stabilizers 4. **[Alan Frances, 2013 Werther Fever Creates Epidemics of Suicide]** - 1774 Goethe wrote 'Die Leider den jungen Werters' 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: - Suicide Clusters (the Virgin suicides- film): people copy a celebrity/relative/ friend etc. - Mass suicide: socially sanctioned to avoid a fate worse than death - Protest suicide: the ultimate form of protest - Group suicide (Kamikaze): defense of a religion/ideal/ nation - Mass religious suicide: follow-the-leader behavior - Natural selection weeds out suicidal DNA - Guidelines for media reporting suicide and avoiding suicide contagion: no detailed how-to descriptions, no promotion of fame suicide, no suggestion that suicide is a rational choice, no sensationalism 5. **Alex Roberts (2023) The biopsychosocial model: its use and abuse** - Proposed by George Engel in 1977 as 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 Criticism: - 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: - The BPSM is too broad and vague, encompassing all possible factors without clear integration. - Critics argue it is more a conceptual framework than a scientific model. - Engel\'s own work relied on conflating \"disease\" with \"illness,\" expanding the definition of disease without sufficient justification. - Wayward Discourse: - Researchers often misuse the BPSM, leading to \"wayward discourse\" characterized 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. - Examples include studies on temporomandibular disorder (TMD) and irritable bowel syndrome (IBS), where symptoms are framed as diseases without validation. - Consequences of Misuse: - Introduces conceptual instability in medical research, undermining progress. - Promotes medicalization by labeling ambiguous conditions as diseases, potentially leading to unnecessary interventions. - Discourages revising or refining diagnostic constructs, resulting in stagnant and chaotic research paths. - Potential Solutions: - Greater conceptual rigor is needed to avoid misuse of the BPSM. - Researchers should recognize the BPSM as a framework for organizing information, not a tool for generating causal claims or defining diseases. - The article highlights the strengths of the BPSM as a conceptual framework for addressing psychosocial determinants of health. However, it criticizes 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 Highlighted in the Article:** 1. **Holistic Framework**: - The BPSM is praised for broadening the scope of medical practice by integrating biological, psychological, and social factors. - It provides a more comprehensive understanding of health and illness compared to the reductionist biomedical model. 2. **Focus on Psychosocial Determinants of Health**: - The model draws attention to the role of psychosocial factors in health outcomes, such as stress, social relationships, and mental well-being. - It has facilitated research into conditions like chronic pain, where psychosocial factors play a significant role. 3. **Utility in Organizing and Communicating Information**: - As a conceptual framework, the BPSM is useful for organizing complex, multi-factorial information about health and illness. - 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**: - The model encourages healthcare providers to view patients as whole persons, considering their psychological and social contexts alongside biological symptoms. - This approach fosters trust and improves the therapeutic relationship. 5. **Applications in Difficult-to-Treat Conditions**: - 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.