B5 Psychopathology Exam Notes PDF

**B5 Psychopathology** **Exam Notes -- Slides** **Lecture 1: General Psychopath.** Psychopathology = studying mental disorders, symptoms, causes, effects; the diagnosis & classification of mental illness, how do these conditions affect thoughts, emotions and behaviors There are different underst...

**B5 Psychopathology** **Exam Notes -- Slides** **Lecture 1: General Psychopath.** Psychopathology = studying mental disorders, symptoms, causes, effects; the diagnosis & classification of mental illness, how do these conditions affect thoughts, emotions and behaviors There are different understandings of 'psychopathology' depending on the professional standpoint: - psychiatry: biological, phenomenological, dynamic, social - psychotherapy: different methodologies have different interpretations - psychology: cognitive, developmental, diagnostic History: evolved out of philosophy, religion, medicine, psychology -- influenced by research, medical development, societal Prehistoric era: supernatural, demonic possession Ancient civilizations: divine or natural causes (imbalances in bodily fluids/ humors) Medieval period: witchcraft & sin & evil 18^th^ -19^th^ century: institutionalization, lunacy asylums (Bethlem London, Narrenturm) 19^th^ century: Pinel, Tuke; la Salpêtrière ( a mental health hospital famous for studying mental illness), Kraepelin (founding father of the psychiatric classification system, emphasis on biological/ empirical approach) 20^th^ century: Breuer & Freud: exploration of the mind, therapeutic relationship, deinstitutionalization, modern research **Psychiatric Paradigms** 1. Biological psychiatry: brain structure, neurotransmitter imbalance, genetic predispositions, neuroimaging, psychopharmacology, mental disorder arising from biological dysfunction a. Treatment: medications, neurosurgical interventions eg. deep brain stimulation, goal -- correct biological dysfunction to improve symptoms 2. Dynamic psychiatry: unconscious processes, emotional conflicts, relationships, mental disorders arise from unresolved internal conflicts b. Unconscious mind (Freud), defense mechanisms (repression, denial), childhood experiences influencing adult behavior c. Treatment: insight-oriented therapy (uncovering unconscious conflicts), techniques (psychoanalysis, psychodynamic therapy); goal -- help patients: gain insight into unconscious emotional struggle, resolve conflicts; d. Therapeutic relationship: transference and countertransference as key therapeutic tools 3. Phenomenological psychiatry: subjective, lived experience of mental illness, core idea -- understand how individuals experience reality and the self in mental disorders -- more Rogers e. 1^st^ person perspective, exploration of time, self-disturbances, alienation and detachment in disorders eg. schizophrenia f. Treatment: empathy & dialogue, goal -- help make an altered sense of experiences, regain coherence, therapy -- existential concerns, identity and meaning in life 4. Social psychiatry: social & environ. Factors of mental health, mental disorders influenced by societal, economic, cultural conditions g. Social determinants, poverty, inequality, isolation, community preventative approaches, social support systems and relationships h. Treatment: community-based care, prevention of societal stressors (eg. unemployment, housing issues), collaborative effort -- integration of psychology, sociology and public health **Limitations / criticisms to paradigms:** 1. Biological: leaves out lived experiences, childhood impact on adult mental life, environmental/social factors -- focus on medicative treatment 2. Phenomenological: does not include treatment for psychosis and affective disorders that may require medication to support symptom relief 3. Dynamic: not every patient has the trust, budget and time to dedicate to the dynamic process which can be an intense process that may not support more serious mental conditions that have underlying biological factors as well, capacity to understand one's mental life and skills required is not available to every patient, what about crisis, suicidal ideation? 4. Social: the close relationship to economic factors and bureaucratic, policy challenges to implanting change in society especially with regards to community health -- it is not prioritized or given sufficient budget, **Lecture 2. Basic Psychoath. Terminology** Symptom = symptoma (Greek) = accidental circumstance, subjective evidence of disease or physical disturbance, something that indicates the existence of something else - The clinical picture, anamnesis - Examples: stupor, lack of concentration, tiredness, anxious thoughts, flashbacks... Syndrome: a combination of multiple symptoms, often at the same time, characterization of a specific abnormality - Syndrome is not cause - Examples: depressive syndrome, manic syndrome, - Example: collection of symptoms: difficulty to concentrate, difficulties to sleep, pessimistic perspective on the future, low self-esteem, feeling worthless - Depressive Syndrome: a cluster of symptoms that can occur in various conditions - Depression is specific disorder *Comorbidity with depressive syndrome*: - OCD - Substance use eg alcoholism - Personality disorder Disorder = to disturb the order, mental illness, mental health condition; a *clinically significant disturbance* in an individual's cognition, emotional regulation, behavior Disease = a condition og the living animal / plant body or of its parts that impairs normal functioning, is manifested by a cluster of signs/ symptoms; an abnormal condition that is clinically significant - Humans: connect it to pain, disfunction, distress - There is a connection to symptoms, syndromes and disorders Comorbidities: additional medial conditions to existing primary diagnosis Morbidity: specific condition Co- : 2 or more conditions Bio-Psycho-Social Model (BPS) - A holistic framework, focus on psychosocial determinant of health, utility in organizing and communicating information, promotes patient-centered care, applications in difficult-to-treat conditions - Widely adopted in the medical field in practice and education, referred to as the dominant model for health & disease **[Criticism: ]** - Lack of specificity- difficulty to test empirically, too broad to encompass all possible factors, more conceptual framework than scientific model, - Concept shifting -- blurring the lines between disease and illness, uses assumptions about validity, BPSM used as 'proof' without provision of evidence - doesn't provide tools to define diseases, distinguishing disease from non-disease - misused as explanatory leading to unconfounded/speculative conclusions - Overgeneralization -- integration may dilute focus and prevent actionable insight - Ambiguity of term definitions, where are the boundaries, interpretations vary - Implementation challenges - Time constraints when addressing all three domains **Aaron Antonovsky** (1923- 1994) born in Israel Salutogenisis = health, supportive factors of health and well-being, actively maintaining health; emphasis on resilience resources, ability to manage stress rather than focus on healing/ improving symptoms and disease pathology Pathogenesis = developmental process of disease/ disorder - Human distress is that of an integrated organism and has both a psychic and a somatic aspect - 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 - Different lifestyle definitions: - 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 - 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? Relevance of salutogenisis in psyhchopath. = the shift from disease treatment to well-being support and actions CBT Role of thoughts, behaviors, beliefs ------------------------------- ------------------------------------------------------------ Psychoanalytic Model Unconscious conflicts, early experience, defense mechanism Humanistic /existential model Personal growth, self-actualization Systemic Model Reciprocal interactions between systems and individuals Lecture 3: Diagnostics