Intro to Psychopathology PDF

Lect. 1. Overview of psychopathology Descriptive psychopathology: Signs and symptoms that are associated with mental illness. Psychopathology or abnormal o Abnormal is seen as stigmatizing, and psychopathology is more polite. The elements of psychopathology o...

Lect. 1. Overview of psychopathology Descriptive psychopathology: Signs and symptoms that are associated with mental illness. Psychopathology or abnormal o Abnormal is seen as stigmatizing, and psychopathology is more polite. The elements of psychopathology o Su@ering o Maladaptation o Statistical Deviancy o Others DSM: The diagnostic and statistical manual of mental disorders o The standard of diagnosis in healthcare o The diagnostic categories are 1. Descriptive 2. Concrete and 3.Problematic. DSM – III – Reliability Di@erence in mental disorder and psychopathology o Mental disorders refer to the DSM-based classification system o Psychopathology is a more broad term that refers to any form of psychopathology, including disorders in the DSM or other behaviors that involve su@ering. Concrete definitions keep psychologists from over diagnosing In one area or another. Lect. 2 Disadvantages of classification o Stigma, Stereotyping o Blame may be placed on individual rather than disorder o System could be problematic or wrong How common are di@erent mental disorders? o Incidence- proportion of new cases of a condition within an incidence of time i.e. incidence one year (new cases) o Prevalence – proportion of individuals a@ected at a given time (all cases)  o Lifetime morbid risk – Proportion of individuals in a population who will develop a condition in their life, assuming they live long enough (probability of developing) o DALY -Disability-adjusted life year Experimental Design o Manipulated aspect o Strength is internal validity o Weakness is poor external validity and Limited large sample size Adolescent Brain Cognition Development Study Quasi-experimental design – manipulation occurs in nature, not by human intervention (natural experiments) Etiology 1, Genes and Environment P=G+E What causes psychopathology? o Genes-> brain structure-> Psychological Symptoms Diathesis stress - combination of genes and environment Genetic variation – locus where there is a variation in alleles, giving rise to di@erent genotypes in di@erent people o Polygenetic – vulnerability to mental illness o Monogenic – influenced by one or a small number of varients Etiology 2 Biometrics A -Additive genetic – e@ects of alleles taken singly aggregated across loci D- Dominance genetic – E@ects of a combination of alleles within each locus, aggregated across loci I- Epitasis Genetic – E@ects of combination of alleles across loci CE- Shared environment – Environment that contributes to sibling similarity NE- Non-shared environment – Environments that contribute to sibling di@erences M E- Measurement error – errors in measuring the phenotype as well as short-term temporal instability Phenotypic variance – di@erences among humans Heritability – the extent to which phenotypic di@erences between individuals can be attributed to the genetic di@erences between those in the study o Not genetically fixed or determined Cor = correlation  R sub a = probability two relatives share a randomly selected allele at a randomly selected locus identical by descent R sub d = probability that two relatives share both alleles at randomly selected locus IBD R sub I = indeterminate, but depends on probability two relatives share alleles across multiple loci IBD R sub c = usually specified as 1.0 for reared together relatives and 0 otherwise Etiology 3 Psychodynamic perspective – that unconscious behaviors unknowingly drive conscious behaviors Behavioral perspective – study observable behavior alone, and behavior is the product of conditioned history Classical fear conditioning o Conditioned stimulus (CS) § Danger cue (CS+) § Safety cue (CS-) o Unconditioned stimulus (US) o Acquisition § Training § Expression o Extinction § Training (with no US) § Expression o Fear conditioning and anxiety o Generalized learning o Conditioned social anxiety § US, embarrassment § CS, people, places, things o Panic attacks generalization § Sensations – heart-racing events § Public – public places § Things – specific things Cognitive-Behavior Perspective o Distorted thoughts -> Maladaptive emotions and behaviors o Awfulizing or catastrophizing / cognitive recalculating o Demandingness / adjusting expectations  o Self–doubting / disputation, exploring other values Stress – Demands that are put on an organism that a@ect its ability to cope o Stress can be good or toxic depending on success of coping § Good stress leads to adaptive growth and brain change § Toxic stress leads to maladaptive brain change o Homeostasis – a process wherein physiological parameters are maintained o Allostasis – response to stress essential for maintaining homeostasis o Allostatic load – wear and tear on the body and brain from chronic dysregulation of allostasis o Two Hormonally driven stress response § Sympathetic-Adrenomedullary System (SAM) Part of sympathetic processing Epinephrine and norepinephrine target multiple areas § Hypothalamic Pituitary Adrenal (HPA) axis Produces glucocorticoids (GCs) GCs cross the blood-brain barrier o Early experiences may shape the stress reactivity in hpa and prolonged stress o Key characteristics of stressors § Severity § Chronicity § Level of human malice § Perceived controllability o Maladaptive reactions to stress DSM disorders defined by stress § Adjustment disorder – Maladaptive response to common stressors occurring within 3 months, more stress than expected, lessens or disappears within 3 months § PTSD Criteria A – stressor (Exposure to death, Threatened death, actual serious or threatened injury or violence) Criteria B – Presence of 1 or more intrusive recollections of the event, distressing dreams, acting or feeling as though the event is recurring, intense distress or physiological reactivity to cues  Criteria C avoidance of stimuli associated with trauma, e@orts to avoid thoughts, feelings, and discussions associated, e@orts to avoid things associated Criteria D negative alterations in cognition/mood, inability to recall features, negative beliefs, distorted thought, and blame. Criterion E Symptoms of increased arousal Irratable or aggressive behavior, self destructive behavior. Criterion F duration of disturbance > 1 month not transient Criterion G Causes clinically significant distress or impairment. § Acute stress disorder o Social determinants we call stress (Risk Factors) § Early trauma § Problems in parenting style § Discord or divorce § Socioeconomic status § Relationships § Discrimination Gene-environment correlation o Not the same as GxE interaction o Correlation between magnitude of genetic e@ect and magnitude of environmental e@ect o Three types § Passive G-E correlation § Reactive G-E correlation § Active G-E correlation o G-E is pervasive in psychology o It makes causal inferences from observational, correlational studies extremely di@icult o Makes things more correlated: smoking gene-> lung cancer, heritability of “lung cancer” o Gene-Environment correlation e@ect the Diathesis-stress model: the combination of genes and environment causing disorder Clinical assessment and diagnosis Purpose of assessment and diagnosis o Take sample of behavior in a controlled setting, test o Sample generalizes to behavior outside § Future behavior § Past behavior § Current behavior o Assessment is a prediction strategy Basic elements of assessments o Presenting problem or referral o History o Symptoms and signs, diagnosis § Psychologists more than psychiatrists are interested in personality assessment o Contextual factors o Prior treatment 4 sources used in psychological assessment o Interview o Clinical observation o Clinical history o Other tests Interviews (linked to DSM categories) o Structured § Set of rules and questions o Unstructured § Semi-structured, structured questions at random Clinical observation o Observation in natural environment o Observation in medical settings § Physical appearance and hygiene § A@ect (flat a@ect) § Speech § Behavior appropriate to setting o Role-playing, event reenactment, think-aloud procedures Psychological tests o Neuropsychological tests, intelligence tests § IQ tests, standardized psychological and educational tests  § Scores are only meaningful in the context of “norms” o Long term memory o Executive function o Naming o Perception o Motor control o Understanding and producing language Psychopathology and personality tests o Projective § Open-ended § Ambiguous o Objective § Close-ended § Concrete § MMPI -Minnesota multiphasic personality inventory Categorical approach: Diagnostic classification of mental disorders o Avoid “reifying” disorders, they are not necessarily real syndromes or entities in nature, they are tests that measure psychopathology o Basic reliability and validity apply to symptom lists in disorders as they apply to all other psychological tests o Reliability tests consistency of test scores across administrations o Di@erent ways to test reliability § Test-retest – consistency over time Var(E) over time § Inter-rater reliability – consistency across raters Var(E) due to raters § Parallel forms or “internal consistency” – consistency across slightly di@erent item banks Var(E) o Measuring Validity § Context validity – how relevant are the items § Predictive validity – how accurately does the test predict relevant outcomes § Construct validity – consideration of all the above Probability o Pr(B|A)Pr(A)/Pr(B) Anxiety and fear Normal Anxiety o Signal of genuine threats o Proportional to threat o Avoid over-interpreting Pathological Anxiety o Present in absence of genuine threats o Cand be disproportionate to threats Primary anxiety disorders in the DSM o PTSD o Acute stress o Specific phobia § Presence or anticipation of specific situation leads to excessive fear § Phobic situation is avoided § Person recognizes fear is excessive § Interferes significantly with function or life quality o Social anxiety disorder § Marked fear of 1 or more social/performance situations in which social scrutiny is possible § Fear of acting in a way that’s humiliating § Fear is disproportionate § Feared situation is avoided § Symptoms last six months or longer § Symptoms cause distress or impairment o Generalized anxiety disorder § Excessive anxiety or worry about a number of events that occurs more days than not for at least six months § Worry is perceived to be di@icult to control § 3 or more Restlessness Easily fatigued Di@iculty concentrating Irritable Muscle tension Sleep disturbance § Symptoms cause distress or impairment  § Focus of anxiety is not confined to features of another disorder o Panic disorder § Recurrent unexpected panic attacks § Panic attack = abrupt surge of intense fear peaking within minutes including 4 of the following Palpitations Sweating Trembling Chest pain Ot flash or chills Fear of no control and dying Nausea § Attack cannot be better accounted for by a di@erent anxiety disorder § Specify with or without agoraphobia o OCD § Obsessions Recurrent/ persistent thoughts, impulses, or images that are intrusive and inappropriate Not simply excessive real-life worries Person attempts to ignore or suppress these things Contamination fears Fears of harming Fear of doom Fear of discarding things § Compulsions Repetitive behaviors driven by obsession Behaviors aimed at lowering distress or preventing situation Cleaning washing Checking Rituals Hoarding Treatment of anxiety disorders o Exposure therapy  § Confront with source of anxiety § Systematic desensitization § Relaxation techniques taught § Confront thoughts or emotions related to disorder § Group therapy § Medications Assessment of anxiety disorders o Interview o Questionnaire screeners (Beck, MMPI) o Di@erential diagnosis often di@icult given overlap with depressed mood and neuroticism o Assessing anxiety assesses broader vulnerability to “internalizing” Correlations of psychopathology o Internalizing § Anxious-Misery Major Depressive Disorder Dysthymia GAD § Fear Social Phobia Simple Phobia Agoraphobia Panic Disorder o Externalizing § Alcohol Dependency § Drug Dependence § Anti-social personality Mood Disorders DALY – Disability Adjusted Life Year What are mood disorders o Abnormalities on a spectrum § Depression Mania Mood episodes o Major depressive episode § Severely depressed mood characterized by loss of interest, self – depreciation, inability to concentrate § Anhedonia  § Suicidality o Manic Episodes § Elevated and expansive mood characterized by grandiosity, distractibility, and excessive pleasure activities Mood Disorders o Unipolar Depression § Onset 20s – 30s § LMR 10% § Moderate Heritability § Dysthymia Mild to moderate depression >2 years Intermittent normal moods briefly Dysthymia + MDE = double depression Lifetime prevalence 2.5% - 6% § Major Depressive Disorder 1 Episode = MDD, single episode 2 or more episodes = MDD, Recurrent o With or without inter-episode recovery o With seasonal pattern o Bipolar Disorder § Teens - 20s § 1% LMR § Strong Heritability § Cyclothymia § Bipolar 1 (1+ Manic episodes, can also have major depressive episodes) § Bipolar 2 (Hypomania and at least 1 major depressive episode) Learned helplessness o Two-stage experiment with 2 groups of dogs § One gets an escapable shock (press lever to turn o@) § Group two receives inescapable shock (lever has no e@ect) § Inescapable shock takes longer to jump hurdle or to want to § Escapable group is quicker to escape box o Helps us learn why anxiety and depression could be comorbid § Anxiety of situation  § Helplessness of situation § Depression in situation o Negative attributions § Internal vs External § Stable vs Unstable § Global vs Specific Stressful life events and depression Mood disorders are elevated among creative individuals Genomic Techniques o Genome-wide association studies (GWAS) – millions of genetic variants are tested for association with disorder status o Highly successful for schizophrenia Somatic treatment of Bipolar disorder o Lithium § Mechanism unclear § Side e@ects Excessive thirst and urination, eventual kidney and thyroid damage § Blood levels must be monitored § Rarely used o Safer less e@ective antidepressants and some antipsychotics most often prescribed Psychosocial Treatment of Bipolar Disorder o Family Therapy § Increase medication compliance § Educate family about symptoms § Help family develop new coping skills and communication styles Suicide o Gender di@erences § Women are far more likely to contemplate suicide and to make non-lethal attempts § Men are 4x more likely to complete suicide § The positive predictive value (Pr(suicide | +)) o Assessment and prediction § Tests for suicide don’t work very well § Some example tet properties  Sensitivity is perhaps 0.70 Recall this is Pr(+|Completed suicide) Specificity is higher, maybe at.9 This is Pr(- | no suicide) Base rate is very low maybe around 1 in 1000 for those who have made a serious previous attempt § The positive predictive value Pr(suicide |+) for sucha test with a base rate =.001 is 10% § The negative predictive value or Pr(no suicide | -) assuming base rate =.001 is 99.97% § If predicting in the general population, the base rate is 4/10,000 -.0004, and the positive predictive value is 0.3% o Beyond suicidal ideation, assess the risk, to the extent possible, especially § Does the patient state that the intend to kill themselves? § Does the patient have a plan? Is it definite? § Have they ever attempted? How serious? o If suicide is imminent, law enforcement or medical doctors ca place patients on involuntary hold o In less imminent cases § Form a plan/contract around the suicidal behavior § Engage if possible with family and friends to monitor § Remove easy means of death from the household § Continue to engage in care Eating disorders Anorexia nervosa – overcontrol o ‘A loss of appetite for psychological reasons” § Anything but a loss of appetite § Higher levels of hunger hormone (ghrelin) o Restriction of energy intake leading to significantly low body weight o Intense fear of gaining weight o Disturbance in the way which one’s body weight or shape is experienced o Severity of anorexia indicated by BMI o Subtypes § Restricting subtype  § Binge – eating – purging subtype o More chronic and resistant to treatment o Perfectionism o Hypercritical o Drive for thinness has an OCD “feel” o Comorbid with other psychological disorders Bulimia nervosa – under control o Recurrent episodes of binging with both § Eating an amount larger than most people in 2 hours § Sense of lack of control over eating o Inappropriate compensatory behavior to prevent weight gain o Binge eating and compensatory behaviors both occur at least 1x a week for 3 months o Purging subtype § Vomiting, laxatives, diuretics § Most common o Non- Purging § Fasting § Exercising § One-third of bulimia o Most are within 10% of body weight o Purging methods can result in severe medical problems § Erosion of dental enamel § Electrolyte imbalance § Gastrointestinal problems § Chronic if left untreated Palliative psychiatry o Anorexia can be highly treatment-resistant o Refractory cases spanning years o Routine hospitalizations including force-feeding Evolutionary mismatch Hypothesis o Evolved to do a specific task that is not required anymore Drugs and drug use Use disorder is classified the same as alcohol use Clear evidence from model organisms that extensive, prolonged drug use damages brain structure and function Schizophrenia Prodrome: A period before the onset of symptoms Onset: Developing the symptom Recovery: Working to recover Symptoms o Thinking § Infer disturbances in thinking from 2 types of abnormalities in language § In the form of thought Disorganized thinking Di@iculty organizing thoughts or connecting them logically Neologism – making up words Clanging – words are selected based on sound Tangentiality Loose associations Word salad § In the content of thought Delusions o Persecutory delusions (Facing persecution) o Grandiose delusions o Religious delusions o Delusions of reference (people referring to you) o Delusions of control § In speech Alogia (Limited speech) § In behavior Dressing unconventionally Looking disheveled Erratic behavior Social isolation o Perceptions § Hallucinations Can occur in all five senses o Auditory (most common) o Visual (Can be mild or severe)  o Scent It can be pleasant or distressing o Emotion § Flat a@ect Lack of outward expression of emotion § Anhedonia Hedonia – pleasure Lack of pleasure o Motor § Psychomotor disturbances / catatonia § Heterogeneous activity Positive symptoms (adding) o Hallucinations o Delusions o Disorganized thinking o Disorganized behavior o Inappropriate a@ects Negative symptoms (taking away, absence) o Flat a@ect o Anhedonia o Lack of motivation o Poverty of speech Criterion A o Two or more of the following present for a significant amount of time for one month § Delusions § Hallucinations § Disorganized speech § Catatonic behavior § Negative symptoms o One of the symptoms must be delusions or disorganized speech Criterion B o Social/occupational dysfunction in one or more major areas Criterion C o Continued disturbance for at least 6 months Non shared E o Birth size  o Maternal conditions o Obstetric Complications o Minor physical abnormalities o Impaired neuromotor development Treatment o 1st generations antipsychotics – neuroleptics § Reduces positive symptoms for 60% of patients § Major side e@ects o 2 generation – atypical antipsychotics nd § Block dopamine and/or serotonin receptors § Less side e@ects than 1st gen o 74% of patients discontinued meds within 18 months o Social skills training § Group therapy to learn about appropriate interpersonal skills § Family therapy o Assertive community therapy § More like social work. Team of individuals. Home visits. Ensuring individual is taking meds, going to appointments. § Chronic conditions, so treatment is ongoing Integrative models of psychopathology