Psychological Disorders UPDATED PDF

Psychological Disorders Notes Mental Disorder (Psychopathology) Definition: A persistent disturbance or dysfunction in behavior, thoughts, or emotions that causes significant distress or impairment in functioning. Medical Model of Mental Disorders The medical model conceptualizes...

Psychological Disorders Notes Mental Disorder (Psychopathology) Definition: A persistent disturbance or dysfunction in behavior, thoughts, or emotions that causes significant distress or impairment in functioning. Medical Model of Mental Disorders The medical model conceptualizes abnormal psychological experiences as illnesses that, like physical illnesses, have: ○ Biological and environmental causes. ○ Defined symptoms. ○ Possible cures. Example of Diagnosis In diagnosis, clinicians seek to determine the nature of a person’s mental disorder by assessing: ○ Signs (objectively observed indicators of a disorder) (high blood pressure). ○ Symptoms (subjectively reported behaviors, thoughts, and emotions) that suggest an underlying illness. (I feel light headed) ○ Example: Symptoms of Robin Williams: depressed mood and struggles with mind-altering substances. These are symptoms of depressive disorder and substance-use disorder. Differentiating Terminology The following are important terms in diagnosis: ○ Disorder: A common set of signs and symptoms. ○ Disease: A known pathological process affecting the body. ○ Diagnosis: A determination of whether a disorder or disease is present. ○ Prognosis:the likely course of a disease or ailment Diagnostic and Statistical Manual of Mental Disorders (DSM) The DSM is a classification system that: ○ Describes the symptoms used to diagnose each recognized mental disorder. ○ Indicates how the disorder can be distinguished from other similar problems. DSM-5-TR: ○ Contains 22 major categories of mental disorders. ○ Lists more than 200 different mental disorders. ○ Comorbidity: More than 80% of individuals with a mental disorder report having two or more disorders (co-occurrence). Epidemiology Epidemiology is the study of the distribution and causes of health and disease. The U.S. has the highest rate of mental disorders among countries. Cultural Context and Mental Disorders Cultural Context: Culture can influence: ○ Experience, description, assessment, and treatment of mental disorders. The DSM-5-TR includes the Cultural Formulation Interview (CFI), which contains 16 questions that clinicians ask clients during mental health assessments to understand how a client’s culture might influence their experience, expression, and explanation of their mental disorder. International Classification of Diseases (ICD): ○ The ICD, created by the World Health Organization (WHO), is similar to the DSM and used in many countries worldwide. ○ In the U.S., hospitals and insurance companies use ICD codes (i.e., specific numbers assigned to disorders) rather than DSM codes.  ○ The use of ICD codes helps countries collaborate in tracking the incidence and treatment of various conditions globally. Prognosis of Mental Disorders A mental disorder is likely to have a common prognosis, meaning a typical course over time and susceptibility to treatment and cure. Limitations of the Medical Model: ○ The basic medical model is usually an oversimplification. ○ It is rarely useful to focus on a single cause that is internal to the person and suggests a single cure. Biopsychosocial Perspective on Mental Disorders The biopsychosocial model suggests that mental health or mental illness is the result of interactions among biological, psychological, and social factors. Diathesis–stress model: Mental illness develops when a person who has some predisposition (the diathesis) to mental illness experiences a major life stressor (the stress). ○ Diathesis: The internal predisposition or vulnerability to a disorder. ○ Stress: The external trigger that activates the predisposition. DSM and the Evolution of Mental Disorder Classification The DSM is not a rigid guide like a bible but functions more like a dictionary introducing new initiatives. Research Domain Criteria Project (RDoC): A new initiative aimed at guiding the classification and understanding of mental disorders by revealing the basic processes that give rise to them. ○ The RDoC approach shifts the focus away from classifications based on surface symptoms and instead emphasizes understanding the processes that cause disordered behavior. ○ Example: Instead of classifying cocaine addiction as a separate disorder, RDoC might focus on abnormalities in "responsiveness to reward" that are present in both cocaine addiction and other addictive behaviors. Research on Addiction and Mental Disorders Research has found that variations in the DRD2 gene, which codes for dopamine D2 receptors, are linked to: ○ Abnormalities in connectivity between the frontal lobe and the striatum. ○ This abnormal connectivity is related to impulsiveness and responsiveness to rewards, factors seen in addictive behaviors. Stigma and Mental Health Treatment The stigma associated with mental disorders may explain why approximately 60% of people with diagnosable psychological disorders do not seek treatment. Anxiety Disorders Anxiety disorders are characterized by anxiety as the predominant feature, and people often experience more than one type of anxiety disorder at a time. There is also significant comorbidity between anxiety and depression. Among the anxiety disorders recognized in the DSM-5-TR: ○ Phobic disorders. ○ Panic disorder. ○ Generalized anxiety disorder (GAD). Phobic Disorders Phobic disorders are marked by persistent, excessive fear, and avoidance of specific objects, activities, or situations. ○ Specific phobia: An irrational fear of a particular object or situation that interferes with functioning. Categories of Specific Phobias: 1. Animals (e.g., dogs, snakes, spiders). 2. Natural environments (e.g., heights, darkness). 3. Situations (e.g., bridges, elevators). 4. Blood, injections, and injury. 5. Other (e.g., choking, loud noises, costumed characters). ○ Prevalence: About 12% of people in the U.S. will develop a specific phobia in their lives, occurring slightly more in women than men. ○ Social phobia: Fear of being publicly humiliated or embarrassed. It can be restricted to specific situations or a variety of social situations.  Prevalence: About 4% of people worldwide experience social phobia, with slightly higher rates in women. Preparedness theory of phobias: Suggests that people are instinctively predisposed to certain fears. ○ Proposed by Martin E. P. Seligman (1971). ○ Family studies show higher concordance rates for identical twins compared to fraternal twins in specific phobias. Panic Disorder Panic disorder is characterized by sudden occurrences of multiple psychological and physiological symptoms that result in extreme terror. Agoraphobia: Fear of public places, often not the places themselves but the fear of experiencing panic symptoms while being unable to escape or get help. ○ In severe cases, individuals with agoraphobia may become unable to leave home for long periods. Hereditary Component: Studies suggest a genetic component, with 30–40% of the variance in liability for developing panic disorder attributed to genetics. Prevalence: About 13% of adults globally report having had at least one panic attack, and approximately 2% of people will have a diagnosable panic disorder in their lifetime. Generalized Anxiety Disorder (GAD) GAD is characterized by chronic, excessive worry not focused on any particular threat, often exaggerated and irrational. ○ Symptoms: Restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance. ○ Prevalence: Approximately 6% of people in the U.S. will experience GAD at some point, with women experiencing it at higher rates (8%) than men (5%). Risk Factors: ○ Both biological and psychological factors contribute to the risk of developing GAD. ○ Family studies suggest mild to modest heritability for GAD. ○ Identical twin studies suggest somewhat higher concordance rates for GAD compared to fraternal twins. ○ Biological explanation: Benzodiazepines, which stimulate the neurotransmitter GABA, can sometimes reduce GAD symptoms, indicating a role for GABA in GAD. ○ Other medications: Buspirone and antidepressants like Prozac also help some individuals with GAD. Psychological Explanations:  ○ High levels of GAD are more prevalent among those with low incomes, living in large cities, or in environments with political and economic instability. ○ Women are more likely to experience GAD due to higher rates of poverty, discrimination, and sexual/physical abuse. ○ Many people in similar conditions to those with GAD do not develop the disorder, supporting the diathesis–stress model that personal vulnerability is key to the disorder's development. Obsessive-Compulsive Disorder (OCD) Classification in DSM-5-TR: OCD is classified separately from anxiety disorders in the DSM-5-TR because it is believed to have a distinct cause and is maintained by different neural circuitry than anxiety disorders. Prevalence: ○ Approximately 28% of adults in the U.S. report experiencing obsessions or compulsions at some point in their lives. ○ However, only about 2% will develop full-blown OCD. ○ OCD is more common in women than in men, similar to other anxiety disorders. Common Obsessions and Compulsions: ○ Checking (79% of cases) ○ Ordering (57%) ○ Moral concerns (43%) ○ Contamination (26%) Genetic Factors: ○ OCD has moderate to strong genetic heritability (about 50%). ○ The heritability is even stronger for OCD traits (~70%). Brain Circuitry: ○ Brain-imaging studies have shown abnormally high activity in the cortico-striato-thalamo-cortical loop, a brain circuit involved in habitual behavior. ○ This loop connects the cortex, striatum, and thalamus. ○ Some treatments that reduce activity in this circuit (such as brain surgery or brain stimulation) have shown promise but are still being developed and tested. Post-Traumatic Stress Disorder (PTSD) Definition: PTSD is characterized by chronic physiological arousal, intrusive thoughts or images of the traumatic event, and avoidance of reminders of the trauma. Prevalence: ○ 12% of U.S. veterans of recent Iraq operations met the criteria for PTSD after deployment. ○ 7% of Americans will experience PTSD at some point in their lives.  Brain Activity in PTSD: ○ Amygdala: Increased activity (associated with fear processing and fear conditioning). ○ Medial Prefrontal Cortex: Decreased activity (important for extinguishing fear responses). ○ Hippocampus: Smaller size (linked to memory and vulnerability to PTSD). A smaller hippocampus may make some individuals more sensitive to PTSD triggers. Mood Disorders Mood disorders are mental disorders primarily characterized by disturbances in mood. They primarily manifest in two forms: depression and bipolar disorder. Major Depressive Disorder (MDD) Definition: MDD is characterized by a severely depressed mood and/or inability to experience pleasure lasting two weeks or more, with symptoms including: ○ Feelings of worthlessness, lethargy, sleep disturbances, and appetite changes. Persistent Depressive Disorder: Similar to MDD, but symptoms are less severe and last longer (at least 2 years). Double Depression: This refers to the co-occurrence of persistent depressive disorder and episodes of major depression. It involves a moderately depressed mood that persists for at least 2 years, punctuated by episodes of major depression. Seasonal Affective Disorder (SAD): Depression that occurs in a seasonal pattern, usually in the winter months due to reduced exposure to sunlight. Prevalence: ○ Around 18% of U.S. adults will experience depression at some point in their lives. ○ Major depression typically lasts about 12 weeks, but without treatment, 80% of individuals with a first depressive episode will experience recurrence. Gender Differences: ○ Depression is more common in women (22%) than in men (14%). ○ Socioeconomic factors and hormonal differences (e.g., estrogen, progesterone) may contribute to women's higher risk of depression. Additionally, postpartum depression occurs due to hormonal shifts after childbirth. Genetic Factors: ○ Depression shows moderate heritability. The heritability estimate is around 35% for less severe depression, and 50% for severe depression. Brain Activity:  ○ Depression is associated with increased activation in the amygdala, insula, and dorsal anterior cingulate cortex (ACC) (areas involved in emotional processing). ○ It also involves decreased activity in regions associated with cognitive control, such as the dorsal striatum and dorsolateral prefrontal cortex (DLPFC). Cognitive Models of Depression: ○ Cognitive Model (Aaron T. Beck): Depressed individuals tend to have distorted perceptions of their experiences, which perpetuate and maintain negative mood states. ○ Helplessness Theory: Depressed individuals often attribute negative experiences to causes that are internal (their own fault), stable (unchangeable), and global (affecting all areas of life). For example, a student who fails a math test might think it reflects their low intelligence (internal), something unchangeable (stable), and that this will result in failure in all future endeavors (global). Negative Schema: ○ Depressed individuals may have biases in: Interpretation: Tendency to interpret neutral information negatively (seeing the world through "gray glasses"). Attention: Difficulty disengaging from negative information. Memory: Better recall of negative information. Bipolar Disorder Definition: Bipolar disorder involves extreme shifts between manic episodes (high mood) and depressive episodes (low mood). Types of Bipolar Disorder: ○ Bipolar I Disorder: Characterized by at least one manic episode and one depressive episode. ○ Bipolar II Disorder: Characterized by at least one depressive episode and one hypomanic episode (a less intense form of mania). ○ Cyclothymic Disorder: A chronic, less severe form of bipolar disorder with periods of hypomania and depressive symptoms that do not meet the criteria for a full mood episode. Symptoms of Mania: ○ Elevated, expansive, or irritable mood lasting at least 1 week. ○ Other symptoms include grandiosity, decreased need for sleep, talkativeness, racing thoughts, distractibility, and impulsive behaviors (e.g., reckless spending, sexual indiscretions). Psychotic Features: Mania can sometimes lead to psychosis (hallucinations or delusions), which can result in a misdiagnosis of schizophrenia. Prevalence: ○ The lifetime risk for bipolar disorder is around 2.5%.  ○ Bipolar disorder affects both men and women at roughly the same rate. Depressive Episodes: ○ The depressive phase in bipolar disorder is clinically indistinguishable from major depressive disorder. Depressive episodes last longer than manic or hypomanic episodes for most people (about 5 months vs. 3 months). Rapid Cycling: About 10% of individuals with bipolar disorder experience rapid cycling (four or more mood episodes per year). This form of the disorder is difficult to treat effectively. Creativity and Bipolar Disorder: ○ Some researchers suggest that people with bipolar disorder may have higher levels of creativity and intellectual ability, particularly during manic episodes when they experience heightened energy and grandiosity. Famous individuals who are thought to have had bipolar disorder include Isaac Newton, Vincent van Gogh, Abraham Lincoln, Ernest Hemingway, Winston Churchill, and Theodore Roosevelt. Genetic Factors: ○ Bipolar disorder has one of the highest rates of heritability among mental disorders, with concordance rates of 40-70% for identical twins and 10% for fraternal twins. ○ The disorder is likely polygenic (resulting from the interaction of multiple genes), though identifying the specific genes involved has been difficult. ○ Evidence of pleiotropy suggests that one gene might influence susceptibility to multiple disorders, which adds complexity to understanding the genetic underpinnings of bipolar disorder. Bipolar Disorder and Schizophrenia: Shared Genetic Vulnerability Shared Genetic Vulnerability: ○ A study revealed that bipolar disorder and schizophrenia share some genetic vulnerabilities. Specifically, genes linked to both disorders affect the brain's ability to filter unnecessary information and recognize memories, as well as issues with dopamine and serotonin transmission (Huang et al., 2010). Further Genetic Findings: ○ A follow-up study of over 60,000 people identified common genetic risk factors for bipolar disorder, schizophrenia, major depression, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD). These disorders share symptoms like mood regulation issues, cognitive impairments, and social withdrawal (Cross-Disorder Group of the Psychiatric Genomics Consortium, 2013). ○ These findings shed light on the overlapping symptoms in disorders previously considered unrelated, though the biological mechanisms behind these links remain unclear. Epigenetic Changes:  ○ Epigenetic changes help explain how genetic risk factors influence the development of bipolar disorder and schizophrenia. For instance, studies of identical twins—where one twin develops bipolar disorder or schizophrenia and the other doesn't—reveal epigenetic differences, such as decreased DNA methylation at specific genetic locations. These changes are associated with brain development and the manifestation of these mental disorders (Dempster et al., 2011; Labrie et al., 2012). Stress and Environmental Factors in Bipolar Disorder Life Stressors: ○ Negative life events often precede manic or depressive episodes in individuals with bipolar disorder. Research shows that people with bipolar disorder experience significantly more negative events right before a mood episode compared to when they are in a euthymic (balanced) state (Lex et al., 2017). ○ This suggests that environmental stressors can trigger mood episodes in bipolar disorder. Family Influence: ○ People living in families with high expressed emotion—characterized by criticism, hostility, and overinvolvement—are more likely to relapse compared to those with supportive families. Expressed emotion is linked to higher relapse rates in a variety of mental disorders, not just bipolar disorder. Schizophrenia: Overview and Genetic/Epigenetic Factors Schizophrenia: ○ Schizophrenia is a psychotic disorder marked by distorted perceptions of reality, emotional disturbance, and disruptions in thought, motivation, and behavior. The DSM-5-TR requires two or more symptoms to persist for at least one month, with signs lasting at least 6 months for a diagnosis. Types of Symptoms: ○ Positive Symptoms: These are "added" experiences not normally present in the general population, such as hallucinations (false perceptions) and delusions (false, irrational beliefs). ○ Negative Symptoms: These refer to the absence of normal functioning, such as emotional/social withdrawal, apathy, and poverty of speech. ○ Disorganized Symptoms: This includes disorganized speech (incoherent verbal communication), grossly disorganized behavior (ineffective behavior or inappropriate actions), and catatonic behavior (lack of movement or excessive rigidity). ○ Cognitive Symptoms: Deficits in executive functioning, attention, and working memory, which are less obvious but important symptoms. Prevalence and Onset:  ○ Schizophrenia occurs in approximately 0.5% of the population and is more common in men. Onset typically occurs between ages 20–29. Genetic Influence: ○ Studies indicate that genetic relatedness plays a significant role in the likelihood of developing schizophrenia, with monozygotic twins (identical twins) having a 33% concordance rate, while dizygotic twins (fraternal twins) show only a 7% concordance rate. However, environmental factors also influence the onset of schizophrenia, especially prenatal and perinatal factors (Jurewicz et al., 2001; Thaker, 2002). Epigenetics and Environmental Stress: ○ Recent research suggests that environmental stressors can trigger epigenetic changes that increase susceptibility to schizophrenia. Studies also suggest that prenatal toxins could contribute to higher concordance rates in identical twins (who share the same prenatal blood supply). Brain Abnormalities: ○ Early studies found that individuals with schizophrenia had enlarged ventricles (hollow spaces in the brain) that may be indicative of brain tissue loss, especially in those with chronic or negative symptoms. However, such abnormalities are not exclusive to schizophrenia and can also be seen in people without the disorder or in individuals treated with antipsychotic medications. Family Environment: ○ Studies show that children adopted into disturbed families (those with extreme conflict, poor communication, or chaotic relationships) and with biological mothers who had schizophrenia were at a higher risk of developing the disorder. This supports the diathesis-stress model that emphasizes the interplay between genetic vulnerability and environmental stress. Autism Spectrum Disorder (ASD) ASD Overview: ○ Autism Spectrum Disorder (ASD) is characterized by persistent communication deficits and restricted and repetitive behaviors. The prevalence in the U.S. is 1 in 44 children (Maenner et al., 2021), though the rise in diagnosis may be due to increased awareness, improved screening, or other factors. ○ Boys are more frequently diagnosed with ASD than girls, with a 4:1 ratio. Theoretical Models: ○ A current theory posits that ASD arises from a combination of impaired empathizing (understanding others' mental states) and superior systematizing (understanding how objects work). Brain-imaging studies support this by showing that individuals with ASD have less activation in areas related to empathy and more activation in regions associated with basic object perception. Attention-Deficit/Hyperactivity Disorder (ADHD)  ADHD Overview: ○ ADHD is characterized by inattention and/or hyperactivity/impulsivity that significantly impairs functioning. It is diagnosed when symptoms persist for at least 6 months in two settings (e.g., home and school). ADHD can present in three ways: predominantly inattentive, predominantly hyperactive/impulsive, or a combined presentation. ○ 10% of boys and 4% of girls meet the criteria for ADHD (Polanczyk et al., 2007). Prevalence in Adults: ○ Approximately 4% of adults meet the criteria for ADHD, with higher rates of divorce and unemployment. Unfortunately, many adults do not receive treatment for ADHD, despite the disorder’s negative impact on job performance and relationships. Genetic and Brain Findings: ○ ADHD shows a strong genetic component, with a 76% heritability rate (Faraone et al., 2005). Brain imaging studies show that individuals with ADHD tend to have smaller brain volumes and abnormalities in the frontosubcortical networks responsible for attention and behavioral inhibition (Makris et al., 2009). Conduct Disorder Conduct Disorder Overview: ○ Conduct disorder is characterized by a persistent pattern of deviant behavior, including aggression toward people or animals, destruction of property, theft, deceit, and rule violations. Approximately 9% of the U.S. population reports a lifetime history of conduct disorder, with 12% of boys and 7% of girls meeting the criteria (Nock et al., 2006). ○ Risk factors include maternal smoking, exposure to abuse and family violence, affiliation with deviant peer groups, and deficits in executive functioning (e.g., decision-making, impulsivity). Symptom Criteria: ○ To meet the criteria for conduct disorder, a child must have at least three symptoms from a list of 15 defined symptoms, which fall into three broad areas: rule-breaking, theft/deceit, and aggression. Genetic and Environmental Interactions in Conduct Disorder Researchers are investigating how inherited genetic factors interact with environmental stressors (e.g., childhood adversities) to influence brain structure and function. ○ Key areas of focus include reduced activity in brain regions associated with planning and decision-making. ○ These brain changes interact with environmental factors (e.g., affiliation with deviant peers) to result in behaviors associated with conduct disorder.  Conduct disorder often co-occurs with disorders like: ○ ADHD (Attention Deficit Hyperactivity Disorder) ○ Substance use disorders ○ Antisocial personality disorder (APD) Personality Disorders (DSM-5-TR) Personality disorders are defined as enduring patterns of thinking, feeling, or relating to others, or controlling impulses that: ○ Deviate from cultural expectations ○ Cause distress or impaired functioning Personality disorders typically begin in adolescence or early adulthood and are relatively stable over time. The DSM-5-TR lists 10 specific personality disorders, grouped into three clusters: ○ Odd/eccentric ○ Dramatic/erratic ○ Anxious/inhibited Controversy: Some critics question whether having a problematic personality qualifies as a disorder, suggesting that many people can simply be difficult to interact with. ○ Approximately 15% of the U.S. population is diagnosed with a personality disorder, prompting debate about whether this constitutes a “disorder” or simply reflects difficult personality traits. In the DSM-5-TR, personality disorders are now given equal footing as full-fledged disorders, unlike in DSM-IV, where they were classified separately as Axis II disorders. Antisocial Personality Disorder (APD) APD is characterized by a pervasive pattern of disregard for and violation of the rights of others, beginning in childhood or early adolescence and continuing into adulthood. ○ Adults with APD typically have a history of conduct disorder before the age of 15. Diagnostic Criteria for APD: A diagnosis requires at least three of the following seven signs: ○ Illegal behavior ○ Deception ○ Impulsivity ○ Physical aggression ○ Recklessness ○ Irresponsibility  ○ Lack of remorse for wrongdoing Prevalence: About 3.6% of the general population has APD. The rate is three times higher in men than in women. Sociopath and Psychopath: Terms used for individuals with APD who are coldhearted, manipulative, and ruthless. ○ These individuals may appear charming or friendly, which contrasts with their underlying antisocial behaviors. Brain Research: Studies show brain abnormalities in people with APD. ○ Psychopaths show less activity in the amygdala and hippocampus (areas related to fear conditioning). ○ Criminal psychopaths, when exposed to negative emotional stimuli (e.g., words like hate or corpse), show lower brain response than non-criminals, suggesting a decreased ability to detect and respond to threats. Suicide and Nonsuicidal Self-Injury (NSSI) Suicide: Suicide (intentional self-inflicted death) is the 10th leading cause of death in the U.S. and the 2nd leading cause among people aged 15 to 24. ○ Suicide causes more deaths annually in the U.S. than HIV/AIDS (5 times more) and homicide (2 times more). Demographic Differences: ○ Around 80% of suicides worldwide are committed by men. ○ White people account for 88% of all suicides in the U.S. (much higher than other racial and ethnic groups). ○ The reasons for these significant sociodemographic differences are not fully understood. Nonfatal Suicide Attempts: ○ Nonfatal suicide attempts are much more common than suicides. ○ In the U.S.: 15% of adults have seriously considered suicide at some point in their lives. 5% have made a plan. 5% have actually made a suicide attempt. Suicidal Thoughts and Behaviors in Adolescence: ○ Rates of suicidal thoughts and behaviors increase dramatically between ages 12-18, leveling off in early adulthood. ○ A national survey of U.S. adolescents found that: Suicidal thoughts and behaviors are virtually nonexistent before age 10. The rate of suicide behaviors rises sharply during adolescence and peaks during young adulthood. Risk Factors for Suicidal Behavior:  ○ 90% of individuals who die by suicide have at least one mental disorder. ○ Significant negative life events, such as physical or sexual assault, increase suicide risk. ○ Severe medical problems are also linked to higher suicide risk. Nonsuicidal Self-Injury (NSSI): NSSI refers to deliberate destruction of body tissue without the intent to die. ○ It is often used to cope with emotional distress. ○ 15-20% of adolescents and 3-6% of adults engage in NSSI at some point in their lives. Rates of NSSI: ○ NSSI is more prevalent among sexual minorities (30%) and gender minorities (47%) compared to the general population. Cultural Context: ○ In some cultures, self-cutting or scarification is a socially accepted practice or even a rite of passage. ○ However, in cultures where self-injury is not socially accepted, people may engage in NSSI to reduce emotional pain or to seek help. NSSI and Emotional Regulation: ○ People who engage in NSSI often experience strong emotional and physiological responses to negative events. ○ They may perceive these responses as intolerable, and use NSSI to diminish emotional intensity (Nock, 2009). ○ NSSI may also serve as a way to communicate distress or elicit help from others (Nock, 2010). DSM (1952): Classification system Describes the features used to diagnose each recognized mental disorder Indicates how the disorder can be distinguished from other similar problems DSM II (1968): First revision Provides common language for talking about disorders DSM III (1980) and DSM IV (1994) Moved from vague disorder descriptions Provided detailed list of symptoms/diagnostic criteria for more than 200 disorders Improved reliability in diagnosis of mental disorders What instruments are most predominantly used? DSM V TR (revised every 5 years) (american psychiatric association are in charge of revising) If symptoms are met for 2 weeks then it is met to as a Diagnosis ICD 11 CM Important teaching point Has codes to it Substance use disorder (functioning) Substance abuse (combat stress, coping strategy) Does the dsmv provide treatment? no just provides diagnostic criteria Physiognomy Mental disorders that could be diagnosed from facial features. Don't worry about Dates for the DSM Comorbidity (question on this) Graph of lifetime prevalence of dsm across WHO regions (don't need to know) WHO- main teaching point Culture relating to disorders don't need to know 2 questions on posed models of how disorders develop (slide ?) (Picture model) What is a diathesis-stress model? Question on test (something in the environment is going to trigger, particular stress to manifest the biological predisposition disorder ) 5 question on RDoC Question on sodium lactate Agoraphobic comorbid with panic attacks (most prevalent of anxiety disorders) Small handful of questions on neurotransmitters (associated with depression, etc) Prevalence and Treatment of Mental Disorders Mental Disorder Statistics in the U.S.: ○ 46.4% of people in the U.S. will experience a mental disorder at some point in their lifetime. ○ 26.2% of people experience at least one mental disorder in a given year. ○ Only about 18% of individuals with a mental disorder in a 12-month period receive treatment. ○ Treatment rates are higher for individuals with more severe mental disorders (e.g., 40% of those with serious mental disorders receive treatment). ○ Most people with mental disorders (including severe ones) do not receive treatment, with an average delay of over a decade between onset and first treatment. ○ The average cost of treating depression is nearly $10,000 per person annually, plus nearly $3,000 in work-loss costs. Reasons People Avoid Treatment 1. Unawareness of Mental Disorder: ○ 45% of individuals with a mental disorder who don't seek treatment don’t realize they need it. ○ Mental disorders are often not perceived as seriously as physical illnesses since their origins are hidden (e.g., not diagnosable by a blood test). 2. Beliefs and Circumstances: ○ 72.6% of people with a mental disorder don’t seek treatment because they believe they should handle it on their own. ○ 42.2% drop out of treatment prematurely for the same reason. ○ Other reasons for not seeking treatment include: Belief that the problem isn’t severe (16.9%). Belief that treatment would be ineffective (16.4%). Perceived stigma from others (9.1%). 3. Structural Barriers: ○ Finding a suitable therapist can be challenging due to the variety of treatment types. ○ Barriers include: Cost (15.3% cannot afford treatment). Lack of clinician availability (12.8%). Inconvenience (9.8%).  Transportation issues (5.7%). ○ Less than 40% of individuals with a mental disorder receive minimally adequate treatment, and only 15.3% of those with serious mental illness receive it. ○ Inadequate treatment is especially common in younger individuals, Black individuals, those in the southern U.S., and those with psychotic disorders. Approaches to Treatment 1. Types of Treatments: ○ Treatments can be divided into: Psychological treatments: Involves interaction with a clinician to use the environment to change behavior and brain function. Biological treatments: Involves drugs, surgery, or other direct interventions to treat the brain. 2. Psychological Treatment (Psychotherapy): ○ Over 500 different types of psychotherapy exist. ○ Eclectic Psychotherapy: Combines techniques from different types of therapy based on the client's needs. 3. Types of Psychotherapy: ○ Psychodynamic Psychotherapy: Based on Freud’s psychoanalysis, it explores childhood events and repressed feelings to develop insight into psychological issues. Psychoanalysis focuses on unconscious thoughts, with clients encouraged to express free associations. Goal: Develop insight into unconscious conflicts. Modern form: Interpersonal Psychotherapy (IPT) focuses on improving interpersonal relationships. ○ Person-Centered Therapy (humanistic): Developed by Carl Rogers, this therapy assumes individuals have a natural growth tendency. The therapist demonstrates three qualities: Congruence: Openness and honesty. Empathy: Understanding the client's experience. Unconditional Positive Regard: A nonjudgmental, accepting environment. ○ Gestalt Therapy (extisentialists): Developed by Fritz Perls, focuses on the present moment and helps clients take responsibility for their thoughts and behaviors. Techniques include: Focusing: Shifting attention to current experiences. Empty-chair technique: Role-playing to address relationship issues. ○ Behavioral Therapy: Assumes disordered behavior is learned and treats it by changing maladaptive behaviors using: Operant Conditioning (reinforcement and punishment). Classical Conditioning (extinction).  Token economy: Giving tokens for desired behaviors. Exposure Therapy: Repeatedly confronting an anxiety-provoking stimulus. ○ Cognitive Therapy: Focuses on identifying and correcting distorted thinking. Aaron Beck's approach emphasizes: Cognitive restructuring: Replacing negative beliefs with more realistic ones. Mindfulness meditation: Being present and aware of one’s thoughts, feelings, and sensations. ○ Cognitive Behavioral Therapy (CBT): A combination of cognitive and behavioral strategies that are: Problem-focused: Focused on specific issues. Action-oriented: Encouraging client participation in exercises to manage symptoms. Proven effective for depression, anxiety disorders, and PTSD. ○ Family Therapy: Focuses on the family as the client and can be particularly effective when adolescents are struggling. 4. Group Therapy: ○ Involves multiple participants working on individual issues in a group setting. ○ The therapist acts as a facilitator, and group therapy can be equally effective as individual therapy. ○ Common types: Self-help and support groups (e.g., Alcoholics Anonymous). Biological Treatments 1. Psychopharmacology: ○ Antipsychotic medications: Treat schizophrenia by blocking dopamine receptors (e.g., chlorpromazine). Newer antipsychotics, such as clozapine and risperidone, affect both dopamine and serotonin systems, treating both positive and negative symptoms of schizophrenia. Tardive dyskinesia: A side effect involving involuntary movements. ○ Antianxiety Medications: Include benzodiazepines (e.g., diazepam, lorazepam) which enhance GABA’s calming effects. These drugs are effective but may cause addiction, tolerance, and withdrawal symptoms. Buspirone is an alternative for generalized anxiety disorder. ○ Antidepressants: Treat mood disorders, especially SSRIs and SNRIs, which increase serotonin and norepinephrine in the brain. 2. Antidepressants: ○ SSRIs (Selective Serotonin Reuptake Inhibitors): Increase serotonin levels. ○ SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors): Increase both serotonin and norepinephrine.  ○ Tricyclic Antidepressants and MAOIs are older, less commonly used options due to side effects. 3. Other Medications: ○ Mood stabilizers: Used to treat bipolar disorder (e.g., lithium). ○ Stimulants: Used to treat ADHD (e.g., methylphenidate). 1. Early Antidepressants: ○ Iproniazid (1950s) was originally used to treat tuberculosis but was found to elevate mood. Monoamine Oxidase Inhibitors (MAOIs): Prevent monoamine oxidase (enzyme) from breaking down neurotransmitters (norepinephrine, serotonin, dopamine). ○ Tricyclic Antidepressants: Including imipramine (Tofranil) and amitriptyline (Elavil), introduced in the 1950s. These drugs block the reuptake of norepinephrine and serotonin, increasing neurotransmitter levels in the synaptic space. Side Effects: Increased blood pressure, constipation, difficulty urinating, blurred vision, and racing heart. ○ Both classes (MAOIs and tricyclics) are used sparingly due to significant side effects. 2. Selective Serotonin Reuptake Inhibitors (SSRIs): ○ Examples: fluoxetine (Prozac), citalopram (Celexa), paroxetine (Paxil). ○ SSRIs block the reuptake of serotonin in the brain, making more serotonin available in the synaptic space. ○ Developed based on the hypothesis that low serotonin levels contribute to depression. ○ SSRIs are more selective than tricyclics, acting primarily on serotonin, whereas tricyclics affect both serotonin and norepinephrine. 3. Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs): ○ Example: venlafaxine (Effexor). ○ SNRIs act on both serotonin and norepinephrine, offering a different approach from SSRIs. 4. Norepinephrine and Dopamine Reuptake Inhibitors: ○ Example: bupropion (Wellbutrin). ○ This class targets norepinephrine and dopamine, providing an alternative for patients who do not respond to SSRIs or SNRIs. 5. Bipolar Disorder Treatment: ○ Antidepressants are not typically used for bipolar disorder (characterized by manic and depressive episodes). ○ Mood Stabilizers: Lithium and valproate are commonly used. Lithium is the most effective mood stabilizer but requires regular monitoring of blood levels due to possible side effects (kidney and thyroid issues).  Lithium can sometimes be combined with traditional antidepressants for treatment-resistant depression. 6. Alternative Treatments for Mental Health: ○ Natural Supplements: Omega-3 fatty acids (fish oils), SAM-e, inositol, and kava are marketed as having positive psychological effects, though evidence remains mixed. Omega-3s have been linked to lower rates of depression and suicide. ○ Phototherapy: Exposure to bright light can treat Seasonal Affective Disorder (SAD), providing a non-drug treatment option. Electroconvulsive Therapy (ECT) and Other Neurological Treatments 1. Electroconvulsive Therapy (ECT): ○ ECT involves inducing a brief seizure by delivering an electrical shock to the brain. ○ It is primarily used for severe depression and some cases of bipolar disorder. ○ Side Effects: Impaired short-term memory (usually improves after treatment), headaches, and muscle aches. ○ Administered under general anesthesia to reduce side effects. 2. Transcranial Magnetic Stimulation (TMS): ○ TMS uses a powerful pulsed magnet placed over the scalp to alter neuronal activity. ○ The treatment targets areas of the brain implicated in depression, such as the prefrontal cortex. ○ Side Effects: Minimal (headaches and small risk of seizures). ○ Effectiveness: Proven effective for patients who haven’t responded to medication, particularly for depression. 3. Deep Brain Stimulation (DBS): ○ A device is implanted to deliver electrical stimulation to specific areas of the brain. ○ Used for severe OCD and also has shown promise for depression and Parkinson's disease. 4. Psychosurgery: ○ Psychosurgery involves the surgical destruction of specific brain areas. ○ The controversial practice started with lobotomies in the 1930s but ended with the advent of antipsychotic drugs. ○ Modern uses: For severe, treatment-resistant OCD (cingulotomy and anterior capsulotomy). ○ Cingulotomy: Destroys part of the corpus callosum and the cingulate gyrus. ○ Anterior capsulotomy: Lesions created to disrupt pathways between the caudate nucleus and the putamen. Treatment Considerations and Effectiveness 1. Placebo Effects: ○ The placebo effect can cause significant improvement in individuals with anxiety, depression, and other conditions, simply due to the belief that they are receiving treatment. ○ Nonspecific treatment effects: These include benefits from simply knowing you are receiving treatment, even if it’s not active. 2. Natural Improvement: ○ Symptoms of depression may naturally improve over time, which can create an illusion that treatment caused the improvement. 3. R esearch Methods for Treatment Evaluation: ○ Randomized controlled trials (RCTs) are essential to determine whether a treatment effectively decreases symptoms. ○ Double-blind studies: Both participants and researchers are unaware of which treatment is being administered, to avoid bias. Ethical and Practical Considerations in Treatment 1. Iatrogenic Illness: ○ Iatrogenic illnesses refer to conditions caused by medical or therapeutic treatments. ○ Clinicians must be mindful of this risk and monitor patients for adverse effects. 2. Ethical Standards: ○ Therapists must adhere to ethical principles, which include: 1. Striving to benefit clients and avoiding harm. 2. Establishing trustful relationships. 3. Promoting honesty and accuracy in treatment. 4. Ensuring fairness and avoiding biases. 5. Respecting the dignity of all individuals. 3. Empirically Supported Treatments: ○ Psychological treatments are evaluated for their effectiveness through research, with some therapies showing better outcomes than medications for specific disorders. ○ The American Psychological Association (APA) developed criteria for empirically validated treatments, categorizing them into well-established and probably efficacious treatments. REFER TO CHARTS AND GRAPHS ON SLIDESHOWS