PSY 183 Introduction to Psychopathology Lecture Notes (2024) PDF

Introduction to Psychopathology Alan J. Fridlund, Ph.D. NOTICE: These Lecture Notes © Copyright 2014, 2019, 2020, 2021, 2023, 2024, by Alan J. Fridlund, Ph.D. All Rights Reserved. For-Profit Reproduction in Whole or In Part Without Written Permission of the Instructor Is a Violatio...

Introduction to Psychopathology Alan J. Fridlund, Ph.D. NOTICE: These Lecture Notes © Copyright 2014, 2019, 2020, 2021, 2023, 2024, by Alan J. Fridlund, Ph.D. All Rights Reserved. For-Profit Reproduction in Whole or In Part Without Written Permission of the Instructor Is a Violation of U.C. Regulations and the Digital Millenium Copyright Act and Is Expressly Prohibited.  Notice All Course materials (class lectures and discussions, handouts, examinations, Web materials) and the intellectual content of the Course itself are protected by United States Federal Copyright Law, and the California Civil Code. UC Policy 102.23 expressly prohibits students (and all other persons) from recording lectures or discussions and from distributing or selling lectures notes and all other course materials without the prior written permission of the Instructor (See http://policy.ucop.edu/doc/2710530/PACAOS-100). Students are permitted to make notes solely for their own private educational use. Exceptions to accommodate students with disabilities may be granted with appropriate documentation. To be clear, in this class students are forbidden from completing study guides and selling them to any person or organization. The text has been approved by UC General Counsel. You are granted permission in Psych 183 to download and retain personal copies of these slides solely for your own use. History and Concepts in Psychopathology (Mental Disorders) Why Studying Mental Disorders Is Important Mental Disorders: ⚫ are common and can affect anyone. ⚫ can be disabling and stigmatizing for sufferers. ⚫ can result in disruptions to families. ⚫ can result in lost lives due to accidents and suicide. ⚫ can be costly to treat.  1- Year Prevalence* of Mental Disorders Among U.S. Adults (18+) (Pre-Covid)** * * Don’t worry – You won’t need to know any percentages for the Exams. Major Substance Use Social Anxiety Depression Disorder Disorder 10 % 9% 8% Posttraumatic Generalized Panic Stress Disorder Anxiety Disorder Disorder 4% 3% 3% Prevalence is the number of cases of a disorder found within a specified time interval; one-year prevalence is the average % of people who have a certain disorder within one year. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2671413; https://www.nimh.nih.gov/health/statistics/ ; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408274/ ; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610617/ ; https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd#part_2609 ; https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd ; https://www.nimh.nih.gov/health/statistics/panic-disorder  Lifetime Prevalence* of Mental Disorders Among U.S. Adults (18+) (Pre-Covid)* Major Substance Use Social Anxiety Depression Disorder Disorder 20% 18% 13% Posttraumatic Generalized Panic Stress Disorder Anxiety Disorder Disorder 7% 6% 5% * Prevalence is the number of cases of a disorder found within a specified time interval; Lifetime prevalence is the % of people who have a certain disorder within their lifetimes. * Sources same as previous slide.  Covid and Mental Health (2021)* ⚫ 1 in 4 adults (18+), and 1 in 3 adults 18-25, had a diagnosable mental disorder in 2021, roughly 25-30% greater than pre-Covid levels. ⚫ People with pre-existing mental health problems suffered more during Covid, due to social isolation, loss of outlets like recreation, and unavailability of treatment during lockdowns. ⚫ 70% of those with mental disorders considered themselves to be recovering. ⚫ BUT the mental health of young people was affected by Covid far more dramatically, despite less physical risk from Covid itself. * https://www.samhsa.gov/newsroom/press-announcements/20230104/samhsa- announces-nsduh-results-detailing-mental-illness-substance-use-levels-2021  Mental Health Decline in Youth (2021 CDC HS Student Survey/ 2021 DHHS SAMHSA* Survey) ⚫ 1 in 5 adolescents had a Major Depressive Episode in 2021. ⚫ 30% of teenage females said they seriously considered suicide, double the rate of teenage males, and up 60% from 10 years ago. ⚫ Almost 20% of young females reported experiencing rape or other sexual violence in past year. ⚫ Almost 50% of LGBTQ students said they had seriously considered suicide. ⚫ These trends predated Covid, but were worsened by Covid- related social isolation and reliance on social media. ⚫ Compared to past 30 years of surveys, “We’ve never seen this kind of devastating, consistent findings” – Director of CDC’s Director of Adolescent and School Health Division. *U. S. Dept of Health and Human Services Substance Abuse and Mental Health Services Administration, www.samsha.gov  College Mental Health ⚫ The mental health of college students has declined steadily over at least the past decade. ⚫ The #’s of college students seeking help with mental health has increased 40% from 2009-2015. ⚫ College counseling centers have had to double or triple in size over the past decade, and the number of patients seen by the average college counselor is now 120. ⚫ Matters worsened with Covid. During the 2020-21 school year, surveys showed that 60-75% of college students had a diagnosable mental disorder. ⚫ Almost ¾ of college students reported moderate or severe psychological distress. ⚫ In a Fall 2022 survey, more than 40% of currently enrolled college students considered dropping out, citing “personal distress and mental health.” ⚫ According to the American Council on Education, student mental health is now the most pressing issue for college presidents. What Explains the Mental Health Decline in Young People? Many Possible Contributors: ⚫ Increased social media use, which because of social comparison, undermines self-esteem (especially among young females). ⚫ “Climate anxiety” from repeated apocalyptic warnings about the planet. ⚫ Overprotective “helicopter” parents who do not allow their children to compete, fail, or endure disappointment. ⚫ Educational systems that do away with competition, honors, etc., leaving students ill-prepared for college. ⚫ Among some college students, family and self-imposed pressures to attend college instead of alternatives. ⚫ Over-pathologizing of normal reactions, e.g. boredom or loneliness is considered “depression.” ⚫ Decreased stigma surrounding mental disorders, with some social–media influencers touting (and identifying with) their own diagnoses, medications, and therapies. Mental Health Is Costly Who Is Involved in Mental Health?  Mental Health Practitioners (Involved in Direct Patient Care) ⚫ Psychiatrists (M.D.’s) ⚫ Clinical Psychologists (Ph.D.’s) ⚫ Social Workers (M.S.W.’s / D.S.W.’s) ⚫ Psychiatric Nurses (R.N.’s) ⚫ Marriage & Family Therapists (M.F.T.’s) ⚫ Psych Technicians ⚫ MH Intake Workers, Staff ⚫ Primary Care Practitioner M.D.’s (PCP’s), Physician Assistants (P.A.’s), and Nurse Practitioners (N.P.’s) Mental Health Researchers ⚫ Psychiatrists ⚫ Clinical Psychologists ⚫ Neuroscientists ⚫ Endocrinologists ⚫ Psychopharmacologists ⚫ Geneticists ⚫ Epidemiologists ⚫ Clinical Trial Managers ⚫ Biostatisticians / Epidemiologists  Mental Health Advocacy Groups Some Examples: ⚫ National Alliance on Mental Illness (NAMI): local chapters provide information, support groups; national organization advocates for people with mental disorders ⚫ Active Minds: promotes reducing stigma about mental disorders among college students ⚫ Trevor Project: 24/7 hotline for at-risk LGBTQ youth. ⚫ Brain and Behavior Research Foundation: fundraising for mental-disorder research ⚫ Bazelon Center for Mental Health Law: protection and advancement of the rights of adults and children with mental disorders or developmental disabilities Mental Disorders Throughout History Early Views of Psychopathology Trephination  Early Views of Psychopathology (~400 BCE) “Humorism” (Hippocrates) Liver Gall Bladder Spleen Lungs  Early Views of Psychopathology (Middle Ages ~500-1400 AD) Recovery from Yersinia pestis infection (bubonic plague) Bubonic plague sufferers outside temple Oriental rat flea infected withYersinia pestis bacterium Early Views of Psychopathology (Middle Ages) Demonic Possession  Early Views of Psychopathology (Middle Ages) Malleus Maleficarum (“Witches’ Hammer”) [Heinrich Kramer, 1486] On Women and Witchery: “Just as through the first defect in their [women’s] intelligence they are more prone to abjure [renounce] the faith; so through their second defect of inordinate passions … they inflict various vengeances through witchcraft. Wherefore it is no wonder that so great a number of witches exist in this sex.” Early Views of Psychopathology (Middle Ages) Diagnosing Witches Early Views of Psychopathology (Middle Ages) Treating Witches: Exorcism  Early Views of Psychopathology (Middle Ages) Treating Witches: Burning  Early Views of Psychopathology (~1700-1870) Mental Illness as Evolutionary Regression: “Mongolism” (Down Syndrome, now known as “Trisomy-21”)  Early Views of Psychopathology (~1700-1850) Mental Illness as Evolutionary Regression: Mentally Ill as Animals  Early Views of Psychopathology (~1700-1850) Mentally Ill Housed as Animals  Early Views of Psychopathology Francisco Goya’s Madhouse (c. 1810) Early Views of Psychopathology (~1700-1850) Treatment By Restraint “Moral Treatment”, or “Unchaining the Insane” (~1800-1900) Philippe Pinel (1745-1826) The “State Hospital” Era (~1900-1960)  The State Hospital Era: Pyrotherapy (1930-40’s) Julius Wagner-Jauregg (1857-1940) Transfusing a General Paresis Patient from a Malarial Patient Nobel Prize in Medicine 1917 The Treatment of Dementia Paralytica by Malaria Inoculation The State Hospital Era: Pyrotherapy (1930-40’s) “Fever Chamber”  The State Hospital Era: Insulin Coma Therapy (1930-40’s)  The State Hospital Era: Metrazol Shock Therapy (1930’s-40’s) The State Hospital Era and Beyond: Electroconvulsive Therapy (ECT) (1940’s-)  The State Hospital Era: Prefrontal Lobotomy (1940’s) Prefrontal area Freeman and Watt’s “Transorbital (Icepick) Leucotomy”  The State Hospital Era: The “Thorazine Era” (1950-60s) ⚫ Thorazine (Chlorpromazine) – first “major tranquilizer” ⚫ Synthesized in 1948 as an antihistamine, began use as an aid to anesthesia in France because it produced “relaxation without sedation” ⚫ In 1952, tried with great success on hospitalized psychotic patients in Parisian hospitals; reduced agitation in all patients, and hallucinations and delusions in psychotic ones. ⚫ Quickly became the most frequently prescribed medication in psychiatric hospitals world-wide; often called a “chemical strait-jacket,” it enabled patients to be maintained as outpatients who would otherwise have required continued hospitalization.  Deinstitutionalization (1960 – Present Day) Cal State University Channel Islands (est 2003) “The Hotel California”? Camarillo State Mental Hospital Camarillo, CA (1936-1997)  Deinstitutionalization* (1960 – Present Day) * Moving severely mentally ill people out of state hospitals and closing those hospitals. ⚫ Factors: – Introduction of Thorazine and other meds. – Over-promising by psychiatric profession regarding effectiveness of medications. – Cost impact of civil rights lawsuits on state hospitals. – Over-selling of “community mental health” as cost-cutting solution to state hospitals. ⚫ Results: – Massive discharge of severely mentally ill patients to unclear destinations. – Insufficient budgets allotted to establish community mental health facilities. – Flooding of streets with mental ill homeless who have no access to treatment and are often victimized. – These days, because of a shortage of psychiatric hospitals, mentally ill people who create disturbances are often sent to jail Deinstitutionalization (1960 – Present Day) How Is Psychopathology Understood Today?  Contemporary Views of Psychopathology: Psychodynamic Views Franz Anton Mesmer Jean-Martin Charcot Sigmund Freud Contemporary Views of Psychopathology: Behavioral Views Little Albert Watson & Rayner (1920) Contemporary Views of Psychopathology: Biological Views “Kill or Cure” – Optional Video on Canvas End