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Psychopathology
- 1. Psychopathologies and Their Treatments
- 2. Psychopathology • Pathologyfrom ‘pathos’ = suffering, and ‘logos’ = study: – The study of the essential nature of disease. • Disease: – Dis-ease: Not at ease, something that impairs functioning. • Abnormal: – Away from (‘ab-’) or deviating from, the normal or average.
- 3. Psychopathology • Abnormalbehaviour: – Behaviour that is other than normal or markedly irregular. – Not necessarily statistically abnormal, often just painful or involving suffering. • Psychopathology: – Study of abnormal behaviour. – Study of the psychological and behavioural dysfunction, distress, and disability. – Such dysfunction, distress, or disability itself.
- 4. Psychopathology Sources •Somatogenic (soma=body and genesis=beginning)—from the body. – e.g., general paresis as a result of syphilis, disordered brain chemistry • Psychogenic (psyche=mental and genesis=beginning)—from the mind. – e.g., hysterical blindness, glove anesthesia
- 5. Structuring Mental Disorders UNDERLYING SYMPTOMS PATHOLOGY Primarily Organic Primarily Mental Somatogenic Psychogenic Measles, tuberculosis, influenza, common cold. General paresis, possibly schizophrenia and bipolar affective disorders. Psychophysiological disorders such as glove anesthesia, hysterical blindness. Anxiety disorders such as phobias, depression, dissociative disorders.
- 6. Psychopathology Pathology Model • Mental disorders can be analyzed as for any disease. • Any disease is a collection of symptoms that together form a syndrome. – Influenza is a syndrome with symptoms such as runny nose, cough, fever, muscles aches. – SARS (sudden acute respiratory syndrome) is a syndrome with symptoms of sudden onset, high fever, respiratory difficulty. – Bird flu is a syndrome with symptoms such as runny nose and conjunctivitis (inflamed eyes). • Assumes an underlying pathology that is responsible for the disorder.
- 7. Psychopathology Models FourMain Perspectives Biomedical View Theoretical Cause of Abnormality Theoretical Cure A process similar to that underlying physical illness. Somatogenic causes (physical factors). Medication or surgery by psychiatrist or neurosurgeon, e.g., antidepressants, electro-convulsive therapy (ECT), insulin shock therapy, surgery.
- 8. Pathology Models FourMain Perspectives Psychodynamic View Theoretical Cause of Abnormality Theoretical Cure Internal, psychological, unconscious conflict (psychological factors). Psychotherapy to develop insights into underlying unconscious conflicts.
- 9. Pathology Models FourMain Perspectives Behavioural View Theoretical Cause of Abnormality Theoretical Cure Maladaptive learning or faulty habits and thoughts (cognitive-behavioural factors). Learning new responses and thoughts. Usually treated by cognitive or behaviour therapists.
- 10. Pathology Models FourMain Perspectives Diathesis- Stress View Theoretical Cause of Abnormality Theoretical Cure Predisposition based on genes or early learning plus excessive stress prior to development of the disorder. Reduction of stress and learning new coping mechanisms for times stress arises in the future.
- 11. DSM-IV • Diagnosticand Statistical Manual – IV. • A system of classification for mental disorders, widely used in North America. • Lays out each disorder as a specific syndrome (collection of symptoms) that serve as identifying features for the physician and clinician.
- 12. DSM-IV Classification Scheme: Five Major Axes • Each mental disorder is classified on five major axes (categories). • Presents a full picture of the individual and their disorder. • Includes not only symptoms but other contributing factors, including mental retardation, physical symptoms, life circumstances, and evaluation of stress.
- 13. DSM-IV Classification Scheme: Five Major Axes • AXIS I: Major Psychological Disorders – Description of symptoms of major clinical disorders • AXIS II: Mental Retardation & Personality Disorders – Antisocial personality disorder, borderline personality disorder, paranoid personality disorder. • AXIS III: Accompanying Physical Disorders – Cancer, epilepsy, obesity, Parkinson’s disease, Alzheimer’s disease. • AXIS IV: Source and Severity of Stress – Unemployment, divorce, legal problems, homelessness, poverty, stressful personal relations.. • AXIS V: Assessment of Functioning – Global Assessment of Functioning (GAF): Uses a scale from 1 to 100 with 1 being very poor functioning, harmful to self, and 100 superior functioning.
- 14. DSM-IV Classification Scheme: A Single Individual with Alcoholism • AXIS I: Major Psychological Disorders – Major depressive disorder. – Alcohol dependence. • AXIS II: Personality Disorders – Personality characteristics that impair normal functioning and involve psychological stress (e.g., Antisocial personality disorder, Borderline personality disorder). • AXIS III: Accompanying Physical Disorders – Alcoholic cirrhosis of the liver. • AXIS IV: Source and Severity of Stress – Divorce, loss of job—severe stress. • AXIS V: Assessment of Functioning – Global Assessment of Functioning (GAF) is 30, which indicates a serious impairment of functioning.
- 15. AXIS I MajorPsychological Disorders • Disorders of Infancy, Childhood, and Adolescence – Speech disorders, phobias, hyperactivity, autism, delayed development. • Organic Mental Disorders – Result from deterioration of the brain (e.g., Altzheimer’s disease, exposure to toxic metals, chemicals). • Substance Abuse Disorders – Problems that result from abuse of drugs such as alcohol, street drugs, or medication.
- 16. AXIS I MajorPsychological Disorders • Schizophrenia (Psychoses) – Characterized by hallucinations, bizarre perceptions, loss of touch with reality, illogical thoughts. • Mood Disorders (Disorders of Affect) – Characterized by extremes of emotional state. – Severe depression (Depression) or excessive elation (Manic disorder), or alternation between the two (Bipolar disorder). – Hypermania vs hypomania. • Anxiety Disorders – Repetitive persistent thoughts accompanied by ritualistic behaviour (Obsessive-compulsive disorder), phobias, attacks of extreme anxiety.
- 17. AXIS I MajorPsychological Disorders • Somatoform Disorders – Characteristized by physical symptoms (e.g.,blindness, pain, paralysis) that have no physical cause (e.g., Glove anesthesia). • Factitious Disorders – Characterized by fake mental or physical disorders (e.g., Munchausen syndrome—frequent hospitalization or surgery for nonexistent illness). • Dissociative Disorders – Person becomes detached from identity (e.g., Amnesia, Dissociative Identity Disorder).
- 18. AXIS I MajorPsychological Disorders • Sexual Disorders – Disorders of sexual functioning (e.g., fetishes, Impotence, Sexual Identity Disorders). • Eating Disorders – Characterized by disordered eating patterns (e.g., Anorexia, Bulimia). • Sleep Disorders – Characterized by sleeping problems (e.g., Insomnia, Sleep Walking, Narcolepsy).
- 19. AXIS I MajorPsychological Disorders • Impulse Control Disorders – Characterized by inability to control impulses (e.g., fire setting, stealing, gambling). • Adjustment Disorders – Characterized by difficulty adjusting to significant life events such as death of a parent or child, job loss, family problems.
- 20. Frequency of MostCommon Mental Disorders 0 5 10 15 20 Eating disorders Schizophrenic disorders Personality disorders Mood disorders Anxiety disorders Substance abuse Percentage of Population
- 21. Treatment of Psychopathologies • Biological Therapies (requires an MD) – Drug Therapies – Psychosurgery – Electroconvulsive Therapy (ECT) • Psychotherapy – Psychoanalysis & Psychodynamic Therapies – Behaviour Therapy – Cognitive Therapy – Humanistic Therapy
- 22. Treatment of Psychopathologies Who Can Help? • Psychiatrist (MD with specialist training mental disorders). • Psychoanalyst (MD, PhD, PsyD): Uses the psychodynamic approach. Not necessarily an MD. • Clinical Psychologist (PhD, PsyD): Some or all therapies except drug interventions. • Psychiatric social worker (MSW): Offering individual and family therapy, counselling, and community work. • School psychologist (MA,PhD, EdD): Counselling and educational testing related to educational issues. • Counselling psychologist (MA, PhD, EdD): Personal and vocational counselling, therapy, rehabilitiation. • Psychiatric nurse (RN): Counselling, therapy, care of hospitalized mental patients. • Paraprofessional (No specific qualifications): Provides support, may lead groups, offer workshops.
- 23. How the DrugsWork: Synaptic Transmission
- 24. How the DrugsWork • Agonists: Increase the effect of neurotransmitters. • Antagonists: Decrease the effect of neurotransmitters.
- 25. Drug Therapies: HowThey Work • Some drugs stimulate or inhibit the production of one neurotransmitter (e.g., dopamine), therefore affect only one set of neurons. – May stimulate constant production (e.g., black widow spider venom stimulates acetylcholine production leading to constant cramping). – May inhibit production (e.g., botulism prevents release of acetylcholine, leads to paralysis).
- 26. Drug Therapies: HowThey Work • Some affect postsynaptic receptor molecules by duplicating the effect of transmitters. – May stimulate postsynaptic neurons (e.g., nicotine stimulates acetylcholine receptors in the brain that create a pleasurable sensation when they fire). – May inhibit postsynaptic neurons (e.g., curare turns off acetylcholine receptors in muscle cells, leading to paralysis.
- 27. Drug Therapies: HowThey Work • Blocks receptor molecules. – Neurotransmitter is produced but is not taken up by the postsynaptic neuron (e.g., antisychotic medications). • Interfere with the reuptake of transmitters in the presynaptic neuron after their release. – Increases effect of the transmitter substance (e.g., cocaine, speed). – Effect is usually brief.
- 28. Drug Therapies: Impacton Behaviour • Sedatives – Have depressive effect on the body, causing relaxation or even unconsciousness. – Several families: barbiturates (downers), tranquilizers (benzodiazepines), alcohol. – Used to relieve anxiety, create relaxation, for sleep. – Some very addicting and line between enough and too much is very narrow. – Very dangerous when combined because effects are more than doubled.
- 29. Drug Therapies: Impacton Behaviour • Stimulants – Stimulate nervous system and may have pleasurable effects. – Can be addicting because of this. – Cocaine and amphetamines are in this class, blocking reuptake of dopamine and prolonging its effects – Used to treat narcolepsy and some forms of hyperactivity. – Excessive use produces symptoms of serious mental illness.
- 30. Drug Therapies: Impacton Behaviour • Hallucinogens – Alter sensations, perceptions, emotions, thinking, self-awareness (e.g., marijuana, LSD, magic mushrooms). – Effects are unpredictable. – Seem to block release of serotonin, which is present when we sleep and is involved in dreaming. – Results in ‘dreaming’ while awake. – Has occasionally been used in therapy.
- 31. Drug Therapies: Impacton Behaviour • Antipsychotics and antidepressants – Dopamine blockers can relieve psychotic symptoms (e.g.,chlorpromazine). – Antidepressants (e.g., Prozac) can relieve depression. • Relieves feelings of extreme sadness and can prevent suicide attempts.
- 32. Using the PathologyModel: Exploring a Disorder • Syndrome – Signs and Symptoms. • Proximate Causes (Underlying Pathology): – What is out of order? – Helps define treatment. • Ultimate Causes – Diathesis (predisposition) – Stress
- 33. One Major Psychological Disorder: Schizophrenia • Syndrome – Disordered cognitions. – Withdrawal from others. – Hallucinations. – Delusions. – Emotional reactivity. – Disordered behaviour related to symptoms above.
- 34. Characteristics of Schizophrenias • Syndrome – Disordered cognition • Unable to maintain logical flow of thoughts • Difficulty in repressing irrelevant thoughts. – Withdrawal from others • Fewer opportunities to do reality checking. – Delusions • Faulty perceptions about the world (e.g., misinterpreting actions of others, paranoid, feel they are the focus of others thoughts. – Hallucinations • Perceptual experience without sensory input. • Primarily auditory.
- 35. One Major Psychological Disorder: Schizophrenia • Syndrome – Emotional reactivity • Overreacts to input from others. • Emotions may be inappropriate. • May become hyper vigilant or gradually become almost indifferent. – Disordered behaviour that accompanies the disordered thoughts and emotions.
- 36. One Major Psychological Disorder: Schizophrenia • Proximate Causes – Believed to be some kind of somatogenic pathology. – Could be malfunction of neurotransmitter systems: • High activity in dopamine circuits suggests problem with dopamine. • Could be result of excess of dopamine, or oversensitivity to dopamine, or result of other neurotransmitters affecting dopamine system.
- 37. One Major Psychological Disorder: Schizophrenia • Proximate Causes—If neurotransmitter system is disturbed: – Dopamine hypothesis: Excess dopamine or an oversensitivity to dopamine. • Treatment with classical antipsychotics that block dopamine receptors (e.g.,chlorpromazine, halperidol) reduces symptoms. • The better they block the better they work. Have calming effect and later reduce hallucinations and delusions. • These drugs have fairly serious side effects (sedation, dizziness, endocrine effects, and other more serious effects).
- 38. One Major Psychological Disorder: Schizophrenia • Proximate Causes—If neurotransmitter system is disturbed: – Dopamine-serotonin interaction hypothesis: Other neurotransmitters affect dopamine system. • Treatment with atypical antipsychotics, e.g., clozapine, that appear to block both dopamine and serotonin receptors are more effective, particularly for those who do not respond to classical antipsychotics. • Seem to reduce both positive and negative symptoms better and have fewer of the more severe side effects.
- 39. One Major Psychological Disorder: Schizophrenia • Proximate Causes – Could be some kind of structural defect in the brain: • MRIs show larger ventricles in males with schizophrenia than in males without schizophrenia. • Suggests either a loss (cerebral atrophy) or genetic deficiency in brain tissue. • However, this is not predictive of the disorder because many with larger ventricles are not affected.
- 40. One Major PsychologicalDisorder: Schizophrenia
- 41. One Major Psychological Disorder: Schizophrenia • Proximate Causes – Could be some kind of combination of these things: • No perspective can explain all cases of schizophrenia. • Leads to multiple syndrome hypotheses. • Crow’s two syndrome hypothesis: positive symptoms (increase from normal) and negative symptoms (decrease from normal) • Three syndrome hypothesis: two types of positive symptoms—psychotic and disorganized, plus negative.
- 42. One Major Psychological Disorder: Schizophrenia • Ultimate Causes – Heredity • Twin studies—median concordance rate for identical twins, even reared in different families, is three times that for fraternal twins. • Adoption studies—adoptees with biological relatives who have chronic schizophrenia are much more likely to have chronic schizophrenia than those who do not have relatives with the disorder. • Family studies—risk to relatives of those who have the disorder is higher than to those who do not have the disorder. • All suggests that the closer the genetic relationship the greater the risk for schizophrenia.
- 43. Genetic Risk Factorsin Developing Schizophrenia 46 14 10 3 1 50 45 40 35 30 25 20 15 10 5 0 Identical Twins Fraternal Twins Siblings Nephew or niece Unrelated individual Relationship Percentage of Risk
- 44. One Major Psychological Disorder: Schizophrenia • Ultimate Causes – Prenatal Environment • There must be more than heredity because concordance rates between identical twins is not 100%. • Complications during pregnancy and delivery are suggested to perhaps influence a genetic predisposition. • An infectious agent, such as influenza, during pregnancy may be a factor. Children of mothers infected during middle of pregnancy seem to be at increased risk.
- 45. One Major Psychological Disorder: Schizophrenia • Ultimate Causes – Social Environment • Incidence of schizophrenia is higher in poorer areas of cities. • Those who have higher socioeconomic status are less at risk. • Two possible interpretations of this: – The social circumstances lead to increased stress, and thus these people are more at risk. – Alternatively, those who have the disorder will be less successful and drift to the bottom of the social hierarchy, downward drift theory.
- 46. One Major Psychological Disorder: Schizophrenia • Major Treatment – Antipsychotic drugs: • Make it possible for individual to resume some aspect of normal life. • Hospitalization is often no longer necessary for more than short periods. – Other therapies must accompany this: • With the control provided by the drug it can possible for the individual to restructure their lives. • Many different approaches can be helpful: groups therapy, cognitive-behavioural therapy, even psychodynamic therapy.