PSY337 Psychopathology Notes

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Joy Cummings
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1 PSY337 Psychopathology Notes DSM Definition of mental s: clinically significant set of symptoms that result in some type of impact in an individual s life. No single rule, which captures a broad definition of mental s. Cultural model: A behaviour is abnormal if it break implicit rules of that society. Allows for cultural variation. Disadvantage: tremendous variation between cultures and time, very difficult to measure (subject) also extremely stigmatising. Danger model: someone has a mental if they re engaging in behaviour if they are a danger to themselves or others. Disadvantage: definition can be abused, suppress individuality and difficult to define, Distress model: Abnormal behaviour is a behaviour, which is personally distressing & interfering. Through tradition people talk about some conditions to talk about certain categories. Classification systems: International Classification of Diseases (ICD). Diagnostic and Statistical manual of Mental s (DSM). Labeling can stigmatise and the way professionals gather information. But diagnostic labels can aid medical communication. What is psychopathology? Study of mental : Also known as abnormal psychology i.e., study of abnormal behaviour Implies a recognition of what is abnormal Definitions of abnormal behaviour: No accepted definition No single definition that covers all mental s Clinically significant set of symptoms that result in life impact (DSM) Several factors that characterise mental s o Statistical rarity o Cultural/ Social inconsistency o Personal or social threat o Personal distress Statistical model: Abnormal if occurrence is infrequent ie top and bottom 5% Advantages o Objective o Definable and measurable o Non-pejorative Disadvantages o Some abnormality moderately common o Many uncommon behaviours are not seen as abnormal Cultural model: Abnormal if behaviour breaks implicit rules of society Advantages o Describes several s o Allows for cultural variation 1

2 Disadvantages o Varies across time and culture o Hard to define & measure o Very pejorative Danger model: Abnormal if it poses a risk or danger to self or others Advantages o Describes certain cases o Protective value Disadvantages o Can be abused and violate rights o May suppress individuality o Hard to define Distress model: Abnormal if behaviour causes personal suffering or distress Advantages: o Non-pejorative o Clear definition self defined o Measurable Disadvantages Doesn t always fit How do we describe mental? No clear rule or definition Problems or s are largely traditional Most commonly described as categories (although this is not the only way) Most common systems Advantages and disadvantages of diagnosing Advantages Aids communication Organises information Helps direct research & treatment Gives clients hope Disadvantages Pejorative / stigmatising May bias & restrict information gathering Understanding mental s Diagnosis: Studies of classification, symptoms, features Epidemiology: Health characteristics across populations e.g., age, sex, SES, etc. Development: Retrospective studies; longitudinal studies Understanding risk and maintaining factors: Genetic involvement o Family studies o Adoption studies o Twin studies Biological correlates o Chemistry o Brain pathways use of MRI etc. 2

3 o Psychological factors o Socio- cultural factors Evidence lectures: A case example of abnormal behaviour: Mary was a 28 year old, single female who was unemployed and lived alone in a low- grade single room flat. On presentation, she was slightly dishevelled in appearance, made little eye contact, and spoke in a low voice. Mary reported that she had a very poor opinion of herself and tended to avoid mixing with people. She also reported a number of physical aches and pains as well as frequent blurred vision and numbness. Her reason for presenting was to feel better about herself and her life. Mary held a doll in her lap throughout the interview. While sitting in the waiting room, she had been noticed muttering to herself in a quiet voice. Mary reported that she had little interest in life and had plans to kill herself if she did not improve soon. How do we decide on diagnoses? Difficult to categorise, depends on purposes MENTAL DISORDERS * DSM*multiple*axes* EXTERNALISING INTERNALISING ANTISOC PD PATHOLOGICAL$ GAMBLING$ DEPRESSION ANXIETY SOCIAL PANIC Axis Description 1 Clinical syndromes (i.e., s) 2 Personality s Mental retardation 3 General medical conditions 4 Psychosocial and environmental problems 5 Global assessment of functioning PHOBIA How common are s? Determined through population surveys. Need to be stratified (representative of the general population). Preferably direct interviews often by lay people Two terms: o Prevalence: total cases over a given time (e.g., Point prevalence; 12-mth prevalence). o Incidence new cases over a given time Nature*of*twin*designs* Information*from*twin*designs* Genetic overlap Fully genetic Partly genetic Monozygotic Dizygotic Unrelated 100% 50% 0% All have Many have Half have Less have Disorder at population levels Disorder at population levels Variance accounted for by Genes (heritability) Shared environment (family, SES, shared stress) Unique environment (plus error) Reflected in Difference between MZ and DZ Difference between DZ and unrelated, minus heritability All remaining (unexplained) variance 3

4 Introduction of the DSM5 Last version DSM-IV 1995 Need for a new revision o Updated views o New data and knowledge DSM5 in development over several years (2003) Published in May, 2013 Guiding principles for taskforce: Must be practical for use in clinical practice Only create changes that are supported by empirical evidence Try to maintain continuity with DSM-IV Harmonise with ICD-11 Aim to include cultural variations where possible The process: DSM5 overarching taskforce 28 members 130 members of 13 work groups (specific areas) Work groups supported by larger group of expert consultants Work groups - regular meetings to discuss criteria Drafted proposed revisions sent to taskforce Some field trials funded to evaluate use of criteria Draft released for public comments (2010) Comments addressed by work groups Final criteria discussed by taskforce at summit committee and ratified Dec Overarching changes: Dimensional consideration premature, categorical classification used (have a or don t). Removal of multi-axial system, rather than single diagnosis, MDD would be axis 1, axis 2, personality problems gave broader, richer diagnosis. Back to idea of single dominant. Personality s two systems. Old + dimensional system. Reduced division between children and adults. Some adjustment and creation of categories; new separate categories: o Obsessive compulsive and related s o Trauma and stressor-related s o Bipolar and related s; o Neurodevelopmental s o Disruptive, impulse control and conduct s Week 2 Anxiety Disorders: Symptoms of Anxiety Disorders: Characteristics of an anxiety : More intense reactions than most people experience More frequent experience Response to larger number of cues (where other people may not feel anxious). Avoidance often leads too Interference with life (hallmark of or problem). Generalized Anxiety Disorder (GAD): WORRY High pure trait anxiety Involves both physical and social anxiety 4

5 Central feature is worry (uncontrollable, inability to stop the worry). Accompanied by physical symptoms (e.g. sleep disturbances) & life interference or distress Panic Disorder: Experience of Panic Attacks (PAs) Central feature is fear of UNEXPECTED panic attacks (sudden rush of extreme distress accompanied with physical symptoms such as breathlessness, chest pains & cognitive symptoms e.g. fears of dying going crazy) in future. Number of physical symptoms Worry about future attacks Tend to have repeated attacks. Can be with or without Agoraphobia o Agoraphobic fears: whole range of situations where PA s may occur, if I have PA here will be stuck and away from safety. Avoid shopping malls, public transport etc. Social Phobia: Fear: o What others will think of me o Negative evaluation o Others thinking badly of you Avoid number of socially related situations Continuum of Social Anxiety? Shyness: o Social Phobia o Generalised Social Phobia refers to people who avoid most social situations. o Avoidant Personality Disorder extreme form of social phobia. Subtypes of specific phobias (tend not to interfere with most people s lives) in DSM-IV: Animal type: dogs, spiders, snakes Natural environment type: storms Blood-injection-injury type Situational type: heights, open spaces Other type Obsessive Compulsive Disorder: Consists of: o Obsessions (repetitive/stereotyped urges, thoughts, images) and/or o Compulsions (repetitive/stereotyped/rigid behaviours, typically occur in response to obsessions). Have insight to bizarreness of behaviour, however insight does vary (poor insight type: think what they are doing is logical and makes sense). Almost manifested in a way that s quite superstitious e.g. must wash hands 4 times, in a certain way Important to distinguish from o Worry 5

6 o Ritual Post Traumatic Stress Disorder (PTSD): Anxiety following some sort of trauma (life threatening event) or seen someone in a trauma. Clear trigger of traumatic event Life threat o Self or other o Fear, helplessness, horror Contains features of depression and anxiety Common Traumas: War Natural disasters Sexual/ Physical assault Accidents Central features of PTSD: Re-experiencing of event o (e.g. Intrusive recollections, dreams) Avoidance of stimuli and numbing o (e.g. Avoidance of thoughts, feelings, amnesia, detachment) Increased arousal o (e.g. Insomnia, difficulty concentrating) Separation Anxiety Disorder: Currently of childhood Fear of separation from attachment figure e.g. when I m away from Mum she ll be in a car accident or in danger Fear of harm to self or attachment Associated features o Avoidance of school o Nightmares o Physical symptoms o Reluctance to be away from attachment Anxiety Symptoms Evidence: Content/features of worries in GAD: Mainly family/home/relationships, followed by miscellaneous (little things/ minor routine e.g. house repairs, paying things on time). Duration much longer than non-clinical also sense of control and realism (can t control and what I worry about is realistic and success of stopping lower). Symptoms/features of Panic Attacks: Fear of losing control (number 1) Median frequency 1.5 per week, 12.6 mins, 7.3 symptoms per attack. Factors making agoraphobic situations easier: Being accompanied by a sympathetic other Being close to home Being in familiar territory Shorter durations Frequency of obsessions in OCD: Aggressive most frequent in adolescents 6

DSM-IV-TR Diagnostic Criteria For Posttraumatic Stress Disorder

DSM-IV-TR Diagnostic Criteria For Posttraumatic Stress Disorder PTSD When an individual who has been exposed to a traumatic event develops anxiety symptoms, re-experiencing of the event, and avoidance