PSYCHOPATHOLOGY

I. Defining abnormality

A. Elements of abnormality: Suffering, maladaptiveness, irrationality, unpredictability or loss of control, unconventionality, observer discomfort, violation of moral or ideal standards

B. DSM-IV, APA, Medical Model, syndrome reflects underlying pathology

C. DSM-IV Multiaxial diagnosis: diagnostic interview, MMPI, etc.

I. Clinical syndromes

II. Personality disorders & mental retardation

III. General medical conditions

IV. Psychosocial and environmental problems

V. Global assessment of functioning

D. Old terminology:

1) Neuroses: disorders marked by defense-oriented behavior aimed at avoiding or lessening anxiety, excessive use of immature ego-defenses = self-deception and distortion of reality
-avoidance behavior is reinforced by anxiety reduction

-self-defeating & self-perpetuating

-includes anxiety, somatoform, and dissociative disorders

2) Psychoses: reality testing impaired, delusions, hallucinations

E. Multidimensional models of etiology

  • genetic factors
  • neurobiological mechanisms
  • psychological factors, e.g., traumatic experience, avoidance behavior, cognitive factors
  • social factors, e.g., modeling
  • integrative models

    • G. Diathesis-Stress Model

  • Diathesis = predisposition, biological
  • Stress = environmental stressor, trauma

    • H. Rosenhan Study - labels stick

     

    II. Anxiety Disorders disorders characterized by panic and anxiety. Fear = immediate alarm reaction to dangerous situation. Panic is a fear reaction that is disproportional the threat. Anxiety = future-oriented, diffuse, anxious apprehension, tension, and negative affect.

    A. Phobias- specific fear, cued or situationally bound panic, agoraphobia, social phobia

      Etiology: neurobiological diathesis (BII), preparedness, acquisition classical conditioning of fear, maintained by avoidance behavior (anxiety reduction à negative reinforcement)

      Treatments: flooding, systematic desensitization

      B. Panic disorder- abrupt intense fear alarm, unexpected or uncued panic or situationally predisposed panic (panic disorder with agoraphobia, panics tend to occur in situations where they feel a loss of control or danger).

    Etiology: interaction between biological predisposition, stress, and cognitive factors.

    Treatment: cognitive therapy to modify thoughts about the danger of sensations associated with panic attacks and situational exposure to practice coping. Extinguish fear and avoidance behaviors (agoraphobic).

    C.. Obsessive-compulsive disorder- recurrent thoughts or actions.

    Etiology: multidimensional

    Treatment: Exposure and response prevention, prevent negative reinforcement.

    D. Post-traumatic stress disorder

    Etiology: traumatic event, typically life threatening, near death experiences, eliciting helplessness and terror

    Treatment: systematic exposure to the memories and cues surrounding the trauma, process the memory until it is no longer painful or distressing. Processing of thoughts and feelings about trauma to restructure distorted beliefs that have developed, e.g., self-blame, distrust, saftey.

    III. Dissociative disorders

    Dissociative amnesia and fugue

    Dissociative Identity Disorder -multiple personality, now dissociative identity disorder, treatment - recognize alters, understand purpose each served, learn new coping strategies, confront and relive early trauma, re-integration of personality.

    IV. Affective/Mood Disorders

    1. Unipolar disorder (major depression)


    a) Symptoms: depressed mood & lack of interest in most activities, 3 associated symptoms, e.g. feelings of guilt, helplessness; loss of energy, etc
    b) Hypothesized causes:
    i) Somatic: neurochemical disturbance causes depressed mood,
    which then causes negative thoughts and behaviors, correlational data.
    a) hereditary, twin concordance, MZ=40%, DZ=11%
    b) neurochemistry decreased norepinephrine (NE) & serotonin (5-HT) CSF metabolites,
    c) antidepressants, tricyclics, increase NE and 5-HT
    d) dysfunction of the endocrine system due to stress

    ii) Psychogenic: stressful life events contribute to the development of a negative cognitive style which causes depression

     
    a) Beck's cognitive theory of depression
    -Negative self-schema formed by trauma or loss early in life, modeling, reactivated by later stress
    -Negative Illogical Interpretations of situations, e.g. small obstacle = impassible barrier, ignore success focus on failure
     
    b) Learned Helplessness: depression due to expectation that bad things will happen and there is nothing they can do to prevent or escape future negative events. Cognitive appraisal or attribution style important depressives make internal, stable & global attributions for negative events, hopelessness.
     
    iii) Diathesis Stressor Model: integrative model, predisposition + stress = depression;
    -the predisposition may be psychological and/or biological

     

    iv) Cognitive therapy and Interpersonal therapy have been shown to be effective interventions for depression. Both forms of treatment reduce relapse rates (Evans et al., 1992, Frank et al., 1990). Combined psychological and drug treatments may produce better therapeutic gains.
    2. Bipolar disorder (manic-depression)
    a) Symptoms: elated, expansive, mood & 3 associated symptoms
    b) Hypothesized Causes:
    i) Somatic:
    a) hereditary, twin concordance rates, MZ=72%, DZ =14%
    b) neurotransmitter disturbance mania oversupply of NE & acetylcholine receptors
    c) lithium decreases effectiveness of NE
    ii) Psychogenic: mania = masked depression

    c) Treatment- Lithium, family therapy to increase medication adherence


    V. Psychotic disorders

     
    A. Schizophrenic disorder- disturbance in thought, reality testing, positive versus negative symptoms
    1) cognitive symptoms: Delusions of reference, delusions of persecution, loose associations, idea hoping, neologisms
    2) perceptual symptoms: hallucinations, attention deficit,
    3) affective/motivational symptoms: flat or inappropriate
    affect, socially uncooperative, social withdrawal, depressed, anxious
    4) behavioral symptoms: grimace, imitate others, odd gestures
    e.g. Catatonic Schizophrenia
    B. Types of Schizophrenia
    1) Paranoid -preoccupation with one or more systematized delusions or with frequent auditory hallucinations related to a single theme. Onset tends to be later in life; more stable overtime, prognosis better
    2) Disorganized -central symptoms are confusion and incoherence.
    -poor functioning
    3) Catatonic -psychomotor disturbance, stupor, mute, unresponsive
    4) Residual
    5) Undifferentiated

    VI. Personality disorders- these disorders begin in adolescence, stable and inflexible maladaptive behavior patterns

    A. Antisocial personality disorder-disturbed family interactions, physiological underarousal hypothesis
    B. Histrionic personality disorder
    C. Narcissistic personality disorder
    D. Dependent personality disorder
    F. Obsessive-Compulsive
    G. Schizoid
    H. Avoidant
    I. Borderline
    Treatments: Psychodynamic psychotherapy and dialectical cognitive behavioral group therapy. Poor prognosis.