Psychopathology

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Psychopathology
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(No Transcript)
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Leading Causes of Disability for the World - 1999

• 1) Respiratory Tract Infections
• 2) HIV
• 3) Perinatal Conditions
• 4) Diarrheal Diseases
• 5) Unipolar Major Depression
• 19) Alcohol Abuse
• 20) Bipolar Disorder

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Defining abnormality

• Statistical deviance

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• Diagnostic and Statistical Manual of Mental
  Disorders
• DSM

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Official (DSM IV-TR) definition

• Mental disorder is
• Personal Distress OR
• Impairment in Functioning OR
• Risk of death, pain, disability or an important
  loss of freedom
• Not just
• Culturally inappropriate
• Statistically deviant
• Conflict between individual and society

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Extent of Abnormal Behavior

• Epidemiology
• Prevalence
• Incidence

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Lifetime prevalence of types of mental disorders
of population
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Prevalence over time

• Is prevalence of depression increasing or
  decreasing?

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Lifetime prevalence and age of onset of major
depression by birth cohort
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Prevalence across cultures

• Is prevalence of mental illness culturally
  variable?

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Culture and Psychopathology

• Prevalence similar across cultures
• Schizophrenia
• Bipolar disorder
• Anorexia Nervosa
• Prevalence varies across cultures
• Major depression
• Bulimia Nervosa
• Alcohol abuse

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Depression Across CulturesLifetime Prevalence
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Prevalence and comorbidity

• How often do mental disorders co-occur?

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Typical Client

• Major Depression
• Panic Attacks
• Alcohol Abuse
• Lightning that strikes twice?

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Comorbidity

• Co-occurrence of 2 or more disorders
• 59 of disorders in 14 of population

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Impact of Comorbidity
Krueger Finger, 2001
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Structure of Comorbidity

• Major depression
• Generalized anxiety disorder
• Agarophobia
• Social anxiety
• Simple phobia
• Obsessive - compulsive disorder
• Antisocial personality
• Marijuana dependence
• Alcohol dependence

Internalizing
Externalizing
Krueger at al., 1998
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Causes (etiology) of mental illnessStressDiathe
ses
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Stress
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Effects of stress

• Short-term Long-term
• Increased energy Fatigue, myopathy
• Increased cardiovascular tone Hypertension
• Slow digestion Ulceration, colitis
• Slow growth Psychogenic dwarfism
• Decreased immune function Higher disease risk
• Improved cognitive function Neuronal death

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How much is too much?

• Heavy work load
• Break-up
• Divorce
• Death
• Combat
• Abuse
• Concentration camp

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Stress is subjective

• Final exams
• Family history of depression - ? reported stress

Berenbaum Connely, 1993
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Diathesis predisposition, vulnerability
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Diathesis-Stress Model
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Major Depression
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Major Depressive Episode

• Dysphoria, sadness
• Anhedonia loss of interest or pleasure
• 3-4 of the following
• Weight and/or appetite disturbance
• Sleep disturbance
• Psychomotor agitation and/or retardation
• Fatigue, loss or energy
• Worthlessness or guilt
• Diminished concentration
• Thoughts of death or suicide

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Diathesis Factors Genes

• Twin studies
• DZ twins 10
• MZ twins 40
• 37 of variance due to genetic influence
• Potential gene candidate promoter of the
  serotonin transporter gene (5-HTT)

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Dunedin Study

• 847 twin pairs
• short/short 5-HTT allele
• long/long 5-HTT allele
• Stressful events (21 and 26 years old)

Caspi et al., 2003
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Diathesis-Stress Model
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Life Stress, Depression, and Serotonin
Transporter Gene (5-HTT)
Caspi et al., 2003
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Becks Cognitive Triad
Beck, 1976, p 256
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Examples of Dysfunctional Beliefs

• I am nothing if a person I love doesnt love me
• If I am to be a worthwhile person, I must be
  truly outstanding in at least one major respect
• If others dislike you, you cannot be happy
• If I do not do well all the time, people will not
  love me

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Becks Cognitive Model of Depression
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Cognitive Diathesis-Stress Theory Depression
Vulnerability

• Cognitive diathesis
• latent dysfunctional self-cognitions
• Stress broadly defined severe life events
• Diathesis is latent unless accessed with stress
  or mood challenge

Beck, 1967, 1987 Bower, 1981 Ingram, 1984
Teasdale, 1988
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College admission study

• High school students
• 8 weeks before admission decision
• Measured
• 1) self-esteem negative views about
  self
• 2) pessimism negative thoughts about future

Abela, 2002
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Enduring Depressive Mood After Rejection
Residual change in depression score
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Depression - summary

• Diatheses factors
• Serotonin transporter gene
• Dysfunctional thoughts
• Stress factors
• Negative life events
• Failure

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Post-Traumatic Stress Disorder
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PTSD Symptoms

• Repeated reexperiencing / Intrusive symptoms
• Avoidant symptoms
• Hyperarousal symptoms

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PTSD - Stressor

• Actual or threatened death or serious injury, or
  a threat to the physical integrity of self or
  others
• Immediate response involving fear, helplessness,
  or horror

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Typical PTSD traumas

• Rape or sexual molestation
• Combat exposure
• Childhood neglect and abuse
• Physical attack
• Torture (immigrant populations)
• Natural disasters
• Severe automobile accidents

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Features of traumatic experiences

• Suddenness
• Lack of controllability
• Extreme negative emotions

Carlson Dalenberg, 2000
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Trauma Exposure and PTSD

• Population
• Prevalence of trauma - 60.7
• Given trauma, 20 of women 8 of men developed
  PTSD

Davidson et al, 1991 Kessler et al., 1995 Kulka
et al., 1990
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Who develops PTSD?
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Neurocognitive deficits

• Neural damage due to stress in animals (Sapolsky
  et al., 1990)
• Smaller hippocampal volume in PTSD
• Neurocognitive deficits in PTSD
• Toxic effects of trauma?

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Diathesis Factors - Hippocampal Volume

• Own HV Twin HV
• Vets (PTSD) small small
• Vets (no PTSD) large large

Gilbertson et al., 2002
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Neurocognitive deficts

• Combat veterans with PTSD and their
• unexposed twins have lower
• Hippocampal volume
• IQ
• Verbal memory
• Attention
• Executive function (perseveration)

Gilbertson et al., 2002, 2006
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PTSD - summary

• Diatheses factors
• Gender
• Low hippocampal volume
• Neurocognitive deficits
• Stress factor
• Traumatic event

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Summary

• Diathesis-stress model holds across disorders
• Diathesis factors can be genetic, biological and
  psychosocial
• Stress factors life events, trauma, family
  environment