Psychopathologies and Their Treatments

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Psychopathologies and Their Treatments
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Psychopathology

• Pathology from 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.

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Psychopathology

• Abnormal behaviour
• 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.

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PsychopathologySources

• Somatogenic (somabody and genesisbeginning)from
  the body.
• e.g., general paresis as a result of syphilis,
  disordered brain chemistry
• Psychogenic (psychemental and genesisbeginning)
  from the mind.
• e.g., hysterical blindness, glove anesthesia

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Structuring Mental Disorders
SYMPTOMS
UNDERLYING PATHOLOGY
Primarily Organic
Primarily Mental
Measles, tuberculosis, influenza, common cold.
General paresis, possibly schizophrenia and
bipolar affective disorders.
Somatogenic
Psychophysiological disorders such as glove
anesthesia, hysterical blindness.
Anxiety disorders such as phobias, depression,
dissociative disorders.
Psychogenic
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PsychopathologyPathology 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.

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Psychopathology ModelsFour Main 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.
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Pathology ModelsFour Main Perspectives
Psychodynamic View
Theoretical Cause of Abnormality Theoretical Cure
Internal, psychological, unconscious conflict (psychological factors). Psychotherapy to develop insights into underlying unconscious conflicts.
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Pathology ModelsFour Main 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.
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Pathology ModelsFour Main 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.
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DSM-IV

• Diagnostic and 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.

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DSM-IV Classification SchemeFive 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.

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DSM-IV Classification SchemeFive 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, Parkinsons disease,
  Alzheimers 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.

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DSM-IV Classification SchemeA 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 jobsevere stress.
• AXIS V Assessment of Functioning
• Global Assessment of Functioning (GAF) is 30,
  which indicates a serious impairment of
  functioning.

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AXIS I Major Psychological 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.,
  Altzheimers disease, exposure to toxic metals,
  chemicals).
• Substance Abuse Disorders
• Problems that result from abuse of drugs such as
  alcohol, street drugs, or medication.

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AXIS I Major Psychological 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.

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AXIS I Major Psychological 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 syndromefrequent
  hospitalization or surgery for nonexistent
  illness).
• Dissociative Disorders
• Person becomes detached from identity (e.g.,
  Amnesia, Dissociative Identity Disorder).

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AXIS I Major Psychological 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).

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AXIS I Major Psychological 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.

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Treatment of Psychopathologies

• Biological Therapies (requires an MD)
• Drug Therapies
• Psychosurgery
• Electroconvulsive Therapy (ECT)
• Psychotherapy
• Psychoanalysis Psychodynamic Therapies
• Behaviour Therapy
• Cognitive Therapy
• Humanistic Therapy

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Treatment of PsychopathologiesWho 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.

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How the Drugs WorkSynaptic Transmission
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How the Drugs Work

• Agonists Increase the effect of
  neurotransmitters.
• Antagonists Decrease the effect of
  neurotransmitters.

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Drug TherapiesHow They 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).

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Drug TherapiesHow They 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.

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Drug TherapiesHow They 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.

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Drug TherapiesImpact on 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.

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Drug TherapiesImpact on 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.

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Drug TherapiesImpact on 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.

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Drug TherapiesImpact on 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.

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Using the Pathology Model Exploring a Disorder

• Syndrome
• Signs and Symptoms.
• Proximate Causes (Underlying Pathology)
• What is out of order?
• Helps define treatment.
• Ultimate Causes
• Diathesis (predisposition)
• Stress

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One Major Psychological Disorder Schizophrenia

• Syndrome
• Disordered cognitions.
• Withdrawal from others.
• Hallucinations.
• Delusions.
• Emotional reactivity.
• Disordered behaviour related to symptoms above.

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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.

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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.

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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.

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One Major Psychological Disorder Schizophrenia

• Proximate CausesIf 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).

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One Major Psychological Disorder Schizophrenia

• Proximate CausesIf 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.

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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.

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One Major Psychological Disorder Schizophrenia
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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.
• Crows two syndrome hypothesis positive
  symptoms (increase from normal) and negative
  symptoms (decrease from normal)
• Three syndrome hypothesis two types of positive
  symptomspsychotic and disorganized, plus
  negative.

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One Major Psychological Disorder Schizophrenia

• Ultimate Causes
• Heredity
• Twin studiesmedian concordance rate for
  identical twins, even reared in different
  families, is three times that for fraternal
  twins.
• Adoption studiesadoptees 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 studiesrisk 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.

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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.

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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.

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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.

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