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Psychopathology
The document discusses various types of mental disorders and their treatment, covering topics such as psychopathology, neurodevelopmental disorders like autism and ADHD, mood disorders, schizophrenia, anxiety disorders, and more. For each topic, diagnostic criteria and treatment options are presented, including pharmacological and psychotherapeutic approaches. The goal of treatment is symptom management and improving functioning for those suffering from mental illnesses.
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Psychopathology
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- 2. Psychopathology v The studyof mental disorders or a mental disorder v What can go wrong? v How do you treat it? v Where do we draw the line?
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- 4. Main Areas of Psychopathology v Neurodevelopmental v Mood disorders v Schizophrenia v Anxiety disorders v Dissociative disorders v Personality disorders
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- 6. Autism Spectrum Summary DiagnosticCriteria • Persistent social communication deficits • Repetitive patterns of behavior • Impairment in social, occupational, other area of functioning Duration & Onset • Early developmental period • Earliest signs are abnormalities in social orienting & responsivity by 12 months Comorbidities • Intellectual Impairments • Language abnormalities • Uneven profile of cognitive abilities • Motor deficits • Self-injurious behaviors Specifiers & Notes • Three levels of care • 1: support • 2. Substantial • 3. Best Treatment • Educational and Vocational Interventions • Behavioral • Applied Behavior Analysis • Pivotal Response Training • Psychotherapy • Structured/ Directive to treat comorbid conditions • Parent/Family Interventions • Pharmaco-therapy • Treat associated symptoms
- 7. Autism Spectrum Disorder Social Interaction • Persistent deficits in social communication and interaction across multiple contexts Repetitive • Restricted, repetitive apatterns of behavior, interests, and activities • Symptoms present in the early developmental period (important change, less focus on age of onset) • Not all symptoms present, symptoms began to appear Deficits in Two Core Domains Has been linked to heredity, irregularities in the structure and functionin of the cerebellum and amygdala, and elevated serotonin Etiology: Better outcomes associated with communication skils by age 5 or 6, an IQ over 70 and later onset of symptoms 50% of children with this label are not speaking by age 5 Prognosis:
- 8. ADHD v Onset beforeage 12 v Significant in at least 2 settings v Duration of symptoms for at leat six months v Subtypes: v Predominantly inattention presentation v Predominantly hyperactive/ impulsive presentation, combined presentation v Hyperactive/impulsive presentation v Combined presentation
- 9. Stimulants v Lifetime nonmedicaluse v This class of drugs, in low to moderate doses, generally have the following effects v Heightened mood (euphoria) v Increase vigilance and alertness v Reduce fatigue v Alertness v In order of prevalence of use v Caffeine v Nicotine v Amphetamines/Cocaine ADHD Treatment
- 10. Psychostimulatns Use: ADHD Examples: • methylphenidate (Ritalin)and pemoline (Cylert), and Dextraamphetamine & amphetamine (Adderall) Mode of Action: • Increase availability of norepinephrine and dopamine Side Effects: • Dysphoria, insomnia, decreased appetite, tics (exacerbates tic disorder, remove drug if it creates tic disorder), and OCD symptoms Drug holidays: • alleviate growth suppression ADHD Treatment
- 11. Schizophrenia v Split-mind v Asplit from reality
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- 13. Schizophrenia Summary Diagnostic Criteria • 2 Active phase symptoms • One is delusion, hallucination or disorganized speech Duration & Onset • At least one month of active phase symptoms • Continuous signs for 6+ months • Onset is typically late teens to early 30s, peak in mid 20s for males and late 20s for females Comorbidities Specifiers & Notes • Active Phase: • Delusions • Hallucinations • Disorganized Speech • Grossly disorganized or catatonic behavior • Negative symptoms • Prevalence: .3 to . 7% Best Treatment • Family psychoeducation • Cognitive behavioral therapy • Social skills training • Supported employment • Social learning/ token economies program • Cognitive remeidaiton • Other • Relpase prevention;family therapy (reduce negatve expressed emotions; medication management)
- 14. Assessment of Schizophrenia Acute: • Diagnosing Stabilization: • monitorand evaluate Tx Stable: • assessments aligned with goals Hospitalization: Risk for suicide or aggression Decompensating, noncomplient, not improving Symptom stabilization is needed Exhibiting signs of Acute psychosis Schizophrenia Tx
- 15. Treatment: Schizophrenia • At risksuicide/aggression • Decompensation/noncompliant • Symptom stabalization needed (changing meds) • Signs of acute psychosis/substance use 1. Hospitalization • Traditional: Haloperidol, help positive symptoms • Atypical: clozapine. Alleviate both 2. Pharmacotherapy • CBT • Skills • Family • Assertive Community Treatment (ACT) • Supported Employment Psychosocial Interventions Treatments Overview • Family psychoeducation • Cognitive behavioral therapy • Social skills training • Supported employment • Social learning/token economies program • Cognitive remeidaiton Other • Relpase prevention; • family therapy (reduce negatve expressed emotions; • medication management Schizophrenia Tx
- 16. Cultural Differences in Schizophrenia v Family: more latitude v Less antipsychotic medication v If it is transient, and you aren’t socially isolated, easier to come back around
- 17. Major Depressive Disorder • SSRIs • TCAs • MAOIs • Other Pharmacotherapy • CBT • Intepersonal Psychotherapy Psychotherapy: Phototherapy Electroconvulsive Therapy (ECT) Mild Depression: No Meds Moderate +: Meds Interventions Overview • Behavior therapy/behavioral activiation • Cognitive therapy • Interpersonal • Problem-solving • Self-management/self-control therapy • Acceptance and commitment therapy • Emotion-focused therapy • Reminiscence/life review (older adults) • Short-term psychodynamic • Other: • Relapse prevention;meds Referrals and Adjuncts • Psychiatrist • Inpatient for acute • Partial hospitlaization programs • Social Security
- 19. SSRIs Type • Fluoxetine Use • Depression • Melacholic depression • OCD • Bulimia • Panic Disorder • PTSD Mode of Action • Block the reuptake of serotonin Side Effects: • Less cardiotoxic, safer and less cognitive impairment • 2-4 weeks benefit • Prozac no more dangerous than other SSRIs • MAOI and SSRI: Serotonin syndrome • Gastrointestinal • Insomnia • Anxiety • Anorexia • Urination • Sexual dysfunction Treating Depression
- 20. Beck’s Cogni-ve Profiles NegativeView of Self Negative View of World Negative View of Future Beck’s Cogni-ve Profile of Depression Beck’s Cogni-ve Profile of Anxiety Excessive Form of Normal Survival Mechanisms • Unrealistic Fears about Physical Threats • Unrealistic Fears about Psychological Threats Treating Depression
- 21. Beck: Cogni-ve Therapy v Collabora-ve empiricism v Socra-c ques-oning v Keep logs, ac-vity schedule, gradual tasks to increase mastery Treating Depression
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- 23. Treating Depression: Interpersonal Therapy Overview PersonalityTheory • Treat depression • Psychodynamic and CBT View of Maladaptive Behavior • Problems in social roles Therapy Goals • Four problems: grief, relationship roles, role transitions interpersonal Therapy Techniques • Assess and encourage new ways of interacting • End with methods of relapse prevention
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- 26. Bipolar I Summary DiagnosticCriteria • One manic episode for ONE week • Symptoms most of day nearly every day • 3+ Symptoms • Leading to hospitalization, significant impairment Duration & Onset • Manic One Week+ Comorbidities Specifiers & Notes • Three or more: • Inflated esteem • Decrease sleep • Pressured speech • Flight of ideas • Distractibility • Increased goal directed acitivty • Psychomotor agitation • Excessive involvement in pleasure Best Treatment • Interventions • Psychoeducation • Cognitive Therapy • Behavioral Interventions: impulse control, role playing, behavioral rehearsal, role reversal • Referrals and Adjuncts • Psychiatrist for medication eval and Tx • Inpatient hospitalization to stabilize acute crisis • Partial hopsitialziation programs • Day treatment programs • Alliance fot he mnetally Ill for families • Social security
- 27. Treatment: Bipolar I Disorder Psychopharmacology: • Lithium • Anti-seizure (carbamezpine) • Antipsychotic for manic/mixed episode Psychotherapy: Reduce relapse • CBT: 1) educate, 2) self-monitor symptoms, 3) adhere to meds, 4) coping strategies, 5) copinig with stressors • Family-Focused Treatment • Interpersonal and Social Rhythm Therapy • Stablizaing daily routines and improve interpresonal relationships Bipolar Tx on Exam I: Nonfunctional Often with substance II: Functional #1: Exam wants you to have Lithium Therapy #2: Bipolar person using, once the mania is under control, other things will clear. Interventions • Psychoeducation • Cognitive Therapy • Behavioral Interventions: impulse control, role playing, behavioral rehearsal, role reversal Referrals and Adjuncts • Psychiatrist for medication eval and Tx • Inpatient hospitalization to stabilize acute crisis • Partial hopsitialziation programs • Day treatment programs • Alliance fot he mnetally Ill for families • Social security
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- 29. Mood StabilizersMood Stabilizers Types • Lithium and • Anticonvulsants Tegretol (Carbamazepine), Depakote Uses • Lithium: Bipolar I disorder • Anticonvulsants: Bipolar, particularly rapid cycling Mode of Action: • May affect reupatake of serotonin and norepinephrine • Anticonvulsants: Serotonin possibly Side Effects: • LIthim: nausea, polydipsia and polyuria, cognitive impairments, fine hand tremor • Lithium Toxicity: Vomiting, slurred speech, death!!! • Tegretol: lethargy, tremor, ataxia and visual disturbances Treating Bipolar Disorder
- 30. Interpersonal and SocialRhythm Therapy Stablizaing daily routines and improve interpresonal relationships Treating Bipolar Disorder
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- 32. GAD Symptoms v Essentialfeatures include anxiety or worry that takes place across a number of settings and more days than not for at least six month. v The individual experiences at least three characteristic symptoms including (as defined by the APA, 2013): v Restlessness or feeling keyed up or on edge v Being easily fatigued v Difficulty concentrating or mind going blank v Irritability v Muscle tension v Sleep disturbance Many of the Anxiety Disorders outlined in this chapter along with Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, Adjustment Disorders, Depressive Disorders, and psychotic disorders possess similar features to GAD. 32
- 33. Treating GAD: Applied Relaxation Finallyyou practise your relaxation technique in real-world anxiety- provoking situations. You then learn to relax really quickly. Next you learn to associate a certain cue, say thinking ‘serenity now!’ (hello Seinfeld fans!) with a relaxed state. The next stage is to cut out the tensing phase and move straight to relaxing each muscle. First you learn to relax you muscle groups one after the other. Applied relaxation builds on progressive relaxation.
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- 35. Specific Phobias Summary Diagnostic Criteria • Excessive fear ofspecific object or situation • Avoid situation or marked distress Duration & Onset • Average 13 Years • Persistent: Usually 6+ Months Comorbidities Specifiers & Notes • Specifiers: • Animal • Natural environment • Blood- Injection • Situational • Other Best Treatment • Interventions • Exposure therapies • Relaxation skills • Referrals and Adjuncts • Pychiatrist for med eval and Tx • Medical evaluation
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- 37. SPECIFIC PHOBIA TREATMENT Treatment: • Exposure • In vivo preferred • Combining exposure with applied tension helpful for blood-injection injury • Prolonged better, but gradual may increase compliance, reduce preterm Cogntiive Interventions • Cognitive therapy alone as effective as in vivo exposure for claustrophobia • Cognitive self-control • CBT with imaginal/in vivo exposure with gradual desensitization
- 38. Trea-ng Anxiety Disorders: Systema-c Desensi-za-on v Countercoundi-ong Wolpe v Anxiety hierarchy v Previously thought to be most effec-ve, flooding now seen as most effec-ve
- 39. OCD v Recurrent obsessions and/orcompulsison that are time consuing or cause significant distress or impaired functioning. Treatment: Exposure with response prevention and the tricyclic clomipramine or an SSRI. v Why does an SSRI work? An increase in the availability of serotonin.
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- 41. OCD & Exposurewith Response Prevention Prolonged exposure to situations that trigger obsessions Procedures that block ability to perform obsessive ritual Supplement with: • Thought stopping • Cognitive interventions that address dysfunctional beliefs and feared consequences
- 42. Trauma- and Stressor- relateddisorders Reactive Attachment Disorder Disinhibited Social Engagement Disorder Posttraumatic Stress Disorder Acute Stress Disorder Adjustment Disorders
- 43. Postraumatic Stress Disorder v Onsetof symptoms after exposure to actual or threatened death, serious injury, or sexual violence with symptoms representing the following categories: v intrusion of symptoms (e.g., distressing memories or dreams) v Avoidance of stimuli associated with the event v Negative alterations in cognition and mood v Alterations in arousal v Symptom Length: v have lasted more than one month and cause distress or impaired functioning v Treatment: v Cognitive behavioral therapyt hat incorporates exposure, cognitive restructuring, anxiety management and other techniques
- 44. VI. Dissociative disorders, somaticsymptom and related disorders, elimination disorders, and sleep-wake disorders
- 45. Dissociative Disorders v DissociaitiveIdenitty Disorder v Dissociative Amnesia v Depersonalization/ Derealization Disorder
- 46. Causes of Dissociative Disorders? v Abuse +[Plus] v Abuse plus an ability to put onself in a hypnotic trance to cope with abusive situations
- 47. The DID Controversy v Is it real? v Fewer than ¼ of psychiatrists believe it is real v Changes over time: v 1930-1960: 2 cases per decade v 1960: Famous case of Sybil made into movie v 1980s: 20,000 cases reported (mostly in US) v Is DID the result of suggestion by therapist and acting by patient? v To what extent is DID an extreme version of normal psychology?
- 48. Feeding and Eating Disorders v Pica v Anorexia Nervosa v Bulimia Nervosa v Binge-Eating Disorder
- 49. Anorexia Summary Diagnostic Criteria • Restriction of food leading to very low body weight • Intense fear of gaining weight or behavior that interferes with gaining weight • Distortions of self-image or denial of seriousness of the problem Duration & Onset Comorbidities Specifiers & Notes • Subtypes: • Restricting type • Binge-eating/ purging type • Course: • Partial or full remission • Severity • Mild, moderate, severe or extreme • Notes: • Femailes 10 x more liekley Best Treatment • Interventions • CBT • Family-based • Coping skills to alleviate anxiety and provide healthy sense of self-control • Referrals and Adjuncts • Med eval • Nutritional counseling • Psychiatrist for med eval • Inpatient Hospitalization • Self-help groups
- 50. Bulimia Summary Diagnostic Criteria • Recurrent binges w/lack of control • Compensatory behavior to prevent weight gain • Self-evaluation unduly influenced by body/appearance Duration & Onset • Once a week for 3+ months • Both binge eating AND compensatory behavior Comorbidities • Differentiate from “Binge Eating Disorder” which is binge eating (no compensatory behavior) once a week for 3+ months Specifiers & Notes • Course: • Partial or full remission • Severity: • Mild, moderate, severe, or extreme • Based on number of compensatory behaviors/week Best Treatment • Interventions • CBT • Interpersonal Therapy • Coping skills to alleviate anxiety and provide healthy sense of self-control • Referrals and Adjuncts • Med eval • Dental Evaluation • Nutritional counseling • Psychiatrist for med eval • Inpatient Hospitalization • Self-help groups
- 51. Bulimia Treatment • Gaincontrol over dysfunctional eating habits • Healthy attitudes • Incorporates: self-monitoring, stimulus control, cognitive restructuring, problem-solving and self- distraction CBT • Handle interpersonal relationships so eomtional upsets aren’t triggering binges Intepresonal Psychotherapy • Correct maladaptive beliefs • Replace unhealhty patterns Nutritional Counseling • Imipramine and fluoxetine effective to reduce binge eating and improve dysphoria • CBT lower relapse Pharmacotherapy Interventions • CBT • Interpersonal Therapy • Coping skills to alleviate anxiety and provide healthy sense of self-control Referrals and Adjuncts • Med eval • Dental Evaluation • Nutritional counseling • Psychiatrist for med eval • Inpatient Hospitalization • Self-help groups
- 52. General personality disorder diagnosiscriteria There are no significant changes to the diagnosis criteria in the DSM-5! NEW: Culture Related Diagnostic Issues More predominantly culturally aware in the DSM-5. 52 Schizotypal: Voodoo, speaking in tongues, belief in an afterlife. Antisocial: tends to be over-diagnosed in clients from lower SES. Avoidant: Acculturation issues Dependent: Some cultures foster this OCPD: Work and productivity in some cultures vary
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- 54. Most murderers arenot mentally ill in the usual sense
- 55. Antisocial Personalty Disorder v Disregard forand violation of the rights of others. Common associated features are lack of empathy, inflated sense of self, and superficial charm v LACK OF DISRUPTION OF AFFECT.
- 56. Antisocial Personality Disorderv •“Moral insantiy” or “Psychopathy” • v Typically male • v Selfish, callous, impulsive, promiscuous • v Deficit in love, loyalty, guilt, anxiety • v Easily bored, seeks out stimulation
- 57. Treating Antisocial Personality Disorder Anitsocial Milieu Tokeneconomy Programs that address moderately high-risk regarding issues associated with criminality and focus on teaching interpresonal skills CBT Clear rules and consequences Tolderate affect Relapse prevention Pharmacotoherapy Generally avoided Mood stablizer/antidepressant reduce impulsivity/aggression
- 58. Borderline Personality Disorder v Instability in interpersonal relationships, self-image, andaffect and marked impulsivity. v DBT Treatment of choice
- 59. Linehan’s Dialec-cal Behavioral Therapy Outpatient Dialectic: Acceptance and Change Focus on present Four requirements: • commit to period of Tx & attend all sessions, • reduce suicidal behavior, • work on behaviors that interfere with therapy, • attend skills training Treating Borderline
- 60. Would They GetBetter Anyway?
- 61. General Conclusions about Therapy v People in treatment do better than those not v Some types of therapy work better for specific problems v Cognitive-behavioral for major depression (maybe) v Medication for bipolar disorder v Some therapists are better than others
- 62. Nonspecific Factors in TherapyEffectiveness v Nonspecific = unrelated to specific principles but critical to outcome v Support v – acceptance, empathy, encouragement, guidance v Hope v – sense of faith in therapy process v – placebo effect = improvement from belief, rather than actual effect