Download Psychopathology2

Psychopathology
Elliot Collins
12.06.16
Slide Credits: Kevin Jarbo and Prof Kody Manke
What is mental illness?
What constitutes addiction?
Substance use disorders
•
•
•
•
•
•
•
•
•
•
•
Tolerance (need more to achieve the same effect)
Withdrawal
Substance taken in larger amounts, over longer time, than desired
Persistent desire or unsuccessful attempts to cut down
Significant energy spent obtaining, using, or recovering from substance
Important social, occupational, or recreational activities reduced because of substance use
Continued use in spite of knowing the problems that it causes
Craving
Recurrent use in physically dangerous situations
Failure to fulfill major obligations at work, school, or home due to use
Social or interpersonal conflicts related to substance use
Number of Criteria Met over 1 year indicates severity: 2-3 (mild), 4-5 (moderate), 6-7 (severe)
Outline
• Mental health vs. Mental Illness
• Diathesis-Stress Model
• Assessment
• Types of Disorders:
•
•
•
•
•
Anxiety Disorders
Depressive Disorders
Bipolar Disorders
Substance Use Disorders
Schizophrenia
• Concluding Thoughts
Risk of Mental Illness Is Widespread
• Point prevalence
• How many people live with a
disorder at a given time
• Lifetime prevalence
• How many people will experience a
given disorder at any point in life
• Lifetime prevalence among US
adults = 46%
DSM-V Definition of Mental illness
Outline
• Mental health vs. Mental Illness
• Diathesis-Stress Model
• Assessment
• Types of Disorders:
•
•
•
•
•
Anxiety Disorders
Depressive Disorders
Bipolar Disorders
Substance Use Disorders
Schizophrenia
• Concluding Thoughts
Modern Views: Diathesis-Stress Model
• Diathesis
• Predisposition (e.g., genetic) for
disorder
• Stress
• Triggers disorder
• Both diathesis (risk) and stress
must be present for disorder
Causes of Psychopathology: Genetic Risk
• Some disorders like schizophrenia
show a strong genetic component
• (Graph) Individual’s Risk for
Schizophrenia as function of type
of relative with Schizophrenia
From: Gottesman, I. I., & Erlenmeyer-Kimling, L. (2001).
Causes of Psychopathology: Environmental
Stressors
• Many disorders show a strong influence of environmental stressors
• (below) Mental Disorder Rates for Australian Korean War Veterans as function of Combat
Exposure
Australian DVA Executive Summary
Causes of Psychopathology: Environmental
Stressors
• Many (but not all) combat exposed veterans develop
psychopathologies such at PTSD
• Why not all?
Australian DVA Executive Summary
Outline
• Mental health vs. Mental Illness
• Diathesis-Stress Model
• Assessment
• Types of Disorders:
•
•
•
•
•
Anxiety Disorders
Depressive Disorders
Bipolar Disorders
Substance Use Disorders
Schizophrenia
• Concluding Thoughts
Assessing Mental Disorders
• Assessment is critical for understanding reasons for symptoms and
developing a treatment plan
• Diagnosis is important
• Specific treatment
• Disease specific resources
• Insurance coverage
• 2 primary methods of assessment
• Clinical interviews
• Self-report measures
Assessment: Clinical Interviews
• Semi-structured interview
• Specific sequence of questions to identify certain diagnostic content
• Symptoms
• Patient report of physical or mental condition
• Signs
• Clinician’s observations of physical or mental condition
Assessment: Self-Report Measures
• Inventory of items to target symptoms or profile patients
• Beck Depression Inventory
• 21 items, specific to depression
• Minnesota Multiphasic Personality Inventory (MMPI-2)
• 567 items, broad profile of personality
• Others
• Montreal Cognitive Assessment (MoCA)
• Mini-mental status exam (MMSE)
Outline
• Mental health vs. Mental Illness
• Diathesis-Stress Model
• Assessment
• Types of Disorders:
•
•
•
•
•
Anxiety Disorders
Depressive Disorders
Bipolar Disorders
Substance Use Disorders
Schizophrenia
• Concluding Thoughts
Test your phobia knowledge
Specific Phobia
Acrophobia
Arachibutyrophobia
Androphobia
Alliumphobia
Automatonophobia
Ablutophobia
Agrizoophobia
Amaxophobia
Anglophobia
1 - 17
Fear of….
Specific Phobia
Specific Phobia
Fear of….
Acrophobia
heights
Arachibutyrophobia
Peanut butter sticking to roof of mouth
Androphobia
men
Alliumphobia
garlic
Automatonophobia
Ventriloquist dummies
Ablutophobia
Washing or bathing
Agrizoophobia
Wild animals
Amaxophobia
Riding in a car
Anglophobia
England or English culture
Want to know more? Try www.phobialist.com
Panic Disorder
• Recurrent panic attacks (requires attack plus 1 month of additional
attacks or persistent concern about additional attacks)
•
•
•
•
•
•
Palpitations
Abdominal Distress
Nausea
Intense fear of dying or losing control, Light-headedness
Chest pain, Choking, Chills,
Sweating, Shaking, Shortness of Breath
• PANICS
• Physical manifestation of anxiety. Sympathetic overdrive
Obsessive-Compulsive Disorder (OCD)
• Obsessions: recurring intrusive thoughts, feelings, or sensations
• Causing severe distress
• Compulsions: repetitive action that relieves obsessions related distress.
• Associated with overactive basal ganglia circuits
https://www.youtube.com/watch?v=ufqFO5B1vQY
Post Traumatic Stress Disorder (PTSD)
• Triggered abruptly by identifiable, horrific event
• Dissociation
• “Numbness” to traumatic event
• Reactions include intense, intrusive recurrent nightmares and
flashbacks
• Affects women and men equally, with different causes
• Women: rape or assault
• Men: combat-related
Specific Differences in PTSD
• Major clusters of symptoms persist >1 month
• Re-experience
• Nightmares, flashbacks
• Arousal
• Difficulty sleeping, concentrating
• Avoidance
• Avoid anything related to trauma
• 7% lifetime prevalence
• More likely in women
Other Disorders of Anxiety
• Body Dysmorphic Disorder
• Anorexia Nervosa
• Bulimia
• Generalized Anxiety Disorder
• Illness Anxiety Disorder (Hypochondriasis)
Outline
• Mental health vs. Mental Illness
• Diathesis-Stress Model
• Assessment
• Types of Disorders:
•
•
•
•
•
Anxiety Disorders
Depressive Disorders
Bipolar Disorders
Substance Use Disorders
Schizophrenia
• Concluding Thoughts
What does DSM diagnosis criteria look like:
Criteria For Major Depressive Episode
A. At least five of the following symptoms have been present during the same 2-week period and represent a change
from previous functioning: at least one of the symptoms is either 1) depressed mood or 2) loss of interest or
pleasure.
•
•
•
•
•
•
•
•
•
•
1. Depressed mood most of the day, nearly every day, as indicated either by subjective report (e.g., feels sad or empty) or
observation made by others (e.g., appears tearful)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated either by
subjective account or observation made by others)
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease
or increase in appetite nearly every day
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or
being slowed down)
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely selfreproach or guilt about being sick)
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed
by others)
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or
specific plan for committing suicide
B. The symptoms do not meet criteria for a mixed episode.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of
functioning.
D. The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a
general medical condition (e.g., hypothyroidism).
E. The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist
for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with
worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
Think Defn of mental illness, then simplify
• 5 of below for at least 2 weeks (SIG E CAPS)
•
•
•
•
•
•
•
•
•
Sleep disburbance
Loss of interest (anhedonia)
Guilt or feelings of worthlessness
Energy loss and fatigue
Concentration problems
Appetite/weight changes
Psychomotor retardation or agitation
Suicidal Ideations
Depressed mood
• Less pervasive variants of MDD include
• Persistent depressive disorder (dysthymia)
• Seasonal affective disorder
Outline
• Mental health vs. Mental Illness
• Diathesis-Stress Model
• Assessment
• Types of Disorders:
•
•
•
•
•
Anxiety Disorders
Depressive Disorders
Bipolar Disorders
Substance Use Disorders
Schizophrenia
• Concluding Thoughts
Bipolar Disorder
• Manic episode: persistent elevated, irritable mood, and high energy
•
•
•
•
•
•
•
•
Diagnosis requires hospitalization or 3 of the following (DIG FAST)
Distractibility
Irresponsibility
Grandiosity- inflated self-esteem
Flight of ideas (racing thoughts)
Increase in goal directed Activity/Psychomotor Activation
Decrease need Sleep
Talkativeness or pressured speech
• Bipolar I: at least 1 manic episode w/ or w/o hypomanic or depressive
episode
• Bipolar II: hypomanic and depressive episode
Outline
• Mental health vs. Mental Illness
• Diathesis-Stress Model
• Assessment
• Types of Disorders:
•
•
•
•
•
Anxiety Disorders
Depressive Disorders
Bipolar Disorders
Substance Use Disorders
Schizophrenia
• Concluding Thoughts
Schizophrenia
• (most common) Psychotic Disorder
• Psychosis: thoughts/emotions so impaired that individual losses touch with reality
• Schizophrenia is not split/multiple personality disorder
• Commonly diagnosed in adolescence or early adulthood; more often in men
• Cognitive symptoms reflect impaired attention, working memory, inhibitory control, and
even early sensory processing
• Positive and Negative symptoms
• Positive Symptoms: behaviors/thoughts that should not be present
• Negative Symptoms: normal behaviors/thoughts that are missing
Positive Symptoms of Schizophrenia
-Not typically present in healthy individuals
• Delusions
• Systematized false beliefs of grandeur or persecution (delusions of reference)
• Hallucinations
• Sensory experience without actual external stimulation
• Anderson Cooper tries a schizophrenia simulator
• Disorganized behavior
• Strangely dressed, violent or nonsensical behavior
Negative Symptoms of Schizophrenia
-Not typically absent or low in healthy individuals
• Flat affect
• Little to no display of emotion
• Catatonic behavior
• Anhedonia
• No interest in pleasurable activities
• Withdrawal
• Isolation from social interactions
• Development of idiosyncratic thoughts and behavior
Schizophrenia: Example
• https://www.youtube.com/watch?v=bWaFqw8XnpA
Discussion
How can we ameliorate the stigma associated with mental illness?
What hurdles would such ideas face in their implementation?
Concluding Remarks
• Mental illness is ubiquitous
• Mental illnesses exist at the extremes
of normal behavior
• Our social context can influence the
illness stigmatization
• We have no specific neural bases for
many diagnoses in mental health.
Behavioral diagnoses frequently
overlap. How can we know what’s
really going on with these patients.