1
Q
Psychopathology
A
The scientific study of mental disorders
- characteristics/diagnostic criteria
- etiology/theoretical models (why occur)
- epidemiology (who is affected)
2
Q
What is abnormal behavior?
A
- Deviant: when behavior deviates from what is acceptable in a culture (e.g., not making eye contact)
- Maladaptive: behavior that interferes with a person’s ability to function effectively in the world (e.g., drinking problem)
- Causing personal distress: great mental strain and stress (e.g., anxiety)
- Dangerous
- Socially deviant? (not statistically the norm)
3
Q
Szasz article
A
- mental illness as “problems of life”
- argues that you can’t equate to the medical model and say mental illness is just like other illnesses
4
Q
Myths about abnormal behavior
A
- Abnormal behavior is always bizarre
- Normal and abnormal behavior are different in kind
- People with a mental disorder are dangerous
- Once people have a mental disorder, they will never get rid of it.
5
Q
Classification
A
putting things into categories
6
Q
Why do we classify?
A
- Need a nomological network for scientific progress
- Provides a common lexicon, constructs for research, and ways to track progress
7
Q
Video on DSM-5
A
- DSM is not a cookbook; must use clinical judgment
- DSM is not perfect
8
Q
Meehl article (cookbook)
A
- Argument that the data are better than our clinical judgment
- Basically saying we need to be more data-driven
- Rule-of-thumb method: generating personality descriptions from tests by looking at the profiles, calling to mind what the various test dimensions mean for dynamics, reflecting on other patients you’ve seen with similar patterns, thinking about the research literature, and combining these considerations to make inferences
- Cookbook method: any given configuration of psychometric data is associated with each facet (or configuration) of a personality description, and the closeness of this association is explicitly indicated by a number
9
Q
First mentions of mental disorders
A
Egyptian Ebers Papyrus, 1500 BCE
- Not diseases of the brain
- The scroll contains some 700 magical formulas and remedies. It contains many incantations meant to turn away disease-causing demons.
- conceived of mental and physical disease in much the same way
10
Q
Hippocrates
A
~400 BCE
- First to consider mental disorders as separate entities
- Mind-body division prominent during late Greco-Roman periods
- Viewed as imbalance of “humors” (bodily fluids - blood, yellow bile, black bile, & phlegm)
11
Q
For around 1000 years, mental illness attributed to ___
A
heresy, demonic possession
12
Q
Philippe Pinel
A
- 1798
- published Nosographie Philosophique: first example of modern classification
- regarded mental illness as the result of excessive exposure to social and psychological stresses and, in some measure, of heredity and physiological damage
- Melancholia, mania (insanity), dementia, idiotism
- Moral therapy: humane treatment of mentally ill
13
Q
“Era of systems”
A
- Late 19th century, early 20th century
- Kraeplin: “empirical dualism” - brain pathology assumed, classification based on observable signs/symptoms
- In opposition to the leading theories, Kraepelin did not believe that certain symptoms were characteristic for specific illnesses. Clinical observation led him to the hypothesis that specific combinations of symptoms in relation to the course of psychiatric illnesses allow one to identify a particular mental disorder.
14
Q
ICD history
A
- First ICD developed in mid-1800s - called “International List of Causes of Death”
- ICD-6 (more like what we use today) was approved in 1948
15
Q
DSM I
A
- 1952
- 3 broad groups of mental illness: 1) disorders with an organic basis, 2) disorders for which an organic basis is unknown, 3) mental retardation disorders
16
Q
DSM II
A
- 1968
- APA more closely collaborated with WHO
- Aimed to develop nomenclature more aligned with the rest of medicine
17
Q
DSM III
A
- 1980
- More thorough descriptions; explicit symptom criteria
- Moved away from theoretical/etiological approaches
- Categorical approach took shape
18
Q
WHO’s ICD
A
- “A standard diagnostic tool for epidemiology, health management, and clinical purposes”
- Diagnostic codes used by physicians
- Most insurance companies use ICD codes
- ICD-10 was approved in 1990; the U.S. adopted ICD-10 in October 2015
- ICD and DSM do not always correspond perfectly
- ICD covers all conditions – not just mental health
19
Q
NIH Research Domain Criteria (RDoC)
A
- “An attempt to create a new kind of taxonomy for mental disorders by bringing the power of modern research approaches, genetics, neuroscience, and behavioral science to the problem of mental illness”
- Matrix where the rows represent functional constructs…constructs are then in turn grouped into higher-level domains of functioning and social behavior
- Effort to get away from diagnostic categories and move towards underlying process, etc.
- Dimensional
20
Q
5 Domains of RDoC
A
1) Negative Valence System: responses to aversive situations or context (fear, anxiety, loss)
2) Positive Valence System: responses to positive motivational situations or contexts (reward seeking, consummatory bx, reward/habit learning)
3) Cognitive Systems: various cognitive processes (attention, perception, memory, language)
4) Systems for social processes: mediate responses to interpersonal settings of various types, including perception and interpretation of others’ actions (attention, attachment, social communication)
5) Arousal/Regulatory Systems: generate activation of neural systems as appropriate for various contexts (balance, sleep)
21
Q
Problems with Classification: Medical Model
A
Medical Model: mental disorders are diseases
- some evidence, but some problems too
- categories not always accurate
- severity of symptoms not a focus; more concerned about whether symptoms are there or not
- symptoms tend to be nonspecific
- foster dependence on professionals?
- individual differences given little attention
22
Q
Problems with Classification: Behavioral Model
A
Behavioral Model: mental disorders are learned
- some evidence and validity, but problematic in other ways
- Schizophrenia, Autism, ADHD, Bipolar, and others biologically based, NOT learned; ignores biological influences
- Tx is symptom-focused and ignores broader systematic factors
23
Q
What’s needed for a good classification system?
A
- Reliable and valid
- Measurable and testable
- Hierarchical
- Usually developed bottom-up
- Needs meaningful units of measurement
- Reflect general patterns, not unique features
- Avoidance of value judgments
24
Q
Equifinality
A
Many etiological pathways may lead to the same disorder (ex - two people with depression who have different histories)
25
Multifinality
A given etiological variable, or set of variables, can lead to a variety of outcomes (ex - two people with traumatic experience but only one has PTSD)
26
Ways to define abnormal behavior
- Statistical deviance: can be useful, but rare does not equal abnormal
- Value judgments, morality: all tend to produce less than ideal results
Harmful dysfunction: pretty much the DSM's approach
27
Categorical
- Discrete constellations or syndromes; have it or don't have it
- What about borderline cases? Overlap of symptoms?
- Few cases are pure, so comorbidity is common
28
Dimensional
- Axes of deviance/dysfunction are used to describe abnormality
- More flexible and can be more accurate, but cumbersome
- Which axes should be used and are there limits to dimensions?
- Spectrums
29
Prototypical
- "Ideal form" made of distinctive features, though, perfect fit not required
- Allows for heterogeneity
- DSM-IV and 5 described as prototypical
30
Diagnosis
Applying a label that identifies a disorder or illness
31
Timeline of DSM-5
1999-2001: Development of Research Agenda
2002-2007: APA/WHO/NIMH DSM-5/ICD-11 Research Planning conferences
2006: Appointment of DSM-5 taskforce
2007: Appointment of workgroups
2007-2011: Lit review and data re-analysis
2010-2011: 1st phase of Field Trials (ended July 2011)
2011-2012: 2nd phase Field Trials (began Fall 2011)
July 2012: Final draft of DSM-5 for APA review
May 2013: Publication date
32
DSM-5 Development
- "Categorical system does not capture clinical experience or important scientific observations"
- Developed 13 diagnostic work groups to oversee development
33
Guiding Principle of DSM-5
1) DSM-5 is intended to be a manual to be used by clinicians and revisions must be feasible for routine clinical practice
2) Recommendations for revisions should be guided by research evidence
3) Where possible, continuity should be maintained with previous editions of DSM
4) No a priori constraints should be placed on the degree of change between DSM-IV and DSM-5
34
Developing and testing recommendations for change
- Work groups reviewed lit base and examined inconsistencies in current system
- Recommendations made, discussed, and examined via field trials
- ---used kappa reliability estimates
- ---divided into 2 designs: large medical/academic settings & routine clinical practices
35
Field Trials
- Patients were assessed twice by two separate clinicians, blind to each others' conclusions
- Kappa reliability estimates: came out all over the place, ranging from unacceptable to very good
36
Review of Proposed Changes
- Posted proposed changes online in 2010, 2011, and 2012 and allowed feedback from general public
- Over 13,000 signed comments
- Numerous meeting to discuss changed; approved in Dec. 2012
37
Focus on DSM-5 Changes
- DSM-5 striving to be more etiological (but difficult because disorders caused by complex interaction of multiple factors, etc.)
- The diagnostic groups have been reshuffled
- Dimensional component to the categories
- Emphasis on developmental adjustment criteria
- New disorders considered and older disorders to be deleted
38
DSM-5 Structure
Section I: DSM-5 Basics (Intro)
Section II: Diagnostic Criteria and Codes
Section III: Emerging Measures and Models
- Conditions for further study
Appendix
39
DSM-5 Groups
1) Neurodevelopmental disorders
2) Schizophrenia and psychotic disorders
3) Bipolar and related disorders
4) Mood disorders
5) Anxiety disorders
6) Disorders related to environmental stress
7) Obsessive compulsive spectrum
8) Somatic symptom disorder
9) Feeding and eating disorder
10) Sleep disorders
11) Disorders of sexual function
12) Antisocial and disruptive disorders
13) Substance abuse-related disorders
14) Neurocognitive disorders
15) Personality disorders
16) Paraphilias
17) Other disorders
40
Broad Changes to DSM-5
- No more multiaxial diagnosis
- Replaced by dimensional component to diagnostic categories
- Developmental adjustments added to criteria
- Make categories more sensitive to gender and cultural differences
- Diagnostic codes now alphanumeric
- No more NOS labeling and attempted for specificity with the dimensional categorization
41
Principal Diagnosis and Reason for Visit
- Principal Diagnosis (inpatient): responsible for occasioning the admission of the individual
- Reason for visit (outpatient): condition that is chiefly responsible for ambulatory care medical services received during visit
- Principal diagnosis listed first, except if mental illness due to general medical condition
- Additional diagnoses listed in order of importance
42
Forensic Considerations
- Definition of mental disorder only meant to meet needs of clinicians and researchers
- Use of DSM by those who are insufficiently trained is not advised
- Info in DSM can "assist legal decision makers in their determinations"
- Always risk of misinterpretation
43
Freedman et al. article (field trials)
- DSM-5 Field Trials: Independent interviews by two different clinicians trained in the diagnoses, each prompted by a computerized checklist, assessment of agreement across different academic centers, and a pre-established statistical plan are now employed for the first time
- Kappas reported in article: range from unacceptable to very good
- ---questionable reliability for MDD
- ---mixed anxiety and depression has a kappa of 0
- ---most personality disorders didn't do well
- ---new childhood disorder: DMDD - more reliably assessed in the inpatient setting where it was examined
- ---other new or redefined diagnoses have good reliability
- Field trials involved diagnosis after a single patient interview with minimal collateral information; Single diagnostic interview does not capture the essence of what is happening to a patient
Psychopathology
flashcards
Decks in class (16)
# Cards
-
Introduction43
-
Neurodevelopmental Disorders66
-
Disruptive, Impulsive-Control, and Conduct Disorders31
-
Elimination Disorders3
-
Schizophrenia Spectrum & Other Psychotic Disorders37
-
Mood Disorders38
-
Anxiety Disorders31
-
Neurocognitive Disorders22
-
Somatic Disorders16
-
Obsessive Compulsive and Related Disorders24
-
Trauma-Related Disorders25
-
Dissociative Disorders12
-
Feeding and Eating Disorders29
-
Sexual Dysfunction, Paraphilias, and Gender Dysphoria49
-
Substance-Related and Addictive Disorders33
-
Personality Disorders33
