L9: Mental health Flashcards
(16 cards)
abnormal psychology
Prevalence
30% of adults and 17% of children/adolescents in the U.S. experience serious psychological issues yearly.
Leading cause of disability worldwide (NAMI, 2019; SAMHSA, 2019).
People with psychological disorders are often stigmatized by the people around them, resulting in shame and embarrassment, as well as prejudice and discrimination against them. Thus the understanding and treatment of psychological disorder has broad implications for the everyday life of many people.
defining abnormality
Defining Abnormality: The “Four Ds”
Because there are no clear biological diagnoses, psychological disorders are instead diagnosed on the basis of clinical observations of the behaviors that the individual engages in. These observations find that emotional states and behaviors operate on a continuum, ranging from more “normal” and “accepted” to more “deviant,” “abnormal,” and “unaccepted.” The behaviors that are associated with disorder are in many cases the same behaviors we that engage in our “normal” everyday life. Washing one’s hands is a normal healthy activity, but it can be overdone by those with an obsessive-compulsive disorder (OCD). It is not unusual to worry about and try to improve one’s body image, but Robert’s struggle with his personal appearance, as discussed at the beginning of this chapter, was clearly unusual, unhealthy, and distressing to him.
Deviance: Unusual, bizarre, or statistically rare behaviour.
Judged against social norms and cultural context.
Changes over time: e.g., homosexuality removed from DSM in 1974.
Distress: Suffering or upset caused to the person.
Must be present in most cases (e.g., Alberto case).
Dysfunction: Interferes with daily functioning (e.g., social, occupational).
E.g., quitting job, isolating from family.
Danger: Risk of harm to self/others.
Rare feature (Ghiasi & Singh, 2019).
eccentricity vs abnormality
Eccentrics may show unusual behaviour without dysfunction or distress.
Common eccentric traits (Weeks, 2015): creativity, nonconformity, humour, idealism, etc.
what is a mental disorder
What Is a Mental Disorder? (APA, 2020)
Clinically significant disturbance in behaviour/emotion/function.
Involves distress, impairment, or risk.
Not a culturally expected response (e.g., grief).
A psychological disorder is an ongoing dysfunctional pattern of thought, emotion, and behavior that causes significant distress, and that is considered deviant in that person’s culture or society (Butcher, Mineka, & Hooley, 2007). Psychological disorders have much in common with other medical disorders. They are out of the patient’s control, they may in some cases be treated by drugs, and their treatment is often covered by medical insurance. Like medical problems, psychological disorders have both biological (nature) as well as environmental (nurture) influences. These causal influences are reflected in the bio-psycho-social model of illness (Engel, 1977).
The bio-psycho-social model of illness is a way of understanding disorder that assumes that disorder is caused by biological, psychological, and social factors (Figure 12.1.1
). The biological component of the bio-psycho-social model refers to the influences on disorder that come from the functioning of the individual’s body. Particularly important are genetic characteristics that make some people more vulnerable to a disorder than others and the influence of neurotransmitters. The psychological component of the bio-psycho-social model refers to the influences that come from the individual, such as patterns of negative thinking and stress responses. The social component of the bio-psycho-social model refers to the influences on disorder due to social and cultural factors such as socioeconomic status, homelessness, abuse, and discrimination.
diagnostic systems
Psychologists have developed criteria that help them determine whether behavior should be considered a psychological disorder and which of the many disorders particular behaviors indicate. These criteria are laid out in a 1,000-page manual known as the Diagnostic and Statistical Manual of Mental Disorders (DSM), a document that provides a common language and standard criteria for the classification of mental disorders (American Psychiatric Association, 2000)1. The DSM is used by therapists, researchers, drug companies, health insurance companies, and policymakers in the United States to determine what services are appropriately provided for treating patients with given symptoms.
DSM-5 (APA)
ICD-11 (WHO)
Categorize disorders by symptoms, severity, course, etc.
Informed by etiology and neurobiology.
Improve diagnosis, reliability, and clinical utility.
DSM Evolution Highlights
From psychoanalytic to atheoretical and empirical.
Increased number of disorders (106 → 298).
Added clinical significance, comorbidity focus.
Dropped multi-axial approach.
DSM-5 Chapter Headings (Selected)
Anxiety, Mood, Psychotic, Personality, Neurodevelopmental, Somatic, Eating, Trauma-related, OCD-related.
Critics of diagnostic systems like the DSM and ICD argue that these frameworks suffer from poor reliability and validity, often leading to inconsistent diagnoses. They highlight an overemphasis on biological explanations for mental disorders, which can neglect important social and psychological factors that contribute to a person’s experience. Additionally, the systems are criticized for high levels of comorbidity, where individuals meet criteria for multiple disorders, raising questions about the distinctiveness of diagnostic categories. Concerns about cultural bias and diagnostic discrimination have also been raised, as these systems are often based on Western norms that may not translate accurately across different cultures. Finally, critics argue that labeling individuals with psychiatric diagnoses can lead to stigma and disempowerment, potentially reinforcing negative self-perceptions and limiting autonomy.
Although the DSM has been criticized regarding the nature of its categorization system (and it is frequently revised to attempt to address these criticisms), for the fact that it tends to classify more behaviors as disorders with every revision (even “academic problems” are now listed as a potential psychological disorder), and for the fact that it is primarily focused on Western illness, it is nevertheless a comprehensive, practical, and necessary tool that provides a common language to describe disorder. Most U.S. insurance companies will not pay for therapy unless the patient has a DSM diagnosis. The DSM approach allows a systematic assessment of the patient, taking into account the mental disorder in question, the patient’s medical condition, psychological and cultural factors, and the way the patient functions in everyday life.
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rdoc
New Paradigm: RDoC
The RDoC framework was initiated to create a set of research principles for investigating mental disorders. Its goal is to foster new research approaches that will lead to better diagnosis, prevention, intervention, and cures.
Traditionally, mental illnesses have been conceptualized as disorders that are diagnosed based on the number and type of symptoms and the presence of distress or impairment. Such a view of mental disorders – and the resulting diagnostic systems – provides benefits such as reliability and ease of diagnosis across a variety of contexts. However, this approach has come at the cost of numerous tradeoffs including the following:
Research based on diagnostic categories can be affected by problems with heterogeneity because of the varied ways people can qualify for a symptom-based disorder diagnosis. Two people can, in some cases, be diagnosed with the same disorder despite having few (or sometimes no) symptoms in common. This makes it difficult for researchers to pinpoint particular aspects of disorders because psychological and/or neurobiological mechanisms may differ greatly among patients who share little to no specific symptoms.
Also, patients who meet criteria for one mental disorder often tend to meet criteria for multiple other mental disorders – a phenomenon known as comorbidity, which has led to further heterogeneity. Researchers seeking to reduce heterogeneity often limit participants in clinical studies to individuals with a single, “pure” diagnosis by excluding those with comorbid disorders. This has led researchers to question whether too much emphasis has been placed on studying specific disorders in isolation from others, prompting concerns that dimensions common across mental disorders are not properly studied in mental health research.
Clinical criteria for defining a disorder, while created through expert practitioner consensus, are somewhat arbitrary. Research indicates that there are important similarities between those whose symptoms meet the criteria for a disorder versus those who just miss the cutoff for diagnosis due to fewer and/or less severe symptoms. To understand the full spectrum of mental health and illness, it is important to adopt dimensional conceptualizations. Therefore, using symptom counts to divide research subjects into two groups of “well” and “ill” may obscure important information about the ways in which psychopathology gradually emerges across development, how risk factors operate, and how quantitative outcomes of prevention and treatment trials can be implemented.
A related point is that diagnostic categories defined by a set of symptoms, by definition, reflect well-advanced problems that are more difficult to treat. The knowledge that developmental trajectories and environmental influences typically shift gradually toward psychopathology indicates that greater understanding of mechanisms across development have the potential to pre-empt disorders with appropriately developed interventions.
These problems, and others, suggest that in order to understand both the development and treatment of mental disorders, the field needs a comprehensive picture of typical and atypical brain and behavioral development across the lifespan. It is essential to find a way to increase knowledge concerning the biological, behavioral, and self-report components and mechanisms through which multiple and interacting mental-health risk and protective factors operate – a research framework that does not rely on disorder-based categories.
The RDoC initiative, launched in 2009, was the response to the growing awareness of these issues. The development of the RDoC framework was the collaborative effort of a core group of NIMH scientists and over 200 leading scientists from varied fields, who worked together to articulate key principles and incorporate the knowledge that formed the basis for the example constructs proposed during the early phases of RDoC. Since its inception, the project has grown into a significant initiative for NIMH and the field continues to refine and explore the research topics afforded by the flexibility of the RDoC framework.
Research Domain Criteria: Etiology-based classification.
Focus on dimensions not categories.
Includes biological, psychological, and environmental factors.
Aims to resolve heterogeneity, comorbidity, and sampling biases.
neurodiveristy movement
ChatGPT said:
The neurodiversity movement, coined by sociologist Judy Singer, views neurological differences—such as autism, ADHD, and dyslexia—as natural variations of the human brain, much like biodiversity in nature. Instead of seeing these conditions as disorders or abnormalities that need to be “fixed,” the movement emphasizes strengths rather than deficits and promotes acceptance of diverse ways of thinking and functioning.
This challenges traditional concepts of abnormality, which are often based on the idea that certain thoughts, behaviors, or traits deviate from a statistical or social norm and are therefore seen as “disordered” or “pathological.” The neurodiversity perspective argues that framing these differences as abnormal can be reductionist, stigmatizing, and disempowering, and instead advocates for inclusion, support, and societal adaptation.
psychological treatment
Psychological Treatment
Jerome Frank’s 3 Essential Features of Therapy:
Sufferer in distress.
Accepted healer with expertise.
Series of therapeutic contacts to produce change.
mood disorders
Mood (or affective) disorders are psychological disorders in which the person’s mood negatively influences his or her physical, perceptual, social, and cognitive processes. People who suffer from mood disorders tend to experience more intense—and particularly more intense negative—moods. About 10% of the U.S. population suffers from a mood disorder in a given year. Mood disorders can occur at any age, and the median age of onset is 32 years (Kessler, Berglund, Demler, Jin, & Walters, 2005). Recurrence of depressive episodes is fairly common and is greatest for those who first experience depression before the age of 15 years. About twice as many women suffer from depression than do men (Culbertson, 1997). This gender difference is consistent across many countries and cannot be explained entirely by the fact that women are more likely to seek treatment for their depression. Rates of depression have been increasing over the past years, although the reasons for this increase are not known (Kessler et al., 2003).
Major Depressive Disorder (MDD)
If the depression continues and becomes even more severe, the diagnosis may become that of major depressive disorder. Major depressive disorder (clinical depression) is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem and by loss of interest or pleasure in normally enjoyable activities. Those who suffer from major depressive disorder feel an intense sadness, despair, and loss of interest in pursuits that once gave them pleasure. These negative feelings profoundly limit the individual’s day-to-day functioning and ability to maintain and develop interests in life (Fairchild & Scogin, 2008).
8% of U.S. adults experience severe MDD annually; 20% at some point.
Higher prevalence in lower-income groups.
Onset typically at age 19; peak in late teens/early adulthood.
Diagnosis Criteria (DSM-5)
5+ symptoms for ≥2 weeks, including:
Depressed mood or anhedonia.
Plus: guilt, sleep/appetite change, fatigue, concentration issues, suicidality, psychomotor changes.
Depression
A low state marked by significant levels of sadness, lack of energy, low self-worth, guilt, or related symptoms.
Mania
A state or episode of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day
Major depressive disorder (unipolar depression)
Depression without a history of mania
Bipolar disorder
A disorder marked by alternating or intermixed periods of mania and depression, often chronic and lifelong condition that may begin in childhood.
Determining whether a person has bipolar disorder is difficult due to the frequent presence of comorbidity with both depression and anxiety disorders.
Mood disorders are known to be at least in part genetic, because they are heritable. (Berrettini, 2006; Merikangas et al., 2002). Neurotransmitters also play an important role in mood disorders. Serotonin, dopamine, and norepinephrine are all known to influence mood (Sher & Mann, 2003), and drugs that influence the actions of these chemicals are often used to treat mood disorders.
The brains of those with mood disorders may in some cases show structural differences from those without them. Videbech and Ravnkilde (2004) found that the hippocampus was smaller in depressed subjects than in normal subjects, and this may be the result of reduced neurogenesis (the process of generating new neurons) in depressed people (Warner-Schmidt & Duman, 2006). Antidepressant drugs may alleviate depression in part by increasing neurogenesis (Duman & Monteggia, 2006).
SYMPTOMS OF DEPRESSION
Cognitive Symptoms:
Hold extremely negative views of themselves: inadequate, undesirable, inferior (Scheffers et al., 2019).
Blame themselves for every unfortunate event, and rarely credit themselves for positive achievements.
Pessimism: nothing will ever improve, and they feel helpless to change any aspect of their lives. Likely to procrastinate.
Suicidal thinking (Schreiber & Culpepper, 2019).
Confused, unable to remember things, easily distracted, and unable to solve even the smallest problems.
In laboratory studies, depressed people do perform somewhat, but not extremely, more poorly than nondepressed people on tasks of memory, attention, and reasoning (Lyness, 2019). These difficulties may reflect motivational problems rather than cognitive ones.
Etiology of major depressive disorder
Origins of depression disorder may include:
Biological factors and interactions with environmental factors:
Genetic vulnerability
Aggregates within families
Moderate genetic influence (30-40%) (Flint & Kendler, 2014)
Diathesis-stress model:
Mental illness is more likely to occur in someone who has a genetic pre-disposition and is exposed to certain conditions
Why do some people experience adverse events but do not develop depression?
correlates of major depressive disorder: rigins of depression disorder may include:
Chemical imbalance (Kaltenboeck & Harmer, 2018)
Serotonin, noradrenaline
Neuroendocrine functioning
hypothalamic–pituitary–adrenal (HPA) axis, most notably subtle signs of cortisol hypersecretion
vasopressin, oxytocin or melatonin
Abnormalities in the immune system especially an increase in levels of inflammatory biomarkers
But: Beware of treatment – causation fallacy
🡺Depression is probably not necessarily due to a “chemical imbalance,” although many sorts of biochemical changes may be associated with depression.
antidepressant drugs
monoamine oxidase (MAO) inhibitors
tricyclics
second-generation antidepressants (selective serotonin reuptake inhibitors (SSRIs))
newer: Ketamine based drugs
“First truly new medication for depression” since
the approval of the second-generation
antidepressant Prozac in 1987 (Chen, 2019)
Alleviates depression very quickly
Increases the activity of the neurotransmitter
glutamate in the brain
Further drugs
MDMA/ecstasy and psilocybin not approved, but seem
to be effective in reducing depression
brain stumulation
Brain stimulation therapies are used for treatment-resistant depression and other mental health conditions. These interventions modulate brain activity through electrical or magnetic stimulation.
deep brain stimulation Brain stimulation: electroconvulsive therapy: Invasive
Induces seizures
Effective for the treatment of depression
But leads to memory loss
vagus nerve stimulation: Invasive
Pulse generator implanted under the skin of the chest
Electrical signals from the pulse generator
through the wire to the vagus nerve
Can bring significant relief in depression
Brain stimulation: transcranial magnetic stimulation (TMS) Non-invasive
Electromagnetic coil on the head
Can increase or decrease neuron activity
To treat depressed patients: target prefrontal areas
TMS targets only superficial brain areas
Reduces depression when it is administered daily
for 4-6 weeks (Kaster et al., 2020; Limori et al., 2019).
deep brain stimulation: Invasive
Pulse generator implanted under the skin
of the chest
Targets subgenual cingulate or other areas
Can reach deep brain areas
Promising findings
(Ramasubbu et al., 2020; Holtzheimer, 2019).
PSYCHODYNAMIC
psychodynamic model of depression: imilarity between clinical depression and grief (Freud and Abraham)
Series of unconscious processes is set in motion when a loved one dies
They direct all their feelings for the loved one, including sadness and anger, toward themselves
Grief worsens over time, and they develop clinical depression
Object relations theorists propose that depression results when people’s relationships — especially their early relationships — leave them feeling unsafe, insecure, and dependent on others
Studies have offered general support for the psychodynamic idea that major losses, especially ones suffered early in life, may set the stage for later depression. Research does not indicate that loss or problematic
early relationships are always at the core of depression
Yes, you can argue that the difficulty in falsifying the psychodynamic model of depression can reduce its reliability as a scientific theory. Here’s how you could frame your argument:
Reddy et al. (2024) meta analysis
Deep brain stimulation achieved 47% improvement in long-term depression scale scores, with an estimated time to reach 50% improvement of around 23 months. There were no significant subgroup effects of stimulation target, time of last follow-up, sex, age of disease onset, or duration of disease, but open-label trials showed significantly greater treatment effects than randomized controlled trials. Long-term (12-60 month) response and remission rates were 48% and 35%, respectively. The time course of improvement with active stimulation could not be adequately distinguished from that with sham stimulation, when available.
Conclusions: Deep brain stimulation produces significant chronic improvement in symptoms of treatment-resistant depression. However, the limited sham-controlled data do not demonstrate significant improvement over placebo. Future advancements in stimulation optimization and careful blinding and placebo schemes are important next steps for this therapy.
antidepressants
Mateychuk et al. (2020)
Since Berman et al.9 demonstrated a rapid antidepressant effect of intravenous ketamine, numerous studies have now replicated this finding. Multiple meta-analyses55–59 have now concluded that intravenous ketamine is effective as a rapid-acting antidepressant for major depressive episodes in both unipolar and bipolar depression, although one study suggested that there was a greater antidepressant effect size for unipolar depression than for bipolar.57 While several of these studies have supported claims that ketamine’s antidepressant effect lasts up to 7 days,55,56 other authors have suggested this to be true only for unipolar depression. One meta-analysis found that ketamine loses its effect in bipolar depression after day 3 or 4.58 Several RCTs have now looked at repeated infusions of six intravenous infusions over several weeks,60–62 but to date no long-term RCTs exist.
