Lecture 1 - Intro

Question 1

Psychiatries 3 Focuses

(Depression as an example)

Answer 1

1. Diagnosis: Clinically significant distress/impairment
2. Treatment: Serotonin enhancing drugs
3. Mechanism: Low serotonin in forebrain region.

Question 2

Emil Kraeplin

Answer 2

• Argued we can’t make a fundamental distinction between normal and morbid mental states
• Safest foundation is finding pathological anatomy, but this is not always possible with mental illnesses

Question 3

DSM 1

Answer 3

• Published in 1952
• Psychoanalysis was the major thearpy
• Neuroses was another prominant theme
• Homosexuality = sociopathic personality disturbance
• Dimensional approach
• In DSM depression was proportional to the actual stress in people’s lives but based on an intuitive weighing

Question 4

Psychoanalysis

Answer 4

• Themes: events in early childhood, importance of subconscious (on irrational drives), Neuroses
• Defence mechanisms protect against drives

Question 5

Dimensional Approach

Answer 5

• Disorders can happen anywhere on a continuum
• Assessed by evaluating symptom severity
• Also based on frequency in the population
• Used in DSM 1 and 2

Question 6

Removing Homosexuality from DSM

(Hooker experiment)

Answer 6

• Gave homosexual/heterosexual men 3 projective personality tests (like Rorschach)
• Experts could not discern between the groups
• Occured in 1974

Question 7

DSM-3

(Problems and Solutions)

Answer 7

• Each mental disorder is conceptuatlized as clinically significant which is typically associated with pain, distress or impairment. This impairment is also a disturbance between the individual and society
  
  • Describes a mental trait as a disorder
• Now uses Categorical Approach

Problems

• Low reliability was found in DSM-2 (non-agreement between different clinicians)
• Psychoanalysis is vague/unscientific

Solutions

• Created checklists
• No assessment for symptoms in relation to situational context
• Made situational context part of checklist

Question 8

Categorical Approach

Answer 8

• Disorders assessed by meeting/passing criteria checklist
  
  • They predefine what is disorder based on the checklist
• Used in DSM 3-5

Question 9

Lifetime and 12-Month Prevelance of DSM3

(How common, which and solution)

Answer 9

• 50% of respondents reported at least 1 lifetime disorder
• 30% reported at least 1 12-month
• Most common were depression, alcohol dependence, social/simple phobia
• Solution: Standardized methods to 1) reduce discrepancies in prevalance rates between similar population surveys and 2) differentiate clinically important disorders from less severe ones
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Question 10

DSM-4

(and new prevalance rates)

Answer 10

• Clinical signifiance added to diagnoses.
  
  • E.g. requires “clinically significant distress or impairment”
• Sets depression as “symptoms cause significant distress or impairment to important areas of functioning”
  
  • Way too broad
• Prevalance: Anxiety (28.8%), mood (20.8%), impulse control (24.8%), substance use (14.6%)
  
  • ANY (46.4%)
  • Almost half of college studies had a disorder in the past year
• Depression: Distress is virtually redundant with symptoms of persistent sadness, even in the abscence of major depression
  
  • Doesn’t help to narrow down the population.

Question 11

Depression

Answer 11

• Very common, 30-50% lifetime prevalance.
• The bereavement clause
  
  • Removed in the DSM-5 and is considered controversial. Some argue that it undermined rather than increased conceptual valididty and usefulness
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Question 12

DSM-5

Answer 12

• Non-disclosure agreements signed for these talks.
  
  • This is a problem, science requires transparency
  • They argued, discussions need to be frank so you have to have privacy

Question 13

Controversies in Psychiatry

Answer 13

• 1) Psychiatrists were given money from drug companies for years and never reported it
  
  • They were involved in the development of drugs for them.
• 2) Psychiatrists publish selectively on the influence of anti-depressants (94% selected are published, but 50/50 with unpublished)

Question 14

Summary

Answer 14

• Research should focus on neurological mechanisms to improve diagnostics and treatmeant
• Diagnostic criteria and treatments are poor.
  
  • Big pharma spinning efficacy of treatments through publication bias, concealing ties with researchers and ghost writing
• Criticisms are not fringe
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