Psychopathologies and Their
Treatments
Psychopathology
• Pathology from ‘pathos’ = suffering, and
‘logos’ = study:
– The study of the essential nature of disease.
• Disease:
– Dis-ease: Not at ease, something that
impairs functioning.
• Abnormal:
– Away from (‘ab-’) or deviating from, the
normal or average.
Psychopathology
• Abnormal behaviour:
– Behaviour that is other than normal or
markedly irregular.
– Not necessarily statistically abnormal, often
just painful or involving suffering.
• Psychopathology:
– Study of abnormal behaviour.
– Study of the psychological and behavioural
dysfunction, distress, and disability.
– Such dysfunction, distress, or disability itself.
Psychopathology
Sources
• Somatogenic (soma=body and
genesis=beginning)—from the body.
– e.g., general paresis as a result of syphilis,
disordered brain chemistry
• Psychogenic (psyche=mental and
genesis=beginning)—from the mind.
– e.g., hysterical blindness, glove anesthesia
Structuring Mental Disorders
UNDERLYING
PATHOLOGY
Somatogenic
Psychogenic
SYMPTOMS
Primarily Organic
Measles,
tuberculosis,
influenza, common
cold.
Psychophysiological
disorders such as
glove anesthesia,
hysterical blindness.
Primarily Mental
General paresis,
possibly schizophrenia
and bipolar affective
disorders.
Anxiety disorders such
as phobias, depression,
dissociative disorders.
Psychopathology
Pathology Model
• Mental disorders can be analyzed as for any
disease.
• Any disease is a collection of symptoms that
together form a syndrome.
– Influenza is a syndrome with symptoms such as
runny nose, cough, fever, muscles aches.
– SARS (sudden acute respiratory syndrome) is a
syndrome with symptoms of sudden onset, high fever,
respiratory difficulty.
– Bird flu is a syndrome with symptoms such as runny
nose and conjunctivitis (inflamed eyes).
• Assumes an underlying pathology that is
responsible for the disorder.
Psychopathology Models
Four Main Perspectives
Biomedical View
Theoretical Cause of
Abnormality
A process similar to that
underlying physical illness.
Somatogenic causes
(physical factors).
Theoretical Cure
Medication or surgery by
psychiatrist or neurosurgeon,
e.g., antidepressants, electroconvulsive therapy (ECT),
insulin shock therapy, surgery.
Pathology Models
Four Main Perspectives
Psychodynamic View
Theoretical Cause of
Abnormality
Internal, psychological,
unconscious conflict
(psychological factors).
Theoretical Cure
Psychotherapy to
develop insights into
underlying unconscious
conflicts.
Pathology Models
Four Main Perspectives
Behavioural View
Theoretical Cause of
Abnormality
Maladaptive learning or
faulty habits and
thoughts (cognitivebehavioural factors).
Theoretical Cure
Learning new responses
and thoughts. Usually
treated by cognitive or
behaviour therapists.
Pathology Models
Four Main Perspectives
Diathesis- Stress View
Theoretical Cause of
Abnormality
Theoretical Cure
Predisposition based on
genes or early learning
plus excessive stress
prior to development of
the disorder.
Reduction of stress and
learning new coping
mechanisms for times
stress arises in the
future.
DSM-IV
• Diagnostic and Statistical Manual – IV.
• A system of classification for mental
disorders, widely used in North America.
• Lays out each disorder as a specific
syndrome (collection of symptoms) that
serve as identifying features for the
physician and clinician.
DSM-IV Classification Scheme:
Five Major Axes
• Each mental disorder is classified on five
major axes (categories).
• Presents a full picture of the individual and
their disorder.
• Includes not only symptoms but other
contributing factors, including mental
retardation, physical symptoms, life
circumstances, and evaluation of stress.
DSM-IV Classification Scheme:
Five Major Axes
• AXIS I: Major Psychological Disorders
– Description of symptoms of major clinical disorders
• AXIS II: Mental Retardation & Personality Disorders
– Antisocial personality disorder, borderline personality disorder,
paranoid personality disorder.
• AXIS III: Accompanying Physical Disorders
– Cancer, epilepsy, obesity, Parkinson’s disease, Alzheimer’s
disease.
• AXIS IV: Source and Severity of Stress
– Unemployment, divorce, legal problems, homelessness, poverty,
stressful personal relations..
• AXIS V: Assessment of Functioning
– Global Assessment of Functioning (GAF): Uses a scale from 1 to
100 with 1 being very poor functioning, harmful to self, and 100
superior functioning.
DSM-IV Classification Scheme:
A Single Individual with Alcoholism
• AXIS I: Major Psychological Disorders
– Major depressive disorder.
– Alcohol dependence.
• AXIS II: Personality Disorders
– Personality characteristics that impair normal functioning and
involve psychological stress (e.g., Antisocial personality disorder,
Borderline personality disorder).
• AXIS III: Accompanying Physical Disorders
– Alcoholic cirrhosis of the liver.
• AXIS IV: Source and Severity of Stress
– Divorce, loss of job—severe stress.
• AXIS V: Assessment of Functioning
– Global Assessment of Functioning (GAF) is 30, which indicates a
serious impairment of functioning.
AXIS I
Major Psychological Disorders
• Disorders of Infancy, Childhood, and
Adolescence
– Speech disorders, phobias, hyperactivity, autism,
delayed development.
• Organic Mental Disorders
– Result from deterioration of the brain (e.g.,
Altzheimer’s disease, exposure to toxic metals,
chemicals).
• Substance Abuse Disorders
– Problems that result from abuse of drugs such as
alcohol, street drugs, or medication.
AXIS I
Major Psychological Disorders
• Schizophrenia (Psychoses)
– Characterized by hallucinations, bizarre perceptions,
loss of touch with reality, illogical thoughts.
• Mood Disorders (Disorders of Affect)
– Characterized by extremes of emotional state.
– Severe depression (Depression) or excessive elation
(Manic disorder), or alternation between the two
(Bipolar disorder).
– Hypermania vs hypomania.
• Anxiety Disorders
– Repetitive persistent thoughts accompanied by
ritualistic behaviour (Obsessive-compulsive disorder),
phobias, attacks of extreme anxiety.
AXIS I
Major Psychological Disorders
• Somatoform Disorders
– Characteristized by physical symptoms
(e.g.,blindness, pain, paralysis) that have no physical
cause (e.g., Glove anesthesia).
• Factitious Disorders
– Characterized by fake mental or physical disorders
(e.g., Munchausen syndrome—frequent
hospitalization or surgery for nonexistent illness).
• Dissociative Disorders
– Person becomes detached from identity (e.g.,
Amnesia, Dissociative Identity Disorder).
AXIS I
Major Psychological Disorders
• Sexual Disorders
– Disorders of sexual functioning (e.g., fetishes,
Impotence, Sexual Identity Disorders).
• Eating Disorders
– Characterized by disordered eating patterns
(e.g., Anorexia, Bulimia).
• Sleep Disorders
– Characterized by sleeping problems (e.g.,
Insomnia, Sleep Walking, Narcolepsy).
AXIS I
Major Psychological Disorders
• Impulse Control Disorders
– Characterized by inability to control impulses
(e.g., fire setting, stealing, gambling).
• Adjustment Disorders
– Characterized by difficulty adjusting to
significant life events such as death of a
parent or child, job loss, family problems.
Frequency of Most Common Mental
Disorders
Eating disorders
Schizophrenic
disorders
Personality
disorders
Mood disorders
Anxiety
disorders
Substance
abuse
0
5
10
15
Percentage of Population
20
Treatment of Psychopathologies
• Biological Therapies (requires an MD)
– Drug Therapies
– Psychosurgery
– Electroconvulsive Therapy (ECT)
• Psychotherapy
– Psychoanalysis & Psychodynamic Therapies
– Behaviour Therapy
– Cognitive Therapy
– Humanistic Therapy
Treatment of Psychopathologies
Who Can Help?
• Psychiatrist (MD with specialist training mental
disorders).
• Psychoanalyst (MD, PhD, PsyD): Uses the
psychodynamic approach. Not necessarily an MD.
• Clinical Psychologist (PhD, PsyD): Some or all
therapies except drug interventions.
• Psychiatric social worker (MSW): Offering individual
and family therapy, counselling, and community work.
• School psychologist (MA,PhD, EdD): Counselling and
educational testing related to educational issues.
• Counselling psychologist (MA, PhD, EdD): Personal
and vocational counselling, therapy, rehabilitiation.
• Psychiatric nurse (RN): Counselling, therapy, care of
hospitalized mental patients.
• Paraprofessional (No specific qualifications): Provides
support, may lead groups, offer workshops.
How the Drugs Work:
Synaptic Transmission
How the Drugs Work
• Agonists: Increase the effect of
neurotransmitters.
• Antagonists: Decrease the effect of
neurotransmitters.
Drug Therapies:
How They Work
• Some drugs stimulate or inhibit the
production of one neurotransmitter (e.g.,
dopamine), therefore affect only one set of
neurons.
– May stimulate constant production (e.g., black
widow spider venom stimulates acetylcholine
production leading to constant cramping).
– May inhibit production (e.g., botulism prevents
release of acetylcholine, leads to paralysis).
Drug Therapies:
How They Work
• Some affect postsynaptic receptor
molecules by duplicating the effect of
transmitters.
– May stimulate postsynaptic neurons (e.g.,
nicotine stimulates acetylcholine receptors in
the brain that create a pleasurable sensation
when they fire).
– May inhibit postsynaptic neurons (e.g., curare
turns off acetylcholine receptors in muscle
cells, leading to paralysis.
Drug Therapies:
How They Work
• Blocks receptor molecules.
– Neurotransmitter is produced but is not taken
up by the postsynaptic neuron (e.g.,
antisychotic medications).
• Interfere with the reuptake of transmitters
in the presynaptic neuron after their
release.
– Increases effect of the transmitter substance
(e.g., cocaine, speed).
– Effect is usually brief.
Drug Therapies:
Impact on Behaviour
• Sedatives
– Have depressive effect on the body, causing
relaxation or even unconsciousness.
– Several families: barbiturates (downers), tranquilizers
(benzodiazepines), alcohol.
– Used to relieve anxiety, create relaxation, for sleep.
– Some very addicting and line between enough and
too much is very narrow.
– Very dangerous when combined because effects are
more than doubled.
Drug Therapies:
Impact on Behaviour
• Stimulants
– Stimulate nervous system and may have pleasurable
effects.
– Can be addicting because of this.
– Cocaine and amphetamines are in this class, blocking
reuptake of dopamine and prolonging its effects
– Used to treat narcolepsy and some forms of
hyperactivity.
– Excessive use produces symptoms of serious mental
illness.
Drug Therapies:
Impact on Behaviour
• Hallucinogens
– Alter sensations, perceptions, emotions,
thinking, self-awareness (e.g., marijuana,
LSD, magic mushrooms).
– Effects are unpredictable.
– Seem to block release of serotonin, which is
present when we sleep and is involved in
dreaming.
– Results in ‘dreaming’ while awake.
– Has occasionally been used in therapy.
Drug Therapies:
Impact on Behaviour
• Antipsychotics and antidepressants
– Dopamine blockers can relieve psychotic
symptoms (e.g.,chlorpromazine).
– Antidepressants (e.g., Prozac) can relieve
depression.
• Relieves feelings of extreme sadness and can
prevent suicide attempts.
Using the Pathology Model:
Exploring a Disorder
• Syndrome
– Signs and Symptoms.
• Proximate Causes (Underlying Pathology):
– What is out of order?
– Helps define treatment.
• Ultimate Causes
– Diathesis (predisposition)
– Stress
One Major Psychological
Disorder: Schizophrenia
• Syndrome
– Disordered cognitions.
– Withdrawal from others.
– Hallucinations.
– Delusions.
– Emotional reactivity.
– Disordered behaviour related to symptoms
above.
Characteristics of Schizophrenias
• Syndrome
– Disordered cognition
• Unable to maintain logical flow of thoughts
• Difficulty in repressing irrelevant thoughts.
– Withdrawal from others
• Fewer opportunities to do reality checking.
– Delusions
• Faulty perceptions about the world (e.g.,
misinterpreting actions of others, paranoid, feel
they are the focus of others thoughts.
– Hallucinations
• Perceptual experience without sensory input.
• Primarily auditory.
One Major Psychological
Disorder: Schizophrenia
• Syndrome
– Emotional reactivity
• Overreacts to input from others.
• Emotions may be inappropriate.
• May become hyper vigilant or gradually become
almost indifferent.
– Disordered behaviour that accompanies the
disordered thoughts and emotions.
One Major Psychological
Disorder: Schizophrenia
• Proximate Causes
– Believed to be some kind of somatogenic
pathology.
– Could be malfunction of neurotransmitter
systems:
• High activity in dopamine circuits suggests
problem with dopamine.
• Could be result of excess of dopamine, or
oversensitivity to dopamine, or result of other
neurotransmitters affecting dopamine system.
One Major Psychological
Disorder: Schizophrenia
• Proximate Causes—If neurotransmitter system
is disturbed:
– Dopamine hypothesis: Excess dopamine or an
oversensitivity to dopamine.
• Treatment with classical antipsychotics that block
dopamine receptors (e.g.,chlorpromazine, halperidol)
reduces symptoms.
• The better they block the better they work. Have calming
effect and later reduce hallucinations and delusions.
• These drugs have fairly serious side effects (sedation,
dizziness, endocrine effects, and other more serious
effects).
One Major Psychological
Disorder: Schizophrenia
• Proximate Causes—If neurotransmitter system
is disturbed:
– Dopamine-serotonin interaction hypothesis: Other
neurotransmitters affect dopamine system.
• Treatment with atypical antipsychotics, e.g., clozapine,
that appear to block both dopamine and serotonin
receptors are more effective, particularly for those who do
not respond to classical antipsychotics.
• Seem to reduce both positive and negative symptoms
better and have fewer of the more severe side effects.
One Major Psychological
Disorder: Schizophrenia
• Proximate Causes
– Could be some kind of structural defect in the
brain:
• MRIs show larger ventricles in males with
schizophrenia than in males without schizophrenia.
• Suggests either a loss (cerebral atrophy) or
genetic deficiency in brain tissue.
• However, this is not predictive of the disorder
because many with larger ventricles are not
affected.
One Major Psychological Disorder:
Schizophrenia
One Major Psychological
Disorder: Schizophrenia
• Proximate Causes
– Could be some kind of combination of these
things:
• No perspective can explain all cases of
schizophrenia.
• Leads to multiple syndrome hypotheses.
• Crow’s two syndrome hypothesis: positive
symptoms (increase from normal) and negative
symptoms (decrease from normal)
• Three syndrome hypothesis: two types of positive
symptoms—psychotic and disorganized, plus
negative.
One Major Psychological
Disorder: Schizophrenia
• Ultimate Causes
– Heredity
• Twin studies—median concordance rate for identical twins,
even reared in different families, is three times that for
fraternal twins.
• Adoption studies—adoptees with biological relatives who
have chronic schizophrenia are much more likely to have
chronic schizophrenia than those who do not have relatives
with the disorder.
• Family studies—risk to relatives of those who have the
disorder is higher than to those who do not have the disorder.
• All suggests that the closer the genetic relationship the
greater the risk for schizophrenia.
Genetic Risk Factors in Developing
Schizophrenia
50
46
Percentage of Risk
45
40
35
30
25
20
14
15
10
10
5
3
1
0
Identical
Twins
Fraternal
Twins
Siblings
Relationship
Nephew or Unrelated
niece
individual
One Major Psychological
Disorder: Schizophrenia
• Ultimate Causes
– Prenatal Environment
• There must be more than heredity because
concordance rates between identical twins is not
100%.
• Complications during pregnancy and delivery are
suggested to perhaps influence a genetic
predisposition.
• An infectious agent, such as influenza, during
pregnancy may be a factor. Children of mothers
infected during middle of pregnancy seem to be at
increased risk.
One Major Psychological
Disorder: Schizophrenia
• Ultimate Causes
– Social Environment
• Incidence of schizophrenia is higher in poorer
areas of cities.
• Those who have higher socioeconomic status are
less at risk.
• Two possible interpretations of this:
– The social circumstances lead to increased stress, and
thus these people are more at risk.
– Alternatively, those who have the disorder will be less
successful and drift to the bottom of the social hierarchy,
downward drift theory.
One Major Psychological
Disorder: Schizophrenia
• Major Treatment
– Antipsychotic drugs:
• Make it possible for individual to resume some
aspect of normal life.
• Hospitalization is often no longer necessary for
more than short periods.
– Other therapies must accompany this:
• With the control provided by the drug it can
possible for the individual to restructure their lives.
• Many different approaches can be helpful: groups
therapy, cognitive-behavioural therapy, even
psychodynamic therapy.