Psychopathology
and
Treatment
Definition


Psychopathology
 Clinical term
 A disorder of the mind that interferes with
everyday functioning
Insanity
 Legal term
 Definition has changed over time
 Mental illness or defect decreased the individual’s
capacity to appreciate the criminality of their
behavior or to conform to the law
Diagnosis

Emil Kraeplin (1883)

First to propose a classification system for
mental disorders

Noticed that not all patients with mental illness
suffered from the same disorder

Noticed that certain symptoms tended to cluster
together as a unique syndrome or disorder
Diagnosis


Categorical vs Dimensional Diagnosis?
Categorical

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Set of symptoms that vary together
Must meet minimum threshold (e.g., 4 or more
symptoms out of 9), to have the disorder
Dimensional


May involve a set of symptoms
Disorder varies in degree of severity (from nonexistent to severe)
Diagnosis

Diagnostic and Statistical Manual of Mental
Disorders IV




Categorical diagnostic system
Specifies sets of observable symptoms for each
disorder
Specifies criteria for having or not having the
diagnosis
Because symptoms of different disorders overlap,
gives information for differential diagnosis
Diagnosis
Difficulties in Diagnosis

Rosenhan (1973)
 8 participants (pseudo-patients) approached 12
different psychiatric hospitals
 All reported hearing voices saying “thud,” “empty,”
and “hollow”
 Reported no history of psychiatric problems
 Reported no other symptoms
 All other information about past history was accurate
 Once in the hospital, stopped reporting symptom and
behaved normally
Difficulties in Diagnosis





All 12 hospitals admitted the pseudo-patients
All pseudo-patients were given the diagnosis
of Schizophrenia
Took between 7 and 52 days to be released
All released with a diagnosis of Schizophrenia
in Remission
None of staff, but some of the patients,
realized that the pseudo-patients were “sane”
Determining Risk

Risk for Self-Harm or Harm of Others



Mental health professionals have legal
responsibility to breach confidentiality if they
determine that a patient is at risk for harming
him/herself or someone else
E.g., Tarasoff Case
Problem  determining potential for harm is
difficult
Causes of Mental Disorder


Biological/Genetic
 Brain structure or
neuronal defect
 Inherited
predisposition
Psychological
 Faulty defense
mechanisms

Social Factors
 Family Systems Model
 Sociocultural Model

Cognitive Behavioral
 Classical/operant
conditioning
 Modeling/Vicarious
reinforcement
Treatment is based on the conceptualization of the disorder
Anxiety Disorders
Anxiety Disorders

Characterized by the experience of excessive anxiety
in the absence of true danger and avoidance behavior


Anxiety is our built-in alarm system  developed
to warn us of a threat and give us the energy to
respond to the threat
Excessive, chronic anxiety without identifiable
cause and that leads to avoidance of nonthreatening stimuli is abnormal
Anxiety Disorders

Phobic Disorders
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Generalized Anxiety Disorder
Panic Disorder

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Social Phobia
Specific Phobias
With or without agoraphobia
Obsessive Compulsive Disorder
Post-Traumatic Stress Disorder
Panic Disorder
with Agoraphobia
Symptoms


Panic Disorder
 Attacks of terror that are sudden, overwhelming, and
unexpected
 Did not follow situation that naturally elicits anxiety or
in which the individual was the focus of other’s
attention
 Involves fear of dying, of going crazy, or losing
control
With Agoraphobia
 Fear of situations where escape might be difficult or
embarrassing or where help may be unavailable in the
event of an attack
 Individual avoids such situations, goes only if
accompanied, or endures with significant discomfort
Causes

Biological/Genetic

Locus coeruleus is the area of the brain that
perceives novelty  serves as an alarm system

Abnormalities of the locus coeruleus result in
increased arousal of the central nervous system

Increased arousal of CNS  increased sensitivity
to internal and external cues signaling threat
Causes

Cognitive Behavioral




Symptoms of anxiety and panic are similar to
symptoms associated with heart attack
Panic-prone people monitor bodily sensations for
symptoms that might signal an attack
Presence of symptoms result in life-threatening
cognitions (catastrophizing)
Increased focus on bodily sensations +
catastrophizing  spiking of anxiety or panic
Causes
Causes

Agoraphobia results from negative
reinforcement




Individuals are fearful of having another panic
attack
Going to places where escape might be difficult or
where it would be embarrassing to have an attack
 increased anxiety
Panic disordered individuals avoid such places
Avoidance avoidance of fear/anxiety 
increased avoidance
Treatment
Panic Disorder with
Agoraphobia
Medication

Anxiolytic medications or tranquilizers

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Benzodiazepines (e.g., Valium; Klonapin)
Used for short-term treatment of anxiety
Reduce anxiety and promote relaxation
High degree of addiction potential
Selective Serotonin Reuptake Inhibitors (SSRI)



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Primarily for the treatment of depression
Appear to have anxiolytic properties
Can be used for long-term
Though not addictive, can have unpleasant side effects
Behavioral Therapy

Cognitive Behavioral Therapy

Education about biological and learning bases of
panic

Cognitive Restructuring



Identifying anxiety-producing thoughts
Challenging thoughts with accurate information
Substituting calming and empowering thoughts for
anxiety-producing thoughts
Behavioral Therapy

Cognitive Behavioral Therapy
 Relaxation training
Diaphragmatic breathing
 Progressive muscle relaxation

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Systematic desensitization
Imaginal exposure
 In vivo exposure

Behavioral Therapy

Systematic Desensitization

Develop fear hierarchy

Expose patient to feared stimuli on hierarchy


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Start with a low-fear stimulus
Continue to expose to low-fear stimulus until fear
extinguishes
Move to slightly more feared stimulus only after lowerfeared stimulus is mastered
Panic Disorder
Exercise
Symptom
Spinning
Dizziness, faintness
Gagging
Choking
Jogging
Increased heart rate, increased B/p, chest
tightness, sweating, flushing
Pushups
Chest tightness, arm tightness
Holding breath
Chest tightness, depersonalization, derealization,
suffocating
Dizziness, disorientation, depersonalization
derealization
Hyperventilating
Inhaling CO2
Choking, suffocating, derealization,
depersonalization
Mood Disorders
Mood Disorders

Mood disorders reflect extreme
emotions that affect our ability to
function and perform everyday
activities
Mood Disorders

Depressive Disorders (AKA unipolar
depression)  pervasive feelings of sadness

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Major Depression
Dysthymia
Bipolar Disorders  radical fluctuations in
mood from sad to elated or irritable

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Bipolar I  Major Depression & Mania
Bipolar II  Major Depression & Hypomania
Cyclothymia  Dysthymia & Hypomania
Major Depression
Symptoms
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Depressed mood most of the day, nearly every day
Loss of interest/ pleasure in previously enjoyed
activities
Significant weight loss or gain (> 5% of body weight)
Insomnia/hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or guilt
Impaired thinking/concentration
Recurrent thoughts of death or of suicide
Causes

Genetic


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Twin, family, and adoption studies suggest a
genetic component for depression
Identical twins 4 X more likely to be concordant
for depression than Fraternal twins
Biological


Low levels of norepinephrine  depression
Low levels of serotonin  depression
Causes

Biological (continued)

Circadian rhythms, particularly patterns of
sleeping and waking, are associated with
depression

Seasonal Affective Disorder
 As amount of daylight decreases, level of
depression increases
Seasonal Affective Disorder
Causes

Social/Environmental
 More stressful events
 greater likelihood of
developing depression

Having a close
friendship  mitigates
against the impact of
stressful life events
Causes

Cognitive (A.T. Beck)

Cognitive Triad

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Attributions

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Depressed people think about themselves, their
situation, and the future in a negative manner
Failures/misfortunes = (internal causes) personal defects
Successes = (external causes) luck
Errors in Logic

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Overgeneralizing based on single events
Magnifying the seriousness of events
Taking responsibility for bad events
Causes

Learned Helplessness (Seligman)


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People view themselves as unable to control the
negative events in their lives
 Attribute negative events to personal defects
stable and global
 People begin to feel helpless about the ability to
make positive changes
Theory based on animal research
Animals placed in aversive situations that they
could not escape  passive and unresponsive
Treatment
Depressive Disorders
Medication

Early Antidepressants
 Monoamine Oxidase Inhibitors (MAOI)
 Effective for treating depression
 Highly toxic

Tricyclic antidepressants
 Effective for treating depression
 Cause weight gain, sedation, sweating,
constipation, heart palpitations, and dry mouth
Medication

Modern Antidepressants

Selective Serotonin Reuptake Inhibitors (SSRIs)
 e.g., Prozac, Lexapro, Paxil
 Increase serotonin levels by blocking reuptake
 Some also have norepinephrine effects
 Also effective for treating anxiety

Atypical Antidepressants

Bupropion  fewer side effects than other
antidepressants (no sexual side effects)
Behavioral Therapies

Cognitive Therapy

People are depressed because of negative beliefs
about themselves, their situation and the future

Therapy focuses on helping clients
 Recognize when they are thinking negatively
 Identify the negative thoughts/beliefs
 Challenge the beliefs with more positive and
adaptive thoughts and/or behavioral
experiments
Cognitive Therapy
Psychotic Disorders
Psychotic Disorders
Psychotic disorders are characterized
by disturbances in thoughts,
perceptions, consciousness, and
emotions
 These disturbances lead to impaired
social, personal, and/or occupational
functioning

Schizophrenia
Symptoms

Positive Symptoms (excesses)

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Delusions  false personal beliefs based on incorrect
inferences about reality
Hallucinations  false sensory perceptions that are
experienced w/o an external source
Loosening of associations  shift rapidly from one topic to
another
Negative Symptoms (deficits)


Socially isolated and withdrawn
Fail to express emotion; speech is monotonic
Causes
Treatment
Schizophrenia
Medication
 Haldol (Haloperidal)


Reduces positive but not negative symptoms
Tardive Dyskinesia



involuntary movements of the lips, tongue, face, legs, or
other body part
Irreversible once present (some medications control these
symptoms)
Clozapine


Reduces both positive and negative symptoms; Works for
unremitting schizophrenia
Side Effects


Seizures, heart arrythmias, weight gain,
Fatal reduction in WBC  frequent blood tests required
Behavioral

Social skills training
 Recognizing social cues
 Regulating affect
 Recognizing signs of relapse

Self-care skills

Family therapy
 Family therapy can address family environment
factors that increase risk of relapse
 Expressed Emotion
Personality Disorders
Personality Disorder

When an individual relates to the world in
inflexible and maladaptive ways that is longlasting and interferes with social, occupational
or other functioning
Types of Personality Disorders

Cluster A  Odd or Eccentric Behavior

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Cluster B  Dramatic, emotional or erratic behavior

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Paranoid
Schizoid
Schizotypal
Histrionic
Narcissistic
Borderline
Antisocial
Cluster C  Anxious or Fearful Behavior


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Avoidant
Dependent
Obsessive-Compulsive
Borderline
Personality Disorder
Symptoms
Causes

Genetics


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Biological


Unclear at present
Often have families members with mood disorders
Low Serotonin  depressed mood and impulsivity
Social/Cultural



70-80% have history of physical or sexual abuse or
other trauma
Caretakers who were critical or rejecting
Caretakers who fostered dependence
Treatment
Borderline Personality
Disorder
Behavioral

Dialectical Behavior Therapy (DBT)

Combines elements of behavioral, cognitive, and
psychodynamic approaches

Involves both group and individual therapy
sessions

Begins with a discussion of what is expected of the
client and what can be expected of the therapist
Dialectical Behavior Therapy

Three Stages of Treatment

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Stage 1  extreme symptoms (i.e., self-injurious and
suicidal behaviors) are replaced with more
effective/acceptable coping strategies
Stage 2  explore and address traumatic experiences
Stage 3  works on development of self-respect and
independent problem-solving
learn to support and validate themselves rather than
relying on others