College 1 - Introduction
Abnormality
- Distress
- Unusual behaviour
- Dysfunction
DSM 5 defining disorders
- Dysfunction: mental disorder is a syndrome characterized by clinically significant disturbance
in an individual’s cognition, emotion regulation or behaviour that reflects a dysfunction in the
psychological, biological or developmental processes underlying mental functioning
(thoughts / feelings / behaviours)
- Distress: in social, occupational, or other important activities
- Deviance: different from the norm, uncommon, rare (but socially deviant behaviour) (e.g.,
political, religious or sexual) and conflicts between the individual and society are not mental
disorders.
- Danger: an individual may be of danger to her / himself or other
Classification of mental disorders: cons Pro’s
College 2 – Etiology
Development of mental disorders as a process of change and development
- Dispositional factors
- Provoking factors
- Maintaining factors
Behaviour-genetics questions
- To which extend is behaviour or are behavioural tendencies inherited?
- Through which processes can behaviour be influenced by genes?
Rules of behaviour of genetics
- All human behavioural traits are heritable that is, they are affected to some degree by
genetic variation
- The effect of being raised in the same family is smaller than the effect of genes
- A substantial portion of the variation in the complex human behavioural traits is not
accounted for by the effects of genes or families
- A typical human behavioural trait is associated with very many genetic variants, each of
which accounts for a very small percentage of the behavioural variability
Psychosocial influences on brain structure and function
- Neurological activity may change because of psychotherapy > suggests that psychosocial
influences affect brain function
, - Placebos may also change brain function
- Stress and early development
Types of neurotransmitters
- Serotonin
- Travels through many key areas of the brain, affecting the function of those areas
- Implicated in depression, anxiety, aggressive impulses
- Dopamine
- Found in areas of the brain associated with the experiences of reinforcements or
rewards
- Affected by substances and behaviour that are pleasurable
- Norepinephrine
- Produced by neurons in the brain stem
- Cocaine and amphetamine, prolong the actions of norepinephrine by slowing its
reuptake process
- GABA
- Inhibits the action of other neurotransmitters
- Tranquilizing effect of some drugs is because they increase the inhibitory activity of
GABA
Hormones
- Cortisol stress hormone or stress regulation hormone?
- Testosterone reason for aggression or medication for social anxiety?
- Oxycontin social or asocial?
The cause of mental disorders van be found in the social environment of the person
- Deprivation in the early development
- Trauma
- Marital problems / divorce
- Parenting styles
- Mental disorders of parents
Culture affects mental illness
- Culture relates to how people cope
Gender effects and roles
- Related to cultural imperatives
- Influences via multiple dimensions
- Type and prevalence of anxieties
- Anxiety behaviour
- Responses
- Coping strategies
Cognitive approach
Classical: cognitive response on events determines your mood. Health problems are consequences of
‘wrong’ thinking’. The way people interpret situations, their assumptions regarding the world and
how they think about themselves, can cause a lot of negative feelings and behaviour.
,College 3 – substance related disorders
DSM-5 criteria of substance use disorders
- Craving
- Craving
- Impaired control
- More than planned
- Failed attempts to stop / desire to
stop
- Time consuming
- Physical dependence
- Tolerance
- Withdrawal
- Functional / social impairment
- Functional impairment (role fulfilment)
- Persistent use despite negative (social consequences)
- Reduction other (healthy) activities
- Risky use
- Physical danger related to use
- Persistent use despite negative health consequences
From liking to wanting
- Chronic substance use is increasingly driven by negative
reinforcement
- Reduced pleasure (tolerance) leads to increased intake to
achieve precious levels of liking
- Increased intake leads to incentive sensitization of wanting
circuits: compulsive substance use (habits)
, From recreative to problematic substance use Predisposing factors
Dual process models of addiction
- Intentional control, reflective processing
(effect on the rider)
- Therapy: strengthen self-control (CBT)
- Desires and impulses, automatic processing (effect on the horse)
- Therapy: reduce cue-reactivity / craving / automatic tendencies (CBM)
3 routes to self-regulation ‘failure” (giving in to short term desires / urges despite negative
consequences):
- Rider (PCF) may be too weak (either duet o premorbid conditions (e.g., ADHD, low IQ) and /
or chronic substance use)
- The horse (sensitised emotional brain / reward system) may be too wild to control
- The rider may get exhausted (the neurons run out of glutamate)
Leaning processes in addiction
- Classical / Pavlovian conditioning: learning through association
Danger of overdose due to change in context: conditioned stimulus /
context elicits compensatory reaction which normally reduces effect
of substance over time, in new context the same dose is now an
overdose
Aversion therapy: pairing substance use / undesirable behaviour with aversive stimulus (e.g.
unpleasant smell, feel or sickness)
- Operant conditioning
Habit learning: when the operant response is no longer motivated
by its outcome (the effect of the substance / behaviour
Motivational interviewing
- Engaging: build a good working relation
and trust by being curious and respectful
of the client’s perspective and priorities
- Focusing: develop a specific direction for change
- Evoking: stimulate motivation for change in the client
- Planning: develop commitment for change, formulate a concrete plan
The Ratpark study
Abnormality
- Distress
- Unusual behaviour
- Dysfunction
DSM 5 defining disorders
- Dysfunction: mental disorder is a syndrome characterized by clinically significant disturbance
in an individual’s cognition, emotion regulation or behaviour that reflects a dysfunction in the
psychological, biological or developmental processes underlying mental functioning
(thoughts / feelings / behaviours)
- Distress: in social, occupational, or other important activities
- Deviance: different from the norm, uncommon, rare (but socially deviant behaviour) (e.g.,
political, religious or sexual) and conflicts between the individual and society are not mental
disorders.
- Danger: an individual may be of danger to her / himself or other
Classification of mental disorders: cons Pro’s
College 2 – Etiology
Development of mental disorders as a process of change and development
- Dispositional factors
- Provoking factors
- Maintaining factors
Behaviour-genetics questions
- To which extend is behaviour or are behavioural tendencies inherited?
- Through which processes can behaviour be influenced by genes?
Rules of behaviour of genetics
- All human behavioural traits are heritable that is, they are affected to some degree by
genetic variation
- The effect of being raised in the same family is smaller than the effect of genes
- A substantial portion of the variation in the complex human behavioural traits is not
accounted for by the effects of genes or families
- A typical human behavioural trait is associated with very many genetic variants, each of
which accounts for a very small percentage of the behavioural variability
Psychosocial influences on brain structure and function
- Neurological activity may change because of psychotherapy > suggests that psychosocial
influences affect brain function
, - Placebos may also change brain function
- Stress and early development
Types of neurotransmitters
- Serotonin
- Travels through many key areas of the brain, affecting the function of those areas
- Implicated in depression, anxiety, aggressive impulses
- Dopamine
- Found in areas of the brain associated with the experiences of reinforcements or
rewards
- Affected by substances and behaviour that are pleasurable
- Norepinephrine
- Produced by neurons in the brain stem
- Cocaine and amphetamine, prolong the actions of norepinephrine by slowing its
reuptake process
- GABA
- Inhibits the action of other neurotransmitters
- Tranquilizing effect of some drugs is because they increase the inhibitory activity of
GABA
Hormones
- Cortisol stress hormone or stress regulation hormone?
- Testosterone reason for aggression or medication for social anxiety?
- Oxycontin social or asocial?
The cause of mental disorders van be found in the social environment of the person
- Deprivation in the early development
- Trauma
- Marital problems / divorce
- Parenting styles
- Mental disorders of parents
Culture affects mental illness
- Culture relates to how people cope
Gender effects and roles
- Related to cultural imperatives
- Influences via multiple dimensions
- Type and prevalence of anxieties
- Anxiety behaviour
- Responses
- Coping strategies
Cognitive approach
Classical: cognitive response on events determines your mood. Health problems are consequences of
‘wrong’ thinking’. The way people interpret situations, their assumptions regarding the world and
how they think about themselves, can cause a lot of negative feelings and behaviour.
,College 3 – substance related disorders
DSM-5 criteria of substance use disorders
- Craving
- Craving
- Impaired control
- More than planned
- Failed attempts to stop / desire to
stop
- Time consuming
- Physical dependence
- Tolerance
- Withdrawal
- Functional / social impairment
- Functional impairment (role fulfilment)
- Persistent use despite negative (social consequences)
- Reduction other (healthy) activities
- Risky use
- Physical danger related to use
- Persistent use despite negative health consequences
From liking to wanting
- Chronic substance use is increasingly driven by negative
reinforcement
- Reduced pleasure (tolerance) leads to increased intake to
achieve precious levels of liking
- Increased intake leads to incentive sensitization of wanting
circuits: compulsive substance use (habits)
, From recreative to problematic substance use Predisposing factors
Dual process models of addiction
- Intentional control, reflective processing
(effect on the rider)
- Therapy: strengthen self-control (CBT)
- Desires and impulses, automatic processing (effect on the horse)
- Therapy: reduce cue-reactivity / craving / automatic tendencies (CBM)
3 routes to self-regulation ‘failure” (giving in to short term desires / urges despite negative
consequences):
- Rider (PCF) may be too weak (either duet o premorbid conditions (e.g., ADHD, low IQ) and /
or chronic substance use)
- The horse (sensitised emotional brain / reward system) may be too wild to control
- The rider may get exhausted (the neurons run out of glutamate)
Leaning processes in addiction
- Classical / Pavlovian conditioning: learning through association
Danger of overdose due to change in context: conditioned stimulus /
context elicits compensatory reaction which normally reduces effect
of substance over time, in new context the same dose is now an
overdose
Aversion therapy: pairing substance use / undesirable behaviour with aversive stimulus (e.g.
unpleasant smell, feel or sickness)
- Operant conditioning
Habit learning: when the operant response is no longer motivated
by its outcome (the effect of the substance / behaviour
Motivational interviewing
- Engaging: build a good working relation
and trust by being curious and respectful
of the client’s perspective and priorities
- Focusing: develop a specific direction for change
- Evoking: stimulate motivation for change in the client
- Planning: develop commitment for change, formulate a concrete plan
The Ratpark study
