Davey chapters 1, 2.1, 7, 15 & 8
Luteijn & Barelds chapters 1, 2, 3, 4 & 9
Chapter 15, 17 & 18
Psychopathology & Psychodiagnostics
Mental Health
Inhoudsopgave
Chapter 1: An introduction to psychopathology: concepts, paradigms, and stigma (Davey) .................................................. 2
Chapter 1: The diagnostic process (Luteijn & Barelds) ......................................................................................................... 16
Chapter 2: Diagnostic quality (Luteijn & Barelds) ................................................................................................................ 21
Chapter 2.1: Classifying psychopathology (Davey) ................................................................................................................ 25
Chapter 7: Depression and Mood Disorders (Davey) ............................................................................................................. 29
Chapter 15: Drug Use, Drug Addiction, and the Brain’s Reward Circuit ............................................................................. 45
Chapter 17: Biopsychology of Emotion, Stress and Health .................................................................................................... 57
Chapter 3: The interview (Luteijn & Barelds) ....................................................................................................................... 68
Chapter 4: Behavioural Observation (Luteijn & Barelds) ..................................................................................................... 75
Chapter 18: Biopsychology of Psychiatric Disorders ............................................................................................................. 80
Chapter 15: Neurocognitive Disorders (Davey) ...................................................................................................................... 90
Chapter 9: Questionnaires for measuring problem areas (Luteijn & Barelds) ................................................................... 104
Chapter 8: Experiencing Psychosis: Schizophrenia Spectrum Problems (Davey) ............................................................... 108
1
, Davey chapters 1, 2.1, 7, 15 & 8
Luteijn & Barelds chapters 1, 2, 3, 4 & 9
Chapter 15, 17 & 18
Chapter 1: An introduction to psychopathology: concepts, paradigms, and stigma
(Davey)
INTRODUCTION
Psychopathology = the in-depth study of mental health problems
• Psychopathology encompasses a scientific approach to understanding the causes of mental health problems, their classification,
and effective interventions
• Important aspects of psychopathology:
o Debilitating (slopend) distress
o Important aspects of your life (e.g., mood, cravings) are out of control
o Failing to function properly in certain spheres of your life (e.g., mother, student)
o Interpretations of the world that are extreme and are probably not real.
• We cannot attempt to define psychopathology on the basis that some ‘normal’ functioning (psychological, neurological, or
biological) has gone wrong. This because:
o Challenges in definition arise from incomplete understanding of processes contributing to mental health problems.
o Many forms of behavior that require treatment by clinical psychologists are merely extreme forms of what we would call
‘normal’ or ‘adaptive’ behavior (e.g., feelings of depression are common and often don't disrupt daily life, for some, it can
become severe and persistent, causing distress and hindering regular activities)
Clinical psychology = the branch of psychology responsible for understanding and treating psychopathology
A BRIEF HISTORY OF PSYCHOPATHOLOGY
• Throughout history, behaviours are labelled as “mad”, “crazy”, or “insane” if it appears unpredictable, irrational, harmful, or if it
simply deviates from accepted contemporary social norms
DEMONIC POSSESSION
Demonic possession = historical explanations of psychopathology such as “demonic possession” often alluded to the fact that the
individual had been “possessed” in some way
• Many forms of psychopathology manifest with noticeable changes in an individual’s personality or
behavior – first symptoms that are noticed (e.g., reserved person becomes manic and outgoing; neglect
important daily activities (parenting or going to work))
• Historical perspectives tended to attribute personality changes in psychopathology to being “possessed”
Demonic possession > their behaviour has changed in such a way that their personality seems to have been taken over and
replaced by the persona of someone or something else
• Individuals with psychological problems historically faced persecution (vervolgd) and physical abuse
instead of receiving support and treatment
• The concept of demonic possession persists as an explanation for mental health issues, often tied to local
religious beliefs. This belief can lead to practices like exorcism
• Ancient civilizations, including Egypt, China, Babylon, and Greece, often attributed psychopathological
symptoms to demonic possession or bad spirits.
• Ritualized ceremonies were employed in attempts to exorcise bad spirits; frequently involved direct
History demonic physical attacks (torture, starvation) on the sufferer’s body in an attempt to force out the demons.
possession • In Western societies, witchcraft, and demonic possession prevalent explanations for psychopathology
• Today, in some less developed areas today, demonic possession remains a common explanation for
psychopathology, reflecting cultural and religious beliefs
THE MEDICAL OR DISEASE MODEL
Medical model = an explanation of psychopathology in terms of underlying biological or medical causes
Being a concern of • Middle 17th century: religious, spiritual, and superstitious explanations of psychopathology were being
theology or replaced by more objective, medical explanations as a consequence of the new empirical scientific
demonology to being methods by thinkers and scientists (Newton, Descartes, Galileo)
the realm of medicine • Descartes: minds could not be diseased, mental health problems must be located in the body, more
specifically in the brain.
Psychiatry = a scientific method of treatment that is based on medicine, the primary approach of which is to identify the
biological causes of psychopathology and treat them with medication or surgery
• Brain abnormalities (e.g., in dementia, autism)
• Biochemical imbalance (especially imbalances of brain neurotransmitters) (e.g., major depression,
bipolar disorder, schizophrenia)
Many explanations • Genetic factors (e.g., learning disabilities, autism, schizophrenia)
link mental health • Chromosome disorders (e.g., intellectual disabilities)
problems to • Congenital (aangeboren) risk factors (maternal infections during pregnancy) (e.g., intellectual disorders,
biological causes, attention-deficit-hyperactivity disorder (ADHD))
explaining symptoms • Abnormal physical development (e.g., autism)
based on factors such
• Physical effects of pathological activities (e.g., the effect of hyperventilation in panic disorder)
as
→ However, biological factors may play a role in some psychopathologies, biological explanations are not the only
way in which psychopathology can be explained > often person’s experiences are problematic
- Medical or biological causes underlie psychopathology
2
, Davey chapters 1, 2.1, 7, 15 & 8
Luteijn & Barelds chapters 1, 2, 3, 4 & 9
Chapter 15, 17 & 18
o Not always the case; bizarre behavior can be developed by perfectly normal learning processes
o In contrast with the medical model, both psychodynamic and contemporary cognitive accounts
of psychopathology argue that many psychological problems are the result of the individual
acquiring dysfunctional ways of thinking and acting, and they acquire these characteristics
through normal functional learning processes > the experience they have had that are
dysfunctional and has led to them thinking and acting in the way they do
- The medical model adopts what is basically a reductionist approach by attempting to reduce the
complex psychological and emotional features of psychopathology to simple biology
o It is arguable whether the phenomenology (i.e., the personal experience of psychopathology) or
Medical model of the complex cognitive factors involved in many psychological problems can be reduced to
psychopathology: simple biological descriptions
implications for the o Complex mental health problems are often not just biological or reducible to psychological
way we conceive problems and processes > they are influenced by the socio-economic situation in which the
mental health individual lives, their potential for employment and education, and the support they are given
problems that will provide hope for recovery and support for social inclusion (recovery model)
- Psychopathology is caused by ‘something not working properly’ (e.g., brain processes not
functioning normally, brain or body chemistry being imbalanced). This ‘something is broken and needs to
be fixed’ view of psychopathology is problematic for a number of reasons:
o Psychopathology can be viewed as being on a dimension rather than being a discrete
phenomenon that is separate from normal experience > evidence that common
psychopathology symptoms such as anxiety and depression are on a dimension from normal to
distressing, rather than being qualitative distinct.
o By implying that psychopathology is caused by a normal process that is broken, imperfect or
dysfunctional, the medical model may have an important influence on how people suffering
from mental problems, and how they might view themselves > stigmatizing; being labelled as
someone who is biological or psychologically imperfect
Recovery model = broad-ranging treatment approach which acknowledges the influence and importance of socio-economic status,
employment and education and social inclusion in helping to achieve recovery from mental health problems.
FROM ASYLUMS TO COMMUNUNITY CARE
Asylums = in previous centuries asylums (gesticht) were hospices converted for the confinement (opsluiting) of individuals
with mental health problems
Community care = care that is provided outside a hospital setting
Bethlem Hospital = one of the first psychiatric hospitals originally established in Moorfields, London
• 18th century: mental health problems were managed by families or local parish authorities.
• Decline in traditional infectious diseases led to the conversion of disease hospices into asylums for
Origin of individuals with mental health issues.
Asylums • Until the 19th century: lack of coordinated government action led to privately funded hospitals or
'madhouses' emerging to address mental health issues.
• Bethlem Hospital: among these institutions, the Bethlem Hospital in the UK was the most famous
• Life in asylums was often cruel and inhumane
• “madhouses” were essentially business established for financial profit, often growing in size to
accommodate more patients without being regulated or inspected under relevant laws at that time."
• Medical treatments were usually crude and often painful (e.g., drawing copious quantities of blood from
the brain, hot and cold baths, mercury pills)
• The nature of the inmates expanded to include not just those with mental health problems, but paupers
Life in asylums and individuals from poor backgrounds (especially young pregnant women)
• In 18th and 19th century: mix of people in old asylums led to improvised care based on combating moral
degeneration and ‘social weakness’, likely laying the groundwork for today's stigma surrounding mental
health.
• In 19th century: gradual movement towards more human treatments for individuals in asylums
o Philippe Pinel: the first to introduce more human treatments > removing the chains and
restraints and treating the inmates as sick human beings rather than animals
o The Quaker movement (UK): developed the moral treatment approach
Moral treatment = approach to the treatment of asylum inmates, developed by the Quacker movement in the UK, which abandoned
contemporary medical approaches in favour of understanding, hope, moral responsibility, and occupational therapy
• Until the 1970s (in UK and US); hospitalization was usually the norm for individuals with severe mental
health problems, often lifelong hospitalization for individuals with chronic symptoms.
• However, not economically possible nor providing an environment in which patients had an opportunity
to improve.
• Rising inpatients diagnosed with mental health issues placed a heavier care burden on nurses and
attendants, due to insufficient training and experience, they often resorted to restraint as the primary
form of intervention.
• This approach led to deterioration (verslechtering) in symptoms, resulting in the development of social
breakdown syndrome among patients. This syndrome included confrontational and challenging
behavior, physical aggression, and a decline in personal welfare and hygiene.
3
, Davey chapters 1, 2.1, 7, 15 & 8
Luteijn & Barelds chapters 1, 2, 3, 4 & 9
Chapter 15, 17 & 18
• Between 1950 and 1970: these limitations of hospitalization were acknowledged and there was some
attempt to structure the hospital environment for patients.
o First attempt: milieu therapies; including mutual respect between staff and patients and the
Start asylum to opportunity for patients to become involved in vocational (beroepsmatige) and recreational
community care activities. Patients exposed to milieu therapy were more likely to be discharged from hospital
sooner and less likely to relapse
o 1970s further therapeutic refinement of the hospital environment: token economy
programmes; based on operant reinforcement: patients receive tokens (rewards) for engaging
desired behaviours. These desired behaviours would usually include social and self-help
behaviours (e.g., communicating coherently, washing, or combing ( kammen) hair), and tokens
could be exchanged for a variety of rewards (e.g., chocolate, cigarettes, hospital privileges).
o Therapeutic gains of patients in a token economy:
▪ Improved significantly more than patients in a tradition ward
▪ Better groomed (verzorgd), spent more time in activities and less time in bed, and made
fewer disturbing comments
▪ Earn discharge significantly sooner
o Despite initial success, the use of token economy in hospitals significantly decreased after the
early 1980s. Reasons for decline:
▪ The legal and ethical difficulties of withholding desired materials and events
▪ Uncertainty persisted regarding whether behaviours nurtured within token economy
schemes were sustained after the program ended and if they were generalized to
other environments or settings.
Milieu therapies = the first attempts to structure the hospital environment for patients, which attempted to create a therapeutic
community on the ward in order to develop productivity, independence, responsibility and feelings of self-respect
Token economy = a reward system which involves participants receiving tokens for engaging in certain behaviours, which at a later
time can be exchanged for a variety of reinforcing or desired items
• In 1963, the US Congress passed a Community Mental Health Act, rather than be detained and treated
in hospitals, people with mental health problems had the right to receive a broad range of services in their
communities (outpatient therapy, emergency care, preventative care, and aftercare)
• Due growing concerns about the rights of mental health patients and change in social attitudes away
from the stigma associated with mental health problems, other countries around the world followed in
making mental health treatment and aftercare available in the community
Community Mental • These events led to the development of a combination of services usually termed assertive community
Health Team & treatment or assertive outreach
→ given these developments, treatments, and care of individuals diagnosed with severe mental health problems has
moved away from long-term hospitalization to various forms of community care
• Psychiatric hospitals remain crucial for treating individuals with severe and distressing symptoms.
• Hospital stays are shorter due to improved early intervention treatments and supportive community care
and outreach programmes. Even for serious mental health issues, the duration ranges from a few days to
weeks based on the diagnosis.
• Many individuals diagnosed with mental health problems often need support and supervision
o Help with maintaining their necessary medication regime
o Finding and keeping a job
o Applying for and securing welfare benefits
o Help with aspects of normal daily living (personal hygiene, shopping, feedings themselves,
managing their money, and coping with social interactions and life stressors)
• Today, these outreach services are delivered by a Community Mental Health Team (CMHT); include
Assertive Outreach psychiatrists, clinical psychologists, social workers, and nurses
Teams
• In complex cases a Care Programme Approach (CPA) might be applied where an individual care plan
is developed to provide ongoing support
• Many mental health services also have Assertive Outreach Teams whose function is to help individuals
with mental health problems, who find it difficult to work with mental health services or have related
problems such as violence, self-harm, homelessness, or substance abuse. They meet their clients in their
own environment (home, park, or street) with the aim of building a long-term relationship between the
client and mental health services.
SUMMARY: A BRIEF HISTORY OF PSYCHOPATHOLOGY
◼ Historical explanations of psychopathology such as ‘demonic possession’ often alluded to the fact that the individual had been
‘possessed’ in some way
◼ The medical model attempts to explain psychopathology in terms of underlying biological or medical causes
◼ Historically individuals with mental health problems were often locked away in asylums or given lifelong custodial care in
psychiatric hospitals
◼ Current models of mental health care espouse compassion, support, understanding, and empowerment
DEFINING PSYCHOPATHOLOGY
• Revolve around what criteria and terminology we use to define psychopathology
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