Chapter 1: Introduction to psychopathology
The medical or disease model:
General paresis = a brain disease occurring as a late consequence of syphilis,
characterized by dementia, progressive muscular weakness and paralysis.
Somatogenic hypothesis = causes of psychological problems can be found in
physical or biological impairments.
Primary approach of the medical model is to identify the biological causes of
psychopathology and treat them with medication or surgery. It adopts a reductionistic
approach, attempting to reduce the complex psychological and emotional features of
psychopathology to simple biology.
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 self-respect.
Study: Patients in a token economy ward improved significantly more, better groomed, spent
more time in activities and less time in bed, made fewer disturbing comments and discharged
earlier than patients in a traditional ward.
Culture-bound symptoms:
Ataque de Nervois = form of panic disorder found in Latinos from the Carribean
Seizisman = psychological paralysis in Haitian community
Diathesis-stress model = model that suggests that a mental health problem develops because
of an interaction between a genetic predisposition and our interactions with the environment.
Genetics X psychopathology:
1. Concordance studies = studies designed to investigate the probability with which
family members will develop a disorder depending on how closely they are related.
2. Twin studies
Dopamine – precursor to other substances
Serotonin – low levels associated with depression
Norepinephrine – anxiety symptoms
GABA – anxiety symptoms
Psychological models:
Hold that the causes of psychopathology are psychological rather than biological or
medical.
Id: the concept used to describe innate instinctual needs – especially sexual needs
Ego: a part of the psyche that aims to control the impulses of the Id.
Superego: develops out of both the Id and the Ego, and represents our attempts to
integrate values that we learn from our parents or society.
These 3 concepts are in conflict, and psychological health is maintained only when they are
balanced.
, Oral stage = the first 18 months of life are based on the child’s need for food from
the mother. If the mother fails to satisfy these oral needs, the child may become
fixated at this stage and in later life display ‘oral stage characteristics’ such as extreme
dependence on others.
Psychoanalysis was the first approach to introduce a number of perspectives on
psychopathology that are still important today including the view that
psychopathology can have its origins in early experiences rather than being a
manifestation of biological dysfunction, and the possibility that psychopathology may
often represent the operation of defense mechanisms that reflect attempts by the
individual to suppress stressful thoughts and memories. but concepts in this theory
are hard to objectively define and measure.
The behavioural model:
Classical conditioning is used to explain the acquisition of emotional disorders with
anxiety-based symptoms. Also, PTSD, paraphilias and substance dependency.
The behavioural approach led to the development of important behavioural treatment
methods.
The idea that individuals can unlearn maladaptive behaviours or emotions led to the
development of treatment methods based on CC principles such as flooding, systemic
desensitization and aversion therapy. OC led to the development of functional
analysis and token economy.
The cognitive model:
Most widely adopted model of psychopathology.
Limitations include; rather than being a cause of psychopathology, it has to be
considered that dysfunctional thoughts and beliefs may themselves simply be just
another symptom of psychopathology.
Humanist-existential approach:
Aims to resolve psychopathology through insight, personal development and self-
actualization.
Client-centered therapy (C. Rogers) = stresses the goodness of human nature,
assuming that if individuals are unrestricted by fears and conflicts, they will develop
into well-adjusted, happy individuals.
Demonstrate genuineness and unconditional positive regard
Uninterested in the aetiology and origins of psychopathology, but more interested in
ameliorating symptoms of psychopathology through encouraging personal
development.
These approaches are difficult to evaluate. Studies show that ps in CCT fair no
different from controls. These methods also dehumanize or are incapable of
measuring the kinds of existential benefits that such approaches claim to bestow.
The medical model of mental health is itself a source of stigma;
1. The medical model implies that mental health problems are on par with physical
illness.
2. It implies diagnosis, and diagnosis implies a label.
,Chapter 2: Classification and assessment in psychopathology
E. Kraepelin – first person to develop a comprehensive classification system. First system
for classifying psychopathology was developed by the WHO. American Psychiatric
Association also contributed.
Problems with classification:
1. DSM does not classify psychopathology according to its causes, but does so based on
symptoms
2. Using DSM criteria to label people with a disorder can be stigmatizing
3. DSM classification tends to define disorders as discrete entities
4. DSM conceptualizes psychopathology as a collection of hundreds of distinct
categories of disorders, but what happens in clinical practice provides a different
picture.
5. DSM is perceived as a hodgepodge collection of disorders, that have been developed
and refined in a piecemeal way across a number of revisions. This makes it
impossible to frame a definition of what a mental health problem actually is.
Syndrome = a distinct set of symptoms.
Hybrid disorders = disorders that contain elements of a number of different
disorders. Similar to disorder spectrum (mixed anxiety-depressive disorder).
Criticisms of changes in DSM5:
Many of the diagnostic changes will reduce the number of criteria needed to establish
a diagnosis. This could lead to over-diagnosis.
DSM5 has introduced disorder categories that are designed to identify populations
that are at risk for mental health issues.
Concerns that changes in diagnosis will lower rates of diagnosis for some particularly
vulnerable populations.
Methods of assessment
Reliability and validity:
Cronbach’s a = test used to assess the internal consistency of a questionnaire.
Concurrent validity = a measure of how highly correlated scores of one test are with
scores from other types of assessments that we know also measure that attribute.
Face validity = a particular assessment method may appear to be valid simply
because it has questions which seem relevant to the characteristic being measured.
Predictive validity = the degree to which an assessment is able to help a clinician
predict future behaviour and symptoms.
Construct validity = evidence showing that a measure of a construct is related to
other similar measures.
Clinical interviews:
, In a structured interview, the questions are all predetermined.
Limitations of interviews;
Low reliability
Interviewer’s race and sex influence a client’s response
Interviewer bias
Client can manipulate the interview or deliberately provide misleading
information.
Psychological tests:
Advantages:
They assess the client on one or more specific characteristics
They have rigid response requirements so the questions can be scored
according to a system
Statistical norms can be established – standardization
MMPI has good internal reliability and excellent clinical validity, but is time-
consuming.
Psychometric approach = the idea that a psychological test assumes that there are
stable underlying traits that exist at different levels in everyone
Projective tests = a group of tests presented to clients, with ambiguous enough
stimuli for clients to put their own interpretation on what the stimuli represent.
Rorschach
TAT
Sentence completion test
Based on psychodynamic view
Because they are open-ended tests, significantly less reliable and valid
Limitations of intelligence tests;
Intelligence is an inferred construct. It does not objectively exist.
If intelligence is what IQ tests measure, then our conception of whether
someone is intelligent or not will depend on the reliability and validity of the
IQ test we use and this can raise difficulties.
Intelligence tests are static tests and provide a snapshot of abilities at any point
in time.
Neurological impairment tests = AMIPB, Halstead-Reitan NP test battery
Electrodermal responding = a measure which uses electrodes attached to the fingers
of participants to test emotional responses such as anxiety or fear by measuring
changes in sweat-gland activity.
EMG = muscles. ECG = heart. EEG = brain.
Neuroimaging techniques;
1. Computerized axial tomography; uses X-ray machines and can be used to
form a 3D picture of the brain
2. Positron emission tomography; allows measurement of brain structure and
brain function by utilizing radiation emitted from the person to develop
images.
3. Magnetic resonance imaging; person in a large magnet chamber that causes
hydrogen atoms to move. This produces an electromagnetic signal that is
converted by the computer into visual pictures of the brain. Pictures of the
