Clinical

• Inferences made through examining bones, artwork, and other remains, concluding that mental health difficulties were likely attributed to ‘possession by supernatural forces, demons, and evil spirits’.
• Holes in skulls across Europe and North America thought to be evidence of ‘trephination’
• Egyptian, Chinese, and Hebrew writings, as well as the old testament, make similar attributions, with exorcism as a key treatment
• Somatogenic is the view that mental health issues are produced in the body
• • Hippocrates (460-377BC): said illnesses had natural causes, and therefore mental health difficulties must be caused by physical problems
• Galen (130-201AD) - subscribed to the humors and used treatments such as bloodletting. Acknowledged the role of psychological stressors in health
• The power of clergy grew across Europe as Rome declined, leading to the return of supernatural understandings of mental health
• Asylums, often church owned, appeared in the late 1400s. Initially designed to be humane, but soon became underfunded and overcrowded, with patients chained to bed in unsanitary conditions
• Pinel studied and classified mental symptoms, using repeated measures of the same individuals to collect observational data and argued that poor mental health was caused by social, psychological, and physiological factors.
• The psychogenic perspective is the view that mental health difficulties have psychological causes
• Kraeplin (1856-1926) - established foundations of a classification system by equating psychiatry as a medical science, informed by observation and empirical practices. He opposed inhumane practices and psychodynamic/philosophical approaches and promoted neuropathological approach.
• The definition of a mental health condition is deeply embodied in societal beliefs and therefore can vary across the world. Behaviour can mostly be seen, but emotion and cognition has to be inferred
• • An expectable or culturally approved response to a common stressor is not a mental disorder.
  • Socially deviant behaviour and conflicts primarily between the individual and society are not mental disorder, unless the deviance or conflict results from a dysfunction in the individual.
• A mental health condition could be summarised as patterns of abnormal behaviour associated with psychological dysfunction within an individual, significant emotional distress and/or impaired functioning, or a response that is not typical or culturally expected.
• Classification is fallible, is a product of social, cultural, and structural phenomena, and there must be evidence that supports its use.
• Diagnostic categories are needed to allow patients and psychologists to understand the symptoms, the treatments, and the prognosis of the condition.
• Spitzer emphasised the importance of empirical findings, championed the use of reliable signs and symptoms of conditions, allowing for clustered systems and sub-defined conditions.
• DSM IV (1994), led by Allen Frances, established a core definition of a mental health conditions, introducing emphasis on functional impairment and clinically significant distress, using ‘field trials’ to test the reliability of diagnoses
• • There is a worry that the DSM is reclassifying normality and ‘pathologising’ normal human experiences.
• Some DSM diagnoses are not valid and reliable as some psychiatrists do not agree about the correct diagnosis for a patient
• • The predominant current approach to mental health conditions focuses on the combination of biological, social, and psychological factors that can impact a persons mental health, specifically looking at the interactions between risk and resilience factors
• Incidence - number of new (or newly diagnosed) cases of a condition/symptom in a specified population, over a specified period of time
• Cure/remission - the rate at which the condition/symptom/clinically significant problems ceases to be present in individuals who have previously shown it.
• Recurrence - the rate at which the condition/symptom occurs again in individuals who previously had it
• Prevalence - reported as a percentage or as the number of cases. Different ways to measure and report depending on the timeframe
• Point prevalence - proportion of a population with the symptom/condition at a specific point in time
• Period prevalence is the proportion of a population with the symptom at any point during a given time period of interest
• Lifetime prevalence - proportion of a population who, at some point in life has ever had the symptom/condition
• Aetiology - process by which a disorder develops
• Course - the progressions of a disorder over time
• Comorbidity/co-occurence - a concurrent condition or difficulty alongside the primary condition
• Odds ratio - the probability of an event happening compared to an alternative event
• Schizophrenia: Psychosis is characterised by:

  • Positive Symptoms - delusions, hallucinations
  • Disorganisation - disorganised thinking/speech, disorganised behaviour
  • Negative Symptoms - social/emotional flatness
• Schizophrenia: False beliefs are those that remain fixed despite conflicting evidence -

  Persecutory, grandiose, nihilistic (end of the world), erotomanic (in love), somatic (stomach acid dissolving body parts), referential, thought broadcasting, thought insertion, thought withdrawal
• Schizophrenia: Delusion content often reflects the socio-political themes of the era - Skodlar, Dernovsek, and Kocmur (2008) found increases in persecution and self-reference-related delusions coincided with a more oppressive political regimes
• Schizophrenia: Hallucinations are vivid, clear sensory perceptions experiences in the absence of external stimulation - auditory, visual, tactile, somatic, gustatory, and olfactory.
• Schizophrenia: Content of hallucinations varies with culture - Luhrmann et al. (2015) found in the USA voices were described as intrusive with unreal thoughts, in South India, voices were described as providing useful guidance, and in West Africa, voices were described as morally good and causally powerful.
• Schizophrenia: Motor Symptoms - Walther and Strik (2012) - catatonic behaviour (decrease in reactivity), resisting instructions and requests (negativism), rigid, inappropriate, or bizarre posture, absence of verbal or motor response, purposeless or excessive motor activity, stereotypes movements (staring, grimacing), and involuntary movements
• Schizophrenia: Disorganised thinking and speech/thought disorder - Kircher, Brohl, Meier, and Engelen (2018) - poverty of speech, derailment, loose associations, tangentiality, perseveration, clanging (rhyme, alliteration), and flight of ideas.
• Schizophrenia: Other cognitive symptoms of schizophrenia include impairments in executive functioning, focusing or paying attention, working memory, and verbal learning and memory - found verbal and working memory deficits predicted subsequent onset of schizophrenia in high-risk adolescents