Psychopathology of Everyday Life

• Definition of abnormality

  Statistical infrequency, Norm violation, Personal distress and dysfunctioning
• Early history of mental illnesses

  People are placed inside asylums with inhumane treatments that values public order over individual recoveries. This lasted until the "shell shock" of WWI
• Deinstitutionalization


  moving people with psychological or developmental disabilities from highly structured institutions to home- or community-based settings. At 1990, most people are treated at GPs, community providers, private psychiatrists and outpatients. Only 2% are hospitalized.
• DSM


  First version introduced in 1952 and newest in 2013
• DSM definition of mental disorder

  1. Behavioural/psychological syndrome in an individual 2. Causes significant distress or disability. 3. Is not a culturally acceptable response to certain stressor. 4. Reflects underlying psychobiological dysfunction. 5. Is not a primary result of social deviance. "clinically significant disturbance in an individual's cognition, emotion regulation or behaviour...usually associated with significant distress or disability in social, occupational or other important activities"
• DSM 5 definition of non-mental disorders


  A culturally acceptable response to a common stressor or loss
• Argument against diagnosis

  1. Lead to restricted thinking. 2. Associated with jargon. 3. Inhibit research. 4. Can be stigmatising. 5. Some even say mental disorder is a myth.
• Argument for diagnosis

  1. Facilitate communication and care. 2. Research. 3. Education. 4. Information management: How much do I pay for specific care.
• Prevalence of mental disorders

  20% of population experienced some thought of mental illnesses, only 74% of which have the appropriate treatments they needed.
• Signs in descriptive psychopathology

  Objective findings observed by the clinician
• Symptoms in descriptive psychopathology

  Subjective complaints made by the patient.
• Syndrome in descriptive psychopathology


  Signs, symptoms and events that occurs in a particular pattern and indicate the existence of a disorder.
• Disorder in descriptive psychopathology


  A syndrome that can be differentiated from other syndromes. There must be a clear course to this syndrome and the epidemiology explained.
• Disease in descriptive psychopathology

  A disorder with underlying structural abnormalities
• Assessments for psychopathology

  Pen & Paper, Psychological, Psychophysiological, Neuropsychological and/or Medical tests. Clinical interview. Behavioural assessment. Activity diary.
• Specifiers to diagnosis

  1. Symptoms cause clinically significant distress in areas of daily functioning. 2. Not better accounted by other psychobiological conditions. 3. Not better accounted by substance usage. 4. Not a culturally acceptable response.
• Anti-psychiatric movement


  Happened during 1960s, against the situation where "diagnosis is mere justification of inappropriate treatments"
• Categorical approach to classification

  distinctions among members of different categories are qualitative (yes or no)Used by DSM and ICD. Has higher utility as decisions are merely dichotomous.
• Dimensional approach to classification

  Objects of classification on a continuum. A better model for disorder vs normality and has a better tracking of improvements. However ultimately treatments are dichotomous.
• Hybrid approach to classification


  Using continuous data to determine categorial items such as an area of focus. E.g. MMPI-2
• Freudian model


  The key is the awareness of the unconsciousness
• Skinner's behavioural model


  Behavioural intervention aim to associate and disassociate stimulus and responses
• Beck's cognitive behavioural model

  A cognitive cycle involves: A. Situation. B. Beliefs. C. Behaviour, emotion and physical response. Change of these will break the cycle, therefore it is the CBT model.
• The biopsychosocial model


  Mental illness results from an interaction of biological situation, psychological state, and social environments.
• Biological paradigm of mental health


  The factors that may influence one's mental health include: 1. Genetics (possible risk factors. 2. Structural brain damage. 3. Physiology (inflammation and depression）4. Neurochemistry (Neurotransmitters not evenly distributed）5. Functional connectivity impairments.
• Social determinants of mental health

  Demographics (e.g. gender equality), economics (e.g.no poverty), neighbourhood (e.g. , sustainable community), environmental event (e.g. climate change), social (e.g. quality education). For each, there are some proximal domains and some distant domains.
• Diathesis stress model


  Neither diathesis (vulnerability) nor stress alone will have a very large impact on one. However, if they are both present, there can be some detrimental effects.Resilience is a key characteristic against them.
• Research Domain Criteria Project (RDoC)


  a new initiative that aims to guide the classification and understanding of mental disorders by revealing the basic processes that give rise to them.The domains investigated are:1. Negative valence2. Positive valence3. Cognitive System4. System for social progress5. Sensorimotor 6. Arousal/regulatory systemThe underlying systems interested involve:genes, molecules, cells, physiology, behaviour, self-report. Hence, people are not grouped by disorders but rather clusters, where clusters are classified in a data-driven manner (e.g. share a same gene）
• Hierarchical taxonomy of mental disorders

  Super spectrum: Psychopathology. Spectra: Internalization. Sub factor: Distress. Disorder: GAD. Signs: Agitation. Trait: Anxiousness. Has a continuous profile
• Clinical staging model


  Focus on early intervention- treatment appropriate for their stage to prevent further worsening. Stage 0: Asymptomatic. 1A: Distress disorder. 1B: Sub-threshold symptoms and distress. 2: First Treated Episode. 3. Recurrence or Persistence. 4. Treatment Resistance
• Transdiagnostic model


  Different disorders may share the same underlying factors, accounting for high levels of comorbidity between disorders.
• anxiety disorders


  Psychological disorders characterized by distressing and persistent anxiety or maladaptive behaviours. Classically thought to be a disorder of avoidance. Crucial contributor to Disability. Adjusted life years
• Fear


  A feeling that occurs when a threat is imminent.
• Anxiety


  A feeling that occurs when a threat is distant or uncertain.
• Generic aetiology of anxiety disorders


  1. Pre-existing vulnerabilities (e.g. genes). 2. Childhood development. 3. Transient and circumscribed dysfunction of fear and anxiety control. 4. Early stages: Occurrence of transient and subthreshold anxiety syndromes. 5. Increasing sensitisation and impairment. 6. Later onset of threshold anxiety disorders. 7. Increased sensitisation and generalization. 8. Development of secondary complications
• Treatments for anxiety disorders in general

  At risk: Careful watching. Moderate anxiety: CBT/Pharmacopherapy. Severe anxiety: CBT+Pharmacopherapy. Generally, psychotherapy and pharmacotherapy has equal effect (except for OCD which prefers psychotherapy）
• Diagnosis for specific phobias

  Marked fear or anxiety of certain things/circumstances. The fear is out of proportion to the actual threat. Typically lasts for at least 6 months.
• Epidemiology of specific phobias

  Life time prevalence: 3-15%. Medium level for high income countries. More common in females. Phobias more commonly concern animals (e.g. spiders).
• Etiology of specific phobias

  1. Classical conditioning (e.g. Little Albert). 2. Social learning. 3. Overrepresentation of certain memories
• Treatment for specific phobias


  Exposure therapy. Can be vivo, imaginary or VR. Can be gradual or flooding. 70-85% reported improvement. However, premature termination is not uncommon.