Davey chapters 1, 2.1, 7, 15 8

Davey chapters 1, 2.1, 7, 15 & 8 Luteijn & Barelds chapters 1, 2, 3, 4 & 9 Chapter 15, 17 & 18 1 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

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Davey chapters 1, 2.1, 7, 15 & 8 Luteijn & Barelds chapters 1, 2, 3, 4 & 9 Chapter 15, 17 & 18 2 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:

• Debilitating (slopend) distress
• Important aspects of your life (e.g., mood, cravings) are out of control
• Failing to function properly in certain spheres of your life (e.g., mother, student)
• 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:

• Challenges in definition arise from incomplete understanding of processes contributing to mental health problems.
• 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

Demonic possession • 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” > 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

History demonic possession • 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 physical attacks (torture, starvation) on the sufferer’s body in an attempt to force out the demons.• 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 theology or demonology to being the realm of medicine • Middle 17 th century: religious, spiritual, and superstitious explanations of psychopathology were being replaced by more objective, medical explanations as a consequence of the new empirical scientific methods by thinkers and scientists (Newton, Descartes, Galileo) • 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

Many explanations link mental health problems to biological causes, explaining symptoms based on factors such as • Brain abnormalities (e.g., in dementia, autism) • Biochemical imbalance (especially imbalances of brain neurotransmitters) (e.g., major depression, bipolar disorder, schizophrenia) • Genetic factors (e.g., learning disabilities, autism, schizophrenia) • Chromosome disorders (e.g., intellectual disabilities) • Congenital (aangeboren) risk factors (maternal infections during pregnancy) (e.g., intellectual disorders, attention-deficit-hyperactivity disorder (ADHD)) • Abnormal physical development (e.g., autism) • Physical effects of pathological activities (e.g., the effect of hyperventilation in panic disorder)

→ 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 / 4

Davey chapters 1, 2.1, 7, 15 & 8 Luteijn & Barelds chapters 1, 2, 3, 4 & 9 Chapter 15, 17 & 18 3

Medical model of

psychopathology:

implications for the way we conceive mental health problems

• Not always the case; bizarre behavior can be developed by perfectly normal learning processes
• 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

• It is arguable whether the phenomenology (i.e., the personal experience of psychopathology) or

the complex cognitive factors involved in many psychological problems can be reduced to simple biological descriptions

• Complex mental health problems are often not just biological or reducible to psychological

problems and processes > they are influenced by the socio-economic situation in which the individual lives, their potential for employment and education, and the support they are given 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:

• 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.

• 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

Origin of Asylums • 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 individuals with mental health issues.• 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 • 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 and individuals from poor backgrounds (especially young pregnant women) • In 18 th and 19 th 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 19 th century: gradual movement towards more human treatments for individuals in asylums

• 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.

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Davey chapters 1, 2.1, 7, 15 & 8 Luteijn & Barelds chapters 1, 2, 3, 4 & 9 Chapter 15, 17 & 18 4

Start asylum to community care • Between 1950 and 1970: these limitations of hospitalization were acknowledged and there was some attempt to structure the hospital environment for patients.

• First attempt: milieu therapies; including mutual respect between staff and patients and the

opportunity for patients to become involved in vocational (beroepsmatige) and recreational activities. Patients exposed to milieu therapy were more likely to be discharged from hospital sooner and less likely to relapse

• 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

• 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

Community Mental Health Team &

Assertive Outreach Teams • 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 • These events led to the development of a combination of services usually termed assertive community 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

• Help with maintaining their necessary medication regime
• Finding and keeping a job
• Applying for and securing welfare benefits
• 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 psychiatrists, clinical psychologists, social workers, and nurses • 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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