Psychopathology 751

1. Psychopathology 751

2. Psychopathology 751 • NUTS AND BOLTS: • blackboard • articles • email • care and feeding

3. Psychopathology 751 • review syllabus • course overview/goals • a few consciousness thoughts • diathesis stress

4. BASICS: To become familiar with the DSM-IV its structure, use, development, & limitations Increased knowledge and basic skills in diagnostic interviewing case conceptualization assessing applied clinical research methods some course goals

5. MORE LOFTY To learn some things about conceptualization of psychopathological conditions. Deepened appreciation of the historical/ cultural context in understanding psychopathology and the constructivist nature of experience and behavior. some course goals

6. A few consciousness thoughts • we don’t understand consciousness • brains are the most complex amazing things in the known world (e.g., 100 billion neurons) • what part of the brain is responsible for consciousness? • is consciousness merely epiphenomenal? • one inescapable conundrum is that consciousness and metapsychological processes represent the brain observing itself in the world • so how can we study consciousness objectively…

7. A few consciousness thoughts • we live in the past and future but experience ourselves as in a ‘now’ • so a large function of consciousness is to construct symbolic representations of the world that persist into the past and can be projected into the future. • allows for a sense of self, cultural and personal history, plans, prediction of future needs…

8. A few consciousness thoughts • so experiences/consciousness is a constructive act based on personal/cultural history we experience as ‘reality’ • for us, pathological brains operate with distorted/broken filters with which they construct their symbolic representation of the world. • this distorting process renders self-identified treatment plan goals suspect.

9. A few more basic ideas • How we construct the questions constrain the answers. e.g., MRI • psychopathology is multicausal. • it is all about the brain and your childhood, learning history and your culture.. • nature and nurture • no one has a corner on the truth • progress in science comes from the critical evaluation of our theoretical assumptions and a willingness to modify our thinking with new information

10. psychopathology • what causes abnormality? • bad genetic code • bad brain: chemical / structural • bad parenting • bad schooling/friends • bad societal institutions/structure • who gets blamed? who gets responsibility? e.g., criminal deviance.

11. psychopathology • How do we describe psychopathology? • symptom clusters • spectrum versus discrete entities • character traits and normal distributions • e.g., personality dimensions: Neuroticism, Extroversion, Openness, Agreeableness, Conscientiousness. • can disorders look both continuous and discrete?

12. psychopathology • how do we explain psychopathology: • biological disease--medical model (descriptive psychiatry) • problems in learning/experience (theory of development) • Diathesis Stress

13. theory in psychopathology • Diathesis— • dispositional vulnerability (trait like). Outside of normal variability. Precede disorder • most commonly accepted are biological (e.g., genetic, neonatal, acquired brain damage) • perhaps include cognitive but harder to differentiate from a symptom (hence not before disorder but part of it). • personality increasingly accepted as relevant and important as underlying neurophysiological vulnerability • multifaceted—polygenic disorders

14. theory in psychopathology • Stress— • “an interference or change in conditions affecting the individual which has an adverse effect, such as worry or hostility, especially when prolonged; also external conditions producing anxiety” Walton, 1985, p.157. • state like (versus trait of diathesis) • desire to create objective, temporally proximal stress definition. Try to reduce the importance of individual differences in stress definition (“what makes me stressed out is…” because they may reflect diatheses. e.g., ).

15. theory in psychopathology • Diathesis—Stress (paul meehl, 1962) • vulnerability interacts with stress (schizogenic mother) causes schizophrenia. • Posits that without right kind/amount of stress, individual will have a residual, genetically coded, condition he labeled schizotaxia • “I favor focusing attention on those at a somewhat lower level of functioning (soft neurology and psychophysiology) rather than social behavior, or even psychometrics, on the ground that the former kinds of behavior are closer to the DNA and so have, by and large, been subject to less influence from complex social learnings contributing to individual differences variation and, hence, to increased statistical overlap.” (p.3, 1990).

16. theory in psychopathology • Diathesis—Stress (paul meehl, 1962) • elegant: • fits data that humans are genetically coded to be the least biologically determined animals. We are the animal most open to environmental influence (culture, language) • limitations: • In the simplified model we have a limited view of both vulnerability and stress as unidimensional but they are not. • e.g., time of stressor may be very important, most disorders are polygenic

17. theory in psychopathology • Diathesis—Stress modified models • additive model • stress causes x disorder but those with a low level of diathesis require much more stress…implies that disorder x will occur with sufficient stress • threshold model • sufficient diathetic risk required to develop x disorder • at some threshold of diatheses, the individual will develop disorder x (without stressors).

18. theory in psychopathology • Diathesis—Stress complications • diathesis—stress interactions: • complicate the picture by questioning the independence of diatheses and stressors. • diathesis may cause stressors (e.g., traits of anxiousness and introversion may lead to greater strain in social support • timing of stressors may be critically linked • x stressor my be crucial a y developmental window but not important before/after • multiple genetic pathways may independently contribute to clinical condition (hard to measure) • genetics probably code for both vulnerability and protection (stress may work similarly)

19. psychodiagnosis • Why diagnose? • treatment planning • predict outcomes/responses • protection of consumers (informs client what to expect) • can be used to communicate empathy • reduce risk of flight from treatment • nomenclature for communication • organize, retrieve info • describe patterns of psychopathology • facilitate theory/research • socio-political functions (who are patients, who gets to treat whom?)