 The scientific study of psychological disorders.

MODULE 1:

Conducted by:
INTRODUCTION TO ABNORMAL PSYCHOLOGY
 Clinical and counseling psychologists (PhD,
NORMAL PsyD)/Registered Psychologists (RPsy)
 Typical for the social context  Psychiatrists (MD)
 Not distressing to the individual  Psychiatric social workers (MSW)
 Not interfering with social life or work/school  Psychiatric nurses (MN, MSN, PhD)
 Not dangerous  Marriage and family therapists (MA, MS, MFT)
 “College students who are self-confident and happy,  Mental health counselors (MA, MS)
perform to their capacity in school, and have good
friends” SCIENTIST- PRACTITIONER

SOCIALLY ESTABLISHED DIVISION BETWEEN Mental Health Practitioner

NORMAL AND ABNORMAL
 Consumer of Science - Enhancing the practice
 Somewhat unusual for the social context  Evaluator of Science - Determining the effectiveness of
 Distressing to the individual the practice
 Interfering with social or occupational functioning  Creator of Science - Conducting research that leads to
 Dangerous new procedures useful in practice
 “College students who are often unsure and self-critical,
occasionally abuse prescription drugs, fail some courses, 3 BASIC THINGS FROM CONDUCTING RESEARCH
and avoid friends who disapprove of drug use”  To describe psychological disorders
ABNORMAL  To determine their causes
 To treat them
 Highly unusual for the social context
 The source of significant individual distress 3 CATEGORIES THAT MAKE UP THE STUDY OF
 Significantly interfering with social occupational PSYCHOLOGICAL DISORDERS
functioning Studying Psychological Disorders
 Highly dangerous to the individual or others
 “College students who are hopeless about the future, are Focus:
self-loathing, chronically abuse drugs, fail courses, and
have alienate all their friends”  Clinical Description
 Causation (Etiology)
PSYCHOLOGICAL DISORDER  Treatment and Outcome

 Describes behavioral, psychological, or biological CLINICAL DESCRIPTION

dysfunctions that are unexpected in their cultural context
and associated with present distress and impairment in COURSE – pattern of behavior
functioning, or increased risk of suffering, death, pain, or  Chronic – last a long time
impairment.  Episodic – likely to recover within a few months only to a
4Ds of ABNORMALITY suffer a recurrence
 Time-limited – to improve in a short period
 DYSFUNCTION - Refers to the breakdown in cognitive,
emotional, or behavioral functioning ONSET – first phase or beginning of the symptoms of the
 DISTRESS - The behavior must be associated with disorder
distress to be classified as a disorder adds an important
 Acute – begins suddenly
component: the criterion is satisfied if the individual is
 Insidious – develops gradually over an extended period
extremely upset.
 DEVIANCE - It deviates from the average. The greater PROGNOSIS – predicted future development of a disorder
the deviation, the more abnormal it is over time
 DANGER - Inflicts danger to self or to another person
 Good
THE SCIENCE OF PSYCHOPATHOLOGY  Bad
PSYCHOPATHOLOGY DEVELOPMENTAL PSYCHOPATHOLOGY
 study of changes in behavior over time  Genetics, Brain Anatomy, Biochemical Imbalances,
 study of changes in abnormal behavior Central Nervous System Functioning, Autonomic
Nervous System Reactivity, etc.
CAUSATION, TREATMENT & ETIOLOGY OUTCOMES
SOCIOCULTURAL DIMENSION
 ETIOLOGY - Cause of development of psychopathology
 TREATMENT - Drugs and/or psychosocial  Race, Gender, Sexual Orientation, Religion,
Socioeconomic Status, Ethnicity, Culture, etc.
OTHER CLINICAL TERMINOLOGIES
SOCIAL DIMENSION
 Presenting Problem – medical way of identifying the
reason why the patient came to the clinic or hospital.  Family, Relationship, Social Support, Belonging,
Presents is a traditional shorthand way of indicating why Love, Marital Status, Community, etc.
the person came to the clinic.
PSYCHOLOGICAL DIMENSION
 Prevalence – a statistical term referring to the number of
cases present in a particular population.  Personality, Cognition, Emotions, Learning, Stress-
 Incidence – refers to the number of new cases during a Coping, Self-Esteem, Self-Efficacy, Values,
given period of time. Developmental History.
 Diagnosis – process of determining whether a presenting
problem meets the established criteria for a specific 4 CATEGORIES OF BIOLOGICAL FACTORS TO THE
disorder DEVELOPMENT OF MALADAPTIVE BEHAVIOR

II. INDIGENOUS CONCEPTS OF ABNORMALITY  Genetic vulnerabilities

 Brain dysfunction and neural plasticity
 Consider these behaviors: Crucifixions during Holy Week  Neurotransmitter and hormonal abnormalities
A man barking like a dog and crawling on the floor on his  Temperament
hands and knees A woman building a shrine to her dead
husband in her living room and leaving food and gifts for THE ROLE OF GENES
him at the altar
WHAT ARE GENES?
CULTURAL RELATIVISM
 Long molecules of DNA
 Cultural relativism is the view that there are no universal  Double helix structure
standards or rules for labeling a behavior abnormal;  Located on chromosomes
instead, behaviors can be labeled abnormal only relative  46 chromosomes in 23 pairs
to cultural norms (Snowden & Yamada, 2005)  Pairs 1 – 22 = body and brain development
 Pair 23 = gender
CULTURAL DIFFERENCES
COMMON TERMINOLOGIES
 Culture and gender can influence the ways people express
symptoms.  Sex Chromosomes – determines an individual’s sex.
 Culture and gender can influence people’s willingness to In females, both chromosomes in the 23rd pair are
admit certain types of behaviors or feelings (Snowden & called X chromosomes. In males, the mother
Yamada, 2005) contributes an X chromosome, but the father
 Culture and gender can influence the types of treatments contributes a Y chromosome. This one difference is
deemed acceptable or helpful for people exhibiting responsible for the variance in biological sex.
abnormal behaviors.  Dominant Gene - one of a pair of genes that strongly
 Cultural universality, on the other hand, refers to the influences a particular trait, and we need only one of
perspective that symptoms of mental disorders are the them to determine, for example, our eye color or hair
same in all cultures and societies (Eshun & Gurung, color.
2009).  Recessive Gene – must be paired with another
MODULE 2: (recessive) gene to determine a trait.
 Polygenic – influenced by many genes, each
APPROACHES TO PSYCHOPATHOLOGY contributing only a tiny effect, all of which, in turn,
may be influenced by the environment.
MENTAL DISORDER
 Genome – an individual’s complete set of genes
BIOLOGICAL DIMENSION
DIATHESIS-STRESS MODEL
 Individuals are assumed to inherit certain EPIGENETICS
vulnerabilities that make them susceptible to a
disorder when the right kind of stressor comes along  the immediate effects of the environment (such as
early stressful experiences) impact cells that turn
DIATHESIS certain genes on or off. This effect may be passed
down through several generations.
 A predisposition or vulnerability  Your brain + your environment and lifestyle = you!
 Inherited predisposition to develop the disorder +
NEUROSCIENCE AND ITS CONTRIBUTIONS TO
STRESS PSYCHOPATHOLOGY
 Environmental stressors CENTRAL NERVOUS SYSTEM (CNS)
 Prenatal trauma or childhood sexual or physical
abuse, family confuse, significant life changes —  processes all information received from our sense organs
and reacts, as necessary.
DEVELOPMENT OF THE DISORDER
PERIPHERAL NERVOUS SYSTEM (PNS)
 The stronger the diathesis, the less stress is necessary
to produce the disorder  coordinates with the brain stem to make sure the body is
 Psychological disorder working properly.
GENE-ENVIRONMENT CORRELATION MODEL MAJOR NEUROTRANSMITTERS

 Also called as reciprocal gene-environment model; Acetylcholine

the individual’s genetic vulnerability toward a certain
disorder may make it more likely that the person will  Influences attention and memory, dream and sleep states,
experience the stressor that, in turn, triggers the and muscle activation; has excitatory and inhibitory
genetic vulnerability and thus the disorder effects
o The child’s genotype may have what has  Alzheimer’s Disease (low)
been termed a passive effect on the Dopamine*
environment, resulting from the genetic
similarity of parents and children.  Influences motivation and reward-seeking behaviors;
o The child’s genotype may evoke kinds of regulates movement, emotional responses, attention, and
reactions from the social and physical planning; has excitatory and inhibitory effects
environment— a so-called evocative effect.  Attention-deficit/hyperactivity disorder (high);
o The child’s genotype may play a more schizophrenia (low)
active role in shaping the environment—a
so-called active effect. Epinephrine (adrenaline)* and norepinephrine*
(noradrenaline)

 Excitatory functions including regulating attention,

arousal and concentration, dreaming, and moods; as a
hormone, influences physiological reactions related to
stress response (constricted attention, blood flow, heart
rate, etc.)
 Anxiety and stress disorders; sleep disorders (high/low)

Glutamate
EXAMPLE OF GENE-ENVIRONMENT CORRELATION
MODEL  Major excitatory neurotransmitter involved in cognition,
memory, and learning
 If you and your spouse each have an identical twin,  Alzheimer’s disease: autism; depression; obsessive-
and both identical twins have been divorced, the compulsive disorder; schizophrenia (high/low)
chance that you will also divorce increases greatly.
 Furthermore, if your identical twin and your parents Gamma-aminobutyric acid (GABA)
and your spouse’s parents have been divorced, the  Major inhibitory neurotransmitter; calms the nerves;
chance that you will divorce is 77.5%. regulates mood and muscle tone
 Conversely, if none of your family members on either
side has been divorced, the probability that you will
divorce is only 5.3%.
 Anxiety disorders; attention-deficit/ hyperactivity  Treatment of psychological disorder, from this
disorder; bipolar disorder; depression; schizophrenia perspective, involves an attempt to restructure the
(low) individual’s personality
 Early life experiences play a formative role in
Serotonin or 5-hydroxytryptamine (5HT)
personality
 Inhibitory effects regulate temperature, mood, appetite,  In order to understand Freud’s view in
and sleep; reduced serotonin can increase impulsive psychopathology, it is necessary to understand how
behavior and aggression he conceived the personality structure
 Depression, suicide, obsessive-compulsive and anxiety  In Freud’s view, a psychological disorder results
disorders, post-traumatic stress disorder, eating disorders from serious imbalance between the id’s needs and
(low) the superego’s restrictions
 Psychological disturbance can also result from
MAJOR HORMONES defects in the ego. In normally functioning
Cortisol individuals, the ego attempts to protect itself from the
id (Defense Mechanisms)
 Steroid hormone released in response to stress
 Anorexia nervosa: depression; stress-related NARCISSISTIC DEFENSES
disorders  Denial, Distortion, Projection
Ghrelin NEUROTIC DEFENSES
 Stimulates hunger and boosts the appeal of food  Controlling ,Isolation, Displacement, Rationalization,
 Eating disorders; obesity Externalization, Reaction, Formation, Inhibition,
Leptin Dissociation, Intellectualization, Repression,
Sexualization
 Suppresses appetite
 Anorexia nervosa; schizophrenia IMMATURE DEFENSES

Melatonin  Acting Out, Blocking,Hypochondriasis, Introjection,

Passive-Aggressive behavior, Regression, Schizoid
 Regulates circadian sleep and wake cycles Fantasy, Somatization
 Bipolar disorder; depression,
particularly seasonal depression; MATURE DEFENSES
schizophrenia; obsessive-
compulsive disorder  Altruism, Anticipation, Asceticism, Humor,
Oxytocin Sublimation, Suppression
 Neuropeptide hormone influencing lactation and POST-FREUDIAN PSYCHODYNAMIC VIEWS
complex social behavior (including nurturing and
bonding)  C.G. Jung believed that the goal of the healthy
 Autism; anxiety; schizophrenia personality development was an integration of the
 unconscious life with conscious thoughts, and that
THE PURPOSE OF THEORIES IN ABNORMAL psychological disorders result from an imbalance
PSYCHOLOGY between these two parts of the personality.
 Offers contrasting perspectives from which to  Alfred Adler placed more emphasis on the
approach the possible causes of psychological individual’s relationship to society, and saw the basis
functioning for psychological disorder as loss of social interest, or
 Provides framework for collecting and analyzing a turning-away from fellow humans
research data  Karen Horney focused more on the inner world of the
 Psychologists of different orientations are likely to individual as the basis for psychological disorder.
examine different aspects of the person She proposed that people with psychological
disorders have become distanced from their true
PSYCHODYNAMIC PERSPECTIVE needs and desires
 Erik Erikson focuses on unconscious roots of
 Theoretical orientation that emphasizes unconscious personality and psychological disorder and
determinants of behavior development proceeds throughout the life span in a
series of eight “crises”
OBJECT-RELATIONS THEORIES  When it comes to social learning or social cognition,
it is not only direct reinforcements that influence
 Object-relation theorists placed far greater emphasis behavior, but indirect reinforcements that people
on the early mother-child relationship acquire. It can also be shown that maladaptive
 Propose that various forms of psychological disorder behaviors are learned through observing other people
arise from defects in the individual’s sense of self.
Some disorders are caused by failure to form an COGNITIVE-BEHAVIORAL APPROACH
integrated self early in life
 Albert Ellis, Aaron Beck and Donald Meichenbaum
 Other disorders may occur when parent’s lack of
empathy, or sharing of the child’s perspective, and emphasized the role of disturbed thinking processes
failure to mirror back or take pride in the child’s in causing maladaptive behavior
achievements cause the individual to develop  Beck – “dysfunctional attitudes”; Ellis – “irrational
unhealthy needs for attention beliefs”; Meichenbaum – people create their own
 Melanie Klein’s contribution was the idea that the unhappiness by having unduly negative thoughts
infant has an active fantasy life built around parents about their situations
 In Heinz Kohut’s view, a disturbed sense of self  Psychological disorder, as George Kelly proposed,
accounts for most forms of psychological disorder occurs when these constructs fail to organize the
 According to Margaret Mahler, psychological individual’s world
disturbances can result from problems arising at any CULTURAL, SOCIAL & INTERPERSONAL FACTORS
of the phases of development
 Social factors are environmental influences—
HUMANISTIC PERSPECTIVE often unpredictable and uncontrollable negative
 The core of the humanistic perspective is the belief events—that can negatively affect a person
that human motivation is based on an inherent psychologically, making him or her less
tendency to strive for self-fulfillment and meaning in
resourceful in coping with events.
 The sociocultural perspective looks at the various
life
circles of influence on the individual, ranging from
 Psychological disorders is the result of blocking of close friends and family to the institutions and
one’s potential for living to full capacity, resulting in policies of a country or the world as a whole. These
a state of incongruence – a mismatch between a influences interact in important ways with biological
person’s self-perception and reality (Person-centered processes and with the psychological contributions
approach) that occur through exposure to particular experiences.
 According to Carl Rogers, a psychological disorder  One important and unique sociocultural contribution
develops in an individual who, as a child, was to psychological disorders is discrimination,
subjected to parents who were too critical and whether based on social class, income, race and
demanding ethnicity, nationality, sexual orientation, or gender.
 On Abraham Maslow’s notion of self-actualization,
OTHER TYPES OF SOCIAL FACTORS Early deprivation or
the maximum realization of the individual’s potential
trauma
for psychological growth
 Maslow defined psychological disorder in terms of  Problems in parenting style
the degree of deviation from the ideal state of being  Marital discord and divorce
 Another source of psychological problems is the  Low socioeconomic status and unemployment
suppression of the higher-level needs required to  Maladaptive peer relationships
achieve actualization  Prejudice and discrimination
BEHAVIORAL APPROACH CULTURAL, SOCIAL & INTERPERSONAL FACTORS
 According to classical conditioning principles, many  Everyone experiences anxiety and fear, and phobias
emotions and behaviors are acquired through the are found all over the world. But phobias have a
pairing of neutral and emotion-provoking stimuli peculiar characteristic: The likelihood of your having
 The classical conditioning paradigm accounts for the a particular phobia is powerfully influenced by your
acquisition or learning through conditioning, of gender.
emotional reactions that interfere with a person’s  Many major psychological disorders, such as
ability to carry out everyday tasks schizophrenia and major depressive disorder, seem to
 Shaping is an important method in the treatment of occur in all cultures, but they may look different from
certain behavioral problems (operant conditioning) one culture to another because individual symptoms
are strongly influenced by social and interpersonal  A suicide assessment should be performed
context (Cheung, 2012; Cheung, van de Vijver, &  Should be asked about any current thoughts of suicide and
Leong, 2011). if thoughts are present, ask the intention.
 Presence of psychotic symptoms should be assessed
MODULE 3  Although the intent of interview is to build rapport, the
CLINICAL ASSESSMENT patient’s safety is the first priority. If he/she is viewed to
be at imminent risk, the interview may need to be
- refers to a systematic evaluation and measurement of terminated and action must be taken
psychological, biological, and social factors in people with
psychiatric disorders to provide idiographic information that HOSTILE, AGITATED & POTENTIALLY VIOLENT
may be helpful in treatment planning. PATIENTS

 Reliability is the degree to which a measurement is  Safety of the patient and psychologist/psychiatrist is the
consistent. priority
 Validity is whether something measures what it is  Hostile patients are often interviewed in emergency
designed to measure—in this case, whether a technique settings
assesses what it is supposed to.  Angry, agitated patients can present in any setting
 Standardization is the process by which a certain set of  Interviewers should be aware of any available safety
standards or norms is determined for a technique to make features
its use consistent across different measurements. (Value  They should be aware of his or her own body position and
Assessment depends on these 3) avoid postures that could be seen as threatening
 Interview approach should be calm, direct manner and not
CLINICAL INTERVIEW to bargain or promise to elicit cooperation
 If patient makes threats, further assessment is necessary
Time-honored means of psychological assessment
DECEPTIVE PATIENTS
 Flexible interview (unstructured)
 Consists of open-ended questions on various  Patients lie or deceive for many reasons (secondary gain,
topics such as reasons for being in treatment, psychological benefits of assuming a sick role)
symptoms, health status, family background, etc.  There are no biological markers to definitively validate a
 Standardized interview (structured) patient’s symptoms
 Contains fixed questions with fixed scoring  Gather collateral information regarding the patient
categories  Psychological tests which can help in further evaluating
the reliability of the client
INTERVIEWING DIFFICULT PATIENTS
DEALING WITH PSYCHIATRIC PATIENTS
PATIENTS WITH PSYCHOSIS
 WITHDRAWN PATIENTS
 Often frightened or guarded; have difficulty with  Active-Friendliness Attitude
reasoning and thinking clearly.  TLC
 Can be actively hallucinating during the interview,  Supportive gestures, should be non-threatening
causing them to be inattentive and distracted  Assurance of safety
 May need to alter the usual format and adapt the interview  Attend to basic needs as possible
to match the capacity and tolerance of the patient  PARANOID PATIENTS
 Ask patient about a specific instance or repeat verbatim  Passive-friendliness
 Should be alert for cues  Maintain your distance
 For patients with paranoid thoughts and behaviors,  Do not stare
maintain a respectful distance. It is also helpful to avoid  He/She must be part of decision-making
sustained eye contact  Do not laugh/smile unless he/she started to
DEPRESSED AND POTENTIALLY SUICIDAL PATIENTS  Do not whisper with others in front of the patient
 Do not make unnecessary movements/gestures
 Feelings of hopelessness may contribute to lack of  MANIPULATIVE PATIENTS
engagement  Matter-of-Fact approach
 May have difficulty during the interview  Stick to the rules
 May have impaired motivation and not report their  No negotiations/bargaining
symptoms  Do not react to his/her manipulations
 Depending on the severity of symptoms, may need more  Do not give in to his/her request at once
direct questioning rather than an open-ended format
 Rule implementation must be consistently followed by all  Where were you born? Where did you go to school? Date
staff of marriage? Birthdays of children?
 Patients with dementia of the Alzheimer type retain
THE MENTAL STATUS EXAMINATION (MSE) remote memory longer than recent memory. Gaps in
 To organize information obtained during an interview, memory may be localized or filled in with confabulatory
many clinicians use a mental status exam. details. Hypermnesia is seen in paranoid personality.
 Often a 1-2 paragraph statement which is an assessment Immediate memory (very short-term)
of the client’s JOIMAT.
 Ask patient to repeat six digits forward, then backward
J-O-I-M-A-T (normal responses). Ask patient to try to remember three
 J – udgment/Insight (Inquired/Observed) nonrelated items; test patient after 5 min.
 O – rientation x3 (Person, place, time) (Inquired)  Loss of memory occurs with cognitive, dissociative, or
 I – ntellectual Functioning (Inquired/Observed) conversion disorder. Anxiety can impair immediate
 M – emory (Inquired) retention and recent memory.
 A – ppearance; Affect (Both Observed) Thought process
 T – hought Process (Inquired/Observed)
 Ask similarity between bird and butterfly (both alive),
Topic Sample Questions Comments and Clinical Hints bread and cake (both food).
General appearance  Loose associations point to schizophrenia; flight of ideas
to mania; inability to abstract to schizophrenia, brain
 Introduce yourself and direct patient to take a seat. In the damage.
hospital, bring your chair to bedside; do not sit on the bed.
 Unkempt and disheveled in cognitive disorder, pinpoint Mood
pupils in narcotic addiction, withdrawal and stooped  *Trigger Warning*
posture in depression. How do you feel? How are your spirits? Do you have
Attitude during interview thoughts that life is not worth living or that you want to
harm yourself? Do you have plans to take your own life?
 You may comment about attitude: “You seem irritated Do you want to die? Has there been a change in your
about something; is that an accurate observation?” sleep habits?
 Suspiciousness in paranoia; seductive in hysteria;  Suicidal ideas in 25% of depressives; elation in mania.
apathetic in conversion disorder (la belle indifference); Early morning awakening in depression; decreased need
punning (witzelsucht) in frontal lobe syndromes. for sleep in mania.

Judgment CAGE & RAPS4

 What is the thing to do if you find an envelope in the  Have you ever Cut down on your drinking?
street that is sealed, stamped, and addressed?  Have people Annoyed you by criticizing your drinking?
 Impaired in brain disease, schizophrenia, borderline  Have you ever felt bad or Guilty about your drinking?
intellectual functioning, intoxication.  Have you ever had a drink the first thing in the morning,
as an Eye-opener, to steady your nerves or get rid of a
Insight level hangover?
 Do you think you have a problem? Do you need  Have you ever felt guilty after drinking (Remorse),
treatment? What are your plans for the future?  Could not remember things said or did after drinking
 Impaired in delirium, dementia, frontal lobe syndrome, (Amnesia),
psychosis, borderline intellectual functioning.  Failed to do what was normally expected after drinking
(Perform),
Orientation x3 (Person, Place, Time)  Or had a morning drink (Starter)?

 What place is this? What is today’s date? Do youknow BASIC COMPONENTS OF A COMPREHENSIVE
who I am? PSYCHOLOGICAL REPORT
 Delirium or dementia shows clouded or wandering
sensorium. Orientation to person remains intact longer I. Identifying Data (Demographic Data)
than orientation to time or place. II. Reason for Referral/Source
III. Presenting Problem/Chief Complaint
Remote memory (long-term memory) IV. History of Present Illness
a. Background
b. Personal PURPOSE OF ASSESSMENT REPORTS
c. Family
d. Medical  To respond to the referral questions being asked.
e. Educational  To provide insight to clients for therapy.
V. Mental Status Examination  To assist in the case-conceptualization process.
VI. Assessment Used (Tools and other methods)  To develop treatment options in counseling (e.g., type of
VII. Test Results counseling, use of medications, etc.)
VIII. Diagnosis (if applicable)  To suggest educational services for students with special
IX. Summary & Recommendations needs (e.g., for students who are mentally retarded,
learning disabled, or gifted)
Identifying data  To offer direction when providing vocational
rehabilitation services.
 Be direct in obtaining identifying data. Request  To offer insight about and treatment options for
specificanswers. individuals who have incurred a cognitive impairment
 If patient cannot cooperate, get information from family (e.g., brain injury, senility).
member or friend; if referred by a physician, obtain  To assist the courts in making difficult decisions (e.g.,
medical record. custody decisions, sanity defenses, determination of guilt
Chief complaint (CC) or innocence).
 To providence evidence for placement into schools and
 Why are you going to see a psychiatrist? What brought jobs.
you to the hospital? What seems to be the problem?  To challenge decisions made by institutions and agencies
 Records answers verbatim; a bizarre complaint points to (social security disability, school IEPs
psychotic process.
PHYSICAL EXAMINATION
History of present illness (HPI)
Diagnose or rule out physical etiologies
 When did you first notice something happening to you?
Were you upset about anything when symptoms began?  Toxicities
Did they begin suddenly or gradually?  Medication side effects
 Record in patient’s own words as much as possible. Get  Allergic reactions
history of previous hospitalizations and treatment. Sudden  Metabolic conditions
onset of symptoms may indicate drug-induced disorder. BEHAVIORAL ASSESSMENT
Previous psychiatric and medical disorders  Uses direct observation to formally assess an individual’s
 Did you ever lose consciousness? Have a seizure? thoughts, feelings, and behavior in specific situations or
 Ascertain extent of illness, treatment, medications, contexts
outcomes, hospitals, doctors. Determine whether illness  May be more appropriate than an interview in terms of
serves some additional purpose (secondary gain). assessing individuals who are not old enough or skilled
enough to report their problems and experiences.
Personal history  Observation
 Self-Monitoring
 Do you know anything about your birth? If so, from
whom? How old was your mother when you were born? OSERVATIONAL ASSESSMENT FOCUSES ON:
Your father? ANTECEDENTS, BEHAVIOR, CONSEQUENCES
 Older mothers (>35) have high risk for Down syndrome
babies; older fathers (>45) may contribute damaged EXAMPLE OF A-B-C SEQUENCE
sperm, producing deficits including schizophrenia.  Mother asking his son to put his glass in the sink
Family history (Antecedent)
 The boy throwing the glass (Behavior)
 Have any members in your family been depressed?  Mother’s lack of response (Consequence)
Alcoholic? In a mental hospital? Describe your living  This antecedent–behavior–consequence sequence (the
conditions. Did you have your own room? ABCs) might suggest that the boy was being reinforced
 Genetic loading in anxiety, depression, schizophrenia. Get for his violent outburst by not having to clean up his
medication history of family (medications effective in mess. And because there was no negative consequence for
family members for similar disorders may be effective in his behavior (his mother didn’t scold or reprimand him),
patient). he will probably act violently the next time he doesn’t
want to do something
SELF-MONITORING

 People can also observe their own behavior to find

patterns, a technique known as self-monitoring or self-
observation (Haynes et al., 2011).
 The goal here is to help clients monitor their behavior
more conveniently. When behaviors occur only in private
(such as purging by people with bulimia nervosa), self-
monitoring is essential.

PSYCHOLOGICAL TESTING

 Interviews and behavioral observation are relatively direct

attempts to determine a person’s beliefs, attitudes, and THOUGHT DISORDERS
problems. Psychological tests are a more indirect means  Incoherence
of assessing psychological characteristics.  Loosening of Associations
 Two general categories of psychological tests for use in  Illogical Thinking
clinical practice are intelligence tests and personality tests  Neologisms
(projective and objective).  Poverty of content of speech
 Projective Personality Tests/Projective Techniques  Blocking
o Rorschach Inkblot Test, TAT, H-T-P  Circumstantiality
 Personality Inventories  Tangentiality
o MMPI-2, MMPI-RF, PAI, MCMI  Clanging
 Intelligence Testing  Confabulation
o SB-5, WAIS-IV, WISC-V  Echolalia
 Neuropsychological Testing  Flight of Ideas
o Bender Visual-Motor Gestalt II  Pressure of Speech
NEUROLOGICAL TESTING/ NEUROIMAGING  Perseveration

STRUCTURAL IMAGING TYPICAL SIGNS AND SYMPTOMS OF PSYCHIATRIC

ILLNESSES DELUSIONS
Computerized axial tomography (CT)
 Grandeur
 X-rays of brain  Control
 Pictures in slices  Nihilism
 Reference
Magnetic resonance imaging (MRi)  Persecution
 Strong magnetic field  Self-Blame
 Improved resolution  Somatic
 Poverty
FUNCTIONAL IMAGING  Infidelity
 Thought Broadcasting
 Electroencephalograph (eeG)  Thought Insertion
 Magnetoencephalography (MeG)  Thought Withdrawal
 functional magnetic resonance imaging (fMRi)
 Diffusion tensor imaging (DTi) MODULE 3.1

 Positron emission tomography (PeT)

 Single photon emission computed tomography DIAGNOSIS
(SPeCT) TYPICAL SIGNS AND SYMPTOMS OF  is the process of determining whether a problem that
PSYCHIATRIC ILLNESSES distresses a person meets criteria for a psychological
disorder.
 International Classification of Diseases 10th Edition (ICD-
10) and 11th Edition (ICD-11)
 Diagnostic and Statistical Manual of Mental Disorders 5 th
Edition-Text Revised (DSM-5 TR)

ELEMENTS OF DIAGNOSIS
 Subtypes – mutually exclusive and jointly exhaustive  DSM IV (1988)

phenomenological subgroupings within a diagnosis and  DSM IV-TR (2000)

are indicated by the instruction “specify whether” in the  DSM 5 (2013)

criteria set  DSM 5-TR (2022)

 Specifiers – as opposed to subtypes, they are indicated by

the instruction “specify” or “specify if” in the criteria set ASSUMPTIONS OF DSM IV
 Other specified – is provided to allow the clinician to  Definition of “mental disorder”; The disorder is clinically
communicate the specific reason that the presentation significant
does not meet the criteria for any specific category within  Syndrome – collection of symptoms that together form a
a diagnostic class. definable pattern
 Unspecified – if clinician chooses not to specify the
reason that the criteria are met for a specific disorder NEUROSIS - Not part of the nomenclature; in reference to
behavior that involves some symptoms that are distressing to
TERMINOLOGIES an individual and are recognized by that person as
APPROACHES unacceptable

 Idiographic - determination of individual, unique features PSYCHOSIS - Refers to various forms of behavior involving
or attributes loss of contact with reality; grossly disturbed
 Nomothetic - determination of general classes and FIVE AXES OF DSM IV
common attributes
 Major disorders (All diagnostic categories except
CLASSIFICATION SYSTEMS personality disorders and mental retardation)
 Taxonomy - Classification in a scientific context  Stable, enduring problems (Personality disorders and
 Nosology - Taxonomy in psychological / medical mental retardation)
contexts  General medical conditions (related)
 Nomenclature - Nosological labels (e.g., panic disorder)  Psychosocial and environmental problems
 Rating of adaptive functioning (Global assessment of
DIAGNOSTIC PROCESS functioning)

 Client’s Reported Symptoms — DSM 5 (2013)

 Diagnostic Criteria—
 Differential Diagnosis—  ICD 10
 Final Diagnosis—  The general consensus is that DSM-5 is largely unchanged
 Case Formulation from DSM-IV although some new disorders are
introduced, and other disorders have been reclassified
HOW DO WE CLASSIFY DISORDERS? o Divided into three main sections
o How to use the manual
 The DSM-5 and ICD-11 are two of the most respected o Disorders
medvcal manuals in the world for classifying disease and o Description of disorders
disorder.  Most notable change is the removal of the multiaxial
WHY DO WE CLASSIFY DISORDERS? system
 DSM-5 introduces cross-cutting dimensional symptom
 Communication measures
 Prognosis o Evaluating a global sense important symptoms
 Treatment Planning that are often present across disorders in almost
all patients such as anxiety, depression, and
HISTORY DSM problems with sleep
Emil Kraeplin 1856-1926  Social and cultural considerations in the DSM-5

 Pioneered classification of mental illness based on DSM IV-TR to DSM 5 Changes Terminology
biological causes  Neurodevelopmental Disorders
 Mental illness as syndrome
 Schizophrenia Spectrum and Other Psychotic Disorders
 Proposed two syndromes: Dementia Praecox, Manic-
 Bipolar and Related Disorders
Depressive Psychosis
 DSM-I (1952) and DSM-II (1968)  Depressive Disorders
 DSM-III (1980) and DSM-III-R (1987)  Anxiety Disorders
 Obsessive-Compulsive Disorders  A dissociative disorder involving outburst of violence and
 Trauma and Stressor-related Disorders aggression or homicidal behavior at people and objects. A
 Dissociative Disorders minor insult would precipitate this condition. Amnesia,
 Somatic Symptom and Related Disorders exhaustion, and persecutory ideas are often associated
with this syndrome.
 Feeding and Eating Disorders
 Sleep-Wake Disorders DHAT
 Sexual Dysfunctions
 Gender Dysphoria  East Indians, Chinese, Sri Lankans
 Extreme anxiety associated with sense of weakness,
 Disruptive, Impulse-Control and Conduct Disorders
exhaustion, and the discharge of semen.
 Substance-Related and Addictive Disorders
 Neurocognitive Disorders TAIJIN KYOFUSHO
 Paraphilic Disorders
 Asians
DSM 5-TR (2022)  Guilt about embarrassing others, timidity resulting from
the feeling that the appearance, odor, facial expressions
 Fully revised text for each disorder with updated sections are offensive to other people.
on associated features, prevalence, development and
course, risk and prognostic factors, culture, diagnostic AMURAKH, LATAH (LATTAH), JUMPING
markers, suicide, differential diagnosis, and more. FRENCHMEN OF MAINE SYNDROME, MYRIACHIT
 Addition of Prolonged Grief Disorder (PGD) to Section II
 Siberians, Malaysian, Indonesian, French Canadians
—a new disorder for diagnosis
 The condition primarily affects middle-aged women and
 Over 70 modified criteria sets with helpful clarifications
is characterized by an exaggerated startle reaction. Its
since publication of DSM-5
major symptoms, besides fearfulness, are imitative
 Fully updated Introduction and Use of the Manual to
behavior in speech (see echolalia) and body movements
guide usage and provide context for important
(see echopraxia), a compulsion to utter profanities and
terminology
obscenities (see coprolalia), command obedience, and
 Considerations of the impact of racism and discrimination
disorganization.
on mental disorders integrated into the text
 New codes to flag and monitor suicidal behavior, WINDIGO PSYCHOSIS
available to all clinicians of any discipline and without the
requirement of any other diagnosis  Algonquin Indians in Canada and Northeastern US
 Fully updated ICD-10-CM codes implemented since  The syndrome is characterized by delusions of becoming
2013, including over 50 coding updates new to DSM-5- possessed by a flesh-eating monster (the windigo) and is
TR for substance intoxication and withdrawal and other manifested in symptoms including depression, violence, a
disorders compulsive desire for human flesh, and sometimes actual
 Updated and redesigned Diagnostic Classification cannibalism. The psychosis is also known by numerous
variant names and spellings, among them whitiko,
CULTURE-BOUND SYNDROME wihtigo, wihtiko, witigo, witiko, and wittigo.
NAME GROUP DESCRIPTION SUSTO
ATAQUE DE NERVIOS  Latinos in the US, Mexico, Central America, South
America
 Hispanics
 After experiencing a frightening event, individuals fear
 Out-of-consciousness state resulting from evil spirits.
that their soul has left their body. Symptoms include
Symptoms include attacks of crying, trembling,
weight loss, fatigue, muscle pains, headache, diarrhea,
uncontrollable shouting, physical or verbal aggression,
unhappiness, troubled sleep, lack of motivation, and low
and intense heat in the chest moving to the head. These
self-esteem.
ataques are often associated with stressful events (e.g.,
death of a loved one, divorce or separation, or witnessing PIBLOKTO
an accident including a family member).
 Inuit and other Arctic populations
AMOK, MAL DE PELEA  Individuals experience a sudden dissociative period of
extreme excitement in which they often tear off clothes,
 Malaysians, Laotians, Filipinos, Polynesians, Papua New
run naked through the snow, scream, throw things, and
Guineans, Puerto Ricans
perform other wild behaviors. This typically ends with
convulsive seizures, followed by an acute coma and  #NoToSelfDiagnosis!
amnesia for the event.
MODULE 4:
INTERNATIONAL CLASSIFICATION OF DISEASES ETHICAL ISSUES IN ABNORMAL PSYCHOLOGY

 The international classification of diseases (ICD) was also PERSPECTIVES ON MENTAL HEALTH LAW
used in classifying mental and behavioral disorders.
 During the post-World War II, the World Health  Mental health professionals face such questions daily.
Organization (WHO) published the sixth edition of ICD, They must both diagnose and treat people and consider
which, for the first time, included a section for mental individual and societal rights and responsibilities.
disorders.  Republic Act 11036 – Mental Health Act
 ICD–6 was heavily influenced by the Veterans
Administration classification and included 10 categories
for psychoses and psychoneuroses and seven categories
for disorders of character, behavior, and intelligence.

Mental & Behavioral Disorders (Chapter V-F00-F99) of

ICD-10 MENTAL ILLNESS
 F00-F09 Organic, including symptomatic, mental  MENTAL ILLNESS is a legal concept, typically meaning
disorders “severe emotional or thought disturbances that negatively
 F10-F19 Mental and behavioural disorders due to affect an individual’s health and safety.” Each state has its
psychoactive substance use own definition.
 F20-F29 Schizophrenia, schizotypal and delusional  Not synonymous with psychological disorder
disorders  Different definitions of mental illness/health in various
 F30-F39 Mood [affective] disorders countries and states
 F40-F48 Neurotic, stress-related and somatoform
disorders List of definition of terms is included in the IRR of RA 11036
 F50-F59 Behavioural syndromes associated with
physiological disturbances and physical factors CIVIL COMMITMENT
 F60-F69 Disorders of adult personality and behaviour  Individuals with psychological problems or behaviors that
 F70-F79 Mental retardation are so extreme and severe as to pose a threat to
 F80-F89 Disorders of psychological development themselves or others may require protective confinement.
 F90-F98 Behavioural and emotional disorders with onset  Civil commitment is defined as involuntary confinement
usually occurring in childhood and adolescence of a person judged to be a danger to the self or to others,
 F99-F99 Unspecified mental disorder even though the person has not committed a crime.
A CAUTION ABOUT LABELING AND STIGMA o Police power
o Parens Patriae (Latin, Parent of the country)
 Problems and pitfalls with labels
o Negative connotations
o Stigmas
o Reification (perceiving something other than for
what it is)

PSYCHOLOGY STUDENT SYNDROME

 A constellation of signs and symptoms which a

medical student believes he or she has while
learning about a particular disease in medical school;
a collection of psychosomatic symptoms resulting
from the study of a disorder as a medical student
 Many psychology students find that various disorders
apply to them
 Not a true syndrome CRITERIA FOR COMMITMENT
 Diagnosing friends and romantic partners may lead to
conflict
 Individuals present a clear and imminent danger to o The defendant must have a factual
themselves or others understanding of the proceedings
 Individuals are unable to care for themselves or do not o The defendant must have a rational
have the social network to provide for such care understanding of the proceedings.
 Individuals are unable to make responsible decisions o The defendant must be able to rationally consult
about appropriate treatments and hospitalization with counsel in presenting his or her own
 Individuals are in an unmanageable state of fright or panic defense.
DANGEROUSNESS INSANITY DEFENSE

 Mental health professionals have difficulty predicting  legal argument used by defendants who admit they have
whether someone, even a person they know well such as a committed a crime but plead not guilty because they were
client, will commit dangerous acts. The fact that civil mentally disturbed at the time of the crime. The insanity
commitments are often based on a determination of plea recognizes that under specific circumstances, people
dangerousness may not be held accountable for their behavior.
o The rarer something is, the more difficult it is to  Article 12, No. 1 of the Revised Penal Code of the
predict Philippines (Circumstances which exempt criminal
o Violence is as much a function of the context in liability)
which it occurs as of the person’s characteristics O When the imbecile or an insane person has
o The best predictor of dangerousness is often past committed an act which the law defines as a
criminal conduct or a history of violence or felony (delito), the court shall order his
aggression confinement in one of the hospitals or asylums
o The definition of dangerousness is itself unclear established for persons thus afflicted, which he
CRIMINAL COMMITMENT
shall not be permitted to leave without first
obtaining the permission of the same court.
 Incarceration of an individual for having committed a MENTAL HEALTH PROFESSIONALS AS EXPERT WITNESS

crime.
 Although the field of psychology accepts different  Judges and juries often must rely on expert witnesses,
perspectives on free will, criminal law does not. individuals who have specialized knowledge, to assist
LEGAL TERMS
them in making decisions (Mullen, 2010). This is also one
conflict between mental health and the law
 Due Process - constitutional guarantee of fair treatment  Mental health professionals appear to have expertise in
within the judicial system identifying malingering and in assessing competence.
 M’Naghten Rule - a cognitive test of legal insanity that o Malingering – fake or grossly exaggeration of
inquires whether the accused knew right from wrong symptoms, usually to be absolved from blame
when the crime was committed  A second area in which mental health professionals are
 Durham Rule - a test of legal insanity also known as the often asked to provide consultation is in assigning a
product test—an accused person is not responsible if the diagnosis.
unlawful act was the product of a mental disease or defect  Recent revisions of diagnostic criteria, most notably
 Irresistible impulse test - a doctrine that contends that a DSM-IV-TR and DSM-5, have addressed this issue
defendant is not criminally responsible if he or she lacked directly, thus helping clinicians make diagnoses that are
the willpower to control his or her behavior generally reliable. Remember, however, that the legal
 Diminished capacity - law standard allowing defendant to definition of mental illness is not matched by a
be convicted of a lesser offense due to mental impairment comparable disorder in DSM-5
 mens rea – guilty mind MALINGERING (Z76.5)

 actus rea – physical act; guilty ones

  The essential feature of malingering is the intentional
COMPETENCY TO STAND TRIAL
production of false or grossly exaggerated physical or
psychological symptoms, motivated by external
 There is, in English common law, a principle that a person incentives such as avoiding military duty, avoiding work,
charged with a crime must be competent to stand trial obtaining financial compensation, evading criminal
(Fogel et al., 2013; Stafford & Sadoff, 2011). prosecution, or obtaining drugs.
 Several factors can influence a court decision that the
defendant in a case is not competent to stand trial.
 Respect for the Dignity of Persons and People
 Competent Caring for the Well-Being of Persons and
People
 Integrity
 Professional and Scientific Responsibilities to Society
Malingering should be strongly considered if any combination  How we resolve ethical issues in our professional lives
of the following is noted: and communities;
 How we adhere to the highest standards of professional
1. Medicolegal context of presentation (e.g., the individual competence;
is referred by an attorney to the clinician for examination,  How we respect for the rights and dignity of our clients,
or the individual self-refers while litigation or criminal our peers, our students, and our other stakeholders in the
charges are pending). profession and scientific discipline;
2. Marked discrepancy between the individual’s claimed  How we maintain confidentiality in the important aspects
stress or disability and the objective findings and of our professional and scholarly functions;
observations.  How we ensure truthfulness and accuracy in all our public
3. Lack of cooperation during the diagnostic evaluation and statement;
in complying with the prescribed treatment regimen.  How we observe professionalism in our records and fees.
4. The presence of antisocial personality disorder.
SOME EXAMPLES UNDER THE PHILIPPINE CODE OF ETHICS
DUTY TO WARN (TARASOFF CASE)

 Boundaries of Competence
 Tarasoff v. Regents of the University of California  Providing Services in Emergencies
(1974,1976)  Multiple Relationships
 It is a standard for therapists concerning their duty to  Confidentiality
warn a client’s potential victims.  Disclosures
 It is difficult for therapists to know their exact  Documentation and Maintenance of Records
responsibilities for protecting third parties from their  Withholding Client Records
clients. Good clinical practice dictates that any time they
are in doubt they should consult with colleagues. A MODULE 5:
second opinion can be just as helpful to a therapist as to a
client. ANXIETY, TRAUMA AND OCD-RELATED
DISORDERS
RIGHTS OF MENTAL PATIENTS

ANXIETY FEAR PANIC

 Right to Treatment Both characterizes a negative affect, but Fear occurring during
 Right to Refuse Treatment both can also be adaptive (Fear – fight an inappropriate time
 Deinstitutionalization or flight; Anxiety – increases
 Rights of Research Participants preparedness)
o The right to be informed about the purpose of the
Future-oriented Instantaneous alarm Two types of panic
research study
reaction attack:
o The right to privacy
Both involve the physiological arousal Cued (Expected)
o The right to be treated with respect and dignity
through the sympathetic nervous system Uncued (Unexpected)
o The right to be protected from physical and
mental harm
o The right to choose to participate or to refuse to
participate without prejudice or reprisals FEAR AND ANXIETY
o The right to anonymity in the reporting of results
o The right to the safeguarding of their records
CODE OF ETHICS

 RA 11036 – Mental Health Act

 RA 10029 – Psychology Act of 2009
 Code of Ethics of Philippine Psychologists
 The PAP shall take steps to ensure that all members of the ANXIETY, FEAR & PANIC
PAP and the larger community of Philippine
psychologists will know, understand, and be properly Anxiety in General
guided by this Code.
 The adaptive value of anxiety may be that it helps us  At least 4 weeks in children and adolescents; 6 months or
plan and prepare for a possible threat. In mild to moderate more in adults
degrees, anxiety actually enhances learning and performance.
 For example, a mild amount of anxiety about how Selective Mutism
you are going to do on your next exam, or in your next sport  Failure to speak in specific social situations
match, can actually be helpful.  At least 1 month (but not limited to the first month of
 But, although anxiety is often adaptive in mild or school)
moderate degrees, it is maladaptive when it becomes chronic
and severe, as we see in people diagnosed with anxiety Specific Phobia
disorders.
 Marked fear or anxiety on a specific subject or situation
ETIOLOGY OF ANXIETY, TRAUMA AND OCD- (e.g. heights, blood-injection-injury, animals)
RELATED DISORDERS  Lasting for 6 months or more (causes clinically significant
distress)
Biological, Psychological, Social
Social Anxiety Disorder (Social Phobia)
 Genetically predisposed
 Unconscious feelings and sensitivity to situations which  Fear or anxiety in one or more social situations wherein
may posed as threats (neurotic disorders) the individual is exposed to possible scrutiny to others;
 Lack of social support most common anxiety disorder
 Associated with specific brain circuits, hormonal  Lasting for 6 months or more (causes clinically significant
systems and neurotransmitters distress)
 Avoidance in situations which can associate fear, panic
and anxiety Panic Disorder
 Other environmental factors can be connected (e.g.  Recurrent un-cued panic attacks
family, career, etc.)  Attacks has been followed by 1 month with additional
criteria (pg. 208)
POSSIBLE TREATMENTS Agoraphobia
Drug treatment Cognitive-Behavioral -Stress  Excessive fear about two (or more) of the five situations
Antidepressants Therapy (majority) management (e.g. using public transportation, being in open spaces,
 Anxiolytics  Trauma-informed Care through healthy etc.)
(Benzodiazep  Exposure lifestyle  Lasting for 6 months or more (causes clinically significant
ines) therapy/Panic control -Meditational distress)
 Anti- treatment and
depressants  Systematic Mindfulness Generalized Anxiety Disorder (GAD)
(SNRIs) Desensitization approaches
 Cognitive  Anxiety that focuses on minor everyday events, not one
Restructuring major worry or concern; the individual finds it difficult to
 Modeling Therapy control.
 Occurs more days than not for at least 6 months

AN INTEGRATED MODEL ANXIETY DISORDERS

 High rates of comorbidity (55% - 76%)

 Links with physical disorders (chronic pain, headache,
hypertension, heart diseases, etc.)
 Comorbidity with depression? Yes. It is possible.
 Suicide attempt rates is also similar as depression (20%)

GENERALIZED ANXIETY DISORDER

ANXIETY DISORDERS
 GAD in children = needs only one symptom
Separation Anxiety Disorder  Insidious onset (early adulthood)
 Chronic course
 Excessive fear from experiencing separation from home  Associated with muscle tension
or from major attachment figures  Inherited tendency to become anxious
 55%-60% of those with GAD are women
 Shopping malls, Being far from home, Cars (as driver or
passenger), Staying at home alone Buses, Waiting in line,
Trains Supermarkets, Subways, Stores, Wide
streets, Crowds Tunnels, Planes Restaurants, Elevators
Theaters, Escalators

Interoceptive Daily Activities Typically Avoided by People

with Agoraphobia

 Running up flights of stairs, Walking outside in intense

heat, Having showers with the doorsand windows closed,
Hot stuffy stores or shopping malls, Walking outside in
very cold weather, Aerobics, Lifting heavy objects,
Dancing, Eating chocolate, Standing quickly from a
sitting position, Watching exciting movies or sports
events, Getting involved in "heated" debates, Hot stuffy
 The key feature of generalized anxiety disorder is rooms, Hot stuffy cars, Having a sauna, Hiking Sports,
that, unlike the disorders you have learned about so far, it does Drinking coffee or any caffeinated beverages, Sexual
not have a particular focus. relations, Watching horror movies, Eating heavy meals,
 People with generalized anxiety disorder feel anxious Getting angry
for much of the time, even though they may not be able to say
exactly why they feel this way. NOCTURNAL PANIC

PANIC ATTACK VS. ANXIETY ATTACK  60% with panic disorder experience nocturnal attacks
 Caused by deep relaxation,
Sudden & extreme - Gradually builds up o Sensations of “letting go” are anxiety provoking to
people with panic attacks
 Sleep terrors (occurs in children)
 Isolated sleep paralysis (occurs during transitional phase)

SPECIFIC PHOBIA

 A PHOBIA is an irrational fear associated with a

particular object or situation. It is common to have some
fear of or at least a desire to avoid such objects as spiders
or situations with enclosed spaces or heights. In a
SPECIFIC PHOBIA, however, the fear or anxiety is so
intense that it becomes incapacitating.
 People with specific phobia go to great lengths to avoid
the feared object or situation. If they can’t get away, they
endure the situation but only with marked anxiety and
discomfort. Like all anxiety disorders, a specific phobia
AGORAPHOBIA induces significant distress.

Typical Situations Avoided by People Agoraphobia Term - Fear of:

 Acarophobia - Insects, mites mood, dissociative symptoms, avoidance symptoms and
 Achluophobia – Darkness, night arousal symptoms
 Acousticophobia - Sounds  Duration of disturbance is 3 days to at least 1 month after
 Acrophobia - Heights trauma exposure; may progress to PTSD after 1 month
 Aerophobia - Air currents, drafts, wind
 Agoraphobia - Open spaces Adjustment Disorder

4 TYPES OF SPECIFIC PHOBIA  The presence of emotional or behavioral symptoms in

response to an identifiable stressor is the essential feature
 Animal of adjustment disorders
 Natural Environment (heights, storm, water)  The disturbance begins within 3 months of onset of a
 Blood-injection-injury stressor; If the stressor is an acute event, the onset of the
 Situational (planes, enclosed spaces, elevators) disturbance is usually immediate (i.e., within a few days)
 Other (phobic avoidance of situations that may lead and the duration is relatively brief
to choking, vomiting, or contracting an illness, etc.)
Prolonged Grief Disorder

 Represents a prolonged maladaptive grief reaction that

can be diagnosed only after at least 12 months (6 months
in children and adolescents) have elapsed since the death
of someone with whom the bereaved had a close
relationship
 Symptoms usually begin within the initial months after
the death, although there may be a delay before the full
syndrome appears.

TRAUMA-RELATED DISORDERS

Major symptom clusters:

TRAUMA AND STRESSOR-RELATED DISORDER
 Intrusion symptoms
Reactive Attachment Disorder  Avoidance
 Pattern of emotionally withdrawn behavior toward adult  Negative alteration in mood or cognition
caregivers; or had experienced extremes of insufficient  Arousal and changes in reactivity
care POST-TRAUMATIC STRESS DISORDER
 Present for more than 12 months; occurs during infancy
or early childhood  An anxiety disorder in which the individual experiences
several distressing symptoms for more than a month
Disinhibited Social Engagement Disorder following a traumatic event, such as a reexperiencing of
 Pattern of behavior in which a child actively approaches the traumatic event, an avoidance of reminders of the
and interacts with unfamiliar adults and experienced a trauma, a numbing of general responsiveness, and
pattern of extremes of insufficient care increased arousal.
 Present for more than 12 months; occurs during infancy 3 FACTORS OF PTSD
or early childhood
 Pre-traumatic
Posttraumatic Stress Disorder (PTSD)  Peri-traumatic
 Exposure to a traumatic event that involves actual or  Posttraumatic
threatened injury; see page 301-305 of DSM-5-TR Most common traumas:
 Applicable to adults, adolescents and children older than
6 years old. Separate criteria for children 6 years and  Sexual
below. Duration varies from the first 3 months, 12 months  Accidents
or 50 years  Combat

Acute Stress Disorder

 Exposure to actual or threatened death, serious injury or

sexual violation; presence of 9 (or more) symptoms from
the 5 categories namely intrusion symptoms, negative
Four major categories

 Checking
 Ordering
 Arranging
 Washing/cleaning

Association with obsessions

OBSESSIVE-COMPULSIVE AND RELATED DISORDERS

Obsessive-Compulsive Disorder (OCD)

 Presence of obsessions, compulsions, or both, which are

time-consuming
 Mean age at onset is 19.5 years;
 Has the tendency to begin before 10 years old;
 Compulsions are easily diagnosed in children than
obsessions

OBSESSIVE-COMPULSIVE AND RELATED DISORDERS Body Dysmorphic Disorder

Obsession - Persistent thoughts  Preoccupation with one or more perceived defects or

flaws in physical appearance that are not observable;
Compulsion - Repetitive behaviors  Also possessed repetitive behaviors
 Typically begins in late adolescence
OBSESSION
Hoarding Disorder
60% have multiple obsessions
 Persistent difficulty in discarding or parting with
 Need for symmetry possessions, regardless of value
 Forbidden thoughts or actions  Usually begins in childhood or early adolescence
 Cleaning and contamination
 Hoarding Trichotillomania (Hair-Pulling)

 Frequent pulling of one’s hair, which results to hair loss

 Can be triggered by feelings of anxiety, which gives a
satisfying feeling of pulling hair or picking the skin or
scab

Excoriation (Skin-Picking)

 Repeated picking of skin, resulting in skin lesions

OBSESSIVE-COMPULSIVE DISORDER

 Female = Male
 Chronic course
 Onset = childhood to 30s

COMPULSION
 Tic Disorder – characterized by involuntary  Ambivalence about suicide; there is a strong underlying
movement (sudden jerking of limbs, for example), to co-occur desire to live.
in patients with OCD  Suicidal intent is communicated directly or indirectly
through verbal or behavioral cues.
OCD VS. OCPD
RISK FACTORS
OBSESSIVE-COMPULSIVE DISORDER (OCD)
Biological Psychological Social Sociocultural
 form of anxiety disorder
 can accept condition and seek help Low serotonin Childhood Isolation Financial
 ritualistic abuse decline
 ego-dystonic behavior Genetic and Mental illness Relationship Male gender
OBSESSIVE-COMPULSIVE PERSONALITY DISORDER epigenetic conflict
(OCPD) effects
Alcohol effects Hopelessness Loss of Suicide
 form of personality disorder partner contagion
 reluctant to seek medical help Sleep difficulties Psych-ache Bullying Access to
 perfectionism firearms
 ego-syntonic behavior Physical Impulsivity Cultural
MODULE 6: illness/disability alienation
Prior attempts
MOOD DISORDERS AND SUICIDE JOINER’S INTERPERSONAL-PSYCHOLOGICAL MODEL
SUICIDE OF SUICIDE

 Intentional, direct, and conscious taking of one’s own life

 Not only a tragic act, but it is also difficult to comprehend

Assess risk of suicide

SEMICOLON PROJECT;  “Have you had thoughts about death, or about killing
 A semicolon is used when an author could have chosen to yourself?” If yes, ask:
end their sentence but chose not to. o “Do you have a plan for how you would do
 The author is you, and the sentence is your life. this?”
 Founder Amy Bleuel took her own life at the age of 31 o “Are there means available (e.g., a gun and
last 2017. bullets or poison)?”
o “Have you actually rehearsed or practiced how
COMMON CHARACTERISTICS you would kill yourself?”
o “Do you tend to be impulsive?”
 Belief that things will never change, and that suicide is o “How strong is your intent to do this?”
the only solution. o “Can you resist the impulse to do this?”
 Desire to escape from psychological pain and distressing o “Have you heard voices telling you to hurt or kill
thoughts and feelings. yourself?”
 Triggering events including intense interpersonal conflicts  Ask about previous attempts, especially the degree of
and feelings of depression, hopelessness, guilt, anger, or intent.
shame.  Ask about suicide of family members.
 Perceived inability to make progress toward goals or to  Preventing suicide is extremely difficult. Most people
solve problems; related feelings of failure, worthlessness, who are depressed and contemplating suicide do not
and hopelessness.
realize that their thinking is restricted and their decision
making impaired and that they are in need of assistance.
 Indeed, only about 40 percent of people with suicidal
thoughts or attempts around the world receive treatment
(Bruffaerts et al., 2011).

3 MAIN THRUST OF PREVENTIVE EFFORTS

 Treatment of person’s current mental disorder(s)

 Crisis Intervention DEFINITION OF TERMS
 Working with High-Risk Groups
 Depressive Episode - a person is markedly depressed or
MOOD DISORDERS loses interest in formerly pleasurable activities (or both)
for at least 2 weeks, as well as other symptoms such as
What is mood? changes in sleep or appetite, or feelings of worthlessness
 Emotional state or our prevailing frame of mind  Mania - mental state characterized by very exaggerated
 Can significantly affect our perceptions of the world, activity and emotions including euphoria, excessive
sense of well-being, and interactions with others excitement, or irritability that result in impairment in
social or occupational functioning
Most of you experience minor mood changes throughout the  Manic Episode/Elevated Mood - a person shows a
day but can stay emotionally balanced and on an even keel. markedly elevated, euphoric, or expansive mood, often
You may also have times where you feel depressed or times interrupted by occasional outbursts of intense irritability
when you experience an emotional high—normal reactions to or even violence— particularly when others refuse to go
the events going on around you. along with the manic person’s wishes and schemes.
 Hypomania - a milder form of mania involving increased
You may have occasional, brief episodes of more significant levels of activity and goal-directed behaviors combined
mood changes— experiencing overwhelming sadness over the with an elevated, expansive, or irritable mood
loss of a friendship or feeling extremely energized or even  Expansive Mood - person may feel extremely confident
ecstatic when you hear great news. or self-important and behave impulsively
 Euphoria - exceptionally elevated mood; exaggerated
Unlike these temporary, normal emotional reactions, the mood feeling of well-being
symptoms in depressive and bipolar disorders:
DEPRESSIVE DISORDER
 affect the person’s well-being and school, work, or social
functioning; TYPES OF DEPRESSIVE DISORDERS [ADAPTED FROM
 continue for days, weeks, or months; THE DIAGNOSTIC AND STATISTICAL MANUAL OF
 often occur for no apparent reason; and MENTAL DISORDERS – 5TH - TEXT REVISION (DSM-5-
TR), 2022]*
 involve extreme reactions that cannot be easily explained
by what is happening in the person’s life. Major Depressive Disorder
CAUSE OF MOOD DISORDERS AND SUICIDE  5 or more symptoms listed in the DSM-5-TR should be
present during the same 2-week period and represents a
 Biological vulnerabilities/early predispositions: change in previous functioning; at least one of the
Genetic contributions, neurochemical and hormonal symptoms is either (1) depressed mood, or (2) loss of
changes, brain changes interest or pleasure
 Early family problems: Poor attachment,  May first appear in any age but likelihood onset increases
disengaged parents, markedly in puberty stage
expressed emotion, modeling of parental depression
 Stressful life events: Family conflict, alienation from Persistent Depressive Disorder (Dysthymia)
others, academic and other challenges
 Cognitive-stress and behavioral vulnerabilities:  Depressed mood that occurs most of the day, for more
Sense of learned helplessness and hopelessness, days than not, at least 2 years; at least 1 year for children
intense negative emotions and arousal, escape- and adolescents
oriented behavior, lack of social support Possible  Often has an early and insidious onset
mood disorder Premenstrual Dysphoric Disorder
 Expression of mood lability, irritability, dysphoria and, CYCLE OF PERSISTENT DEPRESSIVE DISORDER
anxiety symptoms that occur repeatedly during the (DYSTHYMIA)
menstrual phase of the cycle and remit around the onset of
menses CYCLE OF MAJOR DEPRESSIVE DISORDER
 Onset can occur anytime at any point after menarche

Disruptive Mood Dysregulation Disorder SPECIFIERS OF MDD

 Chronic, severe persistent irritability manifested by  Anxious Distress
frequent temper outbursts and angry mood present  Mixed features
between tantrums  Melancholic features
 Onset is before 10 years old and should not be applied to  Atypical features
children with a developmental age of less than 6 years  Mood-congruent psychotic features
CYCLE OF MAJOR DEPRESSIVE DISORDER  Mood-incongruent psychotic features
 Catatonia
Depression – More Severe  Peripartum onset
 Seasonal pattern
EMOTION
ETIOLOGY
 Good mood.
 Feeling upset and sad, perhaps becoming a bit teary-eyed. ETIOLOGY OF DEPRESSIVE DISORDERS
 Mild discomfort about the day, feeling a bit irritable or
down. Biological
 Intense sadness and frequent crying. Daily feelings of  Predisposing – short allele 5-HTTLPR gene
“heaviness” and emptiness.  HPA reactivity and excess cortisol
 Extreme sadness, very frequent crying, and feelings of  Female hormones after puberty
emptiness and loss. Strong sense of hopelessness.  Shrinkage of hippocampus
COGNITIONS Psychological
 Thoughts about what one has to do that day. Thoughts  Negative thoughts
about how to plan and organize the day.  Learned helplessness
 Thoughts about the difficulties of the day. Concern that  Rumination
something will go wrong.  Self-contempt, blame, guilt
 Dwelling on the negative aspects of the day, such as a
couple of mistakes on a test or a cold shoulder from a Social
coworker.
 Thoughts about one’s personal deficiencies, strong  Early life neglect, maltreatment, etc.
pessimism about the future, and thoughts about harming Sociocultural
oneself (with little intent to do so).
 Thoughts about suicide, funerals, and instructions to  Discrimination
others in case of one’s death.  Female gender roles
 Strong intent to harm oneself.  LGBT orientation*

BEHAVIORS

 Rising from bed, getting ready for the day, and going to
school or work.
 Taking a little longer than usual to rise from bed. Slightly
less concentration at school or work.
 Coming home to slump into bed without eating dinner.
Tossing and turning in bed, unable to sleep. Some
difficulty concentrating.
 Inability to rise from bed many days, skipping classes at
school, and withdrawing from contact with others.
 Complete inability to interact with others or even leave
the house. Great changes in appetite and weight. Suicide
attempt or completion.
TREATMENT

 Behavioral
Psychopharmacology
Activation Therapy
 Anti-depressants -Support
 Interpersonal
 Tricyclics from
Psychotherapy
 MAOIs family
 Cognitive-
 SNRIs and loved
Behavioral Therapy
 SSRIs ones
 Mindfulness-based
cognitive therapy
Brain stimulation
therapies (e.g.
Electroconvulsive
Therapy, Vagus
Nerve Stimulation)
OTHER FORMS OF DEPRESSION

SPECIFIER OF BD

 Anxious Distress
 Mixed features
 Loss and the grieving process  Depressive Episode with Mixed Features
 Postpartum “blues”(Postnatal/Antenatal Depression)  Rapid cycling
 Seasonal Affective Disorder (SAD)  Melancholic Features
 Psychotic Depression (MDD with psychotic features)  Psychotic Features
 Catatonia
BIPOLAR DISORDER
 Peripartum onset
Symptoms of a Manic Episode  Seasonal pattern

 Inflated self-esteem or grandiosity ETIOLOGY OF BIPOLAR AND RELATED DISORDERS

 Decreased need for sleep, such as feeling rested after only
BIOLOGICAL
3 hours of sleep More talkative than usual or pressure to
keep talking  Genetic Predisposition
 Subjective experience that one’s thoughts are racing, or  Neurochemical factors (norepinephrine and serotonin
flight of ideas deficiency)
 Distractibility  Abnormalities of hormonal regulatory systems (HPA)
 Distractibility  Circadian rhythm abnormalities
 Distractibility
PSYCHOLOGICAL

 Stressful life events

 Rumination

SOCIOCULTURAL FACTORS

(BIPOLAR AND UNIPOLAR)

 In some cultures, the concept of depression as we know it

simply does not exist.
 For example, Australian aborigines who are “depressed”
show none of the guilt and self-abnegation commonly
seen in more developed countries.
 They also do not show suicidal tendencies but instead are
more likely to vent their hostilities onto others rather than
onto themselves.

TREATMENTS/INTERVENTIONS

 Anti-depressants
 Mood stabilizers (e.g. Lithium)
 Anti-psychotic drugs
 Cognitive-Behavioral Therapy
 Bright Light Therapy
 Behavioral Activation Treatment
 Interpersonal Therapy
 Family and Marital Therapy
 Brain stimulation therapies (e.g. Electroconvulsive
Therapy, Transcranial Magnetic Stimulation, Deep Brain
Stimulation)