Psychopathology:

Study unit 1
o Psychopathology – the study of the illness of the mind
o Psychological disorder – Psychological dysfunction, associated with distress and
impairment/deviating functioning.
What is abnormal behavior? – criteria for abnormal behavior - different disorders?
Statistical deviance – something that is out of the norm – causes personal stress for a
person – maladaptive.
Maladaptive Ness: will get progressively worse for the person.
Abnormal behavior – is within a specific context: dysfunctional behavior.
Abnormal behavior – Dysfunctional behavior (maladaptive, distress, ineffective, harmful,
inappropriate) relative to a specific context, e.g., culture, gender, age
Becomes a psychological disorder when it becomes a regular behavior and has long term
negative affects – person doesn’t have control over it and needs professional help.
➢ Longer duration
➢ Long term negative effect
➢ High intensity
➢ Person is not able to adjust the behavior on his/her own.

Two classification systems:

- International Classification of Disease (ICD)
- Diagnostic and Statistical Manual of Mental Disorders (DSM)

Solutions for criticism of the DSM

➢ Dimensional approach recognizes the continuum of abnormal behavior.
➢ Holistic model that investigates alternative perspectives on mental health
➢ John Hopkins model:
• Disease- general medial illness on the brain
• Dimensions- emphasis on cognitive and emotional vulnerabilities
• Behavior- Patterns of behavior such as substance abuse
• Life story- life experiences and trauma
Assessment

Give next example: You use a test to determine (assessment) whether someone meets criteria
for depression (diagnosis). The test will only be usable if (a) it is RELIABLE: it produces the
same results every time and/or the same results are obtained with it by 2 independent
psychologists (reliability); (b) it is VALID: it really measures depression and not something
else; and (c) it is STANDARDIZED: the norms by which a score is calculated were obtained
by taking the questionnaire in advance on a large group of persons with the same background.

Clinical interview:
➢ Presenting problem
➢ Background History regarding:

• problem

• development

• family

• school, career, financial

➢ Attitudes, emotions, and behavior
➢ Mental status
Mental Status Examination (MSE)
Systematic, detailed observation of patient’s behavior:
• appearance and behavior
• thought processes.
• mood and affect.
• intellectual functioning
• sensorium

Psychological testing
• Regulated by HPCSA
• If used incorrectly: false, negatives or false positives.
• Use of tests:
▪ registered psychologist
▪ psychometrist under direct supervision
▪ trained allied professionals under direct supervision.
Ethical issues
People with mental illness = vulnerable
In past, mental pts were treated inhumanely.
Always make sure their rights, dignity, & safety are addressed.
In SA: 'Kangaroo courts'
• Core ethical values & standards (p.563)
• Challenges to ethical behavior (pp.574-575)
• Case study: Ethical issues

Study unit 2
Cause of abnormal behavior (psychopathology)

1 Biomedical perspective
➢ Genetic predisposition – genetically transmitted
➢ Abnormal neurotransmission – neuron transmission to the brain
➢ Endocrine dysregulation - improper function of the endocrine system – includes the
glands that secrete hormones and the organs impacted by hormones.
➢ Structural abnormalities of the brain

Genetic predisposition
• Abnormalities predispose some individuals – others
directly due to chromosomal abnormalities.
• Multigene model of inheritance vs familial
transmission of Schizophrenia
• Accurate prediction impossible because of
complexity of genes

Abnormal neurotransmission
• Increase or decrease in specific neurotransmitters,
like dopamine and serotonin.
• E.g., dopamine is too high: schizophrenia;
serotonin too low: depression. Table 1.1 pg. 10
Endocrine dysregulation
• Abnormal neuro-endocrine axes in some
disorders
• Neurotransmitters implicated in disorders are also
the primary regulations of the neuro-endocrine
axis.
Neuro-endocrine axes provides the structural and
functional basis for interactions between brain,
hormones, and glands that allow an organism to respond
to external stimuli with complex physiological changes.

Structural abnormalities of the brain

• Brain plasticity
• Neuromodulators
• Structural brain abnormalities

2 Psychological perspectives
Psychodynamic approach
• Freud
• Primitive impulses inappropriate
• ID, EGO, SUPEREGO
• Weak ego not able to balance id and superego.
• Table 1.3

Contemporary psychodynamic theories

• Object relations theorists (e.g., Klein)
▪ internalized object relations
• Attachment theorists (e.g., Bowlby)
▪ bonding between caregiver and child

Behavioral perspective
➢ Pavlov, Watson & Skinner
➢ Behavior is learned.
➢ Habituation
➢ Sensitization
 ➢ Conditioning:
- classical (association)
- operant (reinforcement)
➢ Modeling:
- attention
- retention
- reproduction
- How does a disorder develop?

Cognitive-behavioral perspective
• Role of thought content and information-processing.
• Theories: Helplessness; hopelessness; rational-emotive
- / Psychopathology = irrational beliefs and automatic thoughts.

• Beck's cognitive theory of depression:

- automatic thoughts trigger negative cycle.
- triad of depression.

Humanistic & existential perspective

1 Humanistic
• Rogers & Maslow
• Free will to choose.
• unique world (phenomenal field)
• Sense of self – constantly forming and reforming
• Pathology develops when self-actualization is blocked.

2 Existential
• May & Laing
• Uniqueness, quest for value & meaning.
• Sociopolitical context (e.g., technology) is alienating and dehumanizing.

Community psychology perspective

• Social factors important in psychological problems.
- socio-economic status
- access to resources
- quality of social interactions
 • Importance of social, political, and cultural context in understanding, identifying, and
treating psychological problems.
• Role of Indigenous healers

Importance of the political context

• Socio-political factors impact on mental health.
• Apartheid: Imbalance in mental health provision.
• Importance of cultural awareness and sensitivity.

Cultural / cross-cultural psychology in SA

• Culture=??
• Behavior = function of human-environment interaction
• Macro theories
• Cultural psychology
• Cultural diversity
• Ethnocentrism
• Table 1.5

Religious perspectives
• African traditional Religion
• Islamic perspective
• Christian perspective
African Personality Theory

Indigenous theories of health and illness

Traditional African healing model

Islamic perspective
• Quran mentions 4 components in holistic model of self:
– Interaction between ruh (soul),
– the qalb (connection between soul and body),
– the aql (intellect),
– and the nafs (drives and desires
• The above merges through the dahmeer (consciousness).
• For health, all 4 need to be in balance.
• Islam’s understanding of mental illness corresponds with DSM and ICD, but includes
spiritual elements:
– Sihr (black magic e.g., Jinn)
– Mazr/ayn al husood (evil eye)
• Treatment includes consultation with moulanas and sheiks.
 Christian perspective
• Mutual skepticism between psychologists and pastors in the past
• Recently more accommodating to each other
• Role of confession

Integrated perspectives
• In most cases, a combination of different biological, psychological, and social factors.
• Two models:
- Biopsychosocial model
- Diathesis stress model

Biopsychosocial approach

Diathesis stress model

Study unit 3
Neurodevelopmental and other disorders associated with childhood.

Developmental pathology
• Childhood NB: neurological & completion of developmental tasks
• Developmental disorders = disorders that develop during infancy, childhood, or
adolescence
• Gradually emerges in terms of change.
• Abilities differ.
• Behavior appropriate or inappropriate regarding development

Developmental disorders in SA
• Risk factors – increase probability of mental health problems.
• Protective factors – influence effect of risk factors
• In South Africa:
- Poverty
- Violence
- Security
- Education
- Human rights approach
- Family structures
Internalizing disorders
• Emotional disorders
• Behavior directed inwards.
• Shy, withdrawn, fearful.
- Childhood depression & anxiety

Separation Anxiety Disorder

Externalizing disorders
• Behavioral disorders
• Behaviors directed outwards.
• E.g.: Disobedience, defiance, aggression, stubbornness, tantrums, hyperactivity.
• Disrupt relationship with significant others.
Attention deficit-hyperactivity dis. (ADHD)

Conduct disorders:
• Consistent pattern of rule transgression, disobedience, defiance
• Significant impact on academic, social, and emotional well-being.
• Negative impact on family & other relationships.
• Includes: Oppositional Defiant Disorder & Conduct Disorder

Conduct disorder (CD)

Autism spectrum disorder

Elimination disorders
• NB milestone is ability to control bodily functions.
• Struggle to control specific bodily functions.
• repeated & age-inappropriate urinating & feces passing.
• Includes: Enuresis & encopresis

Enuresis
Study unit 4
• Fear – experience a physical danger – alarms start going off- your body activates the
flight or fight response.
• Anxiety – future danger e.g., Exam – no real threat in the present
• Depression – often things of the past

Anxiety
• Anxiety can help is - when it does not go away / we become maladaptive/ doesn’t have
control over it – becomes dysfunctional.
Stress – perception of your own capabilities / demands is weaker than the available
resources.
Eustress – functional stress e.g., adrenaline
Distress
GAD – people who worry about everything all the time – chronic excessive, uncontrollable
dysfunctional worry.
Underlying anxiety in brain – brain start to make up reasons to worry about, because the
underlying anxiety must latch onto something.

• Restlessness
• Irritability
• Muscle tension
• Difficulty concentrating
• Disturbance in sleep

Panic disorder
• Panic attack vs panic disorder
• Intense fear or discomfort that quickly escalates.
• Experience at least 4 out of 23 somatic and cognitive symptoms
• Worries about another attack.

Disorder – when it occurs regularly, and you can’t control it – happens continuously
Specific Phobias – intense fear has an effect on your daily life – starts affecting
relationships and your ability to show up to places.
Types:
1. Animals
2. Situational
3. Natural environment
4. Blood – injection – injury

Social anxiety disorder

• Fear of being scrutiny and evaluation by others and being embarrassed.

OCD
Often confused with cleanliness.
Always causes distress or anxiety – whenever a person acts on the compulsion to do
something – it becomes a compulsion disorder, not OCD!
The person will never act on a compulsion to do something if it is OCD – because they have
intense anxiety to not do the thing.

Two main categories – Obsession / Compulsion

1. Obsessions: Persistent, intrusive, anxiety provoking thought, images, or impulses that a
person cannot control
2. Compulsion – the way in which the person is trying to get rid of the obsession – washing
hands, praying, etc. – cycle that continues whenever the obsession comes forward –
used to repress the obsession – usually physical or something that the person is
thinking.

DSM-5 criteria NB!!!!!!!!!!!!

A: Presence of obsessions, compulsions, or both - table 6.7 pg. 181
- Obsessions defined by…
- Compulsions defined by…
Can be diagnosed with only one of the factors.
B: O&C time consuming & cause clinically significant distress or impairment in – impact that
the symptoms of criteria A have on the person
C: Symptoms in A - not attributed to physiological effects of substance or medical condition –
must make sure the patient doesn’t have a medical reason for the disorder / uses any
medication – needs to be sent to a doctor
D: Symptoms in A cannot better be explained by another mental disorder – have to be
qualified to make the diagnosis
- If there is one that is unidentified – it is not a diagnosis!!!!
PTSD
During trauma: intense fear, helplessness, horror
Symptoms with show up between 1 – 6 months – after 6 months – delayed PTSD.
3 symptoms groups:

• Re-experience of symptoms – afraid to experience it again / flash backs / dreams.

• Avoidance – avoid being triggered by situation / avoid people / places.
• Hypervigilance – constantly on edge frightened very easily / increase in heart rate
causes close to having panic attack.

Before one month = acute stress disorder – smaller version, less severe, more dissociative
Acute stress disorder can turn into PTSD if it keeps on reoccurring – diagnosis is changed.
LOOK AT THE TIME IN TEST!!!!
Secondary PTDS – hearing about someone else’s traumatic experience e.g., people in
psychology who only works with trauma.
Study unit 5
Mood disorders
• Emotions – reaction that occurs when and organism encounters meaningful stimulus –
based on what happens around you / your environment.
• Feeling – How you experience your emotion – how you manage your emotions.
• Affect – How your emotion is communicated to others – can see it in your face.
• Mood – Sustained emotion over a lengthy period.

Normal mood: appropriate, constructive emotions and affect.

Mood disorder: Inappropriate, destructive mood and affect – starts having impact on your
life.
Euthymic mood – Don’t have any particular mood, you are just okay – not feeling happy or
sad.
Euphoric – happy mood
Mania – manic episode – too happy – overly active – super happy – becomes a disfunction –
start losing contact with reality – becomes neurotoxic – damages the brain.
Hypomania
Dysphoria – disappointed/sad mood
Dysthymia: low level of sadness all the time – doesn’t want to go back to a normal spectrum.
Depression

Depression:
Mood state-feelings of sadness, loneliness, despair, low self-esteem

Mania:
Dysfunctional positive mood (euphoria) – a lot of aggression

PAGE 203

Major depressive episode: five roots to categorize it.

1. Behavior: Psychomotor retardation, psychomotor agitation, diminished interest in
pleasure activities
2. Emotional: Depressed mood, dysphoria, sadness, dejection, guilt
3. Perceptual: In severe cases: Hallucinations
4. Somatic: Fatigue, Lethargy, aches and pains, changes in appetite, loss of libido,
weight loss or weight gain, insomnia (can’t sleep) or hypersomnia (tired)
5. Cognitive: Irrational beliefs, negative self-view, helplessness, hopelessness, thought
blocking, impaired concentration and indecisiveness, suicidal thoughts or thoughts or
of death, feelings of worthlessness or inappropriate guilt.
(Blue = criteria / red = associative symptoms)
DSM-5 criteria: Major depressive disorder
• A: more than 5 symptoms (in blue) for 2 weeks at least a depressed mood or loss of
interest or pleasure needs to be present.
• B: distress or impairment in functioning.
• C: not due to substances or medical condition – alcohol can cause depression – have to
determine whether the depression is due to alcohol or if the person had depression
before they started using alcohol – which came first?
• D: Not another disorder – must make sure it doesn’t meet the criteria of other DSM
• E: No history of mania/hypermania – must make sure that you don’t have an underlying
mania or hypermania – can cause a manic episode if you give them anti depression
medicine if they are bipolar / something else

Manic episode
• Pathological euphoria
• Severe
• Episodic

(Hypermania vs mania)
1. Behavior: Talkative/pressured speech, increased goal-directed activity, overactivity,
impulsive and high-risk activities
2. Emotional: Euphoria, emotional labile, irritability, hostility, anger
3. Perceptual: In severe mania: hallucinations (false information that you are getting from
your senses – seeing things that aren’t there/ hearing something that isn’t there) and
delusions (irrational beliefs that your can do something / are something that you are not
– doesn’t come from senses)
4. Somatic: Decreased need for sleep – indicator that an episode is coming
5. Cognitive: Inflated self-esteem or grandiosity, flight of ideas or racing thought,
distractibility
(Blue = criteria / red = associative symptoms)
!!!NB!!!
◼ Hypermania – a person has better reality contact than people with mania.
◼ Can’t make diagnosis off mania – not a real disorder.

DSM-5 criteria for Mania !!!NB!!!

• A: abnormal, persistent elevated or irritable mood and – goal-directed activity or energy –
more than one week
• B: 3 or more symptoms (4 or more if only an irritable mood) ((blue symptoms)) – must
first identify the mood – are they euphoric or irritable
• C: impairment in functioning or necessitates hospitalizations or there are psychotic
features (mania - can become psychotic = hallucinations / hypermania – cannot
become psychotic = hallucinations) – significant impairment – can’t do daily tasks ((C
DOESN’T APPLY TO HYPERMANIA – C IS A CLEAR INDICATOR THAT IT IS MANIA))
• D: not due to substance or medical condition
Manic episodes come and goes – episode that forms part of bipolar disorder – cannot
diagnose someone with mania!!!!
Can’t make diagnosis if one of the criteria factors are missing.

Unipolar:
Major depressive disorder (D) D = major depressive disorder
• Severe d = mild depressive disorder
• Episodic
• Single and recurrent M = full mania

(Deep depressive episodes – comes and goes) m = hypomania

VDD – Dysthymia (d)

• Moderate
• Chronic – never gets better – always continues.

Bipolar:
BP 1 (D/M/m) (Major depressive, manic, hypomanic) – manic is most important.

• Severe
• Episodic
• Always has a recovery.
(Only manic episode – can diagnose BP1)
BP 2 (D/m) – does not have mania – hypomania is most important.

• Severe
• Episode
Cyclothymia (d/m) – no point in which they are experiencing euthymia – up and down all the
time.

• Moderate
• Chronic – not episodic

!!!MANIC EPISODE – ALWAYS BIPOLAR DISORDER!!!

Symptoms clustered together = episodes
Episodes = disorders
Change of mood in one day – becomes personality disorder.