Chapter 1

Introduction and
Historical Review
Psychopathology is the Study of the nature, development, and treatment of psychological
disorders
Challenges to the study of psychopathology are
Maintaining obectivity
!voiding preconceived notions
Reducing stigma
"our Characteristics of Stigma
#hat are the Characteristics of Mental $isorders
Personal $istress% &motional pain and suffering it means Helplessness and
hopelessness of depression
$isability% Impairment in a 'ey area it means Chronic alcohol consumption results in ob
loss
(iolation of Social )orms% Ma'es others uncomfortable or causes problems it means
!ntisocial behavior of the psychopath
$ysfunction% #a'efield*s Harmful $ysfunction
+ey Characteristics in the $SM,I(,-R $efinition of Mental $isorder
History of Psychopathology
$emonology
Possession by evil beings or spirits it mean &.orcism
&arly /iological &.planations
Hippocrates 01th century /C2
Mental disturbances have natural 0not supernatural2 causes
-hree categories% mania, melancholia, 3 phrenitis
"our humors% blood, blac' bile, yellow bile, 3 phlegm
History of Psychopathology: Dark Ages
$ar' !ges
Mon's cared and prayed for mentally ill
#itches
-orture sometimes led to bi4arre delusional sounding confessions, e5g5, concourse with
demons5
Historians concluded many of the accused were mentally ill5
6ittle support for that conclusion $ar' !ges
Mon's cared and prayed for mentally ill
History of Psychopathology: Lunacy Trials
6unacy -rials
-rials held to determine sanity
/egan in 17th century &ngland
Municipal authorities assumed responsibility for care of mentally ill
6unacy
!ttribues insanity to misalignment of moon and stars
History of Psychopathology: Asylums
!sylum
&stablishments for the confinement and care of mentally ill
Priory of St5 Mary of /ethlehem 018972
:ne of the first mental institutions
-he wealthy paid to gape at the insane
:rigin of the term bedlam
-reatment non,e.istent or harmful at asylums
&arly medical treatment could be harmful
/enamin Rush recommended drawing copious amounts of blood;
Pinels Reforms and Moral Treatment
Philippe Pinel 01<91,1=8>2 he was Pioneered humanitarian treatment at 6a/icetre
Moral -reatment
he made Small, privately funded, humanitarian mental hospitals
"riends !sylum 01=1<2
Patients engaged in purposeful, calming activities 0e5g5, gardening2
-al'ed with attendants
Dorothea Dix !"#$%!""&'
#or'ed for Crusader for prisoners and mentally ill
?rged improvement of institutions
#or'ed to establish 78 new, public hospitals
Hospitals staffed with physicians
(arly )oundations: *iological Approaches
@eneral paresis
$egenerative disorder with psychological symptoms
Caused by syphilis
Since general paresis had biological cause, other mental illness might also5
(arly )oundations: +enetics
@altonAs wor' lead to notion that mental illness can be inherited
/ehavioral genetics
&.tent to which behavioral differences are due to genetics
&ugenics
Promotion of enforced sterili4ation to eliminate undesirable characteristics from the
population
Many state laws reBuired mentally ill to be sterili4ed
(arly *iological treatments
Insulin,coma therapy
Sa'el, 1C7Ds
&lectroconvulsive -herapy 0&C-2
Cerletti and /ini 01C7=2
Induce epileptic sei4ures with electric shoc'
Prefrontal lobotomy
Moni4 01C712
:ften led to listlessness, apathy, and lac' of some cognitive abilities
(arly )oundations: (mil ,raepelin !"-.%!/$.'
Pioneered classification of mental illness based on biological causes
Published 1st psychiatry te.t 01==72
Mental illness as syndrome
Cluster of symptoms that co,occur
Proposed two maor syndromes
$ementia praeco.
Manic,depressive psychosis
(arly )oundations: Psychological Approaches
Mesmer 01<79,1=112
-reated patients with hysteria using Eanimal magnetismF
&arly practitioner of hypnosis
/reuer 01=98,1C812
?sed hypnosis to facilitate catharsis
Catharsis is Release of emotional tension triggered by reliving and tal'ing about event
(arly )oundations: )reud
Psychoanalytic theory
Human behavior determined by unconscious forces5
Psychopathology results from conflicts among these unconscious forces5
Selected $efense Mechanisms
Maor -echniBues of Psychoanalysis
Diagnosis and Assessment
$iagnosis
-he classification of disorders by symptoms and signs is called diagnosis
!dvantages of diagnosis%
"acilitates communication among professionals
!dvances the search for causes and treatments
Cornerstone of clinical care
Relia0ility
Consistency of measurement is called reliability
there are 9 types of reliabilities
Inter,rater
:bserver agreement
-est,retest
Similarity of scores across repeated test administrations or observations
!lternate "orms
Similarity of scores on tests that are similar, but not identical
Internal Consistency
&.tent to which test items are related to one another
1alidity
How well does a test measures what it is supposed to measureGthis is called validity
Content validity
&.tent to which a measure adeBuately samples the domain of interest e5g5, all of the
symptoms of a disorder5
Criterion validity
&.tent to which a measure is associated with another measure 0the criterion2
it has 8 types
Concurrent
-wo measures administered at the same point in time
Hopelessness scale and diagnosis of depression
Predictive
!bility of the measure to predict another variable measured at some future point in time
College @P! and annual salary after graduation
Construct validity 0Cronbach 3 Meehl, 1C112
! construct is an abstract concept or inferred attribute
Involves correlating multiple indirect measures of the attribute
e5g5, self,report of an.iety correlated with increased HR, shallow breathing, racing
thoughts5
Important method for evaluating diagnostic categories
D2M%31%TR
$iagnostic System
$iagnostic and Statistical Manual of Mental $isorders 0$SM,I(,-R2
9th edition revised
Published by !merican Psychiatric !ssociation
Multia.ial system
$iagnosis based on 1 a.es or dimensions
)i4e Axes of D2M%31
!HIS $&SCRIP-I:)
I !ll diagnostic categories e.cept personality disorders and mental retardation
II Personality disorders and mental retardation
III @eneral medical conditions
I( Psychosocial and environmental problems
( @lobal assessment of functioning scale 0@!"2
2elected Axis 3 Diagnostic 5ategories
$isorders usually first diagnosed in infancy, childhood or adolescence
6earning $isorders
Pervasive $evelopmental $isorders
Substance,related disorders
!lcohol,related and !mphetamine,related $isorders
Schi4ophrenia and other Psychotic $isorders
!n.iety disorders
Panic, @enerali4ed !n.iety, :bsessive,Compulsive $isorders
Mood disorders
Maor $epressive and /ipolar $isorders
&ating $isorders
!nore.ia )ervosa and /ulimia )ervosa
Multiaxial Diagnosis of 5arol 26
!.is I Maor $epressive $isorder
!.is II /orderline Personality $isorder
!.is III-hyroid disease
!.is I( Problems with primary support group% marital separation
!.is (@!" I >D Moderate difficulty in social and occupational functioning