Atypical Psychology

Increased prevalence in both boys and girls
High in boys than girls for all years

Increase in men and women
Women: highest percentage in 16-24y
Men: highest percentage in 25-34

Spiritual and supernatural - Eastern and Western countries
Environment
Societal - eg. increase in racial discrimination
Biological / genetic - universal idea

Demonic possession
Unnatural being, evil magin
Alcohol, overwork, grief
Imbalance of the humors

Founded in 13thC
Keeping house for the mentally ill
Hospital in the 16thC
Tourist destination in the 18thC
Deterministic view of mental illness - no control over it

Insanity - irretrievable loss of reason

Led to proliferation of madhouses
Imprisonment of the sane
Prompted increasing public concern

Tuke in England pioneered moral treatment - rest, quiet, productive manual work
Pinel in France banned punishments, argued psych can be altered and mental illness can be treated
Novel physical treatments

1845 County Asylums Act - public asylums required in every county
1845 Lunacy Act - extensice legal powers introduced to monitor practices of public asylums, inmates = "patients"
Reduced legal power of patients
Darwinism - degeneration theory (human race should be evolving but there may be some degeneration of the human line - blame placed on prisoners and patients with mental illnesses)

End of 19thC
Published Compendium of Psychiatry
Insanity = organic origin, disease of the brain requiring medical treatment
Need scientific investigation
Need classification system based on patterns of symptoms
Medical Model - mental illness as discrete categories of mental / brain pathology like physical disease

Psychodynamic model

DSM V
ICD10

DSM III, 3rd edition

1973
Pseudopatients
Reported hearing voices
"empty, hollow, thud"
All diagnosed with SCZ and admitted as inpatients

Operational criteria
Includes time course and prognosis
Inclusion and exclusion criteria
Clinical practice should be aligned with scientific enquiry

2 or more symptoms present for at least one month eg. hallucinations
Level of functioning significantly/long term lowered
Persistence of disturbance of at least 6m

Schizoaffective disorder and depression / bipolar rules out
Symptoms not caused by substance abuse/medical conditons

Rapid expansion of research on genetics, neural mechanisms etc.
Pursuit of genetic/neural markers of mental illness for diagnosis/prediction
Development of improved medication
Widespread medication prescriptions
Efforts towards public communication of biomedical research on mental illness
Effects of public attitudes towards mental health?

Causes:
SCZ and depression - greater support for genetics/neurobiological and reduced support for"way raised"
Alcohol dependence - greater support for bad character

Treatment needs:
SCZ - greater support for physicians and mental hospital
Depression - greater support for physician
Alcohol dependence - greater support for psychiatrist

Stigma:
SCZ - increase for all categories
Depression - decrease in most categories
Alcohol dependence - mixed, highest stigma increase for "marry" (wouldn't want to marry"

Genetic
Biological - eg. maternal illness during pregnancy
Experience
Environment

Diathesis = biological / gentic / personality / cognitive vulnerability
Stress = adversity

Low mood
Disturbed sleep and appetite
Fatigue
Low self-esteem
Poor conc.
Suicidal ideation

Significant and persistent worry, either generally or about a specific stimuli/experience

Complex disorder demonstrating positive and/or negative symptoms

Can't differentiate between nature and nuture

When prevalence among first degree relative of affected individuals compared to unaffected individual or population is greater than 1.0

Identification of genetic variants associated with phenotypic variants
High heritability might indicate high genetic penetrance and vice versa

Case-control design
No hypothesis
Identify genotype for all known SNPs and their association with the condition
Expect many variants with small effect OR very variants with large effect to explain the phenotypic variation

Many common variants with small effect
Few studies observed effects that were significant
Many failed to replicate
BUT may have been double dipping (pps may have been in more than 1 sample)

Meta analysis
44 significant SNPs across samples
All humans carry genetic risk for depression
No specific gene for depression
Many genes close to significance

Study by study review of 9 European ancestry samples using 2 approaches:
Case control
Phenotypic factor score

Case control:
Significant site at 3q12.3

Phenotypic factor score:
Significant site at 2p.21

Review of replications across non-overlapping samples (avoids double dipping)
Identified non-overlapping samples in only 2 studies
Each study found 8 genetic loci in either disorder (SCZ / bipolar)
3 loci common between SCZ and BD

Family and twin studies overestimate
GWAS underestimates heritability
Non-additive genetic effects
Interactions between genes and environment

Mowrer 1947 - two factor theory of phobias
Excessive fear established by Pavlovian conditioning
Fear maintained by instrumental conditioning (avoidance and negative reinforcement)

UCS --- UCR
NS --- NR
UCS + NS --- UCR
CS --- CR

Acquire behaviours which reduce possibility of encountering fear objects
Thorndike's law of effect - behaviour followed by positive consequence likely to be repeated
Avoidance behaviours negatively reinforced by preventing exposure to phobia
Maintains phobia as it removes opportunity for CS --- CR association to be broken

Stimulus specificity (only some stimuli can become phobias) and preparedness (increased liklihood of acquring phobias that were dangerous in our evolutionary past)
Resistnace to extinction (presentation of trained CS with absence of an US = reduction of CR)
Slower extinction of fear CSs compared to NS
Instructed extinction - speeds up reduction of CR in case of NS compared to fear CSs

1977
Measured skin conductance response to fear-relevant (snakes and spiders) vs fear irrelevant (circles and triangles)
Conditioned to fear-relevant/irrelevant via shocks (UCS)
After conditioning, half pps told no more shocks (extinction trials followed)
Instructions removed skin conductance response to fear irrelevant but not fear relevant
Suggests Pavlovian conditioning for fear stimulus unconscious and very difficult to remove association

Irrational beliefs
Excessive worry
Sense of impeding danger
Intense uncertainty about future
Physical/somatic symptoms
Cognitive biases in memory and attention

Attributional style
Rumination
Hopelessness
Guilt
Cognitive biases in memory and attention

Beck's theory
Core beliefs develop from early experience
Act as schemas through which situations are filtered
Produces auto negative thoughts and determines behaviours
Distorted cognition causes depressed state
Cognitive triad

Suggests fast auto, attentional biases for negative info
Stroop task
Shown emotional stroop task
Slower naming of ink colour for emotional words in stroop task

Fixation on centre point
Then shown neutral and negative emotional face on left or right
Asked to look towards the cued dot target
Faster when dot cue is on the same side as the emotional face
Attentional bias
Took longer to look away from a negative emotional face that was being fixated on
Supports Beck's theory that attention is captured by negative emotions

2013
Measured disengagement
Disengagement trials:
Naturalistic viewing of 2 faces
Pps required to shift attention to emotional face
Stimuli on neutral face (ie. circle = respond left, square = respond right)
Attention needs to shift from emotional to neutral face to perform task

Complementary method for engagement trials
MDD slower at directing attention for disengagement from sad face condition compared to controls
Task responses slower after dwelling on sad faces compared to other emotions (due to difficulties disengaging with sadness?)

Poor access to healthcare
Food insecurity
Poor education
Poverty

Randomised control trial
Treatment and placebo
Double blind

Chlorpromazine

Reduces psychotic symptoms
D2 antagonist
Dopamine theory of SCZ has dominated explanation of psychosis for decades as a result

Typical
Atypical

Relieve positive symptoms (hallucinations, delusions etc.)
No amelioration of negative symptoms
Some serotonergic, muscaranic and adrenergic actions
Many side effects - blurred vision, drowsiness, weight gain, high cholesterol
Eg. chlorpromazine

Nigrostriatal pathway - responsible for movement disorders
Tuberoinfundibular pathway - responsible for hyperprolactinemia

Nigrostriatal pathway - rigidity, tremor, restlessness (similar to Parkinson's)
Tuberoinfundibular pathway - production of breast milk, erectile dysfunction, low sperm count

D2 and 5-HT antagonists
Same serotonergic, histaminergic, adrenergic and muscarinic actions as typical
Reduction in extrapyramidal symptoms (looser D2 antagonism binding and faster dissociation)
Eg. clozapine

2017
Meta analysis of 167 double-blind randomised control trials
Compared antipscyhotics with placebo
More reduction in symptoms for antipscyhotic > placebo
Antipsychotic results:
22% show 50% reduction in symptoms
51% show 20% reduction in symptoms

Industry sponsorship - larger differences in non-industry sponsored studies
Sample size - larger sample = larger differences
Mean dose - larger dose = larger differences
Publication year - smaller differences over time

Almost half

Strong empirical base
Highly effective
Response rates equal to of better than other treatments
Cheap and easy to deliver

Associative learning
Pavlovian conditioning and instrumental learning

Systematic desensitisation
Exposure and response prevention therapy

Ordered extinction of associations from least to most feared

Ordered extinction of learned avoidance behaviours

Cognitive theory of mental disorders
Beck's cognitive triad

Automatic negative thoughts relating to self, future and world

Collaborative process between patient and therapist
Identify maladaptive baises and beliefs
Examine evidence for and against biases and beliefs
Test validity of beliefs
Learn to modify thoughts by using experiential evidence

Alters cognitive schema through appraisal processes, rather than extinguishing old schemas and learning new associations

- Single blind at most
- Can't translate gold-standard randomised control trials used to test drugs for testing psychological therapy
- Subject to therapy bias
- Effectiveness influenced by experience/skill of therapist
- Hard for patients to turn up for treatment and complete homework

Meta analysis
Very little difference between CBT and other therapies
Only shows improvement when compared to waiting list control and other forms of pscyhotherapy
So CBT and behavioural therapy useful - but CBT no necessarily the best

Involves any psychotherapeutic treatment (eg. mindfulness)
Delivery can be face-to-face, multimedia or a hybrid

Largest reduction in symptoms compared to placebo, wait list and no treatment

Obscures individual efficacy rates which could be clinically relevant
Prevents elucidation of specific neurocognitive mechanisms of change
Reduces cross talk between resesarch, psychopharmacology, neural substrates and genetis
Limits future treatment developments

Identifying genetic variants requires mega samples - heritability is also a mix of genetics and environment and only looks at a specific population at a specific time
Experimental control - natural, imperfect samples (different gender, ethnicity, SES etc)
Limited control over biases - research allegiance, publication bias, fewer negative results published
Comorbidity
Unclear boundaries for clinical diagnosis

Research has found high comorbidities between different mental disorders
Makes it difficult to draw conclusions about specific disorders
Eg. meta analysis found patients with depression (unipolar and bipolar) have high comorbidity with anxiety, OCD, specific phobia

Medical model assumes that pscyh symptoms present in disorders are absent in rest of population
Some ppl have some symptoms but not enough for clinical diagnosis
Eg. 16% ppl attending GPs in France with no psychiatric history reported auditory halllucinations
Ppl may be on more of a continuum than members of particular categories (eg. SCZ or not)

Aim = understand nature of mental illness in terms of varying degrees of functioning in general pscyh / bio systems
Need to adopt dimensial conceptualisations of constructs in order to fully understand the spectrum of mental health and illness
Advocates for a paradigm shift away from natural categories of mental disorder
Looking at mental disorders as the traits that are involved, rather than a diagnostic entity
Argues that understanding mental pathology is the same as understanding neural pathology

Genes, molecules, cells, neural circuits, self report

Processes, mechanisms and responses

- Still difficult to draw the line between healthy and unhealthy trait dimensions (counters this by looking at statistics: statistical deviance from the normal distribution)
- Subjective experiences vs neuroscientific definitions of pathology (ignores whole context of the person that may not be captured by their neurobiology and is still important in the development of mental disorders)
- Significance of stakeholders in mental health research
- Critics argue mental pathology cannot be reduced to purely neurobiological factors
- Underestimates the context of the environment that the pathologies may be experienced in

Studies of income inequality vary depending on included variables such as:
- country
- measures of mental health
Positive, negative and mixed results found

Only 9 out of 15,000 publications matched criteria for inclusion in meta analysis
1 positive, 6 mixed, 2 no association
Small but significant associations between income inequality and any mental health disorder and depression

Variation in resilience
Involves interactions between vulnerability and adaptation, and risk and protective factors

Individual variation in susceptibility to risk (and protective) factors

Individual variation in response to risk (and protective) factors

Early life stress has an inoculation-like effect (evidence for resilience)
Moderate stress in early life may be protective against future psychopathological conditions caused by recent stressors