Transcript Current paradigms in psychopathology

CURRENT PARADIGMS IN
PSYCHOPATHOLOGY
Psikologi Abnormal-Kuliah 2
Current Paradigms: Genetic
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

Heredity plays a role in most behavior
Genes
 Carriers
of genetic information (DNA)
 Impacted by environmental influences
 e.g.,

stress, relationships, culture
Relationship between genes and environment is
bidirectional
 Nature
via nurture (Ridley, 2003)
Important Genetic Terms
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Gene expression

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Polygenic transmission

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Proteins influence whether the action of a specific gene will
occur
Multiple gene pairs vs. single gene
Heritability

Extent to which variability in behavior is due to genetic
factors


Heritability estimate ranges from 0.00 to 1.00
Group, rather than, individual indicator
Environmental Effects
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
Shared environment
 Events
and experiences that family members have in
common

Nonshared environment
 Events
and experiences that are unique to each family
member
Behavior Genetics
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
Study of the degree to which genes and
environmental factors influence behavior
Genotype
Genetic material inherited by an individual
 Unobservable

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Phenotype
Expressed genetic material
 Observable behavior and characteristics
 Depends on interaction of genotype and environment

Current Paradigms: Neuroscience

Examines the contribution of brain
structure and function to psychopathology
 Mental
disorders are linked to aberrant
processes in the brain.

Four mechanisms:
 Neurons
and neurotransmitters
 Brain structure and function
 Autonomic system
 Neuroendocrine system
Figure 2.3 The Neuron
Basic Unit of the Nervous System
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Neurons and Neurotransmitters
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Neurotransmitter

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Receptor sites on postsynaptic
neuron absorb neurotransmitter

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Chemicals that allow neurons to
send a signal across the synapse
(gap) to another neuron.
Excitatory
Inhibitory
Reuptake

Reabsorption of leftover
neurotransmitter by presynaptic
neuron
Neurotransmitters and Psychopathology
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Serotonin and dopamine


Norepinephrine

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Anxiety and other stress related disorders
Gamma-Aminobutyric Acid (GABA)
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Depression, mania, and schizophrenia
Anxiety
Possible mechanisms

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
Excessive or inadequate levels
Insufficient reuptake
Excessive number or sensitivity of postsynaptic receptors
Figure 2.5 The Process by which a Second
Messenger is Released
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Figure 2.6 Brain Structure and
Function
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Sulci define regions
or lobes:
Frontal
 Parietal
 Temporal
 Occipital

Autonomic Nervous System (ANS)
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Sympathetic Nervous System
Excitatory
 Heartbeat acceleration, pupil dilation, gastrointestinal
inhibition, electrodermal activity increases

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Parasympathetic Nervous System
Quiescent
 Heartbeat deceleration, pupil constriction, gastrointestinal
activation


Involved in anxiety disorders, especially Panic and
PTSD
Copyright 2009 John Wiley & Sons, NY
Neuroscience and Treatment
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
Psychoactive drugs alter neurotransmitter activity
 Antidepressants
 Antipsychotics
 Benzodiazepenes

A neuroscience view does not preclude
psychological interventions
Copyright 2009 John Wiley & Sons, NY
Evaluating the Neuroscience Paradigm
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Reductionism
 View
that behavior can best be understand by reducing
it to its basic biological components
 Ignores
more complex views of behavior
Copyright 2009 John Wiley & Sons, NY
Current Paradigms: Psychodynamic
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
Fails to contribute to our empirical understanding
of the causes of psychopathology
 Greatest
contribution are in treatment
Copyright 2009 John Wiley & Sons, NY
Role of the Unconscious
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Contemporary theorists have attempted to study
the unconscious scientifically
 Pathogenic
beliefs
Beliefs that occur outside of conscious awareness
 Trigger maladaptive thoughts and emotions
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Implicit memory
 Cognitive

neuroscience paradigm
The unconscious may reflect efficient information processing
rather than a repository for troubling material
Copyright 2009 John Wiley & Sons, NY
Importance of Interpersonal
Relationships
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Object relations theory
 Longstanding

patterns of relating to others
Attachment theory
 Type
and style of infant’s attachment to caregivers can
influence later psychological functioning.

Relational self
 Individuals
will describe themselves differently
depending upon which close relationships are told to
think about (Chen et al., 2006)
Copyright 2009 John Wiley & Sons, NY
Neuroscience and Treatment
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
Psychoactive drugs alter neurotransmitter activity
 Antidepressants
 Antipsychotics
 Benzodiazepenes

A neuroscience view does not preclude
psychological interventions
Copyright 2009 John Wiley & Sons, NY
Evaluating the Neuroscience Paradigm
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
Reductionism
 View
that behavior can best be understand by reducing
it to its basic biological components
 Ignores
more complex views of behavior
Copyright 2009 John Wiley & Sons, NY
Current Paradigms: Psychodynamic
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
Fails to contribute to our empirical understanding
of the causes of psychopathology
 Greatest
contribution are in treatment
Copyright 2009 John Wiley & Sons, NY
Role of the Unconscious
21

Contemporary theorists have attempted to study
the unconscious scientifically
 Pathogenic
beliefs
Beliefs that occur outside of conscious awareness
 Trigger maladaptive thoughts and emotions


Implicit memory
 Cognitive

neuroscience paradigm
The unconscious may reflect efficient information processing
rather than a repository for troubling material
Copyright 2009 John Wiley & Sons, NY
Importance of Interpersonal
Relationships
22

Object relations theory
 Longstanding

patterns of relating to others
Attachment theory
 Type
and style of infant’s attachment to caregivers can
influence later psychological functioning.

Relational self
 Individuals
will describe themselves differently
depending upon which close relationships are told to
think about (Chen et al., 2006)
Copyright 2009 John Wiley & Sons, NY
Factors Common to Paradigms
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Emotion
 Components
Expressive
 Experiential
 Physiological
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 Most
psychopathology includes disturbances of one or
more component

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e.g., flat affect in schizophrenia
Cultural factors influence ideal affect (Tsai, 2007)
Copyright 2009 John Wiley & Sons, NY
Factors Common to Paradigms
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Sociocultural Factors
 Culture,
ethnicity, gender, & social relationships
 May increase vulnerability to psychopathology

e.g., women more likely to experience depression than men
 May

also serve as a buffer
e.g., social support
 Some

disorders specific to certain cultures
Hikikomori in Japanese culture
Copyright 2009 John Wiley & Sons, NY
Table 2.2 Lifetime Prevalence Rates of DSM-IV-TR
Disorders among Different Ethnic Groups
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Copyright 2009 John Wiley & Sons, NY
Diathesis-Stress
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Integrative model that incorporates multiple causal factors
(Zubin & Spring, 1977)
Diathesis
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Underlying predisposition
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Increases one’s risk of developing disorder
Stress
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Environmental events
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May be biological or psychological
May occur at any point after conception
Triggering event
Psychopathology unlikely to result from one single factor
Copyright 2009 John Wiley & Sons, NY
Diagnosis Multiaksial
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DSM (Diagnostic and Statistical Manual of Mental
Disorder) published by American Psychiatric
Association (APA)
In Indonesia, mental disorder diagnosis classify in
PPDGJ (Pedoman Penggolongan dan Diagnostik
Gangguan Jiwa)  based on DSM and ICD
(International Classification of Diseases) published by
WHO
Diagnosis Multiaxial
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Classification in DSM (1994) are description,
atheoretical, and multiaxial  more comprehensif
(Millon & Davis, 2000)
DSM-IV-TR includes five axes = multiaxial
classification system, by requiring judgements on
each of the five axes, forces the diagnostician to
consider a broad range of information
5 Axes in DSM-IV-TR
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Axes I:
Clinical Disorder
 Other conditions that may be a focus of clinical attention
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Axes II:
Personality Disorder
 Mental Retardation
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Axes III: General Medical Condition
Axes IV: Psychosocial and environmental problems
Axes V: Global Assesment of Functioning (GAF) Scale
GAF Scale
Consider psychological, social, and occupational functioning on a
hypothetical continuum of mental heal/illness. Do not include
impairment in functioning due to physical (or environment)
limitations.
0
: Inadequate information
1-10 : Persistent danger of severely hurting self or others/
persistent inability to maintain minimal personal hygiene
51-60 : moderate symptoms/moderate difficulty in social,
occupational, or school functioning
91-100: No symptoms, superior functioning in a wide range of
activities
Diagnosis Multiaxial
Axes I
: (296.23) Severe major depression,
without psychotic feature
Axes II
: (301.6) Personality disorder, defence
mechanism denial
Axes III
: none
Axess IV
: Occupational Problem
Axes V
: GAF=35 (current)
Current issues related to DSM-V
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Disorder that might include in DSM-V
 Behavioral
Addiction
 Definition:
excessive use sex, shopping, or computers may
signal addiction. These behavior can be taken to such
extremes that they easily mimic the behaviors of drug
addicts.
 Binge
Eating Disorder
 Definition:
individuals who binge are unable to control
periods of overeating and feel guilty or disgusted with
themselves. They often become obese. Some eat alone to
avoid feelings of shame.
Current issues related to DSM-V

Complicated Grief
 Definition:
after the death of someone close, grief and
sadness normally begin to dissipate within six months.
But some people continue to mourn for much longer.
Current issues related to DSM-V

Disorder that might exclude in DSM-V
 The
Paraphilia: Intense sexual urges involving animals,
children, nonconsensual sex, suffering, or humiliation are
classified as paraphilias – a term that was thought to
be relatively non judgmental when it replaced
“perversions” in 1980.
 Gender Identity Disorder: Since the DSM-III appeared
in 1980, individual who wish to be of the opposite sexand who are uncomfortable with their own-have been
diagnosed with Gender Identity Disorder.