Psych 2AP3 lecture 1 - Dr Richard Day PDF

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Dr Richard Day ...

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Psych2AP3 lecture 1 – January 6th, 2019 Goals of the course  Discuss symptoms of mental disorders – patterns of behaviour, emotional experience and expression  Spend most time – the reasons that symptoms appear in individuals o We can’t imagine how someone develops symptoms of a given disorder – will talk about theories proposed to account for symptom development o Won’t answer definitely where symptoms come from – still a big unknown  We are very ignorant about nature/causes of mental disorder o Confusing, contradictory area of science o Overriding message is that people don’t know much about mental disorder o The more you know in this field, the more ignorant you become o The more you learn, the more you are aware of how little we know o Why are we so ignorant? Have been studying mental illness for 150 years or more o Several reasons:  Ethical – experiments that you can do on animals that would answer some questions – but cannot do them on people with mental illnesses, or people in general – some experiments ethically cannot be performed (there are animal models for some mental disorders – mice with ADHD, autism, bipolar disorder – these are the only subjects we are allowed to work on – but psychological symptoms exist as well, feelings and cognitions – cannot ask mice about this) => no satisfactory animal model for any disorders  More significant reason: complexity of answers – every answer turns out to be super complicated, interactions between body systems, genetic factors, etc. – one of the most challenging fields of science – data are inconsistent, inconclusive, messy and confusing  Appreciate our ignorance  300 names mental disorders in DSM5 – base our discussion on this  How many do we know the causes of – only 1 disorder, intellectual disability (other 299 we are completely ignorant about)  We have successful pharmacological and psychological treatments – but we don’t know why any of these treatments work o Don’t know how antidepressants, antipsychotics, etc. work Extent of our ignorance  Critique of DSM – described as the bible of diagnosis, NA and many Europeans use to decide whether label applied to set of symptoms  But DSM has it wrong – doesn’t divide disorders into organic categories: messy, mixed o Individuals with same label and diff symptoms, etc.  We do not know causes… Why do we know so little?  Talked about first 2 points already  Causes of mental disorder vary both between disorders and from case to case within disorders o Thought we would find genetic change, neural structure underpinning, responsible for psychological changes, which would cause symptoms which we would label and have a specific treatment – diff set of conditions causing disorder A, B and C – distinguishable causes were thought to exist o This is not true o Lots of overlap: must understand that the very same symptoms in diff individuals can be caused by very diff causes – one may be genetic, neurochemical, psychological, etc. o Many causes for same set of symptoms o Worse – same causes may lead to different set of symptoms o There is genetic overlap to some disorders o Very messy situation

The course will not:  Cover clinical psychology o Clinical focuses on diagnosis and treatment – determine what label to place and what to do for the individual o We will discuss criteria in DSM5 and treatments – but not at great length  Will not make us a skilled diagnostician o More experience makes you less certain about diagnosis o The more you know, the less sure you are about what diagnosis to apply o Most reliability in diagnosis is among the most ignorant group (1st year uni group tended to agree the most on a label to give) – least reliability/consistency was those with 15 years of experience in the field – became less certain about what label to apply to a case o Found over and over again: the more you know, the more confused you get o This is desirable -> increased understanding of where we are Diagnostic uncertainty  Rettew 2009: o Reliability of diagnoses made by clinical diagnosticians and researchers o Kappa is a refined version of correlation coefficient o Looking at correlation between diagnostic label employed by research vs clinicians on same patients o With one exception, correlations are very low o The only high one is eating disorders – all agreed on whether individual had eating disorder or not o But affective, emotional, 0.14, generalized anxiety is 0.19, 0.3 overall o *don’t remember these numbers, just the pattern o It is overall BAD, low  Samuel 2015 o Looked at studies comparing reliability of personality disorder diagnoses (more general problems in functioning of individuals) o Clinicians have 0.4 correlation in terms of reliability (40% agreement in terms of what personality disorder person should be labelled with) o Agreement between clinicians and researchers is even worse, only 0.23  Diagnosis is an art form – there are no lab tests for any disorders we will discuss  Every diagnostic decision is subjective – guessing what label, if any, you should apply to someone’s symptoms – no way to tell if you are right or wrong, because there is no right answer Criteria of abnormality  What do we mean by abnormality? What does it mean for behaviour to be sufficiently abnormal enough to warrant diagnostic label being applied?  Many diff criteria employed over the years; we will ignore most of them (fallen out of fashion)  Focus on 2 criteria that DSM (beginning with DSM3) has employed  Impairment criterion: o Behaviour impairs ability to function in important areas of life (holding down a job, forming intimate relationships, trouble in academic settings, impaired to some degree in some important area of functioning) o Impair social, occupation or other domains of functioning OR post danger to self or others  Personal distress criterion: o Symptoms might not impair ability to function o One goal is to familiarize ourselves with those living with symptoms of mental disorders (anxiety, depression, schizophrenia, schizo-affective) – many people have done well, hold down jobs, have degrees, etc.

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o Reason for their label is personal distress: unhappiness, depression, anxiety o Function okay, but feelings bother them (also thoughts – obsessions, compulsions) One of two criteria must be met according to DSM5 for individual to warrant label of some sort DSM is just a set of labels we give to a collection of symptoms No such thing as a “mental disorder” – there are only symptoms causing distress and/or dysfunction We give them a name – that is all we are doing, no such thing as a mental disorder...