Mental Health and Psychopathology I

Learning Objectives
• Be able to understand:
• The concept of health
• The concept of mental health
• The concept of psychopathology
• The concept and significance of diagnosis
• The scientist-practitioner model as applicable to the
individual
• The issues related to mental health and diagnosis
• The integrative approach to psychopathology and
diagnosis
Mental Health has
a long past but a
recent history.
What is Health?
• The Constitution of WHO (1946) states
that good health is a state of complete
physical, social and mental well-being, and
not merely the absence of disease or
infirmity.
What is Mental Health?
• Mental health is defined as a state of
well-being in which every individual
realizes his or her own potential, can
cope with the normal stresses of life,
can work productively and fruitfully,
and is able to make a contribution to
her or his community.
Psychopathology?
• Abnormal behavior: It is a psychological
dysfunction within an individual that is
associated with distress or impairment in
functioning and a response that is not typical or
culturally expected.

• According to the APA:

• Psychopathological functioning - Disruptions
in emotional, behavioral, or thought processes
that lead to personal distress or block one's
ability to achieve important goals.
What Is Psychological Abnormality?
• Many definitions have been proposed, yet none
are universally accepted
• Most definitions, however, share some common
features…
• “The Four Ds”
• Deviance – Different, extreme, unusual, bizzare
• Distress – Unpleasant & upsetting
• Dysfunction – Causes interference with life
• Danger – Poses risk of harm
Deviance
• From what?
• From behaviors, thoughts, and emotions considered
normal in a specific place and time and by specific
people
• From social norms
• Stated and unstated rules for proper conduct in a given
society or culture
• Examples?
• Judgments of deviance also depend on specific
circumstances (i.e., social context)
Distress
• According to many clinical guidelines, behavior must be
personally distressing before it can be labeled abnormal
• Not always the case
• Examples?
 Dysfunction
• Abnormal behavior tends to be dysfunctional – it interferes
with daily functioning
• Culture has an influence on determinations of dysfunction as
well
• Dysfunction alone does not mean abnormality
 Danger
• Abnormal behavior may become dangerous to oneself or
others
• Behavior may be careless, hostile, or confused
• Although cited as a feature of psychological abnormality,
dangerousness is an exception rather than a rule
• The most widely accepted definition used in DSM-5
describes behavioral, psychological, or biological
dysfunctions that are unexpected in their cultural context
and associated with present distress and impairment in
functioning, or increased risk of suffering, death, pain, or
impairment.

• Psychopathology is the scientific study of psychological

disorders.
 What is Diagnosis?
• Diagnosis is the process of determining whether
the particular problem afflicting the individual
meets all criteria for a psychological disorder, as
set forth in the fifth edition of the Diagnostic and
Statistical Manual of Mental Disorders, or DSM-5
(American Psychiatric Association, 2013).
Why do I need to study how to
diagnose?
• Diagnosis serves as a blueprint guiding treatment. It is
important to know the typical course of a disorder so
that we can know what to expect in the future and
how best to deal with the problem.
• The most important development in the recent
history of psychopathology is the adoption of
scientific methods to learn more about the nature of
psychological disorders, their causes, and their
treatment.
• Many mental health professionals take a scientific
approach to their clinical work and therefore are
called scientist-practitioners.
What is a Scientist-Practitioner?
 Issues related to Diagnosis
• What sort of every day stresses do you suffer from? What
distresses you?
• Are all my problems listed in the DSM-5 then?
• Certainly not.
• Clients never come with symptoms, each is different from another.
You need to sort out the symptoms on the bases of tools and
techniques of psychological assessment.
• There certainly exist mental health problems beyond those listed in
the DSM – it is a work in progress at all times.
• More so, the feel of a problem for each client will be personalized –
that’s where psychologists and therapists come in.
• However, DSM – 5 gives you a prototype
• And in order to serve as a scientist-practitioner, you need to be able
to scientifically classify, quantify, record and present your work.
What determines my health?
• According to the WHO, a health determinant is a force or
element that affects health, either positively or negatively.
Health is determined by both intrinsic forces, such as genetics,
behaviour, culture, habits and lifestyles, and extrinsic forces
such as preventative, curative and promotional aspects of the
health sector, as well as elements outside the health sector
including:
• Economic factors, such as trade
• Social factors, such as poverty
• Environmental factors, such as climate change
• Technological factors, such as information technology.
Integrative Approach
• The manner in which we are going to study the different kinds
mental disorders and disturbances.
Jargon Time!
• Presenting problem – a traditional shorthand way of indicating why
the person came to the clinic.
• Clinical description – represents the unique combination of behaviors,
thoughts, and feelings that make up a specific disorder.
• Prevalence – how many people in the population as a whole
• have the disorder.
• Incidence – statistics on how many new cases occur during a given
period, such as a year.
• Course – the pattern that the disorder follows.
• chronic course, meaning that they tend to last a long time, sometimes a
lifetime.
• episodic course, in that the individual is likely to recover within a few
months only to suffer a recurrence of the disorder at a later time.
• time-limited course, meaning the disorder will improve without
treatment in a relatively short period.
• Onset – how and when it begins, could be age or intensity of
the onset.
• acute onset, meaning that they begin suddenly;
• others develop gradually over an extended period, which is
sometimes called an insidious onset.
• The anticipated course of a disorder is called the prognosis.
• Etiology – the study of origins, has to do with why a disorder
begins (what causes it) and includes biological, psychological,
and social dimensions.
Etiology – How does Abnormal
Behaviour Occur?
How does the Etiology
Interact?
• Diathesis–stress model – individuals inherit tendencies to
express certain traits or behaviors, which may then be
activated under conditions of stress.

• And how does the stress develop?

• Gene–environment correlation model – Some evidence now

indicates that genetic endowment may increase the
probability that an individual will experience stressful life
events
The Evolution of Classification
and Treatment of Abnormal
Behaviour
• Historically, there have been three prominent approaches to
abnormal behavior. In the supernatural tradition, abnormal
behavior is attributed to agents outside our bodies or social
environment, such as demons, spirits, or the influence of the
moon and stars; although still alive, this tradition has been
largely replaced by biological and psychological perspectives.
In the biological tradition, disorders are attributed to disease
or biochemical imbalances; in the psychological tradition,
abnormal behavior is attributed to faulty psychological
development and to social context.
• Each tradition has its own way of treating
individuals who suffer from psychological
disorders.

• The behavioral model moved psychology into the

field of science. Both research and therapy focus
on things that are measurable, including such
techniques as systematic desensitization,
reinforcement, and shaping.
The Present State of Affairs
• With the increasing sophistication of our
scientific tools, and new knowledge from
cognitive science, behavioral science, and
neuroscience, we now realize that no
contribution to psychological disorders ever
occurs in isolation. Our behavior, both normal
and abnormal, is a product of a continual
interaction of psychological, biological, and social
influences.
Tools of Assessment
• Funnel type approach.
1. The clinical interview.
2. To organize the information gathered in the clinical
interview, we use a Mental Status Examination, which
involves the systematic observation of an individual’s
behavior. This type of observation occurs when any one
person interacts with another. The exam covers five
categories:
• Appearance and behavior
• Thought processes
• Mood and Affect
• Intellectual Functioning
• Sensorium – our general awareness of our surroundings.
Tools of Assessment
3. Physical Examination
4. Behavioural Assessment
5. Psychological Testing
• Projective Tests
• Personality Inventories
• IQ and Aptitude Assessments
• Neuropsychological tests – measure abilities in areas such as
receptive and expressive language, attention and concentration,
memory, motor skills, perceptual abilities, and learning and
abstraction in such a way that the clinician can make educated
guesses about the person’s performance and the possible
existence of brain impairment.
• Neuroimaging
• Psychophysiological assessments such as EEG.