Psicopatologia (Bilingue) Tema 1, Apuntes de Psicopatología

¡Descarga Psicopatologia (Bilingue) Tema 1 y más Apuntes en PDF de Psicopatología solo en Docsity! Unit 1A: The study of abnormal behavior: An historical overview Abnormal Psychology: Past and Present • What is abnormal psychology? • The scientific study of abnormal behavior in order to describe, predicts, explain, and change abnormal patterns of functioning. • Workers may be: ■ Clinical Scientists: gather information systematically so that they may describe, predict and explain the phenomena they study. ■ Clinical Practitioners: role is to detect, asses, and treat abnormal patterns of functioning. How Was Abnormality Viewed and Treated in the Past? • Many present-day ideas and treatments have roots in the past • A look backward makes it clear that progress in the understanding and treatment of mental disorders has hardly been a steady movement forward • Methodological problems • Myths: «Nave de los Locos» • Finalistic approaches • Common beliefs (cross‐cultural and transhistorical): • The power of “words” • Natural medicine vs. Magic interventions • Dual universe (positive/negative forces) • Folk explanations for madness: ■ Soul stealing ("Robo“): Rituals to bring it back "Posession": Exorcisms • Cosmos explanations → Madness explanations → Treatments Treatment (therapy): is a procedure designed to change abnormal behaviour into more normal behaviour. According to Jerome Frank all forms of therapy have three essential features: • A sufferer • A trained, socially accepted healer • A series of contact between the healer and the sufferer Prehistoric Times • Mystical views dominate this period • No division between health care, magic, and religion - no understanding of why diseases occur • Abnormal behaviour attributed to the supernatural • Treatment included spells cast by Shamans, exorcisms, and perhaps trepanning Historical Conceptions of Abnormal Behaviour • Disorders caused by demons and supernatural powers • Treatments include exorcisms but also body interventions Connecting Treatment to Etiology • Attitudes about a disorder influence how we attempt to treat it. • Consider how you would treat a mental disorder due to: • Weakness of character • Sinfulness • Heredity • Physical environment • Social environment Signs Symptom Sx Treatment Tx Syndrome (5 signs out of 9) History of Abnormality • Possession • Animistic Forces: tarantism, lycanthropy • Satanic Forces: reports of witchcraft increased rapidly with the extensive instability of the late 15th and 16th centuries (e.g., rise of capitalism, Protestant Reformation) Treatment During Prehistoric Times • Trepanning/trephination (8000B.C.-500B.C.) • Earliest known surgery • Hole bored in skull • Used to drive alien spirits from the body • Remedy for insanity, epilepsy and headache • Was done for severe abnormal behaviour Ancient Greece and Rome • Two theories of mental illness: 1. Mental illness is caused by possession (treatment?) ■ Disordered thoughts and madness were thought to be the utterances of the gods 2. Belief that all illness, including mental illness, has natural origins Hippocrates’ Early Medical Concepts • Classification: Three categories • Mania • Melancholia • Phrenitis (Brain fever) • Based on daily clinical observations and records of patients • Treatment: “do no harm” • Humane: “Walking is man's best medicine." • Specific to diagnosis • Recognized the importance of environment • Misconceptions • Hysteria due to “wandering uterus” • Four humors (yellow bile, black bile, blood and phlegm) ■ Excess of yellow bile: mania ■ Excess of black bile: melancholia • Axiomatic medicine Middle Ages (500-1500 A.C.) • The Age of Faith: Christ healed by faith, therefore people believed only the grace of God would provide a cure for physical or mental illness • Cause of mental illness was demonic possession – treatment involved exorcism • Persistence of Hippocrates • Not so Dark Ages! Tarantism: groups of people would suddenly start to jump, dance and go into convulsions. All were convinced that they had been bitten and possessed by a wolf spider (tarantula) and they sought to cure their disorder by performing a dance called a tarantella. Lycanthropy: people thought they were possessed by wolves or other animals. Middle Ages: Europe Etiology and Treatment • Etiology of Mental Illnesses • Scientific approaches rarely used • Saw a return of the belief that mental illness was due to supernatural causes such as superstition or rituals • Treatment of Mental Illness • Left largely to the clergy and occurred primarily in monasteries • 1899: Classification totalled 13 groups • Dementia Praecox: poor prognosis (in 3/4) • Manic-Depressive Illness: favorable px • Other categories: neurosis, febrile psychosis, MR, etc The Early Twentieth Century: The Psychogenic Perspective • The rise in popularity of this perspective was based on work with hypnotism: • Friedrich Mesmer and hysterical disorders ■ Patients sit in a darkened room with music ■ He appeared dressed in colourful costume and touched the troubled area with a rod • Sigmund Freud’s theory of psychoanalysis ■ Psychoanalytic treatment applied to patients suffering from anxiety or depression. Psychoanalysis: the theory or the treatment of abnormal mental functioning that emphasizes unconscious psychological forces as the cause of psychopathology. • The psychoanalytic approach had little effect on the treatment of severely disturbed patients in mental hospitals Early 1900’s • Era of psychoanalysis—the “talking cure” • Freud treated wide variety of patients, but most people with psychosis still given custodial care in institutions • Mild neurosis? Worried well?: YARVIS (Young-Attractive-Rich-Verbal-Intelligent- Successful) Insulin Coma • 1921: Banting and Best discovered insulin • 1927: Manfred Sakel injected insulin into addicts • Treated schizophrenic patients • Infusion sufficient to cause coma • Patient often convulsed • Coma lasted 20-120 minutes • Glucose infusion to recover patient • Effects seen after 10-20 comas Convulsive Therapy • Metrazol-induced convulsions: Ladislaus von Meduna, 1934 • Mistakenly thought there was “biological antagonism” between schizophrenia and epilepsy • Spinal fractures in up to 42% of patients • Extreme pre-ictal anxiety, dysphoria; vomiting • Later combined with curare and scopolamine • Discontinued in mid-late 40’s with advantages of ECT • Electroconvulsive Therapy (ECT): Ugo Cerletti, 1937 • Wanted less dangerous alternative to metrazol • Retrograde amnesia was an unforeseen “advantage” over metrazol • More reliable, controllable • Less injurious Psychosurgery • Leukotomy – Egas Moniz (1935) • The original lobotomy Somatogenic perspective: the view that abnormal psychological functioning has physical causes. Psychogenic perspective: the view that the causes of abnormal functioning are psychological. • Medical procedure consisting of severing the connections between the thalami and the cortices of the orbital surfaces of the frontal lobes • Common result: Patients forgetting their depressing or discouraging feelings or tendencies • Awarded Nobel Prize in Medicine and Physiology in 1949 • Effectively reduced tension, agitation, violence • Adverse effects: apathy; impaired drive, initiative, emotional expression, socially cued behaviours, planning • Walter Freeman • With Watts, popularized “lobotomy” (1936) • 1946: Developed transorbital lobotomy • Traveled all over U.S. • More than 3,000 interventions • White matter in frontal lobes disrupted • Used ice pick-like instrument and hammer • Local anesthetic • Trans-orbital lobotomy • By 1955, >40,000 done in U.S. • Used on children, anyone with disruptive behaviour • Decline due to introduction of neuroleptics Trans-orbital lobotomy The procedure: • To induce sedation, inflict two quick shocks to the head • Roll back one of the patients’ eyelids • Insert a device, 2/3 the size of a pencil, through the upper eyelid into the patients’ head • Guided by the markings indicating depth, tap the device with a hammer into the patient’s head/ frontal lobe • After the appropriate depth is achieved, manipulate the device back and forth in a swiping motion within the patient’s head Early pharmacotherapy Psychotropic medications: drugs that primarily affect the brain and alleviate many symptoms of mental dysfunctioning. • Pre-19th century: • Laxatives • Opiates • Hellebore (purgative) • Morphine • Belladonna alkaloids • Chloral Hydrate (1832) • Apomorphine • Bromides (general sedative) • Barbiturates: • Barbital synthesized in 1903 (VeronalR) • Many followed in next two decades • Deep sleep effects • Standard of sedative/hypnotic treatment until benzodiazepines Modern Pharmacotherapy • 1954: Chlorpromazine introduced (Thorazine) • 1960: Imipramine & chlordiazepoxide introduced • 1971: lithium salts introduced for BD (discovered in 1949, by Australian psychiatrist, J. F. J. Cade to treat psychosis) 1960’s • President John F. Kennedy’s community mental health movement • Community Mental Health Centers Construction Act passes (1963), providing federal money to develop a network of community mental health centers. Mid-1960’s • Deinstitutionalization: number of institutionalized mentally ill people in the US drops from 560,000 to 130,000 by 1980. • Deinstitutionalization possible because antipsychotic drugs control symptoms, but long- term institutionalized people need ongoing mental health treatment and an array of social services that are not uniformly available. • Results: homelessness, “revolving door syndrome,” concern in the community about discharged patients 1961 • Psychiatrist Thomas Szasz publishes The Myth of Mental Illness, which argues that schizophrenia is not a disease but a reasonable adaptation to a mad world • Sociologist Erving Goffman’s book, Asylums, argues that many, if not most, symptoms in patients who have been in psychiatric hospitals for long periods are induced by the institution itself (institutionalization). Anti-psychiatry movement • Ronald Laing (1927-1989) • The Divided Self: An Existential Study in Sanity and Madness (1960) • David Cooper (1931-1986) • The death of family (1974) • Franco Basaglia (1924-1980) • L’istituzione negata (1968) • Thomas Szasz (1920-) • The Myth of Mental Illness (1960) • The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement (1970) The Twentieth Century: An overview • Psychogenic theories (psychoanalysis) • Emphasis in the history of the patient (not history of Sx). • Psychological theory & treatment approach • It creates a new therapeutic scenario • Deinstitutionalized treatment (private office) • Psychotropic drugs • 30´s: Psychosurgery, convulsions, ECT,… • Clorpromazine: 1953 • Imipramine: 1957 • Benzodiazepine: 1960´s • Deinstitucionalization (from the mid 60’s) • Improvements in classification and diagnosis (since 1980) • Community perspective (from the 70’s) • More effective treatments (evidence-based approach) • Need of emphasis on prevention and access to treatments Modern-day focus on treatment • Chronic institutionalization is avoided: Today, emphasis remains on hospitalization of only the most severe cases • Unfortunately, there are too few community programs available; only 40% of those with severe disturbances receive treatment of any kind • Cognitive and behavioural therapy is often utilized (empirically-based interventions) • Recovery Movement • Big Pharma • Stereotyping • Prejudice • Discrimination • Power imbalance to… • Socially oppress people based on their membership in a group (in this case an illness group) Components defined & intertwined • Cognitive component • Labelling • Stereotyping (eg: violence) • Emotional component • Generalized negativity • Prejudice (They don’t belong) • Behavioural component • Unfair treatment • Discrimination • Structural component • E.g., lack of opportunities, poverty, gender biases,.. Some Public Misconceptions (CMHA, Ontario Division, 1994) • Prevalent misconceptions about mental illness include: • Mental health patients are dangerous and violent and unpredictable (88%) • They have a low IQ or are developmentally handicapped (40%) 1. Discrimination at Home • Adverse reactions by family eg lazy / weak • Negative reactions to family members • High rates of homelessness • Neighbourhood reactions to residential care 2. Discrimination in Friendships, Intimate Relationships and Childcare • Loss of husband/wife/partner • Disappearance of friends • Impaired long-term sexual relationships 3. Discrimination at Work • Lower rates of short-listing and hiring • More often sacked • Lower rates of pay • Poorer promotion prospects • Dilemma: conceal or disclose 4. Discrimination in Social Life • Less access to affordable insurance • Limitation on jury service, property ownership, legal ability to sign contracts • Not taken as a reliable witness • Human rights may be fundamentally limited • May be negative trends for attitudes 5. Discrimination in Healthcare • Avoidance of seeking help for fear of stigma • Pessimism of mental health care staff • Worse physical care: ‘diagnostic overshadowing’ Healthcare and Discrimination • Strong evidence that people with mental illness have less access to primary health care. • Receive inferior care for diabetes, heart attacks. • Even though rates of cardio-vascular disease, obesity, diabetes are higher for people with mental illness. 6. Discrimination in the Media • Newspapers: 40-70% of items: violence • 85% of children's animations show characters with mental illness • Few direct accounts from consumers • Clear negative effects on popular views 7. Anticipated Discrimination • Similar ideas: self-stigma, self-discrimination • Avoidance of important actions: ■ Applying for a job ■ Seeking a close relationship ■ Because of previous failure or ■ In anticipation of failure Implications for mental health • Poor social and health outcomes • Disrupted educational and career trajectories • Poverty, disenfranchisement, social exclusion • Poor recognition of signs and symptoms (literacy) • Fear, shame, embarrassment and a wish for secrecy • Treatment avoidance • Poor adherence to treatment plans • Higher morbidity, disability, and mortality National and International Campaigns • Australia: ‘Beyondblue’ • New Zealand • UK: ‘Moving People’, ‘Changing minds’,.. • Canada: Opening minds; “Bell Let´s talk” • Spain: ‘Mentalízate’, ‘Proyecto Chamberlain’ (CRL Nueva Vida), ‘1decada4’,… • World Psychiatry Association • Open-the-Doors Global Network (1996) • Stigma and Mental Disorder Section (2005) • Task force on the destigmatization of psychiatry and psychiatrists (2009) • WASP, WHO, others Mental Health Campaigns • Time to Change • See-Me Scotland • Stamp Out Stigma What is a Social Inclusion Model? • A rights based approach to dealing with discrimination, which • Recognizes of the importance of the central determinants of health • Acknowledges the importance of employment and economic inclusion • Ensures access to treatment, supports and services • Nurtures meaningful participation and full citizenship What can one do? • Don’t accept nihilistic pronouncements, Eg. “You’ll never work again” • Challenge ‘totalizing’ terms Eg. “He is a Schizophrenic” • Challenge pessimistic terms such as “chronic” (e.g., “chronic mental illness”) • Ensure diagnostic information is tailored to the needs of the patient, family and care givers. • Fight against labels! (e.g., Rosenhan’s study)