Lesson 1: Introduction to Abnormal Psychology and Historical Review

Psychopathology: The scientific study of psychological disorders, covering their nature, symptoms,
development, and treatment. Challenges include maintaining objectivity, avoiding preconceived notions,
and reducing stigma.

A. Key Characteristics in DSM Definition of Mental Disorder:

●​ Psychological Dysfunction: Breakdown in cognitive, emotional, or behavioral functioning.

●​ Distress: Behavior causes significant discomfort.
●​ Disability: Impairment in important life areas (e.g., work, relationships).
●​ Deviance: Behavior outside social norms, rare, or culturally unexpected.
●​ Danger: Poses harm to self or others.

B. The Diagnostic and Statistical Manual (DSM):

●​ Widely used for classifying psychological disorders.

●​ Requires behaviors to fit patterns, cause dysfunction, and endure for a specified time.
●​ Defines abnormalities as unexpected behaviors causing distress or impairment.

C. Issues in Defining Abnormality:

●​ Ambiguity in drawing the line between normal and abnormal behavior.

●​ Some individuals experience distress without impaired functioning.

D. Science of Psychopathology

●​ Scientific-Practitioner Approach: Professionals consume, evaluate, and produce scientific

studies.
●​ Clinical Description:
○​ Presenting Problem: Reason for seeking help.
○​ Prevalence: Total affected in the population.
○​ Incidence: Number of new cases in a period.
○​ Onset: Acute (sudden) or insidious (gradual).
○​ Course: Chronic (long-term), episodic (recurs), or time-limited (resolves without treatment).
●​ Etiology: Study of causes, including biological, psychological, and social factors.
●​ Treatment and Outcome: Pharmacologic, psychosocial, or combined approaches.

E. History of Psychopathology

1. Demonology Era: Mental illness attributed to evil spirits. Treatments:

●​ Exorcism: Ritual to expel spirits.

●​ Trephination: Cutting skull holes to release spirits.
●​ Hydrotherapy: Shock therapy with cold water.

2. Early Biological Explanations:

●​ Hippocrates: Mental disorders caused by imbalance of four humors (blood, black bile, yellow bile,
phlegm).
●​ Treatment: Bloodletting to balance humors.
3. Dark Ages:

●​ Galen’s Influence: Greek physician continuing biological perspectives.

●​ Religious Dominance: Monasteries replaced physicians; care included prayer and potions.
●​ Witch Hunts: Mental illness mistaken for witchcraft; accused were tortured or executed.

4. Renaissance and Asylums:

●​ Johann Weyer: First to specialize in mental illness, advocating humane treatment.

●​ Asylums: Institutions like St. Mary of Bethlehem (Bedlam), known for harsh conditions.
●​ Benjamin Rush: Promoted bloodletting and fear-based cures.

5. Nineteenth Century Reforms:

●​ Philippe Pinel & Jean-Baptiste Pussin: Introduced moral treatment (humanitarian care) at La
Bicetre.
●​ William Tuke: Founded York Retreat, offering calm, rural care.
●​ Dorothea Dix: Pioneered the mental hygiene movement, establishing 32 hospitals but faced
overcrowding issues.

F. Evolution of Contemporary Thought

1. Biological Approaches:

●​ Louis Pasteur: Germ theory linking infection and mental illness (e.g., syphilis causing general
paresis).
●​ Francis Galton: Studied genetic inheritance of mental illness, promoting eugenics.
●​ Early Treatments:
○​ Insulin-Coma Therapy: Manfred Sakel induced comas with insulin.
○​ Electroconvulsive Therapy (ECT): Cerletti and Bini used electric shocks to induce
seizures.
○​ Prefrontal Lobotomy: Egas Moniz severed brain tracts, causing severe side effects. A brain
surgery that severs connections in the frontal lobe. Nakatusok sa ulo.

2. Psychological Approaches:

●​ Psychoanalytic Theory (Freud): Human behavior results from unconscious conflicts.

○​ Structure of the Mind: Id (instincts), Ego (reality), Superego (morality).
○​ Psychosexual Stages: Oral, Anal, Phallic, Latency, Genital.
○​ Defense Mechanisms: Repression, denial, projection, etc.
○​ Techniques: Free association and dream analysis.

3. Later Psychoanalytic Theories:

●​ Anna Freud: Focused on ego psychology and defense mechanisms.

●​ Heinz Kohut: Developed self-psychology, emphasizing self-concept.
●​ Non-Freudians:
○​ Carl Jung: Introduced collective unconscious and archetypes.
○​ Alfred Adler: Developed individual psychology, focusing on social interest and the inferiority
complex.
○​ Karen Horney: Emphasized cultural and societal influences on personality.
4. Behavioral Model:

●​ Pavlov (Classical Conditioning): Learning through association (e.g., conditioned reflex in dogs).
●​ John Watson (Behaviorism): Studied observable behavior; famous for the “Little Albert”
experiment.
●​ Mary Cover Jones: Used systematic desensitization in the “Little Peter” case.
●​ Joseph Wolpe: Developed systematic desensitization for phobias.
●​ B.F. Skinner (Operant Conditioning): Focused on reinforcement (positive and negative) to shape
behavior.
●​ Albert Bandura (Modeling): Demonstrated learning through observation (e.g., reducing children's
fear of dogs).

5. Humanistic Model:

●​ Abraham Maslow: Proposed a hierarchy of needs, culminating in self-actualization.

●​ Carl Rogers: Developed person-centered therapy, emphasizing empathy and unconditional positive
regard.

6. Cognitive Model:

●​ Aaron Beck: Developed cognitive therapy, identifying distorted thinking patterns in depression.
●​ Albert Ellis: Created rational emotive behavior therapy (REBT), focusing on changing irrational
beliefs.

7. Modern Integrative Approach:

●​ Uses a multidisciplinary perspective combining biological, psychological, social, and cultural factors.
●​ Employs the scientific method to test theories and treatments.

Lesson 2: Clinical Assessment, Diagnosis, and Treatment of Psychological Disorders

A. Clinical Assessment

Clinical assessment is a systematic approach used to collect, analyze, and document a person’s
mental, emotional, and behavioral health. It helps in diagnosing conditions and planning interventions.

1. Process of Clinical Assessment

●​ Interviews and Information Gathering

●​ Psychological Testing
●​ Analysis, Formulation, and Report Writing
●​ Feedback Session

2. Types of Clinical Interviews

●​ Mental Status Examination (MSE): Observes an individual’s behavior in five areas:

○​ Appearance & Behavior
○​ Thought Process
○​ Mood & Affect
○​ Intellectual Functioning
○​ Sensorium (Consciousness)
●​ Semi Structured Clinical Interviews: A combination of structured questions and spontaneous
discussion.
 ●​ Behavioral Assessment: Observing an individual in specific contexts to assess thoughts,
emotions, and behaviors.
●​ Physical Examination: Identifies medical conditions contributing to psychological symptoms.

3. Psychological Testing

●​ Projective Tests: words, images, or situations are presented.

○​ Rorschach (Rorshak) Inkblot Test: a psychological assessment that involves interpreting
inkblots.
○​ Thematic Apperception Test (TAT): a psychological test that uses a series of pictures to
assess personality.
○​ Draw-A-Person Test: a psychological assessment tool that involves drawing a person.
○​ House-Tree-Person Test: a psychological assessment tool that involves drawing a house,
tree, and person.
○​ Sacks Sentence Completion Test: consists of 60 incomplete sentences across four
domains: self-concept, sex, family, and interpersonal relationships.
●​ Personality Inventories: an assessment tool that analyzes the personal characteristics of job
candidates, measures their competencies, and helps guide Human Resources processes.
○​ Myers-Briggs Type Indicator (MBTI): A self-report questionnaire designed to measure
psychological preferences in how people perceive the world and make decisions.
○​ 16 Personality Factors (16PF): A comprehensive measure of normal personality traits,
developed by Raymond Cattell, used to assess an individual’s personality structure.
○​ NEO Personality Test: A psychological assessment tool that measures the Big Five
personality traits: Neuroticism, Extraversion, Openness, Agreeableness, and
Conscientiousness.
●​ Intelligence Tests: standardized assessments designed to measure an individual’s cognitive
abilities, including reasoning, problem-solving, memory, and verbal and mathematical skills.
○​ Wechsler Adult Intelligence Scale (WAIS): A widely used intelligence test designed to
measure cognitive ability in adults and older adolescents.
○​ Stanford-Binet Intelligence Test: An intelligence test used to measure cognitive abilities,
originally developed to assess children’s intellectual functioning.
●​ Neuropsychological Tests: specialized assessments designed to evaluate cognitive functioning
and brain performance.
○​ Beck Depression Inventory, Anxiety Inventory, and Hopelessness Scale: A series of
self-report assessments designed to measure the severity of depression, anxiety, and
feelings of hopelessness.
○​ Bender Visual Motor Gestalt (BVMG) Test: A psychological assessment used to evaluate
visual-motor functioning, developmental disorders, and neurological impairments.
○​ Boston Diagnostic Aphasia Examination: A test designed to assess language skills and
cognitive abilities in individuals with suspected aphasia or other language impairments.

B. Goals of Clinical Assessment

●​ Diagnosis: Matching symptoms with established mental disorders (DSM-5, ICD-10).

●​ Prognosis: Predicting the course of the mental health condition.
●​ Treatment Planning: Developing interventions tailored to the patient’s needs.
●​ Understanding the Individual: Exploring the individual’s background, strengths, and weaknesses.
●​ Predicting Behavior: Anticipating potential risks and behaviors.
●​ Evaluating Treatment Outcomes: Assessing therapy effectiveness.
C. Clinical Judgement and Decision Making

●​ Objective Judgement: Based on measurable data.

●​ Subjective Judgement: Influenced by clinician experience and intuition.

D. Factors Affecting Assessment Choices

●​ Children & School-Based Assessments

○​ Physical, cognitive, and emotional development
○​ Family and school environment
●​ Adult & Older Adult Assessments
○​ Sensory, cognitive, and environmental influences
○​ Medical conditions
○​ Clinician bias

E. Communicating Assessment Results

●​ Must be clear and understandable to the client.

●​ Should include diagnostic conclusions, treatment recommendations, and explanations of test
results.
●​ Helps clients make informed decisions about their mental health.

F. Ethical Considerations in Assessment

●​ APA Ethical Codes:

○​ Principle A: Beneficence and Non-Maleficence (Do no harm)
○​ Principle B: Fidelity (loyal) and Responsibility
○​ Principle C: Integrity
○​ Principle D: Justice
○​ Principle E: Respect for People’s Rights and Dignity
●​ Common Ethical Issues:
○​ Client Welfare: Protecting vulnerable individuals.
○​ Informed Consent: Clients should understand the purpose, process, and implications of
assessments.
○​ Confidentiality: Safeguarding personal data.
○​ Competence: Clinicians must be adequately trained.

G. Etiology of Abnormal Behavior & Mental Illness

●​ Diathesis-Stress Model:
○​ Diathesis (Predisposition or individual's inherent vulnerability or biological, genetic, or
psychological susceptibility) + Stress (Environmental Trigger) = Mental Disorder

H. Diagnosis & Classification of Mental Disorders

1. History of Diagnosis

●​ Hippocrates (460-377 BCE): Imbalance of bodily fluids.

●​ 19th Century - Philippe Pinel: Categorized melancholia, mania, and dementia.
●​ 1900s - Emil Kraepelin: Introduced manic-depressive psychosis and dementia praecox.
2. Development of DSM

●​ DSM-I (1952): 106 disorders, categorized into psychoses, neuroses, and character disorders.
●​ DSM-II (1968): Expanded to 182 disorders.
●​ DSM-III (1980) & Later Editions:
○​ Introduced multiaxial system
○​ Axis I: Clinical Disorders
○​ Axis II: Personality Disorders & Mental Retardation
○​ Axis III: General Medical Conditions
○​ Axis IV: Psychosocial & Environmental Factors
○​ Axis V: Global Assessment of Functioning (GAF)
●​ DSM-5 (2013):
○​ Eliminated the multiaxial system.
○​ Expanded disorder categories.
○​ Added Premenstrual Dysphoric Disorder, Disruptive Mood Dysregulation Disorder,
Binge Eating Disorder, etc.
●​ DSM-5-TR (Text Revision, 2022):
○​ Clarifications and diagnostic updates.
○​ Added Prolonged Grief Disorder.
○​ ICD-10-CM codes for suicidal behavior & non-suicidal self-injury.

I. Treatment of Psychological Disorders

●​ Psychotherapy Approaches:
○​ Cognitive-Behavioral Therapy (CBT)
○​ Psychodynamic Therapy
○​ Humanistic Therapy
○​ Behavioral Therapy
●​ Medical & Biological Treatments:
○​ Medication (Antidepressants, Antipsychotics, Mood Stabilizers)
○​ Electroconvulsive Therapy (ECT)
○​ Neurosurgery for Mental Disorders (Rare Cases)
●​ Holistic & Alternative Therapies:
○​ Mindfulness-Based Therapies
○​ Lifestyle Changes
○​ Social Support & Community Programs

Lesson 3: Anxiety Disorders and Their Symptoms

●​ Fear: Emotional response to real or perceived threats.

●​ Anxiety: Subjective feeling of fear and uneasiness due to an unknown threat or internal conflict.
●​ Anxiety disorders involve excessive fear and anxiety, often overestimating danger in situations.
●​ Many develop in childhood and persist if untreated.

A. When is Anxiety Considered Abnormal?

Anxiety is normal, but it becomes pathological if:

1.​ It is excessive or persists beyond the developmentally appropriate period.

2.​ It is disproportionate to the situation.
3.​ It interferes with social, occupational, or daily functioning.
B. Classification of Anxiety Disorders

1.​ Social Anxiety Disorder (Social Phobia)

2.​ Specific Phobia
3.​ Panic Disorder
4.​ Agoraphobia
5.​ Generalized Anxiety Disorder (GAD)
6.​ Selective Mutism
7.​ Separation Anxiety Disorder

C. Etiological Theories for Anxiety Disorders

1. Biological Theories

●​ Genetics: Higher risk if a first-degree relative has an anxiety disorder.

●​ Neuroanatomy: Increased sympathetic activity, slow adaptation to stimuli, and exaggerated
response.

2. Psychoanalytic Theory (Freud)

●​ Anxiety results from the ego’s inability to resolve conflicts between the id and ego.
●​ If repression fails, other defense mechanisms (conversion, displacement, regression) develop
neurotic symptoms.

3. Cognitive-Behavioral Theory

●​ Anxiety results from faulty cognitions.

●​ People with anxiety disorders overestimate danger and underestimate coping abilities.

4. Behavioral Theory

●​ Anxiety is a learned response to stimuli.

●​ Example: A person gets sick from contaminated food and starts fearing all restaurant food.
●​ Social Learning: Anxiety can be learned by observing others.

D. Psychological Factors

●​ Disturbed mother-child relationship

●​ Object loss theory
●​ Stressful life events
●​ Childhood abuse or neglect
●​ Overprotective parents
●​ Family environment

E. Symptoms of Anxiety

1. Physical Symptoms

●​ Dry mouth
●​ Palpitations
●​ Restlessness, tremors
●​ Muscle tension
●​ Breathlessness
●​ Tightness in chest and Excessive thirst
2. Psychological Symptoms

●​ Withdrawal
●​ Irritability
●​ Insomnia
●​ Apathy
●​ Feeling worthless
●​ Inability to concentrate
●​ Fear of losing control

F. Types of Anxiety Disorders

1. Separation Anxiety Disorder

●​ Fear of losing/separating from attachment figures.

●​ Symptoms: Nightmares, physical distress, temper tantrums, excessive worry.

2. Selective Mutism

●​ Inability to speak in social settings despite speaking in other situations.

●​ Symptoms: Shyness, social isolation, fear of embarrassment.

3. Social Anxiety Disorder (Social Phobia)

●​ Fear of social scrutiny, leading to avoidance of social situations.

●​ Symptoms: Fear of meeting new people, fear of public speaking, fear of criticism.

4. Specific Phobia

●​ Fear of specific objects or situations (e.g., heights, blood, enclosed spaces).

●​ Exposure triggers immediate panic.

5. Agoraphobia

●​ Fear of situations where escape is difficult (e.g., open spaces, public transport).
●​ Avoidance behavior or enduring situations with intense anxiety.

6. Panic Disorder

●​ Sudden, intense panic attacks with physical symptoms.

●​ Symptoms peak within 10 minutes and subside within an hour.
●​ Symptoms: Chest pain, shortness of breath, fear of dying.

7. Generalized Anxiety Disorder (GAD)

●​ Chronic and excessive worry about everyday situations.

●​ Symptoms persist for at least 6 months.
●​ Symptoms: Muscle tension, restlessness, fatigue, difficulty concentrating, sleep disturbances.
G. Treatment of Anxiety Disorders

1. Medical Management

●​ First-line treatment: SSRIs & SNRIs (e.g., Prozac, Lexapro, Cymbalta, Effexor).
●​ Second-line treatment:
○​ Benzodiazepines (Xanax, Klonopin) for short-term relief.
○​ Buspirone (BuSpar) for chronic anxiety.
○​ Beta-blockers for physical symptoms (e.g., palpitations).
○​ Anticonvulsants for some anxiety disorders.

2. Psychotherapy

●​ Cognitive-Behavioral Therapy (CBT): Replacing negative thoughts with positive ones.

●​ Behavioral Techniques:
○​ Systematic Desensitization (gradual exposure to fears).
○​ Flooding (rapid, intense exposure to fears).
●​ Relaxation Techniques:
○​ Progressive muscle relaxation
○​ Yoga & Meditation
○​ Deep breathing exercises

Final Thoughts

●​ Anxiety disorders are treatable with therapy and medication.

●​ Early intervention is crucial for preventing chronic conditions.
●​ Self-awareness and coping mechanisms can significantly reduce anxiety symptoms.

Lesson 4: Obsessive-Compulsive and Related Disorders

A. Overview of Obsessive-Compulsive Disorder (OCD)

●​ Definition: OCD is characterized by the presence of obsessions (intrusive thoughts, urges, or

images) and/or compulsions (repetitive behaviors or mental acts performed to reduce distress).
●​ Diagnostic Criteria (DSM-5):
○​ A. Obsessions or Compulsions
■​ Obsessions: Recurrent, intrusive thoughts causing distress (e.g., fears of
contamination, harm, or symmetry).
■​ Compulsions: Repetitive behaviors (e.g., washing, checking) or mental acts (e.g.,
counting, praying) aimed at reducing anxiety.
○​ B. Insight: The individual recognizes that obsessions/compulsions are excessive (except in
children).
○​ C. Impairment: Symptoms cause significant distress, take >1 hour/day, or interfere with daily
functioning.
○​ D. Exclusion: Symptoms are not due to another disorder (e.g., eating disorders, depression).
○​ E. Not Substance-Induced: Symptoms are not caused by drugs or medical conditions.
●​ Specifiers:
○​ Insight levels: Good/fair, poor, or absent (delusional).
○​ Tic-related: Presence of a tic disorder (irregular, uncontrollable, and repetitive movements)
B. The OCD Cycle

1.​ Obsessions: Intrusive thoughts/images → anxiety.

2.​ Anxiety: Distress/fear → urge to perform compulsions.
3.​ Compulsions: Behaviors to neutralize anxiety → temporary relief.
4.​ Relief: Short-lived; obsessions return, reinforcing the cycle.

C. Subtypes of Obsessions and Compulsions

●​ Symmetry/Exactness: Need for order, counting, arranging.

●​ Cleaning/Contamination: Excessive washing, fear of germs.
●​ Forbidden Thoughts: Taboo or aggressive thoughts.
●​ Hoarding: Difficulty discarding items.

D. Causal Factors/Etiology

●​ Biological:
○​ Genetic factors (80–87% concordance in identical twins).
○​ Brain abnormalities (overactivity in caudate nucleus, prefrontal cortex).
○​ Role of SPRED2 protein (linked to compulsive behaviors in mice).
●​ Psychological:
○​ Learned behaviors (compulsions reduce anxiety, reinforcing repetition).
○​ Cognitive distortions (e.g., overestimation of threat).
●​ Environmental: Stress, trauma, or hormonal changes may trigger symptoms.

E. Related Disorders

1. Body Dysmorphic Disorder (BDD)

●​ Symptoms: Preoccupation with perceived flaws (often minor or imagined).

●​ Compulsions: Mirror checking, excessive grooming, seeking reassurance.
●​ Specifiers:
○​ Muscle dysmorphia: Belief that one’s body is too small/not muscular enough.
○​ Insight levels: Good/fair, poor, or absent.

2. Hoarding Disorder

●​ Symptoms: Difficulty discarding items, clutter impairing living spaces.

●​ Risks: Social isolation, fire hazards, health issues.
●​ Specifiers: With/without excessive acquisition, insight levels.

3. Trichotillomania (Hair-Pulling Disorder)

●​ Symptoms: Recurrent hair pulling → hair loss.

●​ Gender Bias: More common in females.

4. Excoriation (Skin-Picking) Disorder

●​ Symptoms: Compulsive skin picking → lesions/scarring.

●​ Risks: Infections, shame, social avoidance.
5. Substance/Medication-Induced OCD

●​ Causes: Symptoms emerge due to drug use (e.g., stimulants) or withdrawal.

6. OCD Due to Another Medical Condition

●​ Examples: Autoimmune disorders, brain injuries.

7. Other Specified OCD-Related Disorders

●​ Examples:
○​ Body-focused repetitive behaviors (e.g., nail-biting).
○​ Obsessional jealousy (preoccupation with partner’s infidelity).
○​ Cultural syndromes (e.g., Koro—fear of genital retraction).

F. Gender and Developmental Factors

●​ Males: Earlier onset, more tic-related OCD, symmetry/forbidden thoughts.

●​ Females: More cleaning-related symptoms; postpartum exacerbation.

G. Treatment

1. Psychological Therapies

●​ Cognitive Behavioral Therapy (CBT): Exposure and Response Prevention (ERP) to reduce
compulsions.
●​ Anxiety Management: Relaxation, mindfulness, breathing techniques.
●​ Support Groups: Peer support for coping strategies.

2. Medications

●​ SSRIs (e.g., fluoxetine, sertraline) and clomipramine (TCA).

3. Experimental Treatments

●​ Deep Brain Stimulation (DBS): For severe, treatment-resistant cases.

●​ Electroconvulsive Therapy (ECT): Rare, last-resort option.

H. Key Takeaways

●​ OCD involves a cycle of obsessions → anxiety → compulsions → relief.

●​ Related disorders (BDD, hoarding, trichotillomania) share compulsive features but differ in focus.
●​ Biological, psychological, and environmental factors contribute to etiology.
●​ CBT and SSRIs are first-line treatments; severe cases may require experimental approaches.
Lesson 5: Mood Disorder, Depressive Disorder, and Bipolar Disorder

A. Conceptual Foundations

●​ Mood refers to a sustained internal emotional state, less intense than emotions but longer-lasting.
●​ Affect denotes the outward expression of mood, including tone of voice, facial expressions,
gestures, and posture.

B. Mood Disorders

Mood disorders are classified into two primary categories:

1.​ Depressive Disorders (Unipolar)

2.​ Bipolar Disorders

C. Depressive Disorders

1. Types of Depressive Disorders

1.​ Disruptive Mood Dysregulation Disorder (DMDD)

○​ Characterized by chronic, severe irritability and frequent temper outbursts.
○​ Diagnostic criteria require:
■​ Temper tantrums ≥3 times/week.
■​ Irritable or angry mood between outbursts.
■​ Symptoms must persist for ≥12 months with no symptom-free period longer than 3
months.
2.​ Major Depressive Disorder (MDD)
○​ Defined by a minimum of five (5) of the following symptoms for at least two weeks:
■​ Depressed mood
■​ Anhedonia (loss of interest or pleasure)
■​ Significant weight/appetite changes
■​ Sleep disturbances
■​ Psychomotor agitation or retardation
■​ Fatigue or energy loss
■​ Feelings of worthlessness or guilt
■​ Diminished concentration or decisiveness
■​ Recurrent thoughts of death or suicide
○​ Additional Information:
■​ Lifetime prevalence: 5–20%
■​ Female to male ratio: 2:1
■​ Peak incidence: ages 20–40
3.​ Persistent Depressive Disorder (Dysthymia)
○​ Chronic depressive symptoms for at least 2 years (1 year for youth).
○​ At least two (2) of the following symptoms:
■​ Poor appetite or overeating
■​ Insomnia or hypersomnia
■​ Low self-esteem
■​ Low energy
■​ Difficulty concentrating or decision-making
■​ Feelings of hopelessness
 4.​ Premenstrual Dysphoric Disorder (PMDD)
○​ A severe mood disorder linked to the menstrual cycle.
○​ Criteria:
■​ Five (5) or more symptoms in the week prior to menses.
■​ Symptoms remit shortly after menses onset.
■​ Must cause clinically significant distress or interference in functioning.
■​ Confirmed by prospective ratings over two symptomatic cycles.

D. Etiology of Depressive Disorders

1. Biological Factors

●​ Genetic predisposition (e.g., twin and familial studies).

●​ Neurochemical imbalances (norepinephrine, serotonin).
●​ Dysregulation in the HPA axis.

2. Psychological Factors

●​ Stressful life events

●​ Impaired interpersonal relationships
●​ Cognitive distortions (hopelessness, pessimism)
●​ Hormonal fluctuations

E. Investigations and Diagnostic Tools

1. Routine Laboratory Tests

●​ Complete Blood Count (CBC)

●​ Liver Function Test (LFT)
●​ Thyroid Function Test (TFT)
●​ Glucose level
●​ Calcium level

2. Focused Testing (As Clinically Indicated)

●​ Toxicology screening (urine or blood)

●​ Arterial blood gas (ABG)
●​ Autoimmune screening (ANA, thyroid antibodies)
●​ Infectious disease screening (syphilis serology)

F. Management of Depressive Disorders

1. Hospitalization Criteria

●​ Suicide risk
●​ Danger to others
●​ Severe psychotic symptoms
●​ Severe self-neglect
●​ Comorbid conditions requiring medical intervention
2. Pharmacological Treatment

●​ First-line: Antidepressants
○​ Selective Serotonin Reuptake Inhibitors (SSRIs) – Fluoxetine, Sertraline
○​ Tricyclic Antidepressants (TCAs) – Imipramine, Clomipramine
●​ Second-line: Change drug class or consider augmentation
●​ Electroconvulsive Therapy (ECT) – For treatment-resistant depression, catatonia, severe
suicidality

G. Bipolar Disorders

1. Classification

Disorder Key Features

Bipolar I At least one manic episode; may include depressive episodes

Bipolar II At least one hypomanic episode + one major depressive episode

Cyclothymic Chronic fluctuating mood disturbances with hypomanic and depressive

Disorder symptoms that do not meet full criteria for either

2. Manic and Hypomanic Episodes

●​ Manic Episode Criteria (Bipolar I):

○​ Period of elevated or irritable mood + increased goal-directed activity/energy for ≥1 week.
○​ At least 3 (or 4 if mood is only irritable) of the following:
■​ Grandiosity
■​ Reduced need for sleep
■​ Talkativeness
■​ Flight of ideas
■​ Distractibility
■​ Psychomotor agitation
■​ High-risk activities (e.g., spending sprees, sexual indiscretions)
○​ Causes significant impairment or requires hospitalization.
●​ Hypomanic Episode Criteria (Bipolar II):
○​ Similar to mania but:
■​ Duration: ≥4 consecutive days
■​ Symptoms observable by others
■​ No marked impairment or hospitalization

3. Cyclothymic Disorder

●​ Duration: ≥2 years (≥1 year in youth)

●​ Numerous periods of hypomanic and depressive symptoms that do not meet full diagnostic criteria.
●​ Symptoms present at least half the time with no remission longer than 2 months.

4. Etiology of Bipolar Disorders

●​ Structural and functional brain abnormalities

●​ Genetic predisposition (strong heritability)
●​ Family history
●​ Substance abuse
●​ Environmental stressors
5. Management of Bipolar Disorders

1. Acute Management

●​ Hospitalization (if risk to self/others or severe dysfunction)

●​ Pharmacotherapy:
○​ Mood stabilizers: Lithium, Valproate
○​ Antipsychotics for manic symptoms

2. Maintenance and Prevention

●​ Continued pharmacologic treatment for 4–6 months post-remission

●​ Prophylactic therapy to prevent relapse
●​ Therapeutic alliance and psychoeducation
●​ Family-focused therapy

3. Psychotherapeutic Approaches

●​ Cognitive Behavioral Therapy (CBT)

●​ Interpersonal and Social Rhythm Therapy (IPSRT)
●​ Family therapy
●​ Psychoeducation

H. Summary of Core Differences Between Bipolar I and II

Feature Bipolar I Bipolar II

Manic Episode Present Absent

Hypomanic Episode May occur Required

Major Depressive Episode Often present Required

Psychotic Features Possible Rare

Functional Impairment Severe, often requires hospitalization Less severe

Lesson 6: Dissociative Disorders

A. Overview of Dissociative Disorders

Dissociative disorders involve a disruption in consciousness, memory, identity, emotion, perception,

or behavior, leading to a disconnection from reality. The DSM-5 and ICD-11 classify these disorders into
several types:

1.​ Depersonalization/Derealization Disorder

2.​ Dissociative Amnesia (with or without Dissociative Fugue)
3.​ Dissociative Identity Disorder (DID)
4.​ Other Specified Dissociative Disorder
5.​ Unspecified Dissociative Disorder
B. Key Disorders & Diagnostic Criteria

1. Depersonalization/Derealization Disorder

●​ Core Features:
○​ Depersonalization: Feeling detached from oneself (e.g., "I feel like a robot").
○​ Derealization: Feeling detached from surroundings (e.g., "The world feels unreal").
●​ DSM-5 Criteria (300.6 / ICD-11: 6B66):
○​ Persistent/recurrent experiences of depersonalization/derealization.
○​ Reality testing remains intact (no psychosis).
○​ Symptoms cause significant distress or impairment.
○​ Not due to substances, medical conditions, or other mental disorders.

Differential Diagnosis:

●​ Illness anxiety disorder (no typical dissociative symptoms).

●​ Major depressive disorder (numbness is mood-related, not dissociative).
●​ Psychotic disorders (reality testing is impaired in psychosis).
●​ Substance-induced dissociation (e.g., marijuana, hallucinogens).

Etiology & Prognosis:

●​ Linked to childhood trauma (emotional abuse/neglect).

●​ Onset typically in adolescence (mean age: 16).
●​ Chronic course but no progression to psychosis.

Treatment:

●​ Psychotherapy (CBT, EMDR, DBT).

●​ Meditation/relaxation techniques.
●​ Medications (only for comorbid anxiety/depression).

2. Dissociative Amnesia (DA) & Dissociative Fugue (DF)

●​ Core Features:
○​ Inability to recall autobiographical information (usually trauma-related).
○​ Fugue subtype: Sudden, purposeful travel with amnesia for identity.
●​ DSM-5 Criteria (300.12/13 / ICD-11: 6B61/6B62):
○​ Memory loss inconsistent with normal forgetting.
○​ Causes distress/impairment.
○​ Not due to substances, neurological conditions, or other disorders.

Types of Amnesia:

●​ Localized: Forgets a specific period.

●​ Selective: Remember some parts of an event.
●​ Generalized: Complete loss of identity/life history (rare).
●​ Systematized: Forgets a specific category (e.g., family memories).

Differential Diagnosis:

●​ DID: More complex identity fragmentation.

●​ PTSD: Amnesia limited to trauma.
●​ Neurocognitive disorders: Memory loss is broader (not just autobiographical).
●​ Seizure disorders: EEG abnormalities present.

Etiology & Prognosis:

●​ Triggered by severe trauma (war, abuse, violence).

●​ Memory often returns after removal from trauma.
Treatment:

●​ Psychotherapy (hypnosis, CBT).

●​ Family/creative therapies.

3. Dissociative Identity Disorder (DID)

●​ Core Features:
○​ Two or more distinct identities/personality states.
○​ Recurrent amnesia (gaps in memory, finding unexplained possessions).
●​ DSM-5 Criteria (300.14 / ICD-11: 6B64):
○​ Identity disruption with distinct states.
○​ Amnesia for everyday/traumatic events.
○​ Not part of cultural/religious practices.
○​ Not due to substances or medical conditions.

Differential Diagnosis:

●​ PTSD: No identity fragmentation.

●​ Bipolar disorder: Mood episodes last longer.
●​ Schizophrenia: Hallucinations are external, not identity-based.
●​ Borderline personality disorder: Identity instability is less structured.

Etiology & Prognosis:

●​ Severe childhood trauma (abuse, neglect).

●​ Worse prognosis if abuse is ongoing or treatment is delayed.

Treatment:

●​ Long-term psychotherapy (trauma-focused, DBT, EMDR).

●​ Medications (for comorbid depression/anxiety).

4. Other Specified & Unspecified Dissociative Disorders

●​ Other Specified (DSM-5: 300.15 / ICD-11: F44.89):

○​ Dissociative trance (altered consciousness, unresponsiveness).
○​ Acute dissociative reactions to stress (lasts <1 month).
●​ Unspecified (DSM-5: 300.15 / ICD-11: F44.9):
○​ Symptoms don’t fit any category (e.g., insufficient info in ER settings).

C. Key Takeaways for Review

1.​ Dissociation = Disconnection (memory, identity, perception).

2.​ Depersonalization/Derealization: Detachment from self/reality.
3.​ Dissociative Amnesia: Trauma-related memory gaps.
4.​ DID: Multiple identities + amnesia (linked to severe childhood trauma).
5.​ Treatment: Psychotherapy is primary; meds only for comorbidities.
6.​ Differential Dx: Rule out PTSD, psychosis, substance use, and neurological conditions.

D. Study Tips

●​ Compare and contrast the three main disorders (symptoms, causes, treatment).
●​ Memorize DSM-5 codes for exams.
●​ Focus on differential diagnosis (how to distinguish from PTSD, psychosis, etc.).
●​ Understand the role of trauma in etiology.
Lesson 7: Schizophrenia Spectrum And Other Psychotic Disorders

A. Definition

●​ A group of disorders on a continuum that involve disconnection from reality (psychosis).

●​ This disconnection can include delusions, hallucinations, disorganized thinking, and behavior.
●​ These disorders significantly impair daily functioning (e.g., occupational, academic, social, and
self-care).

B. Types Of Schizophrenia Spectrum & Other Psychotic Disorders

1. Delusional Disorder

●​ Duration: ≥ 1 month.
●​ Types of delusions:
○​ Erotomanic (someone is in love with you)
○​ Grandiose (exaggerated self-importance)
○​ Jealous (partner is unfaithful)
○​ Persecutory (being conspired against)
○​ Somatic (bodily functions/appearance)
○​ Mixed or Unspecified

2. Brief Psychotic Disorder

●​ Sudden onset of ≥ 1 of the following:

○​ Delusions
○​ Hallucinations
○​ Disorganized speech
○​ Disorganized/catatonic behavior

3. Schizophreniform Disorder

●​ Duration: At least 1 month but < 6 months.

●​ Symptoms (≥ 2): Same as schizophrenia.
●​ Must rule out mood disorders and schizoaffective disorder.

4. Schizophrenia

●​ Duration: ≥ 6 months (with 1 month of active-phase symptoms).

●​ Core Symptoms (≥ 2):
○​ Delusions (must have 1 of first 3 symptoms)
○​ Hallucinations
○​ Disorganized speech
○​ Disorganized/catatonic behavior
○​ Negative symptoms (e.g., flat affect)
●​ Must show impaired functioning in major life areas.

5. Schizoaffective Disorder

●​ Combination of schizophrenia symptoms and a major mood episode (depressive or manic).

●​ Must occur during an uninterrupted period of illness.

6. Substance/Medication-Induced Psychotic Disorder

●​ Delusions or hallucinations occur during/soon after substance use or withdrawal.

●​ Substance must be capable of causing psychosis.

7. Psychotic Disorder Due to Another Medical Condition

●​ Prominent hallucinations or delusions due to a medical condition, confirmed by history/lab tests.

8. Catatonia

●​ Must have ≥ 3 of the following:

○​ Stupor, catalepsy, waxy flexibility
○​ Mutism, negativism
○​ Posturing, mannerism, stereotypy
○​ Agitation, grimacing, echolalia, echopraxia

C. Symptoms Of Schizophrenia (3 Stages)

1. Onset (Prodromal Stage)

●​ Early signs:
○​ Anxiety, social withdrawal
○​ Poor self-care
○​ Lack of motivation

2. Active Stage

●​ Severe symptoms:
○​ Delusions, hallucinations
○​ Disorganized speech/movement
○​ Negative symptoms

3. Residual Stage

●​ Mild or lingering symptoms:

○​ Odd beliefs
○​ Low motivation
○​ Blunted affect
○​ Limited speech and pleasure

Other Associated Symptoms

●​ Paranoia
●​ Anosognosia (lack of insight)
●​ Poor hygiene
●​ Depression/anxiety
●​ Suicidal thoughts
●​ Substance use

D. Causes

1. Brain Chemistry

●​ Imbalance in neurotransmitters
●​ Brain development issues from birth

2. Genetics

●​ Family history increases risk

●​ Brain imaging shows structural abnormalities

3. Environmental Factors

●​ Childhood trauma
●​ Chronic or acute stress
E. Risk Factors

●​ Family history of psychosis

●​ Certain infections or autoimmune diseases
●​ Birth complications (e.g., gestational diabetes, low birthweight)
●​ Heavy adolescent drug use (esp. marijuana)

F. Complications (If Untreated)

●​ Suicidal thoughts/behaviors
●​ Depression, anxiety, OCD
●​ Substance abuse
●​ Academic/work failure
●​ Social isolation
●​ Physical illness
●​ Stigma/mistreatment
●​ Possible aggression (rare)

G. Diagnosis

Diagnostic Steps:

1.​ Physical Exam

○​ Rule out medical causes
2.​ Tests and Screenings
○​ Lab work, brain imaging, toxicology
3.​ Psychological Evaluation
○​ In-depth assessment over 1–3 sessions
○​ History taking (family, social, substance, medical, mental)

H. Treatment

1. Medication

●​ First-generation antipsychotics: dopamine blockers

●​ Second-generation antipsychotics: block dopamine & serotonin
●​ Available in pills or injections

2. Psychotherapy

●​ Cognitive Behavioral Therapy (CBT) is effective

●​ Focuses on correcting distorted thinking
●​ Helps with:
○​ Social skills
○​ Hygiene
○​ Self-regulation
●​ May include family therapy, vocational rehab, and supported employment

3. Hospitalization

●​ For severe cases: suicidality, neglect of basic needs

4. Electroconvulsive Therapy (ECT)

●​ For treatment-resistant cases, especially with comorbid depression

KEY CONCEPT: INSIGHT (Anosognosia)

●​ Many individuals with schizophrenia don’t realize they are ill.

●​ This lack of insight fuels paranoia and treatment resistance.
●​ Treatment adherence is critical for successful outcomes.