welcome everyone to uh our second lecture in unit one which focuses on chapter 2 in the last lecture we talked about the difficulty determining what is Normal and abnormal and we were given the four D's to help us make a determination distress dysfunction deviance and dangerousness I just want to add that diagnosis is an inexact science Psychopathology lies on a Continuum with normality that is the line where Behavior becomes abnormal is not always clear psychiatric diagnosis is difficult because it's based on observations of signs and symptoms rather than the underlying pathological processes we don't have a blood test to tell us if someone is depressed or has an anxiety disorder so diagnoses describe symptom clusters or syndromes and not diseases now this unit introduces us to the multipath model because research has shown that disorders are caused by numerous factors and here are the four dimensions of the multipath model and the possible Pathways of influence or possible causes of mental disorders conceptually mental disorders arise from four possible dimensions and from the reciprocal interactions between these factors there can be factors within each Dimension and dental disorder may be the result of influences from more than one of these dimensions and they are biological psychological social and sociocultural psychopathology is complex and as I mentioned diagnosis is an inexact science diagnosis describes syndromes and not underlying pathology we really don't have enough knowledge about the causes or ideology of mental disorders we do need to differentiate between the ups and downs of life or between what Freud called normal human unhappiness and a mental disorder this lecture will explore the dimensions of the multi-path model biological psychological social and sociocultural in this chapter there is a lot of important information on the biological factors that can be involved in mental disorders this information is important to study and thoroughly understand as the brain is composed of neurons and their functioning has a lot to do with mental health or the lack of it it will also help you to better understand how certain medications can help and I hope you'll take some time to view the talk by Thomas insul under video videos in this unit Insel talks about the progress we've made in treating other disorders and argues that we need to better understand mental disorders as brain diseases Insel points out that there are 38,000 suicides in the United States each year and that number has remained steady over the past couple of decades suicide is more common than deaths from traffic accidents and tce tce as common as deaths from homicide 90% of suicides are related to a mental illness and suicide is the third leading cause of death among young people aged 15 to 25 the dsm5 represents a major change in diagnosis and it's added a little complexity as clinicians are adjusting to those changes it has gotten rid of the multi-axial system of diagnosis and simply list diagnoses on a single axis now uh some diagnoses like Aspergers have been eliminated autism and schizophrenia are now considered as Spectrum disorders and hoarding is now a diagnosable mental disorder let's take a peek inside the uh dsm5 which has a complex definition of a mental disorder let me point out a couple of uh aspects of this definition first it's characterized by a clinically significant disturbance which requires some uh clinical judgment and the mental health professional will describe this in the uh assessment or psycho diagnosis secondly uh there's dysfunction thirdly there's significant distress or disability I just want to point out this sentence as well an expectable or cultur approved response to a common stressor or loss is not a mental disorder and this reflects one of the Contemporary Trends in abnormal psychology which we discussed from chapter one and that is the influence of Multicultural psychology the multipath model considers the multitude of factors researchers have confirmed are associated with each disorder it views disorders from a holis IC framework some assumptions of the multipath model include multiple Pathways and influences contribute to the development of any single disorder and not all Dimensions contribute equally there are individual differences and the model is integrative and interactive in other words it is dynamic influences can change over time there are some other important aspects of the multi-path model many disorders tend to be heterogeneous in nature depression for example can be the result of genetics stress and traumatic experiences and substance abuse different combinations within the four dimensions May influence the development of a particular condition within each Dimension distinct theories exist under psychological factors psychoanalysts will have a completely different explanation for a disorder compared to a cognitive behaviorist or an existentialist and we are not all alike or identical so the same triggers or vulnerabilities may cause different disorders let's move on to uh talk about the dimensions of the multipath model starting with Dimension One biological factors in understanding and treating mental disorders it helps to look at brain structures and brain function we know that dysfunction in a particular region of the brain affects people in certain ways now there are a lot of terms in this section to become familiar with so be sure to understand the terminology in the margins of the chapter the text identifies three major divisions of the brain the forbrain the midbrain and the hind brain the forbrain controls all the higher mental functions and these includ include thoughts perceptions intelligence decisionmaking personality and so on the four brain houses the cerebrum which is the largest and most advanced part of the brain the cerebral cortex is also part of the forbrain and it has layers of neurons or nerve cells which transmit information to other parts of the brain and to the body this is the outermost layer of the brain the pre prefrontal cortex is a region of the cerebral cortex which is involved in executive functioning it plays a role in emotions decision-making and memories this area is the last to develop and may explain why adolescence can be impulsive and may not always exercise good judgment the prefrontal cortex keeps our feelings and impulses in check now the limic system is a group of deep brain structures which links our uh emotions to uh memories its uh structures include the amydala hippocampus and Thalamus the lyic system controls our emotional reactions and motivation as well the brain is composed of neurons and we'll take a closer look at these nerve cells in the next slide nerves or uh neurons send information through electrical impulses now here's a diagram of a sending neuron and a receiving neuron at one end of a neuron you see the dendrite which comes from the Greek word meaning Branch or root dendrites are on the cell body and receive information from other neurons this chemical and electrical information is sent along the axon to the axon terminal information is sent from there to the next neuron and its dendrit across a gap called the synapse now here's where it gets interesting information is traveling from top to bottom in this diagram the pre synaptic neuron is at the top synaptic transmission involves the release of a neurotransmitter at the axon terminal this neurotransmitter molecule travels across the synapse where it eventually May bind with a receptor site eventually it is released where it can be taken back in by the sending neuron this is called reuptake now some medications called reuptake Inhibitors block the reuptake leaving more of the neurotransmitter available in the synapse medications called ssris selective serotonin reuptake Inhibitors are used to treat depression and are thought to work by blocking the re-uptake of Serotonin leaving leaving more available for synaptic transmission neuroplasticity is another biological process we used to think that we had a limited number of neurons and when they died or were damaged we had less to work with research has shown us that neurogenesis occurs there can be the birth of new neurons at any point in life neural stem cells have the capacity to generate new neural needed for new skills or experiences here's a photo of human neural stem cells in red neural stem cells are immature neurons researchers are hoping to be able to use stem cells to study and treat mental disorders such as Alzheimer's depression and schizophrenia we know that chronic stress results in negative changes in brain activity and exercise can produce positive changes through altering levels of neurotransmitters and through neurogenesis the biological dimension of the multi-path model also explains mental disorders as being passed on through heredity which is the genetic transmission of traits just because we've inherited a gene for a certain trait doesn't mean it will show up in us there are chemical compounds outside of the genome which control Gene expr expression these compounds determine whether or not genes are turned on or turned off our genetic makeup is called the genotype our genotype interacts with the environment and produces our phenotype which refers to what we observe our physical and behavioral characteristics our genetic characteristics also result from genetic mutations when errors occur in cell reproduction epigenetic is the study of the biochemical activities that occur outside our genes and we are learning how environment can affect gene expression exposure to toxins malnutrition and stress can have an effect another biological factor involves sex differences in brain development differences in size of some brain structures between men and women provide possible explanations the corpor kosum for example which connects uh the two hemispheres of the brain is larger in women compared to men which may explain why men and women use different regions for certain activities males and females are wired differently and different areas of the brain are activated or lit up in research exposing participants to stress the frequency and progression of mental disorders differs disorders involving reactivity to stress are higher among women disorders involving risk-taking are higher among men biology based treatments for mental disorders include psychopharmacology which is the study of effects of psychotropic medications psychotropic medications are prescribed after careful diagnosis there are several medication categories anti-anxiety medications include the benzo dipin such as Xanax and Valium which can be addictive so they have to be prescribed with caution antis psychotics are prescribed to treat symptoms that indicate a break from reality like Visual and auditory hallucinations and paranoid delusions anti-depressants treat symptoms of depression and many increase the availability of neurotransmitters in the synapse many treat both symptoms of depression and anxiety mood stabilizers treat manic episodes and smooth out mood swings under anti-depressants there are several categories there are the selective serotonin reuptake Inhibitors which I previously mentioned there are some older anti-depressant categories uh tricyclic anti-depressants uh aren't used quite as much anymore because of uh the uh side effects associated with these uh medications and MAOI Inhibitors are also available they're an older type of anti-depressant uh they also have some serious side effects sometimes and also individuals on maois uh need to follow a special diet buproprion uh is marketed as Wellbutrin or zyban and it's used to help people quit smoking and it's also used for depression it's uh effective on its own and it's sometimes added though to ssris in cases where the ssris aren't completely effective uh it's believed to work as a norepinephrine and dopamine reuptake inhibitor the important point I want to make here is that medications do not cure mental disorders they do help alleviate symptoms the most effective treatments combine medication with psycho theapy because ideological factors are unclear sometimes people try numerous medications before they find one that works there are some other biological approaches ECT electroconvulsive therapy which involves inducing small seizures with electricity or magnetism may be used but it is reserved for those not responding to other treatments and it's not like it's been protrayed in the movies it uses very low levels of uh electricity which are ad ministered unilaterally only on one side of the brain and not bilaterally also it can be performed on an outpatient basis there are Neurosurgical and brain stimulation treatments psychosurgery which involves removing parts of the brain is very uncommon today and vegus nerve stimulation is very interesting it's a surgical procedure that can be used to treat those with treatment resistant depression it uses a uh pacemaker if you will that's implanted in the body the device is attached to a uh stimulating wire that is threaded along a nerve a cranial nerve called the vagus nerve the vagus nerve travels up the neck to the brain where it connects to areas believed to be involved in regulating mood and once it's implanted the device delivers regular electrical impulses to the Vegas nerve the biological Dimension provides some rather compelling explanations for mental disorders however these explanations alone are one-dimensional and linear they follow the medical model which tells us that once we can identify and eliminate the underlying cause the symptoms will disappear and this overlooks factors outside of the individual science increasingly rejects the idea of one gene for one disease research is indicating that multiple genes are involved in the development of depression for example the dith thesis stress Theory holds that people do not inherit a particular abnormality but rather a predisposition to develop illness we have to consider environmental forces or stressors that may activate the predisposition resulting in a disorder some criticisms of biological models and Therapies include failing to consider an individual's unique circumstances the rapid growth in sale and marketing of psychotropic medications leads us to depend on medications to uh manage symptoms it's also a reflection of our society's Quick Fix attitude sometimes getting better requires hard work and and some time and anytime medications are used we need to be alert to the possibility of drug drug interactions Dimension two of the multipath model looks at psychological explanations for the ideology of mental disorders these explanations vary depending on the theoretical perspective psychodynamic models see abnormal behavior as the result of childhood trauma and unconscious conflicts Sigman Freud developed a model saying that personality was the result of interactions between the id ego and super ego conflicts between these three are largely unconscious and therapy tries to bring these internal conflicts to the surface making them conscious so they can be dealt with the three components of personality the id ego and super ego follow different principles the ID follows the Pleasure Principle the ego is realistic and rational and the super ego is concerned with moral considerations this is where the conscience is personality develops through psychosexual stages Freud proposed that human personality largely developed during the first five years of life if someone is stuck in one of these stages this is called a fixation and this can result in emotional disturbance due to unresolved conflicts related to that stage of development defense mechanisms protect us from anxiety and they operate unconsciously and distort reality traditional psychoanalytic therapy takes a long time and it's not favored by Managed Care some techniques that are used are free association where someone says the first thing that comes to mind this is thought to reveal unconscious conflicts another technique is dream analysis where the therapist interprets the meanings that are HID hidden in dreams the therapist also explores forms of resistance in a client to reveal unconscious conflicts they also look for transference where the client reacts emotionally to the therapist in ways that show unresolved emotions toward significant others a criticism of psychodynamic models is the expert role of the therapist in providing interpretations other criticisms include the need for outcome studies and its failure to address cultural and societal influences on mental health behavioral models are concerned with how we learned certain behaviors classical conditioning explains learning is occurring due to conditioned responses that were paired with unconditioned stimuli this is uh more passive uh automatic learning operant conditioning involves voluntary Behavior and requires an action whether a behavior continues depends on the type of reinforcement that occurred after the behavior be sure that you understand the difference between classical and operant conditioning and study this section of the chapter carefully another type of learning is observational learning which is based on social learning theory this suggests that we can learn Behavior by simply watching others we may then model the behavior of others for example social learning theory says when children are raised by aggressive parents they learn through observation to behave aggressively behavioral therapies include exposure therapy where people are gradually exposed to stimuli that produce anxiety in order to learn new emotional responses systematic desensitization involves having people enter a calm relaxed state and then exposing them to the feared objects or situations a criticism is behaviorist focus on outward behaviors and Overlook internal mental processes cognitive behavioral models focus on both behaviors and cognitions especially how thoughts affect our emotions and behaviors Albert Ellis developed the ABC Theory of Personality where emotions and behavior are seen as the result of irrational thoughts and beliefs rather than being a direct response to the activating event or what happened schemas are identified and pre they're actually preconceived views based on underlying assumptions in therapy these underlying assumptions are disputed and replaced with more rational ones and this is called reframing DBT dialectical behavior therapy is another form of treatment and it's sometimes used to treat borderline personality disorder where therapists reinforce positive behaviors and avoid reinforcement of negative behaviors it is a very structured approach and it includes mindfulness where clients learn to tolerate and accept their negative emotions one criticism of cognitive behavioral models is the therapist's role as the expert and authority figure therapists need to directly point out and attack a client's irrational thoughts and this can intimidate clients humanistic existential models include a set of philosophical attitudes that focus on freedom and a search for meaning in life there's also a focus on personal responsibility for choices and the consequences now there are no specific techniques used but therapy is person centered toward helping individuals uh find and reach their full potential the humanistic perspective has the philosophy that humans are basically good and problems um that occur block an inborn tendency for growth therapists provide environmental conditions such as unconditional positive regard and empathy to Foster personality growth criticisms of this approach include the Reliance on people's individual subject Ive experiences and the model's lack of scientific grounding these models do not explain many mental disorders Dimension three looks at social factors the first two dimensions of the multipath model that I talked about focused on the individual the next two address the social environment and how it can influence the development of mental disorders there are social relational models which have these important assumptions healthy relationships are crucial for human development and functioning because these relationships provide many intangible benefits such as social support love and compassion when relationships are dysfunctional or absent individuals are more vulnerable to mental distress there is the family systems model where the behavior of one family member affects the entire family system system the characteristics of this model is personality development is strongly influenced by Family characteristics mental illness reflects unhealthy family Dynamics and poor communication so therapists must focus on the family system and not just an individual consequently the whole family must be involved in treatment one criticism of family systems models is that uh they can have negative consequences because parental influence may not be a factor in an individual's disorder but the family is burdened with guilt Dimension four looks at sociocultural factors and emphasizes the importance of the following in explaining mental disorders race ethnicity gender sexual orientation religious preference immigration and a Cultura of status and socioeconomic status in an assessment the mental health professional needs to describe these factors as they can affect the expression of mental disorders cultural experiences need to be understood to properly diagnose and treat mental distress we live in an increasingly diverse Society so these factors shouldn't be ignored in society there can be real barriers to healthy growth and development I'll leave it to you to study this section but I'll point out the influence of one of these factors socioeconomic status the influence of socioeconomic class on mental health is often overlooked lower socioeconomic class is often associated with a limited sense of personal control or lower self-efficacy it's also associated with poorer physical health and a higher incidence of depression and hopelessness poverty exposes people to multiple stressors life in poverty includes dealing with low wages unsafe living conditions and a lack of food photojournalist Brenda Anne connley took this picture of Donnie in Troy New York he was suspended four times when he was in kindergarten and for more than 20 days in second grade a number of studies show that children from poor and single parent households are more likely to be suspended and expelled than their middle class peers in conclusion the multi-path model shows us the value of analyzing mental disorders from a variety of perspectives all perspectives have strengths and weaknesses so an integrative or multi-path approach will give us the best picture of what's happening if you'll recall the story of the Seven Blind Men Who were describing an elephant each had a different idea of what an elephant was because each was holding in touching a different part of the elephant it's from a broader perspective that we can truly understand mental disorders evidence-based understanding of mental disorders has evolved and will continue to do so giving us more knowledge about brain activity the diathesis stress theory is still helping us to understand the predisposition to develop illness uh that is inherited and epigenetic research is helping us to understand gene expression cultural Neuroscience is a promising field which is the study of how culture shapes biology and how biology shapes culture this will help clinicians to develop and use treatments that address cultural differences