CURRENT PARADIGMS IN PSYCHOPATHOLOGY Psikologi Abnormal-Kuliah 2.
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Transcript of CURRENT PARADIGMS IN PSYCHOPATHOLOGY Psikologi Abnormal-Kuliah 2.
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CURRENT PARADIGMS IN PSYCHOPATHOLOGY
Psikologi Abnormal-Kuliah 2
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Current Paradigms: Genetic
Heredity plays a role in most behavior Genes
Carriers of genetic information (DNA) Impacted by environmental influences
e.g., stress, relationships, culture Relationship between genes and
environment is bidirectional Nature via nurture (Ridley, 2003)
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Important Genetic Terms
Gene expression Proteins influence whether the action of a
specific gene will occur Polygenic transmission
Multiple gene pairs vs. single gene Heritability
Extent to which variability in behavior is due to genetic factors Heritability estimate ranges from 0.00 to 1.00 Group, rather than, individual indicator
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Environmental Effects
Shared environment Events and experiences that family
members have in common Nonshared environment
Events and experiences that are unique to each family member
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Behavior Genetics
Study of the degree to which genes and environmental factors influence behavior
Genotype Genetic material inherited by an individual Unobservable
Phenotype Expressed genetic material Observable behavior and characteristics Depends on interaction of genotype and
environment
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Current Paradigms: Neuroscience
Examines the contribution of brain structure and function to psychopathology Mental disorders are linked to
aberrant processes in the brain. Four mechanisms:
Neurons and neurotransmitters Brain structure and function Autonomic system Neuroendocrine system
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Figure 2.3 The NeuronBasic Unit of the Nervous System
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Neurons and Neurotransmitters
Neurotransmitter Chemicals that allow
neurons to send a signal across the synapse (gap) to another neuron.
Receptor sites on postsynaptic neuron absorb neurotransmitter Excitatory Inhibitory
Reuptake Reabsorption of leftover
neurotransmitter by presynaptic neuron
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Neurotransmitters and Psychopathology
Serotonin and dopamine Depression, mania, and schizophrenia
Norepinephrine Anxiety and other stress related disorders
Gamma-Aminobutyric Acid (GABA) Anxiety
Possible mechanisms Excessive or inadequate levels Insufficient reuptake Excessive number or sensitivity of postsynaptic
receptors
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Figure 2.5 The Process by which a Second Messenger is Released
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Figure 2.6 Brain Structure and Function
Sulci define regions or lobes: Frontal Parietal Temporal Occipital
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Autonomic Nervous System (ANS) Sympathetic Nervous System
Excitatory Heartbeat acceleration, pupil dilation,
gastrointestinal inhibition, electrodermal activity increases
Parasympathetic Nervous System Quiescent Heartbeat deceleration, pupil constriction,
gastrointestinal activation Involved in anxiety disorders, especially
Panic and PTSD
Copyright 2009 John Wiley & Sons, NY
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Neuroscience and Treatment
Psychoactive drugs alter neurotransmitter activity Antidepressants Antipsychotics Benzodiazepenes
A neuroscience view does not preclude psychological interventions
Copyright 2009 John Wiley & Sons, NY
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Evaluating the Neuroscience Paradigm Reductionism
View that behavior can best be understand by reducing it to its basic biological components Ignores more complex views of behavior
Copyright 2009 John Wiley & Sons, NY
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Current Paradigms: Psychodynamic
Fails to contribute to our empirical understanding of the causes of psychopathology Greatest contribution are in treatment
Copyright 2009 John Wiley & Sons, NY
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Role of the Unconscious
Contemporary theorists have attempted to study the unconscious scientifically Pathogenic beliefs
Beliefs that occur outside of conscious awareness Trigger maladaptive thoughts and emotions
Implicit memory Cognitive neuroscience paradigm
The unconscious may reflect efficient information processing rather than a repository for troubling material
Copyright 2009 John Wiley & Sons, NY
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Importance of Interpersonal Relationships Object relations theory
Longstanding patterns of relating to others Attachment theory
Type and style of infant’s attachment to caregivers can influence later psychological functioning.
Relational self Individuals will describe themselves
differently depending upon which close relationships are told to think about (Chen et al., 2006)
Copyright 2009 John Wiley & Sons, NY
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Neuroscience and Treatment
Psychoactive drugs alter neurotransmitter activity Antidepressants Antipsychotics Benzodiazepenes
A neuroscience view does not preclude psychological interventions
Copyright 2009 John Wiley & Sons, NY
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Evaluating the Neuroscience Paradigm Reductionism
View that behavior can best be understand by reducing it to its basic biological components Ignores more complex views of behavior
Copyright 2009 John Wiley & Sons, NY
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Current Paradigms: Psychodynamic
Fails to contribute to our empirical understanding of the causes of psychopathology Greatest contribution are in treatment
Copyright 2009 John Wiley & Sons, NY
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Role of the Unconscious
Contemporary theorists have attempted to study the unconscious scientifically Pathogenic beliefs
Beliefs that occur outside of conscious awareness Trigger maladaptive thoughts and emotions
Implicit memory Cognitive neuroscience paradigm
The unconscious may reflect efficient information processing rather than a repository for troubling material
Copyright 2009 John Wiley & Sons, NY
21
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Importance of Interpersonal Relationships Object relations theory
Longstanding patterns of relating to others Attachment theory
Type and style of infant’s attachment to caregivers can influence later psychological functioning.
Relational self Individuals will describe themselves
differently depending upon which close relationships are told to think about (Chen et al., 2006)
Copyright 2009 John Wiley & Sons, NY
22
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Factors Common to Paradigms
Emotion Components
Expressive Experiential Physiological
Most psychopathology includes disturbances of one or more component e.g., flat affect in schizophrenia
Cultural factors influence ideal affect (Tsai, 2007)
Copyright 2009 John Wiley & Sons, NY
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Factors Common to Paradigms
Sociocultural Factors Culture, ethnicity, gender, & social
relationships May increase vulnerability to
psychopathology e.g., women more likely to experience depression
than men May also serve as a buffer
e.g., social support Some disorders specific to certain cultures
Hikikomori in Japanese culture
Copyright 2009 John Wiley & Sons, NY
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Table 2.2 Lifetime Prevalence Rates of DSM-IV-TR Disorders among Different Ethnic Groups
Copyright 2009 John Wiley & Sons, NY
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Diathesis-Stress
Integrative model that incorporates multiple causal factors (Zubin & Spring, 1977)
Diathesis Underlying predisposition
May be biological or psychological Increases one’s risk of developing disorder
Stress Environmental events
May occur at any point after conception Triggering event
Psychopathology unlikely to result from one single factor
Copyright 2009 John Wiley & Sons, NY
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Diagnosis Multiaksial
DSM (Diagnostic and Statistical Manual of Mental Disorder) published by American Psychiatric Association (APA)
In Indonesia, mental disorder diagnosis classify in PPDGJ (Pedoman Penggolongan dan Diagnostik Gangguan Jiwa) based on DSM and ICD (International Classification of Diseases) published by WHO
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Diagnosis Multiaxial
Classification in DSM (1994) are description, atheoretical, and multiaxial more comprehensif (Millon & Davis, 2000)
DSM-IV-TR includes five axes = multiaxial classification system, by requiring judgements on each of the five axes, forces the diagnostician to consider a broad range of information
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5 Axes in DSM-IV-TR Axes I:
Clinical Disorder Other conditions that may be a focus of clinical
attention Axes II:
Personality Disorder Mental Retardation
Axes III: General Medical Condition Axes IV: Psychosocial and environmental
problems Axes V: Global Assesment of Functioning
(GAF) Scale
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GAF Scale
Consider psychological, social, and occupational functioning on a hypothetical continuum of mental heal/illness. Do not include impairment in functioning due to physical (or environment) limitations.
0 : Inadequate information1-10 : Persistent danger of severely hurting self
or others/ persistent inability to maintain minimal personal hygiene
51-60 : moderate symptoms/moderate difficulty in social, occupational, or school functioning
91-100: No symptoms, superior functioning in a wide range of activities
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Diagnosis Multiaxial
Axes I : (296.23) Severe major depression, without psychotic feature
Axes II : (301.6) Personality disorder, defence mechanism denial
Axes III : noneAxess IV : Occupational ProblemAxes V : GAF=35 (current)
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Current issues related to DSM-V Disorder that might include in DSM-V
Behavioral Addiction Definition: excessive use sex, shopping, or
computers may signal addiction. These behavior can be taken to such extremes that they easily mimic the behaviors of drug addicts.
Binge Eating Disorder Definition: individuals who binge are unable to
control periods of overeating and feel guilty or disgusted with themselves. They often become obese. Some eat alone to avoid feelings of shame.
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Complicated Grief Definition: after the death of someone
close, grief and sadness normally begin to dissipate within six months. But some people continue to mourn for much longer.
Current issues related to DSM-V
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Disorder that might exclude in DSM-V The Paraphilia: Intense sexual urges involving
animals, children, nonconsensual sex, suffering, or humiliation are classified as paraphilias – a term that was thought to be relatively non judgmental when it replaced “perversions” in 1980.
Gender Identity Disorder: Since the DSM-III appeared in 1980, individual who wish to be of the opposite sex-and who are uncomfortable with their own-have been diagnosed with Gender Identity Disorder.
Current issues related to DSM-V