Clinical psychology

> Branch of psychology that deals with the assessment, diagnosis and treatment of mental health disorders and emotional issues

Assessment

• Clinical psychologists use a variety of assessment tools and techniques to evaluate individuals' mental health and functioning
  - interviews, psychological tests and behavioral observations

Diagnosis

• After a thorough assessment, mental health disorders are diagnosed based on criteria from Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

• Accurate diagnosis is crucial for developing appropriate treatment plans

• It is good to avoid diagnosing if it is possible because of:

1. Stigmatization: people may be labeled, discriminated against or face misconceptions and prejudices from others based on their diagnosis

2. Overpathologizing Normal Behavior: overpathologizing everyday behaviors or emotional states can lead to unnecessary medicalization and treatment

3. Self-Fulfilling Prophecy: diagnosis can influence a person's self-perception and behavior

4. Impact on Insurance and Employment: some diagnoses can affect an individual's access to health insurance and employment opportunities

5. Psychological Well-Being: unnecessary diagnoses can create anxiety and distress for individuals who may believe they have a mental health disorder when they do not

Diagnosis Process

1. Description of symptoms

2. Medical history

3. Etiology (causes)

4. Differential diagnostic thinking

5. Diagnosis

6. Treatment selection

7. Assessment of success

8. Outcome prediction

Psychopathology 

• Involves examining the nature, causes and symptoms of various psychological disorders

• Psychopathologists seek to understand how mental disorders develop and manifest in individuals

Etiology: causes of mental disorders, which can be biological (genetic, neurological), psychological (trauma, stress, personality factors) or social (environmental factors, cultural influences)

Classification: mental disorders are categorized and classified in systems like the DSM-5 to provide a common framework for diagnosis and treatment planning

Assessment: standardized assessment tools to evaluate the severity and impact of mental disorders
-sorces of information: Interview, observing, heteroanamnesis, lifestyle (documents from job,hospitals...), tests

Anxiety Disorders

Anxiety

• Normal and often adaptive emotion that can help us respond to threats and dangers

• When anxiety becomes excessive, uncontrollablea and persistent, it can interfere with daily life and well-being

• Anxiety disorders are a group of mental health conditions characterized by intense, excessive, and often irrational worry or fear about everyday situations

Common Characteristics:

1. Physical symptoms such as rapid heartbeat, trembling, sweating and muscle tension

2. Avoidance of situations or objects that trigger anxiety

3. Difficulty concentrating or making decisions

4. Restlessness and irritability

5. Sleep disturbances

*Generalized Anxiety Disorder (GAD): 

• Characterized by excessive worry and anxiety about various aspects of life

• Often accompanied by physical symptoms like restlessness, muscle tension and sleep disturbances.

*Panic Disorder: 

• Involves recurrent, unexpected panic attacks, which are sudden episodes of intense fear or discomfort- often develop avoidance behaviors

*Social Anxiety Disorder: 

• Marked by an intense fear of social situations and scrutiny by others- may avoid social interactions or endure them with significant distress

*Specific Phobias: 

• Intense, irrational fears of specific objects or situations, such as heights (acrophobia), spiders (arachnophobia) or flying (aviophobia)

*Agoraphobia: Fear of situations or places where escape might be difficult or embarrassing, often leading to avoidance of crowded or open spaces

*Separation Anxiety Disorder: 

• Often seen in children

• Involves extreme fear or anxiety about separation from caregivers or loved ones

*Selective Mutism: 

• Most commonly seen in children

• Involves an inability to speak in certain social situations, despite speaking in other settings

*Substance-Induced Anxiety Disorder: Anxiety symptoms triggered by substance abuse or withdrawal

Mood Disorders

Depression

-Characteristic Cognitive Schema:

1. Negative interpretation of the past, present and future

2. Pronounced underestimation and pessimism

3. Cognitive distortions

4. Negative view of oneself, the world and the future

5. Automatic Thoughts: Immediate interpretation, first thoughts, not always accurate

Causes: predisposition,aversive events, depressive cognitive style and feelings of hopelessness

*Major Depressive Disorder (MDD): 

• Characterized by persistent feelings of sadness, hopelessness and a loss of interest or pleasure in daily activities

• Physical symptoms like changes in sleep and appetite may also occur

*Persistent Depressive Disorder (PDD): 

• Chronic, long-term form of depression, where symptoms persist for at least two years

• Tends to be less severe than MDD but can significantly impact daily functioning

*Postpartum Depression: 

• Occurs in some women after childbirth and is characterized by symptoms like sadness, anxiety and exhaustion

• It can affect the mother's ability to care for herself and her baby

Bipolar Disorders

*Bipolar Disorder: 

• Involves cycles of depressive episodes (similar to MDD) alternating with periods of mania or hypomania, which are characterized by elevated mood, increased energy, and impulsive behavior

• Type I and II:
  -Bipolar I requires at least one manic episode, while Bipolar II involves hypomanic episodes (a milder form of mania) and depressive episodes
  -Some people with Bipolar I may experience psychotic symptoms during manic episodes

*Cyclothymic Disorder:

• Similar to bipolar disorder, but milder

• Involves cycles of mild depression and hypomania that are less severe and shorter in duration

Psychotic Disorders

*Schizophrenia:  

• Characterized by distorted thinking, hallucinations, delusions, disorganized speech and behavior and impaired social functioning

• 4A's
  Associative Looseness: disorganized thinking and speech
  Affect Disturbances:  inappropriate or flattened emotions
  Ambivalence: conflicting feelings or attitudes towards a particular idea, person, or situation
  Autism: In this context, an inward focus on one's own thoughts and experiences rather than engagement with the external world

• Positive Symptoms: involve an excess or distortion of normal functions
  -hallucinations (false sensory perceptions, often auditory), delusions (false beliefs), disorganized thinking and speech and disorganized or abnormal motor behavior

• Negative Symptoms: involve deficits in normal functions
  -lack of motivation (avolition), reduced emotional expression (affective flattening), social withdrawal and difficulty initiating and sustaining activities.

• Cognitive Symptoms: problems with attention, memory and executive functions (e.g., planning, organizing)

Treatment:

1. Antipsychotic Medications: help alleviate positive symptoms but may have limited effectiveness on negative and cognitive symptoms

2. Psychosocial Interventions: therapy and support to improve functioning, address social skills deficits and enhance coping

3. Hospitalization: in severe cases or during acute episodes, hospitalization may be necessary for safety and stabilization

• Chronic condition that requires ongoing treatment and support

• With proper care, many individuals with schizophrenia can lead fulfilling lives and manage their symptoms effectively

*Schizoaffective Disorder: 

• Combines symptoms of schizophrenia with symptoms of a mood disorder, such as major depressive disorder or bipolar disorder

• Individuals with schizoaffective disorder experience periods of psychosis along with significant mood disturbances

*Brief Psychotic Disorder: 

• Short-term psychotic disorder where individuals experience sudden and brief episodes of psychosis

• The symptoms typically last less than a month and may be triggered by stress or trauma

*Delusional Disorder: 

• One or more fixed, false beliefs (delusions) that persist for at least one month

• These beliefs are not bizarre like those seen in schizophrenia but are still firmly held despite evidence to the contrary

*Shared Psychotic Disorder (Folie à Deux):

• Rare condition where an individual develops delusions as a result of close contact with someone who already has a psychotic disorder, often a family member

*Schizophreniform Disorder: 

• Similar to schizophrenia but with a shorter duration of symptoms

• Diagnosed when symptoms persist for at least one month but less than six months

Eating Disorders

• Anorexia Nervosa: Involves an extreme preoccupation with weight and body shape, leading to severe restriction of food intake and often excessive exercise

• Bulimia Nervosa: Marked by recurrent episodes of binge eating followed by behaviors to compensate, such as self-induced vomiting or excessive exercise

Personality Disorders

• Characterized by enduring patterns of behavior, cognition and inner experience that deviate markedly from the expectations of the individual's culture

• These patterns are pervasive, inflexible, and typically lead to distress or impairment in various areas of life

• Criteria A- funcionality in different spheres

SELF- Identity (Self-experience and boundaries with others) Self direction (goals, norms)

INTERPERSONAL - Empathy (understanding emotions, tolerance...) Intimacy (relationship duration, closeness)

*Borderline Personality Disorder (BPD):

• A pervasive pattern of instability in interpersonal relationships, self-image, affect

• Impulsive and sensitive

• Lack in understanding of emotions

• Conflicts: idealisation and distrust

*Antisocial Personality Disorder (ASPD):

• A pervasive pattern of disregard for the rights of others, with associated behaviors such as deceitfulness, impulsivity, irritabilityrisk taking and aggression

• Characterized by lack of empathy or remorse

*Narcissistic Personality Disorder (NPD):

• A pervasive pattern of grandiosity (in fantasy or behavior), a need for admiration and a lack of empathy

• Lack of deeper connection

*Avoidant Personality Disorder (AvPD):

• A pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation

*Obsessive-Compulsive Personality Disorder (OCPD):

• A pervasive pattern of preoccupation with orderliness, perfectionism and control, often at the expense of flexibility and openness

• People with OCPD may have perfectionistic tendencies and difficulty delegating tasks

*Schizotypal Personality Disorder:

• A pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships, as well as cognitive and perceptual distortions.

Obsessive-Compulsive and Related Disorders

*Obsessive-Compulsive Disorder (OCD):

• Features intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) aimed at reducing anxiety

Treatment:

1. Exposure and Response Prevention (ERP): individuals gradually confront their obsessions (the distressing thoughts, images, or urges) without engaging in the associated compulsive behaviors (the repetitive actions or mental acts)

2. Cognitive Restructuring: identifying and challenging irrational or distressing thoughts associated with OCD

3. Mindfulness-Based Cognitive Therapy (MBCT): helps individuals develop a non-judgmental awareness of their obsessions and compulsions

4. Support Groups: can provide emotional support and an opportunity to share experiences with others who have the condition

5. Lifestyle Modifications: healthy lifestyle choices, such as regular exercise, balanced nutrition and stress reduction techniques, can complement treatment efforts

6. Education: can empower individuals and their families to better manage the condition

*Hoarding Disorder :

• Involves an excessive accumulation of possessions and difficulty parting with them, leading to clutter and impairment in living spaces

*Body Dysmorphic Disorder (BDD):

• Individuals with BDD are preoccupied with perceived flaws or defects in their physical appearance, which are often not noticeable to others

• This obsession can lead to compulsive behaviors such as excessive grooming, mirror-checking or seeking cosmetic procedures.

*Trichotillomania (Hair-Pulling Disorder): 

• Irresistible urge to pull out their own hair from various parts of the body, including the scalp, eyebrows, and eyelashes

• This behavior is often driven by anxiety and can result in noticeable hair loss

*Excoriation (Skin-Picking) Disorder: 

• Also known as dermatillomania,involves compulsive skin picking that leads to tissue damage

• Individuals with this disorder often pick at acne, scabs or other minor skin irregularities

*Illness Anxiety Disorder (formerly Hypochondriasis): 

• Intense anxiety about having a serious medical condition despite having no or only mild symptoms

• They may excessively seek medical tests and reassurance from healthcare providers

Trauma and Stressor-Related Disorders

*Post-Traumatic Stress Disorder (PTSD): 

• Occurs after exposure to a traumatic event and involves symptoms like intrusive memories (flashbacks), avoidance, negative changes in mood and heightened arousal (irritability, difficulty sleeping)

• Nightmares, severe anxiety and emotional distress triggered by reminders of the trauma

*Acute Stress Disorder (ASD): 

• Similar to PTSD but with a shorter duration of symptoms (lasting three days to four weeks) following a traumatic event

*Adjustment Disorder: 

• Occurs in response to a specific life stressor, such as divorce, job loss or a medical diagnosis

• Involves emotional and behavioral symptoms that are out of proportion to the stressor and often resolve when the stressor is removed

*Reactive Attachment Disorder (RAD): 

• Typically diagnosed in children, RAD results from neglect or insufficient care during early childhood

• It can lead to difficulties forming attachments and emotional regulation

*Disinhibited Social Engagement Disorder: 

• Another childhood disorder stemming from neglect or limited caregiving

• Characterized by overly familiar and indiscriminate behavior toward strangers

Dissociative Disorders

• individuals experience a disconnection between their thoughts, identity, consciousness and memory

*Dissociative Identity Disorder (DID):

• Formerly known as Multiple Personality Disorder

• Individuals with DID have two or more distinct personality states or identities that take control of their consciousness and behavior

• These "alters" may have unique names, personalities and memories

• The condition is typically associated with a history of severe trauma, often involving childhood abuse

*Dissociative Amnesia:

• Characterized by significant gaps in memory for personal information, events or periods of time

• The memory loss is not due to a medical condition or substance use and is often related to trauma or extreme stress

*Depersonalization-Derealization Disorder:

• Involves feeling disconnected or detached from one's own body or thoughts- may feel as though they are watching themselves from outside their bodies

• Derealization is a sense of unreality or detachment from the external world- may perceive their surroundings as foggy, dreamlike or artificial

• Can be chronic or episodic and may occur in response to stress

Neurodevelopmental Disorders

*Attention-Deficit/Hyperactivity Disorder (ADHD): 

• Characterized by symptoms of inattention, hyperactivity and impulsivity, which can persist into adulthood

*Autism Spectrum Disorder (ASD): 

• Involves challenges in social communication and the presence of restricted interests and repetitive behaviors

• People with ASD often have unique strengths, such as attention to detail, a strong memory and a deep knowledge of specific topics, but may also face challenges in areas like social interactions and sensory sensitivities (More about autism on next subpage)

Substance-Related and Addictive Disorders

*Substance Use Disorders:

• Include disorders related to the misuse of substances like alcohol, drugs or prescription medications, leading to negative consequences

WHENEVER PSYCHOLOGIST/PSYCHIATRIST WORKS ON DIAGNOSIS THEY HAVE TO MAKE SURE :

-THERE ARE NO SOMATIC SOURCES OF DISORDER

-IT CANNOT BE EXPLAINED BY OTHER DEFICITS

-IT CANNOT BE EXPLAINED BY CURRENT SITUATION PERSON IS IN

-IT CANNOT BE EXPLAINED BY UPBRING OR CULTURE OR OTHER DIFFERENCES