BEHAVIORAL
DISORDERS
PSY4062
Mélanie Faltz
2018-2019
,Table of contents
TASK 1: Dichotomy vs continuum ....................................................................................................... 3
1. Diagnostic criteria of psychosis ......................................................................................................... 4
2. Diagnosis of psychosis on continuum vs categorical ........................................................................ 4
3. Pros and cons of a dichotomy and a continuum .............................................................................. 5
4. Auditory hallucinations: clinical/non-clinical .................................................................................... 6
Article notes .............................................................................................................................................. 7
TASK 2: Brain and behavioral development ...................................................................................... 10
1. Pattern of behavioral development................................................................................................ 11
2. Brain development throughout life ................................................................................................ 12
3. Brain development and TBI: behavioral consequences.................................................................. 13
4. A damaged brain is more vulnerable to developmental/psychiatric problems. ............................ 15
TASK 3: Autism ................................................................................................................................ 17
1. Autism diagnosis criteria according to DSM-5 ................................................................................ 18
2. Theoretical models of autism ......................................................................................................... 19
3. Brain neurologically affected by autism ......................................................................................... 28
TASK 4: Attention-deficit/hyperactivity disorder .............................................................................. 30
1. Core symptoms of ADHD ................................................................................................................ 31
2. Development of ADHD .................................................................................................................... 32
3. Which theories about ADHD exist?................................................................................................. 34
4. Biological underpinnings of ADHD .................................................................................................. 37
TASK 5: Adolescence, a sensitive period?.......................................................................................... 39
1. Proneness to psychiatric disorders throughout adolescence ......................................................... 40
2. Vulnerability of adolescents to psychiatric disorders ..................................................................... 42
3. Risk factors for substance abuse..................................................................................................... 44
TASK 6: Obsessive-compulsive disorder ............................................................................................ 47
1. OCD diagnosis criteria (DSM-5)....................................................................................................... 48
2. Etiology of OCD: How it develops and why?................................................................................... 49
3. Different theories about OCD ......................................................................................................... 51
TASK 7: Anxiety Disorders ................................................................................................................ 54
1. Most common anxiety disorders .................................................................................................... 55
2. Brain areas implicated in anxiety and fear ..................................................................................... 55
3. Distinction between anxiety and fear ............................................................................................. 57
4. Difference between shyness and social anxiety? ........................................................................... 60
TASK 8: Depression .......................................................................................................................... 62
1. Diagnostic criteria for depression (DSM-5)..................................................................................... 63
1
, 2. Bio-psycho-social model of depression .......................................................................................... 63
3. Beck’s model of depression and its limitations .............................................................................. 65
4. Risk factors and prevention of depression ..................................................................................... 69
5. Putative beneficial effects of mild to moderate depression .......................................................... 69
TASK 9: Schizophrenia...................................................................................................................... 76
1. Diagnostic criteria for schizophrenia according to DSM-5 ............................................................. 77
2. Environmental causes of schizophrenia ......................................................................................... 78
3. Dopamine and glutamate in schizophrenia .................................................................................... 79
4. Neurodevelopmental model ........................................................................................................... 82
2
,TASK 1: Dichotomy vs continuum
LEARNING GOALS
1. How is a brief psychotic disorder diagnosed, according to the DSM-V criteria?
2. How is a psychosis diagnoses on a continuum vs a dichotomy?
3. What are the pros and cons of both applications?
4. How do you distinguish between clinical/non-clinical in auditory hallucinations?
LITERATURE
• De Leede-Smith, S. & Barkus, E. (2013). A comprehensive review of auditory verbal hallucinations:
lifetime prevalence, correlates and mechanisms in healthy and clinical individuals. Frontiers in human
neuroscience, 7, 367 (1-25).
• Hyman, S. E. (2007). Can neuroscience be integrated into the DSM-V? Nature Neuroscience, 8, 725-
732.
• Johns, L. C. & van Os, J. (2001). The continuity of psychotic experiences in the general population.
Clinical Psychology Review, 21, 1125-1141.
• Lawrie, S. M., Hall, J., McIntosh, A. M., Owens, D. G. C., & Johnstone, E. C. (2010). The ‘continuum of
psychosis’ scientifically unproven and clinically impractical. The British Journal of Psychiatry, 197, 423-
425.
• Linscott, R. J., & van Os, J. (2009). Systematic reviews of categorical versus continuum models in
psychosis: evidence for discontinuous subpopulations underlying a psychometric continuum.
Implications for DSM-V, DSM-VI, and DSM-VII. Annual reviews of clinical psychology, 6, 14.1-14.29.
• Möller, H.-J. (2014). The consequences of DSM-5 for psychiatric diagnosis and
psychopharmacotherapy. International Journal of Psychiatry and Clinical Practice, 18, 78-85..
3
,1. Diagnostic criteria of psychosis
1.1. Brief psychotic disorder (DSM-V)
A. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2), or (3):
1. Delusions
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence)
4. Grossly disorganized or catatonic behavior.
Note: Do not include a symptom if it is a culturally sanctioned response.
B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full
return to premorbid level of functioning.
C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features
or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the
physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
DSM
1.2. Psychosis
DSM-IV: Disorders in which there is a loss of ego boundaries or a gross impairment in reality testing with
delusions (false belief or opinion) or prominent hallucinations.
Psychosis is a common and functionally disruptive symptom of many psychiatric,
neurodevelopmental, neurologic, and medical conditions
Impaired reality testing remains central in classification.
Requiring the presence of hallucinations, delusions or both
Psychosis is not defined in the DSM5, it’s a symptom of many disorders (psychotic disorders)
Psychosis in the DSM5 is diagnosed on biological basis.
DSM-IV
2. Diagnosis of psychosis on continuum vs categorical
Classification/dichotomy: qualitative categorical, qualitative and measurable differences between
those who have psychosis and those who don’t
Dimensional/continuum: quantitative number of experiences, emotional values of them; dimensional
definitions of symptoms can be less stigmatising than categorical distinctions, as they imply that patients
with a diagnosis of schizophrenia are not distinctly different from non-patients
4
, 3. Pros and cons of a dichotomy and a continuum
3.1. Dichotomy
CONS (–) PROS (+)
Heterogeneity between categories (some Easy to use
people have the whole range of symptoms, Valid clinically and reliable (a lot of
others do not!) background)
Homogeneity ( comorbidity) between Important for making dichotomous decisions
diseases! such as whether or not to legally detain
Uncertain validity people, and in some health systems to
Lack of clear ‘zones of rarity’ between approve insurance and other payments.
disorders Easier to communicate
Can increase stigma
3.2. Continuum
CONS (–) PROS (+)
Leads to overdiagnosis, excessive treatment, Less stigmatising
polypharmacy and comorbidity Beneficial for prevention (specially for people
Less reliable on the lower end of the spectrum)
Minor selection of continuum clinically
One continuum or more continua? (e.g. good important
coping strategies on the one hand, severe Symptoms are continuously distributed
symptoms on the other hand) amongst a population
Continuum is based on symptoms instead of The view that psychotic symptoms vary along
multidimensional diagnoses, and symptoms quantitative dimensions also facilitates
are less reliable and can be caused by psychological research into the factors that
different etiopathogenesis drive such variation
Subjective: not everyone will reach the same Preventing individuals from making
conclusion ‘transitions’ from non-clinical to clinical
Time consuming psychotic states (becoming crucial to
Cut off for treatment: it is harder to find a understand what actually causes individuals
point where to decide is the moment to start on some position at the hypothesised
a treatment for somebody continuum to become a clinical ‘case’.)
5
DISORDERS
PSY4062
Mélanie Faltz
2018-2019
,Table of contents
TASK 1: Dichotomy vs continuum ....................................................................................................... 3
1. Diagnostic criteria of psychosis ......................................................................................................... 4
2. Diagnosis of psychosis on continuum vs categorical ........................................................................ 4
3. Pros and cons of a dichotomy and a continuum .............................................................................. 5
4. Auditory hallucinations: clinical/non-clinical .................................................................................... 6
Article notes .............................................................................................................................................. 7
TASK 2: Brain and behavioral development ...................................................................................... 10
1. Pattern of behavioral development................................................................................................ 11
2. Brain development throughout life ................................................................................................ 12
3. Brain development and TBI: behavioral consequences.................................................................. 13
4. A damaged brain is more vulnerable to developmental/psychiatric problems. ............................ 15
TASK 3: Autism ................................................................................................................................ 17
1. Autism diagnosis criteria according to DSM-5 ................................................................................ 18
2. Theoretical models of autism ......................................................................................................... 19
3. Brain neurologically affected by autism ......................................................................................... 28
TASK 4: Attention-deficit/hyperactivity disorder .............................................................................. 30
1. Core symptoms of ADHD ................................................................................................................ 31
2. Development of ADHD .................................................................................................................... 32
3. Which theories about ADHD exist?................................................................................................. 34
4. Biological underpinnings of ADHD .................................................................................................. 37
TASK 5: Adolescence, a sensitive period?.......................................................................................... 39
1. Proneness to psychiatric disorders throughout adolescence ......................................................... 40
2. Vulnerability of adolescents to psychiatric disorders ..................................................................... 42
3. Risk factors for substance abuse..................................................................................................... 44
TASK 6: Obsessive-compulsive disorder ............................................................................................ 47
1. OCD diagnosis criteria (DSM-5)....................................................................................................... 48
2. Etiology of OCD: How it develops and why?................................................................................... 49
3. Different theories about OCD ......................................................................................................... 51
TASK 7: Anxiety Disorders ................................................................................................................ 54
1. Most common anxiety disorders .................................................................................................... 55
2. Brain areas implicated in anxiety and fear ..................................................................................... 55
3. Distinction between anxiety and fear ............................................................................................. 57
4. Difference between shyness and social anxiety? ........................................................................... 60
TASK 8: Depression .......................................................................................................................... 62
1. Diagnostic criteria for depression (DSM-5)..................................................................................... 63
1
, 2. Bio-psycho-social model of depression .......................................................................................... 63
3. Beck’s model of depression and its limitations .............................................................................. 65
4. Risk factors and prevention of depression ..................................................................................... 69
5. Putative beneficial effects of mild to moderate depression .......................................................... 69
TASK 9: Schizophrenia...................................................................................................................... 76
1. Diagnostic criteria for schizophrenia according to DSM-5 ............................................................. 77
2. Environmental causes of schizophrenia ......................................................................................... 78
3. Dopamine and glutamate in schizophrenia .................................................................................... 79
4. Neurodevelopmental model ........................................................................................................... 82
2
,TASK 1: Dichotomy vs continuum
LEARNING GOALS
1. How is a brief psychotic disorder diagnosed, according to the DSM-V criteria?
2. How is a psychosis diagnoses on a continuum vs a dichotomy?
3. What are the pros and cons of both applications?
4. How do you distinguish between clinical/non-clinical in auditory hallucinations?
LITERATURE
• De Leede-Smith, S. & Barkus, E. (2013). A comprehensive review of auditory verbal hallucinations:
lifetime prevalence, correlates and mechanisms in healthy and clinical individuals. Frontiers in human
neuroscience, 7, 367 (1-25).
• Hyman, S. E. (2007). Can neuroscience be integrated into the DSM-V? Nature Neuroscience, 8, 725-
732.
• Johns, L. C. & van Os, J. (2001). The continuity of psychotic experiences in the general population.
Clinical Psychology Review, 21, 1125-1141.
• Lawrie, S. M., Hall, J., McIntosh, A. M., Owens, D. G. C., & Johnstone, E. C. (2010). The ‘continuum of
psychosis’ scientifically unproven and clinically impractical. The British Journal of Psychiatry, 197, 423-
425.
• Linscott, R. J., & van Os, J. (2009). Systematic reviews of categorical versus continuum models in
psychosis: evidence for discontinuous subpopulations underlying a psychometric continuum.
Implications for DSM-V, DSM-VI, and DSM-VII. Annual reviews of clinical psychology, 6, 14.1-14.29.
• Möller, H.-J. (2014). The consequences of DSM-5 for psychiatric diagnosis and
psychopharmacotherapy. International Journal of Psychiatry and Clinical Practice, 18, 78-85..
3
,1. Diagnostic criteria of psychosis
1.1. Brief psychotic disorder (DSM-V)
A. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2), or (3):
1. Delusions
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence)
4. Grossly disorganized or catatonic behavior.
Note: Do not include a symptom if it is a culturally sanctioned response.
B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full
return to premorbid level of functioning.
C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features
or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the
physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
DSM
1.2. Psychosis
DSM-IV: Disorders in which there is a loss of ego boundaries or a gross impairment in reality testing with
delusions (false belief or opinion) or prominent hallucinations.
Psychosis is a common and functionally disruptive symptom of many psychiatric,
neurodevelopmental, neurologic, and medical conditions
Impaired reality testing remains central in classification.
Requiring the presence of hallucinations, delusions or both
Psychosis is not defined in the DSM5, it’s a symptom of many disorders (psychotic disorders)
Psychosis in the DSM5 is diagnosed on biological basis.
DSM-IV
2. Diagnosis of psychosis on continuum vs categorical
Classification/dichotomy: qualitative categorical, qualitative and measurable differences between
those who have psychosis and those who don’t
Dimensional/continuum: quantitative number of experiences, emotional values of them; dimensional
definitions of symptoms can be less stigmatising than categorical distinctions, as they imply that patients
with a diagnosis of schizophrenia are not distinctly different from non-patients
4
, 3. Pros and cons of a dichotomy and a continuum
3.1. Dichotomy
CONS (–) PROS (+)
Heterogeneity between categories (some Easy to use
people have the whole range of symptoms, Valid clinically and reliable (a lot of
others do not!) background)
Homogeneity ( comorbidity) between Important for making dichotomous decisions
diseases! such as whether or not to legally detain
Uncertain validity people, and in some health systems to
Lack of clear ‘zones of rarity’ between approve insurance and other payments.
disorders Easier to communicate
Can increase stigma
3.2. Continuum
CONS (–) PROS (+)
Leads to overdiagnosis, excessive treatment, Less stigmatising
polypharmacy and comorbidity Beneficial for prevention (specially for people
Less reliable on the lower end of the spectrum)
Minor selection of continuum clinically
One continuum or more continua? (e.g. good important
coping strategies on the one hand, severe Symptoms are continuously distributed
symptoms on the other hand) amongst a population
Continuum is based on symptoms instead of The view that psychotic symptoms vary along
multidimensional diagnoses, and symptoms quantitative dimensions also facilitates
are less reliable and can be caused by psychological research into the factors that
different etiopathogenesis drive such variation
Subjective: not everyone will reach the same Preventing individuals from making
conclusion ‘transitions’ from non-clinical to clinical
Time consuming psychotic states (becoming crucial to
Cut off for treatment: it is harder to find a understand what actually causes individuals
point where to decide is the moment to start on some position at the hypothesised
a treatment for somebody continuum to become a clinical ‘case’.)
5
