Psychopathology & Prevention
Lectures
Week 1
Week 2
Week 3
Week 4
Week 5
Tutorials
Week 1
Week 2
Template
Week
, Lectures
Week 1
Lecture 1: Global Burden of (mental) Disease
Literature
- Lancet, 2016: Estimating The True Global Burden of Mental Illness
- CH7 Pomerantz: DSM
Lancet, 2016 Main argument: Global burden of mental illness is underestimated. This
is due to 5 main causes
1. Overlap between psychiatric and neurological disorders
2. Grouping of suicide and self-harm seperate from mental illness
○ Coded as injuries and not included in mental illness
calculations
3. Conflation of chronic pain with musculoskeletal disorders
4. Exclusion of personality disorders from calculations
5. Lack of consideration for mental illness contributing to mortality
CH7 Pomerantz Abnormality: personal distress, deviance from cultural norms,
statistical infrequency, impaired social functioning
- Is culturally dependent (ex. House Bonding in women leading to
OCD & agoraphobia)
Jerome Wakefield: Harmful dysfunction theory
- Scientific data (failure of a natural mechanism) & social
values
Mental disorder in DSM: clinically significant disturbance of
cognition emotional regulation or behavior, indicates dysfunction
Video: Global Burden Aim (1990s) To investigate more causes of heath, standardizing data,
of Disease Study generating comparable estimates
(GBD) - Not just births and deaths!
- Quantifying health with not just mortality from many causes
It helps influence decisions, targeting proteins to help people live longer
more quality lives
- Also investigates health spending and helps to predict future
- Fine tune economic investments
Covid-19 & Mental - Depression & anxiety increase (25%)
Health - Risk factors heightened: Fear of unknown, no routine,
- Protective factors not available: social support, physical activity
WHO, World Mental = widespread, undertreated, under-resourced (pre-pandemic)
Health Report - Prevalence: 1 in 8 (13% globally)
- Anxiety disorders: 31%, Depressive (28%)
- Higher income countries higher prevalence
,Global Burden of = What keeps us from living long healthy lives (not just mental health)
Disease - Beyond standard measurements (mortality)
- What are the world's major health problems, where should
money go, what are we doing about it, preventative measures?
First GBD (1990, 2002, 2007)
- 8 regions, 107 diseases, 10 risk factors
Major update GBD (2010 2013, 2015)
Newest GBD (2019)
- 204 countries, 369 diseases, 87 risk factors
We can see that in the GBD we were not equipped for the pandemic,
preventable risk factors (blood sugar, bmi, air pollution)
Importance: predicting trends, policy decisions
DALYs = Disability adjusted life years
- Measures premature mortality (years lost due to disability)
- Also lose years not in death but “dealing” (Morbidity =
non-fatal effects)
- Helps rank what disease are the most burdensome (allows
comparison)
- Country dependent
Mental health = well being, coping, realizing abilities, learning, contributing (not
just ‘not suffering’ but thriving)
- Prevalence: 1 in 4 throughout lifetime
- 4th position on ranking of “burdensome” (add substance abuse +
mental health)
- Depression has highest burden followed by anxiety
- Everything has increased with time (1990s vs 2019)
- More women than men (internalizing vs externalizing)
Worldwide - Western world (higher developed) countries have higher disease
burden
- Larger income gap the bigger mental health problem
- Cultural differences between defining mental health or
manifestation of symptoms
Issues with GBD - DALYs underestimate true burden
- 93% non-fatal (mental health ≄premature death)
- Suicide & self harm is under ‘injuries’, not included in
mental health disorders
- Substance use disorders are separated from mental health
- YLDs: Years lived with disability
- Are at the highest ranking, 15.6% of global YLDs
- Shows high burden (higher than DALYs)
- Peak at adolescents & young adults
- Depression (second place) & anxiety are highest mental
disorders
, Not included in GBD (underestimate YLDs and DALYs)
- Neurological
- Suicide
- Chronic pain syndromes
- Personality disorders
Abnormality = culture, distress, statistics, frequency, social functioning
Mental Disorders = psychological, biological, or
developmental dysfunctions (personal
distress, impairment in functioning,
unexpected & atypical in cultural context)
1. Extreme expression of otherwise
normal things
2. Impairment & distress
3. Atypical in cultural context
Classification Systems DSM-5 vs ICD-11
- American ($$) vs Global Tool (free)
- DSM has more impact and insurance might require DSM
ICD-11 - Medical & psychiatric diagnoses
- Has more flexible guidelines (don't need to have a specific
number of symptoms)
- Fits with more global mental health
Classifications Professionals
- More attention to research & treatment
- More funding
- Good for insurance
Patients
- Identify and demystify experience (understanding)
- Treatment
Issues
- Too many disorders/classifications
- Where do you draw the line?
Dimensional - Not categorical but on a spectrum
(“Transdiagnostic”) - Everyone has fundamental characteristics but differs in amount
Approach Why?
- Focus on processes which is trains diagnostics
- Addressing comorbidity
- Showing there is not one clear cause
- Includes the variety within diagnosis
What do we use?
- 5-Factor Personality model
- Symptoms of Emotional Distress
- Dysfunctional thinking
Lectures
Week 1
Week 2
Week 3
Week 4
Week 5
Tutorials
Week 1
Week 2
Template
Week
, Lectures
Week 1
Lecture 1: Global Burden of (mental) Disease
Literature
- Lancet, 2016: Estimating The True Global Burden of Mental Illness
- CH7 Pomerantz: DSM
Lancet, 2016 Main argument: Global burden of mental illness is underestimated. This
is due to 5 main causes
1. Overlap between psychiatric and neurological disorders
2. Grouping of suicide and self-harm seperate from mental illness
○ Coded as injuries and not included in mental illness
calculations
3. Conflation of chronic pain with musculoskeletal disorders
4. Exclusion of personality disorders from calculations
5. Lack of consideration for mental illness contributing to mortality
CH7 Pomerantz Abnormality: personal distress, deviance from cultural norms,
statistical infrequency, impaired social functioning
- Is culturally dependent (ex. House Bonding in women leading to
OCD & agoraphobia)
Jerome Wakefield: Harmful dysfunction theory
- Scientific data (failure of a natural mechanism) & social
values
Mental disorder in DSM: clinically significant disturbance of
cognition emotional regulation or behavior, indicates dysfunction
Video: Global Burden Aim (1990s) To investigate more causes of heath, standardizing data,
of Disease Study generating comparable estimates
(GBD) - Not just births and deaths!
- Quantifying health with not just mortality from many causes
It helps influence decisions, targeting proteins to help people live longer
more quality lives
- Also investigates health spending and helps to predict future
- Fine tune economic investments
Covid-19 & Mental - Depression & anxiety increase (25%)
Health - Risk factors heightened: Fear of unknown, no routine,
- Protective factors not available: social support, physical activity
WHO, World Mental = widespread, undertreated, under-resourced (pre-pandemic)
Health Report - Prevalence: 1 in 8 (13% globally)
- Anxiety disorders: 31%, Depressive (28%)
- Higher income countries higher prevalence
,Global Burden of = What keeps us from living long healthy lives (not just mental health)
Disease - Beyond standard measurements (mortality)
- What are the world's major health problems, where should
money go, what are we doing about it, preventative measures?
First GBD (1990, 2002, 2007)
- 8 regions, 107 diseases, 10 risk factors
Major update GBD (2010 2013, 2015)
Newest GBD (2019)
- 204 countries, 369 diseases, 87 risk factors
We can see that in the GBD we were not equipped for the pandemic,
preventable risk factors (blood sugar, bmi, air pollution)
Importance: predicting trends, policy decisions
DALYs = Disability adjusted life years
- Measures premature mortality (years lost due to disability)
- Also lose years not in death but “dealing” (Morbidity =
non-fatal effects)
- Helps rank what disease are the most burdensome (allows
comparison)
- Country dependent
Mental health = well being, coping, realizing abilities, learning, contributing (not
just ‘not suffering’ but thriving)
- Prevalence: 1 in 4 throughout lifetime
- 4th position on ranking of “burdensome” (add substance abuse +
mental health)
- Depression has highest burden followed by anxiety
- Everything has increased with time (1990s vs 2019)
- More women than men (internalizing vs externalizing)
Worldwide - Western world (higher developed) countries have higher disease
burden
- Larger income gap the bigger mental health problem
- Cultural differences between defining mental health or
manifestation of symptoms
Issues with GBD - DALYs underestimate true burden
- 93% non-fatal (mental health ≄premature death)
- Suicide & self harm is under ‘injuries’, not included in
mental health disorders
- Substance use disorders are separated from mental health
- YLDs: Years lived with disability
- Are at the highest ranking, 15.6% of global YLDs
- Shows high burden (higher than DALYs)
- Peak at adolescents & young adults
- Depression (second place) & anxiety are highest mental
disorders
, Not included in GBD (underestimate YLDs and DALYs)
- Neurological
- Suicide
- Chronic pain syndromes
- Personality disorders
Abnormality = culture, distress, statistics, frequency, social functioning
Mental Disorders = psychological, biological, or
developmental dysfunctions (personal
distress, impairment in functioning,
unexpected & atypical in cultural context)
1. Extreme expression of otherwise
normal things
2. Impairment & distress
3. Atypical in cultural context
Classification Systems DSM-5 vs ICD-11
- American ($$) vs Global Tool (free)
- DSM has more impact and insurance might require DSM
ICD-11 - Medical & psychiatric diagnoses
- Has more flexible guidelines (don't need to have a specific
number of symptoms)
- Fits with more global mental health
Classifications Professionals
- More attention to research & treatment
- More funding
- Good for insurance
Patients
- Identify and demystify experience (understanding)
- Treatment
Issues
- Too many disorders/classifications
- Where do you draw the line?
Dimensional - Not categorical but on a spectrum
(“Transdiagnostic”) - Everyone has fundamental characteristics but differs in amount
Approach Why?
- Focus on processes which is trains diagnostics
- Addressing comorbidity
- Showing there is not one clear cause
- Includes the variety within diagnosis
What do we use?
- 5-Factor Personality model
- Symptoms of Emotional Distress
- Dysfunctional thinking
