What topics are discussed?

What is a mental/emotional/behavioural disorder?
It is thought that a behavioural disorder has its origin in the brain. However, the brain is the most complex thing we try to understand, and it is hard to interpret how exactly it works, due to a thick skull which is hard to get through. A behavioural disorder can be seen as a behavioural syndrome. A syndrome is operationalised in terms of a diagnosis and covers a pre-defined set of symptoms. These symptoms should cause impairment in functioning or noticeable stress, to the person or to others. A disorder is not a yes/no thing, but it depends on the dimension of the symptoms. Besides, disorders are hard to distinguish from one another, and it comes with comorbidity too.

The uncubus phenomenon
The uncubus phenomenon is a hypnopompic experience. It is also known as sleep paralysis. It occurs when you’re in-between sleeping and being awake. You have the feeling you cannot move and you have difficulty breathing. You sense presence and you feel like someone or something is sitting on your chest, which causes trouble breathing. This is actually because during your sleep your muscles are paralyzed, so are your muscles which control your breathing. It is probably a (REM-)sleep disorder. You wake up at the wrong time in the middle of the night, during your REM-sleep. The body is paralyzed and the brain is very active. Your brain wants to make sense of what’s going on, which causes stress and impairment because you cannot move. It is discussed whether this would be considered a behavioural disorder.

Who makes changes into severe psychopathology?
Why does one develop a behavioural disorder, meanwhile someone else doesn’t? By what mechanism does this work? It is unclear what mechanism works between two events. Two examples are given. When one has experienced emotional abuse, this person is two to three times more likely to report bulimia or anorexia nervosa. Being a refugee, it is two to three times more likely to develop anxiety, depression or PTSD. For example, it could be the stress that comes with moving to a different environment when you’re a refugee. Other factors play a role as well, for example genetic factors.

Substance use disorder
Substance use, for example alcohol or drugs, causes impairment in functioning or noticeable stress. Two to three symptoms is considered as a mild substance use disorder. Four to five symptoms are considered as a moderate substance use disorder. A severe substance use disorder is when someone shows more than five symptoms.

Classification systems (DSM V and ICD 10)
These classification systems are not universally accepted and it is important to know that these were not intended to be valid, but to be reliable. You can achieve reliability by (mostly) counting behavioural symptoms.

What topics are discussed which aren’t discussed in

What topics are discussed?

Clusters
This topic has not been discussed in the lecture. However, it can be convenient to have a quick summary about the clusters and the different types of personality disorders. Therefore the other topics which were discussed in the lecture and literature are easier to understand.

Cluster A: strange behaviour
- Paranoid: not trusting others, extern attribution bias (blaming others for own failures), easily getting jealous, resulting in problems at work and in relationships, they often seem professional and efficient and are proud they can handle everything rationally/without emotions
- Schizoid: flat, superficial behaviour, not feeling pleasure, not feeling anything like mood swings (although they can experience depression), not understanding how/why they feel the way they feel
- Schizotypal: strange, eccentric, and creative behaviour, feeling like they cannot fit into society, often psychotic features, they want to be in contact with others, but they are very frightened to do so
General characteristics: social aversion, failure to form relationships, poor self-awareness and empathic ability, (relative) indifference to these abilities.

Cluster B: dramatic
- Antisocial: not caring about emotions and rights of others, rationalising own destructive behaviour, lying, often raised in an instable family with lack of parental care, sometimes referred to as sociopaths or psychopaths
- Borderline: instability with moods, relationships, impulsivity which leads to reckless behaviour, self-mutilation, suicide attempts, fear of being abandoned
- Histrionic: constantly seeking attention, paying attention to how others judge and perceive them, inappropriate, seductive or sexual provocative behaviour
- Narcissistic: not interested in others, strong desire to be admired by others, overestimation of their own qualities, easily jealous of others and having the idea that others are jealous of them, not good at taking criticism

Cluster C: anxious
- Avoidant: low self-esteem, extremely shy, sensitive to criticism, anxious and avoiding risks, caused by neglect, abuse, being bullied
- Dependent: extremely dependent on partner, parents or friends, makes others make important decisions, fear of being abandoned, often suicidal
- Obsessive-compulsive: strong desire to have everything neat and organised, perfectionist, often superficial relationships with others, strong comorbidity with Asperger and eating disorders
 

Stigma
There is a stigma around personality disorders. A personality disorder is difficult to treat and it is difficult to deal with in life. Some people think a personality disorder is just bad behaviour instead of a real disorder and that those people just have to change their behaviour. There’s especially a high stigma around those with borderline disorder. For patients themselves there is also a stigma. They often have a low self-esteem as they cannot maintain relationships with others and such. There is also a stigma around care givers, because of the patients’ symptoms they cannot have relationships and they have a hard time when it comes to work.

Reasons to pay more attention to PD
There are multiple reasons why there

What topics are discussed?

Somatic symptoms
90% of the general population has at least one symptom per two weeks. Most symptoms are found to be not pathological. One in 40 symptoms leads to consultation of a general practitioner. This usually happens when the symptoms are of longer duration, the symptoms are aggravated, or when people are worried about the meaning of their symptoms. In 16-74% of the consultations, no explanation of the symptoms is found. This is because many symptoms can have my causes. Most people only experience symptoms for a couple of days or weeks, meanwhile in most psychiatric disorders you have to experience symptoms for some months. After medical consultation, 63-75% of the patients recover. The prevalence at the GP for somatic symptom disorder is 15.7%. The total amount of anxiety disorders is 5.5% and the total amount of depression disorders is 4.1%.

SOLK stands for Somatisch Onvoldoende Lichamelijke Klachten (insufficient physical somatic symptoms). The working hypothesis for SOLK is that somatic symptoms exist during some weeks and the symptoms are not explained by appropriate medical examination. Somatic and mental pathology are ruled out on the basis of a legitimate assumption. However, there is some criticism. For example, the time period given is quite vague (‘some weeks’), and there can be an appropriate medical examination.

About 15% of the somatic symptoms is due to somatic insufficiently explained fatigue. Somatic symptoms are said to be pathological if it lasts longer than 6 months, if the symptoms are significantly distressing, and if the symptoms are significantly disrupting daily life.

DSM V criteria

1. Somatic symptom(s) cause distress or malfunctioning
2. Excessive thoughts, feelings, or behaviour associated with somatic symptoms or worries about health, reflected in at least one of the following:
   
   1. Disproportional and persistent thoughts about symptom severity
   2. Persistent high level of anxiety about health or symptoms
   3. Excessive amount of time devoted to symptoms or health concerns

Somatic symptoms are persistent (6 months or longer).

Related disorders
Psychological factors affect other medical conditions. There are other disorders which are related to somatic symptom disorders, but there are some differences. Fears of treatment contribute to mortality or morbidity.

In Illness Anxiety Disorder, the anxiety comes first, instead of the somatic symptoms. There is a strong belief that they have a serious, life threatening illness and they worry about their health. However, there are no or only mild symptoms.

In conversion/functional neurological symptom disorder, the physical symptoms make it look like a neurological conditions. There are symptoms which affect one’s perceptions, sensations, and movement, but these are not due to a disorder. An example of what can happen is when a leg gets paralysed as a result of major stress.

In a factitious disorder, patients intentionally fabricate psychological symptoms to assume the role of patient. It is not the

The term psychosis

This term was first used by Von Feuchtersleben in 1845. There are different terms throughout the paper written by Beck et al. which might be little bit confusing. These terms are psychosis, psychotic symptom, psychotic disorder, schizophrenia spectrum disorder, and schizophrenia. How are these related to each other? In this lecture the focus will be on psychotic symptoms and psychotic disorders.

The Continuum Model of Psychopathology describes how everyone experiences anxiety and depression from time to time and that this is normal. There is some arbitrary point where there is so much anxiety and/or depression which can be pathological. This is the same for psychotic symptoms. About 10-20% of people in the population hear voices from time to time. This is not necessarily a sign of psychopathology. These voices can say nice and reassuring things, which gets you in the ‘safe area’ of the CMP, but these voices can also say you have to do dangerous things. In psychotic disorders this model works a little bit differently. In psychotic disorders we see the whole collection of symptoms and there is not a continuum anymore.

Psychotic symptoms

Positive symptoms are when there is something extra. Examples of these are delusions, hallucinations, disorganised thought and speech, and disorganised or catatonic behaviour (muscle stiffness). Negative symptoms are when there is something missing or when something as extremely decreased.

Delusions are cognitive phenomena. These are not things we feel or perceive, it’s something we think. Delusions are not self-perceptions. Examples of delusions:

• Persecutory delusions: paranoia, usually paired with loneliness, feeling like someone is spying on them
• Delusion of reference: related to persecutory delusions, thinking that things are about them, thinking that people who are in a restaurant are laughing are laughing about you
• Grandiose delusion: thinking they are much more than they are, e.g. being convinced they are Superman or thinking they are appointed by God. It is usually to people who have lost everything, e.g. job, family, money
• Delusion of being controlled: feeling unfree to have their own actions, thoughts, and will
• Delusion of thought broadcasting: feeling like others can read or hear your thoughts
• Delusion of thought insertion: thinking that others are putting thoughts into their minds, e.g. thinking about having lunch with friends when suddenly a sexual or aggressive thought pops up in their mind, and they find that something that they would not think of
• Delusion of thought withdrawal: when it all goes blank, thinking someone else ‘stole’ their thoughts
• Delusion of guilt or sin: thinking they have sinned, feeling guilty about imagined things they’d done wrong
• Somatic delusions: can be difficult to establish, e.g. feeling like you have four arms

Primary delusions: when delusions just happen to be there and we don’t know where they come form

Secondary delusion: when there is a reason