Lecture 1: Introduction Clinical Psychology

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 the literature?
No literature is discussed this week. This week is mainly an introduction and the content of the lecture will not be covered on the exam.

How has this topic developed over the past few years?
The DSM IV is not being used anymore. Instead, the DSM V or the ICD 10 is relied on when it comes to behavioural disorders. It is important to note that when studying behavioural disorders, there could be a significant difference between the DSM IV and the DSM V. The criteria or categories may have changed, or even some disorders may have been removed or added.

What comments are made with regard to the exam?
The material discussed on the exam will be the lectures, books and articles. Books discussed will be Addictions (2^nd edition) by Teesson (2012) and Anxiety (3^rd edition) by Rachman (2013). These books are freely available through the library (online version). Articles will be discussed per week and per topic. These articles will be about eating disorders, somatic symptom disorder, schizophrenia/psychosis, mood disorders, and personality disorders. Hyperlinks are made available on BlackBoard.

What questions are being asked which could be asked on the exam? What is the answer?
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