Question

1. Define the term psychological disorder.

2. Identify the DSM 5 and why it 's, “a work in progress”.

3. Discuss the Bio psychological theory of mental illness.

Answer 1

1.A psychological disorder, also known as a mental disorder , is a pattern of behavioral or psychological symptoms that impact multiple life areas and create distress for the person experiencing these symptoms.

2.

The Neurocognitive Disorders Work Group of the American Psychiatric Association's (APA) DSM-5 Task Force began work in April 2008 on their task of proposing revisions to the criteria for the disorders referred to in DSM-IV as Delirium, Dementia, Amnestic and Other Cognitive Disorders. (1) Over the past two years we have, among ourselves and with input from outside consultants and advisors, worked to develop a working draft that was posted on the APA's website in February 2010. This draft contained both an overview/rationale for the approach we have taken to date and preliminary criteria for the broadly defined disorders. Without reiterating here all the material posted on the website, we will provide below our approach to the challenges we faced and some rationale for that approach. We are also pleased to have this opportunity to respond publicly both to the many comments directed to the Work Group on and off the website, and to the very thoughtful and constructive commentary provided by Drs. Rabins and Lyketsos in this issue.(2) Finally, while this response is directed to the readership of the American Journal of Geriatric Psychiatry, we emphasize that the neurocognitive disorders are by no means restricted to older adults. We continue our efforts to refine and expand these criteria, working towards the final DSM-5 publication date of May 2013.

By way of background, the Task Force began its work mindful of two guiding principles. The first was to propose changes based on advances both in scientific knowledge and in current views and clinical practices, in full awareness of the controversies and challenges within our field. The second was to avoid making changes for the sake of change, bearing in mind that all change is disruptive and potentially expensive. We are fortunate that most of the disorders we address have been the focus of intense and productive scientific research since DSM-IV was published. We also recognized that ours was a category unique within DSM-5 in that, for most disorders within our purview, the underlying pathology is known, and sometimes the etiology as well.

Scope of the mandate

Our first order of business was to define the scope of our activity, i.e., to identify the common defining characteristics of our group of disorders and, accordingly, to choose a new name for the group. At one time, these disorders used to be referred to as “organic,” implying that they were the result of known structural brain disease. The term “organic” was intended to distinguish these disorders from all other mental disorders, which were designated as “functional.” Thankfully, psychiatry has since rejected the false disconnects between structure and function or organic and non-organic, and recognized that the brain is the basis of all mental disorders.

In keeping with the DSM convention of defining broad categories based on descriptive rather than etiologic concepts, we first delineated our category as comprised of disorders in which the primary clinical deficit is in cognitive function. In addition, we focused on disorders that are acquired rather than developmental, i.e., in which impaired cognition has not been present since birth or early life and represents a decline from a previously attained functioning. This distinction is not always a clear one as we will address later.

Naming the broad category

We initially considered labeling this group of disorders “Cognitive Disorders,” as also suggested by Rabins and Lyketsos among others. We are still considering the shorter term, but note several advantages to “neurocognitive.” First, we note that cognitive impairments are present in all mental disorders including, for example, schizophrenia, bipolar disorder, and autism. Given our initial mandate, we focused on those disorders where the cognitive deficit is the primary one, and attributable to known structural or metabolic brain disease; hence the designation “neurocognitive.” The addition of the prefix “neuro” to “cognitive” provided added specificity because the term “cognitive” has a broader meaning in psychiatry and psychology, covering all mental representations of information processing, even all conscious activity. For example, the cognitive theory of depression envisages depression as characterized by cognitive distortions amenable to correction by cognitive behavior psychotherapy. Further, the term “cognitive” is increasingly used in the context of very specific treatment modalities such as cognitive training and cognitive rehabilitation, and in fact a recent editorial in a neurological journal even refers to these treatments as “cognitive therapy.” In contrast, the term “neurocognitive” describes cognitive functions closely linked to the function of particular brain regions, neural pathways, or cortical/subcortical networks in the brain. In parallel with the designation “neurocognitive,” neuropsychology is a subdiscipline of psychology that focuses on psychological processes and behaviors related to known structural or metabolic brain disease. For all these reasons, the term neurocognitive has seen increasing acceptance in many conditions, e.g. HIV-Associated Neurocognitive Disorders and Post-Operative Neurocognitive Decline.

Identifying the domains

Our next task was to define more specifically the aspects or domains of brain functioning that would be involved in the diagnoses of these neurocognitive disorders. Having listed these (complex attention, learning and memory, executive ability, language, visuoconstructional-perceptual ability, and social cognition), we developed working definitions of the neurocognitive domains and the corresponding impairments in everyday functions that the clinician may elicit or observe. It is difficult to achieve consensus on the precise number and delineation of domains, and other professional groups could and have argued for different approaches; we are considering the proposed alternatives. However, we have received strong support for this initiative, and we hope also to provide, in an Appendix to DSM-5, examples of tools that can be used to measure or rate these domains.

Diagnostic thresholds and the role of functional impairment

The cross-cutting DSM-5 Study Group on Function has emphasized that functional impairment is a consequence of disease/ disorder, and thus cannot be a criterion for diagnosing the disorder, a position consistent with the World Health Organization's publication on the International Classification of Functioning, Disability, and Health (ICF).Therefore, the Study Group has recommended to all DSM-5 Work Groups that no disorders specify functional impairment or disability as a diagnostic criterion; rather, that all disorders, once diagnosed, be rated on the presence and severity of functional impairment using a common measure. This recommendation would have effectively removed one of the traditional diagnostic criteria for dementia, which is that the cognitive deficits be sufficient to interfere with social and occupational functioning. For these disorders, losing such a threshold was controversial for two reasons. First, it would cause potential discontinuity with the previous nomenclature and current clinical practice; second, concerns have been voiced from many quarters about objective cognitive measures being the sole index of disorder.

Responses to our suggested thresholds based on neuropsychological performance norms (e.g. percentiles or standard deviations below the mean) have been divided. Support is based on the objectivity of reliable, standardized measures. Opposition is based on the grounds that neuropsychological testing is not always available to clinicians, and, when it is, appropriate norms do not always exist. In addition, individual variation is such that cross sectional assessment is limited in its ability to evaluate decline. In part for this reason, most Work Group members have supported the retention of a version of the functional threshold for dementia, operationalized as interfering with independence in everyday activity. The distinction between disability and loss of independence is subtle, but we believe it is real and clinically meaningful. The field, however, is moving forward to better measurement instruments that should improve our diagnostic capabilities.

Our current draft proposes requiring both subjective reports/observations and objective assessments of cognitive impairment, especially for the less severe entity we are currently referring to as minor neurocognitive disorder. We have suggested certain thresholds (still evolving) as anchor points for the objective assessments for diagnosis at the syndrome level (major and minor neurocognitive disorder). After the syndromic diagnosis, the next step is to select an etiological subtype, such as Alzheimer's disease (AD) or HIV-associated disorder. Additional criteria to be provided for each etiological subtype are being developed in close collaboration with the relevant expert groups.

3.Biological psychopathology is the study of the biological basis of mental illness . It attempts to elucidate the genetic and neurological etiology behind psychology disorders, including schizophrenia mood disorder , and anxitey disorders.

Although it interacts with clinical psychology it is a specialized subset that usually takes place in an experimental context. It is known by several alternative names, including clinical neuroscience and experimental psycho pathological .

It is an interdisciplinary approach that comes from sciences such as neuro science , biochemistry, genetics, and physiology in order to examine the biological basis of behavior and specifically psychopathology. Biological psychopathology and other approaches relating to mental illness are not mutually exclusive, but many basically attempt to deal with the illness through different levels of explanation. Due to the focus on the biological processes of the nervous system, however, biological psychopathology has been particularly important in developing and prescribing drug based treatments for mental disorders. In practice, typically both medication and psychological therapy are used in synchronization to treat mental illness.