Etiological Models of Mental Disorders

Etiological model OF MENTAL DISORDERS

There is now widespread thinking about the etiology of deviance as the deployment of existing potential, to some extent, in all subjects, showing that the causes of diseases manifest under pluricausal convergence of biological conditions psychological and social determined. Assuming that when these elements were adequate in quality and quantity, then it would allow the creation of a healthy person, and in the absence or presence of anomalous origin of place would psychopathology.

The action and / or specific reaction in each of the etiologic factors have inevitably impact on others. Can not ensure that only one of them put in place the mechanism of pathological behavior, or a failure occurs first and then the organic psychopathological disorder, neither the psychic trauma and its subsequent biological footprint. Everything is interrelated with any of these factors (one or several at once) to end a situation occurring in adverse psychological unease and a biological circuit that enables and sustains.

Variables quantitative aspect (referring to the size) or the qualitative importance, and their timing, are defining conditions such as short-term stimuli are not repeated with sufficient frequency changes only tend to produce modifications at quantitative and not qualitative, only quantitative value of acquiring certain (different depending on the features highlighting even individual idiosyncrasy to the interpretation of the subject), and continuing now working over time on the magnitude, will have its translation in qualitative . Stressing the long-term stimulus, even having the capacity to modify genetic codes and affective stimuli.

Theories and explanations help and complement each other to further investigate the complexity of the human being, through learning about others through biology, social relations ... and they all are but parts of a whole to find healthy coping mechanisms and humans.

As described below, the models biologists seeking the etiology in physiology, psychoanalysis and dynamic models in shaping the self and personality, cognitive-behavioral models, learning, and systemic models the relationship between the individual and other systems nearby.

There are cases in which biological predisposition marked by a heavy burden inherited detract forces with other variables such as genetic abnormalities, but it seems clear that the rest of the spectrum is given in greater proportion in conditions described by psychiatry.

CASE: 45 year old male

Only child of mature parents (born when the mother was 43 years old father and 40 years). Risk pregnancy, bed rest at a loss and nine months. The childhood stage was really dark and unhappy with a parent diagnosed with schizophrenia and because of his delusions kept this child and his wife in complete silence because he believed that the noise caused his head the two of them. So the child spent more hours on the road than at home and hid her breathing when she slept with the bedding, to avoid incurring the wrath of his father. In the marital relationship was known infidelity of his young son, was also a participant. The mother had to go to work because he had left his job as representative of a well known film producer, because he pursued.

The patient's social relationships were limited to a few friends from school and the neighborhood who are not brought home to not create problems. But whose activities were always on the brink of illegality or endangerment of the physical, with several crashes under his belt.

Today the circle of friends is changing, in order not to discover their "quirks?, Has two childhood friends, one of which is already losing touch with him for his alleged membership of my friendship.

When he was young and after notice by the father to his son, who hanged himself at home, he being the first to find it. From this arose his actions were more compulsive and persist today to the point that their rituals will take more than 6 hours per day. He began knocking on doors three times before leaving home or prior to entry.

He has delusions as his father appears in dreams are sitting on the bed and a great need to do things very quickly. Also hear noises that cause pain.

Their relationships none has surpassed the 2-year tenure until his first marriage lasted 14 years.

Their job security was intense, had created a cooperative enterprise system and then created several companies and real estate finance in which continuous, its goal was to become the owner of a building in Madrid and not deprived of any whim.

His wife asked to see a specialist when he was 34 years and their rituals and impulsivity for cleanliness, order and control of all family members and members of his firm were and despair as well have been using cocaine for a long time - from 29 years - even a year before leaving home occasionally took this substance. No treading white stripes zebra crossings, traffic lights before crossing added all license plates that were unemployed and had no additive if not crossed an odd number - to the point that one day the police called his house to be to pick it up because someone had seen him standing on a street light Genoa over an hour and half without crossing; chose a word that is said or would have thought that and repeated an odd number that started at 3 and had no end, if he failed to repeat repeat we made it to us with tricks like asking in different ways, had a real obsession for fun, I did not know anything about diseases, medicine cabinet was full of art just in case, all the clothes fumigated with bactericides, compulsive shopping, excessive concern was the physical appearance, including members of the family, was responsible for buying clothes, needed all the adulation it permanently, this was one of his relievers, other infidelities and feel recognized.

I just felt relief when their purpose could come up and then began another ritual. Never accepted their illness, they were just eccentric enough and if you contradicted showed considerable hostility and distrust.

It won the title in the absence of the Business English course which never showed up. His work is related to the world of finance and investments and is a high stress level.

Of their marital relationship produced a son who is 7 years after the initial joy caused him much anxiety and fear. Treated for taxation of his wife breaks the relationship because it starts a new one.

Today is 43 and left the psychotherapy and never medicated.

ANALYSIS

First note that it is an anxiety disorder and therefore related to reading this type of disorder is always useful for a correct understanding of OCD. The criteria for the diagnosis of obsessive-compulsive disorder in DSM-IV (APA, 1994): · 300.3 Obsessive-Compulsive Disorder

A. Obsessions and compulsions: The multiple and described

Obsessions are defined by:

(1) thoughts, impulses or images that are recurrent and persistent experience, sometime during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress. In recent years, and it came to tire and could not stop them anxiety-producing

(2) The thoughts, impulses or images are not simply excessive worries about everyday problems. I was interested in death, for the appearances of the faces on walls.

(3) The person attempts to ignore or suppress such thoughts or impulses or to neutralize them with some other thought or action. With the compulsive actions

(4) The person recognizes that the thoughts, impulses or images are a product of obsessive his own mind (not imposed as in thought insertion). He knew that only or few people had these thoughts and they were created for himself

Compulsions are defined by:

(1) repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according with rules to be applied rigidly. The aforementioned

(2) The behaviors or mental acts are aimed at neutralizing or reducing distress or some dreaded event or situation, however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

B. Sometime during the course of the disorder, the person recognizes that the obsessions or compulsions are excessive or unreasonable. While trying to hide, when they are detected could not stop talking about them and contrast with the behavior of others, always in a mocking tone like a sympathetic attitude.

C. The obsessions or compulsions cause marked distress, loss of time (usually, the individual uses more than one hour a day on them), or significantly interferes with the normal routine of the individual, with his professional activity, with social activities or relationships with other.

OCD involves a loss of control by the patient, his thoughts and even their behavior. This, plus, we live in a paradoxical way, while the patient recognizes itself as a product of such thoughts and / or behaviors. This leads to certain complications, such as the patient ceases to recognize the excessiveness of their obsessions or compulsions, in short, that have little awareness of the disease (an aspect on which the DSM-IV explicitly calls attention).

The etiology of OCD is multifactorial with an interaction, more or less, genetic, psychological and social Different theoretical frameworks agree to suggest that it could be a combination of genetic, psychological and cultural.

Factors predisposing

They refer to individual characteristics, family and social situations that makes the person more vulnerable to suffer from a disorder. Will increase the likelihood that a particular condition appears

Symptoms heritage and his father are seen as hostile, emotional instability, although he had no self-destructive ideas, his aggressiveness toward others diverted. The father is noted in the text marital instability, aggression.

Personal Variables

Risk behaviors, strange and rare

Substance abuse: It began when he was 29 years

Social skills: He was always shy and withdrawn, with few friends in their instability with their partners: the general trend has been over 16 years of age, and that continues to characterize his adult life?.

Delusions

The fantasies that her father appeared in a dream are sitting on the bed and the need to do things faster

Personality

This unstable, aggressive behavior may have learned and grown for drug use, but equally it is entirely possible to have a biological component inheritance, since her mother that her paternal grandmother was treated by the family in a special way to suffered no "surprises? and moody.

Precipitating Factors

The factors that appear to influence the pathogenesis of the disorder, children with parents

serious psychiatric genetic factor, the child's age, the quality of parentización, family environment, the occurrence of acute life events and chronic adversity, the number of sick parents and chronicity of parental illness. With respect to the child's age, existing data support the idea that there are different conflicts and evolutionary time-dependent problems facing the child, it appears that the age between 0 and 5 years and early adolescence are the most vulnerable. As occurs in this case.

Inconsistency parentización fatherly quality and family atmosphere:

All these factors have been highlighted bold precipitating factors, although chronic adversity can not be held in maturity as their socio-affective and economic environment has been very favorable from 25.

Family Variable

A child has not received parental education trust and stability, but based on fear and hypervigilance, as well as economic adversity.

Family split: there was no family split up his father's death, but had an inconsistent and suspicious atmosphere, affectivity occurred mainly by the mother, but having to work could not overcome the feeling of abandonment.

The family atmosphere was as sordid and low self-esteem booster and protection. In addition to being reduced to the parents and maternal grandmother who sometimes lived with them sporadically.

The occurrence of acute life events and chronic adversity: The more the fear that lived in his childhood with his father's behavior, the violent death of it, bequeathing a great sense of guilt in adolescence occurred in this case-and chronic economic hardship have been the most decisive factors in the development of OCD.

The second acute attack (since the death of his father) was precipitated by the birth of their child and for the imposition by his wife to see a specialist.

Factors maintainers

The raw grief, and family economic situation of economic adversity, until it begins to work. The inability to maintain emotional ties with other women he always distrusted. Relations with his closest friends always testing extreme situations, with a history of several car accidents, that is, their aversion to risk (compulsive) and risk seeking (impulsive) as well as aggressive and unpredictable behavior. Increasingly reducing their social relationships.

Delusions

The fantasies that her father appeared in a dream are sitting on the bed and the need to do things faster

Not wanting expert help - avoidance - the permanent flight maintainers are most relevant factors in their behavior.

Inhibiting factors

The main inhibiting factor is their compulsive acts, as mentioned above, the tension and anxiety stemming from the obsessive thoughts, find relief through the implementation of compulsion

Stability in the goals

The stability of the goals of keeping your job and get to be the owner and builder of a building in Madrid, are more than fulfilled, until the moment of achieving that allowed him to spend a few years without major crisis in your condition. He sought refuge in their marriage and support the stability of this acute crisis without having to have a child.

Falling in love

The initial periods in their relationships are periods when you feel accompanied, loved and in return, all of which exert an inhibitory influence of symptoms of the disorder.

Pathogenesis

Currently accepted hypothesis of the existence of a multifactorial etiology of OCD, but with a predominant substrate of a biological nature. Obsessive-compulsive disorder (OCD) is a disease etiologically heterogeneous and multidimensional, yet from the model is studied biologist from the following perspectives:

Today OCD treatments that have proven effective in a controlled manner: the treatment of exposure with response prevention and psychopharmacological treatment. In addition, several varieties of them, mainly include cognitive therapy, modalities of implementation (imaginal exposure, treatment group, family, etc..), And combination treatments.

So I describe both models and cognitive-behavioral biologist:

Model biologist

Ø serotonergic hypothesis, based on the abnormal regulation of serotonin as an antidepressant reuptake inhibitor of serotonin decreases the intensity of symptoms in this disorder. At present we have identified a large number of serotonin and is known to the receiver more involved is the 5-HT1A, but not alone.

Ø dopaminergic hypothesis. Although it is known that serotonin plays an important role in the disorder, dopaminégico system is also affected, as evidenced by the existence of obsessive symptoms in the syndrome of Gilles de la Tourette and postencephalitic Parkinson's disease. In both disorders are affected by the basal ganglia dopaminergic dysfunction. Today it is believed that the dopaminergic system is implicated in certain subtypes of OCD atypical: the comorbid with tics and comorbid with psychotic symptoms.

Ø autoimmune hypothesis. In autoimmune diseases affecting the basal ganglia, such as Sydenham's chorea, obsessive-compulsive symptoms with motor phenomena and even before.

Ø genetic hypothesis. Family studies reveal, in general, a prevalence rate ranging between 0 and 36%, which suggests the existence of genetic factors involved character in OCD. Recent studies among monozygotic twins, twins heterozygous and Pauls studies, evidence consolidates family disruption involved in this entity. However, it seems clear that heredity can not entirely explain the expression of OCD, additional factors being required to change this prior genetic vulnerability.

In addition, the advancement of neuroimaging techniques has allowed to observe the hemodynamic changes of parts of the brain involved in OCD. The orbitofrontal cortex hyperfunction has been described with positron emission tomography in the TOC, clearly differentiating depressive disorders and schizophrenia, where there is evidence of hypofunction of the same area. The combined use of behavioral techniques and neuroimaging tests will allow a better understanding of the roles and location of the areas involved in this disorder. Recent studies show that the provocation of obsessive-compulsive symptoms correlated with increased flow in the orbitofrontal cortex and caudate alterations. Interestingly, the results of these techniques to assess the effects of treatment is independent of whether it is a behavioral and pharmacological treatment.

In conclusion, serotonergic theory remains the basis for the pathogenesis of OCD, but not sufficient, leaving open the investigation into the involvement of the basal ganglia and the dopaminergic system, without ruling out autoimmune factors or other (neuropeptides, arginine vasopressin , oxytocin and somatostatin) that could help in the future to shed light on the different subtypes of OCD and incardination within spectrum disorders, obsessive-compulsive disorder.

Pharmacotherapy



Psychoactive drugs have been widely used in the treatment of OCD. For a long period, from the 60 to 90, the drug used was clomipramine (Anafranil), a tricyclic antidepressant that is traditionally associated with reduced efficacy of depressive symptoms (Marks et al., 1980). After the 80's are a set of new drugs, selective inhibitors of serotonin reuptake inhibitors (SSRIs), which supported the role that serotonin appears to play in OCD (Barr, Goodman and Price, 1992) have been an important step in the pharmacological treatment of this disorder. The efficacy of SSRIs does not appear linked to the existence of depressive symptoms, and they have fewer side effects than clomipramine (Rasmussen, Eisen and Duck, 1993, Freeman et al., 1994).

Cognitive-behavioral Model

Unlike previous models, which places the causes of internal development factors of people, cognitive-behavioral models of psychopathology explained on the basis of learning inappropriate responses to environmental factors.

These models recognize that genetic and biological factors represent structural constraints operating on learning. They also recognize that there are disorders that are not the result of learning, such as autism, psychotic disorders or bipolar disorder.

His greatest contribution is that it opens the possibility of action to the individual (and therapist) to try to overcome their limitations.

The Court's past treatment achieved psychodynamic temporary improve so the TOC became a renowned reputation for intractable problem (Coryell, 1981). Subsequently, from the Behavior Therapy, initial approaches were also problematic. Indeed, while there was an improvement in the treatment of the problem, it was limited. The application of thought-stopping and other control procedures based on the contingency, were useful only in a small percentage of patients (less than 50%) (Stern, 1978). The situation improved with the application of the techniques used in other anxiety disorders, specifically with phobias. The application of systematic desensitization and other techniques such as paradoxical intention focused on repeated verbalization obsessive thoughts of OCD facilitated the approach although not significantly (Beech and Vaughan, 1978). The TOC resisted the power demonstrated by the treatment of behavioral therapy for anxiety disorders.

However, a specific method of cognitive behavioral therapy called "exposure and response prevention" [Exposure and response prevention "] is effective for many people with OCD. This method implies that the patient faces, deliberately and voluntarily to the object or dreaded notion, either directly or by imagination. At the same time, the patient is encouraged to abstain from its rituals to support and structure provided by the therapist, and possibly recruit others to assist the patient. For example, a person who compulsive hand washing can be encouraged to touch an object he / she believes is contaminated and then the person is urged to avoid washing for several hours until the anxiety provoked has greatly reduced. Treatment then proceeds step by step guided by the patient's ability to tolerate anxiety and control the rituals. As treatment progresses, most patients gradually experience less anxiety caused by obsessive thoughts and compulsive urges can resist.

EPR of behavior therapy emphasizes changing beliefs and thought patterns of the patient with OCD, From one of the theories of Albert Ellis from the psychopathological problems are explained by the inadequate system of beliefs (irrational beliefs) to deal their daily lives and thereby offering inadequate responses.

The cognitive contribution qualifies, both factors related to the acquisition and the maintenance. In the genesis of the disorder, the initial consideration of the problem as normal and the pathological step based on the evaluation and interpretation of it, is an improvement on the model of conditioning and a better explanation of how it causes the disorder. This means, from the therapeutic point of view, influence how the patient evaluates and interprets the intrusive thoughts. On the other hand, in regard to maintenance of the problem, stressing the responsibility, awareness of the patient to reduce the danger exists.

From the cognitive-behavioral approach emphasizes cognitive behavior modification through cognition (products, processes, interpretation ....) And the cognitive structures (beliefs, values).

The meta-analysis of van Balkom et al. (1994) concluded that the EPR, alone or in combination with SSRIs, it is more effective than SSRIs alone.

THEORETICAL BASE

KEY CONCEPTS

METHODOLOGY

THERAPY

ETIOLOGY

BIOLOGICAL MODEL

Biophysical factors such as anatomy and biochemistry are the determinants of psychopathology. The symptoms reflect the existence of a biological defect, either anatomical size or shape of certain regions is irregular or Biochemist: biochemical elements that contribute to neuronal function may have altered its function, plus or minus

anomalous organic process atypical disease:

Infectious microorganism

Systemic malfunction

Traumatic shock or sequel

Mental disorder, being considered as a disease, is classified and diagnosed categorical criteria.

Providing explanatory Resources from the doctor to understand the etiological factors of the condition to the validity of the forecast, increasing the effectiveness of treatment.

The use of pharmacology to modify the biochemical and physiological thresholds

Surgical treatment to destroy the diseased tissue

Electrical stimulation to modify patterns of neural organization.

The diagnostic and treatment is the individual

Causes of mental disorder. Is the alteration of the brain.

- Genetic factors

- Metabolic disorders.

- Hormonal disorders

- Infections

- Allergies

- Tumors

- Cardiovascular disorders

- Physical trauma

- Stress, and so on.

THEORETICAL BASE

KEY CONCEPTS

METHODOLOGY

THERAPY

ETIOLOGY

Psychodynamic MODEL? MICO

Based on the theory of repression. It focuses on data from unconscious processes. The function of the symptom is intrapsychic balance.

Formation of self and personality and their pathological aberrations.

Conscious and Unconscious

The revelation of unconscious relations, mainly through the narrative, free association, slips and study of the dreams of the treated person usually has no knowledge.

The task of therapy is to bring awareness to these remnants of the past and now can be re-evaluated and developed constructively.

The diagnostic and treatment is the individual

The primary origin of the disorder comes from repressed childhood anxieties and progressive sequence of defense mechanisms that evolved to protect the individual against the recurrence of these feelings.

THEORETICAL BASE

KEY CONCEPTS

METHODOLOGY

THERAPY

ETIOLOGY

BEHAVIORAL MODEL

Alternative biological model whose behaviors are objective variables (observables). Conditioning explains the mechanisms of complex behavior.

A) is based on objectivity and experimentation, focusing on the

Objective phenomena

Causal relationships between environmental events and behavior.

B) The principles of learning as a theoretical basis: to extinguish undesirable behavior.

C) Rejection of the disease concept is not applicable to behavioral disorders.

D) dimensional approach: It also rejects the categorical conceptualization of psychological disorders from the medical model. The abnormal behavior differs from the normal quantitatively but not qualitatively.

Abnormal behavior or psychopathological behavior that is maladaptive habits acquired through learning processes

that they have reached conditional on certain types of stimuli. Such habits are the clinical symptoms and abnormal behavior itself

Scientific theory: Provides an explanation of abnormal behavior, objectively and operationally, and hypotheses can be tested empirically.



The modification of behavior.

The diagnostic and treatment is the individual

Relevance of environmental factors: the cause of behavioral disorders due to environmental factors across the individual's experience.

The abnormality involves the malfunction of certain physiological systems

THEORETICAL BASE

KEY CONCEPTS

METHODOLOGY

THERAPY

Etiology of disorders

COGNITIVE MODEL

The study of consciousness and mental activity (cognition), which are higher mental processes of the individual.

The theoretical frameworks that support:

a) The "social cognition? cognitive or social psychology seeks to understand how and why the anomalies of the individual who is a social being. Studying as recorded, processed and retrieved social stimuli, such as information about oneself and others, and what are the contents of these stimuli.

b) The psychology of personality traits on understanding the social construction and studying and cognitive processes involved in acquisition and development.

c) Cognitive theories of emotion in which "all stimulus or situation must first be identified, recognized and classified before it can be evaluated and that may arise or activate an emotional response.



















































BIBLIOGRAPHY



(1998).



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