Abnormal Psychology. William J. Ray

letter is displayed. The test then requires that the person respond when one particular letter followed by another letter is displayed. Children with ADHD have problems with this task. Thus, neuropsychological tests are also being used to understand brain processes in those with mental illness.

      Neuropsychological Tests and Mental Illness

      Neuropsychological tests can help identify cognitive changes associated with a particular disorder. For example, there is a rare occurrence of four sisters who all developed schizophrenia in their twenties. The Genain sisters were monozygotic quadruplets born in the United States in the early 1930s (see photo on this page). These sisters have been studied throughout their lives in terms of genetic makeup as well as cognitive functioning. When the sisters were 66 years of age, Allan Mirsky and his colleagues (2000) readministered a number of neuropsychological tests including the WAIS, the CPT, and WCST. The scores for each sister at age 66 were compared with their performance at ages 27 and 51. By showing that the test scores of the sisters over their lifetime had not changed, these researchers were able to show that cognitive decline is not part of schizophrenia.

      Using Neuroscience Techniques to Identify Mental Illness

      As more and more researchers and clinicians have come to see mental illness as representing problems with the brain, there have been a variety of projects to utilize neuroscience approaches to describe psychopathology (Andreasen, 2001). These have ranged from identifying the presence of certain genes and the manner in which they turn on and off in psychopathology to structural and functional descriptions of brain processes and psychophysiological changes measured throughout the body. The potential for using neuroscience approaches to classify mental illness and inform its treatment is an important one (see Cuthbert & Insel, 2010, 2013; Glannon, 2015; Halligan & David, 2001; Hyman, 2007, 2010; Insel, 2009; G. Miller, 2010; Sumner, Powers, Jovanovic, & Koenen, 2015).

      Traditionally, psychopathology has been defined in terms of signs and symptoms. The experiences of the client and what is observed by the professional are one level of analysis. In general, the mental health professional identifies symptoms that group together and the time of their appearance. Neuroscience techniques offer another level of analysis. From a research standpoint, scientists have sought to identify underlying markers associated with specific mental disorders. Using various brain imaging techniques described in Chapter 2 such as magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), electroencephalography (EEG), and magnetoencephalography (MEG), there has been a search for structural and functional changes associated with psychopathology. For example, researchers have been able to distinguish individuals with autism (Ecker et al., 2010) and with bipolar disorder (Rocha-Rego et al., 2013) from those without the disorder based on fMRI data.

      Part of the potential for using neuroscience markers is related to the fact that not every individual with schizophrenia, for example, reports the same symptoms. Some individuals describe auditory hallucinations, whereas others describe visual hallucinations. This is also the case with depression in that some individuals report different types of depressive symptoms than others. This suggests to some researchers that there might be different underlying brain processes involved in these variations. What now is considered as a single disorder may be better represented as separate disorders based on underlying mechanisms. Further, certain mental disorders also show gender differences. For example, females tend to develop schizophrenia later than males, but both males and females show similar rates of the disorder. However, females do show higher rates of mood and anxiety disorders.

      Overall, neuroscience methods may lead to better diagnostic procedures as well as understanding the mechanisms of the disorder. For example, genetic research suggests similarities between schizophrenia and bipolar disorder in terms of the genes involved. It is also possible to use neuroscience techniques to follow the course of a disorder over time. One study (Raj, Kuceyeski, & Weiner, 2012) based on brain imaging methods suggests that neurocognitive disorders follow specific pathways in the brain. Another potential for neuroscience methods is that by knowing the underlying brain and genetic processes involved in a particular disorder for a particular person, it would be possible to create a treatment that is designed specifically for that individual.

      The potential for using neuroscience approaches to classify mental illness and inform its treatment is an important one.

      National Institute of Mental Health

      Concept Check

       For each of the following types of assessment, what kinds of information can you obtain from it and what is one example of it?Symptom questionnairePersonality testProjective testNeuropsychological testNeuroscience technique

      Diagnostic Considerations in Psychopathology

      Over the past 100 years, there have been a variety of debates on how to diagnose and classify mental disorders. In the past 50 years, the emphasis has been on reliability of diagnosis such that mental health professionals in one location would diagnose the same individual in the same manner as professionals in another location. As part of this emphasis, there has been a push for observable characteristics that would define a specific disorder. Such characteristics as depressed mood over the day, diminished interest in activities, weight loss, insomnia, fatigue, feelings of worthlessness, difficulty thinking, and thoughts of suicide would be considered in the diagnosis of depression. These types of criteria make up the structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA), and the International Classification of Diseases (ICD), published by the World Health Organization (WHO). The DSM is used in North America, whereas the ICD is used in Europe. In general, the criteria used in the DSM and ICD are signs and symptoms that are delineated through observation of, and conversation with, the individual.

      Diagnostic and Statistical Manual of Mental Disorders (DSM): a publication of criteria for diagnosis by the American Psychiatric Association (APA), used in North America

      International Classification of Diseases (ICD): a publication of criteria for diagnosis by the World Health Organization (WHO), used in Europe

      Categorical Versus Dimensional Approaches

      The historical considerations of psychopathology emphasized careful observation and interaction with the afflicted individuals as important methods for understanding the nature of the disorder. Based on these observations of symptoms and signs, individuals were diagnosed and classified as falling into discrete categories of disorders. This is an important level of analysis and one I will emphasize throughout this book. However, there are other levels of analysis for understanding psychopathology.

      With progress in the neurosciences in general and brain imaging and genetics in particular, other levels of analysis have become possible. These new levels of analysis offer different perspectives for the field of mental illness. What seemed like discrete categories of psychopathology previously are now seen to cluster in new and different ways when considered from the standpoint of genetics. Additional groupings have emerged as scientists have considered the neural networks involved in particular manifestations of psychopathology. This has led to the realization that mental disorders can be described in both a categorical and a dimensional manner.

      categorical: in psychopathology, describes the approach to determining whether a person has or does not have a disorder based on the presence or absence of a certain set of symptoms

      dimensional: in psychopathology, describes the assessment of severity of a disorder on a continuum, in terms of differing degrees

      As shown in the physical sciences, there are times in which a phenomenon can be described both categorically and dimensionally. For example, when water is heated, the rise in temperature