Clinical Psychology: Disorders and Therapies

Throughout the world, individuals, groups, and communities are faced with major incidents, crises, and disasters. The impact of disasters can be wide-ranging, involving death, severe injury, the loss of home, shelter, liberty, security, and food, in addition to social dislocation and destroyed infrastructure and networks. Victims can experience distress, anger, grief, and fear together with symptoms of anxiety, depression, and post-traumatic stress. First responders and those delivering longer-term social and psychological support can be adversely affected by direct exposure to the disaster, by learning about the details of the disaster from the testimony of victims, or by viewing distressing images or artifacts connected to the disaster. To reduce the impact of disasters, communities and emergency services need to prepare plans to meet the physical, social, and psychological needs of those involved and undertake thorough testing of these plans to ensure they are fit for purpose. This planning needs to consider natural hazards such as forest fires, floods, drought, and biological hazards, including Covid-19, influenza, foot and mouth disease, and severe acute respiratory syndrome. Human and technological failings can also create hazards seen in transport crashes, the release of toxic substances, and armed conflict. Contingency planning is used to reduce exposure to a hazard by identifying and protecting those at most risk of harm. However, it is impossible to prevent crises and disasters from happening, making it essential to provide appropriate and timely support. Initial support ensures that disaster survivors are taken to a safe place where their immediate needs for food, drinks, and shelter are met. The aim of early psychosocial responses to disasters are fourfold: (a) to increase disaster preparedness to reduce the impact of hazards and vulnerabilities, (b) to respond to the immediate human needs for safety and survival, (c) to communicate care and provide psychological support, and (d) to provide an opportunity for survivors to process and create meaning from experiences. Ideally, all early psychosocial interventions would be evidence-based and delivered by trained and monitored practitioners; however, often, this is not the case. Despite the development of an abundance of disaster-related models, few have been evaluated; this failure is due to a lack of agreement on the aims, scope, measures, and training required to deliver evidence-based interventions. Humanitarian and emergency response organizations look toward psychologists to provide them with the evidence-based interventions, evaluation tools, and guidance they need for dealing with disasters.

Depression is defined in diagnostic literature as a mood disorder characterized by depressed mood, loss of interest or pleasure in activities, significant changes in weight, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, difficulty concentrating, and suicidal ideation and/or attempts. Research suggests a link between depressed mood and monoamine depletion, elevated cortisol, and inflammation, but existing laboratory evidence is inconclusive. Current treatments for depression include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), and lifestyle changes; however, more severe forms of the disorder can require other medication, sometimes in combination with electroconvulsive therapy (ECT). Disagreement persists over how to define and classify depression, in part due to its ambivalent relationship to melancholia, which has existed as a medical concept in different forms since antiquity. Melancholia was reconfigured in 19th-century medicine from traditional melancholy madness into a modern mood disorder. In the early 20th century, melancholia gradually fell out of use as a diagnostic term with the introduction of manic-depressive insanity and unipolar depression. Following the publication of DSM-III in 1980 and the introduction of SSRIs a few years later, major depressive disorder became ubiquitous. Consumption of antidepressants have continued to rise year after year, and the World Health Organization notes depression as the leading cause of disability worldwide. At present, internationally recognized systems of classification favor a single category for depressive illness (alongside a circular mood disorder, bipolar I and II), but this view is challenged by clinicians and researchers who argue for the reinstatement of melancholia as a separate and distinct mood disorder with marked somatic and psychotic features.

The assessment of older adults is quite challenging in light of the many age-related physiological and metabolic changes, increased number of chronic diseases with potential psychiatric manifestations, the associated medications and their side effects, and the age-related changes in the presentation of common mental health problems and disorders. A biopsychosocial approach to assessment is particularly important for older adults due to the substantial interplay of biological, psychological, and social factors that collectively produce the clinical presentation faced by clinicians. An appreciation of age-related and non-normative changes in cognitive skills and sensory processes is particularly important both for planning the assessment process and the interpretation of findings. The assessment of older adults is unfortunately plagued by a paucity of age-appropriate assessment instruments, as most instruments have been developed with young adults. This paucity of age-appropriate assessment instruments is an impediment to reliable and valid assessment. Notwithstanding that caveat, comprehensive and valid assessment of older adults can be accomplished through an understanding of the interaction of age-related factors that influence the experience and presentation of psychiatric disorders, and an appreciation of the strengths and weaknesses of the assessment instruments that are used to achieve valid and reliable assessments.