Complete Guide to Clinical Psychology

Clinical psychology integrates scientific knowledge, theory, and clinical expertise to understand, prevent, and relieve psychological distress and to promote subjective well‑being. Practitioners engage in assessment, diagnosis (largely guided by the DSM‑5‑TR and ICD‑11), psychotherapy, research, and often collaborate with psychiatry for pharmacological management. Key domains include mood, anxiety, psychotic, personality, neurodevelopmental, trauma‑related, substance‑related, eating, and neurocognitive disorders.

Core Pathologies

• Major Depressive Disorder (MDD)
• Persistent Depressive Disorder (Dysthymia)
• Bipolar I & Bipolar II Disorders
• Cyclothymic Disorder

Typical Evidence‑Based Therapies

• Cognitive Behavioral Therapy (CBT) — first‑line for mild‑to‑moderate depression and effective adjunct to medication.
• Interpersonal Therapy (IPT) — focuses on role transitions and interpersonal disputes.
• Psychoeducation & Family‑Focused Therapy — standard adjuncts in bipolar management.
• Electroconvulsive Therapy (ECT) or rTMS for treatment‑resistant or severe episodes.

Neuropsychological Perspective

Mood disorders involve dysregulation of limbic–prefrontal networks. MDD shows hyper‑reactivity of the amygdala and decreased dorsolateral prefrontal cortex activation, with reduced hippocampal volume linked to chronic stress and HPA‑axis hypercortisolemia. Bipolar disorders show oscillating connectivity between ventral striatum, anterior cingulate, and prefrontal cortex, coupled with glutamatergic and dopaminergic signalling shifts.

Typical Medications

• SSRIs (fluoxetine, sertraline, escitalopram) — first‑line antidepressants.
• SNRIs (venlafaxine, duloxetine) and atypical agents (bupropion, mirtazapine) for non‑response.
• Mood Stabilizers: Lithium (gold standard), valproate, carbamazepine for bipolar disorders.
• Atypical Antipsychotics (quetiapine, lurasidone) approved for bipolar depression & mania.

Core Pathologies

• Generalized Anxiety Disorder (GAD)
• Panic Disorder
• Social Anxiety Disorder
• Specific Phobias
• Agoraphobia, Separation Anxiety (across lifespan)

Typical Evidence‑Based Therapies

• CBT with Exposure & Response Prevention (ERP) — cornerstone across the spectrum.
• Mindfulness‑Based Stress Reduction & ACT for worry defusion.
• Brief Psychodynamic Psychotherapy for refractory cases or comorbid personality traits.

Neuropsychological Perspective

Hyper‑activation of the amygdala and bed nucleus of the stria terminalis (BNST) underlies sustained worry (GAD). A deficiency in GABAergic inhibition and heightened noradrenergic firing contribute to autonomic arousal. Chronic anxiety remodels connectivity between the prefrontal cortex (emotion regulation) and limbic structures, reinforcing threat schemas.

Typical Medications

• SSRIs / SNRIs — paroxetine, sertraline, escitalopram, venlafaxine.
• Benzodiazepines (e.g., clonazepam, lorazepam) for short‑term relief; monitor dependence.
• Buspirone (5‑HT_1A partial agonist) for GAD when benzodiazepines unsuitable.
• Beta‑blockers (propranolol) for performance anxiety.

Core Pathology

• Post‑Traumatic Stress Disorder (PTSD) — including complex, dissociative, and delayed‑expression specifiers.

Typical Evidence‑Based Therapies

• Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT)
• Eye‑Movement Desensitization & Reprocessing (EMDR) — recommended by NICE.
• DBT‑PE modules for comorbid suicidality or BPD traits.

Neuropsychological Perspective

PTSD features exaggerated amygdala reactivity, diminished ventromedial prefrontal inhibition, and hippocampal volume loss. Intrusive memories stem from failure to contextualize traumatic cues, linked to disrupted connectivity between the dorsal attention network and salience network.

Typical Medications

• SSRIs (sertraline, paroxetine) — FDA‑approved first‑line.
• Prazosin for trauma‑related nightmares.
• Augmentation: atypical antipsychotics (risperidone) or anticonvulsants (topiramate) for severe arousal.

Core Pathologies

• Obsessive‑Compulsive Disorder (OCD)
• Body Dysmorphic Disorder
• Trichotillomania & Excoriation Disorder
• Hoarding Disorder

Typical Evidence‑Based Therapies

• ERP‑focused CBT — gold‑standard for OCD.
• Habit Reversal Training for body‑focused repetitive behaviors.
• Family‑based CBT for pediatric OCD.

Neuropsychological Perspective

Abnormal cortico‑striato‑thalamo‑cortical circuitry, especially overactivity of the orbitofrontal cortex and caudate, perpetuates intrusive thoughts and compulsions. Dysfunctional error monitoring (hyperactive anterior cingulate) manifests as “not‑just‑right” feelings.

Typical Medications

• High‑dose SSRIs (fluoxetine 60‑80 mg/day, fluvoxamine 300 mg/day) and clomipramine (TCA).
• Atypical Antipsychotic Augmentation (risperidone, aripiprazole) for SSRI‑refractory OCD.

Core Pathologies

• Schizophrenia (paranoid, disorganized, catatonic presentations)
• Schizoaffective Disorder
• Brief Psychotic Disorder, Delusional Disorder

Typical Evidence‑Based Therapies

• Cognitive Behavioral Therapy for Psychosis (CBT‑p) — reduces distress & improves insight.
• Family Psychoeducation & Social Skills Training
• Cognitive Remediation for executive deficits.

Neuropsychological Perspective

Schizophrenia involves dopaminergic hyperactivity in mesolimbic pathways (positive symptoms) and hypoactivity in mesocortical projections (negative symptoms). Structural imaging reveals gray‑matter reductions in superior temporal gyrus and dorsolateral prefrontal cortex, along with enlarged ventricles.

Typical Medications

• Atypical Antipsychotics — risperidone, aripiprazole, olanzapine are first‑line.
• Clozapine for treatment‑resistant schizophrenia.
• Long‑Acting Injectables (paliperidone palmitate) enhance adherence.

Core Pathology

• Borderline Personality Disorder (BPD)
• Cluster A & C disorders (paranoid, avoidant, etc.) — briefly noted

Typical Evidence‑Based Therapies

• Dialectical Behavior Therapy (DBT) — robust evidence for reducing self‑harm and suicidality.
• Mentalization‑Based Therapy & Schema Therapy for affect regulation and attachment.

Neuropsychological Perspective

BPD patients exhibit fronto‑limbic dysregulation: hyper‑reactive amygdala, decreased anterior cingulate/ventromedial prefrontal inhibition, and impaired default‑mode network connectivity, leading to emotional lability and unstable self‑representation.

Typical Medications

• No medication cures BPD; pharmacotherapy is symptom‑targeted.
• SSRIs for mood lability, atypical antipsychotics for impulsivity, low‑dose mood stabilizers (lamotrigine, topiramate) for anger.

Core Pathologies

• Attention‑Deficit/Hyperactivity Disorder (ADHD)
• Autism Spectrum Disorder (ASD)

Typical Evidence‑Based Therapies

• Behavioral Parent Training & Classroom Interventions (children)
• CBT for executive function in adolescents/adults.

Neuropsychological Perspective

ADHD involves fronto‑striatal circuitry inefficiencies, delayed cortical maturation and reduced dopaminergic tone in the nucleus accumbens, leading to deficits in sustained attention and inhibitory control.

Typical Medications

• Stimulants (methylphenidate, dextro‑/lisdexamfetamine) are first‑line.
• Non‑stimulants (atomoxetine, guanfacine ER) for contraindications or side‑effects.

Core Pathologies

• Alcohol, Opioid, Stimulant, Cannabis, Sedative Use Disorders
• Gambling Disorder

Typical Evidence‑Based Therapies

• Motivational Interviewing & CBT‑Relapse‑Prevention
• 12‑Step Facilitation & Community Reinforcement Approach
• Contingency Management (voucher‑based rewards for abstinence)

Neuropsychological Perspective

Chronic substance use hijacks mesolimbic dopamine pathways, particularly the ventral tegmental area to nucleus accumbens circuit, weakening prefrontal executive control and enhancing cue‑reactivity.

Typical Medications

• Alcohol: naltrexone, acamprosate, disulfiram.
• Opioid: methadone, buprenorphine, extended‑release naltrexone.
• Nicotine: varenicline, bupropion SR, nicotine replacement.

Core Pathologies

• Anorexia Nervosa (restricting & binge‑purge)
• Bulimia Nervosa
• Binge‑Eating Disorder
• ARFID (Avoidant/Restrictive Food Intake Disorder)

Typical Evidence‑Based Therapies

• Enhanced CBT‑E — across diagnoses & age groups.
• Family‑Based Treatment (Maudsley) — adolescents with anorexia.
• Dialectical Behavior Therapy — for emotion‑driven binge/purge cycles.

Neuropsychological Perspective

Abnormal reward prediction in the striatum, heightened insula interoceptive awareness, and rigidity linked to fronto‑parietal networks contribute to distorted body image and restrictive control behaviors.

Typical Medications

• Fluoxetine for bulimia nervosa (reduces binge frequency).
• Lisdexamfetamine (Vyvanse) FDA‑approved for binge‑eating disorder.
• No pharmacotherapy reliably restores weight in anorexia; focus remains on nutrition & therapy.

Core Pathologies

• Alzheimer’s Disease
• Vascular, Lewy‑Body, Frontotemporal Dementias

Typical Evidence‑Based Therapies

• Cognitive Stimulation & Reminiscence Therapy
• Caregiver Psychoeducation & Environmental Modifications

Neuropsychological Perspective

Progressive synaptic loss and cortical atrophy impair memory (medial temporal), language (temporoparietal), or executive functions (frontal). Neuropsychological testing tracks domain‑specific decline and guides differential diagnosis.

Typical Medications

• Cholinesterase Inhibitors (donepezil, rivastigmine) slow cognitive decline in mild‑moderate Alzheimer’s.
• Memantine (NMDA antagonist) for moderate‑severe stages.
• Targeted anti‑amyloid monoclonal antibodies (e.g., lecanemab) in select cases (2023 FDA accelerated approval).

This overview condenses contemporary guidelines (e.g., APA, NICE, CDC) and peer‑reviewed meta‑analyses up to May 2025. Treatment should always be individualized, accounting for comorbidities, cultural context, and patient preference. Pharmacologic choices require medical evaluation for contraindications and monitoring of side‑effects.

This overview condenses contemporary guidelines (e.g., APA, NICE, WHO) and peer‑reviewed meta‑analyses up to May 2025. Treatment must always be individualised, accounting for comorbidities, cultural context, and patient preferences. Pharmacologic choices require medical evaluation for contraindications and monitoring of side‑effects.

1. NICE Guideline NG222: Depression in adults – treatment and management (2022; reviewed 2024)
2. NICE Guideline CG185: Bipolar disorder – assessment and management
3. APA Clinical Practice Guideline for the Treatment of Depression across Three Age Cohorts (2019)
4. NICE Guideline NG116: Post‑traumatic stress disorder (2018; surveillance 2024)
5. NICE Guideline CG31: Obsessive‑compulsive disorder & body dysmorphic disorder
6. NICE Guideline CG178: Psychosis and schizophrenia in adults – prevention & management
7. NICE Guideline CG78: Borderline personality disorder – recognition & management
8. APA Draft Practice Guideline for Borderline Personality Disorder (2023)
9. NICE Guideline NG87: ADHD – diagnosis and management
10. NICE Guideline NG69: Eating disorders – recognition & treatment
11. NICE Guideline NG97: Dementia – assessment, management & support for people living with dementia and their carers
12. World Health Organization. ICD‑11 Browser – Mental, behavioural & neurodevelopmental disorders chapter
13. American Psychiatric Association – Clinical Practice Guidelines portal