507- General Psychopathology Flashcards
ADHD
From psychopathology, part of diagnosis.
Attention-deficit/hyperactivity disorder: a neurodevelopmental brain based disorder marked by inattention, hyperactivity and impulsivity, or both. ADHD is commonly diagnosed in children, but symptoms must be age inappropriate for diagnosis.
- Occurs in males4x more than females.
- Commonly co-morbid with learning disorders and ODD/CD; also greater risk for substance abuse.
- Strong genetic component; 30% chance if 1st degree family member carries it
- ADHD is treated with stimulants like Ritalin and/or CBT (operant conditioning and token economies).
Clinical example: 7-yr-old Sophie disrupts her classroom instruction often by getting up and walking over to the window when she is distracted by something she sees outside, or blurting out thoughts and questions. When she is stuck at her desk, she fidgets constantly and is unable to sit still. Sophie’s pediatrician suspects that she may have ADHD.
Anxiety Disorders
Part of: psychopathology
What: Anxiety disorders occur when feelings of anxiety interfere with everyday life, includes multiple physical characteristics, and is irrational, uncontrollable, and disruptive. Anxiety is distinct from fear in that it is the central nervous system’s physiological and emotional response to a vague sense of threat or danger rather than a response to an immediate threat. Worry, physical arousal, panic attacks, feelings of tension and apprehension are common in anxiety disorders.
- more frequent in females (2:1)
- most common of mental disorders (29% of adults in a lifetime).
- Include Social Anxiety Disorder, Generalized Anxiety Disorder, Panic Disorder, Phobias, and Agoraphobia
They are often maintained through avoidance. Treatments include cognitive-behavioral therapy, mindfulness and relaxation techniques, along with exposure (if applicable) and anti anxiety medications.
Clinical example: Mark is afraid he will be judged or rejected in social settings. Even imagining a meal out with coworkers can elicit a physiological anxiety response in him. He avoids such situations as a way to manage his anxiety.
Anxiety sensitivity
Part of: psychopathology
What: A tendency to focus on one’s bodily sensations, assess them illogically, and interpret them as harmful. “Fear of fear.” Bodily sensations such as increased heart rate or nausea are mistaken as harmful and intensify anxiety.
Who: term Anxiety Sensitivity originally coined by Reiss who created Anxiety Sensitivity Index (ASI) which has spurred additional research.
Clinical example: Brenda notices her heart rate increases as she climbs the stairs in her apartment building. She interprets her increased heart rate as a sign of physical danger and presents at the ER a short time later saying she thinks she is having a heart attack.
Assessment interview
Part of: clinical practice
What: Primary technique for clinical assessment; an initial interview in which the counselor gathers information about the patient and begins to conceptualize their case and presenting problem(s) to aid in developing a treatment plan and/or making the diagnosis.
- Counselor should examine all spheres of influence & use multiple sources of info if possible
- A structured interview would include a clinician-administered formal assessment, while a semi-structured interview is more guided by clinical judgment.
- May be used in conjunction with other assessment techniques (e.g. psychological tests or screening tools like the BDI)
Clinical example: Bill schedules a consultation because he is having trouble concentrating at work and his wife says he is withdrawn at home. In his assessment interview, the therapist will gather family history information, ask specifics about his current problems, and use a screening measure like the BDI to get a better idea Bill’s psychological picture.
Bipolar I vs. Bipolar II
Part of: psychopathology
What: Both are mood disorders in which patients experience major depressive episodes, manic episodes, hypomanic episodes, and/or mixed episodes.
- Bipolar I is marked by full manic and major depressive episodes while bipolar II is marked by mildly manic episodes (hypomanic) and major depressive episodes. Bipolar II has later onset (around 20s). Bipolar II can be harder to detect as people do not notice the hypomanic episodes and rarely come into treatment. When they do it is for depression. Bipolar II is capable of turning into Bipolar I.
- Manic episodes typically last a week (hypomanic 3-4 days) & depressive episodes much longer
- Bipolar I and II can include psychotic features either mood congruent (i.e. thinking you are god during manic episode) or mood incongruent
Who:
-Equally common in men and women. Onset between 15-30 yrs old.
- Etiology ~ 50% heritability - strong genetic component
- Treatment usually includes medication to prevent mania and reduce kindling effect (Antipsychotics, mood stabilizers, lithium) and psychotherapy (focus on medication management and social skills; used in conjunction to meds). Therapy shown to help reduce hospitalization.
Clinical example: Drake has been unable to get out of bed most days for the past week. He finds pleasure in nothing, and had neglected his personal hygiene. A short time after this depressive episode, he finds himself staying up all night absorbed in a new project. He charges expensive items to his credit card and impulsively decides to go out with friends and get intoxicated. This episode continues for a week. Drake is suffering from Bipolar I.
Case study
A type of research that includes a detailed description of a specific individual and treatment of that individual. Useful to document success of a specific treatment, to describe a new treatment, or to demonstrate novel application of existing treatment (such as using anti-seizure medications for stabilizing mood) and can show the feasibility of implanting treatment with a specific population. Cannot generalize its results or determine causality.
Clinical example: A therapist working with a child with autism has a novel behavioral intervention. She decides to write a detailed case study of her treatment implementation to document the results of this new treatment.
Categorical v. dimensional diagnosis
A categorical approach (used by the DSM) assumes that traits are either present or absent in people, like a light switch that is on or off. Many theorists argue for a dimensional approach, which would see these traits along a continuum.
Clinical example: A clinician with a categorical approach may diagnose a woman who has volatile relationships, intense moods, self-harm practices and manipulative tendencies with borderline personality disorder. A clinician with a more dimensional approach might assess these behaviors according to severity and the degree to which they impact the person’s life.
Clinical significance
A type of significance assessed in research and measured in the participants. Clinical significance refers to a meaningful outcome of a treatment for a client. If a client’s change matches a relative norm for that behavior, or meets generally accepted standards for adaptive and acceptable functioning, it’s clinically significant. Clinical significance looks at the patient’s quality of life - symptoms, remission, etc. Do they still meet criteria for diagnosis?
Clinical example: Janelle came to treatment because of paralyzing social anxiety. After 12 weeks of CBT, she is pushing herself to attend social events despite her anxiety, and is noticing a decrease in her anxiety after a few exposures. Her outcome is clinically significant because it has made a marked difference in her life.
Comorbidity
A clinical term used to describe the coexistence of two or more clinical diagnoses in the same person at the same time. There are certain disorders that frequently present together, and it’s important to be aware of these as a therapist.
Clinical example: Substance abuse disorders are often comorbid with other mental disorders, so clinicians should assess for other disorders when treating substance abuse, and vice versa.
Competency to stand trial
A person is mentally competent to stand trial if the person charged with crime has capacity to understand the charges against them and ability to assist their lawyers in preparing a defense.
- Has nothing to do with the insanity plea–competency to stand trial is about the person’s mental state at the time of the trial, not at the time of the crime.
- Requires a cognitive assessment.
- The burden is to prove incompetence (on defense)
- If found incompetent, they will be held in a mental health hospital until competent, time dependent on the charges. After the time elapses, they will either be set free or put under civil commitment.
Clinical example: Boris has been diagnosed with schizophrenia. He is arrested on murder charges. Because of his delusions and other mental instabilities, he is held in custody but declared incompetent to stand trial.
Conduct disorder
A childhood disorder characterized by the violation of others’ basic rights by cruel or criminal behavior.
- Generally follows oppositional defiant disorder, and is typically more severe. (Progresses from oppositionality towards parents and adults to all authorities and eventually all of society.)
- Usually begins before age 10 and is exhibited by 6-16% of boys and 2-9% of girls.
- Etiology - poor family environment (inadequate parenting/reinforcement) and also genetic and biological factors
- Treatment is more effective at younger ages, with Parent-Child Interaction Therapy and Parent-Child Relationship Training having the greatest effects.
Clinical example: Trish has a pattern of lying to and yelling at parents and teachers. She was recently caught setting fire to a small shed in her grandparents’ backyard. She is likely to be diagnosed with conduct disorder.
Diagnosis
From the Greek word “a discrimination” - a determination that a person’s problems reflect a particular disorder or syndrome in a particular classification system (typically DSM-5). Diagnostic labels make it possible for clinicians to communicate easily with each other, but they also carry a negative connotation and a social stigma. Diagnoses also may not be accurate or perfectly fit an individual’s symptoms.
Clinical example: After an assessment interview, Claire’s symptoms of a weight below a healthy BMI for her age, starvation behavior, and fixation on thoughts of food and weight qualify her for an anorexia diagnosis.
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
The DSM-5 is a classification system, developed by the American Psychiatric Association and updated in 2013, which lists disorders, descriptions of symptoms, and guidelines for making appropriate diagnoses. It also includes dimensional information, rating how severe a client’s symptoms are and how dysfunctional the client is across various dimensions of personality and behavior.
Advantages of the DSM include that it allows for easy communication between clinicians and helps to stimulate research. Disadvantages include that diagnoses are stigmatizing and there can be significant overlap between disorders.
Clinical example: Shelley, a therapist, uses the DSM-5 to evaluate whether her clients’ symptoms indicate an official diagnosis. She uses the DSM codes when reporting to insurance companies for reimbursement.
Diathesis-stress
From the biopsychosocial model, this model posits that psychological disorders result from an interaction between inherent vulnerability and environmental stress. Diathesis refers to the propensity for the disorder or problem behavior to be expressed. The greater the diathesis and the greater the stress, the more likely you will develop the psychopathology.
Clinical example: Dale had his first episode of psychosis after losing his job and girlfriend. He was eventually diagnosed with schizophrenia. Later brain scans showed increased ventricles common in people with schizophrenia. Dale’s relatively psychologically normal life up until the point of intense stress is an example of the diathesis-stress model at work.
Dissociative disorders
A rare group of disorders characterized by a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment known as dissociation.
- Key features include depersonalization, derealization, a blurred sense of identity, and a profound disturbance in memory that does not have clear physical causes.
- In this family of disorders are dissociative amnesia, dissociative identity disorder (previously multiple personality), and dissociative fugue.
- Dissociative Amnesia: memory loss that cannot be explained by a physical or neurological condition
- With or without dissociative fugue; usually occurs in response to some sort of stressor or trauma
- Dissociative Identity Disorder: presence of 2+ distinct identities w/ recurrent gaps in memory. (Most controversial diagnosis in DSM; VERY rare)
- Dissociative Amnesia: memory loss that cannot be explained by a physical or neurological condition
-Those w/ a dissociative disorder have increased risk of complications, such as self-mutilation and suicide attempts.
Clinical example: Emilia goes missing. Days later, she is found in another state, applying for a job under the name Stephanie. She is suffering from dissociative fugue.
Dopamine
Dopamine is a key neurotransmitter that is involved in the pleasure center of the brain affecting learning, reward, and motivation.
- Critical in use/abuse/dependence roles of substances because almost every substance directly or indirectly affects the DA system.
- Stimulated by several such as ETOH, nicotine, cocaine, caffeine, and Amphetamines.
- Drugs like cocaine and heroin increase dopamine at key neurons, providing the pleasurable feeling that can lead to addiction, especially as naturally produced dopamine declines when it is routinely artificially introduced.
- Low dopamine activity is one of the biological reasons for major depressive disorder, and causes the extrapyramidal effects in Parkinson’s.
- Excessive dopamine activity is thought to contribute to the positive symptoms of schizophrenia, while too little dopamine is thought to contribute to the negative symptoms of schizophrenia.
Clinical example: Stan has been taking Haldol for over a decade to minimize symptoms of schizophrenia. He begins to experience severe shaking and jerky movements, a side effect of the dopamine-minimizing Haldol.
