507- General Psychopathology Flashcards
ADHD
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 males 4x more than females.
- Commonly comorbid 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. Based on Sophies inability to focus and impulsivity, Sophie’s pediatrician screens her for ADHD.
Anxiety Disorders
Part of: Psychopathology
What: Anxiety disorders occur when feelings of anxiety interfere with everyday life, include multiple physical characteristics, and are 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. Mark’s symptoms of physiological arousal, avoidance of stimuli that provoke discomfort, and negative emotions in imagined social interactions indicate he may have an anxiety disorder.
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 1. success of a specific treatment, 2.
to describe a new treatment, or 3. 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.
EXAMPLE: You’re taking on a new client with an extremely rare psychological disorder. You turn to the research and decide to read up on all of the available case studies because that is the bulk of what is available, since it is such a rare condition.
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 or scale rather than as simply present or not present.
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.
EXAMPLE: When using a prototypical categorical approach, you must determine that the client has a depressed mood and a decrease in pleasure, plus a certain number of additional symptoms in order to be diagnosed with depression.
EXAMPLE: A family doctor referred the client to the therapist after making a categorical diagnosis of the client having anxiety and depression. The doctor prescribed 2 separate medications, one for anxiety and one for depression. The therapist will now conduct an assessment interview with the client in order to rate the symptoms and features of anxiety and depression to then make a more dimensional diagnosis.
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. In other words, does the client achieve a meaningful amount of change or reduction in symptoms due to the treatment. 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. Jane reports feeling more hopeful about her ability to be social. 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 such as PTSD and substance use disorders or anxiety and depression, 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.
EXAMPLE: You are assessing a patient’s competency to stand trial. The patient presents with psychotic symptoms and a complete inability to communicate. He cannot even understand simple commands. You recommend that he is not competent to stand trial because you do not think he understands the charge against him nor do you think he can assist the lawyers in prepping a defense.
Conduct disorder
Part of: psychopathology
Who: A childhood disorder
What: characterized by the violation of others’ basic rights by cruel or criminal behavior.
- Generally considered developmental and 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.
EXAMPLE: 13-year-old client was court-ordered to see a child therapist because of his 2nd shoplifting offense. He also has a history of drug/alcohol use, getting into fights, vandalism. He has been abusing the neighborhood cats and has been “the” bully at school since third grade. This client will be screened for a 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 and can aid in treatment planning (especially for identifying ESTs), 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.
EXAMPLE: Kara was a freshman in college and came into the counseling center presenting symptoms of an eating disorder. The counselor asked Kara about her eating habits and Kara said that she would go to the cafeteria once a day, by herself, and consume large quantities of food - especially pasta and ice cream. She would then feel so guilty about eating that she would make herself vomit and not eat for the rest of the day. Kara didn’t like to engage in this behavior but felt that she truly couldn’t stop herself once she started eating. The counselor diagnoses Kara with Bulimia Nervosa based on her symptoms which had lasted for over 6 months.
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
The DSM-5 is a categorical prototypical classification system, developed by the American Psychiatric Associated and updated in 2013, which lists disorders, descriptions of symptoms, and guidelines for making appropriate diagnoses. The DSM-V is used by most mental health practitioners in the US to diagnose mental disorders. 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 a particular disorder.
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.
EXAMPLE: The Diathesis-Stress model can help explain why identical twins separated at birth might have different outcomes. Say, one develops schizophrenia and the other doesn’t. Because they both have the same diathesis, we might conclude that one of the twins had a more stressful upbringing than the other.
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.
EXAMPLE: Client comes to treatment because her parents are incredibly worried about her behavior. 2 weeks ago she went missing, and was recently found in Oregon in a homeless shelter with no recollection of her identity. Her parents filled the clinician in that she has been under extreme stress at school, her sister just died, and she lost her job, didn’t get into boarding school… Therapist diagnoses her with dissociative amnesia w/ 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.
- repeated use of drugs impacts the DA system a lot; difficult to feel pleasure without the substance
- 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.
Eating disorders
Part of: Psychopathology
What: Eating disorders are characterized by being preoccupied with food, weight, and appearance as well as maladaptive patterns of behavior and thinking surrounding food. Individuals w/ eating disorders often struggling with depression, anxiety, obsessiveness, and the need to be perfect.
Who: Suffered most often by adolescent women, and more prevalent in certain sports like gymnastics, wrestling, and horse jockeying.
Types of eating disorders:
- Anorexia nervosa: marked by the pursuit of extreme thinness and by extreme weight loss)
- Bulimia nervosa: marked by frequent eating binges followed by forced vomiting or other extreme compensatory behaviors to avoid gaining weight
- Binge eating disorder: marked by frequent binges without extreme compensatory acts.
- These illnesses are often accompanied by a multitude of health issues and are frequently co-morbid with anxiety and mood disorders, certain personality disorders, and substance abuse.
- Etiology”. Can be caused by learning, family dynamics, or genetic components.
- Treatments include CBT, Interpersonal Psychotherapy (focus on relationship elements and patterns in relationships - for bulimia), family counseling and medication (usually done in conjunction with talk therapy).
Clinical example: Clint started using weight loss strategies to maintain his weight class in wrestling. Over time, his thoughts and daily behavior became fixated on losing more weight, even after he reached his weight loss goal. His diet is very regimented and restrictive, and he exercises for hours each day. Clint’s coach refers him to a psychologist who diagnoses him with anorexia nervosa.
EXAMPLE: Julie’s friend told her that she would probably have a lot of boyfriends if she lost some weight. She began restricting her diet and exercising. As she began to lose weight, boys started noticing her which reinforced the behavior. She also felt a sense of control about losing the weight. Her family sent her to counseling where she was diagnosed with anorexia. She was 5’9 and weighed 90 lbs. She still believed she was fat.
GABA
Part of: psychopathology
What: gamma-aminobutyric acid (GABA): an inhibitory neurotransmitter that regulates anxiety. It carries inhibitory messages: when GABA is received at a receptor, it causes the neuron to stop firing. This finding led researchers to believe that GABA plays a key role in the reduction of normal, everyday fear reactions.
- The anxiety-reducing abilities of ethanol and benzodiazepines work by increasing GABA levels.
- Low levels of GABA are associated with generalized anxiety disorder.
- Increasing GABA also vicariously increases dopamine levels in the pleasure pathway. Contributes to tolerance and withdrawal – conditioned compensatory response
Clinical example: Denise has been diagnosed with Generalized Anxiety Disorder. As part of her treatment, she is prescribed Xanax, which increases GABA activity, a deficiency thought to be common amongst people suffering from anxiety disorders.
EXAMPLE: A veteran suffering from symptoms of PTSD had started abusing alcohol shortly after his return to the United States. The psychiatrist explained the use of Alcohol has been shown to bond to GABA receptors, which lowers anxiety, making him feel better.
Heritability
Part of: genetics term;
What: the proportion of observed variation in a trait or disorder that can be attributed to inherited genetic factors rather than to environmental factors; a factor in the nature vs nurture debate.
EXAMPLE: Understanding the heritability of Bipolar I disorder, the therapist asked the client if his family had a history with the disorder. She also explained to him that one of the biological explanations for the disorder suggests that individuals inherit a predisposition for the disorder.
HPA pathway
Part of: developmental psychology
What: Hypothalamic-Pituitary-Adrenal (HPA) pathway: biological route connected to stress and fear reactions, one route by which the brain and body produce arousal- pituitary gland secretes ACTH (major stress hormone), which stimulates the adrenal glands which secrete corticosteroids (stress hormones).
- This pathway is most associated with PTSD and other trauma/stress disorders.
- Cortisol production tends to be elevated in people with BPD, indicating a hyperactive HPA axis in these individuals.
- Since traumatic events can increase cortisol production and HPA axis activity, one possibility is that the prevalence of higher than average activity in the HPA axis of people with BPD may simply be a reflection of the higher than average prevalence of trauma among people with BPD.
Clinical example: Since being attacked in a parking lot, Jenny reacts to stress with heightened anxiety. Her therapist explains that the trauma may have affected her HPA pathway, causing abnormal activity of cortisol and norepinephrine.
EXAMPLE: A client was diagnosed with Borderline Personality Disorder, and she did not understand why her parents sent her to a therapist who specializes in Dialectical Behavior Therapy, rather than the therapist she had been going to who specialized in CBT. The DBT therapist provided psychoeducation to the client by explaining to her that there is likely increased activity in her HPA pathway due to trauma. This produces a type of anxiety/stress that is more deep rooted in her genetics and body’s stress response than a person with Generalized Anxiety Disorder or Depression and thus takes longer for her to return to baseline. Therefore, Borderline Personality Disorder is best treated with a different type of therapy than cognitive behavioral therapy.
Idiographic v. nomothetic assessment/understanding
An idiographic assessment takes an individualized approach, allowing for the understanding of symptoms in the individual’s cultural context.
A nomothetic understanding is a general understanding of the nature, causes, and treatments of abnormal functioning, in the form of laws and principles. Good assessment/practice combines idiographic and nomothetic approaches. Achieved by means of large research investigations resulting in generalizable laws of behavior. (based on the scientific method)
This type of understanding helps clinicians to have a starting point for diagnosis with each client instead of always beginning anew.
-The DSM is an example of a nomothetic tool that came from years of research.
Clinical example: In her practice, Melanie leans toward an idiographic understanding of her clients, focusing on their individual assets, experiences, and family histories.
Insanity
NOT a clinical term, but rather a legal term describing an individual who was mentally ill at the time of their crime(s) and is therefore not morally responsible for the act(s).
- Developed as an attempt to protect people with mental illnesses from being punished for harmful behavior resulting from their disorder.
- The burden of proof lies on the defense to prove insanity
- Requires psychological assessment
Example: A person is on trial for assault and vandalism. The defense please not guilty by reason of insanity because their client, who has been diagnosed with schizophrenia, was delusional when he committed the crime.
Mania
Part of: psychopathology
What: Characterized by an abnormal mood (irritable, expansive, or high) and at least three or more other criteria including inflated self esteem, increased energy, decreased sleep, racing thoughts, pressured or increased speech, or impulsivity and poor judgement.
- Manic episodes typically last a week or more, hypomanic 3-4 days. Productivity element huge in hypomania. Hypomania also has more irritability.
- Can include psychosis – mood congruent (grandiosity, paranoia) or incongruent (aliens). Mood congruent most common.
- Typically mania is experienced as pleasurable by the client
- Manic episodes come with increased suicide risk
- One manic episode makes following episodes more likely - a process called kindling.
Clinical example: Charlie has been awake for 36 hours working on a screenplay he believes is a work of genius. When he runs into a neighbor on a smoke break, he speaks in an energetic, frenzied, barely comprehensible manner. Charlie is experiencing mania.
Mood disorders
Part of: psychopathology
What: A class of disorders characterized primarily by severe disturbances in mood.
Including: Mood disorders include major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder, bipolar disorder, and cyclothymic disorder. Inadequate serotonin/dopamine function is part of what causes mood disorders.
- These typically include depression, bipolar, and variants of the two.
- Symptoms of these disorders may include depressive or manic episodes.
- Depressive episodes may include symptoms such as hopelessness, lack of energy, and anhedonia, inability to concentrate, increased/decreased appetite, etc.
- Mania may include euphoria, increased energy, racing thoughts, pressured speech
- Etiology includes a variety of causes including genetics, learning, and cognitive errors.
- Heritability 30% depressive disorders, 50% bipolar disorders
- Treatments include medication, CBT, behavioral activation, and mindfulness-based treatment, amongst others.
Clinical example: Patricia finds it difficult to get out of bed, and finds no pleasure in activities she once enjoyed. These symptoms have persisted for a month. Patricia may be diagnosed with depression, a mood disorder.
