8. Psychopathology and 9. Therapeutic Orientations Flashcards
cultural relativism
person’s beliefs and practices need to be understood in context of their own culture and not judged against the criteria of another culture
distressing
behaviour distressing to individual or to ppl around them
deviance
behaviour is not in line w society’s norms
harmful dysfunctional
behaviour interferes with ability to work, and have relationships
etiology
cause or origin of disorder
somatogenic theory
psychological disorders were disease states, arising from illness, genetic issues, or deterioration of brain
humorism
belief by ancient greek physicians that imbalance in bodily humours affecting mental and health states
what happened in mid 1950’s to psych diagnosis
- diff diagnosis
- result was the diagnostic and statistical manual of mental disorders (DSM)
anxiety
state of fear
neurotic anxiety
result of impulses from the Id threatening to break thru
cognitive psychologists support the idea of…
maladaptive thought patterns — stimuli elicit a physiological response that is catastrophically appraised leading to anxiety
behavioural psychologists believe that…
conditioning is involved, especially with phobias
Generalized anxiety disorder
chronic state of anxiety due to over-worrying about everyday issues
- moderately heritable
- sympt need to be present at least 6 months
- hypervigilance
hypervigilance
constant scanning of one’s environment for danger
social anxiety disorder
acute fear of social situations
performance only social anxiety disorder
limited to situations where individual feels they must perform - can impact performance
panic disorder
feelings of helpless terror that occur at unpredictable times, unprovoked by any specific environmental cue
PTSD
anxiety disorder develops following a traumatic experience
acute: 1-3 months post-traumatic event
chronic: more than 3 months post-traumatic event
delayed: begins 6 months post-traumatic event
obsessive compulsive disorder:
associated with uncontrollable tasks or thoughts
compulsions
repetitive actions
obsessions
continual or intrusive thoughts
thought-action fusion
overestimating relationship between thought and action
Unipolar disorders: Depression
lack of pleasure combined w sense of hopelessness
Unipolar disorders: Major depressive disorder (MDD)
severe depression that interferes with functioning; lasts for at least 2 weeks, no history of manic episodes
Depression diagnosis
5 or more of: depressed mood, diminished interest or pleasure in almost all activities (need one of these two), significant weight loss or gain or an increase or decrease in appetite, insomnia or hypersomnia, etc
Persistent depressive disorder
less severe symp that last for at least 2 yrs
- feeling depressed for more days than not
- cannot b without symp for more than 2 months
Manic
persistent euphoric mood or irritable mood, intense energy, and exaggerated behaviours; can exhibit feelings of invincibility or extreme goal-directed behaviour
- last a week or longer, impairment can be significant
- 3-4 symptoms of grandiosity, increased goal-directed activity, reduced need for sleep, racing thoughts/ideas
hypomanic
elevated mood w/o severe impairment; last 4 or more days
bipolar
polar extremes of activity: combo of depression, and mania
- episodes of depressive behaviour, manic behaviour, and normal behaviour
Bipolar 1: single or recurring manic episodes; episodes of depression not necessary
Bipolar 2: single or recurring hypomanic and depressive episodes
- norepinephrine drops during depression and increases during mania (SNS)
bipolar prevalence
increasing in younger
women 2x more likely to suffer from depression
is there a strong hereditary predisposition for depression
yes sir
monoamine theory of depression
depression due to a general depletion of monoamines (dopamine, serotonin, and norepinephrine). drug therapy for depression typically focuses on either raising level of norepinephrine or serotonin
tricyclics
block reuptake of serotonin and norepinephrine
- selective serotonin reuptake inhibitors: increase the activity of serotonin only
lithium
will decrease excitatory neurotrasmitters (dopamine and glutamate) and increase inhibitory neurotransmitters
therapeutic treatment for bipolar disorder
interpersonal and social rhythm therapy
SSRI
(Selective serotonin reuptake inhibitors)
1. serotonin is released into synapse
2. has to be recycled or reuptake
SSRI - inhibit reuptake
3. serotonin stays in synapse
comorbidity
you can be diagnosed w more than 1 disorder
non pharmaceutical treatments (biological)
(biological)
1. electroconvulsive shock therapy (ECT) - effective for major depression. cannot relieve anxiety or schizophrenia. current to induce a seizure.
2. transcranial magnetic stim - noninvasive, delivers pulsating magnetic fields to cortext to induce electrical activity
3. deep brain stim - implanting an electrode into brain to stimulate that region
schizophrenia
- serious disorder
- symptoms seriously impact individuals ability to work, care for themselves, and interact with others
- men 18-25
- women 26-45
- schizophrenia is a psychosis where there is a disconnection from reality
5 main symptoms of schizophrenia
- delusions
- hallucinations
- disorganized speech
- grossly disorganized behaviours
- negative symptoms
(one of the two must be delusions, hallucinations, or disorganized speech)
phases of schizophrenia
- premorbid (b4 onset)
- predromel (beginning -> sympt start)
- recovery or active
- if active then sympt cognitive w treatment, if recovery than residual (no sympt)
precipitating factors
strong evidence for genetic predisposition though no “schizophrenia gene” has been found
brain atrophy
can be a causative agent
- less white matter, ventricles enlarged
dopamine hypothesis
overactivity of dopamine system; some antipsychotic meds work by blocking the dopamine receptors
antipsychotics: typical
blocks dopamine receptor, reduces positive but not negative symptoms or the cognitive side-effects
antipsychotics: atypical
influence dopamine as well as other receptors to reduce dopamine levels, but not to the same extent
personality
characteristic pattern of behaviour, thought, feeling, and beliefs
personality types
represent discrete categories of defining someone’s personality
personality traits
rep continuous levels of definitions
- 3 criteria: consistency, stability, and individual differences
OCEAN (treat theory of personality)
O - Openness
C - Conscientiousness
E - Extroversion
A - Agreeableness
N - Neuroticism (most correlates w health issues)
Trait-based Personality Disorders: Avoidant
social inhibition and hypersensitive to criticism (neuroticism and introversion)
Trait-based Personality Disorders: Antisocial
disregard for rights of others; may be aggressive or destructive and will break laws and be deceitful (antagonism and low conscientiousness)
Trait-based Personality Disorders: Dependent
excessive need to be taken care of; clinging and submissive; separation anxiety (neuroticism and maladaptive agreeableness)
Trait-based Personality Disorders: schizoid
detachment from social relationships and limited range of emotional expression (introversion)
Trait-based Personality Disorders: obsessive compulsive
preoccupied with perfectionism, orderliness, and control (maladaptive conscientiousness)
Trait-based Personality Disorders: borderline
unstable relationships and self-image (neuroticism)
Trait-based Personality Disorders: histrionic
excessively emotional and attention seeking (maladaptive extraversion)
Trait-based Personality Disorders: narcissitic
grandiosity, desire for admiration, lack of empathy (neuroticism, extraversion, introversion, unconventionality, antagonism)
Trait-based Personality Disorders: paranoid
distrustful and suspicious or others
Unspecified Personality Disorder (UPD) and OSPD
When clinician suspects personality disorder, but it does not quite meet criteria for anything
who was the pioneer of psychopathy
Cleckley
described psychopathic as being able to mimic a normally functioning person, presenting as sociable and well adjusted, but lacking internal personality structure
3rd edition of DSM replaced term psychopathy w…
Antisocial Personality Disorder
Dark Triad
narcissism, psychopathy, and machiavellianism
which would be a likely treatment for major depressive disorder
selective serotonin reuptake inhibitors
ex of negative sympt
Anhedonia - loss of joy
Amotivation
Alogia - flat speech
in schizophrenia, disorganized speech is a ____________ sympt and hearing voices is a _________ sympt
positive, and positive
best characterization of comorbidity:
a) disorders without interventions
b) intrusive thoughts about death
c) several members of a family having the same disorder
d) individual has more than one disorder at the same time
d) individual has more than one disorder at the same time
to understand an anxiety disorder we need to look at
both environmental and biological factors
in obsessive-compulsive disorders, obsessions are to ____________ as compulsions are to ____________
thoughts, actions
how could CBT extinguish fear of mice
exposure to feared CS in absence of UCS while using response prevention so extinction can occur
psychoanalysis therapy
goal is to focus on revealing unconscious thoughts
- helps patients achieve insight
3 structures of personality
- Id: pleasure center of mind, concerned with animal-like impulses and urges
- Ego: concerned with making decisions and rational thinking
- Superego: last personality structure to develop, concerned with moral principles and could be thought of as the conscience
transference
transfer feelings to the therapist
countertransferance
therapist feelings displaced onto client
psychodynamic therapy
clients are seen fewer times a week and focus on their current life
interpersonal theory
focuses on clients interpersonal relationships
behavioural therapy: systematic desensitization
gradual exposure to fearful stim along w relaxation techniques
(uses fear hierarchy)
ex: exposure phobia for snakes
1) fear hierarchy: thought, picture, adjacent room, see thru window, in same room
2) “imagine you see snake”
“i don’t feel good”
therapist: guided relaxation techniques to reduce SNS response
behavioural therapy: flooding
full exposure with no possibility of harm
behavioural therapy: interoceptive exposure
induce somatic symp then use relaxation techniques to calm the body
cognitive restructuring/cognitive therapy
result of maladaptive thought processes and seeks to change these processes to something more positive
CBT
- exposure based cognitive behavioural therapies are good for anxiety disorders
- have enlarged in last two decades
- centered on mindfulness and acceptance
- present focused
- restructure thinking based on evidence: challenging distressing thoughts w evidence from reality
Mindfulness Based Stress Reduction (MBSR)
- Mindfulness - focus on the moment; non-judgemental w thoughts
Acceptance and Commitment Therapy (ACT)
- steven hayes
- has mindfulness at its base
- teaches clients to control their thoughts and feelings
- acceptance reduces anxiety
- also determine which life goals are in alignment with their values and commit to working towards them
Dialectical Behavioural Therapy (DBT)
- developed for borderline personality disorder: very challenging to treat
- uses techniques from cognitive, behavioural, psychodynamic, and humanistic fields
- traces the roots of the disorder
- mindfulness is the foundation
- goal to reduce destructive behaviours and suicide attempts
is there a best form of therapy
no
cognitive behaviour therapy for
- phobia
- anxiety
- depression
DBT for
borderline personality disorder
exposure therapy makes use of which classical conditioning
extinction
when conducting therapy outcome research, finding a nonspecific treatment effects is concerning bc it means that…
any treatment is beneficial
best biomed treatment for psychological disorders
drugs and brain interventions
what does psychodynamic therapy aim to explore
the unconscious
tricyclics, monoamine inhibitors, selective serotonin reuptake inhibitors are treatments for
depression
you are a psychiatrist meeting a new patient. B4 picking treatment plan what are things you should know.
- patient history/history of presenting illness (HPI)
- review of sys for psychiatric conditions
- any other relevant mental disorders they have
- personal/social history (meds, alc/drug use)
- relevant family history
patient: zoe
she’s been feeling depressed
got a low grade on assignment, feels like a failure
you challenge her thinking, saying she is on the dean’s list and doing research
what therapy would you use
CBT
- to challenge her inappropriate thoughts
- zoe suffering from maladaptive thoughts -> may lead to anxiety and depression (reconstructing will help)
compare/contrast 3 therapeutic techniques described in this course
- Biological: pharmaceuticals (SSRI)
- Humanistic: client-centered therapy (unconditional positive regard and empathy, active listening to help client reframe thoughts)
- Psychoanalysts: exploring the unconscious (free association/dream interpretation)