Abnormal Flashcards
Components of disorders
- Dysfunction
- Disturbance
- Disability
- Distress
- Violation of norms
- Statistical infrequency
Early views
- Demonology
- Biological (e.g. excess fluids)
- Bethlehem asylum
Paradigm
Conceptual framework or general perspective (shapes what people investigate and find)
Biological paradigm (explaining)
- Mental health legislation
- Classification
- Scientific method
- Medical tech
- Pharmacological and physical treatment
- Reductionist
- Stigma
- Discounts environmental influences
- Side effects of medications
- Medications are not necessarily treating the problems
Psychoanalytic paradigm (explaining)
- Extremely influential
- Legitimised psychotherapy (talking cure)
- Inspired other models
- No longer top choice
- Untestable central concepts
Behavioral paradigm (explaining)
• Lead to important developments (behavioural treatment approach)
- Difficult to trace reinforcement history due to complex nature of MHPs
- Neglects cognitive aspect
Cognitive paradigm (explaining)
• Led to CBT
- Dysfunctional thoughts could be a symptom rather than a cause
- Little insight into the development of such thoughts and beliefs
Cognitive-Behavioural paradigm (explaining)
Hot Cross Bun Model: Cycle between thoughts, behaviour, physical response and feelings (links to specific situation and environment)
Humanistic paradigm (explaining)
- Lead to widely used therapeutic approach
- Evaluations of own behaviour well described
- Overly optimistic
- Difficult to evaluate some concepts
Aims of treatment
- Relief from distress
- Self awareness and insight
- Coping and problem solving skills
- Identify and resolve underlying causes
Treatment is affected by:
- Theoretical orientation and training of practitioner
2. Nature of psychopathology
Features of treatment
- Instilling hope
- Gaining new perspective
- Genuine empathy
- Trusting, caring relationship
- Clear and positive communication
Drug treatment
- Antidepressants
- Antipsychotic
- Anxiolytic
Psychodynamic treatment
- Free association
- Transference
- Dream analysis
Humanistic treatment
- Enable acceptance of responsibility
- Faster awareness of subjective experiences
- Fulfill potential for personal growth
Person-centred treatment
- Congruence
- Empathy
- Positive regard
Cognitive-behavioural treatment
- ABC model
- REBT
- Beck’s cognitive therapy
Diagnosis
Classification of symptoms and signs of disorders
- Important for: treatment, good clinical care
- Correct diagnoses can be used for: description of base rates, causes, treatments
Emil Kraepelin
- First use of classification systems
- Dementia praecox: chemical imbalance
- Manic-depressive psychosis: irregular metabolism
Negatives of diagnosis
- Worry of others knowing
- Fear of another episode
- Stigma (but Lilienfeld et al. (2010) found that labelling reduced stigma because disorder was seen as an explanation for certain behaviour)
- Categorization and losing sight of uniqueness
Positives of diagnosing
- Some are comforted by diagnosis (used to cope and explain)
- Paves a way to take steps to deal with problems
- Helps with referrals and communication between different professionals
- Helps to allocate funding for research etc.
ICD-10
- Expanded to include mental disorders in 1948
* Mental and behavioural disorders in Chapter V (codes F00-F99)
DSM-5
- Section I: introduction
- Section II: diagnostic criteria and codes
- Section III: emerging measures and models, cultural aspects, future research
Aim of clinical assessment
Chart cognitions, emotions, personality, behavior
Uses of clinical assessment
- Diagnosis
- Therapeutic intervention
- Monitor effects of treatment
- Research
Clinical interviews
Interpersonal encounter to gather information
- Unstructured nature
- Interviewer bias
- Reliability
- Merit of information provided by client
General psychological tests
- Rigid response requirements
- Rigorously tested
- Standardization
- Assess client specific traits
Personality inventories
- Utility of validity scales: clinical validity
- Internal reliability
- Time consuming to administer
Specific inventory
- Useful research tool
- Some good psychometric properties
- Diagnostic and theoretical value
- Some underdeveloped
- Many fail to have validity scales
Projective tests
e.g. Rorschach inkblot test, thematic apperception test, sentence completion test
- Use over the years has declined (link to psychodynamic approach)
- Cultural bias traditionally
- Reliability
- Clinical training
- Can infer pathology in absence of other evidence
Intelligence and neurological impairment tests
- Intelligence is a construct- concept too narrow
- Cultural bias
- Measurement of capacity to learn?
Biologically based assessments
- Allows assessment of contextual factors
- Ecologically valid
- Provides workable solutions
- Provides supplementary info
- Overcomes recall bias
- Time consuming
- Observer effect and expectations
- Inter-observer reliability
Anxiety disorders
- Excessive aroused state (apprehension, uncertainty, fear)
- Out of proportion, constant, distressful
- Characteristics: physiological, cognitive biases, dysfunctional beliefs, specific early experiences
Specific phobias definition
Excessive, unreasonable, persistent fear triggered by specific object or situation
Specific phobia etiology
- Psychoanalytic: defence by id; symbolic relevance of fear; avoiding confrontation with actual issue
- Behavioural: classical conditioning
- Evolutionary: biological preparedness
- Risk factors: genetic vulnerability, neuroticism, negative cognition, propensity towards fear conditioning
- Multiple: mix of classical conditioning, disgust, misinterpretation of bodily sensation
Panic disorders definition
- Panic attacks, not specifically explained by specific situation
- Anxiety about recurrent panic attack
Panic disorders etiology
- Neurobiological: Importance of locus coeruleus in fear circuit (source of norepinephrine; related to stress)
- Classical conditioning: conditioning of anxiety (anticipatory) leads to panic attacks (actually in progress) as response
Panic disorder treatment
- Tricyclic antidepressants and benzodiazepines
- CBT
- Typical programme includes: education, breathing training, cognitive restructuring therapy, interoceptive exposure, prevention of safety behaviour
OCD key features
- Repetitive, intrusive, uncontrollable thoughts or urges (Obsessions)
- Repetitive behaviours or mental acts that the person feels compelled to perform (Compulsions)
OCD etiology
- Inflated responsibility
- Thought suppression
- Cognitive-Behavioural
OCD perspectives
- Psychoanalytic: ego trying to fend off anxiety through compulsions; reaction formation
- Behavioural: operant response through negative reinforcement
- Cognitive: compulsions help to gain sense of control
OCD treatments
- Exposure and ritual prevention
- CBT
- SSRIs
Depression
Characteristics:
- Feelings
- Behavioural symptoms
- Motivational deficits
- Cognitive features
- Physical symptoms
MDD diagnosis
5 or more out of 9:
- Depressed mood
- Diminished interest or pleasure
- Significant weight loss or gain
- Insomnia or hypersomnia
- Fatigue
- Feeling worthless
- Low ability to concentrate or think
- Thoughts of death or suicide
MDD Psychodynamic perspective
- Response to loss of loved one or symbolic loss
* Led to introjection: regression and directing feelings to self
MDD Behavioral perspective
- Lack of appropriate positive reinforcement
* Reassurance seeking can increase eliciting of negative responses from others
MDD Social perspective
- Link to interpersonal difficulties: withdraw, irritable, no joy from interacting with others
- Childhood adversity
- Negative life event
MDD Cognitive perspective
- Beck: biased ways of thinking; negative triad
- Learned helplessness and attribution
- Hopelessness theory
- Rumination theory
MDD Biological perspective
- Genetics
- Low serotonin and norepinephrine
- Overactivity of HPA axis
- Low striatum activity
MDD treatment
- Drugs
- Electro convulsive therapy
- Social skills training
- Behavioral activation
- Cognitive therapy
- Mindfulness based cognitive therapy
Bipolar
Bipolar I: needs manic and depressed
Bipolar II: hypomanic instead of manic
Cyclothymic: not manic or depressed to same extent but chronic
Bipolar etiology: Biological
- Genetics
- Serotonin and dopamine receptors
- High striatum activity
- Heightened amygdala activity
Bipolar etiology: Social
- Reward sensitive
* Sleep deprivation
Bipolar treatments
Lithium carbonate
Schizophrenia
Characterized by disordered thinking, in which ideas are not logically related; faulty perception and attention; lack of emotional expressiveness; and disturbances in behaviour
Psychotic symptoms
- Distortions of perception and reality
- Disorganized speech and thought
- Disorders of motor behaviour
Schizophrenia positive symptoms
- Delusions
- Hallucinations
Schizophrenia negative symptoms
- Avolition: motivation
- Asociality: relationships
- Anhedonia: pleasure
- Blunted affect: emotional display
- Alogia: speech
Schizophrenia disorganized symptoms
- Disorganized speech
- Disorganized behavior
Course of schizophrenia
Prodromal (pre) > Active (full-blown symptoms) > (50% go back and forth) < Residual (gradual recovery; cease to show positive symptoms)
Schizophrenia etiology: Diathesis-stress
Interaction between genes (biological predisposition) and environment (environmental stresses)
Schizophrenia etiology: Biological
- Genetics
- NTs
- Enlarged ventricles
Schizophrenia etiology: Psychodynamic
- Freud: regression to ego state and primary narcissism
* Schizophrenogenic mother who is cold rejecting, distant and dominating
Schizophrenia etiology: Person-centered
Loss of ability to differentiate between self and non-self leads to becoming disorientated and passive
Schizophrenia etiology: Behavioral
- Psychotic behaviours may be rewarded through operant reinforcing
- Explains maintenance well but not acquisition
Schizophrenia etiology: Familial factors
- Communication deviance
* High expressed emotions
Schizophrenia treatment
- Social skills training
- Family based programs
- CBT
- Antipsychotic drugs
Personality disorders
Fixed, ingrained, pervasive way of dealing that deviate from cultural expectations and cause disruption and hardship
Cluster A: Odd/eccentric
- Schizotypal
- Paranoid
- Schizoid
Cluster B: Emotional/ dramatic/ erratic
- Antisocial
- Borderline
- Histrionic
- Narcissistic
Cluster C: Anxious/ fearful
- Avoidant
- Dependent
- Obsessive compulsive
BPD
- Intense emotionality
- Unstable identity, self image, interpersonal relationships, affects
- Impulsivity
BPD conceptualization and treatment
- Lack of direction: general equivalence diploma examination
- Feelings of depression or anxiety-provoking situations: cognitive therapy- mood diary; compare actual outcome with best, worst and most likely
- Poor impulse control: time delay procedures
- Excessive and poorly controlled anger: time delay procedures
BPD etiology: Social
- Childhood abuse, neglect, rejection
- Inconsistent or loveless parenting
- Parental substance/ alcohol abuse, promiscuity, etc.
- Lack of protective factors
BPD etiology: Biological
- More for specific traits
- Genetics
- NTs: serotonin, dopamine
- Deficits in frontal lobe (and connection with amygdala)
- Increased amygdala activation
BPD etiology: Psychological
- Object relations theory
- Splitting
- Diathesis-stress theory
BPD treatment
- Dialectical behaviour therapy (Linehan)
- Drugs: anxiolytic, antidepressants, atypical antipsychotics
BPS code of ethics and conduct (2009)
- Respect
- Competence
- Responsibility
- Integrity
BACP ethical framework (2016)
- Being trustworthy
- Justice
- Beneficence
- Autonomy
- Non-maleficence
- Self-respect
Ethical issues within therapist
- Competence/ diligence
- Fitness to practice
- Personal safety
Ethical issues arising through work
- Perceived power balance
- Respect for autonomy
- Contracting and informed consent
- Quality of relationship
- Confidentiality
- Dual relationship
Persistent contact from former client
- Nature of contact
- Intrusion of privacy
- Stalking or harassment: assess level of threat
- Examine the end: who decided, referral, door open
- Responsibility to avoid harm for former clients and self too
- Links to BPS code of responsibility (protection) and integrity (personal boundaries)
- Links to BACP framework: Self-respect (care for self)
Client with serious suicidal thoughts and feelings
- Establish level of intent
- Links to BPS code of respect (confidentiality), competence (ethical decision making), responsibility (protection)
- Confidentiality
- Client autonomy
- Legality
Dual relationships
- Level of involvement
- Type of relationship
- Links to BPS code of competence (ethical decision making), responsibility (termination or continuity of care), integrity (personal boundaries)
Ethical decision making if supported by:
- Parameters
- Research evidence
- Legal guidance
- Peer/ supervisor advice
- Guidance from relevant bodies
