Abnormal behaviour

Question 1

Provide an overview on how mental illness was diagnosed and treated until now

Answer 1

• Mental illness was defined as madness or insanity
o Defined by gross distortion of external reality (hallucinations, delusions), or disorganisation of speech, affect, behaviour (confusion, memory loss, etc.)
o Similar to today’s diagnoses of psychosis, schizophrenia and dementia
• 18-19th centuries:
o Small number of patients treated in mental asylums (mental hospitals) by mad doctors or alienists
 Anyone interested/able to treat disorders: no qualifications required
o Anxiety, sadness, angst, etc. not ‘mental illness’
o Priests, friends, family assisted with problems of living
• Today, 400+ categories of mental disorder
• Definitions defined by social influences and norms

Question 2

What are the two handbooks currently being used today, who were they published by and where are they mainly used?

Answer 2

o Diagnostic and statistical manual of mental disorders (DSM-5)
 Used in Australia and the US and published by APA
o International Classification of Diseases (ICD-10; ICD-11 in preview in 2022)
 Published by world health organisation but used in Australia

Question 3

How many Australians are identified to have a mild, moderate or severe mental disorder?

Answer 3

4 million

Question 4

What are the DSM and ICD and which professionals do they help?

Answer 4

o Two publications contain descriptions of various mental disorders and reflect the consensus of mental health professions regarding the definition and classification of mental disorders at the time of their publication
o DSM and ICD describe symptoms clusters  syndromes
 E.g. Schizophrenia, major depression…
• Treated by psychiatrist, psychologists, clinical psychologists, social workers, counsellors

Question 5

What is the DSM’s definition of a mental illness?

Answer 5

o A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning. Mental disorders are usually associated with significant stress or disability in social, occupational or other important activities

Question 6

Is it easy to define mental disorder? Why/why not?

Answer 6

• But no definition of mental disorders is enough- hard to define as influenced by societal norms

Question 7

What are the advantages of mental disorder diagnoses?

Answer 7

• Improve communication between health professionals (clinicians and researchers)
• May improve communication and understanding of mental illness in the community
• May reduce social stigma
• Helpful to the client-> normalising and validating

Question 8

What are the disadvantages of mental disorder diagnoses?

Answer 8

o Mental disorders are being treated like physical afflictions, but mental illnesses are simply theoretical constructs and are not independent of changing social values
o Used as explanations rather than descriptive terms
o May sometimes be harmful to people- feel as if they have been stigmatised

Question 9

Are ICD and DSM the same? Describe differences if there are any

Answer 9

No-• ICD and the DSM are comparable but not identical
o Problem as diagnosed differently according to where you live
 English speaking countries- DSM
 Europe- ICD
o Mixed Anxiety-Depression (ICD), Generalised Anxiety Disorder (DSM), Binge Eating Disorder (DSM)

Question 10

What are examples of changes through the DSM editions?

Answer 10

 Homosexuality removed from the DSM in 1973
 Generalised anxiety disorder first introduced in DSM-III-R (1987)
 Binge eating disorder first included in DSM-5 (2013)
 Asperger’s disorder symptoms reclassified and included in the section of Autism Spectrum Disorders in DSM-5 (2013)
 Gaming disorder added to the section on Addictive disorders in ICD-11 (2018)

Question 11

Describe the main principles of DSM-I and DSM-II

Answer 11

DSM-I (1952) and DSM-II (1986)
• Strongly influenced by psychoanalytic theory
• Very concerned with causation
• Had two main sections:
o Biological causation diseases
o Psychological reactions to individual’s environment or internal processes
• Thought patient’s defense mechanisms were causes

Question 12

What were the limitations of DSM-I and DSM-II?

Answer 12

o psychoanalysis is not proven and can’t be measured
o limited reliability
o Not a lot of detail on required length of disorder or required severity: line between normal and abnormal blurred

Question 13

Which DSM’s were approached via the Kraepelin approach and what did they do?

Answer 13

• DSM-III (1980)
• DSM-III-R (1987)
• DSM-IV (1994)
• DSM-IV-TR (2000)
• Focus on observable symptoms

Question 14

Talk about the DSM-V and its improvements

Answer 14

• DSM-V (2013)
o Reflects the medical/biological model
o No theoretical assumptions about causation
o Description of symptoms:
 Patient report, direct observation, measurement
 No assumptions about unconscious processes
 Clear, explicit criteria and decision rules
• Improved reliability, but validity questionable
 Focus on symptoms
o Clear guidelines for differential diagnosis
o Interrater reliability increased

Question 15

What are problems of the DSM-V?

Answer 15

o Problems include comorbidity, diagnostic instability and lack of treatment specificity
 Comorbidity questions the validity of separate, independent diagnostic categories

Question 16

What is the difference between DSM-I and II, vs all the DSM’s that came after?

Answer 16

DSM-III, DSM-III-R, DSM-IV, DSM-IV-TR and DSM-5

Specific diagnostic criteria for each category
No explicit assumptions about causation
Polythetic format: a set of optional diagnostic criteria is provided: only a subset is needed for diagnosis

DSM-I and DSM-II
Unspeciffic, general descriptions of categories
Assuming causation from a psychoanalytic viewpoint
Monothetic format: general description of criteria without specifying which ones are necessary and which ones are optional

Question 17

Who were the Rorschach inkblot tests developed by and what were they used for? Was there a lot of evidence suggesting they worked?

Answer 17

 Rorschach in 1921 published psychodiagnostik
• Reflects psychoanalysis, psychodynamic principles
• Originally developed to diagnose schizophrenia
o Small amount of evidence that it works for schizophrenia
• Later further developed to become a personality test used in clinical settings
• Both reliability and validity highly disputed
• Rarely used in Australia
• Helped therapist to get to unconscious process, but not much evidence for it

Question 18

What occurs in an unstructured clinical interview and why?

Answer 18

o For clinical assessment
o Forming a therapist-client therapeutic alliance
 Client needs to trust you and feel you are open minded
o Diagnostic questioning:
 To guide further assessment
 To formulate diagnosis (DSM-5)
 For treatment planning/delivery
o Presenting problem current symptoms
 Try to figure out problem according to their symptoms
o Current living circumstances, relevant history
 Dependent on the clinician’s theoretical orientation
• Behavioural vs psychoanalyst approach
o Case formulation

Question 19

What is involved in case formulation?

Answer 19

 What are the factors that predispose this individual to the development of this or these presenting problems?
 What are the factors that act as precipitants in the presenting problems(s)?
 What are the factors that serve to maintain the presenting problem(s)?
 What are the factors that serve to predict the outcome?
 Form hypothesis about what maintains problems, and what will promote and hinder change

Question 20

What should happen at the end of a psychologist’s first session?

Answer 20

 Explain and summarise this session

 Provide direction to future plans of implementation

Question 21

What is involved in a semi-structured assessment?

Answer 21

o Structured clinical interview for DSM-5
o Interview administered by trained clinicians
o Tailored: client’s response determines the next question
o Presence of symptoms+ severity  diagnosis
o Highly reliable, valid assessment of DSM-based diagnosis
o Only as valid as the DSM is

Question 22

What is involved in structured clinical interviews? What are they used for?

Answer 22

o Treatment evaluation studies, Research studies, Epidemiology
o Composited International Diagnostic Interview -CIDI (WHO)
 Can be administered by not clinically trained interviews
• E.g. National Survey of Mental Health and Wellbeing Australian Bureau of Statistics (ABS)

Question 23

What are self-report diagnostic questionnaires used for?

Answer 23

o Often used to screen for possible diagnosable disorders
o Include DSM diagnostic criteria but less structured and more narrow than structured interviews
 E.g. AUDIT (Alcohol Use Disorder Identification Test) and EDDS (Eating Disorders Diagnostic Scale)
o Based on scores
o Often used for:
 Dimensional assessment of symptoms, emotions, behaviours relevant to mental health
• Varying degrees of severity to a mental disorder
• Bounday between normality and abnormality is indistinct: moves from the “you have it or you don’t” approach for one where there are varying degrees of having it or not.

Question 24

Do all self-report questionaires reflect DSM-based diagnostic criteria? What are examples of this?

Answer 24

 Some reflect DSM-based diagnostic criteria, others do not
• E.g. Narcissistic Personality Inventory (NPI)
o Developed on the basis of DSM-IIII diagnostic criteria for NPD
• Depression Anxiety Stress Scales (DASS)
o Developed independently of DSM criteria
o Focuses on emotion

Question 25

What are disadvantages of self-report questionnaires?

Answer 25

o Disadvantages are that they are transparent and easy to cheat on, and impractical for someone who can’t express their symptoms

Question 26

What are other types of reports and observations?

Answer 26

o Spence Children’s anxiety scale
 Child report
 Parent report
o Direct observation of behaviour
 ABC method: antecedents, behaviour, consequences
 Checklists, coding schemes
o Psychological measurements
 Brain scans, heart rate, skin conductance, etc.
 None of these are diagnostic: used in research for causes and consequences

Question 27

What is the DSM-5 criteria for a depressive episode?

Answer 27

• At least 5+ symptoms during a 2 week period (NEED symptom 1 or symptom 2)
1. Depressed mood most the day, nearly every day
2. Markedly diminished pleasure/interest in activities
3. Significant weight loss or weight gain
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness and excessive guilt nearly every day
8. Diminished ability to concentrate nearly every day
9. Recurrent thoughts of death, suicide, suicide attempts
• Clinically significant distress or impairment
• Not attributed to substance use or other medical condition
• Affective symptoms: depressed mood, anhedonia
• Cognitive symptoms: indecisiveness, lack of concentration
• Somatic symptoms: Fatigue, sleep or appetite change

Question 28

What is defined as a major depressive disorder?

Answer 28

• Under DSM-5, is classed under depressive disorders
• Single or recurrent depressive episode, NOT accounted for by other disorders (e.g. schizophrenia)
• Recurrent episodes are common

Question 29

What is the criteria A for a manic episode? (DSM-5)

Answer 29

o Criteria A:
 At least one week of:
• Abnormally and persistently elevated, expansive or irritable mood and
• Increased goal directed activity/energy, present nearly daily

Question 30

What is criteria B for a manic episode?

Answer 30

 At least 3 or more present to a significant degree and noticeable change from usual behaviour
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• Rapid or pressured speech
• Flight of ideas or racing thoughts
• Distractibility
• Increase in goal-directed activity or psychomotor agitation
• Excessive involvement in activities that have a high potential for negative consequences

Question 31

What are usual manic episode patterns?

Answer 31

o Manic episodes typically evolve over several weeks from heightened wellbeing to euphoria
o Episodes move quickly from an elated mood to an irritable mood or can fluctuate between elation and irritability
o Irritable type manic episode (more common despite popular beliefs about mania) with the elevated/expansive type manic episode

Question 32

What is criteria C of a manic episode?

Answer 32

 Sufficiently severe to cause marked impairment in occupational functioning or in usual social activities
 OR to necessitate hospitalisation to prevent harm to self or others
 OR there are psychotic features (e.g. delusions or hallucinations)

Question 33

What is criteria D of a manic episode?

Answer 33

 The symptoms are not due to the direct physiological effects of a substance (e.g. drug or medication) or a general medical condition (e.g. hypothyroidism)

Question 34

What is a noteworthy change in DSM-5 regarding manic episodes?

Answer 34

the fact that increased activity or energy was now required (along with mood changes) to meet the criteria for a manic or hypomanic episode

Question 35

What is the DSM-5 criteria for a hypermanic episode?

Answer 35

• Bipolar II: Hypomanic episode (DSM-5)
o At least 4 days of:
 Abnormally and persistently elevated, expansive or irritable mood, and
 Increased goal directed activity/energy, present nearly daily
o 3 or more:
 Inflated self-esteem or grandiosity
 Decreased need for sleep
• Can feel quite rested after small amounts of sleep
 More talkative/pressured speech
 Flight of ideas; racing thoughts
 Distractibility
 Increased goal directed activity or psychomotor agitation
 Excessive involvement in pleasurable activities which have a potential for negative consequences
o Change that is uncharacteristic of the individual
o Disturbance and changes are observable by others
o Not severe enough to cause marked impairment, or hospitalisation and no psychotic features- people can mostly go about normal activities
o Not due to substances/medical condition

Question 36

What is the difference between bipolar I and bipolar II?

Answer 36

Bipolar I:
Major depressive episode- can be present but not necessary for diagnosis
Manic episode- YES
Hypomanic episode- Can be present but not necessary for diagnosis

Bipolar II:
Major depressive episode- YES
Manic episode- No: not seen in this disorder
Hypomanic episode: YES

Question 37

Describe DSM-5’s description of cyclothymic disorder

Answer 37

o Chronic, less severe form of bipolar disorder
o Numerous cycles of hypomania symptoms and depression symptoms that are not severe enough to meet criteria for a manic or major depressive episode
o Symptoms for at least 2 years but no more than 2 months without symptoms
o Symptoms cause distress or impairment in functioning

Question 38

What are diagnostic issues that bipolar disorders face and why are these issues?

Answer 38

• Bipolar disorders are often:
o Undetected/undiagnosed
o Over-diagnosed (that is borderline personality disorder) or underdiagnosed
 Overdiagnosis could mean inappropriate and excessive use of mood-stabilising medications, as well as insufficient attention paid to the psychological aspects of unipolar depression or the personality disorder
o Misdiagnosed as schizophrenia (particularly in men) or unipolar depression(particularly in women)
 Bipolar people seem to go to therapist when feeling depressive, not manic
 Problem is that they may not respond to anti-depressants given: need mood stability medicine instead
 Existence of shared features between these disorders can make their diagnosis challenging
o Lack of diagnosis in those with anxiety disorders and substance use disorder
• Diagnostic problems have implications for pharmalogical and psychological interventions

Question 39

What is the 12 month prevalence rate in Australia for bipolar I and II?

Answer 39

Near 1%

Question 40

What is the lifetime prevalence of bipolar I and II?

Answer 40

1.3%

Question 41

Are there gender differences for BPI and BPII diagnosis?

Answer 41

• No gender differences for BPI, BPII more common in women

Question 42

What is the onset of bipolar disorder? Specify:

Answer 42

• Onset: peak at 15-25 years (for both genders)
o No clear definition as to what the onset is
o Tends to be a poorer outcome if the onset occurs in childhood or adolescence
o 25% of individuals experience onset by age 17, and median age is 25
o Rare for onset to occur after 30

Question 43

What is the delay to seeking treatment for bipolar disorder?

Answer 43

10-20 years

Question 44

How many individuals with bipolar disorder experience multiple episodes of mood disturbance during their lifetime? How does this occur?

Answer 44

90%

-Generally occurs over weeks or months rather than a matter of days

Question 45

When untreated, how many episodes will BDI patients experience in their lifetime?

Answer 45

o Untreated: 8-10 lifetime episodes of mania and depression

Question 46

How are relapse rates with treatment in bipolar patients and what is the effect of lithium on treatment?

Answer 46

o With treatment: 40% relapsing within 1 year; 73% within 5- years
 Treatment minimises impact and episode number
 Lithium fully protects on 25-50 % patients against further episodes and there are often problems with gaining compliance from patients in taking their medication

Question 47

How much time do BDI patients stay depressed/ manic or hypomanic?

Answer 47

o Bipolar I: 32% of the time depressed; 9% manic/hypomanic

Question 48

How much time do BDII patients stay depressed/hypomanic?

Answer 48

o Bipolar II: 50% of time depressed; 1% hypomanic

Question 49

How does rapid cycling work in Bipolar disorder patients?

Answer 49

o Rapid cycling: 5-15% of sufferers have 4+ episodes (mania, hypomania or depression) within a year
 Includes those who recover between episodes and those who switch continually from one polarity to the other

Question 50

What can bipolar disorder be comorbid with?

Answer 50

• High rates of co-morbidity:
o 50% anxiety disorders (panic, GAD, social phobia)
 Anxiety symptoms precede, occur during or follow (hypo)manic symptoms at different rates depending on the type of comorbid disorder
 Clear pattern of social phobia preceding (hypo)mania
 Anxiety disorders are often treated with antidepressants, which suggests that antidepressants may at times be triggering manic or hypomanic symptoms
o 39% substance misuse (coping or self-medication or to enhance the high)

Question 51

How many bipolar disorder sufferers attempt/complete suicide? Is there a discrepancy between BDI and BDII?

Answer 51

• At least 25% will attempt suicide; 10-20% will complete suicide
o Higher rates among individuals with bipolar II disorder compared to those with bipolar I disorder, most likely due to the more frequent episodes of depression in the former compared to the latter

Question 52

What are the genetic risks of bipolar disorder?

Answer 52

 Lifetime risk for family members of BP patients: 10% (versus 1% in the general population)
1. Bipolar runs in families- 10x higher risk for someone with a bipolar parent to have bipolar disorder
 Twin studies: BP heritability rate of around 80-85%

Question 53

What is the biological explanation for bipolar disorder?

Answer 53

 BP is a neurobiological disorder, largely due to a malfunction of three “reward system” neurotransmitters: serotonin, dopamine and noradrenaline
1. But how much causes and how much is a result of?
 BP may lie dormant and be either activated spontaneously or be triggered by (e.g. environmental and life) stressors

Question 54

Is there an association between bipolar disorder and stressful life events?

Answer 54

 An association between stressful life events and both manic and depressive episodes
1. Manic episodes likely preceded by:
o Disruption to routines and sleep-wake cycles
o Excessive focus on goal attainment
2. Depressive episodes likely preceded by:
o Low social support
o Low self-esteem
 Individuals with bipolar disorder who experience high levels of stress are four and a half times more likely to have a mood relapse than individuals with low levels of life stress

Question 55

What are the psychological factors that can increase vulnerability to bipolar disorder?

Answer 55

o A negative cognitive style enhances vulnerability to manic and depressive episodes when paired with stressful life events
o Mania may be a defence to counter the negative thoughts and feelings relating to an underlying negative self-esteem
o Excessive pursuits of goals may disrupt routines and hence trigger manic or hypomanic episodes in the excessive pursuit of goals
o Temperament (ensuring personality traits and characteristics) factors:
 Perfectionism
 Sociotropy
1. The need to be socially approved
 More prevalent in individuals with bipolar disorder than those with depressive disorder

Question 56

What is the goal dysregulation model?

Answer 56

 Goal dysregulation model- theory that manic episodes may be triggered by dysregulated goal pursuit, which entails the person being excessively involved in the pursuit of goals

Question 57

Describe the diathesis-stress model

Answer 57

o	Diathesis-Stress model
	Originally developed for schizophrenia
	Holds that psychological disorders result from interactions between underlying vulnerabilities and stressful life events
1.	Life stressors: 
o	Causing poor social routines and/or sleep deprivation 
2.	Biological vulnerability
o	That is circadian rhythm instability which can affect bipolar people
3.	Prodromal stage
o	Early symptoms of mood disturbance
4.	Poor coping strategies
5.	Episode 
o	Manic
o	Hypomanic
o	Depressive
6.	Stigma and Relationship problems
o	Stigma by others or oneself
7.	Cycles once again

Question 58

What does bipolar disorder treatment depend on?

Answer 58

• Depends on:
o Illness stage (acute, maintenance)
o Predominant polarity (depressive, hypo/manic)

Question 59

What is the best treatment for bipolar disorder?

Answer 59

• Most treatment evidence based on Bipolar I: extrapolated to BPII and others
• Best treatment= Pharmacological + (adjunct) Psychological interventions
o Found lithium was a good treatment for mania (Cade)
 50% of clients respond
o Carbamazepine also a good treatment for people who don’t respond to lithium
o Lithium and carbamazepine good combination

Question 60

Talk about bipolar disorder and creativity

Answer 60

o Associated with creative groups
 17% of a sample of British poets received treatment for manic episodes
 Enhanced creativity likely linked to manic/hypomanic states and accompanying suprasensory changes
o Famous people with bipolar disorder:
 Artists: Gauguin; Van Gough; Pollack
 Writers: Lord Byron; Virginia Woolf; Hemingway
 Composers: Handel; Schumann
• Many people with bipolar disorder identify as creative

Question 61

What does psychosis refer to?

Answer 61

• Refers to loss of contact with external reality characterised by:
o Impaired perceptions and thought processes
• First type of mental illness ‘identified’ in olden days

Question 62

What is an overview definition of schizophrenia

Answer 62

• Fragmentation of thoughts
• Splitting of thoughts from emotions
o Disconnect between facial expressions/emotions and thought/speech
• Withdrawal from reality

Question 63

What is criteria A for schizophrenia?

Answer 63

A. Characteristic symptoms:

a. Lasts at least 6 months, with at least one month of two (or more) of following and at least one must be (i) ,(ii), or (iii) below:
i. Delusions
ii. Hallucinations
iii. Disorganised speech (formal thought disorder)
iv. Grossly disorganized or catatonic behaviour
v. Negative symptoms

Question 64

What is criteria B for schizophrenia?

Answer 64

B. Clinically significant impact to social/occupational functioning (functioning is below that prior to onset of the disorder)

Question 65

What is criteria C for schizophrenia?

Answer 65

C. Continuous signs of disturbance are present for at least 6 months

a. May include a gradual deterioration in functioning
b. Must include at least one-month of psychotic symptoms

Question 66

What is criteria D for schizophrenia?

Answer 66

D. Not better accounted for by other diagnosis

Question 67

Compare positive vs negative symptoms

Answer 67

Positive symptoms
-Presence of problematic behaviours
Negative symptoms
-Absence of healthy behaviours

Question 68

What are positive symptoms of schizophrenia

Answer 68

• Hallucinations
• Delusions
• Formal thought disorder
• Behavioural/motor disturbances
• Lack of insight on what’s happening to them (not really a positive symptom but pretty important nonetheless)

Question 69

What are the negative symptoms of schizophrenia?

Answer 69

Affective Flattening (a dampening down in the expression of emotion)-

• –Social withdrawal
• –Anhedonia (Not experiencing pleasure in their life)
• –Emotional blunting
• –Confusion

Avolition (the loss of drive or motivation)-

• –Amotivation
• –Apathy
• –Self-neglect

Alogia (a lack of unprompted speech)-

• –Poverty of speech
• –Poverty of content

Question 70

Do positive or negative symptoms suggest poorer response to treatment?

Answer 70

Negative symptoms

Question 71

What can be seen in schizophrenia from cross-cultural studies?

Answer 71

• Cross-cultural studies: similar forms across societies but cultural differences in content and interpretation
o Hearing voices is the same but content different
o African/Indian studies- voices are positive and cause less distress
o America and Western countries- voices are more hostile or aggressive

Question 72

What is the lifetime prevalence of schizophrenia?

Answer 72

1-2%

Question 73

What is the male: female ratio of schizophrenia diagnosis?

Answer 73

3:2

Question 74

What is the typical age of onset for schizophrenia?

Answer 74

• Typical onset in late adolescence and early adulthood (tends to be later for women)
o 17-30 years old for males
o 20-40 years old for females

Question 75

What is onset of schizophrenia usually preceded/ coinciding with?

Answer 75

• Onset typically preceded by a gradual deterioration in functioning followed by appearance of more acute symptoms
• Onset coincides with an often stressful time of life, further complicated by impact of schizophrenia

Question 76

Is early onset and early treatment of schizophrenia associated with better outcomes

Answer 76

• Early onset associated with poorer outcomes

* Early treatment associated with better outcomes (yet delay in treatment common)

Question 77

Is schizophrenia the same in presentation and course for everyone?

Answer 77

• Highly variable in presentation and course

o One or more episodes, with periods of normal (or near normal) functioning between episodes

Question 78

Can you fully recover from schizophrenia?

Answer 78

• Chronic condition without full recovery

o Most remain chronically unwell with a deteriorating course

Question 79

Describe the future work and social life of those diagnosed with schizophrenia

Answer 79

o 50% unable to work, <25% employed

o Social isolation, homelessness, low income and poor health

Question 80

How many schizophrenia patients attempt/complete suicide?

Answer 80

o 30% of patients attempt suicide; 5-10% complete suicide

Question 81

What are the downsides of assigning medication to schizophrenics?

Answer 81

o Can function with medication but medication has side effects, or patients don’t feel like they need the medication anymore, or they think it will poison them, so don’t take medication and it worsens

Question 82

Describe the 4 stages of schizophrenia

Answer 82

• Premorbid phase-
o Cognitive motor or social deficits

• Prodromal phase-
o Brief/attenuated positive symptoms and/or functional decline
o Median time is 2 years before psychotic symptoms
o Typically late adolescence and early adulthood

• Psychotic/acute phase-
o Florid positive symptoms
o Usually one year delay between this and looking for treatment

• Recovery phase:
o Negative symptoms, cognitive/ social deficits, functional decline if treatment fails
o Risk of further episodes of psychosis remains high during the first 2-5 years after treatment is commenced
 In approximately 80-90% of these cases, relapse will occur during this period
o Relapse can often occur by ditching medication, abusing substances or coming back to overly protective/criticizing families

Question 83

What are the schizophrenia prognostic factors that will indicate good response to treatment

Answer 83

Good premorbid functioning
Acute onset
Later age of onset (females)
Precipitating event (e.g. drug induced psychosis)
Low substance use
Brief active phase
Absence of structural brain abnormalities
No family history of schizophrenia

Question 84

What are the schizophrenia prognostic factors that will indicate poor response to treatment

Answer 84

Poor premorbid functioning
Slow insidious onset
Prominent negative symptoms
Long duration of untreated psychosis
Slower or less complete recovery
Lower socioeconomic class
Migrant status
Poor social support network

Question 85

What are comorbid disorders to schizophrenia?

Answer 85

o Depression
o Anxiety and trauma-related problems
o Substance misuse

Question 86

Is there a genetic risk to schizophrenia? If so, what is the evidence for it?

Answer 86

 Degree of risk related to a degree of heritability
 The risk of developing schizophrenia increases as the degree of genetic relatedness with an affected individual increases
• Determine susceptibility  disorder triggered by other factors
o 7% siblings
o 9% for children of 1 affected parent
o 46% for children with 2 affected parents
 Twin studies concordance rates:
• 12% for DZ twins
• 44% for MZ twins
 Adoption studies:
• 19% for children of biological parents with schizophrenia
• 10% for children of biological parents with no schizophrenia

Question 87

What is the dopamine hypothesis for schizophrenia

Answer 87

Overproduction or oversensitivity of dopamine receptors (especially D-2 receptors)

Question 88

What is the evidence for the dopamine hypothesis?

Answer 88

• Treatment for Parkinson’s disorder:
o L-DOPA (increases dopamine concentration) can induce psychotic symptoms
• Amphetamine (against dopamine) psychosis:
o Abnormally large responses to low amphetamine doses suggests over-sensitivity rather than excessive dopamine level
o Amphetamines, which cause the release of dopamine, can produce symptoms of schizophrenia
• Response to anti-dopaminergic medication (e.g. chlorpromazine and haloperidol which block dopamine receptors, or new clozapine drug which blocks 5-HT receptors)
o Effective in 60% with more impact on positive symptoms

Question 89

What biological aspects are associated with positive schizophrenia symptoms (Type 1 schizophrenia)?

Answer 89

Dopamine activity, specifically increased dopamine levels (but there are problems with this theory- increased dopamine levels not found in patient’s brains) and with increased sensitivity to dopamine (more probable)

• —Still issues with this theory
• Responds well to treament and medication
• Fluctuating course with periods of remission

Question 90

What biological aspects are associated with negative schizophrenia symptoms (type 2 schizophrenia)?

Answer 90

Brain degeneration

• Responds poorly to drugs
• Chronic course with little improvement

Question 91

What is the neuroanatomical make-up of a schizophrenic person?

Answer 91

 Most consistent finding:
• Enlarged ventricles in schizophrenia (post-mortem; CT scans: MRI studies)
o Relative size more than twice that of normal controls
• Most likely cause is loss of brain tissue; scans indicate chronic schizophrenia is associated with brain abnormalities
 Loss of brain tissue tissue in pre-frontal cortex
• Linked to negative symptoms: damage to executive functioning/cognitive abilities
 Non-genetic structural brain abnormalities appear to:
• Predate onset of psychosis
• Worsen with progressive illness
• Deficit in brain matter incre ases with number of episodes
• Schizophrenia as a degenerative brain disorder
• Structural changes in the hippocampus appear to predate the onset of psychosis (smaller hippocampus in those without high risk)
• Psychosis related to disturbances in the Hypothalamic-pituitary-adrenal axis
o Environmental factors affect the HPA axis
o Genes associated with the risk of schizophrenia contribute to dysfunctional HPA axis activity
o Important biological system in the physiological response to stress

Question 92

What are the environmental/psychosocial factors that can encourage schizophrenic development at birth?

Answer 92

	Antenatal complications
	Viral infections
	Nutrition 
	Urban birth
	Seasonal variation
--Winter/early spring birth more likely to have schizophrenia because of decreased levels of vitamin D
	Increased paternal age

Question 93

What are the environmental/psychosocial factors that can encourage schizophrenic development at early adolescence

Answer 93

	Child abuse/trauma
	Social stresses
	Urban upbringing 
	Migration
	Discrimination

Question 94

What are the environmental/psychosocial factors that can encourage schizophrenic development at late adolescence

Answer 94

 Dysfunctional cognitions
 Amphetamine
 Cannabis

Question 95

What are the environmental/psychosocial factors that can encourage schizophrenic development further in life?

Answer 95

 Idiopathic stress
 Social/educational/work stresses
 Interpretation of culturally unacceptable intrusive thoughts (e.g. someone is controlling my thoughts vs I must be tired)
• Result of faulty knowledge about the self and others resultant from bad life experiences
• Encouragement of behaviours that encourage other intrusive thoughts

Question 96

What can happen after onset of psychosis?

Answer 96

 Relapse

 Substance abuse

Question 97

Describe the effectiveness and type of medication used on on schizophrenic patients

Answer 97

o Primary intervention
o 60% of clients with positive symptoms respond
o 10-20% do not show symptom improvement in response to medication
o Relapse rates high with 40% relapsing within one year
o Medication non-compliance common, given common side effects
o Antipsychotic medication
o Mood stabilisers and antidepressants
o Benzodiazepines to assist in sleep and reduce anxiety

Question 98

Describe the psychological interventions used on schizophrenic patients

Answer 98

o Need to be tailored to the stage of illness
o Important to work from the patient perspective
o Designed to target specific deficits or therapy goals:
 Social skills training for interpersonal deficits
 Group based interventions
 Medication compliance
 Stress management
 Managing and reducing residual delusions/hallucinations
• Systematic review and meta-analysis:
o 53 RCTs evaluation 7 psychological interventions
 N=4,068 participants, moderately ill at baseline, receiving antipsychotics + psych therapy
 CBT reduced positive symptoms more than
• Inactive control
• Treatment as usual
• Supportive therapy
 CBT reduces reslapse
 CBT good for reducing the transition to psychosis for individuals at high risk of developing a first episode of psychosis

Question 99

What do we need to do to treat schizophrenics more effectively?

Answer 99

• Need to have more facilities for mental health and make CBT and other forms of treatment more available, as well as reduce stigma about psychosis

Question 100

Is schizophrenia polygenetic or accounted for by a single gene?

Answer 100

Polygenetic

Question 101

What is a drug/substance?

Answer 101

• A drug/substance is any substance that exerts an effect on body or mind (prescription, legal and illicit)

Question 102

What can the effects of drugs/substances be?

Answer 102

•	Effect may be:
o	Neurophysiological
	Respiratory, tachycardia, dilatation 
o	Behavioural
	Sedated, aggressive
o	Emotional
	Excitement, confidence
o	Cognitive
	Impaired judgement and memory

Question 103

What are different drug classifications and some examples of these?

Answer 103

o Depressant (downers)
 Alcohol, barbiturates, inhalants, benzodiazepines, sedatives
o Stimulants (uppers)
 Cocaine, amphetamines, caffeine, nicotine, MDA (ecstasy)
o Hallucinogen (altered perceptions)
 Mescaline, LSD, psilocybin
o Opioid/narcotics (analgesia)
 Morphine, heroine, codeine, methadone
o Cannabinoids
 Marijuana, hash, ganja
o Tobacco, steroids, volatile solvents, prescription drugs

Question 104

What are different ways to administer drugs, and their relative speed?

Answer 104

• Intravenous
o Rapid and controlled pathway
o Fastest activity
• Inhalation
o Substance goes through lungs, blood and then brain
• Oral
o Substance goes through stomach, where enzymes break it down: takes longer

Question 105

What are the social perspectives on each drug? Is each drug inherently dangerous?

Answer 105

• Drugs can be viewed as neutral substances, but are restricted/banned due to their impacts (such as their harmful and addictive effects, which were discovered over time)
• Value judgement (depending on use and effects) determine if they become illicit vs not illicit
o Alcohol is socially acceptable in moderation
 Although harmful, its history would make it hard to ban
o Cigarettes are legal despite having no beneficial effects
o Prescription drugs are accepted but can be abused
o Illicit drugs- have varied social/legal condemnation

Question 106

Is recreational use of marijuana legal in Australia?

Answer 106

No

Question 107

What is physiological dependence?

Answer 107

associated with physical symptoms of tolerance and withdrawal on cessation (need)

Question 108

What is psychological dependence?

Answer 108

cravings/desire leading to repetitive (compulsive) use (want)

Question 109

Describe substance disorders in DSM-IV vs DSM-V

Answer 109

o	DSM-IV
	Substance dependence
	Substance abuse
o	DSM5
	Substance-related and addictive disorder
•	Substance use disorders
•	Substance induced disorders
	Non-substance-related behavioural addictions
•	Gambling

Question 110

For substance related (and addictive disorders), what drugs does DSM5 cover diagnostic criteria for?

Answer 110

separate classes of drugs:
o	Alcohol
o	Caffeine (substance use disorder does not apply to caffeine)
o	Cannabis
o	Hallucinogens
o	Inhalants
o	Opioids
o	Sedatives, hypnotics or anxiolytics 
o	Stimulants
o	Tobacco

Question 111

What is the criteria to be diagnosed with substance related disorders?

Answer 111

o Tobacco
• Criteria A for DSM-5 substance related disorders: Individual must have at least 2 of the following symptoms within a 12-month period, which have resulted in clinically significant distress or impairment, to be diagnosed with a substance use disorder
o Larger amounts of the substance are consumed than the individual intended
o There is a persistent desire, or unsuccessful attempts, to reduce substance use
o A large amount of time is spent obtaining, using or recovering from the effects of the substance
o The individual experiences a failure to fulfil major role expectations due to recurrent substance use
o Ther eis continued substance use even though it results in social or interpersonal difficulties
o Substance use interferes with the individual’s ability to engage in social or occupational activities, so that these activities are reduced or cease entirely
o Substance use occurs in situations where it is physically hazardous
o There is continued use of the substance even though the individual is aware of the problems caused by the substance
o Tolerance is present, as evident by either:
 A need for increased amounts of the substance in order to achieve the same effect
 A markedly diminished effect for the same amount of the substance
o Withdrawal is present, as evident by either
 A range of characteristic physical and psychological symptoms that emerge after a cessation or reduction in substance use
 Taking the substance (or a closely related substance) in order to alleviate these symptoms

Question 112

What are comorbidities of substance use and what could be the cause of these?

Answer 112

o 60% of substance users have a co-morbid psychiatric disorder
 Compared to general population:
• Patients with mood/anxiety disorders twice as likely to suffer substance disorder
• Patients with substance disorders twice as likely to suffer a mood/anxiety
 This could be due to:
• Overlapping genetic vulnerabilities
• Overlapping environmental triggers
• Involvement of similar brain regions
• Interactive effect: drug/other disorders can increase vulnerability to the other

Question 113

Describe the trend for drugs among 12+ years olds for past 30-day illicit drug use

Answer 113

• Among 12+ years old for past 30-day illicit drug use trends, cocaine and marijuana use are going up, but nonmedical use of psychotherapeutics, hallucinogens, binge alcohol use and illicit drugs is staying stable

Question 114

When are people most likely to use substances?

Answer 114

• For substance use, peak substance use is between 20-30 years old, then it goes back down again (downward hyperbola trend)

Question 115

What is the disease model of addiction

Answer 115

o Disease model of addiction- describes addiction as a medical disorder characterised by some form of brain impairment

Question 116

What is the choice theory of addiction

Answer 116

o Choice theory- the apparent loss of control seen in those with a substance use disorder as a consequence of individuals changing their minds

Question 117

How many standard drinks are a low risk amount for males?

Answer 117

4 or less

Question 118

How many standard drinks are a low risk amount for females

Answer 118

2 or less

Question 119

How many standard drinks are hazardous for males?

Answer 119

5-6

Question 120

How many standard drinks are hazardous for females?

Answer 120

3-4

Question 121

How many standard drinks are harmful for males?

Answer 121

7+

Question 122

How many standard drinks are harmful for females?

Answer 122

5+

Question 123

Is drink tolerance the same across all cultures?

Answer 123

No

Question 124

Is there a genetic component to substance use disorders? What is the evidence for this?

Answer 124

• Strong genetic component to substance disorders (found from twin research)
• Monozygotic twins show higher concordance rates for:
o Alcohol, cannabis, tobacco
o Stimulants
o Hallucinogens, opioids
o Sedatives
• Likely that the genetic basis for substance dependence is largely non-specific, rather than unique to specific substances

Question 125

What is the percentage of people who have addictions that give up on their own volition?

Answer 125

• 70% of people who meet addiction give up on their own volition

Question 126

What is the procedure for psychological treatment of substance abuse?

Answer 126

•	Procedure
o	Assessment
o	Evidence-based treatment
o	Substance use monitoring
o	Clinical and case management 
o	Recovery support programs
o	Continuing care

Question 127

What are the groups involved in psychological treatment for substance abuse?

Answer 127

o	Vocational services
o	Mental health services
o	Family services
o	Legal services
o	HIV/AIDS services
o	Educational services
o	Medical services

Question 128

What are the principles of effective management of substance abuse?

Answer 128

o No single treatment is appropriate
o Treatment needs to be readily available and accessible
o Effective treatment involves and attends to multiple psychological, medical and social interventions and needs
 CBT
 Naloxone
 Antabuse
 Methadone
 Peer support
 Aversive conditioning
o Dual diagnosed clients should have both disorders treated in an integrated fashion
o Treatment does not need to be voluntary to effect change
o Recovery from drug addiction can be a long term process and frequently requires multiple episodes of treatment

Question 129

What are the targets of substance use psychological interventions?

Answer 129

o Maladaptive behaviour patterns
o Skills deficits+ resilience training
o Motivational and cognitive barriers to change
 Identify high risk situations and events (e.g. people, places, affect) and deduce likelihood that these events are encountered (providing alternative activities)
 Target cognitive distortions enhancing likelihood of drug use (e.g. rationalising use or giving up on giving up

Question 130

What 3 interrelated sub systems are activated with anxiety?

Answer 130

• Physical system
• Cognitive system
• Behavioural system

Question 131

Describe how the physical system acts when anxiety is triggered

Answer 131

 Fight/flight response
 Mobilises resources to deal with the threat- releases adrenaline which initiates bodily changes
• Less saliva-dry mouth
• Breathing rate speeds up. Nostrils and air passages in lungs open wider to get in air more quickly
• Digestion slows down
• Liver releases sugar to provide quick energy
• Sphincter muscles contract to close openings of bowel and bladder
• Immune responses decrease- useful in short-term to allow massive response to immediate threat- harmful over long
• Muscles tense- ready for action
• Blood is diverted to the muscles
• Sweating increases to help cool the body
• Heart beat speed up. Blood pressure rises
• Blood clotting ability increases, preparing for possible injury

Question 132

Describe how the cognitive system activates with increased anxiety

Answer 132

 Perception of threat
 Attentional shift and hypervigilance on perceived threat
 Difficulty concentrating on other information/situations

Question 133

Describe how the behavioural system activates with increased anxiety

Answer 133

 Escape or avoidance
 Aggression or freezing
• Least safe option

Question 134

What is the difference between true and false alarm?

Answer 134

o True alarms- when fear occurs in response to direct danger
o False alarms- fight or flight response occurs in situations that do not represent an immediate physical threat- false alarms are the hallmark of anxiety disorders

Question 135

What affects someone’s tendency to perceive threat in ambiguous situations?

Answer 135

 Individuals differ in terms of the ease with which the alarm reaction is triggered: triple vulnerability includes
• Biological factors
o Inherit predisposition towards anxiety and depressive disorders- the general neurotic syndrome
• Generalised psychological factors
o Beliefs that the world is a dangerous place
o Events are beyond one’s control
• Specific psychological factors
o Specific to particular objects or situations and include factors that influence the expectation of a negative outcome when confronted with a specific object or event – generalises to other objects/events with similar features

Question 136

What affects someone’s extent to which anxiety response is activated?

Answer 136

• Tendency to experience negative affect from positive affect and arousability of the autonomic nervous system
• Negative affectivity- subjective distress
• Positive affectivity- happy and enthusiastic

Question 137

What are the 2 individual differences in trait anxiety?

Answer 137

• Tendency to perceive threat in ambiguous situations

- Extent to which anxiety response is activated

Question 138

Is anxiety on a continuum? Why so? When does anxiety starts being abnormal and what maintains this anxiety?

Answer 138

o Anxiety is on a continuum
o Not qualitatively different from normal anxiety
o Same (physical, cognitive and behavioural) systems activated, but marked by excessive or inappropriate occurrence, characterised by overestimation of perceived cost/likelihood of a threat
 Defines where you are on anxiety scale
o Arise when the frequency and intensity of anxiety interferes with the person’s functioning/causes distress
o Avoidance maintains and exacerbates anxiety

Question 139

What are anxiety disorders characterised according to in the DSM?

Answer 139

o In DSM, anxiety disorders characterised according to focus of anxiety and what they try to avoid

Question 140

Differentiate between DSM-IV anxiety disorders and DSM-V anxiety disorders

Answer 140

DSM-IV Anxiety disorders
Seperation Anxiety Disorder

Specific Phobia
Social Phobia
Generalised Anxiety disorder
Panic Disorder
Panic disorder with agoraphobia
Acute stress disorder
Posttraumatic stress disorder
Obsessive compulsive Disorder

DSM-V anxiety disorders
Seperation Anxiety Disorder
Selective Mutism
Specific phobia
Social anxiety disorder
Generalised anxiety disorder
Panic Disorder
Agoraphobia

Question 141

What are the trauma and stressor related disorders in DSM-5

Answer 141

• Posttraumatic stress disorder
• Acute stress disorder
• Adjustment disorders
• Reactive attachment disorder
• Disinhibited social engagement disorder

Question 142

What are the obsessive compulsive and related disorders in DSM-5?

Answer 142

• Obsessive-compulsive disorder
• Hoarding disorder
• Trichotillomania (hair pulling disorder)
• Excoriation (skin-picking disorder) disorder
• Body dysmorphic disorder

Question 143

What is criteria A for social anxiety disorder?

Answer 143

: Marked fear or anxiety about one or more social situations in which the person is exposed to possible scrutiny by others e.g. social interactions, being observed, performing in front of others

Question 144

What is criteria for social anxiety disorder?

Answer 144

The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (that is, will be humiliating or embarrassing; will lead to rejection or offend others)

Question 145

What is criteria C for social anxiety disorder?

Answer 145

The social situations almost always provoke fear or anxiety

Question 146

What is criteria D for social anxiety disorder?

Answer 146

The social situations are avoided or endured with intense fear/anxiety

Question 147

What is criteria E for social anxiety disorder?

Answer 147

The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context

Question 148

In DSM5 diagnosis of social anxiety disorder, the fear, anxiety or avoidance must be:

Answer 148

o Is persistent, typically lasting for 6 months or more
 Flexible with specifying time- can diagnose those with social anxiety disorder with times for less than 6 months
o Cause clinically significant distress or impairment in social, occupational or other important areas of functioning
 If does not affect their lives, does not get diagnosis
o Is not attributable to the physiological effects of a substance or another medical condition
o Is not better explained by symptoms or another mental disorder, such as panic disorder, body dysmorphic disorder or autism spectrum disorder
 Distinguish what person is fearing and avoiding
 Body dysmorphic- avoidance because impression that one of their body parts is horribly wrong
o If another medical condition (obesity, disfigurement from burns or injury) is present the fear, anxiety or avoidance is clearly unrelated or is excessive
 Clinical judgement is involved

Question 149

What is a specific sub category of social anxiety disorder?

Answer 149

o Performance only
 Socially anxious only when they perform in public but completely fine in social situation
 Fear restricted to speaking/performing in public
 Impacts actors or musicians

Question 150

What are the prevalence rates in adults within the past 12 months of social anxiety disorder in Australia?

Answer 150

Near 8%

Question 151

Is there a difference in countries in the prevalence rates in adults within the past 12 months of social anxiety disorders? Why/why not?

Answer 151

o Lower rate in European and Asian countries
 In some countries (Japan, Korea…), people are not as much afraid of negative evaluation by others, but fear they are offensive to others
 In cultures that are highly collectivistic, there seem to be more social anxiety in the general population- people seem to judge each other more but less prevalence in terms of anxiety disorders-symptoms are not clinical: high social anxiety but not social anxiety disorder

Question 152

What is the incidence of social anxiety disorder according to gender?

Answer 152

o In the general population: 1.5 higher in women
o In clinical samples: gender rates are equal
 Men seek treatment more often than women if they are socially anxious
 Depends on culturally accepted gender roles
 Less acceptable for men to be socially anxious than women in cultural

Question 153

What is the typical age of onset of social anxiety disorder and why might they develop it at this age?

Answer 153

o Childhood or adolescence
 75% will develop the disorder between the age of 8 years old and 15 years old
 Might have high levels of shyness until it increases to become social anxiety disorder
 Others: the disorder might trigger from traumatic experiences such as being bullied, rejected…
o Not very common to develop disorder in adulthood
 Would be due to crisis or traumatic situation

Question 154

Without treatment, what is the chance of recovery for social anxiety disorder?

Answer 154

o Chronic without treatment
o About 10% of people will recover within a year without any treatment
o About 30% will be better by themselves within 2 years
o About 60% will remain chronically anxious for most of their lives

Question 155

How many people seek treatment for anxiety disorder and why is this so low?

Answer 155

o Only 50% seek treatment (20 years after the onset of symptoms- delayed treatment)
 Difficult to seek treatment as embarrassment about symptoms

Question 156

What are comorbid disorders associated with social anxiety disorder?

Answer 156

o Women tend to have more:
 Other anxiety disorders
 Depression
o Men tend to have more:
 Substance use (alcohol to cope with it better)
 Avoidant personality disorder
o But both genders can experience all of them

Question 157

Is social anxiety disorder subject to genetic vulnerability?

Answer 157

• Genetic vulnerability- 2 to 3 fold increased risk of social anxiety disorder among the relatives of people with the disorder

Question 158

Is social anxiety disorder subject to psychosocial factors?

Answer 158

• Pyshosocial factors- excessive parental criticism may reduce child’s confidence, or child could learn from his/her parents and be overly concerned with the opinions of others

Question 159

Describe Clark and Wells cognitive model of social anxiety disorder

Answer 159

• Expectation of entering social situation will trigger assumptions or long-standing beliefs that the person holds. Four different types of beliefs
o Excessively high standards on themselves
o Conditional beliefs about consequences of social performance -very negative expectations of what’s going to happen
o Unconditional beliefs about self
 Conditional beliefs will enhance the fact that you will make a mistake if you have the unconditional beliefs about self
o Lead to perceived danger
• All this will cause anxiety
o Symptoms will start triggering
• Interpret ambiguous social cues as signs of negative evaluation with expectation that it will go badly
• Attention shifts to the self
o Interpret internal cues as signs of how they are being seen by others
o Hypervigilant to signs of anxiety
o More you pay attention to yourself, the more anxious you get
• Safety behaviours
o Keep yourself safe to avoid negative behaviours
o Hide signs of anxiety
o Don’t make eye contact
o Speak very quietly- don’t draw attention to yourself
o Do not show signs of weakness
 People can come across as cold and aloof
 So people will not be friendly back- fears will be confirmed
o Safety behaviours backfire
o Interferes with ability to participate with conversation or look at social cues
• Increase self-focused attention
• Increase anxiety symptoms
• Interfere with social performance
• Confirm social fears

Question 160

What happens in pre-event processing in social anxiety disorder?

Answer 160

o	Anticipatory processing
o	Imagine/review what might happen
	Anxiety
	Avoid social event or enter in self-focussed processing mode
o	People will remember when I stuff up

Question 161

What happens in post-event processing in social anxiety disorder?

Answer 161

o Remember negative aspects of the social situation
 Sense of shame
 Evaluating themselves with negative judgment
 What they should have done differently
 Everyone is talking about them/laughing about them
o Remember similar past failures
 Negative beliefs strengthened
 Person is hopeless and can’t do this
 Irrational about how much they might have offended the person/make them look stupid
o Increase/maintain anxiety

Question 162

What treatments are common for social anxiety disorder?

Answer 162

•	Cognitive behavioural therapy (CBT)
o	First line evidence-based treatment 
o	Aim: to reduce negatively biased threat appraisal
	Reduce likelihood of negative event 
	Reduce cost of negative event 
	Increase exposure to event 
•	Psycho-education
•	Cognitive techniques
•	Behavioural techniques
•	Reducing safety behaviours
•	Attention training
•	Video feedback
•	Exposure tasks with cognitive rationale
•	Often carried out in group settings
•	About 2/3 achieve substantial improvement

Question 163

What is the biological approach to psychology?

Answer 163

• Biological approach- focus on genetic, hormonal, and neurochemical explanations of behaviour

Question 164

What is the psychoanalysis approach to psychology?

Answer 164

innate drives of sex and aggression (nature). Social upbringing during childhood (nurture)

Question 165

What is the cognitive approach to psychology?

Answer 165

Innate mental structures such as schemas, perception and memory and constantly changed by the environment

Question 166

What is the humanism approach to psychology?

Answer 166

Maslow emphasized basic physical needs. Society influences a person’s self concept

Question 167

What is the behaviourism approach to psychology?

Answer 167

all behaviour is learned from the environment through conditioning

Question 168

What is the cognitive-behavioural model and what are some treatments that stem from it?

Answer 168

o Dominant model in clinical psychology research and clinical practice
 What we think influences how we feel and what we do
o Maladjustment: latent core negative beliefs (Aaron Back)
 Guide our understanding of the world
 Interpretations of experiences are consistent with our core beliefs
 Cognitive distortions/biases (e.g. overgeneralisations, selective attention, catastrophising, black and white thinking etc.)
 Automatic negative thoughts
o Treatment:
 Cognitive restructuring
• Challenging content of thinking
 Exposure
 Behavioural experiments

Question 169

What is the new third wave of CBT and what does it involve/ how is it different from the old treatments?

Answer 169

 Modern (third wave) CBT and evidence based therapy A wider range of approaches from humanistic, existential, analytic and spiritual traditions
• But should not practise just one thing because of different patients and different presentations of disorders
 CBT’s focus on the content of symptoms changed to a process- based therapy  change from WHAT people think about to HOW people think
 Symptom/syndromal/psychopathology focus weakens  Focus on a process

Question 170

What are examples of new third wave CBT?

Answer 170

• Mindfulness based cognitive therapy
• Acceptance commitment therapy
• Dialectic behavioural therapy

Question 171

Describe mindfulness based cognitive therapy

Answer 171

o Mental events
o Don’t have to grab thoughts and make them feel like they are reality
o Observe and distance yourself from thoughts/emotions
o Don’t judge or identify them
o Effective for reducing frequency of depressive relapses
o Good for emotional regulation which is good for borderline personality disorder

Question 172

Describe acceptance commitment therapy

Answer 172

o Assumes person is uncomfortable with negative and painful feelings
o Try to tolerate feeling- feeling is temporary and necessary – it is just a feeling/thought
o Do something despite the uncomfortable feeling
o Psychological flexibility- being present, open, doing what matters to you
o Contact with the present moment
o Chosen values- Chosen values of a person and what can guide their behaviours
 Commitment to values
o Committed action- Effective mental and physical actions guided by values
o Self as context- Observing self, pure awareness of thoughts, behaviours, moods
o Thought defusion- observing thoughts as they come and go without attaching meaning or judgment, detaching from thoughts
o Acceptance/willingness- open to whatever comes

Question 173

Is it important to tailor psychotherapy components to the patient?

Answer 173

• Important to tailor psychotherapy components to the person
o Different types of clients require different treatments/relationships
o Applying an identical psychosocial treatment for all patients is inappropriate and perhaps even unethical
 Want to personalise and treat holistically

Question 174

What do clinical training programs now have to include?

Answer 174

• Clinical training programs now have to include training in evidence-based therapies to be accredited

Question 175

Why is there a need for evidence-based treatment evaluation? Is this need old or new?

Answer 175

o The drive to identify evidence-based treatments is a relatively new idea  previously, client report was sufficient
 Psychiatrists thought it was enough to see if therapy was effective if person had positive feedback, but would not look at dropout rate or worsening
o Need for evidence-based treatment is due to a need for accountability: social/economic (third party payers) want to know that what they’re paying for is worth it and ethical accountability
o Patient care can be enhanced by acquisition and use of up-to-date empirical knowledge
o It is difficult for clinicians to keep up with newly emerging information pertinent to their practice
o If do not keep up with newly emerging information, their knowledge and clinical performance will deteriorate over the years after their training
o Clinicians need summaries of evidence provided by expert reviews and instructions on how to access this information during their routine practice

Question 176

What study did the idea of a need for evidence based treatment come from?

Answer 176

• Study: Hans Eysenck
o People receiving psychotherapy are not better (could be worse off) than no treatment
o People recovered by themselves in about 2 years and found that therapy didn’t really help for everyone
o Predominant theory during this time was psychoanalysis

Question 177

What is the placebo effect in clinical treatment? What are factors of it and how could we determine whether there is one or not?

Answer 177

o Recent studies suggest that treatment is better than no treatment
o But little or no specific effect when comparing two different treatments
o Nonspecific factors could be responsible for this treatment effect, such as:
 Client motivation and hope
 Therapist empathy, general counselling skills
 Therapist-client alliance
• Have someone on their side
o Need for placebo control groups which would reflect those general factors and there is a lack of power in study designs (hard to conduct clinical studies with patients that are not feeling well)
 Hard to get large sample sizes in these studies

Question 178

What is the criteria for well established treatments and who set this criteria?

Answer 178

 At least two good between-group design experiments (Randomised controlled trials-RTCs) must demonstrate that the treatment is superior to:
• Placebo pill
• Psychotherapy placebo
o Needs to account for general effects- type of therapy that has the same duration, counselling aspect, validation and normalization of what person is feeling
o What’s missing is the activate component of therapy that is being tested
• Other treatment
 OR equivalent to an already established treatment (with adequate sample sizes)
o Set by APA task force on promotion and dissemination of psychological procedures

Question 179

What are features of good experimental design?

Answer 179

o Random allocation of participants to treatment groups
o Blind or double-blind design
o Experiments must be conducted with treatment manuals or clear description of treatment enables precise replication
o Characteristics of samples must be specified
 Diagnoses, exclusion criteria etc (DSM)
 Exclusion of comorbidity or not specification
o Characteristics of therapists must be specified
o Effects must be demonstrate by at least two different investigators or teams- to rule out experimenter bias

Question 180

What is the criteria for promising treatment?

Answer 180

o At least 2 experiments show that the treatment is superior to the waiting list control group (rather than placebo control)
o OR meets well-established criteria but experiments not carried out by 2 different teams

Question 181

What is the criteria for emerging (experimental) treatments?

Answer 181

• Experimental treatments (emerging treatments) are those not yet tested in RTCs with adequate methodology
o E.g. not randomised, pre-post only, not manualised

Question 182

What are criticisms of evidence based research?

Answer 182

• EST findings will be:
o Misused by managed care companies to disenfranchise practitioners of psychotherapies that are not so designated
o Will make these same practitioners more vulnerable to malpractice suits
o Will restrict practice to a limited number of treatments, thus precluding flexibility and clinical innovation
• Reliance on DSM to describe samples
• Reliance on treatment manuals
• Reliance on randomised control trials

Question 183

Why is the reliance on DSM to describe samples a criticism of evidence based research?

Answer 183

o Diagnosis is dehumanising
o DSM medical model is not appropriate but need to evaluate generalisability somehow
o Clarity of the criteria and methods for reaching decisions vague

Question 184

Why is the reliance on treatment manuals a criticism of evidence based research

Answer 184

o Reduces treatment quality: treatment should be designed for individual cases but there is no data supporting this contention (no evidence that they don’t work)
 Tailoring more relevant for complex disorders
o Limits generalisability: clinicians don’t normally use treatment manuals but may they should

Question 185

Why is the reliance on randomised control trials a criticism of evidence based research?

Answer 185

o Advantage for CBTs
 CBT is structured
 Measurable
 Observable
o Findings are unlikely to generalise to ordinary treatment settings  strongest argument against evidence-based research findings
 Efficacy vs effectiveness (internal vs external validity)
 Treatment not necessarily equally effective if used in:
• Private practise, community mental health settings or unselected client base
o Ecological validity is an issue
o Some evidence for external validity, but effects sizes are often lower
 Are working in real life, but not to same extent as clinical trials
o More research is needed

Question 186

Do mental professionals work in a team or individually?

Answer 186

• Differ in approaches to understanding and treating mental illness, each having different but complementary skills  holistic treatment/support
• May work independently or as part of a multi-disciplinary team

Question 187

What are the characteristics of an effective psychologist?

Answer 187

• Empathy and genuine concern: active listening and reflection
o Builds an open and trusting rapport with client/patient
• Appropriate boundaries: maintaining appropriate personal distance
• Trustworthiness: confidentiality emphasised (exceptions explained)
• Patience: guiding the client in the process of self-discovery
• Solid ethical core: openness, honestly, transparency
• Cross-cultural sensitivity: self-awareness and commitment to diversity
• Scientist-practitioner: commitment and passion for a life-long learning
o Provides individualised/tailored psychotherapy

Question 188

What is a concurrent schedule?

Answer 188

Animals are given the opportunity to engage in two or more responses that are reinforced according to separate schedules that are running at the same time

Question 189

What is the equation for rate of behaviour?

Answer 189

• Rate of behaviour- B
• Rate of reinforcement- R
• Slope constant-K
• B=kR

Question 190

What is the relative rate of responding of B1 compared to B2?

Answer 190

• We have two behaviours performed at different rates
o B1, B2
• Relative rate of responding of B1 is: B1/ (B1+ B2)

Question 191

What is the relative rate of responding of R1 compared to R2?

Answer 191

• The behaviours are reinforced given at different rates- R1, R2
• The relative rate of reinforcing of R1 is: R1/(R1+R2)

Question 192

What are the equations of the matching law and what is the matching law useful for?

Answer 192

• B1/B2= R1/R2
• B1/(B1+B2) = R1/(R1+R2)
o Matching law
 Describes the choice in concurrent schedules of reinforcement
o The distribution of behaviour can be predicted by the history of the distribution of reinforcement
o Change relative rates of behaviour by changing relative rate of reward

Question 193

What is the schedule matching law?

Answer 193

• T1 and T2- schedules

* T1/T2=R1/R2

Question 194

What is the value matching law?

Answer 194

• V1 and V2- values

* B1/B2= V1/V2

Question 195

What are possible explanations for the matching laws?

Answer 195

• Animals might choose to respond on one alternative or the other on a moment-to-moment basis so as to maximise the momentary rate of reinforcement
• Animals choose in a way that somehow maximises the overall rate of reinforcement In the whole session
• Animals might keep shifting between the alternatives so as to always improve the local rate of reinforcement
o Melioration- stop shifting between alternatives when the two local rates of reinforcement are equal

Question 196

What are the criticisms of matching laws?

Answer 196

• Sometimes, animals overmatch so that B1/B2 is consistently a little greater than R1/R2
• Other times, animals undermatch and B1/B2 is a little less than R1/R2

Question 197

Describe Madsen et.al’s study on how differential reinforcement of other behaviours reduces an unwanted behaviour

Answer 197

• Madsen et.al
o Reinforce alternate behaviour
o More kids out of their chairs when the teacher yelled sit down
o Artistic work in a book instead of going out of chairs- praised them for working
 Kids praised for alternative behaviour to being out of chair and running around
 Doesn’t introduce aggression in the situation
• Change relative rate of behaviour by reinforcing other behaviours instead

Question 198

If your situation in some part influences your behaviour, what can you do to change that behaviour?

Answer 198

• If your situation in some part influences your behaviour, then modifying your environment will modify your future behaviour:
o Behaviours that alter future behaviours
 Stimulus control (e.g. studying)
 Distraction (ignoring easy options)
 Precommittment
 Self-reinforcement (reward self for achieving targets)

Question 199

What is self-control?

Answer 199

o Delaying immediate gratification for a bigger longer-term reward

Question 200

What is impulsivity?

Answer 200

o Forgoing a larger long-term reward for immediate gratification

Question 201

What is the subjective value of a small but immediate reward vs a large but delayed one?
What is an exception to this?

Answer 201

• A more immediate but smaller reward can have a larger subjective reward value at the time of choice, than a delayed but larger reward
o But increase the time until choice, and the subjective value of the smaller reward decays as well to a level that’s below the more valuable delayed reward
• But when the average choice-to-reward delay is relatively short, choose the smaller, more immediate reward. When the choice-to-reward delay is relatively long, choose the larger, more delayd reward

Question 202

Why do we choose the more immediate smaller reward compared to the larger but delayed reward?

Answer 202

• Risk of losing reward
o For each period of time (Delay,D) there is a risk (r ) that the reward (A) may be lost. This risk is compounded for each period of time
o This predicts an exponential curve for the present value of a delayed reward to be B=Ae(-rD)
o However, behavioural data does not fit this but better fits a hyperbolic function -devaluation curve
 Subjective decay in value
o Intertemporal choice- immediate gratifications vs holding out for something in the future
• Expected transaction costs
o More effort to come back for reward later when there is one right in front of you
• Concave utility effects on reward
o Rewards have subjective value depending on how much the person has of that reward if have a lot of that reward, increased amount will be needed to be meaningful. If have little of that reward in the first place, even a small amount of reward will be motivating

Question 203

How can you increase self-control?

Answer 203

• Make the immediate rewards less obvious
• Distraction from the immediate rewards
• Delay the immediate reward too
• Make the longer term rewards or risks more salient
• Exercise

Question 204

Talk about lyengar and Lepper’s study about choice

Answer 204

• Iyengar and Lepper
o If given a choice between 6 jams or a choice between 24 jams:
 6 choices: 40% stopped at booth, 30% bought
 24 choices: 60% stopped at booth, 3% bought
o If given a choice between 6 essay topics or 24 essay topics for extra credit:
 6 choices: 74% completed the essay
 24 choices: 60% completed
 Limited choices essays were better technically and intellectually
o No-choice, limited choice, wide choice of chocolates:
 Frustration: Wide choice > limited choice
 Satisfaction of chocolate: limited choice >wide choice > no choice
 Purchasing: Limited choice (48%) > wide choice (12%) = no choice (10%)

Question 205

Why do too many options reduce choosing?

Answer 205

o Escalation of expectations
o Regret and anticipated regret with choice
o Opportunity cost
o Self-blame

Question 206

What is the marshmellow test and what supplementary studies were done on it?

Answer 206

 Watts Et.Al.
• Replicated marshmallow test (where have one marshmallow in front of you and if wait for a bit get 2 marshmallows)
• Accounted for socioeconomic status
• Found that self-control vs impulse of a person was largely controlled by their environment

Question 207

Describe Bickel et al’s study

Answer 207

• Changeable across individuals
• Current smokers underestimate subjective values of future rewards  more immediate reward choosing
• Smokers who quit have the same level of immediate vs delayed reward choosing than people who’ve never smoked, which is more delayed reward choosing than current smokers

Question 208

What is neuropsychology?

Answer 208

• Matching structure and functions of the brain to psychological processes:
o Experimental neuropsychology aims to match behaviour, mood and cognition to brain functioning
o Clinical neuropsychology aims to understand, assess, treat psychological disorders with reference to abnormal brain functioning

Question 209

What is neurology?

Answer 209

o Largely concerned with neural physiology

Question 210

What is psychology?

Answer 210

o Seeks to understand psychological processes at different levels of explanation

Question 211

What is psychiatry?

Answer 211

o Effects of drugs on mood and thinking

Question 212

What is phrenology and who was it proposed by?

Answer 212

o Gall
o Brain consists of many mental organs, each dedicated to particular mental function
o Hypothesis:
 If used a lot, that part of the brain becomes bigger
 Should read bumps on head to see which sections of the brain are more developed
 Skull shifts to accommodate for this
 However, the part of the brain does not get bigger, and there was no evidence for this so it was scrapped

Question 213

What are the suggested domains of function in phrenology?

Answer 213

	Form
	Size
	Weight
	Colour
	Arithmetic calculation
	Locality (topographic learning and memory)
	Eventuality (memory for facts) 
	Time
	Music
	Language

Question 214

What are the three main sources of evidence that function can be localised to structures?

Answer 214

• Three main sources of evidence that function can be localised to structures include:
o The effect of accidental (via disease or injury) or experimental lesions on psychological functions
o Psychological effects of stimulation
o Recording neural activity while doing tasks

Question 215

What can lesions in the brain do? What is the difference between Broca’s and Wernicke’s aphasia and their location?

Answer 215

o Lesions in brain can cause rapid and psychological change
o Localisation of language by lesions (Broca and Wernicke)
 Broca and Wernicke’s aphasia
• Broca’s patient was Mr Tan
• Wernicke- patient can’t understand what is being said to him
o Fluent in producing speech but speech has no meaning
o Where temporal lobe joins the parietal lobe
• Broca’s aphasia- can’t say what they want to say
o Damage in left prefrontal cortex

Question 216

What is the advantage of experimentally induced lesions?

Answer 216

o Experimentally induced lesions- animals
 Chemically induce lesions in brains and examine the effect on function
 Requires multiple tests to delineate function of the region
 Can repeat among individuals
 Can use specific types of techniques for lesions
 More accurate as choose where lesion is – more experimental control

Question 217

What did Kobinian Brodmann do?

Answer 217

o Kobinian Brodmann
 Used the Nissl method of staining to look for the fine structure of the brain
 Allowed him to see that the brain is organised into morphologically and structurally distinct regions where the cell shapes and sizes differ from each other
 Mapped these regions and divided the cortex into structurally distinct regions

Question 218

What are brain atlases and how are they made?

Answer 218

o Mapping anatomically distinct regions of the brain- modern atlases
 Brains stained with dye
 Fine grained map of all regions
 Can look at types of neurons and chemoarchitecture

Question 219

What are directly implanted electrodes, what do they do and what are their advantages/disadvantages

Answer 219

• Great spatial and temporal acuity
• Requires surgery
• Placed on cortex of person’s brain, then connected to computer which finds signals
• Recording activity whilst people are doing/thinking about things

Question 220

What is electroencephalogram, what does it do and what is their advantage/disadvantage?

Answer 220

• Great temporal acuity, poor spatial accuracy
• Read surface activity of brain- can see localisation of activity
• Can only measure activity below skull
• Millisecond accuracy

Question 221

What does MRI (magnetic resonance imaging) do?

Answer 221

 uses magnetic fields and radio waves to produce high quality images of brain structures
 Does not use ionizing radiation (X rays) or radioactive tracers
 Excellent resolution of 2-3 mm

Question 222

What does fMRI (functional magnetic resonance imaging) do and what are their disadvantages?

Answer 222

 Measures the real-time response of oxygen in the blood stream (different response when bound to haemoglobin) in response to stimuli/tasks, then superimposes that information onto an MRI
 Typically requires a rest period (for control), then a task
• When there is an increase in activity during task, that part of the brain is used in the task
 Can see where brain is doing work by migration of oxygen
 Takes 20-30 seconds for whole brain scan
 Poor spatial and very poor temporal resolution
 Voxels by voxels analysis for graph
• Increasing error rate in making poor rejection of null hypothesis because of low power

Question 223

What is Positron Emission Tomography and what are its advantages/ disadvantages?

Answer 223

 Measures emissions from radioactively labelled chemicals injected into the bloodstream
• Can see where tracers go in the body
 Different compounds can show different things
 Tasks must be very short because of decay
 Good idea about processes going on in brain- types of neurochemical processes depending on radiolabels we use
 Very poor spatial and temporal resolution

Question 224

What is magnetoencephalography and what are its advantages/disadvantages?

Answer 224

 Measurement of the magnetic fields produced by electrical activity in the brain
 Excellent temporal resolution
• Millisecond accuracy
 Poor spatial resolution
 Unlike EEG (electrical) skull does not impede measurement

Question 225

What was revealed from a dead salmon’s fMRI?

Answer 225

Atlantic salmon
–Said to react to pictures of humans but it was dead
–Found some activity due to chance
Shows:
-Poor choice of control tasks, leading to poor conclusions
-Too little statistical power means that chance results are accepted too readily
-Correlational data

Question 226

What is the problem with lesions?

Answer 226

Problem determining which particular function(s) have been changed:

• -Accidental lesions:
• —-Little data on pre-accident functioning of the individual
• —-Most detailed neuroanatomy in humans can only be done post-mortem: brain can change a lot in the meantime
• -Experimental lesions
• —-Usually done in animals, so functional testing is more limited
• —-Problem of determining if structures are homologous with humans

Question 227

What is the problem of neuroimaging?

Answer 227

• —-Spatial resolution is not as clear as post-mortem analysis
• —-Correlational data

Question 228

How can we localise function to specific regions of the brain?

Answer 228

• Lesions
• Cytoarchitectonics and advances in neuroanatomy
• Measuring neural activity
• Neuroimaging

Question 229

What is the Montreal Procedure and who was it done by?

Answer 229

• Montreal procedure- Penfield: would ablate part of the brain responsible for epileptic features
o Stimulated brain to make sure he didn’t take out anything important and asked the person what they were feeling

Question 230

What are the problems with subscribing function to single locations?

Answer 230

• Plasticity in the cortex and developmental effects
• Redundancy and pleiotropy
• Mass effects and network connectivity of structures
• Context-dependent effects

Question 231

Why is plasticity in the cortex and developmental effects a problem to subscribing function to single locations and what are examples of this?

Answer 231

 Brain changes as you age
 Changes in one part of the brain can have downstream/compensatory effects in other parts of brain, especially at key developmental stages
 If one area of the brain is damaged, the functions can be remapped onto new parts of the brain
• Blind people use the visual cortex to discriminate Braille, but there’s a critical period for an increase in visual cortex activity.
o Tends to occur in people who were blind from birth or young
• TMS of the visual cortex produces phosphenes in sighted people and paraesthesia in the fingers of blind Braille readers
o Ptito-
 Draw what phosphenes looked like- different mapping in brain
 Did same things with people in Braille- variation in remapping

Question 232

What is redundancy?

Answer 232

multiple parts of the brain can do similar functions e.g. memory

Question 233

What is pleiotropy?

Answer 233

one part of the brain can have multiple functions

Question 234

Why are network connectivity of structures a problem in assigning a function to a specific part of the brain?

Answer 234

 Functions may require a network of regions correlating activity with each other in a specific way
 Degrading single nodes of the network does not necessarily reduce the function of the whole network

Question 235

What is mass action and who proposed it?

Answer 235

• Karl Lashley
o Mass action:
 If cortical tissue is destroyed following the learning of a complex task, deterioration of performance on the task is determined more by the amount of tissue destroyed than by its location
 Experiences are distributed across the brain, so damage to specific part of the brain won’t affect it-damage has to be mass effect

Question 236

What is equipotentiality ?

Answer 236

 One part of the cortex can take over the function of another part

Question 237

What is diffusion tensor imaging?

Answer 237

 Diffusion tensor imaging- imaging white matter connectivity
• Damage may be to the connections between regions
• Measure flow of water through brain
• Mathematically model synaptic regions

Question 238

What is network analysis?

Answer 238

 Network analysis- the default mode network
• Functional correlations in activity between connected regions may be affected
• Default thought network in brain can predict different pathologies

Question 239

What are context-dependent effects?

Answer 239

 The context can influence how a region of the brain functions during a given activity
 The background emotional state can influence how regions of the brain respond to stimuli

Question 240

What do clinical neuropsychologists do and who do they belong to?

Answer 240

• A college within the Australian Psychological Society
o Most practitioners work within health service teams in hospitals or private practice
o Provide advice on assessment, diagnosis, treatment and rehabilitation
o Research into the neural basis of psychological functions

Question 241

What are the 6 major reasons for assessment?

Answer 241

 Diagnosis, patient care and its planning, treatment planning, treatment evaluation, research and forensic neuropsychology

Question 242

How do you carry out individual assessment?

Answer 242

• How has the person changed from previous function?

* Is the person declining across longitudinal assessments?

Question 243

How do you carry out a normative assessment?

Answer 243

• How is the person’s function compared to their peers in standardised tests?

Question 244

What is the assessment process?

Answer 244

 History taking in a clinical interview
 Selection of the appropriate tests
 Report writing for clinicians, the client, their family or carers

Question 245

What standard tests are available?

Answer 245

 Standard tests to assess cognitive and emotional disorders are commercially available to assess a range of cognitive domains:
• Working memory, executive function, verbal or spatial memory, attention etc.

Question 246

What should a good test be?

Answer 246

• Valid for the function assessed
• Reliable across people and within a single person
• Normative data against large populations
• Standardised instructions so they can be conducted in a variety of contexts
o The test items do not vary
o The test instructions are read from a manual in the same way
o The testing environment is arranged in a specific way
 E.g stroop test (colour and word are different)
• Valid across a variety of cultural settings and developmental stages

Question 247

What is the CANTAB test battery?

Answer 247

 Designed to use tasks that don’t rely on language
 Reduced cultural effects
 Portability and automaticity
 Data collections to aid standardisation, and validity and reliability testing