Abnormal Psychology - Final Flashcards
What is a diagnosis
assigning a patient’s symptoms to a specific classification
What is a clinical assessment
obtaining relevant information and making a judgment based on it
Assessment is collecting relevant information in an effort to reach a conclusion
used to determine how & why a person is behaving abnormally and how that person may be helped
Focus is idiographic (i.e., on an individual person)
psychodynamics: looking at symbols they might be using
behavioral: what behaviors do you exhibit
Also may be used to evaluate treatment progress
What is prevalence
number of people who have a disorder in a given period of time (e.g., life-time prevalence)
What is incidence
total number of new cases identified in a given period of time (e.g. 12-month)
Briefly describe what is the DSM-5
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and Fourth Edition, Text Revision (DSM-IV-TR)
Describes characteristics of many psychological disorders
Identifies criteria, kinds, number, and duration of relevant symptoms
Categorical system; Used in North America
Briefly describe the ICD-11
International Classification of Diseases, 10th Edition (ICD-10) & 11th Edition (ICD-11)
Includes both general medical and psychological disorders
Used in other parts of the world
Name 3 categories of the ICD-10 from the chapter 6: Mental, behavioural and neurodevelopmental disorders
Neurodevelopmental disorders
Schizophrenia or other primary psychotic disorders
Catatonia
Mood disorders
Anxiety or fear-related disorders
Obsessive-compulsive or related disorders
Disorders specifically associated with stress
Dissociative disorders
Feeding or eating disorders
Elimination disorders
Disorders of bodily distress or bodily experience
Disorders due to substance use or addictive behaviours
Impulse control disorders
Personality disorders and related traits
Paraphilic disorders
Neurocognitive disorders
Name 6 uses for the DSM
- common language for clinicians
- tool for researchers
- clinical/research interface
- information for educators and students
- coding system for statistical, insurance, and administrative purposes.
- important role in both civil and criminal legal proceedings
Name 4 downsides to using the DSM
- criteria are somewhat too detailed to be completely convenient to clinicians
- not quite detailed enough for the taste of researchers
- too dull for teachers and students
- not nearly precise enough for lawyers
What was Emil Kraepelin’s contribution (4)
- Created a classification system to establish the biological nature of mental illnesses
- Noticed clustering of symptoms (syndrome) which were presumed to have an underlying physical cause,
each mental illness is seen as distinct, with own genesis, symptoms, course, and outcome - Proposed two major groups of severe mental diseases (affective vs non-affective)
a. Dementia praecox (early term for schizophrenia)
chemical imbalance as the cause of schizophrenia
b. Manic-depressive psychosis (now called bipolar disorder)
irregularity in metabolism as the cause of manic-depressive psychosis
4.proposed that they had different biological underlying causes
Kraepelin’s early classification scheme became the basis for the present diagnostic categories
Explain the development of the DSM
1952: DSM psychodynamically oriented
“neurosis reaction,” “personality disturbance”
130 pages, 106 disorders
1968: DSM II: still psychodynamically oriented
broad descriptions, symptoms not specified in detail
“neurosis,” “psychosis”
134 pages, 182 disorders
In 1980, the APA published an extensively revised diagnostic manual (DSM-III); and then revised it further in 1987 (DSM-III-R) Focused on reliability and validity Did not rest on psychodynamic theory Focused on observations, not inferences Listed explicit criteria for each disorder and used research to develop the criteria Introduced the multiaxial system 494 pages, 265 disorders (DSM–III) 567 pages, 292 disorders (DSM-IIIR)
DSM-IV was published in 1994 and the APA subsequently completed a “text revision” (DSM-IV-TR; APA, 2000)
Overall DSM-IV
Included more current information about each disorder
Prevalence, course, gender and cultural factors
Comorbidity – the presence of more than one disorder at a time in a given patient
DSM-V - published in May 2013
How did both the ICD and DSM started to introduce mental illness (3)
1939 - World Health Organization (WHO) added mental disorders to the International List of Causes of Death
1948 - the list expanded to become part of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD-6)
1952 - American Psychiatric Association (APA) published its own Diagnostic and Statistical Manual (DSM) in 1952
Name 5 major changes from the DSM-IV to the DSM-5
- Autism Spectrum Disorder (ASD): Asperger’s now eliminated, part of ASD
- Obsessive-Compulsive and Related Disorders: OCD removed from the anxiety disorders and moved under this new heading
- Trauma and Stressor-Related Disorders: post traumatic stress disorder (PTSD) is now in this separate category
- Substance-Related and Addictive Disorders: now include non-substance-related addiction, i.e. gambling
- Subtypes of schizophrenia: (paranoid, disorganized, catatonic, and undifferentiated) have been eliminated
What is the multi-axial system
people would be rated on every axis (axis 1 to 5)
all of the psychopathologies except personality disorders
axis 1: clinical disorders (depression, bipolar, schizophrenia, etc.)
axis 2: personality disorders (borderline, antisocial, etc.)
axis 3: general medical conditions (infectious disease, etc.)
axis 4: psychosocial and environmental problems (jobs less, etc.)
axis 5: global assessment of functioning (0-100)
Eliminated from the DSM 5
Describe the 3 main findings in the Frances & Widiger (2012) article, view on mental disorders
there are currently at least 3 ways that we (as researchers, practitioners, educators, students, general population and people with actual diagnosis) understand mental disorders and DSM system
- Mental disorders are real things
mental disorders are real things existing ‘out there’ that will soon reveal their secrets through scientific study. This has been the predominant view among biological psychiatrists, but it is now recognized to be a misleading and reductionist simplification - Mental disorders are heuristic constructs
mental disorders are no more than useful heuristic constructs. This is now the consensus of most serious students of mental illness, including some of the most fervent biological psychiatrists - Mental disorders are social constructs
mental disorders will never be fully understood; they are social constructs - subject to arbitrariness an misuse
Name 5 professional and social contextual forces that impact diagnostic of mental disorders
- starting with DSM-III psychiatric diagnosis became accessible to the general public
- it is fairly easy to meet criteria for one or another DSM diagnosis
- the role of pharmaceutical industry
- the role of media
- we live in a society that is perfectionistic (as individualistic)
Name 4 recent epidemics (over diagnosis)
- autism
- attention deficit
- childhood bipolar disorder
- paraphilia not otherwise specified
Name 3 criticisms of using a classification system
- DSM categories refer to hypothetical constructs that may or may not exist in reality
- psychiatric diagnoses are different from most medical diagnoses where the basic cause is frequently known an the presence of the disease can usually be objectively determined (e.g. blood or urine test)
- psychiatric diagnosis appear to be influenced by fads that provoke overdiagnosis, also referred to as epidemics
Name 3 DSM-5 specific criticisms
- lowering age requirements for some categories promote what is already an alarming overuse of pharmacotherapy in children - sometimes causing serious side effects: obesity, diabetes, cardiovascular complications, etc.
- lowered thresholds for existing categories and the invention of new disorders increases the already high rates of ADHD, PTSD, GAD, substance dependence
- the overall result - an unintended medicalization of normality with consequent overtreatment, stima, and misallocation of scarce mental health resources
What is the difference between a discrete entity and a continuum
the DSM represents a categorical classification, a yes-no approach
continuity argument - abnormal and normal behaviors differ only in intensity or degree, not in kind; therefore, discrete diagnostic categories foster a false impression of discontinuity
in dimensional classification, the entities or objects being classified must be ranked on a quantitative dimension (e.g. a 1-to-10 scale of anxiety)
Describe interviews as psychological assessments
Psychological assessment techniques are designed to determine cognitive, emotional, personality, and behavioral factors in psychopathological functioning
many of the assessment techniques stem from the paradigms we discussed earlier during the course
- Clinical Interview
Initial assessment
History of clients and their current problem(s)
Allows for direct observation of a client
Great skills required to establish rapport and trust
highly important so they don’t feel judged - Structured and Semi-structured Interviews
SCID (Structured Clinical Interview for DSM)
most widely used (clinician, research more detailed, forensic)
Diagnosis of psychopathology
Allow for direct observation of a client
Name 3 psychological test as psychological assessment
3 basic types of tests:
self-report personality inventories
projective personality tests
tests of intelligence
Describe the projective personality tests
a set of standard stimuli (inkblots or drawings) ambiguous enough to allow variation in responses
assumption is that because the stimulus materials are unstructured, the client’s responses will be determined primarily by unconscious processes and will reveal his or her true attitudes, motivations, and modes of behavior
Name 5 types of projective personality tests
- Rorschach Inkblot Test (traditional inkblot)
- Thematic Apperception Test (TAT)
Sees a scene and must attribute a scenario and thoughts to the scene - Roberts Apperception Test for Children
- Sentence completion tests
“I wish …___________________________”
“My father… ________________________” - Drawings
“Draw a person”
“Draw another person of the opposite sex”
Name 4 Intelligence tests
- Wechsler Adult Intelligence Scale (WAIS)
- Wechsler Intelligence Scale for Children (WISC)
- Stanford-Binet
- emotional intelligence (EQ) reflected in such abilities as delaying gratification and being sensitive to the needs of others, may be as important to future success as the strictly intellectual achievements measured by traditional IQ tests. Moreover, high levels of emotional intelligence are associated with greater levels of subjective well-being and reduced proneness to depression
Name 2 types of behavioural and cognitive assessment and one drawback
Direct Observation of Behaviour
observe if the non-verbal matches the verbal (e.g. talking about horrific things with a smile)
Self-Observation (self- monitoring) – also referred to as ecological momentary assessment (EMA) - involves the collection of data in real time as opposed to the more usual methods of having people reflect back over some time period and report on recently experienced thoughts, moods, or stressors
phone app, mood trackers
However – reactivity
people know they are observed
Name 2 types of neuroimaging methods reflecting direct neuronal activity
EEG – electroencephalography
MEG – magnetoencephalography
Name 2 types of neuroimaging methods reflecting tomographic information
PET – positron emission tomography
SPET – single photon emission tomography
Name 4 types of magnetic resonance imaging (MRI) methods:
MRI – structural
fMRI - functional
DTI – diffusion tensor imaging
MRS – magnetic resonance spectroscopy
Why use EEG or MEG in abnormal psychology
we cannot diagnose anybody with scans for psychopathologies resting state/spontaneous activity sleep pattern event-related potential (ERPs) biofeedback
Why use PET scans in abnormal psychology
Resting state metabolism (FDG PET)
cannot look at resting state in fMRI
we can label glucose
Cerebral blood flow (O-15 PET)
we can label oxygen
Neurotransmission (assessing specific receptor occupancy)
look how much antipsychotic (D2 antagonist) and if we could see the receptor occupancy we could limit side effects by finding the optimal dosing, however that is really expensive
Why use MRI in abnormal psychology
observe the difference in the brain structures of people with mental disorder vs healthy
What can you measure in the autonomic nervous system to try to understand the nature of emotions
Activities of the autonomic nervous system are frequently assessed by electrical and chemical measurements in an attempt to understand the nature of emotion.
Heart rate measured with electrocardiogram
Skin conductance measured with electrodermal responding
Brain activity measured by electroencephalogram (EEG)
How do you do a neurochemical assessment (3)
- Analyzing the metabolites of various neurotransmitters that have been broken down by enzymes in a urine, blood, and cerebrospinal fluid samples
- Assessing density of neurotransmitter receptors post mortem
- Biological assessments cannot be used to diagnose psychopathology but can play a role in its accuracy (e.g., neurodegenerative dementia vs. vascular dementia) and in exclusion of any major brain anomalies (e.g., tumor)
Why do a neuropsychological assessment (5)
Some tests are believed to detect effects of brain damage that are not (yet) detectable by neurological examination
selected goals of neuropsychological testing
- measure the behavioral correlates of brain function
- establish possible localization, lateralization, and etiology of a brain lesion
- describe neuropsychological strengths, weaknesses, and strategy for problem solving
- assess patient’s feelings about his or her syndrome
- provide treatment recommendations (i.e., to client, family, school)
What distinguishes fear from anxiety?
Fear is a state of immediate alarm in response to a serious, known threat to one’s well-being
Anxiety is a state of alarm in response to a vague sense of being in danger
Both have the same physiological features – increase in respiration, perspiration, muscle tension, etc.
The implicated neural circuitry might differ slightly
Which neural circuit in involved in fear response
Fear response: central nucleus of the amygdala plays a role in response to sudden, aversive events
Which structure of the brain is involved in both anxiety and fear
Both fear and anxiety are associated with the amygdala, but there are some differences in the circuitry
Which part of the brain is involved in anxiety
amygdala and prefrontal cortex connection
bed nucleus of the stria terminalis (BNST) initiates emotional response when stimuli are less precise predictors of potential danger. This produces a state of sustained preparedness for an unclear danger and prolonged anticipation of unpleasantness.
amygdala aids in formation of emotional memories and conditioned fear or conditioned emotional response, which establishes quickly and is long-lasting
amygdala also contributes to memory consolidation through its connections with the hippocampus
Anxiety disorders are often considered to arise from an imbalance between emotion generating centers and higher cortical control
Which main hormone is involved in anxiety
Corticotropin-releasing factor (CRF) is released from the hypothalamus in response to stress/fear/anxiety
Acts on releasing cortisol, adrenaline and noradrenaline. Overall overactivation of the sympathetic nervous system
How is norepinephrine involved in anxiety
Norepinephrine is involved, important in the formation of emotional memories
NE antagonists reduces anxiety, impair the formation of emotional memories, can block traumatic memories, helps PTSD
NE agonist can lead to panic attacks
How is GABA involved in anxiety
inhibitory neurotransmitter
Benzodiazepines (BDZ) & barbiturates cause sedation and reduced anxiety by binding to modulatory sites of GABA
gaba agonist
GABA antagonists can produce extreme anxiety and panic
GABA & neurosteroids
Neuroactive steroids such as progesterone (which fluctuates across the menstrual cycle) and testosterone (higher levels in men) provide an additional modulatory role in anxiety (they bind to a separate site on GABAA)
Neurosteroids levels tend to be low in people with generalized anxiety disorder and social phobia
Name 6 Major Anxiety Disorders in DSM-IV and which ones were excluded in DSM-5
- Phobia
- Panic Disorder
- Generalized Anxiety Disorder
- Obsessive-Compulsive Disorder
- Post-Traumatic Stress Disorder
- . Acute Stress Disorder
DSM 5 excludes OCD (new section) and PTSD (to Trauma and stress-related disorder)
Name 2 inclusions in the DSM-5 of anxiety disorders
Separation Anxiety Disorder
classified previously in the section “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence”
diagnostic criteria no longer specify that age at onset must be before 18 years, but the duration criteria of 6 months added
Selective Mutism classified previously in the section “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence” classified as an anxiety disorder because a majority of children with selective mutism are anxious diagnostic criteria largely unchanged from DSM-IV children where nothing wrong with language development and communication skills, in specific context they stop talking (e.g. does not talk in school, but they do in their families) fairly involuntary (not just a choice)
Describe the prevalence and common demographics for anxiety disorders
the most common psychological disorders
early age of onset, typically during childhood-adolescence
quite common among university students
more common in women than in men across all age groups
hormonal component, with depression pronounced during reproductive age, but not reproductive age correlation with anxiety
the highest one-year prevalence rates found in women 15 to 24 years of age
gender differences found in 15 countries around the world
What does the comorbidity among anxiety disorders mean
symptoms of the various anxiety disorders are not entirely disorder specific (e.g., perspiration, fast heart rate)
the etiological factors that give rise to various anxiety disorders are probably applicable to more than one disorder (e.g., related to childhood maltreatment and/or ANS dysregulation)
causes are similar but the expression may vary
Yet, theories of anxiety disorders focus on individual disorders; development of theories that take comorbidity into account is a challenge for the future
Describe the comorbidity within anxiety disorders & with other conditions
co-occurrence of the anxiety disorders (panic disorder, GAD, SAD)
is it 3 different issues, or the same one expressed in many ways
anxiety disorders are often comorbid with substance abuse, depression, PTSD, OCD
self medication with alcohol, alcohol binds on GABA receptors just like benzodiazepines
anxiety disorders are also independent risk factors for suicide attempts
Comorbidity of anxiety disorder is the strongest with which other disorder
is strongest with depressive disorders
anxiety and depression appear to be related to each other at both genotypic and phenotypic levels
e.g., behavioral genetic analysis of major depression, panic disorder, agoraphobia, and SAD showed that the disorders strongly co-aggregate within families
Describe the Tripartite Model of Anxiety and Depression
Anxiety: Physiological hyperarousal
Depression: Lack of enjoyment (low level of positive emotions)
Overlap of anxiety + depression: General distress (high level of negative emotions)
he model posits that anxiety and depression share a common component of negative affect/general distress; however, they can be differentiated by physiological hyper-arousal (hypothalamic-pituitary-adrenal axis) associated with anxiety and by low positive affect (anhedonia) associated with depression.
Which theories (2) are the most common with anxiety disorders
2 most common: cognitive & biological theories
a common theme across all anxiety disorders is that dysfunctional levels of anxiety reflect cognitive appraisal processes contributing to the perception of anxiety, as well as physiological factors that render particular people more vulnerable to anxiety
What are phobias
Psychopathologists define a phobia as a disrupting, fear-mediated avoidance that is out of proportion to the danger actually posed (according to DSM-5 it does not need to be recognized by the sufferer as excessive or unreasonable, but it was the case for DSM-IV)
The term “phobia” usually implies that the person suffers intense distress and social or occupational impairment because of the anxiety
Many specific fears do not cause enough hardship to compel an individual to seek treatment (e.g., an urban dweller with an intense fear of bears)
Psychologists tend to focus on different aspects of phobias according to the paradigm they have adopted
Contrast the psychoanalyst views with the behaviourist views on phobias
Psychoanalysts focus on the content of the phobia and see the phobic object as a symbol of an important unconscious fear (e.g., fear of the father transformed into fear of horses in the case of Little Hans)
Behaviorists, on the other hand, tend to ignore the content of the phobia and focus instead on its function (e.g., fear of horses and fear of heights are equivalent in the means by which they are acquired, in how they might be reduced, and so on)
How common are specific phobias, when does it start, which are most common
lifetime prevalence - almost 1 in 10!
mean age of onset - around 10 years old
mean duration - about 20 years
only 8% with a specific phobia received treatment
the most common specific phobia subtypes in order:
(1) animal phobias (including insects, snakes, birds)
(2) heights
(3) being in closed spaces
(4) flying
(5) thunderstorms
(6) blood
Name 2 culture specific phobias
Chinese Paleng - a fear of the cold (fear that loss of body heat may be life-threatening); presumably related to the Chinese philosophy of yin and yang
Japanese taijin kyofusho (TKS) - fear of other people - not a social phobia, but an extreme fear of embarrassing others. Apparently arises from elements of traditional Japanese culture, which encourages extreme concern for the feelings of others yet discourages direct communication of feelings (McNally, 1997)
Describe Social Anxiety Disorder (SAD)
social phobia = social anxiety disorder
Marked, disproportionate, and persistent fears about one or more social situations
May be narrow – talking, performing, eating, or writing in public
May be broad – general fear of functioning poorly in front of others
In both forms, people rate themselves as performing less competently than they actually do
can be extremely debilitating
What is the prevalence and demographic of SAD
onset typically in adolescence (around 13-15 yrs)
the lifetime prevalence about 6-7% in men and 8-9% in women
average duration of symptoms about 20 years
comes with age, we care less about making fools of ourselves as we age
prevalence of social phobia higher among single people, those who have not completed secondary education, had lower income or were unemployed
not the cause, but the results of SAD
What is the three-factor model of SAD
(1) social interaction fears
(2) observation fears: being observed is very uncomfortable
(3) public speaking fears
What is the SAD comorbidity
high comorbidity rate with other disorders, such as GAD, specific phobias, panic disorder, avoidant personality disorder, and mood disorders
high levels of comorbidity with heavy drinking and alcohol dependence, as well as marijuana- related problems
Describe the etiology of Phobias - behavioral perspective (conditioning), which criticisms
avoidance-conditioning
via classical conditioning, a person can learn to fear a neutral stimulus (the CS) if it is paired with an intrinsically painful or frightening event (the UCS).
the person can learn to reduce this conditioned fear by escaping from or avoiding the CS. This second kind of learning is assumed to be operant conditioning; the response is maintained by its reinforcing consequence of reducing fear.
starts as a trigger (classical) and is reinforced through avoidance (operant)
however, evidence demonstrates that only some (certainly not all) fears may be acquired in this particular way
Some people become intensely afraid of heights after a bad fall, etc.
However, many individuals with severe fears of snakes, germs, and airplanes tell clinicians that they have had no particularly unpleasant experiences with these objects or situations…
Describe the etiology of Phobias - behavioral perspective (modeling)
a person can learn fears through imitating the reactions of others (vicarious learning )
e.g., Bandura and Rosenthal (1966) - after the participants had watched the model “suffer” a number of times, they showed an increased frequency of emotional responses when the buzzer sounded
vicarious learning may also be accomplished through verbal instructions (e.g., the anxious-rearing model is based on the premise that anxiety disorders in children are due to constant parental warnings that increase anxiety in the child)
What is prepared learning the the context of phobias
prepared learning, biological predisposition to certain stimuli
people tend to fear only certain objects and events, such as spiders and heights, but not others, such as flowers
some fears may well reflect classical conditioning, but only to stimuli to which an organism is physiologically prepared to be sensitive
Describe the etiology of SAD - cognitive perspective
People with SAD are
- more concerned about evaluation (high degree of public self-consciousness)
- preoccupied with hiding imperfections and not making mistakes (perfectionistic standards for accepted social performances)
- tend to view themselves negatively even when they have actually performed well in a social interaction (an attentional bias to focus on negative social information and interpret ambiguous situations as negative)
Cognitive theorists contend that people with this disorder hold a group of social beliefs and expectations that consistently work against them
Give examples of a cognitive expectations of SAD
- unrealistically high social standards, thus must perform perfectly in social situations
- view themselves as unattractive social beings
- view themselves as socially unskilled and inadequate
- believe they are always in danger of behaving incompetently in social situations
- believe that inept behaviors in social situations will inevitable lead to terrible consequences
- believe that they have no control over feelings of anxiety that emerge during social situations
Name 3 types of phobias that have arise from social media
- FoMO (fear of missing out)
- nomophobia (no mobile phone phobia)
- online social anxiety
Describe the etiology of phobias - predisposing biological factors
biological malfunction (a diathesis) that somehow predisposes some people to develop a phobia following a particular stressful event
the prevalence of social and specific phobias is higher than average in first-degree relatives
However
learning cannot be ruled out
no specific genes have been found
