Abnormal Psychology - Heather Flashcards

Question

Where are Id, Ego and Super ego located?

Answer 1

Conscious - none Preconscious - Ego (tries to control Id impulses) Unconscious - Super ego (integrated learned values) and Id (Innate instinctive needs)

Answer 2

- Present at birth - Operates by 'pleasure principle' e.g. immediate satisfaction of basic needs, relief of tension - A primary process e.g. thinking, images, fantasies; unconsciously driven

Answer 3

- Primarily conscious in its mode of activity - Reality orientated - Mediates between immediate gratification need of Id and what can be achieved in reality - Planning and decision making functions (secondary processes) - Relies on Id for energy therefore always in position of conflict between needs of reality and needs of Id

Answer 4

- Moral conscience - Develops throughout childhood - Grows out of the ego - Polices conflicts between Id and ego

Answer 5

- Psychodynamic conflict creates conscious or unconscious anxiety - Anxiety is controlled by defence mechanisms (repression, projection, denial, displacement, sublimation) - Role of ego and super ego often diminished by defence mechanisms

Answer 6

- Discovery and role of unconscious mechanisms - Framework for understanding abnormal behaviour - 'Talking cure' for mental health practices - Importance of relationships at different stages of development

Answer 7

Conscious - what we are constantly aware of Preconscious - memories not in current awareness but we could if we focused on them e.g. phone number Unconscious - largest part of the mind, brought to awareness only with difficulty. Holds our basic drives, impulses and instincts (mostly sexual)

Answer 8

- Untestable hypothesis and little evidence for effectiveness - Infantile sexuality - no evidence, misconstrued in a social and cultural context - Psychoanalysis is too long and expensive - No longer part of mainstream clinical practice

Answer 9

- John Watson 1878-1958 and B F Skinner 1904-1990 - Followed from Pavlov's work on conditioned reflexes - Behaviour is not the symptom but the problem - Certain abnormal behaviours can be learnt in childhood

Answer 10

conditioned stimulus --> unconditioned stimulus --> unconditioned response bell --> food --> drool bell --> drool/conditioned response

Answer 11

Behaviours increases with more positive reinforcement and diminish if followed by a punishment

Answer 12

- Aaron Beck and Albert Ellis - Meaning of events, more than the events themselves, that trigger anxiety - Same event can evoke a different emotional response in different people - Distorted thinking or schema - Less pathological - Many aspects of psychopathology are understandable errors of normal functioning - Emphasis placed on the continuity between normal and abnormal anxiety or emotions

Answer 13

Cognitive distortions are errors of thinking - Depressed people may have an overly negative view of the world - Exaggerate the significance of negative events - evaluation - Leads to maladaptive behaviour and emotional problems

Answer 14

- Increased incidence of certain psychological disorders in poor, some age groups, some genders, ethnic minorities - Interaction between genetics, environment and psychological factors

Answer 15

Diathesis: - A vulnerability or predisposition to develop a certain disorder - Relevant to a;; illness categories in physical and mental health domains Stress: - Anything that can be seen as a stressor - Anything that exposes or exacerbates a vulnerable disposition Genetic predisposition + environmental stressor = disorder

Answer 16

- Exposure to a stressor can trigger a disorder in a person with vulnerability - A person can be protected from stressors that are likely to trigger a condition - Those with vulnerability need less stress to elicit a disorder - More susceptible to routine life stresses - Greater diatheses, less of a stressor needed to provoke a disorder

Answer 17

- First to publish a form of classification in 1883 | - Studied the differences in dementia praecox and manic-depressive psychosis

Answer 18

ICD: - International classification of mental & behavioural disorders (WHO) - Includes physical health issues - Europe and worldwide DSM: - Diagnostic statistical manual - Psychiatric disorders only - USA

Answer 19

- ICD has no axes - 16 major categories in DSM-IV, 11 in ICD-10 - ICD-10 categories are more general - Some categories e.g. sexual and gender identity appear in DSM-IV but not in ICD-10

Answer 20

- Improves the reliability of psychiatric diagnoses, an everlasting problem in psychiatry (Whaley, 2001) - Research and clinical purposes - USA: insurance companies require DSM diagnoses for reimbursement - Impose homogeneity, develop theories of causation - Aid communication between professionals

Answer 21

- 5 dimensions or axes - Involves biological, psychological and social factors - Should enable a person-centred approach - Should help plan treatment - Should help predict outcome

Answer 22

Axis I: Clinical disorders, including major mental disorders, as well as developmental and learning disorders Axis II: Underlying pervasive or personality conditions, as well as mental retardation Axis III: Acute medical conditions and physical disorders Axis IV: Psychosocial and environmental factors contributing to the disorder Axis V: Global assessment of functioning or children's global assessment scale for children under the age of 18 (on a scale from 100 to 0)

Answer 23

Moved to a non-axial documentation of diagnosis (formerly axes I, II, III) with separate notations for important psychosocial and contextual factors (axis IV() and disability (axis V)

Answer 24

- To account for the last 2 decades of scientific and clinical advancement - To make sure the manual is useful to those who diagnose and treat individuals with mental illness, and to those being treated

Answer 25

- Circular arguments (without bodily signs to confirm the presence of these 'illnesses', diagnoses are not an explanation) - Criteria can mislead people into thinking they have a disorder when they don't

Answer 26

- Level of reliability varies between disorders (less agreement about personality disorders) - Low inter-tester reliability - Poor reliability across clinical settings - Nature of diagnostic criteria is important because some are based on patient reports and some are based on clinical observations - It is always evolving and being refined

Answer 27

Cross-cultural differences - most of the classification systems are based on the western view of what is 'abnormal', and therefore can be considered to represent ''psychiatric imperialism" Gender bias - argued that male-based assumptions influence what is included in DSM There is no absolute cut-off between 'well' and 'ill' Criteria are all essentially subjective There are no medical tests for psychiatric problems and no firm evidence for 'biochemical imbalances', or faulty genes

Answer 28

- Unhealthy influence of the pharmaceutical industry: 67% of the task force had direct links to the pharmaceutical industry - Increasing tendency to 'medicalise' patterns of behaviour and mood that are not considered to be particularly extreme

Answer 29

- Maintains view that difficulties lie 'within' the individual - Under estimates social and cultural role in psychological distress (i.e. power, abuse, neglect etc)

Answer 30

Psychological formulation - core skill for clinical psychologists and counselling psychologists Instead of 'What's wrong with you?' ask 'What's happened to you?'

Answer 31

1. Forebrain and brain stem send action potentials to the hypothalamus 2. Causes the hypothalamus to release corticotropin releasing hormone into the anterior pituitary 3. Anterior pituitary releases adrenocorticotrophic hormone to the adrenal cortex 4. This secrets cortisol which causes the body to react to stress and stops the body from producing more CRH and ACTH

Answer 32

- Psychological response to a trigger or stressor - Any uncomfortable 'emotional experience accompanied by predictable biochemical, physiological and behavioural changes' (Baum, 1990)

Answer 33

World war 1 - Approx. 80,000 soldiers have shell shock - Associated with 'going over the top' - Flashbacks, nightmares, desertion - War neurosis - Many were shot at dawn for cowardice - Did not appear in DSM until version 3, 1980 - Was recognised 60 years earlier in WW1 and may even have been recognised as early as the American civil war, 1861-65 (irritable heart) World war II - Americans coined the term 'battle fatigue' - >900,000 soldiers treated Vietnam war - Combat stress - Increased post 1973; 20-30% of veterans - Later became known as PTSD

Answer 34

- Symptoms of PTSD shortly after a traumatic event recover - Green (1994) approx. 25% of those exposed to traumatic events develop PTSD - PTSD affects 1 in 12 adults at some time in their life (Kessler et al, 1995) - Trauma and disasters are related not only to PTSD but also to concurrent depression, other anxiety disorders, cognitive impairment, and substance abuse (Schnurr et al, 2002)

Answer 35

- 1-3% of general population - 9% exposed to trauma Depends on severity: - 3% physical assault - 20% wounded in combat - 50% of rape or serious sexual assault victims - 50% POWs - 7% New York City dwellers post 9/11

Answer 36

- Exposure to a traumatic event - Mugging, rape, kidnapping, torture, natural disasters, terrorism, combat - Theory of shattered assumptions (Janoff-Bulman 1992) - Develops through classical conditioning - Maintained through operant conditioning; Mowrer's two factory theory, active avoidance

Answer 37

- Type of trauma e.g. threat to life/self integrity - Being female = twice the risk of developing PTSD - Males experience different types of trauma e.g. combat, fighting, increased risk taking - Previous exposure to trauma - Pre-existing anxiety disorder, substance misuse - Sexual trauma - rape victims have high incidence - Poor social support

Answer 38

- Over sensitive noradrenalin system - Threat detection system - Increased levels of noradrenalin in PTSD

Answer 39

- Neuropsychological testing to probe hippocampal function in 26 Vietnam vets, 15 controls - Decreased immediate and delayed recall in vets

Answer 40

Intrusions - Flashbacks, nightmares, hallucinations - Distress at exposure to cues - Physiological response to cue exposure Avoidance - Avoid thoughts, places, people linked to event - Diminished interest in social engagement - Loss of interest and pleasure - Sense of foreshortened future Hyperarousal - Increased startle response - Hypervigilance - Insomnia - Irritability - Outbursts of anger - Lack of concentration

Answer 41

- Medication - Psychological/therapeutic interventions - Cognitive behavioural therapy - Eye movement desensitisation reprocessing - Critical incident debriefing

Answer 42

- Similar to treatments for other anxiety disorders - Medication: SSRIs, SNRIs - Psychotherapy: Behavioural modification, cognitive behavioural therapy, critical incident debriefing, eye movement desensitisation reprocessing - Comes second to trauma-based therapy

Answer 43

- Antidepressants lessen sadness/depression that comes along with PTSD - Anti-anxiety meds can reduce symptoms of hyper arousal - Can have underlying mental health issues that need certain medications are able to help ease their hidden symptoms

Answer 44

- Potential side effects - Examples: Nausea, dizziness, decrease . in sex drive, increased anxiety, weight changes etc. - Increased risk of depression/suicide

Answer 45

- Rauch & Foa, 2006 Traumatic events can lead to develop associations among objectively safe reminders of the event, meaning and responses. Changing these associations that lead to unhealthy functioning is the core of emotional processing

Answer 46

- Benight & Bandurra, 2004 Incorporating the experience of trauma into existing beliefs lead to unhelpful understandings of their experience and perceptions of control of self or the environment.

Answer 47

- Think about trauma whilst following therapists finger with eyes - Talk about negative thoughts - Replace them with positive thoughts with eye exercises - Resolve incomplete processing of the event

Answer 48

- Immediate support within 72 hours - Visit the site of the event - Prevent PTSD and ASD occurring

Answer 49

- It is universal - Useful behaviour because it can energise behaviour and motivate - Disordered if intense and debilitating

Answer 50

The occurrence of unwanted and intrusive obsessive thoughts usually accompanied by compulsive behaviours used to neutralise the obsessive thoughts

Answer 51

- 2% lifetime prevalence, 1% one year prevalence (1-2% in UK adults) - 98% cases show obsessions and compulsions - Equal across genders and cultures - Socio-economic drift noticeable - Onset late adolescence, early adulthood - Childhood onset more common in males (but only about 1%) - Fourth most common mental disorder after depression, alcohol and substance abuse, and social phobia

Answer 52

Obsessions - Recurrent intrusive thoughts - Images - Experienced as disturbing or inappropriate Compulsions - Used to get rid of or deal with obsessions; prevent distress - Repetitive behaviours (hand washing, checking) - Covert mental acts (counting, chanting, sayings) Must be recognised by the sufferer as a product of their own mind - Not externally driven - Distinct from Schizophrenia Degree of insight is variable

Answer 53

- Grouped with related disorders - Disorders grouped in this new chapter have features in common such as an obsessive preoccupation and repetitive behaviours ``` OCD Body dysmorphic disorder Trichtillomania (hair pulling disorder) Hoarding disorder Excoriation (skin-picking) disorder ```

Answer 54

- 80% experience depressive symptoms - 30% experience major depression Co-occurs with other anxiety disorders - Panic - Social phobia - GAD - PTSD - High co-occurence with body dysmorphic disorder

Answer 55

- Intrusive thoughts happen to everyone e.g. did we lock the door? - Repetitive behaviours also normal e.g. checking we locked the door Needs to be excessive, persistent, distressing, dysfunctional - Washing hands 45 times before leaving the house with a rigid sub-routine - Hands bleeding, raw skin, can't get to work on time

Answer 56

- Fear of contamination - Fear of harming self or others - Pathological doubt - Need for symmetry - Religious themes - Sexual obsessions

Answer 57

- Cleaning - Checking - Repeating - Ordering/arranging - Counting

Answer 58

Primary obsessional slowness - Performing every day acts such as dressing extremely slowly Hoarding - 30-40% of sufferers - Failure to discard personal possessions - Cluttered and disorganised - Interfered with normal functioning

Answer 59

- Anxiety is the affective symptom - Compulsions reduce anxiety in the short term - Majority of OCD sufferers fear being responsible for something terrible happening to themselves or others - Risk assessment is unrealistic

Answer 60

1. Fear of neutral stimulus is acquired by classical conditioning 2. Thought of stimulus causes anxiety 3. Anxiety is reduced by performing act 4. Performing act extensively reinforces behaviour

Answer 61

- Thought suppression increases intrusive thoughts in OCD sufferers - Re-bound effect - Helps to associate thought with negative mood state

Answer 62

Increased glucose metabolism in the orbitofrontal cortex Brain basis of OCD: - Primitive urges arise in the orbitofrontal cortex e.g. sex, aggression, hygiene, danger - Urges usually filtered by basal ganglia before reaching thalamus and onto the rest of the cortex - Drugs that increases serotonin alleviate symptoms (50-70% patients show improvement and relapse rates are higher if discontinued) - Behavioural therapies are important

Answer 63

- Behavioural therapy - Cognitive therapy (CBT - ERP) - Medication - Surgery

Answer 64

- 10% of sufferers don't improve with treatment | - Bilateral cingulotomy

Answer 65

- Post-operation follow-up assessment of 44 patients - 32-45% showed improvement in OCD symptoms - N=1: seizure disorder - N=2: memory impairment, resolved within 6 months - N=1: suicide (but also a history of major depression)

Answer 66

- Initial pharmacological treatment should be an SSRI - If effective, consider continuing for 12 months to prevent relapse then review with the patient - Consider prescribing a different a different SSRI if prolonged side effects

Answer 67

- Offer low intensity psychological treatments initially if functional impairment is mild and/or the person prefers a low intensity approach Low intensity treatments include: - Brief individual CBT (including exposure and response prevention [ERP]) using structured self-help materials - Brief individual CBT (including ERP) by telephone - Group CBT (including ERP)

Answer 68

A group of disorders (DSM) which are categorised as such due to a disturbance in mood being the central feature

Answer 69

A term used to describe symptoms and behaviours, not a diagnostic label Biology, emotions, behaviours, and cognitions contribute to the etiology and maintenance of depression

Answer 70

Mood disorder characterised by one or more major depressive episodes (MDE) without a history of manic, mixed, or hypomanic episodes, but not due to a medical condition, medication or substance

Answer 71

- Common (more than bipolar) - Lifetime prevalence 10-20% - Marriage/cohabiting and a good socioeconomic position are associate with a lower risk of depression in both genders - Less common in children and presents differently

Answer 72

- Dysthymia - Perinatal or postpartum depression - Seasonal affective disorder - Bipolar disorder

Answer 73

Unipolar - recurrent episodes of lows Bipolar - both low and high episodes outside of normal range

Answer 74

- Muted and dull - Very low - Very slowed down - Including our thoughts and reactions

Answer 75

- Full of energy - An extreme sense of well-being and optimism - Very happy and excites, irritated if other people who don't share your optimistic outlook - Unable or unwilling to sleep - Full of new and exciting ideas - More important than usual

Answer 76

- More than twice prevalent in young women than men aged 14-25y (5.5% in females and 3.2% in males) - Biological and hormonal factors: variation in ovarian hormone levels and decreases in oestrogen may contribute to triggering depression - Socio-cultural factors: lack of choice, role overload, and competing social roles e.g. mothers who stay at home and are unemployed are increasingly less valued; power and abuse - 3x higher risk of depression in women who lost their own mothers before 11 years

Answer 77

- 90% of suicide and attempts are associated with a psychiatric disorder - Highest rates of suicide associated with depressive disorders - 30,000 suicides in the USA per year are due to depression - 16% of survivors attempt suicide again within a year with 2% of repeat attempts being fatal - Socio-economic inequality in suicide risk - poor people approx. 10x more at risk

Answer 78

- 3x more likely than women to die by suicide - High suicide rates in young men have received some public attention - Rates in middle aged men have been at a comparable level for 40 years and have recently become the age group at highest risk - Particularly those who are socio-economically disadvantaged

Answer 79

- Withdrawal - Feelings of hopelessness & pessimism - Fatigue - Sleep difficulties - Lack of energy - Feelings of guilt and worthlessness - Attention & concentration difficulties - Physical complaints (headaches/digestive problems) - Suicidal thoughts

Answer 80

- Mood changes e. g. a long period of feeling worried or empty - Behavioural changes e.g being restless or irritable

Answer 81

- People who have a first-degree relative with depression appear to have a 2-3x greater risk of developing the condition than the general public - Serotonin transporter gene and short alleles linked to depression

Answer 82

Schildkraut (1965): Depression is caused by a functional deficit of monoamine transmitters (norepinephrine and/or serotonin); and depletion studies have shown a correlation between such deficiencies and depressive symptoms

Answer 83

- Depression results from exposure to chronic mild stressors - Causes over-activity in the hypothalamic-adrenocortical axis - Too much cortisol causes long term damage to some brain areas

Answer 84

Neuroticism (sensitivity to external factors) - Higher risk of experiencing stressful life-events - Heritable trait - Higher levels of neuroticism and lower levels of extroversion noted as risk factors - Social network, together with neuroticism, also showed strong association with depressive severity, independently from current depressive state

Answer 85

Introversion (low positive affectivity) - Unenthusiastic, unenergtic, flat, bored - Vulnerable personalities (characterised by low extraversion, agreeableness and conscientiousness but higher neuroticism) linked to poorer treatment outcomes and longitudinal course of depression

Answer 86

Errors in logic: depressed people draw illogical conclusions when they evaluate themselves Cognitive triad: there are 3 forms of negative thinking that are typical of those with depression

Answer 87

- Negative views about the world "Everyone is against me because I'm worthless" - Negative views about the future "I'll never be good at anything" - Negative views about oneself "I'm worthless and inadequate"

Answer 88

Dichotomous reasoning - If I can't get a perfect score it is not worth trying Selective abstraction - Remembering only the negative points of an otherwise good day Arbitrary inference - Jumping to conclusions, something didn't work today therefore it will never work

Answer 89

- Seligman 1975 - Animals given unavoidable shocks - Become passive if they can't escape - "Non-contingency" (subject's perception of the uncontrollability of events) is the basis of human depression

Answer 90

- Perception that a person has no control over what was going to happen - A certainty that an important bad outcome was going to occur or that a highly desired good outcome was not going to occur

Answer 91

Counselling Psychodynamic psychotherapy: long-term, focused on past Interpersonal psychotherapy: focuses on the connection between current symptoms and interpersonal/relationship problems Cognitive therapy: Cognitive analytic therapy, acceptance, and commitment therapy (ACT), cognitive behavioural therapy, rational emotive behavioural therapy (REBT)

Answer 92

- Targets understanding and identifying thoughts - Attempts to address underlying cognitions driving behaviour - Encourages challenging irrational thinking - Plans for relapse prevention

Answer 93

Guided self-help in primary care: - Some effect and cheaper, but low engagement/completion Group work: - Reduces symptoms, but low on recovery - Not always economically efficient Individual work: - Highest impact - More costly/time-consuming

Answer 94

- Self help (mild to moderate) - Risk management - Activity scheduling - Diary ]- Cognitive restructuring - Behavioural experiments - Homework