Abnormal Psychology - Midterm Flashcards
Define statistical infrequency
statistical infrequency: a behavior that occurs rarely or infrequently
hallucinations and delusion, intellectual disability (under 70%
Within 1 SD from the mean, usually on the lower end
How many Canadians will personally experience a mental illness in their lifetime
20%
Suicide accounts for ___ of all deaths among 15-24 year olds
24%
When do most (70%) mental health problems start
during childhood or adolescence
Canadians in the ___ income group are _ to__ times more likely than those in the __ income group to report poor mental health
lowest/ 4/5/ highest
What does violating the norm implies
a behavior that defies or goes against social norms; it either threatens or makes anxious those observing
What should be consider when refering to violating norms
culture, context & situation, historical context, age, gender, etc.
e.g. stanger culture is different in eastern europe than UK (more touching, closer)
Give examples of norm violation that don’t apply to psychopathologies and vice versa
a prostitute; some cultures it violates norms but isn’t considered a psychopathology
anxiety, depression; doesn’t violate norms and very common
Define personal distress
a behavior that creates personal suffering, distress or torment in the person
this criterion fits many forms of psychopathology/mental health problems, such as depression and anxiety
however
psychopathy, mania : they don’t feel distress, yet still considered a pathology
Name 7 criterion to psychopathologies and name the 4Ds
- statistical infrequency
- violation of norms
- personal distress
- disability/impairment
- risk of harm
- unpredictability
- irrationality/incomprehension
4ds
- deviance
- distress
- dysfunction
- danger
Define Disability or Impairment
a behavior that causes impairment in some important area of life e.g. work, personal relationships, recreational activities
however
sometimes abnormal behavior can be adaptive (e.g. compulsive behavior in OCD)
same for psychopathy
Define risk of harm
to self or others
suicide, auditory hallucinations suggesting violence
however
‘regular’ criminals & ‘professional assassins’
in many psychological disorders there is no risk of harm
Define Unexpectedness & unpredictability
a surprising or out-of-proportion response to environmental stressors can be considered abnormal
we would expect a person to be sad if they lost a loved one; we would not expect a person to laugh after being assaulted, etc
e.g. an anxiety disorder is diagnosed when the anxiety is unexpected and out of proportion to the situation
however
very arbitrary e.g. DSM-IV two months bereavement exclusion (removed from DSM-5, which caused even more controversy)
closely related to the ‘violation of norms’
we could add to this list ‘irrationality & incomprehensibility’ and other characteristics
Why is it important to take into consideration cultual and social aspect when looking at psychopathologies
Some sets of symptoms recognized as disorders in certain parts of the world are not familiar to most Westerners, e.g.
Koro : south eastern asia, huge anxiety developed around the fear that the genitals are going inside you and you are going to die. It shows up in clusters, like mini epidemics
Other behaviors could be considered disorders, e.g.
Possession trance: people who lose someone close to them may experience that the spirit of the deceased possess them and they start acting into specific rituals
Give 3 examples of things that use to be labelled as mental illnesses but aren’t anymore
homosexuality (removed from DSM in 1973)
5,854 psychiatrists voted to remove homosexuality from the DSM, and 3,810 to retain it
sluggish schizophrenia– dissidents in Soviet Union (”invented” in 1960s)
anyone against the regime, or wanting to leave the country
would be given ‘treatment’ such as medication and ECT
drapetomania - slaves’ running away (coined by Samuel A. Cartwright in 1851)
Though a serious mental illness, drapetomania, wrote Dr. Cartwright, was happily quite treatable: ‘‘The cause, in the most of cases, that induces the negro to run away from service, is as much a disease of the mind as any other species of mental alienation, and much more curable. With the advantages of proper medical advice, strictly followed, this troublesome practice that many negroes have of running away can be almost entirely prevented.’’
Who is more at risk of being diagnosed on the Schizophrenia Spectrum
African Americans are 3-5 times more likely than White Americans to receive a diagnosis on the Schizophrenia Spectrum
Latino Americans are 3 times more likely than White Americans to receive a diagnosis on the Schizophrenia Spectrum
Immigrant racial minorities are more likely to receive a diagnosis on the Schizophrenia Spectrum than natives with majority racial background
Why are non-white more at risk of being diagnosed on the schizophrenia spectrum
This could be explained because the diagnosis tools are developed by white american/european. Therefore, the ‘normal’ standard will highlight more atypical elements in racial minorities
International research is comparable: Canada has a Cultural Consultation Service (CCS). After reviewing 323 cases, 49% of Schizophrenia diagnoses were changed; however the largest population whose diagnoses were not changed were Black Canadians (44%)
What diagnosis is under dignosed in african american
mood disorder, and overddiagnosis of schizophrenia
Explain Thomas Szasz point of view
actually proposed that mental illness was a myth
Emphasis on stigma and the fact that diagnosing someone with a mental illness assigns a label that may influence how the diagnosed person feels about himself or herself and how that person is seen and treated by others
What are some stigmas that Canadians hold against mental illness
almost 50% of Canadian believe that ‘we call something mental illness because it gives some people an excuse for poor behaviour and personal failings’
they would avoid socializing with (42%) or marrying (55%) someone who is mentally ill
27% are afraid to be around someone with serious mental illness
50% would decline to tell friends or workers about a family member suffering from a mental illness (but 75% would share a cancer diagnosis)
most would not hire someone with mental illness
the stereotype of a violence ‘madman’ remains despite people diagnosed with psychosis actually being more likely to be assaulted than to assault others
in the US, Canada and western European countries,
the perception of dangerousness and unwillingness to have a ‘schizophrenic’ as neighbor, has increased over the past couple of decades
biologically oriented de-stigmatization programs
‘mental illness is an illness like any other, caused by ‘biological factors such as chemical imbalance, brain dysfunction and genetic heritability’
how do exterior people react (negatively) to diagnostic labeling
perceived dangerousness perceived unpredictability perceived lack of responsibility for own actions perceive lack of ‘humanity’ perceived dependency pessimism about recovery rejection and desire for distance
Name 3 negative attitudes that is produced by the medical model of mental illnesses
despite less blame, the very idea that actions of mentally ill may be beyond their conscious control can create fear of their unpredictability and thus the perception of dangerousness, leading to avoidance
‘us vs them’ attitude - defining individual with mental illness as fundamentally different
mental illnesses seen as less responsive to treatment and more persistent
How to reduce stigma (7)
portraying mental health difficulties as understandable reactions to adverse life events
de-emphasize causality
inclusion/increasing contact with people with mental health problems
promoting their positive participation and contribution
acknowledging and valuing differences
tackling stereotypes about violence
including the people in the receiving end of the discrimination in the design and management of programs
What are 3 major factors associated with mental health problems
current stress
childhood trauma
social support
What are the rates of mental illnesses in Canada + severe mental illness + region differences
About 20% of people in Canada have one or more mental disorders and about 2% are severely mentally ill.
There are some regional differences
good mental health in Newfoundland and Labrador and Prince Edward Island (people there report most happiness and least distress)
Quebec is noteworthy because it reported very high levels of self-esteem and mastery but the least happiness and most distress
What is the goal of Deinstitutionalization
attempt to reintegrate the mentally ill with the rest of Canadian society and
prevent involuntary hospitalization and treatment
What are 3 negative consequences to deinstitutionalization
homelessness
jailing of the mentally ill
multiple re-admissions
What would be an ideal model for deinstitutionalization
research show that a more desirable model would include sufficient number of smaller local community-based services and half-way houses
Explain the pre-scientific view of psychopathologies
Mental disorders were regarded as supernatural; believed to be caused by events beyond the control of humankind, such as:
eclipses, earthquakes, storms, fires…
demonic possession
divine punishment
Where was demonic possession diagnosed and what was the treatment
found in the records of the early Chinese, Egyptians, Babylonians, and Greeks
treatment often involved:
Exorcism
Trepanning
What is trepanning (when, where, to treat what)
used already by the Neolithic cave dwellers (late Stone Age, starting around 10,000 BCE)
used to treat epilepsy, headaches, and psychological disorders attributed to demons
believed to be introduced into the Americas from Siberia
most common in Peru and Bolivia
several British-Columbia Aboriginal specimens found
What is the devine punishment (where, why)
Mesopotamia around 2000 BCE
Ishtar: coordination witchcraft and mischief
Idta: demon in charge of other demons
Persians
Ahriman vs. Ormuzd
if you were believed to be hurt by one god, you would go to the other one for treatment
Hindus
Shiva vs. Vishnu
Old Testament
“A man or woman who is a medium or a wizard shall be put to death; they shall be stoned with stones” (Leviticus 20: 27), however…
“And it came to pass, when the evil spirit from God was upon Saul, that David took an harp, and played with his hand: so Saul was refreshed, and was well, and the evil spirit departed from him” (Samuel 1: 16.23 )
What did hippocrates contribute to the field of abnormal psychology
Separated medicine from religion, magic, and superstition
Rejected belief that gods send physical diseases and mental disturbances as punishments
Insisted that mental disorders had natural causes and thus should be treated like other illnesses (first ‘medical model’ of madness
Explain the difference between Somatogenesis vs. Psychogenesis
Hippocrates is one of the earliest proponents of somatogenesis
Somatogenesis (genesis = origin) (body)
Mental disorders are caused by aberrant functioning in the soma (i.e., physical body) and this disturbs thought and action
hysteria, plato, hippocrates
Psychogenesis (mind)
Mental disorders have their origin in psychological malfunctions
Explain Hippocrates’ Humoral Physiology
Hippocrates’ treatments were different from often violent exorcisms
e.g., tranquility, proper nutrition, abstinence from sexual activity were prescribed for melancholia
Mental health dependent on a delicate balance among four humors, or fluids, of the body
Imbalances and results
increase in blood = changeable temperament, in extreme form today would be mania and bipolar
increase in black bile = melancholia, today would be depression
increase in yellow bile = irritability and anxiousness, today could be anxiety disorder
increase in phlegm = sluggishness and dullness, today could be linked to lack of motivation & pleasure in schizophrenia
What did Plato invent
contributed with the ‘invention’ of hysteria
wandering uterus
pages and pages on symptom, around 25% of women ‘diagnosed’ with hysteria
What did Asclepiades (129-40 BCE) and Cicero (106-43 BCE) proposed instead of Hippocrates’ humoral theories,
e.g., they proposed that melancholy resulted not from an excess of black bile but from emotions such as rage, fear, and grief.
stems from emotional problems
Psychogenesis (mind)
What contribution did Cicero’s bring to diagnosis
Cicero’s questionnaire (like today) for the assessment of mental disorders – similar to today’s mental state examination; it included sections on:
habitus (appearance)
orationes (speech)
casus (significant life events)
What were the Early Chinese conceptualizations of mental illness
YIN & YANG
daoism
treatment based on finding the balance between yin and yang
Chung Ching (2nd century CE) called the Hippocrates of China (organ pathology as primary causes but ALSO stressful conditions could cause organ pathologies…)
2nd-9th century – “ghost-evil insanity” etc. - but those “dark ages” much less severe than in Europe…
What were the Middle East views on mental illness
The first mental hospital established in Baghdad in 792 CE followed soon by those in Damascus and Aleppo
Humane treatment
Avicenna from Persia (c.980-1037) – very innovative almost contemporary talk therapy
physician, mathematician, poet, theologian
What happened during the dark ages
Churches gained in influence, papacy was declared independent of the state
The idea of madness as divine punishment or demonic possession was reinstated
Christian monasteries replaced physicians as healers and as authorities on mental disorder
The monks cared for and nursed the sick by:
praying and touching them with relics
concocting special potions
What led to the persecution of witches
during the 13th and the following few centuries, major social unrest and recurrent famines and plagues
people turned to demonology to explain disasters
obsession with the devil;‘witches’ blamed and persecuted
1484 Pope Innocent VIII exhorted European clergy to leave no stone unturned in the search for witches
sent 2 Dominican monks to northern Germany as inquisitors who later issued the manual entitled the Malleus Maleficarum
used to guide witch hunters
came to be seen by the Catholics and Protestants as a textbook on witchcraft
Over the next several centuries, hundreds of thousands of people accused, tortured, and murdered (mostly women, many children)
What is the Malleus Maleficarum
Malleus Maleficarum specified that a person’s loss of reason was a symptom of demonic possession and that burning was the usual method of driving out the supposed demon.
Those accused of witchcraft were to be tortured if they did not confess; those convicted and penitent were to be imprisoned for life; and those convicted and unrepentant were to be handed over to the law for execution
How was perceived witchcraft from the 15th to the 18th century
15th and 16th centuries - possessed individuals were persecuted; they were seen as being under the Devil’s influence by their own choice
17th century - possessed individuals viewed as the victims of the spell thus not held responsible for their behaviors; at this time the person most commonly persecuted was the presumed perpetuator of the possession
first decades of 18th century most of the behaviors formerly identified with devil’s influences suddenly were seen as the result of God’s intervention; witches and sorcerers became prophets…
What were the beginning of asylum development
Until the end of the 15th century there were very few mental hospitals in Europe but numerous leprosy hospitals. However, leprosy gradually disappeared from Europe and thus…
Leprosariums were converted to asylums
asylums took disturbed people and beggars (social control)
many tailored purely for the confinement, with no specific regimen for their inmates but work (forced labor)
confinement began in earnest in the 15th-16th centuries
Describe the Development of Asylums: St. Mary of Bethlehem
In England some hospitals took over churches’ responsibility to tend to the ill starting in13th century
The priory of St. Mary of Bethlehem - founded in 1243; in 1547 Henry VIII handed it over to the city of London to become a hospital devoted solely to the confinement of the mentally ill
Conditions were deplorable (bedlam)
Eventually became one of London’s great (paid) tourist attractions
Describe the contributions of Benjamin Rush
considered the father of American psychiatry
he slightly improved the living conditions
developed methods such as
drawing large quantities of blood
frightening patients by drowning
Describe the contributions of Philippe Pinel
Philippe Pinel (1745–1826) - primary figure in movement for humanitarian treatment of the mentally ill in asylums
put in charge of a large asylum in Paris (La Bicêtre)
removed the chains
patients treated as human beings with dignity & compassion, not as beasts
light and airy rooms replaced dungeons
walks around the grounds were allowed
Results
got better, and they would eventually leave
Describe the contribution of Emil Kraepelin
Beginning of contemporary thought: somatogenesis
Emil Kraepelin 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
Kraepelin’s early classification scheme became the basis for the present diagnostic categories (DSM & ICD)
Describe the contributions of Franz Anton Mesmer
Beginning of contemporary thought: psychogenesis
Austrian physician practicing in Vienna and Paris in the late 18th century; believed that hysterical disorders were caused by a disturbance of distribution of the universal magnetic fluid in the body.
would put small containers on the ground with different fluids in them
he would then touch people with them according to their symptoms
he would go an magnetize trees so people could touch the tree instead of coming to him to get healed
he gets dismissed when people prove there is no difference between the magnetized tree and regular tree
Discribe the contributons of Jean Martin Charcot
psychogeneis
studies hysterical states, including anesthesia (loss of sensation), paralysis, blindness, deafness, convulsive attacks, and gaps in memory
at first a proponent of a biological causes of hysteria, but later became interested in non-physiological interpretations
interested in hypnosis
Describe the contributions of Joseph Breuer
Psychogenesis: Breuer and the cathartic method
Joseph Breuer (1842-1925) - treated a woman (Anna O.) who have become bedridden with a number of hysterical symptoms; he used hypnosis to release emotional tension… it became very easy for her to talk about her trauma in hypnotic treatment, as it goes the better she becomes physically
What did the rise of genetics understanding cause
1933 Germany - the law has passed allowing compulsory sterilization in case of ‘congenital mental defect, schizophrenia, manic-depressive psychosis, hereditary epilepsy, hereditary chorea, hereditary blindness, hereditary deafness, severe physical deformity and severe alcoholism’
by 1939 about 350,000 had been sterilized (Strous, 2006)
similar laws were passed in Norway, Denmark, Finland, Sweden in 1930s
In U.S. by 1928 20 states had compulsory sterilization for “feeble-minded and insane classes”; in Canada, Alberta (1928) and BC (1933) passed similar laws
by 1938 in Germany sterilization begun to be replaced with murder
by 1942 about 250,000 of mental patients had been killed, primarily with carbon monoxide and later with lethal injection
half of these will be diagnosed with schizophrenia
What happened in McGill in the 1950s with Ewen Cameron
Dr. Ewen Cameron, a world-renowned Montreal psychiatrist, was head of the Allan Memorial Institute at McGill University in the 1950s and early 1960s
in 1955 he initiated a nine-year series of experiments (funded by CIA) on unsuspecting psychiatric patients, apparently in a misguided attempt to discover breakthrough treatments or a “cure” for mental illness - “beneficial brainwashing”
administered massive doses of hallucinogenic drugs, repeated ECT (often three times each day), patients were kept in a drug-induced coma for as long as three months
Name 5 paradigms of abnormal psychology
Biological Paradigm Cognitive-Behavioral Paradigm Psychoanalytic Paradigm Humanistic-Existential Paradigms Integrative Paradigms
What are the main features of the biological paradigm
Continuation of the somatogenic hypothesis
mental disorders caused by aberrant or defective biological processes
also referred to as the medical model or disease model
the dominant paradigm in Canada and elsewhere from the late 1800s until middle of the twentieth century (1950), psychoanalysis will be the other dominant model
Explain the difference between genotype and phenotype
Genotype – unobservable genetic constitution
Fixed at birth, but it should not be viewed as a static entity
Phenotype – totality of observable, behavioral characteristics
Changes over time; product of an interaction between genotype and environment
Explain 3 methods to conduct studies through the biological paradigm
Family method
is it more prevalent in first (50% genetic material), second (25%) family degree vs the population
Twin method
sharing 100% genetic material
Adoptees method
observe if the children mental illnesses are more linked to biological vs adopting parents
Describe the Genetic Overlap Between Major Mental Disorders
Common inherited genetic variation accounted for up to about 28 percent of the risk for some disorders, such as ADHD (dark green). Among pairs of disorders (light green), schizophrenia and bipolar disorder (SCZ-BPD) shared about 16 percent of the same common genetic variation (coheritabilities)
What is epigenetics
genomic sequence (DNA sequence) - identical throughout the body and lifespan we can observe the difference in genetic expression in our own body. Our DNA is the same in our entire body, but the genes are expressed differently in our intestines and in our hair epigenomes - tissue-specific; drive distinct genome expression programs genome defines organism’s genetic information, whereas the epigenome determines for those genes “to be or not to be” expressed looks at how our lifestyle can not only affect our gene expression, but how the epigenome can be passed on to our children and grandchildren
Which parts of the body have been the most extensvely studied for psychopathologies
Central nervous system and the brain
How could the sensory-somatic nervous system be implicated in mental illness
considering bottom-up processing instead of opposite only
perception dysfunction could contribute to emotional/cognitive dysfunction
for example, schizophrenia causes perception dysfunction that may lead to paranoia etc that will contribute to cognitive dysfunction
How could the autonomic nervous system be implicated in mental illness
overactivation of sympathetic, underactivation of parasympathetic
sympathetic can be overly alert or oppositely of complete numbness and dissociation
when are neurodevelopmental disorders belived to stem
in early neurodevelopment
Explain biological perspective of autism
autism could be related to when neurons start connecting to each other. Autism would have more connections locally, but less connectivity in more widespread areas
very narrow interests could be a behaviors resulting from this
We develop with 2-3 times more neurons than we need to function. People with autism have on average a bigger brain (10%). which could point that the ‘sculpting’ phase to going back to optimal levels of neurons would be impaired
How is the frontal lobe involved in psychopathology
primary motor cortex, where all parts of the body are represented + premotor and supplementary motor areas
definitely involved/affected in psychopathology
IMPORTANTLY for this course - involved in mental activity, personality, insight, foresight, reward, regulation of emotion, etc.
Describe the history of frontal lobotomy
frontal lobotomy
psychiatrist hears about a scientist that removed dog’s frontal lobe’s brain, he then performed the same thing on patients with schizophrenia, dismissed by the scientific community
Later, another scientist reports docility from chimpanzees after removing the frontal lobe from the brain, he then thought that maybe if we could cut the connectivity from people with OCD and psychosis that have loops. He then started to remove specific part of the brain to stop the overactivity of the brain, he ended up saying that it should only be performed on extreme cases
Walter freeman heard about his work and started to put an ice pick under the eyelid and would wiggle to disconnect both hemisphere
the results were very random and would be conducted for non-extreme cases such as misbehaviour
⅓ better, ⅓ not much ⅓ worst such as vegetative state
How is the parietal lobe involved in psychopathology
Not linked directly to any specific mental health symptoms
primary somatosensory cortex (postcentral gyrus) - integration and processing of sensory info
however, in depression we see lower threshold for pain
part of Wernicke’s area - language and reading skills
superior parietal gyrus - body image and spatial orientations
How is the occipital lobe involved in psychopathology
the primary and higher-order visual cortex
How is the temporal lobe involved in psychopathology
Temporal and frontal lobe are the most implicated in psychopathologies
Heschl’s gyrus - the primary auditory cortex
Wernicke’s area (language comprehension)
parahippocampal gyrus together with hippocampus and amygdala involved in learning, memory and emotion (medial temporal lobe/limbic system)
memory is usually the result of other issues, psychopathologies don’t start with memory issues
e.g., Capgras Syndrome
the guy came up to the hospital and would not ‘recognize’ his mother. He said she looked like her and sounded like her but perceived like an impostor. However,if it was only by phone it was okay. There is a disconnection between the amygdala and the visual cortex. Because the person is not invoking the usual emotional response, they must be an impostor
Briefly explain how synapses may be implicated in psychopathologies
there are several ways in which synaptic transmission can go wrong (and potentially contribute to mental dysfunction), e.g.
presynaptic neuron may release too much or too little of a given neurotransmitter
faulty reuptake process mechanisms
both can lead to post-synaptic receptor up- or down-regulation
Describe the role of dopamine
Dopamine (DA) - involved in reward and motivation; in cognitive function (working memory, executive function in the PFC), and in movement (planning and execution). Too little dopamine is thought to play a role in ADHD and depression (Bressan & Crippa, 2005), while too much is associated with psychosis (Buchsbaum et al., 2006).
++ dopamine in mesolimbic system can induce psychosis
cocaine/amphetamine increases dopaminergic activity
– dopamine ADHD and depression
Describe the role of serotonine
Serotonin (5-HT) - involved in mood and sleep regulation, as well as motivation. Too little serotonin may play a role in depression and OCD (Mundo et al., 2000); too much of it may reduce a person’s motivation.
++ serotonin can decrease sex drive and overall motivation, pleasure
– serotonin can lead to depression and OCD
Describe the role of acetylcholine
Acetylcholine (ACh) - involved in processes that store new information in memory (in the hippocampus); in the fight-or-flight response (in the ANS). Too little acetylcholine may contribute to formation of delusions (Rao & Lyketsos, 1998), and too much can produce spasms, tremors, and panic responses (Eger et al., 2002).
– ACh causes delusion (e.g. Alzheimer) less well structured than dopamine
++ ACh causes tremors (binds to nicotinic receptors)
Describe the role of glutamate
Glutamate (Glu) – critical for neuroplasticity, memory and pain perception. Too much glutamate has been observed in substance abuse (Kalivas & Volkow, 2005) and too little has been associated with schizophrenia (Muller & Schwarz, 2006)
++ Glu associated with addiction, too much Glu is associated with neurotoxicity
– Glu associated with schizophrenia
Describe the role of adrenaline (epinephrine)
Adrenaline (epinephrine) plays a role in attention and in the fight-or-flight response (Nemeroff, 1998). Too little of this substance in the brain contributes to depression, and too much can lead to over-arousal and feelings of apprehension or dread.
++ EPI panic disorders
– EPI depression
Describe the role of noradrenaline (norepinephrine)
Noradrenaline (norepinephrine) also plays a role in attention and the fight-or-flight response. Too little contributes to distractibility, fatigue, and depression (Meana et al., 1992); too much has been implicated in schizophrenia and anxiety disorders (Nutt & Lawson, 1992).
– noradrenaline : depression, fatigue, add
++ noradrenaline : schizophrenia and anxiety disorder
Describe the role of GABA
Gamma-amino butyric acid (GABA) is a common inhibitory NT. Too little of it is associated with anxiety and panic disorder (Goddard et al., 2001); too much appears to undermine motivation.
– GABA anxiety
++ no motivation
barbiturates, benzodiazepines, alcohol
Describe the role of endogenous cannabinoids
Endogenous cannabinoids are involved in emotion, attention, memory, appetite, and the control of movement (Wilson & Nicoll, 2001). Too little of these substances is associated with chronic pain; an excess is associated with eating disorders, memory impairment, attention difficulties, and possibly schizophrenia (Giuffrida et al., 2004).
– endocan chronic pain
++ eating disorder, ADD, schizophrenia
What are agonists and antagonists
Agonists
Mimic the effects of a neurotransmitter or neuromodulator
Activate a particular type of receptor
Antagonists
Bind to a receptor site on a dendrite (or cell body)
Prevent the neurotransmitter in the synapse from binding to that receptor (or cause less of it to bind)
What’s a reuptake inhibitor
Reuptake inhibitors
Partially block the process by which a neurotransmitter is reabsorbed into the terminal button
Increasing the amount of the neurotransmitter in the synaptic cleft
Has the use of psychoactive drug been increasing or decreasing over the past two decades
increasing
Describe ECT
Electroconvulsive therapy (ECT)
Used primarily to treat severe depression when other treatments have not helped
Causes a controlled brain seizure
Typical course 6-12 sessions over several weeks
Performed in a controlled setting with anesthesia and monitoring of vitals
May cause short-term memory loss
The use of ECT has multiple effects, and many mechanisms have beenproposed for how it works, including alterations in serotonin sensitivity, direct effects of convulsions, increased secretion of hormones and neurogenesis, and glial changes.
ECT increased the volume of the hippocampus and amygdala
Describe TMS
Transcranial Magnetic Stimulation (TMS)
Sends sequences of short, strong, magnetic pulses into the cerebral cortex via a coil placed on the scalp
Sometimes used to treat the symptoms of certain psychological disorders
Treatment-resistant depression
More advantageous than ECT
No anesthesia or hospitalization
Minimal side effects
What is bio- and neurofeedback
Biofeedback : technique by which a person is trained to bring normally involuntary or unconscious bodily activity (such as heart rate or muscle tension) under voluntary control -neurofeedback for psychiatric disorders to increase brain functions
Explain how neurosurgery is used for psychopathologies
Neurosurgery
Brain structures are destroyed or their connections severed
Used very rarely
All other treatments have failed
Disorder remains sufficiently severe to prevent even a semblance of normal life
Deep brain stimulation (DBS)
Explain the behavioral perspective and give an example of a psychopathologies resulting from it
The behavioral (learning) perspective views abnormal behaviors as responses learned in the same ways other human behavior is learned Classical Conditioning Operant Conditioning Modeling
Phobia and overall anxiety disorders may be classically conditioned
Explain the operant conditioning and give an example of a psychopathologies resulting from it
B. F. Skinner (1904-1990) Law of effect Behavior that is followed by positive consequences will be repeated Behavior that is followed by negative consequences will be discouraged Positive reinforcement Negative reinforcement Positive Punishment Negative Punishment
OCD would be perpetrated through negative reinforcement
drug addiction starts as positive reinforcement and then shifts to negative reinforcement
Explain modelling and give an example of a psychopathologies resulting from it
However, in real life, learning often goes on in the absence of reinforcement, but through simple observation and imitation – experimental work by Albert Bandura can attest to that (aggression in children; reduction of fear of dogs, etc.)
Modelling can produce abnormal behaviors e.g., specific phobias, substance abuse problems..
drug abuse, anxiety disorder, depression
Explain conterconditioning
It is a behavioral therapy
Counterconditioning (Mary Cover Jones, 1924)
introduces giving a treat in the presence of the anxiety inducing event until the threat becomes associated with the reinforcement
Explain systematic desensitization
It is a behavioral therapy
used to treat phobias (specific and generalized)
go to a therapist, first steps to learn relaxation techniques, present the threat, create a scale (less to most threatening), and then, systematically you can work your way through the scale. May start with imagination and then more realistic
Explain flooding
It is a behavioral therapy
put people in a threatening situation and let them ‘stay there’ as long as possible. Based on the principle of extinction as they realize the fear is irrational and nothing happens when exposed to it
not inviting for people to want to be exposed to this treatment
can be very fast treatment, however may trigger panic attacks that could reinforce the phobia
Explain aversive conditioning
It is a behavioral therapy
Aversive conditioning
usually less successful
e.g. receiving a drug where you become violently sick if you consume alcohol. Associating alcohol with pain
the need to be accepted, to belong (or other) may override aversion
Explain the critique of the token therapy (or other positive reinforcement)
criticized to be dehumanizing to control behavior in treatment facilities
Name 4 classical conditioning therapies and give an example what it could be used for
Counterconditioning
Systematic desensitization
Flooding
Aversive conditioning
(e.g., to treat phobias)
Name 2 operant conditioning therapies and give an example what it could be used for
Token therapy or other positive reinforcement
Time-out
(e.g., to treat autism)
Name 1 modeling therapy and give an example what it could be used for
Assertiveness training
e.g., to treat social anxiety disorder
Briefly describe the cognitive perspective
Cognition – is a term that groups together the mental processes of perceiving, recognizing, conceiving, judging, and reasoning. The cognitive paradigm focuses on how people (and animals) structure their experiences, how they make sense of them, and how they relate the current events to the past.
our thoughts influence our emotions (and vice versa)
By influencing our thoughts, we could regulate emotions
Explain Cognitive Behavioral therapy
Cognition – is a term that groups together the mental processes of perceiving, recognizing, conceiving, judging, and reasoning. The cognitive paradigm focuses on how people (and animals) structure their experiences, how they make sense of them, and how they relate the current events to the past.
our thoughts influence our emotions (and vice versa)
By influencing our thoughts, we could regulate emotions
Explain Beck’s Cognitive Therapy
Aaron Beck (b. 1921) developed CT for depression based on the idea that a depressed mood is caused by a distortion in a way people perceive life experiences
He dismissed the old psychoanalytic theory that depression is self-directed hostility and replaced it with the model of negative cognitive bias (an automatic misprocessing of information)
find alternative explanations of failures than ‘i’m a failure’ such as ‘I was tired’
The goal of CT is to alter negative cognitive schemas
mostly with depression
Explain Ellis’s rational-emotive therapy (RET)
Albert Ellis (1913-2007) - another leading cognitive therapist; his principle thesis was that sustained emotional reactions are caused by internal sentences that people repeat to themselves (irrational beliefs); especially all the ”MUSTS and SHOULDS”
the aim is to eliminate these self-defeating beliefs through a rational examination of them
would destroy arguments
what is the worst case scenario
therapists who implement Ellis’s ideas differ greatly in how they persuade the client to change their self-talk (from confrontational to compassionate)
very confrontational (borderline/was abusive) but was effective
mostly with anxiety
Name 4 Technology-based and “third-wave” CBT therapies
Virtual reality (exposure-based) useful for behavioral components
Dialectical Behavior Therapy (DBT)
Acceptance & Commitment Therapy (ACT)
Accept your reactions and be present
Choose a valid direction
Take action
Mindfulness-based cognitive therapy (MBCT) etc.
Describe Boderline Personality Disorder
Frantic efforts to avoid real or imagined abandonment
A pattern of unstable and intense interpersonal relationships
Identity disturbance
Impulsivity
Recurrent suicidal behavior
Emotional instability
Chronic feelings of emptiness
Inappropriate, intense anger
Transient, stress-related paranoid thoughts
Describe how Dialectical Behavior Therapy can be useful for people with borderline personality disorder
Dialectical Behavior Therapy (DBT)
DBT seeks to teach the client how to learn to better take control of their lives, their emotions, and themselves through:
self-knowledge: observing one’s own thoughts, being aware
emotion regulation: awareness can diminish the intensity of the emotions
cognitive restructuring: psycheducation
often conducted within a group setting
not appropriate for those who may have difficulty learning new concepts
Explain Acceptance & Commitment Therapy (ACT)
Some acceptance strategies include:
Letting feelings or thoughts happen without the impulse to act on them.
Observe your weaknesses but take note of your strengths.
Give yourself permission to not be good at everything.
Acknowledge the difficulty in your life without escaping from it or avoiding it.
Realize that you can be in control of how you react, think and feel.
Some defusing strategies include:
Observe what you are feeling. What are the physical sensations?
Notice the way you are talking to yourself as these feelings are experienced.
What interpretations are you making about your experience? Are they based in reality?
Grab onto the strands of your negative self-talk and counter them with realistic ones.
Now re-evaluate your experience with your new-found outlook.
Explain MBSR and other mindfulness-based interventions
Mindfulness-Based Stress Reduction (MBSR)
the formal practices include:
mindful movement (gentle hatha yoga with an emphasis on mindful awareness of the body)
body scan (designed to systematically, region by region, cultivate awareness of the body)
sitting meditation (awareness of the breath and systematic widening of the field of awareness to include: awareness of the body, mental states, mental contents, etc.)
Explain the structure of the mind according to Freud
Structure of the mind (according to Freud)
not as popular as CBT
psychoanalysis has returned in the past few decades with some changes that is supported by research
very deterministic model, we are the product of our childhood traumas and only through this tedious lengthy work we can start to get better, trying to uncover what was ‘done’ to us
id, ego and superego are in a constant negotiation, communication, struggle
ID
present at birth, unconscious
basic urges for food, water, elimination, warmth, affection, sex
operates on the pleasure principle
EGO
primarily conscious
begins to develop during the second six months of life
operates on the reality principle
SUPEREGO
Operates roughly as a conscience
Develops throughout childhood
How does Freud explain psychopathologies
Psychopathology results from the unresolved unconscious conflicts in the individual
Neurosis - unresolved conflict between ID and EGO (e.g., in drug abuse, kleptomania), or between ID/EGO and SUPEREGO (e.g., feelings of guilt and shame in anxiety disorders and depression)
Psychosis - conflict between the EGO’s view of reality and reality itself; an escape from reality into one’s own internal world
rather weak approach of explaining psychosis
Explain the psychosexual stages and give example of psychopathologies that are related to each
Freud identified five distinct psychosexual stages of development which proceed from infancy into adulthood
oral (eating, drinking, dependency)
anal (self-control; e.g., OCD vs. BPD)
phallic (gender/sex role and identity; e.g. gender dysphoria)
latency (social/communication skills, self-confidence; e.g., SAD)
genital (balance between various life areas)
These stages must be completed successfully for healthy psychological development
Failure to satisfy the needs of a psychosexual stage will result in fixation and/or psychopathology
Why do we have defence mechanisms (freud)
Defend the Ego from anxiety Moral anxiety-guilt Reality anxiety Neurotic anxiety Are done unconsciously Are normal, useful for coping, unless dramatically overused Help define your personality
What is repression
Unintentionally keeping conflict-inducing thoughts or feelings out of conscious awareness
e.g. you ‘forget’ you were assaulted
What is denial
Not acknowledging the conflict-inducing thoughts or behaviors with explanations
e.g. you don’t admit you have an addiction
What is rationalization
Justifying the conflict-inducing thoughts, feelings, or feelings onto others
e.g. After a father hits her daughter, he justifies that she deserved it
What is projection
Ascribing (projecting) the conflict-inducing thoughts or feelings onto others
e.g. instead of admiting you don’t like that person, you assume they don’t like you
What is reaction formation
Transforming the conflict-inducing thoughts or feelings into their opposite
e.g. instead of admiting you have a crush on someone, you start hating them
What is sublimation
Channelling the conflict-inducing thoughts or feelings into less threatening behaviors
e.g. going boxing to channel the anger instead of hitting someone
What is the goal of psychoanalytic therapy
The goal of therapy is to remove earlier repression, uncover childhood conflict, and resolve it in the light of adult reality
getting the unconscious to consciousness, becoming aware of unconscious forces
Name 5 psychoanalytic therapies and briefly explain them
Free association - verbalizing whatever comes to mind without normal censorship – the analyst pays attention to resistance
Dream analysis – repressed material is disguised and dreams take on a heavily symbolic content - latent content
Transference - responses of the client to the analyst are believed to reflect relationships with important people in the client’s past
Countertransference - analyst’s feelings towards the client
Interpretation -the analyst points out to the client the meaning of certain behaviors
What is Group psychoanalytic therapy
focus on the psychodynamics of individuals in the group or a collective set of psychodynamics, manifested by such things as group transference to the therapist
What is Ego analysis
Ego analysis (Karen Horney, Anna Freud, Erik Erikson et et) - place greater emphasis on a person’s ability to control the environment and to select the time and the means for satisfying instinctual drives
Name two more contemporary psychoanalytic therapies
Brief psychodynamic therapy Interpersonal therapy (IPT)
What is Brief psychodynamic therapy
Brief psychodynamic therapy- alternative to the many years sometimes required for classic psychodynamic treatment. Pioneered by Ferenczi (1952) and Alexander & French (1946)
What is interpersonal therapy (IPT)
Interpersonal therapy (IPT) -contemporary variation of brief psychodynamic therapy, emphasizes the interactions between a client and his or her social environment.
The American psychiatrist Harry Stack Sullivan pioneered the interpersonal approach
concentrates on the client’s current interpersonal difficulties and discusses with the client better ways of relating to others combines empathic listening with suggestions for behavioral changes, as well as how to implement them used commonly to treat depression
The IPT therapist will not: Interpret your dreams; Have treatment go on indefinitely; Delve into your early childhood; Encourage you to free associate; Make you feel very dependent on the treatment or the therapist.
Name 7 myths about psychoanalysis
Psychoanalysis is all about sex
Psychoanalysis never ends
Psychoanalysts require that you lay on the couch
Psychoanalysis only focuses on the past
Psychoanalysis is not for children and adolescents
Psychoanalysis cannot treat psychotic disorders
Psychoanalysis = Freud
Name 4 attachment styles
secure attachment
avoidant attachment
ambivalent attachment
disorganized attachment
Describe secure attachment
represent 65% of US population
child state of being: secure, explorative, happy
mother responsiveness: quick, sensitive, consistent
Fulfillment of child’s needs: believes and trusts that their needs will be met
Describe avoidant attachment
represent 20% of US population
child state of being: not very explorative, emotionally distant
mother responsiveness: distant, disengaged
Fulfillment of child’s needs: subconsciously believes that their needs probably won’t be met
Describe ambivalent attachment
represent 10-15% of US population
child state of being: anxious, insecure, angry
mother responsiveness: inconsistent; sometimes sensitive, sometimes neglectful
Fulfillment of child’s needs: cannot rely on their needs being met
Describe disorganized attachment
represent 10-15% of US population
child state of being: depressed, angry, completely passive, nonresponsive
mother responsiveness: extreme erratic: frightened or frightening, passive or intrusive
Fulfillment of child’s needs: severely confused with no strategy to have their needs met
Briefly explain the humanistic-existential paradigm
imilarly to psychoanalytic therapies, insight-focused, however..
psychoanalytic paradigm assumes that human nature (the id) is something in need of restraint, while..
Humanistic and existential paradigms
Place greater emphasis on the person’s freedom of choice
we always have to freedom to change our mental health, more of an attitude, empowering clients
Free will as the person’s most important characteristic
Exercising one’s freedom of choice takes courage, can generate pain and suffering
Seldom focus on cause of problems
Who is Carl Rogers
Carl Rogers (1902 –1987) - American psychologist of enormous influence – survey of 2,400 North American psychotherapists - Rogers was identified as the most influential psychotherapist figure (Cook, Biyanova, & Coyne, 2009). Beck and Ellis finished second and sixth, respectively.
Creator of client-centered therapy
father of psychotherapy
Explain Client-Centered Therapy (CCT)
By Carl Rogers
Also known as person-centered therapy
horizontal approach, less hierarchy between patient and therapist
Our lives are guided by an innate tendency toward self-actualization, thus focusing on positive factors
it’s all contained within yourself, you just have to find the right solution
we are not inherently dark, bad, traumas
Based on the following assumptions:
People can be understood only from the vantage point of their own perceptions and feelings (phenomenological world)
Healthy people are aware of their behavior, are innately good and effective, and are purposive and goal-directed
Therapists should not attempt to manipulate events for the individual
Create conditions that will facilitate independent decision-making by the client
Features – unconditional positive regard & empathy
Explain both types of empathy in CCT
Primary empathy - therapist’s understanding, accepting, and communicating to the client what the client is thinking or feeling (paraphrasing)
paraphrasing suggests that the client/other knows that you are listening and they are understood
Advanced empathy - entails an inference by the therapist of the thoughts and feelings that lie behind what the client is saying, and of which the client may only be dimly, if at all, aware (interpreting).
‘is it possible that __ and ___ are linked’ as opposed to ‘I think you have ___’
trust the client’s insights
Explain the main difference between humanisitc and existential therapy
derives from the writings of philosophers (e.g., Sartre and Kierkegaard) and psychiatrists (e.g., Binswanger and Frankl).
existential and humanistic points of view both emphasize personal growth. However, important distinctions:
Humanism stresses the goodness of human nature
Existentialism embraces free will and responsibility, but stresses the anxiety that is inevitable in making important existential choices and the fact that each of us is essentially alone
we are forced to make choices = anxiety
must make choices in line with one’s values and beliefs
Avoiding choices may protect people from anxiety (short term), but it also deprives them of living a life with meaning and is at the core of psychopathology
What are the goals of logotherapy & other existential approaches
By Victor Frankl
Type of existential therapy
encourage clients to confront their anxieties concerning existential choices
support clients in examining what is really meaningful in life
emphasize the “will to meaning” rather than “will to pleasure” or “will to power”
encourage relating to others in an open, spontaneous, and loving manner
existential approach may best understood as a general attitude taken by certain therapists toward human nature rather than as a set of therapeutic techniques
the client has all the tools to be happy, the therapist will encourage them to have the environment to do so
What are Viktor E. Frankl’s beliefs
Founder logotherapy
He went on to later establish a new school of existential therapy called logotherapy, based in the premise that man’s underlying motivator in life is a “will to meaning,” even in the most difficult of circumstances. Frankl pointed to research indicating a strong relationship between “meaninglessness” and criminal behaviors, addictions and depression. Without meaning, people fill the void with hedonistic pleasures, power, materialism, hatred, boredom, or neurotic obsessions and compulsions.
For Frankl, meaning comes from three possible sources: purposeful work, love, and courage in the face of difficulty
What are the critiques of the humanistic and existential paradigms
The effectiveness of H-E approaches has been questioned in severe forms of psychopathology.
Rogers should be credited with originating the field of psychotherapy research (pioneered the use of tape recordings so that therapists’ behaviour could be related to therapeutic outcomes)
Name 2 Integrative paradigms and what they emphasize on
Diathesis-Stress Paradigm
Biopsychosocial (Neuropsychosocial) Paradigm
Both paradigms emphasize the interplay among the biological, psychological, and social / environmental perspectives
Describe the Diathesis-Stress Paradigm
Focuses on the interaction between a predisposition toward disease (diathesis) and environmental disturbances (stress)
Diathesis – a constitutional predisposition toward illness
Biological/early environmental (genetic, oxygen deprivation at birth, maternal smoking, etc.)
psychological (e.g., chronic feeling of hopelessness)
Psychological stressors include both major traumatic events (e.g., losing one’s job, divorce, death of a spouse) and more mundane happenings (e.g., being stuck in traffic
Describe the Biopsychosocial Paradigm
complex interactions among many biological, psychological, and socio-environmental and socio-cultural factors
the actual variables and the degree of influence of the variables from the different domains typically differ from disorder to disorder
what are some Cultural Considerations in psychopathologies
higher levels of mental health problems in many Canadian Aboriginal communities (e.g., depression, drug abuse, suicide, low self-esteem)
Hutterites in Manitoba (German-speaking, Anabaptist sect emigrated in the 1870s from central Europe to Manitoba), who live in isolated, religious communities that are relatively free from outside influences, have remarkably low levels of mental illness (e.g. very low lifetime prevalence of schizophrenia)
healthy immigrant effect
immigrants seem to be healthier, why?
Name 7 features of abnormal behavior
- Statistical infrequency
- violation of norms
- personal distress
- disability or impairment
- risk of harm (to self or others)
- unexpectedness & unpredictability
- irrationality/incomprehensibility
Who is Chung Ching
Chung Ching (2nd century CE) called the Hippocrates of China (organ pathology as primary causes but ALSO stressful conditions could cause organ pathologies…)
Explain Emily Eakin’s main points in the article
Argues tha the definition of abnormal behavior is shapes by the values of the society that makes them. in our current day and age, racism should be considered a pathology in the DSM
Dr. Poussaint Arguing that racism can sometimes – though not all the time – be a mental disorder, he says that racists frequently exhibit symptoms associated with major psychopathology, including paranoia (feeling threatened unrealistically by a particular group), projection (imbuing this group with traits that have negative associations) and fixed beliefs (categorical opinions like ‘‘all foreigners are dumb’’).
Mr. Pettigrew examined racist attitudes in eight American towns, four in the North, four in the South. In the Northern towns, he found some correlation of racist attitudes with the syndrome described in ‘‘The Authoritarian Personality.’’
Explain how DBS works
Invasive brain stimulation, particularly deep brain stimulation (DBS), has been heralded as a step forward for psychiatry.
targets in major depressive disorder (MDD) and obsessive-compulsive disorder (OCD)
Recent well-controlled studies for psychiatric illness have failed. We hypothesize that the root of these difficulties is our inability to carefully choose the patients to whom we offer DBS.
Each target has a different hypothesized mechanism of action and addresses a different MDD phenotype. As an intervention on a circuit, we would expect DBS to affect only a subset of symptoms, not the full checklist of criteria
under what principles do id and ego operate
id = please ego = reality
What is negative cognitive schemas, where is it used
used in Aaron Beck Cognitive Theory, it is an automatic misprocessing of information
Name the different types of anxiety freud assocaites with defence mechanisms
Moral anxiety-guilt
Reality anxiety
Neurotic anxiety
