Ch 1-3 (History, Diagnoses, Methods) Flashcards
defining abnormality
varies across time and culture
goodness of fit
behaviour can be problematic or not depending on environment
statistical concept (def and cons)
def: infrequent -> abnormal
cons: define “rare”
personal distress (def and cons)
def: causes distress
cons:
- not all cause distress
- universal distress but not everyone has mental illness
personal dysfunction (def and cons)
harmful: interferes and harms
evolution: interferes ability to reproduce
cons: “appropriate”, patients themselves do not find it harmful
violation of norms (cons)
eg. only 50% of mass murderers/terrorists
- cultural context
expert says so
cons:
1. not all pros are trained for diagnosis
2. arguments about social construct DSM
culture-bound syndrome
abnormal behaviours specific to particular location/group
changing perceptions
influenced by societal trends (eg internet addiction), diagnoses revised every 5 years
stone age (cause and treatments)
cause: supernatural
treatments: exorcism/magic
Hippocrates
1st man to reject supernatural causes
- 4 humours: excess blood/bile/phlegm
- treatment: healthy lifestyle, bleeding/vomiting
Galen
(Hippocrates cont.)
2 sources: physical/psychological
- compassionate care for mentally ill (warm baths, sympathy)
Arab World (500BC \+)
- mentally ill units 800 AD
Avicenna
- natural causes (environmental, psychological)
- early behaviourism principles
Middle Ages Europe (500-1500 AD)
- clergy took care
- return of supernatural beliefs
Teresa Avila/St Paul
- protection of mentally ill
- asylums (good intentions, bad execution) -> workhouses
Phillipe Pinel
huge changes to perceptions of mental health illnesses/asylums
- compassion
- good conditions
- but overcrowded
Dorothea Dix
- better conditions for prison/mentally ill
- campaign -> 32 new hospitals
single factor vs interactionist theory
one cause vs many causes
4 main goals of theories
- etiology
- how disorder maintained over time
- prediction
- treatment design
CNS functioning theories (2 kinds)
brain damage (Parkinson’s, Alzheimer’s) vs neurotransmitter (dopamine)
PNS 3 theories
overactive, underactive, inflexible (constant somatic, underactive parasymp.)
endocrine 3 theories
- thyroid disregulation (cretenism, depression)
- hypoglycemia -> pancreas dysfunction
- HPA axis (stress -> cortisol, anxiety)
Carl Rogers
person-centered theory
- abnormal behaviour -> distorted perceptions of self, no trust
Maslow
self-actualization/hierarchy of needs
- abnormal behaviour -> lack of esteem
diathesis-stress perspective
predisposition + environmental stressors = mental illness
DSM1 1952
- short
- severe disorders seen in inpatient settings
- vague descriptions
- unreliable
- psychoanalytic theory influence
DSM2 1968
- more diagnoses
- broadened outpatient settings
- psychoanalytic theory influence
DSM3 1980
- paradigm shift -> atheoretical
- more diagnoses/supplementary material
- improved descriptions
- multiaxial
DSM3R 1987
- same structure
- diagnostic criteria changes
- new disorders
DSM4 1994 (DSM4TR 2000)
- more diagnoses
- too quickly revised
DSM5 2013
- more diagnoses
- not multiaxial
- after extensive research
- most used
- dimensional approach to personality dis.
- cultural measures
- severity scale
5 arguments against classification
- socially constructed
- stigma
- loss of “identity” as a human being
- excuses
- stuck with diagnosis
assessment (def, 4 components)
- determines diagnosis
1. patient/family interview
2. medical testing
3. psychological testing
4. records review
assessment 1. reliability
test-retest, alternative form, split half reliability
assessment 2. validity
face, content, criterion
assessment 3. normative
comparing to average general population, clinical population, representative samples
clinical judgment vs actuarial measures
c: uses training/expertise
a: standardized measures and techniques
- > structured professional (combined)
neuropsychological testing
- relationship between behaviour and brain functioning
- battery of tests (time-consuming)
- certain errors (eg drawing clock)
interviews: (semi/un)structured (pros/cons)
u: rapport, poor reliability/validity, bias
s: less training, more reliability, interferes w rapport
semi: guideline w no set format, best of both
ABC
antecedent -> behaviour of concern -> consequence
treatment efficacy vs effectiveness
- efficacy: evidence of treatment in controlled study
- effectiveness: real world applications
CBT emphasis and focus
- thoughts/feelings/behaviour
- changing the negative to improve functioning
CBT techniques
- core belief identification
- evidence for/against thoughts
- cost-benefit
- third POV
- behavioural experiments
- relaxation and assertiveness
- problem-solving
strong support for CBT on disorders
- anxiety
- mood
- schizophrenia
- stress
- eating disorders
comorbidity
presence of 1+ disorders
dimensional system approach as DSM alternative
- people w disorders are not qualitatively distinct
- extreme variations of normal experiences
- dimensions of functioning rather than discrete clinical conditions
- bc high comorbidity and within-category variability
- range of traits rather than absence/presence of symptoms
arguments against dimensional system
- categorical: more efficient and simple -> clinical decision making
- no accepted dimensional theory exists (too difficult)
criterion validity
how well measure correlates with other similar measures
concurrent validity
relationship between two measures given at the same time (eg interview measure and questionnaire)
