Clinical Flashcards
What is Medical Student Syndrome? What does it trigger?
a condition whereby many medical students self-report having an assortment of problems and diseases after learning about them in school.
Triggers confirmation bias
What are 3 things to keep in mind when learning about disorders?
- Most symptoms of disorders are also present in everyday normal functioning.
- The prevalence of most disorders is low.
- Only a trained clinical psychologist can diagnose you with a clinical disorder, and self- diagnosis ability is quite poor (even amongst trained professionals!).
What is mental health stigma? how does this effect the experience of having a mental health disorder? What does it make us accept? What does it lead to?
a culturally-specific negative belief and attitude towards those who are seen as suffering from a mental health problem.
Stigma makes the experience of having a mental disorder even worse and more difficult to treat.
But it also makes us accept myths about how mental disorders work, that lead to people being harmed even if they do not actually have a disorder.
leads to people magnifying or minimizing their experiences.
Are there correlations between people who commit acts of violence and people with mental health issues?
there are very weak correlations between people who commit acts of violence and people with mental health issues.
Why can we not define a mental disorder as “when a behaviour is rare or atypical”?
Problem: many atypical/rare things are not disorders (e.g., happiness).
Problem: is atypical always bad?
Problem: some psychological disorders are surprisingly common.
Why can we not define mental health problems as “When normal psychological functions biology malfunction”?
Problem: what is “normal psychological function”?
Problem: psychological traits show very high variability.
Problem: can we apply psychological findings universally?
Why can we not define mental health problems as “condition that causes harm to self and others”?
Problem: lots of things cause harm but shouldn’t be considered psychologically “dysfunctional” (e.g., racism, aging).
Problem: some things that seem to be disorders don’t cause any harm to others (e.g., auditory hallucinations, some personality disorders).
Why can we not define mental health problems as “Behaviour that is in conflict with societal norms”?
e.g., Thomas Szasz: mental illness is a cultural myth we use to attach stigma, filter people, and put them “in their place”.
Problem: many people diagnosed with a disorder are really suffering independent of society and want to find help and treatment.
Why can we not define mental health problems as “ A condition that causes distress and significant problems in everyday function (e.g., social, work, school, etc.)”?
Problem: though many disorders lead to people self-reporting impairment in everyday function, not all of them do (e.g., developmental disorders, many forms of addiction).
Problem: what about significant problems caused by natural variability?
Problem: what about significant problems caused by sociocultural factors (e.g.,
poverty)?
What does clinical psychology allow for in regards to our definition of mental disorders?
Clinical psychology allows our definition of mental disorder to change as we
understand more about their causes and consequences.
What is the current definition of a mental disorder?
a) Cognitive/emotional distress.
b) Significant impairment in daily function.
c) Underlying psychobiological dysfunction and not only environmental factors.
d) That is not primarily the result of social deviance or societal conflict.
e) Is usually long-term (i.e., weeks to months to years).
What is the medical model of disorders?
all psychological disorders are due to physical/biological causes, have clear and identifiable symptoms, and can be cured like any other disease.
What is the bio psycho social model in terms of mental health?
psychological disorders are caused by a complex network of biological, psychological, and social factors.
When was the DSM 5 last updated?
Last updated in March 2022 with very minor changes.
What are the features of the DSM?
- Developed by researchers: the DSM-5-TR is made by psychiatrists and psychologists who research the disorders they diagnose. (It is sensitive to the evolution of scientific research.
- “Atheoretical”: the DSM-5 is a tool for categorizing, not for telling you why somebody is experiencing a disorder. (it does not abide by models (biopsych social etc))
- Impairment in everyday functioning: most disorders can only be diagnosed if symptoms are causing significant problems in everyday functioning. (this is mandatory)
- Medical, environmental, and deviancy exclusions: clinicians are instructed to make sure that the problem is truly psychobiological in origin, and not caused by medical problems or societal conflicts or purely environmental effects.
- Criteria and Decision Rules: each disorder has a set of clearly defined features with
some degree of flexibility. (allows for some differences in presentation from person to person. )
What is the DSM 5? Is it the standard?
The Diagnostic and Statistical Manual 5th Edition Text Revision (DSM-5-TR): a classification system for diagnosing recognized 150+ disorders, indicating how they can be distinguished from other, similar problems and describing their typical presentation.
Though not without its problems, the DSM-5-TR is considered the standard in
diagnosing clinical disorders.
How frequently is the DSM updated? What does this allow us to do? (3 things)
DSM is updated every 8 – 12 years by a team of psychologists and
psychiatrists.
This allows us to:
- Identify new disorders (e.g., hoarding): especially those that may have been considered typical in the past due to cultural or social biases.
- Update existing disorders (e.g., autism, schizophrenia): especially when new research has drastically changed how we think about them.
- Remove previous disorders (e.g., Asperger’s, homosexuality): often because of better understanding of disorders and shifts in cultural norms.
What are some key things to note about the DSM diagnostic for ASD? (4 things) How does this relate to the general criteria for mental disorders?
The problems must be persistent (longterm criteria)
not accounted for by general developmental delays (not only environmental factors)
it must have been present in early childhood (not primarily the result of social conflict)
the symptoms must limit and impair everyday functioning. (significant impairment in daily function)
What are some key things to note about the DSM diagnostic for mild neuro-cognitive disorder? (7 things)
must have evidence of modest cognitive decline from a previous level of performance
information must have been collected by a knowlegeable informant
cognitive impairment must be documented by standardized neuropsychological testing
Cognitive deficits do not interfere with capacity for independence.
cognitive deficits can’t interfere with capacity for independence
cannot exclusively occur n the context of delirium
cannot be better explained by another mental disorder
Where in the world is the DSM 5 most frequently used?
the global north
What are 3 things that the DSM 5 is criticized for?
Ties With Insurance: when the DSM changes, people might suddenly lose their diagnosis and therefore no longer have access to treatment. (mental health care is primarily tied to insurance which requires a diagnosis, this is concerning. Can cause lots of harm to individuals.)
Comorbidity: co-occurrence/correlation of two or more diagnoses within the same person. If we properly categorize disorders, comorbidity should be zero (e.g., having a cold is not correlated with having insomnia). However, the DSM-5-TR disorders show widespread comorbidity. (as many as 50% of people diagnosed with 1 disorder within the DSM also meet the criteria for another. This means that the DSM 5 is not cutting up disorders in the way its says it is. This may imply that the disorders it is capturing is not actually a good fit for the underlying causes.)
Categorical disorders: the DSM treats most disorders as categorical (you have it or you do not), when in reality there are clearly variations in severity. (the vast majority of these disorders actually occur as a spectrum. )
Can the problems with the DSM be fixed? Why?
these problems will not be fixed by the DSM because they are built in.
What is the hierarchical Taxonomy of psychopathology (HiTOP)
a research-informed manual that adopts a multi-dimensional approach that focuses on problems in specific psychological functions across different levels that might lead to overlapping conditions.
this is not a labelling manual. It is a guide that assesses specific functions
if we care more about the underlying causes of these symptoms we can help them better
What are 3 questions that summarize why diagnosing clinical disorders is hard?
Diagnosing clinical disorders is hard.
What is abnormal?
What causes disorders?
How do we diagnose fairly and adaptively?
What gives the DSM a lot of validity?
The DSM-5 is the current best we’ve got, and the fact that it is made by researchers and is regularly updated gives it a lot of validity.
What is anxiety? How is differentiated from fear? Can it vary in severity?
a state of apprehension and tension in which a person anticipates upcoming danger, catastrophe, or misfortune.
Anxiety is differentiated from fear and stress by it’s anticipatory nature and by having a diffuse target. ( fear is very focused on a signle source that has triggered a very active feeling of being afraid)
Anxiety can vary in severity from mild but persistent, to severe.
What is a panic attack?
a severe state of anxiety coupled with difficulty breathing, fast heart beating, choking sensations, sweating, and dizziness; often associated with feelings of losing control and dying. (an extremely severe moment of anxiety that is outside of the typical experience of anxiety.)
Is anxiety natural and adapted? How?
Anxiety is natural and adaptive: it forces us to deal with anticipatory threats and challenges. (it is adaptive like fear and stress but for the future.)
What anxiety characterizes anxiety disorders?
But, anxiety disorders are characterized by anxiety that is:
Irrational and excessive: the person experiences profound anxiety even when they know that there is no immediate threat to their safety and well-being.
Uncontrollable and automatic: the trigger automatically causes anxiety, even if the person knows that they shouldn’t be anxious.
Disruptive to everyday life: the anxiety is severe and frequent enough that it impairs everyday functioning.
What are anxiety disorders?
group of disorders in which excessive, irrational, and impairing anxiety is the primary manifesting symptom.
What is the category prevalence for Anxiety Disorders?
The most commonly diagnosed clinical disorder, with. About 20% of people will at some point in their life be diagnosed.
Do anxiety disorders have a strong genetic component? What do anxiety disorders include?
Anxiety disorders have strong genetic component and prevalence is correlated with high levels of neuroticism.
Category includes: specific phobia, social anxiety disorder, generalized anxiety disorder, panic disorder, separation anxiety disorder, selective mutism, and more.
What are Phobic Disorders? How does the DSM Sub-classify them?
marked, persistent, and excessive fear and avoidance of specific objects, activities, and/or situations (e.g., animals, situations, feelings, etc.).
DSM-5-TR sub-classifies them into “animal” (dogs), “natural environment”, (earthquakes hurricanes) “blood-injection-injury” (fear of seeing/ being around blood), “situational” (Fear of flying, fear of public speaking), and ”other” types (catch-all)
What is the DSM careful to examine?
DSM-5-TR is careful to examine environmental and medical factors as exclusions (e.g., fear of loud noises during wartime would not count as phobia). (you need to make sure that there is no rational basis for the disorder)
What is fear conditioning? What experiment shows this?
the theory that phobias are caused by associating a particular stimulus with a negative event through everyday life experience.
Little Albert Experiment: a 6-month-old infant not previously afraid of white rats was conditioned by pairing a loud noise every time he touched the rat; his fear generalized to other white, furry things. (powerfully demonstrates how a few experiences to aversive stimuli can cause fear to that thing and can be generalized to similar things. )
Are we more likely to be afraid of some things compared to others?
But we are much more likely to be afraid of some things compared to others, and sometimes are afraid without any previous experience (e.g., flying, spiders, heights).
What is preparedness theory? What effect is related to this?
Preparedness Theory: the theory that we are biologically programmed to be afraid of certain things with little experience, or from general stress. (we could witness, hear about etc.)
The Garcia Effect: when a rat mildly poisoned once after drinking sugar water they will – upon recovering – never again drink sugar water again (even if they were actually poisoned by something else).
What is social anxiety disorder?
Social Anxiety Disorder: the most commonly diagnosed anxiety disorder, in which the primary set of symptoms is excessive anxiety around being judged by others, often to the point that the person avoids all social situations. (social anxiety is less than a phobia and more like a developmental disorder.)
Are individuals with social anxiety antisocial?
Individuals with social anxiety are not antisocial: they often crave social contact, but are so worried about humiliation and judgement that their fear prevents them from being social.
When is the most often onset of social anxiety disorder?
Onset is most often in childhood, with moderate heritability and correlations with temperament and neuroticism.
What is generalized anxiety disorder?
an anxiety disorder characterized by chronic and excessive worry accompanied by three or more of the following: fatigue, concentration problems, irritability, muscle tension, and sleep disturbance for more than 6 months. (constant low-level anxiety)
What does GAD seem related to in the brain? Is GAD heritable?
GAD seems related to the brain’s ability to inhibit information: patients suffering from GAD show significantly higher levels of general brain activity. (its like their brains are perpetually over active)
Is moderately heritable, with environmental effects like stress and trauma being the other main predictors. (an especially good example of the stress diathesis model)
What does GAD seem related to in the brain? Is GAD heritable?
GAD seems related to the brain’s ability to inhibit information: patients suffering from GAD show significantly higher levels of general brain activity. (its like their brains are perpetually over active)
Is moderately heritable, with environmental effects like stress and trauma being the other main predictors. (an especially good example of the stress diathesis model)
What is obsessive compulsive disorder?
a clinical disorder marked by:
Repetitive, intrusive and irrational thoughts and worries (obsessions). (perpetual thoughts that they can’t inhibit)
Ritualistic behaviors (compulsions) done in an attempt to fight those thoughts.
The obsessions and compulsions impair everyday function, including ability to maintain a job.
What is the category prevalence of OCD?
Category Prevalence: About 2-5% lifetime prevalence.
Is OCD classified as an Anxiety disorder?
Along with PTSD, it was classified as an anxiety disorder until DSM-5, but is now considered an independent category. (DSM does not classify this as an anxiety disorder.)
What are the most common automatic obsessions?
The most common automatic obsessions are: Concerns with dirt, germs, or toxins
Dangerous events, like fires, death, illness Symmetry, order, exactness
What are the most common automatic compulsions?
The most common automatic compulsions are: Excessive hand washing, bathing, tooth brushing, grooming
Repeating rituals (in/out of a door, up/down a chair Checking doors, locks, appliances
What are the most common automatic compulsions?
The most common automatic compulsions are: Excessive hand washing, bathing, tooth brushing, grooming
Repeating rituals (in/out of a door, up/down a chair Checking doors, locks, appliances
Is OCD commonly progressive?
OCD is a common progressive disorder, the symptoms become more and more severe and it ends up taking more and more time. It is dhibilatating
What is depression?
a negative state marked by unhappiness, sadness, pessimism, hopelessness, and lethargy, coupled with changes in eating and sleeping habits, difficulty concentrating, and social withdrawal.
What are depressive disorders characterized by?
depressive disorders are tied to certain states (depression is the state)
Have some psychologists argued that depression is adaptive? Why?
Some psychologists have argued that depression is adaptive: it makes us re-assess our goals, ask for help, and preventing us from spending energy on wasteful actions.
What is depressive realism?
individuals experiencing depression are somewhat more likely to predict performance on a task due to reduced overconfidence. (people who are depressed are more accurate when it comes to predicting their performance)
What are depressive disorders?
mental disorders whose primary symptom is the presence of impairing depression, accompanied by related changes that significantly affect the individual’s capacity to function. In this circumstance, depression has gone far beyond an adaptive state.
What is the category prevalence of depressive disorders?
second most common (after anxiety) category of disorders, with lifetime prevalence of around 15%.
What does the DSM 5 include in depressive disorders?
major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder, disruptive mood dysregulation disorder, and more.
What are the theorized causes of Depressive disorders?
Many theorized causes, including purely biological, purely cognitive, and mixture
of both.
What are Major Depression Disorder?
a mood disorder characterized by:
A severely depressed mood and/or an inability to experience pleasure that lasts for 2 or more weeks, accompanied by feelings of worthlessness, lethargy, lack of sleep, inappropriate guilt, and appetite disturbance.
Is correlated with increased suicidal ideation and attempted suicide.
Do people with MDD experience depressive episodes or prolonged episodes?
People with MDD experience depressive episodes rather than a perpetually depressed mood. (they can be okay for awhile and come back etc.) (this has changed, this is no longer an exclusion)
What was the exclusion to MDD that was removed in the DSM-5?
DSM-5 removed an exclusion to MDD if a loved one died recently. (this has changed, this is no longer an exclusion)
What is Persistent Depressive Disorder? What do you need to be diagnosed with it?
depressed mood for most of the day, for more days than not, over a period of 2 years; less intense than MDD, but much more long-term.
Individuals with PDD experience their symptoms for 2 years with no longer than 2 month breaks.
Frequently co-occurs with intermittent major depressive episodes
Like MDD, often associated with suicidal ideation and attempted suicide.
What are the three sources of evidence that depression may have a biological bases?
Some depressed individuals have significantly reduced levels of serotonin and norepinephrine, reducing their moods and general arousal activity.
Some depressed individuals have significantly reduced general brain activation. (This is opposite to GAD)
Heritability for depression is moderate-to-strong and similar to IQ.
What is the cognitive model of Depression?
the theory that one’s automatic thought patterns, inferences, and attitudes increase the risk for depressive mood and depressive episodes.
What are the three things relating to the cognitive model of depression?
Negative schemas: depressed individuals are likely to be focused on themes of guilt, worthlessness, loss, separation, and rejection. (focused on creating narratives about their lives based on these things)
Biased attention: depressed individuals might attend more to negative events in the environment, and interpret them as consistent with their schemas. (like a confirmation bias)
Biased memory: depressed individuals recall the past more negatively, are more likely to ruminate, and more likely to blame themselves for outcomes.
What is helplessness theory?
ties back to learned helplessness. Depressed individuals have, through repeated negative events, learned that they have no control over the world, and thus have an explanatory style of negative events that is:
Stable: these bad things will keep happening forever.
Global: this bad event is going to affect everything.
Internal: this bad event is all my fault.
Helplessness theory is sometimes a subcomponent of the schemas of
cognitive theory, but sometimes a theory in its own right that emphasizes
recurrent negative events that have actually happened.
(the helplessness theory requires evidence that this way of thinking has been built form negative experiences, this is not true for the cognitive theory)
What are the problems with the three theories relating to depression? What is the focus of the best treatments for psychology?
The problem with all of these theories is the same: did they cause depression, or did depression cause these symptoms?
As we will learn next week, however, the best treatment of depression focuses on both biological and cognitive factors.
What are Bipolar Related Disorders? How do they affect people?
a category of disorders in which individuals alternate between moments of extremely positive mood (mania) and extremely depressed mood (depression).
These disorders – along with schizophrenia – are some of the most impairing and difficult to treat disorders that are studied today.
What is the category prevalence of Bipolar disorder?
1% for lifetime prevalence. (the lowest of everything talked about).
