Clinical Flashcards
1
Q
What is Medical Student Syndrome? What does it trigger?
A
a condition whereby many medical students self-report having an assortment of problems and diseases after learning about them in school.
Triggers confirmation bias
2
Q
What are 3 things to keep in mind when learning about disorders?
A
- 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!).
3
Q
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
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.
4
Q
Are there correlations between people who commit acts of violence and people with mental health issues?
A
there are very weak correlations between people who commit acts of violence and people with mental health issues.
5
Q
Why can we not define a mental disorder as “when a behaviour is rare or atypical”?
A
Problem: many atypical/rare things are not disorders (e.g., happiness).
Problem: is atypical always bad?
Problem: some psychological disorders are surprisingly common.
6
Q
Why can we not define mental health problems as “When normal psychological functions biology malfunction”?
A
Problem: what is “normal psychological function”?
Problem: psychological traits show very high variability.
Problem: can we apply psychological findings universally?
7
Q
Why can we not define mental health problems as “condition that causes harm to self and others”?
A
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).
8
Q
Why can we not define mental health problems as “Behaviour that is in conflict with societal norms”?
A
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.
9
Q
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.)”?
A
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)?
10
Q
What does clinical psychology allow for in regards to our definition of mental disorders?
A
Clinical psychology allows our definition of mental disorder to change as we
understand more about their causes and consequences.
11
Q
What is the current definition of a mental disorder?
A
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).
12
Q
What is the medical model of disorders?
A
all psychological disorders are due to physical/biological causes, have clear and identifiable symptoms, and can be cured like any other disease.
13
Q
What is the bio psycho social model in terms of mental health?
A
psychological disorders are caused by a complex network of biological, psychological, and social factors.
14
Q
When was the DSM 5 last updated?
A
Last updated in March 2022 with very minor changes.
15
Q
What are the features of the DSM?
A
- 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. )
16
Q
What is the DSM 5? Is it the standard?
A
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.
17
Q
How frequently is the DSM updated? What does this allow us to do? (3 things)
A
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.
18
Q
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?
A
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)
19
Q
What are some key things to note about the DSM diagnostic for mild neuro-cognitive disorder? (7 things)
A
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
20
Q
Where in the world is the DSM 5 most frequently used?
A
the global north
21
Q
What are 3 things that the DSM 5 is criticized for?
A
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. )
22
Q
Can the problems with the DSM be fixed? Why?
A
these problems will not be fixed by the DSM because they are built in.
23
Q
What is the hierarchical Taxonomy of psychopathology (HiTOP)
A
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
24
Q
What are 3 questions that summarize why diagnosing clinical disorders is hard?
A
Diagnosing clinical disorders is hard.
What is abnormal?
What causes disorders?
How do we diagnose fairly and adaptively?
25
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.
26
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.
27
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.)
28
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.)
29
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.
30
What are anxiety disorders?
group of disorders in which excessive, irrational, and impairing anxiety is the primary manifesting symptom.
31
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.
32
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.
33
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)
34
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)
35
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. )
36
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).
37
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).
38
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.)
39
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.
40
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.
41
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)
42
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)
43
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)
44
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.
45
What is the category prevalence of OCD?
Category Prevalence: About 2-5% lifetime prevalence.
46
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.)
47
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
48
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
49
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
50
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
51
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.
52
What are depressive disorders characterized by?
depressive disorders are tied to certain states (depression is the state)
53
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.
54
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)
55
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.
56
What is the category prevalence of depressive disorders?
second most common (after anxiety) category of disorders, with lifetime prevalence of around 15%.
57
What does the DSM 5 include in depressive disorders?
major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder, disruptive mood dysregulation disorder, and more.
58
What are the theorized causes of Depressive disorders?
Many theorized causes, including purely biological, purely cognitive, and mixture
of both.
59
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.
60
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)
61
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)
62
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.
63
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.
64
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.
65
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.
66
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)
67
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.
68
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.
69
What is the category prevalence of Bipolar disorder?
1% for lifetime prevalence. (the lowest of everything talked about).
70
Is Bipolar heritable? How does Bipolar affect the brain?
Bipolar I and II are extremely (and perhaps the most) heritable disorders,
with around 85% of variance in prevalence accounted by genes.
The brains of patients with bipolar disorder show profound changes in activity during manic vs. depressive episodes.
71
What are Schizophrenia Spectrum and Psychotic Disorders? What is the category prevalence? What does it include? is it categorical?
a set of disorders in which the presence of delusions, hallucinations, disorganized speech and motor movements, and absence of typical psychological functions are the characterizing features.
Category Prevalence (about 1 percent)
Includes: schizophrenia, delusional disorder, brief psychotic disorder, and more.
Since the DSM-5, all disorders in this category are on a spectrum: they are rated in severity (0 – 5 scale) and duration, rather than as binary categories.
72
What is schizophrenia? Are there many subtypes? When does it usually emerge?
the most severe of the disorders in the category, includes persistent symptoms for at least 1-month, and ongoing problems for at least 6 months; must show evidence of significant impairment in work, home, and personal relationships.
Before DSM-5, there were many subtypes of schizophrenia, but today there is only one and it is graded on a spectrum.
Usually emerges between late teens and mid-30s; onset is usually gradual.
73
What are positive symptoms? what are 4 positive symptoms of schizophrenia?
symptoms in which abnormal processes are present.
Hallucinations: perceiving things without any external stimulation (auditory hallucinations are most common).
Delusions: false beliefs that are maintained despite evidence to contrary.
Disorganized Speech: disruption of verbal communication in which ideas shift rapidly.
Disorganized Behaviour: odd motor movements,
including catatonia (lack of movement and muscle
rigidity).
74
What are negative symptoms? What are 4 negative symptoms of schizophrenia?
symptoms in which normal processes are absent.
Flat Affect: lack of emotion or emotions that are inappropriate for the situation.
Social Withdrawal: absence of desire for social contact, having friends, or relationships.
Lack of Motivation: lack of desire to accomplish any goal.
Problems with Attention and Working Memory: not able to focus or remember things in the short-term.
75
How heritable is schizophrenia? What are some contributing factors?
Schizophrenia is highly heritable at rates of 0.80 (much higher than IQ, personality, or most other disorders).
Prenatal stressors, including malnutrition, infection, and birth complications are all associated with higher risk.
76
What major brain structure differences have been observed in people with schizophrenia?
Reduced Grey Matter: an indicator of neurons in various brain regions. (lots of regions in the brain don’t have as many neurons as they should.)
Reduced White Matter: indicator of efficient connections between different brain regions. (indicator of myelinations this leads to less efiicient communication between different brain regions, they don’t coordinate as well)
Enlarged Ventricles: hollow regions of the
brain filled with fluid, and thus with reduced
brain mass.
77
What is the dopamine hypothesis?
the hypothesis that schizophrenia is caused by an
overabundance of the neurotransmitter dopamine throughout the brain.
This hypothesis helps explain positive symptoms: too much dopamine would activate various sensory and motor aspects of the brain, leading to hallucinations, delusions, etc.
However – dopamine doesn’t explain all the negative symptoms (thinks that the dopamine is trigeering brain regions that shouldn’t be turned on. leading to false dillusions ex: auditorysymptoms.)
78
What are personality disorders? What are their category prevalence? What do they include? What are they organized into?
disorders characterized by enduring patterns of thinking and behaving that deviates markedly from the norms and expectations of the individual’s culture, are pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.
Category Prevalence: 10.5% lifetime, but varies a lot for specific disorders. Includes: schizoid personality, antisocial personality, borderline personality,
dependent personality, and several others.
These are organized in three “clusters” of similar symptoms.
79
What are the three clusters of personality disorders?
Cluster A (Odd/Eccentric): characterized by social awkwardness and withdrawal,
and strange beliefs or manners of speaking or dressing.
Cluster B (Dramatic/Erratic): problems in impulse control and emotional regulation, including lacking empathy towards others, unstable moods, or attention seeking.
Cluster C (Anxious/Inhibited): associated with feelings of anxiety and discomfort, including in social situations, including oversensitivity to negative comments, perfectionism, lack of self-confidence, etc.
80
What is schizoid personality disorder? How are people with this percieved? Who is it more common for? What does it have to be carefully differentiated from?
- detachment from social relationships and restricted range of expression in social situations that is by choice; usually are indifferent to opinions to others, lack friends, and show flat affect.
- Sometimes are perceived to lack emotions entirely, but they are instead just very passive in relationship to other people.
- Much more common in families with a history of schizophrenia.
- Has to be carefully differentiated from early-onset schizophrenia, and mild autism
spectrum disorder.
81
What is antisocial personality disorder? What is the colloquial name? What is there evidence for in terms of the brain? Who is it more common in?
- pervasive disregard and violation of rights of others, since at least adolescence, with highly impulsive behaviours, aggression and irritability, tendency to deceive others, and lack of remorse.
- This is the DSM-5-TR name for psychopathy/sociopathy.
There is evidence that some APD clients have dysregulation in their amygdala and
- do not experience fear in social situations.
More common with history of child abuse, family history of disorder, and early exposure to violent environments.
82
What is borderline personality disorder? What do people with this often go through? What is happening with the amygdala?
pervasive pattern of unstable interpersonal relationships, self-image, and high impulsivity; frequently includes fear of abandonment, identity disturbance, recurrent suicidal behaviour, and difficulty controlling anger.
- BPD clients often go through cycles of revering and attaching themselves to a person, followed by rejecting them.
- Borderline patients often have very active amygdalas, experiencing intense fear from minor environmental disturbances.
83
What is dependent personality disorder? how is it different from BPD? What is a predictor of late emergence? What is something to keep in mind about its connection to anxiety?
- pervasive pattern of needing to be taken care by others, separation anxiety, difficulty making decisions without excessive amount of advice and support from others, and difficulty in doing things on their own. (really characterized by being unable to function on ur own.)
- Unlike BPD, no issues with impulsivity, anger, or fluctuating relationships.
- Separation anxiety in childhood appears to be a predictor of later emergence of dependent personality disorder.
- But – unlike adult separation anxiety disorder – concern is not with well-being of others, but fear of inability to take care of themselves.
84
What are neurodevelopmental disorders? What is their category prevalence? What do they include? Are they treated as categorical or as a spectrum? Is there a lot of comorbidity?
- category of disorders in which onset in early childhood with significant impairment are the defining feature.
- Category Prevalence: varies tremendously from 1 – 15% lifetime prevalence.
- Includes intellectual development disorders, communication disorders, autism
spectrum disorder, ADHD, and more.
- Strong comorbidity within the category. (ADHD and autism are very co-morbid)
- Since the DSM-5, all neurodevelopmental disorders – but especially autism – are to be treated on a spectrum.
85
What is autism spectrum disorder? What are some changes made in the DSM? Does it vary in severity?
- pervasive and sustained deficits in social communication and interaction, coupled with deficits in non-verbal communication, difficulties in having relationships, and restricted/repetitive patterns of behaviour; symptoms must begin in early childhood.
- DSM-5 combined autism, Asperger’s disorder, and pervasive developmental disorder under one umbrella of ASD.
- Varies in severity, with some individuals able to function without much support, and others requiring very substantial support.
86
Do we know the causes of autism?
The causes of autism are complex and still mostly unknown.
87
What is the heritability of Autism? Environmental risks? association to vaccines? theory of mind?
- Heritability of ASD is high, potentially as high as schizophrenia.
- Environmental risks include advanced parental age, extreme premature birth, and teratogen exposure.
- There is no evidence that autism is related to exposure to vaccines.
- Some have suggested that ASD is a weak or absent theory of mind, but this view is today seen as too simplistic. (doesn’t account for needs for symmetry, ritualistic patterns etc. )
88
What is ADHD? Why is it difficult to diagnose in older adults ? What has happened to the prevalence over the last decade? Where must the symptoms occur?
- Attention-Deficit/Hyperactivity Disorder (ADHD): a persistent pattern of inattention and hyperactivity lasting at least 6 months and present prior to age 12; can be predominantly of one type, or combined both.
- Because of the emergence before age 12 and unreliable memories, it is difficult to diagnose ADHD in adults.
- Symptoms must occur in multiple settings (e.g., school and home).
- Prevalence rates for ADHD have been rapidly rising over the last decade.
89
What is the most commonly accepted definition of a psychological disorder? What is the term for psychological disorders in he DSM?
Psychological disorder = mental disorder.
a clinically significant disturbance in an individual's cognition, emotional regulation, or behaviour that is usually associated with significant distress or disability or disability in social, occupational, and other important activities.
90
What is the most commonly accepted definition of a psychological disorder? What is the term for psychological disorders in he DSM?
Psychological disorder = mental disorder.
a clinically significant disturbance in an individual's cognition, emotional regulation, or behaviour that is usually associated with significant distress or disability or disability in social, occupational, and other important activities.
91
What does the DSM state that psychological disorders are?
syndromes: a cluster of physical or mental symptoms that are typical of a particular condition or psychological disorder and that tend to occur simultaneously
92
What is a symptom?
a physical or mental feature that may be regarded as an indication of a particular condition or psychological disorder.
93
What is psychopathology?
(1) the scientific study of psychological disorders , or (2) the disorders themselves.
94
What is psychopathology?
(1) the scientific study of psychological disorders , or (2) the disorders themselves.
95
What is the goal of abnormal psychology?
seeks to characterize the nature and origins of psychological disorders
96
What is the goal of clinical psychology?
refers to the assessment and the treatment of psychological disorders.
97
What can a syndrome not be to qualify as a psychological disorder? (3 things)
(a) an expectable response to common stressors and losses (such as the loss of a loved one)
(b) a culturally approved response to a particular event (for example, trance states in religious rituals),
(c) simple deviance from social norms (this is why it is important to take into account social context and culture)
98
What does the term prevalence refer to in clinical psych? What are the 2 types researchers typically consider?
how widespread a disorder is
Point prevalence: the percentage of people in a given population who have a given psychological disorder at any particular point in time.
Lifetime prevalence: the percentage of people in a given population who have a given psychological disorder at any particular point in time
99
How are psychological disorders related to death rates/
They represent five of the ten leading causes of disability and premature death worldwide
100
Why are diagnoses important?
They are the first step in identifying why a client is suffering and how they can be helped
101
What is a clinical assessment? What do they often begin with? What is the goal? What are the interview questions like?
a procedure for gathering the information that is needed to evaluate an individuals psychological functioning and to determine whether a clinical diagnosis is warranted
often begin with a clinical interview where the client is asked to describe his or her problems and concerns
Clinical interview: a procedure for gathering the information that is needed to evaluate na individuals psychological functioning and to determine whether a clinical diagnosis is warranted.
Clinician's goal: is to explore the current mental state of the client, life circumstances and history.
Questions: some of the interview questions are open-ended and flexible, with no particular script followed, or the clinician may employ one or more structured interviews asking specific questions in a specific sequence with attention to certain types of content.
102
What are clinicians looking for in a clinical interview?
pay careful attention to the things the client says are concerns.
Also, looks for behaviours that might hint to difficulties that the clients are not reporting. Such as: avoiding eye contact, shaking, tearful.
Clinicians are also alert to discrepancies between what the client reports and what they observe.
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what might accompany a clinical interview?
a self report measure: a standardized clinical assessment tool that consists of a fixed set of question that a patient answers.
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What are projective tests? What is an example?
a form of clinical assessment in which a person responds to unstructured or ambiguous stimuli; it is thought that responses reveal unconscious wishes and conflicts.
Ex: the Rorschach inkblot test
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Does the DSM include culture specific disorders?
yes. they have an appendix listing disorders that seem to appear only in some cultures. Ex: severe anxiety about the discharge of semen.
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can some disorders listed in the main section of the DSM vary by culture?
yes
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Where does bulimia show?
predominantly in Western cultures
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Where does bulimia show?
predominantly in Western cultures
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What is an important benefit of diagnostic labels? (6 thingd)
improved treatment of psychological disorders. Helps make sure that they get appropriate treatment.
Also help create a uniform framework for describing the difficulties that a client is facing, allowing healthcare workers to coordinate treatments.
For a client having a label for a puzzling set of symptoms may provide relief and motivate the client to seek and obtain treatment.
labels also help facilitate research on psychological disorders. Helps us compare results/findings of people with the same disorder.
We wouldn't be able to know how common a disorder is so we wouldn't be able to make rational decisions about how to allocate the finite resources that are available for research purposes.
Allows us to integrate findings across different fields
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What are some drawbacks to diagnostic labels?
- stigma is attached to psychological disorders. People with disorders and their family members are often viewed negatively. (therefore, labels can have negative effects on how we perceive someone and how people perceive themselves).
- labels encourage researchers to think of a psychological disorder as a fixed and enduring diagnosis.
- also encourage the view that each disorder is entirely separate from other disorders making the overlap between disorders more difficult to see.
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How are self-defeating and destructive attitutdes relating to diagnositc labels reinforced by media portrayals?
often portrayed as violent criminals.
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How do psychologists work to destigmatize diagnostic labels?
frame their descriptions as someone suffering from blank not someone is a blank
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When do breakup experiences cause depression?
Only if there are others factors present.
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what are the effects of expeirencing childhood maltreatment on depression and anxiety? When is this expressed?
doubles an individuals risk. However the tendency is unexpressed until the person experiences one or more stressful events.
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What is the diathesis stress model?
a conception of psychopathology that distinguishes the factors that create a risk of illness (diathesis) from the factors that turn risk into a problem (stress).
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What is learned helplessness?
a hopeless and passive acceptance of events beyond one's control.
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Can diathesis be both general and specific?
yes.
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What are some factors that may be relevant to whether an individual develops a psychological disorder?
genes that influence the levels of brain neurotransmitters
cognitive factors that influence how likely one is to ruminate or exhibit learned helplessness
Social factors such as whether one is isolated and lonely
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What is anxiety? Who are they most common in?
a feeling of intense worry, nervousness, or unease. Women.
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what are two common types of anxiety related disorders?
specific phobias: A marked fear of or anxiety about a particular object or situation, such as snakes, bridges, lightening etc. Women are twice as likely as men to have phobias.
Social anxiety disorder: an anxiety disorder characterized by an extreme fear of being watched, evaluated, and judged by others. Typically centred around negative evaluations, but sometimes even positive evaluations can feel threatening. Typically emerges in childhood or adolescence and can place people at elevated risk for depression.
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What might people with social anxiety disorder do when in uncomfortable situations?
fortify themselves with alcohol or drugs, making substance abuse or dependence a risk.
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What is panic disorder?
an anxiety disorder characterized by the occurence of unexpected panic attacks.
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What are panic attacks?
a sudden episode of uncontrollable anxiety, accompanied by terrifying bodily symptoms
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What are panic attacks?
a sudden episode of uncontrollable anxiety, accompanied by terrifying bodily symptoms
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What are common fears by people having a panic attack?
losing control, going insane, having a heart attack or dying.
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When is panic disorder diagnosed?
when recurrent unexpected panic attacks lead to either behavioural or psychological problems.
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What is panic disorder often accompanied by?
agoraphobia: a fear of being in situation in which help might not be available or escape might be difficult or embarrassing.
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What is panic disorder often accompanied by?
agoraphobia: a fear of being in situation in which help might not be available or escape might be difficult or embarrassing.
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What is generalized anxiety disorder? Who is it most common in?
an anxiety disorder characterized by continuous, pervasive, and difficult to control anxiety. Twice as common in women than in men.
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What is generalized anxiety disorder? Who is it most common in?
an anxiety disorder characterized by continuous, pervasive, and difficult to control anxiety. Twice as common in women than in men.
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What are people with GAD often plagued by? What might they experience?
feelings of inadequacy, difficulties in concentrating, and sleep disturbance. They have enormous difficulty making decisions. muscle tension, excessive sweating, a racing heart, difficulty breathing, diahrea
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What do some researchers believe about pervasive worrying? What are the longterm costs.
may actually be a type of avoidance behaviour. May be a cognitive form of avoidance, in which ones limits one's negative emotional reactivity by leaping from one worry to the next.
Less fulfilling social and work lives.
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What is obsessive-compulsive disorder?
An anxiety disorder that manifests itself through obssesions (unwanted and disturbing thoughts, and compulsions (ritualistic actions performed to control obsessions)
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What is obsessive-compulsive disorder?
An anxiety disorder that manifests itself through obssesions (unwanted and disturbing thoughts, and compulsions (ritualistic actions performed to control obsessions)
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Is it possible for someone with OCD to have either compulsions or obsessions?
yes.
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Does OCD affect both sexes equally? If it worsens over time is it associated with depression? When does it often develop?
yes.
Before the age of 10
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What is the relation between OCD and anxiety?
obsessive thoughts can produce anxiety and obsessive thoughts try to counteract this anxiety.
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What is the relation between OCD and anxiety?
obsessive thoughts can produce anxiety and obsessive thoughts try to counteract this anxiety.
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What is the mental ritual?
compulsion that have no visible signs but causes more severe impairment
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What are trauma and stressor related disorders? Who is more likely to suffer from this?
psychological disorders that are triggered by an event that involves actual or threatened death, serious injury, or sexual violation.
Women = more likely
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What are trauma and stressor related disorders? Who is more likely to suffer from this?
psychological disorders that are triggered by an event that involves actual or threatened death, serious injury, or sexual violation.
Women = more likely
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What happens in a period of dissociation?
period in which a sufferer feel wholly alienated, socially unresponsive, and oddly unaffected by the event. subsequwntly intrusice symptoms emerge.
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What happens in a period of dissociation?
period in which a sufferer feel wholly alienated, socially unresponsive, and oddly unaffected by the event. subsequwntly intrusice symptoms emerge.
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what are negative alterations in cognition and mood?
outbursts of anger and loss of interest in things that were once pleasurable.
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what is an acute stress disorder?
a truama or stressor related disorder that lasts less than one month
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what happens if the symptoms of acute stress disorder continue? Who are more likely to develop it?
if the response is enduring, and if their symptoms persist for one month or more after the stressor, the diagnosis becomes post-traumatic stress disorder.
Women .
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what are comorbidities? What do high rates of comorbity suggest?
the occurrance of two or more disorders in a single individual.
there are 2 risk factors at work:
general which make someone vulnerable to moe than one of these disorders.
specific risk factors: make someone vulnerable to one of the disorders but not others
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What are biological risk factors for anxiety?
genetics
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Do all anxiety related disorders engage different brain systems? What specifically?
yes.
specific phobias and social phobia: brain regions involved with fear and learning.
PTSD: less brain activation in prefrontal regions associated with emotional regulation.
Panic disorder: instablity in the autonomic nervous system.
OCD: overactivity in the anterior cingulate cortex, insula, caudate, and putamen
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What are mood related disorders?
disorders that involve prominent disturbances in a person's negative and positive feeling states.
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What is Major depressive disorder
a mood disorder characterized by feelings of sadness, emptiness, and adhedonia
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What is adhedonia?
Diminished interest or pleasure in nearly all of the activities that usually provide pleasure such as eating, exercise, or spending time with friends.
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If you know someone has depression do you know what their symptoms are? Who is more likely to be affected? Why?
no there are too many combinations of symptoms.
women. Maybe becuase they have a greater use of maladaptive forms of rumination.
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If you know someone has depression do you know what their symptoms are? Who is more likely to be affected? Why?
no there are too many combinations of symptoms.
women. Maybe becuase they have a greater use of maladaptive forms of rumination.
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What is something that people with depression experience?
psychotic delusions (unshakable false beleifs) often regarding guilt, worthlessness
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What is something that people with depression experience?
psychotic delusions (unshakable false beleifs) often regarding guilt, worthlessness
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Is there a chance that a person who has had one depressive episode would have another?
yes
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what is bipolar disorder? How long are the episodes?
a mood related disorder characterized by manic episodes and depressive episodes, with normal periods interspersed
as long as several months or as short as a few hours.
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what is hypomania?
a mild form of mania marked by high spirits, happiness ,self-confidence, and seemingly unstoppable
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What will the patient do when in mania?
stop taking mood stabilizing medication
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What is acute mania?
a chaotic state.
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What neurotransmitters play a critical role in regulating mood related disorders? How do the mood stabilizing medications work? What do people think is most important for making drugs work?
norepinepherine, dopamine, serotonin
altering availability of these chemicals at the synapse.
The relative balance of the neurotransmiters
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Does schizophrenia have a more sever course in men or women?
men
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Where is dopamine different in the brains of schizophrenics? What is glutamate relation?
excessive dopamine stimulation in midbrain limbic circuits, insufficient dopamine stimulation in cortical circuits. Glutamate may also play a role.
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Why do ventricles become enlarged in people with schizophrenia?
to compensate with the lacking brain mass.
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Why do ventricles become enlarged in people with schizophrenia?
to compensate with the lacking brain mass.
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at what point in pregnancy will maternal illness most likely lead to schizophrenia?
first trimester
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can a lack of oxygen at birth lead to increased schizophrenia likelihood?
yes
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what did videos of young children before being diagnosed with schizophrenia show?
that they showed less positive and more negative facial expressions, unusual motor patterns,
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What is true about kids with ADHD and their attention problems?
not with focusing heir attention but wiht shifting their attnetion to where it needs to be.
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What is true about kids with ADHD and their attention problems?
not with focusing heir attention but wiht shifting their attnetion to where it needs to be.
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how do ADHD medications work?
methylphenidate enhances the release of dopamine and norepinephrine, which in turn activate inhibitory circuits that guard against impulses that might be triggered by the person’s environment.
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how do ADHD medications work?
methylphenidate enhances the release of dopamine and norepinephrine, which in turn activate inhibitory circuits that guard against impulses that might be triggered by the person’s environment.
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What is dissociative identity disorder?
a disorder (formerly known as multiple personality disorder) defined by the presence of 2 or more distinct personality states within a single person, eahc with its own style, habits, beliefs and memories.
