Clinical Psychology Flashcards
Mental disorder/psychopathology
Persistent disturbance or dysfunction in behavior, thoughts, or emotions that causes significant DISTRESS and IMPAIRMENT
Medical model of mental disorders
Like physical illnesses, mental illnesses have biological and environmental causes, defined symptoms, and cures
Disorder vs disease vs diagnosis
Disorder: common set of signs (OBJECTIVELY observed indicators) and symptoms (SUBJECTIVELY reported thoughts, behaviors, emotions)
Disease: known pathological process affecting the body
Diagnosis: determination of whether a disorder or disease is present
The DSM
- DSM = Diagnostic & Statistical Manual of Mental Disorders
- Standardization of diagnoses; classification system for each known mental disorder, symptoms/diagnostic criteria, etc
- Most recent release is DSM-5 + DSM-5-TR (test revision)
- Used to use roman numerals to number them but now use arabic numbers so we can do updates to the same version (5.1, 5.2, etc) –> publish updates more frequently instead of every 20 yrs
Drawbacks:
- May feel like “labeling”
- Can be problematic if just “below” the cutoff
- Doesn’t acc for subjective experience (ppl can experience things in different ways)
The ICD
USA uses DSM but many other countries use WHO’s International Classification of Diseases (ICD)
The RDoC
- Research Domain Criteria project
- Initiative aiming to guide classification of mental disorders by focusing on underlying processes
- Addresses growing concern that research findings on biopsychosocial factors that appear to cause psychopathology don’t neatly map onto DSM/ICD diagnoses
- Can help explain comorbidity
- Not meant to replace DSM/ICD in any way, but serve as a guide+ inform future revisions
- CONSTRUCT: biopsychosocial processes that, at extremes, can give rise to mental disorders (e.g. fear, anxiety)
Biopsychosocial model of causation
States that mental disorders are the result of interactoins btw biological, psychological, and social factors
Biological: genetics, epigenetics, chem imbalances, brain structure
Psychological: maladaptive learning + coping, biases, dysfunctional attitudes
Social: poor socialization, stress life experience, cultural and social inequities
Diathesis-stress model
- Specific theory within biopsychosocial model; DESCRIBES how the biological, psychological, and social factors interact w each other
- States that a person may be predisposed to a psychological disorder that remains unexpressed unless triggered by stress
- Diathesis –> stress –> psychological disorder
Diathesis: the predisposition (e.g. brain structure, hormones, genes)
Stress: the catalyst (e.g. abuse, loss, onset of physical illness)
Comorbidity
Co-occurrence of 2+ diseases in a person
Anxiety disorder
- Anxiety is the predominant feature
- Significant comorbidity w depression
4 main types of anxiety disorder
Phobic disorders, panic disorders, social anxiety disorder, Generalized Anxiety Disorder (GAD)
Phobic disorders + 2 main types
- Persistent, excessive fear and avoidance of spceific objects, activities, or situations
- Ppl w phobic disorders recognize the fear is irrational but can’t prevent it from interfering w everyday function
- 2 main types: specific and social phobia
Specific vs social phobia
Specific phobia: irrational fear of particular object or situation that markedly INTERFERES w everyday func
Social phobia: irrational fear of public humiliation or embarrassment
- Could be specific situations like public speaking or eating in public, but could also include general social situations involving interacting w unfamiliar ppl
- Social phobia dependent on subjective experience, not physiological response
Preparedness theory
- Subtype of diathesis-stress model focusing on fear and phobias specifically
- Ppl evolutionarily predisposed to fear objects we’re supposed to avoid – supported by heritability
- Temperament (e.g. shyness) + neurological factors may also play role
Panic disorder & agoraphobia
Panic disorder: sudden occurrence of multiple physiological and psychological symptoms that contribute to stark feeling of terror (i.e. panic attacks)
- Acute symptoms can last a few mins and include shortness of breath, heart palpitations, sweating, dizziness
- Occasional panic attack not sufficient for diagnosis; must cause significant dread and anxiety + IMPAIRMENT in person’s life
- Intense anxiety and avoidance related to attack for at least 1 mo
Agoraphobia: specific phobia involving public places
- Often comorbid w panic disorder
- Not frightened of public places themselves but afraid that smthn terrible will happen and they won’t be able to escape or get help
Social anxiety disorder
Fear of social situations –> worry and diminished day-to-day func
Generalized Anxiety Disorder (GAD)
- Chronic excessive worry abt everyday things that is out of proportion to the specific cause of worry
- Generalized bc worries aren’t focused on a particular threat
- At least 6 mo of excessive anxiety + symptoms like fatigue, restlessness, irritability, conc problems
- Mild-modest heritability
- Unpredictable experiences in childhood increase risk of developing GAD
PTSD
- Post-traumatic stress disorder
- Caused by exposure to traumatic event
- Chronic psychological arousal, recurrent unwanted thoughts or images of the trauma, avoidance of things that call the traumatic event to mind for 1+ mo
- Most evident in soldiers returning from war; not everyone develops PTSD –> supports preparedness theory
- Cortical regions: heightened amygdala activity, smaller hippocampus
OCD
- Obsessive-Compulsive Disorder
- Obsessive thoughts and/or compulsions that seem irrational or nonsensical
- Obsession: intrusive, obsessive thoughts that produce anxiety
- Compulsion: repetitive, often ritualistic behavior to remedy intrusive thoughts; may cause relief, but only temporarily
- Classified separately from anxiety disorders bc researchers believe it has a distinct cause maintained by different neural circuitry than anxiety disorders
- Obsession suppression can backfire
- Take up significant amt of time (1+ hrs/day)
- Cause significant distress or impairment in func
- Moderate-strong heritability
Mood disorder
- Mood disturbance as predominant feature
- 2 main forms: depression/depressive disorders and bipolar disorder
MDD
- Major depressive disorder/unipolar depression
- Severely depressed mood and/or inability to experience pleasure
- Must have either depressed mood, anhedonia (reduced pleasure in things that used to cause joy), or both + other symptoms
- Symptoms must last 2+ wks + cause significant distress or impairment in function
PDD
- Persistent depressive disorder
- Same cog and physiological symptoms as depression; less severe but lasts longer (2+ yrs)
Double depression
- MDD and PDD co-occur
- Moderately depressed mood that persists for 2+ yrs; punctuated by periods of MDD
SAD
- Seasonal affective disorder
- Recurrent depressive episodes in a seasonal pattern
- Episodes tend to begin in fall or winter and remit in spring due to lower light lvls in colder seasons
Depression biopsychosocial contributing factors
Biological: genetics, neurotransmitters (esp serotonin and NE)
Psychological: negative thoughts contribute to depression
Social: stressful life events, interpersonal factors
Caspi et al study on serotonin transporter gene
- Serotonin (5-HT) transporter gene that faciliates serotonin reuptake
- One allele is longer (l), one is shorter (s)
- Gene itself is not related to depression, but it seems to make indivs more sensitive to life stressors (gene x env interaction)
- Study examined s/s, l/l/, and s/l combo of alleles
- As # of stressful life events increased, odds of MD episode increased BUT s/s had much higher prob than l/l
–> shorter allele correlated w depression
Beck’s cognitive model of depression
States that biases in how info is processed and remembered leads to + maintains depression
Helplessness theory
Ppl prone to depression automatically attribute neg experiences to causes that are:
- INTERNAL (e.g. my bad math grade = I’m stupid)
- STABLE (e.g. I’ll always be stupid)
- GLOBAL (e.g. I’ll fail in all future life endeavors)
Negative schema
- Deeply ingrained neg beliefs abt oneself, the world, etc
- Caused by combo of genetic vulnerability + neg early life events in ppl w depression
- Seeing the world thru “gray glasses”
Bipolar disorder
- Cycles of mania and depression
- Manic phase must last 1+ wks to fit DSM reqs
- Depressive phase often indistinguishable from MDD
- Depressive episodes tend to last longer than manic episodes (5mo vs 3mo)
- Has one of the highest rates of heritability
- Can be hard to ID – risk factors and symptoms also associated w MDD, autism, schizophrenia, and ADHD
- Biological: genetics (twin studies)
- Psychosocial: life stressors + positive life events can lead to more manic episodes
Bipolar I vs II disorder
Bipolar I: person experiences at least 1 depressive episode and at least 1 manic episode
Bipolar II: person experiences at least 1 depressive episode followed by HYPOMANIC episode – elevated mood but lower intensity than mania
Rapid cycling bipolar disorder
- At least 4 mood episodes (either manic/hypomanic or depressive)
- Esp difficult to treat
Schizophrenia
Psychotic disorder; characterized by profound disruption of basic psychological processes, distorted perception of reality, blunted emotion, and more
- Diagnosed when 2+ symptoms emerge during continuous period of 1+ mo and signs persist for 6+ mo
- Often has onset from 20-29
- Ppl w schizophrenia do not know their perception is disordered
- 3 types of symptoms: positive, negative, cognitive
- Hereditary + prenatal (e.g. toxins in mom’s blood) and perinatal env also affect prognosis
- Social factors include family env and severely disturbed fams
- Dopamine hypothesis: schizophrenia involves excess of DA activity – largely proven to be inaccurate
- Enlarged ventricles (cavity in brain) – suggests loss of brain-tissue mass
Schizophrenia positive symptoms
- Things ADDED when disease is present
- Hallucinations, delusions, disorganized speech, disorganized behavior
HALLUCINATIONS: false perceptions
- Can involve any of the senses
- ~65% report hearing voices repeatedly – voices are negative, scolding, etc; can sound like they’re internal or external
- Auditory hallucinations accompanied by activation of Broca’s area
DELUSIONS: false beliefs that are often bizarre and grandiose but maintained despite irrationality
- Delusions of identity (e.g. person thinks they’re Ariana Grande)
- Delusions of persecution (e.g. person believes the CIA is conspiring to harm them)
DISORGANIZED SPEECH: in verbal communication, ideas shift rapidly and incoherently
- Different than Wernicke’s aphasia bc they understand the question
DISORGANIZED BEHAVIOR: behavior inappropriate for situation or ineffective in attaining goals
- E.g. childlike silliness, disheveled appearance
- Can also be motor disturbances like strange movements and bizarre grimacing
Schizophrenia negative symptoms
- LOSS of normal function
- Anhedonia, amotivation, alogia, flat effect, catatonic behavior
ANHEDONIA: things that used to make you happy don’t anymore
AMOTIVATION: no motivation to do the things you like
ALOGIA: decrease in speech + delayed speech response
FLAT EFFECT: flattening of emotion; apathy
CATATONIC BEHAVIOR: marked decrease in all movement; or increase in muscle rigidity
- Ppl in CATATONIA may actively resist movement or become unresponsive/unaware of their surroundings
- Those doing drug therapy might also exhibit moto symptoms as a side effect
Schizophrenia cognitive symptoms
- Can be present BEFORE onset of distinct schizophrenia symptoms
- Difficulty w attention, executive func, problem-solving, working memory
- Least noticeable of the symptoms but often plays large role in keep ppl w schizophrenia from achieving high lvl of func (making friends, keeping a job)
Psychotherapy
Ineraction btw sanctioned clinician and someone suffering from a psychological problem; VERY broad term
Eclectic psychotherapy
Involves drawing techniques from different forms of therapy; very adaptable depending on the client and the problem
Psychoanalytic therapy
- Patient does most of the insight
- Main goal of bringing repressed material to the surface
- Focuses on how unconscious thoughts and early childhood experiences influence behavior
- Rooted in Freud
Psychodynamic therapy
- Therapist actively works w patient to increase self-awareness
- Emphasis on understanding emotional patterns in real-time (unlike psychoanalytic therapy, which focuses on the unconscious and past)
- Rooted in Freud
Existential-humanistic therapy
- Assumes human nature is generally positive
- Emphasizes natural tendency of each indiv to strive for personal improvement
- Assumes that psychological problems stem from feelings of alienation and loneliness
Ex: Person-centered therapy, Gestalt therapy
Person-centered therapy
- Type of existential-humanistic therapy
- Therapist tends to be more PASSIVE and just paraphrase the client’s words back at them to show support; goal is NOT to uncover repressed conflicts
Gestalt therapy
- Type of existential-humanistic therapy
- Therapist ACTIVELY helps client become aware of their own thoughts, behaviors, etc and to take responsibility for them
- Emphasis on stuff occurring at that moment in the therapy session
Cognitive behavior therapy (CBT)
- Teach ppl new/more constructive ways of thinking and acting (e.g. was the event really negative, or was it neutral and your interpretation was negative?)
- Often involves homework (e.g. exposure exercises, diary, etc)
- Can be better for long-term than
Psychopharmacology
Study of effect of drugs and mind on behavior
Antipsychotic medicine
Ex: chlorpromazine/Thorazine for schizophrenia
- Reduces psychotic symptoms (e.g. hallucinations)
- Blocks DA receptor sites + some also affect 5-HT ssystem
- Treats some positive symptoms but not the negative ones
Conventional vs atypical antipsychotics + which is more commonly used
Conventional: blocks DA receptors
Atypical: blocks DA AND serotonin receptors
ATYPICAL antipsychotics more commonly used as frontline today; conventional antipsychotics usually involve having to take another medication to address side effects
Antianxiety medications
- Drugs that help reduce a person’s experience of fear or anxiety
- Commonly benzodiazepines – class of drugs that increases GABA (primary inhibitory neurotransmitter)
- Doctors are cautious when prescribing bc of potential for abuse
Antidepressant medications (4 main types)
MAOIs, TCAs, SSRIs, SNRIs
- Antidepressants not recommended for ppl w BPD bc the antidepressant effect may inadvertently trigger manic episode
1) MAOIs
- Monoamine oxidase inhibitors
- Inhibits enzyme from breaking down neurotransmitters like DA, NE, and serotonin in synapse
2) TCAs
- Tricyclic antidepressants
- Blocks reuptake of NE and serotonin
3) SSRIs
- Selective serotonin reuptake inhibitors
- Inhibits reuptake of serotonin in synaptic cleft
- Can also help treat anxiety and eating disorders
4) SNRIs
- Serotonin & norepinephrine reuptake inhibitors
- Blocks reuptake of NE and serotonin but has less severe side effects than TCAs
True or false: antidepressant meds work right away
FALSE
Unlike antianxiety meds, antidepressants can take up to a month to have an effect
Mood stabilizers
- Can help suppress swings btw mania and depression in those w BPD
- Can also help w depression
Is medication better than psychotherapy or vice versa?
- Not necessarily – depends on condition being treated
- For schizophrenia, medication is more effective, but for mood and anxiety disorders, meds and psychotherapy can be equally helpful
- One issue is that the 2 treatments are often provided by 2 different ppl –> lots of coordination required btw psychologists and psychiatrists
Electroconvulsive therapy (ECT)
- Shocks delivered to brain via electrodes on scalp
- Primarily used to treat severe depression that hasn’t responded to medication; has also been shown to be effective in treating BPD
Transcranial magnetic stimulation (TMS)
- Powerful pulsed magnet placed over person’s scalp to alter neuronal activity
- Can treat depression
- New but exciting – non-invasive + fewer side effects than ECT, but just as effective
Deep brain stimulation (DBS)
- Small battery-powered device implanted in brain to deliver elec stim to specific areas of the brain
- Has worked for severe depression, OCD, and tremor for Parkinson’s
