Clinical Psychology Flashcards
Bleuers 5 As of symptoms of schizophrenia
disturbance in association disturbance in affect avolition ambivelance autism
whats the general age onset for schizophrenia in men and women
18-24 for men
45-55 for females
Richard McFalls Manifesto said that the clinical assessment had to be
valid
outrage any negative effects
be stated exact nature of what it is/what it will do
the claimed benefits must be described
– ideally all assessments would be done under scrutinised lab conditions
efficacy and effectiveness
efficacy - ideal conditions
effectiveness - real world conditions
to be a clinical psychologist…
4 years undergraduate
masters in psychology
doctoral program (masters) with the scientist-scholar – different to psychiatrists as they do not prescribe medicine
goals of classification
C.C.R.E
communication, clinical, research, educational information
ways to define abnormality
- statistical deviance
- biological dysfunction
- distress and disability
- mental if they engage in behaviour that prevents them from meeting the demands of life
- mental if they experience and exhibit behaviours that are inconsistent with the norm societal way of living
1 - but not every disorder not every rare condition is abnormal and not all abnormal conditions are rare
- not all conditions are due to mental mechanisms failing e.g. fear response
- not all conditions cause distress or disability
- who is to decide the norms of life…
- what if this inconsistent way of living is to do with external circumstances out of their control - homosexuality/fight or flight response
Wakefield proposed two variables that should only be present when making a diagnoses
Harm - to life/others/you
Inability to naturally function
2 ways to describe mental disorder - C AND D
categorical - either yes or no
dimensional - on a continuos ranking scale
Cluster A for personality disorders
paranoid, schizoid, and schizotypal
Cluster B for personality disorders
antisocial, borderline, histronic
Cluster C for personality disorders
obsessive compulsive, avoidant and dependent
mood and affect
mood is a persons subjective internal emotional state and affect is the physical observable state that has come from it
what must be found for a major depressive episode to be diagnosed
symptoms (5 or more) for more than 2 weeks such as anhedonia, weight change, sleep change, depressed mood, irritable
Major depressive disorder
- cannot have a history of mania, hypomania or mixed emotions
-onset for 12-14 year olds
comorbid with anxiety
for panic disorders to be diagnosed
recurrent and unexpected panic attacks for 1 month with worry about them happening and avoiding places where they could happen - onset in teens and symptoms will occur within 10 minutes or less
-30-50% of those diagnosed with a panic disorder will have agoraphobia (fear of going outside)
another type of panic disorder - generalised anxiety disorder which is in the mind
to diagnose they must have this worry for 6+months with symptoms that involve fatigue, finding it hard to concentrate and irritable they must have 3 or more of these symptoms
- they have had at least one axis 1 disorder and 66% of them will be suffering from another axis 1 disorder at the time of diagnosing usually depression
for obsessive compulsive disorder to be diagnosed
- recurrent and persistent thoughts and impulses which you try to suppress in order to make yourself feel better
- they recognise the thoughts are irrational
- the impulses will take 1+ hour out of your day and will be comorbid with depression and the disorder affects 2-3% of the population
for ptsd to be diagnosed
duration of symptoms for 1+ months and causes significant distress - persistent symptoms of 2 or more of hyper vigilance, sleep upset, anger, cannot concentrate etc
the tripartite model of depression
shows that to have anxiety disorders you must just have anxiety arousal and negative affectivity
for depression you must have low positive affectivity and negative affectivity
examples of cognitive processing biases
- arbitrary influence = my friend did not pick up the phone to me they must hate me
- overgeneralisation = everything i do goes wrong
3 personalisation = they always pick on me
4 magnification/minimalisation = he said he thinks I’m pretty/likes me but he probably doesn’t mean it
5 dichotomous thinking = if i don’t succeed in this maths test i am a failure
functions of cognitive functions of depression
- overgeneral autobographical
where you only remember the negative things that have happened in your life
-attributional style of internal, global and stable factors
coynes interpersonal model of depression showed that people are less likely to want to hang around people with depression making their emotional state worse as they then feel unwanted or a burden
what 3 characteristics distinguish a disorder of psychosis?
- symptom configuration
- duration
- relative persuasiveness
positive symptoms of schizophrenia
hallucinations
delusions
- positive thought disorder - clanging, circumstantiality, flight of ideas, derailment, incoherence and pressure of speech
negative symptoms of schizophrenia
avolition alogia anhedonia affective flattening inattention catatonia waxy flexibility bizzareness
what should you have to be diagnosed with schizophrenia on the DSM-5
2+ of the positive of negative symptoms for a month plus
a disturbance of life activities for 6 months and more
-bipolar, mania/mood disturbance and schizoaffective disorder must be ruled out
-males have an early onset - ratio is even however
history of schizophrenia
1st demence precoce
2nd dementia praecox
3rd was schizophrenia and Bleuler argued that there were the 5 A symptoms - affective, abolition, disturbance in association, ambivalence and autism
4th then Schneider said this is not so and created the 11 rank symptoms but through a cross sectional design and the symptoms can easily be linked to bipolar aswell
neurocognitive deficits
- arguably contribute to schizophrenia more than positive and negative symptoms
social cognition impairment of schizophrenia
emotion perception ( cannot understand others emotional language in social contexts)
social perception ( cannot pick up communicative cues)
a diathesis stress model -of depression ->
you need to be vulnerable (diathesis) and to have the stress for depression
-a specific diathesis for depression would be dependiceny, autonomy, self criticism, pessimistic attributional style(internal, global and specific)
a specific diathesis for schizophrenia
shizotypy
a specific diathesis for anorexia
perfectionism
a specific diathesis for bipolar
hypomanic temperament
a specific diathesis for OCD
thought action fusion
a specific diathesis for panic disorder
anxiety sensitivity
to be diagnosed with multiple personality disorder
must have 2+ distinct personalities that switch - one being the host and one being the alter
and a sense of disassociation - amnesia (finding yourself or buying things with no recollection), depersonalisation (you are not real), de realisation (things are not seeming real) and absorption (zoned out/starring off into the distance)
there are controversies about diagnosing MPD as - epidemic in US, dramatic descriptions,
2 theories for MPD
- due to a traumatic experience as a child - abuse..
2. through interaction with an unskilled therapist - implanting false memories
3 phases of CBT
1 - concentrate on non cognitive behaviour techniques
2 - cognitive techniques and problem solving
3 - generalisation and relapse prevention
the main goal of CBT is
to assist patients in changing their maladaptive thinking patterns and overt behaviours by acquiring a more adaptive way of responding with themselves and then others
it is problem focused and goal oriented - an has limited time usually no more than 6 sessions
core beliefs are:
made in childhood
global, rigid and overgeneralised
are viewed as truths
“i must be a good person”
intermediate beliefs are:
attitudes, rules and assumptions
situation->automatic thoughts->reactions
situation: becoming angry at your grandchild
automatic thought: if i were a good grandma i wouldn’t do that
reaction: depressed, upset, avoidant
CBT for depression
phase 1 - nonpsycho educational treatment and non cognitive behavioural techniques
phase 2 - cognitive techniques and problem solving
phase 3 - generalisation and relapse prevention
techniques in CBT for phase 1 of non cognitive techniques
stimulus control - try to trigger the core belief by looking for covert and overt behaviours - if hard to trigger use signs symbols or notebooks to try and release it
activity scheduling - finding pleasurable activities that a distract and b make you feel good
target sleep problems - wake up same time go to sleep same time, no napping, bedroom is for sleep only
distraction techniques
techniques for phase 2 - cognitive behavioural techniques and problem solving
measure the thinking - how valid is it and how useful is it to you
ABC model (antecedents, beliefs and consequences) - and rate their beliefs -- keep a diary
downward arrow techqniue to hit the core belief
socratic questioning (interogate the beliefs), cognitive continuum (you have you child a choc biccy for breakfast - are you the worst mother??), role play, acting “as if” (confidence and fake it till you make it style), self discourse (blushing)
Phase 3 techniques of CBT for relapse prevention
coping cards, homework sheets, reinforce progress and program will last with them for life
tailor the relapse program to them - warning signs
stigma manifests in a 4 factor model
- structural – in grained stigma in institutions etc
- public - attitudes/beliefs + emotional response + behaviours
- self - internalisation + fear of anticipating the stigma + negative effects
- association - public and self stigmas affect those who know someone with a mental disorder
vignettes
a presentation of stories of people with this disorder to proceed with research on stigmas - manipulate symptoms and mental disorder labels
after reading a vignette the participant is asked to complete a questionnaire assessing stigmatised/or not views and beliefs on the disorder
change the label
through informative and descriptive terms
through eponyms
effective approaches of reducing stigma
- contact and familiarity
- education/dispelling the myth/understanding/talking about it
what does a clinical trial look for?
the efficacy and effectiveness of a treatment through systematic and empirical control
internal validity and external validity in a clinical trial
internal = though a randomised clinical controlled trial and this provides evidence of efficacy
external = through a pragmatic control clinical trial which provides evidence of effectiveness
hierarchy of quality of evidence for clinical trial
- randomized control clinical trial
- non randomized
- cohort studies
- uncontrolled studies
criteria for a well established treatment
- two groups one control group
- defined manual
- client characteristics are specified
- effects must be demonstrated by 2 or more investigative teams
criteria for a probably efficacious treatment
- two clinically control groups one wait list
- only one investigative team
- a small series of single subject design experiments
criteria for a promising treatment
- positive support for - one well controlled study and one lesser controlled OR a small number of single cases OR two or more well controlled studies but with just one investigator
a non specific treatment is used to show
placebo effects
neo kraepelininan VS.
symptom specific approach which is what is done when looking at AVHs
how many schizophrenia patients experience AVHS
60%
McCarthy Jones 5 AVH subtypes
- hypervigilance 2 autobiographical memory 3. inner speech 4. epileptic 5. deafferentation
cognitive models of hallucinations
-bottom up
impairments in sensory auditory processing of fundamental acoustic cues such as frequency, tone, pitch, duration, loudness and Cuttings said that this was due to impairments in poor sensory processing of simple cues (prosodic processing) which refers to a persons identity and where they are speaking and what their emotions are like and their linguistic intent - because of the struggle to interpret these cues people own experiences and auditory memories may be misattributed to an external source
evidence for the bottom up approach
sensory deprivation research and naturalistic observation
top down approaches to AVHS
prediction errors - impaired sensory processing renders poor stimulus representation for interpretation so top down executive functions become over active
Mood disorders
MDE
MDD
mood disorder - primary disturbance is a depression or elevation in mood
MDE - 5 symptoms for 2+ weeks (involves psychotic features depressed mood, anhedonia, cationic…)
MDD - have history of MDE - must not have any history of mania, hypomania, or mixed emotions however. Family history of MDD increases the risk by 1.5-3
Anxiety disorders
panic disorder
generalized anxiety disorder
Panic disorders to be diagnosed; worry for 1 month about something that causes you to have distressing panic attacks
- onset in early teens and adulthood
- -panic attack will have 4+ symptoms with a panic time of `10 minutes
- -30-50% will have agoraphobia
- -50-60% will have major lifetime depression
- -20-25% will have a substance dependency
generalised anxiety disorder - more in the mind – and will have this recurrent worry for 6 months with 3 or more symptoms of fatigue, restlessness, can’t concentrate etc
- -90% will have an axis 1 disorder in their lifetime
- -66% will have an axis 1 disorder at that time
- -affects 4-7% of the population
OCD
PTSD
2-3% of general population will experience OCD and for males the onset is childhood/teens and for females its in their 20s – 70-80% will have recurrent depression
for PTSD - less than 1 month of disabling distress
- 3 markers for avoidance to be marked
- 2 more symptoms otherwise
- 30% soldiers, 50-80% will be sexual assault victims and 60-80% will be trauma victims
to be diagnosed with schizophrenia on the DSM 5
2 or more of symptoms such as; delusions, hallucinations, neg symtpoms
disturbance in normal functioning
- continuous signs of symptoms for 6 months with 1 month of active symptoms
-and bipolar and schizoaffective disorder must be ruled out
schizotypy types
social anhedonia physical anhedonia perceptual abberation (your head and limbs aren't your own) magical thinking
