Clinical Psychology Flashcards
what is psychopathology
study of the nature, development and treatment of psychological disorders
how could we define psychopathology - brief 5
deviation from statistical norm deviation from social norm maladaptive behaviour distress and imapriment wakefields dysfunction
problems with using deviation from the statistical norm
does not always imply psychopathology
but usually psychopathology is statistically deviant behaviour
but we need additional criteria
fosters a terminology that labels individuals as abnormal
problems with violation of social norms
different culture differ in what is socially normal and acceptable
behaving in a way that is not socially acceptable does not always imply an underlying psychopathology
can be used as a means of stigmatising those who do not conform to social norms
eg USSR
‘slow progressing schizophrenia’
symptoms could express as reform delusions
political disidents often diagnosed and hospitalised
how can violation of social norms be a criterion for a mental disorder
if violation of social norms in a way that is
-harmful to the individual
or the social counterpart
what introduced the concept of distress
the dsm-5
how does the DSM-5 deal with mental distress
all mental distress is culturally framed and acknowledges that different populations carry varying and culturally determined ways of communicating distress along with coping methods and help-seeking behaviour
what does puerto rican syndrome tell us about cultural mental health problems
the culture bound syndromes suggest that all psychological disorders are possibly based on an underlying pathology/ dysfunction which is further modulated by culture typical display rules
maladaptive behaviour / disability
defines psychopathology on whether their behaviour renders them incapable of adapting to normal daily living
wakefield’s harmful dysfunction analysis
a disorder exists when evolutionary formed mental functions are impaired and when this dysfunction impacts negtively on the well being of the individual, social counterpart or society
combines scientific fact with socailly constructed values
facts specify the process that isnt functioning as it should
social values specify harm to the individual, social counterpart etc
what is distress
emotional pain and siffering
key characteristics in the DSM5 defintion of mental disorder
personal distress disability violation of social norms dysfunction all feeds into the defintion of a mental disorder
two classifcation systems for metnal disorders
international classification of diseases, injuries and causes of death - WHO (ICD-11 is the current version)
diagnostic and statistical manual (DSM,now in edition 5)
what information does the DSM5 conatin
essential features of the disorder
associated features
diagnostic criteria
infromation on differential diagnosis
prboems with classification
disorders are not classified according to cause
labelling people with a diagnostis can be stigmatizing and harmful
DSM defines deisorders as discrete entities but they are rarely like this in practice (category vs continuum
comorbidity is the norm rather than the exception
diagnostic criteria often allow for the extensive within-cateogry heterogenity
summary of the DSM
not ideal however is the most comprehensive classification system we have available
whilst there are several drawbacks, the classification in and of itself does have some advantages
also does try and keep up to date with new research
demonology criteria
loss / lack of appetite
cutting, scratching, bitting of the skin
unnatural bodily posture and change in persons face and body
losing control of their normal personality and entering into frenzied rage and or attacking others
change in persons voice
intense hatred and violent reactions toward all religious objects or items
= all these symptoms are not uncommon in psychiatric disorders
sad case of demonology
anneliese michel
temporal lobe epilepsy with psychotic symptoms + depressoin + anorexia
underwent exorcism for 10 months, totalt of 67 session for up to four hours and died because of stopping medical and psychiatric intervention
died from being in a semi state of starvation for almost a year
had broken knees from continuous genuflections - was unable to move without assistance
paretns and priests found guilty of negligent homicide
general paresis
last stage of untreated syphilis
degenerative disorder with psychological symptoms cause by chronic meningoencephalitis
degenerative changes are associated primarily with the frontal and temporal cortex
can be treated with penicillin
since general paresis had neuroanatomical correlate, other mental illnesses might also
problmes with the medical model for psychopathology
the medical model is static and implies a neurological dysfunction
but
not all psychopathologies have a physical cause
and if they have a neuroanatomical correlate
the biological changes might be triggered by psychological events which cause the release of stress hormone cortisol which has a neurotoxic effect and can destory vulnerable neural tissue and by this can cause emotional and cognitive symptoms
biological treatments for psychopathology
ECT
prefrontal lbotomy
medication
ECT as a treatment
common to treat depression which cannot be controlled by medicaion
70-130 v
may induce nerogenesis in certain parts of the brain
also effective but controversial in treating schizophrenia
pscyhoanalysis and psychopathology
freud founded psychoanalysis
clinincal method for treating psychopathology through dialogue between a patient and a psychoanalysis
developed psychoanalysis therapeutic technique using free association and transference as central components of the analytical process
basic assumptions of psychoanalysis
personality shaped by three pscyhological forces
id - drives, libido, enticement
ego - critical reasoning, control, actions and reactions
superego - prohibition and commands, values and moral concepts
often in conflict and psychological health is only maintained when they in balance
psychoanalytical defense mechanisms
freud discovered various methods his patients dealt with pain
patients unconscious efforts to concel painful thoughts and many of their maladaptive behaviours were manifestations of defense mechanisms
psychoanalysis major contribution to understand psychopathology
discovery of the unconscoiu
humans are driven by schemas they are not aware of
early childhood experince and how infants relate to other maladaptive schemas of interaction that can be life long lasting
repression of emotions can lead to conflicts and pscyhological suffering
basic assumptions of behavioural models
psychopathology is often learnt through reactions to life experiences
largely based on principles of conditioning
what is classical conditioning
a learning process that occurs when two stimuli are repeatedly paired: a response which is at first elicited by the second stimulus is eventually elicited by the first stimulus alone.
what is operant conditioning
reward or reinforcement
sometimes positive, sometimes negative
punishment decreases the frequency of behaviour, reward increases
what are the problems of operant conditioning when using punishment
punished behaviour is not forgotten, its supressed - behaviour returns when punishment is no longer present
causes increased aggression (bandura - model learning) shows thataggresion is a way to cope with problems
does not necessarily guide towards desired behaviour - reinforcement tells you what to do, punishment only tells you what not to do
how operant conditioning relates to psychopathology
aquistion of bizarre behaviours in schizophrenia
aquisition of disruptive and challeging behaviour in individuals with intellectual disibilities
phobias
what does RET hold
virtually all serious emotional problems directly result from
- irrational beliefs
- dysfunctional thinking
- information processing biases
what is rational emotive therapy
is a form of cognitive therapy reduces psychological distress, maladaptive behaviours and dysfunction by correction -dysfunctional cognitions self-instructions self and other evaluations
what are the conceptual backgrounds of RET
responsible hedonism
humanism
rationality
what is responsible hedonism
hedonism - seeking pleasure and avoiding pain
in RET responsible hedonism refers to maintaining pleasures over the long term by avoiding short term pleasures that may lead to pain such as alcohol and drugs
what is humanism
RET is absed on a value system in which human interest and dignity are respected
individuals have worth
they should accept that they make mistakes and that some of their assests and qualities are stronger than others
individuals performances should be reflected on and if necessary criticised, not their personal worth
what is rational thinking and behaviour
thinking feeling and acting in ways that will help individuals attain their goals
in contrast with irrationality in which
thinkgin feeling and scting are self-defeating and interfere with goal attainment
what is the ellis schema
activating event - unpleasant event
belief system - you have a belief about the situation (AND THIS IS USUALLY WHERE THE PROBLEM IS THAT LEADS TO 3)
consequences - you have an emotional reaction to the belief
according to RET what are the three common irrational beliefs
must do well and get the approval of others - this belief often leads to anxiety, depression, shame
others must treat me considerably and fairly and kindly. if they dont then they are no good an deserve to be punished. this leads to rage, passive-agression and scts of violence
i must get what i want etc. this often leads to self pity and procrastination
it is the demandin nature of these beliefs that is the problem and causes them to be unhealthy
RET technique
A - activating event
B - belief
C - consequence
D - disputing
E - more effective ways to think, feel and behave
dysfunctional cognitive processes have been applied to explaining…
depression
anxiety disorders
eating disorders
schizophrenia
human and existential approaches attempt to resolve psychopathology through
insight
triggering personal development
triggering self-actualisation
humanistic and existential approaches
who
how did he think personality formed
carl rodgers
personality formed as a result of self-actualization, that is striving to reach our full human potential
self-actualisation should result in a fully functioning person
according to humanistic and existential approaches
what is the development of self in childhood
as infants gradually the concept of self emerges
defined by words i me myself
is a fragile development and needs to be supported and stabilized by unconditional positive regard
if children only experience conditional positive regard they may identify with ideas which prevent positive natural developments
rodgers uses the term incongruence to describe feelings of depression and unhappiness caused by not living the life we are capabel and destined by nature to live by
how is the humanistic approach related to the DSM
very loosely
5 methods of clinical assessment
clinical interviews personality inventories psychologica tests biological based assessments clinical observation
aims of methods of clinical assessments
describe patients problems determine cause of problem arrive at diagnosis develop a treatment strategy monitor treatment progress
the nature of lcinical interviews
first form of contact the client will have with a clinician
questions realte to symptoms, past history, current living and working conditions
trustful relationship needs to be made
rough layout of a structured interview
ID onset, duration, course psychiatric history family psychiatric history medical history systems review Mental state examination folstein mini mental state examination plan
what does folsteins mini mental state examination try to ascertain
orientation attention memory naming apraxia construction
what are the limitations of the clinical interview
clients often have poor self awareness so may not reveal important information in an interview
interviewers are prone to biaseslike relying on first impressions
name 3 types of personality structure and experience tests
personality inventories
specific trait inventories
projective tests
name 2 types of cognitive tests
intelligence tests
neurological impairment tests
introduction to psychological tests
what are they trying to do and how
assess the client on one or more specific dimension
have rigid responses and scoring requirements
scores can be standardised to provide norms that individuals can be compared with
example of a personality inventory
minnesota multiphasic personality inventory
567 items
14 different measurement scales
name three specific inventories and what they are looking at
BDI - becks depression inventory
HADS - hospital anxiety and depression scale
SAP-AS - standardised assessmen of personality
what is becks depression inventory
21 question survey to be completed by the parient <15 mild depression 15-30 moderate depression >30 severe depression HADS is a similar system
what is SAP-AS
patient answers yes or no
what are projective tests
present a fixed set of stimuli that are ambiguous enough to allow a variety of interpretation
because they are open ended they are significatnly less reliable and valid than more structured tests
still used in clincial practice
example of a projective tezst
thematic apperception test
what is the thematic apperception test
participant is asked to produce a fantasy story to each picture - this gives insight into motivation and needs
rationale
subject encouraged to tell a story on the spur of the moment
stories reveal a signicificant component of personality becuase of the tendency to interpret ambiguous information in conformity with past experience and present wants
pictures are presented as a test of imagination - subject forgets his sensitive and protective self and the necessity of defending it against the probing examiner
before subject knows it they say things relating to their character that applies to themself,things they would have been reluctant to admit to r openly share
as a rule subject leaves unaware of what they just revealed
intelligence tests - how do we use them
used to diagnose intellectual and learning disabilities
as a battery of tests to measure neurological impariment
examples of intelligence tests
raven’s progressive matrices test (shapes and reasoning like grammar school exam)
wechsler adult intelligence scale (WAS) - verbal tests (comprehension, information, arithmetic), performance tests (picture completion, block design, object assembly)
problems with IQ tests
intelligence is a hypothetical construct
some doubt what IQ tests measure
many are culturally biased based on limited views on what is adaptive
current concepts of intelligence may be too narrow
IQ tests do not measure an individuals capacity to learn
neurological impairment tests
designed to measure cognitive ablity and cognitive deficits
can determine whether dericits are the result of brain or neurological damage
used in addition to physiology measures such as EEG and brain scans such as PET or fMRI
examples of neurological impairment tests
RBMT - rivermead behavioural memory test
FEEST - facial expression of emotion (stimuli and tests)
WCST - wisconsin card sorting test
BADS - behavioural assessment of the dysexecutive syndrome
RBMT
ecologically valid way of testing different aspects of memory name learning prospective memory verbal memory visual memory visuo-spatial memory orientation
wisconsin card sorting test
particiants have to work out a rule
then rule changes
and participants has to adapt
how can visuo-construction be tested
asked to recreat / re draw a picture
how can motor performance be tested
purdue pegboard test
how to test short term memory
digit span forwards - backwards
how to test neglect
behvaioural inattention test - BIT
what do we collect information on in clinical observations of behavioyur
frequency context of each beahaviour events that follow a behaviour so may be reinforcing that behaviour ABC charts antecedents of behaviour behaviour itself consequences of behaviour can use coding forms with this format
how and why do we use self-observation and self-monitoring
clients observe and record their own behaviour in a diary
note when certain behaviours or thoughts occur and note their context
enables data to be collected in real time and overcomes problems of poor recall
often known as ecological momentary assessment
what are the four main types of research designs in clinical psychology
correlational desings
experimental designs
meta-analyses
qualitative methods
correlational methods
variables are……
measured but not systematically manipulated
correlational / cross sectional design disadvantages`
correlation does not imply causality because of the directionality problem
x may cause y
but y may cause x ????
what do psychological studies always involve
random assignment
manipulation of IV
measure DV
what are the basic features of experimental design
investigator manipulates IV
participants are allocated condition by random assignment
researcher measures dv
double blind if possible
waht is the aba/a design
initial baseline stage - measure behaviour without intervention
followed by treatment where experimenter maniuplates
effect on behaviour is observed and measured
return to baseline is then introduced in which behaviour is once more observed in the absence of treatment or manipulation
analogue experiment
not always possible in clinical lab - ethics or practicalities examine related or similar behaviour in lab - elicit stress or sadness -college students who tend to be anxious -animal research
epidemiological research
study of the distribution of disorders in a population and possible correlates three features of a disorder - prevelance - incidence - risk factors
what is meta-analysis
integrating findings from multiple studies
- identify relevant studies
- compute effect size
- tranform results to a common scale
qualitative methods
the raw material for qualitative studies is ordinary language rather than quantifiable data
use descriptions of participants own thoughts experiences and feelings
enables researchers to gain an insight into the full experience of psychopathology
whats the difference between qualitative and quantitative methods
take question how are you feeling today
quantitative = gives subjects the opportunity to respond on a 7 point scale
-data which is simple to process but are limited in depth to hide ambiguities
qualitative would ask the same question but request an open-ended answer
-yields potentially large quality of rich complex data which may be difficult and time consuming to analyse
advantages of qualitative methods
some aspects of psychopharmocology are difficult to express
permits intensive in-depth study of individuals and small groups
researchers may discover interesting things about a psychopsthology that they were not oriinally looking for
three big ethical issues in clinical psychology research
informed consent
causing distress of withholding benefits
privacy and confidentiality
what do informed consent forms contain
detials of the purpose of the study
a descirption of the procedures
the duration of the study
who will know about the participants involvement and will confidentiality be maintained
the particiaption is voluntary and whether a payment is offered and a clear indication to participants that they can withdraw from the study at any time (without giving the money back)
issues with informed consent
is problematic when an individual’s understanding of consent is limited
informed consent is also problematic when a study involves some form of deception
all efforts be made to ensure an individuals participation in a study is truly voluntary
in the end the ethics committe decides
causing distress or witholding benefits
clinical research often involves distress for participants
- by asking particiaptns to disclose distressing or embarassing information or asking about situations that may be threatening to the individuals self-image or self-esteem
- presenting physically / emotionally aversive stimuli
dealing with participant distress
researchers should be vigilant for participant distress throughtout a study
participants should leave the study in no worse a condition that when they began
-offer relaxation or mood-enhancing tapes at the end of the study, offer coffe, tea cookies etc…
-provide information about counselling services that may be immediately available for the participant
research and the withholding of participant benefits
this may occur in studies attempting to asses the benefits of treatments
-if an individual with mental health problems is allocated to a control group, they are effectively being denied treatment
researchers try to overcome this by using waiting-list controls (patients on the waiting lists for treatments)
what does privacy mean
participants have the right to decide not to provide some forms of information to the researcher
confidentiality
participants have the right to expect that information they provide will be treated confidentially
issues concerning confidentiality
all information about the participant should be destroyed after a specified period of time (5 years)
confidentialy is problematic when a participant discloses information about illegal activities or potentially harmful intentions
however confidentiality is not the same as secrecy so is not absolute
psychologists have a moral responsibility to provide some support or help to those who reveal serious distress or self-harm intentions
what is major or unipolar depression
extended period of clinical depression which cause significant distress to the indiviual and impairmenr in social or occupational functioning
what is bipolar disorder
periods of mani that alternate with periods of depression
what is schizoaffective disorder
periods of mood alteration and psychotic signs
DSM 5 diagnostic criteria for major depression
+5 weeks of the following symptoms during the same 2 week period
- depressed mood
- diminished interest or pleasure
- weight loss or gain
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue or loss of energy
- worthlessness feeling
- diminished ability to think or concentrate or indecisiveness
- recurrent thoughts of death
characteristics of depression
psychological symptoms
motivational deficits
physical symptoms
cognitive symptoms
bipolar disorders 1 and 2
persisten elevated, expansive or irritable mood for at least one week, alternating with episodes of major depression
- severe mania
- hypomania
- balanced mood
- mild or moderate depression
- severe depression
which type of bipolar disorder is more common
1 is more common than 2
DSM 5 criteria for bipolar disorder
at least three of the following symptoms are present during hypomanic and manic phase
- inflated self-esteem or grandiosity
- decreased need for sleep
- increased talkativeness
- flight of ideas or racing thought
- distractibility
- increased in goal-directed actitivy or psychomotor agitation
- increase in risky behaviour
behavioural features of the hypomania / mania continuum
racing thoughts
high sex drive
tendency to make grand unattainable plans
tendency to show poor judgement such as impulsively deciding to quit job
inflated self-esteem or grandiosity, unrealistic beliefs in ones ability, intelligence and powers - may be dilusional
increased reckless behaviours (such as lavish spending sprees, impulsive sexual indiscretions, abuse of alcohol or drugs, or ill-advised business decisions
DSM-5 diagnostic criteria for schizoaffective disorder
an uninterrupted period of illness during which there is a
-major mood episode (major depressive or manic)
-delusions or hallucinations for 2 weeks or longer
bipolar type - this subtype applies if a manic episode is part of the presentation. major depressice episodes may also occur
depressive type - this subtype applies if only major depressive episodes are part of the presentation
types of delusion in schizophrenia
delusions of grandure
delusions of persecution
delusions of control
delusions of reference
hallucinations
affects the visual, auditory, olfactory and somatosensory domain
voices are the most common type of hallucinatoin in schizophrenia
the voices may talk to the person about his or her behaviourr, order the person to do things or warn the person of danger. voices also talk to each other
medical treatment of schizoaffective disorder
manic type -lithium -antipsychotics depressive type -tricyclic antidepressants -SSRIs -antipsychotics
medical treatment for bipolar disorder
lithium
medical treatment for MDD
tricyclic antidepressants
SSRIs
biological theories behind depression
genetic factors
neurochemical factors
brain abnormalities and depression
neuroendoctrine factors
psychological theories behind depression
behavioural
cognitive
genetic factors behind both bipolar and major depressive symptoms
both bipolar and major depressive symptoms run in families
twin studies indicate significantly higher concordance rates in monozygotic twins over dizygotic twins
neurochemical factors in depression
depression is regularly associated with low levels of the brain neurotransmitters
- serotonin
- norepinephrine / noradrenaline
what drugs can treat depression
depression can be treated by drugs that raise the levels of serotonin and noradrenaline
-tricyclic antidepressants
MOIs
selective serotonin reuptake inhibitors
however the level of neurotransmitters increase quickly but it takes several weeks to reduce the symptoms of depression
how SSRIs work
electrical stimulation from the brain neurotransmitters blocked by SSRI released neurotransmitters receptors brain cell
what areas of the brain are abnormal in depression (or often are abnormal)
prefrontal cortex anterior cingulate cortex hippocampus amygdala cerebellum
insula cortex as a neural substrate potentially associated with these functions
functional imaging studies of self-related processes found increased insula activation association with….
thinking about oneself
self-assurance in situation of personal set back, mistake or failure
frustration
joy
attending to pleasant music
affective touch as one aspect of an intimate social interaction
decoding visually and vocally displayed social signals
empathetic feelings
unfair offers
feeling socially rejected
sexual pleasure
neuroendocrinal factors / stress in depression
depression is associated with high levels or cortisol
cortisol is released in streeeful situations and functions as a gith or flight hormone
permanent release of cortisol is harmful because it is neurotoxic and can lead to atrophic changes of the brain
working hypothesis relating to neuroendocrinal factors / stress in depression
not all people develop a depression
working hypothesis
there might be a genetic determined vulnerability of certain areas in the social brain in certain people, they are prone to show cortisol induced brain atrophy
this suggests that MDD is a reversible neurodegenerative disorder
behavioural theories of depression
according to behavioural theory many aspects of the behavioural repetoire of depression is lack of learning
mid 1970s leinsohn suggested that depression is caused by a combination of stressors in a persons environment which intially deprives a perons from reinforcer and a lack or personal skills to cope with this situation
-
also depressed people also have a heightened state of self-awareness about their lack of coping skills
also some depressed people become positively reinforced for acting depressed when fmaily members and social networks take pity on them and provide them with special support because they are sick
negative cognitions and self-schema
cognitive theory proposed by beck
depression maintained by negative thinking and negative schemas
negative schemas are charaterised by the negative tria
what are the negative triad
negative views about the world
negative views about the future
negative views about oneself
ways to overcome beck’s negative triad
identifying - help clients identify their negative automatic thoughts
linking - helping clients to see how their negative automatic thoughts activate and perpetuate negative mood states
modifying - helping clients to generate alternative ways of thinking
learned helplessness
seligman
a theory of depression that argues people become depressed following unavoidable negative life events because these events give rise to a cognitive set that makes individuals learn to become helpless, lethargic and depressed
derived from animal behaviour observation….
attributional styles
depressed individuals tend to attribute negative events to causes that cannot easilt be changed or manipulated
internal rather than external fctors
stable rather than unstable factors
global rather than specific factors
biological treatments of depression and mood disorders
drug therapy
ect
neurosurgery
psychological treatments for depression and mood disorders
social skills training
behavioural activation therapy
cognitive therapy
mindfulness based cognitive therapy
what does SSRIs also do to help treat depression
able to trigger neurogenesis (growth and development of nervous tissue)
social skills training to treat depression - why
a behavioural therapy that assumes that depression in part results from an individuals inability to communicate and socialize appropriately
adressing these skill deficits should help alleviate many of the symptoms of depression
features of social skills training
role playing tasks, feedback, modelling and positive reinforcement for appropriate behaviours
attention to the specific details of social interactions such as smiles, gestures and the use of eye contact
clients show an increase in social skills and a decrease in depression symptoms Zeiss et all 1979
how does behavioural activation therapy work
increasing clients access to pleasant events and rewards
daily monitoring of pleasant / unpleasant events
social skills and time management training
as effective as many other psychotherapies
cognitive therapy
derives primarily from beck’s work
consists of
heling individuals identify their negative beliefs
assisting clients to challenge these negative beliefs as dysfunctional and irrational
replacing negative and dysfunctional thought with adaptive and rational beliefs
effectiveness of cognitive therapy
at least as effective as drug therapies in alleviating symptoms of depressoin
can have longer term effects than other treatments by preventing relapse
can help clients with medication complicamce, mood monitoring and anticipating stress
5 types of tumors
meningioma astrocyte/ oligodendroglioma pituitary tumors metastatic tumors medulla blastomas
neurodegenerative diseases list 5
huntingtons parkinsons picks fronto-temporal lobe degeneration alzheimers disease
what is the most common type of pediatric malignant primary brain tumor
medulloblastoma
three types of meningitis and encephalitis
bacterial meningitis
viral summer meningitis
herpes encephalitis
brainpathology of bacterial meningitis
symptoms last hours to days fever headaches stiff neck nausea vomiting sensitivty to light delir, confusion, sleepiness sometimes generalised seizures
brainpathology of parkinsons
neurodegenerative disease affecting dopamine containg neurons in the substantia nigra, targeting striatal and cortical regions
medical treatment - L-DOPA precursor of dopamine`
symptoms of parkinsons
tremor at rest
muscule rigidity
akinesis (slowness of movement)
declines in huntingtons
cognitive decline, pscyhiatric symptoms and personality changes run in parallel with motor deficits
neural structures most prominently affected are the BG
huntingtons
prodomal symptoms
35 and 45 yrs motor -first uncontrollable spontaneous movements in the fingers feet face or trunk loss of smoothness of coordinated movements psychoatroc symptoms depressoin anxiety sometimes delusions and paranoia
huntingtons disease
full symptoms
motor jerkey random uncontrollable movements restlessness lack of coordination rigidity and abnormal body postures dysarthia swallowing difficulties symptoms increase in severoty with progression of the disease psychiatric irritability/ aggression apathy anxiety depressed mood OC behaviour psychosis
what type of gene is huntingtons
on the short arm of chromosome 4
mutant and dysfunctional form of HTT called mHTT with >36 glutamine molecules
autosomal dominant
an affected individual has inherited one mutant allele from one of his parents
no skipping of generations
males and females = equally likely chance of inheriting mutant allele
how is huntingtons diagnosed
family history - can be hard to obtain primarily based on motor signs also cognitive psychiatric neuroimaging
genetic testing for huntingtons
only 5% long process because of councelling problems to be discussed consequences for life planning children?
management of huntingtons
no cure 20 year survivial progressive decline of motor and cognitive ablities personality changes medication tetrabenazine for mototr distrubances neuroleptics for psychiatric distr=urbances SSRIs for deptression institutionalisation
way of testing visual memory
benton visual retention test
what is contained in the wechseler memory scale
personal and current informaton orientation mental control logic memory digit span draw figure from memory paired associate learning
what is a cerebrovascular occlusion
thrombus in brain
ischemic stroke is an interruption of the blood supply resukting in damaged brain tissue is lasts longer than a few seconds
due to blood clots, seldom air bubbles or fatty residues
phineas gage
frontal lobe deficit from pole through head
before injury conscientious and well socialised
injury left him with a severe personality change (but no other problems, eg language and memory fully in tact)
had become profane, irresponsible, insensitive, unable to stick to plans he made for himself
poor judgement and erratic mood swings were now common
died after developing epilepsy
neuropsychology frontal lobe tests
trail making test weigl colour form sorting test wisconsin card sorting test BADS rigidity and perservation
broca
aphasia patient tan broca's aphasia damage to broca's area displays speech which varies from complete muteness to a slow deliberate delivery characterised by impaired articulation, flat intonation and simple grammar telegraphic speech
what does damage to wenicke’s area produe
fluent aphasia
alexia without agraphia - disconnection syndrome
ability to write on command byt unable to read the words written
due to separation of the visual processing areas of the visual processing areas from the cortical and subcorical regions associated with language
what is associative agnosia
inability to recognise pbjects despite an appearent perception of the object
can copy object accurately but cannot identify it by vision
neuropsychology - neglect
neglect is a clinical syndrome in which the patient is unaware of meanigful stimuli in the space opposite to their lesin
most typically the left visual field and in even more severe cases the left side of their body is ignored
left side objects are not drawn and features not recognised
deficits in visual, auditory and somesthetic domain
lesion causing neglect do not involve primary sensory areas or projection systems
would show up in a behavioural inattention test
sensory deficit is known as
hemianopia
motor deficit is known as
hemiplegia
DSM 5 diagnostic criteria of schizophrenia
at least 2 of the following 5 symptoms over 6 months
delusions
hallucinations
disorganixed speech
catatonia
common delusions in schizophrenia
grandeur
persecution
reference
control
which systems do hallucinations effect
visual
auditory
olfactory
somatosensory
what is catatonia and how is it treated
muscle rigidity / flying muscles
sedativa and ect to treat
affective flattening
limited range and intensity of emptional expression
anhedonia
inability to react to enjoyable or pleasureable events
avolition
inability or unwillingness to carry put or complete normal day to day goal orientated activities
asociality
withdrawal into an inner wolrd, reduced emotional involvement with other people
10 earliest signs of schizophrenia
restlessness depression anxiety worries lack of self-confidence loss of energy impaired work performace social withdraw
course of schizophrenia disease (terms to describe the phases)
prodromal
earl psychotic
latency
three different disease onsets
acute
-prodromal stage shorter than 3 months. delusion and hallucinations develop within a few days
sub-acute
-early stage etween 1 month and 1 year
slow or chronic
-5 year prodromal stage
no gender difference with respect to onset
biological theories behind schizophrenia
family, twin and high risk adoption studies
dopamine hypothesis
altered brain structures
psychological theories
baeston
expressed emotions
what did twin studies show about schizophrenia
monozygotic (identical) much more liekly to develop schizophrenia if one twin already effected
what happened in high risk adoption studies relating to schizophrenia
gave further insight into genetic and environment contribution for developing schizophrenia (tienari et al 2004)
145 high risk children adoptees of schizophrenic mothers
158 low risj children
also rating scale for impaired family interaction to determine adverse rearing styles in families
results of high risk adoption studies
adoptive family ratings were significant predictors for developing schizophrenia
no impact on rearing style on low risk children
findings that lead to the dopamine hypothesis
amphetamine is a dopmine agonist that elevates dpoamine by inhibiting dopamine re-uptake
amphetamine in high doses can create schizophrenua like psychoses
giving people with schizophrenia amphetamine drastically increases the positive symptoms
what does the dopamine hypothesis assume
that the dopaminergic system in schizophrenia is overactive and that the limbic portion of this system is central for producing positive symptoms
PET scans also show decreased acitivy in the frontal lobes
expressed emotions theory
brown 1972
social groups after discharge from hospital had influence on relapse rate of people with schizophrenia
development of the camberwall family interview
result - relapse rate much higher if family was classified as high in expressed negative emotion
what did the camberwall fmaily interview look at
critique - expression of contempt and anger towards the patient verbally and non-verbally
hostility
- disregard of the patient based on traits
family classified as high EE or low EE
three risk factors for schizophrenia relapse
stressful life events - positive as well as negstive
skipping medication
insufficient aftercare planning
problem of hospitalisation for schizophrenics
untrained attendents and nurses did most of the work
results in social breakdown syndrome
-confrontational and challenging behaviour
physical aggressiveness
lack of interest in personal welfare and hygeine
mileu therapy
introduced to counter social breakdown in hospitals
wards now formed a therapeutic community with aim to create a feeling of self-respect, responsibility , based on mumtal respect between staff and patients
occupational and recreational activites
patient relapse decreased so were discharged sooner
token economy - what
based on operant conditioning principles specific behavioural plans social and self-help behaviour communication hygeine tokens were awarded for deisred behaviour which later could be exchanged for deisred item of priviledges
token economy did it work and does it still work
patients improved significantly gripp and margo 1971)
better grpped
more active
spent less time in bed
more appropriate behaviour
discharged earlier
however token economie are useful in longe term care hospital settings have changed and discharge usually takes place after a couple of weeks so much less useful now
what are antipsychotics
neuroleptics or major tranquilisers
class of psychiatric medication used to treat schizophrenia
ealry antipsychotics discovered in 1950s
atypical antipsychotics developed more recently
block brains dopamine pathways
atypical act on serotonin receptors
effects of antipsychotics
relaxing emotional balance but also indifferenec psychomotor slowing no psychodelic effect no addiction
long term side effects of antipsychoticws
tardive dyskensia
- limb tremor
- involuntary tics
- lip smacking
- emotionless expression
what therapy is a priority for patients with schizophrenia
family training as expressed emotional research highlighted the importance of appropriate functional social interaction within the family
DSM 5 definition of specific phobias
always proveks immediate fear or anxiety
actively avoided or endured with marked fear or anxiety
fear or anxiety is out of proportion
persistent typically 6 months
causes significant distress or impairment in social occupational or other areas of functioning
problem phobic beliefs
phobics develop a set dysfunctional beliefs about their phobic stimulus or event
beliefs are rarely challenged because phobic avoids all circumstances where beliefs might be disconfirmed
aetiology of specific phobias
classical conditioning and phobias
biological accounts evolution and disgust
multiple pathways to phobias
what is mowrers two factor model
pairing of stimulus with aversive ICS leads to fear by classical conditioning
avoidance maintained through negative reinforcement (operant coniditoning)
aversion therapy
create a phobia by classical conditioning to avoid a substance
eg pairing alcohol with a drug that makes you vomit so you avoid alcohol
problems with conditioning accounts of phobias
many phobics cannt orecall the traumatic event in the history of their phobia
not all peple who have taumatic conditiong develop a phobia
phobias only appear to develop in relation to cetain stimuli and events
biological predisposition
enable us to learn quickly to fear ccertain stimuli that were hazardrous to our ancestors
the disgust emotion
a food rejection emotion whose purpose is to prevent the transmission of illness and disease through oral incorporation of contaminated foods
differences in disgust sensitivity is a risk factor for developing specific phobias related to spreading of disease and contamination
successful treatment of specific phobias (list)
exposure therapies -systematic desensitisation -flooding -adress beliefs cbt vistual reality exposure treatments counterconiditoning
social anxiety DSM5
marked fear about one or more social situations
similar classification as phobias
prevalaence of social anxiety disorder
lifetime risk 4-13% in western socities females more affected than males mid-teen = typical age of onset persistent disorder lowest overall remission rate of main anxiety disorders
comorbitieis or social anxiety disorder
substance abuse and depression
aetiology of social anxiety disorder
genetics
familial factors and developemtnal factors
cognitive factors
genetic factors and social anxiety
twin studies
there is a genetic component
accounts for 13% of the variance in social fears
cognitive factors in social anxiety disorers
information and interpretation bias
interpret performance significantly more critically
show self-focused attention
indulge in excessive post-event processing of social events
treatment of socia phobias
cbt exposure therapy social skills training cognitive restructuring drug benzodizepines MAOIs SSRIs
treatment plan for social anxiety
behaviour analysis - ABC
exposition - counterconditioning
cognitive restructuring
end of therapy and relaps prophylaxis
death rates in eating disorders
5-8%
three main types of ED
anorexia nervosa
bulimia nervosa
binge-eating disorder
DSM5 anorexia nervosa
restriction of energy intake in order to lower body weight
intense fear of gaining weight even though underweight
distubances in way in which ones body weight or shape is experienced
2 types of anorexia nervosa explained
resrticted - self-starvation is not associated with concurrent purging
purging type - sufferer regularly engages in purging acitivties to help control weight gain
physiological effects of anorexia nervosa
tiredness,cardiac arythmias, low blood pressure and slow heartbeat dry skin and brittle hair kidney and gastro languo - soft downy hair absence of menstral cycles hypothermic
comorbitities with anorexia nervosa
major depression
ocd
oc personality disorder
DSM bulimia
eating a large amount of food in a discrete amount of time (2 hour period\0
sense of lack of control over eating during an episode
recurrent inappropriate compensatory behaviour in order to prevent weight gain - purging
this cycle occurs at least once a week for three months
self evaluation is unduly influences by body shape and weight
DSM 5 binge eating disorder
recurrent episodes of binge eating is characterised by
eating in a discrete period of time
an amount of food that is definitely larger than most peipe would eat in a similar period of time under similar circumstances
sense of lack of control over esting during the episode
aetiology of ED
biological dispositional facotrs sociocultural influences -media -peer -familial
biological factors in anorexia nervosa
genetic component - may be bigger than 50%
role of lateral hypothalamus
endogenous opiods - during starvation body releases these to counter pain which leads to euphoria which may act a positive reinforcer
neurochemical dysfucntion
dispositional factors in anorexia nervosa
interoception and alexithymia
disturbed interoceptive awareness can explain many of the symptims
perfectionism
individuals with an tend to be perfectionists with an overemphasis on self-imposed standards
familial factors in ed
ed have a trendency to run in families and is best understood by considering family dynamic
-dysfuncitonal family structure actively promotes ed
may distract from bigger problems in the family
allows child to manipulate otherwise fragile family systen
this holds true for many psychological problems, not just ed
treatment of ed
pharmacological
family therapy and prevention programe
cbt
difficulties in treating ed
sufferers often deny they have an ed
individuals with severe ed often require medical treatment prior to psychological interventions
weight often must be increased immediatley to prevent starvation
ed is regularly comorbid with other psychological disorders requiring complex treatment
pharmacological treatments
antidepressants
drug treatment tends to not be very successful in anorexia
very common drop out
school based prevention programmes for ed
role of media discussed
need to develop a healthy body image
healthy balanced diet
development of skills associated with expressing feelings and combating depression
