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)
