CM: Foundations of Psych

Question 1

What is psychiatry and what manifestations of illnesses does it treat?

Answer 1

branch of medicine that deals with mental, emotional, or behavioral disorders
manifest as either subjective disturbance or behavioral dysfunction

Question 2

What are the Feighner criteria that influenced the DSM III?

Answer 2

clinical description of syndrome (most observable)
lab studies
delimitation from other disorders
follow up studies
family studies

Question 3

What are mental disorders associated with according to the DSM IV?

Answer 3

present distress (painful symptom) or
disability or
risk of suffering pain, death, disability or imp loss of freedom

Question 4

What can a syndrome NOT be to be classified as a mental disorder according to the DSM IV?

Answer 4

expectable and culturally sanctioned response to particular event (death of loved one)
deviant behavior or conflict b/w individual and society
MUST be manifestation of behavioral, psychological, or biological dysfunction in individual

Question 5

What are the benefits of the DSM?

Answer 5

reliable
advantages to research = comparing apples w apples
advantages to clinical practice - drs have common language and pts can ask questions

Question 6

What are the problems with the DSM?

Answer 6

validity not as good as reliability
high rates of comorbid disorders
heterogeneity w/i same disorders
relies on expert consensus

Question 7

What are neuroscience discoveries that raised concerns about the DSM?

Answer 7

given disorder might be associated with genetic polymorphisms at many sites
particular mechanism might be implicated in number of different DSM disorders

Question 8

What are the proposed domains of the RDoC?

Answer 8

negative affect: fear, distress, aggression
positive affect: reward seeking and gratification, learning and habit formation
cognition - attention, perception, memory, executive fxn
social processes - attachment, pair bonding, parenting, facial recognition, etc.
regulatory systems - arousal, sleep, circadian rhythyms

Question 9

What are the biological correlates of negative affect according to the RDoC?

Answer 9

Amygdala and hippocampus in fear onset, circuits connecting these to the prefrontal cortex in fear response control, and in fear extinction

Question 10

What are the biological correlates of positive affect according to the RDoC?

Answer 10

mesolimbic dopamine system, orbital frontal cortex, and the ventral and dorsal striatum

Question 11

What are the biological correlates of cognition according to the RDoC?

Answer 11

parietal areas (attention), thalamic and occipital (perception), dorsolateral prefrontal cortex (working memory/executive function), hippocampus (long term memory), and anterior cingulate (conflict resolution)

Question 12

What are the biological correlates of social processes according to the RDoC?

Answer 12

oxytocin and vasopressin circuits

Question 13

What are the biological correlates of regulatory systems according to the RDoC?

Answer 13

reticular activating systems, ventral tegmental area, locus ceruleus

Question 14

Why is neuroscience not enough to explain psychiatric disorders?

Answer 14

need to consider brain, mind (personal subjective experience), and culture

Question 15

What is the four perspectives model of psychiatric illnesses?

Answer 15

disease
dimensions
behavior
life story

Question 16

What is the disease perspective?

Answer 16

begins with abnormal symptoms that form syndrome, then describe pathology, then look for etiology, then target it for Rx
some part of the system is broken

Question 17

When is the disease perspective most useful?

Answer 17

symptoms quite stereotypical and abnormal (ex: voices in schizo)
symptoms already clearly linked to underlying pathology (alzheimers and plaques)

Question 18

What is the dimensions perspective and what is the clearest example?

Answer 18

some traits on bell shaped curve - difficulties if off the curve, manifest when social challenges can’t be met
ex = intelligence and mental retardation, (personality)

Question 19

How does personality apply to the dimensions perspective?

Answer 19

temperament is a matter of degrees

2 axes: introversion-extroversion, neuroticism-stability

Question 20

What is the introversion-extroversion axis?

Answer 20

relates to type of emotional response people have
extrovert - quick emotional rxns that focus on here and now
introvert - slower rxns that focus on implications for future or past

Question 21

What is the neuroticism-stability axis?

Answer 21

relates to variation in intensity of emotional response

neuroticism - very strong emotional response

Question 22

What are the four personality types resulting from the 2 axes?

Answer 22

extrovert-stable: sociable, leaders, easygoing, lively
extrovert-neurotic: restless, impulsive, touchy, excitable
introvert-stable: careful, thoughtful, even-tempered
introvert-neurotic: anxious reserved moody
tend to see clinical problems along neurotic dimension - extroverts have acting out problems, introverts have anxious and obsessional problems

Question 23

How does the dimensions perspective change the approach to treatment?

Answer 23

think of guidance and improved coping, rather than cure - use insight into vulnerabilities, skills training, and maturing of defenses

Question 24

What is the goal driven behavior perspective?

Answer 24

problem arises when either a basic physiologic goal oriented behavior becomes distorted in some way or a normal social need becomes directed toward maladaptive goal

Question 25

When is pathology seen in the behavioral perspective?

Answer 25

Goal in overdrive (alcohol used for social bonding, but now can‟t stop)
Preoccupied with goal
Goal is socially unacceptable ( for eg, getting high on heroin) and has hijacked a normal drive (avoidance of emotional pain/have peace of mind)

Question 26

What is the role of learning in the behavioral perspective?

Answer 26

the appropriate means to pursue, the appropriate and most desirable goals are learned

Question 27

What is the approach to treatment based on the behavioral perspective?

Answer 27

not treating something the pt has, but what they’re doing

can focus interventions at level of choice, drive (biology), or habit (learning)

Question 28

What is the perspective of life story?

Answer 28

people tell stories to make sense of own lives
when people feel there are insurmountable obstacles to fulfillment of wishes, they become demoralized - can manifest as psychological symptoms

Question 29

What types of stories matter most in the life narrative?

Answer 29

love, ambition, redemption, legacy

Question 30

What is the approach to treatment based on the life story perspective?

Answer 30

rewrite the narrative - come up w new stories more accurate or more meaningful