Exam 1 Flashcards
Distress or impairment in functioning - it is a breakdown of functioning in cognitive, emotional, and behavioral areas. Involves a response that is not typical or culturally expected.
Psychological dysfunction
Occurs when person is much more distressed than others would be
Dysfunctional distress
Must be pervasive and/or significant. Mental disorders are often exaggerations of normal processes
Impairment
Consider “normalcy” relative to behavior of others in same context
Culture
Rule of thumb
Mental disorder = harmful dysfunction
Behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and/or impairment in functioning or increased risk of suffering, death, pain, or impairment
An Accepted Definition of a Psychological Disorder
Scientific study of psychological disorders
Psychopathology
Clinical and counseling psychologist (trained in research and delivering treatment
Ph.D
Clinical and counseling “Doctor of Psychology” (trained in delivering treatment)
Psy.D.
Psychiatrist
M.D.
Licensed Clinical Social Worker (trained in delivering treatment)
LCSW
Nurses
Psychiatric nurses
Stays current with research in field. Evaluates own assessment and treatment. Conducts research
Scientist-practitioner
Symptoms that brought the client to seek help
Presenting problem
Aims to distinguish clinically significant dysfunction from common human experience.
Clinical Description
How many people in a population have the disorder
Prevalence
The number of new cases over a period of time
Incidence
Acute vs. insidious
Onset of disorders
Episodic, time-limited, or chronic. Individual pattern of disorder
Course of disorders
Good vs. guarded. The anticipated course of disorder.
Prognosis
Age may shape presentation. Can be acute. Can be insidious
Onset of disorder
The factors contributing to the development of psychopathology
Etiology
Deviant behavior as a battle of “Good” vs. “Evil”. Believed to be caused by demonic possession, witchcraft, sorcery. Treatments included exorcism, torture, religious services.
The supernatural tradition
Experience of an emotion seems to spread to those around us
Emotion contagion
If one person identifies a “cause” of a problem, others may assume that their own reactions have the same source
Mob Psychology
Founded by Hippocrates (460-377 BC). Etiology of mental disorders = physical disease. Linked abnormality with brain chemical imbalances (foreshadowed modern views). Galen (129-198 AD) extended Hippocrates’ work
Biological tradition
Blood - cheerful and optimistic; insomnia and delirium caused by too much blood in the brain
Sanguine
Black bile - depressive
Melancholic
Phlegm - apathy and sluggishness
Phlegmatic
Yellow bile - hot tempered
Choleric
Functioning is related to having too much or too little of four key bodily fluids (humors). Treated by changing environmental conditions or bloodletting/vomiting
Humoral theory of disorders
Popular in first half of 19th century. Referred to psychological/emotional factors. Main idea to treat patients as normally as possible in normal environment. More humane treatment of institutionalized patients. Encouraged and reinforced social interaction
Moral therapy - the psychological tradition
Freudian theory of the structure and function of the mind. Unconscious, catharsis - helpful release of emotion, model sought to explain development and personality.
Psychoanalytic theory
Id (pleasure principle; illogical, emotional, irrational). Superego (moral principles). Ego (rational; mediates between superego/id)
Structure of the mind
Ego’s attempt to manage anxiety resulting from id/superego conflict. Displacement & denial; rationalization & reaction formation; projection, repression, and sublimation
Defense mechanisms
Oral, anal, phallic, latency, and genital stages. Theory: conflicts arise at each stage and must be resolved.
Psychosexual stages of development
Theoretical constructs: intrinsic human goodness, striving for self-actualization.
Humanistic theory
Carl Rogers (1902-1987). Therapist conveys empathy and unconditional positive regard. Minimal therapist interpretation
Person-centered therapy.
Abraham Maslow (1908-1970). Humans fulfill basic needs first before moving onto higher needs like self esteem
Hierarchy of needs
Derived from a scientific approach to the study of psychopathology.
The behavioral model
Ubiquitous form of learning. People learn associations between neutral stimuli and stimuli that already have meaning (unconditioned stimuli). Explains the acquisition of some fears
Classical conditioning
Start to respond the same way to similar stimuli
Stimulus generalization
When the conditioned stimulus is repeatedly presented without the unconditioned stimulus, the association is weakened
Extinction
Behavior will be repeated more often if it is followed by good consequences and less often if it is followed by bad consequences
Law of effect (E.L. Thorndike 1874-1949)
New behavior can be learned by reinforcing successive approximations
Behavior “shaping”
Creating new association by practicing new behavioral habits and/or reinforcing useful behaviors with positive consequences. Tends to by time-limited and direct. Evidence supports its efficacy
Behavior therapy
Individuals gradually exposed to fears (usually through imagination) while practicing relaxation exercises
Systematic desensitization
A broad approach with multiple interactive influences. Scientific emphasis continues to be very important; advances in neuroscience and cognitive and behavioral science will add to our knowledge
The scientific method and an integrative approach
Explain behavior in terms of a single cause. Could be a paradigm, school, or conceptual approach. Tend to ignore information from other areas.
One-dimensional models
Interdisciplinary, eclectic, and integrative. “System” of influences that cause and maintain suffering. Draw upon information from several sources. Abnormal behavior results from multiple influences
Multidimensional Models
Biological, behavioral, emotional, social & cultural, developmental, environmental, and spiritual
Major influences of multidimensional models
Behavioral - Conditioned response to the sight of blood. Biological - genetics (inherited tendencies), physiology (e.g., lightheadedness). Emotional - fear and anxiety. Social - attention from others
Causes of Judy’s phobia
Exceptions to polygenetic development and behavior
Huntington’s disease, phenylketonuria
Disorders are the result of underlying risk factors combining with life stressors that cause a disorder to emerge
Diathesis-stress model
Chemical messengers - relay messages between brain cells
Functions of neurotransmitters
Increases the activity of a neurotransmitter by mimicking its effects
Agonist
Produce effects opposite to a given neurotransmitter
Inverse agonists
Inhibit/block the production of a neurotransmitter/function
Antagonists
Most drugs are
Either agonistic or antagonistic
Giving up trying to control outcomes after unsuccessful attempts
Learned helplessness
Learn to copy the behaviors that seem to turn out well for other people
Modeling and observational (social) learning
Many types of psychopathology are maintained by
Problematic reactions to our own emotions
Systematic evaluation and measurement
Clinical assessment
Areas of clinical assessment
Psychological, biological, social, and spiritual
Degree of fit between symptoms and diagnostic criteria
Diagnosis
Purpose of assessing psychological disorders
Understanding the individual, predicting behavior, treatment planning, and evaluating outcomes
Degree of consistency of a measurement
Reliability
Consistency across two or more raters
Inter-rater reliability
Consistency across time
Test-retest reliability
Whether the test measures what it is intended to measure
Validity
Comparison between results of one assessment with another measure known to be valid
Concurrent (Descriptive) Validity
How well the assessment predicts outcomes
Predictive validity
Degree to which test or item measures the unobservable construct it claims to measure
Construct validity
Application of certain standards to ensure consistency across different measurements. Provides normative population data.
Standardization
Examples of things that are kept constant
Administration procedures, scoring, evaluation of data
Assesses multiple domains: gathers information, presenting problem, current and past behavior, detailed history, attitudes and emotions. Most common clinical assessment method
Clinical interview
Ask the exact same questions in the same order
Structured clinical interview
Outline of questions that are followed, but some flexibility to ask more or less about certain areas depending on the needs of the interviewee
Semi-structured clinical interview
Observes appearance and behavior, thought processes, mood and affect, intellectual functioning, and sensorium (orientation x3 - person, place, time)
Mental status exam
Identification and observation of target behaviors. Direct observation conducted by assessor or by individual or loved one
Behavioral Observation
Determine the factors that are influencing target behaviors
Goal of Behavioral Observation
When individual observes self, informally or formally.
Self-monitoring
Simply observing a behavior may cause it to change due to the individual’s knowledge of being observed
Reactivity
Specific tools for assessment of cognition, emotion, or behavior. Include specialized areas like personality and intelligence
Psychological testing
Rooted in psychoanalytic tradition. Used to assess unconscious processes. Project aspects of personality onto ambiguous test stimuli. Require high degree of inference in scoring and interpretation (very subjective)
Projective tests
May be useful icebreakers. One way to gather qualitative data
Strengths of projective tests
Hard to standardize. Reliability and validity data tend to be mixed
Criticisms of projective tests
Roots in empirical tradition. Test stimuli are less ambiguous. Require minimal clinical inference in scoring and interpretation.
Objective tests
Extensive reliability, validity, and normative database
Personality tests
567 items. T/F responses. Interpretation: individual scales, profiles
Minnesota Multiphasic Personality Inventory
Nature of intellectual functioning and IQ. Originally developed as a measure of degree to which children’s performance diverged from others in their grade.
Intelligence tests
Compare a person’s scores against others of the same age
Deviation IQ
Assess broad range of skills and abilities. Goal is to understand brain-behavior relations
Neuropsychological testing
Designed to assess for brain damage. Test diverse skills ranging from grip strength, rhythm sound recognition, math, memory, attention, concentration.
Luria-Nebraska and Halstead-Reitan batteries. (Neuropsychological tests)
False positives and false negatives
Problems with neuropsychological tests
Mistakenly shows a problem where there is none
False positives
Fails to detect a problem that is present
False negatives
Pictures of the brain to understand brain structure and function
Neuroimaging
Neuroimaging techniques
MRI, CAT/CT, PET, SPECT, fMRI
Yield detailed information. Lead to better understanding of brain structure and function. Still not well understood. Expensive. Lack adequate norms. Limited clinical utility.
Advantages and Disadvantages of Neuroimaging
Assesses brain structure, function, and activity of the nervous system
Psychophysiological assessment
Electroencephalogram (EEG) - brain wave activity. Heart rate and respiration. Electrodermal response and levels
Psychophysiological assessment domains
Disorders involving a strong physiological component. Ex: PTSD, sexual dysfunctions, sleep disorders, headache, hypertension
Uses of routine psychophysiological assessment
Assignment to categories based on shared attributes or relations
Diagnostic classification
Determination of individual, unique features or attributes
Idiographic strategy
Determination of general classes and common attributes - involves the study of large groups with shared features
Nomothetic strategy
Taxonomy
Classification in a scientific context
Taxonomy in a psychological/medical phenomena
Nosology
Labels in a nosological system
Nomenclature
Strict categories
Classical (pure) categorical approach
Classification along dimensions
Dimensional approach
Combines classical and dimensional views. DSM-5 based on this
Prototypical approach
Updated every 10-20 years. Current edition released May 2013.
Diagnostic and Statistical Manual of Mental Disorders. DSM-5. Previous edition DSM-IV-TR
Published by the World Health Organization
International Classification of Diseases (ICD-10)
Classification newly relied on specific lists of symptoms, improving reliability and validity. Diagnoses classified along five “axes” describing types of problems
DSM-III changes in 1980
Eliminated previous distinction between psychological vs. organic mental disorders. Reflected appreciation that all disorders are influenced by both psychological and biological factors
DSM-IV introduced in 1994
Removed axial system. Clear inclusion and exclusion criteria for disorders. Disorders are categorized under broad headings. Empirically-grounded, prototypic approach to classification
Basic characteristics of DSM-5
When groups of individuals are identified whose symptoms are not adequately explained by existing labels
New disorder labels are created
Two or more disorders for the same person. Extremely common. Emphasizes reliability, maybe at the expense of validity
Comorbidity
Lack of dimensional classification. Labeling issues. Stigmatization
Issues in DSM-5
The event that provoked/triggered/caused the behavior
Antecedent
Actions that can be positive, problematic, or pivotal
Behavior
The outcome that resulted from the behavior, which can either extinguish or encourage the behavior
Consequence
6 circuits in the brain. Influences behavior, moods, and though processes
Serotonin
Less inhibition; instability; impulsivity; tendency to overreact. Aggression, suicidal thoughts, impulsive overreacting, excessive sexual behavior
Effects of low serotonin
Treat anxiety, mood, eating disorders
SSRIs: serotonin specific reuptake inhibitor
Rx and herbal Serotonin correctors
Celexa, Lexapro, Prozak, Paxil, Zoloft; St. John’s Wart
Excitatory transmitter that turns on many different neurons for action
Glutamate
Inhibitory transmitter that puts the brakes on. Reduce anxiety
GABA (gamma aminobutyric acid)
Lower arousal and emotional responses. Lower anger, hostility, and aggression. Relaxes muscles (anticonvulsant effect)
Benzodiazepines (GABA Rx)
One circuit, regulating basic bodily functions. Another circuit, influencing emergency reactions/alarm responses. Regulates/modulates behavioral tendencies
Norepinephrine, also called noradrenaline.
5 circuits in brain. Implicated in Schizophrenia, Parkinson’s, and addictions. Described as a SWITCH turning on brain circuits that inhibit or facilitate emotions/behaviors. Pleasure-seeking behaviors.
Dopamine
Muscle rigidity, tremors, impaired judgement
Low levels of dopamine
Marriage and family therapists. Mental health counselors
1-2 years Master’s degree, employed by hospitals or clinics under supervision of doctoral-level clinician
The study of changes in behavior over time
Developmental psychology
The study of changes in abnormal behavior
Developmental psychopathology
The study of abnormal behavior across the entire age span
Life-span developmental psychology
Physical symptoms appear to be the result of a medical problem for which no physical cause can be found
Somatic Symptom Disorder (originally hysteria)
Sexually transmitted disease caused by a bacterial microorganism entering the brain. Can cause delusions similar to psychosis
Advanced syphilis
psychological disorders characterized in part by beliefs that are not based in reality, perceptions that are not based in reality, or both
Psychosis
Giving insulin to psychotic patients in high dosages
Insulin shock therapy. Abandoned because dangerous, leading to prolonged comas or death
Sending electric shocks through the brain
Electroconvulsive therapy
Benzodiazepines brand names
Valium and Librium
Improving the conditions imposed on patients with insanity
Mental hygiene movement
The release of emotional material by recalling and reliving emotional trauma
Catharsis
A fuller understanding of the relationship between current emotions and earlier events
insight
The id has its own characteristic way of processing information. This type of thinking is emotional, irrational, illogical, filled with fantasies, and preoccupied with sex, aggression, selfishness, and envy
Primary process
The cognitive operations or thinking styles of the ego are characterized by logic and reason
Secondary process
Conflicts between the id and the superego that are beyond what the ego can intercede
intrapsychic conflicts
Transfers a feeling about or a response to an object that causes discomfort onto another, usually less threatening object or person
Displacement
Directs potentially maladaptive feelings or impulses into socially acceptable behavior
Sublimation
Refuses to acknowledge some aspect of objective reality or subjective experience that is apparent to others
Denial
Falsely attributes own unacceptable feelings, impulses, or thoughts to another individual or object.
Projection
Conceals the true motivations for actions, thoughts, or feelings through elaborate reassuring or self-serving but incorrect explanations
Rationalization
Substitutes behavior, thoughts, or feelings that are the direct opposite of unacceptable ones
Reaction formation
Blocks disturbing wishes, thoughts, or experiences from conscious awareness
Repression
when we are more or less reactive to a given situation or influence than at other times
developmental critical period
a condition that makes someone susceptible to developing a disorder
vulnerability or diathesis
chemical transporters
can affect the activity of neurotransmitters in the brain
The ways genes are turned on or off by cellular material located outside the genome
Epigenetics
After a neurotransmitter is released, it is quickly drawn back from the synaptic cleft into the same neuron
Reuptake
Monoamine neurotransmitters
Norepinephrine, serotonin, dopamine
Amino-acid neurotransmitters
Gamma-aminobutyric acid (GABA) and glutamate
Benzodiazepine works to
enhance activity of GABA molecules
Overt physical behaviors
Appearance and Behavior aspect of Mental status exam
Rate or flow of speech
Implies thought processes aspect of MSE
slow and effortful motor behavior
Psychomotor retardation
disorganized speech pattern
loose association or derailment
Distorted views of reality
Delusions. of persecution, grandeur, or ideas of reference
everything everyone else does somehow relates back to the individual
Ideas of reference
Things a person sees or hears when those things really aren’t there
Hallucinations
Predominant feeling state of the individual and the feeling state that accompanies what we say at a given point
Mood and Affect aspect of MSE
Affect can be said to be
Appropriate, inappropriate, or blunted or flat
Composed of vocabulary, abstraction and metaphor, and memory
Intellectual functioning aspect of MSE, only very roughly estimated
General awareness of surroundings (date, time, location, identity of self and others)
Sensorium aspect of MSE
Identifying specific behaviors that are observable and measurable
Formal observation by operational definitions
TAT
Thematic apperception test
The wording of questions seems to fit the type of information desired
Face validity
