Exam 1 Flashcards
What is developmental psychopathology and how does it differ from a symptom-focused classification of mental disorders?
• DP is theory that proposes the trajectory of psychopathology multifactorial systems process.
• DP is multidisciplinary
• Multiple vulnerabilities and risk factors interact and transact into case specific yet predictable ways
• Psychopathology unfolds across entire lifespan
• DP is complex conception vs simplistic or linear
◦ Ex: interactions between G and E make psychopathology multifactorial
◦ Linear perspectives seek to blame psychopathology on family or on individual weakness
◦ Static perspectives erroneously lump together illnesses with substantially different etiological pathways > labeled as same condition
Normal vs atypical development
• Without understanding the processes of normal/health processes, such as attention, memory, impulse control,for example, understanding the development of atypical Bx such as ADHD would be incomplete > no sample to determine the range of Bxs
Continuities and discontinuities
• Homotypic continuity: unfolding of a single class of Bx/ emotional disturbance over time
◦ Ex: aggression
• Heterotypic continuity: development of different (but related) internalizing or different externalizing Bxs or disorders across lifespan
◦ Ex: tantrums and hyperactivity (toddler) + ODD (preschool) + CD (elementary) + SUD (adolescence)
• Discontinuity: Bxs that desist over time
◦ Ex: child biting
Risk and protection (and resilience)
• Risks and vulnerabilities > variables that precede and predict dysfunction
◦ Malleable and potentially casual > but not inevitably predictable
• Impairment waxes and wanes over time
• Not all vulnerabilities and risk factors lead to develop pathology
• Resilience: good outcomes despite vulnerability and risks
• Protective factors or processes that mitigate risks and vulnerabilities, promote successful outcomes
• Understanding protective factors help w/intervention and preventive measures (deflect pathology) and understanding atypical Bxs just as the study of normative Bxs do
Transactional models
• Open systems functioning > interaction and transactional patterns are multidirectional overtime
◦ Ex: children influenced by teachers, fathers and peers who in turn each shape development of child
Multi-level analysis
• RDoC: levels of analysis include they ways in which we measure units of
◦ Genes: bio markers that indicate normal or abnormal development
◦ behavior: behavioral tasks (working memory), or observational (toddler Bx)
◦ self reports: interview based scales, or self report measures that indicate normal or abnormal Bx
Equifinaility and multifinality
- equifinality: multiple and different trajectories can lead to development of atypical conditions or outcomes
- Multifinality: similar risk factors and/or vulnerabilities can lead to different conditions or outcomes
How has the DSM changed overtime? How has it improved? What problems and criticisms remain?
• DSM 1 ‘reactions’ to stress
• DSM 2: homosexuality removed: diagnostic systems reflect social values
• DSM 3: more scientific and empirical evidence vs professional consensus of prior DSM. Diagnosis requires reliability
• Current DSM: specification of operational criteria, standardize data on Sxs, structured interviewing, improve validity, dimensional indices, ADHD into neurodevelopment, addition of non suicidal self injury
• Criticisms: with changes made to DSM 5 > years of research to asses validity of diagnosis
◦ Evidence suggests PDs can be diagnosed in adolescence reliably > DSM 5 states PD diagnosis for age 18 younger is dangerous
◦ No evidence for ABC clustering in PD disorders
◦ DSM obscures etiological connection between ADHD and CD > moving ADHD into neurodevelopment
◦ Drop of multiaxial system: downplays importance of environment in shaping Bx even in the face of genetics
What are empirically derived classification systems and how do they differ from the DSM?
• Empirically based assessment: inductive (bottom up) assessment > derived from factor analysis of large sample sets of Sxs of psychopathology > result in hierarchal latent structure of mental illness. Two higher order factors (internalizing and externalizing) account for covariation among first order factors
◦ Raters not forced to chose between dichotomous diagnostic decisions > scales scores can be evaluated from national norms (flag for concern those in the 85th percentile, 95th percentile considered clinically impaired
◦ Does not force clinicians to chose one disorder over another > elevated scores both across and within internalizing and externalizing domains are observed and expected
◦ More sensitive to capturing heterotypic comorbidity (primarily externalizing Sxs, with subclinical internalizing Sxs)
What is the RDoC and how does it differ from the DSM?
• RDoC is a framework to investigate new approaches to mental disorders
(Research Domain Criteria)
◦ Not seeking to replace diagnostic guidelines
◦ Goal > Integrate multiple levels of integration (microsystem, mesosystem, exosystem, macrosystem) to understand basic functioning of human Bx from normal to atypical
◦ RDoC believes multiple units of analysis will yeild more valid phenotypes and better understanding of causes and Txs of mental disorders
What is gene-environment interaction and why is it important?
◦ Environment moderates effect of genes on Bx or genes moderate effects of environment on Bx
What is gene-environment correlation and why is it important? What are the different types of gene-environment correlation
• Situations in which (a) heritable traits of parents affect their child’s exposure to adverse environments (b) heritable traits of children affect their own exposure to adverse environments
◦ Active: heritable vulnerability influences selection of environment > propensity to seek risky environment
‣ Ex: schizophrenia seeking substance abuse
• Passive: parents pass 50% of genes and influence of specific environment
◦ Intelligent parent purchases books for child + lots of reading = greater opportunity
• Evocative: genetic propensity evokes and elicits reaction from others (environment) > increase severity of vulnerability
◦ Ex: musically orientated > parents maintain high exposure to musical environment
What do we know about the genetics of comorbidity? (are genes specific risk factors for types of psychopathology or general risk factors for psychopathology?
• Homotypic comorbidity: co-occurance of multiple externalizing or internalizing Dxs w/in individual
◦ Ex: ADHD + ODD, CD, ASPD, SUD (externalizing)
◦ Ex: Depression, Dysthymia, anxiety Dxs (internalizing)
• Heterotypic comorbidity: co-occurance of at least one internalizing Dx and at least one externalizing Dx w/in individual
◦ CD + Depression rates higher than expected
• Most Dxs share common heritable vulnerability > but shared variance strongly influenced by environment > genetic predispositions manifest differently depending on environment influence
• Comorbidity as covariation of related syndromes that stem from common heritable vulnerability
What do we know about the genetics of continuity?
• Homotypic continuity: unfolding of a single class of Bx/ emotional disturbance over time ◦ Ex: aggression • Heterotypic continuity: development of different (but related) internalizing or different externalizing Bxs or disorders across lifespan ◦ Ex: tantrums and hyperactivity (toddler) + ODD (preschool) + CD (elementary) + SUD (adolescence)
What are the stages of case formulation?
1. Primary characteristics of child’s Px? A. Normative expectations B. Assessment of disorder and etiology 2. How does clinician perform in depth assessment of Px? A. Family Hx a. Genetic b. Events, crisis, trauma 3. How does clinician decide on Tx? A. Evidence based Tx B. Evaluation of Tx effectiveness
