Fundamentals in Psychopathology Flashcards
Abnormal on a bell curve
-Top and bottom 2.5% deviate form the norm
- To be pathology need to cause distress or disfunction
Adaptation
Fitting into the circumstances of your life
- Can be effected by abnormal deviations
Mental Disorder
- Syndrome of clinically significant behaviour, cognitive, or emotional disturbances
- Reflects dysfunction in underlying mental processes
- Associated with distress or disability in important areas of functioning
- Should be diagnosed by an expert
Neurodivergent
Non-medical term used to describe people whose brains function differently than the typical population
- usually associated with different strengths and challenges than the typical population
Prodromal
Symptoms that lead up to disorder or don’t meet threshold
Factors to consider when assessing symptoms
- Frequency: How often
- Intensity: How intense
- Duration How long does it last and how long it reoccurs for
Etiology
The cause of a symptom or disorder
Etiological approaches
- Biological Approaches: Brain dysfunction, genetics, biochemical imbalance
- Psychological Approaches: learned behaviour or thinking patterns, maladaptive cognitions, dysfunction in family system, lack of personal growth, self-acceptance, love, creativity, meaning
- Sociocultural Approaches: socioeconomic disadvantage, physical/cultural upheaval, stigmatization + marginalization, social media
The Biopsychosocial model
- Considers all three approaches to etiology
- Varying emphasis based on person and disorder
The diathesis Stress model
Model that states disorders emerge as a result of the interaction between a vulnerability (diathesis) and a trigger (stress)
- Slightly over threshold = mild disorder
- far past threshold = severe
Risk
Variables that precede and increase the chance of psychological impairment
- Can act on environment and indirectly effect you
- Can contribute to onset or persistence of symptoms
Transdiagnostic Risk factors
Factors that increase risk for multiple types of psychological problems
- Majority of risk factors
Resilience
Relatively positive outcome in the face of significantly adverse or traumatic experiences
- Individual differences in response to risk
- the ability to resist or overcome life’s adversities
- Internal trait
Protective factors
Environmental factors that decrease negative outcome of risk factors
Formulation
Our understanding of a case/client, including relevant risk, resilience, course, treatment
The 4 Ps of Formulation
- Predisposing Factors - Vulnerability
- Precipitating Factors - Triggers or stressors
- Perpetuating Factors - Conditions that are exacerbating the problem
- Protective Factors - Patient’s own competency, skill, interest
Ways to be assessed
- Clinical Interview
- Symptom Questionnaires
- Intelligence Tests
- Personality Inventories
- Neuropsychological Test
- Brain Imaging and psychophysiological tests
Goal of psychopathology assessments
To determine the client’s presenting problem and clinical description
Clinical Interviews
- Conversation between mental health professional and client
- 1st form of assessment
- Information gathered about behaviour, attitudes, emotions, life history, personality
Pros and cons of structured interviews
- Not adaptive
- Standardized preventing clinician bias
- May pick up on questions that wouldn’t normally be asked
Structured interview
A set of identical questions asked in exactly the same way
Semi-structured Interview
An interview schedule that is adapted depending on the replies of respondents
Unstructured Interview
No pre planned schedule, more like a conversation
Symptom Questionnaires
Patients complete themselves to report symptoms
- Not used for diagnosis
- Self report
Pros of symptom questionnaires
- quick
- starting point
- see self perceptions
Challenges in assessment
Resistance in providing information
- don’t want to be there
- scared of specific diagnosis
- look good for assessor
- intimidated by assessor
Cultural differences between assessor and client
- talk and think about symptoms differently
- Racial and cultural bias
Classification
The delineation of major categories
Diagnosis
Assigning a category of a classification system to an individual
Category
A discrete grouping
- Your symptoms either fit in the category or they don’t
Dimension
An attribute is considered continuous and can occur to various degrees
Features used to describe a category or dimension
- Must occur together regularly
- Must occur in one or more situations
- Must be measured by one or more methods
Diagnostic and statistical manual of mental disorders (DSM)
- Most widely used classification system in North America
- Currently on DSM-5-TR (Continuously revised)
- Uses a categorical approach (some disorders are also dimensional)
- Created based on the consensus of clinicians that certain characteristics occur together
Alternatives to the DSM
International Classification of disease
- Primarily categorical some dimensional
- By WHO (global standard)
- Includes mental and physical disorders
Research Domain Criteria
- By NIMH as alternative to DSM
- Neuroscience approach
- Medical approach
Hierarchical Taxonomy of Psychopathology
- By group of influential assessment researchers
- Dimensional model
- Captures disfunction below threshold
- Complicated to use, requires training
Issues with the classification system
Reifying Diagnoses
- seeing a diagnosis as true rather than a set of judgements about how symptoms tend to occur together
- Can cause clinicians to focus on the disorder rather than problems underlying the disorder
Category vs continuum
- Continuum is ideal in theory, perhaps not in practice
Cultural Issues
- A person’s experience with mental illness will depend on their culture
Ghost Sickness
- Specific to some native American cultures
- Preoccupation with death
- manifested with intense dreams and anxiety
- similar to grieving syndrome but don’t need someone to die
Taijin Kyofusho
- Specific to Japan
- Intense fear that ones body offends or displeases others
Amok
- Specific to Malaysia, Laos, Philippines, Polynesia
- Period of brooding and then violent outburst (may be homosidal)
Comorbidity
Person meets criteria for more than one disorder
- Some more linked than others
Many disorders have
- mixed patterns of behaviour
- shared risk factors
- impacts of the onset or development of others
- effective treatments
The impact of labels
- Being placed in a subgroup has implications for how someone may be viewed and treated by others
May lead to: - Overgeneralization
- negative perceptions
- different expectations
- minimization of interpersonal and social context
Stigmatization
The act of regarding someone or oneself with disapproval due to association with devalued label or group
Rosenhan study on mental health problems being a social construct
- Dr. Rosenhan and 7 colleagues visited 12 mental hospitals across the US and reported hearing voices
- All admitted to psychiatric institutions with diagnoses of schizophrenia
- stopped reporting symptoms once admitted and behaved as usual
- remained in hospital for an average of 19 days
- Received minimal attention
- other patients able to recognize that they didn’t belong
Intervention
Umbrella term that encompasses
- Systematic prevention of psychological difficulty
- treatment of psychological difficulty
Prevention
Interventions for individuals who are not yet experiencing a disorder or to prevent disorder from getting worse or side issues form happening
- may be generalized or targeted to those at risk
Treatment
Interventions for individuals who are already experiencing a disorder
- those who experience relatively high symptoms
How has the view on prevention programs changed
THEN
- Cause of disorders difficult to establish
- Prevention programs intrude on parental values
NOW
- Ethically - to reduce suffering
- Practically - there are not enough clinicians
- Financially - treatment is costly
Caplan’s prevention model
PRIMARY - Efforts to prevent
- General health enhancement
- prevention of specific dysfunction
SECONDARY - Efforts to slow progression
- Shorten existing causes
- referral, diagnosis, treatment
TERTIARY - Efforts to reduce residual problems
- Reduce impact on QOL
- Reduce financial strain
- prevent relapse
- rehabilitation and accommodations
Current treatment model
- Universal prevention
- Offered to everyone
- Includes general health knowledge, education, self-esteem, confidence - Selective prevention
- People at higher risk
- Financial, family stress, genetics - Indicated prevention
- High risk individual who show minimal symptoms or signs for casting the disorder
Types of biological treatments
- Drugs
- Electric stimulation
Types of psychological treatments
- Behavior therapies
- Cognitive therapies
- Family systems therapy
- Humanistic therapy
- Psychodynamic therapies
Drug therapies
- Aim to improve neurotransmitter systems
- Standard first-line treatments (helps you so that you can learn coping skills through talk therapy
Antidepressant drugs
- Reduce symptoms of depression
- Selective serotonin reuptake inhibitors
- Selective serotonin-norepinephrine reuptake inhibitors
What is serotonin involved with
Mood, sleep, digestion
What is norepinephrine involved
Attention, arousal, stress reactions
Antianxiety drugs
Barbiturates
- Induce relaxation, sleep
- highly addictive resulting in serious withdrawal symptoms
Benzodiazepines (tranquilizers)
- Lorazepam, diazepam, clonazepam, alprazolam
- very common
- also addictive (80% people experience withdrawal after 6 months)
- Also treat seizures or insomnia
Behavioral Therapies
Identifies reinforcements and punishments that contribute to a person’s maladaptive behaviours
- works to change specific behaviours
- E.x. Systematic desensitization therapy
Systematic desensitization therapy
Gradual method for extinguishing anxiety response to stimuli
STEPS:
1. learn relaxation techniques
2. Create hierarchy of fear stimuli
3. Move through hierarchy
- Want to always feel slightly uncomfortable
Cognitive therapies
Therapist helps client identify and challenge negative thoughts and dysfunctional belief systems
- often combined with behavioral on techniques (focuses on the here and now and encourages the gathering of evidence about the situation)
GOALS
- Identify irrational and maladaptive thoughts
- Challenge thoughts and consider alternatives
- face fears and recognize ways to cope
Multiculturalism
Clinician’s efforts to integrate and embrace cultural differences and acknowledging the influence of their own culture
Should consder:
- World view
- race and ethnicity
- gender
- sexual orientation
- religion
HELPS TO CREATE THERAPEUTIC ALLIANCE
Therapeutic Alliance
Strong client clinician bond resulting in increased effectiveness in treatment
- Leads to increased engagement, more active, satisfaction and persistence
Indigenous Healing Practices
CULTURALLY SPECIFIC THERAPY
- Treat body, mind and spirit
- High community involvement
Hispanic Curanderos/Curanderas
CULTURAL SPECIFIC THERAPY
- Religion-based rituals to overcome illness causing distress
- Prayers, incantations, remedies
Positive Therapeutic Relationship
Focuses on creating an authentic relationship
- open and empathetic
- feelings align with client
- person instead of authority
- Unconditional positive regard (accept mistakes and forgive yourself)
Unconditional positive regard
Freud initially emphasized the importance of a positive relationship with the client
- Currently central to client-centered therapy developed by carl rogers
Client-centered therapy
- Type of humanistic therapy
- therapists express genuineness in their role as a helper
- Serving as an authentic person rather than an authority figure (Congruence)
What are the two effective treatments
- Positive therapeutic relationship
- Explanation + interpretation for distress
What are the 3 broad categories of who works in mental health
Psychiatrist, clinical psychologist, social worker/ psychotherapist
Psychiatrist
- Assesses, diagnosis, treats (including pharmaceutical), and researches major mental health disorders
- Biological or medical perspective
- MD followed by residency training program
Clinical Psychologist
- Assesses, diagnoses, treats (non-pharmaceutical) and researchers major mental health disorders
- A clinical Ph.D. in the field of psychology, which includes research
Social worker/ Psychotherapsit
- Treat disorders with psychotherapy ( but don’t necessarily diagnose)
- Masters in psychotherapy or social work
Research in Mental Health
There are scientists and clinician/scientists that research mental disorders and symptomology focusing on
1. Clinical description or diagnosis
2. Causation (etiology)
3. Treatment and outcome
Science Practitioner model
- Gap between science and practice
- Filled in by those who practice informing science and science legitimizing practice
