Introduction to disorders

Question 1

What does DSM stand for?

Answer 1

The Diagnostic & Statistical Manual of Mental Disorders

Question 2

___ largely influences what people consider to be abnormal, which is possible problem

Answer 2

Culture

Question 3

What 3 factors are important to consider when diagnosing a mental disorder?

Answer 3

1) a set of symptoms, 2) duration & 3) inability to function socially & professionally

Question 4

According to the new DSM-V somebody who is depressed for __ days after a bereavement should be diagnosed with depression because…

Answer 4

15. The same biological mechanisms characterise more and less reactive (to life events) depression

Question 5

Anorexia nervosa & bulimia nervosa are characterised by…

Answer 5

body image distortion & compulsions to control perceived body weight

Question 6

Bipolar depression is characterised by…

Answer 6

alternating expansive (manic) and low moods with secondary, physical & cognitive symptoms

Question 7

Social phobia is characterised by…

Answer 7

fear and avoidance of social evaluation & humiliation

Question 8

Name 4 ways in which we can define abnormality

Answer 8

1) Violation of statistical norms (infrequent behaviours), 2) Violation of social norms, 3) Behaviours which cause personal distress & 4) Behaviours which impair an individual’s own life or society

Question 9

How might a mental disorder impair a) an individual’s own life & b) the functioning of society?

Answer 9

a) If you’re afraid of crowds you may not use public transport. If you abuse alcohol you may not be able to work. b) Pp with aggressive tendencies may be violent towards others

Question 10

Name 2 problems with defining abnormality according to statistical norms

Answer 10

1) The threshold (cut-off point) is arbitrary & 2) It implies that people at the other end of the scale (e.g. very happy people) are abnormal too

Question 11

What is the key problem with defining abnormality according to social norms?

Answer 11

What is socially acceptable varies across cultural & historical contexts e.g. seeing visions & hearing voices may be psychotic or a normal experience in religion. Homosexuality was once deemed a disorder but now a genetically influenced life choice

Question 12

What are the 3 problems with defining abnormal behaviours as those which cause personal distress?

Answer 12

1) Not all mental disorders are characterised by personal distress e.g. antisocial personality disorder & conduct disorder, 2) not all Pp with a disorder experience distress e.g. Asperger’s vs. autism & 3) Pp without disorders experience distress as a normal response e.g. to war

Question 13

What is the problem with defining abnormality according to personal or societal impairments?

Answer 13

What counts as an impairment is subjective

Question 14

Which definition of abnormality is most commonly used? What is the alternative? Why are these not yet used?

Answer 14

The one which refers to societal or personal impairment. However, in a way none of the definitions are sufficient on their own. To use biomarkers. They’re also not 100% reliable

Question 15

According to the DSM-IV there are 3 defining characteristics of a mental disorder - what are they?

Answer 15

A group of associated psychological features associated with 1) present distress, 2) disability & 3) a sig increased risk of death, pain or loss of freedom

Question 16

What are the 3 excluding criteria? Which is likely to be dropped in the DSM-V published in May 2013?

Answer 16

If it is a) an expectable or culturally approved response to an event (to be dropped), b) deviant behaviour (e.g. the actions of political, religious or sexual minorities) or c) the product of conflict between the individual & society

Question 17

What is the difference between the medical (DSM & ICD-10) & non-medical approaches to mental disorders?

Answer 17

The medical approach is qualitative: it assumes that you either have the disorder or you don’t in an all-or-nothing fashion & therefore that symptoms are either present or absent. The non-medical approach is quantitative: we all exhibit risk factors for mental disorders to differing, continuous degrees

Question 18

Describe the 3 of the 5 criticisms of the medical approach which can be grouped under the 2 sub-headings “Symptom presence/absence” & “Qualitative differences”

Answer 18

1) It’s too reliant on subjective, clinical judgement (inter-rater reliability) & arbitrary cut-off points than empirical tests, 2) disorders are often preceded by sub-clinical symptoms, 3) The no. of symptoms exhibited varies continuously & in proportion with the psychosocial impairment

Question 19

Describe the other 2 criticisms of the medical approach to classifying mental disorders

Answer 19

4) Relatives of patients often exhibit sub-clinical symptoms & 5) Symptoms in the normal range (e.g. low mood) are often associated with the same risk factors as the disorders (e.g. amygdala activation in normal and pathological anxiety)

Question 20

Name the 2 disorders which seem more qualitative than any other mental disorders i.e. which don’t have obvious “normal variants” & so don’t seem to lie on a continuum of symptoms. Why is this so?

Answer 20

Schizophrenia & obsessive compulsive disorder (OCD) because they are characterised by a unique combination of symptoms

Question 21

There are 3 main needs to categorise abnormality. What are they?

Answer 21

Medical categorisation is necessary because treatments, thoughts & labels are categorical. Medical diagnosis a) facilitates treatment, b) provides relief & c) raises awareness & reduces stigma = the products of perceiving a mental disorder in line with a physical disorder

Question 22

What are the 2 problems with classifying or quantifying (continuously or categorically) abnormality at the behavioural rather than neural or cognitive mechanistic levels?

Answer 22

1) Disorders which appear different behaviourally may be driven by similar causes & underlying pathways & 2) Disorders which appear similar behaviourally may be driven by different causes & underlying pathways = a problem for treatment suitability

Question 23

Give e.g.s of behavioural dissimilarity but mechanistic similarity & vv

Answer 23

1) Unipolar depression vs. eating disorders = distorted perceptions, 2) OCD vs. eating disorders = persistent, recurrent thoughts & repetitive acts to reduce distress. 1) Avoidance of social situations = autism vs. social phobia = the problem of misdiagnosis

Question 24

Mareno (2007) argues that classification of bipolar depression at the behavioural level and resultant misdiagnoses may be to blame for…

Answer 24

The rise in the % of doctors’ appointments which concerned bipolar depression from 1994 to 2003, especially in youths (for which the rise is more prevalent than in adults)

Question 25

As well as the inappropriate application of a bipolar depression diagnosis to young people who actually have other illnesses, the rise in % of bipolar depression-related visits may be attributable to…(3 things)

Answer 25

1) a true increase in prevalence, 2) previous under-recognition of bipolar disorder & 3) changes in the conceptualisation of bipolar disorder

Question 26

The DSM-IV criteria for a manic episode (which forms part of the diagnosis for bipolar disorder) includes symptoms which are also found in the criteria for ___ e.g…. & ___ ___ ___ e.g….

Answer 26

ADHD e.g. distractibility, decreased need for sleep & psychomotor agitation (part of criterion B) & severe mood dysregulation (SMD) e.g. irritable or elevated mood lasting > 1 week (criterion A)

Question 27

What is criterion C of bipolar disorder?

Answer 27

Marked impairment, hospitalisation or psychosis

Question 28

What does ODD and CD stand for?

Answer 28

Oppositional Defiant Disorder. Compliance Disorder

Question 29

Young sufferers of BD (bipolar disorder) & SMD show similar clinical ___ e.g….. More ___ children were also diagnosed with ADHD, ODD or CD than ___ children

Answer 29

characteristics e.g. age, gender, anxiety disorder comorbidity. SMD than BD

Question 30

What does prognosis refer to?

Answer 30

The course & outcome of the disorder

Question 31

In the Great Smoky Mountains study (Brotman, 2006), the dark black bars refer to ___ (i.e. Pp who don’t have SMD) & are generally smaller than the ___, grey bars. This shows that…

Answer 31

SMD-, SMD+. Pps who had SMD were more likely to show comorbidity than Pps who didn’t have SMD (e.g. had bipolar disorder or ADHD instead or nothing)

Question 32

Pps who were diagnosed with SMD at wave 1 were more likely to suffer from ___ at the last wave than Pps who were diagnosed with something other than SMD/nothing at wave 1. This suggests that…

Answer 32

any depressive disorder. SMD is a mild form of depression

Question 33

Brotman (2007) suggests that BP is distinct from SMD as far as familial loadings are concerned:…

Answer 33

Parents of BD youth are more likely to have BD than parents of SMD children

Question 34

Guyer (2007) suggests that SMD is a less severe form of BD by finding that…make more face emotion labeling errors than…& both types of children make more errors than…

Answer 34

BD children than SMD children. Healthy controls, depressed + anxious people & ADHD & CD children

Question 35

Overall children make less face emotion labeling errors with…than…

Answer 35

child faces than adult faces

Question 36

Whilst looking at neutral faces, Brodman’s (in press) BD Pps rated themselves as more ___ than SMD Pps who in turn were more ___ than ADHD sufferers or healthy controls

Answer 36

Afraid. Afraid

Question 37

In terms of fMRI recordings of amygdala activity, Brotman (in press) found that whilst looking at neutral faces and answering the Q “How afraid are you?” vs. “How wide is the nose?”, ADHD Pps…, whereas SMD Pps…. BD Pps showed…perhaps because…

Answer 37

Showed enhanced amygdala activity, whereas SMD Pps showed reduced amygdala activity. No change in amygdala activity between the 2 Q conditions. 1/2 of BD Pps had comorbid ADHD & resultant counterbalancing of the 2 effects

Question 38

In Brotman (in press) ___ may have been a CV. Note the mismatch between findings at the neural and behavioural levels in this study; in particular, the SMD vs. BD dissociation appears stronger at the ___ level

Answer 38

Treatment. Neural

Question 39

The point of the ADHD vs. SMD vs. BD example is to put the problems of behavioural classification in ___

Answer 39

context

Question 40

Incorrect doctor diagnosis or DSM classification of disorders results in the wrong treatments being given e.g. if SMD = anxiety/MDD, then… vs. = BD, then…vs. = ADHD, then…

Answer 40

SSRIs should be given. Antipsychotics or anticonvulsants should be given. Stimulants should be given

Question 41

Bentall (1992) argued that happiness could be diagnosed as a mental disorder. What 4 criteria does it meet?

Answer 41

1) consists of a discrete cluster of symptoms, 2) is statistically abnormal, 3) can cause personal distress e.g. alcohol abuse & obesity due to indulgence & 4) a functional impairment e.g. annoyance to/jealousy from others

Question 42

Alternative means of classification & diagnosis are…(2 things)

Answer 42

Biomarkers & psychological/cognitive lab markers