Lecture 1/2 Flashcards
what is psychopathology
how do we define what is NOT normal
why define mental illness
some say yes some say no
have to have some sort of boundary as a starting point
what is a medical model/syndrome
physical diseases measurable entities and express themselves as clusters of symptoms - these models have evolved oevrtime
syndrome model was borrowed from what
medical models of illness
not every disease has
a single origin or single etiological source and its not categorized by a single sympltom
who defined metal illness as “harmful dysfunction”
wakefield J
what os dysfunction
an organ system performing contrary to its design; not at the peak of its design
what does wakefield argue
brain is designed to perform number of functions and any problem indicates a disorder
what does wakefield presume/ is problematic with what he says
we understand the fucntion and design of the brain, personality, emotions, etc
what is lillenfields critique
what is “natural function”
natural selection depends on variability
some disorders may represent ___ not ___
adaptations not maladaptations
what is widigers proposal
mental disorders are constructs
what else does widiger say in his proposal
not directly observable or definable, can only be measured indirectly thus needed a multimodal approach
what is a multimodal approach
the process of defining psychopathology is an ongoing iterative bootstrapping process
what do multimodal approaches assume
any form of psychopathology represents a complex latent construct which is multiply determined, meaning each construct represents the sum of all environmental influences in addition to the acivity of things
when measuring psychiatric disorders, what domains are they expressed across
self report, brain functionl, neural response, physiological responses, and behavioural responses
what is the purpose fo classification system
description, prediction, theory, communication
description
highlight critical features of a diagnosis
prediction
may tell you something about course, treatment, response, etiology
theory
provides a set of postulates abotu relationships of diff elements to one another
do symtoms co-occur fro a certain reason?
they should
communication between
clinicians
what are the five criteria proposed for valid classification of disorders
clinical description, course, treatment response, family history, and laboratory studies
clinical description
the disorder has to be characterized by a common set of symptoms that cluster together and are characteristic of the disorder
course
people with the disorder should follow a common trajectory and have similar onset
treatmnet response
if a disorder is valid, most people will response similarily to similar treatments
family hisotry
does the disorder run in the family? if so speaks to validity of diagnosis
laboratory studies
look fro biological and psychophysiological associations
what are the limitations of a classification system
loss of uniqueness and difficulty of boundary cases
loss of uniqueness
diagnosis implies that common features are more important than the ways in which individuals vary
difficulty of boundary cases
what do you do with people who are on the boundary? do we arbitrarily decide which group theyre more similar to?
procrustean beds
we alter or ignore or exclude information about individuals in order to make them fit into these discrete categories instead of altering the categories
what is a categorical system
presence/ absence of a disorder; eother you are anxious or you arent
what is a dimensional system
ran on a continuous quantitative dimension ;
degree to which a symptom is present
what do dimensional systems capture better
an individuals functioning
what does categorical approach have over dimsensional
for research and understanding
advantages of categorical systems
simplifies communication
natural preference among people to employ categories in speech
what happens to people in dimensional models
everybody falls somewhere
categorical systems are better-cuited for
clinical decision making
for clinical decision making what does dimensional lack in
arbitrary cut-offs
what are advantages of dimensional systems
preserves more information;
greater reliability (inter-rater and test-retest)
cutoffs in categorical system tend to what
magnify small differences
when did the DSM 1 come out
1952
DSM 2
1968; had few ccategries, no requirements for # of symptoms
what was the dominant paradigm in the DSM 2
psychoanalysis
DSM 3
1980
demand for more biological, empirical approach; psych needs to be more scientifically grounded
what did the DSM 3 introduce
inclusion criteria, duration criteria, exclusion criteria, multi-axial classification
inclusion criteria
what symptoms do you need to have and how many
duration criteria
how long do you need to exhibit these symtptoms
exclusion criteria
what symtpms rule out a diagnosis
what is not in the DSM 5
multi-axial classification
AXIS 1
major clinical disorders
AXIS 2
personality disorders
AXIS 3
medical conditions that might contribute to be relevant to treatment
AXIS 4
psychosocial stressors- something with which to record environmental contexts
AXIS 5
a simple rating of functions/ summary score for severity
how many number of categories were there in the DSM 1
106
how many number of categories were there in the DSM 2
182
how many number of categories were there in the DSM 3
265
how many number of categories were there in the DSM 3 R
292
how many number of categories were there in the DSM 4-TR
297
how many number of categories were there in the DSM 5
157
assumptions introduced in the DSM 3
symptoms are the most useful basis for assessment
nosology based on behaviour and symptoms
locus of pathology is in the individual
nosology
how we describe the disorder
locus of pathology
the dysfunction adheres to the individual
what is the problem with locus of pathology
what about the family systems? social systems?
DSM 4
1994; more research based
what did the DSM 4 introduce
idea of clinically significant distress or impairment in social, occupational, or other important areas of functioning
DSM 4-TR
2004; did not introduce new diagnosis or specific criteria but provided more information on each diagnosis and provided broad definition of mental illness
dsm 5
2013; removed multi-axial system
what did the DSM 5 introduce
dimensional assessment criteria for some diagnosis
what did the DSM 5 do
re-classify some disorders and remove some diagnosed
what are the challenges to categorical classification system
heterogeneity and comorbidity
heterogeneity
people who get diagnosed with the same illness often look very different from one another
comorbidity
many people who receive a diagnosis of anxiety also qualify for a diagnosis of depression ex
of people who curently meet criteria fro one disorder
50% qualify for more than one and 70% over the course of their lifetime
comorbidity affects
course, development, presentation, treatments response etc for each diagnisis
comorbid patients tend to have poorer outcomes for
Shortened life course
Poor life
Poor academic outcomes
Social outcomes
Occupational functions
what are the research implication of comorbidity
anything you find to be associated with one disorder may actually be a result of the comorbid disorder
why does comorbidity exist
chance, sampling bias
why does comorbidity present a major problem for both research and treatment
do you treat them the same? different times? which one first- there are not always good empirical support for those decisions
of people who currently have any anxiety
64% have some sort of mood disorder
of people with any mood disorder
29% with SOC
36% GAD
32% OCD
what does this tell us about categorical boundaries
suggests that categories arent working very well; have to think about why it might exist
comorbidity greater than chance alone would indicate
sampling bias, problems with diagnostic criteria, poorly draw diagnostic boundaries
sampling bias
each disorder associated with a chance of being treated
individuals with more disorders are more likely to seek treatment
what are problems with diagnostic criteria
many criterion sets overlap
Suicidal ideation in MDD, Schiz, BPD, AUD, SUD
Sleeplessness in MDD and GAD
Worry in GAD and MDD, etc.
multiformity
people with MDD frequently have panic attacks, this might give a wrong diagnosis of panic disorder
comorbid disorders may in fact reflect a 3rd, independent disorder
what is the causal explanation fro comorbidity
one disorder is a risk factor for another
what is RDoc intentend for
tom awakenbot
factor analysis: hierarchical system
what is the hierarchical system
put a bunch of variables in a data set
run factor analysis
which symtoms/ diagnosis circulate
what are two underlined methods of psychopathology
internalizing and externalizing
as long as you look at peoples current symptoms
they replicate very well onto the hierarchical model
what are notable problems in
more disorders than just the ones listed
not always clear trying to load into this structure
hierarchical taxonomy of psychopathology
most recent way of thinking about hierarchical about describing psychopathology
in high top at least some
personality disorders are appearing
what is high top not
a causal model; trying to describe the structure of psychopathology;
descriptive: just identifying factors that we could use to identify further
Research Domain Criteria (RDoc)
intended to be used for research purposes not clinically
trying to move away from categorical diagnosis and express dysfunction in terms of the dysfunction of core systems that are critical to human functioning that can be measured in multiple ways
prevalence
% of people in a population with a disorder at a particular point in time
incidence
the % of people who develop a disorder for the 1st time during a specific time period
prevalence =
incidence x chronicity
risk factor for epidemiologists
a correlate associated with diff disorders
psychologists use risk factor to mean
predictor or cause
major depression
1-year prevalence
- 6.7%
Onset
- 14-15
- 30s
persistent depressive disorder
1-year prevalence
- 1.5%
Onset
- 30s
bipolar
1-year prevalence
- 2.6%
Onset
- 25
panic
1-year prevalence
- 2.7%
Onset
- 24
OCD
1-year prevalence
- 1.0%
Onset
- child/adolescent
social anxiety disorder
1-year prevalence
- 6.8%
Onset
- 13
GAD
1-year prevalence
- 3.1%
Onset
- 31
PTSD
1-year prevalence
- 3.5%
Onset
- Any age
mood disorder
lifetime prevalence 21%
anxiety disorders
lifetimes prevalence 27%
substance abuse disorders
lifetime prevalence 15%
any disorder
lifetime prevalence 46%
onset: Symptoms almost always begun before diagnosis
This is when they meet full criteria = onset
any disorder college vs non
45.8% and 47.7%
anxiety disorder college vs non
11.9% and 12.7%
mood disorder college vs non
10.6% and 11.9%
alcohol use disorder college vs non
20.4% and 17%
mental health usage college vs non
18.5% and 21.5%
what is etiology
the scientific study of the causes of things
environmental factors
Learning experiences
what are freudian theories for environmental factors
“Schizophrenogenic mother”
“refrigerator mother”
schizophrenic mother
idea that schizophrenia was caused by a certain mothering style: Alternating between overprotecting and rejecting
refrigerator mother
mother who lacked genuine warmth can cause autism; popular int he middle of the last century
genetics are not
deterministic
most genes are
probabilistic
probabilistic
the presence of a gene for disorder is alone, not going to determine the outcome; make small contributions to create the ultimate outcome
strong evidence that psycopathology runs in
families
researchers identifying dozens of genes that in certain combinations
lead to symptoms of different forms of psychopathology
polygenic
influenced by many genes
diathesis stress model
nature and nurture don’t acti independently
diathesis
vulnerability or predisposition to develop a disorder
stress
the environment - non-specific
Rosenthol and Niel
give up on idea of nature vs nurture because its both
diathesis present stress present
ILL
stress absent diathesis present
well
diathesis absent stress present
well
stress absent diatheisis absent
well
if you have a high diathesis
youre fine for stress
medium diathesis
more susceptible to stress
low diatheiss
high susceptibility to stress
no diathesis
not perfectly protextive ; exposed to very high levels of stress could develop disorder
etiological heterogeneity
assumes diathesis and stress are independent
gene environment correlation
vulnerability stress-interactions
often non-independent in important ways
scars as vulnerability
the experience of child abuse can become a diathesis for later problems
vulnerability may shape
perception of the stress
stress can influence the development of
the diathesis
equifinality
people who get the disorder get it from different causes
many diff pathways
final common pathway
mutliple pathways converge in this final step
multifinality
can lead to many different results; child abuse can lead to different disorders
