Lecture 1- Understanding Psychopathology Flashcards
-what is abnormail -Models of psychopathology -How do we study psychopathology -DSM framework -Alternate frameworks: dimensional, continuum, RDoC, clinical staging
According to the DSM-5 general definition of a mental disorder, there are two things
that must be present in order to make a diagnosis. Name one of these two things.
Disturbance in cognition, emotion regulation, or behavior OR significant distress and/or functional impairment
Other possibilities (0.5points):
- Not better explained by medical illness, substance use, or another disorder
- Fulfillment of specific criteria for a given disorder (e.g., 5 of 9 symptoms for depression)
- Not due to a culturally normative response to a common stressor or experience
Based on what was presented in lecture, what is the single best argument for using
categorical diagnoses of mental disorders (rather than non-categorical – e.g., dimensional or
transdiagnostic - alternatives)? (Note, it is unacceptable to say that there is not one).
Provision of clinical services. Treatment decisions are always categorical and clinical services are limited, therefore, it is reasonable to make diagnostic decisions on a similar basis.
Other possibilities include (0.5 points):
- Facilitation of communication among clinicians, scientists, etc.
- Facilitation of care (identification of treatment, description of illness, possible aetiology and prognosis)
- Facilitation of research (test treatment efficacy and understand etiology)
- Education (teach models of mental disorders)
- Information management (measure and pay for care)
In lecture, I presented four different ideas (also in textbook) that are often used to determine abnormality. Name one of those four ideas.
- Statistical Infrequency (e.g. bell curve)
- Norm violation (Violation of society rules)
- Personal distress (to the individual themselves)
- Disability/dysfunction (E.g. “pathological” desire to escape slavery)
A 14-year woman has unstable relationships, feels she lacks an identity, has outbursts of anger, and has unstable mood. Is this abnormal? Why or why not?
No, these are normal/common symptoms among adolescents. context is still important
Aaron Beck, Albert Ellis, and Donald Meichenbaum were champions of cognitive models of psychopathology. What do these models emphasize as the core problem and/or target underpinning psychopathology?
- Cognition
- Thinking
- Thought patterns
- Schema
- Relationship between affect/emotion (A), behavior (B), and thoughts/cognition (C)
True or False. Diathesis-Stress models of psychopathology argue that psychopathology emerges as the result of some vulnerability (e.g., genetic liability, maladaptive personality features) OR an influential life experience (e.g., stressor, adverse event, trauma).
FALSE. It is the interaction between these two things (vulnerability & life experience)
Name one of the six broad domains from the Research Domain Criteria framework proposed by Tom Insel and Bruce Cutherbert (National Institues of Health in the US).
- Negative Valence System
- Positive Valence System
- Cognitive Systems
- Systems for Social Processes
- Arousal/Regulatory Systems
- Sensorimotor System
How is the clinical staging model (McGorry, Hickey, Jackson and colleagues) different from a stepped care approach to treatment?
Stepped care argues for an escalation in treatment (start from the lowest level of possible treatment and progress accodringly).
Clinical staging argues for treatment consistent with the level of illness/disease severity (according to stage of illness development).
The Hierarchical Taxonomy of Psychopathology (Kotov and colleagues) is an example of what kind of diagnostic system?
Answer (1 point): - Dimensional - Transdiagnostic Answer (0.5 points): - Contemporary - Categorical Alternative - Hierarchical or nested system
In lecture, I presented 8 different ways that psychopathology is commonly assessed. Name two of these 8 different methods. PCBAPMPN
9th point is context- e.g. grievance may look like depression but it is understandable in the situation
- Pen and paper tests
- Clinical interview
- Behavioral assessment
- Activity diary
- Psychological test
- Medical test
- Psychophysiological test
- Neuropsychological test
What is a mental disorder and what is not a mental disorder according to DSM-5?
A MD is a clinically significant disturbance in an individual’s cognition, emotional regulation and behavior……usually associated with significant distress/disability in social, occupational or other impt activities.
A MD cannot be an expected/ culturally approved response to a common stressor loss, such as death of a loved one (e.g. grief)
*although grief can be considered disorder if prolonged over extended period of time.
Explain the 4 controversies/setbacks of mental health diagnoses.
• Lead to bias or restricted thinking
– Diagnostic boundaries are rarely distinct and diagnoses change over time.
Eg. if one assumed to have PTSD, then only ask questions regarding PTSD.
• Are associated with jargon
– Are clinicians in fact talking about the same construct? Jargon may mask what is actually being discussed.
e.g. clinicians use complex terms for diagnoses that can confuse ppl, assume its of the same construct
• Inhibit research
– See the case for RDoC. If we only study conditions meeting specific criteria, we may be missing a big part of the picture.
• Can be stigmatizing and have personal implications
– How does this effect existing experience? If a brain disorder, is brain ”broken”? If not a brain disorder, is something wrong with ”you”?
But why is it important to diagnose and classify psychopathology? CCREI
- Facilitate Communication: among clinicians, between science and practice
- Facilitate Care: identification of treatment, and prevention of mental disorders, description of experience, possible etiology and prognosis.
- Research: test treatment efficacy and understand etiology
- Education: teach psychopathology
- Information Management: measure and pay for care
In case study, what are the 7 factors to analyze? PCPAACP
• Presenting problem
• Clinical picture or clinical description (Family history etc)
• Prevalence (proportion of population with a disorder),
incidence (new cases over a time period)
• Age of onset
• Acute/ delayed onset
• Course – episodic, recurrent, chronic, time-limited
• Prognosis
Give an example each of sign, symptoms, and syndrome during MD diagnosis
Signs: objective findings observed by a clinician
§ Tachycardia
§ Pressured speech
§ Poor eye contact
Symptoms: subjective complaints reported by a patient
§ Low mood
§ Anxiety
§ Paranoia
Syndrome: signs, symptoms and events that occur in a
particular pattern and indicate the existence of a disorder
§ Bipolar disorder
§ Depression
A 55 year old aboriginal man hears the voice of his
deceased mother. Is this abnormal?
This is culturally dependent. In some cultures, this is a gift rather than a disease.
A 23 year old male hears voices of alien forces
commanding him to kill his siblings. Is this abnormal?
Yes in a way. Kind of. Poses problem to others
A 33 year old single female is unable to sleep, unable to
concentrate or do her usual social and domestic activities. She obtains no pleasure from her usual hobbies. She feels and hopeless about her future. Is this abnormal?
probably. Functional impairment, anhedonia, depressive.
There are 2 classifications to mental disorder. Categorical and dimensional. Explain what both means and why current diagnoses prefer categorical classification over dimensional.
even though psychopathology is mostly dimensional e.g extreme versions of everyday life
- Categorical: divides psychological disorders
into categories based on criteria sets with
defining features.
Advantages:
• Better clinical and administrative utility - clinicians are
often required to make dichotomous decisions, clinical
resources are limited
• Easier communication - Dimensional: aspects of psychopathology
are quantified on a scale.
Disadvantages:
• Lack of sharp boundaries between
disorders, and between disorders and normality
• Greater capacity to detect change, facilitate monitoring
• Can develop treatment-relevant symptom targets- not
simply aiming at resolution of disorder (most treatments
actually target symptoms, not disorders).
According to the learning model of psychopathology, how do ppl develop mental disorders?
(Bandura’s social learning theory)
Learnt behavior since early age from social and developmental factors via classical/operant conditioning. however, it does not explain enough since ppl cannot overlearn or unlearn something.
Explain the cognitive model (CBT= cognitive behavioral therapy) of psychopathology. how does mental disorder come about based on this model.
The model states that how we interpret things as the basis of the problem. Interaction between thoughts, emotions, behavior (how we think, feel and act). The easiest thing to change is how we think (thoughts) which is the usual approach to CBT
A large range of differences exists among individuals’ vulnerabilities to the development of a disorder. This is used to compliment other models, which model uses such approach? Explain it
Diathesis stress model. The diathesis–stress model serves to explore how biological or genetic traits (diatheses) interact with environmental influences (stressors) to produce disorders. It can used in conjunction with other models to explain psychopathology
Which model uses interaction between biological, psychological and social/environment factors to understand MDs?
Biopsychosocial model
- Biological - normal biology, disease processes and genetic influences
- Psychological - thoughts, feelings and perceptions
- Social/Environmental - culture, ethnicity, social environment
Explain how the DIMESIONAL approach of research domain criteria (RDoC) works
It identifies the consistency in group profile of individuals exhibiting multiple forms of a certain disorder and uses the information to treat these individuals
explain what the dimensional clinical staging model focus on, and what are the advantages of such model?
Preventive focus: to stop emergence of first episode of disoder.
Early intervention allows more universal methods of treament that are less costly, less harmful and less intense
