Test 1: Lecture Flashcards
What are the standards for defining abnormal behaviors?
1) Societies Norms: Rules of right and wrong; what to do when, where, and with whom (diff culture to culture)
2) Statistical Rarity: Substantial deviation from the calculated average (“average” may be immoral)
3) Personal Discomfort: Unhappy about their person (still may be abnormal even if they are happy with it)
4) Maladaptive Behavior: Daily demands of life cannot be met
5) Deviation from an ideal: Stray from an ideal to a greater or lesser degree (who creates the ideal?)
What are the basic categories when considering signs of a mental disorder?
- Behavior is harmful to self or others
- Poor reality contact
- Inappropriate emotional reaction
- Erratic behavior
What is a psychological dysfunction?
Associated with distress and/or impairment in functioning - it is a breakdown in functioning in cognition, emotion, and behavior.
Think 4 D’s:
- dysfunction (disrupt social/occupational/daily),
- distress (unpleasant/upsetting: affect others),
- deviance (different, extreme, unusual: statistical/cultural deviance)
- Danger (interfere w/ life or risk of harm)
What are the distress and impairment aspects of psychological dysfunction? Rule of thumb?
Distress: normal in certain situations
- dysfunctional: person MUCH more distressed than others would be
Impairment: Must be pervasive and/or significant
- Mental disorders are often exaggerations of normal processes
Rule of Thumb: mental disorder - harmful dysfunction
What is the DSM? Current version? Use?
Diagnostic and Statistical Manual of Menal Disorders
Five
- Standard for abnormal behavior: keeps mental health workers on same page (criteria)
What are the mental health professionals for psychopathology?
(Scientific study of psychological disorders)
- Ph.D. research
- Psy.D. clinical, hands-on
- MD: psychiatrist, medications (not counseling)
- Psychiatric Nurses: often hospitals
- LCSW: Licensed Clinical Social Worker: delivering treatment (Masters Level)
- Science-practitioner: current with research, evaluates own assessments & treatment, conducts research
What starts the clinical description?
Presenting problem: what pt says
What does the clinical description describe?
- Clinically significant dysfunction vs common human experience
- Prevalence: # people in population with it
- Incidence: # new cases over certain time
- Onset (Acute vs insidious (gradual))
- Course: episodic, time-limited, chronic
- Prognosis: Good/guarded
Consider age of onset, which may shape presentation
What about causation, treatment, and outcomes of a psychological disorder?
Etiology: cause/origin, what contributes to development of the psychopathology
Treatment: include pt because they need to own it.
- How alleviate psychological suffering
- Pharmacological, psychosocial (counseling), and/or combined treatments
What are aspects of the supernatural tradition? (view, causes, treatment, alternative view, other)
- Abnormal is a battle of “Good” vs “evil”
- Causes: demon possession, witchcraft, sorcery
– possessions: treat w/ shocking/scaring out spirits - Treatment: exorcism, torture, religious services
- Insanity caused by emotional “stress and melancholy” = anxiety and depression (competing, coexisting view)
– treatment: rest, sleep, healthy environment, baths, potions - Mass hysteria
- Moon and Stars: their pull, –> “lunatic”
How has mass hysteria been seen in the past and today?
- Past: Saint Vitus’s Dance/Tarantism
- Today:
– Emotion contagion - emotion experience seems to spread
– Mob psychology: person ID “cause” assume reactions same source
What are the aspects of early biological tradition?
Hippocrates: Father modern Western medicine extended by Galen
- Etiology of mental disorders is physical disease, brain chemical imbalances
- Hysteria: “the wandering uterus” (psychological symptoms from uterus moving around body)
- Humoral theory: too much/little, Blood (sanguine - cheerful, optimistic, insomnia, delirium), phlegm (phlegmatic- apathy sluggishness), black bile (melancholic, depressive), yellow bile, (hot tempered)
– treatment: change environmental conditions, bloodletting/vomiting
What about the aspects (specific disease, hospitals, treatments, consequences) of 19th century biological tradition?
- General paresis (syphilis) and the biological link w/ madness
– symptoms, cause: bacterial, treat penicillin - Grey: reform hospitals better care
- Treatment: Psychotropic meds, electric shock, surgery, insulin, tranquilizers
- Consequences: increased hospitalization, seen as untreatable, improved diagnosis/classification, increased science
What about the psychological tradition treatment?
- moral therapy: treat as normally as possible, more humane treatment, social interaction
What caused the decline in the moral therapy?
- Too many hospitals, not enough staff
- Patient staff ratio - too large
- No leaders to follow previous leaders
- Medical model emerged (use of meds)
What about psychoanalytic theory?
- Freudian: unconscious (buried emotions), catharsis (release emotion)
– structure of mind: id, superego, ego - Defense mechanisms: displacement & denial, rationalization & reaction formation, Projection, repression & sublimation
– psychosexual stages of development: conflict arise & must be resolved: oral, anal, phallic, latency, and genital stages
What are later developments of psychoanalytic thought?
- Anna Frud: self-psychology, ego influence
- Klein, Kernberg: object relations theory: incorporate significant others in images, memories, values
- Neo-Freudians: de-emphasized sexual core
- Unearth hidden conflicts: real problems, free association, dream analysis, little efficacy
What about the humanistic theory?
- Intrinsic human goodness, striving for self-actualization
- Person-centered therapy (Carl Rogers)” empathy & unconditional positive regard, minimal interpretation. No evidence, more effective for normal life
- Hierarchy of Needs (Abraham Maslow, basic needs fulfilled first then higher needs (self-esteem)
What is the behavioral model history and people associated with it?
- From scientific approach
- Classical conditioning (Pavlov & Watson) unconditioned & conditioned stimuli, association or extinction
- Watson: more scientific, Little Albert (white)
- Mary Cover Jones: treat phobias with exposure and extinction
- Thorndike: Law of effect repetition based on good/bad consequences
- Skinner; Behavior operates on environment & managed by consequences
- Behavior therapy: new associations and habits,
- Wolpe: systematic desensitization
What is the current approach to psychopathology?
- Broad approach
- Multiple, interactive influences: biological, psychological, social factors
- Scientific emphasis: no more supernatural, advances in neuroscience and cognitive and behavioral science will add to our knowledge
What can effect mood and what can mood effect? What about emotions?
Individuals and circumstances can effect mood and vice versa
Emotions can affect physiological feelings and vice versa.
What is a one-dimensional model of psychopathology?
A model that explains behavior from one cause (one paradigm, school, or conceptual approach) that then ignores information from all other areas
What is a multidimensional model of psychopathology?
It is a model that explains behavior in an interdisciplinary, eclectic, and integrative way considering a system of influences that cause and maintain suffering. It draws upon several sources recognizing that abnormal behavior comes from multiple influences
What are the major influences of abnormal behavior from a multidimensional model?
Biological (genetics: PKU, Huntingtons, physiology), behavioral (conditioned response to sight of blood), emotional (fear, anxiety, shame), social & cultural (pos/neg attention from others), developmental, environmental, and spiritual
What is genotype, phenotype, and polygenetic?
Genotype: genetic status
Phenotype: how the genes manifests
Polygenetic: Several genes contributing to the outcome
What is the diathesis-stress model? (Definition & Diagram)
Disorders are the result of underlying risk factors combining with life stressors that cause a disorder to emerge
[genes] –>
Environmental stressors: trauma, conflict, significant life change
[environment] –>
–> [possibility of a psychological disorder]
[healthy coping skills: prayer, scripture, exercise, eat/rest well, social support]
What is the function of neurotransmitters?
Chemical messengers to transmit messages between brain cells
What are agonists?
Chemical substances that increases the activity of a neurotransmitter by mimicking its effects
What are inverse agonists?
Chemical substances that produce effects opposite to a given neurotransmitter
(most drugs are agonistic or antagonistic)
What are antagonists?
Inhibit/block the production of a neurotransmitter/function
What about serotonin?
- circuits: 6 in brain
- influences: behavior, mood, and thought processes
- Extremely low: less inhibition, instability, impulsivity, overreactions, depression, anxiety, aggression, suicidal thoughts, impulsive over-eating, excessive sexual behavior
- Rx: SSRI (serotonin specific reuptake inhibitor) ie Celexa, Lexapro, Prozac, Pazil, Zoloft, St. John’s Wart
- Tx: Anxiety, mood, and eating disorders
What about glutamate and GABA?
Chemical brothers because they work together to balance brain function
Glutamate:
- Excitatory transmitter: “turns on” many different neurons leading to action
GABA
- inhibitory transmitter: “puts the breaks on” reducing post-synaptic activity
- best known effect: reduce/inhibit anxiety
- Rx: benzodiazepines: minor tranquilizers - reduce arousal and emotional responses and reduce anger/hostility/aggression and relaxes muscles
What about norepinephrine (noradrenaline)?
circuits: major in CNS
- one regulates basic bodily functions
- another influences emergency reactions/alarm responses
Regulates/modulates: behavioral tendencies when we are faced with dangerous situation
What about dopamine?
- circuits: five in brain
- implicated: in schizophrenia, Parkinsons, addictions, depression, ADHD
- Described: as “switch” aka turning on brain circuits that facilitate/inhibit emotions and behaviors
- Associated: with pleasure-seeking behaviors
- Low level: muscle rigidity, tremors, impaired judgement
REVIEW BOOK
Neurotransmitters & medications
What are the contributions of behavioral and cognitive science?
- Classical conditioning: Pavlov
- Respondent & operant learning: repeat behaviors based on desirable/undesirable consequences
- Learned helplessness: Rats occasional shocks give up trying
- Social learning: Albert Bandura, copy what goes well for others
What is the role of emotion in psychopathology?
- Nature: elicit or evoke action, (action tendency different from affect and mood)
- Components: behavior, physiology, cognition (fear: anxious thoughts, elevated heart, tendency to flee)
- anger: greater risk for cardiovascular disease than many physiological risk factors (reversed by practicing forgiveness)
What can result from problematic reactions to our own emotions?
Psychopathology
- many types of psychopathology are maintained by problematic reactions to our own emotions
- suppressing negative emotions increases sympathetic nervous system activity
- Dysregulated emotions are key features of many mental disorders ie panic attack & fear
How do cultural, social, and interpersonal factors effect psychopathology?
- Cultural: influence form & expression (raised to be less fearful, fear only exist b/c certain culture)
- Gender: Men & women differ in emotional experiences (insects, bulimia, alcohol) may be related to gender roles & coping
- Social stigma: limit degree to which express mental disorder
What is clinical assessment?
Assessment - testing
- systematic evaluation and measurement of psychological, biological, social, and spiritual factors
What is diagnosis?
The degree of fit between symptoms and diagnostic criteria (found in DSM-5)
What is the purpose of clinical assessment?
Understanding the individual, predicting behavior, treatment planning, evaluating outcomes
- Funnel: broad, multidimensional start that narrows to specific problems
What is reliability?
The degree of consistency of a measurement
- inter-rater reliability: across 2+ raters
- test-retest reliability: across time
What is validity?
Does the test measure what it’s supposed to?
- Concurrent (descriptive): between results of one assessment with another measure known to be valid
- Predictive: how well the assessment predicts outcomes
- Construct: Degree to which test or item measures the unobseravble construct it claims to measure
What is standardization?
- Application of certain standards to ensure consistency across different measurements
- Provides normative population data
ie: administration procedures, scoring, evaluations
What are the key concepts in assessment?
Antecedents: the event that provoked, triggered, or caused the behavior
Behavior: actions that can be positive, problematic, or pivotal
Consequences: Outcome that resulted from the behavior can extinguish or encourage the behavior
What is the clinical interview used for? What are some forms?
- Most common clinical assessment method
- Structured (same questions & order) or semi-structured (outline followed w/ flexibility to ask more/less depending on interviewee needs)
What is the mental status exam?
Used to assess individual by
- Appearance and behavior
- Thought processes
- Mood and affect
- Intellectual functioning
- Sensorium: orientation x3 (person, place, time)
What about the physical examinations?
Helpful when diagnosing mental health problems because rule out
- toxicities
- medication side effects
- allergic reactions
- metabolic conditions
What are the aspects of behavioral observation?
- Identification and observation of target behaviors (behavior of interest)
- Direct observation by assessor/individual/loved one
- Goal: determine the factor that are influencing target behaviors
- Getting to the heart of the matter
What are the questions of the spiritual selfie?
1) What do I think about
2) How do I spend my money
3) How do I spend my time
4) What words do I speak (most reliable gauge)
What are the types of behavioral assessment?
Behavioral observation and self-monitoring
What are the aspects of self-monitoring?
- when individual observes self
- may be informal or formal (established rating scales)
- the problem of reactivity: (observation may cause behavior to change)
What is psychological testing? What are the types of tests?
Specific tools for assessing cognition, emotion, and behavior
- includes specialized areas like personality and intelligence
- examples: blocks, Myers-Briggs, projective,
What are projective tests?
Think Freud–what you have buried inside will be projected
(psychoanalytic tradition, unconscious process, project personality- ambiguous test stimuli)
- requires high degree of inference in scoring and interpretation (very subjective)
What are examples, strengths, and criticisms of projective tests?
- Ex: Rorschach inkblot test, Thematic/children’s apperception test, House-Tree-Person
- Strengths: icebreaker, qualitative data
- Criticisms: hard to standardize, reliability & validity data is mixed
What are objective tests?
Tests rooted in empirical tradition
- stimuli less ambiguous
- minimal inference in scoring and interpretation
Ex: Beck depression/anxiety
What is an example of a personality test?
Minnesota Multiphasic Personality Inventory
- Extensive reliability, validity, and normative data
- 567 items, true/false
- interpretation: individual scales, profiles
What about intelligence tests?
- Nature of intellectual functioning and IQ
- IQ deviation: compare same age
- Verbal & performance domains
What are the purpose, goals, examples and problems with neurophysiological testing?
- Purpose: assess broad range of skills and abilities
- Goal: understand brain-behavior relations
- Examples: Luria, Nebraska, Halstead-Reitan batteries, assess brain damage, grip, rhythm sound, math, memory, attention, concentration
- Problem: false positives/negatives
What are the aspects of neuroimaging?
Is: pictures of the brain
Objectives:
- Structure: CT (XR), MRI
- Function: PET, SPECT, (radioactive isotopes), fMRI
Advantage: detailed info, better understanding of structure/function
Disadvantages; not well understood, expense, limited –> inadequate norms
What is the purpose, domain, and use/examples of psychophysiological assessment?
- Purpose: asses brain structure & function & nervous sys activity
- Domains: EEG (wave activity) - ERP: event related potentials (spike), HR &strong physiological component
resp, electrodermal (sweat) - Uses: routine psychophysiological assessment- disorders with
- Ex: PTSD, sexual dysfunctions, sleep disorders, headache, hypertensions
What is important about classification?
- part of all sciences: categories based on attributes/relations
- ideographic (individual) & nomothetic (groups) strategy
- Taxonomy: classification in a scientific context
- Nosology: taxonomy in psychological/medical phenomena
- Nomenclature: labels in a nosologically system
- Classical categorical, dimensional, prototypical (combination)
What has changed with the DSM-5?
- Removed axial system
- clear inclusion & exclusion criteria for disorders
- categorized under broad headings
- empirically-grounded, prototypic approach
- new disorders: symptoms x adequately explained existing labels
- problem: comorbidity extremely common
