mid 2 Flashcards
diagnosis
“from a categorical perspective is defined by rules that outline how many and what features of a mental disorder must be present.”
dimensional vs categorical approach
Dimensional
Psychological distress varies along a continuum from
none to extreme, “clinically severe”
All people lie somewhere along this continuum Mental illness is just a variation in degree of
symptoms
Categorical
Psychological disorders are “all or none”—either you
have one or you don’t
Derived from the medical model
How do we know when someone is in psychological distress and/or has a clinically
severe disorder?
Methods of Assessment (Psychological)
Interview (Unstructured, Semi-structured, Structured) Intelligence Tests/Neuropsychological Tests Self-Report Questionnaires
Measures of global personality Measures of specific problems (and/or positive states)
Self-Monitoring Behavioral Observations Projective Tests
Methods of Assessment (Biological)
Neuroimaging (Functional MRIs, PET Scans, etc.) Neurochemical Assessment (Detect neurotransmitters from blood, urine, spinal fluid draws) Psychophysiological Assessment (heart rate/EKG, muscle tension/EMG, sweating/GSR
self report
Client’s retrospective reports of their own
functioning
Indirect measures
Subject to memory bias Subject to social desirability
Clinical Interviews
Necessary starting point that suggests what other types of
measures might be appropriate
Unstructured Structured
Self-Report Questionnaires Self-Ratings
beck depression inventory
Measures cognitive, affective, and somatic symptoms of depression consistent with descriptions in the psychiatric literature Items based on clinical observations and patient symptom reports (atheoretical) High scores in college students could mean overall adjustment problems vs. clinical depression
Psychometric Properties Internal Consistency Ranged from .80 to .90 Test-Retest Reliability Ranged from .48 to .86 in psychiatric populations Was .90 over 2 week among 200 college undergraduates Construct Validity Correlates…. .61 with MMPI Depression Scale .76 with SCLR90-R Scale .66 with Hamilton Depression Scale
self ratings
Subjective Units of Distress (SUDS)
Useful for Anxiety Disorders On a scale of 0-100, how anxious are you right
now?
Typically used in contrived situations
Imaginal, In Vivo, Virtual Reality Exposure
syndrome
“A group of emotional, cognitive, or behavioral symptoms, called a syndrome, that occur within a person.”
self monitoring
The client records the frequency, duration,
intensity, description of events as they happen or as close to that time as possible (e.g. end of the day)
Antecedent, Behavior Consequences Antecedent Belief, Behavior, Consequences
Advantages Does not suffer from recall problems--not retrospective Can provide ongoing data Convenient relative to behavioral observations Provides more complete information than outside observer Thoughts I’m going to fail! Private Situations Sexual Dysfunctions
Disadvantages More time-consuming than questionnaires Reactivity effects Paying attention to behavior and recording it may alter the naturally occurring behavior
behavioral assesment
The therapist records the frequency, duration,
intensity of overt behaviors as they happen or as close to that time as possible
Natural situation or controlled/contrived situation Videotape for later coding Time-consuming and expensive Behavioral reactivity (observation changes client
behavior)
Intelligence test
Wechsler Adult (or Child) Intelligence
Scale
Full-Scale,Verbal& Performance
(Spatial Reasoning) IQ
Neuropsychological Tests
Halstead-Reitan BatteryIndirect measure of brain functioning Assesses many cognitive and behavioral functions Used to make differential diagnoses between cognitive disorders and mood, anxiety, psychotic disorders
Neuroimaging
CT Scan-structural abnormalities MRI-structural abnormalities fMRI-functional abnormalities PET scan-structural and functional
Neurochemical Assessment
Neurotrasmitter metabolites from urine,
blood, spinal fluid (low serotonin levels, high dopamine levels)
psycho-physiological measures
Examining bodily changes associated with
various psychological states via electronic
devices
Primarily used to detect stress, anxiety, and sexual
arousal
DSM-V Cultural Formulation
Cultural identity of the client
Cultural ideas of distress
Cultural factors related to the social environment
Cultural influences on the relationship between
the client and the mental health professional
Overall cultural assessment
Reliability
Is your measure consistent?
Across time Among items Between observers
Validity
Does your measure assess what it’s supposed to
Test-retest reliability
Consistency of test scores or diagnoses across some period of time
Interrater reliability
Agreement between two or more raters or judges about level of a trait or presence/absence of a feature or diagnosis
Internal consistency reliability
Relationship among test items that measure the same variabl
Content validity
How well test or interview items adequately measure various aspects of a variable, construct, or diagnosis
Predictive validity
How well test scores or diagnoses predict and correlate with behavior or test scores that are observed or obtained at some future point
Concurrent validity
How well test scores or diagnoses correlate with a related but independent set of test scores or behaviors
Construct validit
How well test scores or diagnoses correlate with other measures or behaviors in a logical and theoretically consistent way
“Objective personality measures”
“involve administering a standard set of questions or statements to which a person responds using set options.”
projective tests
“such as the Rorschach and TAT rely on the assumption that people project their needs, conflicts, and personality when responding to ambiguous stimuli.”
anxiety disorders
Panic Disorder
With or without Agoraphobia
Social Phobia Simple/Specific Phobia Generalized Anxiety Disorder Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder Separation Anxiety Disorder
Changes to existing Anxiety Disorders
Obsessive-Compulsive Disorder
Removed from Anxiety Disorders
Obsessive-Compulsive & Related Disorders
OCD Hoarding Body Dysmorphic Disorder
Post-Traumatic Stress Disorder
Removed from Anxiety Disorders Trauma & Stress-Related Disorders
PTSD Adjustment Disorder Reactive Attachment Disorder
panic attack
Extreme fear
Intense physical symptoms
Elevated heart rate, chest pain, numbness and tingling in
extremities, dizziness, sweating, shortness of breath
Uncued
No specific stimulus (occurs “out of the blue”) Lasts about 10 minutes Defines Panic Disorder (with or without Agoraphobia)
Cued (Situationally Bound)
In response to a specific situation Characteristic of other Anxiety Disorders
panic disorder
Recurrent unexpected panic attacks and at least one of the attacks have
been followed by 1 month
agorophobia
Marked, Intense Fear: A pronounced and irrational fear of being unable
to get help or find escape if a panic attack should occur. In agoraphobia without history of panic disorder, the expected panic attack is generally
limited in symptoms.
Avoidance or Extreme Distress: The feared situations are avoided if
possible. They can be endured, but only with extreme distress.
social phobia
Marked and persistent fear of social or performance situations and fear of acting in a way that causes personal humiliation or embarrassment
Exposure to the feared social situation causes anxiety that may come in the form of a situationally bound or predisposed panic attack
Recognition that the fear is excessive or unreasonable
Feared social or performance situations are avoided or endured with intense anxiety
Significant interference with daily living or functioning or marked distress about having the disorder
specific phobia
“Animal phobias involve fears of—you guessed it, animals—es- pecially dogs, rodents, insects, and snakes or other reptiles.
Natural environment phobias involve fears of surrounding phenomena such as heights, water, and weather events such as thunderstorms.
Blood-injection-injury phobias involve fears of needles, medical procedures, and harm to self.
Situational phobias involve fears of specific areas such as enclosed spaces in airplanes and elevators.
Other phobias involve any other intense fear of a specific ob- ject. Examples include more common ones such as iophobia (fear of poison) but also unusual ones such as levophobia (fear of things to one’s left), arachibutyrophobia (fear of peanut but- ter sticking to the roof of the mouth), and hippopotomonstro- sesquippedaliophobia (you guessed it—fear of long words).”
gad
Restlessness Easily Fatigued Trouble Concentrating
Irritability Muscle tension seep disturbincw
acute stress disorder
“refers to distressing memories and dreams, negative mood, dissociation (feelings of detachment from reality or dis- connectedness from others), avoidance, and arousal that last between 3 days and 1 month after the trauma.”
anxiety treatments
Biological Treatments
Subject to side-effects and/or dependence, addiction
Psychological Treatments
Psychoeducation (explain causal model and rationale for
treatment)
Somatic Therapy (e.g. relaxation training) Cognitive Therapy (e.g. challenges, replaces cognitive
distortions)
Exposure-Based Therapies (plus Response Prevention)
separation anxiety
“is marked by substantial distress when separation from a major attachment figure occurs or is expected to occur. This distress must last at least 4 weeks in children, so initial distress about going to school is excluded.”
anxiety common…
19-31
women
“Psychophysiological assessment of anxiety-related disorders”
“can consist of determining heart rate, muscle tension, sweat gland activity, and other symptoms to measure their severity.”
“Effective treatment for anxiety-related disorders”
“addresses unpleasant physical feelings, negative thoughts, and avoid- ant behaviors.”
“Psychological treatments for people with anxiety-related dis- orders”
“Psychological treatments for people with anxiety-related dis- orders”
“Cognitive therapy”
“involve techniques such as examin- ing the evidence, hypothesis testing, and decatastrophizing.”
somatic symptom disorder
Medically unexplained
› Pain Symptoms › GI Symptoms › Fatigue › Dizziness › Heart Palpitations
Symptoms not intentionally produced or faked Persistent thoughts and anxiety about symptoms Excessive time, energy devoted to symptoms History of treatment seeking
somatization
“a tendency to communicate distress through physical symptoms and to pursue medical help for these symptoms”
Illness anxiety disorder
“preoccupied with having some serious disease that may explain general bodily changes.”
“last at least 6 months and cause substantial distress or impairment in daily functioning.”
autosuggestability
presenting somatiziation
“refers to somatic symptoms usually presented as part of another mental disorder, especially anxiety or depression”
conversion disorder
Presence of symptoms or deficits affecting
voluntary motor or sensory function that suggest a neurological or other general medical condition
“pseudoseizures, or seizure-like activity such as twitching or loss of consciousness without electrical disruptions in the brain.”
Patients seem relatively unconcerned about these severe symptoms(“la belle indifference,”)
Factitious disorder
deliberately falsifying or producing physical feelings or psychological symptoms
may purposefully make self sick
no external incentives
Munchhausen syndrome
and by proxy
“a factitious disorder in which a person causes symptoms and claims he has a physical or men- tal disorder.”
by proxy=adult onto child
malingering
“refers to deliberate production of physical or psychological symptoms with some external motivation.”
secondary and primary gain
“Secondary gain sometimes refers to receiving social reinforcement for so- matic complaints. Psychodynamic theo- rists view primary gain as unconscious use of physical symptoms to reduce psychological distress.”
“illness beliefs or attributions,”
“perceived causes of physical symptoms.”
Somatosensory awareness
amplifying physical sensations
somatic treatments
Cognitive Therapy
›Reappraisal of physical symptoms ›Re-evaluate probability of disease
Contingency Management
Involve others in the environment to refrain
from reinforcing sick role and other unhealthy behaviors
Response Prevention
›Prevent doctor shopping, surgeries, etc
“Biological risk factors” somatic disorders
“genetic predispositions, as well as key brain changes in the amygdala, hypothalamus, limbic system, and cingulate, prefrontal, and somatosensory cortices.”
Predictors of chronic somatic symptom disorders
Severity of symptoms
Female gender
Co-morbid mood problems
Unrealistic fears of illness
Body dysmorphic disorder
Preoccupation with a “deficit” in
physical appearance
›Related to OCD ›Multiple cosmetic surgeries
dissociative disorder
"often involve disturbance in consciousness, memory, or identity" Dissociative Amnesia ›Dissociative Fugue Depersonalization/Dereali- zation Disorder Dissociative Identity Disorder › Previously Multiple Personality Disord
dissociative amnesia
Forgetting highly personalized information
›Name ›Family members ›Childhood events
Precipitated by a traumatic event Not caused by neurological/medical
disorder or substance abuse
dissociative fugue
Sudden, unexpected travel away from home with inability to recall one’s past Confusion about personal identity or assumption of a new one Precipitated by trauma
Depersonalization/Derealization Disorder
The presence of persistent or recurrent experiences of depersonalization, derealization, or both:
1. Depersonalization: Experiences of unreality, detachment, or being an outside
observer with respect to one’s thoughts, feelings, sensations, body, or actions.
2. Derealization: Experiences of unreality or detachment with respect to
surroundings.
B. During the depersonalization or derealization experiences, reality testing remains intact.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g., seizures).
DSM-5 Depersonalization/Derealization Disorder
E. The disturbance is not better explained by another mental disorde
dissociative identity disorder
Presence of two or more
distinct identities of personalities each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self
one-third of patients complain of auditory or visual hallucinations
dissocaitive prevention
eaching children to report maltreatment Educating children about unsafe situations
Teacher parents appropriate disciplinary practices Providing support groups for parents
dissociative treatment
hypnosis
“The biological treatment of dissociative disorders usually includes medication for concurrent symptoms of anxiety, depression, and other problems. Psychotherapy for dissociation helps a person reintegrate consciousness, process traumatic events, and learn to cope with daily events without using dissociation.”
major depressive episode
“involves a period of time, typically at least 2 weeks but usually longer, in which a person experi- ences sad or empty moods most of the day, nearly every day”
major depressive disorder
“sometimes called major depression or unipolar depression, usually involves a longer period during which a person may experience multiple major depressive episodes”
With anxious distress
With psychotic features
With peripartum onset
Post partum depression
With seasonal pattern
Seasonal Affective Disorder
“Persistent Depressive Disorder (Dysthymia)”
Chronic feeling of depression for at least two years
“low grade” depression
manic episode
Flight of ideas Grandiosity “I feel like I have the world by the balls!” Impulsivity Sexual promiscuousness, affairs Shopping, spending sprees Dangerous activities
hypomanic episode
“comprises the same symptoms as a manic episode but may not cause severe impairment in daily functioning. Unlike “bursts of energy” that many of us occasionally have, hypomanic episodes last at least 4 days”
bipolar 1 disorder
“disorder refers to one or more manic episodes in a per- son. The disorder is sometimes called manic-depression because a person may alternate between episodes of major depression and mania or hypomania.”
bipolar 2
“comprises episodes of hypomania that al- ternate with episodes of major depression. Full-blown manic epi- sodes are not seen as they are in bipolar I disorder”
cyclotymic disorder
“sometimes called cyclothymia, refers to symptoms of hypomania and depression that fluctuate over at least a 2-year period”
mood disordeer risk fCTORS
Biological
Genetics (39-50% Depression; 80% Bipolar Disorder)
Family & Twin concordance rates
Brain Features Neurochemical Features
Depression Lower levels of serotonin Lower levels of norepinehprine
Bipolar Disorder Lower levels of serotonin Higher levels of norepinephrine
Environmental
Stressful Life Events
Precipitate onset Severity and Meaning of the event Uncontrollability of the event
Job loss School failure Relationship break-up Major illness or injury Death of significant other
Cognitive Factors
Cognitive Distortions/Automatic Thoughts Cognitive Triad (Aaron Beck) Negative View of the Future = Hopelessness Learned Helplessness (Martin Seligman)
Nothing I do will make a difference
Interpersonal Factors
Social Skill Deficits Lack of Social Support Relationship Conflicts Social Reinforcement of “Sick Behavior” Depressed people are socially off-putting to
others
prevent mood disorders
Declare existing strengths
Manage stress Modify negative and irrational thoughts Solve problems efficiently
Develop and use social support networks
Enhance social skill and recognize other perspectives
mood disorder treatments
Medications (See Tables 7.14 & 7.15)
Lithium (mood stabilizer for Bipolar Disorders)
Highly toxic, requires regular blood tests
Selective Serotonin Reuptake Inhibitors (SSRIs)
Celexa, Lexapro, Prozac, Zoloft, Paxil, Luvox
Fewest side-effects
Tricyclics
Moderate side-effects
Monoamine Oxidase Inhibitors
Severe side effects, dietary restrictions
Electroconvulsive Therapy
Repetitive Transcranial Magnetic Stimulation
Cognitive Therapy/Cognitive Restructuring
https://www.youtube.com/watch?v=m2zRA5zCA6M
Behavioral Activation Therapy
Increasing daily activities and exercise
Set up reinforcement schedules (self and others)
for these
Mindfulness
Interpersonal Therapy
Social Skills Training
Support for relationship transitions
