Module 1 revision Flashcards
What is psychopathology?
Psychopathology includes the study of clinical descriptions, diagnosis, aetiology epidemiology, prognosis and treatment
What is a mental disorder?
is a syndrome characterised by clinically significant disturbance in an individual’s cognitive, emotion, regulation or behaviour that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning
What distinguishes a mental disorder from normal behaviour?
Significant distress or disability and not explained through a culturally approached response or social deviance between individual and society, APA, 2013
What is reliability?
Reliability = the consistency of the measurement over time
What is inter-rater reliability?
the degree to which 2 independent observers agree on a clinical observation
What is test-retest reliability
The extent to which people receive similar scores across time after taking a test / clinical observation
- only tested on things not liable to change over weeks/months, eg. IQ rather than mood
What is alternate-form reliability and why may it be used?
- The extent to which two forms of the same test are consistent over time
- researchers may use different tests of the same dimension to avoid first-order/repetition effects in participants/clients)
What is internal consistency reliability + example?
Where items on a test are related within the questionnaire, eg. the scores should correlate with one another if they adequately measure a disorder
eg. scores of dry mouth and muscle tension should be higher in anxiety
What is validity?
Whether a measure measures what it is supposed to measure,
eg. whether the questionnaire accurately measures “hostility”, “anxiety”
What is criterion validity and what does it measure?
Criterion validity measures whether test scores are linked with other tests measuring the same dimension,
eg. whether anxiety scores are similar across multiple anxiety tests
What is content validity and what does it measure?
Content validity is whether a measure adequately covers the domain of interest,
Example - a social anxiety test covering anxiety in a range of different social settings
What is construct validity?
- Construct validity is about interpreting a test as a measure of a construct not observed overtly, known as an inferred attribute, eg. distorted cognition
What 4 things does construct validity want to predict?
- biological vulnerability
- triggers
- mental + physiological symptoms
- functional impairments
“A group of high school students given the same IQ test in a row” is an example of what?
Test-retest reliability
Ameasureofthetendencytoblame
oneselfisdeveloped,andresearchersthen test whetheritpredictsdepression,
whetheritisrelatedtochildhoodabuse,andwhetheritisrelatedtoless assertivenessintheworkplace
is a measure of what?
Construct validity
Ameasureofdepressionisdeveloped,andresearchersthentestwhetherit predictsotherinterview-basedand othermeasuresofdepression
is a measure of what?
Criterion validity
Peopleareinterviewedbytwodifferentdoctors.Researchersexamineif the doctorsagreeaboutthe
diagnosis
is a measure of what?
inter-rater reliability
Who started ideas about clustering syndromes as disorders?
In psychiatry, Emil Kraepelin in 1883
noticed groups of symptoms of behaviour clustered together as a syndrome, he hypothesised each to have their own cause, first introduced explanations for dementia praecox (schizophrenia) and manic-depressive psychosis (bipolar disorder)
What are some positives of the ICD and when was it founded
- Founded in 1939 by the WHO current is the ISD-11 (2018)
- available to public at no cost
- Some conditions not in DSM, eg. C-PTSD, gaming disorder, compulsive sexual disorder
What are 2 limitations of the ICD?
- Uses guidelines not criteria, issues for reliability for diagnosis and inter-rater reliability may be affected
- Only one personality disorder present with different domain areas similar to DSM-5, eg. borderline pattern and some new, eg. negative affectivity
What are some markers of the DSM-5?
- Specific markers for diagnosis and good operational definitions and descriptors of a disorder,
Uses clinical discretion + empirical evidence and good reliability
The DSM-5 considered different types of information affecting diagnosis, such as life-span developmental approaches, gender, culture, physical health, disability and diagnostic assessment instruments
Field studies were done to evaluate changes made to DSM-5
Is the multi-axial system still used?
- Diagnoses were listed on separate dimensions / axes, and required judgments on each of the five axes, forcing the diagnostician to consider a broad range of information, but is no longer used since DSM-III
What are 3 types of additions to the DSM-5?
- made arabic letters DSM-5
- New disorders
- disruptive mood dysregulation disorder
- hoarding disorder
- binge-eating disorder
- premenstrual dysphoric disorder
- gambling disorder
- prolonged grief disorder - Combined disorders
- substance abuse + dependence → substance use disorder
autism + Asperger’s → autism spectrum disorder.
Why is the DSM disorders arranged by symptoms instead of biological or genetic etiologies?
we don’t have enough info to base it on aetiology / biological reductionism
Why are DSM disorders organised in chapter categories?
The chapters are grouped in categories to show shared causes and comorbidity patterns, eg. OCD disorders, ED disorders, personality disorders
What are the 3 Cultural additions to the DSM-5-TR?
- Culture-related issues are discussed in the text for almost all disorders
- A cultural formulation interview -
16 questions to understand how culture may be shaping clinical presentation - An appendix of cultural-specific syndromes of distress, + cultural explanations about the causes of symptoms, illness, and distress
What are the arguments for and against including broad syndromes across cultures or to differentiate cultural concepts?
- Some argue for a cross-cultural approach, pointing to similarities between cultural concepts of distress and DSM diagnostic criteria
- Others argue that cultural concepts of distress are central and that ignoring them may lead to underestimation of psychiatric disorder prevalence
What are the 2 main criticisms of the DSM?
- Too many diagnoses
DSM-5-TR even includes the category “unspecified,” disorders which is to be used when a person meets many but not all of the criteria for a diagnosis
- Too many disorders? Could some be grouped/clustered given high comorbidity rates (45%) is the norm?
HOW is caffeine intoxication disorder as a mental illness? Or acute stress disorder?
What are 2 reasons why might it be a good idea to cluster disorders together?
- Many disorder have high comorbidity rates often occur because symptoms are present in multiple diagnostic categories, eg. social withdrawal, repetitive behaviours
- disorders often share risk factors and treatment plans in common, eg. SSRIs, genetic vulnerability to multiple disorders
In the case of Susannah Cahalan, who had anti-NMDA-receptor-autoimmune encephalitis - what was she misdiagnosed as and what do we need to consider?
- Schizophrenia
- Hence we need to consider that behavioural symptoms can be indicative of various conditions.
What does the HiTOP diagnostic model - Hierarchical Taxonomy of Psychopathology use to cluster disorders together?
- The HiTOP uses patterns of COMORBIDITY to group disorders
Example - somatoform, internalising, thought disorder, disinhibited externalising, antagonistic externalising and detachment
What does the Research Domain Criteria, or RDoC use to cluster disorders together? (NIMH)
The RDoc focuses on RISK FACTORS relevant to multiple conditions,
Example - cognitive or social problems, lack of emotional regulation
Why must diagnostic criteria be clear and quantifiable?
When diagnostic criteria are vague, eg. “abnormally elevated mood” - clinicians are liable to personal biases in making judgements
What are the 4 steps clinicians go through before making a diagnosis?
- Clinical interviews
- Physical exams
- Other tests and referrals
- Clinical based assessment
What are the 3 reasons why a diagnosis is made in psychopathology?
- Describe - To give a description to accommodate signs and syndromes within a social construction in a categorisation system
- Find causes - into origins and triggers of behaviours
- To predict - describe behaviours and impaired functions
What are 4 disadvantages to receiving a diagnosis as a patient?
- A diagnosis is descriptive not an explanation, underlying processes may be overemphasised
- Labels can cause stigma and discrimination and affect self-concept
- Overlooks lived experience “client with x” not “x person”
- Could be a misdiagnosis - decision making is still a risk to error,
Decision making can lead to false positives/negatives. What is a false positive and false negative?
(type 1 error) False positives - when therapist makes decision that you have something and you don’t
(type 2 error) False negative - when therapist makes decision that you don’t have something and you do
What are the respective implications of receiving a false negative and a false positive?
- False negatives accidentally deny someone to treatment
- False positives offer a patient the wrong/inappropriate type of treatment
Why do diagnoses need to have both high sensitivity and specificity?
Decisions need to have both high sensitivity and high specificity rate to avoid false positives and negatives, eg. think of Hit/miss model
What is a categorical classification for disorders and what does it assume?
I have disorder or do not have disorder (one threshold to become ‘diagnosable’ - it is a dichotomy and assumes all people are at one of two of those levels
What are the two disadvantages of a categorical classification?
- It has little evidence to support DSMs diagnostic threshold for disorders
- Many people at ‘subthreshold’ level still experience high distress and low functioning
What are the 2 advantages of a categorical classification?
Categorical classification is good to demarcate disorders to make
- differential disorders - comorbidity occurs often but doesn’t always mean people have an overlap in disorders
- appropriate treatment -
What is a dimensional classification?
= the degree to which an entity is present, from 1-10
What are the 2 advantages of a dimensional classification?
- Measures both the presence and the severity of a disorder - indicating pathways to appropriate treatment and resources
- It includes both subthreshold and severe cases of mental illness
- Considers the variability across the population
How is the DSM adopting a more dimensional approach in 2 ways?
- Emerging models and measures contain a dimension approach, but all main disorders still have a categorical approach
- The DSM provides severity rates for nearly all disorders, to distinguish acute, early signs, reactive or clinical rates of a disorder
What are transdiagnostic criteria?
Transdiagnostic criteria are criteria that across disorders
What does a disorder with a large number of transdiagnostic criteria indicate?
- the construct validity may not developed enough?
- the specificity may not good enough
What is an example of low construct validity in a disorder?
ED have overevaluation of body weight leads to EDs but does not do a very good job at identifying or predicting types of eating disorders
What is the Power, Threat and Meaning Framework?
- The PTM framework is a new alternative to diagnostic criteria that focuses on social and relational contexts in disorders
What are examples of each aspect of the Power, Threat and Meaning Framework?
- What happened to you? (power)
- How did it affect you? (threat)
- What sense did you make of it? (meaning)
When may impressions evaluation be used?
- used when formal assessment is not appropriate) - eg. restrictions of environment, emergencies, limited communication skills
- Made not be comprehensive enough to determine a disorder or treatment
What is case formulation?
Comprehensive understanding of patient’s problems, and factors that contributed to their problems to make a treatment plan to ensure needs and interventions can be implemented
- Questions asked in a clinical interview in order
- Areas of distress - why are you here? Voluntary / involuntary
- History of mental health problems / complaints
- Social history - support networks or lack thereof /Cultural factors - to explain behaviour in a socio-cultural context
- Other factors - ie. medical conditions, risk factors
What are unstandardised clinical interviews?
Unstructured interviews
- have open questions
- rely on therapeutic experience/intuition
- get huge scope on patient’s situation
What are 2 disadvantages of unstandardised questions?
- Inter-rater reliability can vary across clinicians
- Less systematic
What are standardised clinical interviews used for?
How are they conducted?
- used to assess whether someone meets diagnostic criteria
- Follows prescribed questions for psychologist to follow in training, eg. SCID
- Symptoms are rated on a three-point scale for severity that are translated into diagnostic status
What 5 skills does a clinician need to have?
- Building and maintaining rapport
- Empathy and reflective listening
- Observation - verbal and non-verbal behaviours, attention, nervousness
- Knowledge of clinical symptoms
- Person-centred and make the interview individualised
What are 4 things clinicians need to consider in cultural compentancy?
- Be aware of cultural values and biases
- Be aware of how cultural values may be [in]congruent with policy, procedures and reform
- Learning how a mental illness is described in a person’s culture
- Knowing what concepts/language may be taboo and cause shame/embarrassment
Cultural awareness vs. cultural safety?
- Cultural safety = refers to the experience of the person seeking help
- Cultural awareness refers to the ability to be culturally competent and practice cultural safety
What is the scientific practitioner model?
- The SMP model is about evaluating and assessing the effectiveness of methodology, diagnostic process, intervention selection and delivery, monitoring outcomes to achieve the outcome
- Combines science with professional practice
What are the two criticisms of the SMP model?
- Scientific research is oversimplified for clinical practice
- There is an over reliance on evidence-based models - may unhelpful for individuals, especially culturally diverse
What does the MMHS stand for and what is it used for?
Mini Mental Health Status Exam =(dementia/alzheimers, depression, TBI, schizophrenia)
- tests for standardised cognitions in 5 areas
- initial assessment for diagnosis, test cognitive functioning, track a disorder over time or determine a diagnosis, monitor treatment
- Score varies from 0-30, scores over 24+ cognitive functioning,
scores under 24 indicate cognitive impairment
What are two different pharmacological treatments for depression and what are they depend on?
MDD without cog. impairment = SSRI
MDD + cog. impairment = Cholinesterase inhibitors to increase acetylcholine to improve cognitive function, memory, attention etc
What are 2 advantages and 2 disadvantages of the SCID interview?
Pro 1 - Has good retest and inter-rater reliability as a diagnostic tool
Pro 2 - Covers multiple diagnoses to use as a screening tool
Con 1 - Time consuming
Con 2 - Western focus and relies on self-reports
What is the ABC framework in clinical settings? and what can it be used for?
ABC framework - “antecedents - behaviour - consequences”
- Can be used for naturalistic or controlled (analogous) observations to watch behaviour
What is the MMPI and what is it used for?
Minnesota Multiphasic Personality Inventory
- for psych and personality constructs 567 questions, depression,, assertiveness, neuroticism
- uses standardised scores on a normal distribution for wide range of settings
2 limitations of the MMPI?
- cultural biases as based on western populations, limited as clinical tool
- Has not integrated new psych constructs into the inventory, static nature
What is the BDI?
Beck Depression Inventory
(BPI-2 1996)
- 22 questions for depressive symptoms
- easy to administer
- high sensitivity to detect subtle changes over time
- used on patients across cultures and ages
2 limitations of the BDI?
- BDI has limited to assess functioning in depression
- limited use as a diagnostic tool and overreliance in clinical settings may oversimply depression experience
What are two examples of projective tests?
- Rotstsch inkblots - patients encouraged to be creative and spontaneous
- Thematic Apperception Test
- a story from a picture and include feelings and desires of characters interpreted in a scene and the outcome of the scene
What are some examples of test factors?
Age, language, disability, education, culture, and reading level
What is the Tower of London test and who is it for?
- Moving items to and from pegs in shortest about of moves in a set time and in accordance with rules
- Measured to assess traumatic brain injury and reasoning skills
What does the intelligence quotient measure and who is it for?
Measures non verbal abilities, perception and verbal comprehension for clinical and research settings in people with learning and neuropsychiatric disorders
Who came up with the first theory of distress and what was the theory called?
Hans Selye + General Adaptation Syndrome (GAS) -
states that biological responses to sustained high levels of stress cause three phases: alarm reaction, resistance, and exhaustion
How do tests like the MMPI use validity designs to account for limitations with self-reporting?
Validity designs to detect over or underreporting symptoms or experiences -
- including statements like “i read newspaper editorials every single day” to detect if people are over reporting behaviours that they are unlikely to do in real life
What is the LEDS test and what is it used for?
The Life Events and Difficulties Schedule (LEDS) (Brown & Harris, 1978)
- with over 200 different kinds of stressors
-The LEDS interviewer and interviewee produce a calendar together of major life stressors to address problems - includes as set of strategies to date when life stressors occurred and used as robust predictors of different disorders, eg. depression, schizophrenia
What does the Big 5 contain?
- openness to experience
- conscientiousness
- extraversion
- agreeableness
- neuroticism
What is the Big 5 test relevant for?
testing personality disorders, mood and anxiety disorders
What is the direction/link between education and IQ?
Positive link between IQ and educational success but unclear of bidirectional relationship
BUT low construct validity because school success is also dependent on other factors such as family life, motivation, socio-economic difficulties, friendships, stereotype threat
Direct Observation
divide sequence behaviours into various parts within a learning framework
behind a one-way mirror for researchers
Experience Sampling + relevant test
= asks people to monitor and record their own behaviour and responses of daily experience to collect data on different people, emotions, stressors, coping behaviours and thoughts
Example - Ecological Momentary Assessment (EMA) a text message alert many times a day
Translations challenges to tests
- Translations - Need to use real translators, back translating and testing with many native speakers to ensure the test is similar and measures the same things as the original
- guidelines are not always followed of test transitions and cultural biases can cause clinicians to over/underestimate mental health problems, this can be reflected in different rates of diagnosis across cultures
How does cultural perception of emotion impact clinical presentation?
Misunderstandings about culture and emotion, despite asian cultures want to feel low-arousal positive emotions like calmness and contentment, over Americans desire for excitement
an asian may appear to have dysthymia/anhedonia when they express emotions and value different emotions
What is the link between the ideal vs. current self in depression?
Depression is more likely to occur when there is a greater discrepancy between what one wants to feel and what one currently feels— that is, a discrepancy between ideal and current affect—is associated with depression
What is more important in genetics? - sequencing or individual genes
sequencing genes (20-25000 genes)
What is heritability?
the extent to which variability in behaviour in a population is accounted for through genetics from 0.0-1.0
Can you discuss heritability at individual or group level?
Only at a group level, eg. ADHD population is found to be 70% attributed to genetics
What is shared vs non. shared environment?
things family members have in common vs. things family members don’t have in common
What is the link between heritability and SES?
- low SES found 60% of IQ is attributed to environment,
- high SES found 40% of IQ is attributed to environment
shows how impoverished environment has a bigger influence on IQ than affluent one
- what is a polymorphism?
- what is the most common polymorphism?
- a polymorphism is a difference in DNA sequence of a gene
- single nucleotide polymorphisms
What are copy number variations?
CNVs occur when there is an abnormal coy of DNA in a gene, can be additions or deletions
What is a polygenic combination in disorders?
genes said to be associated with a disorder
How could neurotransmitters influence disorders?
- poor neurotransmitter uptake - failure of pumps to reuptake chemicals back into the pre-synaptic neuron
What 3 things does the textbook define as a psychological disorder?
- personal distress apart from normal reactions like grief or certain disorders like ASPD
- disability / dysfunction - impairment to daily living, except as not all psych. disorders cause dysfunction and not all disabilities are psychological
- violation of social norms, exceptions is that not all acts of social deviance stem from a psych disorder, not everyone with psych disorder violates social norms, eg. SAD
What did Hippocrates believe mental illness was?
- a disturbance of 4 fluids which physicians prescribed to fix through sobriety, abstinence and good nutrition
