PSY311 Midterm 1 Flashcards
Evolutionary definition of psychological disorders
Harmful dysfunction ‘’. Psychological disorders: failures of one or more mechanisms to perform their evolved function, producing harm
E.g. Feeling queasy vs. fainting at the sight of blood
Acting like you are in danger in both a dangerous or safe place. the degree of dysfunction is important
Psychological dysfunction determined by the presence of following characteristics at one time within a person. Name and explain th e 4
Statistical infrequency: infrequently
personal distress or impairment: can be related to a personal distress. Context and degree of distress matter . impairement helps clarifiy is a disorder is involved
‘’violation’’ of norms: atypical, deviate from average. Think about the example of Massai Tribe: woman who kills goat and hears voices
unexpectedness: Unexpected responses to environmental stressors. (ex. laugh after being assaulted
What is the definition of psychological disorders by the DSM-5?
- Behavioral, psychological or biological dysfunctions
- Unexpected in their cultural context
- Linked to present distress, impairment in functioning, or increased risk of death
- DSM criteria: prototypes/profiles of disorders.
What is scientist-practitioner?
- Latest development in the history of psychopathology
- Evidence-based practice
- Using scientific method the treatment of psychological disorders
e. g. what is it about the treatment that accounts for observed changes in an individual with a psychological?
what are the clinical description of a disorder used before and today? (name and explain the 5)
- Resenting problem: why did client/patient come into the clinic/hospital?
- Prévalence: How many people in the population have the disorder?
- Incidence: How many new cases occur during a given period?
- Sex ratio: proportion of male and females who have the disoder
- Age of onset: When, on average, do people develop the disorder?
Clinical description of a disorder cntd.
Prognosis: Anticipated course of disorder (does it get
worse, does it last, etc.) - it is a global concept
Course:
Chronic: tend to last a long time
Episodic: recover after a few months, but likely
to reoccur
Time-limited: improves without treatment in
short period of time (it is rare)
Onset:
Acute: begin suddenly (not relevant symptoms
that develop) (rare for bipolar
symptoms) (ex. Schizophrenia)
Insidious: develop gradually over time (bipolar
symptoms)
historical concept In the science of psychopathology section, what is the etiology and treatment for a disorder?
Etiology:
Study of the origin of disorders
Complex biological, psychological, and social aspects
Treatment
Success → nature and cause of the disorder
Effect does not always imply the cause!
Past: Historical conceptions of abnormal behavior Dark age (3 traditions)
- Supernatural
- Biological tradition
3 Psychological tradition
Dark age: Supernatural tradition
Demons and Witches:
13th and following few centuries: Recurrent famines and plagues. Demonology to explain disasters: Pope Innocent VIII & Malleus Maleficarum (1484). Individuals with a psychological disorder under influence of devil and witches
anything out of the norm = deviant
Typical treatment: exorcism, trepanning (opening a living crane to take out the ‘’Evil’’
Stress and melancholy (stress and anxiety= mental illnesses) Late 14th / 15th century. Traitement: rest, sleep environment - no more evil in treatment.
Moon and stars : explain behavior, lunatic, Paracelsus a swiss physician. Movements of moon and stars affecting human psychological functioning
Dark age - biological tradition
Hippocrates, Galen, JOhn and treatment + contemporary
Somatogenic perspective: physical/biological causes of mental disorders.
E.g. Important figures Hippocrates and Galen, John P. Grey
Hippocrates: Greek physician (460-377 BC)
Separated medicine from religion, magic, superstition
Mental illnesses had natural causes (brain pathology) →
Should be treated like other illnesses
Possible treatments: rest, good nutrition, exercise, bloodletting. Should consider the environment
Biological factors: Four Humors theory
- Blood: heart
- Black bile: spline
- Yellow bile: liver
- Phlegm: brain
Galen: roman physician
Adapted Four Humors theory, biological factors only
Blood = sanguine (optimistic, cheerful)
Black bile = melancholic (depressive)
Yellow bile = choleric (irritable, anxiousness)
Phlegm = phlegmatic (sluggish)
John P. Grey: American psychiatrist (1825-1886) very important. Insanity always has physical causes
Possible treatments: rest, diet, temperature, ventilation (in hospital especially - making it more liveable)
Hospital care improved, but eventually impersonal
Dark age - biological tradition: biological treatments - continuum
Biological treatments- continuum
1930: Lobotomy: surgical operation, incision
Electroshock (at that time and the difference now is very important) at the time it was introduced to reduce psychotic and behavioral symptoms… It was supposed to ‘’cure’’ by having less brain functioning.
1950: Reserpine: previously used to reduce agitation, but not anymore
Major tranquilizers (neuroleptics): reduce hallucinations, delusions, agitation…
Minor tranquilizers (barbiturates, benzodiazepines): reduce anxiety, muscle relaxant, insomnia
seems like the perfect solution to the problem
side effect isn’t taken into consideration
1970s:
Side effects observed: e.g. dependency, dementia
Dark age - biological tradition: Beginning of contemporary thought and End 19th century
Emil Kraepelin, German psychiatrist (1856-1926) – Founder of modern psychiatry
2 major groups of severe mental diseases
Dementia praecox: praecox madness. Disused term nowadays. dementia in his terms isn’t like AD he describes dementia as: Chronic psychotic disorder characterized by cognitive disintegration- it worsens over time. psychotic disorder (today would be schizophrenia).
Manic-depressive psychosis: today it would be bipolar disorder. depressive episode. Persistent sadness, period of hopelessness. The term is not used anymore.
End 19th century
Search for biological causes
Psychosocial intervention mostly non-existent, before Kraepelin, it was taken into consideration
both needed to be taken into consideration
Dark age - psychological tradition
Moral therapy
Philippe Pinel, French psychiatrist (1745-1826)
- Hospital conditions more humane and therapeutic
Moral therapy Encourage social interaction Reinforcement of behavior Restraint and seclusion eliminated 1.1 Moral therapy declining
§ Mid 19th century
§ Humane treatment declined
Mental Hygiene movement (Dorothea Dix- social activist, school teacher yet teaches in jail) she tries to raise awareness in hospital. She said hospital was a place to treat basic need and not therapy as it should.
Trying to raise awareness of deplorable conditions
Humane treatment ↑ available, but ↑ mental patients
Moral therapy ≈ custodial care
Mental illness caused by brain pathology
Dark age - psychological tradition
hypnosis
Anton Mesmer, German physician (1734-1815)
Individuals’ problems due to unconscious force of “animal magnetism”
- Re-establish equilibrium of magnetic fluid
- walking around and touching patient with a wand and tell the patient to heal themselves with the magnetic fluid around them. he claims it re-establish balance with the animal magnetism
was quickly dismissed by the hospital! But he succeeded in opening the mind of people of that.
Dark age - psychological tradition
6 types + Josef Breuer
Psychodynamic Humanistic-existential Behavioral Cognitive-behavioral ‘’mindfulness’’ but not official yet - it is a new wave
Josef Breuer, Austrian physician (1842-1925) - protégé is Sigmund Freud
Talking cure
- Emotional under hypnosis: express/relieved repressed trauma and related emotions
Relieved post-hypnosis: Patients did not see a link between emotions and psychological disorder
. Ana Quo, a famous case, is a lady that has a bunch of various symptoms. Breuer used a talking cure to address the symptoms.
He said: patients seem to express things that they won’t normally say but when unconscious. Accumulation of conflict, unresolved trauma, within our mind.
Catharsis: Reliving emotional trauma and releasing tension
Psychological tradition - at first + psychodynamic perspective. Explain it
Psychological tradition Intrapsychic conflicts Insight into the processes Mostly unproven traumatic event usually happens within the first 5-6 years of life
3.1 Psychodynamic perspective
Go back in time to understand what led you there (Judith’s approach)
Sigmund Freud, Austrian neurologist (1856-1939) – Breuer’s protégé
Structure of the mind:
Id: “pleasure”; source of (instinctual) drives
Ego: “reality”; mediator
Superego: “moral”; conscience
Psychological tradition - at first + psychodynamic perspective. Ego’s defense mechanisms (today, coping styles)
Name and explain
Rationalization: Justifying unacceptable ideas/actions/feelings (ex. not getting a job = making reason why they did not want the job in the first place)
Displacement: Transferring a feeling/response to object/person causing discomfort (mad at your boss so yo yell at your husband)
Projection: Attributing one’s unacceptable feelings/impulses (if you dislike someone, you start thinking that it is the person that does not like me)
Denial: No acknowledgement unacceptable behaviors/feelings/ideas (ex. : What are you talking about? vs justification: shows statistics, gives reasons…)
Reaction formation: Behaving in the opposite way (ex. assault people, stuck with the urges… but great protector of the society or for wome, or individual against sexual but maybe are against the fact that they are homosexual
Repression: Pushing away a disturbing memory/thought/desire (traumatic events) someone abused, never think about it years later, barely remember. It would translate into your behavior: trouble to commit, to trust someone
Sublimation: Converting unacceptable urges to acceptable behaviors. ex. run because you are angry, keeping a journal
Psychological tradition: Psychodynamic perspective- again with Sigmund Freud
Explain his contributions, critics, and contributions
3.2Psychodynamic perspective- again with Sigmund Freud
Introspection: delve into nature of unconscious mental processes and conflicts
Catharsis
Insight
Free association: “Say whatever comes to your mind”
Dream analysis: Content of dreams ≈ Id processes.
He was criticized because it is very subjectives
Transference: Patients relate to therapists in similar ways that they did to important figures earlier in life. often the patients are unaware of that. Expectation of a relationship that they had in the past but now towards the therapist.
Criticism:
Lack of objectivity
Unscientific (biased)
Contributions:
Early-life experiences help shape adult personality
Highlighted unconscious mental processes
Defense mechanisms, today referred to as coping styles
Therapist-patient alliance
Psychological tradition:Humanistic-existential perspective
Greater emphasis on person’s freedom of choice – conscious process: Free will. Become your best self
Psychopathology ≈ result of difficulties with/blocked self- actualization severe psychological
disorders
Jung and Adler (1875-1961/1870-1937) Jung: setting goals for the future Adler: contributing to society Self-actualization: reaching full potential if freedom of growth positive view, will power
Abraham Maslow (1908-1970) Hierarchy of needs Need for self-actualization the pyramid - Physiological needs, safety needs, love and belonging, esteem and self-actualization
*Carl Rogers (1902-1987): Person-centered therapy
Therapist takes a passive role
the idea is not to guide the patient, the patient is the key to its own success. The therapist is there to remind them that they are the master of their destiny. Each individual has blockage (ex. I won’t get that grade…). Patient is often anxious or have different symptoms, which makes it hard to use this approach nowadays.
Unconditional positive regard
Need for self-actualization
Psychological tradition: Behavioral perspective
Pavlolv, Baby Albert and Systematic desensitization, Skinner and contributions + critics
Ivan Pavlov, Russian physiologist (1849-1936) – Classical conditioning
- Neutral stimulus–response pairing until automatic response
- Experiments with dogs
Baby Albert
Systematic desensitization
Joseph Wolpe, South-African psychiatrist (1915-1997) –
Systematic desensitization
Gradual exposure to words, images, and situations about the fear object to extinct that fear
B. F. Skinner, American psychologist (1904-1990) – Operant conditioning
Not all behavior is automatic
Can be strengthened or weakened:
Reinforcement*
Punishment
Criticism: Little room for cognitive processes
Contribution: Contributed to understanding of
psychopathology
Psychological tradition: Cognitive-behavioral perspective
Thoughts and information processing can become distorted → maladaptive emotions and behavior
Attributions about the events in life
Negative attributional style in depressed
individuals: attribute negative events to internal
sources
Positive attributional style: attribute negative
events to external sources
Psychological tradition: Cognitive-behavioral perspective: faulty attribution to depression
wha is CBT? who is the founder? what are the contributions and critics?
negative: stable, global, internal and depressing
positive: temporary, specific, external, successful coping
Aaron T. Beck, American psychiatrist (1921-2021) – one of the originators of (CBT). Techniques for addressing faulty attributions associated with depression (but now also used to treat different disorders such as ED, PTSD, GAD, etc.)
he role of the therapist is to find ways to address these strategies, identify goals and symptoms of the disorder
helps the client to keep track of their journey, of how they interpret things and with help they overcome.
E.g. Self-monitoring, cognitive restructuring (help with cognitive distortion)
ex. this person did not say Hi to me… I was not invited to that dinner… My friends don’t like me…
Criticism:
Unclear differences between behavior and cognitive influences (also difficult to know is it A to B or B to A?)
No explanation on the causes of schema, nature vs nurture
Contributions:
Strong evidence of its benefits in improving depression,
anxiety disorders, eating disorders, schizophrenia
E.g. CBT can be more effective long-term than antidepressants in treating depression
Present: Scientific method and an integrative approach
What are cumulative drawbacks? and current attitudes?
Much progress - biological, psychoanalytic, and behavioral models continue to further knowledge of psychopathology
Cumulative drawbacks:
Scientific method not always used to provide empirical
support
Health professionals look at psychological disorders
narrowly
Current attitudes
Many are still suspicious of people with mental
health issues
Consequence: many people with mental illness do not
seek help (especially with personality disorder but
others too) so we don’t really know how many
people have a disorder.
Integrative approach to psychopathology : Multidimensional integrative approach
what are the 4 dimensiond?
Biological dimension: Genetics, neuroscience, neurobiology
Psychological dimension: Behavioral, emotional, cognitive processes, thoughts
Social dimension: Interpersonal, social, cultural influences
Developmental dimension: Sensitive developmental periods
It all influences each other
Psychopathology cannot be explained by one cause: abnormal behavior due to multiple influences
Integrative approach to psychopathology ,
1. Biological: genetics and neuroscience
what are gene? What are the nature of genes? and its chromosomes?
Genome: dominant genes vs recessive genes, development/behavior: polygenic
Epigenome
Genes
Molecular hereditary unit of a living organism
DNA molecules at various locations on chromosomes within cell nucleus
Nature of genes 23 pairs of chromosomes (total of 46) 1 from mother and 1 from father 22 pairs determine body/brain development = autosomes 23rd pair = sex chromosomes Female (both X chromosomes) Male (X and Y chromosomes)
dominant genes vs recessive genes : think of hair color, dimples or eyes color
Epigenome: think about the experimentation with the rat (nurture vs nature)
Integrative approach to psychopathology ,
1. Biological: genetics and neuroscience
Twin and adoption studies, studying gene G
Monozygotic: 100% same genes
Dizygotics twins: 50% of genes
Concordance rates MZ> DZ twins: G effect
if 1 twin has schizophrenia, there is 50% chance the other one too
Adoption:
Disentangling G effects from Eeffects + correlation inspecific behavior between adopted child and his/her biological parents: Geffect
Family studies
Degree of genetic overlap over family members - degree of similarity in a behavior:
Genetic relation incrwase - similarity in behavior increase
Integrative approach to psychopathology ,
1. Biological: genetics
Genes and psychological disorders
Diathesis-Stress model
Genes and psychological disorders
1. Specific genes might be linked to psychological disorders: More likely that many genes contribute
2. Cannot study genetic contributions without environment
Diathesis-Stress model
Inherited tendencies, from multiple genes, to express certain traits or behaviors (G)
These tendencies may be activated under conditions of stress (E)à
Le modèle diathèse–stress est une théorie psychologique tentant d’expliquer certains comportements humains par la conjonction d’une vulnérabilité héréditaire et de stress important issu d’expériences vécues
ntegrative approach to psychopathology , 1. Biological: genetics Diathesis-stress model Caspi et al., 2003 Explain it
aim: examine whether serotonin transporter gene predicts depression
conclusion: individual’S response to environment is moderated by genetic makeup
It was a longitudinal study, 3 genotype
always 2: one for the woman and the other from the man
People were separated into 3 gps = significant difference between LL and SS
it is not a guarantee to develop a mood disorder. So the participants were exposed to stress (what’s going on with the caregiver) no treatment to severe maltreatment (various= verbal, physical, sexual - but not highly reported)
No much difference between LL and SL since it is below the 50%
SS: 2 short alleles
SL: one short alleles one long allele
LL:two long alleles - gene is coding quite well for the NT (the serotonin aka mood, sleep, appetite that affect depressif) activity.
Integrative approach to psychopathology ,
1. Biological: genetics
Gene-Environment correlation model
role of the environment
Genetics correlate with environmental exposure, making an individual more likely to choose a certain environment
- your genes make you more likely to experience certain stressors and possibly develop certain disorders
E.g. Parents with history of antisocial (manipulating, drug use,unable to relate to others in a healthy way) behavior (G) and resulting negative family dynamic (E) → the child internalize =
↑ likelihood for deviant peer affiliation (E) →
↑ risk to develop antisocial behaviors
Integrative approach to psychopathology ,
1. Biological: genetics
Epigenetic “inheritance” of behavior
Changes in organisms caused by modification of gene expression (vs. genetic code itself)
Under environmental influences
Micheal Janani: genetic, above the genetic. Genetic effect does not explain everything. Once we are born with a genre, it stays within us all our lives… nature vs nurture
We have these radicals circulating in our body, but there some genes are more expressed than others. This pattern develops before we are born but also early in life; this is why our life experiences matter a lot. they will influence whether a mental group attaches to the genes or not depending on the molecules. These patterns of gene expression develop early one but some continue to develop during our life span.
epigenetic profile is much more sensitive to the environment
Integrative approach to psychopathology ,
1. Biological: neurobiology
Central Nervous System
Structure of the brain, limbic system, cerebral cortex - areas in the brain
Look at page 21
Brain and spinal cord (neurons send messages to and from the brain)
Processes information received from senses
Soma- DNA
dendrite getting the NT
re-uptake and know how it works
Limbic system
Relay information between cerebrum and lower brain parts
Regulate emotional and physiological reactions
Part of the forebrain
amygala: emotion reactivity
hippocampus: memory conversion, ex if i see a danger next time I’ll react quickly
hypothalamus: balance.
thalamus: relay on information
Integrative approach to psychopathology ,
1. Biological: neurobiology
cerebral cortex - areas in the brain
Cerebral cortex
80% of neurons of CNS
- Most evolved “human qualities” e.g. plan, reason)
-2 hemispheres (4 lobes each)
frontal lobe: located in from of the brain: reasoning, long term planning
Purple: receive information from the other lobe, including frontal lobe, and generate movement within the body
temporal lobe: language skill. Hippocampus is located deep inside of it. memory. primary auditory cortex: sounds and language
occipital lobe: vision information, color, objects..
parietal lobe: somato-sensitive.
Integrative approach to psychopathology ,
1. Biological: neurobiology
PNS
2 components
1. Somatic nervous system
Sensory + motor nervous systems
Communicates with sense organs and voluntary muscles
2. Autonomic nervous system
Sympathetic + parasympathetic nervous systems
Regulates cardiovascular system, endocrine system, etc.
Integrative approach to psychopathology ,
1. Biological: neurobiology
Endocrine system
Endocrine system
Endocrine system produce hormones - Released in bloodstream
Hypothalamic-pituitary-adrenal (HPA-) axis
stress release system
situated on top of kidneys which help respond to the stress
travel through bloodstream
Integrative approach to psychopathology ,
1. Biological: neurobiology NEUROTRANSMITTER
GABA, erotonin, Dopamine
Send messages between neurons in the brain
Rarely is one neurotransmitter responsible for a psychological disorder, travel through neuron cell
GABA: major inhibitory NT, it decreases our emotional reactivity and lower our arousal
Serotonin: regulation of various behavior, mood, appetite, sex drive
Dopamine: regulation behavior but mostly in interest, motivation drive linked to addiction. think of cocaine which stimulates it alot
often all work together
Integrative approach to psychopathology ,
Psychological: Cognitive and emotional processes
Social learning and bobo doll studies
Social learning Albert Bandura, Canadian psychologist (1925-) – Modeling or observational learning Bobo doll studies - Exposure to aggressivity \+ reward (vs. punished) ~ ↑ likely to be aggressive Rules of “social learning” according to Bandura: Notice/observe the model’s behavior Remember the model’s behavior Exhibit the model’s behavior Motivations also important - Reward vs. punishmen
Integrative approach to psychopathology ,
Psychological: Cognitive and emotional processe
Prepared learning and helplessness
role of emotion
Prepared learning
Innate preparedness to acquire insight
We learn to fear some objects more easily
By default it is an evolutionary purpose: E.g. bad food, snakes and spiders over rocks and flowers
Learned helplessness
Martin Seligman, American researcher in psychology (1942-)
Animals encounter situations they cannot control. E.g. if “no control” over foot shock → helpless behavior.
People are similar: If stress perceived as uncontrollable
if encountering something you feel you have no control over it you might have a ‘’I give up’’ attitude
Émotions Role in the development of psychopathology Emotions may define certain disorders E.g. sadness and depressive disorders E.g. fear and anxiety disorders
Integrative approach to psychopathology ,
Interpersonal and sociocultural factors
Name the 4 mains points
life expectancy, social stigma…
- Early deprivation
- Inadequate parenting styles: can lead to resilience
- Marital discord: chronic conflict between the romantic partners which affect the child
- Maladaptive peer relationships: social rejection, bullying, lLow socioeconomic conditions: teen pregnancy, poverty, low education
All of this are interdependent
Also, prejudice, discrimination, homelessness
Number and frequency of social contacts, the quality of the interaction = greater life expectancy
Social relationships “protect” against disorders: E.g. social support important for those mourning after spouse
passes away
Problem of social stigma:
Integrative approach to psychopathology ,
Interpersonal and sociocultural factors
Life span development
Experiences during certain times may influence vulnerability
Sensitive periods: puberty, increased change of mood disorder
Clinical assessment and diagnosis
Clinical assessment, diagnosis, and why are they important?
Clinical assessment: Evaluating biological, psychological, and social factors in the individual presenting possible psychological disorders
Diagnosis: Determining whether the individual meet all the criteria for a disorder
Why are they important?
To classify individuals with the same problem
To determine the best treatment
To conduct research on development of disorders and treatment outcomes
Clinical assessment – Psychometrics
Value of clinical assessment depends on:
what 3 aspects?
Reliability
validity
standarization
what is reliability?
Reliability
Degree to which a measurement is consistent
Sensitivity and specificity
Sensitivity refers to the extent to which there is a
degree of agreement that the diagnosis is present.
You want sensitivity and specificity to agree with each other. They are correlated
Kappa or r : measuring degree of consistency over and above chance levels
interrater reliability: two cliniscien using the same techniques = need to have the same result
what is validity?
Degree to which technique is accurate
E.g. concurrent validity, predictive validity (will it happen in the future?), internal validity (drugs, manipulated variables…), external validity (applies outside of your study, did you study the rest of your population? can u generalize?)
every aspect has pros and cons
What is standardization?
Standards/norms determined for a given test
for scoring, protocol for a technique to make sure that everything is consistent
Clinical assessment and diagnosis : Physical examination
Some behaviors, thoughts or emotions may be due to medical condition or medication → physical exam to rule out these causes
not every symptom is related to mental health issues but can be related to physical issues
E.g. Hypothyroidism and depression
Clinical assessment and diagnosis: Psychosocial assessment
Clinical interviews
Behavioral assessments
Psychological testing
Clinical interviews
linical interview – Mental status exam
Systematic observation of individual’s behavior
External appearance and behavior: E.g. psychomotor retardation/agitation. is the client seem agitated?
Thought processes: E.g. pressured speech (very fast), delusions of grandeur/persecution. What is the patient saying? what’s the flow? slow/fast? make sense?
Mood: E.g. depressed/expansive mood
Intellectual functioning: E.g. vocabulary, memory
Sensorium: Orientation x 3 (time, place and identity): checking for their awareness
time: what is the day? month?
Place: where are you?
Identity: who are you? what’s your name?
(+ life history, + social/cultural factors) you might one to look at that also
All of that is very fast…
Clinical interview
Face-to-face verbal goal-directed (assessing the individual) exchange around 1-2 hours
Unstructured interviews (it has been long for a loonnng time) speak about whatever you want
Structured interview: specific set of questions (less popular today) you want the patient to answer yes/no to the questions… no flexibility.
Semi-structured interview: most popular. The idea is a balance of the two. you have a set of questions, a protocol, but there is room to talk in detail about what the patient is trying to tell you.
Behavioral assessments
Naturalistic observation, observed in a natural setting:ex, sit away in a room and observe behavior…it gives you so much data (pro) but it is really long (con). E.g. Aggressive preschooler
Controlled observation. You invite the individual to your lab, office and you will create the environment to see the behavior that you want to see. You control the environment, which is a big pro. A con: the presence of an observer + an unnatural environment : E.g.
Stranger anxiety/paradigm
Rating scales: E.g. Observer- or self-reports Con: might ask a third person to filled out observer self-report because the person in question is too young to answer
Self-monitoring: E.g. Diary, beeper con: takes time pro: less is forgetting and can be structered
Psychological testing
Projective testing
People extend their unconscious fears and personality onto ambiguous stimuli
E.g. Rorschach inkblot & Thematic apperception tests: ask the person what they see. They will eventually tell you about themselves within their answers. ex. someone say it is sexual, then the researcher will dig into that. - they look at disorder thinking and later schizophrenia. but it remains subjective… it is an old one
Psychological testing
- Minnesota Multiphasic Personality Inventory (MMPI-2)
- Intelligence testing
IQ scale
MMPI-2
E.g. “ I usually feel that life is worthwhile and interesting” - If “False”: symptom of depression
“I seem to hear things that other people cannot hear” - If “True”: symptom of schizophrenia
can’t confirm a disorder with that… you should used different assessments to see the presence of a disorder
- Intelligence testing
Intelligence Quotient (army, school)
E.g. Stanford-Binet Intelligence test, Wechsler Adult Intelligence Scale, Wechsler Intelligence Scale for Children. Created at first for children, and if their IQ could predict school performance… ex.
how much does my score deviate from others, the average? Not very used today
Psychological testing
Wechsler Adult Intelligence Scale (WAIS-III) - address the IQ scale
Major disadvantage… it does not take into consideration culture and demographic, how to you define intelligence (it is a construct)
different types of intelligence are not considered. They might be used a lot but each has disadvantage too. you don’t rely on ONE single thing.
Neuropsychological testing
Measuring cognitive processes (e.g. language, memory)
E.g. Luria Nebraska Neuropsychological Battery, Halstead-Reitan Battery
Reflecting the presence of neural dysfunction, lesion
issues with confounders: performance anxiety, mood change, family condition, drugs intake, etc.
the reasoning seems affected = the only thing you can really say after looking at the result of a patient
Neuropsychological testing
Trail Making Test + LOBE INVOLVED
you ask people to draw a line between each, 1 to 2 to 3 to 4…
same thing but with numbers and letters. 1-a-2-b-3-c, etc.
see if there is a problem with the frontral lobe
ISSUES WITH CONFOUNDERS
Impaired performance ~ ↑ risk of dementia, following with their age capacity
with time: their answer did not increase, it is important to not rely on 1 thing …can you really say someone has dementia based on that? Nop.
the frontal lobe is particularly involved
Neuroimaging anatomy
computerized Axial Tomography (CAT scan)
X-rays in the brain
Relatively inexpensive
low(er) spatial resolution
Neuroimaging anatomy
MRI
Magnetic resonance imaging (MRI)
Brain molecules excited with magnetic field -> relaxation signal emitted expensive
high(er) spatial resolution
high strength magnetic field that will be generated: through this field, these radio signals will be transmitted
after they go back to their related state, these signals will relaxe, and these tissues, depending on where they are in the brain, have different time to relax.
it gives you an idea of the brain: is it healthy or not? in case of a lesion, the region might be much darker compared to a healthy brain for instance.
something you might see in schizophrenia
Neuroimaging anatomy- Positron emission tomography (PET)
Low(er) spatial resolution
injected (the only one who does it) with tracer substance -> active brain parts ‘’light up’’
very mildly retroactive
this tracer look at what you want, the substance will change
examine effects of drug therapy
examine NT - or psychopathology-related activity
Functional MRI (fMRI) High(er) spatial resolution
normal Right schizophrenia patient a study shows that schizophrenia patient would perform worse then healthy individualsnot only look at the structure but now at the functionlike ask patient to close their eyes, or do a taskdon’t only see one lobe, but see the whole picture, every aspect don’T inject anything in this one To finish on the neuroimaging_helps to understand neurobiological causes of psychological disordersallows examining neurobiological changes in response to drugs or psychotherapy helps to see gray matter, white matters, etc. spinal fluids etc
Psychophysiological assessment
EEG, NS
measurable changes in the nervous system reflecting psychological processes
Electroencephalogram (EEG) - not at the exam.
electros on the scalp…
first graph vs second (ptsd). PTSD: more sensitive to stimuli
Another type: electrocardiogram, electrodermal responses, neurochemical assessment -metabolites (urine sample)
NS
Meausrable changes in NS reflect the psychological processes
- Electrocardiogram
- electrodermal responses
- neurochemical assment: métabolite
DSM
Emil Kraepelin
Nosology and nomenclature
Emil Kraepelin (1856-1926), German psychiatrist
All disorders only have one causal factor
Specific set of criteria must be met: useful in medicine
he came up with categories for mental health disorder based on their clinical profile
Classification:
Nosology: applying a taxonomic system to psychological or medical phenomena, be able to distinguish between mental and physical disorder based on categories
Nomenclature: labels for disorders
it is much very relevant
DSM: Controversy about defining psychological disorders
Thomas Szasz - ‘’Myth of Mental Illness’’ book
Criticized pseudoscientific psychiatry
argued that there is no physiological basis of mental illness for verifying DSM diagnoses
best known as social critic of the moral psychiatry
father of modern psychiatry because of his idea of it is much relevant: we do name disorder, we do make sure the clinical file is as clear as possible
he saw the social control over psychiatry, he argued that mental illness is no more fact… or a possession of the devil.
In his book: nurse= keeper of a prison, we should do something about it. Hospitalization is not a way to protect society. there are no test to prove that there is a mental illness… but for physic disease
he is not against psychiatry
George Albee
Argued that DSM-related ‘’medical model’’ should not be used 1988 to …
Emphasized societal factors as major determinants
social factor: child abuse, job, childhood, racism, etc.
needs to focus on prevention and not treatment
DSM: Instruments for classification
Instruments:
Diagnostic and Statistical Manual of Mental Disorders. 5th
edition (DSM-5)v - used in North america
International Classification of Diseases and Health Related Problems, 10th edition (ICD-10) - used in european continent
1 instrument like a bible to psychiatr
History of DSM
First DSM 1952: unreliable expert opinion
Second DSM 1968 (more mental health disorder added but nothing different) (ALSO FORGOTTEN)
DSM-III 1980: introducing multiaxial (multiple axes) classification system: 1. Major health disorder (mood, anxiety) 2. Rare one, personality disorder 3. Medical history of the individual, health issue 4. social environmental factors
DSM-IV 1994: Dr Allen Frances’ group task force: as we are expanding the boundaries of psychiatry, we have this constant inflation (more and more mental health disorder). if you over diagnosis= risk of over treatment too. he suggests revising dsm in an old-conservative fashion, we do look at the social aspect (not a lot but still). ADHD: easily triple, with the drug marketing/advertiser. pharmacien convince psychiatrist… that’s why the revision too ! Recognize change in society…
DSM-5 2013: eliminating multiaxial classification system. after the revision..
Product of APA 2013 DSM-5
Dsm change in new and old editions
Early editions (prior to DSM-III)
Unreliable
Many diagnostic disagreements
information provided to make diagnoses depended on what an individual clinician might choose to ask about
Newer editions of DSM
More extensive descriptions
More precise diagnostic criteria
Increased use of standardized diagnostic interviews has improved reliability by providing same detailed information
More objective
How is it a good thing to put a child on drugs when he is young? but can it degenerate? That is still a debate
DSM-5 Address gaps in diagnoses/advantage:
Update criteria based on research knowledge
reduce the number of not otherwise specified (NOS) classification: not every cases fit in those classification (like type 1,2,3 for bipolar disorder) if it does not fit? the issue is if you put someone there, what do you proceed afterwards? conducting more research, conducting behavior, etc.
remove multiaxial classification approach
changes in disorders (adding new disorder)
e.g., new-binge eating disorder
asperger’s syndrome, autism combined into Autism Spectrum Disorders (reclassified)
before DSM 3 = very categorical: either healthy or ill. Today: it is more on the continuum. Adding dimension to it! Mild, moderate or severe … no more: yes/no. ex mood disorder. bipolar vs depression a scale in between
Dsm: Examples of controversies
Disruptive Mood Dysregulation Disorder criticized as ‘’temper tantrum disorder’’
still debated… DMDD
how to distingish between normal vs the disorder with age
Bereavement no longer excludes Major Depressive Disorder: ex. Before someone grieving someone else was not diagnosed with this, you would wait to see if the symptoms are persistent then yes. How long do you wait? Maybe the grieving is just highlighting other symtoms of it…
Now, if the person is grieving AND has symptoms: they will be diagnosed with the Major Depressive Disorder right away. What would be the issue with that? - stigmatize. Not much drug for personality disorder… so they would give drugs for mood disorders to them. You try to combine treatment: drug and therapy! Why does it fit the criteria… Maybe it is just a ‘’phase’’ of grieving.
DSM-5: Criticisms
’Fuzzy categories that blur around the edges’’
comorbidity (mood and anxiety disorder are highly comorbid, bipolar, etc.)
more difficult to treat
more difficult to measure response to treatment
DSM Categorical vs. dimensional classification
Categorical classification
If need to know if person either has or does not have disorder (but too “black or white”)
If need to know whether to start or not start certain treatment
Dimensional classification
Tends to have less comorbidity since measures are on a continuum (important)
Consider levels/dimensions of a disorder (but how many are necessary?)
DSM Prototypical approach
and pros and cons and stigma
combination of categorical and dimensional (still use categorical! but not only that)
identifies certain features of entity for classification + allow for variations
e.g., describing a dog: all share certain features, but divided in different breeds
Not a perfect approach but an improvement
pros and cons
Advantages:
Defining problems
Basis for communication, helps communication
between health workers
Important for research
Important step for treatment
Limitations:
Requires clinical judgment- but there is still
subjectivity in the testing. so use more tests…
Must be reliable and valid… but are they?
Ethical issues
Caution about labeling and stigma
Labeling / calling people by their diagnoses
E.g., schizos, autistics
- Leads to stigma
- People uncomfortable talking about mental illness
- People less likely to seek treatment
Why is research challenging?
Three main types of research questions
Why is research challenging?
- No simple answers
- Inaccessibility: thoughts of individuals
- Normal vs. abnormal (psychopathology instead of abnormal)
Three main types of research questions
What causes mental illness?
How does it cause mental illness?
What treatments are effective?
Basic components of a study
Hypothesis
Educated guess: what the study might find
Testability: Need to be precise, make sure it is
testable
Literature review
Research design
Used to test a hypothesis
Dependent Variable: Behavior/aspect of interest,
measured, outcome, treatment group,
Independent Variable:
- What could influence behavior of interest
- Manipulated
Basic components of a study
internal validity
Extent to which we are confident that IV causes DV to change
- Confound Other variable(s) may explain changes in DV Results difficult to interpret
To ensure internal validity
- Control group: does not receive treatment, right there you can cancel a confound
Similar to experimental group, but not exposed to IV
- Randomization
Random assignment to a group
ex. pills to get approved. You might recruit people that have mild symptoms to get a pill.
Basic components of a study
External validity
How well do results reflect outside world?
Generalizability
o Extent to which results apply to everyone
Internal vs. External validity
Often inversely related: Controlling for all potential confounds vs. Maintaining generalizability
research method, average client and individual cases
Average: Patient uniformity myth. external validity concerned. 1. tendency to see all participants as a homogenous group
2. individual differences ignored = inaccurate generalizations
Today: improved
Individual cases
Case study method
- Study ≥1 individual(s) displaying a behavior
intensively → questionable external validity
- Confounding variables present → low internal validity. Because many behavior can be within 1 indivudal but not from the disorder that you think…
No scientific method
Gain any detailed information
E.g. Study a feral child who created his/her own language
Research by correlation
Correlation
- Statistical relation between two variables
- Positive and negative correlations
- Used to study variables just as they occur
study a group
need a lit review
E.g. Length of relationship ~ similarity in attitudes/opinions? (positive relationship)
Correlation ≠ causation
+1 is the highest coefficient correlation for positive
cannot just say’‘global, wheter’’ need to be precise
Research by experiment
experiment, experimental designs, control groups
Experiment:
Manipulating IV and observing its effects on the DV (outcome variable)
Answers questions about causality
Experimental designs
Clinical trials: Used to determine effectiveness and safety of treatment before it goes on the market
Randomized Clinical Trials (RCTs): Preferred method (mix cancer patient in placebo (control group) and treatment group (experimental) after do a follow-up -> compare results . you should only have result in the experimental group to see in confidence the causation
Control groups
- Double-blind control:the patient and the doctor don’t know what group receive what, expect the researcher (theoritical part = know, practice part: don’t know)
- Compare treatment effects of those who
received treatment to those who did not receive
treatment at all
Placebo effect
Frustro effect
Nocebo effect
Single-case experimental designs
and repeated measurements
Formalized by B. F. Skinner
Helps to better understand individual psychopathology
Limitation: Low external validity
Advantage: Good internal validity (as opposed to case studies) thanks to repeated measurements
repeated measurements
DV measured many times
Level, variability, degree of change: E.g. treatment & anxiety
Epidemiological research
Study of incidence, prevalence, and consequence of a particular problem
Helps point research in the right direction
E.g., Smoking - Lung cancer?
