PSYC 507 General Psychopathology Flashcards
ADHD
clinical psychopathology; a neurodevelopmental brain based disorder marked by inattention, hyperactivity and impulsivity, or both.
3 types; inattentive, hyperactive-impulsive, and combined; combined type most rare
Symptoms are typically maladaptive and age inappropriate
Must be present by age 12 (even if not diagnosed as kid) and usually is lifelong.
Occurs in males4 x more than females.
Commonly comorbid with learning disorders and ODD/CD; also greater risk for substance abuse.
Strong genetic component; 30% chance if 1st degree family member carries it
Typically treated with stimulant medication and/or behavioral therapy. Behavioral therapy can be highly effective but is utilized less
EXAMPLE: You’re seeing a new client that struggles to sit still- he is always tapping his foot. He often interrupts you. He is easily distractible and struggles to keep a job because of it. He is 18 years old and says that his mother wishes “she had had him tested” as a kid. After learning that he has struggled with these symptoms since he was ten, you diagnose him with ADHD.
Anxiety Disorders
clinical psychopathology; Occur when feelings of anxiety interfere with everyday life, includes multiple physical characteristics, and is irrational, uncontrollable, and disruptive.
Anxiety is typically future-focused worry; tends to have cognitive, behavioral, and physiological components.
Includes Generalized Anxiety Disorder, Panic Disorder, Phobias, Agoraphobia, and Social Anxiety Disorder.
Most common type of disorder experienced - 29% of adults in lifetime.
Can be displayed by someone at any age.
Treatments include cognitive-behavioral therapy, mindfulness and relaxation techniques, along with exposure (if applicable) and anti anxiety medications.
EXAMPLE: George comes to therapy because he has been unable to control his worry. He complains of headaches, lack of sleep, and feeling on edge. Based on his symptoms, the therapist believes George may be suffering from an anxiety disorder.
Anxiety sensitivity
clinical psychopathology; ‘fear of fear’; the fear of anxiety- related sensations. Bodily sensations related to anxiety as mistaken as a harmful experience, causing more intense anxiety and fear.
The idea of the fear of fear was originally discussed in terms of panic attacks; people with panic attacks begin to fear subsequent panic attacks. Reiss conceptualized it differently
Term Anxiety Sensitivity originally coined by Reiss who created Anxiety Sensitivity Index (ASI) which has spurred additional research
EXAMPLE: Someone that would likely attribute an increased heart rate or pounding heart to impending cardiac trouble despite their young age would score highly on anxiety sensitivity.
Assessment interview
clinical practice; primary technique for clinical assessment; an initial interview in which the counselor gathers information about the patient and begins to conceptualize their case and presenting problem(s) to aid in developing a treatment plan and/or making the diagnosis.
Counselor should examine all spheres of influence & use multiple sources of info if possible
May be structured or unstructured (scripted or free-form)
May be used in conjunction with other assessment techniques (e.g. psychological tests)
EXAMPLE: Patient enters therapy with depression and anxiety. Therapist uses a mix of structured and unstructured techniques for the assessment interview. This allowed him to obtain a broad picture of the problem through the use of the structured questions as well as the freedom to explore areas of interest with the unstructured questions
Bipolar I vs Bipolar II
clinical psychopathology; Both are mood disorders in which patients experience major depressive episodes, manic episodes, hypomanic episodes, and/or mixed episodes. Equally common in men and women. Onset between 15-30 yrs old
Manic episodes typically last a week (hypomanic 3-4 days) & depressive episodes much longer
Manic episodes change brain structure, making easier for subsequent manic episodes (effect called kindling). Manic episodes often get worse and harder to treat
Bipolar II is capable of turning into Bipolar I.
Bipolar I MDEs and Mania; Bipolar II MDEs and Hypomania
Bipolar II can be harder to detect as people do not notice the hypomanic episodes and rarely come into treatment. When they do it is for depression.
Bipolar II slightly later onsent (around 20s)
Bipolar I and II can include psychotic features either mood congruent (i.e. thinking you are god during manic episode) or mood incongruent
Etiology ~ 50% heritability - strong genetic component
Treatment usually includes medication to prevent mania and reduce kindling effect (Antipsychotics, mood stabilizers, lithium) and psychotherapy (focus on medication management and social skills; used in conjunction to meds). Therapy shown to help reduce hospitalization.
EXAMPLE: Client was hospitalized for manic episode-she was frantically pacing, did not sleep for days, and held the belief that she was God. During interview client says she has never felt better in her life. A few sessions later the client’s mood had totally turned. She was irritable, slow in speech, lethargic and questioning the reason of living any longer. Therapist diagnoses with Bipolar I Disorder.
Case study
type of research that includes a highly detailed description of a single individual, generally used to investigate rare, unusual, or extreme conditions - or to study a new treatment. These can yield useful information regarding “normal” psychological phenomenon. However, it is extremely difficult to determine causality and VERY difficult to generalize to others.
EXAMPLE: You’re taking on a new client with an extremely rare psychological disorder. You turn to the research and decide to read up on all of the available case studies because that is the bulk of what is available, since it is such a rare condition.
Categorical vs dimensional diagnosis
diagnosis in clinical practice; Categorical diagnosis considers eac diagnosis to be unique with non overlapping and essential features.
Most commonly used in medical model. Prototypical diagnoses are a type of categorical, being a combination of essential features and a minimum number of common features - used in the DSM. The prototypical is a little looser than a true categorical approach.
‘Prototype’ exists for each disorder
Dimensional diagnosis views symptoms and features are rated on a scale rather than in categories, the profile determines a diagnosis. Examines symptoms on the continuum. Is used to some degree in the DSM.
EXAMPLE: When using a prototypical categorical approach, you must determine that the client has a depressed mood and a decrease in pleasure, plus a certain number of additional symptoms in order to be diagnosed with depression.
Clinical assessment
clinical practice; the process of gathering and evaluating relevant psychological, social, emotional, and physical data about a client.
The objectives are to determine a diagnosis, conceptualize the current problem, understand the sociocultural context of the symptoms, and to tailor a treatment strategy.
Assessment techniques include interviews (structured and unstructured), behavioral observation, and psychological tests- primary technique is interviewing.
It is best to use multiple sources (examine medical records, talk to family members, etc) when possible to get a complete picture.
EXAMPLE: Louise came to therapy presenting symptoms of depression. At her first visit to the counselor, she filled out a Beck Depression Inventory in which she identified her depressive symptoms. The therapist, after reviewing the BDI, then asked her open-ended questions to aid in a diagnosis and undercover any environmental aspects of his disorder. The counselor used her nomothetic understanding of depression and Louise’s idiographic information during the clinical assessment to aid in a diagnosis and treatment plan.
Clinical significance
A type of significance assessed in research and measured in the participants. How important are the changes to the patient? Clinical significance looks at the patient’s quality of life - symptoms, remission, etc. Do they still meet criteria for diagnosis? What are the percentages of patient benefitting?
EXAMPLE: You are trying to decide between two treatments for your client with treatment resistant depression. One has demonstrated high clinical significance and high statistical significance in RCTs. The other shows high statistical significance but low clinical significance. You choose the one with high clinical significance because it assesses treatment efficacy from the patient perspective.
Comorbidity
a clinical term used to describe the coexistence of two or more clinical diagnoses in the same person at the same time. It is not uncommon. There are certain disorders that frequently present together, and it’s important to be aware of these as a therapist.
EXAMPLE: There is a high comorbidity between depression and PTSD. Because of this, when assessing for PTSD clinicians should be sure to also assess for depression.
Competency to Stand Trial
a person is mentally competent to stand trial if the person charged with crime has capacity to understand the charges against them and ability to assist their lawyers in preparing a defense
Has nothing to do with the insanity plea–competency to stand trial is about the person’s mental state at the time of the trial, not at the time of the crime.
Requires a cognitive assessment.
The burden is to prove incompetence (on defense)
If found incompetent, they will be held in a mental health hospital until competent, time dependent on the charges. After the time elapses, they will either be set free or put under civil commitment.
EXAMPLE: You are assessing a patient’s competency to stand trial. The patient presents with psychotic symptoms and a complete inability to communicate. He cannot even understand simple commands. You recommend that he is not competent to stand trial because you do not think he understands the charge against him nor do you think he can assist the lawyers in prepping a defense.
Conduct disorder
psychopathology; a childhood disorder characterized by the violation of others’ basic rights by cruel or criminal behavior
Generally follows oppositional defiant disorder, and is typically more severe.
Progresses from oppositionality towards parents and adults to all authorities and eventually all of society
Commonly thought of as the predecessor for antisocial personality disorder
Usually begins before age 10 and is exhibited by 6-16% of boys and 2-9% of girls.
Etiology - poor family environment (inadequate parenting/reinforcement) and also genetic and biological factors
Treatment is more effective at younger ages, with Parent-Child Interaction Therapy and Parent-Child Relationship Training having the greatest effects.
EXAMPLE: 13 year old client was court ordered to see child therapist because of his 2nd shoplifting offense. He also has a history of drug/alcohol use, getting into fights, vandalism. He has been abusing the neighborhood cats, and has been “the” bully at school since third grade. Appears to meet the criteria for conduct disorder
Diagnosis
Determination that a person’s problems are reflective of a particular disorder or syndrome in a particular classification system (typically DSM-5). Diagnostic labels make it possible for clinicians to communicate easily with each other, but they also carry a negative connotation and a social stigma. Diagnoses also may not be accurate or perfectly fit an individual’s symptoms.
EXAMPLE: Kara was a freshmen in college and came into the counseling center presenting symptoms of an eating disorder. The counselor asked Kara about her eating habits and Kara said that she would go to the cafeteria once a day, by herself, and consume large quantities of food - especially pasta and ice cream. She would then feel so guilty about eating that she would make herself vomit and not eat for the rest of the day. Kara didn’t like to engage in this behavior, but felt that she truly couldn’t stop herself once she started eating. The counselor diagnoses Kara was Bulimia Nervosa based on her symptoms which had lasted for over 6 months.
DSM-V
This is the Diagnostic and Statistical Manual for Mental Health Disorders. Currently on the fifth edition. The DSM-V is used by most mental health practitioners to diagnose mental disorders and is developed by the american psychiatric association; it provides a categorical prototypical diagnosis approach. Advantages of the DSM include that it allows for easy communication between clinicians and helps to stimulate research. Disadvantages include that diagnoses are stigmatizing and there can be significant overlap between disorders.
EXAMPLE: You are considering diagnosing one of your client’s with borderline personality disorder. You consult the DSM-V to review the criteria for that diagnosis and the prototypical diagnosis.
Diathesis-stress
psychopathology; From the biopsychosocial model, this suggests the combination of diathesis and stress from one’s environment create psychopathology in a person. Diathesis refers to the propensity for the disorder or problem behavior to be expressed. The greater the diathesis and the greater the stress, the more likely you will develop the psychopathology.
EXAMPLE: The Diathesis-Stress model can help explain why identical twins separated at birth might have different outcomes. Say, one develops schizophrenia and the other doesn’t. Because they both have the same diathesis, we might conclude that one of the twins had a more stressful upbringing than the other.
Dissociative disorders
psychopathology; A rare group of disorders characterized by a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment known as dissociation.
Key features include depersonalization, derealization, a blurred sense of identity, and a profound disturbance in memory.
These disorders include dissociative amnesia and dissociative identity disorder.
Dissociative Amnesia: memory loss that cannot be explained by a physical or neurological condition
With or without dissociative fugue; usually occurs in response to some sort of stressor or trauma
Dissociative Identity Disorder: presence of 2+ distinct identities w/ recurrent gaps in memory
Most controversial diagnosis in DSM
VERY rare
Those w/ a dissociative disorder have increased risk of complications, such as self-mutilation and suicide attempts
EXAMPLE: Client comes to treatment because her parents are incredibly worried about her behavior. 2 weeks ago she went missing, and was recently found in Oregon in a homeless shelter with no recollection of her identity. Her parents filled the clinician in that she has been under extreme stress at school, her sister just died, and she lost her job, didn’t get into boarding school… Therapist diagnoses her with dissociative amnesia w/ Dissociative Fugue.
Dopamine
psychopathology; a neurotransmitter that involved in the pleasure center of the brain affecting learning, reward, and motivation.
Critical in use/abuse/dependence roles of substances because almost every substance directly or indirectly affects the DA system.
Stimulated by several such as ETOH, nicotine, cocaine, caffeine, and Amphetamines.
Repeated use affects DA system a lot; takes body long time to recover
Abnormal levels also associated with symptoms of parkinson’s, schizophrenia and depression.
Positive symptoms of schizophrenia (delusions, hallucinations, disorganized behavior) from excess dopamine
Negative symptoms of schizophrenia(loss of speech, lack of motivation, lack of pleasure)) from too little dopamine
Difficulty initiating motions due seen in Parkinson’s to decreased dopamine
EXAMPLE: You are treating a client with a substance use disorder. The client has been able to get sober many times but struggles to maintain it. You decide that some psychoeducation might help and you explain to her that it will take her body a long time to recover from the excess dopamine production that drugs caused in her brain.
Eating disorders
psychopathology; a newer class of disorders related to weight and irregular eating patterns, seen as either minimal to no eating or excessive eating and purging.
Anorexia, Bulimia, and Binge Eating Disorder fall in this category.
Anorexia and Bulimia are characterized by intense preoccupation with food, intense fear of weight gain, some obsessive thinking and compulsive behaviors, and lack of interoceptive awareness.
Anorexia: Failure to maintain adequate weight due to restricted eating, purging, and/or exercise - restricting type or binge-eating/purging type
Bulimia: binge eating and compensatory actions
Binge eating: recurrent episodes of binge eating but wieght is NOT part of it
These illnesses are often accompanied by a multitude of health issues and frequently comorbid with anxiety and mood disorders, certain personality disorders, and substance abuse.
Can be caused by learning, family dynamics, or genetic components.
Treatments include CBT, Interpersonal Psychotherapy (focus on relationship elements and patterns in relationships - for bulimia), family counseling and medication (usually done in conjunction with talk therapy).
EXAMPLE: Julie’s friend told her that she would probably have a lot of boyfriends if she lost some weight. She began restricting her diet and exercising. As she began to lose weight, boys started noticing her which reinforced the behavior. She also felt a sense of control about losing the weight. Her family sent her to counseling where she was diagnosed with anorexia. She was 5’9 and weighed 90 lbs. She still believed she was fat.
GABA
psychopathology; an inhibitory neurotransmitter that regulates anxiety.
The anxiety reducing abilities of ethanol and benzodiazepines work by increasing GABA levels.
Low levels of GABA associated with generalized anxiety disorder.
Increasing GABA also vicariously increases dopamine levels in the pleasure pathway. Contributes to tolerance and withdrawal – conditioned compensatory response
Explains abuse and depression associated with cessation of drug use.
EXAMPLE: A veteran suffering from symptoms of PTSD had started abusing alcohol shortly after his return to the United States. The psychiatrist explained the use of Alcohol has been shown to bond to GABA receptors, which lowers anxiety, making him feel better.
Heritability
a genetics term; the proportion of observed variation in a trait or disorder that can be attributed to inherited genetic factors rather than to environmental factors; a factor in the nature vs nurture debate
EXAMPLE: Understanding the heritability of Bipolar I disorder, the therapist asked the client if his family had a history with the disorder. She also explained to him that one of the biological explanations for the disorder suggests that individuals inherit a predisposition for the disorder.
HPA Pathway
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developmental psychology; The hypothalamic-pituitary-adrenal axis (HPA axis) regulates cortisol production, released in response to stress; long-term stress response
Hypothalamic-Pituitary-Adrenal
This pathway is most associated with PTSD and other trauma/stress disorders.
Cortisol production tends to be elevated in people with BPD, indicating a hyperactive HPA axis in these individuals.
Since traumatic events can increase cortisol production and HPA axis activity, one possibility is that the prevalence of higher than average activity in the HPA axis of people with BPD may simply be a reflection of the higher than average prevalence of trauma among people with BPD.
Idiographic assessment/understanding
an approach that focuses on the individual and their uniqueness rather than what they have in common with others
It allows for the understanding of symptoms in the individual’s cultural context.
Important to recognize many disorders manifest in unique ways.
Good assessment/practice combines idiographic and nomothetic approaches
EXAMPLE: During session, the therapist saught an idiographic understanding of Jill’s depression. He noted that Jill responds to her depression by cleaning to avoid thinking and feeling. Her behavior is unique in comparison to others depression
Insanity
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ethics and mental health law; NOT a clinical term, but rather a legal term describing an individual who was mentally ill at the time of their crime(s) and is therefore not morally responsible for the act(s).
Developed as an attempt to protect people with mental illnesses from being punished for harmful behavior resulting from their disorder.
The burden of proof lies on the defense
If found NGRI, person is criminally committed.
Length of hospitalization often longer than amount of prison time for offense.
Requires psychological assessment
Mania
psychopathology; characterized by an abnormal mood (irritable, expansive, or high) and at least three or more other criteria including inflated self esteem, increased energy, decreased sleep, racing thoughts, pressured or increased speech, or impulsivity and poor judgement.
Manic episodes typically last a week or more, hypomania 3-4 days. Productivity element huge in hypomania. Hypomania also has more irritability
Can include psychosis – mood congruent (grandiosity,paranoia) or incongruent (aliens). Mood congruent most common.
Typically mania is experienced as pleasurable by the client
Manic episodes come with increased suicide risk
One manic episode makes following episodes more likely - a process called kindling.
EXAMPLE: A client comes into you due to severe depression and being unable to leave bed for the past two weeks,. Just two weeks prior she “felt she had all the confidence in the world”, only needed an hour of sleep a night, and had wonderful creative vision. It seems as if the client’s mania turned into depression. You consider a diagnosis of Bipolar I
Mood disorder
psychopathology; a class of disorders characterized primarily by severe disturbances in mood.
These typically include depression, bipolar, and variants of the two.
Symptoms of these disorders may include depressive or manic episodes.
Depressive episodes may include symptoms such as hopelessness, lack of energy, and anhedonia, inability to concentrate, increased/decreased appetite, etc.
Mania may include euphoria, increased energy, racing thoughts, pressured speech
Etiology includes a variety of causes including genetics, learning, and cognitive errors.
Heritability 30% depressive disorders, 50% bipolar disorders
Treatments include medication, CBT, behavioral activation, and mindfulness-based treatment, amongst others.
EXAMPLE: Client comes to treatment because she feels depressed most days. This has been going on for several years. She constantly feels tired, low self-esteem overeats, sleeps whenever possible. The therapist dxs pt with major depressive disorder.
MRI
psychopathology; Magnetic resonance imaging (MRI) is a technique that uses a magnetic field and radio waves to create detailed images of the organs and tissues within your body. Used to study brain functioning and has aided with diagnosis and research. MRIs can be helpful in determining if a disorder has a biological component.
EXAMPLE: Adam is participating in a research study on schizophrenia. Adam agreed to undergo an MRI to determine if his ventricles were enlarged, which might indicate a biological basis for some schizophrenic symptoms reported by Adam and others.
Nomothetic assessment/understanding
an approach that uses norms and standards placing an emphasis on shared features between all clients with a certain problem behavior or disorder.
Achieved by means of large research investigations resulting in generalizable laws of behavior. (based on scientific method)
This type of understanding helps clinician to have a starting point for diagnosis with each client instead of always beginning anew.
The DSM is an example of a nomothetic tool that came from years of research.
EXAMPLE: The therapist was well versed in the nomothetic understanding of bipolar disorder and found that her client, Jane an artist, was displaying clear symptoms of the disorder. Jane was severely depressed and found herself unable to leave bed for the past two weeks, but just two weeks prior she “felt she had all the confidence in the world”, only needed an hour of sleep a night, and had wonderful creative vision.
Obsessive compulsive and related disorders
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includes obsessive compulsive disorder, hoarding disorder (persistent difficulting discarding or parting with possessions) , and body dysmorphic disorder ( a disorder in which one is preoccupied with something being wrong or misshapen about a body part) .
OCD is characterized by obsessive (repeated, intrusive, uncontrollable thoughts or images that provoke anxiety) nd compulsive actions. The person feels driven to perform these behaviors due to the obsessive thoughts.
Thoughts cause anxiety, and behaviors lessen the anxiety felt by the thoughts.
There are different classes of thoughts (contamination, pathological doubt, violent/sexual thoughts) and a wide variety of corresponding compulsions (washing, checking, counting, symmetry, hoarding).
Do not need both for diagnosis but 90% do have both
Almost equal male to female, female slightly higher
Tends to be a chronic lifelong illness, but can be controlled.
Generally attributed to genetic and neurological sources, though can have behavioral and cognitive roots.
Treatment gold standard exposure therapy with response prevention and CBT.
Oppositional defiant disorder
psychopathology; a childhood disorder characterized by chronic misbehavior such as frequent arguing with adults, noncompliance, and problems controlling anger. ODD can be precursor for conduct disorder and antisocial personality disorder in some.
Typically begins by 8 years of age; More common in boys before puberty but equals out after.
Etiology - conflictual and hostile parents/home life, inconsistent punishments, and attention seeking behaviors.
Earlier the treatment begins the better. (> 13 better); Parent Child Relationships Training and Parent Child Interaction Training found to be most effective.
Residential programs, school-based interventions, and skill training limited effectiveness. Drug therapy used but limited support
EXAMPLE: Eric is a 13 year old client that is in therapy because parents describe him as “hell on wheels” and they don’t know what to do about his behavior. Told counselor he doesn’t do chores, doesn’t go to school and when he does he argues with the teacher, screams when he doesn’t get his way, and argues about everything. Bx has occurred for 7 months. Eric’s behavior is consistent with Oppositional Defiant Disorder and therapist suggests parent training and social skills for client and parents.
Panic attack
psychopathology; a sudden episode of anxiety that rapidly escalates in intensity.
Attack can be unexpected or triggered
Includes physical and psychological symptoms such as pounding heart, rapid breathing, sweating, choking sensation, numbness, dizziness, and feeling like “going to die” or “going crazy.”
25% of the population has at least one panic attack in their lifetime.
Panic attacks are seen in a variety of disorders such as PTSD, phobias, and can occur in the context of any disorder, designated by a panic attack specifier.
Usually indicates increased symptom severity, poor treatment response, and higher rates of comorbidity and suicide.
Panic Disorder - a disorder in which one has frequent and unexpected attacks and feels anxiety about having another attack
2:1 women to men
EXAMPLE: A client comes in to see you because she called 911 last week when she started experiencing tightness in her chest. She tells you that when the ambulance arrived, they told her that she was not having a heart attack like she thought. You explain to her that she suffered from a panic attack. You assure her that many people think their first panic attack is a heart attack.
Personality Disorder
psychopathology; a type of disorder characterized by enduring patterns of perceiving, relating to, and thinking about the environment and oneself; person is inflexible and maladaptive, and cause significant functional impairment or subjective distress
There are high comorbidity rates and treatment is refractory and often unhelpful
Usually more troubling to others
9.1% of population has a personality disorder, and are most stigmatized group in psychology due to the difficulty in treating them.
Can be attributed to genetics and/or surroundings, as behaviors may have been previously adaptive and become maladaptive later.
Disorder never really goes away, just manage the symptoms.
There are three clusters of personality disorder; cluster A (odd/eccentric), cluster B (dramatic/emotional), and cluster C (anxious/fearful).
A: Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypal Personality Disorder
B: Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, Narcissistic Personality Disorder
C: Dependent Personality Disorder, Obsessive-Compulsive Personality Disorder, Avoidant Personality Disorder
Lots of overlap between symptoms in same clusters; hence the push for a dimensional approach to diagnosis
EXAMPLE: A client comes to you after he was caught trying to con money from elderly patrons at an ATM. It was revealed that since he was 7 years old he had been bullying students at school, shoplifting, and skipping school. He had been caught stealing a car at age 19 and sent to prison for 1 year. Since then he had been charged with narcotics possession and statutory rape. He lacks remorse for any of his b/h. You believe he may have antisocial personality disorder.
PET Scan
psychopathology; A positron emission tomography (PET) scan is a neuropsychological test that examines brain functioning
The computer produced image shows rates of metabolism, blood flow, and oxygen use throughout the brain.
The patient consumes a radioactive glucose solution that is picked up by the scan. Patient performs certain tasks or asked to think about certain things to see what areas of the brain are being used.
PET scans may detect the early onset of disease before it is evident on other imaging tests.
EXAMPLE: The dopamine hypothesis of schizophrenia proposed that excess activation of D2 receptors was the cause of the positive symptoms of schizophrenia. PET imaging studies have provided supporting evidence for this hypothesis.
Placebo Effect
a phenomenon that occurs when a patient/client sees improvement in their condition even though they are taking a placebo or receiving a sham treatment (not receiving real treatment protocol).
The patient’s expectancies about the outcome of treatment can have a significant effect on what outcome they will see
Many research studies include placebo groups to determine if symptoms improvement is from the actual treatment being studied
EXAMPLE: Participant was randomly assigned to a control group in a study on the effectiveness of a new anxiety medication. Levels of anxiety were recorded before the placebo was administered, and then again after 2-weeks of taking the placebo pill. Patient reported a dramatic decrease in anxiety which reflects a placebo effect since they were not in fact receiving any treatment.
Positive vs negative symptoms
part of psychopathology; labels for classifying symptoms of schizophrenia; Positive symptoms are associated with excesses or additions to normal thoughts, emotions and behaviors while negative symptoms are associated with deficits in normal thoughts, emotions, and behaviors.
Positive symptoms include delusions, hallucinations, disorganized speech and bizarre/disorganized behavior (appearance, affect, actions).
Negative symptoms include alogia (poverty of speech), affective flattening (no display of emotion), avolition (lack of motivation), and anhedonia (inability to experience pleasure).
These are typically more common than positive symptoms. Symptoms can be seen in the prodromal and residual phases as well as the active phase.
EXAMPLE: A client suffering schizophrenia stopped taking medication and comes to treatment showing positive symptoms. She is experiencing delusions that she is on a special mission givin to her by divine beings. She has auditory hallucinations that the aliens are telling her where to go.
Psychosis
psychopathology; a symptom characterized by a fundamental break with reality
Can include hallucinations (hearing, seeing or feeling things that are not there), delusions (false beliefs, especially based on fear or suspicion of things that are not real), disorganization in thought, speech, or behavior, and disordered thinking
Depending on severity, this may be accompanied by difficulty with social interaction and impairment in carrying out daily life activities.
Most commonly associated with schizophrenia; can also be seen with severe cases of bipolar, depression and PTSD, among other disorders.
The presence of psychosis typically worsens one prognosis
Treatment varies
Psychosis shouldn’t be considered a symptom of a mental disorder until other relevant and known causes are excluded (CNS issue, disease, drugs)
EXAMPLE: One of your clients comes in one day in a frenzy. She looks disheveled and does not make much sense because she keeps jumping around topics. She tells you that she is worried aliens have been watching. You suspect that she may be experiencing psychosis, but you decide to rule out other potential causes first.
Primary vs secondary gain
psychopathology; describes the significant subconscious psychological motivators patients may have when presenting with symptoms.
Mainly seen in somatic disorders, but can be present with others.
Primary gain is the gain people achieve when their symptoms keep their internal conflicts out of awareness; distracts them from the ‘real’ underlying problem/issue
Secondary gain is the gain people achieve when their symptoms elicit kindness from others or provide an excuse for avoiding unpleasant activities; things they get out of as a result of sxs
Helps maintain sxs through positive reinforcement
EXAMPLE:One of your severely depressed patients gets out of going to work because of her diagnosed mental disorder. This is an example of secondary gain.
Remission
psychopathology; A period during which symptoms of disease are reduced (partial remission) or disappear (complete remission); usually means that the client is no longer experiencing clinical levels of symptoms related to the original issue.
The course of schizophrenia can include a residual, partial remission phase in which positive symptoms have decreased but negative symptoms still remain
Eysenck postulated that ⅔ of patients with mental disorders will spontaneously remit without psychotherapy; this prompted a close examination of the effective of psychotherapy
EXAMPLE: The female pt was responding well to ACT therapy. She was accepting the fact that her husband had left her for another woman. She was committed to setting goals of adapting to her new life of being divorced. And she was taking action one step at a time. The therapist noted that these positive steps had resulted in a partial remission of her depression as she was functioning much better than she had been.
Schizophrenia
psychopathology; a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality
Two types of symptoms – positive symptoms (excess of behaviors) or negative symptoms (absence of behaviors), with key symptoms of grossly disorganized behaviors, hallucinations and delusions [pt must have one of those]
Three phases; prodromal (before episode- appears more social at first; only applies to pre-schizophrenia), active (psychotic episode), and residual (partial remission; decrease pos sxs neg sxs remain).
Age of onset is between 16-25; 1% of population; men and women equal; > african americans vs whites; > lower SES vs high
CLEAR genetic link but environment still plays a role; also altered neurochemistry.
Treatment is generally antipsychotic medication along with various forms of therapy, including family treatment and skills training in order to help prevent relapse.
EXAMPLE: Client has been admitted as an inpatient because she has been hearing voices and has delusions of grandeur. She has been going around “blessing” everyone because she believes she is God. It turns out she had quit taking t
Serotonin
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psychopathology; a neurotransmitter responsible for regulating mood, appetite, sleep, memory, and other cognitive functions.
Serotonin regulates activity of norepinephrine (NE) and dopamine (DA)
Low levels can be present in depressive disorders, mania, and OCD among others.
SSRIs can aid in regulating serotonin level and are used to treat depression and OCD
Illicit drugs such as Ecstasy and LSD cause a massive rise in serotonin levels.
State anxiety vs trait anxiety
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psychopathology; this refers to the two recognizable ways which anxiety manifests itself.
State anxiety refers to undesirable emotional arousal in the face of threatening demands or dangers
Trait anxiety refers to a relatively enduring disposition to feel stress, worry, and discomfort; a personality trait
Substance Related disorders
psychopathology; Substance Use Disorder is characterized by a maladaptive pattern of substance use leading to significant impairment and/or distress during a 12 month period, including two or more of the following:
Failure to fulfill major role obligations; drug use in situations when it’s physically hazardous; use despite persistent social/interpersonal problems caused by or exaggerated by effects of substance; tolerance; withdrawal symptoms (different for each substance); substance taken in larger amounts than intended; desire or unsuccessful efforts to cut down/control use, significant time spent acquiring, using, or recovering; and social, occupational, recreational activities sacrificed
Severity specified based on # of sxs above 2-3 mild, 4-5 moderate, 6+ severe
DSM-V no longer discerns between abuse and dependence - all substance use disorder listed as ____ use disorder. Each drug has its own name and code
High rates of comorbidity with other mental illnesses such as PTSD and depression. Polysubstance use disorder very common - increases lethality
Etiology - clear genetic component, DA plays crucial role, learning comes into play (pos/neg reinforcement, cues for cravings), and social and cognitive aspects as well
Treatment includes Motivational interviewing, AA/NA, CBT, amongst others. There are medications available, but they are not best practice.
Question of whether or not abstinence is the best approach
No pts get forced by LAW to seek treatment for other problems – resistance common
EXAMPLE: A client comes in to therapy for problems surrounding her use of alcohol. She is no longer attending work or her weekly painting classes and she has not been meeting the obligations of being a MOM and WIFE. Recently she has been driving while under the influence and her husband has become worried over the past year. Therapist recognizes that this as substance use disorder
Tolerance vs withdrawal symptoms
psychopathology; part of substance use disorder; These are key symptoms to look for when determining a substance related disorder, and can be indicative of physical dependence.
Tolerance refers to a physiological state where the effectiveness of a drug has decreased due to chronic administration. This means that more of the drug will be required to achieve the same effect in the future.
Result of adaptive physiological changes in brain and organ systems to accommodate use
Behavioral tolerance can occur through drug-independent learning; context-dependent
Withdrawal is the onset of symptoms, both physical and mental upon cessation. Withdrawal symptoms vary depending on which drug was taken but are typically opposite of the drug’s primary effects
EXAMPLE: A client comes in to therapy for problems surrounding her opiate addition. She is no longer attending work or social obligations with friends. and she has not been meeting the obligations of being a mom and wife. Recently she has been driving while under the influence and her husband has grown very worried. The client also reports having to smoke more than she used to, and becoming extremely irritable and nauseous if she tries to stop. Therapist recognizes this is as indicateions of tolerance and withdrawal.
Trauma and stressor related disorders
psychopathology; A newly separated class of disorders in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criterion
70% of people exposed to at least one trauma in their life
PTSD has 4 core symptoms: intrusion (nightmares, intrusive thoughts, flashbacks, dissociation); negative alterations in cognitions and mood (negative beliefs about self, others and world; distorted cognitions, persistent neg emotional state, diminished interest, detachment, anhedonia); avoidance (triggers and cues of trauma, discussing trauma); and arousal and reactivity (irritability, recklessness, self-destructive bx, hypervigilance, exaggerated startle response, sleep disturbance, difficulty concentrating)
Timeframe of sxs > 1 month
Women 2:1 over men; > for lower SES
High rates of comorbidity, often with depression and substance abuse.
Etiology – neurobiology aspects: trauma triggers physical changes in brain and body; cognitive-behavioral aspects: develop fear structures in response to trauma (stimuli, response, cognitions) inadequate processing due to avoidance; and maintenance of PTSD via neg/pos reinforcement
Acute Stress Disorder has the same core symptoms as PTSD but symptoms last < 4 weeks
Treatment typically includes medication (SSRIs, benzos), exposure therapy, and cognitive and behavioral therapies, though other types have been used successfully.
Also EMDR
