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
needs ex
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
needs ex
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
