Psychological Disorders Flashcards
What are psychological disorders?
Behavioural or psychological syndromes or patterns
Lead to clinically significant distress or disability
How does the DSM-5 define psychological disorders?
According to the DSM-5, a psychological disorder is a “clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior” that is “usually associated with significant distress or disability in social, occupational, or other important activities”
abnormal psychology
Seeks to characterize nature and origins of psychological disorders
clinical psychology
Assessment and treatment of psychological disorders
What three things must a syndrome NOT be in order to qualify as a psychological disorder?
- Expectable response to common stressors and losses
- Culturally approved response to a particular event
- Simple deviance
Point prevalence
Percentage of people in a population who have a disorder at a given time
Lifetime prevalence
Percentage of people in a population who have a disorder at any point in their lives
What is a clinical assessment?
Used to evaluate a person’s psychological functioning and determine whether a disorder is present.
What is a clinical interview? (3)
Clinical interviews systematically explore a client’s current mental state, life circumstances, and history.
Structured interview
Asking specific questions in a specific sequence, while paying attention to certain types of content
What are self-report measures and projective tests frequently used for?
Supplementing a clinical interview.
What 3 parts of a patient’s presentation do clinicians look for when doing assessments?
- What clients say
- Their behaviour
- Discrepancy between 1 and 2
What is the Minnesota Multiphasic Personality Inventory (MMPI)?
Created in 1930s, was trimmed down and now has 338 questions, often used in clinical practice and to assess people for high risk jobs.
What is a projective test? What’s wrong with them?
Clinicians present unstructured or ambiguous stimuli and ask patient to respond to it, e.g. Thematic Apperception Test where client has to say what is going on in a picture.
Time consuming and expensive to deliver and very mixed evidence about their validity. However some specific ones, such as the Adult Attachment Projective Picture System, have more evidence of reliability and validity than others.
When was the most recent edition of the DSM published?
2013
In what edition of the DSM was homosexuality removed and when was it published?
III, published in 1980
Name a culture-specific disorder
Bulimia
Dhat syndrome–South Asian disorder characterized by severe anxiety about release of semen
Shenjing Shuariuo–Chinese, fatigue, dizziness, headaches
Ataque de nervois–central/south american, wide variety of symptoms inc. anxiety, anger, aggression
What are the 4 main goals of the DSM-V?
- Be as useful as possible for clinicians and clients
- Ensure changes from previous editions are based on research and evidence
- Maintain continuing with previous editions
- Reflect current scientific evidence
Name two benefits of diagnostic labels
- Better treatment
a. Know which treatment to provide
b. Allows different clinicians to coordinate care
c. Can provide individuals with self-knowledge and motivation to seek treatment- More precise research
a. Operationalization
b. Find prevalence
c. Direct resources to prevalent disorders
- More precise research
Name two costs of diagnostic labels
- Stigmatization
- Over-emphasis on separation between each disorder–people are not binary
a. Encourages clinicians to see diagnoses as fixed and enduring–70s study where healthy people were admitted to hospital
b. Hinders search for common, underlying mechansisms
What’s one way treatment providers try to distinguish between the person and the disorder?
“People with x” language rather than “xic” language. Lol. Oops.
What’s the diathesis-stress model of psychological disorders?
Provides an overarching framework to understand how disorders arise by looking at how diathesis–things that create predispositions for a disorder, which can be either psychological or biological–can combine with stressors (stressful circumstances) to result in a mental disorder. Based on biopsychosocial model of psychological functioning.
Name some types of diathesis that contribute to the development of psychological disorders? Give an example of each.
- Early life experience
- Cognitive/psychological e.g. learned helplessness
- Social
- Genetic factors
- Biological factors
What are the 3 types of anxiety-related disorder in the DSM?
- Anxiety disorders
- Obsessive compulsive disorders
- Trauma and stressor related disorders
What two symptoms are present in both specific phobias and social anxiety disorder?
- Intense fear
2. Avoidance
What is a specific phobia?
A specific phobia is an intense fear of a particular object or situation, such as snakes, bridges, or heights. Lifetime prevalence 13%.
What is social anxiety disorder?
Social anxiety disorder involves an intense fear of being watched, evaluated, and judged by others. Lifetime prevalence 13%. May be “performance only”.
What is panic disorder?
Anticipation and experience of panic attacks, sudden episodes of terrifying bodily symptoms (like labored breathing, choking, sweating, or heart palpitations) and a sense of going insane and losing control. Panic attacks seem to come out of the blue rather than due to a specific situation.
What is agoraphobia?
A fear of being in situations in which help might not be available or in which escape might be difficult or embarassing
Why does panic disorder often lead to agoraphobia?
Fear of having a panic attack in a public place.
What is generalized anxiety disorder?
- Relentless and pervasive anxiety related to a number of different events and activities.
- A common feature is worry, which some clinicians believe is a cognitive form of avoidance that serves to decrease anxiety responses
- Somatic symptoms
- Lifetime prevalence of 6%.
What is OCD?
- Anxiety disorder characterized by obsessions and compulsions.
- Obsessions: recurrent unwanted and disturbing thoughts
- Compulsions: ritualistic actions done to control obsessions, such as repeated handwashing or checking to make sure stove is off
- Lifetime prevalence of 2%. 1/3rd develop it in childhood.
What symptom of OCD most predicts more severe impairment and a chronic course?
Mental rituals.
What are trauma- and stressor- related disorders?
- Triggered by one or more events that involve actual or threatened death, serious injury, or sexual violation
- Acute stress disorder: lasts 1 month or less
- PTSD: lasts 1 month or longer, lifetime prevalence 7%
- It isn’t well understood why only 1 in 10 people who experience highly traumatic events go on to experience PTSD
What are the two stages of a trauma or stressor related disorder?
Common to initially experience a period of dissociation, followed by intrusive symptoms, arousal symptoms, and avoidance symptoms
Are flashbacks always accurate representations of the traumatic event?
They often are, but they can be composites, or they may include things that were imagined at the time.
What are the 3 main types of symptoms of trauma and stressor related disorders?
- Arousal
- Avoidance
- Negative alterations in cognition and mood
Where are the adrenal glands located?
ON TOP OF THE FUCKING KIDNEYS
What causes anxiety-related disorders? 3 points
- Biological risk factors include: genetic profile, propensity to activate brain regions such as those associated with fear learning
- Psychological risk factors such as fear learning and negative experiences are also thought to play an important role
- The fact some phobias are more common than others may be a result of natural selection favoring those who were predisposed to fear certain things
Concordance rate
Probability that someone with a particular family relationship with a person with a disorder will develop that disorder.
What’s the concordance rate for anxiety in identical twins compared to fraternal twins?
5 times
What do fMRI studies tell us about the cause of specific phobias vs PTSD?
- Specific and social phobias: fear learning–amygdala and insula
- PTSD: less activated of prefrontal cortex i.e. emotional regulation
Affective disorder
Mood disorder
Anhedonia
Diminished interest or pleasure in nearly all activities that previously provided pleasure
What is major depressive disorder? 3 points
- Feelings of sadness, or emptiness and anhedonia
- Depressed mood for most of the day, nearly every day, for more than 2 weeks + a number of other symptoms
- Must cause clinically significant distress or impairment
How common is major depressive disorder? When is it most common?
- Very common. Twice as likely in women than in men. Rumination, turning emotional difficulties over and over in your mind, might be what makes it more common in women.
- Most common in adolescence through to middle adulthood.
How many different ways are there to quality for a depression diagnosis?
16,400!
What two illnesses does the WHO rate severe depression on par with in terms of associated level of disability?
Quadriplegia and terminal cancer
What’s the number one cause of years lost to illness worldwide?
Depression
What are psychotic delusions in depression?
Unshakable false beliefs. E.g. it would be better if I’d never been born, I’m the worst person in the world. More severe, more likely to recur, more likely to lead to death.
When does the gender gap for depression emerge?
Teenage years
What is bipolar disorder? When does it occur?
- Both manic and depressive episodes, with normal periods of mild-to-moderate symptoms interspersed
- Episodes may be as short as a few hours or as long as a few months, and they don’t need to alternate
- Can occur in both children and adults
- Lifetime prevalence of 4%
What is disruptive mood dysregulation disorder?
Childhood disorder characterized by defined by frequent temper outbursts and a persistently angry or irritable mood, ongoing rather than episodic
Hypomania
Can feel intensely pleasurable but often develops into mania
Mixed states
Signs of both depression and mania
Three key facts about suicide
- Leading cause of death worldwide
- Across almost all cultures, women more likely to attempt and men more likely to die
- Overwhelming majority who kill themselves thought to have disorders
Who is at highest risk of suicide in the US?
Textbook says person at highest risk of suicide in the US is male, non-Hispanic white or Native, and either an adolescent or older adult
In which two countries do more women die from suicide than men?
China and Indonesia
When are people who have bipolar at greatest risk of suicide?
- During leaves from hospital
* Immediately after discharge from care facility
What biological factor supports the idea impulsivity is a key factor in suicide attempt?
Low levels of serotonin in prefrontal cortex interrupts self-regulation and long-term planning.
What are the biological and psychological risk factors for mood-related disorders?
• Biological risk factors:
○ Genetic profile
○ Abnormalities in three major neurotransmitters: norepinephrine, dopamine, and serotonin
○ Dysregulation in emotion-generative brain regions such as subgenual anterior cingulate
• Psychological risk factors: ○ Dysfunctional patterns of thinking, like having negative cognitive schema or negative explanatory style ○ High levels of interpersonal stress
What’s the concordance rate for mood disorders in identical vs fraternal twins?
2x
What are 2 key cognitive risk factor for depression?
Negative cognitive schema, where people interpret everything that happens to them negatively, come before mood changes
Explanatory style–internal (I caused this bad thing), global (this type of thing will happen elsewhere in my life), and stable (it will never get better)–also usually predates depression
Name some social risk factors for depression
- Loss of parent before age 11
- War
- Returning from hospital to critical and hostile family
- Low SES
What is schizophrenia?
- Schizophrenia is characterized by a loss of contact with reality and a breakdown of the normal functions of the mind
- Positive symptoms include delusions, hallucinations, and disorganized behaviour
- Negative symptoms include flattening of emotional responses, catatonic behaviour, anhedonia, and social withdrawal
- Cognitive difficulties–sensory processing, episodic memory, cognitive control, coherence
- Lifetime prevalence of 1%
In what ways does the psychological impact of having hallucinations vary across culture?
I could talk about this for days lol
How is life course of someone with schizophrenia affected by gender?
Tends to begin earlier and have more severe course in men than women
What is the dopamine hypothesis for schizophrenia? Why do people think it?
- Dopamine hypothesis says schizophrenia is associated with elevated activity in dopamine system
- Based on classical antipsychotics reducing blocking dopamine receptors. The more they block, the better they work.
- Amphetamines
What’s wrong with the dopamine hypothesis for schizophrenia?
- May in fact be caused by a dopamine imbalance as certain regions seem to have more than usual and and others less
- Newer antipsychotics work just as well and don’t seem to have big effect on dopamine
- PCP creates similar symptoms by blocking glutamate receptors
- Reducing glutamate activity reduces positive and negative symptoms
What brain bases for schizophrenia are known about?
- Differences in dopamine: elevated or imbalanced
- Differences in glutamate
- Enlarged ventricles–to make up for degeneration in brain size
- Loss of brain volume about twice that of normal aging
- Loss of grey matter in prefrontal cortex
What causes schizophrenia?
- Twin and adoption studies strongly suggest genetic basis
- Prenatal risk factors (diatheses) include poor maternal health during pregnancy and birth complications
- Low SES–particularly poverty–plays a potent role
- Many view schizophrenia as a neurodevelopmental disorder, which is a disorder that stems from early brain abnormalities
What are civil commitment laws?
- Specify when people can be hospitalized against their will due to mental limitations associated with a psychological disorder
- Goal is supposed to be preventing harm to self or others, but it has proven very difficult to estimate the level of danger posed by most people who have been committed
What does the pattern of how depression meds works tell us about the underlying issues with neurotransmitters?
They increase levels of a neurotransmitter immediately but the drugs usually take weeks to work, suggesting it’s less a shortage or excess and more an imbalance or dysregulation
IS PATH WARM? Suicide risk factors
Ideation Substance abuse Purposelessness Anger Trapped feelings Hopelessness Withdrawing Anxiety Recklessness Mood shifts
What are the two key factors involved in autism according to the textbook?
- Difficulties with social communication and interaction
2. Restricted or repetitive patterns of interest or behaviour
How common is autism?
Relatively rare, controversy over whether its increase prevalence estimates actually mean there’s more autistic people
What 3 things might be causing rise in autism diagnosis?
- Broadening dx criteria
- Dx substitution
- Increased awareness
What are the 3 reasons the textbook gives for how autism develops?
- Difficulties with theory of mind
- Diminished motivation to engage in social interaction
- Brain abnormalities
What does the textbook have to say about ADHD?
- CHILDREN with ADHD are impulsive and hyperactive and have difficulties moderating their attentional focus
- Childhood prevalence of 8.5%
- Adult prevalence of 4%
How do stimulants for ADHD work?
How do stimulants for ADHD work?
What is DID?
- Presence of two or more distinct personality states, or identities, within a single person.
- Thought many people with DID used their ability to dissociate to manage childhood trauma.
- Used to be a rare diagnosis but become more common in the 80s and 90s
- Controversy over how common it is and how it arises
What’s the posttraumatic model of DID?
Child dissociates in order to cope with serious trauma
What’s the sociocultural model of DID? What’s the evidence for it?
- Was far less common until the 80s and 90s
- Some argue that it started arising when therapists suggested to their clients that they think of certain of their mental events and experiences in a compartmentalized way
- Study of interidentity amnesia showed no signs of memory compartmentalization despite subjective reports
- Some key cases that made the disorder widely known about include features that suggest the patient may have been suggestable and that the disorder may have been suggested
- The common presentation used to be 2-3 alters but now the average is 15
What does a diathesis-stress model suggest about DID?
Some people have a greater skill or habit for dissociating, and this can develop into DID given unusual stress, traumatic abuse, and, potentially, having a sociocultural map for how to do so.
What is the DSM-5 definition of a personality disorder?
• An enduring pattern of inner experience and behavior that
○ (1) deviates markedly from cultural norms and expectations,
○ (2) is “inflexible and pervasive across a broad range of personal and social situations,” and
○ (3) leads to “clinically significant distress or impairment in social, occupational, or other important areas of functioning”
What are the 10 personality disorders in the DSM-V?
- Antisocial
- Avoidant
- Borderline
- Dependent
- Histrionic
- Narcissistic
- Obsessive-compulsive
- Paranoid
- Schizoid
- Schizotypal
What are the 3 clusters of personality disorders?
A: Odd and eccentric
B: Dramatic and emotional
C: Fear and anxiety
What are two problems with diagnosing personality disorders?
- Defined by prototype examples and people rarely exhibit all traits, and may exhibit features of many prototypes
- Each disorder can be seen as the extreme of some ordinary pattern
Treatments for bipolar (4 to do’s and 2 do not do’s)
- Counselling
- Lithium or other salts to temper/prevent mania
- Anti-seizure meds like Depakote can help manage both mania and depression
- Sleep helps medicate emotions
- Never ever prescribe antidepressants because they can cause mania
- Stimulants are contraindicated bc they can cause mood instability and trigger depression or mania
Rapid cycling bipolar
At least 4 total manic/depressive episode in 1 year
Cyclothymia
Mild form of mania and mild form of depression that cycle
• Symptoms (alternating “highs” and “lows”) have been present for at least 50 percent of the time for at least 2 years, and
• There has not been more than a 2-month period of being symptom-free, and
• Symptoms are not due to substance abuse or a medical condition
Bipolar II
At least one hypomanic episode and one depressive episode
Cycling between hypomania and depression
Bipolar I
At least 1 manic episode, often before or after a depressive episode but not necessarily–can have multiple manic or depressive episodes back-to-back.
Cycling between mania and depression.
What are the four types of bipolar disorder?
Bipolar I
Bipolar II
Cyclothymia
Rapid cycling
What are the four unipolar depressive disorders?
Major depressive episodes
Major depressive disorder
Persistent depressive disorder
Seasonal affective disorder
What is a major depressive episode?
• At least 2 weeks • Symptoms mild to severe ○ Significant weight loss or gain ○ Insomnia or hypersomnia ○ Psychomotor retardation or agitation ○ Fatigue every day ○ Diminished concentration ○ Psychotic delusions and/or hallucinations
What is major depressive disorder? Tell me about the pattern of depressive episodes.
- Multiple major depressive episodes.
- Averages ~5-6 major depressive episodes in a person’s lifetime without treatment.
- Likelihood of another episode increases with the number of previous episodes.
- Untreated, depressive episodes average ~9 months.
- Recovery may go back up to a baseline of mild depression rather than normal.
What is persistent depressive disorder?
- Less severe depression
* Lasts for at least two years
What is seasonal affective disorder?
- Occurs during winter
* Depression can be mild or severe
What are the treatments for depression?
- Counselling
- Antidepressants (which are actually antianxiety medications)
- Light therapy
- Electroconvulsive therapy
- Vagus nerve stimulation (VNS)
- TMS
What is electroconvulsive therapy?
Can be used for long-lasting, severe depression. Can provide relief when nothing else has. Electrodes on head initiate a seizure. Unilateral or bilateral. Common side effects: Headache, memory impairments.
Relief may only last a few months or a year.
What is vagus nerve stimulation?
Electrodes surgically implanted into central nervous system so they can provide much smaller dose directly at the tissue that will be most helpful for alleviating depression.
What is transcranial magnetic stimulation?
Using magnets to increase blood flow to certain regions of the brain. Mixed results but may be very useful.
What are the four D’s of psychiatric/psychological disorder
- Distress
- Deviance
- Dysfunction
- Danger
What is deviance? How can it be “diagnosed”?
a. The extent to which an individual is not conforming in their thought and behaviour to other people within their culture
b. In order to diagnose deviance, you have to know their culture. Different cultures have different expectations, stereotypes, and social rules. What appears deviant from one perspective might be normal from another.
What is distress? How is it assessed?
a. Most important and easiest to assess
b. Often simplest to assess. Does the thinking or pattern of behaviour cause you to feel distress about thinking or behaving that way? Are you happy with it or would you like it to be different?
c. Core feature or most (but not all) disorders
What is dysfunction? How is it assessed?
a. Relates to not meeting the responsibilities we have in our everyday lives: our ability to provide for ourselves and others
b. Are you able to secure food, shelter and safety for yourself and your family?
c. Whether someone can work is usually the measuring stick for dysfunction–can you work?
d. Can you fulfill your social role?
What question defines danger?
Are you a danger to yourself or others?
Does every disorder need the 4 D’s?
No. The DSM judges whether each disorder needs to fulfil each of the 4 D’s.
Sometimes, someone may be very sick but may not be distressed–e.g. manic episode
In what way does the category system of the DSM flawed?
○ Categorical distinctions which means it makes things very binary–similar to Myres-Briggs. It’s trying to put something that’s a continuum into a binary. This means we miss out on a lot of nuance.
What is the research domain criteria project?
□ Does not think about categories
□ Thinks about continuums of symptoms
□ Characterizes people based on where they fall on a continuum of symptoms
Diagnosis in DSM-V-TR usually requires which 4 types of criteria to be fulfilled?
- Minimum number of symptoms, usually taken from two lists:
A) Required
B) Minimum number of ‘pick and choose’ symptoms - Minimum duration of symptoms
- Either distress or dysfunction
- Deviance
What are 5 issues with assessing distress?
1) Some symptoms of distress are difficult for people to notice, e.g. stress, anhedonia. Should educate patient about how to recognise it in themself.
2) The nature of some disorders may make some people distressed under some circumstances but not others, e.g. bipolar
3) Some disorders may not include distress and a clinician could induce distress by saying “you’ve got these symptoms, I think you’re missing out on all these things”
4) Is the distress caused by stigma or by the condition?
5) Will the diagnosis induce stigma that is more harmful than the benefit of the diagnosis?
What % of people will get a psychological disorder in their lifetime?
46% lifetime prevalence of disorder
What % of people will have a disorder in any given year?
25%!
What are the three broad classes of anxiety spectrum disorders?
Panic
Phobic
GAD
What is a panic attack?
○ Course: Acute symptoms develop over a few minutes ○ List 1: Must have intense distress ○ List 2: Four or more of: § Heart palpatations § Sweating § Numbness § Choking § Shortness of breath § Trembling/shivering § Dizziness § Intense fear § Depersonalization
What is panic disorder?
Diagnosis of a single panic attack, then diagnosis of a number of these events is diagnosable as panic disorder
○ Symptoms: § Repeated and unexpected attacks § Fear of having attacks in the future § Avoidance § Duration > 6 months § Distress or dysfunction § Deviance: very few cultures induce panic attacks in people
What are two biological causes of panic disorder?
□ If parents have any type of anxiety disorder, you’re more likely to be diagnosed with a panic disorder
□ People with a 5-HT dopamine are more likely to be diagnosed with panic disorder, and this is often traced back to parent
What are two environmental causes of panic disorder?
Stimulants
Conditioning/learning–start to predict situations that will cause attacks, and those expectations can lead to attacks
What are the 5 subtypes of specific phobia?
§ Animal type § Natural environment type § Situational type § Blood/injury type § Misc.
What happens to heart rate in blood/injury type phobias?
Most phobias involve increase in respiration, sweating, and increased HR and BP. This produces a DECREASE in BP–bc if we decrease HR we’ll bleed less.
What are the pros and cons of different therapies for specific phobias?
Exposure until extinction by FAR the best treatment.
Behavioural therapies much more effective than cognitive. Changing your thoughts about the object of fear does not reduce the fear. Cognitive therapy sometimes works if phobia has become generalised from one stimulus to another, e.g. fear of spiders becomes fear of all insects.
Meds usually not prescribed tho serotonin/dopamine abnormalities are common
What is systematic desensitization?
- Person lists situations they’d feel fear in, from lowest to highest.
- Expose them to least fear-inducing situation on list until they feel calm and relaxed
- Move up to next-highest fear-inducing situation
- Repeat until all fear is extinguished
What is virtual exposure for specific phobia?
Often used for fear of heights. Ex. VR. Used when they can get v overwhelmed with real thing.
What is modelling for specific phobia?
Show someone else experiencing the thing and that it’s okay. Not nearly as effective as exposing the person to it themself.
What is flooding for specific phobia?
Start out with the highest or one of the highest things on your list of fear-inducing things. Flood them with it. Make sure they can’t look away or escape.
When would you use flooding vs systematic desensitization for specific phobia?
® Flooding is better in terms of outcomes, but many people won’t want to do it
® Flooding would be a lot cheaper
What is one-session treatment (OST) for specific phobia? What two ideas is it based on? How effective is it?
Type of flooding. 3-hour long, single therapy session for any type of phobia.
Based on idea phobia is driven by catastrophic belief and person needs to challenge that belief.
Doesn’t use deep breathing–deep breathing MASKS anxiety and doesn’t teach people that anxiety isn’t dangerous.
What are the 4 steps involved in one session treatment?
- Patient must make commitment to stay for full session–requires a lot of trust of therapist
- Patient approaches phobic stimulus as close as they can–challenged to do it but not forced
- At closest point on each item on the list, patient will wait until anxiety decreases
- Conclude when anxiety as subsided and when patient states intention never to avoid phobic stimulus in future
How effective is OST for specific phobia?
~96% effective immediately after first treatment. 65% of people said phobia was resolved 4 years after treatment. Average duration of phobia prior to treatment was 18 years.
What is the preparedness theory of specific phobias?
Proposes that most phobias are not random, but instinctual.
Most common phobias are adaptive: spiders, snakes, heights, dogs
What do snakes and buttons tell us about the preparedness theory of specific phobias?
Stage 1:
- Showed snake and button.
- Given small shock every time they see one object but not the other. Elicits anxiety response seeing that object.
- How quickly does anxiety ramp up after seeing shock snake vs shock button?
Result: People can be conditioned to fear snakes more quickly than buttons.
Stage 2:
Reprogram them to not be scared anymore through exposure.
Result: People can be deconditioned from non-instinctual phobia more easily
