Psychopathology Flashcards
Elements of mental disorders
infrequency
deviance
distress
disability
danger
Depression prevalence rates
Life % = 10-20% for women; 5-12% for men
Schizophrenia prevalence rates
Lifetime % = 0.5 - 1.5 %
Any Disorder prevalence rate
Lifetime % = 48.0 %
psychological disorder
- psychological dysfunction
- distress or impairment
- Atypical response `
biological treatments
- see mental illness as a disease
- focus on changing some aspect of physical functioning
- treat with medication or surgery
psychological treatments
- psychodynamic approaches
- humanistic approaches
- behavioral approaches
- cognitive behavioral approaches
- integrated/eclectic treatments (variety of techniques)
psychodynamic aka psychoanalytic
- focus on the PAST
- see behavior as driven by powerful unconscious inner forces
- sees psychological difficulties as stemming from unresolved tension based on early life traumas/conflicts/frustrations/deprivations
goal is for :
- therapist and patient to work together to identify “hidden blocks” (unconscious) that have developed as a result of past conflicts
- then guide the patient to discover the relationship between root causes and current symptoms
- insight orientated
behavioural
- focus is on the PRESENT
- modify problem behaviours by applying the principles of conditioning (pairing)
- treatment focuses on using techniques like exposure, reinforcement, ignoring, and punishment
Goal is to:
- extinguish non-productive/upsetting behaviours
- reinforce desirable behaviours
Cognitive
focus on HOW and WHAT we think
- how you interpret a situation (thought) influences how you feel about the situation
- thoughts - emotions
goal is to:
- identify maladaptive thoughts
- challenge these thoughts
- replace with more adaptive thoughts
humanistic
focus is on teaching the patient to seek fulfilment and reach their potential
goal is to:
- help the patient discover and then achieve their potential
Eclectic
therapist selects techniques from various types of therapy to design a treatment that best suits the case
goal is to:
- meet the individual needs of the patient
- mix and match techniques to suit patients needs
what is anxiety
apprehension about an anticipated issue
what is fear / panic
apprehensive response to immediate threat or danger
instinct
fight/flight response
sympathetic nervous system
- sweat
- shake
- heart racing
- shallow breathing
automatic perception of threat
- physical
- social
- thoughts
Yerkes dodson law
performance increases with mental arousal (stress) but only up to a point
types of anxiety disorders
- phobias
- panic disorder
- generalised anxiety disorder
- obsessive compulsive disorder
- post traumatic stress disorder
generalised anxiety disorder
- charcterised by apprehensive expectation
- anxiety is generalised and persistent
- free floating anxiety not situational
- worried about a number of events and activities
- person finfs it very difficult to control their worry
- feel distressed due to constant worry
panic disorder
- discrete period of intense fear in the absence of real danger
- sudden in onset
- builds rapdily
- accompanied by a sense of imminent danger and the urge to escape
- not predictable or confined to a given situation
- concern about future attacks leads to avoidance
- otherwise relatively free of anxiety between attacks
agoraphobia
marked fear or anxiety about at least 2 of the following situations
- using public transport
- being in open spaces
- being in enclosed spaces
- standing in line or being in a crowd
- being outside of the home alone
social anxiety disorder
- fear or anxiety about one or more social situations where the individual is exposed to possible scrutiny by others
- the individual fears that they will act in a way that will be negatively evaluated by others
- the social situations are avoided or endured with intense fear or anxiety
obsessive compulsive related disorders
disorders
- obsessive compulsive disorder (OCD)
- body dysmorphic disorder (BDD)
- hoarding disorder (HD)
common features
- repetitive thoughts and behaviours which cause distress, feel uncontrollable, and time intensive
- 1/3 BDD comorbid OCD
- 1/4 HD comorbid OCD
OCD
obsessions:
- intrustive and recurring thoughts, images, or impulses that are persistant uncontrollable and irrational
compulsions:
- repetitive excessive behaviors or mental acts a person is driven to perform to reduce anxiety caused by obsessive thoughts or prevent expected consequences
DSM - 5 PTSD
- EXPOSURE to acutal or threatened death, serious injury or sexual violence
- presence of one or more INTRUSIVE symptoms
- persistant AVOIDANCE of associated stimuli
- negative alterations in COGNITION AND MOOD
- marked alterations in AROUSAL and REACTIVITY
- duration - one month
- clinically significant distress, impairment, not sue to substance/medical condition
psychological treatment
common techniques
- relaxation
- cognitive restructuring
- exposure therapy and behavioral experiments to challenge, habituate and learn
exposure therapy
exposure therapy
- prolonged and consistent
- in vivo vs imaginal (During imaginal exposure, patients retell the trauma memory. During in vivo exposure, patients do activities where they gradually approach trauma-related memories)
systematic desensitisation
- with relaxation strategies
- effective in 70-90%
- comprehensive for long term maintenance
Snake phobia video
Used extreme exposure therapy
Believes she is going to have heart failure if a snake goes near her
Strong belief in catastrophe which is driving Mariam’s fear
Motivation to succeed is the most successful for exposure therapy
As she stayed exposed to the snake for a prolonged period of time her anxiety response decreased
Psychological principles that accounted for improvement – habituation which leads to extinction – banduras ideas from a cognitive view self-efficacy – positive reinforcement and modelling
symptoms of major depressive episode
- deppressed mood most of the day
- dimished interest or pleasure in most activities (anhedonia)
- weight loss or gain
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue or loss of engergy
- feelings of worthlessness or guilt
- inability to think or concentrate
- recurrent thoughts of death, plan or attempt
DSM-5 depressive disorders
- major depressive disorder (MDD)
- persistant depressive disorder (dysthymia)
biological factors - biochemical
3 major Nuerotransmitters in depressions (receptor sensitivity)
- norepinephrine (increasing energy)
- serotonin (mood and mood regulation)
- dopamine (processing rewards)
Hormones (dysregulation)
- hypothalamic pituitary adrenal axis (HPA)
- cortisol (released in times of stress, breaks down nuerotransmitters such as serotonin - lower mood)
biological factors - brain abnormalities
emotional or limbic system projects to prefrontal cortex
- serotonergic pathway
(emotional information comes to awarenes
these areas are very important for regulating emotions
if pfc is not functioning then ability to inhibit our maladaptive reaction to experience will not work leading to depression )
emotional regulation system
- amygdala
- subgenual anterior cingulate
- dorsolateral prefrontal cortext
- hippocampus
left frontal hemisphere asymmetry
- people with depression left side of frontal cortex was not as active as right side (right side related to calmness)
cognitive theories Aaron beck
Aaron beck is one of the founders of cognitive theories of depression and cognitive therapy
He found the way people think about things (events in enviroment) leads to how they are going to feel
Hopelessness – major factor in contributing to depression
Rumination – thinking about negative things in their life over and over again
becks cognitive therapy
- four phases 20 sessions
1. increase activities and elevate modd
2. challenge automatic thoughts
3. identify negative thinking and biases
4. change primary attitudes/schemas
biological form of treatment - antidepressant drugs
Mono amine oxo inhibitors
- MAO inhibitors breaks down neurotransmitters in the body, so inhibiting MAO will increase the neurotransmitters that result in MDD, however also breaks down other things such as components in wine and cheese which can have an nehvative effect so not the first choice of treatment
Tricyclics
- Range of difficult side effects
Selective serotonin reuptake inhibitors
- Reuptake of serotonin in synapse enhancing mood, side effects but not as serious as tricyclics
schizophrenia vs psychosis
Psychosis -
- not specific to a certain mental disorder - breaking from reality - having altered states of consciousness
Schizophrenia -
-Type of mental disorder that is characterized by a set of some psychotic symptoms
three symptom clusters of psychoses
positive symptoms
- symptoms in a excess of what would be typical
negative symptoms
- absence of something that would be typical
disorganised symptoms
- affects ability to process thoughts and communicate
DSM - 5 criteria for schizophrenia
2 or more of the following
1. delusions
2. hallucinations
3. disorganised speech
4. disorganised or catatonic behaviour ( rare type of disorganised behaviour causing inability)
5. negative symtoms
positive symptoms: delusions schizophrenia
Persecution – belief that someone is out to get you
Grandeur – believing that one has a special power
Reference – objects or things in an environment are communicating even when there is no basis
Erotomania – fixed or rational belief that another person is in love with them (rare)
Somatic - fixed irrational belief that something is wrong with you – something extreme like you are dying from a terminal illness no matter what doctors says
Nihilistic – the world is ending
positive symptoms: hallucinations schizophrenia
Auditory – most common type of hallucinations (hear what other people can’t – hear voices from other people or their own – voices are usually mean and say hurtful things.)
Visual – typically defused see things like strange clouds or shadows
Olfactory – smells, smelling things that aren’t there hard to determine
Gustatory – taste
Tactile – sense of touch
negative symptoms schizophrenia
affective flattening
- shallow emotions
alogia
- poverty of speech
thought blocking
avolition
- lack of drive/motivation
anhedonia
- inability to experience pleasure
etiology of schizophrenia
Neurodegenerative hypothesis
-Individuals with schizophrenia have lower brain volumes than individuals who do not have schizophrenia
-Individuals with schizophrenia have a faster deuteration of brain matter than what you would see in non-individuals without schizophrenia
Enlarged ventricles
-Space in the brain that contains cerebral spinal fluid
-What they have found in schizophrenia is that these ventricles are far larger in patients
- Enlarged ventricles is an index of overall lower brain volume
Prefrontal hypometabolism
-Information that is processed in the pre frontal lobe tends to be slower
- Less activity in frontal lobe in patients with schizophrenia
dopamine paradox in schizophrenia
excessive dopamine in subcortical areas leads to positive psychotic symptoms (hallucinations, delusions)
reduced dopamine in prefrontal cortex leads to negative psychotic symptoms (implications for learning)
cognitive perspective: treatment
cognitive rehabilitation
- modify over and under attention
cognitive restructuring
- challenge delusional beliefs
- psychoeducation
bipolar disorder: manic episode
- one week of elevated, expansive, or irritable mood
- three changed of the following
Grandoise self esteem – developing beliefs about being superior to others or thinking that they can achieve a lot more than possible
Lower need for sleep – report that they have so much energy and don’t need sleep
Overly talkative -
Racing thoughts – individuals that are experiencing a manic episode often report that their thoughts are running through their minds faster than they can process them
Easily distracted
Increased activity or agitation
Engagement in high risk activities
4 different biopolar disorders
MDE - major depressive episode
ME - manic episode
HME - hyper manic episode
PPD - psycho dynamic disorder
treatments for bipolar disorders
Biological
- Psychotropic medication
Lithium – most effective medication (type of salt)
First method of treatment
Not all patients can tolerate lithium because it comes with severe side effects
Requires very careful monitoring as it is very easy to overdose
- Anticonvulsants
Found to be effective in bipolar disorder
Effective mood stabilisers
Can also have calming effect and help with sleep regulation
2 types of anorexia nervosa
restricting type: no binging or purging
binge eating/purging type: with regular binging or purging
disorders that originate in childhood
nuerodevelopmental disorders
- intellectual disability
- learning disorders
- autism spectrum disorders
- adhd
behavior disruptive disorders
- oppositional defiant disorder
- conduct disorder
- aka externalising disorders
autism spectrum disorder
- defecits in social communication
- restricted, repetitive behavior patterns
- onset in early childhood
- spectrum disorder so ranges from mild to severe
Epidemiology
- symptoms usually recognised during 2nd year of life
- 4 times more common in boys than girls
- Neurodevelopmental disorder
- Brain developed differently than neurotypical individuals
etiology
- Genetic heritability is very high approx. 90%
- If one identical twin meets the bracket for ASD it is 98% likely for the other twin to develop
Implicated in disorder
- Mother having rubella
- Toxic exposure
treatment
- modelling and operant conditioning
- communication training
- parent training (psychoeducation)
- community integration
attention deficit hyperactivity disorder (adhd)
3 substypes
- predominantly inattentive type
- predominantly hyperactive impulsive type
- combined type
inattention
hyperactivity/ impulsivity
etiology
- 60-80% heritability rate
- under responsive prefrontal and striate regions
- abnormalities in dopamine
treatment
- biological - stimulant and non stimulant medications
- psychological - behavior therapy
conduct disorder
- aggression to people and animals
- destruction of property
- deceitfulness or theft
- serious violation of rules
- limited prosocial emotions
etiology
-81% of externalizing disorders that have in common is theat they have genetic vulnerability
Number of risk factors linked to externalising disorders
- Exposure to abuse
- Exposure to family violence
- Social cultural risk factors (growing up in poverty)
treatment
Multi systemic therapy – full family system
Conduct disorder and ODD usually come from family dynamics
Child focused more behavioral approach
Rewarding positive punishing negative
What can be implemented to prevent full development of ODD
Identifying risk factors and intervening
definitions of addiction, tolerance, withdrawl
addiction is a severe substance use disorder (6 or more symptoms)
tolerance - larger doses required, effect of drug less
withdrawl effects - physcial (shaking, flu symptoms etc) psychological (anxiety, irritability, depression)
NZ alcohol
20% of adults drank alcohol in a way that could harm them selves or others in the last year
hazardous drinking rates were higher in maori than european nz
hazardous drinking rates were higher in men than women
rates of hazardous drinking were highest in youth ages 18-24 years
adult drinkers in economically deprived areas were 1.7 times more likely to be hazardous drinkers than adult drinkers in least deprived areas
affects of drug classes
Most common depressants opioids and alcohol
Reduces functioning of pre frontal cortex which reduces inhibition
Depressing effect on central nervous system so functioning is reduced
Prescribed opioids tend to have depressing effect where a person doesn’t feel pain
More synthetic types like heroin have the same but more addictive potential
Stimulants increase activity in central nervous system to seek out more pleasurable rewarding behavior
Hallucinations altered state of consciousness
Polysubstance use = using 3 different substances and meet criteria for all 3
nucleus accumbens
related to reward system – dopaminergic system – people who are more prone to condition positive rewards find the use rewarding and get a positive affect – becomes reinforced and wants to use drug again – people who have sensitive reward system are going to be more prone to want to try
aversion therapy
- psychotherapy designed to cause patient to reduce or aviod an undesirable behaviour pattern by conditioning the person to associate the behavior with an undesirable stimulus
personality disorder clusters
cluster A - odd thoughts and behavior
(paranoid, schizoid, schizotypal)
paranoid pd - deep suspicion or mistrust of others
schizoid pd - social detachment, cold emotional expression
schizotypal pd - magical ideation, social isolation and anxiety
cluster B - dramatic, emotional or erratic
(antisocial, borderline, histronic, narcissitic)
antisocial - disregard for social norms and standards
borderline - emotional dysregulation, attachment disturabnce
histronic - self centeredness and need for attention
narcissistic - entitlement and arrogance, self obsession, lack of empathy
cluster C - anxious or fearful
(avoidant, dependant, obbessive compulsive)
avoidant - social anxiety, fear of rejection
dependant - seperation anxiety, rely on others
obsessive compulsive - need for order
Antisocial PD
- disregard social norms
- reckless behavior
- impulsivity
- irresponsibility
- prone to anger/aggression
- deceitfulness/manipulative
- lack of guilt or remorse
50-80% of correctional inmates
two process model for etiology psychopathy
factor 1 (affective/interpersonal)
- amygdala - poor fear conditioning, inability to read distress cues
factor 2 (antisocial behavior)
- orbiofrontal cortext - disinhibition, poor emotional decision making
etiology and treatment of borderline pd
etiology
- psychodynamic - early parent relationships
- object relations - lack of early acceptance by parents
biopsychosocial theory
- vulnerability to emotional dysregulation
- invalidating childhood enviroments
treatments
- dialectical behavior therapy
- mentalization based therapy
limitations with DSM - 5 system
- excessive comorbidity
- inadequate coverage
- excessive within diagnosis heterogeneity
- no clear boundary between normal and pathological personality
- marked temporal instability
ICD - 11 personality disorder
ICD - international classification of diseases
ICD-11 has changed personality disorder diagnosis from categorical to dimensional
A categorical approach to assessment relies on diagnostic criteria to determine the presence or absence of disruptive or other abnormal behaviors
whereas a dimensional approach places such behaviors on a continuum of frequency
personality disorder is a dimensional impariment continuum
