Unit 1

Question 1

Abnormal Psychology

Answer 1

1. concerned with understanding the nature, causes, and treatment of mental disorders.
2. Study of mental disorders/ mental illnesses/ psycho. disorders/ psychopathology.
3. what they look like, why they occur, what maintains them and their effect on people’s lives.

Question 2

Psychopathology

Answer 2

• defined as a psychological illness diagnosed on the basis of the observed symptoms of the patient.
• One parsimonious and practical way to define abnormal behaviour is to ask
  whether the behaviour causes impairment.

Question 3

Impairment

Answer 3

the extent to which a behaviour or set of behaviours effects the successful functioning
in an important domain of the individual’s life in the person’s life including the psychological, interpersonal and performance/achievement domains.

Question 4

Parameters of abnormality

Answer 4

1. no universal agreement
2. some elements are clear enough to adopt a “prototype” model of abnormality
3. not an end in and of itself to determine or define abnormality

Question 5

Name the domains

Answer 5

Suffering, maladaptiveness, Deviancy, Violation of standards of society, social discomfort and Irrationality and Unpredictability

Question 6

Symptom

Answer 6

A single indicator of a problem

Can involve affective, cognitive, social, behavioural or somatic symptoms

Question 7

Syndrome

Answer 7

A cluster or group of symptoms that all occur together

E.g. Depression patient

Question 8

Acute condition

Answer 8

Relatively shorter, less than six months

Or refers to behavioural symptoms of high intensity

Question 9

Chronic condition

Answer 9

Relatively long-standing and often permanent

It May apply to generally low-intensity disorders

Question 10

Comorbidity

Answer 10

Presence of two or more disorders in the same individual
high in people with severe mental disorders
E.g. Person who drinks excessively and who is simultaneously depressed and suffering from an anxiety disorder.

Question 11

Epidemiology

Answer 11

Study of distribution of a disease in a given population
Mental health epidemiology
A key component: determining the frequencies of mental disorders

Question 12

Prevalence

Answer 12

number of active cases in a given population at a given period of time
figures are typically in percentages
different types: point, one year and lifetime

Question 13

Point prevalence

Answer 13

The estimated proportion of actual, active cases in a population at a given point in time
Example: January 1st of next year

Question 14

One year prevalence

Answer 14

count everyone who suffers from the disorder in question at any given point of time throughout the year
larger number
recovered, active and those whose disorder didn’t begin until the study started

Question 15

Lifetime Prevalence

Answer 15

estimate of the number of people who suffered from a particular disorder at any time in their lives
include both currently ill and recovered individuals
tend to be higher than others

Question 16

Incidence

Answer 16

the number of new cases that occur over a given period of time, typically one year.
exclude preexisting cases, hence lower than others

Question 17

Classification

Answer 17

• nomenclature (naming system)
• enables us to structure information in a helpful manner
• has social and political implications
• delineates which types of psychological problems warrant insurance reimbursement and the extent of such reinforcement.

Question 18

ICD Vs DSM

Answer 18

• differ in format
• same disorders
• similar definitions
• both require that the level of impairment a person is experiencing be taken into consideration when deciding if they meet the criteria for a mental disorder
• An international survey of psychiatrists in 66 countries comparing the use of the ICD-10 and DSM-IV found the former was more often used for clinical diagnosis while the latter was more valued for research.

Question 19

ICD

Answer 19

• International statistical classification of diseases and related health problems.
• WHO
• medical classification for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as maintained by the World Health Organization (WHO).
• work on the 10th edition began in 1983 and finished in 1992.
• The code set allows more than 14,400 different codes and permits the tracking of many new diagnoses.
• Using optional subclassifications, the codes can be expanded to over 16,000 codes.
• Using codes that are meant to be reported in a separate data field, the level of detail that is reported by ICD can be further increased, using a simplified multiaxial approach.

Question 20

DSM

Answer 20

• Diagnostic and Statistical Manual for Mental Disorders
• APA
• Five revisions since 1952
• The coding system used in the DSM-IV is designed to correspond with the codes used in the ICD, although not all codes may match at all times because the two publications are not revised synchronously.

Question 21

Classification history

Answer 21

Initial impetus: need to gather stat info in 1840; single category: idiocy/insanity
1917: a committee of statistics, APA together with a national commission of Mental Hygiene: “Statistical Manual for the use of Institutions of the insane” with 22 diagnoses.

Question 22

DSM 1

Answer 22

In world war 2, US psychiatrists were involved in the Selection, Processing, Assessment and Treatment of soldiers.
1950: APA undertook a review and circulated an adaption of Medical 203, the VA system and Standard’s Nomenclature
After few revisions, DSM was approved in 1951 and published in 1952 with 106 mental disorders

Question 23

DSM 2

Answer 23

Revised in 1968, 182 disorders
Predominant psychodynamic psychiatry, behavioural perspective and Kraepelin’s classification system
Symptoms were not detailed for specific disorders
They were reflections of broad underlying causes and maladaptive reactions to life problems, rooted in the distinction between neurosis and psychosis (roughly anxiety/depression broadly in touch with reality or hallucination/delusion appearing disconnected from reality).
Social and Biological knowledge was included in a model which did not emphasize the clear boundary between normal and abnormal.

Question 24

DSM 2; seventh printing

Answer 24

RONAL BAYERS, Pro homosexuality psychiatrist
under threat and data from researchers like ALFRED KINSEY and EVELYN HOOKER: homosexuality was discarded as a category of mental disorder and the diagnosis was replaced with “Sexual orientation disturbance”
in 1974.

Question 25

DSM 3

Answer 25

in 1980
nomenclature should be consistent with ICD
The goal was to improve the validity and uniformity of psychiatry throughout the US and other countries
The key aim was to base the diagnosis on colloquial descriptive English language rather than the assumptions of etiology
265 diagnoses

Question 26

DSM 3 R

Answer 26

Spitzer
Categories were renamed, reorganized and significant changes in criteria were made
Diagnoses such as pre-menstrual dysphoric disorder and masochistic personality disorder were considered and discarded.
In 1987
292 disorders.

Question 27

DSM 4

Answer 27

1994
297 disorders
inclusion of a clinical significance of criteria required symptoms to cause “clinically significant distress or impairment in social, vocational and other important areas of functioning.”

Question 28

DSM 4 TR

Answer 28

2000
Text revisions
diagnostic categories and vastly major criteria remained the same
Text sections giving extra information on disorders were updated
Diagnostic codes updated to maintain consistency with ICD
Categorial classification system: the categories are prototypes and a close approximation with them of an individual- to have that disorder.

Question 29

Multiaxial system

Answer 29

offers an assessment on several axes, each of which belongs to a different domain of information that helps the clinician to plan treatment and predict outcomes.
A convenient form of organising and communication of complex clinical information; captures the complexity of clinical situations and for describing the heterogeneity of that each individual brings with similar disorders.
Promotes the application of psychosocial models in academic, research and clinical settings.
Categorizes each disorder along five dimensions relating to different aspects of disabilities or disorders.

Question 30

Axis 1

Answer 30

Clinical disorders and other conditions that may be a focus of clinical attention.
Psychological disorders are patterns of maladaptive behaviours that impair an individual’s functioning and causes stress.
Other types of problems that may be the focus of diagnosis or treatment like academic, vocational, social, personal and psychological.
Includes clinical syndromes like mood disorders, anxiety disorders, schizophrenia and other psychotic disorders, disorders that are diagnosed early in infancy, childhood or adolescence except mental retardation which is included in Axis 2.
In addition to this, there are also included problems like relationship problems, academic or occupational problems and bereavement problems which may not fall under the definable criteria of a disorder.
Also coded are psychological factors that affect medical conditions for example depression preventing recovery from a recent surgery.

Question 31

Axis 2

Answer 31

Personality disorders and mental retardation
Personality disorders are enduring and rigid patterns of maladaptive behaviour that typically impair relationships with others and social functioning.
Antisocial, paranoid, narcissistic and borderline personality disorder.
Mental retardation, which is also coded on Axis I1, involves pervasive intellectual impairment.
Either axis one, two or both.
example
indicate prominent maladaptive personality features that do not meet the threshold for a Personality
Disorder
The habitual use of maladaptive defense mechanisms may also be indicated on Axis II.

Question 32

Axis 3

Answer 32

General medical conditions
All medical conditions and diseases that may be important to the understanding or treatment of an individual’s mental disorders
In some cases, it is clear that the general medical condition is directly etiological to the development or worsening of mental symptoms and that the mechanism for this effect is physiological.
For example, if hypothyroidism
Medical conditions that affect the understanding or treatment of a mental disorder (but that are not direct causes of the disorder)
Common general medical conditions include diseases of circulatory system, diseases of respiratory system, congenital anomalies, etc.

Question 33

Axis 4

Answer 33

Environmental or psychosocial problems
Problems that may affect the diagnosis, treatment, and prognosis of mental disorders
They may be a negative life event, an environmental difficulty or deficiency, familial or other interpersonal stress, the inadequacy of social support or personal resources, or other problem relating to the context in which a person’s difficulties have developed.
So-called positive stressors, such as job promotion, should be listed only if they constitute or lead to a problem, as when a person has difficulty adapting to the new situation.
In addition to playing a role in the initiation or exacerbation of a mental disorder, psychosocial problems may also develop as a consequence of a person’s psychopathology or may constitute problems that should be considered in the overall management plan.

Question 34

Axis 5

Answer 34

Global assessment of Functioning
Clinician’s judgement of the patient’s overall level of functioning
Useful in planning treatment and measuring impact, predicting outcome
The GAF
Description of each ten-point range has two components:
the first part covers symptom severity
the second part covers functioning

Question 35

Drawbacks list

Answer 35

1. Dimensions vs category
2. Superficial symptoms
3. Reliability
4. Validity
5. Cultural bias
6. Stigma
7. Pharmaceutical and Medicalization

Question 36

Dimension vs category

Answer 36

Mental disorders categories represent a typology.
Based upon certain presenting symptoms or upon a particular history of symptoms, the patient is placed
in a category.
Easy to confuse such categorization with explanation.
Abnormal behaviour not qualitatively different from the so-called normal behaviour
Rather, these are endpoints of a continuous dimension and difference is one of degree rather than kind. Yet mental disorder diagnoses in terms of categories imply that individuals either have the disorder in question or they do not.

Question 37

Superficial symptoms

Answer 37

By design, the DSM is primarily concerned with the signs and symptoms of mental disorders, rather than the underlying causes.
Little progress has been made toward understanding the pathophysiological processes and etiology of mental disorders.

Question 38

Reliability

Answer 38

consistency of diagnostic judgments across raters
disagreements in diagnosis seemed to stem from inconsistencies in the information patients presented to
the psychiatrists
But much of the unreliability problem seemed to lie with the diagnosticians and/or the diagnostic system itself. The presence versus absence of some disorders may be particularly difficult to judge.

Question 39

Validity

Answer 39

As long as diagnosticians fail to agree upon the proper classification of patients, we cannot demonstrate that the classification system has meaningful correlates that is, has validity.
However, if we can demonstrate that categorization accurately indicates etiology, course of illness, or preferred kinds of treatment, then a valid basis for its use has been established.

Question 40

Stigma

Answer 40

An indirect problem is that diagnosis can be harmful or even stigmatizing to the person who is labelled.
Thus, labels can damage relationships, prevent people from being hired or promoted, and, in extreme cases, even result in a loss of civil rights.
Labels can even encourage some people to capitulate and assume the role of a “sick” person.

Question 41

Cultural bias

Answer 41

Some psychiatrists also argue that current diagnostic standards rely on neurophysiological findings and understate the scientific importance of social-psychological variables
Advocating a more culturally sensitive approach to psychology, critics contend that the cultural and
the ethnic diversity of individuals is often discounted by researchers and service providers.

Question 42

Pharmaceutical companies and medicalization

Answer 42

It has also been alleged that the way the categories of the DSM are structured, as well as the substantial expansion of the number of categories, are representative of an increasing medicalization of human nature, which may be attributed to disease mongering by pharmaceutical companies and psychiatrists, whose influence has dramatically grown in the recent decade.