Unit 12 (Chapters 13 & 14) Flashcards
Symptom
A physical or mental feature that may be regarded as an indication of a particular condition or psychological disorder. A symptom does not constitue the disorder itself.
Syndrome
A cluster of physical or mental symptoms that are typical of a particular condition or psychological disorder that tend to occur simultaneously.
Prevalence
How widespread a disorder is.
Point prevalence
Percentage of people in a given population who have a given psychological disorder at a particular point in time.
Lifetime prevalence
Percentage of people in a certain population who will have a given psychological disorder at any point in their lives.
Generally, in Canada, about 40%.
DSM-5 definition of a psychological disorder
- Clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
- Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved
one, is not a psychological disorder. - Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not psychological disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.
- How much disturbance before it’s considered “clinically significant”?
- Line around “common stressor or loss” is fuzzy.
- Socially acceptable behaviour varies across time and cultures (ex: in 1970s, homosexuality was a disorder)
Cultural variations in disorders and diagnoses
- Psychological disorders are largely a cultural construct
- Cultural beliefs and values play a role in determining whether a particular set of symptoms is a disorder or variation in “normal” behaviour
Attention deficit/hyperactivity disorder (ADHD)
Disorder that involves impulsivity, hyperactivity (e.g., fidgeting, inability to sit still), and difficulty shifting attentional focus.
- Most common psychological disorder in children
- Twice as common in boys
- 4% of adults
- May relate to deficiency in brain areas related to attention and executive function (prefrontal cortex; related to impulse control, attention, decision-making).
ADHD controversies
- Increased diagnosis & treatment. Growing awareness? Better diagnostic practices? Overdiagnosis & cultural obsession with academic performance? (Mismatch betweed ADHD and kids being kids and unable to focus.)
- Is there too much emphasis on individual interventions instead of structural societal changes?
- More opportunities for play, accommodation for range of temperaments & behaviours. Depriving children of “rough and tumble play” in academic settings makes it harder for them to thrive in.
- Labels carry stigma, can contribute to social exclusion, stereotyping, discrimination, shift in self-concept & potential for self-fulfilling prophecies. Once a label is applied, all subsequent behaviour is interpreted through that lens.
- Pharmacological treatments may pose risk of side-effects: ADHD treated with stimulant methylphenidate (activated inhibitory circuits that enable impulse control), which can be addictive and pose long-term side effects.
Clinical assessment
Procedure for gathering the information to evaluate an individual’s psychological functioning and to determine
whether a clinical diagnosis is warranted.
The initial diagnosis of a patient may change!!!
Clinical interview
Interview in which a clinician asks the patient to describe their problems and concerns.
- Usually the first step in assessment
- More open-ended
The initial diagnosis of a patient may change!!!
Self-report measures
Standardized clinical assessment consisting of fixed set of questions that a patient answers.
- More structured
The initial diagnosis of a patient may change!!!
Projective tests
A form of clinical assessment in which a person responds to unstructured or ambiguous stimuli; it is thought that responses reveal unconscious wishes and conflicts.
- Usefulness and validity of some of these tests have been called into question, but some still remain in use.
E.g., Rorschach Inkblot Test
Diathesis-stress model
A model of clinical disorders suggesting that certain factors provide a susceptibility for a disorder that will manifest as symptoms only in certain circumstances (under certain levels of
stress).
- Diatheses and stressors vary in their origin and form. It’s not necessarily genetics: it can be ways of thinking, early life conditions, and pre-natal conditions.
Anxiety
Feeling of intense worry, nervousness, or unease. Involves anticipation of danger (not equal to fear, which is more focused on the present).
- Maladaptive exaggeration of what is normally a useful response (we need some anxiety to avoid doing risky, stupid things).
- Most prevalent of all psychological disorders
- Typically, aware that anxiety is irrational, but unable to control it (doesn’t impair people’s ability to think realistically).
Common causes of anxiety disorders
- High degree of comorbidity among the different anxiety-related disorders (they often coocur).
- Genetic component: concordance rate 5 times higher for identical twins than for fraternal twins or ordinary siblings (related to heretibility studies)
- Two types of risk factors involved: general and specific risk factors
Concordance rate
Probability that a person with a particular familial relationship to a patient has the same disorder as patient.
Comorbidity
Occurrence of two or more disorders in a single individual at a given point in time.
Specific phobia
A pronounced fear of or anxiety about a particular object or situation (e.g., spiders, snakes, heights, blood, flying). The subject typically has some realistic potential for harm.
- May have significant impact on the life of a person as they develop elaborate strategies to avoid the object or situation.
- Women twice as likely as men to have a specific phobia, although rates vary by phobia
- Scope of a phobia may increase over time (generalization)
Potential causes and predisposing factors of specific phobias
Classical conditioning:
- Learning: ~40% of people with phobias report a traumatic situation where they first acquired the fear (ex: bitten by a dog)
- Fear may then become generalized (ex: to all dogs)
Observational learning
- May develop phobias through observation & imitation
- Preparedness: may be biologically predisposed to form connections between certain stimuli (e.g., spiders, snakes) that have historically posed a threat & fear
- Ex: Monkeys fearing snakes after seeing a videos of another monkey scared of a snake.
Social anxiety disorder
An anxiety disorder characterized by extreme fear of being watched, evaluated, and judged by others.
- Typically emerges in childhood or adolescence
- Places individuals at increased risk for depression and substance abuse
- Women and men are equally affected
Ex: Not being able to eat in restaurants.
Panic disorder
Anxiety disorder characterized by repeated panic attacks & debilitating fear of future attacks.
- More common in women than men
Panic attack
Sudden episode of intense, uncontrollable anxiety & autonomic arousal in the absence of real threat.
- Bodily symptoms: laboured breathing, choking, dizziness, tingling hands and feet, sweating, trembling, heart palpitations, chest pain, nausea.
- Symptoms can be really unsettling, and are sometimes even compared to having a heart attack or even dying.
Agoraphobia
Fear of being in situations in which help might not be available or escape might be difficult or embarrassing.
- Common outcome of panic disorder, as one may fear having a panic attach in public places.
E.g., fear of being outside of home or other designated “safe” places, using
public transportation, standing in line or in a crowd.
Potential causes and predisposing factors of panic disorder
- Often manifests after major stressor: in children, more common following experience of parental loss or separation
- Biological explanation: may be due to disturbance in certain neuropeptides involved in regulating arousal, as panic attacks can be induced artificially.
- Cognitive theories: interpretation of physiological arousal as catastrophic (more prone to interpreting bodily symptoms as negative, for example a heart attack, which leads to anxiety, and then more physiological symptoms, then the vicious cycle continues).
Generalized anxiety disorder (GAD)
Anxiety disorder characterized by continuous, pervasive, and difficult-to-control anxiety that is not correlated with particular objects or situations.
- Bodily symptoms: muscle tension, headaches, elevated heart rate, diarrhea, breathing difficulty.
- Cognitive symptoms: feelings of inadequacy, difficulty concentrating and making decisions, sleep disturbances
- Twice as common in women as men
Potential causes and predisposing factors of generalized anxiety disorder
- Decreased inhibition of amygdala reactivity by prefrontal cortex
- Hypervigilance for threat observed in many individuals who experienced unpredictable, traumatic experiences in early life (stressors)
- Other research shows that hypervigilance for threat predates onset of GAD
- Cognitive perspective: worrying as a coping strategy for anxiety (avoid intense emotional reactions brought on by worrying about only one thing)
- Cultural explanation: generalized anxiety has sharply increased in Western societies. May be due to less stable relationships, or rapidly changing social norms.
Obsessive-compulsive disorder (OCD)
An anxiety disorder that manifests itself through obsessions and compulsion. Could be both or only one of the two.
- People with this disorder are usually aware of their obsessions and compulsions but are unable to control them.
Obsession
A recurrent unwanted or disturbing thought. Typically stems from everyday worries.
Compulsion
A ritualistic action performed to control an obsession; the efforts to ward off the anxiety caused by the obsession.
Ex: Hand-washing, rearranging things, listing things out loud…
Potential causes and predisposing factors of obsessive-compulsive disorder
- Has been observed following brain damage due to injury, disease, poisons, difficult births, pre-natal traumas.
- Parts of the frontal lobe, limbic system, and basal ganglia implicated—circuit that controls voluntary actions
- Theory that damage to these areas may impede ability to experience a sense of “closure” after completing an action
Post-traumatic stress disorder
Psychological disorder triggered by an event that involves actual or threatened death, serious injury, or sexual violence. Must last one month or longer, or else accute stress disorder.
- Women are more likely to be diagnosed than men (might be because they are more subjected to traumatic events).
Pattern involves:
- Dissociation (numbness)
- Intrusive symptoms (recurrent nightmares and waking flashbacks)
- Arousal symptoms (high state of readiness to guard against harm)
- Avoidance symptoms (avoiding thoughts, activities, people, and places that relate to the trauma)
- Negative alterations in cognition and mood (anger, loss of pleasure, survivor’s guilt)
Potential causes and predisposing factors of post-traumatic stress disorder
- Smaller hippocampal volume (also cause by chronic stress and trauma). Cause or effect (or both)?
- Variation in emotion regulation ability (tendency to ruminate)
- Lack of social support. E.g., people reporting low social support in 6 mos before 9/11 twice as likely to be subsequently diagnosed with PTSD.
Trauma does not necessarily lead to to PTSD: less than 10% will develop PTSD.
Anxiety disorders
- Specific phobias
- Social anxiety disorder
- Panic disorder
- Agoraphobia
- Generalized anxiety disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
Mood-related disorders
- Major depressive disorder
- Bipolar disorder
Mood disorders
Psychological
disorders characterized by
emotional extremes.
Major depressive disorder
Mood disorder characterized by prolonged feelings of
sadness, worthlessness, emptiness, and anhedonia. Commonly known as depression.
- Other symptoms: fatigue, changes in sleep & appetite, difficulty concentrating, feelings of guilt, recurrent thoughts of death or suicide.
- Symptoms must cause significant disruption persist without remission for at least 2 weeks.
- Hallmark symptom is anhedonia. Decreased sensitivity to reward may be a predisposing factor (can be seen before onset of MDD).
Anhedonia
Diminished interest or pleasure in nearly all of the activities that usually provide pleasure, that one once found rewarding (e.g., eating, spending time with friends, sex).
Prevalence of major depressive disorder
- “Common cold” of psychological disorders (most heard of).
- Lifetime prevalence 7-15% for men and 20-25% for women (may be due to factors like body image). Gender differences in prevalence emerge in teenage years.
- Frequently recurrent symptoms, more severe as they reoccur.
- One of the leading causes of disability worldwide; damaging, debilitating at a personal and social level.
Potential explanations and predisposing factors of major depressive disorder
Cognitive factors:
- Rumination = continuously focusing on emotional pain without active problem-solving
- Explanatory style = cognitive style that determines how individuals explain adverse events
- Internal: blaming oneself (“it’s my fault”)
- Global: generalizing problem to all aspects of life (“everything is ruined”)
- Stable: believing problem is unchangeable (“it will always be like this”)
Social & environmental factors:
- Stressful experiences interact with individual predisposition factors (diathesis-stress model)
Biological factors:
- Serotonin long-considered key player in mood regulation, but precise role is debated.
- Selective serotonin reuptake inhibitors (SSRIs) effective for treating depression (effective for anxiety as well). BUT: delayed effects, takes time to improve symptoms.
- Cortisol-induced inhibition of growth processes, brain shrinkage (stress also leads to shrinkage, so do SSRIs help with this?)
- Reward deficit—dopamine, opioids. Some antidepressants target dopamine neurotransmission.
- Heighted inflammation (diseases leading to depression, ex: cancer).
Evolutionary explanations:
- Dysregulation of an adaptive process. When coping with certain challenges, it may have been useful to withdraw oneself and conserve resources. Depression may be this ability, gone awry.
Selective serotonin reuptake inhibitors (SSRIs)
Prevent serotonin from being reabsorbed too quickly; cause a delay. Used to treat major depressive disorder. May also be effective to treat anxiety.
Bipolar disorder
Mood-related disorder characterized by both manic (excited, euphoric, expansive, and energetic) episodes and depressive episodes.
- Episodes can vary in length & may be mixed (although more rare)
- Lifetime prevalence: 4 percent. Almost always recurrent.
Various states of bipolar disorder
- Mania = state of high excitement and energy often characterized by racing thoughts, a feeling of invincibility or omnipotence, and a lack of boundaries or inhibitions. Leads to very reckless behaviour due to sense of invincibility.
- Hypomania = a mild form of mania marked by high spirits, happiness, self-confidence, and a high level of nervous energy. Not as intense as mania.
- Acute mania = occurs when feelings of invincibility are replaced by terror as a person loses their grip on reality. Severe manic episodes happen in this state.
Prevalence and risk factors of suicide
Worldwide, 800,000 people die each year by suicide
- Many more attempts
- In nearly every country, males are more likely than females to die of suicide, whereas females are more likely attempt suicide but survive. May be due to the methods used (guns vs pills).
An estimated 90% of people who die by suicide had a psychological disorder at the time of death.
- Bipolar most common: Highest risk when recovery from depressive episode begins, as heightened impulsivity may increase suicide risk. When in depressive state, lack motivation.
Suicide risk factors
- Ideation regarding suicide
- Substance abuse
- Purposeless-ness
- Anger
- Trapped feelings
- Hopelessness
- Withdrawing from significant others
- Anxiety
- Recklessness
- Mood shifts
Mnemonic for key risk factors for suicidal behaviour is “PATH WARM”.
Schizophrenia
Psychological disorder characterized by a loss of contact with reality and pronounced disturbance in thinking, perceptions, emotion, and actions.
- Lifetime prevalence: ~1%
- Emerges ealier in men than in women.
Symptoms:
- Delusions
- Hallucinations
- Disorganized speech
- Movement disorders
**Not equal to dissociative identidy disorder.
Positive symtoms
Behaviours that are not present in healthy people.
Negative symptoms
Absence of behaviors usually seen in healthy people. Flattening or cessation of behavioural responses.
Delusions (positive symptoms)
False, unrealistic beliefs that are rigidly maintained despite overwhelming contradictory evidence—for example:
- Grandiosity: Believing one is greatly important
- Persecution: Believing one is being singled out for punishment
- Delusions of reference: Believing one is the object of neutral environmental events
- Delusions of being controlled
- Thoughts are being broadcast
Might stem from a failure to mentally seperate voluntary and involuntary actions.
