week 1 classification, diagnosis and the integrative approach Flashcards
define the key elements in the current conceptualisation of abnormality or psychological disorder;
For there to be an abnormal behaviour /psychological disorder there must be:
a) distress or impairment of function (remembering that function usually occurs on a continuum)
b)a response which is considered atypical for that person’s society
and c) no explanation for the disorder by medical knowledge, medication or drug/alcohol.
describe the scientist-practitioner approach to psychopathology;
This approach endorses keeping up with current practice views/developments, evaluate own treatments and their effectiveness, and possibly conduct rigorous scientific research.
describe the three major categories of focus underlying the study and discussion of psychological disorders
a) Clinical description-includes what patient describes as the problem, how they are impaired, thoughts,feelings,behaviours of the disorder, what the disorder is-ie dsm description, but also signalment, prevalence, sex ratio, incidence (eg cases in a year)
b) . what might have contributed to the disorder. ie aetiology (genetic factors, personality factors, social factors, psychological factors)
c) Treatments
discuss the limitations to one-dimensional models of psychopathology;
A one-dimensional model explains psychopathology as being attributable to one factor only and or treatable by one factor only. This is not usually the case, with multi-factorial aetiologies more likely and treatments varying in effectiveness for individuals.
discuss the relationships between genes and behaviour, genes and environment, and the nongenomic “inheritance” of behaviour;
Some estimates say up to half our personality traits and cognitions are genetically influenced. For psychological disorders genetic influence is likely less than half. It seems also that many genes are involved in any one disorder.
The environment may switch on or off certain genes.
Diathesis Stress Model: the greater the underlying vulnerability, the less stress is required to trigger the condition. eg 2 college students engage in heavy bouts of drinking (stress) , only the one with the genetic vulnerability for alcoholism becomes an alcoholic. Having genetic vulnerability does not necessarily mean will develop the disorder.
The 5-HTT gene is involved in serotonin transport. Has short allele form (S) or long allele form (L). SS individuals were twice as likely to have a major depressive event than LL after both experiencing 4 stressful events. If SS has maltreatment or abuse as children, double the risk of major depression in adulthood cf SS without childhood abuse. ie LL could get depression, but more likely related to events in recent as opposed to distant, past.
The Gene-Environment Correlation Model-says that as well as genes and environment interacting, personality may be involved in creating situations where the disorder becomes more likely. eg.maybe someone with a blood phobia risk is also impulsive, thus more likely to have a trauma, see blood, and trigger the disorder. Maybe applies to depression as some people seem to seek out difficult relationships….get divorced….feel depressed.
Epigenetics=the environment can switch genes on or off.
Nongenomic “inheritance” is where environment overcomes genetic predisposition.eg offspring from stressed rat mothers will be calm if cross fostered and raised by calm rats.o Offspring of schizophrenics far less likely to develop schizophrenia if fostered and raised in good environment, but at high risk if raised in dysfunctional family.
describe the major neurotransmitter systems and their involvement in abnormal behaviour;
NOREPINEPHRIN-(also called noradrenalin)high levels maybe involved in depression. beta blockers block the beta receptors of noradrenalin, this reducing blood pressure.
SEROTONIN-low levels maybe in depression. Also known as 5-hydroxytryptamine (5-HT).influences how we process information. regulates behaviour, mood, thoughts. Very low levels associated with reduced inhibition,impulsivity, tendency to overreact. Low levels associated with suicide, overeating, aggression, excessive sexual behaviour. Tricyclic antidepressants work on serotonin levels.Selective-serotonin reuptake inhibitors (SSRI’s) includes fluoxetine, and these meds used to treatanxiety, mood and eating disorders. St John’s wort also affects serotonin levels.
DOPAMINE-early thoughts increases involved in schizophrenia. Might be involved in addiction and attention deficit hyperactivity disorder.Reserpine is an anti-schizophrenia med and blocks dopamine. Possibly switches on other neurotransmitters.Also might switch on movement. Low levels associated with Parkinsons.
GABA(Gamma-aminobutyric acid);maybe reduced levels involved in anxiety.inhibitory.
GLUTAMATE ;excitatory. With Gaba are “chemical brothers” balance determines if will fire or not. Monosodium glutamate can increase glutamate and cause headaches. benzodiazepines enhance glutamate attachment to cells. reduces arousal.Reduces anger, hostility, aggression, but also reduces eager anticipation and pleasure.
Brain circuits=paths of neurotransmitters. These pathways may play a role in psychological disorders.
Agonist=mimics a neurotransmitter’s action (ie increases it)
Antagonist=decreases or blocks a neurotransmitter
Inverse agonist=has an effect opposite to the neurotransmitter
Reuptake=when a neurotransmitter has been used, is re-taken up and recycled. Some drugs block reuptake which means keeps being utilised or “firing
describe how psychosocial factors influence and interact with brain structure and function;
Initiating factors of a disorder are not the same as mintaining factors. often it is the maintaining factors which are best treated. Psychological treatments can affect brain structure/function, hopefully to normalise abnormal patterns of behaviour, and/or to recruit areas not previously activated. Even placebos often have a partial effect.Sometimes psychotherapy and drugs both have an effect on the condition, but seem to alter the brain in different ways.
Neurotransmitter effects may be very different, in different individuals (with different psychosocial influences). 2 monkey groups, one who had free access to toys/food (ie had control) and other group whose access was reliant on when the first group had them (no control) were later injected with a benzodiazepene inverse agonist (has the opposite effect of Gaba) and the no control monkeysran to a corner with severe anxiety, and the control monkeys were angry and aggressive.
Ina study on crayfish, 2 males fought, in the winner, serotonin made certain neurons more likely to fire, whereas in the loser, serotonin made the same neurons less likely to fire.
in primates, early stressful events produced serotonin deficits in genetically susceptible individuals, but if not stressed, the change did not occur.
Learning and experience can alter number of receptors on a cell.
Rats raised in enriched environments developed cerebellar connections than those raised as couch potatoes.
Monkeys housed in large groups haveincreased grey matter ratios in some brain areas involved in social cognition.
Brain plasticity continues even into old age.
describe how the theories of conditioning, learned helplessness, social learning, and prepared learning are used to explain the origins of abnormal behaviour;
LEARNED HELPLESSNESS occurs when their is perceived lack of control, or responses (eg of a parent) have been random such that one feels cannot predict. Thus people may become depressed if they think they have no control or little can be done about the stresses in their life. (it may seem to others though that there are things they can do about it).
LEARNED OPTIMISM-some people remain optimistic despite many stresses and these people function better psychologically. those with positive attitudes, tend to live longer.
SOCIAL LEARNING includes observation and modelling. Cognition is brought into play in deciding how relevant another’s behaviour is to ourself and situation.
PREPARED LEARNING argues that we are “primed”to learn about certain dangers, such as beware of spiders etc. Such learning has helped us evolutionarily. ie we might fear something without ever having encountered it. Prepared learning seems to affect women more.
The unconscious has an influence also on cognition/behaviour, especially implicit memory eg almost drowned as a toddler, can’t remember it, but have fear of water.
Suppressing emotions such as anger or fear may increase heartrate and may contribute to psychopathology
Panic attack is the normal emotion of fear being expressed at the wrong time.
discuss the role of cultural, social, and interpersonal factors in psychopathology.
What we fear, is influenced by our socioenvironmental state.
Voodoo death by “the evil eye”seems to be where an otherwise healthy individual dies due to belief of having been cursed. Friends and relatives also ignore the cursed one in belief that their death has already occured.
Females more likely to have phobias re insects or small animals.
Alcoholism affects more men than females, possibly because is used to mask fear/uncertainty etc as opposed to talking about it.Gender roles more typically lean towards men being silent or hiding about their issues.
Psychological treatments may have different efficacies for the genders. Exposure therapy for post traumatic stress disorder seemed to be of benefit for longer in females.
Bulimia nervosa more common in females.
If have more social contacts/relationships (or they are of good quality), more likely to live longer, and are somewhat protective against illness, psychological disorder and alcoholism. Living alone makes one 80% more likely to have depression. Some people don’t seem to feel loneliness, and this seems protective. Having fewer social ties also seemed to make one more likely to catch a cold.
Amphetamines injected into monkeys seemed to have little effect, but when sepearated into the social rankings, was clear that it made the higher social order ones increase their dominant behaviours, and the lower social ranking ones to be more submissive.
greater incidence of schizophrenia in those raised in cities.
Depression may manifest differently in different cultures ie as feelings of guilt and inadequacy in Western culture and with physical distress and fatigue in developing countries.
EQUIFINALITY= must consider that there are a number of different paths which may have all led to a given outcome.
define the terms idiographic, nomothetic, taxonomy, nosology, and nomenclature;
IDIOGRAPHIC=unique to the individual
NOMOTHETIC=pertaining to a group or “all”in a category.
TAXONOMY=a scientific method of classification
NOSOLOGY= use of a taxonomy system for psychological or medical phenomena. ie medical classification system of disease.
NOMENCLATURE= the labels within a system
define what is meant by classical categorical, prototypical and dimensional classification approaches;
CLASSICAL CATEGORICAL APPROACH;assumes every dx has a clear pathophysiological (or social)cause and each dx is distinct.No overlap.Defining criteria need to be met in full. This approach works better for medicine than psychopathology.
DIMENSIONAL APPROACH-a variety of dimensions may be present and these are each assessed on a scale. Has been used in psychopathology but there has been disagreement re how many dimensions etc.
PROTOTYPICAL APPROACH-is a blend of classical and dimensional. allows for gradings along dimensions, but also for eg 6 of 10 criteria to be met. ie allows some fuzziness. DSM-5 takes this approach.
discuss the issues of reliability and validity as they apply to classification systems;
RELIABILITY=2 people can judge the same.(ie getthe same result). Assessor biases interfere with reliability.
VALIDITY= able to diagnose accurately.
CONSTRUCT VALIDITY= signs and symptoms used to classify go with the disease defined, and are distinguishable from other diseases.
PREDICTIVE VALIDITY-ie how useful the dx is-can it predict likely outcome or response to tx?
CONTENT VALIDITY-a construct is defined in line with how most experts would define.
discuss the history of classification of psychopathology up to DSM-5
1948 WHO added mental disorders to ICD (international Classification of dz) 6th edition.
DSM(diagnostic and statistical manual)-1 published 1952.
In 1960’s nosological systems started to be utilised for dx of mental illness.
In the 1970’s many countries had very dissimilar systems for dx.
DSM-3 became more precise in terms of how would present to clinician.Improved reliability and validity.
in the 1990”s more clinicians worldwide were using DSM-3revised than the ICD
ICD-10 published 1992
DSM-iv published 1994 and was similar to ICD10. DSM-iv no longer had separate dz entities based on aetiology as it recognised the possible multiple aetiologies involved for any given issue.Also became far more based on empiric evidence.
2000 DSM-ivTR updated refined some definitions.
2013 DSM-5 published.ICD-11 was also collaborated together with this and published 2018. DSM-5 fairly similar to iv, but with some reclassification and a few new disorders.
discuss the importance of considering social and cultural factors in the DSM-5;
Cultural consideration was introduced in DSM-iv and remains in DSM-5. Purely as a recommendation to be aware of it (as yet there is insufficient empirical data pertaining to this culture requires/responds to this assessment/treatment etc)This is important to bear in mind as the cultural perspective influences whether a behaviour is considered abnormal or not.
critically discuss the process involved in the development of new diagnostic categories.
New diagnostic categories are listed in the DSM-5 and need to be researched based on would diagnostic criteria lead to dx and distinct from other dx, and would the dz be severe enough to warrant dx.
Premenstrual Dysphoric Disorder is a new inclusion and seems to be accepted as a mood disorder as opposed to purely an endocrine disorder although that seems arguable.
arguments against DSM-5 suggest a spectrum approach is better although the dimensions ranking seems to achieve the same object
