Week 1 - Intro

Question 1

What is the field of abnormal psych? (x5)

Answer 1

Scientific study of behaviour with four main objectives:
o Describing what behaviours are evident – do they fulfil criteria for a disorder?
o Explaining why behaviour/a disorder is evident.
o Predicting outcome.
o Managing behaviours that are considered problematic

Question 2

Describe the relativist view of abnormal psychology (x3)

Answer 2

o Symptoms & causes vary across cultures
o All individual and specific symptoms;
o Evidence for, eg eating disorders more prevalent in the west

Question 3

Describe the absolutist view of abnormal psychology (x3)

Answer 3

o A disorder is caused by the same biological factors
o Also supported by evidence
o Eg schizophrenia, some psychoses - language for these found in different cultures, not specific to developed, but they seem to fare better in undeveloped countries

Question 4

What are some of the questions/challenges of defining what is ‘abnormal’ psych? (x4)

Answer 4

o NO clear-cut defs - largely subjective.
o Is behaving differently, deviantly, dangerously or dysfunctionally abnormal?
o Does the behaviour cause distress/dysfunction for individual/others?
o Duration also important - Must be persistent

Question 5

Describe 10 elements of psychological abnormality

Answer 5

Personal suffering - Important but not sufficient (e.g. psychopaths don’t suffer)

Maladaptiveness - eg substance abuse disorder

Irrationality and incomprehensibility - eg auditory hallucination

Unpredictability/loss of control - eg gambling

Level of emotional distress - eg major depression can cut capacity for rational thought

Interference in daily functioning

Vividness and unconventionality - Need to interpret behaviour in context

Deviations from the norm (developmental, societal & cultural)

Observer discomfort - eg psychopathy

Violation of moral and ideal standards - Eg DSM disorders/symptoms etc voted on by experts

Question 6

What elements does the DSM-V focus on for defining abnormal behaviour? (x5)

Answer 6

Symptoms and the scientific basis for the disorders
• Clinical presentation – What specific symptoms cluster together?
• Etiology – What causes the disorders?
• Developmental stage – Does the disorder look different for children & adults?
• Functional impairment – Immediate and long term consequences

Question 7

Under the DSM-V, mental disorders involve one or all of… (x3)

Answer 7

• Present distress
• Disability (impairment in one or more areas of functioning)
• Significant risk of suffering death, pain, disability, or an important loss of freedom

Question 8

Why does Thomas Szasz maintain that mental illness is a myth? (x2)

Answer 8

Argues that its a term that equates to ‘problems with living’
And a means of controlling those on the fringe

Question 9

What are the issues around labelling people as mentally ill? (x3)

Answer 9

Misuse - eg draptemonia, when black slaves tried to escape, method of oppression
Can lead to stigma and discrimination

Question 10

What benefits can arise from a mental health diagnosis? (x2)

Answer 10

Access community support

And treatment

Question 11

What is a psychiatrist? (x4)

Answer 11

MD, then specialised,
Very much in the biomedical model,
Use biological treatments,
Can use psych treatments too

Question 12

What is a psychologist? (x2)

Answer 12

Apply psych science in assessment and treatment,

No prescribing

Question 13

What is a psychoanalyst? (x2)

Answer 13

Freudian training,

Not registered health professionals

Question 14

What is a psychotherapist? (x2)

Answer 14

Not registered health professionals,

So can’t look them up, check complaints, training etc

Question 15

What is a counselling psychologist? (x2)

Answer 15

Like clinical,

But often more general issues - marital distress etc

Question 16

What is a clinical psychologist? (x2)

Answer 16

Registered health professional

Treats serious mental health disorders

Question 17

What are three different routes to professional practice?

Answer 17

APS Membership - APS approved six year degree & two years supervised experience
APS College of Clinical Psychologists Membership - Approved post-graduate degree in clinical psychology + two years supervised experience
Registration: Psychologists Board of Australia - Approved four year degree + two years supervised experience
• OR
Approved four year degree and post-graduate degree.

Question 18

What is epidemiology? (x1)

And why is it important? (x1)

Answer 18

Study of the frequency & distribution of disorders within a population
o Very important for the funnelling of resources to right places

Question 19

Regarding epidemiology, what is meant by ‘incidence’? (x1)

Answer 19

Number of NEW cases of a disorder that appear in population within specific time frame

Question 20

Regarding epidemiology, what is meant by ‘prevalence’? (x1)

Answer 20

Number of ACTIVE cases in a population during specific period of time

Question 21

Regarding epidemiology, what is meant by ‘lifetime prevalence’? (x1)

Answer 21

Proportion of population affected at SOME POINT during their lives

Question 22

Regarding epidemiology, what is meant by ‘comorbidity’? (x1)

And why is this especially important? (x1)

Answer 22

Having more than one condition

Because those with multiple conditions often have poor outcomes, e.g. depression and anxiety

Question 23

What is the epidemiology of mental disorders in Qld? (x3)

Answer 23

o 1 in 4 suffer mental disorders during lifetime
o Over ½ million have mental disorder that significantly interferes with daily lives
o 1 in 4 Qlders who visit a GP do so for mental health reasons

Question 24

What is the epidemiology of suicide in Australia? (x4)

Answer 24

100 Australians attempt suicide every day
2,361 Australians committed suicide in 2010 (ABS, 2012)
• 77% were males
35-44 years highest suicide rates

Question 25

In descending order, what is the lifetime prevalence of 10 common mental disorders?

Answer 25

``` Major depression - 17% Alcohol abuse - 13% Drug abuse - 8% PTSD - 7% Panic disorder - 5% Bipolar mood disorder - 4% OCD - 1.5% Schizophrenia - 1.4% Bulimia - 1% Anorexia - 0.8% ```

Question 26

Where does mental illness rank in terms of economic burden in developed countries? (x2)

Answer 26

Second only to cardiovascular conditions (18%), | With 15% of total burden

Question 27

How was psychopathology views in the ancient world? (x5)

Answer 27

Supernatural explanations for mental disorders prevailed (trephination - holes in skull to release spirits) except in Greece: o Hippocrates (5th C. BC) classified mental disorders into three categories: • Mania – look up defs… • Melancholia • Phrenitis (brain-fever

Question 28

What di ancient Greeks hold as the cause of all forms of disease? (x3) Which required what treatments? (x2)

Answer 28

Natural causes (unitary concept): • Imbalance in essential fluids • Blood, Phlegm, Yellow & Black bile • Treatment procedures focused on restoring balance • A lot of blood-letting and purging/vomiting to restore the balance of fluids

Question 29

How was psychopathology views through the Middle Ages? (x6)

Answer 29

After fall of Roman Empire, efforts to discover natural causes virtually ceased Religion dominated → supernatural view of mental disorder Abnormal behaviour interpreted as the work of the devil or witchcraft (exorcisms) Wars, peasant revolts & plagues: “evil forces” • Persecution of those viewed as promoting/hosting the devil • Many with mental disorders treated like witches

Question 30

How was psychopathology views during the Renaissance (14-17th C)? (x6)

Answer 30

More humane view of the mentally ill Critics of demonology: • Paracelsus –Believed stars & planets affected the brain • Weyer – First physician to specialise in treating of mental illness • Search for effective treatments begun Argued probably more natural causes of mental health problem

Question 31

Changing views of psychopathology through the Renaissance led to...(x3)

Answer 31

Development of asylums by mid 16th C e.g. London's Bethlehem Hospital 'Bedlam' Put in for treatment, but also signalled beginning of isolation from society

Question 32

What did early (16th C) asylum treatments consist of? (x3, plus egs)

Answer 32

``` Confinement (shackles, chains, isolation in dark cells), Torturous practices (ice-cold baths, spinning in chairs, severely restricted diets) Medical treatments (bloodletting, purgatives) ```

Question 33

What was introduced to the treatment of psychopathology in the 19th C/beginning of modern thought? (x5)

Answer 33

Moral treatment Precipitated by American & French Revolutions → new focus on human/individual rights, humanitarian ideas Reforms in treatment of people with mental disorders: • Philippe Pinel fought to unshackle the prisoners • People started to improve

Question 34

Panel's Classification System (late 19th C, the first since Hippocrates) contained what 5 categories?

Answer 34

``` o Melancholia o Mania o Mania with delirium o Dementia o Idiotism ```

Question 35

What two major categories were defined by Kraepelin and the German Classifiers (1920s) Which occurred around the same time as... (x2)

Answer 35

• Dementia praecox – later known as schizophrenia • Manic depressive psychosis General paresis got linked with syphilis - a biological disorder, sparking search for biological treatments

Question 36

What 3 somatic treatments were introduced and widely used through 1920-30s?

Answer 36

Fever therapy Insulin coma therapy Lobotomy

Question 37

What was the procedure (x1) and rationale (x1) for fever therapy in the 1920-30s?

Answer 37

Blood from malaria patients injected into psychiatric patients to induce fever Observed symptom disappearance in those that got typhoid fever

Question 38

What was the procedure (x1) and rationale (x1) for insulin coma therapy in the 1920-30s?

Answer 38

Insulin injected into psychiatric patients, lowered blood sugar/induced hypoglycaemia and deep coma Observed mental changes among some diabetic drug addicts treated with insulin

Question 39

What was the procedure (x1) and rationale (x1) for lobotomies in the 1920-30s?

Answer 39

Knife inserted through holes in skull, severing nerves connecting frontal lobes to rest of brain Observed that procedure reduced displayed emotion under stress in chimps

Question 40

What issues plagued somatic treatments of the 1920-30s? (x3) | Which is why they medical model of mental health now... (x1)

Answer 40

Often lead to death, never helped anyone But all based on the biological cause model Awards given in the absence of any scientific evidence of benefits… Relies on medication

Question 41

Outline the psychoanalytic revolution, from the late 18th C (x4 practitioners)

Answer 41

``` Franz Mesmer (late 18th C): o Neurologist who identified hysterical disorders and treated with hypnosis ``` Freud (and Breuer heavily influenced by Mesmer) o Trained by Jean Charcot o Influenced by hypnosis work Joseph Breuer o Hypnosis + catharsis (talking it through lead to relief of emotional burden Freud o Gave up hypnosis - free association to tap unconscious, spark catharsis

Question 42

Outline Meyer's 1940s biopychosocial framework, which is now the dominant view

Answer 42

``` Argued that single model insufficient, as individuals unique: o Biological factors o Psychological factors o Social factors: o Environmental factors ```

Question 43

The biopsychosoial framework culminates in the ... (x1) | Which holds that... (x1)

Answer 43

Diathesis stress framework All disorders may have a biological basis (the diathesis); but predisposition doesn’t = development – that takes stress of environment

Question 44

Describe the psychotropic drugs developed in 1930-40s (x4)

Answer 44

Biomedical model led to new drugs - Mostly serendipitous - side effects of attempts to treat biological illness Mostly just tranquillisers Led to deinstitutionalisation for many - now controlled and subdued

Question 45

What is the current view of psychopathology?

Answer 45

Is the behaviour contextually appropriate? Understanding is best gained through scientist-practitioner approach. o Research informs click practice, and vice versa Variety of theories exist surrounding the development/treatment of abnormal behaviour - best to incorporate a holistic/multidisciplinary approach

Question 46

Define symptom (x2)

Answer 46

Manifestation of pathological condition | Subjective - you can tell someone its happening, so more common than signs in mental health

Question 47

Define sign (x1)

Answer 47

Manifestation of pathology that can be objectively measured, e.g. temperature

Question 48

Define syndrome (x3)

Answer 48

Group of symptoms that occur together,constituting recognisable condition. In DSM-V most disorders are syndromes eg major depression has 9 symptoms – need five in order to claim diagnosis

Question 49

Define 'classification system' (x1)

Answer 49

o List of conditions with a description of the symptoms characteristic of each & guidelines for assigning individuals to categories

Question 50

What are the purposes/advantages of classification? (x5)

Answer 50

o Enables clinicians to diagnose a person’s problem as a disorder o Information retrieval o Facilitates research o Facilitates communication o Facilitates treatment selection (sometimes)

Question 51

What can be problematic about classification? (x2)

Answer 51

Categorical vs. dimensional approach | o If we are all across a spectrum, how do you say where the cutoff goes?

Question 52

What info does the DSM-V provide for each of its 200+ disorders? (11)

Answer 52

``` o Criteria for diagnosis o Essential clinical features o Associated features o Prevalence o Development and course o Risk and prognostic factors o Culture & gender-related diagnostic issues o Suicide risk o Functional consequences o Differential diagnosis (what is this?) o Comorbidity ```

Question 53

What improvements have been made to the DSM-V over time? (x6)

Answer 53

o Criteria more detailed & objective o Focuses entirely on verifiable symptoms o Psychopathology not regarded as subset of medicine o DSM V discarded the multi-axial assessment - problematic for many reasons, eg insurance companies interpreted axes as differently deserving of payment… o Diagnostic specificity o Harmonization with ICD-11

Question 54

What are major criticisms of classification of mental illness? (x6)

Answer 54

Argued to be unnecessary Loss of info - inferring detail based on preconceptions, ignores individual difference Labelling controversy Distinct entity vs continuum approach - we all fluctuate over time, so when to diagnose? Reliability and validity - varies considerably across DSM-V disorders Diagnostic bias - expectations based on e.g. race, sex, SES, context

Question 55

Why is labelling controversial? (x3)

Answer 55

Labels shape perceptions • Recategorise the self through lens of the label Labels cause prejudicial treatment Labels foster self-fulfilling prophecy • eg, if Ps believes other in social situation knows they have schizophrenia, causes poorer performance

Question 56

What is a major concern regarding classification under the DSM-V? (x2)

Answer 56

Forces clinicians to make distinctions that have major treatment implications, Including drug prescriptions and availability of health insurance

Question 57

What is clinical assessment? (x1)

Answer 57

Process of gathering information important to diagnose, plan treatment & predict the future course of a disorder

Question 58

What are the stages of clinical assessment? (x5)

Answer 58

Essential atheoretical component: clinical interview o Augmented with various other assessments to test hypotheses Then: o A diagnostic formulation o A judgement about why the disorder is present o A judgement about treatment

Question 59

Name 10 forms of clinical assessment

Answer 59

``` Clinical intake interview Clinical tests Projective tests Personality inventories Other self-report scales Intelligence tests Neurological tests Neuropsych tests Behavioural assessment Physiological assessment ```

Question 60

How do we decide which clinical test to use? Consider... (x3 plus egs)

Answer 60

Standardisation Reliability - test/retest, alternate form, inter-rater Validity - face, predictive, divergent, content, construct

Question 61

What are two types of projective tests?

Answer 61

Rorschach | Thematic apperception tests - interpreting emotionally ambiguous situations/scenes

Question 62

What are three common personality inventories?

Answer 62

Minnesota multiphase personality inventory - often used on forensics California psychological inventory Eysenck personality inventory

Question 63

Describe the MMPI (x9)

Answer 63

``` 500+ questions, 8 sub scales: • Hypochondriasis • Depression • Hysteria • Psychopathic deviance • Paranoia • Psychasthenia (fears/compulsions) • Schizophrenia • Hypomania (overactivity/inability to concentrate) ```

Question 64

What 'other self-report inventories' might be used in clinical assessment? (x4)

Answer 64

Affective inventories – eg depression scales Social skill inventories – eg schizophrenics often have issues here Cognitive inventories – what people will respond for, or not • Black/white thinking • Exaggerate negatives Reinforcement inventories

Question 65

Give two egs of neurological tests

Answer 65

``` o Computerised Axial Tomogram (CAT Scan) o Electroencephalography (EEG) ```

Question 66

Name 3 types of behavioural assessment

Answer 66

o Direct Observation of Behaviour o Self-Monitoring o Behavioural Checklists

Question 67

Physiological assessments measure... (x1) | Such as... (x3)

Answer 67

Bodily changes that accompany psychological events • Skin conductance • Heart rate • Muscle activity (electromyography)

Question 68

What factors can influence expression of abnormal behaviours? (x3)

Answer 68

Context Personal characteristics - sex, race etc SES

Question 69

What is mass hysteria? (x1, plus e.g.) | Which is understood scientifically as... (x1)

Answer 69

In Middle ages, sweeping belief by masses that they were possessed • Tarantium – though spider bite would cause death unless you danced like a loon, or that the bite caused such dancing Emotional contagion – automatic/involuntary mimicry/synchronisation of expressions, vocalisations, postures etc.

Question 70

Describe biological models of abnormal behaviour and treatment (x6)

Answer 70

Assume abnormal behaviour results from biological processes, esp brain o Eg schizophrenia and manic-depressive disorder found genetic basis = better intervention/prevention Imaging shows structural abnormalities plaques and tangles in Alzheimer’s o Causal direction? – eg PTSD: brain diffs as result of disorder – biological scarring after years with it Brain function differences found in: schizophrenia, depression, anxiety, eating disorders, many others o But unlikely to cause specific disorder - similar diffs seen in multiple disorders

Question 71

Describe psychological models of models of abnormal behaviour and treatment (x2)

Answer 71

o Emphasis on influence of environmental factors, eg family and culture, on abnormal behaviour o Modern psychoanalytic models: still focussed on patterns beginning in childhood; ego psych; object relations theory

Question 72

Describe behavioural models of abnormal behaviour and treatment (x3) And 3 major contributors?

Answer 72

Stress import of external events in onset of abnormal behaviour – result of maladaptive learning Acknowledge biology, but as interaction Significant events at any life stage Wolpe – turned conditioning to extinction Skinner and operant Bandura and vicarious conditioning – social learning through observation

Question 73

Describe cognitive models of abnormal behaviour and treatment (x4)

Answer 73

o Abnormal behaviour as result of distorted mental processes (not internal forces or external events) o Its not the situation, but perception of events o Beck and cognitive distortions o Behaviour change through thought modification

Question 74

Describe humanistic models of abnormal behaviour and treatment (x4)

Answer 74

o Phenomenology: that one’s subjective perception of the world is more important than actual world o People basically good and motivated to self-actualise o Rogers and incongruence between image and actual self = pathology o Unconditional positive regard

Question 75

Describe sociocultural models of abnormal behaviour and treatment (x6)

Answer 75

Abnormality only within context of social, cultural forces Gender: eg girls and phobias – boys trained not to feel/show fear Hunger, work and DV: developing nations – less food; unequal pay; SES: PTSD higher in Afro-American and Hispanic kids after hurricane Andrew – poor houses more easily damaged Factors previously used to unfairly stereotype, now appreciated as contributing factor to all behaviour Enhance therapeutic factors by understanding, as well as any culture-bound syndromes