Week 1 - Intro Flashcards
What is the field of abnormal psych? (x5)
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
Describe the relativist view of abnormal psychology (x3)
o Symptoms & causes vary across cultures
o All individual and specific symptoms;
o Evidence for, eg eating disorders more prevalent in the west
Describe the absolutist view of abnormal psychology (x3)
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
What are some of the questions/challenges of defining what is ‘abnormal’ psych? (x4)
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
Describe 10 elements of psychological abnormality
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
What elements does the DSM-V focus on for defining abnormal behaviour? (x5)
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
Under the DSM-V, mental disorders involve one or all of… (x3)
- Present distress
- Disability (impairment in one or more areas of functioning)
- Significant risk of suffering death, pain, disability, or an important loss of freedom
Why does Thomas Szasz maintain that mental illness is a myth? (x2)
Argues that its a term that equates to ‘problems with living’
And a means of controlling those on the fringe
What are the issues around labelling people as mentally ill? (x3)
Misuse - eg draptemonia, when black slaves tried to escape, method of oppression
Can lead to stigma and discrimination
What benefits can arise from a mental health diagnosis? (x2)
Access community support
And treatment
What is a psychiatrist? (x4)
MD, then specialised,
Very much in the biomedical model,
Use biological treatments,
Can use psych treatments too
What is a psychologist? (x2)
Apply psych science in assessment and treatment,
No prescribing
What is a psychoanalyst? (x2)
Freudian training,
Not registered health professionals
What is a psychotherapist? (x2)
Not registered health professionals,
So can’t look them up, check complaints, training etc
What is a counselling psychologist? (x2)
Like clinical,
But often more general issues - marital distress etc
What is a clinical psychologist? (x2)
Registered health professional
Treats serious mental health disorders
What are three different routes to professional practice?
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.
What is epidemiology? (x1)
And why is it important? (x1)
Study of the frequency & distribution of disorders within a population
o Very important for the funnelling of resources to right places
Regarding epidemiology, what is meant by ‘incidence’? (x1)
Number of NEW cases of a disorder that appear in population within specific time frame
Regarding epidemiology, what is meant by ‘prevalence’? (x1)
Number of ACTIVE cases in a population during specific period of time
Regarding epidemiology, what is meant by ‘lifetime prevalence’? (x1)
Proportion of population affected at SOME POINT during their lives
Regarding epidemiology, what is meant by ‘comorbidity’? (x1)
And why is this especially important? (x1)
Having more than one condition
Because those with multiple conditions often have poor outcomes, e.g. depression and anxiety
What is the epidemiology of mental disorders in Qld? (x3)
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
What is the epidemiology of suicide in Australia? (x4)
100 Australians attempt suicide every day
2,361 Australians committed suicide in 2010 (ABS, 2012)
• 77% were males
35-44 years highest suicide rates
In descending order, what is the lifetime prevalence of 10 common mental disorders?
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%
Where does mental illness rank in terms of economic burden in developed countries? (x2)
Second only to cardiovascular conditions (18%),
With 15% of total burden
How was psychopathology views in the ancient world? (x5)
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
What di ancient Greeks hold as the cause of all forms of disease? (x3)
Which required what treatments? (x2)
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
How was psychopathology views through the Middle Ages? (x6)
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
How was psychopathology views during the Renaissance (14-17th C)? (x6)
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
Changing views of psychopathology through the Renaissance led to…(x3)
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
What did early (16th C) asylum treatments consist of? (x3, plus egs)
Confinement (shackles, chains, isolation in dark cells), Torturous practices (ice-cold baths, spinning in chairs, severely restricted diets) Medical treatments (bloodletting, purgatives)
What was introduced to the treatment of psychopathology in the 19th C/beginning of modern thought? (x5)
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
Panel’s Classification System (late 19th C, the first since Hippocrates) contained what 5 categories?
o Melancholia o Mania o Mania with delirium o Dementia o Idiotism
What two major categories were defined by Kraepelin and the German Classifiers (1920s)
Which occurred around the same time as… (x2)
• Dementia praecox – later known as schizophrenia
• Manic depressive psychosis
General paresis got linked with syphilis - a biological disorder, sparking search for biological treatments
What 3 somatic treatments were introduced and widely used through 1920-30s?
Fever therapy
Insulin coma therapy
Lobotomy
What was the procedure (x1) and rationale (x1) for fever therapy in the 1920-30s?
Blood from malaria patients injected into psychiatric patients to induce fever
Observed symptom disappearance in those that got typhoid fever
What was the procedure (x1) and rationale (x1) for insulin coma therapy in the 1920-30s?
Insulin injected into psychiatric patients, lowered blood sugar/induced hypoglycaemia and deep coma
Observed mental changes among some diabetic drug addicts treated with insulin
What was the procedure (x1) and rationale (x1) for lobotomies in the 1920-30s?
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
What issues plagued somatic treatments of the 1920-30s? (x3)
Which is why they medical model of mental health now… (x1)
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
Outline the psychoanalytic revolution, from the late 18th C (x4 practitioners)
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
Outline Meyer’s 1940s biopychosocial framework, which is now the dominant view
Argued that single model insufficient, as individuals unique: o Biological factors o Psychological factors o Social factors: o Environmental factors
The biopsychosoial framework culminates in the … (x1)
Which holds that… (x1)
Diathesis stress framework
All disorders may have a biological basis (the diathesis); but predisposition doesn’t = development – that takes stress of environment
Describe the psychotropic drugs developed in 1930-40s (x4)
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
What is the current view of psychopathology?
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
Define symptom (x2)
Manifestation of pathological condition
Subjective - you can tell someone its happening, so more common than signs in mental health
Define sign (x1)
Manifestation of pathology that can be objectively measured, e.g. temperature
Define syndrome (x3)
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
Define ‘classification system’ (x1)
o List of conditions with a description of the symptoms characteristic of each & guidelines for assigning individuals to categories
What are the purposes/advantages of classification? (x5)
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)
What can be problematic about classification? (x2)
Categorical vs. dimensional approach
o If we are all across a spectrum, how do you say where the cutoff goes?
What info does the DSM-V provide for each of its 200+ disorders? (11)
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
What improvements have been made to the DSM-V over time? (x6)
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
What are major criticisms of classification of mental illness? (x6)
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
Why is labelling controversial? (x3)
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
What is a major concern regarding classification under the DSM-V? (x2)
Forces clinicians to make distinctions that have major treatment implications,
Including drug prescriptions and availability of health insurance
What is clinical assessment? (x1)
Process of gathering information important to diagnose, plan treatment & predict the future course of a disorder
What are the stages of clinical assessment? (x5)
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
Name 10 forms of clinical assessment
Clinical intake interview Clinical tests Projective tests Personality inventories Other self-report scales Intelligence tests Neurological tests Neuropsych tests Behavioural assessment Physiological assessment
How do we decide which clinical test to use? Consider… (x3 plus egs)
Standardisation
Reliability - test/retest, alternate form, inter-rater
Validity - face, predictive, divergent, content, construct
What are two types of projective tests?
Rorschach
Thematic apperception tests - interpreting emotionally ambiguous situations/scenes
What are three common personality inventories?
Minnesota multiphase personality inventory - often used on forensics
California psychological inventory
Eysenck personality inventory
Describe the MMPI (x9)
500+ questions, 8 sub scales: • Hypochondriasis • Depression • Hysteria • Psychopathic deviance • Paranoia • Psychasthenia (fears/compulsions) • Schizophrenia • Hypomania (overactivity/inability to concentrate)
What ‘other self-report inventories’ might be used in clinical assessment? (x4)
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
Give two egs of neurological tests
o Computerised Axial Tomogram (CAT Scan) o Electroencephalography (EEG)
Name 3 types of behavioural assessment
o Direct Observation of Behaviour
o Self-Monitoring
o Behavioural Checklists
Physiological assessments measure… (x1)
Such as… (x3)
Bodily changes that accompany psychological events
• Skin conductance
• Heart rate
• Muscle activity (electromyography)
What factors can influence expression of abnormal behaviours? (x3)
Context
Personal characteristics - sex, race etc
SES
What is mass hysteria? (x1, plus e.g.)
Which is understood scientifically as… (x1)
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.
Describe biological models of abnormal behaviour and treatment (x6)
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
Describe psychological models of models of abnormal behaviour and treatment (x2)
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
Describe behavioural models of abnormal behaviour and treatment (x3)
And 3 major contributors?
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
Describe cognitive models of abnormal behaviour and treatment (x4)
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
Describe humanistic models of abnormal behaviour and treatment (x4)
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
Describe sociocultural models of abnormal behaviour and treatment (x6)
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
