Week 21: Psychopathology and Therapeutic Orientations Flashcards

Question

Implicated & associated factors GENETICS STATS

Answer 1

* 30-50% * >100 genetic risk loci * > 200 potential genes

Answer 2

* Loss of loved one: death, divorce, breakup * Lost job, money problems * Traumatic events * Serious illness

Answer 3

* Greater neural sensitivity in response to negative stimuli * Brain areas involved in stress response & positively motivated behaviours

Answer 4

* Pessimistic attributional styles * Internal, global, stable

Answer 5

* SSRIs, SNRIs * Act on serotonin and norepinephrine * Fewer side effects & risks than older MAOIs & Tricyclics * BUT, still enough to increase risk of noncompliance * Finding the right one can take time, trial & error * Those that work the best not necessarily the most tolerable * E.g. Venlafaxine one of the most effective, but also with some of the highest dropout rates

Answer 6

* Induced seizure with electric currents under general anesthetic * For severe, treatment resistant depression * High efficacy (80% benefit) * BUT potential for long-term memory loss

Answer 7

* Magnetic fields targets mood-regulatory regions of the prefrontal cortex * Non-invasive, no anesthesia * Effective for 50-60% of patients when other treatments have failed * Side effects are often minor (headache) or rare (seizure)

Answer 8

* Permanently implanted electrode stimulates brain * For severe, treatment resistant depression * Comes with the same risks as major surgery, plus additional side effects of stimulation * Experimental treatment

Answer 9

* Time limited: 12-20 weeks for MDD * Work best in combination with medication E.g. Cognitive Behavioural Therapy * Identify & address cognitive distortions and maladaptive behaviours Interpersonal Therapy * Focus on improving interpersonal relationships, based on a reciprocal mood-relationship model

Answer 10

Mania vs. hypomania * Neither explained by other substances * Both include a distinct period of markedly changed behaviour Mania * 1+ wk * Causes major impairments to daily functioning * Psychotic features common: delusions, hallucinations Hypomania * 4 days+ * Does not cause major impairment, hospitalization, or psychotic features

Answer 11

* Single or recurrent manic episode * More intense “highs” * May/may not also have MDE (not required for diagnosis) Criteria - 3 of the following if euphoric, 4 if irritable: * inflated self-esteem or grandiosity * increase in goal-directed activity/psychomotor agitation * decrease need for sleep * racing thoughts or flight of ideas * distractibility * increased talkativeness * risky behaviour

Answer 12

* Single or recurrent hypomanic episodes & MDE *No manic episode * Less intense “highs”, but with definite depressive episodes

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* Many alternating periods of hypomanic & depressive episodes over 2 years or more * Significant distress/impairment * Less than 2mns between episodes

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* Prevalence: 4.4% * BD I: 1% * Women = men * BD II: 0.5% * Women > men * Cyclothymia: 0.4-1% * Women = men * Age of onset: * BPD I: 14-21 yrs * BPD II: 18-29 * Cyclothymia: adolescence-early adulthood * Comorbidity: 65% * Anxiety & substance use disorders

Answer 15

* Highly heritable * 44-90% * Considered one of the “most heritable” * High heterogeneity * High variation in clinical presentation, time courses, responses to treatment * Psychosocial stressors likely important * Up to ~50% experience early & severe physical & sexual abuse

Answer 16

Medications * Lithium * Reduces dopamine (excitatory) and increases GABA (inhibitory) * Effective, BUT many cognitive & physical side effects increase risk of noncompliance Anticonvulsants * Alone or with lithium * Functionally mood stabilizers aimed at reducing mania Interpersonal and social rhythm therapy (IPSRT) * Psychosocial approach * Focus on stabilizing circadian rhythm * Disruptions common in ppl w/BPD * Emphasizes importance of daily routine * Based on the concept of “zeitgebers” (time givers) * Cues in the environment that synchronize circadian rhythm * E.g. sunlight, eating, sleeping, social relationships

Answer 17

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.

Answer 18

histrionic schizoid paranoid dependent *The rationale for the proposed deletions was in large part because they are said to have less empirical support than the diagnoses that were at the time being retained

Answer 19

most people are largely comfortable with their selves, with their characteristic manner of behaving, feeling, and relating to others

Answer 20

People with personality disorders tend not to seek help because they are egosyntonic (comfortable with themselves and their behaviour) *Exception: Borderline Personality Disorder & Avoidant Personality Disorder Why? High Neuroticism and experience life as one of pain and suffering *Narcacists rarely seek help to reduce arogance *Paranoid people rarely for suspiciousness *Antisocial rarely for criminality, aggression, or irresponsibility

Answer 21

Domain of general personality structure that concerns inherent feelings of emotional pain and suffering, including feelings of distress, anxiety, depression, self-consciousness, helplessness, and vulnerability.

Answer 22

antisocial

Answer 23

The prevalence of personality disorders within clinical settings is estimated to be well above 50%. As many as 60% of inpatients within some clinical settings are diagnosed with borderline personality disorder. Antisocial personality disorder may be diagnosed in as many as 50% of inmates within a correctional setting. It is estimated that 10% to 15% of the general population meets criteria for at least one of the 10 DSM-IV-TR personality disorders

Answer 24

Antisocial persons will tend to be irresponsible and negligent Borderline persons can form intensely manipulative attachments to their therapists Paranoid patients will be unduly suspicious and accusatory; narcissistic patients can be dismissive and denigrating Dependent patients can become overly attached to and feel helpless without their therapists.

Answer 25

Because they involve well-established behaviors that can be integral to a client’s self-image, *moderate adjustments in personality functioning can represent quite significant and meaningful change to patients

Answer 26

Dialectical behavior therapy Cognitive-behavior therapy that draws on principles from Zen Buddhism, dialectical philosophy, and behavioral science. Four components 1. individual therapy 2. group skills training 3. telephone coaching 4. A therapist consultation team *typically last a full year* *expensive form of treatment* Research has indicated that its benefits far outweighs its costs, both financially and socially ALSO mentalization therapy

Answer 27

Unclear why specific and explicit treatment manuals have not been developed for the other personality disorders. This may reflect a regrettable assumption that personality disorders are unresponsive to treatment. It may also reflect the complexity of their treatment. SO MANY OVERLAPPING SYMPTOMS that can be diognosed with different things *Not much effort into making treatment because people tend to not seek treatment for their personality disorder*

Answer 28

Antisocial

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A structure in the brain associated with liking

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e. The disorders involve well-established behaviors that are integral to a person’s self-image.

Answer 31

borderline

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d. "They likely involve genetic and environmental factors".

Answer 33

Charles Manson Jeffrey Dahmer Bernie Madoff.

Answer 34

Synonymous with psychopathic personality, the term used by Cleckley (1941/1976), and adapted from the term psychopathic introduced by German psychiatrist Julius Koch (1888) to designate mental disorders presumed to be heritable.

Answer 35

documented cases of what he called manie sans delire (“insanity without delirium”), in which dramatic episodes of recklessness and aggression occurred in individuals not suffering from obvious clouding of the mind.

Answer 36

introduced the disease-oriented term psychopathic to convey the idea that conditions of this type had a strong constitutional-heritable basis.

Answer 37

described psychopathy as a deep-rooted emotional pathology concealed by an outward appearance of good mental health.

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Present as confident, sociable, and well adjusted. However, their underlying disorder reveals itself over time through their actions and attitudes.

Answer 39

1. superficial charm 2. absence of delusions 3. absence of “nervousness” 4. unreliability 5. untruthfulness 6. lack of remorse and shame 7. antisocial behavior 8. poor judgement and failure to learn by experience 9. pathological egocentricity 10. poverty in affective reactions 11. loss of insight 12. unresponsiveness in interpersonal relations 13. fantastic and uninviting behavior 14. rare suicidal behavior 15. impersonal sex life 16. failure to follow any life plan. *Cleckley’s conception served as a referent for the diagnosis of psychopathy in the first two editions of the official American psychiatric nosology, the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Answer 40

Man who devised the original tests for psychopathy, asserted that some psychopaths may appear as well-adjusted, successful people who maintain respectable careers in fields like business and medicine.

Answer 41

*Replaced the Cleckley-oriented conception of psychopathy Counterpart diagnosis to psychopathy included in the third through fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM; APA, 2000). Defined by specific symptoms of behavioral deviancy in childhood (e.g., fighting, lying, stealing, truancy) continuing into adulthood (manifested as repeated rule-breaking, impulsiveness, irresponsibility, aggressiveness, etc.). *Concerns with this new conception were expressed by psychopathy experts, who noted that ASPD provided limited coverage of interpersonal-affective symptoms considered essential to psychopathy (e.g., charm, deceitfulness, selfishness, shallow affect)

Answer 42

rating instruments and self-report scales Most widely used Instrument: PCL-R Psychopathy Checklist-Revised - comprises 20 items rated on the basis of interview and file-record information * includes interpersonal-affective deficits and behavioral deviance from Ceckley * still limited, indirect coverage of positive adjustment features The manual for the PCL-R recommends the use of a cutoff score of 30 out of 40 High scores = impulsive and aggressive tendencies, low empathy, Machiavellianism, lack of social connectedness, and persistent violent offending.

Answer 43

1. interpersonal-affective relates to indices of narcissism, low empathy, and proactive aggression and to some extent (after controlling for its overlap with the antisocial factor) adaptive tendencies such as high social assertiveness and low fear, distress, and depression 2. antisocial deviance associated mainly with maladaptive tendencies and behaviors, including impulsiveness, sensation seeking, alienation and mistrust, reactive aggression, early and persistent antisocial deviance, and substance-related problems.

Answer 44

Individuals mostly found through self-report-based measures.

Answer 45

Two important factors 1. Fearless Dominance (FD) factor reflecting social potency, stress immunity, and fearlessness 2. Self-centered impulsivity (SCI) factor reflecting egocentricity, exploitativeness, hostile rebelliousness, and lack of planning. Scores on PPI-SCI, like Factor 2 of the PCL-R, are associated with multiple indicators of deviancy—including impulsivity and aggressiveness, child and adult antisocial behavior, substance abuse problems, heightened distress and dysphoria, and suicidal ideation.

Answer 46

In PPI, factors are uncorrelated, and thus even more distinct in their external correlates. Scores on PPI-FD are associated with indices of positive psychological adjustment (e.g., higher well-being; lower anxiety and depression) and measures of narcissism (low) empathy, and thrill/adventure seeking (Benning, Patrick, Blonigen, Hicks, & Iacono, 2005). Given this, PPI-FD has been interpreted as capturing a more adaptive expression of dispositional fearlessness (i.e., boldness; see below) than the interpersonal-affective factor of the PCL-R—which can be viewed as tapping a more pathologic (antagonistic or “mean”) expression of fearlessness.

Answer 47

Measure for psychopathic tendencies in youth *ages 6 through 13 1. Callous-Unemotional (CU) - reflecting emotional insensitivity and disregard for others 2. Impulsive/Conduct Problems (I/CP) - reflecting impulsivity, behavioral deviancy, and inflated self-importance. High in only I/CP - low intelligence - heightened emotional responsiveness to stressors - higher aggression High in both CU & I/CP - average to above average intelligence - low reported levels of anxiety and nervousness - reduced reactivity to stressful events - preference for activities entailing novelty and risk. * learn less readily from punishment * engage in high levels of premeditated as well as reactive aggression and exhibit more persistent violent behavior across time

Answer 48

Model formulated to reconcile alternative historic conceptions of psychopathy and differing methods for assessing it. Conceives of psychopathy as encompassing three symptomatic components: boldness, involving social efficacy, emotional resiliency, and venturesomeness; meanness, entailing lack of empathy/emotional-sensitivity and exploitative behavior toward others; and disinhibition, entailing deficient behavioral restraint and lack of control over urges/emotional reactions. 1. disinhibition - tendencies toward impulsiveness, weak behavioral restraint, hostility and mistrust, and difficulties in regulating emotion. 2. boldness - dominance, social assurance, emotional resiliency, and venturesomeness. 3. meanness - deficient empathy, lack of affiliative capacity, contempt toward others, predatory exploitativeness, and empowerment through cruelty and destructiveness. * According to the model, individuals high in disinhibitory tendencies would warrant a diagnosis of psychopathy if also high in boldness or meanness (or both), but individuals high on only one of these tendencies would not. * Individuals with differing relative elevations on these three symptomatic components would account for contrasting variants (subtypes) of psychopathy as described in the literature

Answer 49

TriPM Subscale - disinhibition 3. I often act on immediate needs (true) 21. I have good control over myself (false) 56. I have had problems at work because I was irresponsible (true) TriPM Subscale - boldness 32. I can get over things that traumatize others (true) 38. I can convince people to do what I want (true) 47. I stay away from physical danger as much as I can (false) TriPM Subscale - meanness 2. How other people are important to me (false) 23. I enjoy pushing people around sometimes (true) 33. I've injured people before to see them in pain (true)

Answer 50

(1) theories emphasizing core deficits in emotional sensitivity or responsiveness (2) theories positing basic impairments in cognitive-attentional processing

Answer 51

1. is psychological/emotional stability a characteristic of psychopathy or not? 2. is lack of anxiety central to psychopathy? 3. Are violent/aggressive tendencies typical of psychopathic individuals and should this be included in the definition of the disorder? 4. Does criminal or antisocial behaviour more broadly represent a defining feature of psychopathy or a secondary manifestation? 5. Do differing subtypes of psychopathy exist? 6. Does psychopathy differ in men and women? 7. Do “successful” psychopaths exist? (how does their behaviour contribute to this?) Some aspects of the psychopathic personality could be beneficial in certain professions requiring leadership and courage *higher estimated levels of PPI-FD (boldness) predicted higher ratings of presidential performance, persuasiveness, leadership, and crisis management ability, whereas higher estimated levels of SCI predicted adverse outcomes such as documented abuses of power and impeachment proceedings. Further research on outcomes associated with high levels of boldness and/or meanness in the absence of high disinhibition should yield valuable new insights into dispositional factors underlying psychopathy and alternative ways psychopathic tendencies can be expressed.

Answer 52

1. Narcissism 2. Psychopathy 3. Machiavellianism

Answer 53

Antisocial Disorder

Answer 54

As a conduct disorder

Answer 55

anxiety levels

Answer 56

half a quarter

Answer 57

most effective approach in the schools of thought of therapy involves work with a therapist as well as homework assignments between sessions. It has proven to be very effective for virtually all psychiatric illnesses.

Answer 58

psychoanalysis - earliest therapy *popularized by Sigmund Freud - mental health problems form due to unconscious conflicts and desires that must be identified and addressed accordingly - often explore childhood experiences - meet longterm for many years Freud - mental health problems stem from our sexual urges Freud later said conflict between Id, Ego, Superego

Answer 59

Id - pleasure-driven unconscious urges (e.g., our animalistic desires for sex and aggression) Superego - the semi-conscious part of the mind where morals and societal judgment are internalized (e.g., the part of you that automatically knows how society expects you to behave) Ego - also partly conscious - mediates between the id and superego. Freud believed that bringing unconscious struggles like these (where the id demands one thing and the superego another) into conscious awareness would relieve the stress of the conflict

Answer 60

Psychoanalytic therapy Sigmund Freud’s therapeutic approach focusing on resolving unconscious conflicts *Goal is to balance Id and Superego desires Psychodynamic therapy Treatment applying psychoanalytic principles in a briefer, more individualized format. *Same basic tenets as psychoanalysis *More focus on social and interpersonal context *focuses more on relieving psychological distress than on changing the person.

Answer 61

In psychodynamic therapy, a process in which the patient reports all thoughts that come to mind without censorship, and these thoughts are interpreted by the therapist. *Also often look into childhood experiences *When difficult to explore deep memories, we also explore dreams with manifest and latent content

Answer 62

a patient begins to express unjustified anger toward the therapist during therapy *the patient may be displacing feelings for people in their life (e.g., anger toward a parent) onto the therapist.

Answer 63

the therapist has to be aware of their own thoughts and emotions so they do not displace their own emotions onto the patient

Answer 64

The key to psychoanalytic theory is to have patients uncover the buried, conflicting content of their mind, and therapists use various tactics—such as seating patients to face away from them—to promote a freer self-disclosure. As a therapist spends more time with a patient, the therapist can come to view their relationship with the patient as another reflection of the patient’s mind.

Answer 65

Advantage - Psychoanalytic theory was history’s first attempt at formal treatment of mental illness, setting the stage for the more modern approaches used today. Disadvantages - # of therapists decreasing worldwide - Not appropriate for all patients; those with severe psychopathology or intellectual disabilities - Expensive because treatment can last years - lack of empirical support for effectiveness - limited research that has been done states Psychoanalytic Therapy does not lead to better mental health outcomes

Answer 66

Belief is that mental health problems result from an inconsistency between patients’ behavior and their true personal identity. - based on the idea that humans have an inherent drive to realize and express their own capabilities and creativity. Goal: Create conditions under which patients can discover their self-worth, feel comfortable exploring their own identity, and alter their behavior to better reflect this identity. * patient should experience both a vulnerability to anxiety, which motivates the desire to change, and an appreciation for the therapist’s support.

Answer 67

Largely unstructured conversation between the therapist and the patient. Rogers’s original name for PCT was non-directive therapy, and this notion is reflected in the flexibility found in PCT. Therapists do not try to change patients’ thoughts or behaviors directly. Rather, their role is to provide the therapeutic relationship as a platform for personal growth. In these kinds of sessions, the therapist tends only to ask questions and doesn’t provide any judgment or interpretation of what the patient says. Instead, the therapist is present to provide a safe and encouraging environment for the person to explore these issues for themself.

Answer 68

In person-centered therapy, an attitude of warmth, empathy and acceptance adopted by the therapist in order to foster feelings of inherent worth in the patient. the therapist is never to condemn or criticize the patient for what s/he has done or thought This creates an environment free of approval or disapproval

Answer 69

benefits - highly acceptable paitents - supportive, flexible environmentals very rewarding - clients also tend to respond well to being treated with nonjudgmental empathy outside of therapy Disadvantages - Mixed findings about effectiveness - Unspecific treatment factors - the therapy focuses on techniques that can be applied to anyone so none specific to patients individual needs (one size fits all)

Answer 70

A family of approaches with the goal of changing the thoughts and behaviors that influence psychopathology. The premise of CBT is that thoughts, behaviors, and emotions interact and contribute to various mental disorders. Present-focused therapy (i.e., focused on the “now” rather than causes from the past, such as childhood relationships) that uses behavioral goals to improve one’s mental illness. Often, these behavioral goals involve between-session homework assignments. When the patient has their next therapy session, the patient and the therapist review the patient’s “homework” together. CBT is a relatively brief intervention of 12 to 16 weekly sessions, closely tailored to the nature of the psychopathology and treatment of the specific mental disorder. Empirical data shows, CBT has proven to be highly efficacious for virtually all psychiatric illnesses

Answer 71

CYCLE: Thoughts create feelings Feelings create behaviours Behaviours reinforce thoughts

Answer 72

Thoughts that occur spontaneously; often used to describe problematic thoughts that maintain mental disorders. schema: A mental representation or set of beliefs about something. 1. beliefs about the self 2. beliefs about the world 3. beliefs about the future CBT is used to rewrite these schemas If I don’t wash my hands constantly, I’ll get a disease BECOMES Washing my hands three times a day is sufficient to prevent a disease rational-emotive-behavioral therapy (REBT) uses really similar concept encouraging patients to evaluate their own thoughts about situations

Answer 73

Reappraisal, or cognitive restructuring: - The process of identifying, evaluating, and changing maladaptive thoughts in psychotherapy. Exposure therapy: - A form of intervention in which the patient engages with a problematic (usually feared) situation without avoidance or escape. - extinction learning - patient “unlearns” the irrational fear

Answer 74

advantages: - brief - cost-effective for average customer - intuitive and logical for patients - adapted to suit needs of different populations - empirical support for its effectiveness - equally or more effective than other forms of treatment, including medication and other therapy disadvantages - involve significant effort on the patient’s part - homework

Answer 75

Idea that a person’s behavioral and emotional responses are causally influenced by one’s thinking. - Greek philosopher Epictetus is quoted as saying, “men are not moved by things, but by the view they take of them.” - how one percieves an event creates more of a response than the actual event itself Beck: automatic thoughts Ellis: self-statements

Answer 76

A - antecedent event B - belief C - consequence During CBT, the person is encouraged to carefully observe the sequence of events and the response to them, and then explore the validity of the underlying beliefs through behavioral experiments and reasoning, much like a detective or scientist.

Answer 77

A form of psychotherapy grounded in mindfulness theory and practice, often involving meditation, yoga, body scan, and other features of mindfulness exercises. *level of accessibility to patients highly important Increasing in popularity: - mindfulness-based stress reduction (MBSR) - mindfulness-based cognitive therapy (MBCT) Advantages - acceptability and accessibility to patients - yoga and meditation already popular *people have more of an interest in related psychological therapies - evidence for helping mood and anxiety disorders Disadvantages - Efficacy of MBT has not reached a consensus between researchers -

Answer 78

Use of - meditation - yoga - attention to physical experiences Goal: - reduce stress - allow for better objective evaluation of thoughts

Answer 79

- less focus on general stress reduction - more focus on one’s thoughts and their associated emotions *helps prevent relapses in depression - encourages patients to evaluate their thoughts objectively, without judgment Help address: - depression - anxiety - chronic pain - coronary artery disease - fibromyalgia

Answer 80

CBT Focus: changing negative or maladaptive thought - treat depression MBCT Focus: use mindfulness and cognitive therapy to be more aware of thoughts - avoiding relapse in depression

Answer 81

A treatment often used for borderline personality disorder that incorporates both cognitive-behavioral and mindfulness elements. *often used to treat borderline personality disorder *focus on skills training ex. distress tolerance - ways to cope with maladaptive thoughts and emotions in the moment.

Answer 82

DBT employs techniques that address the symptoms of the problem (e.g., cutting oneself) CBT addresses the problem itself (e.g., understanding the psychological motivation to cut oneself) *CBT does not teach skills training 'quick fixes' because of the concern that the skills—even though they may help in the short-term—may be harmful in the long-term, by maintaining maladaptive thoughts and behaviors.

Answer 83

A perspective in DBT that emphasizes the joint importance of change and acceptance. not black and white *in the grey *good and bad DBT tries to help patients be less judgmental of their thoughts using mindfulness-based therapy and encourages change through therapeutic progress, using cognitive-behavioural techniques as well as mindfulness exercises.

Answer 84

A therapeutic approach designed to foster nonjudgmental observation of one’s own mental processes. *In this treatment, patients are taught to observe their thoughts from a detached perspective ACT encourages patients not to attempt to change or avoid thoughts and emotions they observe in themselves Goal: recognize which thoughts are beneficial and which are harmful

Answer 85

make psychological treatments more available and accessable ex. smartphones, lap tops, computers

Answer 86

Using exercises (e.g., computer games) to change problematic thinking habits.

Answer 87

drugs used to improve the effects of therapeutic interventions (we know this through animal testing) *certain drugs influence the biological processes known to be involved in learning - if people take these drugs while going through psychotherapy, they are better able to “learn” the techniques for improvement.

Answer 88

Psychiatric drugs = public use by general medical practitioners *frequently used to treat mental disorders, including schizophrenia, bipolar disorder, depression, and anxiety disorders. *further research needed to prove the efficacy of Psychiatric drugs Psychotherapy = qualified psychologist

Answer 89

Describes a state of having more than one psychological or physical disorder at a given time

Answer 90

this term refers to approaches combining multiple orientations (e.g., CBT with psychoanalytic elements). EX. a therapist may employ distress tolerance skills from DBT (to resolve short-term problems), cognitive reappraisal from CBT (to address long-standing issues), and mindfulness-based meditation from MBCT (to reduce overall stress). And, in fact, between 13% and 42% of therapists have identified their own approaches as integrative or eclectic

Answer 91

cognitive behavioral

Answer 92

free association

Answer 93

PCT is based on nonspecific treatment factors, without considering specific treatment factors to directly target a given mental problem.

Answer 94

Thoughts, actions, and emotions interact and contribute to psychopathology.

Answer 95

restructuring

Answer 96

Dialectical behavior therapy