What is DSM good for? Provide 3 contexts in which it can be useful
The DSM is a book with all of the current mental health diagnoses. It is used by health care professional to identify which symptoms point to which mental health disorder.
- It can be useful to choose an appropriate treatment for someone’s symptoms
- It is useful to conduct research on a mental health disorder to make sure everyone is one the same page to define a disorder
- It is useful in the legal system to determine whether a person is criminally responsible for their actions
How did DSM IV differ from DSM III – provide two differences
- The DSM IV includes more statistics such as prevalence, incidence, gender differences
- The DSM IV includes and comorbidity information
- Addition of Bipolar II and Asperger’s disorder
What are the main criticisms of the DSM system? (discuss two)
- Some people argue that it can be fairly easy to meet the criteria for some mental health disorder, which can lead to pathologizing “normal” behavior.
- Due to fake ‘epidemics’ this increases the over prescription of medication which in turns causes significant side effects both in children and in adults such as ADHD and GAD
What are two most popular projective personality tests?
- Inkblot test: this tests shows ambiguous ink shapes and the client must try to describe what they see
- Thematic Apperception Test: there is a scene and the client must project what they believe is going on, what the intentions of the characters are and what they will be doing.
How could MRI and fMRI be useful in clinical practice and assessment?
MRI and fMRI are useful to see differences between ‘healthy’ individuals and those who have a diagnosis of mental health disorders. While the results cannot lead to a diagnosis, it is still helpful to understand how the brain reacts to different stimuli, the strength and weaknesses and to point to specific treatment options..
The MRI can look at the structure of the brain, e.g. people with schizophrenia tend to have enlarged ventricles, while fMRI can look at the activation of certain areas of the brain when prompted with a stimuli.
What are two main goals of neuropsychological testing?
- Recognize strength and weaknesses of the patient
- Propose directions for treatment
- Measure any brain damage, possible localization and lateralization
What is the dual role of CRF (corticotropin-releasing factor) in anxiety
- HPA axis – from hypothalamus to adrenal cortex and release of cortisol
more related to stress - ANS - hypothalamus to adrenal medulla and release of epinephrine & norepinephrine + overall activation of the sympathetic nervous system
What disorders are frequently comorbid with anxiety?
Mood disorders, OCD, substance abuse
List 3 specific phobias
Fear of heights, fear of blood, fear of enclosed spaces
Psychoanalysis and behaviorists have a very different way of explaining phobia. Please discuss how their explanations differ.
- Psychoanalyst believe that the object of the phobia has a significance. They believe that an unresolved conflict anxiety was transferred to the object, thus to resolve their phobia, they must face their inner conflict
- Behaviorist believe that phobia were classically conditioned at first, and then reinforced through operant conditioning. The object of the phobia is irrelevant, but the behavior surrounding the object is self-reinforcing with avoidance.
What is taijin kyofusho?
It is a phobia that is culture specific to Japan. It is an extreme fear of embarrassing people, or making them feel uncomfortable, such as looking at someone in the subway and thinking that you would think any negative thing about them, their outfit or judge their life in any shape or forms.
Many individuals with severe fears of snakes, germs, and airplanes tell clinicians that they have had no particularly unpleasant experiences with these objects or situations. How did they develop their phobias?
According to evolutionary perspective, we are subjected to prepared learning where we are biologically incline to fear things that may hurt us, as opposed to more neutral objects such as tables and flowers. Since the listed elements are all potential threats, they are also part of the imaginative culture in movies where the idea of the threat is reinforced. Therefore, the avoidance leads to a self-reinforcing behavior that soothes the fear related to these objects, which in turn validates the initial anxiety that increases over time.
Cognitive theorists contend that people with social anxiety disorder (SAD) hold a group of social beliefs and expectations that consistently work against them. Please discuss 3 such beliefs
- I am an unattractive social being
- I must be perfect in my social interactions
- If I do not perform perfectly socially, terrible outcomes may occur
Since these beliefs are impossible to uphold, they are going to induce a lot of anxiety, leading to a self-fulfilling prophecy.
What brain structures have been implicated in anxiety? Please list 2
The amygdala: emotional memories and conditioned fear
The prefrontal cortex: coping mechanisms
BNST: gets triggered when the source of the fear/anxiety is not precise. This lead to an overall state of alertness,
What is the best therapy for phobias?
Exposure therapy: To break the cycle of avoidance-reinforcement, the person must be exposed to the source of their phobia until they can regulate their anxiety. This can be done in stages, where initially the person only thinks about the phobia, and then is in the same building, same room, and then touching it (when that is possible).
What is the cognitive explanation of OCD?
Faulty cognitive assumptions
- If I think about the occurrence of something, it increases its chances of happening
- If I think about doing something horrible, it is just as bad as doing it
What brain structures have been associated with OCD? Please list 3
Cortex
Thalamus
Striatum
What type of psychotherapy is typically used to treat panic disorder. Please describe briefly how it works
Mindfulness based CBT, many panic attacks occur due to a misattribution of bodily arousal. By being aware of one’s bodily sensations, the client can better regulate their emotional response to a fast heart rate and use relaxation techniques instead of spiraling out of control into a panic attack. The client will also learn to have more appropriate thoughts and not jump to conclusions that something is wrong with their body, but instead find a more suitable alternative explanations. Eventually, the client can induce some of the bodily sensations to practice the relaxation techniques.
How would you define ‘thought-action-fusion’?
Faulty cognitive assumptions
- If I think about the occurrence of something, it increases its chances of happening
- If I think about doing something horrible, it is just as bad as doing it
List or describe 3 negative symptoms of schizophrenia?
- Lack of social behaviors
- Lack of pleasure
- Lack of energy
What are delusions of reference?
It is a type of delusion where someone believes that random events are significant to their own life, as if signs were sent to them
Describe the Dopamine Imbalance Hypothesis of schizophrenia proposed by Davis (1991)
Initially, people thought that schizophrenia was caused by a generally overload of dopamine in the brain.
However, Davis was able to differentiate that an overactive mesolimbic pathway way was linked to positive symptoms, whereas an underactive mesocortical pathway was linked to negative symptoms.
Why is R.D. Laing’s view of schizophrenia considered to be controversial?
He believes that schizophrenia is an “open dialogue” within a person. It is the expression of one’s interior conflict between unhappiness and the social environment and schizophrenia symptoms are the attempts to resolve that conflict. If we were to simply let people with schizophrenia resolve it by themselves, they would overcome their interior conflict and be cured. However, there is no evidence pointing to this theory.
What are the differences and similarities between anorexia and body dysormorphic disorder
People with anorexia nervosa have an intense fear of gaining weight or appearing overweight even when they are normal weight or underweight. People with BDD are also preoccupied with their appearance, thinking that they look abnormal, ugly, or deformed, when in fact they look normal.
Both BDD and anorexia may also involve appearance-related ritualistic or repetitive behaviors (e.g., mirror checking and body measuring). In addition, in both disorders a quest to improve appearance drives attempts to change the body’s appearance
Although most patients with anorexia may be easily differentiated from patients with more classic BDD (e.g., a male with balding concerns), some patients seem to be in a diagnostic gray zone between these disorders
Much more female in anorexia than BDD (90% vs 50%)
BDD and anorexia respond to different treatments. BDD responds well to SSRI, while not so much anorexia
