1
Q
What is the definition of “etiology”?
A
A set of causes of a disease –> How and why people develop mental illness
2
Q
In general, how do we measure psychopathology?
A
Through abnormality and social deviance
3
Q
What did Thomas Sidenham come up with? (2)
A
- The concept of syndromes
- Diseases could be measured and expressed as clusters of symptoms that have a predictable course over time
4
Q
What did Emille Crapelin do? (1)
A
He applied the concept of syndromes to mental disorders. They are “taxonic” –> exist the same way as physical illnesses
5
Q
What does “taxonic” mean?
A
Syndromes are taxonic in nature, meaning that mental illness exists in the exact same way as physical illness exists in the real world
6
Q
What did James Wakefield propose? (1)
A
He proposed that we should define “mental illness” as a “harmful dysfunction”.
7
Q
- What is the defintion of “dysfunction”?
- According to Wakefield, what does “harmful dysfunction” mean? Who can perceive this harm?
A
- An organ system performing the opposite of what it’s supposed to do
- If you have an issue with the functions of the brain (thinking + emotion regulation), then you have a disorder. The dysfunction has to cause harm and impairment in the person’s own environmental context. However, it does not have to be subjectively perceived; others can perceive it as harmful.
8
Q
- What did Scott Lillienfeld question?
- What was his viewpoint on it?
A
- He questioned the natural function of an organism.
- In his opinion, we have a limited understanding. We don’t know if something is adaptive or if it’s a byproduct of evolutionary processes
9
Q
Explain the following: “Natural selection depends on variability”.
A
Natural selection only works if individuals in a population differ from one another
10
Q
Explain the following: “Some disorders may be adaptations or maladaptations”.
A
Some disorders contain heritable traits that either increase or decrease an organism’s chances of survival
11
Q
What did Widiger propose?
A
Mental disorders are:
- constructs –> something that we cannot observe
- latent –> cannot be measured directly
12
Q
What is the “Multi-Modal Approaches” regarding mental disorders?
A
A disorder represents all things that cause psychopathology and are expressed/measured through multiple domains (self-reports, neural/behavioural tests)
13
Q
- What are the characteristics of a Classification System? (4)
- Give a definition of each term.
A
- Description: highlight critical key features of a diagnosis –> key symptoms that you must have to be diagnosed
- Prediction: The diagnosis should tell us about the course, treatment, and etiology
- Theory: A diagnosis should indicate symptoms that should correlate with one another
- Communication: must be established between physicians
14
Q
What are the criteria that Robins & Guze proposed for a valid classification of disorders? (5)
A
- Clinical Description
- Course
- Treatment Response
- Family History
- Laboratory Studies
15
Q
- Define the criteria “Clinical Description”.
- Give an example.
A
- A disorder has to be characterized by a common set of symptoms that cluster together and are characteristic of the disorder. it’s also important to define what symptoms are not characteristic of the disorder.
- For MDD, you should be able to see symptoms like sadness, sleepiness, etc.
16
Q
Define the criteria “Course”.
A
People with the disorder should follow a common trajectory and have a similar onset
17
Q
Define the criteria “Treatment Response”.
A
If a disorder is valid, most people will respond similarly to similar treatments
18
Q
Define the criteria “Family History”.
A
Does the disorder run in families?
19
Q
Define the criteria “Laboratory Studies”.
A
There should be biological, psychological, or behavioral markers associated with the disorder
20
Q
Define “Categorical” and “Dimensional” Systems.
A
- Categorical: either you have the disorder or you don’t
- Dimensional: treats dynsfunction as continuous –> how anxious are you on a scale of 1-10?
21
Q
What are some advantages of the “Categorical” System? (2)
A
- Simplifies communication –> people often use categories in everyday speech
- Categories are better suited for clinical decision-making –> Do we hospitalize or not?
22
Q
- What are the limitations of a classification system? (2)
- Define each term. For one of the terms, use the concept of “Procrustean beds”.
A
- Loss of uniqueness: Diagnoses tend to prioritize what people have in common over what makes each person unique. The diagnosis treats them as the same type of disorder, even though their lived experiences differ.
- Difficulty of boundary cases: What do we do with people who don’t possess all the criteria for a disorder? “Procustean beds” refers to cutting people’s bodies for them to fit into a bed, meaning that we’re forcing people to fit into the criteria of what defines a disorder.
23
Q
What are some challenges to the Categorical Classification System? (2)
A
- Heterogeneity: Different people can have the same diagnosis but only share 1 symptom in common. People with the same diagnosis can look very different from one another.
- Comorbidity: The presence of more than 1 diagnosis at the same time. It’s hard to link the intervention or even to research one diagnosis because you don’t know which diagnosis is the main one.
24
Q
Why does comorbidity occur, and explain why? (6)
A
It occurs due to:
- Chance
- Sampling bias –> People with more disorders are more likely to seek treatment. So, you’re already presuming that there’s a presence of comorbidity.
- Problems with diagnostic criteria –> Many criteria of symptoms overlap in different disorders
- Poorly-drawn diagnostic boundaries –> Multiformity: disorders can express themselves in different ways
- Having one disorder is a risk factor for another disorder
- Some disorders share etiological risk factors (the same causal mechanisms that cause both diagnosis)
25
What are some advantages of the "Dimensional" System? (3)
1. In the dimensional model, everybody falls somewhere
2. Preserves more information
3. Greater reliability testing
26
1. What year was the DSM-I introduced?
2. What was the context in that time period?
1. 1952
2. It was created to arrive at a consensus on the definition of different mental illnesses
27
1. What year was the DSM-II introduced?
2. What was the context in that time period?
1. 1968
2. It was created in a period of time influenced by psychoanalytic thought
28
What are some characteristics of the DSM-II? (2)
1. There are a few categories
2. There's no required number of symptoms needed for a diagnosis
29
1. What year was the DSM-III introduced?
2. What was the context in that time period?
1. 1980
2. It was created to respond to the demands for a biological approach to psychopathology
30
What are some criteria that the DSM-III introduced? (4). Define each term.
1. Inclusion criteria: what symptoms do you need to have and how many?
2. Duration criteria: How long do you need to have these symptoms
3. Exclusion criteria: What symptoms do you need to rule out?
4. Multi-Axial Classification
31
How does the "Multi-Axial Classification" classify different mental disorders/illnesses? Define each Axis (5).
- Axis 1: Major clinical disorders. They are temporary but do not represent the person's way of being in the world.
- Axis 2: Personality disorders. They are longstanding and maladaptive, representing the person's way of being in the world
- Axis 3: Medical conditions that might contribute or be relevant to treatment
- Axis 4: Psychosocial stressors --> environmental
- Axis 5: GAF is a score of the severity of a person's functioning
32
What are some assumptions about the DSM-III? (2)
1. Symptoms are the most useful basis for assessment and nosology (how we describe the disorder)
2. Locus of pathology is located inside the individual
33
1. What year was the DSM-IV introduced?
2. What was the context in that time period?
1. 1994
2. It was created because symptoms alone were insufficient to make a diagnosis. Now, a disorder must cause distress or impairment in one's life.
34
1. What year was the DSM-V introduced?
2. What were some characteristics of the DSM-V? (3)
1. 2013
2. It removed the multi-axial system, introduced a dimensional assessment criteria for some diagnoses, and re-classified some disorders.
35
What did Tom Achenbach propose?
The Alternative Approaches: Dimensional/Hierarchical Models
36
What is the "Alternative Approaches: Dimensional/Hierarchical Models"?
It describes how symptoms hang together:
- internalizing disorders: "pain" is directed inward (GAD, MDD, Panic disorder)
- externalizing disorders: "pain" is directed outward (substance abuse, ODD)
37
1. What is another name for the "High Top Model"?
2. What does it introduce?
1. Hierarchical Taxonomy of Psychopathology
2. Introduces the "p-factor" --> a general liability to psychopathology
38
In comparison to the "High Top Model", what is the "Research Domain Criteria) RDoC?
It is a bottom-up process that looks at how adaptive and critical domains of functioning go wrong and how that expresses itself as a disorder
39
What is the definition of "Psychiatric epidemiology"?
It describes the frequency and the distribution of traits and diseases/disorders in people. How common they are in different places, at different times, and across demographics.
40
What is the definition of "prevalence"?
The % of people in a population with the disorder at a particular point in time
41
What is the definition of "incidence"?
The % of people who develop a disorder for the very first time at a specific time point
42
What is the definition of "risk factor"?
A correlate that is associated with a specific disorder
43
What is the % of people in a population who had the following disorders at any point during a one-year period? (1 year prevalence)
- MDD
- Persistent Depressive Disorder
- Bipolar
- Panic
- OCD
- Social Anxiety Disorder
- GAD
- PTSD
-MDD: 6.7%
- Persistent Depressive Disorder: 1.5%
- Bipolar: 2.6%
- Panic: 2.7%
- OCD: 1%
- Social Anxiety Disorder: 6.8%
- GAD: 3.1%
- PTSD: 3.5%
44
What is the % of people in a population who will meet the criteria for the following disorders? (lifetime prevalence)
- Mood Disorder
- Anxiety Disorders
- Substance Use Disorders
- Any Disorders
- Mood Disorder: 21%
- Anxiety Disorders: 27%
- Substance Use Disorders: 15%
- Any Disorders: 46%
45
Why is etiology important when talking about psychopathology?
It's important to understand the mechanism of an illness in order to intervene efficiently and design new interventions
46
How do Freudian theories attempt to explain "etiology"?
Parenting plays a role on etiology
47
How does "schizophrenic mother" attempt to explain the etiology of schizophrenia?
Schizophrenia is caused by an overprotective mother
48
How does "refrigerator mother" attempt to explain the etiology of autism?
The cause of autism can be attributed to a mother who lacked genuine warmth towards her children
49
1. Is there any evidence to prove the theories of: "schizophrenic mother" and "refrigerator mother"?
2. What does Dr. Weinburg propose in class?
1. No
2. Since we are typically genetically related to our parents, what looks like an effect of parenting may actually reflect a heritable phenotype (traits) that influence both how parents behave and how children act
- Ex: Parents are more strict because they know that when they were a kid, they were rambunctious, and so is their present child
50
Explain this sentence: "Genes are not deterministic. Most are probabilistic".
Genes provide a range of probabilities. They make small contributions to determine the ultimate outcome but they do not determine exactly how you will turn out
51
What is the definition of "Polygenic"?
The combined effects of MANY different genes, each contributing a small amount, determine your outcome
52
What is the argument of the "Diathesis-Stress Model"?
People who are considered "ill" are people who have diathesis (the underlying vulnerability to psychopathology) and who are exposed to a stressor.
53
1. At what [small, medium, high] levels do you need to at least become vulnerable to stressors?
2. At what levels are you the most vulnerable?
1. Medium
2. High
54
1. Define"etiological heterogeneity"?
2. What does it assume?
1. There is no one pathway to have a disorder
2. It assumes that diathesis and stress are independent. The underlying vulnerability of developing a disease has nothing to do with the types and severity of stressors that you experience in life
55
Explain "vulnerability-stress correlations".
The genetic risk for developing a disorder is correlated with the way a person behaves in the world because it can predict vulnerability to stress
56
Define "Stress Generation".
People are more likely to be depressed after exposure to stressors.
57
Explain "scars as vulnerability".
Scars from an illness or encountering a stressor can affect the next time you encounter another major stressor.
58
Define "Equifinality".
Different people get to the same point/outcome via different developmental pathways
59
Define "Final common pathway".
Although the early causes differ (bullying, parenting style, trauma, substance use, etc.)
These pathways converge on the same underlying process just before the disorder appears
60
Define "Multifinality".
The same ethiological cause can lead to different outcomes/disorders.
61
What are some common problems with psychopathology research?
- It is almost always correlational in nature, making it challenging to make causal claims
- We cannot randomly assign people to have depression or other disorders
62
1. Define "longitudinal designs".
2. Name 3 different types
1. Study done over time
2. Restrospective, Follow-up, High risk
63
1. What are retrospective longitudinal designs?
2. What do they use?
- Studies that look backward in time to reconstruct how a disorder or behaviour developed before the study began.
- Use archival research and home videos
64
What are follow-up longitudinal designs?
Studies where the already ill individuals are assessed repeatedly over time to see how a condition, behavior, or diagnosis changes, persists, or resolves.
65
What are high-risk longitudinal designs?
Following people who are at high risk (more likely to) of developing a disorder
66
Define "Mood State Bias".
When people are in different moods, they tend to recall things differently.
- Ex: In a negative mood, you'll remember things more negatively
67
What are "Vulnerability Markers" used for?
To detect certain disorders in the population
68
List the criteria of what can be a vulnerability marker. They should... (4)
1. Trait-like, meaning they should be stable over time
2. Correlated with the disorder but should persist even after an episode has occurred
3. Has to be present in a population that is high-risk for developing a disorder
4. Has to occur before the disorder
69
Define "Case Control".
Compare one group with the disorder to a group that does not have the disorder
70
Define "Cohort".
Selecting a sample of people where some may have the disorder or not.
71
1. Define "patient population".
2. What is a characteristic of this population?
1. Individuals who have common characteristics relevant to healthcare needs, research, and treatment.
2. They are not representative of people with the disorder in the community
72
1. Define "clinical population"
2. What is a characteristic of this population?
1. Individuals identified by shared health conditions, diseases, or characteristics.
2. They tend to be more severe, have more comorbidities, more likely to be female
73
1. Define "community/general population."
2. What is a characteristic of this population?
1. Broad, non-institutionalized group of individuals living within a specific geographic area
2. They tend to have a milder presentation of disorders and will be closer to the diagnostic threshold
74
1. Who tends to be "controls" (those who don't receive treatment)?
2. Are they representative of the general population?
1. Super healthy controls who don't have any form of psychopathology
2. Not necessarily representative because at least 40% of the population will meet criteria for psychopathology
75
What are the steps of a family study?
1. Identify a proband
2. Assess family members to see if they meet criteria for the disorder
76
Define "proband".
Someone who has the disorder in the family.
77
List and define the 2 ways we can assess family members to see if they meet criteria for the disorder.
1. Interviews (of the entire family)
2. Informant report --> asking the proband what each family member is like
78
When conducting an adoption study where the parent is a proband, who are we ultimately trying to study?
Parents who have a mental illness put up their children for adoption. Then, we go look for that child and assess them.
79
When conducting an adoption study where the adoptee is a proband, who are we ultimately trying to study?
We start by assessing the adopted child, their adopted parents and then their biological parents for a disorder
80
List two situations that represent a cross-fostering design.
1. A child at risk for a disorder is put into a home where parents are normal
2. A child without a disorder is put into a home where parents have a disorder
81
What are 2 disadvantages of an adoption study?
1. Since adoption is a rare event, you've already narrowed down on who can be in your study
2. Adoptive parents are screened and usually do not possess a mental disorder
82
What are the differences between "Monozygotic twins" and "Dizygotic twins"?
1. Monozygotic twins share identical DNA
2. Dizygotic twins share 50% of their genetic makeup
83
When conducting twin studies, list and define 3 components that researchers tend to examine.
1. additive genetic component: are there any additive genes that are liable for psychopathology?
2. common environment component: how much are twins alike in general?
3. unique environment: how much do twins differ from one another due to environmental factors
84
What is a con of twin studies?
Monozygotic twins' environment tends to be more similar than that of dizygotic twins because people treat them as the same person
85
List 3 different types of gene-environment correlations.
1. Passive
2. Active
3. Evocative
86
Define "passive gene-environment correlations".
The parents provide a child's genotype due to parenting or actual genes, leading to a correlation between a child’s genes and the environment they are raised in
87
Define "active gene-environment correlations".
Adolescents select the environment in which they want to be in
88
1. Define "evocative (reactive) gene-environment correlations".
2. Give an example with height.
A child's genotype determines the way their environment responds to them.
- Ex: people act differently towards people who are either tall or short
89
Define "Single-Gene Transmission"
Variants of one gene can influence the ultimate phenotype
90
What are 2 cons of single-gene transmission?
1. It is expected that 50% of relatives would have the disorder, which isn't the case. Thus, single-gene transmission can express itself differently
2. Monogenic disorders (determined by a single gene) are expected to be very distinct and visible from normal functioning, but that isn't the case for depression, schizophrenia, or anxiety.
91
Define "Polygenic Transmission".
The combination of many different genes can influence the ultimate phenotype
92
Define "Mixed Transmission".
One gene plays a major role, but there are other genes that also influence the ultimate phenotype
93
Explain "gene environment interactions".
Genes are a risk for a disorder only in specific environments, like child abuse
94
Define "Endophenotypes".
Internal traits that lie between genes and an observable disorder, helping explain how genetic risk is expressed biologically
95
List the criteria of what can be an endophenotype. They must... (4)
1. Segregate with illness in the population --> the endophenotype must co-occur with the disorder of interest
2. Must be heritable
3. Must be state-dependent --> you should see this endophenotype regardless if the person is tired or sick
4. Must be present at a higher rate within affected families
5. Must be measurable
96
What is an example of an endophenotype for schizophrenia?
Impaired smooth pursuit eye tracking in schizophrenia
PSYC 337
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