1
Q
Disorder definition
A
- Clinically significant → impairment in some way
- 3 areas:
o Cognition: cant think quick or think too quick (anxiety, racing thoughts)
o Regulating Emotion: out of control, yelling and screaming, very sad etc.
o Behavior: totally restless, out of control and everything in between, shown on the outside or maybe impulsive child having a tantrum - Associated with significant distress, disabled or impaired
o Social, occupational or other important activities - Measure how much in each domain and see if its clinically significant
- Root may be in psych, bio, developmental processes underlying mental functioning
- Socially deviant behavior is not a disorder unless it results from a dysfunction in the person
2
Q
historical conceptions
A
- Supernatural explanations: witchcraft, moon and stars
- Assumed that people who acted abnormally were consumed by the devil or were witches → performed exorcisms, witch hunting, etc.
- Biological explanations: Hippocrates and galen along with later medical advances and treatment
- Psychological explanations
o Freud and psychodynamic theory
o Humanistic theories (roger, maslow)
o Learning theorists (skinner, Pavlov, bandura
3
Q
19th century advances
A
- 19th century: general paresis (syphilis), psychosis → biology
o Associated with unusual psych and behavioral symptoms
o Demonstrated a bio basis for psychosis
4
Q
20th century advances
A
o 1930s
• Insulin shock therapy → given insulin and put into shock → v bad, caused death or near death
• Psychosurgery → helpful at first but some people couldn’t form or retrieve memories or properly function afterwards
• Electroconvulsive therapy
o 1950s
• First psychotropic meds (neuroleptics)
• Systematically developed
• Used to successfully treat psychosis, agitation and aggression
• There were unwanted side affects from meds → people stopped taking them and then got worse bc meds don’t necessarily cure (still relevant)
• Benzodiapines can be addictive
5
Q
- Freud and psychodynamic theory
A
o Structure of the mind (id ego superego)
o Stages of psychosexual development
o Defense mechanisms
• Coping styles in response to particular stressors (denial displacement projection rationalization sublimation)
6
Q
- Humanistic theorists
A
o Carl rogers → client centered therapy
o Maslow → self actualization
7
Q
- The behavioral model
A
o Ian Pavlov and john Watson → classical conditioning
o BF skinner → operant conditioning
o Albert bandura → social learning theory
o Treatment: behavior therapy → tends to be time limited and direct
o Legacy → lead to cognitive behavioral therapy
8
Q
Present day conceptions of psychopathology
A
- Must consider the whole person and their individual life experiences
- Along with unique combo of bio psych social and cultural factors that inform their sense fo self and their experience of the world and impact their functioning
- Seems to be a universal human experience
9
Q
Prevalence in Canada
A
- 1 in 3 canadians has or will have a disprder
o leading cuase of disability
o 70% first developed in childhood or adolescence
o 10-20% of you th affected by mental disorders - 9th highest suicide rate among 12 industrial counties
o one of leading cuases from 15-middle age
o 24% of all reaths among 15-24 yo
o 1t6% among 25-44 yo - Mood and anxiety disorders
o ~12% over the age od 18 suffer from mood and anxiety disorders
o Anxiety: 9% of men and 16% of women
o Depression: 1 in 10 men, 1 in 6 women - Substance abuse: 1 in 10 canadiats 15+ report symptoms of consistent with substance abuse and dependence
- Schizophrenia: ~1% of Canadians 16-30
- 1 in 3 canadians cant get the treatment they need
10
Q
Understanding psychopathology
A
- Bio-psycho-social or multidimensional model
o How it impacts who you are, how you see the world - Bio factors: genetics, neurobiology
- Behavioral cognitive emotional factors
- Social, cultural, interpersonal, developmental factors
11
Q
Genetic contributions
A
- Behavioral genetics: what role does it play in regard to tendencies, psychopathology, behaviors, etc.
- Only 50% of behavior/personality that comes from genetics
- What environment has an effect? How can we affect disorders with environment?
12
Q
Gene influences
A
o Inheriting a predisposition to a disorder
o Inherit, but environment can trigger
o No particular gene identifies (polygenetic, multiple genes create predisposition)
o Cant say exactly if someone will get a disorder, but can say that there is a risk
13
Q
- If parent has a disorder will u get it?
A
o Not necessarily
o Disorder could affect ones parenting and there may be neglect etc which could change environment and cuase disorder
- Identical twins? – May both get disorder but not necessarily, 50% chance
14
Q
Diathesis Stress model
A
- Diathesis + stress = genetic vulnerability/expression of trail/disorder
- Diathesis: inherited genetic predisposition for a tendency to express certain traits or behaviors
o Parent struggles with anxiety → I may have a predisposition to potential anxiety
o May have predisposition to other things like trouble controlling emotions
• Some may get anxiety, some may get none some may get depression
o Creates a genetic vulnerability - Stress: diathesis may be activated in certain environments (stress)
o Even if no genetic vulnerability we can still develop a disorder because of stress
o Under stress we are all vulnerable
o With diathesis it takes less stress to develop a disorder
15
Q
Caspi study
A
- People with one type of genetic makeup were less likely to develop depression when exposed to the same stressful events (short vs long alleles)
- 2 short alleles were more likely to develop ptsd compared to having two long alleles
16
Q
Gene environment correlation model
A
- Correlational relationship between genetics and environment
- If have divorces sibling then u are 2x more likely to get divorced
- Bc genetic makeup we work to shape our world to fir out needs
- Seek dangerous and risky situations and develop a phobia if something bad happens
- Introverted, nervous around people, stay only with a couple friends but when put in situation where forces to be social there will be more stress
- Avoiding situations then when put into them there is more stress and a disorder can develop (read Kilpatrick again)
17
Q
Mcgue and Lykken (read again), blood injection
A
- Dr simon sheri → personality and perfectionism
- Observed first year students and adapting to uni
- May be more vulnerable if a perfectionist
- Are there differences between perfectionists and not?
- Have to adjust whole life and perfectionists have v high expectations that can be hard to meet
- Perfectionists select themselves in to tough things and may struggle more
18
Q
Epigenetics
A
- Environmental variables can act on genetic material
o Ex. stress, nutrition and other environmental effects/events - Genes can be turned on or off in certain environments
- May happen pre or postnatally
- Materials act on genes but don’t act permanently may be passed on to next gen
- Does not change genome
19
Q
forebrain
A
abilty to plan, prioritize, emotion regulation, sensory, executive function
o Frontal parietal occipital temporal lobes 2 hemispheres limbic system
o Important because it organizes perception and helps us to figure out how to respond
o Memory, regulation of emotion, fight or flight, limbic system
20
Q
midbRAIN
A
regulates behavior and emotion, arousal, attention, alertness
o Basal ganglia → processing of rewards, orienting behavior
o RAS (reticular activating system) for arousal and alertness
o Thalamus, hypothalamus, parts of RAS
o Important for regulation of emotion (mood, personality disorders), alertness, arousal, fight or flight
21
Q
- Hindbrain
A
: regulates automatic activities/bodily functions and coordination
o Automatic fight or flight, disorders that have to do with movement and coordination
o Structures: medulla, pons, cerebellum
22
Q
- Limbic system
A
emotions, basic drives, impulse control, memory, fight or flight or stress response
o Hypothalamus: eating drinking etc.
o Thalamus: relay station for sensory info
o Hippocampus: memory
o Amygdala: emotional relevance, adding meaning to a situation
o Cingulate gyrus: attention to something, realize something is happening, controlling behavior, problem solving
o Basal ganglia: link between something, both schitz and parkinsons
23
Q
pns
A
- Somatic NS: voluntary movement
- Autonomic NS: involuntary movement
o Sympathetic: directly involved with fight or flight, used in stressful situations, inc HR, BP, dec in digestion, lots of functions turned on high
o Parasympathetic: normalizes nervous system following hyperarousal
24
Q
HPA axis
A
- Integrates and connect the endocrine and nervous systems
- Activated in response to stress
- Hypothalamus, pituary and adrenal gland
- Adrenal is activated, stimulates HCTH, releases cortisol to help deal with stress
- Endocrine and HPA involved with psychopathology under chronic stress HPA can become disregulated, cortisol stimulates to be continuously stress
25
Neurons and neuronal transmission
- Information is transmitted through neuronal communication
- Cell body, dendrites, axon between 2
- Dendrites receive messages, axons pass tehm on
- Function of neuron: send messages
- 10 bil neurons, 1 has ~10000 connections to other neurons
- Axons = presynaptic, dendrites = postsynaptic
- Myelin sheath: insulates axons, makes signal faster
- Action potential: electrical impulse
- Dendrites have spiny things that have receptors for neurotransmitters (chemical signals)
- Each neurotransmitter has a specializd dendrite receptor
- Receptors are excitatory (will cause a graded potential in dendrite and will turn it into an action potential) or inhibitory (no graded potential, doesn’t continue firing)
- Terminal buttons are where neurotransmitters are released
26
Neuronal transmission and neurotransmitter release
- Presynaptic neuron: in response to action potential a neurotransmitter is released into synaptic cleft
- Postsynaptic neuron: neurotransmitter binds to receptor sites
- After binding reuptake or enzymatic degradation takes place
- In axon close to cell body where neurotransmitter begins to be synthesized action potential occurs so the synaptic vesicles move neurotransmitter to end then action potential stimulates release
- After time neurotransmitter is done work so it separates from receptor
- After binding reuptake takes place (enzymatic degredation)
- Selective serotonin reuptake inhibitors: keep axon from engaging in reuptake as fast so serotonin can transmit message for longer
- Neurotransmitters an be deactivated before contact with post synaptic neurons
27
serotonin
o Many derivations in axon and diff receptors
o Inluences lots of overall behavior (mood, coordinates balance with other nts, though processes)
o Less inhibition, aggression, instability, unable to control emotion
28
dopamine
o Most linked to pleasure pathways but also reward, interacts with other nts
o Involved in voluntary behavior → helps orient towards rewarding behavior
o Most psychoactive drugs, exciting ativities
o Implicated in schiz
29
norepinephrine
o Endocrine system, energizing and arousing qualities
o Panic system (fight or flight)
o Respiration reactions to stress
30
glutamate
o Excitatory → brains major excitatory nt
o Helps amplify neural signals
o Prenatal development: important → causes things to happen
o Learning, memory
31
gaba
o Major inhibitory nt
o Slows NT activity
o Regulates nts
32
nt alteration
- Agonists:
o Increase activity on nt
o Increase produciotn, release, time in synapse/reuptake inhibition
o Anything that increases nt
- Antagonist:
o Inhibits or blocks
o Decrease in production, decreased release, decreased time in synapse, degredation
- Inverse agonists:
o Effect opposite to target nt
o Ex. want to regulate glutamate: ia would be substance that would reduce inhibitory effect, cancels out what glutamate would do
33
- Conditioning and cognitive processes
o Antisocial parent → genetics + learn from parent to be antisocial
o Classical and operant conditioning
o If you pair or associate neutral stimulus with unconditioned natural stimulus it can begin to illicit the same response as natural (classical)
o Don’t grow up with phobias unless there is a conditioning of some type
34
learned helplessness
o Rat in cage with electrical grid so it would be shocked if it moved so it just stood still → like depression
-
35
emotion
- Emotion
o Subjective temporary state in response to external event
o Psychological and physical component
o How we process behavior all tied to feeling
o What we attribute in form by feeling
o Emotions impact relationships
o Overall experience of world shaped by emotion
o Coping abilty → good or bad
o Subjective about what is happening to you
- Importance of emotional reactivity sn dysregulation
- Intimately tied with several forms of psychopathy
36
culture factors
- Culture:
o Influence definition, form, experience of and expression of behavior and disorders
o Cultural bound syndromes
37
gender effects and roles
```
o Influence several dimensions
• Self definition
• Behaviors
• Coping strategies
o Gender discrepencies among psychological disorders
```
38
social relationships
o Frequency and quality related to psychopathology, disease and mortality
39
- Impact of developmental stage
o Biological maturation
o Psychological development
o Changing roles, demands and abilities as one transforms from one stage to next
• Developmental stage may influence coping ability how disorders are expressed or change and response to treatments
40
- Equifinality
o Different paths may lead to same or similar outomes
| o Paths often vary y developmental stage
41
purpose of Assessing psychological disorders
o Develop an understanding of the person
o Current distress/symptoms/impairment
o Current functioning
o Past history
o Want to make sure that what people say is happening is happening and why
o Ask lots of questions → has there been a crisis? Have they been dealing with it for a longtime? How does it play in diff seeings? How are social relationships?
o Usually need to see person a couple times before they open up
o Then determine a diagnosis
o Then inform of treatment → what can a patient expect over the course of treatment
42
- Reliability
o Consistency of the measurement (psychological testing) or procedures (clinical interview)
o Need to be able to have a way of assessing that will come out with the same answers each time
o Ask wrong questions and you may be assessing something else
o Types: test-retest, inter-rater
43
- Validity
o Degree to which a technique or test measures what it is designed to measure
o Content, predictive/criteria → kid of test to say how well youll do in a future activity, concurrent → results when compared with another measure gets the same results
44
- Standardization
o Procedures established to ensure consistency
• Used in a standard way
o Interview the same way every time? Interpret the same way?
45
- Structured interviews
o Form → only allowed to ask questions on form
o Skid → answer a question one way then you ask a set of questions and if you answer a different way you ask a different set of questions
46
- Semistructured
o A set of questions that must be used but you can add things into it
o Most frequently used bc it is standard but you can also talk about what the patient wants
47
- Unstructured
o Talks about whatever the client wants to talk about
o Asks questions about what is said
o Can be invalid at times because it is up to the clinitian
o Not suggested
48
- Multiple domains assessed:
o Presenting problems → what made them get help? Why now? → usually a cause
o Current behavior
o Attitudes
o Emotions
o Detailed history → psychological, issues in life
o Coping methods, strengths
o Individual, family, social and occupational/school functioning
o Level of impairment and severity of symptoms
49
- Areas to assess
o Current/recent stresses
o Anxiety
o Current/recent losses or trauma
o Depressive symptoms
o Suicidal/past attempts → overall risks
o Functional impairment
o Physical health → some health problems may have psychological issues tied to it or symptoms that look like mental health issues (anxiety, depression, etc), meds
o Social, emotional, relationship problems
o Substance use or abuse
o Family violence
50
Mental status exam
- Provides clinical information about a clients emotional and cognitive functioning by
o Assessing functioning in several domains related to overall psychological functioning
o Interviewing questions and obtaining a specific set of observations
o Communication style that all goes into painting a picture
51
mse: appearance and behavior
o Hot and long sleeves → maybe anorexia or are shooting up and wear sleeves to hide
o Moving in sluggish or fast way
o How spontaneous is speech (fast or slow)
o Pressured speech or poverty (lack of speech)
52
thought process
o Language or speech
o Word salad, circumstantiality, takes a long time to get to point
o Disturbance in associations, jump from topic to topic
o Loose associations → association there but its hard for the observer to tell
o Perceptual disturbances (delusions, hallucinations)
o What do they think the stress is about
53
mse: intellectual functioning
o How intelligent they are
o Ask questions from cognitive measures
o Memory → questions to remember something and ask about later
54
mse: sensorium
o Orientation
o Awareness of situation
o Consciousness, are they aware of what is going on
55
Behavioral Assessment and Observation
- Identification and observation of target (problematic behaviors)
- Focuses on interactions between events
- Thought diary → cog behave treatment → keeps track of automatic thoughts
o Something happens and you tell yourself something positive or negative
- Classroom observation with kids, they cant always tell you what’s wrong so must observe
o Can be a problem when if a strange adult is in room kid acts better than they normally would
o Also used in adults, ex. couples therapy
- ABCs
o Antecedents
o Behavior
o Consequences
56
Psychological testing
- Trying to answer a particular question → ex does this kid have a learning disability
- To give more info on areas of functioning and impairment
- Helps us ask more questions
- Specific tools for assessing
o Cognition and emotional functioning
o Personality traits and behavior
o Neuropsychological function
- Objective tests
o Standardized, empirically based
o Self report measures
• Depression inventory → cant say out loud but can write it down or may not think to tell something
• Scales for depression, anxiety, panic, behavioral, personality disorders
- Projective tests
o Provides an unstructured, ambiguous stimulus, task or situation to which the person responds
o Herman wershok → ability to pull from unconscious thoughts
o Harvey → could show people pictures from ambiguous events and people could read lots of different meanings
• Not commonly used anymore, wershok now looked at as a perceptual cognitive class
57
Cognitive (intelligence) testing
- To determine intellectual ability and cog functioning including strengths and limitations
- What are strengths? How could you better prepare for life?
- For neuropsychology assessment
o Determine cognitive functioning and potential deficits (memory impairment, cognitive impairment)
- Ex. WISC-IV for kids: non verbal cognitive processing
58
MMPI
- Frequently used
- Highly valid and reliable
- Doesn’t measure psychology so much as psychopatholgy
- 30-70 is normal, no disorder
- Disorders on bottom, numbers on the side
- PD = psychopathic deviance
- How traditional/nontraditional they are in terms of gender
- PA = paranoia
- PT = psychasthemia
- SC = schizophrenia
- M = mania
- SI = social introversion
59
Clinical Scales
- Whether or not a person was truthful or not
- Can be too uncomfortable to say something, may try to look sicker
- Scales pick it up (mmpi)
- Someone trying to sound better than they are
o Questions no one says they do ex. Lying but people say they never lie
- Not a lot of life experience → say things based on how they think they should answer
- Fscale → frequency or infrequency
o Infrequent pattern of responging, where you would pick up exaggeration and high levels of distress
- K = suppressor scale
o Suppress and lessen exaggerations of a person
o Defensive responding style
60
- Psyochophysiologial assessment
o Used for ptsd, sexual attraction with pedophiles and rapists, sleep disorders, sexual dysfunction
o Used to assess activity of nervous system and other bodily systems
o EEG EKG EMG
o What are the physiological responses and bodily functions
o Sleep disorders → brain waves
o Sex dysfunction → can a man physically have an erection? Paraphylic, does a person get an erection by looking at certain images
61
- Different types of neuroimaging
o Brain structure → used to examine structure and assess damage
• CAT, CT, MRI
o Brain function → used to assess functioning of various brains structures, identify functional impairment of various disorders
• PET SPECT fMRI
• fMRI used often in research, easy to use but expensive, able to give a person a task
62
- Classical categorical approach
o Assumes each disorder us unique with its own set of symptoms and causes
o Used for a long time
o Categories for each disorder with separate categories of symptoms
o Not a lot of crossover of symptoms
o Need to fit all or most symptoms → if have 4 out of 5 may not get help
o Each disorder is unique (not the case, they do overlap)
63
- Dimensional
o Places disorders/symptoms on a continuum from non existent to severe based on empirical data
o More inclusive
o Some people may be diagnosed that shouldn’t be
64
- Prototypical
o Attempts to combine both
o Allows for diff presentations of disorders
o All disorders includes features and symptoms but there is variability
65
- Widely used classification systems
o DSM-IV
| o International classification of diseases and health related problems (ICD-11)
66
Diagnostic and statistical manual (DSM)
- Provides a standardized system anc criteria for diagnosis, aids in evaluating prognosis and treatment planning
- Aid diagnostic reliability by describing each disorder with regard to symptoms, severity, duration, onset
- DSM-I published in 1952
o First had poor reliability, based on unproven theories
- 7 revisions, latest in 2013
o Revision utilize experts in clinical psychology/psychiatry to evaluate current criteria, determine need for update
o Each version includes potential new diagnoses needing further study
o At first 106 disorders
o Now has 297
o Now disorders put in but excludes some old also
o Now based on research
o Now clear inclusion and exclusion criteria
o Provides a fuller clinical description
o Takes into account culture, genetics, family impact
o Assessments that help to look at severity
67
Basic characteristics of DSM
- Included considerable reorganization and attempted to align with ICD system
- Continues to use a prototypical approach but places greater emphasis on a dimensional approach
o Consideration given to neural underpinnings, family variables and genetic factors shared among a number of disorders
o Disorders are clustered across a general internalizing and externalizing spectrum
- Greater emphasis on
o Current research and practice
o Developmental considerations
68
Are there epi gen changes that might happen bc early parenting?
Rat licks rat pup → effects pup to be able to cope
o Increase in stress receptors and were calmer when licked
- Shy kids are more likely to suffer from stress when they have anxious moms
- Mcgowan: people who had attempted suicide, some sex abused as kid and some not → w/ abuse had fewer stress terminator receptors
Abnormal Behavior
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