Psychopathology Exam 1

Hippocrates

Greek physician refered to as the father of modern medicine

Hippocrates Beliefs

• Denied that gods and demons were the cause of illness

• Believed dreams were important in understanding a patient’s personality (later a basic concept of modern psychodynamic psychotherapy)

• Emphasized natural causes of diseases and brain pathology

China in Abnormal Behavior

Earliest developed civilization where medicine and attention to mental disorder were given

Chung Ching beliefs

• Hippocrates of China

• Had similar views on mental illness and believed harsh environments worsened the condition

Middle Ages study of abnormal behavior

Supernatural explanations were the cause and with treatments basically rituals and superstitions

Humanism

During the later Middle Ages scientific questioning reemerged, emphasizing the importance of human interests and concern

Asylums

Sanctuaries or places of refuge meant solely for the care of the mentally ill

1st Asylum

Spain

Montastery of St. Mary of Bethlem

London 1547: an asylum by King Henry VII. Came to be called bedlam for it’s deplorable conditions and practices

Lunatic’s Tower

Vienna 1784. Was the showplace in Vienna with ornate decorations and a completely circular building

Early US asylums

Beleived patients neede to choose rationality over insanity

Philippe Pinel (1745-1826)

In charge of “La Bicêtre,” an asylum in Paris. Replaced the harsh treatment and living conditions to humane ones and the result was dramatic improvement

William Tuke (1732-1822)

English Quakers established the York Retreat. Known for its peaceful environment. Pinel’s work reached England, and the Quakers gained the support of Pinel and helped educate English medical practitioners.

Pinel and Tuke’s contribution

Their humanitarian treatment revolutionized the treatment of mental patients throughout the Western world

1842, Lunacy Inquiry Act

requirements regarding effective inspections of asylums and houses, which were to take place every 4 months

1845, the Country Asylums Act

required every country to provide asylum to “paupers and lunatics”

Benjamin Rush (1745 - 1813)

• Founder of American Psychiatry and a signer of the Declaration of Independence

• Considered a transitional figure between old and new eras

• Promoted a scientific study of psychological disorders onece develope by Hippocrates

Moral Management

method of treatment that focused on the patient’s social, individual, and occupational needs

Why was moral management abandoned in 19th century?

• prejudice against the rising immigrant population

• poor training

• larger hospitals

• less good care

• rise of the Mental Hygiene Movement

• advances in biomedical science

Mental Hygiene Movement

treatment method that focused on the physical comfort of the patient with no help for their mental problems, so condemned individuals to helplessness and dependency

Biomedical Science

Mental disorders eventually yield to biological explanations and biologically based treatments. Psychological and social environments were believed to be irrelevant. Only focused on comfort until cures were discovered

20th century Mental institutions

long hospital stays, still inhumane conditions

1946, Mary Jane Ward’s Book

The Snake Pit: called attention to the plight of mental patients and created convern for the need to improve conditions

What occured and the end of the 20th century

Deinstitutionalization: efforts made to close psychiatric hospitals and return patients to the community

• Believed new meds and outpatient treatment were enough, but many were abandoned

Abnormal

away from normal

Components of mental disorders: Suffering

experience psychological pain such as depression or anxiety

Components of mental disorders: Maladaptiveness

unhealthy behaviors

Components of mental disorders: Statistical Deviancy

behavior that is statistically rare

Components of mental disorders: Violation of the Standards of Society

violates standards of norms and morals and is statistically deviant

Components of mental disorders: Social Discomfort

when social rules are violated, cause discomfort to those around you

Components of mental disorders: Irrationality and Unpredictability

behavior that doesn’t make any sense

Components of mental disorders: Dangerousness

a danger to themselves or others

Historical Explanations: Spiritual

The earliest approach, behavior disturbance is the result of possession by evil spirits

Trephing

effort to release the evil spirits from the person’s head by cutting holes in the skull

Exorcism

considered physical and mental practice of torture

Historical Explanations

• Spiritual

• Humanitarian

• Scientific

• The Biophysical Perspective

Causes of Abnormal Behavior: Biological Causes

Genetic and environmental influences on physical functioning

• inherited factors

• exposure to harmful environmental stimuli

• brain damage from head trauma

• toxic substances or allergens in the environment

Causes of Abnormal Behavior: Psychological Causes

disturbance in thoughts and feelings

• past learning experiences

• maladaptive thought patterns

• difficulty coping with stress

Causes of Abnormal Behavior: Sociocultural Causes

circles of influence from family or close friends, institutions, and policies of a country or the world

• discrimiation

• abuse

• poverty

Causes of Abnormal Behavior: The Biopsychological Perspective

• The interaction in which biological, psychological, and sociocultural factors play a role in the development of an individual’s viewpoint

• Biopsychological factors interact to alter behavior patterns over time, so individuals change over time

• As a result, we know it is vital to examine early risk factors that make an individual vunerable to develop a disorder

Mental Disorder

Behavioral or psychological syndrome that is presented in an individual and that reflects some kind of underlying psychobiological dysfunction and results in clinically significant distress, disability, or impairment in key areas of functioning

DSM-5 tr

Newest version of the Diagnostic and Statistical Manual of Mental Disorders. Published by the American Psychiatric Association, it contains standard terms and definitions of psychological disorders

Downside of a classification

• Stigma

• Stereotyping

• Labeling

Epidemiology

The study of the distribution of diseases, disorders, or health-related behaviors in a specific population

Prevalence

refer to the number of active cases in a population during any given period of time (point, 1-year, and lifetime prevalence)

Incidence

refers to the number of new cases that occur over a given period of time (typically 1 year)

Mental Health Professions

Psychiatrist

Psychologist

Licensed Clinical Social Worker

Lisensed Professional Counselor

Psychiatric Nurses

Occupational Therapists

Mental Health Workers

Drug and Alchol Counselots

School Psychologists and Counselors

The person providing treatment

clinician

Those using the service

client or patient

What did we learn through research?

• symptoms of a disorder

• prevalence

• whether it’s acute or chronic

• etiology (causes)

• all problems (symptoms, characteristics, etc.) associated

• the best care (treatment)

The key to diagnosis

gaining an accurate description of symptoms (both from what is reported and what is observed)

Priniciple diagnosis

the disorder that is considered the primary reason the individual seeks professional help

Comorbid

individual has two or more simultaneous disorders

Differential Diagnosis

the ruling out of alternative diagnosis

Treatment

Involves a modality or form of therapeutic process, a crucial component of the treatment plan.

Types of treatment

• individual with various forms of psychotherapy

• family

• group

• inpatient and outpatient treatment programs

Many with mental health disorders will never seek treatment because

• In denial/minimize suffering

• Try to cope or deal on their own

• Dont want medication

• Limitations with insurance

• Stigma

Psychological Assesment

refers to a procedure by which clinicians provide a formal evaluation using psychological tests, observation, and interviews, which provide scorable information of the client’s psychological functioning

Clinical diagnosis

a general “summary classification of the patient’s symptoms following a clearly defined system, such as the DSM V

Note

Assessment is an ongoing process and may be important at various points during treatment, not just in the beginning

Clinical Interview

a series of questions that clinicians administer in face-to-face interaction with the client

Unstructured interview

a series of open-ended questions aimed at determining the client’s reason for being in treatment, symptoms, healtth status, family background, and life history

Areas covered in a clinical interview

• age and sex

• reason for referral

• education and work history

• current social situation

• physical and mental health history

• drug/alcohol use and current medications

• family history

• behavioral observations

structured interview

standardized series of assessment questions with a predetermined wording order

Most widely used clinical interview

The structured Clinical Interview for DSM-V (SCID-50RV and SCID-5-CV)

SCID-1 Axis 1 diagnosis

SCID-2 Axis 2 diagnosis

reliability

the degree to which an assesment measure produces the same result each time it’s used to measure the same thing

Validity

the degree to which the instument actually measures what it is supposed to measure

Standardization

the process by which an instrument is administered, scored, and interpreted is consistent and clearly specifies a test’s instructions and scoring methods

• insrument must be appliciable to all backgrounds and diversity

• must have trust and rapport between client and clinician

• must only disclose info for the purpose of assesment otherwise kept confidential

General Physical Examination

general check up and medical history

Mental Status Examination

assess current state of mind

Neurological Examination

The process of gatherinng information about a client’s brain functioning on the basis of personality tests and other methods

Types of Neuropsychologicaal assesment

• EEG: brain waves

• CAT (limited): diseased part of the brain

• MRI: sharp, clear images

• PET: glucose movement

• fMRI: changes in blood flow

Commonly used standard set of tests used when looking for psychological competencies

Halstead-Reitan battery

Halstead Category

test measures ability to learn and remember

Tactual Preformance test

measures motor speed, ability to learn and use cues, response to the unfamiliar

Rhythm test

measures attention and sustained concentration

Speech sounds Perception test

determines if individual can identify spoken words, concentration, attention and comprehension

Finger Oscillation test

measures the speed at which an individual can depress a lever with the index finger

Psychological Tests

scientifically developed standardized set of procedures or tasks for obtaining samples of behavior

categories of psychological tests

Intelligence tests and Personality tests

Intelliegence tests

tests for measuring the intellectual abilites for children and adults

Stanford-Binet Intelligence test

recieve a deviation intelligence (IQ) score in relation to others of simialr age and gener

• WISC-IV: The Wechsler Intelligence scale for Children-Revised

Personality Tests

included projective and self report (objective)

Projective Personality tests

unstructured and rely on various ambiguous stimuli such as inkblots or vague pictures rather than verbal questions

• Rorschach and TAT

Rorschach Inkblot Test

use of inkblots developed by Hermann Rorschach to uncover motivations

Thematic Apperception Test

series of simple ambiguous pictures some highly representational and other abstract of which the subject is instructed to make up stories

Self-Reports (Objective Personality Tests)

structured, typically questionnaires, self-report inventories, or rating scales in which questions or items are carefully phrased and alternative responses are specified as choices

• MMPI

MMPI Minnesota Multiphase Personality Inventory

a self-report questionnaire consisting of 550 items covering topics ranging from physical condition and psychological states to moral and social attitudes

Behavioral Assessment

record actions rather than responses to rating scales or questions

Target behavior

what client and clinician wish to change

in Vivo observation

method of recording behavior in it’s natural context (home, classroom)

analog observations

method of recording behavior in a clinician’s office or lab designed for observing the target behavior

self-monitoring

self-reported technique, client keeps records of the frequency of behavior

behavioral interviewing

Assessment involving asking questions about frequency, antecedents, and consequences of behavior

Multicultural Assesment

The assessment process takes into account the person’s cultural, ethnic, and racial background

Theoretical perspective

an orientation to understanding the causes of human behavior and the treatment of abnormality

• biological

• psychological: psychodynamic, behavioral, cognitive, humanistic

• sociocultural

biological perspective

belief that abnormalities in the body’s functioning are responsible for symptoms of psychological disorders (disturbances in emotions, behavior, and cognitive processes)

biological perspective: Neurotransmitter and hormonal abnormalities

main part of viewpoint, norepinephrine, dopamine, serotonin, glutamate and gamma-aminobutyric acid

biological perspective: genetic vulnerabilities

uses family history, twin method, adoption

behavior genetics

the field that focuses on studying the heritability of mental disorders