psych topic 1 - clinical psychology

mental health

state of wellbeing that enables people to cope with stresses of life

mental disorder

syndrome characterised by clinically significant disturbance in cognition - defined by dysfunction…

• failure of internal mental mechanisms to perform natural function

and harm…

• dysfunction results in harm

approaches to classical models of mental disorder

categorical (divided into categories based on defining features), dimensional (exists on continuums), alternative (do not focus on mental health & illness concept)

benefits of categorial approach

better clinical/administrative utility, easier communication

benefits of dimensional approach

greater capacity to detect change, treatments target symptoms

diagnosis of disorder

1. use clinical interviews, diagnostic criteria, text descriptions

2. currently presenting symptoms

3. rule out disorder due to general medical condition

4. rule out disorder due to substance

factors impacting mental health

predisposing factor - occur over lifetime, may contribute to presenting problem

precipitating factor - triggers that initiate presenting problem

perpetuating factor - maintain presenting problem

protective factor - resources available to help

cultcultural syndromes

symptoms that commonly occur together in a particular culture, e.g longing for country

stigma

negative social attitude attached to trait, leading to unfair judgement, descrimination, exclusion

types of stigma

public, structural, internalised, association, intersectional

public stigma

links beliefs, emotions, and behaviour to a certain disorder, negative sterotype —> predudicial emotion —> discriminatory behaviour

structural stigma

built into societies rules (laws, policies, practises)

internalised stigma

individual awareness of stigma and applying it to oneself

stigma by association

experienced by people close to people with mental illness, discrimination is transferred to supporters

intersectional stigma

compounds with other forms of marginilisation, e.g someone experiences stigma and racism

mood

pervasive/sustained background emotional state experienced by individual

affect

observable expression of emotion, assessed by clinician during interaction

criteria for diagnosing depression

1. must have > 5 symptoms for > 2 weeks…

• depressed mood

• anhedonia

• decrease/increase in appetite or significant weight loss/gain

• persistent increased/decreased sleep

• decreased concentration or indecisiveness

• recurrent thoughts of death, suicide, or worthlessness

2. then classify the episode

• melancholic features (extreme forms of depression)

• postpardom onset

• catatonic features

• anxious distress (on edge as well)

• psychotic features (mood congruent)

• seasonal pattern (winter depression)

criteria for diagnosing anxiety

1. reccurent unexpected panic attacks, in which > 4 symptoms occur

• sweating & shaking

• pounding heart

• chills/heat sensatios

2. at least one of the attacks has been followed by at least a month of either…

• persistent concern of additional panic attacks

• significant maladaptive change in behaviour related to attacks

3. disturbance is not because of other mental disorder, medical condition, or substance use

negative affect of depression

general distress, negative emotions (guilt, fear)

positive affect of depression

low positivity (lack of pleasure, anhedonia)

anxious arousal of depression

physical symptoms (sweating, tension, palpitations)

HPA axis

hypothalamus, pituitary gland, adrenal gland, regulates body’s response to stress, helps maintain homeostasis, controls inflam and circadian rhythm

• chronic stress can lead to prolonged activation of HPA axis raising cortisol levels

schizophrenia

disruptiotion in various aspects of perceiving reality, thinking, feeling, and behaviour

schizophrenia - positive symptoms

additive to normal experience, hearing voices, hallucinations, delusions

schizophrenia - negative symptoms

deficit in normal function, trouble understanding others and focus, avolition, alogii, catatonia

thought disorder

problems with how a person organizes, processes, & expresses their thoughts, tangentially (drifts off), and loose associations (jumping thoughts)

diagnosing schizophrenia

1. < 2 symptoms, each presented for a significant portion of time

• delusions, hallucinations

• disorganised speech and behaviour

2. level of functioning must be impaired (6 months)

3. mania & depressive disorders, other medical disorders, substance abuse must be ruled out

4. if history of autism, diagnosis of schizophrenia only made if theres prominaant delusions/hallucinations

brain abnormalities in schizo

reduced grey matter, reduced white matter (disrupted connectivity between brain regions, enlarged ventricles causig cognitive defects)

prefrontal cortex

decision making & cognitive control

temporal lobes

involved in auditory processing and memory

hippocampus

critical for memory formation and reality monitoring

amygdala

regulates emotion & threat perception

thalamus

sensory processing

treatments for schizophrenia

antipsychotic medications (only pos symptoms), psychosocial interventions (CBT), physical health care

how mental health issues and disorders and related to personality

vulnerability, personality disorders, personality relates disorders

factors increasing vulnerability to disorders

genes, environmental stress, personality, diathesis (underlying vulerability)

diathesis

a predisposition/vulnerability to a certain disease (higher diathesis results in less stress needed to trigger disease)

cluster A personality disorders

odd/eccentric, paranoid, schizophrenia

cluster B personality disorders

dramatic/emotional/erratic, narcissism, histrionic

cluster C personality disorder

anxious/fearful, avoidant, OCD

paranoid personality disorder

pervasive distrust/suspiciousness of others, must have > 4…

1. suspects (without reason) others are exploiting, harming, or deceiving them

2. preoccupied with unjustified doubts about the loyalty of friends

3. is reluctant to confide in others (fear info is used against them)

4. reads hidden demeaning or threatening messages into benign remarks or events

5. persistently bears grudges

6. perceives attacks on their character tat is not apparent to others

7. has recurrent suspicions regarding infidelity of spouse

narcissistic personality disorder

a pervasive pattern of inflated self importance, lack of empathy, must have > 5…

1. has a grandiose sense of self importance

2. preoccupied with fantasies of unlimited success

3. believes they are special and unique

4. requires excessive admiration

5. has a sense of entitlement

6. is interpersonally exploitative

7. lacks empathy

8. envious of others or believes others are envious of them

9. shows arrogant behaviours

avoidant personality disorder

pervasive pattern of social inhibition, feeling of inadequacy, must have > 4…

1. avoids occupational activities that involves interpersonal contact (fear of criticism, rejection)

2. unwilling to get involved with people unless certain of being liked

3. shows restraint within intimate relationsuips because of fear of being shamed or ridiculed

4. is preoccupied with being criticised of rejected in social situations

5. inhibited in new interpersonal sitatiions because of feeling of inadequancy

6. views self as socially inept, personally unappealing, or inferior to others

7. unusually reluctant to take risks or engage in any. new activities because of embarrassment

dissociative identity disorder (DID)

involves individual having > 2 personalities that switch, one host, multiple alters, recurrent gaps in recalling everyday events, disruption of identity

• amnesia (no idea how you got to a place)

• depersonalisation (seeing themselves, feeling like its another person)

• absorption (sit staring off into space)

models of DID

traumatic development theory, sociocognitive theory, role of suggestibility & hypnotisability

traumatic development theory

develops as an adaptatio to severe repeated childhood trauma

sociocognitive theory

shaped by social and cultural influences

role of suggestibility and hypnotisability

hypnotic suggestibility is elevated on average in dissociative disorder (pre existing or consequence???)

efficacy

how well a treatment works under idea, controlled conditions

effectiveness

how well a treatment works in the real world with everyday variables

cognitive behavioural therapy (CBT)

aims to identify and modify unhelpful pattern in thinking

unhelpful automatic thoughts

catastrophizing, mind reading, all or nothing thinking, selective attention, overgeneralising

principles of CBT

• active process, client must want to be part of it

• formulation of clients and their problems in cognitive terms

• empirical validation of treatment (measureing outcomes, agreeing on goals)

• relatively short term therapy thats active and collaborative, structured, time limited

• problem focused and goal oriented, treatment emphasizes the present

• therapist acts as a teacher to help with rearranging harmful thoughts

• create opportunities for learning in therapy (learning —> new skills —> change)

CBT for depression

1. concentration on psychoeducation, goals —> rationale —> self monitoring —> activity scheduing

2. cognitive techniques, problem solving, identify —> evaluate —> respond to automatic thoughts

3. generalisation & relapse prevention