Psych Exam 1
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\-symptoms can be in each of these categories (worry like anxiety, self-harm, obsessive thoughts)
Others - pedophilic disorder, narcissism
* Violation of social norms
Schizoid personality disorder - uninterested in social interactions and don’t really care to have them
\* Must impact one’s social, interpersonal, and/or occupational functioning \*
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For each diagnosis, the DSM includes:
\-statistical information based on previous cases determines these categories
\-DSM is written in narrative form
\-2 categories: clinical disorders vs personality disorders/ intellectual or cognitive disorders
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1. Course
2. onset
3. prognosis
* Simple definition of the diagnosis
* List of symptoms and say they must have been present for __ amount of time
* Doing this through a clinical interview
* Psychological tests
Suggestions on treatment
\*\*guidelines for differential diagnosis to distinguish very similar diagnoses
Co-morbidity statistics (what are coexisting diagnoses that we often see)
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* Religious/Mystical component
* (460-377 BC)
Believed we had different colored bile which dictates your emotional state
Did not get much correct (Hippocrates, Galen and Gray)
\-they are important because they were thinking about things the right way
\* Humoral theory
\* Outdated medical interventions
We have to understand the brain to know what is going on
Brain surgery, shock therapy, electroconvulsive therapy
American proponent of the biological/medical condition
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On the interpretation of dreams book- laid out his grand theory for the first time
Sigmund Frued was the first to say he understood human beings (healthy vs unhealthy) and where mental illness comes from
Mental illness = physical illness
We have access to only conscious and sometimes subconscious
There is so much we don’t know why we do
Goal of psychotherapy is to make the unconscious conscious
Ego (sense of self), superego, id (unconscious)
High ego= good degree of self awareness, you understand why you are doing things
Id = animalistic, selfish, thrill seeking (this is what I want and I don’t care what happens)
Insulin shock therapy
Brain surgery
ECT
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People returning with addictions, PTSD, depression
Women going to see doctors bc they were being treated poorly by husbands returning from war
Side effects of medications were a lot at that time
The first psychotropic medications
- Neuroleptic and tranquilizers
* Increased hospitalizations
* Improved Diagnoses (Kraeplin)
Treatment should follow diagnosis
First DSM in 1960s
Things did start to improve
More reliance in talk therapy
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Limit side effects (being able to only hit those receptors in the brain)
Throwing big dart on small board and hitting the wrong things
* Much greater understanding of the relationship between brain and behavior (Functional MRIs; Pet-scans etc.)
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* Major advances in understanding of genetic markers and heritability
Freud – 1901 – “On the Interpretation of Dreams”
Psychological symptoms arise from unresolved unconscious conflicts from childhood
Psychological symptoms are the result of learned behavior; refuted the notion of the unconscious mind and unconscious impulses.
Psychosexual stages of development (tasks trying to accomplish during different stages of our life)
Doing things properly means you are on the right track to becoming a healthy adult
Spend our toddler years with negative emotions; up to our parents to help us process them properly
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Id = devil
Ego has a job of fulfilling the id needs in a way that the superego can live with
When we are upset as an adult we employee defense mechanisms to make them go away to deny our true feelings
Defense mechanisms =
\-denial
\-projection (project onto other people)
\-regression (overwhelmed so we act immaturely) looking for something else to make us feel good like drugs or alcohol
\-Reaction formation : demonstrate opposite of what we feel internally (stressed so we make a joke) (gay people becoming homophobic, hyper masculinity)
\* The “Iceberg” Model
People who employee these too much may need therapy because it disconnects us
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Men returning with PTSD
Behaviorists tried to clear the slate
Study observable and testable things (where Freud was concept and immeasurable)
How do we learn
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* Ivan Pavlov - not a psychologist but stumbled upon classical conditioning
* B.F. Skinner - operant conditioning
Colors, phobias, attraction come from a pairing earlier in life
- Operant conditioning
Learn a way of being through rewards and punishment
If you are rewarded, strengthen that behavior
If you are punished, weakened behavior
Behavior acquired through classical conditioning and maintained through operant conditioning
* A more evidence-based, scientific approach than psychoanalysis
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We have an innate drive to be self actualized
Become the best version of ourselves
Key contributors:
* Abraham Maslow : theorist, Maslow hierarchy of needs up to self actualization
- Carl Rogers : brought into the therapy room
* Positive psychology – intrinsic goodness
* Striving for self actualization
* “blocked” growth – the importance of environment
Some of our environments allow for exploration, some dont
Actual vs perceived self ; when they are = you are congruent
If there is a discrepancy = incongruent and where mental illness comes from
Psychological symptoms are the result of “incongruence” between one’s actual self and the version of self they have been encouraged to display.
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multidimensional model
The biospychosocial model - if someone has a diagnosis, there are biological reasons, psychological reasons and social reasons to explain it
systemic (we are complicated)
How are genetics responsible for mental health symptoms?
-genetic underpinning for depression (seratonin transpose gene)
Nature of this gene impacts our ability to process seratonin
Inability to process seratonin = higher chance of depression
Schizophrenia = largely genetic
Phobias, PTSD are mostly result of environment
Psychological causes are what happens early childhood,
Adverse childhood experiences and how they correlate to mental illness
the biological approach
Genes
46 chromosome in 23 pairs
The role of DNA
Intelligence, vulnerability to addiction, aggression and shyness
Dominant vs. recessive genes
Single gene determinants
Black and white; if you have this gene you will get this condition
Huntington’s disease
the activation of genes and the environment
Learning impacts the genetic structure of cells
Learning can impact and change our genes
Eric Kandel
activation of dormant genes
May be present but not turned on until it is activated
CPTSD (complex)
Not in dsm5
Exposure to repeated trauma early in life
Notable changes to brain structure (cognitively and stress)
the diathesis stress model
Diathesis = biological pre disposition for vulnerability
Stress = life events that tap into the vulnerability
Genes shape how we create our environments
genes/environment
~50% of variance in personality or cognitive characteristics
Intelligence is 50% inheritable
Genes:
Behavior, Cognition, Emotions
“Bounds” of environmental impact
Environment:
Genetic structure and activation
may override genetic diathesis
brain structure and brain chemistry
The CNS
Central nervous system - brain and the spinal cord
Take something in from senses, process it, send to PNS
The PNS
Peripheral nervous system - everything beyond that
PNS reacts and then it gets back to CNS
Motor neurons for movement
amygdala
Key to processing emotion
Activating when we are frightened to protect us
Damage to this causes inability to properly process
hippocampus
Process memory!
Build of plaque around the hippocampus the inhibits neural communication and memory loss
Relation to depression and regulation of serotonin
hypothalamus
Promoting motivation of basic needs
Hunger, thirst, body temp, sex drive
See activity here for more complex things like gym, school, sports
frontal lobe
newest part of our brain (develops last prenatally) most different from monkeys, uniquely human
temporal
Auditory information, memory, language development and speech
parietal
All 5 senses : process sensory information
Label what we are seeing and hearing
occipital
helps w/ sight
the neurochemistry of mental illness
The basic building blocks of neuro-communication:
Soma
Dendrites
Axon - primary pathway from one neuron to the next
Synaptic cleft (Synapse) - space where neurotransmitters travel; if successful it will flow to the next neuron
Each neurotransmitter has a specific receptor
glutamate
Helps process memory, general cognitive processing, problem solving, thinking, formulating ideas, to some degree - mood regulation
GABA
Controlling stress, fear, and anxiety
Referred to as the meta neurotransmitter b/c helps w/ overall neurotransmitter communication
Acute control - ex: xanax
serotonin
Sleep, appetite, sex drive, mood
Referred to as happiness neurotransmitter
Ppl w/ depression experience symptoms of depression that relate to these
norepinephrine
arousal /attention
Control stress
Pain management
If have increased levels of this may be more prone to addiction
dopamine
acute/short term pleasure or sensations
Too much in frontal lobe = cause of schizophrenia
Low levels = adhd
uptake and reuptake
Uptake: the taking of action; when the brain produces a neurotransmitter or makes one available
Reuptake: the absorption of a neurotransmitter once it has been reduced
SSRI’s - selective serotonin reuptake inhibitor (mental symptoms)
SNRI’s - serotonin norepinephrine reuptake inhibitors (physical symptoms)
^^ both antidepressants that try to prevent reuptake of these
Depression - serotonin and norepinephrine main neurotransmitters affected; have physical symptoms such as headache and GI issues
Anxiety - serotonin and GABA
*lots of overlap
In ppl who hav depression - there can be a clef or a gap in the synapse
More likely to have larger gaps if hav history of depression
Genetic
Therefore serotonin is not successfully gathered in my the neighboring neuron
Hav a leakage - so serotonin goes places in brain where it shouldntd
the interaction between neurotransmitters and environment
Stress and early development
Environment/Nutrition
If good = stronger neuropathways and better neurocommunication
Opposite if bad
If weakened immune system = more likely to get sick
Children w/ failure to thrive (malnutrition) = more likely to experience stress, depression at an older age, in ability to cope w/ emotions
Bc nutrients are used to help develop the brain
Psychotherapy
Ex of something environmental in nature
Has the potential to rewire neuropathways (redirect neurotransmitters)
Emotional states and “fight or flight” responses
Short lived, temporary states
example: trauma and PTSD (can change the structure of our brain)
trauma/PTSD
Always in fear
Brain cannot tell that it is temporary
Keep producing cortisol (stress hormones) this inhibits the production of other hormones
learned helplessness
When an animal/person begins to fail to make an effort after they have experienced repeated stress, defeat, or trauma
When exposed to constant negativity, people learn to be helpless
Try try try → slow down
Negative environmental influences
Biologically vulnerable
social learning
Social learning (Bandura) - now called social cognitive theory
Much of who we become as adults is the result of learning from and imitating others
Modeling and mirror neurons
In frontal lobe
They are activated the most at age 3-7
Activate when watching someone act a certain way and then we copy it
the role of gender and culture
??????
clinical assessment (aka psychodiagnostics)
More likely to treat a pt properly if hav the correct diagnosis
* Systematic Evaluation:
· Psychological
· Social
· Biological
Diagnosis: The degree of fit between symptoms and diagnostic criteria.
The goodness of fit
purpose
Understanding the individual
Help to understand the person
Predicting behavior
Here's what we can expect to see over the next few weeks
Treatment planning
The roadmap to treatment: the best path to treating the client
Evaluating outcomes
Have a baseline to measure their progress
the funnel method
* Broad multi-dimensional start; Narrowing down to a specific problem
Ask general questions and then ask more specific questions
mental status exam
Try to get a snap shot of that persons functioning in a moment
Alert and oriented x 4
Person, place, time, and event
primary goal
Appearance and behavior
Acting erratically, dangerously, are they disheveled, hygiene
Thought processes (memory)
Ask them to repeat 3 words and hav them repeat them a few min later
Mood and affect
Sensorium
The 5 senses
Mental status exams - EX: A & O x4
clinical interview
Gather info by asking questions; sit across from a person and ask a series of questions; done at the beginning of a psychotherapy treatment; an intake assessment
semi-structured interview
A prescripted set of questions that you want the answer to
But don't stick to it strictly; flexible
Ability to go in a different direction, or ask followup questions
assesses multiple domains
Learn as much as u can through a detailed history
Detailed history:
Apprehension from client
Good psychologists have good people skills
Family dynamic - parents & siblings (relationships w/ them)
Idea of early childhood trauma (abuse)
A + and - memory
Physical health history
Educational history
Alcohol history: how often
Spirituality ?
Tell me what brought you to therapy today
how history may be influencing
Presenting problem/symptoms (dsm related)
Trying to conceptualize ur client; how do the things in their history relate to their present symptoms
behavioral assessment
Watch how they respond to things: body language, eye contact, how open when you ask questions, agreeable/disagreeable, confrontational
How they are presently acting in front of you
leads to direct, in-session observations
“here and now focus”
countertransference
how do you feel when you sit across from someone; gut feeling
physical evaluation
Medical rule-out
Do this before psychological exam
Rule out of physical condition before analyzing a mental health condition
EX: panic attack - heart races, sweating, heavy breathing - physical symptoms but really have anxiety disorder
Anxiety but stomach hurts; could be an ulcer
CAT scan or PET scan to rule out head injury
· Diagnostic possibilities
- Medication side effects
- Metabolic conditions
- Illnesses with psychological symptoms
neuroimaging
principles of psychological testing
Help verify what you were pretty confident is the case; how severe symptoms are;
Psychometrics - a branch of psychology that uses mathematics to determine the accuracy of psychological tests
Good tests are both ____ and _____
validity
How well a test measures what it claims to measure
EX: if assessing depression, is the test actually measuring depression
reliability
consistency in the results
standardization
must be done before they are given to people to take; the piloting stage
types of psychological tests
self report measures
personality tests
projective tests
intelligence tests
self report measures
The client reports the answers;
- Construct based: anything that your doing
EX: happiness, alcoholism
- Forced response
Yes/no or true/false or scale questions
Intentionally not given options
- Standardized (computer scoring)
Compare you to others that took the test
- Face Validity
personality tests
· Scales –
· Profiles -
Purposes:
Example: MMPI
Over 500 questions and gives good idea of who a person is
projective tests
Worshock blot test EX: a novel and ambiguous (diff ppl will see it in different ways) this is a projective test
Projective test: schizophrenia can show up, and personality types can show up
- Novel, ambiguous stimuli
- Projection of the personality
- Psychoanalytic foundation
- Modern Use
Example: Rorschach Inkblot Test
Strengths and weaknesses:
Hard to score; not great reliability or validity
Strength - can reveal things that other psych tests cant (but not as accurate)
intelligence tests
D. Intelligence Tests
- Domains
- IQ (intelligence quotient)
Measures someone's potential for problem solving/intellect
Good tests use tasks that aren't related to formal education
Compares to other ppl that are ur age
- Mental vs. chronological age (diff way IQ is measured; dont worry about)
- Deviation IQ (diff way IQ is measured; dont worry about)
Diagnostic purposes:
Tell us about our strengths and weaknesses (what good at/what struggle w/)
Diagnose intellectual disabilities, dementia, diagnose learning disabilities (a specific type of learning are very challenging for them but often have avg or above avg IQs)
Example: WAIS
overview of anxiety disorders
· Among the most common group of disorders (in the DSM)
· High co-morbidity within the anxiety group
When 2 diagnosis exist @ the same time
· High co-morbidity with other disorders:
- Major Depressive Disorder (one comes first then the other follows; anxiety/depression)
- Eating disorders
- Somatoform disorders
Hypochondriacs
Pain related mental health head tension headaches/ neck pain
Gastric pain
Ppl w/ anxiety also may have ^^^ (highly likely)
· Commonly linked with physical symptoms
· Shared features:
- Worry
- Over-analytic thinking style
- Behaving to avoid unpleasant situations
- Dissociation
EX: ppl w/ social anxiety avoid social situations
Becomes severe when you start changing your life; EX skipping class b/c hav to do a presentation
psychoanalytic theory
Argues that anxiety is the result of unprocessed or repressed fear or stress from childhood
When anxious you are constantly being reminded of being helpless as a child
behavioral theory
Anxiety is a learning reaction
As a child, reinforced to be anxious
Having negative childhood experience, led to more anxious
Worry leads to production → procrastination
worry/anxious behavior → it turns out okay
diathesis-stress model
Genetically vulnerable / predisposed
EX: low serotonin levels
Biological predisposition
Stress = trigger
integrated model
a combination of behavioral and psychoanalytic
generalized anxiety disorder (GAD)
Description
1. The “worry” disorder
2. Worry about multiple, relatively minor concerns
3. Incapable of not worrying (“unable to shut off brain”)
4. Insomnia (worry often worse at night)
5. Frequent complaints about stress
6. Possible somatic symptoms
Lots of different environments and many different reasons
Worry
Negative thinking/ expect the worst
“Unable to shut off brain”
GAD additional info
1. Less symptoms required for child diagnosis
Less of a requirement (less symptoms) compared to an adult
2. More common among women than men (60-70%)
3. High co-morbidity with depression
4. Severity varies/Generally excellent prognosis
GAD treatments
1. As-needed medication (i.e. benzodiazepines)
2. SSRI Anti depressants – more effective long term
Take 4-5 weeks to start working
Numb anxiety but also everything else; feels nothing
3. Cognitive-Behavioral Therapy (CBT)
- Identifying and modifying irrational anxious thoughts
- Learning coping mechanisms
- most widely used form of therapy currently
- works well for anxiety
- train yourself on how to deal w/ ur anxiety
4. Physical/Psychoeducational techniques
- Meditations
- Deep breathing exercises
- Progressive muscle relaxations
- Yoga
- managing anxiety has a lot of things that work
Panic Disorder and Agoraphobia
Description
2 types
Panic disorder w/ agoraphobia
Panic disorder w/ out agoraphobia
1. Frequent, unexpected panic attacks (core symptom)
- Abrupt experience of intense fear
Usually come on seemingly spontaneously
An explosion out of nowhere
Intense
- Symptoms:
Increased HR, sweat, hyperventilation, sensory disorientation (ie. blurred vision/ hearing noises)
May have the sensation of needing to go to the bathroom
General fear that you are dying/having a heart attack
Differentiates mild from severe
After they objectify it and question why they thought that
2. Anxiety, worry fear of additional attacks
Fear of fear
3. Fear persists for at least one month
4. Significant avoidance of anxiety provoking situations
5. Agoraphobia
the fear of public spaces/leaving ones house
Does not exist in DSM b/c ppl are afraid of having panic attacks
Panic Disorder and Agoraphobia additional info
1. 3% Incidence rate and a 5 % Prevalence rate
Incidence rate - when researchers ask, “right now do you have this in your life”
Prevalence rate - over the course of your lifetime “have you ever been diagnosed w/ panic disorder?”
2. 2:1 Ratio – More common among women
3. Age of onset: 20-24 (Pre-morbid anxiety is common)
Would describe themselves as generally anxious people
May hav had GAD
4. 60% of cases involve nocturnal panic attacks
Woken up in the middle of the night
5. High Co-morbiditity with sleep terrors and sleep paralysis
Both of these are sleep disorders in the DSM
6. Good prognosis
Coping strategies - ex: wont leave house w/out partner, wont leave house w/out benzodiazepines
Panic Disorder and Agoraphobia treatments
1. Benzodiazopines (risk of dependency)
Help ppl recognize the onset so then take meds
2. CBT/Psychoeducational treatment (like other anxiety disorders)
EX: yoga
3. Behavioral – exposure therapy
Do it in a safe environment
May instill panic in the client
Learn how to calm and fight it off
specific phobias
description
Intense disproportionately heightened fear
1. Extreme irrational fear of specific object or situation
EX: significantly frightened by cats
2. Causes significant impairment
Noticeable change to our physiological state
3. Recognizes fear as irrational
EX: drowning is rational, fear of just water is irrational
4. Significant focus on avoidance
EX: all friends go on vacation but u wont get on a plane
EX: afraid of ocean so don't go to beach
Changing life
specific types of phobias
- Blood injection-injury phobia
The fear of blood; bleeding itself or seeing others bleed; may be separate from or w/ a fear of needles
Ppl can pass out
- Situational phobia
(social anxiety is NOT this)
Fear of meeting new people, public speaking, public transportation, flying, hikes
- Natural environment phobia
Thunder and lightning
Water / fire
Animals
- Animal phobia
phobias additional info
1. 13% Prevalence rate/9% Incidence rate
2. 4:1 Ratio – More common among women
3. Chronic course without treatment
Can be treated @ childhood; tend to stay persistent through adulthood
4. Onset: most commonly during childhood
5. Usually caused by direct experience; can be caused by vicarious experience
A really powerful negative experience at an early age can trigger a phobia
6. Phobia is the body preparing against exposure
phobias treatment
Respond well to behavioral therapy:
- Exposure/Relaxation
In phobia, the body is preparing (guarding) against exposure
Exposure therapy - exposed and told to relax; behavior therapy to uncondition yourself to the phobia
- Systematic desensitization
Step by step no longer being sensitive to the thing that scares you
Pair talking about flying to something relaxing
Watch video of flying and pair w/ something relaxing
Go in fake plane and help relax
Actually get into a real plane
social anxiety disorder (social phobia)
Description
A. Description
Common diagnosis among younger people (late teens to late 20s)
1. Intense shyness
2. Fear of social situations
Can include fear of talking to strangers
Phone phobia - having to talk to or call a professional
3. Fear of performance/being center of attention
EX: ppl sing happy bday to you at a restaurant
4. Avoidance of these situations
5. Panic-like symptoms when exposed to these situations
social anxiety disorder additional info
1. 7% incidence/12% prevalence
2. Equal among men and women
3. Onset: adolescence
4. Hits peak between ages of 8-29
Symptoms are the worst in this age group
5. Uncommon in older adults
Less self conscious
Care less