AP PSYCH UNIT 8 - Clinical Psychology

Medical Model

 __Abnormal__ behavior is a __treatable disease__.

Diagnosis

__Distinguishing__ one illness from another; “__labeling__” a disorder.

Etiology

__Cause__ of an illness.

Prognosis

__Forecast__ about the __probable course__ of an illness.

Deviance

Behavior that __deviates__ from what society considers __acceptable__.

Maladaptive Behavior (*dysfunction: impairs functioning)*

Behavior that __interferes__ w/ __daily life__ activities.

Personal Distress

__Aversive__, __self-focused__ emotional reaction.

**Psychodiagnosis: The Classification of Disorders**

Defining mental illness (According to the APA): A __syndrome__ marked by a __clinically significant disturbance__ in an individual’s cognition, emotion regulation, or behavior. 

**marked by impaired functioning & personal distress**

The Rosenhan Study (Aim, Procedure, & Results)

Aim of Study: Criticism of psychiatric diagnosis.

\
Procedure: Rosenhan & his associates faked symptoms of hearing voices (“Empy, dull thud”). They were ALL admitted for Schizophrenia.  They all left diagnosed w/ schizophrenia in remission.

\
Results of Study: They felt demonized, & powerless; invisible, normal behavior is seen as abnormal.

Diagnostic & Statistical Manual of Mental Disorders (DSM)

\*\*The latest is the DSM-5

*(look at highlighted/bolded words to memorize better)*

__Included in the DSM:__

* __**Categories**__ of disorders (e.g., anxiety disorders, depressive disorders, dissociative disorders, neurodevelopmental disorders, etc.)
* A detailed __**description**__ of each disorder, including an overview of the disorder (diagnostic features)
* Specific __**symptoms**__ required for diagnosis (diagnostic criteria)
* __**Prevalence**__ information
* __**Risk**__ factors associated with the disorder
* __**Comorbidity**__ rates

Comorbidity

__Co-existence__ of __2__ or __more__ disorders.

Epidemiology

The study of the __distribution__ of mental or physical __disorders__ in a __pop__.

Prevalence

The __%__ of a pop. that __exhibit__ a disorder during a __specific time period__.

**Explaining Psychological Disorders from the Diff. Perspectives**

Psychodynamic: Unconscious; repressed, trauma.

Humanistic: Failure to thrive; one’s loss of touch w/ feelings.

Behavioral: Reinforcement history; their environment.

Cognitive: Dysfunction of thoughts & way of thinking.

Sociocultural: Dysfunction in society; expectations.

Biological: Organic problems; biochemical imbalance; genetic predispositions.

Diathesis Stress Model

a person's __genetic__ or biological vulnerability to a mental illness (diathesis) + __stress__ from life experiences.

**If the two combined exceed the threshold, the person may develop a disorder.*

Insanity *(&* M’*Naghten Rule)*

__Legal status__ (not medical) indicating that a person cannot be held __legally__ responsible for his/her actions because of mental illness.

**M’Naghten Rule:** insanity must be proved (at the time of the crime)

Involuntary Commitment

Legal system’s ability to hospitalize people in psychiatric facilities against their will. Used to help a person who may be mentally ill and harmful to self or others and refuses to seek treatment or whose judgment is so impaired they do not understand their need for treatment. (Commitment usually has a max. time).

Mental Health Parity Law

Anxiety Disorders (def/symptoms)

Marked by feelings of apprehension & anxiety.

**Generalized Anxiety Disorder**

marked by chronic, high levels of anxiety that is not tied to any specific threat

Specific Phobia

__Excessive fear__ of a specific object or situation.

Social Phobias

Fear of social __or performance situations__ where they are being __scrutinized__ (evaluated) by others. (Spotlight effect).

Agoraphobia

Fear of going out to __public places__; fear of __open spaces__ or __leaving  a safe__ space.

Panic Disorder

__Recurrent attacks__ of __overwhelming__ anxiety that occur __suddenly and unexpectedly.__

Obsessive-Compulsive Disorder (OCD) (*Obsession & Compulsion)*

Obsession: __unwanted thoughts__ that are intrusive & will not go away.

Compulsion: __ritualistic/repetitive behavior__ a person engages in to manage anxiety caused by the thoughts *(compulsive behavior is driven by obsession).*

Hoarding

__Difficulty discarding__ or parting w/ __possessions__ regardless of their actual __value__.

Body Dysmorphic Disorder

__Preoccupation__ w/ one or more __perceived flaws__/defects in __physical appearance__ that others do not observe or appear slight.

**Etiology of Anxiety & Obsessive-Compulsive Disorders** *(list them)*

1. Biological Factors \~


1. Concordance rate
2. Neurotransmitter imbalance
2. Conditioning & Learning \~


1. Phobias
2. OCD
3. Cognitive Factors \~
4. Stress
5. Diathesis-Stress

Concordance rate

__%__  of __twin pairs__ or other pairs of __relatives__ who exhibit the __same__ disorder.

Neurotransmitter imbalance

Disturbance in __neural circuits__ using __GABA__; __high__ levels of __norepinephrine__ (anxiety), __serotonin__ & __glutamate__ (OCD).

Conditioning & Learning *(Behavioral approach)*

Phobias: acquired through CC & maintained through OC

OCD: maintained through OC.

Many of the disorders can be influenced by OL.

Cognitive Factors

Misinterpret harmless situations as threatening; excessive attention on perceived threats; selectively recall info that seems threatening, low self-efficacy or self-concept.

Post-Traumatic Stress Disorder (PTSD)

Involuntary recollections of trauma/flashbacks, nightmares, intense/prolonged distress, persistent negative emotions, avoidance behavior, dissociative symptoms.

Etiology of Trauma Disorders

Significant/severe trauma or life stressors.

__**Somatic**__ **Symptoms & Related Disorders** *(& the etiology)*

Physical symptoms w/ no physical cause.

\
\*Etiology: Significant/severe trauma or life stressors.

**Conversion Disorder** *(& the etiology)*

__Temporary functional impairment__ (e.g. blind, deaf, paralyzed) w/ __no__ physical cause.

\
\*Etiology: Trauma (a form of repression?) or a psychological crisis (too much stress/anxiety).

**Somatic Symptom Disorder (AKA Illness Anxiety Disorder; Hypochondriasis)** *(& the etiology)*

__Preoccupation w/ concern__ they have __serious disease__; may believe that __minor complaints__ are signs of __very serious__ medical problems.

\
\*Etiology:

Cognitive: Too much __attention__ to __bodily sensations__; __minor__ symptoms = __catastrophic__, unrealistic def. of health.

Learning: Reinforced for being sick.

Depressive Disorders (Affective/Mood Disorders)

Emotional distrubances of various kinds that disript, physical, perceptual, social, & thought processes.

**Major Depressive Disorder (MDD)**

Persistent feelings of sadness, despair, loss of interest, etc. that impairs everyday adaptive behavior for more than 2 wks. - suicidal tendencies.

Anhedonia

Diminished ability to experience pleasure.

**Persistent Depressive Disorder (PDD)**

"mild depression" - symptoms of depression that come & go over a period of years, often with changing intensity.

**Bipolar Disorder**

Formerly known as "manic-depression"; characterized by experience of one or more manic episodes as well as periods of depression.

Mania

__euphoric__, elated state characterized by impulsiveness, racing thoughts (flight of ideas), delusions of grandeur, little sleep, & spending $.

Bipolar I

Intense mania & intense depression.

Bipolar II

Mild mania & intense depression.

Cyclothymic Disorder

Mild mania & mild depression

__**Etiology**__ **of Mood & Bipolar Disorders** *(list them)*

1. Genetic Vulnerability \~
2. Biological (Neurochemical & Neuroanatomical) \~
3. Hormonal Factors \~
4. Cognitive Factors \~
5. Interpersonal Roots \~
6. Diathesis-Stress

Genetic Vulnerability of Bipolar Disorder

Concordance rates: identical twins = 65%; fraternal twins = 14%.

Biological (Neurochemical & Neuroanatomical) of Bipolar

Abnormal levels of __serotonin__ & __norepinephrine__.

\
e.g. low levels of serotonin = depression;  fluctuation = bipolar.

Hormonal Factors of Bipolar

\*Overactivity among the HPA axis in response to stress.

\*Elevated cortisol levels.

Cognitive Factors of **Bipolar**

\*Learned helplessness (Seligman).

\*Ruminating, irrational thinking, pessimistic viewpoint.

\*Globalized low self-efficacy; negative self-concept.

Interpersonal Roots

__Inadequate social skills__, __lack__ of social support, lack of reinforcers.

Anorexia Nervosa

__Intense fear of gaining weight__, disturbed body image, refusal to maintain normal weight, and use of dangerous measures to lose weight.

**highest fatality rate of any psychological disorder*

Bulimia Nervosa

Habitually engaging in __out-of-control overeating followed__ by __unhealthy compensatory efforts__ (purging, laxatives, excessive exercise).

Etiology of Eating Disorders

\*Genetic Vulnerability - not much research

\*Personality (need for control & perfection)

\*Cultural Values (sociocultural perspective)

\*Critical mothers

**Personality Disorders** *(def & list them)*

**Definition:** marked by extreme, inflexible personality traits that cause subjective distress or impaired social and occupational functioning

\

1. **Antisocial Personality Disorder ~**


2. **Borderline Personality Disorder ~**


3. **Histrionic Personality Disorder ~**


1. **Narcissistic Personality Disorder ~**

Antisocial Personality Disorder

Borderline Personality Disorder

Histrionic Personality Disorder

Narcissistic Personality Disorder

Dissociative Disorders

loss of contact w/ portions of their memory consciousness, resulting in a disruption in their sense of identity.

Dissociative Amnesia

Sudden loss of memory for important personal info (too extensive to be due to normal forgetting & NOT due to physical damage to the brain).

DIssociative Fugue

Loss of memory of entire life/identity; often found in a new location.

Dissociative Identity Disorder (DID)

\*Formerly known as “__Multiple Personalities”__.

\*__Coexistence__ in one person or __two or more diff. personalities__ (each identity has its __own__name, memories, traits, & physical mannerisms).

__Etiology__ of Dissociative Disorders

\*Exessive stress (ALL).

\*Severe emotional trauma in childhood (DID, specifically).

\*Severe repression -- psychoanalytic approach.

\*Lack of coping mechanisms.

Schizophrenic & Psychotic Disorders

Psychotic disorders: a group of disorders marked by irrational ideas, distorted perceptions, deterioration of adaptive behavior & a general loss of contact w/ reality.

__Schizophrenia__ & Its General Symptoms

A disorder characterized by delusions, hallucinations, disorganized speech, &/or diminished, inappropriate emotional expression (affect).

__Delusions__ & Irrational Thoughts

False beliefs that are maintained even though they clearly are out of touch w/ reality.

ideas of reference

The belief that innocuous events have highly personal significance (usually in a neg. or hostile manner).

Delusions of grandeur

The belief that one possesses superior qualities such as genius, fame, omnipotence, or wealth.

Thought broadcasting, Thought blocking/withdrawal, &/or Thought insertion

Beliefs that others can either hear your thoughts, can prevent you from having thoughts, or put thoughts into your head (= paranoia).

Hallucinations

Sensory perceptions that occur in the absence of real, external stimuli or are gross distortions of perceptual input.

Deterioration of Adaptive Behavior

Deterioration of routine functioning in work, social relations, & personal care.

Disturbed Emotion

Little emotional responsiveness (bkunt/flat affect) or inappropriate emotional responses.

Neologisms

Making up words.

Loose associations

Response does not relate to the question asked; the sentence is not logically related to those before/after it.

Clang associations

Association of words based on sounds rather than concepts (rhyming)

\
*Asked: What is your job?*

*Response: I'm just there to make money. Isn't that funny? Bunny..*

Word Salad

Mix of real words/phrases that don't make sense when put together.

Positive v. Negative Symptoms

Positive: __presence__ of problematic behaviors.

Negative: __absence__ of healthy behaviors.

Onset of Schizophrenia

\*Usually emerges in very __late adolescence__ or __early adulthood__ + gradual onset (__75% manifest by 30 yrs__).

Genetic Vulnerability *(bio.)* of Schizophrenia

Concordance rate: identical twins = 48%, fraternal twins = 17% 

Two schizophrenic parents = child w/ high percentage prob.

Neurochemical factors *(bio.)* of Schizophrenia

__Excess dopamine__ activity.

*(abnormal/excessive* __*synaptic pruning*__*)*

*(*__*high*__ *frequency/high potency* __*marijuana*__ *use* __*causing*__ *episodes of* __*psychosis*__*).*

Neurodevelopmental Hypothesis *(bio.)* of Schizophrenia

Issued during prenatal development (disruptions in the normal maturational process of the brain before or at birth).

Diathesis Stress in Schizophrenia

\*stress = key role in triggering.

\*High stress can trigger relapses.

**Intellectual Disability**

Deficits in general mental abilities, impairments of adaptive functioning.

**Autism Spectrum** ***(now includes Asperger’s)***

Lacking theory of mind; persistent deficits in social communication & social interaction across multiple contexts; restricted, repetitive patterns of behavior, interests, or activities.

**Attention Deficit/Hyperactivity Disorder (ADD/ADHD)**

Persistent pattern of inattention and/or hyperactivity/impulsivity.

**Diagnostic Problems**

Too much overlap with other disorders/each other

**Etiology of Neurodevelopment Disorders**

\*Concordance rate: identical twins 67%, fraternal twins 31%.

\*Antisocial - lack inhibitions.

\*Dysfunctional Family Systems.

Treatment: Insight Therapies

__Talk therapy__ to gain increased __insight__ & __sort__ through possible __solutions__; individual or group.

Treatment: Behavior Therapies

Therapists make a direct __effort__ to __alter problematic__ responses & __maladaptive__ habits; __want to change the client’s behavior__; use principles of learning (OC, CC, OL).

Treatment: Biomedical Therapies

__Interventions__ into a person’s __biological functioning__; __drug__ therapy & other treatments of __structural or chemical abnormalities__.

Clients: Who Seeks Therapy?

Individuals __w/ & w/o__ mental illness 

\*Only about __1/3__ of people who __need__ treatment actually __get__ it

Psychologists

**Ph.D., Psy.D, Ed.D**

\*specialize in __diagnosis__ & __treatment__ of psychological disorders (*clinical*) & everyday __behavioral problems__ (*counseling*).

\*Using __*insight*__ or __*behavioral*__ approaches.

Psychiatrists

**M.D. OR D.O.**

\*__diagnosis__ & __treatment__ of psychological disorders.

\*__focus__ more on __severe disorders__ (schizophrenia, depressive disorders, bipolar).

\*Using __*insight*__ or __*behavioral*__  & __*biomedical*__ approaches.

Other Mental Health Professionals (on AP exam only)

\*__Clinical Social Workers__: MS, work w/ patients + their families to ease patients back into the community 

\*__Psychiatric Nurses__: BS or MS, hospitals + inpatient treatment 

\*__Counselors: MA__, schools, colleges, or community agencies

\*__Marriage and family therapists: MA__, couples, & families

**Insight Therapies**

__Talking__ to __enhance self-knowledge__ & to __promote__ healthy __changes__ in personality & behavior.

Psychoanalysis

Emphasizes the __recovery__ of __unconscious conflicts__, __motives__, & __defense__ through techniques such as __free association & transference__.

Free Association

__Spontaneously expressing__ their thoughts and feelings __exactly as they occur__, with as __little__ censorship as possible.

Dream Analysis

Therapist __interprets__ the __symbolic meaning (latent content)__ of the client's dreams.