Psychopathology (REDUCED AND FILLED IN)

Prevalence

• how many people in population has diagnosis in their record,

  • always bigger than incidence

  • decreases bc of death and recovery increases because of incidence

  • lifetime and 1 year prevalence include recovery but point prevalence does not include recovered people   

3 D’s when something is determined to be a mental disorder

• Distress (i.e., subjective feeling; neither necessary nor sufficient)

• Deviance (i.e., abnormality – considering context, culture, characteristics! How much do they deviate from norm)

• Dysfunction (i.e., maladaptive/causes problems for self, others, or society)

etiology

• sutdy of how disorders devleop

diathesis-stress model

• biollogical and environemtnal factors that interact to create psychiatric disorders

• AKA vulnerability/predisposition for illness (nature) + bad things happen (nurture/environmental) → psychiatric disorder

• diathesis  - bio - vulernabilty/predisposition for illness (nature)

• stress - enviro - bad things happen (nurture)

• heritablity = (nature/genes/bio)

  •  how well differences in genese account for difference sin mental health disorders 35% depression, 60% schizophrenia

• 45% childhood onset disorders and 25% adult onset disorders linked to childhood trauma

observational studies

• observe association between two variables of interest

• often used to examine questions regarding etiolology/maintenance 

• better if relatively large sample

• at one time point (cross-sectional) or across time (longitudinal)

  • e.g. screen time associated with anxiety?

• limits

  • 3rd variable 

  • correlation ≠ causation

  • can’t know cause and effect (can’t know which is causing the other, if they are)

case studies 

• describe one person’s etiology (i.e. cause) of, symptoms of, and/or treamet for mental illness

• provides very preliminary support for an early theory or treatment idea 

• limits

  • only one person, can’t really generalize 

single-case experiment/ ABAB testing 

• test an intervention on one person

• compare phase w no intervention (A) to one w intervention (B)

• repeat AB cycle to increase confidence 

  • ex. trichotillomania - hair pulling

    • ABAB w weight on hand for B, it goes down for B, goes back up for 2nd B, goes down for 2nd A, can show more likely was intervention (B) and not another factor 

Open label pilot study 

• bigger group

• e.g., 10 patients, all put in experiemental intervention, see if imrpovement 

• called open label bc patients know the treatment 

• good for safety of treatment of intervention

• limits

  • no control

    • could be placebo

RCT randomized controlled trial: the gold standard

• randomized = randomly assign patients to one of multiple conditions (e.g. treatment or control group; treatment A or treatment B)

• controlled = compares improvement in the experimental intervention to improvement in the control condiiton

• other aspects that make them more rigorous

  • double-blind (ideally): 

    • patient and clinician both don’t know (are “blind” to) which intervention they get

  • When double blinding ins’t possible - blind independent evaluator = Blind clinician who is not administering tremaent assesse the patients progress throughout treatment

  • often larger sample size

• e.g., 100 participants w OCD sign up - random assignemnt to treatment → 50 put in experimental intervention, 50 in control → outcome: see which group improved more (if at all)

  • random so that most responsive aren’t all put in 1 group 

  • time period effects - so randomization should happen throughout

  • why would control group improve

    • regression to mean

    • placebo

  • what would it mean if experimental group improves same amount as control

    • another 3rd factor likely 

psychological assessment

procedure by which clinicians, using psychological tests, observation, and interviews, develop a summary of the client’s symptoms and problems 

clinical diagnosis

process through which a clinician evaluates and classifies the patient’s symptoms according to a clearing defined diagnostic system such as DSM-5-TR

reliability*

• degree to which an assessment measure produces the same result each time it is used to evaluate the same thing 

• measure of consistency

test-retest reliability*

how consistent the result is of a test given to the same subjects on repeated tests

Biological Theory

genetic, neurochemical, hormonal factors lead to maladaptive feelings and behaviors.

inter-rater reliability*

a measure of agreement between different raters, assessing same subject

validity*

extent to which a measuring instrument actually measures what it is supposed to

validity and reliability relationship

• normally the validity requires reliability,

• good reliability doesn’t require/mean validity

internal vs external reliability (and checks)

• internal: the extent to which a measure is consistent within itself

  • checked by split-half method (results of half items correlated with other half)

• external: how consistent a method measures over time when repeated

  • checked by test/re-test method (re-testing, correlating results)

internal vs external validity

• internal: if results are due to the factors researchers suggest

• external: if results can be generalized

Face validity*

does research test what it claims to test

Construct validity*

if the test relates to the underlying theoretical concepts in the research

state-trait anxiety inventory

• meta-analysis of state-trait anxietry inventory

• found depressed patients score higher than anxious individuals

• more of a measure of negative affect/emotions

Concurrent validity

how does new test compare to existing one

predictive validity*

tests how well the test or method predicts future outcomes

ecological validity

how well the test produces data that is/will be reflected in naturally occurring situations

standardization

process by which a psychological test is administered, scored and interpreted in a consistent or “standard” manner

T score distribution

a standard distribution of scores that allows for a comparison of scores on a test by comparing scores with a group of known values (curve to compare scores)

3 sources of influence impact assessment

1. culture

2. professional/theoretical orientation (cognitive therapist (thinking) vs psychiatrist (meds))

3. trust and rapport between client and clinician

Structured assessment interviews

interview with a predetermined format and questions

• (+) maximizes reliability

• (+) can be administered by people without formal clinical training (cost-effective)

semi-structured assessment interviews

interviewer is required to ask questions in a specific order and manner but depending on the answer, the clinician will ask their own follow-ups

• (+) greater validity than structured

• (-) require more interviewer training

unstructured assessment interviews

typically subjective and don’t follow predetermined set of questions, don’t ask same questions to everyone, basd on client

• (-) important information for DSM diagnosis may be skipped

• (-) responses difficult to quantify or compare

projective personality tests

• rely on various ambiguous stimuli like inkblots rather than explicit verbal questions, subject is encouraged to interpret with open ended responses, from which characteristics can theoretically be analyzed

• assumption that individuals “project” their problems/motives/wishes etc.

• (+) unstructured nature and focus on unique aspects of personality

• (+) may be useful icebreakers

• (+) one way to gather qualitative data

• (-) interpretation of responses subjective, unreliable, and difficult to validate, hard to standardize

• (-) take great amount of time and skill to interpret

• (-) reliability and validity data are poor or at best mixed

Rorschach Inkblot Test (NOT SUPER IMPORTANT)

• 10 inkblot pictures, subject responds in successio

• (-) subjective nature of subject response interpretations

• (-) doesn’t give behavioral descriptions of subject

• projective

objective personality tests

• structured tests like questionnaires, self-report inventories or rating scales

• ask lots of questions about their preferences, behaviors etc and deduce something about their personality

• (+) controlled format = much more objectively based quantification

  • (+) precision —> more reliability

• (+) extensive reliability, validity and normative database

• (+) validity scales to detect if people are lying, trying to present in a certain manner etc.

• (+) cost-effective

• (+) can be scored, interpreted and administered by computer

• (-) dependent on reading

• (-) takes long tiem

• (-) some say too mechanistic to display human complexity

• (-) subject can distort answers

DSM advantages

• gives us common nomenclature → continuity of care, research

• structured, more objective system

• guides treatment

• provides a manner of coding for insurance reimbursement

• labels can create self-understanding, normalize symptoms, and can generate communities

disadvantages DSM

• stigma (including self-stigma) for having a “disorder”

• oversimplifies symptoms

• makes disorders seem definitive, concrete and organic rather than ever-changing and subject to bias

• labels can be self-defeating

• always changing

Does the DSM do its job

• successful if

  • creates agreed-upon, distinct, universally recognizable, relatively homogenous categories that are distinct from other relatively homogenous categories

• but independent clinicians reliably agree on the diagnosis only ~60% of the time

• more 600,000 symptom combos meet criteria for PTSD

• comorbidity is very common ~45% of the time

Research Domain Criteria (RDOC)

• transdiagnostic

• organized by phenomena that exists across disorders (e.g., responsiveness to reward, attention)

  • ex. responsiveness to reward

    • high → in DSM diagnoses like gambling addiction, substance use disorder, binge eating disorder

    • low → DSM depression, anorexia

• mainly used in research, but one day may be used to have interventions for e.g., “high reward responsiveness” that would be useful across diagnostic categories

Why assess

• diagnosis

• understanding the individual

• predicting behavior

• treatment planning

• evaluate outcomes

funnel analogy

• broad, multidimensional approach

• narrows to specific problems

personality assessment

• unlike many DSM disorders which can come and go, personality characteristics are thought to be relatively stable

• could be used to inform personality disorder diagnoses or treatment planning

• projective and objective

genetics as factors of mental disorders

• no one gene leading to a mental health disorders

• polygenic = most personality traits and mental health disorders are influenced by multiple gens or multiple polymorphisms (naturally occurring variation) of genes

• genes also interact with environment

  • certain environment → gene expression

interactive vs. additive model

• Additive model

  • probability of diagnosis (low to high on Y-axis), levels of stress (low to high X-axis)

  • no diathesis - no predisposition/genes at risk of disorder

  • medium diathesis - genetic risk of disorder

  • high level diathesis

  • parallel lines

  • stress + diathesis add together to increase risk (person w no diathesis can still develop psychiatric disorder w/ enough stress)

    • cup filled up/empty - overflow

• Interactive model

  • if no diathesis never develop disorder

  • medium or high diathesis can develop disorders

    • high diathesis is steeper slope

    • need diathesis to develop slope

  • effect between stress and the outcome varies at different levels of diathesis

electroencephalogram (EEG)

graphical record of the brain’s electrical activity obtained by placing electrodes on scalp and measuring the brain wave impulses from various brain areas

• (+) painless and non-invasive

• (+) good temporal resolution (recorded immediately after things occur)

  • see how brain responds

• diagnose epilepsy

  • spiky-looking brain waves

ICD-11

• International Classification of Diseases

• published by WHO

• used in Europe and many other countries

• clinical prototypes

risk factor

a correlate that occurs before some outcome of interest

(factor/characteristic associated w increased risk of developing a condition)

(e.g., depression risk factor for suicide)

daithesis

predisposition or vulnerability to developing a disorder (can derive from biological, psychological or sociocultural causal factors)

• results from one or more relatively distal necessary or contributory causes, generally not sufficient to cause disorder (need stressor)

stress

effects created within an organism by a stressor/response or experience of an individual to demands they perceive as taxing/exceeding their personal resources

• proximal factor, may also be contributory or necessary but generally not sufficient by itself to cause disorder except in someone with the diathesis

“steeling”/ “inoculation” effect

when exposure to stressful experiences are protective factors (e.g., stressful experiences dealt w successfully → self-confidence)

• more likely to occur w moderate stressors than mild or extreme

resilience

the ability to adapt successfully to even very difficult circumstances

biopsychosocial viewpoint

acknowledges that biological, psychological, and social factors all interact and play a role in psychopathology and treatment

Gene-environment interaction

different sensitivity or susceptibility to their environment by people who have different genotypes

gene-environment correlation

genotypic vulnerability that can shape a child’s environmental experiences

twin method

use of identical and nonidentical twins to study genetic influences that may play a role in psychopathology (identical twins have same genetic makeup) → compare environmental vs genetic

• monozygotic twins = identical - one egg split

• dizygotic = nonidentical - from 2 diff eggs

PNS

• everything nerve-wise except brain and spinal cord (nerves that connect to sensory receptors and body’s muscles and glands)

• somatic nervous system (skeletal muscles and skin)

• autonomic nervous system (involuntary activities)

autonomic nervnous system

• part of PNS

• involuntary activities like breathing

• connects sensory system to CNS and CNS to non skeletal muscles and glands

• sympathetic and parasympathetic system

sympathetic system

• response to emergency/stress

  • fight/flight/freeze

parasympathetic system

• controls all routine functions like breathing rate

• rest and digest

Causes of NT imbalances

• excessive production and release of NT

• dysfunction in deactivation of NT - reuptake or enzymes

• receptors - overly sensitive or too insentitive

chemical circuits

neural paths btwn diff parts in brain formed by neurons sensitive to particular NT clustering together

monoamines

1. norepinephrine

2. dopamine

3. serotonin

• synthesized from a single amino acid

norepinephrine

• monoamine

• emergency rxns to stressful/danger, and attn, orientation and basic motives

dopamine

• monamine

• pleasure and cognitive processing

• implicated in schizophrenia and addictive disorders

serotonin

• monoamine

• important effects on thinking and processing information from environment, and behavior and moods

• role in emotional disorders like anxiety, depression and suicide

GABA

• inhibitory NT

• implicated in reducing anxiety and other emotional states characterized by high levels of arousal

agonist

• medication that facilitate effects of NT on postsynaptic neuron

antagonist

• medication that opposes or inhibits effects of a NT on a postsynaptic neuron

hormones

chemical messengers secreted by endocrine glands that regulate development of and activity in various parts of the body

neuroendocrine system

links CNS linked to endocrine system by the effects of the hypothalamus on the pituitary gland

pituitary gland

master endocrine gland of the body producing variety of hormones that regulate/control other endocrine glands

hypothalamic-pituitary-adrenal (HPA) axis

• Some psychopathology linked to changes in hypothalamic- pituitary adrenal (HPA) axis.

• The HPA axis controls the release of the hormone cortisol, which mobilizes the body to deal with stress.

• Malfunctioning of this system is associated with PTSD and depression

temperament

a child’s reactivity (emotional and arousal responses) and characteristic ways of self-regulation, believed to be biologically programmed

temperament timeline

• thought to be basis of personality

1. starting 2-3 months - 5 dimensions identified

predict adult personality

5 dimensions of temperament

• identified starting 2-3 months

1. fearfulness (→ relates to adult dimension neuroticism)

2. irritability/frustration (→ relates to adult dimension neuroticism)

3. positive affect (→ relates to adult dimension extraversion)

4. activity level (→ possibly relates to adult dimension extraversion)

5. attentional persistence/effortful control (→ relates to adult dimension constraint)

• related to adult personality

id

id - instinctual drives, 1st to appear in infancy

• operates on pleasure principle

  • demand that an instinctual need be immediately gratified regardless of reality or moral considerations

• (can generate mental images and wish-fulfilling fantasies = primary process thinking, but cannot undertake realistic actions to meet instinctual demands)

ego

• develops after first few months of life

• mediates between demands of id, constraints of superego, and realities of external world

• secondary process thinking - reality oriented rational processes of the ego for dealing w the external world and the exercise of control over id demands

• reality principle - awareness of the demands of the environment and adjustment of behavior to meet those standards

superego

• as child grows, 3rd/last to develop

• conscience; ethical or moral dimensions (attitudes) of personality

intrapsychic conflicts

• inner mental struggles resulting from the interplay of the id, ego and superego when the 3 subsystems are striving for different goals

ego-defense mechanisms

• psychic mechanisms that discharge or soothe anxiety rather than coping directly with the anxiety-provoking situation; usually unconscious and reality disorting (aka defense mechanisms)

8 defense mechanisms (NOT AS IMPORTANT)

1. displacement

2. fixation

3. projection

4. rationalization

5. reaction formation

6. regression

7. repression

8. sublimation

displacement (NOT AS IMPORTANT)

displacement - put feelings onto something/someone else than cause

fixation (NOT AS IMPORTANT)

- attaching oneself in unreasonable/exaggerated way to some person or arresting emotional development on a childhood/adolescent level

rationalization

using contrived explanations to conceal/disguise unworthy motives for one’s behavior

repression

preventing painful or dangerous thoughts from entering consciousness

sublimation

channeling frustrated sexual energy into substitutive activities

attachment theory

• developmental and psychodynamic theory

• emphasizes importance of early experience with attachment relationships in laying foundation for later functioning throughout life

• Bowlby

Freud’s/psychoanalytic lasting impact

• developed techniques still used today

  • psychological factors outside our conscious awareness that influence our behavior

  • early childhood experiences can have an important and lasting impact on the development of personality and psychopathology

• demonstrated certain mental phenomena that can lead to psychopathology occur as an attempt to cope w difficult problems

• importance talking as a way to start treatment

• similar psychological principles apply to both normal and abnormal behavior → reduced stigma

psychoanalytic crticisms

center on failure as scientific theory to explain psychopathology

1. many believe fails to realize scientific limits of personal reports of experience as primary mode of getting info

2. lack of scientific evidence to support many of its explanatory assumptions or effectiveness of tractional psychoanalysis

more:

1. overemphasis on sex drive, unconscious demeaning view of women, pessimism about basic human nature

2. exaggerating role of unconscious processes

3. failing consider motives towards personal growth and fulfillment

4. very philosophical

5. minimal evidence basis

6. difficult to test, given emphasis on unconscious processes

classical conditioning

neutral stimulus paired repeatedly with unconditioned stimulus that naturally elicits an unconditioned behavior

• after repeated pairings, neutral stimulus becomes CS elicits CR

• typically paired simultaneously

operant conditioning

• aka instrumental conditioning

• form of learning in which if a particular response is reinforced, it becomes more likely to be repeated on similar occasions

• reinforcement - reward/addition of pleasant stimulus or removal of aversive stimulus

• and punishment

• response-outcome expectancy - learns response will lead to reward outcome

different from classical

• behavior is typically voluntary rather than involuntary

• no stimulus paired w reward or punishment, reward/punishment based

• typically not simultaneous (behavior, then reward)

observational learning

learning though observation alone - w/o US (classical) or reinforcement/punishment (operant) → can still have this conditioning

schema (?)

underlying representation of knowledge that guides the current processing of information and often leads to distortions in attention, memory and comprehension

implicit memory

memory that you cannot consciously remember (e.g., can’t tell person their phone number from 10 years ago, but could dial it)

attribution

process of assigning causes to things that happen

(internal - has to do w me, external - has to do with outside world)

attributional style

characteristic way in which an individual tends to assign causes to bad events or good events

self-serving bias

cognitive tendency to attribute positive events to internal, personal factors (skill, effort) while blaming external factors (luck, others) for negative outcomes

social factors have important detrimental effects on a child’s socioemotional development

1. early deprivation or trauma → can have direct impact on brain

2. problems in parenting style (parenting psychopathology, style, discipline)

3. marital discord and divorce,

4. low socioeconomic status and unemployment,

5. maladaptive peer relationships (bullying, rejection)

6. prejudice and discrimination

brain results of institutionalization (orphanage etc.)

• reduced brain development

• significant reductions in both gray and white matter volume

disorganized and disoriented styles of attachment

• Abused and maltreated infants and toddlers likely develop

• characterized by insecure, disorganized, and inconsistent behavior with the primary caregiver

4 types of parenting styles

1. authoritative (warm and careful (measured control))

2. authoritarian (high control, low warmth)

3. permissive/indulgent (high warmth, low control)

4. neglectful/uninvolved (low warmth, low control)

• differ in degree of parental warmth (amount of support, encouragement, and affection versus shame, rejection, and hostility)

• differ in degree parental control (extent of discipline and monitoring versus leaving the children largely unsupervised)

  • Parental control includes both behavioral control (rewards and punishments) and psychological control (e.g., expression of approval versus disapproval, or guilt induction)

types of children resulting from parenting styles

1. authoritative → children: well-adjusted, less psychopathology, resilient

2. authoritarian → children: conflicted, irritable and moody, lower social and academic competence than authoritative, boys w authoritarian fathers higher likelihood substance abuse, physical punishment → aggressive behavior

3. permissive/indulgent → children: impulsive and aggressive, spoiled, selfish, impatient, inconsiderate, demanding. less well academically and more antisocial behaviors

4. neglectful/uninvolved → children: disruptions in attachment early childhood, moodiness, low self-esteem, conduct problems later in childhood, problems peer relation and academic performance