Psych 130 M Midterm

Psychopathology

The study of the nature and causes of mental disorders

Mental Disorder

“A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.”

When mental health diagnosis is done for adults (age)

Most adults with mental disorders received a diagnosis (dx) before age 15

Pathoplasticity

The variability in a symptom’s specific form, content, & presentation shaped by events in a patient’s life. (refers to how a person's life experiences, culture, or personality shape the way their symptoms look or show up, even if they have the same diagnosis as someone else.)

Pathoplastic Effects of Age

1. Age specificity of disorders (dementia atter 65), 2.Usual age at onset (Schizophrenia at age 20s), 3.Age effects on symptom expression (Major depression) (children have stomach aches while adults have fatigue/ loss of interest)

DSM-V TR

Standard classification of mental disorders used by mental health professionals in the United States used to classify

Problem List or presenting problems

-used in psychological cases to list problems (for Case Conceptualization)

Client’s Goals for Treatment

what the client wants to do to become better (not what others want for them) in psych cases. (for Case Conceptualization)

Developmental Considerations

What we expect within certain ages (conflicts) to consider it when doing psych cases (Erik Erikson;s psychosocial stages of development) (Ex 12-18 years conflict is identity vs role confusion) (for Case Conceptualization)

Translational Research

Research aimed at translating/ converting results in basic research into results that directly benefit humans. Also Clinical research contributes to treatment

Age of Identity processes

There is broad consensus that identity processes (e.g., ethnic identity, values, beliefs) are generally pertinent to adolescence. Because of increased experiences of discrimination and advances in social perspective-taking ability.

Cultural consideration

Considering shared beliefs, values, customs, behaviors, and traditions that influence how people think, feel, and act in case studies (for Case Conceptualization)

Risk Factors

conditions or traits that increase the chances of developing a psychological problem or mental illness. (trauma, abuse poverty) for Case Conceptualization

Protective factors

conditions or strengths that reduce the chances of developing a mental health problem and promote resilience. (supportive families, positive school etc) for Case Conceptualization

resilience

the ability to adapt well and recover from stress, adversity, trauma, or challenges.

Hypotheses about the Origins of the Mechanisms

educated guesses or theories about how and why certain psychological processes or behaviors develop in the first place.Based on the problem list, protective and risk factors, etc. for Case Conceptualization

Treatment plan

Treatment for the patient (for Case Conceptualization)

Predicted Obstacles to Treatment-

factors that will effect treatment ((for Case Conceptualization)

Case conceptualization list

 • Presenting Problems • Client’s Goals for Treatment • Developmental Considerations • Cultural Considerations • Protective and Resiliency Factors/Assets • Risk Factors • Hypotheses about the Origins of the Mechanisms • Triggers/antecedents to current problems • Readiness to change • Treatment Plan • Predicted Obstacles to Treatment

Psychological assessment-

the process of collecting and evaluating information about a person’s thinking, emotions, behavior, and functioning to understand them better and make informed decisions about their mental health. Consist of clinical interviews, collateral interviews, testing, feedback and report, observation, and review of records

Comprehensive clinical interview

1-2 hour interview face to face, Goal is to establish rapport (trusting connection between two people), accurate diagnosis, assessment of symptom patterns, phobic stimuli, and impairment in functioning, can create a roadmap for a broad psychological/neuropsychological assessment (can be structured, unstructured or semi-structured)

Structured clinical interview

 Clinician follows a standardized interview protocol with a uniform set of questions (and follow up questions) usually designed to measure the specific criteria for disorders as defined in the DSM, Responses are rated and scored. • Can provide enhanced reliability of assessment information.(easier way: follows DSM questions, responses rated and scored, reliability of information)

Unstructured clinical interview

Clinician asks more open-ended questions, Does not follow a specific format or question order, May feel more conversational and less rigid

Semi-structured

a mix of structured and unstructured clinical interiews methods

Collateral interviews

Interviews to Collect data from multiple informants and multiple contexts. (context helps in prevalence and severity) (infortmats observe beaviors in those contexts)

Multiple contexts importance

context helps provide clues in prevalence and severity 

Multiple informants importance

Informants observe behaviors in contexts

Domains for Psychological Assessment

Not sure if it will be on it. However it is Cognitive Academic/Achievement, Adaptive Functioning, Executive Functioning, Visual Motor Integration skills, Language Development, Social Emotional Behavioral, Projective Personality

Basic testing measures

4 Testing measures from the slides (Intellectual & Cognitive,  Academic Achievement,Social-Emotional & Behavioral, Projective & Personality)

Intellectual & Cognitive testing measure

Tests of Intelligence & Broad Cognitive Ability • Verbal • Nonverbal • Cultural Context • e.g., Wechsler Intelligence Scale for Children (WISC-V) 

 Academic Achievement testing measure

 Evaluate competence related to specific topics • e.g., Wechsler Individual Achievement Test (WIAT-III), Ex( reading, essays, math)

Social-Emotional & Behavioral testing measure

test that measures behavior and emotions. Can be done my multiple ifnromats, self report, or observation. Like the behavior rating scale

Behavior Rating Scales

scale for behavior, Includes standardized sets of items • Global ratings scales vs. specific content areas/problems • Example: Child Behavioral Checklist • Multiple versions/informants: parent, teacher, or child-reports • Standardized scales allow normative comparisons 

 Projective & Personality test measures

 test that measures personality EX: Rorschach or Minnesota Multiphasic Personality Inventory (MMPI)

 Evidence-based assessment (EBA)

 assessment methods and processes that are based on empirical evidence in terms of both their reliability and validity as well as their clinical usefulness for prescribed populations and purposes.

Test reliability and test validity

Clinical tests has to have these 2 things to be useful

Test reliability

The consistency of test scores within participants across either: (a) time, (b) items tapping the same construct; (c) context, (d) multiple assessors/raters, (how consistent or dependable a test is.) (simialr results every time)

 Test validity

How thoroughly and accurately an instrument measures a specific theoretical construct of interest, and how useful it is in predicting important outcomes (how well a test measures what it’s supposed to measure.) 

Criticisms of the DSM-5

• Categorical vs. dimensional measurement • Over-specification • Heterogeneity within diagnostic classes • Failure to consider development • Failure to consider culture and other contextual issue, lots of overlap

Nature vs. Nurture

The extent to which genetics (nature) and environmental factors (nurture) influence individual development and behavior

Gene X Environment

shifts the focus away from the traditional "nature vs. nurture" debate, emphasizing that both genetic predispositions and environmental influences work together to shape human development. These interactions influence the expression of phenotypes.

Genotype

considered the basic unit of inheritance. They are passed from parents to offspring and contain the information needed to specify physical and biological traits.

Allele

One of two or more forms of a gene for a specific trait

Phenotype

The observable expression of the genotype, including body characteristics and behavior Ex eye color

Endophenotype

A trait that is intermediate between genotype and disease. a trait or biomarker that is more directly linked to genetic underpinnings and can help researchers understand the pathways to mental illness. CAN BE Neuorobiological or behavioral (ex working memory?)  

MDD and neuroticism

Approximately 55% of MDD’s genetic risk may be shared with this. Probably not on test but interesting to attain

Key points about genetic and environmental influences

• Most mental health problems are influenced by multiple genes (e.g., there is no ADHD or depression gene) • Environment can alter gene expression • Many people who are genetically vulnerable never develop mental illness 

Parenting styles

Authoritative, authoritarian, Permissive, and disengaged. Measured by control/demand and warmth/responsiveness

Authoritative

 High control and high warmth. Parent that controls child but is flexible and listens to child. Lead to popular kids, in control, not antisocial, and best academics and lowest delinquency

Authoritarian

High control but low warmth. Parent controls, rules must be followed without explanation, not much bonding with the child. Not competent children for academics or social life. High antisocial behavior

Permissive

Low control but high warmth/responsiveness. Parent does very little authority. Children have freedom and parent responds to them. Lead to impulsive children, poor academics, high antisocial behavior

Disengaged

Low control and low warmth. Does not support or monitor child. Rejects their responsibility as parent. Leads to high antisocial children, poor academic and social performance

Ecological model of development-

made by Bronfrenbrenner which contains the microsystem, mesosystem, exosystem, macrosystem, and chronosystem. Emphasizes how a person's development is shaped by interactions within various environmental systems 

Microsystem

Direct influence such as family, peers, teachers, health providers

Mesosystem

Interdependence/bidirectional influence.  Links, interconnections, or relationships among microsystems

Exosystem

indirect influence like school system or extended family or mass media

Macrosystem

Indirect influence of sociocultural factors, General societal beliefs and values - laws, racism, colorism, etc

Chronosystem

Transitions/Socio-Historical Contexts • Family immigration Historical/intergenerational trauma • Developmental stages/processes

Adverse childhood experiences ACE

 the single greatest unaddressed public health threat facing our nations. Higher experiences of this then worse health outcomes

Serve and return

child or baby does an action and the parent responds to it

4 types of neglect

occasional inattention, chronic under- stimulation, severe neglect in family context, sever neglect in an institutional setting 

 occasional inattention

occasionally adults do not respond to the child. No harm as child could explore environment

chronic under-stimulation

 Children have less interaction with parents than needed enriched learning can allow them to catch up.

severe neglect in family context

Parents do not attend the child. Also part of not being fed enough or bathe. Children are more likely to be neglected than other mistreatment

severe neglect in an institutional setting

children living in orphanages or institutional care. Not adequate care from caretakers

Latent vulnerability

early abuse or neglect put children at greater risk for mental health problems

Social thinning

hard to maitian relationship, so they are lost with trauma and neglect

Brain systems changed by neglect or trauma

Reward, memory, and threat systems

Dissociation

Pierre Janet coined the term to describe detachments from reality that occurred when individuals with unspecified mental weaknesses were stressed. 

Little Albert experiment

John Watson created cue-specific reactivity by conditioning Albert to be fearful of a neutral cue. Albert demonstrated symptoms of intrusion, altered arousal, and avoidance—key symptoms of PTSD in the DSM-5

Homeostasis

Walter Cannon coined this to describe the body trying to balance itself.

Stress

Hans Selye (1936) first used the term in physiology to describe “nonspecific response of the body to any demand.”

general adaptation syndrome

Three stage process for stress. Includes alarm reaction, the resistance stage (homeostasis) using PNS, and the exhaustion stage (if stressor still continues).

PTSD in DSM

Post-traumatic stress disorder (PTSD), the major trauma-related disorder in the DSM-5, did not appear in the DSM until 1980 (DSM-III)

Trauma and stressor related category

Category in DSM-5 that contains, Five distinct disorders: acute stress disorder (ASD), adjustment disorders (AD), disinhibited social engagement disorder (DSED), PTSD, and reactive attachment disorder (RAD). Two indistinct disorders are also included: other specified trauma- and stressor-related disorders and unspecified trauma- and stressor-related disorders

Acute Stress Disorder

A. Exposure to a trauma

B. Presence of nine (or more) symptoms from any of the five major symptom categories— intrusion, negative mood, dissociation, avoidance, and arousal—which appear to be associated with the traumatic event

C. Duration of three days to one month after the trauma

D. Impairment in functioning E. Symptoms not attributable to another cause

Adjustment Disorders

A. Development of emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months of the onset of stressor

B. Clinically significant level of symptoms

C. Symptoms do not meet criteria for another mental disorder

D. Symptoms are not attributable to normal bereavement

E. Once the stressor is gone, symptoms do not persist past 6 month

Disinhibited Social Engagement Disorder

A. The child actively approaches and interacts with unfamiliar adults, in an overly familiar fashion

B. Such approach behavior is not due to impulsivity (e.g., ADHD)

C. The child has history of insufficient care such as described for RAD D. Such care is presumed to be causal to A

E. The child has a developmental age of at least nine month

Posttraumatic Stress Disorder PTSD

Six years and up

A. Exposure to a trauma 

B. Intrusive symptoms (e.g., intrusive ideations, repetitive play with trauma-related themes, distressing dreams) 

C. Avoidant symptoms (e.g. avoidance of evocative cues or trauma-associated people, places, or experiences)

 D. Altered mood and cognitions (e.g., guilt, dysphoria, anhedonia)

 E. Altered arousal and reactivity (e.g., increase startle response, irritability, hypervigilance) 

F. Duration of more than one month 

G. Significant functional impairment 

H. Symptoms are not due to other causes (e.g., substance use, medical condition) Criteria for PTSD for children who are younger than age six years are essentially the same, aside from developmentally appropriate emotional, cognitive, and behavioral manifestations of intrusive, avoidant, affective, and arousal symptom

Reactive Attachment Disorder RAD

A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both

B. Social and emotional disturbance

C. Extremes of insufficient care (e.g., social neglect, institutionalization, repeated changes in primary caregiver); as well as

D. Care in C that is presumed to be causal of A

E. The behavior is not attributable to autism spectrum disorder

F. Symptoms are evident before age five years G. The child has a developmental age of at least nine month

Equifinality

Different initial conditions or pathways can lead to the same developmental outcome

Multifinality

Individuals with similar starting conditions or early experiences can develop very different outcomes or trajectories

Epigenetics

the study of changes in gene activity that occur without altering the DNA sequence but through environment

Etiology

the cause, set of causes, or manner of causation of a disease or condition.

Genetics in Stress-

Monoamine oxidase (MAO-A), or short allele of serotonin transporter 5-HTTTLPR

Trauma

 The DSM-5 defines it as “exposure to actual or threatened death, serious injury, or sexual violence in one or more of four ways: 

(a) directly experiencing the event; 

(b) witnessing, in person, the event occurring to others; 

(c) learning that such an event happened to a close family member or friend; and

(d) experiencing repeated or extreme exposure to aversive details of such events, such as with first responders. Actual or threatened death must have occurred in a violent or accidental manner, and experiencing cannot include exposure through electronic media, television, movies or pictures, unless it is work-related”

Heterogeneity

Individuals diagnosed with the same disorder can exhibit a wide range of symptoms, severity levels, and underlying causes

TR-Text Revision (2022)

APA reviewed the impact of • Ethnoracial differences • Racism • Discrimination

Sx

symptoms

Dx

Diagnosis

Tx

treatment

Rx

Prescription

DSM-5-TR Criteria for Attention-Deficit/Hyperactivity Disorder (ADHD)

A. Core symptoms threshold reached: Up to 16 yrs old: > 17 yrs and older: 6 symptoms per category > 5 symptoms per category

 B. Age of onset: symptoms were present prior to age 12 yrs

 C. Pervasiveness: symptoms were present in > 2 settings 

D. Impairments

 E. Differential diagnosis 

 Predominantly Inattentive Type

Patient meets inattentive criterion, but not hyperactive/impulse criterion, for the past 6 months

Predominantly Hyperactive/Impulsive Type

Patient meets hyperactive/impulsive criterion, but not inattentive criterion, for the past 6 months

Combined type

Patient meets both inattentive and hyperactive/impulsive criteria for the past 6 months 

3 ADHD dx classifications

Predominantly Inattentive Type, Predominantly Hyperactive/Impulsive Type, or Combined type

Guidelines on evidence-based assessment for ADHD

parent AND teacher rating scales, clinical interview, assesing child functions, and context for best assessment

ADHD overlaps

Anxiety, depression, substance use , ODD, ASD sympotms can overap with this disorder

ADHD impaired functional systems

 1. Attention: Alert/vigilance 

2. Cognitive control/executive function 

3. Motivation and reinforcement 

4. Temporal information processing