Mental Illness Midterm I

3 approaches in defining Normality

1) Normal as an average: most statistcially common

2) Normal as an ideal: state of perfection

3) Normal as adjustment: how one effectively copes according to situataion

What are the cons of approaching normality as an average

For disorders like anxiety where prevalence is high, would not be considered in need for treatment.

Leads to an under diagnosis

What are the cons of approaching normailty as an ideal

standard for perfection is rarely achieved.

Doesn’t take into account different cultural standards of “an ideal”.

factors like SES, relationships, has nothing to do with the normality of ind.

Mental Health Disorder (APA definition)

a mental disorder is a list of sxs that causes arked distress and impairment, puts risk to others and self, socially and culturally unacceptable bahviors

• need all 4 to qualify

Rosenhan Study

confederates (actors) faked MHD symptoms and tried to get admitted to mental hospitals

all actors were diagnosed and admitted

Showed unreliability of psychologists & mental health professionals

changed rigor of diagnosis and improved validity of mental health treatments

Advantages to diagnosing a MHD

ind. can get treatment they need

insurance can cover it

provides language for clinicians

provides relief/empowerment 

Disadvantages to diagnosing a MHD

stigma of being labeled as having a mental illness

doesn’t take into account comorbidity

self-fulfilling prophecy: changes self-concept. Ind. might give in to their illness, feel like they have no control in coping with disorder

inaccurate or misdiagnosis

Mental Health Disorder (APA)

a collection of symptoms characterized by causing:

• marked distress

• impairment

• puts at risk self or others

• socioculturally unacceptable behaviors

DSM-V

Diagnostic and Statistical Manual of Mental Helath Disorders

most widely accepted diagnostic system in US

approved by APA

empirically based

Features of the DSM-V

medical model: biological and environmental reason for disorder

avoids issues of etiology (cause of disorder) except trauma related disorders

“Chinese Menu Style: many different sxs, so disorder can manifest differently based on ind. 

Critiques of DSM-V

categorical: either meet criteria or don’t; but can be combatted by diagnosing as “unspecified” or “other specified” if sxs are sub threshold

gender bias: ED sxs previously included lack of menstrual cycle—> under diagnosis of males with EDs and increased stigma

Political nature of diagnosis: treatment for obesity is psychologically based, but insurance companies don’t want to pay for treatment

APA Ethics Code

psychologists must follow, otherwise license can be suspended or revoked

revised based on real world event

Guantanamo Bay—> prohibition from participating in torture 

3 Ethical Dilemmas

Clinician-Client Relationship: cannot get into a romantic relationship with client until after 2 years. Even though, extremely looked down upon

Psychologist's competency: if client has a problem that is outside your area of expertise, should refer to a colleague with expertise or disclose that you lack expertise

Report to authorities: if client displays potential harm to self or others, strongly advised to report to police, but not responsible for client’s actions

Psychological Assessment

procedure to evaluate psychological, physical, and social factors influence functioning

What is the purpose of psych assessments?

School, treatment, research, aptitude

Clincial Interview

diagnostic interview to determine purpose of appointment and how to build treatement course

Neuropsychological Assessments

how brain functioning impacts socioemotional well-being

medical, sports, and ADHD testing

Theoretical Oriantation

based on theoretical approaches to therapy. guides how clinician treats client

Types of clinical interviews

1) structured: yes no questions

2) unstructured: open ended questions

3) semi-structured: mix of both

Mental Status Exam

way to assess the behavior and functioning of client through clinician interactions

looks at behavior and appearance

language and thinking style

Intelligence Tests

used in school settings: assess learning or intellectual disability

determine if ind. needs learning accommodations like IEPs or 504s

ex) WISC

Personality Tests

used to determine an ind. patterns of behavior

Self-Report vs. Projective

Self-Report: standard questions and fixed responses 

ex) MMPI

Projective: more ambiguous, aims to get at unconscious processes

ex) ink blot, apperception test (story telling)

Behavioral Assessment

self-monitoring:

journaling and checklists (to assess frequency)

behavioral observation:

in vivo: classroom setting

analog: artificially controlled

Ads and DisAds of Intelligence tests

Ads: highly standardized—> high validity and reliability

Dis: cultural bias

Ads and DisAds of personality tests

Ads: gets at ind. unconscious processes

Dis: lacks validity and reliability

Ads and DisAds of behavioral assessments

ads: very specific targeted assessment

dis: leaves of larger context of problem

Ads and Disads for clincial interviews

Unstructured:

ads: creates rapport

disads: subjectivity and bias

Structured:

ads: gives client words to describe problems

dis: feels impersonal

Psychotherapy

“Talk therapy”

interaction between clinician and client that aims to reduce distress, find solutions to problems, modify ways of thinking or behavior

4 main types of theoretical orientation

1) psychodynamic/psychoanalytic

2) behaviorist

3) cognitive

4) family systems

Psychoanalytic Approach

aimed at uncovering unconscious proceses

focus on childhood

effective for anxiety and depression 

4 tenets of psychodynamic theory

1) psychic determinism: there is a reason or cause for a certain behavior

2) defense mechanisms: can be adaptive, but becomes maladaptive when too rigid

3) unconscious processes: psychological tensions result from conflicts between Id and Superego

4) sexual agression and impulses in infancy and childhood

Behavioral Approach

behaviors learned through conditioning (reinforcement and punishment) and observational learning (modeling and imitation)

treatment involves focusing on event or stimulus that elicits behavior, and how to use reinforcers/punishments to teach new behavior

ASD, ADHD, Phobias

Family Systems Theory

ind. is seen as part of a bigger unit (the family)

problems within ind. is caused by dysfunction in the whole system

work with whole family

substance use or eating disorders

Cognitive Theories

Thoughts influence actions and behaviors

Unipolar Depression

only experienced MDE

Bipolar Depression

experienced both MDE and ME

Major Depressive Episode (MDE)

2+ weeks of:

loss of interest in once pleasurable activities

depressed mood almost every or everyday

Other symptoms:

change in appetite, weight, sleep

fatigue or low energy

suicidal ideation

Manic Episode

1+ week of (or until hospitalization):

elevated or irritable mood

feel superhuman (can complete impossible tasks i.e jumping off building and flying)

Other symptoms:

lack of need of sleep

racing thought

risky behavior

Major Depressive Disorder (MDD)

Criteria:

• at least one MDE

Persistent Depressive Disorder (Dysthymia)

Criteria:

• less severe version of M

• 2+ years of chronic low moods

Seasonal Affective Disorder

winter and summer depression

Criteria:

• change in sleep, appetite, weight

• hyposomnia or hypersomnia

Bipolar I

Criteria:

• at least one ME with or without MDE

Bipolar II

Criteria:

• at least one hypomanic episode

• less severe form of manic episode

Prevalence and Course of Unipolar Depression

Prevalence:

• most common reason for seeking services

Course:

• sxs come on gradually

• most remit after 6 months

• kindling: those with depression have higher chance of having another MDE

Prevalence and Course of Bipolar Depression

Prevalence:

• low prevalence (single digits)

Course:

• starts in 20s

• often signs in childhood (moody, hypersensitive)

• mania comes on and goes away suddenly

• kindling: extremely high (almost 100%)

Biological Explantation for Unipolar Depression

Genes

Neurotransmitters

Treatment for Unipolar Depression

SSRIs

Shock therapy (ECT)

CBT: challenge maladaptive thought and replace with adaptaive thoughts

Biological Explantation for Bipolar Depression

genetic

environmental stressors trigger it

Treatment for bipolar disorders

Lithium

medication paired with psychotherapy

Panic Disorder

Criteria:

• panic attacks that are reccurent and unexpected.

• physical sxs similar to heart attack

• fear of losing control or dying

• discrete intense fear or discomfort

Onset:

• usually appears in 20s

• before, children could not qualify due to belief that they were not capable of cognitive aspect; fear realted to have panic attack. Now, research shows that they can be diagnosed, but is rare due to frequency of attacks not meeting criteria

Prevalence:

• while many ppl experience panic attacks, less than 5% have PD

Course:

• can be weeks or months before attacks happen again or can be daily

Impairment:

• 50% seek financial assistance since they cannot go to work

• 94% seek help

Agoraphobia

Criteria:

• fear of being in situations where cannot escape if panic attack occurs (i.e public spaces)

• accompanying disorder to panic disorder

• avoidance of situation that triggers attacks or endurance with intense anxiety

Onset:

• same with PD

Prevalence:

less than 5%

Course:

• same with PD

Impairment:

• same with PD

Generalized Anxiety Disorder

Criteria:

• excessive worry or anxiety; not discrete but a continuous feeling

• difficult to control thought

• restlessness/agitation, muscle tension, difficulty concentrating

Onset:

• mid 20s

Prevalence:

• less than 6%

• under diagnosed b/c anxiety misattributed as a personality trait when it could be a disorder

Course:

• tends to be chronic with some waxing and waning 

Specific Phobia

Criteria:

• intense anxiety in response to a stimulus (object or event)

• exposure provokes immediate anxiety

• avoidance of stimulus or endurance with intense anxiety

Onset:

• starts in childhood

• those diagnosed with SP in childhood can develop into GAD into adulthood

Prevalence:

• most common anxiety disorder (13%)

Course:

• w/o treatment it is lifelong

Impairment:

• ind. can shape their life around their phobia, unless it impairs daily functioning.

• most who seek help have phobias realted to driving, flying, or enclosed spaces

Social Anxiety Disorder

Criteria:

• fear of social situations that causes significant distress or impairment (i.e public speaking)

• fear of embarrassing oneself

Onset:

• early teenage years

• social relationships are extremely important to development

Prevalence:

• also a common anxiety disorder (13%)

Course:

• sxs usually decline as one gets older

Obsessive Compulsive Disorder (OCD)

Criteria:

• Obsessions: thoughts or impulses that are irrational, intrusive, and inappropriate:

• ex) contamination, need for symmetry, fear of harming others or self

• Compulsions: repetitive behaviors that derive from obsessions that aim to decrease distress or prevent a threatening event from happening

• ex) hand washing, checking, arranging

• usually connection between compulsions and goals do not make sense (ex. I need to arrange my clothes in a specific way so that I don’t die)

Onset:

• late adolescence to early adulthood

Prevalence:

• extremely uncommon (less than 2%)

Course:

• tends to be chronic without tx

• can see roots of disorder in childhood

Biological Perspectives of Anxiety

Genetics:

• increased concordance rate of anxiety between monozygotic twins vs. dizygotic twins

• no specific genes linked with anxiety, but it could be associated wtih gene affecting temperment

Neurotransmitters:

• low levels of serotonin and GABA

• GABA: helps regulate nerural activity and control anxiety

Behavioral Perspectives of Anxiety

• conditioning (reinforcements and punishments)

• observational learning (modeling and imitation

• information transfer (if have. not been taught to always stay away from dogs, might develop anxiety when you do encounter them)

Cognitive Perspectives of Anxiety

Inaccurate interpretations:

• internal: feel ineffective in coping

• external: threatening

• never challenged, so anxiety remains

Fear of fear model:

• after experiencing the first panic attack, ind. becomes hypersensitive to physiological sxs. Anxiety is produced from fear of future attacks happening

Treatment of Anxiety Disorders

Medication:

• SSRIs

• Benzodiazapines (high dependence)

Surgery:

DBS: electrical implants in brain stimulated externally

• effective for severe or treatment resistant OCD

CBT:

• psychotherapy of choice (70% improve)

• cognitive reconstructing: replacing maladaptive thoughts with adaptive thoughts

• thought stopping: anxiet management

• relaxation techniques

• simulate physio response to practice controlling with phys. sxs.

• exposure: flooding vs. systematic desensitization (more effective)

• in vivo or analog