Psychopathology Exam 1

What is psychopathology?

The field concerned with nature, development and treatment of psychological disorders

How common are psychological disorders?

1 in 5 adults suffer from mental illness

What are four components of stigma?

- distinguishing label is applied

- label refers to undesirable attributes

- people with the label are seen as different

- people with the label are discriminated against

Why is stigma important to consider when we talk about psychopathology?

Stigma leads to discrimination and prevents people from receiving appropriate diagnoses and treatments

How are psychological disorders defined?

Defined by using several characteristics from DSM-5

What are three characteristics of psychological disorders given in your text and why is no one characteristic sufficient to define all psychological disorders?

- personal distress: person's behavior may be classified as disordered if it causes them great distress, however not all psychological disorders cause distress (ex. personality disorder)

- disability and dysfunction: disability is impairment in some important area of life, not all disorders involve disability (ex. bulimia), dysfunction is something that has gone wrong and is not working as it should

- violation of social norms: violation from widely held standards, social norms vary across cultures and ethnic groups, too broad and too narrow for defining psychological disorder

Discuss somatogenesis vs psychogenesis in the history of psychopathology.

- somatogenesis: belief that abnormality is the result of a problem with a specific body organ and the cure lies in treating or removing the diseased organ, conducted in 2000-3000 B.C.

- psychogenesis: abnormality is the result of how one feels, thinks and/or perceives the world, psychotherapy involves examining behavior and thoughts in order to modify it

How have the causes and treatments of psychological disorders changed over the course of history including present day conceptualizations?

- Hippocrates (5th century BC) provided biological explanation saying that brain contributed to psychological disorder and healthy brain depended on balance between blood, black bile, yellow bile & phlegm, treatment was to restore natural balance by tranquility, sobriety & care in choosing food

- During dark ages (2nd century AD), supernatural explanations like displeasure of gods or possession by demon were causes of psychological disorders. treatment was to be cared by monks, touched by relics and drinking potions

- lunacy trials (13th century England) determined a person's mental health and placed those with strange behaviors in mental institutions

- St. Mary of Bethlehem and other asylums were established in 15th century to confine and care for people with psychological disorders. Non-existent or harmful treatments like drawing copious amount of blood or using fear were recommended from doctors like Benjamin Rush

- Pinel advocated for more humane treatment in asylum. Small, private mental hospitals allowed patients to live almost normal life by engaging in purposeful activities and talking with attendants

- Dix fought for improved conditions and more hospitals for psychological care. However, small staffs at public hospitals could not provide individual attentions.

- Mental hospitals todays are mostly private and the goal is the provide "just enough care"

Describe the historical forces that have helped to shape our current view of psychological disorders, including biological, psychoanalytic, behavioral and cognitive views. Who were the major figures and what were their contributions?

Biological:

-work behind general paresis and syphilis provided credibility for biological causes of psychopathology

-Galton performed genetic research with twins and coined the term nature and nurture and also discovered that mental illness can be inherited

- Sakel - insulin-coma therapy (abandoned over years)

- Electroconvulsive therapy (ETC) still used for its effectiveness

- Moniz - prefrontal lobomuy, made people listless, apathy, and loss of cognitive abilities

Psychoanalytic:

- Mesmer - early practitioner of hypnosis

- Breuer - cathartic method, which allows for release in emotional tension from trauma

- Freud - psychoanalytic theory, psychopathology results from unconscious conflicts between id, ego and superego; defense mechanism - strategy used by ego to protect itself from anxiety

- Psychoanalytic therapy - to understand the person's early childhood experience, key relationships and current relationships. transference is people's response to analyst that seem to reflect attitude and ways of behaving toward important person in the person's past.

- Jung - analytical psychology, collective unconscious, catalogued personality characteristics

- Adler - individual psychology where people get fulfillment derived from working for the social good

Behavioral:

- Pavlov - classical conditioning and learning through association

- Watson - pioneer of behaviorism

- Thorndike - law of effect

- Skinner - principle of reinforcement (positive and negative)

- Bandura & Menlove - used modeling to reduce children's fear of dogs

- Behavior therapy - systematic desensitization (deep muscle relaxation & gradual exposure to fears), intermittent reinforcement (rewarding a response only a portion of the time)

Cognitive:

- Beck - cognitive therapy (changing cognitions to change feelings behaviors or symptoms)

- Ellis - rational-emotive behavior therapy (self statements reflect unspoken assumption and eliminate self-defeating beliefs)

Why is the example of general paresis and syphilis important in this history?

- Louis Pasteur's germ theory of disease laid the groundwork for demonstrating the relationship between syphilis and general paresis

- link established between infection, damage to the brain, and a form of psychopathology

- led to biological approach gaining credibility for causing psychopathology

Describe the major tenets of Freud's psychoanalytic approach (e.g., unconscious conflict, id, ego, superego, defense mechanisms, free association, etc.), as well as strengths and criticisms of this approach.

- id: seeks the immediate gratification of urges

- ego: primarily conscious, deals with reality

- superego: basically a person's conscious

- these unconscious conflicts in the individual and leads results in psychopathology

- defense mechanism: strategy used by ego to protect itself from anxiety

- techniques of psychoanalysis include free association, interpretation and analysis of transference

- strength: childhood experiences help shape adult personalities, there are unconscious influences on behavior, and the causes and purposes of human behavior are not always obvious

- criticism: difficult to study empirically, psychoanalysis involved a distancing between therapist and client, focuses exclusively on early childhood rather than present day problems

What is behaviorism?

focuses on observable behaviors rather than on consciousness or mental functioning

What is classical conditioning, operant conditioning, modeling, and behavioral therapies?

Classical conditioning:

ex) Meat powder is the unconditioned stimulus (UCS) and the natural response of salivation is unconditioned response (UCR). When meat powder is preceded by ringing the bell, the sound of the bell (conditioned stimulus (CS)) can elicit the salivation (conditioned response (CR))

- extinction: when fewer and fewer CRs are elicited, the CR disappears

- Little Albert and white rat - classical conditional can also be used to instill fear

Operant conditioning:

- Thorndike & law of effect: behavior followed by consequences satisfying to organism will be repeated, and behavior that is followed by unpleasant consequences will be discouraged

- Skinner & Principle of reinforcement: positive - strengthening of a tendency responded by a virtue of the presentation of a pleasant event; negative - strengthens the response via the removal of an aversive event

Modeling:

- learning by watching and imitating others' behavior

- can increase or decrease diverse kind of behaviors

- Bandura & Menlove & modeling reduced children's fear of dogs

What are strength and weaknesses of behaviorsm?

- Strength: studying observable behavior so easy to quantify and collect data.

- Weakness: can be seen as one-dimensional approach, does not account for different types of learning, especially ones that occur without reinforcement and punishment

What is deinstitutionalization, what are some factors that contributed to this movement, what are the consequences of it?

- social policy of discharging large number of hospitalized psychiatric patients into the community

- came from concerns about ethics of confinement and advent of antipsychotic medicine

- "revolving door": patients come into hospital, stabilizes from medicine, gets discharged, stops taking their medication, and comes back to the hospital

What are the different mental health professions - how are they similar/different?

- Psychologist - Ph. D. or Psy. D., advanced training in assessment and diagnosis and how to practice psychotherapy

- Psychiatrist - M.D. with training in diagnosis and pharmacotherapy, can prescribe psychotropic medications

- Psychiatric nurses - B.S. or M.S.

- Social worker - trained in psychotherapy, not trained in psychological assessment

What is a paradigm and why is it important?

A paradigm is a conceptual framework or approach within which a scientist works. No one paradigm offers the "best" conceptualization of psychopathology. The paradigms that guide the study and treatment of psychopathology are: genetic, neuroscience and cognitive behavioral. Paradigms offer some (not all) important information about causes and treatment. Integrative paradigm provides the basis for multifaceted approach. Paradigms specify what problems scientists will investigate and how they will go about the investigation.

What factors cut across paradigm?

role of emotion and sociocultural factors. Emotions are expressive (including behavioral and facial expressions), experiential (subjective), physiological (involves bodily changes), and most psychopathology includes disturbance of 1+ emotions. Sociocultural factors can include gender, race, culture, ethnicity, and socioeconomic status. Environmental factors and culture can affect symptoms/seeking of treatment.

Describe the essential components, the believed causes/treatments of mental illness, and strengths/weaknesses of genetic paradigm.

Part of biological paradigm and main components include: Almost all behavior is heritable to some degree, genes do not operate in isolation from the environment (environment shapes how our genes are expressed), and the relationship between genes and environment is bidirectional. It is difficult to determine exactly how genes and environments reciprocally influence one another & several genes can contribute to a specific disorder so it can become complex.

What does it mean that psychopathology has polygenic traits? Why has it been so difficult to identify specific risk genes in the context of psychopathology?

several genes, perhaps operating at different times during development, turn themselves on and off as they interact with a person's environment. We do not inherit psychological disorders from our genes alone; we develop them through the interaction of our genes with our environment. Several genes can contribute to a specific disorder and each individual gene or genetic mutation may reveal a very small effect.

What is heritability?

The extent to which variability in a particular behavior (or disorder) in a population can be accounted for by genetic factors. Two points: 1) heritability estimates range from 0.0 to 1.0 with higher number = greater heritability. 2) heritability is relevant only for large populations of people, not particular individuals so it is incorrect to talk about any one person's heritability for a particular behavior or disorder.

Compare/contrast behavior genetics with molecular genetics.

Behavioral genetics: studies the degree to which genes and environmental factors influence behavior. Includes genotype (genetic makeup inherited by an individual) and phenotype (expressed genetic material). Molecular genetics: identifies genes and their functions; studies alleles which are different forms of the same gene and polymorphisms which are differences in DNA sequence on a gene occurring in a population. In other words, behavioral genetics is not interested in specific genes, but in relative contribution of genes vs. environment. Genes increase our predisposition for disorder but does not cause disorder.

What are gene-environment interactions? What is epigenetics?

Gene-environment interaction: a given person's sensitivity to an environmental event is influenced by genes. Epigenetics: the study of how the environment can alter gene expression or function.

Describe the essential components, the believed causes/treatments of mental illness, and strengths/weaknesses of neuroscience paradigm.

Neuroscience paradigm holds that psychological disorders are linked to aberrant processes in the brain. Major components: neurons and neurotransmitters, brain structure and function, and neuroendocrine system. Neurotransmitter/receptor malfunction, wrong brain development, and poor response to external stressors can contribute to mental illness. Treatment is done through psychiatric drugs (such as antidepressants). The neuroscience paradigm ignores more complex views of behavior, and is seen as reducing mental and emotional responses in biology. It is seen as adopting reductionism, a view that whatever is being studied can and should be reduced to its most basic elements or conditions.

What are the structure and function of neurons?

Includes cell body, dendrites, axons, and terminal buttons. Transmits signals across the synapse

What are the major brain areas involved in psychopathology?

Anterior cingulate, hippocampus (memory), hypothalamus (regulate homeostasis), and amygdala (attention to emotionally salient stimuli).

How does stress influence the immune system?

Stress affects the immune system. Can cause problematic changes in immune system.

How is neuroendocrine system involved in psychopathology?

HPA axis is involved in response to stress and mediates the impact of external stressors on the body through changing the amount of cortisol released. Can lead to mood disorders, trauma-related disorders, insomnia, personality disorders, etc.

What is the autonomic nervous system and why is it relevant here?

Includes sympathetic nervous system (excitatory/fight or flight) and parasympathetic nervous system (rest and digest). Much of our behavior is dependent on a nervous system that operates very quickly. The autonomic nervous system figures prominently in many anxiety disorders (especially panic) and PTSD.

Describe the essential components, the believed causes/treatments of mental illness, and strengths/weaknesses of cognitive behavioral paradigm.

Cognitive behavioral paradigm traces its roots to learning principles and to cognitive science. Problematic behavior is likely to continue if it is reinforced. To alter behavior, the consequences should be modified. Cognitive behavioral therapy used. Unclear if distorted thoughts are the cause or the result of psychopathology.

How does the cognitive behavioral paradigm draw from both behaviorism and cognitive approaches?

The paradigm draws from behaviorism by attempting to alter behavior by modifying consequences (time out, exposure, etc). However, behaviorism alone is criticized for ignoring thoughts and emotions. Cognition is the mental processes of perceiving, recognizing, conceiving, judging, and reasoning. Cognitive science focuses on how people structure their experiences, how they make sense of them, and how they relate their current experiences to past ones that have been stored in memory. Cognitive scientists regard people as active interpreters of a situation, with people's past knowledge imposing a perceptual funnel on the experience. A person fits new info into an organized network of already accumulating knowledge (schema).

What is CBT? How does it work?

CBT incorporates theory and research on cognitive processes; pays attention to private events like thoughts, perceptions, judgments, self-statements, and unconscious assumptions. Cognitive restructure involves changing a pattern of thought and believes that changes in thinking can change feelings, behaviors, and symptoms. CBT in a nutshell: interpretation of an event causes feelings

What is diathesis? What is stress? Why is this an integrative paradigm?

Diathesis: underlying predisposition toward disease. Stress: environmental, or life, disturbances. Integrative paradigm (diathesis-stress): integrates genetics, neurobiological, psychological, and environmental factors.

Why do most contemporary scientists believe in diathesis-stress paradigm?

Psychopathology is unlikely to result from one single factor. Both stress and diathesis are necessary in development of disorders. The data gathered by researchers holding different paradigms are not incompatible with one another, Because each paradigm seems to have something to offer in enhancing our understanding of psychological disorders, an integrative paradigm is most comprehensive.

What is the purpose of diagnosis?

to determine the disorder the patient is suffering from in order to provide clinical care and to facilitate communication among professionals

What is reliability and validity?

Reliability:

-consistency of measurement

- interrater: degree to which two independent observers agree on what they have observed

- test-retest: extent to which people being observed twice or taking the same test twice and receive similar scores

- alternate forms: the extent to which scores on the two forms of the test are consistent

- internal consistency: assesses whether the items on a test are related to one another

Validity:

- whether a measure measures what it is supposed to measure

- content: whether a measure adequately samples the domain of interest

- construct: relevant when we want to interpret a test as a measure of some characteristic or construct that is not observed directly or overtly

*reliability does not guarantee validity

What is the DSM? How does it classify psychological disorders?

- Diagnostic and Statistical Manual of Mental Disorders

Classifies by:

- diagnostic criteria for a diagnosis

- description of associated features

- summary of research literature

What are the advantage of a classification system like the DSM?

- defines diagnoses on the basis of symptoms

- chapters are organized to reflect patterns of comorbidity and shared causes

How has the DSM improved over time?

- increased definition, list of symptoms and list of disorders

- increased cultural sensitivity by asking cultural formation interview questions for clinicians and how different syndromes present across different culture

What are the criticisms of the DSM?

- # of diagnoses continues to increase

- comorbidity: presence of a second diagnosis

- diagnoses don't identify homogenous groups

- reliability is not very good

What's the difference between dimensional vs categorical approach to classification?

Dimensional:

- degree of an entity that is present

- gives the ability to describe sub-threshold symptoms

Categorical:

- do the symptoms fit the category or not?

- one threshold with actual hard boundaries

What is the RDoC initiative? What does it attempt to assess?

- Research Domain Criteria

- investigation of psychological/biological variables relevant for many conditions

- attempts to develop a new classification system

Why do we conduct assessments? Why are standardization and norms important for assessments?

- we conduct assessments to understand the individual, to diagnose, to predict behavior, to plan treatment, and to evaluate treatment outcome

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What are the characteristics of clinical interviews and structured interviews? Why are they used?

Clinical interview:

- establish rapport

- empathize with client experiences

- encourage client to elaborate on concerns

Structured interviews:

- standardized interview where all interviewers ask the same question in a predetermined order

- good interrater reliability for most diagnostic categories

What are the advantages and disadvantages of clinical judgements?

Clinical assessment: systematic evaluation and measurement of psychological problems. Used to: understand the individual, diagnose, predict behavior, plan treatment, and evaluate treatment outcome.

How is stress assessed?

semi-structure interviews, evaluation of important event in person's life, dates when life stressor occurred

What are common personality and IQ tests? What do they tell us about personality and intelligence?

Personality:

- MMPI-2: yields profile of psychological functioning, validity scales to detect lying and faking

- Big Five Inventory-2: assess the broad five domains of personality

IQ:

- assess current cognitive ability

- predict school performance, diagnose learning disabilities

- highly reliable and good validity

How are behavioral and cognitive characteristics assessed?

Behavioral:

- direct observation of behavior as it occurs, possibly in lab settings

- self-monitoring, use of ecological momentary assessment (EMA) where people enter responses into devices

Cognitive:

- questionnaires, like dysfunctional attitude scale (DAS)

What are the different brain assessment techniques and what exactly do they measure?

CT scan for brain structure and detecting differences in tissue density or structural abnormalities; MRI for brain structure (higher quality than CT) using electromagnetic signals; fMRI for brain structure and function by measuring blood flow in the brain; PET scans for brain structure and function (more invasive than fMRI) by injecting radioactive isotopes into bloodstream; SPECT (less invasive form of PET).

What neuropsychological and psychophysiological assessment techniques are used and what do they measure?

Neuropsychological tests are based on the idea that different psychological functions rely on different areas of the brain; can provide clues about where in the brain the damage may exist that can then be confirmed with more expensive brain imaging techniques. Two types: Halstead-Reitan battery test includes: tactile performance test-time, tactile performance test-memory, speech sounds perception test. Laura-Nebraska battery determines basic and complex motor skills, rhythm and pitch abilities, tactile and kinesthetic skills, verbal and spatial skills, receptive speech ability, expressive speech ability, writing, reading, arithmetic skills, memory, and intellectual processes.

Psychophysiology is concerned with the bodily changes that are associated with psychological events/ Includes measurement of heart rate, skin conductance, brain electrical activity, and muscle tension. Psychophysiological measurement can be used for treatment as well via biofeedback (patients become aware of their physical changes and try to control it).

What are the strengths/weaknesses of all of these neurobiological assessments?

Expensive and not standardized. Cannot diagnose anything based on brain images. Measurements also do not differentiate between different emotional states. Scanning environments can induce change. Brain activity cannot be manipulated to measure change in behavior.

How do cultural and ethnic diversity affect assessment and how can this bias be avoided?

Measurement developed for one culture may not be valid or reliable for another. Guidelines for translating and adapting tests exists, but are not always followed. Cultural biases may cause a clinician to over or underestimate problems in members of a culture. Can be avoided by: training programs, modifying assessment procedures to ensure that the person truly understands the requirements of the task, use structured diagnostic interviews.

Define science and describe the scientific method.

- Science - "to know"

Scientific method:

- testability: is the study question testable?]

- hypothesis: a scientific proposition stated clearly and precisely, has to be falsifiable

- replicability: can other scientists follow your method and get same result?

What is the difference between correlation and causation? How do we test for each?

Correlation: do variables x and y vary together?; use of correlation coefficient form -1.0 to +1.0; includes family , twin, adoptees method

Causation: does x cause y (or vice versa)? includes epidemiological research

What's the difference between statistical and clinical significance?

Statistical significance:

- probability ≤ 0.05

- influenced by number of participants, larger samples increase likelihood significance

Clinical significance:

- is the relationship between variables large enough to matter?

Correlation

including how to conduct and interpret findings from each. Describe advantages and disadvantages of each method. Identify and describe common types of correlational designs and experimental designs and note advantages and disadvantages of each.

- study of relationship between two or more variables, as they exist in nature (do x and y vary together?)

- do not involve manipulation of variable

- correlation coefficient (r): -1.0 to 1.0, higher the absolute value = stronger relationship

- positive direction: increase of X associated with increase of Y

- negative direction: increase of X associated with decrease of Y

- advantage: good for when there are ethical reasons not to manipulate a variable, used to study heritability of different disorders, incidence, prevalence, risk factors, etc.

- disadvantage: directionality and third-variable problems can interfere with determining casuality (use longitudinal study to overcome the directionality problem)

Case Study

including how to conduct and interpret findings from each. Describe advantages and disadvantages of each method. Identify and describe common types of correlational designs and experimental designs and note advantages and disadvantages of each.

- recording detailed info about one person at a time

- lack the control and objectivity of other research methods; validity of the info gathered is sometimes questionable

- does not provide good evidence in support of a particular theory because they do not provide a way to rule out alternative hypotheses

- used to provide a rich description of a new or unusual clinical phenomenon or treatment

- used to disprove an allegedly universal hypothesis

- used to generate hypotheses that can be tested through controlled research

Experimental

including how to conduct and interpret findings from each. Describe advantages and disadvantages of each method. Identify and describe common types of correlational designs and experimental designs and note advantages and disadvantages of each.

- for determining casual relationships

- the investigator manipulates an independent variable and participants are assigned to conditions by random assignment (MUST)

- randomization: equally distributes bias across groups

- advantages: powerful method for determining causal relationship, often used for treatments, examine analogue versions of risk factors

- disadvantages: single-case experimental designs can have limited external validity.

Define internal and external validity and ways to increase each of them

- internal validity: extent to which experimental effect is due to independent variable

- external validity: extent to which results generalize beyond the study (would results apply to others besides the study participants?)

- internal and external validity have negative correlation

Explain the standards and issues in conducting psychotherapy outcome research. What does it mean for a treatment to be empirically supported? What types of studies must be conducted?

Treatment studies should include:

- clear definition of sample

- clear description of treatment

- inclusion of a control or comparison condition

- an experimental design, including random assignment

- reliable and valid measures

- large sample size

- empirically supported treatment has to show that these treatments were more effecting than some control or comparison condition in a randomized control trial

- randomized control trial must be conducted

What is meta-analysis? What are the advantages and disadvantages?

- systematic approach for drawing conclusions from a series of investigations

- synthesize quantitative results across studies to arrive at some general understanding of the findings

- disadvantages: poor quality studies are included