Psychology 385 Psychopathology University of Calgary Final Exam Study Notes

What is psychopathology?

Boundaries of abnormal behavior

Psych = Mind

Pathology = Study of disease

What are the 4Ds of abnormal behavior?

The 4 Ds:

Deviance = violation of social norms. May vary across culture and time periods.

Dysfunction = significant impairment in everyday behavior and relationships ; harmful dysfunction

Distress = extreme anxiety or negative emotions to self or others because of behavior

Danger = behavior is harmful and detrimental to self or others

Just because something is unusual doesn't mean it's abnormal

What 2 other things determine abnormal behavior?

statistical infrequency = rarity of the disorder amongst the population

cons = abnormality cut off is subjective and there are also frequently occuriring mental health disorders such as anxiety or depression

diagnosis by an expert using DSM-5

What is a mental disorder according to DSM-5?

A syndrome characterized by clinically significant disturbance in cognition, emotional regulation, or behavior that causes dysfunction in psychological, biological, or developmental processes in charge of mental functioning.

What is the exclusion criteria for mental disorders?

1. expectable and culturally appropriate response to an event -- eg. death of a loved one

2. deviant behavior -- eg. being a part of a religious or sexual minority

3. conflict b/w individual vs. society -- eg. voluntary effort to express individuality

In a year, how many Canadians experience a mental disorder or an addiction problem?

1 in 5

By the time Canadians reach 40, how many have had or have a mental disorder?

1 in 2

What percent of mental health problems have an onset during childhood?

70%

What age group is more likely to have a mental disorder and/or substance abuse disorders?

Young people aged 15 to 24

Who has higher rates of addiction?

Men

Who has higher rates of anxiety and mood disorders?

Women

What group of Canadians are more likely to report poor to fair mental health and by how much?

Lowest income group are 3 to 4 times more likely than highest income group

What is strongly tied to poor mental health?

Lower education

What is the mortality rate in people with mental disorders compared to without?

2.2 times more likely

How many years can mental disorders cut off from life expectancy?

10 to 20 years

How many Canadians die from sucicide a year? How many suicides is that a day?

Over 4500 -- 12 suicides a day

What is the leading cause of disability in Canada?

Mental disorders

How many Canadians are unable to work due to mental health problems in a week? This includes who?

At least 500,000

Includes 355,000 disability cases

175,000 full time workers

What is comorbidity?

The presence of more than one condition at the same time

Where are the most severe mental disorders concentrated?

In small segments of the general population

epidemiologists are looking at functional impairment rather than an absolute number of people with these problems

What is disease burden?

The extent of functional impairment and loss associated with a health problem

How do epidemiologists measure disease burden?

By combining mortality (premature death) and disability (lost years of healthy life/years living with a disability)

premature death + disability = total burden of disease

measured by DALY (daily adjusted life years)

What is health economics?

The costs to society associated with diseases

What is a DALY?

DALY (daily adjusted life years)

Measure of total disease burden

One DALY is = to?

One year of healthy life lost

What is the rank of mental disorders in total disease burden and what percent?

5th leading cause and 6.63%

What percent of all deaths do mental disorders cause?

1%

What percent of disabilities are mental disorders responsible for in developed countries?

47%

The costs associated with mental disorders is comparable to what?

Those associated with physical diseases

What was the total cost of mental disorders in Canada in 2011? How much will it be in 2041?

$51 billion in 2011, $2.53 trillion by 2041

Costs of mental disorders is related to what?

Production losses b/c number of hospital workers was reduced because they had mental health issues so they couldn't work

What is etiology?

a cause of disease

What is the classical psychodynamic paradigm? Explain concepts

S. Freud used this to explain abnormal behavior

Central concepts = the unconcious, conflict, and suppression

mind divided into 3 personality structures:

- the id = goverened by pleasure principle = illogical = unconscious = develops first

-the ego = governed by reality principle = balance b/w impulses and reality and keeps priorities straight = preconscious = develops 2nd

-the superego = governed by moral principle = overbearing and accumulates expectations for self and society = unconscious = develops last

Freud's classical psychodynamic paradigm: What is libido?

Sexual energy that's expressed in psychososexual stages:

-oral

-anal

-phallic = oedipus complex occurs and after resolution, personality structure is fully developed

-latency

-genital

Freud's classical psychodynamic paradigm: What is the oedipus complex in the phallic stage?

son wants access to mother but is blocked by the father. Resolves when son develops male characteristics by mimicking father--vise versa for girls (electra complex)

Freud's classical psychodynamic paradigm: What do defense mechanisms do?

Unconscious process that protect the ego

Freud's classical psychodynamic paradigm: What causes mental disorders?

1. fixation at certain stages caused by trauma or parental neglect

2. inability to defend against overwhelming emotions that come from internal conflicts or past traumas

Freud's classical psychodynamic paradigm: What are the different defense mechanisms?

Primative defenses:

-denial

-regression = return to earlier developmental stage

-projection

Higher level (neurotic) defenses:

-repression = unwanted memories and thoughts pushed into unconscious mind

-intellectualization = try to reason logically

-reaction formation = expressing opposite of true feeling

-displacement

Mature defenses:

-humor

-suppression

-sublimation

What is the current psychodynamic paradigm?

The object relations theory by Gabbard.

Much of mental life is unconscious and childhood experiences combined with genetic factors shape an adult.

early experiences with others and the associated emotional states are internalized to produce representations of those interactions. these internal object relationships repeat throughout life

The current psychodynamic paradigm: Gabbard's object relations theory: what are objects?

Something that acts as a stimulus and elicits a response from someone. refers to people one is associated with.

1. perception of object--eg. mother is a good object because she feeds me when I am hungry

2. self-perception in relation to object--eg. I'm getting fed therefore I am worthy of getting taken care of

3. relationship between individual and object--eg. I love my mother because she feeds me good

The current psychodynamic paradigm: object relations theory: what causes mental disorders?

When internal representations are defective because of poor parenting, problematic attachments, abuse, neglect, etc. it will cause problems in other areas of life and relationships and cause symptoms of mental disorders

The current psychodynamic paradigm: What are the levels of personality organization?

Neurotic level = intact reality, consistent sense of self and other people, generally high level defense mechanism, good superego = "normal"

Borderline level = fragmented sense of self and others, primative defenses, weak ego, weak superego

Psychotic level = disorganized personality, compromised reality, bad sense of self and others, poor defenses, difficulty distinguishing between experiences and perceptions, don't function well in society = "abnormal"

What is the cognitive behavioral paradigm?

Central concepts are reinforcement and punishment; direct or vicarious

abnormal behavior is learned like any other behavior:

classical conditioning = conditioning of involuntary behavior = autonomous nervous system including emotions

operant conditioning = conditioning of voluntary behavior = somatic nervous system

Cognitive behavioral paradigm: what is social learning theory?

learning of complex social behaviors such as patterns of aggression and interpersonal aspects of depression through observation of patterns of reinforcement and punishment

Cognitive behavioral paradigm: what are the three common principles between classical conditioning, operant conditioning, and social learning theory

1. thinking affects emotions and behavior

2. thoughts can be monitored and changed

3. by altering thoughts, a person will experience desired behavioral and emotional change

Cognitive behavioral paradigm: What causes mental disorders?

They're caused or influenced by an individual's cognitive appraisal of events

Cognitive behavioral paradigm: What therapy is used to treat mental disorders?

Rational Emotive Therapy - Albert Ellis = changing irrational thoughts that negatively affect a person using the ABC model

Cognitive behavioral paradigm: what is the ABC model?

Activating events (A) and beliefs (B) about an experience result in consequences (C) of life events

Cognitive behavioral paradigm: What is Aaron Beck's cognitive theory?

Emotions and behaviors are heavily influenced by individual beliefs and cognitive appraisal of events

Cognitive behavioral paradigm: what are the three main levels of cognition?

1. conscious thoughts = information processing and intermediate beliefs = rational thoughts and choices made with full awareness

2. automatic thoughts

3. schemas = core beliefs and personal rules for processing information that are shaped by influences in childhood and other life experiences

Cognitive behavioral paradigm: What is Cognitive Behavior Therapy (CBT)

Bringing a person's attention to their automatic thoughts, info processing errors, and schemas in efforts to modify them

What is the Humanistic-Existential Paradigm?

Central concepts = importance of person, self-actualization, and freedom/free will

Humanistic-Existential Paradigm: What causes mental disorders?

Humans struggle with fundamental aspects of life such as isolation and freedom. Psychopathology and anxiety arises from confronting these inevitable problems.

What is the systems theory: the bio-psycho-social conceptualization of mental disorders?

Examines the interactions between biological, psychological, and social factors to determine what causes mental illness. Every condition is connected

The systems theory: the bio-psycho-social conceptualization: What are underlying principles?

Holism = hollistic approach

Multiple causality

Diathesis (tendency for) and stress = biological, social, and adverse childhood events

Equifinality = multiple pathways

Multifinality = multiple outcomes

Reciprocal causality = causes and effects are bi-directional

Development

The systems theory: the bio-psycho-social conceptualization: What are biological factors that cause mental disorders?

Neurons

Neurotransmitters:

-amino acids = glutamate-Aminobutyric acid (GABA)

-monoamines = dopamine, norepinephrine, epinephrine, histamine, serotonin

-Acetocholine

Major Brain structures

Psychophysiology

-endocrine system

-HPA axis = hypothalamic-pituitary-adrenal access

Behavior genetics = heritability

The systems theory: the bio-psycho-social conceptualization: What are psychological factors that cause mental disorders?

Motivation

-Maslow's hierarchy of needs

-attachment

-dominance

Emotional regulation

Impulse Control

Personality factors: 5 factor model

1. neuroticism

2. extraversion

3. openness to experience

4. agreeableness

5. consciousness

Learning and cognition

Sense of self

Developmental issues

The systems theory: the bio-psycho-social conceptualization: What are social factors that cause mental disorders?

Socio-economic status

-ethnicity

-education

-income

Relationships

Marital status

Social support

Gender and gender roles

Racism, discrimination, stigma

What is the concept of resilience and what are some protective factors of psychopathology?

Resilience = resistance to stress

1. hardiness

2. self-enhancement

3. positive personal dispositions

4. repressive coping

5. social support

6. adequate socio-economic status

What is diagnosis?

Identification of a disorder on basis of characteristic symptoms

Why do you classify disorders?

1. to make sense of things

nosology precedes etiology

2. assist in treatment decisions

3. to organize the search for new knowledge

What is nosology?

The classification of diseases or disorders

What are the classification systems of disorders?

1. The diagnostic and statistical manual (DSM) system by the American Psychiatric Association

2. The international classification of diseases (ICD) from the world health organization -- used in other parts of the world especially Europe

What are the features of DSM-5?

Based description rather than theory

divided into 3 sections:

1. introduction and use of manual

2. broad categories of clinical disorders

3. emerging measures and models

Harmonization with ICD system (iICD-11)

The DSM-5 is a ____?

Collection of mental disorders, diagnostic codes, and descriptive text about each mental disorder

What do the descriptive texts in the DSM-5 cover?

-Diagnostic features

-prevalence of a mental disorder if known

-development and course of each disorder

-risk factors

-sex and gender related and cultural related diagnostic issues

-association with suicide

-differential diagnosis

-comorbidity with other disorders

What were the innovations of DSM-5 in 2013 compared to past issues?

Addition of some disorders such as hoarding disorder

Modification of other disorders such as schizophrenia spectrum disorders

Categorization changes such as OCD which is now a category of its own

More allignment with ICD

More recognition of age, gender, and culture

50 disorders subsumed into spectrum or non spectrum disorders

"Not otherwise specified" categories replaced by "other specified disorders" and "unspecified disorders"

More emphasis on clinical utility = impact of a test towards improved health outcomes

What are the further innovations in DSM-5-TR in 2022?

Addition of prolonged grief disorder

Symptom codes for suicidal behavior and non suicidal self-injury

Criteria refined for some disorders

Descriptive text updated to reflect most recent literature

Language changes in light of racism, cultural considerations, and social factors such as gender and gender identity to reduce stigma

How many pages does the current DSM-5-TR have? How many disorders?

947 pages

158 disorders

80 "other specified" and unspecified disorders

What does a DSM-5 diagnosis look like?

1. most severe disorder

2. with multiple diagnosis, other diagnosis follow in order of severity and/or implications for quality of life and functioning

3. psychosocial, cultural, and other issues follow as comments

What are mental disorders?

Syndromes = collection of symptoms

What are mental disorders determined by?

-certain symptom cluster

-exclusion criteria

-duration

-level of dysfunction

-type of etiology

-statistical deviation (infrequency)

-chemistry involved

How is inter-rater reliability measured?

classification

How is test-retest reliability measured?

tests

How is internal consistency measured?

tests

how is concurrent validity measured?

classifications

how is predictive validity measured?

tests and classification

how is face validity measured?

tests

how is criterion validity measured?

tests

how is construct validity measured?

What are some unresolved issues in the classification of mental disorders?

DSM-5 definition of disorders and criteria are not uniformally scientifically based

included research is severely criticized

number of symptoms needed to diagnose disorder often poorly justified

time periods vary and seem arbitrary

inter-rater reliability inconsistent

poor use of longitudinal information

social and political issues such as cultural differences in norms including stigma attached to mental disorders

What is psychological assessment?

The process of collecting and interpreting info that will be used to understand another person

What are the 3 major goals of psychological assessment?

1. making predictions

2. planning interventions

3. evaluating interventions

What are some major assumptions about behavior?

1. there is consistency in behavior

2. different levels of analysis may be used depending on questions that must be addressed

3. assessment procedures vary in usefulness depending on cases

What are the 6 possible sources of information on an individual's personality?

1. the psychological interview = unstructured, structured, or semi-structured

2. peer and significant others reports

3. behavioral observation and ratings

4. cognitive and neuropsychological testing

5. personality tests and self report inventories

6. projective tests

What are some types of projective techniques?

Association eg. rorschach inkblot test = what do you see in the image?

construction eg. thematic apperception test = ask to make a story based on a picture

completion of sentences or stories eg. sentence completion test

free expression, usually artistic eg. draw a person test, house-tree-person test

What social systems are assessed?

Families and groups

What biological systems are assessed?

Psychophysiological assessment:

-Brain imaging techniques:

CT SCAN

MRI

PET SCAN

What are some research methods in abnormal psychology?

Controlled experimental research = laboratory research and clinical trials

Quasi-experimental methods

Non-experimental methods = correlational research, case studies, and single-subject research

Epidemiological research

Studies of heritability = family studies, adoption studies, twin studies

How do you evaluate research in abnormal psychology?

Statistical significance

clinical significance

normative comparisons

What is mania?

a mood symptom marked by a hyperactive, wildly optimistic euphoric state. Very obvious impaired functioning and judgement. Associated with psychosis

lasts over a week

What is unipolar mood disorder?

only one extreme of mood is experienced--eg. only episodes of depression

unipolar mania is very rare

What is bipolar mood disorder? What's the diffference between BP I and BP II?

Episodes of depression and mania (BP I) or hypomania (BP II)

What is the difference between normal sadness and depression?

Sadness is temporary while depression is persistent over a period of time

Depression can occur without anything particularily "sad" happening

What is depression accompanied by?

Impaired ability to function in usual social and occupational roles. It also is accompanied by many symptoms besides a dejected mood.

What can depression be described as?

Being engulfed in a black cloud

What is hypomania?

A less severe form of mania--associated with elevated, euphoric mood. Less noticable to others compared to mania.

Lasts less than a week

What are the symptom categories of mood disorders? Explain the emotional symptoms

1. Unipolar depression:

-dysphoric mood

-despondency = low hope

-despair

-one third to two thirds experience anxiety

2. Mania

-elation

-euphoria

-irritability

-mood swings within short time period

What are the symptom categories of mood disorders? Explain the cognitive symptoms

1. Unipolar depression

-slow thinking and poor concentration

-guilt and worthlessness

-beck's depressive triad: focus on negative aspects of self, environment, and future

-suicidal ideation

2. Mania

-racing thoughts and impulsivity

-high distractability

-grandiosity = inflated ego and self-esteem

-perceptual disturbances = psychotic episodes in 2/3 of paitents

What are the symptom categories of mood disorders? Explain the somatic symptoms

1. Unipolar depression

-fatigue, lethargy, aches, and pains

-anhedonia = inability to experience pleasure

-loss of interest in activities and sex

-loss of appetite or overreating

-insomnia or hypersomnia

2. Mania

-excessive, intense energy

-pressured speech = rapid and loud speech

-psychomotor agitation = constantly moving around

-decreased need for sleep