True Adult Psych Exam I Cards

Chronological History of Abnormal Psychology

Ancient and Naturalistic Perspectives, Middle Ages through the 17th Century, 1800s - Biological Viewpoints and Early Talk Therapy, Mid-to-Late 1800s - Humane Treatment Movement, Early 1900s - Behaviorism, Mid-20th Century - Research and Medication, Late 20th into 21st - Affordable Care Act and Technology Assisted Therapy

Hippocrates viewpoint

Proposed mental issues were rooted in heredity and environment; famously attributed psychological problems to imbalance of the four “humors”

Plato viewpoint

Psychological phenomena as the responses of the whole organism

Middle Ages through the 17th Century

Reversion to supernatural explanations for abnormal behavior; common responses to mental distress included exorcism and accusations of witchcraft

1800s

Pasteur’s germ theory of disease, discovery of general paresis, talk therapy, Breuer and Freud

General Paresis

Disorder linked to syphilis bacteria, major breakthrough for biological view on mental illness

Breuer

Found symptoms disappeared after patients spoke about trauma while in a trance

Freud

Developed the technique of psychoanalysis

Dorothea Dix

Investigated the poor conditions of jails and almshouses and campaigned for better treatment

Nellie Bly (Elizabeth Cochran)

Faked a psychological disorder to spend 10 days in an asylum; reported on the abuse and neglect witnessed

Behaviorism

Viewpoint rooted in lab science focused on directly observable behavior; period exemplified by Pavlov’s classical conditioning paradigm

What was established in 1949 to provide funding for mental health research?

National Institute of Mental Health

What shift occurred in 1950s in terms of psychopathology?

Depopulation of mental hospitals began as a result of introduction of psychotropic medications, including the first antidepressants

What happened in 1987?

Prozac was introduced

What act was brought about in the 2010s?

Affordable Care Act, mandated that insurance companies offer mental health and substance use benefits

What does the one-dimensional approach assume?

That a single factor is the sole cause of a disorder

Pitfalls of the One-Dimensional Model

• False Dichotomies - either or mentality (e.g. nature vs nurture)

• Lack of integration - ignores possibility that multiple factors can contribute to a single disorder

• Ignoring reciprocity - Falls to recognize reciprocal nature of different factors, such as how culture might influence physical brain development

What does the Multipath model assume?

Mental health is integrative and interactive, involving four distinct dimensions

Multipath Model dimensions

1) Biological - genetics, neurotransmitter imbalances, brain development 2) Psychological - emotions, personality traits, learning 3) Social - social support, belongingness 4) Sociocultural - race, gender, SES, sexual orientation

Multiple Paths to Same Outcome

Two individuals can develop the same disorder through different pathways. Ex: One having a genetic vulnerability and another experiencing chronic financial stress

Same starting point, different endpoints

Multiple people might share a specific biological risk factor but end up with different results. Ex: overly active HPA axis could lead to development of PTSD, another GAD, and a third with no disorder

Risk factors: Biological

Genetic vulnerabilities, brain function imbalances, and an overactive HPA axis stress response

Risk factors: Psychological

Thinking traps, poor emotion regulation, and high levels of neuroticisim

Risk Factors: Social

Absent or dysfunctional relationships, social isolation, and family stress

Risk Factors: Sociocultural

Low SES, experiences of discrimination, and cultural pressures

Buffers and Protective Factors

Health relationships, effective emotion regulation, social support (sense of belonginess)

Health relationships provide both ___ and ___ benefits that can shield individuals from distress

Tangible and intangible

Reliability

Refers to the consistency of a test or procedure — specifically, the degree to which it produces the same result repeatedly

Key question a clinician concerned about reliability may ask

Does the measure consistently do its job?

Interrater Reliability

Specific type of reliability measuring whether different scorers reach the same results when scoring the same test

What common diagnoses have a very good level of interrater reliability?

Major Neurocognitive Disorder and PTSD

What two disorders have questionable levels of interrater reliability?

Major Depressive Disorder and GAD

Validity

The accuracy of a test or procedure — the degree to which it actually measures what it is intended to measure

What is a key question a clinician concerned about validity ask?

Does the measure correctly measure what we want?

Example of validity

Math test has validity if it measures math skills, but lacks if it inadvertently measures reading skills instead

Validity criticism of IQ tests

Poor predictive validity for future behavior or achievement, as they may reflect cultural and social factors rather than innate intelligence

Comorbidity

Mental health conditions can often co-occur

GAD is highly comorbid with what?

Depression - 40-70% of individuals experience both

SAD often occurs alongside what three things?

Major depressive disorder, substance-use disorders, and suicidal ideation

Agoraphobia is often described as being comorbid with what disorder?

Panic disorder

PTSD is often comorbid with what 3 conditions?

Alcohol and substance use disorders, depression, and increased suicide risk

Differential diagnosis

Systematic method used by providers to distinguish a specific disease or condition from others that present with similar signs and symptoms

Differential diagnosis: Typical worry vs. GAD

GAD is uncontrollable and non-situational; typical worry is focused on a specific, time-limited issue

Differential Diagnosis: Acute Stress Disorder vs. PTSD

Duration as main difference; symptoms lasting less than a month are labeled as Acute Stress Disorder but come PTSD if they persist

Differential Diagnosis: DID vs Schizophrenia / Why should a patient with memory gaps and internal voices not be diagnoses with a psychosis-related disorder like schizophrenia

Standardization often involves a fixed format to minimize the influence of…

The clinician’s subjective interpretation

Benefit of structured interview as an assessment method

Uses specific set of questions to ensure every patient is evaluated using the same criteria

Benefit of uniform scoring systems (Beck Depression Inventory - II)

Scores symptoms; provides consistent way to quantify the severity of key symptoms

Standardization aims for higher ____

Objectivity. Reduces the amount of interpretation a clinician needs to do compared to more ambiguous tools like projective tests

OCD is characterized by ____ and ____

obsessions and compulsions

Obessions

Consistent, anxiety-producing, unwanted, and intrusive thoughts or images

Compulsions

An overwhelming need to engage in mental acts or behaviors to counteract anxiety

List common obsessions

Fears of contamination, doubt or check for harm/safety, a need for symmetry or order, and forbidden/taboo thoughts

List common compulsions

Hand washing, repeated checking of locks/appliances, seeking reassurance, and mental compulsions (praying/counting)

OCD Multi Model (Biological)

Involves vulnerabilities in habit formation, error detection, and inhibitory control. Associated with serotonin deficits and an underactive prefrontal cortex that fails to override the threat-detection systems

OCD Multi Model (Psychological)

Compulsions negatively reinforced because the provide brief relief from anxiety. It is also linked to an intolerance of uncertainty

OCD Multi Model (Social)

Family accommodation (providing reassurance) can unintentionally maintain symptoms

Sex Differences - OCD

Lifetime prevalence of 2-3%. More common among boys during childhood, but more common in women during adolescence and adulthood

Characterization/symptoms of Panic Disorder

Characterized by sudden, intense panic attacks that peak within minutes. Accelerated heart rate, sweating, dizziness, fear of losing control or dying

Epidemiology of Panic Disorder

Lifetime prevalence of approx 5%. 2x as prevalent in women

Multi Model - Panic Disorder (Biological)

Moderate heritable component (30-40%); linked to decreased serotonin and GABA availability

Multi Model - Panic Disorder (Psychological)

Anxiety sensitivity - interpreting bodily sensations as dangerous/ catastrophizing

Multi Model - Panic Disorder (Sociocultural)

Influence how symptoms are interpreted (e.g. as a medical emergency vs. a spiritual concern)

GAD Definition

Chronic, excessive, and difficult-to-control worry about multiple events occurring for at least 6 months

GAD symptoms

Include at least three of the following: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance

GAD Epidemiology

Twice as prevalent among women then men

Hoarding Disorder

Inability to discard items regardless of value, leading to congestion and clutter that interferes with safety/life activities

Hoarding Disorder Neurology

May be neurologically distinct from OCD, involving disruptions in the ventromedial prefrontal cortex and insula (related to anticipating loss)

Hoarding Epidemiology

Prevalence is 2-6% in adults but found in 10-40% of people with OCD

Specific Phobia and landmark symptom

A strong, persistent, excessive fear triggered by a specific object or situation. Avoidance of the trigger is a landmark symptom

Primary types of specific phobias

Living creatures, environment, blood/injection/injury, situational factors

Specific Phobia Epidemiology

Lifetime prevalence is about 12%, more common in women then men

Agoraphobia definition/what is it highly comorbid with

Intense fear of at least two situations where escape or help may not be available, such as being outside alone, in open spaces, or in crowds (comorbid with panic disorder)

BDD

Preoccupation with an imagined physical flaw that leads to repetitive behaviors like mirror checking, compulsive grooming, seeking cosmetic surgery; equally prevalent among men and women

Exposure Therapy - General Principle

Involves having specific learning experiences where a feared object or situation is shown not to cause harm

Exposure Therapy - Interoceptive Exposure

Used for panic disorder; patients deliberately induce physical symptoms to reduce fear of internal bodily sensations

Exposure and Response Prevention

Behavioral treatment for OCD; deliberately triggers obsessions while blocking the engagement in compulsive behavior

Prolonged Exposure (PE)

Used for PTSD; includes imaginal exposure (recounting the trauma) and in-vivo exposure (facing avoided real-life situations)

Which kinds of compulsions are hardest to observe or assess?

Mental or internal compulsions; examples include praying or counting compulsively

What neurotransmitter is strongly implicated in OCD?

Deficit in serotonin; acts as a modulator for brain’s threat detection and response system

Motivation of individuals with hoarding disorder to hold onto items:

Perceived need for the items or sense of intense distress at the thought of giving them away

Neurological Comparison: OCD vs. Hoarding

OCD - characterized by excessive error signaling in the brain and significant difficulty with inhibitory control

Hoarding: Disruptions in the ventromedial prefrontal cortex and the insula (areas related emotional salience/value placed on items and loss anticipation)

Treatment Effectiveness - OCD

Response to behavioral therapy - strong, response to medication - moderate/strong

Treatment Effectiveness - BDD

BT - moderate; SSRIs - moderate

Treatment Effectiveness - Hoarding

CBT - limited; SSRIs - weak

Definition of a disorder

Significant disturbance in thinking, emotional regulation, or behavior caused by a dysfunction in basic psychological, biological, or developmental processes

To establish a diagnosis, clinicians look for at least one of the two criteria:

Distress or dysfunction

Four main methods of assessment

Interviews, behavioral observations, psychological tests, neuropsychological methods

Interviews

Used to collect data about a patient’s life history, current situation, personality, and strengths

Behavioral observations & Common Tool

Clinicians watch for speech patterns, body language, and general behavior; common tool is MSE

What does MSE assess?

Client’s functioning on a specific day, focusing on appearance, thought content, cognition, and mood

Psychological Tests/Inventories - 2 Types

Projective Tests and Self-Report Inventories (BDI-II)

4Ds clinicians use as criteria to determine if a behavior/mental state constitutes psychopathology

Distress, deviance, dysfunction, dangerousness

What is distress?

Subjective feelings of emotional pain

True or False: Presence of distress alone is sufficient to warrant diagnosis

False

What are the limits of using distress for diagnosing a disorder? Provide an example.

Variability within a person or situation. Ex. Some might find giving a speech more stressful than others

True or False: Disorders always have distress attached to them.

False. Can have challenges with no distress

Define deviance

A difference from average; relies on statistical standards

Limitation(s) of using deviance to diagnose a disorder?

Who are we comparing to? Not much diversity. And one might deviate from the norm for other reasons not disorder related

What is dysfunction? Provide an example.

One is having challenges performing expectations; student not showing up to class