psychopathology test one study guide

What are some of the advantages and disadvantages associated with classifying mental disorders?

Advantages: Classification provides nomenclature, a common language/shorthand for scientists to share findings, structure information in a helpful way, facilitates research, find appropriate treatments, and get insurance coverage

Disadvantages: shorthand causes information loss, stigma/discrimination, stereotyping, labeling (only seeing a person as their illness)

What has recent research revealed about stigma toward those with mental disorders?

Research has shown that stigma is not restricted to industrialized nations. It has also shown that educating people that mental illnesses have a neurobiological cause doesn’t solve the problem. People seem to have the same amount of prejudice towards people with mental illness even if they understand the biological causes behind it. Stigma does seem to be reduced when people have more contact with the stigmatized group. However, this can be difficult as people perceive interactions with people diagnosed with mental disorders as stressful or unpleasant.

Define/understand the following terms: nomenclature, family aggregation, epidemiology, incidence, prevalence, point prevalence, lifetime prevalence, comorbidity, acute, chronic.

Nomenclature: a naming system
Family Aggregating: whether a disorder runs in families
Epidemiology: the study of the distribution of diseases, disorders, or health-related behaviors in a given population
Incidence: the number of new cases that occur over a given period of time (typically 1 year).
Prevalence: the number of active cases in a population during any given period of time
Point Prevalence: the estimated proportion of actual, active cases of a disorder in a given population at a given point in time
Lifetime Prevalence: an estimate of the number of people who have had a particular disorder at any time in their lives
Comorbidity: the term used to describe the presence of two or more disorders in the same person
Acute: when a disorder is short in duration
Chronic: when a disorder is long in duration

What are the weaknesses of the case study method of research?

The information presented in case studies can be subject to bias because their author selects what information to include and what information to omit. Material from case studies also isn’t generalizable: it is only relevant to the individual being described. They can’t be used to draw conclusions about other cases even when those cases involve people with a seemingly similar abnormality. When there is only one observer and one subject, and when the observations are made in a relatively uncontrolled context and are anecdotal and impressionistic in nature, the conclusions we can draw are very narrow and may be mistaken.

Understand what the following terms mean and how they apply to research on psychopathology: sampling, representative sample, internal validity, external validity, random assignment, meta-analysis.

Sampling: a technique in which researchers try to select people for an experiment that are representative of the much larger population of interest
Representative Sample: a small group of people that is still representative of the characteristics of the larger population
Internal Validity: reflects how confident we can be in the results of a particular given study; it is the extent to which a study is methodologically sound, free of confounds or other sources of error, and able to be used to draw valid conclusions
External Validity: the extent to which we can generalize our findings beyond the study itself
Random Assignment: every research participant has an equal chance of being placed in the treatment or no-treatment condition
Meta-Analysis: a statistical approach that calculates and then combines the effect sizes from all of the studies on a particular topic

Explain the key differences between correlational and experimental research designs, and retrospective and prospective designs. Why is the source of most information about mental disorders correlational rather than experimental research?

Correlation VS Experimental Research: Correlation research takes things as they are and determines associations among observed phenomena. Even if two variables have a very strong correlation, that does not mean there is causation because there could be a third variable causing the correlation. Additionally, we cannot tell the directionality of the effect. However, we can use this information to explore causation through an experiment. In experimental research designs, scientists control all factors except one—the factor that could influence a variable or outcome of interest. They then actively manipulate that one factor (independent variable). If the outcome of interest, called the dependent variable, is observed to change as the manipulated factor is changed, then the independent variable can be regarded as a cause of the outcome.
Retrospective VS Prospective Designs: A retrospective research strategy would allow us to learn about what participants were like before they developed a specific disorder. This strategy involves looking back in time and collecting information about how patients behaved early in their lives with the goal of identifying factors that might have been associated with what went wrong later. A challenge with this technique is that memories can be faulty and selective. A prospective research strategy involves looking ahead in time. The idea is to identify individuals who have a higher-than-average likelihood of becoming psychologically disordered and to focus research attention on them before any disorder manifests. This allows us to have more confidence in our hypotheses about the causes of a disorder. One example of this type of study is a longitudinal study.
Source: Most information about mental disorders is correlational rather than experimental for both ethical and practical reasons. Many of the variables that may affect mental disorders (such as childhood abuse, or loss of parent) cannot be manipulated and thus must be studied using correlational studies.

What is a single-case research design?

A single-case research design involves studying the same individual over time. Behavior or performance at one point in time can then be compared to behavior or performance at a later time, after a specific intervention or treatment has been introduced. One of the most basic experimental designs in single-case research is called the ABAB design. In this design, the first A phase serves as a baseline condition. In the first B phase, the treatment is introduced. In the second A phase, the treatment is withdrawn. Finally, in the second B phase, the treatment is reintroduced to see if the behavior changes again.

Be familiar with the context around deinstitutionalization. Why did it happen? What outcomes did it lead to?

There were many concerns about reforming mental hospitals during the 1950s and 1960s. Additionally, in the last half of the twentieth century, many scientific advancements were made in the development of medications. During the latter decades of the twentieth century, vigorous efforts were made to shut down mental hospitals and return psychiatric patients to the community in order to provide more integrated and humane (as well as more affordable) treatment. Large numbers of psychiatric hospitals were closed. Although this movement was motivated by benevolent goals, it has created great difficulties for many people with psychological challenges and for many communities as well. Many former patients have not fared well in community living. Moreover, just as rates of hospitalization decreased, rates of incarceration increased, leading many to suggest that as a society we were changing the way we treat those with severe mental illness – and focusing on imprisonment rather than treatment.

How are the following terms/people relevant to the history of abnormal psychology: exorcisms, general paresis, moral management, mental hygiene movement, Dix, Kraepelin, Mesmerism.

Exorcisms: the primary type of treatment for demonic possessions, which is what mental disorders used to be often attributed to
General Paresis: syphilis of the brain; the discovery of its cause led to hopes that organic, biological causes could be found for other mental disorders
Moral Management: a wide-ranging method of treatment that focused on a patient’s social, individual, and occupational needs that became relatively widespread during the period of reform in the nineteenth century; moral management in asylums emphasized the patients’ moral and spiritual development and the rehabilitation of their character rather than their physical or mental disorders
Mental Hygiene Movement: a movement led by Dorothea Dix which advocated a method of treatment that focused almost exclusively on the physical well-being of hospitalized patients
Dix: Dorothea Dix was a woman who became a champion of poor and “forgotten” people who had been consigned to prisons and mental institutions for decades during the nineteenth century. She became an important driving force in humane treatment for psychiatric patients, and she carried on a zealous campaign between 1841 and 1881 that aroused people and legislatures to do something about the inhuman treatment accorded to people with mental illness
Kraepelin: a German psychiatrist who played a large role in the development of methods for classifying different types of abnormal behavior; he noted that certain symptoms occurred together regularly enough to be regarded as specific types of mental disease; he worked out a scheme of classification that is the basis of the system we still use today
Mesmerism: a technique developed by Franz Anton Mesmer that involved the belief that the planets affected a universal magnetic fluid in the body; Mesmer concluded that all people possessed magnetic forces that could be used to influence the distribution of the magnetic fluid in other people, thus effecting cures

Understand the basic methodology of Rosenhan’s original study and the arguments he set forth based on this study. Be familiar with the major arguments in Spitzer’s critique.

Methodology
Basic question behind the study
If there is such a thing as sane and insane, can we really tell the difference?
He had 8 “sane” people try to get into a mental hospital (by claiming they were hearing voices that said “thud” “hollow” “empty”) and ended up with 12 admissions
They told the truth about everything but their one symptom and their job if applicable
Some stayed a while some stayed a few days
Did not take the medication
They were supposed to behave normally during their time there
Basic outcomes
Most of them were diagnosed with schizophrenia and they were all released eventually
Follow-up pseudopatient study
He told a hospital that he was sending them fake patients and told them not to do anything and just mark down who they thought there were
He did not send anyone, but the hospitals marked people down who they thought were the pseudopatients
His point was that psychiatrists cannot tell the sane from the insane
Spitzer’s Critique:
Insane/Sane are legal terms, not even a psych term
There would be no reason to suspect the patients were faking (like they would gain nothing from faking) so doctors were not on the lookout for fakers
The “In Remission” tag is extremely rare, which signified that the doctors did realize that the patients were no longer showing symptoms
It’s not unreasonable to think that the drugs worked and cured the symptoms
Everyone did get sent home eventually, so the doctors could at least tell
Simply wanting to be admitted to a mental hospital is a symptom in itself
Were they really behaving normally?

According to the author, what does psychiatry offer in place of biochemistry? Explain this argument.

According to the author, psychiatry offers expert consensus about which clusters of symptoms make up a particular mental illness and which mental illnesses are real. Because psychiatrists do not understand the biological and chemical basis of many mental illnesses, they found that the best way to make psychiatry seem more credible would be to define mental illnesses by the symptoms associated with them.

What scientific evidence was offered to back up melancholia as a valid diagnostic category?

Evidence from clinical observation was presented. People who showed the clinical symptoms for melancholia (despondency, sense of guilt that arises for no reason, lack of response) also showed physical symptoms such as hand-wringing and psychomotor retardation. They also showed proof from multiple studies performed over thirty years that showed that patients with those signs and symptoms had a sleep architecture and cortisone metabolism that was different from other people, including those who were depressed. Sleep studies detected reduced deep sleep and increased time in REM sleep for people with melancholia. Additionally, a dexamethasone suppression test could determine if a patient’s stress hormones were in overdrive—they normally were among melancholic patients. Melancholia also responded better to tricyclic antidepressants and electroconvulsive therapy than other types of depression. People with melancholia were also less likely to respond to placebos than people with other types of depression.

According to the author, what are the problems with our current diagnostic system?

According to the author, part of the problem with our current diagnostic system is that it uses the language of medical diseases to describe normal human responses of people to traumatic or distressing circumstances. Additionally, the reliability statistics for the DSM have fallen over time, indicating that it has become difficult for professionals to reliably distinguish different disorders using the current system.

Explain the author’s argument about the logic of claiming that all emotional distress can be explained in terms of neural functioning.

The author doesn’t agree with some people’s belief that all emotional distress can be attributed to neural functioning because there is an abundance of evidence that shows that distressing life experiences result in symptoms of mental illnesses. Although neural activity lies behind the brain’s function, neurons and chemical processes are not responsible for creating the distressing events that some people experience. Experiences shape our brain, and there is increasing evidence that even severe mental health problems are not only a result of faulty genes or brain chemicals.

Why is the author concerned about stigma and biological explanations for mental disorders?

The author believes that emphasizing the biological explanations for mental health problems does not help reduce stigma and may in fact worsen it because people will then view mental illness as a fundamental, heritable and immutable part of the person. However, approaching mental illness as a response to challenging and distressing experiences would help people be more empathetic as everyone has had emotional responses to difficult life experiences.

What is the difference between relapse and recurrence in depression?

Relapse in depression refers to the return of symptoms within a fairly short period of time. This usually reflects the fact that the underlying episode of depression has not yet run its course. Recurrence refers to the onset of a new episode of depression. The probability of recurrence increases with the number of prior episodes and also when the person has comorbid disorders.

Describe the controversy over dropping the bereavement exclusion for MDD.

Research showed that people who suffered other types of losses other than loss of a loved one (such as losing a job, divorce, etc.) experienced very similar symptoms as bereaved individuals. Many people expected that, due to these findings, the bereavement clause would be expanded to include other types of losses. However, it was removed altogether over concerns that the assumption that any depressive response to loss is “normal” could delay needed treatment. However, we now risk misdiagnosing normal grief and all the negative consequences that come with it.

How common is postpartum depression? Explain.

It was once thought that postpartum depression was very common, but research showed that what was actually common was postpartum blues, in which women experience a changeable mood, crying easily, sadness, and irritability intermixed with happy feelings. These symptoms usually occur within 10 days of the birth and usually subside on their own. Meanwhile, major depression in women seems to occur no more frequently in the postpartum period than women of the same age and socioeconomic status who have not given birth. However, there is a greater likelihood of developing major depression after the postpartum blues, especially if they are severe.

Explain the findings regarding dexamethasone suppression and depression.

It was found that in about 45 percent of patients with serious depression, dexamethasone either fails entirely to suppress cortisol or fails to sustain its suppression. This means that the HPA axis is not operating properly and there will be sustained elevations in cortisol. Research has shown that several groups of psychiatric patients, such as those with panic disorder, also exhibit high rates of non-suppression. This could mean that non-suppression is a nonspecific indicator of generalized mental distress.
Depressed patients more likely to have elevated cortisol levels, Dexamethasone suppresses cortisol.

What changes in REM sleep are associated with depression?

Research shows that many patients with depression enter the first period of REM sleep after only 60 minutes or less of sleep (as opposed to 75 to 80 minutes). They show greater amounts of REM sleep during the early cycles, and have more intense and frequent rapid eye movements. This can result in less deep sleep and can precede the onset of depression and follow into recovery; it’s a possible vulnerability marker.

What is the difference between an independent and a dependent life event?

An independent life even is one that is independent of the person’s behavior and personality, such as losing a job because the company is shutting down or losing a house to a hurricane. Dependent life events are ones that may have been at least partially generated by the depressed person’s behavior or personality, such as being unable to resolve conflicts with a spouse because of poor interpersonal problem solving.

Describe the evidence for the role of stressful life events in depression.

Research suggests that severely stressful life events play a causal role in about 20 to 50 percent of cases. People with depression who have experienced stressful life events tend to show more severe depressive symptoms than those who have not experienced a stressful life event. The relationship between severely stressful life events and depression is much stronger in people who are having their first onset than in those undergoing recurrent episodes. It has been estimated that about 70 percent of people with a first onset of depression have had a recent major stressful life event, whereas only about 40 percent of people with a recurrent episode have had a recent major life event.

What personality traits seem to predispose individuals to depression?

Neuroticism is the primary personality variable that serves as a vulnerability factor for depression. Neuroticism, or negative affectivity, refers to a stable and heritable personality trait that involves a temperamental sensitivity to negative stimuli, so people with this trait are prone to experiencing a broad range of negative moods. Studies have also shown that neuroticism predicts the occurrence of more stressful life events, which frequently lead to depression. There is also some limited evidence that high levels of introversion may also serve as vulnerability factors for depression.

What is a depressogenic schema?

A depressogenic schema are the underlying dysfunctional beliefs that are rigid, extreme, and counterproductive that would lead someone to develop depression according to Beck’s theory. These depression-producing schemas are thought to develop during childhood and adolescence as a function of negative experiences with parents and significant others and are thought to serve as the underlying vulnerability to developing depression.

Explain the ruminative response style theory of depression and how this theory might elucidate differences between men and women in depression.

The ruminative response style theory of depression focuses on different kinds of responses that people have when they experience feelings and symptoms of sadness and distress, and how their differing response styles affect the course of their depression. When some people have feelings of depression, they focus intently on how they feel and why they are feeling that way (rumination) which involves a pattern of repetitive and passive mental activity. Meanwhile, others have a more action-oriented or problem-solving response to such feelings and distract themselves with another activity or will attempt to solve the problems that are causing the sadness and distress. It seems that women are more likely to ruminate than men when they become depressed, and when gender differences in rumination are statistically controlled, gender difference in depression are no longer significant. Men, on the other hand, are more likely to engage in distracting activity that seems to reduce depression. This difference may explain differences in men and women in depression

Make sure to read the box on p. 230 about gender differences in unipolar depression in adolescence.

sex difference in depression emerges at age 12, peaks during middle-adolescence, and then declines but remains stable into adulthood

Explain what a genotype-environment interaction is.

A genotype-environment interaction is when genetic factors are not sufficient to cause mental disorders but instead contribute to a vulnerability to develop psychopathology that only happens if there is a significant stressor in the person’s life.

Describe the major findings regarding cross-cultural differences in depressive symptoms.

Although depression occurs in all cultures that have been studied, the form it takes varies widely. In Western cultures, the psychological symptoms of depression are prominent, whereas they are not prominently reported in non-Western cultures. Instead, the people in non-Western cultures exhibit more physical symptoms. Some possible reasons for these differences may stem from Asian beliefs in the unity of the mind and body, a lack of expressiveness about emotions more generally and the stigma attached to mental illness in these cultures. Differences in views of the self may also contribute to the differences in symptoms, as in Western cultures the individual is viewed as independent whereas, in many Asian cultures, individuals are viewed as inherently interdependent on others.

How might mindfulness-based therapy help to treat depression?

The logic of mindfulness-based therapy is based on findings that people with recurrent depression are likely to have negative thinking patterns activated when they are simply in a depressed mood. Rather that trying to alter the content of the negative thoughts, it might be better to change the way in which people related to their thoughts, feelings, and sensations. This group treatment involves training in mindfulness meditation techniques aimed at developing patients’ awareness of their unwanted thoughts, feelings, and sensations so that they no longer automatically try to avoid them but rather learn to accept them for what they are—simply thoughts and not a reflection of reality. Research has shown that mindfulness-based therapy is an effective treatment for reducing risk of relapse.

Describe behavioral activation treatment.

Behavioral activation treatment focuses on getting patients to become more active and engaged with their environment and with their interpersonal relationships. The techniques used include scheduling daily activities and rating pleasure and mastery while engaging in them, exploring alternative behaviors to reach goals, and role-playing to address specific deficits. It doesn’t focus on implementing cognitive changes directly but rather on changing behavior with the goal of increasing levels of positive reinforcement and reducing avoidance and withdrawal.

Describe the concerns about “polypharmacy” that are covered in this article.

There are a lot of concerns that doctors are prescribing many medications because they are trying to prevent adolescents from harming themselves, but they are lacking proper information on all the medications. There is also concern that prescribing multiple pills is being seen as a solution instead of effective therapy. Additionally, there is also a concern that drugs are being prescribed to dull the regular angst of adolescence, thus resulting in the medicalization of adolescence.

Distinguish between a correlate of a mental disorder and a risk factor for a mental disorder; distinguish between necessary, sufficient, and contributory causes in terms of psychological disorders. Give examples.

Correlate VS Risk Factor: A correlate is a variable associated with an outcome of interest (in this case, a mental disorder). An example would be the experience of physical abuse during childhood being associated with greater risk of depression later on in life, so abuse is correlated with depression. If the variable is shown to occur before the outcome can, we can infer the variable is a risk factor. It is a factor or characteristic that is associated with an increased risk of developing a certain condition.
A necessary cause is a characteristic that must exist for a disorder to occur. For example, general paresis cannot develop unless a person has previously contracted syphilis.
A sufficient cause of a disorder is a condition that guarantees that occurrence of a disorder. For example, a current theory hypothesizes that hopelessness is a sufficient cause of depression. However, this is not the same as a necessary cause because other conditions can lead to depression as well.
A contributory cause is what we study most often. A contributory cause increases the probability of a disorder developing but is neither necessary nor sufficient for the disorder to occur. More generally, if X occurs, then the probability of Y occurring increases. For example, parental rejection could increase the probability that a child will later have difficulty in handling close personal relationships or could increase the probability that being rejected in a relationship in adulthood will precipitate depression.

Also distinguish between distal and proximal factors.

Distal risk factors are those that occur relatively early in life but may not show their effects for many years. Proximal risk factors are those that operate shortly before the occurrence of the symptoms of a disorder.

What is a reinforcing contributory cause? Give an example.

A reinforcing contributory cause is a condition that tends to maintain maladaptive behavior that is already occurring. An example is the extra attention, sympathy, and relief from unwanted responsibility that may come when a person is ill. These pleasant experiences may unintentionally discourage recovery. Another example is when a depressed person’s behavior alienates friends and family, leading to a greater sense of rejection that reinforces the existing depression.

In the context of psychopathology, explain what the terms “protective factor” and “resilience” mean.

Protective factors decrease the likelihood of negative outcomes among those at risk. A protective factor is not simply the absence of a risk factor, but instead is something that actively buffers against the likelihood of a negative outcome among those with some risk factors.
Protective factors often lead to resilience – the ability to adapt successfully to even very difficult circumstances. More generally, the term resilience has been used to describe the phenomenon that “some individuals have a relatively good outcome despite suffering risk experiences that would be expected to bring about serious sequelae.” In other words, resilience is overcoming the odds against you.

Explain what a genotype-environment interaction is and distinguish it from a genotype-environment correlation.

A genotype-environment interaction is when a genetic factor contributes to a vulnerability or diathesis to develop psychopathology that only happens if there is a significant stressor in the person's life. On the other hand, a genotype-environment correlation is when the genotype shapes the environmental experiences a person has, later leading to the potential development of psychopathology (ex: a child who genetically predisposed to aggressive behavior may be rejected by his or her peers in early grades which may lead the child to associate with similarly aggressive peers later on, leading to an increased likelihood of developing a pattern of delinquency in adolescence).

Explain the three primary methods used in behavioral genetics.

The family history method requires that the investigator observe samples of relatives of each proband or index case (subject) to see whether the incidence increases in proportion to the degree of hereditary relationship. The incidence of the disorder in a normal population is compared (as a control) with the incidence among relatives of the index cases. The limitation for this method is that people who are more closely related tend to share more similar environments which can make it difficult to differentiate between genetic and environmental effects.
The twin method is often used and involves studying identical (monozygotic) twins because they share the same genetic endowment. Thus, if a given disorder or trait were completely heritable, one would expect the concordance rate to be 100 percent. That is, if one twin has a disorder the other should as well. No forms of psychopathology have concordance rates this high so we can safely conclude that no mental disorders are completely heritable. However, more severe forms of psychopathology do exhibit higher concordance rates. These rates are especially meaningful when they differ from those found for dizygotic twins.
The adoption method capitalizes on the fact that adoption creates a situation where individuals who do not share a common family environment are nonetheless genetically related. In one variation on this method, the biological parents of individuals who have a given disorder (and who were adopted away shortly after birth) are compared with the biological parents of individuals without the disorder (who also were adopted away shortly after birth) to determine their rates of disorder. If there is a genetic influence, one expects to find higher rates of the disorder in the biological relatives of those with the disorder than in those without the disorder. There are other methods and although pitfalls may arise in interpreting each of these methods, if the results from studies using all three strategies converge, one can draw reasonably strong conclusions about genetic influences.

Understand what psychologists mean when they talk about “temperament.”

Temperament refers to a child’s reactivity and characteristic ways of self-regulation, which is believed to be biologically programmed. When psychologists say that babies differ in temperament, they mean that the babies show differences in their characteristic emotional and arousal responses to various stimuli and in their tendency to approach, withdraw, or attend to various situations. Our early temperament is thought to be the basis from which our personality develops.

Explain the author’s major concern about the use of psychiatric drugs as “mood brighteners."

The author’s major concern about the use of psychiatric drugs as “mood brighteners” is that there is a reason we are not happy all the time. If we experience emotions like pain and anxiety, it is because they serve an evolutionary purpose. Pain allows us to avoid injury and death and anxiety serves as a warning so that we may protect ourselves from physical or social threats. Thus, using mood brightening medication may be unwise because they can block these useful emotions.

What is the author’s explanation for why pain is painful? What is his explanation for why we don’t have neutral emotions?

The author says that pain is painful because if it wasn’t, we would not be motivated to remove the source of pain. The suffering it causes brings our attention to the source of pain and is almost impossible to ignore, forcing us to respond to it. His explanation for why we don’t have neutral emotions is that situations that don’t present a threat nor an opportunity elicit no emotion at all. This is due to “Darwinian algorithms” that have developed for evolution that make us feel emotions only in order to further our success at living and thriving.

What purpose does sadness fill, according to this author?

According to the author, sadness allows people to see the world through a more realistic lens than they normally would. This will normally happen when something is simply not working out for someone. They will typically become sad, allowing them to stop and reconsider their choices and hopefully find a different path that will be more successful for them.

Explain why the author believes we weren’t designed to be happy.

The author believes we aren’t designed to be happy because emotions have evolved to maximize Darwinian fitness and not happiness. Once upon a time, human beings had to be very responsive to their environments and aware of physical and social threats because being caught off guard could have dire consequences. Nowadays, in an industrialized society, that doesn’t apply as much. However, he believes that many people are “overresponsive” because it is how humans have evolved to be.

Explain the opposing views in this article regarding the nature/usefulness of rumination.

Recently, psychiatrists have come to see rumination as a dangerous mental habit because it leads to fixation on flaws and problems, extending negative moods. It is “a recursive loop of woe.” Rumination takes over a person’s thoughts, making them extremely focused on their pain and causing them to struggle to think about anything else. It results in people performing poorly on memory and executive function tests. This research has enforced that idea that rumination is a waste of mental energy.
On the other hand, Andrews and Thomson began to see rumination as something with an evolutionary advantage. They observed that rumination was often a response to a specific psychologically distressing situation. They saw that rumination leads people to really reconsider their decisions and focus on the problem causing their distress. They believe that rumination allows people to more effectively problem solve by allocating more mental resources to breaking down a problem and finding a solution.

What are the key criticisms of Andrews and Thomson’s “analytic rumination hypothesis”?

One major criticism of their hypothesis is that it doesn’t explain the many different types of depressive disorder people may experience, and that their hypothesis only applies to sadness brought on by social stressors. Another criticism is that people with depression often stop doing things that are evolutionarily beneficial for their survival and the survival of their offspring. If rumination is something that has evolutionary benefits, it still wouldn’t offset the costs of these destructive behaviors.
Another criticism is that depression is just not simple enough to have one evolutionary explanation. People and their emotions are complex, and no single theory is really sufficient to explain an illness that affects so many people. It fails to address the heterogeneity of depressive disorder. Nesse compares depression is like chronic pain. Sometimes there is an underlying cause, but other times the pain itself is the dysfunction.

Describe the concerns of Greenberg, Wakefield, and Kirsch regarding depression/depression treatment.

Greenberg is concerned that emotions of melancholy and despair over a crazy, stressful world are being pathologized and that pills that make you feel better are being offered as the solution. He believes that the aim of this conspiracy is to convince people that all their problems are in their brains (a result of chemical imbalances) and not out in the world. He is critical of medication, but he is even more critical of CBT, calling it “a method of indoctrination into the pieties of American optimism, and ideology as much as a medical treatment.” He believes that most current treatment for depression is about getting people to accept their situation, and that drug companies and the psychiatric establishment are pathologizing sadness (and many other emotions and behaviors) in order to make money providing a cure.
Wakefield argues that the increase in depression diagnoses suggests that what has changed isn’t the number of people who are clinically depressed but rather the definition of depression. He argues that more exceptions need to be made in the DSM for when intense sadness is a natural response.
Kirsch criticized antidepressants as “fancy placebos.” After conducting a meta-analysis of drug trials he concluded that the statistical edge that turns up for antidepressants in studies is simply the placebo effect. Even though the trials are double-blind, Kirsch argues that people who experience side effects can deduce that they received the actual medication and thus start to feel better. He argues that since antidepressants are not effective, the brain chemistry theory of depression is a myth and that CBT should be used to treat depression.

Why does Kirsch dismiss the results of the STAR*D trial?

Kirsch says that the result in STARD* may be one big placebo effect. They were given so many drugs, and thus so many opportunities for it to be a placebo. He cites a study done in which subjects were given a drug that induced nausea and vomiting and then another drug, which they were told prevents nausea and vomiting. After the first anti-nausea drug, the subjects were switched to a different anti-nausea drug, then a third, and so on. Eventually, all the subjects reported that they no longer felt nauseous even though all the anti-nausea drugs were placebos.

According to the article, why were SSRIs initially marketed as antidepressants even though they’re commonly used to treat anxiety?

According to the article, SSRIs were initially marketed as antidepressants because anxiety drugs had gotten a bad rap after the end of the “anxiety era.”

Be familiar with the different approaches to defining abnormality (i.e., the list of criteria we discussed in class and the additional ones mentioned in your text) and the respective weaknesses associated with using each criterion.

Suffering/Distress
Hard to draw the line, how much suffering is too much, duration and causes matter
Maladaptiveness
How much impairment is too much/little; you can have a disorder and still be high-functioning
Statistical
Requires drawing a boundary and categorzing people who are too functioning/too happy, individuals vary greatly
Violation of Cultural Norms
This could be abused if you use one group’s culture to judge another
Irrationality/Can’t Control
Philosophical Questions: What are you responsible for? Are you your disorder? Where is the line drawn?
Cultural Relativism and Abnormality
Behaviors can only be judged relative to the cultural/gender/age norms
Social Discomfort
Changes with circumstances
Dangerousness
Not every dangerous activity is a sign of a disorder and not ever disorder involves dangerous tendencies

In terms of the history of approaches to psychopathology, be familiar with how the following terms/people are important to this history: Hippocrates, The four humors, Hysteria, Syphilis, ECT, Insulin Shock Therapy, Neuroleptics, Benzodiazepines

Hippocrates
He treated it like any other disease; with kindness and compassion rather than brutality and prejudice; brain was the origin; classified mental disorders into three cateogires: mania, melancholia, phrenitis (brain fever)
The four humors
Idea that you have these four bodily fluids (humors) and if you have mental disorders (personality/temperment) it’s because you have too much or too little of one/some of these disorders; treatments were based around balancing these outs; similar to the concept of “chemical imbalance”; blood, phlegm, bile, black bile
Hysteria
“Wandering Womb”; Their uterus was moving around their body in ways that it shouldn’t, causing erratic behavior; Treatment: Marriage
Syphilis
Changed our understanding of psychopathology
Advanced syphilis looks a lot like psychosis/schizophrenia
Hallucinations, ect.
Scientists managed to trace these complex mental symptoms to a very precise source of infection and managed to come up with a treatment
This made people believe that, with enough science and progress, we could learn the specific thing that caused each mental disorder and be able to treat it
An early treatment for syphilis was malarial treatment
Malaria gives you a fever and, ideally, your fever would get high enough to kill the syphilis
ECT
Roots in epilepsy
Someone noticed that people with epilepsy did not have schizophrenia
This is not true
Thought that seizures could prevent schizophrenia
It is still used as a treatment, but not for schizophrenia
Sometimes used for depression (treatment-resistant depression)
Insulin
Insulin Shock Therapy
In mental hospitals they would give people shots of insulin to get their appetites up
They would deliberately give people too much insulin, make them go into shock, and (ideally) they would wake up and their symptoms would be better
This did not work at all
Neuroleptics
Antipsychotics; used to treat schizophrenia/psychosis
Benzodiazepines
Sedatives
Massively prescribed, particularly to white middle-class housewives
They do calm you down though
Downside is they’re super addictive

Distinguish between pure categorical, dimensional, and prototype-based approaches to classification of disorders.

Categorical:
Each disorder is unique, you can only have one
You must meet all of the criteria to be in the category
You either have it or you don’t; the bucket analogy
Dimensional:
Standard Normal Distribution
It works well for science, but it’s not clear what you’re supposed to to with it
“Well you’re in the 78th percentile for sadness, but it’s not a bucket”
It’s a more faithful representation of how symptoms appear, but it’s not helpful for treatment or self-understanding
Spectrum
Prototype
Each disorder has essential and non-essential characteristics
You don’t have to have every symptom for the diagnosis, but there are some key ones
You can have more than one disorder
DSM

Understand how the terms reliability and validity apply to psychiatric diagnoses. Explain how the concern for reliability can lead to decreases in validity. What are the two major methods of assessing the reliability of DSM diagnoses? How did choice of method affect reliability estimates for DSM 5?

Reliability
Degree to which measurement is consistent; Multiple assessors should agree on a classification
Validity
The extent to which you are measuring what you intend to measure
Methods for Assessing Reliability
Audio-Recording Method
You record therapy sessions, come to a conclusion, share the recording, and compare your conclusions/assessments
First clinician interviews, second hears recording of interview
Challenges with this method
Leading questions
Only one person gets to ask questions
Makes reliability look higher than it is
People behave differently with different people
Test-Retest Method
Each clinician does a separate interview
Reliability is lower
Reliability vs. Validity
They sacrificed validity in the name of reliability
They made things too specific; it was too narrow to apply to a range
Moved to test-retest method for field trials
But then lowered reliability thresholds to account for results

How were the early DSMs (I and II) different from later versions? What major changes came along with the DSM III?

The first two were very psychoanalytic case-studies; very theoretical as opposed to the atheorectical approach of the later DSMs.
DSM III
Massive overhaul led by Robert Spitzers
Led by anti-Freudians, wanted to be taken seriously as scientists
Looked like medical manual
Made it atheoretical, anyone could use it, it was a list of symptoms that made no claims as to the symptom’s source
Increased focus on reliability
Made things more specific
Helps with prescription of drugs

Understand the major criticisms of the (current) DSM system of classification and general concerns about the effects of labels.

Reliability vs. Validity
They sacrificed validity in the name of reliability
They made things too specific
Comorbidity
Having two or more disorders at once
The norm for the DSM is to have more than one disorder
Often 4 or more
Maybe we are carving the categories up too small
Lack of Scientific Grounding
A lot of the categories are consensus categories rather than science-based
There are in there due to clinical tradition rather than evidence
They predate scientific research
Arbitrary decisions
Author bias
Conflict of Interest
Who’s sponsoring trials, who is being paid by drug companies, ect.
Labels can lead to stigma, be abused, and affect rights

Explain Szasz’s perspective on psychiatric diagnosis.

Wrote a lot about how naming disorders is an act of power
That power has been abused throughout history
Highly concerned with the civil rights of psychiatric patients
Lived in a time where people could be sent to psych wards indefinitely with no way to get out
Concerned about how there were no biological tests for diagnoses

What was NIMH’s/Insel’s primary problem with the DSM 5?

Accused DSM of lack of validity
Said we have to get rid of it in regards to research
The DSM was holding back researchers because it was too narrow and not valid enough
Unlike medical issues, there are no objective lab tests available

Describe the RDoC approach. (Just in general terms.)

Incel proposed
RDoC is a research framework meant to guide research that could eventually turn into a better diagnostic system
Focused on small biological parts (celluar, ect.) and hoped to build up biological understanding of disorders

What are the weaknesses of the RDoC approach?

Ignores experience/environment
No clear link with intervention (treatment)
Assumes neuroscientific research inherently better than psych research
Focuses on genetics - where results are messy and effect sizes small (note update, ditching “candidate genes” in favor of GWAS)
Not very person-centered

Describe (just in general terms) the HiTOP model. What are the weaknesses of this model?

American Psychological Association
Flow Chart; Dimensional approach instead of categorical
No arbitrary thresholds to cross to get treatment
Scientific evidence instead of expert opinion; based on data that we have
It cannot currently be used in a clinical setting that requires categorical decisions
Will need to determine “actionable” ranges of scores
Can indicate how intrusive/costly treatment approach should be
How much treatment you need; mild to severe

What is disruptive mood regulation disorder? Why was this diagnosis recently added to the DSM?

Persistent irritability and frequent episodes of extreme behavioral dyscontrol
They made this to counteract the skyrocketing rates of bipolar disorder diagnoses in young children
Pull people back from giving serious diagnoses to children
Researchers found that kids diagnosed with bipolar as a child did not grow up to have it as an adult

What are the primary symptoms of mania? How does hypomania differ from mania?

A distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree AND REPRESENT CHANGE FROM USUAL BEHAVIOR:
1) inflated self-esteem/grandiosity
2) decreased need for sleep
3) more talkative, pressured speech
4) flight of ideas, racing thoughts
5) distractibility
6) increase in goal-directed activity or psychomotor agitation
7) excessive involvement in pleasurable activities that have a high potential for painful consequences
Hypomania
Lasts at least four days
Same symptoms of a manic episode, except no marked impairment in functioning
Has to be a change from typical functioning

What does it mean to say that there is diagnostic heterogeneity in depression?

Symptoms of depression look different in everyone.
Symptoms/Presentation
Course
The timeframe/reoccurnce rate
Causes

What is the “cohort effect” in depression? What recent evidence points toward this cohort effect?

With each new generation there have been increased rates of depression
Measures for Changes in Depression Rates
Severe Psychological Distress Scale
Structured interview for MDE in past year
Suicidal ideation, plans, attempts, and completed suicides in past 12 months
Shows up across all racial/ethnic groups

What types of cultural influences seem to have significant effects on rates of depression?

Industrialization
The more industrailzied an area is, the higher the rates of depression are
Immigration
Immigrants who are starting new with no family or social support in their new country have higher rates of depression
Western Cultures
The pressure to be happy in western cultures leads to increased rates of depression
When you deviate from the happiness norm you feel guilty, thus getting more depressed

How is persistent depressive disorder different from major depressive disorder?

Majority of days, most of day, two years or more
Never without for 2 months
Depressed mood and two additional symptoms
Can present as a chronic but less severe or chronic and severe

Why would a practitioner give an “other specified” or “other unspecified” mood disorder diagnosis?

Other Specified
You attach it to another diagnosis and explain why (like they don’t meet all of the criteria)
Other Unspecified
You need more time to do an assessment, you don’t know yet

Distinguish between Bipolar I, Bipolar II, and cyclothymic disorder.

Bipolar 1
One or more manic or mixed episodes
Mixed: depressive and maniac symptoms at the same time
Generally followed by a major depressive episode
You don’t need to have already had a depressive episode to get the diagnosis
Bipolar 2
One or more major depressive episodes
At least one hypomanic episode
Essentially the depression is at the forefront, mania is less severe
Cyclothymic Disorder
Less severe, more chronic
Hypomaniac symptoms and depressive symptoms; not fully episodes

What is a diathesis-stress model?

A vulnerability, or diathesis, is a predisposition toward developing a disorder that can derive from biological, psychological, or sociocultural causal factors. Stress, the response or experience of an individual to demands that he or she perceives as taxing or exceeding his or her personal resources

What are the three major processes (as discussed in class) that can lead to dysfunction in neurochemical communication?

Synapsis is the site of neurocommunication
Presynaptic neuron releases neurotransmitters and some of them bind to the postsynaptic neuron
Some of the ones that don’t bind go through reuptake, they go back into the presynaptic
By blocking reuptake, more serotonin becomes available for binding,
SSRI
Some drugs also enhance reuptake, which can help
Some neurotransmitters are just destroyed by enzymes, degradation
Some meds work by destroying these enzymes
Theoretically some could work by synthesis, creating more serotonin, but we on’t have drugs that do this

Explain the monoamine theory of mood disorders and evaluate its success in explaining these disorders.

Monoamine Theories
1965
Monamines are a class of neurotransmitters, the ones psychologists are usually interested in, mood, sleep, attention ones
You have a disorder because you either don’t have enough or have too much of a certain monoamine
“Person in waiting room theory”
It’s a commonly held theory
There’s not really evidence to back it up
Drugs that increase serotonin take 3 to 6 weeks to work
However, biologically it works within the day, but it takes you that long to feel better
They can work, but they don’t just work because they increase the availability of serotonin, they probably work through a different mechanism
Possible Explanation:
Neurogensis, the development of new braincells
Tianeptine - SSRE
Selective Serotin Reuptake Enhancer
Increases Reuptake, but somehow seems to treat depression just as well

Be familiar with the strengths and weaknesses of the different types of drug treatments for depression and bipolar disorder discussed in class.

Tricyclics
Work on serotonin (and a little norepinephrine) reuptake
Also used to treat pain conditions and migraine
Not that common anymore, didn’t work that well
Worked on norepinephrine and serotonin; blocked reuptake
Had unpleasant side effects, and took 4-8 to work
3-4x the daily prescription could kill you; way too easy to overdose on
Could also cause liver damage
MAOIs
Monoamine Oxidase Inhibitors
Block degradation
Dangerous side effects, can interact with food wrong and kill you
Interacts badly with a lot of other medications
Can cause liver damage
SSRIs
Selective Serotonin Reuptake Inhibitors
Most common type of antidepressant
Work in about 3-6 weeks
Less fatal in overdose
Still has the same side effects as Tricyclics, including stomach issues
SSNRIs
Selective Serotonin Norepinephrine Reuptake Inhibitors
Advertised that they help with the pain that depression causes
Doesn’t really help more than others
Bupropion
Nasty side effects
Said they might help with weight loss and not have sexual side effects
Doesn’t tend to be the go-to choice