PSYC 339: Abnormal Psychology (Midterm 1)

History, etiological factors, diagnosis & treatment, research

Criteria of a psychological disorder

1. Psychological dysfunction

2. Impairment/distress

3. Atypicality/statistical rarity

Psychological dysfunction

Disruption in cognitive, emotional, or behavioural functioning, including disruptions from what is normal for the individual and/or what is normal for society

Clinicially significant distress and/or impairment

• Distress: more intense than stress and experienced very strongly

• Impairment: decreased ability to function in society

Trephining

Puncturing holes in the skull to release trapped demons; may have had effectiveness due to the placebo effect, damaging problematic brain areas (essentially lobotomy), or reducing intercranial pressure in cases of brain injury

Moral therapy (late 1700s)

Movement beginning in France that argued that patients in asylums should be treated humanely; involved socialization with patients and removal of restraints; requires a low client-to-staff ratio

Mental Hygiene Movement

Movement associated with improving conditions for psychiatric patients via the building of new asylums with better conditions; these new asylums doubled as homeless shelters

Psychoanalytic techniques

• Free association
• Dream analysis/hypnosis
• Interpretation
• Transference/countertransference
• Resistance

Criticisms of psychoanalysis

• Hard to falsify
• Long-term and unfocused therapy
• Derived from small and unrepresentative samples
• Poor empirical support

Person-centred therapy (Rogers)

Focuses on unconditional positive regard and empathetic reflection of the client

Scientist-practitioner model

Model of training professional psychologists that emphasizes both research and clinical skills and argues that psychologists should be both consuming and producing research in how they practice

Rational-emotive therapy (Ellis)

Therapy centred around the idea that people with disorders have dysfunctional core beliefs that can be challenged to be replaced with rational, realistic thinking

Cognitive therapy (Beck)

Therapy that focuses on addressing automatic negative thoughts, cognitive distortions, and dysfunctional beliefs (without necessarily addressing deep-rooted personal schemas); clients are asked to look for evidence for their thoughts and do homework outside of therapy

The p factor

Psychopathology factor; predicts likelihood of having a disorder, the disorder being more severe, having multiple disorders, and having family members with the disorder; affected by genes, childhood maltreatment, and neuroticism

Three facets of the p factor

• Internalizing disorders: issues that are internal to the person
• Externalizing disorders: issues that affect others/that others can see
• Thought disorders: issues with the reality of one's thinking

Diathesis-stress model (classic vs contemporary)

Model that argues that a risk factor, referred to as diathesis, combines with a stressor to create symptoms. In the classic model, diathesis refers to genetic predisposition; in the contemporary model, diathesis refers to anything that is not happening now that increases your odds of developing the disorder

Mice fearing cherry blossoms study

Male mice were classically conditioned via shocks to fear the smell of cherry blossoms; the children of these mice showed enhanced sensitivity (but not fear) to the scent of cherry blossoms compared to mice whose fathers had not received the conditioning

Major areas of the brain

• Hindbrain (medulla, pons, cerebellum): involved in automatic functions
• Midbrain: involved with coordination movement with sensory input and with sleep and arousal
• Forebrain: everything above the midbrain

The Limbic System

Neural system involved in emotional regulation and impulse control, composed of four structures:

• Thalamus: involved in emotion regulation and behaviour, relays between the forebrain and brainstem

• Hypothalamus: involved in the four f's (fighting, fleeing, feeding, mating)

• Amygdala: involved in the sex drive, aggression, and threat detection

• Hippocampus: involved in memory

Norepinephrine

Neurotransmitter involved in the fight-or-flight response that seems to be involved with anxiety (anxiety is linked with too much norepinephrine, though this seems to be a byproduct rather than a cause) and depression

Glutamate

Major excitatory neurotransmitter, seems to be involved with schizophrenia (overexcitation of the brain)

Gamma-aminobutryic acid (GABA)

Major inhibitory neurotransmitter; possibly linked to anxiety (too little, based on anxiolytics raising/mimicking GABA), anger, and aggression

Serotonin

Neurotransmitter that affects mood, appetite, sleep, memory, and learning, dysfunction of which is linked to basically every disorder (namely depression, anxiety, and eating disorders)

Dopamine

Neurotransmitter involved with reward and motor control, linked to addictions and schizophrenia

Antagonist and reuptake inhibitors

Drugs that block the neurotransmitter from activating the receiving dendrite and from returning to the axon; may act differently at different recpetor sites

2D:4D

The ratio of the length of your index finger to the length of your ring finger, determined in the second trimester based on how much testosterone was around the baby (more testosterone = longer ring finger); high 2D:4D (long ring finger) is linked to anxiety and depression, and low 2D:4D (long index) is linked to ADHD, alcohol abuse, autism, aggression, and antisocial personality disorder

Equifinality

The same symptom may be explained by different disorders/behaviours, and the same disorder can be caused by multiple paths

Baxter et al.

Compared the brains of OCD patients to healthy controls via brain imaging before and after treatment; OCD patients had increased basal ganglia activity pre-treatment; both medication and CBT led to basal ganglia activity becoming indistinguishable from healthy controls

Rhesus monkey study

• Yoked pairs of rhesus monkeys, with one monkey in control of what both monkeys received (food, reward, etc.)
• Both monkeys given benzodiazepine inverse agonists, which produce intense anxiety (inverse of GABA)
• The monkeys with no control had panic reactions, whereas the monkeys in control had aggressive reactions

Two-process theory of anxiety

Theory that classical conditioning establishes the fear/anxiety, and operant conditioning (negative reinforcement) maintains it

Prepared learning

Evolutionary predispositions to easily learn (fear) associations with certain stimuli

Cognitive science

Study of how we subconsciously acquire, process, store, and retrieve information (e.g. modified Stroop Task)

Susto

The Latin American belief that you are the subject of black magic/witchcraft, causing somatic effects

Emotion vs mood vs affect

• Emotion: an action tendency elicited by an external event and a feeling state, accompanied by a characteristic physiological response
• Mood: enduring periods of emotionality
• Affect: the emotional tone that accompanies a given action

Three components of emotion

• Behaviour (e.g. motivator of behaviour, means of communication)
• Physiology (e.g. brain areas)
• Cognition (e.g. appraisal, attribution)

Caspi et al. (2003)

• Looked at individuals with two long alleles (LL) or short alleles (SS) for a gene involved in serotonin transmission
• Individuals with SS genes were more susceptible to depressive episodes following major life stressors
• Childhood maltreatment increased risk of depression for individuals with SS alleles, but did not for those with LL alleles

Kilpatrick et al. (2007)

• Individuals with SS genes were more likely to develop PTSD following a hurricane
• Indivdiuals with SS genes were not more likely to develop PTSD if they had strong social support

Three reasons to diagnose

1. Ease of communication
2. Influences treatment decisions
3. Gives clients a name for their experience

Subclinical

Either just under having enough symptoms to be considered clinical or having enough symptoms but not enough distress/impairment

Prototypical approach to diagnosis

Approach to diagnosing in which there are core aspects of the disorder that must be met for diagnosis (the prototype), and other symptoms differ from person to person

Axes of the DSM-IV

Axis I: all disorders other than Axis II disorder
Axis II: personality disorders
Axis III: medical conditions
Axis IV: psychosocial issues
Axis V: global assessment of functioning (GAF) score (0-100)

Mental status exam

Initial assessment of a client's overall thinking and functioning, which assesses:

• Appearance and behaviour
• Thoughts/thought processes
• Mood/affect
• Intellectual functioning
• Sensorium (oriented times three; date, time, location)

Multidimensional instruments

Self-report questionnaires containing hundred of items that test for many types of symptoms and incorporate various validity scales (positive impression management, negative impression management, random responding)

MMPI-2

A purely empirical multidimensional instrument with 10 symptom scales and 9 validity scales with good reliability and good predictive validity for many disorders

PAI

A rational-empirical multidimensional instrument with 11 symptom scales and 4 validity scales with good reliability, predictive validity, and construct validity

Brief scales

Short questionnaires that test for one or a few specific disorders, symptoms, and/or etiological factors with no validity scales

Anxiolytics (benzodiazepines)

Anti-anxiety drugs that increase/mimic GABA activity; work quickly with short-lived effects; may cause rebound anxiety; addictive

Antidepressants

Drugs such as SSRIs or SNRIs that treat depression, anxiety, and eating disorders

Mood stabilizers

Drugs used to treat bipolar disorder that pull people out of mania and reduce the likelihood of future manic episodes, including lithium and anticonvulsants

First-wave/conventional antipsychotics (aka neuroleptics)

Drugs that target the positive symptoms of schizophrenia

Second-wave/atypical antipsychotics

Antipsychotics commonly used today that treat both positive and negative symptoms of schizophrenia (primarily positive symptoms), primarily by decreasing dopamine

Electroconvulsive therapy (ECT)

Stimulating the brain with up to 800 milliamps of electricity; effective for treating severe depression and potentially schizophrenia and bipolar disorders

Repetitive transcranial magnetic stimulation (rTMS)

Strong magnetic fields directed into the brain in order to mimic the effects of ECT; safer than ECT with fewer side effects, but potentially less effective

Transcranial direct current stimulation (tDCS)

Targeting specific brain areas with mild amounts of electricity (2 milliamps), potentially effective for schizophrenia and depression

Interpersonal Therapy (IPT)

A brief psychodynamic therapy that focuses on working on interpersonal relationships through the therapeutic alliance and has dropped the unconscious aspects; effective for depression and eating disorders

Motivational interviewing (MI)

A humanistic/existential therapy designed to treat addictions that helps clients resolve ambivalence regarding treatment by helping clients reflect on their own goals

Emotion-focused therapy (EFT)

A humanistic/existential therapy designed to increase awareness and acceptance of emotions and shift emotions from unproductive to productive forms, with limited research on effectiveness

Acceptance and commitment therapy (ACT)

A cognitive-behavioural therapy that aims to help clients accept thoughts as just thoughts rather than challenge them, with the goal of making people happy rather than just removing disorders; effective for anxiety and depression

Metacognitive therapies

Therapies that challenge beliefs about your own thought process

Cognitive/attentional bias modification therapy

A computer-assisted therapy that focuses on targeting implicit cognitions associated with anxiety and depression

Step-care approach

Matching clients to therapists with appropriate level of expertise based on the severity of their disorder

Non-clinical sample

A sample in which people are brought into the sample without formal diagnosis procedures; it is assumed that most people do not have severe levels of the disorder

Analogue sample

Individuals recruited to non-clinical samples and selected based on responses to questionnaires as they appear to be diagnosable

Computer analysis

Data is recorded a multiple points, and a person's data is only incorporated if they gave data at each timepoint

Intent-to-treat analysis

Analysis in which all participants' data is included, and if a person drops out, their last point of data is carried over to fill the slots in which there is no data for them

Clinical significance

The extent to which the treatment is meaningfully effective and patients notice the improvement; often measured in terms of 1) no longer meeting criteria for the disorder or 2) being within one standard deviation of the mean of a non-clinical sample

Brown and Finn (1982)

Cross-sectional study that examined the beliefs of 12, 15, and 17 year olds regarding drinking; found that the majority of 15 year olds drink for the purpose of getting drunk, compared to fewer 12 and 17 year olds

Nagin and Tremblay (1999)

Study of physical aggression in low SES boys with four overall patterns: chronic, high but declining, moderate but declining, and low; having a teenage mom and and being hyperactive predicted being in the first two groups

Epidemiological research

Research examining the prevalence, distribution, and consequences of disorders in large populations

Prevalence

Percentage of the population who have the disorder, including 12-month prevalence rate and lifetime prevalence rate

Incidence

The number of new cases in a specific period of time, typically in the last year

National Comorbidity Survey (NCS)

A series of studies examining the prevalence of mental disorders in the US and the degree to which they overlap with each other

National Epidemiologic Survey of Alcohol and Related Conditions (NESARC)

Series of cross-sectional and longitudinal research on the prevalence of alcohol use disorder and other mental health disorders; the NESARC-I and -II measured the same group of participants, whereas the NESARC-III measured a new group of participants and included saliva DNA samples for future genetic research

Mechanism of change studies

Studies that try to determine the means by which a treatment is effective (i.e. what changes first)

Process studies

Studies examining what parts of a treatment are the most effective/necessary and how treatment outcomes change in different settings

Community-based studies

Studies that train people in a community and track treatments over time in order to test treatments in real-world settings

Proband

in genetics research, the individual with a disorder

Family studies

Examining symptoms in the proband and their first-degree relatives vs distant relatives

Patient uniformity myth

Tendency to consider all members of a category as more similar than they are, ignoring their individual differences

Blanchard et al. (2004) and Asmundson et al. (2004)

Studies that compared the rates of acute stress disorder and PTSD following 9/11 in New York, Georgia, North Dakota, and Canada, and found that New York had higher rates of stress disorders relative to all other locations

Positive development strategies (health promotion)

Efforts to develop skills and protective behaviours in entire populations of people without targeting specific risk factors

Universal prevention strategies

Efforts that focus on entire populations but target certain risk factors

Selective prevention strategies

Efforts that target at-risk groups within a population

Indicated prevention strategies

Efforts that target individuals who are beginning to show symptoms but do not yet have a disorder