Psychopathology Exam 1

Describe how a psychological disorder is defined/understood and what is psychopathology?

Dysfunction in psychological, biological or developmental processes that causes personal distress and is Atypical or not a culturally expected response.

The science of psychopathology is done by mental health professionals that are united in the scientist-practitioner framework.

How do you go about giving a clinical description of a client - understand each term?

Begins with presenting the problem

clinical description

describe prevalence and incidence of disorders

describe onset of symptoms

state specifiers (course of disorders, severity)

Prognosis

What were the initial supernatural theories of abnormal behavior ?

People increasingly turned to magic and sorcery to solve their problems. People assumed that individuals possessed by evil spirits were responsible for misfortune of townspeople. Treatments included exorcism, shaving a cross on victims head. Snake pits were also used to scare a spirit out of someone. Movement of moon and stars led to definition of lunatic.

Describe the varying practices of psychopathology.

Clinical & counseling psychologists either a Ph.D. or Psy.D.

Psychiatrist: M.D.

MFT & mental health counselors

Mass Hysteria

demonstrates the phenomenon of emotion contagion in which the experience of an emotion seems to spread to those around us.

Paracelus suggested that..

movements of the sun and stars had profound effects on people's psychological functioning. Said that the gravitational effect of the moon on bodily fluids could be a possible cause for mental disorders. This theory inspired the word LUNATIC. Still common with followers of astrology.

What were the initial theories of the biological tradition?(e.g., Grey, Hippocrates....using the information on your worksheet can be helpful to review and guide you on where to look in text)? Be able to correctly place the theories of supernatural from the biological traditions.

Greek physician, Hippocrates, thought to be the father of modern medicine.

Humeral theory of medicine

Somatoform disorders

John P.Grey

Erin Kraeplin

Hippocrates

Greek physician, Hippocrates, thought to be the father of modern medicine. He considered the brain to be the seat of wisdom, consciousness, intelligence, and emotion. He believed all psychological disorders could be treated. Disorders involving these would then be logically located in the brain. Also recognized the importance of interpersonal interactions on psychology.

Hippocratic-Galenic approach and the Humoral Theory of Disorders.

four bodily fluids or humors:

- blood (heart), sanguine - cheerful and optimistic

- black bile (spleen) melancholic - depression

- yellow bile (liver) phlegmatic personality - sluggish, apathetic, calm

- phlegm (brain) choleric - hot tempered

first example of associating psychological disorders with chemical imbalance.

Somatoform disorders

physical symptoms appear to be the result of a medical problem for which no physical cause can be found.

hysteron (hysteria) - greek for uterus, assumed this only happened in women.

John P. Grey

Causes of insanity were always physical. Therefore mentally ill patients should be treated as physically ill. Because of this, conditions in hospitals greatly improved in order to help treat these disorders.

Erin Kraeplin

one of the first to distinguish among various psychological disorders, seeing that each may have a different age of onset and time course, with somewhat different clusters of presenting symptoms and probably a different cause.

difference between one-dimensional vs. multidimensional approaches

One dimensional: psychopathology is caused by a single cause.

multidimensional: This perspective on causality is called systemic because it implies that any particular influence contributing to psychopathology cannot be considered out of context (biology and behavior of individual including cognitive, emotional, social and cultural environment).

Diathesis-stress model

Asserts that most psychiatric disorders result from a combination of genetic vulnerability and negative environmental stressors

Diathesis = a condition which makes someone susceptible to developing a disorder.

differences/similarities of diathesis-stress model and the reciprocal gene-environment model.

Similarities are genetic disposition and stressors both are present.

Diathesis stress model it is the combination that leads to disorder, while in reciprocal gene environment model genetic vulnerability leads us to seek environments that stress and that leads to disorder.

structures of the brain that are discussed to play a role in abnormal psychology

central nervous systems

peripheral nervous systems

neurotransmitters

structure of the brain

How has cognitive science (e.g., prepared learning, learned helplessness, social learning) contributed to the understanding of abnormal behavior?

learned helplessness occur when rats or other animals encounter conditions over which they have no control.

prepared learning - we might have become highly prepared for learning about certain types of objects or situations because this knowledge contributes to the survival of a species.

social learning - organisms do not have to experience certain events in their environment to learn efficiently. they can learn by observing someone else

unconscious - implicit memory

How does social support impact health?

the greater the number and frequency of social contacts the longer you are likely to live. The lower you score on a social index, the shorter your life expectancy. Social relationships seem to protect people from many physical and psychological disorders.

Reciprocal gene-environment model

our genes may influence us to seek out certain environments that then trigger other genetic tendencies

central nervous systems

processes all information received from our sense organs and reacts as necessary. Sorts what is necessary, figures out why, and chooses how to react. Has brain and spinal cord.

Neurons

contains a central cell body with two kinds of branches, dendrites and axons.

dendrites

have numerous receptors that receive messages in the form of chemical impulses from other cells, which are converted into chemical impulses

axon

transmits electrical impulses to other neurons

neurotransmitters

biochemicals that are released from the axon of one neuron and transmit the impulse to the dendrite receptors of another neuron

brain stem

is the lower and more ancient part of the brain -- handles most essential automatic function such as breathing, sleeping and moving around in a coordinated way.

hind brain

lowest part of brain stem, contains medulla pons and cerebellum.

hind brain - automatic activities

cerebellum

controls motor coordination, possibly coordinated with autism

hypothalamus and thalmus

associated with regulating behavior and emotion.

limbic system

around edge of center of brain.

hippocampus

cingulate gyrus

septum,

amygdala

helps regulate emotional experience and expression

cerebral cortex

left hemisphere - verbal and other cognitive processes

right hemisphere - perceiving the world around us and creating imaged.

Peripheral nervous system

somatic nervous system - controls muscles

autonomic nervous system. - regulate cardiovascular system, endocrine system, and perform various other functions (like digestion).

parasympathetic nervous system

balances the sympathetic nervous system to normalize arousal

Hypothalmic-pituitary-adrenocortical axis (HPA Axis)

cortical part of the adrenal glands also produce the stress hormone cortisol.

Glutamate

Amino acid. Excitatory transmitter that turns on many different neurons, leading to action.

Gamma-aminobutyric acid

inhibit or regulate the transmission of information and action potentials.

Agonists

effectively increase the activity of a neurotransmitter by mimicking its effects

Antagonist

decrease or block a neurotransmitter

inverse agonists

produce effects opposite to those produced by the neurotransmitters.

serotonin

regulates our behavior, moods, and thought processes. Extremely low levels of serotonin are associated with less inhibition, with instability, impulsivity, and a tendency to overreact.

dopamine

activity associated with exploratory, outgoing, or pleasure seeking activity.

associated with schizophrenia, and disorders of addiction.

Describe common concerns with the DSM-5 (e.g., role of comorbidity)?

The problem of comorbidity

- Defined as two or more disorders for the same person

- Threatens the validity of separate diagnoses

Labeling

What is a mental status exam (MSE) and how is it used (may review handout)? / Understand what are common features of an MSE and what is not included.

Standard first assessment in a number of different clinical areas. It is to assess the general situation and appearance of behavior, through processes, mood and affect, intellectual functioning and sensorium (no hallucinations).

Understand the basic organization of sections in the DSM-5

Section I - introductory material

Section II - disorder descriptions

Section III - "emerging measures and models"

Appendices

Diagnostic manual

Clear inclusion and exclusion criteria for disorders

Attempt for increased dimensional vs categorical approach

Disorders are categorized under broad headings

Empirically-grounded approach to classification

What are the thoughts on early identification of developmental disorders?

It is the best route

Describe the basic features of ADHD.

- inattention, overactivity & impulsivity

Difficulty with sustained attention (challenge to finish games or watch TV)

Constant motion, fidgeting

Act without thinking

What is the role of genetics in contributing to ADHD?

ADHD seems to run in families

- Research with dopamine, norepinephrine, serotonin & gamma-aminobutyric acid

DRD4, DAT1, and DRD5 genes have been implicated

Describe the pros and cons associated with stimulant versus non-stimulant medication in the treatment of ADHD?

Stimulants: Reduce core symptoms of ADHD in 70%+ of cases

Common side effects: loss of appetite, weight loss, sleeping problems (insomnia), irritability, drowsiness

Non stimulants: Effective for some; avoid related "highs" of stimulants

What approaches are implemented in the treatment of ADHD?

Psychosocial Intervention: Parent Training, Education related to structure & how to respond, Social Skills Training, Behavioral Treatments, Aim to increase appropriate behaviors & decrease inappropriate behaviors

Educational Interventions: Special Education Services for existing learning problems, Classroom accommodations, Classroom behavior modification programs

Combined biopsychosocial treatments - meds & behavioral: Appears long-term psychosocial treatment necessary to maintain gains

Describe how intelligence and academic functioning are used in diagnosing a learning disorder.

difficulties learning & using academic skills by 1+ of following for 6+ mos., despite the provision of interventions that target those difficulties.

academic skills are substantially & quantifiably below those expected for age & cause significant interference (substantially below usually 1.5 SD)

begin during school-age years but may not become fully manifest until demands exceed limited capacities

not better accounted by intellectual disabilities..etc.

Describe available interventions for learning disorders and effectiveness of the interventions.

Requires intense educational interventions

- Remediation of basic processing problems

- Direct instruction & teaching for mastery

Targeting skills to compensate for problem areas

- Though may not strengthen area of weakness

Individualized Educational Program

Treat comorbid emotional/attentional problems

Identify the features of Autism Spectrum Disorder.

. Persistent deficits in social communication & social interaction across multiple contexts, as manifested by:

Restricted, repetitive patterns of behavior, interests, or activities manifested by at least 2 of the following:

sxs must be present in early developmental period

cause clinically significant impairment in social, occupational, or other important areas of current functioning

not better explained by intellectual disability or global developmental delay

Describe available interventions for the Autism Spectrum Disorders and the effectiveness of these interventions.

Psychosocial "behavioral" treatments

- Skill building

- Reduction of problem behaviors

- Target communication & language problems

- Address socialization deficits

Biological & medical treatments generally unsuccessful

Integrated treatments: The preferred model

Focus on children, their families, schools & home

Build in appropriate community & social support

Describe the basic features for diagnosing Intellectual Disabilities.

Deficits in intellectual functions (e.g., reasoning, judgment..)

B. in adaptive functioning that result in failure to meet developmental & sociocultural standards for personal independence & social responsibility

Onset during the developmental period

Deficits in intellectual & adaptive functioning

Range of impairment varies greatly across persons

different type of ADHD

314.00 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive presentation

Symptoms of inattention

314.01 Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive/Impulsive Presentation

Symptoms of hyperactivity & impulsivity

314.01 Attention-Deficit Hyperactivity Disorder, Combined Presentation

Symptoms of hyperactivity, impulsivity and inattention

314.01 Other Specified Attention-Deficit/Hyperactivity Disorder

Cause clinically significant distress but do not meet criteria & clinician chooses to list specific reason

314.01 Unspecified Attention-Deficit/Hyperactivity Disorder

Ditto but clinician chooses not to specify

Fear

present-oriented mood state

Immediate fight or flight response to danger or threat

Marked negative affect

What are the main theories in the biological considerations for the etiology of anxiety disorders?

Genetic vulnerability

Anxiety & brain circuits

Depleted levels of GABA

Corticotropin releasing factor (CRF) & HPA axis =cortisol

Limbic (amygdala) & the septal-hippocampal systems

Behavioral inhibition system (BIS)

Anxiety

Fight/flight (FF) systems

Fear/panic response

What are common characteristics & treatments for Generalized Anxiety Disorder (GAD)?

Excessive anxiety (apprehensive expectation) & worry occurring more days than not for at least 6 mos about a number of events or activities

Difficult to control the worry

3+ sxs (kids only 1):

Restlessness or feeling keyed up

Being easily fatigued

Difficulty concentration

Irritability

Muscle tension

Sleep disturbance

Somatic symptoms differ from panic

Psychological interventions: CBT, meditational approach

Benzodiazapines and SSRI's

Combined treatments: short vs. long-term outcomes

What are common characteristics & treatments for specific phobias?

Marked fear or anxiety of a specific object or situation

In kids may be expressed by crying, tantrums, freezing or clinging

Most recognize fear & avoidance are unreasonable

Fear or anxiety usually immediate

Actively avoided or endured with intense fear or anxiety

Clinically significant distress or impairment

_______________

Cognitive-behavior therapies are highly effective

Exposure exercises

Describe the different categorical types of specific phobias (not individual names such as claustrophobia).

300.29 Animal phobia

300.29 Natural environment phobia

300.29 Blood-injury-injection phobia: unusual vasovagal response

300.29 Situational phobia (e.g. airplanes,

elevators, enclosed places)

300.29 Other

Describe the general presentation, features and treatment of social anxiety disorder.

Marked fear or anxiety of 1+ social/performance situations in which individual exposed to possible scrutiny by others

Fears acting in a way or show anxiety sxs that will be negatively evaluated

Social situations almost always provoke fear or anxiety

Social situations avoided or endured with intense fear or anxiety

Fear or anxiety out of proportion to actual threat posed by social situation & to sociocultural context

Causes clinically significant distress or impairment

Kids

________________

Cognitive-behavioral therapies highly effective

SSRIs Paxil & Zoloft and Effexor - FDA approved

Relapse high with medication discontinuation

Describe the general presentation, diagnostic features and treatment of panic disorder and the nature of panic attacks.

Panic attack: abrupt surge of intense fear or intense discomfort

Palpitations, pounding hear

Trembling or shaking

Chest pain

Nausea or abdominal distress

___

Situationally Bound: Know you are afraid of heights or driving over bridges, you may have a panic attack in these situations.

Unexpected: Opposite of situationally bound. Don't have a clue when or where your next attack could be.

Situationally Predisposed: Between the 2 types. Most likely have a panic attack in a place you have before. Example: In a large mall.

___

Education is usually first line of treatment; recognize & identify sensations & triggers

Relaxation, breathing, mind-body awareness/meditation

Cognitive-behavioral therapy discussing irrational fears

Behavioral approach emphasizing graduated exposure

All relaxation skills taught must be reinforced by daily exercises at home

medications for anxiety and attacks

Describe the general presentation and features of Agoraphobia.

marked fear or anxiety about 2+ of the following:

Using public transportation

Being in open spaces (e.g., parking lots, marketplaces, bridges)

Being in enclosed places (e.g., shops, theaters)

Standing in line or being in a crowd

Being outside of the home alone

Situations are feared or avoided because of thoughts that escape might be difficult or help might not be available in event of developing panic-like sxs

C. situations almost always provoke fear or anxiety

D. agoraphobic situations actively avoided, require presence of companion or endured with intense fear or anxiety

E. fear or anxiety out of proportion to actual danger

F. Last 6+ months

Anxiety

the future-oriented mood state

Apprehension about future danger or misfortune

Somatic symptoms of tension

Marked negative affect

Understand the diagnostic features and treatment of OCD?

Obsessions; recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted

Compulsions; repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly

Can include

preoccupations

repetitive behaviors or mental acts in response to the preoccupations

recurrent body-focused repetitive behaviors (e.g., hair pulling, skin picking) and repeated attempts to decrease or stop the behaviors

---

Psychological

ERP - exposure and ritual prevention

Benefit 86%

Drugs

inhibit the reuptake of serotonin

only benefit up to 60%

relapse likely when discontinued

Psychosurgery

Lesion to the cingulate bundle (cingulotomy)

Most radical

Benefit 30%

List the risk factors and understand the prevalence of OCD?

Onset in childhood or adolescence.

Females are affected at a slightly higher rate than males in adulthood

These themes occur

across different cultures

Understand general diagnostic feature of Hoarding Disorder?

Hoarding disorder is a form of OCD, gather/buy items that are not necessary/no room for

What are the features of PTSD? How is it similar/different to acute stress disorder?

Describes the setting event as exposure to a traumatic event during which someone feels fear, helplessness, or horror, victims re-experience the event through memories and nightmares

They avoid anything that reminds them of the trauma, display numbing of emotional responsiveness and are sometimes unable to remember certain aspects of the event

Acute stress disorder can lead to PTSD, but can only last 3 days up to 1 month.

Understand the diagnostic features of Adjustment Disorder.

Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.

The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.

The symptoms do not represent normal bereavement.

Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.

Describe the role of genes in absolute vs relative influence

• Genes - long molecules of deoxyribonucleic acid (DNA) at various locations on chromosomes, within the cell nucleus

o Genes seldom determine our physical development in an absolute way

To some extent our weight and even our height are affected by nutritional, social, and cultural factors

Genes do provide some boundaries to our development, exactly where we go within these boundaries depends on environmental influences

True for most characteristics, but not all

• Some characteristics are strongly determined by one or more genes (eye color/hair color), rare disorders (Huntington's disease)

common concerns with DSM-V

• Comorbidity - individuals are often assigned more than one psychological disorder at the same time, sometimes as many as 3 or 4

o Cannot be definite about the course of a disorder, the response to treatment, or the likelihood of associated problems if we are dealing with combinations of disorder

• Labeling

Understand how prognosis is assessed in Autism Spectrum Disorder.

• The better the language skills and IQ test performance, the better the prognosis

o Language abilities and IQ scores are reliable predictors of how children with autistic disorder will fare later in life

• Also what we observed with her daughter

thoughts behind moving autism spectrum disorder and Asperger's into the same category

Asperger's is minor form of ASD

Asperger's did not have enough differentiating symptoms to be considered its own disorder