AP Psych Unit 5: Clinical Psychology

DSM

contains the symptoms of everything considered to be a psychological disorder

4 Ds that are analyzed regarding clinical disorders

Dysfunction, distress, deviation, and duration

Problems with the DSM

danger of over-diagnosis, potential confusion of serious mental disorders with normal life problems.

labeling theory

primary (view of self) and secondary (how others view he labeled person impacts.

Power of diagnostic lables

problem of the self-fulfilling (linked to the “looping effect”

David Rosenhan’s “On Being Sane In Insane Places”

pseudopatients that fake hearing voices were diagnosed as schizophrenic and manic depressive.

benefits of DSM

provides standardization, labels: allow treatments to occur quickly, biases can be combatted with awareness and better research

IDC-11

includes chapters relevant to clinical psycology

biophysical model of psyschological disorders

Biological (genetic factors, neurological function), Psychological (Mental and emotional states), and Social (societal and cultural factors)

Diathesis-Stress model

Diathesis (predisposed vulnerability to genetics) coupled with stress may lead to psychological disorders

Generalized Anxiety Disorder (GAD)

-constant uncontrollable, low-level anxiety that is NOT brought on by physical causes

-symptoms: restlessness, difficulty concentrating, muscle tensions

-vigilance scanning: heightened attention to everything around them, increased distractibility and decreased concentration

-brain regions: overactive amygdala, under active frontal lobe

Panic Disorder

• characterized by suddenly severe anxiety attacks: overreaction of the sympathetic nervous system

• symptoms: trembling, dizziness, chest pain, sweat

ataque de nervious (attack of nerves)

culture-bound symptoms

phobias

intense and irrational fear of some object or situation

Agoraphobia

intense fear of public places or open spaces

specific phobias

anxiety elicited by a specific object or situation (examples: acrophobia - fear of heights, arachnophobia-fear of spiders)

social phobia (social anxiety disorder)

persistent and irrational fear of social situations or performance situations

taijin kyofusho

culture-bound syndrome (Japan) in which a person fears that their appearance or bodily functions are often offensive or displeasing to others

PTSD

extreme emotional reaction to a negative event

• symptoms: intrusion/ re-experiencing

• avoidance of trauma-related thoughts or feelings and external reminders

• negative alterations in cognition and mood

• alterations in arousal and reactivity

Three key factors that promote recovery/ resilience

cohesive and egalitarian society, discouragement of victimhood/ helplessness narrative, importance of feeling necessary and productive

OCD

• obsession: persistent and irrational thoughts or wishes

• compulsion: uncontrollable and repetitive act

• often comorbid with depression

• may also be linked to deficiencies in serotonin and different function in frontal lobe

hoarding disorder

characterized by persistent difficulty discarding or parting with possessions resulting in harmful effects

Body Dysmorphic Disorder (BDD)

a person becomes excessively preoccupied by perceived flaws of a body part(s).

-extremely marginal case: apotemnophilia/ xenomelia (to have healthy limbs removed)

somatoform disorders

disorders in which there is an apparent physical disorder for which there is no organic basis

conversion disorders

identified by freud, a person converts psychological distress into imaginary physical ailments (now often referred to psychogenic illness)

hypochondriasis

a person interprets small and insignificant symptoms as a sign of serious illness

munchausen syndrome (factitious disorder)

a person deliberately harms themselves in order to get medical treatment (find comfort in the role of medical patient).

dissociative disorders

conditions in which consciousness is split or altered in some fashion, symptoms are intense, usually last a long time, and appear to be out of the individual’s control

depersonalization/ derealization disorder

• depersonalization: persistent feelings of detachment from one’s body and thoughts.

• derealization: may feel that surroundings (people and things) aren’t real.

psychogenic amnesia

1. inability to remember important personal information, usually of a traumatic and stressful nature

2. It is not caused by physical or organic damage (known as the organic amnesia)

3. with he passage of time, memory usually returns

Fugue

a person forgets his/her identity entirely and wanders far from home

Dissociative Identity Disorder (DID)/ Multiple Personality Disorder

the existence in a single individual or two or more distinct identities or personalities that alternate in controlling behavior

DID controversy

one side: thinks DID is a genuine illness, which is frequently a response to severe trauma

other side: feels that DID is the “fad” illness (# of people diagnosed with DID increased substantially form 1970s to 1990s, however rates have declined since of 1990s)

There may be an element of pressure and the power of suggestion by clinicians/ therapists (iatrogenic suggestion)

sociocognitive perspective: DID is simply an extreme form of presenting different aspects of personality

Mood disorders

a person with mood disorders experiences extreme or inappropriate emotions

Major Depressive Disorder (Unipolar Disorder)

Emotional symptoms: sadness, feelings of worthlessness, increased irritability and anger, loss of pleasure (anhedonia)

Cognitive Symptoms: negative view of self, hopelessness, poor concentration, and memory lapses

Aaron Beck’s Cognitive Triad

• negative views of self, world, and future

• involves attributional style (one’s own explanation for one’s mood)

Abramson’s Theory oof attribution (explanatory style)

Internal vs. External, Stable vs. Unstable, Global vs. Specific

Seligman’s Learned helplessness theory

when one’s prior experiences have caused that person to view himself/herself as unable to control aspects of the future that are controllable.

Persistent depressive disorder

chronic low-level depression (dysthymia) that is not severe, but may be longer lasting than, major depressive disorder

Bipolar Disorder (Manic Depression)

characterized by extreme mood swings (highs and lows-referred to as cycling): often experience 2 cycles per year

Rapid cycling: 4 or more episodes in a 12-monthperiod

General symptoms of mania

Grandiosity: feel incredibly powerful, meaningful.

Impulsivity during manic phases can be a significant problem

Three different stages of mania

Euphoria: confident, self-assured, creative, charismatic

Irritability: charisma is mostly gone, outbursts of temper; life becomes unmanageable

Panic: delusional, hallucinations, desperate need for hospitalization

Bipolar I

-Experience more severe manic episodes.

-May not have depressive episodes.

Bipolar II

-less severe manic phases (hypomania).

-More depressive episodes.

Bleur’s Four A’s

• Associations- Associations among thoughts are disturbed (lack

associative connectivity).

• Affect- Emotional responses are flattened or inappropriate.

• Ambivalence-Hold conflicting feelings toward others and

  themselves.

• Autism- turning toward an inner world, detachment from reality

Symptoms a person must exhibit at least two of to be diagnosed with schizophrenic

-Hallucinations

-Delusions

-Incoherent speech

-Grossly disorganized behavior

-Certain thought disorders

-Loss of normal emotional responses and

social behaviors.

Positive symptoms

behaviors that are notable because of their presence (delusions, hallucinations, inappropriate affect and thought disorders)

Thought Control

insertion, withdrawal, broadcasting

Negative symptoms

symptoms that are notable because of their absence

Flat/ blunted affect

lack of emotional expression, a deficit of speech, and anhedonia (lack of pleasure)

Avolition

decrease in motivation to initiate and perform self-directed/purposeful activities. (e.g., pay bills, school/work responsibilities, personal hygiene).

Catatonia

lack of mobility or responsiveness (stupor) sometimes alternating with odd body positions and overactivity

causes of schizophrenia

genetics- monozygotic (identical) twins: some studies indicate as high as 50% concordance rates, concordance rates for offspring and siblings are above the average rate

neurological abnormalities: temporal lobe, insula and cerebral ventricles

Dopamine hypothesis: too much may produce hallucinations and delusions.

Personality disorders

an enduring pattern of inner experience that is deviant, pervasive, and inflexible

difference between anxiety/ mood disorders and personality disorders

people with personality disorders do not feel upset or anxious and may not be motivated to change

Cluster A (odd or eccentric) Personality Disorders

Schizoid lack of ability to desire to form relationships (emotional coldness) and restricted affect

Paranoid-irrational suspicion and mistrust. Interpreting motivations of others as malevolent.

Schizotypal- derealization, transient psychosis, social anxiety.

Cluster B (dramatic, emotional or erratic)

Borderline- Emotional outbursts, impulsivity, fear of abandonment, instability regarding relationships

Histrionic- pervasive pattern of attention-seeking behavior (excessive emotional expression and exaggerated or false stories).

Narcissistic- self-centered, grandiosity, arrogant, incessant mendacity (lying), hypersensitivity to criticism

Antisocial (Psychopath/ Sociopathy)-disregard and violate rights others (exploitative), manipulative, callous, remorseless

Cluster C (anxious or fearful) Personality Disorders

Dependent, Avoidant, Obsessive-Compulsive

What happened in the 1960s

movement towards deinstitutionalization

why did deinstitutionalization occur?

• media had revealed negligence and abuse

• rise of psychotropic drugs

• problems of funding

Involuntary commitment and treatment

generally only applied for people with long-term, severe problems that are a danger to themselves or others

anosognosia

lack of insight or recognition of one’s own psychiatric symptoms

duty to protect

psychotherapy is based on trust and confidentiality

tarasoff case

if the client is dangerous, the therapist is obligated to break the pledge of confidentiality

M’naughen rule

knowing “right from wrong” standard

primary prevention

efforts to reduce incidence of societal problems

secondary prevention

involves working with people at-risk for developing specific problems

tertiary prevention

efforts aim to keep people's mental health issues from becoming more severe

psychiatrist

medical degree, can prescribe medication and hospitalization

Counseling psychologist

PhD in counseling psychology, focus on clinical (mental disorders) and counseling (problems of adustment)

psychiatric social workers

2-year master’s degree, extend treatment procedures to the home and the community

Jerome frank’s five common features of effective psychotherapy

i) trusting relationship

ii)belief in the efficacy of therapy techniques

iii) some type of healing setting, usually private

iv) increased feelings of relief

v) increased feelings of mastery and control

nonmaleficence

obligation not to harm

fidelity

degree to which treatments are delivered competently and accurately

cultural humility

willingness to respect and learn from patients about their experiences

psychodynamic/ psychoanalytic theories

• unconscious basis: concept of blocking or resistance (areas that need to be explored), use of free association and dream analysis

• Emphasis on early relationships with parents and siblings

• transference: tendency of client to make the therapist the object of his/her thoughts and emotions

• counter-transference: therapist may become emotionally reactive or entangled with cliemts
  

Interpersonal Therapy

more modern, meet less frequently, more emphasis on current relationships and direct discussion of problems

behavior theories

• based on principles of learning and conditioning

• emphasis on direct behavior itself

• tend focus on phobias and bad habits

• counterconditioning

• systematic desensitization

counterconditioning

unpleasant (aversive) conditioned response is paired with a pleasent one

systematic desensitization

• getting the client to relax

• hierarchies of anxiety-producing situations are imagined while in this relaxed condition

• in vivo desensitization: actually confronting the fear-provoking situations live (in vivo)

implosive therapy

unlike gradual process of systematic desensitization: involves having the client imagine the most frightening scenario first. based on the notion that if the client based his/her fears and does not back down, they will realize that he fear is irrational

flooding

involves experiencing, rather than imagining, one’s peak fear until the anxiety diminishes (exposure therapy)

modeling

observing and imitating others (social learning theory)

behavioral rehearsal

useful for assertiveness training and other social situations

selective reinforcement

use of reinforcement for desired behavior

applied behavior analyis

application of operant conditioning principles to improve the functioning of children with neurodevelopmental disorders

aversive conditioning

associate unwanted behavior with negative aspects

self-regulation

monitor and observe one’s own behavior

cognitive therapies (CBT)

therapist often challenges the irrational thinking of the client

cognitive reconstructing

teach client to “flip the script” on misguided “automatic thinking” (“thought traps”) that are overly broad, negative, and perfectionistic. Focus on developing a healthier attributional style (interpreting negative events in a more external, specific, and temporary fashion)

REBT

looks to expose and confront the dysfunctional thoughts of the client by asking 5 questions (what evidence is their for this belief?. ect)

Dialectical Behavioral Therapy

• mindfulness

• distress tolerance: geared towards increasing a person’s tolerance of negative emotion rather than trying to escape from it

• emotional regulation: manage and change intense emotions

• interpersonal effectiveness: techniques to allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationship

Humanistic therapies

emphasis on the individual’s natural tendency toward growth and self-actualization

• belief that people say things in distress that they don’t really mean

• operate on the belief that people are innately good and also possess free will

• goal of. the therapist: facilitate exploration of the individual’s own thoughts, feelings, goals

Client/ Person- Centered Therapy (Carl Rogers)

assumed that each individual is the best expert on him/ herself and that people are capable of working out their own solutions

Gestalt therapy

emphasize the importance of the whole: encourage people to get in touch with their whole self

eclectic/ integrative approach

most psychologists don’t just use one technique, but combine multiple

Anti-psychotic drugs (neuroleptics)

• block or reduce the sensitivity of the brain receptors that respond to dopamine

• can reduce agitation, delusions, and hallucinations (positive symptoms)

• offer little relief from jumbled thoughts, concentration problems (negative symptoms)

• negative symptoms: tardive dyskinesia, neuroleptic malignant syndrome

• alter metabolism

anti-depressant drugs

• used primarily to treat depression, anxiety, phobias, and OCD

• SSRIs are most common type

• block re-uptake of serotonin by the pre-synaptic neuron

• most effective for more severe cases of depression

anti-anxiety drugs

• barbiturates and benzodiazapines

• decrease activity of nervous system

• increase activity of GABA

• risk of memory impairment, over seduction

lithium carbonate

• used to moderate mood swings for bipolar disorder

• reduces excitatory neurotransmitters (dopamine and glutamate) while increasing GABA