Abnormal Psychology Exam 1: Chapters 1-3

Psychological Disorder

Behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and/or impairment in functioning, or increased risk of suffering, death, pain, or impairment

3 Criteria of Psychopathology

·       Psychological dysfunction – breakdown in cognitive, emotional, or behavioral functioning

·       Distress/impairment: causes problems in social, occupational, or other important activities

·       Atypical or not culturally expected response: violating social norms

· Consider "normalcy" relative to the behavior of others in the same cultural context

Clinical description

The process of assessing a client’s mental health through testing and observation

Components of clinical description

Presenting problem

Prevalence

Incidence

Course

Onset

Prognosis

3 Prominent historical approaches

Supernatural, biological, psychological

Supernatural

·       Abnormal behavior believed to be caused by demonic possession, witchcraft and sorcery; treatments included exorcism, torture, and religious rituals

  · Mass hysteria evidence of demonic possession (Saint Vitus’s Dance/Tarantism) – emotion contagion; mob psychology

·       Insanity caused by emotional stress, not supernatural forces; treatments: rest, sleep, healthy environment, baths, potions

·       Paracelsus (Swiss physician): mental health problems are affected by the pull of the moon and stars – led to term “lunatic”

Biological

·       Hippocrates Humoral Theory of Disorders: Four key bodily fluids (humors) – disease caused by having too little or too much

o   Blood, phlegm, black bile, yellow bile

o   Ex. depression caused by too much black bile

o   Treatment: changing environmental conditions or bloodletting/vomiting

·       General paresis (late-stage syphilis) – caused by bacterium

o   Symptoms similar to psychosis – bolstered view that mental illness = physical illness

·       John P. Grey and the reformers – mental illness has physical roots

o   Treatment for mentally ill same as physically ill

o   Led to reforms of hospitals to give psychiatric patients better care – became too big patients weren’t given proper care

·       Treatments: insulin shock therapy, electroconvulsive therapy (ECT) – Ben Franklin, medication – neuroleptics (major tranquilizers now called antipsychotics) and minor tranquilizers prescribed for anxiety disorders

Psychological

• Moral therapy – treated institutionalized patients as normally as possible in a setting that encouraged and reinforced normal social interaction

  • Declined in use due to

    • Size and composition of institutionalized population (many after civil war + immigrants) works best with smaller number of ppl

    • Dorothea Dix and mental hygiene movement – focused on providing care to everyone who needed it – influx of patients

    • Mental illness believed to be incurable (caused by brain pathology – due to biological tradition)

• Psychoanalytic Theory – Freud

  • Role of unconscious drives (such as sex and power) and importance of early life experience

  • Psychoanalytic therapy: reveal the nature of unconscious mental processes and conflicts

    • Free association, dream analysis, and analysis of transference

    • Little evidence of effectiveness

  • Psychodynamic therapy: more goal-oriented than psychoanalytic

    • Focuses on affect/expression of emotions, past experiences, etc.

    • Research shows may be effective for treating mental disorders

Cognitive-Behavioral Model

Combines insights from behavioral, cognitive, and social models – revolutionized the field by bringing about systematic development of more scientific approach to study of psychological disorders

Watson

Believes psychology is a purely objective experimental branch of natural science with goals of prediction and control of behavior

Multidimensional integrative approach

Interdisciplinary, eclectic and integrative system – abnormal behavior results from multiple influences: biological, behavioral, cognitive, emotional, social and cultural, developmental, and environmental

Genes

determine parts of physical and mental characteristics

Genotype

each pair of alleles

Single nucleotide polymorphisms (SNPs)

Variants of a single nucleotide

Two undeniable facts about psychopathology

• Psychopathology is heritable: genes account for less than 50% of variations in psychopathology and all mental disorders are somewhat heritable

• Development, behavior, and psychological disorders are almost always polygenic

Diathesis-stress model

·       Individuals inherit tendencies to express traits/behaviors, which may then be activated under conditions of stress

·       The greater the underlying vulnerability, the less stress is needed to trigger a disorder

·       Low stressful environment, high genetic vulnerability = intermediate risk for developing mental disorder

·       Low stressful environment, low genetic vulnerability = low risk for developing mental disorder

·       High stressful environment, high genetic vulnerability = high risk for developing mental disorder

·       High stressful environment, low genetic vulnerability = intermediate risk for developing mental disorder

Gene-environment correlation model

·       People with a genetic predisposition for a disorder may also have a genetic tendency to create environmental risk factors that promote the disorder

·       Genetics may make people more likely to seek out certain environments, thus affecting their experiences

Epigenetics

• The study of factors other than inherited DNA sequences, such as new learning or stress, that alter the phenotypic expression of genes

• Environmental influences (e.g. stress, nutrition) actually affect the expression of certain genes both for the individual and their descendants

• Nongenomic "inheritance" of behavior: cross-fostering studies of development

Central nervous system

brain and spinal cord

Peripheral Nervous System

Autonomic nervous system and somatic nervous system

Autonomic nervous system

Sympathetic division and parasympathetic division – involuntary processes, regulates cardiovascular system/body temperature/endocrine system and aids in digestion

Somatic nervous system

controls voluntary muscles and movements

axon

trunk of neuron that sends messages to other neurons

Glutamate

Excitatory – “turns on” many different neurons, leading to action

GABA

o   Inhibitory - regulate transmission of information

o   Benzodiazepines used to treat anxiety

Norepinephrine

o   Noradrenaline

o   Part of endocrine system

o   Involved in alarm responses and basic bodily processes (e.g. breathing)

Serotonin (5-HT)

o   Inhibition and constraint

o   Influences information processing, behavior, mood, and thoughts

o   May contribute to depression

Dopamine

o   Reward seeking and motivation

o   Exploratory, outgoing, pleasure-seeking behaviors

forebrain

cortex and subcortex - where most of the study of psychopathology takes place

subcortex (below cortex)

thalamus and hypothalamus

thalamus

relay station of sensory information between brainstem and forebrain

hypothalamus

regulated endocrine system (HPA axis); maintains homeostasis

midbrain

coordinates movement with sensory input

hindbrain (brainstem)

regulates breathing, heart rate, digestion, etc. and includes medulla, pons, and cerebellum

frontal lobe

plans movements, recent memory, emotions

parietal lobe

receives and processes sensory input (touch, pressure, heat, cold, pain), perception of body awareness, constructs spatial “mental map” of our world

occipital lobe

visuospatial processing, distance and depth perception, object and face recognition

temporal lobe

processes auditory information, encodes memories, visual perception, language, emotion processing

prefrontal cortex

higher cognitive functions such as thinking, judgment, and reasoning, planning for the future, long-term memory

limbic system

·       Part of the cortex – responsible for emotion, long-term memory, and behavior regulation

·       Hippocampus: learning and forming new memories

·       Amygdala: emotion (fear, anxiety, anger, pleasure); evaluating stimuli

·       Basal Ganglia: movement and reward

·       Cingulate Gyrus: emotion processing and behavior regulation

Hypothalamic-Pituitary-Adrenocortical (HPA) axis

·       Exerts widespread effects on metabolism, immunity, and behavior, to help us cope with stress

·       Stress results in the hypothalamus releasing the corticotropin releasing hormone (CRH) which stimulates anterior pituitary to release ACTH which causes adrenal glands to release cortisol (stress hormone)

cortico-limbic circuit

supports recognition, reactions, and threat-related processing; key regions are amygdala and prefrontal cortex – dysfunctions implicated in mood and anxiety disorders

cortico-striatal circuit

supports motivation, actions, and reward-related processing; key regions are basal ganglia and prefrontal cortex – dysfunctions implicated in mood, anxiety, eating, ADHD, substance use, and behavioral/impulse-control disorders

cortico-hippocampal circuit

supports memory and executive control; key regions are hippocampus and prefrontal cortex – dysfunctions implicated in schizophrenia, cognitive/memory impairments, and substance use, mood, and anxiety disorders

cognitive model

• aaron beck and albert ellis

• “You are what you think you are” – conscious thoughts influence our emotional and behavioral experiences; people create their problems by the way they cognitively interpret events and situations

beck’s cognitive theory

• rational and maladaptive assumptions/thought processes can become habitual and automatic that influence our behaviors and feelings that lead to mental disorders

• cognitive schemas, cognitive triads, cognitive distortions

cognitive triad

• people have certain errors in their beliefs and these errors are relevant to three aspects: the self, the world, and the future

  • Involves individuals most likely prone to depression – they would have negative views of themselves (“I’m worthless and inadequate”) and negative views of the world around them (“Everyone is against me because I’m worthless”) and negative views of the future (“I’ll never be good at anything”) which would result in psychological disturbances especially relevant to depression

cognitive distortions

• exaggerated thought patterns

  • All or nothing thinking, overgeneralizing, mental filter, disqualifying the positive, jumping to conclusions, and magnification/minimization

implicit processing

cognitive processes that occur outside conscious awareness or conscious control

nature of emotions

·       pattern of action elicited by an external event and a feeling state, accompanied by a characteristic physiological response

o   6 primary emotions: happiness, sadness, fear, disgust, anger, surprise

primary functions of emotions

organize and motivate action; communicate information to others; provide us with information

3 components of emotion

physiology, emotion, cognitive

physiology - component of emotion

emotion is a brain function involving (generally) the more primitive brain areas; direct connection between these areas and the eyes may allow emotional processing to bypass the influence of higher cognitive processes

emotion/behavior - component of emotion

basic patterns of emotional behavior (freeze, escape, approach, attack) that differ in fundamental ways; means of communication

cognitive - component of emotion

appraisals, attributions, and other ways of processing the world around you that are fundamental to emotional experience (how we think about emotional experience)

cognitive/expressive suppression

try to hide or inhibit or suppress your emotional experience because you don’t want to think about or experience it

cognitive reappraisal

attempt to reinterpret some emotion/emotional situations that alters its meaning and emotional impact (thinking about positives rather than only negatives)

lifespan development

Prevalence and age of onset differs for mental disorders throughout development (ex. gender distribution in depression is approximately equal until puberty, when it becomes more common in girls

equifinality

a single outcome may have several causes

• ex. people with PTSD can get it from different things (sexual assault, car accident, gun violence, etc.)

multifinality

a single cause may have several outcomes

• ex. trauma can lead to no mental illness, PTSD, major depression disorder, substance-use disorder, etc.

3 key concepts in assessment

reliability, validity, standardization

clinical assessment

Systematic evaluation and measurement of psychological, biological, and social factors

mental status exam

·       Brief preliminary test of a client's judgment, orientation to time and place, and emotional and mental state (typically done in an initial interview like the patient coming for the first time to seek treatment)

·       Involves systematic observation of an individual's behavior and covers five categories: appearance and behavior; thought processes; mood and affect; intellectual functioning; and sensorium

thought processes

rate of speech, continuity of speech, content of speech

mood and affect

• Predominant feeling state of the individual

• Feeling state accompanying what individual says (does affect match what they are saying - such as laughing when talking about the death of a loved one would be mismatching affect)

intellectual functioning

type of vocab and use of abstractions and metaphors

physical exam

·       Purpose is to rule out possible "organic cause" of psychological disorder

·       Examples:

o   Hypothyroidism -> depression and/or anxiety

o   Brain tumor -> psychosis

o   Cocaine withdrawal -> panic attacks

behavioral observation/assessment

·       Uses direct observation or role-play to assess an individual's thoughts, feelings, and behavior in specific situations or contexts

·       Target behaviors are identified and observed with the goal of determining antecedents and consequences

·       ABC's - Antecedent, Behavior, Consequence

o   Antecedent: what event or action occurred immediately before the behavior

o   Behavior: what did the person do (should be an observable action)

o   Consequence: what action or response immediately followed the behavior

·       Likely done in the patient's home/work/school environment (often outside of clinic) - can be done in one setting or multiple

neuropsychological testing

·       Measure abilities in areas such as receptive and expressive language, attention and concentration, memory, motor skills, perceptual abilities, and learning and abstraction

·       Allow the clinician to make inferences about brain functioning and organic damage

structural imaging methods

CAT/CT scans; sMRIs

computerized axial tomography (CAT) or CT scans

utilizes x-rays

structural magnetic resonance imaging (sMRI)

• Utilizes strong magnetic fields

• Better resolution than CT scan

functional imaging methods

PET and SPECT scans; fMRI

positron emission tomography (PET) and single photon emission computed tomography (SPECT) scans

involve injection of radioactive isotopes

functional MRI (fMRI)

uses blood-oxygen-level dependent (BOLD) signal to identify brain activity patterns

psychophysiological assessment

·       Measure changes in indicators of nervous system functioning that reflect emotional or psychology events

o   Electroencephalogram (EEG) measures electrical activity in the brain

o   Heart rate, respiration, cortisol, skin conductance (i.e., sweat gland activity) controlled by the peripheral nervous system

classification/diagnosis

Degree of fit between symptoms and diagnostic criteria (currently outlined in DSM); must be reliable and valid

construct validity

criteria are consistently associated and distinct from those for other diagnostic categories

predictive validity

tells the clinician what is likely to happen with the prototypical patient

content validity

criteria reflect the way most experts in the field think about the disorders

3 critiques of DSM-5

comorbidity, dimensionality, heterogeneity

comorbidity

o   When one individual has more than one diagnostic category at the same time

o   Pretty common

o   People tend to have greater impairment, treatments tend to be more complex, and outcomes tends to be worse

o   Hard to make out individual causes of disorders

dimensionality

o   Having cut offs for what meets the disorder and what doesn't, may not reflect how people really are

o   Could lead to people not getting treatment that they need because they don't meet the requirements

heterogeneity

So many ways symptoms can manifest in individuals with disorders

alternate classification systems

HiTOP and RDoC

the hierarchal taxonomy of psychopathology (HiTOP)

o   Looks empirically at the structure of psychopathology

o   Combines individual signs and symptoms into homogenous components/traits and syndromes

research domain criteria (RDoC)

o   Integrate many levels of information to explore the full range of human behavior

o   Goal is to understand the nature of mental health and illness

o   Not meant for diagnosis (yet) but rather to better inform research into the causes of mental disorders