Exam 1

Chapters 1, 2, 3, 5, and 6.

What are the 3 Main Factors that make something a disorder?

1. Deviation from normal

2. Distress or impairment

3. Persistence over time

What is meant by “Scientist-practicioner”?

Mental health professionals whose clinical work is influenced by research (and vice versa)

What are the basic components of psychoanalysis?

• emphasized the role of unconscious drives

• releasing emotional tension (catharsis) from early trauma through talk therapy

• Free association, dream analysis

What Is the structure of the mind?

Id - (pleasure principle; illogical, emotional, irrational)

Ego - (rational; mediates between superego and id)

Superego - (moral principle)

What are the major themes of humanism?

• people are basically good

• humans strive toward self-actualization (desire to become the most one can be)

What is meant by a multidimensional, integrative approach to understanding psychopathology?

• psych disorders are the products of multiple interacting factors

• its not nature or nurture, its both

• Nature - genes

• Nurture = everything else

What is meant by polygenetic?

that more than one gene contributes to most traits

What are the 2 primary models for conceptualizing how genes and environment interact?

Diasthesis-Stress Model

• person has a genetic vulnerability

• stress “turns on” the genes

Gene-Environment Correlation Model

• person has a genetic vulnerability

• that person also has an inherited tendency to create the kind of stressful experience needed to turn on the genes (and ultimately develop a disorder)

Describe the structure of a neuron including the function of each part.

Axon - fiber that extends from the cell body of a neuron and transmits electrochemical impulses from that neuron to the dendrites of a receiving neuron

Neurotransmitter - brain chemical that carries information from the axon of a sending neuron to the dendrites of a receiving neuron

Dendrites - receive messages from other neurons

Myelin - covering the axon speeds transmission of neural impulses

Synapse - intersection between axon and dendrite

Describe the 4 lobes of the cerebral cortex and their unique responsibilities.

Frontal - thinking and reasoning abilities, memory

Parietal - touch recognition

Occipital - integrates visual input

Temporal - recognition of sights and sounds, long-term memory storage

Describe the function of the HPA Axis.

• integration of the endocrine and nervous system function

• body’s stress response system

• involves the hypothalamus, pituitary, and adrenal glands

What is the difference between clinical assessment and diagnosis?

Clinical assessment - the systematic evaluation and measurement of psychological, biological, and social factors in an individual with a possible psychological disorder

Diagnosis - the process of determining that those factors meet all criteria for a specific psychological disorder

What is the purpose of the clinical interview? What are its components?

Purpose: to understand this patients experience, factors that contributed to onset/maintenance, and identify what else you need to know in order to establish a diagnosis

• helps to identify what other assessment tools may be needed

• help make recommendations and plan for treatment

Components:

• presenting problem

• medical and social history

• prior treatments

• health behaviors

• structure/semistructured/unstructured

What are some situations in which a professional may want to gather information from someone other than the patient?

• patient may not be good at explaining history and may have a bad memory

• family are the one that encouraged the patient to get help

• get insight to see if they are doing well medically

Identify general ethical issues relevant to assessment/diagnosis?

• patients age

• patients privacy

• right to refuse care

• disclosure of sensitive/reportable info

• dual relationships

• personal bias

Distinguish between reliability, validity, and standardization.

Reliability - consistency in measurement, test-retest reliability

Validity - what an assessment measures and how well it does so

Standardization - ensures consistency in the use of a tool/technique, provides population benchmarks (norms) for comparison

Recognize/distinguish different types of psychological testing and the purpose of neurological testing.

Personality testing: MMPI

Intelligence testing - gives overall IQ and verbal and performance domains (blocks, pictures, designs) : WAIS, WISC

Projective testing - used to assess unconscious processes and is rooted in psychoanalytic tradition. Scoring/interpretation tends to be more subjective. : Rorschach Inkblot Test

Objective testing - more objective scoring and test stimuli is less ambiguous (what you see is what you get)

Neurological testing - assess broad range of skills and abilities, goal is to understand brain behavior relations, test range of skills including concentration, processing speed, mental flexibility, memory, and visual-spatial abilities

Describe the meaning of comorbidity.

two or more disorders for the same person

What is the difference between anxiety and fear?

Anxiety - worry about possible future danger/threat eg. “What if the plane goes down” when there is no indication of a problem

Fear - present-oriented mood state eg. [as engine is sputtering] “The plane is going down

Describe the relationship between physiological arousal and performance.

Up until a point arousal increases performance, too much arousal hinders performance

Prevalence rates for anxiety disorders and general demographic trends

• younger people experience more anxiety compared to older people

• women experience more anxiety than men

• non hispanic whites experience more anxiety compared to other races

Clinical Descriptions

Specific phobia - fear of specific objects or situations, object/situation consistency triggers fear and is avoided or endured with difficulty ex. needles

Social anxiety disorder - fear of negative evaluation in social situations, consistently trigger fear and avoided or endured with difficulty

Panic disorder - recurrent, unexpected panick attacks, persistent worry over having subsequent attacks, significant maladaptive change in behavior. Often paired with Agoraphobia - fear of avoiding places or situations

Generalized anxiety disorder - excessive worry that Is difficult to control, occurring most days for over 6 months, presence of 3+ of the following: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance

Biological and psychological contributions to anxiety disorders.

Biological contributions

• genetics - more likely if anxiety is in family history

• deficits in GABA, norepinephrine, and serotonin

• limbic system

Psychological contributions

• early history of uncontrollable and unpredictable environmental stressors

• conditioning

• cognitive appraisals play a role ex. catastrophic thinking (thinking the worst of things)

General prevalence rates for PTSD amongst trauma survivors.

20% of trauma survivors develop PTSD

What is the criteria and causes for PTSD

Criteria

• exposure to potentially traumatic life events

• re-experiencing symptoms (flashbacks or intrusive thoughts or images)

• avoidance symptoms

• negative impact on cognitions and mood

Causes

• intensity of the trauma and one’s reaction to it (true alarm, fear for one’s own safety)

• biological vulnerability

• uncontrollability and unpredictability

• learn alarms through direct conditioning and observational learning

What is the difference between obsessions and compulsions in OCD?

Obsessions - intrusive and nonsensical thoughts, images, or urges ex. contamination

Compulsions - thoughts or actions to neutralize anxious thoughts ex. hand washing to the point of hands getting raw

Describe the OCD cycle and causes of OCD?

Cycle

Obsessions → Anxiety/Distress → Compulsions → Temporary Relief → Repeat

Causes

• parallels other anxiety disorders

• early life experiences

• learning that some thoughts are dangerous/unacceptable

• thought-action fusion - the thought is similar to the actions thinking something will make it more likely to happen

Distinguish between situations where anxiety and fear are normal vs abnormal reactions.

Job Interview - Normal Anxiety

Seeing a Bear Outside House - Normal Fear

Driving on the highway thinking you are going to get hit - Abnormal Anxiety

Seeing a friendly dog - Abnormal Fear

What is the Role of Mental Status Exams and what are some circumstances in which they may be appropriate to administer?

Role - to see how the patient is doing through

• appearance and behavior (cleanliness, eye contact)

• thought content and processes (how are they speaking)

• mood and affect (how pt states they feel)

• intellectual functioning

• sensorium (orientation, place, time)

Circumstances

• Self-referral for anxiety or by neurologist for neurological testing

• pre-surgical assessment

• admitted for suicide attempt

What Classification systems are used to diagnose psychopathology and distinguish the 3 approaches to classification.

Systems

• Diagnostic and Statistical Manual of Mental Disorders (DSM)

• International Classification of Diseases (ICD-10)

3 Approaches

• Classical (or pure) categorical approach - strict categories

• dimensional approach - classification along dimensions

• prototypical approach - combines classical and dimensional views

Difference between classical and operant conditioning.

Classical

• people learn associations between neutral stimuli (unconditioned stimuli) and stimuli that already have meaning (conditioned stimuli) ex. Pavlovs dogs

• conditioning explains the acquisition of some fears

Operant

• reinforcement/punishment

• voluntary behavior is controlled by consequences)

Describe early types of biological treatments.

Insulin shock therapy - give patients higher and higher doses of insulin to result in convulsions. Some got better, some didn’t

Electroconvulsive therapy - delivering electrical currents to the brain to “reset” things, sort of a last result

Frontal lobotomy - sever connections in the brain by inserting tool through eye to brain

Tranquilizers - sedate patients

Identify prevailing beliefs about the causes of and treatments for abnormal behavior in the Middle Ages.

Supernatural

• the devil and witches were responsible for irrational behavior

• treatments for demonic possession included exorcisms, torture, and religious services

• moon and stars

Historical

• Hippocrats and Galen - Humoral Theory - 4 humors must be in balance. Treated with bloodletting or changing environmental conditions

• Hysteria “the wandering uterus” - psychological symptoms were a result of the uterus moving around in the body. Treatment was to get married

• Syphilis and biological link with madness. Treatment was to give small amounts of malaria

Describe the role of serotonin and dopamine.

Serotonin - influences information processing, behavior, mood, and thoughts

• dysregulated serotonin may contribute to depression

• low serotonin linked to impulsivity

Dopamine - gives you feeling of pleasure, satisfaction, and motivation (rewarding sensation)

• link between excessive dopamine and schizophrenia

• link between reduced dopamine and Parkinson’s disease

• implicated in depression and ADHD

Role of the Limbic System.

• helps to regulate our emotional experiences and expressions and ability to learn and control our impulses

• also involved in basic drives

Distinguish between the responsibilities of the brainstem vs the forebrain and recognize structures within both.

Brainstem - vital function of life ex. breathing

• hindbrain

• midbrain - arousal, temp regulation, coordination

• thalamus and hypothalamus

Forebrain - sensory processing, behavior response to stress and fear

• limbic system

• basal ganglia - motor control

• cerebral cortex (largest part of the brain)

Recognize the branches of the nervous system and their responsibilities.

Central Nervous System - take in sensory info, process info, and send out motor signals

• Brain and Spinal Cord

Peripheral Nervous System

• somatic - controls voluntary muscles and movements

• autonomic branches - involuntary processes, regulates cardiovascular system and body temp, sympathetic and parasympathetic

• endocrine system - regulates all hormones ex. adrenal and thyroid glands

Function and components of emotion and describe how emotions relate to psychopathology.

Some emotions can affect us both mentally and physically

Components of emotion

• cognition

• physiology

• behavior

Ways in which the sociocultural context can influence psychopathology

Taijin kyofusho - fear of being disrespectful to others

Dhat - anxiety related to semen loss

Susto - belief that you have been victim of black magic

Hippocampus and Amygdala Roles

Hippocampus - main job is to help with memory, helping move short term memory to long term

Amygdala - feeling of fear and perception of threat, memory is involved, tendency toward aggression

Recognize evidence-based treatments for anxiety & related disorders including the components and assumptions of cognitive-behavioral therapy and the role of exposure.

Cognitive Behavioral Therapy

• at the core of the problem is 1) faulty ways of thinking and 2) unhelpful behaviors

• we can practice more adaptive ways of thinking and behaving

• people can learn to be their own therapist

Recognize faulty cognitions

• all or none thinking

• emotional reasoning

• over generalizing

Treatments

• real life - being exposed to a fear in real life

• imagined - vividly imagining a fear

• virtual reality - using vr to be exposed to a fear

• interceptive - bringing sensations into play in an effort to disconfirm the idea that physical sensations will lead to harmful events

Clinical Descriptions of Somatic Symptom Disorder and Functional Neurological Symptom Disorder

Somatic Symptom Disorder

• at least one bodily symptom that is distressing and/or significantly impairing

• excessively thinking about, worrying about, and/or spending time devoted to these symptoms

• symptoms typically last 6+ months

Functional Neurological Symptom Disorder

• at least one symptom affecting a persons sensation, perception, or voluntary movement without identified cause (tingling, blindness, partial paralysis)

• typically comes on suddenly

• causes significantly distress or impairment

Causal Factors and Components of treatment for somatic symptom disorder and functional neurological symptom disorder.

Factors for Somatic Symptom Disorder

• familial history of illness

• stressful life events

• sensitivity to physical sensations

• experience suggesting that there are benefits to illness (treated nice)

Treatment for Somatic Symptom Disorder

• support for CBT

• reduce tendency to visit numerous medical specialists

• assign “gatekeeper” physician

• reduce supportive consequences of talk about physical symptoms

Treatment for Functional Neurological Symptom Disorder

• similar to Somatic Symptom Disorder

• if onset after a trauma, may need to process trauma or treat post traumatic symptoms

• remove sources of secondary gain

• reduce supportive consequences of talk about physical symptoms

Clinical Description of Factitious Disorder

• purposely faking physical symptoms

• may actually indicate physical symptoms or just pretend to have them

• no obvious external gains

• different from malingering (faking symptoms for a benefit such as money or attention)