ABNORMAL PSYCHOLOGY

EXAM #1

mental status exam

relatively coarse preliminary test of a client’s judgement, orientation to time and place, and emotional and mental state; typically conducted during an initial interview

psychological disorder

a psychological dysfunction within an individual associated with distress or impairment in functioning and a response that I not typical or culturally expected

the criteria for defining a psychological disorder

\-psychological disfunction→abnormal cognitive, emotional, or behavioral functioning

\-impairment→problems with job, relationship, daily routines and is set in the context of a person’s background and culture

\-atypical response or personal distress

the diagnostic and statistical manual (DSM-5)

contains diagnostic criteria

psychopathology

the scientific study of psychological disorders

mental health professional

clinical and counseling psychologist→

\-receives a Ph.D, E.D, or Psy.D

\-counseling psychologist study and treat adjustment and vocational issues

\-clinical psychologists concentrate on sever psychological disorders

psychiatrist→

\-receives an M.D.

\-investigates the nature and causes of psychological disorders, make diagnoses and offer treatment (often drugs or other biological treatment)

psychiatric social workers→

\-earn master degree in social work

\-treat disorders, often concentrating on family problems associated with them

psychiatric nurses→

\-advanced degrees

\-specialize in the care and treatment of patients with psychological disorders, usually in the hospital apart of a team

scientific practitioner

mental health professionals take a scientific approach to their clinical work

three ways mental health practitioners function as scientist practitioners:

1) keep up with the latest development in their field and use the most current diagnostic and treatment procedures

2)evaluate there own assessment or treatments procedures to see whether they work

3)conduct research that produces new information about disorders or their treatment

clinical description

uniques combination. of behaviors, thoughts, and feelings that make up a specific disorder

→presenting problem- original complaint reported by the client to the therapist is the first step in determine clinical description

→clinical refers both to the types of disorders you would find in a clinic or hospital and to activities connected with assessment and treatment

→aims to distinguish clinically signifiant dysfunction from common human experience

prevalence

number of people displaying a disorder in the total population at any given time

incidence

number of new cases of a disorder appearing during a specific period

acute onset

when a disorder beings suddenly

insidious onset

disorder gradually develops over an extended period

course of disorders

episodic→happens in episodes

time-limited→it happens and never reoccurs

chronic cases→the disorder can be treated but it is always present

prognosis

predicted development of a disorder over time

good prognosis→ improvement can be made by using a treatment plan

guarder prognosis→ little to no improvement can be made

etiology

cause of source of a disorder

→includes biological, psychological, and social development

treatment

any ways we can help treat a disorder

→includes pharmacological, psychosocial, and/or combined treatments

historical conceptions of abnormal behavior

\-major psychological disorder have existed in all cultures and across all time periods

\-causes and treatments of abnormal behavior vary widely across cultures, time periods, and world views

supernatural model

\-agents outside our bodies and environment influence our behaviors, thinking, and emotions

\-agents might be demons, spirits, or other phenomenas such as the moon or stars

\-deviant behavior as a battle of “good” vs “evil”

\-treatments included exorcism, torture, or religious services

biological model

Hippocrates: abnormal behavior as a physical disease (linked abnormality with brain chemical imbalance)

→hysteria “the wandering uterus”- psychological symptoms were a result of the uterus moving around the body

Galenic-Hippocratic tradition:

→human theory of disorders-function is related to having too much or too little of four key bodily fluids(humors: blood, phlegm, black bile, and yellow bile)

blood=heart

phlegm=brain

black bile=spleen

yellow bile=liver

→treated by changing environmental conditions or bloodletting/vomiting

What illness helped society see the biological link to psychological madness

general paresis aka syphilis

→caused unusual psychological and behavioral symptoms

→Louis Pasteur discovered the cause of syphilis-a bacterial microorganisms soon after this discovery penicillin become a successful treatment to the disease

who was John P. Grey?

\-the champion of the biological tradition in the U.S. and was the most influential psychiatrist who believed mental illness had physical roots

early biological treatments

\-electric shock→used for people with severe depression

\-crude surgery

\-insulin→used to calm psychotic patients

\-major tranquilizers

\-minor tranquilizers→commonly prescribed to help reduce anxiety

consequences of the biological tradition

\-reduce or eliminate interest intreating mental patients, because they thought mental disorders were the result of some undiscovered brain pathology that was incurables

\-Emil Krapelin: classification of disorders which emphasized that different disorder have unique age of onset, symptoms, and causes

Moral therapy

involves treating patients as normally as possible rather than to a code of conduct

→main idea was to treat patients as normal as possible in normal environment

→encouraged and reinforced social interaction

Freudian theory of structure and function of the mind

→unconscious-the part of the psychic makeup that is outside the awareness of the person

→catharsis-rapid or sudden release of emotional tension through to be an important factor in psychoanalytic theory

→psychoanalytic model-seeks to account for the development and structure of personality, as well as the origin of abnormal behavior, based primarily on inferred inner entitles and forces

three major facets of psychoanalytic theory

1) the structure of the mind and the functions of personality that sometime clash with one another

2) the defense mechanisms with which the mind defends itself from these conflicts

3) the stages of psychosexual development that contribute to our inner conflicts

structure of the mind

id→pleasure principle; illogical, emotional, and irrational

superego→moral principle

ego→rational; mediates between superego and id

defense mechanisms

egos attempt to manage anxiety resulting from id/superego conflict

examples:

\-denial

\-displacement

\-projection

\-rationalization

\-reaction formation

\-repression

\-sublimation

psychosexual stages of development

\-oral stage

\-anal stage

\-phallic stage

\-latency stage

\-genital stage

object relations

the study of how children incorporate the images, the memories, and sometimes the values of a person to whom they were (or are) emotional attached

psychoanalytic psychotherapy

designed to reveal the nature of unconscious mental process through catharsis and insist “the real problem”

techniques:

free association:

\-patients are instructed to say whatever comes to mind

\-intended to reveal emotionally charged material that may be repressed because its too painful or threatening to bring into consciousness

dream analysis:

\-interprets the content of dreams, supposedly reflecting the primary-process thinking of the id, and related the dreams to symbolic aspects of unconscious conflicts

\-suppose to help patient gain insight into the nature of conflicts

transference

suggest that clients may seek to relate to the therapist as they do the important authority figures (typically parents)

counter-transference

therapist projects their own issues and feelings, usually positive onto the patient

humanistic theory

major themes:

→people are basically good

→humans strive toward self -actualization

→self-actualization-people strive to achieve their highest potential against difficult life experiences

→person-centered therapy- therapist conveys empathy and unconditional positive regard (minimal therapist interpretation)

behavioral model

explanation of human behavior, including dysfunction, based on the principles of learning and adaption derived from experimental psychology

classical conditioning (pavlov;watson)

type of learning in which a neutral stimulus is paired with a repose until it elicits response

operant conditioning (thorndike;skinner)

means behavior operates on the environment and changes it in some way

\-based on reinforcements

positive reinforcement

continent delivery of a desired consequence

negative reinforcement

contingent escape from an averse consequence

shaping

process of reinforcing successive approximations to a final behavior or set of behavior

behavior therapy

creating new association by practicing new behavioral habits and/or reinforcing useful behaviors with positive consequences

integrative approach

psychopathology is multiply determines and unidimensional accounts of psychopathology are incomplete

3 components of integrative approach

1) must consider reciprocal relations among:

\-neuroscience, cognitive science, behavior sciences, and developmental science

2) defining abnormal behavior

\-complex, multifaceted , and has evolved

3) science of psychopathology is evolving

\-multidimensional and integrative

multidimensional integrative approach

→approach to the study of psychopathology that holds psychological disorders are always the product of multiple interacting casual factors

→each component of the system inevitably affects the other component

types of factors:

\-biological→factors from the fields of genetics and neuroscience

\-psychological→factors from behavioral and cognitive processes

\-emotional influences and social interpersonal influence

\-developmental influences

\-environmental influences

one-dimensional model

explains behavior in terms of a single cause and tends to ignore information from other areas and is often seen as systemic

systemic→it implies no single influence contributing to psychopathology- that is, the biology and behavior of the individual and the cognitive, emotional, social, and cultural environment-can be considered out of contexr

genes

long deoxyribonucleic acid (DNA) molecule, the basic physical unit of heredity that appears as a location on a chromosome

→physical characteristics are determined or at least strongly influence by our genetic endowment

phenotype

observable characteristics or behaviors of an individual

genotype

specific genetic makeup of an individual

deoxyribonucleic acid (DNA)

\-shaped in double helix (two spirals intertwined, turning in opposite directions)

\-located on the double spiral are pairs of molecules bound together and arranged in different orders and the ordering of these base pairs influences how the body develops and works

Nature vs Nurture

nature-genes

nurture-ubringing and other environmental influences

chromosomes

arrange in 23 pairs

→the first 22 pairs of chromosomes provide programs and directions for the development of body and brain

\-the 23rd pair aka sex chromosomes determine the individual sex ( female= two X chromosomes and male=X and Y chromosomes

polygenic

influenced by many genes, each contributing only a tiny effect, all of which may be influenced by the environment

human genome

an indivduals’s complete set of genes-consists of more than 20,000 genes

dominant gene

one of a pair of genes that strongly influences a particular trait and only need one of them to determine a trait

→can predict fairly accurately how many offsprings will develop a certain trait, characteristic, or disorder, depending on whether one or both parents carry that dominant gene

recessive gene

must be paired with another (recessive) gene to determine a trait

gene dominance

occurs when one member of a gene pair is consistently expressed over the other

Eric Kandel (gene-environment interactions)

suggested that the very genetic structure of cells may change as a result of learning if genes that were inactive interact with the environment in such as way that they become active or in the other words the environment may occasionally turn on certain genes

diatheses-stress model

hypothesis that both an inherited tendency (a vulnerability) and specific stressful conditions are required to produce a disorder

→each inherited tendency is a diathesis, a condition that makes someone susceptible to developing a disorder

→vulnerability-susceptibility or tendency to develop a disorder

→examples: blood-injury-injecton phobia, alcoholism

gene-environment correlation model or reciprocal gene-environment model

hypothesis:that people with a genetic predisposition for a disorder may also have a genetic tendency to create environmental risk factors that promote the disorder

→outcomes are a result of interactions between genetic vulnerabilities and experience

→examples:depression, impulsivity

epigenetic

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

\-environmental manipulations, particularly early in life, may do much to override the genetically influenced tendency to develop undesirable behavioral and emotional reactions

Neuroscience

study of the nervous system and its role in behavior, thoughts, and emotions

→the human nervous system includes the central nervous system, consisting of the brain and the spinal cord, and the peripheral nervous system, consisting of the somatic nervous system and the autonomic nervous system

branches of human nervous system

\-central nervous system (CNS)

→brain and spinal chord

\-the peripheral nervous system (PNS)

→somatic and autonomic branches

neurons

individual nerve cell responsible for transmitting information

→transmit information throughout the nervous system

→contains a central cell body with two kinds of branches: dendrite and axon

→operate electrically, but communicate chemically

parts of a neuron

soma→cell body

dendrites→branches that receive messages from other neurons

axon→trunk of neuron that sends messages to other neurons

axon terminals→buds at end of axon form which chemical messages are sent

synapses→small gaps that separate neurons

neurotransmitters

chemical that crosses the synaptic cleft between nerve cells to transmit impulses from one neuron to the next

→relative excess or deficiency of neurotransmitters is involved in several psychological disorders

→the chemical messengers

excitatory

causing excitation/activating

inhibitory

causing inhibition/suppressing

neurotransmitters relevant to psychopathology:

\-norepinephrine→ involved in alarm responses and basic bodily processes

\-serotonin→ influences information processing, behavior, mood, and thoughts

\-dopamine→implicates in depression and ADHD

\-gamma-aminobutyric acid→inhibit (or regulate) the transmission of information and action potentials

\-glutamate→ turns on many different neurons

two main parts of brain structure:

brainstem:

→hindbrain-regulates automatic processes

\-medulla-regulates heart rate, blood pressure, and respiration

\-pons-regulates sleep stages

\-cerebellum-involves in physical coordination

→midbrain

\-coordinates movement with sensory input

\-contains parts of the reticular activating systems (RAS)

→thalamus and hypothalamus

\-involved broadly with regulating behavior and emotion

\-function primarily as a relay between the forebrain and the remaining lower areas of the brain stem

forebrain:

→ limbic system

\-figures prominently in much of psychopathology, includes such structures as the hippocampus (sea horse), cingulate gyrus (girdle), septum (partition), and amygalda (almond)

\-system helps regulates our emotional experiences and expressions, to some extent our ability to learn and to control our impulses, and involved with the basic drives of sex, aggression, hunger, and thirst

→basal ganglia

\-include the caudate (tailed) nucleus

\-involved in changing our posture or twitching or shaking, they are believed to control motor activity

→cerebral cortex (larges part of the brain, the wrinkled outer structure)

\-provides us with out distinctly human qualities, allowing us to plan, reason, and create

lobes of the cereal cortex

frontal lobe→ responsible for higher cognitive functions such as thinking and reasoning, planning for future, and long-term memory

temporal lobe→associated with recognizing sights and sounds and with long-term memory storage

parietal lobe→ associated with recognizing sensations of touch and monitoring body positioning

occipital lobe→ associated with integrating making sense of visual inputs

peripheral nervous system

coordinates with the brain stem to make sure the body is working properly

→two major components: somatic nervous system and the autonomic nervous system

somatic nervous system

controls voluntary muscles and movement

autonomic nervous system

\-includes the sympathetic nervous system and parasympathetic nervous system

→sympathetic nervous system-primary responsible for mobilizing the body during times of stress or danger by rapidly activating the organs and glands under its control

→parasympathetic system- takes over after sympathetic nervous system has been active for a while, normalizing our arousal and facilitating the storage of energy by helping the digestive process

\-regulates the cardiovascular and endocrine systems and performs other functions including aiding digestion and regulating body temperature

endocrine system

\-includes number of glands, each of which produces its own chemical messenger, called a hormone, and releases it directly into the blood stream

→hormone-chemical messenger produced by the endocrine glands

hypothalamic-pituitary-adrenocortical axis (HPA axis_

integration of endocrine and nervous system function

implications of neuroscience for psychopathology

\-relations between brain and abnormal behavior

\-psychosocial influences

\-treatments for mental health problems may now focus on the brain regions found to be relevant for these problems

\-psychotherapy

clinical assessment

systematic evaluation and measurement of psychological, biological, and social factors in a person presenting with a possible psychological disorder

purpose of clinical assessment

\-to understand the individual

\-to predict behavior

\-to plan treatment

\-to evaluate treatment outcome

three basic concepts help determine the value of clinicians’ assessments

1) reliability

→consistency in measurement

→examples include test-retest and inter-rater reliability

→inter-rater reliability- consistency across two or more raters

2)validity

→what an assessment measures and how well it does so

→examples include concurrent, discriminant, and predictive validity

3)standardization

→ensures consistency in the use of a technique

→provides population benchmarks for comparison

→examples include structured administration, scoring, and evaluation procedures

clinical interview

gathers information on current and past behavior, attitudes, and emotions, as well as detailed history of the individual’s life in general and of the presenting problem

→semistructured clinical interviews-made up questions that have been carefully phrased and tested to elicit useful information in a consistent manner

→structured clinical interviews-

five categories of mental status exam

1) appearance and behavior

2)thought processes

3) mood and affect

4)intellectual functioning

5) sensorium

physical exam

behavioral assessment

measuring, observing, and systematically evaluating (rather than interfering) the client’s thoughts, feelings, and behavior in the actual problem situation or context

→target behaviors are identified and observed with the goal of determining the factors that seem to influence them

→focus on the present-here and no

→ABC’s- Antecedents, Behaviors, and Consequences

→ formal vs informal

formal-involves identifying specific behaviors that are observable and measurable

informal- relies on the observer’s recollection as well as interpretation of events

self-monitoring vs being observed by others

self-monitoring→action by which clients observe and record their own behaviors as either an assessment of a problem and its change or a treatment procedure that makes them more aware of their responses

being observed by others→ you presence may change their behavior

psychological testing

includes specific tools to determine cognitive, emotional, or behavioral responses that might be associated with a specific disorder and more general tools that asses long-standing personality features, such as a tendency to be suspicious

→must be reliable and valid

projective tests

psychoanalytically based measure that presents ambiguous stimuli to clients on the assumption that their responses can reveal their unconscious conflicts

→require high degree of interference in scoring an interpretation

→lack high reliability and validity

objective tests

→roots in empirical tradition

→test stimuli are less ambiguous

→require minimal clinical inference in scoring and interpretation

personality inventories

self-repot questionnaire that assesses personal traits by asking respondents to identify descriptions that apply to themselves

→Minnesota multiphase personality inventory (MMPI)

\-valid and reliable

\-lie scales

\-time

intelligence testing

→nature of intellectual functioning and IQ

\-originally developed as a measure of degree to which children performance diverged from others in their grade

→the deviation IQ

\-compare a persons scores against those of other people who are of the same age

→verbal and performance domains

neuropsychological testing

assessment of brain and nervous system functioning by testing and individuals performance on behavioral tasks

→purpose and goals

\-assess broad range of skills and abilities

\-goal is to understand brain-behavior relations

neuroimaging

sophisticated computer-aided procedure that allows nonintrusive examination of nervous system structure and function

two categories of neuroimaging

1) procedures that examine the structure of the brain, such as the size of various parts and whether there is any damage

\-computerized axial tomography (CAT or CT scan)

\-magnetic resonance imaging (MRI)

2) procedures that examine the actual functioning of the brain by mapping blood flow and other metabolic activity

\-positron emission tomography (PET)

\-single photon emission computed tomography (SPECT)

\-functional MRI (fMRI)

psychophysiological assessment

measurement of changes in the nervous system reflecting psychological or emotional events such as anxiety, stress, and sexual arousal

psychophysiological assessment domains

→electroencephalogram (EEG)-measure of electrical activity patterns in the brain, taken through electrodes placed on the scalp

→heart rate and respiration-cardiorespiratory activity

→electrodermal response and level-sweat gland activity

issues with classifying and diagnosing psychological disorders

→classical (or pure) categorical approach

\-method founded on the assumption of clear-cut differences among disorders, each with a different known cause (e.g., you either have social anxiety disorder or you don’t)

→dimensional approach

\-method of categorizing characteristics on a continuum rather than on a binary, either-or, or all-or-none basis (e.g., different people have varying amounts of anxiety in social situations)

→prototypical approach

\-combines classical and dimensional views

widely used classification systems for classifying and diagnosing psychological disorders

→diagnostic and statistical manual of mental disorders (DSM)

\-updater every 10-20 years

→ international classification of diseases (ICD-10)

the DSM-5 (latest addition)

\n -Removed axial system \n – Clear inclusion and exclusion criteria for disorders \n – Disorders are categorized under broad headings \n – Empirically grounded, prototypic approach to \n classification

unresolved issues in DSM-5

→The problem of comorbidity

– Defined as two or more disorders for the same person \n – High comorbidity is extremely common \n – Emphasizes reliability, maybe at the expense of validity (i.e., may artificially “split” diagnoses that are very similar)

purpose of clinical assessment and diagnosis

– Aims to fully understand the client \n – Aids in understanding and ameliorating human suffering \n – Based on reliable, valid, and standardized information