Psychopathology Exam 1

Psychopathology

The scientific study of mental difficulties or disorders, including their explanations, causes, progression, symptoms, assessment, diagnosis, and treatment

Etiology

The cause or causes for a condition

Psychodiagnosis

Assessment and description of an individual’s psychological symptoms, including inferences about what might be causing the distress

Treatment plan

a proposed course of treatment, developed collaboratively by a provider and client.patient that addresses the client’s mental health symptoms

What makes a mental disorder ?

Diagnostic and Statistical Manual :

1) involves significant disturbance in thinking, emotional regulation, or behavior caused by a dysfunction in the basic psychological, biological, developmental processes involves in normal development

2) causes significant distress with day-to-day function

3) Is not merely a culturally expected response to common stressor or losses or a reflection of political or religious beliefs that conflict with societal norms

• Distress

• Deviance

• Dysfunction

• Dangerousness

Distress

The person experiencing the symptoms is distressed about the symptoms

Examples :

• Trying to hide or mask symptoms

• Wishing symptoms go away

• Self-perception that symptoms are causing problems

• Ex : unpleasant emotions such as worry or guilt, thought patterns that are confusing or distracting, physiological responses such as racing heart or stomach aches

Deviance

Behavior that is unusual/atypical

The DSM has incidence rates for disorders, demonstrating the prevalence of the condition in populations

Dysfunction

Is the person’s life negatively impacted by the symptoms, particularly in important life domains : work or school, relationships, or take care of themself

Is there a marked difference between this person’s life with these symptoms and someone else’s life without these symptoms

Did this person experience new impairment after these symptoms emerged or increased?

Dangerousness

If the symptoms puts the person or others at risk

Prevalence

The % of individuals in a targeted population who have a particular disorder during a specific period of time

• 21% of adults had mental illness in 2020

• 30% of young adults 19-25 years of age had a mental illness in 2020

• 50% of adolescents 13-18 has experienced a mental illness at some point in their lives

Diagnosis, Treatment, & Insurance

US passed federal parity law in 2008 intended to equalize healthcare coverage for mental and physical health

Managed care system: healthcare coverage in which the insurance company largely controls the nature, scope, and cost of medical and psychological services

• Healthcare insurance provides more access to mental health services (like psychotherapy) to more people

• This system constrains diagnosis, treatment, and pay rates by the terms set by insurance companies

Research concepts in mental health applications

Operational definitions : concrete description of the variables that are being studied

Clinical significance : the degree to which the finding of the study is useful in practice/ clinical contexts

• Statistical significance is influenced by the sample size

  • A study with many participant may find a small difference that is statistically significant but so small that it has little impact on clinical decision making

Research on mental disorders

• Case study

• Correlational design

• Experimental design

• Quasi experimental design

• Meta analysis

• Qualitative

Case Study

an intensive study of one individual that relies on clinical data, such as observations, psychological tests, and historical and biographical data

Correlational Design

Correlation: relationship between variables

• Often large studies to have the statistical power to detect even very small magnitude relationships between variables

What can we learn from correlational design ?

• Twin studies: examine similarities and differences between twins, compare to non-twin pairs

Experimental design

Scientific inquiry in which a prediction is made about two variables; the independent variable is then manipulated in controlled situation, and changes in the dependent is measured

Special types of experimental design important in research on mental disorders:

• Experimental design : random assignments and includes a true control group

  • Randomized control trial (RCT)

    • Randomization, control group, treatment condition, measurement points

    • Double blind RCT (or masked design)

Quasi-Experimental Design

Similar to an experimental design, except one or both of the following are true:

• It contains a quasi-independent variable (does not meet the criteria pf controlled experimenter manipulation)

  • Lacks randomization

• Lacks control group

Why might this be used??

• Ethics

• Feasibility

Types of Quasi-Experimental Designs

• Single subject multiple baseline

• single subject reversal ABAB

• Matched designs

• Natural experiments

• Analogue Experiments

Integrative models

• Biopsychosocial model : perspective that includes interactions between biological, psychological, and social factors in the etiology of mental disorders

  • biopsychosocial spiritual models is an adaptation

• Sociocultural influences : factors such as gender, sexual orientation, spirituality, religion, SES, race/ethnicity, and culture that can have an effect on mental health

• Integrative models also tend to include strengths, resources, and/or protective factors

Developmental Psychopathology Perspective

• Integrative model

• Includes timing of developmental needs (risks and protective factors)

  • Accumulation of risks and protective factors

• Trajectories over time

• Equifinality : multiple paths can lead to the same outcome

• Multi finality : multiple outcomes can come from the same experiences/biological factors

Multi-path model

An integrative model that provides an organizational framework for understanding the numerous influences on the development of mental disorders, the complexity of their interacting components, and the need to view disorders from a holistic and resilience inclusive framework

Assumptions :

• multiple dimensions must be considered in development of mental disorders

• multiple pathways can result in the same disorder

• not all dimensions contribute equally to all disorders

• dimensions interact with each other in complex combinations or reciprocal relationships

• dimensions include protective influences as well as risks. assests may exert preventative influence, mitigate severity, or improve recovery in mental disorders

Multi-path model dimension

• Biological

• Psychological

• Social

• Sociocultural

Biological Dimension

CNS :

• structures such as hypothalamus, hippocampus, amygdala, pituitary gland

• systems such as : autonomic nervous system (SNS and PNS), hypothalamic-pituitary-adrenal (HPA) axis regulates hormones

• functions such as : synaptic transmission, neurotransmitter reuptake

Genetics :

• heritable traits

• epigenetic - interactions between environmental conditions and the genome, influencing gene expression

Biological dimension : Treatment

Psychopharmacology/Psychotropic medications

• Created enormous change in the field of mental health treatment

  • Has reduced institutionalization and hospitalization for many people

• widely used

Neurostimulation Treatments

• Devices/psychosurgery: deep brain stimulation, vagus nerve stimulation

• Treatments: Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS)

Psychological Dimension

• thoughts

  • thought patterns

  • can be risk factor or protective factors

• emotions

  • How much of different emotions does a person feel

• beliefs

  • Personal philosophies that are often about self, others, or the way the world works

• personality traits

  • Ex — grit, openness, rigidity

Psychological Dimension : Treatment

Contemporary Psychodynamic Therapy : Object relations, self theory, and attachment

• Focus is resolving past conflicts or “traumas”

Behavioral :

• classical conditioning and operant conditioning

• observational learning

• exposure therapies : OCD, PTSD, phobias

Cognitive Behavioral :

• Cognitive Behavioral Therapy

• Dialectal Behavior Therapy (DBT) and acceptances and commitment therapy (ACT) incorporate mindfulness

Humanistic : Core beliefs : basic goodness and power of unconditional positive regard

Existential : attention to topics such as isolation, meaning, death, freedom

• contemporary existential therapist : Irvin Yalom

Social Dimension + Treatment

• Quality of social support and social connections

Treatment :

• Social relationship models — emphasize the formation and maintenance of quality relationship

Family and Couple Therapy :

• Family systems theory → based on an application of General Systems Theory with assumption such as “The whole is greater than the sum of its part” and includes application of concepts such as feedback loops, homeostasis, and adaptation

• Considers pathology in a relational, systemic context- the focus is typically bi-directional interactions and influences that sustain patterns, including biopsychosocial factors (not about blaming parents)

• Treatment can be effective with individuals-indidvuals are influential parts of the system they belong to

Sociocultural Dimension

A person’s social location may afford them benefits or marginalization within their cultural context

Treatment : Multicultural models and trans theoretical multicultural competence

• providers may be culturally informed or the intervention may be culturally designed or adapt

Clinical interviews

• extremely common in mental health care, psychotherapy, psychiatry

• can range from structured, semi-structured, to unstructured

• Pros :

  • Provides opportunity for simultaneous observation of some behavior

  • Allows provider to make a connection with client

  • Allows for open communication that can be more descriptive

• Cons :

  • Provider/assessor bias

  • Factors that may limit communication or self-awareness for the individual

  • The less structured, the reliability and validity tend to be compromised

Observations

• Can be formal or informal

  • Formal : ex → certain tests for ADHD, Austism spectrum disorder

  • Informal : ex → noting the person’s speech patterns, body posture, facial expression

• External, behavioral signs

• Pros :

  • Additional information can be gathered from behavior

  • Very helpful with conditions that limit self-awareness

• Cons

  • Cultural differences with behavior meanings can lead to inaccurate conclusions

    • Can be context specific rather than a general pattern

Psychological Tests and Inventories

Projective Personality Tests: Rorschach, TAT, sentence completion

• Wide range of interpretation, limited utility for diagnosing disorders

• Self-report : beck depression inventory, PHQ-9, MMPI

• Pros :

  • can be helpful with scaling the severity of symptoms

  • can gather information in a systematic way

• Cons :

  • not all have been tested with sufficiently diverse populations

  • require some level of self awareness

  • the individual can answer inaccurately

Assessment

Methods for understanding accuracy :

• reliability

  • how confident are we that each administration of this assessment neans the same thing as other administrations of this assessment ?

    • intra-rater reliability : the same assessor draws the same conclusion from the same information

    • inter-rater reliability : different assessors draw the same conclusions from the same information

    • test-retest reliability : multiple assessments of the same individual result in the same conclusion

• validity

  • how confident are we that this assessment measures what we think is measuring?

Diagnosing mental disorders

• Any diagnostic system is a method for organizing information so that it can be communicated with a shared understanding

• Diagnostic and statistical manual (DSM)

  • organized by symptom sets into diagnoses which are grouped by categories

  • some disorders include clear etiology, some do not

  • some disorders have standardized assessment tools to assist with diagnosing others do not

  • recent revisions have included more dimensional focus within diagnoses

    • autism spectrum disorder and alternative

    • adding subtypes and specifiers to the existing diagnoses

Purposes for diagnosing

How diagnosing is approached, and the decisions about what methods are acceptable, depend partially on the purpose

• in research, reliability is essential

• in outcome studies, sensitivity to change is also important

• in clinical work, individualized treatment utility is more important than in research

Accuracy in diagnosing always matters but the decision on how to execute accuracy may depend on the purpose

Evaluating effectiveness of treatment

psychopharmacology: clinical trials (double blind RCTs)

psychotherapy: RCTs

• what should the control conditions be ?

  • nothing at all

  • some type of non-therapy condition (placebo)

  • treatment as usual (TAU)

  • another specific type of therapy

Common factors research

• since different models for psychotherapy tend to perform similarly, what is it that makes therapy work?

  • common factors research tries to identify the “active ingredients” in successful therapy across different therapy models

  • client-therapist relationship is the strongest common factor in predicting successful outcomes

Evidence-based treatment and practice

evidence based treatment/therapy (EBTs) — treatment techniques with strong research supp.

• psychotherapy interventions tend to be manualized, step-by-step

• require specific training

• may apply to a small range of mental health disorders

• tend to be preferred by insurance companies

• criticisms : can limit clinical judgement, adaptations are often untested, some models are easier to test in an experimental design than others

Examples of EBT :

• narrative exposure therapy for PTSD

• exposure response prevention for OCD

• Parent management training for children with ADHD

evidence based practice (EBPs) — treatment decisions based on current research combined with clinician judgement and client need

Inter-rater reliability of DSM-5

Inter-rater reliability — do different assessors assign the same diagnosis to the same individual?

• depends on the diagnosis

  • high inter-rater reliability (major neurocognitive disorder)

  • low inter-rater reliability (GAD)

• how reliable is relaible enough ?

HiTOP

organized by looking at the structure (latent patterns) of symptoms in the data

• group similar symptoms instead of creating many different categories

• people can have any of the symptoms on a spectrum of severity

Assumptions :

• psychopathology is best characterized as dimensional

• natural organization of psychopathology can be discerned in co-occurence

• psychopathology is better understood as varying in symptom

  om presentation for each person than as distinct categories of symptoms

Anxiety Disorder

US 12 month prevalence :

• 19.1% adult prevalence prior to COVID-19 pandemic

US lifetime prevalence for adolescents :

• 31.9% lifetime adolescent prevalence prior to COVID-19 pandemic

Increase during COVID-19 pandemic :

• 25% global increase in anxiety disorders in 2020

More common in woman than men

Specific phobias

• refers to intense, persistent, fear reaction to a specific object or situation

  • does not include instances when the object is associated with a traumatic event

Agoraphobia

intense fear of situations related to being in public places

etiology of phobias

• biological: limbic system, specifically amygdala

• psychological:

  • classical conditioning

  • observational learning

  • negative info.

  • cognitive0behavioral

• social:

  • family environment

  • peer experiences : bullying

• sociocultural

  • experiences w/ discrimination

  • cultural values

Treatment of phobias

biochemical:

• SSRIs, SNRIs, tricyclics, MAOIs somewhat effective

• beta blockers (blood pressure medication)

• benzodiazepines for short acting short term solutions

therapy