Lecture - 300

What is psychopathology?

The field concerned with the nature, development, and treatment of psychological disorders. It is a continually evolving science.

What does "etiology" mean in the context of psychological disorders?"

The causes or origins of a disorder.

According to the DSM-5-TR, is behaviour that is merely statistically deviant enough to constitute a mental disorder?

No — statistical deviance alone is not sufficient for a mental disorder diagnosis.

According to the DSM-5-TR, is behaviour that is merely socially inappropriate enough to constitute a mental disorder?

No — social inappropriateness alone is not sufficient for a mental disorder diagnosis.

What are the three components of a disorder

Personal Distress, Disability, and Dysfunction.

"In the psychopathology model, what is ""personal distress""?"

Subjective suffering or emotional pain experienced by the individual.

"In the psychopathology model, what is ""disability""?"

Impairment in one or more important areas of functioning (e.g., work, relationships, self-care).

"In the psychopathology model, what is ""dysfunction""?"

When something is not working as it should

What is stigma in the context of mental illness?

The negative beliefs and attitudes held by a society about groups considered different in some way, such as people with mental illness.

What are the THREE purposes of psychological assessment?

1. Identify appropriate therapeutic interventions. 2. Monitor the effects of treatment over time. 3. Conduct research on the causes of psychological disorders.

What does an ideal psychological assessment involve?

Multiple measures and methods (e.g., interviews, personality inventories, behavioural observations) rather than a single tool.

What is a clinical interview?

A face-to-face conversation used to gather information about a client's history, symptoms, and functioning.

What is essential to conducting an effective clinical interview?

Good rapport between the clinician and the client.

What is an unstructured (informal) clinical interview?

A flexible, conversational interview guided by the clinician's judgment rather than fixed questions.

What is a structured (formal) clinical interview, how does it fair with reliability?

An interview that follows a standardised set of questions to ensure consistency and reliability across assessors.

What is the Structured Clinical Interview for DSM (SCID)?

Structured Interview specifically for the DSM 5

What type of assessment tool is the MMPI?

A self-report objective personality inventory.

What does the MMPI measure?

Psychological functioning and personality traits across 10 clinical scales, used to assist in clinical diagnosis.

What does Scale 1 of the MMPI-2 (Hypochondriasis) measure?

Excessive concern with bodily functions.

What does Scale 2 of the MMPI-2 (Depression) measure?

Pessimism, hopelessness, and slowing of thoughts and behaviours.

What does Scale 3 of the MMPI-2 (Hysteria) measure?

Unconscious use of physical and mental problems to avoid conflicts or responsibility.

What does Scale 4 of the MMPI-2 (Psychopathy) measure?

Disregard for social customs, shallow emotions, and inability to learn from experience.

What does Scale 5 of the MMPI-2 (Masculinity-Femininity) measure?

Items that differentiate between traditional masculine and feminine sex roles.

What does Scale 6 of the MMPI-2 (Paranoia) measure?

Abnormal suspiciousness and delusions of grandeur or persecution.

What does Scale 7 of the MMPI-2 (Psychasthenia) measure?

Obsessions, compulsiveness, fears, guilt, and indecisiveness.

What does Scale 8 of the MMPI-2 (Schizophrenia) measure?

Bizarre or unusual thoughts and behaviour, social withdrawal, hallucinations, and delusions.

What does Scale 9 of the MMPI-2 (Hypomania) measure?

Emotional excitement, flight of ideas, and overactivity.

What does Scale 10 of the MMPI-2 (Social Introversion) measure?

Shyness, disinterest in others, and social insecurity.

What is the projective hypothesis?

The idea that responses to ambiguous stimuli reflect unconscious processes and will reveal a person's true attitudes, thoughts, and feelings.

What is the Rorschach Inkblot Test?

A projective test where a person describes 10 inkblots; the Exner scoring system focuses on perceptual/cognitive patterns. Reliability is achievable; validity is debated.

What is the Thematic Apperception Test (TAT)?

A projective test where a person tells stories about black-and-white pictures; has limited reliability and validity.

What is a Completion Technique in projective testing? Give an example.

A projective technique where the client completes an unfinished stimulus. Example: Sentence Completion Test.

What is an Association Technique in projective testing? Give an example.

A projective technique where the client responds to a stimulus with the first thing that comes to mind. Examples: Word Association, Rorschach.

What is a Construction Technique in projective testing? Give an example.

A projective technique where the client constructs a narrative or story. Example: Thematic Apperception Test (TAT).

What is an Expressive Technique in projective testing? Give an example.

A projective technique where the client creates a drawing or other expressive output. Examples: Draw-A-Person, Kinetic Family Drawing (KFD).

What is the Kinetic Family Drawing (KFD)?

A projective expressive technique where a client (often a child) draws their family doing something together; the drawing is interpreted for family dynamics and emotional content.

"What is ""response deviation"" as a problem with objective personality tests?"

The tendency for respondents to answer items in unusual or atypical ways that may not reflect their true personality.

"What is ""social desirability"" as a problem with objective personality tests?"

The tendency for respondents to answer in ways they believe are socially acceptable rather than honestly.

What are the two main criticisms of projective tests?

1. Reliability and validity have been heavily scrutinised. 2. Scoring is subjective and can vary significantly between clinicians.

What is the difference between an intelligence test and a psychoeducational assessment?

Intelligence tests assess current cognitive ability only. Psychoeducational assessments have broader goals including academic abilities, learning styles, learning disabilities, and giftedness.

Name the three most commonly used intelligence tests mentioned in the lecture.

Wechsler Adult Intelligence Scale (WAIS), Wechsler Intelligence Scale for Children (WISC), and Stanford-Binet Intelligence Scale.

What is one major criticism of intelligence tests regarding their scope?

They measure a narrow definition of intelligence and do not capture the full range of human cognitive abilities.

What groups are disproportionately disadvantaged by bias in intelligence tests?

Racialized groups, individuals with lower socioeconomic status, people with different language backgrounds, and those from non-Western cultural contexts.

What is the overall goal of a neuropsychological assessment such as the Mini-Mental Status Exam (MMSE)?

To assess cognitive functioning.

What five areas does the Mini-Mental Status Exam (MMSE) assess?

1. Alertness. 2. Orientation (person, place, time). 3. Speech. 4. Memory. 5. Vocabulary.

What is behavioural observation in psychological assessment?

Directly observing a client's behaviour as it naturally occurs, often in a lab setting, and analysing the antecedents and consequences surrounding targeted behaviours.

"In behavioural observation, what are ""antecedents""?"

Events or conditions that occur before a target behaviour and may trigger it.

"In behavioural observation, what are ""consequences""?"

Events or outcomes that follow a target behaviour and may reinforce or discourage it.

What is self-monitoring in psychological assessment?

A method in which individuals observe and systematically record their own behaviour, moods, or experiences over time.

What is Ecological Momentary Assessment (EMA), what is an advantage of EMA?

Real-time data collection via smartphone — a person is signaled and enters responses immediately, avoiding retrospective bias.

"What is ""reactivity"" as a limitation of self-observation methods?"

The phenomenon where the act of monitoring one's own behaviour changes that behaviour.

"What is one advantage (""insight"") of self-observation methods like EMA?"

They can help individuals gain insight into their own behavioural and emotional patterns.

Name the six types of bias that can affect psychological assessment.

1. Cultural bias. 2. Measurement bias. 3. Predictive bias. 4. Assessor bias. 5. Socioeconomic bias. 6. Linguistic bias.

A clinician is meeting a patient for the first time and wants to build rapport. Which assessment method is most appropriate?

An unstructured (informal) clinical interview — it is flexible and conversational, allowing rapport-building while gathering the client's story.

A clinician is concerned a patient will not be honest. Which assessment tool is most appropriate and why?

The Rorschach Inkblot Test — its indirect, ambiguous stimuli make deliberate deception more difficult than in direct self-report tools.

A 5-year-old has intense emotional reactions and the mother doesn't know why. Which assessment method best captures their interactions?

Behavioural Observation — directly observing the child and mother interacting allows the clinician to identify antecedents and consequences of the child's emotional reactions.

What is the minimum duration of symptoms required for a Major Depressive Episode?

2 weeks

How many symptoms are required to meet criteria for a Major Depressive Episode?

At least 5 out of 9

Which two symptoms must be present (at least one) in a Major Depressive Episode?

Depressed mood OR anhedonia (loss of interest/pleasure)

What is anhedonia?

Loss of interest or pleasure in previously enjoyable activities

What are the 9 possible symptoms of a Major Depressive Episode?

1. Depressed mood

2. Anhedonia

3. Sleep changes

4. Appetite/weight changes

5. Fatigue/loss of energy

6. Psychomotor agitation or retardation

7. Worthlessness or guilt

8. Difficulty concentrating or indecisiveness

9. Thoughts of death or suicide

What is the key difference between a Major Depressive Episode (MDE) and Major Depressive Disorder (MDD)?

An MDE is a period of symptoms — not a diagnosis on its own. MDD is the diagnosis, requiring one or more MDEs with no manic or hypomanic episodes.

What is required to diagnose Major Depressive Disorder (MDD)?

One or more Major Depressive Episodes AND no history of manic or hypomanic episodes

What is the lifetime prevalence of MDD in North America?

16.6%

What is the lifetime prevalence of MDD in women in North America?

10–25%

What is the lifetime prevalence of MDD in men in North America?

5–12%

What is the typical course of MDD?

Episodic and recurrent

How does the number of prior depressive episodes affect future risk?

Each recurrence increases both the probability and speed of future episodes

What is Persistent Depressive Disorder (Dysthymia)?

Depressed mood more often than not for at least 2 years (1 year for children/adolescents), plus 2 or more additional depressive symptoms, with no symptom-free period longer than 2 months

What is the minimum duration of depressed mood required for Persistent Depressive Disorder in adults?

More than 2 years

What is the minimum duration of depressed mood required for Persistent Depressive Disorder in children/adolescents?

1 year

What is the maximum symptom-free gap allowed in Persistent Depressive Disorder?

No more than 2 months without symptoms

What are the 6 additional symptoms for Persistent Depressive Disorder (must have 2)?

1. Poor appetite or overeating 2. Sleep problems 3. Low energy 4. Low self-esteem 5. Trouble concentrating or making decisions 6. Hopelessness

What is Premenstrual Dysphoric Disorder (PMDD)?

A mood disorder with at least 5 symptoms appearing in the week before menses and resolving within a few days of onset, occurring in most cycles over the past year

When do PMDD symptoms appear and resolve?

Appear in the final week before menses; improve within a few days of menstruation onset

What is Disruptive Mood Dysregulation Disorder (DMDD)?

Severe recurrent temper outbursts (≥3 times/week) that are out of proportion to the situation, plus persistently negative mood between outbursts, with onset before age 10, lasting at least 1 year

What is the minimum frequency of temper outbursts required for DMDD?

At least 3 times per week

What is the age of onset requirement for DMDD?

Onset before age 10

What are the three DSM-5 Bipolar Disorders?

Bipolar I, Bipolar II, and Cyclothymic Disorder

What is the defining requirement for Bipolar I Disorder?

At least one lifetime manic episode (depressive episodes are common but not required)

What is the defining requirement for Bipolar II Disorder?

At least one hypomanic episode AND at least one major depressive episode — with NO history of a full manic episode

What is the minimum duration of Cyclothymic Disorder?

At least 2 years (equivalent to Persistent Depressive Disorder in MDD)

What is the minimum duration of a Manic Episode?

At least 1 week (or any duration if hospitalization is required)

What mood state is required for a Manic Episode?

Elevated or irritable mood in the context of increased activity or energy

How many additional symptoms are required for a Manic Episode when mood is elevated?

3 or more (from the 7-symptom list)

How many additional symptoms are required for a Manic Episode when mood is only irritable?

4 or more (from the 7-symptom list)

What are the 7 possible additional symptoms of a Manic Episode?

1. Inflated self-esteem/grandiosity

2. Decreased need for sleep

3. Rapid/pressured speech

4. Racing thoughts/flight of ideas

5. Distractibility

6. Increased goal-directed activity or psychomotor agitation

7. Risky or pleasurable activities

What is the minimum duration of a Hypomanic Episode?

At least 4 days

How does a Hypomanic Episode differ from a Manic Episode in terms of functional impairment?

Hypomania causes NO significant functional impairment and does not require hospitalization; mania does

What feature must be present in hypomania that is absent in normal mood but not as severe as mania?

The change in functioning must be observable by others, but there is no significant impairment or psychotic features

What is the lifetime prevalence of Bipolar Disorder?

Approximately 4%

What is the typical age of onset for Bipolar Disorder?

Average age of onset is in the 20s

What is the heritability estimate for Bipolar Disorder?

Approximately 93%

What is the heritability estimate for MDD?

Approximately 37%

What is the role of the serotonin transporter gene in depression?

It is a genetic diathesis — combined with stress, it increases risk of developing depression (diathesis-stress model)

What did original neurotransmitter models propose about mood disorders?

That mood disorders were related to abnormally low absolute levels of neurotransmitters (especially serotonin/dopamine) in the synaptic cleft

What is the current neurotransmitter model of mood disorders?

Focus has shifted from absolute NT levels to the sensitivity of post-synaptic receptors

Which two neurotransmitters are most implicated in mood disorders?

Dopamine and serotonin

What does the HPA axis stand for?

Hypothalamus-Pituitary-Adrenal axis

What hormone does the HPA axis trigger the release of?

Cortisol (the stress hormone)