Psychopathology Exam 1 - Dr. Herman Rutgers

Hippocrates

• Greek physician (460-377 B.C): referred to as the father of modern medicine.

Asylums

• sanctuaries or places of refuge meant solely for the care of the mentally ill.

Phillippe Pinel

in charge of "La Bictre" an asylum in Paris.
- Replaced the harsh treatment and living conditions to humane ones and the result was dramatic improvement.

William Tuke

• English Quaker, established the York Retreat. Known for its peaceful environment.

Benjamin Rush

• Founder of American Psychiatry and signed the Declaration of Independence.

• Ultimately promoted the scientific study of psychological disorders once developed by Hippocrates.

Moral Management

• method of treatment that focused on the patient's social, individual, and occupational needs.

Mental Hygiene Movement

• treatment method that focused on the physical comfort of the patient with no help for their mental problems, so condemned individuals to helplessness and dependency.

Biomedical Science

• mental disorders eventually yield to biological explanations and biologically based treatments.

• Believed psychological and social environments were irrelevant. Only focused on comfort until cures were discovered.

Components of mental disorders

- Suffering: experience psychological pain such as depression or anxiety.
- Maladaptiveness: unhealthy behaviors.
- Statistical Deviancy: behavior that is statistically rare.
- Violations of the Standards of Society: violates standards of norms and morals and is statistically deviant.
- Social Discomfort: when social rules are violated, cause discomfort to those around you.
- Irrationality and Unpredictability: behavior that doesn't make any sense.
- Dangerousness: a danger to themselves or others.

Historical Views of Abnormal Behavior

1. Spiritual: the earliest approach, behavior disturbance is the result of possession by evil spirits.
2. Humanitarian
3. Scientific
4. The Biophysical Perspective

Biological causes of abnormal behavior

genetic environmental influences on physical functioning.
- Inherited factors
- Exposure to harmful environmental stimuli
- Brain damage from head trauma
- Toxic substances or allergens in the environment

psychological causes of abnormal behavior

disturbances in thoughts and feelings.
- Past learning experiences
- Maladaptive thought patterns
- Difficulty coping with stress

sociocultural causes of abnormal behavior

circles of influence from family or close friends, institutions, and policies of a country or the world.
- Discrimination
- Abuse
- Poverty

biopsychosocial perspective

the interaction in which biological, psychological, and sociocultural factors play a role in the development of an individual's viewpoint.
- Combines all three causes.
- Biopsychosocial factors interact to alter behavior patterns over time, so individuals change over time.
- As a result, we know it is vital to examine early risk factors that make an individual vulnerable to developing a disorder.

mental disorder

• behavioral or psychological syndrome (or pattern) that is present in an individual and that reflects some kind of underlying psychobiological dysfunction and results in clinically significant distress, disability, or impairment in key areas of functioning.

DSM-5

• newest version of the Diagnostic Statistical Manual of Mental Disorders.

Stigma (disgrace)

• a label that causes certain people to be regarded as different, defective, and set apart from mainstream members of society.

• With stigma comes both stereotyping and labels.

Stereotyping

automatic beliefs based on minimal information.

Labeling

the person is classified instead of the disorder.

Epidemiology

the study of distribution of diseases, disorders, or health-related behaviors in a specific population.

Prevalence

refers to the number of active cases in a population during any given period of time (point, 1-yr, and lifetime prevalence).

Incidence

refers to the number of new cases that occur over a given period of time (typically 1 year).

Principle diagnosis

the disorder that is considered the primary reason the individual seeks professional help.

Comorbid

individual has two or more simultaneous disorders.

Differential diagnosis

the ruling out of alternative diagnosis.

treatment

involves a modality or form of therapeutic process, a crucial component of the treatment plan.

modality

• form of therapeutic process/method of treatment.

• individual, family, group, etc.

psychological assessment

a procedure by which clinicians provide a formal evaluation using psychological tests, observation, and interviews that provide scoreable information about the client's psychological functioning.

Clinical diagnosis

a general "summary classification" of the patient's symptoms following a clearly defined system such as the DSM V.

Clinician interview

A series of questions that clinicians administer in face-to-face interaction with the client.

- Age and sex
- Reason for referral
- Education and work history
- Current social situation
- Physical and mental health history
- Drug/alcohol use and current medications
- Family history
- Behavioral observations

Unstructured interview

a series of open-ended questions aimed at determining the client's reasons for being in treatment, symptoms, health status, family background, and life history.

Reliability

the degree to which an assessment measure produces the same result each time it's used to measure the same thing.

Validity

the degree to which the instrument actually measures what it is supposed to measure.

Standardization

process by which an instrument is administered, scored, and interpreted, is consistent and clearly specifies a test's instructions and scoring methods.

two categories of psychological tests

intelligence tests and personality tests

Intelligence tests

tests for measuring the intellectual abilities of children and adults.

- Most widely used in children:
Stanford-Binet Intelligence test (receive a deviation intelligence (IQ) score in relation to others of similar age and gender).
WISC-IV: The Wechsler Intelligence scale for Children-Revised
- Most widely used with adults:
WAIS-IV: The Wechsler Adult Intelligence Scale-Revised

Projective Personality tests

unstructured and rely on various ambiguous stimuli such as inkblots or vague pictures rather than verbal questions.

- 2 most popular: Rorschach and TAT
The Rorschach Inkblot Test: use of inkblots developed by Hermann Rorschach (1844-1922) to uncover unconscious motivations.
The Thematic Apperception Test (TAT): 1935, series of simple ambiguous pictures some highly representational and other abstract of which the subject is instructed to make up stories.

Self-reports (Objective Personality Tests)

structured, typically questionnaires, self-report inventories or rating scales in which questions or items are carefully phrased and alternative responses are specified as choices.

Theoretical Perspective

an orientation to understanding the causes of human behavior and the treatment of abnormality.

Theoretical perspectives include:
- Biological
- Psychological: psychodynamic, behavioral, cognitive, humanistic
- Sociocultural

Biological Perspective

The belief that abnormalities in the body's functioning are responsible for symptoms of psychological disorders (disturbances in emotions, behavior, and cognitive processes).

Biological Perspective Focuses

1. Neurotransmitter and hormonal abnormalities in the brain and central nervous system (main part of viewpoint).

2. Genetic vulnerabilities
   - Behavior genetics: the field that focuses on studying the heritability of mental disorders.
   - Utilizes 3 primary methods of study: Family history, Twin method, Adoption method.
   3. Temperament refers to the child's reactivity and characteristic ways of self-regulation. Thought to be the basis of personality formation.
   4. Brain dysfunction neural plasticity: flexibility in the brain for making changes in organization and function.

Biological therapies

- Psychotherapeutic medications.
- Psychosurgery
- Deep brain stimulation (DBS) also called neuromodulation
- Electroconvulsive therapy (ECT)

Psychoanalytic/Psychodynamic perspective

- first systematic approach to showing how human psychological processes can result in mental disorders.
- Structures of personality: Id, Ego, Super Ego, Defense Mechanisms, Psychosexual stages of development, Oedipus, and Electra complex.

Behavioral perspective

- mental disorders are the result of maladaptive behaviors
- study direct, observable behavior & treating maladaptive behavior (do not care about unconscious or why/how you have your disorder).

cognitive perspective

• assumes abnormality is caused by maladaptive thought processes that result in dysfunctional behavior.

Cognitive Behavioral Perspective

• focuses on how thoughts and information processing can become distorted and lead to maladaptive emotions and behavior.

Humanistic Perspective

• known as the 3rd force in psychology, people are motivated to strive for self-fulfillment and meaning in life.

• Emphasizes that disorders arise when people are unable to experience living in the moment, to fully appreciate each moment as it occurs.

Sociocultural perspective

emphasizes the ways that individuals are influenced by people, social institutions, and social forces in the world around us.

Anxiety

involves a general feeling of apprehension about possible future danger.

Fear

an alarm reaction that occurs in response to immediate danger. Involves the "fight-or-flight" response of the autonomic nervous system.

Anxiety disorders

an unrealistic, irrational fear or anxiety of disabling intensity and often includes maladaptive methods of response.

- Separation anxiety
- Selective mutism
- Social anxiety disorder
- Panic disorder and agoraphobia
- Generalized anxiety disorder

Separation anxiety disorder

Childhood disorder characterized by intense and inappropriate anxiety, lasting at least 4 weeks concerning separation from home or caregivers.

Selective Mutism

Disorder originating in childhood in which the individual consciously refuses to talk.

Phobia

• Irrational fear associated with a particular object or situation.

• Specific phobias: persistent, irrational, and intense fear that is triggered by the presence of a specific object, activity, or situation.

• Must be present for at least 6 months.

5 Categories of Specific Phobias

1. Animal
2. Natural environment (storms, heights, fires)
3. Blood-injection-injury
4. Situational activities (driving, flying, enclosed space, bridges, etc.)
5. Miscellaneous stimuli or situations (fear of clowns, contracting illnesses, etc.)

Social Anxiety Disorder

disabling, intense fear and anxiety of social situations. Ultimately fears exposure to scrutiny and potential negative evaluation of others.

Panic Disorder

occurrence of panic attacks on a recurrent basis or has constant apprehension and worry about the possibility of recurring attacks.

- Must have symptoms for at least 1 month.

Panic attack

a period of intense fear, dread, and physical discomfort accompanied by the overwhelming feeling of "going crazy" and "loss of control" with frightening physical sensations.

Agoraphobia

intense anxiety triggered by the real or anticipated exposure to situations in which they may be unable to get help should they become incapacitated.

prepared learning

rapidly acquired fears of certain objects or situations that posed real threats to our early ancestors.

Treatments for anxiety disorder and agoraphobia

- Anxiety sensitivity theory: the belief that panic disorder is caused in part by the tendency to interpret cognitive and somatic manifestations of stress and anxiety in a catastrophic manner.
- Antianxiety meds (Xanax and Klonopin)
- SSRI's
- CBT similar to specific and social phobias but doesn't target panic attacks.
- Relaxation training: progressive and systematic patterns of muscle tensing and relaxing.
- Interoceptive exposure: deliberate exposure to feared internal sensations.
- Panic control treatment: cognitive restructuring, exposure to bodily cues associated with panic attacks and breathing retraining.

Generalized Anxiety Disorder

• Anxiety disorder characterized by anxiety and worry that is not associated with a particular object, situation or event but seems to be a constant feature of a person's day to day existence.

• Must occur for at least 6 months.

Obsessive-compulsive disorder (OCD)

Recurrent obsessions or compulsions that are inordinately time-consuming or that causes significant distress or impairment.

Obsessions

persistent and recurrent intrusive thoughts, images or impulses that are experienced as disturbing, inappropriate or uncontrollable.

Compulsions

overt repetitive behaviors that are performed as lengthy rituals or covert mental rituals.

​​4 major dimensions to the symptoms of OCD

1. Obsessions associated with checking compulsions (repeated checking, counting, repeated reassurance).
2. Need to have symmetry and to put things in order (ordering/arranging).
3. Obsessions about cleanliness associated with compulsions to wash (washing, cleaning).
4. Hoarding related behaviors (repeated need to buy a product).

Hoarding Disorder

A compulsion in which people have persistent difficulties discarding things, even if they hold little value.

Trichotillomania

The compulsive, persistent urge to pull out one's own hair in response to an increasing sense of tension or urge (aka hair-pulling disorder).

Excoriation (skin-picking) disorder

Recurrent picking at one's own skin.

Reactive Attachment Disorder

severe disturbance in the ability to relate to others in which the individual is unresponsive to people, is apathetic and prefers to be alone rather than to interact with friends or family.

Acute stress disorder

​​anxiety disorder that develops after a traumatic event and symptoms last up to 1 month.

4 categories of symptoms of acute stress disorder

- Intrusion of distressing reminders of the event (nightmares).
- Dissociative symptoms such as feeling numb or detached from others (emotional numbing).
- Avoidance of situations that might serve as reminders of the event
- Hyper-arousal including sleep disturbances or irritability (jumpy anxiety)

Post-traumatic Stress Disorder (PTSD)

- anxiety with generalized feelings of fear and apprehension as a result of exposure to an extreme traumatic event that included actual or life-threatening events and involved fear, helplessness or horror.
- Durations must be more than 1 month and causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
- Clinical symptoms associated with PTSD are the same as acute stress disorder.

Prolonged Grief Disorder (PGD)

- also known as complicated grief, is a condition characterized by profound and debilitating feelings of loss.
- PGD is referred to as traumatic, chronic, or pathological grief.
- The main characteristics of prolonged grief include significant emotional distress and changes to a person's level of functioning.