NYU abnormal psych exam 111

dogmatism

tendency to cling to one's beliefs

Dogma

a principle or set of principles laid down by an authority as incontrovertibly true

Empiricism

the belief that accurate knowledge can be acquired through observation

empirical

based on, concerned with, or verifiable by observation or experience rather than theory or pure logic

History of Psychopathology

-Efforts to understand and resolve problems of psychopathology

-traced throughout many centuries & cultures (where mysticism and charlatanism were present)

-originally unfolded without the care of scientific methods

-many current techniques are connected to past efforts

The Sacred Approach

Psychopathology was the expression of transcendent magical action brought about by external forces

Demonological Phase

Two competing forces struggled for superiority

Creative and positive

Represented by a good parent or God

Destructive and negative

Represented by the willful negation of good in the form of demonic forces

Animistic Phase

disorders were attributed to the mysterious forces of nature

Mythological Phase

Every symptom of a disorder was thought to be caused by a deity who, if appropriately implored, could benevolently cure

Early Hindu Sumatra

Suggested that passions and strong emotions of the mentally disordered brought about physical ailments

Hindu Medicine

Proposed the existence of three emotional inclinations:

1. Wise and enlightened goodness

-Seated in the brain

2. Impetuous passions

-The source of the pleasure and pain qualities

-Seated in the chest

3. Blind crudity of ignorance

-The basis for animalistic instincts

-Seated in the abdomen

Chakra Samhita

Different appearances of mental disorders result from Heredity, imbalanced doshas, temperament, inappropriate diet, and metapsychological factors

Doshas = bodily fluids

Chinese medicine

Stated that the primary causes of psychiatric illness were vicious air,abnormal weather, and emotional stress

Principle of Tao (i.e. the way)

Achieved by integrating the individual self into the realm of nature

Personality types were portrayed on the basis of a combination of the five elements

Greek Civilization

Balances and imbalances would account for health or disease

Thought the soul was composed of three parts

Reason

-reflected truth

Intelligence

-synthesized sensory perceptions

Impulse

-derived from bodily energies

Brain=Center of the rational parts of the soul

Heart= Center of the irrational parts of the soul

Hippocrates

Identified four basic temperaments:

Choleric

• excess in yellow bile

• Associated with a tendency towards irascibility

Melancholic

• excess in black bile

• Characterized by an inclination towards sadness

Sanguine

• excess in blood

• Individuals are prompted towards optimism

Phlegmatic

• excess in phlegm

• Conceived of as an apathetic disposition

Plato

Conflicts exist among different components of the psyche

Discord between the rational side and emotions

Mental disorders do not result from simple ignorance, but from irrational superstitions and erroneous beliefs

Emil Kraepelin

Established definitive patterns of two major disorders

Manic-depressive psychosis (now known as bipolar disorder)

Dementia praecox (now known as schizophrenic disorders)

Termed the autistic temperament: "These children exhibited a quiet, shy, retiring disposition, made not friendships, and lived only for themselves."

Eugene Bleuler

coined the term schizophrenia (formerly dementia praecox - split mind)

Adolf Meyer

-saw psychiatric disorders as consequences of environmental factors and life events

-psychobiological approach to schizophrenia

Egodystonic vs egosyntonic

aware that they have a problem and want to stop vs unaware (ocd vs obsessive compulsive personality disorder)

Classification

The process of grouping things based on their similarities

diagnosis

the process by which individuals are assigned to already existing groups

Taxonomy

-the study of how groups are formed

-A meta-level concept looking at different theoretical ways classifications can be organized, studied, and changed

Problems with Classification

The definition of what a mental disorder is

The nosological principles for organizing psychiatric classifications-what's the best way to classify disorders

Distinction between normality and pathology

Why classify?

defines boundaries

Purposes of classification

1. Provides nomenclature for practitioners

2. Serves a basis for organizing and retrieving information

3. Describes the common patterns of symptom presentation

4. Provides a basis for making predictions

5. Forms the basis for the development of theories

symptoms vs signs

Symptoms- subjective sensation that the person feels from the disorder/ self reported

Sign- objective abnormality; *seen* by others

syndrome

when signs and symptoms co-occur frequently

Disease

a condition with a known etiology and known path from the causal agent to the symptoms and signs

advantages of classification

Easy to use because they are more "black and white"

Consistent with biological and medical classification systems

Disadvantages to classification

Result in loss of information

Aristotle, Posterior Analytics

presented the notion that we do not have knowledge of something until we know the cause

David Hume

We are naturally inclined to attribute the experience of constant contiguity to causality

John Stuart Mill 5 Minutes of Induction

1. .Direct Method of Agreement: if something is a necessary cause, it must always be present when we observe the effect

2. Method of Difference: If 2 situations are exactly the same in every aspect except one and the effect occurs in one but not the other situation then the one aspect they do not have in common is likely to be the cause of the effect

3. Combination of the methods of agreement and difference

4. Method of residue: if many conditions cause many outcomes...and we have matched the conditions to the outcomes on all factors except one...then the remaining condition must cause the remaining outcome

5. Method of Concomitant Variation: If one property of a phenomenon varies in tandem with some property of the circumstance of interest, then that property most likely causes the circumstance

Nine Criteria for Causal Inference

strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experiment, analogy

Popper

Popper is seen as the forefather of empirical falsification

For Popper, proving causality was the wrong goal

Induction should proceed not by proving, but by disproving

Always a matter of rejecting the null hypothesis

Never a matter of accepting the alternative hypothesis

The Counterfactual Condition

what would have happened in a different world; impossible to observe

sufficient-component cause model

A model that is constituted from a group of component causes, which can be diagrammed as a pie; also known as the causal pie model.

Component causes: individual factors that contribute to a disease

-Shown below as individual "slices" of the pie

Sufficient cause: the complete pie

-May be considered a causal pathway

Necessary cause: a component cause that appears in every pie or pathway

- Without it, the disease does not occur

Paul Meehl: Causes

A causal factor can also be neither necessary nor sufficient for psychopathology

Specific etiology: A categorical (all-or-none) variable that is both necessary and sufficient for a disorder to emerge

threshold effect

When the threshold is exceeded, the individual is at risk for the disorder

Below the threshold, there is no risk for the disorder

step function

The individual's risk for the disorder increases sharply once past the threshold

The individual's risk for the disorder is low below the threshold, but not zero

case study

the detailed examination of a single individual

Good for the context of discovery

Poor for the context of justification

experimental design

A design in which researchers manipulate an independent variable and measure a dependent variable to determine a cause-and-effect relationship

quasi-experimental design

a comparison of two or more groups defined by pre-existing characteristics (e.g., depressed vs. non- depressed individuals)

Should not draw causal inferences from quasi-experimental studies

matching

equating the quasi-experimental groups on potentially confounding variables

For example, a researcher could match the schizophrenic and non-schizophrenic groups on SES and IQ

Animals Models of Psychopathology

Involves attempts to produce a simulated form of a mental disorder in non-humans

Challenge Paradigm

when researchers present participants with stimuli thought to trigger a pathological response

single-subject experimental design

a research method in which a single participant is observed and measured both before and after the manipulation of an independent variable

Epidimiology

study of where and when diseases occur and how they are transmitted within populations

study of the distribution of disorders in a given population

Studying Genetic and Environmental Influence

Behavior genetics: the study of genetic and environmental influences on behavior

Psychophysiology: the study of involuntary physiological responses that may be affected by psychological processe

Biological studies

Observing Brain Structure

CAT (computerized axial tomography) scans

MRI (magnetic resonance imaging)

Observing Brain Functioning

EEG (electroencephalography)

Measures brain waves

fMRI (functional MRI)

Examines changes in the magnetic properties of brain regions

PET (positron emission tomography) scan-

Uses radioactive isotopes

Fear vs. Anxiety

Fear (or panic): an alarm response when danger is perceived to be present

-Involves a triggering of the fight-flight-freeze (FFF)

Anxiety: a future-oriented mood state associated with preparation for possible harm

- Involves a priming (simultaneous excitatory and inhibitory input to) the FFF mechanism when danger is perceived to be possible at a later point in time

Fear and Anxiety Overlapping Symtpoms

Both involve the perception of danger

Both involve excitatory input to the FFF mechanism

Distinct Aspects of Fear and Anxiety

Fear (panic) is more immediate

Anxiety is longer lasting and future oriented

Fear (panic) is purely excitatory input to the FFF mechanism

Anxiety is simultaneous excitatory and inhibitory input to the FFF mechanism

Panic Attacks

Expected: the individual is aware of a cue or trigger at the time of the attack

Unexpected: the individual is not aware of a cue or trigger at the time of the attack

Non-Clincial Panic vs Panic Disorder

Non-clinical panic: Do not experience anticipatory anxiety about their attacks

Panic Disorder: Do experience anticipatory anxiety about their attacks

panic disorder

Persistent worry about having attacks (or about their consequences)

The development of significant, maladaptive behavioral changes designed to avoid having attacks

Agoraphobia

the fear and avoidance of situations in which the individual fears having a panic attack and from which it would be difficult to leave or get out

DSM-5 has reverted to identifying agoraphobia as an independent diagnosis, as in DSM-III

Generalized Anxiety Disorder (GAD)

cardinal feature is excessive, uncontrollable worry about a number of different life circumstances

This worry must be accompanied by at least three common manifestations of anxiety

e.g. muscle tension, sleep disturbance, or irritability

Specific Phobia Subtypes

Animal: fear cued by animals or insects

Natural environment: fear cued by an object in the natural environment; e.g. heights, thunderstorms, or water

Blood-injury-injection: fear cued by seeing blood, injury, or receiving an injection

Situational: fear cued by specific situations; e.g. driving, enclosed spaces, or flying

Other: fear cued by other triggers

To recieve DSM diagnosis of specific phobia...

The cue has to almost invariably provoke an immediate fear response

The fear has to be excessive*

The fear must be associated either with: Some avoidance of the phobic cue or endurance of exposure to that cue with intense fear

The fear must be associated either with: some functional impairment or significant distress about having the fear

social anxiety disorder

A persistent and marked fear of social situations in which the individual might be judged or evaluated by others

Exposure to the feared social situation(s) has to almost invariably provoke an immediate fear response

Specific phobia is the most prevalent of the anxiety disorders

Social anxiety disorder is the second most prevalent anxiety disorder covered here

Most common fears reported are those related to performance-based situations

SAD and conditioning

Vicarious conditioning: Simply observing others experiencing a trauma or behaving fearfully can sufficiently induce phobia

Both mother and individual reports indicate more social avoidance among families of patients with SAD compared with non-clinical controls

Selective Associations

Prepared fears: those fears that are not truly inborn or innate, but which are very easily acquired and/or especially resistant to extinction such as snakes or heights

Ohman and Dimberg (1987) conditioned two types of stimuli: Fear-relevant stimuli (snakes, spiders, and angry faces) and fear-irrelevant stimuli (flowers, mushrooms, electric outlets, or neutral or happy faces)

Found that the fear-relevant stimuli were more easily conditioned to be fearful than fear-irrelevant stimuli

Uncontrollability and Unpredictability

Perceptions of controllability can explain these individual differences

Fear is more easily conditioned when the aversive event is inescapable than when it is escapable

learned helplessness

A condition that occurs after a period of negative consequences where the person begins to believe they have no control.

results from repeated social defeat; This effect is usually seen in response to uncontrollable shock (and not controllable shock)

Differences between OCD and other anxiety disorders

Centrality of anxiety symptoms

Neurobiological pathways

Obsessions and Compulsions

Obsessions: Characterized by recurrent intrusive thoughts, images, and impulses

Compulsions: Repetitive behaviors or mental rituals, governed by specific rules that the individual feels compelled to perform (typically performed to neutralize intrusions/obsessions)

An ego-dystonic disorder: The majority of patients have good insight regarding their obsessions

Cognitive Behavioral Model

•Focuses on maladaptive behaviors and/or cognitions in understanding and treating psychological abnormality

•Shares key principles between behavioral and cognitive perspectives

Patients misinterpret normally occurring intrusive thoughts as overly important and dangerous—-This causes the patient to feel distressed

Patient attempts to alleviate the distress using ritualistic behaviors, avoidance behaviors

Behaviors results in transient distress reduction

Paradoxically reinforces the likelihood that patients will engage in these behaviors in the future

thought action fusion (OCD)

Thought-Action-Fusion (TAF): cognitive biases seen in patients with OCD

Moral TAF: the belief that thoughts have an equal moral weight to actions

Likelihood TAF: the tendency to believe that thoughts increase the probability of real- life events occurring

YBOCS (Obsessive Compulsive)

Meta-analysis found four basic symptom categories

Symmetry: symmetry obsessions and repeating, ordering, and counting compulsions

Forbidden thoughts: aggression, sexual, religious, and somatic obsessions and checking compulsions

Cleaning: cleaning and contamination

Hoarding: hoarding obsessions and compulsion

Treatment of OCD

Most effective psychological treatment is cognitive-behavioral therapy (CBT) with a prominent Exposure and Response Prevention (ERP) component

ERP is of equal or better efficacy when compared to pharmacological treatment for OCD

Cognitive therapy for OCD: Developed to challenge maladaptive cognitive processes (i.e. intolerance and uncertainty)

Deep brain stimulation (DBS): Typically for patients who don't respond to pharmacological and psychological intervention; Shown to be effective in at least 50% of cases

Body Dysphoric Disorder

OCD and BDD similarities

Patients with both disorders experience obsessions or preoccupation; In this way, BDD more closely resembles MDD than OCD; Focus is on self-defeating and negative self-worth beliefs

OCD/BDD differences

OCD:

Majority perceive the content of their obsessive thoughts to be irrational

Intact level of insight reported in 66%-85% of patients

"Delusional insight" only observed in 2-3% of patients

BDD:

"Delusional insight" is highly prevalent; Observed in 32%-39% of patients

Nearly 50% report delusional appearance related beliefs

Delusions of reference are seen in 2/3 of patients; e.g. the belief that others are taking special notice of the patients' perceived defects

Hoarding Disorder

characterized by persistent difficulty in discarding or parting with possessions, regardless of their actual value, which results in the accumulation of a large number of possessions that fill up and clutter active living areas of the home or workplace to the extent that their intended use is no longer possible

OCD vs hoarding disorder

OCD

Thoughts are intrusive and unpleasant

Primary aim is to avoid, reduce, or neutralize anxiety

HD

Thoughts are ego-syntonic

Distress comes from clutter and/or interference in role obligations rather than collecting item

Hoarding Disorder has a chronic course with very little waxing and waning

This is distinct from the variable course of OCD

hair pulling disorder

The recurrent pulling out of one's hair resulting in hair loss, consequential distress, or functional impairment, and repeated attempts at reducing hair- pulling behaviors

skin-picking disorder

The recurrent skin picking resulting in skin lesions, clinically significant distress, or functional impairment, and repeated attempts to decrease or stop skin picking

Symptom Comparison: HPD, SPD, OCD

Similarities

Each involve repetitive behaviors in response to urges

Behaviors are Anxiety relieving, Often symmetrical, Possess ritualistic characteristic

Differences

Feelings following behaviors

Patients with OCD experience a reduction of anxiety after repetitive behaviors

Patients with grooming disorders experience a sense of gratification after behavior

History of PTSD

Now clear that traumatic events can produce psychiatric symptoms

Used to be held that stress-induced symptoms were transient and persistent symptoms implied the presence of another neurotic or characterological disturbance

The Vietnam War and Post Vietnam Syndrome

Clinicians became convinced that the war itself could cause chronic psychiatric disability Rather than seeing them as having pre-existing conditions exacerbated by the war

Leaders of the DSM-III revision process initially opposed this proposal for two reasons: Combinations of several traditional diagnoses could cover the problems of these veterans and Atheoretical DSM aimed to be explicitly defined by signs and symptoms, rather than debated etiology

Similarities in the symptoms of Vietnam veterans were similar to those who survived other traumatic experiences e.g. rape, disaster, and concentration camps

This resulted in the consensus that any terrifying, life-threatening event could cause a chronic syndrome

PTSD (Post Traumatic Stress Disorder)

an anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience

Central idea: A traumatic event establishes a memory that gives rise to a characteristic profile of signs and symptoms

When people continue to recall traumas involuntarily with the full emotional force of the original experience

Failure of stress symptoms to abate despite the absence of danger justifies PTSD as a mental disorder

PTSD Intrusion cluster

Includes reexperiencing symptoms such as Traumatic nightmares, Intrusive sensory images of the trauma, Physiological reactivity to reminders of the trauma

PTSD avoidance cluster

Includes efforts to avoid feelings, thoughts, and reminders of the trauma

negative alterations in cognition and mood

Includes symptoms such as Emotional numbing, Distorted blame of self or others, Pervasive negative emotional states

alterations in arousal and reactivity

Includes symptoms such as Exaggerated startle, Aggression, Reckless behavior

Traumatic Stressors

A situation that threatens one's physical safety, arousing feelings of fear, horror, or helplessness.

PTSD in DSM-3

Presupposed that only traumatic stressors falling outside the boundary of everyday experience could produce PTSD

e.g. rape, torture, natural disasters

Some people met criteria for PTSD with no direct traumatic experience; in response, DSM-IV broadened the concept of trauma exposure to include, Being "confronted with" information about a threat to the "physical integrity" of another person

PTSD in DSM-5

DSM-5 committee tightened the Criterion A

People who learn of physical threats to others must be a close friend or relative of the threatened person

Trauma exposure via the media has also been excluded; except for those whom such exposure is part of their vocational role

Epidemiology and Sex Ratio of PTSD

Men are exposed to traumatic events more often than women are, yet the rate of PTSD is more than twice as great in women as in men

Delayed-onset PTSD is extremely rare

Commorbidity of PTSD

Pure PTSD is unusual, and comorbidity is common

Most common comorbid disorders Men and women: Alcohol use and depression

Men: Generalized anxiety disorder

Women: Panic disorder

Cognitive Aspects of PTSD Phenomenology of Traumatic Memory:

Rumination vs Intrusion

Ruminative and intrusive thoughts about the trauma

Repetitive and intrusive thoughts of the trauma

DSM and rumination

Only intrusive sensory memories qualify as reexperiencing symptoms

Ruminative thoughts about the trauma no longer qualify

Positive memories vs traumatic memories

Compared to traumatic memories, memories of positive events...

Fade in terms of vividness and emotional intensity

Decrease in accuracy over the course of several year

Disossiative Disorders

These disorders have the chief feature of "dissociation"

Some clinicians regard seemingly opposing phenomena as the same dissociative process

Vivid sensory recollection of traumatic events; e.g. "dissociative flashbacks"

Reports of inability to recall traumatic events; i.e. "dissociative amnesia"

Disossiative Amnesia

The more often trauma occurs and the more emotionally distressing it is for the victims

The more likely it supposedly is that they will not remember having suffered any trauma

Disocciative Identity Disorder

In many cases of DID, patients had no memories of childhood abuse until therapists (using hypnosis, guided imagery, etc.) helped them recall presumably dissociated traumatic memories

Authentication of these memories is questionable

Traumatic memories are seldom, if ever, inaccessible to awareness

Depersonalization and Derealization Disorder

During a depersonalization episode people feel emotionally numb and disconnected from their body

Experience the world as an unreal dream (i.e. derealization)