Clinical psych

4 D's

Distress dysfunction deviance dangerousness

Distress

Significant internal discomfort

Dysfunction

Impairment in daily life

Deviance

Culturally unexpected behavior/thoughts

Dangerousness

Danger to self or others

Continuum of experience

Typical → disordered with no clear cutoff

Categorical diagnosis

Have it or don't

Dimensional diagnosis

Where you fall on a spectrum

DSM-5-TR

U.S. mental disorder diagnostic manual

ICD-11

International diagnostic system

Sign

Objective observable evidence

Symptom

Subjective patient experience

Diagnosis

Identifies symptom cluster NOT cause

Differential diagnosis

Distinguish disorders with similar symptoms

Comorbidity

2+ diagnoses in one person

Clinical judgment

Evidence-based reasoning NOT opinion

Etiology

Cause/origin of a disorder

Biological model

Disorders linked to biological processes

Neuroplasticity

Brain changes with experience

Neurotransmitters

Chemicals carrying signals between neurons

NT imbalance theory

Too many/few NTs or altered receptors

NT theory limitation

Too simplistic + hard to measure

Epigenetics

Environment changes gene expression NOT sequence

Endocrine system

Glands release hormones into blood

HPA axis

Stress/fight-or-flight system

Sickness behavior

Inflammation → fatigue/anhedonia/sleep-appetite changes

Biological model strength

Researchable + produces new knowledge

Biological model weakness

Can overemphasize medication

Operant conditioning

Learning through consequences

Reinforcement

Makes behavior more likely

Positive reinforcement

Add something rewarding

Negative reinforcement

Remove something unpleasant

Classical conditioning

Learning through association

Stimulus generalization

Fear spreads to similar stimuli

Little Albert

Fear learned through conditioning

Little Peter

Fear unlearned through exposure

Behavioral model strength

Testable + supports effective therapy

Behavioral model weakness

Can ignore cognition

Cognitive model

Thoughts/beliefs affect emotion and behavior

Causal attribution

Meaning assigned to an event

Global assumptions

Broad beliefs about self/world

Placebo effect

Positive effect from expectation

Nocebo effect

Negative effect from expectation

Cognitive model strength

Useful + researchable

Cognitive model weakness

Hard to prove thoughts cause disorder

Diathesis-stress

Predisposition + stress → disorder

Equifinality

Different causes → same outcome

Multifinality

Same cause → different outcomes

Case study

Detailed study of one person

Case study strength

Can support/challenge theories

Case study weakness

Cannot generalize well

Epidemiology

Patterns of disorders in populations

Prevalence

Existing cases at a given time

Incidence

NEW cases over a period

Risk factor

Increases likelihood of disorder

Protective factor

Decreases likelihood of disorder

Experimental method

Can establish causation

Randomization

Random group assignment

Why randomize?

Reduce confounds/selection bias

Confound

Outside variable affecting results

RCT

Randomized study of an intervention

Control group

No treatment/comparison group

Experimental group

Receives treatment

Statistical significance

Does an effect exist?

Clinical significance

Is the effect meaningful/useful?

Human lab study

Controlled exposure to study effects

Internal validity

Effect is due to independent variable

Sleep + mental health

Strongly linked in both directions

Dyssomnia

Problem with sleep quality

Parasomnia

Behavior/experience during sleep

Circadian rhythm

Internal sleep-wake clock

Strongest circadian cue

Light-dark cycle

Other circadian cues

Meals activity social interaction

SCN

Master clock in hypothalamus

Melanopsin

Light-detecting receptor for circadian rhythm

Melatonin

Hormone regulating sleep timing

Sleep benefit

Clears metabolic waste

Beta-amyloid

Alzheimer's-linked waste cleared during sleep

Partial sleep deprivation

Reduced/disrupted sleep

Lack of sleep consolidation

Interrupted sleep

Selective stage deprivation

Loss of specific sleep stages

Reduced sleep duration

Not enough total sleep

Insomnia: sleep symptoms

Trouble starting/staying asleep or waking early

Insomnia: daytime requirement

Must cause daytime impairment

Insomnia opportunity rule

Not caused by inadequate sleep opportunity

Insomnia frequency

≥3 nights/week

Acute insomnia

Chronic insomnia

≥3 months

Predisposing insomnia factors

Vulnerability before insomnia

Precipitating insomnia factors

Trigger that starts insomnia

Perpetuating insomnia factors

Behaviors maintaining insomnia

Bed + wakefulness

Classical conditioning can maintain insomnia

CBT-I

Behavioral/cognitive treatment for insomnia

Insomnia medication

Can help but has limitations

Abnormal anxiety

Excessive + impairing + out of proportion

Panic attack

Acute fear with ≥4 symptoms

Panic attack somatic symptoms

HR sweat tremble SOB choking chest pain etc.

Panic attack cognitive symptoms

Fear dying or losing control

Panic disorder

Attacks + ≥1 month worry/behavior change

Panic differential

Rule out medical causes