American Literature Review

Psychological Disorders

Diathesis - Stress Model

  • 2 major factors of symptomology…

    • Stressors - familial/ marital conflict, stressful work environments, not having employment, money problems, legal issues, bereavement, loss of control, abuse/mistreatment (can by physical or psychological)

    • Diathesis (vulnerability or predisposition to developing disorders) - genetics, biopsychological, mindsets (pessimism), personality (neuroticism), traumatic events/experiences (current trauma = stressor, past trauma = predisposition)

Criteria for diagnosing a mental disorder

  • behavior is derivate of cultural norms

  • behavior is distressing to the individual

  • behavior is maladaptive or dysfunctional for normal/regular life

How do we actually diagnose mental disorders in America? - The DSM

  • the classification system for mental disorders like Major Depressive Disorder (MDD)

  • The DSM tells of Primary/Defining symptoms, Secondary Symptoms, Time courses, and Differential Symptoms

    • Primary - symptoms that ALL patients share (need one or two of primary symptoms)

    • Secondary - ways that primary symptoms effect one’s normal life

    • Time course - length of depressive (or other disorder) episode

    • Differential symptom - how to provide treatment for individual (you do not want to misdiagnose/ give the wrong treatment which may make disorder worse)

DSM and Anxiety Disorders

  • the DSM focuses strictly on diagnosis (do you have symptoms) and prognosis (severity of symptoms), NOT treatment or cause of disorders/symptoms

  • treatment can be found in other sources like a treatment manual

Pros and Cons of DSM - 

  • allows for universal language of psychologists and avoids misdiagnosis

  • can come with stigmas and categorical diagnosis may not be the most ideal approach

Anxiety Disorders - distressing, persistent anxiety or maladaptive behavior to reduce anxiety

  • generalized anxiety, panic attacks, and specific phobias

Generalized Anxiety - excessive, uncontrollable worry lasting months (constant worry over everyday things) (doesn’t know why they are anxious, moderate intensity, almost always)

  • automatic nervous system is always on (manifest in eye twitching, low attention span, etc.)

Panic attacks - recurrent panic attacks (high intensity, doesn’t know why they feel anxious, lasts a few minutes, feels of going to die)

  • fearing the attacks leads to agoraphobia

Specific phobias - consumed by persistent thoughts of irrational fears and avoidance of objects/situations that would trigger the fear (the person is aware of their specific trigger, it is moderate to high in intensity, lasts a few minutes)

Assessments - different approaches to assessing a patient for a mental health symptom/diagnosis

  • Mental Health status exam - observes behavior: referral non-diagnostic

  • Structural Clinical Interview for DSM - funnel procedure = diagnosis (the structure clinical interview assessment has good reliability for diagnoses)

  • Unstructured Clinical Interview - clinical experience outcome - diagnosis (lower reliability than structural clinical interview)

  • Neuropsychological assessment - asses abilities related to neuropsychological damage and impairment

Specific Disorders - 

  • bipolar and depressive disorders

  • emotional extremes that deviate from a “normal” sadness pattern

  • Depressive episode - (MDD) long lasting period (over two weeks) of negative emotions, but it eventually resolves

  • Persistent Depressive Disorder - (PDD) sad for years (two or more years) but not as sad as a major depressive disorder (but still much longer period of sadness)

    • anhedonia - can’t be happy

    • inconsistent sleep

    • loss of appetite

    • lethargy

    • irritability

    • suicidal

    • negative thoughts towards your self (i hate myself)

  • Double Depressive Disorder - both persistent depression an major depressive disorder symptoms are seen in a patient (meets criteria’s for both disorders)

Bipolar Disorder-

Depression = extremely negative mood

Mania = extremely positive mood

Bipolar disorder = depression and mania

  • milder forms of bipolar disorder are called cyclothymic (when an individual constantly tetters between positive and negative moods without neutral days)

  • Bipolar 1 - at least one consecutive week of a manic episode and probably a depressive episode (not required though)

  • Bipolar 2 - hypomanic (only a few days of mania not a full week, and less severe symptoms) and depressive episode (would give mood stabilizers instead of depressive medication

  • Cyclothymia - rarely have a neutral day, always happy or sad

Schizophrenia - epitome of psychotic disorder

  • a split from reality not a split in personality

  • disturbed perceptions and beliefs, disorganized speech, diminished and inappropriate emotions

  • can display positive (an excess) or negative (deficient) symptoms

  • manic episodes result in hypercreativity, hyperaggitation, aroused for days at a time without sleep, racing thoughts, push of speech (world salad), psychomotor arousal (goal directed behavior which can be destructive - missing days of work because you cleaned your entire house), impulsive and destructive behavior

Positive symptoms -

delusions (false beliefs)

  • persecutory thoughts

  • control

  • identity

  • grandiose

Hallucinations - false perceptions

  • auditory

  • olfactory

  • visual

Negative Symptoms -

disconnected emotion

  • flat effect (your mom died, no emotional response)

  • anhedonia

loss of motivation

  • just stop doing things (not for any reason)

  • poverty of speech

social withdrawal

Disorganized -

repetitive or catatonic (loss of movement, no response to stimuli - like if a ball is thrown at you) (responds to medication) behaviors

inappropriate emotional responses - laughing when told your mom is dead

disorganized thinking and speech (not rapid speech)

  • preservation (repeating)

  • clang (rhyme)

  • neologism (making up words)

  • loose associations

Biomedical Therapies-

  • psychopharmacology - application of moods medications for the treatment of mental health

    • introduced in the 1950’s with Thorazine

    • leads to wide spread de-institutionalization

  • medications tend to target neurotransmitters

    • anti-anxiety meds. (increase GABA - like benzodiazepines)

    • anti-depressants - (blocks enzymes that breakdown epinephrine, dopamine, and serotonin - like MAOI)

*these two are agonists

  • anti-psychotics (block receptors sites for serotonin and dopamine - like Clozapine)

*this is an antagonist

Pro’s of medications -

  • they work, sometimes they are the only way to manage mental health symptoms

  • can supplement psychotherapy

  • cast and time effective

Con’s of medications -

  • addictive (can lead to tolerance or withdrawal)

  • side effects

  • short management

Mental Health Treatments

Goal of psychoanalysis - to achieve healthier living by expressing, understanding, and resolving unconscious conflicts

  • to become aware of repressed feeling sin the unconscious to better understand oneself (and what you may be doing that is maladaptive)

  • there is not much supporting evidence for the psychoanalysis treatments

Techniques of Psychoanalysis -

  • free expression - relaxing on a couch and being prompted by your therapist and saying whatever comes to your mind (without hesitation), to uncover what is really going on in your mind

  • Dream analysis - psychoanalysis believes that your conscious mind is fully relaxed in sleep which allows your unconscious mind to influence your dreams and offer a look into what your unconscious mind is made of (this requires a recording of your dreams for your therapist to analyze)

  • Projective Tests - inkblot tests, give ambiguous stimulus that can be interpretated by any person, and ask the patient to explain what they see

More Modern Techniques -

  • more focused on relationships in one’s life

  • helps understand current thoughts and feelings by focusing on important relationships and events

  • these techniques have not been found to relieve depressive symptoms

    • typically performed in weekly sessions that go one for weeks or months, NOT years as traditional psychoanalysis would

    • prescribes anti-depressants instead of cocaine like Freud did

Goal of Behavior treatments -

  • doesn’t look for underlying causes, but assumes that problem behaviors are the sole problem that need to be fixed

  • work on getting rid of unwanted behaviors

    • works through operant conditioning, classical conditioning, and social learning

Goal of Cognitive Therapies -

  • assumes that thinking influences feelings

  • works to break unhealthy thought processes and introduce healthier ways of interpretating events

    • changes what you say to change how you feel and think

More treatments -

  • Electroconclusive Therapy (ECT) - induced seizures by electrical stimulation

    • historically misused in asylums

    • used in the modern day treatments, it effectively reduces severe symptoms in treatment resistant depression (in cases where other options have failed) (used as a last resort)

Modern day alternatives -

  • Deep brain stimulation - brain surgery

  • Transcranial magnetic stimulation - very few risks

    • these are better options because it minimizes side effects and risks

Client Centered approach - humanistic therapy

  • all individuals tend to grow and be better when supported by someone

  • give unconditional positive regard by

    • empathy - see from clients perspective

    • congruence - nonjudgmental openness

  • encourage patient to feel comfortable to engage in the therapy treatment

    • motivational interviewing

Psychotherapy

  • Cognitive-Behavioral therapy - effect the things you can control so that it indirectly effect the things that you can not control

  • foal of psychotherapy is not curing the mental disorder, but managing and reducing the symptoms of the mental disorder so the patient can live normally

What treatments should be used?

  • consider factors like diagnosis and symptoms and prognosis

  • consider finances of the patient, the emotions of the patient, and their cultural backgrounds

  • evaluate treatments through research

    • Randomized Controlled Clinical Trials

      • placebo effect

      • regression to the mean

  • the eclectic approach

    • use best tool first and then determine what works for the patient (individualized plans - just because something works in general does not mean it works for every patient)

    • be weary of lactogenic (harmful) treatments

Psychology careers

  • Biomedical approaches (MD - specialized psychiatry)

    • psychiatrist

    • psychiatric nurse practitioner

  • Psychotherapeutic Approaches

    • PhD in psych. (research and practice)

    • Psy/PhD in counseling (MSW) (treat less severe disorders)

  • Specific therapeutic goals

    • marriage and family therapy

    • applied behavioral analysis

Social Psychology

  • Social Cognition

    • examining the way in which people attempt to understand and explain their own and others’ behavior

    • Cognitive evaluation of social situations will be influenced by motives related to

      • accuracy and efficiency

      • motives

  • Attribution theory

    • there is a reason for everything we do, even if we do not know the reason

    • guess the reason: is it disposition or situation

  • Disposition -

    • assumptions (within persona control) (others are not likely to repeat this same behavior because it is unique to your disposition) (likely to be repeated by the individual)

    • thinking as a personality psychologists

  • Situation -

    • assumptions (outside of personal control) (others are likely to do the same behavior) (unlikely to be repeated because it is unique to that one situation)

    • thinking as a social psychologist

  • Actor-observer Effect

    • explanations about behavior will depend upon whether you are the actor or the observer

  • Actor -

    • explaining your own behavior

    • more focused on disposition if the outcome is positive (if you perform well)

    • focus on the situation if the outcome is negative

    • Self-serving bias - give explanations to cast self in best light

  • Observer -

    • explaining behavior of others

    • Fundamental Attribution Error - tendency to overemphasize dispositional explanations and underestimate situational explanations

    • more disposition focused

    • too much disposition not enough situation

  • Social Influence -

    • Conformity - change of behavior, attitude, or belief because of real or imagined social pressure

  • 2 factors of conformity…

    • normative social influence: behavior shaped buy desire for social approval

      • results in compliance

      • Ash - conformity of obviously incorrect responses - people would worked alone or in a group, all others present were confederates

    • Informational social influences: behavior aimed at resolving uncertainty

      • results in internalization (come to believe its true)

      • following others’ responses because your unsure

      • misinformed leading misinformed

  • Bystander Apathy -