MAJOR REVIEW FINAL BEFORE EXAM

Hippocrates (460–377 BCE)

🌿 Separated medicine from religion/superstition → illnesses have natural causes (somatogenesis).
🧠 Classifications: mania, melancholia, phrenitis.
⚖ Mental health = balance of 4 humours (blood, black bile, yellow bile, phlegm).

Benjamin Rush (1745–1813)

🇺🇸 Father of American psychiatry.
🩸 Believed mental disorder = excess blood in brain → used bloodletting.
😨 Thought frightening patients could cure them.

Philippe Pinel (1745–1826)

🇫🇷 Humanitarian reformer, key figure in moral treatment.
🏥 In charge of La Bicêtre asylum in Paris.
✨ Treated patients with dignity & compassion.

William Tuke (1732–1822)

🇬🇧 Founded York Retreat with the Society of Friends (Quakers).
🕊 Promoted moral treatment in a more homelike setting.

Dorothea Dix (1802–1877)

🇺🇸 Advocate for the mentally ill. (shocked at jail/asyulum conditions)
🔄 Resurrected moral treatment movement in the 19th century.
🏥 Helped establish many hospitals (Nova Scotia + Newfoundland)

Emil Kraepelin (1856–1926)

🧬 Created first classification system of mental disorders.
📑 Distinguished dementia praecox (schizophrenia → chemical imbalance) from manic-depressive psychosis (bipolar → metabolic irregularity).
🔬 Strongly biological view.

Louis Pasteur (1822–1895)

🦠 Developed germ theory of disease.
🔗 Linked infection (syphilis) → brain damage → general paresis (mental illness).
🧩 Showed biological roots of psychopathology.

Ewen Cameron (1901–1967)

🇨🇦 Scottish-born Canadian psychiatrist; president of APA, CPA, and first president of WPA.
💡 Developed “psychic driving” → erase (“depattern”) patients’ minds and rebuild them.
⚡ Extreme methods: high-dose ECT, drug-induced comas, sensory deprivation, LSD.
❌ Involved in CIA’s MKUltra program.
⚖ Legacy: infamous case of unethical psychiatric experimentation in Canada; major ethics cautionary tale.

Counterconditioning

Replacing a maladaptive response with a new response to a stimulus.

Displacement

Redirecting emotion from threatening target → safer one.

Index case (proband)

The person who in a genetic investigation bears the diagnosis or trait in which the investigator is interested.

Introspection

Reporting conscious experiences (early psychology method).

Law of effect

Behaviour shaped by consequences (Thorndike).

Linkage analysis

Genetic method comparing disorder occurrence with genetic marker.

Neurotic anxiety

Ego’s fear of id impulses breaking through.

Sublimation

Redirecting impulses into socially acceptable behaviours.

Successive approximations

Responses that closer and closer resemble the desired response in operant conditioning.

Albert Ellis (1913–2007)

💬 Founder of Rational Emotive Behaviour Therapy (REBT). Goal: replace irrational beliefs with rational ones → reduce distress.

Lerner’s Contemporary Analytic Thought

🔑 Expansion of Freud’s ideas into modern branches: (1) Structural theory (id, ego, superego refinements). (2) Self-psychology (focus on self-cohesion). (3) Object relations (early relationships shape psyche). (4) Interpersonal-relational (relationships drive behaviour). (5) Attachment theory (bonds in early life shape later mental health).

Harry Stack Sullivan (1892–1949)

🌐 Pioneer of interpersonal approach. His ideas led to Interpersonal Therapy (IPT) → focus on improving relationships to reduce depression.

Carl Rogers (1902–1987)

🌱 Founder of Client-Centred Therapy (humanistic). Key principles: empathy, unconditional positive regard, genuineness. Aim: foster self-actualization.

Fritz Perls (1893–1970)

🎭 Founder of Gestalt Therapy. Focus on awareness, present-moment experience, wholeness. Uses role-play, empty chair technique.

Bandura (Social Learning → Social Cognitive Theory)

🔹 Social learning theory = learn by observation + imitation (Bobo doll). 🔹 4 steps: Attention → Retention → Reproduction → Motivation. 🔹 Later: Social cognitive theory → self-efficacy + self-regulation (observe, judge, self-reinforce/punish). 🔹 Expanded to group & collective efficacy → social change. 🔹 Recent Book: Moral Disengagement → how people justify harm.

Construct validity

Whether a test truly measures the theoretical concept it claims to.

Content validity

Whether a test covers the full domain of interest.

Criterion validity

Whether a test relates to a criterion (another trusted measure).

DSM-5 V codes

Non-disorders (life factors) noted in diagnosis as influencing treatment.

• Homelessness, divorce, child-maltreatment

Internal consistency reliability

Extent test items measure the same construct.

Kappa (κ)

Statistic showing agreement between raters beyond chance. (Closer to 1 = better).

Neuropsychological tests

Tests (e.g., Luria-Nebraska) detecting brain impairment via cognition.

Luria-Nebraska

Can detect impairment in different parts of the brain.

PET scan

Brain imaging using radioactive isotopes to show activity.

Projective hypothesis

Assumption that vague stimuli reveal unconscious motives.

Projective test

Assessment with unstructured stimuli (e.g., Rorschach inkblots).

Thematic Apperception Test (TAT)

Projective test with pictures → client tells stories, revealing motives/conflicts.

Ernest H. (Case Study) 🚨

High-yield: illustrates diathesis (genetic + early environment) + stress (work/marriage), comorbidity (mood, substance, sexual dysfunction, PD).

Internet Addiction Disorder (IAD) 💻

Risk factors: ↑ neuroticism, ↓ agreeableness, impulsivity, social anxiety, depression.

🧩 Branching Interview (SCID)

Structured Clinical Interview for DSM (SCID)

Clinician-led, branching Qs → skip irrelevant sections. Used for diagnosis (DSM disorders).

🧠 Intelligence Tests

Stanford-Binet, Wechsler Adult Intelligence Scale (WAIS)

Measures IQ (verbal + performance). Standardized → compares to norms.

🎭 Projective Personality Tests

Rorschach Inkblot Test, Thematic Apperception Test (TAT)

Unstructured, ambiguous stimuli → client “projects” unconscious motives/conflicts.

📋 Self-Report Personality Inventory

Minnesota Multiphasic Personality Inventory (MMPI)

Long questionnaire, objective scoring, detects patterns linked to personality & psychopathology.

✋🕰 Tactile Performance Test (Time & Memory)

Right parietal lobe

🧩 Category Test

Brain damage

🗣👂 Speech Sounds Perception Test

Left hemisphere (parietal + temporal)

📖 Case study

Detailed info on 1 person. Strength = great for generating hypotheses. Weakness = ❌ no causality.

📊 Epidemiology

Studies frequency, distribution, incidence, prevalence, risk factors. Gives clues to causes.

🔗 Correlation (method)

Measures relationships; no causality (directionality + third variable problem). Widely used in psychopathology research.

🧪 Experiment (groups)

Independent variable manipulated, random assignment, control group. Gold standard for causality (esp. therapy studies).

🔄 Experiment (single subject, ABAB)

Manipulate variable in 1 person, compare on/off phases. Shows causality ✅ but limited generalization.

⚖ Mixed design

Combines experimental (manipulated) + correlational (classification). Shows differential effects (e.g., therapy × illness severity).

🧪 Analogue experiment

Study of a related phenomenon in the lab instead of the exact disorder (e.g., induced stress to study anxiety).

➗ Correlation coefficient (r)

Statistic for strength/direction of relationship (–1.00 to +1.00). Closer to ±1 = stronger correlation.

📈 Developmental trajectories

Age-related behaviour patterns over time (increase, decrease, stable).

👥 Group-based trajectory models

Identifies subgroups with different developmental paths (latent class growth analysis).

🙋 Idiographic research

Focus on the individual (case studies, qualitative research).

🔍 Latent class growth analysis

Stats method to find hidden subgroups with different developmental trajectories.

🧩 Moderator variables

Variables that change how another variable relates to outcomes (e.g., stress × coping style).

🌍 Nomothetic research

Variable-centred, aims for generalizations about a population.

✨ Statistical significance

Result unlikely due to chance alone (p < .05 common cutoff).

Panic disorder 😱

Physiological: Overactivity in locus ceruleus (norepinephrine).
Psychological: Fear-of-fear hypothesis (catastrophizing bodily sensations).

Autonomic lability ⚡

Tendency for the autonomic nervous system (ANS) to be easily aroused.

Interoceptive exposure 🌀

Exercises exposing panic pts to anxiety sensations (e.g., breathing through a straw, spinning). Helps reduce fear of body symptoms.

David Moscovitch (2009) 🧠

Cognitive theory of social phobia → core fear = “the self is deficient.”

Lacey (1967) 🔄

Stability–lability hypothesis → people differ in ANS reactivity (stable vs labile responses).

Jerome Kagan 👶

Identified behavioural inhibition/shyness as temperament trait linked to anxiety disorders.

CCK (cholecystokinin) 💉

CCK-4 exposure can trigger panic attacks; effect blocked by benzodiazepines.

Borkovec (GAD) 🔄

Cognitive theory: worry persists in GAD b/c it provides negative reinforcement (reduces distress temporarily → cycle continues).

Panic-Control Therapy (Barlow) 🛠

Exposure-based therapy combining:
1⃣ Relaxation training
2⃣ CBT
3⃣ Interoceptive exposure.

ASI (Anxiety Sensitivity Index) 📊

Measures fear of fear (catastrophizing body symptoms).
ASI-3 factors: physical, cognitive, social.
High ASI = stronger startle response to white noise.
Gender differences:
- Men: more reactive to social/psychological threat cues.
- Women: more reactive to physical threat cues.
High-AS → recall threat words more readily.

RESPONDS WELL TO CBT TREATMENT

Social Anxiety Disorder – Fear Order 😳

1⃣ Public performance
2⃣ Socialization
3⃣ Fear of being perceived/judged

OCD 🔄

- Cognitive: catastrophic misinterpretations of intrusive thoughts. (RACHMAN)
- Thought–action fusion (thinking = doing, or morally equal).
- Maintained by negative reinforcement (compulsions reduce fear short-term).
- Serotonin deficits implicated.
- Non-verbal memory deficits
- Exercise may enhance CBT outcomes, but not a replacement.

-Onset = 20 years old; male=female

** OBSESSIONS = EGO DYSTONIC

• Basal ganglia

3 multipliers increasing compulsive checking:

1. Sense of personal responsibility

2. Probability of harm if checking doesn’t take place

3. The predicted seriousness of harm

Hoarding 📦

- Difficulty thinking in categories.
- Distractibility plays a role.
- May respond to SSRIs/SNRIs.

Trichotillomania / Excoriation 💇‍♀💅

- Linked to cortical thickness changes.
- Maintained by negative reinforcement (reduces tension).
- Fits the frustrated action model (boredom, urges).
- Tx: SSRIs + Habit Reversal Training (HRT).

Rachman 🧠

- Cognitive theory of OCD.
- Obsessions = catastrophic misinterpretations.
- Key factors: inflated responsibility + thought–action fusion.

Alfred Adler 👶

- Psychoanalytic view: OCD from inferiority complex.
- Overprotective/dominating parents prevent competence → rituals used to gain control & feel proficient.

Salzman (1985) 📚

- Psychoanalytic perspective.
- Indecision in OCD = need for guaranteed correctness before acting.
- Tx: teach tolerance of uncertainty/anxiety (since total certainty impossible).

Dr. Siskin 👩‍⚕

- OCD maintained because fear is reduced by compulsions → reinforces the cycle. (Behavioral; negative reinforcement)

Major Depressive Disorder (MDD) 😔

≥ 5 symptoms for ≥2 weeks.
2× more common in women. (~Age 20 most common)
35% heritability.

• Two copies of the short variant of the serotonin transporter gene
  

• ↑ cortisol (HPA axis). (Removing tryptophan = improves depression)
  Treatments: Psychoanalytic, CBT, Interpersonal

• (Effectiveness of CBT decreasing as time goes on)

• Therapy; biological = antidepressants, ECT, rTMS, DBS.

FREUD = ORAL STAGE = Overdependence

Beck’s Cognitive Theory 🧠

Negative cognitive triad = negative views of self, world, future.

• Cognitive biases:

  • Arbitrary inference,

  • Selective abstraction,

  • Overgeneralization,

  • Magnification / Minimization.

Bipolar I Disorder 🔥

≥ 1 full manic episode (± depression).
85% heritability.
Tx: Lithium, anticonvulsants, atypical antipsychotics.

Bipolar II Disorder ⚡

Major depression + hypomania (less severe than full mania).

Dysthymia / Persistent Depressive Disorder 🌧

Depressed mood ≥ 2 years, but not as severe as MDD.

Cyclothymic Disorder 🌪

≥ 2 years of mild hypomanic + depressive swings.
Never full mania or MDD.

Chronic Traumatic Encephalopathy (CTE) 🏈

Brain atrophy from repeated head trauma (athletes).

Congruency Hypothesis 🎯

Depression risk ↑ when life stress matches personality vulnerability (e.g., perfectionist + failure).

Stress Generation Theory (Hammen) ⚖

Depressed ppl may create their own stress (conflict, reassurance seeking, poor partners).
↑ risk in girls w/ childhood maltreatment.
G×E: serotonin transporter s-allele + abuse → depression risk.

Suicide Types (Durkheim) 💀

Altruistic = for social purpose (e.g., monks).
Anomic = after social upheaval / loss of structure.
Egoistic = extreme alienation / isolation.

Psychache 💔

Shneidman’s term = unbearable psychological pain linked to suicide.

Attribution 🔎

Explanation a person gives for behaviour (internal vs external).

Sociotropy 👥

Dependency + need to please → vulnerability to depression.

Canadian Perspectives 8.2 🇨🇦

- Beck (cognitive): Sociotropy vs Autonomy.
- Blatt (psychoanalytic): Anaclitic (dependency) vs Introjective (self-criticism).
- Zuroff (McGill): Self-criticism = strong predictor; dependency also risk.
- Hewitt & Flett: Perfectionism (self-oriented + socially prescribed) = chronic depression.
- Congruency hypothesis: stress × personality = depression.
- Mixed support: Self-critical perfectionism → poor CBT response.

Suicide Myths (NOT TRUE ❌)

1⃣ Talking about suicide = won’t do it.
2⃣ Suicide = no warning.
3⃣ Suicidal ppl clearly want to die.
4⃣ Motives are obvious.
5⃣ Mood improvement = no more risk.

Shneidman’s approach to suicide

1. Reduce physiological suffering

2. Lifting the blinders helping the person see options

3. Encouraging the person to pull back from self-destructive acts

Bulimia Nervosa (BN) 🤮

• Criteria: 1+ episode/week for 3+ months
• Typical onset = late adolescence–early 20s
• Often comorbid with substance use
• Neuro links: serotonin–estrogen
• Fluoxetine (SSRI) = FDA-approved (for BN only, not AN)
• CBT > IPT for treatment effectiveness

Anorexia Nervosa (AN) 🚫🍴

• Onset = early to mid teens
• Ego-syntonic → patients see behaviours as consistent with self-identity (harder to treat)
• 41% relapse within 1 year
-70% recovery rate

• Opioids may be released
  • Severe low weight + intense fear of gaining weight

• DSM4 —> Must weigh less than 85%

• Recovery: White matter CAN increase; grey matter CANT

Binge Eating Disorder (BED) 🍔

• Criteria: 1+ episode/week for 3+ months
• Must include distress + ≥3 symptoms (e.g., rapid eating, eating until uncomfortably full, eating when not hungry, eating alone due to embarrassment, feeling disgusted/depressed/guilty after binge)
• No compensatory behaviours (unlike BN)

Lateral Hypothalamus 🧠

• Brain region crucial for feeding regulation
• Lesions → loss of appetite

Psychodynamic Views 🛋

• Hilde Bruch: eating disorders = struggle for control + feelings of ineffectiveness
• Salvador Minuchin: family dynamics = enmeshment, overprotection, rigidity, conflict avoidance → risk for eating disorders

Alcohol (biphasic) 🍷

• Later stage (2nd phase) = stimulant-like
• Mechanisms: ↑ GABA (tension reduction), ↑ serotonin/dopamine (pleasure), ↓ glutamate (speech/memory impairment)

Spanagel —> Alter gene expression + synaptic plasticity

FAS = 1 in 100

Inhalant Use 🛢

• Hydrocarbons (e.g., glue, gasoline)
• Youth use ≈ 17.3%

—> DEPRESSANTS

Nicotine 🚬

• Single most preventable cause of premature death (1 in 5 deaths)
• Mechanism: ↑ dopamine release (reinforcement)

Biological Treatments 💊

• Alcohol: disulfiram (Antabuse) → makes drinking aversive
• Opioids: agonist substitution (methadone, buprenorphine), antagonists
• Smoking: nicotine replacement (gum, patches, inhalers)

Behavioural Strategies (Drinking Control) 🧠

• Stimulus control: limit drinking situations (e.g., only on special occasions)
• Modify topography: e.g., mixed drinks, sip slowly
• Reinforce abstinence: reward self (non-alcoholic treat) when resisting urge

Barbiturates 💊

• Potent sedative-hypnotics
• High doses → respiratory depression, fatal
• Highly addictive

Conditioning Theory of Tolerance 🔄

DEVELOPMENTAL PROCESS

• Drug tolerance (and extinction) are learned
• Environmental cues → conditioned signals altering drug response

Covert Sensitization 🖼

• Imaginal aversion therapy: pair tempting drug images with unpleasant imagery → reduce craving

Feedforward Mechanisms 🔮

• Anticipatory bodily responses to drug-paired cues
• Prepare/offset expected drug effects

Moral Model of Addiction ⚖

Disease Model of Addiction

• Addiction = personal failing/character deficit
• Contrasts with disease model (biological/medical condition)

** HARM REDUCTION = Alan Marlatt Compassionate Pragmatism (Meet ppl where they are)

No cure is possible; abstinence is best approach

Illness Anxiety Disorder 😷

Hyperchondriasis

• Preoccupation with illness despite little/no somatic symptoms
• Must last 6+ months (fear of contracting disease)

—

Fear of HAVING disease

Somatic Symptom Disorder 💭

• Distress + impairment from symptoms themselves
• Focus on distress, not medical explanation

Treat —> Psychoanalysis, CBT, Exposure therapy

Conversion Disorder ⚡

• Sensory/motor symptoms without medical cause
• Classic: la belle indifférence (odd lack of concern)
• Psychoanalytic theory: unexpressed trauma/emotion → converted to physical symptoms
• Freud: rooted in unresolved Electra complex (in women)

**Working memory affected in children

SYMPTOMS MORE COMMON ON LEFT BODY

Research Updates 🧠

• Now explained by automatic/unconscious processing (not hidden psychic structures)

Behavioural Theories 🎭

• Symptoms reinforced by:
- Attention, care, avoidance of responsibility
- Modelling (family/peers)
• Cognitive factors: catastrophic misinterpretations
• 💡 Treatment: CBT = gold standard

Psychodynamics 🔗

• Similar to PTSD (trauma-focused origins)

Other Specified Dissociative Disorder 🌀

• Mixed symptoms: coercive persuasion, acute stress-related dissociation, trance states

Anaesthesias 🖐

• Numbness/loss of sensation without medical cause (conversion subtype)

Dissociative Disorders 🌪

• Disruptions in memory, identity, or consciousness
• Includes: amnesia, fugue, DID, depersonalization/derealization

Dissociative Amnesia

• Reduced activities with autobiographical memories

• Associated w/ HYPOmetabolism in right inferolateral prefrontal cortex

Factitious Disorder 🏥

• Intentional production of symptoms for sick role
• Includes by proxy (parent makes child ill)
• ❌ Different from malingering (external gain like money, avoiding jail)

Hysteria (historical) 🏛

• Ancient Greek term → unexplained paralysis, anaesthesia, analgesia
• Old name for conversion disorder

Nicholas Spanos (Socio-Cognitive Theory of DID) 🎭

• Critic of DID as “real” disorder
• Suggested role-playing + therapist cues explain many cases
• Example: Hillside Strangler (Ken Bianchi) pretended alter under hypnosis
• Lab: 81% of students could role-play an alter
• Conclusion: DID may be socially constructed, not purely trauma-based

TRAMA MODEL OF DISSOCIATION

Repressed Memories Debate 🧩

• Williams (1995): 38% of CSA victims couldn’t recall → supports forgetting
• Goodman et al. (2003): only 19% couldn’t recall → forgetting less common
• Loftus: false memories can be created (therapist suggestion, hypnosis, imagination)
• DePrince & Freyd (2004): high dissociators show impaired recall → supports dissociation link
• McNally et al. (2005): no special forgetting ability in recovered memory groups

DSM-IV-TR Subtypes (removed in DSM-5)

• Disorganized (Hebephrenia) 🤪 incoherent speech, silly behaviour, flat/inappropriate affect
• Catatonic 🤐 motor extremes (immobility ↔ excitement, echolalia, echopraxia)
• Paranoid 👀 delusions (persecution, grandeur, jealousy); agitated but organized speech
• Residual 🔄 past episode, no current psychosis but lingering signs

DSM-5 change 📘

Subtypes dropped → replaced with dimensional ratings (severity of positive, negative, cognitive symptoms)

** MORE COMMON IN MEN ~20+ years (hospitalization)

Neurobiology 🧠

• Dopamine dysregulation (classic DA hypothesis)
• Serotonin & glutamate also involved
• Low glutamate → negative symptoms
• Hypofrontality = ↓ activity in prefrontal cortex (→ negative symptoms)
• MRI: grey matter reductions in prefrontal, temporal lobes, hippocampus before onset

• Thinner cortex

• Larger ventricles

• Reduction in activity in the prefrontal cortex

POSITIVE SYMPTOMS

• Release of mesolimbic from inhibitory control (serotonin)

NEGATIVE SYMPTOMS:

• Underactive prefrontal cortex

Negative Symptoms ⬇

• Alogia = poverty of speech/content
• Avolition = loss of motivation, drive

Other Key Symptoms 🌀

• Derailment = loose associations, drifting off topic
• Ideas of reference = random events/messages seen as directed at self

**Heightened responsivity to stressors = increased risk for psychosis

Treatment Approaches 💊

• Medications: antipsychotics (dopamine focus; 1st gen + atypicals)
• Psychosocial: social skills training, CBT
• Cognitive Enhancement Therapy (CET): computer-based training for memory/cognition

History 📜

• Dementia praecox = Kraepelin’s early term (early onset, progressive decline)
• Heinz Lehmann 🇨🇦 Montreal psychiatrist; brought chlorpromazine to North America (1953); pioneer of psychopharmacology; promoted humane care; later promoted imipramine (depression)

Genain Quadruplets 👩‍👩‍👩‍👩

Identical quadruplets (rare 1 in 1.5 billion) → all developed schizophrenia by 24. Different life outcomes despite identical genes. Shows gene × environment interaction (e.g., father treated them differently).

Ego-syntonic 😌

Many PDs are ego-syntonic → patients don’t see their behaviour as a problem.

• they’re enduring (long lasting + stable overtime)

DSM-5 Clusters 🧩

• Cluster A (Odd/Eccentric): Paranoid, Schizoid, Schizotypal → milder schizophrenia-like traits (Heritability 21-40%)
• Cluster B (Dramatic/Erratic): Borderline, Histrionic, Narcissistic, Antisocial
• Cluster C (Anxious/Fearful): Avoidant, Dependent, OCPD

Borderline PD (BPD) 💔

• Object-relations theory: inconsistent parental love → insecure ego development
• Linehan’s Diathesis-Stress Model: emotion dysregulation + invalidating environment
• Therapies: object-relations therapy, CBT-based, DBT = emotion regulation, assertiveness, coping, reduces black-and-white thinking

—> Amygdala; dorso-lateral prefrontal cortex; limbic system

TREAT W ANTIPSYCHOTICS

Antisocial PD (APD) vs Psychopathy 😈

• All psychopaths = APD, but only ~20% of APD = psychopaths
• APD criteria: must include conduct disorder <15 yrs
• Bio correlates: ↓ prefrontal activity, abnormal amygdala/hippocampus, low fear response

OCPD 📏

Psychoanalytic view: fixation at the anal stage

Dark Triad / Tetrad 🌑

• Dark triad: narcissism + psychopathy + Machiavellianism
• Dark tetrad: adds sadism

Personalized therapy 🎨

Millon & Grossman → tailor therapy to personality style/needs

Schema therapy 🧩

Young’s CBT-based therapy → targets deep maladaptive schemas underlying PD

Five-Factor Model & PDs ⭐

• PDs = often high neuroticism + low agreeableness
• Avoidant PD: unique = high neuroticism + introversion

Normal: Neuroticism, Openness, Agreeableness, Conscientiousness, Extraversion

Prevalence 📊

~18% (1 in 6) of students meet PD criteria (vs 22% non-students). Most common = OCPD & Paranoid PD

Robert Hare & Psychopathy 🕵

• Developed PCL-R (20 items)
• Factor 1: emotional detachment (egocentric, manipulative, no remorse)
• Factor 2: impulsive, irresponsible, antisocial lifestyle
• Psychopaths = higher recidivism, more violent crimes, often charm parole staff
• Psychopathic homicides = cold-blooded, planned, instrumental (vs impulsive “crimes of passion”)

Grandiosity 👑

• Entitlement rage (anger when not admired/treated special)
• Exploitativeness (using others)
• Grandiose fantasy (exaggerated visions of power/success)
• Self-entitlement (belief they inherently deserve special treatment)

Vulnerability 😔

• Contingent self-esteem (self-worth depends on others’ approval)
• Hiding the self (avoids showing flaws, conceals vulnerability)
• Devaluing (puts others down to protect fragile self-esteem)

Somatic-Weakness Theory

Some people have weak organs (e.g., weak lungs → asthma).

Specific-Reaction Theory 🧬

Stress response differs individually (idiosyncratic).

** GOOD MOOD = INCREASED slgA

Psychoanalytic Theory (Horowitz) 🧠

Certain unconscious conflicts/emotions → specific disorders.

Anger-in Theory 😡➡🤐

Repressed anger → linked to hypertension.

Chronic SNS activation ⚡

Leads to health problems (allostatic load = “wear & tear”).

Type A (Hostile/Aggressive) 🚨

Must be treated/managed; other Type A traits are fine.

Biofeedback 🎛

Training to gain control over physiological responses to stress.

PTSD Symptom Clusters 🎗

• Intrusion: re-experiencing trauma
• Avoidance: avoiding reminders
• Arousal/reactivity: irritability, hypervigilance, sleep disturbance.

PTSD Stats & Tx 🇨🇦💊

Lifetime ≈ 10%, 1-month ≈ 4% in Canada. More common in women. Tx: CBT, prolonged exposure, crisis intervention, VR, EMDR, SSRIs, MDMA (investigational).

Functional Social Support 🤝

Quality of relationships (e.g., happy vs. distressed marriage).

General Adaptation Syndrome (Selye) ⏳

3 stages: Alarm → Resistance → Exhaustion. (GAS)

Hans Selye – Father of Stress

Coined “stress”; introduced

• distress vs. eustress; showed stress impacts all diseases.

Interactionism 🔄

Behaviour = shaped by both personal traits & situations.

Perseverative Cognition 🔁

Repetitive, ruminative thoughts. NORMAN ENDLER

Perseverative Cognition Hypothesis 🕰

Rumination prolongs stress response → ↑ health risk.

Self-Efficacy (Bandura) 💪

Belief in one’s ability to achieve goals.

Norman Endler – Interaction Model ⚖

Personality × situation → coping/stress.
• CISS = task, emotion, avoidance coping.
• CHIP = coping with health problems.
• Emotional preoccupation ↑ distress in chronic illness.

PERSERVATIVE COGNITION INCREASES STRESS

Elevated instrumental coping = good outcomes

Paraphilias 🔄

Sexual attraction to unusual objects/activities. Must last ≥6 months, cause distress/impairment.

Frotteurism 🚉

Touching/groping unsuspecting people.

Psychodynamic Theory 🧠

Unconscious conflicts, fixation at pre-genital stages.

Behavioural/Cognitive 📚

Childhood abuse, poor social skills, distorted thinking.

Biological 🧬

Androgen levels, prenatal hormone disruption, frontal/temporal lobe changes.

Treatment (Paraphilias) 💊

Behavioural (orgasmic reorientation),

Cognitive (challenge distortions, empathy training, relapse prevention),

Biological (anti-androgens).

⭐ Most promising = CBT + relapse prevention.

CSA prevalence 🚨

~27% girls, 5% boys report child sexual abuse.

Sexual Desire Disorders 💭

• Hypoactive desire (low fantasies/urges)
• Sexual aversion disorder (rare, not DSM-5).

Sexual Arousal Disorders 🔥

• Female arousal disorder (20%)
• Male erectile disorder (3–9%)
• Hypersexuality (“sex addiction”) not in DSM-5.

Orgasmic Disorders 💦

• Female orgasmic disorder (16–46%)
• Male delayed ejaculation (3–8%)
• Premature ejaculation (up to 40% men).

Sexual Pain Disorders ⚡

• Dyspareunia = pain with sex
• Vaginismus = involuntary spasms preventing intercourse.

Maintaining factors 🔄

Performance anxiety, cognitive distortions, poor communication, stress, relationship conflict.

Historical antecedents ⏳

Early sexual trauma, strict/repressive family, negative conditioning.

Accommodation vs Assimilation 🧩

• Accommodation = modify schema for new info.
• Assimilation = fit new info into existing schema.

Sensate Focus (Masters & Johnson) ✋❤

Non-intercourse touching → reduces anxiety.

—> Interpretation of each partner’s sexual value system

Spectator Role 👀

Over-focus on performance → blocks arousal.

Sexual Aversion Disorder 🚫

Avoidance of nearly all genital contact (rare).

Transsexualism

Strong belief in being opposite sex; desire transition.

Transvestic Disorder 👗

Sexual arousal from cross-dressing (with distress/impairment).

Joan/John Case (David Reimer) 🇨🇦

Reassigned female after accident → reverted to male. Shows strong biological influence on gender identity. Later suicide.

Canadian Reassignment Case 🍁

Boy reassigned female after burn injury → identified female in adulthood (with masculine traits). Suggests biology + environment interact.

Child Sexual Abuse (CSA) Data 👶

62% victims <18; 30% <12. Mostly girls; boys = 31% of <12 victims. Usually known perpetrators (family/friends). Mandatory reporting in Canada.

Neurobiology of Sex & CSA 🧠

Reward system: hypothalamus + amygdala.
Men: ↑ thalamus/hypothalamus activation.
Women: nonspecific genital response.
Pedophiles: abnormal frontal/temporal activity, addiction-like brain patterns; strong response to nude children (distinct neural signature).

Intermittent & natural reinforcement 🎲

Don’t reward every time → reward occasionally + shift to natural reinforcers (e.g., praise). Makes behaviour last longer.

Brief psychodynamic therapy ⏳

Present-focused, shorter, targets current interpersonal problems. More empirical support vs. traditional psychoanalysis.

Carl Rogers – Client-Centered Therapy 🌱

Therapist = non-directive.
Core conditions: unconditional positive regard, empathy, genuineness → client leads, therapist facilitates self-actualization.

Environmental modification 🌍

Change surroundings (parents, peers, community) to support new behaviour.

Eliminating secondary gain 🎭

Remove hidden benefits of symptoms (e.g., panic attacks → avoid work).

Attribution to self 💪

Encourage “I did it” attitude → client credits themselves, not therapist → prevents relapse.

Psychotherapy Integration 🔄

• Technical eclecticism: borrow techniques across models.
• Common factors: alliance, empathy, hope.
• Theoretical integration: blend theories into new model.
• Assimilative integration: stay in one model but add elements of others.

Core competencies ⭐

Essential therapist skills: empathy, communication, cultural competence.

• Clients find WARMTH most important

When it comes to CBT though

• CBT competence of therapist contributes to effectiveness of treatment

Client:

Variability in personality contributes to 35-40% variability in client outcomes

Demoralization hypothesis (Jerome Frank) 😞

People seek therapy due to hopelessness, alienation, ↓ self-esteem.

COMPASSION FOCUSED THERAPY USE!!!

Empirically informed therapies 🧩

Flexible, guided by research but tailored by therapist’s judgment + experience.

Empirically supported therapies (ESTs) 📊

Proven effective in controlled research (e.g., CBT for anxiety). ANXIETY SUPPORTED

Evidence-based practice 📚

Best research + clinician expertise + client values.

Research vs. Practice in PTSD 💥

Gap: exposure therapy underused → therapists fear harm/lack training.

Experts agree (therapy research) ✅

1) Therapy helps most
2) Change happens early
3) Dodo bird effect (all ≈ effective)
4) Common factors > specific techniques
5) Alliance = best predictor
6) Therapists learn more from experience than research
7) ~10% worsen → informed consent needed.

Emotion-Focused Couples Therapy (EFT)

💞

Integrative Behavioural Couples Therapy

Focus: maladaptive emotions + attachment injuries.
3 phases: (1) De-escalate conflict & access emotions, (2) Change positions & accept new needs, (3) Consolidation with new solutions/cycles.

Criminal Commitment 🚔

Federal law → confinement in psych hospital.
Occurs when: (1) determining competency to stand trial, or (2) after NCRMD verdict.

Civil Commitment 🏥

Provincial law → involuntary admission if mentally ill AND dangerous (to self, can’t meet basic needs, or to others).
• Formal: via justice of the peace (~72h).
• Emergency: hospital board detains.

Violence Prediction 🔮

Clinicians = poor predictors.
• VRAG = actuarial tool.
• HCR-20 = Canadian structured clinical judgment tool (historical, clinical, risk).

• BEST predictors of violence = PCL-R + elementary school maladjustment score

NCRMD reoffence within 3 years is 1 in 6 (~16.7%)

Violence Recidivism Negative Correlation

• Age at the time of the index offence

• Meets DSM-5 criteria for schizophrenia

• Most serious victim injury

• Female victim

M’Naghten Rules (1843) ⚖

“Didn’t know what they were doing OR that it was wrong.”
🧠 Mnemonic: McNotsure. Start of modern insanity defence.

—> Wanted to kill British prime minister (England)

Louis Riel Case (1885) 🇨🇦

Executed for treason → refused insanity plea. Believed he was a prophet (“Riel Phenomenon”). Debate if NCRMD or not fit for trial. (Megalomania)

Chaulk (1990) 📜

Wrong = both morally + legally wrong.
📝 Mnemonic: “Chaulk it up to morals.”

Swain (1991) 🔄

Switched “Not guilty by reason of insanity” → NCRMD. Created review boards (Bill C-30).

Oommen (1994) 👀

Must apply knowledge of right/wrong, not just know it.
Mnemonic: “Oops, can’t apply my knowledge

Winko (1999) 🔓

If no significant risk → absolute discharge.
Mnemonic: “Window open = freedom.”

Conception (2014) 💊

Must treat immediately → can’t delay/refuse.

Duty to Warn / Confidentiality 🛑

• Tarasoff (1974, US) ☎: Must warn/protect identifiable victims. (TIPOFF)
• Wenden v. Trikha (1993, CAN) 🚗: Duty in Canada → warn identifiable victims.
• Smith v. Jones (1999, CAN) 🔐: Public safety > privilege (even lawyer-client). SMITH SPILLED THE SECRET
• Ahmed v. Stefaniu (2006, CAN) ⚠: Psychiatrist liable for releasing too early → patient killed sister. (Set Free, Sister Stabbed)

Starson Case (2003, CAN) 🌌

Physicist with schizoaffective disorder → refused meds, said it would “slow his brain.”
Supreme Court: right to refuse treatment if legally capable.
Mnemonic: “Starson reached for the stars and kept his say.”