clinical psych
clinical psych: investigates the factors that cause psychological disorders and the methods to treat hem
psychological disorders
psychopathology: disorder of the mind, when life disrupted and distress caused over a long period
psychopathology characterization based on these four criteria:
does it deviate from cultural norms
is it maladaptive
is it self-destructive
does it cause discomfort and concern to others
causes of psychological disorder:
diathesis-stress model: disorder may develop as a result of an underlying vulnerability coupled with a precipitating event
biopsychosocial approach: disorders are influenced by…
biological aspect: physiological factors (brain, genetics, neurotransmitters, etc.)
psychological aspect: role of thoughts, emotions, personality, and learned experiences
sociocultural factors: family relationships, socioeconomic status, and the cultural context
when investigating disorders, psychologists aim to:
assess the symptoms
make a diagnosis by grouping symptoms into categories in order to understand the prognosis (course of the conditions and its probable outcome) using the diagnostic and statical manueal of mental disorders (DSM)
identify the etiology
identify possible treatments
DSM-5:
systematic categorization of mental disorders since 1952
provides diagnostic criteria for mental disorders
describes 19 major categories of disorder
groups disorders so that similar ones located near each other
even if treated as separate disorders, mental disorders may occur together (comorbidity)
includes a guide for future research describing conditions not yet recognized as disorders
dimensional approach: mental disorders ona continuum (degrees vs. types)
anxiety disorders
excessive anxiety in the absence of true danger
continuous arousal of the autonomic nervous system which leads to bodily symptoms
etiology: best explained using a biopsychosocial approach (many fears are learned)
types of anxiety disorders:
phobias
generalized anxiety disorder
panic disorder
anxiety disorder - phobias: fear of a specific object or situation that is out of proportion with an actual threat
social anxiety disorder (social phobia): fear of being negatively evaluated by others
specific phobia examples:
agoraphobia: fear of being in situations from which escape is difficult
geliophobia: fear of laughter
panophobia: fear of everything
pentheraphobia: fear of mothers-in-law
fomonia: fear of missing out
obsessive-compulsive disorders (OCD)
frequent intrusive thoughts that create anxiety and compulsive actions that temporarily reduce the anxiety
obsessions: recurrent, intrusive, and unwanted thoughts, urges, or mental images
compulsions: specific acts that one feels driven to perform over and over again
etiology: biopsychosocial approach, evidence for biological factors (genetics and from brain imaging)
morbidity: begins in early adulthood, affects 1-2% of population, more common among women
depressive disorders
mood disorder with persistent and pervasive feelings of sadness
etiology: biopsychosocial factors
genetic component, neural structures possibly involved
social relationships
self-perception, reverse self-serving bias
learned helplessness (perception of self as unable to affect life veents)
morbidity: across multiple countries and contexts, twice as many women as men diagnosed, internalization (women) vs. externalization (men) of feelings
types of depressive disorders:
major depressive disorder:
mood disorder with extremely depressed moods or lack of interest in normally pleasurable activities for 2 weeks or more
6-7% of Americans in any given year
16% will experience major depression at some point in their life
persistent depressive disorder:
mood disorder, with mildly or moderately depressed moods, that persists for at least 2 years
approx 2-3% of the population
bipolar and related disorders
bipolar I disorder: mood disorder with extremely elevated moods during manic episodes
bipolar II disorders: mood disorder with alternating periods of extremely depressed and mildly elevated moods
etiology: strong and complex genetic component
morbidity: emerger during late adolescence or early adulthood, 3-4% of pop will experience bipolar disorder in their lifetimes, equally prevalent in women and men
schizophrenia spectrum and other psychotic disorders
psychotic disorder with split b/w thought and emotion with difficulty distinguishing whether altered thoughts, perceptions, and conscious experiences are real or imagined
motor, cognitive, behavioral, and perceptual abnormalities
impaired social, personal, or vocational functioning
continuous signs of disturbances for at least 6 months
etiology: biological (genetics, brain disorder, potential abnormality in neurotransmitters) and environmental (stress)
morbidity: more often diagnosed when people are in ther 20s/30s, less than 1% of pop, similar for men and women
major symptoms:
diagnosis requires 2 or more, with at least one from 1-3…
delusions: false beliefs based on incorrect inferences
hallucinations: false sensory perceptions experienced without an external sources
disorganized speech: speaking in an incoherent way with frequent topic changes and inappropriate considerations
disorganized behavior: acting in strange or unusual ways
negative symptoms: marked by deficits in functioning (ex: apathy, lack of emotion, slowed speech)
neurodevelopmental disorders: autism spectrum disorder
deficits in social interaction, impaired communication, and restricted, repetitive interests and behavior
high functioning autisms sometimes called asperger’s syndrome
etiology: biological, prenatal and/or early childhood events that may result in brain dysfunction, brains with faulty wiring in a large numder of areas
morbidity: 3-6 children out of 1000 show signs of ASD, and males outnumber females 3 to 1, from 1991-1997 dramatic increase (556%) in children diagnosis
psychological treatments
there are three main approaches:
psychotherapy: treatment in which a therapist works with patients to help them understand their problems and work towards solutions, generally used to change patterns of thought or behavior
psychotropic medications
alternative treatments
effectiveness of treatment is assessed with empirical research using randomized clinical trials
evidence-based psychological treatments are characterized by the following
treatments vary according to the psychological disorder and the patient’s specific symptoms
techniques used have been developed in the laboratory by psychologists
no overall grand theory guides treatment, adoption of specific treatment based on the evidence of its effectiveness
psychotherapy
psychodynamic theory: treatment in which a therapist works with patients to help them become aware of how their unconscious processes may be causing conflict and impairing daily functioning
only weak evidence for its effectiveness
sigmund freud and josef breuer as pioneers of the psychoanalysis method (free association, dream analysis, etc.)
humanistic therapy: treatment in which a therapist works with patients to help them develop their full potential for personal growth through greater self-understanding
client-centered therapy with:
a safe and comforting setting for patients
active listening
unconditional positive regard
behavioral and cognitive therapies:
behavior therapy: treatment in which a therapist works with patients to help them unlearn behaviors that negatively affect their functioning
cognitive therapy: treatment in which a therapist works with patients to help them change distorted thought patterns that produce maladaptive behaviors and emotions
cognitive-behavioral therapy (CBT): treatment in which a therapist incorporates techniques from cognitive therapy and behavior therapy to correct faulty thinking and maladaptive behaviors (one of the most effective therapies for many types of psychological disorders)
group therapy: significant variety in the types of patients enrolled in the group, duration of treatment, theoretical perspective of the therapist running the group, and group size (many groups organied around a certain type of problem, cost benefit)
family therapy: systems approach according to which an individual is part of a larger context, any change in individual behavior will affect the whole system
biological therapy
psychotropic medications: drugs that affect mental processes, most psychotropic medications fall into five categories…
anti-anxiety drugs: temporary sedative, calming effects (Valium, Ativan, etc.)
antidepressants: increase positive mood, decreases emotionality (Prozac)
mood stabilizers: evening out moods (Lithium)
antipsychotics: reduce positive/negative symptoms (Thorazine, Closaril)
stimulants: decrease hyperactivity, increase attention (Ritalin, adderall)
alternative treatments:
electroconvulsive therapy (ECT): treatment that involves administering a strong electrical current to the patient’s brain to produce a seizure, effective in some cases of severe depression
transcranial magnetic stimulation (TMS): treatment that uses a magnetic field to interrupt function in specific regions of the brain
deep brain stimulation (DBS): treatment that involves passing electricity through electrodes planted in the patient’s brain to stimulate the brain at a certain frequent and intensity, especially valuable for treating severe obsessive-compulsive disorder and depression
treatments for anxiety and ODC
cog-behavioral therapy: most adult anxiety disorders and ODC is best treated with cognitive-behavioral therapy (CBT)
CBT effects persist long after treatment
CBT more effective for OCD than tricyclic antidepressant
anti-anxiety drugs: beneficial in some cases of anxiety disorders due to their sedative effects
deep brain stimulation: may also be an effective treatment for people with OCD
exposure: therapy technique that involves repeatedly exposing patients to an anxiety-producing stimulus or situation, with the goal of reducing fear
recent alternative: exposure without putting patients in danger by using computers to stimulate the environments and the feared objeccts
systematic desensitization: therapy technique that involves exposing clients to increasingly anxiety-producing stimuli or situations while coaching them to relax
aversive conditioning: behavioral conditioning in which unpleasant stimuli are associated with undesirable behavior that is to be modified or abolished
treatments for depressive disorders
no “best” way to treat depression
psychotropic drug treatment:
since SSRIs have the fewest serious side effects, tend to be used as first-line medication
use of antidepressants based on belief that depression cause by neurotransmitters imbalance or problems with neural receptors
60-70% of patients who take antidepressants experience relief from their symptoms
cognitive behavioral treatment: as effective as antidepressants at treating depression
combination of CBT and antidepressant medication is more effective than either approach alone
alternative treatments: phototherapy, ECTs, TMS, DBS, etc.
treatments for bipolar disorders
psychotropic medications:
use of psychotropic medications as a clear optimal treatment, especially the mood stabilizer lithium
the process by which lithium stabilizes mood not well understood
lithium has unpleasant side effects (thirst, hand tremors, excessive urination, memory problems, etc.)
combining lithium with the antipsychotic quetiapine (i.e. Seroquel) improves treatment outcomes
treatments for schizophrenia
antipsychotic medications
psychotropic drug treatments:
conventional antipsychotics → reduced the positive symptoms (ex: delusions, hallucinations, disorganized speech/behavior)
little to no effect on negative symptoms
irreversible tardive dyskinesia (involuntary movement of body parts) as side effect
atypical antipsychotics → beneficial in treating both the positive/negative symptoms
serious side effects (ex: seizures, heart rate problems, substantial weight gain, fatal reduction in white blood cells)
behavior therapy
behavior therapy can include social skills training to elicit desired behavior (ex: appropriate ways to act in specific social situations)
treatments for neurodevelopmental disorders
autism spectrum disorder → structured behavior therapy
applied behavioral analysis: an intensive behavior therapy based on operant conditoning
method used successfully
intensive approach of 40h/week of treatment (min)
drawbacks: time commitment, financial and emotional drains
biological treatments: despite evidence that caused by brain dysfunction, neurobiology of autism spectrum disorder not well understood
personality disorders
identities leading to interaction with the world in maladaptive and inflexible ways
when long-lasting and causing occupational or social problems
etiology: various physiological abnormalities
morbidity: 1-4% of population
three types of personality disorders:
Cluster A:
odd or eccentric behavior
paranoid, schizoid, and schizotypal
Cluster B:
dramatic, emotional, or erratic behaviors
antisocial, borderline, histrionic, and narcissitic
Cluster C:
anxious or fearful behavior
avoidant, dependent, and obsessive-compulsive
borderline personality disorder (BPD)
disturbance in identity, in moods, and in impulse control
morbidity: 1-2% of adults
etiology: possible environmental component (link b/w disorder and trauma/abuse)
antisocial personality disorder
disregard for and violation of the rights of others and by lack of remorse
psychopaths: often seen as charming and intelligent
treatments for personality disorders
while very difficult to treat, some therapies helpful for →
bordeline personality disorder treatments:
traditional psychotherapy approaches largely unsuccessful
dialectical behavior therapy (DBT): combination of elements of behavior, cognitive, and psychodynamic therapies with a mindfulness approach based on Eastern meditative practices
antisocial personality disorder (APD):
most psychotherapies seem ineffective in treating APD
behavior therapy approaches using operant procedures have had some success
dissociative disorders
D. amnesia and D. identity disorders
involve disruptions of identity, memory, conscious awareness
dissociative amnesia:
disruption of memory for personal facts or loss of conscious awareness for a period of time
most extreme and rarest form: dissociative fugue (i.e. traveling to another location and assuming a new identity)
dissociative identity disorder:
occurrence or 2 or more distinct identities in the same individual
formerly called multiple personality disorder
generally, women who report being severely abused as children
neurodevelopmental disorders: attention-deficit/hyperactivity disorder
excessive activity or fidgeting, inattentiveness, and impulsivity
morbidity: 12.1% of boys and 5.5% girls, 4% of adult population, symptoms before age 12 - first diagnosed b/w ages 5 and 7
etiology: unknown
poor parenting? social disadvantage?
connection b/w frontal lobes and limbic system impaired?
treatments:
some diagnosed with ADHD as children do grow out of it
psychotropic medication treatment:
a central nervous system stimulant (ritalin/methylphenidate or adderall)
drug actions not fully understood
side effects: sleep problems, reduced appetite, body twitches, and temporary slowing of growth
ideally supplemented by psychological behavior therapies