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Abnormal Psych Midterm 1
Clinical psychologists - typically have a Ph.D. or Psy.D. degree, which entails four to seven years of graduate studies Psychiatrists - hold an MD degree and have had postgraduate training, in which they receive supervision in the prac&ce of diagnosing and pharmacotherapy Psychoanalysts - have specialized training at psychoanalytic institute Psychiatric nurses - hold BA or MA, and receive specialized training as nurse practitioner to prescribe medications Social workers - have MSW and training in psychotherapy Psychopathology: - is a field concerned with the nature and development of abnormal A - Affect (feelings or emotions) B - Behaviours C - Cognitions (thinking) Abnormality - is usually determined by the presence of several characteristics at one time such as Statistical infrequency Violation of Norms Personal suffering Disability or dysfunction Unexpectedness Statistical Infrequency - A behaviour that occurs rarely or infrequently Violation of Norms - A behaviour that defies or goes against social norms; it either threatens or makes anxious those observing it Personal Suffering - A behaviour that creates personal suffering, distress, or torment in the person This criterion fits many of the forms of abnormality (e.g., depression and anxiety) But... some disorders do not necessarily involve distress (e.g., psychopaths)
Disability or Dysfunction - A behaviour that causes impairment in some important area of life (e.g., work, personal relationships, or recreational activities) Unexpectedness - A surprising or out-of-proportion response to environmental stressors can be considered abnormal. **brushing off sexual assault experience Definition Of Abnormal Behaviour - No one definition, by itself, yields a fully satisfactory definition of abnormal behaviour, but together they offer a useful framework for beginning to define abnormality. Three major models Historical Perspectives of Psychopathology -
- The supernatural
- The biological
- The psychological Supernatural Explanations - Mental disorders were believed to be caused by: Events beyond the control of humankind Eclipses, earthquakes, storms, fire, diseases were regarded as supernatural Behaviour that seemed outside individual control was subject to similar interpretation **possession by demon nor wrath of gods - possession Demonology: - the idea that an evil being (e.g., the devil), may dwell within a person and control his or her mind and body Given that abnormal behaviour was caused by possession, treatment often involved exorcism Trepanning: - the making of a surgical opening in a living skull by some instrument Used to treat epilepsy, headaches, and psychological disorders attributed to demons Witchcraft - People turned to demonology to explain disasters
- Led to an obsession with the devil and "witches" were blamed and zealously persecuted Delusion-like "confessions" were obtained during torture Most accused were not mentally disturbed The Moon and the Stars - Hospitals took over churches' responsibility to tend to the ill (13th century) Laws allowed dangerously insane and
! William Tuke (1732-1822) = carried forth these ideas- should be happier places than asylums , wanted private run places ! Benjamin Rush (1745-1813) father of American psychiatry -brought these ideas to america Asylum reform and the decline of moral therapy - didnt last long - treatments wasnt more humane they were using more drug, discharge rates were fewer (outcome wasn't as favourable) Dorothea dix- wanted to improve the lives of people with mental illness (mental hygiene movement) - these institutions got voer burned with patients and they were understaffed hospitals moral therapy- more close contnact with caregiver - more freedom - small ratio of caregivers to patients Emergence of New Psychological Explanations -
- Psychogenesis (malfunctioning of the mind ) "in fashion" in 18th and 19th centuries -Franz Anton Mesmer (1734-1815) early practitioner of hypnosis (mesmerized comes from mesmer, magnetic fluids caused mental disorders )
- Jean Mar&n Charcot (1825-93) legitimized hypnosis -Josef Breuer (1842-1925) cathartic method (could release tension through a process of hypnosis )
- Sigmund Freud (1856-1939) psychoanalytic model Advancements in Biological Explanations - ! Mid-1800s progress understanding senile and pre-senile psychoses and mental retardation from biological perspective ! Increasing use of empirical approaches to understand mental illness ! Discovery about the nature and origin of syphilis General paresis - characterized by steady physical and mental deterioration, delusions of grandeur and progressive paralysis from which there was no recovery Germ Theory of Disease - (Louis Pasteur, 1860s/70s): view that disease is caused by infection of the body by minute organisms ! Laid the groundwork for demonstrating the relation between syphilis and general paresis ! Also helped establish a causal link between infection, destruction of brain areas, and a form of psychopathology Emil Kraepelin (1856-1926) - created a classification system to establish the biological nature of mental illnesses Syndrome - clustering of symptoms presumed to have an underlying physical cause
Proposed two major groups of severe mental diseases: -Dementia praecox (early term for schizophrenia) -Manic-depressive psychosis (now called bipolar disorder) Shock Therapy (1930s) - Ladislas von Meduna - Metrazol induced convulsions Ugo Cerletti - electroconvulsive therapy (ECT) Beginnings of Psychopharmacology (1950s) View that mental illness results from disordered brain chemistry Deinstitutionalization Mental Illness In Canada - 1 out of every 10 Canadians aged 15 and over (about 2.7 million people) reported symptoms consistent with a mood or anxiety disorder, or alcohol or illicit drug dependence during the previous 12 months. ! 1 in 20 met criteria for either major depression or bipolar disorder. ! 1 in 20 met criteria for panic disorder, agoraphobia, or social phobia. ! 1 in 30 met criteria for substance dependence (alcohol or illicit drug use). ! 1 in 50 met criteria for moderate risk of problem gambling. Issues and Challenges - ! Cost of mental illness -- Largely unknown --Both economic and personal costs ! Wait times --3 months to 1 year or more --Longer for specialists! Help-seeking ! Professional services underused --Access to services --Deinstitutionalization Current Atitudes toward People with Psychological Disorders - Stereotyping and stigmatization --Results in self-stigma and reduced help seeking Public misperceptions and myths --E.g., dangerous and incurable Anti-stigma campaigns Mental health literacy Which characteristic of abnormal behaviour do cultural differences affect most? - Violation of norms Psychiatrists differ from clinical psychologists in that psychiatrists - prescribe medication
! There are other potential confounds (e.g., child rearing practices, imitation of parents) !The ability to offer a genetic interpretation of data from twin studies hinges greatly on what is called the equal environment assumption Biological Paradigm: Molecular Genetics - Molecular genetics tries to specify particular gene(s) involved and precise functions of target genes Methods: Genetic polymorphism Linkage analysis - --Refers to variability among members of the species, including differences in DNA sequences, and mutations in a chromosome --Typically study families in which a disorder is heavily concentrated; gene0c markers Gene-environment interactions - the no0on that a disorder or related symptoms are the joint product of a gene0c vulnerability and specific environmental experiences or conditions Mitigates concerns related to: --notion that illness and mental illness are predetermined --the extent to which people try to modify lifestyle and environmental factors related to mental health problems Genetic Differences Reflected In Temperament - Three types or categories of temperament: (1) The resilient type ! cope well with adversity. ! is quite adaptive and high functioning (i.e.,high IQ and high self-esteem and school performance). (2) The over controlling type ! are overly inhibited and prone to distress ! are linked with shyness, loneliness and moderate self- esteem and school performance (3) The under-controlling type ! are impulsive and seem out of control at times ! is prone to acting out and aggressive behaviours ! is associated with delinquency and externalizing problems school conduct difficulties and lower levels of IQ and school performance Neuroscience - is the study of the brain and the nervous system The nervous system is composed of billions of neurons.
Each neuron has four major parts: (1) the cell body (2) several dendrites (3) one or more axons of varying lengths (4) terminal bu^ons Nerve impulse - a change in the electric potential of the cell that travels down the axon to the terminal endings. Synapse: - the small gap between two neurons Neurotransmitters - chemical substances that allow a nerve impulse to cross the synapse Reuptake - process whereby some of the neurotransmitter is pumped back into the presynaptic cell Neurotransmitters and psychopathology: - Assumption that a given disorder is caused by The amount of neurotransmitters --Either too much or too little of a particular transmitters --Alterations in the usual processes by which transmitters are deactivated after being released into the synapse Receptors Too numerous or too easily excited Biological Approaches to Treatment - Assumes that prevention or treatment of mental disorders should be possible by altering bodily functioning Psychoactive drugs ! Electroconvulsive Therapy (ECT) ! Deep brain simulation: planing battery- operated electrodes in the brain that deliver low- level electrical impulses Evaluating the Biological Paradigm - Reductionism is the view that whatever is being studied can and should be reduced to its most basic elements or constituents. An influential viewpoint that has been severely criticized -the whole is greater than the sum of its parts One's observable characteristics are called: - Phenotype
Albert Ellis - Rational-Emotive Behaviour Therapy - Sustained emotional reactions are caused by internal sentences (irrational beliefs) that people repeat to themselves. Aim is to rationally examine irrational beliefs and substitute with positive self-talk Cognitive behaviour therapy (CBT) - represents a blend of cognitive and learning principles Focused on cognitions to understand and modify behaviour Cognitive restructuring - is a general term for changing a patern of thought that is presumed to be causing a disturbed emo0on or behaviour Evaluation of the Cognitive-Behavioural Paradigm Criticisms: - ! The fact that a treatment based on learning principles is effective in changing behaviour does not mean that the behaviour was itself learned in a similar way. ! How does observing someone lead to a new behaviour? Cognitive processes must be engaged. ! Schemas are not well defined ! Unclear differences between behaviour and cognitive influences: importance of behaving in new ways for change to occur. Evaluation of the Cognitive-Behavioural Paradigm Contributions - ! Integration of two perspectives, i.e., CBT, has shown benefits in psychotherapy ! Strong evidence of its benefits in improving depression, anxiety disorders, eating disorders, autism, and schizophrenia Sigmund Freud (1856-1939) - Psychopathology results from unconscious conflicts in the individual. Structure of the Mind
- Id
- Ego
- Superego Psychosexual Stages
- Oral
- Anal
- Phallic
- Genital Objective anxiety - When one's life is in jeopardy, one feels objective (realistic) anxiety —the ego's reaction, according to Freud, to danger in the external world. Neurotic anxiety - a feeling of fear that is not connected to reality or to any real threat.
Moral anxiety - arises when the impulses of the superego punish an individual for not meeting expectations and thereby satisfying the principle that drives the superego—namely, the perfection principle. Defence mechanisms - Unconscious strategies used to protect the ego from anxiety Repression - (which pushes unacceptable impulses and thoughts into the unconscious) Denial - (disavowing a trauma0c experience and pushing it into the unconscious) Projection - (attributes to external agents characteristics or desires that an individual possesses but cannot accept in his or her conscious awareness) Displacement - (redirecting emotional responses from a perhaps dangerous object to a substitute) Reaction forma0on - (converting one feeling into its opposite) Regression - (retreating to the behavioural paterns of an earlier age) Rationalization - (inventing a reason for an unreasonable ac0on or attitude) Sublimation - (converting sexual or aggressive impulses into socially valued behaviours) Psychoanalytic Therapy: - An insight therapy that attempts to remove the earlier repression and help the client face the childhood conflict, gain insight into it, and resolve it in the light of adult reality. Psychoanalytic Approaches to Treatment - Some key components of psychoanalytic therapy: ! Transference ! Countertransference ! Interpreta0on Modifications in Psychoanalytic Therapy: - Brief Psychodynamic Therapy ! Therapy is limited, few sessions! Focus on only worst symptoms! Concrete goals Harry Stack Sullivan - Interpersonal Therapy (IPT) - ! This approach emphasizes the interactions between a
! Healthy people are aware of their behaviour, are innately good and effective, and are purposive and goal-directed. ! Therapists should not a^empt to manipulate events for the individual. ! Focus should be on actualization and maximizing potenial (positive psychology) Carl Roger's Client-Centered Therapy - Although client-centered therapy is not technique oriented, empathy is a central feature to this approach: ! Primary empathy refers to the therapist's understanding, accepting, and communicating to the client what the client is thinking or feeling. ! Advanced empathy entails an inference by the therapist of the thoughts and feelings that lie behind what the client is saying and of which the client may only be dimly, if at all, aware. Evaluation of the Humanistic Paradigm - Criticisms ! Therapists inferences of the client's phenomenology (world) may not be valid. ! Assumption not demonstrated: People are innately good and would behave in satisfactory and fulfilling ways if faulty experiences did not interfere. ! Self-awareness does not necessarily lead to change. Contributions ! Rogers insisted that therapy outcomes be empirically evaluated. Consequences of Adopting a Paradigm - Guides the data that will be collected and how they will be interpreted ! Leads to ignoring possibilities and overlook other information ! Impacts type of treatment recommended ! Most therapists use a Prescriptive Eclectic Theory, a combination of ideas and therapeutic techniques. Psychosocial Influences On Mental Health - External factors, especially psychosocial influences, contribute to mental health versus mental illness. Psychosocial influences include: ! Familial Factors ! Peers and the Broader Social Context Familial Factors: Parenting Style - Three parenting styles:
! Authoritarian parenting ! Permissive paren0ng ! Authoritative paren0ng Familial Factors: Parental Marital Discord - ! Conflict ! Violence and abuse ! Stress Familial Factor: Parental Mental Illness - ! One of the most pernicious risk factors is exposure to mental illness in one or both parents. ! In Canada, 1 in 8 children live in households where there is one or more of parental mood, anxiety, or substance use disorders. Peers And The Broader Social Environment - ! Research on peer influences tends to emphasize two elements: peer status and peer victimization. ! It is difficult to disentangle whether mental health difficulties and behavioural tendencies were precursors or consequences. The Cultural Context - ! Cultural diversity is important to highly heterogeneous countries like Canada ! Most of our discussion of psychopathology is presented within the context and constraints of Western European society ! Studies of the influences of culture on psychopathology have proliferated in recent years... but not in Canada ! Research runs the risk of stereotyping because results are made based on generalizations about groups of people from different cultures ! People from minority groups can differ as much from each other as their cultural or racial group differs from another cultural or racial group Two main integrative paradigms: - ! Diathesis-Stress Paradigm ! Biopsychosocial Paradigm Both paradigms emphasize the interplay among the biological, psychological, and social/environmental perspectives Diathesis-Stress Paradigm: - Not limited to one particular school of thought, but focuses on interaction between predisposition toward disease (diathesis) and environmental, or life, disturbances (stress)
Reliability - refers to consistency of measurement, measured by correlation Inter-rater reliability - refers to the degree to which two independent observers or judges agree. Test-retest reliability - measures the extent to which people being observed twice or taking the same test twice score in generally the same way. Alternate-form reliability - uses two forms of a test. Internal Consistency Reliability - assesses if the items on a test are related to one another. Validity - refers to how well a measure fulfills its intended purpose. Content validity - refers to whether a measure adequately samples the domain of interest. Criterion validity - is evaluated by determining whether a measure is associated in an expected way with some other measure (the criterion).
- concurrent validity (same point in time) -predictive validity (a point in the future) Construct validity - is a test or measure of some characteristic or construct that is not simply defined Kinds of Psychological Assessments -
- ClinicalInterviews
- PsychologicalTests --Personality tests --Intelligence tests
- Behavioural and Cognitive Assessment Techniques Clinical Interview - The paradigm within which an interviewer operates influences the type of information sought, how it is obtained, and how it is interpreted. The interviewer pays attention to how the respondent answers—or does not answer— questions. Unstructured interviews - rely on the intuition and general experience of the interviewer -- Reliability for initial clinical interviews is probably low
Structured interviews - have questions that are set out in a prescribed fashion for the interviewer E.g. Structured Clinical Interview for DSM-5 Disorders (SCID) Psychological tests - are standardized procedures designed to measure a person's performance on a particular task or to assess his or her personality, or thoughts, feelings, and behaviour. Standardization - Responses of person being assessed are compared to test norms that have been established. Test norms - The test is administered too many people and the responses are analyzed to establish how a group of people tend to respond. Types of Psychological Tests -
- Personality Inventories
- Projective Personality Tests
- Intelligence Tests Personality inventories - The person is asked to complete a self-report questionnaire indicating whether statements assessing habitual tendencies apply to him or her. Projective Personality Tests: - a psychological assessment device in which a set of standard stimuli, ambiguous enough to allow variation in responses, is presented to the individual. Based on the projective hypothesis Examples Rorschach Ink Blot Test Thematic Apperception Test (TAT) Intelligence Tests - Alfred Binet, a French psychologist, originally constructed mental tests to help the Parisian school board predict which children were in need of special schooling. An intelligence test, often referred as an IQ (intelligence quo0ent) test, is a standardized means of assessing a person's current mental abilities. Examples of Intelligence tests - E.g., Wechsler Adult Intelligence Scale (WAIS), the Wechsler Intelligence Scale for Children (WISC), and the Stanford-Binet cognitive-behavioural case formulation - is "a provisional map of a person's presenting problems that describes the territory of the problems and explains the processes that caused and maintain the problem" (Bieling & Kuyken, 2003, p. 53).
Neuropsychological assessment - examines the func0ons of the nervous system and focuses on ameliorating problems caused by disease or injury to the brain. Neurologists - physicians who specialize in medical diseases that affect the nervous system. Both kinds of specialists contribute much to each other as they work in different ways, often collaboratively Neuropsychologists - psychologists who study how dysfunctions of the brain affect the way we think, feel, and behave. Both kinds of specialists contribute much to each other as they work in different ways, often collaboratively Neuropsychological tests - assess behavioural disturbances caused by brain dysfunctions. often used in conjunction with brain imaging. based on the idea that different psychological func0ons (e.g., motor speed, memory, language) are localized in different areas of the brain. Psychophysiology - is concerned with the bodily changes that accompany psychological events or that are associated with a person's psychological characteristics. Psychophysiological test instruments - ! Electrocardiogram ! Electrodermal responding ! EEG. The MRI (magne0c resonance imaging) test is superior to a CT scan (i.e., computerized axial tomography) because: - It does not rely on the use of radiation History of Classification and the DSM Classification System - Early efforts in late 1800s to early 1900s - but uptake and consistency of use were lacking ! First Diagnostic and Statistical Manual (DSM) published in 1952 by the American Psychiatric Association ! DSM-III (1980) introduced extensively revised version that included multi-axial classifications (each person is rated on five separate dimensions) ! DSM-IV (1994) ! DSM-5 (2013) introduces changes including elimination of multi-axial system The Value of Classification and Diagnosis -
--Helps to more clearly define problems --Provides basis for communication --Necessary for research and advancing scientific understandings --First step to deciding on treatment Criticisms of Classification and Diagnosis - --Classification results in loss of information about the individuals --Stigmatization --Dimensional Classification vs. Categorical Classification Epidemiology - study of frequency of disorders in populations *field that studies it Prevalence - proportion of people who have a diagnosis at any given time *rates it happens Lifetime prevalence - proportion who have ever had a diagnosis in their lifetime Comorbidity - the co-occurrence of different disorders. Inter-Rater Reliability - is the most important for diagnosis Components of reliability: Sensitivity - Extent to which there is agreement that the diagnosis is detected as being present Components of reliability: Specificity - Extent to which there is agreement that the diagnosis is absent Components of reliability: Kappa - Statistic used to measure extent of agreement over and above chance levels Construct validity - is most important for diagnosis -- How well does the diagnosis relate to other aspects of the disorder? Science - The pursuit of systematized knowledge through observation Theory -
