Chapter 14 Psychological Disorders

What are the three criteria that we use to determine whether something is a disorder?

1.What do we mean by the Diathesis-Stress model of mental health? What is the difference between a  diathesis and a stressor?

The diathesis stress model is a way to figure out what is causing a psychological disorder. Diathesis: a  vulnerability that makes you more likely to develop a psychological disorder. It could be caused by a  biological function in our genes or an environmental factor like childhood trauma, going to war, or  experiencing emotional abuse. Even if you lack the diathesis, you can still develop a disorder. Stress acts  like a catalyst to the diathesis. Low infrequent stress leads to a low probability of emergence. High  frequent stress leads to a high probability of emergence.

2. What do we mean when we say there are Biological, Cognitive/Psychological, and Situational causes  of mental health issues?

What are the other types of psychological assessment employed by clinicians?

Three ways to Approaching & Understanding Disorders: Biological factors: influence brain chemistry and  neurotransmission. Cognitive factors: influence thoughts, attention, and behavior. Situational  experiences: lead to the development of the disorder.

3.What are the three criteria that we use to determine whether something is a disorder?

Must have all 3 of the following criteria for a behavior to be classified as a disorder: Deviant: Irregular  behavior, makes you different from other people. Distressing: behavior that hurts you. Dysfunctional/maladaptive: behavior that interferes with your life, relationships, and job.

4.What is the DSM? What does it provide and how do clinicians utilize it?

The DSM is a classification system for a broad range of disorders. There are systematic guidelines for  each disorder. It was developed by the APA (American Psychological Association). DSM-V has already  been developed because psychologists are constantly gathering new information.

What is the difference between an obsession and a compulsion?

If you want to learn more check out What are the retroviruses?

5.What are each of the axes in the DSM-IV? How have these changed for DSM-V?

o Axis I: Acute (symptoms wax and wane) psychological disorders.

▪ Depression, Anxiety, Schizophrenia

o Axis II: Chronic (daily symptoms) mental disorders.

▪ Personality Disorder, Developmental Delays, Schizophrenia

o Axis III: General medical conditions relevant to psychological disorders.

▪ Cancer, Epilepsy, Obesity, Parkinson’s, Alzheimer’s

o Axis IV: Psychosocial or environmental problems.

▪ Unemployment, divorce, homelessness If you want to learn more check out How is a sigma different from a pi bond?

o Axis V: General Functioning (0-100).

▪ Social, psychological, occupational

▪ Rating of 1 means danger of hurting oneself or others

▪ Rating of 100 means superior functioning

DSM-V Changes

o No Axis, all thrown together.

o No more Medical Conditions (ex: saying someone is bisexual is a medical condition) o GAF is gone because it had poor psychometric properties and lacked conceptual clarity,  it was replaced with WHODAS (World Health Organization Disability Assessment  Schedule) which assesses illness related to disability. We also discuss several other topics like What are the essential parts of an explanation?

6. What are the pros and cons of the way in which the DSM classifies mental health disorders? Don't forget about the age old question of What is the nosocomial?

Pros: high agreement among various clinicians, useful for research on mental health. Cons: implies  illness which can lead to stigmatization, cross-category diagnosis (depression and anxiety), categorical  rather than dimensional

7.What is a Mental health status exam?  

It doesn’t result in a diagnosis; it is a snapshot into a patients psychological functioning. 8.What are the differences between a structured vs. unstructured clinical interview?  

Structured is a series of questions to assess presence of symptoms (SCID) based off DSM criteria.  Unstructured is based on the clinicians past experience, can have errors.

9. What are the other types of psychological assessment employed by clinicians? Obsevational: 1. Psychological testing (self-report): same problems as all self-report measures.  Faking good vs faking bad (acting like you have more/less symptoms than you actually do).

2. Neuropsychological Assessment: assess planning, coordinating motor responses, and memory. Used  to assess impairments with particular regions of the brain

10. What are the key features of Generalized Anxiety Disorder, Panic Disorder, and Specific Phobias?  Focus on the similarities and differences between each disorder (note: You do not need to know each of  the specific phobias presented in lecture. Those were just examples) We also discuss several other topics like What is the velocity at +=2?

Generalized Anxiety Disorder: Constant free-floating tension & ANS (sympathetic autonomous nervous  system) arousal- higher HR, pupils dilate, lasts hours over days. Free-floating means anxiety comes  about for no reason, no trigger.  

Panic Disorder: Sudden increase ANS arousal and fear. Feel like heart will explode, very fatiguing. Higher  in intensity than GAD, but doesn’t last as long. (5-15 min). Also free-floating, can have a trigger. Phobias:  Ex) fears of snakes, spiders, heights, and enclosed spaces. Intense, irrational fear of specific  objects or situations, not free-floating, most easily treated disorder, ends when you get away from  object.

11. What is the difference between an obsession and a compulsion? What is hoarding disorder?  Obsession (distress)= unwanted, repetitive thoughts. Compulsions (even more distress) = repetitive actions, consume time. Hoarding is a type of obsessive compulsive disorder that is caused by anxiety.

12.What are the key features of the mood disorders? How do they differ from one another? For  depression, make sure you are aware of the accompanying symptoms in addition to the pattern of  mood. Characterized by emotional extremes, think of mood as a sine wave and deviations from it would  reflect a mood disorder. Major depressive disorder: most common, bad mood drops really low,  depressive episodes last 2 weeks, it’s more than just a bad mood. It can be accompanied by sleep  disturbances, loss of appetite, lethargy, global negative self-evaluation, and thoughts about death or  suicide. Dysthymia: long lasting (2 yrs) of slightly negative mood, less extreme than a depressive episode Don't forget about the age old question of Who studied the structure of the brain?

13. What are the positive and negative symptoms of Schizophrenia?  

Positive symptoms are additional things other average people don’t experience such as  delusions/paranoia, disturbed perceptions/hallucinations (usually auditory or olfactory rarely visual),  disorganized behavior (odd and eccentric), “word salad” their sentences don’t make sense. Negative symptoms are things that regular people experience and people with schizophrenia do not  such as inappropriate emotions, lack of emotion (anhedonia), loss of interest in daily activities, lack of  response.

Chapter 15 and Therapy lecture

14. Who receives therapy?

People with psychological disorders diagnosed by a licensed psychologist who report symptoms and  experience dysfunction; People dealing with life stressors such as a death in the family, divorce,  occupational/academic problems, and marriage therapy; someone hoping to improve their skills like  study or social skills (they visit life coaches).

15. What are the differences between biomedical approaches and psychotherapy? What are some  examples of biomedical and psychotherapeutic approaches? What are the key features and differences  between the different approaches to psychotherapy (Psychoanalytic, Psychodynamic, Cognitive, and  Behavioral therapies)? What techniques does each specific psychotherapy employ?

Biomedical therapies (ex: psychopharmacology), Psychotherapy (talk therapy, based off the  psychologist’s theoretical perspective), psychodynamic therapy, client-centered therapy. Drug Therapy:  1950s the chemical lobotomy “Thorazine” was a psychotropic medication and like other drugs it acted to  change brain neurochemistry which lead to deinstitutionalization. Major types (have fewer side effects  than Thorazine): (Side note: Psychopharmaceutical drugs target nuerotransmitters) Anti-anxiety  (tranquilizers & beta blockers) increase GABA and slow thinking ex) Xanax, Antidepressants increase  dopamine, norepinephrine, serotonin ex) Wellbutrin and SSRIs like Prozac, Antipsychotics block  dopamine. Drugs are able to target neurotransmitters that are believed to cause disorders, effective in

treating a variety of disorders, cost and time effective. Psychoanalytic therapy: created by Freud, “talk  therapy” the first nonmedical approach, based on unconscious drives leading to maladaptive behaviors/thoughts, treatment involves uncovering conscious feelings and thoughts (identify the cause  and resolve so that symptoms will go away), Use free/word association and dream analysis to try and  uncover feelings. Psychodynamic therapy: a variation of psychoanalytic theory that examines the  patients needs, motives, and defenses to understand what causes distress. Still embraces “talk therapy” by being conversational, focuses on childhood events and relationships, practiced by using the object  relations theory and exploring your dreams, fantasies, and day-dreams. Client-centered Therapy:  originated from humanistic perspective & Carl Rogers, created a safe and accepting environment and  had the patient and psychologist work together having a good relationship. The core features of it were  unconditional positive regard (judgment free), Empathy/genuineness, and motivational interviewing. Cognitive Therapy: Distorted thoughts lead to maladaptive behaviors and emotions; it focuses on  changing thoughts through cognitive restructuring. Behavioral Therapy: Behavior is learned and can be  unlearned using classical and operant conditioning (Reward/Punish behavior), counter conditioning/extinction. They may have to teach a behavior (ex: social skills) by the therapist modeling  appropriate social behavior and through role-play. Exposure Therapy/Systematic Desensitization (used  to treat phobias) Step 1: make a fear hierarchy by showing the patients things associated with their fear.  Ex) someone with a fear of spiders: a spider on their shoulder would be a 100, a spider on the table in  front of them could be an 80, a picture of a spider could be a 15, etc. Step 2: expose them to a low  anxiety situation where they remain calm while being exposed to some sort of stimulus dealing with  their fear. Step 3: work through higher anxiety situations until the patient eventually becomes  comfortable enough to deal with their fear. Cognitive Behavioral Therapy: corrects distorted thoughts  while also teaching new behaviors, very effective.

16. What is cognitive restructuring?

Correcting distorted thoughts

17. What are the strengths and weaknesses as well as controversies surrounding the different  biomedical therapies?

Electroconvulsive Therapy (ECT): Works for severe major depressive disorder, Used as a punishment  during the ’50s in mental institutions, negative consequences

The lobotomy was cutting the skull open and severing the connections between the prefrontal cortex  and other sections to reduce psychotic symptoms. Some side effects were blunting of personality,  convulsive seizures, irresponsibility, childishness, and incontinence.

18. How do we evaluate therapies? client & clinical perceptions, clients could drop out if it is ineffective,  regression to the mean (peoples’ emotions fluctuate naturally and only see a doctor when they’re  getting out of hand so naturally over time they will get better and stop going ex: cyclical depression),  patient motivation is important (so is motivational interviewing).

19. What is an Iatrogenic treatment? Be careful: some therapies work and others are benign (doesn’t  help nor hurt) and others a harmful. Harmful & benign therapy is iatrogenic. Ex) lilienfeld ’07 and  repressed memory theory, scared straight program, and the DARE program.

20. What are the different routes that you can take to practice therapy? How do each of these routes  differ in terms of how the therapist will approach treatment of mental health disorders?

Treat mental health issues with biomedical treatments

-MD psychiatry or Psychiatric nurse practitioner

Treat with psychotherapy

-PhD/Psy. D in clinical psychology. (Psy. D is treatment oriented instead of research oriented) (deals with  mild disorders)

-MSW/PhD in counseling psych (deals with slight stress)

Couples counseling/ Parent training

-Marriage & family therapist

-Applied behavior analysis (ABA)

Chapter 12 and Social Psychology Lectures

21. What is the difference between a dispositional/internal attribution and a situational/external  attribution? Dispositional/internal attribution is a behavior due to internal reasons, unique to the  individual. Situational/external attribution is a behavior due to external factors, a product of the  situation they’re in.

22. What is the Fundamental Attribution Error (FAE)? What is the Self-Serving Bias (SSB)?  

The Fundamental Attribution Error is the tendency of humans to attribute strangers’ negative behavior  to their personality and underestimate situational influences. the Self-Serving Bias is blaming other for  your problems but praising yourself for succeeding, it just makes your life easier.

23. What is the difference between acceptance and compliance? What is the difference between  normative and informational social influence? What do these concepts have to do with one another?

Compliance is saying yes even when you don’t want to n order to make your relationships better (ex:  you want dessert but your friends want to leave so you don’t get dessert) and is a result of Normative  social influence. Informational social influence: evidence about reality that we receive from others,  results in acceptance.

24. How does informational social influence affect helping behavior? What do we mean by pluralistic  ignorance? If others are around you and are not helping out, you are more likely to not help out.  Pluralistic ignorance is when a group of people are ignoring someone in need of help.

25. What do we mean by diffusion of responsibility?

The more people present makes you feel less responsible to deal with someone who is ie: drowning  because if they drowned you wouldn’t be the only one responsible.

26. What is an attitude? How do social psychologists measure them? How do we form attitudes?

An attitude is how you feel about something. Psychologists measure them by the mere exposure effect, foot in the door theory, and low-ball effect. We form attitudes through socialization and conditioning.

27. How does behavior influence attitudes? What do we mean by cognitive dissonance? How do people  reduce dissonance? You want to have consistent behavior, if you don’t it makes you uncomfortable and you need to create a reason why this varied behavior is ok in order to adjust your attitude (cognitive  dissonance is the uncomfortable feeling when you don’t have consistent behavior).