Psychopathology (PSYC 4240) Test 1 Notes
Psychopathology (PSYC 4240) Test 1 Notes PSYC 4240
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Psychopathology (PSYC 4240) Test 1 Study Guide TEST 1 – 45 Multiple Choice questions, 5 fill in the blank 1 hour 15 min CHAPTER 1 Historical Concept Disorder – no single definition Important consequences -Insurance: diagnosis for treatment -Legal responsibility -Disability Diagnoses are always changing according to culture Most behavior is on a continuum Myths w/ mental illness: can be controlled, crazy, lazy, dumb, dangerous Approaches to Defining Ab. Behavior (Wakefield) Disorder as a pure value concept -judgment according to social norms and disorders Disorder as whatever professionals treat -internalizing (depression/anxiety) vs. externalizing (ADHD, addiction, narcissism) disorders -but people can come in just to talk Disorder as statistical deviance -can be statistically deviant in other direction or many traits…being deviant does not = disorder (i.e. being super rude) but does this lead to impairment? Disorder as biological disadvantage -if it lowers reproductive fitness -if mental mechanism is not performing specific function it was designed to perform (normal anxiety vs. pathological anxiety) -if designed mechanism doesn’t work and leads to impairment, then it is a disorder Disorder as distress or suffering *Wakefield – “harmful dysfunction”: Hybrid of “value judgment” and biological advantage -society defines what is socially harmful Psychological Dysfunction -breakdown in cognitive, emotional and behavioral function Personal Distress or Disability (functional impairment) -difficulty performing applied and expected roles -may be unable to judge when something is bad A typical or unexpected cultural response -reaction varies Widiger Argues 2 constructs are fundamental to define mental disorder -dyscontrol -maladaptivity DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) Widely accepted system -used to classify psych problems and disorders -American Psychiatric Association puts it out…but psychologists use it the most DSM contains diagnostic criteria for behavioral patterns -fits pattern -causes dysfunction/distress -present for specified duration (i.e. depression – 2 weeks; anxiety – 6 months; schizophrenia – 6 months) -threshold of matching prototype (i.e. 4 of 9 symptoms) Clinical Descriptions of Abnormality Begins w/ the Presenting Problem -what is bringing client/patient into treatment -what client says is the problem (not diagnosis) Clinical Description -distinguish clinical significant dysfunctions vs. common human experience -describe demographics, symptoms, age of onset, precipitating factors Keep in mind: -prevalence (# of ppl w/ it) vs incidence (# new cases over time) -course of disorders – episodic, time-limited, chronic -onset of disorder – acute (suddenly) vs insidious (creeping) -acute means you can recover better Prognosis – good v. guarded -Anorexia is guarded prognosis…no good treatment Causation, Treatment and Outcome in Psychopathology Etiology – what contributes to development (genetics, social?) Treatment Development – How can we help alleviate psych suffering -Includes pharm, psychosocial, or combined Treatment Outcome Research – How do we know we’ve helped -limited in figuring actual causes of disorders Historical Concepts – The Past Major Psych Disorders have existed -in all cultures, across all times Causes and treatments vary widely -across cultures and time 3 dominant traditions -Supernatural, Bio and Psych Supernatural -battle between Good vs. Evil -demonic possession or witchcraft, movement of stars -Treatments: exorcism, torture, beatings, crude surgeries -Some worked… -Still around, but less common in West Biological -Hippocrates believed psych disorders could be treated like any disease -Believed disease, head trauma, heredity could cause disorders -Galen extends Hippocrates’ Work -Humoral Theory of Mental Illness -Imbalance of blood, black bile, yellow bile, and phlegm -Linked abnormality w/ brain chemical imbalances -Foreshadowed modern views -Biological interest comes back in 1800s -Treatment of syphilis brought back Biological ideas -Advanced syphilis led to psychosis -mental illness = physical illness -provided a biological bases for madness = biological treatment -1930s: standard practices include insulin shock therapy, ECT, brain surgery -1950s: medications become available Neuroleptics: (antipsychotics) reduce hallucinations, delusions, aggressions (i.e Haldol) These are like tranquilizers -1970s: Valium, antidepressants Psychological Plato vs. Aristotle thought social and cultural environment had affects Moral Therapy: normalizing treatment of mentally ill – reinforce and model appropriate behavior. Emphasized nurturing environment This treatment was short-lived b/c there weren’t enough people to help with treatment Dix – led mental hygiene movement: “custodial care”, gave care to a lot of ppl -rise of bio tradition and notion and notion that mental illness was due to pathology and is incurable -psych tradition re-emerges in 1900s; psychoanalysis, Humanism, Cognitive- Behaviorism Freud and Breuer Breuer’s patients describe problems under hypnosis 2 “discoveries” Unconscious mind – hypnosis led to material outside of explicit awareness Catharsis – indiv. Felt better after discussing/reliving emotionally painful events/feelings, or “release” Freudian Theory: Structure and Function of Mind -Id (pleasure) – demands immediate gratification -processes info in primary process – emotional, irrational, primal -dream analysis primary process -libido: sexual and aggressive motives; “energy” -Eros: drive for sex and fulfillment -Thanatos: “death instinct” drive for aggressions/death -Ego: reality principle or “negotiator” -balances Id w/ society; logic and reason -Ppl after Freud focused on this concept -Superego: “conscience” represents morality learned from parents, etc. -develops from punishment/rewards for behaviors -counteracts Id Ego must balance Id and Superego -if this balance is broken, intrapsychic conflict will occur Freud felt Id and Superego were almost entirely unconscious. Defense mechanism when balance is ruined leads to anxiety which is a warning that ego may be overwhelmed -defense mechanism (unconscious) process which keeps primitive feelings in check -i.e. humor, denial, projection -can be adaptive or maladaptive -seen as primitive ***Review defense mechanisms Psychosexual Stages of Development 5 basic stages which represent different ways to gratify needs -Inappropriate/Inadequate gratification leads to being stuck in a phase, but ppl can digress, too. Oral (birth – 2): central focus on food; sucking, lips, tongue -adults -> smoking, eating, gum, chewing Anal (2-3): Expulsion v. retention; completed w/ successful toilet training -adults -> uptight, controlling vs. disorganized, impulsive Phallic (3-5/6): Notice genitals (own and others) -adults -> Oedipal complex (identifies w/ dad) Electra complex -child identifies w/ same gender parents (girls want a penis???) Latency (6-puberty): sexual interest is dormant and interests include school and play Genital (Puberty – onward): central focus returns to genitals in a sexual phase -fixation at earlier phases = not fully developed -development was done when people developed heterosexual relationships Psychoanalysis Therapy Many times (3-5x) a week for years (2-5yrs) Used catharsis and insight to make fundamental changes about someone -very expensive -focus is not on symptom reduction, but on lifetime changes Techniques -patient lies on couch; analyst sits behind couch -Free association – no censorship -Dream analysis -Examine Transference and Counter-Transference End goal – trying to project client’s issues on psychoanalyst Efficacy Data is limited – too expensive to test a lot of ppl and see if this method works Psychodynamic Theory This therapy can be found more easily than psychoanalysis Focus on affect and patient’s expression of emotions -Therapist may interpret and discuss issues immediately Explores patients’ avoidance of topics or decision to engage in behaviors that hinder the therapy treatment -i.e. not showing up, not calling to cancel, being too reserved (bringing up important things at the end of the session), coming late, not paying... Identifies patterns in patient’s behaviors, thoughts and feelings -shares psychanalysis’ goal of making major, lasting changes in behavior Emphasis on role of past experiences -isn’t focused on childhood as much as psychoanalysis Focus on interpersonal experiences Emphasis on therapeutic relationship -how the therapist and patient get along; “therapeutic alliance” -this relationship is crucial for successful treatment Exploration of patients’ fantasies, dreams and wishes -NOT dream analysis This therapy can last for very long periods of time Humanistic Theory and the Psychological Tradition Notion that there was a positive quality of humanity (unlike Freud). Humans were seen as beings that strive for improvement and excellence This therapy does not strive to give people answers… Self-actualization: attain one’s highest potential which is only achieved in you overcome obstacles -obstacles like: basic needs like food and shelter, but also psychological problems and interpersonal problems Major contributors – Carl Rogers, Abraham Maslow and Fritz Perls *People are good and are trying to obtain self-actualization (becoming better) Carl Rogers Client (or person) – centered therapy -His ideas are represented in almost every form of therapy today Treatment: -Therapist conveys empathy, unconditional positive regard -minimal therapist interpretation (no explanation for behavior) -genuine attitude (being honest with the patient) -helped with reflective behavior, tried to let patient interpret mostly on their own -client had resources within to solve own problems with enough support -client-therapist relationship was more important part of treatment Maslow Maslow’s Hierarchy of Needs ***review pyramid Physical -> Security -> Social -> Ego -> Self-actualization The Behavioral Model and the Psych Tradition Classical Conditioning (Pavlov; Watson) -Common form of learning -Pairing neutral stimuli and conditioned stimuli 4 aspects -Unconditioned stimulus (food; chemo) -Unconditioned response (saliva; nausea) -Conditioned stimulus (bell; nurse) -Conditioned response (saliva; nausea) **Bell and nurse become conditioned stimulus and evoke response of unconditioned stimulus (food; chemo) -If you present the conditioned stimulus without the unconditioned stimulus for a long time, the conditioned response will stop Watson (father of behaviorism): uninterested in studying unobservable processes like thought or emotions -Little Albert experiment showed the extent of conditioning to explain fear acquisition, or how we learn fear (Albert was afraid of rabbits, even though it was the noise that scared him, not the rabbit) Operant Conditioning (Thorndike; Skinner) Another common form of learning in which voluntary behavior is controlled by consequences (positive or negative) Skinner noticed that classical conditioning did not explain many behaviors Thorndike’s’ law of effect: behavior is either strengthened or weakened depending on consequence of behavior (more or less likely to happen again) Skinner’s Reinforcements and Punishments -Reinforcement: whether the outcome is positive or negative, the reinforcement increases behavior -Positive reinforcement is giving candy or praise -Negative reinforcement is taking something away that someone didn’t like (less chores, less homework) -Punishment: whether the outcome is positive or negative, the reinforcement decreases behavior -Positive punishment is giving something that someone doesn’t like (more chores, spanking) -Negative punishment is taking away something they liked (can’t play outside) Shaping: reinforced successive approximation of desired behavior (reward for every step towards end goal) *Main idea was that children were born as blank slates and equal, so you can turn any kid into a doctor or criminal…not accepted today. From Behaviorism to Behavior Therapy Reactionary Movement -Against psychanalysis and non-scientific approaches -How could we know if something was valid or not? Early Pioneers -Wolpe: systematic desensitization -Beck: cognitive therapy -Albert Elis is also important in this field -Bandura: Social learning/cognitive-behavior therapy -Kids mimicked adult’s behavior; we learn from watching others; “vicarious” learning Behavior Therapy -Tends to be time-limited (12 session), direct, here-and-now focused (not childhood focused) -Goal is to get patient’s back on their feet, not make them perfect or even optimal -Behavior therapies have widespread empirical support (many therapists can provide support) CHAPTER 2 ***Review Chapter 2 Detailed Slides since they will not be discussed in class. I will upload summaries of these notes in an additional file! Psychopathology One Dimensional vs. Multidimensional Models One Dimensional Models -Explaining behavior in terms of a single cause (it’s genetics, it’s a chemical imbalance) -Could mean a paradigm, school, or conceptual approach -Problem: other information is often ignored Multidimensional Models -Interdisciplinary, eclectic and integrative - “System” of influences that cause and maintain suffering -Uses information from several sources -Abnormal behavior as determined from many sources of information -Multidimensional is the approach we want to use. Don’t worry about the specifics Multidimensional Models of Ab. Behavior Take all of these into account: Biological Factors (genetics, physiology, neurobio): Depression, Bipolar Behavioral Factors: ADHD Emotional Influences Social Factors Developmental Factors: Schizophrenia Genetic Contributions to Psychopathology Phenotype (observable trait) vs. Genotype (genetic makeup) Nature of Genes -Double helix DNA -23 chromosome pairs (46 total) -23 pair indicates sex -Dominant vs. recessive genes Development and behavior is often polygenetic – contribution of many genes *Genetic Contribution to Psychopathology -Generally less than 50% Interaction of Genetic and Environmental Effects Eric Kandel and Gene-Environ Interactions – proposed that learning could affect genes by turning them on or activating them. -Genetic structure is malleable and receptive to the environment -Even if you have the gene, you may have never been exposed to the environment to “turn it on” -i.e. if a mom has the flu while pregnant, schizophrenia is more common The Diathesis-Stress Model -A genetic vulnerability or predisposition (diathesis) interacts with the environment and life events (stressors) to trigger behaviors or psychological disorders -i.e. PTSD only happens to some soldiers even if many were in a similar situation -i.e. College binge-drinkers don’t go on to become alcoholics Gene-environment interactions -Life stress depression. But interaction with short allele of a serotonin transporter (moderated) which led to more depression and suicidality Gene-environment correlations -Genes can increase the probability that an individual will experience environmental events (which might increase psychological problems) -i.e. Lower IQ bad home environment -Examples: you can inherit depression, divorce, and substance use. -You may inherent personality traits that don’t work well in relationships *Diathesis and stressor may not be independent 3 types of Correlations Passive – Types of genes a child inherits may be correlated with the environment one is raised in (Ppl with low IQ continue to be raised in bad environments, and continue to pass on their low IQ genes with other ppl similar to them) Evocative – Individual’s genes may lead to behavior that evokes a response from the environment - Antisocial kids evoke a certain response from environment (aggressive kids receive aggressive treatment back) Proactive – Individual’s genes make the selection of certain environments more likely (genes lead you to choose to skydive or own a motorcycle) Epigenetics – Environment can affect how genes are expressed (your diet/behaviors/stressors turn genes on or off) Non-genomic inheritance of Behavior -Environmental influences may override genetic influences. This can be true for very early developmental experiences (stressed, anxious babies who are raised by calm parents can become calm parents themselves) -Some genes will never express themselves unless in a certain environment. And some environment may have little effect unless the genetic predisposition is there too. -Genes can help make sense of which environments might lead us to mental illness Neuroscience Contributions to Psychopathology Field of Neuroscience – the roles of the nervous system in disease and behavior Branches of the Human Nervous System -central nervous system (CNS): brain and spinal cord -peripheral nervous system (PNS): somatic and autonomic branches Functions of Main Types of Neurotransmitters Relation to psychopathology – almost all current psychiatric drugs impact neurotransmitters Functions of Neurotransmitters can be studied by introducing: -Agnostics: increase activity by mimicking hormone effects -Antagonists: decrease or block a neurotransmitter -inverse agonists: produce effects opposite to those produced by the neurotransmitter (reward vs. punish) Can be manipulated at different levels and shows impact of functions Main types of functions of neurotransmitters -Serotonin: regulates behavior, mood, cognition low levels: disinhibitions, emotional reactivity, impulsivity related to aggression, suicide, depression, impulsive overeating treated with SSRIs (serotonin specific reuptake inhibitors; Prozac, Celexa, Paxil…) -Glutamate: excitatory transmitter which causes action -Gamma aminobutyric acid (GABA): reduced postsynaptic activity which leads to an inhibitory effect Broad influence on mood and behavior. Affect anxiety and arousal in general. Reduces anxiety, emotional reactivity, anger, and positive moods. Benzodiazepines (valium, Xanax, klonopin) increase GABA -Norepinephrine (noradrenaline): increases heart rate and blood pressure which may be active in flight or fight situations Beta-blockers are used for hypertensions and to reduce anxiety responses -Dopamine: worked as “switch” that impacts effects of the other neurotransmitters Dopamine is linked to exploratory, reward seeking behaviors and is implicated in schizophrenia (high levels) Low levels found in Parkinsons Implications of Neuroscience for Psychopathology Relations between brain and abnormal behavior -Learning from fMRI, PET screening procedures about function and structure of brain and what roles they play in psychopath Psychosocial Influences -Can change brain functions, particularly earl experiences with regard to feelings of control and safety Therapy -Also changes brain functions Psychosocial Factors -Interact with brain structures and functions -i.e. Identical group of monkeys; 1 has control (can choose when to/what toys to play with) while 2 doesn’t have control and gets whatever group 1 chooses. -Then given a terror-causing drug -Group 2 is used to being passive, so they accept while Group 1 freaks out and become aggressive *Neurotransmitters interact with psychosocial factors (past experiences) to affect current behavior Contributions of Behavioral and Cognitive Science Conditioning and Cognitive Processes -Animal research in learning and cognition led to important insights into psychopathology -Classical conditioning only worked if it was consistent. If there was a strict association between bell and food, the reaction would be quickly forgotten. To keep reaction going longer, use a variable reinforcement schedule (Sometimes 1 ring, sometimes 5 or 12). -Learned Helplessness (Seligman) -Group of 2 dogs; both shocked but 1 can do something to stop the shock like press a lever while the other group cannot -The group that couldn’t escape previously, didn’t try to get away even when they were given the opportunity *Resembles depressed humans; not even worth trying to get away or get what I want -People who believe they have control over their life and/or situation is a sign of good health -Social Learning (Bandura) -Modeling and observational learning; prominent in substance use, aggression and interpersonal relationships -Prepared Learning -There is an evolutionary program to learn things better than others (what to be afraid of) -Food poisoning is a good example of this Cognitive Science and the Unconscious -Revolutionized knowledge of “unconscious”: “We simply seem to process and store info and act on nit without having the slightest awareness of what the information is or why we’re acting on it.” -Unconscious isn’t necessarily filled with primal lusts like Freud thought but other info that is impacting our behavior without realizing this -Ways to study implicit memories of beliefs: Stroop color test (relationship between words and colors) Role of Emotion in Psychopathology The Nature of Emotion -To elicit or evoke action (flight or fight; repair damaged relationships; continued behavior) -Emotion: motivational, short lived, temporary states -Mood: a more persistent, enduring state -Affect: momentary emotional tone that accompanies behavior Affect/emotion are to mood what weather is to climate -Intimately tied with several forms of psychopathology Harmful Side of Emotional Dysregulation Anger and hostility: strong link to heart disease due to decreased pumping efficiency for the heart. All basic disorders can be linked to psychological disorders if they occur too frequently and seemingly without cause – too strongly or lacking internal control -Depression -Mania -Panic Mood has an impact on cognition and changes our interpretation Cultural, Social and Interpersonal Factor in Psychopathology Cultural Factors -Influence form and expression of behavior -Most experience similar symptoms European American w/ Schizophrenia – describe their lives with terms related to illness Latinos w/ Schizophrenia – seen less pejorative and elicits more sympathy Gender Effects -Strong effect on psychopathology -Certain disorders have a very strong gender link (depression, eating disorder, phobias, antisocial personality disorder) *Men are higher in disease with externalizing disorder; Women are higher in diseases with internalizing disorders -Why? Gender roles or biological differences? Social Effects on Health and Behavior -Frequency and quality of social interactions are important -Related to morality, disease and psychopathology -Relationships have a protective quality against both physical and psychological disorders Give meaning to life Help us cope with physical or psychological pain Promotes healthy behavior -Perceptions of social support differs between people Life-span and Developmental Influences Over Psychopathology Life-span Developmental Perspective -Addresses developmental changes; different periods of life are associated with different challenges that may influence psychological health 20-30 years of age when most psych disorders present -Developmental stage with also influence how disorders are treated and the symptoms they present i.e. antisocial men at 20 are different from antisocial men at 50 Heterotypic continuity – different traits may manifest themselves different at different ages even though they’re still apparent (i.e ADHD) Principle of Equifinality -Concept in developmental psychopathology -Multiple path to a given outcome like psychosis CHAPTER 3 Assessing Psychological Disorders Clinical Assessment – systematic evaluation and measurement of psychological, biological, and social factors in a present individual with a possible psych disorder Diagnosis – process of determining whether the particular problem afflicting the individual meets all criteria for a psych disorder, set forth in the DSM-5 *Purpose of clinical assessment -to understand individual, to predict behavior, to plan treatment, and to evaluate treatment outcome Analogous to a funnel: start broad, multidimensional in approach, narrow to specific problem areas Three Concepts Determine the Value of Assessment Reliability – the degree to which a measure is repeatable and consistent -Consistency in measurement: across time (Test-retest reliability), rater (inter-rater reliability), items (internal consistency) [This is shown by alpha, α, a high alpha means high internal consistency] Validity – the degree to which a measure captures what it is designed to measure (i.e. does an IQ test measure intelligence?) -Content validity: does the measure captures the full range of the concept? -Convergent validity: is it related to other validated measures of the same construct? -Criterion validity: is it related to other constructs that are thought to be related? -Discriminant validity: is it unrelated to constructs it shouldn’t be related to? -Face validity: (unimportant, you may not want to even have this) is it obvious that the measure is measuring what you want? -Predictive validity: does it predict important and relevant outcomes? (i.e. does IQ predict GPA) *Construct validity: the degree to which a test measures the construct, or the psychological concept or variable at which it is aimed? ***You can’t have validity if you don’t have reliability. But reliability doesn’t mean you have validity. Reliability is a necessary but is not a sufficient aspect of validity. Standardization and Norms -Foster consistent use of techniques, to apply standards to ensure consistency of measurement -Provide population benchmarks for comparison -Examples include administration procedures, scoring and evaluation of data Domains of Assessment: The Clinical Interview and Physical Exam Clinical Interview -most common clinical assessment method -unstructured – no systematic format -semi-structured – set questions; room for departure from those questions/more consistent info gleaned; less spontaneity -fully-structured – set questions; no departure Presenting problem (when is started; precipitating events) Can ask about demographics, previous drugs taken, familiar history, drugs families have taken, ask about other problems/co-morbid conditions, daily life, education, work, developmental history, medical history, substance use, abuse history, social history/romances Mental Status Exam -Appearance and behavior: over behaviors, dress, hygiene, motor behavior, posture -Thought processes: rate of speech, continuity, content- delusions/hallucination -Mood and affect: mood and affect feeling -Intellectual functioning: rough estimate of intelligence based on vocabulary, occupation, memory, thought processes -Sensorium: awareness of surrounding, person, place and time Sometimes clients have a good understanding of their issues, but some may not. Confidentiality Can break confidentiality in cases of: Self-harm or harm to others Abuse to children and elderly If a court subpoena’s psychologist’s files Domains of Assessment: Behavioral Assessment and Observation For children and people w/ sever psycho disabilities and intellectual disabled Behavioral Assessment – used with those clients who may or may not be able to provide adequate information -Focus on here and now -Target behaviors are identified and observed as to which factors are influencing the behaviors -Use the ABCs: antecedents, behaviors, and consequences Behavioral Observation and Behavioral Assessment -Can be formal or informal -Self-monitoring vs. others observing Smoking, eating disorders, drinking -The problem of reactivity using direct observations Presence of an observer (or even one’s own self-monitoring) can change the behavior Domains of Assessment: Psychological Testing and Projective Testing Psychological Testing -Must be reliable and valid -Intelligence; neuropsychology; psychopathology Used to assess specific forms of psychopathology or uses broad tests to diagnose long-standing personality traits/disorders Projective Tests -This type of testing was developed by modern-day psychologists (not done by Freud) -Projects aspects of personality onto ambiguous stimuli with roots in psychoanalytic tradition -High degree of inference in scoring and interpretation (low inter-rater reliability, so not reliable in general) -Rorschach Inkblot Test, Thematic Apperception Test Objective Tests -Test stimuli are minimally ambiguous -Roots in empirical tradition -Require minimal inference in scoring and interpretation Objective Personality Tests -Minnesota Multiphasic Personality Inventory (MMPI, MMPI-2, MMPI-A); Over 549 true or false items Extensive reliability, validity, and normative database Items picked not for face validity but because of predictive utility Validity scales: Lie scale (measures if you’re trying to make yourself look good), Infrequency scale (measures if you’re trying to make yourself look bad), Defensiveness (a little like Lie scale), Cannot-say (skipped too many items) Objective Intelligence Tests -IQ tests (intelligence quotient) was originally designed to predict school performance 1916 Stanford-Binet is prominent American version Old way: mental age/chronological age x 100 (doesn’t really work because types of intelligence change when you get older; children develop faster at a certain age) Current way: deviation score – how much does an individual’s score deviate from the average performance of other similarly aged individuals (SD=15; IQ – 130; 2 SDs above the mean) Wechsler Adult Intelligence Scale (WAIS-III) Includes verbal and performance domains (verbal: vocab, arithmetic, comprehension; performance: picture completion, block design, picture arrangement) Psychological Testing and Neuropsychology Neuropsychological Tests -Assess broad range of skills and abilities (i.e. receptive and expressive language, memory, attention, concentration, learning, abstraction) -Goal is to understand brain-behavior relations -Used to evaluate a person’s assets and deficits -Overlap with intelligence tests, but are linked to organic brain damage (stroke, concussions, etc.) Problems with Neuropsychological (and all) Tests -False Positives: diagnosing a problem that isn’t there -False Negatives: saying there isn’t a problem when there is Neuroimaging and Brain Structure 2 types of examinations of the brain -Structure: signs of damage, size of parts, presence of tumors -Function: look at blood flow during certain tasks Imaging Brain Structure: -CAT or CT scan; detailed x-rays of brains -MRI; better resolution than CAT scan and less radiation, but takes longer and is more expensive Imaging Brain Function -PET scan, SPECT -Inject radioactive isotopes which react with oxygen, blood and glucose in the brain to show which parts of the brain “light up” when performing certain tasks -fMRI (preferred method) can show changes in brain activity Advantages and Limitations -Provides detailed info, but they are expensive and lack a “norm” baseline, so they have limited clinical utility in psychology Psychophysiological Assessments Methods used to assess brain structure, function and activity of the nervous system Psychophysiological Assessment Domains -EEG: brain wave activity -Heart rate and respiration: cardiorespiratory activity -Electrodermal response and levels: sweat gland activity -Electromyography (EMG): muscle tension -Penile/Vaginal plethysmograph: sexual arousal Uses of Routine Psychophysiological Assessment -Disorders involving a strong emotional component like PTSD, sexual dysfunctions, sleep disorders, headache and hypertension -Can provide insight into underlying causes of disorder Diagnosing Psychological Disorders: Foundations in Classification Clinical Assessment vs. Psychiatric Diagnosis Assessment: idiographic approach – what is unique to that person (personality, family background, culture, etc) Diagnosis: nomothetic approach – applying what we know about patient to what we know about people more broadly and seeing if specific problems fit with a general class of problems Both important for treatment planning and intervention Diagnostic Classification -Classification is needed for all science -Develop categories based on shared attributes Terminology of Classification Systems -Taxonomy: classification in scientific context -Nosology: taxonomy in psych/medical contexts -Nomenclatures: nosological labels (i.e. panic disorder) Two Widely Used Classification Systems International Classification of Diseases and Health Related Problems (ICD-10); published by WHO Diagnostic and Statistical Manual of Mental Disorders (DSM); published by the American Psychiatric Association; currently the DSM-5 (2013) The Nature and Forms of Classification Systems Classical (or pure) categorical approach -Yes/No decisions. Each disorder viewed as fundamentally different from others with a clear underlying cause. Individual is required to meet all requirements for classification -Considered more useful in medicine; if you know diagnosis, you know the treatment -Viewed as inappropriate to the actual complexity of psychological disorders Dimensional Approach – classification along dimensions -Symptoms or disorders existing on a continuum (i.e. 0 to 100) -Patient might be mildly depressed and moderately anxious while leads to a patient’s profile to represent their functioning -There’s no agreement on number of dimensions needed or which dimensions needed to represent psychopathology Prototypical approach – Both classical and dimensional -categorical (yes/no) but individual does not have to fit every symptom. Rather, patient must meet some minimal number of prototypical criteria (i.e. 5 out of 9 symptoms) Creates within-category heterogeneity Presumes homogeneity with the “yes” and “no” groups; so you’re treating them all the same. Patients with 0/9 vs. 4/9 should be treated differently Purposes and Evolution of the DSM Purposes of the DSM System -Aids communication -Evaluate prognosis and need for treatment -Treatment planning DSM-I (1952) and DSM-II (1968) Both relied on unproven theories and were unreliable -Based on psychoanalytical ideas DSM-III (1980) through IV (1994) Atheoretical, emphasizing clinical description not underlying etiology Detailed criterion sets for disorders Emphasis on reliability (inter-rater; test-retest) Questions about validity -Many decisions were not empirical; why depressed symptoms for 2 weeks? Why 4 panic attacks in 4 weeks? Why 5 out of 9 symptoms? DSM-5 (2013) Emphasis on understanding that many symptoms aren’t specific to a single disorder, but cut across many disorder (co-morbidity) like anxiety, depression and suicidal ideation Introduction of new dimensional measures that exist across disorders CHAPTER 4 Science and Abnormal Behavior Questions Driving a Science of Psychopathology -What problems cause distress or impair functioning? -Why do people behave in unusual ways? -How can we help people behave in more adaptive ways? Basic Components of Research Starts with Hypothesis or an Exploratory/Educated Guess -Not all hypotheses are testable -Scientific hypotheses must be testable (Freud’s theories were not testable) Can be rejected (you can’t really accept hypotheses…) Research Design -Method to test hypotheses -Independent variable/Dependent variable i.e. Exercise reduces depression Considerations in Research Design Balancing Internal vs. External Validity -Internal: Did you study rule out confounds? Did the independent variable really produce those outcomes? Confidence in our IV -External: Are the findings generalizable to other settings, locations, types of samples, other problems? Increase internal validity by minimizing confounds -Factors that might make the results uninterpretable -By: controlling for levels of depression, levels of exercise, random sample, making sure they’re exercising -Use a control group (individuals NOT exposed to IV but are similar to experimental groups in other ways) Group A: exercises 4 days a week Group B: exercises 0 days/exercises normally -Random assignment procedures to avoid systematic bias -Used of analog models: study related phenomenon in controlled conditions of laboratory settings (i.e. alcohol) Relation Between Internal and External Validity Can be opposite to each other Increasing IV can lower EV -i.e getting people drunk in a lab vs. watching drunk people downtown *In an experimental environment, internal validity is more valued at first since we’re trying to explain relationship between IV and DV Example: Exercise reduces depression Increase IV: Only include people with depression, but no other comorbid disorders like anxiety Hurts EV: It’s uncommon to see depression without anxiety Researchers work to balance these variables by designing multiple studies -Start with strict IV and then slowly move towards EV and see if your findings are generalized Research by Correlation Nature of Correlation -Statistical relation between 2 or more variables -No IV is manipulated Correlation and Causation -Problem of directionality (i.e. break-ups and depression; substance use and impulsivity) -Correlation =/= causation Nature of Correlation and Strength of Association -Range from -1.0 to 1.0 -Negative and positive correlation Why use correlational studies? -True experiments are hard to conduct -We can’t really assign people to certain groups (smoking vs. not smoking; have a psych disorder, don’t have one) Epidemiological Research -Study incidence, prevalence, and course of disorders; searching for clues Incidence: # of new cases during a specified time Prevalence: # of people with a disorder at any given time Distribution: more or less common in certain populations -What factors are associated with frequency of disorders (i.e. gender, SES, certain behaviors) -Goal of epidemiological work is to find clues for the etiology Research by Experiment Nature of Experimental Research -Manipulation of IV (i.e. therapy or not; meds or not; levels of exercise) -Random assignment -Attempt to establish a causal relationship (since you’ve accounted for confounds) -Great internal validity Group Experimental Designs -Nature and purpose of control groups Needed to show that IV is responsible for changes Should be nearly identical to treatment group -Placebo and double-blind controls Instead of a sugar pill, you may want to give them drugs that give them the same side-effects of the treatment group Trying to rule out that the treatment effect isn’t due to the expectation that you’ll get better Easy to do with medications, but not with psychotherapy treatment Double-blind: both researcher and participants are unaware of their group assignment Comparative Treatment Designs Type of group design; next step after showing the treatment is better than the placebo Compare different forms of treatment in similar persons (i.e. psychotherapy vs. medication vs. combination) Addresses treatment outcome; did a change occur? -Dismantling studies (break studies into parts and remove or focus only on certain aspects); Necessary to figure out the “active” components of the treatment Single-Case Experimental Designs Nature of Single Subject Design -Person is both control group and experimental group - “Systematic study of individuals under a variety of conditions” -Rigorous study of single cases; manipulations of experimental conditions and time -Repeated measurements needs to be done; not just once before and once after treatment -Good internal validity/ bad external validity Types of Single-Subject Design -Withdrawal Design (ABAB Design): -Baseline (depression) -Treatment (i.e. Zoloft); Assess depression -Withdrawal (stop medication); Assess depression Assets: better sense if treatment caused changes Liability: remove a treatment that might be helpful, risk relapse, it’s not possible to “withdraw” psychological treatments like therapy -Multiple Baseline Design: Not starting/stopping treatment Starting treatment at different times at different settings (home vs. school) or behaviors (hitting, talking back, doing homework) Assets: Don’t need to withdraw treatment Liabilities: Can’t really make conclusions about general population based on a small number of people (low external validity) Genetic Research Strategies Cannot make conclusions about individuals; only the population Behavioral Genetics -Interaction among genes, experience and behavior -Phenotype (observable characteristics/behavior) vs. Genotype (genetic make-up of an individual) Down syndrome: phenotype (mental retardation, slanted eyes, thick st tongue); genotype (extra 21 chromosome) Strategies Used in Genetic Research -Family studies: examine behavioral pattern/emotional traits in family members Problems: cannot distinguish between environment and genetic factors -Adoptee studies: allows separation of environmental from genetic contributions Are children more like their adoptive parents or biological parents? Number of studies looking at crime via adoption studies: showed a heritable component (more for property crime than violent crime) -Twin studies: evaluation psychopathology in fraternal vs identical twins More representative of the general population than adoptee studies Risk of developing schizophrenia Monozygotic twins: 48% Dizygotic twins: 17% *This method requires the “equal environment” assumption is correct. We assume that MZ twins are not treated any more similarly than DZ twins. Most results agree with this concept -Genetic linkage and association studies: locate sites of defective genes Very difficult to find replicable samples Studying Behavior Over Time Rationale and Overview: How does the problem or behavior change over time? -If not stable (i.e. normal response to environment and likely to “go away” soon) and doctors may choose not to intervene -Alternatively, if viewed as “too stable”, they may not try to intervene or change the behavior -Studying behavior over time can show insight into what factors lead to the manifestation of a disorder (i.e. “risk factors”) Important in prevention research -Study of risk factors for development of disorder: biological, psychological, environmental) Important in treatment research -What help individuals recover and how long they feel better and what happens when they stop using the treatment: psychoeducation, emotional support, medication, behavioral activation Time-Based Research Strategies Cross-sectional designs: take a sample of the population across age groups and compare on a certain characteristic -i.e. Substance Use Cohorts: participants in each age group Members of cohort should be the same age, same historical time and exposed to similar experiences Problems include differences across ages may be due to both age and dissimilar experiences (substance use and 1960s); it tells us little about how problems develop; can tell us that two variables are related but not causal information Cohort effect: confounding effect of age and experience is a major limitation of cross-sectional designs Longitudinal designs: follow one group over time and assess changes -No cohort effect problem Gets us closer to understanding causality (order of relationship; depression leads to fewer friends vs. fewer friends leading to depression) Problems: take a long time to do, high attrition rates, expensive and time- intensive, study topic may not be relevant by the time the study is done Cross-generational effect: your data may not generalize other groups whose experiences are different Studying Behavior Across Cultures Value of Cross-Cultural Research -Studying abnormal behavior from various cultures tells us about the origins and treatment of disorders from different perspectives. -Overcoming ethnocentric research Predictors of substance use in White adolescents not same for Black adolescents Issues in Cross Cultural Research -Clarify how psychopathology manifests in different ethnic groups; terminology may be different across cultures Nonwestern cultures tend to emphasize somatic aspects of depression (i.e. changes in appetites, sleep or energy) -Different thresholds for abnormal behavior -Treatment exists within cultural context (i.e. not making eye contact, responding differently) The Nature of Programmatic Research Components of a Research Program -No one study will answer the question -Studies proceed asking slightly different questions, using slightly different procedures -Conducted in stages, often involving replication -Scientific knowledge typically build incrementally (not like the media/movies/shows makes it seem like) -Replication is very important
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