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NORTHEASTERN UNIVERSITY / Psychology / PSYC 3406 / What is the most prevalent psychological disorder?

What is the most prevalent psychological disorder?

What is the most prevalent psychological disorder?

Description

School: Northeastern University
Department: Psychology
Course: Abnormal Psychology
Term: Fall 2019
Tags: abnormal psych, Studyguide, Models, Of, abnormality, Clinical Assessment, Diagnosis, treatment, and Psychology
Cost: 50
Name: Abnormal Psychology Study Guide for Chapter 1, 3, 4
Description: This is the Study Guide for our upcoming exam on Thursday (10/3/19)
Uploaded: 09/28/2019
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Abnormal Psychology 3406 (Dr. Cisewski) Study Guide Chapters 1, 3, 4


What is the most prevalent psychological disorder?



Highlight = Important people Highlight = Important Concepts Highlight = Important Terms

Chapter 1- Abnormal Psychology: Past & Present Psychological disorders 

● Deviance 

○ Behaviors experienced by the greatest number of people in a culture is normal ○ Behaviors that are atypical or rare or abnormal If you want to learn more check out What are the key differences and similarities between bargaining and cooperation?

○ Poor criterion because some rare features (ex. Genius) i’m not considered abnormal

○ Context important

● Distress 

○ Psychological problems causing distress and require treatment


How do cultural factors affect perception of normal and abnormal?



○ Considered to be harmful

○ However, some events that caused distress or not pathological (ex. Grief) ○ Also, some people with pathological disorders do not experience distress ● Dysfunction 

○ Symptoms caused impairment in daily functioning

● Danger 

○ Is there a potential harm to the individual or others

Accepted definition of psychological disorder 

- Describes behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and impairment in functioning, or increased risk of suffering, death, pain, or impairment”


What does prognosis mean?



If you want to learn more check out What are the types of cellular transport?

Cultural factors 

- Culture plays a large role in what we determine is normal versus abnormal - Think about variations in norms across cultures

- Think about variations and norms within our culture

Scientific vocabulary 

- Prevalence -Number of people displaying a disorder in the total population at any given time

- Incidence -Number of new cases of a disorder appearing during a specific period - Course- Pattern of development and change of a disorder over time

Onset 

- acute versus gradual

- Age Of set

- Prognosis 

- Predicted future development of a disorder overtime

Current statistics on psychological disorders 

- Nearly half of us are impacted by mental illness at some point in our lives - 26% of us will experience a psychological disorder in any given year

Providers 

- Psychiatrist

- Psychologist

- psychiatric nurses

- family/marital counselors

History of perspectives of psychological disorders 

- Ancient views and treatments

- Greek and Roman views and treatment Don't forget about the age old question of What is the difference between adp and atp as phosphate groups?

- Europe in the Middle Ages

- Renaissance

- Reform and moral treatment

- Somatogenic and Psychogenic

- State Prison

Demonological model 

- Trephination To let out evil spirits

- Neolithic period

- Ancient Egypt-scrapings from skulls used to make potions

- Continues into the renaissance

- Supernatural causes- possession (ex. Exorcisms)

Hippocrates and Galen 

- Hippocrates believed the brain to be core of emotion, intelligence, wisdom, and consciousness

- Hysteria

- Wandering uterus

- Galen believed the “humoral theory” where an imbalance of humors create abnormal behavior

● Excess of phlegm

○ Lethargic or sluggish

● Excess of black bile

○ Melancholic/depression

● Excess of blood

○ Sanguine- cheerful, confident, optimistic Don't forget about the age old question of What is the meaning of limiting reactant?

● Excess of yellow bile

○ Bilious and choleric- quick tempered

Witchcraft 

- 15th and 17th centuries - started by Pope Innocent VIII, decreed that witches be executed - Diagnostic tests

- If you drowned, you passed

- Salem witch trials

- 19 witches hanged in gallows hill in 1692

- Goles Cory tortured to death

- Five, including an infant, died in prison

Moon and stars 

- Movements of the moon and stars affect psychological functioning

- Gravitational forces cause of mental disorders

- Lunatic

- Full moon theory

- Astrology

Asylums 

- Late 15th and early 16th centuries Don't forget about the age old question of What was the earliest form of policing in the south?

- Some were shrines and provided humane treatment

- Later, became asylums (no specific treatments, primarily for confinement) - Chained to beds

- Public spectacles

Reform and Moral Treatment 

- Jean Baptiste Pussin And Philippe Pinel and William Tuke - La Bicetre - Moral therapy

- Saw it as a disease

- Treat people humanely

- Dorothy Dix and Benjamin Rush Don't forget about the age old question of Where do osteoclasts come from?

- Dix- Boston school teacher who advocated for those in asylums & jails regarding the horrible conditions

- Resulted in 32 mental hospitals devoted to psychological disorder

- Rush- believed mental illness was due to engorgement of the blood vessels in the brain

- Bloodletting

- Purging

- ice baths

- In late 19th century, primarily just providing custodial care

- Conditions deteriorated again

Somatogenic Perspective 

- Syphilis

- Discovered that advanced syphilis, affecting the central nervous system, can lead to behavioral and cognitive changes

- William Griesimger argued abnormal behavior was from diseases in the brain - Emil Kraeplin Likened mental disorders to physical diseases

- Dementia praecox- schizophrenia

- Caused by bio chemical in balance

- Manic depressive psychosis- bipolar disorder

- Caused by abnormal body metabolism

John Grey 

- Psychiatrist that believed causes of insanity or biological

- Mentally ill should be treated as physically

- Resulted in improved conditions of hospital

- Alzheimer’s disease

Development of Biological Treatments 

- Insulin shock therapy

- Water Therapy

- Lobotomies

- Electric shock therapies

- Eugenics

- Development of psychopharmacological agents

- Neuroleptic

Psychogenic Perspective

- Hypnotism- Mesmer 

- Jean Martin Charcot 

- Hysteria

- hypnosis

- Sigmund Freud 

- Psychodynamic model

- Joseph Breuer 

- Anna O.

- Talking cure /catharsis

Psychoanalytic perspective 

● Jung 

○ Personal unconscious and collective unconscious motivates behavior

○ Archetypes

● Adler 

○ Personality due to an innate desire to overcome infantile feelings of helplessness (striving for superiority or striving for success)

● Horney 

○ Basic anxiety arises in parent child relationships

○ Respond by moving towards, moving away, or moving against

● Erickson 

○ Expanded upon Freud‘s stages of development

○ Focus on ego development throughout the lifespan

● Mahler 

○ Object relations

○ Intraject representations of caregivers into our personalities

Evaluating Psychodynamic Models 

- Critics say Freud placed too much emphasis on sexual desires and aggression, rather than social relationships

- Freud’s mental processes are not scientific not falsifiable

- However, Neuroanatomical research has validated concept of unconscious

Humanistic Theory 

- Rogers, Maslow, May 

- Self Actualization

- Genuineness and authenticity

- View world from clients perspective

- Abnormal behavior is a result of been blocked in our growth

- Conditions of worth result in distorted self concepts

- Anxiety/depression results from incongruence between real and false self

Evaluating Humanistic Models 

- Focus on conscious experience

- Teacher’s responsibility, free choice

- Critics Say it’s too subjective

- Difficult to study objectively

- Self actualization not measurable or observable

Behavioral Model 

- Abnormal behavior is symptomatic of emotional/psychological problems - Behavior is learned through associations and reinforcement

- Focus on behavior, not motivations

- Classical conditioning- Pavlov / Watson 

- Phobias

- Systematic desensitization -Wolpe

- Operant conditioning-Skinner 

- Positive/negative reinforcement

- Punishment

Evaluating Behavior Model 

- Used for phobias, anxiety disorders, sexual dysfunctions, and depression - Reinforcements used in schools, families, psychiatric hospitals

- Critics comment that learning models don’t address the complexity of human behavior - Critics also state that it does not incorporate genetic influences

Socio-Cultural Perspective 

- Psychological problems due to societal stressors and issues

Biopsycho Social Perspective 

- Interactionist model

- Takes into account multiple perspectives

- Biological

- Psychological

- social/cultural factors

The Community Mental Health Movement 

- 1963- created community mental health centers

- Provide care to those released from hospitals

- Phenothiazines (anti-psychotics)

- Reduced need for hospitalization

Chapter 3- Models of Abnormality

Models of Abnormality 

- Abnormal behavior viewed from perspective that is results from multiple influences - Causality is systematic

- Focuses on

- Behavioral influences

- Learned or conditioned

- Biological influences

- Emotional influences

- Social influences

- Developmental influences

Biological Model 

- What are potential biological aspects of mental health disorders ?

- Neurochemical

- Anatomical

- Genetic

- Evolutionary

The Nervous System 

- Neurons

- On average-140 billion

- Used to transmit information

- Use neurotransmitters, which are released into the synaptic cleft

- Neurotransmitters 

- Neurons that are sensitive to one type of neurotransmitter cluster together and form pathways to and from various parts of the brain

- Thousands of brain circuits

- Currently, believe there are over 100 different neurotransmitters

- Agonists 

- Increase activity of neurotransmitter by mimicking its effects

- Antagonists 

- Decrease or block a neurotransmitter

- Inverse agonists 

- Produce effects opposite of neurotransmitter

- Reuptake 

- Neurotransmitter is quickly drawn back from the synaptic cleft into the presynaptic neuron

- Monoamines 

- Norepinephrine

- involved in learning and memory

- Low levels associated with depression

- Two groups of receptors

- Alpha adrenergic

- Beta adrenergic

- Circuits in the hindbrain

- Serotonin (5-hydroxytrptamine- or 5HT)

- Regulates mood states, satiety, and sleep

- Low levels associated with depression and eating disorders

- Low levels also associated with less inhibition and instability, impulsivity, and overreacting

- Over 15 different receptors

- Dopamine - catecholamine

- Regulares muscle contradictions and learning, memory, and emotions - Low levels associated with Parkinson’s disease

- High levels associated with Schizophrenia

- Also implicated in addiction and ADHD

- Five different receptor sites

- Serotonin and Dopamine circuits cross each other and have complementary functions

- Amino acids 

- glutamate

- Excitatory

- Learning and memory

- Gamma-aminobutyric acid (GABA)

- Inhibitory

- Brain anatomy

- Central nervous system

- Brain and spine

- Peripheral nervous system

- Somatic

- Autonomic

- Sympathetic

- Parasympathetic

- Central Nervous System 

- Forbrain

- Limbic system- involved in emotional processing and memory

- Amygdala

- Regulates body temperature, concentration of fluids

in blood, reproductive processes. And

emotional/motivational states

- Basal ganglia

- Regulares postural movements and coordination

- Huntington’s disease and Parkinson’s disease

- Hippocampus

- Involved in learning and memory

- Cerebral cortex 

- Occipital lobe -interpreting visual stimuli and information 

- Temporal lobe -interpreting sounds 

- Parietal lobe -sensory information such as pressure, touch, and pain. 

- Frontal lobes -reasoning, motor skills, higher level cognition, and 

expressive language 

- Endocrine system 

- Adrenal glands produce epinephrine in response to stress

- Thyroid gland produces thyroxine

- Pituitary gland -master gland

- Gonadal glands produce estrogen and testosterone

- Hypothalamic-pituitary-adrenocortical axis (HPA Axis)

- Hypothalamus connects to pituitary gland, which may then

stimulate adrenal glands

- Cortical part of adrenal glands also produce cortisol, a stress

hormone

Genetic Contributions to Psychopathology 

- 23 chromosomes from mom and 23 from dad

- DNA contains genes

- Have dominant and recessive genes

- Most characteristics are polygenic

- Human genome -20,000 to 30,000 genes influencing and

interacting with each other

- Only a small proportion of the genes in any one cell is “turned on”

- Environmental influences can affect which genes are turned on

- Developments in the study of genes and behavior 

- Currently believe that half of our personality traits and cognitive abilities are due to genetic influences

- Genetic factors responsible for stability in cognitive factors, while

environmental factors responsible for changes

- Significant traumatic events, such as a chaotic, can overwhelm genes

- The interaction of genes and the environment 

- Diathesis-stress model

- We inherit certain tendencies to express certain traits or behaviors,

but they need to be triggered in order for them to be expressed

- This helps to explain why not all of us will develop a

psychological disorder after experiencing a traumatic or stressful

event, but some of us will

- PTSD

- Depression

- The reciprocal gene-environment model 

- We may have a genetic endowment that increased the possibility of

expertas event to trigger the gene

- Other factors to consider

- Evolution

- Viruses

- toxins

Psychodynamic model 

- how are mental health symptoms explained by the psychodynamic model? - ID,ego, superego

- Fixation

- Defense mechanisms

- Behavioral model 

- How are mental health symptoms explained by behavioral model?

- Conditioning

- Learning

- Behavioral and cognitive science

- Conditioning and cognitive processes

- Learned helplessness vs learned optimism

- Example of nolan feeling sad and not wanting to find friends to play with - Social learning 

- Modeling and observational learning

- Prepared learning 

- More likely to learn biologically adaptive information

- Children afraid of snakes or bugs but not electrical outlets

- Cognitive science and the unconscious

- Dissociation

- Implicit memory

- Emotions 

- The physiology and purpose of fear

- Fight or flight response

- Emotional phenomena

- Subjective interpretation of physiological responses

- Motivates us-an action tendency

- Emotions are short-lived feeling states in response to an event

- Mood-more persistent feeling state

- Affect-momentary emotional tone that accompanied what you do - The components of emotion 

- Behavior

- Physiology

- Cognition

- Humanistic-existential 

- Are any of mental health issues related to humanistic/existential factors ? - Cultural, social, and interpersonal factors 

- Each culture has its own specific disorders

- Gender also influences the susceptibility of various disorders

- Social/cultural 

- Social labels and roles

- Social support is protective

- Family systems

- Life span developmental 

- Experiences throughout life influence the susceptibility of developing a disorder

- Psychotropic medication affect children and adults differently

Chapter 4- Clinical Assessment Diagnosis, and Treatment Assessing psychological disorders 

Clinical assessment - Somatic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder

Diagnosis - The process of determining whether the particular problem afflicting the individual meets all criteria for a psychological disorder

- ex. DSM-5

- ICD-10

Reliability 

- consistency - different parts of the test have same result

- Test-retest reliability

- Inter-rater reliability

Validity 

- content validity 

- Test looks like it measures what it is supposed to

- Concurrent validity 

- Correlated to other tests measuring the same construct

- Predictive reliability 

- Does it predict future performance?

- Sensitivity- does the test identify those with the disorder ?

- Specificity - does the test avoid diagnosing those with the disorder that do not really have it ?

- Construct validity 

- Does the test measure the trait is supposed to measure?

Standardization 

- tests are administered in the same manner

- Given to wide range of individuals

The Clinical interview -is the most common assessment

- what day should be collected ?

- Family history (genetic)

- Medical history (biological)

- Medications (dynamic)(could affect symptoms, side effects)

- Lifestyle information (changes, social support, living arrangements

- Substance/ drug use

- Sleep (mood)

- Diet

- Exercise

- Name/education

- Hobbies

What are the types of interviews ?

- Role play

- Some are very structured

- Some are semi structured

- Some are not at all

- Computerized interviews

- Data suggests that it is as accurate at making correct diagnosis

All are effective!! But may not build rapport and sometimes the lack of structure is not always efficient

- used to record behaviors

- Do function analysis of problem behavior

- Antecedents, behavior, consequences

- Interview vs direct observation

Self monitoring 

- Keep behavioral log

Analogue measures 

- simulate real environment

- Role plays

Behavioral rating scales

The mental status exam 

- appearance & behavior (grooming, social norm)

- Thought processes (comprehension, insight to behavior)

- Mood & affect

- “Insight” - do they understand their distress, do they know why their there, do they understand symptoms, or how aware are they?

- Affect- feeling are that accompanies what is said at a given point

Intellectual functioning 

- some are concrete

- Some respond to abstract treatment

- This is helpful for which exercises to give them

Sensorium 

- are they oriented (person place time)

Speech 

- how fast/slow they are talking

- Abnormal speech, tonality

- Speech impediments

MOTOR movements 

- fidgeting, tapping

- Slow motion speed indicators

Pathology 

- normal personality

- Can’t always use just one data set

Socio Cultural & ethnic factors 

- Spanish speakers judged to have more psychological problems when interviews in English as opposed to Spanish

- Need to make sure objective measures have been standardized on the population you are assessing

- Also helpful if you use version in their language

Projective tests - unstructured, stimuli can be interpreted in many ways, so it is ambiguous, with no inherent meaning

- based on the belief that people will respond to ambiguous stimuli consistent with unconscious conflicts by projecting them

- (Ex. Thematic apperception test)

- Freud believed that you can reveal, “project” unconscious issues into the objects

Pros-

- helps see within,

- you never know what could be pulled out,

- inter-intra reliability

Cons-

- results are subjective, if you are interpreting, you really could just be projecting - lack of reliability/validity

Objective tests 

- how are they different ? (objective tests are quantifiable)

- Contain direct, unambiguous items relating to the individual

- Self-report

- Compare results to normative sample

- Used to draw inferences about personality

- Personality inventories

- A questionnaire in which people respond to items designed to gauge a wide range of feelings and behaviors; used to assess selected personality

traits

- (ex. NEO-PI-R) 

- Measures 5 traits of personality

- Based on “normal” personality

- Has 2 versions (respondents & collaterals)

- MMPI-2 

- Assessed abnormal personality traits

- Empirically derived

- MCMI 

- TRUE/false test

- Assesses pathology

- Mourned I’m patient populations

INTELLIGENCE TESTS 

- Binet 

- Commissioned by school officials in Paris to identify children needing extra help - With Simon, created intelligence test

- Stanford-Binet intelligence was scale

- IQ = mental age/chronological age

- Wechsler 

- “Intelligence is “capacity” to understand the world….and..resourcefulness to cope with its challenges”

- WAIS-IV/WISC-IV 

- Most widely used intelligence test

- Eleven subtests

- Provides scores for verbal comprehension, perceptual organization,

working memory, and processing speed

Normal curve 

- For most data, the majority of scores tend to fall in the middle of the distribution, with fewer and fewer scores occurring as you move towards the extremes

- Histograms tend to smooth out until they are bell shaped, known as the normal distribution or normal curve

- When a distribution follows a truly normal distribution, it’s mean, median and mode all have the same values

Neuropsychological evaluation 

- Uses cognitive tests to examine various brain functions

- Memory

- Language

- Attention

- Visuo-spatial skills

- Executive functions

- The bender visual motor Gestalt test

- The Halstead-Reitan Neuropsychological Battery

- The process approach

Neuroimaging 

- Images of brain structure

- CT-SCAN

- MRI

- Images of brain functioning

- PET scan

- SPECT

- fMRI

Psycho physiological assessment 

● EEG

● Biofeedback

● Neurofeedback

 Diagnosing psychological disorders 

● Idiographic Strategy 

○ Close and detailed investigation of an individual emphasizing what makes that person unique

● Nomothetic Strategy 

○ Identification and examination of large groups of people with the same disorder to notes similarities and develop general laws

● Classification 

○ Assignment of objects or people to categories on the basis of shared

characteristics

● Taxonomy 

○ Classification of entities for scientific purposes

● Nosology 

○ Classification and naming system for medical and psychological phenomena

● Nomenclature 

○ Labels or names applied to disorders

Classification types 

● Diagnostic Statistical Manual (DSM)

○ First introduced in 1952

○ Just published 5th edition in May 2013 (DSM-5)

● International Statistical Classification of Diseases and Related Health Problems (ICD) ○ World Health Organization

○ I’m it’s 10th edition (ICD-10)

Categorical approach 

● Emil Kraeplin 

● Every diagnosis has clear underlying pathophysiology

● More useful in medicine

Dimensional approach 

● Focuses on variety of symptoms

● However, most theorists are unable to agree on how many dimensions are required Prototypical approach 

● Identify certain essential characteristics

● Allows nonessential variations

● DSM-5 based on this approach and categorical

Diagnosis before 1980 

● Kraeplin has strong influence of using classical categorical model

● 1948- World Health Organization added mental disorders to ICD

● 1952-DSM-I

● 1968- DSM-II

○ Lacked precision and differed from ICD

○ Poor reliability

● 1980- DSM-I & DSM-II-R

○ Atheoretical approach 

■ Does not focus on cause

○ Descriptive 

■ Classified disorders, not people

○ Specificity made it possible to study reliability and validity

○ Rated on five dimension/axes

● Axis I 

○ Clinical disorders and other conditions that may be a focus of clinical attention ● Axis II 

○ Personality disorders and mental retardation

○ More chronic disorders

● Axis III 

○ General medical conditions

● Axis IV 

○ Psycho social and environmental problems

● Axis V 

○ Global assessment of functioning

● 1994- DSM-IV & DSM-IV-TR

○ Based on scientific data

○ Studied reliability and validity

○ Eliminated distinction between organically-based disorders and

psychologically-based disorders

● Changes include: 

○ Elimination of axes

■ Now uses non-axial documentation, with separate notations for important psychosocial and contextual factors (formerly Axis IV) and disability

(formerly Axis V). Axis III is now combined with Axes I & II

○ Re-organize to reflect lifespan approach

○ Integration of scientific findings in genetics and Neuroimaging

○ Consolidation of autistic disorder, asked burgers disorder, and pervasive developmental disorder in autism spectrum disorder

○ Streamlined classification of bipolar and depressive disorders

DSM - 5 continued 

● restructuring of substance use disorders

○ Eliminated substance abuse and substance dependence

○ Replaced with substance use disorders

● Enhanced specificity for major &mild neurocognitive disorders

● Transition in conceptualizing personality disorders

Reorganization 

● gambling disorder now included with addictive disorders instead of impulse- control disorders

● Hair-pulling disorder/trichotillomania now grouped with obsessive compulsive and related disorders, not impulse- control disorders

● body-dysmorphic disorder now grouped with obsessive compulsive and related disorders, not somatic symptom disorders

● PTSD and acute stress disorder now grouped with trauma- and stressor-related disorders instead of anxiety disorders

● Obsessive-compulsive disorder now grouped with obsessive-compulsive and related disorders instead of anxiety disorders

New names

● Mental retardation now is intellectual developmental disorder

● Specific learning disorder replaces reading disorder, mathematics disorder, and disorder of written expression

● Major neurocognitive disorder replaces dementia

● Gender dysphoria replaces gender identity disorder

● Depersonalization- Derealization disorder replaces depersonalization disorder ● Illness anxiety disorder replaces hypochondriasis

● Dissociative amnesia now includes both dissociative amnesia and dissociative fugue New categories 

● Added hoarding disorder and Excoriation (Skin picking) disorder to obsessive compulsive and related disorders

● Premenstrual dysphoric disorder added to depressive disorders

● Disruptive mood dysregulation disorder added to depressive disorders ● Somatic symptom disorder added to somatic symptom and related disorders ● Binge eating disorder added to feeding and eating disorders

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