Abnormal behavior and psychological disorders

Lesson 1: Abnormal Behavior in Historical Context

• Behavior is considered abnormal if it deviates from the average, becomes infrequent, and significantly departs from social or cultural expectations.
• The greater the deviation, the more abnormal the behavior.
• Psychological disorder: Dysfunction within an individual is associated with distress, impairment in functioning, or a response that is not typical or culturally expected.
• DSM-5 describes behavioral, psychological, or biological dysfunctions unexpected in their cultural context, associated with distress, impairment in functioning, or increased risk of suffering, death, pain, or impairment.

Case Study: The Girl Who Fainted at the Sight of Blood

• Judy, a 16-year-old, developed a blood-injection-injury phobia after viewing a graphic film in biology class
• She began avoiding situations involving blood or injury and felt lightheaded at the mention of blood.
• Judy started fainting 5-10 times a week, disrupting her school life, so the principal suspended her, believing she was being manipulative.
• Judy suffered from a blood-injection-injury phobia, a psychological disorder with marked and persistent fear of an object or situation
• Impact: Such phobias can be disabling and cause individuals to avoid certain careers and potentially putting their health at risk.

The Science of Psychopathology

• Psychopathology entails the scientific study of psychological disorders.

Mental Health Professionals

• Clinical/Counseling Psychologists (Ph.D., Ed.D., or Psy.D.): Focus on research, diagnosis, assessment, and treatment of psychological disorders.
• Psychiatrists (M.D.): Approach from a biological perspective, diagnosis, and treatment often emphasizing drugs or biological treatments.
• Psychiatric Social Workers (Master's degree in social work): Collect information on social and family situations, treat disorders, and focus on family problems.
• Psychiatric Nurses (Advanced degrees - Master's or Ph.D.): Provide care and treatment of patients with psychological disorders in hospitals.
• Marriage/Family Therapists & Mental Health Counselors (Master's degree): Provide clinical services in hospitals or clinics, usually under supervision.

Scientist-Practitioners

• Mental health professionals take a scientific approach to their clinical work.
• Functions:
  • Consumers of science: Keep up with the latest scientific developments.
  • Evaluators: Evaluate their own assessments or treatment procedures.
  • Researchers: Conduct research to produce new information about disorders or their treatment.

Clinical Description

• The presenting problem is a specific problem or set of problems, and represents the unique combination of behaviors, thoughts, and feelings.
• Clinical refers to both the types of problems found in a clinic or hospital and the activities connected with assessment and treatment.
• Statistics:
  • Prevalence: How many people in the population have the disorder.
  • Incidence: How many new cases occur during a given period.
  • Sex ratio and age of onset: Differ from one disorder to another.

Course of Disorders

• Chronic course: Disorders tend to last a long time, sometimes a lifetime.
• Episodic course: Individuals recover within a few months only to suffer a recurrence later.
• Time-limited course: Disorders improve without treatment in a relatively short period.
• Acute onset: Disorders begin suddenly.
• Insidious onset: Disorders that develop gradually over an extended period.
• Prognosis: The anticipated course of a disorder.
• Developmental psychology: The study of changes in behavior over time.
• Developmental psychopathology: The study of changes in abnormal behavior across the age span.
• Life-span developmental psychopathology: Study of abnormal behavior across the entire age span.

Etiology, Treatment, and Outcomes

• Etiology represents the study of origins, including why a disorder begins (its causes) and encompassing biological, psychological, and social dimensions.
• Treatments can provide insights into the nature and causes of psychological disorders.
• Psychopathology is rarely simple; effect does not necessarily imply cause.

Historical Conceptions of Abnormal Behavior: The Supernatural Tradition

• Agents outside our bodies and environment influence our behavior, thinking, and emotions (divinities, demons, spirits, magnetic fields, the moon, or the stars).
• The mind (or soul/psyche) is considered separate from the body.
• Supernatural Model: Belief that abnormal behavior is caused by evil spirits or supernatural forces.
  • Treatments included exorcism and religious rituals.
• Mass Hysteria: Groups of people simultaneously exhibiting strange behavior.
• Emotion contagion: The experience of an emotion spreads to those around us.
• Mob psychology: Shared response in a community due to suggestibility in states of high emotion.
• The Moon and the Stars: Belief that the movements of the moon and stars influence psychological functioning.
  • Paracelsus suggested that the movements of the moon and stars had profound effects on people's psychological functioning.
• Lunatic derived from the Latin word "luna," meaning moon.

The Biological Tradition

• The mind has often been called the soul or the psyche and considered separate from the body.
• Biological Model: Abnormal behavior is caused by biological factors.

Hippocrates and Galen

• Hippocrates (460-377 B.C.) is considered the father of modern Western medicine.
  • Psychological disorders could be treated like any other disease, and could be caused by brain pathology, head trauma, heredity, or psychological and interpersonal beliefs.
• Hippocratic Corpus: A body of work that stated the above beliefs, written between 450 and 350 B.C.
• Galen (A.D. 129-198): Adopted Hippocrates' ideas and developed them further.
• Humoral Theory of Disorders: Normal brain functioning is related to four bodily fluids or humors.
  • Blood (heart)
  • Black bile (spleen)
  • Yellow bile (liver)
  • Phlegm (brain)
• Disease results from too much or too little of one of the humors, which is the first example of associating disorders with a chemical imbalance.
• Humors were related to the Greeks' conception of the four basic qualities: heat, dryness, moisture, and cold.
• Excesses of humors are treated by regulating the environment.
• Hysteria is a word to describe somatic symptom disorders, where physical symptoms appear to be the result of a medical problem for which no physical cause can be found, coined by Hippocrates.

The 19th Century

• Syphilis: Advanced syphilis can cause delusions of persecution or grandeur, and other bizarre behaviors.
  • The bacterial microorganism that caused syphilis was discovered thanks to Louis Pasteur's germ theory of disease.
  • A cure for general paresis was discovered when physicians observed a surprising recovery in patients with general paresis who had contracted malaria.

John P. Grey

• The champion of the biological tradition in the United States, and the most influential American psychiatrist of the time.
• Believed that the causes of insanity were always physical, so the mentally ill should be treated as physically ill.
• Emphasized rest, diet, proper room temperature, and ventilation.

Development of Biological Treatments

• Insulin shock therapy: Manfred Sakel used increasingly higher dosages of insulin until patients convulsed and became temporarily comatose, which sometimes led to recovery.
• Electric shock: Benjamin Franklin discovered that a mild electric shock to the head produced a brief convulsion and memory loss but otherwise did little harm.
• Electroconvulsive therapy (ECT): Ugo Cerletti and Lucio Bini treated a depressed patient by sending six small shocks directly through his brain, producing convulsions.
• The first effective drugs for severe psychotic disorders were developed in the 1950s.
  • Rauwolfia serpentine (reserpine) and neuroleptics (major tranquilizers) diminished hallucinatory and delusional thought processes and controlled agitation and aggressiveness.
  • Benzodiazepines (minor tranquilizers) reduced anxiety.
• Emil Kraepelin (1856-1926): One of the founding fathers of modern psychiatry.
  • Distinguished among various psychological disorders, seeing that each may have a different age of onset and time course, with somewhat different clusters of presenting symptoms, and probably a different cause.

The Psychological Tradition

• This approach puts psychological development, both normal and abnormal, in an interpersonal and social context.
• Plato: Thought that the two causes of maladaptive behavior were the social and cultural influences in one's life and the learning that took place in that environment.
• Aristotle emphasized the influence of social environment and early learning on later psychopathology.

Moral Therapy

• A strong psychosocial approach to mental disorders that became influential during the first half of the 19th century.
• Treated institutionalized patients as normally as possible in a setting that encouraged and reinforced normal social interaction.
• Individual attention emphasized positive consequences for appropriate interactions and behavior, and restraint and seclusion were eliminated.
• Philippe Pinel (1745-1826) and Jean-Baptiste Pussin (1746-1811) instituted remarkable reforms by removing all chains used to restrain patients and instituting humane and positive psychological interventions.
• William Tuke (1732-1822) followed Pinel's lead in England.
• Benjamin Rush (1745-1813) introduced moral therapy in the U.S.

Mental Hygiene Movement

• Dorothea Dix (1802-1887) campaigned for reform of the treatment of the mentally ill and the poor, and worked hard to make sure that everyone who needed care received it, including the homeless.
• Her work became known as the mental hygiene movement.

Psychoanalytic Theory

• Psychoanalysis, based on Sigmund Freud's (1856-1939) elaborate theory of the structure of the mind and the role of unconscious processes in determining behavior.

Asylum Reform and the Decline of Moral Therapy

• Humane treatment in asylums declined in the mid-19th century due to several converging factors:
  • Overcrowding: Moral therapy thrived when institutions housed 200 or fewer patients, allowing for individualized attention. Post-Civil War, massive immigration waves led to patient loads skyrocketing to 1,000 or even 2,000 in some hospitals.
  • Disparity in treatment: Immigrant groups were often denied moral treatments afforded to native-born Americans due to prevailing social attitudes.
  • Dorothea Dix's Influence: Dorothea Dix advocated for improved treatment of the mentally ill, but her efforts inadvertently contributed to the decline of moral therapy as resources were stretched thin due to increasing patient populations.

Mesmer and Hypnosis

• Franz Anton Mesmer (1734-1815) was a controversial figure who developed a treatment called Mesmerism.
  • Mesmerism proposed that an undetectable fluid in all living organisms (animal magnetism) could become blocked, causing mental illness.
• Mesmer's methods involved patients sitting in a darkened room around a vat of chemicals with rods extending from it. Mesmer, in flowing robes, would touch areas of their bodies where animal magnetism was blocked, suggesting they were being cured.
• Benjamin Franklin put animal magnetism to the test,conducting a double-blind experiment
  • Patients received either magnetized or non-magnetized water, but neither patients nor therapists knew which water was which.
  • When both groups improved, Franklin concluded that animal magnetism was strong suggestion.
• Despite the skepticism, Mesmer is considered the father of hypnosis.
• Hypnosis: A state in which extremely suggestible subjects sometimes appear to be in a trance.

Charcot, Breuer, Freud, and the Unconscious

• Jean-Martin Charcot demonstrated that Mesmer's techniques were effective for psychological disorders; He legitimised the practice of hypnosis.
• Sigmund Freud studied with Charcot and later teamed up with Josef Breuer. Breuer experimented with hypnosis, asking patients to describe their problems in detail.
• Breuer observed two key phenomena:
  • Patients became emotional and felt relieved after hypnosis.
  • Patients couldn't recall details described under hypnosis, suggesting the unconscious mind.
• Unconscious Mind: The part of the mind that is inaccessible to conscious thought but influences behavior.
• Breuer and Freud discovered the unconscious mind's influence on psychological disorders. They also found that recalling and reliving emotional trauma released tension.
  • Catharsis: The release of emotional material.
  • Insight: A fuller understanding of the relationship between current emotions and earlier events.
• Freud and Breuer's theories were based on case observations, like Breuer's treatment of Anna O.

Anna O. Case Study

• Anna O. developed various symptoms after caring for her sick father, including:
  • Blurred vision
  • Difficulty moving her arm and legs
  • Speech problems
  • Unpredictable behavior
• Breuer used hypnosis to trace each symptom to its origin, resolving them one by one.

The Present: Scientific Method and Integrative Approach

• The review of supernatural, biological, and psychological perspectives on psychopathology finds while supernatural explanations still exist, biological, psychoanalytic, and behavioral models continue to advance.
• Each tradition has limitations as scientific methods weren't often applied to theories and treatments, and health professionals viewed disorders from their own perspectives.
• In the 1990s, two developments converged:
  • Sophistication of scientific tools and methodology
  • Realization that influences (biological, behavioral, cognitive, emotional, social) never occur in isolation. Our thoughts, feelings, and actions influence the brain and body.
• Therefore, behavior is the product of interacting psychological, biological, and social influences.
• Adolf Meyer advocated for the equal contributions of biological, psychological, and sociocultural factors, but his ideas weren't fully recognized for a century.
• A new model was needed to consider all influences on behavior by 2000, as cognitive science, neuroscience, and behavioral science were rapidly growing.
• In 2010, the National Institute of Mental Health (NIMH) supported research on the interrelationship of these factors.
• The only valid model of psychopathology is multidimensional and integrative, combining neuroscience, cognitive science, behavior science, and developmental science.

Lesson 2: An Integrative Approach to Psychopathology

• A one-dimensional model attempts to trace the origins of behavior to a single cause, like a chemical imbalance or overwhelming family conflicts
• A multidimensional model acknowledges that abnormal behavior results from multiple influences.
• A systemic perspective implies that any influence contributing to psychopathology cannot be considered out of context and includes the individual's biology, behavior, cognition, emotional state, social environment, cultural environment.
• People react differently at different ages, meaning there are developmental critical periods when more or less reactive to a given situation. Judy's susceptibility to a vasovagal reaction might have been highest during her teenage years.

Genetic Contributions to Psychopathology

• Genes are long molecules of deoxyribonucleic acid (DNA) at various locations on chromosomes within the cell nucleus.
• Each normal human cell has 46 chromosomes arranged in 23 pairs. The first 22 pairs provide directions for the development of the body and brain, while the last pair (sex chromosomes) determines an individual's sex.
• The DNA molecules containing genes have a double helix structure. A dominant gene strongly influences a particular trait, needing only one for expression. A recessive gene must be paired with another recessive gene to determine a trait.
• Current evidence suggests that many genes contribute to psychological disorders, each having a relatively small effect. Advances in gene mapping, molecular genetics, and linkage studies aid in this research.
• Linkage studies: studying individuals with the same disorder and shared features to link known gene locations with the possible location of a gene contributing to the disorder.
• Genetic contributions cannot be studied without considering interactions with environmental events that trigger genetic vulnerability or activate specific genes.
• Epigenetics: studies factors other than inherited DNA sequence, like new learning or stress, that alter the phenotype expression of genes.
• A complex interaction between genes and the environment plays an important role in every psychological disorder.

The Interaction of Genes and The Environment

• Neuroscientist Eric Kandel suggests that learning can change the genetic structure of cells by activating previously inactive genes.
• Diathesis-Stress Model: Individuals inherit tendencies to express certain traits or behaviors which are then activated under stress.
  • A diathesis: Condition that makes someone susceptible to developing a disorder.
  • Judy inherited a tendency to faint at the sight of blood (the diathesis), which became prominent when specific environmental events occurred.
• Gene-Environment Correlation Model indicates that genetic endowment may increase the probability of experiencing stressful life events.
• Strong environmental influences alone may override genetic diatheses.

Neuroscience and Its Contributions to Psychopathology

• Neuroscience focuses on understanding how the nervous system and brain function with human nervous system consisting of
  • The central nervous system: brain and spinal cord
  • The peripheral nervous system: somatic and autonomic nervous systems

The Central Nervous System

• The central nervous system processes information received from sense organs and reacts accordingly, and uses an average of 140 billion neurons (nerve cells) to control every thought and action.
• Neurons transmit information throughout the nervous system.
• A typical neuron contains:
  • Dendrites: receive chemical impulses from other nerve cells
  • Axon: transmits impulses to other neurons
• Neurons are not directly connected:
  • Space between the axon of one neuron and the dendrite of another: Synaptic cleft
  • Neurotransmitters: Biochemicals reased from the axon of one neuron, transmitting the impulse to the dendrite receptors of another neuron.
• Glia (or glial) cells play active roles in neural activity.
• Major neurotransmitters relevant to psychopathology include:
  • Norepinephrine
  • Serotonin
  • Dopamine
  • Gamma-aminobutyric acid (GABA)
  • Glutamate

The Structure of the Brain

• Brain can be divided into two parts
  • Brain stem
  • Forebrain
• Lists each section of the brain and its function

The Peripheral Nervous System

• The peripheral nervous system coordinates with the brain stem to ensure that the body functions correctly.
• Main components:
  • Somatic nervous system: Controls muscles
  • Autonomic nervous system: Includes the sympathetic and parasympathetic nervous systems
• The autonomic nervous system regulates the cardiovascular system and endocrine system.
• Endocrine glands produce hormones that are released directly into the bloodstream.
• The hypothalamus connects to the pituitary gland, which stimulates the adrenal glands; system called hypothalamic-pituitary-adrenocortical axis (HPA axis), implicated in several psychological disorders.
• Sympathetic nervous system mobilizes the body during stress or danger by activating organs and glands, increasing heart rate, respiration, and stimulating the adrenal glands.
• Parasympathetic nervous system balances the sympathetic system, normalizing arousal and facilitating energy storage.

Neurotransmitters

• Neurotransmitters carry messages from one neuron to another. Research focuses on changes in activity levels, studied through:
  • Agonists: increase neurotransmitter activity
  • Antagonists: decrease or block a neurotransmitter
  • Inverse agonists: produce effects opposite to the neurotransmitter
• Drugs can affect neurotransmitters by:
  • Inhibiting or blocking production
  • Increasing the production of competing biochemical substances
  • Preventing the chemical from reaching the next neuron
  • Blocking the reuptake process
• Reuptake: Process where a neurotransmitter is drawn back into the same neuron after being released.
• Two types of neurotransmitters (monoamines and amino acids) have been most studied regarding psychopathology.
  • Glutamate, an excitatory transmitter, turns on many different neurons, leading to action.
  • Gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, inhibits the transmission of information and action potentials.
• Glutamate and GABA work in concert to balance functioning in the brain; overactivity of the glutamate system could burn out sections of the nervous system.
• GABA reduces postsynaptic activity, inhibiting a variety of behaviors and emotions and is best known for reducing anxiety.

Serotonin

• Is a monoamine neurotransmitter, and regulates behavior, moods, and thought processes.
• Low serotonin activity associated with less inhibition, instability, impulsivity, and overreacting to situations, as well as aggression, suicide, impulsive overeating, and excessive sexual behavior.
• Serotonin has different effects depending on the subtype of the receptor involved.
  • Selective-serotonin reuptake inhibitors (SSRIs) affect serotonin more directly than other drugs and are used to treat anxiety, mood, and eating disorders.

Norepinephrine

• Is a neurotransmitter in the monoamine class, stimulates alpha-adrenergic and beta-adrenergic receptors, and influences emergency reactions or alarm responses.

Dopamine

• Is a monoamine neurotransmitter implicated in schizophrenia and disorders of addiction though may also play a role in depression and attention deficit hyperactivity disorder.
• Dopamine acts as a switch that turns on various brain circuits associated with behaviours; it is associated with exploratory, outgoing, pleasure-seeking behaviors, balancing serotonin's role in inhibition and constraint.

Behavioral and Cognitive Science

• Cognitive science studies how we acquire, process, store, and retrieve information.
• Robert Rescorla concluded that pairing events in time is not the key factor in classical conditioning. Instead, various judgments and cognitive processes determine the outcome of learning.

Learned Helplessness

• Martin Seligman and Steven Maier described learned helplessness, which occurs when animals encounter conditions over which they have no control.
• People become depressed if they think they can do little about the stress in their lives, making an attribution that they have no control.
  • Learned optimism is attained when people display an optimistic attitude despite stress and difficulty, leading to better psychological and physical functioning.

Social Learning

• Albert Bandura observed that organisms can learn by observing what happens to someone else, known as modeling or observational learning.
  • Bandura emphasized the importance of the social context of learning and integrated these ideas with the genetic and biological bases of social behavior in social neuroscience.

Prepared Learning

• Suggests that biology and genetics influence what we learn, as we are highly prepared to learn about certain objects or situations that contribute to survival.

Implicit Cognition

• Implicit cognition reveals unconscious mental processes using reaction time measures.

Emotions

• Play a significant role in our lives, and can contribute to the development of psychopathology
• The flight or fight response is the alarm reaction that activates during potentially life threatening emergencies.

Walter Cannon's Speculations

• Walter Cannon (1929) speculated on the physiological reasons behind fear stating that fear activates the cardiovascular system, causing blood vessels to constrict and redirect blood flow to the skeletal muscles and vital organs. This prepares the body for fight or flight.
• When experiencing fear, people may turn pale due to decreased blood flow to the skin.
• Trembling and hair standing on end result from shivering and piloerection, conserving heat when blood vessels are constricted.
• Breathing becomes faster and deeper to oxygenate the rapidly circulating blood, stimulating cognitive processes and sensory functions.
• Glucose is released from the liver into the bloodstream, energizing muscles, organs, and the brain. Pupils dilate, hearing becomes more actue, and digestive activity is suspended, leading to a dry mouth.
• The body prepares for action by voiding waste material.

Cognitive Science and the Unconscious

• Advances in cognitive science have transformed our understanding of the unconscious. The unconscious is not a cauldron of emotional conflicts, but a place where we process and store information without awareness.
• Lawrence Weiskrantz described blindsight or unconscious vision.
• Implicit memory is apparent when someone clearly acts on the basis of things that have happened in the past but can't remember the events; it can be selective for only certain events or circumstances..
• The black box refers to unobservable feelings and cognitions inferred from self reports; psychologists and neuroscientists use new methods to reveal the unobservable unconscious.

Emotional Phenomena

• Emotion consists of 3 components of behaviour, physiology and cognition.
• Emotion is an action tendency elicited by an external event and a feeling state, accompanied by a physiological response as the purpose of a feeling state is to motivate behavior.
• Emotions are usually short-lived in nature lasting minutes to hours in response to an external event
• Mood is a more persistent period of emotionality
• Affect refers to the momentary emotional tone that accompanies what one says or does

Cultural, Social, and Interpersonal Factors

• Cultural, social and interpersonal factors are powerful social influences which can affect well-being

Fright Disorders

• There are many cultures where individuals may suffer from 'fright disorders' that are exaggerated startle responses & fear reactions.
• A Latin American disorder called Susto, involves anxiety based symptoms caused by the belief that the individual has become the object of witchcraft or black magic.

Voodoo Death

• Cannon in 1942, examined voodoo death occurring in Haiti, stating that that the sentence of death by a medicine man may create intolerable autonomic arousal in the participant, who lacks social support which in turn leads to damage to internal organs and death.

Gender Roles

• Gender roles influence the content/form of a disorder as psychopathology cannot be studied separate to the social/interpersonal factors.
• Psychological disorders can vary between cultures and symptoms be influenced by the social context
• E.g depression in Western cultures can involve guilt/ inadequacy, whilst in developing, more physical distress.

Life-Span Development

• Life-span developmental that we view psychological disorders from a snapshot perspective, emphasising how experiences between diff developmental periods influence peoples vulnerability to stress/psychological disorders.

Equifinality

• This principle indicates that we must consider a number of paths to a given outcome
• A delusional syndrome may be in aspect of schizophrenia or arise from amphetamine abuse
• Delirium can occur in older adults or from thiamine deficiency. Autism can occur in children whose mothers are exposed to rubella during pregnancy

Lesson 3: Introduction to Clinical Assessment and Diagnosis

• Clinical assessment: the systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder.
• Diagnosis: the process of determining whether a particular problem meets all criteria for a psychological disorder, as defined in the DSM-5.

Key Concepts in Assessment

• Three basic concepts that help to determine the value of assessments:
  • Reliability: degree to which a measurement is consistent
  • Validity: whether a measurement measures what it is designed to measure
  • Standardization: the process by which a certain set of standards or norms is determined for a technique to make its use consistent across different measurements
• A reliable measurement is consistent and produces the same results when repeated.
• A valid measurement measures what it is supposed to measure.
• Standardization ensures that the same procedures are used to administer and score a test, and that the results are compared to a standard or norm.

Types of Assessment

• There are several types of assessments used in clinical psychology, including:
  • Clinical Interview: A face-to-face conversation to gather information about the patient's thoughts, feelings, and behaviors.
  • Behavioral Assessment: The use of direct observation to assess an individual's thoughts, feelings, and behaviors in specific situations or contexts.
  • Psychological Testing: Standardized tests to assess cognitive, emotional, or behavioral responses that may be associated with a specific disorder.
  • Neuropsychological Testing: Sophisticated tests to assess brain dysfunction and identify the location of the problem.
  • Neuroimaging: Techniques to take pictures of the brain structure and function such as MRI or PET scans.

Behavioral Assessment

• Takes the process of sampling how people think, feel, and behave one step further by using direct observation to assess formally an individual's thoughts, feelings, and behaviors in specific situations or contexts:
  • Self-Monitoring: Self-report measures to track an individual's behavior and identify patterns or triggers.
  • Checklists and Behavior Rating Scales: Standardized measures to assess an individual's behavior and track changes over time.
  • Semistructured Clinical Interviews: Carefully phrased and tested questions to elicit useful information in a consistent manner.

Psychological Testing

• Includes specific tools to determine cognitive, emotional, or behavioral responses that might be associated with a specific disorder.
• Rorschach Inkblot Test: Uses ambiguous stimuli to assess unconscious thoughts and feelings.
• Thematic Apperception Test (TAT): Projective test that uses pictures to assess thoughts, feelings, and behaviors.
• Minnesota Multiphasic Personality Inventory (MMPI): Assesses personality traits and psychological symptoms in a standardized way.
• Wechsler Adult Intelligence Scale (WAIS): Standardized test that assesses cognitive abilities and intelligence.

Neuropsychological Testing

• Measures abilities in areas such as receptive and expressive language, attention and concentration, memory, motor skills, perceptual abilities, and learning and abstraction.
• Bender Visual-Motor Gestalt Test assesses visual-motor skills and brain dysfunction.
• Luria-Nebraska Neuropsychological Battery assesses a range of cognitive and motor skills.
• Halstead-Reitan Neuropsychological Battery: Assesses brain dysfunction and cognitive abilities.

Neuroimaging

• Techniques such as MRI or PET scans to take pictures of the brain structure and function and help to identify brain damage or dysfunction.

Psychophysiological Assessment

• Uses techniques such as EEG or heart rate monitoring to assess nervous system activity and physiological responses to emotional stimuli, which can help identify psychological disorders such as post-traumatic stress disorder or sexual dysfunctions.
• Psychophysiology: measuring changes in the nervous system that reflect emotional or psychological events. Measurements can be taken directly from the brain or from other parts of the body (e.g. electroencephalogram (EEG)).

Nomothetic vs. Tailored Treatment

• Nomothetic strategy: Classify the presenting naming or classifying the problem (determine a general class of problems to which the presenting problem belongs to).
• Diagnosis: A specific psychological disorder is identified, i.e., a mood disorder.

Classification in Science

• Classification: assign individuals to groups/categories based on shared relations or attributes
• Taxonomy: The scientific classification of entities (behaviours, rocks, insects)
• Nosology: when a taxonomic system is applied to medical. clinical. or psychological phenomena.

Classification Approaches

• Classical Categorical Method: founded on Emil Kraepelin/ biological tradition;
• Each diagnosis has underlying pathophysiological cause and is assumed unique
• Only one set of criteria is needed for every category member to fit requirements (e.g if major depressive episode criteria is met, individual has diagnosis).
• Dimensional Method: notes/quantifies moods/behaviours/cognitions on scale
• Prototypical method: Combines both methods; uses essential classification characteristics and allows non-essential variations (some criteria but additional also needed, fits current understanding of psychopathology).

Reliability and Validity in Classification

• Reliability: The system identifies clear subgroups of symptoms that clinicians can easily recognise and should observe and test the same set of behaviours/emotions of a patient separately (an unreliable system is prone to bias).
• Validity: It measures what it says it will (in terms of validity: sign and symptoms are consistently related and differ to other categories)
  • Predictive validity: the diagnosis will predict the likelihood of course or effect of medical treatment.
  • Content validity: reflects how experts diagnose

Historical Context

• Kraepelin first identified bipolar disorder and schizophrenia, and WHO added mental disorders to the ICD in 1948

• In 1980, there are major changes to DSM-III:

  • A theoretical approach
  • Specificity and details
  • Multiaxial system

• Then to the DSM-5, notable changes include:

  • the introduction of cross-cutting symptoms/measures evaluating stress, anxiety, depression, problems sleeping across disorders/multiaxial system/additional dimensions

Social and Cultural Considerations

• DSMS 3/4 integrated better social/cultural influences on diagnosis (also remained in DSM5), i.e. cultural formulation and questions to help medical professionals understand the patients/culture's experience/impact of their disorder.

Critisms Of DSM-5

Criticism include that :

• It has some fuzzy categories that blur (leads to comorbidity)/ reliability over validity
• Perpetuates from past definitions and can misuse diagnostic tool.

Lesson 4: Anxiety, Trauma, and Obsessive-Compulsive Disorders

• Anxiety: Negative mood state characterized by physical tension and apprehension about the future.
• Fear: Immediate alarm reaction to danger, activating the autonomic nervous system.
• Panic: Sudden, overwhelming reaction.
• Two types of panic attacks described in DSM-5:
  • Expected (cued) panic attacks: Occur in specific situations
  • Unexpected (uncued) panic attacks: Occur without any clue as to when or where the next attack will occur.

Causes of Anxiety and Related Disorders: Biological Contributions

• Inherited tendencies to be tense and/or anxious, with collection fo genes making people vulnerable when in society/psychological factors
• Stress and environmental factors can activate these genes
• Depletion of GABA is associated with increased anxiety
• The noradrenergic and serotonergic systems are involved, as well as the corticotropin releasing factor (CRF) system.
• CRF system activates the hypothalamic-pituitary-adrenocortical (HPA) axis; CRF has effects on the limbic system, the locus coeruleus, the prefrontal cortex, and the dopaminergic neurotransmitter system.
• The limbic system acts as a mediator between the brain stem and the cortex.
• The behavioral inhibition system (BIS) is activated by signals from the brainstem of unexpected events, causing the person to freeze, experience anxiety, and evaluate the situation.
• The fight/flight system (FFS) originates in the brain stem and travels through the midbrain.
  • When stimulated it produces an immediate alarm-and-escape response, and is activated partly by deficiencies in serotonin.
• The sensitivity of these brain circuits can be changed by environmental factors.

Brain Imaging

• Shows that the limbic system in people with anxiety disorders is overly responsive to stimulation while the cortex's controlling functions are deficient.

Psychological Contributions

• Freud: Anxiety emerged as a psychic reaction danger surrounding the reactivation of an infantile/ fearful situation.
• Behavioural theorists thought: Anxiety was a product of learning through conditioning and modeling, or forms of learning

Integrated Model of Anxiety

• Involves a variety of psychological factors where: one may acquire awareness events happen to them outside their control and parents interact in positive/predictable ways to foster that control.
• Panic involves conditioning and cognitive explanations.

Social Contributions

• Stressful life events cause trigger biological and psychological vulnerabilities to anxiety and can often be social/innate.

Integrated Model Of Anxiety

• Includes Tripple Vunerability theory

1. Generalized biological vulnerability: there is inherited tendency to be uptight/ high-strung
2. Generalized psychological vulnerability: Belief that the world is dangerous and you can't cope.
3. Specific psychological vulnerability: Learning which object is dangerous

Comorbidity of Anxiety and Related Disorders

• The most common additional diagnosis for any anxiety disorder is major depression (50% of all cases). Additional alcohol/diagnose of drug abuse is less likely the individual will recover from anxiety & more relapse, with anxiety disorders co-occurring with physical (arthritis etc)

Anxiety Disorders

• Grouped as such:
  • Generalized anxiety disorder
  • Panic disorder and agoraphobia
  • Specific phobia
  • Social anxiety disorder
  • Separation anxiety disorder
  • Selective mutism

Generalised anxiety disorder

Ruled by worry, its characterised by difficulties in controlling life / excessvie anxiety

Statistics On Generalized Anxiety Disorder

Approx 3.1% of the population meet this during a given year, with med age of onset 31, affecting older patients/more females.

Causes Of Generalised Anxiety Disorder

Results in being an anxious rather than to Generalized Anxiety Disorder itself, where high sensitivity may have risen through early experiences where the world is felt to be uncontrollable (the generalized psychological)

Treatment Of It

Benzodiazpines (or anti depressants / paroxetine), where those help patients get throught process and info using images (cognitive behavioural therapy); all leads people through worry phases then provokes thinking into action

Panic Disorders And Agorphobia

• Panic disorder (PD): anxiety where individuals experience severe, unexcepted panic attacks.
• Agorphobia can become independent of panic attacks, mostly determined by the extent someone thinks another one will occur opposed to many in actually will, where interoceptive avoidance (behaviour removing physical behaviours resembling early panic attacks).

Panic Disorder Statistics.

PD is fairly common (with people as high as 2.75% of population fitting symptoms during a year, where around 75% are women).

The model is called triple vulnerability

Nocturnal Panic

Panic attacks more common b/w 1.30am to 3 am, and occurs during delta wave sleep (often after person has began sinking into delta sleep), in contrast no real nightmare dream going on that may be frightening to personal body.

Causes

Stress/panic = sleep apnoea / paralysis - where Agorohobia develops for person as has had panic attacks (which determine how it happens in society) Triple Vunerbility model We have vulerability through biological over reaction = leading people to alarm reaction

Cognitive Processes

Emphasise special psychological vulnerabilities to people with the disorder, where interpreted normal sensations from a catastrophic way, where people create these cycles by having a panic attack in the beginning Psychodynamic - early separation may predispose this.

Medication treatment

Benzodiazepines and serotinic/ neurotransmitter system seems effctive, with SSRI drugs for patient, and anti -seizers + lithium (mood changes), plus high doses of medication will often = high amount relapse / psych interventions.

Psychological Intervention

Exposure exercises with relaxing or retraining to cope + minimise the thought or panic. Concentration can help expose panic disorders.

Combined Drug Treatment

All treatment were