Psychopathology: Distress and Impairment

Distress, Impairment, and Cultural Context

• Distress is considered normal in certain situations.
• Dysfunctional distress arises when someone experiences distress disproportionate to the situation.
• Impairment must be pervasive and significant to be considered dysfunctional.
• Culture must be considered regarding normalcy in relation to how others behave to have context.
• Psychological dysfunction includes behavioral, psychological, or biological dysfunctions unexpected in a cultural context, associated with distress and impairment.
• Psychological dysfunction increases the risk of suffering, death, pain, or impairment.

The Science of Psychopathology

• Psychopathology is the scientific study of psychological dysfunction.
• Mental health professionals include Ph.D.s, Psy.Ds, M.D.s, psychiatric nurses, and licensed clinical social workers.
• Ph.D.s are clinical and counseling psychologists trained in research and treatment delivery.
• Psy.Ds are clinical and counseling "Doctors of psychology" trained in treatment delivery.
• M.D.s are psychiatrists who can prescribe medication.

Clinical Description

• Clinical description starts with the presenting problem.
• Symptoms include chronic worry and panic attacks.
• Descriptions differentiate clinically significant dysfunction from common experiences.
• Aspects of clinical description includes prevalence and incidence of disorders.
• Course of disorders can be episodic (major depressive disorder), time-limited (a cold), or chronic (schizophrenia).
• Prognosis can be either good or guarded.
• A good prognosis indicates a positive outlook.
• A guarded prognosis indicate an uncertain outlook.

Historical Conceptions of Abnormal Behavior

• Moral therapy focuses on individual attention.
• Moral therapy treats institutionalized patients as normally as possible, encouraging normal social interaction.
• The size and composition of institutions lead to declining cases of use.
• Influxing patients after immigration led to institutions thinking that they don't deserve moral therapy.
• The mental hygiene movement then focused on providing care to everyone.

Psychoanalytic Theory

• Defense mechanisms are the ego's attempt to manage anxiety from the id/superego conflict.
• Defense mechanisms include displacement, denial, rationalization, reaction formation, projection, repression, and sublimation.
• Psychosexual stages of development include the oral, anal, phallic, latency, and genital stages.
• Conflicts arise and must be resolved at each psychosexual stage.
• Libido is the life energy or sex drive associated with psychosexual stages.

Humanistic Theory

• Abraham Maslow's hierarchy of needs starts with basic physical needs and progresses to self-actualization, love, and self-esteem.
• Carl Rogers' person-centered therapy emphasizes unconditional positive regard, empathy, and innate growth tendency.
• This theory is useful for individuals without psychological disorders dealing with life stresses.

One-Dimensional vs. Multidimensional Models

• One-dimensional models explain behavior from a single cause.
• One-dimensional models tend to ignore information from other areas.
• Multidimensional integrative approach is interdisciplinary, eclectic and integrative.
• Abnormal behavior results from a multitude of influences; biological, behavioral, emotional, social/cultural, developmental, and environmental.
• Psychological disorders typically arise from both biological and psychological factors.

Interaction of Genes and Environment

• Through gene-environment interactions, the genetic structure of cells changes because of learning experiences.
• The diathesis-stress model shows how disorders result from risk factors combined with life stressors.
• The reciprocal gene-environment model shows outcomes result from interactions between genetic vulnerabilities and experience.
• Genetics influence a person's likelihood of selecting certain environments.
• Epigenetics - Environmental influences impact gene expression for the individual and descendants.

Neuroscience and its Contributions to Psychopathology

• Neuroscience studies the nervous system's role in disease and behavior.
• Key systems and structures are outlined in images of the nervous system.
• The nervous system includes the central and peripheral nervous systems, the neuron, the brain, and the endocrine system.

The Contributions of Behavioral and Cognitive Science

• Classical conditioning shows simple associations between two things that occur together.
• Research shows that higher-order processes sometimes play a role
• Operant conditioning involves repeating behaviors with desirable consequences and decreasing behaviors with undesirable consequences.
• Learned helplessness results from a lack of control.
• Observational learning involves modeling.
• Prepared learning involves associations that are easily learned.

Assessing Psychological Disorders

• Clinical assessment involves understanding a patient's life and experiences.
• Clinical assessment includes systematic evaluation and measurement of psychological, biological, and social factors.
• Diagnosis involves degrees of symptoms fitting a certain criteria.
• Reliability is the consistency of a measurement.
• Inter-rater reliability demonstrates consistency between scores from different evaluators.
• Test-retest reliability means consistency in scores when the same test is given repeatedly.
• Validity shows successful measurement.
• Concurrent validity compares results with another measure known to be valid.
• Predictive validity shows the assessment's ability to predict outcomes.
• Standardization involves consistent use by determined standards a technique.

The Mental Status Exam

• The mental status exam uses systematic observation of an individual's behavior.
• An observation is made regarding appearance and behavior.
• Observation is conducted about the thought process of the individual..
• An observation is made regarding the mood and affect of the individual.
• An observation is made regarding the intellectual functioning of the individual.
• Observation is conducted about the sensorium of the individual.

Personality Inventories

• Personality inventories are self-report questionnaires that assess personal traits.
• The Minnesota Multiphasic Personality Inventory use, for example, an empirical approach.
• Personality Inventories are easy to administer and score.
• Personality Inventories contain validity scales for detecting lies, defensiveness, and infrequent responses.
• Personality Inventories ensure excellent reliability.

Intelligence Testing

• Developed to predict academic success originally.
• Intelligence quotient (IQ) = (Mental age / Chronological age) * 100.
• Deviation IQ estimates how much performance in school will vary within the average of the same age.
• Intelligence goes beyond what a IQ test result shows.
• Intelligence includes adapting to the environment, creating new ideas, and processing information efficiently.

Evaluation of DSM-5

• "Fuzzy" categories show associations with comorbidity.
• Emphasis on reliability can undercut validity.
• Methods of constructing a nosology of mental disorders may perpetuate flawed definitions.
• They are subject to misuse.
• Diagnostic labels may have negative connotations that contribute to the stigma.

Diagnosis

• Diagnosis requires the symptom experienced to fit set criteria.
• Do not confuse diagnosis with prognosis.

Diagnostic and Statistical Manual (DSM)

• The DSMis published by the American Psychiatric Association.
• The first Diagnostic and Statistical Manual was published in 1952.
• Currently, the DSM-5-TR is used.
• Authors rely on scientific data.

Misdiagnosis

• Misdiagnosis includes mistakes such as Epilepsy vs. Schizophrenia.
• Medication reaction vs. Depression is another potential misdiagnosis.
• Brain tumor vs. Anorexia Nervosa is also potential misdiagnosis.

Independent and Dependent Variables

• The independent variable is the variable that is manipulated.
• The independent variable is used influence or change the dependent variable.
• The dependent variable is the variable that is measured.
• Change in the dependent variable is caused by the independent variable.

Considerations in Research Design

• Aspects of internal vs. external validity affect research design results.
• Internal validity- results come from the specific study
• External validity represents the generalizability of the research study
• Increase internal validity by minimizing confounds.
• Use control groups.
• Employ randomization procedures and analogue models.

Statistical vs. Clinical Significance

• Statistical methods help protect against biases in evaluating data.
• Statistical significance indicates if the findings are due to change.
• Clinical significance indicates the results are meaningful and will likely change patients.

Studying Individual Cases

• The case study method focuses on extensive observation and detailed description of client.
• The case study method uses foundation of recent historical developments in the field of psychology.
• Lack of rigor, poor internal validity, and several confounds are major limitations.

Correlational Research

• Correlation research is used for the degree that specific valuables connect to other valuable.
• Statistical associations between two or more variables are parts of its nature.
• Independent variables aren't impacted.
• Ranges from -1.0 to 0 to +1.0
• Correlation doesn't mean causation and directionality.

Epidemiological Research

• Epidemiological research is a type of correlational research
• This research involves surveying groups of people to find an entire population to study.
• Distribution consequences of a set of issues and problems is typically studied.
• Incidence focuses on causation and prevalence examines examples.

Group Experimental Research

• The researcher must manipulate an independent variable and watch dependent variable effects.
• Attempts to determine a potential causal relationships, which ensure premium on internal validity.
• The process should be a clinical trial, evaluating treatment.

Clinical Trials

• A control group creates a common comparison point.
• The two groups are matched by common background attributes.

Studying Genetics

• Placebo control group provides inactive treatment for comparison for the active group, neither being aware of their placement .
• Double-blind means that either the participants or the assessors know what they are getting.
• Behavioral genetics focuses on genetics, experience, and behavior relationships
• Looking at genotype allows for study of genetic makeup.
• Examining phenotype allows for study of observable characteristics.
• Study on endophenotype, a genetic mechanism that can contribute to the problems of symptoms. Family studies
• Proband is the person with the interesting trait to be examined.
• There are great influences if the first degree relative also has the some trait examined.
• Adoption studies separate environment effects.
• Similarities can be found with separated siblings to confirm those similarities. Study children similar to adoptive and birth parents.
• Twin studies allow for identical and fraternal comparisons.
• Those with a trait that twins share can confirm the genetic aspect.
• Adoption studies and twin studies when grouped allow the the separation of similar and raised apart children to see if they share traits through genetics.

Studying Behavior Over Time

• Time-based research strategies help to identify behavior over intervals.
• Cross-sectional designs examines cross sections of groups.
• Comparison traits in cohorts (age groups) should be examined.
• Longitudal desings, group studies should be analyzed on the same individual to better asses.
• Specific experiences must be considered during these examinations.

Cross Generational Effect

• Considers the generations being studied.
• Institutional review boards (IRBs) and APA ethics codes cover ethics of research.
• Protection is for right of human participants and ensure data is handled responsively.
• Informed consent is important for this process as research has had dark past like the testing under Nazi Germany.
• Capacity - Ensure people can give consent
• Voluntarism - Assure that there no coercion
• Comprehension - Discuss benefits and risks

Post Traumatic Stress Disorder (PTSD)

• Duration should last one month.
• Re-experiencing past trauma, nightmares, flashbacks, psychological distress.
• Avoid disturbing memories, feelings or events.
• People will likely Blame themselves or others.
• Anger outburst, reckless, self destructive behaviors, and hypervigilance.
• Stabbings, shootings and murders are triggers for PTSD.
• Few can get PTSD from this type of exposure.
• Shield oneself from PTSD after getting shield.

Trauma and Stressor Related Disorders

• Are disorders related to events
• Acute stress disorder before PTSD can sometimes prevent long-term issues.
• People can face adjustment in Reactive attachment disorder
• Can be for a set period with hard work stress.
• People may fall out of the attachment
• Unspecified and specific is trauma that can add stress.

Complexity of Anxiety

• Immediate, present oriented
• Sympathetic nervous system

Psychological Factors Affecting Medical Condition

• Indicates psychological variables may be impacting a general medical issue
• Dissociative amnesia involves some forms of psychogenic memory loss.
• Generalized or selective types are included.
• May also involve dissociative fugue.
• Amnestic episodes cause some people to transfer to an area and assume a new identity.
• One cannot easily know why or where they ended up.

Factitious Disorders

• Known as Munchausen syndrome
• Act of Purposely inducing physical symptoms
• External gains

Overview of Dissociative Disorders

• Cause severe detachment from life.
• This can affect memories and conscience from those
• Depersonalization is a detachment of reality and mind from self.
• Derealization id the same, just of their own mind

Mood Disorders and Suicide

• Mood disorders are prevalent to the new two chapters
• Depresses and Bipolar disorder are the most well known.

Depressive Disorders

• Disruptive mood regulation disorder is extreme.
• Major depressive disorder is persistent and is serious.
• Persistent depressive disorder
• Premenstrual Dysphoric Disorder
• Psychotic features - Hallucinations
• Anxious distress - Comorbid disorders and anxiety symptoms
• Mixed features - At least 3 symptoms of mania
• Atypical features - Oversleeping and overeating
• Catatonic features - Catalepsy
• Melancholic - Severe somatic symptoms, weight loss, loss of sex drive, anhedonia
• Peripartum onset - Immediately before or after childbirth; 13-19% meet criteria for depression
• Seasonal pattern - Seasonal affective disorder (SAD), 2.7% of population, Morning light, melatonin phototherapy, cognitive behavioral therapy (CBT)

Bipolar Disorders

• Bipolar I - Full blown mania with episode
• Bipolar II - Elevate mood that not affect functioning or go in need of hospitalization
• Both show good levels of production.

Manic Episodes

• Affect individual for about a week
• Individual must be able to self esteem
• Decreased sleep hours
• Talkative ness and goals
• Excessive involvement in activities that may cause self-harm
• Must be hospitalized and show 3+ of mania for at least a week
• Shows potential psychotic symptoms.

Hypomania

• Mood lasts 4 a week.
• Not fully full symptoms and elevated feeling.
• There are not many require needed
• At any point not require hospitals.
• There are not many need to psychosis.

Cyclothymic Disorder

• Moody and explosive at fast speeds.

• Hyper can occur

• Never takes fulls care of responsibilities

• Suicidal ideation

• Suicidal ideation - Ranges in types

• Suicidal ideation (Thoughts to detailed plans suicide)

• Passive - Wish to not be dead without plans

• Active - Is the though and included with good plan

Suicide Contagion

• People are likely to follow after others do the same.
• The most famous being what the media puts out may affect them.
• For example the lead singer killed himself.

Feeding and Eating Disorders

• Anorexia and Bulimia are feeding disorders.
• Eating large amounts and Obesity is not disorder.
• Everything starts with "I want to be thinner".

Causes of Feeding and Eating Disorders

• Social dimension are the real issues. Cultural should be the main point
• Thin is the new happiness in the current zeitgeist
• Internal mind are real factors
• 3 of that after must follow at least in month. Eating move speed Eat and feeling fill

Bulimia Nervosa

• Binge that follow the good.
• Fast eat to full is main part.
• Most people with bulimia are normal.

Treatment of Bulimia Nervosa

• Good treat and weight control.
• Should try to help with function.
• Can help but not long effect.

Anorexia Nervosa

• Not enough body weight is issue for people
• BMI is way is shown for that.

Anorexia Nervosa

• Restrict avoid and binge eat.
• Purge often exist as side for person.

Binge Eating Disorder

• Eat too fast to full is only way.
• Control is always is gone.