Psychopathology Chapter 1 Gambling is a top addiction The mind has a mental and physical aspect (affects each other) The most serotonin receptors are in your stomach. DSM 3 - (a th... Psychopathology Chapter 1 Gambling is a top addiction The mind has a mental and physical aspect (affects each other) The most serotonin receptors are in your stomach. DSM 3 - (a theoretical) describes disorders/phobias took out homosexuality focus on clinical description (not presumed etiology) DSM 1&2 - unproven Your DNA. life experiences, and information processing all matter Emotions are really central Diathesis-Stress Model - the biological factors, social factors, and psychological factors PLUS the biological triggers, social triggers, and psychological triggers Vulnerability + Trigger = disorder Dimensional is a spectrum Categorical is one or the other (threshold based) For suicide you have to dimensionally look at the symptoms, not categorically Frequency, intensity, duration Psychopathology - the scientific study of - mental, psychological, psychiatric, emotional - disorders To consider abnormality, context and duration matter All diagnoses needs functional impairment for it to be a disorder Not easy to describe normality No single definition to define abnormality Abnormal behavior often lies on a continuum from “normal” to “abnormal” 4 Characteristics (4 “Ds”) Applies to: Thoughts (cognition), Feelings (emotions), Behaviors Psychological Dysfunction (impairment) Individual is not able to perform expected roles (functional impairment) Personal distress (suffering) Individual experiences distress/discomfort Deviance (Atypical Cultural Response) Behavior is outside cultural norms Dangerousness Self or others One or two of these characteristics to be considered abnormal For every disorder: Criteria A: Symptoms Criteria B: Functional impairment Criteria C: Not organic Criteria D,E: Not other disorder Broad areas of clinical research related to psychopathology Description/Classification/Phenomenology Etiology/Maintenance - Potential cause Treatment Key Concepts: Operational Definition of a Disorder: Emphasis on reliability and validity of diagnosis Prevalence (duration) and Incidence (new cases) of Disorders Onset of Disorders Acute (sudden) vs Insidious (over time) Course of Disorders Episodic, time-limited, or chronic Prognosis With no treatment With treatments Etiology What contributes to the development and maintenance of psychopathology? Treatment Development How can we help to alleviate psychological suffering? Can be based upon understanding on presumed etiology of the disorder. Includes pharmacologic, biological, psychosocial, and/or combined treatments Treatment Outcome Research How do we know we have helped? Mental Health Professionals Primary groups who diagnose and treat mental illness (practice requires license in NY) Psychiatrists: MD (psychopharmacologists) Clinical Psychologists: PhD, PsyD Masters Level Counselors: Licensed Mental Health Counselors Social Works Marital/Family Therapists Other groups: e.g. Pastoral Counselors, CASAC (certificate) Chapter 3 About 20% experience functional impairment and distress triskaidekaphobia - fear of the number 13 Hotels skip floor 13 and airlines skip row 13 Does everyone who drinks alcohol become an alcoholic? (addiction) Does everyone who is exposed to a trauma experience PTSD? Exposure to alcohol increases the potential use of it when growing up. 1-2 glasses of wine a week can cause early signs of dementia One dimensional Models Explain pathology in terms of a single course Could mean a paradigm or conceptual approach (e.g., biological, psychoanalytical) Problem: other information is often ignored Multidimensional Models Use information from several sources Abnormal behavior is multiply determined Biological Factors (genetics, physiology, neurobiology) Social Factors (culture, environment, interpersonal relationships) Psychological (thought process, self-esteem, unconscious) The Biological Tradition Mental illness is seen as a result of brain abnormalities: Structural brain differences Neurochemical dysregulation (schizophrenia) Treatment emphasis: modifying biology Medication is primary modality Other modalities: ECT, TCMS, psychosurgery Increased stress: increase in central nervous system Limbic system (emotion system) Thalamus - receives and integrates sensory information Hypothalamus - eating, drinking, aggression, sexual activity Amygdala - fear, anger (fight or flight) Hippocampus - memory, sense of self, experiences Lobes of Cerebral Cortex Frontal - thinking and reasoning abilities, memory Parietal - touch recognition occipital - integrates visual input Temporal - recognition of sights and sounds and long term memory storage Main Neurotransmitters Released to Emotion Serotonin (5 - HT) - mood regulation reward, memory, cognition, sleep, sexual function, eating+ Gamma aminobutyric acid (GABA) - inhibitory (alcohol increases GABA) Norepinephrine (NE) - stress response Dopamine (DA) - pleasure, motivation Have effects on a variety of psychological functions especially mood. Most existing psychotropic medications target one or more of these Our bodies weren’t built to be stressed all day Exercise is important to remove norepinephrine Anticipation of pleasure is important, people depressed can't feel that Serotonin flows throughout the brain, major serotonin pathways in the brain. SSRI dont increase serotonin, it allows serotonin to stay around longer by blocking pathways. Psychological Tradition Psychoanalytic (Freud) - unconscious conflicts - inherent drives conflict with the real world Humanistic (Rogers) - lack of self-acceptance, validation Interpersonal (Sullivan, Klerman & Weissman) - interpersonal roles and traditions, interpersonal conflicts Behavioral (skinner, wolpe) - learning and conditioning, reinforcement/punishment in the environment Cognitive (Beck, Ellis) - information processing Freud - Psychodynamic Approach Significant historical figure Proposed psychological roots of psychopathology Developmental model (experience and driven) First to propose the “talking cure” Conflict between emotion and reason Id - cheat on exam Ego - wants to cheat, but doesnt do it because you could get caught Superego - not cheating because it is wrong Learning theory is reinforcement/punishment in the environment Ex: person is afraid of dogs, because they were bitten by dog or modeled by parents Common Factors Approach Race, country, sex are all important when checking suicide rates The Role of Emotion in Psychopathology Emotions are action tendencies that include affective, physiological, behavioral, and cognitive components Emotions are intimately tied to most types of psychopathology Emotional Dysregulation may play a role in all emotional disorders Ex: Pitbull running towards you Affective: fear Physiological: muscles tense, sweating Behavioral: escape, avoidance Cognitive: what's on my mind Chapter 3 Emotions (feeling) - central component Brain is not built for happiness Emotions are adaptions? A feature that results from natural selection that is common in a population because it provides some improved function and therefore increases successful survival and mating Emotions guide to meet our evolutionary motives Humans are reward-based learners (reward & punishment) Dopamine - reward chemical Having fear protects your from danger Relief can be a reward, avoidance Human’s superpower is that we can store calories, unlike other animals Emotions -> Motivational States (action tendencies) Goal congruent or incongruent (good or bad for us) “Positive Emotions” - direct us towards things that are good for our survival, mating, inclusive fitness “Negative Emotions” - direct us away from things that are bad for our survival, mating, inclusive fitness Empirical View of Human Nature Parenting Mate retention Mate acquisition status/esteem Affiliation Self-protection Immediate physiological needs Positive emotional states - seek to increase these Happiness - making reasonable progress toward or realization of a self-enhancing goal, success, you will never reach full happiness Pride - taking credit for a valued object or achievement, either our own or that of someone or group with whom we identify Relief - a distressing goal - incongruent condition has changed for the better or gone away Negative reinforcement Ex: eating when you’re hungry Love - desiring or participating in affection, usually but not necessarily reciprocated Negative emotional states - motivated to reduce these Boredom - response to lack of “meaningful activity” Value: feels displeasurable, looks to do something Fear, anxiety - response to danger 2 of the most biggest phobias - spider, public speaking value/function: physical threat and social threat Social anxiety is good, keeps you aware of surroundings Benign sadism Anxiety disorder is the most common Disgust - response to infectious disease Neophobia - fussiness to food, safe eating Sadness (depression) - a response to loss, failure to attain a goal Value/function: tears Sulking - fake sadness, manipulation tactic If you fail, you can get attention by physically showing it, can get help (sulking) (social support) Subordination - knowing your place, don’t want to challenge someone higher than you otherwise you could get killed Low self-esteem - despite having a lot of achievements, usually looks down on themselves Resignation - giving up, realize the loss is not achievable Anger - a demanding offense occurred against me or significant others, not being treated right, not treated fairly Feelings of being mistreated, usage of verbal attacks to change the other person’s view and output Physical aggression for self-defense and war Intermittent anger, self critical Someone who is homicidal can be suicidal, and vice versa Envy - occurs when a person lacks another’s (perceived) superior quality achievement, or possession and either desires it - or wishes that the other lacked it Schadenfreude: pleasure derived from the misfortunes of others People at the top still feels envious Guilt - having transgressed a moral imperative, recognizing that one has done something “wrong” Cheating is providing an advantage to the individual. When cheating, you feel guilt for doing something that would be advantageous. Shame (the response when you’re caught) - others have detected one’s failure to live up to an ideal or moral imperative Chapter 4 Assessing psychological disorders Purposes of clinical assessment To understand the individual (diagnosis, symptoms, life) To predict behavior, experiences, etc) To inform the selection of treatment (whether it be psychotherapy or medication, inpatient/outpatient, etc) To evaluate the effectiveness of treatment Value of Assessment Depends On: Reliability - the degree to which measurement is consistent Validity - the degree to which a technique measures what is is designed to measure Standardization - application of certain standards to ensure consistency across difficult measurements Domains of Assessment - clinical interview to assess for DSM diagnosis Mental State Exam - observation and description of a patient’s broad mental state Psychological Testing (e.g., self-report questionnaires, objective tests, projective tests) Physical Exam (after first appearance of the disorder to rule out organic cause) Biological tests not accurate, behavioral is more accurate Psychological testing Projective Tests: e.g. Rorschach, TAT Project aspects of personality onto ambiguous stimuli Roots in psychoanalytic tradition High degree of inference in scoring interpretation Reliability and validity are questionable Response inventories Usually based on self-reported responses Typically focus on one specific area of functioning For example Mood inventories (example: beck depression inventory) Relationship functioning (e.g., dyadic adj scale) Scale for suicidal ideation Hopelessness scale Sometimes you do not want such high “face validity” Minnesota Multiphasic Personality Inventory (MMPI) (1943) Consists of more than 500 self-statements that can be answered “true”, “false”, or “cannot say” Statements describe physical concerns, mood, attitudes toward religion, sex, and social activities, and psychological symptoms Assesses careless responding and lying (validity) MMPI Development Criterion validity approach: Clinical scales were derived by selecting items that were endorsed by patients known to have been diagnosed with certain pathologies (e.g. how do people with a certain disorder respond). E.g., of criterion approach - political party Republican: profile, gun rights Democrats: prochoice, gun control Chapter 18 Mental Health and the Legal System Guided by ethical principles and state and federal laws Issues to be discussed: Involuntary hospitalization Predicting dangerousness privacy/confidentiality Mandated (forced) treatment Insanity Defense:: civil (hospital) vs. criminal commitment (prison) Patient’s Rights The Right to Treatment - is this so? Uninsured Poor mental health coverage The Right to Refuse Treatment - not always The Right to Confidentiality - exceptions HIPAA federal privacy law - exceptions to privacy Commitment laws are not ideal for protecting the public in this area Confidentiality laws (protect public vs patient’s right to privacy) also create complicated scenarios Deinstitutional Movement: The advent of antipsychoctic medications: starting in the 1950’s, made it possible to manage symptoms of mental illness more effectively, reducing the need for long-term institutionalization Civil rights advocacy: concerns about the rights and living conditions of people in institutions led to legal and social action to promote their integration into the community Cost concerns: the high cost of maintaining large institutions prompted governments to seek less expensive alternatives The deinstitutionalization movement has largely been a failure Mandated Outpatient Treatment Assisted Outpatient Commitment (AOC) for serious mental disorders Compelled by court order to show up for prescribed outpatient care New York State:: Kendra’s Law, named for a young woman pushed to her death onto subway tracks by a mentally ill person Authorizes AOC “to prevent a relapse which or deterioration which would likely result in serious harm to the patient or others.” -> Attempting to correct for the failure of the “deinstitutional movement” (1970s, 1980s) to provide adequate services to those who were released from the hospital. Assisted Outpatient Care Saves money: $104,000 before the program to $39,000 (as a result of decreased hospital, ER, arrests). More humane: by keeping them well restores dignity to the patient and allows for improved quality of life **Controversy: violates civil rights (i.e., right to refuse treatment). Bottom line: Totally underfunded program - not near what is necessary. Results in the following… madman of 92st Psych Hospitalization New York went from: 600 beds per 100,000 population to 27 beds per 100,000 population BIG DECREASE Psych Beds decreased and suicide increased NY State: Involuntary Hospitalization (Civil Commitment) Emergency admission: Evidence that person has a mental illness which is likely to result in serious harm to self or others Must be examined within 48 hours by a psychiatrist Individual may be held for 15 days Medical certification: “TWO PC” = 2 physician’s consent -REQUIRED Typically initiated by someone familiar with the individual (eg, family member, treating doctor) Maximum = 60 days After 60 days hospital must apply to a judge for authorization to retain involuntary status. Pt receives legal representation Decision becomes a legal decision HIPAA & Public Safety Exception “Immenent” is in the process of being changed to “reasonably foreseeable” Mass shooters/killers: Mental illness (i.e., psychotic) Disenfranchised, alienated, angry individuals. Rage directed outwards. Ideologically driven (totally “rational”) Read more