Psychology Week 3 PDF

lOMoARcPSD|5194257 Social Perspective Exposure to multiple uncontrollable and unpredictable frightening life events is likely to leave a person vulnerable to psychopathology  Early life deprivation or trauma  Problems with caregivers  Marital discord and divorce  Low SES and unemployment...

lOMoARcPSD|5194257 Social Perspective Exposure to multiple uncontrollable and unpredictable frightening life events is likely to leave a person vulnerable to psychopathology  Early life deprivation or trauma  Problems with caregivers  Marital discord and divorce  Low SES and unemployment  Maladaptive peer relationships  Prejudice and Discrimination This approach has highlighted the importance of environment and has contributed to the development of programs designed to improve the social conditions that lead to maladaptive behaviour No single cause of Psychopathology Week 3: (Introduction to Psychopathology continued) Multidimensional Models Multidimensional Models  Interdisciplinary, eclectic, and integrative  “System” of influences  Draw upon information from several sources Interactive nature Just because a faulty brain circuit might cause a mental problem, it does not mean that surgery and drugs are the only options available for treatment. Psychological and social factors and psychological and social interventions can influence brain functioning. Thus, we always need to consider factors together. Cause vs Maintenance What causes a problem, does not necessary explain why a problem persists. It is typically more important to know the maintaining factors as opposed to the initiating factors to treat a problem. Thus, one needs to go beyond the stress-diathesis model in order to help someone with a psychological problem. Multidimensional Model of Psychopathology Inuences Downloaded by Jackson Pullar ([email protected]) lOMoARcPSD|5194257 Biological  Genes, Neurotransmitters, Brain functioning, Hormones, HPA axis Behavioural  Emotional and Cognitive  Pavlovian conditioning, Operant conditioning, Prepared learning, Learned helplessness, social learning Flight or fight response, emotional phenomena, implicit memory These terms can be used interchangeably but they mean different things o Emotions are short-lived o Mood is more persistent o Anxiety and mood disorders are chronic Cultural factors, gender effects, social support Prenatal development, infancy and toddlerhood, childhood, adolescence, early adulthood, middle adulthood, late adulthood  Social and Interpersonal Developmental   Principle of Equifinality  Several paths to a given outcome  Paths vary be developmental stage Triple Vulnerability Model Multidimensional Model  General biological vulnerability  General psychological vulnerability  Disorder-specific psychological vulnerability What’s the evidence?  General biological vulnerability (neuroticism & extraversion) exerted the strongest effects on disorders  General psychological vulnerability (perceived control) contributed weakly  Disorder-specific vulnerabilities contributed weakly and sometimes in the opposite direction as expected o Provides evidence for moving toward transdiagnostic treatment for neuroticism and extraversion. However, assessing other disorder-specific vulnerabilities may lead to different results. Assessment & Diagnosis Assessing Psychological Disorders Clinical assessment: Systematic evaluation and measurement – Psychological, Biological, Social Diagnosis: Degree of fit between symptoms and diagnostic criteria Purpose:  Understanding the individual  Predicting behaviour  Treatment planning  Evaluating outcomes Value of Assessment Downloaded by Jackson Pullar ([email protected]) lOMoARcPSD|5194257 Clinical interview  Assesses multiple domains o Presenting problem o Current and past behaviour o Detailed history o Attitudes and emotions  Structured or semi-structured o Anxiety Disorders Interview Schedule for DSM-5 (ADIS-5) o Structured Clinical Interview for the DSM-5 (SCID- 5) Mental Status Exam  Appearance and behaviour  Thought processes  Mood and affect  Intellectual functioning  Sensorium Physical Exam Physical examinations can be helpful in diagnosing mental health problems. Understand and rule out physical etiologies:  Toxicities  Medication side effects  Allergic reactions  Metabolic conditions Behavioural Exam Behavioural observation  Identification and observation of target behaviours o Target behaviour: Behaviour of interest (e.g., something that needs to be increased or decreased)  Direct observation conducted by assessor (e.g., therapist) or by individual or loved one  Goal: Determine the factors that are influencing target behaviours The ABCs of observation  Antecedents  Behaviour  Consequences  But don’t forget context Self-monitoring – Reactivity Psychological Assessment We can use standardised tools to assess:  Cognition  Emotion  Behaviour Examples:  Projective tests  Objective tests  Intelligence tests  Neuropsychological tests Downloaded by Jackson Pullar ([email protected]) lOMoARcPSD|5194257   Neuroimaging Physiological assessment Diagnosing Psychological Disorders Idiographic strategy – What is unique about an individual’s personality, cultural background, or circumstances Nomothetic strategy – Often used when identifying a specific psychological disorder, to make a diagnosis Categorical and dimensional approaches:  Classical (or pure) categorical approach – strict categories (e.g., you either have social anxiety disorder or you don’t)  Dimensional approach – classification along dimensions (e.g., different people have varying amounts of anxiety in social situations)  Prototypical approach – combines classical and dimensional views Widely used classification systems:  ICD-11 o International Classification of Diseases (ICD-11) o Published by the World Health Organization (WHO)  Diagnostic and Statistical Manual of Mental Disorders (DSM) o Updated every 10 to 20 years o Current edition (released May 2013): DSM-5 o Previous edition called DSM-IV-TR Evolution of DSM  DSM-I (1952)  DSM-II (1968) o 10 loosely described categories based on psychoanalytic theory o Poor reliability  DSM-III (1980) introduced to improve reliability o DSM became atheorietical with expanding categories  DSM-IIIR (1987) – Aimed to improve clarity and eliminate inconsistencies  DSM-IV (1994); DSM-IV-TR  16 categories  DSM-5 (2013) o Initial rationale was to improve validity of diagnoses and change from categorical to dimensional criteria o 21 categories, 300+ diagnoses DSM-5 Guiding Principles  Must be practical for use in clinical practice  Only create changes that are supported by empirical evidence  Try to maintain continuity with DSM-IV  Harmonise with ICD-11  Aim to include cultural variations where possible  Reduce excessive use of “not otherwise specified” DSM-5 Changes  Dimensional consideration – scientifically premature  Organised on developmental and lifespan considerations—begins with diagnoses that start early in life and ends with late-life disorders Downloaded by Jackson Pullar ([email protected]) lOMoARcPSD|5194257     Disorders defined in relation to cultural, social, and familial norms and values—can’t just use the criteria as a checklist Removal of multi-axial system—should now use ICD codes for psychosocial and environmental problems NOS replaced with “other specified disorder” and “unspecified disorder” Added a few new disorders DSM-5 Pros Cons  Improved patient care  Highly heterogeneous disorders  Improved scientific study of mental disorders  Lots of comorbidity o o   Culturally limited Prevalence, comorbidity, treatments, outcomes  Atheoretical Better instruments  Biomedical in nature  Susceptible to reification  May cause or add to stigma  Lack of validity (but not invalid)  Too many categories – Doesn’t decipher between normal psychological phenomena and psychopathology Summarise distinctive features and thereby improve communication among providers and educators, as well as the general public  Improved reliability of diagnoses  Realisation that mental disorders account for a substantial burden of disease o Medicalisation of normality Problems with Diagnosing  Disorders are not things with distinct and independent existence  Disorders might merge into each other with no natural boundaries between them—fuzzy boundaries o Many disorders cluster together, some seem to share genetic predispositions  Clinical signs and symptoms do not constitute the disorder—we might have the symptoms wrong DSM-5 Aims for Clinical Validity A diagnosis is valid if it offers:  Clinical description  Lab research  Natural history  Family studies A schizophrenia diagnosis tells us:  A person is not exhibiting psychotic sxs due to a mood disturbance or drug  Has a greater than ave chance of scoring abnormally on test of sustained attention and eye tracking  Has a greater than ave probability of having first degree relatives with a schizophrenia spectrum dx  Likely will have a chronic course Downloaded by Jackson Pullar ([email protected]) lOMoARcPSD|5194257  Likely to respond well to medication that blocks the action of dopamine Always remember It is wrong to think of DSM diagnoses as definitive, natural categories – They are artificial. Tommy meets DSM-5 criteria for hoarding disorder  Not Tommy has hoarding disorder  Not Tommy is a hoarder Case Formulation Assessment is used to:  Develop a hypothesis about the causes of a client’s symptoms and diagnosis  Develop a hypothesis about the mechanisms that maintain a client’s symptoms and problems  Learn about the precipitants that activated the mechanisms causing the symptoms  Understand the how the patient and their environment may influence treatment outcomes  Select an intervention that will best target these outcomes  Monitor outcomes regularly and Amend formulation if needed Week 4: Anxiety and Related Disorders (Part 1) Anxiety, Fear, and Panic Anxiety  Apprehensive, future-oriented  Somatic symptomps: muscle tension, restlessness, elevated heart rate Fear  Immediate, present – oriented  Sympathetic nervous system activation: sweating, heart palpitations, rapid breathing, urge to run Panic  Abrupt experience of intense fear when there is no real danger attack DSM-5 anxiety disorders Types of anxiety disorders  Generalized Anxiety Disorder  Panic Disorder and Agoraphobia  Specific Phobias  Social Anxiety Disorder  Separation Anxiety Disorder  Selective Mutism Generalised anxiety disorder  Excessive anxiety and worry about multiple things occurring more days than not for at least 6 months  Difficulty controlling the worry  Anxiety and worry associated with other physical symptoms  Anxiety causes clinically significant distress or impairment  Not due to substance use or medical condition  Not better explained by another mental disorder  Prevalence: o 3.1% (year) o 5.7% (lifetime) o Might be as high as 10% in the elderly  Typically begins in adolescence/early adulthood  Chronic course  Associated factors o Threat beliefs o Poor problem-solving o Overestimate likelihood of feared events o Catastrophise costs o Intolerance of uncertainty o Engagement in unnecessary safety behaviour  Treatment – Cognitive-behavioural treatments o Exposure to worry process Downloaded by Jackson Pullar ([email protected])