abpsych-prelim-reviewer-ko.pdf

ABPSYCH PRELIM 311 Reviewer Abnormal Behavior in Historical Context  Atypical or Not Culturally Expected-. - Understanding Psychopathology Reaction is outside cultural norms....

ABPSYCH PRELIM 311 Reviewer Abnormal Behavior in Historical Context  Atypical or Not Culturally Expected-. - Understanding Psychopathology Reaction is outside cultural norms. The  Psychological disorder, a greater the deviation, the more psychological dysfunction within an abnormal. individual associated with distress or impairment in functioning and a An Accepted Definition response that is not typical or culturally expected.  The most widely accepted definition  Phobia a psychological disorder used in DSM-5 describes behavioral, characterized by marked and persistent psychological, or biological dysfunctions fear of an object or situation that are unexpected in their cultural context and associated with present What Is a Psychological Disorder? distress and impairment in functioning, or increased risk of suffering, death, - Psychological disorder, or abnormal behavior: pain, or impairment. It is a psychological dysfunction within an  The diagnostic criteria from DSM-IV-TR individual that is associated with distress or as well as the emerging criteria for impairment in functioning and a response that DSM-5 found throughout this book are is not typical or culturally expected. all prototypes. This means that the  Psychological dysfunction refers to a patient may have only some features or Breakdown in cognitive, emotional, or symptoms of the disorder (a minimum behavioral functioning. number) and still meet criteria for the disorder because his or her set of symptoms is close to the prototype  Psychopathology is the scientific study of psychological disorders.  Mental health professionals take a scientific approach to their clinical work and therefore are called scientist-  Personal Distress or Impairment - practitioners Difficulty performing appropriate and expected roles Impairment is set in the context of a person’s background it is often quite normal to be distressed for example, if someone close to you dies. The human condition is such that suffering and distress are very much part of life. This is not likely to change. Furthermore, for some disorders, by definition, suffering and distress are absent. Consider the person who feels extremely elated and may act impulsively as part of a manic episode.  Clinical description, which represents Causation, Treatment, and Etiology Outcomes the unique combination of behaviors, thoughts, and feelings that make up a  Etiology, or the study of origins, has to specific disorder and to the activities do with why a disorder begins (what connected with assessment and causes it) and includes biological, treatment. psychological, and social dimensions.  As you will see in the next chapter,  Prevalence of the disorder. Statistics on psychopathology is rarely simple. This is how many new cases occur during a because the effect does not necessarily given period, such as a year imply the cause. To use a common example, you might take an aspirin to  Incidence of the disorder. Other relieve a tension headache you statistics include the sex ratio—that is, developed during a grueling day of what percentage of males and females taking exams. If you then feel better, have the disorder—and the typical age that does not mean that the headache of onset, which often differs from one was caused by a lack of aspirin. disorder to another. Historical Conceptions of Abnormal Behavior Three dominant traditions  Individual pattern, or course- a chronic 1. Supernatural model course, meaning that they tend to last a 2. Biological long time, sometimes a lifetime. 3. Psychological  Episodic course, in that the individual is likely to recover within a few months  Ancient Greece, the mind has often only to suffer a recurrence of the been called the soul or the psyche and disorder at a later time. This pattern considered separate from the body. may repeat throughout a person’s life.  The Supernatural Tradition- deviant  Time-limited course, meaning the behavior has been considered a disorder will improve without treatment reflection of the battle between good in a relatively short period. and evil.  During the last quarter of the 14th  Acute onset, meaning that they begin century, religious and lay authorities suddenly; others develop supported these popular superstitions  Gradually over an extended period, and society as a whole began to believe which is sometimes called an insidious more strongly in the existence and onset. It is important to know the power of demons and witches. typical course of a disorder.  Treatments included exorcism, torture, beatings, and crude surgeries, Caused  The anticipated course of a disorder is by demonic possession, witchcraft, called the prognosis. So we might say, sorcery in which various religious rituals “The prognosis is good,” meaning the were performed in an effort to rid the individual will probably recover, or “the victim of evil spirits. Other approaches prognosis is guarded,” meaning the included shaving the pattern of a cross probable outcome doesn’t look good. in the hair of the victim’s head and securing sufferers to a wall near the  front of a church so that they might conception (the Greek word for benefit from hearing Mass. “uterus” is hysteron) The Biological Tradition  Sanguine: (literal meaning “red, like  Hippocrates: Abnormal behavior as a blood”) cheerful and optimistic, physical disease insomnia and delirium caused by too - Hysteria “the wandering uterus” much blood in the brain - Greek physician Hippocrates (460–  Melancholic: black bile, depressive 377 b.c.) is considered to be the  Phlegmatic personality: phlegm, apathy father of modern Western medicine and sluggishness - Hippocrates considered the brain to  Choleric: yellow bile, hot tempered be the seat of wisdom,  Galenic-Hippocratic tradition consciousness, intelligence, and - Linked abnormality with brain emotion. chemical imbalances - Foreshadowed modern views  Hippocrates also coined the word  But rather than “humors,” the Chinese hysteria to describe a concept he and Asia focused on the movement of learned about from the Egyptians, who air or “wind” throughout the body. had identified what we now call the Unexplained mental disorders were somatic symptom disorders. caused by blockages of wind or the presence of cold, dark wind (yin) as  Galen extends Hippocrates’ work opposed to warm, life-sustaining wind - Humoral theory of mental illness (yang). - Treatments remained crude  General paresis (syphilis) and the  Hippocratic-Galenic approach is the biological link with madness. humoral theory of disorders. - Several unusual psychological and Hippocrates assumed that normal brain behavioral symptoms functioning was related to four bodily - Pasteur discovered the cause – a fluids or humors: blood, black bile, bacterial microorganism yellow bile, and phlegm. - Led to penicillin as a successful  Blood came from the heart, black bile treatment from the spleen, phlegm from the brain, - Bolstered the view that mental illness and choler or yellow bile from the liver. = physical illness  Melancholia (depression). In fact, the  Syphilis, a sexually transmitted disease term melancholer, which means “black caused by a bacterial microorganism bile,” is still used today in its derivative entering the brain, include believing form melancholy to refer to aspects of that everyone is plotting against you depression. (delusion of persecution) or that you  The four humors were related to the are God (delusion of grandeur), as well Greeks’ conception of the four basic as other bizarre behaviors. Although qualities: heat, dryness, moisture, and these symptoms are similar to those of cold.  psychosis—psychological disorders  The empty uterus wandered to various characterized in part by beliefs that are parts of the body in search of not based in reality (delusions),  perceptions that are not based in reality Therefore, the mentally ill patient (hallucinations) should be treated as physically ill.  Acquired immune deficiency syndrome  Benjamin Franklin made numerous (AIDS) discoveries during his life with which we  human immunodeficiency virus (HIV) are familiar, but most people don’t know that he discovered accidentally,  Mass hysteria may simply demonstrate and then confirmed experimentally in the phenomenon of emotion contagion, the 1750s, that a mild and modest in which the experience of an emotion electric shock to the head produced a seems to spread to those around us. brief convulsion and memory loss (amnesia) but otherwise did little harm.  People are also suggestible when they are in states of high emotion. Therefore,  Insulin was occasionally given to stimulate appetite in psychotic patients who were not if one person identifies a “cause” of the eating, but it also seemed to calm them down. In problem, others will probably assume 1927, a Viennese physician, Manfred Sakel, that their own reactions have the same began using increasingly higher dosages until, f source. In popular language, this shared inally, patients convulsed and became temporarily comatose (Sakel, 1958). Some response is sometimes referred to as actually recovered their mental health, much to mob psychology. the surprise of everybody, and their recovery was attributed to the convulsions. The procedure  Paracelsus speculated that the became known as insulin shock therapy. gravitational effects of the moon on bodily fluids might be a possible cause  discovery of Rauwolfia serpentine (later of mental disorders (Rotton & Kelly, renamed reserpine) and another class 1985). This influential theory inspired of drugs called neuroleptics (major the word lunatic, which is derived from tranquilizers), for the first time the Latin word luna, meaning “moon.” hallucinatory and delusional thought processes could be diminished in some John P. Grey patients; these drugs also controlled agitation and aggressiveness. included  Champion of the biological tradition in benzodiazepines (minor tranquilizers), the United States was the most which seemed to reduce anxiety. influential American psychiatrist of the time.  Psychosocial treatment approaches to  Editor of the American Journal of the causation of psychopathology, Insanity, the precursor of the current which focus not only on psychological American Journal of Psychiatry, the factors but also on social and cultural flagship publication of the American ones as well. Psychiatric Association (APA).  Moral therapy- first half of the 19th  Grey’s position was that the causes of century, referred more to emotional or insanity were always physical. psychological factors rather than to a code of conduct. Basic tenets included  treating institutionalized patients as Defense mechanisms normally as possible in a setting that encouraged and reinforced normal  Defense mechanisms, unconscious social interaction protective processes that keep primitive emotions associated with conflicts in  Plato, for example, thought that the two check so that the ego can continue its causes of maladaptive behavior were coordinating function. the social and cultural influences in  Some people may redirect energy from one’s life and the learning that took conflict or underlying anxiety into a place in that environment. more constructive outlet such as work, where they may be more efficient  Aristotle, also emphasized the influence because of the redirection. This process of social environment and early learning is called sublimation. on later psychopathology. These philosophers wrote about the  Denial: Refuses to acknowledge some importance of fantasies, dreams, and aspect of objective reality or subjective cognitions and thus anticipated, to experience that is apparent to others some extent, later developments in psychoanalytic thought and cognitive  Displacement: Transfers a feeling about, science. or a response to, an object that causes discomfort onto another, usually less-  Proponents of moral therapy threatening, object or person - Philippe Pinel and Jean-Baptiste Pussin  Projection: Falsely attributes own - Benjamin Rush – led reforms in U.S. unacceptable feelings, impulses, or - Dorothea Dix – mental hygiene thoughts to another individual or object movement - William Tuke – followed Pinel’s lead in  Rationalization: Conceals the true England motivations for actions, thoughts, or  Asylum reform and the decline of moral feelings through elaborate reassuring or therapy self-serving but incorrect explanations  Emergence of competing alternative psychological models  Reaction formation: Substitutes behavior, thoughts, or feelings that are  This release of emotional material the direct opposite of unacceptable became known as catharsis. ones  A fuller understanding of the relationship between current emotions  Repression: Blocks disturbing wishes, and earlier events is referred to as thoughts, or experiences from insight. conscious awareness  Because these conflicts are all within the mind, they are referred to as  Sublimation: Directs potentially intrapsychic conflicts. maladaptive feelings or impulses into socially acceptable behavior  Neuroses, or neurotic disorders, from  Counter transference, therapists project an old term referring to disorders of the some of their own personal issues and nervous system. feelings, usually positive, onto the  Self-psychology - psychoanalytic patient. approach by Heinz Kohut (1913–1981) focused on a theory of the formation of Humanistic Theory self-concept and the crucial attributes  Self-actualizing was the watchword for of the self that allow an individual to this movement. The underlying progress toward health, or conversely, assumption is that all of us could reach to develop neurosis. our highest potential, in all areas of  Object relations is the study of how functioning, if only we had the freedom children incorporate the images, the to grow. memories, and sometimes the values of  Carl Rogers (1961) originated client a person who was important to them centered therapy, later known as and to whom they were (or are) person-centered therapy. In this emotionally attached. Object in this approach, the therapist takes a passive sense refers to these important people, role, making as few interpretations as  The process of incorporation is called possible. The point is to give the introjection. Can become an integrated individual a chance to develop during part of the ego or may assume the course of therapy, unfettered by conflicting roles in determining the threats to the self. identity, or self.  Humanistic therapists believed that Psychoanalytic Psychotherapy relationships, including the therapeutic relationship, were the single most  Free association, in which patients are positive influence in facilitating human instructed to say whatever comes to growth. mind without the usual socially required censoring. Free association is intended  Classical conditioning, a type of to reveal emotionally charged material learning in which a neutral stimulus is that may be repressed because it is too paired with a response until it elicits painful or threatening to bring into that response. consciousness. - Extinction- without the food for a long  Dream analysis (still quite popular enough period would eventually today), in which the therapist interprets eliminate the conditioned response to the content of dreams, supposedly the food. reflecting the primary-process thinking  Systematic desensitization. In principle, of the id, and systematically relates the it was similar to the treatment of little dreams to symbolic aspects of Peter: individuals were gradually unconscious conflicts. introduced to the objects or situations  Transference, patients come to relate to they feared so that their fear could the therapist much as they did to extinguish; that is, they could test important figures in their childhood, reality and see that nothing bad particularly their parents. happened in the presence of the phobic object or scene.   Shaping, a process of reinforcing  46 chromosomes arranged in 23 pairs. One successive approximations to a final chromosome in each pair comes from the behavior or set of behaviors. father and one from the mother Chapter 2: An Integrative Approach to Psychopathology  Vasovagal syncope, which is a common  Phenylketonuria (PKU), which can cause of fainting. result in intellectual disability  Syncope means “sinking feeling” or (previously called “mental retardation”). “swoon” caused by low blood pressure This disorder, present at birth, is caused in the head. by the inability of the body to - possible cause of the vasovagal metabolize (break down) phenylalanine, syncope is an overreaction of a a chemical compound found in many mechanism called the sinoaortic foods. baroreflex arc, which compensates for  The first 22 pairs of chromosomes sudden increases in blood pressure by provide programs or directions for the lowering it development of the body and brain, and the last pair, called the sex chromosomes, determines an individual’s sex.  A dominant gene is one of a pair of genes that strongly influences a particular trait, and we need only one of them to determine, for example, our eye color or hair color. A recessive gene, by contrast, must be paired with another (recessive) gene to determine a trait. Genetic Contributions to Psychopathology  dominant gene, using Mendelian laws of genetics we can predict fairly  Genes are long molecules of accurately how many offspring will deoxyribonucleic acid (DNA) at various develop a certain trait, characteristic, or locations on chromosomes, within the disorder, depending on whether one or cell nucleus. both of the parents carry that dominant  Huntington’s disease, a degenerative gene. brain disease that appears in early to  Human genome—an individual’s middle age, usually the early 40s. This complete set of genes—consists of disease has been traced to a genetic more than 20,000 genes. defect that causes deterioration in a  Polygenic—that is, influenced by many specific area of the brain, the basal genes, each contributing only a tiny ganglia. It causes broad changes in effect, all of which, in turn, may be personality, cognitive functioning, and, influenced by the environment. particularly, motor behavior, including involuntary shaking or jerkiness  Quantitative genetics basically sums up throughout the body. all the tiny effects across many genes  without necessarily telling us which neuron and transmit the impulse to the genes are responsible for which effects. dendrite receptors of another neuron a  Molecular genetics focuses on  Axon, The other kind of branch, examining the actual structure of genes transmits these impulses to other with increasingly advanced technologies neurons. such as DNA microarrays; these  Synaptic cleft- The space between the technologies allow scientists to analyze axon of one neuron and the dendrite of thousands of genes at once and identify another. broad networks of genes that may be  Major neurotransmitters relevant to contributing to a particular trait. psychopathology include norepinephrine (also known as The Interaction of Genes and the Environment noradrenaline), serotonin, dopamine,  Eric Kandel speculated that the process gamma-aminobutyric acid (GABA), and of learning affects more than behavior. glutamate. You will see these terms He suggested that the very genetic many times in this book. Excesses or structure of cells may change as a result insufficiencies in some of learning if genes that were inactive or neurotransmitters are associated with dormant interact with the environment different groups of psychological in such a way that they become active. disorders.  Diathesis–stress model, individuals  Endocrine gland produces its own inherit tendencies to express certain chemical messenger, called a hormone traits or behaviors, which may then be  The adrenal glands produce activated under conditions of stress. A epinephrine (also called adrenaline) in condition that makes someone response to stress, as well as salt susceptible to developing a disorder. regulating hormones;  A gene that produces a substance called  Thyroid gland produces thyroxine, a chemical transporter that affects the which facilitates energy metabolism and transmission of serotonin in the brain. growth;  It seems that genes are turned on or off  Pituitary is a master gland that by cellular material that is located just produces a variety of regulatory outside of the genome (“epi,” as in the hormones; and the word epigenetics, means on or around)  Gonadal glands produce sex hormones and that stress, nutrition, or other such as estrogen and testosterone. factors can affect this epigenome, which  The cortical part of the adrenal glands is then immediately passed down to the also produces the stress hormone next generation and maybe for several cortisol. This system is called the generations. hypothalamic–pituitary–adrenocortical  Dendrites have numerous receptors axis, or HPA axis; it has been implicated that receive messages in the form of in several psychological disorders. chemical impulses from other nerve cells, which are converted into electrical Neurotransmitters impulses.  Agonists that effectively increase the  Neurotransmitters -The biochemicals activity of a neurotransmitter by that are released from the axon of one mimicking its effects;  substances called antagonists that found intriguing differences between decrease, or block, a neurotransmitter; the brains of patients with OCD and the  Substances called inverse agonists that brains of other people. Although the produce effects opposite to those sizes and structures of the brains are produced by the neurotransmitter. the same, patients with OCD have increased activity in the part of the  Reuptake- After a neurotransmitter is frontal lobe of the cerebral cortex called released, it is quickly drawn back from the orbital surface. the synaptic cleft into the same neuron.  They treated the patients with a cognitive-behavioral therapy known to  Glutamate, is an excitatory transmitter be effective in OCD called exposure and that “turns on” many different neurons, response prevention. leading to action.  Cognitive science, which is concerned with how we acquire and process Serotonin information and how we store and  Technical name for serotonin is 5- ultimately retrieve it (one of the hydroxytryptamine (5HT). It is in the processes involved in memory). monoamine category of Social Learning neurotransmitters, along with norepinephrine and dopamine  Another influential psychologist, Albert Bandura (1973, 1986), observed that  Norepinephrine seems to stimulate at organisms do not have to experience least two groups (and probably several certain events in their environment to more) of receptors called alpha- learn effectively. Rather, they can learn adrenergic and beta-adrenergic just as much by observing what receptors. Someone in your family may happens to someone else in a given be taking a widely used class of drugs situation. This fairly obvious discovery called beta-blockers, particularly if that came to be known as modeling or person has hypertension or difficulties observational learning. with regulating heart rate. Prepared Learning Obsessive compulsive disorder (OCD).  This conclusion is based on our learning to fear some objects more easily than  Individuals with this severe anxiety others. In other words, we learn fears based disorder (described in Chapter 5) and phobias selectively. suffer from intrusive, frightening  Prepared learning, we have become thoughts—for example, that they might highly prepared for learning about have become contaminated with poison certain types of objects or situations and will poison their loved ones if they over the course of evolution because touch them. To prevent this drastic this knowledge contributes to the consequence, they engage in survival of the species (Mineka, 1985; compulsive rituals such as frequent Seligman, 1971). Even without any washing to try to scrub off the imagined contact, we are more likely to learn to poison. A number of investigators have fear snakes or spiders than rocks or  flowers, even if we know rationally that ability to process color information. the snake or spider is harmless (for example, Fredrikson, Annas, & Wik, 1997; Pury & Mineka, 1997). In the absence of experience, however, we are less likely to fear guns or electrical outlets, even though they are potentially deadlier.  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. (A good memory for events is called explicit memory.) But implicit memory can be selective for only certain events or circumstances.  Fright disorders, which are  The black box refers to unobservable characterized by exaggerated startle feelings and cognitions inferred from an responses, and other observable fear individual’s self-report. and anxiety reactions. One example is  Stroop paradigm, participants are the shown a variety of words, each printed  Latin American susto, which describes in a different color. They are shown various anxiety-based symptoms, these words quickly and asked to name including insomnia, irritability, phobias, the colors in which they are printed and the marked somatic symptoms of while ignoring their meaning. Color sweating and increased heart rate naming is delayed when the meaning of (tachycardia). But susto has only one the word attracts the participant’s cause: T he individual believes that he attention, despite efforts to concentrate or she has become the object of black on the color; that is, the meaning of the magic, or witchcraft, and is suddenly word interferes with the participant’s badly frightened. In some cultures, the sinister influence is called the evil eye.  The principle of equifinality is used in developmental psychopathology to indicate that we must consider a number of paths to a given outcome