abnormal exam 1
What is the current lifetime prevalence of DSM-5 diagnoses, for one disorder, two disorders and three disorders?
0= 53% 1= 19% 2= 10% 3= 17%
Know and understand the three types of clinical observations we discussed in class. What are the strengths and limits of naturalistic and analog observations?
1) Naturalistic- occur in daily enviro, focus on relationship, participant observers report to clinician 2) Analog- focus on a specific interaction, such as a couple attempting to settle a disagreement. Strengths and weaknesses: Much can be learned from witnessing behavior, Reliability is a concern, Different observers may focus on different aspects of behavior, Validity is a concern, Risk of "overload," "observer drift," and observer bias, Client reactivity may also limit validity, Observations may lack cross-situational validity
How do we distinguish functional anxiety from dysfunctional anxiety? Know the yearly and lifetime prevalence of anxiety disorders in the US.
1. Is the anxiety triggered by inappropriate events or by inaccurate appraisals of events? 2. By intensity Affective intensity + Number of worries Ask: Is the fear or worry reasonable given the level of threat? Panic is an intense reaction, often unreasonable 3. By chronicity Does anxiety persist after threat abates in the short term? Are the fears appropriate over time? 4. Does the fear lead to dysfunction? Does it lead to avoidance? lifetime prevalence: Close to 29 percent develop one of the disorders at some point in their lives
What are the strengths and limits of self monitoring?
3) Self Monitoring- careful recording of frequency for certain behav/ feelings made by client pros: useful for infrequent behav, measures private thoughts and feelings that won't be known otherwise. cons: may be inaccurate, behav could change due to self monitoring (although this could be a good thing for the purpose of treatment)
What are the essential features of randomized controlled studies?
=experimental research design w/ random assignment... A study in which people are allocated at random (by chance alone) to receive one of several clinical interventions. One of these interventions is the standard of comparison or control.
PSYCHODYNAMIC basic theoretical assumptions as well as their strengths and weaknesses.
=underlying, unconscious forces interact dynamically. too much conflict results in abnormal behav. ego develops defense mechanisms to control id impulses~ repression, denial, projection, rationalization, etc. catharsis= relive repressed feelings to settle internal conflict. working through= examine same issue repeatedly, gain more clarity each time resistance= a client's unwillingness to discuss a particular topic in therapy transference= describes a situation where the feelings, desires, and expectations of one person are redirected and applied to another person/ a person in therapy may apply certain feelings or emotions toward the therapist. dream interpretation= the perceived, manifest content of a dream is analyzed to reveal its latent meaning to the psyche of the dreamer. STRENGTHS: views abnormal funct as rootes in normal funct / psychological conflict. first to apply theory and techniques systematically to treatment. LIMITS: unsupported ideas that are difficult to research because they are non-observable
Humanistic Model basic theoretical assumptions as well as their strengths and weaknesses.
A model of abnormal behavior that emphasizes personal growth, free will, and responsibility. Believes people are basically good, and have a drive to self-actualize through honest recognition of their own strengths and limitations. Rogers- unconditional positive regard will allow their client to be vulnerable and authentic. client centered therapy= skillful listening in a supportive enviro fostered by therapist conditions of worth= the conditions we think we must meet in order for other people to accept us as worthy of their love or positive regard. As children, we learn that there are certain things we do that please our parents or caregivers, and we strive to do those things. pro: paved the way for psychotherapy con: little research on impact in practice
Emil Kraepelin
A pioneer of diagnostic categorization in mental health who was one of the first to assign formal labels to particular clusters of symptoms
Dorothea Dix
A reformer and pioneer in the movement to treat the insane as mentally ill, beginning in the 1820's, she was responsible for improving conditions in jails, poorhouses and insane asylums throughout the U.S. and Canada. She succeeded in persuading many states to assume responsibility for the care of the mentally ill. She served as the Superintendent of Nurses for the Union Army during the Civil War.
What is the dodo verdict?
A term used to describe the overall finding that no single psychotherapy is superior to other psychotherapies overall; comes from "Alice in Wonderland" certain treatments are more effective for certain disorders (behav- phobias, drugs- schizo, psychotherapy + drugs- depression)
William Tuke
An English Quaker who opened the York Retreat, which pioneered new methods of treatment of mentally ill patients.
Anton Mesmer
Believed that the healing of physical ailments came from manipulation of people's bodily fluids. His technique of mesmerism was used with hypnotism. he used this technique to treat hysteria
COGNITIVE MODEL basic theoretical assumptions as well as their strengths and weaknesses.
Cognition as center of behav, thought, and feeling. abnormal funct can result from faulty assumptions and attitudes, overgeneralization (common in depressed people). cog distortion= all or nothing thought, catastrophize, mind-reading. People can overcome their prob by developing new, more functional ways of thinking. Becks cog therapy= challenge neg thoughts, then restructure them. --> widely used for treating DEPRESSION! pro: effective treatment for some disorder con: role of cog in abnormality has yet TBD and doesn't help everyone
What is the rapprochement movement? What are some common strategies of all effective therapists?
Effort to identify a set of common strategies that run through the work of all effective therapist. successful therapy gives feedback to clients, helps client focus on their thoughts and behav, pay attention to what client wants, promote self mastery.
What are empirically supported treatments? What is the standard for a well-established/efficacious treatment versus a probably efficacious treatment versus a promising treatment?
Empirically supported treatments: APA Task Force on Psychological Intervention Guidelines Well-established/efficacious treatments= Support from at least two independent randomized controlled studies Probably-efficacious treatments= Support from one randomized controlled trial or a small number of single-subject studies Promising treatments = Show efficacy in quasi-experimental studies or one single-subject research study
Benjamin Rush
Father of American Psychiatry
Philippe Pinel
French physician who worked to reform the treatment of people with mental disorder
Goal of clinical interview + What types of clinical interviews are there (unstructured, structured and mental status exam)? How does a structured clinical interview differ from an unstructured clinical interview? What are the limitations of clinical interviews?
Goals of clinical interviews: establish nature of the problem, obtain full psychosocial history and how it relates to the problem, est primary goals for treatment. Most are unstructured (aka open ended Q's) but some are prepared (such as the Mental Status Exam). A structured interview is very standardized and therefore in some ways more reliable because it isn't up for much interpretation. Limitations: may lack validity and accuracy, may contain interview bias/ mistakes in judgment, my lack reliability, people respond differently to certain interviewers
what is comorbidity?
Having multiple chronic illnesses
Hippocrates view of abnormal behavior. (greek and roman)
Hippocrates believed illness had natural cause/ arose from physical problems. brain pathology + imbalance of 4 fluids or humors (humors= bodily chemicals that influence mental and physical funct)
What is meta-analysis? What does the Smith and Glass (1977) meta-analysis tell us about whether therapy works?
Meta-analysis combines results from many psychotherapy outcome studies. Smith and Glass say that therapy works bc/ clients are better off then 75% of untreated people.
19th century
Reform and Moral Treatment. Individual care and humane standards. Each state responsible for having a public mental hospital.. Get rid of asylums
predictive validity
The success with which a test predicts the behavior it is designed to predict; it is assessed by computing the correlation between test scores and the criterion behavior.
Bernheim & Liebault
Their (psychogenic perspective) experiments showed that hysterical disorders could actually be induced in otherwise normal people while they were under the influence of hypnosis.
important terms: demonology, trephination, exorcism
Trephination is the practice of drilling a hole in a skull to relieve a brain or mental ailment. In the Neolithic days, trephination was probably used to allow demons to escape from the skull, but in modern neurology, it is sometimes used to treat the swelling of the brain. Neolithic society and most people during ancient times believed that mental illness and abnormality were due to demons. Henry's seizures, for example, would have been viewed as possession, and trephination or other religious ceremonies would have been used to treat mental illness. exorcism is the expulsion or attempted expulsion of a supposed evil spirit from a person or place.
Breuer
Used hypnosis to facilitate catharsis in Anna O.
What are projective tests? What are some examples of projective tests? What are the strengths and limits of projective tests?
a psychological test in which words, images, or situations are presented to a person and the responses analyzed for the unconscious expression of elements of personality that they reveal. EX: rorschach, TAT. strengths: used as personality assessment tool until 1950s, now it just gives supplementary info cons: hasn't demonstrated reliability/ validity. bias against ethnic groups
personality inventories? What is the MMPI? What is an MMPI profile? Familiarize yourself with the 10 clinical scales of the MMPI. What are the strengths and limits of personality inventories? What are response inventories? What are their strengths and limits?
a questionnaire (often with true-false or agree-disagree items) on which people respond to items designed to gauge a wide range of feelings and behaviors; used to assess selected personality traits. MMPI= 500 self statements, answer T/F, statements describe physical concerns, mood, etc. A score above 70 is considered deviant. strengths: objective. limits: SUPER LONG. people can fake their answers to create a good impression, and the ease of computerized testing may lead to misuse of these tests. if the question isn't understood (say by an ethnic minority) or their context/ culture isn't considered... they could be falsely proclaimed as abnormal
According to Thomas Insel, why should we think of mental disorders as brain disorders?
because it starts at an early age and there is a change in the brain before symptoms are present. early detection and prevention is key in the medical community, so if we can change our way of thinking about mental disorders to centralize more on the brain, then we can change the way they are treated.
Understand the categorical and dimensional approach to diagnosis and classification. How does the DSM integrate both categorical and dimensional approaches of diagnosis into the DSM-5?
categorical= medical model. yes or no. dimensional= mental illness on a continuum, the gray area. The DSM is categorical, but integrates the dimensional approach by adding measures indicating degree of acuteness to several combined diagnoses. Seeing mental illness on a spectrum is a dimensional way of viewing MH.
Renaissance (1400 to 1700)
community mental health programs. convert hospitals into ASYLUMS, which was well intentioned but resulted in overpopulation, filthy conditions, cruelty. hospital ("bedlam") even became a popular tourist attraction.
Middle Ages (500 to 1350 AD)
demonology part 2. religious beliefs were highly superstitious. distrust science. exorcisms were revived to treat... also torture.
What are the Four D's + define them. How do the Four D's help us to define abnormal behavior? What are the limits of using the Four Ds as criteria to define abnormal behavior?
deviance= different and extreme/bizarre behavior, distress= unpleasant for the person, dysfunction= interferes with ability to conduct daily life, and danger= poses risk or harm (to themselves or others). Context must also be considered. This criteria is rather vague and subjective, but that's what makes it a good starting point from which to consider psychological abnormality.
general paresis
disease that leads to paralysis, insanity, and eventually death; discovery of this disease helped establish a connection between biological diseases and mental disorders
eugenics, hypnotism, hysteria
eugenics= study of factors that influence the hereditary qualities of the human race and ways to improve those qualities, hypnotism= procedure in which a person is placed in a trance-like mental state to become highly suggestible hysteria= a psychological disorder (not now regarded as a single definite condition) whose symptoms include conversion of psychological stress into physical symptoms (somatization), selective amnesia, shallow volatile emotions, and overdramatic or attention-seeking behavior. The term has a controversial history as it was formerly regarded as a disease specific to women.
test-re-test reliability
if you take an intelligence test twice in 3 months, the results should be approximately the same -- ex. if you take the SATs in March, you should get the same scores when you take the SATs in April
Ancient view of abnormality -- Demonology
in medieval Europe, the study of demons and the treatment of persons "possessed" by demons. believe mentally ill person is possessed by a demon and must be exorcised to get rid of the demon (usually thru trephination) to be healed.
mass madness and tarantism
mass madness= large numbers of people share absurd false beliefs and imagined sights or sounds. tarantism= groups of people would suddenly jump, dance, or convulse. they were convinced they had been bitten by a tarantula and had to perform the dance to be cured.
inter-rater reliability
measure of agreement among observers on how they record and classify a particular event
Greek and Roman empire (500 BC to 500 AD)
mental illness had a natural/ physical cause. brain pathology + imbalance of 4 fluids: yellow bile, black bile, blood, and phlegm. Treat by eating more vegetables, exercising, celibacy, even bleeding.
Shrines at Geel in Belgium
model of community based care- Belgian town that for more than 700 years has welcomed people with mental disabilities and illnesses into their homes as "boarders," These are people who, whatever their diagnosis, have come here because they're unable to cope on their own, and because they have no family or friends who can look after them
What are neurological tests? Understand the examples presented in class for neurological tests (e.g., MRI, fMRI, etc).
neuro tests assess brain funct by assessing cog, perceptual, and motor funct. MRI = structure of the brain, comp generated img to distinguish dif types of soft tissue. fMRI= A technique for revealing blood flow and, therefore, brain activity by comparing successive MRI scans.
What control group options are there for clinical research?
no-treatment controls waitlist controls attention-placebo controls standard treatment controls (treatment as usual; TAU) (A clinical control group is a group of individuals, involved in a healthcare experimentation, who do not receive the treatment, in order to determine the effectiveness of the drug, supplement or treatment being tested.)
Understand the advantages and limitations of the DSM approach to diagnoses.
pros: simple, good for professional communication, creates a shared language, validates clients experience, useful tool in prediction and treatment plan. sci discovery cons: doesn't put the disorder in context, abnormality can be subjective,disorder are often comorbid (diagnostic overinflation), stigma
20th century
psychoanalytic theory and treatment. outpatient therapy gains popularity. Deinstitutionalization= release hundred of thousands of patients from public mental hospital > rise in homelessness + mentally ill people in jail.
define the terms psychopathology and mental disorder.
psychopathology is the scientific study of mental disorders. mental disorder is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. ... Mental disorders are usually defined by a combination of how a person behaves, feels, perceives, or thinks.
Know the characteristic symptom criteria of each of the anxiety disorders we discussed as well as OCD. Make sure you know and understand all of the theories of etiology (i.e., causal theories) that we discussed for the anxiety disorders and OCD. Review and understand the treatment approaches we discuss for anxiety disorders and OCD.
review notes and lecture slides
Based on your observations from the section video/audio, what are the five controversies associated with the DSM-5 (i.e., secrecy, false epidemics, lack of biological tests, drugs are the answer and imprecise diagnosis)?
secrecy= non disclosure agreement false epidemics= diagnostic inflation lack of biological tests= only symptoms are listed in the DSM critera, no phys tests drugs are the answer= pharmaceutical companies want to make money!! so people are being prescribed more drugs than ever, perhaps as a way to make money/ it doesn't truly help the individual or society as a whole imprecise diagnosis= based primarily on self-reports (people could lie/ just not understand their own symptoms exper as accurately as is necessary to make a proper diagnosis
somatogenic perspective vs psychogenic perspective
somatogenic perspective= view that abnormal functioning has physical causes. DSM~mental disoders have physical symptoms. SYPHILIS psychogenic= view that chief cause of abnormal functioning are psychological. hypnotism used to make someone highly suggestible.
Compare the methods of evaluating treatment outcomes: statistical significance versus effect size versus clinical significance. Know how to determine effect size.
statistical signif= the likelihood that a relationship between two or more variables is caused by something other than chance effect size= Effect sizes tell us how "large" was the outcome effect compared to the untreated control group using a SD as a standard form of comparison. ES = (Mtreatment group -Mcontrol group) / SDcontrol group. Effect size is a measure of practical significance- commonly used to evaluate how much change results from one therapy vs. another. clinical signif= measure whether a person or group recovers from a mental health disorder as a result of intervention? Does the individual or group show the same, or similar scores on the outcome measure as in the normal population?
What is the DSM and how does it contribute to diagnosis? What important changes to the classification system were introduced with the DSM-III? How many disorders are reviewed in the DSM-5?
the Diagnostic and Statistics Manual of Mental Disorder is the current classification system of mental disorders. It lists the symptoms of each disorder and provides info on its etiology, course, and prognosis. Diagnostic criteria was introduced in the DSM 3. There are 541 diagnoses in the DSM 5.
What is the biopsychosocial approach to understanding mental disorders?
the biopsychosocial approach is the interaction of biological (genetics), psychological (enviro, personality, stress), and social aspects (culture, relationships, economic stressors). The biopsychosocial perspective attributes complex phenomena or events to multiple causes.
face validity
the degree to which a procedure, especially a psychological test or assessment, appears effective in terms of its stated aims.
concurrent validity
the extent to which two measures of the same trait or ability agree
Johann Weyer
the first medical professional to specialize in mental illness aka PSYCHOPATHOLOGY
Freud's theory of psychoanalysis
the unconscious mind controls much of our conscious behavior. gain insight into our unconscious to overcome psychological problems
psychological assessment + it's purpose?
the use of specified procedures to evaluate the abilities, behaviors, and personal qualities of people. gather data to reach diagnosis and prognosis.
How are tests standardized?
they have common steps for administering the test, the test measures the score by comparing it to the norm using normal distrib. if score is exceptionally high or low/ clinically significant, then that person is special!
How did the authors of the DSM-5 try to ensure that it would be a valid and reliable system of classification?
they kept it rather simple by describing the disorder and symptoms that accompany it-- tool for diagnosis. they tested that the DSM would yield reliable results/ similar diagnoses when used by dif professionals. Valid bc/ top researchers worked on it.
