SOCI/HSOC 277: Exam 1

National Comorbidity Survey

national survey conducted in person in early 90s that studied non institutionalized people. Focused on 19 Axis I/focal disorders aka most common disorders. Led to Four Assumptions

normal sadness versus depression

normal sadness is not a disorder, but the DSM can conflate normal everyday suffering with MD

lifetime prevalence: older vs younger generations

older people actually have a lower lifetime prevalence than young people despite having lived longer, shows that MI prevalence is increasing over time

On Being Sane in Insane Places (Rosenhan) part one

part one: 8 fake patients into 12 different hospitals; told to complain of hearing voices upon admission and then act normally. None of the students were detected and stayed 19 days on average, released as "schizophrenic in remission" showing stickiness of labels. Only patients detected them. Also showed that the pseudopatients got psych symptoms from being there; felt powerless and depersonalized

genetic optimism

people are optimistic that finding the gene for an ailment gives hope for a cure; news stories emphasize that the gene exists, can be found in individuals, and will lead to a cure

mild disorders aren't important

prevalence is way too high.. nearly 50% is crazy treatment needs to be focused on those with serious issues note that high prevalence can cast public doubt on psych

medicalization

process by which non-medical problems become defined and treated as medical problems

which shows higher prevelence of MI: retrospective or prospective?

prospective. ask you what happened in the last year, and come back year after year to get lifetime prevalence. prevalence could be higher (it doubles!) bc you're asking people to remember less time so they won't forget as much critics say if you forgot it must've not been significant

what causes more sympathy: understanding the psychosocial causes of MI or the biological ones?

psychosocial; even clinicians showed lower empathy for biological caused situations than psychosocial ones.

renaissance and 17th century view of mental illness

renaissance: the mad had a gift of perception; seen as artists, valorized as unique perspective 17th century: mad were lacking reason, committing moral error, worthy of segregation

measuring depression

circle is disorder with arrows pointing to the boxes of symptoms; you don't need all symptoms to have diagnosis. A systemic measure of disorder

general definition of mental disorder as included in DSM IV

clinically significant behavioral or psychological syndrome or pattern that occurs in an individual that is associated with present distress or disability or with increased risk of suffering death, pain, loss of freedom -out to be associated with dysfunction and disability? (you could argue that many things are dysfunctional and you could also say that anxiety is evolutionary and depression could be a signal from the brain to look for ways out of a poor situation)

reliability

critical to DSM; the extend to which something we are measuring can be measured similarly at different times and between different people

example of vignette used for public opinion data

(name) is a (race)(man/woman) who has completed (education). They sniffed coke at party once with friends, and for the last few months, they have been snorting in binges that last several days. They lost weight and experience chills when binging. They spent their savings on cocaine. They tried stopping but can't and lost their job because they didn't show up. diagnosis: drug depedence

Four ongoing controversies in MI

-Categorical versus dimensional measures -conflation of normal sadness and depression -are mild disorders important? -the meaning of comorbidity

Causes of comorbidity

-brain: people with anxiety and mood disorders tend to share a hyperactive response to negative emotion/aversion in the amygdala -SNPs (single nucleotide polymorphisms) associated with a range of disorders like ADHD, autism, depression, schizo -genes don't discriminate, some disorders lead to other disorders, etc

dimensional measures

-like the RDoC -mental illness on continuum -each symptom can have its own level of severity -K10 histogram. most people are doing pretty well generally but it is hard to attach meaning

why we should distinguish normal sadness

-pathologizing normal conditions is harmful -distinction improves ability to make prognosis -accurate prevalence estimates -better estimates of need -avoids medicalization

basic characteristics of the DSM

-specific and discrete symptoms (lists) -duration criteria (need to not only experience symptoms, but for a finite period of time) -thresholds of illness (based on number of symptoms and the presence of key symptoms) -differential diagnosis (differentiate between different illnesses) -exclusions (bereavement, things that may produce symptoms of MI but shouldn't be regarded as such) -provides basic definitions of mental disorder

categorical measures

-specific and qualitatively distinct -you either have a MI or you don't -all psychiatrists can reach same assessment

graded nature of risk

-used to predict progression of mild disorders -if mild disorders were really insignificant, they would have an odds ratio of 1 -people with mild disorders shouldn't be at increased risk for negative outcomes (suicide, hospitalization) the study found that mild disorders still presented increased risk for all negative outcomes showing that mild disorders were indeed consequential and important

3 approaches to understanding meaning of genes

1. Genetic optimism 2. Genetic essentialism 3. A contigent approach

What are the four assumptions from the NCS

1. Mental illness is common 2. Many disorders are mild 3. Comorbidity is common 4. Treatment is uncommon but increasing

4 reasons for including bereavement

1. remove implication that bereavement lasts only 2 months when experts know its 1-2 years 2. Bereavement is recognized as a severe psychosocial stressor that can precipitate a major depressive episode in a vulnerable individual 3. BRD is more likely to occur in people with past personal/family history of depression. so if you exclude bereavement you're excluding those with fam history of issue 4. the depressive symptoms of BRD respond to same psych and drug treatment as normal depression

key changes in perceptions of metnal illness over 20th century

1950: more perception of psychosis, anxiety, and depression 1996: social deviance, mental retardation, and nonpsychosis. Over time our understanding has grown, thinking of more things like symptoms behaviors etc. As knowledge grows though there are now more things to stigmatize. our definition of mental illness is now broader

DSM I and II

1952/1968; heavily focused on psychodynamic speculation and childhood origins of mental disorder as well as unresolved conflict; discussions based just as much on what caused the symptoms as the symptoms themselves. NON SPECIFIC diagnostic material

DSM III

1980; much more symptom focused now over the DSM I/II; highly detailed and descriptive rather than etiological Theory neutrality was big: set aside psychodynamic theory or intuitions about about was caused the illness; we should be able to describe diagnosis entirely through symptoms allowed for common knowledge/reliability in assessment. Change from II (pamphlet) to III (thick book) was huge

beliefs about treatment

Americans support treatment, starting informally. Highest-lowest: Friends/family religious leader therapist self help group general doctor psychiatrist less common: natural healer, mental hospital

labels and dangerousness

At low levels of perceived dangerousness, the labeled line (of social distance) in the graph is lower than unlabeled. perhaps we give sympathy for MI at a certain point, it is a medical issue. However, at a certain higher level of dangerousness, the labeled line is higher than unlabeled. This means more dangerous percieved people have more social distance with the label than without.

pro including bereavement as disorder

DSM 5 included it because "evidence does not support separation of loss of loved one from other stressors" and that BRD seems related to SMD in that they both get better through therapy, sleep and persistence patterns are similiar

DSM in a survey

National Comorbidity Survey (NCS)

sensitivity

No false negatives; you will not miss any diagnosis of mental illness in your patients

specificity

No false positives (finding mental illness when there isn't one) premised on the idea that mental illness is rare

RDoC vs DSM

RDoC starts with science and moves backward rather than with symptoms and move forward, RDoC is dimensional while DSM is categorical. RDoC is mainly behavior and neuroscience, DSM fulfills aims of consistent diagnosis but not in seeking nature of MI

RDoC

Research Domain Criteria NIMH wnated a science guided metric for mental illness that was a good tool for research (unlike DSM) Dimensions nestled within 5 main domains of functioning

taxon

a group that differs from another group because of a natural thing; a non-arbitrary classification. psych disorders are hard to classify because they are not taxonic; it is also hard bc we only see symptoms

public opinion data on mental illness

The General Social Survey, people don't want to admit to being intolerant of the mentally ill! This is social desirability bias!`

comorbidity

The coexistence of two or more disorders -Same genes may underlie many psych disorders, are the genes truly discrete.. does one disorder cause another? -some say that comorbidity is caused by relationships among symptoms; that there are "bridge" symptoms common among psych disorders. One syndrome doesn't directly cause certain behaviors but the relationships among the disorders themselves -there are v few disorders with completely unique symptoms

assumption 4: treatment is uncommon but increasing

about 1 in 5 in NCS; went up to 17 in NCS-R (from early 2000s serious condition sufferers def increase in seeking treatment; in NCS it was only a quarter but NCS-R was up to 40 (which sounds great but that means that 60% of severe ill people aren't getting treated)

true prevalence

actual rate of disorder

criterion validity

assessment of the relationship between one measure and a different but related one that is valid Takes DSM and correlates it to another similar literature

why are the thresholds of mental illness in the DSM controversial

because when diagnosis is categorial and discrete, when you're either above or below the threshold to have a diagnosis.. that threshold/line is arbitrary. you can't make mental illness on par with physical and make acute diagnoses

network approach

bridge approach to comorbidity. symptoms should be networks or CLUSTERS. Comorbidity is a relationship between SYMPTOMS not DISORDERS NODES!! many different symptom pathways..

why is descriptive epidemiology of MI important

budget planning, health promotion programs, ID at risk populations, facilitate research, know approx how many americans are mentally ill

Type 2 errors

calling the healthy sick

Type I errors

calling the sick healthy

clinical prevalence

census of those being treated for mental disorder, issue is that it doesnt capture those who aren't getting treatment (barriers to care) can misrepresent what disorders are most prevalent bc people tend to get treated for some disorders over others

validity

degree to which an instrument measures what it is intended to measure. measured indirectly. DSM III was definitely more reliable but was it valid?

illnesses with high perceptions of violence

drug dependence is high harm to self AND others depression is low harm to others, high to self schizo is high in both (higher to self tho)

social construction

every culture has ideas about what abnormality is; we aren't indifferent to abnormality; we will always be socially constructing what mental illness is

bereavement

focal point of normal sadness controversy; the idea that people who have depressive symptoms as a result of grief will eventually get better while the person who has randomly brought on depression won't and will respond better to Prozac. Some argue that it doesn't matter what brought on depression

benefits of categorical over dimensional

for diagnosis, good for treatment, isn't perfect but is def useful, categories can create unity in a group. diagnostic decisions are categorical even if MI isn't

where did people tend to go for psych treatment (according to NCS/NCS-R)

general practitioners

contigent approach to genes

has different implications based on what disorder is being discussed. genetic arguments on depression tend to focus on its causes while those on schizophrenia are on its dangerousness. Genes may increase tolerance of somethings (depression) while decreasing tolerance of others (schizo)

genetic essentialism

idea is that genetic arguments not only make someone appear not responsible for their actions, it might actually INCREASE the stigma by emphasizing differentness and contagion within families they also increase seriousness. if something is seen as genetic, it is seen as more severe/consequential

negative valence domains

in RDoC, fear

positive valence domains

in RDoC, things that are ordinarily good but may turn bad like a positive motivation is good but can be impaired in mental illness

assumption 2: many disorders are mild

in the 26% 12 month prevalence of MI, 40% were mild. if you suffer from one disorder, it is likely mild. The most common MI are mild (anxiety is usually not severe)

On Being Sane in Insane Places part two

informed staff of set of hospitals that over 3 months, one or more pseudopatients would try to gain admission when in reality no fake patients were admitted. out of 193 people admitted that time, 41 were alleged to be fake by staff (19 by both staff and psychiatrist). Showed unreliability of diagnoses

face validity

instrument appears to measure what it is supposed to; most important for DSM

labels: they do a lot, but it's complex

labeling symptoms as a psych disorder fundamentally changes perceptions. they can make things worse or better (if you know someone is ill you may be more tolerant of their behavior, "cut them a break")

problems with diagnoses

limit information; confound the attributes of people (like their symptoms) with judgement about those attributes allows for professional dominance of psychiatry (DSM created business model where only limited group of professionals can diagnose people)

assumption 3: comorbidity is common

many people have multiple MI simultaneously; strong correlation with severity of MI and number of disorders, comorbidity is strong both in categories (ie within anxiety disorders) and out of categories. people can accumulate disorders in life

normal sadness

mild, proportionate to what's happening, and transient (goes away) real depression used to be regarded as sadness without cause

rise of genetic model

more informed public with more info, popularity of genetic arguments for traits are widely accepted as true, public accepts genes as facts of human nature

causes of mental illness as perceived by general american public

more so than 1950, 1996 survey showed Americans supported more genetic/chemical imbalance/neurobiological causes, and STRESS was biggest explanation. other causes: social, character, god's will

perceptions of violence in the mentally ill

more violent behavior is associated with mental illness now than before, we are tying mental illness and violence closer together now :( race/ethnicity/education did not sway perceptions of violence tho gender did (people fear men more)

dimensional spectrum

retardation to bipolar disorder certain disorders more related than others shows the symptoms that are related/shared with certain disorders rather than multiple comorbid disorders, a person gets a point on the spectrum

21st century view of mental illness

sees it much more as an illness with genetic causes, however stigma has not gone away. It has simply changed form.

US vs UK study

showed the unreliability of psych disorders (professionals coming to v different conclusions) -US psychiatrists tended to apply diagnosis of schizophrenia to a much wider variety of conditions than UK -Hospital diagnosis of schizophrenia in US was higher than its project diagnosis (hospital overdiagnosed) -London did better job at separating mood disorders from affective disorders as their hospital vs projects

Stigma

social distance is a great way to measure stigma.. Americans are more willing to befriend mentally ill but still likely to reject them. especially the closer/more personal they get (like marrying into the family)

which do psychiatrists tend to favor, specificity or sensitivity? why?

specificity. since specificity leads to no false positives. False positives are worse than false negatives because with false positives a huge chunk of healthy people get a diagnosis whereas with false negatives only a small portion of ill people get diagnosed as healthy

two notions of deviance

statistical notions: frequently occurring behaviors are normal, infrequently occurring behaviors are not. Mental illness ought to be rare ideal notions: judgements on what characteristics are good or bad regardless of prevalence; judgements about behavior we deem desirable or not (ex: we know depression is bad/deviant bc happiness is desirable)

discriminant validity

test whether one measure is unrelated to another it is supposed to be unrelated to

comorbidity controveries

the DSM doesn't draw clear distinction so there are too many "things" we can qualify for, and there is not a lot of discrimination in nature between different disorders

mild disorders are important

the definition of a case is not synonymous with the need for treatment, mild cases can lead to serious problems in the future; mild disorders still had higher rates of hospitalization, work disability, suicide attempt, etc than those without a diagnosis.. Psych disorders also tend to worsen with age

20th century view of mental illness

the mad are sick, we provide treatment but we have no real tolerance, still great deal of shunning and social distance

labels: they do nothing

the stigma is not surrounded on the label but on the behavior itself (like schizophrenia)

the public and theory neutrality

they don't stand for it. if you ask them to think about depression, certain symptoms will be elevated over others. more consistent with network approach. public seeks causal relationships among symptoms

assumption 1: mental illness is common

total lifetime prevalence of MI is 46, most common category is anxiety disorders

reification and its process

trying to make something concrete that is not in nature concrete Process: assess specific symptoms, split symptoms along arbitrary cut points, promote criteria as valid some say diagnoses are a reified measurement, based in artificial measurements and reduces information

vignettes

used to see people's perceptions of the mentally ill through providing stories of mentally ill people, varied the demographics so that that wouldn't affect their view of the person.. although how we perceive weakness in men/women differed

construct validity

using testable hypothesis

coercion into treatment

we believe treatment should be mandated/required and that people should be forced to be admitted to hospital if dangerous to self or others part of stigma

cycle of construction

what is mental illness? provide workable answer -> conduct research based on that answer -> get findings based on research, leading to -> what is mental illness, get workable answer its a cycle

involutional melancholia

what the DSM I called major depression