psych 303-1

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psych 303-1
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  1. the 7 modes of mental illness
    • Statistical
    • SOcial Deviance
    • Moral
    • Medical
    • Ecological/impairment
    • Harmful dysfunction
    • Transactional
  2. statistical mode of mental illness
    • mental illness is behavior at extremes of normal distribution
    • BUT -
    • - where do we draw the line
    • - it may leave out problems that are not rare
    • - are both extremes abnormal?
  3. social deviance mode of mental illness
    • behavior that violates a society's social norms/standards are abnormal
    • BUT
    • - unpopular/politically controversial as abnormal??
    • - some deviant behavior is a benign norm violation (standing too close to someone)
    • - its an extreme of cultural relativity - different cultures have determinants
  4. moral model of mental illness
    • moral violations are a product of mental illness
    • moral weakness/moral deficits/evil
    • BUT
    • - the morality thing changes with time (homosexuality as disorder?)
    • - cultural relativity again
  5. medical model of mental illness
    • disease processes operating at level of brain and then mind (look for signs/symptoms for a certain disease)
    • affects treatment
    • neuroimaging
    • BUT
    • - no environment factor is taken into account
    • - some mental illnesses don't have a objective marker
    • - the same symptoms may have different neural signatures (hard to deduce down to single problem in the brain)
  6. ecological impairment model of mental illness
    • theres a mismatch between the person and the context (not just faulty environment alone, or faulty inner dysfunction alone)
    • BUT
    • - some behavior could be adaptive in one environment and harmful in another (can be interpreted differently)
  7. harmful dysfunction
    • behavior creates HARM and reflects an underlying dysfunction in a naturally-selected mental function (like evolutionarily related - Wakefield)
    • BUT
    • - understanding natural selection in producing htese behaviors is hard
    • - how do you define dysfunction?
  8. transactional model of mental illness
    • psychopathology is a product of development
    • strongest theory
    • continuum
    • deflect from normal development pathways
    • childhood disorders extend into adulthood
    • source of adult disorders are form childhood
    • environment effects on genotype
  9. what percept of population will have any disorder at any point in life?
    • 46%, very high
    • its a pervasive problem
    • and these prevalence rates are comparable around the world
  10. severe mental illness prevalence?
    moderate prevalence?
    child forms?
    • severe - 6%
    • moderate - 20%
    • child forms (25%)
  11. why bother defining abnormality?
    • high prevalence!
    • impairment (relationships, health, skills, shame)
    • debilitating (5 of top 10 most disabling = mental disorders)
  12. The elements of abnormality
    • suffering (neither sufficient nor necessary)
    • maladaptiveness (self or society)
    • deviancy (must be stat. rare and undesirable)
    • violation of standards of society
    • social discomfort
    • irrationality or unpredictability (no control)
    • cultural factors
  13. DSM definition of diorders
    • tries to be impartial to causality (does not mention etiology)
    • 1. clinically significant behavioral/psychological syndrome
    • 2. associated with distress/disability (impairment)
    • 3. not predictable or culturally sanctioned response
    • 4. reflects behavioral/psychological/biological dysfunctions
  14. why is classifying a mental disorder hard?
    • borderline cases
    • how to define clinically significant?
    • how do you measure impairment?
    • the behavior could meet the descriptive criteria but not really feel pathological (eyebrow trichotillomania)
  15. the disadvantages to classifying disorders
    • loss of information - (b/c of shorthand classification)
    • labelling - a persons self concept can be affected by having a label
    • stereotyping
    • stigma- negative perception of those with a diagnosis
  16. examples of culture specific disorders
    • different ways of talking about depression - somatic vs. feelings
    • taijin kyofusho (Japan, don't want to upset people with their gaze/facial expression)
    • ataque de nervios (Caribbean, loss of control, crying, screaming, faint)
  17. deinstitutionalization
    the trend away from the use of traditional hospitalization (long in patient stays)
  18. the mental health professionals
    • psychiatrist - prescribe medications
    • clinical psychologyist - individual therapy
    • clinical social workers - family problems
    • psychiatric nurse - checks in with patient
  19. sources of abnormality research information
    • case studies - bias, low generalizability
    • self-report data - people aren't good reporters of own states, etc.
    • observational - direct observations, brain imaging,
  20. ways to view the brain
    • fMRI (use magnetic field on water molecules)
    • transcranial magnetic stimulation (magnetic field on top of head - brian tissue is stimulated)
  21. criterion group vs. comparison group
    • criterion group: people with disorder
    • comparison group: control group (no disorder but comparable to other group)
  22. Research designs
    • observational: no manipulation, like correlation (we use the natural groupings of people)
    • correlational: determines associations between phenomena
    • Retrospective vs. prospective strategies
    • experimental methods
    • treatment research - difference between two groups, one treated, one not
    • single case experimental designs
    • animal research
  23. retrospective vs. prospective strategies
    • retrospective: looking back in time, how they behaved earlier in life, events earlier in life (difficulties involved, because of biases in procedure)
    • prospective: look ahead in time (identify those with higher than average likelihood of becoming psychologically disorders and focus on them before hte disorder manifests itself)
  24. standard treatment comparison gorup
    • two or more treatments are compared in differing yet comparable groups
    • control group - efficacy of htat treatment has been established
    • see if NEW treatment has greater improement
  25. single case research designs
    • same individual is studied over time (behavior at one point is compared to another point)
    • ABAB - treat, then return to baseline, treat, then regturn to baseline
  26. analogue studies
    • can we generalize the results from animal studies to humans?
    • use this
    • study an approximation to the true item of interest
  27. study of abnormal behavior should be based on three principles
    • scientific approach
    • oppenness
    • respect for dignity, integrity and growth potential of all persons
  28. Monism
    • mind is entirely the product of the physical brain
    • mental disorder can be entirely traced and reduced to phsyical processes
  29. dualism
    • mind is separate from the body/brain
    • mental experiences not contained in cells, bodies, brains
  30. substance dualism vs property dualism
    • substance dualism: the mind and the body are completely different materials
    • property dualism: mind and body may emanate from same substances, but can't reduce one to other
    • - can see chemical acitvity, but not content
    • - can see location of activity, but not "thoughts" "feelings" per se
  31. the three core views of human mind
    • spritualism
    • naturalism
    • humanism
    • its not a linear progression through the three (waxes and waves over history, current theories tend to blend the views
  32. spiritualism
    • dualistic viewpoint
    • uniqueness of mind from spirits (higher religious powers, devils, demons, mysterious forces)
    • bodies are just the holding binds for spiritual forces/souls
    • treatment by religious institutions
    • disorders are due to possession by particular spirits (lycanthropy - possessed by wolves, or tarantism by spiders)
    • the social context is essential! (black death, koro in Nigeria)
  33. naturalism
    • the mind and disorder are a product of observable physical properties
    • a science
    • roots to ancient greece, china, egypt (hippocrates)
    • Paracelsus
    • "nervous exhaustion"
    • promoted the scientific approach
    • behaviorism
  34. the greek concept of four humors
    • 4 material elements - earth, fire, air, water
    • (heat, cold, moist, dryness)
    • (blood, phlegm, bile, black bile)
  35. humanism
    • rationality, reason, ethics, justice = guide for human behavior and disorder
    • humans actively shape own behavior and give meaning to life
    • psychological influences on disorder - psychoanalytic theory, humanistic psychology,
  36. trephining
    • a very early approach to treat mental disorders
    • chip away circular area of skull to let the evil spirit escape
  37. exorcism
    • primary means for treatment of possession (spirtualism theory)
    • cast an evil spirit out of an afflicted person
  38. Hippocrates - naturalism
    • natural causes/clinical observation/brain pathology
    • 3 categories: mania, phrenitis, melancholia
    • doctrine of 4 humors --> inbalance = disorder
    • importance of dreams (modern psychodynamic psychotherapy)
  39. Plato
    • viewed psychological phenomena as responses of the entire organism (reflects internal state/natural appetites)
    • looked at sociocultural influences
  40. Aristotle
    • student of plato
    • descriptions of consciousness
  41. Galen
    • greek physicians
    • contribution to the understanding of anatomy of nervous system (physical and mental categories!)
    • work to use medications to treat mental disorders (apotherapy)
  42. Early views in China
    • earliest civiliaitons that focused on medicine/attention to mental disorders
    • belief in natural not supernatural
    • focused on restoring balance in treatment
    • Chung Chiang (hippocrates of china)
    • but these views regresesd to belief in supernatural! (just like in the west)
  43. Middle Ages view of abnormality
    • mental hospitals established
    • Avicenna from Arabia (humane practices)
    • scientific inquiry limited (more characterized by ritual/superstition)
  44. mass madness
    • occurred in middle ages
    • whoel gorups of people affected simultaneously (hysteria)
    • tarantism (impulse to dance)
    • Saint Vitus's dance ( same as tarantism)
    • lycanthropy (possessed by wolves)
    • koro: fear of genital retraction (a view help today in Nigeria)
  45. Exorcism/Witchcraft
    • in middle ages
    • exorcism to get rid of evil spirit
  46. Paracelsus
    • during humanism movement - importance of human interests
    • mental disorder = product of disease
    • but had elements of spirituality - moons influence
  47. Johann Weyer
    • hated the accusement of witchraft
    • one of first physicans to specialize in mental disorders
  48. The establishment of asylums
    • places of refuge for care of the mentally ill
    • grew in number in 16th century
    • Bedlam = first asylum - bad conditions/practices
    • treated like beasts, chaining, inadequate food, uncleanliness
  49. Pinel
    • humanitarian reform in 1792
    • chains removed from asylums, sunny rooms, excersize, kindness
  50. moral management in usa
    • by benhamin rush
    • treatment that focused on a patient's social, individual, and occupational needs
    • moral/spiritual development (not focus on the disorders)
    • effective but abandoned in 19th century
  51. mental hygiene movement
    treatment that focused on physical well-being of hospitalized mental patients
  52. Dorothea Dix
    • humane treatment for patients - attention to the conditions fo the asylums and prisons
    • mental hygiene movement
    • money to build many hospitals
  53. electric shock therapy
    • benjamin franklins - explore shock to treat mental illness because he was shocked and it changed his memories
    • but not till later htat it was used as treatment for depression
  54. Clifford Beers
    • followed work on Dix - told of bad treatment -
    • campaign to get awareness
    • hated straight jackets
  55. Stuff that lead to the promotion of a scientific approach
    • paresis due to syphilis (treatment by malaria)
    • brain pathology = a cause (led to labotomies)
  56. Freud
    • psychoanalsis
    • inner dynamics of unconscious motives
    • free association, dreams, early conflicts, hypnosis to release emotions!
  57. Nancy school vs. Charcot
    • Nancy: hysteria = self hypnosis - psych cause
    • Charcot = degenerative changes caused hysteria - bio cause
  58. Wundt and James
    wanted to study psychopathology objectively - American labs and clinics
  59. Behaviorism
    emphasized the role of learning
  60. classical conditioning:
    • unconditioned behavior with neutral stimulus
    • Watson
  61. operant conditioning
    skinner - consequences of behavior influence behavior
  62. interactive vs. additive diathesis stress model
    • interactive: some amt of diathesis and some amoutn of stress
    • additive: they combine and must go past some critical level
  63. protective factors
    • make it less likely you'll respond badly to stressors
    • leads to resiliency!
    • Biological - genes, temperament
    • Psychological - high self esteem, high IQ
    • Social (parents, friends)
  64. Biological causes of disordres
    • neurotransmitters
    • hormones
    • genetics
    • genotype - environment interactions
    • genes/evolution
    • temperatment
    • brain dysfunction/neural plasticity
  65. which neurotransmitters associated with which diseases?
    • norepinephrine: emergency reactions
    • dopamine: shizophrenia/addiction
    • glutamate
    • serotonin: depression/anxiety
    • GABA: anxiety
    • there are environmental effects on neurotransmitters !! (rhesus monkeys and neurotransmitter)
  66. problems with HPA axis
    • sometimes there are problems in the negative feedback loops
    • problems with cortisol usually
  67. Temperament
    • reactivity/ways of self regulation
    • fearfulness/irritability, frustration, affect, control
    • --> neuroticism/extraversion/constraint
    • modulated by the environment - these effects can be passed on (epigenetic changes)
  68. Freud's psychodynamic theory to causes of disordrs
    • Id - instinct/pleasure
    • Ego: reality, manages the id
    • Superego: internalize moral views/taboos, conscience
    • disorders occur when there are conflicts between the 3!
    • Anxiety plays a huge role - ego-defense mechanisms
    • Psychosexual stages of development
    • Oedipus/Electra complex
  69. object relations theory for psycho causes to disorders
    • Mahler, Klein
    • indivudals relationships with other people, internal/external ojects
  70. the interpersonal perspective to causes of disorders
    • psychopathology is rooted in tendencies in interpersonal environment
    • Erikson
  71. attachment theory
    • Bowlby
    • early experiences with attachment relaitionships
  72. Behavioral viewpoints for causes of disorder
    • observable behavior!! - learning
    • classical conditioning/operant conditions (learn how to get goal)
  73. generalization vs. discrimination in behavioral learning
    • generalization: response evoked by similar stimuli
    • discrimination: learns to distinguish between stimuli
  74. Cognitive Behavioral viewpoint on causes of disorder
    • Bandura - cognitive aspects of learning
    • internal reinforcement, thoughts
    • how thoughts/info processing get distorted
    • Schemas - bad ones
    • attribtuion theory
  75. schemas and distortion of them
    • representations of knowledge, our guides to information
    • assimiliation: new info is distorted to fit existing schemas
    • accomodation: schmeas are changed to incorporate new info (harder)
  76. attribution theory
    • how people assign causes to events
    • non-depressed people have self serving biases for the positive things that happen in their lives (blame it on their goodness)
  77. Psychological Risk Factors
    • Early deprivation/trauma, institutionalization, neglect/separation
    • Bad parenting styles (authoritative = best)
    • Interpersonal Relationships - marital discord, divorce, peers rejection
  78. parenting styles
    • authoritative - competent children
    • authoritarian - conflicted, irritable chidlren
    • permissive/indulgent - impulsive/aggressive children
    • neglectful/uninvolved - moody, sad kids
  79. sociocultural viewpoints on causes of disorders
    • there is a universality of symptoms but the culture shapes the disorder/how its is viewed/its course
    • cultural bound syndromes
    • interpret behavior differently because of different norms
  80. sociocultural risk factors
    • low SES, unemployment
    • prejudice/discrimination
    • social change/adjustments (helplessness like 9/11)
    • violence/homelessness in urban areas
  81. 3 types of classification
    • categorical: healthy/disordered
    • dimensional: differing intensities on certain dimensions
    • prototype: essential characteristics, prototypical criteria, match a description or not?
  82. benefits of labelling
    • communication
    • search for causes/treatments
    • prognosis
  83. problems wiht labelling
    • leads to expectations
    • stigma
    • self-fulfilling biases
    • subjectivity
    • reification
    • power issues
  84. DSM
    • cateogircal with sharp boundaries
    • multiaxial
    • categories of signs/symptoms
    • exact, specific dimensions
    • IV- incorporated cultural/ethical considerations
  85. Axis I
    syndromes/other conditions that are a focus
  86. Axis II
    personality disorders, metnal retardation
  87. Axis III
    general medical conditions that are relevant
  88. Axis IV
    • psychosocial/environment problems
    • stressors
  89. Axis V
    global assessment of functioning (GAF scale)
  90. criticisms of the DSM
    • reliable? valid? interview biased?
    • comorbidity
    • need more axes?
    • not scientific! - biased, subjective, conflict of interests
    • hard to fit real people to criteria
  91. purpose of assessments
    • understand the person, predict behavior, plan treatment, evaluate treatment outcome
    • starts broad then narrows down
  92. procedure of assessments
    • physical exam
    • neurological exam (EEG, CAT, MRI, fMRI, PET)
    • neuropsych exam (cog./perceptual motor performances)
    • observation of behavior (natural vs. structured)
    • assessment interviews - structured vs. unstructured
    • psych tests (intelligence, personality - projective vs. objective)
  93. intelligence tests
    • WAIS-III, Stanford-Binet
    • Verbal (vocab) and performance (digit span)
  94. objective personality tests
    • MMPI - T/F questions
    • compare answers to the norms, detect lying
    • can you really test individuals complexities?
    • actuarial data - behavior can be scored
  95. projective testing
    • very ambiguous stimuli
    • Rorschack - can overpathologize
    • Sentence completion - little more structured
    • TAT - outdated, but can see concerts

    is this an art or a science? reliable? valid?
  96. 5 ethical issues of assessment
    • cultural bias
    • theoretical orientation
    • underemphasis on external stuff
    • insufficient validation
    • inaccurate data/premature evaluation
  97. SCAN
    • a systematic diagnostic schedule for classifying disorders
    • diagnostic algorithms
  98. emotion vs. mood
    • emotion: interupts thinking, very short lasting
    • mood: affects environment/thinking, lasts much longer
  99. Affective styles
    • we all have a baseline that we return to
    • rooted in temperatment (genetics)
    • psotivity vs. negativity

    breakdown in the affect regulation system that causes disorders!
  100. dysthmic disorder
    • low, longstanding depressivity, depressed mood + 2 more symptoms
    • at least for 2 years
    • never without it for more than 2 months
  101. major depression
    • more symptoms/persistent than dysthmic
    • fatigue, guilt, hopelessness, no pleasure, lazy, appetite changes, sleep changes, suicide
    • incidence rises in adulthood
  102. major depression specifiers
    • with melancholic features (loss of interest)
    • with psychosis (no contact with reality)
    • with atypical features (mood congruent)
    • with catatonic features
    • with seasonal pattern
    • with postpardum onset
  103. cultural differences in prevalence of major depression
    • 2x as likely in women
    • more in w. industrialized nations
  104. Biological Causes to major depression
    • genetics, serotonin transporter gene
    • neurotransmitters
    • HPA abnormality
    • Brain changes
    • abnormal sleep REM patters, circadian rhythm dysfunctions
  105. brain changes in depression
    • lower activity in L. hemisphere
    • increased activity in amygdala
    • decreased volume of orbital prefrontal cortex
    • decreased volume of hippocampus
    • decreased activity in anterior cingulate cortex
  106. psychological causes to major depression
    • stress events and how they are perceived
    • vulnerabilities (neuroticism/negative affect, early adversity)
  107. psychodynamic theories to cause of MD
    • Freud: anger turned inward (ambivalence between love and hate)
    • emphasize the importane of loss
  108. behavioral theories to MD
    dont' get positive reinforcment, increasing negative reinforcments
  109. Beck's cognitive thoery
    • dysfuntional beliefs
    • negative automatic thoughts
    • Negative Cognitive Triad
    • Think in extremes, attention to negative stuff, arbitrary evidence
    • errors in thinking
  110. Becks' negative cognitive triad
    neg. thoughts abotu self, experiences, future
  111. the helplessness/hopelessness theory
    • no control leads to helplessness
    • internal/external, global/specific, stable/unstable
    • Rumination (may be why women are more depressed than men)
  112. cycothymic disorder
    • less serious than bipolar, more chronic,
    • hypomania and moderate depression
  113. Bipolar I disorder vs. II
    • I: one or more manic episodes and major depression
    • II: no full blown manic episode (hypomania + MDE)
  114. biological causes to bipolar disorder
    • 70-80% heritability - big genetic contribution, polygenic genes
    • changes in norep/serotonin/dopamine
    • HPA abnormalities (increased cortisol)
    • deficits in dorsolateral prefrontal cortex
    • circadian rythm offsets
  115. psychological causes to bipolar disorder
    • stressful events
    • low social support
    • attritbution styles
    • thought processes
  116. suicide, prevalence, common themes
    • very likely to ocur during mixed moods (mania and depression)
    • more attempts by women, more completed by men
    • mood disorders, coduct disorders, substance abuse
    • alterations in serotonin
    • more whites than blacks
  117. 3 things for suicide prevention
    treat disorders, crisis intervention, focus on high risk groups
  118. Biological treatments for mood disorders
    • Monoamine theories
    • Drugs
    • Other treatments - electroconvulsive therapy, transcranial magnetic stimulus, bright light therapy
  119. drugs for mood disordrs
    • Lithium - mood stabilizer for mania, prevents cycling
    • anticonvulsants
    • antipsychotics
  120. monoamine theories
    • MAOI's - inhibit monoamine oxidase from breaking down serotonin/norepinephrine
    • tricyclics- bad side efects, increased transmission of hte neurotransitters
    • SSRI's - stops reuptake!
    • Buproprion
  121. behavioral treatments for mood disorders
    • focus on symptoms
    • teach new skills
    • change environment
    • reinforce good behaviors
  122. cognitive treatment for mood disorders
    • cognitive revolution in depression (bad schemas, thought processes)
    • Beck's cognitive triad for negative thinking
  123. 5 errors in thinking
    • 1. dichotomous/polarized
    • 2. overgeneralizations
    • 3. magnification
    • 4. personalization
    • 5. arbitrary inference (not enough evidence!!)

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