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Abnormal Psych-Diagnostics and Depression
Exam 1
57
Psychology
Undergraduate 3
02/22/2014

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Term
What is "abnormal?"
Definition
a syndrome characterized by clinically significant disturbance of an individual's cognition, emotional regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes associated with mental functioning

associated with significant distress or disability in social, occupational, or other important activities

has cultural qualifications (loss/grief, social deviance)
Term
unidimensional model of psychopathy
Definition
-one school or approach
-one dimension of persons (behavioral, biological, social, emotional, developmental)
Term
multidimensional model of psychopathy
Definition
-interdisciplinary, integrative
-involves "systems" of influence that cause and maintain suffering
-draw on information form several sources
-address several dimensions of persons
Term
Biological model
Definition
-unidimensional
-physical disability, neurotransmitters, genetics, hormones, prenatal factors, trauma, drugs/alcohol

Treatments: drugs, exercise, treat disability, meditation
Term
Psychoanalytical model
Definition
-unidimensional
-childhood origins, unconscious, patterns of relationships and emotional reactions, defense mechanisms (repression, projection, regression, denial, sublimation), psychosexual stages, attachment

Treatments: talking, uncover causes, insight, short-term psychodynamic
Term
Learning/Behavior model
Definition
-unidimensional
-observation, classical conditioning, operant conditioning (positive/negative reinforcement and punishment), learned helplessness

Treatments: new behaviors/responses, change conditional responses, assertiveness training, shaping, social/relationship skills, exposure therapy, role playing
Term
Cognitions model
Definition
-unidimensional
-negative thinking about self, situations, future

Treatments: change self-talk, raise self-esteem and self-control, identify and alter maladaptive thoughts
Term
Humanistic/Existential model
Definition
-unidimensional
-emotional awareness, relationship with therapist, societal rules squash self and potential

Treatments: increase emotional autonomy
Term
Environmental/Community/Cultural model
Definition
-unidimensional
-patriarchy, environment of isolation (disability) and dependency, SES, race/ethnicity, lack of resources

Treatment: provide resources, work towards equality
Term
Family systems model
Definition
-unidimensional
-change in family causes change in self

Treatment: family therapy
Term
Diathesis-Stress model
Definition
-multidimensional
-looks at relationship between predisposition and stressors
Term
Reciprocal model
Definition
-multidimensional
-cyclical pattern: genetic predisposition, behavioral tendencies to engage in risky behaviors leads to stressful experiences/predisposition to develop a disorder, ultimately cause disorder
Term
Holism model
Definition
-multidimensional
-the whole is different from, and greater than, the sum of its parts
-integrative, emergent properties (the whole that emerges may be qualitatively different from its parts)
Term
Equifinality (multiple pathways) model
Definition
-multidimensional
-there are many ways to end up with the same disorder
Term
Multifinality model
Definition
the same event can lead to different outcomes in different circumstances, depending on which other factors play a role
Term
Interaction model
Definition
-multidimensional
-experience can change our brain structure and function
-brain structure and function can change experience
-psychopathy can change
the effect of a neurotransmitter varies with a person's previous psychosocial experience
-multiple causation is the rule, not the exception in explaining normal and abnormal behavior
Term
Best model perspective
Definition
-a broad, comprehensive system is best (address biological, psychological, social, cultural, ethical, spiritual, and developmental factors)

-multidimensional, integrative perspective is usually helpful in causation and treatment
Term
Why classify?
Definition
-starting point for treatment/overall easier to treat
-easier transfer of knowledge
-communication between professionals
-to understand people with similar problems
-research
-insurance
-need diagnosis to make money
Term
Classification ideals
Definition
-reliability: is same across time/location

-validity: does it say what it's supposed to, is it useful?
explanation
etiology: cause of disorder
course of disorder: is it predictive/consistent
associated features: concurrent validity, what comes with disorder
treatment

-categorical vs. dimensional vs. prototypical
categorical: you have it or you don't
dimensional: diagnoses fall on a scale
prototypical: compare to a prediagnosed patient/case
Term
Diagnostic Systems
Definition
-DSM
-Research Domain Criteria (RDoC)
-International Classification of Diseases
Term
DSM
Definition
-APA's classification system
-descriptive, atheoretical diagnostic tool, research-based, values include that impairment and subjective distress are not good

Criticisms
-reliable, but not valid
-has produced too many disorders
-pathologizes normal problems
-ignores individual differences
-biased by political influences and money
-overly medical/biological
Term
Research Domain Criteria (RDoC)
Definition
-breaks down disorders into units on analysis and negative valence systems
-focus on symptoms and behavior, not diagnosis
-leaves a lot of categories out (such as personality, relationships, culture, experiences, etc)
-maybe too far towards biological reductionism
-believes that psych problems are medical problems (BIOLOGICAL)
Term
International Classification of Diseases (ICD)
Definition
-a lot of content overlaps with the DSM
Term
classification vs. assessment
Definition
classification: narrower
-usually pertains to diagnosis

assessment: broader
-produces a comprehensive understanding
-integrates a wider range of considerations about the individual
Term
Assessment
Definition
Technical purpose: problem description, diagnosis, categorization, individuals as examples of applicable science laws

Understanding the person: being there, connection, meaning, culture/contexts, STORY

-"the process of collecting and interpreting information that will be used to understand another person"
-the person who conducts assessment must adopt a theoretical perspective regarding the nature of the disorders and the causal processes involved in the origins

Approaches
-Intuitive: vibes, senses, subjective to cognitive biases and errors
-Observation
-Interviews: structured or unstructured
-Formal testing: personality, objective, projective (ex: inkblot)
Term
Major depressive episode
Definition
-extreme depression
-2 weeks long
-cognitive symptoms
-physical dysfunction
-anhedonia: lack of interest
-duration: 4-9 months of left untreated
-will naturally subside
Term
Major Depressive Disorder
Definition
-no mania/hypomania
-single episodes are rare, likely to be recurrent
-recurrent: usually about 4 episodes over lifetime with the duration of 4-5 months each
Term
Dysthymic Disorder
Definition
-milder symptoms
-2+ years long
-chronic, persistent
-onset: early 20s
-early onset: before 21 (greater chronicity, more continuous, likely to run in family)
-median duration: 5 years, but depends on co-morbity
Term
Double Depression
Definition
-both major depressive episodes and dysthymic disorder
-dysthymia occurs first, consistently, then episode occurs
-severe psychopathic disorder
-poor course
-high recurrence rates
Term
Grief and depression
Definition
-62% of people who experience death have symptoms of depression

Pathological or complicated grief
-persistent intense symptoms of acute grief
-presence of thoughts, feelings, or behaviors reflecting excessive or distracting concerns about the circumstances/consequances of the death
Term
Depression Diagnostics
Definition
Need at least 5

-depressed mood
-anhedonia: decreased interest
-significant weight loss/gain or increase/decrease in appetite
-insomnia
-psychomotor agitation (irritability, physical tics)
-fatigue, loss of energy
-feelings of worthlessness or guilt
-cognitions (lack of concentration, rumination, etc)
-recurrent thoughts of death
Term
Biological causes of mood disorders
Definition
-familial and genetic influences: family studies/adoption studies/twin studies
-higher concordance with higher symptoms
-balance of various neurotransmitters and their interaction with symptoms of self-regulation are more important than level of any one neurotransmitter

-Dopamine: chronic stress reduces levels and produces depressive-like behaviors
-Endocrine stress: overactive HPA axis, neurohormones, elevated cortisol, suppressed hippocampal neurogenesis

-sleep and circadian rhythms: REM sleep, decreased slow wave sleep, sleep deprivation
Term
Psychological causes of mood disorders
Definition
-stressful life events: context, meaning, timing
-effects of stress: poorer treatment response, delayed remission/recovery, trigger for relapse
-Reciprocal-gene environment model: stress triggers depression
-learned helplessness: lack of perceived control
-depressive attributional style: internal (I caused it, my fault), stable (it always happens), global (it happens everywhere in my world)
-sense of hopelessness: lack of control and belief that they will never regain control
-pessimism
-negative cognitive styles: negative schemas, automatic thoughts,
-types of cognitive errors: arbitrary inferences (look at negative side of things), overgeneralization
-cognitive vulnerability: pessimistic explanatory style, negative cognitions, hopelessness attributions
Term
Social causes of mood disorders
Definition
-marriage, relationships
-gender differences (socialization)
-social support
Term
Treatment of mood disorders
Definition
-changing chemistry of the brain: tricyclics, MAO inhibitors, SSRIs, ECT or TMS

-psych treatments: cognitive therapy, behavioral activation, interpersonal psychotherapy
Term
Kinds of mood disorders
Definition
-Depressive disorders: dysthymia, major depressive disorder

-Premenstrual Dysphoric disorder

-Bipolar and related disorders: Cyclothymia, Bipolar, Bipolar II
Term
Manic episode
Definition
-a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity
-lasts at least a week

Symptoms
-inflated self-esteem
-pressure of speech/coherence
-distractibility
-increased involvement in goal-directed activities or psychomotor agitation
-excessive involvement in pleasurable activities having a high potential for negative consequences (ex: shopping spree)
-decreased need for sleep
-little logic

-treatments: mood stabilizers (lithium), antipsychotics, reduce triggers
-issues with treatment: patients enjoy the high, don't want to take meds, poor judgment, medication difficult to balance, poor side effects, can take several episodes to recognize need for treatment
Term
Bipolar disorder
Definition
Bipolar I
-one or more manic episodes or mixed (manic and depressive symptoms within a week) episodes

Bipolar II
-recurrent major depressive episodes accompanied by a least one hypomaniac episode

Rapid Cycling
-quick back and forth between mania and depression
-easier to treat with meds

-Has a strong genetic component: if a twin or both parents have Bipolar, you are 70% more likely to have it too
Term
Suicide facts
Definition
-based on disorder, tragedy, demographics
-methods: pills (over 50%), cutting (33%), jumping, hanging, shooting

-1/10 people who attempt suicide are successful
-1/100 adolescents who attempt suicide are successful
Term
Suicide causes
Definition
mental disorders: 80% greater risk with more than 1
-mood disorders: 50% of all people who commit suicide have one, 75% of adolescents who commit suicide have one
-impulse control disorders
-schizophrenia and other psychotic disorders
-alcohol abuse and dependence

contagion: if you see someone else commit suicide, you are at increased risk of doing so yourself

choice: is there a choice? is it rational?

prediction: there is no way to accurately predict suicide
Term
Suicide risk factors
Definition
-older than 45
-male
-white
-living alone
-unemployed/retired
-poor physical health
-stress
-separated/divorced/widowed
-mood disorder, alcoholism, mental disorder
-suicidal plans/ideations
-previous attempts
-family member suicide
-poor resources
-hopelessness
-being a member of certain disorganized communities
-growing up in poverty
-being sexually abused
-being a member of certain professions (dentist, lawyer, veteran, veterinarian, doctor, psychologist, etc)
Term
Suicide treatment options
Definition
-crisis intervention (acutely suicidal)
hotlines: short-term

-longer-term (chronically suicidal)
resolve underlying problems, screening and tailored treatment leads to a 75% drop in suicide rate
Term
anxiety
Definition
-a future-oriented state characterized by marked negative affect
-somatic symptoms of tension
-apprehension about future danger
-is adaptive at low levels
-often associated with pessimistic thoughts and feelings
-can refer to a symptom
Term
anxiety apprehension
Definition
-high levels of diffuse negative emotion
-a sense of uncontrollability
-a shift in attention to a primary self-focus or a state of self-preoccupation; worry about self
Term
Biology of anxiety
Definition
-neurotransmitters: GABA and serotonin

-brain circuits: GABA-benzodiazepine system, noradrenergic system, CRF system, behavioral inhibition system

-particularly active brain regions: limbic system, amygdala

-possible gastrointestinal problems
Term
fear
Definition
-present-oriented mood state with marked negative affect
-immediate fight or flight response to danger or threat
-strong avoidance/escapist tendencies
-involves abrupt activation of the sympathetic nervous system
-neural circuitry: fight or flight system
Term
panic
Definition
abrupt, intense fear with physical symptoms
Term
panic attacks
Definition
-more focused/intense than anxiety
-often triggered at an unwarranted time or place
-abrupt surge of intense fear or discomfort
-includes 4 or more symptoms (ex: sweating, increased heart rate, etc)
Term
panic disorder
Definition
-recurrent, unexpected panic attacks
-at least 1 month of persistent concern or worry about having additional panic attacks or their consequences
-significant behavioral change related to the attacks
Term
treatment of panic attacks
Definition
-exposure therapy
-cognitive-behavioral therapy, cognitive intervention
-identify and cope with triggers
-manage stress
Term
kinds of anxiety disorders
Definition
-panic disorder
-phobia
-social anxiety disorder
-agoraphobia
-generalized anxiety disorder
-related disorders: OCD and trauma-related disorders
Term
Phobias
Definition
-marked fear or anxiety about a specific object or situation which almost always provokes immediate fear or anxiety and is actively avoided
-the fear is out of proportion to the danger prosed
-fear is persistent (>6 months)
-causes distress or impairment
Term
Social Anxiety Disorder
Definition
-pathological shyness
-includes fear of public speaking
Term
Agoraphobia
Definition
-fear of being in situations that could cause anxiety or panic
-possibly with co-morbid panic disorder
Term
Generalized Anxiety Disorder
Definition
-excessive anxiety or worry occurring for many days at a time for at least 6 months
-difficult to control the worry

social factors
-stressful life events
-childhood adversity
-attachment or separation anxiety

psychological factors
-classical conditioning
-cognitive factors: perception of lack of control, misinterpretation of an external threat that makes them believe they're in imminent danger, biased information processing (over=sensitively focus attention on perceived threats)

biological factors
-genetic (moderate heritability)
-neurobiology: brain circuits, neurotransmitters (serotonin, norepinephrine, GABA, dopamine)
Term
Depression and anxiety
Definition
almost all depressed patients are anxious, but not all anxious patients are depressed

comorbidity
-of those with an anxiety disorder, 55% had a second anxiety or depression diagnosis (76% over lifetime, and 50% had a major depressive disorder diagnosis over lifetime)
-comorbidity predicts poor outcome and high relapse rate
Term
treatment of anxiety disorders
Definition
psych treatments
-exposure: systematic desensitization, interoceptive exposure (oping by understanding self better), flooding
-relaxation and breathing techniques
-cognitive therapy
-psych treatments are more effective in the long term

medication
-anti-anxiety meds (are addictive)
-Buspar (targets serotonin)
-anti-depressants (SSRIs)
-DCS (facilitates extinction)

combinations of meds and psych interventions may be more effective than either alone
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