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Mental Illness
Mental Illness: Midterm Lectures 1-2
113
Psychology
Graduate
10/17/2011

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Cards

Term

Current understanding of Mental Illness 

focuses on a _______

Definition

Holistic Understanding

 

-MI is complicated and disorder occurs at multiple levels

Term
6 ways mental illness can be defined
Definition
  1. evolutionary perspective
  2. statistical persepctive (deviance)
  3. pragmatic (whatever professionals treat)
  4. skeptical antipsychiatry view (ppl diagnose to get ride of bad behavior)
  5. value view (determined by social norms)
  6. harmful dysfunction model 
Term
Harmful dysfunction
Definition

- model used to define mental illness

 

Wakefield (1992)

Term
Current mental illness defintion
Definition

Harmful Distress

Distress discovered by self-report (subjective) and behavioral observations

Term
Problems associated w/ current MI definition (7)
Definition
  1. says nothing about cause/etiology
  2. bad inter-rater reliab: inconsistent & biased reporting, temporarily unstablity w/in the person
  3. comorbidity between disorders 
  4. limited predictive validity
  5. limited relation to tx
  6. definitions are arbitrary and hard to measure
  7. biased by culture
Term
Holistic understanding of MI (6 levels)
Definition
  • cultural/social (opportunities)
  • interpersonal/environmental (reinforcement)
  • mental
  • organ (hypofrontality)
  • cellular/molecular (serotinergic)
  • genetic/epigentic (5-HTTLPR)
Term

Examples of mental level phenomenon

associated with MI

Definition
  • Metacognitive beliefs 
    • depressogenic thoughts
  • basic neurocognition, motivation, affect
    • poor attention
  • autonomic or basic functions
    • decreased reactivity
Term

Reasons holistic understanding of MI is

better than previous definitions (7)

Definition
  • help thoerize and test models of etiology (etiology)
  • object & performance-based assessments (inter-rater reli)
  • isolates more specific unit of analysis (comorbidity)
  • identifies core neurodevelopmental or vulnerability features (predictive valid)
  • new entry points for tx (tx relation)
  • objective, ratio based measures (arbirtrary)
  • quanitify influences of various sources (culture)
Term
 Issues with Holistic approach to MI (5)
Definition

Issues with conceptual overlay, not a public policy

  • where is bx and self-report, critical for diagnosis?
  • creates confusion, who is the expert to tx and R?
  • how does causality work (each level effects each other)
  • one path to MI from simple to broad? (equifinality/multifinality)
  • social & professional issues: what level do you diagnose & tx, insurance, legal responsibility? 
Term
Inspiring change in MI
Definition
  • cities became center of civilization
    • large populations of indigent ppl w/ mental illness
    • gov't charged with their car
  • Islamic culture: scientific wave created scientific method
  • Asylums
Term
Asylums
Definition

Asylums: a natural laboratory

-superintendents were medical doctors trained in experimental science

 

Term

Organizations for professionals

caring for the  mentally ill

Definition
-1st called Association of Medical Superintendents of American Institutions for the Insane (AMSAII): changed to American Psychiatric Association
Term
Plan for running an asylum 
Definition

Thomas Kirkbride

 

Pennsylvania Hospital for the Insane

"Kirkbride" Plan-privacy, socialization, sun, air

-stoped blaming individual

Term

19th century understanding of

psychopathology: summary

Definition

-recognition that organs of the nervous system are related to MI

 

-recognition that clearly defined exogenous agents can cause MI

Term

20th century treatments (3)

(non pharmacological)

Definition

1908: Antibiotic for synphilis

1953: Psychosurgeries (lobotomy)

1938: ECT (based on faulse observation that schizo & epilepsy don't co-occur & correct observation that epilepsy are euthymic post-seizure)

Term
Invention of Chlorpromazine
Definition

1952: chlorpromazine (AP), started as anesthetic for surgery, sedetive effect used in schizo but found the calming effects (putatively) occur above and beyond the sedative side effects

 

1955: Impiramine (AD), Tricyclic 5-HT reuptake inhibitor made psychosis worse but helped depression

 

1957: Benzodiazepine (Tranquilizer), muscle relaxation and helped fear/anxiety. Improved neg affect w/ lots of disorders (psychosis, OCD, trauma, and addicts)

Term
What chlorpromazine showed
Definition

Extrogenous chemicals can alter neurochemistry

to alter MI

Term
Deinstitutionalization
Definition

Effect of drugs: 93% of state inpatient beds were lost

 

1955: community mental healthy study act enacted by congress to get info on effects of deinstitutionalization

 

1965-Community Mental Health Act: grants to establish local community mental health

Term
Effect of Community Mental Health Act (5)
Definition
Grants to states for local community mental health centers
  • inpatient tx for emergencies
  • outpatient tx
  • partial hospitalization programs
  • emergency/crisis tx
  • consultation/education
Term
Where have patients gone?
Definition

Forensic system

 

7.5-15% of ppl incaracerated have severe MI

Term
Categorical system
Definition

Emil Kraepelin: founder of modern psychiatry

  • Assumption that MI was biological in nature
  • categorical system (≈20 diagnoses)
    • seperated dementia praecox from manic depression
  • don't know cause but know the symptoms
Term
Krapelin's diagnoses
Definition

dementia praecox: persistent & psychotic symtpoms and deteriorating state

manic depression: intermittent psychotic symptoms and erratic course 

 

(1st time these had been split, psychotic by nature meaning symptoms had to with a seapartion from the body

Term
Hierarchical system
Definition

-continuum or spectrum w/ broad categories

(Freud example)

  • Healthy: efffective for handling anxiety, well functioning w/ work or love
  • neurosis: ineffective for handling anxiety, problems w/ work or love
  • psychosis: ineffective for keeping engaged w/ reality, considerable problems w/ work or love

 

Term
Dimensional System
Definition

continuum in population (e.g. Eysenck)

  • Neuroticism: tendency to experience negative emotions
  • extroversion: tendency to enjoy positive events
  • psychoticism: vulnerability to reality disturbances
Term
Examples of each broad type of taxonomies
Definition
  • Categorical
    • DSM, ICD
  • Hierarchical
    • psychodynamic systems
    • coping strategies/ defense mechanisms
    • hybrid DSM systems
  • Dimensional 
    • symptom-based assessments
    • Big 5
Term
ICD
Definition

first in 1900

most recent 1999

Chapter 5: mental & Behavioral Disorders

Term
ICD vs. DSM
Definition
  • Category checklist for DSM is very clearly defined algorithms, ICD is less clear
  • ICD gives more room for clinician interpretation 
  • ICD has less behaviorally ranked symptoms
  • DSM has x our of y symptoms in z categories (not this detailed in ICD)
Term
DSM I 
Definition
  • Emphasized hierarchical approach
    • viewed psychopathology as dimensional, but w/ distinct categories
  • Diagnoses meant as a guideline
  • Categories mainly descriptive in nature
  • based on APA's psychoanalytic orientation
Term
DSM-II
Definition
  • improved compatibility w/ ICD
  • Shift from psycho-analysis to psychodynamic thought
    • focus on fit between personality & environment

 

Term
3 problems associated with the DSM-II
Definition
  • DSM-II drifted from behavioral & medical sciences and allienated psychiatry from science
  • Efficency: Post WWII lots of mental health professionals (most not psychiatrists or trained in psycho-analysis) were seeing patients
  • Legal: Diagnoses were not defensible in court
Term
Evaluating the DSM-II
Definition

Spitzer & Fleiss (1975) created Kappa to show DSM-II was crap

 

Kappa=(Po-Pc)/(1-Pc)

 

Interpreting Kappa for dichotomous decisions

% agreement= 100, Kappa = 1.00

% agreement= 75, Kappa = .5

% agreement= 50, Kappa = 0

% agreement= 25, Kappa = -.5

% agreement= 0, Kappa = 1.00

Term
Interpretive guidelines for Kappa
Definition

Greater than .90 = uniformly high

.6-.9 = only satisfactory

.4-.75 = no better than fair

less than .4 = poor

Term
Fixing the theoretical  bias
Definition
  • Changes made from DSM-II to III
  • steer away from psychoanalytic to be more consistent w/ larger med and bx science
  • limited use of psychoanalytic terms (neurosis, moved these disorders to Axis II)
  • criteria focus on "atheoretical behavior"
    • symptoms: maladies reported by patient
    • signs: maladies detected by clinicians
Term
Issue with fixing the theoretical bias
Definition
Many claim biased on a medical orientation: assumption that problem bxs reflect underlying biological abnormalities
Term
Fixing the issue of clearer criteria
Definition

Fixed from DSM-II to III

The Feigner Criteria: Behavioral-based criteria for 14 disorders developed

Term
Fixing the issue of standardizing the clinical interview
Definition

Changes made from DSM-II to III

  • Schedule for affective disorders and schizophrenia (SADS)
  • semi-structured clinical interview for the DSM-III (SCAD)
  • diagnostic interview schedule (DIS)
  • mini-international neuropsychiatric interview (MINI)
  • composite international diagnostic interview (CIDI)
Term
Evaluating structured interviews
Definition

Kappa: >.7 = good

.5-.7=fair

<.5=poor

 

SCID=most of Axis 1 in fair to good range but differed a lot between sites (Williams, 1992)

 

Term
DSM-III
Definition

Multi-axial system

  • axis I: mental illness
  • axis I: stable metnal illness
  • III: medical
  • IV: psychosocial & environmental factors
  • V: GAF
Term
specific GAF cut-offs
Definition

40= highest if you have psychotic symptoms

20=highest if you have suicidal ideations

10=highest if suicidal

Term

DSM III

DSM-IV

Definition

III (1980): homosexuality deleted

 

IV (1994): clinical significant criteria included for 1/2 of disorders

-empirically baed: 3 step review process

 

Term
Personality diagnositc system
Definition

Hierarchical bc they are somewhat stable

[image]

 

Term
personality
Definition

-individual cognitive, affective and other genetic characteristics that contribute to a relatively stable set of behaviors

 

-thought to occur through social learning, genetics, and environmental factors

Term
Defense mechanism- hierarchical example
Definition
  • Adaptive Coping Strategies: Level 4
    • ways of dealing w/ stress, satisfactory to self & others
  • Neurotic Coping Strategies: Level 3
    • manipulate emotive & cog processes w/in the ind, when used chronically not adaptive
  • Immature or Borderline Coping Strategies: Level 2
    • manipulate cog and emotive processes b/ individuals instead of wihin an ind
  • Psychotic Coping Strategies: Level 1
    • distortion of reality to cope
Term
Level 4 defenses (3)
Definition

Hierarchical defense mechanisms

Adaptive Coping strategies

- Altruism

-sublination: indirect expression of instincts w/out adverse consequences or displeasure

-suppression: temporary loss of painful emotion

 

Term
Level 3 defenses (3)
Definition

 hierarchical defense mechanisms

Neurotic Coping Strategies

-repression: awareness lost but emotion retained

-intellectualization: awareness retained but emotion lost

-dissociation: both awareness and emotion lost

 

 

 

 

 

Term
Level 2 defenses (3)
Definition

hierarchical defense mechanism

immature or borderline coping strategies

-projection: external attribution of internal psych processes

-passive aggression: implicit aggression w/ intent of changing others behavior

-acting out: instinctive expression (toward another) to avoid awareness of cog or emotive process

Term
Level 1 defenses (2)
Definition

Hierarchical defense mechanism

Psychotic coping strategies

-Projection: external attribution of internal psych processes and out of touch with reality

-denial: frank rejection of reality

Term
evaluating defense mechanisms
Definition

-hierarchical defense mechanisms in the DSM-IV

-followed really successful adults  and assessed defense mechanism levels

-DSM-IV was decently reliable

 

-if clinicians are given disorders and told to sort and resort them you come up w/ an outline of where disorders fit from broad to more narrow (hierarchical)

Term

Other hierarchical diagnostic system

(not defense mechanisms)

Definition
[image]
Term
5-factor model
Definition

Dimensional approach

 

  • Neuroticism: enduring tendency to have neg emotions
  • extraversion: end tend to have positive emotions, especially w/ social relations
  • opennesses to experience: end tend to show creativity and ingenuity
  • agreeableness: end tend to be pleasent and accommodating in social situations
  • conscientiousness: end tend to act w/ ones conscience
Term
FFM vs. DSM
Definition

-FFM more reliable but validity worked into DSM bc of impairment criteria

But.. FFM is valid in that it converges w/ DSM

 

-psychometric methods can be used to assess FFM but not w/ DSM

Term
Genetics key terms
Definition
Genotype:molecular level, genetics
Phenotype: physical characteristics reflecting genotype & environment (can see w/ naked eye)subtle stable phenotypes that directly reflect the genotype (boimarkers, vulnerability markers, intermediate phenotypes) e.g. cog ability, facial asymetry, eye tracking
Mutations: changes to DNA sequence from radiation, UV light, chemicals, viruses, or copy errors
Epigenetics: Basic DNA sequence stays the same but changes in how genes are expressed
Endophenotype:
Term
Identifying the endophenotypes
Definition
1. associated w/ illness
2. heritable
3. stable trait, present regardless of if symptoms are present
4. within families, illness & endophenotypes co-occur
5. found in unaffected biological family members (e.g. mem impairment in mono twins of schizo even if twin doesn't have schizo)
Term
Sign of taxometric graph
Definition
-Peak means categorical, flast means dimensional
Term
Taxometric graph properties
Definition
Y axis is variability of a characteristic and X axis is another characteristic (both indicators of the same group)

Peak in the middle means more variability here because people from both groups are present, flat ends because it is all one group or the other
Term
MAXCOV
Definition
Taxometric approach
take 1 indicator, stratify it, and calculate the covariant w/ the other 2 measures as a function of the first measure
Term
Taxometric important terms
Definition
Fallible indicators: tangible measures of whatever you are trying to figure out is categorical/dimensional
Latent structure: dimensional vs. categorical
taxonic: aka categorical
taxon rate: estimate of the group membership
Term
Ways to estimate taxometrics
Definition
Mean Above Minus Below A Cut (MAMBAC): 2 dimensional indicator

Maximum Covariance (MAXCOV): 3 dimensional indicators
Maximum Eigenvalue (MaxEig): 3 dimensional indicators

1 scale you can do factor analysis and use subscales as diff indicators
Term
Taxometric who
Definition
Paul Meehl
-determine if schizophrenia is a discrete entity or a dimensional quality within a population
Term
Epidemiology Defined
Definition
Study of what is upon people
-correlations between variables in large samples
Term
Epidemiology Terms
Definition
Incidence: # of new cases in a defined period of time
Point Prevalence: # of cases at as specific moment
Period Prevalence: # of cases during a defined period of time
Relative Risk: prob of an event occurring in one group compared to probability of it occurring in another group
Odds Ratio: odds of en event occurring in one group compared to odds of it occurring in another group
Term
Relative Risk Equation
Definition
Rr=(# in group1 with disease/total # in group1) / (# in group2 with disease/total# in group 2)

e.g. 200 smokers, 50 have cancer: 200 nonsmokers, 10 get cancer
Rr= (50/200)/(10/200)=.25/.05=5
Term
Rr interpretation
Definition
Rr is 5 times that of developing cancer if you are a smoker (easier to understand)
Term
Or Equation
Definition
Or=(# in group1 with disease/# in grp1 without disease)/(# in grp2 with disease/# in grp2 without disease)

e.g. 200 smokers, 50 cancer: 200non, 10 cancer
Or=(50/150)/(10/190)=6.6
Term
Or interpretation
Definition
You are 6.6 times more likely to develop cancer if you are a smoker compared to a nonsmoker (better mathetmatically)
Term
Or coefficient values
Definition
4 = large
Term
Measuring Disease Burden
Definition
Financial (direct: cost associated w/ tx or basic needs that can’t be met, Indirect: loss of productivity)
Mortality: deaths associated w/ a specific cause in a defined period of time per 1,000
Morbidity: incidence or prevalence rates

Disability adjusted life years = (years of life lost + years lived in disability)/total years
Term
Effect Size
Definition
Measure of the strength of a relationship between variables
-descriptive, no inferential (does not increase with n)

Cohen’s = (M1-M2)/Pooled SDs
Term
Cohen's D sizes
Definition
Negligible = 0-.19
Small = .2-.49
Medium = .5-.79
Large = .8*
Term
R Sizes
Definition
Negligible = 0-.09
Small = .1-.29
Medium = .3-.49
Large = .5*
Term
NIMH studies
Definition
ECA: epidemiology
LCS: comorbidity
CATIE: schizophrenia
Term
Large epidemiology study
Definition
ECA: Epidemiological Catchments Area Study
NIMH funded

Gave Diagnostic Interview Schedule for the DSM-III to lots of people across multiple cites (1 year apart)
-lots of stuff written based on this data
Term
Lifetime prevalence of MI
Definition
ECA found w/in 1 year over 33% of general population met diagnostic criteria for some disorder
Term
Large Comorbidity Study
Definition
NCS: national comorbidity survey
NIMH funded
Composite international diagnostic interview administered twice (1 year apart)
Prevelance study

Found 50% lifetime prevalence and 30% year long period prevalence
Term
NCSR
Definition
NCSR: replicated using structured clinical interview for DSM-IV
Any disorder occurred about 50% (lifetime)
2 or more comorbid 28%
3 or more comorbid 17%
Term
Treatment of MI across time
Definition
Trend of increases in treatment
Still not enough, especially w/ severe MI
Term
WHO
Definition
World Health Organization
Started in 1948 in Geneva as part of NATO

Mission: “attainment by all peoples of the highest possible level of health”
-each year focus on one area of interest and do comprehensive R in that area (2001=mental health)
Term
GBD
Definition
Global Burden of Disease Study
WHO: first worldwide epidemiological project
DALY statistic formulated from world wide data
Study is completed annually
Term
DALY
Definition
Disability adjusted life years
One DALY = one year of life lost or life disabled
Weighted towards mid adult (most productive years)
Term
ESEMD
Definition
European Study on the Epidemiology of Mental Disorders
-CIDI interviews to a lot of people in 8 countries
(U.S. had highest prevalence of any disorder and only about 50% were getting treatment)

YLD=years of healthy life lost to disability
Term
Epidemiology Conclusions
Definition
-epidemiological methods are relatively well-established
-challenges involve data procurement, which has improved w/ globalization, improved population racking & tech advances
-MI is quite common
-MI is quite costly to societies
-TX is underutilized, especially by those who need it most
Term
Behavioral Genetics- Family Study
Definition
2 groups
-ill probands (person w/ illness)/family
-control proband/family

Procedure: determine % of family who develop illness
analysis: compare rates of illness between 2 groups
Term
Behavioral Genetics- Adoption studies
Definition
2 groups:
-probands from ill relatives raised by adopted family
-probands from ill relatives raised by biological family
Procedure: determine % of proband who develop illness
Analysis: compare rates of proband illness, higher illness rates in bio group supports genetic omponent
Term
Behavioral Genetics - Twin studies
Definition
Concordance (twins w/ at least 1 afflicted relative)

Pairwise: # of twins that are both ill/total twins
Term
ACE model
Definition
A+C+E=1
provides contribution of genetics, common and unique environment
Term
Calculating genetic contribution
Definition
A or h2: additive genetics = 2*(rmz-rdz)
C: common environment = rmz-A
D: unique environment = 1-rmz
Term
Methods in molecular genetics
Definition
Forward genetics: identify "mutant" or abnormal genes and liking them to endophenotypes of phenotypes (linkage studies)

Reverse genetics: inducing "knockout gene"-deletion of a specific gene and linking them to endophenotypes and phenotypes (animal analogue studies)
Term
Glutamate
Definition
excitatory, memory
Term
GABA
Definition
inhibitory
Term
Acetylcholine
Definition
autonomic muscle, sensory & REM
Term
norepinephrine
Definition
getting ready for action (amphetamine)
Term
dopamine
Definition
involuntary motor activity, reward
Term
serotonin
Definition
emotion & mood
Term
endorphins
Definition
pain reduction & pleasure
Term
Transmitter problems (6)
Definition
1. production in dendrites
2. transmitter release
3. number of receptors
4. reuptake
5. processing of used transmitter
6. neuromodulators
Term
Brain organization
Definition
Hindbrain: cerebellum, pons, medulla oblongata
midbrain:relays, substantia nigra, basal ganglia
forebrain: thalamus hypothalamus, limbic, cerebrum
Term
Limbic System
Definition
Hippocampus: consolidation of memories
parahippocampal gyrus: spatial mem
dentate gyrus: new memories
Amygdala: emotion, memory, arousal
hypothalamus: four Fs
Septa nuclei: reward
Nucleus accumbens: reward, pleasure, addiction
Term
Cortex
Definition
Cingulate cortex: bridges limbic & cortex (awareness, conflict monitoring, comparing internal/external stimuli)
Temporal: auditory processing center
Posterior: sensory info, spatial
Occipital: visual processing
Frontal: higher order cognition, planning
Term
Anterior vs. posterior cingulate cortex
Definition
anterior: error and conflict monitoring, effortful decision making

posterior: episodic mem retrieval, evaluating outcomes
Term
dorsolateral vs orbitofrontal
Definition
dorsolateral: motor planning, organization & regulation, WM

orbitofrontal: affective value of reinforcers, decision making, expectancy, planning to reward and punishment
Term
Neural Imagin
Definition
Event Related potentials: responses to an external or internal stimuli
EEG (oddball paradigm- response to unpredictable stimuli)
Term
Waves of interest to psychopathology
Definition
P300-parietal region occurring 300ms after stimulus onset- implicit info processing

N400-semantic integration, mag increases w/ more effort

P50-responds to second of identical stimuli, sensory gating
Term
Frontal asymmetry
Definition
differential activation of R vs L cortical regions

R frontal cortical: avoidance bx, negative affect
L: approach bx, extroversion, pos affect
Term
Single Photon emission computer tomography
Definition
3-d images of metabolism using exogenous radio-isotopes
Term
fMRI
Definition
blood floow
good spatial, bad temporal
Term
Function Near Infra Red (fNIR)
Definition
similar to fMRI, poorer resolution, better portability
Term
peripheral NS measurement
Definition
Cardiovascular activity
pupilometrics: increased mental effort/awareness
galvanic skin conductance
startle response
Term
startle response
Definition
strength of reaction to unexpected stimuli

Information processing: prepulse inhibition, warning stimuli to inhibit response to following response)

Affective modulation of startle response: magnitude of response is modified by affective state (scared easily when relaxed)
Term
Problem w/ multiple measurement
Definition
Chapman & Chapman, 1973
0saying grps differ on one measure but not another suggests differnetial deficit is not always true
-the difference could be due to the sensitivity of tests
Term
higher-order cognitive processes
Definition
Social Cognition:encoding, retrieval, processing, motivated bx related to same species interaction

schematic organization:association of concepts w/in LTM that forms beliefs

Meta-cognition: insight, self-awareness of ones own cognitions
Term
Attributional biases
Definition
Higher-order cog processes

-fundamental attribution: state explains self, trait explains others
-optimism bias
-self-serving bias: claim responsibility for success
-just world bias
-hindsight bias
-confirmation bias
-rosy retrospection
Term
Insight
Definition
Higher-order cog process

Awareness regarding one's mental illness, need for tx, consequences of bx
Term
measurement of implicit attitudes
Definition
Subjective-based
interviewer-based
behaviora: objective assessments

methods adopted from cog sciences (e.g. implicit attitudes test)
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