Clinical and Abnormal Psychology Flashcards
This section comprises 12-14% of the Psychology GRE subject test. When finished with this deck, you should have a better understanding of the following: Stress, Conflict, Coping, Diagnostic Systems Assessment, Causes and Development of Disorders, Treatment of Disorders, Epidemiology, Culture and Gender Issues.
What did Emil Kraeplin contribute to psychology?
Kraeplin created one of the first textbooks of co-occurring mental disorders, which he grouped together and classified with common symptoms. He also created the term “dementia praecox” for schizophrenic symptom clusters.
This became the ancestor to our modern Diagnostic and Statistical Manual of Mental Disorders (DSM).
Who was Philippe Pinel?
Pinel was one of the first mental health professionals to treat his patients with compassion and kindness. The model set by the Parisian hospital he ran was adopted by many other asylums.
Which American activist fought for asylum reform in the mid-1800s?
Dorothea Dix
Who wrote The Myth of Mental Illness?
Thomas Szasz
What is The Myth of Mental Illness about?
This book espouses the belief that labeling people as mentally ill makes them conform to the norms of society, rather than examining the societal roots of their mental problems. Szasz also espoused the belief that “mental illness” is a social construction.
To hear an excerpt of a speech by Szasz, please go here.
To what do the terms incidence, prevalence, and lifetime prevalence refer?
- Incidence is the number of new cases that appear in a population in a given period of time.
- Prevalence is the total number of active cases (old and new) present in a population in a given period of time.
- Lifetime prevalence is the total proportion of people who will meet criteria for diagnosis at some point in their lives.
What is comorbidity?
Comorbidity is another term for co-occurrence.
For instance, if an individual meets diagnostic criteria for both obsessive-compulsive disorder (OCD) and alcohol dependence, then that person could be said to have comorbid OCD and alcohol dependence.
Comorbidity is very common in clinical settings, and high rates of comorbidity suggest that many mental disorders are not clear-cut categories.
Diagnosis and Causes:
What is a necessary cause?
A necessary cause is something that must be present for a particular illness to occur:
If illness X occurs, then A must have been present.
Diagnosis and Causes:
What is a sufficient cause?
A sufficient cause is something that by itself may cause a particular illness to occur:
B, in the absence of other factors, can result in illness X.
Diagnosis and Causes:
What is a contributing cause?
A contributing cause is something that makes it more likely that a particular illness either will occur or will continue:
If C is present, then illness X is more likely to happen or continue.
What does ICD stand for?
What is the ICD-10?
The ICD-10 is the International Classification of Diseases. The ICD currently is in its tenth edition.
(The ICD-11 is expected to be released in 2018. Some of the revisions in the DSM-5 were made to make it more consistent with the ICD.)
The ICD is a system of classifying diseases; it is published by the World Health Organization.
The U.S. and Canada use the DSM system for diagnosing mental illnesses; most of the rest of the world uses the ICD system.
What are 3 important factors to consider when determining whether or not an individual’s behavior is abnormal?
- Whether the behavior causes subjective distress or suffering to the individual
- Whether the behavior causes impairment or dysfunction
- Whether the behavior is atypical or deviant with respect to the individual’s current cultural context
Most definitions include only these 3 Ds (Distress, Dysfunction, and Deviance). But another factor to consider is Danger, whether the behavior can be harmful to one’s self or others.
Clinicians use signs and symptoms when diagnosing mental illness. What is a symptom? What is a sign?
Signs: perceived by the clinician (e.g., patient appears disheveled, patient speaks unusually slowly, patient does not make eye contact)
Symptoms: perceived by the patient (e.g., patient feels hopeless, patient experiences intrusive thoughts, patient has suicidal thoughts)
Describe the diathesis-stress model of mental illness.
This is a model in which a person has a diathesis (i.e., a vulnerability, which may be a distal necessary cause or a contributory cause) to mental illness which can be activated by a stressor/stressors (i.e., an experience or experiences that overtax an individual’s resources), thus precipitating mental disorder.
Using MDD, provide an example of a diathesis.
Using MDD, provide an example of a stress.
Diathesis example: Having a short short (ss) allele for the serotonin transporter gene is a diathesis for depression.
Stress example: Getting divorced is a stressor.
What is primary prevention?
Primary prevention refers to attempts to prevent disease or disorder onset, i.e., reducing the incidence of preventable illnesses.
Primary prevention is not (yet) achievable for mental illness. Challenges include identifying what factors encourage the precipitation of mental illnesses (only some have been identified) and attempting to prevent these situations before they happen, via good public mental health practices (some may not be preventable). However, some are preventable. For instance, because prenatal malnutrition doubles the risk for an individual developing schizophrenia in adulthood, providing universal prenatal care may help reduce the incidence of schizophrenia.
Define:
dysphoria
An unusually high level of negative mood
Define:
anhedonia
An unusually low level of positive mood; inability to feel pleasure.
Describe what David Rosenhan reported in his classic 1973 Nature article, “On Being Sane in Insane Places.”
Rosenhan and several other confederates were admitted into mental health facilties presenting with illnesses. The confederates all received diagnoses and had a difficult time being released, because the staff began to classify their regular behaviors as indicative of illness. Rosenhan interpreted the results to mean that diagnoses exist in the minds of the observers.
To read the original Rosenhan article, go here.
To see a brief interview with Rosenhan, go here.
What were the implications of David Rosenhan’s experiment?
Rosenhan reported that the pseudopatients, rather than being released as never having been ill, were released with a diagnosis of schizophrenia in remission. Rosenhan noted that being labeled “insane” can persist throughout the life-span, which is dangerous. Rosenhan concluded that psychiatric diagnoses exist in the minds of observers: By naming something, we behave as if it is real (so yes, symptoms are real, but how we understand illnesses may be wrong.)
Perhaps the most disturbing finding was that pseudopatients averaged less than seven minutes of direct therapeutic care per day, suggesting that patients in general received inadequate clinical care.
What are some limitations or critiques of Rosenhan?
Among other issues:
- The diagnosis of schizophrenia in remission was (and is) quite rare, suggesting that the psychiatrists were aware that these patients’ cases were not standard cases.
- Because symptoms, which are not externally visible, are used to determine diagnosis, in most situations, treaters must depend on patients to be honest to the best of their ability. The ability to fake an illness does not mean that the illness does not exist.
To read Spitzer’s critique of Rosenhan, go here.
From what school of thought are Beck’s cognitive therapy (for depression) and Ellis’s rational-emotive therapy?
They are forms of Cognitive Behavioral Therapy (CBT).
One of the important strengths of CBT is that it has empirical support. Empirical support means that is has been scientifically tested in clinical trials and found to be beneficial for patients.
What are the components of Beck’s Negative Cognitive Triad?
Negative views of the self: e.g., “I suck.”
Negative views of the world: e.g., “Everybody hates me.”
Negative views of the future: e.g.,” My life will always suck.”
What is Beck’s theory of depression? In other words, according to Beck, how does depression happen?
Negative early experiences can lead to the formation of dysfunctional beliefs or schemas, which may lay dormant until a critical incident of some kind occurs (e.g., losing a job or breaking up with a significant other).
The individual then experiences cognitive distortions about the critical incident (or incidents). These cognitive distortions lead to negative, dysfunctional automatic thoughts and self-talk, which can turn into a negative feedback loop and cause the individual to experience depressive symptoms. Cognitive errors reinforce negative schemas.
Describe the experiment Martin Seligman designed that developed his theory of learned helplessness.
He would place dogs in cells with high walls, then electroshock the floor, causing the dogs to try to jump out of the cells. Eventually, the dogs stopped trying to escape: they had learned to be helpless. This is much like people with depression who eventually feel powerless to escape their problems.
What are the steps of CBT?
- Identify situations that are troubling
- Become aware of relevant thoughts and beliefs
- Identify inaccurate, negative thinking
- Challenge inaccurate, negative thinking
Repeat until cognitive errors are reduced and adaptive thinking patterns become habitual.
What are some of the benefits of the Cognitive Behavioral paradigm?
What are some of the strengths of CBT?
Empirically validated treatments!! Research supports that CBT works for treating many disorders, such as anxiety and unipolar mood disorders.
For depression, CBT treatment is as successful as SSRIs; plus patients who do CBT have a significantly lower recurrence rate!
Versatility– CBT has successfully been adapted for use with patients from a variety of cultures. Also, CBT has been successfully used for a variety of uses, such as helping individuals develop healthier sleeping habits.
CBT is empowering: Patients do homework and actively collaborate on their treatment.
The cognitive behavioral paradigm has many strengths. However, it also has limitations. What are some of the limitations?
CBT may not adequately address biological factors
Therapists need special training; relatively few patients have access to CBT services. Needs better dissemination!
Research focuses on patients without comorbidity, so short length of treatment may not be realistic for patients in the community
It is challenging, so high drop out rates can be problem
According to the DSM-5, what are the two types of mood disorders?
There are two major types of mood disorders are:
- Bipolar and Related Disorders (Bipolar I Disorder; Bipolar II Disorder; Cyclothymic Disorder…)
- Depressive Disorders (Major Depressive Disorder; Persistent Depressive Disorder (Dysthymia); Premenstrual Dysphoric Disorder…)
In order to met criteria for Major Depressive Disorder (MDD), one must have 5 or more symptoms for two or more consecutive weeks; the symptoms must be a change from previous functioning, there must be no history of mania or hypomania, and must not be attributable to another medical condition.
Name the 9 possible DSM-5 MDD symptoms, and note which 2 are cardinal symptoms.
(One or both cardinal symptoms must be present to qualify for MDD.)
- depressed mood (dysphoria) *
- general lack of interest in once enjoyable activities (anhedonia) *
- low sense of self-worth
- hypersomnia or insomnia
- possible suicidal ideation
- significant weight loss/gain
- loss of energy
- diminished ability to concentrate
- restlessness
* Symptom 1 (dysphoria) and Symptom 2 (anhedonia) are the cardinal symptoms; one or both must be presnt for a DSM-5 MDD diagnosis.
What is a difference between the DSM-IV and DSM-5 criteria for Major Depressive Disorder (MDD)?
In the DSM-IV, there was a grief/loss exclusion for diagnosing Major Depressive Disorder (MDD). This exclusion has been removed in the DSM-5.
The exclusion originally was included to avoid pathologizing grief. However, MDD often is triggered by exposure to significant stressors. A compelling reason to remove the exclusion is that in a treatment study, treatment seeking individuals who otherwise met criteria for MDD responded to treatment as successfully as did treatment seeking individuals who met the full criteria. Thus a grief exclusion may have been an unintended barrier to beneficial treatment.
What are the diagnostic criteria for Persistent Depressive Disorder (Dysthymia)?
- Depressed mood for most of the day for more days than not for at least 2 years (in children and adolescents, at least 1 year).
- Presence (while depressed) of at least 2 of the following symptoms: Poor appetite or overeating; Insomnia or hypersomnia; Low energy or fatigue; Low self-esteem; Poor concentration/difficulty making decision; or Feelings of hopelessness.
- During the 2 year period, the individual has never been free from these symptoms for more than 2 months at a time.
- Symptoms cause clinically significant distress or impairment in functioning.
(Also, no history of mania, and the disorder is not better accounted for by schizoaffective, schizophrenia, delusional disorder, or another psychotic illness; not caused by a substance or medical condition)
Is Persistent Depressive Disorder (Dysthymia) just a milder form of Major Depressive Disorder?
No. Persistent Depressive Disorder (Dysthymia) is no longer considered a milder form of depression than Major Depressive Disorder (MDD).
The DSM-5 explains that although there can be wide variation in how the disorder impacts social &/or occupational functioning, “effects can be as great or greater than those of major depressive disorder”
Although the symptoms may be less severe, their longstanding nature can lead to significant impairment as well as an even higher risk for suicide than MDD.
Define:
bipolar disorder
This mental disorder is characterized by periods of depression and mania.
Annie has been hospitalized. Over the last week, she has exhibited increased self-esteem, a lack of sleep, rapid-fire ideas, increased promiscuity and risk-taking behavior. What mental disorder does she have?
bipolar disorder type I
What are the major characteristics of cyclothymic disorder?
one or more periods of hypomanic symptoms interspersed with one or more periods of depressive symptoms.
Who first introduced electroshock therapy as a cure for seizures?
Cerletti and Bini
These doctors introduced electroshock therapy in 1938. The spasms from this treatment were often so severe that their patients were often seriously injured during the therapy.
However, electroshock therapy can now be performed safely and is used as a treatment for some severely depressed patients. (It is reserved for patients who are severely depressed and are not responding to or are unable to take other forms of treatment.)
What is an iatrogenic treatment?
An iatrogenic treatment is one which makes a condition worse.
Although most therapies are helpful, some treatments (e.g., debriefing for PTSD; psychoanalysis for schizophrenia) have been found to worsen outcomes. The possibility of iatrogenic treatment is one of the reasons that clinical research trials are very important.
Is insane a psychological term?
No, insane is a legal term.
Mental health professionals and medical doctors cannot diagnose people as being insane. Determinations of sanity are a legal matter.
Diagnosis with a mental disorder may be used as evidence in determining a defendant’s fitness to stand trial, but in and of itself, diagnosis is not sufficient to determine sanity.
(Sane also is a legal term.)
Do most people who try an addictive substance, such as alcohol, become addicted?
No. Most people who experiment with addictive substances do not become addicted.
However, a minority will, and it is not possible to know for certain in advance whether or not one has a brain that is especially vulnerable to developing addiction.
What are the disadvantages of conceptualizing alcoholism as a disease?
Disadvantages of disease model:
- reduces addicted individual’s accountability
- removes incentive to abstain
- places addicted individual in victim role
- inconsistent with data that say “controlled” use may be achieved
- self-fulfilling prophecy
In the development of addicition, what are the key
distinctions between early stage drug use
and late stage drug use?
In early stage, the drug use is pleeasure-based and goal-driven, i.e., drug taking behavior
In late stage, the drug use is compulsive and habit-driven, occuring even if there are significant negative consequences, i.e., drug seeking behavior
In addiction, as time goes on, the individual likes or enjoys the drug less, but craves the drug more and more.
What are the advantages of conceptuallizing alcoholism as a disease?
Advantages of using a disease model:
- brought the problem to public awareness
- achieved funding to study alcoholism
- reduces stigma
- promotes treatment development and funding
What is Alzheimer’s disease?
What changes in the brain are associated with Alzheimer’s disease?
Alzheimer’s disease is a lethal neurodegenerative disorder. Individuals with Alzheimer’s disease experience dementia, progressive losses in memory and cognition, social withdrawal, lapses in judgement, and eventually lose their ability for self care.
Post mortem (after death) examination of the brains of people with Alzheimer’s disease reveal neurofibrillary tangles, amyloid plaques, and reduced brain volume.
Currently there is no way to cure or to prevent Alzheimer’s disease.
Which diagnosis is the most lethal?
(In other words, which diagnosis has the highest risk for the patient dying due to the illness?)
Anorexia nervosa (AN).
According to the DSM-5, the majority of the AN deaths are due either to medical complications (e.g., multiple organ failure) or to suicide.
What Feeding and Eating Disorders appear in the DSM-5?
- Pica
- Rumination Disorder
- Avoidant/Restrictive Food Intake Disorder
- Anorexia Nervosa (AN can be restricting type OR can be binge-eating purging type)
- Bulimia Nervosa
- Binge-Eating Disorder
- Other Specified Feeding or Eating Disorder
- Unspecified FEeding or Eating Disorder
A patient presents at your clinic; she is severely underweight from excessive control over her body. The patient believes that she weighs too much, even though she is 20 pounds underweight, and is severely malnourished. Her body weight is less than 85% of what one woulld expect someone her height to weigh. What mental disorder does she likely have?
anorexia nervosa
In bulimia nervosa, someone will have multiple large eating binges and then compensate for the binges with: _______, ________, or __________.
purging; excessive exercise; fasting
However, if the individual also meets criteria for anorexia nervosa, you diagnose anorexia nervosa (binging and purging subtype) instead.
The DSM-5 addresses temperamental, environmental, genetic, and physiological risk factors for developing anorexia nervosa (AN). (There are others, but the DSM-5 addresses some significant, well-established risk factors).
List the risk factors for AN identified in the DSM-5:
- Having developed an anxiety disorder as a child or having had obsessional traits as a child.
- Environmental–Being in a culture or setting in which thinness is valued/idealized (e.g., modeling).
- Genetic–Having a first degre relative with AN. Monozygotic (identical) twins have a higher concordance rate than dizygotic (fraternal) twins.
- Possibly brain abnormalities, but it is unclear if abnormalities are the result of or a cause of AN.
In addition, being female, being Caucasian or Asian, negative affect (neuroticism), dieting, body dissatisfaction, dieting, and perfectionism also are individual risk factors. Childhood sexual abuse also has been implicated in some research.
Is there a gender difference in the incidence of anorexia nervosa?
Yes! Anorexia nervosa is much more common among females. It is estimated that for every 1 male with AN, there are 10 females.
Another mental disorder often diagnosed in early childhood is _______, which is characterized by sensitivity to sensory stimuli, impaired communication skills, few facial expressions, and repetitive behaviors.
autism
Is Asperger’s Syndrome a valid DSM-5 diagnosis?
No.
In the DSM-IV, the diagnosis Asperger’s Syndrome (a very high functioning form of autism,) has been subsumed into the diagnosis of Autism Spectrum Disorder.
Do all people who have autism also have an intellectual disability?
No. Although it is common for people who have autism to have an intellectual disability, many individuals who meet criteria for autism do not meet criteria for an intellectual disability.
In the DSM-5, the term mental retardation has been replaced by the term _________ _______.
(2 words)
Intellectual Disability