Clinical psychology Flashcards
(108 cards)
1
Q
What is the diagnostic handbook
A
DSM-5 was published in 2013, it’s a rule book which distills criteria of diagnosis for disorders
2
Q
Who writes the DSM books
A
There are working groups where they gather information continuously, do field trials, and look at how the diagnostic criteria mesh with how patients appear in the real world
3
Q
What are the new changes made to DSM-5
A
- Binge eating disorder/Bulimia
- Gender Dysphoria/
- disruptive mood disorder
4
Q
What is the change made to Gender Dysphoria
A
only if a person is experiencing an external distress due to their gender, and this was a change in emphasis.
5
Q
What is the disruptive mood disorder diagnosis
A
a huge spike in bipolar disorder, the BP disorder was captured as a different diagnosis in adults and children.
6
Q
What is in the DSM-5 book
A
- Criteria checklist
7
Q
What is not in the DSM book
A
- causes
- prognosis
- Treatment
IT’S VERY NARROW AT WHAT IT DOES
8
Q
The major Groups of Psychological disorders
A
- dipressive diorders
- anxiety Disorder
- Psychotic Disorders ( e.g, Schizophrenia )
9
Q
How do we define Abnormal
A
It’s a concept that is defined around the world where people set that there is a set way of behaving, doing
10
Q
How do we define Abnormal
A
- Australian and Brazilian Jesus
11
Q
Do we think of abnormality in a different way
A
It was normal for Jesus to claim him self as Messiah 2000 yrs ago . Cutting is normal in some cultures ( like tattoo scraping )
12
Q
for somethins To be abnormal what are the Necessary criteria
A
- a narcasict might cause distress for other people but not for themselves
- you can’t think of one !!
13
Q
For something to be abnormal, what are the distinguishing criteria
A
is x is present it is abonrmal if x is not present it isnt
- out of the reality touch
14
Q
What are the four D’s for what is abnormal/ Disorder
A
- Dysfunction
- Distress
- Danger - person poses danger to others/ themselves (a small percentage of people who are dangerous to other people)
- Deviance -
15
Q
What is Deviance
A
it’s outside the range of normal behavior
- It can vary across culture,s so we don’t define it by how frequently it happens.
- it’s hard to draw spectrum of whats normal
e
16
Q
How does a provider come up with prognosis
A
Objective test vs Observation/self-report
Problem - assemble is subjective
17
Q
Why is assembly considered subjective
A
because its unique to the person
18
Q
Are Pschological Disorders categorical or dimensional
A
catergorical you meet a category or you don’t
e.g you are either a dog or not a god
dimensional - is a spectrum, what you think of as the core of dimension, it’s not a yes or no, it a rating and you look up what people’s patterns are over a system.
19
Q
Is DSM - 5 way of defining the depression disorder categorical or dimesional
A
- its the catergorical system as it mentions that you either have 5 out of the 9 categories listed then they would have depression if not they are not depressed
20
Q
Are diagnoses a procrustean fit
A
You will not believe that I have a magical bed, then he cuts off their leg
21
Q
Why categorize at all
A
- Professional communication
- Epidemiology
- Treatment
- research
22
Q
what are the magor Paradigms ( none capture disorder fully )
A
- Biological
- Psychodynamic
- Behavioral
23
Q
Biological
A
-Structural abnormalities
- diorder
24
Q
Pschological
A
- we all have inherent drives
- there are powerful conflicts among their drives
- these conflicts are unconscious.
the resolution of these unconscious conflicts is what determine our psychological health.
25
what are Deuds structure of the mind
- ID - wanna have sex you do it / hungry eat
- ego - evaluates how to rationally act I cant just assault someone because I wanna have sex
-Super ego - what is considered right and what's not
26
What is a defense mechanism
Projection, e.g I am starting to doubt if I like some as I as to so I start saying you don't love me anymore, that's projection
27
what is the behvaorial Paradigm
- Classical conditioning you throw up infront of your class and now you associate going to class
28
what is operant condiitoning
- avoiding something makes you feel good so you do it over and over again
29
what is the congnitive approach
30
What is the major depressive episode
Depressed mood , dimnished intrest in activities
31
other depressive episodes
- Significant weight change
- sleep difficulty
- Psychomotor change ( subjectively moving slowly )
- fatigue Behavorial domain
- feelings of guilt ( cognitive domain )
- Inability to concentrate ( cognitive domain)
- Inability to make decisions( cognitive domain
- Morbid thinking
32
Who are more likely to be depressed
Women are 2x more likely to have depression in their lifetime than men
33
The natural course of untreated depression usually has
-65% recovery time
-typical episode lasts 3- 11 months
-60% recover within 6 months
-2/3 people have a recurrence
-highest relapse rate inthe first 6 months after recovery
34
What are the 3 major models that we can apply for what causes depression
- Biological perspective
- cognitive perspectove
- social perspective
35
WHat is the biological perspective
- Pedigree disorder/ Twin study
Genetic contribution
Using a pedigree, you can identify who has depression and identify the individuals related to that individual.
36
what is concordance rate
Concordance Rate is a statistical measure that describes the proportion of pairs of individuals that share an attribute, given that one already possesses this trait.
37
Genetic risk factors may be sex specific in effect ( increased risk in response to specific hormonal changes)
38
Why serotonin activity?
because low levels of serotonin activity are associated with depression .
serotonin isn't attaching to its receptor
or something is blocking it from leaving the presynaptic neuron
or reuptake is happening, causing a low level of serotonin.
39
What is Isoniazid
It is a medication for tuberculosis
- people's mood was elevated, weight gain
40
What is reserpine
a medication designed to treat blood pressure turned out to decrease mood
41
How did Isonize elevate mood
it increased the avaivabilty of monoamines - serotonin ,dopamine and norepinephrine
42
what about but for the reserpine
It decreased the availability of the monoamines (serotonin, dopamine and norepinephrine
43
What are SSRIs ( fluoxetine, prozac
fluoxetine prozac decreases the uptake of serotonin
Meaning it increased the availability of serotonin in our system
44
Why is it a problem
- Lowering serotonin levels doesn't always lead to increased depression
- SSRIs have a rapid effect on serotonin levels but take weeks to have an impact on patients.
45
Why is the Hippocampus in depressed people smaller
because there are fewer connections between neurons
46
SSRI effect
It increases the protein Neurotrophic factor which gives rise to neurosynaptic connections
47
WHat is Spravato ( Esketamine )
- is a related form of ketamine; it's FDA-approved for treatment-resistant depression.
- only if other methods aren't working
48
doctors do Off label treatment
Once it's FDA approved, doctors can use it for any other reason
49
What is the learned helplessness Seligman
shuttle box used in learned helplessness exiperment
- shocked and tone conditioning
50
What did he find out for his experiment
passive in the face of stress, failing to initiate coping strategies
- he related this to human feelings like helplessness in stressful situations
51
What is reformulated self-helplessness theory
- it's internal (I am just not good enough)
- stable ( I have always been like this)
- Global ( this has ruined my whole life)
- He calls this The Pessism ( internal, global and stable attribution)
52
opposite of pessimistic triad
external - we had different priorities and goals in life
, unstable. Maybe if circumstances were different,t it would have worked out
53
Does Pessimism cause depression
We only have correlational evidence, so we can draw a causal relationship
54
It's a combination of bad things happening to your pessimistic view that contributes to your depression
30% of those who failed
30% of those who were pessimistic
70% of those who were pessimistic and failed
55
Drugs for depression tend to work for 50 - 60% of people who take them.
Tricyclics ( blurred vision, dry mouth, constipation, drowsiness, weight gain,n sexual dysfunction)
SSRIs ( prozac,celexa, Paxil
Lexapro, zoloft ) ( fewer side effects, still weight gain, sexual dysfunction)
56
The difference between medication and cognitive therapy
Drugs are faster to help, but have higher relapse rates
Cognitive therapy takes longer, but relapse if lower
57
combo had benefit for fatigure
all groyps improved combo did best both combo and CbT worked the best
58
Why does it make sense from socio-evolutionary theory when you make the impression you didn't want on someone else you interacted with ?
We need group bonds because we really don't know how to survive by ourselves.
People on the outside did not survive you wanna be in the group
59
What is the DSM criteria for social anxiety
1 . Out of proportion to a threat
2. trigger avoidance
3. Persist over time
4. cause impairment
60
What are the shared characteristics of social anxiety
- sweating
- blushing
-Heart racing
61
What is different about social anxiety
it's that the people experiencing it feel like it's too obvious for the other person observing them.
62
What is cognitive perspective of social anxiety
- Anxious self-preoccupation
- negative evaluation
- Mind reading ( social anxiety people think they can predict what others think about them
63
Why doesn't the fear decrease on its own with all that practice?
- Behavorial manifestation
(- worried thought, negative expectations. highdistress leads to
- avoidance ( we have built in strategy to avoid things that make us feel terrible ( - Negative reinforcement)
- safety behaviors ( active form of avoidance) planning ahead
-
64
What is negative reinforcement
Negative reinforcement is the encouragement of certain behaviors by removing or avoiding a negative outcome or stimulus. It is also known as a type of behavior modification.
65
Why are avoidance and safety behaviors bad
becasue they are temporary solutions that make us feel good only at the moment. they help the cycle presist over time
66
What is the paradoxical effect and self-fulfilling prophecy?
Holding glass togthly thinking it makes it better but it turns out to be a bad method
e.g the man wearing foundation
67
Epidemology
_ Twice as many women
- Early onset
- Chronic course
- associated disability
- marital status
- education
- employment
- comordibity
- culturally specific
68
How does social anxiety emrge
Diathesis-stress model ( biological predisposition)
69
how does Diathesis relate to disorder
direct proportional
under high level of stress low diatheis tend to have a low impact on a disorder.
70
What is the name Kagan categorization of babies' temperament
- called it behavioral inhibition
71
Behaviorial difference babies pyisological diffs
- more upset
- less active
- slower to adapt
- less active
when they grow up they are more likely
- more careful - high heart rate
greater BP
larger pupil dilation
more activation right frontal cerebral cortex
72
Is behavioral inhibition a diathesis
Psychiatric rates among children with behavioral inhibition show that children who are behaviorally inhibited make up the most ratio of those who develop social anxiety.
73
How do some babies develop behavioral inhibition while others don't
Research shows that babies with behavioral inhibition have 50 % parents' social anxiety, while babies with no behavioral inhibition have 26.6 % parents anxiety
74
What is Steven Suomi's research
- biology is not destiny
He swapped monkey babies to see how they would react
What happens if a highly reactive mother raises a low-reactive infant vs low low-reactive mother raising high high-reactive infant?
The result is that babies born to highly reactive mothers tend to do better when they are raised with low low-reactive mother.
75
What is cognitive behavioral treatment
- Exposure therapy is designed to break the avoidance behavior of social anxiety. If you sit in the situation long enough, your anxiety naturally goes down by itself
76
When does the exposure happen
- imaginary exposure
- Go personally to the place
- Joining conversations
- asking for assistance
- returning or exchanging items
- making mistakes
- setting up a social occasion
77
what are the ways treat social anxiety
- exposure
- cognitive reconstruction
- social skill training
- medication (SSRI)
78
CBT head to head with medication
- cognitive threapy has almost same effect as medication but later on it was discovered the relapse rate is 50% for medication respnder vs 17% for CBT responders.
79
what is the clinical picture
- perceiving sensory information
- concentrating
- thinking
- language and speech
- feelings
- relationships
80
What is unique about
it's a global impairment of complex functional loss of the above clinical pictures
and it's gender-neutral
81
schizophrenia
positive delusion and hallucination
negative withdrawal
82
Postive symptoms of schzophrneia
Delusion and Hallucination
83
What is delusion
Beliefs that are extremely out of touch with reality
- Grandeur
- persuciotory
-referential
- Loss of control over mind ( believing that other people can control what I think)
84
What are hallucinations
-sensory experiences without any environmental stimulation
-Auditory hallucinations are by far the most common kind of hallucination in schizophrenia.
85
What are negative symptoms
things that schizophrenic people have trouble doing that most people do.
Avolition
Alogia
86
Avolition
Avolition
Definition: A lack of motivation to initiate and persist in goal-directed activities.
Example: Someone may not shower, go to work, or even get out of bed—not because they don’t care, but because they lack the internal drive.
87
2. Alogia
Definition: Poverty of speech or reduced speech output.
Definition: Poverty of speech or reduced speech output.
Example: A person might give brief, empty responses in conversation or seem to have nothing to say, even when prompted.
88
3. Asociality
Definition: Lack of interest in social interactions or relationships.
Example: The person may withdraw from family, avoid friends, or show no interest in forming new social connections.
89
1. Anhedonia
Definition: A reduced ability to experience pleasure from activities usually found enjoyable.
Example: Someone who used to love music, food, or spending time with friends may no longer feel any enjoyment from these things.
90
2. Affective Flattening (or Flat Affect)
Definition: A severe reduction in emotional expressiveness.
Example: The person may speak in a monotone, show little facial expression, and have limited gestures or reactions, even when discussing emotional topics.
91
what is the onset schizophrenia
-sudden
- gradual - prolonged period of undiagnosed illness]- withdrawal
unusual interest
occupation/ educational difficulties ( onset as a function of gender
92
Follow-up studies of symptoms in childhood
- developmental delay
93
Follow-up of the UK 1946 Birth cohort
Schizophrenia N=30
- Tracked all 5362 people born in one week in a circumscribed geographical area.
94
What is the cause of schizophrenia
The closer the genetic relationship you have with someone who has schizophrenia, the more you are at risk of developing schizophrenia
95
What is the genetic bias of schizophrenia
- Neurological damage
- soft signs
- abnormal reflexes, eye tracking
- inattentiveness
where
- enlarged ventricles
- underactuve frontal lobe
How
- Obstetrical complications ( problems with labor and delivery)
- Virus ( higher rates of SZ to those born in late winter/ early spring
- Higher rates of SZ following major flu
96
What is Chlorpromazine
had the effect of providing some relef for hallucinations
97
how do dopamine induce SZ
og antipsychotics are dopamine and act to reduce SZ symptoms
- Dopamine agonist increase SZsymptoms
_ ldopa
98
Contradictory evidence
- Time lag in treatment
- Meds are more effective for treating positive symptoms
- Negative symptoms look like what you expect with a lack of dopamine
99
Dopamine pathways
There is more than 1 pathway ( the Mesolimbic dopamine pathways and ventral tegmental areas
100
how are negative symtpoms caused
dopamine receptors under the mesolmibic dopamine pathway underactive menaing when it has the appropriate receptors ut exhibits the right pathway.
101
Psycotherapy
- theory
Data
-Published the first psychotherapy analysis
102
How did Eysenck do his study on psychotherapy
- methodology 19 peer review studies
- 5 Psychoanalytic groups 14 eclectic groups.
findings - Psycoanalytic recovery 44%
eclectic recovery = 62%
spontaneous recovery/No treatmnet = 72%
- criticism
103
how did the revieweing changed the new finding
30% = spontanous remision
104
Smith and Miller ( conducted a meta-analysis again
- has to be comparing the psychotherapy to something
- systematically searched data bases
- 475 studies
- used over 10000 participants and they looked at each of the result and measure the effective size
- affect size ( d) compare affect size across studies
105
Dodo bird effect
if you are collapsing all across disorder have some type of benefit
106
What are the nonspecific factors
core parts of effective treatments
- warmth and trust
- Desensitization ( being able to talk about something out loud, feeling like you are not being judged)
- The therapist provide
- Reinforcement
107
3 big take-home messages of
- Nonspecific factors are key
- Factors alone are not enough
Theoretically driven treatments are only effective if they add benefit beyond nonspecific factors.
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