Why do we need to define and classify?
Common nomenclature in clinical practice, research, & social and political implications
Limitations of defining and classifying
Labeling (person is not the diagnosis), loss of info, stereotyping, stigma
Prevalence
Number of active cases (point, one-year, & lifetime)
Point prevalence
At a given point in time
Incidence
Number of new cases
Comorbidity
More than one disorder in the same person
Etiology
Cause
Onset
Acute or sudden, gradual or insidious
Course
Chronic, acute or time-limited, episodic
Prognosis
Forecast of course
Humanitarian Reform
18th century, suitable hospitals were built, patients unchained and places in more humane conditions, emphasized spiritual and moral development
Deinstitutionalization Movement
20th century, large number of mental hospital closures, shift to community-based residences, created problems
Willowbrook (1947-87)
State-supported institution for children with intellectual disabilities, overcrowded and poor conditions, controversial medial studies –> Geraldo Rivera investigation (1972)
Wilhelm Wundt
First experimental psych lab (1879), structuralism (structure of mind)
William James
Principles of Psych (1890), functionalism (purpose of behavior and consciousness), “Father of American psych”
Counter-conditioning: Systematic desensitization
Breaking link between CS and CR, aversive stimulus becomes less aversive (ex: use relaxation)
Counter-conditioning: Aversive conditioning
Pairing CS with an aversive UCS –> CR, less aversive stimulus becomes aversive (ex: pair unpleasant thing with smoking)
Multidimensional Integrative Approach
Biological, psychological, social, and developmental influences
Necessary cause
Must exist for disorder to exist (ex: gene)
Sufficient cause
Guarantees occurrence of disorder
Contributory cause
Increases probability of disorder
Distal risk factor
Distant (ex: early abuse, childhood factor)
Proximal (immediate) risk factors
Tell over short term
Diathesis
Stress model, combo of inherited vulnerability/susceptibility & stress (environmental factors)
Equifinality
Start different –> end same
Multifinality
Start same –> end different
Protective factor
Decreases likelihood of negative outcomes among those at risk
Resilience
Ability to adapt successfully to even very difficult circumstances
4 categories of biological factors relevant to maladaptive behavior
- Genetic vulnerabilities
- Brain dysfunction and neural plasticity
- NT and hormonal abnormalities
- Temperament
How to measure heritability (3)
- Family history
- Adoption studies
- Twin studies (MZ, DZ, compare)
Passive effect
Inherit genes from parents, affects how both approach environment
Evocative effect
Child’s phenotype evokes certain reaction from environment
Active effect
How we build on environment
Brain abnormalities in…
Structure of brain regions, function of brain regions and neural circuits (ex: ADHD)
Id
Constantly striving to satisfy basic drives (pleasure principe)
Ego
Seeks to gratify the Id in realistic ways (reality principle)
Super Ego
Voice of conscience that focuses on how we ought to behave (morality principle)
Psychosexual stages of development (5)
- Oral (0-2)
- Anal (2-3)
- Phallic (3-5 or 6)
- Latency (6-12)
- Genital (after puberty)
Behavioral Perspective
Reactionary movement against psychoanalysis and “non-scientific” approaches
Extinction in conditioning
When a CS is repeatedly presented without the UCS (can return later: spontaneous recovery)
Generalization
Response is conditioned to one stimulus and can be evoked by other similar stimuli
Discrimination
Learning to distinguish between similar stimuli
Observational learning
Learning through observation alone, without directly experiencing an UCS
Impact of behavioral perspective (3)
- Maladaptive behavior
- Failure to learn necessary adaptive behaviors or competencies
- Learning of ineffective or maladaptive responses
Schema
Underlying representation of knowledge that guides current processing of info
Attributions
Process of aligning causes to things that happen
Attribution style
Characteristic way in which individual may tend to assign causes to bad or good events
Universality of some disorders
Certain psychological symptoms are consistent among similar diagnosed clinical groups (ex: schizophrenia)
Sociocultural factors for disorders
Which disorders develop (eating disorders), prevalence (major depression rates vary), course
Retrospective research strategies
Involve looking back in time
Prospective research strategies
Involve looking ahead in time
Psychological Autopsy
Investigation into person’s death by reconstructing what they thought, felt, and did before death based on info gathered from personal docs and others
DSM-II to DSM-III
Explicit behavioral criteria, atheoretical approach, more detailed description, emphasis on reliability
Settings for assessment
Psychiatric, general medical, legal, academic/educational, psychological clinic
Reliability
Degree to which a measurement is consistent (across time, across raters)
Validity
Degree to which a technique measures what it is designed to measure (concurrent, predictive)
Standardization
Application of certain standards to ensure consistency across different measurements
Mental status exam
Check appearance, attitude, behavior, mood, awareness of surroundings (oriented x3- person, place, time)
Clinical interview
Most common clinical assessment, presenting problem, history of problem, used to establish diagnosis (structured, semi-structured vs. unstructured)
Behavioral assessment and observation
Systematically evaluate behavior in its natural situation/context, identify ABCs, helpful for child or nonverbal patients
Behavioral Assessment: Antecedents
Events that occur prior to behavior and can increase probability of behaviors
Behavioral Assessment: Behaviors
Observable events performed by organism
Behavioral Assessment: Consequences
Events that follow behaviors and can increase or decrease the probability of behaviors
Functional Assessment or Chain Analysis
One event leads to another, find points to intervene
2 types of personality tests
Projective (inkblot & TAT) and objective
Implicit Association test
Uses reaction time to measure strength of association between concepts and attributes
Classical categorical approach
Strict categories, all criteria must be met
Dimensional approach
Classification along dimensions with potential arbitrary cutoffs
Prototypical approach
There are no perfect indicators