Midterm 1 Flashcards
(397 cards)
1
Q
Deviance
A
Behaving differently, behaviours straying from societal norms or standards
2
Q
Abnormal
A
Those having abilities that differ from the general public
3
Q
Goodness of it
A
Understanding behaviour within a specific context, a behaviour can be problematic or not problematic depending on the environment in which it occurs
4
Q
Culture
A
Shared patterns and lifestyle that differentiate from one group of people from another
5
Q
Culture-bound syndrome
A
Originally described abnormal behaviours that were specific to a particular location or group, some of these patterns are now recognized to extend across ethnic groups or areas
6
Q
Eccentric Behaviour
A
May violate societal norms, but it is not considered abnormal because it is not always negative or harmful to others (ex. millionaire leaving estate to his dog)
7
Q
Behaving dangerously that -
A
May result from intense emotional state or signal of a psychological disorder, but alone is not necessary or sufficient (skydiving is dangerous but is not a sign of abnormal behaviour)
8
Q
Behaving dysfunctional -
A
Behaviour that interferes with normal daily routines and / or causes significant distress, frequency of behaviours can cause distress and dysfunction
9
Q
Abnormal behaviour
A
Behaviour that is inconsistent with the individual’s developmental, cultural and societal norms and creates emotional distress or interferes with daily functioning
10
Q
1 in __ Canadians meet the criteria for at least one of the six disorders at some point in their lives
A
1 in 3
11
Q
How many Canadians meet the criteria for a substance use disorder?
A
6 million (20%)
12
Q
How many Canadians meet the criteria for a mood disorder?
A
3.5 million (13%)
13
Q
Prevalence and sex for mood disorders
A
More common among women
14
Q
Prevalence and sex for substance use disorders
A
More common among men
15
Q
Mood disorders and substance use disorders prevalence highest among people aged
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15-24 years
16
Q
By age 16, 1 in ___ children and adolescents have suffered from a psychological disorder
A
1 in 3
17
Q
Categorical approach to abnormal behaviour
A
Do you meet the criteria or not? Either have it or you don’t. Problem is symptoms rarely fall neatly into just one category and may not appear sufficient in severity to determine that they represent a psychological disorder
18
Q
Dimensional approach to abnormal behaviour
A
Abnormal behaviour is on a continuum and constantly changes in severity over time. Recognizes that abnormal behaviour varies
19
Q
Developmental trajectory
A
Symptoms vary by age - adolescent vs. child has a different way of interpreting things thinking
20
Q
Example of developmental trajectory
A
Generalized anxiety disorder is more seen in adults because it requires the ability to understand the concept of “future” which is a cognitive skill that usually emerges around age 12
21
Q
Socioeconomic status and the development of psychological disorders
A
Study has shown that all SES groups developed disorders at the same rate, but once the child had the disorder, children from lower SES were less likely to overcome or recover from the disorder
22
Q
Downward drift
A
The idea that the impairment that results from a psychological disorder (inability to sleep, addiction to alcohol) leads to job loss or limited educational achievement (anxiety causing someone to skip classes an drop out)
23
Q
The rate of psychological disorders ___ as boys enter __ years
A
Decrease as boys enters teen years
24
Q
Te rate of psychological disorders ___ as girls enter ___
A
Increase as girls enter adolescence
25
Ancient cultures in Egypt on abnormal behaviour
Believed spirits controlled someone's behaviour
26
Ancient treatment of mental disorders (ancient Egypt)
Used Trephination - created a hole in the skull to release the evil spirits or maybe to just fix wounds
27
Cause of mental illnesses according to classic Greek and Roman views
Mental illness considered result from traumatic experience of imbalance in fluids found within the body, these fluids were called humours
28
Hippocrates
(460-377 BC) father of medicine - produced diagnostic classification system and a model to explain abnormal behaviour. First to identify symptoms associated with schizophrenia, somatoform disorder and mood disorders
29
Four symptoms Hippocrates identified
Hallucinations, delusions, melancholia and hysteria
30
Hallucinations
Hearing or seeing things not evident to others
31
Delusions
Beliefs with no basis in reality
32
Melancholia
Severe sadness
33
Hysteria
Blindness or paralysis with no organic cause
34
Hysteria is now called
Conversion disorder
35
Hysteria used to be thought ..
To be only in women - empty uterus wandering through the body searching for conception, external symptoms = where the uterus was lodged internally
36
What are four humours?
Blood, black bile, yellow bile and phlegm
37
What does blood represent?
Courageous and hopeful outlook on life
38
What does phlegm represent?
Calm and emotional attitude
39
What does yellow bile represent?
Mania
40
What does black bile represent?
Melancholia
41
Hippocrates' views on treatment of mental illness
Advocated the removal of patients from their families as treatment - foreshadowing the practice of humane treatment and institutionalization
42
Galen's contribution
Attributed hysteria to a psychological cause, believing it to be a symptom of unhappiness in women who had lost interest and an enjoyment of sex. Saw people with delusions
43
Middle ages through the renaissance - perspective on mental illness
Influence of the Roman Catholic Church, abnormal behaviour was seen as the work of the devil (demons). Witchcraft also explained abnormal behaviour - mass hysteria (caused by spirits)
44
Tarantism
During the middle ages there was a belief that the bite of a wolf spider (tarantula) would cause death unless a person engaged in joyous, frenetic dancing. This was fuelled by mass hysteria, as this bite as completely harmless
45
Lycanthropy
During the middle ages there was a belief that people were possessed by wolves, also driven by mass hysteria
46
Scientific basis for mass hysteria
Emotional contagion - automatic mimicry and synchronization of expressions, vocalizations, postures and movements of one person by another
47
Enlightenment by Johann Weyer and Paracelsus on treatment of mental illness
Refuted idea that abnormal behaviours were linked to demonic possession, believed there could be psychological origin to some physical illnesses. During the middle ages
48
Where were the people with mental disorders placed in the middle ages?
Housed in asylums - often called madhouses, treatment consisted of confinement (chains, shackles, isolation in dark cells), torturous practices (ice-cold baths, spinning in chairs, severely restrictive diets) and medical treatments (emetics, purgatives and bloodletting)
49
19th Century's views on mental illnesses
Removed patients from warehouse asylums into specialized facilities devoted to the care and treatment of the mentally ill. More advocation for more humane, moral treatment. Us of respect, kindness, religion and vocation
50
Key founders of new outlook on mental illness in the 19th century
Pinel, Tuke, Rush, Diz, Kraepelin
51
Kraepelin
Etiology - cause of mental illness and Prognosis - development of the illness
52
Pinel advocated for ...
Physicians listening to the patient and observing their behaviour
53
Mesmer
Demonstrated power of placebo effect
54
Perspective change within the 19th century on development / cause of mental illnesses
Discovery that a physical disease could cause a psychological disorder was significant (syphilis led to general paresis - physical paralysis and mental illness)
55
First asylum in what is now North America
Hotel Dieu in Quebec in 1639
56
Conversion asylums in the 1800s
Many jails and military barracks converted into asylums
57
Homewood retreat in Guelph
Received moral treatment, catered to the wealthy, wanted routine, activities, healthy diet, exercise (paying for treatment). Privately funded so residents had control over interventions
58
Biological scarring
Years of living with a disorder causes changes in the brain
59
Behavioural models, behavioural genetics
Brain malfunctioning or structural abnormalities can exist from psychological disorders (ex. frontal lobe of schizophrenics is less dense than normal)
60
Viral infection theory
A fetus is exposed to toxins or a virus in prenatal stage, or shortly after birth (may take several pathways to produce disorder)
61
Freud
Found of psychoanalysis, believed roots of abnormal behaviour were established in the first five years of life (unconscious memory). All behaviour originated in the unconscious motivations
62
Freud's three regions of the brain
Id - basic instinctual drives, source of psychic energy (libido), pleasure seeking
Ego - develops when id comes in contact with reality
Superego - imposes moral restraint on the id's impulses (especially sexual and aggressive)
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Defence mechanisms
The mind's negative or distressing thoughts and feelings are disguised to emerge to consciousness in a more acceptable form
64
Psychosexual stages of development
Oral, anal, phallic (sexual fantasies about parents), latency and genital phases
65
Which psychosexual stages of development play a more limited role in abnormal behaviour?
Latency phase and genital phase
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Fixation in psychosexual development
Individuals become fixated (stalled) at a stage of psychosexual development, leaving a psychological mark on the unconscious
67
Treatment of psychoanalysis
Dream analysis, interpretation, free association, insight and catharsis (release of emotion)
68
Denial
Dealing with an anxiety-provoking stimulus by acting as if it doesn't exist
69
Displacement
Taking out impulses on a less-threatening target
70
Intellectualization
Avoiding unacceptable emotions by focusing on the intellectual aspects of an event
71
Projection
Attributing your own unacceptable impulses to someone else
72
Rationalization
Supplying a plausible but incorrect explanation for a behaviour rather than the real reason
73
Reaction formation
Taking the opposite belief because the true belief causes anxiety
74
Regression
Under threat, returning to a previous stage of development
75
Repression
Burying unwanted thoughts out of conscious thought
76
Carl Jung
Analytic therapy, believed behavioural motivators are psychological and spiritual (not sexual) and that future goals rather than past events motivate behaviours
77
Alfred Adler
Individual psychology (birth order, sibling rivalry, inferiority complex)
78
Ego psychology
Increased focus on conscious motivations and healthy forms of human functioning
79
Object relations theory
Addresses people's emotional relations with important objects, emphasizes people's basic drive for social interactions and that motivations for social contact are more than simply to satisfy sexual and aggressive instincts
80
Behaviourism
All behaviour (normal or abnormal) is to be learned as a result of experiences of interactions with the environment (importance of external events)
81
We learn both adaptive and manipulative behaviours as a ..
Source of coping
82
Pavlov's dogs and classical conditioning
UCS (meat) --> UCR (salivation), neutral stimulus of the bell paired with UCS --> CS --> CR
83
Watson
All behaviour is learned (little Albert and little Peter), observable behaviours
84
Little Albert
Paired a white rabbit with a loud noise, eventually paired fear with rabbit, eventually showed rabbit without the noise and elicited fear response
85
Wolpe
Demonstrated that classical conditioning could be used in the development of anxiety and to eliminate fear. Used a hierarchy of events to eliminate anxiety and taught patients how to relax
86
Wolpe based his theories on ..
Reciprocal inhibition
87
Example of hierarchy of events to eliminate anxiety by Wolpe
Someone who fears flying would divide up the task into small, doable tasks - first go to the airport, then sit in the boarding area, then go onto the plane, then take off (deal with the small things first)
88
Vicarious conditioning
Learning by observing another's behaviour, then incorporating that into own way of behaving. No trial learning - the person does not need to actually do the behaviour in order to learn it (watching a model, observation)
89
Operant Conditioning
Reinforcement (positive and negative) increases behaviour and punishment (positive and negative) decreases behaviour
90
Operant conditioning - primary reinforcers
Those that have their own intrinsic value (satisfy basic need - food, water or even attention)
91
Operant conditioning - secondary reinforcers
Those that have gained value to the person because they become associated with primary reinforcers (money)
92
Operant conditioning - shaping
Closer steps or successive approximations to a final goal are rewarded (teaching dolphin to do long tricks for a show). Start with rewarding small behaviour and then gradually expect and therefore reward for larger behaviour
93
Biological
Field of behavioural genetics emerged with works by Galton
94
Biological field suggests potential relationship between
Viral infection and the onset of psychological disorders - virus may act directly by infecting the CNS or virus may act indirectly by changing the immune system of the mother of the fetus thereby making one or both more susceptible to other biological or environmental factors
95
Psychological approaches
Emphasizes how environmental factors (family and cultural factors) may influence the development and maintenance of abnormal behaviour
96
Cognitive
Proposes that abnormal behaviours is a result of distorted cognitive (mental) processes, not internal forces or external events. The way we perceive or think about the events we experience shapes who we are
97
Aaron Beck
Cognitive perspective. 3 distorted views of depression (the negative cognitive triad) - negative view of self, world and future
98
Negative assumptions often called
Cognitive distortions
99
Treatment for cognitive
Change these distorted thoughts using behavioural experiments and talk therapy
100
Example of all-or-nothing thinking
If I don't go to an Ivy League school, I'll be a bum
101
Example of overgeneralizing
Everything I do is wrong
102
Example of mental filtering
The instructor said the paper was good but criticized an example of page 6, therefore he really hated the paper.
103
Example of disqualifying the positive
Sure I got an A, but that was pure luck. I'm not that smart
104
Example of jumping to conclusions
The bank teller barely looked at me, she really hates me
105
Example of magnifying or minimizing
I mispronounced that word in my speech, I really screwed up OR I can dance well, but that's not really important, being smart is important and I'm not smart
106
Example of catastrophizing
I failed the quiz. I'll never graduate from college
107
Example of reasoning emotionally
I feel hopeless, so this situation must be hopeless
108
Example of making "should" statements
I should get an A in this class even though it is really hard
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Example of mislabeling
I failed this quiz. I'm a complete and total idiot
110
Example of personalizing
We did not get that big account at work. It's all my fault
111
Humanistic
Based on phenomenology - a person's subjective perception of the world is more important than the actual world. Humans are good and are motivated to self-actualize (develop to their full potential)
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Humanistic approach on abnormal behaviour
Occurs when there is a failure in the process of self-actualization
113
Carl Rogers
Abnormal behaviour originates when one's self image and actual self are incongruent, limits ability to achieve's one full potential, the larger the discrepancy, the motion emotional and real-world problems the person experiences
114
Client centered therapy
Part of cognitive approach - release the individual's existing capacity to self-actualize through interactions with the therapist. Focuses on genuineness, epithetic and understanding (trying to understand how the client sees themselves), unconditional positive regard
115
Sociocultural models
Abnormal behaviour must be understood within the context of social and cultural forces such as gender roles, social class, interpersonal resources and ethnicity. Abnormal behaviour reflects the social and cultural environment in which a person lives
116
Sociocultural models - boys
Tend to be discouraged from showing emotion because it shows weakness (less likely to admit to having a phobia, seek help)
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Sociocultural models - girls
Girls are more likely to develop eating disorders from expectations from society
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Biopsychosocial model
No single model can fully explain the presence of abnormal behaviour, examines biological, psychological, social and cultural factors
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Diathesis-stress model
Diathesis indicates a predisposition to a psychological disorder. Assumes that psychological disorders may have a biological basis - presence of predisposition and a stress to set it off results in psychological disorders
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Translational research
Scientific approach that focuses on communication between basic science and applied clinical research - scientific discoveries must be translated into practical applications
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3 main points of ethics and responsibility
Respect for persons (subjects in study must be capable of making decisions about themselves)
Beneficence - maximizing benefits and minimize harm
Justice - fairness in distribution of what is deserved
122
Important points of ethnics and responsibility
Informed consent, subjects remain anonymous, research ethics boards must review studies, based on tri-council policy statement - sets standards for research ethnics
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Two main parts of the nervous system
CNS (brain and spinal cord), PNS
124
Dendrite
Tree-like branches that receive messages from the neurons
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NTM
Chemicals that transmit information to and from the neurons
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Soma
Keeps the cell alive, cell body containing the nucleus
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Axon
Tube-like structures that carry messages to the cells
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Synapse
Space between the neurons
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Neuron
Nerve cell found throughout the body (86 billion nerve cells)
130
Brain stem
Primital, controls fundamental biological functions - breathing
131
Hindbrain
Medulla, pons, cerebellum (regulations breathing, heart beat, motor control, balance)
132
Lesion
Area of damage or abnormality
133
Midbrain
Coordinates sensory information and movement, houses the reticular activating system which regulates our sleep and arousal systems
134
Thalamus
Relay station, directs nerve signals that carry sensory data to the cortex
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Hypothalamus
Homeostasis, regulation of blood pressure, body temperature, fluid and electrolyte balance and body weight
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Forebrain
Cerebral cortex, plus limbic system and basal ganglia
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Limbic system
Amygdala, cingulate gyrus and hippocampus - deals primarily with emotions and impulses
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Hippocampus
Memory formation (linked with memory deficits)
139
Basal ganglia
Controls movement (finger tapping), associated with dopamine, may inhibit movement (structures within - caudate putamen, nucleus accumbens, globus plaids, substantia nigra and subthalamic nucleus)
140
Alzheimer's brain
Contains greater number of plaques and tangles
141
Biological scarring
Changes in the brain over time with years of living with a disorder
142
Cerebral cortex
Higher cognitive functioning - reasoning, abstract thought, perception of time and creativity
143
Left hemisphere
Language and cognitive functioning, processes information in a linear and logical manner
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Right hemisphere
Processes the world in a holistic manner, spatial, creativity, imagery and intuition
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Each hemisphere has ..
4 lobes - temporal, parietal, occipital and frontal
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Temporal lobe
Understanding auditory / verbal information and verbal memory
147
Parietal lobe
Integrates sensory information from various sources, visuospatial processing
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Occipital lobe
Center of visual processing
149
Frontal lobe
Reasoning impulse control, judgement, memory, problem solving and sexual and social behaviour
150
Corpus callosum
Allows communication between the two hemispheres
151
PNS
Sensory-somatic nervous system and autonomic NS
152
Sensory-somatic nervous system
Nerves which control sensation and muscle movement, consists of the cranial nerves
153
Autonomic NS
Sympathetic NS which controls involuntary movements, activated the body and actives in presence of stress or anxiety (bodily arousal) and parasympathetic NS which returns the body functioning to resting levels
154
The Endocrine system
Works together twitch the CNS, a system in the body that sends messages to the bodily via hormones, endocrine glands produce hormones - released into the bloodstream to act on target organs
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Pituitary gland
Master gland
156
Hypothalamus
Regulates the pituitary gland
157
Adrenal glands
Above the kidneys, releases epinephrine (adrenaline)
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Thyroid glands
Regulates metabolism, body temperature and weight
159
Which hormones may be elevated in people with depression, anxiety and other psychological disorders?
Cortisol, prolactin
160
Patient H.M
Hit his head when he was young, developed grand mal seizures, part of his medial temporal lobe was removed from each side. Two thirds of his hippocampus was removed (suffered from amnesia of long term memories that occurred after the surgery
161
What did patient H.M teach us?
Short term memories do not depend on a functioning hippocampus
Long term memories must go through the hippocampus in order to be permanently stored
162
Hebb
Human behaviour and mental functioning could not be adequately explained by focusing only on the workings of the brain, he emphasized a systems approach, whereby nervous system in a way that each modifies the other - network of neurons can be modified to recognize incoming stimuli (inputs) and to produce specific responses (outputs)
163
Communication in the NS is ..
Both electrical and chemical
164
NTM
Chemical substances that relay electrical signals between one neuron to the next
165
When the electrical signal reaches the axon terminal..
The NTM is released, travel across the synapse and land on the surface of the neighbouring neuron - it can cause excitation or inhibition depending on the NTM
166
Neuroimaging
Pictures of the brain, neuroanatomy --> brain structure (CT or CAT scans, MRI), neurophysiology (brain function), PET scans, fMRI
167
Loci
Specific places on specific chromosomes that are associated with many complex traits
168
Influence of genes on characteristics
Height, eye colour, various diseases, personality, abnormal behaviour
169
Complex traits
Many genes and environmental factors exert small to moderate effects to influence most behavioural traits
170
Law of segregation
Individual receives one of two elements from each parent, one dominant (expressed in offspring) another recessive (genetically present but not expressed in offspring unless received two recessive genes from both parents)
171
Law of independent assortment
Alleles (variations) of one gene assort independently from the alleles of other genes
172
Behavioural genetics
Studies the interaction between genes and environment in determining individual differences in behaviour
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Family studies
Family history, cannot separate genetic vs. environmental
174
Family aggregation
Studies examine whether the family members of someone with a disorder (the proband) are more likely to have that disorder than are family members of people without the disorder
175
When is the disorder considered to be familial or to aggregate in families?
If the disorder is more commonly found among the proband's family
176
Adoption studies, adopted away offspring similar to biological parents =
Genetic influence
177
Adoption studies, adopted away offspring similar to adopted parents =
Environmental influence - doesn't work for selective adoptions (adopted into a family that is similar to their original family)
178
Twin studies, monozygotic
MZ = identical, allows for examination of the role of environmental influence
179
Twin studies, dizygotic
DZ = fraternal, dizygotic twins with behavioural differences can be caused by environmental or genetic factors
180
Molecular genetics
Study of the structure and function of genes at a molecular level, looks at more specifically which gene may cause the development of a disorder
181
Genome wide linkage analysis
Large samples of affected relative pairs (people with the same disorder) or large family in which many people have the disorder. Looks for regions on genome that affected relative share. Narrows the search for genes from the whole genome to areas on specific chromosomes
182
Candidate gene association study
CGAS - compares a large group of individuals who have a specific trait or disease with a well matched group without trait or disease, choose one or several genes in advance based on some knowledge of the biology of the trait or the function of the gene
183
Genome wide association study
GWAS - study thousands of genes vs. as few as CGAS, also uses large samples of cases and well-matched controls, GWAS does not require choice of gene prior
184
Epigenetics
Focuses on heritable changes in the expression of genes, which are not caused by changes in actual DNA sequence but rather by environmental exposures - environment has the ability to influence which genes are activated vs. silenced
185
Case study
A comprehensive description of an individual or group of individuals
186
Benefits of a case study
Can focus on the assessment and description of abnormal behaviour or its treatment, examine rare phenomena, generate hypothesis for group studies, allows practitioners to be involved in research and illustrates important clinical issues
187
Limitations of a case study
Impossible to replicate, nothing is manipulated by the observer, limited in ability to understand abnormal behaviour, inability to make any firm conclusions (no causality - no control group)
188
Single-case designs
Experimental studies conducted with a single individual, most common ABAB studies (patients are their own control group, therefore we can get causality from these studies)
189
Benefits of single-case designs
Controlled study = some causality, individual serves as his / her own control group
190
Limitations of single-case designs
Not generalize results to heterogenous groups, not address the impact of individual differences (age, sex and ethnicity), telling someone you are measuring or observing a certain behaviour may increase or decrease the frequency of that behaviour
191
ABAB studies
A represents a baseline phase and B represents a treatment phase, the two phases are alternated to examine their impact on behaviour - ensure behaviour is stabilized within each condition, can be used to reverse certain learned behaviours (bad habits)
192
Multiple baseline design
When a behaviour cannot be reversed, applies only one AB sequence, but the sequence is repeated across individuals, settings or behaviours (can be applied to a single individual across different behaviours (first smoking then overeating) or settings
193
Multiple baseline design, how do we know if the intervention is effective
If the B phase consistently produces the same behaviour change (or is replicated) this is evidence that the intervention is effective
194
Research at the group level
One group will be given treatment while the other will not (control), most common kind of research. Allows researchers to evaluate the impact of different treatments, but cannot draw conclusions about any one individual
195
Correlation Methods
Relationship between two or more variables
196
Correlation coefficient
One variable change causes a change in another variable, describes the direction and strength of the relationship, ranges from -1.0 to +1.0 C
197
Positive correlation
Variable A increases causes increase in variable B - same direction
198
Negative correlation
Variable A increases causes decrease in variable B - opposite direction
199
Controlled group design
Ensures the design of the study is appropriate to the question of interest, includes a good size sample size. Different groups are exposed to different conditions at least one of which is experimental and one of which is a control group. Experimental group exposed to variable
200
Moderators
Third variables can influence the relationship and make it appear like there is some kind of relationship between the variables
201
Limitation of controlled group design
The failure of inclusion in their sample (age, sex, race)
202
Correlation vs. causation
Correlation suggests some type of relationship, but causation is that one variable actually causes the other
203
Predict vs. causality
Predict indicates that a certain level of variable x, assessed at time 1 are significantly associated with certain levels of variable y, assessed at time 2
204
IV
Independent variable is controlled by the experimenter (what is manipulated)
205
DV
Dependent variable is assessed to determine the effect of the IV (what is measured)
206
Placebo control group
Control group with an inactive treatment is provided (ineffective drug but the subjects are unaware of their involvement in this group - blind)
207
Random assignment
Of subject involvement in each group, variabilities of the subjects spread out between the groups (reduces affect of third variables)
208
Random assignment helps to increase
Internal validity
209
Internal validity
Does you study measure what it is supposed to study? Control of the study, the extent to which the study design allows conclusion that the IV (intervention) caused changes in the DV (outcome)
210
External validity
Can the results of the study be generalized to subjects outside of the study
211
Internal vs. external validity =
Efficacy vs. effectiveness
212
Reliability
How reliable is the study in measuring the variable you are examining (Math test used to measure IQ is not a reliable test), the consistency of the study, to get the same results among different trials
213
Valid
Measure of a variable accurately
214
Statistical significance
Using numbers to prove relevancy of the data, probability that the conclusions of the study were not due to chance
215
Clinical significance
More generalized conclusions of significance in the subject's actual life, of more practical or clinical value
216
Analogue study
Advertise for subjects who have same interests or behaviours you want to study
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Clinical sample
People seeking help
218
Double blind studies
Neither the subject nor the evaluator are aware of which group the subject is in
219
Single blind studies
Either the subject OR the evaluator is aware of which group the subject is in
220
Cohort
A group of people who share a common characteristic and move forward in time as a unit
221
Birth cohort
Born in a certain geographic area in a given year
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Inception cohort
Individuals enrolled in a study at a given point in time
223
Exposure cohort
Individuals based on common exposure such as witnessing the events of 9/11 or exposure to lead paint in childhood
224
Cohort studies used to study ..
Incidence (onset of new cases), causes and prognosis (outcome)
225
Cross sectional design
Cohorts are assessed once for the specific variable under investigation, they are fast and efficient
226
Main problem of cross sectional designs
Main problem what is causing this relationship over time, is it something in the subject's past, there are many other variables to take into account, cause and effect can rarely be determined
227
Longitudinal design
A research design in which a cohort are assessed at least twice over a certain time interval
228
Project Impact Study
Example of a longitudinal design study where they found a decrease in the prevalence of smoking rate in students over time using school-based tobacco control policies and programs
229
Main problem of longitudinal studies
People may die during this time or just leave the study
230
Research at the population level
Looking at issues at the population level and the cause of these, examples - what is causing people to decide to smoke? crime? unemployment rate?
To understand abnormal psychology at the broadest possible level
231
Epidemiology
Focuses on the prevalence and incidence of mental disorders, disease patterns in human populations and factors that influence these patterns
232
Prevalence
Is the number of cases of a disorder in a given population at a designated time
233
Incidence
Is the number of new cases that emerge in a given population during a specified period of time
234
Observational epidemiology
Documents the presence of physical or psychological disorders in human populations, diagnostic interviews
235
Experimental epidemiology
Manipulation of exposure to either causal or preventive factors, random assignment
236
Psychotic disorders
Unusual thinking, distorted perceptions and odd behaviours (out of touch with reality and unable to think in a logical or coherent manner)
237
Psychosis
A loss of contact with reality (emotions, thoughts, behaviours)
238
Delusion
A false belief (overwhelming including basically everything in their life)
239
Hallucinations
A false sensory perceptions (of all senses, including taste)
240
Psychotic symptoms may also occur in patients with..
Bipolar disorder, major depressive disorder, PTSD and substance-related disorders
Or people with neurological disorders or brain tumours
241
Psychotic symptoms in someone with neurological disorders
Typically more rapid onset
242
Brief, limited psychotic experiences
Occurs in 2-12% of adults, but thoughts or voices are more positive, still feel in control
243
Schizophrenia
Characterized by disorganization in thought, perception and behaviour, it is a severe psychological disorder - typically don't recover once you have it
244
First person to look at schizophrenia
Kraepelin called it Dementia Praecox (thought it was an earlier form of dementia)
245
What does preacox mean?
Early life onset
246
Schizo
Greek word for split, but it is not describing split personalities, but the split between an individual's thoughts and feelings
247
Schizophrenia vs. DID
Not split or multiple personalities with schizophrenia
248
Bleuler focused on four core symptoms of schizophrenia including ..
Ambivalence, disturbances of affect, disturbances of association and preferences for fantasy over reality
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DSM-5 Criteria for schizophrenia
Two or more of the symptoms active for much of a 1 month period, one must be delusions, hallucinations and disorganized speech, other two symptoms may be grossly disorganized or catatonic behaviour and negative symptoms. Level of functioning is below onset, continuous signs for a least 6 months, no mood episodes, no physiological cause, no history of autism spectrum disorder
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Positive symptoms of schizophrenia
Those that are above the normal scope of sensations and perceptions (things normal people would not experience)
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Examples of positive symptoms of schizophrenia
Unusual thoughts, feelings, perceptions and behaviours, delusions, hallucinations
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Persecutory delusions
Someone is out to get them
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Of influence delusions
Someone / something is trying to control their thoughts and influence how they think
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Hallucinations in schizophrenics
Visual, auditory (most common), olfactory, somatic, gustatory
Visual hallucinations are less common, more seen in severe cases of the disorder but often include seeing the devil or a dead relative or friend
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Loose associations
Sentences or words one after another will not make sense, no association between thoughts, no connection, positive symptom of schizophrenia
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Thought blocking
Time delay within thoughts, positive symptom of schizophrenia
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Clang associations
Governed by words that sound a like, one sentence will hinge off of a word and the next sentence will be about a word that sounds similar to that one word, positive symptom of schizophrenia
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Catatonia
Muscle rigidity and mental stupor, person is awake but is non-responsive to external stimulation, positive symptom of schizophrenia, may be paired with waxy flexibility (if you put someone's arm up it will stay there)
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Negative symptoms of schizophrenia
Negative symptoms are those behaviours, thoughts and perceptions that are absent in people with schizophrenia that normal people have
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Examples of negative symptoms of schizophrenia
Blunted affect, anhedonia, abolition, alogia, psychomotor retardation
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Blunted effect
Minimized emotion or even no emotion (in voice - monotonic voice, and in facial expressions), negative symptom of schizophrenia
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Anhedonia
No capacity for joy or pleasure, negative symptom of schizophrenia
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Avolition
No motivation, inability to initiate or follow through on plans, negative symptom of schizophrenia
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Alogia
Without / poverty of speech, decreased quality or quantity of speech, negative symptom of schizophrenia
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Psychomotor retardation
Retarded in their movement, slow in reaching for something they want to get (slowness in mental or physical activities)
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Negative symptoms to be more ___ to medication
More resistant, often persisting with medication
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Social cognitive deficit of schizophrenia
Doesn't know the generally accepted rules of social interaction (doesn't know not to go up to someone and just stare at them in the face), difficulty in identifying emotional states of others, lies and sarcasm
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People with schizophrenia struggle with visual, verbal and abstract learning
Difficult time learning about abstract concepts like social interactions, relationships and love
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Echolalia
People with schizophrenia can sometimes show this by repeating what the other person said with no purpose
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Cognitive deficits symptoms in schizophrenics
Cognitive deficits are one of the earliest signs of schizophrenia and are often long-lasting, persisting with medication
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Comorbidity with schizophrenia
Can have comorbidity with depression (higher rates of suicide) or anxiety. Often paired with substance abuse - self-medication hypothesis (medication may help the patients deal with negative symptoms, like not feeling pleasure)
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Has to have some type of ___ to be diagnosed as disorder
Functional impairment
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Symptom severity vs. level of impairment of schizophrenia
Positive correlation
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Cycle of symptoms in schizophrenia
Remission and relapses of positive symptoms
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Period of recovery form in schizophrenia
Presence of all of the following for one year - no psychotic symptoms, no negative symptoms and demonstration of adequate psychosocial functioning (working at least half-time, moderate social activity, no hospitalizations)
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Someone is "in recovery" with schizophrenia when ..
They were formerly substance dependent and now can manage most aspects of their life, but may still have symptoms
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Schizophrenics and violence
Tend to be more violent than general population, but not necessarily more than other psychotic disorders. Higher risk of being victims and perpetrators of violence. Violence more likely if the person also shows substance abuse
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Prevalence rates of schizophrenia
Averages about 1% of general population among various groups
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Schizophrenia is more common for people ..
Who live in urban settings (more complicated lifestyle), who move to a new area / country (social isolation and discrimination) and who are male
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Schizophrenia is often premorbid
Before the illness, features exist for many years before the actual psychotic symptoms emerge
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Prodromal phase of schizophrenia
Social withdrawal or deterioration in hygiene
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Acute phase of schizophrenia
Starts to exhibit positive symptoms
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Residual phase of schizophrenia
Psychotic symptoms no longer present, negative symptoms remain (typically happens when taking anti-psychotics, negative symptoms not touched well)
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Phases of schizophrenia development
Prodromal, acute and residual
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Onset of schizophrenia
Typically occurs in late adolescence or early adulthood
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Women vs. males with schizophrenia
Women tend to develop at an older age and have milder forms
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More positive outcomes for schizophrenics
Found in developing countries than in developed - possibly because there is fewer social supports in more industrialized countries
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Developmental factors for schizophrenia
Much less social when 11 to 13 years old, as children, adults who develop schizophrenia may have situational anxiety, nervous tension, depression, magical thinking or ideas or delusions of reference
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Early onset of schizophrenia
17-19 years, lose more cortical gray matter over 5 years compared to any other disorder, the gray matter is the neurons, loss is from the front to back. 8-20% achieve full remission - much worse than an adult with schizophrenia
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Magical thinking
Possible early symptom seen in childhood for people who could develop schizophrenia when they are adults. Involves beliefs that thinking about something can make it happen (thinking about parents dying will cause them to)
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Ideas of reference
Possible early symptom seen in childhood for people who could develop schizophrenia when they are adults. Involves someone interpreting casual events as being directly related to them (walking by two people laughing, they'll think they are laughing at them)
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Delusions of reference
Possible early symptom seen in childhood for people who could develop schizophrenia when they are adults. Involves the idea that someone is sure that people are talking about you
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Hormonal implications of schizophrenia
Estrogen levels in females have strong influence on brain development, might be a result of estrogen imbalance that causes retardation in brain development in schizophrenia
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The most common type of schizophrenia
Paranoid schizophrenia
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Intermediate onset of schizophrenia
22 years
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Late onset of schizophrenia
33 years
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Limitations in studying schizophrenia
Data often collected retrospectively (asking the patient or parents about their childhood once they are already diagnosed)
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Inaccurate diagnosis of schizophrenia
No cultural competence among clinicians (not trained well across different cultures), language barriers and diagnosis solely based on symptoms without knowing culture can lead to misdiagnosis
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Etiology
Cause of the disorder
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Biological etiology of schizophrenia
Low levels of GABA and glutamate associated with cognitive deficits (as they are responsible for learning and memory). Low levels of dopamine and serotonin in the cortex associated with negative symptoms and too much dopamine in the neural synapses in the limbic areas associated with the disorder
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Dopamine hypothesis of schizophrenia
Too much dopamine in the limbic system neural synapse may lead to some symptoms (including psychosis) of the disorder
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Neuroanatomy and schizophrenia
Increased size of ventricles - pushes on other brain structures, decreased amount of cortical gray matter. Theses changes can also be seen in family members of someone who has the disease, when they themselves do not. Therefore abnormalities are not the result of the illness, but rather are present before the positive symptoms emerge
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Viral theories of schizophrenia
Wonder if viruses (including the influenza during the first or second semester) may increase the risk of development for the fetus
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Pregnancy events increasing risk of schizophrenia
Maternal genital or reproductive infections during time of conceptions, nutritional deprivation during early gestation, severe prenatal maternal stress and bleeding during pregnancy
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Synaptic pruning and schizophrenia
Synaptic pruning of weak neurons occurs faster in individuals with schizophrenia - less communication (may lead to neural retardation), acceleration of this during adolescence
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Genetic risk of schizophrenia
15% - one parent
| 50% - both parents
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How many chromosome have been identified to possibly contribute to the onset of schizophrenia
9
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Development of schizophrenia can possibly be direct or indirect
Direct transmission of the actual disorder from one family member to another or indirect transmission by affecting the functioning or NTMs such a dopamine
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What we expect is the cause of the development of schizophrenia
Involves the action of hundreds of genes (polygenic influence) and that epigenetic and environmental stressors factors are likely to also play a role
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Expressed emotion
The level of emotional involvement and critical attitudes that exist within a family of a patient
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Family influences and etiology of schizophrenia
With a parent with schizophrenia - family environment high in conflict and criticism and low EE
Without parent with schizophrenia - family environment with high EE (high levels of emotional over-involvement and critical attitudes) are more likely to relapse (environmental stressors)
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Historical treatment of schizophrenia
Lobotomies were used to remove part of the brain to reduce violence and aggressive behaviour
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1950s treatment of schizophrenia
Used chlorpromazine to treat symptoms
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Delay of treatment of schizophrenia, increases..
Severity of impairment - more time for neuronal damage
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Pharmacological treatment of schizophrenia
Anti-psychotic drugs block dopamine receptors D1-D4 (a lot of side effects from typical anti-psychotics including muscle stiffness, tremors and tardive dyskinesia), but does treat positive symptoms.
Atypical anti-psychotic drugs cause less severe side effects of tardive dyskinesia and can have some effects on negative symptoms and cognitive impairments
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Tardive dyskinesia
Typical symptoms of anti-psychotic drugs especially the typical anti-psychotic drugs. It involves abnormal and involuntary motor movements of the face, mouth, limbs and trunks
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Transcranial Magnetic Stimulation (TMS) for schizophrenia
Provides stimulation to a targeted area of cerebral cortex to change brain activity. Decreased (temporarily) the frequency of voices (auditory hallucinations) and reduced distractions when they do occur. Does not reduce delusions
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Psychosocial treatment of schizophrenia (main)
Psychoeducation - both patient and family members are educated about what to expect, types of schizophrenia and symptoms
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Cognitive-behavioural treatment (CBT)
Used to reduce or eliminate psychotic symptoms, somewhat effective when taken in conjunction with anti-psychotic drugs
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Psychosocial treatment of schizophrenia (others)
Social skills training - teaches the basics of social interactions and both verbal and non-verbal skills. Supported employment - a psychological intervention that provides job skills
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Brief psychotic disorder
Sudden onset of psychotic symptoms (lasts less than a month), returns to normal level of functioning, related to psychological stress
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Schizophreniform disorder
Identical to schizophrenia but is, more than one month but less than 6 months, and some patients are able to still have some normal functioning
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Schizoaffective disorder
Has schizophrenia and depression, mania or mixed
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Delusional disorder
Have non-bizarre delusions (events that could actually happen), no disruption in functioning
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Shared psychotic disorder
Two people sharing a delusional belief (inducer or primary case is the individual who develops the disorder with the delusional content and then the secondary individual over time adopts the belief system, if the relationship is interrupted, the secondary person will lose the delusional beliefs quite quickly)
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Common delusional themes among individuals with delusional disorder
Erotomanic, grandiose, jealous, persecutory, somatic
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Erotomanic delusions
The person believes that someone of higher status is in love with them (sometimes found among celebrity stalkers)
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Grandiose delusions
The person has feelings of inflated worth, power, knowledge, identity or special relationships to a deity or a famous person
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Jealous delusions
The person's sexual partner is unfaithful
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Persecutory delusions
The person (or someone close to the person) is being badly mistreated
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Somatic delusions
The person has a medical condition or physical defect for which no medical cause can be bound
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Clinical assessment
Involves gathering information to make decisions about the nature, status and treatment of psychological problems
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Clinical assessments begin with..
A set of referral questions (usually from general practitioners or other psychologists) that determine goals of assessment (want to answer this specific question of concern)
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Successful clinical assessments
Clinical assessments that lead to a diagnosis usually includes the evaluation of symptom and disorder severity, patterns of symptoms over time and the patient's strengths and weaknesses
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Screening process of clinical assessments
Identifying problem or predict the risk for future problems (ex. risk of suicide for someone with clinical depression)
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Answering the questions of clinical assessments gives insight into ..
What instruments to use for diagnosis and treatment (what procedures to do)
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CES-D scale
Scale used for depression, score of 16 or higher out of 20 indicates the possibility of significant depression
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To evaluate the usefulness of any particular screening measure, psychologists looks for instruments that have strong ...
Sensitivity - the ability to identify a problem that exists and strong specificity (percent of time that the screener actually identifies the absence of a problem)
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Important to tailor assessment to ..
Patient's symptoms, age and medical status (medical history can lead to depression)
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How to evaluate patient's progress through clinical assessments
Clinical assessment can be repeated at regular intervals during treatment to evaluate a patient's progress
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Diagnosis
Identification of illness, derived from all of the information gotten prior, requires the presence of a cluster of symptoms in psychology
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Differential diagnosis
Attempt to determine which diagnosis most clearly describes the patient's symptoms
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Treatment plan
Specific to the type of disorder or illness identified
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Outcome evaluation
Wide range of outcomes, to be useful the same measures must be administered consistently over the course of treatment
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Clinical significance
The amount of change in symptoms
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Reliable change index
Frequently used to determine whether the degree of change from beginning to end of treatment is meaningful
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Misdiagnosing
Misdiagnosing can quite easily occur, especially with something like schizophrenia when details of the symptoms are not taken correctly
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Examples of misdiagnosis
Deafness vs. intellectual disability
Epilepsy vs. schizophrenia
Medication reaction vs. depression (some medications cause depression)
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Standardization
Giving the same test to everyone involved (or of the same type)
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Normative comparison
Comparing scores with thousands and thousands of people of the same age
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Self-referent comparison
Comparing scores of one subject to an older score of their own (when someone gets a possible concussion - seeing impact of it)
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Reliability
Of the tests and the results, the test should produce the same scores if taken multiple times by the same person (consistency)
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Types of reliability
Test-retest reliability - the scores of the tests should be the same between different trials taken at different times
Inter-rater agreement - different people give out the same test (2 different interviewers reach same conclusions = good reliability)
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Validity
Is what I'm measuring actually what I want to be measuring
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Types of validity
Construct - is it measuring what it's supposed to be
Criterion - how well is this IQ test correlated with other measures of IQ
Concurrent - given two tests for depression, are they well correlated
Predictive - can a test predict certain behaviours or outcomes (MCAT scores correlate well with success in medical school)
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What are the three important properties of psychological assessment instruments =
Standardization, reliability and validity
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Clinical assessments with different ages
Developmental changes over time, changes the type of tests and the people you want to ask about the patient's behaviour
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Clinical assessments and development status
Where are they developmentally, are they acting as they should?
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The Letter International Performance Scale
No written / verbal component, more related to matching objects or shapes. Used to try to avoid cultural bias because simply translating the tests may not be completely sufficient in inclusivity
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Assessment instrument types
Self-report measures (patients evaluate symptoms - rating scale) or clinician-rated measures (clinician rates symptoms)
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Types of assessments
Clinician interviews (feels more personal with the patient), psychological tests, behavioural assessments, psychophysiological assessments
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Clinical interviews
Conversation to gather information. Purpose screening, diagnosis, treatment planning or outcome evaluation. Trusts with the patient is essential for them feeling comfortable sharing their symptoms and experiences - more likely to share more if they feel like they're not being judged
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Types of clinical interviews
Unstructured (conclusions unreliable - nothing to compare it to) or structured (open / close-ended questions)
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Psychological tests / personality tests
Objective tests - give someone a sentence, is it true or false, they know what the sentence means and what answer to give
OR
Projective tests - used to discover the underlying personality or issue, don't know how to respond to the test so it tests more of your fantasy (asked to respond to ambiguous stimuli)
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Example of objective psychological tests
Minnesota Multiphasic Personality Inventory (MMPI) - empirical keying = discriminates among groups along various clinical dimensions (people with anxiety or depression) and the Million Clinical Multiaxial Inventory (MCMI) - lacks fit with the DSM system and categories, therefore difficult to use, one thing it is good for is validity of personality disorders
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Details about the MMPI test
Minnesota Multiphasic Personality Inventory test - uses validity scales (faking good / bad can be detected using f scale), if the f scale score is low then they are faking, whether they are thinking good or bad, if it is high there is some mental disorder present
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Types of projective tests
Rorschach inkblot test (shown ambiguous stimuli and then projects unique interpretation onto them that reflects their underlying unconscious processes and conflicts (of ego and id)
Thematic appreciation test (TAT) - consists of 31 black and white pictorial cards and the patient is asked to make up a story about the image
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Is the rorschach good to use?
It was poor validity and normative data, good reliability using Exner's system (gives examples of what each response can mean)
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Benefits of using projective tests
Helpful with children, asking them to draw something (like draw your family) can be valuable in showing their feelings towards that situation because they often don't want to talk negatively about their parents. Also helps get clients talking initially
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Psychological assessment use for job applications in Canada
Leadership roles (psychopathology, personal strengths), law enforcement (MMPI-2 looks for judgement of behavioural problems that may impair decision making) and military (applicant's aptitude for specific role, cognitive ability and personality)
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Neurophysiological testing
Used to detect impairment in cognitive functioning, measures memory, attention, concentration, motor skills, perception and learning
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Types of Neurophysiological testing
Halstead-Reitan Neurophysiological battery, Wisconsin card sorting test (WCST) and bender visual motor gestalt talk (cognitive test)
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Wisconsin card sorting test
WCST - discriminates a frontal lesion from a non-frontal lesion, shifts attention from one aspect of something to another aspect. This instrument measures set shifting or the ability to display flexibility in thinking as the goal of the task changes (may be sorting cards by colour first and then without knowing it will switch and they will told their answers are wrong and they have to figure out the pattern switch)
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Intelligence tests
Used to measure intelligence quotient (IQ) - cognitive functioning that compares a person's performance to their age-matched peers, normative data
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Stanford-Binet Intelligence Scale
Verbal and non-verbal shows those at both ends of IQ continuum (good at identifying gifted individuals)
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Wechsler Adult Intelligence Scale (WAIS-IV)
Verbal comprehension index (VCI), perceptional reasoning index (PRI), working memory index (WMI) - short term memory and processing speed index (PSI) - how fast you process this information
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Wechsler Intelligence Scale for Children (WISC-IV)
7-16 years, minimal ago because of certain developmental requirements need to be met
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Wechsler Preschool and Primary Scale of Intelligence (WPPS-III)
2 1/2 to 7 years
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Functional analysis of behavioural assessments
Identifies causal links between behaviour, it's antecedent and it's consequences (what happened before the episode - maybe stress causes you to eat?), something is causing this behaviour, something that make the behaviour worth while - behaviour is reinforced in some way (positive or negative)
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Types of behavioural assessments
Self-monitoring - a patient records and observes own behaviour
Behavioural observation - measurement of behaviour by a trained observer
Behavioural avoidance tests - to assess avoidance behaviour
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The goal of behavioural assessment
Is to understand behaviour within the context of learning. It is learned behaviour, it is not something you did when you were young, but something that has been reinforced over time and become a habit
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Behavioural tests for specific symptoms
Beck depression scale, beck anxiety scale, the brief psychiatric rating scale (measures broad range of psychological symptoms)
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Psychophysiological assessment
Assessment strategies that measure the brain and nervous system activity
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Types of psychophysiological assessments
EEG, electrodermal activity, biofeedback
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EEG
Electroencephalography - measures and records brainwaves
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Electrodermal activity
Changes in electrical conductance due to changes in sweat gland activity
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Biofeedback
Trains patients to recognize and modify physiological signals (headache, relaxation sessions, teaching how to release muscles within the body)
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DMS-5
Diagnostic and Statistical Manual of Mental Disorders
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Comorbidity of diseases
The presence of more than one disorder (ex. depression and anxiety). 50% of people have comorbidity
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Lifetime comorbidity
Refers to the occurrence of at least two disorders at some point in the person's life, even though the disorders need not to occur at the same time
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Relationship of disorders in comorbidity
Comorbidity may exist because the two might be caused by some common genetic or environmental factor, or one disorder might be a consequence of another disorder
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Cultural-bound syndrome
Sets of symptoms that occur together uniquely in certain ethnic or racial groups
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When is a diagnostic system harmful?
Stereotypes and labels (stigmas), premature or inaccurate assumptions by clinicians can cause misdiagnosis, self-fulfilling prophecies. Normal variations of behaviour are over-medicated. Not all persons with the exact same diagnosis experience the exact same symptoms
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International Classification of Diseases (ICD)
Uses code-based classification system for physical diseases and a broad array of psychological symptoms and syndromes
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Categorical systems of diseases
DSM and ICD are both primarily based on categorical systems that classify sets of symptoms into disorders
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Dimensional systems of classifying disorders
Suggests that people with disorders are not qualitatively distinct from people without disorders, dimensional more complex. Disorders are simply extreme variations of normal behaviour
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What are the two features that support the value of dimensional approaches?
High frequency of comorbidity and within category variability
