Midterm

Question 1

3 philosophical approaches to psychopathology

Answer 1

Kendler article

1. Realism: “real” disorders, independent of human perception
   •Ex. Chemistry approach, periodic table of elements. The elements are real, have an essence, such as atomic #; no one argues this is contingent upon human beings
   • Ex. Biology approach to realism. Species exist, but do not have an “essence.” The boundaries are fuzzy, members of species not identical like atoms in an element
2. Pragmatism: makes no claim about underlying reality of psych. disorders. “if it works, who cares how it works”
   • Kendler did NOT like this approach:
   • It demeans reality of patient suffering
   • Psychiatry is a legit biomedical discipline. Other branches of medicine don’t have to defend their field is “real”
3. Constructivism: psych disorders seen as socially constructed (like currency)
   •E.g. PTSD has always existed, but has been systematized
   •Existence of culture-bound syndromes

Question 2

pessimistic induction

Answer 2

Argument against realism:

All past beliefs about nature turned out to be false at some point. Could still happen with our truths of today

Question 3

Kendler’s opinion on philosophy of psychopathology

Answer 3

Kendler advocates a “soft realist” approach. Closer to biology (less rigid) than chemistry, some elements of pragmatism (focus on what works)

Question 4

Biggest change between DSM versions

Answer 4

from 2 to 3

Question 5

“Types” vs “Tokens”

Answer 5

Kendler article

Tokens – specific manifestations of a broader general class (i.e. individual disorders)

Types – are the broader general class (i.e. Psychiatric disorders would be the superordinate “type,” subtypes would include mood disorders, psychotic disorders, etc)

Question 6

Thomas Insel

Answer 6

NIH director, huge believer in RDoC/biology. Anti-DSM (poor validity)

Question 7

Richard Friedman

Answer 7

Critiques of RDoC:

• RDoC lacks historical perspective
• The goal of using biology to diagnose has been tried in the past, but has been difficult to achieve (“frustratingly elusive”)
• We can still identify and treat disorders now

Question 8

David Kupfer

Answer 8

Chair of DSM-5 task force.

Response to RDoC:
We hope for Dx based on biomarkers, but we are a long way from achieving this.

DSM is a guidebook for clinicians.

Question 9

Thomas Szasz

Answer 9

Antidiagnostic. Anti-psychiatry

No such thing as mental illness, only “real” physical diseases that can be seen on the autopsy table.

Social criticism of psychiatry

Conceptualize mental illness diagnosis and treatment as means to control people and judge them

Question 10

Alan Leshner

Answer 10

Article on SUD: “Addiction is a brain disease”
- social, legal, tx implications

The fact that addiction causes changes in brain structure and function is what fundamentally makes it a brain disease

Should be approached like a chronic illness

Question 11

Nesse and Berridge

Answer 11

Evolutionary perspectives of addiction

Pursuit of pleasure

Rewards systems are separated into:

• “liking” (pleasure upon receiving)
• “wanting” (anticipates reward, incentive motivation and behavioral pursuit)
• Wanting = result of neural sensitization dopamine

Question 12

Shaffer

Answer 12

Behavioral addictions: dependencies similar to substance dependence (withdrawal, relapse, tolerance, mood changes)

Define objects of addiction - robustly and reliably shift subjective experience

Question 13

Paranoid PD

Answer 13

suspicious, paranoid, few meaningful relationships

Question 14

Schizoid PD

Answer 14

Does not desire close relationships, flat affect

Question 15

Schizotypal PD

Answer 15

Psychotic-like sx, odd/eccentric behavior/beliefs, impaired relationships

Question 16

Antisocial PD

Answer 16

disregard for social norms/laws/rights of others, deceitful, impulsive, sensation-seeking

Question 17

Borderline PD

Answer 17

Instability of relationships and self-image, effort to avoid abandonment, impulsive

Question 18

Histrionic PD

Answer 18

excessive emotionality and attention-seeking

Question 19

Narcissistic PD

Answer 19

grandiosity, self-importance, need for admiration, fantasies of power and success

Question 20

Avoidant PD

Answer 20

social anxiety, hypersensitive to negative evaluation

Question 21

Dependent PD

Answer 21

need to be taken care of, clingy

Question 22

Obsessive-Compulsive PD

Answer 22

perfectionism, preoccupation with order and rules

Question 23

Interrater reliability

Answer 23

Kappa statistic:

rate of agreement corrected for chance of agreement.

Question 24

Sensitivity

Answer 24

How many people did we identify as positives of all the true positives in the population

positive hits /total # true positives

Important to epidemiologists

Not influenced by prevalence

Question 25

Specificity

Answer 25

How many people did we identify as negative of all the true negatives in the population negative hits /total # true negatives Important to epidemiologists Not influenced by prevalence

Question 26

Positive Predictive Power

Answer 26

how many people are actually positive of all people we diagnosed as positive positive hits/total #diagnosed positives Important to clinicians Influenced by prevalence - higher prevalence Increases positive predictive power

Question 27

Negative Predictive Power

Answer 27

how many people are actually negative of all people we diagnosed as negative negative hits/ total # diagnosed negative Important to clinicians Influenced by prevalence - higher prevalence reduces negative predictive power

Question 28

Jane Murphy

Answer 28

Cultural Relativism: Studied Eskimos and Nuthkavihak to examine role of culture on psychopathology

Question 29

Cultural Relativism

Answer 29

Jane Murphy - Behavior we call mental illness may be considered normal in another culture - Some differences, some similarities in what is considered psychopathology

Question 30

Robins and Guze

Answer 30

Establishment of Diagnostic Validity in Psychiatric Illness: Schizophrenia 5 ways to validate categories of a disorder: 1. Clinical Description of cluster of covarying sx 2. Laboratory Studies 3. Delimitation from other disorders/exclusion criteria 4. Follow-up studies to determine whether it follows a predictable course 5. Family studies- does your new disorder run in families? Heredity supports validity

Question 31

Kandel

Answer 31

All mental processes derive from operations from the brain. Psychopharmacology brings psychiatry back into mainstream

Question 32

Weinberger and Goldberg

Answer 32

Critique RDoC - doesn't account for time or clinical vs subclinical (i.e. auditory hallucinations) lumpers vs splitters RDoC as new way to split then lump

Question 33

Caspi

Answer 33

P Factor hypothesis is that most common psychiatric disorders are unified by a single psychopathology dimension representing lesser or greater psychopathology (P). Internalizing and externalizing factors did add something to the model. Take home message: their data supported the notion of P

Question 34

Smoller

Answer 34

genome-wide association studies (GWAS) confirm: (1) psychiatric disorders are highly polygenic (2) genetic influences on psychopathology commonly transcend the diagnostic boundaries

Question 35

GWAS

Answer 35

The method of genome-wide association studies (GWAS) = comparing control to clinical pop and detecting differences between entire genomes in each population. Gave us a tool for identifying common DNA risk variants: - single-nucleotide polymorphisms (SNPs) - rare copy number variants (CNVs).

Question 36

Polygenic Risk Scores

Answer 36

Smoller Individual SNPs account for tiny fraction of heritable variance for psych disorders Aggregation of these effects into polygenic risk scores (PRS) capture additive effects, of thousands of SNPs (accounts for larger portion of heritable variance)

Question 37

Brown and Conway

Answer 37

Argued need for more research before adopting 2-factor structure (internalizing/externalizing) of psychopathology. Pro HI-ToP/P Factor. Used clinical px w/ emotional disorders 1, 2, 3 factor models didn't fit - why?

Question 38

Bob Spitzer

Answer 38

Pro diagnosis Critiqued Rosenhan’s “On being sane in insane places” to defend diagnostic approach of DSM. Helped develop DSM-III

Question 39

Mark Vonnegut

Answer 39

Anti-diagnostic The Eden Express memoir Mental illness a social construction (at best) or a fiction (at worst)

Question 40

Thomas Scheff

Answer 40

Anti-diagnostic Labeling theory of mental illness - behavior is influenced by society. Mental illness as a social construct

Question 41

David Rosenhan

Answer 41

Anti-diagnostic "On being sane in insane places" study - pseudopatients admitted

Question 42

Hervey Cleckey

Answer 42

“The Mask of Sanity: an attempt to clarify some issues about the so-called psychopathic personality” (1941) Book to categorize psychopathology Can hide psychopathic personality, which results in underestimated prevalence

Question 43

Seymour Kety

Answer 43

- Became leader at NIH - Interested in biological aspects of mental disorders (schizophrenia, depression, bipolar) - Changes in neural connection based on learning/experience (Nobel Prize)

Question 44

Cultural aspects of DSM5

Answer 44

Changes to DSM-5: - including culture as "interpretive framework" - removal of axis-iv (env and psychosocial factors) - included throughout - Includes Cultural Formation Interview (CFI): nuanced definition of culture CRITIQUES OF DSM-5 - Criticism of validity based on western beliefs - if the DMS5 is too biological, we’ll neglect important cultural aspects of disorders - Cultural sensitivity has not been fully embraced in the entire DSM - Personality d/o’s are most impacted by culture. - instead of deleting avis-iv, should expand to include racism, etc

Question 45

DSM vs. RDoC

Answer 45

Diagnosis based on signs (observable) and symptoms (reported) rather than causal mechanisms. - important but limited 1. Etiology (genes + env) 2. Categories (for decision-making and communication) vs dimensions (capture complexity) 3. Thresholds (necessary for decision-making but arbitrary) 4. comorbidity (imperfect classification system)