Week 2: Models of Psychopathology, Clinical Assessment and Diagnostic Formulation

Question 1

What is the scientist-practitioner model, and what are the three relevant aspects?

Answer 1

The scientist-practitioner model is a training model founded on the idea that trained professional psychologists should be knowledgeable in both research and clinical practice. The three aspects are evidence-based practice, practice-based evidence, and ongoing professional development.

Question 2

Describe the scientist-practitioner approach

Answer 2

Psychologists will use research findings to guide assessment, diagnosis and treatment of people with mental health disorders.

Question 3

In the scientist-practitioner approach, what do models do?

Answer 3

Models provide representations of the real world. Research tests hypotheses derived from models.

Question 4

What are biological models?

Answer 4

Biological models study psychological issues through focussing on the body itself. They are aetiological models.

Question 5

What are four examples of a biological model?

Answer 5

Genetics, biochemistry, neuroanatomy, and the endocrine system

Question 6

What does the genetic approach focus on, and how?

Answer 6

Studies on gene environment interactions, through the pedigree method, classical twin designs, adoption studies, and molecular genetics.

Question 7

Explain the pedigree method

Answer 7

Pedigrees are used to analyse the pattern of inheritance of a particular trait throughout a family. The proband (first person presenting with disorder) is identified, and then the question is posed, if there is a higher prevalence methos of disorders in the family of a proband than expected to happen by chance.

It essentially asks the question: how prevalent is the disorder in the family.

Question 8

Explain classical twin designs

Answer 8

Classical twin designs compare concordance rates for monozygotic and dizygotic twins.

If MZ rate of the disorder is > DZ rate: indicated genetic conditions

If MZ + DZ and both show high concordance; indicates shared environmental contributions, e.g. growing up in poverty

If MZ and DZ twins show low concordance; indicates non-shared environment contributions; e.g. experiences unique to one twin

Question 9

Explain adoption studies

Answer 9

Compares concordance of a disorder in adopted children to their biological relatives, and then their adoptive relatives.

Question 10

What are the two main ways molecular genetics are studied?

Answer 10

Candidate gene studies and genome wide association studies (GWAS)

Question 11

What are candidate gene studies

Answer 11

Studies which examine if one allele is more frequently seen in people with the disorder, than in people without the disorder.

Question 12

What are genome wide association studies (GWAS)?

Answer 12

Studies which assess common variation across the entire genome.

Question 13

Explain biochemistry as aetiology

Answer 13

It studies the role of chemical messengers in influencing emotions, thoughts, and actions.

Question 14

What are four key neurotransmitters involved in mental health?

Answer 14

Serotonin, Gamma Aminobutyric Acid (GABA), Noradrenaline, and Dopamine

Question 15

What is the role of serotonin?

Answer 15

Serotonin regulates behaviour, mood and thought processes.

Question 16

What are drugs that primarily affect the serotonin system?

Answer 16

Tricyclic antidepressants, and Serotonin specific reuptake inhibitors

Question 17

What is the role of Gamma Aminobutyric Acid (GABA)?

Answer 17

GABA inhibits a variety of behaviours and emotions, and seems to reduce overall arousal.

Question 18

Which drug makes it easier for GABA molecules to attach themselves to the receptors of specialised neurons?

Answer 18

Benzodiazepines (e.g. Valium)

Question 19

Why should benzodiazepines be avoided for long term use?

Answer 19

They have a high addiction potential.

Question 20

What is the role of noradrenaline?

Answer 20

Noradrenaline is secreted by the adrenal glands, and has circuits in the central nervous system (hindbrain: controlling basic bodily functions; and the emergency reactions that occur when we suddenly find ourselves in an emergency situation)

Question 21

Explain the role of domine

Answer 21

Dopamine is known as a ‘reward’ neurotransmitter - release facilitates learning - we feel a burst of pleasure when we master something difficult. It can be hijacked by addictive substances and behaviours. It also has effects on motor and hormonal systems (e.g. Parkinson’s).

Question 22

What other biological processes/problems can affect neurotransmitters?

Answer 22

As neurotransmitters are proteins, they are affected by nutrition, sleep and gastro-intestinal problems.

Question 23

Explain the role of the endocrine system

Answer 23

The endocrine system produces hormones, which help regulate physiological processes, and co-ordinate internal bodily processes with external events.

Question 24

What is an example of how prolonged stress can cause dysfunction?

Answer 24

High cortisol levels and cause low serotonin levels - leads to comorbidity between PTSD and depression

Question 24

What are the 5 overlapping stages of psychosexual development?

Answer 24

Oral (0-1.5), Anal (1-3), Phallic (3-4), Latency (5-12), Gential (11-20)

Question 25

According to the Freudian view, if a developing child experiences some trauma or significant problem at one of the stages of psychosexual development, what will occur?

Answer 25

They will become fixated at a particular stage, and then develop certain problematic characteristics.

Question 26

What is the Id?

Answer 26

The primal, unconscious part of the personality that operates on the pleasure principle, driven by instinctual desires and seeking immediate gratification. It is motivated by biologically driven instincts.

Question 27

In the psychodynamic model, what are the 3 parts to personality?

Answer 27

The Id, the ego, and the super ego

Question 28

What is the ego?

Answer 28

The ego is the conscious, rational part of the personality that mediates between the id's primitive impulses and the superego's moral constraints, operating according to the reality principle. It often uses defence mechanisms to ward off unpleasant feelings.

Question 29

What is the super ego?

Answer 29

The part of the psyche that acts as our conscience, and ego ideal.

Question 30

In terms of Freud, how do symptoms form?

Answer 30

Traumatic childhood -> defence mechanisms -> symptoms

Question 31

In terms of Freud, how are symptoms best removed?

Answer 31

Free association -> recovery of material -> awareness and interpretation

Question 32

What were some contributions of psychodynamic theory?

Answer 32

- Impact of childhood experiences on later development - The impact on unconscious behaviour - The continuity of normality and abnormality - Demystified mental illness - Identification of defence mechanisms - Transference and counter-transference

Question 33

What are some limitations of psychodynamic theory?

Answer 33

- Resistance to empirical investigation (how to study unconscious processes) - Emphasises abnormality rather than psychological health - Apparent blaming attachment figures for individual concerns - Hasn't contributed to prevention or early intervention methods - Ascribes a medical model power structure to the patient and doctor/analyst

Question 34

Who founded the humanistic model?

Answer 34

Carl Rodgers and Abraham Maslow

Question 35

What is the humanistic model?

Answer 35

A holistic approach that emphasizes individual potential, growth, and self-actualization, focusing on subjective experiences and the conscious human experience rather than solely on behaviour or the unconscious.

Question 35

What therapies does the humanistic model include?

Answer 35

Person centred therapy, existential therapy, gestalt therapy, as well as mindfulness

Question 36

What is the Behavioural Model?

Answer 36

A model that posits that human behaviour, including psychological problems, is learned through interactions with the environment, emphasizing the role of reinforcement and conditioning.

Question 37

What are some behavioural treatments?

Answer 37

Classical conditioning techniques: systematic desensitisation, aversion therapy, exposure therapy Operant conditioning techniques: positive reinforcement, extinction, token economies, behavioural activation

Question 38

What are some strengths of the behavioural model?

Answer 38

- Theory and treatments can be tested in the lab - Lab research support the behavioural model - Many of the techniques remain useful

Question 39

What are some weaknesses of the behavioural model?

Answer 39

- No indisputable evidence that abnormal behaviour is due to improper conditioning - Too simplistic (no account for individual differences, culture, social context) - Over-emphasis on learning and environmental determinants of behaviour - Human cognition could not be accounted for

Question 40

What is the cognitive model?

Answer 40

A methodology that emphasizes a person's perceptions and thoughts as the main influencers of their feelings and behaviours

Question 41

What is the cognitive principle?

Answer 41

- Emotional reactions and behaviours are strongly influenced by cognitions - Different cognitions give rise to different emotions - By changing cognitions one can change the way that they feel

Question 42

What are some strengths of the cognitive model?

Answer 42

- Amendable to empirical enquiry - Complements behavioural strategies

Question 43

What are some weaknesses of the cognitive model?

Answer 43

- Precise mechanism role of cognitions in psychopathology not clearly known - Lack of evidence for hypothesised mediators of change in CBT - Lack of evidence that cognitive therapy added to behaviour therapy

Question 44

How do 'third-wave' CBT approaches differ?

Answer 44

They observe and accept thoughts and feelings, rather than identifying and revising unhelpful thoughts and behavioural change.

Question 45

What are included in 'third-wave' CBT approaches?

Answer 45

Dialectical Behaviour Therapy Mindfulness Based Stress Reduction Schema focused therapy Acceptance and Commitment Therapy Mindfulness-Based Cognitive Therapy

Question 46

What is mindfulness?

Answer 46

The awareness that emerges through paying attention on purpose, in the present moment, and non-judgementally to the unfolding of experience, moment by moment

Question 47

What is ACT?

Answer 47

A therapy approach that uses acceptance and mindfulness processes to produce greater psychological flexibility. The goal is psychological flexibility (contact with the present moment and changing or persisting in behaviour in the service of chosen values)

Question 48

What is a benefit for new emerging treatments in the cognitive model?

Answer 48

CBT does not work for everyone, so we need alternative evidence based options, such as MBSR, MBCT and ACT

Question 49

In the biomedical model, what is considered the cause of psychological disorder?

Answer 49

Inherited or acquired brain disorders involving imbalances in neurotransmitters or damage to brain structures

Question 50

In the psychodynamic model, what is considered the cause of psychological disorder?

Answer 50

Unconscious conflicts over impulses such as sex and aggression, originating in childhood

Question 51

In the Humanist model, what is considered the cause of psychological disorder?

Answer 51

Lack of unconditional positive regard leads to self deprecation and a distorted view of one's experiences leads to psychological dysfunction

Question 52

In the behavioural model, what is considered the cause of psychological disorder?

Answer 52

Phobias, depression, children's misbehaviour, etc, result from faulty learning processes

Question 53

In the cognitive model, what is considered the cause of psychological disorder?

Answer 53

Irrational or maladaptive thinking about one's self, life events, and the world in general

Question 54

In mindfulness, what is considered the cause of psychological disorder?

Answer 54

Attentional processes associated with being in the past or the future (as opposed to being in the present moment with a non-judgemental, open attentiveness)

Question 55

In ACT, what is considered the cause of psychological disorder?

Answer 55

A primary source of psychopathology is the way that language and cognition interact with direct contingencies to produce an inability to persist or change behaviour in the service of long term valued ends. This psychological inflexibility emerged from weak or unhelpful contextual control over language processes.

Question 56

What is the biopsychosocial model/diathesis-stress model?

Answer 56

A model that recognises that a person's physical, mental, and social well-being are interconnected and influenced by biological, psychological, and social factors, promoting a holistic approach to understanding health and illness. Diatheses and Stressors lead to mental disorders

Question 57

In the diathesis-stress model, what is included in diatheses

Answer 57

Genes, biological characteristics, and psychological traits

Question 58

In the diathesis-stress model, what is included in stressors?

Answer 58

Environmental trauma, economic adversity, loss of loved ones, and harsh family background

Question 59

What is clinical assessment,?

Answer 59

The process clinicians use to gather information about clients

Question 60

In clinical assessment, what is the information gathered crucial for?

Answer 60

Diagnosis, formulation, treatment planning, and predicting the future course of a diagnosis

Question 61

What does a clinical assessment typically commence with?

Answer 61

A clinical interview

Question 62

What are the two broad aims of a clinical interview?

Answer 62

To gather information: diagnosis, formulation, implementation of appropriate assessment strategies To establish therapeutic relationship: rapport, openness and willingness to share information, receptive to therapeutic strategies

Question 63

In a clinical interview, what information is collected?

Answer 63

Biographical information: demographic, name, age, marital status, gender, occupation, ethnicity, country of birth, religion, current living circumstances Referral information: Self-referred/family member referred/court ordered, and reason for referral Presenting problems: recent triggers, impact of problems, onset, course, duration, historical precipitants, past episodes of illness not already covered, previous treatment, effect and compliance with treatment Medical history and drug/alcohol use: general health, major illness, hospitalisations, prescribed/over the counter drugs, when last taken, recreational drugs Family History: family membership and environment, history of psychiatric or medical conditions, parental occupational status Personal and social history Strengths, resources, needs: Support system, coping skills, friendships, social relationships, general health, emotional, spiritual, cultural needs

Question 64

What is a Mental State Examination?

Answer 64

A culmination of a therapists observations and impressions of client's mental functioning at the time of the interview

Question 65

What information is included in the MSE?

Answer 65

Appearance: hygiene and grooming, facial expressions, dress, physical characteristics Behaviour: posture, facial expression, general body movements, attitude towards examiner, mood and affect, speech, perceptual disturbance, though process and content, cognition, insight, judgment, reliability

Question 66

What is echopraxia?

Answer 66

Imitation of movements of another person

Question 67

Define tic

Answer 67

Involuntary, spasmodic motor movements

Question 68

Define stereotypy

Answer 68

Repetitive fixed pattern of movement

Question 69

Define lability

Answer 69

Rapid and abrupt changes in emotional tone; unrelated external stimuli

Question 70

Define illusion, in terms of perceptual disturbance

Answer 70

A wrong perception of a real physical external stimulus

Question 71

Define comprehension, in terms of perceptual disturbance

Answer 71

A sensory perception despite no physical external stimulus

Question 72

Define neologism

Answer 72

New words created in flow of speech

Question 73

Define word salad

Answer 73

Flow of speech is an incoherent mixture of words

Question 74

Define circumstantiality

Answer 74

Indirect speech that is delayed in reaching the point but eventually gets from original point to desired point

Question 75

Define tangentiality

Answer 75

Inability to have goal directed associations of thought, client never gets from original point to desired goal

Question 76

Define flight of ideas

Answer 76

Rapid, continuous verbalisations, shift from one idea to another

Question 77

After initial assessment interview, which assessment strategies are used to obtain more detailed information?

Answer 77

Structed interview, collateral information from those around the client, psychometric assessments, neuropsychological testing, behavioural observation, self-monitoring

Question 78

When selecting appropriate assessment measures, what is it guided by?

Answer 78

Theoretical orientation of the clinician, presenting problems of the client, and resources available

Question 79

What is diagnostic formulation?

Answer 79

A guide for intervention that explains the processes that caused and maintain the presenting problems. It is an active and ongoing process, responsive to new data, information, and is influenced by theoretical orientation

Question 80

What are the 5 P's of diagnostic formulation?

Answer 80

1. Presenting factors 2. Predisposing factors 3. Precipitating factors 4. Perpetuating factors 5. Protective factors

Question 81

What are presenting factors?

Answer 81

The problems/symptoms the client is presenting with

Question 82

What are predisposing factors?

Answer 82

Physical, psychological, or social factors that have affected the client in the uterus or early life, making them vulnerable to later psychiatric disorders. Factors may include, genetic influence, maternal substance abuse, traumatic events, parental influences, and negative early childhood experiences

Question 83

What are precipitating factors?

Answer 83

Historical: A trigger for the initial onset of psychological difficulties Recent: a trigger for the exacerbation or the re-emergence of symptoms/difficulties

Question 84

What are perpetuating factors?

Answer 84

The factors that are maintaining the symptoms over time

Question 85

What are protective factors?

Answer 85

Factors that are seen as protective or that support recovery

Question 86

How is a categorial approach to classification different from a dimensional approach?

Answer 86

A categorical approach assumes that distinctions among members of different categories are qualitative, whereas a dimensional approach describes the objects of classification in terms of continuous dimensions (focus on specific characteristic and determine how much of that characteristic the object exhibits)