Abnormal Psych (Midterm I)

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Etiology

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CAUSAL pattern of abnormal behavior

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What defines Abnormal behavior?

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SVIS-MD:
Suffering
Violates social standards
Irritability
Social discomfort
Maladaptiveness
Deviangy

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How is abnormal behavior classified?

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-Categorical: dicrete (no continuum), all criteria or no diagnosis
-Dimensional: on continuum w/ consideration of ind. strength/weaknesses
-Prototypical: (DSM) acknowledges that no one fits all criteria, but models prototypes of each disorder

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What are DSM's 5 axes?

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I - Particular Clinical syndromes
II - Personality Disorders
III - General medical conditions
IV - Psycho-social/envi. probs
V - Global assessment of functioning

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Epidemiology

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Study of the distribution of disease/disorder

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Incidence

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Rate of new cases of a given disorder in a given population in a time period

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Prevalence

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Active cases in a given population during time period

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Lifetime prevalence

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Living persons in population that have ever experienced the disorder

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Comorbidity

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Occurrence of 2 or more identified disorders in the same individual

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Retrospective Studies

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One research method in Psychology
Looks backwards to reconstruct developmental history

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Prospective studies

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One research method in Psychology
Follows large sample of individuals and observes who does/does not develop disorder

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Animal research

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One research method in Psychology
Observes animal behavior as an analogue study
-benefit: can create well-controlled environments

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Clinical case studies

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One research method in Psychology
Offers detailed information on which to base hypothesis, but individual biases/quirks strong

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Approaches and Models of Etiology

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BIOLOGICAL
1. Hormonal abnormalities
2. NT dysfunctions
3. Genetics
4. Temperament
5. Neural Plasticity

PSYCHO-SOCIAL
(Psychodynamic)
1. Freud's models
2. Object-relations
3. Interpersonal perspective
4. Attachment theory

(Behavioral)
5. Classical Conditioning
6. Instrumental conditioning
7. Generalization

(Cognitive behavioral)
8. CBT perspective

SOCIO-CULTURAL

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Risk factor

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variables correlated with emergence of disorder

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Necessary Cause

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If disorder Y occurs, then X must have preceded it
-disorders cannot occur without this factor
-very few of these in psychology

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Sufficient Cause

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If X occurs, then Y will occur
-guarantees the emergence of disorder
-very few of these, eg, stressful life event & PTSD

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Contributory cause

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If X occurs, then the probability of Y increases
-neither necessary nor sufficient

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Distal Causal Factor

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Occurs early in life but shows effects later on

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Reinforcing Contributory cause

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Condition that maintains maladaptive behaviors that are occurring

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Feedback

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Get feedback from environment, this can be a stressor

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Proximal Causal Factor

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Occurs shortly before the disorder develops

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Mutual 2 way influences

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Individual changes and reacts to his/her environment
-like a genotype-environment correlation

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Diathesis

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Predisposition to developing disorder

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Proximal stressor

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Necessary or contributory factors

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Diathesis Stress models

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1. Additive: total “sum” reached to develop disorder (if low disposition, need high levels of stress to develop)
2. Interactive view: must have diathesis for disorder to occur

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Resilience

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Overcoming the odds – MI SPEC
Motivation to achieve/drive
Intelligence
Self-regulation
Protected from stress
Effective parenting
Cognitive development

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Serotonin

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Associated with mood, cognitions, depression

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GABA

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Associated with anxiety

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Dopamine

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Associated with Schiz

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Norepinephrine

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Assoc. with Schizophrenia

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What are the genotype-environmental correlations?

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-Passive effect: kids of smart parents raised in stimulating environment
-Evocative effect: evoke rxn in others (smiley baby)
-Active effect: niche building, create suitable environments

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Temperament

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Emotional/arousal responses & reactions in individuals, and how they differ
-baby-temp thought to be correlated with adult temp
PAFAI
Positive Affect (→extraversion = pos. emo later on)
Activity level (→extraversion = positive emo later)
Frustration (→neuroticism = neg emo later on)
Attentional persistence (→constraint = agreeable)
Irritability (→neuroticism = neg emo later on)

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Neural Plasticity

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Ability of brain to make changes in organization and functioning of the brain on a neurological level

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Freud's Model of Mental Functioning

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Dimensions of personality:
Id: libido and death drive, pleasure principle, primary process thinking, “I can do that!”
Ego: mediator between the two, secondary thinking, in touch with reality, executive branch
Superego: internalization of parental figures, cause of individual’s drive to please others

Anxiety: MR.N
Reality anxiety: fear of reality
Neurotic anxiety: intra-psychic conflict
Moral Anxiety: pt with punitive SuperEgo

Defense Mechanisms: coping mechanism for anxiety
-Repression: suppressing info from cs
-Reaction formation: trying to deny emotions and overcompensate by exhibiting opposite behaviors
-Displacement: of emotion
-Projection: take feelings and attribute to someone else so there is less emotional responsibility

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Object Relations Rehotry

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Object (symbolic of a person) are internalized and interactions of self and other objects give us sense of who we are
-engages introjection

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Interpersonal Theory

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Similarities to behavioral perspective
-doesn’t include intra-psychic conflict
-observe socio-cultural patterns (as part of learning)

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Introjection

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Process where child symbolically internalized people intro own personality

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Attachment Theory

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Bowlby
-early childhood attachment relationships lay down framework for later functioning

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Classical Conditioning

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Pavlov
-UCS and CS both eventually trigger UCR
-extinction does not mean unlearning
-see spontaneous recovery

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Instrumental Condiotioning

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-has element of reinforcement
-individual learns to act in a certain manner to achieve desirable goal/avoid undesirable

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Generalization

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inability to distinguish between phobias

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Schema

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Underlying representation of the world that guides information processing, shaped by personal biases

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Obervational Learning

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learn through looking, not experiencing it directly

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Attribution theory

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Assign cause to things that happen
-pts with depression = more negative self attributions; healthy people = self-serving biases

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Early Deprivation/trauma

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Psycho-social causal factors of Mental Disorder
-affects basic trust skills/schema/acquiring skills
-separation makes people prone to deprivation
-abuse/neglect can lead to disorganized attachment (laughing while whimpering)

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Inadequate parenting

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Psycho-social causal factors of Mental Disorder
-if parents have psychopathologies, see inability to devote attention to kids, exhibit insecure attachment, increased life stress

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What are differences in parenting styles?

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When goes wrong, Psycho-social causal factor
-Authoritative: friendly, competent, securely attached
-Authoritarian: conflicted, irritable, moody, aggr.
-Permissive/Indulgent: spoiled, selfish, impatient, inconsiderate, demanding
-Neglectful/Uninvolved: moody, low self-esteem, conduct problems

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Marital Discord

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In comparison, these kids have less edu, lower incomes & life satisfaction, welfare, get divorced
-correlation unclear
-Amato’s studies show that effects are minimal

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Maladaptive peer relationships

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Psychosocial causal factor
Evidences reinforcing contributory factors, feedback
-withdrawn kids may become more withdrawn

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Schizophrenia

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Bleuler, Swiss shrink terms it “split mind” – mind is divorced from consensual reality
Exhibit Psychosis: loss of contact with reality
1% lifetime prevalence

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Positive symptoms

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-hallucinations
-delusions
-easier to treat with medication

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Negative symptoms

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-emotional flattening
-poverty of speech
-harder to treat

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Hallucinations

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Sensory experiences in absence of external stimulus
-auditory most common; Broca’s area is activated

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Delusions

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Disturbances in content of thought
-Delusions of Reference: find sig. in things
-Thought insertion: believe thoughts are inserted
-Thought broadcasting: believe others can read their thoughts
-Thought withdrawal: believe thoughts are being taken away from them

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Neologisms

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Use Neologisms: made up words
-word salad
-loose associations made, cognitive slippage, derailment

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Undifferentiated type

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Wastebasket category
-when pt doesn’t fit into other categories
-common in people “breaking down”
-rapidly changing symptoms (might be transitional state)

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Paranoid

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-coherent, persecutory delusions
-delusions of grandeur
-auditory hallucinations
-higher adaptive, coping skills (recover most easily)
-no evidence of disorganized speech

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Catatonic

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alternates between stuporous and excitement
-Exhibits echopraxia: imitation of gesture
-exhibits echolalia: imitation of speech

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Delusional disorder

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-believes delusions, sometimes act on them
-pt exhibits NO other symptoms

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Residual schizophrenia

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-pt recovering from schizophrenia, no active symptoms

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Schizoaffective

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comorbidity w/ schizophrenia and mood disorder

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Schizophreniform

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-schiz-like symptoms, but less than 6 mo.

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Shared psychotic disorder

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-delusion develops in the context of a close relationship

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Brief psychotic disorder

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-disorganized/catatonic behavior for less than 1 mo.

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Evidence for Genetic Causal Factors of schizophrenia

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-prevalence for 1st degree relative is 10%, 2nd is 3%
-Mono twins show 28% concordance, dizy show 6%
-16.6% of children of schiz mother develop it
-Wahlberg study: showed that high Communication deviance in families at risk developed schiz; see gene-environment interaction
-while family concordance exits, it’s not 100% = schiz is not purely genetic

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Neurodevelopmental factors in Schizophrenia

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-Dutch Hunger winter
-Flu outbreak in Finland 1957
-Complicated deliveries
-Walker’s home videos: ppl who develop schiz have decreased facial/emo expr & motor skills as children
-Brain areas are abnormal:
-enlarged ventricles
-decreased brain volume
-frontal lobe dysfunction (=neg symp & attn deficit?)
-reduced thalamus
-abnormalities in temporal lobe, incl: hippocampus, amygdala (memory & emotions)

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NT abnormalities in Schizophrenia

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Dopamine: see excess amounts, due to excess production or too many dopamine receptors?
-Glutamate: dopamine receptors inhibit release of glutamate, which is excitatory NT. Less glutamate = less glutamate receptors, which can lead to cell death. Pts with schiz have less glutamate.

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Neurocognitive deficits

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-eye tracking test: 54-86% of pts with schiz couldn’t
-50% of 1st degree relatives also couldn’t track
-would indicate that there is a genetic vulnerability
-interestingly, controls administered glutamate inhibitors also showed an inability to track

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Psychosocial/Cultural aspects

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-Expressed emotion: feelings of hostility, criticism… is especially stressful to pts with schiz, and may trigger cortisol release, which signals dopamine
-lower SES = higher levels of schizophrenia
-sociogenic (breeder) hypothesis
-social drift hypothesis

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Sociogenic (breeder) hypothesis

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diathesis-stress model
-poverty = extreme stressor, so predisposed @ high risk

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Social Drift hypothesis

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-feedback & mutual influence
-inability to function makes performance worse, and this cycles until lose job/daily routine/etc.

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Treament & Clincal outcome in Schizophrenia

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Antipsychotics: have two kinds, 1) conventional neuroleptics and 2) novel antipsychotics (better, but rel. to weight gain and extrapyramidal side effects)
-Psycho-social approaches (rapport, rel involved):
-Case-management: make sure pt has job, house, etc.
-Social Skills training: develop interpersonal skills
-CBT: examine evidence for delusions
-Family therapy: try to create low CD/EE environment

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Rapport

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Unconditional positive regard for pt during session

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Mood disorder (DSM-IV)

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Intense, persistent disturbances in mood shown to be mal-adaptive
-DSM-IV: 5 or more in 2 wks, with 1 of those being depressed mood/loss of interest
-depressed most of the day
-hypersomnia/insomnia
-weight gain/loss
-diminished intrest
-psychomotor agitation/retardation
-feelings of worthlessness/guilt
-diminished ability to concentrate
-recurrent thoughts of death
-Lifetime prevalence for uni 13% males, 21% females
-lifetime prevalence for bipolar 0.4-1.6%

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Subtypes of Major Depression

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-MD episode with psychotic: mood congruent delusions and hallucinations, feelings of worthlessness/guilt; distinguished from schizoaffective b/c hallucinations are mood congruent
-MD episode with melancholic: (need 3)
-early morning awakening
-depression is worse in the morning
-loss of appetite
-excessive guilt
-pscyho-motor agitative
-qualitatively different sadness (punitive, despair)

-MD episode with atypical: (need 2)
-mood reactivity (can brighten, but not to normal)
-leaden paralysis (body is heavy)
-weight gain/increase in appetite
-hypersomnia
-pronounced sensitivity to interpersonal rejection
-Chronic: lasts more than 2 years
-Seasonal: recurrent during (winter) season
-Dysthymia: milder but longer-lasting symptoms of depression

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Beck's Cognitive Model

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-Early experience
-Formation of dysfunctional beliefs
-Critical incidence (stressors)
-Negative beliefs/schemas activate
-Negative automatic response cascades
-Symptoms of depression (keep schemas active)

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Negative Cognitive Triad

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-part of Beck’s model, about Self, Future, and Others
-all or none reasoning
-selective abstraction: only take negative data
-arbitrary inference: seek negative data to support idea despite contrary evidence

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Helplessness Theory

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-developed from animal studies
-when animals/humans are unable to control their environment, learn helplessness
-humans learn helplessness with attributional style, too
-internal/external: attribute blame to self/others
-global/specific: belief in temporary state/not
-stable/unstable: belief in ability for things to change

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Hopelessness Theory

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-similar to helplessness theory but includes expectancy of hopelessness
-in attributional criteria, disregards internal/external in favor of hopeless expectancy
1. pessimistic attributions
2. life stressor
3. sureness that other negative events will occur

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Suicidal Ambivalence

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-communication of suicidal intent, exhibits a desire to communicate with others, perhaps a drastic cry for help
-30-40% make implicit communication
-40% make explicit communication

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Warning Signs of Suicide

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-lack of interest
-change in mood
-marked self-esteem
-deteriorating hygiene
-interpersonal problems (also acts as proximal stressor)

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Biological Factors in unipolar depression

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-genetic contribution: mono zygotic twins are 2x likely to have depression than dizygotic (30-40% variance)
-non-shared environmental factors show more variance than shared environmental factors
-5-HTT gene combo include 1 or 2 short alleles correlated with higher rates of depression
-Dysregulated thyroid functioning: show sim symptoms
-low levels of activity in left pre-frontal cortex
-Dexamethasone: usually suppresses cortisol, but isn’t functioning, so depressed pts have extra-high levels of cortisol, indicating that HPA is dysfunctional

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Suicide - prevalance rates

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-among top 10 leading causes death in West
-attempts most common 18-24, completed in elderly over 65
-rates for younger attempts increasing
-40-60% completed suicided performed by people in recovery phase
-1% risk for pts with depression, 15% for pts with chronic depression
-15% risk in recurrent mood disorders, 10% in schizophrenia, 1% general
-10% of children/adolescents have attempted
-2nd leading cause of death in college students
-3rd leading cause of death in young

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Risk Factors for Suicide

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-drug/alcohol abuse
-sensitivity to lack of control
-conduct disorder
-exposure to media
-academic/ID pressures

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Bipolar disorder

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-Distinguished from unipolar depression by presence of manic/hypomanic symptoms that show themselves for at least 1 week
-medications for depression can send manic-depressive sufferers into manic state; need for correct diagnosis!

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Cyclothymic disorder

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-cycles through hypomanic and depressed states, but less severe than bipolar disorder
-lasts 2 years

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Mania

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-elations, expansiveness, grandiosity, eupohira, irritable
-flight of ideas, goal-directed behavior for foolish endeavors
-need to have 1 week of manic state for bipolar disorder

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Subtypes of bipolar

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-Bipolar I: 1 full on manic episode and depression
-Bipolar II: hypomanic and depression
-Bipolar with seasonal patterns

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Biological Causal for Bipolar

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-Genetic: greater genetic contribution than in unipolar
-8-9% of 1st degree relative concordance, gen 1%
-mono have 60% concordance, di have 12%
-estimated that genes account for 80-90% variance
-NTs: norep, serotonin, and dopamine dysfunctions
-not well-understood
-think there are abnormalities in the way ions are transported across neural membrane
-perhaps that’s why lithium is effective, it works like sodium to pass down neural impulses down axon
-Hormonal: cortisol, disturbances in bio rhythm?
-Neuro: shifting patterns of blood flow to the left and right prefrontal cortex

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Psychosocial causal factors of bipolar

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-stressful life events
-personality variables (high self-standards, neuroticism)
-psychodynamic think manic = coping mech for depr