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86 Cards in this Set

  • Front
  • Back
Why is personal distress an inadequate way to define a mental disorder?
Not everyone is bothered by their disorder
Why is statistical rarity an inadequate way to define a mental disorder?
Some disorders, such as depression, are common
Who developed the "harmful dysfunction" approach to defining mental disorders, upon which the DSM-IV classification is based?
Jerome Wakefield (1999)
The DSM-IV classification of psychological/behavioral syndromes is associated with which 3 characteristics?
1. Present distress (painful symptoms)
2. Disability or impairment in functioning
3. An increased risk of suffering death, pain, disability, or loss of freedom
What 3 conditions are excluded from the DSM-IV classification of mental disorders?
1. An expectable and socially sanctioned response to an event (e.g. death of loved one)
2. Deviant behavior (political, religious, sexual minorities)
3. Conflicts between the individual and society (voluntary efforts to express individuality)
Who thought that health was maintained through the balance of 4 humors?
Hippocrates; 4 humors were yellow bile, black bile, blood, phlegm
Who was an advocate of the humane treatment of the mentally ill?
Dorothea Dix (1802-1887)
How did psychiatry emerge?
Psychiatry emerged from the development of large institutions
Why did deinstitutionalization occur?
In the 1950s, phenothiazines were developed, which treated severe disorders
What is comorbidity?
The co-occurrence of of more than one condition simultaneously, e.g. anxiety & depression or bulemia & substance abuse
4 facts regarding schizophrenia
- Observed worldwide
- Prevalence: .5 - 1.5%
- Median age for onset is 20s
- Higher incidence for 2nd generation African Caribbeans
3 facts regarding bulimia nervosa
- Lifetime prevalence of substance abuse or dependence is 30%
- 90% females
- Lifetime prevalence: 1% - 3%
What percentage of the population receives at least one diagnosis of mental disorder in their lifetime?
For which disorders are gender differences noticed?
- Depression and anxiety disorders are more common among women

- Alcoholism and antisocial personality are more common among men
Which disorders occur with equal frequency among women and men?
Bipolar mood disorder and schizophrenia
What is the relative risk of developing schizophrenia, bipolar disorder, depression, and phobias if a family member has one of these conditions?
High risk: bipolar & schizophrenia

Low risk: depression & phobias
Who initiated the Biological Paradigm by discovering a biological cause to a mental disorder?
Kraft Ebbing discovered that paresis was related to the infection of syphilis
Who developed the Psychodynamic Paradigm?
Sigmund Freud, and followers of his theories
What are the 3 components of the mind according to Psychodynamic Theory?
Id: Pleasure-seeking impulses
Ego: Operates in reality as it fulfills id impulses and performs other functions
Superego: Conscience
Who is solely associated with the Psychoanalytic Paradigm?
Sigmund Freud
How did Freud suggest that the ego protects itself from anxiety?
Through various defense mechanisms:
– Denial: "I don't have that condition"
– Displacement: kick your dog because you're mad at your boss
– Projection: Saying "they hate me", when you hate them
– Rationalization: I failed the test, but the questions were stupid
– Reaction formation: Saying the opposite of what you feel, like hating your crush
– Repression: Not expressing feelings at all
– Sublimation: Converting a destructive impulse into something socially acceptable, e.g. aggressive people like sports
What is the Psychodynamic approach in identifying and treating mental disorders?
Look for unconscious causes to behavior, typically stemming from childhood
What is the Cognitive Behavioral approach in identifying and treating mental disorders?
Views behavior as a byproduct of learning, so they identify repeated examples of behavior and coping skills that need to be learned
Who is primarily associated with Classical conditioning research?
Ivan Pavlov
Define Classical conditioning
Learning through association
In Pavlov's experiments, what were the conditioned and unconditioned stimuli and responses?
Unconditioned stimulus: meat
Unconditioned response: salivation

Conditioned stimulus: bell
Conditioned response: salivation
What is extinction?
Extinction occurs once a conditioned stimulus is no longer paired with an unconditioned stimulus, and no longer produces a conditioned response
Who is associated with Operant conditioning?
B. F. Skinner, who worked with rats and pigeons
Define operant conditioning
Asserts that behavior is a function of its consequences, meaning behavior increases if rewarded, and decreases if punished
Define positive reinforcement, negative reinforcement, and punishment
Positive reinforcement: pleasant stimulus which increases behavior

Negative Reinforcement: Removal of negative stimulus which increases behavior

Punishment: Addition of negative stimulus to decrease behavior
Define the humanistic paradigm
Human behavior is not caused by internal or external events, but by voluntary choices
Who is associated with the Humanistic Paradigm?
Carl Rogers, Fritz Perls, Abraham Maslow
What are 3 problems with strict adherence to a single paradigm?
- Some theories cannot be tested
- Available options are reduced
- Behavior is a multi-variable issue which cannot be explained by one paradigm
Define diathesis
Predisposition to developing a disorder
What is the Diathesis-Stress model?
Suggests disorders only develop when stress is added to a predisposition
What neurotransmitter may be involved in schizophrenia?
Define genotype
An individual's actual genetic structure
Define phenotype
Expression of a genotype
What are autosomal traits?
Dominant/recessive traits caused by a single gene, e.g. color of Mendel's pea plants
What are polygenic traits?
Traits caused by more than one gene, e.g. height
What is a concordance rate?
The rate of one twin having the same condition as the other twin
What percentage of genes do monozygotic twins and dizygotic twins share?
Monozygotic twins: 100%

Dizygotic twins: 50%
What do the various concordance rates in twin studies support the influence of?
MZ > DZ: Genes
MZ = DZ (both high): Shared environment
MZ = DZ (both low): Nonshared environment
Whose ideas of the stages of development were based in psychosexual theory, and what were the stages?
Freud's stages of development include oral, anal, phallic, and genital
Whose ideas of the stages of development were based in psychosocial theory?
Erik Erikson
What are the forms of treatment for each of the paradigms?
Biological: medical illness
Psychodynamic: insight into unconscious motivations
Cognitive behavioral: altering thinking and behaviors
Humanistic: increase emotional awareness and genuine emotional expressions; take responsibility for own life choices
What are some biological treatments for mental disorders?
- Electroconvulsive therapy (rare, only used as a last resort)

- Cingulotomy (aka psychosurgery), which is used in extreme cases of OCD with a 25-30% improvement rate. Developed in 1938

- Psychopharmacology, such as antidepressants which produce a 60% response rate
What classes of antidepressants exist?
- Tricyclic and tetracyclic: Block certain neurotransmitters. Serious side effects, but potent

- MAOIs: Inhibits the enzyme which breaks down certain neurotransmitters. Severe side effects

- SSRIs: Current standard of treatment which increases levels of serotonin by inhibiting reuptake by the presynaptic neuron

- Atypical antidepressants: Norepinephrine-dopamine reuptake inhibitors like Wellbutrin
What in involved in psychoanalytical (Freudian) treatments of disorders?
- Free association: say whatever comes to mind

- Dream interpretation

- Insight: attempt to discover unconscious motives

- Transference: will transfer feelings about others onto therapist

- Countertransference: When therapists' feelings influence their responses
What is ego analysis?
Emphasizes the patient’s coping
with the external (past/present relationships) as well as the internal (unconscious) world
Which four people are typically associated with ego analysis?
- Harry Stack Sullivan: stressed the importance of interpersonal relationships

- Karen Horney: people have competing needs for closeness, dominance, and autonomy

- Erik Erikson: psychosocial stage theory; looked at social rather than sexual aspects of development

- John Bowlby: attachment theory
Which 3 individuals are associated with cognitive behavioral therapy?
B.F. Skinner
John B. Watson
Ivan Pavlov
What are 8 cognitive behavioral techniques?
– Systematic desensitization: induce relaxation and go through hierarchy of anxieties

– In vivo sensitization: confront fear in real life

– Flooding: immerse person with object of fear

– Aversion therapy: pair aversive stimulus w/ undesired behavior

– Contingency management: systematically reward good behavior and punish bad behavior

– Social skills training: people can learn assertiveness and social problem solving

– Cognitive techniques such as attribution retraining (cognitive restructuring) & self-instruction training

– Dr. Aaron Beck: practiced cognitive therapy in which depressed people are taught to correct their errors in thinking
For what percentage of the population is psychotherapy effective?
- Of those who seek treatment, 2/3 improve significantly

- Of those who do not seek treatment, 1/3 improve over time
What are the characteristics of an effective psychotherapy for a depressed person?
• Time limited

• Explicit rationale for Rx shared with the patient

• Active-directive therapist

• Focus on current problems

• Emphasis on changing current behavior

• Self monitoring of Progress

• Involvement of significant others

• Expression of cautious optimism

• Problems divided into manageable units with short term goals

• Homework assignments
What are 3 factors influencing improvement?
• Therapist's supportiveness and warmth

• YAVIS clients: young, attractive, verbal, intelligent, successful people do better

• Nature of Problems: phobias are easier to treat
What disorders are on each axis of the DSM multiaxial system?
• Axis I: Clinical disorders and other conditions that may be the focus of clinical
attention (psychosis, anxiety, mood)

• Axis II: Personality Disorders and Mental Retardation (considered to be lifelong)

• Axis III: General Medical Conditions which may impact/be impacted by psychological issues

• Axis IV: Psychosocial and environmental problems like legal problems, homelessness, employment issues, divorce

• Axis V: GAF (Global Assessment of Functioning), where 100 = functioning perfectly. Subjective.
What does the use of "NOS" specify when used in conjunction with a diagnosis?
A diagnosis such as PD NOS means the client does not meet the full criteria for personality disorder; NOS = "not otherwise specified"
What is Kappa?
Inter-rater reliability; the degree to which clinicians agree above and beyond chance.

Kappa is high for schizophrenic disorders, lower for personality disorders
What is reliability?
The consistency of measurements, including diagnoses
What is validity?
Validity is a measure of the success that has been achieved in understanding a disorder
What is concurrent validity?
Concurrent validity is concerned with the present time and with correlations between the disorder and other symptoms, circumstances, and test procedures.
What is predictive validity?
Predictive validity is concerned with the future and stability of a problem over time, such as persistence, outcomes, and effectiveness of treatments.
What are some criticisms of the DSM?
- Comorbidity: 56% of those who met criteria for 1 disorder also met criteria for at least one other disorder

- 2 people with same diagnosis may have no symptoms in common

- Frequency of NOS diagnoses

- Are Axis I and Axis II really distinct (e.g. difference between schizotypal personality disorder and schizophrenia)
Other than a standard interview for examining mental status, what are additional assessment strategies?
- Structured interviews: SCID

- Observational procedures: Informal, use of rating scales, behavioral coding, journals

- Personality tests: MMPI, CPI, MCMI

- Other self-report inventories: Beck Depression Inventory, POMS (profile of mood states), MSI (multiphasic sex inventory)

- Projective tests (used in Psychodynamic model): Rorshach, TAT

- Biological forms of assessment (used for research): EEG, ECG, MRI, PET, SPECT, fMRI
What is the difference between emotion, affect, and mood?
• Emotion: A state of arousal defined by subjective feeling states

• Affect: A pattern of observable behaviors associated with emotion

• Mood: Pervasive and sustained emotional state

Example: despression is a mood which can pass with time, while clinical depression refers to a clinical syndrome
What is a mixed episode?
A period of rapidly alternating moods nearly every day for at least one week.
What is a hypomanic episode?
- Persistently elevated, expansive, or irritable mood, lasting for at least 4 days, accompanied by 3 or more symptoms:

(1) inflated self-esteem or grandiosity
(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
(3) more talkative than usual or pressure to keep talking
(4) flight of ideas or subjective experience that thoughts are racing
(5) distractibility
(6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
(7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish
business investments)

- It does NOT cause clinically significant impairment in social or occupational functioning
What are 3 depressive disorders?
• Major Depressive Disorder: One or more major depressive episodes without a manic, mixed, or hypomanic episode

• Dysthymic Disorder: Chronically depressed mood, most of the day, more days than not, for 2 years

• Double Depression (NOT a DSM diagnosis): The person is dysthymic for 2 years and then has a major depressive episode. 68-90% of people with dysthymic disorder have a depressive episode
Describe 3 bipolar disorders
• Bipolar I: Occurrence of one or more manic episodes or mixed episodes, often having one or more major depressive episodes

• Bipolar II: One or more major depressive episodes, accompanied by a hypomanic episode, but never a manic or mixed episode

• Cyclothymic: Chronic fluctuating mood disturbance involving numerous hypomanic episodes
What can other mood disorders be caused by?
- Medical conditions, such as Parkinsons, Huntingtons Chorea, MS, Alzheimer's

- Substance induced mania, during intoxication or withdrawal states from steroids, antidepressants, and stimulants
What disorders are likely to be comorbid with each other?
• Depression tends to be comorbid with:
- Medical illness
- Anxiety disorders
- Schizophrenia
- Personality Disorders

• Substance use disorders tend to be comorbid with unipolar and bipolar disorders
What are some specifiers for mood disorders?
• Mild, Moderate, Severe

• With or without psychotic features

• In partial remission; in full remission

• With catatonic features

• With melancholic features
– (lack of pleasure in all or almost all activities, depression worse in a.m., early a.m. awakening)

• Post-partum onset (within 4 weeks of birth)

• Seasonal pattern
What is the relationship between mood disorders and genetics?
• Studies have shown that mood disorders are familial

• Relatives of people with mood disorders are 2-3x as likely to have a mood disorder
What have brain imaging results found about those with mood disorders?
• PET: Reduced metabolic activity in frontal lobe of unipolar and bipolar patients

• EEG: Less left frontal activation
What hormone, released by the HPA axis in the neuroendocrine system, is related to depression?
Cortisol; an excess of this hormone appears related to depression
What have studies using suppression of the synthetic hormone dexamethasone shown?
– People without mood disorders show a suppression of cortisol when administered

– 50% of depressed people do not show suppression
What are the psychological theories that attempt to explain mood disorders?
• Abnormal reactions to loss

• Other psychodynamic theories (depression is anger turned inward)

• Interpersonal theory (depression is due to dysfunctional relationships or loss of relationships)

• Cognitive theory (negative self-talk)

• Learned helplessness (rats stopped trying to escape)

• Behavior theories (people isolate themselves and no longer receive positive reinforcement from others)
What are some demographic risk factors for suicide?
- Male
- Recent relationship or status loss
- Never married (no support system or no one to recognize symptoms)
- Older age (loss of purpose due to retirement, onset of medical issues)
What are thoughts that indicate increased risk of suicide?
– Presence of a specific plan

– Means available to carry out plan

– Absence of factors that would keep person from completing plan

– Rehearsal of plan
On which axis does alcohol abuse fall?
Axis I
What is the typical course of unipolar mood disorder?
Typical course is several episodes of major depression, but one is sufficient for diagnosis.
What disorder has the greatest disease burden?
What is a recent application of brain imaging?
Dynamic images taken while subjects are performing tasks
Challenging one's tendency to blame themselves would fall under which treatment paradigm?
Cognitive therapy
What is the depressive triad?
Focus on the negative aspects of the self, future, and world.