Abnormal Psychology

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Median

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middle score

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Mean

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arithmetic average

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Mode

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most frequent score

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Range

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low to high scores

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1 standard deviation

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66% fall within

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2 standard deviations

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97% fall within
only 3% left: 1.5% to each side of the bell curve

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IQ

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(Mental Age/Chronological Age) x 100

Avg = 100
1 standard deviation = 15 points. ∴ 85-115 (66% of population)
2 standard deviations = 70-130 (97% of population).

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Mental retardation

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1.5% of population have IQ lower than 70.

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Epidemiological study says 3% of population has MR. Why the discrepency?

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1.5% familial retardation (mild) = normal distribution. Relatives mean would be lower than 100.

1.5% pathological retardation = environmental factors. Relatives mean would equal to 100.

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Clinical Psychology

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PhD: requires a unique contribution to knowledge by dissertation. Scientist/practitioner model. Apprenticeship model. ~5 years

PsyD: emphasizes practitioner role. Larger classes

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Counseling Psychology

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PhD: graduate school of arts and science

Ed.D: school of education

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Psychiatry

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Psychiatrists (MD): branch of medicine with psychiatry residence (3-4 years). Can prescribe Rx

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Social Work

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MSW: typically 2 years in length

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Prevalence

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how many people in the population as a whole have the disorder

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Incidence

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how many new cases occur during a given period

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Biofeedback

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our bodies are not good at telling us what is going on inside (exactly where it is). Uses an outside device to give us information about us.
Ex. scale, blood pressure, muscular tension.

Biofeedback for treatment of migraine (directing more blood to the periphery of the body than the brain).

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Etiology

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study of origins, has to do with why disorder begins

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Epidemiology

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study of disease across populations (not within the individual). Draws clues from how diseases are distributed.

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History: Supernatural

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Prehistoric times: drilled holes in "crazy" patients to get rid of possession or demons

Salem Witch Trails: Young girls were "bewitched" by middle aged women. May have been suffering from ergotism = fungus that grows on grain and can cause psychological changes (hallucinations).

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History: Biological

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Hippocrates believed that disorders incorporating higher functions would logically be located in the brain

Hippocrates and Galen:
Humoral theory
1) Choler (yellow bile). Choleric = hot tempered and angry.
2) Melancholer (black bile). Melancholeric = depressed and sad
3) Phlegm. Phlegmatic = unemotional, unresponsive, passive
4) Sanguine (blood). Energetic, optimistic, full of life.

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History: Biological (2)

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Syphilis: major reason to admission to psychiatry hospitals in 19th century was general paresis (tertiary stage of disease). Most of this stage is psychological symptoms (but caused by microorganism attacking brain).

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Emil Kraepelin (1856-1926)

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Lasting contribution in diagnosis and classification.

Kept careful records at his psychiatry hospital. Confident of biological basis for mental illness.

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History: Psychology
Psychoanalytical Theory (Sigmund Freud)

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Id = basic biological drive that we are born with; pleasure principle

Ego = reality principle; how an I gratify myself within the constraints of the world?

Superego = conscience, morals.

Defense mechanisms = unconscious protective processes that keep primitive emotions associated with conflicts in check so the ego can continue its coordinating function.

Phallic stage: Oedipus complex = fear of castration by father because of lust for mother.

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Pneumoencephography

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1940s: Biological examination of brain begins
Air picture of the brain. Do lumbar tap and take out CSF: see brain as opposed to the skull.

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CT scan

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Shows cross section of the brain. Cant distinguish between white matter and grey matter

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NMR/MRI

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More detailed picture of the brain. Can distinguish between white and grey matter. Can show the different tracks.

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fMRI

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Capitalizes on change of blood flow in the brain. More blood is allocated to the areas of brain working harder.

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Classical conditioning

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Pavlov
Relationship between the unconditioned stimulus (meat powder) and the unconditioned response (salivating) // conditioned stimulus (tone) and the conditioned response (salivation to tone).

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Charles B. Watson

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Father of behaviorism
Rejected intraspectraism. Wanted to use observable type of behavior.

Induce phobia in 11 mo old Albert. Scared the child when playing with a little white rabbit. Then afraid of it. Generalized to fear of white soft things.

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Intraspectraism

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ask the person what is going on in their mind

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Operant Conditioning

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Probability of behavior is determined by its effects.

Reinforcers = anything that increases the probability of behavior
--Positive: getting something good
**Primary = something that satisfies biological need. (ex. if hungry, food)
**Secondary = something that has gained reinforcing properties through its association with primary reinforcers (ex. money)
--Negative: taking away something bad (ex. taking advil for a headache)

Punisher = anything that decreases the probability of the behavior that receives it
--Positive: giving something bad. (ex. dog does bad, hit with newspaper)
--Negative: taking something good away. (Ex. get a fine for late book to library--taking away your money).
--

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1880 Seven types of disorders

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1. Mania (elevated mood)
2. Melancholia (depression)
3. Monomania (delusion disorder)
4. Paresis (tertiary state of syphilis)
5. Dementia (loss of cognitive functioning)
6. Dipsomania (alcoholic)
7. Epilepsy (no longer thought of as psychopathology)

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DSM

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1952: first publication

1980: DSM III

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DSM III Changes
--Reliability
--Validity

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--Reliability of disorder = does the test give the same results each time. Can test predict itself properly

--Validity of diagnosis = does the test mesure what it is suppose to measure. Can it predict properly.

Cannot have a valid measure unless it is reliable!!

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Seven types of disorders (1880s)

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-Mania (elevated mood)
-Melanchoia (depression)
-Paresis (tertiary state of syphilis)
-Monomania (delusion disorder)
-Dementia (loss of cognitive functioning)
-Dipsomania (alcohol)
-Epilepsy

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DSM III

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1980!! Huge changes!!

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Reliability

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Does the test give the same results each time.
Reproducible?

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Validity

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Does the test measure what it is suppose to measure

Cannot have a valid measure unless it is reliable

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Standarization

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Making a normal

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DSM II vs DSM IV

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Depression

--II: Depressive neurosis (unconscious conflict). Suggests that disorder is not real and it is out of consciousness.

--IV: Eliminates causal reaction. Reliability of diagnosis by inter-rater reliability.
Wants to avoid theory. Sticks to symptoms and observations.
Diagnosis: Need 5 out of 9 symptoms in a 2 week period. Need to have 1 of the first 2:
*Depressive mood most of the day, almost everyday
*Diminished interest or pleasure in activities

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Five axis system

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1) Mental disorder (more episodic)
2) Personality disorder or developmental disorder (more permanent)
3) General medical condition
4) Social/environmental problems
5) Global assessment of functioning.

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DSM III controversial diagnoses

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-Homosexuality
-Egodistonic homosexuality (do not want to be homosexual, but feel that they are)
-Masochistic personality disorder (someone who likes being hurt): blames the victim
-PMS (late luteal disorder)

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Labeling

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Categorizing certain behaviors as mental disorders.
Scheff: once give a label, people will change their behavior to fit it.

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Szasz

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Mental illnesses are inappropriate metaphor. People actually have problems with living--not an illness. Just a hoax to allow is to control other people

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On being sane in insane places
Rosenhan

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Anti-diagnostic
-Eight pseudopatients claimed to be hearing voices. Admitted to psych hospitals. 7 with diagnosis of schizophrenia and 1 manic depressive. Told to act normal after admission
-None identified as impostors by hospital. Stays ranged from 7-52 days. 19 days being average.
-Other patients were suspicious of their behavior.
-Another well known research and teaching hospital claimed they would not make similar errors as first study
-Rosenhan arranged to send pseudopatients. Of 193, 41 considered to be. In reality, he sent none

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Spitzer

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Pro-diagnostic

Can fool someone, does not discredit the validity of diagnosis. In psych, diagnosis is based on sign/symptoms and not lab results. So can fake it

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Signs
Symptoms

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Signs = can be observe. Ex. Fever
Symptoms = cannot be observed. Must be reported by the patient. Ex. headach

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RD Laing

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Stressed role of family in developing psychosis.
Idea of phoenix. Psychosis is like bursting into flames, so you could come back together better than ever. Patients encouraged to go to the depth of craziness.

Provoked anger because of his view that mothers were to blame for schizophrenia: gave conflicting signs in their life.

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Eden Express
Mark Vonnegut

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Anti-diagnostic

Encounter of his insanity, his attempts to deny, understand, control it. LSD trips

Notion of mental illness is a social construct, at worst a fiction.
If society was mad, who could provide a standard of society.

Diagnosed with schizophrenia (then later bi-polar disorder). When it happened to him, realized it wasnt a social problem but rather a problem of the brain. CHANGED OPINION!!

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Cognitive Testing

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-IQ Tests
Correlates with grades in school, how long ppl stay in school, job success in some fields (secretary and not physics or cab driver)
-Spearman: general "g" factor = general intellectual ability

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Personality Tests: Objective

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Objective
Scored by a machine, no interpretation in scoring. Results generate a profile of scales.
Ex. MMPI-II

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Personality Tests: Projective

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psychoanalytical idea of "lying the patient on the couch"
Patient will project his feelings onto the analyst. Target of analysis = understand whats going on with the patient.
Do not have clear answers, unlike objective tests
Ex. TAT, DAP, HTP, Rorschach inkblot tests

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TAT

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Thematic Apperception Test
Pictures with scenes and ask the patient to tell a story about it. Will reflect something in their lives

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DAP

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Draw A Person Test
Give person blank paper and draw a person. Then draw inferences about patient. Looking for pathognomonic signs (1:1 relationship)
Ex. Big eyes = paranoid or suspicious

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HTP

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House Tree Person Test
Tell the person to draw each object. More structured with a series of follow up questions

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Rorscharch inkblot test

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10 blots. Tell them to say what they see. Even more than one response is best. When done, go back and ask specifics about what they saw.
Problem: number of responses is uncontrollable.
Evidence for validity of this test is poor.

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Hooper Visual Organization Test

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Good reliable and valid test
Finds brain defects (picture of hand...can the brain compile it?)

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Clinical Interview

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Unstructured interview
-Open ended questions
-As progresses, questions get more focuses and pointed
-Controlling for error variance: use lg amount of items (makes the test more reliable). Ask for examples to reinforce reliability of test (Ex. having hallucinations, tell me about them). Cross examine the individual, if needed.

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Mental Status Exam

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Generic type of questions. Assesses: appearance, presentation, orientation, mood, affect, mental associations, speech, though content, hallucinations, ideas of reference, phobias, sleep and dreams, appetite and weight, obsessions/compulsions, calculations, memory, intellectual functioning, recall of information, etc.

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Mental status exam
Problems!

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Bad inter-rater reliability.
A) criterion variance: different ideas about what a MD is
B) information variance: different clinicians ask different things.
So should try to standardize questionnaire = SCID

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SCID

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Structured Clinical Interview DSM IV NP (Non-patient) edition

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Ultimate causation

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Why some traits are selected over others

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Proximate cause

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Cause individual differences
(Stress and genetics)

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Mood and evolution

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Euthymia = neutral type of mood

+ mood increases behavior
- mood decreases behavior

Suggested link = self esteem
Favorable environment, self esteem goes up
Unfavorable environment, self esteem goes down

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Anticipated pleasure vs. Hedonic pleasure

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Anticipated = chase
Hedonic = joy of feast

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Anxiety and evolution

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Escape from bad situations and avoid in future
Pain is a strong motivator

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Emotional and sensory experience of pain

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Opiate (heroine, codeine) block emotional experience of pain (so could feel sensory experience of acupuncture)
Novocain blocks the sensory and therefore the emotional experience

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Prepared Learning

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We have become highly prepared for learning about certain types of objects or situations over the course of evolutions because this knowledge contributes to the survival of the species.

Ex. Drink w/ chemo. Associate with drink and not hospital
Ex. basic phobia of snakes, insects, etc-- do not encounter on daily basis but still scared.

But our brain can only make certain connections!! Clockwork orange did not work with violent acts and nausea

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Phylogenetically fear relevant

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= snakes and spiders

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Ontogenetically fear relevant

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= outlets

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Lifetime prevalence for anxiety disorder

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25%

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Fear

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response that occurs when danger even is occurs. Characterized by compelling action tendencies of fight or flight.
Activation of ANS

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Anxiety

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Cognitive affective structure. Combination of how people are thinking and feeling.
Positive feedback loop to increase it.
Strong physiological characteristics

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Introceptive Awareness

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Awareness of self
People with anxiety disorders have this

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Locus of control
Internal and external

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Refers to ones attitude to the extent of why you influence what happens to you.
Internal = feels like they control what happens to them
External = feels like what is outside controls you

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Anxiety disorders and sex differences

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Females have higher risk because of differential treatment by parents (boys vs. girls).

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Panic Disorder

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A) Experience 1 or more panic attacks
B) At least one attack has been followed by (for 1 month): concern about having more attacks, worry of implications of attack, significant change in behavior

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Panic Attack

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Overwhelming experience of fear
Discharge of SNS
Symptoms: accelerated HR, shaking, chest pain, nausea, dizzy, sweating, derealization (feelings things are not real), depersonalization (being detached from oneself)

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Agoraphobia

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A) Anxiety about being places from where escape may be difficult or embarrassing
B) Situations are avoided or endured with marked distress or with anxiety about having a panic attack. May require the presence of companion.

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Introceptive avoidance

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People avoid situations that have given them "panic like symptoms"

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Controlled panic

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Exposure to panic like symptoms in a controlled environment.
Ex. breathe through a straw, spin in a chair

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Klein's theory on panic

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False alarm in the suffocation. Brain starts to act like we are suffocated when having a panic attack.

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Psychoanalytical theory on panic

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Unconscious impulses are on the verge of breaking through to awareness to cause the panic attack.
Id is about to enter the awareness of the person (superego does not accept). The person's defense mechanism is to have an emotional response of panic.

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Trait

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stable characteristic

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State

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transient feelings. Right, I feel relaxed but later will feel anxious

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Fear of fear

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learn to fear the symptoms of anxiety through introceptive classical conditioning.
Key variable in having panic attacks and then going on to develop panic disorder.

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GAD
Generalized Anxiety Disorder

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A) Excessive worry/anxiety about a number of events (for most days) for at least 6 months
B) Difficult to control the worry
C) Worry is associated with at least 3 of 6 physical symptoms

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Specific Phobia

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A) Fear that is excessive or unreasonable that is cued by presence or anticipation
B) Exposure to phobia is marked with immediate anxiety
C) The situation is avoided or endured with great anxiety

18 month duration

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Social Phobia

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A) Fear of one or more social situations where person is exposed to unfamiliar people or possible scrutiny by others.
B) Exposure to social situation provokes fear
C) The feared situations are avoided or endured with anxiety or distress

1 month duration

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OCD

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1) Obsessions = ideas, thoughts, mental images, impulses that are intrusive and inappropriate. Cause distress
2) Compulsions = repetitive behavior. Ex. hand washing, ordering, checking, touching. Or mental acts = praying, counting, repeating words silently. Prevent or reduce stress.

Doing compulsions = negative reinforcement

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Treatment of OCD

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Too much activity in prefrontal cortex
SSRIs and CBT reduce this activity

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PTSD

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A) Person witnessed, experienced, or confronted with an event that involves death, injury, or threat to self.
B) Traumatic event is re-experienced through: recollections, dreams, feeling the event is recurring, internal/external cues that resemble event, physiological activity
C) Avoidance of stimuli that are associated with trauma and numbing response

Symptoms for less than month = acute stress syndrome

1-3 months = Acute PTSD
3+ months = Chronic PTSD

Risk of PTSD is greater from man made/human inflicted