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PSY3171 (271)

Psychopathology lecture notes up to January 31st 2014

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Mary Theresa Howard

PSY3171 January 10, 2014 Video: Training • Dr. Reid is very caring and casual. He creates an environment for the patients to feel comfortable and build trust • Personality disordered people have the same behaviors throughout all situations A: Greg – Paranoid Schizophrenic • Three guys with beards follow him • Whisper to him to do bad things (steal, hurt people, etc) • Worried about them getting too close • Not always sad and never had thought of killing himself but the three guys tell him to sometimes • His Uncle was in a mental hospital before • Symptoms: family history, can’t hold down a job, hallucinations, wasn’t present until 18 years of age • Affect: face had no affect with his emotions B: Gary – Schizoid personality disorder • Delayed, talks very slowly • No affect at all on his face even when he is happy • Monotone, very down about everything • Has had a job for five years and likes it • Likes to be alone all the time. Doesn’t ever want to hang out with friends • He turned down a promotion at work because he doesn’t want to have to deal with people • Isn’t down nor depressed • Happy to be on his own and doesn’t suffer from hallucinations • Successful in what he does • *difficult diagnosis* • Symptoms: dulled affect, loner, self-sufficient C: Joe – Anti-social personality disorder • Robs because he doesn’t have a job • Doesn’t want to hurt anyone • Before his 20s he was very aggressive, got into fights a lot • Stole little things when he was young but when he was 20 he committed his first serious robbery • Occasionally would drink and smoke weed • He was married for 20 years and doesn’t seem affected by the divorce • Has 5 children, says he cares about them • Symptoms: may be going to prison AGAIN, doesn’t seem too upset about leaving his kids, no conscience, functional, not keeping a job and deciding to get money his own way, dysfunctional attachment to ex and kids, no substance abuse (anti-social people always want to feel in control) D: Mary – Mildly retarded due to birth problems • Has a good job and loves it • Amused by little things • Very good at what she does • Loves life and is a very caring, empathic girl • Remembers a good childhood other than being bullied • Childlike personality • Almost always happy • She was born premature and back then there wasn’t much help with things like this • Symptoms: can’t live on her own, likes to help people, can maintain relationships, realizes many things normal people don’t, caring and empathic E: Vivian – Dementia in the form of Alzheimer’s disease • She forgets things and gets lost a lot • Started forgetting around 55/56 • Got fired from her bookkeeping job • In denial • Can’t remember her grand babies names • Symptoms: gradual loss of memory, very healthy, doesn’t see this as a problem F: Rita – Delusional paranoid disorder (arotis manic) • Living with her mother • Having a relationship with a married man who has children and her mother doesn’t believe that this man loves her as much as she loves him • Met him when he was autographing pictures and treated her specially. Said “this is for you” when handing a signed picture and now this is a code thing for them • They haven’t met since this first time because people might see them. She hasn’t talked to him directly but when he uses “this is for you” on the radio it is for her and she writes him all the time • Never hallucinated before • She has fallen in love before but this is the first time it has been reciprocated like this before • This is a prelude to stalking • This leads to stalking because she believes she is in love with him and she believes he is in love with her G: Joyce – Conversion disorder • She sound one of her neighbors doing nasty things with her daughter and had to call the police • The police came and got the neighbor and she needs to be a witness • When she was watching television one time she was all of a sudden blind • She had seen too much and therefore went blind • Cured her blindness by giving her an injection of medication which was a placebo • The mind cannot handle what has happened and it reverts to blindness or possibly lose use of arms January 14, 2014 Video: Inside out: The Magic of the Mind • Cognitive studies • Understand how people will process and understand information • Study of membrane • Psychology is the core aspect of our lives. Relates to everything • Not all of psychology is analyzing what is wrong with people • Scientific study of behavior and mental processes • Psychology is just understanding human behavior • People talk about other people with the most passion because humans are a social animal • Psychological interest: wanting to understand people • People can obviously be good and bad at the same time • Initial aspects of psychology are different then when you actually take a course • Depending on what is in your head already you hear things differently • We construct what is in the world we don’t just perceive • It’s our human nature to think that others see the world as we do and think that we share the same views • Used to believe that good and bad things were caused by god. Punishment and reward • Are the mind and body connected? • Contemporary psychologist see mental and physical functioning as unified • Relate properties of the brain • Everything psychological is in a way biological • What is the contribution of biology to psychology? • How the mind emerges from the brain • Structuralism emerged first, then functionalism • Biological, cognitive and cultural all link together • Field of psychology is expanding its focus • Boundaries between fields are driven by tools • Children are like sponges and will pick up anything they are exposed to Video: Inside Out: Endless Questions • Born with curiosity • Psychologists unlock mysteries of the brain • Culture is resistant to giving up theories whether they are true or not • Often so attached to notions of common sense that we wonder why psychologists studies about things that are obvious • Hindsight bias: I knew it all along • Once you know the result it’s easy to see it as obvious • Overconfidence phenomenon: more confident about judgments than they are correct • Must measure what you think you are measuring reliably • Relationship between persons emotional well being and their health • Operational definitions needed • Do case study: look at one or a few individuals • Survey: broaden the group. Randomly sampling for a representative sample of a entire population. Decontextualized • People can lie about how they feel • Naturalistic observations: catches people in their natural habitats and don’t influence them in anyway. Lack of internal thoughts • Correlation study: association between two variables. Natural occurring association. Correlation can be negative or positive • Depression is correlated with a depressed immune system. Cause or effect? • Could be depression causes the changes but it could be that the immune system causes the depression • There could be a third variable that causes this • Takes an experiment to sort out cause and effect • Control: manipulate a variable and keep the rest the same • Have to compare a new drug against a placebo • Controlled experiment • Can do experiments on animals that will give a specific cause. Can control better • Animals are not people but there are some aspects that are very similar to people • Proximix: the study of personal proximity • People maintain personal space even in the virtual world • Human beings react to being observed • Require some levels of deception • Experiments all have to be approved by a committee within each university • No one method is the best method • You need all methods to truly understand human behavior • Genetically modified mice (up to $50,000/mouse) January 17, 2014 Concepts of Abnormality • Definition of abnormality is up in the air • Cannot tell if someone has a pathology unless there is something abnormal about their behavior • Operationalizing: defining what it is you want to look at • There can be numerous definitions for one concept but you have to be very specific for your study • Pathology underlying word. Pathology/abnormality connected to the brain Attempts at Definition: Abnormality • Is it just one of these definitions? Or is it a combination of all of these things? • How do we define abnormality from different perspectives • Have to take a look at components used over time to define abnormality 1. Stats • Definition is that which occurs infrequently in the population • Limitations: some examples of unusual functioning are considered advantages rather than problematic (ex. High intelligence). Considered an outlier by not psychopathologically inclined 2. Personal distress • Identified in the DSM-IV-TR as a common feature of many disorders • Not true of some psychological dysfunction (ex. Mania: no described as distressful) • Distress, is a normal part of life and does not necessarily indicate psychological dysfunction 3. Personal dysfunction • One expert suggested that harmful dysfunction is a critical feature of all people diagnosed as disordered • Entails negative impact on the individual • Many individuals with diagnosable disorders can function in daily lives • Boundaries between normal, abnormal and dysfunctional are unclear • Personal distress has to be harmful to the person • Ex. Mania is not harmful in most circumstances 4. Violation of norms • Other theorists have suggested disordered people manifest violations in their normative functioning (ex. Bizarre thoughts expressed by persons with schizophrenia) • Criminals (most do not meet diagnostic criteria for any disorder), violate norms • Most mentally disorder individuals are not dangerous or harmful to others • Social norms change over time and vary across cultures • Thus, violation of norms cannot be the sole criteria for defining abnormality 5. Expert diagnosis • Mental health professionals include psychiatrists , clinical psychologists, psychiatric nurses, and psychiatric social workers • Huge number of people that would be classed experts to understand psychopathology • Abnormality is essentially defined when diagnosticians apply the criteria for disorders as specified in the DSM (expert opinions put into criteria in a book for psychiatrists all around to refer to) • Critics such as Thomas Szas claim that mental disorders are socially constructed to give more power to mental health professionals • Expert designation determined by people so they could control what was going on. Give themselves a reason to be Summary • No single definition, which can on its own satisfy the multidimensionality of psychological function • To identify a person’s behavior as abnormal, no sole criterion is necessary of sufficient • Typically some combination of criteria is used • It’s a combination of all five of those criteria to determine what is abnormality Development of Modern Views • Medicine is considered a science, psychology is sometimes considered an art Biological Approaches: Heredity • Morel introduces degeneration deviations from normal functioning are transmitted by heredity processes • Possibility that human behavior could be passed on led theorists to propose possibility of identifying people as potentially mentally disturbed or as criminals, before they developed such problems • Certain predisposition to certain disorders • Lombroso concluded criminality was inherited and could be identified by the shape of the skull (phrenology) • Aren’t too many people with the same skulls Syndromes • Emil Kraepelin’s Clinical Psychiatry, published in 1883, attempted to classify mental illnesses • Kraepelin called groups of symptoms syndromes, and recognized different disorders had distinct features. Infections • Richar Von Krafft-Ebing suggested that general paresis of the insane might be the result of infection • Not known to result from untreated syphilis spirochete • Confirmation that GPI was the result of an infectious agent encouraged confidence that all mental disorders would be found to be cause by biological factors and encourages physical approaches to treatment Shock Therapy • Was applied to a whole range of disorders • Manfred Sakel used it to treat withdrawal symptoms related to morphine addiction • Insulin-induced comas and drugs that produced convulsions, were used to treat schizophrenics • Electroconvulsive therapy (ECT) introduced a Ugo Cerletti was used as treatment of schizophrenia by the psychiatric community • Finally determined in the late 1950s that ECT induce convulsions were beneficial only for depressed patients Psychopharmacology • Mental illness was seen to result from disordered brain chemistry and there was a rejection of psychological perspective • Chlorpromazine (an antipsychotic drug) radically changed the management of seriously disordered psychiatric patients and freed most of them from the restraints • Still some strange side effects • These drugs allowed psychotic patients to be returned to community living far sooner than before • Deinstitutionalization was set in motion. Psychological Approaches Hypnosis, psychoanalysis • Charcot believed that hypnotism might have value in treating hysterics and suggested that psychological factors caused hysteria • Josef Breuer felt patients should talk freely about unpleasant past experiences (cathartic method) • Did work on the cases it was used for on the people it was used • Did exactly what it was supposed to do on hysterical personalities • Anton Mesmer: hysteria was the result of disturbed distribution of the magnetic fluid in the body and believed that magnetic force called animal magnetism would rearrange their fluids • Charcot believed hypnotism might have value in treating hysterics and suggested that psychological factors cause hysteria • Freud (internist) developed complex intrapsychic theory from which he derived his method of treatment known as psychoanalysis. Developed a whole therapy on transference, dream analysis, etc. • Psychosexual theory on development of personality something wrong with you in the teen years and up he can trace it back to something that happened in your childhood that you likely repressed • Best way in DID to bring together all the alter egos • People who are suggestible (put a thought into their heads) more likely to be hypnotized Behaviorism • John B. Watson brought revolutionary ideas to psychological thought • Routed in things like classical conditioning. Believed if you learned it you can unlearn it • Watson considered abnormal functioning to be learned , and felt that all problem functioning was the result of unfortunate conditioning experiences • Treatment procedures offered promise but were not enthusiastically until 30 to 40 years • Problem: happening just around the time of Freud and Freud’s followers so it didn’t take off the way it could have because it was so basic • Desensitization, stress inoculation: trying to get them to unlearn Growth of Mental Health Psychological Approaches: Behaviorism • First asylum during in Quebec – housing people with all types of mental dysfunction and providing humane treatment. People were humanely treated. They also housed the cirmnally insane and criminals in general • Growth of mental health services in the rest of Canada evident in the increase in the number of asylums that occurred during the 19 century • Criminals were warehoused with lunatics • From the 1940s-1960s lobotomies (frontal lobes section were disconnected from the parts that caused inappropriate behavior) were performed on countless Canadians to alleviated their suffering • Lack of evident of any clear benefits • Ewen Cameron conducted brain washing and LSD studies at Montreal’s Allen Memorial Hospital during the 1950s and 1960s • Cameron’s research was offered as treatment to patients who did not realize they were guinea pigs in his CIA funded research • Many other Canadians helped in introduction of antipsychotic drugs, trying to alleviate suffering of many patients • Contributed to the development of cognitive behavioral treatments Theories o All kinds of theories in psychopathology Nature of Theories Attempts at Definition: 1) Levels • Theories with cause of behavior to be result of single factor (ex. Genetic disposition or a traumatic experiences) are limited in their power to explain behavior • Most current theories considered multiple factors (a number of variables that impact) as influences on human behavior (interactionist explanations) • Research has demonstrated that biological factors and experience interact • Each may influence the other • Changes in behavior may change biological functioning and vise versa • But single-factor theories can have value • Nature = biology, nurture= environment • Does biology cause behavior or does the environment change the behavior 2) Testing • Scientific experiments want to reject the theory • Called testing the null hypothesis • To disprove a theory requires the most rigorous tests of its value • Theory is strong and reliable, if data does not contradict main tenets Search for Causes Theories • If you can’t prove it to the world it is useless • The general aims of theories: o Explain etiology (what’s the cause?) o Identify the factors that maintain the behavior (what causes it to stay?) o Predict the course of disorder (when does it start?) o Design effective treatment • Different theories: biological, psychodynamic, learning (behavioral or cognitive- behavioral theories), cognitive theories, humanistic-existential theories, and socio- cultural theories (newer) • Have to know how to work with people from different cultures • Collectivism: series of things to treat the person the best way possible • Can’t be trained in one thing • The view that biological, behavioral and environmental systems operate as a whole system is gaining wide acceptance • Must understand separately • Most useful theory is one where behavior has many influences – an integration of biology or environment experience January 21, 2014 Video: The Enduring Self • Kid killed both his parents and brought them to school and shot up the school as well • Classroom avenger- personality developing over the years • Caucasian males from middle class background and very bright. Depressed kids with personality problems • Told people what they were going to do before they did it but people didn’t pick up on it7 • Psychotherapy • 512 divorce autopsies: 75% of the cases the marriages were in deep trouble when they started. • 29 factors: some to do with life facts and experience and others with personality. • Interested in personality because it’s the search for knowledge and different characteristics and configurations of traits are related to performance in a variety of different tasks • Study of personality: characteristic pattern of thinking, feeling and acting • Unconscious mind is huge: process huge amounts of information without the conscious being aware • Familial context to understand people the best • Distort reality to protect ourselves • Project what you think about yourself on others • Repression of horrific memories • Humanistic: bridging gap between Freudians and contemporary. Positive psychologists • Rogers and Maslow: humanistic. Nurture and enable peoples capacities for growth • More interested in research the basic dimensions of personality and their construction of behaviors • The big five: traits described by Openness to experience, Conscientiousness, Extroversion, Agreeableness, and Neuroticism (emotional instability). Most personality measures map on to one or more on to these five traits • Tend to be stable traits • Biological underpinnings: genetic component and set points • Not to say it is set for good , these set points can be changed depending on context and culture you are in • Experience that operates on us which makes us who we are • 20% of healthy babies begin life with a low threshold of excitability. Triggers easily. • You can conquer your shyness • Personality interest studies: personality assessment. Started at phrenology. Real beginning with actual inventories grew out of the assessment of intelligent • MMPI developed just after WWII: good job of giving a portrait of someone in a variety of dimensions • CPI California psychological inventory • Two phenomenon: the you people see and the internal you that no one sees • Control: stopping or changing what you are doing • People can change anything once they know what is going on and have the intention to control it • Enduring self: self product of various interactions and product of mediating stimuli. Self is operating centre of a person • Live in a world with multiple ways of being a self • Self-esteem: sense of self worth from input from others and feedback. As it goes on becomes less externally impacted and more internally impacted • Self-serving bias: tend to perceive and present ourselves in favorable ways • When you are negatively stereotyped in a domain the way to relieve this stereotype is to leave the domain • Albert Bendura = Canadian. “Self-efficacy is not about what you have (abilities), it is how you use the abilities you have” Video: Personality disorders and anxiety: out of balance • Mental abnormalities are just exaggerations of what everyone feels • Dysfunctional behavior that gets people in to trouble in life • Before treatment and illness it was perceived by the perspective of religion • Involve both biological and psychosocial environment components • DSM: diagnostic and statistical manual for mental disorders- diagnose with greater reliability • Whites  bipolar most likely African American  schizophrenia most likely • Overcoming the stigma associated with mental illness is the biggest issue • Patients don’t want to come in for treatment because they feel like they are being labeled • Four major categories: anxiety, personality, mood disorders and schizophrenia Anxiety • Everyone gets anxious but people with the disorder have a dysfunctional alarm system • Combination of fear/panic and anxiety • Some more by fear and others more by anxiety but they co-occur • No longer has an adaptive function • Panic is essentially the exact same thing as being chased by a bear • So scared of having another attack they avoid situations because of this horrible experience • Post traumatic stress disorder: so scared of the memory • Re-experiencing of the event is a major trigger. Beings memories of the attack • Avoidance: swing back and forth between it happened and no it couldn’t have possibly happened • Intrusion is the first message avoidance is the second message • Having control will affect the likelihood of developing PTSD, may have something to do with psychological preparedness in a general way • Generalized social phobic: freighted by any kind of social situations • OCD: condition in which people experience occurring unwanted obsessive thoughts or images they find disturbing. Associated with compulsive rituals to neutralize these thoughts • Link this with classical conditioning of fear • Tend to be chronic: don’t go away unless treated • Activity in the amygdala Personality • Healthy narcissism: have a sense of self of being competent based on reality and able to use the reality perception in healthily maintaining self esteem • Antisocial personality: lack of conscious is glaring apparent. Overachieving personally who is getting what they want. • Psychopathic behavior is for their own manipulation and gain • Without relationship with others antisocial behavior persists • Psychopath: don’t have relationships want to control the world and get what they want more severe than antisocial Biological Models Theories: Role of CNS • Neurotransmitter systems o Many types of neurotransmitters associated with various brain circuits o Mediating various behaviors and cognitive processes o Interactions of dysfunctional neurotransmitter systems play a role in disordered behavior o Possibly a combo of environmental events, the person’s response to them and the biological substrates Role of the PNS • Includes the somatic nervous system and the autonomic nervous system • ANS has two parts: the sympathetic and the parasympathetic – maintain homeostatic activity (i.e balance) • Stress- sympathetic “fight or flight” • Overactive or under-active sympathetic or parasympathetic responses may play a role in various disorders o The sympathetic mediated anxiety Genetics • Behavioral genetics: genotype-environment interaction – family studies, twin studies and adoption studies are types of genetic linkage studies • Genetic linkage studies, where a genetic marker (ex. Eye color) is linked to the occurrence of a mental disorder • Molecular biology • DNS segments to identify genes that determine individual characteristics Psychosocial Models: Psychodynamic Freud: 1. Levels of consciousness: primary processes in the unconscious, well-practiced behaviors activated by preconscious process, conscious is aware 2. Structures of personality: ID, Ego, Superego 3. Psychosexual stages of development: oral stage, anal stage, phallic stage (Oedipal and Electra complex), the latency stage, and the genital stage Behavioral • Problems led to the inclusion of operating conditioning principles • Operant principles (behavior changes as a result of reinforcement and punishment) explain a broad range of abnormal behaviors • Both classical and operant conditioning are empirically based and have effective treatment and management procedures • Social learning theory focuses on the importance of self-control and self-efficiency • Provides more satisfactory learning-based account of disorders and normative behaviors Cognitive • Beck’s cognitive theory and therapy: people develop dysfunctional cognitive schemata directing their thinking and must be changed in treatment • Different types of beliefs are related to different kinds of abnormal behavior (Beck reffered to as content-specificity) Humanistic • Rogers and Maslow: experience provides the opportunity to develop potential • Frustration of development leads to problems • Rogers: person-centered approach, believed abnormal behavior results from a person’s distorted view from inability to trust experience Existential • Clients develop “the courage to be” • May and Frankl: struggle for meaning and acceptance of responsibility is central • Treatment confronts clients with responsibility for actions, assisting in finding meaning Socio-Cultural • Labeling theory: much of abnormal behavior, and clinician’s responses results from expert labeling the person as having a disorder • Client accepts label and responds accordingly • Other people in the client’s environment treat him or her as someone displaying all features of that disorder Integrative • Biopsychosocial model claims that biological deficits, psychological problems, and social factors interact to cause disorders • Both are integrative and do not set nature vs. nurture to explain the etiology of disorders • Most theorists today ad
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