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Lecture

abnormal lecture.docx

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Department
Psychology
Course Code
PSY240H5
Professor
Hywel Morgan

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Lecture 1 • Syllabus and stuff Lecture 2 • Easy to recognize, difficult to define • What is abnormal behaviour? o Statistical criteria- restricted to behaviours that are most common, disregards deviant behaviours that are favourable and includes common behaviours that are unfavourable o Cultural norms- what might be normal in one society, culture or situation, may not be normal in another one o Developmental norms o Frequency, intensity, duration a) Statistical Criteria • Criticism of DSM-5: abnormal behaviour is not easy to define. • DSM-4: learning disability is a deviance in language and mathematical ability in children- there’s something wrong with this definition since it contains too many people • Normal means the behaviour most people are displaying • Defining abnormal as statistical deviation from norm- collect date from a lot of people on what they think, feel and do and then find what most people think, feel and do…. Deviation of this would be considered abnormal • Abnormal behaviour deviates statistically from the norm • Is memory behaviour? Yes it is • Is “I’m thirsty” a behaviour? Yes • For our purpose all these things are behaviours • Blowing nose is a behaviour- statistically blowing nose too many times can be abnormal o This is the objective definition of abnormal behaviour • We are going to call the average “normal” o Restricted to behaviors that are most common o Disregards deviant behaviours that are favourable o Includes common behaviours that are unfavourable • Average IQ- there’s a one: one correspondence between you and the average; you are like most other people • Standard Deviation: abnormal… If you score below 75 on IQ your intelligence is called abnormal o Problem with definition is the curve has two ends- the gifted end would be pathological too o Disregarding deviant behaviour ^ • Above average weight baby- good thing, but still “abnormal”- according to DSM • DSM-5: goal is to make more statistical but that fails o If you use substance that changes your state of mind on regular basis- that’s pathology o DSM-5 includes unfavourable behaviours that are common Cultural norms • Schizophrenia would be considered abnormal in most societies because it is so distinctive o Some situations do exist where this is normal o Induced hallucination are common in aboriginal o Content of hallucinations differs among cultures o Culture/environment are situational defined  Eg. prof getting naked in class- its abnormal AND illegal  Situationally defined- its normal in locker room or strip club • Alcohol drinking/binge drinking very common in West, but not so much in muslim/jewish places Developmental norms • `Developmental norms: at 7 you hit sister, it’s normal, if 5 year old wet bed, its normal o Greater deviation form norm- the higher the concern o By age of 2 most children speak words- milestone. • Generally fast development is considered positive and slow considered negative Frequency, intensity and duration • Current criteria to determine what abnormality is • Still is statistics • Depression is very common o Things that are supposed to make you happy don’t anymore o The number one source of depression is loss of loved one o Lonely and sad= normal o Using depression in clinical sense- when does it become abnormal?  When it lasts too long= duration  Current definition: SAD affect (lost job, loss of loved one, etc) that lasts for a really long period of time- required  SAD affect is so intense that you might want to harm yourself…. This is probably pathology • Frequency- Anxiety o Every time see doorknob it makes anxious- probably pathology • Could be any of three or combination… must interfere with daily functioning to be pathology Etiological (course and cause) models of abnormal • Nature vs nurture? Which one more important? o Both equally important probably • If you have depression and you see a professional, first thing they’ll do is prescribe medication o Abnormal behaviour= abnormal brain dysfunction is how it is seen currently but it is not right o We haven’t discovered drugs that treat effectively or for sure o Currently how we see psychopathology- the treatments pharmacologically are not effective a) Medical disease models • Genetic models o Genes primary determinant of one’s behaviour o You inherit behaviour through genes o A lot of disorders have genetic markers o Usually more than one genetic marker- multiple genes involved o If you have the genetic marker that does not mean you will develop a psychopathology o Schizophrenia-known it was related to genes even before gene mapping. Identical twin studies reared apart developed schizophrenia. Concordance rate (percentage chance) - if one twin develops schizophrenia what would the concordance rate be that the other would too? If genetically identical then you are 50% likely to get schizophrenia- other 50% is environment (usually stress). Only disorder effectively treated with pharmacology o Concordance rate of depression- 70-80& you will develop depression if close family member is clinically depressed • Biochemical models o Neurotransmitter o Schizophrenia- too much dopamine imbalance o Depression- serotonin imbalance, dopamine imbalance and norepinephrine imbalance- too little of all of these • Neurophysiological models o Abnormal behaviour resides in the brain- inherited, congenital(around time at/around birth) or acquired o ADHD- specific part of brain= prefrontal cortex not functioning properly • Psychoanalytic model o Freud was first to propose that abnormal behaviour is caused by internal forces rather than external o b) Environmental models • Sociocultural models o Depression- loss of loved one o Rural vs urban living, socioeconomic status, religious things o DSM-4: global functioning= very subjective • Learning models o Classical and operant conditioning o Learned and interacted in environment in faulty way o Most psychologists subscribe to this model (cognitive-behavioural) o Depression- learned that bad things are “my fault” I can’t do anything right, it’s hopeless. Learning model proposes that you have learned that • Treatment is relearning • Humanistic models o YAY o Stresses experience in the individual’s reaction to themselves and their external world o You have the tools to change the behaviour o Capitalizing skills that they have o Respects worthiness in all people and they are right to make their choices o Unconditional positive regard o Have to want to find a better way of doing things, I’m just here to find it o HIPPIE SHIT YAY Lecture 3: Legal vs Ethical Issues • What is Legal? o Rules made by law o Rules that have to be followed • What is ethical? o Based on morals- differ culture to culture and time to time o Ethics are guidelines that you should follow o Don’t fuck client=unethical  Not illegal o Overlap on legal and ethic o Not everything unethical is illegal • Legal Issues o People in social conflict o Power of mental health professionals o Psychological conditions are not needed  Unable to hold job, get along with other people or do things other normal people do  Social problems  Psychological problems that are not a problem for other people don’t get treated= social conflict  Law: set of rules that regulates our interactions with other people  When someone behaves abnormally and hurts someone else- maybe, maybe not  If someone takes a drug that impairs judgement/reaction time and gets in car accident then that is not legal  Psychiatrist cant declare a person legally insane • Canadian Legal System o Constitutional Law (federal)- charter  Highest level  Charter of rights and freedoms  Things you HAVE to do  Only country that documents rights and freedoms of people with mental health issues  Federal Level- difficult to change o Statutory Law  Provincial Level  Somewhat more changeable  Putting someone with mental illness in custody  If someone believes you are GOING to hurt someone, you should be put in hospital confinement o Common Law  Quebec doesn’t follow common law- its called civil law there  Interpretations of statutory laws  Judges or jury’s interpretations  Frequently ambiguous not by accident  Precedence= interprets statutory law  When mental issues do  Parens patnae (responsibility and authority to care)- government is responsible to care for all individuals BUT people can make their own decisions (ethical/legal dilemma)  Involuntary commitment: civil and criminal- depends on perceived intent • “I am gonna kills you”- depends on situations (joke or serious) • Mens rea: what is in your head • Civil Custody: I take you out of society because I think you have mental illness and you may be harmful to yourself or other people • Criminal commitment: statutory/Common law • Must be suffering from a mental illness • Unwilling or incapable of consent • Be at risk of harming (self or others) • Person with homicidal thoughts= eligible for commitment involuntary • Ontario: if committed-have to stay in hospital and be assessed o People can refuse treatment in Ontario o They can leave after their assessment • Substitute decision maker is assigned to patient that is incapable of decision-making (involuntary treatment) • Advocates (substitute decision maker) can be social workers, psychologists, etc  Involuntary Treatment • Capable wished principle- person speaking for you has the best interest for you • Compulsory treatment orders  Psychologist’s environment (ethics) • Clinical • Research • Teaching  Informed consent • History • No harm • Confidentiality (limits- if person intends to hurt themselves/other people) • Psychologists behaviour Lecture 4 • Major difference between this science is: o Methodically test theories- we do it, but there’s this different ways from looking at and testing • All other sciecn3es has one paradigm- one set of theory- they are called laws • Source of abnormal behaviour was subconscious o Not easily testable- original paradigm o Can’t investigate something you can’t measure o Only interested in measurable behaviors- if not measurable, it’s not psychology. You can measure memory, although you can’t see it o Freud: your abnormal behaviour is the result of things you learned/experienced when younger and they were ongoing but pushed into subconscious  Method devised to measure: free-association o Classical psychotherapy: patient does not look at anything and then free- associates o Freudian slip- not efficient method to see what’s going in someone’s head • Behaviourism movement o Paradigm swing from freud • Biological model o Favourable paradigm • Cross-section: Conceptual and function subdivisions of the brain- biolecture2 o Hindbrain (evolved first): involved in most basic of behavioural functions o Midbrain: o Forebrain (most recently) : • Source of All Behaviour o Neurologist: spinal cord and reflexes/brain o Psychiatrist: disorders of nervous system- biochemical o Anatomist: structure of nervous system, not a doctor but has phd o Neuropsychologist: studying structure and function of the brain • Hindbrain- slightly above spinal cord. Damage or dysfunction leads to serious behaviour problems o Medulla: lowest part of hindbrain- dysfunction of medulla would lead to death o Pons: dysfunction would lead to narcolepsy or insomnia o Cerebellum: dysfunction leads to lack of balance/lack of coordination • Midbrain- o Pain is registered here o Addiction o Movement- o Parts:  Superior colliculus: important in relaying visual information- relay before information is consciously aware. A lot of research with this and psychotic behaviour  Inferior colliculous: important in relaying auditory information  Substantial nigra: bad things, good things, dysfunction results in Parkinson’s disease- behavioural dementia involving movement. Starting and stopping voluntary movements • Forebrain- right above midbrain o Subcortical structures (below the cortex): sophisticated function  Thalamus: sensory switchboard- all incoming and outgoing information is processed through this. Thinking, reasoning, voluntary movement, problem solving. Hallucinations are typically generated at cortical level (maybe its not going through thalamus that’s why)  Hypothalamus (hypo= below): motivational behaviours. Closely connected to limbic system  Limbic system (multiple structures): on top of thalamus and hyp othalamus. Dysfunction results in depression and anxiety. Amygdala • Cerebral Cortex: higher order functions- rezoning, judgement, problem solving. Has different regions that have different functions • Lobes of Cortex: o Frontal Lobes  Primary motor cortex  Voluntary movement is being generated  Prefrontal cortex (very front part): problem-solving, attention, decision- making. Dysfunction= ADD, anti-social personality disorder, dementia/Alzheimer’s (chance of developing it past age 80 is 80%), Phineas Gage- frontal cortex separated from rest of brain • Temperament, emotion (impulse-control)- Phineas Gage was really impulsive- excessively aggressive mostly but also excessively happy o Parietal Lobes  Primary somatosensory  Consciously feeling things  Consciously detecting incoming information from tips of fingers and all that. Pressure/vibration, pain, temperature in environment  Spinal cord damage: no incoming sensory information  Front down up wtc o Temporal Lobes  Process information concerning hearing, smell and balance and equilibrium  Smell goes directly here  Vestibular system- balance (seasickness- people who cannot tolerate change in the vestibular system)  People who get startled by loud noises but don’t know what or where it came from- they have an intact inferior colliculous (orient towards sound) but no idea what just happened (damaged temporal lobes o Occipital Lobes  Processes information for the sense of vision  LGB: lateral something  Damaged occipital lobe- throw ball at them, they will catch It or move out of way but they wouldn’t know what was thrown at them, it’s like it never happened • Limbic System o Hippocampus: aids in the processing of memory for storage  Long term storage  Damage= amnesia o Amygdala: involved in fear and aggression  People who suffer from anxiety disorders  the drugs target neurotransmitters in the amygdala  enhance effectiveness of GABA o Hypothalamus: bodily maintenance functions and pleasurable rewards  Related to midbrain structures in involved in pleasure and reward • Left Hemisphere o Right side body movement and touch o Contralateral organization o Speech disorders o Organized for the function of speech o More involved in generating positive emotions • Right Hemisphere o Left side body movement and touch o All nonverbal imagery o More involved in generating negative emotions, depression and anxiety • Associative Learning or “Conditioning” o More sophisticated then habitual learning o Does not require conscious understanding o Learning: Relatively permanent change in behaviour o Long-term, doesn’t require conscious leaning o Looking at behaviour and modifying them using techniques known as conditioning  Classical (pavlonian, S-S, Type 1) : associate one stimulus with another stimulus  Operant (instrumental, S-R, Type 2): pair a stimulus with a response o Classical  History: pavlov was a physiologist, looking at different levels of physiological reactions to different foods (reflexive salivate), noticed that dogs salivated before putting food in mouth  Overview: UCS, CS, CR, UCR  Principles of classical conditioning • Extinction process • Spontaneous recovery • Many anxious conditions seem to be classically conditioned • Principle of contiguity: have to occur at the same time • Superstitious behaviour/learning: something happens when you do something once so you never do it again • Phobias have to be unlearned to go away • Systematically de-sensitization: you learn that bunny rabbit is good o Operant  History: Thorn Dyke. Behaviors become more or less likely depending on their consequences • Put cat in box- putting nothing but a lever. When lever pressed then it opens box and cat can access treat • Eventually cat learns that there is consequence to pressing lever • Principle of reinforcement  Reinforces and Punishers: a matter of Consequences Lecture 5- Diagnosis- process of abnormal psychology 1. Assessment: compare your behaviour to other people’s behaviour 2. Diagnosis: 3. Treatment: • Typically in that order but all three of them are ongoing processes • Diagnosis o Potential benefit: selecting a treatment  Schizophrenia: pharmacological intervention, not psychotherapy of something o Potential harm: stigmatizing label  Somebody that has schizophrenia is called schizophrenic  Labelled “schizophrenic”- negative connotation  Labelled as their disorder  Mental health we stigmatize people… in health we don’t  Attempting to abandon the schizophrenic term o We use the Diagnostic and Statistical Manual version 5  Attempted to devise statistical norms and look at behaviours that are outside these norms  DSM (1955) , DSM 2(60s), DSM 3 (late 70s), DSM 3R (80s), (DSM 4 (early 90s), DSM 4TR -more elaborate text, simplified text (late 90s), DSM 5 – more normative/statistical data, lots of research and data, (may, 2013)  There are some statistically deviant behaviours that we do call normal  The goal of a diagnostic or classification system is to identify syndromes, syndromes of abnormal behaviour • Syndromes area set of symptoms that occur together regularly • Not schizophrenia, but depression • Not OCD, but anorexia  Can purchase DSM but cannot diagnose someone unless you have a degree  North America uses DM but not the rest of the world  The rest of the world uses ICD- International Classification of Disease • Current version is 10 • Published by American psychiatry association (group of physicians in close conjunction to psychologists) • Medical tool that outlines various disorders and syndromes and their symptoms  The other goal of DSM 5 was made to be 100% compatible with ICD 10  Next year, ICD 11 will come out o Biological Assessment and Diagnosis 1. Genetic 2. Neurochemical 3. Imaging • Structural: Is there a part of brain that is structural different than average brain- fMRI and CAT • Functional: Do different parts of brain function differently, statistically – PET, o What makes a good classification system?  Kriklin was first to develop different categories of psychopathology  Criteria: 1. Categories should be clearly defined (DSM 5 has done a good job at this but broader than DSM 4, also ICD has done this)  Depression: certain # of symptoms over a certain period of time 2. Categories exist- symptoms occur regularly, features occur together regularly  For the most part, DSM is good at this  Do delusions and hallucinations only occur with schizophrenia? A: no o One of the big problems with this diagnostic system o Symptom overlap 3. Good reliability- consistent, predictive. Is it consistent across time and people?  Test and retest  Symptoms are one time, and same symptoms later, I should diagnose you with same disorder  Two people should diagnose with same disorder at same time  DSM 5 is relatively reliable because categories are clearly defined 4. Validity- What is it measuring and what is it supposed to measure?  DSM no good at this  Misdiagnosis: symptom overlap 5. Clinical utility- useful in a clinical setting  It is useful  No good, neuroimaging tests, blood tests or genetic tests to determine psychopathology  Looking at statistics is not reliable either • Diagnostic System o Empirical derived  Empirical system- numerical data of you compared to numerical data from other people  DSM is not an empirically derived system  Moving towards it though o Clically derived  DSM (and ICD) is a clinically derived system- system derived by consensus o Derived by study groups of professionals in the field o They just agree on a consensus and that’s the criteria for diagnosis • DSM 4 Axes (DSM 5 discontinued 5 diagnosis) 1. Existing Disorders  You get 5 different diagnoses  Axis 1 diagnosis (you still get that but in DSM 5 it’s just called Diagnosis)  Comorbid disorders: depression and anxiety 2. Personality Disorders  Axis 2: if you had any present personality disorders  Entirely separate section in DSM 4 but not in DSM 5  Relatively permanent  Part of who you are, but can be treated 3. Relevant Physical Conditions  DSM 5- remains in it  DSM 4- separate category for physical conditions  Loud noise to child- deaf(physical condition) or autistic (psychological condition) 4. Severity of Psychosocial stressors  Prognostic value  DSM 4 and DSM 5 is  Functioning- stress in environment leads to less functioning 5. Global Assessment of Functioning (now gone)  Eliminated in DSM 5 because it pretty much serves the  same as DSM 4  Psychopathology prevents from having relationships or going to work Lecture 6 Psychological Assessment Assessment is ongoing Misdiagnosis is frequent Doctors do15 minutes -too short time for assessment 3-4 hours minimum for psychologists’ assessments 3 tools for assessment for psychopathology: 1. Interview: asking questions. Not good for children. Most common. Standardized: structured interview, questionnaire/survey, exhaustive, long time to register, 12 pages long, questions on different disorders, covers everything and high degree of accuracy in assessment, bad for rapport, Non-standardized: unstructured interview, psychologists that have a lot of experience Questions are based on the information that comes from the referral Identifying data 2. Observation: good for children and adults. Most do both. More intuition required. Get better with practice. Only observe 3 hours of life. Anyone nervous at the interview could be labelled as having anxiety disorder. General appearance (and attire)/deportment- if person looks dishevelled (poor hygiene, etc), maladaptive appearance, then they are of concern Gestures and expressions- body language super important. Behaviour presentation and personality makeup. May be subtle Motor act- unnecessary movements Verbalizations- context/structure, how they are saying things, is it appropriate to age or socioeconomic status, tangential speech, 3. Testing: psychological tests. Exclusive domain of psychology. Every year publishing new tests. More scientific and requires data. All tests are standardized and are quantifiable. Based on statistics Cognitive tests- severely depressed people score low on this but they are not intellectually disabled WAIS intelligence tests ravens test (figure out what the rule is) Personality tests- affective tests, Minnesota multiphasic personality inventory, not good for rapport lots of information, over 500 questions, time consuming, malingering (responses are not reliable or honest) is accounted for Rorschach tests (projective tests) ”tell me what you see?”=if says inkblot- a) malingering, b) concrete response of brain damage, XMAS system- objective things any person can see… asked what person sees and compares it to the list Unstructured and ambiguous stimuli Psychologically determined Stimuli provide opportunity for eliciting answers that reflect basic personality Ambiguity leads to less offensive- free expression Thematic Apperception test ( the other projective test) Still ambiguous Slightly more affective/emotionally charged Originally interpreting fantasy Look at card and tell story of picture Stories reflect own experiences, attitudes, needs, and interests Wider application than psychopathology Validity has been questioned for these projective tests because of cultural differences STATISTICS: taking averages: psychologists been really good at this Referral: send to specialist. Like a triage. When referral comes from legal system: low motivation to participate Forced to be treated If participate, then less punishment Provides therapist with orientation of major problems Basic, not formal. Based on referral, bias is existing Observer-bias: picking up this you are expecting to see. Munchausen disorder Most common in adults for assessment is interview Referral Social worker Psychologist Physician Classification and Diagnoses Could be wrong Lecture 7: Research Methods A lot of material in class today is not in textbook Psychologists are scientists, unlike physicians Physicians are not trained to do science, they are practitioners Primary thing in grad school for psychologists is how to do science Clinical psychologists practice arts Collecting statistics, developing theories, gathering facts, surveys Psychologists are primarily trained in scientific research and secondly practice clinical art Boulder model of psychology: Psychologists must be primarily trained as scientists Science is a rigorous strict process 1970s- most psychologists have phd Psychiatrists have md PSY-D- Does not require that you do science or do research before you practice Majority of people have done science before going to graduate Science is a way of thinking 4 recognized ways of thinking in order of sophistication: Tenacity: least sophisticated way of thinking. A level of stubbornness…won’t let go. Thoughts and feelings we do not let go of. Impervious to contradictory evidence. Only pay attention to things that support their beliefs. Research shows these people are happier. Hah. Most efficient method. Authority: you think what you think because someone has told you to think this way. Gathering of information through interactions through an authoritative figure. Slightly more sophisticated. OUR PROFESSOR IS AN AUTHORITY FIGURE. A Priori (translation: before the fact, before you determine the fact) Method: A priori is not gathering facts but thoughts and beliefs are agreeable to reason. Mostly rational and logical, gravitate towards natural occurrence. “That’s what it looks like, I’ll show you”. Eg. Longest time people thought world was flat- it was logical and agreeable to reason. “you can see the edge of planet, you can see it! No need to test it.” Method of Science: Most sophisticated requires rules and structure, scientific method. It is rigorous and has rules. People sailed around earth and proved it is not flat. Most reliable way of thinking is logical and rational too but has rules. No opinion. Correct outcome most of the time with the scientific method. Most likely to come to correct outcome… but really time consuming Why is this topic important? To become a scientist Foundation for understanding research As the number of religious institutes in a city increases, number of murders increase… They do not have to be causal though. They do not prove cause and effect DSM is not scientifically derived, it is consensually derived Become an informed and critical consumer of information Important for students To become a practitioner To apply to the assessment of psychopathology
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