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Abnormal Psych.docx

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Konstantine Zakzanis

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Lecture 1, Sept, 13 Digit span=test of working memory 5 ways of explaining abnormal psych: -Statistical infrequency: anything which falls outside the normal curve problem- some things don’t fall into stats definition e.g. highly athletic person -Violation of norms-behaviour that violates social norms or threatens or makes anxious those observing it. problem- gay marriage isn’t a violation of social norms anymore, as well as cross dressing thats why violation of norms doesn’t always explain abnormalities -Presence of personal distress problem-guy jerking of to shit was not distressed -Disability or dysfunction(impairment) e.g. depression is so bad that you cant work, school, etc. But you still do, you are impaired (dysfunctional) not disabled. -Unexpectedness someone with great deal of wealth is anxious about their money, so much so that they cant work, they are disabled and it is unexpected. Early demonology -demonology -exorcism -trepanning-drill hole in skull and release demons Hippocrates ____ believe that something wrong with soma (greek word for body) this can discourage thoughts or actions, emotions, behaviours phrenology Broca’s aphasia-patient can’t speak but patient can comprehend Wernicke - patient can speak but cant comprehend- found lesion in left medial temporal lobe (called Wernicke’s area) Harlow discovered judgment, planning, problem solving dealt with frontal lobe. Lecture 2, Sept. 20 5 paradigms Paradigm-conceptual framework or approach within which a scientist works Biological paradigm psychoanalytic approach paradigm humanist/existential approach paradigm classical conditioning paradigm cognitive approach paradigm Paradigm-set of assumptions, defines how to conceptualize and study a subject or patient, how to gather and interpret data. Biological paradigm- Study of individual differences in behavoir that are attribtual to inpart differences in genetic makeup. Behaviour genetics -genotype-inherited, unobservable genetic constitution that is fixed (youre born with it) vs -phenotype- totality of observable behavioural characteristics e.g. level of anxiety, (product of genotype and environment). So if your genetically anxious and then at a job that maeks you anxious you will be show this trait alot. -family method- Family method- inherit 50% of genes from both parents, 1 degree relatives nd are those who give us 50% of our genetic makeup, 2 degree are those that contgribute 25% e.g. nephew. If kid has 10% chance of schizo and his parent does as well then there is a genetic component to it. -twin method -monozygotic twins (MZ) identical-share 100% genes -Dizygotic twins (DZ) If 1 identical twin has schizo the other one doesn’t necesariy have to have it because the environment influences the children as well -adoptees method-siblings split at birth. Key terms: Neurotransmission, reuptake. Cortical structures are responsible for higher order cognition: learning language etc. sub-cortical-found within the brain-more important with respect to movement Frontal lobe- planning, organizing, insight, understanding humour. temporal lobe- comprehension centre. parietal lobes- occipital lobes-vision Biological paradigm treatments Psychoactive drugs -anxiolytics (anxiety, paranoia) -antidepressants (post traumatic stress disorder) -antipsychotics (schizophrenia, bipolar) -psycho-stimulants (ADD, ADHD) Psychoanalytic Paradigm structure of the mind: id- pleasure principle, seeks immediate gratification unconciously, when not satisfied tension results. (sex, food, water) -Primary process thinking- fantasize about something in order to bring short-term gratification e.g. thinking about sex ego- reality principle, conscious thinking. Prevents immediate gratification from the id. -Secondary thinking- planning and thinking. superego- values, morals, and ideals we live by. Referee between id and ego. Moderates our behaviour. Psychopathology results from unconscious conflicts from individual. Defense mechanisms unconsciously employed defence mechanisms to reduce anxiety, tension etc. -repression-mind pushes impulses and thoughts into unconscious -denial- saying no completely -projection- external agents. e.g. fail a test and you don’t blame yourself but blame teacher -displacement-redirect emotional responses from perhaps dangerous object to substitute. e.g. graffiti, angry at your parents so you bully kids at school -regression-retreat to behavioural patterns of earlier age. E.g. mid-life crisis so the guy buys sports cars etc., bed wetting. -rationalization- when we invent a reason for an unreasonable action or attitude. E.g. girl denies guy so guy thinks to himself he never liked her in first place. -reaction formation- acting in the opposite way. E.g. someone’s gay and they keep calling someone else gay to hide it Psychoanalytic Therapy -free association-person has free reign to say whatever comes to their mind. -resistance- largely unconscious defensive manoeuvres intended to hinder progress of therapy -dream analysis-in sleep our ego defences are relaxed and repressed material enters or conscious. therapist interprets symbolic meaning of clients dreams -transference- clients unconcoiusly start relating to their therapist in ways that mimic critical relationships in their lives. -counter transference- analsts feelings toward patient, -interpretation- therapists attempt to explain inner significance of clients thought, feelings, memories, and behaviours. Humanistic and existential paradigm carl rogers client-centered therapy -self actualization-deals with here and now unlike Freud and discovereing the past -unconditional positive regard-accept person unconditionally for he/she is. -empathy- 2 types: primary- therapist understands and accepts client; advanced: make inferences (find meaning) of thoughts and feelings behind patients words. goal of humanist treatment is 3 fold: st 1 look at way patients experience event rather than events themselves. 2 -healthy people are aware of their behaviour so humanists therapists makes people aware of how they’re feeling in the moment. rd 3 when no longer concerned of evaluation, demands and preferences of others we can self actualize. Learning paradigms -behaviourism-focuses on study of observable behaviour rather than on consciousness Operant conditioning Law of effect-if a behaviour is reinforced it is more likely for that behaviour to happen again positive reinforcement- is when response in strengthened because it is followed by presentation of rewarding stimulus. Eg. Adding something good to strengthen response eg. Paycheque negative reinforcement- is when a response is strengthened because it is followed by the removal of an aversive stimulus Eg. Something shocking you, that shock being taken away shaping-systematic desensitization: hierarchy of anxiety, modeling-learning by watching and imitating others Cognitive Paradigm cognitive behaviour therapy (CBT): goal is to change pattern of thought that is presumed Ellis’s rational-emotive behaviour therapy (REBT): Aim is to eliminate self defeating beliefs Lecture 3, Sept. 27 th classification and diagnosis DM-IV definition of mental disorder -clinically significant behavioural or psychological syndrome or pattern that occurs in an individual. Must include: -present distress or disability, or -significant increased risk of suffering death, pain, disability, or an important loss of freedom. No definition adequately specifies precise boundaries of concept. Excludes -expectable and culturally sanctioned response to particular event E.g. death -deviant behaviour e.g. political, religious, sexual. E.g. cross dressing -conflicts that are primarily between the individual and society (unless deviance or conflict is symptom of a dysfunction in individuals). E.g. protesting 5 dimensions of classification: Axis I-all diagnostic categories except personality disorders and mental retardation Axis II-personality disorder and retardation Axis III- general medical condition-cancer can increase depression, should know what medicine patient is on Axis IV-psychosocial and environmental problems-rough childhood, lose job Axis V- current level of functioning 3,4,5 help us understand moderating variables Axis I and II are separated to ensure that long term disturbances are not overlooked. For e.g. Most people consult a helath profession for Axis I conditions such as depression or anxiety, Axis II is for personality disorders so if they ahve a dependent personality disorder. Therefore the problem was occurring before the onset of the Axis I condition, also its more difficult to treat patients that fall in both categories. Axis III is important for any medical conditions which could make something like depression (if patient has it) more worse, also important to know in case they are on medication sine you can’t prescribe certain medications together. Axis IV is for psychosocial and environmental problems such as occupational problems, economic, family etc. Axis V is for persons current level of adaptive functioning. Life areas considered are social relationships, occupational functioning, leisure time, etc. Diagnostic Categories: Disorders Substance related disorders Ingestion of some substance (drugs etc.) that changes behaviour enough to impart social or occupational functioning. nd st -highly co morbid (2 disorder above and/or beyond 1 ) schizophrenia -typically lifelong -positive (adding something, hallucinations) and negative symptoms Mood disorders Moods are high or low -major depressive disorder (suicide, social withdrawal) -mania (hyper arousal, exceedingly euphoric) -bipolar disorder (episodes of both depression and mania) Anxiety disorders -irrational or overblown fear of something -phobia (irrational fear of something, E.g. dolls) -panic disorder Generalized anxiety disorder - unrelenting sense of stress, anxiety. Constant worry. Obsessive-compulsive disorder -obsessions and compulsions. Obsession will create some sort of anxiety and compulsions follow to minimize that anxiety. Post-traumatic stress disorder (PTSD) -stress after a traumatic experience -belief that person was going to lose their life or severely disabled -flashbacks, nightmares, can’t talk about event. Acute stress disorder -like PTSD but doesn’t last as long Somatoform disorders Physical symptoms with no known physiological cause, that serve some type of psychological purpose. -somatisation disorder - long list of physical complaints -conversion disorder - loss of motor or sensory -pain disorder - complaining about pain -hypochondriasis - -body dysmorphic disorder - convinced something is wrong with their body Dissociative disorders psychological dissociation that is sudden and effects memory and identity -dissociative amnesia - transiently forget past -dissociative fugue – person will suddenly and unexpectedly travel somewhere and start new life and can’t remember their identity -dissociative identity disorder – more than one dominant personality (multiple personality) -depersonalization disorder – severe and disruptive feeling of detachment from everything Sexual and gender identity disorders -paraphilia - source of sexual gratification is unconventional -sexual dysfunctions – cant complete sexual cycle -gender identity disorder – individuals Who feel extreme discomfort with their anatomical sex and identity Sleep disorders -dyssomnias – sleep is disrupted in the amount (too much or too little), quality, and timing -parasomnias – events that occur e.g. nightmares Eating disorders -anorexia nervosa – fear of gaining weight -bulimia nervosa – episodes of bing , eating followed by behaviour that will get rid of calories, e.g. inducing vomiting, excessive exercise Factitious disorders People who intentionally produce or complain of symptoms to assume role of sick person or for secondary gain. Adjustment disorder someone who has emotional or behavioural impairment after major life stressors – symptoms after car accident Personality disorders -schizoid personality disorder -narcissistic pers. Dis. – think highly of themselves -antisocial persn. Dis. Other conditions that may be a focus of clinical attention -psychological factors affecting physical conditions underachievement job loss Cognitive disorders when cognitions are impaired -delirium – transient (doesn’t get worse) confusion, severe anterograde -dementia – progressive (gets worse), alzeihmers -amnestic syndrome – Impulse disorders intermittent explosive- episodes of violent behaviour resulting in destruction of property or injury kleptomania- stealing pyromania-fire pathological gambling- Research methods in ab. Psych case study -historical and biographical info, on single ind. -providing detailed description -case study as evidence -generating hypothesis Epidemiological research study of frequency and distribution of disorder in population -Prevalence – proportion of pop. That has disorder at a given time -incidence – number of new cases of disorder that occur in some period of time -risk factors – conditions or variable that if present increase likelihood of disorder (the older you get the higher chance of dementia) Measuring correlation -correlation coefficient Statistical significance -probability that finding is not due to chance effect size number that we derive that tells us magnitude of abnormality that is presence Double-blind procedure – External validity – how well do the results of experiment or test generalise to the real world Lecture 4, October 4 th psychological tests are based on two things: Reliability – consistency of a measurement: - test-retest reliability – how reliable the measure is if we give it more than once (gave a test today then in 3 months, scores should be relatively the same). Doesn’t apply to everything e.g. depression tests - alternate form reliability – more than one form of the test exists but are equivalent. (version A and B exam in a course and compare averages, it should be similar. Clinically (memory test). - internal consistency reliability – refers to whether or not the items on a test are related to one another. -inter-rated – degree to which 2 independent observers or judges agree. (e.g. baseball judges) Validity – whether a measure fulfills its intended purpose: - Content validity – whether a measure, adequately samples the domain of interests. (Depression test, and asking random questions.) - Criterion validity – correlating subjects score on a test with another test score. E.g. Zakzanis depression inventory test and patient scores high and then they score high on Bech test as well, so there is concurrence. Also tested in divergence. Construct validity – extent to which there is evidence a test measures a particular hypothetical construct. E.g. measuring anxiety and asking questions about your favourite colour are low in construct validity. But measuring anxiety and giving test about anxiety might work (might not work for external reasons such as willingness to talk about it, etc.) Psychological Assessment clinical interview- ask developmental questions, medical problems, family history. 2 ways these interviews are done: - structured-questions are set out in prescribed fashion for interviewer(brings you to a diagnostic conclusion using SCID[clients response to 1 question determines next question]) /semi structured (allow process to unfold naturally, just ask basic questions then lead to more complex ones) - behavioural observations (eye contact, fidgeting) Psychological Tests Standardized procedures designed to measures persons performance on particular task or to asses personality, thought, feelings, and behaviour. never interpret the results of a test in isolation Take the beck test but it makes you look bad even though you are not. Psychologists then administer Omnibus measures to understand what sort of symptoms patient may be dealing with. Omnibus Measures- (MMPI) - extensive measures that attempt to cover a wide range of clinical psychopathology - typically self-report measures -contain clinical measures and validity (fake, lying, malingering scale.) measures and look into those patients that deny symptoms being there. - can directly asses clinical psychopathology or asses mental and personality clusters and infer psychopathology from that profile The MMPI- inexpensive means of detecting psychopathology. If individual answered questions in the same way they were compared to a normal group and seen what the difference was. Personality inventories Personality inventories- person is asked to take self-report questionnaire indicating whether statements assessing habitual tendencies apply to him or her. PAI – 344 item self-report questionnaire that tries to understand individual’s personality traits and characteristics. - Renders diagnostic considerations based on DSM-IV - provide clinical and validity scales Projective tests - Projective hypothesis – notion that highly unstructured stimuli are necessary to bypass defences in order to reveal unconscious motives and conflicts. - Projective techniques – tests of personality that involve use of unstructured stimulus materials. Use of such materials maximizes role of internal factors such as emotion and motives perception. Rorschach inkblot test – projective test where subject is tol to interpret 10 inkblots scored based on: popularity of response, response to colour = indicative of emo. control, shading = anxiety Thematic Apperception test – projective consisting of a set of 31 black and white pictures reproduced on cards, each depicting a potentially emotion-laden situation. Specific inventories - trauma symptom inventory – 100 item measure that specifically measures posttraumatic stress disorder with clinical and validity scales -pain patient profile (P3) – 44 item measure test that specifically measures specific psychopathology. Intelligence tests standardized means of assessing persons current mental ability. -Alfred Binet – Stanford-Binet. Basically mental age test for slow learning kids. - WAIS-III – 14 subscale measure consisting of verbal and performance subtests that yield full- scale, verbal, and performance scores. 4 types of examination data: -background data (asking questions, medical files, etc.) -behavioural observations -quantitative data (test scores) -qualitative data Cultural diversity and clinical assessment culture bias in assessment what is appropriate culture? - the clients ? - country of origin - Canadian culture ? Strategies for avoiding cultural bias in assessment Language and bias -assess language and skills -are there tests in their language -translators? Behavioural and cognitive assessment Stimuli- environmental aituations that precede the problem. E.g. situations which elicit anxiety Organismic-physiological and psychological factors operating “under the skin” Responses-overt responses (what behaviour is problematic) consequent variables- events that reinforce or punish behaviour in question Gathered through- direct observation, interviews, and self report measures. Biological Assessment -brain imaging -CAT scan: good for finding calcification, bleeding, bone abnormality. Helps to asses structural brain abnormalities. -MRI: specific lesions that aren’t large, atrophy, shearing/tearing -IMRI -fMRI-picture of the brain at work rather than as a whole -PET scan- Neuropsychological Assessment A neuropsychological evaluation is comprehensive assessment of cognitive and behavioural functions using a set of standardized tests and procedures. Various mental functions are systematically tested, including: -intelligence -language -academic skills -attention, memory, and learning etc. Neuropsychological tests idea that different psychological functions are located in different areas of the brain so finding a deficit on a particular test can provide clues about where damage in the brain might be. Halstead-Reitan battery test: 1. Tactile performance test-(time)-blindfolded then put shapes into foam board with dominant then worse hand. 2. Tactile performance test-(memory)-draw the board from memory (damage to right parietal lobe) 3. Category test- problem solving test (brain damage) 4. Speech sounds perception test- listen to nonsense words with long “e” sound in middle (measures left-hemisphere function) Luria-Nebraska- 269 items making up 11 sections (motor skills, verbal and spatial skills, etc.) Pscyhophysiological Assessment EEG- record electrical activity in brain Limitations of Neuropsychological Evaluations - ecological validity Ch. 1 -Define abnormality, different way which we do that and the limitations. -know different mental health professionals and how they differ -early history of psychopathology, e.g. demonology, somotagensis and important figures, witchcraft, early asylums, important figures with respect to social reform. Ch. 2 -ins and outs of the paradigms and how they differ, basic principles (biological paradigm – different types of studies and terms, genetic types of research) - basic of neuroscience (transmitters, structure and function of brain) -carl rogers -little bit about gestalt therapy -learning paradigm (conditioned, operant conditioning, negative reinforcement, positive reinforcement etc.) -modeling -cognitive paradigm (behavioural therapy, beck and ellis) -diathesis stress paradigm Ch.3 -Know DSM in detail -know disorders (differentiate between them) -reliability and validity -clinical assessment procedures -know differences between types of reliabilities and validities -know a little about interviews and psychological tests -projective tests and limitations and examples -limitations of intelligence testing -know a lot about neuropsychological tests and neuro imaging Ch.5 - things covered in lecture LECTURE 5 Somatoform disorders: -bodily symptoms that suggest a physical defect or dysfunction, but no physiological basis can be found Dissociative disorders: -disruptions of consciousness, memory, and identity Somatoform disorders: -Pain disorder -psychological factors play a significant role in the onset and maintenance of pain Pain has to cause significant distress and impair or disable you. DSM has specifiers: Acute (less than 6
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