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Hywel Morgan

LECTURE 1&2 What is abnormal behavior? 1) Statistical criteria 2) Cultural norms 3) Developmental norms 4) Frequency, intensity, duration Sometimes there are behaviors that are not considered abnormal but are at a low frequency (high IQ) Sometimes there are behaviors that are considered abnormal but are at a high frequency (taking drugs) We’re looking at behavior that interferes with daily functioning *The frequency/intensity/duration can be the high OR low Etiology – the study of the causes of abnormal behavior (the study of causes and prevalence) 2 types of etiological models: 1) Medical-disease models *These four models are inter-related *Nowadays – if you develop a psychopathology – you will most likely be medicated) Schizophrenia is the ONLY psychopathology that is CLEARLY linked with biology (it cannot be treated with psychotherapy) *If a close relative has suffered depression, the chances of you developing the same disorder are VERY high – there is a genetic component to depression Twin studies look at concordance rate – what are the chances that if one twin develops Schizophrenia, that the other will as well (50%) -The concordance rate in separately reared identical twins in regards to depression is 80% *Stress is the #1 environmental contributor to psychopathology (if you have a genetic predisposition for a genetic disorder, and you are exposed to an extremely stressful environment, the chances this disorder will express itself are much higher) Drugs are manipulating the levels of neurotransmitter in the brain (in schizophrenia dopamine is the targeted neurotransmitter – there is too much dopamine in patients in the limbic areas and too little in the prefrontal cortex which affects the motor area of brain) Serotonin is the targeted neurotransmitter in depression – there is too little serotonin in patients (however – not all patients respond to drug treatments that enhance the amount of serotonin) Cortex – voluntary functioning/speech/processing visual information/motor movements Sub-Cortex – emotions/memories/coordination Lower areas – basic functions: sleep cycle/breathing/heart beat Psychoanalytic model: founded by Freud -He said that psychopathology was created internally 2) Environmental models -Sociocultural models (emphasis socio and cultural determinacies) -Death in the immediate family would be the most significant stressor -Others include losing your job, divorce, starting a significant relationship, living environment, etc. -This model is very effective in studying depression – the more stress you have the more likely you are to be depressed – not just correlational, it is experimental -Learning models -These are the conditioning models (Pavlov and Skinner) -What we learn from our environments -Views abnormal behavior as primarily determined by learning (ex: in depression – we think we are worthless because somehow we have learned that – therapy would be simply to re-learn) -Humanistic models -The humanistic paradigm: “touchy feely” – this is where you are taught you are worth/loved/good and you love yourself -This model stresses the individual’s reaction to themselves and to their external world -It’s not interested in exploring the sub-conscious or how you learned certain things -It emphasizes safe environment, acceptance, and exploration of feelings What is assessment in psychology? What are the tools that we use as clinical psychologists/mental health professionals to assess what it is? Clinical Methods *The process of seeing a psychopathology specialist is usually brought about through a referral (can come from a number of professionals – usually from family physicians) *In a referral – basic information is given – an orientation of the major problem(s) – co-morbid (more than one psychopathology at the same time) – also includes duration, onset, and medical status 1) Interviews (the most prominent with adults) *The most common way of inquiring about a psychopathology is called “self-report” (ask and tell) *There are problems with this – deception (either intended or not) 2) Testing -Psychologists have created hundreds and thousands of psychological tests -A lot of different data collected and norms are found -Devised to gather information that is not readily accessible from the interview (fantasies, aspects of memory, perceptions, achievements) 2 types of tests 1) Cognitive tests/Intelligence tests – Testing what and how we think -Very common: The Weschler Adult Intelligence Scale (WAIS - yields an IQ) -Gives 3 scores (performance score (right hemisphere) verbal score (left hemisphere functioning) and overall IQ (combination of both)) Culturally biased: (how many senators are in the United States senate?) 2) Personality tests – Testing what and how we feel 2 types: 1) Self-report inventories -Most common: MMPI - Minnesota Multiphasic Personality Inventory (over 500 questions – very extensive – very sophisticated – looks to see if you are answering truthfully – or if you are simply answering what is socially acceptable) 2) Projective tests -They present ambiguous stimuli to which people may respond to freely (because it is not clear what the stimuli are meant to evoke) -Exner system: An encyclopedia book filled with standardized responses -Roshak tests: “what do you see here” tests – if they say “an ink plot” that is a concrete response (usually an indication of a serious psychological problem) -One test is if a person is shown a red spot and they say that they see a patch of blood it is a clear sign that they may be sociopathic -TAT Thematic Apprehension Test: the stimuli provide an opportunity to elicit answers that reflect that person’s personality – the ambiguity of the stimuli will make the person feel freer to reflect their personality 3) Observations and Behavioral Assessment -What are they doing? -Pitfall: you are observing the behavior in only one point in time in one particular situation (the situation is artificial – it is not natural and normal – it is unfamiliar to them) -Another problem: there is observer bias – especially if you have been given a referral – you may be looking for behaviors that conform to that referral (can lead to misdiagnosis) There are 5 categories under observational assessment: 1) General appearance and attire – can tell you a lot about their physical social and personality characteristics (are they washed? Shaved? Is their clothing age appropriate? Do they have bumps and bruises on their body? Cuts?) (Lots of assessments can be made based on this – drugs use, abuse relationship, recklessness, epilepsy, etc.) 2) Emotional gestures/Facial expressions – body language is very important – anxiety is very common 3) Gross and fine motor acts –responsivity of an individual can be affected by the brain, the chemistry, the coordination of movements, and mind (is the person unusually over-active? If so, what would you want to investigate further? Drug abuse? Attention Deficit Disorder?) -Is the person unusually un-active? If so, what might you suspect? Depression? *Catatonia (a type of Schizophrenia) can be unusually active or unusually un-active 4) The quality of the clients relationships -The quality of their interactions 5) Verbalizations of the client – the quality and the structure of those verbalization (not just the content) – gives us at the least a rudimentary understanding of the intelligence level of the client – -Pitfall: is English my clients first language? Perhaps it is their second or third language? -Neo-logisms: new words (how did you get here today? “dinpa”) – could be an indication of neurological damage -Tangential thinking can be an indicator of psychosis (how did you get here today? “I am made of blood and bones just like the wind moves the trees) -Confabulation – made up stuff – not lying – it’s where your brain fills stuff in that’s not true (can be an indication of a sociopathic orientation) Interviews -The questions asked would be based on the referral -Questions will cover a lot of information on family history, individual history (including medical history) -Interviews typically ask about demographics (where have you lived? for how long? Where did you attend school?) -Also going to be asked a lot of information about the extending problem – much more than in the referral -Main reason for interview is to gather all of this information – second reason is to interact with the client and establish a rapport (establishment of a comfortable dialogue/understanding/interaction between two people) 2 Types of Interviews: 1) Structured Interview: -Very specific questions (probably a booklet filled with questions that must be asked) -High degree of reliability -However, they suck when it comes to rapport -They take hours and you do not have anytime to hear someone’s response and say to them “oh tell me more about this” 2) Unstructured Interview -The next question usually depends on the previous answers of the last -Room for error/questions missed -Difficult to determine which information is important/unimportant (trying to record everything can be ineffective and can once again, have a negative effect on rapport) -Must monitor the clients cooperativeness and truthfulness during the interview DIAGNOSIS What makes a good classification system? -Why is a good diagnosis important? Treatment. -It can be beneficial yet harmful -When we label someone with a diagnosis, we frequently think of that person as BEING that diagnosis (stigma) -The stigmatization can lead to bad self-esteem/even make them sicker (we don’t label people with cancer with their disorder) -Diagnostic systems are tools (just like an MRI or a x-ray) – the can only be used by a professionals – doing so without falling into this category would be breaking the law DSM (TR): diagnostic statistical manual (text revision) – lists the symptoms that MUST be present in order to diagnose somebody with a particular disorder First DSM published in 1952 DSM 2 published a few years later DSM 3 in the 70’s DSM 3R 80’s DSM 4 90’s -Most widely used diagnostic system in North America (Published by the American Psychiatric Association – in cooperation with psychologists and psychiatrists) Another widely used diagnostic system used around the world: -ICD 10: International Classification of Diseases (published by the world health organization – division of the united nations) Why do we use two different systems? -Some of the diagnosis accepted in NA are not accepted or recognized in the rest of the world -However they are working on making them 100% compatible -When reporting mental health disorders, clinicians are required to use ICD codes, not DSM4 2 ways to construct a diagnostic system: 1) Clinically – you get a bunch of experts in a field (perhaps in anxiety) and you have them decide amongst themselves what the hallmark symptoms of that particular disorder are and what differentiates one disorder from another 2) Empirically – using empirics (measurements/experiments/numbers/statics) – statically derived – we get together a large number of people that we think have a disorder, measure all of their behaviors and see which of these behaviors occurs more frequently (you look for trends) DSM 4 is not an empirically derived system (it is clinically derived) (it is very difficult to get a group of psychologists and psychiatrics to agree) DSM 5 will be coming out shortly – it was supposed to come out in 2011 but they want to include a lot more factor analysis in their diagnostics – there is too much variation in the data What makes a good diagnostic system? -Things to consider: 1) The categories are clearly defined: DSM 4 does a good job at this 2) Categories exist – that these symptoms do occur together regularly (DSM is somewhat arbitrarily defined – but it seems that the categories do exist) 3) Validity – your diagnostic system should have a significant degree of validity – the categories are clearly discriminable from one another – and its measuring what it should measure (DSM4’s validity is poor – evidence for this is misdiagnosis) 4) Reliability – your system should have a high degree of reliability (2 ways to measure this would be inter-rater reliability: that one mental health professional would give the same diagnosis as another mental health professional AND test re-test: if they come back at another time with the same symptoms, they would receive the same diagnosis) DSM4 does have high reliability (this might unfortunately mean that we keep making the same mistake in diagnosis) 5) Clinical Utility: Its useful – DSM4 has a significantly high degree of clinical utility – it has its problems (validity – probably because it is clinically derived) – but the categories do exist and it has a high degree of reliability LECTURE 3 Psychologist’s environments 3 main environments in which psychologists practice their profession: -Clinical -Research (scientist) -Teaching (a teacher) 3 other environments: -Administration -Test construction and administration -Expert witnesses (phrenic psychology) Clinical Psychology (involved with pathology) What are the issues of ethics and legalities? The aftermath of World War 2 effected how we (as a profession) practice what we do – seeing other people who have psychopathologies (illnesses in the mind or problems in behavior) It was the aftermath of World War 2 dictated what the ethical guidelines should be The Nuremburg trials set guidelines on how to interact with people professionally, behaviorally, and medically that are still used to this day The key issue that came out of these Nuremburg trials was the concept of informed consent – humans have the right to deny participation Laws – written rules (something you have to do) Ethics – guidelines (they are not how you MUST behave, they are how you SHOULD behave) *Both tell us how to behave Psychologists’ behavior: #1 thing they tell you as a clinical psychologist – don’t have sex with your client Informed Consent: “when I interact with you, I tell you what the interaction is going to be and what the limits of the interaction will be” – “informed consent is you saying ‘yes, I agree’” When we get together as therapist and client – I describe to you what is going to happen – I tell you what my qualifications are – I tell you what my training is in – and what you cant expect of me There are limits to confidentiality with regards to informed consent? That means that I need to tell you as a client, is that everything that we discuss is confidential (and if it’s a group – the other members of a group) The privilege that you have as a client is that everything you say is in confidence Legally enjoy privilege: psychologists, physicians, lawyers, and spouse *As part of informed consent, you must inform your client that there are limitations in confidentiality (that you can break) in certain situations (here’s where confidentiality can be broken - #1 case is: confidentiality must be broken is if you are licensed as a psychologist/medical professional/social worker and you learn of a potential case of child abuse (verbally or physically) – you are then legally required (in this province) to report that information on to the authorities) -#2 case is if they have threatened to harm themselves or harm someone else -However there can be many grey areas You may lose the license to practice your professional (either temporarily or permanently) if you break an ethical guideline (will not necessarily get you in trouble with the law but it can get your in trouble with your professional circle) *If you have somebody that you know that says, “I feel like killing myself” – what should your response be? Should you take it seriously? Yes. You should then ask – “have you thought of a way of killing yourself?” if the answer is yes, then it is very serious. They need a hospital or a clinic right away. “Have killed someone” – expected privilege – cannot report Are you legal obligations only to your client? Yes, just your client. So what if your client tells you “my spouse killed somebody” – ethical grey area!! Tarasoff case: Tatiana Tarasoff: young university student – befriended a foreign exchange student and he misread her affection for him (she kissed him on the cheek and he misread the affection – he was suffering from some type of mood disorder) – she went away, he stopped seeing his psychologist – she came back – and he murdered her. While he was seeing the psychologist – he had told the psychologist about the relationship he had with Tatiana and that he had feelings for her and that she had rebuffed his feelings – and he began to feel very angry towards her – In fact, near the end of his session with the psychologist he had stated that he was “so angry with her he could kill her” – The statement was so violent that the psychologist did indeed inform the authorities (campus police) – he figured he was ethically responsible to inform the authorities – the authorities followed up – they interviewed him, yet the authorities were satisfied that he wasn’t an immediate threat to Tatiana. Her parents were very angry that the psychologist hadn’t gone one step further and informed Tatiana or her parents directly – went all the way to court and they sided with her parents. There has since then been a legal precedent that is followed. There is one more limit on informed consent and confidentiality (here in Ontario): if during my assessment I become suspicious of your ability to drive a motorized vehicle – it is my legal responsibility to inform the ministry of transportation – not the case in other provinces (you must tell them that before the assessment begins – informed consent) The age of legal consent (for medical reasons) is 10. However to cover your ass you should also get parental consent until you’ve reached age of majority (18) If the court gets a supine – and they tell you that you are required to break confidentiality – you must. If between the age of 10 and 18 the parent gives consent but the child doesn’t – we have an ethical dilemma Developmentally delayed, mentally incapacitated, mental retardation, people passed an age and may be dementing, people under the influence of a particular drug, incarcerated (you have been striped of your rights) – cannot provide consent in the eyes of the law Ethical dilemma: (someone is so severely depressed that they need treatment yet they cannot give consent) your damned if you do, and your damned if you don’t – what’s the solution? There isn’t a right solution. Perhaps seek consent from the closest relative? However this treatment involved side effect of memory loss – the person is then no longer depressed but angry – they sue you – your damn if you do and your damned if you don’t Risk/Harm: the clinical ethical guidelines – right at the top is: “I will not hurt or harm my client” (sounds easy to follow – but it is not as simple as it sounds) Grey area: what constitutes harm? Ethics in Research: I need to inform the research subject that all the information is confidential. They have the right to withdraw at any point. Often in experimental research a technique is used called deception. Included information that isn’t true or withholding information that is true. Sometimes it is a central part of many experiments. Milgrim experiment: most of us will submit to authority – experiment was conducted to try and understand why the German’s follow Hitler in complying to all the of outrageous things they were told to do Deception is acceptable – when harm is minimized When considering the value of deception: 1) The importance of the research 2) The availability of other methods 3) The noxiousness of the deception (how bad the deception is) 3 environment in which they have ethical obligations: teaching -“It would be unethical for me to ask you to participate in one of my research experiments” – this is unethical (“if I don’t participate, they could give me a bad grade”) -It is also unethical for a teacher and a student to have a relationship that “bleeds over” to other environments (talking to your teacher as a clinician) Section 2: Treatment Approaches *They overlap but we will look at them separately 1) Psychological Approaches (Mind) Individual psychotherapies are less common now, group therapies are more common – they are cheaper There is therapeutic value in belonging to a group in and itself* Individual psychotherapy: psychologically planned and ongoing interaction between a trained person (therapist) and a client who has some type of behavioral disorder (this began with Freud). The METHOD that Freud used was free association. Offered no interpretation and no intervention. You were offered a place in a quiet area with a psychoanalyst and the instructions were “say whatever you want to say”. They would be looking for Freudian slips (unconscious thoughts rising to the surface). This type of psychotherapy is not so common anymore – expensive, time consuming, etc. 3 types of psychological approaches: 1) Cognitive therapies 2) Behavior therapies 3) Group and family therapies Cognitive therapies: understanding that you are a thinking being. You understand and interpret your environment in a unique way. You have an inner world of thoughts and perceptions. Psychopathology comes about as a result of faulty learning of these thoughts and perceptions. (Somebody who is depressed has learned incorrectly that they have useless and worthless). Cognitive approach attempts to restructure/reteach these beliefs. Simplest way to reteach this: RET: rational emotive therapy. Simply tell them. “I am worthless” “NO, your NOT”. You can also use modeling – where you can pantomime particular behaviors. Behavioral therapies (behavioral modification): Invented here at the labs at U of T. Behavior is something that we want to measure overtly. We are only interested in what is going on RIGHT now. Measure, and observe current, overt behavior. It refers to treatment using methods that have derived from experimental psychology. Not interested in what’s going on cognitively, not interested in subconscious, simply interested in what’ s going on now. Anxiety disorders are probably the most common psychopathology. Next most common, mood disorders. These two psychopathologies are usually co-morbid (occur together). A couple techniques: Systematic desensitization: pairing of an incompatible experience with the gradual presentation of fear evoking stimuli (used to clear phobias – irrational fears) There is a good reason to have a fear of falling – but it is not rational to be fearful of heights. These fears have been incorrectly learned somehow – through classical conditioning – it must be re-taught – we systematically desensitize you to have a different response to that stimulus For example: fear of spiders We bring you in and tell you we will present you will a stimulus that might disrupt you. But first, we relax you. Close your eyes, and when you open them, there will be a picture of something that evokes an anxiety response from you. You begin to feel anxiety but we tell you to concentrate on the way your feeling. After this is repeated multiple times, you are able to keep your state of calmness while looking at the spider. Teaching you to pair your relaxed state with the spider. Inclosive therapies: put in an extreme situation (shoved in a room full of spiders): this is very useful for OCD patients Modeling: show the client exactly how to behave with or around a certain stimulus Extinctions: you remove the reinforcement (effective in children – perhaps a child who is throwing a lot of tantrums) – you find out what the tantrum is in response to and you remove the reinforcement Positive reinforcement (with children we call this the token economy): giving something that the client likes, in response to a behavior that I want to increase Group and family therapies: the treatment of a number of people together. Typically the theory is that the abnormal behavior is a result of some type of faulty social environment. It provides social support. The idea that “I am not alone” – there are other people that are experiencing the same symptoms that I am “we can help each other”. Biological Approaches/Somatic Approaches (Body) -The current zeitgeist (current health issues) – these are treatments that are conducted from the medical disease model or point of view -They are frequently radical (invasive) – when people see them they do not sound or look very pleasant – physiologically invasive – not frequently used (except drug therapy) ECT: electro convulsive shock therapy – it has been used extensively in the past (not currently – still is used – but in the past it has been used very regularly in the treatment of psychosis (schizophrenia)) -Many invasive procedures were used for psychotic conditions in the past: electric shock, ice baths, wrapping, and lobotomy -ECT is still used for severe depression (their cognitive perspective of themselves and others around them is extremely different then that of the average human, they take no pleasure in anything, extremely low self-esteem “I hate me and I hate the world and I don’t want to do anything”) – it is no psychosis, but it looks psychotic – they are simply sitting and breathing and pretty much not doing anything else (this is life threatening) These people are not going to be very compliant to do psychotherapies or drug therapies – which is when ECT is administered (frequently without patients consent) – with as little as one administration is works -Main side effect is memory loss – it can be quite severe –often suffer retrograde amnesia – which means that past memories are lost – patients can become quite upset by this (these effects are permanent) Anterograde amnesia: unable to build new memories In order to reduce the invasiveness of ECT is now usually performed unilaterally (to one side of the head – usually the right side of the head) - all the neurons in your brain are firing at the same time (a seizure) – they used to be performed bilaterally but not anymore (however it does still effect the whole brain) –unilaterally administering ECT does reduce the amount of memory loss A family member must give consent for this procedure* Psychosurgery: still used. It is a surgical technique usually used to separate parts of the brain or to remove parts of the brain. Removing the frontal lobe is called a frontal lobectomy. Separating the frontal lobes from the rest of the brain (they are still there but they are not doing anything – they have no means of communication with the rest of the brain or body - more common of the two procedures) is a frontal lobotomy). This is refered to as the “ice pick” procedure. This is permanent. If you remove part of your liver, it will grow back, the brain will not. Not a lot of plasticity in your brain when you are an adult (there still is plasticity but not nearly as much as in children). Frontal lobes are mostly responsible for monitoring and modification of emotional output (large problem in schizophrenia – their emotional output is unmonitored) – removing frontal lobes (in psychotic patients) effectively eliminates the affective component of that disorder (affectively flattened – no emotion). This is not the same as depression – depression is not flat affect – it is sad affect – depression is an emotional state. In the past however, they were unaware that the frontal lobes were also responsible for problem solving, judgment, decision making, therefore the removal of the frontal lobes eliminated these functions of the brain as well. Split brain – sever the communication link between the two sides of the brain – done to treat epilepsy -Most seizures can be treated with drugs -Faulty communication between neurons: a seizure -Sometimes the treatment for seizures is to find the focus of the seizure and remove it -Psychosurgeries are most frequently conducted in children (due to a child’s brain’s plasticity) -World famous site for conducting psychosurgeries: Sick Kid’s in Toronto Psychoactive Drug Therapy: most commonly used. This is the major current somatic/biological approach to treating psychopathology. There are 4 basic classes of drugs (we will come back to these). All 4 of them are used therapeutically (in this country) The stimulants: they stimulate your nervous system The depressants: they slow down your nervous system The cannabinoids: marijuana - very rarely used therapeutically – it has stimulatory qualities, depressant qualities, and hallucinogenic qualities and we are not quite sure why The hallucinogens: has been used in experimental psychopathology LECTURE 4 Perhaps the most common psychopathologies: Anxiety Disorders – extremely common – clinical grade anxiety – prevents you from enjoying things that you might/should normally enjoy – it interferes with your life and your daily functioning Anxiety is the increased physiological arousal and feelings of apprehension (dread, fear). However fear and anxiety are physiologically different from each other. Anxiety is not a bad thing – it is a necessary emotional response (emotional has both cognitive component “oh that scares me” and physiological component “rapid breathing” – emotions are adaptive – they help us to function properly). The emotion of anxiety is an adaptive emotion – helps us to function in our current environment. When we feel anxious about something, it motivates us either towards or away from a stimulus. When you are hungry, you have a motivation towards food, the emotion you feel after you’ve eaten the food is content. Hypothalamus: involved with emotions. Example of anxiety: you are going to have a pop quiz next week – your response: “whaaaat?” – motivation towards studying An anxiety can become maladaptive – when the emotional response goes above and beyond what it is supposed to do – “there’s going to be a pop quiz next week” – response: “whaaaat? My life is ending, I’m never going to graduate, I’m going to live on the streets” – this is maladaptive. Extreme anxiety – someone will depersonalize (unawareness of surroundings, almost always includes not knowing who you are) and the physiological reaction will look psychotic (only occurs in very extreme cases). -To want to eliminate all anxiety from your life is abnormal, because now you are no longer experiencing an emotion that you need to function in daily life. -It is preparing you for a threat -If you perceive something to be threatening and it isn’t - that is a phobia -Number one anxiety provoking situation: public speaking -Number two fear/anxiety provoking situation: death (getting older and dying) -In general, anxiety helps you cope 1) Psychophysiological component: physiological change in behavior - when a person is anxious, their reactions are objectively measurable (pupil dilation, heart racing, sweating – you can measure these things) -You produce more adrenaline when anxious 2) Psychological component: cognitive component (characterized by irritability, lack of concentration and feelings of fear). Unlike the psychophysiological component which is measurable, the psychological component is much more subjective. This is the most common measurement of anxiety – psychological/subjective measures. “on a scale of 1 to ten, how anxious do you feel?” 3) Interpersonal component (observable component) – what we observe in your behavior. Observable, bodily changes occur – shoulders tense up, you begin to shake, etc. Fear releases endorphins Limbic system is in the subcortical part of the brain (seems to be where emotions are generated) – most important part for the production of fear and anxiety is the amygdala. -We know from animal studies that lesion of the amygdala’s you create a very tame animal – they show no fear to humans or other stimuli anymore Least sophisticated scanning method: CAT scan – Three-dimensional X- Ray The frontal lobes are activated, the limbic system is activated, and the amygdala is activated. The autonomic nervous system: a part of the nervous system (peripheral nervous system – the nerves going in and out of the central nervous system) Sympathetic: part of the autonomic nervous system that goes out to the visceral effectors and tells them to activate Parasympathetic: its effect is exactly the opposite – it is to decrease heart rate, decrease respiration, constrict pupils, sweat less, and generally feel more relaxed (can be induced by meditation – one of the treatments for anxiety disorders) One of the functions of emotions is to help you prioritize the goals and tasks surrounding you in your environment (they are efficient – this is why they are adaptive) Your environment is not perfectly predictable so you have to change those plans and goals from moment to moment – emotions help you do this Function of Anxiety and Emotions - Part of a management system to coordinate each individual’s multiple plans and goals under constraints of time and other resources. o Emotions help to prioritize goals, making you more efficient - Emotions are part of the biological solution to the problem of how to plan and to carry out action aimed at satisfying multiple goals in environments which are not perfectly predictable o Emotions help to re-prioritize those goals because environment is always changing These subsequent disorders involve a sense of apprehension about a stimulus that is threatening: they have all the components of anxiety: psychical, psychological. 1) Generalize Anxiety Disorder - The most common anxiety disorder/most difficult to treat - Marked by chronic high level of anxiety not tied to specific threat - Duration + intensity - The anxiety doesn’t go away and there’s nothing that precipitates it o There’s nothing identifiable for treatment o Chronic high level of cortical is physiologically damaging, as is with other chronic high level of physiological responses o Relaxation training (psychological) o Anxiolytics (anti-anxiety drugs): some, like valium, can become addictive—habit-forming drug -Inhibitory NT: GABA, Benzodiazipines. -They are depressant drugs: fatigue, change in consciousness 2) Phobic Disorder - Irrational fear that seems to be learned through behavioral conditioning - Classical conditioning: unpleasant response= unconditional stimulus - Treatment is to unlearn that association—reconditioning o Systematic desensitization  Replacing with a different reaction  Hierarchical o Flooding 3) Panic Disorder - The panic attack usually reoccur - Attacks of overwhelming anxiety that occur suddenly and unexpectedly - It can be quite severe (the physiological response) and difficult to stop a panic attack o Thus, most treatments focus on preventing panic attacks 4) Agoraphobia - Frequent occur with panic attack - Fear of being in public places—don’t like to go out, like to stay at home o In extreme cases, lock themselves in bathroom for months, or cover the windows to block out the external world - It is related to panic attack because when it is necessary for those with agoraphobia to go out in the public, their response is a panic attack 5) Obsessive-Compulsive Disorder - Persistent and uncontrollable intrusion of an unwanted thought (obsessions) and urges to engage in senseless rituals (compulsion) o Neat freak: obsession with neatness, compulsion of cleaning - Can be disruptive o Don’t step on a crack when walking - Conscious of their obsessive compulsion - Obsession is creating anxiety; compulsion is reducing it - Treatments: anti-depressant medication for OCD, impulsive therapy, types of behavioral modification, counseling and psychotherapy 6) Post-traumatic Stress Disorder - Enduring psychological disturbance - Attributed to a major traumatic event - Involves flashback to that event - It is quite common in the last decade - It was initially called shell-shock after being discovered in WWI - Sexual Assault/Rape is the most traumatic event that causes PTSD LECTURE 5 Depression – the most common mood disorder Affects 5% of the world’s population (1 in 10) It is not a “funk” – a clinical depression is not a mood – it is not something that comes and goes, it is something that comes and sticks around The number one attribute of a depression is the duration – a permanent alteration of a mood state (sadness) Extreme depression can resemble psychoses (especially schizophrenia) You do not see flat affect in depression – you see extreme sad affect The Mood Disorders Unipolar disorders VS Bipolar disorder These disturbances spill over to disrupt physical, perceptual, social and cognitive domains Physical: restlessness, fatigue, change in movement (become lethargic or very active), don’t take care of themselves, an extreme weight loss or weight gain Perceptual: an increase perception of threat, nothing seems important anymore Social: people who are depressed are not interacting socially Cognitive (thought): internal thought processes change (“I am worthless, no one enjoys my company”) Unipolar disorders (Depression) -There is an extreme in one direction -There is constant extreme happiness (mania without depression) but it is very rare Major depression (clinical depression) -If your close family members who suffer from depression, you may have a genetic predisposition to this disorder -Depression is not abnormal – it is a normal state of affairs - sadness is a normal emotion -Why do we have happiness and sadness? It teaches us consequences – they allow us to process information regarding punishment and reward -Sugary food makes us happy – it gives us energy - therefore we seek it out -Certain food makes us feel bad/sick – therefore we learn to avoid it -Happiness and sadness are adaptive – when it lasts past the period of when you need it, it becomes maladaptive - when it is no longer of any use to you -For example, if after the death of a loved one, 6 weeks to 3 months later, the person is still unable to go to work, care for yourself, shower, eat, etc. that would be considered psychopathological and maladaptive -Described as sad, miserable, tearful, lonely, worried, useless, guilty - often described as “inward looking” – they are fixated on what is going on inside them -There is a genetic component as well as an environment component (stress) -There are sleep disturbances associated with depression - one of the oldest treatments for depression (and we don’t know why this works) was sleep deprivation (not allowing the depressed person to sleep at all) -We do not know why this works – it is partially hormonal and partially neurochemical – it creates a euphoria – it elevates your mood (over 24 hours of being sleep deprived) – the lack of REM sleep (dream sleep) create an elevated mood – the problem with this method is that it doesn’t last -Depression is on the rise – why might this be? – We are getting better at diagnosing it, it might be that there is more stress in the environment that there used to be, less stigma -It is an extremely treatable disorder - if you have depression, you will get better – however if you’ve suffered from depression at some point in your life, the chances of it coming back are very high -Can depression go away/get better on its own? Yes – spontaneous remission (this is pretty common) -Woman are more likely to develop depression over men (about 2 to 1) – 50% more common for women to develop depression than men -It is entirely possible that the very definition of depression may not be applicable to some people who feel a permanent change in mood – when women feel bad about themselves they feel hopeless and they don’t want to do anything that would normally give them pleasure – their expression of that is sadness (the core of the definition of depression – a saddened affect) – When men feel bad about themselves – they feel that things are hopeless and they feel like they don’t want to do thing anymore that used to give them pleasure – their expression of this is anger – and that is not part of the definition of depression – this may be one of the reasons why this statistic is so distorted – another reason may be because women are more likely to seek help Dysthymic disorder -“Depression light” -It is a lower grade of depression – people who are dysthymic are usually likely to be able to function in their everyday lives -People who are constantly complaining - “I hate my job, I don’t like this” – constantly miserable about everything – but they can function -Dysthymia continues and lasts – sometimes for years and years -It has been likened to a personality disorder because they do not go away – they are treatable but they do not go away -It is difficult to treat, it is not as severe as a major depression, but it lasts for a long time -Intensity and duration are different (less intensity, longer duration) -Double depression: a major depression on top of a dysthymic disorder – this is even more difficult to treat Melancholia -(This is not typically seen as an abnormal behavior – it is not seen as a mental health illness) -If it is not watched carefully it can turn into a disorder -It can turn into a major depression (for example after the loss of a loved one) Treatments for Depression -Sleep deprivation -ECT and Psychosurgery (see notes) – severe side effects (flat affect) -In the 1930’s - A drug was used to treat bacterial infections called Ipronizaid (very strong antibiotic for people who were in the terminal stages of bacterial infections) – it made them feel good and happy and optimistic about the world – this side effect was noticed quite quickly and it was decided that they would look into this drug as an emotional alleviation drug (an anti depressant) (Marci Led) – the first piece of information that depression might be bio chemical -This antibiotic prevented the release of molecules that breakdown monoamines (you require the neurotransmitters in order to not feel depressed – perhaps one of the reason we are depressed is because we don’t have enough of these neurotransmitters in our brain – because if we raise the levels of these neurotransmitters – depression is alleviated) -MAOI’s – a class of drugs that alleviated depression – bad news – there are potentially significant side effects – they interact with other chemicals or compounds to create potentially lethal side effects – can cause extremely high blood pressure which can be life threatening -In the 60’s: another drug was discovered by accident – it was used as an anti psychotic to treat schizophrenia – it was elevating mood – imipramine – it was also found to elevated monoamine levels – but it did it in a very different way – re-uptake – requires more energy – but in the end, re-uptake is more efficient (cells prefer this) – what this new class of drugs does is it prevents the re-uptake – re-uptake inhibitors – re-uptake is the main way that monoamines are removed from the synapse – this class of drugs was called the Tricyclic Anti Depressants and they were much more effective than the MAOI’s (effective in 70% of the patients who take them) – they also safer than MAOI’s – however there is one significant side effect and that is overdose – fairly easy to overdose – they can be lethal – this was used right up until the 80’s Third generation of drugs (since the 80’s) – SSRI selective serotonin re- uptake inhibitors – (the first one was Prozac - two more called Zoloc and Paxal) – block the re-uptake of the neurotransmitter serotonin – 1987 Prozac was introduced – can also be used to treat panic disorder, alcoholic withdrawal, bulimia, anxiety – side effects are minor but can be considerably irritating for some people – however can cause a loss of libido – this class of drugs is very successful due to minimal side effects – some include insomnia, headache, vomiting (usually temporary side effects and tend to go away) -Aggression or restlessness in children can be indicators of depression -The SSRI’s are now not recommended by the Canadian Medical Association for the treatment for depression in children – the reason for this is that there are a sufficient number of studies that show that the outcome is more likely to be extremely negative – significant outcome of suicidal behavior later on (the speculated reason for this is that children and teens are impulsive) Bipolar disorders (Manic Depression) -Bipolar disorder There is a swing between extreme happiness and extreme sadness -Bipolar disorder is often misdiagnosed as depression -The depression, we notice, the euphoria we do not -Somebody who is over enthused is going to make errors – someone who is over enthused because they have just won a lot of money they might gamble it all away – there are negative aspects to a mania -The swing between the two poles are usually not very quick (weeks), sometimes you see swings from day to day (but this is very rare) (week to week or day to day would be called rapid cycling) -Typically we see these cycles that occur between months – sometimes years -The manic episodes are usually much shorter than the depressed episodes (the manic episodes usually occur suddenly) – they include racing thoughts, euphoric mood, and insomnia -Emotional domain: it sounds attractive when we say that people suffering from mania have an elevated happiness (this is abnormal – it is not normal to feel overly happy all the time) – their mood is elevated and expensive – an abnormally happy mood can be refered to as grandiose (this word typically has a negative connotation associated with it) - There is a severe irritability that is associated with a manic state – commonly people can become so happy that they cry -Cognitive domain: flight of ideas - racing thoughts, high distractibility, delusional (delusional can look psychotic – the potential for misdiagnosis) -Motivational domain: frantic, overactive, hyperactive (in a number of different functions – religious, sexual, social, work), it often has an intrusive and demanding quality about it – its wreck less – wreck less gambling, drug use, driving, financial decisions etc. -Physical domain: a significantly decreased capacity for sleep (this can lead into the crash of depression) -Much less common than major depression – occurs in every 1 in 100 people (this may in part be due to misdiagnosis) -This affects both genders equally -There is usually a normally functioning period in between the two extremes (manic, normal, depression, normal, manic) -Identical twin concordance rate can be as high as 90% - strong genetic component behind this disorder – it is a genetic disorder (they have found the genes) – there is also however an environmental component -Anti depressants do not work as a viable treatment for people with bipolar disorder -Lithium is used to treat bipolar disorder – it is not a synthetic drug – it is a naturally occurring substance –it is an element all on its own – we are not entirely sure of the way it works – but it is particularly effective – its mechanism of action is not well understood -80% of people treated with lithium respond positively -The age of onset is usually in the 20’s and 30’s – depression is usually younger (teen years) -Cognitive therapies can be used for bipolar disorders but there is need of drug therapy beforehand -There are natural extreme mood swings in children so it is difficult to diagnose properly -People who suffer from bipolar disorder are typically on medication (lithium) for the rest of their lives -They are not always manic or depressed; they go through large periods of “normal” behavior in between -Average cycle time is 14 months (on lithium the average time between cycles is 9 years) -Minimum side effects to lithium 2 main types of bipolar disorders -Mania -Involves 1 or more manic episodes, and often 1 or more depressed episodes, in between of which there are normal functioning periods -Hypomania (cyclothymic disorder) -One major depression episode with a hypomania (hypo meaning less – less severe manic episode) -Bipolar light – less severe mania, less severe depression – episodes are shorter – less severe – and typically don’t occur with regularity -Treated differently Midterm is on weeks 1-6 MC and short answers LECTURE 6 Somatoform Disorders and Dissociative Disorders Look very similar to anxiety and depression – often co-morbidly diagnosed – anxiety and depression might very well be the cause of somatoform and dissociative disorders Somatoform Disorders *These disorders are NOT psychosomatic diseases Psychosomatic diseases: are genuine physical ailments caused in part by psychological factors (example: asthma attack) Somatoform disorders: when you believe you are physically sick, but we cannot find a somatic physical reason for it Symptoms suggest a physical disorder Symptoms cannot adequately be explained physiologically Difficult to properly diagnose (panic disorder – believing you are having a heart attack when in reality you are not – very much overlap in these disorders) Physical ailments that cannot be explained by organic factors – said to be due to psychological factors Other disorders, such as anxiety disorders, mood disorders, and personality disorders, often co-exist Somatization Disorder (Briquet’s Syndrome) -Many physical complaints -Often marked by a history of diverse physical complains -They appear to be psychological in origin -Complaints are neurological, gastrointestinal and sexual -Much more common in women (most research shows a factor of 2 to 1) -Used to be called hysteria (literal translation from Latin as “disease of the uterus”) -This disorder will begin before the age of 30 -Must include 4 different pains – 1 sexual symptom, 2 gastrointestinal and 1 pseudo neurological system) -Must feel pain in a least 4 different areas -Symptoms are unfounded or/and exaggerated -This disorder is not uncommon (2-5% of the population) Conversion Disorder -Significant loss of physical functioning with no apparent organic function -Usually in a single organ system (loss of hearing, consciousness, sight) -Physical symptoms suggesting neurological problems -Sensory impairment: any modality -Sudden onset, sudden termination, sudden reappearance -Mostly women; men in combat -Often misdiagnosed: over-pathologized -Symptoms look physiological Pain Disorder -Main symptom is pain -Pain is considered an experience; the only way to measure it is through self-report -Most efficient way (on a scale of one to ten how much pain are you feeling?) – extremely subjective measure -Psychological in origin -The cause of the pain people feel could be due to stress (all the more reason to believe that this disorders origins may linked to anxiety) Hypochondriasis -People do not report physical symptoms -They worry about getting an illness -Excessive preoccupation with ones health and becoming ill -Preoccupied with the possibility that normal sensations are symptoms of a serious disease -People who experience this disease will often have frequent visits to physicians -Difficult to treat and is a life long disorder -Persists despite medical reassurance Body Dysmorphic Disorder -Excessive concern with real or imagined defects in appearance, especially facial marks or features -Frequent visits to plastic surgeons -Often see this as culturally-influenced, but not culture-bound -Picking up on facial features that they see as abnormal but other people would not detect -Justin (from the movie) fits the symptomatology of this disorder -Most plastic surgeons should ethically not perform these procedures (when they are clearly suffering from this type of disorder) -May be a symptom of more pervasive disorders: obsessive-compulsive or delusional disorder, for example (again, could lead to misdiagnoses) -Could also be related to an eating disorder – could again lead to misdiagnosis (however, a key symptom and component to this disorder is plastic surgery and you do not see that in eating disorders) -They think they look normal More somatoform-like disorders -Malingering: when you fake that you are sick (motivation is usually an external award) -Factitious disorder: people will hurt themselves to get attention - psychological in origin –Used to be refered to as Munchausen (still refered to as this when it is an extreme case) –Will apply electricity to give themselves a heart attack, will swallow chemicals, etc. They will report symptoms that are very serious and/or hurt themselves. -Usually one or the other: -Personal: reporting or causing harm to them selves -By proxy: to somebody else (most common is mother with their children) -This is intentional *Read about the other 2 Undifferentiated Somatoform Disorder* Somatoform Disorder NOS* Etiology of somatoform disorders – Psychoanalytic theory/Behavior theory* (LECTURE SLIDES 9+10) Dissociative Disorders A class of disorders in which people loose contact with a portion of their consciousness (sometimes memory), which results in disruptions of their sense of identity Dissociative Amnesia -Sudden loss of memory for important personal information -The most important piece of information you can lose: who you are (name, kids, where you live, where you’re from, etc.) -Can usually be caused by a trauma -Retrograde (loss of memory for past events) Dissociative Fugue -Loss of memory or identity and removal from familiar environments (very rare) -For example: wind up in say Seattle with no ID, a strange accent, and no idea of who they are or how they got there -Can usually be traced back to a trauma Dissociative Identity Disorder (Multiple Personality Disorder) -One of the most contentious disorders -Used to be so rare it could only be studied through case studies -It has become fairly common now – what happened? -Two or more distinct identities that control behavior -The coexistence in one person of two or more largely complete and usually quite different personalities -They don’t usually manifest at the same time however (they don’t speak to each other) -They are usually aware that they have this psychopathology -Typical alter personalities take 3 forms: child, protector, and persecutor -Thought to be caused by trauma (usually stemming from childhood – usually some type of abuse - more than 80% severely abused in childhood) -About 90% female -Treatment for this is not chemical – usually a cognitive therapy that seeks to integrate personalities into a whole MOVIE: Neurotic, stress-related and somatoform disorders LECTURE 7 – MIDTERM EXAM LECTURE 8: Psychophysiological Disorders Psychophysiological disorders: the physical illnesses can be caused by the mental illnesses. They symptoms seem to be physical disorders but they are not. * Psychosomatic: a specific type of psychophysiological disorders.  Researches show that the most critical/major environmental component of psychophysiological disorders: Stress  Biological component: Genetic  The most common strategy people use for (minor) environmental component: they ignore/avoid the stresses Health Psychology: the significant sub-(clinical) discipline of the psychology that deals with the pathologies, which concerns with how psychological and social variables affect health and illness.  It develops programs to reduce the levels of risk factors related to diseases. * Neuroscience: Another critical sub-discipline for dealing clinical psychology. Stress: the concept of how individual reacts to stress was first developed by Hans Selye. * We are interested in measuring the changes of behaviors: Variability  He’s interested in looking wide range of the variables and changes.  Things change all the time, and which make us to adapt to them  Changes cause stress, because we have to strive for the equilibrium with our environment.  Can we avoid stresses? No, since the environment is constantly changing. Stressors: the environmental events that cause an organism to adjust and display this non-specific stress response.  Fight-or-fly: the physiological reactions which cue (it’s adaptive), when the stress is removed, the physiological reactions fade  Anxiety: when the stressors go away, one still continues to have the same response  What we are focusing on now is: the cases that stressors don’t go away with high frequency, intensity, and duration  We often think stressors are negative events, but it’s not all the cases, such as marriages and pregnancies.  We quantify the events that will cause life changes and stresses General Adaptation Syndrome (GAS): 1 stage: Alarm(flight-or-flight): nd One doesn’t want to avoid but confront it. 2 : as the time goes on, the resistance increases. The physiological overdrive that decreases overtime and enters to the 3 stage: exhaustion; at this stage, the stress response has lost its adaptive quality and actually contributes to pathological changes that result in disease.  Hermon (epinephrine) that kicks in and stimulates the body to adapt the environments  Overstimulation of the system leads to disease  Stress also can be cumulative (refer to minor stressors, daily hassles)  Minor stressors causes Hassles cumulatively, which can lead to a significant stress (deviated frequency)  They usually cumulate the events in a short time like a week The way you assess a stress is a significant component as the personality  Primary Appraisal: the determination we made for the event or situation whether it is stressful or not.  Secondary Appraisal: designs of how to deal with the stresses Distress: the effect of unpleasant and undesirable stressors that is because we don’t have enough resources to deal with it. Bacteria& Immune System  We develop anti-biotic (Secretory gIa)  Immune system of the body identifi
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