Psy 103 Fair Game Midterm

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University of California - Santa Barbara
PSY 103

History and Basic Concepts-  Ways of defining psychopathology (e.g., ―four D’s‖)-   Psychopathology: applied to describe the many problems that seem closely tied to the human brain or mind.  1. Deviance: different, extreme, unusual, bizarre o behaviors, thoughts and emotions= abnormal when they differ markedly from a society’s ideas about proper functioning o judgments of abnormality depend on specific circumstances as well as cultural norms  ex: excessive hopelessness and unhappiness of a patient is considered abnormal but after hurricane Katrina, seen as normal reaction.  2. Distress: unpleasant and upsetting to patient o behaviors, ideas, or emotions must be distressful to be abonormal o some who function abnormally maintain a positve frame of mind  3. Dysfunction: interfering with the person’s ability to conduct daily activities in a constructive way o dysfunction alone does not necessarily indicate psychological abnormality o culture plays role in defining abnormality  4. Danger: behavior is consistently careless, hostile or confused o placing themselves and those around at risk o exception not the rule  Mesmerism-   Franz Mesmer- Austrian Physician o Opened a clinic in Paris in which his patients suffered hysterical disorders o French dilatants o Forces of magnetism and inducing a trancelike state that seemed to make symptoms ease or disappear o Rich Parisian women would swoon over the magnetism o “Mesmerized” aka “hypnotized”  Trephination-   Ancient operation in which a stone instrument cut a circular section in the skull to perhaps treat abnormal behavior  Thought was that people had evil spirits in head and had a hole cut into skull to release the spirits (had neuropsychological diseases)  Earliest believed form of neurosurgery  No evidence that trephining works, more like placebo effect  Most effective treatment for extreme depression is actually convulsive shock therapy o Not the barbaric ways of the past  Humoral Theory-   Created by Hippocrates  Believed that fluid controlled actions and beliefs and that illnesses had natural causes o Abnormal behavior= disease coming from internal physical problems  Melancholic- black bile o Deep, dark depression, morose, repetitive dwelling  Choleric- yellow bile o Hair trigger temper o Easily pissed off, irritable  Phlegmatic- excess of phlegm o Stoic, almost comical, things roll of back,  Sanguine- blood o Extth Cheerful person, upbeat, can be manic  Asylums- 16 century   Institutions whose primary purpose was to care for the mentally ill.  Overflow of patients  the inability to give quality care to all patients o Turned into virtual prisons o Filthy, cruel, inhumane living conditions and treatments  Many became popular tourist attractions to see the mentally ill as entertainment  Nature of ―lunacy‖-   Belief that the moon has magical, mystical powers that could affect many aspects of life including behavior, pregnancy  “Transylvania Effect”: power of moon to effect behavior.  “lunacy”: behaviors that capture lunar or moonlike qualities  Water-Bodily Fluid Theory  Hysteria-   Hysterical ailments: mysterious bodily ailments with no apparent physical basis o Determined to be largely psychological in origin  Phrenology-   pseudoscience primarily focused on measurements of the human skull, based on the concept that the brain is the organ of the mind, and that certain brain areas have localized, specific functions or modules.  Joseph Franz Gall- German physician  Popular in 19 thcentury  Origins for modern day “little man”  Demonological view-   1 appeared in early societies. Religious in nature o exorcism: idea and performance of coaxing evil spirits to leave or make the person’s body an uncomfortable place to live in  earliest form of treatment for demonological views of abnormality  reappears in 500- 1500 AD “The Middle Ages” o Why?-  due to increase of Church power and clergy influence. Heavy religious beliefs  Europe hit with famines, plagues  couldn’t explain natural phenomenon’s, turned to demonological theories to explain o Impact-  Abnormal behavior greatly increases  Mass madness, delusions, tarantism, lycanthropy o Treatment-  Revival of exorcisms  treatments extremely bizarre  ―baking out”- head in oven, go in as rambling, come out quiet and submissive. Therefore, treatment “worked”  demonological views eventually lead to Witch Hunt Age o Catholic Church leads the efforts o Women accused of being witches  Either exorcised, burned or drowned  Moral treatment-   The term for efforts of Philippe Pinel (Chief Physician of La Bicêtre Asylum) and William Tuke (founder of York Retreat in Northern England) o Argued that the patients should be treated with sympathy and kindness rather than chains and beatings to cure diseases. o Both allowed patients to move freely about, have sunny ventilated rooms, combined support, advice, rest talk and prayer.  Emphasized moral guidance and humane and respectful techniques  Spread to US by- o Benjamin Rush: physician at Penn Hospital. Aka father of American psychiatry o Dorothea Dix: made humane care a public and political concern in US  Campaigned for asylum reform  Led to new laws and greater gov funding for treatment.  Each state had to have an effective public mental hospital  Decline of Moral theatment: o End of 19 century o Factors:  Speed of movement spread  money/ staffing shortages, declining recovery rate, overcrowding  Not all patients could be cured by moral treatment  Emergence of prejudice against mentally ill  Somatogenic view of mental illness-   Abnormal psychological functioning has physical causes  Important Figures: o Emil Kraepelin- argued that physical factors are responsible for mental dysfunction  1 modern system for classifying abnormal behavior o Richard von Krafft-Ebing- theorized that syphilis caused general paresis  Injected syphilis into patients suffering from general paresis. No patients developed syphilis.  Psychogenic view of mental illness –   View that chief causes of abnormal functioning are psychological  Gained a following after studies of hypnotism  Deinstitutionalization-   Releasing of hundreds of thousands of patients from public mental hospitals  Rationale- development and distribution of psychotropic medications lead to many signs of improvement in patients o Pressured by public outcry about hospital conditions o Released patients immediately  Outcome- o Supposed to set up community mental health centers o Funding never saw these places o Most released patients make up homeless population o Closing of many state hospitals (Hotel California aka Camarillo State Hospital)  Multicultural psychology-  Studies the impact of culture, race, ethnicity gender and similar factors on our behaviors and thoughts.  focuses on how such factors may influence the origin, nature and treatment of abnormal behavior.  Types of professions in mental health-   Psychiatrists (M.D.’s): o Go to med school o Treat patients with medical means o “bottom” of medical hierarchy o barely above witch doctors o “internests of the mind”- became psychopharmacologist  nowadays, prescribe meds to patients  Clinical Psychologists (Ph.D.’s): o 5-6 year programs, o psychological research involving mental disorders, methods for diagnosis, therapy on a years internship, clinical training  Social Workers (M.S.W.’s / D.S.W.’s): o Applied mental health workers o Front lines in medical realm o 2 year MSW program o case managers in health management system o go out in field, hook clients up with entitlements (food, clean housing, water, therapy)  Psychiatric Nurses (R.N.’s): o Found in mental hospitals or outpatient mental places o May see patients who need periodic visits  Marriage & Family Therapists (M.F.T.’s): o 1-2 yr training program o specialize in adjustment disorders (jobs, motherhood, role problems)  Psych Technicians: o Escort patients around mental institutions o Replaced somewhat by nurses aids in mental facilities  MH Intake Workers, Staff: o Insurance, billing, assesments, intake  Primary Care Practitioner M.D.’s (PCP’s), Physician’s Assistants (P.A.’s), and Nurse Practitioners (N.P.’s): o PCP- everyday doctor, most likely will prescibe medicine for depression o PA/NP- fastest growing paramedical professions in US  Work for less money, trained more, MD’s are declining in numbers  PA’s- work under MD. Develop own patient-case load  NP- are RN who specialize beyond the RN and become individual NP. Prescribe MD, own patients, practice as psychiatrists do.  Managed care-   System of health care coverage in which the insurance company largely controls the nature, scope, and cost of medical or psych services  Typically disliked by both patients and therapists o Shortened therapy, unfairly favor treatments whose results are not always lasting, pose a special hardship for severe mental disorder patients.  Reimbursements for mental disorders= lower than those for med disorders Research Methods in Psychopathology-  Advantages/disadvantages of:  (a) clinical case study (case history)- o detailed and interpreted description of a person’s life and psychological problems o describes person’s history, present circumstances, symptoms, why problems developed, may describe application and results of treatment. o advantages:  source of new ideas about behaviors  offers tentative support for a theory  challenge a theory’s assumptions  inspire new therapeutic techniques or describe unique applications of existing techniques  offer opportunities to study unusual problems that do not occur often enough to permit a large number of observations o disadvantages:  reported by biased observers (therapists)  rely upon subjective evidence  low internal validity (accuracy)  little basis for generalization  low external validity (accuracy)  (b) experimental methods-  o research procedure where a variable is manipulated and the effect of the manipulation is observed o consists of independent/ dependent variables, control/ experimental groups  (c) correlational methods-  o Research procedure used to determine how much events or characteristics correspond with each other o Variables described by +/-/ 0 correlation and magnitude o Advantages:  High external validity o Disadvantages:  Lack internal validity  Do not explain relationships between variables  Nature of correlation in clinical studies-   + correlation: o when variables in a correlation study change in the same way o have + direction  - correlation: o value of one variable decreases while the other value increases o have – direction  unrelated correlation: o no relationship between them  magnitude: o how closely the two variable correspond (strength) o high or low  correlation coefficient: o symbolized by r o sign of coefficient shows direction o number represents magnitude  Correlational studies-  epidemiological (cross-sectional)-  o reveal the incidence and prevalence of a disorder in a particular population  incidence: # of new cases that emerge in period of time  prevalence: total # of cases in the population during a period of time o goal: describe the incidence or prevalence of a disorder w/o trying to predict or explain when and why it occurs o info is collected over long term  longitudinal (developmental)-  o study that observes the same participants on many occasions over a long period of time o correlations provide clues about which events are more likely to be causes and which are to be consequences  Experimental studies-   Experimental groups- o the participants who are exposed to the independent variable  Control groups- o Group of participants who aren’t exposed to the independent variable  Blind designs- o An experiment in which participants do not know whether they are in the experimental or the control condition o Double blind design:  Neither the participant nor the experimenter know whether the participant has the experimental treatment or placebo o Placebo therapy:  Sham treatment that a patient in an experiment believes to be genuine  Experimenter bias- o Experimenters have expectations that they are unintentionally transmitting to the participants in their studies o Rosenthal Effect  Alternative Experimental Designs-  Natural-  o an experiment where nature, rather than an experimenter, manipulates an independent variable o participants are selected by an accident of fate rather than conscious design o can’t be repeated at will, broad conclusions from single events must be concluded which can be incorrect o identified patterns of reactions that occur in such situations  Analogue- o Experimenter produces abnormal-like behavior in laboratory participants and then conducts experiments on the participants o Manipulate independent variables relatively freely  single-subject experiments-  o a single participant is observed and measured both before and after the manipulation of an independent variable o rely on baseline data (info collected prior) o ABAB Design- reversal design  Reactions are measured and compared not only during a baseline period (condition A) and after the introduction of independent variable (condition B), but after independent variable has been removed (condition A) and yet again after it has been reintroduced (condition B)  Participant= compared to themselves under diff conditions o Multiple- Baseline Design-  Experimenter picks 2+ behaviors (dependent variables) displayed by participant and observes effect that manipulation of an independent variable has on each behavior. Assessment and Diagnosis-  Semantic vs. prototype conceptions of diagnosis-  Semantic- o The study concerned with the relations between signs and their referents; between the signs of a system; and human behavioral reaction to signs,  including unconscious attitudes, influences of social institutions, and epistemologic and linguistic assumptions.  Prototype-  o Making typical identifications based on characterizations o However, not all subjects in that category have all those characteristics  EX: a dog= fur, tail, 4 legs, bark, loyal. But some dogs don’t have these traits  Phenotypic vs. genotypic diagnosis.  Phenotypic-  o Signs: observable traits o Symptoms: what patient feels o Course: how long symptoms and signs persist o Outcome: results of disorder o Response to treatment: how successful was recovery using prescribed treatment  Genotypic-  o Cause: genes and germs o Laboratory tests  In physical medicine, progress= phenotypic  genotypic diagnosis  Advantages and disadvantages of psychodiagnosis-  Advantages- o Prognosis:  good prognosis or poor o Treatment:  different medications, predict better responses, different counseling approaches o Communication among profession:  shorthand communication, gives medical/ psychological jargon, understand condition o prospects for contagion or other transmission, and possible prevention: o Legal reasons (e.g., competence, insanity determinations):  judge wants to know if accused or juror or persons involved in the case are mentally stable o Financial reasons (compensation to patient and/or treatment provider):  worker’s comp, insurance companies have big interest o Research:  can work towards a cure  Disadvantages- o Sacrifices the uniqueness of individual patient:  people get fed into the system, life stories/ special factors are lost, fit into categories  Ex: Bipolar I, 23 yr old male. o Can falsely imply etiology (cause):  went looking for causes that psychologists believed were true. If wasn’t there, must be repressed. o Rigidifies treatment alternatives:  “cookbook treatment styles” o Iatrogenic illness: “healer” “beginnings”  The healer causes the patient to become ill  Therapy backfires (psychologists), medicine backfires (psychiatrists)  Fail to understand cultural differences and advice gives rise to new problems o Stigmatization:  People don’t want others to know they are getting help o Secondary gain:  Benefits patients get from diagnosis  Disability is more profitable than working  Kinds of information that go into a psychodiagnosis.-   Signs:  Symptoms:  Course of illness:  Age of Onset:  Family History  Recent events/ behavior:  Psychological tests  Laboratory tests (eg neuroimagins, hormonal assays, genetic testing)  Response to treatment (current or prior):  Clinical interview: kinds of information solicited or observed-   ~1 hr; most valuable single source of info leading to a diagnosis  personal and family history: medical, mental health, social, occupational, financial problems  treatments that have worked/ not worked in past  symptomatology: o what brings you here today? What have you been feeling?  signs from patient’s presentation: o attire & grooming, o posture, o physical characteristics (skin tone, weight, stature, symmetry, bodily anomalies), o mannerisms, spasms/tics, o speech (articulation, prosody), o consciousness (level of alertness, fogginess, hypervigilance), emotional state, o general attitude (defiant, compliant, guarded, defensive, sincere, plaintive, resistant, apathetic) o thought content (solicited by free inquiry) o thought processes (thought broadcasting, removal, insertion) o general knowledge (facts, pop culture)  Ex: what is your opinion of _____? o abstract thinking:  ex: is your life how you imagined it would be when you were 10? o social judgment: o insight o cognitive functioning  goals: o suitability and readiness for psychotherapy (self or another therapist) o determined need for referral to:  psychiatrist or PCP for medication  neurologist for neurological testing and/ or neuroimaging  social worker, vocational counselor, physical therapist  Basic diagnostic concepts:   Nosology- o Process of categorization and classification of disease o Scheme of possible labels  Ex: if lung nosologist, study all the causes and diseases o Neural Nosology: List of mental disorders that people are diagnosed with  Diagnosis- o assigning a nosological category to a patient o Collection of all the possible labels from nosology  Etiology- o cause  All the risk factors added together  Course- o trajectory  some have a smooth course: chronic o Others: acute flair ups, chronic deteriorating, acute course then never again  Prognosis- o outcome  Endpoint of disorder  Normally good or poor prognosis  EX: alzheimers type dementia= poor prognosis  Signs- o observable markers patients give off  Symptoms- o patient reports  Syndrome- o Signs + symptoms  Disease- o Syndrome + course  Incidence/Prevalence of illness- o Incidence-  measure of the risk of developing some new condition within a specified period of time. o Prevalence-  proportion of a population found to have a condition  Co-morbidity- o the presence of 1+ disorder or diseases in addition to the primary one  Cognitive tasks commonly used in the clinical interview and Mini-Mental Status Exam (MMSE)-  Clinical Interview- o Projection Tests-   Patient must interpret vague stimuli  Ex:  Rorschach Inkblots: interpret an inkblot on paper  Thematic Apperception Test: 30 B & W pictures and asked to make up dramatic story about each  sentence-completion tasks- complete unfinished sentences  drawings- draw a human figure and discuss o Personality Inventories-   Ask wide range of questions about their behavior, beliefs and feelings  Ex:  Minnesota Multiphasic Personality Inventory (MMPI): asks 500+ self-statements, made of 10 clinical scales, earn score from 0-120 o Response inventories-   Focus on specific areas of functioning in personal questions o Psychophysiological tests-   Measure physiological responses of possible indicators of psychological problems  Ex:  Polygraph o Neurological and neuropsychological tests-   Measure brain structure and activity directly  Ex:  EEG, CAT, PET, MRI o Intelligence tests-   Series of tasks requiring peole to use various verbal and nonverbal skills  Ex:  Wechsler Adult Intelligence Scale, Stanford- Binet Intelligence Scale  MMSE-  o Orientation: (up to 3x)  Time, place, person o Registration:  Names of 3 common objects, ask patients to repeat them o Attention & calculation:  Serial 7’s or WORLD backwards o Recall:  Ask for the names of 3 common objects o Language:  Write a sentence  Copy a design  Nature of projective vs. structured inventories-  Projective inventories-  Overview of TAT and Rorschach administration, interpretation, and value-  TAT- Thematic Apperception Test  o Pictorial projective test o 30 B & W pictures of people in vague situations  patients must make up a dramatic story about each card  patients always identify with 1 character, the hero, and stories relect individuals own circumstances, needs, emotions. Etc  Rorschach-  o Ink blots are dropped on a paper, folded in half creating a symmetrical design o Patient describes “image” they see  Image= corresponds in important ways w/ their psychological condition  Thematic content= themes and images that the inkblots evoked o Rorschach Psychodynamic Inkblot Test  General makeup of MMPI-2 (not specific scales).-   567 self- statements, updated version  more valid indicator of personality and abnormal functioning o sampled people who more properly represent the diverse population of Western society  Psychophysiological tests & polygraphy-  Psychophysiological tests-  o Measure physiological responses as possible indicators of psychological problems  Physiological changes include:  Heart rate, body temperature, blood pressure, skin reactions and muscle contractions  Polygraph- lie detector  o Electrodes are attached to different part of subjects body  Detect changes in breathing, perspiration, heart rate when answering questions  when sharp increases occur, suspected of lying  drawbacks- o expensive equipment o high maintenance o can be inaccurate and unreliable  Major types of brain imaging-   CAT/ CT Scan- computerized axial tomography o The x-rays of the brain’s structure are taken at different angles then composed into a single image o 3D  PET- positron emission tomography o Shows the functioning of different areas in the brain o Administered harmless radioactive compound which travels to the brain  Performs a cognitive task  Higher radioactivity in brain areas= higher blood flow and neuron activity in those areas  Converted into motion picture showing activity  MRI- magnetic resonance imaging o Computer gathers info about magnetic properties of hydrogen atoms in the brain and produces very detailed picture of the brain’s structure o fMRI- functional MRI  produces detailed picture of functioning brain  MRI scanner detects rapid changes in blood across brain while patient is emotional or performing a task  Comp generates images of which brain areas were active during tests  Neuropsychological tests-  measure cognitive, perceptual and motor performances on certain tasks and interpret abnormal performances as an indicator on underlying brain problems  Bender Visual- Motor Gestalt Test: o 9 cards displaying simple designs o patients look at design, copy on paper then redraw designs from memory later. o Notable errors in accuracy may reflect organic brain impairment  IQ testing and use of IQ-   Series of tasks requiring people to use various verbal and nonverbal skills  Very high reliability and validity  Intelligence Quotient (IQ): general score from intelligence tests  Ex: o Wechsler Adult Intelligence Scale, Wechsler Intelligence Scale for Children  DSM-IV-TR—   History- o Most widely used classification system in US o Created in 2000 as updated version of DSM-IV  Made changes to DSM-IV categories and diagnostic criteria  Development and construction- o Requires evaluation of client’s condition on 5 separate axes  Axes-  Axis I: major mental disorders and V-codes  Axis II: personality disorders and mental retardation  Axis III: general medical conditions  Axis IV: psychosocial/ enviro problems  Axis V: global assessment of functioning  principles- o more reliable but still contains many errors tha result in lower validity and reliability  GAF Scale- o Rating a person’s psychological, social and occupational overall functioning on a 100 point scale o Part of axis V  Psychotherapy-   general effectiveness- o therapy= more helpful than no treatment or placebos  meta-analysis- o special statistical technique o Results: those who receive treatment were 75% better Depression-  Major Depression, and cultural specificity-  Cognitive-  o Pervasive sadness, guilt, or worthlessness  Guilt is main factor in European definition o Recurrent thoughts of death or suicide o Extremely negative self views  Motivational-  o Pervasive anhedonia  Nothing brings you pleasure or enjoyment o Less active/ productive, don’t want to do anything o Lack of drive, initiative and spontaneity  Neurovegetative-  o Significant change in weight  15-20 lbs average loss  Exceptions: carbohydrate cravers o Sleep disturbance  Go to bed at normal time but wake up at odd hours
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