Development & Mental Health 2: Psychopathology From A Life-span Perspective (SOWPSB2DH10EA)
Institution
Radboud Universiteit Nijmegen (RU)
Book
Abnormal Psychology
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Summary Development & Mental Health 2: Psychopathology (SOW-PSB2DH10EA)
Chapter 12 - Psychological Disorders
Ch 2 Abnormal Psychology
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Radboud Universiteit Nijmegen (RU)
Psychologie
Development & Mental Health 2: Psychopathology From A Life-span Perspective (SOWPSB2DH10EA)
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College 1 (H1 & H3)
Equifinaliteit
dezelfde uitkomst kan door verschillende dingen veroorzaakt worden
Multifinaliteit
één oorzaak kan veel verschillende uitkomsten hebben
How does the DSM define disorders?
1. Dysfunction mental disorder = syndrome characterized by clinically significant disturbance in
individual’s cognition, emotion regulation or behavior that reflects dysfunction in
psychological, biological or developmental processes underlying mental functioning
(thoughts / feelings / behaviors)
- does behavior impair individual’s ability to function in life?
- some individuals with diagnosis live functional lives (e.g. specific phobias)
- some don’t function, but have no diagnosis
2. Distress in social, occupational or other important activities
- behavior or feelings may be abnormal if it creates great distress (e.g. people
with depression experience considerable distress)
- not all distressed individuals are mentally ill
- some mentally ill individuals don’t show distress (e.g. psychopaths)
3. Deviance different from the norm, uncommon, rare
- but: socially deviant behavior (e.g. political, religious or sexual) and conflicts
between individual and society are not mental disorders
- abnormal behavior often violates social norms of given culture
- violation of norms explicitly makes abnormality a relative concept
4. Danger individual may be of danger to oneself or others
Why do we diagnose or classify?
1. Accurate description
2. Prediction
3. Intervention
Classification of mental disorders: pros and cons
CONS
- typologies can ‘hide’ basic dimensions
- confusing description and ‘explanation’
- reifying diagnosis: seeing diagnosis as an existing entity, rather than a product of set of judgements
and conventions
- losing information due to ‘labels’ (bijv. comorbidity)
- stigmatizing due to labeling
PROS
- communication (standardized)
- organization and reduction of information
- efficient trans of information
- basis for the accumulation of knowledge (treatment, research)
- instruction for clinical diagnostics and theory
- explicit classification is better than implicit classification
,NIMH Strategical Plan: RDoC
“Develop, for research purposes, new ways of classifying mental disorders based on dimensions of observable
behavior and neurobiological measures.” → tasks include:
1. initiate process for bringing together experts in clinical and basic sciences to identify fundamental
behavioral components that may span multiple disorders and are more amenable to neuroscience
approaches
2. determine full range of variation, from normal to abnormal, among fundamental components to improve
understanding of what is typical vs. pathological
3. develop reliable and valid measures of these fundamental components of mental disorders for use in
basic studies and in more clinical settings
4. integrate fundamental genetic, neurobiological, behavioral, environmental and experiential components
that comprise these mental disorders
RDoC: Conclusions
- ‘translational’ approach: disorders in terms of disruption of basic mechanisms
- framework: studying mechanism cutting across borders from traditional disorders
→ development of personalized healthcare in psychiatry
DSM-5 provides 3 axes on which clinicians can assess individuals:
1. Axis I: major clinical syndromes and any medical conditions individuals have are noted
2. Axis II: psychosocial and environmental stressors are noted
3. Axis III: individual’s general levels of functioning are assessed
Clinical interviews
can be structured as well as unstructured
- unstructured interview: clinician asks mostly open questions
- structured interview: clinician asks prepared questions, often based on published interview
- can contain mental status exam = assesses person’s general functioning
- appearance and behavior
- thought processes
- mood and affect
- intellectual functioning
- orientation
Personality inventories
questionnaires that assess people’s typical ways of thinking, feeling and behaving
- used to obtain info about well-being, self-concept, attitudes and beliefs
Behavioral observation
method for assessing frequency of client’s behaviour and specific situations in which they occur
Self-monitoring
method of assessment in which client records number of times per day that they engage in specific behavior
and conditions surrounding behavior
Neuropsychological tests
tests of cognitive, sensory and / or motor skills that attempt to differentiate people with deficits in these areas
from normal subjects
CT scan can construct image of the brain, PET scan can provide picture of brainacitivty. MRI measures both
brain structure and brain functioning
Psychophysiological tests
tests in which instruments are attached to the periphery of body to record changes due to activity in NS
,Projective test
presentation of ambiguous stimulus to client, who projects unconscious motive and issues onto stimulus in
their interpretation of its content (e.g. Rorschach test)
- low reliability & validity
The goal of the interview? Inform treatment:
- therapeutic decision must be based on knowledge of disorder and change
- steps in therapy should have a plan and goal
- professional psychotherapy is critical: evaluation of own procedure
- therapeutic decision must be scientifically justified
Standardized assessment
Validity ability of an instrument to measure what it is supposed to measure
face validity when items seem to measure what the test is intended to
content validity when a test assesses all important aspects of a phenomenon
concurrent validity when a test gives similar results as compared to an established test of the
same phenomenon
predictive validity when a test predicts well future thoughts, feelings and behaviors
construct validity when a test measures psychological construct it is supposed to measure
(and not something else)
Reliability consistency in measuring what it is supposed to measure
test-retest reliability consistency over time
internal reliability when splitting a test in 2, each half gives similar results
inter-rater reliability when a test administered by 2 different people gives similar results
alternate form reliability when people’s answers to different forms of a test are similar
Samengevat: Diagnosis
- more than an interview: interview (classification) → hypothesis
- background information (history, stressors, context)
- assessment with standardized tools (e.g. questionnaires)
- behavior analyses + observations
→ therapeutic plan
College 2 (H2 & H4)
Cultural relativism
view that norms among cultures set standard for what is normal behavior
- implies that abnormal behavior can only be defined relative to these norms and that no universal
definition of abnormality is therefore possible
- only definitions of abnormality relative to a specific culture are possible
Multidimensional models of abnormal behavior
Psychological approach
- behavioral, cognitive, psychodynamic, family system, third-wave, humanistic
Biological approach
,Sociocultural approach
Development of mental disorders as a process of change and development
- dispositional factors (vulnerabilities) → birth & first few years experiences
- not biological
- provoking factors (usually stressors)
- how a stressor is perceived is crucial
- maintaining factors
Biological theories: imbalance in neurotransmitters or functioning of receptors → psychopathology
Genetic theories: accumulation of faulty genes → psychopathology
Interpersonal theories: focus on current relationships and concerns
Humanistic theories: all humans strive to fulfill their potential for good and to self-actualize
Psychodynamic theories of psychopathology
- focus on unconscious conflicts that cause anxiety
- Freud: conflicts arise when impulses of id clash with constrained by ego and superego
- use of various types of defense mechanism to handle internal conflict
Four rules of behavior of genetics
1. all human behavioral traits are heritable → they are affected to some degree by genetic variation
2. effect of being raised in the same family is smaller than the effect of genes
3. substantial portion of variation in complex human behavioral traits is not accounted for by effects of
genes or families
4. typical human behavioral trait is associated with many genetic variants, each accounts for a very small
% of the behavioral variability
Psychosocial influences on brain structure and function
- neurological activity may change as result of psychotherapy → suggests psychosocial influences affect
brain function
- placebo's may also change brain function
- stress and early development
Types of Neurotransmitters
Serotonine - travels through many key areas of the brain, affecting function of those areas
- implicated in depression, anxiety, aggressive impulses
Dopamine - found in areas of brain associated with experience of reinforcements or rewards
- affected by substances (e.g. alcohol) and behaviors (e.g. sex) that are
pleasurable
Norepinephrine - produced by neurons in brain stem
- cocaine and amphetamine prolong action of norepinephrine by slowing its
reuptake process
GABA - inhibits action of other neurotransmitters
- tranquilizing effect of some drugs is because they increase inhibitory activity of
GABA
Hormones
- Cortisol: stress hormone or stress regulation hormone?
- Testosterone: reason for aggression? Or medication for social anxiety?
- Oxytocin: social or asocial?
, The cause of mental disorders can (partly) be found in social environment of the person:
- deprivation in the early development
- trauma
- marital problems / divorce
- parenting styles (overprotecting and neglecting are both bad)
- mental disorders of parents
Culture affects mental illness
- prevalence rates for major depression varies from 2 to 19% across countries
- culture related to how people cope → Asian American groups place a higher emphasis on suppression
of affect
Gender
- gender effects and roles
- related to cultural imperatives
- influences via multiple dimensions
- types and prevalence of anxieties
- anxiety behavior
- responses
- coping strategies
Learning theories
Mechanisms of learning:
- classical conditioning → little Albert
- operant conditioning → Mowrer and Miller
- observational learning (or social) → preparedness, Mineka
Components of effective therapy
- good therapist-client relationship
- explanation for symptoms
- confrontation and expression of negative emotions
College 3 (H14)
Substance use disorder
disorders characterized by inability to use substance in moderation and / or intentional use of substance to
change one’s thoughts, feelings and / or behavior
- leading to impairment in work, academic, personal or social endeavors
- substance = naturally occurring or synthetically produced product that alters perceptions, thoughts,
emotions and behaviors when ingested, smoked or injected
Four conditions important in defining an individual's use of substances:
1. Substance intoxication = experience of significantly maladaptive behavioral and psychological
symptoms due to effect of substance on CNS that develops during or shortly after substance use
2. Substance withdrawal = experience of clinically significant distress in social, occupational or other
areas of functioning due to cessation or reduction of substance use
3. Substance abuse = diagnosis given when a person's recurrent substance use leads to significant
harmful consequences, as manifested by …
- failure to fulfill obligations at work, school or home
- use of substance in physically hazardous situations
- legal problems and continued use despite social and legal problems
4. Substance dependence = diagnosis given when a person’s substance use leads to physiological
dependence or significant impairment or distress, as manifested by …
- inability to use substance in moderation
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