DIAGNOSIS AND PSYCHOPATHOLOGY MIDTERM EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+

1 DIAGNOSIS AND PSYCHOPATHOLOGY MIDTERM EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+ Criteria to determine presence of psychopathology? Correct Answer: 1. Psychological dysfunction with cognitive processes and/or behavior and/or emotion 2. Distress and/or functional impairment in social and/or vocational and/or education and/or daily life 3. Culturally Unexpected When was the "birth date" of psychology? Correct Answer: 1886 Who was Wilhelm Wundt Correct Answer: German, First psychological lab, one of the first to identify the limits of short-term memory Who was thought of as the first Clinical Psychologist? 2 Correct Answer: Lightner Witmer Who developed the first widely used intelligence test Correct Answer: Binet and Simon What initiated the development of the first DSM? Correct Answer: Assessment was inconsistent. Agreement for diagnosis was at approximately 20%. When did Beck publish his study on diagnostic agreement? What did he find? Correct Answer: 1962 - After the first DSM was published, level of agreement increased to 32%-42%. When was psychology recognized for treatment with psychotherapy? Correct Answer: During and after WWII DSM III Correct Answer: established in 1980, heavy dose of empiricism in DSM concrete, discrete populations, use of field trials to check the check lists. DSM III-R Correct Answer: 1987, new symptom checklists, more etiology 3 DSM IV Correct Answer: 1994 What are some problems with the DSM-5? Correct Answer: 1. The shift from multiracial diagnosis (Axis I and Axis II), 2. Psychological disorder may be less categorical and more dimensional, people below the threshold are suffering maybe just as much as people above the threshold, 3.Generalizability-field trials done mainly in the USA which may or may not apply to various cultures, 4. Controversy with proposed diagnostic categories for the future 5. Rampant comorbidity- hard to do research on an individual diagnostic criteria-adds to unreliability, 6. symptom clusters seem to overlap 7. having a DSM in the first place creates a code for stigmatizing people Defining Features of Psychological Disorders Correct Answer: 1. discontrol-lack of self-control, inhibition (discontrol is a key element of substance use disorders, ADHD, personality disorders 2. impairment-- What is clinically significant in regards to impairment? ex: Autism disorder used to be diagnosed only if severe, non-verbal. What's viewed as significant has changed over the years. Note: unclear boundaries are often prevalent in diagnosis (ex: same treatment used to address depressive and anxiety disorders) Who initiated the categorical model, recognizing its gray area? Correct Answer: Kraeplin, he began insisting clear distinctions between normality and psychopathology. 4 Theories of dual diagnosis Correct Answer: Primary/Secondary Theory-Psychological disorder first, then substance use disorders (SUD). Substance use is attempt at self-medication, SUD related to neurocoginitive deficits related to disorders (ex: schizophrenia symptoms may put someone at a higher risk for SUD). OR SUD is primary and psychological condition is secondary (ex: SUD primary, MDD secondary). cycle of need would drive to MDDfeeling hopeless Bidirectional Causality Model- SU influences psych disorder at the same time psych disorder is influencing SU. cyclic in nature ex: anxiety disorders and dual diagnosis Common Factors Model- ASP disorder common factor to explain disorder and SUD, not a lot of good studies with conclusive factors. DSM-IV-TR Correct Answer: 2000 Strengths of categorical system Correct Answer: Simplicity Credibility What was the Epidemiological Catchment Area (ECA)? Correct Answer: Largest and most comprehensive study of mental disorders ever completed in the United States. The study collected data on the prevalence and incidence of mental disorders in the United States. 5 Characteristics of Dual Diagnosis? Correct Answer: Treatment compliance is terrible. Higher rates of homelessness, legal trouble, treatable illnesses. They consume the most health care dollars (despite the fact that they have trouble with treatment compliance). DSM 5 Correct Answer: 2013 What are some assumptions about the DSM? Correct Answer: 1. It identifies/classifies things that are readily distinguishable 2. the accurate diagnosis of disorder is actually important -Dx facilitates choice of a specific treatment that is effective for that disorder 3. substantiates a medical model for psychological disorders which leads to assumption that medical intervention should be prioritized. What is it that makes a discrete illness? Correct Answer: 1. There is a reliably observes set of symptomatic criteria 2. criteria can be observed by clinicians 3. Dx are predictable in terms of their course What is important to examine in addition to psychological dysfunction for identifying cases? 6 Correct Answer: life impairment, perceived distress, coping styles-adaptive, maladaptive, readiness for treatment--not ready, ready, ambivalent, social support-no, little, moderate, good What are the benefits of discrete, effective treatments? Correct Answer: 1. significantly better than no treatment or placebo 2. specific treatments rather than general treatments for all people with psych disorders What are the five advantages of using the SCID Correct Answer: 1. increases coverage of diagnoses covered 2. enhances ability to accurately determine whether any Dx is present 3. reduces variability b/t clinicians, therefore leads to increased reliability and diagnosis 4. increase validity 5. very good for trainees-takes guess work out of creating questions Snowballing Correct Answer: nature of worry that's practically unstoppable once it starts For example: Anxiety rolls over people with GAD. What is the "All evidence is equally good" fallacy? Correct Answer: don't treat anecdotal evidence and empirical evidence the same. What is the "ignorance of statistical logic fallacy?" Correct Answer: inferring personality trait from a single of limited sample of behavior. ex: person responding in anger to specific issue has anger management issues--one instance(or 2 or 3) of behavior is not a pattern 7 DSM I Correct Answer: 1952 DSM II Correct Answer: 1968 DSM-IV Correct Answer: 1994 The Barnum Effect Correct Answer: common behaviors/experiences are deemed important in diagnostic process. Ex: bereavement and depression. Also of the behaviors shown by those grieving a loss may now be deemed as depression. May be including more ppl in the depressed Dx than we need to. The sick-sick fallacy Correct Answer: know of someone that had a disorder and compare the individual to someone who behaves same way and say that they have that dx too. The "me too" fallacy or Uncle George's pancakes fallacy Correct Answer: people who are "like us" must not be abnormal and people who are not like us must be abnormal.Ex: pancakes everyday for breakfast is absolutely necessary for an individual or they will break down--which seems abnormal, but justify it 8 by saying "oh, no, my uncle george had pancakes everyday for breakfast and he was fine." The understanding makes it normal fallacy Correct Answer: logical explanation for why a person behaves that way--assuming there is a causal explanation Multiple Napoleons Fallacy Correct Answer: if patient believes is something that can't be true and acts on that belief. Ex: Client believes he is Napoleon so saying that how he behaves is normal and ok/explainable The soft-hearted, soft-headed fallacy Correct Answer: ignoring/mislabeling a Dx so result would be less severe for client, making things less severe for the client. This is a disservice to the client-underestimates problems the person has. Calling a Dx what it appears to be is important. Describe features of GAD Correct Answer: people with this Dx tend to have less instances of panic. They have chronic distress due to cognitive hypervigilance--the vigilance for potential and imagined negative outcomes to situations. Worry about multiple domains-Top 4: relationships(family), money, work, health. Snowballing effect common, speed with which thoughts happen. The worry process is a verbal process of worry-spinning a story in mind looking at potential negative outcomes, a string of words b/c they don't have ability to worry in images. Verbal processing is faster. Physiological arousal: constant, low-level chronic and constant worry, experience headaches-tension, gastrointestinal, sleep disturbances 9 Describe features of Panic Disorder Correct Answer: onset typically mid 20s, very rare to see someone experience PD after age 40, almost always occurs after puberty, Prevalence is 3-4% in US with lifetime prevalence rate -Panic itself becomes a target of fear Anxiety related to misfiring of fear, fear of panic attacks out of the blue, fear of unpredictability -Agoraphobia is often comorbid with PD. avoidance to the extreme-major impairment, social, academic, and vocational Physical symptoms: increase heart rate, sweating, feel dizzy, pressure on chest, shaking/trembling Those changes are detected by brain which over interprets as being an indication of a threat. Anxiety sensitivity- bodily focus/vigilance, related but may be separate constructs related to risk for PD What is nocturnal panic? Correct Answer: unconscious mind detecting different sleep cycles-different heart rates and blood pressures, brain interpreting normal physiological changes of sleep in extreme way-triggering panic Describe the evolutionary perspective of things that may cause us to feel anxiety. Correct Answer: Predators, other unknown animals, spoiled/poisoned food, dark, harm to self/family, loud, strange noises 10 What would heighten your fear of a predator? The dark, can't see Being in enclosed space bc escape is impossible High places being along-biggest predictor of death being rejected/cast out-greatest fear What are specific fears related to evolution? Correct Answer: fear of heights, dark, spiders, dogs, snakes, enclosed spaces, fear of thunder, fear of blood and injury Features of Social Anxiety Disorder Correct Answer: preprepared to fear rejection, ejection from the group, making a fool of themselves in front of others, irrational ways: natural interactions with people are viewed as catastrophically bad, 5-13% prevalence approximately equivalent in males and females. Age of onset about 15yrs old Features of PTSD Correct Answer: environment and etiology are very influential-requires a traumatic experience. Sense of imminent personal danger of self or someone else, being a witness to a traumatic event is enough to qualify for clinical level trauma. -Personal events-assaults, sexual assault, attempted murder, held at gunpoint,war, terrorist attack, chronic threat of medical or sociological situation, natural events- 11 wildfires, earthquakes, hurricanes, living as a refugee, living w/cancer/HIV, motor vehicle accidents, manmade events What are risk factors of PTSD? Correct Answer: not everyone's experience is the same. Increased intensity of personal threat, increase intensity of PTSD. Ex: victim of rape followed over time. Women within highest intensity level (raped, injured, and told they would be killed if they made noise) of personal threat is HIGH level of PTSD-about 1:2. Women who experienced rape but were not injured and had their life threatened ~30% rate of PTSD Women raped, not injured or threatened with death had a rate of PTSD below 20%. Still spectrum of risk due to physical threat of one's life. Proximity to catastrophe can be predictor of levels of PTSD. What are the cognitive risk factors of PTSD? Correct Answer: People differ in how they react/interpret experiences. Ex: helplessness v. optimism. Sense of personal control. Those who react in a way that includes personal ability to get through it tend to not be at the greatest risk; people who are helpless are at greatest risk fro developing PTSD. What are the physical features of PTSD? Correct Answer: trauma itself becomes a trigger for panic and high anxiety. Intrusive thoughts about trauma, flashbacks, even sleep isn't safe, dreams of being back in the traumatic event, heightened physical sensitivity, hyper vigilance, on edfe, startle response, disturbed sleep, highly irritable, general emotional numbing as a protective 12 mechanism.Experience or onset an be very delayed-months or even years before fullblown symptoms, which can lead to underidentificatiin. Clinicians should always ask about traumas experienced earlier in life. What do obsessions consist of? Correct Answer: intrusive thoughts, undesired thoughts-hard to dismiss, "sticky thoughts"- can't get rid of them, disturbing, some can be unusual, some can be context appropriate What do compulsions consist of? Correct Answer: something you need to do because of the concern, behaviors that tend to counter obsessions, they are time consuming and elaborate ex: hand washing 15-45 min following obsessions related to contamination. If compulsion is interrupted, have to start all over again. They are usually irrational ex: someone may have obsessions about harming someone else, but as a compulsion they may need to count objects to counter the anxiety. This is "magical thinking" that can occur. Compulsions have a neutralizing quality to deal with anxiety but are dysfunctional within themselves. What are the top 3 obsessions? Correct Answer: 1. contamination 2. aggressive impulses 3. need for symmetry What are the top 3 compulsions? Correct Answer: 1. washing 2. checking 3. counting Prevalence and onset of OCD 13 Correct Answer: Lifetime prevalence of about 2%, the earlier the presentation, typically the more severe the case. Age of onset in males-in early teens Age of onset in females-in 20s Boys and men tend to have somewhat more severe presentation than girls and women What is thought action fusion? Correct Answer: thinking something might happen transforms into the thought that it WILL happen. It goes from this may happen to this is going to happen to this is happening . Ex: a person believes they could accidentally harm someone-they aren't really harming the person, they just think they did. What does thought action fusion lead to? Correct Answer: leads to sense of responsibility or guilt about things the person hasn't done. Explain the relationship of anxiety and OCD Correct Answer: Anxiety is the cardinal symptom. the individual with OCD knows these obsessive thoughts are from their own mind without rational reason and are difficult to get rid of. This leads to chronic anxiety bc ppl with OCD can't know what they need to avoid bc what causes their anxiety is their OWN thoughts. What are the common risk factors for Anxiety, OCD and related disorders, and trauma/stress disorders? 14 Correct Answer: environmental risk factors: PTSD ultimate env. risk factor, traumatic experience with doc and develop a specific anxiety disorder, bad social experience and be predisposed for anxiety disorders and develop social anxiety disorder Social support: good network, feeling supported, and being connected are related to remission. A lack of social support increases symptoms Learning: learning experiences. ex: specific anxiety disorder-role model/parent displays phobic behaviors around a stimulus may develop into a specific disorder Biology-anxiety disorders tend to run in families, unusual for genetic risk to be for a specific sort of anxiety risk, but more of a general, overall risk. Ex: overactivity in arousal centers of brain, amygdala Temperament-Inhibited, shy, overly inhibited is increase risk for anxiety disorders and evaluation of others' judgment Biomarkers-present in the blood of ppl who develop PTSD vs. those who didn't develop PTSD What is the 5HTTLPR polymorphism? Correct Answer: it gates of enables acquisition of fear response What is the COMTVAL158met polymorphism? 15 Correct Answer: it gates the extinction of fear, someone without the met polymorphism may be at a higher risk for developing an anxiety disorder Summary of Resnick (1997) article- A brief history of practice Correct Answer: Psychology has its roots in philosophy--can be traced back to the times and ideas of Aristotle and Plato. Wilhelm Wundt- credited with being the founder of psychology as we know it. Lightner Witmer established the first psychological clinic at the University of Pennsylvania in 1896. In the beginning stages, psychology was used primarily for assessments, not psychotherapy. In fact, the first 50 years of psychology were primarily dealing with testing. There was an ongoing battle for psychologists to be able to practice independently, in hospitals, etc. The Virginia Blues lawsuits established psychology as a competent practice and independent providers of services in competition with psychiatry. By 1990, the practice of psychology was booming. It continues to expand and evolve throughout the years. There was a major sense of competition between the psychiatric field and the psychological field. 16 Summary of Greenberg (2013) article-The book of woe Correct Answer: -drapetomania: the disease causing Negros to run away. -40-50 years ago homosexuality was still listed in the DSM. Doctors could get paid to treat it, scientists could search for its causes and cures. It also leads to the victimization and shunning of clients -Problem: there was no definition of a mental disorder. Frances said "you can't define it" o Reflects what is worse about the DSM- the desire to control, to manipulate, and to turn others' vulnerabilities to our advantage Be cautious of taking the DSM to seriously Prejudices and fallacies are often blind to us o The desire to relieve suffering can pull a veil over our eyes Summary of Spiegel (2005)-The dictionary of disorder Correct Answer: Robert Spitzer: largely influential psychologist known for establishing the DSM as a scientific power. · DSM diagnosis is now required for reimbursement from insurance companies This was during the 1960s psychiatry was struggling due to lack of diagnosis reliability among clinicians o These issues were highly noticeable during world war two when rejection rates were greatly variable in individual territories o Ash (1949) found that three psychiatrists reached the same diagnostic conclusion only 20% of the time o Beck(1962) found that nine psychiatrists shared diagnostic conclusion 32-42% of the time 17 o Allen Frances stated that without reliability diagnosis is completely random and means almost nothing · 1966 Spitzer was named Chairman of the task force for the DSM III o He appointed several DOPs (data oriented people) to 25 committees to determine the detailed descriptions of mental disorders o He focused on the existence of studies and evidence when entering disorders into the DSM III, which had not been done in its predecessors He hoped to decrease interpretive variance by standardizing definitions of mental disordersThe DSM III was widely accepted and got lots of publicity · One thing that made the DSM III different from its earlier versions was the addition of a checklist to justify diagnosis · Reliability increased in psychiatry and psychology with the introduction of the DSM III · Spitzer admits reliability has improved but has a great amount of improving left to do · This version of the DSM saw controversy due to people thinking it was too authoritative, labeling normal behaviors as abnormal, and that it did not improve reliability as much as it has been said to. · Despite controversies surrounding it, the DSM III is seen a revolutionary instrument in the psychological field because it provided clinician Summary of Halter (2013) Historical Perspectives of DSM-5 Correct Answer: Classifying Mental Illness -Necessary for replication of research -Common language aids in understanding of global epidemiology -Supports interdisciplinary case collaboration 18 Kraepelinian Grouping of Mental Disorders 1883- German psychiatrist, Kraepelinian, argued that psychiatric care was as legitimate as medical care and should be examined systematically Exogenous (originating outside of person; treatable) and endogenous (originating inside person; organic; incurable) Catatonic, hebephrenic, paranoid International Classification of Diseases First International Statistical Classification of Diseases to include mental disorders was the 5th edition, which had a section that included mental deficiency, manic-depressive psychosis, etc. 6th edition greatly expanded section on mental disorders because the World Health Organization (WHO) formed and provided oversight for publication; however, it was virtually ignored by the medical community DSM-1 (1952) Disorders were viewed as "reactions" of personality, with Freudian bases for etiologies What distinguished DSM from prior nosology was that it was a document with pragmatic, clinical utility Included 106 disorders--Anxiety was considered a psychoneurotic disorders, and addiction was considered a personality disorder DSM-2 (1968; revised 1974) "Reactions" terminology was removed (so, for example, "schizophrenic reaction" changed to schizophrenia), but still retained gap between neurosis and psychosis 19 Diagnosis of homosexuality switched to ego-dystonic homosexuality in revision, due to research that indicated homosexuality might not be as related to psychopathology as once thought DSM-3 (1980; revised 1987) Significant move toward empiricism to remedy American distrust of psychiatric profession Influenced by study "Being Sane in Insane Places," where people pretended to hav Kihlstrom (2002)-To honor Kraepelin Correct Answer: There are three models of psychopathology, according to the author, that the history of psychology can be traced back to: 1. Supernatural model (pre- Enlightenment period; before the 18th century) - abnormalities = possession by demons...... response = exorcism. 2. Moral Model (late 18th, early 19th centuries) - abnormal behavior is purposeful much like criminal behavior.... response = confinement and other forms of punishment 3. Medical Model (19th century) - "psychopathology is the product of natural causes that can be identified by the techniques of empirical science" (p.281). response = "diagnosis according to a scientifically validated system and attempts at cure or rehabilitation by means of scientifically proven methods" (p. 281). Kraeplin preferred diagnosis based on pathological anatomy or etiology to diagnosis based on symptoms Neuropsychology is incorporated-Ex: damage to modules involved in attention or reasoning may be implicated in what we now know as schizophrenia, etc.. Present proposal: Test for differential psychological deficits, in the same way that clinical pathologists now test blood for the presence of antigens and antibodies or image 20 the body to detect legions in various tissues or organs. This testing may lead to the unity of symptoms of even replacing some diagnosis with a new nomenclature that is tied to underlying psychopathology Some diagnosis maybe be based on psychological testing rather than on observation of symptoms Ex: autism Laboratory roles: diagnostic tests, identify diseases, and evaluates the progress of treatment Future: Moving beyond symptoms and diagnosing mental illness in terms of underlying pathology Regier (2013) DSM-5 Field Trials Correct Answer: The focus of these field trials is reliability between clinicians via intraclass kappa, a statistical measure of agreement between 2 raters that would adjust for change agreement What are the top 3 mood disorders? Correct Answer: Bipolar, Major Depressive Disorder, and Dysthymic Disorder What features/behaviors characterize mania? Correct Answer: psychomotor agitation- excessive talking, racing thoughts, high distractibility, flights of ideas, illogical leaps and content changes, talking quickly/hard to understand; causes distress in others 21 people stuck in elation/ecstatic phase-make horrible choices financially, drug use, unprotected sex overconfident, overcommitment, endless energy without sleep or minimal sleep. starting but not finishing a lot of tasks. Can perform at a high level with minimal sleep Why is treatment hard for manic phase? Correct Answer: these individuals in this phase are feeling great and are not experiencing personal distress, but they are causing distress in others. When they are high, they don't want to take meds or do therapy. What are the features/behaviors that characterize MDD? Correct Answer: all day,everyday feeling down/miserable, anhedonia-lack of interest in things you used to find pleasure in. Slumped over, drooped posture, react slower, vegetative Sx: someone who doesn't move much, looks droopy, fatigued, low energy/motivation, sleep disturbances-sleeping more than usual or sleep substantially less. these people get less done during the day, concentration problems, suicidal thoughts begin to make sense as an escape from pain, appetite lessens or increases-- weight loss/gain due to change in metabolism from inactivity Why is bipolar disorder a better predictor of suicide than MDD? Correct Answer: most people with bipolar experience manic and depressive sides of the spectrum, the contrast is so clear that as they come down from the high to "normal" they are at the highest risk--they know that the price for being manic is about to be paid when they come back down to reality. They don't know when the next MDE will comestill able to plan and obtain means to commit suicide before getting to MDE bc they have energy and motivation to do so. 22 What are the features and characteristics of dysthymia? Correct Answer: "depression jr." intense in chronicity magnitude of negative affect no intact emotional anchor-no happy experiences, very rare rightfully thought of as a severe mood disorder very needy in terms of care What is the worst type of depression? What is the prognosis for treatment? Correct Answer: Comorbid MDD and Dysthymia- aka double depression. Their best is feeling sad and pretty bad-not ok. Prognosis for treatment --more treatment resistant than those in just the major depressive group What is the minimal length of time for the top 3 mood disorders? What is the average length of time? Correct Answer: MDE-minimal is 2 weeks, but average is about 9 months and 6 months for recurrent episodes MANIC- 1 week minimum, but average is 4-5 months DYSTHYMIC- must be present for 2 years but average is minimum of 4-5 years but seen up to 30 years What three conditions must be met for a Bipolar II diagnosis? 23 Correct Answer: person must have MDE that are fully equivalent to unipolar MDD . 2. the person must have at least one clear-cut hypomanic episode. 3. the person must have never had a full-blown manic episode. What component of risk for Major Depressive Disorder appears to be stronger in women than in men? Correct Answer: Genetic Component What are some neurological factors for MDD? Correct Answer: Neurological differences: serotonin deficiency, cortisol (associated with stress) overabundance, fewer deep restful patterns of sleep Why is stressful events a psycho-social factor for MDD? Give an example that illustrates how a stressful situation can invoke depression and how it cannot? What factor moderates the relationship between stress and depression? Correct Answer: interpretation and meaning given to those stressful events (context) stressful events are not inherently depressogenic. It depends on the context of the stressor. For example: If someone loses their job, they will be stressed out until they find another one, but it won't necessarily lead to depression unless the context of the situation includes a severe lack of available jobs, economic instability, and/or many people are losing their jobs. Describe Beck's cognitive triad. Correct Answer: 3-way interaction between negative views of self, future, and the world. 24 Negative view of the self: "It's all my fault" Negative view of the future: "Bad things like this will always happen to me" Negative view of the world: "Bad things will happen to me in everything I do" or "nobody loves me" Another way to label the three negative views, according to Will, is Internal, Stable, and Global, respectively. What are some examples of cognitive distortions that accompany negative views associated with the cognitive triad, also described by beck? Correct Answer: Arbitrary Inference- "it's my fault, no reason to explain why it's my fault. It just is. Overgeneralization - making broad generalizations based on just a few instances. *Also, not talked about it class, there are a few other types of cognitive distortions described by Beck including: selective abstraction, magnification and minimization, personalization, and dichotomous thinking. * What are some reasons that adolescents with bipolar disorder tend to be at high risk for suicide? Correct Answer: They are impulsive and immature about what death means and the consequences. Their impulsive nature is even more of a risk when the individual is coming down from a manic episode. What are some risk factors of Bipolar Disorder than differ from those of Major Depressive Disorder? 25 Correct Answer: Dopamine Excess, sensitivity to light due to suppression of melatonin (they need more complete darkness to regulate sleep), stressful life events: reoccurence of mood episodes, not have stress-management skills, family and friends not understanding how to interact with the individual in a way that prevents future episodes. Genetic risk factors (relatives of BD individuals) Why is treatment important for individuals in a manic state if they don't feel distressed? Are they receptive to treatment? Correct Answer: People who are stuck in these extreme moods make bad choices. People that are too elated/invulnerable have a "why not" attitude. Treatment for someone in a manic state is really difficult because they are not distressed, but they are causing distress to others. What are some symptoms of MDD? How frequent and long should it last to be considered MDD? Correct Answer: present for most of the day, everyday, must last at least a few weeks, must cause clinically severe impairment Anhodonia, vegetation, low energy, low motivation, sleep disturbances (mostly sleeping a lot), some sleep less but still unproductive (lying in bed, but not sleeping), appetite and eating reduction or increase, weight loss or weight gain, concentration problems What are some symptoms of Bipolar Disorder? Correct Answer: task-oriented (they start a lot of things but don't finish them), they overcommit (i.e. with finances they go on buying binges), psychomotor agitation, Define Anhedonia 26 Correct Answer: lack of interest in something that used to be found interesting What are some examples of psychomotor agitation? Correct Answer: excessive talkativeness, racing thoughts, high distractibility Who was William Wundt and what were his contributions to the field of psychology? Correct Answer: credited with being the founder of psychology as a science, as we know it. He was a physiologist and philosopher who believed psychology was the study of immediate experience. Resinik (1997) A brief history of practice Correct Answer: Psychology has its roots in philosophy--can be traced back to the times and ideas of Aristotle and Plato. Early schools of psychology: structuralism, behaviorism, Gestalt psychology, psychoanalysis The American Psychological Association began in 1892; founded by philosophers, educators, physicians, and 1-2 psychologists Article talked about William Wundt and Lightner Witmer The practice of psychology was often looked down upon by those who practiced medicine, specifically in psychiatry. In the beginning stages, psychology was used primarily for assessments, not psychotherapy. The first 50 years of psychology were primarily dealing with testing. 27 There was a major sense of competition between the psychiatric field and the psychological field. After WWII, doors began opening for the field of psychology. There were hundreds of thousands of cases dealing with shell shock and after effects from the war. There was a shortage of properly trained therapists. This initiated the beginning of psychotherapy to be utilized by psychologists. Licensure and certification became available shortly thereafter as well. There was an ongoing battle for psychologists to be able to practice independently, in hospitals, etc. The Virginia Blues lawsuits established psychology as a competent practice and independent providers of services in competition with psychiatry. By 1990, the practice of psychology was booming. It continues to expand and evolve throughout the years. Who was Lightner Witmer and what were his contributions to the field of psychology? Correct Answer: established the first psychological clinic at the University of Pennsylvania in 1896. Possibly published the 1st ever psychological case history. He coined the term "clinical psychology" He focused on school psychology, but was considered the first "clinical psychologist." Because of thim, in the early stages of clinical psychology, school psychology was the primary focus. What significance did WWII play on the development of the field of clinical psychology? Correct Answer: After WWII, doors began opening for the field of psychology. There were hundreds of thousands of cases dealing with shell shock and after effects from the war. There was a shortage of properly trained therapists. This initiated the beginning of psychotherapy to be utilized by psychologists. Licensure and certification became available shortly thereafter as well. 28 Spiegal (2005) The dictionary of disorder Correct Answer: Robert Spitzer: largely influential psychologist known for establishing the DSM as a scientific power. · DSM diagnosis is now required for reimbursement from insurance companies · He did poorly when applying psychoanalysis due to it being too abstract and theoretical, he noted his clients rarely got better. · This was during the 1960s psychiatry was struggling due to lack of diagnosis reliability among clinicians o These issues were highly noticeable during world war two when rejection rates were greatly variable in individual territories o Allen Frances stated that without reliability diagnosis is completely random and means almost nothing The DSM III was widely accepted and got lots of publicity One thing that made the DSM III different from its earlier versions was the addition of a checklist to justify diagnosis Reliability increased in psychiatry and psychology with the introduction of the DSM III. This version of the DSM saw controversy due to people thinking it was too authoritative, labeling normal behaviors as abnormal, and that it did not improve reliability as much as it has been said to. Despite controversies surrounding it, the DSM III is seen a revolutionary instrument in the psychological field because it provided clinicians with a tool to use in the field Who was Robert Spitzer and what was his contributions to the field of psychology? Correct Answer: largely influential psychologist known for establishing the DSM as a scientific power 29 He did poorly when applying psychoanalysis due to it being too abstract and theoretical, he noted his clients rarely got better. 1966 he was named Chairman of the task force for the DSM III. He appointed several DOPs (data oriented people) to 25 committees to determine the detailed descriptions of mental disorders. He focused on the existence of studies and evidence when entering disorders into the DSM III, which had not been done in its predecessors. Spitzer made many of the final cuts with very little consultation. He hoped to decrease interpretive variance by standardizing definitions of mental disorders. What was one of the main struggles in psychiatry during WWII on into the 1960's? Correct Answer: psychiatry was struggling due to lack of diagnosis reliability among clinicians Ash (1949) found that three psychiatrists reached the same diagnostic conclusion only 20% of the time Beck(1962) found that nine psychiatrists shared diagnostic conclusion 32-42% of the time Allen Frances stated that without reliability diagnosis is completely random and means almost nothing Baer et al. (2012) is it GAD or poverty? Correct Answer: Anxiety is a normal part of the human condition; the concern about anxiety is the distress it causes and is not necessarily symptomatology. This can make diagnosis difficult because where to draw the line between "disorder" and not disorder can be ambiguous DSM criteria for anxiety disorders do not take into account context or etiology. "The same symptoms that determine disorder often occur in response to life events in the absence of disorder" 30 It has been questioned whether or not Generalized Anxiety Disorder (GAD) should be a distinct disorder It has been conceptualized as a combination of symptoms, residual from other disorders Criteria changed from "generalized, persistent anxiety" in DSM-III to "excessive and/or unrealistic worry" in DSM-III-R After DSM-III-R, the consideration of context in diagnosing GAD was removed. GAD is commonly diagnosed in socially disadvantaged individuals and individuals living in poverty GAD runs in families but lacks a genetic etiology; (possibly because) environmental risk factors such as home environment, low SES, maltreatment, and maternal internalizing symptoms, in childhood are associated with future onset of GAD. Social factors are important in samples used to study GAD, but are not considered in diagnosis Results from a study on GAD prevalence: The poorest mothers had higher odds of being classified as having GAD. However, poor mothers do not show signs of a malfunction in an internal mechanism; anxiety is a response to the physical needs being unmet.Assessment should include attention to contextual and environmental factors and treatment should be modified accordingly. Mislabeling still creates social stigma; "the need for services should not be predicated on the basis of mental disorder" (i.e. we can provide treatment for symptoms even if there is no official diagnosis) Describe the Articulated Thoughts in Simulated Situations (ATSS) Correct Answer: Think aloud cognitive assessment procedure allows for open-ended, verbal reports of the thoughts that occur during emotional arousal. Participants listen to emotion-eliciting audiotaped scenarios and are asked to imagine that the situations they are hearing are actually occurring. 31 At the end of each segment, a tone sounds and participants are asked to articulate their thoughts and feelings into a tape recorder during a 30-second pause Participant is usually left alone in the room with a tape recorder in an effort to encourage more open responding ATSS may be a useful alternative to an interview when gathering data regarding psychological functioning What was Meehl's main point in his article? What are his five reasons for not attending case conferences? Correct Answer: Case conferences are not based in empirical evidence. 1.They are based on assumptions that "all evidence is equally good" i.e. anxiety test - high score 2.Reward everything - gold and garbage a like - tenderness and "therapeutic attitude" à nobody is negatively reinforced at case conferences - everybody is always right or not never wrong which does not reach educational goals 3.Tolerance of feeble inferences - example of person comparing an adult with hallucinations to personal story of child having an imaginary friend and neurology case involving incontinent adult to child wetting the bed; first would be accepted as psych case conference 4. ignorance statistical knowledge 5. jumping to diagnostic conclusions We are all indiviudals, we are all unique and different. There's norms though. Some things are abnormal What are the common types of fallacies discussed in Meehl's article? Describe each one. 32 Correct Answer: Barnum effect - saying things that are true of basically all psych patients Sick-sick fallacy - classification of people who have a different background or belief system as us as sick "me too" fallacy - people who commit the sick-sick fallacy are likely to also commit this one; minimizing signs or symptoms because of thinking anybody would do it Uncle George's pancake fallacy - relating the sign or symptom to somebody that you know and their behavior and normalizing it because of assumption that family and friends don't have an psych illness Multiple napoleons fallacy - "It is reality for him/her." Crummy criterion fallacy - tendency to ignore important questions about contradictions in the psychometrics of tests and observations "understanding it makes it normal" = some argue that understanding a person's behavior somehow makes it normal even if it is not Ad hoc fallacy - committing an error that you know is a source of error What are some reasons problems with the DSM 5 that Frances points out? Correct Answer: Introduced three new disorders that are at the fuzzy boundary with normality 1.Binge eating disorder 2.Disruptive mood dysregulation 3.Mild neurocognitive disorder (normal people being mislabeled and subjected to harmful treatment and unnecessary stigma) 33 Combined substance use and dependence together into one category- confusing for different treatment needs *None of these changes were based on a solid scientific foundation; none have been tested sufficiently; none has any proven relation to effective treatment; and all are subject to grave misuse Ex: Mood Dysregulation disorder is included in DSM, despite its having been studied by just one research group for only 6 years What article is this from and what does it mean, "If you hear hoof beats on Broadway, think horses, not zebras"? Correct Answer: Frances; when in doubt go with the odds. Is it better to underdiagnose or overdiagnose when you are in doubt? Correct Answer: Underdiagnose What are some reasons Frances gives for why it is important to give an accurate diagnosis? Correct Answer: done well, diagnosis leads to appropriate treatment and a good chance for cure or at least substantial improvement Done poorly, diagnosis leads to a nightmare of harmful treatments, unnecessary stigma, missed opportunities, reduced expectations, and negative fulfilling prophecies What six steps does Frances give for "Stepped Diagnosis" and why is it important? 34 Correct Answer: Step 1) Engage in watchful waiting: Many people come for their first visit when symptoms are at their highest pitch- they may seem less troubled on repeat visits Step 2) Make sure the symptoms are Severe and persistent enough to count: Some symptoms are a part of everyday living experiences. It is only when symptoms are grouped together in a recognized pattern, persist over time, and cause distress or impairment. Step 3) Educate, Normalize, reassure: It is useful for people to know that their symptoms may turn out to be normal, expectable, and or reactions to life's stresses and disappointments Step 4) Rule out the role of substances: Always be sure to consider whether substance use or a medication side effect is the possible cause of the patient's presentation (notepeople often reluctant to admit they have substance abuse problems; careful questioning is needed) Step 5) Rule out the role of medical illness: especially in the elderly, always consider neurological or other medical illnesses as a possible cause of the psychiatric problems. Can recommend medical evaluations Step 6) Rule out bipolar and depressive disorder: These are common and include a wide variety of symptoms. Always consider these first before making another diagnosis What are some symptoms for Mood-Congruent Psychotic Features? Correct Answer: depressive preoccupations can become delusional convictions --ex: patient believing they are responsible for death of a loved one that was beyond their control, being sure all of their money is gone despite having good financial statements, Auditory hallucinations may occur-hearing harsh, condemning voices, attacking the patient for their thoughts and past imagined crimes 35 What are some symptoms for Mood-Incongruent Psychotic Features? Correct Answer: patient has delusions and hallucinations that are not related to depressive themes and are fully equivalent to those that occur in schizophrenia, but only occur during the depressive episode What are some symptoms of Melancholia? Correct Answer: most severe nonpsychotic form of depression --nothing can shake them out of feeling terrible. Loss of appetite, little sleep, waking up early and having trouble getting back to sleep, some are agitated, others are immobile, some have both What are some symptoms of Reactive Depression? Correct Answer: triggered by external stressors, less severe and pervasive, more responsive to context --patient gets depressed when lost job but cheers up when people visit and when they get another job. This is hard to distinguish b/t normal reactions to stress and loss What are some common disorders that are comorbid with PTSD? Correct Answer: Major depression GAD Panic Disorder Alcohol abuse Substance abuse Borderline Personality disorder Increased likelihood of suicide attempts for PTSD-BPD individua 36 What are some helpful treatment options for individuals with comorbid PTSD and BPD? Correct Answer: PTSD-BPD have a high degree of life-time co-occurrence Treatment for PTSD-BPD individuals Dialectical behavioral therapy (DBT) Mentalization based treatment Transference focused therapy PTSD and depression equally increase the risk of suicide What risk factors for PTSD were mentioned in the Ozbay (2013) article about 9/11? Correct Answer: Pre-event psychopathology Female sex Recent immigration to the US Increased hours of viewed even-related media coverage What was the difference in prevalence rates for PTSD in Police Vs. unaffiliated volunteers according to the WTC Registry conducted after 9/11? (Ozbay, 2013). Correct Answer: PTSD prevalence was lower in police (6.2%) than in unaffiliated volunteers (21.2%) This may be due to misreporting as a diagnosis of PTSD would have probable negative impacts on their role a police officer. What is the best sample to use when studying sex difference? Correct Answer: opposite-sex dizygotic twin pairs 37 What number or percentage of females and males in a sample of 208 opposite-sex dizygotic twin pairs reported symptoms for major depression in the past year. Correct Answer: Female as affected member in 130 pairs, or 62% Male as affected member in 78 pairs, or 38% In Kendler & Gardner (2014) Sex differences in the pathways to major depression, what were the differences in pathways for depression in males and females? Correct Answer: Path from childhood sexual abuse to both conduct disorder and early-onset anxiety disorders were much stronger in males than females. The paths from drug use disorders to distal and dependent proximal stressful life events were also much more robust in males than females. The path from dependent proximal stressful life events to past-year major depression was considerably stronger in males than females. Path from low parental warmth to early-onset anxiety disorders and prior history of major depression were both stronger in females than males. The paths from low marital satisfaction and social support to past-year major depression were both considerably more robust in females than males. North, Barney, and Pollio (2015) Correct Answer: Most research about the effects of 9/11 has primarily focused on PTSD. There were many people who were involved in the 9/11 attacks that did not develop PTSD but were still affected, and most research has missed this population. 38 This study (focus group) focused on the people who were at or around the WTC at the time of the attacks that might not necessarily have PTSD. (during second year after attacks) 140 participants; 21 focus groups; six different companies; 1 hour long Split into two categories: At Ground Zero at time of attacks or Near Ground Zero at time of attacks and Five themes emerged 1. Disaster Experience a. Ground Zero - described seeing the planes hit, feeling building shake, deaths, etc. b. Outside of Ground Zero - described the learning of the attacks, saw images (media and from other people), difficult time processing the events 2. Emotional Responses a. Ground Zero - reported experiencing thoughts of the attacks again and again, psychological hyperarousal and hypervigilance b. Outside of Ground Zero - Similar concerns including nightmares, sleep difficulties, etc. Also increase appreciation of others and concerns about others' wellbeing (i.e., children) 3. Workplace Issues a. Ground Zero - hard adjustment period, had to hire new people to fill positions, lots of lost work, low on space and resources b. Outside of Ground Zero - not really affected 4. Coping a. Ground Zero - relied heavily on workplace and coworkers during coping process b. Outside of Ground Zero - heavily relied on family members for support during coping process; therapy, religion, and altruistic volunteering 5. Issues of Public Concern a. Ground Zero - lack of preparedness and lacking communication. disorganization and chaos; frustrated with process b. Outside of Ground Zero - more focused on personal effects after 9/11 (i.e., fi 39 Describe the relationship between inflammation and depression as discussed by Almond (2013) Depression and inflammation. Correct Answer: 1.Depression is frequently in comorbid with many inflammatory illnesses 2. Increased inflammatory biomarkers are associated with MDD 3. Exposure to immunomodulating agents may increase the risk of developing depression 4. Stress can activate pro-inflammatory pathways 5. Antidepressants can decrease inflammatory response 6. Inhibition of inflammatory pathways can improve mood What is the difference in prevalence rates for cancer patients compared with the general population? Correct Answer: 15-25% of cancer patients experience depression compared to 9% of the general population Controversies of the DSM 5 Correct Answer: Shift from multi-axial Diagnosis 2. DSM Recognition 3. Generalizability 4. Research needs to be done in cross-culturally 5. proposed new categories 6. what traits are and what effect they have one people 40 Axis I and Axis II Correct Answer: Axis I - Everything Else Axis II - Personality DAT Syndrome Correct Answer: Dat syndrome - worried about seman loss. causes anxiety , fatigue practical issues with interviewing Correct Answer: interviewer training order effects choice of informant generalizability across cultures