Psy 8 midterms notes – penelope mutya  Diathesis stress model

- A disorder is developed when risk factors and

triggers come together
THEORIES AND TREATMENT OF ABNORMALITY  Diathesis
- Risk factors that make one susceptible to
develop a disorder
 3 General Approachers to understanding  Stress
psychological disorders - Events or circumstances that trigger the
 Biological significant expression of diathesis
- Views disorders as the result of abnormal  Diathesis + stress = disorder
genes or neurobiological dysfunction
 Psychological
- Views disorders as the result of thinking  Biological approaches
processes, personality styles, emotions, and  The odd case of Phineas Gage
conditioning. - Injury of the frontal lobe can result in disruption
 Sociocultural of the brain’s executive functions which
- Views these disorders as the result of represent higher level cognitive abilities
environmental conditions and cultural norms
 Brain dysfunction
- The brain can be divided into 3 main regions:
 Biopsychosocial  Hindbrain
- Integrates all three approaches - Crucial for basic life functions
 Risk factors  Midbrain
- Biological, psychological, and/or social factors - Responsible for sensory information relay,
that increase the risk of developing movement control, and response regulation to
psychological disorders rewards
 Transdiagnostic risk factors  Forebrain
- Factors that increase risk for multiple types of - Responsible for higher cognitive functions
psychological problems.
 Biochemical imbalances
 Neurotransmitters
 Gamma-aminobutyric acid (GABA)
- Biochemicals that act as messengers carrying
- Inhibits the action of other neurotransmitters
impulses from one neuron, or nerve cell,to
- Plays an important role in anxiety symptoms,
anotherin the brain and in other parts of the
particularly when it is low.
nervous system.
 Reuptake
- When the initial neuron releasing the
 The endocrine system
neurotransmitter into the synapse reabsorbs
- This system of glands produces chemicals
the neurotransmitter, decreasing the amount
called hormones which are released directly
left in the synapse
into the blood
 Degradation
 Pituitary gland
- When the neuron releases an enzyme into the
- Aka master gland
synaplse that breaks down the
- Produces the largest number of different
neurotransmitter into other biochemicals
hormones and controls the secretions of other
endocrine glands
 Types of neurotransmitters
- Lies below the hypothalamus
 Serotonin
- A neurotransmitter that travels through many
key areas of the brain, affecting the function of
 Genetic abnormalities
those areas.
 Behavioral genetics
 Dopamine
- The study of the genetics of personality and
- A prominent neurotransmitter in those areas of
abnormality that is concerned with the extent
the brain associates with our experience of
to which behaviors or behavioral tendencies
reinforcements or rewards
inherited and identifying the processes by
- Affected by substances, such as alcohol, that
which genes affect behavior
we find rewarding.
- Alternations in the structure or number of
 Neuroepinephrine (aka neuroadrenaline)
chromosomes can cause major defects
- A neurotransmitter produced mainly by
 Polygenic process
neurons in the brain stem,
- It takes multiple genetic abnormalities coming
- Plays an essential role in the regulation of
together in one individual to create a specific
arousal, attention, cognitive function, and
disorder
stress reactions.
 - Reduce symptoms of mania (agitation,
excitement, grandiosity)
-
 Anti-anxiety drugs
- Reduce symptoms of anxiety (fearful, worry,
 Genes and the environment
tensions)
- Genetic factors can influence the kinds of
environments we choose, which then reinforce
our genetically influences personalities and
 ECT and other brain simulation techniques
interests
 Electroconvulsive therapy (ECT)
- The environment may acts as a catalyst for a
- Used to treat mood disorders
genetic tendency
- Involves inducing seizures by electrocution
- The fascinating line of research called
 Repetitive transcranial Magnetic simulation (rTMS)
epigenetic indicates that environmental-
- Non invasively exposes patients to repeated,
conditions can affect the expression of genes
high-intensity magnetic pulses focused on
particular brain structures
 Vagus nerve stimulation (VNS)
 Treatments
- Is an invasive brain simulation methods where
 Drug therapies
electrodes are surgically implanted at the
 Electroconvulsive therapy and newer brain
vagus nerve, a part of the nervous system that
simulation techniques
carries information to several areas of the
 Psychosurgery
brain, including the hypothalamus and
amygdala
 Drug therapies
 Antipsychotic
 Psychosurgery
- Reduce symptoms of psychosis (loss of reality
 Prefrontal lobotomy
testing, hallucinations, delusions
- Introduced by antonio de egas moniz in 1935
- Examples: thorazine, haldol
- Frontal lobes of the brain are severed from the
 Antidepressant drugs
lower centers of the brain in people with
- Reduce symptoms of depressions (sadness,
psychosis
loss of appetite, sleep disturbances
- Psychosurgery remains highly controversial
- Examples: parnate, elavil, proznac
because up to date, it is still unknown what
 Lithium
 areas of the brain are involved in producing
most psychiatric symptoms, and it is likely that
 Operant conditioning
many areas of the brain are involved in any
- Refers to the shaping of behaviors by providing
given disorder
rewards for desired behaviors and providing
punishments for undesired behaviors
PSYCHOLOGICAL APPROACHES  Extinction
- Eliminating behavior (whether learned or not)
- Continuous reinforcement schedule vs. partial
 Behavioral reinforcement schedule
- Focused on how our environment influences  Continuous VS. partial
and shapes human behavior through the  Continuous reinforcement
experiences of reinforcement and/or - Desired behavior is reinforced every time it
punishment occurs
 Common processes - Most effective when teaching a new behavior
- Classical conditioning - Creates a strong association between behavior
- Operant conditioning and response
- Observational learning  Partial reinforcement
- Most effective once a behavior has bee
established
 Classical conditioning - New behavior is less likely to disappear
 Unconditional stimulus - Various partial reinforcement schedules
- Stimulus that naturally produces a desired available to suit individual needs
response
 Unconditional response
- Response naturally occurring in the presence of  Modeling and observational learning
the unconditioned stimulus  Modeling
 Conditioned stimulus - People learn new behaviors from imitating the
- Previously neutral stimulus paired with the behaviors modeled by important people in their
unconditioned stimulus lives
 Conditioned response  Observational learning
- Response occurring in the presence of the - Takes place when a person observes the
conditioned stimulus rewards and punishments that another person
receives for his or her behavior and then
 behaves in accordance with those rewards and  Modeling and observational learning
punishments - Models desired behaviors, so that the client can
learn through observation

 Behavior therapies
 Removal of reinforcements  Cognitive
- Removes the individual from the reinforcing - Posits that people’s emotions and behaviors
situation or environment are influenced by perceptions of events
 Aversion therapy  Causal attribution
- Makes the situation or stimulus that was once - One’s personal answer to why certain events
reinforcing no longer reinforcing happen
 Relaxation exercises - It influences behavior due to its impact on the
- Help the individual voluntarily control meaning given to the event and the
pshysiological manifestations of anxiety expectations for future similar events
 Distraction techniques - The attributions for own behavior affect
- Help the individual temporarily distract from emotion and self-concept
anxiety-producing situations; divert attention  Global assumptions/ core beliefs
from physiological manifestations of anxiety - Broad beliefs about ourselves, our
 Flooding or implosive therapy relationships, and the world
- Exposes the individual to the dreaded or feared - Can be either positive or negative
stimulus while preventing avoidant behavior - Negative emotions/maldaptive behaviors are
 Systematic desensitization often results of dysfunctional global
- Pairs the implementation of relaxation assumptions
techniques with hierarchal exposure to the
aversive stimulus
 Response shaping through operant conditioning  Dysfunctional assumptions
- Pairs rewards with desired behaviors - Are rigid, conditional “rules of living” which
conditioning may be unrealistic and thus, maladaptive
 Behavioral contracting - Example: I should be loved by everyone for
- Provides rewards for reaching proximal goals everything I do
 - The unconscious dimensions of our relationship
with one another from pregnancy and infancy
 Cognitive therapies
throughout all of life
 Goals
- Principal: collaborate with clients to define
problems and teach them more effective
problem-solving techniques for dealing with the
concrete problems in their lives
 Assists clients in identifying their irrational and
maladaptive thoughts
 Teach clients to challenge their irrational or  Psychodynamic therapies
maladaptive thoughts to consider alternative ways  Goal
of thinking - To help clients recognize their maladaptive
 Encourage clients to face their worst fears about a coping strategies and the sources of their
situation and recognize ways they could cope unconscious conflicts
 Free association
- Allowing clients to talk freely about what
 Psychodynamic comes to mind without censorship
- Suggests that all behaviors, thoughts, and  Resistance
emotions whether normal or abnormal, are - Reluctance to talk during therapy
influenced to a large extent by unconscious  Transference
processes - The client’s reaction to the therapist as if the
- Started with Freud’s Psychoanalysis therapist were an important person in the
 Ego psychology client’s early development, such as his or her
- Emphasizing the importance of the individual’s father or mother
ability to regulate defenses in ways that allow  Working through
healthy functioning within the realities of - Going over and over about painful memories
society and difficult issues until the client understand
 Object relations them and weave them into their self-definition
- Early relationships create unconscious mental in acceptable ways
images, or representations, or ourselves and  Interpersonal therapy
others which are carried throughout adulthood - Focused on the client’s pattern of relationships
and affect all subsequent relationships with important people in their life.
 Self psychology and relational psychology
 adolescents that impede communication and
systematic barriers to problem solving
 Humanistic
- Based on the assumption that humans have an
innate capacity for goodness and for living a
 Third-wave
full life
- Combination of cognitive and behavioral
- Carl Roers developed the most widely known
approaches in dealing with psychological
humanistic theory
disorders, primarily focusing on emotions
- Ideal self vs. true self

 Humanistic therapies
 Goal  Third-wave therapies
- To help clients discover their greatest potential - Dialectical behavioral therapy
through self-exploration - Acceptance and commitment therapy
 Person-centered theory - Mindfulness-based therapies
- A therapy where the therapist communicates a
genuineness in their role as helper to the
client, acting as an authentic person rather SOCIOCULTURAL APPROACHES
than an authority figure
 Transdiagnostic risk factors
 Reflection
 Socioeconomic disadvantage
- A method of response in which the therapist
 Upheaval and disintegration of societies due to
expressess an attempt to understand what the
war, famine, and natural disaster
client is experiencing and trying to
 Social norms and policies that stigmatize and
communicate
marginalize certain groups

 Family systems
 Culture and psychological disorders
- Views the family as a complex interpersonal
- Shared beliefs within a culture impact the way
system, with its own hierarchy and rules that
in which psychological disorders are identified
govern family members’ behavior
and understood
 Behavioral family systems therapy
 Some disorders appear to be specific to certain
- Targets family communication and problem
cultures:
solving, those beliefs of parents and
 - Japan: Taijin Kyofusho  Hypothesis
- China: Koro - A testable educated guess derived from an
- Malaysia/Philippines: Amok observation
- Latin America: Ataque de Nervios - Null hypothesis
- Alternative hypothesis
 Variables
- Factors or characteristics that can vary within
or between individuals
 Multiculturalism
- Individual variables
- Refers to a clinician’s efforts to integrate and
- Dependent variables
embrace cultural differences of their clients,
- Confounding variables
while also acknowledging the influence of their
 Operationalization
culture on how they perceive and respond to
- Refers to the way we measure or manipulate
their clients
the variables in a study
RESEARCH, LEGALITY, AND ETHICS IN  Case studies
PSYCHOPATHOLOGY - A research method that includes detailed
histories of individuals with unique
characteristics or experiences
 The scientific method  Drawbacks
- The systematic process of obtaining and - Lacks generalizability
evaluating information relevant to a problem - Lacks objectivity
 Defining a problem  Correlational studies
 Formulating hypothesis - A research method that examines the
 Identifying the research method relationship between an IV and a DV without
 Collecting data manipulation
 Analyzing the data - Most common type of research in psychology
 Drawing of conclusion  Types of correlational study in psychopathology:
- Studying continuous variables
- Group comparison study
 Basic research terms  A correlational study can either be
 Theory - Cross-sectional
- A set of propositions meant to explain a class - Longitudinal
of observations or hypotheses  Measures of relationship:
 - Correlation coefficient - The proportion of the population that has the
- Can either be positive or negative disorder at a given point or period in time
 Statistical significance 2. Incidence
- An index of how likely it is that the result - The number of new cases of the disorder that
occurred simply by chance develop during a specified period of time
 Correlation is not causation 3. Risk factors
 This variable problem - Conditions or variables that are associated with
- The possibility that variables not measured in a a higher risk of having the disorder
study are the real cause of the relationship  Advantages
between the variables that are measured - Determines who has the highest risk for a
 Sampling – method of choosing research psychological disorder
participants - Contributes to formulating testable hypotheses
- Representativeness  Drawbacks
- Comparison groups - Cannot establish cause-effect relationship
 Involves manipulation of independent variable
and/or possible third variables
 Advantages  Types:
- Focused on real world situations  Human laboratory studies
- Good external validity - Internal validity – control vs experimental
- Generalizable - Demand characteristics – double blind
- Longitudinal> cross-sectional experiments
 Drawbacks  Advantages
- Longitudinal: expensive and time consuming - Controls for third variables
- Cannot indicate cause-effect relationship  Drawbacks
- Third variable problem - Lacks generalizability
- Serious ethical concerns
 Therapy outcome studies
 Epidemiological studies - Test a therapy’s effectiveness in treating
 Epidemiology psychological disorders
- The study of the frequency and distribution of a  Control groups:
disorder, or a group of disorders in a population - Simple control group
 3 types of data: - Waitlist control group
1. Prevalence - Placebo control group
 Drawbacks  Twin studies
- May lack standardization of therapy - Examining occurrence of psychological disorder
- Unethical to withhold treatment to individuals among twins
in control groups  Concordance rate – the probability that both twins
- Lacks generalizability will have the disorder if one twin has it
 Single-case experiment design  Adoption studies
- Like a case study but with manipulation of - Examining occurrence of psychological disorder
variables among adopted individuals
 ABAB design - Genetics vs environment
- Baseline assessment (A)  Molecular genetic studies
- Treatment (B) - Aka association studies studying
- Withdrawal of treatment (A) - Studying associating of genetic markers and
- Reinstatement of treatment (B) psychopathology
- Single-case experimental design  Linkage analysis
 Multiples baseline design - Looking into co-occuring characteristics with a
- Same individual but multiple settings disorder and their genetic markers
- Multiple individuals at different points in time
 Advantage
- Intensive assessment CROSS CULTURAL RESEARCH
 Drawback
-Takes into account cultural influences in
- Lacks generalizability
psychopathology
 Animal studies
 Participants language
- Analogue design
 Competent interprenters
 Drawbacks
 Reliability and validity translated instruments
- Unethical to treat animals with aversive
conditions
- Lacks generalizability from animals to humans
 Meta analysis
 Family history studies
- A statistical technique for summarizing results
- Tracing family pedigrees of both individuals
across several studies
with and without psychological disorder
 Advantages
 Probands
- Provides more power to find significant effects
- Group of people who clearly have the disorder
than single studies
in question
 Drawbacks
 - Methodological flaws - Behavioral observation
- File drawer effect - Fitness interview test-revised
 Assessment is ofter conducted by psyciatrist
 Any research must be evaluated to ensure it is
ethical
 Basic participants’ rights:
- Understanding the study
- Confidentiality
- Right to refuse or withdraw participation
- Informed consent
- No deception
- Debriefing
LEGALITY AND ETHICS

 Ethics in research
 M’Naghten Rule
 Do no harm
- The accused was unaware of the nature and
- Setting professional boundaries
quality of the act he was doing or if he did
- Ensuring competence of professional practice.
know it, that he did not know he was doing was
- Upholding utmost confidentiality and privacy
wrong
except for the following situations:
 Insanity defense reform act
 Posing danger to self or others
- A defendant is not criminally liable if at the
 Mandated by law to divulge information
time of the commission of the acts constituting
 Patient’s right to treatment and refuse treatment
the offense, the defendant, as a result of a
sever mental disease or defect, was unable to
appreciate the nature and quality of the
wrongfulness of his acts
 Competency to stand on trial LOOKING AT ABNORMALITY: INTRODUCTION AND
- Before people can be tried for a criminal HISTORICAL OVERVIEW
offense, they must be able to understand the
charges against them and to assist with their
own defense.  Abnormal psychology
 Tools commonly used to assess competency
- Mental status examination
 - The field of study devoted to understanding,  Disease model of mental illness
treating, and preventing psychological - This model views behaviors, thoughts, and
dysfunction feelings as abnormal if they are symptoms of
- Aka psychopathology mental illness
 Cautions:  Problem with this model
- Do not lose sight of the humanness of the - Psychological disorders do not have singular,
person behind every disorder identified definite causes and so they cannot
- Realize that all disorders are treatable, and be considered as diseases
many are preventable - Mental health experts view psychological
- Avoid self-diagnosing disorders as a collection of problems in thinking
 Stigma or cognition, in emotional responding or
- Destructive beliefs and attitudes held by the regulation, and in social behavior
society that are ascribed to groups considered
different in some manner, such as people with
mental illness
- Ex. When a person with mental illness is made
fun of
 The four Ds  Cultural relativism
1. Dysfunction - It is the view that there are no universal
- Behaviors, thoughts, and feelings interfere with standards or rules for labeling a behavior
the person’s ability to function in daily life, to abnormal; instead, behaviors can be labeled
hold a job, or to form close relationships abnormal only relative to cultural norms
2. Distress  Danger
- Behaviors, thoughts, and feelings cause - May be used to justify injustices against certain
distress to the individual or those around them people
3. Deviance - Ex. Hitler branded Jews abnormal and used this
- Behaviors, thoughts, and feelings deviate from label as one justification for the Holocaust
the social norm  Impact of culture and gender
4. Dangerousness - Culture and gender can influence the ways
- Behaviors, thoughts, and feelings pose people express symptoms
potential harm to the individual or to others - Culture and gender can influence people’s
willingness to admit to certain types of
behaviors or feelings
 - Culture and gender can influence the types of  4 categories of abnormal behavior:
treatments deemed acceptable or helpful for - Epilepsy
people exhibiting abnormal behaviors - Mania
 Historical perspectives on abnormality - Melancholia
 Types of theories across history - Brain fever
- Biological  Treatments:
- Supernatural - Psychological and intrusive procedures
- Psychological - Rest and relaxation or change in scenery
 Ancient theories - Diet
 Prehistoric civilizations - Living a temperate life
 Demonology and exorcism  Society’s regard towards insanity
- Driving away evil spirits possessing the - Family’s responsibility to keep insane relatives
mentally ill through incantations at home
 Trephination - Cannot own properties and marry
- Drilling holes unto the skull so evil spirits can
exit
 Medieval Views
 Witchcraft
 Ancient China - Accused witched must have been mentally ill
- Balancing Yin and Yang  Psychic epidemics
- Taoism and Buddhism beliefs - Dance frenzies in germany
 Ancient Egypt, Greece, and Rome - Tarantism in italy
 Wandering uterus  The spread of asylums
- Attributing women’s disorders to their uterus  Asylum
wandering anywhere in their bodies - An institution offering shelter to people with
- Greeks called in hysteria mental illness
- Ultimate treatment: marriage, sex, and  Mental hospitals
pregnancy - Known for its deplorable conditions
 Affliction from the gods - Patient exhibitions
- Healing ceremonies in the temple - Laws were more protective of the public than
 Imbalance of the four basic humors the welfare of the mentally ill
(hippocrates)  Act for regulating madhouses
- Blood phlegm, yellow bile, and black bile
 - Provided for the licensing and inspection of professionals dedicated to the moral treatment
madhouses and required that physician, a of patients
surgeon, on an apothecary sign a certificate - Helped establish more than 30 mental
before a patient could be admitted institutions in the US, Canada, etc.
 Disadvantages  Decline of moral treatment
- Favorable only for paying clients not the poor - The number of asylums grew fast and so were
- Led to the establishment of more the patients admitted which made it difficult for
psychologically intrusive treatments the mental health workers to cater all of them
 Moral treatment in 18th-19th century - The rapid immigration rate into the US
 Mental hygiene movement increased the percentage of patients with
- A more humane treatment of people with diverse cultural background
mental health problems - Prejudice against foreigners + perceived
- Based on the psychological view that people failures of moral treatment = reduced funding
developed problems because they had become - Reduced funding led to greater declines in
separated from nature and had succumbed to quality of care
the stresses imposed by the rapid social  The emergence of modern perspectives
changes of the period  Biological perspectives
 Wilhem Greisinger
- All psychological disorder can be explained in
 Moral treatment terms of brain pathology
 Philippe Pinel  Emil Kraepelin
- Many forms of abnormality could be cured by - Developed a scheme for classifying symptoms
restoring patient’s dignity and tranquility into discrete disorders that is the basis of our
 Quaker william tuke modern classification systems
- Opened an asylum in england called the retreat - Coined the term “dementia praecox” that
- Tuke’s treatment was designed to restore means premature dementia to describe
patients’s selfrestraint by treating them with schizophrenia
respect and dignity and encouraging them to  General paresis
exercise self-control - A disease that leads to paralisis, insanity, and
 Dorothea Dix eventual death caused by syphilis
= her efforts led to the passage of laws and - This led to the idea that biological factors can
appropriations to fund the cleanup of mental cause abnormality
hospitals and the training of mental health  Psychoanalytic perspectives
 Franz antom mesmer and catharsis – which served as foundations of
# Animal magnetism Freud’ psychoanalysis
- The notion of people having a magnetic fluid in  Roots of behaviorism
the body that must be distributed in a  Ivan Pavlov
particular pattern in order to maintain health, - Developed methods and theories of
which could be influenced by the magnetic understanding behaviors in terms of stimuli
forces of other people, as well as by the and responses rather than in terms of the
alignments of the planets internal workings of the unconscious mind
# Mesmerism through his experiments with a dog.
- A procedure involving the application of - This was later called classical conditioning
magnets to ailing parts of a patient’s body and  E.L Thorndike & B.F. Skinner
the induction of a trancelike state by gazing - Studied how the consequences of behaviors
into the patient’s eyes, making certain shape their likelihood of recurrence
“magnetic passes” over them with the hands, - Argued that behaviors followed by positive
and so forth. consequences are more likely to be repeated
# Hypnosis than are behaviors followed by negative
- The trancelike state experienced by patients to consequences
which cures were effected. Under this state, - Later called operant, or instrumental,
patients tended to be highly suggestible conditioning
 Cognitive revolution
 Albert Bandura
- Argued that people’s beliefs about their ability
to execute the behaviors necessary to control
 Jean Charcot
important events – which he called self-efficacy
- Worked with Bernheim and Liebault in
– are crucial in determining people’s well-being
advancing psychological perspectives on
 Albert Ellis
abnormality through their research despite his
- Argued that people prone to psychological
initial brain pathology claim
disorders are plagued by irrational negative
 Sigmund Freud
assumptions about themselves and the world
- The mental life of an individual remains hidden
- Developed rational-emotive therapy which
from consciousness
requires therapists to challenge, sometimes
- Collaborated with Josef Breuer in laying out
harshly, their patients’ irrational belief systems
their discoveries about hypnosis, unconscious,
 Aaron Beck
 - Developed cognitive therapy which focuses on - Sufficiently severe to cause marked
the irrational thoughts of people with impairment functioning ( social or
psychological problems occupational) or to require hospitalization to
- Cognitive triad depression prevent harm to self or others or there are
psychotic feature.
- Not due to substance or any other medical
 Professions within psychopathology condition
 Mental health professionals - Bipolar 1 diagnosis = at least one lifetime
- Psychiatrist manic episode
- Psychiatric nurses  3 or more of the ff symptoms:
- Psychologists - Inflated self-esteem or grandiosity
- Psyshometricians - Decreased need for sleep
- Social workers - More talkative than usual or pressure to keep
- Occupational therapists talking
- Flight of ides or subjective experience that
thoughts are racing
- Distractibility
- Increase in goal-directed activity or
psychomotor agitation
- Excessive involvement in activities that have a
high
- Potential for painful consequences

BIPOLAR AND SUICIDE

 Mood spectrum
- Mania <> depression
 Mania : opposite of depression  Bipolar 1 or II disorder
 Core criterion for Bipolar Disorders
Criteria Bipolar 1 Bipolar II
 DSM 5 criteria for manic episode:
Major depressive Can occur but Are necessary
- Abnormal and persistent elevation or episodes are not for diagnosis
expansion of mood (or irritable mood) and necessary for
energy at least 1 week diagnosis
Episodes Are necessary Cannot be - Family history remains the strongest predictor
meeting full for diagnosis present for of bipolar disorder
criteria for diagnosis - 5-10 times likelihood for first-degree relatives
mania  Neurotransmitter factor: monoamines
Hypomanic Can occur Are necessary
- Associated with dysregulation of dopamine
episodes between for diagnosis
episodes of levels
severe mania or
major  Theories of depression
depression but  Biological theories
are not  Brain abnormalities
necessary for - Associated with abnormalities in:
diagnosis
- Prefrontal cortex
- Striatum
 Other Bipolar disorders
- Hippocampus
 Cyclothymic disorder
- Amygdala
- Less intense but more chronic (at least 2 years)
- White matter
- Hypomanic and depressive symptoms are
 Psychosocial contributors
insufficient in number to meet full criteria of
 Reward sensitivity
hypomania and major depressive episode
- People with bipolar disorder, even when they
 Rapid cycling bipolar disorder
are asymptomatic, show greater sensitivity to
- 4 or more episodes of mood episodes that
rewards than do people without the disorder
meet full criteria for manic, hypomanic, or
 Stress
major depressive episodes within 1 year
- Experiencing stressful events and living with an
 Prevalence and course of bipolar disorders
unsupportive family where discord, criticism,
- Less common than depressive disorders
and conflict are high may trigger new episodes
- 2.4% lifetime prevalence globally
of bipolar disorder
- No difference between male and female
- Even positive events can trigger new episodes
- Average age of onset is 25
of mania or hypermania, particularly if they
- Associated with poor prognosis
involve striving for goals seen as highly
rewarding
 Treatments of bipolar disorder:
 Theories of bipolar disorders
 Drug therapies
 Biological theories
- Antidepressant drugs
 Genetic factors: runs in the family
 - Mood stabilizers biological factors, family problems, and peer
- Lithium, anticonvulsant victimization and bullying
- Atypical antipsychotic drugs  Suicide among LGBTQIA+
 Interpersonal and social rhythm therapy - A particularly high-risk population for suicide
- Combines IPT techniques with behavioral ideation and behavior due to higher risk for
techniques to help patients maintain regular mental health conditions like depression
routines of eating, sleeping, and activity, as  Risk factors:
well as stability in their personal relationships - Isolation from family and peers
 Family-focused therapy (FFT) - Substance use disorder
- Patients and their families are educated about - Victimization such as bullying and abuse
bipolar disorder and trained in communication  Suicide among college students
and problem-solving skills - Transition to college is associated with an
increase risk of suicidality among young adults
due to increased academic and social
 Suicide pressures
- Among the three leading causes of death  Suicide among older adults
worldwide among people ages 15-44yrs old - Older people, particularly older men, still
- Associated with mood disorders remain at relatively high risk for suicide
- Defined as death from injury, poisoning, or = risk factors:
suffocation where there is evidence that the - Loss spouse
injury was self-inflicted and that the decedent - Illness & disabilities
intended to kill themselves  Non-suicidal self-injury (NSSI)
 Completed suicide – end in death - No intent to die
 Suicide attempt – may or may not end in death - Global lifetime prevalence: 18%
 Suicide ideation – thoughts of committing suicide - Most prevalent among adolescents
 Gender difference: - Increase risk for suicide attempts
- Women are more likely to attempt suicide - It functions as a way of regulating emotion
- Men have 3x higher rates of completed suicide and/or influencing the social environment

 Suicide among children

- Linked to risk factors such as mental health
 Understanding suicide
problems, family history or suicidal behavior,
 Psychological disorders & suicide
 - More than 90% of people who commit suicide - To prevent imminent suicide attempt
probably have been suffering from a  Community-based crisis intervention programs
diagnosable mental disorder - To reduce the risk of an imminent suicide
- Depression: 6x attempt by providing suicidal persons someone
- Bipolar: 7x to talk with who understands their feelings and
- BPD, substance abuse, and anxiety disorder problems
are predictors of suicidal behaviors too  Drug treatment
 Stressful events and suicide - SSRIs
- Interpersonal violence, especially sexual abuse,  Dialectical behavior therapy
is the traumatic event most strongly linked to - Focuses on managing negative emotions and
suicidal thoughts and attempts controlling impulsive behaviors
- Loss of loved on through death, divorce, or  Suicide prevention programs:
separation is also consistently related to - Psychoeducation
suicide attempts or completions - Screening
 Suicide contagion
- It often occurs when a suicide death that is
widely publicized by the media results in  What to do if a friend is suicidal?
increases in suicide rates - Take them seriously
 Suicide cluster - Get help from professionals
- Two or more suicides or attempted suicide - Express your concern empathetically
occur together in space or time - Pay attention and listen intently
 Personality and cognitive factors - Ask questions about whether they have a plan
- Personality: impulsivity for suicide and if so, what that plan is
- Cognitive: hopelessness - Acknowledge the person’s feelings in a
 Biological factors nonjudgemental way
- Genetic predisposition - Reassure the person that things can be better
- Neurotransmitter dysfunction: low levels of - Don’t promise confidentiality
serotonin - Make sure guns, old medications, and other
means of self-harm are not available/accessible
- If possible, don’t leave the person alone until
they are in the hands of professionals

 Treatments of suicide
 Hospitalization
DEPRESSION

 Symptoms of depression Subtype Characteristic

- Dysphoria symptoms
- Anhedonia Anxious distress Prominent anxiety
- Significant weight loss when not dieting or symptoms
Mixed features Presence of at least
weight gain, or decrease or increase in appetite
three
- Insomnia or hypersomnia manic/hypomanic
- Psychomotor agitation or retardation symptoms, but does
- Fatigue or loss of energy not meet criteria for a
- Feelings of worthlessness or excessive or manic episode
inappropriate guilt
Melancholic features Inability to
- Diminished ability to think or concentrate, or experience pleasure,
indecisiveness distinct depressed
- Recurrent thoughts of death, recurrent suicidal mood, depression
ideation without specific plan, or a suicide regularly worse in the
attempt or a specific plan for committing morning, early
suicide. morning, awakening,
marked psychomotor
 Major depressive disorder (MDD)
retardation or
 DSM 5- TR criteria agitation, significant
- Five or more of the symptoms mentioned anorexia or weight
earlier for at least 2 weeks loss, excessive guilt
- Symptoms cause distress, impairment in Psychotic features Presence of mood-
functioning congruent or mood-
- Episode is not due to substance or another incongruent delusions
or hallucinations
medical condition
- Normal response to a negative event = no
MDD
Unless symptoms include atypical behaviors Catatonic features Catatonic behaviors:
- Not better explained by psychotic disorders not actively relating
to environment,
- Never have or no maniac/hypomanic episode
mutism, posturing,
 Can either be agitation, mimicking
- MDD, single episode another’s speech or
- MDD, recurrent episode movements
Atypical features Positive mood - Before menstruation
reactions to some - Cognitive-affective and physical symptoms
events, significant - A mix of depression, anxiety, tension,
weight gain or irritability, and anger
increase appetite,
 Disruptive mood dysregulation disorder (DMDD)
hypersomnia, heavy
or leaden feelings in - Age 6-18
arms or legs, long- - Sever and chronic irritability persistently
standing pattern of negative mood and sever temper outbursts
sensitivity to  Prevalence and course of depressive disorders
interpersonal - Common cold of psychiatric conditions
rejection
- 10% lifetime prevalence globally
Seasonal pattern History of at least 2
years in which major - 3.34% in the Philippines and 8.9% among
depressive episodes Filipino young adults
occur during one - Higher in female adults than male
season of the year - Long lasting and recurrent
(usually winter) and - If left untreated, remission within 7-9 months
remit when the after onset but highly likely to relapse
season is over
- If treated, faster remission and reduced risk of
Peripartum onset Onset of major
depressive episode relapse
during pregnancy or
in the 4 weeks
following delivery  Theories of depression
 Biological theories
 Genetic factors “runs in the family
- Associated with disruptions on neuroplasticity
- Neuroendocrine factors: chronic hyperactivity
in HPA Axis
- Gut microbiome and infamation
 Psychological theories:
 Behavioral theories
 Other depressive disorders
- life stress leads to depression because it
 Persistent depressive disorder (PDD)
reduces the positive reinforcers in a person’s
- less intense but more chronic (at least 2 years)
life
 Premenstrual dysphoric disorder (PMDD)
 => learned helplessness - Interpersonal difficulties and losses frequently
- the type of stressful event most likely to lead precede depression
to depresison is an uncontrollable negative - Chronic conflict in their relationships with
event family, friends, and co-workers \
- lacks psychological flexibility  Rejection sensitivity
- Some depressed people have a heightened
 Cognitive theories need for approval and expressions of support
 Negative cognitive triad: Beck from others but at the same time easily
- People with depression have negative views perceive rejection by others
about themselves, the world, and the future  Parenting styles
 Reformulated learned helplessness - Influences the cognitive and behavioral
- People’s negative causal attribution to events patterns of children
lead to depression  Sociocultural theories:
 Hopelessness depression - Cohort effects
- Depression develops when people make - Gender differences
pessimistic attributions for the most important - Ethical/racial differences
events in their lives and perceive that they
have no way to cope with the consequences of
these events  Treatments of depression
 Ruminative response styles theory  Drug treatments:
- Focused on process of thinking - Selective serotonin reuptake inhibitors. (SSRI)
- People with more ruminative coping style are - Selective serotonin-norepinephrine reuptake
more likely to develop major depression inhibitors (SNRI)
 Negative information bias - Bupropion: a norepinephrine-dopamine
- People who are depressed show a bias toward reuptake inhibitor (NDRI)
negative thinking in basic attention and - Tricyclic antidepressants
memory processes - Monoamine oxidase inhibitors (MAOIs)
 Overgeneral memory
- Depressed people develp the tendency to store
and recall memories in a general fashion as a  Electroconvulsive therapy and brain stimulation
way of coping with a traumatic past - Repetitive transcranial magnetic stimulation
 Interpersonal theories (rTMS)
- Vagus nerve stimulation
 - Deep brain stimulation and regard new roles in a
 Light therapy more positive manner
 Behavioral therapy Interpersonal skill deficits Review the client’s past
- Focuses on increasing reinforcers and relationships, helping the
client understand these
decreasing aversive experiences in an
relationships and how they
individual‘s life by helping the depressed might be affecting current
person change his or her patterns of interaction relationships; directly
with the environment and with other people teach the client social
- Short-term (12 weeks) skills, such as
 Cognitive-behavior therapy assertiveness
 2 goals:
- Change the negative, hopeless patterns of
thinking
- Help solve concrete problems in their lives and
develop skills for being more effective in their
world so they no longer have the deficits in
reinforcers described by behavioral theories of
depression
 Interpersonal therapy

Type of problem Therapeutic approach

Grief, loss Help the client accept

feelings and evaluate a
relationship with a lost
person; help the client
invest in new relationships
Interpersonal role disputes Help the client make
decisions about
concessions willing to be
made and learn better
ways of communicating
Role transitions Help the client develop
more realistic perspectives
toward roles that are lost
ASSESSING AND DIAGNOSING ABNORMALITY  Standardization
- The process of ensuring both validity and and
 Assessment
reliability of the test, including its
- The process of evaluating psychological, social,
administration, scoring, and interpretation
and emotional functioning through a variety of
 Types of validity
clinical methods.
 Content validity
 It may include:
- Test assesses all important aspects of a
- Interviews
phenomenon
- Observation
 Predictive validity
- Psychological tests
- Test predicts the behavior it is supposed to
- Neurological tests
measure
 Construct validity
- Test measures what it is supposed to measure,
 Types of information gathered:
not something else
- Current symptoms
 Concurrent validity
- Coping strategies
- Test yields the same results as other measures
- Recent events
of the same behavior, thoughts, or feelings
- Physical conditions
 Face validity
- Drug and alcohol use
- Test appears to measure what it is supposed to
- Personal and family history of psychological
measure
disorders
 Test-retest
- Cognitive functioning
- Test produces similar results when given at two
- Sociocultural background
points in time
 Assessment tools
 Alternate form reliability
 Validity
- Two versions of the same test produce similar
- The accuracy of a test in assessing what it is
results
supposed to measure
 Interrater, or interjudge, reliability
 Reliability
- Two or more raters or judges who administer
- The consistency in measuring what it is
and score a test come to similar conclusions
supposed to measure
 Internal reliability
- Different parts of the same test produce similar
results
 - Used to assess deficits in client skills or their
ways of handing situations
 Common assessment tools
 Clinical interview
- The initial, typically face-to-face, conversation
 Self-monitoring
between a clinician and a client where
- Used to assess behaviors outside of the clinic
information is gathered about the latter’s
as monitored and reported by the client
behavior, attitudes, emotions, life history, and
 Intelligence test
personality.
- Used to determine an individual‘s level of
 Mental status exam
cognitive functioning, and consists of a series
- Used to organize the information gathered
of tasks that involve both verbal and nonverbal
during the interview and systematically
skills
evaluate the client through a series of
 Intelligence quotient
questions
- Used to describe a method of comparing an
- It may be structured, unstructured, pr semi-
individual‘s score on an intelligence test with
structured
the performance of individuals in the same age
 Symptom questionnaires
group
- Self-report
 Neuropsychological test
- Can be generalized or focused
- Used to detect neurological impairments
- It is important to note that these instruments
- Ex. Bender-gestalt test II
are not used to diagnose a psychological
 Brain-imaging techniques
disorder
- Used to identify specific deficits and possible
- Ex. Beck’s depression inventory – II
brain abnormalities
 Personality inventories
 Computerized tomography (CT)
- Designed to assess people’s typical ways of
- Enhanced X-ray procedure
thinking, feeling, and behaving
- Provides image of the brain structure
- Used as part of an assessment procedure to
 Positron-emission tomography (PET)
obtain information on people’s well-being, self-
- Procedure includes injecting the patient with
concept, attitudes, and beliefs, ways of coping,
harmless radioactive isotope to see brain
perceptions of their environment, social
activity
resources, and vulnerabilities
- Shows which parts of the brain are most active
 Single photon emission computed tomography
 Behavioral observation and self-monitoring
(SPECT)
 Behavioral observation
 - Uses a different traces substance than in PET - 10 cards with symmetrical inkblot in black,
- Less expensive than PET but less accurate too gray, and white
 Magnetic resonance imaging (MRI)  Thematic appreciation test
- Provides more finely detailed pictures of the - Developed by henry murray and christiana
anatomy of the brain at any angle morgan in 1930s
- Structural MRI vs Functional MRI - Includes a series of pictures without captions
with which the client is asked to make a story
of it
 Psychophysiological tests
- Alternative methods to brain-imaging
techniques
- Used to detect changes in the brain and
nervous system that reflect emotional and
psychological changes  Challenges in assessment
 Electroencephalogram (EEG) - Resistance to providing information
- Measures electrical activity along the scalp - Evaluating children
produced by the firing of specific neurons in - Evaluating individuals across cultures
the brain
- Used to detect seizure activity, tumors, and
stroke  Diagnosis
- The label attached to a set of symptoms that
tend to co-occur together in specific patterns.
 Projective tests This helps idetify the characteristics of a
- Based on the assumption that when people are specific disorder for effective
presented with an ambiguous stimulus, such as  Syndrome:
an oddly shaped inkblot or a caption-less - A set or cluster of symptoms
picture, they will interpret the stimulus in line - People usually differ in which of these
with their current concerns and feelings, symptoms will be most prominent
relationships with others, and conflicts of - Syndromes are not a list of symptoms that all
desires people have all the time if they have any of the
 Rorschach inkbolt test symptoms at all
- Developed by herman rorschach - The symptoms of one syndrome may overlap
those of another
 - Criteria are in the form of behaviors people
must show or experience, or feelings they must
 Classification system in diagnosis
report
- Constitutes a set of syndroms and the rules for
 Continuing debates about DSM
detering whether an individual‘s symptoms are
- Reifying diagnoses
part of one of these syndroms
- Category or continuum
 Hippocrates
 Comorbidity
- First classification system of psychological
- Meeting criteria for multiple diagnoses
disorders
- Addressing cultural issues
- Mania
 Social-psychological dangers of diagnosis:
- Melancholia
- Stigma
- Paranoia
- Self-fulfilling prophecy
- Epilepsy
 Emil kraepelin
- Published the first modern classification system
which became the basis for the current
systems
- Diagnostic and statistical manual of mental
disorders (DSM 5- TR)
- International classification of diseases (ICD –  What happens after a diagnosis is made?
11)  Work with a therapist
- Once diagnostic process is completed, the
client must work with their therapist to develop
 DSM editions a comprehensive treatment plan specially
 DSM 1 and DSM II designed to meet the client’s needs and
- Reflect the heavy influence of the improve psychological function
psychoanalytic theory - Clinicians must address the most critical
- Low reliability of the diagnoses psychological issued first
 DSM III and DSM III-R; DSM IV, and DSM IV TR
- Replacing the vague descriptions of disorders
with specific and concrete criteria for each ANXIETY DISORDERS
disorder

 Anxiety
 - A future-oriented apprehension, tension, or  Drug therapy
sense of dread - SSRI
 Fear - SNRI
- An immediate emotional response to danger or - Tricyclic antidepressants
perceived threat in the environment - Benzodiazepine
 Panic disorder  Cognitive behavioral therapy
 Panic attacks
- Short but intense periods during which one  Separation anxiety disorder
experiences many symptoms of anxiety such
as: heart palpitations, trembling, shortness of - Associated with childhood onset
breath, dizziness, intense dread, and the fear - Occurs in about 4-10% of children and is
of dying equally common in boys and girls
 Diagnosis of panic disorder - DSM 5 TR acknowledges it as a condition that
- Common occurrence (not usually provoked but may span the entire life, and begin at any age
unexpected) - Highly comorbid with both internalizing and
- Worrying about having panic attacks externalizing disorders
- Changes in behavior as results of worry

 Theories of panic disorder

 Theories of separation anxiety disorders
 Cognitive factors:
 Biological factors
 Cognitive loop
- Heritability: 70%
- Paying very close attention to bodily sensations
 Behavioral inhibition
- Misinterpreting these sensations in a negative
- Family histories of anxiety and depressive
way
disorders
- Engaging in snowballing catastrophic thinking,
 Psychological & sociocultural factors
exaggerating symptoms and their
 Parenting
consequences
- Controlling and intrusive parents
 Anxiety sensitivity
- Modeling of anxious parents
 Interoceptive awareness
- Parent styles – over-permissive, overprotective
- Interoceptive conditioning
 Treatments for separation anxiety disorder
 Controllability beliefs
 Drug therapy
 Treatment for panic disorder
- SSRI
 - Benzodiazepine - Chronic headaches
- Stimulants  Theories of generalized anxiety
- Antihistamine  Biological factors
 Cognitive behavioral therapy - Modest heritability
- Mindfulness-based therapy - Increased activities in sympathetic nervous
- Acceptance and commitment therapy system and amygdala
- Abnormalities in GABA neurotransmitters
 Selective mutism system
- Typically emerges in early childhood and can  Emotional and cognitive factors:
last into adulthood if untreated  Maldaptive assumptions
- Average age of onset: 27-46 years old - Beliefs about controllability
- Appears to result from the interaction of - High sensitivity to threatening stimuli
various genetic, temperamental, - Unpredictable and uncontrollable life
environmental, and developmental factors experiences
- Slightly more common in girls than in boys - Abuse negative parental behaviors
 Prevalence  Cognitive avoidance
- Relatively rare condition - Worrying actually triggers people with GAD to
avoid awareness of internal and external
threats and thus helps reduce their reactivity to
 Generalized anxiety disorder unavoidable negative events.
 Defining feature  Social anxiety disorder
- Uncontrollable worry - Intense anxiety or fear of being in social
- Worrywarts situations
 Excessive anxiety over ordinary, everyday - Being rejected, being judged, being humiliated
situations in public
- Intrusive - Avoidance of social interactions
- Causes distress and functional impairment - Most prevalent
- Encompasses multiple life domains - Contributes to the development of other
 Associated with physical symptoms: disorders
- Sleep disturbance - Challenging to treat
- Chronic restlessness  Accompanied symptoms
- Muscle tension - Trembling, sweating, confusion, dizziness,
- Astrointestinal symptoms palpitation, eventual panic attacks
 - Onset: early preschool or adolescence
- Taijinkyofu-sho
 Specific phobia
- Irrational fear of specific objects or situation
 Important: phobias are psychological disorder that
 Theories of social anxiety disorder
should not be confused with normal fears
 Biological factors:
 5 categories:
- Has genetic basis
- Animal type
- Dysregulation in some brain ares
- Natural environment type
- Amygdala, hippocampus, prefrontal cortex
- Situational type
 Cognitive factors
- Blood-injection-injury type
- High social performance standards
- Other
- Highly attuned to their self-presentation and
 Key symptoms:
internal feelings
- Marked fear or anxiety about a specific object,
- Hyperfocused on negative social cues
disproportionate to the actual danger
Self-defeating construal
- Avoidance of the object, or enduring it with
- Safety behaviors – to reduce anxiety
intense fear or anxiety
- Excessive rumination of social performance
- Lasts at least 6 months
and other’s reactions
- Cause clinically significant distress and
 Environmental factors:
functional impairment
- Overprotective, controlling, critical and
negative parenting
- Modeling of social anxiety by parents
 Agoraphobia
 Treatments of social anxiety disorder
- Fear of places where they might have trouble
 Drug therapy
escaping or getting help if they become
- SSNRI
anxious
- SNRI
- Often fear that they will embarrass themselves
 Cognitive behavioral therapy
if others notice their symptoms or their efforts
- Behavior: exposure
to escape during an attack
- Cognitive: challenging negative thoughts about
- Usual onset: young adulthood
themselves
- More common among women
- Acceptance and commitment therapy
 Theories of phobias
 Biological factors:
- First degree: 3-4x likelihood to have phobia
 Behavioral theories
- Two-factor theory
 Classical conditioning
- Creates the fear of the phobic object
 Operant conditioning
- Helps maintain it
- Negative reinforcement
- Observational learning
- Prepared classical conditioning

 Treatment for phobias

 Drug therapies
- Benzodiazepine
 Behavior therapy
- Systematic desensitization
- Modeling
- Flooding
- Applied tension technique