Psychopathology: Background and Methods
Terms
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- comorbidity
- having more than one disorder at the same time
- epidemiology
- scientific study of the frequency and distribution of disorders in a population
- experimental hypothesis
- a prediction made by an investigator to be tested in an experiment
- abnormal psychology
- the application of psychological science to the study of mental disorders
- symptoms
- reportable indicators (e.g. hearing voices)
- signs
- observable indicators (e.g. slashed wrists)
- syndrome
- a group of signs and symptoms that represent a specific type of disorder
- psychosis
- disorder, out of touch with reality
- personal distress
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a way of defining psychopathology; subjective expression of feelings
inadequate when the person does not realize s/he is delusional (cf. Kevin the schizophrenic) - statistical rarity
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a way of defining what is psychopathology; statistically unusual behavior
does not say how far outside of statistical norms something must be or consider whether the behavior is harmful or adaptive - harmful dysfunction
- Wakefield's way of defining psychopathology; if the condition causes harm (as judged culturally) and results from internal dysfunction of a mental capacity, it is mental illness
- DSM definition of psychopathology
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associated with:
1. present distress
2. disability
3. significant risk of suffering pain, death, disability, etc. - biological disadvantage
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Kendell's definition of psychopathology: if something causes an evolutionary disadvantage (increased mortality, decreased fertility)
YET, homosexuality, psoriasis meet these criteria, aren't considered mental illnesses - social constructions
- Sedgwick's idea that all branches of medicine involve social value judgements, points of view
- Antipsychiatrist critique
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Thomas Szasz: mental illness is a myth. Mental problems caused by problems in living (moral conflicts)
argued that since psychiatry wasn't objective, it wasn't a legitimate medical profession
said too much power was given to psychologists - incidence
- the number of new cases of a disorder that appear in a given time period
- prevalence
- the total number of cases of a disorder in a given time period
- culture
- shared values, beliefs, and practices
- disease burden
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the impact of disease on someone's life
takes into account mortality + disability - labeling theorist critique
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self-fulfilling prophecies
Rosenhan Pseudopatient study: patients who were normal but said they were hearing voices were kept at mental institutions for weeks/months. - exaptations
- something indirectly selected for (e.g. feathers originally provided warmth, not flight)
- adaptations
- something directly selected for (e.g. standing erect)
- central tendency
-
want to find the middle for statistical purposes
mean, median, or mode - general paresis
- (schizophrenia) found to be caused by the syphillus spirochete
- father of systems theory
- Ludwig von Bertalanffy
- paradigm
- comprised of a specific theory and a set of assumptions about how the theory is tested; thus the paradigm itself limits the field of possible factors to be evaluated
- holism
- the whole is greater than the sum of its parts
- reductionism
- the whole is only the sum of its parts
- biological paradigm
- abnormal behavior based on biological abnormalities
- psychodynamic paradigm
- abnormal behavior caused by unconscious mental conflicts rooted in childhood experience
- cognitive-behavioral paradigm
- abnormal behavior as a product of learning
- humanistic paradigm
- human behavior caused by choices. Emphasis on free will.
- equifinality
- many causes, one disorder
- multifinality
- one cause, many outcomes
- reciprocal causality
-
instead of A causing B, B could be causing A
mutual simultaneous influence (e.g. parents and children) - diathesis
- biological predisposition
- stress
- a difficult life experience that "triggers" predispositions
- risk factor
- things that are correlated with increased chance of having a disorder
- third variable
- the relationship between A and B could be caused by C.
- premorbid history
- pattern of behavior that precedes the disorder
- prognosis
- typical path that the disorder follows
- descriptive psychopathology
- describing (but not explaining) signs and symptoms
- dualism
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the idea that the mind and body are separate entities
can't describe PP as "chemical imbalances" because all psychological processes have a biological basis - bidirectional causality
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each variable affects the other
e.g. brain injury effects psychological experience; loss of loved one effects brain activity - eliminative materialism (mind-body problem)
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the idea that behavior and experience stem from purely biological causes
one-way causality from brain to mind
no free will -
functionalism
(mind-body problem) -
the idea that states of mind are functional states of the brain
two people can both have depression, but it could result from different biological causes
against: Searle's Chinese Room thought problem - probands
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index cases
if a higher incidence of illness is found in families with an ill proband, it suggests genetic causation - concordance rates
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higher concordance in MZ twins points to genetic influence
high concordance for MZ and DZ twins points to shared environment
low concordance for MZ and DZ points to non-shared environment. - causal factors for PP: psychological
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1. human nature and temperament
2. learning and cognition
3. sense of self
4. stages of development - causal factors for PP: social
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1. relationships
2. gender and gender roles
3. prejudice and poverty
4. societal values - limbic system
- central to regulation of emotion and learning
- psychophysiology
- study of changes in the functioning of the body based on psychological experiences
- possible misinterpretations of genetic findings
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1. that a disorder is caused by a gene
2. that a genetic disorder is inevitable
3. that a characteristic of a genetic disorder cannot be modified - temperament
- one's basic style of relating to the world (e.g. extroverted)
- social cognition
- how humans process information about themselves and others
- modeling
- learning through imitation
- attributions
- perceived causes; people's beliefs about cause-effect relations
- mind-body problem
- a philosophical and scientific challenge regarding how best to explain in compelling terms the fact that human consciousness, intentionality, subjectivity, agency and free will are somehow realized in the pysical materials or properties of functioning brains
- biological approach to treating PP
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ECT
psychosurgery
psychopharmacology - psychodynamic approach to treating PP
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intervenes in unconscious motivations and defenses
hydraulic model of the mind
use transference, ego analysis (focuses on defense mechanisms) - cognitive-behavioral approach to treating PP
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intervenes in learned patterns of behavior and cognition
Pavlov: classical conditioning
Skinner: operant conditioning
treatments: exposure, aversion, contingency management, social skills, cognitive techniques, Beck's cognitive tx, rational-emotive tx - humanistic model
- intervenes in self-awareness, client-centered, therapist is non-expert, empathetic relationship
- therapeutic triad
- vulnerable patient + costly service + experienced clinician
- independent variable
- e.g. treatment vs. no treatment
- dependent variable
- the outcome that is proposed to vary (e.g. symptoms)
- internal validity
- whether something works (reliable causal interference)
- external validity
- whether something is generalizable (usefulness)
- efficacy
- can treatment work? (concerned with internal validity)
- efficiency
- does treatment work in the real world (concerned with external validity)
- outcome research
- the study of how effective therapies are in terms of alleviating symptoms
- process research
- which aspects of therapy are generating results?
- consumer reports study
- found 87% of people were helped by therapy, medication added little to treatment
- neo-Kraepelinian revolution
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when psychopathology started being viewed under scientific terms, led to DSM
opposed to psychoanalytic dominance
committed to principles of medicine, biological reductionism - kappa
- measures if something is caused by chance or not. A kappa below .4 means it is likely chance, over .7 means likely not
- DSM III
- offered improved diagnostic reliability, multiaxial diagnostic procedure, diagnostic categories, larger and more comprehensive
- DSM IV
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more disorders, 16 diagnostic classes
organized by phenomenology, etiology, developmental onset
hierarchical classification - diagnosis
-
a judgement about disorders, application of the DSM IV criteria.
includes judgements about all axes at once - reliability
- how consistently can professionals use the classification to correctly organize particular instances of the domain of interest?
- coverage
- how comprehensively the classification specifies the domain of interest (DSM inclused a NOS category)
- diagnostic overlap
- how precisely does the classification partition the domain of interest?
- sources of variation that limit reliability
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1. clinician variance
2. instrument variance
3. patient variance
4. method variance
5. disorder variance within single classification - validity
- how persuasively does evidence support the classification in terms of its meaningfulness and utility?
- content validity
- does the disorder include the attributes and characteristics that are actually observed?
- criterion validity
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does the disorder correlate with relevant external variables?
examples: concurrent and predictive validity - concurrent validity
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concerned with present time and with correlations between the disorder and other symptoms, circumstances, and test procedures
e.g. schizophrenia correlates with present drop in IQ - predictive validity
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concerned with the future and with the stability of the problem over time
e.g. schizophrenia correlates with future suicide attempt - hypothetical construct
- conceptual abstraction or postulated entity cast within a broader theoretical network
- intervening variable
- the measure of a hypothetical construct (e.g. vaginal congestion)
- operational definition
- specification of measures for intervening variables used to investigate hypothetical constructs (e.g. penile plethysmograph)
- construct validity
- the overall strength of the network of relations that have been observed among variables that are used to define a construct. The extent to which the construct possesses some systematic meaning.
- construct validation
- scientific efforts to assess the construct validity of a given hypothetical construct
- inclusion
- conditions that must be present for a positive diagnosis
- exclusion
- conditions that, if present, rule out a positive diagnosis
- etiological validity
- deals with what we know about a disorder prior to onset
- artifactual comorbidity
- only one disorder is present, but overlap makes it seem like more than one disorder is present
- validation strategy: syndrome ID
- systematic description (e.g. dementia praecox)
- validation strategy; boundary ID
- demonstrated distinctions (e.g. dementia praecox vs. manic-depression)
- assessment procedures
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1. interviews
2. observation
3. personality tests
4. self-report inventories
5. projective tests
6. psychophysiological tests
7. brain imaging - goal of construct validation
- to identify the distinctive etiology or specific pathways and processes leading to PP