psychopathology

A developmental disorder marked by an inability to focus attention, overactive & impulsive behavior, or both. 

In DSM-5, ADHD is included in section on Neurodevelopmental Disorders, rather than being grouped with the disruptive behavior disorders, i.e., Oppositional Defiant Disorder and Conduct Disorder. This change better reflects the way ADHD is currently conceptualized.

DSM-V also requires clinicians to specify the severity level of a client's ADHD as either Mild, Moderate, or Severe.  

Primary cause is thought to be biological, possibly relating to the frontal lobes of the brain. 

Several inattentive or hyperactive-impulsive symptoms must be present in two or more settings.

Combined presentation, Predominantly inattentive presentation, and Predominantly hyperactive-impulsive presentation.

Children with this disorder may have school difficulties as a result of their inability to focus and hyperactivity. ADHD is typically treated with stimulant medications and behavior therapy.

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Clinical psychopathology

Group of disorders in DSM characterized by anxiety (emotional/physiological response to an anticipated or imagined danger) & avoidance of anxiety-provoking stimuli. 

Includes GAD, OCD, panic disorder, and phobias.

Anxiety disorders are typically treated with medication (benzodiazepines and SSRIs) & CBT (exposure therapy). 

Often overlaps with mood disorders.

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psychopathology & Reiss' Index

Fear of behaviors or sensations associated with experience of anxiety. 

Bodily sensations related to anxiety are misattributed as a harmful experience causing more intense anxiety or fear.

Reiss developed a scale he called the “Anxiety Sensitivity Index”, which created a construct of anxiety sensitivity which other studies in this area could expound upon.

People with high anxiety sensitivity place a significantly higher value on their safety than does the average person. 

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An initial interview in which the counselor is gathering information about the patient and beginning to form a conceptualization of their case and their particular problems.

Interviews may be structured, in which case a certain order of questions is strictly adhered to, or they may be unstructured, in which the interviewer is free to follow their own course of questioning. 

Structured interviews are generally more reliable and valid, but lack the freedom of unstructured interviews to pursue a topic of interest or an instinct the interviewer has.

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Bipolar I vs. Bipolar II

Originally diagnosed by Kraeplin & called manic depressive psychosis

Mood disorder characterized by alternating periods of depression and mania or by mania alone. 

In Bipolar I, the person has episodes of full mania, characterized by euphoria and frenzied activity, often alternating with major depressive episodes. 

In Bipolar II, the person experiences periods of hypomania, a less severe form of mania, that may alternate with major depressive episodes.

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Case Study

Type of research in which one takes an in-depth look at one individual and their history, difficulties, and particular circumstances.

Case studies can be useful for such things as trying new treatments, using a treatment in a new population, or studying disorders that are very rare. 

However, case studies lack generalizability since they are only done with one individual and cannot establish a cause and effect relationship.

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Diagnosis in clinical counseling

Different approaches applied in approach to classifying mental disorders used in different versions of the DSM (in reference to DSM-IV and DSM-5).

Both approaches are represented in DSM-5 

While all disorders in DSM-5 remain in specific categories, measures indicating degree of acuteness have been added to several combined diagnoses.

The Categorical approach is the approach to classifying mental disorders involving assessment of whether individual has a disorder on basis of symptoms & characteristics described as typical of the disorder. This approach also uses 2 classification strategies: DSM & ICD.

The DSM names the disorders & describes them in specific terms. The ICD identifies symptoms that indicate the presence of a disorder.

Strengths for using this approach include: Helps communication; Allows diagnosis.

Weaknesses for using this approach include: Low inter-rater reliability; Lots of overlap between symptoms which can make diagnosis tricky; Stigma & labelling.

The Dimensional approach is approach to classifying mental disorders that quantifies person’s symptoms or other characteristics of interest & represents them with numerical values on one or more scales or continuums, rather than assigning them to a mental disorder category. Diagnosis more about degree to which particular characteristic is present.

Instead of making judgements, the dimensional approach asks the question “how much?” Lower scores equate to lower impairment and higher scores equate to higher impairment.

Strengths for using this approach include:

More detailed information on each symptom

It takes into account a wider range of factors. 

A profile created instead of labelling.

Weaknesses for using this approach include:

Time consuming

There is no standard inventory to compare scores, making diagnosis difficult.

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Process of gathering and evaluating relevant psychological, social, emotional, and physical data about a client. 

Assessment tools may be nomothetic (compared to norms) or idiographic (specific to the individual). 

Tools include interviews (structured and unstructured), observation, objective/projective tests, psychophysiological tests, and more. 

Assessment helps the clinician develop a diagnosis, a problem list, and a treatment plan.

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Presence of 2 or more disorders in one individual at the same time. 

Comorbidity is not uncommon.

Some disorders frequently present together, and it’s important to be aware of these so the therapist can check for them.

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Legal decision as to whether person charged with crime has capacity to understand the charges against them and ability to assist their lawyers in preparing a defense.

Has nothing to do with the insanity plea–competency to stand trial is about the person’s mental state at the time of the trial, not at the time of the crime. 

If found incompetent to stand trial, they will be treated until they are competent to stand trial.

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Disorder that is diagnosed in individuals under 18

Characterized by repeatedly violating the rights of others, displaying aggression, and other antisocial behaviors.

Conduct disorder is more serious than oppositional defiant disorder.

It is commonly thought of as the predecessor of antisocial personality disorder. 

Conduct disorder is tied to severe family dysfunction.

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Determination that a person’s problems are reflective of a particular disorder or syndrome in a particular classification system (typically DSM-5). 

Diagnostic labels make it possible for clinicians to communicate easily with each other, but they also carry a negative connotation and a social stigma. 

Diagnoses also may not be accurate or perfectly fit an individual’s symptoms.

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Diangostic and Statistical Manual of Mental Disorders 

(DSM 5)

Categorical system of diagnosis developed by the American Psychiatric Association & used by most mental health practitioners to diagnose mental disorders, updated in 2013.

The DSM-5 also contains research on each particular disorder and provides assistance in making a differential diagnosis.  

Advantages of the DSM include that it allows for easy communication between clinicians and helps to stimulate research.

Disadvantages include that diagnoses are stigmatizing and there can be significant overlap between disorders.

In most respects DSM-5 is not greatly changed from DSM-IV-TR. Notable changes include dropping Asperger syndrome as a distinct classification; loss of subtype classifications for variant forms of schizophrenia; dropping the "bereavement exclusion" for depressive disorders; a revised treatment and naming of gender identity disorder to gender dysphoria, and removing the A2 criterion for post traumatic stress disorder (PTSD) because its requirement for specific emotional reactions to trauma did not apply to combat veterans and first responders with PTSD.

DSM-5 has discarded the multi-axial system of diagnosis (formerly Axis I, Axis II, Axis III), listing all disorders in Section II. 

Beginning with the fifth edition, it is intended that diagnostic guidelines revisions will be added incrementally. (i.e., DSM-5.1)

Critics assert, for example, that many DSM-5 revisions or additions lack empirical support; inter-rater reliability is low for many disorders; several sections contain poorly written, confusing, or contradictory information; and the psychiatric drug industry unduly influenced the manual's content.

The new version replaces the NOS categories with two options: other specified disorder and unspecified disorder to increase the utility to the clinician. 

The first allows the clinician to specify the reason that the criteria for a specific disorder are not met; the second allows the clinician the option to forgo specification.

It has replaced Axis IV with significant psychosocial and contextual features and dropped Axis V (Global Assessment of Functioning, known as GAF). 

The World Health Organization's (WHO) Disability Assessment Schedule is added to Section III (Emerging measures and models) under Assessment Measures, as a suggested, but not required, method to assess functioning.

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psychopathology

Model hypothesizes that individuals who develop disorders have an inherited predisposition towards a disorder which is activated through stress in their environment. 

The diathesis-stress model is a biopsychosocial explanation of abnormal behavior, one that explains pathology as an interaction of all the influences in a person’s life (biological, genetic, social, emotional, etc.). 

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psychopathology

Characterized by one’s conscious awareness separating (dissociating) from certain memories, caused almost entirely by psychosocial factors rather than physical ones.

In the updates to the diagnostic manual (DSM-5), these include: dissociative amnesia (including dissociative fugue), dissociative identity disorder, and depersonalization/derealization disorder. 

Typically, a traumatic event precedes the loss in memory, and dissociation is thought to be a way of coping with this trauma.

5 core traits: amnesia, depersonalization, derealization, identity confusion, and identity alteration; one or more of these describe symptoms of varying dissociative disorders.

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Pathophysiology and Psychopathology

Dopamine is a neurotransmitter in the brain implicated in disorders such as schizophrenia.

In the 1950s, individuals with Parkinson’s disease were given a drug that increased their dopamine levels, and they subsequently began exhibiting schizophrenic-like symptoms.

Conversely, medications for schizophrenia may lead to Parkinson’s-like side effects.

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Disorders characterized by severe disturbances in eating behavior caused by a fear of gaining weight, or other issues surrounding eating habits.

They include binge eating disorder (where people eat a large amount in a short period of time), anorexia nervosa (where people eat very little and thus have a low body weight), bulimia nervosa (where people eat a lot and then try to rid themselves of the food), pica (where people eat non-food items), rumination disorder (where people regurgitate food), avoidant/restrictive food intake disorder (where people have a lack of interest in food), and a group of other specified feeding or eating disorders.

Anxiety disorders, depression, and substance abuse are common among people with eating disorders. Those who have experienced sexual abuse are also more likely to develop eating disorders.

Anorexia and bulimia occur nearly ten times more often in females than males.

Typically they begin in late childhood or early adulthood.

These disorders do not include obesity.

Only one eating disorder can be diagnosed at a given time.

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GABA

An inhibitory neurotransmitter used in the brain, lack of which is frequently associated with anxiety. Benzodiazepines are used in treatment of anxiety to increase GABA.

In addition, individuals who lack GABA may self-medicate with alcohol, which also increases GABA.

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Heritability

Genetics term to describe how much of a disorder is attributable to genetics, as opposed to how much a disorder is caused by the environment. 

Heritability is a factor in the nature versus nurture debate about how much of a disorder is attributable to biology and how much is attributable to the environment.

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HPA Pathway

developmental psychology

The hypothalamic-pituitary-adrenal axis (HPA axis) regulates cortisol production, released in response to stress. 

Cortisol production tends to be elevated in people with BPD, indicating a hyperactive HPA axis in these individuals. 

Since traumatic events can increase cortisol production and HPA axis activity, one possibility is that the prevalence of higher than average activity in the HPA axis of people with BPD may simply be a reflection of the higher than average prevalence of traumatic childhood and maturational events among people with BPD.

Increased cortisol production is also associated with an increased risk of suicidal behavior.

Chronic stress is seen to affect the parts of the brain where memories are processed through and stored. 

Also high cortisol levels can be tied to the deterioration of the hippocampus and decline of memory that many older adults start to experience with age.

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Idiographic Assessment/understanding

Term introduced by Allport

Idiographic assessments are those which are unique to the individual and cannot be compared to norms or standards.

A clinician must understand that many disorders manifest in idiographic ways.

Focuses on the individual and what is unique to them instead of what they have in common with others.

Insanity

Historically, everyone who was mentally ill was considered insane; presently, the term insane is largely a legal term used to describe an individual who was mentally unstable at the time of their crimes and is therefore innocent of all wrongdoing.

A person may plead not guilty by reason of insanity, and if they are judged to have been mentally unstable at the time of their crimes, they are committed for treatment until they improve.

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Mania is a state of abnormally elevated arousal, affect, and energy level with enhanced affective expression together with lability of affect.

Suicide is more common among manic depressives. A mixed affective state, especially with prominent manic symptoms, places the patient at a greater risk for completed suicide.

Depression coupled with increase in energy and goal-directed activity, increases suicide risk

The symptoms of mania are: heightened mood (either euphoric or irritable); flight of ideas and pressure of speech; and increased energy, decreased need for sleep, and hyperactivity.

Mania varies in intensity, from mild mania (hypomania) to delirious mania, marked by such symptoms as disorientation, florid psychosis, incoherence, and catatonia. 

It is a key component of other psychiatric disorders (as schizoaffective disorder, bipolar type).

In current DSM-5 nomenclature, hypomanic episodes are separated from the more severe full manic episodes, which, in turn, are characterized as either mild, moderate, or severe, with specifiers with regard to certain symptomatic features (e.g. catatonia, psychosis). 

May be divided into 3 stages: hypomania, or stage I; acute mania, or stage II; and delirious mania, or stage III. This “staging” of a manic episode is, in particular, very useful from a descriptive and differential diagnostic point of view.

Manic persons often can be mistaken for being on drugs.

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Mood Disorders

Characterized primarily by severe disturbances in mood.

Individuals with a mood disorder suffer from depression (significant sadness, lack of energy, and anhedonia), mania (euphoria, a belief that the world is theirs for the taking), or periods of both. 

Too little serotonin is thought to be a contributing factor to depression; too much norepinephrine is thought to be a contributing factor to mania.

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MRI

Magnetic Resonance Imaging is a noninvasive neuropsychological procedure which produces a very detailed picture of the brain’s structure through gathering information about the magnetic properties of hydrogen atoms of the brain.

MRIs have better resolution than their predecessor, CAT scans; however, they are also more expensive (and they will not show every minute detail, such as some microscopic tears from mild to moderate head injuries).

Can be helpful in determining if a disorder has a biological component. 

Ex: Adam, an individual diagnosed with schizophrenia, agredd to undergo an MRI to determine if the ventricles in his brain were larger than a normal individual’s, which might indicate a biological basis for some of Adam’s symptoms.

Nomothetic Assessment/Understanding

Term introduced by Allport

Nomothetic assessments are those which use norms and standards to determine if a person’s results are normal or abnormal. 

Nomothetic assessments prevent the clinician from starting from scratch every time they see a new client.

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Obsessive-Compulsive and Related Disorders

OCD is a classification found in the DSM-V, along with other anxiety-related disorders.

Other disorders under this classification include hoarding disorder (when a person doesn’t see a problem with excessive collecting), body dysmorphic disorder (BDD) (some with BDD have a compulsion in which they check themselves repeatedly, or obsessively), Body Focused Repetitive Behaviors (BFRBs) (when someone is obsessed with things like pulling their hair out or picking their skin), and Obsessive Compulsive Personality Disorder (people with OCD do not like their symptoms, while those with OCPD don’t see any issue).

Obsessive-compulsive disorder (OCD) is an anxiety disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), or behaviors that make them feel driven to do something (compulsions).

Often the person carries out the behaviors to get rid of the obsessive thoughts, but this only provides temporary relief. Not performing the obsessive rituals can cause great anxiety. 

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Oppositional Defiant Disorder

A childhood disorder, characterized by chronic misbehavior such as frequent arguing with adults and problems with anger.

Differs from conduct disorder in that it is more reactive, while conduct disorder is more proactive in violating the rights of others.

ODD may become CD without any intervention and with the influence of a deviant peer group.

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Panic Attack

psychopathology

Happens when an individual experiences a sudden period of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something really bad is going to happen.

The maximum degree of symptoms occurs within minutes. 

May be fear of losing control or chest pain. Panic attacks themselves are not dangerous.

Panic attacks can occur due to number of disorders including panic disorder, social anxiety disorder, post traumatic stress disorder, drug use, depression, and medical problems.

They can either be triggered or occur unexpectedly.

People who have repeated, persistent attacks or feel severe anxiety about having another attack are said to have panic disorder. 

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Personality Disorder

Personality disorders are characterized by chronic and inflexible patterns of responding to the environment that are exhibited in a wide range of contexts. Personality disorders disrupt an individual’s functioning in interpersonal, occupational, and psychological functioning. 

Can be hard to treat because personality disorders are ego-syntonic, or consistent with other aspects of an individual’s personality and belief systems.

3 clusters: A (schizotypal, paranoid and schizoid); B (histrionic, narcissistic, antisocial, and borderline); and C (dependent, avoidant, and obsessive compulsive).

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PET (Positron Emission Tomography) Scan

A neuropsychological test which looks at the functioning of the brain.

In order to take a PET scan, individuals must drink a radioactive solution which contains glucose which is then picked up on the scan. 

The person performs certain tasks or feels certain things and the areas of their brain that they are using shows up in the scan.

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Placebo Effect

Phenomenon that occurs in research when patients see an improvement in their condition even though they are taking a placebo or a sham treatment (not receiving the treatment). 

Shows that a patient’s expectancies about the outcome of treatment can have a significant effect on what outcome they will see.

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Positive vs. Negative Symptoms

Labels to classify symptoms seen in schizophrenia–positive symptoms are associated with excesses o additions to normal thoughts, emotions, and behaviors, while negative symptoms are associated with deficits in normal thoughts, emotions, and behaviors. 

Positive symptoms include delusions, hallucinations, and inappropriate affect.

Negative symptoms include poverty of speech (alogia), flat affect, and avolition. 

Determining which symptoms an individual has can help the clinician classify the type of schizophrenia. 

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Psychosis

psychopathology

An abnormal condition of the mind described as involving a "loss of contact with reality". 

Psychosis is a descriptive term for the hallucinations, delusions and impaired insight that may occur.

Psychosis is generally the term given to noticeable deficits in normal behavior (negative signs) and more commonly to diverse types of hallucinations or delusional beliefs, particularly with regard to the relation between self and others as in grandiosity and paranoia.

People with psychosis are described as psychotic. 

People experiencing psychosis may exhibit some personality changes and thought disorder. 

Depending on severity, this may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out daily life activities.

Psychosis as a sign of a psychiatric disorder is a diagnosis of exclusion (of other medical illnesses as a cause). 

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Primary vs. Secondary Gain

Primary gain or secondary gain are used in psychology to describe the significant subconscious psychological motivators patients may have when presenting with symptoms. 

Primary morbid gain produces positive internal motivations. 

Primary gain is most typically demonstrated in conversion disorder – a psychiatric disorder in which stressors manifest themselves as physical symptoms without organic causes. 

Secondary gain can also be a component of any disease, but is an external motivator. If a patient's illness allows him/her to miss work, avoid military duty, obtain financial compensation, obtain drugs, or avoid a jail sentence, these would be examples of a secondary gain. 

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Remission

A decrease in the severity of a disease or an absence of symptoms of the disease, typically from a chronic/lifelong disease that may manifest at a later time.

Eysenck postulated that 2/3 of patients with mental disorders will spontaneously remit without psychotherapy, which promted a close examination of the effectiveness of psychotherapy.

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Schizophrenia

First discovered by Emil Kraeplin

A psychotic disorder characterized by hallucinations, delusions, disorganized or inappropriate affect and behaviors, or catatonia. 

Symptoms must have been present for six months and include at least one month of active symptoms. 

Schizophrenia is thought to be related to an excess of dopamine in the brain, among other factors.

Medications to treat schizophrenia may have side effects as severe as the disease itself. The disease can be debilitating and lifelong.

DSM-5 raises the symptom threshold, requiring that an individual exhibit at least two of the specified symptoms (previously only one needed).

The DSM 5 removed subtypes and some of the subtypes are now specifiers to help provide further detail in diagnosis. 

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Serotonin

Neurotransmitter in the brain. Lack of serotonin is associated with a number of disorders, including anxiety and mood disorders. 

Treatment for these disorders typically involves the use of selective serotonin reuptake inhibitors, which prevent serotonin from being taken back into the neuron, thereby leaving the serotonin in synapses for longer.

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State vs. Trait Anxiety

psychopathology

State anxiety can be defined as fear, nervousness, discomfort, and the arousal of the autonomic nervous system induced temporarily by situations perceived as dangerous (i.e., how a person is feeling at the time of a perceived threat).

Examples: A child feels anxious when confronted by a large, strange animal. A person feels anxious to get on an airplane for the first time.

Trait anxiety can be defined as a relatively enduring disposition to feel stress, worry, and discomfort.

Examples: A child experiences anxiety in social situations and is always anxiety prone throughout their childhood and adulthood. A person experiences anxiety in an array of normal situations such as going to the grocery store or going to work.

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Substance-related Disorders

psychopathology

Characterized by a pattern of maladaptive behavior associated with the use or abuse of drugs that alter the way one thinks, feels, and/or behaves. 

Disorders are characterized by an inability to abstain from the drug or an inability to use it in moderation (i.e. with alcohol). 

Abuse of drugs may lead to legal problems and impairment in social, occupational, and interpersonal functioning.

The more recently published DSM-5 combined substance abuse and substance dependence into a single continuum; this is simply known as substance use disorder and requires more presenting symptoms before a diagnosis is made. It also considers each different substance as its own separate disorder. It also distinguishes the difference between dependence and addictions as two separate disorders, not to be confused.

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Tolerance vs. Withdrawal Symptoms

substance-related disorders & clinical assessment

Tolerance describes the diminishing effect of a drug resulting from repeated administration at a given dose; withdrawal symptoms are those that occur upon cessation of repeated drug use.

Behavioral tolerance may occur through drug-independent learning or as a form of pharmacodynamics tolerance in the brain.

Behavioral tolerance is often context dependent, meaning tolerance depends on the environment in which the drug is administered, and not the drug itself.

Withdrawal symptoms from opiate abuse (such as heroin/morphine) include anxiety, sweating, vomiting, and diarrhea. Symtoms vary widely according to the substance.

The route of administration, whether intravenous, intramuscular, oral or otherwise, can also play a role in determining the severity of withdrawal symptoms. 

There are different stages of withdrawal as well; generally, a person will start to feel bad (crash or come down), progress to feeling worse, hit a plateau, and then the symptoms begin to dissipate. 

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Trauma and Stress or Related Disorders

psychopathology

Disorders in which the diagnostic criteria explicitly list exposure to a traumatic or stressful event.

These disorders include: acute stress reaction, adjustment disorder, disinhibited social engagement disorder (child walks up to any adult), post-traumatic stress disorder, reactive attachment disorder (failure to form healthy attachments and inappropriate social relations), and ulysses syndrome (migrants experiencing chronic stress).

All psychological traumas originate from stress, a physiological response to an unpleasant stimulus.

Studies surely show a correlation between the size of hippocampus and one's susceptibility to stress disorders.

Psychological trauma may cause an acute stress reaction which may lead on to posttraumatic stress disorder (PTSD). 

The symptoms of PTSD must persist for at least a month for diagnosis.  

4 main categories of symptoms: Trauma (i.e. intense fear), reliving (i.e. flashbacks), avoidance behavior (i.e. emotional numbing), and hypervigilance (i.e. irritability).

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In the context of research statistics in psychology, clinical significance is the practical importance of a treatment effect - whether it has a real genuine, palpable, noticeable effect on daily life.

Clinical significance yields information on whether a treatment was effective enough to change a patient’s diagnostic label. 

In terms of clinical treatment studies, clinical significance answers the question "Is a treatment effective enough to cause the patient to be normal [with respect to the diagnostic criteria in question]?"

It is very possible to have a treatment that yields a significant difference and medium or large effect sizes, but does not move a patient from dysfunctional to functional.

Later defined as “the extent to which therapy moves someone outside the range of the dysfunctional population or within the range of the functional population.”

Clinical significance is also a consideration when interpreting the results of the psychological assessment of an individual.

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