Title: Abnormal Psychology
1Abnormal Psychology
2- Study of Clinical Psychology
- Psychological Disorders
- Mental Health
3What is Abnormal Psychology?
- The study of the Division of Clinical Psychology
- Often will hear the term Mental Health
4What is the focus of the Mental Health Field?
- Diagnosis Diagnostic Statistical manual (DSM
IVTR), Normal versus Abnormal - Etiology Schools of Psychology
- Treatment Evidenced Based Practice
- Prognosis outcome of the disorder once it is
treated - Multi-Disciplinary field Psychologists,
Psychiatrists, Social Workers and others!
5Diagnosis What is abnormal?
- DSM V Diagnostic Statistical Manual V-May 2013
- Committees of Psychologists, Psychiatrists, and
Social Workers - Manual of psychological/psychiatric disorders
6- Great care taken to the greatest extent possible,
avoid subjectivity and try to have an objective
definition (i.e. homosexuality as a disorder) - Start with the premise that All Behavior Is
Normal! (i.e. depression, anxiety, even
killing!) - Normal-------------------------\------------------
--------Abnormal - Whether a behavior is abnormal depends on a
number of factors which determine where it falls
on this continuum
7Behavioral Domain
- Context- expectable and culturally sanctioned
response - Societal norms law
- Frequency/Duration/Intensity
- Personal Distress ? Ego Dystonic
- Distress to others
- Loss of control
- Maladaptive impairment/interference in daily
functioning, risk - Threat to self/others
- Psychosis loss of touch with reality
- Competency- Has legal/civil rights issues
attached to it
8ISSUES WITH DIAGNOSIS
- Reliability whether or not two different doctors
arrive at the same diagnosis for the same patient - Comorbidity when two or more separate disorders
in an individual- happens a lot with DSM
classification and is often used as a criticism
of it - Differential Diagnosis when there is overlap of
two symptoms, which of 2 disorders is it?
9Epidemiology the study of the distribution and
determinants of health-related states in
specified populations, and the application of
this study to control health problems.
- Prevalence rate number of people who have the
disorder over a given time period - (2005)- Major depressive Disorder (6.7)
- Compare Anxiety/Depression now to assess
etiological contributions of financial stress -
10- Lifetime Prevalence Rate probability of being
diagnosed with the disorder over a life-time - Kessler, et. al (2005)- 46.4 of Americans will
be diagnosed with a Psychological Disorder in
their life-time- it is normal! -
- Heritability Estimate statistical measure that
estimates the proportion of variance of a
disorder that is due to genetic factors -
11Steps of the Diagnostic Process
- Identification of presenting problem
- Is it situational (divorce, loss of job) or is it
more pervasive? - How much has it affected the persons
functioning? - Is crisis intervention necessary (i.e.
suicide/psychosis) - Deterioration in cognitive functioning
- Acute changes
12Background history/Psychosocial assessment
- Individual and Family Information Related to
- Prenatal/Birth/Developmental History
- Educational/employment history
- Psychiatric history
- Past/present Social Functioning
- Past/Present Relationship History
13Psychosocial Risk factors these can lead to
actual changes in the brain!
- Early deprivation/trauma
- Abuse (Sexual, Physical, Emotional)
- Inadequate parenting styles
- Marital discord/divorce
- Maladaptive peer relationships
- Low SES
- STRESS
-
14Confidentiality
- Most information is obtained via a clinical
interview. It is recognized that such data may be
prone to inaccuracies. - It is good clinical practice to try and obtain
objective verification of this information. - Health Insurance Portability and Accountability
Act (HIPAA) - The strength of the therapeutic alliance is
strongly dependent on the concept of
confidentiality - HIPAA and other laws are designed insure
information that is obtained within a
psychotherapy session remains confidential
15Limits of Confidentiality
- If the patient is a threat to themselves
- Threat to others- Duty to warn- Tarasoff (1974)
- Child Abuse (physical, psychological, sexual,
neglect) - Insurance
- Subpoena
- New York State (2012)- if you believe a person is
in possession of a weapon is a danger to others
16Physical assessment
- General physical examination to rule out any
organic problems (ie. Hormonal irregularities)
that might account for the symptoms - Neurological examination to assess the
possibility of brain involvement, includes the
use of more sophisticated brain imaging
techniques (MRI, PET, etc)
17- Neuropsychological evaluation determines
brain-behavior relationships-for when physical
changes are not detectable- the use of various
testing devices to measure a persons cognitive,
perceptual and motor performance for clues to the
extent and location of brain damage. - Typically the best way to diagnose those
disorders in which brain deterioration is of
primary concern (i.e. Alzheimers disease,
Stroke, M.S.)
18Psychological Testing
- Projective Tests present an ambiguous stimulus
to the patient and they will project their
unconscious mind onto it - Rorschach Test
19Thematic Apperception Test (T.A.T)
20Standardized Tests are scientifically developed
- 1. Standardized Administration
- 2. Standard Scores measure of how much a
particular score is above or below the mean - Norm Referenced Scoring- relative to the norms
21Intelligence tests
- The Weschler Scales WISC-IV, WAIS-IV) are the
most widely used IQ tests - Since they are labor intensive, and expensive,
they are only used in those situations where
cognitive impairment is a primary concern (i.e.
learning disability, dementia)
22Personality Testing
- Minnesota Multi-phasic Personality Inventory-2nd
edition (MMPI-2) - 364 true/false questions assessing various areas
of psychological functioning
23(No Transcript)
2410 Clinical Scales
- Hypochondriasis (Hs) The Hypochondriasis scale
tapes a wide variety of vague and nonspecific
complaints about bodily functioning. These
complaints tend to focus on the abdomen and back,
and they persist in the face of negative medical
tests. There are two primary factors that this
subscale measures poor physical health and
gastrointestinal difficulties. The scale contains
32 items. - Depression (D) The Depression scale measures
clinical depression, which is characterized by
poor morale, lack of hope in the future, and a
general dissatisfaction with ones life. The
scale contains 57 items. - Hysteria (Hy) The Hysteria scale primarily
measures five components poor physical health,
shyness, cynicism, headaches and neuroticism. The
subscale contains 60 items. - Psychopathic Deviate (Pd) The Psychopathic
Deviate scale measures general social
maladjustment and the absence of strongly
pleasant experiences. The items on this scale tap
into complaints about family and authority
figures in general, self alienation, social
alienation and boredom. The scale contains 50
items. - Masculinity/Femininity (Mf) The
Masculinity/Femininity scale measures interests
in vocations and hobbies, aesthetic preferences,
activity-passivity and personal sensitivity. It
measures in a general sense how rigidly a person
conforms to very stereotypical masculine or
feminine roles. The scale contains 56 items.
25- 6. Paranoia (Pa) The Paranoia scale
primarily measures interpersonal sensitivity,
moral self-righteousness and suspiciousness. Some
of the items used to score this scale are
clearly psychotic in that they acknowledge the
existence of paranoid and delusional thoughts.
This scale has 40 items. -
- 7. Psychasthenia (Pt) -The Psychasthenia scale
is intended to measure a persons inability to
resist specific actions or thoughts, regardless
of their maladaptive nature. Psychasthenia is
an old term used to describe what we now call
obsessive-compulsive disorder (OCD), or having
obsessive- compulsive thoughts and behaviors.
This scale also taps into abnormal fears,
self-criticisms, difficulties in concentration
and guilt feelings. This scale contains 48
items. - 8. Schizophrenia (Sc) The Schizophrenia scale
measures bizarre thoughts, peculiar perceptions,
social alienation, poor familial relationships,
difficulties in concentration and impulse
control, lack of deep interests, disturbing
question of self-worth and self-identity, and
sexual difficulties. This scale has 78 items,
more than any other scale on the test.
26 9. Hypomania (Ma) The Hypomania scale is
intended to measure milder degrees of
excitement, characterized by an elated but
unstable mood, psychomotor excitement (e.g.,
shaky hands) and flight of ideas (e.g., an
unstoppable string of ideas). The scale taps
into overactivity both behaviorally and
cognitively grandiosity, irritability and
egocentricity. This scale contains 46 items.
- 10. Social Introversion (Si)- The Social
Introversion scale measures the social
introversion and extroversion of a person. A
person who is a social introvert is
uncomfortable in social interactions and
typically withdraws from such interactions
whenever possible. They may have limited social
skills, or simply prefer to be alone or with a
small group of friends. This scale has 69 items.
27VALIDITY SCALES
- Lie (L) The Lie scale is intended to identify
individuals who are deliberately trying to avoid
answering the MMPI honestly and in a frank
manner. The scale measures attitudes and
practices that are culturally laudable, but
rarely found in most people. In other words,
people who make these items are often trying to
make themselves look like a better person than
they really are (or that anybody is). - F The F scale is intended to detect unusual or
atypical ways of answering the test items, like
if a person were to randomly fill out the test.
It taps a number of strange thoughts, peculiar
experiences, feelings of isolation and
alienation, and a number of unlikely or
contradictory beliefs, expectations and
self-descriptions. If a person answers too many
of the F and Fb scale items incorrectly, it will
invalidate the entire test. - Back F (Fb) The Back F scale measures the same
issues as the F scale, except only during the
last half of the test. The scale has 40 items. - K The K scale is designed to identify
psychopathology in people who otherwise would
have profiles within the normal range. It
measures self-control, and family and
interpersonal relationships, and people who score
highly on this scale are often seen as being
defensive.
28Other Standardized Tests to Assist with Assessment
29ETIOLOGY
- Generally understood in the theoretical context
of one of the schools we have discussed - In general, research has shown certain theories
tend to fit better with certain disorders - Psychoanalysis Personality Disorders
- Behaviorism Children, Substance Abuse
- Humanism Adjustment issues
- Cognitive Depression/Anxiety
- Biological versus psychological or with it?
- Plasticity and interaction with environment!
- Diathesis-Stress A person has a diathesis
(predisposition) towards developing a disorder
which is then brought out by the presence of a
stressor
30TREATMENT
- Psychotherapy is a general term for treating
mental health problems by talking with a
psychiatrist, psychologist or other mental health
provider. - During psychotherapy, you learn about your
condition and your moods, feelings, thoughts and
behaviors. Psychotherapy helps you learn how to
take control of your life and respond to
challenging situations with healthy coping
skills. - There are many specific types of psychotherapy,
each with its own approach. The type of
psychotherapy that's right for you depends on
your individual situation. Psychotherapy is also
known as talk therapy, counseling, psychosocial
therapy or, simply, therapy.
31- Does Psychotherapy Work?
- Hans Eysenck (1952) the percentage of clients
who improved following any kind of psychotherapy
was lower than those who received no treatment - There have been plenty of studies which have
suggested otherwise and it is probably impossible
to answer scientifically in a way that applies to
all treatments and/or disorders- too many
confounding variables! - Clinically significant benefits improvement must
be measurable and substantial enough to make
treated clients similar to those people whom have
not experienced a disorder
32Factors Related to Success in Therapy
- Client Factors persistence, openness, faith,
optimism, resilience, social support - Strength of the therapeutic alliance- trust
- Expectancy/Placebo client's belief of being
helped and the hopeful expectations that
accompany the method. - Match between the approach and the problem
- Personality Disorders Psychodynamic
- Substance Abuse Behavioral
- Depression/Anxiety Cognitive-Behavioral
- Adjustment Related Disorders Humanism
33MEDICATION
- Medications treat the symptoms of mental
disorders. They cannot cure the disorder, but
they make people feel better so they can
function. - Medications work differently for different
people. Some people get great results from
medications and only need them for a short time.
For example, a person with depression may feel
much better after taking a medication for a few
months, and may never need it again. People with
disorders like schizophrenia or bipolar disorder,
or people who have long-term or severe depression
or anxiety may need to take medication for a much
longer time.
34- Some people get side effects from medications and
other people don't. Doses can be small or large,
depending on the medication and the person.
Factors that can affect how medications work in
people include - Type of mental disorder, such as depression,
anxiety, bipolar disorder, and schizophrenia - Age, sex, and body size
- Physical illnesses
- Habits like smoking and drinking
- Liver and kidney function
- Genetics
- Other medications and herbal/vitamin supplements
- Diet
- Whether medications are taken as prescribed.
35PSYCHOTHERAPY VERSUS MEDICATION
- Pros and Cons of Each
- Medication Faster, Cheaper, less work side
effects, higher rate of relapse, dependence - Psychotherapy teach skills that apply elsewhere,
less chance of relapse slower, more work - Combination of both