Abnormal Psychology

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Abnormal Psychology
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• Study of Clinical Psychology
• Psychological Disorders
•  Mental Health

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What is Abnormal Psychology?

• The study of the Division of Clinical Psychology

• Often will hear the term Mental Health

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What 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!

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Diagnosis What is abnormal?

• DSM V Diagnostic Statistical Manual V-May 2013
• Committees of Psychologists, Psychiatrists, and
  Social Workers
• Manual of psychological/psychiatric disorders

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• 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

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Behavioral 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

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ISSUES 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?

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Epidemiology 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
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• 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!
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• Heritability Estimate statistical measure that
  estimates the proportion of variance of a
  disorder that is due to genetic factors
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Steps 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

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Background 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

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Psychosocial 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
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Confidentiality

• 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

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Limits of Confidentiality

1. If the patient is a threat to themselves
2. Threat to others- Duty to warn- Tarasoff (1974)
3. Child Abuse (physical, psychological, sexual,
   neglect)
4. Insurance
5. Subpoena
6. New York State (2012)- if you believe a person is
   in possession of a weapon is a danger to others

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Physical 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)

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• 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.)

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Psychological Testing

• Projective Tests present an ambiguous stimulus
  to the patient and they will project their
  unconscious mind onto it
• Rorschach Test

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Thematic Apperception Test (T.A.T)
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Standardized 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

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Intelligence 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)

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Personality Testing

• Minnesota Multi-phasic Personality Inventory-2nd
  edition (MMPI-2)
• 364 true/false questions assessing various areas
  of psychological functioning

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10 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.

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• 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.

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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.
  

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VALIDITY 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.

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Other Standardized Tests to Assist with Assessment
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ETIOLOGY

• 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

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TREATMENT

• 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.

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• 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

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Factors 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

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MEDICATION

• 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.

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• 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.

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PSYCHOTHERAPY 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