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Abnormal Psychology

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Abnormal Psychology 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. – PowerPoint PPT presentation

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Title: Abnormal Psychology


1
Abnormal Psychology
2
  • Study of Clinical Psychology
  • Psychological Disorders
  •  Mental Health

3
What is Abnormal Psychology?
  • The study of the Division of Clinical Psychology
  • Often will hear the term Mental Health

4
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!

5
Diagnosis 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

7
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

8
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?

9
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
  •  

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
  •  

11
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

12
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

13
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
  •  

14
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

15
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

16
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)

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.)

18
Psychological Testing
  • Projective Tests present an ambiguous stimulus
    to the patient and they will project their
    unconscious mind onto it
  • Rorschach Test

19
Thematic Apperception Test (T.A.T)
20
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

21
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)

22
Personality Testing
  • Minnesota Multi-phasic Personality Inventory-2nd
    edition (MMPI-2)
  • 364 true/false questions assessing various areas
    of psychological functioning

23
(No Transcript)
24
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.

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.

27
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.

28
Other Standardized Tests to Assist with Assessment
29
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

30
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.

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

32
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

33
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.

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.

35
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
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