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Abnormal Psychology - Lecture notes - Chapter 1

Abnormal Psychology (Texas Tech University)

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Chapter 1:

 History of abnormal behavior

o Understanding psychopathology
 Psychological disorder – different from norm, could be
biological, psychological dysfunction, distress or impairment,
atypical response
 Psychological dysfunction:
 Breakdown in function
o Cognitive
o Behavioral
o Emotional
 Personal distress or impairment:
 Individual vs. others
 Appropriateness to situation
 Degree of impairment
 Response/behavior is atypical or culturally unexpected
 More than deviations from average or norm
 Violation of social norms
 Harmful dysfunction
 Psychopathology – scientific study psychological disorders
 Who studies:
 Clinical and counseling psychologists (PhD, PsyD)
 Psychiatrists (MD)
 Psychiatric social workers (MSW)
 Psychiatric nurses (MN, MSN, PhD)
 Marriage and family therapists (MA, MS, MFT)
 Mental health counselors (MA, MS)
 Clinical description – behaviors, thoughts, and feelings
involved in disorder
 Prevalence (how many people have it in general) and
incidence (how many new cases did we get in a certain
time period)
 Course (how does it manifest)
o Chronic – always present
o Episodic – you’ll have it for a little bit
o Time-limited – have it for a little bit of time
 Onset (when did it start)
o Acute (quick/right now) vs. insidious (gradual)
o May shape outcome
 Prognosis (outcome?)
o Goovisdegarsis
 Age of onset may shape presentation
 Developmental psychology
 Developmental psychopathology

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 Life-span development psychopathology

 Etiology
 Biopsychosocial dimension
 Treatment
 Pharmacological
 Psychosocial
 Outcome
o Historical conceptions of abnormal behavior
 Major psychological disorders have existed across time and
cultures
 Causes and treatment of abnormal behavior varied widely,
depending on context
o Supernatural tradition
 Deviance – battle of good vs. evil
 Etiology – devil, witchcraft, sorcery
o Great Persian Empire (900 to 600 BC)
o 14th and 15th century Europe
o Salem witch trials in U.S.
 Demons and witches
 Treatments – exorcism, torture, and crude surgeries
 Stress and melancholy
 Etiology – natural, curable phenomenon
 Illness model
 Still connected with sin
 Treatments for possession
 Mass hysteria
 St. Vitus’ dance
 Tarantism
 Modern mass hysteria
 Emotion contagion
 Mob psychology
 The moon and the stars
 Moon and stars
 Paracelsus
o Lunacy
 Modern examples:
o Astrology (horoscope/zodiac)
o Biological tradition
 Hippocrates (469 – 377 BC)
 Father of modern Western medicine
 Etiology – physical disease
 Precursor to somatoform disorders (body)
o Hysteria
 Galen (129 – 198 AD)
 Hippocratic foundation

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 Humoral theory of mental illness (imbalance of liquids

in brain and body)
 Etiology – brain chemical imbalances
 Treatments – environmental regulations
o th
19 Century
 Syphilis and general paresis
 STD with psychosis-like symptoms
o Delusions
o Hallucinations
 Etiology – bacterial microorganism
o Louis Pasteur’s germ theory
 Biological basis for madness
 John Grey*
o Development of biological treatments
 Mental illness – physical illness
 1930s
 Insulin shock therapy
 Brain surgery
 ECT
o Treatment for depression?
 1950s
 Psychotropic medications
o Increasingly available
o Systemically developed
 Neuroleptics
o Reserpine and psychosis
 Tranquilizers
o Benzodiazepines and anxiety
o Consequences of biological tradition
 Increased hospitalization
 Untreatable conditions
 Improved diagnosis and classification
 Emil Kraepelin
 Increased role of science in psychopathology
o Psychological tradition
 Plato, Aristotle, and Greece
 Etiology
o Social and environmental factors
 Treatment
o Reeducation via discussion
o Therapeutic environments
 Similar practices in ancient Muslin countries
o Moral therapy
 Moral = emotional or psychological/what you think is right
and wrong (as an individual)

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 Treating patients normally

 Encouraging social interaction
 Focus on relationships
 Individual attention
 Education
o Asylum reform and decline of moral therapy
 Declines in mid-19th century
 Increased numbers of patients
o Immigrants
o Homeless
 Mental Hygiene Movement – treating
mentally unstable people as actual people
 Dorothea Dix = prodigy of Petite 
she brought over his hygiene
thoughts and treating them like
people
 Staffing problems
 Outcome = decreased treatment efficacy
o Psychoanalytic theory
 Anton Mesmer
 Mesmerism and hypnosis
 Suggestibility
 Jean Charcot
 Hypnosis as treatment
 Mentor to Freud
 Josef Breuer
 Furthered hypnosis treatments
 Collaborator with Freud
 Conscious vs. unconscious:
 Id
o Innate pleasure principle
o Illogical, emotional, irrational
o Unconscious
o Bad angel on shoulder
 Ego
o Reality principle
o Logical and rational
o Conscious
 Superego
o Moral principle
o Balances id and ego
o Conscious
o Good angel on shoulder
 Defense mechanisms
 Ego fights to stay on top of id and superego

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 Loss = anxiety
 Coping strategies include:
o Displacement
o Denial
o Rationalization
o Reaction formation
o Projection
o Repression
o Sublimation
 Stages of psychosexual development
 Patterns of gratifying basic needs
o Oral – babies put everything in their
mouth/most developed sense
o Anal – potty training/elimination/pleasure out
of controlling bowel movements, anal people =
control freaks
o Phallic – boys realize they have phallus and girls
realize they don’t
o Latency – nothing really happens for a while 
erupts in puberty
o Genital – puberty/everything is about genitals
 Conflicts at each stage must be resolved
 Adult personality reflects childhood experience
 Later developments
 Self-psychology
o Anna Freud
o Ego defines behavior
 Object relations theory
o Melanie Klein and Otto Kernberg
o Children incorporation of objects
 Freud’s students de-emphasize sexuality
 Carl Jung
o Collective unconscious
o Enduring personality traits
 Intro vs. extroversion
 Emphasis on life-span development
 Unearth intrapsychic conflicts
 Long-term treatment model
 Techniques:
 Free association – stream of words, what first comes to
mind
 Dream analysis
 Transference – all therapeutic relationships  taking on role
of patient (putting yourself in their shoes)

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 Counter-transference – becoming too close, inappropriate

relations
 Efficacy data are limited
 Emphasizes conflicts and unconscious
 Trauma and active defense mechanisms
 Focus on:
o Affect
o Avoidance
o Patterns
o Past experience
o Interpersonal experience
o Therapeutic relationship
o Wishes, dreams, fantasies
 Criticisms
 Pejorative terms neurosis [ crazy ]
 Unscientific
 Untested
 Contributions
 Unconscious processes
 Emotions triggered by cues
 Therapeutic alliance
 Defense mechanisms
o Humanistic theory
 Theoretical constructs
 Intrinsic goodness
 Striving for self-actualization
 Blocked growth
 Person-centered therapy
 Carl Rogers
 Hierarchy of needs
 Abraham Maslow
o Behavioral Modal
 Classical conditioning – taking something with no meaning to
an organism and giving it value to produce a wanted outcome
 Ivan Pavlov ***DIGESTIONsaliva production/contents
 Ubiquitous form of learning
o Unconditioned stimulus (UCS)
o Unconditioned response (UCR)
o Conditioned stimulus (CS)
o Conditioned response (CR)
 Behaviorism
 John B. Watson
o Scientific emphasis
o Objective
o Little Albert experiment

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Operant conditioning – creating outcome with

reward/reinforcements
 B.F. Skinner
o Behavior operates on environment
o Reinforcements
o Punishments
o Behavior shaping
o Present: scientific method and integrative approach
 Defining and studying psychopathology
 Requires broad approach
 Multiple, interactive influences
o Biological, psychological, social factors
 Scientific emphasis
o Neuroscience
o Cognitive, behavioral sciences

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Chapter 2:

 One-dimension vs. multidimensional models

o 1-D
 Single cause, operating in isolation
 Linear causal model
 Ignores critical information
o Multidimensional
 Systemic
 Several independent inputs that become interdependent
 Causes cannot be considered out of context
 Contributing agents
o Influencing psychopathology  interacting interdependently
 Behavior
 Biology
 Emotion
 Society/culture
 Development
 Gene fundamentals
o Genome = full set of instructions (genes):
 How to build a living organism
o Chromosomes = volumes of the set
o Genes = chapters within volumes
 Long molecules of DNA
 Double helix structure
 Located on chromosomes
 Nature:
 Determine parameters of physical characteristics
 Dominant vs. recessive
 Single-gene determinants (very rare)
 Polygenetic influences
o Rule, not exception
o DNA = words, linked together (no punctuation)
 Genetic contributions to psychopathology
o Most disorders are polygenetic
 Quantitative genetics accounts for small, individual effects of
several genes
o Gene expression and gene-by-environment interactions – genes can
be affected by environment
 Gene interaction and environment
o Eric Kandel – learning affects genetic structure of cells
 Activation of dormant genes
 Continues development in brain
 Plasticity vs. hardwired
 Diathesis-Stress model – stress triggers a certain pathology

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 Diathesis:
o Inherited tendency to express
traits/behaviors/pathology
o Genetic
o Triggered by stress
 Stress:
o Life events or contextual variables
o Environmental
o Triggers certain traits/behaviors/pathology
o Combining both yields activation under right conditions
o Gene-environment correlation model
o Genes shape how we create our environments
o Inherited predispositions or traits that increase one’s likelihood to
engage in activities or seek out situations
o Example: divorce
 Neuroscience and contributions to psychology
o Role of nervous system in disease and behavior
o Central nervous system
 CNS
 Brain and spinal cord
o Peripheral nervous system
 PNS (everything that comes from spinal cord, ect.)
 Somatic
o Voluntary muscles and movement
 Autonomic branches
o Sympathetic (activating)
o Parasympathetic (normalizing)
o Both divisions regulate:
 Cardiovascular system/body temp
 Endocrine system/digestion
 Neuron = basic building block
 Soma
 Dendrites
 Axon Soma
 Axon terminals
 Synaptic cleft
o Space in
between
neurons (in
between ends of
axon terminals)
 Function: electrical
 Communication: chemical
 Neurotransmitters (packaged in vesicles) – fast acting,
complex subsystems, implicated in anxiety

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o Serotonin (5HT)
 Widespread, complex circuits
 Regulates behavior, moods, thought
processes
 Low levels and vulnerabilities
 Implicated in several psychopathologies
o Norepinephrine
 Respiration, reactions, alarm response
 Implicated in panic
o Dopamine
 Switch function in brain circuits
 Interacts with other neurotransmitters
 Implicated in schizophrenia
 Parkinson’s disease
o Glutamate
 Excitatory – saying GO
o GABA
 Inhibitory
o Structure of brain:
 Hindbrain
 Midbrain
 Thalamus and hypothalamus
 Relays between brain stem and forebrain
 Behavioral and emotional regulation
o Pituitary gland – release of hormones
 Limbic system
 Emotions, basic drives, impulse control
 Associated structures and psychopathology
 Basal ganglia
 Caudate nucleus
 Motor activity
 Forebrain (cerebral cortex)
 Most sensory, emotional, and cognitive processing
 Two specialized hemispheres
o Left = verbal, math, logic
o Right = perceptual
 Lobes of cerebral cortex: ******************
 Frontal
o Thinking and reasoning, memory
 Parietal
o Touch recognition
 Occipital
o Integrates visual input
 Temporal

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o Sight, sound recognition, long-term memory

storage
o Behavioral and cognitive sciences
 Conditioning and cognitive processes
 Respondent and operant learning
 Environmental relationships
 Learned helplessness
 Perceptions of control
 Social learning
 Albert Bandura – Bobo doll
 Modeling
 Observational learning
 Interactive and contingent on perceptions of similarity
o Emotional phenomena
 Emotion – short-lived, temporary states
 Nature:
o Fight or flight
o Fear response
 Cardiovascular
 Cortical – cortex (flower part)
 Emotional response is terror, motivation
for action
o Short-lived, temporary states
o Different from mood or affect
 Components:
o Behavior
o Cognition – thoughts
o Physiology – physical actions
 Anger and your heart
o Hostility and anger are risk factors for heart
disease
 Cardiovascular efficiency
o Interactions with genetic risks
 Psychopathology
o Timing of emotional responses
o Degree of response
o Environmental and social interactions
 Cultural factors – voodoo, evil eye, and other fears
o Influence form and expression of behavior
o Culturally-bound fright disorders
o Influence on objects of fear
o Interaction with physiology
 Gender
o Effects and roles
 Related to cultural imperatives

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Influence across several dimensions

 Type and prevalence of fears
 Fear behaviors
 Responses
 Coping strategies
 Mood – persistent period of affect or emotionality
 Affect – momentary emotional tone; an observable
manifestation of emotion or emotional state (smiling,
frowning, tone of voice, language, ect.)
o Social effects on health and behavior
 Social effects
 Frequency and quality are critical
 Low social contacts
o Higher mortality
o Higher psychopathology
o Lower life expectancy
 Mediated by meaning and perception
 Stigma of psychopathology
 Influences expression of distress
 Limits help-seeking behaviors
 Helps maintain cycle of pathology
o Global incidence of psychological disorders
 Disorders are common across cultures accounting for 13% of
global burden of disease
 Rates and expression varies
 Prevalence and incidence influenced by:
 Poverty
 Political unrest
 Technological disparities
 Treatment depends on views and provider availability
o Life-span development
 Change over time
 Biological maturation
 Psychological development
 Social complexity
 Roles and demands
 Expression of disorders
 Treatment response
 The end of history illusion
 The principle of equifinality
 Several paths to a given outcome
 Paths vary by developmental stage
o Delirium (difficulty focusing attention, confusion,
disorientation)

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Aspect of schizophrenia or amphetamine

abuse
 Anesthesia or renal disease
 Interaction with other dimensions
o Social support
o Psychosocial effects on development of brain structure and function
 Neuron structure can be changed by learning and experience
(plasticity)
 Increase number of receptors, dendrites 
connections

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Chapter 3:

 Clinical assessment and diagnosis

o Assessing psychological disorders
 Clinical assessment:
 Systemic evaluation and measurement of psychological,
biological, and social factors in an individual presenting
with a possible psychological disorder
o Process
 Collect info
 Client functioning is key
 Rule out some areas, concentrate on others that may be more
relevant
 Measure potential pathology
 Key concepts:
 Reliability – degree to which a measurement is
consistent
o Test-retest – same test, different times
o Inter-rater – different raters, same answers
o Internal – different questions, same construct
(same question, just asked differently)
 Validity – degree to which technique measures what it’s
designed to measure
o Concurrent – comparing results of one measure
with others
o Predictive – how well it predicts what will
happen
o Contrast – measuring the unobservable (thought
process)
o Face – is it reasonable at first glance?
 Standardization – application of certain standards to
ensure consistency across different measures
o Provides normative population data
o Examples:
 Administration procedures
 Scoring
 Evaluation of data
o Purpose
 Understanding individual
 Predicting behavior
 Treatment planning
 Evaluating outcomes
o Clinical interview – *starts with first phone call
 Clinical core – just tryna get at main things

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 Structured – like having questions lined out before client gets

there
 Assesses multiple domains
 Current and past behavior
 Attitudes
 Emotions
 Detailed history
 Presenting problem
 Mental status exam (MSE) *quick
 Appearance and behavior
 Thought processes
 Mood and affect
 Intellectual functioning
 Sensorium – senses, oriented, ect.
o Physical examinations
 Diagnose or rule out physical etiologies
 Toxicities
 Medication side effects
 Metabolic conditions
 Potential comorbidities – two things happening at once
 Inform clinical interview
o Behavioral assessment
 Expands on or supplants MSE
 Helpful for low-verbal individuals
 Support of disconfirm consistency reports
 Methods:
 Role play
 Naturalistic
 Observation:
 Focus is to determine the ABC-sequence (Antecedent –
Behavior – Consequence sequence)
 Types:
o Informal – attention paid to behavior sans
definition or systematic documentation
o Formal – structured documentation of behavior
that is measurable and well defined
o Self-observation
 Less reliable
 Important with pathologies involving
privacy
o Psychological testing
 Specific tools to determine cognitive, emotional, and
behavioral responses that may be associated with specific
pathologies
 Types:

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 Projective
o Presentation of ambiguous stimuli
o Projection of personality and the unconscious
o Psychoanalytic roots
o Examples:
 Rorschach Inkblot – what do you see?
 Thematic apperception – what’s going on
in the picture?
o Criticisms
 Scoring/interpretation
 Reliability and validity
o Strengths
 Qualitative data
 Icebreakers
 Standardization efforts
 Personality
o Face vs. construct validity
o Empirically based
o Minimally ambiguous stimuli
o Minimal inference
 Scoring/interpretation
o Minnesota Multiphasic Personality Inventory
(MMPI)
 T/F
 Takes a long time ~ 3 hours
o PAI
 Similar to MMPI but shorter
 Intelligence
o Initial purpose  academic prediction
o Intelligence quotient (IQ)
 Mental vs. chronological age
 Deviation IQ – cohort comparison
o Domains
 Verbal
 Performance
o IQ vs. intelligence
o Examples:
 Stanford-Benet (adults)
 WAIS-III (adults)
 WISC-IV (children)
 WPPSI-III (preschoolers)
o All contain verbal scales
 Vocab
 Knowledge of facts
 Verbal reasoning

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 Non verbal reasoning

 Psychomotor abilities
 Ability to learn new relationships
 Neuroimaging
o Receptice and expressive language
o Attention and concentration
o Memory motor skills
o Perception
o Learning
o Abstraction
o Attribute:
 Organic damage detection
o Concerns:
 False positives – something’s there when
it’s not
 False negatives – something’s not there
when it is
o Images of brain structure
 CAT/CT
 X-rays of brain
 Pictures in slices
 MRI
 Strong magnetic field
 Improved resolution
 Colors/clearer
 Utility:
 Locating tumors, injuries,
structural or anatomical
abnormalities
o Images of brain functioning
 PET
 SPECT
 Injection of radioactive isotopes
 React with brain oxygen, blood,
and glucose
 Reveal metabolic deficiencies
 fMRI
 Immediate yet brief changes in
brain activity
 Replaced PET
o Advantages and limitations:
 Yield detailed info
 Expense
 Lack adequate norms
 Limited clinical utilities

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o Psychophysiological assessment
 Emotional or psychological events reflected by ???
 Other bodily responses
 Electrodermal
o Galvanic skin response
 Biofeedback: assist individual with regulating biological
responses (blood pressure, respiration, ect.)
 Limits:
 High skill level needed
 Inconsistent result
 Assessing response to stimuli is useful in disorders strong
emotional component
 Diagnosing:
 Approaches:
o Idiographic – unique to one individual
o Nomothetic – applicable to large groups of
people
 Diagnostic classification
o Categories based on commonalities
 Terminology of classification systems
o Taxonomy – scientific classification
o Nosology – taxonomy in psychological contexts
o Nomenclature – nosological labels (panic
disorders, eating disorders, ect.)
 Classification issues
 Nature and forms of approach
o Classical (or pure) categorical approach
o Dimensional approach
o Prototypical approach
 Two widely used classification systems:
o ICD-10 (international)
o DSM
 Critical issues
 Reliability
o Decreases bias
 Validity
o Improved coherence
 Purposes
o Communication
o Prognosis
o Treatment planning
 Diagnosis before 1980
 DSM I&II
o Low precision
o Based on unproven theories

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o Poor reliability
 DSM-III & IIIR
o Atheroretical
o Introduces axis
o Low reliability
o Reliance on consensus
 DSM-IV & IV-TR
o Comprehensive
o Boundaries are clearer
o Broad categorization headings
o Empirically grounded
o Prototypic approach
 DSM-V
o ICD-10 – General consensus is DSM-V is largely
unchanged from DSM-IV although some new
disorders are introduced and other disorders
have been reclassified
 Divided into 3 main sections:
 How to use the manual
 Disorders
 Descriptions of disorders
o Introduces cross-cutting dimensional symptom
measures
 Evaluating global sense important
symptoms that are often present across
disorders in almost all patients such as
anxiety
o Comorbidity
o Emphasize reliability sometimes at expense of
validity
o Complexity of categorizing psychopathology
 Caution about labeling and stigma
 Problems and pitfalls with labels
o Negative connotations
o Stigmas
o Reification (treating concept as object)
o Beyond DSM-V: dimensions and spectra
 New findings on brain circuits, cognitive processes, and
cultural factors that affect our behavior could date diagnostic
criteria relatively quickly

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Chapter 4:

 Research methods
o Basic components
 Question based theory
 Hypothesis
 Minimizing confounds
o Control groups
o Randomization
o Analog models (similar to phenomenon)
 Generalizability
 Research design
 Dependent variable
 Independent variable
 Internal validity
 External validity
o Statistical (.5/5% chance of happening) vs. clinical (clinically
significant) significance
 Chance?
 Meaningful?
 Does one mean other?
 Effect size and social validity
o Studying individual cases
 Extensive observation
 Detailed description – tons of note taken
 Foundation for early developments
 Freud
 Unique problems
 Contributions/challenges to theories
 Limitations – reactivity
o Research by correlation
 Statistical relationship
 No manipulated independent variable
 Directionality
 Correlation coefficient
 Correlation does NOT imply causation.
o Research by experiment
 Manipulate independent variable
 Observe effects on dependent variable
 Attempt to determine causality
 Premium on internal validity
 Control groups
 Matched control group
o Age, gender, SES, ect.
 Placebo control groups

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 Single-blind control
o They know one aspect
 Double-blind control
o No one knows who’s getting the treatment
 Minimizes allegiances effects
o Genetics and research across time and cultures
 Adoption studies:
 Sibling pairs separated after birth
 Parcels out effects of environment
 Observed frequency vs. chance
o Studying behavior over time
 Prevention research  treatment and services
 Universal prevention – broadly applied
 Selective prevention – individual
 Indicated prevention – not exactly certain
 Time-based research strategies
 Cross-sectional designs
o Cohorts (college students, ect.)
o Retrospective info
 Longitudinal designs
o Cross-generational effect
o Sequential design
o Research ethics
 Institutional review boards
 Informed consent
o Competence
o Voluntarism
o Full info
o Comprehension
 APA ethics
o Ethical principles of psychologists and code of
conduct
 Involving consumers
 Participatory action research
 Design
 Running
 Interpreting research
 Relevance of research

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Chapter 5:

*go over diagnostics in book on disorders, along with causes and symptoms?

 Anxiety disorders, trauma and stressor-related, and obsessive-compulsive

and related disorders
o Anxiety – negative mood state characterized by bodily symptoms of
physical tension and by worry about future nervous about something
that’s going to happen
 Somatic symptoms:
 Racing heart
 Shortness of breath
 Light-headedness
 Perspiring
 Muscle tension
 Psychological symptoms:
 Excessive worry
 Unease
 Escape
 Closely related to depression
 Adaptive
 Maladaptive – too much, or happens inconveniently
 Complexity of anxiety disorders:
 Fear – immediate, present oriented
o Sympathetic nervous system activation
 Anxiety – apprehensive, future-oriented
 Biological contribution:
 Increased physiological vulnerability
o Polygenetic influences
 Corticotrophin releasing factor (CRF)
o Brain circuits and neurotransmitters
 GABA – reduces synaptic activity
 Noradrenergic system – CNS, autonomic
 Serotonergic systems –
movement/coordination
o CRF and HPA axis
 Limbic system
o Parts of forebrain
o Ability to learn/control impulse
o Sex, hunger, thirst, aggression
 Behavioral inhibition system (BIS)
 Psychological contribution:
 Freud
o Anxiety = psychic reaction to danger
o Reactivation of infantile fear situation

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 Behaviorists (Pavlov, Watson, Skinner, Bandura)

o Classical and operant conditioning
o Modeling
 Social contribution:
 Biological and psychological vulnerabilities triggered by
stressful life events
o Family
o School
 Comorbidity:
 Most anxiety disorders co-occur with something else 
increased relapse/decreased recovery
 Commonalities:
 Features
 Vulnerabilities
 Suicide – similar to major depression
 Integrated model
 Triple vulnerability
o Generalized biological vulnerability
 Diathesis
o Generalized psychological vulnerability
 Beliefs/perceptions
o Specific psychological vulnerability
 Learning/modeling
 Disorders:
 Generalized anxiety disorder (GAD)
o Clinical description
 Shift from possible crisis to crisis
 Worry about minor, everyday concerns =
job, family, chores, appointments, ect.
 Sleeping problems
o In children
 Need only one physical symptom
 Worry = academic, social, athletic
performance, ect.
o Insidious onset
o Chronic course
o In elderly (55+) – worried about health, dying,
loss of functioning, ect.
o Causes:
 Primarily genetic
 Environmental
 Threats
 Frontal lobe activation (reasoning)
 Left vs. right
o Treatments:

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Pharmalogical
 Benzodiazepines (BZD; sedative)
o Benefits
 Short-term, modest
relief
o Risks
 Cognitive/motive
functioning
 Fall risk
 Dependence
 Antidepressants
o Paxil, Effexor, valium
 Psychological
 CBT
o Confronting anxiety
provoking images
o Coping strategies
 Acceptance & meditation
(mindfulness)
o Similar benefits
o Better long-term results
 Panic disorder and agoraphobia
o Clinical description
 Unexpected panic attacks
 Anxiety, worry, or fear of another attack
 Persists for 1 month or more
 Agoraphobia
 Fear or avoidance of
situations/events
o Acute onset
o In children
 Hyperventilation
 Cognitive development
o ~ ¾ w/ agoraphobia are female
o Similar prevalence rates globally
o Variable symptom expression
 Somatic symptoms
o Nocturnal panic
 60% experience nocturnal attacks
 non-REM sleep
 Delta wave
 Caused by deep relaxation
 Sensation of letting go
 Sleep terrors
o Causes

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Generalized biological vulnerability

 Alarm reaction to stress
 Cues get associated with situations
 Conditioning occurs
 Generalized psychological vulnerability
 Always on your mind
o Treatment
 Medication
 Multiple systems
o Serotonergic
o Noradrenergic
o Benzodiazepine GABA
 SSRIs (Prozac and Paxil)
 High relapse rates
 Psychological intervention
 Exposure-based
 Reality testing
 Relaxation
 Breathing
 Panic-control treatment
 Exposure
 Cognitive therapy
 Relaxation/breathing
 High degree of efficacy
 Specific phobias
 Social anxiety disorder
o Clinical description
 Mostly with children, unrealistic and
persistent worry that something will
happen to parents or other important
people in their lives-with adults,
something will happen to their children
(kidnapping, ect.)
 Separation anxiety disorder
o Clinical description
 Extreme and irrational fear/shyness
 Social/performance situations
 Significant impairment
 Avoidance or distressed endurance
 Generalized subtype
 Selective mutism
o Panic attack – abrupt experience of intense fear or acute discomfort
 Some symptoms:
 Palpitations
 Chest pain/tension

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 Dizziness
 Expected (cued)  phobia
 Unexpected (uncued)  panic disorder
o Trauma and stressor–related disorders
 PTSD
 Clinical description
o Trauma exposure
o Extreme fear, helplessness, or horror
o Continued re-experiencing
o Avoidance
 Conversation of situation or PTSD
 Similar places of occurrence
o Emotional numbing
o Reckless or self-destructive behavior
o Interpersonal problems
o Dysfunction
o One month
 Most common traumas
o Sexual assault
o Accidents
o Combat
 Causes
o Trauma intensity
o Generalized biological vulnerability
 Twin studies
 Reciprocal gene-environment interaction
o Generalized psychological vulnerability
 Uncontrollability and unpredictability
o Social support – contributing factor to resiliency
o Neurobiological model
 Threatening cues activate Corticotrophin
Releasing Factor system
 CRF activates fear and anxiety
 Amygdala (central nucleus)
 Increased HPA axis activation
 Cortisol
 Treatment
o CBT
 Exposure Psychoanalytic therapy,
catharsis
 Imaginal
 Graduated or massed
 Increase positive coping skills
 Increase social support
 Highly effective

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o Treatment
 Medications
 SSRIs
 Adjustment disorders
 Clinical description
o Anxious or depressive reactions to life’s
stressors
 Attachment disorders
 Clinical description
o Disturbed and developmentally inappropriate
 Reactive attachment disorder
 Clinical description
o Child won’t seek out???
 Obsessive-Compulsive Disorder (OCD)
 Clinical description
o Obsession
 Intrusive can’t be stopped and
nonsensical
 Thoughts, images, or urges
 Attempts to resist or eliminate
 60% of people have multiple obsessions
 Need for symmetry
 Forbidden thoughts or actions
 Cleaning and contamination
 Hording
o Compulsions
 Thoughts or actions
 Suppress obsessions
 Provide relief
 Four major categories
 Checking
 Ordering
 Arranging
 Washing/cleaning
 Association with obsessions
 Body Dysmorphic Disorder (BDD)
 Preoccupation with some imagined defect in
appearance by someone who actually looks reasonably
normal
o Comorbid with OCD 10%
o Course: lifelong
o Onset – early adolescence through 20s
o Reaction to horrible or grotesque feature
o Two treatments:
 SSRIs

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 Exposure and response prevention

 Hoarding disorder
 Acquiring things during teen years and often experience
great pleasure from shopping or otherwise collecting
various items
 OCD tends to wax and wane, whereas hoarding can
begin early in life and get worse with each passing
decade
 Twice as high as prevalence of OCD
o Men = women
 Trichotillomania (hair pulling disorder) and excoriation (skin
picking disorder)
 Trich. – urge to pull out own hair from anywhere on
body
 Exco. – repetitive and compulsive picking of skin
leading to tissue damage
o Habit reversal training shows best results

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Chapter 6:

 Dissociative (separation of consciousness) disorders

o Disruption of, and, or discontinuity in normal integration of
consciousness, memory, identity, emotion, perception, body
representation, motor control, and behavior
o Conversion disorder (functional neurological symptom disorder)
 Generally have to do with physical malfunctioning, such as
paralysis, blindness, or difficulty speaking (aphonia) without
any physical or organic pathology
 Clinical description:
 Physical malfunctioning
o Sensory-motor areas
 Lack physical or organic pathology
 Lack awareness
 La belle indifference
o Possible, but not always
 Intact functioning
 Malingering (faking)
 Special populations
 Soldiers
 Children
o May have better prognosis
 Female > male
 Cultural considerations
 Religious experiences
 Rituals
 Onset – adolescence
 Course: chronic intermittent
 Rare
 Prevalence depends on environment
 Causes:
 Freudian psychodynamic view
o Trauma, conflict experience
o Repression
o Conversion to psychical symptoms
 Primary gain
o Attention and support
 Secondary gain
 Behavioral view
o Traumatic event must be escaped
o Avoidance isn’t an option
o Social acceptability of illness
o Negative reinforcement
 Family/social/cultural

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o Low SES
o Limited disease knowledge
o Family history of illness
 Treatment:
 Similar to somatic symptom disorder
o Attending to trauma
o Remove secondary gain
o Reduce supportive consequences
o Reward positive health behaviors
 No cures
 Cognitive-behavioral interventions
o Initial reassurance
o Stress-reduction
o Reduce frequency of help-seeking behaviors
 Gatekeeper physician
o Reduce visits to numerous specialists
o Types of disorders
 Depersonalization/derealization
 Severe alterations or detachments to normal perceptual
experiences
 Significant impairments with:
o Identity
o Memory
o Consciousness
 Depersonalization
 Derealization
 Dissociative amnesia
 Generalized type
 Localized or selective type
 Dissociative identity disorder (DID)
 Clinical description
o Amnesia – recurrent, ordinary events
o Discontinuity of personality
o Adopt several new identities or alters
 2 – 100 personalities
 Unique characteristics
 Host – typically main personality
 Switch - ?
 Controversy:
o Malingering?
 Real vs. fake memories
 Suggestibility
 Hypnosis studies
 Simulated amnesia
 Demand characteristics

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 Physiological measures
 Eye movements
 EEG
 Popular media
 Cinema
 Television
 Mass hysteria
 Escape responsibility
 Iortrogenic – caused by therapist
 Real memories and false
 Stats:
o Female : male = 9:1
o Onset – childhood
o Course: chronic, lifelong
o Time to diagnosis
o Suicide attempt rates are high
 Comorbidities:
o PTSD
o Depressive disorders
o Trauma and stressor-related disorders
o Conversion disorder
o Somatic symptom disorder
o Eating disorders
o Substance-related disorders
o OCD
o Sleep disorders
o Personality disorders (BPD)
 Causes:
o Biological vulnerability
 Reactivity
 Hippocampal and amygdalar volume
o Severe childhood abuse/trauma history
o Links with PTSD
o Highly suggestible
 Autohypnotic model
 Treatment:
o Similar to PTSD
 Reintegration of identities
 Identify and neutralize cues/triggers
 Visualization
 Coping
 Hypnosis
o Antidepressant medications?
 Benzodiazepines (minor tranquilizers)
o Accumulated clinical wisdom

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 Other specified dissociative disorder

 Chronic and recurrent syndromes of mixed dissociative
symptoms
 Identity disturbance due to prolonged and intense
coercive persuasion
 Acute dissociative reactions to stressful events
 Dissociative trance
 Unspecified dissociative disorder
 Book?

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Chapter 7:

 Mood disorders and suicide

o Understanding and defining mood disorders
 Mood disorders
 Depressive disorders
 Affective disorders
 Depressive neuroses
 Gross deviations in mood
o Depression
o Mania – period of abnormally excessive elation
or euphoria
o Overview of depression and mania
 Major depressive episode
 Extreme depression
 2 weeks
 Cognitive symptoms
 Physical dysfunction
 Anhedonia – low, blue, down feeling
 Duration – 4-9 months, untreated
 Single episode:
o No mania/hypomania
o Rare
 Recurrent:
o 4-7 episodes (lifetime)
o Duration – 4-5 months
 Hypomanic episode
 Exaggerated
 Opposite
 Excited
 Duration – average, 1 week
o Structure of mood disorders
 Unipolar disorders
 Depression or mania alone
o Typically depression
 Bipolar disorders
 Depression and mania
 Dysphoric mania episode
 Mixed manic episode
o Depressive disorders:
 Persistent depressive disorder (Dysthymia:
 Milder
 2+years
 Double depression

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 Major depressive episodes and dysthymic disorder

 Dysthymia first
 Severe psychopathology
 Poor course
 Symptom specifiers:
 Psychotic features
o Hallucinations – seeing/hearing something not
there
o Delusions – misconception of a belief/something
that is there
 Anxious distress
o Comorbid disorders or anxiety symptoms
 Mixed features
o At least 3 symptoms of mania
 Melancholic
o Severe somatic symptoms
 Additional defining criteria for depressive disorders
 Symptom specifiers
o Atypical features
 Oversleeping and overeating
o Catatonic features – holding positions (laying
down)
 Catalepsy
o Peripartum onset
o Seasonal pattern
 Seasonal affective disorder (SAD)
 Melatonin phototherapy – spending time
in ultraviolet rays to uplift mood
 CBT
 Onset and duration
o Onset – average 30 years old for depression
o Duration – 2 weeks to several years for
depression
o Early onset has poor prognosis
o From grief to depression
 Depression frequently follows loss
 Integrated grief
 Pathological or impacted grief reaction
 Severity or symptoms
 Dysfunction
 Persistence of symptoms
 Duration – when it hits you, how long does it take to get over it,
if at all?
o Other depressive disorders
 Premenstrual dysphoric disorder

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o Bipolar I disorder
 Alternating major depressive and manic episodes
 Single manic episode
 Recurrent
 Symptom free for two months
 Onset – 15-18
o Bipolar II disorder
 Alternating major depressive and hypomanic episodes
 Onset – 19-22
o Cyclothymic disorder
 Alternating manic and depressive episodes
 Less severe
 Persists longer
 Chronic symptoms
 Risks for bipolar disorders
 Rapid – cycling specifier
o Prevalence of mood disorders
 Children and adolescents
 Similar to adults
 Adolescence
o Female disorder
 Misdiagnosis
o ADHD
 Older adults
 Diagnosis difficulty
 Across cultures
 Similar among U.S.
o Exceptions
 Native Americans
 Physical or somatic symptoms
 Comparability
 Among creative
 Higher prevalence
o Melancholia
o Mania
 Gender differences
o Causes of mood disorders: biological
 Familial and genetic influences
 Family studies
 Twin studies
o Bipolar
o Unipolar
 Higher heritability for females
 Neurotransmitter systems
 Serotonin – depression

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 Permissive hypothesis – one allows the other

o Dopamine – mania
o Norepinephrine
 Endocrine system
 Stress hypothesis
o Overactive HPA axis
o Neurohormones
o Elevated cortisol (stress)
o Suppressed hippocampal neurogenesis –
recently learned that new neurons can be
created
 Dexamethasone suppression test (DST)
 Sleep and circadian rhythms
 REM sleep
o Reduced latency
o Increased intensity
 Decreased slow wave sleep – longer, bigger waves
 Sleep deprivation effects
 Additional studies of brain structure and function
o Brain wave activity
 Indicator of vulnerability?
 Greater right side anterior
activation
 Less alpha wave activity
o Causes of mood disorders: psychological
 Stressful life events
 Context
 Meaning
 Stressful life events are strongly related to onset of
mood disorders
 Reciprocal model
 Stress and bipolar disorder
 More positive set of stressful life events seems to trigger
mania
 Episode develop a life of their own
 Loss of sleep and jet lag
 Learned helplessness (Seligman)
 Lack of perceived control
 Will not regain control
 Pessimism
o Before or after?
 Depressive attributional style
 Internal
 Stable
 Global

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 Negative cognitive styles

 Cognitive theory of depression (Beck)
 Cognitive errors in depression
o Negative interpretations
 Types of cognitive errors
o Arbitrary inference
o Overgeneralization
 Depressive cognitive triad
 In spiral...
o Psychological treatments for depression
 Interpersonal psychotherapy (IPT) – similar to psychoanalysis;
designed to be more short-term treatment
 Address interpersonal issues in relationships
o Role disputes
o Loss
o New relationships
o Social skill deficits
 Stage of dispute
o Negotiation stage
o Impasse stage
o Resolution stage
 CBT and IPT outcomes
 Comparable medications
 More effective than:
o Placebo
o Brief psychodynamic treatment
o Combined treatments for depression
 Possible benefits above individual treatments
o Preventing relapse
 Universal programs
 Selected interventions
 Indicated interventions
 Preventing relapse
o Psychological treatment of bipolar disorders
 Management of interpersonal problems
 Increase medication compliance
 Interpersonal and social rhythm therapy (rhythm of social
engagements routine )
 Family-focused treatment
o Suicide
 Types (Durkheim):
 Altruistic – honor
 Egoistic – loss of social support
 Anomic – marked disruptions; loss of prestige
 Fatalistic – loss of destiny

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 Risk factors:
 Family history
 Neurobiology
 Preexisting disorder
 Alcohol/drugs
 Stressful life event
 Shameful/humiliating stressor
 Suicide publicity and media coverage
 Treatment
 Importance of assessment
o Suicidal desire – ideation
o Suicidal capability – past attempts
o Suicidal intent – plan
 No suicide contract – assessing for suicidal ideation;
creating a list of things to do, if you become on the verge
of following through, if none work, THEN you can follow
through  controversial
 Hospitalization
o Complete or partial
 CBT – learning how to cope and interrupt feelings and
thoughts
 Population specific
 Caucasians
 Native Americans
 Increasing rates
 Adolescents
 Elderly

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Chapter 8:

 Eating and sleep-wake disorders

o Major types of eating disorders
 Bulimia and anorexia nervosa
 Disruptions in eating behavior
 Fear of gaining weight
 Vast majority are females
o Caucasian, upper class
 Onset = age 10-21
 Chronic, if untreated
 Bulimia
o Binge eating
 Excess amounts of foods
 Perceived as out of control
o Compensatory behaviors – trying to make up for
eating as much as they did
 Purging
 Excessive exercise
 Fasting
 Laxatives
 Water pills
 Having a diet coke with meal, or a salad
o Belief that popularity and self-esteem are
determined by weight and body shape
o Subtypes
 Purging (most common)
 Non-purging
 Exercising and/or fasting
o Medical consequences
 Salivary gland enlargement
 Erosion of dental enamel
 Electrolyte imbalance
 Kidney failure
 Cardiac arrhythmia – changing of beats
 Seizures
 Intestinal problems
 Permanent colon damage
 Hand calluses
o Comorbidities
 Anxiety
 Mood disorders
 Substance abuse
o Men
 5-10%

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 Caucasian, middle to upper class

 Gay or bisexual
 Athletes with weight regulations
 Onset = older
 Anorexia
o Over successful weight loss
 15% below expected weight
 Intense fears about
 Gaining weight
 Losing control of eating
 Relentless pursuit of thinness
 Often begins with dieting
o Subtypes
 Restricting
 Binge-eating-purging
o Associated features
 Body image disturbance
 Pride in diet and control
 Rarely seek treatment
o Medical consequences
 Amenorrhea
 Dry skin
 Brittle hair and nails
 Sensitivity to cold temps
 Lanugo – feathery hair
 Cardiovascular problems
 Electrolyte imbalance
o Comorbidities
 Anxiety
 OCD
 Mood disorders
 Substance abuse
 Suicide
o More female than males
o Onset = 18-23
 Binge-eating disorder
 Binging repeatedly and find it distressing but do not
attempt to purge
 Better response to treatment
 Associated features
o Many are obese
o Older
o More psychopathology
 Vs. non-binging obese
o Concerned about shape and weight

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 Sociocultural origins
 Westernized views
 Cross-cultural considerations
 North American minority populations
 Immigrants to western cultures
o Increase in eating disorders
o Increase in obesity
 Cultural values are different
 Standards for body image
 Obesity
 Rates are increasing
 BMI vs. weight
 Health risks
 Developmental considerations
 Adolescent onset
 Weight gain
 Interaction with social ideals
 Causes
 Social dimensions
o Cultural imperatives
 Thinness = success, happiness
o Ideal body size standards
 Change rapidly
o Media
o Social and gender standards
 Internal and perceived
o Dieting
o Perceptions of fat
 Family influences
o Typical family
 Successful
 Driven
 Concerned about appearance
 Maintains harmony
o History of dieting, eating disorders
 Mothers
 Biological dimensions
o Hereditability studies
o Inherited tendency to be emotionally responsive
to stress  eat impulsively
o Perfectionism
o Hypothalamus
 Serotonin
 Psychological dimensions
o Low sense of personal control

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o Low self-confidence
o Perfectionistic attitudes
o Distorted body image
o Preoccupation with food and appearance
o Mood intolerance
 Treatment
o Drugs
 Anorexia
 No demonstrated efficacy
 Bulimia
 Antidepressants
o May enhance psychological
treatment
o No long-term efficacy
o Bulimia
 CBT
 Treatment of choice
 Target problem eating behaviors
 Target dysfunctional thoughts
 Interpersonal psychotherapy (IPT)
 Improve interpersonal functioning
 Similarity effective, long-term
 CBT may work quicker
o Binge-eating
 Similar to bulimia
o Anorexia
 Weight restoration
 May require hospitalization
 Target dysfunctional attitudes
 Body shape
 Control
 Thinness = worth
 Family involvement
 Communication about eating/food
 Attitudes about body shape
 Long-term prognosis
 Poorer than bulimia
 More people die from anorexia
 Prevention
o Identify specific targets
 Early weight concerns
o Screening for at-risk groups
o Provide education
 Normal weight limits
 Effects of calorie restriction

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 Healthy weight

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Chapter 12:

 Personality disorders
o Broad overview
 Personality disorders: persistent pattern of cognitions,
emotions, and behavior resulting in enduring emotional
distress for person affected and/or for others and may cause
difficulties in work and relationships
 Highly comorbid
 Poorer prognosis
 Therapist reactions
 Countertransference – therapist becomes more
interested in client’s disorder than helping him/her
 10 specific personality disorders
 3 clusters
o Categorical and dimensional models
 Big Five (OCEA[N/E])
 Openness
 Conscientiousness
 Extraversion
 Agreeableness
 Emotional stabilityused to be neuroticism
 Cross-cultural research establishes universal nature of five
dimensions
o Clusters
 Cluster A: intense, odd, eccentric, (paranoid schizoid,
schizotypal)
 Paranoid personality disorder:
o Mistrust and suspicion
 Pervasive
 Unjustified
 i.e. foil hats so no one can
penetrate their thoughts
o Few meaningful relationships
 Volatile
 Tense
 Sensitive to criticism
o Causes
 Possible relationship to schizophrenia
(weak)
 Possible role of early development
experience
 Trauma
 Schemas

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o People are malevolent and

deceptive
 Cultural factors increase susceptibility
 Prisoners
 Refugees
 People with hearing impairments
 Older adults
o Treatment
 Unlikely to self-refer or seek on own
 Crisis
 High recidivism
 Focus on developing trust*
 Cognitive therapy
 Helping with their assumptions
 No empirically-supported treatments
 Poor improvement rate
o Treatment adherence
 Schizoid personality disorder
o Appear to neither enjoy nor desire relationships
 Loner
o Limited range of emotions
 Appear cold, detached
 Lack of affect
o Appear unaffected by praise, criticism
 Unable or unwilling to express emotion
o No thought disorder
o Causes
 Limited research
 Precursor: childhood shyness
 Possibly related to:
 Abuse/neglect
 Autism
o Lack of affect
o Treatment
 Unlikely to seek on own
 Crisis
 Focus on relationships
 Social skills therapy
 Empathy training
 Role playing
 Social network building
 Empirically-supported treatments limited
 Schizotypal personality disorder
o Psychotic-like symptoms
 Magical thinking

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 Ideas of reference
 Illusions
o Odd and/or unusual
 Behavior
 Appearance
o Socially isolated
o Suspicious
o Causes
 Schizophrenia phenotype?
 Lack full biological or
environmental contributions
 Cognitive impairments
 Left hemisphere
 More generalized
o Treatment
 Highly comorbid with depression
 Multidimensional approach
 Social skill training
 Antipsychotic medications
 Community treatment
 Cluster B:
 Antisocial personality disorder
o Noncompliance with social norms = going
against society
o Social predators
 Violate rights of others
 Irresponsible
 Impulsive
 Deceitful
o Lack of conscience, empathy, and remorse
o Nature of psychopathology
 Glibness/superficial charm
 Grandiose sense of self-worth
 Pathological lying
 Conning/manipulative
 Lack of remorse
 Callous/lack of empathy
o Developmental considerations
 Early histories of behavioral problems
o Conduct disorder
 Childhood onset type
 Adolescent onset type
o Family histories of:
 Inconsistent parental discipline
 Variable support

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 Criminality
 Violence
o Causes
 Gene-environment interaction
 Genetic predisposition
 Environmental triggers
 Arousal hypothesis
 Under-arousal
 Fearlessness
 Borderline personality disorder
o Patterns of instability
 Intense moods
 Turbulent relationships
o Impulsivity
o Very poor self-image
o Self-mutilation
o Suicidal gestures
o Mood goes to opposite side of spectrum at any
time
o Comorbidities
 Depression
 Suicide
 Bipolar
 Substance abuse
 Eating disorders
 Bulimia
o Causes
 Genetic/bio components
 Serotonin
 Limbic network
 Cog. biases
 Early childhood experience
 Neglect
 Trauma
 Abuse
o Treatment
 Highly likely to seek treatment
 Antidepressant medication
 Dialectical behavior therapy (DBT) *made
specifically for this disorder
 Really in your face, harsh, to the
point, etc.
 Reduce interfering behaviors
o Self-harm
o Treatment

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o Quality of life
 Outcomes
 Histrionic personality disorder
o Attention seeker
o Sexually provocative
o Shallow/shifting emotions
o Physical appearance-focused
o Impressionistic
o Overly dramatic
o Suggestible
o Misinterprets relationships and social cues
o Causes
 Little research
 Links with antisocial personality
 Sex-typed alternative expression
o Treatment
 Helping individual problematic
interpersonal relationships
 Attention seeking
 Long-term consequences of
behavior
 Little empirical support
 Narcissistic personality disorder
o Like histrionic, but on steroids*
 Difference = narcissists don’t care about
offending people, thinks they are THE
best in everything, always over the top,
everyone else is beneath them
o Exaggerated and unreasonable sense of self-
importance
 Grandiosity
o Require attention
o Lack sensitivity and compassion
o Sensitive to criticism
o Envious
o Arrogant
o Causes
 Deficits in early childhood learning
 Altruism
 Empathy
 Sociological view
 Increased individual focus
 Me generation
o Treatment focuses on:
 Grandiosity

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 Lack of empathy
 Hypersensitivity to criticism
 Cluster C: fearful/anxious, avoidant, dependent,
 Avoidant personality disorder
o
o Causes

o Treatment

 Dependent personality disorder
o
o Causes
 Limited empirical research
o Treatment

 Obsessive-Compulsive personality disorder (what’s the
difference between OCD and this [OPCD])***
o Fixation on doing things the right way
o Rigid
o Perfectionistic
o Orderly
o Preoccupation with details
o Poor interpersonal relationships
o Obsessions and compulsions are rare
o Causes
 Limited research
 Weak genetic contributions
 Predisposed to favor structure?
o Treatment
 Similar to OCD
 CBT
 Address fears related to need for
orderliness
 Limited efficacy data
o Stats
 Origins and course:
 Childhood
 Chronic
o Can remit but replaced by other personality
disorder
 Highly comorbid
o Gender differences
 Man diagnosed with personality disorder tend to display traits
characterized as more aggressive, structured, self-assertive,
and detached

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 Women tend to present with characteristics that are more

submissive, etc.
 Clinician bias
 Assessment bias
 Criterion gender bias
 Histrionic = extreme stereotypical female
o Women’s uterus floated around body making
them hysterical all the time
 No macho disorder
 Ford and Widiger (1889)

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Chapter 13:

 Schizophrenia spectrum and other psychotic disorders

o Perspectives on schizophrenia
 Psychosis
 Hallucinations – seeing or hearing something that’s not
there
 Delusions – having a huge misconception of something
(FBI is after me, they are God, etc.)
 Schizophrenia
 Disturbances; where problems are:
 Perception
 Thought
 Speech
 Movement
o Early figures in diagnosing schizophrenia
 Impact on current thinking
 Kraeplin
o Combo of symptoms
 Catatonia (fixated staring/holding poses,
for extended periods of time; rare),
hebephrenia, and paranoia
o Dementia praecox
o Distinction from bipolar
 Bleuler
o Associative splitting
o Cognitive impairments
 Importance of onset and course
o Clinical description, symptoms, and subtypes
 Psychotic behavior
 Distinguishing between positive and negative behaviors
 Positive – additive of something that already exists (i.e.
hallucinations)
o Delusions
 Gross misrepresentations of reality
 Disorder of thought content
 Grandeur
 Persecution
o Hallucinations
 Sensory experience in absence of
environmental stimuli or input
 Can involve all senses
 Most common: auditory
 Own vs. others voice
 Broca’s area

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o Speech
production/contribution
 Prosody
 Negative – absence of something that already exists (i.e.
flat affect)
o Symptom cluster
 Avolition (or apathy)
 Alogia – absence of speech
 Anhedoinia – low, feeling down/lack of
feeling pleasure
 Affective flattening
 Disorganized symptoms
 Erratic behaviors that affect many domains
 Disorganized speech
o Cognitive slippage
o Tangentially
o Loose association/derailment
 Inappropriate affect/emotional expression
 Unusual behavior
o Catatonia
 Wild agitation, waxy flexibility (putting
someone in a certain position/pose and
they’ll keep it, regardless of how hard it is
to hold), immobility
o Prevalence and cause of schizophrenia
 Four causes:
 Possible genes involved
 Chemical action of drugs that help many people with
this disorder
 Abnormalities in working of brains of people with this
disorder
 Environmental risk factors that may precipitate onset of
symptoms
 Course = chronic
 Moderate – to – severe lifetime impairment
 Life expectancy = less that average
o Suicide
 Female : male ~ 1 : 1
 Females
o Later age of onset
o Better outcomes
 Development
 Early childhood clinical features
o Typically difficult to diagnose children
o Mild physical abnormalities

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o Poor motor coordination

o Mild cognitive problems
o Social problems
 Prodromal phase
o 1-2 years before serious symptoms
o Less severe, yet unusual
 Ideas of reference
 Magical thinking
 Illusions
 Isolation
 Marked impairment in functioning
 Lack of initiative, interests, and/or energy
o Diagnosis and treatment typically occur 1-2
years after symptom onset
o Relapse and recovery (from symptoms)
o Most experience several episodes
o Poor overall prognosis
o High suicide rates
 Cultural factors
 Does schizophrenia even exist?
o Label for difficult/unusual people
 Worldwide prevalence is similar
o Course and outcomes are different
 Higher prevalence in African Americans (U.S.)
o Misdiagnosis
o Bias and stereotyping
 Genetic influences
 Inherited vulnerability for schizophrenia
 Multiple gene variation
 Family studies
 Parent’s severity increases likelihood for children
 Do inherit: general predisposition
 Do not inherit: specific forms
 Familial risk for a spectrum of psychotic disorders
related to schizophrenia
 Risk increases with genetic relatedness
 Twin studies
 Genian quadruplets
o Same genetics and environment (general)
o Differences:
 Ages of onset
 Symptoms
 Diagnoses
 Courses
 Outcomes

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o Importance of unshared environments

 Adoption studies
 Increased risk for children of biological mothers with
schizophrenia
o If mom has it, you have a higher risk of getting it
 Offspring of twins
o Higher risk of getting it
 Linkage and association studies
 Many candidate genes
 Likely multiple genes
o Neurobiological influences
 Dopamine hypothesis
 Agonists
o Increase schizophrenic-like behavior
 Antagonists
o Reduce schizophrenic-like behavior
 Antipsychotic drugs (neuroleptics), Parkinson’s, L-Dopa
(wonder drug), amphetamines
 Overly simplistic
 Problematic
o Antagonists don’t always work
o Slow response to medications
o Little impact on negative symptoms
o Olanzapine
 Brain structure
 Enlarged ventricles (enlarged spaces in brain/4 spaces)
 Hypofrontality
o Dorsolateral prefrontal cortex
 Prenatal and perinatal influences
 Viral infections
o Influenza
o Meningitis
 Pregnancy complications
o Bleeding
 Delivery complications
o Asphyxia – chord gets wrapped around neck,
breeched baby, etc.
 Chronic and early use of marijuana
 Likely interact with genetics and environment
o Psychological and social influences
 Stress
 Activated vulnerability
 Increases relapse risk
 Family and relapse
 Schizophrenic mother

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 Double-bind communication
 Expressed emotion (EE)
 Criticism, hostility, emotional over involvement
o Treatment
 Biological interventions
 Historical treatments (30s – 40s)
o Insulin coma therapy
o Psychosurgery
 Prefrontal lobotomies
o Electroconvulsive therapy
 Antipsychotic medications (neuroleptics)
o First line treatment
o Began in 50s
o Decrease positive symptoms
o Side effects: common, acute, permanent
 Extrapyramidal (motor issues: feet
shuffling, drooling, etc.)
 Parkinson-like
 Tardive dyskinesia
o Compliance problems
 Transcranial magnetic stimulation
o Magnetic fields
o Possible benefits
 Auditory hallucinations
 Effects last less than a month
 Psychosocial interventions
 Historical approaches
o Focus on role of early personal histories
 Psychodynamic
 Psychoanalytic
o Little benefit, possible harm
 Psychosocial approaches
o Behavioral
 Token economy – given a token to turn
in for a prize like object[s] (in assisted
living)
 Inpatient units
o Community care programs
o Social and living skills training
o Behavioral family therapy
o Vocational rehab
 Necessary adjunct to medication
 Virtual reality technology
o Simulation of multiple cognitive tasks
o Diagnosis

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 Assertive community treatment

o Multidisciplinary teams
 Medication management
 Psychosocial treatment
 Vocational rehab
o Integrated elements increase efficacy
 Treatment across cultures
o Adapting treatment to cultural involving family
members
o Adhering to beliefs
o Community-based treatments
 Prevention
o Targeting at risk populations
o Increasing parenting skills
o Reducing birth complications
o Decreasing early illnesses
 Viral vaccinations
o Prodromal stages
o Other psychotic disorders
 Schizophreniform
 Schizophrenic symptoms
 Few months only
 Associated with good premorbid functioning
o No prodromal phase/stage
 Most resume normal lives
 Schizoaffective
 Symptoms of schizophrenia plus a mood disorder
 Disorders are independent
o Delusions for 2 weeks in absence of mood
 Prognosis = similar to schizophrenia
o Persistent
o No improvement without treatment
 May end up being chronic
 Delusional
 Delusions are contrary to reality
 Lack other positive and negative symptoms of
schizophrenia
 Types:
o Erotomanic
o Grandiose
o Jealous
o Persecutory
o Somatic (guy that said he didn’t have a heart,
etc.)
 Shared psychotic

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o Delusions from relationship with delusional

person (starting to take on partner’s delusions,
etc.)
 Rare
 Later age of onset
 Female>male
 Brief psychotic
 One or more positive symptom
 Lasts 1 month or less

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Chapter 14:

 Neurodevelopmental disorders
o Overview
 Neurodevelopmental disorders new combo of disorder in
DSM-5
 What is normal? Abnormal?
 Psychopathology
 Developmental impact of early skill impairments
 First diagnosed = infancy, childhood, adolescence
o Developmental disorders
 Attention deficit hyperactivity disorder (ADHD)
 Central features
o Inattentive
o Hyperactive
o Impulsivity
 DSM-5 differentiates two categories of symptoms
o Problems of inattention
o Problems of hyperactivity and impulsivity
 Impairments
o Behavioral
o Cognitive
o Social
o Academic
 Stats
o Children with ADHD
 Onset = 3 or 4
 Boys : girls = 3 : 1
 Males are more externalized
 Females are socialized to
internalize
 Possible cultural construct
o Adults with ADHD
 Lower level jobs
 Less education
 More likely to be divorced, have
substance use problems and antisocial
personality disorder
 High risk behaviors
o High comorbidity
 ODD – oppositional defiant disorder
 Mood disorders
 Causes
o Genetics
 Familial component

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 Copy number variants (CNVs)

 Dopamine
 Norepinephrine
 GABA
 Serotonin
o Neurobiological contributions
 Smaller brain volume
o Role of toxins
 Allergens and food additives
 No evidence
 Maternal smoking
 Increases risk
 Interacts with genetic
predisposition
o Psychosocial and social factors
 Negative responses
 Teachers
 Peers
 Adults
 Peer rejection
 Low self-esteem
 Poor self-image
 Treatment
o Psychosocial intervention
 Improving academic performance,
decreasing disruptive behavior, and
improving social skills
 Behavioral interventions before
medication
 Parent training
 Social skills training
o Biological intervention
 Goals
 Reduce impulsivity and
hyperactivity
 Improve attention
 Stimulants
 Effects
 Improve compliance
 Decrease negative behaviors
 Do not affect learning and
academic performance
 Possible abuse issues
 Side effects
o Combined treatments

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 Behavioral and dedication

 Recommended
 Controversy exists
 Specific learning disorders
 Performance substantially below expected levels ~
deficits in:
o Age
o IQ
o Education
 Actual vs. expected achievement
 Unexpected underachievement
o Key
 Not die to sensory deficits
 Combined under DSM-5 into specific learning disorder
o Reading disorder
o Mathematics disorder
o Written expression
 Response to intervention
 Stats
o Boys = girls
o Students with learning disorders are more likely
to:
 Have higher drop-out rates
 Be unemployed
 Have suicidal thoughts
 Have negative school experiences
o Possibly related to communication disorders
 Causes
o Genetic and neurobiological contributions
 Familial component
 Multiple gene influences
o Communication disorders
 Childhood onset, fluency disorder –
stuttering
 Language disorder
o Disorders of reading have been diagnoses more
often in English-speaking countries
 Work recognition – dyslexia
 Comprehension
o Psychosocial contributions
 Motivational factors
 SES
 Cultural expectations
 Parental interactions
 Expectancies

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 Child management practices

 Treatment
o Educational interventions
 Specific skills instructions
 Vocab
 Discerning meaning
 Fact finding
 Strategy instructions
 Decision making
 Critical thinking
 Compensatory skills
o Biological treatment (drugs) is typically
restricted to individuals who may have comorbid
ADHD
o Direct instruction
 Systemic instruction
 Teaching for mastery
 Autism spectrum disorder (ASD)
 Neurodevelopmental disorder that affects how one
perceives and socializes with others
 DSM-5 combined following into ASD
o Sutistic disorder
o Asperger’s
 Pervasive developmental disorder not otherwise
specified dropped in DSM-5
 Social (pragmatic) communication was added to DSM-5
 Two major characteristics of ASD
o Impairments in communication and social
interaction
 Fail to develop age-appropriate social
relationships
 Social communication and interaction
 Joint attention
 Deficits in nonverbal
communication
o Prosody
 Echolalia – repeating what someone else
has said
 Conversational impairments – starting,
maintaining, or ending conversations
o Restricted, repetitive patterns of behavior,
interests, or activities
 Maintenance of sameness
 Stereotyped and ritualistic behaviors
 Three levels of severity

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o Level 1 – requiring support

o Level 2 – requiring substantial support
o Level 3 – requiring very substantial support
o Described qualitatively and, as yet, has no
quantitative equivalent
 Stats
o Prevalence
 Male : female  4.4 : 1
 Occurs worldwide
 Causes
o Historical views
 Failed parenting
 Perfectionistic, cold, and aloof
 High SES
 Higher IQ
 Lack of self-awareness
 Limited self-concept
 Behavioral correlates
 Echolalia
 Self-injury
o Biological
 Significant genetic component
 Familial component
o Second child with autism
 Numerous genes on number of
chromosomes involved
 Oxytocin receptor genes
o Bonding and social memory
 Older parents increase risk
 Neurobiological influences
 Amygdala
o Larger at birth = higher
anxiety, fear
o Elevated cortisol
o Increases neuronal damage
o Similar size when older
o Fewer neurons
 Oxytocin
o Lower levels
 Vaccinations
o Mercury
o No increased risk
o Negative effect of not
vaccinating
 Treatment

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o Psychosocial
 Behavioral approaches
 Skill building
 Reduce problem behaviors
 Communication and language
training
 Increase socialization
 Naturalistic teaching strategies
 Early intervention is critical
o Biological
 Medical intervention has had little
positive impact
 Decrease agitation
o Tranquilizers
o SSRIs
o Integrated
 Preferred model
 Multidimensional, comprehensive focus
 Children
 Families
 Schools
 Home
 Community and social support
 Intellectual disability (ID)
 Evident in childhood as significantly below-average
intellectual and adaptive functioning
o Measured by standardized tests
o IQ of 70 – 75 or below
o Adaptive problems
 Communication
 Self-care
 Home living
 Social and interpersonal
 Use of community resources
 Self-direction
 Functional academic skills
 Work
 Leisure
 Health and safety
o Level of disability
 Mild
 50 – 55 to 70
 Moderate
 35 – 40 to 50 – 55
 Severe

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 20 – 25 to 35 – 40
 Profound
 Below 20 – 25
o Other classification systems
 American association of intellectual and
developmental disabilities (AAIDD
 Based on assistance required
o Intermittent
o Limited
o Extensive
o Pervasive
 Stats
o Chronic course
o Highly variable individual prognosis
 Causes
o Hundreds of known causes
 Environmental –
pollutants/poisons/toxins
 Genetic
 Prenatal
o Fetal alcohol syndrome
o Disease
o Chemicals
o Poor nutrition
o Lack of oxygen (anoxia)
during birth
o Malnutrition
o Head injuries
 Perinatal
 Postnatal
 Multiple genes
 Chromosomal disorders
o Down syndrome
 Increases Alzheimer
risks
 Mitochondrial disorders
 Multiple genetic mutations
 GENES & ENVIRONMENT
 Treatment
o ID parallels that of people with more severe
forms of autism
o Goals
 Skill building  community life, school,
job, social relationships, etc.

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 Behavioral innovations can help teach

following skills
 Basic self-care as dressing
 Bathing
 Feeding
 Prevention
o Early intervention
 At risk children, families
 Head-start program
 Educational
 Medical
 Social supports
o Genetic screening
 Detection and correction
 Prenatal gene therapy

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Chapter 15:

 Neurocognitive disorders
o Perspectives
 Affect multiple cognitive processes
 Learning
 Memory
 Consciousness
 Most develop later in life
 Three classes
 Delirium
 Mild
 Major
o Delirium
 Clinical description
 Global impairments
o Consciousness
 Confusion, disorientation, can’t focus
o Cognition
 Memory and language deficits
 ACUTE – RAPID ONSET
o Several hours
o Days
 Stats
 Highest prevalence
o Older adults
o AIDS patients
o Cancer patients
o Medical patients
 Full recovery = several weeks
 Vital signs
 Subtypes
 Delirium due to a general medical condition
 Substance-induced delirium
 Delirium due to multiple etiologies
 Delirium not otherwise specified
 Causes
 Drug intoxication
o Medications
o Illicit drugs
 Ecstasy
 Poisons
 Withdrawal from drugs
 Infections
 Head injuries

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o Swelling
 High fever
 Older age
 Sleep deprivation
 Immobility
 Excessive stress
 fMRI scanning used to monitor/locate potential sources
of delirium
 Ethical concerns
 Treatment
 Treat underlying medical or withdrawal problems
 Acute delirium
o Haloperidol or olanzapine
 First line of treatment – psychosocial intervention
o Education
o Reassurance
o Coping strategies
 Prevention
 Proper medical care
 Proper medication use
o Major and minor neurocognitive disorders
 Clinical description
 Gradual deterioration of brain functioning that affects
o Memory
o Judgment
o Language
o Other advanced cognitive processes
o INSIDIOUS – GRADUAL ONSET
 Initial symptoms
 Memory impairment
 Visuospatial skills deficits
o Clumsy – running into things when you are
consciously aware
 Agnosia
o Facial agnosia
 Delusions
 Depression
 Agitation
 Aggression
 Apathy
 Later symptoms
 Continued cognitive decline
 Assistance with activities of daily living
 Death = inactivity + other illnesses

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o Pneumonia
 Stats
 Onset = any age, but most commonly later on
 Prevalence
o Longer lifespan
 Etiology
 Dementia of Alzheimer’s type
o Multiple cognitive deficits
 Memory
 Orientation
 Judgment
 Reasoning
o Insidious and progressively gets worse
o Confusion
o Agitation/combativeness
o Depression
o Anxious
o Sundowner syndrome
 End of notebook – she starts
remembering, then snaps, forgets again,
and gets aggressive towards him
o Significant social and occupational impairments
o Definitive diagnosis = autopsy
o Brain scans can be helpful
o Spinal fluid testing
o Mental status exam – only helpful if client is wise
to Alzheimer’s
o Range of cognitive
deficits***********************
 Aphasia – language impairment or loss
 Apraxia – voluntary movement
impairment
 Agnosia – inability to recognize and name
objects
 Executive functioning
o Stats
 Nature and progression of disease
 Deterioration
o Early and later stages =
slow
o Middle stages = rapid
 Post-diagnosis survival = 8 years
 Onset = 60s and 70s
o Early onset = 40s and 50s
 Prevalence

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Higher: 
o Poorly educated
o Women
 Estrogen?
 Lower:
o Higher education
 Cognitive reserve
theory
o American Indians
 Vascular injury - veins, capillaries, arteries
o Progressive, common cause of neurocognitive
deficits
o Blockage or damage to blood vessels
o Cognitive disturbances
 Speed of info processing and executive
functioning
 Greater motor problems
 Weakness in limbs
o Severe impairments
o Prevalence
 Men > women
 Higher rates of cardiovascular
 Most will require formal nursing care
 Death from infection
 Pneumonia
 Weak immune system
o Cause
 Frontotemporal degeneration
 Traumatic brain injury
 Lewy body disease
 Parkinson’s
 HIV
 Substance abuse
 Huntington’s disease
 Prion disease
 Normal pressure, hydrocephalus
(excessive water in brain)
 Head trauma
 Accidents most common cause
 Memory loss is primary symptom
 Chronic traumatic encephalopathy
(CTE)
o Sports
 Frontotemporal degeneration

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o Damage to frontal or temporal regions of brain

affecting:
 Personality
 Language
 Behavior
 Two types
 Decline in appropriate behavior
 Declines language
 Traumatic brain injury
o Symptoms persisting at least a week following
trauma, including executive dysfunction
 Loss of consciousness
 Confusion/disorientation
 Posttraumatic amnesia
 Neurological signs
o Treatment
 Ginkgo biloba
 Studies not replicated
 Antioxidants
 Lewy body disease
o Plaquey substance – protein  damages brain
cells over time
 Parkinson’s disease
o Degenerative/progressive
o Dopamine pathway disintegrates
o Motor problems
 Tremors
 Posture
 Walking
 Speech
o Sub-cortical impairment pattern
 Not all develop dementia
 HIV infection – subcortical dementia
o Slows cognitions
o Impaired attention
o Forgetfulness
o Clumsiness
o Repetitive movements
 Tremors/leg weakness
o Apathy
o Social withdrawal
o Occurs in later stages
o Sub-cortical dementia
 Motor skill impairments
 Slowing

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 Anxiety
 Depression
 No aphasia
 Substance use
o Drug use, plus poor diet
 Alcohol, inhalants, sedatives, hypnotics,
anxiolytics
o Brain damage may be permanent
o Symptoms similar to other neurocognitive
disorders
 Aphasia – language
 Apraxia – movement
 Agnosia – memory
 Executive function impairments
 Huntington’s disease
o Genetic autosomal dominant disorder
o Early onset = 40s and 50s
o Motor symptoms
 Chorea – jerky movements
o Sub-cortical
 Prion disease
o Always fatal
o Not contagious in humans
 Cannibalism
 Blood transfusions
o Linked to mad cow disease
 Causes
 Early, unsupported views
o Smoking
 Alzheimer’s most common cause
 Neurobiological influences
o Neurofibrillary tangles
 Tau
o Amyloid plaques
 Plaque
 Spinal fluid
 Genetic influences
o Polygenetic
o Chromosomes
 Psychosocial/social factors
o Drug use
o Diet
o Exercise
o Stress
 Cultural

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o Ethnicity
o Economic conditions
 Treatment


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Chapter 16:

 Mental health services: legal and ethical issues

o Perspectives
 Guidance
 Ethical principles
 State and federal laws
 Issues
 Civil vs. criminal commitment
o Civil commitment
 Laws detailing when a person can be legally
declared to have a mental illness and be placed
in hospital for treatment
 General criteria:
 Mentally ill and needs treatment
 Dangerous to themselves or others
 Gravely disabled
o Inability to care for self
 Governmental authority
o Police power
 Health
 Welfare
 Safety of society
o Parens patriae
 State acts as a surrogate
parent
 Initial stages
o Person fails to seek help
o Others feel that help is needed
o Petition is made to a judge
o Individual must be notified
 Subsequent stages
o Involves normal legal proceeding
o Should person be committed?
o Judge makes determination
o Assisted outpatient treatment
(AOT)
 Defining mental illness
o Legal concept
o Sever emotional or thought
disturbances
o Definitions vary by state
o Often exclude:
 Cognitive disability

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
Substance-related
disorders
o Not synonymous with a
psychological disorder
 Subjective
 Flexible
 Dangerousness
o Self or others
o Mental illness generally increases
likelihood of future violence
o Central to commitment
proceedings
o Questionable links to mental
illness
o Specific symptoms raise risk
 Hallucinations
 Delusions
 Personality disorders
o Gender and ethnic biases
 Role of mental health professionals:
 Brain blame
 Assessment tools
o Psychopathy checklist-revised
(PCL-R)
 Best at identifying persons
low at risk of being violent
o Drug or alcohol dependence
o Cannot predict whether an
individual will become violent
 Procedural changes:
 Supreme court
o Restrictions on involuntary
commitment
o Insufficient grounds
 Non-dangerous person
 Need for treatment alone
 Gravely disabled
 Consequences of supreme court
o Criminalization of mentally ill
o Deinstitutionalization and
homelessness
o Transinstitutionalization
 Reactions to strict commitment
procedures
o Return to broader procedures

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o Easier commitment
o Increase in involuntary
commitments
 Dangerous and non-
dangerous
 Need for treatment alone
o Special cases of sex offenders
 Treatment vs. punishment
o Periodic change in laws is a sign of
a healthy system
o Criminal commitment
 Nature:
 Accused of committing crime
 Detainment in mental health facility
o Evaluation
 Fitness to stand trial
 Findings
o Guilty
o Not guilty by reason of insanity
 Insanity defense: legal
statement/definition,
insanity at time of crime,
treatment facility vs. prison,
and/or diagnosis of
disorder doesn’t equal
insanity
 Don’t know what you’re
doing; don’t know it’s
wrong
 Ethical vs. legal considerations
o Therapeutic jurisprudence:
 Integrating knowledge of behavior change
 Problem solving courts
 Address unique needs
 Focus on specific problems
o Example – delayed sentencing if
job for six months
o Competence to stand trial:
 Requirements
 Understand legal charges
 Ability to assist in defense
 Essential for legal processes
 Burden of proof = defense
 Consequences
 Loss of decision-making authority

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 Results in commitment
 Psychologists’ role in legal matters
o Duty to warn:
 Professional responsibility to inform those in
danger
 Right to confidentiality
 Threat must be specific
 Consultation is imperative
 Tarasoff vs. Cali
 Therapist knew of danger, did not warn,
got sued
o Mental health professionals as expert witness
 Psychologists’ roles
 Specialized knowledge and expertise
 Competency determinations
 Assess risk – dangerousness
 Reliable DSM diagnoses
 Advise the court
o Psychological assessment
o Diagnosis
o Assess malingering
 Patient and research subject rights
o Patients’ rights and clinical practice guidelines
 Right to treatment
 Must treat if involuntarily committed
 Reduce symptoms
 Provide humane
o Clean and sanitary environment
 Least restrictive alternative
o More to less structure living
o Large to small facilities
o Large to smaller living units
o Group to individual residences
o Segregated from community to
integrated into community
o Dependent living to independent
living
 Right to refuse treatment
o One of most controversial issues
o Medical or drug treatment
o Cannot force competence
o Individual participant rights
 Practice standards
o Evidence-based practice and clinical practice guidelines
 Effective health care practices

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 Empirical support
 Systematic
 Agency for healthcare research and quality
 Patient protection and affordable care act
 Mental health services
o Efficient
o Cost-effective
 Dissemination of state-of-the-art info
o Practitioners
o General public
o APA practice guidelines
 Standards fro clinical research
 Efficacy
o Is it effective vs. alternative or
placebo?
 Utility
o Does it make a difference?
o Can we apply if in real world?
 Feasibility
 Generalizability
 Mental health care evolution

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