Full summary of all lectures (learning material) and book chapters (lecture 7) of Clinical Psychology
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Course
Clinical Psychology (6463PS013Y)
Institution
Universiteit Leiden (UL)
ENG: This document is a full summary of all the lectures given in of Clinical Psychology. It also treats the aspects of 'worrying' and 'trauma-related therapy for PTSD' which were the book chapters that needed to be learned. In this document I also included pictures to explain some theory's even be...
- Exam material:
o All lectures
o 3 articles + 2 chapters of a book can be found in the
syllabus
o Exam consists of 10 open questions with a score of 10
per question maximum 100 points
o Questions not about diagnostics, but about psychological
(and biological) effects of theories of psychopathology
(also more complex diagnoses in society and how we
deal with them)
- A metamorphosis/change causes anxiety, worries, shame, withdraw,
poor sleep, etc.
- The norm/healthy above the norm = amount of attention to
below the norm = your mood
- The origins of
many disorders are the same to each other; deviations of the
norm/healthy.
- Taxonomy
o Certain behavioral/psychological syndrome(s) are detected
within an individual
o A syndrome is operationalized in the term of a diagnosis
o That diagnosis is a pre-defined form that compartmentalize a
set of symptoms, not jet explained by the diagnosis.
, o This causes impairment in functioning or noticeable stress (to
the person or others)
As you can see the
diagnosis does not
account for all the
symptoms within the
syndrome
- The norm/healthy is defined by culture, society, time, etc.
- Take for instance: hysteria above norm; attention to behavior
(feeling person) below norm (defined by culture/society)
homosexuality
- Taxonomy: useful I: [made up] construct of psychopathology serve
a certain form for communication and understanding
- Taxonomy: useful II: DSM 5 and ICD 11 serve as a explanation for
certain observations
- See lecture slides for the deaths of adversity Americans die
younger nowadays
- What leads a person to develop mood disorders?
- How does it develop?
- Transformation or metamorphosis ? mood disorders
- Illness the subjective experience of symptoms [what the patient
brings to the clinician]
- Disease the pathology (biology) / illness from the clinician’s
perspective/theory
,- What does the clinician need + is needed for a good diagnosis +
treatment:
o Verstehen (understanding of inter-subjective meaning,
empathy)
o Explanation (causal knowledge)
When both these come together holism
- The two-factor theory: Mowrer (anxiety)
o Classic conditioning: a (earlier neutral) stimulus gets a
meaning (negative or positive)
o Operant conditioning: avoidance of the stimulus comes with
relief of negative emotions
- The medical model
o Reductionistic approach: the languages of chemistry and
physics will explain it but to some extent more symptoms
within a diagnosis (spectrum)
o In extremis: exclustionistic approach
o Medical model biological model
But what about non-biological factors?
Tryptophan depletion in brain depression
biological but what about the non-biological factors?
- A cognitive account for Major Depressive Disorder:
o Stressful experiences during development
o Vulnerability [latent dysfunctional schemas]
o Activation of latent schemas (by stress)
o Negative cognitive bias
o Depression
- A neurotrophins account for Major Depressive Disorder:
o Stressful experiences during development
o Vulnerability [low expression of neurotrophic factors]
o Poor neuronal functioning: neurogenesis, apoptosis
o Poor cognitive functioning: memory, concentration, …
o Depression
- Data: raw observations. They are evidence for the phenomenon
- Phenomenon: Relatively stable features of the world/or observations
(e.g., placebo response, trauma depression risk)
- Theory: a description of how phenomenon come about (e.g., the
mentalistic theory for the placebo response: patient expectation is
primary cause of the effect)
, - Comorbidity the presence of more than 1 disorder/symptom type
in an individual at the same time (or in a sequence)
Mental health of refugees this week’s topic (and other comorbidity
themes within individuals)
- Refugee problem is not a countries problem, it a problem of the
entire world.
- Some forces that make you want to leave your country:
o Not being able to express your political/religious belief
o Exposed to physical dangers like hunger or thirst
o No medical care
o Lose friends or family
o Not being able to live up to your sexuality
o Natural causes: earthquakes, flood, fires, and the likes
o These themes usually don’t come together, but
clustered to a certain extent
- Pyramid of Maslow:
o If you want to be somewhere in your life, you should
(preferably) be somewhere up in this pyramid.
o (Above) Transcendence you can connect to greater
things like: social groups, nature, etc. You can be a part of a
(good developed) community
o Self-actualization Live up to your own opportunities, that
you can develop as a person in the best way you can develop
o Aesthetic
o Cognitive
o Esteem
o Belonging and love
o Safety
o Physiological (below)
- Being stuck as a refugee can mean that you are stuck somewhere
along the bottom of this pyramid wont surprise you: many forced
migrants of refugees develop some sort of mental disorder
- Study (that is referenced) is a study by teachers of the course:
(ADULTS)
o What was researched
PTSD
MDD major depression disorder
Anxiety disorders
o Research was done with refugees that we re-settled in
Western-European countries, after fleeing
o Self-report research
, o Diagnoses after the Self-report was lower in the cases of PTSD
and Anxiety disorders because giving a diagnosis is a
strictly measured occurrence, this might explain the lower
rate. MDD is about the same.
o They also compared the group of refugees (for a reliable
result) to the group of residents living in those countries, and
the group of refugees scored 2 times higher on those three
themes; meaning it is a high score (about 1 in 3 refugees)
o Within the group “Children/adolescents” they also found high
ratings of the 3 different themes.
Again; 2 to 3 times higher than the residents (W-E)
- Then another study was conducted:
o The effect of post-migration-factors on these prevalence rates
(PTSD, MDD, Anxiety disorders)
o Used Australia as a country they detain refugees on islands
around the main land country demotivating people to come
to Australia what happens to them? (post migration factors)
Higher prevalence rates that are 2 to 3 times higher
than the No detention group (refugees without the
detainment of Australia)
o When you don’t detain the refugees, a lager group of them
(most of them) will actually not develop any large cases of the
themes largely resilient
o When you DO detain the refugees largely not resilient
they will be way more likely to develop more difficult forms of
the themes of disorders
- Stress-sensitization Concept used in Clinical Psychology a lot it
says that people are exposed to stresses in their lives (not bad (for a
test), not good (trauma, refugees)), but if you are exposed to too
many stressors, than their impact of successive stresses, will cause
an increase and increase until it reaches a point where it is just too
much, you feel that you are drowning, that there is not much you
can do anymore this is the moment you lose control and that you
for some type of disorder
- Allostatic load theory related to stress-sensitization more a
theory that explains the things that you see
o Allostatic load theory accumulating wear and tear on the
body because of exposure to repeated stressors
o Theory starts out that some stressors are not bad. Reacting on
things around us is a good thing, things we can learn from.
always sets back to a setpoint which is healthy for us
o BUT because of the stress-sensitization theory if
stressors become to excessive repeated stress, that they
, happen too often, they a chronic, they also take up too much
time
o What happens:
The level of stress mediators, often defined in terms of
stress hormones (but you can also fill out other variables
(like cognitive variables)) can create a new setpoint
new variation this new setpoint is toxic bad for you
comes with too much allostatic load wears you
out
o Some proof:
When there is a accumulating theme of traumatic
exposures, the onset for anorexia nervosa also increases
in odds ratio
It is a linear effect
Exposure to more traumas can cause development of
(multiple) disorders as outcome
It is a method and proof for stress-sensitization, without
the definite underlying mechanisms known.
o Nature doesn’t just function in a linear way, it fluctuates so
do the mental disorders within humans
o Take the example of “Hormesis”:
Adaptive responses of cells/organisms to moderate
exposure and maladaptive responses on
high-level/intense exposure
When the toxic exposures (of events) become too high,
than it becomes difficult to function maladaptive for
functioning
For example when you put a plant in an environment
with plants that are toxic for the first plant, then that
plant (not within high vicinity) will grow the best out of
all, BUT when you plant too many of those toxic plants
around that first plant (high vicinity) than that first plant
will die quicker
o Some (big) stressors are not too bad per se they also
initiate some type of (genetic) adaptation of cells/organisms to
survive better with (changing) environments
o Conclusion:
There is a large (and chronic) burden in refugees due to
poor mental health
o Implications:
This burden impedes functioning and possibilities to
adapt
, Scalable/adapted treatment options should be/become
available
- Illness: The subjective experience of symptoms (what the patient
brings to the clinician)
- Disease: the pathology/illness from the clinician’s
perspective/theory
- Consequenses of those two theme’s can be devided into the
following two:
o Idiographic N = 1 (Illness)
Idiographic consequences consequences that are
experienced by the individual
o Nomothetic N > 1
Consequences that come from the diseases can be
described by nomothetic terms they apply to a larger
number than 1
Formulated in “Averages” or “Proportions of
people”, “etc”
Total costs to society
Average absenteeism from work
Average drop-outs from school
- Consequences are very important to understand mental disorders.
For various reasons:
o Consequences sketch (a part) of the scope (of the problem)
Prevalence rates [X] consequences = big problem
(action)
o Consequences of mental disorders (including themes about
despair) are common to result in suicide. A few moments
about that followed this lecture
Suicide doesn’t come with mental disorders, suicide
comes with high levels of (chronic) stressors making
people think about to be, or not to be
Suicide contagion copy-cat behavior this has been
documented quite some time.
Not reporting about suicide on social media correlates
with lower rates of suicide
Show “13 reasons why” was also risky problem was
that the explicit way of showing her suicide (and the
romanticizing of it) increased the number of suicides
following time
An important thing to do, for us as scientists, is of
course trying to understand the problems to
, partly/to some extend prevent these problems from
occurring
o Consequences ask for prevention/treatment (plus can serve as
primary prevention)
for example the problem suicide more media = more
cases of suicide consequences is the media but
media can also prevent 113 helpline
Antipsychotic drugs notably the newer versions of it,
cause unfavorable metabolic profile (without them
eating more or sporting less) harm them in the end
(obesity, diabetes, etc) BUT if you know such a
consequence exists of the medication; then you can
inform and advice people when you give the medication
to them
o Knowledge about the consequences of mental disorders can
actually create more support and empathy and with that;
less stigmatization and less discrimination of mental disorders
discuss this more in week 4
o A bit difficult to categorize BECAUSE: consequences of mental
disorders are actually (almost always) consequences of
consequences…
Age and onset of 2 different mental disorders (Anxiety
disorders and Unipolar depression)
Consequences of development in earlier years of your
life SES, Social network (group of friends or not), good
schooling or not, etc those consequences have a high
influence of the consequences of mental disorders
therefore: consequences of consequences
Life expectancy consequence of for example mental
disorders like schizophrenia, bipolar disorder, depression
ARE consequences of consequences consequence 1 is
bad medication OR bad sleep, unhealthy diet, etc
Consequences 2 = lower life expectancy
Back to the mental health of refugees:
- PTSD, Depression, and Anxiety in forced migrants: psychological and
psychosocial treatment effects
o Metha-analysis
o Depression outcome:
Different forms of treatment (like EMDR, CBT, NET,
TAU/DAU, mindfulness/meditation, nothing, waitlist, etc)
All treatment works some more than others
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