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Summary/Samenvatting Clinical Psychology Specialisation

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Clinical Psychology

Instelling
Universiteit Leiden (UL)

This is a document filled with summaries of the articles, chapters and lectures for the Clinical Psychology specialisation from Leiden University.

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Examination Summary
Clinical Psychology

Week 1
Lecture Notes
A behavioural/psychological syndrome (within an individual) → a syndrome is operationalised in
terms of a diagnosis → a diagnosis is a predefined set of symptoms, not explained by other factors →
all in all causes impairment functioning or noticeable stress (to the person or others)

Made up constructs → back in history
Hysteria → women experience extreme emotions due to uterus 'wandering' through their bodies
Homosexuality → was seen as a mental disorder as it was not correct in regards to the norm
Sluggish Schizophrenia → (USSR) people who had a large suspicion against the communist beliefs
Constructs that can 'change' in the future
ADHD → ⅓ boys issues with this… should it be a disorder or is it miscommunication in the body?
Somatic Symptom Disorder → physical complaint that cannot be explained… what next?

Study: “rising morbidity and mortality in midlife among white non-hispanics in 21st century”
Below: the rates of death, but not due to cancer, diabetes, etc., instead, these are the reasons:

Substance Abuse Disorder = use alcohol or another substance that causes impairment in
functioning or noticeable stress → at least 1 out of 10 other symptoms (e.g. tolerance, cravings, etc.)
→ severity: 2-3 symptoms = mild, 4-5 symptoms = moderate, > 5 symptoms = severe

Case-Formulations = a hypothesis on causes, precipitants, and maintaining influences on a
person's mental well-being → dynamic: active ongoing process responsive to new data
→ it is also detailed, but less scientific/reliable and differs from just forming a diagnosis

Two Factor Theory = (Mowrer) avoidance learning and also anxiety involves two processes:
1. Classic Conditioning → a (earlier neutral) stimulus gets meaning
2. Operant Conditioning → avoidance of the stimulus comes with relief of negative emotions

,Clinical Psychology = (definition from lecture) an integration of science and clinical knowledge for
purpose of understanding, preventing & relieving psychologically-based distress/dysfunction and to
promote well-being & development → starts with knowledge & knowledge starts with observation

1. Data ↔ 2. Phenomenon ↔ 3. Theory (Eronen & Brinkmann)
1. Data → raw observations, they are evidence for the phenomenon
2. Phenomenon → relatively stable features of world and/or observations (e.g. placebo response)
3. Theory → a description of how phenomenon come about (e.g. the mentalistic theory for the
placebo response: patient expectation is the primary cause of the effect)
Example:
1. Data → there are people in the world with an alcohol problem
2. Phenomenon → people who abuse alcohol, very often actually don't like drinking alcohol
3. Theory → Sensitisation Theory = liking becomes wanting and craving in addiction (shift
positive reinforcement (pleasure) to negative reinforcement fed by cues (withdrawal))

Mental State Exam (MSE) = a tool/skill that allows (semi) structured assessment and observation
of a person's mental state → common sense: state of mind. There are indications of mental states:
1. Orientation → aware of the self, the place, the time, and the situation (one, two, three or all)
2. Insight → symptoms, recognised?: 100% denial → intellectual insight → emotional insight
3. Appearance → the way someone looks reflects their personality and their state of mind
4. Thought Processes & Content → form of thinking (logical, circumstantial) & think about what?
5. Speech → how does someone speak about themselves? → "I", "we", etc.
a. Example: people become more disconnected from the social context, like a poet talks
about "we" much more, but closer to suicide uses more "I" as becoming disconnected
6. Behaviour → intended to express: emotions are endowed with communicative function
7. Mood & Affect → mood: emotional climate & long lasting, affect: response to certain events
8. Memory & Concentration → consolidating memory & concentration level rely on mental state
a. In relation to mental disorders e.g. schizophrenia & depression have impairments

, Week 2
The three-hit concept of vulnerability and resilience: Toward understanding adaptation to early-life
adversity outcome - Deskalakis et. al.
Stress Hypo-Responsive Period (SHRP) = initially described a period during development when
the endocrine responses to stress were markedly diminished → subsequent studies indicated that the
rodent pup can respond selectively to systemic stimuli

The three-hit concept of vulnerability and resilience to stress-related mental disorders, is based on
gene-environment interactions during critical phases of perinatal and juvenile brain development.
The three-hit consists of:
1. Hit-1: Genetic Predisposition
2. Hit-2: Early-Life Environment
3. Hit-3: Later-Life Environment
The concept accommodates the cumulative stress hypothesis stating that in a given context
vulnerability is enhanced when failure to cope with adversity accumulate → this also points to the
individual’s predictive adaptive capacity: underlies stress inoculation & match/mismatch hypothesis

"For Better or For Worse" = genetic susceptibility should be contextually interpreted:
vulnerability in an environment may actually constitute an adaptive benefit in another environment

The interaction of genetic factors: (hit-1) with early-life environmental factors (hit-2), as reflected
in altered endocrine regulations and epigenetic modifications, programs during brain development
gene expression patterns relevant for an evolving phenotype. A certain programmed phenotype
when exposed to a later-life environment (hit-3) mental functions may become compromised and a
higher risk of psychiatric symptoms may arise (vulnerability), but when exposed to another type of
environment the same individual is expected to be resistant to mental dysfunction (resilience)

Lecture Notes
Chronic Disease = there are several different definitions:
1. Centres for Disease Control and Prevention: “chronic diseases are defined as conditions that last
1 year or more and require ongoing medical attention/limit activities of daily living or both”
2. World Health Organisation: “chronic diseases are not passed from person to person. They are
of long duration and generally slow progression”
3. MedicineNet: “a disease lasting 3 months or more, by the definition of the U.S. National
Center for Health Statistics. Chronic diseases generally cannot be prevented by vaccines or
cured by medication, nor do they just disappear”

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