Chapter 1: Abnormal Psychology: Overview and Research Approaches

Abnormal psychology (psychopathology) —> Understanding the nature, causes, & treatment of mental disorders
Family aggregation —> Whether certain disorders runs in the family

Indicators of Abnormality:
1) Subjective distress —> If people suffer or experience psychological pain, this indicates abnormality
2) Maladaptiveness —> A behaviour in which it interferes with our well-being & with our ability to enjoy our work & our relationships
- This behaviour may not seem maladaptive for the patient, but it is for & towards the society
3) Statistical deviancy —> If something is statistically rare (i.e., away from the normal) & undesirable, then it is considered abnormal
4) Violation of the standards of society —> Failing to follow conventional social & moral rules of their culture group, is considered an
abnormal behaviour
5) Social discomfort —> Violating an implicit (i.e., unwritten) social rule make those around us feel uncomfortable, thus violating this will
result into producing abnormal behaviour
6) Irrationality & unpredictability —> If someone exhibits behaviours that are unpredictable & make no sense for the general population,
along with the fact that the person cannot control his behaviour, then this is a case of abnormality
7) Dangerousness —> Someone who is in danger of himself or to another person is behaviour considered abnormal
Culture plays a huge role on what is considered normal & abnormal, since things that were abnormal decades ago are normal nowadays

The DSM-5 & the Definition of Mental Disorder:

DSM-5 was published in 2013 & contains 947 pages along with 541 diagnostic categories, DSM-5 is also used mainly in America
The WHO has their own psychiatric classification system in which its called the international classification of diseases (ICD)
- ICD & DSM have many similarities but also differences like names of certain mental disorders
DSM-5 definition of mental disorder —> Syndrome that is present in an individual and that involves clinically significant disturbance in
behavior, emotion regulation, or cognitive functioning
The first DSM was published in 1952, but further updates came with scientific developments on mental disorders

Classification & Diagnosis (Advantages):

Science heavily relies on classification system since it provides us with nomenclature (i.e., a naming system)
- This facilitates researchers & clinicians having both a common language & shorthand terms for complex clinical system
- It also helps to shape information in a more organized manner (e.g., anxiety disorder includes panic disorder, phobias, agoraphobia)
Classification system of mental disorders has political & social implications (e.g., which psychopathology warrants insurance reimbursement)
Classification & Diagnosis (Disadvantages):
We use a discrete classification system in which is provides information in a shorthand form, this leads to a loss of information
There is a stigma associated with mental disorders, such that people are less comfortable to disclose psychiatric than physiological problems
- A study was conducted in which results showed that 96% of schizophrenia patients reported stigma part of their daily lives
- Stigma also leads people to not have treatment of their mental disorders
- This is more true to younger people, men, ethnic minorities, military personal, mental health professionals
There is also stereotyping with mental disorders in which we may automatically & incorrectly infer certain behaviours of mental disorders
Labeling is also a problem in which a person’s self concept may be directly affect with the psychopathology diagnosis
- In some situations however diagnostic labeling may provide a partial explanation for the inexplicable behaviour of the patient
- The use of more considerate language should be used where instead of saying a schizophrenic, we should say a person with
schizophrenia
There is a lot of prejudice with people affected with mental disorders, in which healthy people do not want to socialize with them even if they
are educated about the mental disorder
- One way to reduce th effect of stigma is having more contact with people in the stigmatized group
- Some people avoid those with mental illness because of the psychophysiological arousal that creates an unpleasant experience
Culture & Abnormality:
In the definition to the DSM-5 of disorder, it acknowledges that within a culture & its shared beliefs there are many practices that are normal
for them in which it might be abnormal for other cultures
- e.g., In Christian countries the number 13 tends to avoided, whereas in Japan the number 4 tends to be avoided
In some languages of Native America, Alaska Natives, & southeast Asian cultures, the word “depressed” does not exist
- There was a case of an Indian man who presented depressive symptoms, yet refused to be diagnosed with this, instead an Indian
psychiatrist diagnosed him with the “Dhat” syndrome, which the man believes they are producing less semen
- In China there is also a larger focus on the physiological symptoms (e.g., fatigue, dizziness, headaches) than psychological symptoms of
depression
Taijin Kyofusho syndrome —> Highly prevalent in Japan, which is an anxiety disorder is characterized by the fear that one may upset
others by one’s gaze, facial expression, or body odor
Ataque de nervios syndrome —> Prevalent in people of Latino descent (i.e., Caribbean), where the symptoms are triggered by stressful
event such as divorce or bereavement, include crying, trembling, and uncontrollable screaming

Prevalence & Incidence:

Epidemiology —> The study of the distribution of diseases, disorders, or health-related behaviors in a given population
- Mental health epidemiology —> Study of the distribution of mental health disorder
Prevalence —> The number of active cases in a population during any given period of time, usually expressed in percentage
- Point prevalence —> The estimated proportion of actual, active cases of a disorder in a given population at a given point in time
- 1-year prevalence —> Asses everyone at any point of time during the one year who had the disorder
Incidence —> Refers to the number of new cases that occur over a given period of time (typically 1 year), typically lower than prevalence

Prevalence Estimates for Mental Disorders:

The lifetime prevalence of having any DSM-4 disorder is 46.4% (excluding eating disorders, schizophrenia, autism, personality disorders)
- However almost half of the people who met the criteria of a disorder were mild in severity
The most prevalent disorders are major depressive disorder, alcohol abuse & specific phobia
Comorbidity —> Term used to describe the presence of two ore more disorders in the same person
- It is especially high in people who have serious mental disorders
Anxiety, depressive & substance disorders account for 184 million disability adjusted years of life (DALY), where one DALY is the loss of 1
year of healthy life
- Depression accounts for 40% of the DALY
Worldwide, mental disorders will cost around 16 trillion USD in the next 20 years
Half the people with depression delay seeking treatment for more than 6-8 years, & 9-23 years for anxiety disorders
Inpatient care is the preferred treatment for severe disorders, however most insurances will not cover these fees
Treatments from mental health professionals can involve medications or psychotherapy

Research Approaches in Abnormal Psychology:

Through research we can learn if disorders are acute (i.e., short in duration) or chronic (i.e., long in duration)
Etiology —> Cause of disorders
Research protects investigators from their own biases in perception & inference
Abnormal psychology research can be done in many different settings like clinics, hospitals, schools, prisons, & other contexts where
naturalistic observations are used

Sources of Information:
1) Case studies —> Method in which we use specific cases of patients to infer a certain disorder, however it tends to be bias since the
writer selects what information to include & exclude
- The material of the case is often only relevant to the individual being described which produces low generalizability
 - Generalizability —> A measure of how useful the results of a study are for a broader group of people or situations
- They are good to illustrate clinical material & can provide positive or negative evidence for some theories
2) Self-Report Data —> Involves having research participants complete questionnaires, or researcher doing interviews
- Can be misleading since the individuals may not be good reporters of their own subjective states or experience
- The data cannot always be regarded as accurate or truthful since some people will lie
3) Observational Approaches —> Collecting information in a way that does not involve asking people directly
- Direct observation —> Collecting data by directly observing the participants
- A variety of methods can be used via that such as collecting biological samples (e.g., cortisol levels from saliva), to observing the brain of
a patient via brain imaging approaches

Forming & Testing Hypotheses:

Hypothesis —> An effort to explain, predict, or explore something
- Important for determining therapeutic approaches used to treat a particular clinical problem
Our working hypotheses regarding the causes of different disorders very much shape the approaches we use when we study and treat the
disorders
The more people we study, the more confident we can be about our findings
Sampling —> Try to select people who are representative of the much larger group of individuals with the experimental condition
Samples of convenience —> Studying groups of people who are easily accessible to them and who are readily available (e.g., college
students)
External validity —> The extent to which we can generalize our findings beyond the study itself (i.e., outside the laboratory)
Internal validity —> How confidant we can be in the results of a particular given study (i.e., free of other sources of errors, thus drawing
valid conclusions)
Control/Comparison group —> Group of people who do not exhibit the condition being studied but are in the criterion group (e.g., age, sex,
educational level, demographic variables)

Correlational Research Designs:

Correlational research —> Involves studying the world as is, it does not involve any manipulation of variables
- The researcher would select the group of interest & compare the group on a variety of different measures
- “Correlation does not mean causation”
Correlation coefficient —> The strength of the correlation which is denoted by the symbol “r”, & ranges from -1 to 1
- Positive correlation is a positive ‘r’, negative correlation is a negative ‘r’, & no correlation is when r = 0
Statistical significance —> p <.05 would mean that the probability that the correlation would occur purely by chance is less than 5%
- The ‘r’ is highly influenced by sample size, where larger sample size give more accurate correlations
Effect size —> Size of the association between two variables independent of the sample size, where closer to 0 means that there is no
association between the variables
Meta-analysis —> Statistical approach that calculates and then combines the effect sizes from all of the studies
Third variable problem —> Often present when there is correctional that gives an absurd causation, where a third variable which is unknown
might be causing this correlation
Retrospective research —> Looking back in time where we try to collect information about how the patients behaved early in their lives with
the goal of identifying factors that might have been associated with what went wrong later
- However it involves a bias procedure
Prospective research —> Looking ahead in time, where we try to identify individuals who have a higher-than-average likelihood of becoming
psychologically disordered and to focus research attention on them before any disorder manifests
Longitudinal study design —> A study that follows people over time and that tries to identify factors that predate the onset of a disorder
Replication of studies is very important in order to be confidant the findings found are correct, however some engage in data fraud to prove or
disprove some findings
The Experimental Method in Abnormal Psychology:
Direction of effect problem —> Does variable A cause B, or does variable B cause A
Treatment research —> Research in which we try to see if the given treatment to one group is superior to the control group
Random assignment —> Every research participant has an equal chance of being placed in the treatment or the no-treatment condition
Standard treatment comparison study —> Two (or more) treatments are compared in differing yet comparable groups
Double-blind study —> Study in which neither the experimenter nor the subject knows who is receiving the treatment
Single-case research designs —> Case studies that can be used to develop & test therapy techniques within a scientific framework
ABAB design —> Where phase A is the baseline condition, & phase B is the treatment condition, in which the patient goes in A-B-A-B
Animal research —> Research in which things that cannot be done on human is done onto animals (e.g., raised by different mother)
- Relies on the assumption that the findings of the animal study can be generalized onto humans
Analogue studies —> Studying not the true item of interest (e.g., Humans with back pain), but an approximation of it (e.g., rat with back
pain)
- Hopelessness model of depression was created via analogue study of animal, where dogs were used & then were depressed
Chapter 3: Casual Factors & Viewpoints

Hippocrates disease model —> An imbalance in the four bodily humors produced abnormal behaviour, each humor connected with certain
kinds of behaviors

Risk Factors & Causes of Abnormal Behaviour:

Primary goal of clinical psychology —> Understand the nature of relationship among the variables of interest
Risk factor —> If X is shown to occur before Y, then X is a risk factor of Y. It increases the likelihood of negative outcomes
Variable risk factor —> If X can be changed for outcome Y
Fixed marker —> If X cannot be changed for outcome Y
Variable marker —> If changing X does not lead to a change of Y
Causal risk factor —> If X changing X does lead to change of Y
Necessary cause —> Characteristic that must exist (X) for a disorder (Y) to change, where if Y occurs then X must have preceded it
Sufficient cause —> Sufficient cause of condition that guarantees the occurrence of a disorder, where if X occurs then Y will also occur
Contributory causes —> Most often studied in psychopathology, which states that this cause is one that increases the probability of a
disorder of developing but it neither a necessary or sufficient for the disorder to occur
Distal risk/causal factor —> Where some factors occur early in life but may not show their effect many years later
Proximal risk factor —> Factors that operate shortly before the occurrence of the symptoms of a disorder
Reinforcing contributory cause —> Condition that tends to maintain maladaptive behaviour that is already occurring
Causal pattern —> When more than one causal factor is used (e.g., A, B, C… lead to condition Y)

Diathesis-stress model —> Mental disorder developed when someone who has a preexisting vulnerability for that disorder experiences a
major stressor
- Diathesis (vulnerability) —> Predisposition toward developing a disorder that can derive from biopsychosocial factors
- Results from one ore more relatively distal necessary or contributory causes, but isn’t sufficient to cause the disorder
- Stress —> Response or experience of an individual to demands that he or she perceives as taxing or exceeding his or her personal
resources
- Often occurs when individual experiences chronic or episodic events that are undesirable
- A proximal factor that is contributory or necessary but is not suffocating to cause the disorder except in someone with diathesis
Additive model —> The diathesis & the stress simply add up or sum together, therefore a person with no diathesis or low level of diathesis
could still develop a disorder with high level of stress, whereas a person with high level of diathesis may only need a small level of stress
Interactive model —> Some amount of diathesis mist be present before the stress will have any effect, thus it assume someone who doesn’t
have diathesis will never have the disorder no matter the extent of stress
Proactive factors —> Decreases the likelihood of negative outcomes of those at risk, it is something that actively buffers against the
likelihood of negative outcomes
- Moderate stressors can promote coping much more than mild or extreme stressors
- It can lead to resilience —> The ability to adapt successfully to even very difficult circumstances
Child’s fundamental systems of adaptation —> Intelligence and cognitive development, ability to self-regulate, motivation to achieve mastery,
effective parenting, and well-functioning neurobiological systems for handling stress
- When these are operating normally, then most stressors will have minimal impact
- When 1-2 of those systems is weak, or when a serious stressor damages one of these system, this results into problems
The combination of diathesis & stressor can lead to abnormal behaviour
Multi-causal developmental model —> Propose that multiple risk factors over the course of development interact with stressors and
protective factors contributing to normal development or psychopathology
Developmental psychopathology —> Determining what is abnormal at any point in development by comparing & contrasting it with the
normal & expected changes that occur in the course of development
Perspectives to Understanding the Causes of Abnormal Behaviour:
Biopsychosocial viewpoint —> Acknowledges that biological, psychological, and social factors all interact and play a role in psychopathology
and treatment

The Biological Perspective:

Biological viewpoint —> Focuses on mental disorders as diseases, many of the primary symptoms of which are cognitive, emotional, or
behavioral
- Views that mental disorders are disorders of the central nervous system, automatic nervous system, &/or the endocrine system that are
either inherited or caused by a pathological processes
- However this can only be the case for neurological diseases, in which damage to a brain area caused a mental disorder
4 categories of biological factors that seem particularly relevant to the development of maladaptive behaviour;
1) Genetic vulnerabilities
2) Brain dysfunction & neural plasticity
3) Neurotransmitter & hormonal abnormalities in the brain or other parts of the central nervous system
4) Temperament

Genetic vulnerabilities:
Genes —> Very long molecules of DNA that are present at various locations on chromosome
Chromosomes —> Chain-like structures within a cell nucleus that contains genes, where humans have 23 pairs
Polymorphism —> Naturally occurring variations of genes
Polygenic —> A disorder would be influenced by multiple genes or by multiple polymorphisms of genes, where one gene only has a small effect
- Vulnerabilities to mental disorders are almost always polygenic, where no one specific gene is responsible for a mental disorder
- The polygenics of a disorder would lead to structural abnormalities in the central nervous system, abnormalities in the regulation of brain
chemistry & normal balance, or excess/deficiencies in the reactivity of the automatic nervous system
Certain genes can actually be activated/deactivated in response to environmental influences such as stress
Genotype —> A person’s total genetic makeup where no two humans have the same genotype, except for monozygotic twins
Phenotype —> Observed structural & functional characteristics that result from an interaction of the genotype & the environment
Genotype-environment interaction —> Genetic factors that can contribute to a diathesis to develop a psychopathology if there is a
significant stressor that is present in the person’s life
- e.g., PKU-induced intellectual ability is present when a person body react with phenylalanine, where a change of diet resolves this disorder
- There was a study done on depression, where people with one variant of a serotonin gene (2 short alleles) who experienced 4+ stressors
had twice the probability of developing major depressive disorder than the other variant (2 long alleles)
Genotype-environment correlation —> When the genotype shapes the environmental experience a child has in this way, in which there are
3 way that an individual genotype may shape his environment
1) The child’s genotype may have what has been termed a passive effect on the environment, resulting from the genetic similarity of parents
and children (e.g., Intelligent parents provide a stimulating environment for the child, thus creating an environment that will interact with the
genes for intelligence)
2) Evocative effect —> The child’s genotype may evoke particular kinds of reactions from the social and physical environment
3) Active effect —> The child’s genotype may play a more active role in shaping the environment
3 methods have been used in behavioral genetics —> The field that studies the heritability of mental disorders
1) Family history (pedigree) method —> Requires that an investigator observe samples of relatives of each proband or index case (the
subject, or carrier, of the trait or disorder in question) to see whether the incidence increases in proportion to the degree of hereditary
relationship
- Problem with this is that those who are closely related genetically, also tend to share similar environment, thus difficult to disentangle
genetic & environmental effects
2) Twin method —> Monozygotic twins share the same genetic material, thus the concordance rate is 100%
- Concordance rate —> Percentage of twins sharing the disorder or trait
 - However there is no mental disorder that has a 100% concordance rate, but there are some high for severe psychopathologies
- Concordance rate is also lower for dizygotic twins
3) Adoption method —> Capitalizes on the fact that adoption creates a situation in which individuals who do not share a common family
environment are nonetheless genetically related
5 common misconception about the interaction of genes & the environment;
1) Strong genetics effects means that environment influence is not important
2) Genes impose a limit on potential
3) Genetic strategies are of no value of studying environmental influences
4) Genetic effects diminish by age
5) Disorder that run in the families must be genetic, & those that do not run in families must not be genetic
Shared environmental influence —> Those that would make children in a family more similar, whether the influence occurs within the family
or in the environment
Nonshared environmental influences —> Those in which children in a family differ, these appear to be more important for psychopathology
- Experience that a single child receives has more impact than experience that all the children in the family received
Linkage analysis & association studies —> Attempt to determine the actual location of genes responsible for mental disorders
- Linkage analysis studies —> Capitalize on several currently known locations on chromosomes of genes for other inherited physical
characteristics or biological processes
- Association studies —> Compares two groups of individuals one with the disorder & the other without, in which then they look at
certain genetic markers that are known to be located in particular chromosome, & if the genetic markup occurs in a higher frequency in the
disorder group an association can be made that certain genes from the particular chromosome is associated with the disorder
Many postnatal environmental events affect the brain development of the infant & the child
- e.g., Rats in enriched environments show thicker cell development in certain portions of the cortex
Developmental systems approach —> Acknowledges that genetics influences neural activity, which in turn influences behavior, which in
turn influences the environment, but also that these influences are bidirectional
Nerve impulse travel to cell body —> axon —> axon endings —> release of neurotransmitters in presynaptic neuron —> postsynaptic neuron
Imbalance of neurotransmitters can be done in many ways; excessive production of neurotransmitters, dysfunctions in the reuptake or enzyme
degradation, problems with the postsynaptic neuron that may be too sensitive, or too insensitive
Chemical circuits —> Neurons that are sensitive to certain neurotransmitters tend to cluster together & form neural paths
5 neurotransmitters that are the most studied for psychopathology; 1) Norepinephrine, 2) Dopamine, 3) Serotonin, 4) Glutamate, 5) GABA
- Norepinephrine is important for emergency reaction to acute stress, as well as attention, orientation, basic motives
- Dopamine is important for pleasure & cognitive processing, it is also implicated in schizophrenia
- Serotonin is important on how we think & process information, as well as behaviour & mood, it plays a role in depression & anxiety
- Glutamate is the excitatory neurotransmitter (it is implicated in schizophrenia) & GABA is the inhibitory neurotransmitter
Hormones —> Chemical messengers secreted by a set of endocrine glands in our bodies
Pituitary gland —> The most important gland in the neuroendocrine system mediated by the hypothalamus to produce a variety of hormones
Activation of the hypothalamic-pituitary-adrenal (HPA) axis;
1) Messages in the form of corticotropin-releasing hormone (CRH) travel from the hypothalamus to the pituitary
2) Pituitary releases adreno-corticotropic hormone (ACTH) that produces epinephrine & cortisol
3) Cortisol provides a negative feedback to the hypothalamus & pituitary to decrease CRH & ACTH production
Temperament —> Refers to a child’s reactivity & characteristic ways of self-regulation, which is believed to be biologically programmed
At 2-3 months of age, 5 dimensions of temperament can be identified, & 3 dimensions can be identified for adult personality
- 1) Fearfulness, 2) Irritability/frustration, 3) Positive affect, 4) Activity level, and 5) Attentional persistence/effortful control
- 1) Neuroticism or negative emotionality, 2) Extraversion or positive emotionality, and 3) Constraint
A child’s fearfulness & Irritability/frustration dimension correspond to the adults neuroticism
A child’s positive affect & activity level dimension corresponds to the adults extraversion
A child’s attentional persistence/effortful control corresponds to the adults constraint
Children born in low socioeconomic status tend to have less supportive parents, thus when the child has high levels of negative emotionality the
parents are less prone to support him
Behaviourally inhibited —> Children who are fearful & hypervigilant in many novels or unfamiliar situations, they are more prone to anxiety
disorders
Behaviourally uninhibited —> Children who show little fear to anything, they are more prone to have difficulty in learning moral standards
- They also tend to show aggressive & delinquent behaviour in adolescence (i.e., 13 years of age)

The Psychological Perspective:

Psychoanalytic school —> Emphasize the role of unconscious motives & thoughts & their dynamic interrelationships in the determination
of both normal & abnormal behaviours
- Freud believed that unconscious material continues to seek expression & emerges in fantasies, dreams, slips of the tongue…
The structure oof personality relies on Id, ego & superego
- Id —> Appears in infancy, it operates on a pleasure principle, engaging in completely selfish & immediate gratification behaviour
- Instinctual drives can be life instincts which constitutes of sexual nature & libido (i.e., basic emotional & psychic energy of life), the
instinctual drives can be death instincts which are destructive drives that tend toward aggression & destruction
- Primary process thinking —> Id can generate mental images and wish-fulfilling fantasies
- Ego —> Appears in the first few months of life, it mediates between the demands of the id & the reality of life, it operates on the reality
principle
- Secondary process thinking —> The ego’s adaptive measures
- Superego —> The outgrowth of internalizing the taboos & moral values of society concerning what is right or wrong
Intrapsychic conflicts —> When id, ego, superego are striving for different goals, in which when unresolved this leads to a mental disorder
Anxiety —> Generalized feelings of fear & apprehension, in which this concept is prominent in the psychoanalytic viewpoint
- Freud believed that anxiety plays a causal role in most forms of psychopathology
Ego-defence mechanism —> Ego resorting to irrational protective measures (e.g., argument with a boss leads to argument with wife)
Psychosexual stages of development —> Oral stage (0-2), anal stage (2-3), phallic stage (3-6), latency period (6-12), genital stage
(post-puberty)
- Freud believed that if one didn’t get appropriate gratification in one of the stages he would be be fixated in one of the levels
- e.g., Fixated at oral stage leads to problems related with mouth like eating disorders
Ego psychology —> From Anna Freud, which states that psychopathology develops when the ego does not function adequately to control or
delay impulse gratification or does not make adequate use of defense mechanisms when faced with internal conflicts
Objects-relations theory —> Branch of psychodynamic thought that focuses on relationships being more crucial to personality development
than are individual drives and abilities
Interpersonal perspective —> From Alfred Adler, which stated the focus on psychopathology rooted in the unfortunate tendencies we have
developed while dealing with our interpersonal environment, in which we are people are social beings motivated to belong in a group
Attachment theory —> From John Bowlby, emphasizes the importance of early experience, especially early experience with attachment
relationships, as laying the foundation for later functioning throughout childhood, adolescence, and adulthood
- Very influential theory in child psychology, child psychiatry & adult psychopathology
Freuds contribution stand out in the fact that he stated there is psychological factors outside our conscious awareness, early childhood
experience have an important role on normal & abnormal personality, some abnormal metal phenomena occur as an attempt to cope with
difficult problems
- Problems with this theory is that it fails to realize the scientific limits of personal reports, & also there is a lack of scientific evidence to
support many of its explanatory assumptions or effectiveness of traditional psychotherapy
Humanistic perspective —> Human nature is good, it emphasizes present conscious processes and places strong emphasis on people’s
inherent capacity for responsible self-direction
Existential perspective —> Less optimistic views on human, where it places more emphasis on their irrational tendencies and the difficulties
inherent in self-fulfillment; particularly in a modern, bureaucratic, and dehumanizing mass society
The Behavioral Perspective:
Behavioural perspective —> The study of directly observable behavior and of the stimuli and reinforcing conditions that control it could
serve as a basis for understanding human behavior, normal and abnormal
- Learning —> The modification of behaviour as a consequence of experience is the central theme of the behavioural approach
Classical conditioning (Pavlov) —> A form of learning in which a neutral stimulus is paired repeatedly with an unconditioned stimulus that
naturally elicits an unconditioned behavior
- Condition stimulus (CS) paired with an Unconditioned stimulus (UCS) gives rise to a conditioned response (CR), in which afterwards only
the CS is necessary to create the CR
- Relies on stimulus-stimulus expectancy
- Extinction —> If a CS is repeatedly presented with the UCS, the CR will gradually extinguish
- However extinction in different environmental contexts may not be present (e.g., Removing fear in therapist office ≠ Removing fear
everywhere else)
Operant (instrumental) conditioning —> An individual learns how to achieve a desired goal via reinforcement
- Reinforcement —> The delivery of a reward or pleasant stimulus, or to the removal of or escape from an aversive stimulus
- Relies on response-outcome expectancy
Conditioned avoidance response —> When a subject has been conditioned to anticipate an aversive event & so consistently avoids those
situations
Generalization —> When a response is conditioned to one stimulus or set of stimuli, it can be evoked by other, similar stimuli
Discrimination —> Occurs when a person learns to distinguish between similar stimuli and to respond differently to them based on which
ones are followed by reinforcement
Observational learning —> Learning through observation alone, without directly experiencing an unconditioned stimulus or a reinforcer
For behaviourists, maladaptive behaviour is viewed as essentially the result of 1) failure to learn necessary adaptive behaviours or competencies
&/or 2) the learning of invective or maladaptive responses
Behaviour therapy —> Focus of therapy is on changing specific behaviors and emotional responses, eliminating undesirable reactions and
learning desirable ones

The Cognitive-Behavioral Perspective:

Cognitive-behavioural perspective —> Focuses on how thoughts & information processing can become distorted & lead to maladaptive
emotions and behaviour
Schema —> Underlying representation of knowledge that guides the current processing of information and often leads to distortions in
attention, memory, and comprehension
Self-schemas —> Our views on who we are, what we might become, and what is important to us
Assimilation —> We tend to work new experiences into our existing cognitive frameworks, even if the new information has to be
reinterpreted or distorted to make it fit
Accommodation —> Hanging our existing frameworks to make it possible to incorporate new information that doesn’t fit
- It is the basic goal of psychological therapies especially in cogntiive-behavioral therapy
Individuals who are depressed show memory biases favoring negative information over positive or neutral information
- This type of bias is what help reinforce or maintain one’s current depressed state
Nonconscious mental activity —> A descriptive term for mental processes that are occurring without our being aware of them
Attribution theory —> Concerned with how ordinary people explain the causes of behavior and events
Attributional style —> Characteristic way in which an individual tends to assign causes to bad events or good events
- e.g., People with depression tend to attribute bad events to internal, stable, and global causes
Self-serving bias —> Nondepressed people tend to make internal, stable, and global attributions for positive rather than negative events
Cogntiive-behavioral clinicians use a variety of techniques designed to alter whatever negative cognitive biases the client harbours

The Social Perspective:

Social factors are environmental influences, often unpredictable and uncontrollable negative events, that can negatively affect a person
psychologically, making him or her less resourceful in coping with events, there are 6 social factors that have important socioemotinal effects
1) Early deprivation or trauma —> Children who do not have the resources that are typically supplied by parents or parental surrogates
may be left with deep and sometimes irreversible psychological scars
Institutionalization is when children are raised into institutions instead of regular homes, where this can result into unfavourable long term
consequences (i.e., < 6 months) that can lead to many psychopathology
- This may be due to the fact that these children have reduced brain development, where they have a reduction in grey & white matter
Parental abuse is associated with many negative effects, & some studies state that gross neglect is worse than an abusive relationship
A study was done in which children who were abused when young two third of them had elevated rates of adolescent & adult
psychopathology
Disorganized & disoriented style of attachment —> Often present in infants whom were abused which is characterized by insecure,
disorganized, and inconsistent behavior with the primary caregiver
Short term or acute effects of separation —> Significant despair during the separation as well as detachment from the parents upon reunion
- Multiple acute separations can result into the development of an insecure attachment
2) Problems in parenting style —> Many kinds of deviations in parenting can have profound effects on a child’s subsequent ability to cope
with life’s challenges and thus can create a child’s vulnerability to various forms of psychopathology
- Parent-child relationships are bidirectional —> The behaviour of each person affects the behaviour of the other
Parents who have various forms of psychopathology tend to have one or more children at a higher risk for developmental difficulties
There are 4 types of parenting style in which they vary in the degree of warmth (amount of support, encouragement, and affection versus
shame, rejection, and hostility) and in the degree of parental control (extent of discipline and monitoring versus leaving the children largely
unsupervised)
I) Authoritative parenting style —> Parents are both very warm and very careful to set clear standards and limits on certain kinds of
behaviors while allowing considerable freedom within these limits, they are high in warmth & moderate in control
- This type of parenting is associated with more positive benefits & less prone for the child to have a psychopathology
II) Authoritarian parenting style —> Parents high on control but low on warmth
- Leads to children with poor social & cognitive style, the children are also at a higher risk of substance abuse & delinquent activity
III) Permissive indulgent parenting style —> Parents high on warmth but low on control
- Leads to children with impulsive & aggressive behavior
IV) Neglectful/uninvolved parenting style —> Parents low on warmth & low on control
- Leads to children that tend to be moody & low self-esteem, they also have peer relationships & academic performance problems
3) Marital discord & divorce —> Disturbed family structure is an overarching risk factor that increases an individual’s vulnerability to
particular stressors
- Marital discord —> Children of parents with high levels of overt conflicts tend to show greater disposition of aggressivity to peers
- Effect of divorce on parents —> Has negative effects at first, but can be beneficial in some instances, particularly in women
- Effect of divorce on children —> Children from this are more prone to psychopathology, & more prone for them to also end in divorce
- In some instances the effects of divorce is more favourable than the martial conflict
4) Low socioeconomic status & unemployment —> The lower the socioeconomic status the higher the incidence of mental disorders
- Anti-social personality disorder is 3 times more likely to be present in low socioeconomic status than high socioeconomic status
- This might be due to the fact that people with low socioeconomic status have more severe stressors in their lives
5) Maladaptive peer relationships —> Problems such as becoming a bully or its victim, in peer relationships are associated with an
increased risk of psychological disorders
- Bullies show high levels of proactive aggression (i.e., initiating it) & reactive aggression (i.e., overreacting)
- There is also rates as high as 1/3 or 1/2 of teenagers reporting being victim of cyberbullying
- Prosocial popular children tend to be good students relative to their less popular peers
- Antisocial popular children tend to be the though boys, they are more athletically skilled but less academically, they are also more
aggressive & defiant towards authority
6) Prejudice & discrimination in race, gender, & ethnicity —> Prejudice & discrimination can lead to higher levels of stress & other
negative effects of the individuals physical & mental health
- Access discrimination —> When certain member of a group & not hired based on their personal characteristics
 - Treatment discrimination —> When certain types of people are given a job, but paid less & receive fewer work opportunities
- Perception of discrimination leads to increase in anger & cardiovascular reactivity, risk-taking behaviour, lower level of well being (in
woman)

The Cultural Perspective:

The cultural perspective is concerned with the impact of culture on the definition and manifestation of mental disorders
Sociocultural factors often influence which disorders develop, the forms they take, how prevalent they are, and their courses
- e.g., Prevalence of major depressive disorder is 3% in Japan & 17% in USA
People from China often report physiological symptoms of depression (e.g., fatigue, weakness) instead of psychological one’s
Updated version of DSM-5 suggests that psychologists and other health professionals should be mindful of three different cultural concepts of
distress
1) Cultural syndromes —> Refers to clusters of clinical symptoms that often appear together within people from specific cultures
2) Cultural idioms do distress —> Refers to culture-specific ways of expressing distress to others (e.g., “feeling down” for
“depressed”)
3) Cultural explanation —> Refers to different ways of explaining the causes of different symptoms or disorders (e.g., loss or stress is
believed to be a causal factor in depression)
Advantage of having a theoretical perspective —> They ensure a consistent approach to one’s practice or research efforts
Electic approach —> Aspects of two or more diverse approaches may be combined into a more general, electic approach
- e.g., Psychologist might be using cogntiive-behavioral approach with interpersonal approach to reduce the anxiety of the patient
Biopsychosocial unified approach —> This viewpoint reflects the conviction that most disorders are the result of many causal factors
biological, psychological, and sociocultural interacting with one another
Chapter 4: Clinical Assessment & Diagnosis

Psychological assessment —> Refers to a procedure by which clinicians, using psychological tests, observation, and interviews, develop a
summary of the client’s symptoms and problems
Clinical diagnosis —> Process through which a clinician evaluates and classifies the patient’s symptoms according to a clearly defined
diagnostic system such as DSM-5

Three Fundamental Concepts:

Reliability —> Describing the degree to which an assessment measure produces the same results each time it is used to evaluate the same
thing, thus being a measure of consistency
- Test-retest reliability —> This tells us whether a test result gives us a similar value today as it did a few days earlier
- Inter-rater reliability —> The degree to which different clinicians agree on the diagnosis that should be assigned to summarize the
symptoms of a particular patient
Validity —> Extent to which a measuring instrument actually measures what it is supposed to measure
- In the context of testing or classification, validity is the degree to which a measure tells us something additional and meaningful about
the person now or helps us predict the future course of the disorder
Standardization —> A process by which a psychological test is administered, scored, and interpreted in a consistent or “standard” manner

The Nature & Goals of Assessment:

In the initial clinical assessment, the clinician tries to identify the main dimensions of a client’s problem and to predict the probable course of
events under various condition
A less obvious, but equally important function of pre-treatment assessment is to establish baselines for various psychological functions, this is
so that the effects of treatment can be measured
The clinician needs to know the presenting problem —> Major symptoms and behavior the client is experiencing, must be identified
Assessment should include a description of any relevant long-term personality characteristics
It is also important to assess the social context in which the individual functions
Dynamic formulation —> Describes the current situation of the individual but also includes hypotheses about what is driving the person to
behave in maladaptive ways

Important Factors Influencing Assessment:

1) Ensuring culturally sensitive assessment procedures —> Psychologists who use tests in a culturally competent manner must bear in
mind a range of issues and factors involved with culturally and linguistically diverse clients
- e.g., Clients that are from non-english-speaking countries might have insufficient English language skills, which will influence their test
results & the translated version might be biased thus must be carefully adapted
2) The influence of professional orientation —> How clinicians go about the assessment process often depends on their basic treatment
orientation
- A biologically oriented clinician is likely to focus on assessment methods aimed at determining any underlying biological factors that may
be causing the maladaptive behavior
- A psychodynamic or psychoanalytically oriented clinician may choose unstructured personality assessment techniques, to identify
intrapsychic conflicts or may simply proceed with therapy, expecting these conflicts to emerge naturally as part of the treatment process
- A behaviorally oriented clini- cian, in an effort to determine the functional relationships between environmental events or reinforcements
and the abnormal behavior
- A cognitively oriented therapist, the focus would be on the dysfunctional thoughts supposedly mediating those patterns
3) Trust & rapport between the clinician & the client —> For psychological assessment to proceed effectively and to provide a clear
understanding of behavior and symptoms, the client being evaluated must feel comfortable with the clinician
- Providing test feedback is an important element of the treatment process, & when client are given feedback they tend to improve
- Patients whom are provided with their feedback tend to increase in their self-esteem as a result of a clearer understanding of resources
Methods of psychological assessment:
1) Clinical interviews —> Considered the central element of the assessment process, usually involves a face-to-face interaction in which a
clinician obtains information about various aspects of a client’s situation, behavior, and personality
- Structured assessment interview —> All questions are asked of each client in a preset way, and the interviewer is not supposed to
change the order of the questions or to deviate from them in any way, in which the answers should only be yes, no, sometimes/somewhat
- Advantage is that it can be used by people who have & don’t have clinical training, it is also more reliable
- Structured interviews tend to be much longer than unstructured interviews, it may also feel to unnatural for the client
- Semi-structured assessment interview —> The interviewer is required to ask questions in a specific order and in a specific way.
Then, depending on the answer, the clinician will ask his or her own follow-up questions designed to obtain more information
- Disadvantage is that it requires much more interviewer training
- Advantage is that the resulting diagnose tend to show greater validity
- Unstructured assessment interview —> Typically subjective and do not follow a predetermined set of questions
- Since the clinician ask questions in its own way, important information needed for a DSM-5 diagnosis might be skipped
2) Clinical observation of behaviour —> Main purpose of direct observation is to learn more about a person’s psychological functioning by
attending to his or her appearance and behavior in various contexts
- Some clinicians provide their patients instruction in self-monitoring: self-observation and objective reporting of behavior, thoughts, and
feelings as they occur in various natural settings
- Rating scales can help both to organize information and to encourage reliability and objectivity
- Brief psychiatric rating scale (BPRS) —> Instruments for assessing the presence and severity of psychiatric symptoms
- Contains 23 items that asses multiples symptoms like anxiety, depression, grandiosity…
- Hamilton rating scale of depression (HRSD) —> Widely used procedures for selecting research subjects who are clinically
depressed and also for assessing the response of such subjects to various treatments
3) Psychological tests —> Standardized sets of procedures or tasks for obtaining samples of behavior
Two general categories of psychological tests for use in clinical practice are intelligence tests and personality tests (projective and objective)
- Intelligent tests are used in clinical settings for measuring the intellectual abilities WISC-4 & SBIC are used to measure intelligence
in children, whereas WAIS-4 is used in adults, these test typically require 2-3 hours to administer, score & interpret
- Personality tests —> Designed to measure personal characteristics other than intellectual ability which is grouped into projective &
objective measures
- Projective personality tests —> Unstructured in that they rely on various ambiguous stimuli, where response is not limited to
true, false or cannot say
- Relies on the assumption that in trying to make sense out of vague, unstructured stimuli, individuals “project” their own problems,
motives, and wishes into the situation
- Rorschach inkblot test —> The test uses 10 inkblot pictures, to which a subject responds in succession after being instructed
- The results tend to be unreliable because of the subjective nature of test interpretation, it also has poor validity
- Thematic apperception test (TAT) —> Uses a series of simple pictures, some highly representational and others quite abstract,
about which a subject is instructed to make up stories
- It can provide information about a person’s conflicts and worries as well as clues as to how the person is handling these problems
- There is limits to the reliability & the validity of the test
- Sentence completion test —> Procedure in which a client is asked to respond freely, are somewhat more structured than the
Rorschach and most other projective tests
- Projective personality tests is important for those trying to comprehend the person’s psychodynamic functioning
- Their strength lies in their unstructuredness & focus on personality, but their weakness is the subjectivity & low reliability &
validity
- Objective personality tests —> They are structured tests in which in involves a more controlled format than projective devices, they
hold more power than the projective tests since they are more precise thus enhancing the reliability of test outcomes
- Minnesota multiphasic personality inventory (MMPI) —> Personality test for clinical & forensic assessment, has 550 question
- 10 clinical scales that each measures tendencies to respond in psychologically deviant ways
 - The MMPI also includes a number of validity scales to detect whether a patient has answered the questions in a straightforward,
honest manner, thus the participant cannot lie on test since it will be detected
- Advantage of objective personality tests is that they are cost effective, highly reliable, and objective; they also can be scored and
interpreted (and, if desired, even administered) by computer

Physical assessment:
1) Physical examination —> Typically a medical history is obtained, and the major systems of the body are checked
2) Neuropsychological examination —> Involves the use of various tests to measure a person’s cognitive, perceptual, and motor
performance, this can provide important clues about the extent and location of brain damage
- It is not used to diagnose mental disorders due to the overlap on how some perform on neuropsychological tests
- Neuropsychological tests are performance based and standardized, with the person’s performance being compared with normative
standards
- Halstead-Reitan neuropsychological test —> Provides specific information about a subject’s functioning in several skill areas

Neurological approaches to assessment:

Electroencephalogram (EEG) —> Electrodes placed on scalp measures the brain’s electrical activity, it as high temporal resolution
Computed tomography (CT) scan —> Person is placed in a CT scanner where X-ray measurements are then taken at various angles and
combined to provide more detailed information than that given by a conventional X-ray
Magnetic resonance imaging (MRI) —> Can scan a body with magnetic fields in which they produce images with clarity & detailed
- Structural MRI (sMRI) —> Informs us about brain structure (e.g., schizophrenics have reduction in brain volume)
- Functional MRI (fMRI) —> Informs us about neuronal activity in the brain via blood oxygenation levels (i.e., blood volume)
Position emission tomography (PET) scan —> Involves injecting a radioactive substance in an individual in which with this we can
examine the functioning of the brain
- Drawbacks include a patients perspective on injection of radioactive substance, it is time consuming

Integrating assessment data & optimizing decision making:

Because of the impact that assessment can have on the lives of others, it is important that those involved keep several factors in mind when
evaluating test results:
1) Potential cultural bias of the instrument or the clinician
2) Theoretical orientation of the clinician —> Does he follow a psychoanalytical, behaviourist, cognitive-therapy viewpoint
3) Underemphasis on the external situation —> Many clinicians don’t pay enough attention to the possible role of stressors
4) Insufficient validation —> Some psychological assessment procedures in use today have not been sufficiently validated
5) Inaccurate data or premature evaluation —> Some risk is always involved in making predictions for an individual on the basis of group data
or averages

Classifying abnormal behaviour:

In abnormal psychology, classification involves the attempt to delineate meaningful subvarieties of maladaptive behavior
The categorical approach —> Seeks to classify behavior into distinct categories
- Some problems are; how can we be certain that we are identifying and classifying different conditions correctly, since there are no
objective tests for a psychopathology, how many categories should be created, comorbidity is involved, the they don’t consider severity
- One assumption of this approach is that it assumes that discrete categories actually exist in nature, which isn’t appropriate for some
mental disorders
The research domain criteria (RDoC) —> Goal to provide biological explanations for intermediate psychological constructs that are
thought to be relevant to psychopathology
The dimensional approach —> Assumes that a person’s typical behavior is the product of the differing strengths or intensities of definable
dimensions such as mood, emotional stability, aggressiveness, clarity of thinking and communication, social introversion, and so on
- An advantage of this approach is that it preserves information about variability (which is usually lost when we create simple categories)
 - However where the person lies on the broad range of the dimension creates complexity in communication about how the person behaves
The prototypal approach —> Comparing the individual with a prototype, which is a conceptual entity that represents the perfect case or
theoretical ideal case
- It was used in the older DSM-1 & 2, & a person who uses this approach is not using a structured or semi-structured interview
- Advantage is that it fits the way people actually think

Formal diagnostic classification of mental disorders:

ICD-11 uses clinical prototypes, unlike DSM-5 that used categories
- This makes one require more clinical judgment for a particular diagnosis
The criteria that define the recognized categories of disorder consist for the most part of symptoms and sign
- Symptom —> Refers to the patient’s subjective description about what is wrong
- Signs —> Refers to the health professional objective description about what is wrong
DSM-1 —> Appeared in 1952, it was heavily influenced by psychoanalytic concepts of mental disorders, it offered brief sentences of the
mental disorder
DSM-2 —> Appeared in 1968, took the same approach as DSM-1, but included more details about various signs & symptoms
However DSM-1 & 2 provided disorders that were to vaguely described for mental health professionals which caused limitations of reliability
Revision of DSM-2 provided radical changes such as;
- Standardized diagnostic criteria’s were provided & decision rules were introduced for all diagnoses
- No assumptions were made about etiology, and concepts tied to psychoanalysis or other theoretical orientations were largely removed
DSM-3 & DSM-4 —> 1987 & 1994 respectively, where revisions reflected some changes in diagnostic decision rules
- DSM-4 included an appendix for culture-specific syndrome
The number of mental disorders recognized has been increased from DSM-1 to DSM-5
A major source of controversy in DSM-5 is that the thresholds for several disorders were relaxed
- This led to concerns that normal behaviour is becoming over-medicalized
The DSM-5 contains a Cultural Formulation Interview (CFI) which contains 16 questions that the practitioner can use to obtain information
about the potential impact the client’s culture can have on mental health care
Labeling of certain disorder can make the person act like the stereotype of the disorder
Chapter 7: Mood Disorders & Suicide

Mood disorder —> Involves much more severe alterations in mood for much longer periods of time
Depression —> Usually involves feelings of extraordinary sadness and dejection
Mania —> Often characterized by intense and unrealistic feelings of excitement and euphoria
Mixed-episode cases —> The person experiences rapidly alternating moods such as sadness, euphoria, and irritability, all within the same
episode of illness

Types of mood disorders

Unipolar depressive disorder —> A person experience only depressive episodes, & then moves on to bipolar disorders
Bipolar disorder —> A person experiences both depressive & manic episodes
Depressive episode —> A person is markedly depressed or loses interest in formerly pleasurable activities (or both) for at least 2 weeks, as
well as other symptoms such as changes in sleep or appetite, or feelings of worthlessness
- It is the most common form of mood disturbance
Manic episode —> A person shows a markedly elevated, euphoric, or expansive mood, often interrupted by occasional outbursts of intense
irritability or even violence, particularly when others refuse to go along with the manic person’s wishes and schemes
- These extreme moods must last a week post-diagnosis along with 3 or more symptoms such as behavioral, mental & physiological
symptoms
- Behavioural symptoms —> Increase in goal-directed activity
- Mental symptoms —> Flight of ideas or racing thoughts
- Physiological symptoms —> Decrease need of sleep or psychomotor agitation
Hypomanic episode —> Symptoms mentioned like above, but in milder cases where a person experiences abnormally elevated, expansive, or
irritable mood for at least 4 days
- Unlike mania, there is much less impairment in social and occupational functioning in hypomania, and hospitalization is not required

Prevalence of mood disorders

Major depressive disorder (also called unipolar depression) in which only major depressive episodes occur is the most common mood disorder
- Prevelance of 17%, with a ratio of 2:1 for women
- Low socioeconomic status individual have higher rates of major depressive disorder due to more life stress
Prevalence of bipolar disorder is around 1% with no sex difference in terms of prevalence
- Bipolar disorder has a higher frequency in individual who have high accomplishment in arts (e.g., poets, writers, composers, and artists)

Major depressive disorder

The diagnostic criteria for major depressive disorder requires that a person must be in a major depressive episode and never have had a manic,
hypomanic, or mixed episode
People with major depressive disorder have more severe mood symptoms, physical symptoms (e.g., lack of energy) & cognitive symptoms (e.g.,
feeling of worthlessness & thoughts about death & suicide)
- There is very high level of comorbidity between depressive disorders & anxiety disorders
Persistent depressive disorder —> When people with major depressive disorder still have their symptoms unfixed after 2 years
Return of depressive symptoms can be one of two types;
1) Relapse —> Refers to the return of symptoms within a fairly short period of time, a situation that probably reflects the fact that the
underlying episode of depression has not yet run its course
2) Recurrence —> Refers to the onset of a new episode of depression, occurs in approximately 40 to 50 percent of people who
experience a depressive episode
During adolescence, incidence of major depressive disorder is around 15-20%, this is where sex differences occurs
Prevalence of major depressive disorder in people over the age of 65 is much lower than younger adults
Specifiers —> Patterns of symptoms or features that are important to note when making a diagnosis, these are the following 5 specifiers;
 1) Major depressive episode with melancholic feature —> A patient either has lost interest or pleasure in almost all activities or does
not react to usually pleasurable stimuli or desired events, it is often associated with a history of child trauma
2) Major depressive episode with psychotic features —> Characterized by loss of contact with reality and delusions (false beliefs) or
hallucinations (false sensory perceptions), may sometimes accompany other symptoms of major depression
3) Major depressive episode with atypical features —> Pattern of symptoms characterized by mood reactivity; that is, the person’s
mood brightens in response to potential positive events
4) Major depressive episode with catatonic features —> A range of psychomotor symptoms from motoric immobility to extensive
psychomotor activity, as well as mutism and rigidity
5) Major depressive episode with a season pattern —> Individuals who experience recurrent depressive episodes show a seasonal
pattern

Persistant depressive disorder (dysthymic disorder or dysthymia)

Persistent depressive disorder —> Characterized by persistently depressed mood most of the day, for more days than not, for at least 2
years (1 year for children and adolescents)
- Prevalence of 2.5-6%, average duration of 4-5 years
- Often begins during adolescence
Double depression —> When major depressive disorder & persistant depressive disorder co-occur at the same time
- e.g., Individual who is moderately depressed on a chronic basis & undergo increased problems from time to time
- In the DSM-5 it is classified as a form of persistant depressive disorder

Other forms of depression

Postpartum major depression —> Occurs to new mothers with symptoms including changeable mood, crying easily, sadness & irritability
- Postpartum blues or depression may be especially likely to occur if the new mother has lack of social support or has difficulty in
adjusting to her new identity and responsibilities, or if the woman has a personal or family history of depression that leads to heightened
sensitivity to the stress of childbirth

Hippocrates (c. 400 b.c.) hypothesized that depression was caused by an excess of “black bile” in the system

Biological causal factors

Family studies have shown that the prevalence of mood disorders is approximately 2-3 times higher among blood relatives of persons with
clinically diagnosed unipolar depression than it is in the population at large
Monozygotic co-twins of a twin with major depressive disorder are twice as likely to develop major depressive disorder
Experience that family members do not share has more influence than genetic factors in major depressive disorder
Serotonin transporter gene —> People with the s/s gene variant may be more likely to have depression than people with the l/l gene variant
- A study showed that those who posed the genotype with the s/s alleles are twice as more likely to develop major depressive episode
following 4+ stressful events than people with the genotype with the l/l alleles who had 4+ stressful events
- Study also showed that people with s/s alleles whom experienced maltreatment as child were twice likely to develop major depressive
disorder than people with the l/l alleles
Early research on psychopharmacology was devoted on monoamine neurotransmitters such as serotonin & norepinephrine
Monoamine theory of depression —> Depression was at least sometimes due to an absolute or relative depletion of one or both of these
neurotransmitters (i.e., serotonin & norepinephrine) at important receptor sites in the brain
Monoamine neurotransmitter are involved in regulation of behavioral activity, stress, emotional expression, and vegetative functions
Modern research states that dopamine dysfunction (i.e., reduced dopaminergic activity) leads to depression with atypical features & bipolar
depression
Increase of norepinephrine —> Activation of HPA axis —> CRH —> ACTH —> Cortisol
- Depressed people often have high levels of cortisol
- Dextamethasone (i.e., cortisol suppressor) does not seem to work on depressed people
Hypothyroidism (i.e., low levels of thyroid) is correlated with low levels of depression, where HPT axis controls thyroid levels
- Some people who do not respond to antidepressant, show response to thyroid stimulating medications (e.g., synthroid)
Damage to the left anterior prefrontal cortex often leads to depression
Decreases volume of the orbital prefrontal cortex (area associated with responsivity to reward) is associated with depression
Lower activity in the dorsolateral prefrontal cortex is associated with depression
Decreased volume of the hippocampus is associated with depression
Decreased volume & activation of the anterior cingulate cortex is associated with depression
Increased activation of the amygdala is associated with depression
Reduced time to enter REM sleep & decreased amount of deep sleep (i.e., stage 3-4) is associated with depression
Much research on people with major depressive episode with seasonal affect show that reduced level of light is associated with this depression

Psychological causal factors

Many studies have shown that severely stressful life events often serve as precipitating factors for unipolar depression
Dependant life events —> When a persons own behaviour generates stressful life events which leads to interpersonal stress which creates a
vicious cycle
- This has a stronger role to play on the onset of major depressive disorder than independent life events
Independent life events —> When a stressful event occurs in which you had no control of (e.g., loss of home due to hurricane)
People with depression who have experienced a stressful life event tend to show more severe depressive symptoms than those who have
not experienced a stressful life event
Chronic stress is associated with increased risk for the onset, maintenance, and recurrence of major depression
People with high genetic risk for depression appear to be much more likely to respond to stressful life events with depression
- This a gene-environment interaction
Neuroticism (negative affectivity) —> Refers to a stable and heritable personality trait that involves a temperamental sensitivity to negative
stimuli
- Neuroticism is the primary personality variable that serves as a vulnerability factor for depression
- Neuroticism also predicts the occurrence of more stressful life events that often lead to depression
- Cognitive diathesis in which a negative patterns of thinking that can make people prone to depression makes one more likely to become
depressed when faces with more stressful life events
- People with whom are pessimistic (i.e., internal, stable, global causes) makes one more prone to depression
Psychodynamic theory & depression —> Freud believed that we hold an unconscious hold negative feelings towards those we love, &
thus when one experiences loss, one becomes angry & hostile
- This promotes the psychodynamic idea that depression is anger turned inwards
Behavioural theory & depression —> Proposes that people become depressed either when their responses no longer produce positive
reinforcement or when their rate of negative experiences increases
- However this doesn’t show that depression is caused by these factors, such that when one becomes depressed, this individual becomes
pessimistic & has low levels of energy, which in turn causes this same individual to have less reinforcement, which in turn maintains the
depression
Beck’s cognitive theory & depression —> Cognitive symptoms of depression often precede and cause the affective or mood symptoms
rather than vice versa
- e.g., If you think that you are a failure or that you are ugly, it would not be surprising for those thoughts to lead to a depressed mood
- Dysfunctional beliefs (depressogenic schemas) —> Rigid, extreme, & counterproductive schemas about self
- These are often developed during childhood & adolescence
- Negative automatic thoughts —> Thoughts that often occur just below the surface of awareness and involve unpleasant, pessimistic
predictions
- Critical incidents makes the depressogenic schemas activated which fuels the negative automatic thoughts
- The pessimistic predictions tend to center on the three themes of the negative cognitive triad
 - Negative cognitive triad —> Negative thoughts about (1) self (“I’m worthless”); (2) world (“No one loves me”); and (3) future (“It’s
hopeless because things will always be this way”)
- Each of these three themes of the negative cognitive triad involves biased processing of negative self-relevant information
- Dichotomous or all-or-none reasoning —> Involves a tendency to think in extremes
- Selective abstraction —> Involves focus on one negative detail of a situation while ignoring other elements of the situation
- Arbitrary inference —> Which involves jumping to a conclusion based on minimal or no evidence
- Becks theory highlights why depressed people think more negatively about themselves & the world around them which further reinforces
these negative cognitions
- Stressors are not necessary to be activate the depressogenic schemas, simply inducing something that has a depressive mood (e.g., sad
music or recalling sad memories) in an individual who was previous depressed is enough to activate depressogenic schemas
- Depressed people have cognitive biases for negative self-relevant information (e.g., they show better/biased recall on negative
information & negative autobiographical memories)
Learned helplessness theory —> States that when animals or humans find that they have no control over aversive events (such as shock),
they may learn that they are helpless, which makes them unmotivated to try to respond in the future, thus exhibiting depressive symptoms
- However unlike the experiment that was done on animals it couldn’t explained the kind of attributions humans make when negative event
- Attributions —> Can be internal/external, global/specific, stable/unstable
- Pessimistic attributional style —> Internal, global & specific, where this makes one have a diathesis for depression
- Explains sex differences in depression, since women are more prone to experience a lack of control over negative events
Hopelessness theory —> Proposed that having a pessimistic attributional style in conjunction with one or more negative life events was not
sufficient to produce depression unless one first experienced a state of hopelessness
- Hopelessness expectancy —> Perception of one not having any control of what’s going to happen & an absolute certainty that a
bad outcome would occur (or absolute certainty that a good outcome will not occur)
Learned helplessness vs hopelessness theory —> Learned helplessness theory suggests that individuals may develop a sense of
helplessness and lack of motivation when repeatedly exposed to uncontrollable situations. Hopelessness theory focuses on the role of negative
beliefs and expectations in predicting depression and suicidal ideation in response to stressful events
Ruminative response styles theory of depression —> Focuses on different kinds of responses that people have when they experience
feelings and symptoms of sadness and distress, and how their differing response styles affect the course of their depression
- Rumination —> People having a feeling of depression typically tend to focus intently on how they feel and why they feel that way
- People who tend to ruminate a lot tend to have longer periods of depression & are more likely to have major depressive episodes
- Explains gender differences in depression with the argument that woman are more likely to ruminate compared to men
Half the people who receives a diagnosis of mood disorder also receive a diagnosis of anxiety disorder
Positive affect —> Includes affective states such as excitement, delight, interest, and pride
- Depressed people have low levels of positive affect vs. Anxious people don’t have this effect
People who are lonely, socially isolated, or lacking social support are more vulnerable to becoming depressed
Depressed people often have a social-skill deficiency
People whom are depressed tend to behave in ways that elicit negative feelings towards others
People whom their parents (or one parent) whom were previously depressed & their child also becomes depressed tend to become depressed
earlier & show more severe & persistent course of depression

Cyclothymic disorder
Cyclothymic disorder —> Refers to the repeated experience of hypomanic symptoms for a period of at least 2 years
- Less serious version of full-blown bipolar disorder because it lacks the extreme mood and behavior changes, psychotic features, and
marked impairment seen in bipolar disorder (hypomanic symptoms are less severe & a shorter in duration, around 4 days)
- Symptoms of the hypomanic phase of cyclothymia are essentially the opposite of the symptoms of persistent depressive disorder
- Symptoms of the depressed phase of cyclothymia are very similar to persistant depressive disorder
- Individuals with cyclothymic disorder are more prone de develop bipolar disorder 1 or 2
Bipolar disorders (bipolar I disorder & bipolar II disorder
Bipolar I disorder —> Distinguished from major depressive disorder by the presence of a manic phase
Mixed-episode —> Characterized by symptoms of both full-blown manic and major depressive episodes for at least 1 week, either intermixed
or alternating rapidly every few days
- People whose first episode of mania is a mixed episode have a worse long-term outcome than those originally presenting with a
depressive or a manic episode
Bipolar II disorder —> The person does not experience full-blown manic (or mixed) episodes but has experienced clear-cut hypomanic
episodes as well as major depressive episodes
Bipolar disorder occurs equally in men & women, usually starts during adolescence or young adulthood
- Bipolar II disorder has an onset of 5 years later than Bipolar I disorder

Manic phase —>

Hypomanic phase —>

Persistant depression episode —>

Major depressive episode —>
(Unipolar major depressive episodes)

Bipolar disorder with a seasonal pattern —> Similar to major depressive disorder with a seasonal pattern, but with bipolar disorder
symptoms
People with bipolar depressive episode tend to show more mood lability, more psychotic features, more psychomotor retardation, and more
substance abuse compared to people with unipolar major depressive episodes
Misdiagnoses between major depressive disorder & bipolar disorder are very common & one way it is found out is via medication treatment
- Treatment for major depressive disorder is antidepressants, but if given to a bipolar disorder patient he will get a manic phase
Rapid cycling pattern —> 5-10% of people with bipolar disorder whom experience at least 4+ episodes (manic/depressive) per year
- More likely to be women who develop this pattern with an earlier onset & make suicide attempts

Biological causal factors

Genetic influences —> 8-10% of first degree relatives of a person with bipolar I disorder can be expected to have bipolar disorder
- There is a 60% concordance rates for monozygotic twins & 12% for dizygotic twins
- Evidence also suggests that bipolar disorder genetic transmission is polygenic (i.e., multiple genes interaction causes bipolar disorder)
Neurochemical factors —> There is evidence that there is high levels of norepinephrine during manic phases & low serotonin levels in both
depressive & manic phases
- High levels of dopamine is also associated with manic symptoms (e.g., grandiosity & euphoria), & drugs like lithium are antagonist of that
Abnormalities of hormonal regulatory systems —> Cortisol levels seems to be high in bipolar depression & low in manic episodes
- Many bipolar patient tend to have hypothyroidism, in which they can make antidepressants work better but also trigger manic episodes
Neurophysiological & neuroanatomical influences —> Deficits in the activity of prefrontal cortex in bipolar patients
- Basal ganglia & amygdala size in enlarged in bipolar disorder but reduced in unipolar depression
Sleep & other biological rhythms —> During manic phases they tend to sleep little, but during depressive episode they sleep too much

Psychological causal factors

Stressful life events —> Stressful live events are important into precipitating bipolar depressive episodes
- Stressful life events during childhood & adulthood increases the likelihood of developing bipolar disorder
- The diathesis–stress model would suggest that stressful life events influence the onset of episodes by activating the underlying
vulnerability
- Low social support perception for bipolar disorder patient tend to have more depressive recurrence
- Personality variable neuroticism tend to be associated with symptoms of depression & mania for bipolar individuals
- Pessimistic attributional style individuals show an increase in depressive symptoms but also increase in manic symptoms
Cross-cultural differences in depressive symptoms
In western cultures there is an emphasis on psychological symptoms of depression
In non-western cultures there is an emphasis on physical symptoms of depression

Pharmacotherapy
Antidepressant, mood-stabilizing, and antipsychotic drugs are all used in the treatment of unipolar and bipolar disorders
Monoamine oxidase inhibitors (MAOIs) —> Inhibit the the action of the enzyme monoamine oxidase which is responsible for the
breakdown of norepinephrine & serotonin
- Tend to have a lot of reactions with foods containing amino acid tyramine & it is toxic in large doses
Tricyclics antidepressants (TCA) —> Increases primarily the increase of neurotransmission of norepinephrine & a little serotonin
- Tend to have many side effects that people dislike & it is toxic in large doses
Selective serotonin reuptake inhibitors (SSRI) —> Much less side effects than TCA & also less toxic at large doses compared to others
Antidepressants tend to take at least 3-5 weeks to start feeling its effect
It is important to still keep the medication even when feeling better in order to prevent a relapse of depressive episodes
Mood stabilizers —> Drugs such as lithium that have anti manic & antidepressant effects, thus exerting mood stabilizing effects in the whole
continuum
- Lithium is effective during manic episodes of bipolar patient, but as effective as traditional antidepressant for bipolar depression
- It can also reduce the risk of a bipolar patient having a manic episode due to taking antidepressants
- A lot of people with bipolar disorder tend to not take lithium because they want to experience manic episodes, & there is many side
effects associated with lithium long-term use that are significant
Anticonvulsants —> These drugs are often effective in patients who do not respond well to lithium or who develop unacceptable side effects
from it, and they may also be given in combination with lithium
- Increases the risk of suicide by 2-3 times than people on lithium alone

Alternative biological treatment

Electroconvulsive therapy (ECT) —> Used with patients who are severely depressed (especially among the elderly) and who may present an
immediate and serious suicidal risk, including those with psychotic or melancholic features
- After 6-12 sessions there is clinical significant reduction in depression compared to 4-6 weeks for traditional antidepressants
Transcranial magnetic stimulation (TMS) —> Noninvasive technique allowing focal stimulation of the brain in patients who are awake
Deep brain stimulation —> Involves implanting an electrode in the brain and then stimulating that area with an electric current
Bright light therapy —> Originally used in the treatment of seasonal affective disorder, but it has now been shown to be effective in
nonseasonal depressions as well

Psychotherapy
Cogntive-behavioral therapy (CBT) —> It is a relatively brief form of treatment (usually 10 to 20 sessions) that focuses on here-and-now
problems rather than on the more remote causal issues that psychodynamic psychotherapy often addresses
- Cogntive-behavioral therapy also has long term beneficial effects where a longitudinal study was done in which when cogntive-behavioral
therapy & medications were discontinued after a year 50% relapsed for the medication group vs. 25% for the CBT group
Mindfulness-based cognitive therapy —> The logic of this treatment is based on findings that people with recurrent depression are likely to
have negative thinking patterns activated when they are simply in a depressed mood
Behavioral activation treatment —> Focuses intensively on getting patients to become more active and engaged with their environment and
with their interpersonal relationships
Interpersonal therapy (IPT) —> Focuses on current relationship issues, trying to help the person understand and change maladaptive
interaction patterns
- Interpersonal & social rhythm therapy —> Adapted for bipolar disorder where patients are taught to recognize the effect of
interpersonal events on their social and circadian rhythms and to regularize these rhythms
Family & marital therapy —> Use of family & spouse interventions to reduce hostile & increase information available for family about coping
Suicide: The clinical picture & the causal pattern
Suicide —> Intentionally taking one’s life, in which this is a significant factor in all types of depression
All psychopathology leads to the increase risk of suicidal behaviors, & those with multiple mental disorder are at even greater risk
Suicide is the 15th leading cause of death in the world, where 1.4% of all deaths are by suicide
We are also more likely to die by our own hand than someone else’s
5 percent of Americans have made a nonlethal suicide attempt at some time in their lives and 15 percent have experienced suicidal thought
(i.e., suicidal ideation)
Non-suicidal self-injury —> Refers to direct, deliberate destruction of body tissue (often taking the form of cutting or burning one’s own
skin) in the absence of any intent to die
- 15-20% of adolescents & young adults report engaging in non-suicidal self-injury at least once

Who attempts to die by suicide

Woman are more likely than men to think about suicide & make nonlethal suicide attempts, but men are 4 times more likely to die by suicide
- Men that are more likelier to die by suicide can be explained by the fact that they use more lethal means than woman to commit suicide
Suicidal thoughts and behaviors increase in prevalence starting around age 12 and continue to increase into the early to mid-20s
The rate of suicide death follows a similar pattern, followed by a peak in middle age (45–55 years) and a slight decrease and leveling off for
the remainder of the life span
There has been an increase risk of suicide among young adults & adolescents in the past decades
- Can be explained by the fact that we now live in periods in which depression, anxiety, alcohol and drug use, and conduct disorder
problems show increasing prevalence, and these are all factors associated with increased risk for suicide
There are racial/ethnic differences in terms of suicide where 90 percent of suicides in the United States are classified as people who are
white, 6 percent black, 3 percent Asian/Pacific Islander, and 1 percent American Indian or Alaskan Natives

Psychological disorders
Disorders characterized by agitation and aggression/impulsiveness predict acting on one’s suicidal thoughts, such as post-traumatic stress
disorder, bipolar disorder, conduct disorder, and intermittent explosive disorder that predict this transition from suicidal thoughts to attempts
- Depression on the other hand is a strong predictive factor of suicidal thoughts but not suicide attempts

Other psychosocial factors associated with suicide

According to Edwin Shneidman, he suggested that people become commit to the action of suicide because of psychological pain
People who become suicidal often come from backgrounds in which there was some combination of a good deal of family psychopathology,
child maltreatment, and family instability
Severe anxiousness & agitation is also a risk factor of suicide
People whom have strong implicit associations between the self & death/suicide are also at elevated risk of suicide
- Implicit associations —> Mental associations that people hold between two concepts that they are unwilling or unable to report
Implicit association test can predict suicidal behavior when suicidal people classify words/concepts related to suicide in the “like me” group

Biological factors
The concordance rate for suicide in monozygotic twins is 3 times higher than dizygotic twins
Reduced levels of serotonin in suicidal individuals is also correlated with increased risk of suicide

Theoretical models of suicidal behavior

Many have conceptualized suicide using diathesis–stress models in which underlying vulnerabilities (e.g., genetic, neurobiological) interact
with stressful life events to produce suicidal thoughts and behaviors
Joiner’s interpersonal-psychological model of suicide —> Suggests that the psychological states of perceived burdensomeness (e.g.,
feeling like a burden to others) and thwarted belongingness (e.g., feeling alone) interact to produce suicidal thoughts and desires
- When the third factor of acquired capability of suicide is present then the person has the desire & ability to commit to it
Currently, there are three main thrusts of preventive efforts: treatment of the person’s current mental disorder(s) as noted earlier, crisis
intervention, and working with high-risk groups

Treatment of mental disorders

Treating mental disorder such as depression is favorable to decrease the risk of suicide
- For depression one would take antidepressants for the individual to have their mental disorder treated & suicide behaviors decreased
- There has been a controversy in which the use of antidepressant increases suicidal behaviors in adolescents but not adults
Lithium is a medication that is a powerful anti suicidal agent if used long term, & benzodiazepines are good for acute severe anxiety & panic

Crisis intervention
If an attempt has been made one must be followed for a referral to an inpatient/outpatient health facility
If a person is willing to talk about contemplating suicide, one must put emphasis on;
1) Maintaining supportive & directive contact
2) Make them realize that the acute distress they are experiencing is impairing their ability to ashes the situation accurately & correctly
3) Making them realize that the present distress will not be endless

Focus on high-risk groups & other measures

Cogntive-behavioral therapy used on someone who previously attempted suicide will make them 50% less likely to reattempt in the following
18 months
Chapter 6: Panic, Anxiety, Obsessions & Their Disorders

Anxiety —> Involves a general feeling of apprehension about possible future danger
Fear —> Alarm reaction that occurs in response to immediate danger
Anxiety disorder (From DSM) —> Characterized by unrealistic, irrational fears or anxieties that cause significant distress and/or
impairments in functioning
- Prevalence of 29% & most common category of disorder for woman
- Anxiety disorder have the earliest age of onset compared to other disorders
When the source of danger is obvious, the experienced emotion has been called fear (e.g., “I’m afraid of snakes”)
- With anxiety, however, we frequently cannot specify clearly what the danger is (e.g., “I’m anxious about my parents’ health”)

Fear
Fear is a basic emotion (shared by many animals) that involves activation of the flight or fight response of the automatic nervous system
- It has an adaptive evolutionary value to respond to imminent danger & allow us to escape
Spontaneous/Uncued panic attack —> When the fear response occurs in the absence of any obvious external danger
- Symptoms are identical of fear but is accompanied with the subjective sense of impending doom (e.g., fear of dying)
Fear & panic have 3 components that are loosely coupled, where one may only show 2 of the components out of 3;
1) Cognitive/Subjective components 2) Physiological component 3) Behavioral component

Anxiety
Anxiety response pattern is a complex blend of unpleasant emotions and cognitions that is both more oriented to the future and much more
diffuse than fear
- At the cognitive/subjective level, anxiety involves negative mood, worry about possible future threats or danger, self-preoccupation,
and a sense of being unable to predict the future threat or to control it if it occurs
- At a physiological level, anxiety often creates a state of tension and chronic overarousal, which may reflect risk assessment and
readiness for dealing with danger should it occur (“Something awful may happen, and I had better be ready for it if it does”)
- At a behavioral level, anxiety may create a strong tendency to avoid situations where danger might be encountered, but the immediate
behavioral urge to flee is not present with anxiety as it is with fear
The adaptive value of anxiety may be that it helps us plan and prepare for a possible threat, where mild/moderate forms enhance learning &
performance
- In more severe forms anxiety is maladaptive, this is when people usually have anxiety disorders
Many of our sources of fear & anxiety are learned, where their response patterns are highly conditionable
- Previously neutral and novel stimuli (conditioned stimuli) that are repeatedly paired with, and reliably predict, frightening or unpleasant
events such as various kinds of physical or psychological trauma (unconditioned stimulus) can acquire the capacity to elicit fear or
anxiety themselves (conditioned response)

Overview of the anxiety disorders & their commonalities

Anxiety disorders —> Characterized by unrealistic, irrational fears or anxieties that cause significant distress and/or impairments in
functioning, DSM-5 recognizes the following anxiety disorders;
- Specific phobias, social anxiety disorder —> Experience a fear or panic response not only when they encounter the object or
situation that they fear, but also in response to even the possibility of encountering their phobic situation
- Panic disorder —> Experience both frequent panic attacks and intense anxiety focused on the possibility of having another on
- Agoraphobia —> Go to great lengths to avoid a variety of feared situations, ranging from open streets and bridges to crowded public
places
- General anxiety disorder —> Experience a general sense of diffuse anxiety and worry about many potentially bad things that may
happen; some may also experience an occasional panic attack, but it is not a focus of their anxiety
It is common that people with anxiety disorder experience one more anxiety disorder/depression concurrently/different point in their life
Personality traits such as neuroticism (i.e., proneness to experience negative mood states) is a common risk factor for both mood & anxiety
disorders

Specific phobias
Specific phobias —> Present if a person shows strong and persistent fear that is triggered by the presence of a specific object or situation
and leads to significant distress and/or impairment in a person’s ability to function
- Can be phobias to animals, natural environment, blood/injection/injury, situational & other specific phobias
- Phobic behavior tends to be reinforced because every time the person with a phobia avoids a feared situation, his or her anxiety decrease
Blood-injection-injury phobia —> Prevalence of 3-4%, where they experience as much disgust as fear, when they encountered to this
phobia their physiological response is an acceleration of blood pressure & heart rate, & then a sudden drop which makes the individual
nauseous, dizzy or faint

Prevalence, age of onset & gender differences

Prevalence of 12%, gender differences vary in phobias such that animal phobias are composed of 90-95% woman & less than 2:1 ratio for
women for blood-injection-injury phobia
Animal, dental & blood-injection-injury phobia tend to develop in childhood whereas other phobias develop in adolescence & early adulthood

Psychological causal factors

Psychoanalytic viewpoint —> Phobias represent a defense against anxiety that stems from repressed impulses from the id
Learning theory —> Explains the development of phobic behavior through classical conditioning
- Vicarious learning —> Watching a phobic person behaving fearfully with his or her phobic object which results in fear to the observer
- Individual differences in learning —> Some life experiences may serve as risk factors and make certain people more vulnerable to
phobias than others, whereas other experiences may serve as protective factors for the development of phobias
- Fearful experiences that happened & were uncontrollable condition fear much more than experiences that could’ve been controlled
- Phobic people also have a cognitive bias that overestimate the probability that a feared object will be accompanied by a frightening event
- Prepared learning —> Rapidly associate certain objects (such as snakes, spiders, water, and enclosed spaces) with frightening or
unpleasant event due to evolution making those who acquired those fear survive more than others who did not have this fear
- Experiment shows that fear is conditioned more effectively to fear-relevant stimuli than to fear-irrelevant stimuli

Biological causal factors

Individuals that are carriers of the ‘s’ allele of the serotonin-transporter gene show superior fear conditions than those without the ‘s’ allele
Behaviorally inhibited toddler (i.e., very timid, shy, easily distressed) at 21 months of age tend to develop multiple phobias by 7-8 years old
Twins studies show that monozygotic twins are more likely to share animal & situational phobias than dizygotic twins

Treatments
Exposure therapy —> Form of behavior therapy that involves controlled exposure to the stimuli or situations that elicit phobic fear
- Highly effective when administered in a single long sessions (+3 hours), which makes people prone to seek treatment
Participant modeling —> Variant of exposure therapy where therapist calmly models ways of interacting with the phobic stimulus or situation
D-cycloserine is a drug that can enhance the effectiveness of exposure therapy for fear of heights in a VR environment
- This drug is known to facilitate extinction of conditioned fear in animals, but if used by itself it has no effect

Social anxiety disorder

Social anxiety disorder —> Characterized by disabling fears of one or more specific social situations
- A person fears that she or he may be exposed to the scrutiny and potential negative evaluation of others or that she or he may act in an
embarrassing or humiliating manner
- People with the more general subtype of social anxiety often have significant fears of most social situations & are also often diagnosed
with avoidant personality disorder
Prevalence, age of onset, & gender differences
Prevalence of 12%, more common in women (60% of of sufferers are woman), & typically has on onset during adolescence or early
adulthood
2/3 of people with social anxiety suffer from one or more other anxiety disorder
50% of people with socially anxious people also have a depressive disorder
People with social anxiety tend to have lower employment rates, lower socioeconomic status, & more impairments in one or more domain of
their lives

Psychological causal factors

Social anxiety as learned behaviors —> Social anxiety often seems to originate from simple instances of direct or vicarious classical
conditioning such as experiencing or witnessing a perceived social defeat or humiliation, or being or witnessing the target of anger or criticism
Social fear/phobia in terms of evolution —> Social fears and phobia evolved as a by-product of dominance hierarchies that are a
common social arrangement among animals such as primates
- Humans also process social stimuli such as facial expressions of anger more rapidly & readily
Perceptions of uncontrollability & unpredictably —> Being exposed to uncontrollable and unpredictable stressful events (such as
parental separation and divorce, family conflict, or sexual abuse) may play an important role in the development of social anxiety
Cognitive biases —> People with social anxiety tend to expect that other people will reject or negatively evaluate them
- People with social anxiety tend to overestimate how easily other will detect their anxiety
- People with social anxiety tend to interpret ambiguous social information in a negative manner

Biological causal factors

Behavioral inhibition tends to share characteristics from neuroticism & introversion which makes one more at risk to develop social anxiety
12-30% of variance in liability to social anxiety is due to genetics
- However there is a much larger variance in people who get social anxiety in nonshared environmental factors

Treatments
Exposure therapy is found to be effective when exposed to the phobia gradually
Cognitive restructuring —> Therapist attempts to help clients with social anxiety identify their underlying negative, automatic thoughts
- After the client understands the automatic thoughts, the therapist changes the clients thoughts by logical reanalysis
- Logical reanalysis —> Involve asking oneself questions to challenge the automatic thoughts
Antidepressants such as monoamine oxidase inhibitor, tricylic antidepressants & selective serotonin reuptake inhibitors are effective to treat
social anxiety
- However cogntive-behavioral treatments tend to be more beneficial for the long term with low rates of relapses
D-cycloserine is also deemed an effective co-treatment with exposure therapy

Panic disorder
Panic disorder —> Characterized by the occurrence of panic attacks that often seem to come “out of the blue”
- DSM states that one must have experienced recurrent unexpected attacks & must be persistently concerned about future attacks
- Panic attack symptoms reach peak intensity within 10 minutes, & subside within 30 minutes
- Nocturnal panic —> Unexpected panic attack during relaxation or sleep
There is often misdiagnosis with panic disorder with other cardiac, respiratory or neurological problems
Panic disorder causes as much impairment in social & occupational functioning as that causes by major depressive disorder

Agoraphobia
Agoraphobia —> People with this phobia tend to be anxious about being in places or situations from which escape would be difficult or
embarrassing, or in which immediate help would be unavailable if something bad happened (e.g., shopping malls, movie theaters, crowed places)
- In mild cases the individual avoids situations where attacks occurred, whereas in severe cases the person does not go beyond his home
 - Agoraphobia can sometimes develop as a complication of having panic disorder
- Lifetime prevalence of agoraphobia without panic is around 1.4%

Prevalence, age of onset, & gender differences

Prevalence of 4.7% of panic disorder with or without agoraphobia
Panic disorder with or without agoraphobia has a later onset which is usually in the 20s-40s but sometimes in late adolescence
Panic disorder and agoraphobia tends to be twice as more prevalent in woman than men
- This may be due to culture where it is more acceptable for woman to experience panic & men to “tough it out”

Comorbidity with other disorders

Majority of people with panic disorder tend to have at least one comorbid disorder (i.e., general anxiety disorder, social anxiety, specific
phobia, & substance-use disorder)
Panic disorder is a strong predictor of suicidal behavior, & it is also associated with an increased risk of suicidal ideation & attempts

Timing of a first panic attack

The first panic attack frequently occurs following feelings of distress or some highly stressful life circumstance such as loss of a loved one,
loss of an important relationship, loss of a job, or criminal victimization

Biological causal factors

Genetic factors —> 30-34% of the variance in liability to panic symptoms is due to genetic factors
Brain activity —> Increased activity in the amygdala, which is highly involved the emotion of fear
- Hippocampus is also thought to generate conditioned anxiety as a response to multiple panic attacks, & it is also thought to be involved
in learned avoidance such as in cases of agoraphobia
Biochemical abnormalities —> Noradrenergic activity in certain brain areas can stimulate cardiovascular symptoms associated with panic
- Increased serotonergic activity also decreases noradrenergic activity, thus selective serotonin reuptake inhibitors are used for that
- GABA levels also tends to be abnormally low in certain part of cortex of people with panic disorder

Psychological causal factors

Cognitive theory of panic disorder —> Proposes that people with panic disorder are hypersensitive to their bodily sensations and are very
prone to giving them the most dire interpretation possible
- In other words they have a tendency to catastrophize about the meaning of their bodily sensation
- e.g., A person with panic disorder might notice his heart racing & conclude that he is having a heart attack
- Automatic thoughts —> A person not aware of the catastrophic interpretations where these thoughts are outside their awareness
Panic circle —> When there is a trigger stimulus the person perceives a threat —> The person starts to apprehend/worry —> Body
sensations start to commence —> Interpretations of these sensations are done in an catastrophic manner —> Leads to a perceived threat
Comprehensive learning theory of panic disorder —> Suggests that initial panic attacks become associated with initially neutral internal
(interoceptive) and external (exteroceptive) cues through an interoceptive conditioning (or exteroceptive conditioning) process, which leads
anxiety to become conditioned to these CSs (conditioned stimuli), and the more intense the panic attack, the more robust the conditioning that
will occur
- Panic attacks come suddenly due to people experiencing CS (e.g., internal bodily sensations) with no conscious awareness
Anxiety sensitivity —> Trait-like belief that certain bodily symptoms may have harmful consequences
- People who have high anxiety sensitivity are more prone to develop panic attacks & panic disorder
Perceived control —> When one has a sense of control in the situation or is with someone considered safe, this will reduce the symptoms
of panic such as reduced distress & physiological arousal
Cognitive biases for people with panic disorder —> Interpretation of ambiguous bodily sensations as threatening & interpret these
situations are more threatening than do others
- They also tend to have their attention drawn into threatening information
Treatment
Exposure therapy is often used by gradually presenting situations that they fear & make them learn that there is nothing to fear of
Interoceptive exposure —> Variant of exposure therapy in which there is deliberate exposure to feared internal sensation
Panic control treatment (PCA) —> Integrative cogntive-behavioral treatment for panic disorder
1) Clients are educated about the nature of anxiety and panic and how the capacity to experience both is adaptive
2) Involves teaching people with panic disorder to control their breathing
3) Clients are taught about the logical errors that people who have panic disorders are prone to making and learn to subject their own
automatic thoughts to a logical reanalysis
4) Clients are exposed to feared situations and feared bodily sensa- tions to build up a tolerance to the discomfort
Medications used are primarily anxiolytics such as benzodiazepines which act very quickly, thus useful for acute situations
Antidepressants such as selective serotonin reuptake inhibitors, tricylic antidepressant, & serotonin norepinephrine reuptake inhibitors are
often used which have the advantage of not creating physiological dependence
D-cycloserine can enhance the speed of treating specific phobia & social anxiety disorder, but also responds to panic disorder

General anxiety disorder

General anxiety disorder (DSM-5) —> Worry must occur on more days than not for at least 6 months and that it must be experienced
as difficult to control
- People suffering from general anxiety disorder live in a relatively constant, future-oriented mood state of anxious apprehension, chronic
tension, worry, and diffuse uneasiness that they cannot control
- The most common areas of worry tend to be family, work, finances, and personal illness

Prevalence, age of onset, & gender differences

Prevalence of 5.7%, tends to be chronic however after the age of 50 the symptoms tend to decreases
General anxiety disorder is twice as more common for females than males
Age of onset is usually into older adults where general anxiety disorder tend to be the most common anxiety disorder for them

Comorbidity with other disorders

Generalized anxiety disorder often co-occurs with other disorders, especially other anxiety and mood disorders such as panic disorder, social
anxiety, specific phobia, PTSD, and major depressive disorder
People with general anxiety disorder also tend to experience panic attacks without panic disorder

Psychological causal factors

Psychoanalytic viewpoint —> Generalized or free-floating anxiety results from an unconscious conflict between ego and id impulses that
is not adequately dealt with because the person’s defense mechanisms have either broken down or have never developed
Perceptions of uncontrollability & unpredictability —> Uncontrollable and unpredictable aversive events are much more stressful than
controllable and predictable aversive events, thus creating more fear & anxiety
Sense of mastery & control —> Individual that have a larger sense of mastery & control are more adapted to anxiety provoking situations
Reinforcing properties of worrying that maintain the high levels of anxiety and worry;
1) Superstitious avoidance of catastrophe —> Worrying makes it less likely that the feared event will occur
2) Avoidance of deeper emotional topics —> Worrying about most of the things I worry about is a way to distract myself from
worrying about even more emotional things, things that I don’t want to think about
3) Coping and preparation —> Worrying about a predicted negative event helps me to prepare for its occurrence
Negative consequences of worry —> Leads to a greater sense of danger & anxiety, leads to more negative intrusive thoughts, leads to
more intense negative emotions when reacting to sad films, leads to an enhanced perception of being unable to control intrusive thoughts
Cognitive biases for threatening information —> Anxious people tend to preferentially allocate their attention toward threatening cues
when both threat and nonthreat cues are present in the environment
- Anxious people are also more likely than nonanxious people to think that bad things are likely to happen in the future
 - Anxious people also interpret ambiguous information in a threatening way

Biological causal factors

Genetic factors —> Heritability estimate of 30%, however environmental factors have a much more stronger effect
Neurotransmitters/Neurochemicals abnormalities —> Functional deficiency of GABA, serotonin & epinephrine also play a role
- GABA agonists (e.g., benzodiazepines) are used for anxiety for this reason
Overactive HPA axis tends to release CRH, ACTH & cortisol which plays a role in generalized anxiety
Neurobiological differences between anxiety & panic —> Panic activates mostly the amygdala, whereas anxiety involves the stria
terminalis which is an extension of the amygdala
- People with general anxiety disorder also tend to have a smaller left hippocampal region similar to major depressive disorder

Treatments
Cogntive-behavioral therapy —> Combination of behavioral techniques, such as training in applied muscle relaxation, and cognitive
restructuring techniques aimed at reducing distorted cognitions and information-processing biases associated with general anxiety disorder as
well as reducing catastrophizing about minor events
Medications —> Benzodiazepines are used but create dependence & withdrawal symptoms with sudden stop
- A new medication called buspirone is also a great anxiolytic with less sedating effects & withdrawal symptoms
- Antidepressants are also good for the long term treatment of general anxiety disorder

Obsessive compulsive disorder

Obsessive compulsive disorder —> Defined by the occurrence of both obsessive thoughts and compulsive behaviors performed in an
attempt to neutralize such thoughts
Obsessions —> Persistent and recurrent intrusive thoughts, images, or impulses that are experienced as disturbing, inappropriate, and
uncontrollable
Compulsions —> Involve overt repetitive behaviors that are performed as lengthy rituals (such as hand washing, checking, putting things in
order over and over again)
- They can also be more covert mental rituals (e.g., counting, praying, saying certain words in repetitions)
- Compulsive behaviors are performed with the goal of preventing or reducing distress or preventing some dreaded event or situation
- Diagnosis requires that obsessions and compulsions take at least 1 hour per day, and in severe cases they may take most of the person’s
waking hours
- Many obsessive thoughts involve contamination fears, fears of harming oneself or others, and pathological doubt
- Other obsessive thoughts can be about symmetry, sexual obsessions, obsessions about religion or aggression
There are five primary types of compulsive rituals;
- 1) Cleaning (hand washing and showering), 2) checking, 3) repeating, 4) ordering or arranging, and 5) counting

Prevalence, age of onset & gender differences

Prevalence of 2-3% where 90% of people with obsessive compulsive disorder have obsessions & compulsions
Divorced & unemployed people represent the large spectrum of people with obsessive compulsive disorder
There is usually no gender differences between men & woman
- However early onset is more frequent in men than woman
Obsessive compulsive disorder usually begins in late adolescence or early adulthood

Comorbidity with other disorders

OCD frequently co-occurs with other anxiety disorders, most commonly social anxiety, panic disorder, general anxiety disorder, and post-
traumatic stress disorder
- A lot of people with obsessive compulsive disorder experience depressive symptoms at some point in their lives
Psychological causal factors
Obsessive compulsive disorder as learned behavior —> Learning view of obsessive-compulsive disorder is derived from Mowrer’s
two-process theory of avoidance learning
Mowrer’s two-process theory of avoidance learning —> Neutral stimuli become associated with frightening thoughts or experiences
through classical conditioning and come to elicit anxiety
- e.g., Touching a door knob associated with frightening thoughts may make the person discover that washing hands reduces anxiety
- The learned behavior is very difficult to extinct
- This theory supports exposure therapy, which would deem that gradual exposure with to the obsession & stopping the compulsion can be
deemed as an effective treatment for obsessive compulsive disorder
Obsessive compulsive disorder viewed from an evolutionary perspective would state that we have a lot of obsessions & compulsion focused on
dirt and contamination which may have evolutionary roots
One factor contributing to the frequency of obsessive thoughts, and the negative moods with which they are often associated, may be these
attempts to suppress them
A lot of people with obsessive compulsive disorder think that having these intrusive obsessional thoughts is as bad as actually doing them
- This inflated sense of responsibility is what can motivate the compulsive behaviors
Cognitive biases —> People with obsessive compulsive disorder have an attentional bias toward disturbing material relevant to their
obsessive concerns, much as occurs in the other anxiety disorders
- They also have difficulty blocking negative, irrelevant input or distracting information & try to suppress those negative thoughts
- Suppressing negative thoughts leads to an increase of their frequency
- People with obsessive compulsive disorder have low confidence in their memory ability

Biological causal factors

Genetic factors —> High concordance rates for obsessive compulsive disorder for monozygotic twins & lower for dizygotic twins
- Family studies also support a 3-12 times more likelihood of obsessive compulsive disorder in first degree relatives
- Early onset of obsessive compulsive disorder is associated with higher genetic loading than later onset
Brain abnormalities —> High level of activity in the basal ganglia leads to abnormalities to amygdala & the limbic system
Neurotransmitters abnormalities —> Tricylic antidepressant such as clomiparamine is an effective treatment for obsessive compulsive
disorder
- Selective serotonin reuptake inhibitors show that serotonin deficiency has a large role in obsessive compulsive disorder

Treatments
Exposure & response prevention —> The exposure component involves having individuals with obsessive compulsive disorder repeatedly
expose themselves to stimuli that provoke their obsessions, whereas the response prevention component requires that they then refrain from
engaging in the rituals that they ordinarily would perform to reduce their anxiety or distress
- Results of these are are superior than medications
D-cycloserine enhances the effectiveness of behavioral therapies, however the enhancement is blocked if the person uses antidepressants
Medications —> Drugs such as clomipramine (tricylic antidepressant) & fluoxetine (selective serotonin reuptake inhibitors) reduce intensity
of obsessive compulsive disorder symptoms
- Disadvantage of this medication is sudden stop of this medication will result into relapse

Body dysmorphic disorder

Body dysmorphic disorder —> Obsessed with some perceived or imagined flaw or flaws in their appearance to the point they firmly believe
they are disfigured or ugly
- People with body dysmorphic disorder can focus on almost any body part from skin to chest to face shape
- Almost everyone with body dysmorphic disorder have an interference with social function due to this disorder
- People with this disorder often ask a lot of reassurance from friends & family but this does not provide help for them
- They engage in a lot of grooming behavior trying to camouflage their perceived deficit
Prevalence, age of onset, & gender differences
Prevalence of 2%, with no gender differences (however there is gender differences in the perceived defective body part)
Age of onset is usually during adolescence
There is high rates of depression & suicidal ideation along with suicide attempt with body dysmorphic disorder

Overlap between obsessive compulsive disorder & eating disorder

People with body dysmorphic disorder tend to have obsessions similar to obsessive compulsive disorder
People with body dysmorphic disorder tend to look normal in contrast to people with eating disorder which are physically unwell people

Biopsychosocial approach to body dysmorphic disorder —> Twins studies indicate there a moderately heritable trait, in terms of
sociocultural context there is a emphasis that people put in attractiveness & beauty, they also show biased attention & interpretation of
information relating to attractiveness
Treatment of body dysmorphic disorder —> Selective serotonin reuptake inhibitors, cogntive-behavioral therapy in exposure & response
treatments

Hoarding disorder
Hoarding disorder —> Persistent difficulty getting rid of or parting with possessions due to the perceived need to save the items
- Prevalence of 3-5% in general population, prevalence of 10-40% in population with obsessive compulsive disorder
- Medication used to treat obsessive compulsive disorder do not help people with hoarding disorder
- Cogntive-behavioral therapy & exposure & response therapy also is less effective

Trichotillomania
Trichotillomania —> Primary symptom the urge to pull out one’s hair from anywhere on the body (most often the scalp, eyebrows, or arms),
resulting in noticeable hair loss
- The onset can be in childhood or later, with onset post-puberty being associated with a more severe course

Cultural perspectives
Lifetime risk for social anxiety disorder, generalized anxiety disorder, and panic disorder is somewhat lower among ethnic minority groups
than among non-Hispanic whites
People from the Caribbean’s tend to have higher rates of attaque de nervios
- Attaque de nervios —> Symptoms are the same as in a panic attack, but they may also include bursting into tears, anger, and
uncontrollable shouting
Anxiety disorder from mostly all culture have the highest prevalences
There is also cultural differences in culture specific disorders that are more common in Asian countries such as koro & taijin kyofusho
Chapter 13: Schizophrenia & Other Psychotic Disorders

Schizophrenia —> A severe disorder that is often associated with considerable impairments in functioning
- The main characteristics of schizophrenia is psychosis —> Significant loss of contact with reality

Origins of the schizophrenia construct

The first detailed clinical description of what we now recognize to be schizophrenia was offered in 1810 by John Haslam
Belgian psychiatrist Benedict Morel described aa case of a 13 year old boy & used the term démence précoce to describe him —> Mental
deterioration at an early age to describe the condition & distinguish it from other cementing disorder associated with old age
Finally, Emil Kraepelin is the one who gave the careful description of what is now known as schizophrenia
- Kraepelin noted this disorder as dementia praecox —> Someone who becomes suspicious of those around him, becomes delusional, it
is also characterized by hallucinations, apathy and indifference, withdrawn behavior, and an incapacity for regular work
Eugen Bleuler is the one who gave the term schizophrenia where “schizo” means ‘to split or crack’ & “phren” means disorganization of
thought processes a lack of coherence between thought and emotion, and an inward orientation away (split off) from reality
In schizophrenia there is a split within the intellect, between the intellect and emotion, and between the intellect and external reality

Epidemiology
Lifetime prevalence of 0.7%
People who have schizophrenia in their family are more likely to develop it as well
People whom fathers were older when they were born (i.e., >50 years old) are at an elevated risk to develop schizophrenia
Rates of schizophrenia are also higher than expected in first/second-generation immigrants, particularly those from black Caribbean and black
African countries who live in majority white communities
The vast majority of cases of schizophrenia begin in late adolescence and early adulthood, with 18 to 30 years of age being the peak time for
the onset of the illness
- In men, there is a peak in incidence of schizophrenia between ages 20 and 24
- In addition to having an early age of onset, they tend to also have more severe forms of schizophrenia
- In women, the peak in incidence is also in the same age bracket, but it much less marked compared to men
- For woman however, there is another peak at the age of 40 & third peak at the 60’s
Male to female ratio is around 1.5 to 1
There is a theory that woman tend to have less severe symptoms due to female sex hormones acting as a protective role
- Low levels of estrogens is associated with worse schizophrenia symptoms & this might also explain the late peak in 60s (i.e., menopause)

One change that occurred from DSM-IV to DSM-5 was the elimination of the requirement that only one other symptom had to be present if
delusions were bizarre or if the auditory hallucinations were of a certain type

Delusions
Delusion —> An erroneous belief that is fixed and firmly held despite clear contradictory evidence
- People with delusions believe things that others who share their social, religious, and cultural backgrounds do not believe
- Delusions are not a requirement for schizophrenia but 90% of schizophrenic patients have them
There are some types of delusions in schizophrenic patients that are characteristic;
- Made feelings or impulses —> Beliefs that one’s thoughts, feelings, or actions are being controlled by external agents
- Thought broadcasting —> One’s private thoughts are being broadcast indiscriminately to others
- Thought insertion —> Thoughts are being inserted into one’s brain by some external agency
- Thought withdrawal —> Some external agency has robbed one of one’s thoughts
- Delusions of reference —> Some neutral environmental event (such as a television program or a song on the radio) is believed to have
special and personal meaning intended only for the person
- Delusions of bodily changes —> Delusion of one’s body organ not functioning right
Hallucinations
Hallucination —> Sensory experience that seems real to the person having it, but occurs in the absence of any external perceptual stimulus
- This is different than an illusion —> A misperception of a stimulus that actually exists
- Hallucinations can occur from any senses but the most common is auditory hallucinations (e.g., hearing voices)
- In a study it was found that 75% of schizophrenic patients had auditory hallucinations
People who consider themselves to be socially inferior tend to perceive the voices they hear as being more powerful than they are and to
behave accordingly
In a study conducted by Nayani and David (1996), they interviewed 100 hallucinating patients and asked them a series of questions about
their hallucinatory voices. The majority of patients (73 percent) reported that their voices usually spoke at a normal conversational volume
Patients with nonhallucinating patients suggest that patients with speech hallucinations have a reduction in brain (gray matter) volume in the
left hemisphere auditory and speech perception areas
- Reduced volume in this area can lead to difficulty correctly identifying internally generated sound vs. externally generated sounds
- Patients with schizophrenia tend to have increased activity in Broca’s area , which is involved with speech production
Auditory hallucinations occur when patients misinterpret inner speech as coming from another source

Disorganized speech
Delusion reflect disorders about thought content unlike disorganized speech
Disorganized speech —> The external manifestation of a disorder in thought form
- An affected person fails to make sense, despite seeming to use language in a conventional way and following the semantic and syntactic
rules governing verbal communication
- The words & word combinations sound communicative, but the listener is left with little to no understanding of what the speaker says
- Neologism —> New, made-up words

Disorganized behavior
Goal-directed activity is almost universally disrupted in schizophrenia
The impairments tend to be so severe that the observers note that the person is not themselves anymore
- These disruptive behaviors come from impairment of the prefrontal region of the cerebral cortex
Catatonia —> The patient with catatonia may show a virtual absence of all movement and speech and be in what is called a catatonic
stupor, in some cases the patient can maintain an odd position for a large amount of time

Positive & negative symptoms

Positive symptoms —> Reflect an excess or distortion in a normal repertoire of behavior and experience, such as delusions and
hallucinations
Negative symptoms —> Reflect an absence or deficit of behaviors that are normally present
- Negative symptoms fall into 2 broad domains
1) Domain of reduced expressive behavior (in voice, facial expression, gestures or speech) that may show itself in the form of blunted
affect or flat affect or in alogia —> which means very little speech
2) Domain of reduction of motivation or in the experiences of pleasure
- Avolition —> The inability to initiate or persist in goal-directed activity
- Anhedonia —> Diminished ability to experience pleasure
In a study done by Kring & Neale, they made people with schizophrenia watch happy, sad & neutral movie clips & then trained clinicians
looked at their physical behavior
- The results showed that they showed less facial expressiveness than control
- However although they may sometimes appear emotionally unexpressive, they are nonetheless experiencing plenty of emotion

There are a number of other types of psy- chotic disorders, such as schizoaffective disorder, schizo- phreniform disorder, delusional disorder,
and brief psychotic disorder
Schizoaffective disorder
This diagnosis is conceptually something of a hybrid, in that it is used to describe people who have features of schizophrenia and severe mood
disorder (such as unipolar or bipolar in type)

Schizophreniform disorder
Schizophreniform disorder is a category reserved for schizophrenia-like psychoses that last at least a month but do not last for 6 months and
so do not warrant a diagnosis of schizophrenia

Delusional disorder
Patients with delusional disorder, like many people with schizophrenia, hold beliefs that are considered false and absurd by those around them
Unlike individuals with schizophrenia, however, people given the diagnosis of delusional disorder may otherwise behave quite normally
- The behavior does not show gross disorganization or performance deficiencies

Brief psychotic disorder

Involves the sudden onset of psychotic symptoms or disorganized speech or catatonic behavior, this lasts however only for a matter of days
- After this episode, the person may return to his former self without ever having another episode again
- It is often triggered by stress

Genetic factors
There is a strong association between the closeness of the blood relationship (i.e., level of gene sharing or consanguinity) and the risk for
developing the schizophrenia disorder
- The prevalence of schizophrenia for a first degree relative is 10%, & 3% for a second degree relative