Clinical Psychology lectures 2019/2020

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Lecture 1: Introduction Clinical Psychology

What topics are discussed?What is a mental/emotional/behavioural disorder?It is thought that a behavioural disorder has its origin in the brain. However, the brain is the most complex thing we try to understand, and it is hard to interpret how exactly it works, due to a thick skull which is hard to get through. A behavioural disorder can be seen as a behavioural syndrome. A syndrome is operationalised in terms of a diagnosis and covers a pre-defined set of symptoms. These symptoms should cause impairment in functioning or noticeable stress, to the person or to others. A disorder is not a yes/no thing, but it depends on the dimension of the symptoms. Besides, disorders are hard to distinguish from one another, and it comes with comorbidity too. The uncubus phenomenonThe uncubus phenomenon is a hypnopompic experience. It is also known as sleep paralysis. It occurs when you’re in-between sleeping and being awake. You have the feeling you cannot move and you have difficulty breathing. You sense presence and you feel like someone or something is sitting on your chest, which causes trouble breathing. This is actually because during your sleep your muscles are paralyzed, so are your muscles which control your breathing. It is probably a (REM-)sleep disorder. You wake up at the wrong time in the middle of the night, during your REM-sleep. The body is paralyzed and the brain is very active. Your brain wants to make sense of what’s going on, which causes stress and impairment because you cannot move. It is discussed whether this would be considered a behavioural disorder. Who makes changes into severe psychopathology?Why does one develop a behavioural disorder, meanwhile someone else doesn’t? By what mechanism does this work? It is unclear what mechanism works between two events. Two examples are given. When one has experienced emotional abuse, this person is two to three times more likely to report bulimia or anorexia nervosa. Being a refugee, it is...

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Lecture 2: Anxiety disorders

What topics are discussed?PhobiasA lot of phobias make sense from an evolutionary perspective. Being afraid of snakes meanwhile you have never had an encounter with a snake could be due to ancestors having to deal with dangerous snakes. Many people with phobias choose to live with their symptoms rather than seeking treatment. This is because they don’t realise they are having irrational thoughts, or because they are embarrassed. Phobias are very treatable if done properly. Exposure treatment is an effective treatment. however, people fear those because they don’t want to be exposed. Conclusions to start with- Understanding the nature of anxiety disorders is vital to evidence-based and effective treatment. It starts with a thorough understanding of the conditioning theory. If you don’t understand the conditioning theory you might not be able to perform an effective treatment.- The search for new treatments continues because of incomplete response to existing treatment, relapses, and problems with acceptability of treatment.- In general, new treatments are being implemented fast, with little attention to potential adverse effects.Mowrer’s theory of fear and avoidanceAccording to Mowrer’s theory of fear and avoidance, acquisition of fear is done via classical conditioning. There must have been an incident in which the person has experienced fear. Avoidance would be reinforced by operant conditioning, which reduces anxiety. People avoid situations that they associate with their phobia. Avoiding these situations immediately reduces anxiety/fear. This theory describes that fear generates search for safety. Fear is considered a balance between signals of threat and signals of safety. If someone is fearful for birds, that person may be so generalised that he or she might not be able to drive or go outside, unless there is someone’s with him or her who can scare away birds. This is a signal of safety. Video 1A video is shown in which a woman...

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Lecture 3: Personality disorders

What topics are discussed?ClustersThis topic has not been discussed in the lecture. However, it can be convenient to have a quick summary about the clusters and the different types of personality disorders. Therefore the other topics which were discussed in the lecture and literature are easier to understand.Cluster A: strange behaviour- Paranoid: not trusting others, extern attribution bias (blaming others for own failures), easily getting jealous, resulting in problems at work and in relationships, they often seem professional and efficient and are proud they can handle everything rationally/without emotions- Schizoid: flat, superficial behaviour, not feeling pleasure, not feeling anything like mood swings (although they can experience depression), not understanding how/why they feel the way they feel- Schizotypal: strange, eccentric, and creative behaviour, feeling like they cannot fit into society, often psychotic features, they want to be in contact with others, but they are very frightened to do soGeneral characteristics: social aversion, failure to form relationships, poor self-awareness and empathic ability, (relative) indifference to these abilities.Cluster B: dramatic- Antisocial: not caring about emotions and rights of others, rationalising own destructive behaviour, lying, often raised in an instable family with lack of parental care, sometimes referred to as sociopaths or psychopaths- Borderline: instability with moods, relationships, impulsivity which leads to reckless behaviour, self-mutilation, suicide attempts, fear of being abandoned- Histrionic: constantly seeking attention, paying attention to how others judge and perceive them, inappropriate, seductive or sexual provocative behaviour- Narcissistic: not interested in others, strong desire to be admired by others, overestimation of their own qualities, easily jealous of others and having the idea that others are jealous of them, not good at taking criticism...

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Lecture 4: Addiction

What topics are discussed?Classification psychoactive substancesThere are three classifications of psychoactive substances. First, there are sedatives. Examples of these are opiates, barbiturates, GHB, alcohol and laughing gas. They give a relaxed and euphoric feeling. They are very strong and therefore an overdose is a high risk. Stimulants can be for example cocaine, oat, nicotine and caffeine. Cocaine when snorted has a different effect than when it is smoked (crack). Hallucinogens are psychedelic drugs and when snorted in a high dose it can have a dissociative effect. People become energetic, euphoric and empathetic when using hallucinogens. They can also be psilocybin (changes in perceptions). Hallucinogens make you ‘high’ or ‘stoned’ and mostly give a relaxing effect. Examples of hallucinogens are LSD, ketamine, XTC, mushrooms and cannabis. DSM IV criteria abuse and dependenceThe DSM IV made a distinction between abuse and dependence and these were criteria to be diagnosed with a substance use disorder. Abuse is described as a maladaptive pattern of use, with significant impairment or distress, as manifested by at least one criterion within a 12 month period:- Failure to fulfil major role obligations as a result of use- Recurrent use in physically hazardous situations- Recurrent use-related legal problems- Continued use despite persistent social problems caused by use Dependence is describe as a maladaptive pattern of use, with significant impairment or distress, as manifested by at least three criteria within a 12 month period:- Tolerance (having to use more every time to get the same effect(s))- Withdrawal / use to avoid withdrawal- Use in larger amounts / over longer period than intended- Persistent desire / failed efforts to cut down or control use- Much time spent in activities to obtain, use, or recover from effects of use- Important social or occupational activities given up or reduced because of use- Continued use...

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Lecture 5: Somatic Symptom Disorders

What topics are discussed?Somatic symptoms 90% of the general population has at least one symptom per two weeks. Most symptoms are found to be not pathological. One in 40 symptoms leads to consultation of a general practitioner. This usually happens when the symptoms are of longer duration, the symptoms are aggravated, or when people are worried about the meaning of their symptoms. In 16-74% of the consultations, no explanation of the symptoms is found. This is because many symptoms can have my causes. Most people only experience symptoms for a couple of days or weeks, meanwhile in most psychiatric disorders you have to experience symptoms for some months. After medical consultation, 63-75% of the patients recover. The prevalence at the GP for somatic symptom disorder is 15.7%. The total amount of anxiety disorders is 5.5% and the total amount of depression disorders is 4.1%.SOLK stands for Somatisch Onvoldoende Lichamelijke Klachten (insufficient physical somatic symptoms). The working hypothesis for SOLK is that somatic symptoms exist during some weeks and the symptoms are not explained by appropriate medical examination. Somatic and mental pathology are ruled out on the basis of a legitimate assumption. However, there is some criticism. For example, the time period given is quite vague (‘some weeks’), and there can be an appropriate medical examination. About 15% of the somatic symptoms is due to somatic insufficiently explained fatigue. Somatic symptoms are said to be pathological if it lasts longer than 6 months, if the symptoms are significantly distressing, and if the symptoms are significantly disrupting daily life. DSM V criteriaSomatic symptom(s) cause distress or malfunctioningExcessive thoughts, feelings, or behaviour associated with somatic symptoms or worries about health, reflected in at least one of the following:Disproportional and persistent thoughts about symptom severityPersistent high level of anxiety about...

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Lecture 6: Eating disorders

What topics are discussed?Anorexia Nervosa: DSM V criteriaUnderweightIntense fear of gaining weightDisturbance in the way in which one’s body weight or shape is experiencedThere are two types of AN: the restrictive type (not eating, eating very little), and binge/purging type, in which one first eats and then purges. However, these binges are not as big as in other disorders.Bulimia Nervosa: DSM V criteriaObjective binge eating episodesInadequate compensatory behavioursSelf-evaluation is unduly influenced by body shape and weightThe main difference between BN and AN is that those with BN usually have a normal body weight. VideoA video is shown. The woman in this video tells how eating disorders have a biological basis. Eating disorders have the highest death rate of all mental disorders and therefore it is important to pay attention to it. She explains how food plays a role in one’s thoughts and behaviours. Whereas healthy people feel calm and relaxed when eating, people with an eating disorder, e.g. AN or BN, feel high anxiety and severe disturbance when they eat. Other specified feeding and eating disorder (OFSED)This disorder was first called eating disorder not otherwise specified (EDNOS) in the DSM IV. In OFSED, most patients have characteristics of all ED subtypes. OFSED is the most prevalent eating disorder, as 75% of the people with an eating disorder suffer from OFSED.It is important to note that diagnoses of eating disorders are not static. There is migration between the subtypes and there is a lot overlap. It can happen that when one has recovered from AN they later on develop signs of BN. Eating disorders like Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder (BED) have over-evaluation of body weight and shape in common. Dieting and fear of weight gain in the population In the general population, between 21% and 66% of the women fear weight gain, a large proportion being 13 years old or 50 years or...

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Lecture 7: Psychotic disorders

The term psychosisThis term was first used by Von Feuchtersleben in 1845. There are different terms throughout the paper written by Beck et al. which might be little bit confusing. These terms are psychosis, psychotic symptom, psychotic disorder, schizophrenia spectrum disorder, and schizophrenia. How are these related to each other? In this lecture the focus will be on psychotic symptoms and psychotic disorders. The Continuum Model of Psychopathology describes how everyone experiences anxiety and depression from time to time and that this is normal. There is some arbitrary point where there is so much anxiety and/or depression which can be pathological. This is the same for psychotic symptoms. About 10-20% of people in the population hear voices from time to time. This is not necessarily a sign of psychopathology. These voices can say nice and reassuring things, which gets you in the ‘safe area’ of the CMP, but these voices can also say you have to do dangerous things. In psychotic disorders this model works a little bit differently. In psychotic disorders we see the whole collection of symptoms and there is not a continuum anymore. Psychotic symptoms Positive symptoms are when there is something extra. Examples of these are delusions, hallucinations, disorganised thought and speech, and disorganised or catatonic behaviour (muscle stiffness). Negative symptoms are when there is something missing or when something as extremely decreased.Delusions are cognitive phenomena. These are not things we feel or perceive, it’s something we think. Delusions are not self-perceptions. Examples of delusions:Persecutory delusions: paranoia, usually paired with loneliness, feeling like someone is spying on themDelusion of reference: related to persecutory delusions, thinking that things are about them, thinking that people who are in a restaurant are laughing are laughing about you Grandiose delusion: thinking they are much more than they are, e.g....

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Lecture 8: Mood disorders

What topics are discussed?DepressionTo receive a diagnosis of depression 5 (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning. At least one of the symptoms is either 1 or two.Depressed mood most of the day, nearly every day. (Note: In children and adolescents, can be irritable mood.) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day. Significant weight loss when not dieting or weight gain/decrease or increase in appetite nearly every day. (Note: In children, consider failure to make weight gain.) Insomnia or hypersomnia nearly every day. Psychomotor agitation or retardation nearly every day. Fatigue or loss of energy nearly every day. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self reproach or guilt about being sick). Diminished ability to think or concentrate, or indecisiveness, nearly every day.Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The episode is not attributable to a substance (e.g. alcohol, drugs, medication) or to another medical condition. Mood disorder: the mood spectrumWithin mood disorders there are multiple different levels/dimensions of mood disorders. These and their characteristics will be explained.First, there are two types of depression which can be distinguished.A unipolar depression is characterised by just depression. Two types of unipolar depression are major depressive disorder (shorter amount of time, at least two weeks, but very severe) and dysthymic depression/persistent depressive disorder (longer amount of time, at least two years).A bipolar disorder...