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Clifford Beers The Mind That Found Itself
General/global adaptive functioning. Example of one of the problems in measurement. “how really are you doing?” Below 40-50 capable of dunctioning but 2 major areas of life, 50-60 one problem, 70+ doing well, 90 doing great, functioning well with stressors
DSM - 5
-current edition ofthe DSM that came out in 2013
-currently 400 mental disorders
-requires clinicians to provide both categorical and dimensional info as part of a proper diagnosis
--also evaluate a client's condition on 5 seperate axes of info
5 pre-schizophrenia: some science behind it...is it good enough to justify the label?
Collapse of categories of autism disorders
· Why did we collapse the spectrum?
· Couldn’t find a dividing line between autism/aspergers etc
· “We want to carve nature at it’s joints”
the nature of the neurological development of infants where connections develop—
o Some are solidified and some are not depending on experience
Over time structures in the brain grow (at different rates)
· There are things that can disrupt this development and this shows up later
increase speed of neural transmission
· 50 fps
· doesn’t finish until age 20
· Neural pathways don’t work as well at 16 than they do at 26
· Long inhibitory transits aren’t as active in younger brains
o Chaotic/not-consistent environment
o Lack in any input
§ Example, nuns were providing all needs for children EXCEPT for responsive needs of children
§ The children failed to thrive
§ No connectedness, so networks that are supposed to be laid out for learning to predict mood, for relationships, weren’t being stimulated
ú Arborization NEVER STARTED
§ they have bad genes, Mutations (Not that common but occur.)
§ Dominant/recessive genes (code for faulty branch in development)
§ Used to always look for gene and then disorder
ú “gene for bipolar disorder”
ú but it probably doesn’t work that way and instead there is a causal pathway and for many things the genetic link is causatory
§ Heavy metal toxin
ú Lead paint
· By 2 they will lose IQ points
ú Paint fumes
§ Mother’s toxins
§ Other issues with mother
ú Fever while pregnant
ú Forcep damage
ú Accident (premature delivery)
§ Inhaled nuconium
§ Fever 105+ lose nerve fibers (optic nerve)
o Lesion from head injury
o Substantial neurological defect not associated with family “maybe you were dropped on your head” before age 2
§ Sometimes that could have happened
§ Nutritional depravation, genetic, etc.
§ This causes things like sexual maturation is delayed/truncated
§ Malfunctioning? Stress response cycle effected (hyper/hypo sensitized)
§ Tiny peti-mal ones that aren’t detectable butfunctioning impaired
§ Early sign of HIV is that certain neurological tasks are impaired
§ Age? Not sure. Adults.
Model has changed greatly
· Before 1970s all discoveries from clinic
o Physician in florida discovered HIV/AIDS
(1940s) Kids with developmental delays by age 5, Ex cognitively not growing couldn’t string together sentences,Diapers had a odd odor. Determined that the kids had a massive amount of amino acids: PKU. They weren’t breaking it down like normally.
Lose 10 IQ points every year: Aka IQ of 60
§ Diet can only eat one thing: phenolac?
ú If caught early, they can catch up by age 5 and eventually eat normal food but don’t lose IQ points
o Anomalous cases
§ Calkax? One with bipolar, rest are schizophrenic
ú Look at family history
o Developed model of family transition (1900)
o Same time as social movement of Eugenics
o Is it learned?
o see behavior genetics and neuroscience come into it’s ownStill a lot of times just correlation
(middle east)§ Eating sheep brain--Mad cow. Folded protein. Looked genetic but it was the family. § Eating brain with ancestors. Passed on in food for a cultural reason
o Biological cause or cultural cause? Both!
o Store episodic memory
o Fluid memory: Memory of how to walk, do things,
o Episodic memory: We don’t remember when we learned s something, like open doorknob
§ Ex dramatic case: guy cant remember what a basketball is, no idea, then dribbles down court and shoots the hoop
o Regulation of affect goes through here,
o May or may not connect to frontal cortex
o Anxiety, fear?
o Regulation of things like eating
o It’s at war with frontal cortex when you want to eat the donut
Schizophrenia and connections in brain
o See things going wrong at this level at an early age
§ Major implications with “pre-schizophrenia” label
· Underconditions of stress, produce adrenaline, too much, overload, then the system releases cortisol to manage the stressful system
· Ultimately you will have organ failure
ú Block Repuptake of serotonin, a lot floating around
ú What we think actually happens is that it blocks reuptake and creates new receptors—so when you stop taking it (especially suddenly) symptoms are back because you lost receptors
Selective Seratonin Reuptake Inhibitors
-a 2nd generation anti-depressant drug for anxiety, depression adn personality disorders
Tricyclic anti. depressants
· Produces a lot of seratonin
· Bad side effects
· Mao inhibiter
· MAO is the thing that breaks down the NEUROTRANSMITTERs in the gap
· But what you cant eat when you are on it will make you awful (overly restrictive)
o Ccan trigger effects of depression
· Said give me 3 infants and I can create a doctor and a lawyer and an indian chief
Built right on pavlovs conditioning
o Wanted to be an artist (painter) didn’t have the talent
o Interested in learning, read about Pavlov
§ Thought interesting paradigm
o S>  > R
§ Stimulus goes into black box (person)
§ Have no proof of what happens in the box
§ Response comes out
o “operant conditioning model”
o recognized that we can develop a functional analysis of almost any behavior without having to know what happens inside the black box!
o To change a behavior we don’t need to know background
§ Just need to understand reinforcement
§ Consequence is anything that changes the probability of the behavior happening next time
§ Shaping: use successive approximations of target desired behavior
ú Shaping is how we acquire a new behavior
· How we learn to feed, to ride a bike, how we are potty trained
§ If we don’t give a pellet then rat will gradually extinguish behavior
§ Study on infants and mothers response
§ If we give a pellet every 3-4 times, he learns that schedule
ú how long it takes between a reinforcer and desired behavior
· different based on frequency of schedule
· steady state
§ Intemittent schedule
ú More of a u shape
ú Based on time
· start to look for
o ex depressed people have self defeating set of cognitions
o Fundamental attribution error
§ Not only did you drop it but I feel responsible too
§ Look this up again, his explanation didn’t really do it for me
o Depressed people have a lot of depressing/defeating cognitions that make it harder to get through the day?
· Skinners model doesn’t explain what many people are interested in
S > [mental activity] > R
§ 27 year old male, wife left him because he was feckless, wakes up every morning looks at her picture then has depressive behavior and people stop associating with him, loses job, cycle over
§ Cant change: other people’s behavior
§ Have complete control over our own mind
o We can intervene in abnormal behavior conditions by treating mental activity like it’s a behavior
o Hard to know when projection Is happening
o Easy to study this
some are permeable, some are impermeable. They are redundant, homeostatic, and isomorphic.
§ communication takes place and to be understood needs to be redundant
ú check consistency between areas—between words and body language for example
ú return to and perpetuate their own level of organization. Cellular to national level
ú system could be a family
ú parent system, family system, kid system
· rules on direction: kids cant barge into parents room, parents can barge into childs room.· System couldn’t reconstitute again
· Behaviormight be a response of system
· The fish stinks at the head
o Organization that is going to go all the way down
· Relationships hierarchical (vertical hierarchy), spokes on a hub (equal, participatory democracy)—isomorphy
o There are nominal rules, and other ones???
o Isomorphy example: Professor jones says he needs a book, so future press of board goes to get a book, hears that smith has the book checked out, goes to smiths classes and asks
§ Says that’s initiative( Stagner says it’s rude)
o You do what you want you apologize, and you keep doing it.
o On different levels –people doing what they wanted and apologizing
there was a vegitative state disorder where people had depressive symptoms but were much worse. It was discovered that they needed a month intensive bed rest and then bam would recover
running amok was actually being jealous of sexual exploits of others? Significant other?
· Chinook winds are 70-80mph for a few days/week yearly
· Associated with crazy acts because they are irritating
· People get dispensation for crimes during the time
< mid 1980s
· People were dying of an eating disorder
· BUT THEY had no issues with body image
· It was that food was considered toxic, foreign,
· Symptoms are manifested in different ways
· A crazy family members are seen as “capable” and their ability is seen to be given from God
o Its an honor to care for the family
· There is a cultural context for symptoms.
· Clothes? Eye contact? Activities. Look at eyes (bags) Facial abnormalities. Grooming? Odor? Bruises, cuts? Calm/Agitated? General health? Emaciated, vomiting, hydration? Gait—did he walk in by himself? “reasonably good gross motor movement”
Also fine motor movements
§ Coffee and sugar packet to see if he opens it or spills it
· Is he reactive? IF something drops behind him does he startle normally or ok?
· Ask questions: Name, Does he know what day it is? Where he’s from?/lives? Are you hurt? Are you in pain? Is there anyone we can call? How did you get here? Job? Where he is/where he was? What he was doing? Have you done this before? Family, family history?
o How are you feeling right now?
§ Get them to focus on immediate experience
§ Can they rapport, establish a relationship, do they think I’m asking reasonable questions, am I to be trusted?
§ Can I establish a helpful connection in his mind?
ú This can help establish a lot
§ Observe, ask more questions
§ If he gets upset can he pull the mood back in?
§ can he control his mood?
§ Does he have a range of mood?
§ Does he only have one mood or multiple ones? Flat affect?
§ “mood and affect not appropriate to content”
§ ask benign questions
§ Yes, don’t have to do a lot about attention.
§ If no, confused, gets off on tangents, cant pay attention
§ Backwards from 96 by 7’s
§ Ask them to remember 3 words, easy, and ask for recall a few minutes later
§ If they cant, we have hypothesis about working and long term memory
§ We started with nonsense words
§ Is it fluid? Easy to produce speech? Is language truncated, simplistic or complex?
§ Fluidity or freedom of expressiveness??
§ What they can tell of a story that you tell?
ú Capacity to take stuff in, store, and retrieve
§ Want to know “can I send you home”
§ Is there someone there to watch you?
§ Interested in how you talk about your roommate
ú Is there connectedness?
§ Do you experience me as being helpful or interested, or like a cop, or like telephone solicitor (no connection)
§ Connection will also help you determine your boundaries you have to set
Poverty of content
ú Only two subjects?
· Ex food and creatues from outer space. Ask if eyes play tricks on you. Anxious, tired, or moving into psychotic break, Ask same with ears
§ Delusions, Hallucinations. Process of thought, Flight of Ideas: Crazy ideas jumping around?
ú Ask what you said started the conversation
o Harm to self or others? Direct questions
are good and interesting but usually we do that when they think they are sick!
ú Isolate functionally what this person is capable of
ú Isolate particular functions
ú Use info like a hallmark issue of stroke is impaired ability to speak
· Test verbal expression, repetition, ---- Test for various kinds of aphasia
· Aka give them directions with different stages (can they do two, three, four step tasks?)
· Score and compare to norms in the population
· Could be looking for just memory, or motor function, or both
· Grip strength? Why? (looking at both sides—is it different)
ú Hot issues with looking at cognitive function
· Some tasks we can detect when people are not putting forth the best effort
ú Tasks: one task a perfect score is 50, they come in and do 15-18 , when Nobody gets less than 20 unless you are trying. They do what they think an impaired person would do, and its so far below what a really impaired person would do.
§ Galton—grip strength, memory, calculation tasks
ú Took all the highly educated people of British aristocracy and wanted to use them as smart standard
ú Tasks not well thought through because they were a function of education
ú Wanted a test because they were interested in universal education, but wanted to screen out the people who couldn’t benefit from an education model
ú He created tasks—verbal, visual puzzle solving, memory tasks, tried to come up with system for predicting who will do well in school
ú Asked questions, they got harder, and calculated mental age
ú IQ = Mental age/Current age X 100
ú studied gifted children
ú wanted to identify when young and do a big longitudinal study on them
ú Found binets things, adopted many tasks. That’s where we get Stanford-Binet test
ú Still used today
ú adult intelligence scale (4th iteration now) WAIS
ú intelligence scale for children (5th interation) WISC
ú tasks have been modified to make them less culturally biased, to catch up with research,
ú WPSSI (preschool)
ú Nationally stratified national sample
ú Random from country
ú Except trying to get from all over, all SES, ethnic background
ú National sample thatts representative of the country at that age group
ú Age brackets XX-YY age
ú Materials outlive the norms—the population changes
ú Change every 10 years
ú Give blocks with different colors on different sides,
Some people get it, others will keep trying faulty thing, trial and error
§ Go until they fail 2
§ Visio-spatial analysis
§ Average score of 10, can get as much as 20 (computed later)
§ Go with tasks, how can they think abstractly with verbal information
§ 63, 713942568
§ World record for repetition is 88 digits
§ Working memory
§ Can you hold information in your head while you problem solve
§ Give numbers, repeat back backwards
§ Problem solving
§ Have to igure out the rule
§ Visual spatial, abstract
§ Don’t have to be able to articulate
§ Right hemisphere function
§ What does winter mean
§ If you’ve had a really good education, pretty smart, have good education, good vocabulary
§ If you have a head injury but still have good vocabulary you can see about what they functioned like before that
§ He doesn’t think he is measuring math skils
§ Can you hold stuff in your brain
§ Working memory
§ Can you recognize if a stimulus has already occurred in an array?
§ Working memory, visiospatial
§ Pattern recognition
§ How many weeks in a year, what is the boiling point of water, who wrote fausz
ú Might have someone whose information score is much lower on information
· Retrieval problem?
o Memory (input, storage, retrieval)
· Education problem
o Timed and see how many you can do
o This and symbol search is a real measure of associated
o You start to learn/associate them after about 25
o UNLESS you have
§ Attention probs
§ Visual memory problems
o Presented mixed up
o Repeat in order numbers then letters
o working memory and holding memory
o how much ram do you have
o Social awareness, Capaz for abstraction
o Social rules/conventions
§ Tell me some reasons why food need to be cooked
o Answers have points—1 point answers, 2 point answers
§ More reasons, more points, Some are more abstract
§ What does this saying mean: "People who live in glass houses shouldn’t throw stones"
ú No such thing, Windows will break Or what?
§ Social convention, think abstractly
o Show them array of triangles and squares
o Draw line through all pink squares
o Gets more complicated
§ Do stroop, cross out words printed in blue
ú Herman, young scholar in 1920, interested in personality theories of Carl Jung. Interested in what people thought about things, how they processed information. Tried to establish a procedure for getting an a sample of mental information. He had 15 but only budget for 10 so that’s why there are 10.
ú Controversial because of findings that it is not valid (for what), reliability
· Still is used very commonly
· Used to be top 4-5 assessment tools
ú Reliable in the sense that in 14 hours he could train us to have interrater reliability of 90%
ú What do we do with that?
· Validity come in with this question
Score a number of things
· whole thing vs one piece that is clearly defined, vs a tiny piece that doesn’t fit (OCD)
· colored ink, does this affect the way you respond, the time it takes you to respond, how are you processing this?
· Some get anxious, upset, and then their response doesn’t map onto the image well
o Changing reality to fit their perceptions (someone with thought disorder might do)
Do they keep sliding or do they recover?
· Do they see motion?
ú Score responses on 10-15 categories
· Can say most of the time they incorporate the whole block
· 3.Good source of hypotheses about how this person functions: Expectations in relationships (reciprocal, facilitative, dangerous, or no template for relationships?)
o How well they control emotion, access to a range of emotion
§ Checklist of some sort
§ Designed to capture very specific information about specific question
§ Hypothesis tend to be robust
§ Validity is very good
ú Because you are asking specific things
§ Help track specific symptoms—might track every 2 months
§ Ask questions about symptoms (symptom checklist)
ú Hallucinations? Have panic, depression? Etc.
§ Useful to know if they think they are depressed
§ Perception of problems, if lingering or not
ú Perception vs. reality of their life,
ú This is why self report isn’t the best predictor for whats going on
§ Other methods as well
· Thought they would get an output where there were different scales/scores output for depression, anxiety, where most would be normal with spike for the problem
Got mixed pattern! Very mixed
What was this persons frame of mind when they were taking this test? If you score one way (opposite of usual) get points. F scale, have a lot of points if trying to file a lawsuit, get out of jail. KL: virtue claiming. (good person, sophistication). Lots of specific scales based on substance abuse, passivity, etc..
o age related change in IQ? test people at 20, 30, 40, 60
changes in reaction time, also in ability to work with spatial puzzles, difference in the ends in fund of information at disposal
Not really age related change sometimes (how many holes on punch card, obesity)
o Sometimes really helpful,
§ Esp in course of disease (childhood leukemia).
Schizophrenia from then/now much difference in drug
o Follow person over 30 years
§ 1950 vs 1995 have very different medication history, very expensive, learned a lot doing this, especially with schizophrenia
§ followed kids starting at 8 (with high risk)
lots of very interesting information
o can do them retrospectively
§ using archival data
cumbersome, less expensive (somewhat)
· The number of new cases in the last month, year, decade.
how many people will get (depression) at some point in their life. 20%
how many people at this point have (depression). A little higher than lifetime.
· Took grid, tried to interview everyone in that grid
· Used standardized assessment—standardized questions then gave a 1-6 score based on how distressed they were.
o 1-6 rating is rather crude
Theory about some disorder, testing. Need to get real cases of this disorder: “grumpiness in the morning disorder”
All things we study will get low point prevalence.
o Lets say the prevalence is 1%, Our test is 95% accurate
o But because base rate is so low, the test identifies more people than have the actual disorder (predicting a rare event = statistical rare events).
o Have to be tractable
o Have good research questions answering
o Laser, zap small area of brain
o Done with individuals who are going to be hospitalized for life
6mo: Real: 50%
· psychotherapy works if you are suffering mild to severe ailment. More likely to be improved than if you aren’t. More people get better than the control groups
· No particular brain of psychotherapy is better than any other brand
o Suggests to many that there are non-specific factors and unification projects
· Is family therapy better than group therapy?
· If we look at nonspecific factors
o Has therapist communicated optimism
o Does client experience strong therapeutical alliance
o Therapist exhibit willingness to be honest about what they do, don’t know
o Boundaries very clear?
· They are a big predictor of psychotherapy outcomes
-seeks to change how an individual views and reacts to their hallucinatory experiences; the individual may not suffer the fear and confusion if they interpret the experiences differently
1.educating the client on the biological causes of their hallucinations
2.learn the triggers for their fears
3.challenge clients inaccurate ideas about their fears/haluc.
4.help the client more accurately interpret them
5.teach them coping techniques
Behavioral therapy can what?
help patients gain a greater sense of control over their hallucinations and reduce their delusional ideas
**THEY DO NOT ELIMINATE THEM
1st Generation Anti-depressants
-MonoAmine Oxidase inhibitors (MAO): marplan, nardil
-Tricyclics: triavil, elavil, vivactil, norpramin, sinequan
2nd Generation Anti-Depressants
Selective Serotonin Reuptake Inhibitors (SSRI’s): prozac, zoloft, paxil, anafranil, luvox, lexapro
-most popular 2nd Generation anti-depressant
-“reach for mothers little helper” -1994 Newsweek
-“The personality Pill.”-Time 1993
-“Makes you weller than well”
“talking back to prozac.” 2005 book by Dr Peter Breggin.
-associated with more hospitalizations, death, or other serious adverse reactions reported to the FDA than any other leading drug in america
National Institute of Mental Health
natural foods or supplements used to treat or prevent disorders
-Increasingly being used as treatment for mental disorders such as depression
§ Problem solving instead of worrying about how bad it is
§ Focusing on the worst is ntot helping
Many of the things we worry about in the short term are meaningless in the long term