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119 Cards in this Set

  • Front
  • Back
obsessions
- Unwanted thoughts images or urges that cause distress and interfere with daily life
- Usually nonsensical
- Cause high levels of anxiety, often creating ritualistic behaviors
- Most common-contaimination, sexual aggressive impulses, body problems
compulsions
- impulse to repeat certain behaviors or mental acts to avoid distress
- repetitive, ritualistic, and time consuming
- person feels that they must perform
- leckman et al found that checking and reordering and washing and cleaning were the most common categories of rituals
- most common compulsions
- excessive hand washing
- germ preoccupation
- fear of contamination
- counting rituals
- checking and rechecking
Theories of OCD- Biological, caudate nucleus
tends to run in families, more prevalent among identical twins than fraternal
• Compose brain circuit that converts sensory info into thoughts and actions, either area may bee too active, letting through troublesome thoughts and actions
• Low serotonin activity might interfere with the functioning
theories of oct, cognitive behavioral
People blame themselves for normal thoughts and epect that terrible things will happen as a result
To avoid negative outcomes, they attempt to neutralize their thoughts with actions or other thoughts
-when a neutralizing action reduces anxiety, it is reinforced. Client becomes ore confinced that the thoughts are dangerus, the fear increases the thoughts increase
-people with ocd are more depressed, have higher standards for morality and conduct, believe thoughts=actions and are capable of bring harm,
believe that they should have perfect control over their thoughts and behaviors.
treatments of ocd, biological
• Serotonin based antidepressants
• Prozac, anafranil
• Bring improvement to 50-80% of those with ocd
• Combination medication + cognitive behavioral therapy may be most effective
Treatments of OCD behavioral
Exposure and response prevention, ERP
-clients repeatedly exposed to anxiety stimuli, but aren’t allowed to do a compulsion

therapist model behavior while client watches
significant long lasting improvements for most patients
Caudate Glucose Metabolic Rate Changes with Both Drug and Behavior Therapy (Baxter et al., 1992)
Both pharmacological and cognitive behavioral psychological approaches changed brain metabolism in patients who respond to them
dissociation
- detachment or loss of integration between identity or reality and counsiousness.
depersonalization disorder
- episodes of feeling detatched from ones self or having a sense of unreality about ones surroundings.
- Feeling like someone is living a dream or acting like a robot
- Persistent episodes
dissociative amnesia
- inability to recall important personal material that cannot be accounted for by medical causes
- info is lost from traumatic or stressful experiences
dissociative fugue
- amnesia on the run, person cant remember past, reports a past that is false, but the person thinks its true
- person is confused about identity or assumes a new identity
- may start a new family or business
alters, child alters, persecutors, helpers
-child alters- appear during trauma, the alter takes over while the host escapes the abuse
- persecutor- punishes the other personalities
may self mutilate or inflict pain in other ways
- helper, offer advice and perform functions (engaging in sex with adults)
- may also control the switching between personalities
DID symptoms in children
- erratic behavior and emotional problems, antisocial behavior, sexual relations, drug use
reasons why did is controversial
many professionals express profound doubts about the diagnosis
-some people say its over diagnosed
-appears to be mainly in the usa
-role play that becomes a reality
theories of DID
-some researchers believe it is iatrogenic, unintenially produced by practitioners
-psychodynamic theories- ego defense mechanism, repression
-behavioral- learned operant conditioning. Escape behavior
Research testing validity of DID
Did memory test show that normal and did people have the same unconscious memory processes
Clinical Phenomenology of DID (Putnam et al., 1986)
no signs prior to therapy, 80% of did patients possess no knowledge of there multiplicity before beginning treatment
no awareness of alters at the time of diagnosis
clinicians, 400 questionaires, to people that indicated an interst in mpd, received 92 responses
the mean # of did patients was 1-100, they were 10-11 times more likely to report having seen did than members of CPA, shoing that diagnoses are made by a small # of therapists
a large portion did not have any signs previously
treatment of DID
- integrating subpersonalites
- merge them into one personality
- the patients don’t like this usually and see integration as death
- social and coping skills needed to be taught
Somatoform disorders
- problems that appear to be medical but are due to psychiatric factors
- people believe their problems are genuinely medical
- disorders marked by unpleasant or painful physical symptoms that have no apparent organic cause and are often not physciologically possible, suggesting that psychological factors are involved.
psychosomatic disorders
- syndromes marked by identifiable physical illness or defect caused at least partly by psychological factors
malingering
intentially faking illness for external gain
factitious disorder
faking symptoms to be a patient
conversion disorder
- psychosocial conflict or need is converted into dramatic physical symptoms that affect voluntary or sensory functioning
- diagnosed in women twice as much
- sudden and rare
- paralysis, blindness, loss of feeling
somatization and pain disorder
- psycho social factors play a central role in the onset, severity, or continuation of pain
- often develops after an accident or illness that has caused genuine pain
hypochondriasis
- people interpret bodily symptoms as signs of serious illness
- normal bodily changes such as coughing, sores, or sweating
DSM-IV Conceptualization
- A. odd centric- paranoid, schizoid, schizotypal personality disorders
- B. anxious fearful cluster- dependent, obcompulsive, avoidance personality disorders
- C. dramatic erratic cluster- histrionic, narcissistic, borderline, antisocial personality disorders
- On axis II
stability of pds
- longstanding, inflexible ways of behaving that are not disorders as much as dysfunctional styles of living
- lifetime prevalence is about 10-13%
- occurs more frequently in men than women
paranoid PD
- distrust, suspicious of others
- interpret others motives as malevolent
- has to start early in adulthood, social and occupational dysfunction
• Theories
o Negative childhood experience in a threatening domestic atmosphere
o Coping mechanism
o Increases with schizophrenia in a member of the family
o Genetic factors. Twin studies show that genes contribute
o Maybe mild schizophrenia, very common in people with schizo in family
• Treatment
o Individual supportive psychotherapy is the choice treatment
o Medications sometimes used, anxiety, or anti psychotic medications to treat symptoms
o Antidepressants worsened the symptoms
o Offer friendly corteous approach
schizoid PD
- detachment from social relationships
- restrict range of affect
- form stable, but not close relationships
- reclusive
• Theories
o Fear of disappointment illness threatens their seclusion
o Possible links to asbergers, autism
o Undersocialized
• Treatment
o Psycho dynamically oriented therapies- build therapeutic relationship with client
o Cognitive behavioral therapy- cognitively restructure patients thoughts can enhance self insight
o Group therapy-socializing experience
o Offer quiet reassurance
schizotypal PD
- intense discomfort in ip relationships
- cognitive perceptual distortions
- eccentric behavior
- intense anxiety in social settings
- familiarity does not reduce anxiety
• Theories
o Patients may go on to meet schizophrenia
o Linked to schizophrenic spectrum disorders
o Stable course
• Treatment
o Neuroleptic and atypical antipsychotic drugs appear to reduce the odd thinking of, people with schizotypal personality disorder
avoidant PD
soc inhibition
-feelings of inadequacy
-hypersensitivity to negative evaluation
-fear rejection
-extreme social anxiety
• Theories
o Highly heritable, isorder specific effects are related to environmental factors
o History of caregiver hostility
• Treatment
Dependent PD
- excessive need to be taken care of
- submissive, clingy
- fear separation
- reluctant to disagree
- rely on others to make decisions
• Theories
o Authoritarian parenting, depression,
• Treatment
obsessive compulsive PD
preoccupation with details, rules, lists, organization, schedules
-perfectionistic
-rigid, stubborn, controlling
• Theories
• Treatment
Histrionic PD
Esscessive emotionality, attention seeking, dramatic over reactive, impressionable, shallowness
• Theories
o Want to merge with others via intense emotional interactions
o Poor decision makers
o Emotionality and attention seeking
o Lack of caregiver attention
• Treatment
o Calm firm reassurance, guidance
Narcissistic PD
Grandiosity, sense of superiority, need for admiration
Lack empathy
• Theories
o Hypersensitivity, aggression, overindulgent parenting styles
• Treatment
Borderline PD
Unstable relationships, avoid abandonment, poor self image, mood swings, impulsivity, substance abuse, sex, suicidalty
• Theories
o Linehans diathesis stress theory- difficulty controlling emotions, raised in invalidating family environment
o Reduction in serotonin
o Childhood trauma
o Biological/environmental
Treatment
- few controlled studies, dialectal behavior therapy, medications, antidepressants, mood stablizers antipsychotics
borderline personality features in non clinical adults, trull
Individuals with borderline features were more likely to have academic difficulties over the succeeding 2 years, and these participants were more likely to meet lifetime criteria for a mood disorder and to experience interpersonal dysfunction than their peers at the 2-year follow-up assessment. These findings indicate that BPD features are associated with poorer outcome even within a nonclinical population.
psychopathy
overlap with some features of antisocial personality, but not all
antisocial pd
- shows a long term pattern of irresponsible, impulsive, unscrupulous behavior beginning early in life
- most serious personality disorder from the view of public safety
- lack of anxiety, remorse, guilt
- genetic predisposition
gender diff in antisocial PD
more in men than women
causal factors for anitsocial personality
- genetic predisposition, testosterone on fetal brain development
- low levels of serotonin
- low levels of arousability
- harsh parenting, assumptions abut the world that promote aggressive responses
deficits linked to antisocial personality
- psychopaths have abnormally low levels of cortical arousal
- cerebral cortex is not fully developed
Sociocultural factors and antisocial personality
various features of impoverished homes
treatment for antisocial personality
Lithium, ssris,, and antipsychotic drugs may help control impulse behaviors
Few seek treatment on their own
Very poor prognosis
problems with PD diagnosis
Not stable over time, individuals with dif characteristics have same diagnosis, individuals with same characteristics receive dif diagnosis, no clear boundary with normality, most individuals diagnosed multiple mixed or atypical
Only fair agreement across methods
intrapersonal circumplex, PD
-alternate for the dsm-IV system of categorizing personality disorders
-more elaborate description of two big five traits, extroversion and aggreableness, 8 perosnality styles made up of blends of two basic dimensions- love/hate and dominance/submission.
5 factor model of personality
-Neuroticism
- extroversion
-oppenness
-aggreableness
-consiousness
unipolar depression
- people only experience the symptoms of depression…sad mood, loss of interest, disruption in sleep and appetite, motor retardation, loss of energy, guilt. Two categories: 1. Major depression: severe, acute
o 2. Dythmyic- less severe, more chronic form
dysthymia
- less severe pattern of depression, one has sad mood, lack of interest, and loss of pleasure in a milder form lasting for at least two years, a dysthymic person can still function reasonably well
double depression
Dysthymic disorder with occasional spike into episodes of major depression
Less likely to respond to treatments
Typically comorbid with substance abuse, eating disorders, anxiety disorders
subtypes of depression
• Melancholic features
o Prominent physiological symptoms
• Psychotic features
o Dellusions/hallucinations during an episode
• Catatonic features
o Complete lack of movement or excited agitation
• Postpartum onset
o When onset occurs within 4 weeks of childbirth
• Seasonal patterns
o SAD at least 2 years
premenstrual dysphoric disorder
Significant increase in distress symptoms prior to menstration
prevalence and prognosis of depression
- common, but differs across age gender and cross cultural differences
biological casual factors of depression
- first degree relatives of people with depression are 2-3 times more likely to get it
- genetics play a greater role for women than men
genetics
bipolar disorder genetic
neurotransmitters (depression)
o Imbalance of norepinephrine, serotonin, dopamine, may be important
depression;brain abnormalities
problems in frontal lobe, hippocampus, and other brain regions involved in mood
depressionneuroendocrine
o Hypothalamic-pituitary-adrenal axis, elevated levels of cortisol and CRH
depression, concordance rate
in bipolar depression can reach 80% in monozygotic twins
depression monoamines
Serotonin and norephinephrine are the most important in major depressive disorder
psychological causal factors

behavioral depression
o Life stressors create a reductionin positive reinforcers in a persons life. Person withdrawls, reinforcers further reduced, person withdrawls more and becomes depressed
learned helplessness
o A learned feeling of lack of control over ones life, especially stressors
o Unocontrollable negative event leads a person to believe they are helpless to control important outcomes in their environment, people lose motivation
negative cogitive triad
o Aaron becks neg. triad, negative view of self world and future
reformulated learned helplessness
o Focus on peoples causal attribution style
o Internal, stable, global
o Pessimistic attributions for most important events in life.
ruminative response styles theory
o Tendency to dwell on negative events, on why they occur and on feeling depressed
o Depression may be less likely in those who use a distracting style, which involves pursuing activities that help counteract a negative mood
o More likely in women
o Biased toward negative thinking in basic attention and memory processes
Sociocultural Causal Factors
depression
Historical changes put more recent generations at higher risk for depression than previous ones, rapid changes in social values and disintegration of family unit,
cohort effect
o People in one historical period are at different risk for a disorder than people born in another historic period.
o More recent generations more at risk for depression because of the rapid changes in social values that began in 1960’s and the disintegration of the family unit
gender differences, depression
women more than men
ethnicity, depression
hispanic, highest rates of depression
cross cultural studies
o Depression is lower in less industrialized and less modern countries.
rumination. distraction, depression
Women are more likely than men to ruminate
People focus on how they feel, and not the content of their thinking, just the process of thinking, without trying to do anything for them
biological treatments for depression
• Medications
o Ssris, snri, ndri, tricyclic antidepressants, maoi
o Mood stablilizers, lithium
• ECT
o Muscle relaxant followed by induced brain seizure
• Repetitive Transcranial Magnetic Stimulation
o Expose patients to repeated high intensity magnetic pulses, focused on particular brain structures, may change the functioning of neurotransmitters
• Vagus Nerve Stimulation
o Stimulate by a small electronic device much like a cardiac pacemaker which is surgically implanted under a patients skin in left chest, may increase activity in the hypothalamus and amygdala
• Deep brain stimulation
o Increases the activity of the basal ganglia
o Stimuatlion can be altered by the clients reactions in the treatment
light therapy
o Expose individual to bright light, may reset circadian rhythms
ssris
Work directly to affect serotonin than tryciclics
Less severe side effects
Helpful with anxiety, binge eating and premenstrual symptoms
Snris
Affects norepinephrine
Buproprion
Affects the norephinephrine and dopamine systems, may be especially useful in people suffering from psychomotor retardation anhedonia, hypersomnia cognitive slowing, inattention, and craving. Helps stop cigarete cravings
Tricyclic Antidepressants
Reduce symptoms of depression by preventing the reuptake of norepinephrine and serotonin in the synapses or by changing the responsiveness of the receptors for these neurotransmitters
mao inhibitors
Side effects more than tricyclics, food interactions,
Psychological Treatments

• Behavioral therapy
a. Connections between specific circumstances and depressed persons symptoms
b. Identificaltion of symptoms
c. Techniques for changing their negative circumstances
d. Increased positive reinforcers and decrease aversive events by teaching the new skills for managing interpersonal situations and the environment and engaging in pleasant activities
cognitive behavioral therapy
a. Brief time limited
b. Discover negative automatic thoughts
c. Helps clients recognize deeper beliefs that are feeding the assumption
d. Challenges disorted thinking and helps the person learn more adaptive ways of thinking and new behavioral skills
interpersonal thoery
a. Four types of problems are looked for
i. Grief, interpersonal role disputes, role transitions, deficits in interpersonal skills
ii. Helps the person change dysfunctional relationship patterns
drug v psychotherapy
Longterm psychodynamic therapies have not proven very effective in the treatment of depression
They are equally effective
bipolar disorder
- alternating appearance of two emotional extremes, or poles, one extreme is depression, the other is mania, which is agitated, usually elated emotional state
mania
-Agitated elated emotional state
- extreme optimism, boundless energy, delusions, racing ideas, irritablilty and impulsiveness
hypomania
- not severe enough interfere with daily functioning
- md episodes
bipolar 1
- manic depression, episodes of mania alternate with deep depression
bipolar II
- milder form and consists of major depressive episodes alternating with less severe hypomanic episodes
cyclothymia
- Pattern of milder mood swings
- Less severe pattern of bipolar disorder
- Episodes of hypomania and moderate depression
- Chronically over at least two years
rapid cycling bipolar disorder
- 4+ cycles of mania/depression within one year
bipolar and creativity
Relatives of people with bipolar disorder were more creative than those without any relatives with bipolar disorder
Causal factors in bipolar disorders
• Genetic evidence
o Seems to run in families, not very clear what role it plays thoughb
Causal factors in bipolar disorders• Brain abnormalities
o Amygdala, PFC, striatum (basal ganglia) white matter in PFC
o NT Factors-monamines, disrgetualation of dopamine system
Causal factors in bipolar disorders
• Psychosocial contributors
o Greater sensitivity to reward
o Stress as a trigger
o Changes in sleep/eating patterns that lead to relapse
Treatment for BPD
• The role of psychotherapy
• Medications
Lithium – effectiveness and negative effects
Treatment of choice for bipolar disorder, effective in preventing relapses, curbs mania
Side effects are pain, nausea, vomiting, diarrhea, tremors, and twitches
Anticonvulsants and atypical antipsychotics
Alternatives to lithium for the treatment of mania
Reduces symptoms of mania, but unknown longterm effects
Interpersonal and social rhythm therapy
- enhancement of interpersonal therapy specifically for bipolar patients
schizo

Positive, Type I, Reactive Symptoms
• Delusions
persecutory, reference, grandiose, thought control
o False beliefs of persecution are common, cia is tapping my phone
o Ideas of reference- delusions that everything is somehow related to oneself- radio static is sending messages to me
o Grandiose- I am gods personal messenger
o Thought control, ones thoughts are heart by others, or they can steal ones thoughts, and that others thoughts appear in their mind
schizo, hallucination
o False perceptions of nonexistent sensations
o Usually auditory in voices
catatonia
o Disorder of movement
o Person alternates between total immobility or stupor and wild excitement
o Waxy flexibility
o They wont initiate movement on their own
• Disorganized speech – neologisms, word salad
- neologisms are new words, only meaningful to the speaker
- word salad- verbal expression of a jumble of unconnected thoughts
Negative, Type II, Process Symptoms
• Affective flattening


• Alogia


• Avolition
]
• Affective flattening
o Showing little or no emotion
o If they do display emotion its inappropriately

• Alogia
o Loss of words or notable lack of spontaneity or responsiveness in conversation

• Avolition
o Lack of initiative and unwillingness to act
DSM-IV Types of Schiz.
• Paranoid
o Delusions of persecution, or grandeur are accompanied by anxiety, anger, argumentativeness, or jealousy
o Signs of impairment may be subtle
• Disorganized
o Jumbled and unrelated delusions and hallucinations, incoherent speech, inappropriate affect, and neglected personal hygiene
• Catatonic
o Disorder of movement
o Person alternates between immobility or stupor and wild excitement
• Undifferentiated
o Abnormal behavior, thought and emotion not placed in any other subtype
• Residual
o Have experienced prior schizophrenic episode but are not currently displaying sympotms
• Prognosis of schizophrenia
o 40% of those with schizophrenia improve with treatment and are able to function reasonably well.
• Gender and age factors
o 1-2 % of the population, and equal among men and women
o tends to strike in adolescence or early adulthood
• Sociocultural factors
o Not considered primary causes of schizo but they may contribute to the appearance of schizophrenia and influence its course
• Prodromal symptoms
o Prior to the active phase where individual shows progressive deterioration in social and interpersonal functioning
o Social withdrawal, inability to work productively, eccentricity, poor groming, innapropriate emotionality, peculiar thought and speech, unusual beliefs, odd perceptual experiences and decreased energy and initiative
o Usually followed by a residual phase
• Schizoaffective Disorder
o People who experience either a major depressive episode, a manic episode or a mixed episode at the same time that they meet diagnosis for schizophrenia
o At least two weeks where the person doesn’t have prominent mood symptoms but continues to have psychotic symptoms such as hallucinations or delusions
• Schizophreniform Disorder
o Takes the form of schizophrenia but is somehow different
o Psychotic symptoms that are essentially the same as those found in schizophrenia, except for durating
o Last long than those of brief psychotic disorder but not long enough to be schizo
o 1-6 months
o at least two: delusions, hallucinations, disorganized speech, disturbed behavior, negative symptoms
• Brief psychotic disorder
o At least one day but less than one month
o Sudden onset of psychotic cymptoms that lasts less than one month
o Often appear after a stressful event
o Eventually return to normal functioning
• Delusional Disorder
o People have a single striking psychotic symptom, an organized stystem of non bizarre false beliefs
o Delusions are systematic and prominent but lack the bizarre quality commonly found in schizophrenia
o Functioning not impaired
• Shared Psychotic Disorder
o One or more people develop a delusional system as a result of a close relationship with a delusional person