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84 Cards in this Set
- Front
- Back
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Diagnostic Criteria for Substance Abuse
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-Maladaptive pattern of use leading to impairment or distress and 1+ of following:
-Recurrent substance use resulting in failure to fulfill major role obligations -use that is physically hazardous -substance-related legal probs -continued use despite interpersonal probs -Never met criteria for dependence |
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Diagnostic criteria for Substance Dependence
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-Maladaptive pattern of abuse leading to impairment or distress as manifested by 3+ of symptoms within 12-mo.period
-Tolerance (Need for more, diminished effect with same amount) -Withdrawal (relief comes by taking same substance) -Larger amounts over longer period of time than intended -Persistent desire or unsuccessful efforts to cut down -Activities given up -Continued use despite physical or psychological problems |
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Diagnostic Criteria for Alcohol Intoxication
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A. Recurrent ingestion of alcohol
B. Significant maladaptive behavioral or psychological changes -Inappropriate sexual behavior, aggression, mood instability, impaired judgment C.1+ shortly after ingestion (slurred speech, uncoordinated, unsteady gait, nystagmus, impairment in attention or memory, stupor or coma D. Not better accounted for by condition or mental disorder |
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Diagnostic Criteria for Alcohol Withdrawal
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A. Alcohol use that is heavy and prolonged
B. 2+ after cessation: -Increased hand tremor, insomnia, nausea, hallucinations, psycho-motor agitation, anxiety C. Significant distress or impairment D. Not better accounted for |
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Short-term negative physical and social effects of alcohol abuse
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-25,000 highway deaths per year
-Industrial, public accidents -Over 1/2 of murders involve alcohol -Child + Spouse abuse -1/2 of suicides involve alcohol -Fetal-alcohol syndrome |
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Long-term negative physical and social effects of alcohol abuse
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-Increased risk of heart disease
-Risk of throat and stomach cancer -Cirrhosis of liver -Amnestic disorder -Depression -Marital breakup -Loss of job and school failure |
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Genetic factors in alcohol abuse
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-Twin and adopted away studies indicate genetic components
-Twin studies show inheritance in males -Adopted SOMAs 4X as likely to be alcoholic as adopted nonSOMAs -polygenetic |
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Cloninger's Type I alcoholics
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-later onset
-more likely to be triggered by specific event -more environmental influence -equal number of males and females |
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Cloninger's Type II alcoholics
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-early onset
-physical problems -much larger heritability -associated with antisocial acts -more likely to be aggressive -much more common in males |
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Advantages of the disease model of alcoholism
(Asserts that alcoholism is caused by physiological defect similar to diabetes...Alternate model characterizes alcoholism as a character flaw) |
-Brought problem to public awareness
-Got funding to study alcoholism -Removes stigma -Got treatment developed and funded |
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Disadvantages of Disease Model
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-Reduces addict's accountability
-Removes incentive to abstain -Places addict in victim role -Inconsistent with data that say "controlled" use may be achieved -Self-fulfilling prophesy |
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Drugs used in treatment of alcohol abuse and their effectiveness
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-Benzodiazapines
-Antabuse |
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Method of action of cocaine dependence in the brain
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-use dopamine agonists that flood synapses with DA and overshadow normal rewarding activities
-attempt to restore homeostasis -down-regulating DA receptors on post-synaptic neurons -upregulating MAO -lower levels of DA in synapses during "non-use" periods -craving for more of the dopamine-agonist substance |
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Diagnostic criteria for General Personality Disorder
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-Inflexible and pervasive across a broad range of personal and social situations
-Distress or impairment -Pattern is stable and of long duration and can be traced back to childhood -Not better accounted for by an Axis I disorder or medical conditions |
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Diagnostic criteria for Schizotypal Personality Disorder
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A. Pattern of social and interpersonal deficits, reduced capacity for close relationships, cognitive or perceptual distortions, eccentric behavior beginning and early adulthood indicated by 5+ of:
-Ideas of reference -Odd beliefs or magical thinking -Stereotyped speech -Suspiciousness -Lack of close friends B. Not during course of schizophrenia |
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Diagnostic Criteria for Schizoid Personality Disorder
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A. Pattern of detachment from social relationships and restricted range of emotions in interpersonal settings beginning in early adulthood and indicated by 4+ of:
-Solitary activities -Little interest in sex -Little pleasure in activities -Lack of friends -Indifference B. Does not occur within schizophrenia |
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Diagnostic criteria for Paranoid Personality Disorder
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A. Pattern of distrust and suspiciousness, motives are interpreted as malevolent beginning in early adulthood and indicated by 4+
-Suspects, without any basis, that others are exploiting, deceiving, or harming -Preoccupied with doubts about loyalty of friends -Won't confide in others -Reads meanings into benign remarks or events -Bears a grudge B. Does not occur in schizo |
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Diagnostic criteria for Histrionic Personality Disorder
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A. Pattern of excessive emotionality and attention seeking, beginning in early adulthood and indicated by 5+ of:
-uncomfortable in situations where not center of attention -Interactions with others with inappropriate sexual behavior -Rapidly shifting and shallow expression of emotions -Use physical appearance to draw attention to self -Speech lacks in detail |
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Diagnostic criteria for Narcissistic Personality Disorder
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A. Pattern of grandiosity, need for admiration, and lack of empathy, beginning in early adulthood and indicated by 5+
-Grandiose sense of self importance -Preoccupied with fantasies of success -Believes they are special and should only affiliate with high-status people -Requires excessive admiration -Sense of entitlement -Takes advantage of others -Lacks empathy |
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Diagnostic criteria for Avoidant Personality Disorder
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A. Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning in early adulthood and indicated by 4+ of:
-Avoids occupations that involve social contact for fear of rejection or criticism -Unwilling to get involved with people unless certain will be liked -Restraint in close relationships -Preoccupied with being criticized or rejected -Views self as socially inept or inferior |
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Diagnostic criteria for Dependent Personality Disorder
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A. Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning in early adulthood
-Difficulty making everyday decisions without excessive advice -Needs others to assume responsibility -Difficulty expressing disagreement -Difficulty initiating projects or doing things on own -volunteers to do unpleasant tasks to obtain support -uncomfortable or helpless when alone |
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Diagnostic criteria for Obsessive-Compulsive Personality Disorder
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A. Pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency, beginning in early adulthood and indicated by 4+ of:
-Preoccupied with details, rules, lists and order to the extent that the point of the activity is lost -Shows perfectionism that interferes with task completion -Excessively devoted to work -Unable to discard worthless objects -Rigid and stubborn |
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Diagnostic criteria for Borderline Personality Disorder
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A. Pattern of instability of interpersonal relationships, self-image, and affect, and marked impulsivity beginning by early adulthood and present in a variety of contexts as indicated by 5+ of:
-Paranoid ideas -Relationships instability -Angry outbursts -Impulsive behavior -Suicidal behavior -Emptiness |
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Criteria for Antisocial Personality Disorder
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-Pattern of disregard for and violation of the rights of others since the age of 15 indicated by 3+ of:
C - cannot follow law O - obligations ignored R - remorselessness R - recklessness U - underhandedness P - planning deficit T - temper B. At least 18 yrs old' C. Conduct disorder before 15 D. Not schizo or manic episoide |
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Three Clusters of Personality Disorders
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-Cluster A: Odd/Eccentric
(Schizotypal, Schizoid, Paranoid) -Cluster B: Dramatic/Erratic (Histrionic, Narcissistic, Borderline, Antisocial) -Cluster C: Anxious/Fearful (Avoidant, Dependent, Obsessive-Compulsive) |
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Overlap between Antisocial Personality Disorder and Psychopathy
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A. Interpersonal & Affective Traits lifestyle
-Glibness, grandiose sense of self-worth, need for stimulation, pathological lying, cunning/manipulatie, lack of remorse guilt, shallow affects, lack of empathy B. Unstable and Antisocial -Parasitic lifestyle, poor behavioral controls, promiscuous, early behavioral probs, lack of realistic goals, impulsive, irresponsible, delinquency |
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Biological factors associated with ASP/psychopathy
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-Genetics
-Serotonin hypothesis -Testosterone hypothesis -Low cortical arousal hypothesis -Avoidance learning deficit hypothesis |
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Risk factors associated with ASPD/psychopathy
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-low SES in urban setting
-male -parent with ASPD -early childhood aggressive -childhood abuse or neglect -unstable or erratic parenting -inconsistent discipline |
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Treatment for ASPD/psychopathy
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-Insight oriented treatment not effect
-SSRI's for impulsiveness and aggressiveness -Enforced incarceration best therapy -As of now, therapy not effective |
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Causes of borderline personality disorder
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Childhood trauma
+ Predisposing temperamental traits + Current life stressor = BPD |
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Treatment of BPD
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A. Drugs (although not primary)
-SSRIs or tricyclics -Lose-dose neuroleptics -Naltrexone B. CBT or Dialectical Behavioral Therapy |
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Dialectical behavioral therapy
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-Combines CBT, Rogerian acceptance, and Zen
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Insanity Defense (NGRI)
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-Not guilty by reason of insanity
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M'Naughten rule
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-Defendent did not know right from wrong at time of act
-based on English law -"right/wrong test," "knowledge test," "cognitive test" |
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Guilty but mentally ill (GMI)
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-Example...Jeffrey Dahmer
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Competency to stand trial
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-Person must have rational and factual understanding of the proceedings against him
-Person must have sufficient present ability to consult with lawyer rationally -More people committed for incompetency than found NGRI -consequences for being found incompetent |
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Involuntary civil commitment and what conditions warrant it
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-Danger to self
-Danger to others -Unable to provide basic own needs |
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Mnemonics for Paranoid personality disorder
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S - spouse is cheating suspected
U - unforgiving - bears grudges S - suspicious (of others) P - perceives attacks (and reacts quickly) E - enemy in everyone - suspects associates, friends C - confiding in others feared T - threats seen in benign events |
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Mnemonics Schizoid personality disorder
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S – shows emotional coldness
O – omits close relationships L – lacks close friends or confidants I – involved in solitary activities T – takes pleasure in few activities A – appears indifferent to praise or criticism R – restricted interest in sexual experiences Y – yanks himself from social relationships |
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Mnemonics Schizotypal personality disorder
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P - paranoid ideation
E - experiences unusual perceptions C - constricted affect U - unusual thinking & speech L - lacks friends I - ideas of reference A - anxiety (socially) R - rule out psychotic disorders & pervasive developmental disorder M - magical thinking that influences behavior, superstitiousness or the paranormal E - eccentric behavior or appearance |
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Mnemonics Antisocial personality disorder
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C - cannot follow law
O - obligations ignored R - remorselessness R - recklessness U - underhandedness P - planning deficit T - temper |
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Mnemonics Borderline personality disorder
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I - Identity disturbance
D - Dysregulated emotion E - Emptiness S - Suicidal behaviour P - Paranoid ideation A - Abandonment I - Impulsivity R - Relationships - unstable R - Rage |
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Mnemonics Histrionic personality disorder
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P - provocative (or seductive) behavior
R - relationships, considered more intimate than they are A - attention, must be at center of I - influenced easily S - speech (style) - wants to impress, lacks detail E - emotional lability, shallowness M - make-up - physical appearance used to draw attention to self E - exaggerated emotions - theatrical |
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Mnemonics Narcissistic personality disorder
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R - requires excessive admiration
E - entitlement G - grandiose self-importance A - arrogant affect L - lacks empathy S - “special” -only be understood by other special people T - takes advantage E - envious or believes others are envious of him or her P - preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love |
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Mnemonics Avoidant personality disorder
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A – Avoids occupational activities
V – Views self as socially inept O – Occupied with being criticized or rejected I – Inhibited in new interpersonal situations D – Declines to get involved with people E – Embarrassed by engaging in new activities R – Refrains from intimate relationships |
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Mnemonics Dependent personality disorder
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D – Difficulty making everyday decisions
E – Excessive lengths to obtain nurturance and support from others P – Preoccupied with fears of being left to take care of self E – Exaggerated fears of being unable to care for himself or herself N – Needs others to assume responsibility for his or her life D – Difficulty expressing disagreement with others E – End of a close relationship is the beginning of another relationship N – Noticeable difficulties in initiating projects or doing things on his or her own T – “Take care of me” is his or her motto |
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Mnemonics Obsessive-compulsive personality disorder
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L – Loses point of activity (due to preoccupation with detail)
A – Ability to complete tasks (compromised by perfectionism) W – Worthless objects (unable to discard) F – Friendships (and leisure activities) excluded (due to a preoccupation with work) I – Inflexible, overconscientious (on ethics, values, or morality, not accounted for by religion or culture) R – Reluctant to delegate (unless others submit to exact guidelines) M – Miserly (toward self and others) S – Stubbornness (and rigidity) |
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Panic disorder and treatment
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A.Unexpected panic attacks
B.At least 1 has been followed by 1 (+) mo. of either: -concern of having another attack -worry about implications -change in behavior -not due to drugs or med. con. C. Treatment: -Xanax, CBT |
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Social phobia and treatment
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-Fear of performance in social situations where person feels they may be judged
-exposure to feared situation results in anxiety response -person realizes fear is excessive -interferes with normal routine Treatment: SSRIs, betablockers, benzos, CBT, exposure |
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Agoraphobia and treatment
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-Anxiety about being in places or situations from which escape might be difficult
-situations are avoided or endured w/ distress -not better accounted for |
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OCD and treatment
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A. Must have either obsessions or compulsions
B. Recognizes that it is unreasonable C. Cause marked distress and are time-consuming D. Not better accounted for or due to a substance -Treatment: SSRIs, Anafranil, ERP |
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Specific phobias and treatment
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-Fear that is excessive or unreasonable, cued by presence or anticipation of a specific object or situation
-Exposure to phobic stimulus provokes anxiety response -Recognizes that fear is excessive -Phobic situation is avoided or causes distress -Interferes with routine -Treatment: Benzos, SSRIs and imipramine effective but could relapse, CBT |
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PTSD and treatment
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A. Exposure to trauma
B. Re-experiencing symptoms (1+) -Intrusive recollections -Distressing dreams -Reliving the experience -Psychological distress C. Avoidance/Numbing symptoms (3+) -Efforts to avoid distressing thoughts -Avoidance of activities that arouse recollections -Inability to recall an important aspect of the trauma -Diminished interested in activities -Feeling of detachment from orthers D. Arousal symptoms (2+) -Difficulty sleeping -Irritable -Difficulty concentrating -Startled easily E. Duration longer than 1 mo. F. Distress and impairment Treatment: CBT, skills training and management, exposure, SSRIs, benzos, betas, cross cultural considerations |
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Effectiveness of Benzodiazepines
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Work quickly, safe when used properly, good patient tolerance
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Risks of benzodiazepines
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Dependence, abuse, withdrawal, wakefulness, attention and memory problems, cognition problems, possible mild cognitive decline long-term
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Major depressive disorder
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-presence of 1 or more depressive episodes
-No history of mania or hypomania -Treatment: CBT, Interpersonal therapy (IPT), tricyclics, MAOIs, SSRIs, ECT |
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Bipolar I Disorder
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-At least 1 manic or mixed episode, but there may be episodes of hypomania or manic depression
-classic concept of Manic depressive illness |
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Bipolar II
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-NEITHER a manic nor a mixed episode but does require at least 1 episode of hypomania in addition to an episode of major depression
-Treatment: Lithium, Depakote, Tegretol, Haldol, Anti-D's, CBT, |
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Schizophrenia
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A. Active phase symptoms (2+)
for 1 month -Delusions -Hallucinations -Disorganized speech -Disorganized or catatonic behavior -Negative symptoms B. Impairment -Below normal functioning C. Must be present at least 6 months |
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Positive symptoms
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-Delusions
-Hallucinations -Disorganized speech -Grossly disorganized or catatonic behavior |
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Negative symptoms
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-Avolition: Inability to initiate goal-directed activities
-Alogia: Reduction in content of speech -Flat affect: Emotions absent -Anhedonia: Inability to experience pleasure -Asociality: Social isolation |
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Risk factors for schizophrenia
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-Genetic predisposition
-Obstetric complications -Flue hypothesis -Winter birth hypothesis -Brain abnormalities -Vulnerable to stress |
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Protective factors for schizophrenia
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-Family history of mood disorder
-Good premorbid adjustment -acute onset -higher IQ -late age of onset -absence of brain abnormalities -married -paranoid subtype -positie symptoms |
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Risk factors for relapse in schizophrenia
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-Substance abuse
-Urban setting -lower IQ -industrialized nation -low SES -high family EE |
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Expressed Emotion
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-Certain negative attitudes expressed toward the mentally ill person by family members with whom the ill person live with
-Criticism (disapproval) -Hostility (animosity) -Emotional overinvolvement (intrusiveness) |
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Treatment for schizophrenia
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-Overall goals to decrease frequency and severity of episodes and to maximize functioning between episodes
-family therapy and education (psychotherapy=bad) -Self-managements -Drugs (antipsychotics) |
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Conventional antipsychotics
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-Haldol, Thorzine, Prlixin
-Side effects: sedation, tremors, dry mouth, weight gain -Depot: injected, time released |
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Atypical antipsychotics
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-Clozaril, Risperdal, Zyprexa
-Advantages: Little side-effects, works well -Disadvantages: Expensive, reduced white blood cell count, dose-related seizures |
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CBT treatments for schizophrenia
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-Psychosocial therapy (symptom management, support, skills training, relapse prevention)
-Social (relapse prevention, re-assimilation, family training, EE reduction) |
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Token Economy for schizophrenia
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work really well for schizophrenia
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Diagnostic criteria for Dissociative Amnesia
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-1+ episodes of inability to recall important personal info, usually of a traumatic nature, that cannot be explained for normal forgetfulness
-does not occur in other disorder -distress and impairment |
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Dissociative fugue
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-Sudden, unexpected travel away from one's home or one's customary place of work, with inability to recall one's past
-confusion about identity or assumption of a new one -not due to other disorder -distress and impairment |
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Depersonalization
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-recurrent experiences of feeling detached from one's mental processes or body
-reality testing remains intact -distress or impairment -not during course of another disorder |
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Dissociative Identity Disorder
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-Presence of 2+ distinct personalities or identities
-at least 2 take control -inability to recall important personal info -not due to another disorder or substance |
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Classical case of DID
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-Host personality plus 2 fully developed personalities
-Each personality has unique memories and behavior patterns -Alters may be more aggressive or sexual -sudden switching -alters aware of one another but host not -lost time -personalities may differ biologically, intellectually, talents |
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Debate over legitimacy of DID
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1. Recovered memories versus false memories
2. Severe childhood trauma produces a mental splitting but DID can be suggested to patient or by media and is socially rewarding |
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Diagnostic criteria for Anorexia
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A. Refusal to maintain body weight at or above a minimally normal weight or failure to make expected weight gain
B. Intense fear of weight gain or becoming fat C. Disturbance of body image D. No period |
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Subtypes of anorexia
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-binge-eating/purging
-Restricting |
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Treatment for anorexia
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-Inpatient treatment
-SSRIs -first goal to promote weight gain -cognitive therapy -family therapy -group therapy |
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Bulimia
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A.Recurrent episodes of binge-eating characterized by:
-Eating a large amount of food in a two hour period -Sense of lack of control over eating B. Recurrent inappropriate compensatory behavior in order to prevent weight gain: -Vomiting -Laxitives -Fasting -Excessive exercise C. Occurs at least 2x a week for 3months D. Self-eval is always influenced by weight or body E. Does not occur during anorexic episode |
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Subtypes of Bulimia
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-Purging type
-Non-purging type |
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Treatment of Bulimia
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-Multimodal: Behavioral, cognitive, group therapy
-SSRI's |
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Social/cultural factors associated with eating disorders
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-Intense emphasis on thinness in females in Western society
-steady decrease in BMI in celebrities -Barbies -peer pressure |
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Individual risk factors associated with eating disorders
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Family factors:
-typical anorexic family -successful, hard-driving, concerned about appearances -family deny or ignore conflicts -attribute problems externally -mothers as society's messengers Personality factors: -low self esteem -perfectionism -neuroticism -eating disorders in fam -overweight as child -obesity in fam -sexually abused as child |
