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27 Cards in this Set

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Do minority patients w/ eating disorders require modification of existing treatment protocols, which were developed for white patients?
According to the study by Grange, minority patients with eating disorders do not require any modifications of the protocols that already exist for treatment. They did not find any significant results on the demographics in their study (marital status, employment status, or educational level) between white and minorities. The white and minority subjects also reported similar psychotic symptoms. 60% of white and minority participants reported recieving treatment from a mental health professional in the past and 5% of minorities and 10% of whites reported being hospitalized for tx of eating disorders. Only significant differnece was between BN minorities purging at an earlier age.
Breifly identify the main findings of the NIMH Epidemiologic Catchment Area Study of somatization and psychiatric disorder?
Somatization symptoms was a weak association that accounts with alcohol abuse and antisocial personality, but there is a strong association with symptoms of panic disorder. They also found a strong relationship between somatization and severe psychiatric disturbances instead of specific association with psychosis. They also found high rates of depression of depression with somatic patients than they did with anxiety. Somatization groups also showed a high prevalence of social phobia.
What are the implications of the findings for the care of somatizing patients?
This implies that somtisizing patients should be treated with strategies foucsed on reducing underlying symptom sensitivity because they get offended if you tell them that they do not have these symptoms which could be done with cognitive behavioral treatment.
What were the three principal goals of the Fabrega study?
1. To determine whether statistical associations between diagnosis and ethnicity in our elderly patients could be better explained by taking into consideration related sociodemographic differences. 2. To analyze the relationship between ethnicity and descriptive manisfestations of psychopathology in elderly patients. 3. To clarify the role of ethnicity on the response to inpatient psychiatric treatment.
What measures of SES did they use to separate the effects of this variable from ethinicity in their data analysis?
The ethnic differences they reported in admitting diagnosis and responses to treatment were that blacks when compared to whites were significantly more likely to receive a diagnosis of one of the DSM-II R and less likely to recieve a primary diagnosis of one of the DSM-IIIR mood disorders. Blacks also appear to derive signifcant benefits from acute hospitalization, the evidence suggest that they may leave the hospital with greater and more rapid improvement than whites.
Do you think that this was adequate control for SES?
They used level of education to measure social difference and social class. I dont think this was an adequate control of SES because the level of education really has nothing to do with individuals SES. There are several individuals out there that have a very high SES and never completed college. Likewise there are several individuals out there that have very low SES and have completed college. The amount of education an individual completes is more liekly fo to a persons motivation. If a person is making a sufficient amount of money at their job then they may not continue their education.
What differences fif Jeste (1996) find for their study variables of ethnicity?
They did not find any significant ethinic differences in the development of tardive dyskinesia because there was a relatively small number of blacks in the study. Although there was no significant differences blacks did show higher rates of tardive dyskinesia. The results show that 48% of black and 26% of white had an incidence. They also found that blacks had a lower risj of neuroleptic-induced parkinsonism.
What differences did Jeste (1996) find for their study of gender?
There where no significant gender differences found in the incidence of tardive dyskensia, but the annual incidence was slightly lower amoing women (21%) than men (26%).
What can you say about the differences in the Jeste (1996) study about ethnicity and gender?
After a review of the research it is evident that past research on gender and ethnic differences of schizophrenia may be biased due to the fact that women patients were often given highers doses of medication. This study found no gender or ethnic differences. Therefore, one could conclude from this study that schizophrenia is equally common among races and genders.
According to Kawanishi (1992), in what ways do defective therapeutic relationships contribute to the view Asian patients tend to somatize their emotional distress?
Racial stereotyping- Therapists tend to have stereotypic responses of minorities and may predispose giving a minority a diagnositic label. If client see this label it may hinder therapy; Western Psychotherapy- Society tends to use psychoanalysis and this may not be congruent with some minority groups because they do not use language and emotions to describe themselves and this may hinder therapy
Explain the term "Facultative Somatization"?
Patients who presented with at least one somatic symptom and no psychosocial symptoms intially, but later accepted "nerve" or worries as a possible factor when prompted. It can also be interpreted as those who present somatic distress as a main problem in some situations and not others.
Discuss the implications of facultative somatization for the therapist working with Asian clients?
The first implication is that researchers have an enormous difficulty where cross-cultural research is concerned. Methodology and researchers personal attitude must be taken into account more than in the past. Asians might be more expressive in other contexts (friends) than they are with the therapist. Somatization may only be a situational and superficial disguise for Asian patients.
Explain the Diathesis Stress Model?
A theory that stipulates that behavior is a result of both genetic and biological factors ("nature"), and life experiences ("nurture"). According to this model, mental disorders are produced by the interaction of some vulnerability characteristic, or predisposition, and a precipitating event in the environment.
Describe the development of a disorder in terms of the Diathesis Stress Model?
Current research proposes that schizophrenia is caused by a genetic vulnerability coupled with environmental and psychosocial stressors, the diathesis-stress model. Family studies suggest that people have varying levels of inherited genetic vulnerability, from very low to very high, to schizophrenia. Whether or not the person develops schizophrenia is partly determined by this vulnerability. At the same time, the development of schizophrenia also depends on the amount and types of stresses the person experiences over time. How the interaction works in schizophrenia is unknown, yet the subject of ongoing research.
Explain the Transactional Model?
Defined as risk factors within a given level that can influence outcomes and processes surrounding ecological levels. Ongoing transactions determine the amount of risk, both biological and psychosocial, that a person may face. Stressful events affect this model and the person with the disorder.
Describe the 6 functions of a classification system outlined by Blasfield and Livesly.
• P: To provide prediction which allows for clinicians to know that patients each respond differently to treatment.
• O: To provide organization and structure information so it can be easily retrieved so the clinician can understand the diagnostic concept to get etiology and treatment.
• N: To provide nomenclature to facilitate description and communication by defining the mental disorder.
• D: To provide descriptions of common patterns of symptom presentation and then to change accounts of individuals into principles and generalizations.
• D: To provide a basis of development of theories that gives a systematic description of phenomena.
• S: To provide sociopolitical functions that directly impact health/social politics, forensic decisions, and economics of mental health.
Describe three components of contemporary classification. Identify these and describe briefly what goes into each component.
• F: Formal Component is concerned with the theoretical principles of implicitly and explicitly when creating a classification. Focus on the organizing principles; the hierarchal structure; the format use to define; and the formal procedures used to create and classify system.
• E: Evaluative Component refers to the criteria that should be used to asses the utility of a classification for clinical and research purposes. These include reliability, coverage, diagnostic overlap, and validity.
• S: Substantive Component describes the domain of mental disorders by defining what a mental disorders is; by identifying diagnoses; by formulating diagnostic criteria; and by organizing diagnosis into groups.
Define polythetic and monothetic criteria.
• Polythetic- Defined by the large number of attributes and each member of the category possess some but not all of these attributes.
• Monothetic- Defined by a set of features that are jointly necessary and sufficient for diagnosis.
What is the tradeoff in choosing between these monothetic and polythetic for a category within a diagnostic system?
• Tradeoff- The polythetic approach allows for more heterogeneity by allowing for a greater number of differences within in one particular disorder, but this also allows for more overlap. The monothetic approach allows for more focus on specific features that are sufficient for a certain diagnosis, but this leads for a vast amount of disorders
Describe briefly the advantages and disadvantages of categorical systems?
• Categorical- Is set in terms of criteria that are discrete and mutually exclusive.
o Advantage- Familiar concepts make it easy. This is the mode we typically think in which we fit people into categories.
o Disadvantage- Most cases have multiple issues (comorbidity) and there is a loss of information associated with this system
Describe briefly the advantages and disadvantages of dimensional classification systems?
Dimensional-View that function is based along a series of different dimensions.
o Advantage- Always noted on continuum without assuming boundaries between disorders. There are no normal or pathological types of disorders.
o Disadvantage- There is so many dimensions making it difficult to determine various diagnoses for people, making it less user friendly.
Explain how prototypes and ideal types fit in these systems.
Prototypes- Provides the best examples that seem to fit into a categorical system.

Ideal Types- Provide the framework to guide clinical questioning, to organize, and to understand individual cases.
Why is it important to consider personality factors to understand the development of Axis I disorders?
• It is important to consider because Axis II disorders can affect the development of an Axis I disorder by exacerbating the symptoms of that particular disorder. So it is important to be aware of any underlying possible Axis II disorders that may help account for the symptomatology. Models= CVS PM
Identify and describe the models that have been used to characterize the developmental relationship between personality and depression.
• C: Complication Model is a scar model that Axis I and II interweave and thus complicates the clinical status of the other. Therefore the second disorder is effectively a scar that may be seen if the first disorder diminishes.
• V: Vulnerability Model is a diathesis model in which Axis II disorders create a situation in which an individual is more vulnerable to an Axis I disorder.
• S: Spectrum Model is a biological model that has biological based traits acting as a third variable that inhibits the development of more stable characteristics. Allowing Axis I and II to develop together not apart, making it more pathological.
• P: Pathoplasty Model has Axis I and II disorders influencing the course and status of each other, but it doesn’t mean that if someone has an Axis II that they will develop and Axis I disorder.
• M: Mediational Model is a cognitive model in which symptoms from Axis II act as an intervening variable to an Axis I disorder
Kirk and Kutchins (1993) suggest that reliability was more the tool than outcome in a struggle between what two groups in the development of DSM-III?
• The struggle was between the supporters of Freud and Kraepelin. Freudian supporters were more concerned with etiological parts of mental disorders, while Kraepelin supporters wanted to classify and categorize disorders. His approach helped remedy the difficulties the psychiatric profession was having in dealing with the unreliability of psychiatric diagnoses. The unreliability created self-doubt and vulnerability to public and scientific criticism. A turning point appeared with the controversy of the psychiatric status of homosexuality as a diagnosis. To avoid similar disputes, research psychiatrists headed by the DSM-III task force presented the DSM-II as a solution to the problem of psychiatry. It marked the transition from psychoanalytic to scientific based psychiatry.
Describe 4 reasons given by W & J (1997) for the variation of psychiatric symptoms and signs across cultures. Is variation or similarity the rule in signs and symptoms across cultures?
• Signs and symptoms may be under or over-reported in a culture due to their taboo or valued status. For example, in Korean cultures there would be an under-reporting due to seeing mental illness as weakness of the family and they attempt to keep it quite.
• Interpersonal styles or customs prescribed by a culture influence the manner of communication (direct/indirect, passive/assertive, egalitarian/hierarchical). For example, using different terminology and presentation when talking to peers about issues relating to sex/drugs as opposed to talking to clinicians.
• Historical changes within a society may later psychopathological expression over time thus leading to either increase/decrease certain signs and symptoms. For example, a decrease seen of la belle indifference and catatonia, while increase of bulimia and substance abuse.
• The difference in cultural definitions and prevalence. The values, beliefs, and mores that may cause or precipitate psychopathological states such as initiation rituals, arranged marriages, meaning of dreams, etc.
• Psychiatric signs and symptoms tend to be noticeable with a degree of similarity across cultures. Although some signs and symptoms do appear to occur with different rates across cultures and languages.
Carson (1991) described a number of dilemmas associated with the design of DSM-IV. List these and briefly describe in a sentence or two for each the gist of each dilemma.
o Carson feels that we can not fit all the blending of disordered behaviors into a finite and discontinuous set that fits into a monothetic format. There is a difficulty in making sense of a system in which the same set of data may lead to membership in any several purported clinical groupings axial. He does not agree that such a complex and interwoven etiology of disorders can be fit into distinct categories without affecting the credibility of the system.
• Acceptance of Traditional Categories of Disorders
o Carson feels that we have not yet evolved from the archaic categories that began the field, and that essentially we are still using the same structure. He doesn’t feel that there are new original ideas/concepts to empirically ground the DSM and thus all that has occurred so far is fine tuning of what already is acknowledged. Without a new way of organizing mental disorders.
• Reliance in Reliability and Validity of Categories
o Carson feels that the DSM-IV and DSM-III have only given the book a cosmetic makeover and that the reliability that clinicians are focused with is in the form of a arbitrary nature and an unproductiveness of their outcomes. It is thought that the DSM-III only provided a fix to the problems from previous versions but did nothing for diagnosis decisions that yield illusory truths.