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515 Cards in this Set

  • Front
  • Back
core assumption for Freudian theroy
psychic structure split into 3 main components - id, ego , superego
unrganized energy resevoir; all instincts and bioogcial drives; dom,inated by pleasure prin ciple; unconscious
how do you test for id impulses?
dreams, slips of the tongue, daydreams, neurotic symptoms formation
ego devlops through what mechanism?
devlops from id's unteractions with the world
ego dominated by what princilpe? What is its function?
reality principle who function is to suspend the pleasure principle; the ego is organizing, critical, and synthesizing to lead to reason
superego devlops through what process?
successful passing throught eOedipla complex; internalization of parental rstricitons
ego is conflict with…
the id, superego, and reality
what are defense mecahnisms?
used by the ego to relieve presure from the drives
rejection from consciosness of painful or shameful expeirences
reaction formation
replace urges that are unacceptable to the ego by the opposite (e.g. OCD)
giving socially acceptable reason to exmaplin unaccepatalbe behavior or thoughts
atttirbute own unaccepatable wishes to another
transfer emotion from original to more acceptable (e.g. phobias)
stuck at stage of devlopment that has been attained successfully when problmes too difficult to deal with
transform libidinal desires to socially accptable interests/actions; most mature of the defenses
projective identificaiton
deposit unwanted aspects of the self into another so that theperson feels one with the object; modified, then retrieve
projective identificaiton has what affect on others
pressures them to feel as you do
divide external objects into "all good" or "all bad"
control of affect and imp;luses by way of thinking v. experiencing them,
symbolic acting out in reverse of unacceptalbe thing thathas already been done (e.g. driving slowly after accident)
anxiety occurs when (a/t Freud)
defenses fail and impulse starts to break down --> signal anxiety
primary process thinking
governed by the id and pp; unconscious
secondary process thinking
logical, sequntial; reality principle
pt projects own feelgins, wishes, etc. about person in the past onto the therapist = projection plus repetition compulsion
positive and negative transference
postive - love, longing, desire for health; negative - aggressive drives from parent
therepeutci alliance is fomred from what a/t Frued
postive transference
coutnertransference (postive and negative)
own desires, thoughts, etc. from the past onto patient --> gratify own needs but can lead to better understanding of transference
4 steps in psychoanalysis
1. Confrontation (points out sx of neurosis); 2. Clarification why/what/how pt. Is resiting 3. Interpretation once motivated, pt must be ready to hear; over and over; 4. Working htrough assimilation of insight into the personlaity
interpetation should lead to what?
cahtarsis and insight (connect behavior to unconscious material)
Jung's version of unconscious
2 levels: individual/personal unc. (arises from repression) and collective unconsicous (inherited neural patterns)
predisposiont to perception and emotions hsared by all
pleasure in external things
turning inward of the libido; devlops at midlife crisis (@40)
Adler is known for
inferiority complex, masculine protest, compentsatory patterns, style of life,
masculine protest
whne inferiority complex turned into a desire to dominate or be superior =
compensatroy patterns
defense mechanism to overcome inferiorirty feelings =style of life
maladaptive style of life leads to
neurosis, psychosis, ot delinquency (unproductive life styles)
goal of Adlerian therapy
replace unhealthy styles of life with healthy ones
STEP and STET (systematic training for efective parenting and teaching) is based on who's work?
horney, stack-sullivan, fromm
Horney main theory
parents' behavior--> basic anxiety (helplessness and isolation in a hostile world)
defense mechanism defined by honey
using style of relating to others (moving towards, away, or against)
health a/t honey
integrating styles of relating
Harry stack Sullivan basic theory
role of cognitive experience in personality development
3 modes developing infant (modes and theorist)
Harry stack Sullivan 3 modes are protaxic, prataxic, syntaxic
discrete, unconnected momentary states that refer to experiences prior to language (1st months of life and schizophrenia)
private or autistic symbols and see causal connections between unrelated events - serves developing self and reduces anxiety or related to neurosis
symbols that have shared meaning (by end of 1st year) sequential, consistent --> lang. acquisition
Eric Fromm main theory
society prevents people from realizing their true nature (creative, loving)
5 chs styles of rx to demands of society a/t Fromm
5 chs styles of rx to demands of society a/t Fromm receptive, hoarding, exploitive, marketing, productive (allows reach potential)
ego analysis
emphasizes the ego's role in personality development; more focus on current exp vs. transference
2 fx of ego a/t ego psych
ego defensive fx (resolution of conflict) and ego-autonomous (adaptive non-conflict, learning, memory, speech)
a mental representation of an ind. (self or other); by 3rd year, maintained by ego as stable
poorly developed introjects occur b/c
disturbed parents
Kernberg is associated with which theory
object relations - esp. in BPD
Kohut is associated with which theory?
object relations - esp. in BPD
Kohut is associated with which theory?
self-psychology and the fact that natural self-love is thwarted by unempathic parenting --> grandiosity
Self-psychology methods of tx
re-parenting to protect ego and reduce grandiosity
3rd force psychology
humanism and existentialism; individuality and inherent ability to grow/change stressed
client centered therapy
self-actualizing tendency
goal of treatment is to realize this
when not a unified whole - conflict btwn the self concept and experience
what causes anxiety a/t Rogers
when we deny or minimize incongruence to maintain pos. self image
what leads to a constructive client response a/t Rogers
accurate empathetic understanding; unconditional pos. regard, congruence in therapist
existential therapy theory of personality
struggle btwn individual and ultimate concerns of existence
existential theory of pathology
neurotic anxiety - when try to avoid normal anxiety (which is proportionate to cause) leads to subjective sense of loss of free will
goals and tech of existential
eliminate neurotic anxiety by identifying instances when pt avoids responsibility for own life
gestalt theory
each person is capable of assuming responsibility and living life as a whole integrated person
gestalt theory of personality
self-image imposes external standards and impairs actualization and growth of the self
boundary disturbance a/t gestalt theory
interactions with the env. That result in an ind. Controlled more by self-image than self
gestalt theory of pathology
awareness of the needs and incorporating wants (self) and should (s-I) and modulating boundaries
goals of gestalt tx
awareness of environment, self, and boundaries through focus on here-and-now
reality therapy
GLASER; focus on present; be realistic about fulfilling own needs w/out harm; encourages resp.
5 basic needs of Glasser
survival, power, belonging, freedom, and fun
meet 5 basic needs of reality leads to
success identity
transactional analysis theory of pers.
ego state; scripts; strokes; ;life positions
ego states (ta)
pos or neg recognition from others that facilitate transactions
life plan from an in reaction of parents and society; chs. Pattern of giving or receiving strokes
life plan from an in reaction of parents and society; chs. Pattern of giving or receiving strokes
life positions
I'm OK - you're ok (only healthy one) and its variations
3 TYPES OF transactions
complementary, crossed, ulterior
goal of at
integrate ego states and alter maladaptive scripts etc.
feminist therapy goals
emphasizes seeing alt roles and empowerment; equal power is fundamental tenent
non-sexist therapy
focus on equal power, validating non-stereotypical gender roles; doesn't focus on political change
feminist object relations theory
change will only occur with change in parenting of equality btwn da and sons
automatic thoughts
appraisal of a situation
core beliefs - internal models of self and world
cognitive distortions a/t Beck
link dysfunctional schemas and automatic thoughts - info is distorted to fit schema
arbitrary reference
draw conclusions without evidence or contradictory evidence
selective abstraction
focus on detail taken out of context
general rules from isolated instances and apply to other situation broadly
attributing external events to oneself without evidence
dichotomous thinking
cognitive triad
negative thoughts about the self, the future, and world -linked to depression
tech of CBT
monitor neg. at, examine evidence, substitute more reality based interpretations for biased cog, identify and alter schema that predispose distortions
cog techniques of CBT
decatasrophizing, eliciting at's through journaling, reattribution, redefining problem as concrete/sp
beh techniques of CBT
homework, activity scheduling, graded task assignments toward goal, hyp. Testing, beh. Rehearsal, diversion tech for reducing strong emotions
people have rational and irrational beliefs about negative events
rational beliefs lead to
appropriate emotional and beh rx
tech of RET
direct confrontation, contingency contracting, in-vivo
goal of RET
modify irrational beliefs, specifically must statements
ways CBT differs from RET
CT holds dysf. Thoughts are so b/c they interfere with normal cog processing of info not b/c they are irrational and RET is more behavioral b/c more directive
self-control techniques
stimulus control and stimulus monitoring only have minor short-term effects
stress inoculation training
cognitive prep (why faulty prevent coping); skills acquisition, practice in-vivo
stress inoculation training works well for
useful for reducing aggression
hypnotherapy involves 3 factors
absorption, dissociation; suggestibility
hypnotherapy useful for
phobias, habit cessation, dissociative disorders, PTSD
hypnotherapy contraindicated for
psychosis, paranoia, cod, depression, mania
who is easiest to hypnotize, hardest?
anxious versus manic/dep
paradoxical intervention
prescribe sx for which wants relief; used to circumvent anticipatory anxiety
transtheoretical model of change (theorist)
Prochaska and DiClemente
transtheoretical model of change
5 stages people pass through - precontemplation, contemplation, preparation, action, maintenance
low insight
considering but not committed (6 mo)
clear intent of action, small steps poss. at this point (1mo)
time & energy - others notice
lasted at least 6 mo --> consolidation
Motivational Interviewing (theorists and goal)
Miller and Rollnick; resolve ambivalence and build commitment; based on TM
Motivational Interviewing (5 principles)
express empathy through reflective listening; develop discrepancy btwn goal and beh.; avoid argument; roll w/ resistance; support self-efficacy
properties of family systems theory
wholeness, non-summativity, equifinality, equipotentiality, homeostasis, negative feedback, positive fdbk
wholeness -
interrelatedness, change one change all
whole is greater than sum of its parts
pattern of behavior is more imp. than individual topics
one cause can lead to different results on different members of family
family tends towards keeping status quo
negative feedback (in family system)
maintains homeostasis
pos. fdbk (in family system)
disruption of homeostasis
communication/interaction therapy concepts
double-bind comm, metacomm (implicit nonverbal comm), symmetrical comm (when 2 equals --> conflict), complementary comm (inequality and reciprocal e.g. th and pt)
extended family systems theorist
extended family systems theory - how is it transmitted
intergenerational dysfunction
extended family systems theory - 8 interlocking constructs
differentiation of self, triangulation, nuclear family emotional system, family projective process, emotional cutoff, multigen transmission process, sibling position, societal regression
differentiation of self
separation v. fusion
2 conflicting members involve a 3rd
nuclear family emotional system
mechanisms used to deal with tension and instability
family projective process
projection of parental conflict onto children
emotional cutoff
method of children to distance from parents (lack of self-diff)
multigenerational transmission process
escalation over gen. -- severe dysf.
sibling position
older children tend to care for younger
societal regression
stress on family system
goal of Bowen extended family therapy
encourage differentiation of self
tech of Bowen EFT
genograms and triangualtion by therapist
Structural Family therapy - theorist
Methods of SFT (Minuchin)
directive, here and now framework that created crises to jar out of homeostasis
Minuchin theory
family is a system with implicit structure and subsystems with boundaries that maint. Homeo.
boundaries (SFT)
rules about how much and w/ whom ind. Can communicate
boundaries (SFT) (types)
rigid --> disengagement diffuse--> dependence
parent reinforces bad beh to refocus
triangulation (Minuchin)
each parent demands child side with them
stable coalition
one parent and child against other parent
goals of SFT
restructure family
techniques of SFT
joining, tracking, creating family maps, restructuring
joining (SFT)
thx blends into family system
tracking (SFT)
identify with values and history
family map (SFT)
tracks transactional patterns
enactment (SFT)
role plays
reframing (SFT)
re-label family behavior
block usual beh to lead to new and healthy beh.
Strategic Family Therapy (theorist)
main theory of Strategic Family Therapy
power struggle to disrupt
Strategic Family Therapy (goals)
effect immediate change by focusing on current problem
Strategic Family Therapy (techniques)
directives (straightforward or paradoxical), reframing, circular questioning (see diff accounts)
operant interpersonal therapy
increase positive and decrease negative exchanges
object relations family therapy is different from others how?
not based on systems approach
group therapy (main theorist)
composition of groups imp.
gender only imp with kids, devt level (not >2yrs w/ kids), IQ (very imp), stability--> cohesive, 7-10members
stages of group tx
hesitancy, establish power and participation (more hostile), trust (> support and cohesion)
role of the group leader a/t Yalom
knowledgeable of group dynamics so can manage, handle muti-trans/countertrans, encourage part from all, avoid presenting sx directly
co therapists (+/-)
broader transference, complement and support, m/f; competition and disagreement
disagreement in session
not openly in beg., later ok if tactful resolution
installation of hope, belongingness, universality, express flgns, interpersonal learning (*), catharsis
most imp benefit of group tx for lower fx
installation of hope
advantages/dis of both ind and group part
adv: explore issues more and insight complements group cohesion dis: < discussion in group
crisis intervention goals
immediate sx redux, strengthening of coping mechs, restoration of fx, prevention of further dysf.
crisis therapy
short term, supportive v analytic, active, use supports, limited in scope
assumptions of crisis interv. (Saposnek)
people are healthy, focus on present and future, not due to MI, increase coping, small tx --> big gain, assess is ongoing
brief psychotherapy (goals)
remove or reduce most severe sx. ASAP, restore cl to previous emotional state, acquire understnading and skills to cope better in future
best cl for STT
acute onset, satisfactory adjustment, high motivation, good IP skills
Solution Focused Tx (theorists)
DeShazer and Insoo Kim Berg
Sltn Focused Tx
problems and goal should be client-chosen, cl has resources, change is desired, rejection of tech is lesson
tech of Sltn Focus. Tx
exception q,, formula tasks, miracle Q, skeleton keys, narratives
narrative in SFT
narratives derives from transactions of shared meanings
binocular vision
when cl and thx meaning intermingle to crease deeper meaning
progressive narrative
reflects how cl is progressing
moving away from goal
stability narrative
life is static for client
language games in SFT
creatively misunderstanding call's confusion
MMPI-2 (T-scores)
mean 50, SD 10, 65 deviant
MMPI-2 (Age)
18 and older
MMPI-A (age)
MCMI-III (chs)
175 T/F q, 21 scales, DSMIII theory
adolescent version of MCMI-III
self-report, DSM-III, 5pt Likert Scale, 0=not at all
Rorchach (chs)
10 cards, 5 b/w, 2 red, 3 pastels
4 steps of Exner Admin
allay anxiety, instruction "what might this be", free ass, query
W - IQ to org. env, Dd - usual detail avoidance
chs of the blot, Form (shape features), F. Quality (degree blot conforms to response)
many A (children), few H (detachment)
many (conventionality or defense) few (rebelliousness, thought disorder)
special scores
many (psychosis)
Draw a Person test
expression of self or body image, draw man, woman, self
Strong Campbell Interest Inventory (SCII) valid at...
more valid at predicting choice than success
Strong Campbell Interest Inventory (SCII) whose theory
general occupational themes derived from Holland's theory
Strong Campbell Interest Inventory (SCII) scales
Basic Interest (realistic, artistic, social, enterprising, conventional, investigative) and Occupational Scales (124) empirically keyed
Strong Campbell Interest Inventory (SCII) scales
Basic Interest (realistic, artistic, social, enterprising, conventional, investigative) and Occupational Scales (124) empirically keyed
Kuder Vocational Preference Record (KVP-R)
interest in 10 broad areas (outdoor, computational, scientific, musical, persuasive, artistic, literary, musical social service, clerical)
Kuder Vocational Preference Record (KVP-R) validity?
based on content validity
Kuder General Interest Survey (ages)
kids 6-12 grade
neuropsych testing (goals)
identify impairments, residual strengths, differentiate brain damage from not, degree of deficits on everyday fx, specific rec for rehab, localizing lesions
Halstead Reitan measures what different areas?
lateral dominance, psychomotor f., sensory perceptual fx, speech and lang, visuospatial, abstract reasoning, mental flex, attn/concentr.
how is the Reitan used?
often supplemented with WAIS-III or WISC-III
how long to admin Reitan?
4-5 hours
Luria Nebraska - how many items and scales?
239 items on 11 scales plus supp scales
Luria Nebraska - what does it measure?
motor, rhythm, tactile, visual, receptive speech, expressive sp, writing, reading, arithmetic, memory, intellprocess
what are the supplemental scales of the Luria-Nebraska used for?
severity, acuteness, localization of dysfunction
Bender Visual Motor Gestalt Test is used for what?
as a screening device for brain damage and indication of poss. Psych disorders such as mania, seizures, dep, obs, etc
Bender Gestalt is made up of
9 designs to re-create and often used with other tests
Bender Gestalt rel/val
highly rel/valid in predicting brain damage, emotional problems, school perf
Illinois test of Psycholinguistic Abilities (ITPA) age
kids 2-10 yrs old
Illinois test of Psycholinguistic Abilities (ITPA)used for
assess channels (auditory/vocal, visuomotor), processes (org, expressing, understanding) & levels (representation, automatic)
Stroop Color Word Test used to assess for
frontal lobe damage, try to inhibit color
Eysenck found what in what year?
tx=no tx; 1952; 19 studies; only BT > placebo
Smith and Glass found what when?
1978; ave. cl at the end of tx is better off than 80% w/out
Smith and Glass found what ES?
tx ES .85 >placebo on average; placebo better than nothing
Rosenthal when and what
1983 and found 66% of tx show improvement v. 34% of controls
Smith and Glass found what about BT ?
not significantly better, just more studies
client variables that increase effectiveness of tx
IQ, openness, understanding goals, anxiety tolerance, moderate expectations
client variables that decrease effectiveness of tx
low or high expectations, low IQ, lower SES
client variables with no effect
gender (wo seek more), age, motivation (inconsistent)
therapist variables - age
modest effect for young cl w/ mild disorders - similarity helps
therapist variables - ethnicity
not a factor a/t Sue but some rch suggests AA more disclosing to AA
therapist variables - emotional well-being
modest rel.
therapist variables - expectations
when matches pt, increases outcome
therapist variables - professional background
paragraph = proff; cl view of this imp, > exp imp when difficult and measured early
therapist var - self-disclosure
therapist var - gender
no diff
therapist var - orientation
no real diff
therapist var - competence
difficult to operationalize, but in some situations, the most important
treatment variables - therapeutic alliance
most important, more than sp. Interv.
treatment variables - duration
ambiguous, STT favored, 26 seems to be ceiling
treatment variables - type
BT and combo of psychothx and pharm for some disorders
outcome for adolescents
girls more effect, ES > for BT
outcome for geriatrics
effective - no better type
3 phases of effective tx (Howard, 96)
remobilization, remediation, rehabilitation (reduce hopeless, reduce sx over 16 sess, then gradual inc. in fx) respectively
studying a culture from the inside to see as they do
studying culture from the outside through one's own lens
why are ethnic minorities underserved?
1. language diffs; 2 class boundaries; 3. culture bound values
similarity of cl and pt (ethnicity)
depends on study, but probably decreases drop-out
factors that effect ThAlliance
racial/cultural identification, attitude similarity (> imp than race), thx sensitivity, possibly presenting issues
low acculturation prefers what type of th?
similar to them
Berry Acculturation Model
based on 2 dimensions: retention of culture and maintaining mainstream culture
4 types of Acculturation a/t Berry
integration, assimilation, separation, marginalization
integration a/t Berry
high minority/high majority --> low stress
assimilation a/t Berry
low minority/high majority
separation a/t Berry
high minority/low majority (high stress)
marginalization a/t Berry
low minority/low majority (high stress)
a/t Berry what moderates integration?
ss, cog, style, values, majority culture
Hall 1976 communication styles
low and high context -
high context communication -
AfAm, Hisp, Native - restricted codes, shortened w/out loss of meaning
low context communication
Anglo-Americans - wordy
Hall's cultural overgeneralization leads to?
drop out of th b/c thx assumes problems are d/t culture
Sue et al 91 on utilization
Af-Am use more but lower outcomes, Hispanic use less and terminate more quickly
Minority Identity Dev't Model who?
Minority Identity Dev't Model applies to
those exp. Oppression
Minority Identity Dev't Model 5 stages
conformity, dissonance, resistance, introspection, synergistic articulation and awareness
prefers dominant culture, - flngs towards own culture
challenges majority values, confusion, conflict
resistance and immersion
rejects dominant, endorse min. values, combat oppression, distrust Whites
conflict btwn autonomy and rigidity of resistance
synergistic articulation and awareness
resolves introspection phase; best thx someone w/ similar values, still wishes to eliminate oppression, more fulfilled
4 patterns of interactions a/t Helms
parallel, regressive, progressive, crossed -based on idea that stage effects X's
White Racial Identity Dev't Model (who and what)
Helms 1995; the forming of non-racist identity
6 stages of WRIDM
first stage - make contact with minority
increased awareness of inequalities leads to conflict
justify inequality and see White as superior - may fixate here
dissatisfactions with reintegration stage
embrace whiteness without rejecting minorities - learn pride despite hx
internalize non-racist White identity and seek out cross racial interaction
treating African-American's
problem oriented and time limited; cl are more emotional, more concrete
Nigrescence Theory (who and what)
Cross (78); process of developing authentic Black identity
5 stages of Nigresence Theory
preencounter, encounter, immersion/emersion, internalization, internalization/commitment
identify with majority world view and see assimilation as the answer
become more open to new interpretations
frantic search after encounter to destroy old identity, denigrate majority
resolution of conflict leading to flexibility and renewal of old friendships
non-racist perspective and increased political involvement
Hispanic cl tend to be
diverse, from patriarchal families with rigid sex roles
Ruiz and Padilla state what about therapy with Hispanic cl.?
use active, goal-oriented tx plan, consider imp. of family, assess level of belonging, level of acculturation, avoid stereo.
cuento tx
use of folktales, dramatization, group setting, can lead to coping
When counseling Native American cl
know details of tribe & family system, non-directive, hx-oriented, cooperative, focus on dev. happiness, wisdom, peace (not problem), Listen
Factors imp. when tx Asian American cl
family, age, sex, level of traditional family, role of the father, elders, if roles are rigid, inhibited,
why is tx underutilized by Asian Americans?
problems seen as family issue
When Asian Am. Comes into tx, what helps?
instruction at the outset, know that they may come in under education or vocational guise, prefer direct, ST,, structured approach
stereotypes of elderly that are wrong:
irritable, rigid, impaired (actually internally stable and active)
thx with elderly usually involved the following:
guidance thru identity transitions, common depression, prevention, tech of reminiscence is useful
8 stages of identity formation in homosexuals (McLaughlin, 2000)
isolation, alienation/shame, rejecting self, passing, consolodation identity, acculturation, integration of self and public identity, pride/synthesis
term used to replace homophobia
sexual prejudice
DSM-IV is based on
descriptive, non-etiological (unless cause is known), atheoretical, beh signs & sx
Axis I
clinical distress,
Axis II
clinical distress, mental retardation, PD's
axis III
med cond that might influence mental
Axis IV
psychosocial and env. Probs
Axis V
don't count impairment d/t physical or env. Limits
principal dx
focus of tx
dx deferred
tentative, but uncertain
class is right, but not specific
polythetic criteria
fit x out y number of symptoms - to deal w/ limits of categorical
Mental Retardation (def)
IQ < 70,, deficits in fx, onset prior to age18
Mentally retarded infants are
less active, more compliant, less reactive to stim, parent, and less vocal
4 degrees of severity of MR
mild, moderate, severe, profound
mild MR
IQ 50-70, 85% of dx, late childhood dx, can live independently, get to 6th grade level
moderate MR
IQ 35/40-50/55, 10% of dx, minimal guidance, sheltered workshops, 2nd grade level
severe MR
IQ 20/25-35/40, 3-4%, poor motor/communication skills, elementary hygiene, simple tasks, close spvs
profound MR
IQ < 20/25, 1-2%, severe limitations, very structured env, constant aid, sheltered workshops
Etiology of MR
30% early alteration of embryonic devt. (Down's), 15% environment (low nutrition), 10% preg. problems, 5% heredity, 30-40% no clear etiology
Biofactors causing MR
phenylketonuria, Tay-Sachs, Fragile X, Down's, HIV, anoxia, prematurity, infection, brain injury
Psychosocial influences on MR
low nutrition, stimulation, healthcare
Pervasive Developmental Disorders (list them)
Autistic, Rett's, Childhood Disintegration, & Aspergers Disorders
Autstic Disorder (def)
gross, sustained abnormality in multiple areas (soci, motor, lang, etc.) at least 6 signs
Rett's Disorder
dvt regression prior to age 4, accelerated head growth, reduced hand skills, gait, ex & rep lang, social x (ONLY IN Females)
Childhood Disintegration Disorder
progressive after normal devt (like Rett's); reduced in 2 areas before age 10, social and lang, play, motor, bladder prob, later & rarer than autism
Asperger's Disorder
no lang probs, self-help , cog, or curiosity, > males, prognosis better (mainly social)
Autstic Disorder (signs)
impaired social interaction (at least 2), impaired comm (at least 1), restricted, repetitive, & stero patterns (at least 1), before 3 delay fx in soc, lang, or play
tx for autistic disorder
neuroleptics reduce agg, withdrawal and SIV, operant cond inc. comm, red. - beh, best if start when young and intense
autistic disorder demo
25/10,000; 75% MR, 4-5x > common in males, unrelated to schiz and no psychosis
learning disorders (def)
chs by lower than expected ach on a stdz test of reading, math, or written expression (, 2 SD btwn IQ and ach)
can LD be dx with MR?
yes, if criteria met and ADL lowered
how often LD comorbid with ADD?
common comorbid dx with LD
ADD, depression, conduct disorder, ODD
ability to read only regularly spelled words (red v. might) = surface dysl.
deep dyslexia
several types of reading errors including semantic paralexia
semantic paralexia
produce a response that is related to a word in meaning but not visually or phono. (hot for cold)
when does stuttering first appear?
2-7 yrs old
6 or more sx; dev innapp degree of inattention, impulsiveness/hyperactivity
Attention Defi. Hyperactivity, Combines type
6 or > sx of inatt AND 6 or > sx of hyp/imp
Att Deficit Hyperactivity Dis, Predominately Inattentive type
6 or :> sx of inatt but < 6 of hyper
Att Def Hyper Dis, predom Hyper/Inatt type
6 or > hyp/imp but <6 of inatt.
dx criteria for ADHD
must be dx before age 7; duration >6mo, in at least 2 settings, not d/t MR or other
distracted, careless
fidgety, loud
interrupting, blurting
what percent of children meet criteria for ADHD? Subclinical %?
3-5% of all children; 10% subclinical
problems correlated to ADHD
lowered IQ, academic problems, conduct disorder (50%), 20% LD,, 25% emotional dis
what is a prerequisite for adult ADHD?
childhood ADHD
by what age do sx show up for ADHD? When is it usually dx?
age 3; dx in school
how common is ADHD in boys compared to girls?
4-9x > common than in girls
in adults, what is ADHD often masked by?
depression, anxiety, OCD, sub abuse
etiology of ADHD
lowered blood flow in prefrontal cortex, reduced caudate fx (low inhibition),
genetic percentage in ADHD?
.80 in twins
minimal brain dysfunction
ADHD - normal IQ but behavioral problems, EEG abnormal, memory probs, perc/motor fx lowered
best tx for ADHD?
no one best b/c of combo of sx
types of tx for ADHD
no cure, only suppress; CNS stimulants, CBT
CNS stimulants for ADHD do what at which level?
e.g. Ritalin; low dose increase att, high dose reduces activity
What problems are associated with CNS stimulants for ADHD?
does not help IP skills, somatic sx (lowered appetite, insomnia), mvmnt (Tourettes, tics), OC sx, growth suppression,
why are drug holidays needed with Ritalin?
growth suppression
CBT probs for ADHD
no long term sltn, best if parent takes part
dx criteria for Conduct disorder
chronic pattern of defying society's rules, 3 or > signs: aggression, stealing; 12 mo at least 1 sign in 6 mo
onset of Conduct disorder
1st sx prior to age of 10; more severe than if 1st sx in adolescence
CD beginning in adolescence is usually associated with
peers, better prognosis, lower SE, lower ach, empathy
CD beg. In childhood is ass. With
worse prognosis usually leading to APD, ADHD< and Sub Abuse
correlates with CD
ADHD, family with antisocial activity, high emotional arousal levels
ODD correlates
negativism, argumentative, defiant to adults; often only prob at home; less severe than CD (but can become); externalizes blame,,
non nutritive eating
regurgitate and chew - 25% fatal
Feeding Disorders of Infancy/ Early Childhood
don't eat enough and can lead to death - must r/o med, poverty, etc.
Tourette's is classified as a
Tic Disorder
Tourette's dx criteria
btwn 2-17 yrs; involuntary jerky mvnt, vocal tics multi times a day, daily, for a year and < 3 mo w/out
what percent of Tourette's have coprolalia
10% use vulgarity
comorbid withTourette's
ADHD, LD, OC,, depression,
tx of tourette's
school intervention, ind, family, and pharm combos (haloperidol, pimozide) or (Clonidine lowered se but longer to effect)
what tx for Tourette's increases tics?
those that increase attention b/c CND stims
what tx used for OC related to tourette;s?
antidepressants (clomiprimine, fluoxetine)
single vocal or motor tics less severe than Tourette's is dx with
Chronic Motor or Vocal Tic Disorder
encopresis is what type of disorder?
elimination disorder (n/d to gen med); feces
elimination disorders gen info
> common in males, most remit by 3, moisture alarms work well, antidepressants short term sx relief, exercise to tx of choice
separation anxiety
fantasizes of danger, somatic complaints; school phobia often as well; may be sign of dep,
reactive detachment disorder of infancy or early childhood (age, def, types, etiology)
before age 5; dvt innapp social relatedness; inhibited or disinhibited; often due to pathogenic care of the child
failure to thrive, dev delays, mild-mod of MR, facial chs (short nose, flat midface); thin
apnea at birth, low birth weight, short, 5/10,000 births
childhood depression
sep anx, school ph, antisocial, may mask ; accident prone, acquiescent, recurrent th of death,
mental disorders due to a general medical condition def.
directly caused by a med cond;
3 factors imp in mental disorders due to a general medical condition def. (card1)
did the sx of the mental and med disorder occur together in time; are the signs of the MD representative of a MD or atypical;
3 factors imp in mental disorders due to a general medical condition def.(card 2)
does the medical cond typically produce mental sx; can a mental dis better explain the disturbance (e.g. depression as rxn to illness not direct phy process);
3 factors imp in mental disorders due to a general medical condition def.(card 3)
and mental sx not occurring solely in the course of Delerium
personality change d/t GMC
lasting personality dist. Directly d/t med and causes distress/impairs fx
subtypes of pers. Change d/t med cond
labile;disinhibted; aggressive; apathetic; paranoid; other, unspec; combined
catatonic disorder d/t gmc
motoric immobility, increased motor activity, extreme negative, mutism
substance intoxication
reversible, maladaptive behavior d/t effects on CNS (e.g. alcohol, PCP, cannabis, etc.)
substance withdrawal
reversible, d/t recent termination/redux of heavy drug sue with distress/impaired fc
sub induced psychotic disorder, mood dist. Etc. are only applied when
sx are excess of normal w/ withdrawal and sig enough to warrant clinical attention
hallucinogen persisting perception disorder
flashbacks of perc. Disturbance while not using hallucinogens
delerium, dementia, amnestic & oterh cog dis - 2 xriteria
1. impaired cog/mem that rep. sig. change from prev. fx. and 2. direct physio consequence of a GMC, sub, or combo
delerium, dementia, amnestic & oterh cog dis - also fall into which categories
Mental dis d/t GMC and/or Substance Induced MD
delerium def
disturbance of consciousness w/ either a change in cog or dvt. of a perceptual dist.
delerium (problems)
reduced awareness of env, red. focus, red. maintainence or switch attention; memory, lang; hallucinations; confusion, "clouding"
what differentiates deleirum from dementia?
delerium is rapid onset and brief and dist in consc (ie alert in dementia); course variable with Dementia
delerium (who gets it)?
most common > 60 but also feverish kids
etiology of delerium
infections, metabolic instability, (if medical --> DTGM or Subst)
Dementia (def)
multicog impairment - always memory plus at least1: aphasia, apraxia depite motor fx intact, agnosia despite visual pathway, red. executive fx
Dementia (who?)
> 85 or younger d/t GMC (e.g HIV, Head Trauma)
Dementia (course)
progressive, concerned over cog decline
dementia v. depression
memory problems are transitory, specific to procedualr and recall
Dementia Alzheimer's Type
1/2 of all cases, risk inc w/ age, recent memory loss, lack of awareness as time goes on,
Death from onset of Alzh.
8-10 years
who gets Alzh?
> women, perhaps b/c live longer
genetic invovlement in Alz?
1st primary rel. increased risk by 3-4x
Detecting Alzheimer's?
85% by CT, PRT, MRI and interview,
Tx for Alz?
no pharm, structured env.
Vascular Dementia (formerly multi-farct) - d/t, onset and course, how many cases, chs?
d/t red blood flow to brain (stroke), onset abrupt and course stepwise and flcutuatin, 10-20% of all Dem cases, nature of signs depends on foci
Dementia d/t HIV
occurs in 2/3 of all AIDS pt, reduced concentration, memory --> motor --> seizures, psych sx; death follows 6mo later
Substance Induced Persisiting Dementia
causally related cognitvie deficits, cog probs well after intox/withdrawl,(tx & fam support help do better)
Amnestic disorders
just memory probs,
antereograde amnesia
reduced ability to learn new info
retrograde amneisa
cannot recall learned info,
etiology of amnesia
(if d/t GMC, label, alcohol, sedatives, hypnotics, anxiolytics) if alcohol --> Korsakoff's = Alcohol induced persistant amensitc dis
tx for amnesia
depends on etiology
Substance Dependence
continued use despite sig. related problems 3 signs > 12 mo
Signs related to Sub Dep
tolerance, wdrawl sx (or avoidance); increase over time, desire or failure to stop; time spent using/obt/recovering; red. Imp social etc, cont use despite awareness
Sub Abuse
maladaptive pattern of use at elast 1 sx > 12 mo
Sub Abuse sx
sub use --> failure of major role obs, use in phys dang sit, related legal probs, cont use despite probs and never met Dependence
alcohol chs
depressant on NS, also depresses inhibitory mechs,
probs ass with alcohol
reduced cog evident on WAIS-III visuospatial, Korsakoff's (red Thiamine) --> thalamus damage -->retrograde; <5% DT's
cocaine sx of use
increased activity, vigilance, reduced judgement, euphoria,
cocaine sx of chronic use
(chronic --> fatigue, sadness)
cocaine sx of wdrawl
(wdr --> dysphoria, fatigue, insomnia/hypersomnia, increased appetite, vivide dreams, motor changes,
cocaine wdl is simalr to
amphetemine wdrl
sedation, mild euphoria, complex motor reduction, no long term - effects (ie not toxic), no dependence, withdrl, can cause disinhgibition of agg.
caffein - how many mg a lot
250 mg's
tx for alcoholism
AA, Antabuse, fam/ind,
chs of alcohol tc
must overocme denial, relapse common, restructure cog,
tx for opiates
maybe methadone
most stopon own w/ storng desire to quit, - health risks, social support- ind tx if used to relax helpful, substitutes OK if fearing withdrawl, but need combo with BT
Relapse Prevention Therapy
CBT approach to build coping mechs, no disease model, overlearned habits/patterns
a/t RPT 3 high risks for 75% of all drug relapses
neg emotional states, interpersonal conflict, social pressure; effective
chs sx of schiz
content of th, form of th, perceptions, affect, sense of self, volition, interpersonal fx, psychomotor beh.
dx of schiz
presence of chs sx during active phase for sig time during 1 mo., deterioration from prev. fx, persists for 6mo.
schizophreniform is determined by if
sx persist less than 6 mo and sx acute
onset of sx
late teens to mid 30's; premorbid often eccentric
chs of schiz (death rate, prognosis, chornicity)
die earlier, chronic, best prognosis: f, late onset, precipitating event, fam hx of mood but not schiz, good premorbid adjustment
type of schiz
disorganized, catatonic, paranoid, undifferentiated, residual
disorganized sciz
regression to primitive, unhibited and uorganized beh.
psychomotoe disturbance
undifferetiated type
doesn't fit neatly into other categoreis
residual type
one schiz episode, continue to display negative signs or attentuated + sx (e.g. odd beliefs) but no prominent + psychotic or strong affect
genetic twin studies say what about schiz
genetic predisp, but disconcoredance is higher than concordance
structural brain abnormalityes in sciz
increased volume oif lateral and third ventricle
functional brain abnormality in schiz
decreased blood flowto cortex
nt imbalance in schiz
imbalance of norepinephrine, serotonin, and glutamte; clozapine has postive effects (also dopamine hyp)
genetic risks for schiz
unrelated: 1%, bio sibs: 10%; Dizygotic twins: 16%; mono twins: 48%
race effects on schiz
AF > white but maybe misdx or SES/stressors; whites > sx 3rd world more acute, shorter duration (> ss)
pharmacological tx have what effects on schiz
decrease pos. sx but increase neg sx and SE such as Tardive Kinesia; best in combo w/ social skills traing and fam tx
schizophreniform dis
sx 1mo-6mo; better prognosis
schizoaffective dis.
have both sx; mood must be present for subst. part of illness but psychotic features > prominent than Mood Dis w/ psychptic features
schizoaffective dis - mood issues
at least 2 wks without mood but w/ psychotic sx
delusional disorder
no other odd behaviors or fx impairment but had delusion (e.g. grandeur, erotomania, somatic, etc.)
briefr psychotic disorder
< mo., full remission, w/ marked stressor, w/out marked stressor, w/post partum onset; r/o subtances
point elaborated on in detail
loose associations
point lost (vs. elaborated on)
bipolar disorder v depressive disorder
1 or more episodes of mania, mixed, or hypomanic w/ hx of depression v. depression w/out mania
manic episode
abnomrally elevated, expansive, or irritable mood over 1 wk; 3 chs sx such as grandiostiy, low sleep, risky --> marked impariment or dvt of psychotic features
hypomanic episode
not as severe, no need for hosp, no impaired fx, 4 days (not a week)
mixed episode
at least 1 wk almost everyday both manic and dep episodes; high to low quickly
major dep episode
at least 5 over 2 wks - must have depressed mood and loss of pleasure; worthless, th of death, diff concentrating, agitation/retard, sleep, fatigue, weight
bipolar 1 , single manic episode
no past depresive episodes
bipolar 1 most recent episode hypomanic
current plus at least one manic or mixed and signficant distress
bipolar 1,most recent episode manic
current plus at elast one major dep,mixed, or manic
bipolar 1, most recent episode mixed
current plus at least 1 major dep, manic, or mixed
Bpiolar 1, most recent episode depressed
current plus at least 1 mixed or manic (only one requiring depression)
bipolar 1, most recent episode unspecified
at least 1 manic or mxed in past
Bipolar II
1 or more dep. Episodes and at least 1 hypomanic episode and must never had a manic or mixed episode and must --> sig distress
cyclothymic disorder
distrubance in mood for at least 2 yrs, alt. btwn hypomanic and dep. That are too mild to be major dep; no dist in daily fx
major depressive disorder
1 or more mo w/out manic
chs of dep (uni v bi, % second episode, w v m)
uni > suicide, 2x more women, 50-605 have 2nd ep in 2 years
,multiple roles effect on depression
reduces it
postpartum depression
10-20% severe for 2-8wsk (some > ; onset 4 wks from birth
dythymia disorder
less severe than depresion, 2 yrs or longer; chronic but few impairments
double depression
major depresion and dythymia, very poor prognosis
etiology of dep/bi
genetic > bipolar, stress, catehcolemine (low - dep; high - mania); intrapsychic ambivalence
tx for bipolar
tx for depression
antidep (tricyclics, SSRI's, MAOI for atypical w/ anxiety/OCD) help 60%, CBT, IPT, BT (low effect)
helpful on right side
CBT v phram
some support for additive effect, but most CBT better
expression of an or avoidance of triggers
panic attacks
discrete intense sense of doom, 4 cog/som sx; devlop suddenly, reach peakin 10 min
fear of being in a place diff to escape or no help
panic disorder w/ or w/out agoraphobia
at least 1 mo of chronic worry @ panic attacks
agoraphobia in kids
, not seen in kids b/c can't catasrophize
etiology of panic disorder
hihglevels of sodium lactate, genetic
phobic disorders
agoraphobia, social phobia, specific phobia
agoraphobia w/out hx of panic disorder
fear of devloping panic sx
social phobia
recognize fear is unreasonable plus sig. distress/impairment
specific phobia
exposure leads to panic attack
etiology of panic disorder
classically cond, conflict d/t unacceptable impulses, bio prepped stimuli (Seligman)
tx for panic disorder
antidepressants reduce agoraphobic anxiety and best fo social, exposure w/ response rpevnetion (exitnguishes), imaginal exposure helpful for specific,
ocd comorbidity and correlates
often comorbis w/ dep., > SES and IQ
ocd treatment
flooding for compulsions but obsessions diff. to reduce; use clomiprimine and fluoxetine to reduce sx
exposure to event where death/serious injury possible and rxn is fear/helplessness/horror
sx of PTSD
for >1 mo,. - reexperiencing, avoidance of related stim and numbing of general responsivness, sx or persistant heightened arousal
sx of heightened arousal
hypervigilance, irritiability, reduced sleep, impaired concentration
PTSD can be (time)
acute or chronic and delayed or immediate
tx for PTSD - preventative
crisis intervention (prevents delayed/chronic);
tx for PTSD- current
CBT/BT (system. Des.); relaxation/hypnosis (motor tension/arousal); antidep for flashbcks;
tx for PTSD - preferred
STT b/c suggests regain control
prgonsis for PTSD
gets worse if delayed and chronic
combines CBT & Cl Centered w/ eye mvmnts
path of EMDr
describe --> eye --> "what comes up" --> eye --> anxiety lower
effectivness of EMDR
as effective as exposure (> than no tx) and eye mv not nec.
acute stress disorder
PTSD w/out sx lasting > 1 mo and immediate occurnace
Generalized Anxiety Disorder
excess worry over life circumstances; lasts > 6mo
chs sx of Gen. Anx. Disorder
difficulty controlliong worry; restless, fatigue, concnetration, iritable, sleep, tension; r/out sub abuse
tx gen anx disorder
BT plus CT - progressive relaxation; CBT most effective w/ LT benefits
best prognosis with gen anx
worries specific and high expectations of tx