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515 Cards in this Set
- Front
- Back
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core assumption for Freudian theroy
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psychic structure split into 3 main components - id, ego , superego
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id
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unrganized energy resevoir; all instincts and bioogcial drives; dom,inated by pleasure prin ciple; unconscious
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how do you test for id impulses?
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dreams, slips of the tongue, daydreams, neurotic symptoms formation
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ego devlops through what mechanism?
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devlops from id's unteractions with the world
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ego dominated by what princilpe? What is its function?
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reality principle who function is to suspend the pleasure principle; the ego is organizing, critical, and synthesizing to lead to reason
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superego devlops through what process?
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successful passing throught eOedipla complex; internalization of parental rstricitons
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ego is conflict with…
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the id, superego, and reality
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what are defense mecahnisms?
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used by the ego to relieve presure from the drives
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repression
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rejection from consciosness of painful or shameful expeirences
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denial
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disavowal
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reaction formation
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replace urges that are unacceptable to the ego by the opposite (e.g. OCD)
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rationalization
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giving socially acceptable reason to exmaplin unaccepatalbe behavior or thoughts
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projection
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atttirbute own unaccepatable wishes to another
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displacement
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transfer emotion from original to more acceptable (e.g. phobias)
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fixation
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stuck at stage of devlopment that has been attained successfully when problmes too difficult to deal with
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sublimation
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transform libidinal desires to socially accptable interests/actions; most mature of the defenses
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projective identificaiton
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deposit unwanted aspects of the self into another so that theperson feels one with the object; modified, then retrieve
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projective identificaiton has what affect on others
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pressures them to feel as you do
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splitting
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divide external objects into "all good" or "all bad"
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intellectualization
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control of affect and imp;luses by way of thinking v. experiencing them,
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undoing
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symbolic acting out in reverse of unacceptalbe thing thathas already been done (e.g. driving slowly after accident)
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anxiety occurs when (a/t Freud)
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defenses fail and impulse starts to break down --> signal anxiety
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primary process thinking
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governed by the id and pp; unconscious
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secondary process thinking
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logical, sequntial; reality principle
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transference
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pt projects own feelgins, wishes, etc. about person in the past onto the therapist = projection plus repetition compulsion
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positive and negative transference
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postive - love, longing, desire for health; negative - aggressive drives from parent
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therepeutci alliance is fomred from what a/t Frued
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postive transference
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coutnertransference (postive and negative)
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own desires, thoughts, etc. from the past onto patient --> gratify own needs but can lead to better understanding of transference
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4 steps in psychoanalysis
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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
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interpetation should lead to what?
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cahtarsis and insight (connect behavior to unconscious material)
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Jung's version of unconscious
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2 levels: individual/personal unc. (arises from repression) and collective unconsicous (inherited neural patterns)
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archetypes
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predisposiont to perception and emotions hsared by all
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extraversion
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pleasure in external things
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introversion
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turning inward of the libido; devlops at midlife crisis (@40)
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Adler is known for
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inferiority complex, masculine protest, compentsatory patterns, style of life,
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masculine protest
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whne inferiority complex turned into a desire to dominate or be superior =
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compensatroy patterns
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defense mechanism to overcome inferiorirty feelings =style of life
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maladaptive style of life leads to
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neurosis, psychosis, ot delinquency (unproductive life styles)
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goal of Adlerian therapy
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replace unhealthy styles of life with healthy ones
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STEP and STET (systematic training for efective parenting and teaching) is based on who's work?
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adler
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neofreudians
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horney, stack-sullivan, fromm
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Horney main theory
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parents' behavior--> basic anxiety (helplessness and isolation in a hostile world)
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defense mechanism defined by honey
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using style of relating to others (moving towards, away, or against)
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health a/t honey
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integrating styles of relating
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Harry stack Sullivan basic theory
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role of cognitive experience in personality development
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3 modes developing infant (modes and theorist)
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Harry stack Sullivan 3 modes are protaxic, prataxic, syntaxic
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protaxic
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discrete, unconnected momentary states that refer to experiences prior to language (1st months of life and schizophrenia)
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prataxic
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private or autistic symbols and see causal connections between unrelated events - serves developing self and reduces anxiety or related to neurosis
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syntaxic
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symbols that have shared meaning (by end of 1st year) sequential, consistent --> lang. acquisition
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Eric Fromm main theory
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society prevents people from realizing their true nature (creative, loving)
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5 chs styles of rx to demands of society a/t Fromm
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5 chs styles of rx to demands of society a/t Fromm receptive, hoarding, exploitive, marketing, productive (allows reach potential)
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ego analysis
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emphasizes the ego's role in personality development; more focus on current exp vs. transference
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2 fx of ego a/t ego psych
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ego defensive fx (resolution of conflict) and ego-autonomous (adaptive non-conflict, learning, memory, speech)
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object/introject
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a mental representation of an ind. (self or other); by 3rd year, maintained by ego as stable
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poorly developed introjects occur b/c
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disturbed parents
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Kernberg is associated with which theory
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object relations - esp. in BPD
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Kohut is associated with which theory?
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object relations - esp. in BPD
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Kohut is associated with which theory?
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self-psychology and the fact that natural self-love is thwarted by unempathic parenting --> grandiosity
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Self-psychology methods of tx
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re-parenting to protect ego and reduce grandiosity
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3rd force psychology
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humanism and existentialism; individuality and inherent ability to grow/change stressed
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client centered therapy
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Rogers;
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self-actualizing tendency
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goal of treatment is to realize this
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incongruence
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when not a unified whole - conflict btwn the self concept and experience
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what causes anxiety a/t Rogers
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when we deny or minimize incongruence to maintain pos. self image
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what leads to a constructive client response a/t Rogers
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accurate empathetic understanding; unconditional pos. regard, congruence in therapist
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existential therapy theory of personality
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struggle btwn individual and ultimate concerns of existence
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existential theory of pathology
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neurotic anxiety - when try to avoid normal anxiety (which is proportionate to cause) leads to subjective sense of loss of free will
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goals and tech of existential
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eliminate neurotic anxiety by identifying instances when pt avoids responsibility for own life
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gestalt theory
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each person is capable of assuming responsibility and living life as a whole integrated person
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gestalt theory of personality
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self-image imposes external standards and impairs actualization and growth of the self
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boundary disturbance a/t gestalt theory
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interactions with the env. That result in an ind. Controlled more by self-image than self
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gestalt theory of pathology
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awareness of the needs and incorporating wants (self) and should (s-I) and modulating boundaries
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goals of gestalt tx
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awareness of environment, self, and boundaries through focus on here-and-now
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reality therapy
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GLASER; focus on present; be realistic about fulfilling own needs w/out harm; encourages resp.
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5 basic needs of Glasser
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survival, power, belonging, freedom, and fun
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meet 5 basic needs of reality leads to
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success identity
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transactional analysis theory of pers.
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ego state; scripts; strokes; ;life positions
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ego states (ta)
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CHILD, PARENT, ADULT
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strokes
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pos or neg recognition from others that facilitate transactions
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scripts
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life plan from an in reaction of parents and society; chs. Pattern of giving or receiving strokes
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scripts
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life plan from an in reaction of parents and society; chs. Pattern of giving or receiving strokes
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life positions
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I'm OK - you're ok (only healthy one) and its variations
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3 TYPES OF transactions
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complementary, crossed, ulterior
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goal of at
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integrate ego states and alter maladaptive scripts etc.
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feminist therapy goals
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emphasizes seeing alt roles and empowerment; equal power is fundamental tenent
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non-sexist therapy
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focus on equal power, validating non-stereotypical gender roles; doesn't focus on political change
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feminist object relations theory
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change will only occur with change in parenting of equality btwn da and sons
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automatic thoughts
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appraisal of a situation
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schema
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core beliefs - internal models of self and world
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cognitive distortions a/t Beck
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link dysfunctional schemas and automatic thoughts - info is distorted to fit schema
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arbitrary reference
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draw conclusions without evidence or contradictory evidence
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selective abstraction
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focus on detail taken out of context
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overgeneralization
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general rules from isolated instances and apply to other situation broadly
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personalization
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attributing external events to oneself without evidence
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dichotomous thinking
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extremes
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cognitive triad
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negative thoughts about the self, the future, and world -linked to depression
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tech of CBT
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monitor neg. at, examine evidence, substitute more reality based interpretations for biased cog, identify and alter schema that predispose distortions
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cog techniques of CBT
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decatasrophizing, eliciting at's through journaling, reattribution, redefining problem as concrete/sp
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beh techniques of CBT
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homework, activity scheduling, graded task assignments toward goal, hyp. Testing, beh. Rehearsal, diversion tech for reducing strong emotions
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RET
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people have rational and irrational beliefs about negative events
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rational beliefs lead to
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appropriate emotional and beh rx
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tech of RET
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direct confrontation, contingency contracting, in-vivo
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goal of RET
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modify irrational beliefs, specifically must statements
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ways CBT differs from RET
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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
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self-control techniques
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stimulus control and stimulus monitoring only have minor short-term effects
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stress inoculation training
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cognitive prep (why faulty prevent coping); skills acquisition, practice in-vivo
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stress inoculation training works well for
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useful for reducing aggression
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hypnotherapy involves 3 factors
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absorption, dissociation; suggestibility
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hypnotherapy useful for
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phobias, habit cessation, dissociative disorders, PTSD
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hypnotherapy contraindicated for
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psychosis, paranoia, cod, depression, mania
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who is easiest to hypnotize, hardest?
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anxious versus manic/dep
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paradoxical intervention
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prescribe sx for which wants relief; used to circumvent anticipatory anxiety
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transtheoretical model of change (theorist)
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Prochaska and DiClemente
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transtheoretical model of change
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5 stages people pass through - precontemplation, contemplation, preparation, action, maintenance
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precontemplation
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low insight
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contemplation
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considering but not committed (6 mo)
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preparation
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clear intent of action, small steps poss. at this point (1mo)
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action
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time & energy - others notice
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maintenance
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lasted at least 6 mo --> consolidation
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Motivational Interviewing (theorists and goal)
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Miller and Rollnick; resolve ambivalence and build commitment; based on TM
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Motivational Interviewing (5 principles)
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express empathy through reflective listening; develop discrepancy btwn goal and beh.; avoid argument; roll w/ resistance; support self-efficacy
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properties of family systems theory
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wholeness, non-summativity, equifinality, equipotentiality, homeostasis, negative feedback, positive fdbk
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wholeness -
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interrelatedness, change one change all
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non-summativity
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whole is greater than sum of its parts
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equifinality
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pattern of behavior is more imp. than individual topics
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equipotentiality,
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one cause can lead to different results on different members of family
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homeostasis
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family tends towards keeping status quo
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negative feedback (in family system)
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maintains homeostasis
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pos. fdbk (in family system)
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disruption of homeostasis
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communication/interaction therapy concepts
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double-bind comm, metacomm (implicit nonverbal comm), symmetrical comm (when 2 equals --> conflict), complementary comm (inequality and reciprocal e.g. th and pt)
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extended family systems theorist
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Bowen
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extended family systems theory - how is it transmitted
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intergenerational dysfunction
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extended family systems theory - 8 interlocking constructs
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differentiation of self, triangulation, nuclear family emotional system, family projective process, emotional cutoff, multigen transmission process, sibling position, societal regression
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differentiation of self
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separation v. fusion
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triangulation
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2 conflicting members involve a 3rd
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nuclear family emotional system
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mechanisms used to deal with tension and instability
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family projective process
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projection of parental conflict onto children
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emotional cutoff
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method of children to distance from parents (lack of self-diff)
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multigenerational transmission process
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escalation over gen. -- severe dysf.
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sibling position
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older children tend to care for younger
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societal regression
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stress on family system
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goal of Bowen extended family therapy
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encourage differentiation of self
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tech of Bowen EFT
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genograms and triangualtion by therapist
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Structural Family therapy - theorist
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Minuchin
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Methods of SFT (Minuchin)
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directive, here and now framework that created crises to jar out of homeostasis
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Minuchin theory
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family is a system with implicit structure and subsystems with boundaries that maint. Homeo.
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boundaries (SFT)
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rules about how much and w/ whom ind. Can communicate
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boundaries (SFT) (types)
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rigid --> disengagement diffuse--> dependence
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parent reinforces bad beh to refocus
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detouring
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triangulation (Minuchin)
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each parent demands child side with them
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stable coalition
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one parent and child against other parent
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goals of SFT
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restructure family
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techniques of SFT
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joining, tracking, creating family maps, restructuring
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joining (SFT)
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thx blends into family system
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tracking (SFT)
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identify with values and history
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family map (SFT)
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tracks transactional patterns
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enactment (SFT)
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role plays
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reframing (SFT)
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re-label family behavior
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blocking
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block usual beh to lead to new and healthy beh.
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Strategic Family Therapy (theorist)
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Haley
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main theory of Strategic Family Therapy
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power struggle to disrupt
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Strategic Family Therapy (goals)
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effect immediate change by focusing on current problem
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Strategic Family Therapy (techniques)
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directives (straightforward or paradoxical), reframing, circular questioning (see diff accounts)
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operant interpersonal therapy
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increase positive and decrease negative exchanges
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object relations family therapy is different from others how?
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not based on systems approach
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group therapy (main theorist)
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Yalom
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composition of groups imp.
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gender only imp with kids, devt level (not >2yrs w/ kids), IQ (very imp), stability--> cohesive, 7-10members
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stages of group tx
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hesitancy, establish power and participation (more hostile), trust (> support and cohesion)
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role of the group leader a/t Yalom
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knowledgeable of group dynamics so can manage, handle muti-trans/countertrans, encourage part from all, avoid presenting sx directly
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co therapists (+/-)
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broader transference, complement and support, m/f; competition and disagreement
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disagreement in session
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not openly in beg., later ok if tactful resolution
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benefits
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installation of hope, belongingness, universality, express flgns, interpersonal learning (*), catharsis
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most imp benefit of group tx for lower fx
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installation of hope
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advantages/dis of both ind and group part
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adv: explore issues more and insight complements group cohesion dis: < discussion in group
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crisis intervention goals
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immediate sx redux, strengthening of coping mechs, restoration of fx, prevention of further dysf.
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crisis therapy
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short term, supportive v analytic, active, use supports, limited in scope
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assumptions of crisis interv. (Saposnek)
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people are healthy, focus on present and future, not due to MI, increase coping, small tx --> big gain, assess is ongoing
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brief psychotherapy (goals)
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remove or reduce most severe sx. ASAP, restore cl to previous emotional state, acquire understnading and skills to cope better in future
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best cl for STT
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acute onset, satisfactory adjustment, high motivation, good IP skills
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Solution Focused Tx (theorists)
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DeShazer and Insoo Kim Berg
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Sltn Focused Tx
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problems and goal should be client-chosen, cl has resources, change is desired, rejection of tech is lesson
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tech of Sltn Focus. Tx
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exception q,, formula tasks, miracle Q, skeleton keys, narratives
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narrative in SFT
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narratives derives from transactions of shared meanings
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binocular vision
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when cl and thx meaning intermingle to crease deeper meaning
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progressive narrative
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reflects how cl is progressing
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digressive
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moving away from goal
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stability narrative
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life is static for client
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language games in SFT
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creatively misunderstanding call's confusion
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MMPI-2 (T-scores)
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mean 50, SD 10, 65 deviant
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MMPI-2 (Age)
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18 and older
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MMPI-A (age)
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14-18
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MCMI-III (chs)
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175 T/F q, 21 scales, DSMIII theory
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MACI
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adolescent version of MCMI-III
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SCL-90
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self-report, DSM-III, 5pt Likert Scale, 0=not at all
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Rorchach (chs)
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10 cards, 5 b/w, 2 red, 3 pastels
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4 steps of Exner Admin
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allay anxiety, instruction "what might this be", free ass, query
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location
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W - IQ to org. env, Dd - usual detail avoidance
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determinants
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chs of the blot, Form (shape features), F. Quality (degree blot conforms to response)
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content
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many A (children), few H (detachment)
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populars
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many (conventionality or defense) few (rebelliousness, thought disorder)
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special scores
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many (psychosis)
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Draw a Person test
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expression of self or body image, draw man, woman, self
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Strong Campbell Interest Inventory (SCII) valid at...
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more valid at predicting choice than success
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Strong Campbell Interest Inventory (SCII) whose theory
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general occupational themes derived from Holland's theory
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Strong Campbell Interest Inventory (SCII) scales
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Basic Interest (realistic, artistic, social, enterprising, conventional, investigative) and Occupational Scales (124) empirically keyed
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Strong Campbell Interest Inventory (SCII) scales
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Basic Interest (realistic, artistic, social, enterprising, conventional, investigative) and Occupational Scales (124) empirically keyed
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Kuder Vocational Preference Record (KVP-R)
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interest in 10 broad areas (outdoor, computational, scientific, musical, persuasive, artistic, literary, musical social service, clerical)
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Kuder Vocational Preference Record (KVP-R) validity?
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based on content validity
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Kuder General Interest Survey (ages)
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kids 6-12 grade
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neuropsych testing (goals)
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identify impairments, residual strengths, differentiate brain damage from not, degree of deficits on everyday fx, specific rec for rehab, localizing lesions
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Halstead Reitan measures what different areas?
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lateral dominance, psychomotor f., sensory perceptual fx, speech and lang, visuospatial, abstract reasoning, mental flex, attn/concentr.
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how is the Reitan used?
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often supplemented with WAIS-III or WISC-III
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how long to admin Reitan?
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4-5 hours
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Luria Nebraska - how many items and scales?
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239 items on 11 scales plus supp scales
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Luria Nebraska - what does it measure?
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motor, rhythm, tactile, visual, receptive speech, expressive sp, writing, reading, arithmetic, memory, intellprocess
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what are the supplemental scales of the Luria-Nebraska used for?
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severity, acuteness, localization of dysfunction
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Bender Visual Motor Gestalt Test is used for what?
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as a screening device for brain damage and indication of poss. Psych disorders such as mania, seizures, dep, obs, etc
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Bender Gestalt is made up of
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9 designs to re-create and often used with other tests
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Bender Gestalt rel/val
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highly rel/valid in predicting brain damage, emotional problems, school perf
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Illinois test of Psycholinguistic Abilities (ITPA) age
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kids 2-10 yrs old
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Illinois test of Psycholinguistic Abilities (ITPA)used for
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assess channels (auditory/vocal, visuomotor), processes (org, expressing, understanding) & levels (representation, automatic)
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Stroop Color Word Test used to assess for
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frontal lobe damage, try to inhibit color
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Eysenck found what in what year?
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tx=no tx; 1952; 19 studies; only BT > placebo
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Smith and Glass found what when?
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1978; ave. cl at the end of tx is better off than 80% w/out
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Smith and Glass found what ES?
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tx ES .85 >placebo on average; placebo better than nothing
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Rosenthal when and what
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1983 and found 66% of tx show improvement v. 34% of controls
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Smith and Glass found what about BT ?
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not significantly better, just more studies
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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
|
inconsistent
|
|
|
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
|
|
|
emic
|
studying a culture from the inside to see as they do
|
|
|
etic
|
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?
|
Atkinson
|
|
|
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
|
|
|
conformity
|
prefers dominant culture, - flngs towards own culture
|
|
|
dissonance
|
challenges majority values, confusion, conflict
|
|
|
resistance and immersion
|
rejects dominant, endorse min. values, combat oppression, distrust Whites
|
|
|
introspection
|
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
|
C D R PI IE A
|
|
|
contact
|
first stage - make contact with minority
|
|
|
disintegration
|
increased awareness of inequalities leads to conflict
|
|
|
reintegration
|
justify inequality and see White as superior - may fixate here
|
|
|
psuedo-independence
|
dissatisfactions with reintegration stage
|
|
|
immersion-emersion
|
embrace whiteness without rejecting minorities - learn pride despite hx
|
|
|
autonomy
|
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
|
|
|
pre-encounter
|
identify with majority world view and see assimilation as the answer
|
|
|
encounter
|
become more open to new interpretations
|
|
|
immersion-emersion
|
frantic search after encounter to destroy old identity, denigrate majority
|
|
|
internalization
|
resolution of conflict leading to flexibility and renewal of old friendships
|
|
|
internalization-commitment
|
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
|
uncertain
|
|
|
provisional
|
tentative, but uncertain
|
|
|
NOS
|
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?
|
20-50%
|
|
|
common comorbid dx with LD
|
ADD, depression, conduct disorder, ODD
|
|
|
dyslexia
|
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
|
|
|
ADHD
|
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
|
|
|
inattention
|
distracted, careless
|
|
|
hyperactivity
|
fidgety, loud
|
|
|
impulsivity,
|
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,,
|
|
|
Pica
|
non nutritive eating
|
|
|
Rumination
|
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
|
|
|
FAS
|
failure to thrive, dev delays, mild-mod of MR, facial chs (short nose, flat midface); thin
|
|
|
SIDS
|
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
|
|
|
Cannabis
|
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
|
|
|
nicotine
|
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
|
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|
chs of schiz (death rate, prognosis, chornicity)
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die earlier, chronic, best prognosis: f, late onset, precipitating event, fam hx of mood but not schiz, good premorbid adjustment
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type of schiz
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disorganized, catatonic, paranoid, undifferentiated, residual
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disorganized sciz
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regression to primitive, unhibited and uorganized beh.
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catatonic
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psychomotoe disturbance
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undifferetiated type
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doesn't fit neatly into other categoreis
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residual type
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one schiz episode, continue to display negative signs or attentuated + sx (e.g. odd beliefs) but no prominent + psychotic or strong affect
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genetic twin studies say what about schiz
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genetic predisp, but disconcoredance is higher than concordance
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structural brain abnormalityes in sciz
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increased volume oif lateral and third ventricle
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functional brain abnormality in schiz
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decreased blood flowto cortex
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nt imbalance in schiz
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imbalance of norepinephrine, serotonin, and glutamte; clozapine has postive effects (also dopamine hyp)
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genetic risks for schiz
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unrelated: 1%, bio sibs: 10%; Dizygotic twins: 16%; mono twins: 48%
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race effects on schiz
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AF > white but maybe misdx or SES/stressors; whites > sx 3rd world more acute, shorter duration (> ss)
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pharmacological tx have what effects on schiz
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decrease pos. sx but increase neg sx and SE such as Tardive Kinesia; best in combo w/ social skills traing and fam tx
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schizophreniform dis
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sx 1mo-6mo; better prognosis
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schizoaffective dis.
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have both sx; mood must be present for subst. part of illness but psychotic features > prominent than Mood Dis w/ psychptic features
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schizoaffective dis - mood issues
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at least 2 wks without mood but w/ psychotic sx
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delusional disorder
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no other odd behaviors or fx impairment but had delusion (e.g. grandeur, erotomania, somatic, etc.)
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briefr psychotic disorder
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< mo., full remission, w/ marked stressor, w/out marked stressor, w/post partum onset; r/o subtances
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circumstantiality
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point elaborated on in detail
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loose associations
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point lost (vs. elaborated on)
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bipolar disorder v depressive disorder
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1 or more episodes of mania, mixed, or hypomanic w/ hx of depression v. depression w/out mania
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manic episode
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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
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hypomanic episode
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not as severe, no need for hosp, no impaired fx, 4 days (not a week)
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mixed episode
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at least 1 wk almost everyday both manic and dep episodes; high to low quickly
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major dep episode
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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
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bipolar 1 , single manic episode
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no past depresive episodes
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bipolar 1 most recent episode hypomanic
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current plus at least one manic or mixed and signficant distress
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bipolar 1,most recent episode manic
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current plus at elast one major dep,mixed, or manic
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bipolar 1, most recent episode mixed
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current plus at least 1 major dep, manic, or mixed
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Bpiolar 1, most recent episode depressed
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current plus at least 1 mixed or manic (only one requiring depression)
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bipolar 1, most recent episode unspecified
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at least 1 manic or mxed in past
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Bipolar II
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1 or more dep. Episodes and at least 1 hypomanic episode and must never had a manic or mixed episode and must --> sig distress
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cyclothymic disorder
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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
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major depressive disorder
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1 or more mo w/out manic
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chs of dep (uni v bi, % second episode, w v m)
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uni > suicide, 2x more women, 50-605 have 2nd ep in 2 years
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,multiple roles effect on depression
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reduces it
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postpartum depression
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10-20% severe for 2-8wsk (some > ; onset 4 wks from birth
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dythymia disorder
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less severe than depresion, 2 yrs or longer; chronic but few impairments
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double depression
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major depresion and dythymia, very poor prognosis
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etiology of dep/bi
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genetic > bipolar, stress, catehcolemine (low - dep; high - mania); intrapsychic ambivalence
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tx for bipolar
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lithium
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tx for depression
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antidep (tricyclics, SSRI's, MAOI for atypical w/ anxiety/OCD) help 60%, CBT, IPT, BT (low effect)
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ECT
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helpful on right side
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CBT v phram
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some support for additive effect, but most CBT better
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anxiety
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expression of an or avoidance of triggers
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panic attacks
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discrete intense sense of doom, 4 cog/som sx; devlop suddenly, reach peakin 10 min
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agoraphobia
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fear of being in a place diff to escape or no help
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panic disorder w/ or w/out agoraphobia
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at least 1 mo of chronic worry @ panic attacks
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agoraphobia in kids
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, not seen in kids b/c can't catasrophize
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etiology of panic disorder
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hihglevels of sodium lactate, genetic
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phobic disorders
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agoraphobia, social phobia, specific phobia
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agoraphobia w/out hx of panic disorder
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fear of devloping panic sx
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social phobia
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recognize fear is unreasonable plus sig. distress/impairment
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specific phobia
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exposure leads to panic attack
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etiology of panic disorder
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classically cond, conflict d/t unacceptable impulses, bio prepped stimuli (Seligman)
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tx for panic disorder
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antidepressants reduce agoraphobic anxiety and best fo social, exposure w/ response rpevnetion (exitnguishes), imaginal exposure helpful for specific,
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ocd comorbidity and correlates
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often comorbis w/ dep., > SES and IQ
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ocd treatment
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flooding for compulsions but obsessions diff. to reduce; use clomiprimine and fluoxetine to reduce sx
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PTSD
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exposure to event where death/serious injury possible and rxn is fear/helplessness/horror
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sx of PTSD
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for >1 mo,. - reexperiencing, avoidance of related stim and numbing of general responsivness, sx or persistant heightened arousal
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sx of heightened arousal
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hypervigilance, irritiability, reduced sleep, impaired concentration
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PTSD can be (time)
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acute or chronic and delayed or immediate
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tx for PTSD - preventative
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crisis intervention (prevents delayed/chronic);
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tx for PTSD- current
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CBT/BT (system. Des.); relaxation/hypnosis (motor tension/arousal); antidep for flashbcks;
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tx for PTSD - preferred
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STT b/c suggests regain control
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prgonsis for PTSD
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gets worse if delayed and chronic
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EMDR
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combines CBT & Cl Centered w/ eye mvmnts
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path of EMDr
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describe --> eye --> "what comes up" --> eye --> anxiety lower
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effectivness of EMDR
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as effective as exposure (> than no tx) and eye mv not nec.
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acute stress disorder
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PTSD w/out sx lasting > 1 mo and immediate occurnace
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Generalized Anxiety Disorder
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excess worry over life circumstances; lasts > 6mo
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chs sx of Gen. Anx. Disorder
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difficulty controlliong worry; restless, fatigue, concnetration, iritable, sleep, tension; r/out sub abuse
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tx gen anx disorder
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BT plus CT - progressive relaxation; CBT most effective w/ LT benefits
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best prognosis with gen anx
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worries specific and high expectations of tx
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