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274 Cards in this Set

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  • Back
What are the four types of cost analysis?
• Cost benefit analysis (CBA)
 Involves determining the costs and benefits of a particular intervention in monetary terms and then comparing the total costs with the total benefits
 This method is often used to compare different intervention options for a particular disorder
• Cost effectiveness analysis (CEA)
 Used to determine the costs and metnal health outcomes of two or more interventions in order to identify the intervention that is most effective (i.e., produces the greatest benefits for the least cost)
 Useful when it is not possible to assign a monetary value to an intervention’s outcomes
• Cost minimization analysis (CMA)
 Use dto determine the least costly option among several options that produces equivalent outcomes
 CMA might be used, for example, to determine if paraprofessionals can provide services that are comparable to those provided by professionals at a lower cost
• Cost utility analysis (CUA)
 Involves attributing a monetary value to various quality-of-life or other relevant client outcome measures in order to evaluate the impact of one or more interventions
Why is cost analysis conducted?
• To determine the optimal allocation of financial resources (i.e., identify the most cost effective method for delivering training to interns or entry level clinicians)
How do Jungian therapists view transference?
- View client’s transferences to be projections of the personal and collective unconscious and consider the analysis of transference to be a crucial part of therapy
- Therapist’s countertransference is also a useful therapeutic tool that can provide the therapist with information about what is actually occurring during the course of therapy
What techniques are primarily used in Jung’s analytical psychotherapy?
• Interpretations that are designed to help a client become aware of his or her inner world
• Because material in the collective unconscious is often expressed symbolically, Jungians are particularly interested in dreams, and the interpretation of dreams is a key component to therapy
• Analysis reflects an optimistic view of human nature and emphasizes the health aspects of the client’s personality
• Focus if the hear-and-now with information from the past being sought only when it will help the client understand the present
What is the primary goal of Jung’s analytical psychotherapy?
To rebridge the gap between the conscious and the personal and collective unconscious
What is Jung’s view of maladaptive behavior?
Symptoms are “unconscious messages to the individual that something is awry with him and present him with a task that demands to be fulfilled
What is a key concept in Jung’s personality theory?
• Individuation – refers to integration of the conscious and unconscious aspects of one’s psyche, leading to the development of a unique identity
• An important outcome of individuation is the development of wisdom, which occurs in the later years when one’s interests turn toward spiritual and philosophical issues
How did Jung view development?
• As continuing throughout the lifespan
• Most interested in growth after the mid-30s
What are the Four basic psychological functions?
• thinking, feeling, sensing, and intuiting
• although all four functions operate in the unconscious of all people, one function ordinarily predominates in consciousness
According to Jung, what are the two attitudes of the personality?
Extraversion & Introversion
According to Jung, what are the archetypes of particular importance to personality development?
• The self, which represents a striving for a unity of the different parts of the personality
• The persona, or public mask
• The shadow, the “dark side” of the personality
• The anima and animus, which are, respectively, the feminine and masculine aspect of the personality
According to Jung, what is the difference between personal unconscious and collective unconscious?
• Personal unconscious – contains experiences that were once conscious but are now repressed or forgotten or were unconsciously perceived
• Collective unconscious – the repository of latent memory traces that have been passed down from one generation to the next
־ Archetypes are included – these are “primordial images” that cause people to experience and understand certain phenomena in a universal way
How does Jung’s analytical psychotherapy define personality theory?
• Personality is the consequence of both conscious and unconscious factors
• Conscious – oriented toward the external world, governed by ego, and represents the individual’s thoughts, ideas, feelings, sensory perceptions, and memories
• Unconscious – made up of the personal unconscious and the collective unconscious
How is Jung’s view of personality development similar and different than Freud’s?
• broader than Freud’s
• defined libido as general psychic energy
• believed that behavior is determined not only by past events but also by future goals and aspirations
In what settings have Adlerian techniques been applied?
• Individual psychotherapy
• Group therapy
• Family and marital counseling
• Parent education
• Teacher-student relationships
• Systematic Training for Effective Teaching (STET) is based on Adler’s approach and assumes that all behavior is goal-directed and purposeful
־ The misbehavior of young children is viewed as having one of four goals – attention, power, revenge, or to display deficiency – with each goal reflecting a desire to belong, accompanied by faulty beliefs about what is needed in order to belong
־ i.e., attention-seeking behavior, for example, stems from the mistaken belief that “I belong only when I’m being noticed or served”
According to Adler, what are the therapy goals and techniques?
• Entails establishing a collaborative relationship with the client
• Helping the client identify and understand his/her style of life and its consequences
• Reorienting the client’s beliefs and goals so that they support a more adaptive lifestyle
• Techniques: use “lifestyle investigation” which yields information about the client’s family constellation, fictional (hidden) goals, and basic mistakes (distorted beliefs and attitudes)
What is Adler’s view of maladaptive behavior?
• Mental disorders represent a mistaken style of life, which is characterized by maladaptive attempts to compensate for feelings of inferiority, a preoccupation with achieving personal power, and a lack of social interest
Freud's structural theory posits the personality with three structures: The ** consists of a person's instincts, which serve as the source of all psychic energy.
The ego mediates conflicts between the ** and reality or superego.
The superego develops at about age ** and represents an internalization of society's valuses and standards.
4 or 5
Freud's developmental theory proposes that an individual's personality is formed during five ** stanges of development.
During each psychosexual stage of development, the id's ** is centered in different parts of the body.
libido (sexual energy)
Anxiety, an essential component of Freud's personality theory, serves to alert the ** to internal or external danger related to a conflict between the id and the superego or reality or to an actual threat in the external environment.
to ward off danger, the ego may resort to one of its defense mechanisms, such as **, which involves avoiding anxiety-arousing instinct by expressing its opposite.
reaction formation
Psychoanalysis entails a combination of techniques, including...
a combination of confrontation, clarification, interpretation, and working through
Recent modifications to the Freudian approach consider the therapist's ** to be an important source of information about a patient as long as it is recognized and managed appropriately.
Adler emphasized the role of ** factors in personality development.
Adler adopted a ** approach that views behavior as being motivated largely by future goals.
According to Jung, what is the personal unconscious?
contains material that was once conscious but is now repressed or forgotten
According to Jung, what is collective unconscious?
contains memories that have been passed down from one generation to the next
According to Jung, what are archetypes?
include the self, the persona, and the shadow. they are part of the collective unconscious and have particular importance for personality development
Object relations theorists consider ** to be a basic inborn drive.
Mahler emphasizes the ** process, which begins at aboutfour months of age, and she attributes many forms of psychopathology to problems during this phase.
According to Kernberg, Borderline Personality Disorder is due to inadequate resolution of ** of objects and object relations into "good" and "bad" components
What is the basis of object relations theory?
• Consider object-seeking (relationships with others) as a basic inborn drive
• Emphasize a child’s early relationships with objects, especially the child’s internalized representations (“introjects”) of objects and object relations
What are the names of the object relations theorists?
• Melanie Klein
Ronald Fairbairn
Margaret Mahler
Otto Kernberg
What is clinical psychology?
concerned with the study, diagnosis, and treatment of psychological and behavioral disorders
Roger's person-centered therapy is based on the assumption that all people have an inherent tendency to **.
Roger's theory proposes that incongruence between ** and experience interferes with the tendency to self-actualize.
What are the 3 facilitative conditions that person-centered therapists provide clients with in therapy.
Unconditional positive regard
Accurate empathy
Genuineness (congruence)
Gestalt therapy is based on what principle?
Each person is capable of living fully as an integrated whole
How does Gestalt therapy view maladaptive behavior?
As a "growth disorder" that occurs when the individual abandons the self for the self-image
According to Gestalt therapy, what are neuroses related to?
Boundary disturbances such as introjection
In Gestalt therapy, what is introjection?
When a person psychologically swallows whole concepts from the environment without full understanding them
In Gestalt therapy, what is the primary curative factor?
In Gestalt therapy, what is needed for awareness?
a full understanding of one's thoughts, feelings and actions
How does existential therapy regard maladaptive behavior?
as a normal part of the human condition
In existential therapy, what is the most important therapeutic tool?
Therapist-client relationship
In existential therapy, what are the four basic psychological needs and one basic physical need?
power, freedom, fun, belonging
basic physical need - survival
In existential therapy, what happens when people do and do not fulfill their needs in a responsible way?
They develop a success or failure identity
What is the client/therapist relationship in Solution-focused therapy?
• Client is viewed as the “expert” while the therapist acts as a consultant/collaborator who poses questions designed to assist the client in recognizing and using his/her strengths and resources to achieve specific goals
What is the view of maladaptive behavior according to Solution-focused therapy?
• Focus on solutions to problems
• Believe that understanding the etiology or attributes of problem behavior is irrelevant
What are the two primary goals of interpersonal therapy?
symptom reduction and improved interpersonal functioning
In interpersonal therapy, interventions typically address what problem areas?
grief, interpersonal role disputes, role transitions, and/or interpersonal deficits
Where were the basic assumptions of motivational interviewing derived from?
• Rogers’ client-centered therapy and Bandura’s notion of self-efficacy
• With regard to client-centered therapy, motivational interviewing stresses therapist empathy, reflective listening, and responding to client resistence in a nonconfrontational way
• In terms of self-efficacy, it explicitly addresses the client’s beliefs about his/her ability to change
Why was motivational interviewing developed?
• Developed specifically for clients who are ambivalent about changing their behaviors
• Consistent with the transtheoretical model of behavior change, motivational interviewing recognizes five stages of change
What is an important assumption of the transtheoretical model of behavior change?
• An intervention will be most effective when it matches the person’s stage
What is the maintenance stage?
• Behavior change has lasted for at least 6 months and the person is taking steps to prevent relapse
What is the action stage?
• The individual actually takes steps to bring about change
What is the preparation stage?
• The person has a clear intent to take action within the next month
What is the contemplation stage?
• The person is aware of the need for change, is considering change in the next 6 months, but it not yet committed to it
What is the precontemplation stage?
• The individual has little insight into the need for change and does not intend to change
According to the transtheoretical model of behavior change, what are the five stages of change?
• Precontemplation stage
• Contemplation stage
• Preparation stage
• Action stage
• Maintenance stage
How does the transtheoretical model of behavior change view maladaptive behavior?
• Does not address the etiology or characteristics of maladaptive behavior, but, instead, focuses on factors that facilitate behavioral change
What does the transtheoretical model of behavior change propose?
• The process of change is essentially the same regardless of the target behavior
• Optimal interventions are those that match the individual’s stage of change
• Originally developed as an intervention for cigarette smoking and other addictive behaviors, it has since been applied to a wide range of other behaviors
What is the transtheoretical model of behavior change based upon?
• 18 leading approaches to therapy, which led to the identification of ten basic change processes
• e.g., consciousness-raising, contingency management, helping relationships
What names are typically associated with the transtheoretical model of behavior change?
• Prochaska and DiClemente
The various models of family therapy have been influenced by general systems theory and view the family as primarily an ** system that receives input from and discharges output to the environment.
In family therapy, what is a negative feedback loop?
provides the family system with information that helps it maintain the status quo
According to family therapy, what type of communication is associated with Schizophrenia?
What are the two types of communication patterns according to family therapy?
symmetrical communication - participants are equal
complementary communication - participants are unequal and the differences between them are maximized
According to Bowen, when family members have low levels of self-differentiation, they easily ** with other family members, which can result in an undifferentiated family ego mass.
According to Bowen, what is the emotional triangle?
Develops when a two-person system recruits another person into the system in order to increase stability and reduce tension.
For Bowenians, the assessment of a family often includes construction of a **.
genogram - depicts the relationships between family members
Practitioners of structural family therapy view maladaptive behavior as being related to boundaries that are too rigid or, at the other extreme, overly **.
diffuse or permeable
According to Minuchin, what is a stable coalition?
when a parent and child consistently "gang up" against the other parent
What is the first step in structural family therapy?
joining - entails "blending" with the family by adopting its style
Strategic family therapy emphasizes the impact of ** on maladaptive behavior and, in particular, how it is used to control one's relationships.
According to Strategic family therapy, an ** unpleasant task that a client must perform when he/she engages in symptomatic behavior.
What are some of the techniques used by Milan systemic family therapists?
hypothesizing, neutrality, circular questions
used to help family members recognize the differences in their perceptions
What is the primary goal of object relations family therapy?
to resolve each family member's attachment to family introjects, which entails interpreting **, resistances, and other factors to foster insight.
According to Yalom, in the third stage of group therapy, ** developms, self-disclosure increases, attendance improves and members who concern whenever a member is absent.
According to Yalom, to establish group norms, the therapist adopts two roles - technical expert and **.
What curative factors are group members most likely to rate as the most important according to Yalom?
interpersonal input
** and post-selection preparation are useful ways to reduce premature termination and enhance the outcomes of group therapy.
Feminist therapy assumes that intrapsychic events always occur within an ** context.
oppressive social
Feminist therapists are less interested in fitting a client to the mainstream and more in ** the client so that she is more self-defining and self-determining.
Nonsexist therapists place more emphasis on modifying **.
personal behavior
Feminist therapists focus more on **.
social change
Feminist object-relations theorists trace gender differences to differences in which relationships?
Feminist object-relations theorists believe that females are encouraged to stay attached to their mothers and males are encouraged to **.
What is hypnosis according to Orne and Dinges?
• Involves experiencing alterations of memory, perception, and mood in response to suggestions and characterize its essential feature as “subjective experiential change”
What are the rates of premature termination in group therapy?
10-35% of group members drop out of therapy during the first 12 to 20 sessions
According to research on the curative factors of group therapy, what do group members typically find most important? Least valuable?
• Most important – interpersonal input, catharsis, self-understanding, and cohesivenes
Least valuable – family re-enactment, guidance, and identification
Who developed Milan systemic family therapy?
• Mara Selvini-Palazzoli
• Trained as a child psychoanalyst but altered her therapy techniques when she found a family systems approach to be more effective for treating anorectic children
What is a paradoxical intervention according to strategic family therapy?
• Uses the client’s resistance in a constructive way (by resisting the directive, the client ends up abandoning his/her dysfunctional behavior)
The first goal of most crisis interventions is to alleviate the individual's current symptoms. This is followed by restoring the client to his/her **.
previous level of functioning
** are most frequent callers to suicide hotlines.
young white females
What are the three types of prevention programs?
Primary, Secondary, Tertiary
What is a Primary Intervention Program?
make an intervention available to all members of a particuar group or population
What is a Secondary Intervention Program?
emphasize early detection and intervention and target specific indidviduals
What is a Tertiary Intervention Program?
aimed at reducing the duration and consequences of a meanl disorder
What is the Health Belief Model?
health-related behaviors are related to a person's perceptions about susceptibility to illness and teh severity of its consequences
What are the 4 stages of consultation?
entry, diagnosis, implementation, disengagement
What is a formative evaluation?
conducted to assess the consultation process
What is a summative evalution?
conducted to assess the consultation project
According to Caplan, what are the four types of mental health consultation?
Client-Centered Case Consultation, Consultee-Centered Case Consultation, Program-Centered Administrative Consultation
and Consultee-Centered Administrative Consultation
What is Client-Centered Case Consultation?
• Type of mental health consultation
• Involves working with the consultee (e.g., teacher or therapist) to develop a plan that will enable the consultee to work more effectively with a particular client (e.g., student or patients
• The consultant acts as an expert and provides the consultee with as much relevant information as possible
What is Consultee-Centered Case Consultation?
• Type of mental health consultation
• Goal is to enhance the consultee’s performance in delivering services to a particular population or group of clients
• Focus is on the consultee’s skills, knowledge, abilities, and/or objectivity
• A lack of objectivity can stem from several factors including theme interference, a type of transference that occurs when a past unresolved conflict related to a particular type of client or circumstance is evoked by and interferes with the consultee’s current situation
What is Program-Centered Administrative Consultation?
• Type of mental health consultation
• Involves working with one or more administrators (the consultees) to resolve problems related to an existing program
What is Consultee-Centered Administrative Consultation?
• Type of mental health consultation
• Goal is to help administrative-level personnel improve their professional functioning so they can be more effective in the future with regard to program development, implementation, and evaluation
Eysenck concluded that the apparent effects of psychotherapy are due to **.
spontaneous remission
The effectiveness of various psychoogical interventions for older adults is generally ** to younger adults.
According to Howard et. al., duration of therapy has a positive correlation with outcomes, at least up to about ** sessions.
Howard et. al.'s phase model predicts that ** (remediation) requires about 16 therapy sessions.
symptomatic relief
A current debate in the literature is whether efficacy or ** studies are more useful for assessing psychotherapy outcomes
In psychotherapy research, placebo control groups most often provide subjects with ** factors.
nonspecific or common
The term ** was originally used to describe the tendency of health practitioners to attribute all problems to mental retardation in individuals with this diagnosis.
diagnostic overshadowing
What is some of the data about the demographic characteristics of psychiatric inpatients?
• Marital status – lowest among the widowed, intermediate for those who are married or divorced/separated and highest for never married
• Race/ethnicity – patients from races other than whites are overrepresented
• Age – 25-44 largest proportion of admissions
• Diagnosis – schizophrenia is the most common diagnosis (18 to 44 range); patients 65 and older – organic disorder is most common, followed by an affective disorder
What is the ratio of admission rates to state and country psychiatric hospitals of men versus women?
• Rates are higher for men
• This discrepancy is due to the fact that men are more likely to exhibit “acting out” behaviors that are considered more threatening by society than anxiety and depression, which are the most common symptoms among women
• Also note that the increase in the male to female ratio that began in the mid-1960s reflects the change in emphasis in commitment criteria from “psychopathology” to “perceived dangerousness”
What is the ratio of mental illness in men versus women?
Higher among females
What are common sources of work-related distress?
• Suicidal statements
• Lack of therapeutic success
• Issues related to confidentiality
What is the research on therapist distress?
• 74.3% of participants said they had experienced personal distress in the past three years
• 36.7% said it decreased the quality of their work
• 4.6% admitted that it resulted in inadequate treatment
What is the relationship between treatment length and outcome?
• Research by Howard and his colleagues indicates that the relationship between treatment length and outcome “levels off” at about 26 sessions
• About 75% of patients show measurable improvement at 26 sessions and at 52 sessions, the number increases to only about 85% (does-dependent effect)
According to research, what is the most effective psychological intervention for older adults?
• They respond well to a variety of forms of psychotherapy and can benefit from psychological interventions to a degree comparable with younger adults…though often responding more slowly
What are the most common mental health problems among older adults?
• Anxiety
• Severe cognitive impairment
• Depression
Sue et al. found that, as a group, ** clients have the least favorable treatment outcomes.
African Americans
Sue et al. found that overall, while client-therapist matching in terms of ethnicity, culture, or race may reduce ** and increase treatment length, it does not have a predictable effect on therapy outcome.
premature termination
Sue and Sue (2002) propose that cultural competence involves what three competencies?
awareness, knowledge and skills
According to Wrenn, what are culturally encapsulated counselors?
define everyone's reality according to their own cultural assumptions and stereotypes
What is high-context communication according to Hall?
relies heavily on shared cultural understandings and nonverbal cues
Landrum and Batts propose that exposure to racial oppression can result in **, which may be manifested as system beating, blaming the system, or denying the political significance of race.
internalized oppression
Ridley proposes that nondisclosure by African American clients may be due to healthy ** paranoia and/or functional paranoia.
Herek proposes that ** is a more precise term than homophobia.
sexual prejudice
DSM-IV-TR is a ** classfication system.
To allow for heterogeneity, it includes a ** criteria set.
The GAF scale is used to rank the individual's psychological, social, and occupational functioning on a scale from **.
Diagnostic uncertainty about a person's condition can be indicated by coding Diagnosis (or Condition) Deferred, **, or (Class of Disorder) Not Otherwise Specified.
Specific Diagnosis (Provisional)
What is the DSM?
• American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders
• First edition was published in 1952
• Current version published in 2000
• Categorical classification system that divides the mental disorders into types that are defined by a set of diagnostic criteria
A diagnosis of Mental Retardation requires an IQ of ** or below, deficits in ** functioning; and an onset of symptoms prior to age **.
70; adaptive; 18
Down Syndrome accounts for about 10 to 30% of all cases of moderate to severe retardation and is caused by the presence of an extra **.
** is a recessive gene disorder that involves an inability to metabolize phenylalanine.
A Learning Disorder is diagnosed when a person's score on a measure of academic achievement is substantially below his or her score on a(n) ** test.
The onset of Stuttering is most often between the ages of ** and may be effectively treated with **, which combines regulated breathing, awareness training, and social support.
2 and 7; habit reversal
A diagnosis of Autistic Disorder requires evidence of qualitative impairments in **, qualitative impairments in communication, and the presence of ** behaviors and interests.
social interaction; restricted, repetitive, and stereotyped
Autistic Disorder has a better prognosis is associated with the development of ** by age 5 or 6, an IQ of 70 or above, and a later onset of symptoms.
verbal communication skills
In terms of treatment, ** were originally used by Lovaas and continue to be used to increase communication skills.
shaping and discrimination training
Wehn a child exhibits a characteristic pattern of head growth deceleration, loss of hand skills, and impaired coordination following a period of normal development, the diagnosis is **.
Rett's Disorder
When a child shows impairments in social interaction and a restricted repertoire of behaviors without significant delays in language, self-care, or cognitive skills, and likely diagnosis is **.
Asperger's Disorder
What does the research say regarding cultural/ethnic groups and therapy?
• Regardless of cultural/ethnic group, people benefit from therapy
• There are some differences – Hispanic Americans had the best outcomes, followed, in order, by Anglo, Asian, and African Americans
What does racial/ethnic identity refer to?
• A person’s perception that he or she shares a common racial or ethnic heritage with a specific group
What are some commonly-cited models of racial/ethnic and gay/lesbian identify development?
• Racial/Cultural Identity Development Model (Atkinson, Morten, and Sue, 1993)
• Black Racial (Nigrescence) Identity Development Model (Cross, 1991)
• White Racial Identity Development Model
• Homosexual (Gay/Lesbian) Identity Development Model (Troiden)
What are some factors to be aware of when working with Hispanic/Latino Americans?
• Emphasize family welfare over individual welfare
• View interdependence as both healthy and necessary and highly value connectedness and sharing
• Consider discussing intimate personal details with strangers as highly unacceptable, and believe that problems should be handled within the family or other natural support systems
• Adopt a concrete, tangible approach to life (rather than an abstract, long-term perspective)
• Attribute the control of life events to luck, supernatural forces, acts of God, or other external factors
What are the 5 Axes of the DSM?
• Axis I
־ Clinical Disorders
־ Other Conditions That May Be a Focus of Clinical Attention
־ Example: Major Depression, Recurrent
• Axis II
־ Personality Disorders
־ Mental Retardation
־ Example: Paranoid Personality Disorder
• Axis III
־ General Medical Conditions
־ Example: Hearing Loss
• Axis IV
־ Psychosocial and Environmental Problems
־ Example: Unemployment; Inadequate Finances
• Axis V
־ Global Assessment of Functioning
־ Example: GAF = 30 (current); 65 (highest in past year)
ADHD is characterized by a persistent, developmentally-inappropriate pattern of ** and/or hyperactivity-impulsivity.
A diagnosis of ADHD requires an onset of symptoms prior to age ** and evidence of impairment in at least two different settings.
It has been estimated that up to ** percent of individuals with this disorder continue to experience problems related to school, work, or family in adulthood.
According to the ** hypothesis, ADHD is not due to attentional deficits but to an inability to regulate one's behavior to fit the demands of the situation.
behavioral disinhibition
A combination of ** and psychosocial interventions is most effective for ADHD.
CNS stimulant (methylphenidate)
Conduct Disorder is characterized by a pattern of behavior that violates the rights of others and/or **.
age-appropriate social rules
According to Moffit, ** conduct problems are often a result of a "maturity gap".
** is characterized by a persistent eating of non-nutritive substances.
** is diagnosed in the presence of at least one vocal tic and multiple motor tics.
Tourette's Disorder
Treatment for Tourette's Disorder often includes a(n) ** drug.
Enuresis is usually treated with the **, which wakes the child up when he or she urinates in bed at night.
night alarm (bell-and-pad)
Children with ** exhibit inappropriate, excessive anxiety when separation from home or attachment figures occurs or is anticipated.
Separation Anxiety Disorder
When a child exhibits disturbed social relatedness in multiple settings prior to age 5, the diagnosis may be **.
Reactive Attachment Disorder
What has been found to be useful for reducing anxiety about medical procedures and the pain they cause in children?
• Multicomponent cognitive-behavioral interventions
• These are based, in part, on Meichenbaum’s stress inoculation model and involve providing the child with information about the procedure and using a variety of techniques to help the child cope with anxiety and stress
• Commonly-used techniques include filmed modeling, reinforcement, breathing exercises, emotive imagery/distraction, and behavioral rehearsal
** have particular difficulty complying with medical regimens.
According to studies, what is the risk for children who are hospitalized?
• They are at risk for emotional and behavioral disorders
• A major contributor to this risk is the child’s separation from his or her family
• Recognition of the impact of separation led to increased visitation hours in hospitals and “rooming-in” (allowing parents to stay with hospitalized children 24 hours per day
What do studies say regarding compliance with medical regimens and chronically ill children and adolescents?
• Common problem
• Linked to several factors: lack of knowledge or skill, parent-child conflict and communication difficulties, and developmental issues
• Compliance is a particular difficulty for adolescents and that noncompliance during this period is often related to concerns about peer acceptance, reduced conformity to rules, questioning of the credibility of the healthcare provider, and/or reduced parental supervision
What do studies say with regard to school adjustment of youth with chronic medical conditions?
• Higher rates of school-related problems than other children and adolescents
• In some cases, these difficulties are the direct result of the illness itself
• In others, they are caused by the treatment or by the child’s frequent absences from school
• Treatment can also lead to a higher-than-normal rate of learning disabilities and neurocognitive functioning deficits
What is recommended with regard to disclosure and children and illness?
• In most situations, open communication with a child about his/her illness is advisable
• Studies of children with cancer, for example, have found that children who are told about their diagnosis in the early stages of treatment cope better than those who learn about the diagnosis later
• Disclosure must involve developmentally appropriate language and procedures
What is behavioral pediatrics?
• Pediatric psychology
• Branch of behavioral medicine that is concerned with the psychological aspects of children’s medical illnesses
What is Reactive Attachment Disorder of Infancy or Early Childhood?
• Essential features is markedly disturbed and developmentally inappropriate social relatedness in most settings that begins prior to age 5
• Diagnosis requires evidence of pathogenic care (e.g., neglect or frequent changes in caregivers that prevented the development of attachment)
• The Inhibited Type is characterized by a persistent failure to initiate and respond to most social interactions and involves a pttern of inhibited, hypervigilant, or highly ambivalent responses
• The Disinhibited Type involves indiscriminate sociability or a lack of selectivity in the choice of attachment figures
How is Separation Anxiety Disorder manifested?
• School refusal, which involves intense anxiety about going to school and is usually accompanied by a stomachache, headache, nausea, and other physical symptoms
• School refusal often occurs at three different ages: 5-7 years (child first begins school), 11-12 years (when child changes schools). And at 14 years or older
• School refusal manifested between the ages of 5-7 is most likely due to separation anxiety
• When it occurs during adolescence, it is frequently a first sign of depression or other more severe disorder
• Most authorities agree that any intervention should include an immediate return to school
What is Separation Anxiety Disorder?
• Involves developmentally inappropriate, excessive anxiety related to separation from home or attachment figures
• The disturbance must last for at least 4 weeks, the onset of symptoms must be before the age of 18, and at least 3 characteristic behaviors must be present (e.g., excessive distress when separated from home or attachment figures; persistent fear of being alone, frequent physical complaints when separation from attachment figures occurs or is anticipated)
• These children often come from close, warm families, and their symptoms are frequently precipitated by a major life stress such as the death of a relative or pet or a move to a new neighborhood
What are the Tic disorders?
• Tourette’s Disorder
• Chronic Motor or Vocal Tic Disorder
• Transient Tic Disorder
According to the DMS-IV-TR, what is a tic?
• A sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization…that is experienced as irresistible but can be suppressed for varying lengths of time
• Motor tics include eye blinking, facial grimicing and gestures, jumping, smelling objects, and echokinesis (imitating someone else’s movements)
• Vocal tics include grunting, snorting, barking, echolalia, coprolalia (repeating socially-undesirable words) and palilalia (repeating one’s own sounds and words)
What is pica?
• Involves persistent eating of nonnutritive substances (paint, plaster, insects, clay) for at least one month without an aversion to food
• Behaviors if inappropriate for the person’s developmental level and is not part of a culturally-sanctioned practice
• Onset of disorder is most often between the ages of 12 and 24 months
• Occasionally found in pregnant women
What is Oppositional Defiant Disorder?
• Essential feature is a recurrent pattern of negativistic, defiant, and hostile behaviors toward authority figures
• Characteristic symptoms include: often loses temper, argues with adults, actively defies or challenges the rules or requests of adults, deliberately annoys people, blames others for own mistakes or misbehaviors, is angry and resentful, and is spiteful or vindictive
What is the treatment for Conduct Disorder?
• most effective when they target pre-adolescents (rather than adolescents) and when they include a family intervention
• family intervention – Patterson and his colleagues (1992) have developed parent management training, which teaches parents to reward the positive behaviors of their children and replace physical punishment with time-out, response cost, and similar techniques
What are the 2 subtypes of Conduct Disorder?
• Childhood-Onset Type – when symptoms occur prior to age 10
• Adolescent-Onset Type – symptoms begin at age 10 or later
• Childhood-Onset Type is associated with a higher degree of aggressiveness and a greater risk for an eventual diagnosis of Antisocial Personality Disorder and/or Substance-Related Disorder
What is the Diagnostic Criteria for Conduct Disorder?
• Requires the presence of at least three characteristic symptoms during the past 12 months
• Symptoms are divided into 4 categories: aggression to people and animals, destruction of property, deceitfulness or theft, and serious violation of rules
Delirium is characterized by a disturbance in ** that is accompanied by impairments in cognition and/or abnormalities in **.
consciousness, perception
Delirium symptoms typically develop rapidly and ** in severity during the course of the day.
Treatment for delirium involves providing the indivdiual with an environment that is designed to minimize ** an may include administration of an antipsychotic drug.
Dementia is characterized by impaired ** and evidence of at least one other cognitive disturbance (e.g., apraxia, agnosia)
One distinction between Dementia and pseudodementia (depression) is that, in the former, deficits in declarative memory are most obvious, which in the latter, impairments in ** memory are most salient.
Alzheimer's disease, the single-most common cause of Dementia, usually begins with ** amnesia and deficits in visuospatial skills. This is followed by increasing ** amnesia, fluent aphasia, and ideomotor apraxia.
anterograde, retrograde
** Dementia is caused by cerebrovascular disease and is characterized by a ** fluctuating course.
Vascular, stepwise
The most salient symptoms of ** disease are bradykinesia, rigidity, and resting tremor, while ** disease involves Dementia, chorea, and athetosis.
Parkinson's, Huntington's
What is behavioral family therapy based upon?
• Principles of operant conditioning, social learning theory, and social exchange theory
• Included in this category are behavioral marital therapy, behavioral parent training, and conjoint sex therapy
What is the view of maladaptive behavior according to behavioral family therapy?
• Maladaptive behavior, like all behavior, is learned and maintained by its consequences
What are the therapy goals of behavioral family therapy?
1. Increasing the couple’s recognition and initiation of pleasurable interactions
2. Decreasing the couple’s aversive interactions (negative exchanges)
3. Teaching the couple effective problem-solving and communication skills
4. Teaching the couple to use a contingency contract to resolve persisting problems
What are the therapy techniques of behavioral family therapy?
• Establishing a therapeutic relationship with the family, making a behavioral assessment of the family’s problems
• Using reinforcement, modeling, and other behavioral strategies to foster change in family members
What is the view of maladaptive behavior, according to object relations family therapists?
• The result of both intrapsychic and interpersonal factors
• One source of dysfunction is projective identification – occurs when a family member projects old introjects onto another family member and then reacts to that person as though he/she actually has the projected characteristics or provokes the person to act in ways consistent with the projected characteristics
What is the primary therapy goal of object relations family therapy?
• To resolve each family member’s attachment to family introjects
According to Yalom, what is cohesiveness?
• The client’s relationship to the group therapist, other group members, and the group as a whole
• Critical aspect of group therapy
• Yalom describes it as the analogue of the therapist-client relationship in individual therapy
A diagnosis of Substance Dependence requires at least ** characteristic symptom during a 12-month period, while Substance Abuse requires the presence of ** or more symptoms.
The research has shown that the most common precipitant of relapse in Alcohol and other Substance Dependence is **.
a strong negative emotion
According to Marlatt and Gordon, the potential for relapse is reduced when the indivdiual attributes his/her drinking to ** factors.
specific, external, and controllable
The majority of cigarette smokers are ** to nicotine and, consequently, a fear of ** is a major barrier to cessation.
addicted, withdrawal
Effective treatments for nicotine dependence incorporates three elements - nicotine replacement therapy, ** therapy, and support and assistance from a clinician.
multicomponent behavior
Alcohol ** is characterized by inappropriate sexual and aggressive behavior, emotional lability, slurred speech, incoordination, and impairments in memory or judgment.
** invovles autonomic hyperactivity, insomnia, psychomotor agitation, and transient illusions or hallucinations afer a period of heavy or prolonged alcohol use.
Alcohol withdrawal
Korsakoff Syndrome (Alcohol-Induced Persisting Amnestic Disorder) involves retrograde and anterograde amnesia and confabulation and is believed to be due to a ** deficiency.
** and Cocaine Intoxication are both characterized by euphoria, hyperactivity, anxiety, dilated pupils, perspiration, and nausea.
** Intoxication is marked by restlessness, nervousness, flused fact, and diuresis.
What are the symptoms of caffeine intoxication?
• Low doses – restlessness, nervousness, excitement, insomnia, flushed fact, diuresis, and gastrointestinal problems
• High doses – muscle twitching, rambling thoughts or speech, cardiac arrhythmias, and psychomotor agitation
What are the symptoms of Amphetamine or Cocaine Withdrawal?
• Dysphoric mood, fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, and psychomotor agitation or retardation following heavy or prolonged use
• Withdrawal after an intense, high-dose use can cause a “crash” that involves intense lassitude and depression
What is Amphetamine or Cocaine Intoxication?
• Characterized by a maladaptive behavioral and psychological changes (euphoria, anxiety, hyperactivity, grandiosity, confusion, anger, paranoid ideation, auditory hallucinations), tachycardia, elevated or lowered blood pressure, dilated pupils, perspiration or chills, nausea or vomiting, with loss, psychomotor agitations, muscular weakness, confusion, and seizures
What is Alcohol-Induced Sleep Disorder?
• Usually of the Insomnia Type and can be the result of either Intoxication or Withdrawal
• When produced by Intoxication, it involves a period of increased sleepiness followed by increased wakefulness, restlessness, and vivid anxiety-arousing dreams
• When produced by Withdrawal, the disorder involves a severe disruption in sleep continuity with vivid dreams
What is Alcohol-Induced Persisting Amnestic Disorder (Korsakoff Syndrome)?
• Characterized by retrograde and anterograde amnesia
• Confabulation (attempts of compensate for memory loss by fabricating memories
• Believed to be due to a thiamine deficiency
• Anterograde amnesia is most severe, especially for declarative memories
• Often preceded by Wernicke Syndrome, which involves ataxia, abnormal eye movements (e.g., nystagmus, double vision), and confusion
• The co-occurrence of the two disorders is referred to as Wernicke-Korsakoff Syndrome
A diagnosis of Schizophrenia requires a duration of the disturbance for at least ** months with one month of ** phase symptoms (delusions, hallucinations, disorganized speech and behavior).
six; active
The onset of Schizophrenia is most often between ** for males and between ** for females.
18-25; 25-35
The Paranoid subtype of Schizophrenia is characterized by preoccupation with one or more ** or hallucinations.
The ** Type of Schizophrenia involves disorganized speech and behavior and flat or inappropriate affect.
A genetic etiology for Schizophrenia is suggested by studies showing that the condordance rate for biological siblings is about ** percent, while the rate for monozygotic (identical) twins is ** percent.
10; 48
Until relatively recently, the ** hypothesis was the most widely-accepted neurochemical theory of Schizophrenia.
The dopamine hypothesis has been modified by research suggesting that Schizophrenia is also related to elevated levels of **.
norepinephrine and serotonin
Of the structural brain abnormalities linked to Schizophrenia, ** have been found in the largest proportion of patients.
enlarged ventricles
Treatments for Schizophrenia often include traditional ** drugs, which are most effective for eliminating the ** symptoms of the disorder.
antipsychotic; positive
Advantages of clozapine and other atypical antipsychotics are that they are less likely to cause ** and may be effective for negative symptoms.
tardive dyskinesia
Family interventions for Schizophrenia are beneficial, especially when they target high levels of **.
expressed emotion
What is the difference between Schizophreniform and Schizoaffective?
Schizophreniform - symptoms duration is one to six months
Schizoaffective - mood and psychotic symptoms occur concurrently with a period of at least two weeks when delusions and hallunications occur alone
A diagnosis of Delusional Disorder requires the presence of ** delusions.
What are the criteria for Brief Psychotic Disorder?
• Characterized by delusions, hallucinations, disorganized speech, and/or grossly disorganized or catatonic behavior
• presents for at least one day but less than one month
• eventual return to full premorbid functioning
• Onset of this disorder often follows an overwhelming stressor
What are the subtypes of Delusional Disorder?
• Erotomanic: belief that someone is romantically in love with the individual
• Grandiose: the individual has great (but unrecognized) talent or insight or has a special relationship with a prominent person
• Jealous: the individual believes that his/her spouse or lover is unfaithful
• Persecutory: the individual is being conspired against, cheated, spied on, poisoned, etc.
• Somatic: involves bodily functions or sensations
What is the rate of Major Depressive Disorder in women in relation to men?
Twice the rate of men
What are common symptoms of MDD in children?
somatic complaints and irritability are common
What are common symptoms of MDD in the elderly?
cognitive impairments that may resemble Dementia
What is the catecholamine hypothesis?
that depression is due to a deficiency of norepinephrine
What is Seligman's notion of learned helplessness?
links depression to internal, stable and global attributions for negative events
What is Beck's theory of depression?
links depression to a "cognitive triad", which is characterized by negative beliefs about oneself, the world, and the future
For which depressive symptoms are TCAs most effective?
vegetative symptoms and more severe symptoms in the morning
For which depressive symptoms are SSRIs most effective?
melancholic depressions
What did the NIMH study find regarding effectiveness of treatment for depression?
imipramine, cognitive therapy and interpersonal therapy are about equally effective but cognitive therapy is slightly more effective for reducing relapse
Seasonal Affective Disorder may be related to ** and alleviated by **.
elevated melatonin; phototherapy
What is required for a diagnosis of Dysthymic Disorder?
presence of a depressed mood for at least two years in adults or one year in children and adolescents
The Bipolar I Disorders involve one or more ** or Mixed Episodes with or without a Depressive Episode.
Bipolar Disorder has most consistently been linked to ** factors. However there is evidence that the ** episodes are often precipitated by a stressful life event.
genetic; first few
Treatment for Bipolar Disorder often includes **, which not only reduces manic symptoms but also levels out mood swings.
Rates of completed suicides are highest for individuals aged **.
65 and older
The highest rates for suicide attempts are among people aged **.
In terms of gender, ** are at greatest risk for completed suicide.
Beck found ** to be a better predictor of suicide than the intensity of depressive symptoms.
Which mental disorders are most often linked to suicide?
Major Depression and Bipolar Disorder
Suicide is the **th leading cause of death in the United States
• 30,000 Americans commit suicide each year (conservative estimate)
What is Cyclothymic Disorder?
• Characterized by the presence of fluctuating hypomanic symptoms and numerous periods of depressive symptoms
• Depressive symptoms are not severe enough to meet the criteria for a Major Depressive Episode, and hypomanic symptoms do not meet the criteria for a Manic Episode
• Duration of symptoms must be at least 2 years for adults or one year for children and adolescents
What medication is used for individuals with Bipolar who do not respond to lithium, have rapid cycling or dysphoric mania (prominent anxiety or depressive symptoms)?
• Anti-seizure drug such as carbamazepine or divalproex sodium may be effective
What tends to be a frequent problem with Lithium?
• Compliance
• Patients often discontinue the medication because they feel better and think medication is unnecessary, are unwilling to give up the “highs” of mania, or do not like the drug’s side effects
• Evidence that compliance with drug treatment and overall treatment effectiveness are enhanced when pharmacotherapy is combined with psychotherapy
What is the treatment of choice for Bipolar Disorder?
• Lithium
• Effective in 60-90% of cases of “classic” Bipolar Disorder
• Reduces manic symptoms and prevents recurrent mood swings
What is the etiology of Bipolar Disorder?
• Genetic factors
• 65% concordance rate for monozygotic twins’
• 14% rate for dizygotic twins
• also evidence that stressful life events often precipitate the first few episodes but are less likely to precede later episodes
What are the statistics on gender and age in Bipolar Disorder?
• Bipolar I is equally common in males and females
• Bipolar II is more common in females
• Average age for first episode of mania is in the early 20s
What is Bipolar II Disorder?
• A person has had at least one Major Depressive Episode and one Hypomanic Episode
• Never had a Manic or Mixed Episode
What is Bipolar I Disorder?
• Involves the occurrence of one or more Manic or Mixed Episodes with or without a history of one or more Major Depressive Episodes
• Subtypes: Single Manic Episode, Most Recent Episode Manic, Most Recent Episode Hypomanic, Most Recent Episode Mixed, and Most Recent Episode Depressed
What is the treatment for dysthymia?
• Combination of antidepressant drug (especially an SSRI) and either cognitive-behavioral therapy or interpersonal therapy
What is Dysthymic Disorder?
• Involves chronically depressed mood that is present most of the time for at least two years in adults or one year in children and adolescents
• Must never be a period of more than two months in which the person is symptom free, and depressive symptoms must not be severe enough to meet the criteria for a Major Depressive Episode
• In children and adolescents, the mood can be depressed or irritable
What is the difference between primary and secondary when referring to sexual dysfunction?
• Primary – have always existed
• Secondary – develop after a period of normal functioning
What is the timeline of Sexual Dysfunctions?
• When they are due to psychological factors or a combination of psychological and physical factors, they can be Lifelong or Acquired and Generalized or Situational
What is Vaginismus?
• Involuntary spasms of the pubococcygeus muscle in the outer third of the vagina that interfere with sexual intercourse
What is Dyspareunia?
• Genital pain associated with sexual intercourse
What is Premature Ejaculation?
• When orgasm and ejaculation occur with minimal sexual stimulation, before, on, or shortly after penetration and before the person desires it
• Linked to low serotonin levels and may be effectively treated with an SSRI (e.g., dapoxetine)
What is Female Orgasmic Disorder/Male Orgasmic Disorder?
• Involves a delay in, or absence of, orgasm following a normal sexual excitement phase
What is Male Erectile Disorder?
• Impotence
• An inability to attain or maintain an adequate erection
• Physical factors that have been linked to this disorder include DM, liver and kidney disease, MS, and antipsychotic, antidepressant, and hypertensive drugs
What characterizes the Sexual Dysfunctions?
• A disturbance in the sexual response cycle or pain related to sexual intercourse that resuls in marked distress or interpersonal difficulty
• Disorders include: Male Erectile Disorder (Impotence), Female Orgasmic Disorder/Male Orgasmic Disorder, Premature Ejaculation, Dyspareunia, Vaginismus
What is Depersonalization Disorder?
• Characterized by one or more episodes of depersonalization, which involves a feeling of detachment or estrangement
• From one’s mental processes or body
• Reality testing remains intact
• Symptoms must be sufficiently severe and persistent to cause significant distress or functional impairment
What is Dissociative Fugue?
• Involves abrupt, unexpected travel away from home or work with an inability to recall some or all of one’s past
• Person exhibits confusion about his/her personal identity or a partial or total assumption of a new identity
• During the fugue, the person may seem “normal” to people who didn’t know him/her previously
• Following recovery, the person may not recall the events that took place during the fugue
What are the different types of Dissociative Amnesia?
• Localized – an inability to remember all events related to a circumscribed period of time
• Selective – person cannot recall some events related to a circumscribed period
• Generalized – person’s loss of memory encompasses his/her entire life
• Continuous – involves an inability to recall events subsequent to a specific time through the present
• Systematized – unable to recall memories related to a certain category of information (e.g., memories related to the individual’s spouse)
What is Dissociative Amnesia?
• Characterized by one or more episodes of an inability to recall important personal information that cannot be attributed to ordinary forgetfulness
• Most commonly, this disorder involves gaps in memory that are related to a traumatic or extremely stressful event
• The DSM distinguishes between several patterns of dissociative amnesia (the most common are localized and selective)
What is important to consider when making a diagnosis of Dissociative Disorder?
• Potential cultural influences on symptoms
• In many cultures, dissociative states are an acceptable expression of religious or cultural beliefs and do not necessarily constitute a mental disorder
What is the primary feature of the Dissociative Disorders?
• Disruption of consciousness, identity, memory or perception of the environment that is not due to the effects of a substance or a general medical condition
• Includes Dissociative Amnesia, Dissociative Fugue, Dissociative Identity Disorder, and Depersonalization Disorder
How is Factitious Disorder differentiated from Malingering?
• Goal of the behavior in Factitious Disorder is to obtain an external reward, such as avoiding work, receiving financial compensation, or obtaining drugs
• Malingering should be considered when the person is seeking a medical evaluation for legal reasons, there is a marked discrepancy between the person’s symptoms and objective findings, the person does not cooperate with the diagnostic evaluation or prescribed treatment, and the person has Antisocial Personality Disorder