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152 Cards in this Set
- Front
- Back
Normal Sexual behavior, per DSM-IV
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non-destructive interplay between consenting adults
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different kinds of sexual disorders
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anything that is not non-destructive interplay between consenting adults; ability to respond sexually (sexual dysfunction); paraphilia; gender identity disorder
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two types of sexual dysfunction
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disorders involving: disruption of sexual response cycle; or pain during intercourse
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Stages of the sexual response cycle
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desire; arousal;plateau;orgasm;resolution (refractory period for men)
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Desire
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first stage of sexual response cycle; largely psychological; though somewhat physiological
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arousal
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stage of sexual response cycle characterized by obvious changes by the sympathetic nervous system; including blood pressure increase and engorgement of erectile tissue
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plateau
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full arousal; orgasm feels imminent; fully erect tissues
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orgasm
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you know this one
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resolution
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stage of sexual response cycle; men enter a refractory period; women may reslove back to plateau stage
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disruptions to desire portion of sexual response cycle
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hypoactive sexual desire disorder; sexual aversion disorder
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hypoactive sexual desire disorder
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disinterest in sexual activity;the obvious psych causes from each perspective;plus low levels of testosterone and estrogen, or high levels of prolactin
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sexual aversion disorder
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repulsion or disgust at the idea of sex; easy to see how this can happen according to each psychological school
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treatment of disruption to desire portion of sexual response cycles
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cog: alter thinking about sexuality; behav: systematic desentization in couples’ treatment; med: hormone therapy
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disruptions to arousal stage of sexual response cycle
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Female sexual arousal disorder; Male erectile disorder
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female sexual arousal disorder
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insufficient vaginal lubrication; likely same factors as in hypoactive sexual desire disorder, also possibly medical, also things like poor communication with self and partner
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treatments for female sexual arousal disorder
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hormonal treatment; couples’ therapy focused on communication; sensate focus techniques
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sensate focus techniques
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exercises to combat sexual arousal disorders for men and women; increasing levels of sensation from fully clothed massage and so on; with communication; with no expectation of intercourse or orgasm so the pressure is off; can use paradoxical instruction
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paradoxical instruction
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“it’s really important you don’t get an erection for this,” which resolves anxiety around getting an erection
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anxiety and male erectile disorder
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causes a “spectator role” effect of monitoring and worry, rather than being “in the moment” especially when combined with alcohol use to form a cycle (ooh, maybe you should drink more, to alleviate the anxiety!)
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treatments for male erectile disorder
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drugs like viagra, which work great for circulation issues, but not so great for psych issues; sensate focus techniques with paradoxical instruction; prosthesis
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disruptions to orgasm stage of sexual response cycle
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female orgasmic disorder; male orgasmic disorder; premature ejaculation
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female orgasmic disorder
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trouble reaching orgasm regularly or at all; is pretty much just an extension of arousal; treatment involves the techniques for sexual arousal disorder, plus basic anatomy education
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male orgasmic disorder
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inability to orgasm; causes and treatments similar to ED; also: stop the death grip, move away from overused masturbatory habits
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premature ejaculation
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reaching orgasm before, upon, or immediately after penetration; likely due to lack of learning how to control arousal; poss. phys. differences: neurotransmitter differences, hypersensitive penis;
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treatments for premature ejaculation
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special thick condoms; squeeze / startstop techniques: back down from orgasm 3 or 4 times before allowing it; thus teaching the man about the sensations on the leadup to orgasm
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sexual pain disorders
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dyspareunia and vaginismus
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dyspareunia
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pain during sexual activity;obvious biological factors;also can be caused by fear of pain or difficulty communicating how to avoid pain
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vaginismus
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involuntary contraction of vaginal muscles; likely caused by traumatic experiences (though not necessarily rape or abuse; treat with practiced control fo vaginal muscles and gradual exposure to penetration with differently sized dilators
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diagnostic subtypes of sexual dysfunctions
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lifelong v. acquired; generalized v. situational (check if man achieves erections during sleep)
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risk for sexual dysfunction
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women tend to be 2-3 times more likely to experience dysfunction; partially because of the usual stuff; but also because we still base “normal” on male patients’ scores
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diagnosis of paraphilia
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an object or pattern of behavior becomes central focus of a person’s arousal and gratification -- and must cause distress or impairment to self OR OTHERS
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Gender and paraphilia
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men are much more likely to experience them, especially for “victimed” paraphilias
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Fetishism
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reliance on inanimate objects or body parts for sexual gratification; blurry line between when it’s an issue and when it’s a non-issue; to be a true fetish, arousal must occur with the object alone (for heels, the shoes themselves must be arousing factor, not just when a woman is in them)
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transvestism
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sexual gratification through dressing in the clothes of a opposite sex; remember, it’s a sexual gratification thing, not the same as desiring to BE another gender
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exhibitionism
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a victimed paraphilia; sexual gratificaiton by way of the disgust and shock of the victims, rather than in being exposed
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voyeurism
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victimed; sexual gratification through clandestine observation of other people’s sexual activities or anatomy; an extreme version of the normal behavior of watching pornography
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sadism and masochism
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to be paraphilias, we’re talking about prety extreme stuff that is causing damage or distress (of course, the distress part is difficult to determine)
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frotteurism
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sexual gratification through touching or rubbing against a non-consenting person
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pedophilia
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sexual gratification through sexual contact with prepubescent children.
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diagnosis of pedophilia
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age gap of 5 years; perpetrator must be at least 16; child must be under 13 -- otherwise it’s illegal and gross, but not diagnosable pedophilia
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examples of paraphilia not otherwise specified
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necrophilia, enemas, feces or urine, amputees, obscene phone calls having sex with a violent offender, stealing from sexual partners
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behavioral treatment for paraphilia
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stimulus satiation; covert sensitization; shame aversion therapy
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stimulus satiation
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treatment for paraphilia; masturbate to “normal” stimuli, then exposure to paraphillic stimuli immediately after orgasm -- thus only when not aroused, so they cannot get an erection
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covert sensitization
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imagine the worst possible scenario during arousal
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shame aversion therapy
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learn to pair the activity with something that is humiliating; like acting out or prettenidng to act out the paraphilia in front of significant others while they comment
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diagnostic criteria for gender identity disorder
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gender dysphoria (dissatisfaction with gender); desire to change genders
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intersex conditions
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partial androgen insensitivity (male body is ambiguous or looks female); congenital androgen hyperplasia (too much testosterone, genital ambiguity, “male” traits and behavior)
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GID patterns
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homosexual v. heterosexual transsexuals; homosexual transsexuals would “start out” homosexual, then transition into a heterosexual relationship
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steps in obtaining sex reassignment surgery
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detailed mental health evaluation; three months of psychotherapy; hormonal therapy to initiate changes; live as desired gender for a full year; then surgery
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satisfaction in sex reassignment surgery
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66 - 90 % reported; ftm yields higher satisfaction; satisfaction increases as time spent as desired gender prior to surgery increases
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the key point of psychotic disorders
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distortion or dissociation from reality
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four major types of schizophrenia symptoms
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problems with:;cognition and language;distortion of perception;mood or affect; bizarre behavior
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define bizarre behavior for schizophrenia
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behavior that doesn’t seem to make sense, have a goal, or be adapttive
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schiz: problems with cognition and language
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delusions; loose associations; poverty of content; neologisms; clanging; word salad
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word salad
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schiz symptom; saying words and phrases that make no sense at all
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clanging
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schiz symptom; pairing words that have no relation to one another except sounding alike;you can see how these things would pop up in your head, but non-schiz folks just filter it out; sounds like dr. seuss
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neologisms
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schiz symptom; making up new words; might be pormanteau; but might just be strange -- “belly bad luck”
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poverty of content
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schiz symptom; poor communication despite correct grammar and adequate vocabulary; saying a lot of words without really expressing a lot of relevant content
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loose associations
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schiz symptom; ideas jumping from one to another nonsensically, leading further and further away from original topic. non-schiz have these thoughts, but schiz would not filter them out, and would run with them as if they’re the content of the discussion
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def. of delusions
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firmly held faulty beliefs (not same as hallucination); need to be idiosyncratic (so, not religions), and really firmly held (unlike folks with OCD)
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types of delusions
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persecution, control, reference, grandeur, sin or guilt, hypochondriacal, nihilistic;thought delusions
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delusion of persecution
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eloborate scheme of the gov’t or the mob being out to get you
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delusion of control
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feeling that someone outside is controlling you; may include implant delusions
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delusions of refernece
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belief that everyday events have some kind of special meaning; they “refer” to the person in some way;that papers or tv speak to them in code;
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delusions of grandeur
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extremely inflated sense of self esteem; believing you have mystical powers
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delusions of sin or guilt
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psychotic depression; very negative delusions of the self; belief that they’ve murdered someone; or that they’re truly, demonically evil
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hypochondriacal delusions
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not like hypochondriasis, but irrational concerns -- moldy brains, snakes in your skin
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nihilistic delusions
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the idea that you or other people don’t exist, or that the world is not actually real
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thought delusions
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broadcasting or insertion/withdrawal -- feeling that others know your private thoughts; or that someone has inserted or withdrawn thoughts from your brain
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Problems with perception (schiz)
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breakdown of selective attention; intensification; hallucinations
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breakdown of selective attention
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inability to confine extraneous data to edges of consciousness
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intensification of perception
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colors are brighter, lights are brighter, sounds are louder
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hallucinations
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perceptions in absence of stimulus; commonly auditory, can also be visual, tactile, olfactory
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“hearing voices”
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auditory hallucinations; believed to be coming from outside the person -- if “it’s in my head,” that’s probably not actual psychosis
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problems with mood (schiz)
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blunted affect, flat affect, inappropriate affect
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problems with bizarre behavior (schiz)
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distorted motor behaviors; stereotypy; catatonic behavior; social withdrawal
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stereotypy
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schiz symptom; repetitive purposeless behavior; like making an odd movement over and over
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catatonic behavior
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schiz symptom; lack of movement; usually in bed or in a chair; but can be in statue-like poses; and you can actually pose them sometimes and they’ll hold it
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social withdrawal
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schiz symptom; lack of attention or interest in external world; possibly just trying to filter out the stimulus, or because of not trusting others
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positive v. negative schiz symptoms
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presence of abnormal phenomenon, or absence of a normal one; can be difficult to classify behaviors -- disorganized speech could be either; can co-occur
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phases of schiz
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prodromal; active; residual
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prodromal phase
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schiz; exhibiting oddity and gradual deterioration of functioning before full onset of psychotic symptoms
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active phase
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schiz; full on psychosis
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schiz prevalence
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1% lifetime, and about .7% 1-month; cuz you just kinda have it forever;about double for black folks; 75% of cases happen between 16-25yo; slight concentration of birthdays with late winter and early spring;high comorbidity iwth substance abuse
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schiz and birth date
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slight concentration of schiz over those born in late winter and early spring
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schiz subtypes
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disorganized, catatonic, paranoid
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disorganized schizophrenia
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incoherence, mood disturbance; disorganized behavior, avoltion
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catatonic schizophrenia
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marked by catatonia
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paranoid schizophrenia
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generally different from disorganized type (though may co-occur); primary focus on delusions and hallucinations; but are coherent if untrustworthy
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dimensions of schizophrenia for prognosis
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process-reactive, good-poor premorbid functioning, paranoid-nonparanoid; these have high correlations
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process-reactive dimension
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did schiz come on gradually or due to an environmental stressor? - gradual has worse prognosis
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good-poor premorbid functioing dimension
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schiz: before active phase, was person generally well-functioning? If so, prognosis is better
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paranoid-nonparanoid dimension
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paranoid type have better prognosis than nonparanoid schizophrenics (though this may be due to more reactive nature of paranoid schizophrenia)
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diagnoses of “lesser” schizophrenias
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< 1mo: brief psychotic episode; 1-6mos: schizophreniform disorder; > 6mos: schizophrenia; and also delusional disorder
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delusional disorder
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like schiz, but only symptom is delusions; generally less bizarre, and are generally “possible”; also jealous type and stalking behaviors when you think you’re in a relationship
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neuroscience perspective on schizophrenia
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possible medical/structural issues in brain; genetics a major factor; 50% prevalence in mz twins and children of two schiz parents; but not 100%...; seems linked to eye-tracking issues (so probably on same gene). also ventrilces are larger -- atrophy, perhaps, and abnormal blood flow is also present; and also prenatal brain injury (maybe)
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evidence for prenatal brain injury theory of schiz
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births in the late winter and early spring mean fetus was in the second trimester during cold and flu season; and schiz persons tend to have antibodies for odd viruses; and twins in the same v. separate placenta and amnion tend to be more alike
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biochemical perspective on schiz
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dopamine!; schiz associated with excess activity in dopamine-heavy parts of brain; and we know that thorazine binds to dopamine receptors;and drugs that increase dopamine seem to have the same sort of effect; not that L-Dopa overdose in Parkinson’s patients can also cause hallucinations
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cog perspective on schiz
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bio causes set stage for the disorder; but may lead to interesting cog phenomena; so, deal with dysfunctional interpretations of strange experiences which might otherwise lead to or reinforce delusions
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sociocultural perspective on schiz
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stigma and social labeling can lead to people taking on the labeling,;and family dysfunction can further exacerbate
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behavioral perspective on schiz
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learned nonresponsiveness, leading to further isolation and response only to unusual idiosyncratic information; combat it with token economy to help develop life skills
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learned nonresponsiveness
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behav take on schiz: not being reinforced for responding to relevant info leads to isolatoin and response only to unusual idiosyncratic info.; fight it with a token economy to encourage development of life skills
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diathesis-stress model
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another way to look at schiz (or anything, really); a biological predisposition is triggered by an environmental stressor...
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primary difference between presentation of Axis I and Axis II disorders
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axis 1 is cyclical, while axis 2 are generally constant; and are not likely to be “cured” so much as managed
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define personality disorder
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enduring pattern of inner experience and behavior which deviates markedly from the expectatoins of the culture; it’s pervasive, it’s inflexible, it has fairly early onset, it must be maladaptive or cause distress. And, people tned to not recognize their experiences as maladaptive, and so if they’re in therapy, it’s usually for comorbid axis I disorders
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Personality disorder clusters
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odd/eccentric; dramatic/emotional; anxious/fearful; and there’s a ton of overlap
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examples of odd/eccentric PDs
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paranoid, schizotypal, schizoid
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paranoid PD
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suspiciousness in almost all situations and toward all people; may be members of fringe groups; may involve cog impairments leading to poor “theory of mind”
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schizotypal PD
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“low grade schizophrenia”; doesn’t tend to cycle; may involve some magical thinking -- coincidences “mean something,” responds to antipsychotics and is related to schiz
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schizoid PD
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(no connection to schizophrenia); disinterest in having relationships or sharing behaviors with others; is sorta autism-lite; tends to have few or no friends and be anhedonic
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examples of dramatic/emotional PDs
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antisocial PD, borderline PD, Histrionic PD; Narcissistic PD
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antisocial PD
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predatory behavior; serial killers have it, though not all who have it are killers; often accompanied by the unholy trinity of childhood behvaviors; THE BIGGIE: do not experience empathy or guilt, and do not respond physiologically to risky or aggressive situations
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borderline PD
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Fatal Attraction; The most commonly diagnosed PD; rely on relationships for sense of self, cannot abide ambiguity, distrust others and fear abandonment; impulsive, self-destructive behavior
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histrionic PD
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extreme and exaggerated display of emotion to garner sympathy
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narcissistic PD
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grandiose feelings of self-importance; combined with periodic feelings of inferiority; display of emotion for sake of being admired
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anxious/fearful PDs
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avoidant, dependent, obsessive-compulsive
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what goes on each axis?
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1 - clinical symptoms, 2 - PDs and MR, 3 - general medical conditions, 4 - psychosocial/environmental stressors, 5 - GAF scale
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examples of disruptive behavioral disorders
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(stuff with poor control, impulsivity, acting out); ADHD; oppositional defiant disorder; conduct disorder
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types of ADHD
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primarily hyperactive; primarily inattentive; both
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diagnosis for ADHD
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importantly: all areas of life must be affected (so, both home and school)
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prevalence and comorbidity of ADHD
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3-5% lifetime, 90% of cases are boys; comorbid with conduct disorder and antisocial personality disorder
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oppositional defiant disorder
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“consistent hostility and defiance,” ignoring rules and requests; somewhat sadistic in its intentional annoyance
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conduct disorder
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basically like antisocial PD for kids,; includes the deceitfulness and cruel, reckless behavior
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prevalence and course for ODD and conduct disorder
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8-10% lifetime, more boys than girls; much more prevalent than antisocial PD, which means that the kids get better; course depends on onset -- childhood onset leads to poorer prognosis; is always super hard to turn around, even with supportive family
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diagnosing emotional stress disorders in children
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it’s hard!; kids have trouble articulating, and informants may not report behaviors in ways that accurately reflect internal stats
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types of anxiety disorders of childhood
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separation anxiety disorder; social phobial; generalized anxiety disorder
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relationship between anxiety and performance
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(for something you know how to do well):; curvilinear relationship
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prevalence of childhood depression
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3-5%, for both boys and girls (so why don’t girls get better?); difficult to diagnose and may be recognized as irritability or withdrawal
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childhood bipolar disorder
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suuuuuper controversial; diagnosis has increased 40-fold over last 20 years; not usually “manic,” per se, but rather depressed with episodes of rage and tantrums
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elimination disorders
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enuresis, encopresis -- diagnosis requires high frequency in 5 and 4yo children
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primary v. secondary elimination disorders
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primary types were never under control; secondaries are triggered after control has already been established
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treatment of elimination disorders
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behavioral,; try token economies; moisture-activeated alarm systems, etc, which wake child up, hopefully leading to a pairing of the sensation of needing to pee and waking up
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what axis for autism?
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strangely, it’s still classified on Axis 1, though most disorders of this sort are on axis 2
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diagnosis of MR
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must measure 2 stdvs below mean IQ, and person must have inability to keep up with life’s demands
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mild v. moderate v. severe MR
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mild - iq below 70, fluent communication, can run relatively normal lives; mod - below 50, some communication issues, might live in a 24hr group home setting, but can take care of self; severe - below 35, generally unable to live without nursing care
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Genetic causes of MR
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fragile X syndrome, Down syndrome
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Fragile X syndrome
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weak spot on x chromosome; leads to physical symptoms like large prominent ears and elongated face, and behavioral symptoms like hyperactivity, limited communication, self harm like headbanging
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Down syndrome
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extra chromosome on pair 21; occurs in ovaries, generally in older women; causes 3 21st chromosomes; huge percentage get alzheimer’s very early (40-45yo); testable through amniocentesis
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metabolic causes of MR
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PKU - inability to metabolize necessary amino acid, can be regulated through low PKU diet; Tay-Sachs disease: absence of an enzyme in brain tissue, concentrated among eastern european jews
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environmental causes of MR
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prenatal drugs or toxins like in FAS; prenatal malnutrition; postnatal toxins like lead; physical trauma; neglect and malnutrition; all kinds of stuff that concentrate for those with low SES
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classes of causes of MR
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genetic, metabolic, environmental
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symptoms of autistic disorder
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profound lack of social skill; isolation; MR; communcation and language deficits (starting as verrry young kids); stereotypical behavior (banging, biting, rocking)
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asperger’s disorder symptoms
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like autistic disorder, but without the intellectual issues and communication problems seen there; inflexibility of thought or action; clumsiness; rigid adherence to rules; inability to really get metaphor, repetition, emphasis, sarcasm
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theories of autism
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mmr and sociocultural theories debunked; biological abnormalities are left -- it runs in families, shows correlation with prenatal toxin exposure, and is characterized by structural brain anomolies leading to trouble with theory of mind
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History of insanity defense
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mcnaughten in 1843 (didn’t understand nature or quality of actions); irresistible impulse test later on (could not conform behavior to law); ALI MPC62 - combined the concepts; we’ve since reverted toward mcnaughten
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GBMI
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guilty but mentally ill (as opposed to NGRI)
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philosophical issues with insanity defense
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how can you really prove it? what would the evidence be? usually, not knowing the law is not a valid defense. do we really have free will, or are we the product of our environment? are our actions ever really dichotomous (are we really either in or out of control?)
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competency to stand trial
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different from what state they were in during the crime; can they assist in their own defense? if not, release or commit them.
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civil commitment procedure
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can commit without evaluation if in immediate danger; then must be evaluated; then 2 physicians must agree that the person is in need of treatment and poses a threat to sel orothers;then must appear before a judge within 60 days and may have an attorney present
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standard of proof for civil commitment
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much lower than criminal conviction -- “preponderance of evidence” (50%) v. “beyond a reasonable doubt” (95%) -- but now “clear and convincing evidence” (75%)
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rights during commitment
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right to receive treatment; right to refuse treatment; right to a humane environment
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exceptions to confidentiality
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imminent danger; child abuse; if client refuses to pay; if client sues you; duty to warn; working with parents and adolescents
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