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152 Cards in this Set

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Normal Sexual behavior, per DSM-IV
non-destructive interplay between consenting adults
different kinds of sexual disorders
anything that is not non-destructive interplay between consenting adults; ability to respond sexually (sexual dysfunction); paraphilia; gender identity disorder
two types of sexual dysfunction
disorders involving: disruption of sexual response cycle; or pain during intercourse
Stages of the sexual response cycle
desire; arousal;plateau;orgasm;resolution (refractory period for men)
Desire
first stage of sexual response cycle; largely psychological; though somewhat physiological
arousal
stage of sexual response cycle characterized by obvious changes by the sympathetic nervous system; including blood pressure increase and engorgement of erectile tissue
plateau
full arousal; orgasm feels imminent; fully erect tissues
orgasm
you know this one
resolution
stage of sexual response cycle; men enter a refractory period; women may reslove back to plateau stage
disruptions to desire portion of sexual response cycle
hypoactive sexual desire disorder; sexual aversion disorder
hypoactive sexual desire disorder
disinterest in sexual activity;the obvious psych causes from each perspective;plus low levels of testosterone and estrogen, or high levels of prolactin
sexual aversion disorder
repulsion or disgust at the idea of sex; easy to see how this can happen according to each psychological school
treatment of disruption to desire portion of sexual response cycles
cog: alter thinking about sexuality; behav: systematic desentization in couples’ treatment; med: hormone therapy
disruptions to arousal stage of sexual response cycle
Female sexual arousal disorder; Male erectile disorder
female sexual arousal disorder
insufficient vaginal lubrication; likely same factors as in hypoactive sexual desire disorder, also possibly medical, also things like poor communication with self and partner
treatments for female sexual arousal disorder
hormonal treatment; couples’ therapy focused on communication; sensate focus techniques
sensate focus techniques
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
paradoxical instruction
“it’s really important you don’t get an erection for this,” which resolves anxiety around getting an erection
anxiety and male erectile disorder
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!)
treatments for male erectile disorder
drugs like viagra, which work great for circulation issues, but not so great for psych issues; sensate focus techniques with paradoxical instruction; prosthesis
disruptions to orgasm stage of sexual response cycle
female orgasmic disorder; male orgasmic disorder; premature ejaculation
female orgasmic disorder
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
male orgasmic disorder
inability to orgasm; causes and treatments similar to ED; also: stop the death grip, move away from overused masturbatory habits
premature ejaculation
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;
treatments for premature ejaculation
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
sexual pain disorders
dyspareunia and vaginismus
dyspareunia
pain during sexual activity;obvious biological factors;also can be caused by fear of pain or difficulty communicating how to avoid pain
vaginismus
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
diagnostic subtypes of sexual dysfunctions
lifelong v. acquired; generalized v. situational (check if man achieves erections during sleep)
risk for sexual dysfunction
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
diagnosis of paraphilia
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
Gender and paraphilia
men are much more likely to experience them, especially for “victimed” paraphilias
Fetishism
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)
transvestism
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
exhibitionism
a victimed paraphilia; sexual gratificaiton by way of the disgust and shock of the victims, rather than in being exposed
voyeurism
victimed; sexual gratification through clandestine observation of other people’s sexual activities or anatomy; an extreme version of the normal behavior of watching pornography
sadism and masochism
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)
frotteurism
sexual gratification through touching or rubbing against a non-consenting person
pedophilia
sexual gratification through sexual contact with prepubescent children.
diagnosis of pedophilia
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
examples of paraphilia not otherwise specified
necrophilia, enemas, feces or urine, amputees, obscene phone calls having sex with a violent offender, stealing from sexual partners
behavioral treatment for paraphilia
stimulus satiation; covert sensitization; shame aversion therapy
stimulus satiation
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
covert sensitization
imagine the worst possible scenario during arousal
shame aversion therapy
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
diagnostic criteria for gender identity disorder
gender dysphoria (dissatisfaction with gender); desire to change genders
intersex conditions
partial androgen insensitivity (male body is ambiguous or looks female); congenital androgen hyperplasia (too much testosterone, genital ambiguity, “male” traits and behavior)
GID patterns
homosexual v. heterosexual transsexuals; homosexual transsexuals would “start out” homosexual, then transition into a heterosexual relationship
steps in obtaining sex reassignment surgery
detailed mental health evaluation; three months of psychotherapy; hormonal therapy to initiate changes; live as desired gender for a full year; then surgery
satisfaction in sex reassignment surgery
66 - 90 % reported; ftm yields higher satisfaction; satisfaction increases as time spent as desired gender prior to surgery increases
the key point of psychotic disorders
distortion or dissociation from reality
four major types of schizophrenia symptoms
problems with:;cognition and language;distortion of perception;mood or affect; bizarre behavior
define bizarre behavior for schizophrenia
behavior that doesn’t seem to make sense, have a goal, or be adapttive
schiz: problems with cognition and language
delusions; loose associations; poverty of content; neologisms; clanging; word salad
word salad
schiz symptom; saying words and phrases that make no sense at all
clanging
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
neologisms
schiz symptom; making up new words; might be pormanteau; but might just be strange -- “belly bad luck”
poverty of content
schiz symptom; poor communication despite correct grammar and adequate vocabulary; saying a lot of words without really expressing a lot of relevant content
loose associations
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
def. of delusions
firmly held faulty beliefs (not same as hallucination); need to be idiosyncratic (so, not religions), and really firmly held (unlike folks with OCD)
types of delusions
persecution, control, reference, grandeur, sin or guilt, hypochondriacal, nihilistic;thought delusions
delusion of persecution
eloborate scheme of the gov’t or the mob being out to get you
delusion of control
feeling that someone outside is controlling you; may include implant delusions
delusions of refernece
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;
delusions of grandeur
extremely inflated sense of self esteem; believing you have mystical powers
delusions of sin or guilt
psychotic depression; very negative delusions of the self; belief that they’ve murdered someone; or that they’re truly, demonically evil
hypochondriacal delusions
not like hypochondriasis, but irrational concerns -- moldy brains, snakes in your skin
nihilistic delusions
the idea that you or other people don’t exist, or that the world is not actually real
thought delusions
broadcasting or insertion/withdrawal -- feeling that others know your private thoughts; or that someone has inserted or withdrawn thoughts from your brain
Problems with perception (schiz)
breakdown of selective attention; intensification; hallucinations
breakdown of selective attention
inability to confine extraneous data to edges of consciousness
intensification of perception
colors are brighter, lights are brighter, sounds are louder
hallucinations
perceptions in absence of stimulus; commonly auditory, can also be visual, tactile, olfactory
“hearing voices”
auditory hallucinations; believed to be coming from outside the person -- if “it’s in my head,” that’s probably not actual psychosis
problems with mood (schiz)
blunted affect, flat affect, inappropriate affect
problems with bizarre behavior (schiz)
distorted motor behaviors; stereotypy; catatonic behavior; social withdrawal
stereotypy
schiz symptom; repetitive purposeless behavior; like making an odd movement over and over
catatonic behavior
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
social withdrawal
schiz symptom; lack of attention or interest in external world; possibly just trying to filter out the stimulus, or because of not trusting others
positive v. negative schiz symptoms
presence of abnormal phenomenon, or absence of a normal one; can be difficult to classify behaviors -- disorganized speech could be either; can co-occur
phases of schiz
prodromal; active; residual
prodromal phase
schiz; exhibiting oddity and gradual deterioration of functioning before full onset of psychotic symptoms
active phase
schiz; full on psychosis
schiz prevalence
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
schiz and birth date
slight concentration of schiz over those born in late winter and early spring
schiz subtypes
disorganized, catatonic, paranoid
disorganized schizophrenia
incoherence, mood disturbance; disorganized behavior, avoltion
catatonic schizophrenia
marked by catatonia
paranoid schizophrenia
generally different from disorganized type (though may co-occur); primary focus on delusions and hallucinations; but are coherent if untrustworthy
dimensions of schizophrenia for prognosis
process-reactive, good-poor premorbid functioning, paranoid-nonparanoid; these have high correlations
process-reactive dimension
did schiz come on gradually or due to an environmental stressor? - gradual has worse prognosis
good-poor premorbid functioing dimension
schiz: before active phase, was person generally well-functioning? If so, prognosis is better
paranoid-nonparanoid dimension
paranoid type have better prognosis than nonparanoid schizophrenics (though this may be due to more reactive nature of paranoid schizophrenia)
diagnoses of “lesser” schizophrenias
< 1mo: brief psychotic episode; 1-6mos: schizophreniform disorder; > 6mos: schizophrenia; and also delusional disorder
delusional disorder
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
neuroscience perspective on schizophrenia
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)
evidence for prenatal brain injury theory of schiz
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
biochemical perspective on schiz
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
cog perspective on schiz
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
sociocultural perspective on schiz
stigma and social labeling can lead to people taking on the labeling,;and family dysfunction can further exacerbate
behavioral perspective on schiz
learned nonresponsiveness, leading to further isolation and response only to unusual idiosyncratic information; combat it with token economy to help develop life skills
learned nonresponsiveness
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
diathesis-stress model
another way to look at schiz (or anything, really); a biological predisposition is triggered by an environmental stressor...
primary difference between presentation of Axis I and Axis II disorders
axis 1 is cyclical, while axis 2 are generally constant; and are not likely to be “cured” so much as managed
define personality disorder
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
Personality disorder clusters
odd/eccentric; dramatic/emotional; anxious/fearful; and there’s a ton of overlap
examples of odd/eccentric PDs
paranoid, schizotypal, schizoid
paranoid PD
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”
schizotypal PD
“low grade schizophrenia”; doesn’t tend to cycle; may involve some magical thinking -- coincidences “mean something,” responds to antipsychotics and is related to schiz
schizoid PD
(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
examples of dramatic/emotional PDs
antisocial PD, borderline PD, Histrionic PD; Narcissistic PD
antisocial PD
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
borderline PD
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
histrionic PD
extreme and exaggerated display of emotion to garner sympathy
narcissistic PD
grandiose feelings of self-importance; combined with periodic feelings of inferiority; display of emotion for sake of being admired
anxious/fearful PDs
avoidant, dependent, obsessive-compulsive
what goes on each axis?
1 - clinical symptoms, 2 - PDs and MR, 3 - general medical conditions, 4 - psychosocial/environmental stressors, 5 - GAF scale
examples of disruptive behavioral disorders
(stuff with poor control, impulsivity, acting out); ADHD; oppositional defiant disorder; conduct disorder
types of ADHD
primarily hyperactive; primarily inattentive; both
diagnosis for ADHD
importantly: all areas of life must be affected (so, both home and school)
prevalence and comorbidity of ADHD
3-5% lifetime, 90% of cases are boys; comorbid with conduct disorder and antisocial personality disorder
oppositional defiant disorder
“consistent hostility and defiance,” ignoring rules and requests; somewhat sadistic in its intentional annoyance
conduct disorder
basically like antisocial PD for kids,; includes the deceitfulness and cruel, reckless behavior
prevalence and course for ODD and conduct disorder
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
diagnosing emotional stress disorders in children
it’s hard!; kids have trouble articulating, and informants may not report behaviors in ways that accurately reflect internal stats
types of anxiety disorders of childhood
separation anxiety disorder; social phobial; generalized anxiety disorder
relationship between anxiety and performance
(for something you know how to do well):; curvilinear relationship
prevalence of childhood depression
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
childhood bipolar disorder
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
elimination disorders
enuresis, encopresis -- diagnosis requires high frequency in 5 and 4yo children
primary v. secondary elimination disorders
primary types were never under control; secondaries are triggered after control has already been established
treatment of elimination disorders
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
what axis for autism?
strangely, it’s still classified on Axis 1, though most disorders of this sort are on axis 2
diagnosis of MR
must measure 2 stdvs below mean IQ, and person must have inability to keep up with life’s demands
mild v. moderate v. severe MR
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
Genetic causes of MR
fragile X syndrome, Down syndrome
Fragile X syndrome
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
Down syndrome
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
metabolic causes of MR
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
environmental causes of MR
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
classes of causes of MR
genetic, metabolic, environmental
symptoms of autistic disorder
profound lack of social skill; isolation; MR; communcation and language deficits (starting as verrry young kids); stereotypical behavior (banging, biting, rocking)
asperger’s disorder symptoms
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
theories of autism
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
History of insanity defense
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
GBMI
guilty but mentally ill (as opposed to NGRI)
philosophical issues with insanity defense
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?)
competency to stand trial
different from what state they were in during the crime; can they assist in their own defense? if not, release or commit them.
civil commitment procedure
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
standard of proof for civil commitment
much lower than criminal conviction -- “preponderance of evidence” (50%) v. “beyond a reasonable doubt” (95%) -- but now “clear and convincing evidence” (75%)
rights during commitment
right to receive treatment; right to refuse treatment; right to a humane environment
exceptions to confidentiality
imminent danger; child abuse; if client refuses to pay; if client sues you; duty to warn; working with parents and adolescents