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58 Cards in this Set
- Front
- Back
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Abnormality
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statisically unusual behavior
socially unacceptable behavior dysfunctional behavior personally distressing behavior |
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Psychological Disorder
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a psychological problem (difficulties in cognitions, emotions, or behavior)
-distress OR impairment -not culturally consistent |
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Why is diagnosis necessary?
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communication (b/w other doctors/therapists)
treatment reinforcement for patient insurance |
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DSM
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-categorical
-no unifying theory Pros: simple and clear to use, controversial diagnoses determined, can be regulated, careful analysis of diagnoses Cons: too complicated, too long, controversial diagnoses influenced by political forces, lacks consistent conceptual framework, standards of validity and reliability compromised |
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Multi- axial approach
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Axis I: Clinical Disorders
Axis II: Personality Disorders Axis III: Medical conditions Axis IV: Psychosocial problems Axis V: Global assessment of functioning |
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Diagnosis- Information based on...
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-Record review (history)
-Self reported symptoms (current and historic)- clinical or structured interview -Observable signs (current) -Family interview (current and historic) |
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Comorbid
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2 diagnoses
primary and secondary |
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Diagnostic dilemmas
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Disadvantages of the categorical approach
-where do you draw the line b/w mental illness and healthy? -either you have it or you don't- limitation -Diagnosis in children- still developing, is it a phase? -Politics- influential person can skew additions/omissions from the DSM, human element -Pressure of Insurance- request and expect diagnosis- will not provide therapy for certain reasons -Reliability and validity of diagnosis |
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Where does diagnosis and treatment occur?
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Inpatient settings- psychiatric units (private and public), drug treatment facilities (private and public)
Day Treatment facilities- individual lives on their own, but goes to treatment during the day Outpatient settings- community mental health centers, private practitoners, employee assistance programs, counseling centers |
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Who pays?
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-individual (out of the pocket)-sliding scale
-private insurers -medicare/medicaid- federally funded -charities -the therapist- will provide some treatment essentially for free for those that can afford it |
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Mental Status Exam
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appearance and behavior
orientation (to time, person, place) thought content thinking and language (speech) affect (facial expressions) mood perceptions cognitive abilities insight and judgement |
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Behavior assessment
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-behavior observation- behavior chart, operational definitions for behaviors, frequency and intensity, antecedent and consequences
-self reports of behavior- self monitoring, frequency and intensity |
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Psychophysiological assessment
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peripheral psychophysiology- used for anxiety disorders
EEG- measures electrical activity of the brain- used for epilepsy CAT (computer assisted tomography)-used for alzheimers/schizophrenia PET (positron emission tomography)- measures blood flow to brain and oxygen utilization MRI/fMRI |
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Neuropsychological Assessment
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Purpose: assessment of cognitive functioning
Verbal and visual recall- immediate and delayed, words, syllables, sentences, paragraphs Complex copying- visual-spatial difficulties Switching tasks Sustained attention Puzzle Solving Motor Speed Visual Search Interpretation of Proverbs WAIS |
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Personality Tests
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MMPI- physical symptoms and somatic conditions, objective measure of personality
TAT(Thematic Apperception Test)- aspects of personality, projective test, look at picture- what is happening Rorsach Inkblot Test- themes, form, color |
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Theory
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a proposed explanation whose status is still conjectural
a good theory should be: logical, falsifiable, accurate in its predictions, parsimonious |
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psychodynamic theory
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the idea that behavior may be the result of contentious and often unconscious conflicts within one's personality
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id
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present at birth
basic drives, motives, instincts based on the pleasure principle (immediate need) Libido: pressure for gratification (high libido- more driven by id) characterized by primary process thinking- disjointed, no filter, sexual/agressive impulses -completely in unconscious level |
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superego
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one's conscience and ego ideal (the image of who one wants to be)
-direct conflict with the id -in both preconscious and unconscious level |
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ego
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one's sense of self
negotiates conflicts with id and superego characterized by secondary process thinking (conscious narrative that we are aware of) based on reality principle -lies in conscious, preconscious, and unconscious levels |
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Psychosexual stages
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Oral Stage- 0-18 months
-biting, nursing -fixation- cigarette smoking, overeating Anal Stage (18 months-3 years) -stimulation of anal area- potty training -fixation- anal retentive (overcontrolled) or anal expulsive (sloppy, impulsive) Phallic Stage (3-5 years) - interest in genitalia -Oedipal complex Fixation- neurosis Latency period (5- 12)- period of dormancy Genital Stage (12- adult) -development of normal adult impulses -interest in the opposite sex |
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Regression
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dealing with emotional conflict or stress by reverting to childish behaviors
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denial
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dealing with emotional conflict or stress by refusing to acknowledge a painful aspect of reality or experience that would be apparent to others
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repression
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unconsciously expelling disturbing wishes, thoughts, or experiences from awareness
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projection
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attributing undesirable personality traits or feelings to someone else to protect one's ego from acknowledging distasteful personal attributes
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rationalization
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concealing true motivations for thoughts, actions, or feelings by offering reassuring or self-serving but incorrect explanations
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displacement
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shifting unacceptable feelings or impulses from the target of those feelings to someone less threatening or to an object
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reaction formation
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transforming an unacceptable feeling or desire into its opposite in order to make it more acceptable
i.e fathers against porn |
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sublimation
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taking impulse (sexual/aggresive) and finding societal outlet
i.e. painting, sculpture, poetry, writing |
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Psychoanalytic treatment
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Insight- bringing un conscious material to conscious awareness
Dream Analysis- sense of underlying impulses Free Association- saying first thing that comes to mind Freudian slips- things said during free association that gives something away Analysis of the transference- relieves conflictual relationships with parents by transferring them onto the clinician |
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Evaluation of Psychodynamic theories
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dynamic processes unseens and not always testable
-same treatment regardless of diagnosis -parsimonious? |
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behaviorism
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conviction that psychology can be scientific only if it restricts research to observable events
behavioral perspective: abnormality is caused by faulty learning experiences cognitive-behavioral perspective: abnormality is caused by maladaptive thought processes which result in dysfunctional behavior |
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classical conditioning
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Pavlov
a response elicted automatically by one stimulus will in time be elicted by a second stimulus on the condition that the two stimuli consistently occur together -issues: opportunites for extinction are minimal opportunities for generalization of maximal |
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Treatment (Behaviorism)
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systematic desenitization
exposure therapy instrumental conditioning (operant) |
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systematic desensitization
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therapy for specific anxieties in which anxiety-producing stimuli are repeatedly presented along with an incompatible response (usually deep muscle relaxation)
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exposure therapy
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therapy in which an individual is exposed to a fear provoking stimulus until the fear becomes extinct
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instrumental (operant) conditioning
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process by which a voluntary behavior is modified by its consequences
postive/negative reinforcement, punishment, response cost |
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positive reinforcement
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apply a positive stimulus to increase behavior
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negative reinforcement
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remove aversive stimulus to increase behavior
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punishment
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apply aversive stimulus to decrease behavior
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response cost
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remove a positive stimulus to decrease behavior
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Cognitive-Behavioral Perspective
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maintain strong scientific grounding of traditional behavioral perspective but does not exclude such unseen processes as memory and thought
Elias A-B-C theory of emotion and behavior A= activating event, B= belief (cognitive distortions), C= consequence -automatic thoughts (that are distorted and lead to a consequence) -Irrational beliefs |
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Cognitive treatment
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conversations with the therapist emphasize cognitive distortions that impact on feelings and behaviors
-therapist attempts to identify automatic thoughts and irrational beliefs and help the patient recognize those patterns in themselves -therapy can take on a "confrontational" dimension as therapist challenges patient about long held beliefs |
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Evaluation: Cognitive- Behav perspec.
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-acknowledges the value of thought processes in behavioral outcomes
-firmly based in research -potentially compatible with all other perspectives -assumes thoughts precede and maintain emotional responses -confrontational approach may not fit with all clients |
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humanistic perspective
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view that humans are more capable than other animals and are uniquely aware of the world and their role in it
-human motivation is based on an inherent tendency to strive for self fulfillment and meaning in life -congruence (agreement)= real ideal |
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Client-centered therapy
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Carl Rogers
Belief that people are innately good and that the potential for self improvement lies within the individual rather than the therapist or therapeutic techniques |
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Unconditioned positive regard
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Carl Rogers
Involves total acceptance of what the client says, does, and feels. As clients feel better about themselves they become better able to tolerate the anxiety associated with acknowledging weaknesses |
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Self-actualization
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Abraham Maslow
The maximum realization of the individual's potential for psychological growth -capable of peak experiences -hierarchy of needs |
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Humanistic treatment
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-provide nurturing environment
-client response most precise index of functioning -never tell clients what they should do, allow clients to find their own solutions -Help clients accept responsibility for their lives |
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Evaluation: Humanistic Approach
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-many humanists and existentialists are opposed to scientific research
-even so, notion that each person is unique and needs to find meaning in life has been accepted by most therapists |
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Biological perspective
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-brain is the basis of all behavior, normal and abnormal
-most disorders have a brain basis (either in structure or neurotransmitter) that may or may not be identified at this point -Genetic factors (diathesis stress model) -the impact of infection? |
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Diathesis-stress model
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A proposal that people are born with a genetic predisposition or acquire a vulnerability very early in life due to such formative events as traumas, diseases, birth complications, and even family experiences
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Medication effects
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Gap at the juncture between neurons (synaptic cleft). a chemical substance (neurotransmitter) released from the transmitting neuron into the synaptic cleft, where it drifts across the synapse and is absorbed by the receiving neuron
-Medications act at level of synapse (blocks release/removal of neurotransmitter, enhance release of NT) |
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Types of Drugs
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Depression: selective serotonin reuptake inhibitors (SSRIs)- increase serotonin by blocking serotonin reuptake at the synapse
Anxiety: Benzodiazepines- binds to GABA, which inhibit brain sites involved in producing symptoms of anxiety such as panic attacks Bipolar disorder: Lithium- decreases catecholamines (dopamine, norephinephrine, ephinephrine) Schizophrenia: Blocks dopamine (Thorzine + Haldol), blocks dopamine and serotonin receptors(clozapine, risperidone OCD: antibiotics? |
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Insanity Defense
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M'Naughten Rule (1843)- Not guilty, by reason of insantiy, couldn't tell right from wrong
Durham Rule (1954)- Act was due to disease or defect Brawner Rule (1962)- Appreciating wrongfulness or irrestible impulse Reform act of 1984- severe disturbance, burden is on the defense to prove person is insane, guilty by mentally ill |
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Mandated Reporting
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requirement of professionals when they learn firsthand of cases involving child abuse or neglect
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Duty to Warn
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if clinican learns that a client is planning to hurt another person, he/she is required to inform intended victim that the client plans to harm him or her
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least restrictive alternative
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clients have the right to be placed in a treatment setting that provides the fewest constraints on the client's freedom
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