Abnormal Psych Final Oltmanns

Nicotine

Active ingredient in tobacco, which is its only natural source o Nicotine is toxic Sbsorbed into the blood through the membranes of the lungs o From there is it carried from the lungs to the heart and from there to the brain

In vivo desensitization

gradually confronting fears in real life while simultaneously maintaining a state of relaxation

Dura

leathery covering over the brain

Abstinence

less than one drink per month for more than one year

psychiatrist

licensed to practice medicine and therefore can prescribe medication

Developmental transitions

mark the end of one stage and the beginning of a new one

Depression - Behavioral symptoms

may range from constant pacing and fidgeting to extreme inactivity

Correlation coefficient

measures how strongly two factors are related

Relapse rates

more likely for women

Controlled drinking

more than one drink per month for at least two years with no reported problems

Cerebellum

motor movements

Frontal lobe

movement, speech, reasoning, and emotion

psychosexual stages

oral (ego develops), anal, phallic (superego develops), latent, genital

Immunosuppression

release of cortisol and CRF cause immunosuppression,* the decreased production of immune agents*

Reliability

• Concerned with *consistency* • Inter-judge agreement in diagnosis • Measured with kappa - at least in the range of .6-.7 is pretty good

Modeling

Learning through imitation • A concern for abnormal behavior is when parents or other important adults model dysfunction behavior (excessive drinking)

lifetime prevalence

Lifetime prevalence of all schizophrenia spectrum disorders is 1%

Clinical Depression

a depressed mood is accompanied by several other symptoms, such as fatigue, loss of energy, difficulty sleeping, and changes in appetite - involved with a variety of changes in thinking and overt behavior

Social theory of somatic symptom disorders:

When people in certain cultures experience psychological distress, they describe and experience their emotions as physical distress - Theory assumes that some cultures do not teach or allow open emotional expression

DSM-5 requirements

1. the symptoms have persisted for at least six months 2. the symptoms lead to marked distress in the person who experiences them

is nicotine addictive?

1996, FDA People who use tobacco clearly develop symptoms of dependence, including tolerance, withdrawal, and pattern of compulsive use o Nicotine is one of the most addictive drugs

lifetime prevalence (nicotine)

24% o Has declined since 1964 when U.S. Surgeon General's Report announces link between smoking and cancer o Among 18-25-year-olds, smoking increased during 1990s

% who receive treatment for anxiety disorders

25%

Dimensional model retains

6 of the 10 specific types of PDs from the categorical model

Antisocial Personality Disorder

Defined in terms of a persistent pattern of irresponsible and antisocial behavior that begins during childhood or adolescence and continues into the adult years

APA

emphasizes medicine published "Clinical Practice Guidelines," which contains most effective treatment guidelines

People who suffer from ASD symptoms are _______ to develop PTSD

"more likely to develop PTSD" - These symptoms are the best predictors of future PTSD - Numbing - Depersonalization - A sense of reliving the experience

BN - Medical Complications

* vomiting leads to erosion of dental enamel * enlargement of salivary glands * electrolyte imbalances * rupture of the esophagus or stomach * death

Reexperiencing:

- Some experience repeated, distressing memories of the incident - Others relive the trauma in horrifying dreams

Unconscious Mental Processes

- Unconscious mental processes play a role in both normal and abnormal emotion and cognition - Scientists debate the role of unconscious processing - Some propose elaborate models of unconscious mental processes:

Low-dose ECT

- Uses just enough current to produce a seizure- is less effective, but causes less memory impairments than high-dose ECT (2.5 or more times the minimal current)

outcome of schizophrenia

- poor outcome - Deteriorating course used to be one of the principal defining features - usually never restore "normal" function

Panic can be distinguished from anxiety

in two other respects: it is *more intense*, and it has a *sudden onset*

Informed consent

includes providing accurate information about risks and benefits in an understandable and noncoercive manner

psychopathology

pathology of the mind, i.e. the symptoms and signs of mental disorders such as depressed mood, panic attacks, and bizarre beliefs

Temporal lobe

processes sound and smell, regulates emotions, and is involved in aspects of learning, memory, and language

cannabinoids

produce euphoria and an altered sense of time ex. marijuana

Social support

the emotional and practical assistance received from others

Axon terminal

the end of the axon, where messages are sent out to other neurons

Personality

the essential traits that describe human behavior

specific symptoms that are used to define personality disorders:

Represent maladaptive variations in several of the building blocks of personality: o Motives o Cognitive perspectives regarding the self and others o Temperament o Personality traits

Informed consent

Requires that (1) a clinician tell a patient about a procedure and its associated risks, (2) the patient understands the information and freely consents to the treatment, and (3) the patient is competent to give consent

Structured interventions with ASD

Research shows that structured interventions with ASD can lead to prevention of future PTSD - These treatments use principles of cognitive behavior therapy - Typically involve five 90-min sessions

harmful dysfunction

the definition of a mental disorder in terms of an objective evaluation of the person's performance in the real world and hinderence to natural function

"flourishing"

a description, in the realm of psychological functioning, of the people who function at the highest levels - people who experience many positive emotions, interested in life, calm and peaceful o approaches to mental health in the community must be concerned both with efforts to diminish the frequency and impact of mental disorders and with activities designed to promote flourishing

Psychopharmacology

the use of medications to treat psychological disturbances

culture

the values, beliefs, and practices that are shared by a specific community or group of people - very large influence on the process of defining psychopathology

Schizophrenia

the ventricles of the brain are enlarged, and asymmetries are also found in other brain structures

clinical psychology

concerned with the application of psychological science to the assessment and treatment of mental disorders. o Ph.D - doctor of philosophy o Psy.D. - doctor of psychology

Preparedness model:

conditioned responses to fear-relevant stimuli (spiders) are more resistant to extinction than are those to fear-irrelevant stimuli (flowers); Also it is possible to develop conditioned fear responses after only one trial of learning

preventive detention

confinement before a crime is committed - can lead to substantial abuse

Antidepressants (meds)

depression, PTSD, anxiety

Behavior therapy

developed to treat anxiety disorders, especially specific phobias

Nervous breakdown

development of some sort of incapacitating but otherwise unspecified type of mental disorder

rape

"acts involving nonconsensual sexual penetration obtained by physical force, by threat or bodily harm, or when the victim is incapable of giving consent by virtue of mental illness, mental retardation, or intoxication" 14% adults raped 1/5 women report engaging in sexual activity without consent

examples of malpractice

(1) a professional has a duty to conform to a standard of conduct, (2) the professional is negligent in that duty, (3) the professional's client experiences damages or loss, and (4) it is reasonably certain that the negligence caused the damages inappropriate use of medication and negligent treatment are common

Personality disorder

(presented in DSM-5) emphasizes the duration of the pattern and the social impairment associated with the symptoms in question; the pattern must be evident in two or more of the domains: o Cognitive (way of thinking about the self and other people) o Emotional responses o Interpersonal functioning o Impulse control

lifetime prevalence

* 1.5% = lifetime prevalence of Bulimia * 3.5% = lifetime prevalence of binge-eating disorder among women * 4.9% = lifetime prevalence of occasional being eating among women * 2.0% = lifetime prevalence of binge-eating disorder among men * 4.0% = lifetime prevalence of occasional binge eating among men

Reaching orgasm

* 29% women - always orgasm with their specific partner * 75% men * 44% of men reported that their female partner always orgasmed (lol)

Who raped you?

* 4% raped by stranger * 46% raped by someone who they were in love with * 22% knew the rapist well * 9% raped by spouse * 19% acquaintance rape

Percent of high schoolers trying to lose weight

* 44% of high school females are attempting to lose weight * 15% of high school males are attempting to lose weight * Many boys want to gain weight in order to look stronger

Course and outcome of Bulimia

* 70% of patients are free of symptoms after 5 years following the original diagnosis * 20% show improvement but continue to struggle * 10% are chronically ill * Mortality is rare, but there has been a recent increase in suicide * Comorbid disorders also ten to improve when bulimia improves

Vaginal Intercourse

* 95% men * 97% women

Antidepressant Medications

* All classes are somewhat effective * medication alone is not the treatment of choice * the disordered behaviors improve only among a minority of people treated with antidepressants, and relapse is very common when medication is stopped * research shows CBT is more effective

Predictors of a better prognosis

* An early age of onset * conflict free parent child relationships * early treatment * less weight loss * absence of binging and purging

Anorexia Nervosa

* Anorexia literally meaning "loss of appetite" * extreme emaciation = obvious characteristic * people are hungry, yet they starve themselves

sexual behavior across the lifespan

* As men get older they tend to achieve erection slower but can often maintain erection for longer * harder to regain an erection once lost * As women get older, vaginal lubrication may occur at slower rate, but response of the clitoris remains essentially unchanged * Older people seem to engage in sex more frequently if they did so at a younger age as well * Sexual dysfunctions usually increase among the elderly, particularly among men * however, women reported to experience less pain during sex as they aged * Relation between sexual experience and aging is closely related to other health problems that increase with age

BN - Comorbid Psychological Disorders

* Depression is common - cause or reaction * usually lifts after treatment * anxiety disorders, personality disorders, and substance abuse

Who is most susceptible?

* Develop most frequently among young women in their teens and early twenties * Incidence among women reflects the intense focus on young women's physical appearance and the difficulties many adolescent girls have in adjusting to the rapid changes in body shape and weight that begin with puberty

Standards of beauty culturally

* Eating disorders are much more common in North America, Western Europe, and industrialized Asia countries * Bulimia may be completely culture bound * in other countries women who are more rounded are considered to be more beautiful * In third world countries, where food is scarce, being larger symbolizes beauty and success

Social causes of PD

* distorted "mating process" * "courtship disorder" - these people have not learned the adaptive type of courtship behavior * background factors: * sexual abuse * hearing about this type of behavior * lack of consistent parental environment in which normative sexual behavior and values were modeled * lack of self esteem * lack of confidence and social ability * ignorance and poor understanding of human sexuality * interpersonal skills * lonely, insecure, and isolated and have significant deficits in social skills

Hormones and medication

* drugs that reduce testosterone are frequently used (ex. triptorelin) * results show a decreases in sexual fantasies of children * manage sexual urges * Antidepressants and anti anxiety drugs have also been used * results show SSRIs can have a positive effect for males * reduce social anxiety

Biological Causes of Sexual Dysfunction for *men* in particular

* erectile dysfunction - vascular, neurological, or hormonal impairment * drugs influence a man's erectile response * correlation between cigarettes and erectile dysfunction * alcohol and weed may have negative effects on sexual arousal as well

Ratings of physical and emotional satisfaction

* even though 29% of women orgasm 41% say they are physically satisfied * this suggests that an orgasm is only one aspect of sexual satisfaction, especially for women

Biological causes of PD

* focus on the endocrine system, glands that regulate sexual response * found: elevated levels of testosterone * hard to tell whether biological abnormalities are causes of a certain disorder because there is so much variation * neurological abnormalities may also be involved in the development of disorders * temporal lobes of the brain appear to play an important role in control of aggression and sexual behavior * limbic structures

Defense mechanisms

1. Denial - insistence that something did not occur 2. Displacement - feelings or actions are transformed from one person or object to another 3. Projection - Attributing one's own feelings or thoughts to other people 4. Rationalization - Intellectually justifying a feeling or event 5. Reaction formation - converting a painful unacceptable feeling into its opposite 6. Repression - Suppressing threatening material form consciousness but without denial 7. Sublimation - diverting id impulses into constructive and acceptable outlets

gender dysphoria symptoms

* transsexualism * one who believes that their physical anatomy, they are more like the other gender * becomes more intense during adolescence (puberty) * dress as the opposite gender in order to feel more comfortable

AN - Significantly Low Weight

* usually begins with a diet gone awry * BMI under 18.5 * average victim is 25-30% below normal weight * 5% with people with anorexia nervosa die of starvation, suicide, or medical

double-blind study

* where neither the patient nor the therapist knows whether the patient is receiving an active treatment or a placebo * no always easy to interpret * Medications are more effective when they produce more side effects Impossible for psychotherapy studies

Epidemiological studies

** National Co-Morbidity Survey Replication (NCS-R) ** ♣ 9,000 people interviewed (national probability sample) between 2001 and 2003 ♣ 46% LIFETIME prevalence for at least one disorder • did not include eating or personality disorders ♣ First onset usually during childhood or adolescence

Superego

** conscience ** o Contains societal standards of behavior, particularly rules that children learn in their preschool years from trying to be like their parents

Biological Therapists

** o Would approach mental illness by drawing an analogy with physical illness ** o Would focus on making a diagnosis of her problems o Would note her father seemed depressed too ♣ Perhaps she has a genetic predisposition o Would not blame her or her family for their troubles o Would blame depression ** o Would explain that depression is caused by a chemical imbalance in the brain **

TCAs (tricyclic antidepressants)

- 1950 - Declined use since SSRIs because they have more side effects - Side effects - blurred vision, constipation, drowsiness, drop in blood pressure - block uptake of neurotransmitters from the synapse - TCAs and SSRIs compare about equal in effectiveness - positive response to about 50-60% of depressed patients

MAOIs (monoamine oxidase inhibitors)

- 1950s - not used as much as TCAs for two reasons: 1. develop high blood pressure when taken with foods containing large amounts of tyramine (cheese, chocolate) 2. not as effective as TCAs - can be used safely if patients avoid certain foods (cheese, wine, beer)

OCD prevalence

- 2% of the US meets criteria at some point in their lifetime - 12 month prevalence rate is 1.2% - less common than most anxiety disorders - doesn't show a significant gender difference

CBT

- Involves training in the use of social skills, which might be used to resist pressures to drink heavily - Includes problem-solving procedures, which help people to identify situations that might lead to heavy drinking and formulate alternative courses of action • Focus of CBT is on factors that initiate and maintain problem of drinking rather than act of drinking itself • CBT challenges expectations about the effects of alcohol - addresses negative effects of thinking about self and events

Treatment of panic disorders

1) Situational exposure - used to treat agoraphobic avoidance. Person repeatedly confront situations that have been avoided (being in crowded places) 2) Interoceptive exposure - aimed at reducing person's fear of internal, bodily sensations that are frequently associated with onset of a panic attack. Person engages in exercises that produce these physical sensations. Works well

Ways hoarding differentiates from OCD:

1) Unlike obsessions, thoughts associated with hoarding are not intrusive or unwanted. Hoarders find it pleasant to think about their possessions 2) Hoarding results in congestion of person's home (and issues with family or authority who have to deal with it) rather than thoughts about possessions or hoarding behaviors 3) Obsessions leads to increase in anxiety, but hoarding behaviors are associated with positive emotion. Anxiety increased if person forced to get rid of possessions

Two considerations are important when considering the self-perpetuating nature of worry:

1) Worry is an experience made up of "self-talk" - things people say to themselves rather than visual images 2) Worry serves the function of avoiding unpleasant somatic activation through the suppression of imagery - some people will continue to worry even when not productive because worrying is reinforced by immediate reduction in uncomfortable physiological sensations

Types of Individual therapies

1. *Bruch's* modified psychodynamic therapy designed to increase interoceptive awareness and correct distorted perceptions of self 2. *Feminist therapies* encourage young women to pursue their own values rather than blindly adopting prescribed social roles 3. Cognitive behavioral therapies - Little evidence that supports the effectiveness of any of these types of therapy

Basic Coping Strategies

1. *Problem-focused coping* involves attempts to change a stressor - i.e. If your job is stressful, look for a new one 2. *Emotion-focused coping* is an attempt to alter internal distress - i.e. Before big exam, breathe quietly to yourself

Psychological factors

1. A struggles for perfection and control 2. Depression, Low Self-Esteem, Dysmorphia 3. Negative Body Image 4. Dietary Restraint

Expectations about alcohol:

1. Alcohol transforms experiences in a positive way 2. Alcohol enhances social and psychical pleasure 3. Alcohol enhances sexual performance and experience 4. Alcohol increases power and aggression 5. Alcohol increases social assertiveness 6. Alcohol reduces - all can lead people to drinking more - short term positive effects

Psychopaths

1. Are emotionally impoverished o Lack of anxiety and fear o Do not show an exaggerated startle response that is indicative of fear in the presence of aversive stimuli (most people do show this) 2. Have difficulty shifting or reallocating their attention to consider the possible negative consequences of their behavior o Psychopaths respond normally to punishment in some situations, but not in others o Psychopaths are preoccupied with the potential for a successful outcome o They fail to inhibit inappropriate behavior because they are less able than other people to stop and consider the meaning of important signals that their behavior might lead to punishment

alcohol use disorder symptoms

1. First four symptoms of "alcohol use disorder" can be used to describe a person's impaired control over use of alcohol - includes unsuccessful attempts to quit drinking as well as craving for alcohol 2. Next three symptoms describe social impairment following drinking 3. Next 2 symptoms describe risky use, such as drinking and driving and continued use in spite of serious psychological and medical complications 4. Last two symptoms are tolerance and withdrawal, aka pharmacological criteria

DSM-5 definition of social anxiety disorder

Almost identical to that for specific phobia, but it is focused on social situations in which the person may be closely observed or evaluated by other people - People with social anxiety disorder are afraid of (and avoid) social situations in which they may be scrutinized - These situations fall into two broad headings: doing something in front of unfamiliar people (performance anxiety) and interpersonal interactions (such as dating and parties) - Fear of being humiliated or embarrassed lies at the heart of the person's discomfort

Suicide Rate increased:

Among adolescence from 1970 to 1990, corresponding to an increase in the prevalence of depression and decrease in the average age of onset of depression

Naltrexone (Revia)

An antagonist of endogenous opioids that has been found to be useful in the treatment of alcohol dependence following detoxification o Patients who receive this drugs and psychotherapy are less likely to relapse than those who receive psychotherapy and a placebo o This drug dampens the person's craving by blocking alcohol's ability to stimulate opioid system o Works by reducing the rewarding effects of alcohol

IPT (Interpersonal therapy)

An evidence-based treatment that focuses on changing emotions and styles of interacting in close relationships o Views parent-child and other close relationships as teaching patterns, or characteristic styles, in relating to others ♣ Certain patterns can create psychological problems in relationships or during life transitions o Focuses on making changes in the present and solid support from research

Theories suggest that dissociation is...

An unconscious defense that helps victims cope with trauma - However, dissociation predicts more, not less PTSD

Psilocybin

Another type of hallucinogen whose chemical structure resembles serotonin

Medication use

Antianxiety, antidepressant and antipsychotic medications are sometimes used but these reduce stress at best, they do not cure the disorder

Three ways in which the law assumes that mental disorders may affect an individual's ability to exercise his or her rights and responsibilities

1. Defendants who are not guilty by reason of insanity are not criminally responsible for their actions 2. Defendants who are incompetent to stand trial are unable to exercise their right to participate in their own defense 3. Mental illness may be a mitigating factor that can lead to a less harsh sentence - or a harsher one

multifaceted approach to treatment

Antipsychotic medication is the primary mode of treatment ○ Because many patients remain impaired between episodes, long-term care must often involve the provision of housing and social support ○ Treatment requires attention on multiple fronts (impaired social and occupational skills) and is necessarily concerned with the cooperative efforts of many types of professionals

Exhibitionistic disorder defined in terms of:

1. over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one's genitals to an unsuspecting person, as infested by fantasies, urges, and behaviors 2. the individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" * this is known as indecent exposure

Forms of child abuse

1. physical abuse 2. sexual abuse 3. neglect 4. psychological abuse

Issues in child custody

1. physical custody, or where the children will live at what times 2. legal custody, or how the parents will make decisions about their children's lives

6 types of feeding and eating disorders

1. pica 2. Rumination disorder 3. Avoidant/Restrictive disorder 4. Binge-eatint disorder 5. Anorexia nervosa 6. Bulimia nervosa

What reduces stress?

1. predictability - allows coping to being before onset of a stressor 2. control - illusion of control helps alleviate stress 3. Physical activity reduced physiological reactions to stress, even when it does not include problem-focused coping (having outlets for frustration does reduce stress)

Phases of predictable and unpredictable duration

1. prodromal 2. active 3. residual

Two broad types of substance-related disorder in DSM-5

1. substance use disorders 2. substance-induced disorders

Depression counts for nearly ___ of all disability

10%

Lifetime prevalence for having at least 1 PD

10%

combined lifetime prevalence for abuse or dependence of any substance

10.3% - more common among men than women

how much more common is anorexia and bulimia in females than males?

10x

Body dysmorphic disorder prevalence

2%

lifetime prevalence (gambling disorder)

2% - more common in men

Percent ion American women who have a negative body image

50% usually concerning their hips, waist, or thighs - European American and Latina women report highest rates

Oral Sexual Activities

75% men 65% women

Worrying

A cognitive activity that is associated with anxiety

Age of onset for anxiety

Average age of onset for anxiety is much younger than the age for onset for depression, so if someone has both, anxiety usually presented first

Illness behavior

Behaving as if you are sick - also is stress related - i.e. Will visit doctor's office more frequently or allow chronic pain to interfere with life - Effective coping may be ignoring some physical discomfort with chronic illness

(Jerome Wakefield's Definition of) Harmful Dysfunction

A condition should be considered a mental disorder if, and only if, it meets two criteria: ♣ Condition results from the inability of some internal mechanism to perform natural function • Ex. Regulate emotions, distinguishing between real/fake auditory sounds ♣ Condition causes some harm to the person as judged by the standards of the person's culture

Short-term psychodynamic psychotherapy

A form of treatment that uses many psychoanalytic techniques o Maintain therapeutic neutrality o Transference is a central issue o Therapy focuses on a particular emotional issue rather than relying on free association o Limited to 25 sessions, far less expensive

DSM-5 definition of mental disorder

A group of persistent maladaptive behaviors that result in personal distress or impaired functioning

Social skills training

Aims to teach clients new ways of behaving that are both desirable and likely to be rewarded in everyday life

Critical incident debriefing

A specific, 7-phase, small group, supportive crisis intervention process.

Trauma is not an event outside the range of usual human experience

Almost 90% of adults living in Detroit had experienced at least one trauma in their lifetime - Only about 9% developed PTSD - women are more likely than men to develop PTSD after trauma

A panic attack

A sudden, overwhelming experience of terror or fright - Panic is more focused than anxiety - Some clinicians think of panic as a normal fear response triggered at an inappropriate time - a "false alarm" - Largely defined in terms of a list of somatic or physical sensations, ranging from heart palpitations, sweating, and trembling to nausea, dizziness, and chills

MDMA (aka Ecstasy)

A synthetic amphetamine derivative o Causes enhanced mood state and a feeling of well-being o Does not cause changes in perceptual experience o Causes changes in blood pressure and body's ability to regulate temperature

Phencyclidine (PCP)

A synthetic drug that is classified with hallucinogens, although effects are very different from LSD and mescaline o Originally developed as a pain killer

Systematic desensitization

A technique for eliminating fears o Has been studied extensively and shown to be a very effective treatment for fears and phobias ** Exposure is the key to fear reduction **

Paraphilic disorder

A term that describes a paraphilia that either leads to subjective distress or social impairment for the person or that causes harm to, or threatens, other people

substance dependence

A term used to describe use disorders that were at least moderate in severity (e.g., those with pharmacological consequences)

Long-term outcome for the treatment of alcoholism

Best predicted by person's coping resources, the availability of social support, and the level of stress in the environment o These are more important than the specific type of intervention • Those with less stressful life situations, with families that are more cohesive, and those who are better equipped with active coping skills are most likely to sustain their improvement

Most common PD among patients treated at mental health facility

Borderline PD found in > 30% of all patients treated for psychological disorders

Jean-Martin Charcot used hypnosis...

Both to induce and treat hysteria - He greatly influenced Freud and Pierre Janet - Both developed theories of unconscious mental processes to explain hysteria - Janet saw dissociation as an abnormal process that occurred as part of psychopathology - Freud considered dissociation to be a normal means for the ego to defend itself against unacceptable, unconscious thoughts - Saw dissociation and repression similarly

OCD NCS-R survey

About 30% of people reported experiencing obsessions or compulsions at some point during their lives, but most did not qualify for an OCD diagnosis

Female Sexual Interest/Arousla Disorder

Absence or reduced frequency or intensity of several indicators in or response to sexual cues

Hoarding

Added to DSM-5 as new mental disorder - Used to be listed as potential symptom of OCD because person's fear of losing possessions was thought to be an obsessive thought (increasing anxiety)

Cognitive factors role in anxiety disorders

Additionally, people learn to avoid certain stimuli if they observe other people showing a strong fear response to those stimuli - People who believe that they are able to control events in their environment are less likely to show symptoms of anxiety than are people believe that they are helpless - Additionally, feelings of lack of control are linked to the onset of panic attacks in those with panic disorder, submissive behavior seen among those with social anxiety disorder, and chronic worrying among those with GAD

Genetic Factors

Bulimia nervosa concordance rate * MZ = 23% * DZ = 9% * Anorexia nervosa concordance rates are higher * Contribute to symptoms as well

Treatment for Bulimia

CBT, interpersonal psychotherapy, and antidepressant medication

The concept of schizotypal PD (SPD)

Closely tied to the history of schizophrenia as a diagnostic entity o Maladaptive personality traits are presumably seen among people who possess the genotype that makes them vulnerable to schizophrenia o The symptoms of schizotypal PD represent early manifestations of the predisposition to develop the full-blown disorder o A fairly large proportion of the family members of schizophrenic patients exhibit strange or unusual behaviors that are similar to, but milder in form than the disturbance shown by the patient

Twin Studies

Compare MZ and DZ twins - several twin studies of mood disorders have show higher concordance of MZ twins than DZ - Concordance rates: - *Bipolar disorder:* - MZ = .69 - DZ = .19 - *Depressive disorders:* - MZ = .54 - DZ = .24 - Also show us that environmental factors influence the expression of genetically determined vulnerability to depression - If genes told the whole story the concordance rate for MZ twins would be 1 (always concordant)

Cluster A

Describes behavior that is typically odd, eccentric or asocial o Includes: paranoid PD, schizoid PD, and schizotypal PD o These share similarities with the symptoms of schizophrenia o These types of PDs may represent behavioral traits of interpersonal styles that precede the onset of full-blown psychosis o Sometimes called schizophrenia spectrum disorders

SSRIs (selective serotonin reuptake inhibitors)

Developed in the 1980s, most frequently used form of medication (80%) - synthesized in labs by pharmaceutical companies - they are "selective" because they only effect reuptake of serotonin - have fewer side effects than other meds - *Side effects* - nausea, headaches, sleep disturbance - most troublesome = sexual desire and orgasmic dysfunction (50%) - weight changes

1. Metabolic tolerance

Develops when repeated exposure to the drug causes the person's liver to produce more enzymes than are used to metabolize (break down) the drug => drug is metabolized quickly so person must take larger doses of drug

Line between normal behavior and compulsive behavior

Difficult to define - Arbitrary threshold is that rituals take more than one hour per day or that they impair occupational or social functioning

Female Orgasmic Disorder

Difficulty experiencing orgasm and/or markedly reduced intensity of orgasmic sensations * orgasmic impairment is generalized - never experienced orgasm by any means * women can still find pleasure in foreplay and show signs of arousal - hard to diagnosis because of the various components of female sexual response

Symptoms of PTSD......

Diminish over time - Rapidly during the first year, and more gradually after - Diminish faster among people who receive treatment

Egoistic Suicide

Diminished Integration - occurs when people become relatively detached from society and when they feel that their existence is meaningless - more common among groups such as people who have been divorced and people who are suffering from mental disorders - emotions - depression and apathy

"freedom of choice"

Diminished control over drinking is a crucial feature of the disorder

Anomic Suicide

Diminished regulation - occurs following a sudden breakdown in social order or a disruption of the norms that govern people's behavior - explains increased suicide rates that occur following an economic or political crisis - emotions - anger, disappointment, exasperation

Temperament + personality traits

Explains how people behave a certain way

Motivation

Explains why people behave a certain way

Mood disorders are most common among younger and middle-aged adults

Explanations: - older people are likely to experience memory impairments - many depressed people may not have survived until old age

Detox

Extremely difficult as person experiences withdrawal and gradually adjusts to absence of drug • With CNS depressants detoxification is accomplished gradually • In contrast, stimulant drugs can be stopped abruptly • People going through alcohol detoxification are often given various types of medications to minimize withdrawal symptoms (controversial)

Suicide

Extremely personal, private, and complicated act - Highest rate in the US is seen in *white males over the age of 50* - those who are occupationally successful are more likely to commit suicide, especially if that success is threatened or loss *50% of suicides occur in a result of a primary mood disorder*

Maudsley method

Family therapy * parents take complete control over the anorexia child's eating, planning meals, preparing food, and monitoring eating * parents do not blame the adolescent for her problems, but emphasize the uncontrollable nature of anorexia and the importance of food in order to get better * age appropriate autonomy is returned to the teenager as eating and weight improve

Illness and stress

Illness can also cause stress: have to deal with treating illness, may be stereotypes associated with illness, have to deal with long-term side effects of illness

False memory syndrome

Implanting false beliefs (and presenting them as repressed memories) - The malleability of memory suggests many reasons for skepticism - Some patients with apparently recovered memories are victims of their therapists, not of abuse

Amygdala

Important part of the neural circuit involved in *emotion* - responsible for monitoring the emotional significance of information that is processed by the brain and regulating social interactions

1897 Emile Durkheim - studied the social context (political, religious) in which human problems appeared

In Suicide, he argued that suicide rate would increase if levels of social integration and regulation are either excessively low or excessively high - he identified 4 types of suicide: 1. Egoistic Suicide 2. Altruistic Suicide 3. Anomic Suicide 4. Fatalistic Suicide

Symptoms - physical impairments

In dramatic cases, symptoms involves substantial impairment, particularly in the sensory of muscular system - Eg. patient is unable to see or reports paralysis of an arm In other cases, patients experience one or more minor physical symptoms, or some vague complaint that is misinterpreted as a sign of a serious illness - Eg. patient believes pain, upset stomach or dizziness is a sign of cancer - Anxiety persists despite negative medical tests and a physician's reassurance

DSM-5 definition of substance use disorders

In terms of a maladaptive pattern of behaviors that are related to the continual use of drugs, in spite of the fact that their use creates a set of significant problems for one person

Psychiatry and asylums

Physicians served as superintendents of asylums and developed systems for describing, classifying, and treating people with various types of mental disorders - Their efforts led to the use of scientific methods to test these new ideas

Neuroendocrine System

Pituitary, Thyroid, and Adrenal glands secrete hormones to the bloodstream in response to signals from the brain - *Hypothalamic-pituitary-adrenal (HPA) axis* - an important pathway that may be closely related to the etiology of mood disorders - *when person detects threat —> hypothalamus signals pituitary gland to secrete a hormone called ACTH —> modulates secretion of hormones, such as cortisol, from the adrenal glands into bloodstream* - may be involved in the development or maintenance of clinical depression - *Dexamethasone suppression test* (DST) - used to study endocrine deduction in patients with mood disorders - Dexamethasone - a potent synthetic hormone - 1/2 of depressed people patients show a failure of suppression in response to the DST - Overproduction of cortisol may lead to changes in brain structure and function

Posttraumatic growth

Positive changes resulting from trauma - Linked with less depression and more positive well-being - Linked with more intrusive and avoidant thoughts

Prejudice, Poverty, and Society

Prejudice and poverty are social influences on psychological well-being in the US because they are two factors that are so commonly linked to American life ♣ Prejudice experienced by gays and lesbians leads to increased risk for mental health problems ♣ Poverty is linked to many stressors, including exposure to traumas, chemical toxins

Age differences

Prevalence rates for anxiety disorders have been found to be lower when people are over the age of 60 compared to younger adults - Agoraphobia is noticed to increase late life

Erectile disorder

Repeated failure to obtain or maintain erections during partnered sexual activities * Appear anytime prior to orgasm * Impotence - old name for disorder was dropped due to negative implications * can be transient or chronic

Excessive worriers

Report content of thoughts as negative, have less control over direction of their thoughts, and their worries are less realistic

U relationship of stress

Research shows too little stress as well as too much stress can be harmful

Close relationships

Researchers find that relationship problems are associated with various emotional disorders

ECT side effects

Short memory loses Chance of death is same as going under anesthesia

Victims of acquaintance rape..

Show increased symptoms of PTSD when they encounter victim blaming behaviors from professionals who are supposed to help them - Two thirds of stranger rapes and four fifths of acquaintance rapes are not reported to authorities

allegiance effect

Shows us that a therapist's beliefs also help make treatment work * tells us CBT should have been more successful in the study because the investigators are cognitive behavior therapists * the results however, overcame the allegiance effect * a way to address this problem is to have two investigators who are opposing allegiances participate in the same study * overcomes allegiance effect but creates a new problem - effects due to the different, individual therapies cannot be controlled

Somatic Symptom disorders Comorbidity

Somatic symptom disorders typically occur with other psychological problems, particularly depression and anxiety - The link with depression has several possible explanations: - Either condition may cause the other - Both may be caused by a third variable, such as life stress - Some patients may express depression indirectly through somatic complaints - The link with anxiety: - Anxiety is often experienced physically and may be misreported in terms of physical symptoms

Sullivan (ego analyst)

Suggested that personality characteristics can be conceptualized in interpersonal terms o Saw two basic dimensions of relationships ♣ Interpersonal power ranges from dominance to submission ♣ Interpersonal closeness ranges from love to hate

Sell v. United States

Supreme Court upheld the right of defendant to refuse treatment when the purpose what to establish competence to stand trial

Symptoms

Symptoms seem to stem from a fundamental breakdown in basic cognitive functions that govern the way the person perceives and thinks about the social world ● Most common symptoms include changes in the way a person thinks, feels that relates to other people and the outside environment ○ No single symptom or set of symptoms is characteristic of all schizophrenia patients

Active phase

Symptoms such as hallucinations, delusions and disorganized speech

Tardive dyskinesia (TD)

Syndrome consists of abnormal involuntary movements of the mouth and face (eg tongue protrusion, chewing, lip puckering, spasmodic movements of the limbs and trunk of the body) - distressing problem - induce by antipsychotic treatment and is irreversible in patients

Psychopathy Checklist (PCL)

Systematic approach to the assessment of psychopathy o Includes two major factors: ♣ Emotional/interpersonal traits ♣ Social deviance associated with an unstable or antisocial lifestyle o Indicates that the emotional and interpersonal traits can be used reliably

product test

The Durham opinion (Durham v. United States) indicated that an accused is not criminally responsible if his or her unlawful act was the product of mental disease or defect o This ruling made no attempt to define either product or mental disease o Terms were intended to be very broad to allow mental health professionals wide discretion in determining insanity and testifying in court

Included in the DSM-5

The inability to control the use of the drug, risky use of the drug, social impairment following repeated use, and pharmacological consequences including tolerance (the need for increased amounts of the drug to achieve intoxication) and withdrawal (unpleasant psychical and psychological effects that the person experiences when he or she tries to stop taking the drug)

Anhedonia

The inability to experience pleasure ○ Patients typically lose interest in recreational activities and social relationships, which they do not find enjoyable ○ Unable to experience pleasure from physical sensations such as taste and touch ○ This is an enduring feature of schizophrenia for many people ○ This may be an early marker, signaling the onset of the prodromal phase of the disorder

ICD-10

The international version of the DSM-5 o World Health organization o Difference between 2 manuals

Flight-or-Flight response

The reaction you witness in a time of immediate threat or danger - you either run away or you fight the stressor - maladaptive reaction - seen as common among men - activates your sympathetic nervous system

Symptoms of a PD

Themes of aggression, violence, and hostility are common in paraphilia fantasies, as are impulses involving strangers or unwilling partners * lack of human intimacy * compulsion and lack of flexibility * they feel compelled to engage in certain acts that may be personally degrading or harmful to others * similar to addiction * preoccupations with fantasies * experience sexual dysfunctions involving desire, arousal, or orgasm during conventional sexual behavior with a partner

Most effective treatment for PTSD

Therapeutic reexposure to trauma

Cognitive Therapy

Therapists are active and directive in their interactions with clients, focusing their attention on their clients' current experience - Assume that people have conscious access to cognitive events - Serious commitment to the empirical evaluation of the efficacy of treatment programs - *Studies show it is effective in the treatment of nonpsychotic depression*

How psychologists select the most effective treatment

Therapy outcome -how well a treatment works Therapy process -what makes therapy work

Analogue Studies

They focus on behaviors that resemble mental disorders—or isolated features of mental disorders—that appear in the natural environment - depend on the use of animal models of psychopathology, which have provided important insights regarding the etiology of conditions such as anxiety, depression, and schizophrenia - When lab animals are exposed to uncontrollable stress they frequently exhibit behavioral symptoms that are similar to those seen in depressed humans

Lithium

Useful for *manic and depressive episodes* - if taken consistently patients are less likely to experience a relapse - *40%* of patients *do not improve* with this type of medication - usually seen with patients who exhibit a mixture of depressive and manic episodes - *50%* of patients *fail to take it regularly due to negative side effects* - nausea, memory problems, weight gain, impaired coordination

Eclectic

Using different treatments for different disorders o Most mental health professionals describe themselves as such

Early Treatment - Psychodynamic

Using hypnosis to induce troubled patients to talk freely about problems in their lives (Breuer came up with it) o Upon awakening, many patients reported relief from symptoms o Catharsis -the release of previously unexpressed feelings

Highest prevalence rates

Usually found to be associated with OCPD, antisocial PD and avoidant PD ~ 3-4%

Following medical advice

Very important health behavior that as many as 93 percent of patients fail to do fully - Especially dangerous when stop medication for illness with no external symptoms because can't see internal effect it's having - Stress can interfere with treatments that do affect symptoms - i.e. Less likely to adhere to medical advice about diet and exercise

Treatment for victims of trauma

Victims of trauma must find a balance between gradually facing their painful emotions while not being overwhelmed by them - Lower rates of PTSD in people who are better at enhancing and suppressing emotional expression

substituted judgement

When the patient's competence is in question, a common approach is to appoint an independent guardian who offers a substituted judgement, deciding not what is best for the patient but what the patient would do if he or she were competent

Five-factor model (FFM)

Widely accepted point of view about the basic dimensions of temperament and personality o Includes neuroticism, extraversion, openness to experience, agreeableness and conscientiousness o Many PDs are defined in terms of maladaptive variations of these traits ♣ Problems may arise in association with extreme variations in either direction

Derealization

a marked sense of unreality - Might think the trauma had only been a nightmare (as in 9/11) a symptom that involves feelings of unreality or detachment from the environment

seasonal affective disorder

a mood disorder in which the onset of episodes is regularly associated with changes in the season - a pattern of depression in which the person becomes depressed in the fall or winter, followed by a recovery in the following spring or summer

Sedative

a more general term that describes drugs that calm people or reduce excitement

mediator

a neutral third party who facilitates the parents' discussions during a custody decision

Systematic desensitization

a patient taught progressive muscle relaxation while working through hierarchy of feared stimuli - effective treatment - Repeated until patient no longer feels increase in anxiety - Crucial feature: systematic maintained exposure to the feared stimulus - Flooding: beings with most frightening stimuli rather than working way up from bottom

Premorbid history

a pattern of behavior that precedes the onset of the disorder

Bipolar II

a person who experiences at least one major depressive episode, at least one hypomanic episode, and no full-blown manic episodes - *hypomania* - episodes of increased energy that are not sufficiently severe to qualify as full-blown mania - different than manic episode because of duration and severity - the mood change must be noticeable but the disturbance must not be severe enough to impair social or occupational functioning or to require hospitalization

Bipolar I

a person who has experienced at least one manic episode - Vast majority of people with this disorder experience episodes of major depression as well

Motive

a person's desires and goals; describe the way that the person would like things to be, and they can help to explain why people behave in a particular fashion o Can be conscious or unconscious

Mood

a pervasive and sustained emotional response that, in its extreme form, can color the person's perception of the world

Obsessive-Compulsive PD

a pervasive pattern of orderliness, perfectionism and mental and interpersonal control, at the expense of flexibility, openness and efficiency

Dependent Personality Disorder

a pervasive pattern of submissive and clinging behavior

A Diathesis

a predisposition toward developing a disorder

substance-induced disorders

Include the immediate impact of taking the drug (intoxication) or discontinuing its repeated use (withdrawal)

Fear

Is experienced in the face of real, immediate danger - It usually builds quickly and intensely and helps organize the person's behavioral responses to threats from the environment

Anxiety

Is focused on the future rather than the immediate present - It helps us anticipate and prepare for important events - Physical signs include dry mouth, pounding heart, heavy breathing

operational definition

a procedure that is used to measure a theoretical construct - for males - penile plethysmograph - for females - vaginal photometer

Effectiveness of SSRIs

Is likely at least partially due to the high comorbidity between PTSD and depression - Only 30% of patients treated with SSRIs recover fully from PTSD symptoms *Traditional anti anxiety medications are not effective for PTSD*

Similarity between gambling disorder and substance use disorders

Is strongest with regard to loss of control of behavior and weakest with regard to possible development of physiological aspects of tolerance and withdrawal

Chasing loses

Is unique feature of gambling disorder; this is process of trying to win back money that has already been lost

State-dependent learning

a process where learning that takes place in one state of affect or consciousness is best recalled in the same state - Experiences that occur during a dissociated state may be most easily recalled within the same state of consciousness - Perhaps through the repeated experience of trauma, dissociation, and state-dependent learning, more complete and autonomous memories develop, leading to independent personalities

Psychosomatic disorders

a product of both the mind (psyche) and body (soma)

social work

a profession that is concerned with helping people to achieve an effective level of psychosocial functioning

Assertive community treatment (ACT)

a psychosocial intervention that is delivered by an interdisciplinary team or clinicians who provide a combination of psychological treatments (including education, support, skills training, and rehabilitation, as well as medication) - provided on regular basis - hopes to minimize need for hospitalization

Social Readjustment Rating Scale (SRRS)

a scale that assigns stress value to life events based on the judgments of a large group of normal adults - views stressors that produce more life change units as causing more stress - Holmes and Rage's 1967

syndrome

a set of characteristic features and symptoms that appear together, that represent a specific type of disorder

Paradigm

a set of shared assumptions that includes both the substance of a theory and beliefs about how scientists should collect data and test hypothesis o The Four broad theories of abnormal behavior ♣ Biological paradigm ♣ Psychodynamic paradigm ♣ Cognitive-behavioral paradigm ♣ Humanistic paradigm

Schizophrenia

a severe form of abnormal behavior that encomplasses what most of us have come to know as "madness" ○ People exhibit many different kinds of psychotic symptoms, indicating that they have lost touch with reality - May hear voices that aren't there - May make comments that are difficult, if not impossible, to understand - Behavior may be guided by absurd ideas or beliefs

Critical incident stress debriefing (CISD)

a single one- to five-hour group meeting offered one to three days following a disaster - May be the most widely used early intervention - Research shows no evidence that it prevents future PTSD - Some studies find that it is harmful - May provoke too much emotion too soon after trauma - It is also unnatural because it is provided by outsiders to groups of individuals who have no relationship to one another

Emotion

a state of arousal that is defined by subjective states of feeling - sadness, anger, disgust - often accompanied by physiological responses - increase heart rate and respiration rate

Social skills training (SST)

a structured, education approach to problems in social and occupational functioning that involves modeling, role playing, and the provision of social reinforcement for appropriate behaviors - improves social adjustment - unclear if helps with relapse

Heroin

a synthetic opiate • can be injected, inhaled though the nose in the form of snuff, or smoked and inhaled through a pipe or tube

Paraphilia

a term that describes "any intense and persistent sexual interest other than sexual interest other than sexual interest in genital stimulation or preparatory fondling with a phenotypically normal, physically mature, consenting human partner"

Stress

any challenging event that requires physical, biological, cognitive, or behavioral adaptation - could be defined as an individual's reaction to an event - an adaptive, important response to our surroundings and aspects of life

Psychopathy and ASPD

are two different attempts to define the same disorder o They are sufficiently different that they do not identify the same people o They are not used interchangeably

John B. Watson

argued for behaviorism - suggesting only observable behavior was appropriate subject matter for the science of psychology

Historically, dissociative disorders were viewed...

as forms of hysteria - The term hysteria reflects ancient views that frustrated sexual desires (esp a woman's desire to have a baby) cause unusual symptoms

Labeling theory

asserts the that emotional disorders themselves are enactments of prescribed social roles

Family treatment programs

attempt to improve the coping skills of family members, recognizing the burdens that people often endure while caring for a family member with a chronic mental disorder - medication on an outpatient basis - educational component to help fam - goal = to eliminate unrealistic expectations - goal = improve communication and problem-solving skills - can delay relapse!

guilty but mentally ill (GBMI)

attempt to reform the insanity defense

Reductionism

attempts to understand problems by focusing on smaller and smaller units, suggesting that the smallest account is the "true" cause

First wave CBT

based on operant and classical conditioning

criminal responsibility

because people act out of free will, they are accountable for their action when they violate the law

Is it culture bound?

been observed in virtually every culture that has been subjected to careful analysis ○ The frequency of schizophrenia is not constant around the world ■ Urban populations have higher rates than rural rates, but incidence is not related to a country's economic status ○ Studies show that clinical and social outcomes are significantly better for schizophrenic patients in developing countries than in developed countries ■ May be a product of the greater tolerance and acceptance extended to people with psychotic symptoms in developing countries

sadistic rapists

behavior is sexual and aggressive

Social roles

behavior that is shaped by a social "scripts"

joint custody

both parents retain physical or legal custody or both

Oedipal conflict

boys harbor sexual desire from their mothers - boys resolve this impossible impulse by identifying with their fathers

Dendrites

branch out from the soma and serve as the primary function of receiving messages from other cells

irresistible impulse test

broadened the insanity defense to include defendants who were unable to control their actions because of mental disease

How do antipsychotic medications act?

by blocking dopamine receptors in the cortical and limbic areas of the brain as well as affecting a number of other neurotransmitters including serotonin, norepinephrine and acetylcholine

formal commitment

can be ordered only by a court

Misperceiving intentions, motives and abilities of other people

can severely disturb our relationships!! o People with PDs run into problems because they misperceive other people in many ways (as being threatening, uncaring, or incompetent)

inhibited sexual arousal

cannot either achieve or maintain genital response, such as lubrication and swelling, that are necessary to complete sexual intercourse

Reuptake

captures some neurotransmitters in the synapse and returns the chemical substances

Tend and Befriend

caring for offspring, protecting them from harm and social affiliation, finding safety in numbers, and sharing resources - seen among women

Schizotypal Personality Disorder

centers around peculiar patterns of behavior

Antisocial PD

central feature = egocentricity and the stunning lack of concern for the impact of their behavior on other people, especially those who are close to them - people with ASPD show callous indifference and shallow emotional experience

psychotherapy placebos

challenging to do

Temperament

characteristic styles of relating to the world

sex roles

characteristics, behaviors, and skills that are defined within a specific culture as being either masculine or feminine

Illness anxiety disorder

characterized by a fear or belief that one is suffering from a physical illness, but physical symptoms are either absent or minor - Formerly called hypochondriasis - Disorder is preoccupying, enduring and often leads to substantial impairment in life functioning - Even thorough medical evaluation does not alleviate fears - Patient is not delusional

Histrionic Personality Disorder

characterized by a pervasive pattern of excessive emotionality and attention seeking behavior

Narcissistic Personality Disorder

characterized by a pervasive pattern of grandiosity, need for admiration, and inability to empathize with other people

Avoidant Personality Disorder

characterized by a pervasive pattern of social discomfort, fear of negative evaluation, and timidity

Seasonal Mood Disorders - Treatment

Light therapy (1980s) - exposure to bright, broad spectrum light for one to two hours every day - improvement in mood is often seen within 2-5 days - outcome is slightly equivalent to the use of standard antidepressant medication - light + cognitive therapy = more effective

Male body image

Males are equally divided between those who want to lose weight or gain weight

Denial

Many people fail to take advantage of treatment because do not realize severity of their problems

Cannabis sativa

Marijuana and hashish are derived from this hemp plant - Active ingredient is THC

Delayed Ejaculation

Marked delay in or inability to achieve ejaculation * must be experienced in at least 75% of sexual encounters * person must show a normal interest in and response to sexual stimuli

Project MATCH

Matches clients to certain kinds of treatment o Evaluated 3 forms of physiological treatment: 1. CBT 2. 12-step facilitation therapy 3. Motivational enhancement therapy o All three led to major improvements in amount of drinking and other areas o Very few differences found between the different methods o 12-step facilitation program was slightly favored ♣ 24% achieved abstinence one year after treatment compared to 15% in other two groups

mitigating factors

Mental disorders are one of several mitigating factors that judges are required to consider before sentencing a guilty party

Bipolar Disorders - Treatment

Mood stabilizers are usually used, sometimes antidepressants are used as well - antidepressants can sometimes trigger a switch from depression into a hypomanic or manic episode 1. Lithium 2. Anticonvulsant Medications 3. Psychotherapy 4. ECT *therapy + medication has been found to be more effective than just medication alone*

Social Factors affecting depression

stressful life events —> development of depression - Troublesome problem: the direction of the relationship between life events and mood disorders - being fired —> depression - depression —> being fired *Major losses* of important people or roles seems to play a crucial role in precipitating major depression *Severe events* - those that are particularly threatening and have long-term consequences for the woman's adjustment— increase the probability that a woman will become depressed

Base rates, population frequencies

strongly contribute to errors

Behavior geneticists

study how genes influence individual differences

High-risk research design

subjects selected from general population based on well-documted risk factor - follow participants over time - identity factors that increase or decrease vulnerability to a disorder

Resilience

successful psychological coping - The most common human response to trauma

Assertiveness training

teaches clients to be direct about their feelings and wishes • May involve different levels of detail (from learning to make eye contact to asking for a raise) • Role playing is frequently used in this training

Aspects of sexual satisfaction

tenderness, intimacy, affection - are also very important

The idea behind the insanity defense

that mental disability should limit criminal responsibility

What increases stress?

the *perception of control* increases stress when people believe they could have exercised control but failed to do so, or when lose control over something that used to be in their control (failed attempts to control intensify stress)

resilience

the ability to cope successfully with the challenges of life, including very stressful ones - is attributed partly to the individual and partly to social support and environment - some grow and get stronger as a result of stress

Working memory

the ability to maintain and manipulate information for a short period of time - researched to search for signs of vulnerability

null hypothesis

the alternative to the experimental hypothesis. It always predicts that the experimental hypothesis is not true

abnormal psychology

the application of psychological science to the study of mental disorders

Evolutionary psychology

the application of the principles of evolution to understanding the animal and human mind

Conduct disorder

the best predictor of antisocial PD in childhood

psychiatry

the branch of medicine that is concerned with the study and treatment of mental disorders - creation of large institutions for mental patients led to the development of this profession

free will

the capacity to make choices and freely act on them

Shell shock (combat neurosis)

the cause of men leaving the field of action (called battle dropout) - In Vietnam war, battle dropout was less common but delayed reactions to combat were far more frequent - This is what prompted much interest in PTSD

Lateral ventricles

the cavities on each side of the brain that are filled with cerebrospinal fluid

Soma

the cell body and largest part of the neuron ♣ This is where most of the neurons metabolism and maintenance are controlled and performed

Confidentiality

the ethical obligation not to reveal private communications - is the basic psychotherapy (standard for all major mental health professionals) - must also be broken when clients are dangerous to themselves or others, so that civil commitment can proceed

Phenotype

the expression of a given genotype ♣ Different genotypes can produce the same phenotype ♣ Environment affects a phenotype, but cannot change a genotype

construct validity

the extent to which these specific measures procedure results that are consistent with the theoretical contstruct

Gene-environment correlation

the fact that our experience is correlated with our genetic makeup

Mania

the flip side of depression, also involved a disturbance in mood that is accompanied by additional symptoms: - accompanied by inflated self-esteem, decreased need for sleep, distractibility, pressure to keep talking, and the subjective feeling of thoughts racing through the person's head faster than they can be spoken

Dominance

the hierarchal ordering of a social group into more and less privileged members

Attachment theory

the human need to form close relationships - based off ethology - the study of animal behavior

Deterrence

the idea that people will avoid committing crimes because they fear being punished for them, is a major public policy goal of criminal law

Holism

the idea that the whole is more important than the sum of its parts

Diagnosis

the identification or recognition of a disorder on the basis of its characteristic symptoms

moral treatment

the laudable but failed movement to alleviate mental illness by offering respite and humane care

Iatrogenesis

the manufacture of a disorder by its treatment - Theory that dissociative disorders are caused by iatrogenesis - This explains the explosion of DID diagnoses

Mind-Body dualism

the mistaken view that the mind and body are somehow separable

Child neglect

the most commonly reported form of child abuse, places children at risk for serious physical or psychological harm by failing to provide basic and expected care

Medication

the most effective and most commonly used biological approach to the treatment of anxiety disorders - Medication is often used in conjunction with psychological treatment

malfunction of interpersonal relationships

the most important and seriously debilitating aspects of schizophrenia ○ Many people with schizophrenia become socially withdrawn ○ Social isolation develops before the onset of symptoms in many cases ○ Social withdrawal appears to be both a symptom of the disorder and a strategy employed by some patients to deal with their symptoms

incidence

the number of new cases of a disorder that appear in a population over a period of time

- Dissociative amnesia

the partial or complete loss of recall for particular events or for a particular period of time - Results from trauma or severe emotional distress - May occur alone or in conjunction with other dissociative experiences - Dissociative fugue sometimes accompanies it

Affect

the pattern of observable behaviors, such as facial expression , that are associated with these subjective feelings - other examples: pitch of voice or hand and bandy movements

refractory period

the period of time in which men are unresponsive to sexual stimulation after reaching orgasm

Bipolar disorder is considered *rapid cycling* if

the person experiences at least 4 episodes of major depression, mania, or hypomania within a 12 month period - patients are likely to show a problematic course with treatment

Casual drinking

• About two out of every three males in western countries drink alcohol regularly, at least on a social basis; less than 25% abstain from drinking completely • 20% of all men and women who use alcohol will develop serious problems as a result of prolonged consumption • 60% of women in the U.S. drink at least occasionally • In comparison to men, fewer women develop alcoholism

Gender disparities (alcohol)

• For all age groups, men more likely to be diagnosed with alcohol-related disorder • Persistent gender differences can be attributed to social and biological variables o Example is negative view of intoxicated women o Biologically, women will have higher peak in blood alcohol level compared to men - more sensitive ♣ Men have higher average content pf body water o Women who drink heavily for many years are more vulnerable to liver disorders

Why do we need classificaiton?

• For making treatment decisions • For research (advancing knowledge)

Genes and alcohol

• Genes are involved in the metabolism of alcohol • Genes are involved in personality traits

Genetic factors

• Genetic factors become increasingly important in shaping patterns of use • A genetic predisposition to alcohol dependence probably causes the person to react to alcohol in an abnormal fashion • Biological mechanisms responsible for abnormal reactions to alcohol seem to involve several interrelated neurotransmitter systems

Humanistic goal and focus

• Goal = emotional awareness • Focus = free will o Developed as a counterpoint to both psychodynamic and cognitive-behavior therapy o Believes that therapy can help you to solve only your own problems, to make better choices in your life

Diagnostic Interviews

• Great for things like psychosis, depression, and anxiety • Structured interviews improved reliability of diagnosis • Have limits, especially when self-knowledge is limited • He thinks they are the most used assessment

Assessment Procedures Changes for Psychologists

• Psychologists were "testers" for many years o 1940s-1950s - just gave tests and reported the results to MDs o 1960s - psychologists won the right to treat patients independently of MDs • Our field has developed an industry of doing testing, with instruments like IQ tests, objective personality tests (MMPI-2), and projective tests being administered in standard batteries • That part of the filed has been diminished in importance over the past 30 years, but it's still there

Cognitive behavior therapy (CBT)

• Therapist = active, directive, nonjudgmental, teacher • Primary method = instruction, guided learning, homework - Homework: *Hang out with friends *Log your feelings during panic attacks A practical approach oriented to changing behavior rather than trying to understand the dynamics of personality

Somatic symptom disorder

characterized by at least one and usually several somatic complaints accompanied by excessive concern about the symptoms - Chronic pain may or may not be a part of the presentation - Patients sometimes present their symptoms in a histrionic manner (a vague but dramatic, self-centered and seductive style) - Patients may exhibit la belle indifference -a lack of concern about their symptoms - Begins in adolescence - Sometimes called Briquet's syndrome - usually more common among women (sexual abuse?)

Negative symptoms

characterized by the absence of a particular response ■ Include characteristics such as lack of initiative, social withdrawal, and deficits in emotional responding - may be harder to recognize than positive ones - more subtle over time

Positive symptoms

characterized by the presence of an aberrant response ■ Include hallucinations and delusions; also called psychotic symptoms

Common compulsions

checking and cleaning 1. Compulsive cleaning is associated with irrational fear of contamination (like phobia) 2. Compulsive checking frequently represents an attempt to ensure the person's safety or the safety and health of a friend or family member

Neurotransmitters

chemical substances in the vesicles of the axon terminal ♣ Serotonin and dopamine

Psychotropic medications

chemical substances that affect psychological states o Do not cure underlying causes ♣ Symptom alleviation is still extremely important o Many must be taken for a long time ♣ Because they do not produce a cure

Neuromodulators

chemicals that can influence communication among many neurons by affecting the functioning of neurotransmitters

Cyclothymia

chronic but less severe form of bipolar disorder - person must experience several periods of time with hypomanic symptoms and frequent periods of depression during a period of two years

American Psychological Association

claims psychotherapy is more effective in the long run

predicting violence

clinicians are wrong two-thirds of the time when they predict violence will occur - predicting rare events is flawed for mathematical reasons

Clinical syndrome

combination of emotional, cognitive, and behavioral symptoms

Masturbation

common for both men and women

Anxious apprehension

consists of: (1) high levels of diffuse negative emotion, (2) a sense of uncontrollability, and (3) a shift in attention to a primary self-focus or a state of self-preoccupation

Hindbrain

control basic bodily functions - includes the medulla, pons, and cerebellum

Sympathetic nervous system

controls activities associated with increased arousal and energy expenditure

Parasympathetic nervous system

controls the slowing of arousal and energy conservation

any disruption of the response cycle

could led to sexual dysfunctions

Riggings v. Nevada

court upheld right of defendant on trial for murder to refuse an extremely high dose of antipsychotic

"almost a revolution"

created by libertarian cases and legislation which defined patient's rights - ended in the 90s with the rise of paternalistic concerns

Unilateral ECT

current is passed through only one side of the brain (the nondominant hemisphere) o Produces less retrograde amnesia -loss of memory of past events -than bilateral ECT o Less effective than bilateral ECT

A subtype of PTSD

defined by the presence of dissociative symptoms, depersonalization or derealization - This subcategory reflects controversy about the role of dissociation in PTSD

Specific phobia

defined in DSM-5 as "a marked fear or anxiety about a specific object or situation that almost always provokes immediate fear or anxiety"

Schizoid Personality Disorder

defined in terms of a pervasive pattern of indifference to other people, coupled with a diminished range of emotional experience and expression

Mood disorders

defined in terms of episodes - discrete periods of time in which the person's behavior is dominated by either a depressed or manic mood - Person usually experiences more than one episodes

OCD-related disorders definition

defined in terms of presence of unwanted intrusive thoughts and/or habitual behaviors

Antipsychotics (meds)

delusions, hallucinations

The distinctions among healthy traits, eccentricity and personality pathology..

depend on the person's ability to adapt to the demands of different situations o Variety and flexibility in interpersonal behavior are very helpful

Some experts believe that ASD...

describes a normal reaction to trauma and suggests it should not be considered a mental disorder

New "mental health courts"

designed to accommodate the mental health needs of the accused and convicted, are one effort to address this problem

Sexual predator laws

designed to keep sexual offenders confined for indefinite periods of time

Longitudinal studies

determine is risk factors play a causal role - expensive - require large number of people

DSM-5

diagnostic and statistical manual o Published in 2013 o Published by the American Psychiatrist Society o Lists hundreds of mental disorders

cohort effects

differences that distinguish one cohort from another * lifetime prevalence of bulimia was far greater among women who born after 1960 than before 1950

Adjustment disorders

difficulties coping with normal challenges in life, and a few adjustment problems found among children

Neurochemical hypotheses

dopamine neurotransmitter system plays a crucial role in supporting activities involved in working memory

Recovered memories

dramatic recollections of long-ago traumatic experiences supposedly blocked from the conscious mind by dissociation

"Freebasing"

drug is heated and vapors are inhaled => dangerous

number of patients in mental institutions shuck in 1950

due to medication and the deinstitutionalization movement

Preoccupation

during periods of acute psychosis, many patients find it difficult, if not impossible, to avoid thinking or talking about these beliefs

Euphoria

elated mood - exaggerated feeling of physical and emotional well-being - associated with mania

Bilateral ECT

electrodes are placed on the left and right temples and the current passes through both brain hemispheres

The deinstitutionalization movement

embraced the philosophy that many patients can be better cared for in their community than in large mental hospitals

Schemas

enduring and highly organized representations of prior experience - they may be latent but they are presumably reactivated when the person experiences a similar event

Personality

enduring patterns of thinking and behavior that define the person and distinguish him or her from other people, including: o Ways of expressing emotion o Patterns of thinking about ourselves and other people

Vasocongestion

engorgement of the blood vessels of various organs, especially the genitals

short-term stressors and physical threats

enhance immune responses that are quick, require little energy, and contain infection due to an injury

psychotic features

episode specifiers allow the clinicians to indicate the presence of hallucinations or delusions during the most recent episode of depression or mania - can be consistent or inconsistent with the patient's mood

Suicide common motive

escape from psychological suffering

Borderline Personality Disorder

essential feature is a pervasive pattern of instability in mood and interpersonal relationships

Retrospective reports

evaluations of the past from the vantage point of the present - Memories may be selectively recalled, distorted, or even created to conform to a clinician's expectations

Meaning making

eventually finding some value or reason for having endured trauma, ultimately a reframing and reinterpretation of the experience of trauma - Similar to last step in Edna Foa's emotional processing - May involve religion or a renewed appreciation for life or public service

clinical psychologist

has received graduate training in the use of assessment procedures and psychotherapy have extensive knowledge regarding research methods

Hypothalamus

helps control basic biological urges like eating, drinking, and sex, regulates blood pressure and heart rate

nature of schizophrenia

heterogeneous nature - suggests that it should be explained in terms of multiple pathways

Heritability

how analyses, like twin studies, are expressed - 0% = genetic factors are not involved - 100% = genetic factors alone are responsible for the development of the trait in question - 80% = bipolar disorder - 50% = major depressive disorder

Delusions

idiosyncratic beliefs that are rigidly held in spite of their preposterous nature ■ Delusional patients express and defend their beliefs with utmost conviction, even when presented with contradictory evidence

An attack is said to be expected, or cued

if it occurs only in the presence of a particular stimulus

stress impairs

immune responses that drain energy from the flight-or-fight response

Sexual selection

improves inclusive fitness through increased access to mates and mating

Hypoactive SD defined

in terms of subjective experiences - lack of fantasies or interest in sexual experiences

disorganization

include verbal communication problems (incoherent or disorganized speech) and bizarre behavior

Depressive schemas

increase the probability that the person will overreact to similar stressful events in the future

sexual excitement

increases continuously from initial stimulation to the point of orgasm - may last mins-hours - vasocongestion - increase muscular tension, heart rate, and respiration

Avolition

indecisiveness, ambivalence, and a loss of willpower - Person becomes apathetic and ceases to work toward personal goals or to function independently

The third variable problem

indicates that a correlation between any two variables might be explained by their join relation with some unmeasured factors - a third variable

Polygenic inheritance

influenced by multiple genes and by the environment ♣ Usually the cause for mental disorders

Crazy

informal, pejorative term that does not convey specific information and carries with it many unfortunate, negative implications

sexual dysfunctions

inhibitions of sexual desire and interference with the physiological responses leading to orgasm

Parietal lobe

integrates sensory information and spatial reasoning

Characteristics of people with gambling disorders

intelligent, well-educated, competitive people who enjoy challenge and risks involved in betting

central issue (Male Hypoactive Disorder)

interest - actively seeking out sexual experiences - rather than just participation

Emotions

internal feeling states, which are essential to our understanding of mental disorders ♣ Six basic emotions: • Love • Joy • Surprise • Anger • Sadness • Fear ♣ Controlled by subcortical brain structures that are older in evolutionary terms and more similar to brain structures found in other animals

Self-control

internal rules for guiding appropriate behavior • Learned though **socialization** - parents, teachers, and peers use discipline, praise, and their own example to teach children prosocial behavior • Over time these standards are internalized - external rules become internal regulations

Occipital lobe

interprets visual information

vaginismus

involuntary muscular spasm prevents sexual intercourse as well as other activities, such as vaginal examination and the insertion of tampons * often leads to fear of intercourse

Midbrain

involved in some movements, especially related to fighting and sex

Midbrain

involved in the control of some motor activities, especially fighting and sex ♣ Reticular activating system - regulates sleep and walk

Planum temporal

involved in understanding speech, larger in the left hemisphere

Study comparing treatment programs

involved naturalistic evaluation of substance abuse treatment programs administered by VA - o Compared 12-step programs, CBT, and "electic therapy" (combination of several approaches) o Not randomly assigned to treatments o All three groups were significantly improved o Those who participated in more treatment sessions had better outcomes o 12-step program was most effective

physical child abuse

involves the intentional use of physically painful or harmful actions

Disorganized speech

involves the tendency of some patients to say things that do not make sense signs: ■ Making irrelevant responses to questions ■ Expressing disconnected ideas ■ Using words in peculiar ways

Inability to care for self

is a broad criterion used for people unable to care for themselves or who have no family or friends to care for them

Disulfiram (Antabuse)

is a drug that can block the chemical breakdown of alcohol o If person using this drug takes even small amount of alcohol, they become violently ill o Causes people to stop drinking to avoid this extremely unpleasant reaction o Many discontinue taking disulfiram

The overriding characteristic of BPD

is a pervasive pattern of instability in self-image, in interpersonal relationships and in mood o Lack ground emotionally o Exist from moment to moment without any sense of continuity, predictability, or meaning Experience life in fragments

Health behavior

is any action that promotes good health (i.e. balanced diet, exercise) - Poor health habits, not stress per se, may be responsible for much of the relation between stress and illness - influenced by cultural as well as individual characteristics

Mental health law

is based on the state's police power; virtually all of family law is premised on parens patriae duties

The statistical potential for accurate prediction

is maximized when the predictor and the outcome have more similar base rates

legal definition of insanity

is no the as psychological definition of mental illness

Addiction

is often used to describe problems such as alcoholism

Repression

keeping feelings bottled up, is a maladaptive form of emotion-focused coping - Have greater psychophysiological reactions to stress - Reduce stress when we talk about our problems

Posttraumatic stress disorder (PTSD)

lasts longer than one month and sometimes has delayed onset

legally insane

law assumes that if you are legally insane you are not acting out of free will

Corpus Callosum

links the left and right hemisphere

Psychodynamic problems

long term, costly, unstructured; not much evidence supporting its use

The Biological paradigm

looks for biological abnormalities that cause abnormal behavior, for example, brain diseases, brain injuries, or genetic disorders o Specific biological causes, many genetic, probably will be discovered for a very small amount of mental disorders

Social selection hypothesis

low social class is an outcome rather than a cause of schizophrenia

Inappropriate affect

marked by incongruity and lack of adaptability in emotional expression

Relapse rate

may be as high as 65-70% in the first year after hospital discharge if patients discontinue medication - continuing medication after recovery from an episode is encouraged - many patients stop taking medication

post tracking performance

may be associated with predisposition ○ Tracking ability is stable over time ○ Tracking ability is influenced by genetic factors ○ Tracking ability impairment is also found among people who exhibit features associated with schizotypal personality disorder

Tertiary prevention

may involve any of the previous treatments

nonsadisitic rapists

men who are preoccupied with sexual fantasies, but not violent ones

opportunistic rapists

men with an extensive history of impulsive behavior in many kinds of settings and who might be considered psychopaths * behavior governed largely by immediate environmental cues

Diathesis-stress model

mental disorders develop when a stress is added on top of a predisposition

law

more concerned with justice than truth solution: appoint neutral experts

Reciprocal causality

mutual influences where "cause" and "effect" - Introduced byAlbert Bandura to refer to the mutual influence between three sets of factors: personal factors (e.g., cognitive, affective and biological events), the environment, behavior.

Less common PD

narcissistic PD - <1%

duties of mental health professionals

negligence and confidentiality

incidence

number of new cases each year

Short-term effects of cannabis

o "Getting high" - refers to pervasive sense of well-being and happiness o Can cause temporal disintegration - a condition in which people have trouble retaining and organizing information, even over relatively short periods of time

Worcester Lunatic Hospital: A model institution

o 1833 Worcester, MA opened a lunatic hospital o Samuel Woodward - present - also became president of the AMSAII o Recovery rates varied from 82-91%

Epidemiological data

o 20% with active disorder received treatment o Most SEVERE disorder are concentrated in a group of people with 3 or more "co-morbid" disorders (14% of the population) o Global Burdern of Disease study by the World Health Organization

Sources of Treatment

o 40% specialty providers o 34% Primary Care MDs o 26% Social Services of Self Help Groups

Overlap between PDs and Other mental disorders

o 75% of people who qualify for a PD diagnosis also meet criteria for a syndrome (such as major depression, substance dependence or anxiety disorder) o The reverse is also true: many people who are treated for another type of mental disorder would also meet the criteria for a PD

Dependent Personality Disorder Characteristics

o Afraid of separating from other people on whom they are dependent for advice and reassurance o Unable to make everyday decisions on their own o Feel anxious and helpless when they are alone o Easily hurt by criticism, extremely sensitive to disapproval, lacking in self-confidence o Somewhat similar to avoidant PD, but the main difference is the point in a relationship at which they experience the most difficulty ♣ People with avoidant PD have trouble initiating a relationship ♣ People with dependent PD have trouble separating from other people with whom they already have a close relationship

When does therapy work best?

o Being young, attractive, verbal, intelligent, successful (YAVIS) o Works best for most advantaged members of society o When therapists are trained to be sensitive to minority issues o When therapist and client share a similar cultural background o When there is a strong relationship between the patients and the doctor

Short-term effects of alcohol

o Blood alcohol levels are measured in the amount of alcohol per unit blood o A "drink" is 12 oz beer, 4 oz wine, 1 oz 86-proof whiskey o Strong correlation between blood alcohol levels and CNS intoxicating effects o According to DSM-5, symptoms of alcohol intoxication include slurred speech, lack of coordination, an unsteady gait, nystagmus (involuntary movement of eyes when person looks up or to side), impaired attention or memory, and stupor or coma

Steps in the Labeling Process

o Breaking "residual rules" ♣ Talking to yourself in public ♣ Standing too close to people in conversation o Very frequent; most often ignored o Assume that deviance will be TRANSIENT if ignored o We learn stereotypes about mental illness from the media o People are rewarded for accepting the role; punished for rejecting it o The probability of being labeled is a function of the extent of the rule-breaking, the power of the rule breaker, and tolerance level of the community

Short-term effects of cocaine and amphetamines

o Called stimulants because they activate the sympathetic nervous system o Used and abused because they induce a positive mood state ♣ Low doses make people feel confident, friendly, and energetic o Leads to sexual dysfunction o Tolerance develops quickly o Acute overdoses can cause irregular heartbeat, convulsions, coma, and death

Panic disorder

person must experience recurrent, unexpected panic attacks - At least one of those attacks must be followed by a period of one month or more in which the person has either persistent concern about having additional attacks, or a significant maladaptive change in behavior related to the attacks

transvestite

person who dresses in the clothing of the opposite gender

The Cognitive Perspective

pervasive and persistent negative thoughts about the self and pessimistic views of the environment play a central role in the onset and subsequent maintenance of depression after these thoughts are activated by the experience of a negative life event

Base rates

population frequencies - must be taken into account when predicting an infrequent event

Prodromal phase

precedes the active phase and is marked by an obvious deterioration in role functioning as a student, employee, or homemaker ■ Change in personality ■ Signs and symptoms are similar to those associated with schizotypal personality disorder ● Peculiar behaviors, unusual perceptual experiences, outbursts of anger, increased tension and restlessness ● Social withdrawal and lack of willpower are often seen

Prognosis

predictable course for the future

ASD symptoms...

predicts PTSD better than the full diagnosis

Adrenal glands

prepare the body to respond and deal with stress or an emergency

Id

present at birth and houses biological drives, such as hunger, as well as two key psychological drives: sex and aggression

Malingering

pretending to have a physical illness in order to achieve some external gain, such as a disability payment

Persistent maladaptive behaviors

problematic behaviors interfere with the person's social and occupational ability

-Somatic symptom disorder

problems where physical symptoms are prominent and are accompanied by impairing psychological distress - Involve complaints about physical symptoms that create psychological distress either out of proportion to actual physical problems or in the absence of diagnosable physical illness - Symptoms are not feigned or exaggerated - Physical problem is very real in the mind (though not the body)

Conversion disorder

problems with motor or sensory function occurring in the absence of a known physical illness - Historically included in hysteria - Appears to involve dissociation - DSM-5 treats as a somatic symptom disorder

Psychomotor stimulants

produce their effects by simulating the actions of certain neurotransmitters, specifically epinephrine, norepinephrine, dopamine, and serotonin

Psychosocial rehabilitation (PSR)

professionals who work in crisis, residential, and case management programs for people with severe forms of disorder, such as schizophrenia. They teach people practical, day-to-day skills that are not necessary for living in the community, thereby reducing the need for long-term hospitalization and minimizing the level of disability experienced by their clients

inpatient programs

programs, especially those that follow behavioral principles, can have important positive effects for chronic schizophrenic patients - some people need long-erm institutional treatmenttt

Community Mental Health Centers (CMHC) Act

provided for the creation of community care facilities for the seriously mentally ill as alternatives to institutional care

Schizophreniform disorder

psychotic symptoms for at least one month but less than six months ○ Changed to schizophrenic disorder if the person's problems persist beyond the six-month limit

Parens patriae

rationales for commitment have been overused and abused

Receptors

receive the neurotransmitters that are released into the synapse ♣ On the dendrites or soma of another neuron

Thalamus

receives an integrates sensory information from sense organs and from higher brain structures

placebo control group

receives only a placebo treatment - must be included in research

Interoceptive awareness

recognition of internal cues, including hunger and various emotional states

Antipsychotic drugs

reduce the severity of psychotic symptoms ○ Within a week of taking this medication, patients may see beneficial effects on problems such as agitation and hostility ○ Improvement with regard to psychotic symptoms usually takes two to three weeks 25% of patients do not improve on antipsychotic drugs Another 30-40% might be considered partial responders

psychoanalytic theory

referring to Freud's theorizing

Sole custody

refers to a situation in which only one parent retains physical or legal custody of the children

Catatonic behavior

refers to an obvious reduction in reactivity to external stimuli; most often referring to immobility and marked muscular rigidity, but can also refer to excitement and overreactivity

Marijuana

refers to dried leaves and flowers, which can be smoked in cigarette or pipe

Hashish

refers to dried resin from the top of the female cannabis plant

Alogia

refers to impoverished thinking ○ Forms of alogia: ■ Poverty of speech -patients show remarkable reductions in the amount of speech ■ Thought blocking -patient's train of speech is interrupted before a thought has been completed

Social drinking

refers to problem-free drinking for 10 years or more

malpractice

refers to situations in which professional negligence results in harm to clients or patients

"Hopeless"

refers to the person's negative expectations about future events and the associated belief that these events cannot be controlled

Autonomic nervous system

regulates the functions of the various body organs, such as heart and stomach, and is completely involuntary (as opposed to the somatic nervous system - muscular control - which is voluntary

Expressed emotion (EE)

relatives expressing negative or intrusive attitudes toward the patient including: ○ Being overprotective ○ Too closely identifying with the patient ○ Extreme anxiety about the patient ○ Showing exaggerated forms of self-sacrifice ○ Criticising patients - more common in western cultures

False negatives

releasing someone who is dangerous to self or others - puts lives at stake

Psychological abuse

repeated denigration in the absence of physical harm

Compulsions

repetitive behaviors or mental acts that are used to reduce anxiety - These actions are typically considered by the person who does them to be irrational - Person attempts to resist performing actions but cannot - unwelcome, nonsensical thoughts - People with OCD are unable to dismiss these thoughts or urges - Can interpret these thoughts or urges as meaning they are a terrible person (they might actually want to harm someone)

Obsessions

repetitive, unwanted, intrusive cognitive events that may take the form of thoughts or images or urges - Lead to increase in anxiety

Community notification laws

requires the distribution of information to the public regarding the presence of child molesters and sexually violence offenders when they are released from pailin or placed on parole

The burden of proof

rests on the prosecution, and the standard of proof is very high - beyond a reasonable doubt

Implicit association test

reveals implicit memories by comparing response times to cues - Evidence shows that implicit attitudes about delicate subjects like racial prejudice differ considerably from explicitly reported beliefs

Adonis Complex

reverse anorexia * characterized by excessive emphasis on extreme muscularity and often accompanied by excessive emphasis on extreme muscularity and often accompanied by the abuse of anabolic steroids

Important rights to consider for mental patients

right to treatment, right to treatment in the least restrictive environment, and the right to refuse treatment

polygenic characteristic

schizophrenia is the product of a reasonably large number of genes rather than a single gene

Atypical antipsychotics

second generation antipsychotic drug - produce a broader range of neurochemical actions in the brain than do the traditional drugs, which act primarily on dopamine receptors

Pituitary gland

secretes hormones, connected to the brain through hypothalamus

gender dysphoria

sense of discomfort with one's anatomical sex

Hallucinations

sensory experiences that are not caused by actual external stimuli ○ Can occur in any of the senses ○ Most often auditory ■ Many patients hear voices that comment on their behavior or give them instructions ■ Some patients find the voices frightening ■ Other patients find the voices comforting or pleasing

Perfectionists

set unrealistically high standards, are self-critical, and demand a nearly flawless performance from themselves

Psychomotor retardation

several features of behavior that may accompany the onset of serious depression

"shopping for experts"

shows how legal system and science differ in defining "truth" - layers manipulate the system by finding lawyers that interpret evidence in a way that helps their case

Rebirthing therapy

simulation of the birth process - one trial ended in death of a 10 year old

sadist

someone who derives pleasure by inflicting physical or mental pain on other people

Negative side effects

something is missing that should be there ex. organized speech --> disorganized speech (negative side effect)

Vulnerability to schizophrenia

sometimes expressed as schizophrenia-like personality traits and other types of psychoses

Attachment

special, selective bonds with their caregivers • Insecure or anxious attachments - parent-child relationships that are a product of inconsistent and unresponsive parenting during the first year of life o Results in mistrust, dependency of child, rejecting in subsequent relationships

expert witnesses

specialists allowed to testify about matters of opinion (not just fact) that lie within their area of expertise

Psychodynamic therapist and their method

• Therapist = passive, nondirective, interpreter • Primary method = interpretation of defenses • Therapeutic neutrality - maintaining a distant stance toward the patient in order to minimize the therapist's personal influence o Essential to probing the unconscious mind • Patients are supposed to meet with their analyst for an hour several times each week and these sessions could go on for years o Only accessible to people who are functioning well, introspective, and financially secure

Culture-bound syndromes or idioms of distress

• These represent a manner of expressing negative emotion that is unique to a particular culture and cannot be easily understood or translated in terms of its individual parts • Their appearance is easily recognized and understood to be a form of abnormal behavior by members of certain cultures, but they do not conform to typical patterns of mental disorders in the US and Europe

Assessment procedures can be used for several purposes

• To describe the nature of the person's principle problem o Goal typically is to make a diagnosis • Also used for making predictions, making treatments, and evaluating treatments • Another use is to evaluate the likelihood that a particular form of treatment will be helpful for a specific patient and provide guideposts for which effectiveness of treatment programs can be measured

Age disparities

• Tolerance is reduced along the elderly but withdrawal may be more severe and prolonged • Elderly are less likely to suffer occupational impairment because not often employed • Elderly are less likely to experience social impairment because often live apart from families

Drug etiology

• Twin studies also suggest that alcohol dependence and other forms of drug dependence share a common etiology

B.F. Skinner (1953)

♣ Operant conditioning = asserts that behavior is a function of its consequences - increases when rewarded, decreases when punished • Positive reinforcement - the addition of a stimulus increases the frequency of a behavior • Negative reinforcement - the taking away of a stimulus increases the frequency of a behavior • Positive punishment - the addition of a stimulus decreases the frequency of a behavior • Negative punishment - the taking away of a stimulus decreases the frequency of a behavior

alcohol use disorder

♣ Person must have 2 of the 11 criteria in a 12-month span to be diagnosed ♣ Mild (2-3) symptoms; moderate (4-5 symptoms); severe (6+ symptoms)

3 key factors (of systematic desensitization)

♣ Progressive muscle relaxation -a method of inducing a calm state by tightening and then relaxing all the major muscle groups ♣ Hierarchy of fears -a ranking that allows clients to confront their fears gradually • ranges from very mild to very intense ♣ Learning process -maintaining relaxation while confronting ever-increasing fears

Social relationships

♣ Research shows that a good relationship with someone outside of the family is associated with better mental health among children • One close relationship can provide as much support as many relationships ♣ It has been proven that it is much worse to be actively rejected than neglected

Group therapy:

♣ Several people facing similar issues ♣ Less expensive ♣ Social support ♣ Hospital/residential setting ♣ Core component of DBT ♣ When it DOESN'T work - Ex. ASPD ("deviancy training")

Psychotherapy

♣ Talking to someone ♣ Anytime you are with a counselor, therapist, psychiatrist, etc. Ex. Psychoanalysis, Psychodynamic, Humanistic

EMDR (Eye Movement Desensitization and Reprocessing)

♣ Technically evidence-supported - but what is the operative component? ♣ Thought Field Therapy ("meridian tapping")

Marital Status and psychology

♣ They are correlated ♣ Children and adults from divorced or never-married families have somewhat more psychological problems than people from always-married families ♣ Researchers use MZ twins to see if this is genetic or based off of environment • If MZ twin divorces and has more problems than the other twin who is married than we know it is not genetic

Resistance (Freud)

♣ Transference - therapist reminds them of someone from their past - gets in the way of treatment ♣ Repression - patient does not remember certain things that have happened - Must guard against countertransference - letting their own feelings influence their responses to their patients

medicine and somatic symptom disorders

- Antidepressants may be helpful in treating somatic symptom disorders - Less research has been done on their effectiveness

frequency of gender dysphoria

* 1/12,000 men * 1/30,000 female * very rare

Human sexual response cycle

* excitement * orgasm * resolution

Cocaine

A naturally occurring stimulant drug

Explicit memory

Conscious recollection

Unconscious mental processes

Information processing outside of conscious awareness

Investigations of brains

MRIS PET - not diagnostically meaningful tests

Early behavior therapists

Relied heavily on Pavlov's classical conditioning and Skinner's operant conditioning

Withdrawal is more common when

Withdrawing from alcohol, opioids, sedatives, hypnotics, and anxiolytics

hypothesis

a new prediction made by an investigator

Synapse

a small gap filled with fluid that separates the axon terminal from other cells

Second wave CBT

based on cognitive therapies

confined sex offenders

get little or no treatment

Reverse causality

indicates that causation could be operating in the opposite direction: Y could be causing X

Forebrain

site of most sensory, emotional, and cognitive processes

vindictive rapists

violence directed exclusively toward women

AN - Fear of Gaining Weight

* For some even just a little more food is terrifying * May believe they'll instantly become "fat" * Fear may grow more intense as the individual loses more weight

Is pathological gambling an addiction?

"Addiction" implies absence of responsibility for one's behavior o Some would not call alcohol or drug abuse addictions for this reason DSM-5 includes gambling disorder with substance use disorders because all activate reward pathways in the brain - previously was an impulse disorder

"The search for meaning" vs. "Finding meaning"

"The search for meaning" is associated with more PTSD symptoms "Finding meaning" is linked to better adjustment

70-74 yo sexual behavior

* 65% of men are sexually active * 30% of women

Antidepressant meds

1. SSRIs 2. TCA

Biological Treatments

Medication, ECT, rMTS, Psychosurgery

Multifinality

the same event can lead two different outcomes

In disastrous situations...

Emergency workers are *less than half* as likely to develop PTSD as victims - Protected by their training, preparation, and sense of purpose - Hardiness -a sense of commitment, control, and challenge in facing stress, predicts lower risk of PTSD

Cognitive model

Emotional dysfunction is influenced by the negative ways in which people interpret events in their environments and the things that they say to themselves about those experiences

Treatment of Anorexia

Focuses on two goals: 1. to help the patient gain at least a minimal amount of weight 2. to address the broader eating difficulties

Lifetime prevalence of PTSD

In the US = 6.8%

Is most gambling associated with mental disorders?

NOPE

Temporal stability

One of the most important assumptions about PDs o Categorically defined diagnoses do not tend to be particularly stable o From a dimensional perspective, maladaptive traits the represent the core features of the disorders remain relatively stable

Amphetamines

Produced synthetically

Self-instruction training

The adult first models and appropriate behavior while saying the self-instruction aloud, then the child is asked to repeat the action and also say the self-instruction aloud o Child repeats task while whispering, then repeats the task while repeating self-instruction silently o Procedure is designed for children to internalize behavior

Equifinality

There are many pathways to developing an ED * some women are naturally thin, but their perfectionism drives them to become even thinner * some women are naturally curvier bodies, and they struggle and fail to mold their body into something it was never meant to be * finding the middle ground of healthy weight can be very difficult

Psychological factors

These events may be particularly harmful to people who are genetically predisposed to the disorder

Who creates the DMS-5?

Work groups for each disorder ♣ Each one has a chair - psychiatrist ♣ 10-12 members at least - psychologists are included ♣ Well known and respected ♣ Leading experts in their field ♣ Received wisdom, not arbitrary, it's what the field knows - It's not a complete understanding

Categorical approach for diagnosis

Would recognize that she meets the criteria for certain disorder PD o Clinician would have to note the presence of some features of other disorders

Is it hard to do research on psychotherapy?

YES o But if psychologists don't do it, who will? o It needs to be backed up in order for insurance to pay for it

placebo

a treatment that contains no active ingredients for the disorder being treated

Munchausen-by-proxy syndrome (MBPS)

a unique, rare, but potentially very harmful form of physical child abuse where parent feigns, exaggerated, or induces illness in a child

The Humanistic Paradigm

argues that human behavior is the product of free will, the view that we control, choose, and are responsible for our actions o This is a reaction against determinism - the scientific assumption that human behavior is caused by potentially knowable factors o Explicit positive view of human nature o All psychologists are technically humanists in the sense that their ultimate goal is to improve the human condition

acquaintance rape

committed by men who know their victims

Psychodymanic Goal

growth and self-actualization, insight into unconscious motivations

Family environment

has a significant impact on the course of schizophrenia not the cause or original onset

Diminished emotional expression (blunted affect)

involves a flattening or restriction of the person's nonverbal display or emotional responses ○ Patients fail to exhibit signs of emotion or feeling ○ They appear to be completely indifferent ○ Faces are apathetic and expressionless ○ Voices lack the typical fluctuations in volume and pitch ○ May demonstrate a complete lack of concern for themselves and others

Flooding

involves confronting fears at full intensity

Child sexual abuse

involves sexual contact between an adult and a child

Child abuse

involves the accidental or intentional infliction of harm to a child due to acts or omissions on the part of an adult responsible for the child's care

Ego

part of the personality that must deal with the realities of the world as it attempts to fulfill id impulses as well as perform other functions o Operates on the Reality principle o Begins developing in the first year of life, evolving during the preschool years o Resides in conscious awareness, unlike id

Advance psychiatric directives

patients can use these legal instruments to declare their treatment preferences, or appoint a surrogate to make decisions for them, should they become psychotic or otherwise are unable to make sound decisions - used commonly among the aged

Disorganized type of schizophrenia

patients say things that are difficult to understand, behave in a disorganized way, and fail to express expected emotions

Dissociative amnesia

people are unable to remember aspects of the trauma events

Placebo Effect

produces change through expectations abut a treatment's effectiveness - placeboes are important both as controls for common factors and to study as an "active ingredient" because they produce change psychologically

Central nervous system

♣ Brain ♣ Spinal Cord

cohort

a group that shares some features in common ex. year of birth

Mescaline

a hallucinogen that resembles norepinephrine

Optimism

a healthy coping style - Optimists have positive attitude about dealing with stress, even when can't control it - Positive thinking is linked with better health habits and less illness

postpartum onset

a major depressive or manic episode that occurs within four weeks after childbirth

hypnotics

Depressants of the central nervous system (CNS) include alcohol as well as types of medications that are used to help people sleep

sedatives or anxiolytics

Depressants of the central nervous system (CNS) that relieve anxiety

- Imaging studies show that major depressive disorder is connected to:

Elevated levels of resting blood flow and glucose metabolism in amygdala - higher metabolism rates

Bowlby (ego analyst)

Elevated the need for close relationships to a primary human characteristic o Evident in his attachment theory

1. A struggles for perfection and control

* Hilde Bruch - one of the 1st and most prolific clinical observes of EDs * she viewed struggle for control as the central psychological issue * girls seemed overly conforming and eager to please * use food as a way to establish control * young people with anorexia "succeed" and take pride in their extreme self-contol * Perfectionists * women with EDs endorse these type of goals about eating and weight and general expectations for themselves * Interoceptive awareness * lack of this predicted the development of EDs 2 years in the future * People with Meds tend to ignore these cues and pay attention to how they look rather than how they feel - sad, angry, happy, or hungry

NHSLS survey - have you experienced any of these in the last 12 months?

* Low Desire * Men - 16% * Women - 34% * Arousal Problem * Men - 11% * Women - 18% * Lack of Orgasm * Men - 8% * Women - 24% * Rapid orgasm * Men - 28% * Women - 10% * Pain during sex * Men - 3% * Women - 14%

how can we create a treatment that contains no active ingredients but increases the client's expectations for change just as much as real treatment?

* One approach = offer an established, alternative therapy that is not designed to treat the disorder being studied * example: interpersonal therapy for bulimia * investigators believed that this therapy contained no "active ingredients" for treating bulimia but thought clients would view it as legitimate

AN - Disturbance in Experiencing Weight or Shape

* People with anorexia usually don't recognize their emaciation for what it is * Many deny their weight * distorted body image - an inaccurate perception of body size and shape

Frotteurisitc disorder

* a person who is fully clothes becomes sexually aroused by touching or rubbing his genitals against other, nonconsenting people * usually choose crowded places, so that he can easily escape an arrest * he will either rub his genitals against the victim's thigh or butt or he will fondle her genitalia or breasts * high frequency form of paraphilia

Exhibitionistic disorder

* about 1/2 of these men have erections while exposing themselves, and some masturbate at the time * other masturbate right after and fantasize about it * usually intent involves a desire to shock the observer * rarely attempt to touch or otherwise molest their victims * almost exclusively a male disorder * beginning usually when one is a teenage * seldom an isolated behavior * tend to do it frequently

AN - Comorbidity

* associated with OCD and obsessive-compulsive personality disorder * obsess with food and diet * follow compulsive eating rituals * a study showed that this can actually help them prevent starvation but sticking to a schedule * WWII - as men lost more with, they developed extensive obsessions about food and compulsive eating rituals * Obsessive-compulsive behavior may be a reaction to starvation, not a risk factor * usually show symptoms of depression - sad mood, irritability, insomnia, social withdrawal, diminished sex drive * can be a cause or reaction to the disorder * often co-occurs with bulimia * purging follows binging * purging may just be a way to further control eating that is already restricted * Those who do not binge or purge have lower rates of depression

pseudohermaphrodite

* both male and female reproductive organs * many of these children are raised as girls * puberty = increase in testosterone leads to "clitoris" turning into more of a penis, and testicles descend into a scrotum * child's voice gets deeper, muscle mass increases, * adopt a masculine gender identity after their brain has been programmed to think otherwise

pedophiles

* can be attracted to children or adults * most are straight * victims more often girls then boys * sexual contact with child usually involves caressing and genital fondling * penetration of any kind is less common * in most cases the child knows the person, making them more likely to comply to the molesters intentions * more than half of the offenses occur in the child or offender's home

Bulimia Nervosa

* characterized by repeated episodes of binge eating, followed by inappropriate compensatory behaviors such as self-inducted vomiting, misuses of laxatives, or excessive exercise * Weight is normally in the normal range * Bulimia literally means "ox appetite" * usually have an average appetite * Binge eating usually presents a failure of control, but it really is their body's natural reaction to unnatural weight suppression

CBT

* cognitive restructuring, social skills training, and stress management procedures * reduces rate of relapse * results were more positive for those convicted of rape rather than child molestation

AN - Medical Complications

* constipation * abdominal pain * intolerance to cold * lethargy * low blood pressure and body temp * skin can become dry and cracked * laguna - a fine, downy hair, on their face or trunk of their body * anemia * infertility * impaired kidney function * cardiovascular problems * dental erosion * bone loss * electrolyte imbalance - a disturbance in the level of potassium, sodium, calcium, and other vital elements found in bodily fluids * can lead to cardiac arrest or kidney failure * death

Sexual Sadism Disorder

* defined in terms of intense, sexually arousing fantasies, urges, or behaviors that involve the physiological or physical suffering or a victim * often involves inserting dominance over the victim * power and control are very important * can be consented but also not :/

Sexual predator laws

* designed to keep some criminals in custody indefinitely * if jury decides someone has a "mental abnormality" that will lead them to commit more sexual offenses then the person can hospitalized involuntarily

orgasm

* different from the gradual buildup of sexual excitement that precedes it * intense pleasure * varies for each person

situational orgasmic

* difficulties occur when the woman is able to reach orgasm in some situations, but not others * during masturbation but not intercourse or perhaps with certain people

Transvestic Disorder

* disorder is defined as cross-dressing for the purpose of sexual arousal* * most common among strait men * may be done in private or public * person may masturbate while crossed-dressed, often imagining himself to be a male as well as the female object of his own fantasy * men with this disorder are unremarkably masculine in their interests, occupations, and other behaviors * Some men may develop persistent discomfort with their gender role or identity and may eventually want to live permanently as a women

Interpersonal Psychotherapy

* focuses on difficulties in close relationships - not so much specifics of eating disorders * initially studied as a placebo treatment - to test in CBT has specific effect beyond general psychotherapy * hypothesized that CBT would outperform interpersonal * CBT is more effective in changing dieting behavior, self-induced vomiting, and attitudes about weight and shape * Results of the two therapies were similar in other respects * At a 12 month checkup: * The behavior therapy group deteriorated over time, and a large number of patients dropped out * The Cognitive behavior therapy group maintained fairly stable improvements * The interpersonal therapy group continued to improve! * becoming equal to CBT's immediate results * This was surprising and impressive because: 1. The interpersonal treatments explicitly excluded direct discussions of eating, diet, and related topics 2. The investigations had lower expectations for interpersonal therapy and the allegiance effect often influence treatment outcome

Predictor of continued binge eating include a longer duration

* greater emphasis on shape and weight * childhood obesity * poorer social adjustment * persistent compensatory behavior * comorbid alcohol abuse

The link between trauma and DID

* is controversial* - Some argue DID is linked with past trauma, particularly chronic physical or sexual childhood abuse - Many are skeptical because information is based solely on client's reports - May be distorted by many factors, including therapist's expectations

Psychological causes of PD

* love map - a mental picture representing a person's ideal sexual relationship * if distorted results in strange ways of thinking about sexual relationships * don't know how to feel both love and lust for the same person

Biological Causes of Sexual Dysfunction for *women* in particular

* neurological disorders, pelvic disease, and hormonal dysfunction can interfere with process of vaginal swelling and lubrication * research done shows genetic factors may influence the frequency with which women are able to experience orgasm * abuse of alcohol or drugs can lead to inhibited orgasm

hypothetical construct

* other examples: anxiety, depression.. * they are theoretical devices * refer to events or states that reside within the person and are proposed to help us understand or explain a person's behavior

gender identity

* our sense of ourselves as being either male or female * usually reflects child's anatomy * fixed by the time one is 2 or 3 years old

Pedophilic Disorder

* people who persistently engage in sexual activities with children * many harmful affects can be produced by sexual abuse * can lead to PTSD or eating disorders * entails recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child * in order to be diagnosed, the person must be at least 16 year of age and at least five year * child molester = a person who has committed a sexual offense against a child victim * all child molesters are not pedophiles * sometimes they molest their own child * personalty style of offenders is usually passive and dependent * they are unable to emphasize with the plight of their victims

medication placebos

* physicians give patients a pill that looks like real medication but contains no active chemical ingredients * easily administered

BN - Inappropriate Compensatory Behavior

* purging - elimination of consumed food from the body * most commonly - self-induced vomiting * also includes laxative use, diuretics, enema * purging only has limited effectiveness in reducing caloric intake * vomiting prevents the absorption of only about 1/2 the calories consumed during a binge, and laxatives, diuretics, and enemas have few lasting effects on calories or weight * extreme exercising or rigid fasting * DSM-5 indicates binge eating and contemporary behavior must occur once a week, on average, for at least three months

CBT

* reasons that bulimia comes from "black and white" thinking * Fairburn's treatment includes: 1. The therapist uses education and behavioral strategies to normalize eating patterns * The goal is to end the cycle where extreme dietary restraint leads to binge eating and purging 2. The therapist addresses the client's broader, dysfunctional beliefs about self, appearance, and dieting 3. The therapist attempts t consolidate gains and prepare the client for expected relapses in the future * Goals are to develop realistic expectations about eating, weight concerns, and binge eating, as well as strategies for coping with relapses in advance * overall leads to 70% -80% reduction in binge eating and purging * 33%-50% of clients cease binging activity completely * also affective in group and self-help formats * individual is said to be more effective

BN - Excessive Emphasis on Weight and Shape

* self-evulation and self-esteem are influenced and are centered around weight and shape * negative comment can make someones self-esteem plummet * an individual's sense of self is linked too closely to appearance instead of personality, relationships, or achievements

Voyeuristic disorder

* the act of observing an unsuspecting person, usually a stranger, who is naked, in the process of disrobing, or engaging in sexual activity * not aroused by watching people who know they are being observed * "peeping" arouses the person * observation and the risk of discovery * reaches orgasm while watching or remembering it later * most keep their distance and are not dangers

penile plethysmograph

* the man places a thin elastic strain gauge around his penis, underneath his clothing * the rubber loop is filled with a column of mercury that changes in its electrical conductance as the circumference of the penis changes - amplified on the plethysmograph

sexual arousal

* the state the precedes orgasm * Physiological responses - vascular engorgement of the genitals * Subjective feelings of pleasure and excitement - referred to as a *hypothetical construct"

Aversion therapy

* the therapist repeatedly presents the stimulus that elects inappropriate sexual arousal in association with an aversive stimulus, such as repulsive smells, electric shock, or chemically induced nausea * mixed results

AN - Struggle for Control

* theorists say that the disorder actually develops out of sense of having no control * feels good to be in complete control of something

BN - Binge Eating

*= consuming an amount of food that is clearly larger than most people would eat under similar circumstances in a fixed period of time* * there have been attempts to define binging more objectively (i.e. 1000 calories) * however a "binge" differs for every person so its hard to define more specifically * 35% of people report binging occasionally * 29% report they fast * 8% use self-induced vomiting * 5% use laxatives * some are plan, some are spontaneous * usually consists of the individual eating extremely fast and becoming uncomfortably full * usually foods that are no commonly eaten, easily thrown up * triggered by an unhappy mood, which may be the result of self-criticism about weight or appearance, or intense hunger following a period of fasting * initially receives unhappy feelings, but physical discomfort, shame, and fear of gaining weight quickly return * key diagnostic feature = sense of leack of control during a binge * some describe a dissociated state * sometimes it becomes easier to stop after they have the disorder for a while

AN - Amenrrhea

*= the cessation of menstruation * * a reaction to the loss of body fat and associated physiological changes * not considered a symptom anymore * common with bulimia too

Suicide treatment - Psychotherapy

*CBT does not show any significant reduction tin suicidal behavior* - Recommendations for patients who are suicidal - Reduce lethality - Negotiate agreements - Provide support - Replace tunnel vision with a broader prospective

Split-half reliability

*Internal consistency of items within a test* ♣ If a test with many items measures a measures a specific trait or ability, and if the items are divided in half, will the person's scores on the two halves agree with each other?

Common features of disorganized speech in schizophrenia include:

*Loose associations* (derailment) -shifting topics too abruptly *Tangentiality* -replying to a question with an irrelevant response *Perseveration* -persistently repeating the same word or phrase over and over again

Response styles to depression

*Ruminative style* - turning their attention inward, contemplating the causes and implications of their sadness - writing in a diary, talking with a friend *Distracting style* - divert themselves from their unpleasant mood - engaging in hobbies, sports, activities that draw their attention away from symptoms of depression

Diagnosis of Avoidant/Restrictive food Intake Disorder

*apparent lack of interest in food* * occurs mostly in infants and is characterized by an apparent lack of interest in food

Diagnosis of Binge-eating disorder

*episodes of binge eating without compensatory behavior* - associated with a number of psychological and physical difficulties, including, obesity, often defined as a BMI greater than 30

Diagnosis of Rumination disorder

*involves repeated regurgitations of food, sometimes rechewing* * often occurs in infants, sometimes in the context of neglect and/or intellectual disabilities * Avoidant/Restrictive food Intake Disorder - apparent lack of interest in food * occurs mostly in infants and is characterized by an apparent lack of interest in food * Binge-eating disorder - episodes of binge eating without compensatory behavior * associated with a number of psychological and physical difficulties, including, obesity, often defined as a BMI greater than 30

Evidence supports that mood disorders of _____

*polygenic* - influenced by many genes rather than a single gene - each of these genes on its own only changes risk for the disorder by a small amount

sex therapy's focus

*sensate focus* - a series of simple exercises in which the couple spends time in a quiet, relaxed setting, learning to touch each other *scheduling* - people should schedule time for sex *education and cognitive restructuring* - changing the way in which people feel about sex *communication training* - structured training procedures aimed at improving the ways in which couples talk to each other

Sexual Masochism Disorder

*sexual arousal when subject to pain or embarrassment* * defined in terms of recurrent, intense sexually arousing fantasies, urges, or impulses involving being humiliated, beaten, bound, or otherwise made to suffer * may be an individual event or with a partner * one common fantasy = forced to show naked body to others * masochists desire certain types of pain, but go to great lengths to avoid injury * must experience distress or impairment to be diagnosed * the pattern of this disorder leads to the suggestion that masochism may be motivated by an attempt to escape temporarily from the otherwise constant burden of maintaining personal control and pursuing self-esteem

Fetishistic Disorder

*the association of sexual arousal with non-living objects* * range is unlimited * most often involves women's underwear, shoes, boots, or products made out of rubber or leather * person may go to great lengths to obtain certain kinds of objects * People usually masturbate while holding, rubbing, or smelling the objects * sensory qualities of the object - texture, visual appearance, and smell - can be very important in deterring whether the person finds it arousing * Person may not be able to become sexually aroused without fetish object

Diagnosis of Pica

*the eating of nonnutritive substances like paper or dirt* - found commonly among children with intellectual disabilities

Emotional Symptoms of Mood Disorders

- *Dysphoric* (depressed) - unpleasant - most common and obvious symptom of depression - *Mania symptoms* - As these feelings become more intense and prolonged, they can become ruinous - it is unclear the boundary between being productive and energetic to being out of control and self-destructive - Depressed and Manic - usually very irritable - Anger can be directed at themselves or others - frequently both - *Anxiety* - common among people with mood disorders, just as depression is a common feature of some anxiety disorder - People who are depressed are sometimes apprehensive fearing that matters become worse than they already are or that other will discover their inadequacy - Sometimes report they are *chronically tense and unable to relax*

Should mood disorders be defined in a broad or a narrow fashion?

- *Narrow approach* - focuses on the most severely disturbed people - *Broader approach* - focuses on and includes the milder forms of depression - Some critics say that the definition of depression includes just normal sadness because it doesn't exclude reactions to many negative events - Is Depression necessarily "normal" if it follows a stressful event? - need research evidence

Criteria for major depressive disorder in the DSM-V

- 5 or more of the following symptoms during the same 2-week period (and must include one of the first two criterion): • Depressed mood most of the day, nearly every day (NED) • Anhedonia most of the day, NED • Weight loss/gain, or persistent change in eating habits NED • Insomnia or hypersonmia NED • Psychomotor agitation/retardation NED • Fatigue or loss of energy NED • Feelings of worthlessness/excessive guilt NED • Lowered concentration/increased indecisiveness NED •Recurrent thoughts of death or suicide, an attempt, or a plan

Comorbidity of anxiety disorders

- 50 percent of those who meet the criteria for one anxiety disorder also met the criteria for at least one other form of anxiety or mood disorder - Approximately 60 percent of people diagnosed with major depression also qualify for a secondary diagnosis of some type of anxiety disorder (both based on emotional distress) - Substance dependence is also frequent

Anticonvulsant Medications

- 50% of patients respond positively - reduces frequency and severity of relapse and can be used for acute manic episodes - Side effects - nausea, vomiting, diarrhea, sedation

Full blown panic attack

- A person must experience at least four of the thirteen DSM-5 symptoms in order for the experience to qualify as a full-blown panic attack - These symptoms must develop suddenly and reach peak within 10 minutes

Factors that may contribute to the development of somatic symptom disorders

- A tendency to amplify somatic symptoms - *Alexithymia* -a deficit in one's capacity to recognize and express the emotions signaled by physiological arousal - The misattribution of normal somatic symptoms - Memory biases

Essential difference between ASD and PTSD is duration

- ASD lasts no longer than a month - PTSD continues or sometimes begins at least a month after the trauma

Azapriones

- Act on serotonin transmission (different pathway than benzodiazepines) - Most common brand is buspirone (BuSpar) - Effective for treatment of GAD - Some say preferable to benzodiazepines because does not cause drowsiness and does not interact with alcohol - Disadvantage is slower relief from symptoms

Heterogeneity

- All depressed patients do not have exactly the same set of symptoms, the same pattern of onset, or the same course over time - Some manic, some only depressed - Some experience *psychotic symptoms* - hallucinations, delusions - Are these qualitatively distinct forms of mood dirsoder, or are they different expression of the same underlying one of severity?

Levels of anxiety

- Anxiety can be adaptive at low levels, because it serves as a signal that the person must prepare for an upcoming event - High levels of anxiety become incapacitating by disrupting concentration and performance

More likely to develop PTSD following a trauma:

- Anxious people - People with a family or personal history or mental disorder

Commonly taught skills (social skills)

- Assertiveness training - Social problem solving

Overlap between PDs

- At least 50% of people who meet the diagnostic criteria for one PD also meet the criteria for another PD ♣ Similar symptoms are used to define more than one disorder - Contributes to issues regarding prevalence rates

Attention's role in disorders

- Attention plays a crucial role in the onset of GAD and panic disorder - People who are prone to excessive worrying and panic are unusually sensitive to cues that signal future threats (pay lots of attention to possible threats, even when the possible threat is miniscule, which can become maladaptive) - This cycle can be easily reactivated - Attention mechanisms are involved in the etiology and maintenance of social anxiety disorder (can perform task when alone but not in front of an audience) - Caused by anxious apprehension

Depressive disorders: course and outcome

- Average age of onset is 32 - Mean number of lifetime episodes is 5 or 6 - *Remission* - a period of recovery - *Relapse* - a return to active symptoms in a person who has recovered from a pervious episode - Approximately 1/2 of patients recover within 6 months of the beginning episode - Risk of relapse goes down as the length of remission increases

Dimensional approach to diagnosing

- Begins with a consideration of level of personality functioning - Would then focus on describing the nature of her PD in terms of a combination of traits: ex. antagonisms, negative affectivity, detachment, rigid perfectionism - offers a more straightforward and comprehensive description of personality pathology

Trauma

- Both ASD and PTSD are under the diagnostic group Trauma- and stressor-related disorders - Also includes adjustment disorders

Anxiety disorders share several important similarities with mood disorders

- Both categories are defined in terms of negative emotional responses - Feelings such as guilt, worry, and anger frequently accompany both anxiety and depression - Many patients who are anxious are also depressed and visa versa - Order of these can vary, but usually anxiety precedes the onset of depression

Humanistic reasonings

- Causes of abnormality = frustration of society - Inborn human nature = basic goodness

Environment and signs of ASPD

- Certain forms of conduct disorder that are evident during childhood, especially among boys, are reliable predictors of other forms of antisocial behavior when they become adults - Our current diagnostic approach places principal emphasis on observable behaviors and repeated conflict with, including failure to conform to, social norms with respect to lawful behavior o Greater reliability because it focuses on concrete consequences of the disorder

Children and PTSD

- Children are especially vulnerable to PTSD - 20-40% develop PTSD

Both ASD and PTSD involve essentially the same symptoms:

- Intrusive reexperiencing of the event - Avoidance of reminders of the trauma - Negative mood or thoughts - Increased arousal or reactivity - Dissociation

BIS - decreased activity

- some areas show *decreased activity* - the prefrontal cortex on the left side of the brain - person may have motivational problems, such as inability to work toward a pleasurable goal

Most effective treatment of OCD

- Combines prolonged exposure to the situation that increases the person's anxiety with prevention of person's compulsive response - Neither component is effective by itself - Some patients (up to 20 percent) do not response positively to this treatment and continue to exhibit mild symptoms - Selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Luvox, and Zoloft, are used most frequently to treat OCD - Clomipramine (Anafranil), a tricyclic antidepressant, used to treat OCD - More than 50 percent of those who use it improve to normal level of functioning - Relapse is common if medication is discontinued

The purpose of compulsions

- Compulsions are used to reduce anxiety; otherwise person becomes very uncomfortable - Compulsions are not usually delusional because person knows they are nonsensical - paradox of OCD - Compulsions do not produce pleasure (gambling and drinking are not compulsions) - Compulsive rituals are associated with experiencing diminished control not complete loss of control

"Virginia Adult Twin Study"

- Concordance rates were higher in MZ twins than DZ twins - Found that genetic factors account for between 20-30% of GAD transmission - Conclusion of study: (1) Genetic risk factors for these disorders are neither highly specific (a different set of genes being associated with each disorder) not highly nonspecific (one common set of genes causing vulnerability for all disorders) (2) Two genetic factors have been identified: one associated with GAD, panic disorder and agoraphobia, and the other with specific phobias (3) Environmental risk factors that are unique to individuals play an important role in the etiology of all anxiety disorders; environmental factors that are shared do not play an important role

Somat symptom disorder DSM-5 classification

- DSM-5 lists five major somatic symptom disorders - Conversion disorder (very rare) - Somatic symptom disorder - Illness anxiety disorder - Factitious disorder - Psychological factors affecting other medical conditions - Physical illness is real and emotional reactions are not exaggerated - Psychological factors affecting other medical conditions are diagnosed for stress-involved physical illnesses

2. Depression, Low Self-Esteem, Dysmorphia

- Depression is often comorbid with EDs, particularly bulimia * Depression improves following successful group psychotherapy * Anorexia found considerable depression rates at the time of diagnosis but not at a six-year follow-up * Depression may play an important role in EDs * Low-self esteem is a huge concern -*social self* - how people present themselves in public and how other people perceive and evaluate them * women with EDs are normally concerned with this * Women with bulimia or a negative body image report more public self-consciousness, social anxiety, and perceived fraudulence * also show increase in self-criticism and deterioration in mood following negative social interactions * people with EDs often depend on others for self-esteem * Depressive symptoms play a role in maintaining eating behaviors

Little systematic research has been done on the causes of dissociative disorders

- Dissociative amnesia and fugue are precipitated by trauma - Many cases suggest that DID develops in response to trauma, esp child abuse - Note that studies of long-term consequences of child abuse find little evidence of dissociation, or any consistent forms of psychopathology

CBT and somatic symptom disorders

- Evidence indicates that CBT can reduce physical symptoms in somatic symptom disorder, illness anxiety disorder, and body dysmorphic disorder - Addresses the emotional and cognitive components of pain - CBT approaches to chronic pain alter the contingencies that reward pain behavior and the sick role - Goal is to reward successful coping and life adaptation instead

PTSD is linked with general physiological arousal

- Ex. increased resting heart rate - Suggests that the sympathetic nervous system is aroused and the fear response is sensitized in PTSD

Interpersonal Therapy

- Focused on current relationships, especially those involving family members - Therapist helps the patient develop a better understanding of the interpersonal problems that presumably give rise to depression and attempts to improve the patient's relationships with other people by building communication and problem solving skills - Therapy sessions = nondirective discussions of social difficulties and unexpressed or unacknowledged negative emotions, as well as role-playing to practice specific social skills

Aversion therapy

- Goal is to create, rather than eliminate, an unpleasant response o Used primarily in treating substance use disorders o Technique involves pairing the sight, smell and taste of substance with severe nausea produced artificially by a drug o Controversial because of aversive nature o Not clear whether it is an effective treatment o Often achieves short-term success but relapses are high

Dimensional view of PDs

- Grounded in extensive research on the basic elements of personality o Could provide a more complete description of each person - More useful with patients who fall on the boundaries between, or present combinations of, different types of PDs

TCA

- Imipramine (Tofranil) is a tricyclic antidepressant medication used to treat panic disorder - Patients less likely to become addicted to these than benzodiazepines - Used less than SSRIs because have a few bad side effects, some of which resemble the symptoms of anxiety

Preparedness, purpose, and the absence of blame can aid coping with trauma

- Importance of preparedness: pilots cope more successfully with helicopter crashes if they have training than if they have none - Importance of purpose: political activists develop fewer psychological symptoms than non-activists following torture (despite greater physical suffering) - Importance of absence of blame: when the rape victim blames herself, or the driver thinks he could have avoided the accident, they have an increased risk of PTSD

Frequency of Suicide

- In US + Canada = 12/100,000 people annually - 35,000 people in the US every year - Rates vary as a function of age, gender, class status - Suicide is the *3rd leading cause of death for people between ages 15-24* - *8th leading cause of death overall*

Brain Imaging Studies

- Indicate that severe depression is often associated with abnormal patterns of activity as well as structural changes in various brain regions - Abnormal patters of activation in regions of the prefrontal cortex (PFC) are often found in association with depression - evidence found using PET and fMRI scans

Research Methods: Statistical Significance: When Differences Matter

- Just because study reveals a statistical difference in one form of treatment versus another form of treatment does not automatically mean that the difference is statistically significant - First you collect your data and use statistical test to determine whether or not you can reject the null hypothesis - Your results are statistically significant if they exceed the 0.05 level (occur more than 5% of the time because if something is random it will occur less than 5% of the time) - Statistical significance should not be equated with clinical importance - Clinical importance is sometimes measured in terms of the proportion of people in the treatment group whose outcome scores fall below a certain threshold of severity or within the range of scores that are produced by people without the disorder in the question - Clinical investigators also should consider the kinds of changes that they expect to find as well as the amount of change - In addition to looking at changes in symptoms, also important to ask about changes in patient's quality of life

DSM-5 Classification of Suicide

- Lists suicidal ideation only as a symptom of mood disorders - Based on casual theories rather than descriptive factors

DSM-5 classification of depressive disorders

- Major Depressive Disorder - Persistent Depressive Disorder - Premenstrual Dysphoric Disorder - Disruptive Mood Dysregulation Disorder - added in the DSM-5 - intended to describe children with chronic, severe irritability

Lifetime risk of mood disorders

- Major depressive disorder - 16% - Persistent depressive disorder (dysthymia) - 3% - Bipolar I and II combined - 4% - Ratio of depression to bipolar 5:1 - 8% of women experience moderate to severe symptoms of premenstrual dysphoric disorder and about 3% meet the criteria

Most victims of sexual assault show the symptoms of PTSD:

- May reexperience the horrors of the assault - May feel numbed in reacting to others (esp sexual partners) - May avoid any potentially threatening situation - May maintain both autonomic hyperarousal and hypervigilance against possible victimization - Depression is also common - Sadness, crying, withdrawal from others, sleep and appetite disturbances - Loss of interest in sex - Insecurities about sexual identity - Sexual dysfunction - Negative feelings toward men in general - Tend to blame themselves

combining treatment for somatic symptom disorders

- Medicine and CBT may be effective, in part because they alleviate the depression and anxiety that are often comorbid with somatic symptom disorders - Mindfulness based therapies encourage acceptance of symptoms as passing event

Who is more likely to experience trauma?

- Men - Young people - Those with a history of conduct disorder - Extroverts --> reason - more likely to engage in risky behavior! - Anxious people and those with a family history of mental illness experience more trauma - Reasons are less clear

gender disparities

- Men are 30-40% more likely to develop schizophrenia than women - Average age of onset is about four or five years younger for men than women - Men are more likely than females to exhibit negative symptoms - Men are more likely than females to follow a chronic, deteriorating course

Minority Groups and PTSD

- Minority group members are more likely to experience PTSD - In large part because of their most difficult living conditions

More naturalistic treatment for soldiers showed more promise; it was based on three principles:

- More naturalistic treatment for soldiers showed more promise; it was based on three principles: 1. Immediate treatment 2. In the proximity of the battlefield 3. With the expectation of return to the front lines upon recovery - Results indicated that 60% of soldiers treated using this method recovered sufficiently to return to battle within 72 hours

Religion and its effect on stress

- Mortality risk is lower among those who attend church services, probably as a result of improved health behavior (usually from accepting concept of forgiveness) - Study showed that religion encourages active, not passive, coping - Religion helps people gain control with God, not just accept control by God (active versus passive religious coping)

Critical Thinking Matters: Can a strep infection trigger OCD in children?

- National Institute of Health said, in some cases, OCD symptoms developed right after strep infection - Thought antibodies from infection attacked nerve cells in basal ganglia - Called these weird occurrences PANDAS - So claimed that when children are diagnosed with OCD they should get step test and if they are positive, they should be put on long-term antibiotics - Say that some kids were cured - Emphasizing antibiotics as treatment could lead parents to ignore effective medications as cause children to become antibiotic resistant - SSRIs and cognitive behavior therapy have been shown to be effective when treating children with PANDAS-related OCD - PANDAS is false hypothesis because not supported by strong empirical evidence

Fears are learned

- Not necessarily born with them - Additionally, people learn to avoid certain stimuli if they observe other people showing a strong fear response to those stimuli

Bipolar disorders: course and outcome

- Onset is usually between 18-22 years of age - The first episode is equally likely to be manic as it is depressive - Average duration of a manic episode lasts between 2-3 months - onset not always sudden - Most patients have more than one episode - and tend to have more than depressive patients - Approximately 1/2 of patients are able to achieve a sustained recovery from the disorder

Length of symptoms

- Over one third of people still report symptoms 10 years after the trauma, regardless of whether or not they were treated - Some prisoners of war from WWII reported symptoms 40 years later

Suicide Treatment - Involuntary Hospitalization

- People on the brink of suicide are often hospitalized, either with or without their permission - Safety first - commitment to a hospital stay could save someones life - Person will be monitored continuously and have access to treatment

Hypothesis of response styles:

- People who engage in ruminative responses have longer and more severe episodes of depression than do people who engage in distracting responses - *Women are more likely to employ a ruminative style* in response to depression, whereas men are more likely to employ a distracting technique. - Ruminative style - leads to episodes of greater duration and intensity, women are more susceptible to depression than men

How do they view themselves?

- People with personality disorders frequently do not see themselves as being disturbed o they may not have insight into the nature of their own problems - Many forms of personality disorder are defined in terms of the problems that these people create for others rather than in terms of their own subjective distress - Many people with personality disorders are unable to view themselves realistically and are unaware of the effect their behavior has on others o Assessments based exclusively on self-report may have limited validity ♣ They may underestimate the frequency or severity of certain aspects of personality pathology

Common Elements of Suicide

- Purpose = Seeking a solution - Goal = Cessation of consciousness - Stimulus = Unbearable psychological pain - Stressor = Frustrated psychological needs - Emotion = Hopless-ness - Cognitive State = ambivalence - Perceptual State = constriction - Action = Escape - Interpersonal act = Communication of intention - Pattern = consistency of lifelong styles

Benzodiazepines

- Reduce many symptoms of anxiety, especially vigilance and subjective somatic sensations - Most widely prescribed psych medication until the 90s - Bind to receptor site in brain associated with neurotransmitter GABA - Work by enhancing activity of GABA based on rate of absorption and elimination from the body - Effective in treating GAD and social anxiety disorder - Many relapse if stop taking medication; exposure may be better treatment - Common side effects are sedation and mild psychomotor and cognitive impairments - Most serious side effect is risk of addiction (40% experience withdrawal)

Somatic Symptoms of Mania

- Reduction in need for sleep - Bursting with energy in spite of lack of sleep

Causes of Suicide - Social factors

- Religious affiliation strongly related to suicide rate - active social networks encouraged by church communities can lead to effective support and protection from influences of self-destruction - Social policies regulating access to hand guns - 60% of deaths in USA are due to guns - in countries with restrictive gun laws, suicide rates usually decrease, particularly among adolescence

rTMS (repetitive Transcranial Magnetic stimulation)

- Repeated, high-intensity magnetic pulses focused on specific brain structures - Used to treat depression & OCD - Targets left prefrontal cortex - Patient can stay awake - Usually closer to 30 session

Suicide treatment - Medication

- SSRIs - been shown to be very helpful - Luvox, Prozax - because of the link between suicide and serotonin disregulation - Studies show that the intake of SSRIs reduces suicide rates - relationship is neither direct nor simple - should use caution when prescribing drugs to suicidal patients

SSRI

- Selective serotonin reuptake inhibitors (SSRIs) are first choice for treating panic disorder and social anxiety disorder - Brands are Prozac, Luvox, Zoloft, and Paxil - Fewer negative side effects and less prominent withdrawal

Gender differences in PTSD

- Sexual violence is a particular risk for women - Combat exposure is a particular risk for me - women more likely overall to develop the disorder

NCS-R study about treatment

- Slightly more than 20% of those who meet the diagnostic criteria for a mood disorder in the past 12 months had received adequate treatment during that same time period

For who are Somatic Symptom disorders most common?

- Somatic symptom disorders are more common among women than men - Often blamed on widespread sexual abuse - Somatic symptom disorders are more common among lower socioeconomic groups, people with less than a high school education, and African Americans

Environment and BPD

- Some investigators argue that BPD patients suffer from the negative consequences of parental loss, neglect and mistreatment during childhood o Supported by studies of families and BPD patients - Studies point toward the influence of widespread problematic relationships with their parents for BPD patients o Adolescent girls with BPD report a pervasive lack of supervision, frequent witnessing of domestic violence, and being subjected to inappropriate behavior by their parents and other adults (including verbal, physical and sexual abuse) ♣ Extent and severity of abuse varies widely among individuals - maladaptive patterns of parenting and family relationships increase probability that a person will develop PD

ASD and PTSD were previously classified as anxiety disorders because of the hyperarousal symptoms:

- Some people become irritable and prone to angry outbursts - Other people have trouble concentrating or sleeping - People may be unable to experience positive emotions - People may experience persistent fear, anger, or guilt, or feelings of detachment from others - Some experience numbing of responsiveness or emotional anesthesia -emotional dampening - Individuals may blame themselves, repeatedly question what they might have done differently, or see the world in an uncharacteristically negative way

NCS-R found that anxiety disorders are more common than any other form of mental disorder

- Specific phobias are the most common type of anxiety disorder with a one-year prevalence of about 9 percent of the adult population - Social anxiety disorder has a one-year prevalence of 7 percent - Panic disorder and GAD affect about 3 percent of the population - Agoraphobia affects 1 percent of the population

In a study of Iraq veterans, they were randomly assigned to one of three groups:

- Stress education -the army's normal treatment, groups of about 100 (control) - Battlemind debriefing -discussions in groups of about 20 to 32 that included some review of combat experiences but focused on the transition home and building peer support - Battlemind training -focused on finding inner strength in combat, teaching skills to help unit members, and reframing redeployment difficulties as normal problems that require adapting occupational coping skills, offered in both small groups (18-45) and larger groups (126-225) - The three experimental groups produced a significant reduction in PTSD symptoms compared to the control, but only in those veterans who were exposed to large numbers of combat events

The close relationship between symptoms of anxiety and depression suggests that these disorders may share common causal features

- Stressful life events seem to play a role in the onset of both depression and anxiety - From a cognitive/ biological point of view, certain brain regions and a number of neurotransmitters are involved in the etiology of anxiety disorders as well as mood disorders

Causes of Suicide - Biological factors

- Studies show that their is a connection between reduced levels of serotonin and suicide - may be related to poor impulse control as well as increased of violent and aggressive behavior - Genes associated with various neurotransmitter systems, especially serotonin, influence the development of impulsive personality traits, and suicide appears to be an especially likely outcome when a person inherit a predisposition to both psychopathology and impulsive or violent behavior - Genetic factors moderate the impact of environmental factors on suicidal behavior

Causes of Suicide - Psychological factors

- Sucide is an attempt to escape unbearable psychological pain produced by prolonged frustration of psychological needs - needs - affiliation and competence - desire to die is linked closely with social isolation and the belief that one has become a burden to others - fear of death and self-preservation is a powerful motive - these instincts protect people in distress - people often work their way up to the act gradually - usually repeated non-sucidial self-harm proceeds - allows someone to habituate to pain and fear of death - suicide requires both the desire to die and the ability to inflict self harm

Diagnostic and Statistical Manual of Mental Disorders

- The APA introduces a new one about every 20 years or so - DSM V (2013) lists hundreds of mental disorders

mental illness and violence

- The rate of violence is about five times higher among people diagnosed with a major mental disorder than those with no diagnosis - People who use drugs/alcohol are more likely to engage in violent behavior - Substance abuse symptoms increase risk of violence

Thought Suppression

- The struggle to control our thoughts often leads to process known as thought suppression, an active attempt to stop thinking about something - Trying to rid one's mind of unwanted thoughts may make them more intrusive - Thought suppression may increase, rather than decrease, negative emotions associated with unwanted thoughts

Psychologists test reliability

- They want to know if they can generalize, or draw inferences about the person's behavior in the natural environment on the basis of the samples of behavior that are obtained in their assessment - Psychologist typically seek out more than one source of information when conducting a formal assessment. And they like to consider the consistency across sources when evaluating the possible meaning or importance of the information collected

Cognitive Symptoms of Depression

- Thinking is typically slow, trouble concentrating, easily distracted - Guilt and worthlessness - Blame - Focus on the most negative features of themselves, their environments, and the future = "depression triad" - Self destructive ideas and impulses - suicide interest begins increasing - Fatigue and loss of pressure

Somatic Symptoms of Depression

- Tired - Simple things seem to require an overwhelming amount of effort - Getting out of bed is virtually impossible - Hard time falling asleep and staying asleep - usually wake up early - Less common - more time sleeping - Usually a reduction in appetite - sometimes increase can occur - Food just doesn't taste good anymore - Lose a lot of weight without dieting or change in eating - Loss of interest in activities that use to be pleasureful - ex. sexual desire decreases - Less likely to enjoy or initiate sexual activity - Headaches and muscular pains and aches

In most cases, ASD and PTSD develop as a result of a combination of factors:

- Trauma - Personality characteristics that predate the trauma - Exposure during the trauma - Emotional processing - Social support afterwards

Gender difference

- Women are three times more likely to develop a specific phobia than men - Women are twice as likely than men to develop panic disorder, agoraphobia, or GAD - Social anxiety disorder is also more common among women, but not by much

Persistent depressive disorder (dysthymia)

- a chronic mild depressive condition that has been present for many years - differs from major depression in terms of both severity and duration - DSM-5 Criteria: person must, over a period of at least two years, exhibit a depressed mood for most of the day

Persistent depressive disorder (dysthymia)

- a chronic mild depressive condition that has been present for many years - differs from major depression in terms of both severity and duration - DSM-5 Criteria: person must, over a period of at least two years, exhibit a depressed mood for most of the day, more days than not - Two or more of the following symptoms: - Poor appetite or overeating - Insomnia or hypersomnia - Low energy or fatigue - Low self-esteem - Poor concentration of difficulty making decisions - Feelings of hopelessness - These symptoms must not be absent for more than two months at a time during the two-year period

MRIS show

- a decrease in tot volume of brain tissue among schizophrenia patients - enlarged lateral ventricles - decreased size of hippocampus, parahippocampus, amygdala, thalamus (limbic system)

Premenstrual dysphoric disorder (PMDD)

- added as a new diagnostic category - Women commonly experience premenstrual symptoms that center around emotional and physical complaints, but they are typically mild - Defined in terms of various mood-related symptoms that occur repeatedly during the premenstrual phase of the cycle and are then diminished at the onset or shortly after menses - Symptoms: - mood lability - irritability - dysphoria - anxiety - cognitive - difficulty concentrating, feeling overwhelmed or out of control - somatic - lethargy, changes in appetite, sleep problems, joint or muscle pain, sensation in bloating - Must exhibit at least 5 symptoms to meet the criteria for this disorder, and at least one of them must involved a disturbance in mood - The symptoms must be present for most of the woman's menstrual cycles in the past year - Must be associated with clinically significant distress or interference with social or occupational functioning

T cells

- affected by stress, white blood cells that fight off antigens - foreign substances like bacteria that invade the body - this can make the body more susceptible to infectious disease

Treatment - Psychological procedures

- sex therapy - positive outcomes 85% for male 78% for female

Behavioral Symptoms of Depression

- slow movement ** - most obvious behavioral symptom - sometimes immobile - slow speech and response to questions

Cross-cultural differences

- comparisons of emotional expression and emotional disorder across cultural boundaries encounter a number of methodological problems - vocabulary - each culture has its own ways of interpreting reality, including different styles of expressing or communicating symptoms of physical and emotional disorder - words and concepts that are used to describe illness behaviors in one culture might not exist in other cultures - Have been confirmed by a number of research projects that have examined cultural variations in symptoms among depressed patients in different countries - specific type of symptoms expressed by the patients varies from one culture to the next - China - depression described in terms of "*somatic symptoms* - sleeping problems, headaches, and loss of energy - Europe/North America - depressed patients more likely to express *feelings of guilt and suicidal idea* - Clinical depression is a universal phenomenon - The comparisons indicate that a person's cultural experiences, including linguistic, educational, and social factors, may play a role in shaping the manner in which he or she expressed and copes with the anguish of depression

Central executive component

- component of working memory responsible for the manipulation and transformation of data that are held in the storage buffers - people with schizophrenia can not do tasks that depend on this component of working memory

Risk factors

- culture about drugs - frequency of drug use - age at with people begin use of drug

Limitations of Emile Durkheim's view of suicide

- doesn't explain why one person would commit suicide while the rest of the group members don't - different types of suicide overlap and may be difficult to distinguish

Serotonin

- enhanced by Prozac - shows that some type of serotonin malfunction is involved in the etiology of depression - effect on mood, high levels of feelings of serenity and optimism - regulates sleep and appetite

Causes of gender dysphoria

- etiology poor understand - evidence that gender identity is influenced by sex hormones *pseudohermaphroditism* *pseudohermaphrodite*

Highly structured interviews

- everyone gets asked the same question - very scripted ♣ Ex. If you are beginning to ask about depression... the opening question is "during the last year has there been a 2-week period of time where you have felt down, depressed of blue?" - no other clarifying questions

Behavioral Symptoms of Mania

- gregarious and energetic - flirtatious and provocative behavior - everything is interesting and is easily distracted - flitting from one idea to the next - excessive pursuit of life goals

Treatment for BPD

- hardest PD to treat - hard to form relationship with the therapist - 1/2-2/3 patients quit therapy - DBT has been proven to be effective - psychotropic medication

Defendants (GBMI)

- if they are guilty of the crime, were mentally ill at the time it was committed, but were not legally insane at that time - sentences like any other criminal, but court can order treatment for the mental disorder as well

Risk of schizophrenia in offspring

- maternal malunutrition - winter birth? more viral infections - susceptibility to brain injury following obstetric difficulties

resolution

- may last 30 mins or longer - person returns to resting state - men are unresponsive to further stimulation for a period of time after reaching orgasm - women may be able to respond to further stimulation immediately

Treatment - Biological procedures

- medications men: viagra, etc - erectile dysfunction women: being developed - penile implant - used to make penis hard during intercourse - recommended with the use of therapies

Psychological Causes of Sexual Dysfunction

- mental scripts - the way we learn about life - beliefs and attitudes toward sexuality (especially women) - quality of relationship - culture attitudes - own personal attitudes, feelings - lack of communications - traumatic experiences (sexual abuse) - performance anxiety

Hoarding Prevalence

- much more common than OCD - affects 6% of community residents - no gender difference

3. Negative Body Image

- negative body image - a highly critical evaluation of one's weight and shape, widely thought to contribute to the development of EDs - one way to assess body image is to compare people's current and ideal size - this may be a problem and potential risk factor when combined with other risk factors

Treatment of ASPD

- people seldom seek professional mental health services - seldom effective - no form of intervention has been proven effective

Psychological response to stress - Adrenal hormones

- perceived threat comes into cortex —> signals the amygdala —> secretes corticotrophin-releasing factor (CRF), which stimulates the brainstem to activate the sympathetic nerve system --> adrenal glands secrete 2 hormones

Reported reasonings of self-harm

- punish the self - reflects anger and frustrations - combat extended periods of dissociation and feelings of emptiness - maladaptive way to regulate intense , negative emotional states

Somatic Symptoms

- related to basic physiological or bodily functions - *mood disorders* = Fatigue, aches and pains, and serious changes in appetite and sleep patterns

Stress checklists

- rely on retrospective reports - contain stressors that do not apply to people of different ages and ethnic backgrounds - treat both positive and negative events as stressors - fail to distinguish between short-lived and chronic stressors; and most importantly - treat the same event as causing the same amount of stress for everyone

DSM-5 diagnosis of PD

- requires erotic preoccupation must have lasted at least 6 months - If it leads to distress or impairment * impaired = the urges have become compulsory, if they produce sexual dysfunction, require the participation of non consenting persons, if they lead to legal problems, or interfere with social relationships - If one acts on urges: * pedophilic, exhibitionistic, voyeuroistic and frotteuristic disorders

Biological Causes of Sexual Dysfunction

- sex hormones (testosterone is highly correlated to sexual appetite and desire) - drugs - alcohol - inhibits orgasm - neurological disorders - disease

Social factors affecting bipolar disorders

- some have found that the weeks preceding the onset of a manic episode are marked by an increased frequency of stressful life events - different from those preceding depressive episodes - include schedule-disrupting events as well as goal attainment events - some patients experience an increase in manic symptoms after they have achieved a significant goal toward which they had been working - major job promotion, acceptance into a competitive school program, a new relationship - A relationship between relapse and emotional climate within families has been found through various studies - if the family members are hostile toward or critical of the patient, the patient is more likely to relapse shortly after discharge from the hospital - patients with less social support are more likely to relapse or have slower recovery rates - The disorder can be influenced by the social environment in which the person is living

Why are women two or three times more vulnerable to depression than men?

- some observers say that is due to shortcomings in the data collected - Women may be more likely than men to seek treatment or be labeled as being depressed - Culturally defined sanctions make it more difficult for men to admit to subjective feelings of distress - None of these have supported by substantial evidence - This is genuine based off of data - Possible explanations: - sex hormones - stressful life events - childhood adversity - gender roles

Social factors

- standards of beauty and the premium placed on young women's appearance contribute - more common among working women in fields that emphasize weight and appearance (models, dancers, gymnasts) - culture of thinness plays a stronger role in bulimia than anorexia * bulimia has been seen to increase more with in response to cultural ideals of thinness - troubled family relationships - sexual abuse - parents struggle with ED

4. Dietary Restraint

- symptoms can be direct consequences of overly restrictive eating - "out of control" symptoms can be caused by efforts to "control" * weight suppression* - highest adult weight minus current weight - predicts the maintenance and onset of bulimia 10 years later - overly restrictive diet includes: * hunger, frustration, lack of attention to internal cues * which all make binging more likely - sensible dieting is not restricting

Assessment

- the process of gathering information • Use data gathered from your assessment to compare patient's experiences with those of other patients who you're treated or read about

Cognitive Symptoms of Mania

- thoughts are speeded up, ideas flash through one's mind faster than they can articulate thoughts - also easily distracted, responding to random stimuli - Grandiosity and inflated self-esteem

The National Research Council (NRC) found life-expectancy in the U.S.....

- to be behind other high-income countries and blamed discrepancy primarily on behavioral issues: 1) poor health behaviors like excessive smoking, drinking, and eating 2) poverty due to large income disparities in the U.S. 3) physical environments that depend more on driving and less on exercise 4) health care systems that limit access to primary care

Biological factors

- weight set points - body doesn't differentiate between attempt to lose weight and starvation - genes influence personality characteristics such as anxiety --> ED - genes affect your BMI - body type that you inherited - genes and eating pathology before and after puberty - hormonal disturbance or lesion in the hypothalamus, the area of the brain which controls appetite

Semi structured interviews

- you can ask follow up questions ♣Flaws: If the person doesn't understand the nature of their own problem it's not very helpful

Suicide - different methods by gender

-Males are more likely to use *violent and lethal methods* - firearms, hanging - Females are more likely to *overdose* - which may allow to time for discovery and interventions by other people

Ataques de nervios (Culture-bound syndromes)

-Observed in Puerto Rico and other Caribbean countries o Experience includes four dimensions, in which central theme is loss of control - inability to interrupt the dramatic sequence of emotion and behavior (screaming, crying, feelings of anxiety, depression, and anger, dramatic gestures, trouble eating and sleeping, suicidal ideations, etc.) o Ataques is typically provoked by situations that disrupt or threaten the person's social world, especially the family (i.e. death of a loved one) o Most common in women o Serves as a signal to distress to other people who can rally needed sources of social support

ECT

-Usually used in an *inpatient setting* and consists of a series of treatments given three times a week for two to seven weeks - improvement typically seen after six to eight sessions, some require more - muscle relaxants are administered before ECT - eliminates bone fractures and dislocations - unilaterally placement on the nondominant hemisphere may minimize the amount of post-seizure memory impairment, also may be less effective than bilateral placement - ECT reservations center around widely publicized cases of pervasive and persistent memory loss - usually short lived memory loss - does not induce loss of neurons or other changes in brain structure

12 month prevalence

0.4 females 0.9 USA females

prevalence of sysptoms

1 out of every 100 people will experience or display symptoms of schizophrenia at some point during their lives

Obsessive thinking can be distinguished from worry in two primary ways:

1) Obsessions are usually experienced by the person as being nonsensical, whereas worries are often triggered by problems in everyday living 2) The content of obsessions most often involves themes that are perceived as being socially unacceptable or horrific, whereas worries tend to center around more acceptable, commonplace concerns

Hair-pulling and skin-picking disorders are similar in several ways (and unlike OCD):

1) People with these problems report negative emotional experiences before episodes and reduction in these feelings after behavior has stopped - Suggests purpose of these behaviors may be to regulate negative emotional states 2) People with these problems do not have episodes that are triggered by intrusive, unwanted thoughts or impulses - unlike those with OCD 3) Most people with these problems say they are in trance-like state while episode is occurring; they are unware of what they are doing - again unlike OCD whose victims are acutely aware when engaging in compulsive ritual

Tolerance

The process to which the nervous system becomes less sensitive to the effects of alcohol or any other drug of abuse

Psychiatric classification criticized

1. Because there was a lack of consistency in diagnostic decisions 2. Because there was concern about the use of diagnostic labels o Person who is labeled with a disorder might experience discrimination and might find it more difficult to establish and maintain relationships with other people

Symptoms of Bulimia

1. Binge Eating 2. Inappropriate Compensatory Behavior 3. Excessive Emphasis on Weight and Shape 4. Medical Complications 5. Comorbid Psychological Disorders

Biological assessment procedures

1. Brain imaging techniques: - fMRI - PET scans - MRI 2. Psychological recording procedures • primarily uses in research studies • Do not ye have diagnostic value in clinical situations, except for the purpose of ruling out certain conditions, such as brain tumors and vascular disease

DSM-5 includes 2 different approaches to the classification of PDs

1. Categorical definition of personality disorders -each of the 10 specific types of PDs is defined by a set of characteristic symptoms and people who meet the general criteria for a PD and who also exhibit enough symptoms to pass the diagnostic threshold for a specific type of disorder qualify for a diagnosis - Described in the main body of the manual 2. Dimensional definition of personality disorders -emphasizes the description of maladaptive personality traits using a set of 25 dimensional scales - This approach was ultimately rejected - Included in Section III of the manual

questions raised by involuntary hospitalizations

1. Civil commitment, the legal process of hospitalizing people against their will 2. Patients' rights 3. Deinstitutionalization, treating patients in their communities instead of in mental hospitals

Dimensional approach is based on a two-part process

1. Clinician is asked to make a judgement regarding impairment in personality functioning as defined by problems with the person's view of self and others as well as difficulties with maintaining interpersonal relationships ♣ These problems identified serve as general markers for the presence of a personality disorder ♣ This replaces the categorical model's general criteria for PDs 2. Clinician specifies the nature or form of the disorder using ratings of pathological personality traits ♣ Generally follows the Five Factor Model (FFM) but the broad domains are labeled in a way that emphasizes the maladaptive nature of characteristics associated with PDs ♣ 25 core traits ♣ Involves selecting and rating traits in this list that best describe the nature of the personality problems that are related to the person's impaired personal and social functioning ♣ Traits replace the diagnostic criteria for each PD in the categorical model

Research on ASPD and psychopathy fall into three general areas

1. Concerned with the biological underpinnings of the disorder, especially the possible influence of genetic factors 2. Focused on investigating social factors such as the relationship between familial conflict and the development of antisocial behavior in children 3. Exploring the nature of the psychological factors that might explain the apparent inability of people with antisocial personality disorder to learn from experience

Limitations of the MMPI-2 (aka personality tests)

1. Controversies about the scale's ability to discriminate between different types of mental disorders 2. Test depends upon person's ability to read and respond to written statements. Not everyone can do this 3. Many patient's test results don't have a code for which extensive data is associated. Therefore, actuarial interpretation is not really possible for these profiles 4. Some studies have found that profile types are not stable over time. Not clear if this instability should be interpreted as lack of reliability or as sensitivity to change in person's level of adjustment

Treatment of Suicidal People

1. Crisis Centers and Hotlines - suicide prevention 2. Psychotherapy 3. Medication 4. Involuntary Hospitalization

Criteria for schizophrenia DSM-5

1. Criterion A -the patient must exhibit two or more active symptoms for at least one month; negative symptoms also play a relatively prominent role in the definition 2. Criteria B -takes into account the person's level of functioning ■ Requires evidence of a decline in the person's social or occupational functioning 3. Criteria C -takes into account the duration of the disorder ■ Requires the presence of disturbed behavior over a continuous period of at least 6 months ■ Active phase symptoms do not need to be present for this entire period ■ Total duration of disturbance is determined by adding together continuous time during which the person has exhibited prodromal, active, and residual symptoms of schizophrenia ○ The diagnosis also involves the exclusion of related conditions (especially mood disorders) ■ Active phase symptoms of schizophrenia must appear in the absence of a major depressive or manic episode ■ If symptoms of depression or mania are present, their duration must be brief relative to the duration of the active and residual symptoms of schizophrenia

Patterns of Genito-Pelvic Pain/Pentration Disorder

1. genitor-pelvic pain 2. fear of pain or vaginal penetration 3. tension of the pelvic floor muscles 4. trouble having intercourse

Two important cautions must be kept in mind regarding the complexity of the search for causes of mood disorders:

1. Genetic heterogeneity - within the general population there may be more than one locus that contributes to the development of depression - mood disorders may be linked to one marker within a certain extended family and to an entirely different marker in another family 2. Environment plays a role in the development on mood disorders - onset of a mood disorder is determined by a combination of genetic and environmental risk factors that the individual experiences

Advantages of brain imaging techniques

1. In clinical practice, imaging techniques can be used to rule out neurological conditions (i.e. brain tumors) that might explain behavioral or cognitive deficits 2. Techniques such as fMRI and PET can help researchers find relation between brain functions and specific mental disorders

Three dominate ground for involuntary hospitalization:

1. Inability to care for self 2. Dangerous to self 3. dangerous to others

Causes of Alcoholism in stages

1. Initiation and continuation 2. Escalation and transition to abuse 3. Development of tolerance and withdrawal

How should we think of psychotherapy?

1. Is it a form of entertainment (like palm-reading)? ♣ Expensive route Do you expect insurance company to pay for it compared to someone who needs a new liver or cancer treatment? 2. A service (like investment counseling or SAT preparation)? ♣ No one questions if the service has been tested and proven to work - just like the curriculum at the SAT prep 3. A medical treatment (like a drug or surgery)? ♣ Drugs evaluated by FDA. We start to assume that the if I'm receiving medication that it is evaluated and approved and will help.

Self-Knowledge and Interpersonal Awareness

1. Known to Self + Known to Others = Self and Peer report should be similar 2. Know to Self + Not Known to Others = Self-report has unique advantage 3. Not Known to Self + Known to Others = Peer report has unique advantage

Limitations of projective tests

1. Lack of standardization in administration and scoring was a problem, but Comprehensive System for scoring Rorschach as made improvements 2. Little information on how to compare results to those of normal adults/ children 3. Can be very time consuming, especially if results are scored with standardized procedure (such as the Comprehensive System) 4. Mixed information regarding the reliability and validity of projective tests

Two sources of continuity of antisocial behavior

1. Limited range of behavioral skills ♣ Person does not learn social skills that would allow them to pursue more appropriate responses than maladaptive behaviors ♣ Once the opportunity to develop these skills is lost during childhood, they may never be learned 2. The results of antisocial behavior during childhood and adolescence ♣ Person becomes progressively ensnared by the aftermath of earlier choices

Symptoms of Anorexia

1. Low Weight 2. Fear of gaining weight 3. Distrurbance in experiencing weight or shape 4. Amenorrhea 5. Medical Complications 6. Struggle for control 7. Comorbid Psychological Disorders

Development of drug tolerance is result of 3 mechanisms

1. Metabolic tolerance ♣ 2. Pharmacodynamic tolerance occurs when receptors in the brain adapt to continued presence of the drug • => neuron may adapt by reducing the number of receptors or by reducing their sensitivity to the drug - down regulation 3. Behavioral conditioning mechanisms - cues that are regularly associated with the administration of a drug begin to function as conditioned stimuli and elicit a conditioned response that is opposite in direction to the natural effect of the drug

Antianxiety meds

1. Most frequently used type of minor tranquilizer are benzodiazepines (i.e. Valium and Xanax) 2. Azapirones are another class of antianxiety medication

Limitations of brain imaging techniques

1. Not yet possible to use brain imaging procedures for diagnostic purposes because norms have yet to be established for these measures 2. Procedures can be expensive and some expose patient to radioactive substances so must be used cautiously 3. Should not assume that all cognitive processes, emotional experiences, or mental disorders are linked to activity (or lack of activity) in specific area of the brain. Extent of use of imaging is still under debate

Limitations of observational procedures

1. Observational procedures can be time-consuming and therefore expensive. Raters usually require extensive training before they can use a detailed behavioral coding system 2. Observers can make errors. Their perception may be biased. Reliability of ratings as well as behavioral coding systems must be monitored 3. People may alter their behavior, either intentionally or unintentionally, when they know they are being observed - a phenomenon known as reactivity 4. Observational measures tell us only about the particular situation that was selected to be observed. We don't know if the person will behave in a similar way elsewhere or at different times, unless we extend the scope of our observations 5. There are some aspects of psychopathology that cannot be observed by anyone other than the person who has the problem (especially true for subjective experiences, such as guilt or low self-esteem)

Two notable differences in definitions of gambling disorder in DSM-IV and DSM-5:

1. One diagnostic criteria - illegal acts - was dropped ♣ Stipulated that person had to commit illegal acts to finance gambling 2. Threshold for diagnosis was dropped from five features to four ♣ Empirical data supports validity of this change

Useful distinctions btw those who are and are not addicted to a substance

1. Patterns of pathological consumption, including impaired control over use of the drug and continued use in spite of mounting problems 2. Consequences that follow a prolonged pattern of abuse, including social and occupational impairments, disruption of important interpersonal relationships, and deteriorating medical condition

Advantages of observational procedures

1. Rating scales are primarily useful as an overall index of symptom severity or functional impairment 2. Behavioral coding systems provide detailed information about the person's behavior in a particular situation

We have two systems of information processing

1. Rational system -uses abstract, logical knowledge to solve complex problems over time 2. Experiential system -uses intuitive knowledge to respond to problems immediately without the delay of thought - Hypothesized to be emotional, powerful and illogical

Non-RCTs

1. Rebirthing therapy 2. Critical incident debriefing 3. EMDR 4. FC

Types of Anorexia in the DSM-5

1. Restricting type - includes people who have not engaged in binge or purging in the last three months 2. Binge eating/purging type - defined by regular binging eating and purging - They do not differ in terms of comorbidity, recovery, relapse, or mortality * 62% of restrictors meet the criteria for binge/purge * 12% of the restrictors do not engage in binge/purge

Antidepressant Medications

1. SSRIs 2. TCAs 3. MAOIs 4. "other" recently developed drugs - Improvement is typically seen within 4 to 6 weeks - Current episode is usually resolved within 12 weeks - Medication usually continued for at least 6 to 12 months after remission in order to reduce the chance of relapse - Studies show that medication and psychotherapy are approximately equal in treatment effectiveness

Why would people drop out of treatment that is working?

1. Side effects of medication 2. Health insurance 3. Some efficacious but very different treatments (ex. exposure)

Peripheral Nervous system

1. Somatic NS - mostly controls voluntary movements 2. Autonomic NS - not voluntary - heart, stomach, organs

Limitations of clinical interviews

1. Some patients may be unwilling or unable to provide a rational account of their problems (especially true of young children who have undeveloped verbal skills and of psychotic and demented patients who can't speak coherently) 2. People may be reluctant to admit experiences that are embarrassing or frightening. May feel they should report only feelings and behaviors that are socially desirable 3. Information provided by the client is necessarily filtered through the client's eyes. It is a subjective account and may be influenced or distorted by errors in memory or by selective perception 4. Interviewers' can influence the clients' accounts by the ways in which they phrase their questions and respond to the clients' responses

Advantages of projective tests

1. Some people are more comfortable talking in an unstructured situation rather than if they had to participate in a structured interview or take the lengthy MMPI 2. Provide interesting source of information about person's unique view of the world, and are a useful supplement to information obtained through other assessment tools 3. Provide information that cannot be obtained through direct interviewing methods or observational procedures

Advantages of the MMPI-2 (aka personality tests)

1. The MMPI-2 provides information about the person's test-taking attitude, which alerts the clinician to the possibility that clients are careless, defensive, or exaggerating their problems 2. The MMPI-2 covers a wide range of problems in a direct and efficient manner. Take a long time to cover all that information in an interview 3. Because the MMPI-2 is scored objectively, the test's description of the person's adjustment is not influenced by the clinician's subjective impression of the client 4. The MMPI-2 can be interpreted in an actuarial fashion, using extensive banks of information regarding people who respond to items in a particular way

Adrenal glands secrete two key hormones in response to the activation

1. epinephrine (adrenaline) - neuromodulator leads to —> norepinephrine + more epinephrine into the bloodstream 2. cortisol = "stress hormone" - functions quickly to help the body make repairs in response to injury or infection - function - "containment" of pathogens in the body - promotes healing in the short run - excess can harm the hippocampus, cause muscular atrophy, and produce hypertension

Rationales for involuntary hospilization

1. The first is based on the state's *parens patriae* authority, the philosophy that the government has a humanitarian responsibility to care for its weaker members. (Parens patriae has the literal Latin translation of "state as parent.") Under parens patriae authority, civil commitment may be justified when mentally disturbed are either dangerous to themselves or unable to care for themselves. Concept is also used to justify state's supervision of minors and physically incapacitated adults 2. The second rationale is based on state's police power - its duty to protect public safety, health, and welfare

Advantages of clinical interviews

1. The interviewer can control the interaction and can probe further when necessary 2. By observing the patient's nonverbal behavior, the interviewer can try to detect areas of resistance. In that sense the validity of the information may be enhanced 3. An interview can provide a lot of information in a short period of time. It can cover past events and many different settings

DSM-5 addresses the relation between cultural issues and the diagnosis of psychopathology in two principle ways

1. The manual encourages clinicians to consider the influence of cultural factors in both the expression and recognition of symptoms of mental disorders o i.e. Intense, public displays of anger or grief might be expected in one culture but considered signs of disturbance in another 2. Clinician must consider the cultural context in which the problem appeared when considering a diagnosis o This is particularly challenging when clinician and person with problem do not share the same cultural background

Important Considerations in Distinguishing Clinical Depression from Normal Sciences

1. The mood change is *pervasive* across situations and *persistent over time*. The person's mood *does not improve*, even temporarily, when he or she engages in activities that are usually experienced as pleasant 2. The mood change may occur in the absence of any precipitating events, or it may be completely out of proportion to the person's circumstances 3. The depressed mood is accompanied by *impaired ability to function* in usual social and occupational roles. Even simple activities become overwhelmingly difficult. 4. The change in mood is accompanied by a cluster of additional signs and symptoms, including cognitive, somatic, and behavioral features. 5. The nature or quality of the mood change may be different from that associated with normal sadness. It may feel "stance", like being engulfed by a black cloud or sunk in a dark hole

Distortions, errors, and biases are characteristic of the thinking of depressed people:

1. The tendency to assign global, personal meaning to experiences of failure - You don't get a job and immediately think "I'm a failure" instead of considering the other logical possibilities - maybe 1000 talented people were interviewed for the same position 2. The tendency to overgeneralize conclusions about the self based on negative experiences - "The fact that I didn't get the job shows that I'll never get one and I'll continue to fail every time i apply" 3. Drawing arbitrary inferences about the self in the absence of supporting evidence - If a soccer player's team loses a game and the coach is upset, he might arbitrarily decide that it was all his fault and the coach doesn't like him, even though nothing he did contributed to the team's defeat 4. The tendency to recall selectively events with negative consequences and to exaggerate the importance of negative events while simultaneously discounting the significance of positive events - If an athlete is looking back over her entire performance last season, she would be more likely to feel depressed about her mistakes that made and the games the team lost rather than emphasizing the positive contributions she made and the successes of the team

Individual differences in temperament and personality

1. These differences may not be evident in all situations; some important personality features may be expressed only under certain challenging circumstances that require or facilitate a particular response 2. Social circumstances frequently determine whether a specific pattern of behavior will be assigned a positive or negative meaning by other people, and the meanings that are assigned to a particular trait depend on the environment in which they are observed

Adoption study

1. They had a biological parent who was alcoholic 2. They were adopted from their biological parents at an early age and raised by adoptive parents • The adoption twin studies point toward influence of genetic factors in the etiology of alcohol use disorder o Offspring of alcoholic parents who are reared by nonalcoholic adoptive parents are more likely than general population to have alcohol problems o Being reared by an alcoholic parent. In the absence of other etiological factors, does not appear to be a critical consideration in the development of the disorder

paternalistic concerns

1. Treating severely disturbed patients who lack insight into their condition 2. Protecting the public from the violently mentally ill

Treatment for gender dysmorphia

1. change the person's identity to match his or her anatomy 2. change the anatomy to match the person's gender identity * sex-reassignment surgery - person's genitals are changed to match the gender identity * results are usually positive * leads to reduced anxiety and depression

DSM-5 lists 3 types of dissociative disorders

1. dissociative amnesia 2. depersonalization disorder 3. dissociative identity disorder - Dissociative fugue is classified as a subtype of dissociative amnesia

Social problem solving

A multistep process that has been used to teach children and adults ways to go about solving a variety of life's problems • First, involves defining the problem in detail, breaking a complex difficulty into smaller, more manageable pieces • Second, involves "brainstorming" -therapists ask clients to come up with as many alternative solutions as they can imagine without evaluating these alternatives • Finally, the best option is chosen and implemented (then its success is evaluated objectively) • If it is not successful, the entire process can be repeated • Difficult to evaluate effectiveness of social problem solving bc patients can learn new social skills in therapy, but it is unclear whether these skills are used effectively in real life

outpatient commitment

A newer, assertive approach to treating patients who lack insight - mandatory court-ordered treatment in the community

Motivational interviewing

A non-confrontational procedure that can be used to help people resolve their ambivalence about using drugs and make a definite commitment to change their behavior o Primary goal is increase person's awareness of the nature of their substance sue problems o Emphasis is placed on how person sees their problems rather than assigning diagnostic labels

Psychopath

A person who is intelligent and superficially charming but also chronically deceitful, unreliable, and incapable of learning from experience

Temperament

A person's most basic, characteristic styles of relating to the world, especially those styles that are evident during the first year of life (typically include dimensions) o Factors vary considerably in level or degree from one infant to the next and have important implications for later development

Breathing training

A procedure than involves education about the physiological effects of hyperventilation and practice in slow breathing techniques (breathe using diaphragm) - Treatment for panic disorder - Works by enhancing relaxation or increasing patient's sense of control

Thematic Apperception Test

A projective psychological test. Proponents of the technique assert that subjects' responses, in the narratives they make up about ambiguous pictures of people, reveal their underlying motives, concerns, and the way they see the social world.

Victims of attempted rape...

Are more likely to develop PTSD if the rape is completed, if they are physically injured during the assault, and if they perceive the sexual assault as life threatening

Victims of trauma...

Are more likely to develop PTSD when the trauma is more intense, life threatening, and involves greater exposure

Phobias

Are persistent, irrational, narrowly defined fears that are associated with a specific object or situation - Avoidance is an important component of the definition of phobias - A fear is not considered a phobia unless the person avoids contact with the source of the fear or experiences intense anxiety in the presence of the stimulus - Phobias are also irrational or unreasonable

Erikson (ego analyst)

Argued that an individual's personality is not fixed by early experience but develops as a result of predictable psychosocial conflicts throughout life span o Also focused on interpersonal context (evident in his psychosocial stages of development)

Horney (ego analyst)

Argued that there are competing human needs for closeness, for dominance, and for autonomy o The key to a healthy personality is finding a balance among these three styles of relating to others

Psychosexual development

Argues that different stages of child development are defined by sexual conflicts

Genetic risk

As the degree of genetic similarity between an individual and a schizophrenic patient increases, the risk to that person also increases ○ The risk in the second-degree relatives is greater than the 1% that is typically reported for people in the general population ○ The risk is much greater among first degree relatives than it is among second-degree relatives

Family Incidence studies

Ask whether diseases "run in the family" o Identify normal and ill probands, or index cases, and tabulate the frequency with which other members of their families suffer from the same disorder ♣ If a higher prevalence of illness is found in the family of an ill proband, this is consistent with genetic causation and environmental causation ♣ Cannot lead to firm conclusions about the role of genes versus the environment because families share environments and genes

The Psychodynamic paradigm

Asserts that abnormal behavior is caused by unconscious mental conflicts that have roots in early childhood experience o Outgrowth of Freud's theories (1856-1939) o Freud trained in Paris by Jean Charcot, who used hypnosis to treat hysteria o Freud's conclusions about hysteria led him to theorize that many psychological processes are unconscious o Internal mental conflict

Course and outcome of anorexia

At 10-20 year follow-up, nearly half of the patients have a weight within the normal range * 20% remain significantly below their healthy body weight * 30% intermediate weight 5% of patients starve themselves to death or die of complications, including suicide More than 50% of people with a history of anorexia continue to be preoccupied with diet, weight, and body shape Most people never fully recover unfortunately

Psychotherapy - BD treatment

Can be an effective *supplement* to biological intervention - cognitive therapies - address the patient's reactions to stressful life events as well as his or her reservations about taking medication - interpersonal therapies - interpersonal and social rhythm - commonly used with bipolar patients - based on the recognition that a repeated episode of either mania or depression is often precipitated by one of the following factors: stressful life events, disruptions in social rhythms, and failure to take medication - emphasis on the relationship between symptoms and social interactions - help patients learn how to lead more orderly lives - used with mood stabilizers

Worry

Can be defined as a relatively uncontrollable sequence of negative emotional thoughts that are concerned with possible future threats or danger - This sequence of worrisome thoughts is usually self-initiated or provoked by a specific experience or ongoing difficulties in a person's daily life - Excessive worriers emphasize the predominance of verbal, linguistic material rather than images - i.e. Worriers are preoccupied with "self-talk" rather than unpleasant images

Stimulants

Can be taken orally, injected, or inhaled • Stimulants are absorbed more slowly through the digestive system • More dramatic effects of stimulants can be achieved if taken by injecting or sniffing

Social support after trauma

Can play a crucia role in alleviating long-term psychological damage (in less severe stressors) - A lack of social support is thought to have contributed to the high prevalence of PTSD found among Vietnam veterans - Made it difficult for Vietnam veterans to find meaning in their sacrifices --increased their risk of PTSD

Client Centered Therapy

Carl Rogers - ♣ Therapist should be trying to show empathy, understanding, not give them an answer, but be supportive ♣ Positive regard for others ♣ A lot of assurance - nods at the patient, smiles ♣ Asks her a lot of questions ♣ Reflects back to her what she says ♣ He doesn't give her any advice just kind of repeats back to her what she says to him frustrating ♣ Claims he wants what is best for her

Hallucinogens

Cause people to experience hallucinations similar in molecular structure to many neurotransmitters - Most common hallucinogen is called LSD, which has strong chemical resemblance to serotonin

Cluster B disorders

Characterized by dramatic, emotional, or erratic behavior, all are associated with marked difficulty in sustaining interpersonal relationships o Includes: Antisocial PD, Borderline PD, Histrionic PD, and Narcissistic PD

Dissociative disorders

Characterized by persistent, maladaptive disruptions in the integration of memory, consciousness, or identity - Symptoms verge on unbelieveable: - Psychologically produced amnesia - Confused travel of long distances from home (perhaps under a new identity) - The existence of two or more separate personalities in one person - These disorders are quite controversial - Multiple personality disorder was an old name for a dissociative disorder

Dissociative fugue

Characterized by sudden, unplanned travel, the inability to remember details about the past, and confusion about identity or the assumption of a new identity - This was what that girl (above) suffered from - Typically follows a traumatic event - Commonly observed among soldiers following a gruesome battle - Purposeful travel is the distinguishing symptom

Paranoid Personality Disorder

Characterized by the pervasive tendency to be inappropriately suspicious of other people's motives and behaviors

The DSM-5

Classifying anxiety disorders is based primarily on descriptive features and recognized several specific subtypes: specific phobia, social anxiety disorder (social phobia), panic disorder, agoraphobia, and generalized anxiety disorder

Actuarial interpretation

Clinicians analyze the results of a specific test on the basis of a specific set of rules that are derived from empirical research • Helps avoid bias and inconsistency of researcher • Actuarial descriptions are probability statements - nothing is certain • The accuracy of actuarial statements can be verified through interviews with the person or through direct observations of his or her behavior

Treatment for SPD

Complicated because of two considerations: 1. The ego-syntonic nature of PDs ♣ This is related to the relatively high proportion of PD patients who prematurely terminate treatment 2. Comorbidity ♣ There is tremendous overlap between specific personality disorder categories and other forms of abnormal behavior, which complicates treatment ♣ Treatment is seldom aimed at problem behaviors that are associated with only one type of PD

The core questions about dissociative disorders??

Concern the split between conscious and unconscious psychological experience

Personality inventories

Consist of a series of straightforward statements; the person being tested is typically required to indicate whether each statement is true or false in relation to himself or herself

diffused patterns of neuropathology

Consistent findings suggest structural as well as functional irregularities in the frontal cortex and limbic areas of the temporal lobes - associated with schizophrenia

3. Behavioral conditioning mechanisms

Cues that are regularly associated with the administration of a drug begin to function as conditioned stimuli and elicit a conditioned response that is opposite in direction to the natural effect of the drug

Evolutionary

Current theories regarding the causes of anxiety disorders often focus on the evolutionary significance of anxiety and fear (they helped us survive) - Generalized forms of anxiety probably evolved to help the person prepare for threats that could not be identified clearly - More specific forms of anxiety and fear probably evolved to provide more effective responses to certain types of danger

The frequency and intensity of panic attacks tend to...

Decrease as people reach middle age, but agoraphobic avoidance typically remains stable

Excoriation disorder

Defined as repeated skin picking which produces skin lesions - Skin picking is resisted unsuccessfully - much more common than Trichotillomania

Hoarding definition in the DSM-5

Defined in DSM-5 as an unrelenting trouble associated with getting rid of personal belongings - Person must feel strong need to save these possessions - Throwing away items leads to sharps increase in strong negative emotions

How are PDs defined?

Defined in terms of behavior that "deviates markedly from the expectations of the individual's culture" o Judgements regarding appropriate behavior vary considerably from one society to the next

"Disease burden"

Defined in terms of mortality and disability, both measured in years - 5 of the 10 leading causes of disability are mental disorders (50%) - depression is the leading disorder

Trichotillomania

Defined in terms of recurrent hair-pulling - People who meet criteria pull their own hair and therefore experience hair loss - Person attempts unsuccessfully to stop pulling hair

Contingency management

Directly changes rewards and punishments for identified behaviors o Contingency -the relationship between a behavior and its consequences o Goal is to reward desirable behaviors and extinguish or punish undesirable behaviors ♣Therapist must control relevant rewards and punishments ♣Used primarily in circumstances where the therapist has considerable direct or indirect control over the environment (eg institutional settings) o Research has proved its effectiveness for diverse problems (such as institutionalized patient with schizophrenia or juvenile offenders) but not in real-life situations

Efficacy

Does it work in a "pure" laboratory environment? ♣ Can manipulate participants to be exactly what you want ♣ Everything is in a controlled environment ♣ Investigators have control over independent variable ♣ Patients are very clearly diagnosed with textbook symptoms and diagnoses

Effectiveness

Does it work in the "real world"? ♣ Consumer reports (1995) survey of 3,000 readers seemed to show that people were satisfied ♣ Remember that most people who qualify for a diagnosis did not receive treatment

Opiates

Drugs that have properties similar to those of opium • Main active ingredients in opium is morphine and codeine, which are used in medicine to relieve pain • Opiates are available legally only by prescription in U.S. • Opiates can be taken orally, injected, or inhaled o When taken orally, opiates are absorbed slowly through the digestive system o Most people inject because leads more quickly to high concentrations in brain tissue

Emotional processing

Edna Foa's theory that involves three key steps: 1. Victims must engage emotionally with their traumatic memories 2. Victims need to find a way to articulate and organize their chaotic experience 3. Victims must come to believe that, despite the trauma, the world is not a terrible place

Barlow's cognitive components for panic patients

Effective treatment 1) Error analysis of the ways in which people think about situations in their lives 2) *Decatastrophizing* - therapist asks client to imagine what would happen if his or her worst-case scenario actually happened

___ and ____ were the most common types of Suicide in Durkheim's terms

Egoistic and Anomic

Premature Ejaculation

Ejaculation occurs prior to or shortly after vaginal penetration * cannot complete intercourse due to inability to prolong the period of sexual excitement * reach orgasm extremely quickly *most common with men* * 90% ejaculate within one minute after insertion of the pension the vagina * DSM-5 says ejaculation before the person wants to

Social support

Encourages positive health behavior and has direct, physical benefits - Asians and Asian Americans benefit from implicit social support such as focusing on valued social groups - Explicit social support such as seeking advice and emotional solace does not buffer stress for Asians, but it does for European Americans - Providing social support promotes good health at least as much as receiving it does - A good marriage is a critical form of social support - Study that showed partners who were hostile when discussing marital problems had more immunosuppression over next 24 hours and elevated blood pressure

endorphins

Endogenous opioids that are relatively short chains or amino acids, or neuropeptides, are naturally synthesized in the brain and are closely related to morphine - important in activities associated with systems that control pain, emotion, stress, and reward, feeding and growth

Twin Studies and PTSD

Environmental: - Prevalence of PTSD was nine times higher for co-twins who served in Vietnam and experienced high levels of combat in comparison to their identical twins who did not serve Biological: - MZ twins had a higher concordance rate for exposure to combat than DZ twins - Following exposure, MZ twins also had higher concordance rates for PTSD symptoms than DZ twins - Genetic contributions differed across symptoms - Genes contributed most strongly to arousal symptoms and least strongly to reexperiencing - Level of combat exposure predicted reexperiencing and avoidance but not arousal

Psychosocial

Erikson emphasized social tasks and conflicts involved in meeting the demands of the external world

Twin Studies and SPD

Evidence from twin studies points to a significant genetic contribution in the etiology of schizotypal PD o The first-degree relatives of schizophrenic patients are considerably more likely than people in the general population to exhibit symptoms of schizotypal PD ♣ Paranoid and avoidant PD also tend to show increased frequency among the relatives of schizophrenic patients • Schizotypal PD is genetically related to schizophrenia

Circular definitions

Ex. "sexual addiction" or "hypersexual disorder" - Tiger Woods - Not an official disorder in the DSM-5 o There is no way to step outside the circular definitions o There are no symptoms, no treatment o How do you know that he has a disorder? He has sex with too many people - Too circular

generalized anxiety disorder (GAD)

Excessive anxiety and worry are the primary symptoms - The person must have trouble controlling these worries, and the worries must lead to significant distress or impairment in occupational or social functioning - Must be about a number of different events or activities and cannot be focused on having a panic attack (panic disorder), being embarrassed in public (social anxiety disorder), or being contaminated (OCD) - *Must have at least three of the following symptoms: (1) restlessness/ feeling on edge, (2) easily fatigued, (3) difficult concentrating or mind going blank, (4) irritability, (5) muscle tension, and (6) sleep disturbance*

Altruistic Suicide

Excessive integration - occurs when the rules of the social group dictate that the person must sacrifice his or her own life for the sake of others

Fatalistic Suicide

Excessive regulation occurs when the circumstances under which a person lives become unbearable - ex. a slave might choose to commit suicide in order to escape his horrible existence - extremely uncommon

Brain circuits involved in fear conditioning follow two distinct pathways

First sensory information is projected to the thalamus 1. Path one ("short-cut pathway): - Represents the evolved module for conditioned fear - Direct connection thalamus and amygdala, which is connected to the hypothalamus - Used with "fight-or-flight" response (adaptive; "hardwired response") - Path one does not involve connections to cortical areas (higher-level thinking and decision making) - Amygdala stores unconscious, emotional memories (prepared learning) 2. Path two - Thalamus leads to the cortex and provided detailed, slower analysis of the information - Evaluated with information in memory - Message sent to amygdala, which triggers an organized response

Residual phase

Follows the active phase and is defined by signs fo symptoms that are similar in many respects to those seen during the prodromal phase ■ Most dramatic symptoms of psychosis have improved, but the person continues to be impaired ● Negative symptoms may remain pronounced

"directionally problem"

For correlation - which came first? ex. depression or stress

The National Comorbidity Survey Replication (NCS-R)

Found that 18 percent of adults in the U.S. population have at least one type of anxiety disorder in any given year - Mood disorders (10%); substance use disorders (4%)

Beck's cognitive therapy

Founded on the idea that depressed people have errors in their thinking, and these distortions lead depressed people to draw incorrect, negative conclusions about themselves that create and maintain depression o Challenges cognitive errors, often by having clients analyze their thoughts more carefully

Ellis's rational-emotive therapy (RET)

Founded on the idea that emotional disorders are caused by irrational beliefs (absolute, unrealistic views of the world) o Designed to challenge cognitive distortions o Therapist searches for irrational belief, points out impossibility and uses any opportunity to persuade patient to adopt more realistic belief o Shares concepts and techniques with Beck's approach ♣ Except that rational-emotive therapist strongly challenges beliefs during therapy

mental ill in prison

Four times as many people with mental illnesses are incarcerated in prisons as are held in state mental hospitals

Somatic Symptom disorders + antisocial personality disorder

Frequently linked with antisocial personality disorder - Do not typically co-occur in the same individual, but are often found in different members of the same family - Antisocial personality disorder is more common among men - Somatic symptom disorder is more common among women - Antisocial personality disorder may be the male expression of high negative emotion and the absence of inhibition, whereas somatic symptom disorder may be the female expression of these characteristics

Psychosexual

Freud highlighted the child's internal struggles with sexuality as marking the various stages

5-HTT gene

Gene has 2 alleles - "s" = reduced efficient of neural transmission in serotonin pathways - people homozygous for "s" (ss) are at a particularly high risk for becoming clinically depressed if they experience stressful life events - in the absence of the stressful events the risk does not increase if an individual has "ss" - BOTH factors are necessary (ss + stress)

The Biological paradigm example

General paresis (general paralysis) is caused by syphilis, a STD ♣ In 1798, John Haslam, distinguished general paresis from other forms of "lunacy" based on its symptoms, which include delusions of grandeur, cognitive impairment, and progressive paralysis, which inspired the search for the cause of the disorder - took 100 years to solve the mystery

Psychoanalysis (Freud)

Goal = thorough understanding of unconscious conflicts and early relationships

Couples therapy

Goal = to improve the relationship, not the individual - Conflict resolution; promoting mutual satisfaction

Disturbance

Has a dramatic and lasting impact on their quality of life ■ In terms of their own subjective satisfaction ■ And their ability to complete an education, hold a job, and develop social relationships with other people ● ~10% of schizophrenic patients commit suicide ● Consequences of schizophrenia can also be cruel on friends and family members of patients ● Schizophrenia has an enormous impact on society

Revolving door phenomenon

Has developed in which more patients are admitted to psychiatric hospitals more frequently but for shorter periods of time

Cluster C disorders

Have a common element of anxiety and fearfulness (this doesn't fit OCPD as well as the others) o Includes: Avoidant PD, Dependent PD, and Obsessive-Compulsive PD

Suicide Prevention - Crisis Centers and Hotlines

Helping person through immediate crisis and then refer him or her to mental health professionals - Studies show that *suicide rates do not differ in comparisons of similar communities that either have or do not have suicide prevention programs* :( - Availability to these resources does not seem to reduce suicidal rates in communities Challenges: - many people with the most lethal suicidal ideation will not call a hotline or crisis center - most clients are young men, most suicides are by older men - people who they are trying to serve are very difficult to reach - Only a small portion of those who use these resources are seriously suicidal

Distinction between pathological versus normal worry

Hinges on quantity - how often the person worries and about how many different topics the person worries

Treatment programs

IT is believed that the outcome would be more positive if the intervention could be started earlier - focus on the earliest overt signs of the disorder - focus on the genetic predisposition to the disorder

Barbiturates and benzodiazepines

Informally known as tranquilizers, sedatives, and hypnotics - Nobarbital (Nembutal) and amobarbital (Amytal), use for various purposes, including treatment of chronic anxiety - Valium and Xanax, replaced barbiturates in treatment of anxiety disorders because less likely to produce lethal overdose

FDA regulation on nicotine

Intended to reduce rate at which young people are recruited to become new smokers and to minimize future health casualties from tobacco use - modestly succesful

Self-image

Intimately connected to mood states o If you vacillate back and forth between unrealistically positive and negative views of yourself, your mood will swing dramatically ♣May need constant reassurance from others ♣May be too dependent on their opinions as a means of maintaining your own self-esteem

Psychoneuroimmuniology (PNI)

Investigates the reaction between stress and immune function - heightened immune system might seem to better prepare the body for the infection that may follow injury - immune response also causes inflammation, maintains fever, and intensifies pain - impairing immediate action

Attribution retraining

Involves changing attributions, often by asking patients to abandon intuitive strategies, and instructing them to use more scientific methods such as objectively testing hypotheses about themselves and others o Attributions -perceived causes (may or may not be objectively accurate) o Based on the idea that people are "intuitive scientists" who are constantly drawing conclusions about the causes of events in their lives Rooted in cognitive psychology

Identification of somatic disorders

Involves diagnosis by exclusion - Assumed to be a psychological disorder after various known physical causes are ruled out (sometimes referred to as medically unexplained syndromes)

Imagery rehearsal therapy

Involves reliving nightmares while awake, but rewriting the nightmare script in any way the client wishes - Successfully reduces recurrent nightmares

Relaxation training

Involves teaching client to tense and relax certain muscle groups while breathing slowly and deeply - Works to treat various forms of anxiety disorder

Violence

Is a low-frequency event, and for statistical reasons alone, this makes it difficult to predict

The presence of pathological personality traits during adolescence

Is associated with an Increased Risk for subsequent development of other mental disorders o Negative emotionality (high neuroticism) often predicts the later onset of major depression or an anxiety disorder o Impulsivity and antisocial personality increase the person's risk for alcoholism - presence of personality disorder can interfere with the treatment of a disorder such as depression

Average time between initial use of drug and onset of substance use disorder

Is between two and three years

Subjective experience of bodily sensations

Is closely associated with maladaptive or catastrophic thoughts among patients with panic disorder - This connection itself does not provide strong evidence for a causal link because catastrophic thoughts are part of the definition of panic disorder

Etiological validity

Is concerned with factors that cause or contribute to the *onset of the disorder* o The ultimate question with regard to etiological validity is whether there are any specific causal factors that are regularly, and in fact uniquely, associated with this disorder

Predictive validity

Is concerned with the future and with the stability of the problem over time o i.e. Will it be persistent? Will the disorder have a predictable outcome?

Concurrent validity

Is concerned with the present time and with correlations between the disorder and other symptoms, circumstances, and test procedures o i.e. Is the disorder currently associated with any other types of behaviors, such as performance on psychological tests?

Impact on society

It is the second leading cause of disease burden ■ Substantial indirect costs are associated with loss of productivity and unemployment

Societal Impact

It is the second leading cause of disease burden ■ Substantial indirect costs are associated with loss of productivity and unemployment

What does it mean to say you have a mental disorder?

Just means they meet the criteria

Common obsessions

Most common forms of obsession include immoral thoughts, thoughts about being contaminated or exposed to illness, unwanted sexual or religious thoughts, and thoughts about harming other people

Cerebral hemispheres

Most of the forebrain ♣ Left = language and related functions ♣ Right = spatial organization and analysis ♣ Many brain functions are lateralized = one hemisphere serves a specialized role as the side of specific cognitive and emotional activities

Behavioral Medicine

Multidisciplinary field that includes both medical and metal health professionals who focus on psychological influences on the symptoms, cause, and treatment oh physical illnesses - health psychologists specialize in this - encourage healthy coping through stress management, proper diet, regular exercise, and avoidance of tobacco

Does this evidence support confining the seriously mentally ill based on their dangerousness?

NO, for several reasons: 1. The risk of violence is much lower than publicly perceived ♣ About 90 percent of the mentally disturbed have no history of violence 2. Family and friends, not strangers, are the victims of over 85 percent of violent acts committed by the mentally ill 3. Current psychotic symptoms predict violence, but a past history of psychosis does not

Abnormal Behavior

No one has been able to provide a consistent, universal definition that easily accounts for all situations in which the concept is provoked --> multiple definitions

What is in the DSM-5?

Not a classification system based on etiology (causes) ♣ Causes are not considered or known it is just based on symptoms o Create descriptive groups that people fit into o No treatments are mentioned o It just describes mental disorders

Why not ban tobacco products?

Not because so many people are already addicted, extensive black markets would spring up immediately - Outright ban on nicotine would fail

What is a mental disorder?

Not exactly the question to answer - there is no general definition o Any behavior that is rare or unusual? - not quite ♣ Not just statistical infrequency o All disorders listed in DSM-5? ♣ However, disorders get added each time the manual is revised so a disorder now may not have been a disorder 10 years ago

Cognitive cause of OCD:

OCD may be related to maladaptive consequences of person trying to suppress unwanted thoughts that they believe to be dangerous or forbidden - Resistance may be a key component in association between emotional sensitivity and development of unwanted obsessive thoughts - Those vulnerable to OCD react strongly to events that trigger an emotional response - They become aware of exaggerated reactivity and find it unpleasant - To try to control their reaction, they attempt to suppress the emotion - Causes vicious cycle

Biological Causes of OCD

Obsessions and compulsions are associated with multiple brain regions, including the basal ganglia, the orbital prefrontal cortex, and the anterior cingulate cortex (all circuits), which are overly active in people with OCD

orgasm in males

Occurs in 2 stages 1. Sensation of ejaculatory inevitability - triggered by the movement of seminal fluid toward the urethra 2. Regular contractions propel some through the urethra - expelled though urinary opening

orgasm in females

Occurs in 3 stages 1. Sensation of suspension or stoppage - strong genital sensation 2. Feeling warmth spreading throughout the pelvic area 3. Sensations of throbbing or pulsating, tied to rhythmic contractions of the vagina, the uterus, and rectal sphincter muscle

2. Pharmacodynamic tolerance

Occurs when receptors in the brain adapt to continued presence of the drug => neuron may adapt by reducing the number of receptors or by reducing their sensitivity to the drug - down regulation

Personality Inventories advantages

Offer several advantages as assessment devices 1. They can score objectively 2. Often contain validity scales that reflect the person's attitude and test-taking set 3. They can be interpreted in reference to well-established standards for people with and without specific types of adjustment problems

receiving treatment (alcohol)

Only 24% of those diagnosed with alcohol dependence receive treatment

"relational selves"

Others argue that we do not have one identity but many "selves"

____ of those who developed PTSD following trauma exposure met criteria for some other diagnosis earlier in life

Over 90% - These people are at greater risk following a second trauma

Gender disparities

Overall prevalence of PDs is approx equal in men and women, but there are some consistent gender differences with regard to specific disorders: - Antisocial PD is unquestionably much more common among men than women ♣ Approx 5% reported for men, 2% reported for o BPD and dependent PD may be somewhat more prevalent among women than men o Paranoid PD and OCPD may be somewhat more common among men than women

Cultural comparisons

PDs may be more closely tied to cultural expectations than any other kind of mental disorder o In other cultures, what are the personality traits that lead to marked interpersonal difficulties and social or occupational impairment? Are they different from those that have been identified for our own culture? o Are the diagnostic criteria that are used to define personality disorder syndromes in DSM-5 (and ICD-10) meaningful in other cultures?

Minors

Parents can commit children to hospital against their own will - most are "voluntary" patients

PTSD is often comorbid with another mental disorder...

Particularly depression, anxiety disorders and substance abuse - Other comorbid problems include disturbing nightmares, physical symptoms (headaches, gastrointestinal problems) grief, and relationship difficulties - PTSD is often noted as comorbid with anger (at others or at oneself) - This is why negative thoughts and emotions became a part of the new DSM-t definition of PTSD *Notably increased risk of suicide with PTSD*

EE and relapse

Patients who returned to live in a home with at least one member who was high in EE were more likely than patients from low EE families to relapse in the first 9 months after discharge

Cultural concepts of distress

Patterns of erratic or unusual thinking and behavior that have been identified in diverse societies around the world and do not fit easily into other diagnostic categories that are listed in the main body of the DSM-5 (also called culture-bound syndromes or idioms of distress)

Who has the strongest influence on adolescents?

Peer and sibling substance use are robust predictors of adolescent alcohol and drug use, even more than parental alcohol use Impact of friends' alcohol use is greater among adolescent girls than boys

psychological dependence

People who are dependent of drugs often say that they take drug to control how they are feeling

Abnormal Behavior 2

People will unusually high levels of anxiety and depression would be considered abnormal because their experience deviates from the expected norm ♣ Based on statistical norms - how common or rare it is in the general population ♣ Flaw: Does not specify how unusual the behavior must be before it is considered abnormal. Does not distinguish between deviations that are harmful and those that are not.

Brain differences in people with PTSD

People with PTSD show differences in the functioning, and perhaps the structure of the amygdala and hippocampus

birth complications

People with schizophrenia are more likely than the general population to have been exposed to various problems during their mother's pregnancy and to have suffered from birth injuries - Birth complications include: extended labor, breech delivery, forceps delivery, and the umbilical cord wrapped around the baby's neck - may cause neurodevelopment abnormalities

Somatic symptom disorder treatment

People with somatic symptom disorders do not seek a mental health professional, instead they repeatedly consult their physician - This often leads to unnecessary medical treatment - Often complain about realistic physical symptoms that are difficult to evaluate objectively - Sometimes, physicians perform unnecessary medical procedures

polysubstance abuse

People with substance use disorder frequently abuse several types of drugs; this condition

Male Hypoactive Disorder

Persistence or recurrent lack of desire for sex and deficient/absent erotic thoughts or fantasies regarding sexual activities

Features of paraphilia

Persistence sexual urges and fantasies that are associated with: 1. nonhuman objects 2. suffering or humiliation of oneself or one's partner 3. children or other non consenting persons

Dimensional model identifies other forms of PDs using a new diagnosis called

Personality Disorder Trait Specified (PDTS) o Person must exhibit significant impairment in self or interpersonal functioning as well as one or more pathological personality traits o This replaces the other 4 categorical types

Are they Stable?

Personality disorders have a stable and long-standing nature ex. Individuals with antisocial personality disorder often commit senseless illegal and immoral acts and have an apparent lack of remorse and exhibit an inability to learn from experience that accompanies a history of delinquent behavior

Anterior cingulate cortex (ACC)

Provides a connection between the functions of *attention* and *emotion* - allows us to focus on subjective feelings and to consider the ration between our emotions and behavior - ex. activated when a person has been frustrated in the pursuit of a goal or when a person experiences sadness where it is not expected - Major depressive disorder = *decreased activation of the ACC* - Reduction in ACC activity = a failure to appreciate the maladaptive nature of prolonged negative emotions and a reduced ability to engage in more adaptive harries that might help to resolve the person's problems

Ego analysts

Psychoanalysts who developed variations on Freud's theory that emphasizes the role of the ego over that of the id

Suicide attempts vs. completion

Ratio of attempts to completed suicide = 10:1 - among adolescents = 100:1 - Females age 15-19 make 3x as many suicide attempts compared with males - Completion rates are 4x higher among males - Risk of completed suicide is highest among older people

Acamprosate (Campral)

Reduce the average number of drinking days from 30-50% o Increases proportion of people who are able to achieve abstinence o Used in conjunction with psychological treatment

Symptom alleviation

Reducing the dysfunctional symptoms of a disorder but not eliminating its root cause

Learning processes

Refer to classical conditioning: when an unconditioned stimulus (US) is associated with a conditioned stimulus (CS) causing the CS to elicit a conditioned response (CR) that is very similar to the original unconditioned response (UR)

Psychoanalytic theory

Refers specifically to Freud's theorizing ♣ Not commonly taught in psychology classes today - rich in theorizing but weak in science

Genito-Pelvic Pain/Pentration Disorder

Refers to a set of frequently overlapping symptoms involving having difficulty with intercourse, genitor-pelvic pain, fear of pain or vaginal penetration, and tension of the pelvic floor muscles

Agoraphobia

Refers to an exaggerated fear of being in situations from which escape might be difficult, such as being caught in a traffic jam on a bridge or in a tunnel "fear of public places"

Abstinence violation effect

Refers to guilt of perceived loss of control that the person feels whenever he or she slips and finds himself or herself having a drink after an extended period of abstinence o People blame themselves o See this a signal that further efforts to control their drinking will be useless o CBT teaches them to interpret these behaviors as temporary "lapses" rather than a total "relapse"

Risk

Refers to hazard - the possibility of suffering harm Probability that a certain outcome will occur o Implies only probability not certainty o Implies association not causality o Correlation between risk factor and the disorder

The Barnum effect

Refers to the practice of saying things about a specific person that are true of virtually all people o i.e. If someone says sometimes you lack in self-confidence and sometimes your expectations are unrealistic, people often accept these vague, superficial statements as being meaningful comments about themselves, not realizing that these vague generalizations apply to almost everyone

Withdrawal

Refers to the symptoms experienced when a person stops using the drug o Side effects include: hand tremors, sweating, nausea, anxiety, and insomnia and can also include convulsions and hallucinations

Prolonged exposure

Reliving the trauma over the course of many sessions, may involve confronting feared situations in real life, in one's imagination, or by recounting events - Reduces PTSD symptoms more than other alternatives (including relaxation/stress management, supportive counseling or doing nothing) - Approx 50% of patients still meet diagnostic criteria for PTSD after treatment - The most strongly supported treatment for PTSD

BIS - elevated activity

Some areas show abnormally *elevated levels of activity* in depressed people - this includes the orbital PFC and the ventromedial PFC, areas of the brain that are important for deterring a person's responses to reward and punishment - *Orbital PFC* - inhibits inappropriate behaviors and helps the person ignore immediate reward while working toward a long-term goal - *Ventromedial PFC* - involved in the experience of emotion and the process of assigning meaning to perceptions - Overactivity may be associated with the prolonged experience of negative emotion

Panic attacks also have cognitive symptoms

Some people feel as if they will die, lose control, or go crazy

Comparing treatments

Some say medication and psychotherapy as treatment might be better in short-run, but just therapy may be better in long-run because no issue when medication is stopped

Stress as Appraisal of Life Events (Lazarus 1966)

Stress as the individual's appraisal of a challenging life event - *Primary appraisal* - our evaluation of the challenge, threat, or harm posed an event - *Secondary appraisal* - our assessment of our abilities and resources for coping with that event - Appraisal approach recognizes that the same event is more or less stressful for different people but runs that risk of circular reasoning

Triggers

Stressful life events, particularly those involving danger and interpersonal conflict, can trigger the onset of certain kinds of anxiety disorders - People who experienced a severe loss are more likely to develop depression - Children who experience higher levels of adversity (prenatal stress, multiple maternal partner changes, parental neglect, and physical abuse) are more likely to develop anxiety disorders later in life - Insecurely attached infants are more likely to develop anxiety disorders when they become adults, especially agoraphobia

Behavior genetics

Studies broad genetic influences on normal and abnormal behavior, focusing on whether genes are more or less important in development ♣ Today many experts in genetics and behavior genetics are working together in the hope of identifying specific genes involved in normal and abnormal behavior

Abnormal Behavior 1

Subjective discomfort that leads the person to seek help from a mental health professional ♣ Emphasis on the individual's experience of personal distress ♣ Flaw: some people are unable to realize distress or discomfort or that they have a problem at all - they don't seek help

Hypnosis

Subjects experience loss of control over their actions in response to suggestions from the hypnotist - Different people are more or less susceptible to hypnosis - Some experts assert that hypnosis is a dissociative experience - Dissociative experience -an altered state of consciousness - Others argue that hypnosis is merely a social -a subject voluntarily complying with suggestions due to social expectations

Flashbacks

Sudden memories during which the trauma is replayed in images or thoughts, often at full emotional intensity - Many people experience these

Current views on the process by which fears are learned..

Suggest that the process is guided by a module, or a specialized circuit in the brain, that has been shaped by evolutionary pressures

Watson's behaviorism argued

That the appropriate focus of psychological study is observable behavior o Viewed the therapist as a teacher o Said that the goal of treatment is to provide new, more appropriate learning experiences

Test-retest reliability

The consistency of measurements over time ♣ Will a person receive the same score if an assessment procedure is repeated at two different points in time?

Affiliation

The desire for close relationships with other people ♣ Severely diminished or absent motivation for social relationships is one pervasive theme that defines certain kinds of PDs

Power

The desire for impact, prestige, or dominance ♣ Exaggerated motivation for power and achievement also contribute to the description of PDs (lack of balance can have a serious disruptive effect on the person's social adjustment)

Alcohol withdrawal delirium

The development of delirium, a sudden disturbance of consciousness that is accompanied in changes in cognitive processes such as lack of awareness of the environment or inability to sustain attention, when withdrawing from alcohol

Dissociation

The disruption of the normally integrated mental processes involved in memory, consciousness, identity or perception - The existence and importance of the unconscious mind is controversial

Genetics and BPD

The fundamental personality traits that define the disorder (neuroticism and impulsivity) are also influenced by genetic factors

Extrapyramidal symptoms (EPS)

The most obvious and troublesome side effects of antipsychotic drugs; including an assortment of neurological disturbances (eg muscular rigidity, tremors, restless agitation, peculiar involuntary postures, motor inertia, etc) ■ EPS may diminish spontaneously after the first few months of treatment, but some patients continue to experience EPS for years

Rating scale

The observer is asked to make judgements that place the person somewhere along a dimension - ex. clinician observes a person's behavior for an extended period of time and then completes a set of ratings that are concerned with dimensions such as the extent to which a person exhibits compulsive ritualistic behaviors

Categorical Model

The official DSM-5 approach to defining personality disorders o Includes 10 types of PDs that are organized into three clusters on the basis of broadly defined characteristics

Client-centered therapy

The therapist-client relationship is the treatment (developed by Rogers) o Three qualities are necessary and sufficient for therapeutic change: ♣ Warmth ♣ Genuineness ♣ Empathy -emotional understanding o Encourages appropriate self-disclosure -revealing some personal feelings and experiences as a way of helping clients to better understand themselves o Therapists must demonstrate unconditional positive regard -valuing clients for who they are and not judging them

Right to refuse treatment, particularly psychoactive medication, is a newer issue:

This issue is problematic for several reasons: o The patient who is committed to the mental institution refused inpatient treatment but is receiving it anyway o Most experts argue that patients than also lose their right to refuse treatment once they are involuntarily hospitalized

- General adaptation syndrome (GAS) Hans Selye -

Three stages: 1. Alarm - involves mobilization of the body in reaction to threat 2. Resistance - a period of time when the body is physiologically activated and prepares to respond to the threat 3. Exhaustion - occurs if the body's resources are depleted by chronic stress - body is damaged by continuous, failed attempts to reactivate the GAS - analogy: a car running at such high speeds that the cooling and lubricant systems cannot keep up, making a breakdown likely

FC (Facilitated communication)

Train interpreters to stand behind a person while a person picked out letters

ESTs (Empirically supported treatments)

Treatments and therapies that have research-based medical and scientific evidence showing that they work ex. RCTs

DSM-III (1980)

Turning Point o More complete descriptions o Inclusion and exclusion criteria o Personality disorders on Axis II o Dropped terms like "neurosis"

Mental disorder

Typically defined in terms of typical signs and symptoms rather than identifiable causal factors - Syndrome Unfortunately, there are no definite psychological or biological tests that can be used to confirm the presence of psychopathology Presently, the diagnosis of mental disorders depends on observations of the person's behavior and descriptions of personal experience

Implicit memory

Unconscious and evident only because past experience can change behavior

Why is it hard to study psychotherapy?

Unknown length of treatment How can you measure change? ♣ Ask people how they feel? - rely on self-report ♣ Interview everyone by a blind psychologist ♣ When do you measure it? When therapy ends or extended beyond treatment ♣ Will patients come back?

SSRIs

Used for long-term treatment of alcoholic patients o SSRIs have small and inconsistent effects o Are effective with those with dual diagnosis of alcohol dependence and depression

Eye movement desensitization and reprocessing (EMDR)

Used while clients with PTSD simultaneously relive vivid images of trauma - A technique that has been greeted with enthusiasm and skepticism - May be effective, but prolonged exposure, not eye movements, is the active ingredient

psychosis

a general term that refers to several types of severe mental disorders where the person is considered to be "out of touch" with reality - delusions, hallucinations, disorganized speech

Who seeks the most/least treatment?

Women > Men Whites > racial and ethnic minorities

Brief psychotic disorder

a category that includes those people who exhibit psychotic symptoms (delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior) for at least one day but no more than one month ○ An episode is typically accompanied by confusion and emotional turmoil, often following a markedly stressful event ○ After symptoms resolve, person returns to the same level of functioning that they had before the psychotic episode ○ Long-term outcome is good ○ Diagnosis is not assigned if the symptoms are better explained by a mood disorder, schizophrenia, or substance abuse

Endocrine system

a collection of glands found at various locations throughout the body ♣ Ex. Ovaries and testes and the pituitary, thyroid, and adrenal glands ♣ Endocrine glands produce responses by releasing hormones - chemical substances that affect the functioning of distant body systems and sometimes act as neuromodulators

Cognitive enhancement therapy (CET)

a comprehensive, integrated program aimed at the improvement of cognitive abilities, including those that are concerned with performance on laboratory tasks (eg attention, working memory, etc) as well as social cognition (eg recognizing the perspectives of others) - for those taking medication and recovered from active symptoms but show cognitive disability - small group exercises

pseudohermaphroditism

a condition in which someone is genetically male, but they are unable to produce a hormone that is responsible for shaping the penis and scrotum in the fetus * child is born with external genitalia that are ambiguous in appearance

Competence

a defendant's ability to understand the legal proceedings that are taking place against them and to participate in their own defense - contains no reference to "mental disease or defect"

vaginal photometer

a device shaped like a tampon and inserted into the vagina used to measure sexual arousal * walls of vagina become congested with blood when sexually aroused * Vascongestion causes changes in te amount of red light that can be transmitted through the tissue * it is sensitive to subtle changes in vaginal tissue

A Stress

a difficult experience risk factors

PET shows

a dynamic brain imaging technique that can reflect changes in brain activity as the person responds to various task demands - dysfunction in neural circuits

Factitious disorder

a feigned condition that, unlike malingering, is motivated primarily by a desire to assume the sick role - People undergo extensive and often painful medical procedures to garner attention from health care professionals - *Munchausen syndrome* -a rare, repetitive pattern of factitious disorder

Limbic system

a group of central brain structures that regulate emotions, basic learning, and basic behaviors - links the forebrain and midbrain

Melancholia

a term used to describe a particularly severe type of depression - some believe it represents a subtype of depression that is caused by different factors than those that are responsible for other forms of depression - indicator that a person is likely to have a good response to biological forms of treatment - Patient must have: - lose the feeling of pleasure associated with all, or almost all, activities - Lose the capacity to feel better—even temporarily—when something good happens - Also must have at least three of the following: - The depressed mood feels distinctly different from the depression a person would feel after death of a loved one - The depression is most often worst in the morning - The person awakens early, at least two hours before usual - Marked psychomotor retardation or agitation - Significant loss of appetite or weight loss - Excessive or inappropriate guilt

Disorganization

a third category of symptoms that include thinking disturbances and bizarre behavior

Age of onset

adolescence or early adulthood - hormonal change, sexual problems, natural to gain weight, breasts and hips get bigger - puberty = risk for anorexia

Developmental norms

aged-graded averages - standards by which the progress of a child's development can be measured

chronic stressors and losses

also create immunosuppression, perhaps permanently altering immune functioning in a way to explain associations between childhood stress and diseases of aging

Cognitive psychologists

also study attention, information processing, and memory • They often draw analogies between human thinking and computers • Affected the thinking about mental disorders, as the field parallels with social cognition - they study of how humans process information about the social world • One cognitive theory suggests that automatic and distorted perceptions of reality cause people to become depressed ** Treatment ** = encourage depressed people to be more scientific and less intuitive in evaluating conclusions about themselves

Symptoms of conversion disorder

altered motor or sensory function that typically mimic neurological problems with one exception: they make no anatomic sense - A patient may complain about anesthesia or pain in a way that does not correspond with the innervation of the body - Psychological conflicts are converted into physical symptoms

duty to warn

altered to a more general duty to protect general duty to protect, which may involve warning but alternatively might involve protective actions like hospitalizing that potentially dangerous patient

Alleles

alternate forms of genes

Developmental psychopathology

an approach to abnormal psychology that emphasizes change over time

Community psychology

an approach within clinical psychology that attempts to improve individual well-being by promoting social change

deinstitutionalization movement

an attempt to care for the mentally ill in their communities - suffered many problems: patients moved from mental institutions and into private mental hospitals, nursing homes, or homeless

Biopsychosocial model

an effort to integrate evidence on these broad contributions to mental disorders o Biological contributions - range from brain chemistry to genetic predisposition o Psychological contributions - range from troubled emotions to distorted thinking o Social and contributions - range from conflict in family relationships to sexual and racial bias

Catechol O-methyltransferase (COMT)

an enzyme that is involved in breaking down the neurotransmitter dopamine - located on chromosome 22 - increased risk for schizophrenia - affecting dopamine transmission in the prefrontal cortex, impairing cog. ability

Schizoaffective disorder

an episode in which the symptoms of schizophrenia partially overlap with a major depressive episode or a manic episode ○ Must have the presence of delusions for at least 2 weeks in the absence of prominent mood symptoms ○ Diagnosis is not assigned if delusions and hallucinations are only present during a depressive episode or a manic episode

Traumatic Stress

an event that involves actual or threatened death, serious injury, or sexual violence to self, or witnessing others experience trauma, learning that loved ones have been traumatized, or repeatedly being exposed to details of trauma - DSM-5 definition

insanity

an exception to criminal responsibility

DSM-5 definition of trauma

an exposure to actual or threatened death, serious injury, or sexual violation either: - Directly - As a witness - Learning of violence to a loved one - Through repeated exposure to details of trauma - *Sexual violence is a new part of the definition

case study

an in-depth look at the symptoms and circumstances surrounding one's mental disturbance - do not provide conclusive evidence about he cause of, or treatments for, mental disorders

Genotype

an individual's actual genetic structure

Identity

an integrated sense of self (Erik Erikson 1968)

Systems Theory

an integrative approach to science, one that embraces not only the importance of multiple contributions to casualty but also their interdependence

Mental disease or defect

an issue of obvious importance to the mental health professions must be "severe"

Emotions associated with sexual dysfunction

anger, fear, resentment, embarrassment --> leads to depression or anxiety emotional consequences can be devastating

Anti anxiety (meds)

anxiety disorders

In contrast to fear, anxiety....

anxiety involves a more general or diffuse emotional reaction - beyond simple fear - that is out of proportion to threats from the environment - Rather than being directed toward the person's present circumstances, anxiety is associated with the anticipation of future problems

Developmental Stages

periods of time marked by age and/or social tasks during which children or adults face common social and emotional challenges

Nonsuicidal self-injury

ex. Cutting, burning, or catching the skin - intentions are not to end one's life - the pain serves a useful purpose for them regardless of its impact on their appearance - deliberate self-harm is a symptom of borderline personality disorder - it also occurs among people suffering from other disorders, depression, an post traumatic stress disorder - *4% of population report they have engaged in self-harm* - episodes are typically preceded by strong feelings of anxiety, anger, frustration, or sadness - emotion diminish once cutting has begun and the person experiences relief - final phase usually involves guilt or shame

Neurotransmitters

ex. Serotonin, Norepinephrine, Dopamine - Development of antidepressant drugs stimulated research on several specific neurotransmitters - more than 100 different ones

All of the personality disorders are based on

exaggerated personality traits that are frequently disturbing or annoying to other people

Psychotherapy outcome research

examines the result of psychotherapy, its effectiveness for relieving symptoms, eliminating disorders, and improving life functioning

Exaggerated startle response

excessive fear in reaction to the unexpected

Gender roles

expectations regarding the appropriate behavior of males or females ♣ Can dramatically affect our behavior ♣ Influence the development, expression, or stigma of psychopathology

Traumatic stress

exposure to actual or threatened death, serious injury, or sexual violence

Depression - Cognitive symptoms

extreme guilt, feelings of worthlessness, concentration problems, and thoughts of suicide

According to parens patria theory

family courts are supposed to help and protect children and families, a goal that is psychological as well as legal

Typical specific phobias

fear of heights (acrophobia), hear of enclosed spaces (claustrophobia), fear of small animals (zoophobia), fear of blood (hemophobia), fear of flying on airplanes (aerophobia), fear of being in paces from which escape might be difficult (agoraphobia)

Depersonalization

feeling cut off from themselves or their environment - Might feel like a robot or as if they were sleepwalking a less dramatic symptom where people feel detached from themselves - Eg out-of-body experience

Depressed mood

feelings associated usually include disappointment and despair - No one has been able to located the exact point where "feeling down or blue" crosses a lone and becomes depression

Ventricles

filled with cerebrospinal fluid - each of the four connected fluid-filled cavities in the center of the brain

Classical or traditional antipsychotics

first generation of antipsychotic drugs

Third wave CBT

focused on broad, abstract principles such as acceptance, mindfulness, values, and relationships

Secondary prevention

focuses on the early detection of emotional problems in the hope of preventing them from becoming worse

Dopamine hypothesis

focuses on the function of specific dopamine pathways in the limbic area of the brain - symptoms of schizophrenia are product of excessive levels of dopaminergic activity - neural pathways have elevated sensitivity to dopamine - imaging studies show patients have elevated levels of dopamine functioning in the striatum

craving

forceful urge to use drugs, but relationship between craving and drug use is very complex - index of craving = the amount of time that the person spends planning to take the drug

Brain stem

forms connections with spinal cord, allowing brain-body communication

Highest prevalence of schizophrenia

found in neighborhoods of the lowest socioeconomic status found among people who have migrated to a new country

Maladaptive schemas

general patterns of thought that guide the ways in which people perceive and interpret events in their environment

Stuporous state

generally reduced responsiveness; the person seems to be unaware of his or her surroundings ■ Often associated with catatonic posturing

Gene-environment interaction

genetic predispositions and environmental experiences combining to produce more than their separate influences

Study - species-typical characteristics

genetically influenced motivations that people share in common

Electra complex

girls yearn for something their fathers have and they are "missing" - a penis

Other neurotransmitters that have important roles in schizophrenia

glutamate and GABA -gamma-aminobutyric acid

token economics

goal is to increase the frequency of desired behaviors (eg appropriate grooming and participation in group activities) by praising and reinforcing such behavior by the presentation of a token, and decreasing the frequency of undesirable behaviors (eg violence or incoherent speech) by ignoring such behaviors or the loss of privileges if necessary

Social causation hypothesis

harmful events associated with membership in the lowest social classes play a causal role in the development of the disorder

Insanity

has nothing to do with diagnosing o A legal term o Concerned with "responsibility" o Should the person be punished?

DBT (diabetic behavior therapy)

o Combines the use of broadly based behavioral strategies with the more general principles of supportive psychotherapy o Emphasis placed on learning to be more comfortable with strong emotions, and learning to think in a more integrated way that accepts both good and bad features of the self and other people o Employs traditional behavioral and cognitive techniques to help patient improve interpersonal relationships, tolerate distress, and regulate emotional responses o Considerable emphasis is placed on the therapist's acceptance of patients ♣ Including their frequently demanding, manipulative and contradictory behaviors o Has been shown to decrease the rate of premature termination of treatment o Has been shown to reduce the frequency and severity of suicide attempts and hospitalizations o Has shown an increase in self-reported social adjustment scales o Has shown an improvement with regard to symptoms such as depression and hopelessness

Integrated systems

o Consider different levels of analysis o Diathesis-Stress models o There are multiple pathways to disorder

People who meet the criteria for schizotypal PD frequently meet the criteria for additional disorders

o Considerable overlap between schizotypal PD and other PDs in Cluster A o Considerable overlap between schizotypal PD and avoidant PD o Quite a bit of overlap between schizotypal PD and BPD

Paranoid Personality Disorder Characteristics

o Constantly on guard o Expect that other people are trying to harm them o Take extraordinary precautions to avoid being exploited or injured o Pattern is stable and wide-ranging and interferes with the person's social and occupational adjustment o Completely inflexible in the way that they view the motives of other people, and they are unable to choose situations in which they can trust other people o Trouble maintaining relationships with friends and family members o Frequently overreact in response to minor or ambiguous events to which they attribute hidden meaning o Often behave aggressively or antagonistically ♣ Actions can easily create a self-fulfilling prophesy o Not a psychotic disorder; does not reach delusional proportions ♣ Not sufficiently severe to be considered obviously false and clearly preposterous • Subtle distinction that is difficult to make sometimes

ACT core principles

o Core principles: ♣ Cognitive diffusion: learning methods to reduce the tendency to reply thoughts, images, emotions and memories ♣ Acceptance: allowing thoughts to come and go without struggling with them ♣ Contact with the present moment: Awareness of the here and now, experienced with openness, interest, and receptiveness. ♣ Observing the self: Accessing a transcendent sense of self, a continuity of consciousness which is unchanging. ♣ Values: Discovering what is most important to one's true self. ♣ Committed action: Setting goals according to values and carrying them out responsibly.

Lessons from the history of psychopathology

o Creation of psychiatry laid the foundation for expanded public concern o Mental disorders cannot be defined in a cultural vacuum or in a completely objective fashion o Importance of scientific research - people who claim that a new form of treatment is effective should be expected to prove it scientifically

Antisocial Personality Disorder Characteristics

o DSM-5 definition is based on features that, beginning in childhood, indicate a pervasive pattern of disregard for, and violation of, the rights of others o Difficulties in adulthood include persistent failure to perform responsibilities that are associated with occupational and family roles o Conflict with others, including physical fights, is common o Irritable and aggressive o Impulsive, reckless, and irresponsible o Not only serious criminals meet this criteria

Long-term consequences of nicotine

o Development of both tolerance and withdrawal o Physiological symptoms: drowsiness, lightheadedness, headache, muscle tremors, nausea o Those who attempt to quit usually experience sleeping problems, weight gain, concentration problems, and mood swings o Increased risk of developing fatal diseases such as heart disease, lung disease, and various types of cancer ♣ 80% of all deaths caused by lung cancer are attributed to smoking tobacco o Causes fertility problems in women o Babies born to smoking moms often weigh less and may have birth defects

Controversial

o Difficult to identify reliably o Show high levels of comorbidity among themselves and with other mental disorders o Definition has not been well-grounded in scientific knowledge regarding basic elements of personality

Social and occupational impairment

o Disrupt interpersonal relationships o Play an important role in many cases of marital discord and violence

General Therapy

o Disrupt the conversation o Can't just let the patient ramble on o Asks her questions o Treating her like she is stronger than she is o Not protecting her o She gets mad at him - he is "picking on her"

Long-term effects of alcohol

o Disruption of relationships with family and friends o Heavy use of alcohol in pregnant women can damage the fetus o Many alcohol abusers experience blackouts o Heavy alcohol use interferes with job performance o Causes financial difficulties o Can encounter problems with the fuzz o Can cause people to have violent behavior o On a biological level, can disrupt a person's organ systems, especially liver, pancreas, gastrointestinal system, cardiovascular system, and endocrine system o Can cause cirrhosis of the liver, heart problems, various forms of cancer, and neurocognitive disorder o Misuse of alcohol leads to many severe injuries and premature deaths ♣ Deaths due to alcohol-related injuries are more common among young men, while deaths from alcohol-related diseases are more common among older men

Mental disorder defined in terms of a harmful dysfunction

o Disruption of thoughts, feelings, communication, perception, and motivation o Only dysfunctions that result in significant harm to the person are considered to be disorders

MBCT (Mindfulness-based cognitive therapy)

o Effective for preventing relapse in individuals with MDD (3= episodes)] o CBT + mindfulness & mindfulness meditation o • Improving the quality and quantity of activity in which the patient finds value • Empowerment & behavioral skills training • Less directly symptoms reduction/

dyspareunia

persistant genital pain during or after sexual intercourse * both in men and women * much more common in women * can lead to a lack of interest in sex

Primary prevention

tries to improve the environment in order to prevent new cases of a mental disorder from developing o Aims to promote wellness, not just treat illness

The creation of the Asylum

o Europe during the Middle Ages "lunatics" aroused little interest and were given marginal care o It was said it was the family's responsibility o Mentally disturbed people who were violent were usually thrown in jail as criminals o 1600s-1700s insane asylums were established to house mentally disturbed ♣ were created to serve heavily populated cities and to assume responsibility o Moral treatment reforms helped insane asylums improve o Dorothea Dix - 1800s - argued that treating the mentally ill in hospitals was both more humane and more economical than caring for them haphazardly in their communities o American Psychiatric Association was founded in 1844

The correlational method

o Ex. Stress and depression are correlated o Which came first? o This is known as the "directionally problem" o Brain functions may differ in depressed people, but experience (and drugs can alter the brain o Only types of studies that work ♣ Treatment outcome study - randomly assigned Animal analog studies

What is not a mental disorder?

o Expected response to an event ♣ Ex. Death of a loved one - it's normal to be very sad for a short period of time o Voluntary efforts to express individuality o Political and religious beliefs o Note: our field has a long history of considering behaviors that are "different" to be abnormal

Borderline Personality Disorder Characteristics

o Find it very difficult to be alone o Form intense, unstable relationships with other people o Are often seen by others as being manipulative o Mood may shift rapidly and inexplicably o Intense anger is common ♣ May be accompanied by temper tantrums, physical assault or suicidal threats or gestures o Identity disturbance -great difficulty maintaining an integrated image of themselves that simultaneously incorporates their positive and negative features ♣ Diagnostic hallmark of BPD o Frequently express uncertainty about such issues as personal values, sexual preferences, and career alternatives o Chronic feelings of emptiness and boredom o Case Study in Borderline PD: ♣ Most noticeable personality traits: anger, argumentativeness, scornfulness, irritability and vanity ♣ She was intense and demanding

Several things to note about legal definition of competence:

o First, competence refers to defendant's current mental state, whereas insanity refers to the defendant's state of mind at the time of the crime o Second, as with insanity, the legal definition of incompetence is not the same as the psychologist's definition of mental illness o Third, competence refers to the defendant's ability to understand criminal proceedings, not willingness to participate in them o Finally, the "reasonable degree" of understanding needed to establish competence is fairly low

Behavioral coding systems

o Focus on the frequency of specific behavioral events o Coding systems can be used with observations that are made in the person's natural environment as well as with those that are performed in artificial, or contrived, situations that are specifically designed to elicit the problem behavior under circumstances in which it can be observed precisely o Used usually in research studies more so than in clinical settings because require extensive time and training o Observations can be made by the therapist, or they can be provided by people who have a better opportunity to see the person's behavior in the natural environment (parents, teachers, etc.) o Some adult clients are able to complete this kind of record by keeping track of their own behavior - a procedure known as self-monitoring

Psychoanalysis (Freud) Methods:

o Free association o Resistance o Dream analysis

Rosenhan Study at Stanford

o Had people walk into the hospital and report that they were hearing voices o Would college students be admitted into the hospital if they did this? o They were all admitted and given a diagnosis of Schizophrenia o All stayed for 1 week-many months o They were told to pretend to take medication and see if the staff noticed any differences o Rosenhan publishes an article in the journal Science - "Being Sane in Insane Places" ♣ Thesis: If you check into a hospital it takes a long time for people to recognize you are actually fine • Clearly if you lie.... they will believe you o Rosenhan states the stupid staff couldn't o Classification system is not based on causes or tests... it is heavily weighted on what the patient says o People believe what the patient says because that is how diagnoses are made

Long-term consequences of Hallucinogens

o Hallucinogens, except PCP, are often used sporadically rather than continuously o No withdrawal symptoms o Sometimes experience flashbacks - brief visual aftereffects that occur at unpredictable intervals long after drug has been cleared from person's body

Narcissistic Personality Disorder Characteristics

o Have a greatly exaggerated sense of their own importance o Preoccupied with their own achievements and abilities o Cannot empathize with the feelings of other people o Often seen as being arrogant or haughty o May react with anger if criticized o Considerable overlap with BPD (both feel that other people should recognize their needs and do special favors for them) ♣ Unlike BPD, people with Narcissistic PD have an inflated sense of self-importance (whereas people with BPD have a deflated sense of self)

Alcoholics Anonymous (AA)

o Helps people who use and abuse alcohol become and remain sober o "First line of attack against alcohol" o The original 12-step program o In the first step, person must acknowledge that he or she is powerless over alcohol and unable to manage his or her drinking o process of working through 12 steps to recovery is facilitated by regular attendance of AA meetings o AA meetings are opportunities to talk with other people who have similar problems o Difficulty to evaluate the effectiveness of AA => long-term follow-up is difficult o Early dropout rates are relatively high: about half leave in less than three months o Survival rates are much higher for those who remain in AA

Long-term consequences of cocaine and amphetamines

o High doses can lead to onset of psychosis ♣ Symptoms are auditory and visual hallucinations, and delusions of persecution and grandeur o Disruption of occupational and social roles o Linked to increase in violent behavior o Do not usually cause severe withdrawal symptoms ♣ Most common withdrawal symptom is depression

Long-term consequences

o High doses cause chronic lethargy and loss of motivation and productivity o At low doses, people can remain healthy and productive despite their addiction o Tolerance develops quickly o Very expensive

The Greek tradition in medicine 460-377 B.C.E.

o Hippocrates hypothesized that abnormal behavior, like other forms of disease, had natural causes o Health depended on maintaining a natural balance within the body, specifically a balance of four body fluids: blood, phlegm, black bile, and yellow bile o Physicians did not distinguish between mental disorders and other types of illness "disease" is "disease" o "heroic" treatments - a drastic attempt to quickly reverse the course of an illness ♣ bloodletting - cutting someone to reduce amount of blood ♣ purging ♣ use of temperature

BPD overlaps with several other PD categories and disorders

o Histrionic PD o Narcissistic PD o Paranoid PD o Dependent PD o Avoidant PD - impulse control problems - depressive disorders

What makes different genders more susceptible?

o Hormones o Patterns of learning o Social pressures

Short-term effects of nicotine

o Increases heart rate and blood pressure o Stimulated release of norepinephrine, causing CNS arousal o Causes release of norepinephrine and dopamine in mesolimbic dopamine pathway (reward center of the brain) o Mimics the effects of antidepressant drugs o Makes people feel more relaxed ♣ Controls people's responses to stress ♣ This is paradoxical because nicotine leads to increased arousal of sympathetic nervous system

Short-term effects of Hallucinogens

o Induce vivid, sometimes spectacular, visual images o "Bad trips" - unpleasant experiences that can lead to panic attacks and the fear of losing one's mind o Not toxic but PCP is much more toxic

Short-term effects of opiates

o Induces state of dreamlike euphoria, sometimes accompanied by increased sensitivity in hearing and vision o Those who inject morphine or heroine experience a rush - a brief, intense feeling of pleasure that is sometimes described as being like an orgasm in the entire body o Effects do not last and are replaced by negative mood changes o Decrease in levels of sex hormones => reduced sex drive and fertility o Speedball - mixture of cocaine and opiates - enhances subjective feelings

Pattern of maladaptive behavior must be:

o Inflexible and pervasive across a broad range of personal and social situations o The source of clinically significant distress or impairment in social, occupational, or other important areas of functioning o Stable and of long duration, with an onset that can be traced back at least to adolescence or early adulthood

Short-term effects of Barbiturates and benzodiazepines

o Leads to intoxicated state ♣ Impaired judgement, slow speech, lack of coordination, low attention range, diminished sexual and aggressive impulses o Causes pleasant, warm, drowsy feeling o Sometimes causes increase in aggressive behavior - this is called a "rage reaction" or aggressive dyscontrol

Schizoid Personality Disorder Characteristics

o Loners o Prefer social isolation to interactions with friends or family o People see them as being cold and aloof o They do not experience strong subjective emotions such as sadness, anger or happiness (by their own report)

SPD and schizophrenia treatment overlap

o Low doses of antipsychotic medication are beneficial in alleviating cognitive problems and social anxiety in schizotypal PD patients o Patients with schizotypal PD may respond positively to antidepressant medications (including SSRIs) o Patients do not respond well to insight-oriented psychotherapy

Meta-analysis

o Lumping results together for several studies o This approach seems to support the "Dodo bird Verdict" (all have won, and all must have prizes) o Fans of common factors of psychotherapy favor meta-analysis o Quantity vs. quality? what's better one good study or a bunch of studies just lumped together?

Benefits to dimensional model

o Makes it easier to describe problems exhibited by people with a variety of maladaptive traits o Avoids the need to assign more than one type of PD diagnosis o People who exhibit a few symptoms that would be below the diagnostic threshold in the categorical system are easily described with one set of ratings o Trait descriptors actually help explain the overlap or comorbidity that has been observed for many of the PD types

Schizotypal Personality Disorder Characteristics

o Many peculiar behaviors take the form of perceptual and cognitive disturbance o May report bizarre fantasies and unusual perceptual experiences o Speech may be slightly difficult to follow because they use words in an odd way or because they express themselves in a vague or disjointed manner o Affective expressions may be constricted in range or may be silly and inappropriate o Not psychotic or out of touch with reality o Bizarre fantasies are not delusional o Unusual perceptual experiences are not sufficiently real or compelling to be considered hallucinations

Problems with the Labeling Theory

o Many symptoms are NOT transient if they are ignored o Need to balance benefits with problems that follow from labeling o Stigma (a negative effect of labeling is perhaps exaggerated (some people are relieved by the diagnosis) o Don't have sufficient information from cultural stereotypes to feign mental disorders o Is residual rule-breaking voluntary? o What causes the symptoms in the first place? (Primary Deviance) o Is the best solution to abandon the use of labels?

Developmental Psychopathology

o Most disorders are chronic and episodic o Some type of vulnerability sets the stage (a predisposition) o Some event precipitates the problem o Consider factors that maintain or prolong symptoms o There is some predisposition, that is yet to be identified, and unknown environmental event that may trigger ♣ One cannot tell who does or who does not have the predisposition for a disorder

substance use disorders and comorbidity

o Most prominent is antisocial personality disorder (ASPD), mood disorders, and anxiety disorders o Conduct disorder (childhood manifestation of ASPD) is strongly related to alcohol use in adolescence and subsequent development of alcohol dependence

DBT (Dialectical Behavior Therapy)

o Synthesis ♣ thesis <--> antithesis o Everything is connected to its opposite in someway o Acceptance and change - accept where you are and move towards change o Everyone is doing their best and everyone has to do better o Very time intensive o Individual therapy: 50-90 minutes once a week o Skills training in a group setting ♣ Mindfulness - focusing on the present ♣ Distress tolerance ♣ Emotion regulation ♣ Interpersonal effectiveness o Therapist consultation team o Phone calls - therapists are on call 24/7

The DSM-5 is hampered by a number of problems that suggest that it does not classify clinical problems into syndromes in the simplest and most beneficial way

o One of the thorniest issues involves comorbidity, which is defined as the simultaneous appearance of two or more disorders in the same person o Several ways to interpret comorbidity: 1. Some people may independently develop two separate conditions 2. The presence of one disorder may lead to the onset of another ♣ *neither of these creates a conceptual problem for the DSM-5 o The problem with comorbidity arises when a person with a mixed pattern of symptoms, usually of a severe nature, simultaneously meets the criteria for more than one disorder (i.e. OCD, generalized anxiety, and major depressive disorder) ♣ Is it better to diagnose them with multiple personality disorders? Or is it more accurate to he had a complicated set of interrelated problems, which constituted one complex and severe type of disorder? o The comorbidity issue is related to another limitation of the DSM-5: the failure to make better use of information regarding the course of mental disorders over time ♣ Unfortunately, most disorders listen in the DSM-5 are defined largely in terms of snapshots of symptoms at particular points in time. Diagnostic decisions are seldom based on a comprehensive analysis of the way that a person's problems evolve over time

Long-term consequences of cannabis

o People do not develop tolerance to THC ♣ Some say they actually become more sensitive to drug, rather than less sensitive - a phenomena called reverse tolerance o Withdrawal symptoms are unlikely ♣ Those who take high doses may experience withdrawal o Heavy doses can cause performance deficits on neurophysiological tests that require learning, decision making, and sustained attention o Some evidence of cognitive decline associated with long-term use

Adoption studies

o People who were adopted are compared with their biological versus their adoptive relatives in terms of concordance for a disorder o If concordance is higher for biological than adoptive relatives, then genetic factors are involved adopted children share their biological relatives' genes but not their environment o If children are more similar to their adoptive than to their biological relatives, then environment is casual adopted children share their adoptive relatives' environment but not their genes o Possible problems: the fact that adoption placement can be selective

PDs and maladaptive parenting and family relationships

o People with documented evidence of childhood abuse and neglect were 4 times more likely to develop symptoms of personality disorders (strongest connections were with Cluster B disorders) o Physical abuse was most closely associated with subsequent antisocial personality disorder o Sexual abuse was most closely associated with BPD o Childhood neglect was most closely associated with antisocial, borderline, narcissistic and avoidant PDs

Concept of social dysfunction plays an important role in the definition of personality disorders

o Personality characteristics identified in DSM-5 criteria sets typically interfere with the person's ability to get along with other people and perform social roles o Lead to impaired social functioning or occupational impairment

Requirements for a diagnosis of ASPD

o Presence of symptoms of conduct disorder prior to age 15 o Presence of at least 3 out of the 7 signs of irresponsible and antisocial behavior after the age of 15

Twin Studies

o Provide strong evidence about genetic and environmental contributions o Monozygotic (MZ) twins - identical - one egg is fertilized by one sperm and create identical genotypes o Dizygotic (DZ) twins - fraternal - two eggs are fertilized by two sperm - on average share about 50% of their genes

Psychotropic medication

o Psychiatrists employ the entire spectrum of medications o Different drugs are recommended to treat individual symptoms o There is no systematic proof that a specific drug is effective for any of the borderline features

Common factors among all types of Psychotherapy

o Quality of the therapeutic relationship (empathy, support, feedback) ♣ Strong bond or if the person trusts the therapist - can be a very helpful relationship - leads to getting better o Client's level of self-knowledge (insight) ♣ Does the client embrace the idea that they are willing to learn things about themselves? o Placebo Effect (and the allegiance effect) involving expectations of success by client and therapist ♣ Change that takes place in the function of a patient believing that something will help you

Treatments that are harmful

o Rebirthing therapy -suggests that people can be freed from emotional problems by teaching them to breathe using their diaphragm instead of their chest o Primal therapy -patients overcome the trauma of their own birth by learning the appropriate way to scream, thereby releasing destructive emotions o Attunement- enhancing, shame-reducing, attachment therapy -involves holding a child firmly and encouraging her rage and despair as a way of getting the child to talk about trauma o Alien abduction therapy -helps people to cope with various mental disorders caused by being abducted by aliens o Facilitated communication -a technique in which a facilitator helps someone with impaired communication speak by "assisting" his or her typing on a keyboard

How can we improve the validity of psychological assessments?

o Recognize their fallibility ♣ Like everyone else, clinical psychologists are prone to cognitive biases and errors in decision making ♣ The impact of these cognitive biases might be minimized if clinicians deliberately considered alternative hypotheses (diagnoses other than their first impression) and then consider evidence that would either confirm or disconfirm that possibility ♣ Use careful, objective reasoning and evaluation

Reliability of ICD-10

o Schizophrenic disorders (.82) o Mood disorders (.77) o Anxiety disorders (.74) o Obsessive compulsive disorder (.81) o Generalized anxiety disorder (.48) o Personality disorders (.47) • EXTREMELY IMPORTANT • People need to be consistent with their diagnoses

Obsessive-Compulsive PD Characteristics

o Set ambitious standards for their own performance that frequently are so high as to be unattainable o Workaholics o So devoted to work that they ignore friends, family members and leisure activities o So preoccupied with details and rules that they lose sight of the main point of an activity of project o Intellectual endeavors are favored over feelings and emotional experience o Excessively conscientious, moralistic, judgmental o Tend to be intolerant of emotional behavior in other people o Marked need for control and lack of tolerance for uncertainty o Characteristics interfere with social and occupational adjustment o Find it difficult to delegate responsibilities to others o Extreme difficulty in finishing projects within established deadlines

Avoidant Personality Disorder Characteristics

o Tend to be socially isolated when outside their own family circle because they are afraid of criticism o Want to be liked by others (unlike schizoid PD) o Extremely shy o Easily hurt by even minimal signs of disapproval from others o Avoid social and occupational activities that require significant contact with other people o Often indistinguishable from social anxiety disorder ♣ Some experts argue that they are two different ways of defining the same disorder ♣ Others argue that people with avoidant PD have more trouble relating to others than those with social anxiety disorder ♣ People with avoidant PD are presumably more withdrawn and have very few close relationships because they are so shy, whereas people with social anxiety disorder may have lots of friends but are afraid of particular situations, such as public speaking • Much more difficult to make this distinction if an individual's social anxiety becomes more generalized

Null Hypothesis and the burden of proof

o The scientist who makes a new prediction must prove it to be true o New predictions are assumed to be false until supported by data

Gender theories:

o Theory: Women's traditional roles foster dependency and helplessness, which accounts for the considerably higher rates of depression o Others argue that gender roles may not cause abnormal behavior, but influence how psychopathology is expressed o People tend to stigmatize gender-typical emotional problems ♣ Women have depression and men alcohol abuse people are less sympathetic and less inclined to offer help o Some people view androgyny - the possession of both "female" and "male" gender-role characteristics - as the answer to the problems with being either overly feminine or masculine

Does therapy work?

o Therapy works for MANY, but not ALL, people and problems ♣ Most improvement occurs early in psychotherapy o Successful therapies share key "active ingredients" o Different treatments are more or less effective for different disorders o Some treatments do NOT work, and can actually be harmful ** o Without treatment - people usually get better 1/3 of the times ** ** o With treatment - people usually get better 2/3 of the times ** - The average therapy client is better off than 80% of untreated people

Limitations to the categorical approach

o There are a lot of people with serious personality problems who do not fit the traditional diagnostic types o It forces clinicians to employ an arbitrary threshold to distinguish between normal and abnormal personality types o There is considerable overlap among categories and many patients meet the criteria for more than one type ♣ Many clinicians are reluctant to diagnose more than one PD ♣ Much information is frequently left out o General criteria for PDs can be vague and unreliable

The Problem with paradigms

o They can direct and misdirect scientists - our assumptions can lead us to overlook possible answers o The biological paradigm can overemphasize the medical model - the analogy between physical and psychological illnesses o The psychodynamic paradigm can be unyielding in focusing on childhood experiences, unconscious conflicts, and interpreting Freud literally o The cognitive-behavioral paradigm can overlook the rich social and biological context of human behavior o The humanistic approach can be antiscientific

Why do we need treatment research?

o This field is notorious for embracing new treatments without data o Lobotomy in the 1930s ♣ 20 years before psychotic drugs ♣ Sever connections between frontal lobes and the rest of the brain by cutting open a patients' skull ♣ It worked in monkeys.... So they tried it in psychotic patients ♣ This does not work - gets rid of troubles but destroys their lives o Rebirthing therapy (example from PBS) --> resulted in death o Eye-movement desensitization EMDR o We need evidence that goes beyond one person saying it worked for them ♣ Need many examples ♣ If a psychologist is saying that it is working than they should do it

Long-term consequences of Barbiturates and benzodiazepines

o Those who abruptly stop taking high doses can experience discontinuance syndrome - this is a return and sometimes a worsening of anxiety symptoms o Causes drug withdrawal ♣ Less likely to occur if medication is discontinued gradually

Histrionic Personality Disorder Characteristics

o Thrive on being the center of attention o Self-centered, vain, and demanding o Constantly seeking approval from others o Behavior is often inappropriately sexually seductive or provocative o Frequently react to situations with inappropriate exaggeration o Overlaps extensively with other PDs, especially BPD (both intensely emotional and manipulative) ♣ Unlike BPD, people with Histrionic PD have an essentially intact sense of their own identity and a better capacity for stable relationships with other people

Moffitt's theory of antisocial behavior

o Two primary forms of antisocial behavior: ♣ Transient ♣ Nontransient o Adolescence-limited antisocial behavior is a common form of social behavior that is adaptive and that disappears by the time the person reaches adulthood o Life-course-persistent antisocial behavior -found in a small proportion of antisocial individuals (mostly males) engage in antisocial behavior at all ages

ACT (acceptance and commitment therapy)

o Uses: ♣ Acceptance and mindfulness strategies ♣ Commitment and behavior-change strategies to increase psychological flexibility o Goal = to be present, be emotionally aware, and move toward valued behavior

Family Therapy

o View the individual with in the family systems ♣ Ex. Anorexia

CBT Therapist

o Would hone in on her cognitive and behavioral patterns now o Would see her self-blame as a cognitive error o Would see her withdrawal from pleasing activities and unassertiveness as contributing to her depression o Would be more direct (in comparison to psychodynamic therapist) in discussing these topics o Would tell her that her thinking was distorted and causing depression o Would make direct suggestions to teach her new ways of thinking, acting and feeling o Would encourage her to blame others appropriately rather than just herself and try new ways of relating to her family o Would want her to play an active role in the process by completing homework (activities outside therapy, such as writing about her anger) o Would expect her depression to lift once she learned to assert herself and no longer blame herself for everything that went wrong

Self-fulfilling prophesy

people's actions conform to the expectations created by the label

Attributions

perceived causes people's beliefs about cause-effect relations

Psychodynamic Therapist

o Would likely focus on her defensive style o Would view her justification of parents and husband's behavior as rationalization o Would note a pattern of denial in her refusal to acknowledge the imperfections of her loved ones and their failure to fulfil her needs o Would view her saying that she is a burden as projecting onto them her own feelings of being burdened by mother's demands and husband's indifference o Would begin by exploring her past o Would focus on a goal of illuminating patterns in her internal conflicts, unconscious motivations and defenses o Would eventually confront her defenses in order for her to gain insight • Psychodynamic psychotherapists are much more involved with their patients than are psychoanalysts

Humanists Therapist

o Would predominantly focus on her lack of emotional genuineness -her inability to "be herself" with other people and within herself o Would explore her tendency to bury her true feelings o Would focus on a goal of helping her recognize how she really feels o Would be nondirective about discussion but would continually focus on underlying emotions o Would initially just empathize with her o Would over time suggest that she had other feelings that she did not express o Would tell her that all of her conflicting feelings were legitimate and encourage her to "own" them o Would not directly encourage her to act differently ♣ She might make changes to her life as a result of her increased emotional awareness

Social judgment problems

oSome people with PDs experience persistent problems with social distance oDeficits in the ability to empathize with others (to understand the emotions of other people) present one of the core features of PDs

social workers all have professional responsibilities

obligations to meet the ethical standards of their profession and to uphold the laws of the states in which they practice

negligence

occurs when a professional fails to perform in a manner that is consistent with the level of skill exercised by other professionals in the field A new area of professional negligence is failure to inform clients about effective treatment alternatives

Dominant/Recessive inheritance

occurs when a trait is caused by a single or autosomal gene that has only two alleles

Acute Stress Disorder (ASD)

occurs within a month after exposure to traumatic stress

most sexual activity

occurs within relationships

laws prohibit confinement

of someone simply on the suspicion that he or she will commit a crime, with a single exception: civil commitment, the involuntary

Tarasoff v. Regents

of the University of California made it that therapists also have a duty to warn the potential victim of someone's violent intentions - Tarasoff was killed by Poddar

A pervasively anxious mood

often associated with pessimistic thoughts and feelings

psychoactive substances

often taken in excess, chemicals that alter the person's mood, level of perception, or brain functioning

"Harmful Dysfunction"

one definition of a mental disorder o "dysfunction" refers to some mental function that is presumably broken o Unfortunately, the basic functions of the mind have not been identified o "harmful" ♣ show that it shows that it leads to reduced fertility or increase in mortality ♣ if you're just not happy ♣ interferes with friendships or ability to hold a job

To qualify for a DSM-5 diagnosis of a personality disorder

one must fit the general definition for a personality disorder, and must also meet the specific criteria for a particular type of personality disorder

A diagnosis of PTSD by the DSM-5

only requires 4 of the symptoms above

Pathological gambling

out of control, takes over person's life, and had horrendous financial and interpersonal consequences - central features = centered around impaired control of gambling activities, social impairment that follows gambling, and continued problem behavior in spite of accumulation of harmful consequences

Medulla

part of brain stem, controls functions, including heart rate, respiration, and blood pressure

Hippocampus

part of the limbic system, affects ability to learn, identifies sensory information worth learning

Amygdala

part of the limbic system, contributes to some emotions

Delusional disorder

people do not meet the full symptomatic criteria for schizophrenia, but they are preoccupied for at least one month with delusions that are not bizarre ○ Their delusions are beliefs about situations that could occur in real life ○ The presence of hallucinations, disorganized speech, catatonic behavior, or negative symptoms rules out a diagnosis of delusional disorder ○ The person's behavior is not bizarre and social and occupational functioning are not impaired except for those areas that are directly affected by the delusional belief

Depressogenic attributional style

people tend to explain negative events in terms of internal, stable, global factors - failing an exam —> the result of one's own inadequacies (internal), which she has recognized for a long time and which will persist into the future (stable), and which also are responsible for her failure in many other important tasks, both academic and otherwise (global)

Ego-dystonic

people with these disorders are distressed by their symptoms and uncomfortable with their situations (eg. anxiety disorders and mood disorders)

Ego-syntonic

people with these disorders believe the ideas or impulses with which they are associated are acceptable to them (eg. personality disorders)

DSM-5 defines OCD in terms of

the presence of either obsessions or compulsions - Most who meet these criteria experience both symptoms - Person must attempt to ignore, suppress, or neutralize these unwanted thoughts or impulses, and they must be time-consuming (take more than one hour per day) or cause significant subjective distress or social impairment - Thoughts cannot be worries about real problems (i.e. paying bills) - DSM-5 provides specification regarding person's level of insight regarding beliefs associated with OCD symptoms (1) Good or fair insight (thinks beliefs are probably or definitely not true) (2) Poor insight (thinks OCD beliefs are probably true) (3) Absent insight/ delusional beliefs (convinced beliefs are true)

comorbidity (co-occurrence)

the presence of more than one condition within the same period of time (ex alcoholism, major depression)

Body dysmorphic disorder

the problem involves preoccupation with some imagined defect in appearance - Typically focuses on some facial feature - Far exceeds normal worries about physical imperfections - Endless worry causes significant distress, and may interfere with work or social relationships - Considered an obsessive-compulsive disorder but is similar to somatic symptom disorder

Assume that animal and human psychology evolved through natural selection

the process in which successful, inherited adaptations to environmental problems becomes more common over successive generations

the termination of parental rights

the removal of any right a parent has to care for and supervise his or her child

Inclusive fitness

the reproductive success of those who have the adaptation, their offspring,

epidemiology

the scientific study of the frequency and distribution of disorders within a population. Researchers of this are concerned with questions of frequency, commonality, and types of people

Comorbidity

the simultaneous manifestation of a mood disorder and other syndromes - The greatest overlap is with anxiety disorders - Alcohol and depression are closely related - Many people who are depressed, drink heavily - Many people who are dependent on alcohol - 40% - experience major depression at some point - The order of onset varies per person

Psychophysiology

the study of changes in the functioning of the body that result from psychological experience o Responses include: pounding heart, flushed face, tears, sexual excitement

Genetics

the study of genes and their hereditary functions

Homeostasis

the tendency to return to a steady state of normal functioning (Cannon 1935) - prolonged arousal of the SNS damages the body, because it doesn't return to its normal state - analogy: a car that has run out of gas and is damaged because stress keeps turning the key, trying to restart the engine repeatedly - the stress response may use so much energy that the body cannot do routine upkeep like storing energy or repairing injury

Splitting

the tendency to see people and events alternately as entirely good or entirely bad o Common feature of people with BPD

prevalence

the total number of active cases, old and new, that are present in a population during a period of time

determinism

the view that human behavior is determined (or at least constrained) by biological, psychological, or social forces

Cognitive Vulnerability

the way in which people perceive, think about, and remember events in their world can have an important influence on the way that they feel - 2 people may react very differently to the same event - because of the way they interpret in

Equifinality

there are many routes to the same destination = "multiple pathways"

Depressive disorders

those in which a person experiences only episodes of depression

Bipolar disorders

those in which the person experiences episodes or mania as well as depression - used to be referred to as manic depressive disorder

Neurons

tiny nerve cells that form the basic building blocks of the brain

Residual rx

treats positive symptoms

Dissociative identity disorder (DID)

two or more personalities coexist within a single individual (formerly known as multiple personality disorder) - Two or more of these personalities repeatedly take control of the person's behavior, with alterations in mood, behavior, and at least some loss of recall between the personalities - Original personality is likely to have amnesia for subsequent personalities - Subsequent personalities may or may not be aware of other "alters" - Extremely unusual diagnosis - Demonstrates that the mind can function on multiple levels of consciousness

Treatment

typically accomplished in a sequence of stages, beginning with a brief period of detoxification - the removal of a drug on which a person has become dependent - for three to six weeks

Onset of schizophrenia

typically during adolescence or early adulthood ○ Risk period for development of a first episode is considered to be between the ages of 15 and 35 ○ Number of new cases drops off slowly after age 35 ○ Very few people experiencing an initial episode after the age of 55

Catatonic patients

typically resist attempts to alter their position, even though maintaining their awkward postures would normally be uncomfortable or painful

Genes

ultramicroscopic units of DNA that carry information about heredity ♣ Located in chromosomes

narcotic analgesics

used clinically to decrease pain ex. opiates

Tranquilizers

used to decrease anxiety or agitation

Psychoanalytic psychotherapy

used to gain insight on unconscious motives that cause patient's symptoms (still used, but not shown to be effective)

Hypnotics

used to help people sleep

Cognitive therapy

used to treat anxiety disorders - Therapists help clients identify cognitions that are relevant to their problem; recognize the relation between these thoughts and maladaptive emotional responses

base rate of predicting violence

using the clinical method (i.e. 6 percent) was close to the actual base rate (i.e. 3 percent). However, the base rate of predicting violence using the coin flip (50 percent) was much higher

Psychological treatments

usually concentrated on long-term strategies rather than the resolution of acute psychotic episodes

Self-esteem

valuing one's abilities • High self-esteem has seen to be as much of a product of success as a cause of it • Low self-esteem can result from psychological problems as well as cause them ♣ May be localized in the frontal lobe

The Cognitive-Behavioral Paradigm

views abnormal behavior as a product of learning o Wilhelm Wundt - 19th century o Ivan Pavlov 1928 o B.F. Skinner (1953) o John B. Watson

emergency commitment

when an acutely disturbed individual is temporarily confined, typically for no more than a few days

Correlational study

when the relation between 2 factors is studied systematically

Dissociative state

where the person feels and acts as if the trauma actually were reoccurring in the moment - Rare form of reexperiencing - Typically have short duration but can last for days in rare cases

foster care

where they live temporarily with another family - maltreated children - children in physical danger - 1/2 remain in foster care for at least 2 or 3 years

Mitigation evaluations

which include an assessment for mental disorders, are required in all death penalty cases

PTSD is more prevalent in Vietnam veterans...

who were wounded, who were involved in the deaths of noncombatants, or who witnessed atrocities

Cortex

wrinkled surface of the brain involved in many complex tasks, including memory, language, and perception - divided into 4 lobes

False positives

wrongly hospitalizing someone who is not dangerous to others of suicidal - unfairly restrict civil rights - Clinical prediction of suicide risk

Insanity

years ago referred to mental dysfunction but today is a legal term that refers to judgements about whether a person should be held responsible for criminal behavior if he or she is mentally disturbed

____ generations are experiencing higher rates of depression

younger

Who uses the most illegal drugs?

younger people - elderly people use the most legal drugs, but there is a problem with abuse of prescription drugs

Humanistic method

• "client-centered" • Therapist = passive, non directive, warm, supporter • Method= empathy, support, exploring emotions - views making choices and shaping our own future as the most essential part about being human

Validity

• *Systematic meaning or importance* • No single measure of validity • No measure like kappa • Asking: "does it mean anything"

Observational Procedures

• Allow (or encourage) clinician to focus on the context in which problems occur • Especially useful for childhood problems, such as ADHA and conduct disorder in classroom settings • Expensive and time-consuming • *Reactivity - when people alter their behavior, intentionally or unintentionally, when they know they are being observed* • Some forms of psychopathology cannot be observed directly • Useful for couples experiencing marital distress o Bring couple into lab and make them fight so you know how they actually are o Not useful to talk individually • Can be difficult to arrange

Projective Tests (aka Performance Tests)

• Ambiguous stimuli (e.g., inkblots or drawings) • Ask the person "what does it look like?" or "what is happening in the picture?" • Original emphasis was on unconscious motivations • Person presumably "projects" their own conflicts and impulses into their answers • Your unconscious projects on the ambiguous object • Current advocates of these tests describe them as sampling perceptual and cognitive styles

ECT = Electroconvulsive Therapy

• An alternative to drug therapies • Electrical currents to induce a brain seizure • Process: oInduce sleep, give muscle relaxants oElectrodes, 70-150 volt currents oTypically 1 minute seizures oMultiple sessions • Great with people with treatment resistant depression, anxiety, or OCD • Very useful but dangerous

Descriptive Classification - DSM V

• An early stage of science • Progress toward etiological classification as science becomes more sophisticated

Money related with DSM sales

• Annual sales of DSM approximately $100,000/year with $5 million for DSM-IV • Cost of DSM-5 production $25 million, compared to $5 million for DSM-IV • Copyright charges • Of course, critics make money too

Arguments against classification systems

• Argument: People say let's not have a classification system because the patients will experience judgement from society o This doesn't work - people need treatment • Another argument made: everyone needs the same treatment and we'll all be fine... this way we don't need classification o However, some people need treatment right now and others can wait o People in manic episodes need help ASAP o There are 2 categories: people who need treatment now and others who can wait o Also, among those two categories: people are going to need different types of treatment this means we need a classification system

Problems with Self-Report Arguments

• Assessment of psychopathology is based almost exclusively on questionnaires and clinical interviews • Like everyone else, people with mental disorders are frequently unable to view themselves realistically and NOT AWARE of the impact their behavior has on other people • Some are UNWILLING (or unable) to report problems, even when they know about them

Categorical Classification

• Based on "yes" or "no" decisions • **Qualitative distinctions** o Lists hundreds of categories and the clinician is asked whether or not she/he has it • Medical example: AIDS virus or not

Understanding Addiction

• Biological factors obviously play an important role in the causes of addiction • Addicting properties of certain drugs are crucial to why people become addicted • We must understand how addicting drugs effect the brain in order to understand the process of dependence • Need to understand social and cultural factors that influence how and under what circumstances an individual first acquires and uses drugs

Medication

• Can be combined with Psychotherapy, sometimes offered on their own • Primary care physician is usually the first person someone sees so they often provide the first medication - Not a Magic bullet - Different types for different symptoms

Labeling Theory

• Concerned with the negative consequences of assigning a diagnostic label, especially the impact that diagnosis has on ways in which people think about themselves and the ways in which other people react to the designated patient • Primarily concerned with social factors that determine whether a person will be given a psychiatric diagnosis rather than a psychological or biological reason for abnormal behaviors • Assumes that mental illness is a social role • Labeling establishes that role • Emphasizes SECONDARY DEVIANCE rather than primary deviance

Twin studies

• Concordance rates are higher among MZ than DZ twins for alcoholism • Differences between MZ and DZ concordance rates were significant for both genders • The fact that concordance rates were higher for men than for women reflects much higher prevalence rate of alcoholism among men • Heritability estimates were the same for both men and women

Possible Solutions to Self-Report Limitations

• Develop subtler self-report items • Collect information from other people who know the person well (but there are limitations) • The best solution is to use multiple sources of information, with each being collected over time (longitudinal analysis)

Assessment Procedures

• Diagnostic interviews • Observation • Self-report questionnaires • Projective tests (e.g., Rorschach inkblots)

Dimensional Classification

• Emphasis is on "how much" • **Quantitative distinctions** • Psychological example: intelligence o IQ scores • Medical example: hypertension

Questionnaires and Personality Tests

• Examples: MMPI-2, Beck Depression Inventory o Takes an hour or 2 to fill out and gives clinicians a lot of information • Useful for covering lots of ground efficiently • Scored objectively; some measure "test-taking sets" o Compared with 1000s of other scores • Grounded in empirical research • Covers a lot of disorders • Gives hints to clinicians • There is a faking scale - they mark down a tick for every unreasonable answer • Defensiveness - doesn't mean you're lying

CBT goal, focus, and reasonings

• Focus = observable behavior • Cause of abnormality = social learning • Inborn Human Nature = blank slate • Exposure: o Phobias: exposure to the feared animal/object/situation o Social anxiety disorder o Panic disorder: exposure to panic symptoms o PTSD: exposure to feared objects/situations associated with the past event; retelling the story o Goal = learn that you can face the fear situation and be ok - Encourages collaborative therapist-client relationships - Encourages a focus on the patient - Encourages direct efforts to change problems - Encourages empirically supported treatments

Problems and limitations of the DSM-5 system

• Hard to define the boundary between normal and abnormal behavior - there is not a bright line that divides people with problems from people who do not have problems • Absence of a specific definition of social impairment is another practical issue plagued previous forms of the diagnostic manual • Some clinicians and investigators have argued that the symptoms defined in the DSM-5 do not represent the most useful ways to think about psychological problems, either in terms of planning concurrent treatments or in terms of designing program for research

International Classification of Mental Disorders:

• ICD-10 (1992) • World Health Organization • New edition is in preparation (ICD-11) and expected to be published in 2018 • Links between DSM and ICD are perhaps less closely orchestrated than in the past

ex. Borderline Personality Disorder

• Inappropriate, intense anger • Unstable and intense relationships • Impulsivity (e.g., reckless driving) • Emotional instability / reactivity of mood • Stress-related paranoid ideation

The Experimental Method

• Investigator has control of the "independent" variable o Participants are randomly assigned to experimental and control groups • Allows strong casual inferences • Outcome research is one of the only situations in psychopathology that allows experiments to be done • Efficacy vs. Effectiveness

Most studies of psychiatric diagnosis employ an index known as kappa... what is it?

• Kappa indicates the proportion of agreement that occurred above and beyond that which would have occurred by chance • Negative values of kappa indicate that the rate of agreement was less than which would have been expected by chance • Kappa of zero indicates change agreement, and a kappa of 1.0 indicates perfect agreement • One traditional convention suggests that kappa values of .70 or higher indicate relatively good agreement, but that is seldom met outside of highly controlled research situations • Values of kappa below .40 are often interpreted as indicating questionable or poor agreement • Relatively few diagnostic categories showed "very good" agreement, defined in terms of kappa higher than .60 (autism, PTSD, ADHD) • The diagnostic reliability for several categories was "good," if we take values of kappa between .40 and .60 as criterion for that judgement (bipolar disorder, binge eating disorder, schizophrenia) • Quite a few categories demonstrated "questionable" levels of reliability, including major depressive disorder and generalized anxiety disorder • This evidence suggests that we cannot blindly accept that the diagnostic categories of the DSM-5 should be used reliably

Diagnostic and Statistical Manual

• Known as DSM-5 (2013) • DSM-IV published in 1994 (year does not matter but it took 20 years to create a new edition) • Revision process took more than 5 years • Lists hundreds of mental disorders • Used for many purposed - insurance payments for treatment, selecting treatments by clinicians, guiding research effort • Some people favor broad coverage, others greater precision

(NCS-R) Frequency of mental disorders in the community (lifetime prevalence)

• Major depression - 17% • Alcohol abuse - 13% • Drug Abuse 8% • PTST - 7% • Panic disorder - 5% • Bipolar mood disorder - 4% • OCD - 2% • Schizophrenia - 2% • Anorexia Nervosa - 1% • Bulimia Nervosa - 1%

DSM-5

• More than 200 specific diagnostic categories arranged under 22 primary headings • Disorders that present similar kinds of symptoms are grouped together o i.e. Conditions that include prominent display of anxiety are listed under "Anxiety Disorders" • Manual lists specific criteria for each diagnostic category • In addition to the inclusion criteria, symptoms that must be present, many disorders are also defined in terms of certain exclusion criteria o i.e. For OCD, diagnosis can be ruled out if symptoms are the result of drug use or another medical condition • For various types of disorders, the duration of the problem is considered as well as the clinical picture o i.e. For OCD, patient's compulsive rituals must take more than one hour per day to preform • Clinical disorders are defined largely in terms of symptomatic behaviors • A person can be assigned more than one diagnosis if he or she meets the criteria for more than one disorder

How do you decide if someone has a disorder?

• Must show a group of symptoms • Symptoms must be enduring • Problem behaviors must lead to subjective distress or social • Her unusual behavior has involved other people • Her children say "it's happening it again" - happens more than once

lifetime prevalence (alchohol)

• NESARC study showed lifetime prevalence rate of about 30% for some type of alcohol use disorder • Alcohol-related disorders are among the most common form of mental disorders in the U.S.

DSM-5 (2013) - Most Recent changes

• OCD and PTSD split off from Anxiety Disorders to from their own chapters • Bipolar disorder gets its own chapter, spate from Depressive • Gambling disorder moves to substance related and addictive disorders • Sexual disorders split up into sexual dysfunctions, gender dysmorphia, and one other

RCTs (Randomized controlled trials)

• Participants in the study have been assigned in no particular way to the groups that will be studied. • One of the groups studied does not receive the new ("active") treatment being tested. Instead, they receive a "placebo" (e.g. psychoeducation)

Psychoactive drugs

• People may be dependent on psychoactive drugs because they stimulate areas of the brain that are known as "reward pathways" • Electrical stimulation of the medial forebrain bundle can serve as a powerful source of positive reinforcement for animals as they perform an operant learning task • Natural rewards, such as food and sex, increase dopamine levels in certain crucial sections of this pathway, which is also known as the mesolimbic dopamine pathway

Psychosurgery

• Prefrontal lobotomy - sever frontal lobes from the lower centers of the brain • Destroys small areas of the brain thought to be involved in symptoms • Not very common • A last resort options

Depression

• Prolonged heavy drinking or use of psychoactive drugs can result in feelings of depression and anxiety • Person feels guilt about inability to control problem • Often leads to conflict with family members • Sometimes depression and anxiety precede the onset of substance use disorders => self-medicate in order to control problem

Brain imaging techniques

• Used heavily in research, not as often in clinical settings • Allow scientists to examine which parts of the brain are involved in various kinds of events, such as perception, memory, language, and emotional experience • Allow us to learn whether specific areas or pathways are uniquely associated with specific types of mental disorders • Magnetic resonance imaging (MRI) - obtains precise measures of the brain • Position emission tomography (PET) - scanning technique used to create functional brain images o Can reflect changes in brain activity as the person responds to the demands of various tasks • Functional MRI (fMRI) - measure movement of oxygenated-blood to different parts of the brain o Can identify changes in the brain that last less than one second

Classification Systems

• Used in all forms of science • They're not right or wrong; simply more or less useful (for what purpose?) - Extremely controversial • Ours is not currently driven by knowledge of causes • Diagnosis does not imply understanding - It is a description of symptoms - not how you got them, or why • Diagnostic decisions in psychiatry are not based on laboratory measures - Cannot be tested - Lots of people are working on these sorts of tests for men

Psychodynamic

• Young, Erikson, Adler • Freud's followers • Modern from of psychoanalysis • Causes of abnormality = early childhood experiences • Inborn human nature = aggressive, sexual

Risk factos

• demographic, biological, and psychological variables as well as expectancies about effects of drugs

Temperament: OCEAN

•Openness to experience - imaginative and curious vs shallow and imperceptive •Conscientiousness - organized and reliable vs careless and negligent •Extraversion - active and talkative vs passive and reserved •Agreeableness - trusting and kind vs hostile an selfish •Neuroticism - nervous and moody vs calm and pleasant

Benefits of Atypical antipsychotics

■ Less likely than the classical antipsychotics to produce unpleasant motor side effects ■ At least as effective as traditional drugs for the treatment of positive symptoms of schizophrenia ■ They are useful in maintenance treatment to reduce the risk of relapse ■ Less likely to produce tardive dyskinesia

Limitations of atypical antipsychotics:

■ Not significantly more effective for treating negative symptoms (contrary to initial claims) ■ Produce additional side effects, some of which are serious ● Many lead to weight gain and obesity, which increase a person's risk for additional medical problems (eg diabetes, hypertension, coronary artery disease) ■ These adverse reactions lead many patients to discontinue medication, thus increasing their risk of relapse

○ Identifying characteristics of delusions:

■ Preoccupation ■ Delusional patients are unable to consider the perspective that other people hold with regard to their beliefs ○ Delusional beliefs are typically personal ○ Delusional beliefs are not shared by other members of the person's family or cultural group ○ Many delusions focus on grandiose or paranoid content ○ Delusions are not always coherent belief systems that are consistently expressed by the patient ■ Delusions are often fragmented, especially among severely disturbed patients

impairments to eye-movements

○ In schizophrenic patients, tracking records show frequent interruptions of smooth-pursuit movements by numerous rapid movements ○ 50% of first-degree relatives of schizophrenic persons show similar smooth-pursuit impairments

Medication from the patient's perspective

○ Medication allows them to be less bothered or preoccupied by troublesome thoughts and perceptual experiences ○ Medication seldom eliminates hallucinations and delusional beliefs completely

hypotheses for gender disparities

○ Schizophrenia is a single disorder and its expression varies in men and women ■ Genetic vulnerability to schizophrenia may be expressed differently in men and women ■ Could be accounted for by biological differences (hormones) or different environmental demands ○ There are two quantitatively different subtypes of schizophrenia, one with an early onset that affects men more often than women, and another with a later onset that affects women more often than men

Limitations to a neurochemical model focused narrowly on dopamine

○ Some patients do not respond positively to drugs that block dopamine receptors ○ The effects of antipsychotic drugs require several days to become effective, but dopamine blockage beings immediately ○ Research studies that examined the by-products of dopamine in cerebrospinal fluid were inconclusive at best

Defining Characteristics of Mental Disorders in the DSM-5

♣ A syndrome that is characterized by disturbance of a person's cognition, emotion regulation, or behavior ♣ The consequences of which are clinically significant distress or disability in social, occupational, or other important activities ♣ The syndrome reflects a dysfunction in the psychological, biological, or developmental processes that are associated with mental functioning ♣ Must not be merely an expectable response to common stressors and losses or a culturally sanctioned response to a particular event ♣ That is not primarily a result of social deviance or conflicts with society

Moral Anxiety

♣ Ego mediates between the two others • Superego and ego conflict between moral anxiety and • Id and ego conflict between neurotic anxiety

Neurotic Anxiety

♣ Ego protects itself from neurotic anxiety by utilizing *defense mechanisms* - unconscious self-deceptions that reduce conscious anxiety by distorting anxiety-producing memories, emotions, and impulses

Ivan Pavlov 1928

♣ Experiment: rang a bell when he fed meat powder to dogs. After repeated trials the sound of the bell alone elicited salivation ♣ Classical conditioning = learning through association, involving 4 key components • Unconditioned stimulus (meat powder) • Unconditioned response (salivation • Conditioned stimulus (bell) • Conditioned response (salivation ♣ Extinction = gradually occurs once a conditioned stimulus no longer is paired with an unconditioned stimulus

Methods involved in the biological paradigm

♣ First step: accurate diagnosis ♣ Second: identifying a specific biological cause ♣ Third: developing a treatment that prevents, eliminates, or alters the cause

Dream Analysis

♣ Manifest - everything you would tell someone about your dream ♣ Latent - shows you what the dreams actually mean

Concordance rate

♣ Twin pair is concordant when both twins either have the same disorder or are free from the disorder - ex. Both have schizophrenia ♣ Twin pair is discordant when one twin has the disorder but the other does not ♣ Scientists should find a concordance rate of 100% for MZ twins and a discordant rate of 50% for DZ twins ♣ High concordance rates point to the influence of the shared environment, experiences twins share in common ♣ Low concordance rates point to the influence of the nonshared environment, experiences unique to the one twin