abnormal psychology final exam

PTSD etiology: sociocultural

-Lack of social support after trauma -childhood experiences: poverty, separation/divorce -Gender difference: women are twice as likely as men to suffer stress disorder -Ethnic differences: higher vulnerability among Hispanic Americans -Recent immigrants and refugees from countries where there was civil conflict

Differences between AN and BN

AN: low body weight; almost all have amenorrhea BN: More concerned about pleasing and being attractive to other people; impulsive; mood swings; poor coping; damage from purging; normal-ish weight

Family-social perspective

Family relationships, social interactions, community events act directly on individuals

Panic Disorder

Fear of panic attacks Intense fear accompanied by 4+ physical symptoms (pounding heart, trembling, shortness of breath, dizziness, fear of losing control, fear of dying) all at once (within minutes) Recurrent, unexpected panic attacks with one month or more of: -worry about having another panic attack or worrying about consequences of having an attack -Maladaptive changes in behavior or activities designed to avoid another panic attack May lead to agoraphobia

Arousal

Fight or flight response is set in motion by the hypothalamus Two important systems are activated 1) Autonomic NS -Sympathetic NS pathway 2) Endocrine system -Hypothalamic-pituitary-adrenal (HPA) pathway People differ in: -their general level of arousal and anxiety ("trait" anxiety) -Their level of anxiety in specific situations ("State" anxiety)

Delusions of grandeur (grandiose)

False impression of one's own importance

Sociocultural causes of Antisocial personality disorder (ASD)

Family and socialization: poor parental supervision and involvement; parental rejection/deprivation; dysfunctional family structure; parental separation or absence; antisocial parent, especially father Cultural values: competitive environment bred by US values could fuel aggressive and violent behavior behavior of antisocial individuals

During family communication and education (for schizophrenia) family based treatment approaches for schizophrenia

Family communication and education -normalize family experience and set expectations -demonstrate concerns, empathy, sympathy -education family members about schizophrenia -avoid blame -express positive feelings -identify strengths and competencies -develop problem solving and stress management skills -teach family to cope with symptoms -strengthen communication

When is it OCD?

Thoughts and behaviors are irrational and excessive (>1 hour per day) Having obsessive thought or not doing a ritual in "the right way" causes distress Significant impairment in home, occupational, and or social domains

Danger

To self and or others violence, injury; neglect, malnourishment *Exception not the rule

Prevalence of Antisocial personality disorder (ASD)

US prevalence -> 2-3.6% of the population -4x more common in males than females ~30% of people in prison -No ethnic group differences -More common in urban than rural areas -high rates of comorbidity of substance/alcohol use disorders

OCD Comorbidity

Up to 90% of adults with OCD also meet current or past diagnostic criteria for another mental health disorder (Approx estimates, up to:) Anxiety: 75% Mood: 60% Impulse control: 60% Substance abuse and dependence (40%) Individuals with autism spectrum disorder may engage in repetitive behavior that looks like OCD (but isn't)

Bipolar disorders

Usually involve episodes of depression alternating with mania (though not always) Mania: states of intense elation or irritability (dramatic and inappropriate); not necessarily "happy" or on a high "high" Hypomania: symptoms of mania, but less intense. Four or more days of elevated mood. Does not interfere with functioning.

Mindfulness strategies

View the present experience with curiosity Thoughts are just thoughts: they come and go Distress is just an emotion: is comes and goes

Psychodynamic model

We're shaped by dynamic intrapsychic factors (Id, superego, ego) Adult disorders arise from early experiences (childhood traumas or anxieties) Anxieties operate unconsciously and are repressed through defense mechanisms because they are too hard to face thoughts and actions are rooted in sexual and aggressive instincts personality develops through a series of psychosexual stages

A yes to these questions is a success

Will you go with me to see ____ (a counselor, priest/minister, school nurse, psychologist, etc)? Will you let me help you make an appointment with ___? Will you promise me _______?

Limitations of the cognitive model

Works best for certain types of problems; can be abstract for some individuals; changing thoughts is sometimes not enough...behaviors need changing too

AN onset and prevalence

Younger onset: age 14-18 years 90-95% females ~0.5-3.5% of females in Western countries (but many more display at least some symptoms) -Rates increasing in North America, Europe, and Japan

classical conditioning

associations (Pavlov, Watson) Pairing events that occur together Watson: little Albert --> generalized fear Pavlov's dog

Social withdrawal

attend to their own ideas and fantasies and withdraw from social environment (usually due to fear or avolition)

psychomotor symptoms of schizophrenia

awkward movements, repeated grimaces, odd gestures, catatonia catatonia involving posturing, rigidity, stupor, or excitement (rigid postures; neurologically staying in certain positions)

Alcohol and suicidality

alcohol can dissolve the resistance that keeps people from taking their life. Most completed suicides include alcohol in their system. "For the suicidal person, there is no safety without sobriety" Alcohol worsens depression, impairs thinking and judgement, and increases impulsivity

"conventional" antipsychotics: first generation antipsychotics

also called Neuroleptics -Phenothiazines (e.g. Thorazine), butyrophenones (e.g. Haldol), thioxanthenes (Navene) -Block dopamine receptors, help with positive symptoms, reduce agitation, violent behavior, little effect on negative symptoms helpful in 65% of cases Extrapyramidal-side effects: parkinsonism (muscle tremors, shakiness), dystonia (slow, involuntary movement), akathesis (motor restlessness), neuroleptic malignant syndrome (muscle rigidity) Tardive dyskinesia - side effect. abnormal movements of lips, tongue and jaw and may involve the trunk or arms as well.

Common medical consequences of Anorexia nervosa

amenorrhea (no menstruation) dry skin brittle hair and nails low body temp (cold very easily) irregular heart rate, low blood pressure, and weakened heart muscle electrolyte imbalance extreme tiredness reduced bone density lanugo (peach fuzz) relatively high mortality rate (2-6%) usually from all the medical consequences

avoliton v. anhedonia

anhedonia is not experiencing pleasure while avolition is a lack of interest

If it seems like someone has both AN and BN, then they have ________, because the two cannot be co-morbid.

anorexia

Treatment of depression: biological

antidepressants are best (for unipolar depression only) -SSRIs -SNRIs -Tricyclics -MAOIs SSRIs are first line: harder to overdose, and fewer side efefcts Meds don't help 35% of people

Agoraphobia

Intense fear of at least two of the following: -being outside of the home alone -traveling in public transportation -being in open spaces -being in stores or theaters -standing in line or being in a crowd these situations are feared because escape or help may not be readily available

Borderline Personality Disorder

Intense fluctuations in mood, self-image, and interpersonal relationships Impulsive, have chronic feelings of emptiness, and form unstable relationships High probability of self-harm, suicide, and suicide attempt (75% try; 10% complete) May exhibit auditory hallucinations and have ego-dystonic reaction to them very sensitive and very reactive

What is OCD: Obsessions

Intrusive, persistent, unpleasant thoughts, images, and or impulses

Distress

Is a certain set of behaviors causing significant distress? Negative emotions, upsetting, suffering

Dysfunction

Is it causing a problem in some way (or problems) Interference/impairment; difficulty doing what you need or what to do e.g. anxiety causing avoidance is impairment

Common myths about OCD

Its all about cleanliness or being a neat freak Something bad happened as a child Strong religious or cultural beliefs cause OCD Your brain is broken or diseased A brain test can confirm OCD Just stop thinkint about it and youll get over it Ocd has to include observable compulsions Ocd isnt treatable

How to question someone about suicidal thoughts

Less direct approach: Have you been unhappy lately? Have you been very unhappy lately? Have you been so very unhappy you wished you were dead? or Do you ever wish you could go to sleep and never wake up? or You know, when people are as upset as you seem to be, they sometimes wish they were dead. I'm wondering if you're feeling that way too? More direct approach: Have you ever wanted to stop living? You look pretty miserable. Are you thinking of killing yourself? Are you thinking about suicide?

Epidemiology of OCD

Lifetime Prevalence: 1-3% of population (common) Higher rates of individuals with elevated OCD symptoms Onset age: Bimodal peaks in early adolescence (10-13) and early adulthood (18-25) Often preceded by an anxiety or tic disorder Gender ratio: comparable in adolescent and adult males and females; maybe slightly more common in boys in childhood (3:2) OCD tends to be relatively stable: but the foci of symptoms can change over time

Cerebrum

Limbic system: emotions, basic drives, impulse control Amygdala: emotional memory and processing Hippocampus: regulates emotions and memory formation Basal ganglia: movement; planning Cerebral cortex: 4 lobes- frontal (executive functions); parietal (somatosensory), occipital (visual processing), and temporal (auditory processing)

How to persuade someone to get help

Listening: give full attention, don't interrupt, not judging or condemning, taming own fear so you can focus on the other person

DSM cons

Lowers diagnostic thresholds; allows for diagnosis of mild symptoms inclusion of questionable new disorders ex) disruptive mood dysregulation disorder cultural concerns

borderline personality disorder: self injury

Maladaptive self-regulatory behaviors are common self-injurious or self-mutilating behaviors ex: cutting, burning, banging head negative reinforcement --> physical act leads to relief from emotional pain -Distraction; "snap out" of emotional overload

Etiology of anxiety (cognitive)

Maladatpive; irrational assumptions: negative, automatic thoughts; focus on what's possible instead of what's probable Unrealistically high standards: negative thoughts about self Misinterpretation of bodily sensations: anxiety sensitivity in children Meta-cognitive theory: people hold negative and positive beliefs about worrying; intolerance of uncertainty (GAD) -the way we think about our thoughts is going to affect our thoughts

traumatic events stats

Males are more likely to experience traumatic events, but females who experience trauma are more likely to develop PTSD

Routines are normal

everyone has some sort of a routine; lots of people follow rituals or traditions; consider cultural and environmental context of routine: do others with the same beliefs and practices follow the routine? Consider the individual's belief system about the routine: done because of convenience or closeness to a community? Or because the routine reduces anxiety? Can the routine be interrupted or modified without distress?

meds for schizophrenia are _________ but ______________.

helpful but high risk

Therapy strategies for AN

identify and modify thought process that maintain restriction, and challenge beliefs about worth of shape and weight monitor feelings, hunger levels, and food intake to recognize patterns recognize need for independence and learn appropriate ways to be in control recognize and understand internal sensations change family interaction patterns (The Maudsley Approach)

FEAR

immediate fight-or-flight response to threat/danger

systematic desensitization is an example of

classical conditioning Extinguishes a conditioned response by forming new associations

People with BN use inappropriate ____________ behaviors, including forced vomiting, misusing laxatives, diuretics, or enemas, fasting, or exercising excessively

compensatory behaviors

Reliability is another way to say _______ 2 types of reliability:

consistency test-retest reliability inter-rater reliability: 2+ assessors make ratings on someone and get the same results

Effective QPR means ____ our emotions

controlling our emotions; it is unhelpful to fear, deny, or be angry with the person in danger

Medications for schizophrenia

conventional anti-psychotics atypical (second generation) anti-psychotics

Two main goals for treatment of eating disorders

correct dangerous eating patterns address broader psych and situational factors that have led up to, and are maintaining, the eating problem

Other emotional troubles and personal problems can trigger suicidal thoughts, but these problems also yield to _____________, ________, and _________.

counseling, support, and the passage of time

Overall prevalence is similar across countries for schizophrenia, but ________________ differs.

course and outcome

Prevention for PTSD: psychological debriefing

crisis intervention: trauma victims talk extensively about their feelings and reactions within days of the critical incident; usually in a group setting major components: normalizing responses to the disaster; encouraging expressions of anxiety, anger, and frustration; teaching self-help skills; providing referrals if needed Controversial practice: may only benefit at-risk individuals; may increase risk of PTSD for some individuals (harmful)

Multicultural treatment includes

cultural sensitive therapies: inclusion of client's cultural and moral examples; awareness of stress/social pressures/labeling that the individual might encounter; consideration of immigrant issues; awareness of conflict between one's culture and dominant culture; identification of emotional expression

Although sometimes it seems like an impulsive act, most people will think about suicide for:

days, weeks, months, or even years before they make an attempt

other symptoms of schizophrenia

declining functioning in school, work, interpersonal relations, or self care

For at least 1 month, 2 or more of the following symptoms must occur for a significant portion of time (schizophrenia diagnosis)

delusions, hallucinations, disorganized speech, negative symptoms, gross abnormal psychomotor or catatonic behavior

Common comorbidities with AN

depression (~70%) anxiety low self esteem insomnia or other sleep disturbances substance abuse obsessive-compulsive patterns perfectionism

Unipolar disorders are

depression only (no mania)

It seems counterintuitive, but psychosocial environments of ______________ countries are more supportive that _________

developing countries are more supportive than developed countries developing countries have a better long term prognosis.

Nutraceuticals for unipolar depression

effective for mild or moderate depression; not effective for severe

Suicide takes many forms and some suicide threats are __________.

efforts to control the behavior of other people

Psychosis

loss of contact with reality -the ability to perceive and respond to the environment is significantly disturbed -deterioration in functioning -symptoms may include hallucinations (false sensory perceptions) and or delusions (false beliefs)

Biological causes of Antisocial personality disorder (ASD)

lower serotonin activity (impulsivity and aggression) deficient functioning of frontal lobes (PFC) ANS abnormalities --> fearlessness or lack of anxiety -low bodily arousal interferes with learning from negative experiences -respond to stress with low brain and body arousal -may seek thrills and take risks to experience excitement/arousal Possible genetic predisposition: MAO-A gene (low activity) x environment interaction (like child maltreatment)

Dialectical Behavior Therapy (treatment for borderline personality disorder)

marsha linthan, PHD Dialetical approach: create a whole (synthesis) by finding a balance in opposing forces (CBT emphasizes change) -Acceptance AND change -Challenge AND nurture -Flexible AND stability Overarching goal --> a life worth living

Experimental Methods

maximize internal validity and guard against confounds has random assignment manipulate independent variable blind design

Limitations of unstructured clinical interview

may lack validity/accuracy interviewers may be biased or may make mistakes in judgement may lack reliability

We don't see catatonia much anymore because of what?

medications

monozygotic twins have a _____ percentage of schizophrenia, while dizygotic twins have a __ percentage

monozygotic (identical) have a 48% percentage dizygotic have a 17% percentage

Comorbidity

presence of two or more disorders in an individual at the same time

three phases of schizophrenia

prodromal, active, residual

Psychodynamic explanation of Antisocial personality disorder (ASD) etiology what causes it

psychodynamic -> lack of parental love; no basic trust; cope by being emotionally distant; bond with others through power and destruction

outcome is better for ______ onset, and or if you're ____ with first symptoms

rapid onset; older you are

Single blinding v. double blinding

single: subjects don't know whether they are in the study or control group double: experimenters and participants both do not know which participants are in the study or control group

Sociocultural contributing factors to eating disorders

societal pressures to be thin (western): celebrities, media, websites family environment: emphasis on thinness, appearance, and dieting; enmeshed [entangled] family patterns, "sick" role racial/ethnic differences in standard of beauty: the U.S. the differences are disappearing gender: different standards for women; methods of weight loss: exercise v. dieting; men: reverse anorexia, muscle dysphoria

Extraordinary stress and trauma play a critical role in

stress disorders: acute stress disorder, post traumatic stress disorder Dissociative disorders: Dissociative amnesia; dissociative identity disorder Disorders featuring somatic symptoms: conversion disorder

Stress vs stressors

stressor: external event or situation that places a physical or psychological demand on a person Stress response: Person's internal psychological or physiological response to a stressor Can be chronic or acute

Residual phase of schizophrenia

subthreshold symptoms of schizophrenia; more managed; more awareness and insight. Finally, many people with schizophrenia eventually enter a residual phase in which they return to a prodromal-like level of functioning. They may retain some negative symptoms, such as blunted emotion, but have a lessening of the striking symptoms of the active phase. Although 25 percent or more of patients recover completely from schizophrenia, the majority continue to have at least some residual problems for the rest of their lives

Behavioral exposures

systematic desensitization -face fears gradually; extinguish fear associations -create a fear/exposure hierarchy: rank from easiest to most difficult -practice and repeat

You inherit ________ not ___________

tendencies, not disorders Different disorders have different levels of heritability

Thinking of suicide provides feelings of both _______ and _______

terror and relief relief that all one's problems can be finally solved and terror at the idea of having to die to find that relief

Strengths of cognitive model

testable, appealing, and in general effective for anxiety and depress

Forebrain divisions

thalamus and hypothalamus and the cerebrum

Research has shown that once a person is asked if they are thinking about suicide...

that they feel relief, not distress. Anxiety decreases while hope increases. A chance to go on living has been offered.

Downward drift theory

the idea that low income/poverty is the effect of having schizophrenia HOWEVER correlation is not causation and is it unclear if this is the case or if stress is the cause or people become impoverished because of having schizophrenia

Prevalence

the percentage of individuals in a targeted population who have a particular disorder during a specific period of time

Point prevalence

the percentage of people with a disorder in the past month/year/etc. [specified period]

Neurotransmission

the process of transferring information from one neuron to another at a synapse

Psychiatric epidemiology

the study of the prevalence of mental illness in a society

Active phase of schizophrenia

they are meeting diagnostic criteria for schizophrenia. During the active phase , symptoms become apparent. Sometimes this phase is triggered by stress or trauma in the person's life. For Laura, the middle-aged woman described earlier, the immediate trigger was the loss of her cherished dog.

Anxiety is fear in the absence of

threat

Goals of psychodynamic therapy

to uncover past traumas and resulting inner conflicts to resolve conflicts and resume personal development to help clients achieve insight into desires and motivations; to discover and resolve conflicts themselves

T/F people who talk about warning signs often to go on to attempt or complete suicide

true

T/F most people who attempt suicide give warning signs

true; the warning signs are often given during the week preceding the attempt

onset of schizophrenia

typically onsets in late teens to mid 30s; may be precipitated by stress; earlier onset in males (23 m, 28 f), prodrome onset is between ages 15 to 25 overall there's no gender difference in lifetime prevalence but there is a difference in male onset. relapses are more likely during times of stress for schizophrenic individuals.. people who are trying to recover from schizophrenia are almost four times more likely to relapse if they live with such a family than if they live with one low in expressed emotion. people recovering from schizophrenia are considered more likely to relapse if their families rate high in expressed emotion. ppl recovering from severe disorders in day centers often do better and have fewer relapses than those who spend extended periods in a hospital or in a traditional outpatient therapy. Research has found that family therapy—particularly when it is combined with drug therapy—helps reduce tensions within the family and so helps relapse rates and hospital readmissions go down Comer, Ronald J.,Comer, Jonathan S.. Fundamentals of Abnormal Psychology (p. 1580). Worth Publishers. Kindle Edition.

___ to ___ percent of individuals struggling with schizophrenia do not utilize treatment

40% to 60%

Side effects of atypical antipsychotics

can impair immune symptom functionning; seizures, dizziness, fatigue, drooling, weight gain

Binge eating disorder is the same cycle as BN, but it excludes what?

compensatory behavior

"Shoulds"

words like should or must makes us feel guilty, like we have already failed. e.g. I shouldn't feel depressed, I'm just weak.

Prev, lifetime prev, or incidence? Almost 10% of adults have major depressive disorder in any given year

"in any given year" tells us it's point prevalence

BN subtypes

1) purging: vomiting, laxatives, or diuretics 2) nonpurging: exercise and/or fasting

Tardive Dyskinesia

A side effect of conventional antipsychotics; abnormal movements of lips, tongue, and jaw; may involve the trunk or arms as well.

With the rise of the drug revolution in the 1950s, what occurred?

Deinstitutionalization (from nearly 600,000 patients to less than 100,000)

Prev, lifetime prev, or incidence? Approximately 15% of individuals living in the U.S. will experience depression during their lifetime

"During their lifetime" tells us it's lifetime prevalence

Generalized Anxiety

"Everyday" threats and worries

Prev, lifetime prev, or incidence? Approximately 10% of adolescents will experience a first episode of depression this year?

"First episode" tells us it's new cases. Therefore, incidence

Direct verbal clues of suicide (Examples)

"I've decided to kill myself" "I wish I were dead" "I'm going to commit suicide" "I'm going to end it all" "If (such and such) doesn't happen, I'll kill myself"

restricted affect

(blunt/flat affect); exhibiting little or no emotional expression in face or voice. ex) stoic

Alogia

(lack of)/poverty of speech/content

Delusions of control

(more specific than persecution) people are trying to take over their mind ex) thought insertion

Biological contributing factors for Borderline personality disorder

*Prefrontal cortex (underactive) *Amgydala (overactive) *Genes: close relatives 5x more likely to have BPD *Lower brain serotonin activity (impulsivity; suicide attempters) [hypothalamus, somatosensory cortex, thalamus]

Treatment for AN: main goal

*restore healthy weight*

weaknesses of sociocultural model

- Research is difficult to interpret - Correlation does not equal causation - Model unable to predict abnormality in specific individuals

Similarities between AN and BN

-Preoccupation with food, weight, appearance/fear of becoming obese/drive to become thin -Distorted body perception -Feelings of anxiety, depression, obsessiveness, and perfectionism -Substance abuse -Risk for suicide attempts

Limitations of biological model

-Reductionistic in that it doesn't consider the environment/non-biological factors -Difficult to isolate effects of genes, NTs, etc. -Treatments can have undesired side effects

Strengths of the psychodynamic model

-Saw abnormal functioning as rooted in same processes as normal functioning. -Systematic application of theory to treatment

Dialectical behavior therapy (DBT treatment priorities for borderline personality disorder

-decrease self-harm, life threatening homicidal, sucidal behaviors -decrease therapy-interfering behaviors (e.g. noncompliance, dropout, reactions to therapist) -decrease depression, drug abuse, impairment (e.g. school dropout), criminal behavior, i.e., anything that decreases quality of life -increase behavioral skills

Strengths of the biological model

-good research evidence of links between biological processes and behaviors -biological treatments are general pretty effective

Persuasion works best when

-persist in statements that suicide is not a good soln and suggest that better alternatives can be found -focus on solns to problems, not the suicide soln -accept the reality of the person's pain, but then offer alternatives -offer hope in any form and in any way

Anorexia Nervosa Symptoms

-restriction of energy intake relative to requirement leading o a significantly low body weight in the context of age, sex, developmental trajectory, and physical health -DSM5 intense fears of becoming overweight -distorted view of weight and shape

DSM 5 Criteria for Acute and PTSD

1) trauma is re-experienced through intrusive and distressing recollections (e.g. flashbacks, nightmares, etc) 2) avoidance of things that remind you of the event (e.g. people, places) 3) Negative changes in mood and cognitions (e.g. impaired memory of event, self-blame, loss of interest, emotional numbing (e.g. survivor's guilt) 4) Heightened arousal and reactivity (e.g. irritability, reckless behavior, startle response, difficulty concentrating, sleep problems)

DBT Skills modules (borderline personality disorder how can we help)

1) Mindfulness: focused attention 2) Distress tolerance: surviving crises (wise mind); accepting reality (radical acceptance) 3) Interpersonal effectiveness: assertiveness 4) Emotion regulation: de-escalation skills; reduce emotional episodes (opposite action)

Four major psychotropic drug groups

1) anti-anxiety: minor tranquilizers, anxiolytics, and anti psychotic 2) antidepressants 3) Antibipolar drugs: mood stabilizers 4) Antipsychotic drugs: reduce confusion, hallucinations, and delusions; marked by a loss of contact with reality

Important considerations for ASD and PTSD

1) magnitude of traumatic event (e.g. there's a diff between experiencing it v. just hearing about it) 2) level of danger involved 3) individual's characteristics and perception of event (e.g. anxious people are more prone to PTSD)

To access (involuntary) treatment professionals

1-800-273-TALK or 1-800-SUICIDE (784-2433)

Types of depressive disorders

1. Major Depressive Disorder(MDD) (unipolar) -episode of depression, then periods of time you don't meet criteria. presence of at least one major depressive episode. no history of a manic or hypomanic episode 2. Persistent Depressive Disorder (also called dysthymic disorder): more chronic/persistent, but lower grade; minimum of 2 years. symptoms are present most of the day for more days than not during a two year period with no more than two months symptom free. mild/chronic depression. Ongoing presence of at least two symptoms:Feelings of hopelessness, Low self-esteem, Poor appetite or overeating, Low energy or fatigue, Difficulty concentrating or making decisions, Sleep difficulties 3. Premenstrual Dysphoric Disorder: depressive symptoms the week before menstruation

Prevalence of Schizophrenia

1.1% of the population (no gender diff) (lifetime prevalence)

Prison inmates

16-20% mentally ill undertreated mental health court

Schizophrenia's high cost to society

2.5% of all U.S. health care expenditures 10% of those permanently disabled 25% of the people who are homeless (some psychosis)

What percentage of youth suffer from a diagnosable mental disorder?

20-40%

what percentage of people with schizophrenia attempt suicide?

25% for number of reasons; like hopelessness, paranoia, etc.

Schizophrenic Recovery in __ of cases

25% (1/4) of cases

What percent of adults in the U.S. have a mental health disorder any given year?

25%(to 30%)

DSM 5 Criteria for Borderline personality disorder

5 or more: 1) extreme attempts to avoid real or imagined abandonment 2) Impulsivity that is potentially self-damaging 3) anger control problems 4) Lack of a sense of self, or unstable self image 5) Recurrent suicidal behavior or self-mutilating behavior 6) Dissociation or paranoid thoughts that occur in response to stress. 7) Chronic feeling of emptiness 8) Intense and unstable interpersonal relationships 9) Affective instability due to a marked reactivity of mood primary problems with poor emotion regulation and interpersonal difficulties

Duration of schizophrenia and lifetime prevalence

6 months or more; 1% lifetime prevalence

Intrusive thoughts are normal

80-98% of adults report experience of of occassional intrusive thoughts The content of these thoughts are similar to content of obsessions in OCD Intrusive thoughts can be exacerbated by stress and eventually subside The difference between OCD and a random intrusive thought I'd what you do with the thought

Weight set point theory (what causes eating disorders) biological factor

A predisposition to maintain a certain weight level, in part by the hypothalamus -may shut down in anorexia -may spiral into binge-purge pattern

What is a delusion?

A false fixed belief

Typical case of anorexia

A norml to slightly overweight female has been on a diet escalation toward AN may follow a stressful event -separation of parents, move away from home, experience of personal failure many patients recover with treatment -however, many struggle for many years

DSM 5 criteria for antisocial personality disorder (APD)

A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by 3 or more of the following: 1) chronic failure to conform to social and legal codes (grounds for arrest) 2) deceitfulness (repeated lying, aliases, conning others for personal profit/pleasure) 3) impulsivity or failure to plan ahead 4) irritability and aggressiveness (physical fights, assaults) 5) reckless disregard for safety of self or others 6) consistent irresponsibility (lack of accountability) 7) lack of remorse also at least 18 years of age evidence of conduct disorder onset before age 15

Exposure/Response Prevention (ERP)

A special type of CBT Exposures: slowly facing feared stimuli in a graded, step by step, way Response Prevention: Resist or modify rituals for shorter, then longer, periods of time Learn over time to tolerate distress associated with intrusive thoughts without compulsions e.g. exposure hierarchies

Sociocultural Model

Argues abnormal behavior is best understood in light of the social and cultural forces that influence an individuals Focuses on norms and roles in society 2 major perspectives

Anxiety Epidemiology

As a class, anxiety disorders are most common mental illness 1 year prevalence of any anxiety disorder is 18% Lifetime prevalence of any anxiety disorder is 29% More common in women across the board (except OCD) Most anxiety disorders onset earlier in life age 11 is average of of onset but panic disorder is rare before adolescence (same with agoraphobia)

CBT for schizophrenia

Adjunct to medication; better suited for some patients Teach clients to re-attribute or more accurately interpret their hallucinations/delusions Identify which psychotic symptoms they experience and what triggers those symptoms. -Catch it early before it becomes a full blown psychotic episode -stress management and coping enhancement

schizophrenia heritability

HIGH heritability

New wave cognitive therapies involve

Acceptance and Commitment Therapy (ACT) includes mindfulness techniques -Accept thoughts rather than to judge them or try to change them "thoughts are just thoughts" and move on -Act in accord with values and commitments =thinking isn't doing; conscious choices despite thoughts; better for people resistent to thought-challenging, like OCD

strengths of sociocultural model

Added greatly to the clinical understanding and treatment of abnormality Increased awareness of clinical and social roles Clinically successful when other treatments have failed

Trichotillomania

Hair pulling disorder think "Trich(a) pulls her hair"

Common thinking errors

All or nothing thinking overgeneralizing mental filter: only paying attention to certain types of evidence jumping to conclusions Magnification (catastrophising) Should/must/ought emotional reasoning: Assuming that because we feel a certain way that it must be trye labeling disqualifying the positive personalisation: blaming yourself or taking responsibility for something that wasn't completely your fault. Conversely, blaming other people for something that was your fault.

Projective tests

Ambiguous stimuli and open responses ex) Rorschach ink blot, thematic apperception test

If people at risk refuse to get help

Are they a danger to themselves? If yes, time-limited treatment. Crisis resolution, counseling, and, if desired, medication. Involuntary treatment law.

Trephination

An ancient operation in which a stone instrument was used to cut away a circular section of the skull, perhaps to treat abnormal behavior.

Trauma

An experience (stressor) that threatens physical integrity or life and that overwhelms an individual's capacity to cope -can also be repeated or extreme indirect exposure *PTSD must have an identifiable traumatic event Generally, traumatic events evoke feelings of extreme fear and helplessness

Medication for bulimia

Antidepressants may enhance psychological treatment; no long-term efficacy

Common comorbidities with BN

Anxiety (80.6%) Mood disorders (50-70%) Substance abuse (36.8%) Personality disorder (~1/3) [highly co-morbid with Tend to be more impulsive

Comorbidities with PTSD

Anxiety disorders depressive disorders ADHD (externalizing) Substance use disorder

Anxiety Comorbidity

Anxiety is hard to study because so few people have just one type (19%) Two or more independent anx disorders (26%) To or more anxiety disorders, one caused by the other (55%) Comorbidity within anxiety disorders is very common eg) Separation anx when young can lead to panic disorder later; they have similar underlying causes

Cluster C (check lecture)

Anxious, fearful avoidant (fear of rejection and humiliation, reluctance to enter into social relationships), dependent, obsessive compulsive

Gatekeeper

Anyone in a position to recognize a crisis and warning signs that someone may be contemplating suicide

Dialectical behavior therapy DBT structure for borderline personality disorder

Approximately 1+ year of therapy, consisting of -individual therapy: weekly sessions, telephone skills coaching, telephone crisis management -Skill training (groups of 5-10 people): cannot talk about self-injury or suicidal intent/behavior; very structured; didactic format

Clinical assessment: neurological tests

Assess for abnormalities in brain functioning or structure EEG: measures electrical brain activity through the scalp CT scan: x rays get image of brain PET scan: radioisotopes detect brain activity MRI: magnetic field and radio waves to get brain image fMRI: measure oxygen levels to detect brain activity

Labeling

Assigning labels to ourselves or to other people e.g. Because you make a mistake, you star to think that you are a "loser."

Bipolar I

At least one episode of fill mania

Cognitive causes of Antisocial personality disorder (ASD)

Attitudes that trivialize that needs of others difficulty recognizing a point of view other than their own

First line of treatment for schizophrenia

Atypical antipsychotics (which are also safer)

Two types of hallucinations

Auditory: (most common) -hearing commenting, arguing, and a "committee in my head" can be hard to distinguish what's being said Visual: seeing things

Developmental consideratons for Antisocial personality disorder (ASD)

Before age 15: truancy, running away, cruelty to animals and people, destroying property, enuresis (bed wetting) Cannot be diagnosed before age 18 -usually conduct disorder or oppositional defiant disorder before age 18 callous-unemotional traits

Mindfulness

Being in the present moment, with awareness, without judgement

How can we help: evidence based treatments for anxiety

Best treatment is antidepressants AND therapy (both is best) can have meds (antidepressants), psychotherapy like SSRI + CBT/BT -in milder cases one or the other works well

Case studies: limitations

Biased observers, subjective evidence; little basis for generalization

Empirically supported treatments for PTSD

Biological: SSRIs (Paxil, Zoloft) Psychological: prolonged exposure (PE); Cognitive Processing Therapy (CPT); Trauma-Focused Cognitive Behavior Therapy (TF-CBT), Eye movement desensitization and reprocessing (EMDR): controversial; active ingredient may be the exposure

Biological model explains ab behav through

Brain anatomy, brain chemistry, and other biological sources like genetics, evolution, illness, and injury

For OCD, ignore the __ in CBT

C: cognitive: attempts to neutralize thoughts doesn't work, and trying to suppress results in rebound Rationalizing thoughts doesn't let the obsession be disconfirmed Reframing thoughts results in continued beliefs that thoughts are more important than they actually are

Mental Health Services at CSULB

CAPS: Counseling and Psychological Services: helps students with personal challenges and meeting goals (academic, career, and life) -Counseling services, individual and group counseling, and group counseling; drop-in groups; psycho-educational presentations Project OCEAN: on campus emergency assistance network: suicide prevention education; reduce stigma Not Alone @ the Beach Sexual Assault Survivor's Advocacy

PTSD Therapy techniques

CBT for trauma -psychoeducation about pTSD and treatment rationale -exposure -identify faulty thinking related to traumatic event (becoem less judgemental toward themselves) -stress management -muscle relaxation *Exposure therapy is key!!* -expose patient to the *memory* of the event (gradual, controlled, repeated exposure to trauma narrative) -Expose patient to cues associated with trauma to allow for extinction of fear response

Adjunctive therapies

CBT, family therapy, community-based approaches

What are the four main approaches in clinical science

Case study and correlational method (observational) experimental and quasi-experimental

Breaking the OCD cycle with CBT

Change BEHAVIORS(Compulsions) because it's easier to change a behavior than a thought

Prodrome phase of schizophrenia

Changes in behavior are noticable, but not meeting criteria for diagnosis; usually 1-3 years; functioning starts to decline; subthreshold symptoms of schizophrenia. During the prodromal phase , symptoms are not yet obvious, but the person is beginning to deteriorate. He or she may withdraw socially, speak in vague or odd ways, develop strange ideas, or express little emotion.

Bulimia nervosa

Characterized by (DSM criteria) Binges: Repeated bouts of uncontrolled overeating during a limited period of time Sense of lack of control over eating Inappropriate compensatory behaviors, including forced vomiting, misusing laxatives, diuretics, or enemas, fasting, or exercising excessively Base self-evaluation on weight/shape Symptoms occur ~1x/wk for 3 months *Most are generally within 10% of normal weight *Often guilt and secrecy

Cultural considerations Prevalence is not universal

China- ) 60 % of DSM IV anxiety disorder NOS Panic Disorder → much higher in U.S. ( 4.7-5.1 % ) than Nigeria , Korea , China Japan 1.0 % Social AnxietyHigher in U.S. than non-Euro countries, but almost 50 % Udmurtia ( Constituent Republic of Russian Federation) Why not ? True differences prevalence ? Cross-cultural validity of diagnostic criteria? Measurement bias?

Etiology of anxiety (behavioral)

Classical conditioning of fears and phobias (e.g. Little Albert) Operant conditioning: avoidance behaviors are reinforced and maintain the anxiety (avoidance is relief through negative reinforcement) Modeling/social learning: anxious kids tend to have anxious parents

We learn in one of three ways

Classical conditioning, operant conditioning, or modeling/social learning

Etiology of OCD: behavior

Classical conditioning: it only takes one trial to learn a new behavior. Operant conditioning: at some point, you experience relief after doing a ritual "Since that made me feel good, next time I feel bad I'll do a ritual to feel better" This association strengthens each subsequent ritual Eventually generalization to new scenarios occurs.

CBT for depression

Cognitive restructuring -> coping skills, behavioral activation, problem solving, effective communication -->relaxation (and psychoeducation)

Treatment through CBT

Cognitive restructuring <--> behavioral exposures <--> relaxation

How prevalent is PTSD given diff traumatic events

Combat: 29% of Vietnam vets met criteria for PTSD; OEF/OIF veterans ~20% met PTSD criteria -not all had direct combat experience -45% reported witnessing death or gravely wounded -10% direct injury or hospitalization -Multiple deployments increase risk Car accidents: ~40% (adult or youth) develop PTSD within a year Sexual assault ~94% of rape victims develop ASD ~1/3 later develop PTSD

Biosocial Theory (Borderline personality disorder)

Combination of internal and external forces (cause BPD) Internal --> difficulty indentifying and controlling one's emotions (emotional vulnerability) External --> emotions are punished, misinterpreted, or disregarded (invalidating environment) This combination of these forces may result in individuals who do not properly learn how to recognize, control, or tolerate emotional distress Often (but not always) associated with a history of abuse (emotional, verbal, physical, sexual), loss, neglect

OCD Symptom clusters

Contamination Harm avoidance Ordering/arranging Counting/repeating Scrupulosity Hoarding

Multicultural perspective

Cultural context (values, attitudes, beliefs, normative behaviors), ethnicity, and gender affect behavior

Prevalence of PTSD

Current prevalence: 3.5% (it's not easy to meet criteria) Lifetime prevalence: ~7-9% Those who have ever had it Of those exposed to a traumatic event, women are twice as likely than men to develop the disorder: 20% v. 8%

Emil Kraeplin

DSM godfather; perceived somatogenic factors as cause of abnormal behavior (e.g. physical/brain disease as cause)

DBT outcomes (borderline personality disorder how can we help)

DBT associated with: fewer suicidal behaviors and hospitalizations increased ability to tolerate stress less anger greater social satisfaction improved work performance reduction in substance abuse more appropriate social skills

Depression: behavioral factors

Depression from insufficient reinforcement -positive relationship between the number of rewards and the presence and absence of depression -strong relationship between positive life events and life satisfaction and happiness -social rewards are particularly important Also, social learning and modeling of poor coping can play a role

Depression and suicide

Depression might make someone too tired to carry out suicidal intentions, but if they start to feel well enough they might. Depression is very common but also very treatable.

Etiology of depression: sociolcultural (family-social) perspective

Depression repeatedly linked to the unavailability of social support e.g. people who are separated or divorced display 3x the depression rate of married or widowed persons and 2x rate of people who have neber been married people who are isolated without intimacy are more likely to be depressed during stressful times behavior of depressed parents: less affectionate, more frustrated

Abnormal psych attempts to

Describe (a set of behaviors) Explain Predict and change/modify behaviors

Challenges in neuropsych testing

Determining premorbid functioning (functioning before mental illness); measuring change over time [practice effects]; malingering (exaggeration of illness to get out of responsibilities); differential diagnosis (multiple pathologies)

Psychodynamic Model

Deterministic assumption that no symptom or behavior is accidental

Cultural differences for schizophrenia

Developing countries have more support and less stigma Western countries have a huge emphasis on biology *indigenous belief systems influence etiology and treatment

Common features of abnormality (4 D's)

Deviance, distress, dysfunction, and danger

Acute v. PTSD

Differ in onset: ASD is within 4 weeks PTSD is any time after (longer than a month) [So ASD can become PTSD] Differ in duration: ASD is 2-28 days PTSD lasts longer than a month Likely to receive initial diagnosis of ASD and then PTSD if symptoms persist longer than a month (80%) Cannot have both

Clues and warning signs to suicidality

Direct verbal clues Indirect or coded verbal clues Behavioral clues situational clues

Disqualifying the positive

Discounting the good things that have happened e.g. You believe everyone dislikes you, so you think there is something wrong with a person who is nice to you

Behavioral clues (examples)

Donating body to a medical school purchasing a gun stock-pilling pills putting personal and business affairs in order making or changing a will taking out insurance or changing beneficiaries making funeral plans giving away money or prized possessions changes in behavior, especially episodes of screaming or hitting, throwing things, or failure to get along with family, friends or peers Suspicious behavior like going out at odd times waving or kissing goodbye if not characteristic sudden interest or disinterest in church or religion scheduling an appointment with a doctor for no apparent physical causes, or very shortly after the last routine visit loss of physical skills, general confusion, or loss of understanding, judgement or memory Relapse into drug or alcohol use after a period of recovery

Treatment for Bulimia

Eliminate binge-purge patterns establish healthier eating habits address underlying cause of bulimic patterns strategies similar to AN: monitoring, recognizing patterns; challenge maladaptive thoughts exposure and response prevention to break binge-purge cycle

Weaknesses of the behavioral model

Neglects inner determinants of behavior unclear if all abnormal behavior is acquired in this way Difficulty generalizing behaviors outside of treatment setting

Treatment of bipolar depression: adjunctive psychotherapy

Emphasis on psychoeducation about bipolar disorder symptoms and causes; medication management; problem solving around family, social, school, and occupational problems. Helps to reduce hospitalization improve social functioning and ability to stay employed

Correlational studies

Epidemiological (incidence and prevalence) and longitudinal Pros: many participants improves generalization; can be replicated; uses stats Cons: doesn't explain relationship "correlation is not causation"

Generalized Anxiety Disorder (GAD)

Excessive or ongoing worry about two or more activities; symptoms present for at least 6 months Plus 3 the following: restlessness, fatigue, poor concentration, irritability, muscle tension, sleep problems Individual finds it difficult to control the worry Significant distress or impairment Develops gradually, beginning in childhood and adolescence High co morbidity depression

Humanistic Existential Model

Existential therapy: accept responsibility for own life and to live with greater meaning and value focuses on human need to successfully deal with philosophical issues self-actualization; recognitzing and accepting needs Abnormal behavior as the result of hiding from life's responsibilities

Four primary methods of psychodynamic treatment

Free association, therapist interpretation (resistance, transference, dream interpretation, catharsis, and working through

Common medical consequences of BN

From vomiting: erosion of tooth enamel, dehydration, lower potassium, and swollen parotid glands (swelling in face) from binge eating: stomach rupture (also can't feel fullness cues) Gastrointestinal disturbances: inflammation of esophagus, gastric and rectal irritation

Etiology of depression: sociocultural (multicultural perspective)

Gender differences: artifact theory, hormones, life stress, body dissatisfaction, lack of control, rumination Cultural factors: physical symptoms, recurrence of episodes, within group variation

Bipolar depression: biological factors

Genetic: heritability estimates range from 65-93%; 40% of identitical twins; 5-10% in families v. 1-2.6% in general population Neurochemical activity: neurotransmitter abnormalities: high levels of norepinephrine and dopamine; low levels of serotonin Ions: irregular transport of ions with a neuron; fire too easily (mania) or resist firing (depression) Neuroanatomy: abnormalities in basal ganglia and cerebellum (smaller), as well as amygdala, hippocampus, and PFC

Biological contributing factors for eating disorders

Genetics: MZ twin concordance especially high for anorexia (~70%)/(~23% for bulimia) Low levels of serotonin: may cause bodies to crave and binge on carbs Hypothalamus: lateral produces hunger; ventromedial reduces hunger weight set point theory A predisposition to maintain a certain weight level, in part by the hypothalamus May shut down in anorexia May spiral into binge-purge pattern

Standarization and norming

Gives consistency (reliability and validity) allows for meaningful interpretation requires an appropriate comparison group think SAT exam

Etiology of depression: biological factors

High heritability genetics: MZ twins (46%); fraternal (DZ) twins (20%) Immune system dysregulation: reduced lymphocytes (white blood cells); increased C reactive protein (causes inflammation) Neurotransmitter activity: low levels of norepinephrine and serotonin; may be linked to genes responsible for serotonin activity These are correlational: not sure if cause or result

Diagnoses require

Higher (deviance/danger) and distress Functional impairment (dysfunction) symptoms

Three major divisions of the brain

Hindbrain: for primitive functions Midbrain: for basic functions; make neurotransmitters Forebrain: higher mental functions like learning speech, thought, emotion, and memory [executive functions]

Obsessive-compulsive-related disorders

Hoarding disorder ロ Trichotillomania ( hair - pulling disorder ) Ex disorder ( skin - picking ) Body dysmorphic disorder

Indirect or coded verbal clues (examples)

I'm tired of life What's the point of going on? My family would be better off without me Who cares if I'm dead anyway I can't go on anymore I just want out I'm so tired of it all You would be better off without me I'm not the person I used to be I'm calling it quits, living is useless Soon I won't be around You shouldn't have to take care of me any longer Soon you won't have to worry about me any longer Goodbye, I won't be here when you return It was good at times, but we must all say goodbye You're going to regret how you treated me You know, son, I'm going home soon Here, take this (cherished possession); I won't be needing it Nobody needs me anymore How do they preserve your kidneys for transplantation if you die suddenly

Mind reading

Imagining we know what others are thinking e.g. When you wave at someone and they don't wave back, you assume they are mad at you

treatment of schizophrenia: Community care settings

Impatient hospitalization: -stabilization; milieu therapy; token economies Community approaches social therapy Partial hospitalization Occupational training and support -social therapy the broadest approach for treating schizophrenia. Some of the key features of effective community care programs are (1) coordination of patient services, (2) short-term hospitalization, (3) partial hospitalization, (4) supervised residencies, and (5) occupational training. milieu therapy: A humanistic approach based on the premise that institutions can help patients recover by creating a climate that promotes self-respect, responsible behavior, and meaningful activity. patients can run their own lives and make their own decisions. token economy program: A program in which a person's desirable behaviors are reinforced systematically by the awarding of tokens that can be exchanged for goods or privileges. In the 1950s, clinicians interested primarily in behaviors and in principles of learning discovered that the systematic use of operant conditioning techniques on hospital wards could help change the behaviors of patients with schizophrenia and programs that apply these techniques are called token economy programstabi

How common are traumatic events?

In the National Survey of Children's Exposure to Violence more than half (60.6%) of the sample experienced or witnessed victimization -almost half (46.3%) experienced physical assault -1 in 10 (10.2%) experienced child maltreatment -6.1% had experienced sexual victimization -More than 1 in 4 (25.3%) had witnessed domestic or community

Antidepressants: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Increase serotonin and nor-epinephrine ex) venlafaxine (effexor) and Duloxetine (cymbalta) May be especially helpful for GAD; relatively new

Diathesis Stress Model

Individual vulnerability x experience. Diathesis is another way of saying vulnerability. Stress is like a change, doesn't have to be stressful. Diathesis can be: genetics, temperament, sensitivity to startle Stress can be individual, cultural, and societal influences

Cultural considerations Culture-specific symptoms of anxiety

Japan → Taijin kyofu - sho ( TKS ) Fear of offending others (e.g., by odor, gaze) Latin AmericansAtaque de nervios Acute anxiety, uncontrollable crying/screaming, hot flushes, S aggression/suicidality; precipitated by stressor Cambodia khyâl (wind) attacks o Tinnitus, neck soreness o Eastern Asia koro; fear of penile retraction African - American → sleep paralysis crawling through skin / skull

Obsessions and compulsions often linked but not always

Just right symptoms Younger youth often deny experience of obsessions

Modeling/social learning

Kids are sponges Bobo Doll experiment

Common characteristics of Antisocial personality disorder (ASD)

Law breaking; unreliable and insincere; lack of anxiety and guilt; superficial charm and good intelligence; shallow emotions and lack of empathy; blame the victim; arrogant and inflated self-esteem; believe everyone is out for themselves

Etiology of bipolar depression: social-environmental

May be precipitated (triggered) by stressful life events like unexpected loss, financial problems, general medical illness, major life changes coping skills (routine, and social support too) play an important role difficult relationships: family conflict is associated with likelihood of doing well drug abuse: can kickstart a manic episode; as can lack of sleep An event may not be identifiable

Clinical assessment: neuropsychological testing

Measurement of cognitive, perceptual, and motor performances to determine potential neurological or psychiatric disorders Diagnostic, descriptive, treatment, and surgical planning ex) executive functioning tests -trail making test, Rey complex test, stroop test ex) visuospatial deficits: difficulties with spatial judgment, spatial localization, visuospatial construction (design copying)

Treatment for schizophrenia

Medication and adjunctive therapy! Medications (most effective - this is usually necessary) Conventional antipsychotics Atypical (second generation) antipsychotics Reduce symptoms in ~70% of cases CBT Family therapy Community-based approaches Note: 40% to 60% of individuals struggling with schizophrenia do not utilize treatment

Cyclothymic disorder

Milder, chronic form of bipolar disorder Numerous periods with hypomanic and mild depressive symptoms (not fill-blown episodes of either) 2+ years; only very brief periods of wellness

Alternative experimental methods

Natural experiments: observe the effects of naturally occurring events Analogue experiments: experimenter produced abnormal behavior in a lab setting Single-subject design: subject is measured before and after manipulation (ABAB, reversal design)

Social Phobia

Negative evaluation from others Intense fear of being scrutinized or doing something embarrassing or humiliating in the presence of others (in kids, must occur with peers; can appear as crying/tantrums/freezing) Generalized versus performance type Fear that will act in a way or show anxiety symptoms that will be negatively evaluated Fear is out of proportion Can be chronic or disabling

Higher prevalence in African Americans in the US for schizophrenia, but why?

Misdiagnosis, bias and stereotyping, economic status

Behavioral/learning (etiology of Antisocial personality disorder (ASD)

Modeling and imitation: presence of poor models and lack of positive role models aggressive behavior was reinforced [e.g. lying gets me what I want so I'm gonna continue to lie] Poor conditioning to fear (low anxiety)

DSM pros

Moves away from categorical system and towards a dimensional one (still categorical though) developed to increase reliability and validity

Multipath (biopsychosocial) model

Multiple pathways to abnormal behavior; integrates several approaches

Etiology of OCD: Cognitive Biases

My thoughts are dangerous and I need to get rid of them; attempts to neutralize don't work. Attempts to neutralize also strengthen links between bad thoughts and bad feelings (can become compulsions) Thought-action fusion: thinking it is as bad/the same as doing it. Inflated sense of responsibility: I am responsible for harm comong to others; low probability of outcome doesn't change that I'm responsible Low levels of cognitive control over thoughts: I can't control my thoughts and it really bothers me; my thoughts need to be perfect or all good

Biological Causes of schizophrenia: Neurotransmitter activity and neuroanatomy

Neurotransmitter activity -dopamine hypothesis: excess dopamine as cause -Newer research suggests relation to serotonin levels (serotonin plays a big regulatory role) positive symptoms. Neuroanatomy -Abnormal interconnectivity of brain circuitry -PFC, subsantia nigra, striatum, thalamus, hippocampus (see Fig. 12-3) -Enlarged ventricles (brain cavities) -Smaller temporal and frontal lobes -Smaller amounts of grey matter, abnormal blood flow Negative symptoms

Bipolar disorders: epidemiology

No gender diff in prevalence rates (~1-2.6%) cultural variability: no evidence of ethnic/cultural variabilirt in prevalence rates more common in low income individuals Average onset: ~25 years old Societal consequences: "Severe" mental illness: 1/3 are unemployed a year after hospitalization High risk for completed suicide

Antisocial personality disorder (ASD) and homicidal behavior

Not all APD are serial killers; behaviors occur on a spectrum. many break laws and show aggression; not all kill. Not all killers have APD The disorders that killers do have (sometimes) are schizophrenia, bipolar, severe mood, ptsd, or other personality disorders like borderline, schizotypal, and antisocial) common traits shared by killers: severe feelings of anger/resentment, being persecuted or mistreated, or desire for revenge Which disorders do killers have? Not all killers have a diagnosable DSM disorder, but common ones include: Schizophrenia; bipolar; severe mood, ptsd, or other personality disorders (borderline, schizotypal).

Etiology of OCD: Neurobiology

Not enough neurotransmitter production: serotonin: mood, memory, and learning Glutamate: excitatory and inhibitory behavior, especially for executive functioning Structural and functional abnormalities: these areas get too excited and can't calm down: Cingulate cortex: emotion formation, processing, learning, and memory Orbitofrontal conrtex: emotions, rewards, decision making Amygdala: Emotions, faces, danger, and threat Caudate nucleus and basal ganglia: motor processing and ritualistic behavior *Note: it's due to dysregulation in how the regions communicate with one another*

Antianxiety medications

Not the best treatment! An avoidance strategy Benzodiazepines provide immediate relief Increase GABA (inhibitory) ex) alprazolam (xanax), lorazepam (ativan), diazepam (valium), clonazepan (klonopin) short term management might lead to tolerance and dependence

Current treatments for Antisocial personality disorder (ASD)

Not very effective because APD people have lack of conscience and desire to change -need to focus on antisocial youths who appear amenable to treatment and involve families and peers Behavioral and cognitive approaches: therapist must build rapport and guide APD toward higher levels of thinking regarding self and others (moral issues); create a therapeutic community. ineffective. major obstacles to treatment include the individuals lacking a conscience, a desire to change, or repeat for therapy. medication: atypical antipsychotics: no systematic evidence

OCD cycle

Obsessions, compulsions, and relief going back and forth in any direction anxiety causes obsessions and compulsions, doing the compulsions provides relief (as a form of negative reinforcement)

Cluster A (personality disorder) (check lecture)

Odd, eccentric -Paranoid (unwarranted suspiciousness, hypersensitivity, reluctance to confide in others), Schizoid (socially isolated, emotionally cold, indifferent to others), and Schizotypal (peculiar thoughts and behaviors, poor interpersonal relationships

Manic episode criteria

One week or longer period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, for most of the day nearly every day and presence of at least 3 of the following: inflated self-esteem or grandiosity; decreased need for sleep; increased talkativeness, or pressure to keep talking, flight of ideas or the experience that thoughts are racing; distractability; increase in goal-directed activity or psychomotor agitation; excessive involvement in activities that have a high potential for painful consequences also significant distress or impairment

BN onset and prevalence

Onset: age 15-21 90-95% females Up to ~5% in Western countries (~25-50% have symptoms) Higher rates in college students

Anxiety: Epidemiologic Statistics

Overall ethnic minorities (except with social anxiety) are at a higher risk of developing anxiety and OCD

sociocultural factors: cultural differences schizophrenia

Overall prevalence is similar across countries, BUT course and outcome of schizophrenia differs! Psychosocial environments of developing countries (more likely to recover) more supportive than developed countries? Higher prevalence in African Americans (U.S.) due to Misdiagnosis? Bias and stereotyping? Economic stress?

Borderline personality disorder mnemonic PRAISE

P --> paranoid ideas R --> relationship instability A --> anger; affect; abandoment I --> impulsive behavior; identity disturbance S--> suicidal behavior E --> emptiness

Delusion of persecution

People out to get you; ex) paranoia

Delusions of reference

People thinking things are referring to them when they're not ex) receiving special messages

Diathesis stress relationship with schizophrenia

People with a biological predisposition will develop schizophrenia only if certain kinds of stressors or events are also present

PTSD Etiology: cognitive and behavioral perspectives

Personality and cognitive risk factors: -trait anxiety or pre-existing anxiety or depression -View that negative events are beyond one's control -Inability to perceive positive meaning Behavioral factors -classical conditioning between the cues associated with the trauma and fear response -operant conditioning: avoidance Protective factors: -high intelligence -positive attitudes and cognitive styles

positive symptoms of schizophrenia (excess)

Positive meaning things that are added on/excess Hallucinations -> Sensory experiences in the absence of sensory stimulation Auditory: Voices commenting, arguing, "committee in my head" Visual disorganized thinking and speech thought disorder - loose associations( derailment; "word salad"); neologisms (made up words) -perserveration [repeating words or statements] -clang [rhymes] inappropriate affect: incongruent with situation eg) laughing when talking about mother's death

Depression criteria

Presence of 5 or more of the following symptoms, including 1 of 2 (cardinal) symptoms: 1*) Daily depressed mood for most of the day 2*) Daily diminished interest or pleasure in almost all activities for most of the day (anhedonia) 3) change in sleep patterns (more or less) 4) Change in appetite or weight (eating more or less) 5) Psychomotor agitation or psychomotor retardation (lethargy) 6) Loss of energy, fatigue 7) Feelings of self-blame, worthlessness, guilt 8) Difficulty concentrating, indecisiveness 9) Thoughts of death or suicide (very common, passive too) For at least 2 weeks, most of the day, more days than not Impairment in daily functioning

MDD

Presence of at least one major depressive episode No history of manic or hypomanic episode

Bipolar II

Presence or history of both depressive and hypomanic episodes no history of a full manic episode

Depression epidemiology

Prevalence of MDD: 8% of adults currently 19% lifetime 26% women (1/4 of women); 12% of men Average onset is mid-late 20s 5-12 years is 5% (no gender diff) 13-17 years is 19% (gender diff emerges) 18-23 years 24% (most onset is during late adolescence, early adulthood) 24-30 years is 16% More common among ppl in poverty

Prevalence and course of BPD

Prevalence: 1-2.5% of the general population 3 times as many women than men (but maybe it looks different in men?) instablity and risk for suicide peak during young adulthood (decreases as they get older) Interferes with job performance and interpersonal relationships high comorbidity --> anxiety, depression, substance use, and eating disorders (especially bulimia)

psychological contributing factors to eating disorders

Psychodynamic: ego deficiencies, ineffective parenting cognitive: distorted perceptions of bodies and internal sensations behavioral: positive reinforcement of weight loss (early stages); negative reinforcement of tension (binges)

Schizophrenogenic mothers

Psychodynamic; little supprt. Rejected by most psychodynamic theorists. Rejected idea; "refrigerator mothers" are cold moms, unloving

Psychotherapeutic Interventions for Schizophrenia

Psychoeducation: helpful for families too Individual Cognitive-Behavioral Therapy: may be helpful for higher functioning individuals. hallucination reinterpretation and acceptance. cognitive remediation to help with attention, planning, memory and problem solving. Two kinds of cognitive-behavior therapy are now used for people with schizophrenia, (1) cognitive remediation and (2) hallucination reinterpretation and acceptance . Cognitive remediation is an approach that focuses on the cognitive impairments that often characterize people with schizophrenia—particularly their difficulties in attention, planning, and memory ( Fan, Liao, & Pan, 2017 ; John et al., 2017 ). Here clients are required to complete increasingly difficult information-processing tasks on a computer. They may start with a simple task such as responding as quickly as possible to various stimuli that are flashed on the screen—a task designed to improve their attention skills. Once they can perform this task with considerable speed, they move on to more complex computer tasks, such as tasks that challenge their short-term memory. As they master each computer task, they keep moving up the ladder until they eventually reach computer tasks that require planning and social awareness. cognitive remediation A treatment that focuses on the cognitive impairments that often characterize people with schizophrenia—particularly their difficulties in attention, planning, and memory. Studies indicate that, for many people with schizophrenia, cognitive remediation brings about moderate improvements in attention, planning, memory, and problem-solving—improvements that surpass those produced by other treatment interventions ( Bustillo & Weil, 2018 ; Fan et al., 2017 ). Moreover, these improvements extend to the client's everyday life and social relationships. Family Interventions (Multi-Family Group): Decrease expressed emotion

QPR stands for

Question...a person about suicide Persuade...the person to get help and Refer...the person to the appropriate resource

Beck's cognitive therapy goals

Recognize negative thoughts, biased interpretations, and errors in logic challenge dysfunctional thoughts and generate more realistic alternatives/interpretations practice and apply new ways of thinking

antisocial personality disorder (APD)

Related terms -Sociopathy -Psychopathy - Dissocial personality disorder Antisocial ≠ unsocial/asocial Disorder most closely linked to criminal behavior. But not everyone who commits crimes has ASPD Common characteristics of ASD Law-breaking Unreliable, insincere Erratic life; lie repeatedly; deceit and manipulation Lack of anxiety and guilt Lack moral conscience; failure to learn from experience Superficial charm and good intelligence Shallow emotions and lack of empathy Trouble maintaining close relationships Blame the victim ("losers deserve to lose") Arrogant, inflated self-esteem Believe everyone is out for themselves

SSRIs and SNRIs

Release neurotransmitter in synapse; SSRIs block reuptake of receptors They are not fast acting; they take 1-2 months before they have effects

What is OCD: Compulsions

Repetitive thoughts or behaviors Some might be visible to others Others might not be visible (like mental rituals)

Two main subtypes of Anorexia Nervosa

Restricting type: lose weight by cutting out sweets and fattening snacks, eventually eliminating nearly all food; almost no variability in diet Binge-eating/purging type: love weight by self-inducing vomit after meals or by abusing laxatives or diuretics; like those with bulimia nervosa, people with this subtype may engage in eating binges

Operant

Rewards (Skinner)

Treatment of unipolar depression: Interpersonal therapy (IPT)

Rooted in sociocultural model Addresses 4 key ares in interpersonal functioning: 1) loss 2) role dispute 3) role transition 4) interpersonal deficits As successful as CBT

Evidence Based Treatments for OCD

SSRIs and CBT SSRIs like Prozac, Anafranil, Luvox, and Zoloft CBT like Exposure and Response Prevention

Antidepressants: Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs increase serotonin serotonin regulates neural activity ex) Sertraline (Zoloft) and Fluoxetine (Prozac)

Medication for kids

SSRIs most support (Luvox, zoloft, prozac) anti-anixety meds NOT good for kids; have paradoxical effects

Johann Weyer

Said body AND mind were susceptible to illness

Multipath model (biopsychosocial approach)

Schizophrenia as multiply determined (biological explanations have received the most research support)

characteristics for each compared:

Schizophrenia characteristics: various psychotic symptoms such as delusions, hallucinations, disorganized speech, restricted or inappropriate affect, and catatonia Borderline personality disorder: 5 or more: 1) extreme attempts to avoid real or imagined abandonment 2) Impulsivity that is potentially self-damaging 3) anger control problems 4) Lack of a sense of self, or unstable self image 5) Recurrent suicidal behavior or self-mutilating behavior 6) Dissociation or paranoid thoughts that occur in response to stress. 7) Chronic feeling of emptiness 8) Intense and unstable interpersonal relationships 9) Affective instability due to a marked reactivity of mood primary problems with poor emotion regulation and interpersonal difficulties P --> paranoid ideas R --> relationship instability A --> anger; affect; abandoment I --> impulsive behavior; identity disturbance S--> suicidal behavior E --> emptiness Antisocial personality disorder: common characteristics: Law breaking; unreliable and insincere; lack of anxiety and guilt; superficial charm and good intelligence; shallow emotions and lack of empathy; blame the victim; arrogant and inflated self-esteem; believe everyone is out for themselves. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by 3 or more of the following: 1) chronic failure to conform to social and legal codes (grounds for arrest) 2) deceitfulness (repeated lying, aliases, conning others for personal profit/pleasure) 3) impulsivity or failure to plan ahead 4) irritability and aggressiveness (physical fights, assaults) 5) reckless disregard for safety of self or others 6) consistent irresponsibility (lack of accountability) 7) lack of remorse also at least 18 years of age evidence of conduct disorder onset before age 15

Causes of psychosis

Schizophrenia, substance use, or brain injury

PTSD Etiology: biology

Sensitized (hypersensitive alarms) ANS -increased reactivity (hypersensitivity) -Diminished ability to inhibit or extinguish conditioned fear. -Changes in sensitivity may not be permanent : over half with PTSD recover Biochemical abnormalities -Increased norepinephrine and cortisol activity -Impaired hippocampus and amygdala 1/3 of PTSD risk is due to genetics

How to target obsessions

Separate obsessions and irrational behaviors from the sufferer: a thought is just a thought; I won't get sick if I touch this; that's just my OCD talking Reality testing, or challenging (behaviorally irrational thoughts: "So everyone who touched the doorknob will get sick?" Learning to tolerate uncertainty: Take the risk that the bad thought will come true and expose yourself to it Increase distress tolerance for obsessions over time with ERP

Separation Anxiety

Separation/harm to loved ones

similarities and differences between antisocial personality disorder and borderline personality disorder

Similarities Between ASPD and BPD Both ASPD and BPD are classified as Cluster B personality disorders in the DSM-5. Cluster B disorders are characterized by overly emotional, dramatic, and unpredictable thinking and behavior. Among the similarities between ASPD and BPD: Disinhibition: Both ASPD and BPD are associated with disinhibition. However, people with ASPD demonstrate disinhibition by engaging in impulsive behaviors "because they can," while people with BPD do so to combat negative emotions. Hostility: People with ASPD and BPD will get inordinately angry over minor slights. People with ASPD tend to lash out with consciously cruel and hostile acts, while those with BPD remain persistently angry and may engage in self-harm. Impulsivity burn-out: According to the DSM-5, by later middle age, people may be less likely to meet the diagnostic criteria for either ASPD or BPD. This is referred to as "burn-out," a state in which the emotional expression of the disorder changes with age. Suicidality: The rate of suicide in both ASPD and BPD is between 3% to 10%.4 Differences in ASPD vs. BPD There are just as many differences between ASPD and BPD as there are similarities, including: Symptoms: ASPD consists of few emotions, while BPD consists of extreme emotions, mood swings, and an inability to regulate emotions. Gender: Some research suggests that BPD is equally common in men and women, but that men are less likely to seek treatment. By contrast, ASPD is around five times more common in men than women.5 Age: There is no age requirement for BPD. However, you must be 18 or over to be diagnosed with ASPD.1 Treatment: Certain forms of cognitive-behavioral therapy (CBT), such as dialectical behavior therapy (DBT) and mentalization-based therapy (MBT), have been extremely effective in treating BPD.6 By contrast, ASPD is notoriously difficult to treat with psychotherapy.

Case studies

Single subject Pros: useful for hypothesis generation Cons: subjective; observer bias; lacks internal validity; diff to generalize (lack of external validity); can't replicate

Excoriation Disorder

Skin picking (a compulsion)

Other factors that contribute to schizophrenia

Social labeling: Rosenhall study with pseudo-patients. Rosenhan's study demonstrated that normal people often cannot be distinguished from the mentally ill in a hospital setting. According to Rosenhan, this is because of the overwhelming influence of the psychiatric-hospital setting on the staff's judgment of the individual's behavior. Cognitive: believes biological view; people try to understand their perceptions and reject feedback from others; faulty interpretation of symptoms

Selective Mutism

Speaking in front of others

Specific Phobias

Specific things/situations; strong, persistent fear of a specific object or situation; extreme anxiety or panic is expressed when phonics stimulus is encountered; causes impairment

Situational clues (examples)

Sudden rejection by a loved one, or an unwanted separation or divorce A recent move, especially if unwanted Death of a spouse, child or friend (especially if by suicide or accident) Diagnosis of a terminal illness Flare up with friends or relatives for no apparent reason Sudden unexpected loss of freedom (e.g. about to be arrested) Anticipated loss of financial security Loss of a cherished counselor or therapist

dysthymic disorder (Persistent Depressive Disorder)

Symptoms are present most of the day for more days than not during a two year period with no more than two months symptom-free Ongoing presence of at least two symptoms: -feelings of hopelessness -low self-esteem -poor appetite or overeating -low energy or fatigue -difficulty concentrating or making decisions -sleep difficulties Mild/chronic depression

What does the cycle of BN look like?

Tension and powerlessness --> Binge --> relief --> shame/disgust --> compensatory behavior (repeat)

Strengths of the behavioral model

Testable, produce symptoms in lab; treatments very effective for some disorders

Lifetime prevalence

The percentage of people in the population who have had a disorder at some point in their life (all who have or have had it)

Stress-diathesis and schizophrenia

There is a high risk if already a high risk group for those with schizophrenia and high family conflict/criticism; there is not much difference between high and low family conflict if people are low risk for schizophrenia

Pinel. Rush, and Dix contributions

They all acknowledged the need for humane treatment of the mentally ill. Pinel: sympathy and kindness; sunny rooms; support Rush: Nice staff, walks, talking Dix" campaigned for state hospitals

Deviance

Think statistically a behavior that is extreme in some way with regard to frequency or severity e.g. crying everyday Deviant from the norm; defined by culture/society; changes over time

I. ANXIETY, OBSESSIVE-COMPULSIVE, & RELATED DISORDERS

a. Anxiety i. The role of the amygdala in anxiety is to take in sensory information and send impulses to the body. ii. Some of the physiological signs of anxiety are sense of dread, shaking, feeling faint, wobbly legs, rapid heartbeat, choking (short of breath), etc. These signs can be measured by looking at skin conductance, heart rate, and startle response (measure blink when startled, usually long > habituating causes shorter blink). iii. The tripartite model of anxiety looks at the similarities and differences between depression and anxiety: 1. Positive Affectivity: Low levels of happy, joy, optimism for Depression. 2. Negative Affectivity: High levels of negative thinking about self, others, future in both Depression and Anxiety. 3. Physiological Hyper-arousal: Hyperactive amygdala causing increased 'fight or flight' & bodily function response in Anxiety. iv. Anxiety is learned through conditioned responses, in which one begins to associate this stress response to a specific stimulus, like Little Albert. v. Generalized Anxiety Disorder (GAD) 1. GAD is characterized by worries. 2. The diagnostic criteria for GAD is to have at least 3 of the following symptoms > restlessness, fatigue, poor concentration, irritability, muscle tension, sleep disturbance. It must also cause distress and impair daily functioning. 3. The diathesis-stress model of GAD is that certain people have a biological vulnerability toward developing GAD that is caused by a trigger that leads to the symptoms above. b. Phobias i. Phobias are persistent and unreasonable fear towards a specific object, causing an interruption with daily life. ii. Avoidance reinforces phobias by influencing someone to continue to avoid the object because it makes them feel good after doing so. iii. Phobias are treated through: 1. Exposures: exposure to fear-causing stimulus, slowly. 2. Systematic Desensitization (w/relaxation training): desensitized to stimulus, not to fear. Deep breaths, addressing fear with logic. 3. Flooding: go straight to the scary stimulus, no exposure. c. Social Anxiety Disorder (SAD) i. SAD is fear/anxiety about social situations where there may be scrutiny from others. Engaging in avoidance and safety behaviors to decrease chance of social disaster. ii. SAD is treated by antidepressants, exposures, cognitive therapy & social skills training. d. Panic Disorder i. Panic disorder is periodic, short bursts of panic; occur suddenly; peak within 10 minutes. ii. The diagnostic criteria for Panic Disorder is to have at least 4 trembling, chest pains, tingling, shortness of breath, dizziness, nausea, etc. e. Obsessive Compulsive Disorder (OCD) i. Obsessions are persistent thoughts or urges/compulsions are behaviors to reduce anxiety. ii. The purpose of a compulsion is to reduce anxiety temporarily of recurring thoughts. iii. Some common OCD themes are dirt/ orderliness/ sexuality/ violence/"checking". iv. OCD is treated by "Exposure & Response Prevention" (ERP) 1. Face fears 2. Make a choice to NOT do compulsive behaviors when triggered 3. Over time person will actually feel a drop in anxiety level 4. Habituation due to exposure and preventing compulsions.

DISORDERS OF TRAUMA & STRESS

a. Autonomic Nervous System i. The role of the sympathetic response is to "fight or flight". The role of the parasympathetic response is to "rest and digest". b. Cortisol i. The diurnal pattern of cortisol is that cortisol levels have a peak in the morning but decrease during the rest of the day. Can be measured with cotton swabs/diary of feelings during the day. ii. The role of cortisol in stress/anxiety is to prepare us for the day. c. PTSD and Acute Stress Disorder i. PTSD and ASD occur after a traumatic event. ii. Many types of traumatic events/triggers include combat, disasters, victimization, sexual assault, terrorism, torture. iii. Types of exposure to trauma include: 1. DIRECT - happened to you. 2. WITNESS - actually saw. 3. INDIRECT - relative/friend had actual or threatened death in violent way. 4. REPEATED INDIRECT EXPOSURE - professionals repeatedly exposed to details of multiple events, multiple times. iv. The difference between PTSD and Acute Stress Disorder is that the length of the symptoms differ, PTSD can last months/years and may not see symptoms until way after traumatic events, whereas acute lasts less than a month and symptoms may occur immediately. v. Treatments for trauma include drug therapy (to reduce arousal), behavioral exposure therapy (flood & relaxation), insight therapy (process reaction), family/group therapy (help normalize event), debriefing (can be bad). d. Dissociative Disorders i. Dissociative amnesia is inability to recall personal autobiographical memory associated with a traumatic event (no physiological explanation). There are 5 types: 1. Localized - before/after event, specific to a time around event 2. Selective - remember different parts but not whole thing 3. Generalize - significant block of memory lost 4. Continuous - memory loss continues after event 5. Dissociative fugue occurs when one forgets their life and takes on a new identity. ii. Amnesia can be treated by: 1. Psychodynamic therapy (recover repressed memories) 2. Hypnotic therapy (guided recall of forgotten memories) 3. Drug therapy (truth serums) iii. Dissociative identity disorder is 2 or more different personalities in someone, AKA multiple personalities. (Each with own memories, talents) iv. Dissociative identity disorder treatment is: 1. Recognizing the disorder 2. Recovering memories 3. Fusion of subpersonalities v.Depersonalization/derealization disorder is persistent and recurrent episodes of depersonalization (sense of out of body experience) and derealization (something isn't right)

MOOD DISORDERS

a. Unipolar Depression i. The five symptom domains of unipolar depression are: 1. Emotional - feeling hopeless, sad, lonely 2. Motivational - not motivated to eat or be with partner 3. Behavioral - in room, in bed, isolation, no socialization 4. Cognitive - thoughts of "what's the point", guilt of past, failure 5. Physical - headaches, stomach aches, dizzy, moving slow, tired ii. The criteria for major depressive disorder is 5 of the symptoms below: 1. Depressed mood, diminished interest, significant weight loss, insomnia/hypersomnia, fatigue, feeling worthless, can't concentrate, thoughts of death/suicidal. 2. + happening for 2 weeks with NO mania. iii. The criteria for a 'depressive episode' is symptoms above plus: 1. 2+ years = Persistent Depressive Disorder (PDD) 2. Not as disabling but persistent = Dysthymia iv. The biological model of depression explains it may be due to genetics or low levels of norepinephrine/serotonin. The psychological model of depression explains it may be due to real/imagined loss. The behavioral model of depression explains it may be due to decrease of positive rewards in life over time. The cognitive model of depression explains it may be due to maladaptive attitudes that are not working like automatic thoughts with little or no evidence. v. Treatment approaches to depression are antidepressants (to increase serotonin), ECT (if severe), cognitive-behavioral therapy (CBT - changing primary attitudes to new way of thinking by acknowledging maladaptive thinking. vi. The multicultural perspective of depression is we may not know how other cultures perceive depression, as others may have physical symptoms instead of emotional. b. Bipolar Depression i. A manic episode is abnormally and persistently elevated or irritable mood. Increased activity most of the day, everyday for at least 1 week, with at least 3 of these: inflated self-esteem, decreased need for sleep, talkative, racing ideas, activities w/painful consequences. ii. Differences in the disorders: 1. Bipolar I Disorder: 1 manic episode in someone's life + MDD coming before/after. 2. Bipolar II Disorder: 1 depressive episode + 1 hypomanic episode (not a whole week of mania, less days) 3. Cyclothymic Disorder: At least 2 years of episodes of hypomania + dysthymia episodes not meeting full criteria for mania or MDD, just lasts longer

criterion validity

ability to measure to predict (correlate) scores on other relevant measures concurrent validity: measures given at the same time point that are "supposed: to be correlated Predictive validity: predicts performance on some additional measure given at future time point

IQ tests measure

ability, aptitude, and achievement

Etiology of depression: neuroanatomy

abnormalities in brain structures that affect motivation, appetite, sleep, energy level, circadian rhythm, and response to rewarding and aversive stimuli blood flow: high in amygdala, low in PFC Smaller size hippocampus and BA25 (but very active); BA25 involves serotonin and its regulation

Cognitive model

abnormality results from inaccurate assumptions, beliefs, appraisals/interpretations, expectations, and conclusions

People with BN have symptoms that occur how often?

about 1 times per week for at least 3 months

PTSD treatment

about half of all cases of PTSD improve within 6 months; the remainer may persist for years general goals: decrease stress reactions; gain perspective on painful experiences, *return to constructive living*

DSM-5 Personality Disorders

according to dsm-5: Enduring pattern of inner experience and behavior that deviates from person's culture in 2+ of the following areas -Cognition, affect, interpersonal functioning, or impulse control inflexible and pervasive across personal and social situations significant distress or impairment in social, occupational or other areas of functioning pattern is stable and long-term and can be traced to early childhood or adolescence Not accounted for by another medical condition

Validity is another way to say _________

accuracy

Atypical antipsychotics aka second generation

aka second generation antipsychotics (Risperdal, Zyprexa, Seroquel, Geodon, Abilify) -impact serotonin and dopamine receptors -fewer motor side effects -improves pos and neg symptoms -improved treatment compliance -reduces relapse Side effects: Can impair immune symptom functioning (clozapine risk fo agranulocytosis - drop in white blood cells) Seizures, dizziness, fatigue, drooling, weight gain Note: these are the first line treatment now

Multicultural perspective

behavior is shaped by cultural context and group membership; normal v. abnormal shaped by context like race/ethnicity, SES, and sexual orientation

Behavioral Model

behaviors as a result of learning; behaviors change in response to the environment behaviors are internal and external

Referral situations for suicidality

best: personally taking person of concern to a mental health provider/professional next best: get person to agree to see someone and actually keep the appointment third best: get person to agree to accept help, even if in the future

Bulimia nervosa involves ____ and ____

binging and compensatory behaviors

You can inherit ________, but not a _____. biological perspective of schizophrenia

biological predisposition, but not a disorder. Genetic factors Inherit a biological predisposition, not a disorder Polygenic disorder (combination of gene defects)

Personality Disorder

characterized by inflexible/rigid long standing/enduring, and maladaptive personality traits that cause significant functional impairment, subjective distress, or a combination of both -impairs sense of self, emotional experiences, goals, and capacity for empathy and or intimacy *Personality traits more extreme and dysfunctional compared to most other people in their culture

Mania

characterized by intense elation or irritability; hyperactivity, talkativeness, and distractibility

Depression

characterized by: sadness, feelings of worthlessness and guilt, withdrawal from others, changes in sleep and appetite, and anhedonia

Those who need services and aren't getting them are...

children, ethnic minorities, people getting medication instead (biomedical model)

Triggers for ASD and PTSD include

combat, disasters, terrorism and torture, victimization

Cluster B (check lecture)

dramatic, emotional, erratic antisocial personality disorder, borderline personality disorder (intense fluctuations in mood, self image and interpersonal relationships), histrionic (self-dramatization, exaggerated emotional expressions, attention seeking behaviors), narcissistic (exaggerated sense of self importance, exploitative, and lack of empathy

Trauma and suicidality

experiencing trauma and witnessing trauma can increase suicide risk

Content Validity

extent to which an assessment tool adequately measures what it says it is measuring

ANXIETY

future-oriented mood state

Predictors of recovery for schizophrenia

good pre-morbid functioning; when disorder triggered by stress, started suddenly, or developed during middle age

Family social treatments

group therapy, family therapy, couples therapy, and community mental health treatment

avolition

lack of interest and drive (apathy); ambivalence about most things.

Quasi-experimental

lacks random assignment groups are preexisting can use matched control (case-control) designs for comparison

family environment plays a ______ role in schizophrenia

large role; individuals are 4x more likely to relapse if they live with a family that is critical, hostile, disapproving, and intrude on each other's privacy.

Etiology of depression: cognitive

learned helplessness: believe no control over reinforcers, self-blame for helpless state, internal, stable, global attributions ("I suck, I'm always gonna suck") Cognitive triad: negative view of self, world/experiences, and future Maladaptive attitude: tendency to see the world negatively Cognitive biases: tendency to process information in negative ways; errors in thinking; negative automatic thoughts

Biological treatment of bipolar depression

mood stabilizers treat MANIC episodes (and depression to a lesser extent) -Lithium -Anticonvulsants: tegretol, depakote Modulate neurotransmission to achieve homeostasis -treating a bipolar patient with antidpressants in not recommended; it can induce a manic episode

More prevalence in which groups?

more prevalent in low income groups. cause? stress. effect? downward drift theory. those earning below $20,000

negative symptoms of schizophrenia (deficits)

negative referring to deficits. reduction or removal of normal processes Alogia:poverty of speech Restricted affect (blunt/flat) -> Exhibits little or no emotional expression in face or voice Avolition: Lack of interest and drive (apathy); ambivalence about most things Social Withdrawal: attend to their own ideas and fantasies and withdraw from social environment

Schizophrenia is viewed as a ________________ disorder

neurodevelopmental impaired connections in the brain regions due to genetic vulnerability and early neurodevelopmental insults

Medication for Anorexia

no demonstrated efficacy

Incidence

number of new cases of a disorder that appear in an identified population within a specified time period

Common MYTHS about anxiety

o Xanax (benzo) is best for anxiety All medications are addictives You need to explore childhood events It's important to avoid stressful situations If l diet and exercise , it will go away - That's just how she is, you cant help her Its not a real problem

Case studies: uses

offer tentative support for a theory; challenge a theory's assumptions; value of new therapeutic techniques; opportunity to study unusual problems

ABA therapy for autism is an example of

operant conditioning increasing reinforcement of desired behaviors; remove reinforcement of undesired behaviors

Most people end their own lives for _______ reasons.

ordinary reasons

Self monitoring can be accurate, but be aware of _______

participant reactivity: knowing you're being observed so changing your behavior

sociocultural factors: family dysfunction schizophrenia

risk of schizophrenia and how likely to recover is dependent on family dysfunction. Family stress More conflict Poor communication Criticism and overinvolvement Schizophrenogenic mothers Psychodynamic; little support rejected by most psychodynamic theorists Expressed emotion -> criticism, hostility, and disapproval and intrude on each other's privacy Individuals with schizophrenia are almost 4x more likely to relapse if they live with such a family

Biological causes of schizophrenia: viral problems

schizophrenia rates higher when mother had flu in second trimester of pregnancy (virus interferes with brain development at same point) presence of antibodies to certain viruses in 40% of participants with schizophrenia. increased activity of microglia (immune cells that protect against brain infections and inflammation)

All or nothing cognitive bias

seeing things as completely good or completely bad e.g. If I'm not perfect, I'm a failure

Hallucinations

sensory experiences in the absence of sensory stimulation

Limitations of psychodynamic model

unsupported ideas (difficult to research); Non observable Not suited for a wide range of problems or people

Most often, wanting to die and feeling suicidal is a primary symptom of:

untreated depression; suicidal thoughts are strongly associated with disturbances in brain chemistry

Key features of schizophrenia

various psychotic symptoms such as delusions, hallucinations, disorganized speech, restricted or inappropriate affect, and catatonia

thalamus and hypothalamus

which act as rely station that transmits nerve impulses throughout the brain; regulates bodily drives and body conditions; involves experiencing/expressing emotions and motivation

Etiology of anxiety (biological factors)

worry and cognitive symptoms: GABA inactivity (too much tells your brain to slow down); overactive fear circuitry (prefrontal cortex, anterior cingulate cortex, amygdala Panic/physical symptoms: excess norepinephrine activity; overactive fear circuitry: amygdala, ventromedial nucleus of hypothalamus, locus ceruleus (big role for panic symptoms), central gray matter Genetics: 50% heritability or less; so yes is plays a role [predisposition] but environment plays a big role. We inherit autonomic sensitivity; predispositon to excessive autonomic reaction to stress Biological preparedness (evolutionary)-these things are correlates; we inherit vulnerability to anxiety in general; we don't inherit the disorder

What percent of adults receive mental health services?

~12/13%