Chapters for Finals

Psychological, Social, and Sociocultural Dimensions of ADHD

Social adversity Stressors in family Cultural and regional expectations Interpersonal conflict Exercise and outdoor activity Reduces risk of ADHD symptoms

Etiology of Sexual Dysfunctions (cont'd.)

Social dimension Social upbringing and current relationships Strict religious upbringing Traumatic sexual experiences Relationship issues often forefront of sexual disorders Marital satisfaction associated with greater sexual frequency

Learning Disorders

Academic disability characterized by reading, math, or writing skills deficits Primarily interferes with academic achievement and daily living activities requiring reading, writing, or math skills Prevalence Approximately five percent of students in public schools Occurs twice as frequently in boys

Review

According to the multipath model, how are biological, psychological, social, and sociocultural factors involved in the development of anxiety disorders? What are phobias, what contributes to their development, and how are they treated? What is panic disorder, what produces it, and how is it treated?

Medical Conditions Influencedby Psychological Factors

Actual tissue damage Disease process Physiological dysfunction Relative contributions of physical and psychological factors vary greatly Both medical treatment and psychotherapy may be required

Delirium

Acute state of confusion characterized by disorientation and impaired attentional skills Abrupt onset Develops over a period of several hours or days Symptoms can be mild or severe Psychotic symptoms may be present Treatment: identify underlying cause Hospitalized individuals and the elderly at increased risk

Pedophilic Disorder

Adult obtains erotic gratification through urges, acts, or fantasies involving children under the age of 13 Sexual abuse of children is common 15 percent of girls and six percent of boys Most people who act on pedophilic urges are friends, relatives, or acquaintances of their victims Effects of sexual abuse can be lifelong

Etiology of Phobias

All phobia subtypes have moderate genetic contribution 31 percent heritability Perspectives regarding the psychological dimension Classical conditioning Observational learning or modeling Negative information Cognitive-behavioral response

Cognitive-Behavioral Therapy

Altering negative thought patterns associated with depression Identify thoughts associated with upsetting emotions Distance self from these thoughts Examine accuracy of beliefs Individuals treated with CBT less likely to relapse than those treated with antidepressants

Fear Circuitry in the Brain

Amygdala Plays a central role in triggering state of fear or anxiety HPA activity triggers "fight-or-flight" response Sensory signals travel to hippocampus and prefrontal cortex Process sensory input and evaluate danger Higher-level mental processing may result in signals to stop the HPA response

Arousal and Sensation Seeking

Another hypothesis People with APD have lower levels of physiological reactivity Generally underaroused May require more stimulation to reach optimal level of arousal Thrill seeking behavior without concern for conventional behavior standards

Cluster B - Disorders Characterized by Dramatic, Emotional, or Erratic Behaviors

Antisocial personality disorder Pervasive pattern of disregard for and violation of the rights of others Must have occurred since age 15 Lack of anxiety and guilt over failure to conform to social or legal codes Individuals seek power over others Diagnosis applies to individuals age 18 or older Prevalence: 0.6 to 4.5 percent

Chapter 5 Understanding Anxiety Disorders from a Multipath Perspective

Anxiety Produces tension, worry, and physiological reactivity Anxiety disorders Unfounded fear Produces clinically significant distress Symptoms interfere with an individual's day-to-day functioning

Physiological Symptoms of Depression

Appetite and weight changes Sleep disturbance Unexplained aches and pain Aversion to sexual activity Dramatically reduced sexual interest and arousal

The Sexual Response Cycle

Appetitive phase Characterized by person's interest in sexual activity Arousal phase May follow or precede the appetitive phase Heightened when specific, direct sexual stimulation occurs Various physical changes occur Example: increased blood flow to penis in males

Biological Treatment of Panic Disorder

Benzodiazepines Antidepressants Beta-blockers High relapse rates after cessation of drug therapy

Contemporary Trends and Future Directions

Areas of research focus How positive emotions affect stress responses Role of psychological factors on disease progression and prevention Examining why gender and racial differences in stress response exist

Cluster C - Disorders Characterized by Anxious or Fearful Behaviors

Avoidant personality disorder Characterized by pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation Individuals with disorder crave affection and an active social life Prevalence ranges from 1.4 to 5.2 percent Some researchers believe this disorder is on a continuum with social anxiety disorder

Etiology of Schizophrenia

Best understood using a multipath model Integration of heredity, psychological characteristics, cognitive processes, and social adversities Each dimension interacts with the others

Psychological and Behavioral Treatments

Behavioral activation therapy Focus on increasing exposure to pleasurable events and activities and social interactions Steps Identifying and rating activities in terms of pleasure and self-confidence Performing some of the selected activities Identifying day-to-day problems and using behavior techniques to solve Improving social and assertiveness skills

Psychological Dimension in Depression

Behavioral explanations Depression occurs when people receive insufficient social reinforcement Variables that enhance or hinder positive reinforcement Participating in few potentially reinforcing activities Few reinforcements available in the environment The individual's social skills and behavior

Psychological Dimension of OCD

Behavioral perspective Obsessive-compulsive behaviors develop because they reduce anxiety Cognitive characteristics Exaggerated estimates of probability of harm Control Intolerance of uncertainty Thought-fusion Disconfirmatory bias

Etiology of Alzheimer's Disease

Believed to be influenced by hereditary and environmental factors APOE-e4 allele of the APOE gene increases risk for AD People with this genotype do not necessarily develop AD Three rare genetic mutations identified for autosomal-dominant AD Lifestyle variables associated with stroke and cardiovascular disease Also affect AD

Date Rape

Between eight and 25 percent of female college students report having "unwanted sexual intercourse" Many reluctant to report Many universities conducting workshops to encourage understanding that intercourse without consent is rape

Treatment of Somatic Symptom Disorders

Biological Antidepressant medications such as SSRIs reduce anxiety and depression Medication rarely successful by itself Psychological treatments Understanding the client's view of the problem Demonstrating empathy Accepting symptoms as genuine Providing information about stress-related symptoms

Etiology of Bipolar Disorders

Biological dimension Complex genetic basis involving interactions among multiple genes Including several genes influenced by lithium Genes influencing circadian cycle Neurological abnormalities Brain dysregulation after reaching a goal, or in response to obstructed goals Some SSRIs and stimulants can trigger mania Hormonal influences

Etiology of Dissociative Disorders

Biological dimension Disruptions in memory encoding due to acute stress Atypical brain functioning has been documented Permanent structural changes in brain due to trauma may play a role Reduction in amygdalar volume

Etiology of a Panic Disorder

Biological dimension Heritability is 32 percent Individuals with panic disorders have fewer serotonin receptors SSRIs have been shown to be effective Designed to increase serotonin levels Psychological dimension Individuals show heightened fear responses to bodily sensations

Attention-Deficit Hyperactivity Disorder: Etiology

Biological dimension Highly heritable with up to 80% of symptoms explainable by genetic factors Exact nature is unclear Hypotheses about neurological mechanisms Abnormalities in prefrontal cortex Brain structure and circuitry irregularities in frontal cortex, cerebellum, and parietal lobes Reduction in neurotransmitters

Etiology of Sexual Dysfunctions

Biological dimension Levels of testosterone (low) or estrogens (high) linked to lower sexual interest in men and women, and erectile difficulties in men Medications used to treat medical conditions affect sex drive Many antidepressant and antihypertensive medications Alcohol as leading cause of disorders Illnesses and other physiological factors

Etiology of Generalized Anxiety Disorde

Biological dimension Small but significant heritability factor May disrupt prefrontal cortex modulation of response to threatening situations Psychological dimension Cognitive theories: dysfunctional thinking and beliefs

Etiological Influences on Physical Disorders

Biological dimension Stressors can dysregulate physiological processes in the brain and body Release of norepinephrine, epinephrine, and cortisol Early environmental influences may produce changes in stress-response systems Brief exposure to stressors enhances immune functioning

Etiology of Externalizing Disorders

Biological factors appear to exert greatest influence on development of CD Risk increases for "low-activity MAOA" genotype individuals subject to childhood maltreatment Family and social context play a large role in externalizing disorder development

Autism Spectrum Disorders: Etiology

Biological influences Strong genetic influence Twins and siblings Degree of impairment varies ASD linked with neurological findings Unique patterns of metabolic brain activity Reduced gaze towards eye regions of faces High serotonin levels Accelerated growth of am

Treatment of Sexual Dysfunctions

Biological interventions Hormone replacement Special medications Mechanical means to improve functioning Vacuum pumps, suppositories, penile implants For ED, injecting medication into penis Oral medications (Viagra, Levitra, Cialis) Psychological boost may lead to feelings of enhanced pleasure

Treatment of Obsessive-Compulsive and Related Disorders

Biological treatments SSRI antidepressants Only about 60 percent respond to this therapy Outcome improved when combined with behavioral interventions Behavioral treatments Flooding Response prevention

Diagnosis and Classification of Bipolar Disorders (cont'd.)

Bipolar I At least one manic episode (with or without a history of major depression) Bipolar II At least one major depressive episode and at least one hypomanic episode Cyclothymic disorder Milder hypomanic symptoms consistently interspersed with milder depressed moods for at least two years

Other Types of OCD-Related Disorders

Body dysmorphic disorder Preoccupation with a perceived physical defect Symptoms cause significant distress or impairment in life activities Hair-pulling disorder Recurrent and frequent hair-pulling despite repeated attempts to stop Skin-picking disorder Results in skin lesions

Biological Dimension of ASD and PTSD

Body systems designed for homeostasis Fear extinction Decline in fear responses associated with the trauma SS genotype Two short alleles of the serotonin transporter gene More prone to heightened anxiety reactions associated with PTSD

Commonalities between Bipolar Disorders and Schizophrenia

Both chronic disorders with neurological irregularities Psychotic features Certain risk alleles contribute to both disorders Similar gray matter abnormalities Similar cognitive deficits Confused thought processes and poor insight Impairment in vocational functioning

Cerebral Contusion

Bruising of the brain Occurs when brain strikes skull with sufficient force to cause bruising Involves actual tissue damage to both side of the impact and opposite side Symptoms similar to those of a concussion Neuroimaging can detect brain damage and monitor swelling

Delusions (cont'd.)

Capgras delusion Rare delusion Belief in the existence of "doubles" who replace significant others Most common with brief forms of psychosis developing suddenly after an emotionally distressing event

Link Between Cannabis Use and Psyc

Cannabis use appears to increase the chance of developing a psychotic disorder Higher the intake, greater the likelihood of psychotic symptoms Several possible interpretations for link Cannabis may influence dopamine levels Individuals may use cannabis to self-medicate Individuals predisposed to psychosis may also be predisposed to use cannabis

Mindfulness-Based Cognitive Therapy

Calm awareness of one's present experience, thoughts, and feelings Attitude of acceptance instead of judgmental, evaluative, or ruminative Disrupt the cycle of negative thinking by focusing on present

Lifestyle Changes

Can help prevent or reduce progression of some neurocognitive disorders Cardiovascular fitness Smoking cessation Weight reduction Control of blood sugar, cholesterol, and blood pressure

Review

Can one's personality be pathological? What traits are associated with personality disorders? How does an antisocial personality develop and can it be changed? What problems occur with personality assessment? Are there alternative methods of personality assessment?

Antipsychotic Medication

Can reduce intensity of symptoms Thorazine Introduced in 1955 First-generation antipsychotics Still viewed as effective treatments Reduce dopamine levels Atypical antipsychotics Act on both dopamine and serotonin

Vascular Neurocognitive Disorders

Can result from a one-time cardiovascular event (stroke) or from unnoticed, ongoing disruptions to cardiovascular system Often begin with atherosclerosis Stroke Obstruction of blood flow to or within the brain, leading to loss of brain function

Coronary Heart Disease

Cardiac arteries narrow Results in complete or partial blockage of flow of blood and oxygen to heart Some risk factors for CHD Poor eating habits Obesity and lack of physical activity Hypertension Stress Depression

Recent Research Findings

Careful analysis of postmortem brains of children with ASD found patchy areas of disrupted neuronal development Suggests brain abnormalities begin during pregnancy in the normal cell-layering process Effects of genetic mutations associated with ASD occur during fetal development Children with ASD metabolize environmental toxins differently

Factors Associated with Negative Thinking Patterns

Carriers of two short 5-HTTLPR alleles Maltreatment during childhood Early stressful interactions Emotions such as shame and guilt Negative thinking patterns can persist even after depressive symptoms subside

Grossly Disorganized or Abnormal Psychomotor Behavior

Catatonia Extremes in activity level Excited catatonia Withdrawn catatonia Peculiar body movements or postures Loud, inappropriate laughter

DSM-5 Methods of Diagnosing and Classifying Personality Psychopathology

Categorical diagnostic model Ten specific personality disorder types Each a distinct clinical syndrome Alternative model Has components of both dimensional and categorical assessment

Etiology of Sleep-Wake Disorders

Causes of sleep problems Neurological vulnerabilities Psychological factors Stress, anxiety, and depression Environmental factors Noise, light, other stimuli Heath or behavioral habits

Medication Treatment for Trauma-Related Disorders

Certain antidepressants show some effect Effective in fewer than 60 percent of individuals Only 20-30 percent show full recovery D-cycloserine Mixed results Prazosin (hypertension medication) Propranolol (beta-blocker) Under study; may offer little benefit

Aging and Sexual Dysfunctions

Changes in sexual function common as we age Menopause Women's estrogen levels drop Vaginal dryness and thinning of the vaginal wall Older men at increased risk for prostate problems and cardiovascular difficulties May increase risk of ED

Schizoid Personality Disorder

Characteristics Pervasive detachment from social relationships Restricted range of emotions in interpersonal settings Individuals have a long history of impairment in social functioning Neither desire nor enjoy close relationships May be associated with cold, emotionally impoverished childhood

Diagnostic Controversy of DID

Characteristics have changed over time Some believe clinician bias, faulty assessment, or diagnostic techniques may influence diagnosis Questions regarding reports of memories retrieved from very early ages

Schizotypal Personality Disorder

Characterized by odd, eccentric, or paranoid thoughts and behaviors and poor interpersonal relationships Many with disorder believe they have magical abilities or special powers Some are subject to recurrent illusions Abnormalities in cognitive processing Many characteristics resemble schizophrenia Few individuals seek therapy

Disruptive Mood Dysregulation Disorder

Characterized by chronic irritability and severe mood dysregulation Results in episodes of temper triggered by common childhood stressors Diagnosis not made in children younger than six years old Often predicts development of depressive or anxiety disorders later in life

Borderline Personality Disorder

Characterized by enduring pattern of volatile emotional reactions Unstable interpersonal relationships Poor-self image Impulsive responding Intense mood fluctuations May engage in behaviors with negative consequences Poor coping skills

Attention-Deficit Hyperactivity Disorder

Characterized by inattention and/or hyperactivity and impulsivity Diagnostic requirements Symptoms begin before age 12 and persist for at least six months Symptoms interfere with social, academic, or occupational activities Display symptoms in at least two settings Most frequently diagnosed disorder in preschool and school-age children

Tourette's disorder (TD)

Characterized by multiple motor tics and one or more vocal tic Present for at least one year Coprolalia Involuntary uttering of obscenities or inappropriate remarks Present in ten percent of those with TD Comorbid conditions often more disruptive than the tics themselves

Histrionic Personality Disorder

Characterized by pervasive pattern of excessive emotionality and attention-seeking Intensely dramatic emotions and behaviors Superficially charming and warm Shallow and self-centered Prevalence may be 0.4 to 1.8 percent Diagnosed more often in females In clinical settings

Autism Spectrum Disorders

Characterized by significant impairment in social communication skills Stereotyped interests and behaviors Symptoms range from mild to severe Occurs five times more frequently in boys Prevalence has increased over 120 percent between 2002 and 2010 Expanded awareness, possible unknown influences

Asthma

Chronic inflammatory disease of the lungs Stress or other triggers cause excessive mucus secretion Spasms and swelling of the airways, which reduces the amount of air that can be inhaled Symptoms range from mild to severe

Illness Anxiety Disorder

Chronic pattern of preoccupation with having or contracting a serious illness Pattern must be present for at least six months Involves minimal or no somatic symptoms High anxiety level Strongly associated with a person's cognitions

Circadian Rhythm Disturbances in Depression

Circadian rhythms: internal biological rhythms maintained by hormone melatonin Play a role in depression, particularly seasonal depression Sleep disturbances, including irregularities in REM sleep, strongly linked to depression Insomnia doubles the risk of developing depression Sleeping for more than 10 hours per night also increases risk

Neurocognitive Disorder Due to HIV Infection

Cognitive impairment sometimes the first sign of untreated HIV infection Slower mental processing Difficulty concentrating AIDS dementia complex (ADC) HIV becomes active in the brain Antiretroviral therapies can prevent or delay onset Brain changes still occur in half of those taking antiretroviral medications

Contemporary Trends and Future Directions

Cognitive-behavioral therapies considered most effective in treating anxiety and OCD Many who show improvement relapse Novel methods and approaches Specialized therapy programs targeting specific disorders Treatment protocols that can be used across anxiety disorders Technology to improve CBT outcome and outreach

Treatments (cont'd.)

Cognitive-behavioral therapy Effective for treatment of insomnia Sleep apnea treatments Losing weight, side sleeping Continuous positive airway pressure mask Medications Clonazepam Melatonin Variety of sleep-inducing medications

Traumatic Events Associated with ASD and PTSD

Combat Sexual assaults Violent crime or domestic violence Sexual harassment Natural disasters Car accidents or work-related accidents

More Characteristics of Male Rapists

Come from environments of parental neglect or physical or sexual abuse Initiate coitus earlier in life than men who are not sexually aggressive Have more sexual partners than non-sexually aggressive men

Emotional Symptoms in Depression

Depressed mood Sadness, emptiness, hopelessness, worthlessness, or low self-esteem Limited enthusiasm for things that previously brought joy and pleasure Irritable, anxious, or worried

Obstructive Sleep Apnea

Common breathing-related sleep disorder Soft tissue in rear of throat collapses Obstructs upper airway Repeatedly interferes with breathing during sleep Brain sends signals to resume breathing Results in snoring or gasping for breath Remains undiagnosed in 80-90 percent of individuals with this condition

Dissociative Fugue

Confusion over personal identity Complete loss of memory of one's entire life Unexpected travel to a new location Partial/complete assumption of new identity Recovery is often abrupt and complete Some individuals who have experienced several fugue episodes decide to wear personal identification In case of future occurrence

Sociocultural Dimensions of Panic Disorder

Contributing factors Stressful childhood Separation anxiety, family conflicts, school problems, or loss of a loved one Asian American and Latino/Hispanic adolescents Higher anxiety sensitivity than European American adolescents Less likely to have panic attacks

Defining Sexual Behavior as a Mental Disorder

Controversy surrounding definition of deviant sexual behavior Some argue that sexual behavior is only deviant if it threatens society, causes distress to participants, or impairs social or occupational functioning Greater controversy regarding whether gender dysphoria should be considered a psychiatric disorder

Dimensional Personality Assessment and the DSM-5 Alternative Personality Model

Dimensional model assesses personality traits on a continuum Consider significant deviations from normal on five key personality dimensions Extraversion Agreeableness Neuroticism Conscientiousness Openness to experience

Negative Symptoms (cont'd.)

Diminished emotional expression Facial expression Voice intonation Gestures Approximately 15-25 percent of individuals with schizophrenia display primarily negative symptoms

Contemporary Trends and Future Directions

DSM-5 criteria for somatic symptom disorder have changed dramatically Only one problematic symptom is now necessary for diagnosis "Medically unexplained" terminology removed Affects disorder prevalence

Sexual Interest/Arousal Disorders (cont'd.)

DSM-5 diagnosis for sexual dysfunction not appropriate when severe relationship problems, mental disorders, or significant stressors play a role Individuals often capable of experiencing orgasm Little interest in, or derive minimal pleasure from sexual activity

Contemporary Trends and Future Directions

DSM-5 has made a clear distinction between paraphilias and paraphilic disorders May change societal views on sexual differences that are not harmful to others Gender dysphoria may eventually be removed as a psychiatric diagnosis Sweden has removed transvestism, fetishism, and sadomasochism from list of mental illnesses

Paraphilic Disorders

DSM-V definition Sexual interest in non-normative targets May involve unusual erotic behavior or socially unacceptable targets Diagnosed only when paraphilia harms, or risks harming others and is acted on Or causes the individual to experience distress or impairment in social functioning

Social and Sociocultural Dimensions

Daily environmental stress can produce anxiety People with biological or psychological vulnerabilities are most likely to be affected Factors Poverty, traumatic events, adverse working conditions, limited social support, and acculturation Culture can influence how anxiety is expressed

Dementia

Decline in mental function and self-help skills Resulting from major neurocognitive disorder Examples of affected areas: memory, problem solving, and impulse control Gradual onset and continuing cognitive decline Age is strongest risk factor for dementia

Negative Symptoms

Decreased ability to initiate actions or speech, express emotions, or feel pleasure Avolition: inability to take action or become goal-oriented Alogia: lack of meaningful speech Asociality: minimal interest in social relationships Anhedonia: reduced ability to experience pleasure

Physiological Symptoms of Hypomania/Mania

Decreased need for sleep Often first sign of hypomanic or manic episode High levels of physiological arousal Increased libido May lead to reckless sexual activity Weight loss due to high energy expenditure

Encopresis

Defecation onto clothes, floor, or other inappropriate places Diagnosis Must be at least four years old and have defecated inappropriately at least once a month for three months or more Typical pattern History of constipation and withholding of painful bowel movements

Etiology of Schizophrenia: Psychological

Deficits in empathy Deficits in the theory of mind Ability to recognize that others may have different emotions, beliefs, and desires Association between early developmental delay and schizophrenia Low cognitive ability test scores in childhood and adolescence Misattributions and negative attitudes

Symptoms of Autism Spectrum Disorder

Deficits in social communication and social interaction Atypical social-emotional reciprocity Atypical nonverbal communication Difficulties developing and maintaining relationships

Characteristics of Male Rapists

Create situations in which sexual encounters may occur Misinterpret friendliness as provocation and protests as insincerity Manipulate women into sexual encounters with alcohol (70%) or other drugs Attribute failed attempts at sexual encounters to perceived negative features of the woman

Sociocultural Dimension

Cultural differences in symptoms, treatment, doctor-patient interactions, and outcomes Triggers for depression differ among cultural groups Depression among Chinese adolescents often associated with poor academic performance Discrimination or perceived discrimination a risk factor for depression

Cultural Issues with Schizophrenia

Culture affects how people view or interpret symptoms Highly stigmatized in Japan Change in terminology in the year 2000 resulted in more patients being told of their disorder Many psychiatrists in Turkey will not mention diagnosis to clients or family Belief of supernatural causation in India

Other Schizophrenia Spectrum Disorders

Delusional disorder Brief psychotic disorder Schizophreniform disorder Schizoaffective disorder

Positive Symptoms of Schizophrenia

Delusions Hallucinations Disordered thinking Incoherent communication Bizarre behavior Symptoms range in severity, and may persist or fluctuate Poor insight Failure to recognize symptoms as abnormal

Gender and Depressive Disorders

Depression is far more common among women than among men Evidence suggests difference is real, rather than an artifact of bias or tendency to self-report Gender differences begin appearing during adolescence Differences during phases of the menstrual cycle and in menopause

Mood Disorders in Early Life

Depressive disorders most prevalent among females and older adolescents Environmental factors primary cause during childhood Biological factors exert more influence during adolescence Evidence-based treatments Individual or group therapy, family-focused therapy, and programs focused on building resilience

Cognitive-Behavioral Therapy

Designed to improve coping skills and manage stress Shown to improve immune functioning in breast cancer patients Opportunities to talk about health situation help predict adjustment to cancer Those who did not talk reported more depressive symptoms

Diagnosis and Classification of Bipolar Disorders

Diagnosed when assessment confirms presence of hypomanic or manic symptoms Other considerations Frequency of mood states Severity of depressive and hypomanic/manic symptoms Types of bipolar disorders Bipolar I, bipolar II, and cyclothymic

Understanding Schizophrenia

Diagnosis involves presence of at least two of the following symptoms: Delusions Hallucination Disorganized speech Gross motor disturbance Negative symptoms Deterioration from a previous level of functioning

Evaluating Mood Symptoms

Diagnosis is complicated Brief depressive and hypomanic symptoms can occur in individuals without a mood disorder Depression occurs both in depressive and bipolar disorders Symptoms may vary considerably Severity of symptoms considered

DSM-5 Alternative Personality Model

Diagnostic criteria Evidence that client's pattern of personality traits matches characteristics of one of six specific personality disorder types Evidence of at least moderate impairment in two key domains of personality functioning Four key areas in assessing impairment Identity, self-direction, empathy

Chapter 8 Symptoms Associated with Depressive and Bipolar Disorders

Differ from temporary emotional reactions Characteristics of mood symptoms Affects a person's well being, school, work, or social functioning Continues for days, weeks, or months Often occurs for no apparent reason Involves extreme reactions not easily explained by individual's circumstances

Adjustment Disorders

Difficulty coping with or adjusting to a specific life stressor DSM-5 diagnostic criteria Exposure to an identifiable stressor that results in onset of symptoms Symptoms are out of proportion to the severity of the stressor Symptoms persist no longer than six months after exposure to stressor has ended

Cognitive Symptoms

Disorganized thinking, communication, and speech Common characteristics of schizophrenia Loosening of associations (cognitive slippage) Continual shifting from topic to topic without apparent logical or meaningful connection between thoughts Overinclusiveness Abnormal categorization

Externalizing Disorders Among Youth

Disruptive, impulse control, and conduct disorders Can result in negative parent-child interaction High family stress and negative feelings about parenting Early intervention can help interrupt negative course Diagnosing these disorders is controversial Difficult to distinguish from normal defiance/noncompliance

Premature Ejaculation

Distressing and recurrent pattern of having an orgasm with minimal sexual stimulation before, during, or after vaginal penetration Must occur within one minute of penetration Most common sexual dysfunction Affects 21-33 percent of men

Psychological Treatment Approaches

Education Replace myths and misconceptions with facts Anxiety reduction Desensitization or graded approaches Changing negative thoughts and beliefs Structured behavioral exercises Tasks that gradually increase amount of sexual interaction Communication training

Etiology of Rape (cont'd.)

Effects of pornography and media portrayals of violent sex may affect rape prevalence "Cultural spillover" theory Rape is high in environments that encourage violence United States has highest rape rate among countries reporting rape statistics

Biochemical Influences

Dopamine hypothesis Schizophrenia may result from excess dopamine activity in certain brain areas Supported from research with three drugs Phenothiazines: block dopamine receptor sites L-dopa: increases dopamine levels and sometimes produces schizophrenic-like symptoms Amphetamines: increase dopamine availability and produces symptoms similar to acute paranoid schizophrenia in non-schizophrenics

Treatment of Generalized Anxiety Disorder

Drug therapy Benzodiazepines Issues with dependence Antidepressants Lower less risk of dependence Cognitive-behavioral therapy Effective psychological treatment 60 percent showed significant symptom reduction that persisted 12 months after treatment

Etiology of Sleep-Wake Disorders (cont'd.)

Dyssomnias Tend to be associated with lifestyle and psychological factors Parasomnias Less known about etiology Many with sleep disorders have family members with sleep difficulties

Other Etiological Influences on ASD

Early psychological theories pinned cause on deviant parent-child interactions Widely agreed today that biological factors are the primary cause of ASD Behavioral characteristics and caretaking demands associated with ASD can cause family stress Children with ASD may feel isolated

Cognitive Symptoms of Hypomania/Mania

Energized, goal-oriented behavior May talk excitedly without concern about giving others an opportunity to speak Unaware of inappropriateness of actions Pressured speech Mania: difficulty maintaining focus Change topics frequently

Cognitive-Behavioral Therapy Steps

Engagement Assessment Identification of negative beliefs Normalization Collaborative analysis of symptoms Development of alternative explanations Recent approach Teach clients to accept hallucinations in a nonjudgmental manner

Elimination Disorders

Enuresis Periodic voiding of urine during the day or night into clothes, bed, or floor Usually involuntary Most likely to occur during sleep Diagnostic criteria Must be at least five years old and void inappropriately at least twice a week for three months or more Prevalence varies with age of the child

Contemporary Trends and Future Directions

Epigenetic changes occurring during early development can exert lifelong effects Efforts to prevent early childhood stress and trauma Research into developing medications that increase the brain's neuroplasticity in adulthood Personalized medicine based on individual's unique genetic profile

Sociocultural Dimension of ASD and PTSD

Ethnic differences Different exposure to previous trauma Cultural difference in responding to stress Women are twice as likely as men to suffer a trauma-related disorder Female police officers less likely than civilian women to have PTSD symptoms

Etiology of Schizophrenia: Sociocultural

Ethnic differences Immigrant groups have highest rates of schizophrenia in Western Europe Especially those of African descent Difference may be due to clinician bias or misinterpretation of "healthy paranoia" by African Americans due to actual discrimination Other factors Lower educational level of parents Lower occupational status of fathers

Etiology of Intellectual Disability

Etiology differs depending on level of intellectual impairment Mild ID is often idiopathic (no known cause) Pronounced ID related to genetic factors, brain abnormalities, or brain injury Genetic factors 40 genes have been identified 80 percent reside on the X-chromosome Fragile X syndrome results in mild to severe ID

Etiology of Gender Dysphoria

Etiology is unclear Research has focused on other sexual disorders Likely an interaction of multiple variables Most transgender children have normal hormone levels No specific neurological explanation Brain alterations associated with psychosocial distress and social exclusion

Biological Dimension of APD

Evidence suggests interactions between biological vulnerabilities and environmental adversity Genetic influences Genetic factors are implicated Includes behavioral characteristics observed during childhood and adolescence Risk taking, impulsivity Supported by twin studies and adoptive child studies

Interpersonal Psychotherapy

Evidence-based treatment focused on current interpersonal problems Goals Improving communication Identifying role conflicts Increasing social skills

Cluster Headaches

Excruciating stabbing or burning sensations located in the eye or cheek Pain so severe that 55 percent report suicidal thoughts Attacks have a rapid onset 15 minutes to three hours in duration End abruptly Headaches preceded by aura in about 20 percent of cases

Paraphilic Disorders Involving Nonconsenting Persons

Exhibitionistic disorder Urges, acts, or fantasies of exposing one's genitals to strangers, intent to shock Voyeuristic disorder Urges, acts, or fantasies involving observation of an unsuspecting person disrobing or engaging in sex activity Diagnosed only in those age 18 or older Individual must be distressed by or have acted on the voyeuristic urges

Psychological and Social Influences

Explanations must be viewed with caution Hypothesis Childhood experiences influence development of gender dysphoria Parent encouragement of feminine behavior, overprotection, lack of male role models, etc. Psychosocial stressors Stigma and lack of societal acceptance play a role in distress and impairment associated with gender dysphoria

Cognitive-Behavioral Treatments

Exposure therapy Gradual introduction to the feared situation Systematic desensitization Exposure techniques with relaxation Cognitive restructuring Identifying and changing irrational thoughts Modeling therapy Viewing another person's successful interactions with the subject of the phobia

Down Syndrome (DS)

Extra copy of chromosome 21 originates during gamete development Most have mild to moderate ID With support, many adults with DS can have jobs and live semi-independently Prenatal detection is possible Environmental influences during pregnancy play a role

Specific Phobia

Extreme fear of a specific object or situation Exposure to stimulus nearly always produces intense anxiety or panic attack Primary types Living creatures (example: spiders) Environmental conditions (example: heights) Blood/injection or injury (example: needles) Situational factors (example: flying)

Etiology of ASD and PTSD

Factors associated with increased risk More severe physical injuries Stroke or injury to the head or extremities Major burn injuries Rape or sexual assault Intentional trauma Close relationship with the perpetrator of sexual assault

Delusions

False personal beliefs Consistently held despite evidence or logic Lack of insight common Delusional themes Grandeur, control, thought broadcasting, thought withdrawal, persecution, and reference Paranoid ideation Often connected with persecutory delusions

Caregiver Support

Family and friends who provide care may need support May feel overwhelmed, helpless, frustrated, anxious, or angry Skilled nursing or assisted-living Alternatives to individual remaining at home

Treatment (cont'd.)

Family and peer involvement necessary once individual leaves treatment setting Cognitive approaches Therapist must build rapport and guide client away from thinking in terms of self-interest and immediate gratification, and toward higher levels of thinking Prevalence of APD diminishes with age Recent study showed promising results with clozapine

Social Dimension of APD

Family relationships are paramount factor Social factors Poor parental supervision and involvement Rejection or neglect Parental separation or absence Children's risk of personality dysfunction increases when adults in the home exhibit antisocial behavior Or when subject to neglect, hostility, or abuse

Social and Sociocultural Dimensions

Family variables Controlling, overly critical parenting styles Low parental warmth Discouragement of autonomy Reactions of family members to OCD can increase symptom severity Culture may affect how symptoms are expressed

Psychosocial Treatments for Bipolar Disorders

Family-focused therapy Educating families reduces risk of relapse and hospitalization Interpersonal therapy Cognitive-behavioral therapy Interventions focused on regulating sleep patterns Mindfulness interventions

Behavioral Symptoms of Depression

Fatigue, social withdrawal, and reduced motivation May appear to not care about grooming or personal cleanliness Possible agitation and restlessness Daily activities take immense effort and feel overwhelming May cry for no particular reason or in reaction to sadness, frustration, or anger

Orgasmic Disorders

Female orgasmic disorder Persistent delay or inability to achieve orgasm despite receiving adequate sexual stimulation Marked reduced intensity of orgasmic sensation Delayed ejaculation Persistent delay or absence of ejaculation after excitement phase is reached

Sociocultural Dimension of Somatic Symptom and Related Disorders

Female roles in society Early view: insufficient outlets for aggression or sexuality Risk factors Lower educational levels Ethnicity Immigrant status

Sociocultural Dimension

Females more likely to have phobias Some objects of phobia trigger both fear and disgust responses Disgust response stronger in females Social anxiety disorder (SAD) more common in collectivistic cultures Individual behaviors seen to reflect on entire family or group SAD expression differs among cultures

Paraphilic Disorders Involving Nonhuman Objects

Fetishistic disorder Extremely strong sexual attraction and fantasies involving inanimate objects Examples: shoes or undergarments Person is often sexually aroused to the point of erection in the presence of the fetish item Person may choose sexual partners on the basis of having that item Must cause significant distress or harm to others

Costs and Prevalence of Schizophrenia

Financial costs of hospitalization, treatment, and loss of productivity Estimated $62.7 billion annually Lifetime prevalence of schizophrenia in the United States 1.1 percent Many show impairment in premorbid functioning Abnormalities prior to major symptom onset

Major Neurocognitive Disorder

For diagnosis, must show significant decline in: One or more cognitive areas Deficits in multiple areas are common Ability to independently meet daily living demands Clinicians specify underlying medical reason, if known

Other Facts About Autism Spectrum Disorders

For some, a period of relatively normal development precedes ASD symptoms Not diagnosed before the age of four ASD highly linked with declining eye gaze beginning from a young age (2 months) Encouraging sign towards early diagnosis Intense, early intervention has reversed progression and eliminated the disorder in some children

Dissociative Identity Disorder (DID)

Formerly called multiple personality disorder Disruption of identity Caused by two or more personality states Alterations in behaviors, attitudes, and emotions Alternate personality state may appear to help deal with difficult situations faced by the primary personality Legal debate over responsibility for actions

Intellectual Disability (ID)

Formerly referred to as mental retardation Characterized by limitations in intellectual functioning and adaptive behaviors Four distinct categories Mild Moderate Severe Profoun

Alternative Model (cont'd.)

Four personality disorders removed from the model Paranoid Schizoid Histrionic Dependent New model allows these traits to be considered in noncategorical fashion

Neurocognitive Disorder Due to Parkinson's Disease (PD)

Four primary symptoms Tremor of the hands, arms, legs, jaw, or face Rigidity of the limbs and trunk Slowness in initiating movement Drooping posture, or impaired balance and coordination Motor symptoms evident at least one year prior to notable cognitive decline Mild cognitive impairment affects about 27 percent of those with PD

Stroke

Fourth leading cause of death in U.S. Significant cause of disability Can occur at any age One-third of strokes occur under age 65 Some risk factors Cigarette smoking (major contributor) Stress Poor eating and sedentary lifestyle Depression

Neurocognitive Disorder Due to Frontotemporal Lobar Degeneration (FTLD)

Fourth leading cause of dementia Several variants depending on affected brain region Symptoms Changes in behavior, personality, and social skills Difficulty with fluent speech or word meaning Muscle weakness Average age of onset is between 45 and 64

Sociocultural Dimension of APD

Gender Men more likely to exhibit characteristics of APD Traditional gender-role training accepts or encourages aggression in boys but not girls Cultural values in the U.S. Individualism and independence viewed as aspects of healthy function Idea that people can and should control their own lives

Factors Influencing Recovery

Gender Women have a better outcome Higher education level Being married Having a higher premorbid level of functioning Intervention early in course of the illness Peer support and work opportunities also beneficial

Treatment of Gender Dysphoria

Gender reassignment therapies Changing physical characteristics through hormone therapy or surgery Many involve reconstructing genital organs Some insurance beginning to include coverage for transgender individuals Studies show positive outcomes Some risk remains for psychiatric difficulties, including suicidality

Psychological, Social, and Sociocultural Dimensions

Genetic background interacts with environmental factors Children with socioeconomically advantaged homes often experience enriching activities Strong, positive influences Enriching, encouraging home environment Ongoing education intervention Religious and cultural beliefs affect parent attitudes and coping strategies

Etiology of Schizophrenia: Biological

Genetics and heredity play a role Interactions among a large number of different genes Closer blood relatives have greater risk 16% chance for close relatives (e.g. mother and son) 4% chance for distant relatives (e.g. aunt and niece) 1% for general population

Support for Individuals with Neurodevelopmental Disorders

Goal of intervention Build skills and develop potential to the fullest extent possible For those with moderate to severe ID or ASD Support often begins in infancy and extends across the life span

Treatment for Bipolar Disorders

Goal: eliminate symptoms to greatest degree possible Prevention of future episodes Combination of mood-stabilizing medications, psychotherapy, and psychoeducation Biomedical treatments May involve multiple medications or multiple medication changes

Sleep-Wake Disorders

Good quality sleep associated with mental and physical resilience Most adults need seven to nine hours of sleep per night Normal sleep pattern Non-rapid eye movement (NREM) sleep Rapid eye movement (REM) sleep Associated with dreaming

Types of Strokes

Hemorrhagic stroke Involves leakage of blood into the brain Ischemic stroke Caused by a clot or severe narrowing of the arteries supplying blood to the brain 87% of strokes Transient ischemic attack (TIA) "Mini-stroke" resulting from temporary blockage of arteries Symptoms often precede ischemic stroke

Etiology of Obsessive-Compulsive and Related Disorders

Heredity is involved Endophenotype characteristics for OCD Impairment in: Decision-making Planning Mental flexibility Increased metabolic activity in frontal lobe of left hemisphere of the brain

Review

How can we determine whether someone has a neurocognitive disorder? What are the different types of neurocognitive disorders? What are the causes of neurocognitive disorders? What treatments are available for neurocognitive disorders? What do we know about sleep disorders?

Emotional Symptoms of Hypomania/Mania

Hypomania Unusually in high spirits, full of energy and enthusiasm, or uncharacteristically irritable May overreact with hostility Mania Unstable and rapidly changing emotions Grandiosity

DSM-5 Diagnostic Guidelines

Impairment in functioning for most of the day, and nearly every day, for two weeks or more Depressed mood, sadness, or emptiness Loss of pleasure in previously enjoyed activities At least four additional changes in functioning: Alteration in weight, atypical sleep patterns, restlessness, low energy, feelings of worthlessness, difficulty concentrating, or preoccupation with death or suicide

Diagnosis and Classification of Depressive Disorders

Important aspect Ensure patient has never experienced an episode of hypomania or mania Helps differentiate between bipolar and depressive disorders Consider severity and chronic nature of symptoms

Erectile Disorder

Inability to attain or maintain an erection sufficient for sexual intercourse or other sexual activity Studies show up to 70 percent of erectile dysfunction is due to limited blood flow Distinguishing between biological and psychological causes is often difficult Distinction may be made based on presence or absence of nocturnal penile tumescence

Long-Term Outcome Studies

Increased optimism regarding course of the disorder Follow-up study results 10 year study Majority improved over time; minority deteriorated 15 year study 40% showed periods of substantial recovery Sizable minority were not on medication

Support in Childhood

Individualized home-based or school-based programs Parent involvement an integral part of early intervention programs School services individualized to meet needs of the child Maximize learning opportunities Improve skills needed for independent or semi-independent living

Treatment of APD

Individuals feel little anxiety and as a result, lack motivation for treatment Approaches that require cooperation of client may be ineffective Treatment must provide enough control to force confronting inability to form close relationships Incarceration or psychiatric hospitalization may offer setting for treatment Material rewards for behavior modification

Analysis of One PersonalityDisorder: Antisocial Personality

Individuals with APD often involved with criminal justice system Results in relatively more information on this disorder The multipath model explains how the biological, psychological, social, and sociocultural dimensions contribute to development of APD

Functional and Anatomical Brain Changes with Depression

Individuals with depression have increased connectivity in the default mode network brain regions Antidepressant medications appear to normalize connectivity Depressed individuals have different patterns of neural activity Reduced activation in the prefrontal cortex Increased activity in the amygdala

Neurostructures

Individuals with schizophrenia have decreased volume in the cortex and ventricle enlargements Rapid loss of brain cells over six-year period Ineffective communication between different brain regions May lead to the cognitive, negative, and positive symptoms

Narcissistic Personality Disorder

Individuals with this disorder have a sense of entitlement, exaggerated self-importance, and superiority Grandiosity Talk mainly about themselves Lack of empathy Little research on causes Treatment recommendations frequently based on clinical experience

Psychosocial Therapy

Inpatient approaches Milieu therapy (hospital as community and patients have responsibilities) and behavioral therapy can be beneficial Psychosocial skills training: increasing appropriate self-care, conversational skills, and job skills Undesirable behaviors are decreased through reinforcement and modeling techniques Community homes can assist in transition from inpatient programs to community living

Dyssomnias

Insomnia disorder Difficulty in falling asleep or maintaining sleep Caused by various factors Hypersomnolence disorder Excessive sleepiness Naps do not provide relief from sleepiness Sleep inertia Significant grogginess and impaired alertness upon waking

Agoraphobia

Intense fear of at least two of the following Being outside of the home alone Traveling via public transportation Being in open spaces Being in stores or theatres Standing in line or being in a crowd Situations are feared because escape or help may not be readily available

Social Anxiety Disorder

Intense fear of being scrutinized or doing something embarrassing or humiliating in the presence of others Often comorbid with major depressive disorder and substance-use disorders Women twice as likely as men to have social anxiety disorder Can be chronic and disabling

Symptoms of Depression

Intense sadness and loss of interest in normally enjoyed activities Changes in emotional reactions, thinking, behavior, or physical well-being

Transvestic Disorder

Intense sexual arousal associated with cross-dressing (wearing clothes appropriate to the opposite gender) Do not confuse with gender dysphoria Most people who cross-dress are exclusively heterosexual Incidence higher among men than women Men may become sexually aroused by thoughts of themselves as female

Chapter 16 Internalizing Disorders Among Youth

Internalizing disorders involve inward-directed emotional symptoms Anxiety and depressive disorders most common internalizing disorders Often lead to substance abuse and suicide Abrupt behavior changes May signal possible sexual abuse

Treatment of Externalizing Disorders

Interventions that address family and social context and psychosocial skills Significant improvement seen Parent-focused interventions effective Interventions that focus on teaching child assertiveness and anger management techniques Mobilizing adult mentors who demonstrate empathy, warmth, and acceptance

Bipolar Disorders

Involve episodes of hypomania and mania Alternate with episodes of depression Very strong genetic component People with bipolar disorders respond to medications that have little effect with depressive disorders Peak age of onset is teens and early twenties

Neurodevelopmental Disorders

Involve impaired development of the brain and central nervous system Symptoms become increasingly evident as child grows and develops Types Tic disorders Attention-deficit hyperactivity disorder Autism spectrum disorders Intellectual and learning disorders

Dissociative Disorders

Involve some sort of dissociation (separation) of a part of a person's consciousness, memory, or identity Types of dissociative disorders Dissociative amnesia Depersonalization/derealization disorder Dissociative identity disorder (multiple personality) Relatively rare

Learned Helplessness and Attributional Style

Learned helplessness Belief that we have little influence over what happens Negative attributional style Focus on causes that are internal, stable, and global

Nonsuicidal Self-Injury (NSSI)

Involves intentionally inflicted superficial wounds Pain induces a temporary sense of calm and well-being Intense negative thoughts or emotions and a preoccupation with engaging in self-harm typically precede episodes of NSSI DSM-5: NSSI a category under study For diagnosis: episodes happening more than 5 times per year

Genito-Pelvic Pain/Penetration Disorder

Involves physical pain or discomfort associated with intercourse/penetration Dyspareunia Pain in the pelvic region during intercourse Vaginismus Involuntary spasm of the outer third of the vaginal wall Prevents or interferes with sexual intercourse

DLB

Lewy bodies Brain cell irregularities Result from the buildup of abnormal proteins in the nuclei of neurons Also present in Parkinson's disease When present in the cortex Deplete the neurotransmitter acetylcholine When present in the brain stem Deplete dopamine

Prevalence of Bipolar Disorders

Lifetime prevalence 1.0 percent for bipolar I and 1.1 percent for bipolar II Cyclothymic disorder lifetime prevalence between 0.4 and 1 percent Bipolar may be underdiagnosed Research on gender differences is mixed Associated with high unemployment and decreased work productivity

Etiology of Alzheimer's Disease (cont'd.)

Link between sleep and amount of beta-amyloid in the brain Older adults with poor sleep quality or quantity had more beta-amyloid deposits

Treatment for Bipolar Disorders (cont'd.)

Lithium Considered most effective medication for those who respond to its effects Anticonvulsant drugs are also being used Antidepressants are added to deal with depressive symptoms, but they may exacerbate manic symptoms Failure to take medication a major issue

Types of Dissociative Amnesia

Localized Inability to recall a specific event or events Systematized Loss of memory for certain categories of information Selective amnesia Inability to remember certain details of an incident

Etiology of Schizophrenia: Social

Long ago, dysfunctional family patterns were considered the primary cause Certain social factors have influence Maltreatment during childhood Chronic bullying Relationships within the home Expressed emotion Negative communication pattern among relatives of individuals with schizophrenia

Symptoms of MDD with a Seasonal Pattern

Low energy Increased sleep Social withdrawal Carbohydrate craving

Treatment of Sleep-Wake Disorders

Maintaining a regular sleep-wake cycle Exercising regularly Avoiding caffeine, naps, and heavy meals Avoiding alcohol and nicotine within two hours of sleep Relaxed frame of mind Minimize worry about not sleeping Eliminating distractions from bedroom

Depressive Disorders

Major depressive disorder Persistent depressive disorder Premenstrual dysphoric disorder

Chapter 13 Types of Neurocognitive Disorders

Major neurocognitive disorder Minor neurocognitive disorder Delirium

Symptoms of Mania

Mania Even more pronounced mood change than hypomania Variety of behaviors from euphoria to extreme irritability Cause marked impairment in social or occupational functioning May involve loss of contact with reality

Treatment for Rapists

Many believe sex offenders are not good candidates for treatment Most common penalty is imprisonment High recidivism rates When intervention occurs, it usually incorporates behavioral techniques Some treatment techniques show success with exhibitionists and child molesters Outcomes tend to be poor for rapists

Endophenotypes

Measurable, heritable traits Endophenotypes associated with schizophrenia Irregularities in working memory, executive function, sustained attention, and verbal memory

Contemporary Trends and Future Directions

Medical professionals continue to emphasize lifestyle changes to reduce vulnerability Research efforts Identification of early biomarkers for neurodegenerative diseases Therapies to stop degeneration once it has begun Relationship between sleep impairment and psychiatric disorders

Assessment Process (cont'd.)

Medical tests EEG CT MRI PET Comprehensive baseline assessments Used to monitor progress or decline in functioning

Treatment for Depression

Medication Classes of antidepressants Tricyclics, monoamine oxidase inhibitors, and serotonin-norepinephrine reuptake inhibitors Atypical antidepressants Circadian-related treatments Sleep deprivation followed by sleep recovery Light therapy

Treatment of Phobias

Medications with efficacy for SAD Benzodiazepines Examples: Ativan, Xanax, Valium Can produce dependence SSRIs Often prescribed for chronic forms of anxiety Beta-blockers D-cycloserine

Other Factors Affecting Memory Loss

Memory loss occurs for a variety of reasons Early symptom of AD Gradual loss of brain neurons due to aging Temporary conditions Infections or reactions to prescription drugs Older adults continue to generate new brain cells Brain reorganizes to maximize cognitive efficiency

Types of Headaches

Migraine headaches Result from constriction of the cranial arteries Pressure on nearby nerves produces moderate to severe pain Often accompanied by nausea and vomiting Tension headaches Stress creates a prolonged contraction of scalp and neck muscles Results in vascular constriction and steady pai

Features and Conditions Associated with Bipolar Disorder

Mixed features Three or more symptoms of hypomania/mania or depression occurring during an episode from the opposite pole Rapid cycling Four or more mood episodes per year Increases chances that disorder will be chronic and symptoms more severe

Biological Dimension of Somatic Symptom and Related Disorders

Modest contribution of genetic factors Biological vulnerabilities Lower pain thresholds Heightened sensitivity to pain Hypervigilance or exaggerated focus on bodily sensation Dysregulated connectivity has been found in brain regions associated with symptoms Neural connections normalize after successful treatment

Minor Neurocognitive Disorder

Modest decline in at least one major cognitive area Individuals able to participate in normal activities May require extra time to complete tasks Overall independent functioning not compromised Often an intermediate stage between aging and major neurocognitive disorder

Pediatric Bipolar Disorder (PBD)

Mood variability, depressive episodes, and departure from typical functioning that characterize adult bipolar disorder Hypomanic/manic episodes may alternate with depressive/irritable episodes Elevated neurological responsiveness to emotional stimuli and various brain abnormalities have been found May be overdiagnosed

Depersonalization/Derealization Disorder

Most common dissociative disorder Characterized by feelings of unreality or being detached from oneself and the environment Diagnosis guidelines Symptoms cause significant impairment or distress

Anxiety, Trauma, and Stressor-Related Disorders in Early Life

Most common mental health disorder in childhood and adolescence (32%) Anxiety disorders Significant level of discomfort or fear when facing unfamiliar situations Can significantly impact academic and social functioning Types of anxiety disorders Separation anxiety disorder Selective mutism

Concussion

Most common type of TBI Trauma-induced changes in brain functioning Symptoms include headache, dizziness, nausea, and sensitivity to light Usually temporary (few weeks), but sometimes last much longer Many occur in competitive sports and recreational activities About half are unreported

BPD (cont'd.)

Most commonly diagnosed personality disorder Prevalence ranges from 1.6 to 5.9 percent More common in women Up to ten percent of those with BPD die by suicide Many show remission of symptoms over a course of six or more years

Personality Psychopathology

Most people are flexible in responding to life situations Shy people are not necessarily shy in all situations Individuals with personality psychopathology Rigid, inflexible patterns of responding Patterns are long-standing and enduring Present in nearly all situations

Neurocognitive Disorder Due to Alzheimer's Disease (AD)

Most prevalent neurodegenerative disorder Affects more than 5 million Americans Involves progressive cognitive decline Age a major risk factor Clear physiological indicators required to predict whether patients with mild memory impairment will likely develop AD

Social and Sociocultural Dimensions of GAD

Mothers with anxiety may be less engaged with their infants Associated with increased likelihood of child developing GAD Some stressors that influence GAD Poverty, poor housing, prejudice, and discrimination Peer relationship conflicts

Conversion Disorder

Motor, sensory, or seizure-like symptoms Inconsistent with any recognized medical disorder Motor weakness and abnormal movements most common symptoms among children Individuals not consciously faking symptoms Believe problem is genuine

Contemporary Trends and Future Directions

Move from pessimistic views regarding outcome to recovery model Not necessary to be symptom-free in order to move beyond label of being mentally ill and achieve one's potential Early identification and treatment of high risk individuals Common in children and adolescents Most symptoms disappear by age 18 Ability to talk with a therapist beneficial

Rehabilitation Services

Must be comprehensive and sustained Physical, occupational, speech, and language therapy Individual's commitment and participation in therapy plays an important role Depression, pessimism, and anxiety can stall progress Constraint-induced therapy Repeated and intensive use of affected side of the body

Parasomnias

NREM sleep arousal disorders Sleep terrors Sleepwalking Nightmare disorder Dreams of danger frightening enough to produce awakening REM sleep behavior disorder Involves vocalizations and motor behavior during sleep

Psychological Dimension of GAD

Negative schemas play a key role Ambiguous or positive situations may be viewed with apprehension Aspects of worrying Cope with stressful events or situations Constantly generate solutions to "what if" scenarios Worry about worry

Environmental Support

Neurodegenerative disorders involving dementia Irreversible Best managed with supportive environment Exposure to bright lighting Improve sleep and decrease agitation and depression Family visits Labeling family photos

Other Side Effects of Antipsychotic Medication

Neuroleptic malignant syndrome Muscle rigidity Tardive dyskinesia Involuntary and rhythmic tongue movement Chronic condition Metabolic syndrome

Etiology of Depressive Disorders: Biological Dimension

Neurotransmitters and depressive disorders Low levels of neurotransmitters Norepinephrine, serotonin, and dopamine Depression tends to run in families Same type of disorder Genes interact with environmental factors to produce depression Short allele of the serotonin transporter gene

Hypertension

Normal blood pressure Systolic pressure lower than 120 Diastolic pressure lower than 80 Hypertension Systolic pressure at or above 140 Diastolic pressure at or above 90 Prehypertension Blood pressure levels higher than normal but not meeting hypertension levels

Depressive Reactions to Grief

Normal grief-related reactions May last for several years Frequency and intensity diminishes over time Important to distinguish from MDD Persistent complex bereavement disorder Condition undergoing study as a diagnostic category in the DSM-5

Interventions Focusing on Family Communication and Education

Normalize family experience Demonstrate concern, empathy, sympathy Educate family members about schizophrenia Avoid blame Identify strengths and competencies Develop problem solving and stress management skills Strengthen communication

Biological Treatment

Objective: prevent, control, or reduce symptoms Medication Levodopa increases dopamine availability High doses of vitamin E can slow AD progression Antidepressants Early stages of research into deep brain stimulation

Obsessive-Compulsive and Related Disorders

Obsessive-compulsive disorder Consistent, anxiety producing thoughts or images Overwhelming need to engage in activities or mental acts to counteract anxiety or prevent occurrence of dreaded event Hoarding disorder Inability to discard items regardless of their value

Minor Neurocognitive Disorder (cont'd.)

Often goes undiagnosed Early detection can allow individual to plan for future care before the disorder progresses Sometimes major neurocognitive disorder is downgraded to minor As a result of recovery from stroke or traumatic brain injury

Medication Effectiveness

Older and newer medications found to have the same effectiveness Newer medications much more costly Relatively large group of people with schizophrenia do not benefit at all from antipsychotic medication Between 50 and 75 percent of patients discontinue use of antipsychotics Various reasons stated, including side effects

Lack of Fear Conditioning and Emotional Responsiveness

One hypothesis Biological abnormalities make people with APD less susceptible to fear and anxiety Less likely to learn from experiences involving punishment Youth exhibiting antisocial behaviors showed diminished reactivity in the amygdala when shown pictures depicting fearful facial expressions

Prevalence of Depressive Disorders

One of the most common psychiatric disorders Second leading cause of disability worldwide Women at significantly greater risk Chronic disorder for many people About 15 percent fail to show significant symptom reduction Possibly due to undiagnosed bipolar disorder

Other Etiological Factors Associated with Bipolar Disorders

Onset of bipolar sometimes directly follows major stressful event Individuals may have selective attention and recall of negative information about themselves Biological factors appear to play a much more prominent role than other factors

Cerebral Laceration

Open head injury Brain tissue is torn, pierced, or ruptured Immediate medical care involves reducing bleeding and preventing swelling Symptoms vary with severity of laceration

The Sexual Response Cycle (cont'd.)

Orgasm phase Characterized by involuntary muscular contractions throughout the body and eventual release of sexual tension Resolution phase Characterized by relaxation of the body after orgasm Heart rate, blood pressure, and respiration return to normal

Cortisol, Stress, and Depression

Overproduction of stress-related hormones appear to play an important role in depression People with depression have higher blood levels of cortisol Exposure to stress during early development affects cortisol levels High levels of cortisol can damage the hippocampus Neurons die and fail to regenerate

Cluster A - Disorders Characterized by Odd or Eccentric Behaviors

Paranoid personality disorder Pervasive distrust and suspiciousness of others Motives interpreted as malevolent Tend to be rigid in thinking May seem aloof and lacking emotion Use projection as a defense mechanism "I am not hostile, they are" Prevalence ranges from 2.3 to 4.4 percent

Social Dimension

Parental behaviors influence development of social anxiety in children Overprotection Lack of support for independence Punitive maternal parenting style Negative family interactions and family stress Associated with social anxiety in middle childhood

Extrapyramidal Symptoms

Parkinsonism Muscle tremors, shakiness, immobility Dystonia Involuntary muscle contractions in limbs and tongue Akathesia Motor restlessness

Dissociative Amnesia

Partial or total loss of important personal information May occur suddenly after traumatic event or stressful circumstances

Factitious Disorder Imposed on Another

Pattern of falsification of physical or psychological symptoms in another individual In many cases, the individual is a mother who appears loving and attentive Simultaneously sabotaging child's health Relatively new diagnostic category Diagnosis of this condition is difficult

Oppositional Defiant Disorder (ODD)

Pattern of negativistic, argumentative, and hostile behavior Loss of temper Argue and defy adult requests Primarily directed toward parents, teachers, and others in authority No serious violation of societal norms Symptoms often resolve Especially with intervention

Circadian Rhythm Sleep Disorder

Pattern of recurrent sleep disturbance Caused by disrupted biological sleep-wake cycle Jet lag Temporary disruption in circadian rhythm Shift work can produce problems Work schedule opposes sleep-regulating cues associated with sunlight

Somatic Symptom Disorder (SSD)

Pattern of reporting and reacting to pain or other distressing symptoms Pattern occurs for at least six months Involves persistent thoughts or high anxiety about the symptoms Person remains convinced they have a serious disease Even when tests rule out illness In about ten percent of cases, symptoms are early indications of a medical condition

Prevalence of Personality Disorders

People with personality psychopathology often function well enough and see themselves as not having a problem Many individuals do not seek help or come to the attention of mental health professionals Prevalence is difficult to determine Estimated to be 9-13 percent of general population

Hallucinations

Perception of a nonexistent or absent stimulus Auditory (hearing) Most common type of hallucination Visual (seeing) Olfactory (smelling) Tactile (feelings) Gustatory (tasting)

Conduct Disorder (CD)

Persistent pattern of antisocial behavior that violates rights of others Requires presence of at least three different behaviors Aggression, bullying, cruelty to people or animals, property destruction, theft or deceit, serious rules violations Those with CD exhibit limited prosocial emotions Significant concern to the public

Generalized Anxiety Disorder (GAD)

Persistent, high levels of anxiety and excessive, hard-to-control worry over life circumstances DSM-5 diagnostic criteria Symptoms must be present on the majority of days for six months Causes significant impairment in life activities Develops gradually Often begins in childhood or adolescence

Chapter 15 Introduction to Personality

Personality is a psychological characteristic Influenced by biological factors Children have differences in temperament from birth Different levels of reactivity to outside stimulation Personality trait Tendency to feel, perceive, behave and think in a relatively consistent manner

Obsessive-Compulsive Personality Disorder (OCPD)

Pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control Differs from OCD OCD involves unwanted, intrusive thoughts and urges Individuals with OCPD see their way of functioning as correct Genetic or early childhood environmental factors

Dependent Personality Disorder

Pervasive, excessive need to be taken care of Leads to submissive and clinging behavior Individuals have fear of separation High risk for becoming a victim of relationship violence Associated with overprotective, authoritarian parenting Relatively rare disorder

Gender Dysphoria

Previously called gender identity disorder (GID) or transsexualism Marked incongruence (mismatch) between one's experienced or expressed gender and biologically assigned gender Not the same as sexual orientation Diagnosed when there is significant distress or impairment Experienced differently at different ages

Psychological Dimension of Somatic Symptom and Related Disorders

Psychodynamic perspective Symptoms seen as defense against awareness of unconscious emotional issues Primary and secondary gain Cognitive-behavioral perspective Cause: reinforcement, modeling, cognitions, or combination of these Idea that somatic disorders may develop in predisposed individuals

Issues with Diagnosing PersonalityPsychopathology

Poor inter-rater reliability for personality disorder categories Comorbidity is high, reducing diagnostic accuracy Exclusive categorical approach has limitations Arbitrary diagnostic thresholds All-or-none method does not take into account continuous nature of personality traits

Etiology of rape

Power rapist: 55 percent of rapists Compensate for feelings of personal/sexual inadequacy by trying to intimidate victims Anger rapist: 40 percent of rapists Angry at women in general Sadistic rapist: 5 percent of rapists Derives satisfaction from inflicting pain May torture or mutilate victims

Factitious Disorder Imposed on Self

Presentation of oneself to others as ill or impaired Through recurrent falsification or induction of physical symptoms May include sabotaging or intentionally interfering with medical care No obvious rewards except attention, support, and social relationships

Intermittent Explosive Disorder

Prevalent, persistent, and seriously impairing disorder Both underdiagnosed and undertreated Involves recurrent outbursts of verbal or physical aggression Symptom frequency Twice weekly for at least three months, or three outbursts per year that result in injury or property damage

Psychological Dimension of APD

Psychodynamic perspective Faulty superego development Cognitive perspective Core beliefs influence behavior Learning perspective Neurobiological traits that impede learning Lack of positive role models Type of punishment may influence learning

Sexual Interest/Arousal Disorders

Problems with sexual excitement in the appetitive and arousal phases Male hypoactive sexual desire disorder Little or no interest in sexual activities Female sexual interest/arousal disorder Little or no interest, or diminished arousal to sexual cues 40-50 percent of all sexual difficulties involve deficits in interest

Phases of Schizophrenia

Prodromal phase Onset and buildup of symptoms Social withdrawal and isolation Inappropriate affect Poor communication patterns Neglect of personal grooming Active phase Full-blown symptoms Residual phase Symptoms no longer prominent

ASD Intervention and Treatment

Prognosis is mixed Most children retain diagnosis and require support throughout lifetime Individuals with milder symptoms may be self-sufficient and successfully employed Social awkwardness, restrictive interests, or atypical behaviors often persist Significant recovery linked with intense early intervention

Support in Adulthood

Programs focusing on specific job skills Institutionalization is rare Many adults live with family members "Least restrictive environment" possible As much independence and personal choice as is safe and practical Many assisted living environments promote social interaction with the larger community

Characteristics of AD

Progressive decline in cognitive and behavioral functioning Physiological processes that produce AD begin years before onset of symptoms Early symptoms Memory dysfunction, irritability, and cognitive impairment Other symptoms that often appear Social withdrawal, depression, apathy, delusions, impulsive behaviors, neglect of personal hygiene No cure exists

Chronic TraumaticEncephalopathy (CTE)

Progressive, degenerative condition Diagnosed in individuals who have had multiple episodes of head injury Associated with psychological symptoms and increased risk of dementia Four stages of CTE Each with different symptoms

Psychotherapy for Trauma-Related Disorders

Prolonged exposure therapy (PE) Involves exposure to trauma-related cues Cognitive-behavioral therapy (CBT) Involves identifying and challenging dysfunctional cognitions

Somatic Symptom and Related Disorders Chapter 7

Prominent physical or bodily symptoms associated with significant impairment or distress Actual physical illnesses may or may not be present

Cognitive-Behavioral Treatmentof Panic Disorder

Promotes self-efficacy General steps Educating the client about panic disorder Identifying and correcting catastrophic thinking Teaching client to self-induce physiological symptoms in order to extinguish the conditioning Encouraging client to face the symptoms

Psychological Dimension of Dissociative Disorders

Psychodynamic theory Repression protects the individual from painful memories or conflicts Contemporary theory Post-traumatic model of DID Personality split develops because of the traumatic experience and the inability to deal with it Difficult to formulate and test hypotheses

Psychological Dimension

Psychological and personality characteristics can influence health status Positive emotions help regulate stress reactions Negative emotions accentuate the stress response Commitment, control, and openness to challenge associated with thriving through stressful situations

Psychological Dimension

Psychological characteristics can interact with biological predispositions Can produce anxiety symptoms Negative appraisal Interpreting events as threatening Skill of reappraisal Looking at a situation from various perspectives Minimize negative responses

Etiology of Sexual Dysfunctions (cont'd.)

Psychological dimension Predisposing or historical factors Current problems and concerns Presence of anxiety disorders Performance anxiety and spectator role Role of early sexual experiences Situational or emotional anxiety for women Negative thoughts and dysfunctional beliefs

Cognitive and Behavioral Treatment

Psychotherapy Enhance coping and participation in rehabilitation efforts Reduce frequency and severity of problem behaviors Meditation and mindfulness-based stress reduction Reduced brain atrophy

Interactions Between Biological and Environmental Influences

Puzzling result: only some children with short alleles of the 5-HTTLPR gene exhibit behavioral inhibition Subsequent study results Behavioral inhibition occurred when certain environmental factors interacted with a child's genetic predisposition

Etiology of Rape (cont'd.)

Rape has more to do with power, aggression, and violence than sex Sexual motivation also plays a role in rape Most rape survivors are in their teens or 20s Age range associated with sexual attractiveness Most rapists name sexual motivation as primary reason for actions Many rapists have multiple paraphilias

Effects of Rape

Rape trauma syndrome symptoms Include psychological distress, phobic reactions, post-traumatic stress symptoms, and sexual dysfunction Phases in rape trauma syndrome Acute phase: disorganization Feelings of self-blame, fear, or depression Long-term phase: reorganization Survivors deal directly with feelings and attempt to reorganize their lives

Neurocognitive Disorder Due to Huntington's Disease (HD

Rare, genetically-transmitted degenerative disorder Symptoms Involuntary twitching movements Eventual dementia Early symptom Difficulty in executive functioning No effective treatment Death occurs 15-20 years after symptom onset

Contemporary Trends and Future Directions

Recent research data suggests personality disorders appear to remit more often than previously believed Leads to a less pessimistic outlook for individuals with personality psychopathology Clinicians favor the traditional categorical model Use of alternative model in clinical diagnosis unknown

Sexual Dysfunctions

Recurrent and persistent disruption of any part of the normal sexual response cycle DSM-5 requires that symptoms be present for at least six months and be accompanied by significant distress Types of dysfunctions Lifelong Acquired Generalized Situational

Panic Disorder

Recurrent, unexpected panic attacks Combined with apprehension about having another attack or behavior changes designed to avoid having another attack Reactions present for one month or more Twelve month prevalence rate in the U.S. is 2.7 percent Twice as common in women as in men

Frotteuristic Disorder

Recurrent/intense sexual urges, acts, or fantasies of touching or rubbing against a nonconsenting person For diagnosis, person must be markedly distressed by urges or have acted on them Prevalence is difficult to determine Behavior may go unnoticed or presumed to be accidental

Social Dimension of Somatic Symptom and Related Disorders

Rejection or abuse from family members Feeling unloved History of sexual abuse Previous physical illness Parents or family members with chronic physical illness Parental attentiveness to somatic complaints

Treatment of Stress-Related Disorders

Relaxation training Learn to relax muscles of the body under almost any circumstances Biofeedback training Learn to voluntarily control physiological processes in order to improve physical or mental health Examples: heart rate, blood pressure

ASD Symptoms (cont'd.)

Repetitive behavior or restricted interests or activities involving at least two of following: Repetitive speech, movement, or use of objects Intense focus on rituals or routines and strong resistance to change Intense fixations or restricted interests Atypical sensory reactivity

Types of Dissociative Amnesia (cont'd.)

Repressed memory Amnesia may come to light only after recalling details of a traumatic event Not all researchers believe in the validity of repressed memories Possibility of feigning amnesia Especially by criminals

Diagnosis of Acute and Post-Traumatic Stress Disorders

Requirements for diagnosis Exposure to traumatic event Intrusion symptoms Avoidance Negative alterations in mood or cognition Arousal and changes in reactivity Hypervigilance

Etiology of Neurocognitive Disorders

Result from variety of medical conditions Some involve specific events Stroke Head injury Some become worse over time Neurodegeneration Progressive brain damage involving death of brain cells Individuals show decline, not improvement

Psychological Dimension of ASD and PTSD

Risk factors Preexisting conditions such as anxiety and depression, hostility, and anger Specific cognitive styles or dysfunctional thoughts Interpret stressors in a catastrophic manner Social dimension Social support can diminish PTSD symptoms

Social Dimension

Risk factors for adverse health outcomes Lack of social support Maltreatment in social relationships Good relationships moderate the link between hostility and poor health

Biological Dimension

Ruling out medical or physical causes of anxiety symptoms is important Hyperthyroidism Cardiac arrhythmias Asthma medications Stimulants Withdrawal from alcohol

Cognitive Symptoms of Depression

Rumination Continually thinking about certain topics or reviewing distressing events Inability to concentrate, remember things, or make decisions Frustration over inability to handle tasks normally managed without difficulty Thoughts of suicide

Chapter 12Introduction

Schizophrenia Serious chronic mental illness Falls on the severe end of the schizophrenia spectrum Disorders on the schizophrenia spectrum Involve psychosis, impaired cognitive processes, unusual or disorganized motor behavior, and uncommon behaviors affecting social interactions

Neurodegenerative Disorders Due to Dementia with Lewy Bodies (DLB)

Second most common form of dementia Characteristics Progressive cognitive decline Unusual movements seen in Parkinson's disease Significant fluctuations in attention and alertness Hallucinations Impaired mobility Sleep disturbance

Parkinson's Disease (cont'd.)

Second most common neurodegenerative disorder in the U.S. Later stages of PD Cognitive and behavioral symptoms similar to those of DLB Disorder occurs more frequently in Northern Midwest and the Northeast in urban settings Raises questions about environmental toxins

Premenstrual Dysphoric Disorder

Serious symptoms of depression, irritability, and tension appearing the week before menstruation and remit soon after the onset of menses At least five symptoms must be present Significant depressed mood or mood swings, anger, irritability, anxiety, tension, difficulty concentrating, social withdrawal, food cravings, insomnia or excessive sleeping, feeling overwhelmed, and lack of energy

Genetic Influences

Serotonin (a neurotransmitter) linked to depression and anxiety Research focused on variation in serotonin transporter gene, 5-HTTLPR Result: short alleles of the 5-HTTLPR gene are associated with a reduction in serotonin activity and increased anxiety-related behaviors Numerous genes affect vulnerability Only influence an individual's predisposition

Rape

Sexual aggression that involves sexual activity performed against a person's will through the use of force, argument, pressure, alcohol or drugs, or authority Not considered a psychological disorder Number of rapes in the U.S. has risen dramatically One in five adult women has been raped One in 71 men

Paraphilic Disorders Involving Pain or Humiliation

Sexual masochism disorder Sexual urges, fantasies, or acts that involve being humiliated, bound, or made to suffer Individual does not seek harm or injury Finds sensation of helplessness appealing Sexual sadism disorder Sexual urges, fantasies, or acts that involve inflicting physical or psychological suffering on others

Tics

Short-term suppression of a tic is possible Often results in subsequent increases in the tic Tension may build prior to tic, followed by a sense of relief after tic occurs Symptoms often peak prior to puberty Symptoms often temporary and may disappear without treatment Due to neuroplastic brain reorganization

Alzheimer's Disease and the Brain

Shrinkage of brain tissue Abnormal structures Neurofibrillary tangles Twisted fibers of tau found inside nerve cells Beta-amyloid plaques Beta-amyloid proteins aggregate in spaces between neurons Brain changes appear years before dementia appears

Attachment Disorders

Significant difficulties with emotional attachment and social relationships Cause: stressful early environments that lack predictable caretaking and nurturing Types of attachment disorders Reactive attachment disorder (RAD) Disinhibited social engagement disorder (DSED)

Social and Sociocultural Dimensions of Dissociative Disorders

Sociocognitive model of DID Individuals learn about DID through mass media and begin to act out its roles Iatrogenic disorder Condition unintentionally produced by a therapist through mechanisms placed on the client Individuals who report dissociations score high on fantasy proneness and fantasy susceptibility

Etiology of Sexual Dysfunctions (cont'd.)

Sociocultural dimension Influenced by gender, age, cultural scripts, sexual orientation Examples of sociocultural aspects People in Asian countries consistently report lowest frequency of sexual intercourse Cultural scripts for men in the United States Sexual potency as a sign of masculinity Homophobia toward lesbians or gays

Somatic Symptom and Related Disorders (cont'd.)

Somatic symptom disorder (SSD) Illness anxiety disorder Conversion disorder (functional neurological symptom disorder) Factitious disorder Psychophysiological disorders (Chapter 6)

MDD with a Seasonal Pattern

Some individuals with MDD and bipolar report seasonal pattern to depressive episodes Associated with changes in daylight as the seasons change Occurs more often in Northern latitudes Previously termed seasonal affective disorder DSM-5 refers to MDD with a seasonal pattern

Personality Disorders

Specific disorders grouped into three behavior clusters Odd or eccentric (cluster A) Dramatic, emotional, or erratic (cluster B) Anxious or fearful (cluster C)

Assessment of Brain Damage and Neurocognitive Functioning

Steps in assessment Gather background information Evaluate overall mental functioning, personality characteristics, and coping skills Rule out sensory conditions or emotional factors Test to pinpoint areas of cognitive difficulty

Treatment of ADHD

Stimulants such as Ritalin have been used for decades Normalize neurotransmitter functioning 30 percent do not respond or experience significant side effects Still considered first-line treatment approach Likelihood of medication use greatest for those with severe symptoms Behavioral and psychosocial treatment shown effective

Psychological Factors Affecting Medical Conditions

Stress Causes a multitude of physiological, psychological, and social changes that influence health Psychophysiological disorder Physical disorder with a strong psychological basis or component

Stress and the Immune System

Stress itself does not appear to cause infections Appears to decrease immune system's efficiency Results in more susceptibility to disease Stress response involves release of hormones (such as cortisol) that impair immune functioning Chronic stress accelerates disease progression

Social Dimension

Stressful interpersonal events increase risk of depression Severe acute stress more likely than chronic stress to cause first depressive episode Failure to develop secure attachments and trusting relationships early in life Targeted rejection Active, intentional social exclusion or rejection Strongly linked with depressive symptoms

Chapter 6 Stress Definitions

Stressors External events or situations that place physical or psychological demands on a person Stress Internal psychological or physiological response to a stressor

Phobias

Strong, persistent, unwarranted fear of a specific object or situation Extreme anxiety or panic is expressed when phobic stimulus is encountered Most adults recognize fear is excessive, but children may not Most common mental disorder in United States

Treating Depersonalization/Derealization Disorder

Subject to spontaneous remission Slower rate than dissociative amnesia and fugue Treatment focuses on alleviating feelings of depression, anxiety, or fear of detachment symptoms Antidepressants and antianxiety medications Behavioral therapy Reinforcement of appropriate responses

Persistent Depressive Disorder

Symptoms are present most of the day for more days than not for a two-year period Two or more of the following symptoms Feelings of hopelessness Low self-esteem Poor appetite or overeating Low energy or fatigue Difficulty concentrating or making decisions Sleeping too little or too much

Symptoms of Schizophrenia Spectrum Disorders

Symptoms fall into four categories Positive symptoms Psychomotor abnormalities Cognitive symptoms Negative symptoms

Factitious Disorder and Factitious Disorder Imposed on Another

Symptoms of physical or mental illness are deliberately induced or simulated with no apparent incentive Individuals usually unaware of motive Differs from malingering Faking a disorder to achieve some goal, such as an insurance settlement

Cognitive-Behavioral Therapy

Teach coping skills that allow clients to manage their positive and negative symptoms 18-month follow up results: Those receiving CBT demonstrated more days of normal functioning compared to those treated with medication and contact with a psychiatric nurse

Narcolepsy

Very rare sleep disorder Irresistible or overwhelming need for daytime sleep Even when adequate sleep occurs at night Individuals go immediately into REM sleep Many individuals experience cataplexy Sudden loss of muscle function Often triggered by laughter, anger, or fear Can go undiagnosed for many years

Contemporary Trends and Future Directions

The root of many adult mental disorders lies in a stressful childhood Prevention programs to minimize cascading effect of negative experiences remains a high priority Evidence-based interventions that promote resilience in children who have experienced maltreatment Research to address long-term risks and benefits of various interventions

Cognitive Explanations in Depression

The way people think causes depression Pessimism Damaging self-views Feelings of helplessness Co-rumination Constantly talking of problems or negative experiences with others Increases depression risk, especially in girls

BPD (cont'd.)

Three basic assumptions of individuals with BPD The world is dangerous I am powerless and vulnerable I am inherently unacceptable Early childhood experiences, neglect, or abuse may play a role CBT and DBT have shown to be effective Schema therapy

Tics and Tourette's Disorder

Tics Recurrent, sudden, involuntary, nonrhythmic motor movements or vocalizations Examples of motor tics Blinking, grimacing, jerking the head, tapping, flaring nostrils and contracting the shoulders Examples of vocal tics Coughing, grunting, throat-clearing, sniffling, or sudden, repetitive, and stereotyped outburst of words

Psychotherapy Methods (cont'd.)

Trauma-focused cognitive-behavioral therapy (TF-CBT) Eye movement desensitization and reprocessing (EMDR) Nontraditional therapy Involves visualizing traumatic experience while following a therapist's fingers moving side to side

Treatment of DID

Trauma-focused therapy Help individual develop healthier ways of dealing with stressors Major goal is integration of personalities Examples of steps Working on safety issues, stabilization, and symptom reduction Reducing cognitive distortions Developing healthy relationships and practicing self-care

Neurocognitive Disorder Due toTraumatic Brain Injury (TBI)

Traumatic brain injury Can result from bump, jolt, blow, or physical wound to the head 1.7 million people per year receive emergency care for traumatic brain injury Effects can be temporary or permanent Neurocognitive disorder diagnosed with: Persisting cognitive impairment due to a brain injury

Treatment of Dissociative Disorders

Treating dissociative amnesia and dissociative fugue Symptoms tend to abate spontaneously Depression often associated with the fugue state Reasonable approach: alleviate depression and stress Antidepressants, cognitive-behavioral therapy, and stress management techniques

Treatment Considerations with Neurocognitive Disorders

Treatment approaches vary widely due to different causes, symptoms, and dysfunctions Major interventions Rehabilitative services Biological interventions Cognitive and behavioral treatment Lifestyle changes Environmental support

Symptoms of Hypomania

Two intensity levels Hypomania (milder form) Mania Hypomania Increased levels of activity or energy Combined with self-important, expansive mood or irritable, agitated mood Impulsivity and risk taking may appear Person may talk excessively Uncharacteristic of how person normally functio

Brain Stimulation Therapies

Types Electroconvulsive therapy (ECT) Vagus nerve stimulation Transcranial magnetic stimulation Used for severe or chronic depression Specifically for depression not responding to more traditional treatments

Trauma- and Stressor-Related Disorders

Types of disorders covered in this chapter Adjustment Acute stress Post-traumatic stress Childhood disorders are covered in chapter 16

Trauma-Related Disorders

Typical outcomes after exposure to traumatic incidents Resilience Recovery Initial distress with symptom reduction over time Delayed symptoms Few initial symptoms Increasing symptoms over time Chronic symptoms

Treatment of Schizophrenia

Typical treatment today Antipsychotic medication with some type of psychosocial therapy Recent shift from focus on illness and deficit to recovery, promotion of health, independence and self-determination

Chapter 14 What is "Normal" Sexual Behavior?

Understanding what is normal Important when classifying or diagnosing sexual problems and behaviors Difficult to determine what is normal Example: people report tremendous variation in frequency of sexual outlet or release Influenced by cultural norms and values Definitions of sexual disorde

Behavioral Symptoms of Hypomania/Mania

Uninhibited Impulsivity and uncharacteristically risky behaviors Fail to evaluate consequences of decisions Energetic and productive, or agitated and angry Rapid movement and incoherent speech May include psychotic symptoms

Neurocognitive Disorder Due to Substance Abuse

Use of drugs or alcohol Can result in delirium or chronic brain dysfunction Mild neurocognitive disorder common with history of heavy substance use Symptoms continue with initial abstinence but can improve over time

Etiology and Treatment of Paraphilic Disorders

We still have much to learn Some research findings conflict with each other Some men may be biologically predisposed to pedophilic disorder Psychological factors also contribute Paraphilias may result from accidental associations between certain situations and sexual arousal

Behavioral Approaches to Treatment

Weakening or eliminating sexually inappropriate behaviors through extinction or aversive conditioning Acquiring or strengthening sexually appropriate behaviors Developing appropriate social skills Aversive behavior rehearsal for exhibitionism

Review

What are normal sexual behaviors? What do we know about normal sexual responses and sexual dysfunction? What causes gender dysphoria, and how is it treated? What are paraphilic disorders, what causes them, and how are they treated? Is rape an act of sex or aggression?

Review

What are symptoms of depression and mania? What are depressive disorders, what causes them, and how are they treated? What are bipolar disorders, what causes them, and how are they treated?

Review

What are the somatic symptom and related disorders and what do they have in common? What are the causes and treatments of these conditions? What are dissociations? Why do they occur, and how are they treated?

Review

What are the symptoms of schizophrenia spectrum disorders? Is there much chance of recovery from schizophrenia? What causes schizophrenia? What treatments are currently available for schizophrenia, and are they effective? How do other psychotic disorders differ from schizophrenia?

Review

What do we know about disorders caused by exposure to specific stressors or traumatic events? In what ways can stress affect our physical health?

Review

What internalizing disorders occur in childhood and adolescence? What are the characteristics of externalizing disorders? What are elimination disorders? What are neurodevelopmental disorders?

Review (cont'd.)

What is generalized anxiety disorder, what are its causes, and how is it treated? What are characteristics of obsessive-compulsive and related disorders, what causes these disorders, and how are they treated?

Sociocultural Dimension

Women are more likely to be impacted by stress Due to care-giving role for children, parents, and partners More likely to live in poverty Exposure to racism and discrimination Coping skills, resources, and social support mitigate vascular reactivity to ra

Post-Traumatic Stress Disorder in Early Life

Youth with PTSD experience recurring, distressing memories of a shocking experience Direct experience with witnessing death, serious injury, or sexual violation Witnessing or hearing about the victimization of others can also result in PTSD Symptoms Distressing dreams, intense reactions to cues, playacting, or dissociative reactions