Abnormal Psychology Cumulative
Immunosuppression
release of cortisol and CRF cause immunosuppression,* the decreased production of immune agents*
12 month prevalence
0.4 females 0.9 USA females
Three dominate ground for involuntary hospitalization:
1. Inability to care for self 2. Dangerous to self 3. dangerous to others
False negatives
releasing someone who is dangerous to self or others - puts lives at stake
Suicide common motive
escape from psychological suffering
Psychological abuse
repeated denigration in the absence of physical harm
Societal Impact
It is the second leading cause of disease burden ■ Substantial indirect costs are associated with loss of productivity and unemployment
Borderline Personality Disorder
essential feature is a pervasive pattern of instability in mood and interpersonal relationships
Sedative
a more general term that describes drugs that calm people or reduce excitement
Who uses the most illegal drugs?
younger people - elderly people use the most legal drugs, but there is a problem with abuse of prescription drugs
Is most gambling associated with mental disorders?
NOPE
Amphetamines
Produced synthetically
Percent of high schoolers trying to lose weight
* 44% of high school females are attempting to lose weight * 15% of high school males are attempting to lose weight * Many boys want to gain weight in order to look stronger
insanity
an exception to criminal responsibility
70-74 yo sexual behavior
* 65% of men are sexually active * 30% of women
narcotic analgesics
used clinically to decrease pain ex. opiates
Risk factos
• demographic, biological, and psychological variables as well as expectancies about effects of drugs
Is pathological gambling an addiction?
"Addiction" implies absence of responsibility for one's behavior o Some would not call alcohol or drug abuse addictions for this reason DSM-5 includes gambling disorder with substance use disorders because all activate reward pathways in the brain - previously was an impulse disorder
rape
"acts involving nonconsensual sexual penetration obtained by physical force, by threat or bodily harm, or when the victim is incapable of giving consent by virtue of mental illness, mental retardation, or intoxication" 14% adults raped 1/5 women report engaging in sexual activity without consent
examples of malpractice
(1) a professional has a duty to conform to a standard of conduct, (2) the professional is negligent in that duty, (3) the professional's client experiences damages or loss, and (4) it is reasonably certain that the negligence caused the damages inappropriate use of medication and negligent treatment are common
Course and outcome of Bulimia
* 70% of patients are free of symptoms after 5 years following the original diagnosis * 20% show improvement but continue to struggle * 10% are chronically ill * Mortality is rare, but there has been a recent increase in suicide * Comorbid disorders also ten to improve when bulimia improves
Vaginal Intercourse
* 95% men * 97% women
Personality disorder
(presented in DSM-5) emphasizes the duration of the pattern and the social impairment associated with the symptoms in question; the pattern must be evident in two or more of the domains: o Cognitive (way of thinking about the self and other people) o Emotional responses o Interpersonal functioning o Impulse control
lifetime prevalence
* 1.5% = lifetime prevalence of Bulimia * 3.5% = lifetime prevalence of binge-eating disorder among women * 4.9% = lifetime prevalence of occasional binge-eating among women * 2.0% = lifetime prevalence of binge-eating disorder among men * 4.0% = lifetime prevalence of occasional binge eating among men
frequency of gender dysphoria
* 1/12,000 men * 1/30,000 female * very rare
Reaching orgasm
* 29% women - always orgasm with their specific partner * 75% men * 44% of men reported that their female partner always orgasmed (lol)
Who raped you?
* 4% raped by stranger * 46% raped by someone who they were in love with * 22% knew the rapist well * 9% raped by spouse * 19% acquaintance rape
Antidepressant Medications
* All classes are somewhat effective * medication alone is not the treatment of choice * the disordered behaviors improve only among a minority of people treated with antidepressants, and relapse is very common when medication is stopped * research shows CBT is more effective
Predictors of a better prognosis
* An early age of onset * conflict free parent child relationships * early treatment * less weight loss * absence of binging and purging
Anorexia Nervosa
* Anorexia literally meaning "loss of appetite" * extreme emaciation = obvious characteristic * people are hungry, yet they starve themselves
sexual behavior across the lifespan
* As men get older they tend to achieve erection slower but can often maintain erection for longer * harder to regain an erection once lost * As women get older, vaginal lubrication may occur at slower rate, but response of the clitoris remains essentially unchanged * Older people seem to engage in sex more frequently if they did so at a younger age as well * Sexual dysfunctions usually increase among the elderly, particularly among men * however, women reported to experience less pain during sex as they aged * Relation between sexual experience and aging is closely related to other health problems that increase with age
BN - Comorbid Psychological Disorders
* Depression is common - cause or reaction * usually lifts after treatment * anxiety disorders, personality disorders, and substance abuse
Who is most susceptible?
* Develop most frequently among young women in their teens and early twenties * Incidence among women reflects the intense focus on young women's physical appearance and the difficulties many adolescent girls have in adjusting to the rapid changes in body shape and weight that begin with puberty
Standards of beauty culturally
* Eating disorders are much more common in North America, Western Europe, and industrialized Asia countries * Bulimia may be completely culture bound * in other countries women who are more rounded are considered to be more beautiful * In third world countries, where food is scarce, being larger symbolizes beauty and success
AN - Fear of Gaining Weight
* For some even just a little more food is terrifying * May believe they'll instantly become "fat" * Fear may grow more intense as the individual loses more weight
1. A struggles for perfection and control
* Hilde Bruch - one of the 1st and most prolific clinical observes of EDs * she viewed struggle for control as the central psychological issue * girls seemed overly conforming and eager to please * use food as a way to establish control * young people with anorexia "succeed" and take pride in their extreme self-contol * Perfectionists * women with EDs endorse these type of goals about eating and weight and general expectations for themselves * Interoceptive awareness * lack of this predicted the development of EDs 2 years in the future * People with Meds tend to ignore these cues and pay attention to how they look rather than how they feel - sad, angry, happy, or hungry
NHSLS survey - have you experienced any of these in the last 12 months?
* Low Desire * Men - 16% * Women - 34% * Arousal Problem * Men - 11% * Women - 18% * Lack of Orgasm * Men - 8% * Women - 24% * Rapid orgasm * Men - 28% * Women - 10% * Pain during sex * Men - 3% * Women - 14%
how can we create a treatment that contains no active ingredients but increases the client's expectations for change just as much as real treatment?
* One approach = offer an established, alternative therapy that is not designed to treat the disorder being studied * example: interpersonal therapy for bulimia * investigators believed that this therapy contained no "active ingredients" for treating bulimia but thought clients would view it as legitimate
AN - Disturbance in Experiencing Weight or Shape
* People with anorexia usually don't recognize their emaciation for what it is * Many deny their weight * distorted body image - an inaccurate perception of body size and shape
Frotteurisitc disorder
* a person who is fully clothes becomes sexually aroused by touching or rubbing his genitals against other, nonconsenting people * usually choose crowded places, so that he can easily escape an arrest * he will either rub his genitals against the victim's thigh or butt or he will fondle her genitalia or breasts * high frequency form of paraphilia
Exhibitionistic disorder
* about 1/2 of these men have erections while exposing themselves, and some masturbate at the time * other masturbate right after and fantasize about it * usually intent involves a desire to shock the observer * rarely attempt to touch or otherwise molest their victims * almost exclusively a male disorder * beginning usually when one is a teenage * seldom an isolated behavior * tend to do it frequently
AN - Comorbidity
* associated with OCD and obsessive-compulsive personality disorder * obsess with food and diet * follow compulsive eating rituals * a study showed that this can actually help them prevent starvation but sticking to a schedule * WWII - as men lost more with, they developed extensive obsessions about food and compulsive eating rituals * Obsessive-compulsive behavior may be a reaction to starvation, not a risk factor * usually show symptoms of depression - sad mood, irritability, insomnia, social withdrawal, diminished sex drive * can be a cause or reaction to the disorder * often co-occurs with bulimia * purging follows binging * purging may just be a way to further control eating that is already restricted * Those who do not binge or purge have lower rates of depression
pseudohermaphrodite
* both male and female reproductive organs * many of these children are raised as girls * puberty = increase in testosterone leads to "clitoris" turning into more of a penis, and testicles descend into a scrotum * child's voice gets deeper, muscle mass increases, * adopt a masculine gender identity after their brain has been programmed to think otherwise
pedophiles
* can be attracted to children or adults * most are straight * victims more often girls then boys * sexual contact with child usually involves caressing and genital fondling * penetration of any kind is less common * in most cases the child knows the person, making them more likely to comply to the molesters intentions * more than half of the offenses occur in the child or offender's home
gender identity
* our sense of ourselves as being either male or female * usually reflects child's anatomy * fixed by the time one is 2 or 3 years old
Bulimia Nervosa
* characterized by repeated episodes of binge eating, followed by inappropriate compensatory behaviors such as self-inducted vomiting, misuses of laxatives, or excessive exercise * Weight is normally in the normal range * Bulimia literally means "ox appetite" * usually have an average appetite * Binge eating usually presents a failure of control, but it really is their body's natural reaction to unnatural weight suppression
CBT
* cognitive restructuring, social skills training, and stress management procedures * reduces rate of relapse * results were more positive for those convicted of rape rather than child molestation
AN - Medical Complications
* constipation * abdominal pain * intolerance to cold * lethargy * low blood pressure and body temp * skin can become dry and cracked * laguna - a fine, downy hair, on their face or trunk of their body * anemia * infertility * impaired kidney function * cardiovascular problems * dental erosion * bone loss * electrolyte imbalance - a disturbance in the level of potassium, sodium, calcium, and other vital elements found in bodily fluids * can lead to cardiac arrest or kidney failure * death
Sexual Sadism Disorder
* defined in terms of intense, sexually arousing fantasies, urges, or behaviors that involve the physiological or physical suffering or a victim * often involves inserting dominance over the victim * power and control are very important * can be consented but also not :/
Sexual predator laws
* designed to keep some criminals in custody indefinitely * if jury decides someone has a "mental abnormality" that will lead them to commit more sexual offenses then the person can hospitalized involuntarily
orgasm
* different from the gradual buildup of sexual excitement that precedes it * intense pleasure * varies for each person
situational orgasmic
* difficulties occur when the woman is able to reach orgasm in some situations, but not others * during masturbation but not intercourse or perhaps with certain people
Transvestic Disorder
* disorder is defined as cross-dressing for the purpose of sexual arousal* * most common among strait men * may be done in private or public * person may masturbate while crossed-dressed, often imagining himself to be a male as well as the female object of his own fantasy * men with this disorder are unremarkably masculine in their interests, occupations, and other behaviors * Some men may develop persistent discomfort with their gender role or identity and may eventually want to live permanently as a women
Social causes of PD
* distorted "mating process" * "courtship disorder" - these people have not learned the adaptive type of courtship behavior * background factors: * sexual abuse * hearing about this type of behavior * lack of consistent parental environment in which normative sexual behavior and values were modeled * lack of self esteem * lack of confidence and social ability * ignorance and poor understanding of human sexuality * interpersonal skills * lonely, insecure, and isolated and have significant deficits in social skills
Hormones and medication
* drugs that reduce testosterone are frequently used (ex. triptorelin) * results show a decreases in sexual fantasies of children * manage sexual urges * Antidepressants and anti anxiety drugs have also been used * results show SSRIs can have a positive effect for males * reduce social anxiety
Biological Causes of Sexual Dysfunction for *men* in particular
* erectile dysfunction - vascular, neurological, or hormonal impairment * drugs influence a man's erectile response * correlation between cigarettes and erectile dysfunction * alcohol and weed may have negative effects on sexual arousal as well
Ratings of physical and emotional satisfaction
* even though 29% of women orgasm 41% say they are physically satisfied * this suggests that an orgasm is only one aspect of sexual satisfaction, especially for women
Human sexual response cycle
* excitement * orgasm * resolution
Biological causes of PD
* focus on the endocrine system, glands that regulate sexual response * found: elevated levels of testosterone * hard to tell whether biological abnormalities are causes of a certain disorder because there is so much variation * neurological abnormalities may also be involved in the development of disorders * temporal lobes of the brain appear to play an important role in control of aggression and sexual behavior * limbic structures
Interpersonal Psychotherapy
* focuses on difficulties in close relationships - not so much specifics of eating disorders * initially studied as a placebo treatment - to test in CBT has specific effect beyond general psychotherapy * hypothesized that CBT would outperform interpersonal * CBT is more effective in changing dieting behavior, self-induced vomiting, and attitudes about weight and shape * Results of the two therapies were similar in other respects * At a 12 month checkup: * The behavior therapy group deteriorated over time, and a large number of patients dropped out * The Cognitive behavior therapy group maintained fairly stable improvements * The interpersonal therapy group continued to improve! * becoming equal to CBT's immediate results * This was surprising and impressive because: 1. The interpersonal treatments explicitly excluded direct discussions of eating, diet, and related topics 2. The investigations had lower expectations for interpersonal therapy and the allegiance effect often influence treatment outcome
Predictor of continued binge eating include a longer duration
* greater emphasis on shape and weight * childhood obesity * poorer social adjustment * persistent compensatory behavior * comorbid alcohol abuse
Psychological causes of PD
* love map - a mental picture representing a person's ideal sexual relationship * if distorted results in strange ways of thinking about sexual relationships * don't know how to feel both love and lust for the same person
Biological Causes of Sexual Dysfunction for *women* in particular
* neurological disorders, pelvic disease, and hormonal dysfunction can interfere with process of vaginal swelling and lubrication * research done shows genetic factors may influence the frequency with which women are able to experience orgasm * abuse of alcohol or drugs can lead to inhibited orgasm
hypothetical construct
* other examples: anxiety, depression.. * they are theoretical devices * refer to events or states that reside within the person and are proposed to help us understand or explain a person's behavior
Pedophilic Disorder
* people who persistently engage in sexual activities with children * many harmful affects can be produced by sexual abuse * can lead to PTSD or eating disorders * entails recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child * in order to be diagnosed, the person must be at least 16 year of age and at least five year * child molester = a person who has committed a sexual offense against a child victim * all child molesters are not pedophiles * sometimes they molest their own child * personalty style of offenders is usually passive and dependent * they are unable to emphasize with the plight of their victims
medication placebos
* physicians give patients a pill that looks like real medication but contains no active chemical ingredients * easily administered
BN - Inappropriate Compensatory Behavior
* purging - elimination of consumed food from the body * most commonly - self-induced vomiting * also includes laxative use, diuretics, enema * purging only has limited effectiveness in reducing caloric intake * vomiting prevents the absorption of only about 1/2 the calories consumed during a binge, and laxatives, diuretics, and enemas have few lasting effects on calories or weight * extreme exercising or rigid fasting * DSM-5 indicates binge eating and contemporary behavior must occur once a week, on average, for at least three months
CBT
* reasons that bulimia comes from "black and white" thinking * Fairburn's treatment includes: 1. The therapist uses education and behavioral strategies to normalize eating patterns * The goal is to end the cycle where extreme dietary restraint leads to binge eating and purging 2. The therapist addresses the client's broader, dysfunctional beliefs about self, appearance, and dieting 3. The therapist attempts t consolidate gains and prepare the client for expected relapses in the future * Goals are to develop realistic expectations about eating, weight concerns, and binge eating, as well as strategies for coping with relapses in advance * overall leads to 70% -80% reduction in binge eating and purging * 33%-50% of clients cease binging activity completely * also affective in group and self-help formats * individual is said to be more effective
BN - Excessive Emphasis on Weight and Shape
* self-evulation and self-esteem are influenced and are centered around weight and shape * negative comment can make someones self-esteem plummet * an individual's sense of self is linked too closely to appearance instead of personality, relationships, or achievements
Voyeuristic disorder
* the act of observing an unsuspecting person, usually a stranger, who is naked, in the process of disrobing, or engaging in sexual activity * not aroused by watching people who know they are being observed * "peeping" arouses the person * observation and the risk of discovery * reaches orgasm while watching or remembering it later * most keep their distance and are not dangers
penile plethysmograph
* the man places a thin elastic strain gauge around his penis, underneath his clothing * the rubber loop is filled with a column of mercury that changes in its electrical conductance as the circumference of the penis changes - amplified on the plethysmograph
sexual arousal
* the state the precedes orgasm * Physiological responses - vascular engorgement of the genitals * Subjective feelings of pleasure and excitement - referred to as a *hypothetical construct"
Aversion therapy
* the therapist repeatedly presents the stimulus that elects inappropriate sexual arousal in association with an aversive stimulus, such as repulsive smells, electric shock, or chemically induced nausea * mixed results
AN - Struggle for Control
* theorists say that the disorder actually develops out of sense of having no control * feels good to be in complete control of something
gender dysphoria symptoms
* transsexualism * one who believes that their physical anatomy, they are more like the other gender * becomes more intense during adolescence (puberty) * dress as the opposite gender in order to feel more comfortable
AN - Significantly Low Weight
* usually begins with a diet gone awry * BMI under 18.5 * average victim is 25-30% below normal weight * 5% with people with anorexia nervosa die of starvation, suicide, or medical
BN - Medical Complications
* vomiting leads to erosion of dental enamel * enlargement of salivary glands * electrolyte imbalances * rupture of the esophagus or stomach * death
double-blind study
* where neither the patient nor the therapist knows whether the patient is receiving an active treatment or a placebo * no always easy to interpret * Medications are more effective when they produce more side effects Impossible for psychotherapy studies
BN - Binge Eating
*= consuming an amount of food that is clearly larger than most people would eat under similar circumstances in a fixed period of time* * there have been attempts to define binging more objectively (i.e. 1000 calories) * however a "binge" differs for every person so its hard to define more specifically * 35% of people report binging occasionally * 29% report they fast * 8% use self-induced vomiting * 5% use laxatives * some are plan, some are spontaneous * usually consists of the individual eating extremely fast and becoming uncomfortably full * usually foods that are no commonly eaten, easily thrown up * triggered by an unhappy mood, which may be the result of self-criticism about weight or appearance, or intense hunger following a period of fasting * initially receives unhappy feelings, but physical discomfort, shame, and fear of gaining weight quickly return * key diagnostic feature = sense of leack of control during a binge * some describe a dissociated state * sometimes it becomes easier to stop after they have the disorder for a while
AN - Amenrrhea
*= the cessation of menstruation * * a reaction to the loss of body fat and associated physiological changes * not considered a symptom anymore * common with bulimia too
Suicide treatment - Psychotherapy
*CBT does not show any significant reduction tin suicidal behavior* - Recommendations for patients who are suicidal - Reduce lethality - Negotiate agreements - Provide support - Replace tunnel vision with a broader prospective
Common features of disorganized speech in schizophrenia include:
*Loose associations* (derailment) -shifting topics too abruptly *Tangentiality* -replying to a question with an irrelevant response *Perseveration* -persistently repeating the same word or phrase over and over again
Response styles to depression
*Ruminative style* - turning their attention inward, contemplating the causes and implications of their sadness - writing in a diary, talking with a friend *Distracting style* - divert themselves from their unpleasant mood - engaging in hobbies, sports, activities that draw their attention away from symptoms of depression
Diagnosis of Avoidant/Restrictive food Intake Disorder
*apparent lack of interest in food* * occurs mostly in infants and is characterized by an apparent lack of interest in food
Diagnosis of Binge-eating disorder
*episodes of binge eating without compensatory behavior* - associated with a number of psychological and physical difficulties, including, obesity, often defined as a BMI greater than 30
Diagnosis of Rumination disorder
*involves repeated regurgitations of food, sometimes rechewing* * often occurs in infants, sometimes in the context of neglect and/or intellectual disabilities
Evidence supports that mood disorders of _____
*polygenic* - influenced by many genes rather than a single gene - each of these genes on its own only changes risk for the disorder by a small amount
sex therapy's focus
*sensate focus* - a series of simple exercises in which the couple spends time in a quiet, relaxed setting, learning to touch each other *scheduling* - people should schedule time for sex *education and cognitive restructuring* - changing the way in which people feel about sex *communication training* - structured training procedures aimed at improving the ways in which couples talk to each other
Sexual Masochism Disorder
*sexual arousal when subject to pain or embarrassment* * defined in terms of recurrent, intense sexually arousing fantasies, urges, or impulses involving being humiliated, beaten, bound, or otherwise made to suffer * may be an individual event or with a partner * one common fantasy = forced to show naked body to others * masochists desire certain types of pain, but go to great lengths to avoid injury * must experience distress or impairment to be diagnosed * the pattern of this disorder leads to the suggestion that masochism may be motivated by an attempt to escape temporarily from the otherwise constant burden of maintaining personal control and pursuing self-esteem
Fetishistic Disorder
*the association of sexual arousal with non-living objects* * range is unlimited * most often involves women's underwear, shoes, boots, or products made out of rubber or leather * person may go to great lengths to obtain certain kinds of objects * People usually masturbate while holding, rubbing, or smelling the objects * sensory qualities of the object - texture, visual appearance, and smell - can be very important in deterring whether the person finds it arousing * Person may not be able to become sexually aroused without fetish object
Diagnosis of Pica
*the eating of nonnutritive substances like paper or dirt* - found commonly among children with intellectual disabilities
Emotional Symptoms of Mood Disorders
- *Dysphoric* (depressed) - unpleasant - most common and obvious symptom of depression - *Mania symptoms* - As these feelings become more intense and prolonged, they can become ruinous - it is unclear the boundary between being productive and energetic to being out of control and self-destructive - Depressed and Manic - usually very irritable - Anger can be directed at themselves or others - frequently both - *Anxiety* - common among people with mood disorders, just as depression is a common feature of some anxiety disorder - People who are depressed are sometimes apprehensive fearing that matters become worse than they already are or that other will discover their inadequacy - Sometimes report they are *chronically tense and unable to relax*
Should mood disorders be defined in a broad or a narrow fashion?
- *Narrow approach* - focuses on the most severely disturbed people - *Broader approach* - focuses on and includes the milder forms of depression - Some critics say that the definition of depression includes just normal sadness because it doesn't exclude reactions to many negative events - Is Depression necessarily "normal" if it follows a stressful event? - need research evidence
TCAs (tricyclic antidepressants)
- 1950 - Declined use since SSRIs because they have more side effects - Side effects - blurred vision, constipation, drowsiness, drop in blood pressure - block uptake of neurotransmitters from the synapse - TCAs and SSRIs compare about equal in effectiveness - positive response to about 50-60% of depressed patients
MAOIs (monoamine oxidase inhibitors)
- 1950s - not used as much as TCAs for two reasons: 1. develop high blood pressure when taken with foods containing large amounts of tyramine (cheese, chocolate) 2. not as effective as TCAs - can be used safely if patients avoid certain foods (cheese, wine, beer)
OCD prevalence
- 2% of the US meets criteria at some point in their lifetime - 12 month prevalence rate is 1.2% - less common than most anxiety disorders - doesn't show a significant gender difference
Comorbidity of anxiety disorders
- 50 percent of those who meet the criteria for one anxiety disorder also met the criteria for at least one other form of anxiety or mood disorder - Approximately 60 percent of people diagnosed with major depression also qualify for a secondary diagnosis of some type of anxiety disorder (both based on emotional distress) - Substance dependence is also frequent
Anticonvulsant Medications
- 50% of patients respond positively - reduces frequency and severity of relapse and can be used for acute manic episodes - Side effects - nausea, vomiting, diarrhea, sedation
Full blown panic attack
- A person must experience at least four of the thirteen DSM-5 symptoms in order for the experience to qualify as a full-blown panic attack - These symptoms must develop suddenly and reach peak within 10 minutes
Azapriones
- Act on serotonin transmission (different pathway than benzodiazepines) - Most common brand is buspirone (BuSpar) - Effective for treatment of GAD - Some say preferable to benzodiazepines because does not cause drowsiness and does not interact with alcohol - Disadvantage is slower relief from symptoms
Heterogeneity
- All depressed patients do not have exactly the same set of symptoms, the same pattern of onset, or the same course over time - Some manic, some only depressed - Some experience *psychotic symptoms* - hallucinations, delusions - Are these qualitatively distinct forms of mood dirsoder, or are they different expression of the same underlying one of severity?
Levels of anxiety
- Anxiety can be adaptive at low levels, because it serves as a signal that the person must prepare for an upcoming event - High levels of anxiety become incapacitating by disrupting concentration and performance
Overlap between PDs
- At least 50% of people who meet the diagnostic criteria for one PD also meet the criteria for another PD ♣ Similar symptoms are used to define more than one disorder - Contributes to issues regarding prevalence rates
CBT
- Involves training in the use of social skills, which might be used to resist pressures to drink heavily - Includes problem-solving procedures, which help people to identify situations that might lead to heavy drinking and formulate alternative courses of action • Focus of CBT is on factors that initiate and maintain problem of drinking rather than act of drinking itself • CBT challenges expectations about the effects of alcohol - addresses negative effects of thinking about self and events
Attention's role in disorders
- Attention plays a crucial role in the onset of GAD and panic disorder - People who are prone to excessive worrying and panic are unusually sensitive to cues that signal future threats (pay lots of attention to possible threats, even when the possible threat is miniscule, which can become maladaptive) - This cycle can be easily reactivated - Attention mechanisms are involved in the etiology and maintenance of social anxiety disorder (can perform task when alone but not in front of an audience) - Caused by anxious apprehension
Depressive disorders: course and outcome
- Average age of onset is 32 - Mean number of lifetime episodes is 5 or 6 - *Remission* - a period of recovery - *Relapse* - a return to active symptoms in a person who has recovered from a pervious episode - Approximately 1/2 of patients recover within 6 months of the beginning episode - Risk of relapse goes down as the length of remission increases
Dimensional approach to diagnosing
- Begins with a consideration of level of personality functioning - Would then focus on describing the nature of her PD in terms of a combination of traits: ex. antagonisms, negative affectivity, detachment, rigid perfectionism - offers a more straightforward and comprehensive description of personality pathology
Anxiety disorders share several important similarities with mood disorders
- Both categories are defined in terms of negative emotional responses - Feelings such as guilt, worry, and anger frequently accompany both anxiety and depression - Many patients who are anxious are also depressed and visa versa - Order of these can vary, but usually anxiety precedes the onset of depression
Environment and signs of ASPD
- Certain forms of conduct disorder that are evident during childhood, especially among boys, are reliable predictors of other forms of antisocial behavior when they become adults - Our current diagnostic approach places principal emphasis on observable behaviors and repeated conflict with, including failure to conform to, social norms with respect to lawful behavior o Greater reliability because it focuses on concrete consequences of the disorder
Most effective treatment of OCD
- Combines prolonged exposure to the situation that increases the person's anxiety with prevention of person's compulsive response - Neither component is effective by itself - Some patients (up to 20 percent) do not response positively to this treatment and continue to exhibit mild symptoms - Selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Luvox, and Zoloft, are used most frequently to treat OCD - Clomipramine (Anafranil), a tricyclic antidepressant, used to treat OCD - More than 50 percent of those who use it improve to normal level of functioning - Relapse is common if medication is discontinued
The purpose of compulsions
- Compulsions are used to reduce anxiety; otherwise person becomes very uncomfortable - Compulsions are not usually delusional because person knows they are nonsensical - paradox of OCD - Compulsions do not produce pleasure (gambling and drinking are not compulsions) - Compulsive rituals are associated with experiencing diminished control not complete loss of control
"Virginia Adult Twin Study"
- Concordance rates were higher in MZ twins than DZ twins - Found that genetic factors account for between 20-30% of GAD transmission - Conclusion of study: (1) Genetic risk factors for these disorders are neither highly specific (a different set of genes being associated with each disorder) not highly nonspecific (one common set of genes causing vulnerability for all disorders) (2) Two genetic factors have been identified: one associated with GAD, panic disorder and agoraphobia, and the other with specific phobias (3) Environmental risk factors that are unique to individuals play an important role in the etiology of all anxiety disorders; environmental factors that are shared do not play an important role
2. Depression, Low Self-Esteem, Dysmorphia
- Depression is often comorbid with EDs, particularly bulimia * Depression improves following successful group psychotherapy * Anorexia found considerable depression rates at the time of diagnosis but not at a six-year follow-up * Depression may play an important role in EDs * Low-self esteem is a huge concern -*social self* - how people present themselves in public and how other people perceive and evaluate them * women with EDs are normally concerned with this * Women with bulimia or a negative body image report more public self-consciousness, social anxiety, and perceived fraudulence * also show increase in self-criticism and deterioration in mood following negative social interactions * people with EDs often depend on others for self-esteem * Depressive symptoms play a role in maintaining eating behaviors
Interpersonal Therapy
- Focused on current relationships, especially those involving family members - Therapist helps the patient develop a better understanding of the interpersonal problems that presumably give rise to depression and attempts to improve the patient's relationships with other people by building communication and problem solving skills - Therapy sessions = nondirective discussions of social difficulties and unexpressed or unacknowledged negative emotions, as well as role-playing to practice specific social skills
Dimensional view of PDs
- Grounded in extensive research on the basic elements of personality o Could provide a more complete description of each person - More useful with patients who fall on the boundaries between, or present combinations of, different types of PDs
TCA
- Imipramine (Tofranil) is a tricyclic antidepressant medication used to treat panic disorder - Patients less likely to become addicted to these than benzodiazepines - Used less than SSRIs because have a few bad side effects, some of which resemble the symptoms of anxiety
Frequency of Suicide
- In US + Canada = 12/100,000 people annually - 35,000 people in the US every year - Rates vary as a function of age, gender, class status - Suicide is the *3rd leading cause of death for people between ages 15-24* - *8th leading cause of death overall*
Brain Imaging Studies
- Indicate that severe depression is often associated with abnormal patterns of activity as well as structural changes in various brain regions - Abnormal patters of activation in regions of the prefrontal cortex (PFC) are often found in association with depression - evidence found using PET and fMRI scans
Serotonin
- enhanced by Prozac - shows that some type of serotonin malfunction is involved in the etiology of depression - effect on mood, high levels of feelings of serenity and optimism - regulates sleep and appetite
Research Methods: Statistical Significance: When Differences Matter
- Just because study reveals a statistical difference in one form of treatment versus another form of treatment does not automatically mean that the difference is statistically significant - First you collect your data and use statistical test to determine whether or not you can reject the null hypothesis - Your results are statistically significant if they exceed the 0.05 level (occur more than 5% of the time because if something is random it will occur less than 5% of the time) - Statistical significance should not be equated with clinical importance - Clinical importance is sometimes measured in terms of the proportion of people in the treatment group whose outcome scores fall below a certain threshold of severity or within the range of scores that are produced by people without the disorder in the question - Clinical investigators also should consider the kinds of changes that they expect to find as well as the amount of change - In addition to looking at changes in symptoms, also important to ask about changes in patient's quality of life
DSM-5 Classification of Suicide
- Lists suicidal ideation only as a symptom of mood disorders - Based on casual theories rather than descriptive factors
DSM-5 classification of depressive disorders
- Major Depressive Disorder - Persistent Depressive Disorder - Premenstrual Dysphoric Disorder - Disruptive Mood Dysregulation Disorder - added in the DSM-5 - intended to describe children with chronic, severe irritability
Lifetime risk of mood disorders
- Major depressive disorder - 16% - Persistent depressive disorder (dysthymia) - 3% - Bipolar I and II combined - 4% - Ratio of depression to bipolar 5:1 - 8% of women experience moderate to severe symptoms of premenstrual dysphoric disorder and about 3% meet the criteria
gender disparities
- Men are 30-40% more likely to develop schizophrenia than women - Average age of onset is about four or five years younger for men than women - Men are more likely than females to exhibit negative symptoms - Men are more likely than females to follow a chronic, deteriorating course
Religion and its effect on stress
- Mortality risk is lower among those who attend church services, probably as a result of improved health behavior (usually from accepting concept of forgiveness) - Study showed that religion encourages active, not passive, coping - Religion helps people gain control with God, not just accept control by God (active versus passive religious coping)
Critical Thinking Matters: Can a strep infection trigger OCD in children?
- National Institute of Health said, in some cases, OCD symptoms developed right after strep infection - Thought antibodies from infection attacked nerve cells in basal ganglia - Called these weird occurrences PANDAS - So claimed that when children are diagnosed with OCD they should get step test and if they are positive, they should be put on long-term antibiotics - Say that some kids were cured - Emphasizing antibiotics as treatment could lead parents to ignore effective medications as cause children to become antibiotic resistant - SSRIs and cognitive behavior therapy have been shown to be effective when treating children with PANDAS-related OCD - PANDAS is false hypothesis because not supported by strong empirical evidence
Fears are learned
- Not necessarily born with them - Additionally, people learn to avoid certain stimuli if they observe other people showing a strong fear response to those stimuli
Bipolar disorders: course and outcome
- Onset is usually between 18-22 years of age - The first episode is equally likely to be manic as it is depressive - Average duration of a manic episode lasts between 2-3 months - onset not always sudden - Most patients have more than one episode - and tend to have more than depressive patients - Approximately 1/2 of patients are able to achieve a sustained recovery from the disorder
Suicide Treatment - Involuntary Hospitalization
- People on the brink of suicide are often hospitalized, either with or without their permission - Safety first - commitment to a hospital stay could save someones life - Person will be monitored continuously and have access to treatment
Hypothesis of response styles:
- People who engage in ruminative responses have longer and more severe episodes of depression than do people who engage in distracting responses - *Women are more likely to employ a ruminative style* in response to depression, whereas men are more likely to employ a distracting technique. - Ruminative style - leads to episodes of greater duration and intensity, women are more susceptible to depression than men
How do they view themselves?
- People with personality disorders frequently do not see themselves as being disturbed o they may not have insight into the nature of their own problems - Many forms of personality disorder are defined in terms of the problems that these people create for others rather than in terms of their own subjective distress - Many people with personality disorders are unable to view themselves realistically and are unaware of the effect their behavior has on others o Assessments based exclusively on self-report may have limited validity ♣ They may underestimate the frequency or severity of certain aspects of personality pathology
Common Elements of Suicide
- Purpose = Seeking a solution - Goal = Cessation of consciousness - Stimulus = Unbearable psychological pain - Stressor = Frustrated psychological needs - Emotion = Hopless-ness - Cognitive State = ambivalence - Perceptual State = constriction - Action = Escape - Interpersonal act = Communication of intention - Pattern = consistency of lifelong styles
Benzodiazepines
- Reduce many symptoms of anxiety, especially vigilance and subjective somatic sensations - Most widely prescribed psych medication until the 90s - Bind to receptor site in brain associated with neurotransmitter GABA - Work by enhancing activity of GABA based on rate of absorption and elimination from the body - Effective in treating GAD and social anxiety disorder - Many relapse if stop taking medication; exposure may be better treatment - Common side effects are sedation and mild psychomotor and cognitive impairments - Most serious side effect is risk of addiction (40% experience withdrawal)
Somatic Symptoms of Mania
- Reduction in need for sleep - Bursting with energy in spite of lack of sleep
Causes of gender dysphoria
- etiology poor understand - evidence that gender identity is influenced by sex hormones *pseudohermaphroditism* *pseudohermaphrodite*
Causes of Suicide - Social factors
- Religious affiliation strongly related to suicide rate - active social networks encouraged by church communities can lead to effective support and protection from influences of self-destruction - Social policies regulating access to hand guns - 60% of deaths in USA are due to guns - in countries with restrictive gun laws, suicide rates usually decrease, particularly among adolescence
Suicide treatment - Medication
- SSRIs - been shown to be very helpful - Luvox, Prozax - because of the link between suicide and serotonin disregulation - Studies show that the intake of SSRIs reduces suicide rates - relationship is neither direct nor simple - should use caution when prescribing drugs to suicidal patients
SSRI
- Selective serotonin reuptake inhibitors (SSRIs) are first choice for treating panic disorder and social anxiety disorder - Brands are Prozac, Luvox, Zoloft, and Paxil - Fewer negative side effects and less prominent withdrawal
NCS-R study about treatment
- Slightly more than 20% of those who meet the diagnostic criteria for a mood disorder in the past 12 months had received adequate treatment during that same time period
Environment and BPD
- Some investigators argue that BPD patients suffer from the negative consequences of parental loss, neglect and mistreatment during childhood o Supported by studies of families and BPD patients - Studies point toward the influence of widespread problematic relationships with their parents for BPD patients o Adolescent girls with BPD report a pervasive lack of supervision, frequent witnessing of domestic violence, and being subjected to inappropriate behavior by their parents and other adults (including verbal, physical and sexual abuse) ♣ Extent and severity of abuse varies widely among individuals - maladaptive patterns of parenting and family relationships increase probability that a person will develop PD
NCS-R found that anxiety disorders are more common than any other form of mental disorder
- Specific phobias are the most common type of anxiety disorder with a one-year prevalence of about 9 percent of the adult population - Social anxiety disorder has a one-year prevalence of 7 percent - Panic disorder and GAD affect about 3 percent of the population - Agoraphobia affects 1 percent of the population
The close relationship between symptoms of anxiety and depression suggests that these disorders may share common causal features
- Stressful life events seem to play a role in the onset of both depression and anxiety - From a cognitive/ biological point of view, certain brain regions and a number of neurotransmitters are involved in the etiology of anxiety disorders as well as mood disorders
Causes of Suicide - Biological factors
- Studies show that their is a connection between reduced levels of serotonin and suicide - may be related to poor impulse control as well as increased of violent and aggressive behavior - Genes associated with various neurotransmitter systems, especially serotonin, influence the development of impulsive personality traits, and suicide appears to be an especially likely outcome when a person inherit a predisposition to both psychopathology and impulsive or violent behavior - Genetic factors moderate the impact of environmental factors on suicidal behavior
Causes of Suicide - Psychological factors
- Sucide is an attempt to escape unbearable psychological pain produced by prolonged frustration of psychological needs - needs - affiliation and competence - desire to die is linked closely with social isolation and the belief that one has become a burden to others - fear of death and self-preservation is a powerful motive - these instincts protect people in distress - people often work their way up to the act gradually - usually repeated non-sucidial self-harm proceeds - allows someone to habituate to pain and fear of death - suicide requires both the desire to die and the ability to inflict self harm
mental illness and violence
- The rate of violence is about five times higher among people diagnosed with a major mental disorder than those with no diagnosis - People who use drugs/alcohol are more likely to engage in violent behavior - Substance abuse symptoms increase risk of violence
Thought Suppression
- The struggle to control our thoughts often leads to process known as thought suppression, an active attempt to stop thinking about something - Trying to rid one's mind of unwanted thoughts may make them more intrusive - Thought suppression may increase, rather than decrease, negative emotions associated with unwanted thoughts
Cognitive Symptoms of Depression
- Thinking is typically slow, trouble concentrating, easily distracted - Guilt and worthlessness - Blame - Focus on the most negative features of themselves, their environments, and the future = "depression triad" - Self destructive ideas and impulses - suicide interest begins increasing - Fatigue and loss of pressure
Behavioral Symptoms of Mania
- gregarious and energetic - flirtatious and provocative behavior - everything is interesting and is easily distracted - flitting from one idea to the next - excessive pursuit of life goals
Somatic Symptoms of Depression
- Tired - Simple things seem to require an overwhelming amount of effort - Getting out of bed is virtually impossible - Hard time falling asleep and staying asleep - usually wake up early - Less common - more time sleeping - Usually a reduction in appetite - sometimes increase can occur - Food just doesn't taste good anymore - Lose a lot of weight without dieting or change in eating - Loss of interest in activities that use to be pleasureful - ex. sexual desire decreases - Less likely to enjoy or initiate sexual activity - Headaches and muscular pains and aches
Gender difference
- Women are three times more likely to develop a specific phobia than men - Women are twice as likely than men to develop panic disorder, agoraphobia, or GAD - Social anxiety disorder is also more common among women, but not by much
Persistent depressive disorder (dysthymia)
- a chronic mild depressive condition that has been present for many years - differs from major depression in terms of both severity and duration - DSM-5 Criteria: person must, over a period of at least two years, exhibit a depressed mood for most of the day
Persistent depressive disorder (dysthymia)
- a chronic mild depressive condition that has been present for many years - differs from major depression in terms of both severity and duration - DSM-5 Criteria: person must, over a period of at least two years, exhibit a depressed mood for most of the day, more days than not - Two or more of the following symptoms: - Poor appetite or overeating - Insomnia or hypersomnia - Low energy or fatigue - Low self-esteem - Poor concentration of difficulty making decisions - Feelings of hopelessness - These symptoms must not be absent for more than two months at a time during the two-year period
MRIS show
- a decrease in tot volume of brain tissue among schizophrenia patients - enlarged lateral ventricles - decreased size of hippocampus, parahippocampus, amygdala, thalamus (limbic system)
Premenstrual dysphoric disorder (PMDD)
- added as a new diagnostic category - Women commonly experience premenstrual symptoms that center around emotional and physical complaints, but they are typically mild - Defined in terms of various mood-related symptoms that occur repeatedly during the premenstrual phase of the cycle and are then diminished at the onset or shortly after menses - Symptoms: - mood lability - irritability - dysphoria - anxiety - cognitive - difficulty concentrating, feeling overwhelmed or out of control - somatic - lethargy, changes in appetite, sleep problems, joint or muscle pain, sensation in bloating - Must exhibit at least 5 symptoms to meet the criteria for this disorder, and at least one of them must involved a disturbance in mood - The symptoms must be present for most of the woman's menstrual cycles in the past year - Must be associated with clinically significant distress or interference with social or occupational functioning
T cells
- affected by stress, white blood cells that fight off antigens - foreign substances like bacteria that invade the body - this can make the body more susceptible to infectious disease
Cross-cultural differences --depression
- comparisons of emotional expression and emotional disorder across cultural boundaries encounter a number of methodological problems - vocabulary - each culture has its own ways of interpreting reality, including different styles of expressing or communicating symptoms of physical and emotional disorder - words and concepts that are used to describe illness behaviors in one culture might not exist in other cultures - Have been confirmed by a number of research projects that have examined cultural variations in symptoms among depressed patients in different countries - specific type of symptoms expressed by the patients varies from one culture to the next - China - depression described in terms of "*somatic symptoms* - sleeping problems, headaches, and loss of energy - Europe/North America - depressed patients more likely to express *feelings of guilt and suicidal idea* - Clinical depression is a universal phenomenon - The comparisons indicate that a person's cultural experiences, including linguistic, educational, and social factors, may play a role in shaping the manner in which he or she expressed and copes with the anguish of depression
Central executive component
- component of working memory responsible for the manipulation and transformation of data that are held in the storage buffers - people with schizophrenia can not do tasks that depend on this component of working memory
Risk factors
- culture about drugs - frequency of drug use - age at with people begin use of drug
Limitations of Emile Durkheim's view of suicide
- doesn't explain why one person would commit suicide while the rest of the group members don't - different types of suicide overlap and may be difficult to distinguish
Treatment for BPD
- hardest PD to treat - hard to form relationship with the therapist - 1/2-2/3 patients quit therapy - DBT has been proven to be effective - psychotropic medication
Defendants (GBMI)
- if they are guilty of the crime, were mentally ill at the time it was committed, but were not legally insane at that time - sentences like any other criminal, but court can order treatment for the mental disorder as well
Risk of schizophrenia in offspring
- maternal malunutrition - winter birth? more viral infections - susceptibility to brain injury following obstetric difficulties
resolution
- may last 30 mins or longer - person returns to resting state - men are unresponsive to further stimulation for a period of time after reaching orgasm - women may be able to respond to further stimulation immediately
Treatment - Biological procedures
- medications men: viagra, etc - erectile dysfunction women: being developed - penile implant - used to make penis hard during intercourse - recommended with the use of therapies
Psychological Causes of Sexual Dysfunction
- mental scripts - the way we learn about life - beliefs and attitudes toward sexuality (especially women) - quality of relationship - culture attitudes - own personal attitudes, feelings - lack of communications - traumatic experiences (sexual abuse) - performance anxiety
Hoarding Prevalence
- much more common than OCD - affects 6% of community residents - no gender difference
3. Negative Body Image
- negative body image - a highly critical evaluation of one's weight and shape, widely thought to contribute to the development of EDs - one way to assess body image is to compare people's current and ideal size - this may be a problem and potential risk factor when combined with other risk factors
Treatment of ASPD
- people seldom seek professional mental health services - seldom effective - no form of intervention has been proven effective
Psychological response to stress - Adrenal hormones
- perceived threat comes into cortex —> signals the amygdala —> secretes corticotrophin-releasing factor (CRF), which stimulates the brainstem to activate the sympathetic nerve system --> adrenal glands secrete 2 hormones
outcome of schizophrenia
- poor outcome - Deteriorating course used to be one of the principal defining features - usually never restore "normal" function
Reported reasonings of self-harm
- punish the self - reflects anger and frustrations - combat extended periods of dissociation and feelings of emptiness - maladaptive way to regulate intense , negative emotional states
Somatic Symptoms
- related to basic physiological or bodily functions - *mood disorders* = Fatigue, aches and pains, and serious changes in appetite and sleep patterns
Stress checklists
- rely on retrospective reports - contain stressors that do not apply to people of different ages and ethnic backgrounds - treat both positive and negative events as stressors - fail to distinguish between short-lived and chronic stressors; and most importantly - treat the same event as causing the same amount of stress for everyone
DSM-5 diagnosis of PD
- requires erotic preoccupation must have lasted at least 6 months - If it leads to distress or impairment * impaired = the urges have become compulsory, if they produce sexual dysfunction, require the participation of non consenting persons, if they lead to legal problems, or interfere with social relationships - If one acts on urges: * pedophilic, exhibitionistic, voyeuroistic and frotteuristic disorders
Biological Causes of Sexual Dysfunction
- sex hormones (testosterone is highly correlated to sexual appetite and desire) - drugs - alcohol - inhibits orgasm - neurological disorders - disease
Treatment - Psychological procedures
- sex therapy - positive outcomes 85% for male 78% for female
Behavioral Symptoms of Depression
- slow movement ** - most obvious behavioral symptom - sometimes immobile - slow speech and response to questions
BIS - decreased activity
- some areas show *decreased activity* - the prefrontal cortex on the left side of the brain - person may have motivational problems, such as inability to work toward a pleasurable goal
Social factors affecting bipolar disorders
- some have found that the weeks preceding the onset of a manic episode are marked by an increased frequency of stressful life events - different from those preceding depressive episodes - include schedule-disrupting events as well as goal attainment events - some patients experience an increase in manic symptoms after they have achieved a significant goal toward which they had been working - major job promotion, acceptance into a competitive school program, a new relationship - A relationship between relapse and emotional climate within families has been found through various studies - if the family members are hostile toward or critical of the patient, the patient is more likely to relapse shortly after discharge from the hospital - patients with less social support are more likely to relapse or have slower recovery rates - The disorder can be influenced by the social environment in which the person is living
Why are women two or three times more vulnerable to depression than men?
- some observers say that is due to shortcomings in the data collected - Women may be more likely than men to seek treatment or be labeled as being depressed - Culturally defined sanctions make it more difficult for men to admit to subjective feelings of distress - None of these have supported by substantial evidence - This is genuine based off of data - Possible explanations: - sex hormones - stressful life events - childhood adversity - gender roles
Social factors
- standards of beauty and the premium placed on young women's appearance contribute - more common among working women in fields that emphasize weight and appearance (models, dancers, gymnasts) - culture of thinness plays a stronger role in bulimia than anorexia * bulimia has been seen to increase more with in response to cultural ideals of thinness - troubled family relationships - sexual abuse - parents struggle with ED
4. Dietary Restraint
- symptoms can be direct consequences of overly restrictive eating - "out of control" symptoms can be caused by efforts to "control" * weight suppression* - highest adult weight minus current weight - predicts the maintenance and onset of bulimia 10 years later - overly restrictive diet includes: * hunger, frustration, lack of attention to internal cues * which all make binging more likely - sensible dieting is not restricting
Cognitive Symptoms of Mania
- thoughts are speeded up, ideas flash through one's mind faster than they can articulate thoughts - also easily distracted, responding to random stimuli - Grandiosity and inflated self-esteem
The National Research Council (NRC) found life-expectancy in the U.S.....
- to be behind other high-income countries and blamed discrepancy primarily on behavioral issues: 1) poor health behaviors like excessive smoking, drinking, and eating 2) poverty due to large income disparities in the U.S. 3) physical environments that depend more on driving and less on exercise 4) health care systems that limit access to primary care
Biological factors
- weight set points - body doesn't differentiate between attempt to lose weight and starvation - genes influence personality characteristics such as anxiety --> ED - genes affect your BMI - body type that you inherited - genes and eating pathology before and after puberty - hormonal disturbance or lesion in the hypothalamus, the area of the brain which controls appetite
Suicide - different methods by gender
-Males are more likely to use *violent and lethal methods* - firearms, hanging - Females are more likely to *overdose* - which may allow to time for discovery and interventions by other people
ECT
-Usually used in an *inpatient setting* and consists of a series of treatments given three times a week for two to seven weeks - improvement typically seen after six to eight sessions, some require more - muscle relaxants are administered before ECT - eliminates bone fractures and dislocations - unilaterally placement on the nondominant hemisphere may minimize the amount of post-seizure memory impairment, also may be less effective than bilateral placement - ECT reservations center around widely publicized cases of pervasive and persistent memory loss - usually short lived memory loss - does not induce loss of neurons or other changes in brain structure
prevalence of sysptoms
1 out of every 100 people will experience or display symptoms of schizophrenia at some point during their lives
Obsessive thinking can be distinguished from worry in two primary ways:
1) Obsessions are usually experienced by the person as being nonsensical, whereas worries are often triggered by problems in everyday living 2) The content of obsessions most often involves themes that are perceived as being socially unacceptable or horrific, whereas worries tend to center around more acceptable, commonplace concerns
Hair-pulling and skin-picking disorders are similar in several ways (and unlike OCD):
1) People with these problems report negative emotional experiences before episodes and reduction in these feelings after behavior has stopped - Suggests purpose of these behaviors may be to regulate negative emotional states 2) People with these problems do not have episodes that are triggered by intrusive, unwanted thoughts or impulses - unlike those with OCD 3) Most people with these problems say they are in trance-like state while episode is occurring; they are unware of what they are doing - again unlike OCD whose victims are acutely aware when engaging in compulsive ritual
Treatment of panic disorders
1) Situational exposure - used to treat agoraphobic avoidance. Person repeatedly confront situations that have been avoided (being in crowded places) 2) Interoceptive exposure - aimed at reducing person's fear of internal, bodily sensations that are frequently associated with onset of a panic attack. Person engages in exercises that produce these physical sensations. Works well
Ways hoarding differentiates from OCD:
1) Unlike obsessions, thoughts associated with hoarding are not intrusive or unwanted. Hoarders find it pleasant to think about their possessions 2) Hoarding results in congestion of person's home (and issues with family or authority who have to deal with it) rather than thoughts about possessions or hoarding behaviors 3) Obsessions leads to increase in anxiety, but hoarding behaviors are associated with positive emotion. Anxiety increased if person forced to get rid of possessions
Two considerations are important when considering the self-perpetuating nature of worry:
1) Worry is an experience made up of "self-talk" - things people say to themselves rather than visual images 2) Worry serves the function of avoiding unpleasant somatic activation through the suppression of imagery - some people will continue to worry even when not productive because worrying is reinforced by immediate reduction in uncomfortable physiological sensations
Types of Individual therapies
1. *Bruch's* modified psychodynamic therapy designed to increase interoceptive awareness and correct distorted perceptions of self 2. *Feminist therapies* encourage young women to pursue their own values rather than blindly adopting prescribed social roles 3. Cognitive behavioral therapies - Little evidence that supports the effectiveness of any of these types of therapy
Basic Coping Strategies
1. *Problem-focused coping* involves attempts to change a stressor - i.e. If your job is stressful, look for a new one 2. *Emotion-focused coping* is an attempt to alter internal distress - i.e. Before big exam, breathe quietly to yourself
Psychological factors
1. A struggles for perfection and control 2. Depression, Low Self-Esteem, Dysmorphia 3. Negative Body Image 4. Dietary Restraint
Expectations about alcohol:
1. Alcohol transforms experiences in a positive way 2. Alcohol enhances social and psychical pleasure 3. Alcohol enhances sexual performance and experience 4. Alcohol increases power and aggression 5. Alcohol increases social assertiveness 6. Alcohol reduces - all can lead people to drinking more - short term positive effects
Psychopaths
1. Are emotionally impoverished o Lack of anxiety and fear o Do not show an exaggerated startle response that is indicative of fear in the presence of aversive stimuli (most people do show this) 2. Have difficulty shifting or reallocating their attention to consider the possible negative consequences of their behavior o Psychopaths respond normally to punishment in some situations, but not in others o Psychopaths are preoccupied with the potential for a successful outcome o They fail to inhibit inappropriate behavior because they are less able than other people to stop and consider the meaning of important signals that their behavior might lead to punishment
Symptoms of Bulimia
1. Binge Eating 2. Inappropriate Compensatory Behavior 3. Excessive Emphasis on Weight and Shape 4. Medical Complications 5. Comorbid Psychological Disorders
DSM-5 includes 2 different approaches to the classification of PDs
1. Categorical definition of personality disorders -each of the 10 specific types of PDs is defined by a set of characteristic symptoms and people who meet the general criteria for a PD and who also exhibit enough symptoms to pass the diagnostic threshold for a specific type of disorder qualify for a diagnosis - Described in the main body of the manual 2. Dimensional definition of personality disorders -emphasizes the description of maladaptive personality traits using a set of 25 dimensional scales - This approach was ultimately rejected - Included in Section III of the manual
questions raised by involuntary hospitalizations
1. Civil commitment, the legal process of hospitalizing people against their will 2. Patients' rights 3. Deinstitutionalization, treating patients in their communities instead of in mental hospitals
Dimensional approach is based on a two-part process
1. Clinician is asked to make a judgement regarding impairment in personality functioning as defined by problems with the person's view of self and others as well as difficulties with maintaining interpersonal relationships ♣ These problems identified serve as general markers for the presence of a personality disorder ♣ This replaces the categorical model's general criteria for PDs 2. Clinician specifies the nature or form of the disorder using ratings of pathological personality traits ♣ Generally follows the Five Factor Model (FFM) but the broad domains are labeled in a way that emphasizes the maladaptive nature of characteristics associated with PDs ♣ 25 core traits ♣ Involves selecting and rating traits in this list that best describe the nature of the personality problems that are related to the person's impaired personal and social functioning ♣ Traits replace the diagnostic criteria for each PD in the categorical model
Research on ASPD and psychopathy fall into three general areas
1. Concerned with the biological underpinnings of the disorder, especially the possible influence of genetic factors 2. Focused on investigating social factors such as the relationship between familial conflict and the development of antisocial behavior in children 3. Exploring the nature of the psychological factors that might explain the apparent inability of people with antisocial personality disorder to learn from experience
Treatment of Suicidal People
1. Crisis Centers and Hotlines - suicide prevention 2. Psychotherapy 3. Medication 4. Involuntary Hospitalization
Criteria for schizophrenia DSM-5
1. Criterion A -the patient must exhibit two or more active symptoms for at least one month; negative symptoms also play a relatively prominent role in the definition 2. Criteria B -takes into account the person's level of functioning ■ Requires evidence of a decline in the person's social or occupational functioning 3. Criteria C -takes into account the duration of the disorder ■ Requires the presence of disturbed behavior over a continuous period of at least 6 months ■ Active phase symptoms do not need to be present for this entire period ■ Total duration of disturbance is determined by adding together continuous time during which the person has exhibited prodromal, active, and residual symptoms of schizophrenia ○ The diagnosis also involves the exclusion of related conditions (especially mood disorders) ■ Active phase symptoms of schizophrenia must appear in the absence of a major depressive or manic episode ■ If symptoms of depression or mania are present, their duration must be brief relative to the duration of the active and residual symptoms of schizophrenia
Three ways in which the law assumes that mental disorders may affect an individual's ability to exercise his or her rights and responsibilities
1. Defendants who are not guilty by reason of insanity are not criminally responsible for their actions 2. Defendants who are incompetent to stand trial are unable to exercise their right to participate in their own defense 3. Mental illness may be a mitigating factor that can lead to a less harsh sentence - or a harsher one
alcohol use disorder symptoms
1. First four symptoms of "alcohol use disorder" can be used to describe a person's impaired control over use of alcohol - includes unsuccessful attempts to quit drinking as well as craving for alcohol 2. Next three symptoms describe social impairment following drinking 3. Next 2 symptoms describe risky use, such as drinking and driving and continued use in spite of serious psychological and medical complications 4. Last two symptoms are tolerance and withdrawal, aka pharmacological criteria
Two important cautions must be kept in mind regarding the complexity of the search for causes of mood disorders:
1. Genetic heterogeneity - within the general population there may be more than one locus that contributes to the development of depression - mood disorders may be linked to one marker within a certain extended family and to an entirely different marker in another family 2. Environment plays a role in the development on mood disorders - onset of a mood disorder is determined by a combination of genetic and environmental risk factors that the individual experiences
Causes of Alcoholism in stages
1. Initiation and continuation 2. Escalation and transition to abuse 3. Development of tolerance and withdrawal
Two sources of continuity of antisocial behavior
1. Limited range of behavioral skills ♣ Person does not learn social skills that would allow them to pursue more appropriate responses than maladaptive behaviors ♣ Once the opportunity to develop these skills is lost during childhood, they may never be learned 2. The results of antisocial behavior during childhood and adolescence ♣ Person becomes progressively ensnared by the aftermath of earlier choices
Symptoms of Anorexia
1. Low Weight 2. Fear of gaining weight 3. Distrurbance in experiencing weight or shape 4. Amenorrhea 5. Medical Complications 6. Struggle for control 7. Comorbid Psychological Disorders
Development of drug tolerance is result of 3 mechanisms
1. Metabolic tolerance 2. Pharmacodynamic tolerance 3. Behavioral conditioning mechanisms
Antianxiety meds
1. Most frequently used type of minor tranquilizer are benzodiazepines (i.e. Valium and Xanax) 2. Azapirones are another class of antianxiety medication
Two notable differences in definitions of gambling disorder in DSM-IV and DSM-5:
1. One diagnostic criteria - illegal acts - was dropped ♣ Stipulated that person had to commit illegal acts to finance gambling 2. Threshold for diagnosis was dropped from five features to four ♣ Empirical data supports validity of this change
Useful distinctions btw those who are and are not addicted to a substance
1. Patterns of pathological consumption, including impaired control over use of the drug and continued use in spite of mounting problems 2. Consequences that follow a prolonged pattern of abuse, including social and occupational impairments, disruption of important interpersonal relationships, and deteriorating medical condition
Types of Anorexia in the DSM-5
1. Restricting type - includes people who have not engaged in binge or purging in the last three months 2. Binge eating/purging type - defined by regular binging eating and purging - They do not differ in terms of comorbidity, recovery, relapse, or mortality * 62% of restrictors meet the criteria for binge/purge * 12% of the restrictors do not engage in binge/purge
Antidepressant meds
1. SSRIs 2. TCA
Antidepressant Medications
1. SSRIs 2. TCAs 3. MAOIs 4. "other" recently developed drugs - Improvement is typically seen within 4 to 6 weeks - Current episode is usually resolved within 12 weeks - Medication usually continued for at least 6 to 12 months after remission in order to reduce the chance of relapse - Studies show that medication and psychotherapy are approximately equal in treatment effectiveness
Rationales for involuntary hospilization
1. The first is based on the state's *parens patriae* authority, the philosophy that the government has a humanitarian responsibility to care for its weaker members. (Parens patriae has the literal Latin translation of "state as parent.") Under parens patriae authority, civil commitment may be justified when mentally disturbed are either dangerous to themselves or unable to care for themselves. Concept is also used to justify state's supervision of minors and physically incapacitated adults 2. The second rationale is based on state's police power - its duty to protect public safety, health, and welfare
Important Considerations in Distinguishing Clinical Depression from Normal Sciences
1. The mood change is *pervasive* across situations and *persistent over time*. The person's mood *does not improve*, even temporarily, when he or she engages in activities that are usually experienced as pleasant 2. The mood change may occur in the absence of any precipitating events, or it may be completely out of proportion to the person's circumstances 3. The depressed mood is accompanied by *impaired ability to function* in usual social and occupational roles. Even simple activities become overwhelmingly difficult. 4. The change in mood is accompanied by a cluster of additional signs and symptoms, including cognitive, somatic, and behavioral features. 5. The nature or quality of the mood change may be different from that associated with normal sadness. It may feel "stance", like being engulfed by a black cloud or sunk in a dark hole
Distortions, errors, and biases are characteristic of the thinking of depressed people:
1. The tendency to assign global, personal meaning to experiences of failure 2. The tendency to overgeneralize conclusions about the self based on negative experiences 3. Drawing arbitrary inferences about the self in the absence of supporting evidence 4. The tendency to recall selectively events with negative consequences and to exaggerate the importance of negative events while simultaneously discounting the significance of positive events
Individual differences in temperament and personality
1. These differences may not be evident in all situations; some important personality features may be expressed only under certain challenging circumstances that require or facilitate a particular response 2. Social circumstances frequently determine whether a specific pattern of behavior will be assigned a positive or negative meaning by other people, and the meanings that are assigned to a particular trait depend on the environment in which they are observed
Paraphilic disorder
A term that describes a paraphilia that either leads to subjective distress or social impairment for the person or that causes harm to, or threatens, other people
Adoption study
1. They had a biological parent who was alcoholic 2. They were adopted from their biological parents at an early age and raised by adoptive parents • The adoption twin studies point toward influence of genetic factors in the etiology of alcohol use disorder o Offspring of alcoholic parents who are reared by nonalcoholic adoptive parents are more likely than general population to have alcohol problems o Being reared by an alcoholic parent. In the absence of other etiological factors, does not appear to be a critical consideration in the development of the disorder
paternalistic concerns
1. Treating severely disturbed patients who lack insight into their condition 2. Protecting the public from the violently mentally ill
Treatment for gender dysmorphia
1. change the person's identity to match his or her anatomy 2. change the anatomy to match the person's gender identity * sex-reassignment surgery - person's genitals are changed to match the gender identity * results are usually positive * leads to reduced anxiety and depression
Adrenal glands secrete two key hormones in response to the activation
1. epinephrine (adrenaline) - neuromodulator leads to —> norepinephrine + more epinephrine into the bloodstream 2. cortisol = "stress hormone" - functions quickly to help the body make repairs in response to injury or infection - function - "containment" of pathogens in the body - promotes healing in the short run - excess can harm the hippocampus, cause muscular atrophy, and produce hypertension
Patterns of Genito-Pelvic Pain/Pentration Disorder
1. genitor-pelvic pain 2. fear of pain or vaginal penetration 3. tension of the pelvic floor muscles 4. trouble having intercourse
Exhibitionistic disorder defined in terms of:
1. over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one's genitals to an unsuspecting person, as infested by fantasies, urges, and behaviors 2. the individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" * this is known as indecent exposure
Forms of child abuse
1. physical abuse 2. sexual abuse 3. neglect 4. psychological abuse
Issues in child custody
1. physical custody, or where the children will live at what times 2. legal custody, or how the parents will make decisions about their children's lives
6 types of feeding and eating disorders
1. pica 2. Rumination disorder 3. Avoidant/Restrictive disorder 4. Binge-eatint disorder 5. Anorexia nervosa 6. Bulimia nervosa
What reduces stress?
1. predictability - allows coping to being before onset of a stressor 2. control - illusion of control helps alleviate stress 3. Physical activity reduced physiological reactions to stress, even when it does not include problem-focused coping (having outlets for frustration does reduce stress)
Phases of predictable and unpredictable duration
1. prodromal 2. active 3. residual
Two broad types of substance-related disorder in DSM-5
1. substance use disorders 2. substance-induced disorders
DSM-5 requirements
1. the symptoms have persisted for at least six months 2. the symptoms lead to marked distress in the person who experiences them
Depression counts for nearly ___ of all disability
10%
Lifetime prevalence for having at least 1 PD
10%
combined lifetime prevalence for abuse or dependence of any substance
10.3% - more common among men than women
how much more common is anorexia and bulimia in females than males?
10x
substance dependence
A term used to describe use disorders that were at least moderate in severity (e.g., those with pharmacological consequences)
is nicotine addictive?
1996, FDA People who use tobacco clearly develop symptoms of dependence, including tolerance, withdrawal, and pattern of compulsive use o Nicotine is one of the most addictive drugs
Body dysmorphic disorder prevalence
2%
lifetime prevalence (gambling disorder)
2% - more common in men
lifetime prevalence (nicotine)
24% o Has declined since 1964 when U.S. Surgeon General's Report announces link between smoking and cancer o Among 18-25-year-olds, smoking increased during 1990s
% who receive treatment for anxiety disorders
25%
Percent ion American women who have a negative body image
50% usually concerning their hips, waist, or thighs - European American and Latina women report highest rates
Dimensional model retains
6 of the 10 specific types of PDs from the categorical model
Oral Sexual Activities
75% men 65% women
Worrying
A cognitive activity that is associated with anxiety
Cocaine
A naturally occurring stimulant drug
outpatient commitment
A newer, assertive approach to treating patients who lack insight - mandatory court-ordered treatment in the community
Motivational interviewing
A non-confrontational procedure that can be used to help people resolve their ambivalence about using drugs and make a definite commitment to change their behavior o Primary goal is increase person's awareness of the nature of their substance sue problems o Emphasis is placed on how person sees their problems rather than assigning diagnostic labels
Psychopath
A person who is intelligent and superficially charming but also chronically deceitful, unreliable, and incapable of learning from experience
Temperament
A person's most basic, characteristic styles of relating to the world, especially those styles that are evident during the first year of life (typically include dimensions) o Factors vary considerably in level or degree from one infant to the next and have important implications for later development
MDMA (aka Ecstasy)
A synthetic amphetamine derivative o Causes enhanced mood state and a feeling of well-being o Does not cause changes in perceptual experience o Causes changes in blood pressure and body's ability to regulate temperature
Phencyclidine (PCP)
A synthetic drug that is classified with hallucinogens, although effects are very different from LSD and mescaline o Originally developed as a pain killer
Breathing training
A procedure than involves education about the physiological effects of hyperventilation and practice in slow breathing techniques (breathe using diaphragm) - Treatment for panic disorder - Works by enhancing relaxation or increasing patient's sense of control
A panic attack
A sudden, overwhelming experience of terror or fright - Panic is more focused than anxiety - Some clinicians think of panic as a normal fear response triggered at an inappropriate time - a "false alarm" - Largely defined in terms of a list of somatic or physical sensations, ranging from heart palpitations, sweating, and trembling to nausea, dizziness, and chills
Genito-Pelvic Pain/Pentration Disorder
Refers to a set of frequently overlapping symptoms involving having difficulty with intercourse, genitor-pelvic pain, fear of pain or vaginal penetration, and tension of the pelvic floor muscles
Agoraphobia
Refers to an exaggerated fear of being in situations from which escape might be difficult, such as being caught in a traffic jam on a bridge or in a tunnel "fear of public places"
DSM-5 definition of substance use disorders
In terms of a maladaptive pattern of behaviors that are related to the continual use of drugs, in spite of the fact that their use creates a set of significant problems for one person
specific symptoms that are used to define personality disorders:
Represent maladaptive variations in several of the building blocks of personality: o Motives o Cognitive perspectives regarding the self and others o Temperament o Personality traits
Psychoneuroimmuniology (PNI)
Investigates the reaction between stress and immune function - heightened immune system might seem to better prepare the body for the infection that may follow injury - immune response also causes inflammation, maintains fever, and intensifies pain - impairing immediate action
Relaxation training
Involves teaching client to tense and relax certain muscle groups while breathing slowly and deeply - Works to treat various forms of anxiety disorder
Violence
Is a low-frequency event, and for statistical reasons alone, this makes it difficult to predict
Informed consent
Requires that (1) a clinician tell a patient about a procedure and its associated risks, (2) the patient understands the information and freely consents to the treatment, and (3) the patient is competent to give consent
U relationship of stress
Research shows too little stress as well as too much stress can be harmful
Panic attacks also have cognitive symptoms
Some people feel as if they will die, lose control, or go crazy
Comparing treatments
Some say medication and psychotherapy as treatment might be better in short-run, but just therapy may be better in long-run because no issue when medication is stopped
Categorical approach for diagnosis
Would recognize that she meets the criteria for certain disorder PD o Clinician would have to note the presence of some features of other disorders
Opiates
Drugs that have properties similar to those of opium • Main active ingredients in opium is morphine and codeine, which are used in medicine to relieve pain • Opiates are available legally only by prescription in U.S. • Opiates can be taken orally, injected, or inhaled o When taken orally, opiates are absorbed slowly through the digestive system o Most people inject because leads more quickly to high concentrations in brain tissue
OCD NCS-R survey
About 30% of people reported experiencing obsessions or compulsions at some point during their lives, but most did not qualify for an OCD diagnosis
Female Sexual Interest/Arousla Disorder
Absence or reduced frequency or intensity of several indicators in or response to sexual cues
Nicotine
Active ingredient in tobacco, which is its only natural source o Nicotine is toxic Sbsorbed into the blood through the membranes of the lungs o From there is it carried from the lungs to the heart and from there to the brain
Hoarding
Added to DSM-5 as new mental disorder - Used to be listed as potential symptom of OCD because person's fear of losing possessions was thought to be an obsessive thought (increasing anxiety)
Cognitive factors role in anxiety disorders
Additionally, people learn to avoid certain stimuli if they observe other people showing a strong fear response to those stimuli - People who believe that they are able to control events in their environment are less likely to show symptoms of anxiety than are people believe that they are helpless - Additionally, feelings of lack of control are linked to the onset of panic attacks in those with panic disorder, submissive behavior seen among those with social anxiety disorder, and chronic worrying among those with GAD
DSM-5 definition of social anxiety disorder
Almost identical to that for specific phobia, but it is focused on social situations in which the person may be closely observed or evaluated by other people - People with social anxiety disorder are afraid of (and avoid) social situations in which they may be scrutinized - These situations fall into two broad headings: doing something in front of unfamiliar people (performance anxiety) and interpersonal interactions (such as dating and parties) - Fear of being humiliated or embarrassed lies at the heart of the person's discomfort
Suicide Rate increased:
Among adolescence from 1970 to 1990, corresponding to an increase in the prevalence of depression and decrease in the average age of onset of depression
Naltrexone (Revia)
An antagonist of endogenous opioids that has been found to be useful in the treatment of alcohol dependence following detoxification o Patients who receive this drugs and psychotherapy are less likely to relapse than those who receive psychotherapy and a placebo o This drug dampens the person's craving by blocking alcohol's ability to stimulate opioid system o Works by reducing the rewarding effects of alcohol
Psilocybin
Another type of hallucinogen whose chemical structure resembles serotonin
multifaceted approach to treatment
Antipsychotic medication is the primary mode of treatment ○ Because many patients remain impaired between episodes, long-term care must often involve the provision of housing and social support ○ Treatment requires attention on multiple fronts (impaired social and occupational skills) and is necessarily concerned with the cooperative efforts of many types of professionals
Phobias
Are persistent, irrational, narrowly defined fears that are associated with a specific object or situation - Avoidance is an important component of the definition of phobias - A fear is not considered a phobia unless the person avoids contact with the source of the fear or experiences intense anxiety in the presence of the stimulus - Phobias are also irrational or unreasonable
Genetic risk
As the degree of genetic similarity between an individual and a schizophrenic patient increases, the risk to that person also increases ○ The risk in the second-degree relatives is greater than the 1% that is typically reported for people in the general population ○ The risk is much greater among first degree relatives than it is among second-degree relatives
Course and outcome of anorexia
At 10-20 year follow-up, nearly half of the patients have a weight within the normal range * 20% remain significantly below their healthy body weight * 30% intermediate weight 5% of patients starve themselves to death or die of complications, including suicide More than 50% of people with a history of anorexia continue to be preoccupied with diet, weight, and body shape Most people never fully recover unfortunately
Age of onset for anxiety
Average age of onset for anxiety is much younger than the age for onset for depression, so if someone has both, anxiety usually presented first
Cyclothymia
chronic but less severe form of bipolar disorder - person must experience several periods of time with hypomanic symptoms and frequent periods of depression during a period of two years
Most common PD among patients treated at mental health facility
Borderline PD found in > 30% of all patients treated for psychological disorders
Illness behavior
Behaving as if you are sick - also is stress related - i.e. Will visit doctor's office more frequently or allow chronic pain to interfere with life - Effective coping may be ignoring some physical discomfort with chronic illness
Long-term outcome for the treatment of alcoholism
Best predicted by person's coping resources, the availability of social support, and the level of stress in the environment o These are more important than the specific type of intervention • Those with less stressful life situations, with families that are more cohesive, and those who are better equipped with active coping skills are most likely to sustain their improvement
Abstinence violation effect
Refers to guilt of perceived loss of control that the person feels whenever he or she slips and finds himself or herself having a drink after an extended period of abstinence o People blame themselves o See this a signal that further efforts to control their drinking will be useless o CBT teaches them to interpret these behaviors as temporary "lapses" rather than a total "relapse"
Genetic Factors
Bulimia nervosa concordance rate * MZ = 23% * DZ = 9% * Anorexia nervosa concordance rates are higher * Contribute to symptoms as well
Risk
Refers to hazard - the possibility of suffering harm Probability that a certain outcome will occur o Implies only probability not certainty o Implies association not causality o Correlation between risk factor and the disorder
The presence of pathological personality traits during adolescence
Is associated with an Increased Risk for subsequent development of other mental disorders o Negative emotionality (high neuroticism) often predicts the later onset of major depression or an anxiety disorder o Impulsivity and antisocial personality increase the person's risk for alcoholism - presence of personality disorder can interfere with the treatment of a disorder such as depression
Average time between initial use of drug and onset of substance use disorder
Is between two and three years
any disruption of the response cycle
could led to sexual dysfunctions
Psychotherapy - BD treatment
Can be an effective *supplement* to biological intervention - cognitive therapies - address the patient's reactions to stressful life events as well as his or her reservations about taking medication - interpersonal therapies - interpersonal and social rhythm - commonly used with bipolar patients - based on the recognition that a repeated episode of either mania or depression is often precipitated by one of the following factors: stressful life events, disruptions in social rhythms, and failure to take medication - emphasis on the relationship between symptoms and social interactions - help patients learn how to lead more orderly lives - used with mood stabilizers
Subjective experience of bodily sensations
Is closely associated with maladaptive or catastrophic thoughts among patients with panic disorder - This connection itself does not provide strong evidence for a causal link because catastrophic thoughts are part of the definition of panic disorder
Treatment for Bulimia
CBT, interpersonal psychotherapy, and antidepressant medication
Worry
Can be defined as a relatively uncontrollable sequence of negative emotional thoughts that are concerned with possible future threats or danger - This sequence of worrisome thoughts is usually self-initiated or provoked by a specific experience or ongoing difficulties in a person's daily life - Excessive worriers emphasize the predominance of verbal, linguistic material rather than images - i.e. Worriers are preoccupied with "self-talk" rather than unpleasant images
Stimulants
Can be taken orally, injected, or inhaled • Stimulants are absorbed more slowly through the digestive system • More dramatic effects of stimulants can be achieved if taken by injecting or sniffing
Hallucinogens
Cause people to experience hallucinations similar in molecular structure to many neurotransmitters - Most common hallucinogen is called LSD, which has strong chemical resemblance to serotonin
Cluster B disorders
Characterized by dramatic, emotional, or erratic behavior, all are associated with marked difficulty in sustaining interpersonal relationships o Includes: Antisocial PD, Borderline PD, Histrionic PD, and Narcissistic PD
Paranoid Personality Disorder
Characterized by the pervasive tendency to be inappropriately suspicious of other people's motives and behaviors
The DSM-5
Classifying anxiety disorders is based primarily on descriptive features and recognized several specific subtypes: specific phobia, social anxiety disorder (social phobia), panic disorder, agoraphobia, and generalized anxiety disorder
The concept of schizotypal PD (SPD)
Closely tied to the history of schizophrenia as a diagnostic entity o Maladaptive personality traits are presumably seen among people who possess the genotype that makes them vulnerable to schizophrenia o The symptoms of schizotypal PD represent early manifestations of the predisposition to develop the full-blown disorder o A fairly large proportion of the family members of schizophrenic patients exhibit strange or unusual behaviors that are similar to, but milder in form than the disturbance shown by the patient
Riggings v. Nevada
court upheld right of defendant on trial for murder to refuse an extremely high dose of antipsychotic
Twin Studies
Compare MZ and DZ twins - several twin studies of mood disorders have show higher concordance of MZ twins than DZ - Concordance rates: - *Bipolar disorder:* - MZ = .69 - DZ = .19 - *Depressive disorders:* - MZ = .54 - DZ = .24 - Also show us that environmental factors influence the expression of genetically determined vulnerability to depression - If genes told the whole story the concordance rate for MZ twins would be 1 (always concordant)
Treatment for SPD
Complicated because of two considerations: 1. The ego-syntonic nature of PDs ♣ This is related to the relatively high proportion of PD patients who prematurely terminate treatment 2. Comorbidity ♣ There is tremendous overlap between specific personality disorder categories and other forms of abnormal behavior, which complicates treatment ♣ Treatment is seldom aimed at problem behaviors that are associated with only one type of PD
diffused patterns of neuropathology
Consistent findings suggest structural as well as functional irregularities in the frontal cortex and limbic areas of the temporal lobes - associated with schizophrenia
Fear
Is experienced in the face of real, immediate danger - It usually builds quickly and intensely and helps organize the person's behavioral responses to threats from the environment
3. Behavioral conditioning mechanisms
Cues that are regularly associated with the administration of a drug begin to function as conditioned stimuli and elicit a conditioned response that is opposite in direction to the natural effect of the drug
Evolutionary
Current theories regarding the causes of anxiety disorders often focus on the evolutionary significance of anxiety and fear (they helped us survive) - Generalized forms of anxiety probably evolved to help the person prepare for threats that could not be identified clearly - More specific forms of anxiety and fear probably evolved to provide more effective responses to certain types of danger
Anxiety
Is focused on the future rather than the immediate present - It helps us anticipate and prepare for important events - Physical signs include dry mouth, pounding heart, heavy breathing
Similarity between gambling disorder and substance use disorders
Is strongest with regard to loss of control of behavior and weakest with regard to possible development of physiological aspects of tolerance and withdrawal
Chasing loses
Is unique feature of gambling disorder; this is process of trying to win back money that has already been lost
Withdrawal
Refers to the symptoms experienced when a person stops using the drug o Side effects include: hand tremors, sweating, nausea, anxiety, and insomnia and can also include convulsions and hallucinations
The frequency and intensity of panic attacks tend to...
Decrease as people reach middle age, but agoraphobic avoidance typically remains stable
Excoriation disorder
Defined as repeated skin picking which produces skin lesions - Skin picking is resisted unsuccessfully - much more common than Trichotillomania
Hoarding definition in the DSM-5
Defined in DSM-5 as an unrelenting trouble associated with getting rid of personal belongings - Person must feel strong need to save these possessions - Throwing away items leads to sharps increase in strong negative emotions
Antisocial Personality Disorder
Defined in terms of a persistent pattern of irresponsible and antisocial behavior that begins during childhood or adolescence and continues into the adult years
How are PDs defined?
Defined in terms of behavior that "deviates markedly from the expectations of the individual's culture" o Judgements regarding appropriate behavior vary considerably from one society to the next
Trichotillomania
Defined in terms of recurrent hair-pulling - People who meet criteria pull their own hair and therefore experience hair loss - Person attempts unsuccessfully to stop pulling hair
Detox
Extremely difficult as person experiences withdrawal and gradually adjusts to absence of drug • With CNS depressants detoxification is accomplished gradually • In contrast, stimulant drugs can be stopped abruptly • People going through alcohol detoxification are often given various types of medications to minimize withdrawal symptoms (controversial)
Suicide
Extremely personal, private, and complicated act - Highest rate in the US is seen in *white males over the age of 50* - those who are occupationally successful are more likely to commit suicide, especially if that success is threatened or loss *50% of suicides occur in a result of a primary mood disorder*
hypnotics
Depressants of the central nervous system (CNS) include alcohol as well as types of medications that are used to help people sleep
sedatives or anxiolytics
Depressants of the central nervous system (CNS) that relieve anxiety
Egoistic Suicide
Diminished Integration - occurs when people become relatively detached from society and when they feel that their existence is meaningless - more common among groups such as people who have been divorced and people who are suffering from mental disorders - emotions - depression and apathy
"freedom of choice"
Diminished control over drinking is a crucial feature of the disorder
Anomic Suicide
Diminished regulation - occurs following a sudden breakdown in social order or a disruption of the norms that govern people's behavior - explains increased suicide rates that occur following an economic or political crisis - emotions - anger, disappointment, exasperation
Cluster A
Describes behavior that is typically odd, eccentric or asocial o Includes: paranoid PD, schizoid PD, and schizotypal PD o These share similarities with the symptoms of schizophrenia o These types of PDs may represent behavioral traits of interpersonal styles that precede the onset of full-blown psychosis o Sometimes called schizophrenia spectrum disorders
SSRIs (selective serotonin reuptake inhibitors)
Developed in the 1980s, most frequently used form of medication (80%) - synthesized in labs by pharmaceutical companies - they are "selective" because they only effect reuptake of serotonin - have fewer side effects than other meds - *Side effects* - nausea, headaches, sleep disturbance - most troublesome = sexual desire and orgasmic dysfunction (50%) - weight changes
1. Metabolic tolerance
Develops when repeated exposure to the drug causes the person's liver to produce more enzymes than are used to metabolize (break down) the drug => drug is metabolized quickly so person must take larger doses of drug
Line between normal behavior and compulsive behavior
Difficult to define - Arbitrary threshold is that rituals take more than one hour per day or that they impair occupational or social functioning
Female Orgasmic Disorder
Difficulty experiencing orgasm and/or markedly reduced intensity of orgasmic sensations * orgasmic impairment is generalized - never experienced orgasm by any means * women can still find pleasure in foreplay and show signs of arousal - hard to diagnosis because of the various components of female sexual response
Barlow's cognitive components for panic patients
Effective treatment 1) Error analysis of the ways in which people think about situations in their lives 2) *Decatastrophizing* - therapist asks client to imagine what would happen if his or her worst-case scenario actually happened
___ and ____ were the most common types of Suicide in Durkheim's terms
Egoistic and Anomic
"almost a revolution"
created by libertarian cases and legislation which defined patient's rights - ended in the 90s with the rise of paternalistic concerns
Premature Ejaculation
Ejaculation occurs prior to or shortly after vaginal penetration * cannot complete intercourse due to inability to prolong the period of sexual excitement * reach orgasm extremely quickly *most common with men* * 90% ejaculate within one minute after insertion of the pension the vagina * DSM-5 says ejaculation before the person wants to
- Imaging studies show that major depressive disorder is connected to:
Elevated levels of resting blood flow and glucose metabolism in amygdala - higher metabolism rates
Cognitive model
Emotional dysfunction is influenced by the negative ways in which people interpret events in their environments and the things that they say to themselves about those experiences
Social support
Encourages positive health behavior and has direct, physical benefits - Asians and Asian Americans benefit from implicit social support such as focusing on valued social groups - Explicit social support such as seeking advice and emotional solace does not buffer stress for Asians, but it does for European Americans - Providing social support promotes good health at least as much as receiving it does - A good marriage is a critical form of social support - Study that showed partners who were hostile when discussing marital problems had more immunosuppression over next 24 hours and elevated blood pressure
endorphins
Endogenous opioids that are relatively short chains or amino acids, or neuropeptides, are naturally synthesized in the brain and are closely related to morphine - important in activities associated with systems that control pain, emotion, stress, and reward, feeding and growth
Twin Studies and SPD
Evidence from twin studies points to a significant genetic contribution in the etiology of schizotypal PD o The first-degree relatives of schizophrenic patients are considerably more likely than people in the general population to exhibit symptoms of schizotypal PD ♣ Paranoid and avoidant PD also tend to show increased frequency among the relatives of schizophrenic patients • Schizotypal PD is genetically related to schizophrenia
generalized anxiety disorder (GAD)
Excessive anxiety and worry are the primary symptoms - The person must have trouble controlling these worries, and the worries must lead to significant distress or impairment in occupational or social functioning - Must be about a number of different events or activities and cannot be focused on having a panic attack (panic disorder), being embarrassed in public (social anxiety disorder), or being contaminated (OCD) - *Must have at least three of the following symptoms: (1) restlessness/ feeling on edge, (2) easily fatigued, (3) difficult concentrating or mind going blank, (4) irritability, (5) muscle tension, and (6) sleep disturbance*
Altruistic Suicide
Excessive integration - occurs when the rules of the social group dictate that the person must sacrifice his or her own life for the sake of others
Fatalistic Suicide
Excessive regulation occurs when the circumstances under which a person lives become unbearable - ex. a slave might choose to commit suicide in order to escape his horrible existence - extremely uncommon
Temperament + personality traits
Explains how people behave a certain way
Motivation
Explains why people behave a certain way
Mood disorders are most common among younger and middle-aged adults
Explanations: - older people are likely to experience memory impairments - many depressed people may not have survived until old age
Maudsley method
Family therapy * parents take complete control over the anorexia child's eating, planning meals, preparing food, and monitoring eating * parents do not blame the adolescent for her problems, but emphasize the uncontrollable nature of anorexia and the importance of food in order to get better * age appropriate autonomy is returned to the teenager as eating and weight improve
Brain circuits involved in fear conditioning follow two distinct pathways
First sensory information is projected to the thalamus 1. Path one ("short-cut pathway): - Represents the evolved module for conditioned fear - Direct connection thalamus and amygdala, which is connected to the hypothalamus - Used with "fight-or-flight" response (adaptive; "hardwired response") - Path one does not involve connections to cortical areas (higher-level thinking and decision making) - Amygdala stores unconscious, emotional memories (prepared learning) 2. Path two - Thalamus leads to the cortex and provided detailed, slower analysis of the information - Evaluated with information in memory - Message sent to amygdala, which triggers an organized response
The National Comorbidity Survey Replication (NCS-R) on Anxiety Disorder
Found that 18 percent of adults in the U.S. population have at least one type of anxiety disorder in any given year - Mood disorders (10%); substance use disorders (4%)
Treatment of Anorexia
Focuses on two goals: 1. to help the patient gain at least a minimal amount of weight 2. to address the broader eating difficulties
Residual phase
Follows the active phase and is defined by signs fo symptoms that are similar in many respects to those seen during the prodromal phase ■ Most dramatic symptoms of psychosis have improved, but the person continues to be impaired ● Negative symptoms may remain pronounced
mental ill in prison
Four times as many people with mental illnesses are incarcerated in prisons as are held in state mental hospitals
5-HTT gene
Gene has 2 alleles - "s" = reduced efficient of neural transmission in serotonin pathways - people homozygous for "s" (ss) are at a particularly high risk for becoming clinically depressed if they experience stressful life events - in the absence of the stressful events the risk does not increase if an individual has "ss" - BOTH factors are necessary (ss + stress)
Disturbance
Has a dramatic and lasting impact on their quality of life ■ In terms of their own subjective satisfaction ■ And their ability to complete an education, hold a job, and develop social relationships with other people ● ~10% of schizophrenic patients commit suicide ● Consequences of schizophrenia can also be cruel on friends and family members of patients ● Schizophrenia has an enormous impact on society
Revolving door phenomenon
Has developed in which more patients are admitted to psychiatric hospitals more frequently but for shorter periods of time
Cluster C disorders
Have a common element of anxiety and fearfulness (this doesn't fit OCPD as well as the others) o Includes: Avoidant PD, Dependent PD, and Obsessive-Compulsive PD
Suicide Prevention - Crisis Centers and Hotlines
Helping person through immediate crisis and then refer him or her to mental health professionals - Studies show that *suicide rates do not differ in comparisons of similar communities that either have or do not have suicide prevention programs* :( - Availability to these resources does not seem to reduce suicidal rates in communities Challenges: - many people with the most lethal suicidal ideation will not call a hotline or crisis center - most clients are young men, most suicides are by older men - people who they are trying to serve are very difficult to reach - Only a small portion of those who use these resources are seriously suicidal
Distinction between pathological versus normal worry
Hinges on quantity - how often the person worries and about how many different topics the person worries
Treatment programs
IT is believed that the outcome would be more positive if the intervention could be started earlier - focus on the earliest overt signs of the disorder - focus on the genetic predisposition to the disorder
Illness and stress
Illness can also cause stress: have to deal with treating illness, may be stereotypes associated with illness, have to deal with long-term side effects of illness
Amygdala
Important part of the neural circuit involved in *emotion* - responsible for monitoring the emotional significance of information that is processed by the brain and regulating social interactions
1897 Emile Durkheim - studied the social context (political, religious) in which human problems appeared
In Suicide, he argued that suicide rate would increase if levels of social integration and regulation are either excessively low or excessively high - he identified 4 types of suicide: 1. Egoistic Suicide 2. Altruistic Suicide 3. Anomic Suicide 4. Fatalistic Suicide
substance-induced disorders
Include the immediate impact of taking the drug (intoxication) or discontinuing its repeated use (withdrawal)
Barbiturates and benzodiazepines
Informally known as tranquilizers, sedatives, and hypnotics - Nobarbital (Nembutal) and amobarbital (Amytal), use for various purposes, including treatment of chronic anxiety - Valium and Xanax, replaced barbiturates in treatment of anxiety disorders because less likely to produce lethal overdose
FDA regulation on nicotine
Intended to reduce rate at which young people are recruited to become new smokers and to minimize future health casualties from tobacco use - modestly succesful
Self-image
Intimately connected to mood states o If you vacillate back and forth between unrealistically positive and negative views of yourself, your mood will swing dramatically ♣May need constant reassurance from others ♣May be too dependent on their opinions as a means of maintaining your own self-esteem
Impact on society
It is the second leading cause of disease burden ■ Substantial indirect costs are associated with loss of productivity and unemployment
lifetime prevalence
Lifetime prevalence of all schizophrenia spectrum disorders is 1%
Seasonal Mood Disorders - Treatment
Light therapy (1980s) - exposure to bright, broad spectrum light for one to two hours every day - improvement in mood is often seen within 2-5 days - outcome is slightly equivalent to the use of standard antidepressant medication - light + cognitive therapy = more effective
Investigations of brains
MRIS PET - not diagnostically meaningful tests
Male body image
Males are equally divided between those who want to lose weight or gain weight
Denial
Many people fail to take advantage of treatment because do not realize severity of their problems
Cannabis sativa
Marijuana and hashish are derived from this hemp plant - Active ingredient is THC
Delayed Ejaculation
Marked delay in or inability to achieve ejaculation * must be experienced in at least 75% of sexual encounters * person must show a normal interest in and response to sexual stimuli
Project MATCH
Matches clients to certain kinds of treatment o Evaluated 3 forms of physiological treatment: 1. CBT 2. 12-step facilitation therapy 3. Motivational enhancement therapy o All three led to major improvements in amount of drinking and other areas o Very few differences found between the different methods o 12-step facilitation program was slightly favored ♣ 24% achieved abstinence one year after treatment compared to 15% in other two groups
mitigating factors
Mental disorders are one of several mitigating factors that judges are required to consider before sentencing a guilty party
Bipolar Disorders - Treatment
Mood stabilizers are usually used, sometimes antidepressants are used as well - antidepressants can sometimes trigger a switch from depression into a hypomanic or manic episode 1. Lithium 2. Anticonvulsant Medications 3. Psychotherapy 4. ECT *therapy + medication has been found to be more effective than just medication alone*
Common obsessions
Most common forms of obsession include immoral thoughts, thoughts about being contaminated or exposed to illness, unwanted sexual or religious thoughts, and thoughts about harming other people
Behavioral Medicine
Multidisciplinary field that includes both medical and metal health professionals who focus on psychological influences on the symptoms, cause, and treatment oh physical illnesses - health psychologists specialize in this - encourage healthy coping through stress management, proper diet, regular exercise, and avoidance of tobacco
Cognitive cause of OCD:
OCD may be related to maladaptive consequences of person trying to suppress unwanted thoughts that they believe to be dangerous or forbidden - Resistance may be a key component in association between emotional sensitivity and development of unwanted obsessive thoughts - Those vulnerable to OCD react strongly to events that trigger an emotional response - They become aware of exaggerated reactivity and find it unpleasant - To try to control their reaction, they attempt to suppress the emotion - Causes vicious cycle
Does this evidence support confining the seriously mentally ill based on their dangerousness?
NO, for several reasons: 1. The risk of violence is much lower than publicly perceived ♣ About 90 percent of the mentally disturbed have no history of violence 2. Family and friends, not strangers, are the victims of over 85 percent of violent acts committed by the mentally ill 3. Current psychotic symptoms predict violence, but a past history of psychosis does not
Why not ban tobacco products?
Not because so many people are already addicted, extensive black markets would spring up immediately - Outright ban on nicotine would fail
Biological Causes of OCD
Obsessions and compulsions are associated with multiple brain regions, including the basal ganglia, the orbital prefrontal cortex, and the anterior cingulate cortex (all circuits), which are overly active in people with OCD
orgasm in males
Occurs in 2 stages 1. Sensation of ejaculatory inevitability - triggered by the movement of seminal fluid toward the urethra 2. Regular contractions propel some through the urethra - expelled though urinary opening
orgasm in females
Occurs in 3 stages 1. Sensation of suspension or stoppage - strong genital sensation 2. Feeling warmth spreading throughout the pelvic area 3. Sensations of throbbing or pulsating, tied to rhythmic contractions of the vagina, the uterus, and rectal sphincter muscle
2. Pharmacodynamic tolerance
Occurs when receptors in the brain adapt to continued presence of the drug => neuron may adapt by reducing the number of receptors or by reducing their sensitivity to the drug - down regulation
Temporal stability
One of the most important assumptions about PDs o Categorically defined diagnoses do not tend to be particularly stable o From a dimensional perspective, maladaptive traits the represent the core features of the disorders remain relatively stable
receiving treatment (alcohol)
Only 24% of those diagnosed with alcohol dependence receive treatment
Gender disparities
Overall prevalence of PDs is approx equal in men and women, but there are some consistent gender differences with regard to specific disorders: - Antisocial PD is unquestionably much more common among men than women ♣ Approx 5% reported for men, 2% reported for o BPD and dependent PD may be somewhat more prevalent among women than men o Paranoid PD and OCPD may be somewhat more common among men than women
Cultural comparisons
PDs may be more closely tied to cultural expectations than any other kind of mental disorder o In other cultures, what are the personality traits that lead to marked interpersonal difficulties and social or occupational impairment? Are they different from those that have been identified for our own culture? o Are the diagnostic criteria that are used to define personality disorder syndromes in DSM-5 (and ICD-10) meaningful in other cultures?
Minors
Parents can commit children to hospital against their own will - most are "voluntary" patients
EE and relapse
Patients who returned to live in a home with at least one member who was high in EE were more likely than patients from low EE families to relapse in the first 9 months after discharge
Who has the strongest influence on adolescents?
Peer and sibling substance use are robust predictors of adolescent alcohol and drug use, even more than parental alcohol use Impact of friends' alcohol use is greater among adolescent girls than boys
psychological dependence
People who are dependent of drugs often say that they take drug to control how they are feeling
Erectile disorder
Repeated failure to obtain or maintain erections during partnered sexual activities * Appear anytime prior to orgasm * Impotence - old name for disorder was dropped due to negative implications * can be transient or chronic
Excessive worriers
Report content of thoughts as negative, have less control over direction of their thoughts, and their worries are less realistic
birth complications
People with schizophrenia are more likely than the general population to have been exposed to various problems during their mother's pregnancy and to have suffered from birth injuries - Birth complications include: extended labor, breech delivery, forceps delivery, and the umbilical cord wrapped around the baby's neck - may cause neurodevelopment abnormalities
polysubstance abuse
People with substance use disorder frequently abuse several types of drugs; this condition
Male Hypoactive Disorder
Persistence or recurrent lack of desire for sex and deficient/absent erotic thoughts or fantasies regarding sexual activities
Features of paraphilia
Persistence sexual urges and fantasies that are associated with: 1. nonhuman objects 2. suffering or humiliation of oneself or one's partner 3. children or other non consenting persons
Dimensional model identifies other forms of PDs using a new diagnosis called
Personality Disorder Trait Specified (PDTS) o Person must exhibit significant impairment in self or interpersonal functioning as well as one or more pathological personality traits o This replaces the other 4 categorical types
Are they Stable?
Personality disorders have a stable and long-standing nature ex. Individuals with antisocial personality disorder often commit senseless illegal and immoral acts and have an apparent lack of remorse and exhibit an inability to learn from experience that accompanies a history of delinquent behavior
Neuroendocrine System
Pituitary, Thyroid, and Adrenal glands secrete hormones to the bloodstream in response to signals from the brain - *Hypothalamic-pituitary-adrenal (HPA) axis* - an important pathway that may be closely related to the etiology of mood disorders - *when person detects threat —> hypothalamus signals pituitary gland to secrete a hormone called ACTH —> modulates secretion of hormones, such as cortisol, from the adrenal glands into bloodstream* - may be involved in the development or maintenance of clinical depression - *Dexamethasone suppression test* (DST) - used to study endocrine deduction in patients with mood disorders - Dexamethasone - a potent synthetic hormone - 1/2 of depressed people patients show a failure of suppression in response to the DST - Overproduction of cortisol may lead to changes in brain structure and function
Age differences
Prevalence rates for anxiety disorders have been found to be lower when people are over the age of 60 compared to younger adults - Agoraphobia is noticed to increase late life
Anterior cingulate cortex (ACC)
Provides a connection between the functions of *attention* and *emotion* - allows us to focus on subjective feelings and to consider the ration between our emotions and behavior - ex. activated when a person has been frustrated in the pursuit of a goal or when a person experiences sadness where it is not expected - Major depressive disorder = *decreased activation of the ACC* - Reduction in ACC activity = a failure to appreciate the maladaptive nature of prolonged negative emotions and a reduced ability to engage in more adaptive harries that might help to resolve the person's problems
Suicide attempts vs. completion
Ratio of attempts to completed suicide = 10:1 - among adolescents = 100:1 - Females age 15-19 make 3x as many suicide attempts compared with males - Completion rates are 4x higher among males - Risk of completed suicide is highest among older people
Acamprosate (Campral)
Reduce the average number of drinking days from 30-50% o Increases proportion of people who are able to achieve abstinence o Used in conjunction with psychological treatment
Learning processes
Refer to classical conditioning: when an unconditioned stimulus (US) is associated with a conditioned stimulus (CS) causing the CS to elicit a conditioned response (CR) that is very similar to the original unconditioned response (UR)
allegiance effect
Shows us that a therapist's beliefs also help make treatment work * tells us CBT should have been more successful in the study because the investigators are cognitive behavior therapists * the results however, overcame the allegiance effect * a way to address this problem is to have two investigators who are opposing allegiances participate in the same study * overcomes allegiance effect but creates a new problem - effects due to the different, individual therapies cannot be controlled
BIS - elevated activity
Some areas show abnormally *elevated levels of activity* in depressed people - this includes the orbital PFC and the ventromedial PFC, areas of the brain that are important for deterring a person's responses to reward and punishment - *Orbital PFC* - inhibits inappropriate behaviors and helps the person ignore immediate reward while working toward a long-term goal - *Ventromedial PFC* - involved in the experience of emotion and the process of assigning meaning to perceptions - Overactivity may be associated with the prolonged experience of negative emotion
Stress as Appraisal of Life Events (Lazarus 1966)
Stress as the individual's appraisal of a challenging life event - *Primary appraisal* - our evaluation of the challenge, threat, or harm posed an event - *Secondary appraisal* - our assessment of our abilities and resources for coping with that event - Appraisal approach recognizes that the same event is more or less stressful for different people but runs that risk of circular reasoning
Triggers
Stressful life events, particularly those involving danger and interpersonal conflict, can trigger the onset of certain kinds of anxiety disorders - People who experienced a severe loss are more likely to develop depression - Children who experience higher levels of adversity (prenatal stress, multiple maternal partner changes, parental neglect, and physical abuse) are more likely to develop anxiety disorders later in life - Insecurely attached infants are more likely to develop anxiety disorders when they become adults, especially agoraphobia
Current views on the process by which fears are learned..
Suggest that the process is guided by a module, or a specialized circuit in the brain, that has been shaped by evolutionary pressures
Sell v. United States
Supreme Court upheld the right of defendant to refuse treatment when the purpose what to establish competence to stand trial
Symptoms
Symptoms seem to stem from a fundamental breakdown in basic cognitive functions that govern the way the person perceives and thinks about the social world ● Most common symptoms include changes in the way a person thinks, feels that relates to other people and the outside environment ○ No single symptom or set of symptoms is characteristic of all schizophrenia patients
Active phase
Symptoms such as hallucinations, delusions and disorganized speech
Tardive dyskinesia (TD)
Syndrome consists of abnormal involuntary movements of the mouth and face (eg tongue protrusion, chewing, lip puckering, spasmodic movements of the limbs and trunk of the body) - distressing problem - induce by antipsychotic treatment and is irreversible in patients
Psychopathy Checklist (PCL)
Systematic approach to the assessment of psychopathy o Includes two major factors: ♣ Emotional/interpersonal traits ♣ Social deviance associated with an unstable or antisocial lifestyle o Indicates that the emotional and interpersonal traits can be used reliably
product test
The Durham opinion (Durham v. United States) indicated that an accused is not criminally responsible if his or her unlawful act was the product of mental disease or defect o This ruling made no attempt to define either product or mental disease o Terms were intended to be very broad to allow mental health professionals wide discretion in determining insanity and testifying in court
Cognitive Therapy
Therapists are active and directive in their interactions with clients, focusing their attention on their clients' current experience - Assume that people have conscious access to cognitive events - Serious commitment to the empirical evaluation of the efficacy of treatment programs - *Studies show it is effective in the treatment of nonpsychotic depression*
sexual dysfunctions
inhibitions of sexual desire and interference with the physiological responses leading to orgasm
Equifinality
There are many pathways to developing an ED * some women are naturally thin, but their perfectionism drives them to become even thinner * some women are naturally curvier bodies, and they struggle and fail to mold their body into something it was never meant to be * finding the middle ground of healthy weight can be very difficult
Psychological factors
These events may be particularly harmful to people who are genetically predisposed to the disorder
Systematic desensitization
a patient taught progressive muscle relaxation while working through hierarchy of feared stimuli - effective treatment - Repeated until patient no longer feels increase in anxiety - Crucial feature: systematic maintained exposure to the feared stimulus - Flooding: beings with most frightening stimuli rather than working way up from bottom
Withdrawal is more common when
Withdrawing from alcohol, opioids, sedatives, hypnotics, and anxiolytics
Munchausen-by-proxy syndrome (MBPS)
a unique, rare, but potentially very harmful form of physical child abuse where parent feigns, exaggerated, or induces illness in a child
Affiliation
The desire for close relationships with other people ♣ Severely diminished or absent motivation for social relationships is one pervasive theme that defines certain kinds of PDs
Power
The desire for impact, prestige, or dominance ♣ Exaggerated motivation for power and achievement also contribute to the description of PDs (lack of balance can have a serious disruptive effect on the person's social adjustment)
Alcohol withdrawal delirium
The development of delirium, a sudden disturbance of consciousness that is accompanied in changes in cognitive processes such as lack of awareness of the environment or inability to sustain attention, when withdrawing from alcohol
Tolerance
The process to which the nervous system becomes less sensitive to the effects of alcohol or any other drug of abuse
Flight-or-Flight response
The reaction you witness in a time of immediate threat or danger - you either run away or you fight the stressor - maladaptive reaction - seen as common among men - activates your sympathetic nervous system
Genetics and BPD
The fundamental personality traits that define the disorder (neuroticism and impulsivity) are also influenced by genetic factors
Included in the DSM-5
The inability to control the use of the drug, risky use of the drug, social impairment following repeated use, and pharmacological consequences including tolerance (the need for increased amounts of the drug to achieve intoxication) and withdrawal (unpleasant psychical and psychological effects that the person experiences when he or she tries to stop taking the drug)
Anhedonia
The inability to experience pleasure ○ Patients typically lose interest in recreational activities and social relationships, which they do not find enjoyable ○ Unable to experience pleasure from physical sensations such as taste and touch ○ This is an enduring feature of schizophrenia for many people ○ This may be an early marker, signaling the onset of the prodromal phase of the disorder
Extrapyramidal symptoms (EPS)
The most obvious and troublesome side effects of antipsychotic drugs; including an assortment of neurological disturbances (eg muscular rigidity, tremors, restless agitation, peculiar involuntary postures, motor inertia, etc) ■ EPS may diminish spontaneously after the first few months of treatment, but some patients continue to experience EPS for years
Categorical Model
The official DSM-5 approach to defining personality disorders o Includes 10 types of PDs that are organized into three clusters on the basis of broadly defined characteristics
Symptoms of a PD
Themes of aggression, violence, and hostility are common in paraphilia fantasies, as are impulses involving strangers or unwilling partners * lack of human intimacy * compulsion and lack of flexibility * they feel compelled to engage in certain acts that may be personally degrading or harmful to others * similar to addiction * preoccupations with fantasies * experience sexual dysfunctions involving desire, arousal, or orgasm during conventional sexual behavior with a partner
Analogue Studies
They focus on behaviors that resemble mental disorders—or isolated features of mental disorders—that appear in the natural environment - depend on the use of animal models of psychopathology, which have provided important insights regarding the etiology of conditions such as anxiety, depression, and schizophrenia - When lab animals are exposed to uncontrollable stress they frequently exhibit behavioral symptoms that are similar to those seen in depressed humans
Right to refuse treatment, particularly psychoactive medication, is a newer issue:
This issue is problematic for several reasons: o The patient who is committed to the mental institution refused inpatient treatment but is receiving it anyway o Most experts argue that patients than also lose their right to refuse treatment once they are involuntarily hospitalized
- General adaptation syndrome (GAS) Hans Selye -
Three stages: 1. Alarm - involves mobilization of the body in reaction to threat 2. Resistance - a period of time when the body is physiologically activated and prepares to respond to the threat 3. Exhaustion - occurs if the body's resources are depleted by chronic stress - body is damaged by continuous, failed attempts to reactivate the GAS - analogy: a car running at such high speeds that the cooling and lubricant systems cannot keep up, making a breakdown likely
Medication
the most effective and most commonly used biological approach to the treatment of anxiety disorders - Medication is often used in conjunction with psychological treatment
SSRIs
Used for long-term treatment of alcoholic patients o SSRIs have small and inconsistent effects o Are effective with those with dual diagnosis of alcohol dependence and depression
Lithium
Useful for *manic and depressive episodes* - if taken consistently patients are less likely to experience a relapse - *40%* of patients *do not improve* with this type of medication - usually seen with patients who exhibit a mixture of depressive and manic episodes - *50%* of patients *fail to take it regularly due to negative side effects* - nausea, memory problems, weight gain, impaired coordination
Highest prevalence rates
Usually found to be associated with OCPD, antisocial PD and avoidant PD ~ 3-4%
Following medical advice
Very important health behavior that as many as 93 percent of patients fail to do fully - Especially dangerous when stop medication for illness with no external symptoms because can't see internal effect it's having - Stress can interfere with treatments that do affect symptoms - i.e. Less likely to adhere to medical advice about diet and exercise
substituted judgement
When the patient's competence is in question, a common approach is to appoint an independent guardian who offers a substituted judgement, deciding not what is best for the patient but what the patient would do if he or she were competent
Five-factor model (FFM)
Widely accepted point of view about the basic dimensions of temperament and personality o Includes neuroticism, extraversion, openness to experience, agreeableness and conscientiousness o Many PDs are defined in terms of maladaptive variations of these traits ♣ Problems may arise in association with extreme variations in either direction
Brief psychotic disorder
a category that includes those people who exhibit psychotic symptoms (delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior) for at least one day but no more than one month ○ An episode is typically accompanied by confusion and emotional turmoil, often following a markedly stressful event ○ After symptoms resolve, person returns to the same level of functioning that they had before the psychotic episode ○ Long-term outcome is good ○ Diagnosis is not assigned if the symptoms are better explained by a mood disorder, schizophrenia, or substance abuse
Cognitive enhancement therapy (CET)
a comprehensive, integrated program aimed at the improvement of cognitive abilities, including those that are concerned with performance on laboratory tasks (eg attention, working memory, etc) as well as social cognition (eg recognizing the perspectives of others) - for those taking medication and recovered from active symptoms but show cognitive disability - small group exercises
pseudohermaphroditism
a condition in which someone is genetically male, but they are unable to produce a hormone that is responsible for shaping the penis and scrotum in the fetus * child is born with external genitalia that are ambiguous in appearance
Competence
a defendant's ability to understand the legal proceedings that are taking place against them and to participate in their own defense - contains no reference to "mental disease or defect"
Clinical Depression
a depressed mood is accompanied by several other symptoms, such as fatigue, loss of energy, difficulty sleeping, and changes in appetite - involved with a variety of changes in thinking and overt behavior
vaginal photometer
a device shaped like a tampon and inserted into the vagina used to measure sexual arousal * walls of vagina become congested with blood when sexually aroused * Vascongestion causes changes in te amount of red light that can be transmitted through the tissue * it is sensitive to subtle changes in vaginal tissue
PET shows
a dynamic brain imaging technique that can reflect changes in brain activity as the person responds to various task demands - dysfunction in neural circuits
cohort
a group that shares some features in common ex. year of birth
Mescaline
a hallucinogen that resembles norepinephrine
Optimism
a healthy coping style - Optimists have positive attitude about dealing with stress, even when can't control it - Positive thinking is linked with better health habits and less illness
postpartum onset
a major depressive or manic episode that occurs within four weeks after childbirth
seasonal affective disorder
a mood disorder in which the onset of episodes is regularly associated with changes in the season - a pattern of depression in which the person becomes depressed in the fall or winter, followed by a recovery in the following spring or summer
mediator
a neutral third party who facilitates the parents' discussions during a custody decision
Bipolar II
a person who experiences at least one major depressive episode, at least one hypomanic episode, and no full-blown manic episodes - *hypomania* - episodes of increased energy that are not sufficiently severe to qualify as full-blown mania - different than manic episode because of duration and severity - the mood change must be noticeable but the disturbance must not be severe enough to impair social or occupational functioning or to require hospitalization
Bipolar I
a person who has experienced at least one manic episode - Vast majority of people with this disorder experience episodes of major depression as well
Motive
a person's desires and goals; describe the way that the person would like things to be, and they can help to explain why people behave in a particular fashion o Can be conscious or unconscious
Mood
a pervasive and sustained emotional response that, in its extreme form, can color the person's perception of the world
Obsessive-Compulsive PD
a pervasive pattern of orderliness, perfectionism and mental and interpersonal control, at the expense of flexibility, openness and efficiency
Dependent Personality Disorder
a pervasive pattern of submissive and clinging behavior
operational definition
a procedure that is used to measure a theoretical construct - for males - penile plethysmograph - for females - vaginal photometer
Psychosomatic disorders
a product of both the mind (psyche) and body (soma)
Assertive community treatment (ACT)
a psychosocial intervention that is delivered by an interdisciplinary team or clinicians who provide a combination of psychological treatments (including education, support, skills training, and rehabilitation, as well as medication) - provided on regular basis - hopes to minimize need for hospitalization
Social Readjustment Rating Scale (SRRS)
a scale that assigns stress value to life events based on the judgments of a large group of normal adults - views stressors that produce more life change units as causing more stress - Holmes and Rage's 1967
Schizophrenia
a severe form of abnormal behavior that encomplasses what most of us have come to know as "madness" ○ People exhibit many different kinds of psychotic symptoms, indicating that they have lost touch with reality - May hear voices that aren't there - May make comments that are difficult, if not impossible, to understand - Behavior may be guided by absurd ideas or beliefs
Emotion
a state of arousal that is defined by subjective states of feeling - sadness, anger, disgust - often accompanied by physiological responses - increase heart rate and respiration rate
Social skills training (SST)
a structured, education approach to problems in social and occupational functioning that involves modeling, role playing, and the provision of social reinforcement for appropriate behaviors - improves social adjustment - unclear if helps with relapse
Heroin
a synthetic opiate • can be injected, inhaled though the nose in the form of snuff, or smoked and inhaled through a pipe or tube
Paraphilia
a term that describes "any intense and persistent sexual interest other than sexual interest other than sexual interest in genital stimulation or preparatory fondling with a phenotypically normal, physically mature, consenting human partner"
Melancholia
a term used to describe a particularly severe type of depression - some believe it represents a subtype of depression that is caused by different factors than those that are responsible for other forms of depression - indicator that a person is likely to have a good response to biological forms of treatment - Patient must have: - lose the feeling of pleasure associated with all, or almost all, activities - Lose the capacity to feel better—even temporarily—when something good happens - Also must have at least three of the following: - The depressed mood feels distinctly different from the depression a person would feel after death of a loved one - The depression is most often worst in the morning - The person awakens early, at least two hours before usual - Marked psychomotor retardation or agitation - Significant loss of appetite or weight loss - Excessive or inappropriate guilt
Disorganization
a third category of symptoms that include thinking disturbances and bizarre behavior
placebo
a treatment that contains no active ingredients for the disorder being treated
Age of onset
adolescence or early adulthood - hormonal change, sexual problems, natural to gain weight, breasts and hips get bigger - puberty = risk for anorexia
chronic stressors and losses
also create immunosuppression, perhaps permanently altering immune functioning in a way to explain associations between childhood stress and diseases of aging
duty to warn
altered to a more general duty to protect general duty to protect, which may involve warning but alternatively might involve protective actions like hospitalizing that potentially dangerous patient
____ generations are experiencing higher rates of depression
younger
deinstitutionalization movement
an attempt to care for the mentally ill in their communities - suffered many problems: patients moved from mental institutions and into private mental hospitals, nursing homes, or homeless
Catechol O-methyltransferase (COMT)
an enzyme that is involved in breaking down the neurotransmitter dopamine - located on chromosome 22 - increased risk for schizophrenia - affecting dopamine transmission in the prefrontal cortex, impairing cog. ability
Schizoaffective disorder
an episode in which the symptoms of schizophrenia partially overlap with a major depressive episode or a manic episode ○ Must have the presence of delusions for at least 2 weeks in the absence of prominent mood symptoms ○ Diagnosis is not assigned if delusions and hallucinations are only present during a depressive episode or a manic episode
Mental disease or defect
an issue of obvious importance to the mental health professions must be "severe"
Emotions associated with sexual dysfunction
anger, fear, resentment, embarrassment --> leads to depression or anxiety emotional consequences can be devastating
In contrast to fear, anxiety....
anxiety involves a more general or diffuse emotional reaction - beyond simple fear - that is out of proportion to threats from the environment - Rather than being directed toward the person's present circumstances, anxiety is associated with the anticipation of future problems
Stress
any challenging event that requires physical, biological, cognitive, or behavioral adaptation - could be defined as an individual's reaction to an event - an adaptive, important response to our surroundings and aspects of life
Psychopathy and ASPD
are two different attempts to define the same disorder o They are sufficiently different that they do not identify the same people o They are not used interchangeably
Family treatment programs
attempt to improve the coping skills of family members, recognizing the burdens that people often endure while caring for a family member with a chronic mental disorder - medication on an outpatient basis - educational component to help fam - goal = to eliminate unrealistic expectations - goal = improve communication and problem-solving skills - can delay relapse!
guilty but mentally ill (GBMI)
attempt to reform the insanity defense
criminal responsibility
because people act out of free will, they are accountable for their action when they violate the law
Is it culture bound?
been observed in virtually every culture that has been subjected to careful analysis ○ The frequency of schizophrenia is not constant around the world ■ Urban populations have higher rates than rural rates, but incidence is not related to a country's economic status ○ Studies show that clinical and social outcomes are significantly better for schizophrenic patients in developing countries than in developed countries ■ May be a product of the greater tolerance and acceptance extended to people with psychotic symptoms in developing countries
sadistic rapists
behavior is sexual and aggressive
joint custody
both parents retain physical or legal custody or both
irresistible impulse test
broadened the insanity defense to include defendants who were unable to control their actions because of mental disease
How do antipsychotic medications act?
by blocking dopamine receptors in the cortical and limbic areas of the brain as well as affecting a number of other neurotransmitters including serotonin, norepinephrine and acetylcholine
formal commitment
can be ordered only by a court
Misperceiving intentions, motives and abilities of other people
can severely disturb our relationships!! o People with PDs run into problems because they misperceive other people in many ways (as being threatening, uncaring, or incompetent)
inhibited sexual arousal
cannot either achieve or maintain genital response, such as lubrication and swelling, that are necessary to complete sexual intercourse
Tend and Befriend
caring for offspring, protecting them from harm and social affiliation, finding safety in numbers, and sharing resources - seen among women
Schizotypal Personality Disorder
centers around peculiar patterns of behavior
Antisocial PD
central feature = egocentricity and the stunning lack of concern for the impact of their behavior on other people, especially those who are close to them - people with ASPD show callous indifference and shallow emotional experience
psychotherapy placebos
challenging to do
sex roles
characteristics, behaviors, and skills that are defined within a specific culture as being either masculine or feminine
Histrionic Personality Disorder
characterized by a pervasive pattern of excessive emotionality and attention seeking behavior
Narcissistic Personality Disorder
characterized by a pervasive pattern of grandiosity, need for admiration, and inability to empathize with other people
Avoidant Personality Disorder
characterized by a pervasive pattern of social discomfort, fear of negative evaluation, and timidity
Negative symptoms
characterized by the absence of a particular response ■ Include characteristics such as lack of initiative, social withdrawal, and deficits in emotional responding - may be harder to recognize than positive ones - more subtle over time
Positive symptoms
characterized by the presence of an aberrant response ■ Include hallucinations and delusions; also called psychotic symptoms
Common compulsions
checking and cleaning 1. Compulsive cleaning is associated with irrational fear of contamination (like phobia) 2. Compulsive checking frequently represents an attempt to ensure the person's safety or the safety and health of a friend or family member
predicting violence
clinicians are wrong two-thirds of the time when they predict violence will occur - predicting rare events is flawed for mathematical reasons
Clinical syndrome
combination of emotional, cognitive, and behavioral symptoms
acquaintance rape
committed by men who know their victims
Masturbation
common for both men and women
Preparedness model:
conditioned responses to fear-relevant stimuli (spiders) are more resistant to extinction than are those to fear-irrelevant stimuli (flowers); Also it is possible to develop conditioned fear responses after only one trial of learning
preventive detention
confinement before a crime is committed - can lead to substantial abuse
Anxious apprehension
consists of: (1) high levels of diffuse negative emotion, (2) a sense of uncontrollability, and (3) a shift in attention to a primary self-focus or a state of self-preoccupation
Specific phobia
defined in DSM-5 as "a marked fear or anxiety about a specific object or situation that almost always provokes immediate fear or anxiety"
Schizoid Personality Disorder
defined in terms of a pervasive pattern of indifference to other people, coupled with a diminished range of emotional experience and expression
Mood disorders
defined in terms of episodes - discrete periods of time in which the person's behavior is dominated by either a depressed or manic mood - Person usually experiences more than one episodes
OCD-related disorders definition
defined in terms of presence of unwanted intrusive thoughts and/or habitual behaviors
The distinctions among healthy traits, eccentricity and personality pathology..
depend on the person's ability to adapt to the demands of different situations o Variety and flexibility in interpersonal behavior are very helpful
New "mental health courts"
designed to accommodate the mental health needs of the accused and convicted, are one effort to address this problem
Sexual predator laws
designed to keep sexual offenders confined for indefinite periods of time
Longitudinal studies
determine is risk factors play a causal role - expensive - require large number of people
Behavior therapy
developed to treat anxiety disorders, especially specific phobias
cohort effects
differences that distinguish one cohort from another * lifetime prevalence of bulimia was far greater among women who born after 1960 than before 1950
Neurochemical hypotheses
dopamine neurotransmitter system plays a crucial role in supporting activities involved in working memory
"Freebasing"
drug is heated and vapors are inhaled => dangerous
number of patients in mental institutions shuck in 1950
due to medication and the deinstitutionalization movement
Preoccupation
during periods of acute psychosis, many patients find it difficult, if not impossible, to avoid thinking or talking about these beliefs
Euphoria
elated mood - exaggerated feeling of physical and emotional well-being - associated with mania
The deinstitutionalization movement
embraced the philosophy that many patients can be better cared for in their community than in large mental hospitals
Schemas
enduring and highly organized representations of prior experience - they may be latent but they are presumably reactivated when the person experiences a similar event
Personality
enduring patterns of thinking and behavior that define the person and distinguish him or her from other people, including: o Ways of expressing emotion o Patterns of thinking about ourselves and other people
Vasocongestion
engorgement of the blood vessels of various organs, especially the genitals
short-term stressors and physical threats
enhance immune responses that are quick, require little energy, and contain infection due to an injury
psychotic features
episode specifiers allow the clinicians to indicate the presence of hallucinations or delusions during the most recent episode of depression or mania - can be consistent or inconsistent with the patient's mood
Nonsuicidal self-injury
ex. Cutting, burning, or catching the skin - intentions are not to end one's life - the pain serves a useful purpose for them regardless of its impact on their appearance - deliberate self-harm is a symptom of borderline personality disorder - it also occurs among people suffering from other disorders, depression, an post traumatic stress disorder - *4% of population report they have engaged in self-harm* - episodes are typically preceded by strong feelings of anxiety, anger, frustration, or sadness - emotion diminish once cutting has begun and the person experiences relief - final phase usually involves guilt or shame
Neurotransmitters
ex. Serotonin, Norepinephrine, Dopamine - Development of antidepressant drugs stimulated research on several specific neurotransmitters - more than 100 different ones
All of the personality disorders are based on
exaggerated personality traits that are frequently disturbing or annoying to other people
Traumatic stress
exposure to actual or threatened death, serious injury, or sexual violence
Depression - Cognitive symptoms
extreme guilt, feelings of worthlessness, concentration problems, and thoughts of suicide
According to parens patria theory
family courts are supposed to help and protect children and families, a goal that is psychological as well as legal
Typical specific phobias
fear of heights (acrophobia), hear of enclosed spaces (claustrophobia), fear of small animals (zoophobia), fear of blood (hemophobia), fear of flying on airplanes (aerophobia), fear of being in paces from which escape might be difficult (agoraphobia)
Depressed mood
feelings associated usually include disappointment and despair - No one has been able to located the exact point where "feeling down or blue" crosses a lone and becomes depression
Classical or traditional antipsychotics
first generation of antipsychotic drugs
Dopamine hypothesis
focuses on the function of specific dopamine pathways in the limbic area of the brain - symptoms of schizophrenia are product of excessive levels of dopaminergic activity - neural pathways have elevated sensitivity to dopamine - imaging studies show patients have elevated levels of dopamine functioning in the striatum
craving
forceful urge to use drugs, but relationship between craving and drug use is very complex - index of craving = the amount of time that the person spends planning to take the drug
Highest prevalence of schizophrenia
found in neighborhoods of the lowest socioeconomic status found among people who have migrated to a new country
Maladaptive schemas
general patterns of thought that guide the ways in which people perceive and interpret events in their environment
Stuporous state
generally reduced responsiveness; the person seems to be unaware of his or her surroundings ■ Often associated with catatonic posturing
confined sex offenders
get little or no treatment
Other neurotransmitters that have important roles in schizophrenia
glutamate and GABA -gamma-aminobutyric acid
token economics
goal is to increase the frequency of desired behaviors (eg appropriate grooming and participation in group activities) by praising and reinforcing such behavior by the presentation of a token, and decreasing the frequency of undesirable behaviors (eg violence or incoherent speech) by ignoring such behaviors or the loss of privileges if necessary
Social causation hypothesis
harmful events associated with membership in the lowest social classes play a causal role in the development of the disorder
Family environment
has a significant impact on the course of schizophrenia not the cause or original onset
nature of schizophrenia
heterogeneous nature - suggests that it should be explained in terms of multiple pathways
Heritability
how analyses, like twin studies, are expressed - 0% = genetic factors are not involved - 100% = genetic factors alone are responsible for the development of the trait in question - 80% = bipolar disorder - 50% = major depressive disorder
"Hopeless"
refers to the person's negative expectations about future events and the associated belief that these events cannot be controlled
Delusions
idiosyncratic beliefs that are rigidly held in spite of their preposterous nature ■ Delusional patients express and defend their beliefs with utmost conviction, even when presented with contradictory evidence
An attack is said to be expected, or cued
if it occurs only in the presence of a particular stimulus
stress impairs
immune responses that drain energy from the flight-or-fight response
Hypoactive SD defined
in terms of subjective experiences - lack of fantasies or interest in sexual experiences
Panic can be distinguished from anxiety
in two other respects: it is *more intense*, and it has a *sudden onset*
disorganization
include verbal communication problems (incoherent or disorganized speech) and bizarre behavior
Informed consent
includes providing accurate information about risks and benefits in an understandable and noncoercive manner
Depressive schemas
increase the probability that the person will overreact to similar stressful events in the future
sexual excitement
increases continuously from initial stimulation to the point of orgasm - may last mins-hours - vasocongestion - increase muscular tension, heart rate, and respiration
Avolition
indecisiveness, ambivalence, and a loss of willpower - Person becomes apathetic and ceases to work toward personal goals or to function independently
Characteristics of people with gambling disorders
intelligent, well-educated, competitive people who enjoy challenge and risks involved in betting
central issue (Male Hypoactive Disorder)
interest - actively seeking out sexual experiences - rather than just participation
vaginismus
involuntary muscular spasm prevents sexual intercourse as well as other activities, such as vaginal examination and the insertion of tampons * often leads to fear of intercourse
Study comparing treatment programs
involved naturalistic evaluation of substance abuse treatment programs administered by VA - o Compared 12-step programs, CBT, and "electic therapy" (combination of several approaches) o Not randomly assigned to treatments o All three groups were significantly improved o Those who participated in more treatment sessions had better outcomes o 12-step program was most effective
Diminished emotional expression (blunted affect)
involves a flattening or restriction of the person's nonverbal display or emotional responses ○ Patients fail to exhibit signs of emotion or feeling ○ They appear to be completely indifferent ○ Faces are apathetic and expressionless ○ Voices lack the typical fluctuations in volume and pitch ○ May demonstrate a complete lack of concern for themselves and others
Child sexual abuse
involves sexual contact between an adult and a child
Child abuse
involves the accidental or intentional infliction of harm to a child due to acts or omissions on the part of an adult responsible for the child's care
physical child abuse
involves the intentional use of physically painful or harmful actions
Disorganized speech
involves the tendency of some patients to say things that do not make sense signs: ■ Making irrelevant responses to questions ■ Expressing disconnected ideas ■ Using words in peculiar ways
Inability to care for self
is a broad criterion used for people unable to care for themselves or who have no family or friends to care for them
Disulfiram (Antabuse)
is a drug that can block the chemical breakdown of alcohol o If person using this drug takes even small amount of alcohol, they become violently ill o Causes people to stop drinking to avoid this extremely unpleasant reaction o Many discontinue taking disulfiram
The overriding characteristic of BPD
is a pervasive pattern of instability in self-image, in interpersonal relationships and in mood o Lack ground emotionally o Exist from moment to moment without any sense of continuity, predictability, or meaning Experience life in fragments
Health behavior
is any action that promotes good health (i.e. balanced diet, exercise) - Poor health habits, not stress per se, may be responsible for much of the relation between stress and illness - influenced by cultural as well as individual characteristics
Mental health law
is based on the state's police power; virtually all of family law is premised on parens patriae duties
The statistical potential for accurate prediction
is maximized when the predictor and the outcome have more similar base rates
legal definition of insanity
is no the as psychological definition of mental illness
Addiction
is often used to describe problems such as alcoholism
Repression
keeping feelings bottled up, is a maladaptive form of emotion-focused coping - Have greater psychophysiological reactions to stress - Reduce stress when we talk about our problems
legally insane
law assumes that if you are legally insane you are not acting out of free will
Abstinence
less than one drink per month for more than one year
Social selection hypothesis
low social class is an outcome rather than a cause of schizophrenia
Inappropriate affect
marked by incongruity and lack of adaptability in emotional expression
Relapse rate
may be as high as 65-70% in the first year after hospital discharge if patients discontinue medication - continuing medication after recovery from an episode is encouraged - many patients stop taking medication
post tracking performance
may be associated with predisposition ○ Tracking ability is stable over time ○ Tracking ability is influenced by genetic factors ○ Tracking ability impairment is also found among people who exhibit features associated with schizotypal personality disorder
Depression - Behavioral symptoms
may range from constant pacing and fidgeting to extreme inactivity
nonsadisitic rapists
men who are preoccupied with sexual fantasies, but not violent ones
opportunistic rapists
men with an extensive history of impulsive behavior in many kinds of settings and who might be considered psychopaths * behavior governed largely by immediate environmental cues
law
more concerned with justice than truth solution: appoint neutral experts
Relapse rates
more likely for women
Controlled drinking
more than one drink per month for at least two years with no reported problems
Less common PD
narcissistic PD - <1%
duties of mental health professionals
negligence and confidentiality
incidence
number of new cases each year
Short-term effects of cannabis
o "Getting high" - refers to pervasive sense of well-being and happiness o Can cause temporal disintegration - a condition in which people have trouble retaining and organizing information, even over relatively short periods of time
Overlap between PDs and Other mental disorders
o 75% of people who qualify for a PD diagnosis also meet criteria for a syndrome (such as major depression, substance dependence or anxiety disorder) o The reverse is also true: many people who are treated for another type of mental disorder would also meet the criteria for a PD
Dependent Personality Disorder Characteristics
o Afraid of separating from other people on whom they are dependent for advice and reassurance o Unable to make everyday decisions on their own o Feel anxious and helpless when they are alone o Easily hurt by criticism, extremely sensitive to disapproval, lacking in self-confidence o Somewhat similar to avoidant PD, but the main difference is the point in a relationship at which they experience the most difficulty ♣ People with avoidant PD have trouble initiating a relationship ♣ People with dependent PD have trouble separating from other people with whom they already have a close relationship
Short-term effects of alcohol
o Blood alcohol levels are measured in the amount of alcohol per unit blood o A "drink" is 12 oz beer, 4 oz wine, 1 oz 86-proof whiskey o Strong correlation between blood alcohol levels and CNS intoxicating effects o According to DSM-5, symptoms of alcohol intoxication include slurred speech, lack of coordination, an unsteady gait, nystagmus (involuntary movement of eyes when person looks up or to side), impaired attention or memory, and stupor or coma
Short-term effects of cocaine and amphetamines
o Called stimulants because they activate the sympathetic nervous system o Used and abused because they induce a positive mood state ♣ Low doses make people feel confident, friendly, and energetic o Leads to sexual dysfunction o Tolerance develops quickly o Acute overdoses can cause irregular heartbeat, convulsions, coma, and death
DBT (diabetic behavior therapy)
o Combines the use of broadly based behavioral strategies with the more general principles of supportive psychotherapy o Emphasis placed on learning to be more comfortable with strong emotions, and learning to think in a more integrated way that accepts both good and bad features of the self and other people o Employs traditional behavioral and cognitive techniques to help patient improve interpersonal relationships, tolerate distress, and regulate emotional responses o Considerable emphasis is placed on the therapist's acceptance of patients ♣ Including their frequently demanding, manipulative and contradictory behaviors o Has been shown to decrease the rate of premature termination of treatment o Has been shown to reduce the frequency and severity of suicide attempts and hospitalizations o Has shown an increase in self-reported social adjustment scales o Has shown an improvement with regard to symptoms such as depression and hopelessness
People who meet the criteria for schizotypal PD frequently meet the criteria for additional disorders
o Considerable overlap between schizotypal PD and other PDs in Cluster A o Considerable overlap between schizotypal PD and avoidant PD o Quite a bit of overlap between schizotypal PD and BPD
Paranoid Personality Disorder Characteristics
o Constantly on guard o Expect that other people are trying to harm them o Take extraordinary precautions to avoid being exploited or injured o Pattern is stable and wide-ranging and interferes with the person's social and occupational adjustment o Completely inflexible in the way that they view the motives of other people, and they are unable to choose situations in which they can trust other people o Trouble maintaining relationships with friends and family members o Frequently overreact in response to minor or ambiguous events to which they attribute hidden meaning o Often behave aggressively or antagonistically ♣ Actions can easily create a self-fulfilling prophesy o Not a psychotic disorder; does not reach delusional proportions ♣ Not sufficiently severe to be considered obviously false and clearly preposterous • Subtle distinction that is difficult to make sometimes
Antisocial Personality Disorder Characteristics
o DSM-5 definition is based on features that, beginning in childhood, indicate a pervasive pattern of disregard for, and violation of, the rights of others o Difficulties in adulthood include persistent failure to perform responsibilities that are associated with occupational and family roles o Conflict with others, including physical fights, is common o Irritable and aggressive o Impulsive, reckless, and irresponsible o Not only serious criminals meet this criteria
Long-term consequences of nicotine
o Development of both tolerance and withdrawal o Physiological symptoms: drowsiness, lightheadedness, headache, muscle tremors, nausea o Those who attempt to quit usually experience sleeping problems, weight gain, concentration problems, and mood swings o Increased risk of developing fatal diseases such as heart disease, lung disease, and various types of cancer ♣ 80% of all deaths caused by lung cancer are attributed to smoking tobacco o Causes fertility problems in women o Babies born to smoking moms often weigh less and may have birth defects
Controversial
o Difficult to identify reliably o Show high levels of comorbidity among themselves and with other mental disorders o Definition has not been well-grounded in scientific knowledge regarding basic elements of personality
Social and occupational impairment
o Disrupt interpersonal relationships o Play an important role in many cases of marital discord and violence
Long-term effects of alcohol
o Disruption of relationships with family and friends o Heavy use of alcohol in pregnant women can damage the fetus o Many alcohol abusers experience blackouts o Heavy alcohol use interferes with job performance o Causes financial difficulties o Can encounter problems with the fuzz o Can cause people to have violent behavior o On a biological level, can disrupt a person's organ systems, especially liver, pancreas, gastrointestinal system, cardiovascular system, and endocrine system o Can cause cirrhosis of the liver, heart problems, various forms of cancer, and neurocognitive disorder o Misuse of alcohol leads to many severe injuries and premature deaths ♣ Deaths due to alcohol-related injuries are more common among young men, while deaths from alcohol-related diseases are more common among older men
Borderline Personality Disorder Characteristics
o Find it very difficult to be alone o Form intense, unstable relationships with other people o Are often seen by others as being manipulative o Mood may shift rapidly and inexplicably o Intense anger is common ♣ May be accompanied by temper tantrums, physical assault or suicidal threats or gestures o Identity disturbance -great difficulty maintaining an integrated image of themselves that simultaneously incorporates their positive and negative features ♣ Diagnostic hallmark of BPD o Frequently express uncertainty about such issues as personal values, sexual preferences, and career alternatives o Chronic feelings of emptiness and boredom o Case Study in Borderline PD: ♣ Most noticeable personality traits: anger, argumentativeness, scornfulness, irritability and vanity ♣ She was intense and demanding
Several things to note about legal definition of competence:
o First, competence refers to defendant's current mental state, whereas insanity refers to the defendant's state of mind at the time of the crime o Second, as with insanity, the legal definition of incompetence is not the same as the psychologist's definition of mental illness o Third, competence refers to the defendant's ability to understand criminal proceedings, not willingness to participate in them o Finally, the "reasonable degree" of understanding needed to establish competence is fairly low
Long-term consequences of Hallucinogens
o Hallucinogens, except PCP, are often used sporadically rather than continuously o No withdrawal symptoms o Sometimes experience flashbacks - brief visual aftereffects that occur at unpredictable intervals long after drug has been cleared from person's body
Narcissistic Personality Disorder Characteristics
o Have a greatly exaggerated sense of their own importance o Preoccupied with their own achievements and abilities o Cannot empathize with the feelings of other people o Often seen as being arrogant or haughty o May react with anger if criticized o Considerable overlap with BPD (both feel that other people should recognize their needs and do special favors for them) ♣ Unlike BPD, people with Narcissistic PD have an inflated sense of self-importance (whereas people with BPD have a deflated sense of self)
Alcoholics Anonymous (AA)
o Helps people who use and abuse alcohol become and remain sober o "First line of attack against alcohol" o The original 12-step program o In the first step, person must acknowledge that he or she is powerless over alcohol and unable to manage his or her drinking o process of working through 12 steps to recovery is facilitated by regular attendance of AA meetings o AA meetings are opportunities to talk with other people who have similar problems o Difficulty to evaluate the effectiveness of AA => long-term follow-up is difficult o Early dropout rates are relatively high: about half leave in less than three months o Survival rates are much higher for those who remain in AA
Long-term consequences of cocaine and amphetamines
o High doses can lead to onset of psychosis ♣ Symptoms are auditory and visual hallucinations, and delusions of persecution and grandeur o Disruption of occupational and social roles o Linked to increase in violent behavior o Do not usually cause severe withdrawal symptoms ♣ Most common withdrawal symptom is depression
Long-term consequences
o High doses cause chronic lethargy and loss of motivation and productivity o At low doses, people can remain healthy and productive despite their addiction o Tolerance develops quickly o Very expensive
BPD overlaps with several other PD categories and disorders
o Histrionic PD o Narcissistic PD o Paranoid PD o Dependent PD o Avoidant PD - impulse control problems - depressive disorders
Short-term effects of nicotine
o Increases heart rate and blood pressure o Stimulated release of norepinephrine, causing CNS arousal o Causes release of norepinephrine and dopamine in mesolimbic dopamine pathway (reward center of the brain) o Mimics the effects of antidepressant drugs o Makes people feel more relaxed ♣ Controls people's responses to stress ♣ This is paradoxical because nicotine leads to increased arousal of sympathetic nervous system
Short-term effects of Hallucinogens
o Induce vivid, sometimes spectacular, visual images o "Bad trips" - unpleasant experiences that can lead to panic attacks and the fear of losing one's mind o Not toxic but PCP is much more toxic
Short-term effects of opiates
o Induces state of dreamlike euphoria, sometimes accompanied by increased sensitivity in hearing and vision o Those who inject morphine or heroine experience a rush - a brief, intense feeling of pleasure that is sometimes described as being like an orgasm in the entire body o Effects do not last and are replaced by negative mood changes o Decrease in levels of sex hormones => reduced sex drive and fertility o Speedball - mixture of cocaine and opiates - enhances subjective feelings
Pattern of maladaptive behavior must be:
o Inflexible and pervasive across a broad range of personal and social situations o The source of clinically significant distress or impairment in social, occupational, or other important areas of functioning o Stable and of long duration, with an onset that can be traced back at least to adolescence or early adulthood
Short-term effects of Barbiturates and benzodiazepines
o Leads to intoxicated state ♣ Impaired judgement, slow speech, lack of coordination, low attention range, diminished sexual and aggressive impulses o Causes pleasant, warm, drowsy feeling o Sometimes causes increase in aggressive behavior - this is called a "rage reaction" or aggressive dyscontrol
Schizoid Personality Disorder Characteristics
o Loners o Prefer social isolation to interactions with friends or family o People see them as being cold and aloof o They do not experience strong subjective emotions such as sadness, anger or happiness (by their own report)
SPD and schizophrenia treatment overlap
o Low doses of antipsychotic medication are beneficial in alleviating cognitive problems and social anxiety in schizotypal PD patients o Patients with schizotypal PD may respond positively to antidepressant medications (including SSRIs) o Patients do not respond well to insight-oriented psychotherapy
Benefits to dimensional model
o Makes it easier to describe problems exhibited by people with a variety of maladaptive traits o Avoids the need to assign more than one type of PD diagnosis o People who exhibit a few symptoms that would be below the diagnostic threshold in the categorical system are easily described with one set of ratings o Trait descriptors actually help explain the overlap or comorbidity that has been observed for many of the PD types
Schizotypal Personality Disorder Characteristics
o Many peculiar behaviors take the form of perceptual and cognitive disturbance o May report bizarre fantasies and unusual perceptual experiences o Speech may be slightly difficult to follow because they use words in an odd way or because they express themselves in a vague or disjointed manner o Affective expressions may be constricted in range or may be silly and inappropriate o Not psychotic or out of touch with reality o Bizarre fantasies are not delusional o Unusual perceptual experiences are not sufficiently real or compelling to be considered hallucinations
substance use disorders and comorbidity
o Most prominent is antisocial personality disorder (ASPD), mood disorders, and anxiety disorders o Conduct disorder (childhood manifestation of ASPD) is strongly related to alcohol use in adolescence and subsequent development of alcohol dependence
Long-term consequences of cannabis
o People do not develop tolerance to THC ♣ Some say they actually become more sensitive to drug, rather than less sensitive - a phenomena called reverse tolerance o Withdrawal symptoms are unlikely ♣ Those who take high doses may experience withdrawal o Heavy doses can cause performance deficits on neurophysiological tests that require learning, decision making, and sustained attention o Some evidence of cognitive decline associated with long-term use
PDs and maladaptive parenting and family relationships
o People with documented evidence of childhood abuse and neglect were 4 times more likely to develop symptoms of personality disorders (strongest connections were with Cluster B disorders) o Physical abuse was most closely associated with subsequent antisocial personality disorder o Sexual abuse was most closely associated with BPD o Childhood neglect was most closely associated with antisocial, borderline, narcissistic and avoidant PDs
Concept of social dysfunction plays an important role in the definition of personality disorders
o Personality characteristics identified in DSM-5 criteria sets typically interfere with the person's ability to get along with other people and perform social roles o Lead to impaired social functioning or occupational impairment
Requirements for a diagnosis of ASPD
o Presence of symptoms of conduct disorder prior to age 15 o Presence of at least 3 out of the 7 signs of irresponsible and antisocial behavior after the age of 15
Psychotropic medication
o Psychiatrists employ the entire spectrum of medications o Different drugs are recommended to treat individual symptoms o There is no systematic proof that a specific drug is effective for any of the borderline features
Obsessive-Compulsive PD Characteristics
o Set ambitious standards for their own performance that frequently are so high as to be unattainable o Workaholics o So devoted to work that they ignore friends, family members and leisure activities o So preoccupied with details and rules that they lose sight of the main point of an activity of project o Intellectual endeavors are favored over feelings and emotional experience o Excessively conscientious, moralistic, judgmental o Tend to be intolerant of emotional behavior in other people o Marked need for control and lack of tolerance for uncertainty o Characteristics interfere with social and occupational adjustment o Find it difficult to delegate responsibilities to others o Extreme difficulty in finishing projects within established deadlines
Avoidant Personality Disorder Characteristics
o Tend to be socially isolated when outside their own family circle because they are afraid of criticism o Want to be liked by others (unlike schizoid PD) o Extremely shy o Easily hurt by even minimal signs of disapproval from others o Avoid social and occupational activities that require significant contact with other people o Often indistinguishable from social anxiety disorder ♣ Some experts argue that they are two different ways of defining the same disorder ♣ Others argue that people with avoidant PD have more trouble relating to others than those with social anxiety disorder ♣ People with avoidant PD are presumably more withdrawn and have very few close relationships because they are so shy, whereas people with social anxiety disorder may have lots of friends but are afraid of particular situations, such as public speaking • Much more difficult to make this distinction if an individual's social anxiety becomes more generalized
Limitations to the categorical approach
o There are a lot of people with serious personality problems who do not fit the traditional diagnostic types o It forces clinicians to employ an arbitrary threshold to distinguish between normal and abnormal personality types o There is considerable overlap among categories and many patients meet the criteria for more than one type ♣ Many clinicians are reluctant to diagnose more than one PD ♣ Much information is frequently left out o General criteria for PDs can be vague and unreliable
Long-term consequences of Barbiturates and benzodiazepines
o Those who abruptly stop taking high doses can experience discontinuance syndrome - this is a return and sometimes a worsening of anxiety symptoms o Causes drug withdrawal ♣ Less likely to occur if medication is discontinued gradually
Histrionic Personality Disorder Characteristics
o Thrive on being the center of attention o Self-centered, vain, and demanding o Constantly seeking approval from others o Behavior is often inappropriately sexually seductive or provocative o Frequently react to situations with inappropriate exaggeration o Overlaps extensively with other PDs, especially BPD (both intensely emotional and manipulative) ♣ Unlike BPD, people with Histrionic PD have an essentially intact sense of their own identity and a better capacity for stable relationships with other people
Moffitt's theory of antisocial behavior
o Two primary forms of antisocial behavior: ♣ Transient ♣ Nontransient o Adolescence-limited antisocial behavior is a common form of social behavior that is adaptive and that disappears by the time the person reaches adulthood o Life-course-persistent antisocial behavior -found in a small proportion of antisocial individuals (mostly males) engage in antisocial behavior at all ages
Social judgment problems
oSome people with PDs experience persistent problems with social distance oDeficits in the ability to empathize with others (to understand the emotions of other people) present one of the core features of PDs
social workers all have professional responsibilities
obligations to meet the ethical standards of their profession and to uphold the laws of the states in which they practice
negligence
occurs when a professional fails to perform in a manner that is consistent with the level of skill exercised by other professionals in the field A new area of professional negligence is failure to inform clients about effective treatment alternatives
most sexual activity
occurs within relationships
laws prohibit confinement
of someone simply on the suspicion that he or she will commit a crime, with a single exception: civil commitment, the involuntary
Tarasoff v. Regents
of the University of California made it that therapists also have a duty to warn the potential victim of someone's violent intentions - Tarasoff was killed by Poddar
A pervasively anxious mood
often associated with pessimistic thoughts and feelings
psychoactive substances
often taken in excess, chemicals that alter the person's mood, level of perception, or brain functioning
To qualify for a DSM-5 diagnosis of a personality disorder
one must fit the general definition for a personality disorder, and must also meet the specific criteria for a particular type of personality disorder
Pathological gambling
out of control, takes over person's life, and had horrendous financial and interpersonal consequences - central features = centered around impaired control of gambling activities, social impairment that follows gambling, and continued problem behavior in spite of accumulation of harmful consequences
Advance psychiatric directives
patients can use these legal instruments to declare their treatment preferences, or appoint a surrogate to make decisions for them, should they become psychotic or otherwise are unable to make sound decisions - used commonly among the aged
Disorganized type of schizophrenia
patients say things that are difficult to understand, behave in a disorganized way, and fail to express expected emotions
Delusional disorder
people do not meet the full symptomatic criteria for schizophrenia, but they are preoccupied for at least one month with delusions that are not bizarre ○ Their delusions are beliefs about situations that could occur in real life ○ The presence of hallucinations, disorganized speech, catatonic behavior, or negative symptoms rules out a diagnosis of delusional disorder ○ The person's behavior is not bizarre and social and occupational functioning are not impaired except for those areas that are directly affected by the delusional belief
Depressogenic attributional style
people tend to explain negative events in terms of internal, stable, global factors - failing an exam —> the result of one's own inadequacies (internal), which she has recognized for a long time and which will persist into the future (stable), and which also are responsible for her failure in many other important tasks, both academic and otherwise (global)
Ego-dystonic
people with these disorders are distressed by their symptoms and uncomfortable with their situations (eg. anxiety disorders and mood disorders)
Ego-syntonic
people with these disorders believe the ideas or impulses with which they are associated are acceptable to them (eg. personality disorders)
dyspareunia
persistant genital pain during or after sexual intercourse * both in men and women * much more common in women * can lead to a lack of interest in sex
Panic disorder
person must experience recurrent, unexpected panic attacks - At least one of those attacks must be followed by a period of one month or more in which the person has either persistent concern about having additional attacks, or a significant maladaptive change in behavior related to the attacks
transvestite
person who dresses in the clothing of the opposite gender
The Cognitive Perspective
pervasive and persistent negative thoughts about the self and pessimistic views of the environment play a central role in the onset and subsequent maintenance of depression after these thoughts are activated by the experience of a negative life event
Base rates
population frequencies - must be taken into account when predicting an infrequent event
Prodromal phase
precedes the active phase and is marked by an obvious deterioration in role functioning as a student, employee, or homemaker ■ Change in personality ■ Signs and symptoms are similar to those associated with schizotypal personality disorder ● Peculiar behaviors, unusual perceptual experiences, outbursts of anger, increased tension and restlessness ● Social withdrawal and lack of willpower are often seen
Expressed emotion (EE)
relatives expressing negative or intrusive attitudes toward the patient including: ○ Being overprotective ○ Too closely identifying with the patient ○ Extreme anxiety about the patient ○ Showing exaggerated forms of self-sacrifice ○ Criticising patients - more common in western cultures
cannabinoids
produce euphoria and an altered sense of time ex. marijuana
Psychomotor stimulants
produce their effects by simulating the actions of certain neurotransmitters, specifically epinephrine, norepinephrine, dopamine, and serotonin
inpatient programs
programs, especially those that follow behavioral principles, can have important positive effects for chronic schizophrenic patients - some people need long-erm institutional treatmenttt
Community Mental Health Centers (CMHC) Act
provided for the creation of community care facilities for the seriously mentally ill as alternatives to institutional care
Schizophreniform disorder
psychotic symptoms for at least one month but less than six months ○ Changed to schizophrenic disorder if the person's problems persist beyond the six-month limit
Parens patriae
rationales for commitment have been overused and abused
placebo control group
receives only a placebo treatment - must be included in research
Interoceptive awareness
recognition of internal cues, including hunger and various emotional states
Antipsychotic drugs
reduce the severity of psychotic symptoms ○ Within a week of taking this medication, patients may see beneficial effects on problems such as agitation and hostility ○ Improvement with regard to psychotic symptoms usually takes two to three weeks 25% of patients do not improve on antipsychotic drugs Another 30-40% might be considered partial responders
Sole custody
refers to a situation in which only one parent retains physical or legal custody of the children
Catatonic behavior
refers to an obvious reduction in reactivity to external stimuli; most often referring to immobility and marked muscular rigidity, but can also refer to excitement and overreactivity
Marijuana
refers to dried leaves and flowers, which can be smoked in cigarette or pipe
Hashish
refers to dried resin from the top of the female cannabis plant
Alogia
refers to impoverished thinking ○ Forms of alogia: ■ Poverty of speech -patients show remarkable reductions in the amount of speech ■ Thought blocking -patient's train of speech is interrupted before a thought has been completed
Social drinking
refers to problem-free drinking for 10 years or more
malpractice
refers to situations in which professional negligence results in harm to clients or patients
Compulsions
repetitive behaviors or mental acts that are used to reduce anxiety - These actions are typically considered by the person who does them to be irrational - Person attempts to resist performing actions but cannot - unwelcome, nonsensical thoughts - People with OCD are unable to dismiss these thoughts or urges - Can interpret these thoughts or urges as meaning they are a terrible person (they might actually want to harm someone)
Obsessions
repetitive, unwanted, intrusive cognitive events that may take the form of thoughts or images or urges - Lead to increase in anxiety
Community notification laws
requires the distribution of information to the public regarding the presence of child molesters and sexually violence offenders when they are released from pailin or placed on parole
The burden of proof
rests on the prosecution, and the standard of proof is very high - beyond a reasonable doubt
Adonis Complex
reverse anorexia * characterized by excessive emphasis on extreme muscularity and often accompanied by excessive emphasis on extreme muscularity and often accompanied by the abuse of anabolic steroids
Important rights to consider for mental patients
right to treatment, right to treatment in the least restrictive environment, and the right to refuse treatment
polygenic characteristic
schizophrenia is the product of a reasonably large number of genes rather than a single gene
Atypical antipsychotics
second generation antipsychotic drug - produce a broader range of neurochemical actions in the brain than do the traditional drugs, which act primarily on dopamine receptors
gender dysphoria
sense of discomfort with one's anatomical sex
Hallucinations
sensory experiences that are not caused by actual external stimuli ○ Can occur in any of the senses ○ Most often auditory ■ Many patients hear voices that comment on their behavior or give them instructions ■ Some patients find the voices frightening ■ Other patients find the voices comforting or pleasing
Perfectionists
set unrealistically high standards, are self-critical, and demand a nearly flawless performance from themselves
Psychomotor retardation
several features of behavior that may accompany the onset of serious depression
"shopping for experts"
shows how legal system and science differ in defining "truth" - layers manipulate the system by finding lawyers that interpret evidence in a way that helps their case
sadist
someone who derives pleasure by inflicting physical or mental pain on other people
Vulnerability to schizophrenia
sometimes expressed as schizophrenia-like personality traits and other types of psychoses
expert witnesses
specialists allowed to testify about matters of opinion (not just fact) that lie within their area of expertise
Social Factors affecting depression
stressful life events —> development of depression - Troublesome problem: the direction of the relationship between life events and mood disorders - being fired —> depression - depression —> being fired *Major losses* of important people or roles seems to play a crucial role in precipitating major depression *Severe events* - those that are particularly threatening and have long-term consequences for the woman's adjustment— increase the probability that a woman will become depressed
Base rates, population frequencies
strongly contribute to errors
High-risk research design
subjects selected from general population based on well-documted risk factor - follow participants over time - identity factors that increase or decrease vulnerability to a disorder
Aspects of sexual satisfaction
tenderness, intimacy, affection - are also very important
The idea behind the insanity defense
that mental disability should limit criminal responsibility
What increases stress?
the *perception of control* increases stress when people believe they could have exercised control but failed to do so, or when lose control over something that used to be in their control (failed attempts to control intensify stress)
resilience
the ability to cope successfully with the challenges of life, including very stressful ones - is attributed partly to the individual and partly to social support and environment - some grow and get stronger as a result of stress
Working memory
the ability to maintain and manipulate information for a short period of time - researched to search for signs of vulnerability
Conduct disorder
the best predictor of antisocial PD in childhood
free will
the capacity to make choices and freely act on them
Lateral ventricles
the cavities on each side of the brain that are filled with cerebrospinal fluid
Confidentiality
the ethical obligation not to reveal private communications - is the basic psychotherapy (standard for all major mental health professionals) - must also be broken when clients are dangerous to themselves or others, so that civil commitment can proceed
construct validity
the extent to which these specific measures procedure results that are consistent with the theoretical contstruct
Mania
the flip side of depression, also involved a disturbance in mood that is accompanied by additional symptoms: - accompanied by inflated self-esteem, decreased need for sleep, distractibility, pressure to keep talking, and the subjective feeling of thoughts racing through the person's head faster than they can be spoken
Deterrence
the idea that people will avoid committing crimes because they fear being punished for them, is a major public policy goal of criminal law
moral treatment
the laudable but failed movement to alleviate mental illness by offering respite and humane care
Child neglect
the most commonly reported form of child abuse, places children at risk for serious physical or psychological harm by failing to provide basic and expected care
malfunction of interpersonal relationships
the most important and seriously debilitating aspects of schizophrenia ○ Many people with schizophrenia become socially withdrawn ○ Social isolation develops before the onset of symptoms in many cases ○ Social withdrawal appears to be both a symptom of the disorder and a strategy employed by some patients to deal with their symptoms
Affect
the pattern of observable behaviors, such as facial expression , that are associated with these subjective feelings - other examples: pitch of voice or hand and bandy movements
refractory period
the period of time in which men are unresponsive to sexual stimulation after reaching orgasm
Bipolar disorder is considered *rapid cycling* if
the person experiences at least 4 episodes of major depression, mania, or hypomania within a 12 month period - patients are likely to show a problematic course with treatment
DSM-5 defines OCD in terms of
the presence of either obsessions or compulsions - Most who meet these criteria experience both symptoms - Person must attempt to ignore, suppress, or neutralize these unwanted thoughts or impulses, and they must be time-consuming (take more than one hour per day) or cause significant subjective distress or social impairment - Thoughts cannot be worries about real problems (i.e. paying bills) - DSM-5 provides specification regarding person's level of insight regarding beliefs associated with OCD symptoms (1) Good or fair insight (thinks beliefs are probably or definitely not true) (2) Poor insight (thinks OCD beliefs are probably true) (3) Absent insight/ delusional beliefs (convinced beliefs are true)
the termination of parental rights
the removal of any right a parent has to care for and supervise his or her child
Comorbidity
the simultaneous manifestation of a mood disorder and other syndromes - The greatest overlap is with anxiety disorders - Alcohol and depression are closely related - Many people who are depressed, drink heavily - Many people who are dependent on alcohol - 40% - experience major depression at some point - The order of onset varies per person
Homeostasis
the tendency to return to a steady state of normal functioning (Cannon 1935) - prolonged arousal of the SNS damages the body, because it doesn't return to its normal state - analogy: a car that has run out of gas and is damaged because stress keeps turning the key, trying to restart the engine repeatedly - the stress response may use so much energy that the body cannot do routine upkeep like storing energy or repairing injury
Splitting
the tendency to see people and events alternately as entirely good or entirely bad o Common feature of people with BPD
determinism
the view that human behavior is determined (or at least constrained) by biological, psychological, or social forces
Cognitive Vulnerability
the way in which people perceive, think about, and remember events in their world can have an important influence on the way that they feel - 2 people may react very differently to the same event - because of the way they interpret in
Depressive disorders
those in which a person experiences only episodes of depression
Bipolar disorders
those in which the person experiences episodes or mania as well as depression - used to be referred to as manic depressive disorder
Treatment
typically accomplished in a sequence of stages, beginning with a brief period of detoxification - the removal of a drug on which a person has become dependent - for three to six weeks
Onset of schizophrenia
typically during adolescence or early adulthood ○ Risk period for development of a first episode is considered to be between the ages of 15 and 35 ○ Number of new cases drops off slowly after age 35 ○ Very few people experiencing an initial episode after the age of 55
Catatonic patients
typically resist attempts to alter their position, even though maintaining their awkward postures would normally be uncomfortable or painful
Tranquilizers
used to decrease anxiety or agitation
Psychoanalytic psychotherapy
used to gain insight on unconscious motives that cause patient's symptoms (still used, but not shown to be effective)
Hypnotics
used to help people sleep
Cognitive therapy
used to treat anxiety disorders - Therapists help clients identify cognitions that are relevant to their problem; recognize the relation between these thoughts and maladaptive emotional responses
base rate of predicting violence
using the clinical method (i.e. 6 percent) was close to the actual base rate (i.e. 3 percent). However, the base rate of predicting violence using the coin flip (50 percent) was much higher
Psychological treatments
usually concentrated on long-term strategies rather than the resolution of acute psychotic episodes
vindictive rapists
violence directed exclusively toward women
emergency commitment
when an acutely disturbed individual is temporarily confined, typically for no more than a few days
foster care
where they live temporarily with another family - maltreated children - children in physical danger - 1/2 remain in foster care for at least 2 or 3 years
Mitigation evaluations
which include an assessment for mental disorders, are required in all death penalty cases
False positives
wrongly hospitalizing someone who is not dangerous to others of suicidal - unfairly restrict civil rights - Clinical prediction of suicide risk
Casual drinking
• About two out of every three males in western countries drink alcohol regularly, at least on a social basis; less than 25% abstain from drinking completely • 20% of all men and women who use alcohol will develop serious problems as a result of prolonged consumption • 60% of women in the U.S. drink at least occasionally • In comparison to men, fewer women develop alcoholism
Understanding Addiction
• Biological factors obviously play an important role in the causes of addiction • Addicting properties of certain drugs are crucial to why people become addicted • We must understand how addicting drugs effect the brain in order to understand the process of dependence • Need to understand social and cultural factors that influence how and under what circumstances an individual first acquires and uses drugs
Twin studies
• Concordance rates are higher among MZ than DZ twins for alcoholism • Differences between MZ and DZ concordance rates were significant for both genders • The fact that concordance rates were higher for men than for women reflects much higher prevalence rate of alcoholism among men • Heritability estimates were the same for both men and women
Gender disparities (alcohol)
• For all age groups, men more likely to be diagnosed with alcohol-related disorder • Persistent gender differences can be attributed to social and biological variables o Example is negative view of intoxicated women o Biologically, women will have higher peak in blood alcohol level compared to men - more sensitive ♣ Men have higher average content pf body water o Women who drink heavily for many years are more vulnerable to liver disorders
Genes and alcohol
• Genes are involved in the metabolism of alcohol • Genes are involved in personality traits
Genetic factors
• Genetic factors become increasingly important in shaping patterns of use • A genetic predisposition to alcohol dependence probably causes the person to react to alcohol in an abnormal fashion • Biological mechanisms responsible for abnormal reactions to alcohol seem to involve several interrelated neurotransmitter systems
lifetime prevalence (alchohol)
• NESARC study showed lifetime prevalence rate of about 30% for some type of alcohol use disorder • Alcohol-related disorders are among the most common form of mental disorders in the U.S.
Psychoactive drugs
• People may be dependent on psychoactive drugs because they stimulate areas of the brain that are known as "reward pathways" • Electrical stimulation of the medial forebrain bundle can serve as a powerful source of positive reinforcement for animals as they perform an operant learning task • Natural rewards, such as food and sex, increase dopamine levels in certain crucial sections of this pathway, which is also known as the mesolimbic dopamine pathway
Depression
• Prolonged heavy drinking or use of psychoactive drugs can result in feelings of depression and anxiety • Person feels guilt about inability to control problem • Often leads to conflict with family members • Sometimes depression and anxiety precede the onset of substance use disorders => self-medicate in order to control problem
Age disparities
• Tolerance is reduced along the elderly but withdrawal may be more severe and prolonged • Elderly are less likely to suffer occupational impairment because not often employed • Elderly are less likely to experience social impairment because often live apart from families
Drug etiology
• Twin studies also suggest that alcohol dependence and other forms of drug dependence share a common etiology
Benefits of Atypical antipsychotics
■ Less likely than the classical antipsychotics to produce unpleasant motor side effects ■ At least as effective as traditional drugs for the treatment of positive symptoms of schizophrenia ■ They are useful in maintenance treatment to reduce the risk of relapse ■ Less likely to produce tardive dyskinesia
Limitations of atypical antipsychotics:
■ Not significantly more effective for treating negative symptoms (contrary to initial claims) ■ Produce additional side effects, some of which are serious ● Many lead to weight gain and obesity, which increase a person's risk for additional medical problems (eg diabetes, hypertension, coronary artery disease) ■ These adverse reactions lead many patients to discontinue medication, thus increasing their risk of relapse
○ Identifying characteristics of delusions:
■ Preoccupation ■ Delusional patients are unable to consider the perspective that other people hold with regard to their beliefs ○ Delusional beliefs are typically personal ○ Delusional beliefs are not shared by other members of the person's family or cultural group ○ Many delusions focus on grandiose or paranoid content ○ Delusions are not always coherent belief systems that are consistently expressed by the patient ■ Delusions are often fragmented, especially among severely disturbed patients
impairments to eye-movements
○ In schizophrenic patients, tracking records show frequent interruptions of smooth-pursuit movements by numerous rapid movements ○ 50% of first-degree relatives of schizophrenic persons show similar smooth-pursuit impairments
Medication from the patient's perspective
○ Medication allows them to be less bothered or preoccupied by troublesome thoughts and perceptual experiences ○ Medication seldom eliminates hallucinations and delusional beliefs completely
hypotheses for gender disparities
○ Schizophrenia is a single disorder and its expression varies in men and women ■ Genetic vulnerability to schizophrenia may be expressed differently in men and women ■ Could be accounted for by biological differences (hormones) or different environmental demands ○ There are two quantitatively different subtypes of schizophrenia, one with an early onset that affects men more often than women, and another with a later onset that affects women more often than men
Limitations to a neurochemical model focused narrowly on dopamine
○ Some patients do not respond positively to drugs that block dopamine receptors ○ The effects of antipsychotic drugs require several days to become effective, but dopamine blockage beings immediately ○ Research studies that examined the by-products of dopamine in cerebrospinal fluid were inconclusive at best
alcohol use disorder
♣ Person must have 2 of the 11 criteria in a 12-month span to be diagnosed ♣ Mild (2-3) symptoms; moderate (4-5 symptoms); severe (6+ symptoms)
