PSY 600 Final Exam Study

What are 4 main categories of symptoms in the DSM diagnosis of conduct disorder?

1)Aggression to people and animals 2) Destruction of property 3)Deceitfulness or theft 4)Serious Violations of rules -Specifies: with limited prosocial emotions (lack of remorse/guilt, callous-lack of empathy, unconcerned about performance, shallow or deficient affect)

What are the four main symptom categories of PTSD in the DSM?

1)Intrusion symptoms 2)Avoidance symptoms 3)Negative cognitions/mood alteration symptoms 4)Arousal/reactivity symptoms

1)Are attacks in panic disorder expected or unexpected? 2)Is one attack sufficient? 3)In addition to panic attacks, what else has to occur for 1 or more months?

1)Panic attacks are unexpected 2)Individual must have experienced recurrent, unexpected attacks to qualify for diagnosis 3)Persistent concern or worry about additional panic attack or their consequences or a significant maladaptive change in behavior related to attacks (e.g. avoiding situations altogether)

DSM definition of obsessions

1)Recurrent and persistent thoughts, urges, or images that are experienced at some point during the disturbance as intrusive and unwanted and that in most individuals cause marked stress and anxiety and 2)the individual attempts to ignore or suppress such thoughts, urges, or images or to neutralize them with some other thought or action (e.g. compulsion)

interoceptive exposure therapy

Having the client induce panic-like symptoms purposefully (e.g. rapid exercise, spinning in chair, rapid breathing) in order to sit with the symptoms and realize that while uncomfortable, they are not dangerous.

Does DSM diagnosis of hoarding disorder apply if hoarding is the result of a medical condition?

Hoarding disorder is NOT diagnosed If symptoms are judged to be direct cause of another medical condition such as a brain injury

How can therapists help by providing psychoeducation during about panic symptoms?

--People who understand the physiology of the panic attack are more likely to be less terrified when another one occurs. -Helps people understand that while symptoms are uncomfortable, they are not dangerous.

What is a concern about using medication prior to interoceptive exposure in the treatment of phobias or other anxiety disorders?

-Medication may enforce that the fear is real.

What is the primary goal of motivational enhancement therapy

-Motivation enhancement therapy has been found to reduce anger and hostility, reduce resistance to therapist, enhance readiness for behavioral change, and produce abstinence rates twice that of controls -Motivational enhancement therapy combines feedback based on client-provided assessment data with motivational interviewing and reflective listening to help clients mobilize their own internal motivations to change

Is it important to involve parents when treating children with Separation anxiety disorder?

-Parental involvement in treatment of children with mental disorders usually increases efficacy but clinicians need to make a determination based on the family dynamics that may be causing or contributing to the separation anxiety. -Interventions that involve parents tend to reduce child anxiety

What is the prognosis for the treatment of specific phobia?

-Prognosis for the specific phobia is the best for any of the anxiety disorders with 70-85% of people experiencing significant improvement.

What are 3 DSM criteria for bulimia nervosa?

-Recurrent episodes of binge eating (eating more in a discrete period of time than the average person would and lack of sense of control over eating during the episode), recurrent inappropriate compensatory behaviors in order to prevent weight gain, self-evaluation is unduly influenced by body weight/image -Binge eating and compensatory bxs- on average at least once a week for 3 months

How many symptoms are required for SUD, over what period of time?

# of symptoms needed: -Mild- 2-3 symptoms -Moderate- 4-5 symptoms -Severe- 6+ symptoms Duration of symptoms: -In early remission -In sustained remission -On maintenance therapy -in a controlled environment

Examples of deceitfulness or theft in conduct disorder?

(has broken into someone's house, building, or car; often lies to obtain goods or favors or to avoid obligations; has stolen items of nontrivial value without confronting the victim)

Examples of property destruction in conduct disorder?

(has deliberately engaged in fie setting with intention to cause serious damage, has deliberately destroyed another's' property)

Examples of aggression to people and animals for conduct disorder?

(often bullies, threatens, intimidates others; often initiates physical fights, has used a weapon that can cause serious injury to others, has been physically cruel to people, has been physically cruel to animals, has stolen while confronting a victim, has forced someone into sexual activity)

Examples of serious violations of rules in conduct disorder?

(often stays out at night despite parental prohibitions, beginning before age 13; has run away from home overnight at least twice while living in parental home or at least once without returning for a lengthy period, often truant from school beginning before age 13)

External Exposure

Gradually Exposing an individual to feared stimulus in a controlled setting in order to help break the pattern of fear/anxiety/avoidance.

What are some distinct research-supported treatments for bulimia, anorexia, and BED?

-BED: CBT (guided self-help has shown to be more effective than self-help alone in treatment of BED) and IPT have proven to be the most effective long-term showing remission rates over 80% (DBT also shows promise) -AN: CBT and Family-based treatment for AN, IPT and DBT as well (family therapy for adolescents and olanzapine as an adjunctive therapy for adults seem to be the most effective) -BN: CBT, DBT (combination of CBT and fluoxetine seems to be current most effective treatment intervention)

Frequency and timeframe for BED? How is severity determined?

-Binge eating occurs at least once a week for 3 months -Severity is based on the frequency of binge-eating episodes (mild: 1-3 episodes per week, moderate: 4-7 episodes per week, extreme: 8-13 episodes per week, extreme: 14+ episodes per week)

How is "client-provided assessment data" used?

-Client-provided assessment data can provide info on frequency, dependence, and negative consequences to assist with developing coping skills as well as provide additional talking points, reinforce progress, and boost motivation to succeed

What is the treatment of choice for panic disorder?

-Cognitive behavioral therapy- reduction of catastrophic cognitions results in reduction of symptoms in majority of cases -Medication and mindfulness-based stress reduction serve as adjunts

Besides prolonged exposure therapy, what are two other evidence-supported interventions for PTSD?

-Cognitive processing (exposure is combined with anxiety management training and cognitive restructuring to help clients alter disrupted cognitions) -Anxiety management therapy (combines activation of traumatic memories with skills known to reduce anxiety to modify memories associated with fear) -Eye movement desensitization and processing (EMDR recommended first-line treatment for PTSD- no more effective than other therapies and still unclear how it works) -Group and Family therapy (group therapists should screen for potential group members readiness to engage in group treatment) -Medication (SSRI's beta-blockers, antipsychotic meds, and anticonvulsants -caution should be exercised with prescribing benzos for the risk of addiction and lack of efficacy studies)

What are the two DSM categories of impairment for autism spectrum disorder?

-Criteria A: Social impairment (persistent deficits in social communication and social interaction across many situations such as emotional deficit in emotional reciprocity, deficits in nonverbal communicative behaviors, and deficits in developing, understanding, and maintaining relationships) -Criteria B: Restrictive, repetitive patterns of behavior (stereotyped or repetitive motor movements , use of objects or speech ; insistence on sameness, inflexible adherence to routines, and ritualized patterns of verbal or nonverbal behavior; highly restricted, fixated interests that are abnormal in focus/intensity; hyper or hyporeactivity to sensory input o unusual interest in sensory aspects of the environment)

PIC-SIR for Substance Use Disorder

-DSM symptoms for a substance abuse disorder can fit into 4 main groups: impaired control, social impairment, risky use, and pharmacological criteria

What are 4 components of a combination intervention for the treatment of substance use disorders?

-Detox, individual therapy, family or group therapy, and relapse prevention

Under prognosis, what is the most important factor for a positive outcome for ASD?

-Early intervention appears to be the most important factor related to a positive outcome -Important to note that even with early intervention, there is no cure for ASD. Treatment for children and their families requires a life-span developmental approach

What Is one way a therapist could help enhance motivation for a person with hoarding disorder?

-Helping a client visualize how they can usr their space and what their bedroom will like after the clutter is removed can be a useful strategy in motivating change -Helping individuals to internalize the necessity of reducing clutter is in the client's best interest

A diagnosis of intellectual disability (ID) requires deficits in intellectual functioning and what else?

-ID requires deficits in intellectual functioning and adaptive functioning and onset occurs during the developmental period

In prolonged exposure therapy, to what is the person exposed

-In prolonged exposure therapy the individual is exposed to the trauma-memory in order to activate fear memory while providing new information that is incompatible with the fear so that new learning results

Do those with hoarding disorder usually seek treatment voluntarily?

-Individuals usually seek treatment for symptoms of depression, anxiety, or OCD so the therapist bust be tact in teasing out the hoarding symptoms -More likely to be prodded by family to seek help but few seek treatment on their own accord.

What is involved in a specific phobia? Duration?

-Involves the marked fear or anxiety of a specific situation or object that almost always evokes fear, is actively avoided or endured with intense fear, and fear is out of proportion to actual threat. -Duration: Typically lasting for 6 mo or logner

How common is binge eating disorder relative to other eating disorders? Treatable?

-It may be the most frequently occurring eating disorder affecting 7 million adults and 1.6% of 13-18 y.o. adolescents in the community -Highly treatable and remission rates are higher than those of anorexia nervosa and bulimia nervosa.

What are the 2 specifiers of anorexia nervosa?

-Restricting type: weight loss is accomplished through primarily dieting, fasting, excessive exercise -Binge eating/purging type: recurrent episodes of binge eating and/or purging behavior

What are essential diagnostic features of anorexia nervosa?

-Restriction of energy intake leading to low body weight that is very unhealthy -Intense fear of gaining weight or of becoming fat -disturbance in the way one's body weight or shape is experienced, persistent lack of recognition of seriousness of one's weight

What is the possible gain of self-induced vomiting?

-Self-induced vomiting seems to increase feelings of self-control and reduce anxiety which often make it hard to extinguish this behavior

How is severity determined in bulimia nervosa?

-Severity is based on the frequency of inappropriate compensatory behaviors (mild: 1-3 episodes per week, moderate: 4-7 episodes per week, extreme: 8-13 episodes per week, extreme: 14+ episodes per week)

How is the severity level determined of someone with ID determined?

-Severity level is ranked through mild, moderate, severe, and profound and is measured based on the adaptive functioning domains of conceptual (competence in memory, language, reading, writing, math acquisition, knowledge, problem solving, and judgement in novel situations amongst others), social (awareness of others' thoughts, feelings, and experiences, empathy, interpersonal communication skills, friendship abilities, and social judgement among others), and practical (learning and self-management across life settings including personal care, job settings, money management, recreation, self-management of behavior, and school/work task organization amongst others).

Besides typical symptoms of being "under the influence" (slurred speech, incoordination), what else is needed for the DSM diagnosis of alcohol intoxication?

-Slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, stupor or coma

What are 2 helpful components to include in interventions for autism spectrum disorders?

-The combination of early intervention and intensive, behaviorally based treatment is key to developing positive outcomes in children with ASD. -For adolescents, social skills training, peer modeling/peer buddies at school, parental involvement in educating teachers on what child needs

Can substances, medications, or medical conditions contribute to anxiety symtpoms?

-Yes, if anxiety symptoms are not better explained by an anxiety disorder and if symptoms are direct cause of substance/medications then Substance/medication induced anxiety disorder should be diagnosed.

What are avoidance symptoms of pTSD?

-avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with traumatic events -avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations)that arouse distressing memories, thoughts, feelings about the traumatic event

For the person with bulimia, what are common triggers for binges (usually negative emotional states)?

-common triggers (in descending order):tension and anxiety, food cravings, unhappiness, inability to control appetite, hunger, and insomnia -Eating disorders are often thought to be a coping mechanism for the regulation of intense emotions

What are 2 similarities of the criteria for gambling disorder and the substance use disorders?

-has repeated unsuccessful attempts to cut down or stop behavior -is often preoccupied with behavior -significant impairment in social or occupational functioning

What are Negative cognitions/mood alteration symptoms in PTSD?

-inability to remember an important aspect of the traumatic event -persistent and exaggerated negative beliefs or expectations about oneself, others,or the world -persistent, distorted cognitions about the cause or consequences of the traumatic events -persistent negative emotional state -markedly diminished interest or participation in significant activities -feelings of detachment or estrangement from others -persistent inability to experience positive emotions

What are arousal/reactivity symptoms in PTSD?

-irritable behavior and angry outbursts typically expressed as verbal or physical aggression towards people or objects -reckless or self-destructive behavior -hyper-vigilance -exaggerated startle response -problems with concentration -sleep disturbances

For ADHD, what are examples of inattentive symptoms?

-often fails to close attention to details or makes careless mistakes in schoolwork, work, or other activities -often has difficulty sustaining attention in tasks or play activity -often does not seem to listen when spoken to directly -often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace -often has difficulty organizing tasks and activities -often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort -often loses things necessary for tasks or activities -is often easily distracted by extraneous stimuli -is often forgetful in daily activities

What are hyperactivity-impulsivity symptoms

-often fidgets with or taps hands/feet/squirms -often leaves seat in situations when remaining seated is expected -often runs about or climbs in situations where it is inappropriate -often unable to engage in play or leisure activities quietly -is often "on the go" as if "driven by a motor" -often talks excessively -often blurts out an answer before a question has been completed -often has difficulty waiting his turn -often interrupts or intrudes on others

What are intrusion symptoms?

-recurrent, involuntary, and intrusive distressing memories of the traumatic events -recurrent, distressing dreams in which the content and/or affect of the dream are related to the traumatic events -dissociative reactions in which individual feels or acts as if traumatic events were recurring -intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic events -marked physiological reactions to cues of traumatic event

What are 3 typical symptoms (from DSM) of oppositional defiant disorder?

1)angry/irritable mood (often loses temper, is touchy or easily annoyed, often angry or resentful) 2)argumentative/defiant behavior (often argues with authority figures, or for children, with adults; often actively defies or refuses to comply with requests from authority figures or with rules, often deliberately annoys others, often blames others for his or her mistakes/misbehaviors) 3)vindictiveness (has been spiteful or vindictive at least twice w/I past 6 months)

What are 4 components in the treatment for ADHD?

1)classroom interventions and teaching strategies, 2)parent management training (can help reduce parent-child conflict, implement successful parental strategies to use at home, and overall reduce escalation along developmental pathway to conduct disorder) 3)medication (stimulant medication in order to reduce symptoms of inattention to level playing field in school settings), and 4)behavioral interventions

What are the 12 symptoms of a panic attack?

1)palpitations 2)pounding heart/accelerated heart rate 3)sweating 4)trembling or shaking 5)sensations of shortness of breath or smothering 6)feelings of choking 7)chest pain or discomfort 8)nausea or abdominal distress, unsteady, light-headed, faint 9)feeling dizzy 10)chills or heat sensations 11)paresthesias (numbness or tingling sensations) 12)derealization (feelings of unreality) or depersonalization (being detached from oneself) 13)fear of losing control/going crazy/fear of dying

DSM definition of compulsions

1)repetitive behaviors that the individual feels driven to perform n respone to an obsession or according to rules that must be rigidly applied and 2)the behaviors or mental acts are aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation however these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive

What is the distinction between PTSD and acute stress disorder in terms of duration of symptoms?

Acute stress disorder symptoms occur usually immediately after the trauma and persist for 3 day to 1 mo period, it persisting longer than a month then the diagnosis should be changed to PTSD

What is involved in a binge?

Binge- eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances

The diagnosis of specific phobia: A)involves general worries about multiple things b) represents a typical, expected response to an object or situation c)involves a fairly consistent reaction of fear or anxiety to an object or situation , which can lead to active avoidance of the feared object or situation d)represents a short-term diagnosis, lasting less than 6 months

C) involves a fairly consistent reaction of fear or anxiety to an object or situation , which can lead to active avoidance of the feared object or situation

The most effective treatment for generalized anxiety disorder is:

Cognitive Behavioral Therapy(CBT)

What is the first DSM criterion for social anxiety disorder?

Criteria A: Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others -Fear of being negatively evaluated by others

To what is a person "exposed" to in ERP?

Exposure involves gradually moving through situations that evoke low anxiety onto higher levels of anxiety

What are two components of the treatment plan for social anxiety disorder?

Exposure therapy and cognitive restructuring are the typical interventions for SAD.

What constitutes a trauma for PTSD or acute stress disorder

Exposure to actual or threatened death, serious injury, or sexual violence through direct experience, witnessing, learning of the event from a loved one, experiencing repeated or extreme exposure to aversive details of traumatic event

A therapeutic approach for hair pulling or skin picking designed to identify stimulus triggers for the behavior, increase involvement in more positive competing behaviors, and encourage social support is:

Habit Reversal Training (HRT)

Ideally, when should treatment begin for PTSD?

Early intervention and treatment of symptoms is very important- as early as possible

What is the perceived threat for a person with agoraphobia?

Escape might be difficult or help might not be available in the event of developing panic-like symptoms

What is characteristic of separation anxiety disorder?

Excessive fear or anxiety concerning separation from the home or attachment figure that exceeds what is expected given the person's developmental level

T/F: During treatment for PTSD, exposing a person to the memories of the trauma is generally discouraged.

False

T/F: In general, parents are discouraged from being involved in the treatment of a child with separation anxiety disorder.

False

T/F: The treatment of specific phobias has had very limited success (I.e. <20% improve)

False

The DSM5 diagnosis of excoriation is defined as recurrent skin-picking that results:

In skin lesions even though one has attempted to stop or reduce this behavior

How many/which settings needed for agoraphobia?

In two or more of the following: -using public transportation -being in open spaces -being in enclosed spaces -standing in line or being in a crowd -being outside of the home alone

What is the "response prevention" part?

Involves exposing individual to anxiety-provoking situation and preventing individual from performing compulsions and to make them sit with the anxiety at all stages without performing their rituals

What is the key distinction between bulimia nervosa and binge eating disorder (BED)?

Key distinction is that if inappropriate compensatory behaviors are present than the diagnosis is Bulimia Nervosa and if not, the diagnosis is BED

What medications are effective in treating ADHD

Medications effective in treating ADHD are stimulants (Dexedrine, Ritalin, Cylert). *Straterra also proven to be effective- not a stimulant so no chance of being abused.

Does the typical separation anxiety that often occurs during childhood qualify as separation anxiety disorder?

No, only atypical and maladaptive symptoms of separation that cause signifiant impairment or distress can qualify for the diagnosis of SAD.

Does a person need both obsessions and compulsions for OCD diagnosis?

No, only one needs to be present although it is most common for both to be present

Why do those with hoarding disorder acquire and maintain so many posessions?

Persistent difficuly discarding or parting with possessions, regardless of their actual value due to perceived need to save items and due to distress associated with attempts to discard

What is the primary concern for those with body dysmorphic disorder?

Preoccupied with one or more perceived defects or flaws in their physical appearance which they believe look ugly, unattractive, abnormal, or deformed (these flaws are usually not even noticed by others)

For ADHD, In how many settings do these symptoms need to be evident?

Several inattentive or hyperactive-impulsive symptoms are present in TWO or more settings and began before age 12

How is severity level determined for ASD?

Severity Level determined- based on social communication impairments and restricted, repetitive patterns of behavior -With or without accompanying intellectual impairment -with or without accompanying language impairment -associated with a known medical or genetic condition or environmental factor -associated with another neurodevelopmental, mental, or behavioral disorder -with catatonia

How is severity rated for anorexia nervosa?

Severity is measured by BMI

How does skin-picking or hair removal in BDD differ from that of excoriation or trichotillomania?

Skin-picking or hair-pulling in BDD is related to preoccupation of looking ugly/deformed whereas trich/excor are unable to stop

Body dysmorphic disorder involves _____________ in one's __________.

perceived flaw, appearance

What are two ways that the obsessions and compulsions in OCD are viewed as maladaptive?

Time consuming (more than 1 hour a day) and cause significant clinical distress or impairment

T/F: There are substances, medications, and medical conditions that can cause or contribute to anxiety symptoms.

True

A difference between acute stress disorder and PTSD is: a) acute stress disorder involves a shorter duration of symptoms than pTSD b)a traumatic event Is require as part of PTSD and not acute stress disorder c)acute stress disorder applies to childhood trauma and PTSD applies to adult trauma d)none of the above

a) acute stress disorder involves a shorter duration of symptoms than pTSD

Individuals who meet the criteria for social anxiety disorder: a)avoid social situations or endure them while feeling anxious b)often ruminate about what they dislike about others, which is what increases their anxiety c)have a fairly rare mental health disorder d)are usually remarkably comfortable once they enter into social situations or performance situations

a)avoid social situations or endure them while feeling anxious

Obsessive Compulsive Disorder (OCD): A)can be diagnosed if someone only experiences obsessions or compulsions b)is solely caused by environmental factors c)requires good insight on the part of the person who is diagnosed d)typically begins after age 35

a)can be diagnosed if someone only experiences obsessions or compulsions

All of the following can be a part of the DSM5 diagnosis of hoarding disorder except: a)hoarding that results from a brain injury b)difficulty discarding possessions regardless of value c)distress that arises at the thought of discarding items d)clutter that results in not being able to use living areas for their intended use

a)hoarding that results from a brain injury

All of the following are characteristic of the diagnosis of separation anxiety disorder except: a)the typical stranger anxiety that occurs around age 2 b)refusal to sleep away from home c)nightmares that involve a fear of separation d)excessive worry about a bad event happening, like being kidnapped, that would prevent the person from being with attachment figured

a)the typical stranger anxiety that occurs around age 2

Which of the following is NOT characteristic of agoraphobia? a)concern about having panic-like symptoms or other incapacitating/embarrassing symptoms b)fear that help may not be available if symptoms are experienced c)anxiety that is associated with only one setting or situation d)fear about being unable to escape if symptoms are experienced

c)Anxiety that is associated with only one setting or situation

Regarding hoarding disorder: a)most individuals are self-referred to therapy and are motivated to change b)it is a temporary condition that generally improves with age c)few people seek treatment for hoarding disorder d)medication is the primary intervention with proven effectiveness

c)few people seek treatment for hoarding disorder

Which of the following is characteristic of panic disorder? a)requires the person initially experienced predictable or "expected" panic attacks b)is most commonly diagnosed right after a person has had his or her first panic attack c)involves persistent worry of experiencing additional panic attacks OR changes in behavior to avoid the recurrence of an attack d)requires panic attacks limited to two or three symptoms of anxiety

c)involves persistent worry of experiencing additional panic attacks OR changes in behavior to avoid the recurrence of an attack

Which of these is the least likely component to include when developing an initial treatment plan for an adult with a specific phobia? a) a collaborative and trusting relationship between the client and therapist b)the creation of fear hierarchy c)exposure to the feared situation d)medications like benzodiazepines

d)medications like benzodiazepines

All of the following are associated with the diagnosis of PTSD except: a)intrusion symptoms (e.g. memories or dreams) b)negative changes in moods or thoughts (e.g. negative beliefs about oneself, feeling detached) c)alterations in arousal (e.g. angry outbursts, hyper-vigilance) d)symptoms for <1 month

d)symptoms for <1 month

Habituation

decreasing responsiveness with repeated stimulation to fear stimulus

__________ is the first-line (best initial choice) treatment for adults with OCD.

exposure and reSponse prevention therapy (ERPT)

What Is recommended treatment for OCD?

exposure and response prevention therapy (ERP)

Common compulsions

hand washing, ordering, checking, praying, counting, and repeating words silently

Common obsessions

relating to contamination, images of violent or horrific scenes, or urges for example to stab someone

Expectancy Violation

when an individual's beliefs or expectations are proven to be wrong/are violated leading to cognitive reframing of situation/object