Ab Psych Exam 3
Down Syndrome
most common chromosomal disorder cause of IDD (Intellectual Developmental Disorder)
recovery from schizophrenia
A fuller recovery from the disorder is more likely in people With good premorbid functioning Whose disorder was triggered by stress With abrupt onset With later onset (during middle age) Who receive early treatment 25% of patients fully recover, 75% continue to have residual problems
"Big Five" Theory of Personality Disorders
A large body of research conducted with diverse populations consistently suggests that the basic structure of personality may consist of five "supertraits" or factors Factors--> Neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness Each of these factors, collectively referred to as the "Big Five", consists of a number of subfactors Theoretically, everyone's personality can be summarized by a combination of these supertraits
cognitive explanation of schizophrenia
Agree with biological view that brains of people with schizophrenia produce strange and unreal sensations during hallucinations and related perceptual differences Suggest further features emerge when people try to understand these unusual experiences "Rational path to madness"
Substance Abuse Later in Life
Alcohol-related disorders 3 to 7 percent of older people, particularly men, have alcohol-related disorders in a given year Differences between new and long-term older problem drinkers Alcohol use disorder in elderly people is treated much the same as in younger adults Approaches include detoxification, Antabuse, Alcoholics Anonymous (AA), and cognitive-behavioral therapy Prescription drug misuse Leading kind of substance problem in the elderly Most often unintentional Nursing home medication misuse
Treatments for Childhood Anxiety Disorders
Around two-thirds of anxious children go untreated Therapies used Psychodynamic, behavioral, cognitive, cognitive-behavioral, family, and group therapies, separately or in combination, have been applied most often - each with some degree of success Drug therapy, often in combination with psychotherapy, has begun only recently to receive much research attention Psychodynamic therapists use play therapy as part of treatment: A treatment approach that helps children express their conflicts and feelings indirectly by drawing, playing with toys, and making up stories
Paranoid Personality Disorder Treatment
Few come to treatment willingly; others distrust and rebel against their therapists Therapy has limited effect and moves slowly Object relations therapy: try to see past the patient's anger and work on the underlying wish for a satisfying relationship. Behavioral and cognitive therapy: Behavioral and cognitive therapists try to help clients control anxiety and improve interpersonal skills. Cognitive therapy: try to restructure clients' maladaptive assumptions and interpretations. Drug therapy: of limited help Little systematic research
Biological View of Schizophrenia
Following principles of the diathesis-stress perspective, genetic and biological studies of schizophrenia have dominated clinical research Key roles of inheritance and brain activity and important changes in treatment have been reported Genetic view and factors supported by research Relatives of people with schizophrenia Twins with this disorder People with schizophrenia who are adopted Genetic linkage and molecular biology
Schizophrenia DSM
For 1 month, individual displays two or more of the following symptoms much of the time: Delusions, Hallucinations, Disorganized speech, Very abnormal motor activity, including catatonia, Negative symptoms At least one of the individual's symptoms must be delusions, hallucinations, or disorganized speech. Individual functions much more poorly in various life spheres than was the case prior to the symptoms. Continuation of symptoms of psychosis for 6 months or more Deterioration in social relations and ability to care for themselves must be shown
Disruptive Mood Dysregulation Disorder
For at least a year, individual repeatedly displays severe outbursts of temper that are extremely out of proportion to triggering situations and different from ones displayed by most other people of his or her age. The outbursts occur at least three times per week and are present in at least two settings (home, school, with peers). Individual repeatedly displays irritable or angry mood between the outbursts. Individual receives initial diagnosis between 6 and 18 years of age. New Diagnosis Especially important because of over-diagnosis and adult medication prescribed for children
Consequences of Inadequate Community Treatment of Schizophrenia
No treatment at all Short-term help (hospitalization) and premature discharge Inadequate follow-up Homelessness
Juvenile Delinquency
Occurs when children between the ages of 8 and 18 break the law Boys are much more involved in juvenile crime than are girls The number of arrests of teenagers for serious crimes has fallen by one-third during the past decade
Narcissistic Personality Disorder Treatments
One of the most difficult personality patterns to treat Clients who consult therapists usually do so because of a related disorder, most commonly depression Once in treatment, the individuals may try to manipulate the therapist into supporting their sense of superiority None of the major treatment approaches have had much success
Delirium
Over the course of hours or a few days, the individual experiences fast-moving and fluctuating disturbances in attention and orientation to the environment. Individual also displays a significant cognitive disturbance. Awareness of the environment becomes less clear and often accompanies great difficulty concentrating and thinking in an organized way This leads to misinterpretations, illusions, and, on occasion, hallucinations
When Therapy for Intellectual Developmental Disorder is Needed
Presence of emotional and behavioral problems Around 30 percent or more have a diagnosable psychological disorder other than IDD Some suffer from low self-esteem, interpersonal problems, and adjustment difficulties These problems are helped to some degree by individual or group therapy Psychotropic medication is sometimes prescribed
Disorders of Cognition
With age, memory difficulties and lapses of attention increase, and they may occur regularly by age 60 or 70 Most cognitive problems have organic roots, particularly when they appear in later life The leading cognitive disorders among elderly persons are DELIRIUM, NEUROCOGNITIVE DISORDER, and MILD NEUROCOGNITIVE DISORDER Cognitive "mishaps" (e.g., leaving without keys, forgetting someone's name) are a common and quite normal feature of stress or aging
Dramatic, Emotional, or Erratic Cluster
antisocial, borderline, histrionic, narcissistic Behaviors are so dramatic, emotional, or erratic that it is almost impossible for them to have relationships that are truly giving and satisfying
negative symptoms
symptoms of schizophrenia that are marked by deficits in functioning, such as apathy, lack of emotion, and slowed speech and movement Deficits of thoughts, emotion, and behavior poverty of speech, blunted or flat affect, loss of volition (loss of motivation or directedness), and social withdrawal
Sociocultural View of Schizophrenia
three main social forces contribute to schizophrenia: Multicultural factors, Social labeling, Family dysfunction Research has not yet clarified what their precise causal relationships might be
Type II Schizophrenia
-Dominated by negative symptoms -May be tied largely to structural abnormalities in the brain
psychomotor symptoms
-unusual movements or gestures -awkward movements, repeated grimaces, odd gestures, catatonia (stupor, rigidity, posturing, or excitement)
Milieu Therapy
1950s The premise is that institutions can help patients make clinical progress by creating a social climate ("milieu") that promotes productive activity, self-respect, and individual responsibility. Milieu-style programs have been set up in institutions throughout the Western world with moderate success. Research has shown that patients with schizophrenia in milieu programs often leave the hospital at higher rates than patients receiving custodial care.
Anxiety in Later Life
ANXIETY is common among the elderly At any given time, around 6 percent of elderly men and 11 percent of elderly women in the United States experience at least one of the anxiety disorders Causes: Declining health Researchers have not, however, systematically tied anxiety disorders among the elderly to specific events or losses. Treatment: Psychotherapy of various kinds, particularly cognitive-behavior therapy Antianxiety medications
ADHD Treatment
About 80 percent of all children and adolescents with ADHD receive treatment Heated disagreement about the most effective treatment for ADHD Most commonly applied approaches Drug therapy (Methylphenidate/Ritalin) Behavioral therapy Combination Diagnostic interviews, rating scales, and psychological test Parents and teachers learn how to apply operant conditioning techniques to change behavior. These treatments have often been helpful, especially when combined with drug therapy.
Schizophrenia prevalence
Affects approximately 1 in 100 people in the world Creates enormous financial and emotional costs Appears in all socioeconomic groups, but is found more frequently in the lower economic levels Is diagnosed equally in men and women Differs diagnostically by marital status (3% of divorce/separated people, 2% of single people, 1% of married people)
Separation Anxiety Disorder
Begins as early as the preschool years and is displayed by 4 percent of all children May further take the form of a SCHOOL PHOBIA or SCHOOL REFUSAL Common problem in which children fear going to school and often stay home for a long period Symptoms: Repeated separation-related upset, loss-related concern, fear of experiencing separation-caused events, resistance to leaving home, resistance to being alone, resistance to sleepaways, separation-focused nightmares, separation-triggered physical symptoms.
Depression in Later Life Therapy
Behavioral therapy Interpersonal therapy Antidepressant medications Combination of these approaches Impact Depression improvement with over 50 percent of older patients Antidepressant drugs side effects: body's metabolism works differently later in life so drugs effects may be altered Among elderly people, antidepressant drugs have a higher risk of causing some cognitive impairment.
ADHD Causes
Biological theorist: Abnormal dopamine activity Abnormalities in frontal-striatal regions of the brain Sociocultural theorists: ADHD symptoms and a diagnosis of ADHD may themselves create interpersonal problems and produce additional symptoms in the child
community approach to schizophrenia
Broadest approach, treated in the community In 1963, Congress passed the Community Mental Health Act: Provided that patients should be able to receive care within their own communities, rather than being transported to institutions far from home Led to massive deinstitutionalization of patients with schizophrenia REVOLVING DOOR SYNDROME
Prenatal and birth-related causes of Intellectual Developmental Disorder
CRETINISM: low iodine FETAL ALCOHOL SYNDROME (FAS) Prenatal maternal infections ANOXIA: birth complications, prolonged period without oxygen
Encopresis Causes and Treatments
Causes: Stress, constipation, improper toilet training, or a combination of all three Common treatments Behavioral and medical approaches, or combinations of the two Family therapy
Conduct Disorder
Characterized as a severe problem; children repeatedly violate the basic rights of others Overt-destructive Overt-nondestructive Covert-destructive Covert-nondestructive They are often aggressive; may be physically cruel to people and animals; may steal from, threaten, or harm their victims, committing such crimes as shoplifting, forgery, mugging, and armed robbery. Often leads to problems later in life Mostly diagnoses in boys Symptoms for at least 6 months
Oppositional Defiant Disorder
Characterized by extreme hostility and defiance Those with oppositional defiant disorder are argumentative and defiant, angry and irritable, and, in some cases, vindictive As many as 10 percent of children qualify for this diagnosis. Disorder is more common in boys than girls before puberty, but equal in both sexes after puberty. Most kids grow out of this
Obsessive-Compulsive Personality
Characterized by preoccupation with order, perfection, and control that those with this disorder lose all flexibility, openness, and efficiency As many of 7.9 percent of the adult population are diagnosed, with white, educated, married, and employed individuals receiving the diagnosis most often Men are twice as likely as women to display the disorder Unreasonably high standards set for self and others, fear of making a mistake Tendency to be rigid and stubborn Trouble expressing affection and their relationships are often stiff and superficial
Enuresis
Characterized by repeated involuntary or intentional bedwetting or wetting of one's clothes Typically occurs at night during sleep but may also occur during the day May be triggered by a stressful event Must be at least 5 years of age to receive this diagnosis Prevalence: Decreases with age Often involves a close relative who has had or will have the same disorder Corrects without treatment in most cases
Encorpresis
Characterized by repeatedly defecating in one's clothing; less common than enuresis and less well researched The problem: Is usually involuntary Seldom occurs during sleep Starts after the age of 4 Is more common in boys than girls Causes intense social problems, shame, and embarrassment
Elimination Disorders
Children with elimination disorders repeatedly urinate or pass feces in their clothes, in bed, or on the floor These symptoms are not caused by physical illness or medications
Schizotypal Personality Disorder Treatments
Clients helped to reconnect and recognize the limits of their thinking and powers Cognitive-behavioral therapists try to teach clients to objectively evaluate their thoughts and perceptions and provide speech lessons and social skills training Drug therapy (antipsychotic drugs) appears to be somewhat helpful in reducing certain thought problems Therapy is difficult
Histrionic Personality Disorder Treatments
Cognitive therapists try to help change their belief that they are helpless and try to help them develop better, more deliberate ways of thinking and solving problems Psychodynamic therapy and group therapy have also been applied to help clients deal with their dependency Drug therapy is less successful, except as a means of relieving the depression Unlike people with most other personality disorders, those with histrionic personality disorder are more likely to seek treatment on their own. Working with them can be difficult because of their demands, tantrums, seductiveness, and attempts to please the therapist.
Autism Spectrum Disorder Treatments
Cognitive-behavioral therapy: help to adapt better to their environment, although no known treatment totally reverses the autistic pattern Communication training: Other forms of communication taught Parent training: Behavioral programs train parents to apply behavioral techniques at home. Individual therapy and support groups help parents deal with their own emotions and needs. Community integration: Many of today's school-based and home-based programs for autism teach self-help and self-management, as well as living, social, and work skills. In addition, greater numbers of group homes and sheltered workshops are available for teens and young adults with autism spectrum disorder.
Psychosis
Defined by a loss of contact with reality Includes symptoms of hallucinations (false sensory perceptions) and/or delusions (false beliefs) May be substance-induced or caused by brain injury, but most psychoses appear in the form of schizophrenia Involves significant disturbance of ability to perceive and respond to the environment; functioning is impaired
Most common mental health problems of older adults
Depression As many as 20 percent of people experience this disorder at some point during old age; highest in older women Depression among older people raises risk of developing significant medical problems and committing suicide
PERSONALITY DISORDER TRAIT SPECIFIED (PDTS)
Dimensional approach to personality disorders Individuals whose traits significantly impair their functioning should receive this diagnosis Clinicians would further identify and list problematic traits and rate the severity of impairment caused Five groups of problematic traits would be eligible for a diagnosis of PDTS When clinicians assign a diagnosis, they must also rate the degree of dysfunctioning caused by each of the person's traits, using a four-point scale ranging from "minimally descriptive" (= 0) to "maximally descriptive" (= 3) Traits: Negative affectivity, Detachment, Antagonism, Disinhibition, Psychoticism
Antipsychotic Drugs
Discovery of ANTIPSYCHOTIC DRUGS in the 1950s revolutionized treatment for schizophrenia Conventional antipsychotic drugs PHENOTHIAZINE - Antihistamine used to calm surgery patients CHLORPROMAZINE - Tested successfully on patients with psychotic symptoms; approved in United States as Thorazine Second generation antipsychotic drugs
Dimensional approach to personality disorders
Each trait is seen as varying along a continuum extending from nonproblematic --> extremely problematic Instead of categorical, which assumes that symptoms are either there or not
Psychotic Disorders Later in Life
Elderly people have a higher rate of psychotic symptoms than younger people Causes: Among aged people, these symptoms are usually due to underlying medical conditions such as the disorders of cognition SCHIZOPHRENIA is less common in older persons than in younger ones Symptoms lessen in later life Emergence of new cases uncommon DELUSIONAL DISORDER develops in a few elderly people
Abnormal Brain Structure and Schizophrenia
Enlarged VENTRICLES; abnormalities in hosts of brain structures Some studies show that people with schizophrenia have relatively small temporal and frontal lobes, as well as abnormalities in brain structures such as the hippocampus, amygdala, and thalamus Brain abnormalities may result from exposure to viruses before birth: Interrupt brain development Remain quiet until puberty or young adulthood when activated by changes in hormones or another virus
Psychodynamic explanation of schizophrenia
Freud believed that schizophrenia developed from two psychological processes. 1. regression to a pre-ego stage 2. efforts to restablish ego control Near-total regression leads to self-centered symptoms such as neologisms, loose associations, and delusions of grandeur Attempts to reestablish control and contact reality may influence development of other psychotic symptoms Schizophrenia develops from regression to pre-ego stage of primary narcissism - only personal needs are recognized and met -- and efforts to reestablish ego control.
Schizoid Personality Disorder Psychodynamic and Cognitive Theories
Many psychodynamic theorists, particularly object relations theorists, link schizoid personality disorder to an unsatisfied need for human contact, The parents of those with the disorder are believed to have been unaccepting or abusive of their children. Cognitive theorists propose that people with schizoid personality disorder suffer from deficiencies in their thinking
Failure of Community Treatment of Schizophrenia
In any given year, 40 to 60 percent of all people with schizophrenia receive no treatment at all Two factors are primarily responsible Poor coordination of services: Mental health agencies in a community often fail to communicate with one another. To combat this problem, a growing number of community therapists have become case managers for people suffering from schizophrenia Shortage of services: The number of community programs available to people with schizophrenia falls woefully short. The centers that do exist generally fail to provide adequate services for people with severe disorders. While there are various reasons for these shortages, the primary one is economic.
Social Labeling and Schizophrenia
Many sociocultural theorists believe that the features of schizophrenia are influenced by the diagnosis itself Society labels people who fail to conform to certain norms of behavior; well-documented Once assigned, the label becomes a SELF-FULFILLING PROPHECY Rosenhan's 1973 "pseudo-patient" study
Personality Disorder
Individual displays a long-term, rigid, and wide-ranging pattern of inner experience and behavior that leads to dysfunction in at least two of the following realms: Cognition, Emotion, Social interactions, Impulsivity The individual's pattern is significantly different from ones usually found in his or her culture. Individual experiences significant distress or impairment.
Intellectual Development Disorder
Individual displays deficient intellectual functioning in areas such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning, and learning from experience. The deficits are reflected by clinical assessment and intelligence tests. Individual displays deficient adaptive functioning in at least one area of daily life, such as communication, social involvement, or personal independence, across home, school, work, or community settings. The limitations extend beyond those displayed by most other persons of his or her age and necessitate ongoing support at school, work, or independent living. The deficits begin during the developmental period (before the age of 18). IQ must be 70 or lower. The person must have difficulty in such areas as communication, home living, self-direction, work, or safety.
Mild Neurocognitive Disorder
Individual displays modest decline in at least one of the following areas of cognitive function: • Memory and learning • Attention • Perceptual-motor skills • Planning and decision-making • Language ability • Social awareness. Cognitive deficits do not interfere with the individual's everyday independence.
Major Neurocognitive Disorder
Individual displays substantial decline in at least one of the following areas of cognitive function: • Memory and learning • Attention • Perceptual-motor skills • Planning and decision-making • Language ability • Social awareness. Cognitive deficits interfere with the individual's everyday independence.
Causes of Conduct Disorder
Linked to genetic and biological factors, drug abuse, poverty, traumatic events, and exposure to violent peers or community violence Often tied to troubled parent-child relationships, inadequate parenting, family conflict, marital conflict, and family hostility
family dysfunctioning and schizophrenia
Many studies suggest that schizophrenia is often linked to family stress Family theorists recognize that some families are high in EXPRESSED EMOTION: Family members frequently express criticism and hostility and intrude on each other's privacy Individuals who are trying to recover from schizophrenia are almost four times more likely to relapse if they live with such a family. Parents of people with the disorder often: Display more conflict, Have greater difficulty communicating, Are more critical of and overinvolved with their children than other parents
Four Levels of Intellectual Developmental Disorder
Mild (IQ 50-70): most common, "educable level" bc individuals can benefit from schooling Moderate (IQ 35-49): 10% Severe (IQ 20-34): 3%-4% Profound (IQ below 20): 1%-2%
Enuresis Treatment
Most cases of enuresis correct themselves without treatment. Therapy, particularly behavioral therapy, can speed up the process.
Alzheimer's Disease
Most common type of neurocognitive disorder and accounts for as many as two-thirds of all cases This disease sometimes appears in middle age (early onset), but most often occurs after the age of 65 (late onset) Individual displays the features of major or mild neurocognitive disorder. Memory impairment is a prominent feature. Genetic indications or family history of Alzheimer's disease underscores diagnosis, but are not essential to diagnosis. Symptoms are not due to other types of disorders or medical problems.
Histrionic Personality Disorder Psychodynamic, Cognitive, Sociocultural, and Multicultural Theories
Most psychodynamic theorists believe children experienced unhealthy relationships Cognitive theorists look at the lack of substance and the extreme suggestibility found in people with the disorder Sociocultural and multicultural theorists believe the disorder is caused in party by society's norms and expectations
Metabolic Causes of Intellectual Developmental Disorder
PHENYLKETONURIA (PKU) TAY-SACHS DISEASE Body's breakdown or production of chemicals is disturbed. Intelligence and development are typically caused by the pairing of two defective recessive genes, one from each parent.
Obsessive Compulsive Treatments
People do not usually believe there is anything wrong with them Unlikely to seek treatment unless they also are suffering from another disorder or unless someone close to them insists that they get treatment. Respond well to psychodynamic or cognitive therapy and with SSRIs
Avoidant Personality Disorder Treatments
People seek acceptance and affection in therapy Disorder treated like social anxiety and other anxiety disorders Group therapy formats help by providing practice in social interactions (cognitive-behavioral principles) Antianxiety and antidepressant drugs are also sometimes useful Treatments have had modest success Keeping them in therapy can be challenging because they soon begin to avoid sessions. A key task of the therapist is to gain the individual's trust.
Diathesis-Stress Relationship and Schizophrenia
People with a biological predisposition will develop schizophrenia only if certain kinds of stressors or events are also present
Dependent Personality Disorder Treatments
People with this disorder usually place all responsibility for their treatment and well-being on the clinician. A key task is to help patients accept responsibility for themselves. Treatment can be at least modestly helpful Psychodynamic therapists focus on many issues similar to depression Cognitive-behavioral therapists help clients challenge and change their assumptions Antidepressant drug therapy is helpful when depression is manifested Group therapy provides clients opportunity for peer support and modeling
Causes of Intellectual Developmental Disorder
Primary causes of mild IDD Environmental Biological factors may be operating in some cases Primary causes of moderate, severe, and profound IDD Biological People who function at these levels are also greatly affected by their family and social environment Injuries and accidents Poisoning, serious head injury, excessive exposure to X-rays, and excessive use of certain chemicals, minerals, and/or drugs Undiagnosed or untreated infections MENINGITIS ENCEPHALITIS
Dependent Personality Disorder Psychodynamic, Behavioral, and Cognitive Theories
Psychodynamic explanations are similar to those for depression Freudian theorists: Unresolved conflicts during the oral stage Object-relations theorists: Early parental loss or rejection Other theorists: Overinvolved and overprotective parents Behaviorists propose unintentional rewards and punishments Cognitive theorists identify two maladaptive attitudes
Obsessive Compulsive Psychodynamic, Freudian, and Cognitive Theories
Psychodynamic explanations dominate and research is limited Freudian theorists: suggest that people with obsessive-compulsive personality disorder are ANAL REGRESSIVE. Cognitive theorists offer limited theories about the origins of the disorder, but propose that illogical thinking processes help maintain it
Borderline Personality Disorder Psychodynamic, Object-Relations, Biological, Biosocial, and Sociocultural Theories
Psychodynamic theorists consider early parental relationships when explaining the disorder Object-relations theorists propose a lack of early acceptance or abuse/neglect by parents Biological theorists suggest biological abnormalities, such as overly reactive amygdala, underactive prefrontal cortex, lower brain serotonin activity, and genetics, are linked Biosocial theory presents results from a combination of internal and external forces Some sociocultural theorists suggest that cases of borderline personality disorder are particularly likely to emerge in cultures that change rapidly
Enuresis Theories
Psychodynamic theorists explain it as a symptom of broader anxiety and underlying conflicts Family theorists point to disturbed family interactions Behaviorists often view it as the result of improper, unrealistic, or coercive toilet training Biological theorists suspect a small bladder capacity or weak bladder muscles
Avoidant Personality Psychodynamic, Cognitive, and Behavioral Theories
Psychodynamic theorists focus mainly on the general sense of shame felt; early toileting experiences Cognitive theorists believe that harsh criticism and rejection in early childhood may lead people to assume that their environment will always judge them negatively Behavioral theorists suggest that people with this disorder typically fail to develop normal social skills
Narcissitic Personality Disorder Psychodynamic, Object-Relations, Cognitive-Behavioral, and Sociocultural Theories
Psychodynamic theorists focus on cold, rejecting parents Object-relations theorists interpret grandiose self-presentation as a way for people to feel self-sufficient and without need of warm relationships Cognitive-behavioral theorists propose that narcissistic personality disorder may develop when people are treated too positively rather than too negatively in early life Many sociocultural theorists see a link between narcissistic personality disorder and "eras of narcissism" in society
Antisocial Personality Disorder Psychodynamic, Behavioral, Cognitive, and Biological Theories
Psychodynamic theorists propose that disorder begins with absence of parental love, leading to a lack of basic trust Many behaviorists suggest antisocial symptoms may be learned through modeling or unintentional reinforcement Biological view proposes hormonal and brain abnormalities
Paranoid Personality Disorder Psychodynamic Theory, Cognitive Theory, and Biological Theory
Psychodynamic theorists trace the pattern back to early interactions with demanding parents Cognitive theorists suggest that maladaptive assumptions such as "People are evil and will attack you if given the chance" are to blame Biological theorists propose genetic causes and have looked at twin studies to support this model
Borderline Personality Disorder Treatments
Psychotherapy DIALECTICAL BEHAVIOR THERAPY (Integrative treatment approach): grows largely from the cognitive-behavioral treatment model and borrows heavily from humanistic and psychodynamic approaches, often supplemented by the clients' participation in social skill building groups Drugs Combination of drug therapy and psychotherapy
Institutional Care of Schiozphrenia
Questions have been raised about Milieu and Token Economy programs: Many research studies have been uncontrolled Are such programs truly effective?: Token economy programs are no longer as popular as they once were but they are still used in many mental hospitals, usually along with medication
Multicultural Factors and ADHD
Racial differences exist among children with significant attention and activity problems who are or are not assessed, diagnosed, or treated for ADHD Economic disadvantage Social bias and racial stereotyping African American and Hispanic American children with significant attention and activity problems are less likely than white American children to be assessed, diagnosed, or treated for ADHD Children from racial minorities are less likely than white American children to be treated with stimulant drugs or a combination of stimulants and behavioral therapy—the interventions that seem to be of most help to those with ADHD.
Multicultural Factors of Schizophrenia
Rates of the disorder differ between racial and ethnic groups Although the overall prevalence is stable, the course and outcome of schizophrenia differs between countries Another explanation is that clinicians from majority groups are unintentionally biased in their diagnoses or misread cultural differences as symptoms of schizophrenia. Some theorists believe that the psychosocial environments of developing countries tend to be more supportive than developed countries, leading to more favorable outcomes for people with schizophrenia.
Childhood Major Depressive Disorder
Recent research disputes the wisdom of using adult treatment for depression with children NIMH TADS data suggest that depressed teens respond less well to cognitive-behavioral therapy than adults Antidepressant drugs may be highly dangerous for some depressed children and teenagers Neither antidepressants alone nor cognitive-behavioral therapy alone was as effective for teenage depression as was a combination of antidepressants and cognitive-behavioral therapy. Antidepressants alone tended to be more helpful to depressed teens than cognitive-behavioral therapy alone.
Fromm-Reichman Psychodynamic Explanation of Schizophrenia
SCHIZOPHRENOGENIC MOTHERS: Use children to meet own needs; act overprotecting and rejecting, which confuses and sets stage of schizophrenic functioning for children.
positive symptoms
Schizophrenic symptoms that involve behavioral excesses or peculiarities, such as hallucinations, delusions, bizarre behavior, and wild flights of ideas Excesses of thought, emotion, and behavior Loose associations (derailment), neologisms (made-up words), perservation (repeating word and statements), clang (rhymes), heightened perceptions, inappropriate affect (emotions that are unsuited to the situation), disorganized thinking and speech
Childhood Bipolar Disorder
Since the mid-1990s, clinical theorists recognized that many children display bipolar disorder Causes: Increase in prevalence or new diagnostic trend Most theorists believe that the growing numbers of children diagnosed with this disorder reflect not an increase in prevalence but a new diagnostic trend. Many clinical theorists believe the diagnosis is currently being overapplied to children and adolescents. They suggest the label has become a clinical "catchall" that is being applied to almost every explosive, aggressive child.
Schizoid Personality Disorder Treatments
Social withdrawal and reluctance to enter into or participate in therapy Even then, patients are likely to remain emotionally distant from the therapist, seem not to care about treatment, and make limited progress. Cognitive-behavioral therapists focus on thinking about emotions Behavioral therapists focus on teaching social skills Group therapy offers a safe environment for social contact Drug therapy is of little benefit
Autism Spectrum Disorder Causes
Sociocultural causes: Family dysfunction and social stress Psychological causes: Central perceptual or cognitive disturbance or limitations Theory of mind "Mind-blindness" Biological causes: Brain abnormalities Examination of relatives keeps suggesting a genetic factor in the disorder Prenatal difficulties or birth complications Specific biological abnormalities No proven MMR vaccine link
Conduct Disorder Treatments
Sociocultural treatments Family interventions Parent-child interaction therapy Video modeling Parent management training Residential treatment in community and programs at school Treatment foster care Institutionalization Juvenile training centers: has not met with much success and may, in fact, strengthen delinquent behavior. Because aggressive behaviors become more locked in with age, treatments for conduct disorder are generally most effective with children younger than 13 CHILD-FOCUSED TREATMENTS focus primarily on the child with conduct disorder, particularly cognitive-behavioral interventions Problem-solving skills training: therapists combine modeling, practice, role-playing, and systematic rewards Anger Coping and Coping Power Program Stimulant drug therapy Prevention Early prevention programs
Schizotypal Personality Disorder Theories
Some of the same biological factors found in schizophrenia, such as high dopamine activity Family conflicts and psychological disorders in parents High activity of the neurotransmitter dopamine, enlarged brain ventricles, smaller temporal lobes, and loss of gray matter relatives of people with depression have a higher than usual rate of schizotypal personality disorder, and vice versa
Cognitive-Behavioral Therapy for Schizophrenia
Techniques to help patients change how they view and react to their hallucinatory experiences Provide education and evidence of the biological causes of hallucinations Help clients learn about the "comings and goings" of their own hallucinations and delusions Challenge clients' inaccurate ideas about the power of their hallucinations Teach clients to reattribute and more accurately interpret their hallucinations Teach techniques for coping with their unpleasant sensations New-wave cognitive-behavioral therapy Therapy helps clients to accept their streams of problematic thoughts, gain a greater sense of control, become more functional, and move forward in life
Side Effects of Antipsychotics
The most common of these effects are Parkinsonian symptoms, reactions that closely resemble features of the neurological disorder Parkinson's disease, including: Muscle tremor and rigidity Bizarre movements of the face, neck, tongue, and back Great restlessness, agitation, and discomfort in the limbs Tardive dyskinesia: involves writhing or ticlike involuntary movements, usually of the mouth, lips, tongue, legs, or body. Can be difficult and sometimes impossible to eliminate
Psychotherapy for Schizophrenia
The most helpful forms of psychotherapy are often combined therapies Cognitive-behavioral therapy: Techniques to help patients change how they view and react to their hallucinatory experiences Two broader sociocultural therapies Family therapy: Over 50 percent of persons recovering from schizophrenia and other severe disorders live with family members Creates significant family stress Are at greater risk for relapse when they live with relatives who display high levels of expressed emotion Social therapy: Addresses social and personal difficulties in the clients' lives Includes practical advice, problem solving, decision making, social skills training, medication management, employment counseling, financial assistance, and housing Reduces rehospitalization
Treatments for Intellectual Developmental Disorder
The quality of life attained by people with IDD depends largely on sociocultural factors Intervention programs try to provide comfortable and stimulating residences, social and economic opportunities, and a proper education Since deinstitutionalization, reforms have led to the creation of small institutions and other community residences that teach self-sufficiency, devote more time to patient care, and offer education and medical services. Today the vast majority of children with intellectual developmental disorder live at home rather than in an institution.
Token Economies
Treatment for Schizophrenia Based on operant conditioning principles, token economies are used in institutions to change the behavior of patients with schizophrenia. Patients are rewarded when they behave in socially acceptable ways and are not rewarded when they behave unacceptably. Immediate rewards are tokens that can later be exchanged for food, cigarettes, privileges, and other desirable objects. Acceptable behaviors likely to be targeted include care for oneself and one's possessions, going to a work program, speaking normally, following ward rules, and showing self-control. Researchers have found that token economies help reduce psychotic and related behavior.
Antisocial Personality Disorder Treatments
Treatments are typically ineffective Some cognitive therapists guide clients to think about moral issues and others' needs Therapeutic community approach tried in hospitals and prisons Atypical antipsychotic drugs also have been tried but systematic studies are still needed Major obstacle is the individual's lack of conscience or desire to change. Most have been forced to come to treatment.
Personality Disorder Prevalence
Typically becomes recognizable in adolescence or early adulthood and symptoms last for years Has been estimated that 10 to 15 percent of all adults may have a personality disorder Is often COMORBID with another disorder Is among the most difficult psychological disorders to treat. Many sufferers are not even aware of their personality disorder.
Major Depressive Disorder
Typically, very young children lack some of the cognitive skills that produce clinical depression Yet, depression in the young may be triggered by negative life events (particularly losses), major changes, rejection, or ongoing abuse Clinical depression is much more common among teenagers Suicidal thoughts and attempts are particularly common Before age 13: No gender difference By age 16: Girls twice as likely to be depressed, One explanation for this gender shift that has received attention is teenage girls' growing dissatisfaction with their bodies. Depression is often characterized by headaches, stomach pain, irritability, and a disinterest in toys and games.
Personality/Personality Traits
Unique and long-term pattern of inner experience and outward behavior Particular characteristics that lead us to react in a predictable manner
Contemporary Psychodynamic Explanations of Schizophrenia
Views of Freud and Fromm-Reichmann rejected Biological abnormalities affect extreme regression of other acts that may contribute to schizophrenia
New Antipsychotic Drugs
atypicals They appear more effective than conventional antipsychotic drugs, especially for negative symptoms. They cause few extrapyramidal side effects and seem less likely to cause tardive dyskinesia. Some, however, do produce significant undesirable effects of their own. Antipsychotic drugs allow people with schizophrenia to learn about their disorder, participate in therapy, think more clearly, and make changes in their behavior.
Anxious or Fearful Cluster
avoidant, dependent, obsessive-compulsive Treatments for this cluster appear to be modestly to moderately helpful, considerably better than for other personality disorders
Paranoid Personality Disorder
characterized by deep distrust and suspicion of others Suspicion usually not "delusional" Criticism of weakness and fault in others, particularly at work They are unable to recognize their own mistakes and are extremely sensitive to criticism. They often blame others for the things that go wrong in their lives and they repeatedly bear grudges. As many of 4.4 percent of U.S. adults are believed to experience this disorder, apparently more common in men than women
Avoidant Personality Disorder
characterized by discomfort and inhibitions in social situations, feelings of inadequacy, and extreme sensitivity to negative evaluation Research has not directly tied the personality disorder to the anxiety disorders Feel unappealing or inferior and often have few close friends Similarities between the two disorders include a fear of humiliation and low self-confidence. A key difference is that people with social anxiety disorder mainly fear social circumstances, while people with avoidant personality disorder tend to fear close social relationships. Men diagnosed as frequently as women
Histrionic Personality Disorder
characterized by extreme emotionality and attention-seeking Always "on stage" Approval and praise are the lifeblood Vain, self-centered, and demanding 2 to 3 percent of U.S. adults, with males and females equally affected Some make suicide attempts, often to manipulate others.
Narcissistic Personality Disorder
characterized by grandiose behavior, need for much admiration, feeling no empathy with others More common in men Behavior is common among normal teenagers and does not usually lead to adult narcissism Exaggerate achievements and talents, often appear arrogant, and seldom interested in the feelings of others Many take advantage of others to achieve their own ends Want to be better than everyone around them, not necessarily adored or liked by others
Attention-Deficit/Hyperactivity Disorder (ADHD)
characterized by great difficulty attending to tasks, behaving overactively and impulsively, or both About half the children with ADHD also have learning or communication problems Disorder usually persists through childhood, but many children show a lessening of symptoms as they move into mid-adolescence Gender and age differences seen (mostly boys)
Boderline Personality Disorder
characterized by great instability, including major shifts in mood, an unstable self-image, impulsivity, and unstable interpersonal relationships Suicidal actions and threats close to 75 percent of those diagnosed are women Bouts of anger, which sometimes result in physical aggression and violence toward others or self-intense conflict-ridden relationships while struggling with recurrent fears of impending abandonment Many of the patients who come to mental health emergency rooms are individuals with the disorder who have intentionally hurt themselves. Impulsive, self-destructive behavior Alcohol and substance abuse Reckless behavior, including driving and unsafe sex Self-injurious or self-mutilation behavior Biggest fear: people they love are going to abandon them
Autism Spectrum Disorder
characterized by lack of responsiveness and social reciprocity, communication problems, wide range of highly rigid and repetitive behaviors, interests, and activities Individuals with autism may also exhibit unusual, rigid, and repetitive motor movements or self-stimulatory or self-injurious behaviors, and hyperreactivity or hypo-reactivity The individual's lack of responsiveness and social reciprocity—extreme aloofness, lack of interest in other people, low empathy, and inability to share attention with others—has long been considered a central feature of autism. Many sufferers become strongly attached to particular objects - plastic lids, rubber bands, buttons, water - and may collect, carry, or play with them constantly. Children may at times seem overstimulated and/or understimulated by their environments.
Schizoid Personality Disorder
characterized by persistent avoidance of social relationships and limited emotional expression Withdrawn and reclusive Self-focus, flat, cold, humorless, and dull Present in 3.1 percent of the adult U.S. population; slightly more likely to occur in men than in women do not have close ties with other people; they genuinely prefer to be alone
Antisocial Personality Disorder
characterized by persistent disregard and violation of others' rights, repeated lying, recklessness, and impulsiveness Person can be cruel, sadistic, aggressive, and violent Aside from substance use disorders, this is the disorder most linked to adult criminal behavior Sometimes described as "PSYCHOPATHS" or "SOCIOPATHS The DSM-5 requires that a person be at least 18 years of age to receive this diagnosis Antisocial personality disorder pattern often displayed before age 15 four times more common in men than women Higher rates of alcoholism and other substance use disorders occur within this group Estimated that at least 40 percent of people in prison meet the diagnostic criteria for this disorder.
Dependent Personality Disorder
characterized by pervasive, excessive need to be taken care of; clinging and obedient, fear of separation from loved ones Risk for depression, anxiety, and eating disorders and may be especially prone to suicidal thoughts Fewer than 1 percent of the population experience the disorder; men and women are affected equally Many people with this disorder feel distressed, lonely, sad, and dislike themselves
Neurocognitive Disorder
characterized by significant decline in at least one area of cognitive functioning Memory and learning Attention Visual perception Planning and decision making Language ability Social awareness Personality and behavior changes
Type I Schizophrenia
dominated by positive symptoms Seems to have better adjustment prior to the disorder, later onset of symptoms, and greater likelihood of improvement May be linked more closely to biochemical abnormalities in the brain Prognosis more optimistic than Type II
dopamine hypothesis of schizophrenia
idea that schizophrenia results from excess activity at dopamine synapses in certain brain areas Certain neurons using dopamine fire too often, producing symptoms of schizophrenia. This theory is based on the effectiveness of antipsychotic medications
schizotypal personality disorder
involves a range of interpersonal problems, marked by extreme discomfort in close relationships, odd (even bizarre) ways of thinking, and behavioral eccentricities. Estimated that 3.9% of adults (slightly more males than females) may have the disorder. People with the disorder often have great difficulty keeping their attention focused; conversation is typically digressive and vague, even sprinkled with loose associations. They tend to drift aimlessly and lead an idle, unproductive life, choosing undemanding jobs in which they are not required to interact with other people.
Relational Aggression
is another pattern of aggression found in certain cases of conduct disorder in which individuals are socially isolated and primarily display social misdeeds Relational aggression is more common among girls than boys
Odd or Eccentric Cluster
paranoid, schizoid, schizotypal People with these disorders display behaviors similar to, but not as extensive as, schizophrenia Some clinicians call them schizophrenia-spectrum disorders
Course of Schizophrenia
prodromal phase: beginning of deterioration, mild symptoms active phase: symptoms become apparent, must be in active phase for at least a month for diagnosis residual phase: return to prodromal-like levels Each phase of the disorder may last for days or years
Fragile X Syndrome
second most common chromosomal cause of Intellectual Developmental Disorder
