Abnormal Psych Final

Reactive Attachment Disorder

-Key symptom: in a child, inhibited and emotionally withdrawn behavior toward adult caregivers, with social and emotional disturbances relating to neglect or insufficient care. -Minimum duration for diagnosis: none, but onset before age 5 -sex ratio: equal

Disinhibited Social Engagement Disorder

-Key symptoms: In a child, approaching and interacting with unfamiliar adults in an overfamiliar and disinhibited manner, related to neglect or insufficient care. -minimum duration of diagnosis: none -sex ratio: equal

Post-traumatic stress disorder

-Key symptoms: after exposure to intense trauma, recurrent recollection and distress related to the trauma with marked arousal. -Minimum duration of diagnosis: 1 month -Sex ratio: more common in females

Adjustment disorders

-Key symptoms: development of behavioral or emotional symptoms within 3 months of the onset of a stressor -minimum duration for diagnosis: one -sex ratio: equal

Which age group tends to have greater incidence of diagnosed substance use disorders?

18-24

PTSD was first listed as a mental disorder in the DSM-III in_________

1980

Contemporary Themes: Reminder ... level of need

Lifetime prevalence: Major depression ≈ 52.8 million (in U.S.) Lifetime prevalence: Anxiety disorder ≈ 36.3 million-plus Lifetime prevalence: Eating disorder ≈ 13.2 million Lifetime prevalence: Schizophrenia ≈ 3.3 million One year prevalence: Any mental health disorder ≈ 85.8 million adults One year prevalence: Two or more disorders ≈ 19.1 million adults One in four homeless residing in shelters have >1 mental health disorder Fewer than one in four with any disorders receive adequate care Who is available to help?

Causal factors: Borderline PD

Linehan (1987): biosocial model ... heritable traits + psychosocial experience assumes these increase sensitivity to negative events Invalidating environments - - involving greater stress than support - - produce signs of disorder Sociocultural: focus on rapidly changing cultural environment

Psychological, social impact on health

May adversely impact health: Psychological factors → biological processes → illness, disease Long-standing behavioral patterns increase risk for physical disorders May also positively impact health Examples: Exercise ... yoga ... relaxation training Effects of acute or prolonged stress primary interest Other potential focal interests include: - inequity in healthcare decisions - risk factors for significant medical conditions - interpersonal factors affecting prevention, treatment, outcome

Cluster A Personality Disorders

May be related to Psychotic disorder, particularly Schizophrenia Differ in breadth, depth of symptoms Exclusion criterion: must not occur exclusively during: Schizophrenia Other Psychotic Disorder Mood Disorder with Psychotic Features Cluster A Personality Disorders may precede Psychotic Disorder

The______is a legal guideline that describes insanity in terms of an individual's ability to distinguish right from wrong.

McNaughton rule

Extreme Risk Protection Orders

Mental illness presumed to represent a primary risk factor in assessing risk Males more likely subject to application of these laws (4 to 5 higher) Proponents argue that ERPO laws reduce risk for suicide by firearm, harm to domestic partners, harm to in random or mass shootings Research in states where ERPO laws have been in effect longest reflect significant reduction (8% to 14%) reduction in rates of suicide by firearm Unfortunately, lack uniformity re: mental illness is regarded as factor in assessing risk ... also, no federal guidelines for such regulations

Perceived risk to others

Moreover, public perception that MI represents threat to others -aggression 2 to 3 times more likely among serious mental illness -violent behavior 3 to 5 times more likely among patients who abuse drugs / alcohol following discharge

Which of the following statements is most accurate regarding antisocial personality disorder?

Most who have it are not treated, and most who are treated are not helped much.

Rethinking what it means to be "disordered"

Much of focus this semester on the "abnormal" side of debate about functioning, despite acknowledgement that we all experience variations in cognitive / emotional / behavioral patterns at varying times. Some of this bias related to how the field is funded ... to focus on "departures from normality." TED Talk by Rosie King offers a different perspective on "normal"

Insanity defense prevaling views

Not far removed from prevailing views in US See DSM-5 statement (near top of page 456 of your text) General public shares skepticism of claims that history of mental illness was cause of acts that cause of significant injury to many. Consider, for example: Laurel Schlemmer (Apr 2014): Drowned 3 & 6 year old sons Sentence: 30 to 80 years James Eagan Holmes (Jul 2012): Shooting at The Dark Knight Rises debut Sentence: 12 life sentences + 3,318 years

categorical v dimensional-Not necessarily ideal approach

Not necessarily ideal approach: -some characteristics of Personality Disorder can't be directly observed -clinicians differ in judgments about "normal" vs "problematic" -significant overlap in definition of Personality Disorders -significant variability in definition of Personality Disorders

Overview: Cluster A Personality Disorders

Odd / eccentric Paranoid [PPD], Schizoid [SPD], Schizotypal [SzPD] Central features ... Discomfort with and/or suspicion about others Difficulty establishing relationships, fitting into social network

Impact of mental health deficits

One in two adults in US affected Very fine line separates "normal" from disorder - breadth of symptoms - duration of symptoms - severity of symptoms - degree of distress and/or impairment - impact on others Not limited to those diagnosed with disorder - Also those living, working with, providing care for ... -Need to also consider developmental, cultural context

Diagnostic Criteria for Post-Traumatic Stress Disorder

PTSD -the following criteria apply to adults, adolescents, and children older than 6 months. A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: 1. Directly experiencing the traumatic event(s) 2. Witnessing, in person, the event(s) as it occurred to others 3. learning the traumatic event(s) occurred to a close family member or a close friend, in cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental 4. Experiencing repeated or extreme exposure to aversion details of the traumatic events (eg. first responders collecting human remains; police officers repeatedly exposed to details of child abuse). B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic events -in children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed 2. Recurrent distressing dreams in which the content and /or affect the dream are related to the traumatic event(s) -in children, there might be frightening dreams without recognizable content 3. Dissociative reactions (flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring (such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings) -in children, trauma-specific reenactment may occur in play 4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). 5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s) C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following: 1.Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about closely associated with the traumatic events 2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic events D. Negative alterations in cognitions and mood associated with the traumatic events, beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: 1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs) 2. persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (eg. I am bad, No one can be trusted, the world is completely dangerous, my whole nervous is completely ruined) 3. Persistent, distorted cognitions about the cause or consequences of the traumatic events that lead the individual to blame himself/herself or others 4. Persistent negative emotional state (eg fear, horror, anger, guilt, or shame) 5. Markedly diminished interest or participation in significant activities 6. Feelings or detachment or estrangement from others 7. Persistent inability to experience positive emotions (eg inability to experience happiness, satisfaction, or loving feelings) E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic events occurred, as evidenced by two (or more) of the following: 1. Irritable behavior or angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects 2. Reckless or self-destructing behavior 3. hypervigilance 4. exaggerated startle response 5. problems with concentration 6. sleep disturbance (eg, difficulty falling or staying asleep or restless sleep) F. Duration of the disturbance (criteria B, C, D and E) is more than 1 month G. The disturbance causes clinically significant distress or impaired in social, occupational, or other important areas of functioning F. The disturbance is not attributable to the physiological effects of a substance (eg, medication, alcohol) or other medical conditions

Personality Disorders overview

Personality Stable / predictable psych / behav characteristics Inherited ... learned ... or both Flexible ... learn from experiences Personality disorders Persistent patterns of dysfunctional behavior that: Are relatively inflexible Interfere with individual's life Interfere with interpersonal interactions

Mental Illness and stigma (revisited)

Potential strategies to combat stigma by: ... talking openly about mental illness ... education self, others about mental illness ... being aware of language usage; refrain from using MH conditions as adjectives ... encouraging equity between physical and mental illness ... showing compassion for those with mental illness ... choosing empowerment over shame for people with mental illness ... being honest about treatment, including our own use and its utility ... letting the media know when they are being stigmatizing about mental illness ... not giving in to stigma ourselves ... by not hiding!

Patient issues

Prevalence rates, revisited: Major Depressive Disorder: >16% Any Anxiety Disorder: >11% Substance-related Disorder: >25% Schizophrenia: 1% > one in four meet criteria for > 1 disorder ≈ half will display significant symptoms by age 14 Few (<25%) receive formal treatment Majority who do have relatively mild, transient deficits Severe, chronic mental illness poses greater challenge ... ... significant burden on individual, family, society If they do develop mental health disorder, many believe that among worst possible outcomes is that others might learn about it!!

Who are mental health specialists?

Psychiatrists (MD, OD) Psychologists (PhD, PsyD, EdD) Psychiatric nurse specialists (CNS) Counselors (MA, MS) Psychiatric social workers (MSW, LCSW) Addictions-, other counselors (master's and lower level)

According to studies regarding psychological disorders and prisoners, which statement is MOST accurate?

Psychological disorders are more common in prison populations than in the general population.

psychologists are seeking legislation

Psychologists are seeking legislation that would allow them to prescribe psychotropic medications after they receive the necessary training. Limited numbers of psychologists have gained prescriptive authority within a Department of Defense pilot program and in the states of Idaho, Illinois, Iowa, Louisiana, and New Mexico. Psychiatry opposes this extension of prescription privileges, as do some psychologists who are concerned about the integrity of psychological science under the influence of the pharmaceutical industry.

Psychologists limitations

Psychologists must acknowledge limitations regarding level of training / experience, note when receiving supervision Psychologists may not take advantage of clients, students or other subordinates Ethical guidelines expressly forbids sexual relationship between psychologist and current / former therapy clients for at least two years after the end of treatment (if even then)

Patient's rights: Right to treatment

19th / 20th century reforms in housing and treatment of individuals with mental illness ... yielded founding / enlarging of state institutions for the custody and care of those with mental illness Reforms include the Community Mental Health Act of 1963 Promises unrealized Example: Bryce State Hospital (Tuscaloosa) and related facilities in Alabama - by 1970, had 5,200 patients in woefully inadequate / inhumane conditions - "dumping ground" for socially undesirables, severely mentally ill, geriatirics - 1970 tax cut forced staffing layoff - 15 y/o "delinquent" Ricky Wyatt placed to help "make him behave"

Overall, the prevalence of violence among those with mental disorders is_____________those without a mental disorder.

5 times as high as

When a court order for civil commitment is issued, the person named would be required to enter a hospital for observation and psychiatric examination that usually lasts __________________.

72 hours

Of those diagnosed with borderline personality disorder,_______are female.

75%

In the general population,_____________display at least one of the personality disorders.

9%

__________________ of those diagnosed with a DSM-5 mental disorder are not violent.

90%

Treatment

< 25% receive professional assistance Treatment from wide range of sources Psychotherapy: Increasing emphasis upon empirically-supported techniques

psychologists permitted to offer info

Psychologists permitted to offer info / advice in public forums (e.g., books, TV, radio, etc.) ... must ensure that is based on appropriate psychological knowledge and practice ... particularly important for internet, where monitoring & regulation are difficult at best

Psychologists who make evaluations

Psychologists who make evaluations for - - and who testify in - - court must base assessment / testimony on sufficient information to substantiate findings Psychologists responsible for accuracy / integrity of research findings presented for peer / public consumption

Research has demonstrated how inescapable shocks impaired immunological function in research animals who received it. What field of study would this research fall under?

Psychoneuroimmunology

M'Naghten Rule

Queen Victoria was infuriated ... demanded tougher rule M'Naghten Rule: Person can be declared insane if, at time of crime: did not know what he / she was doing, or did not know that what he / she was doing was wrong

Personality disorders prevalence

> 10% in general population Comorbidity: About 50% diagnosed with one Personality Disorder meet criteria for > 1 additional Personality Disorder Considerable comorbidity w/ anxiety-, mood-, psychotic-spectrum, and other major mental health disorders Cluster A: Paranoid : male > female Schizotypal: male > female Schizoid: female > male Cluster B: Antisocial, Narcissistic: male > female Borderline, Histrionic: female > male Cluster C: Avoidant: male ≈ female Dependent: female > male OCPD: male > female

Which of the following can a person who is found "guilty but mentally ill" expect?

A prison term, with a recommendation for treatment

Treatment: Personality Disorders

Rarely present for treatment Unlikely to experience significant personal distress Viewed as very difficult to treat Poor treatment adherence Little empirical evidence to support specific treatment strategies for most PDs Overall, drug therapy appears of little utility May reduce anxiety / mood-related Sx that may otherwise interfere with Tx progress, particularly for Cluster B Limited evidence that drugs with tranquilizing effects helpful for Antisocial PD

Accessing treatment: Availability

Recently enhanced via Mental Health Reform Act of 2016 -Strengthened enforcement of mental health parity laws -Eliminated Medicaid same-day exclusion rules -Enhanced how criminal justice system responds to mental health issues -Clarified health information privacy protections Still ... face shortcomings in what and how such services are available Not just in the United States

Which statement does NOT reflect evidence that supports expanding prescription writing privileges?

Reducing competition among medical doctors, psychologists, and psychotherapists. DO REFLECT: -patients could have greater access to the most commonly used psychiatric medications -promote comprehensive care for clients by allowing psychologists to be active in all aspects of treatment -meet the demand for mental health services that currently far exceed the supply of providers

Circumstances such as interpersonal conflicts, negative emotional states, or social pressures in the abstainers' life are addressed in which of the following?

Relapse prevention

civil commitment: early 1980's

Since early 1980's, greater emphasis on majority concerns Mental illness ≠ psychological disorder Mental illness = legal concept severe emotional disturbance, or severe thought disturbance negatively affecting health, safety

Which of the following is BEST supported by current research?

Social support seems to aid recovery in cancer patients.

Which of the following is true regarding the relationship between obsessive-compulsive disorder (an anxiety disorder) and obsessive-compulsive personality disorder?

Some people with obsessive-compulsive personality disorder also experience obsessive-compulsive disorder (an anxiety disorder).

Hypertension (HTN) & Stress

Stress and heart attack Long-term survival related to subsequent stress High stress without treatment → higher risk for later heart attack, 3 times more likely to die during 5-year follow-up

HIV: Reducing Disease Progression

Stress-reduction treatment before receipt of HIV antibody results Upon receipt of test results, treatment group: Less likely to show substantial increase in anxiety, depression Showed increases in immune system function Reduced disease progression among HIV+ subjects @ 2 year follow-up Keane et al. (2007) Integrated medical / psych treatment beneficial

HIV: Co-factors, Consequences

Substance use disorder = risk factor, consequence Mood, anxiety disorder 3 to 5 times higher than in general population Cognitive-motor effects: Reduced speed of motor functioning, reaction time, info processing Affective changes (e.g., anxiety, depression, apathy) Appear to reflect HIV effects on mid-brain regions Major neurocognitive disorder unlikely until advanced AIDS

How good are mental health professionals at predicting dangerousness?

All of these answers are correct: -They are better at accurately predicting short-term than long-term risks of dangerousness. -They tend to overestimate the likelihood that a patient will be violent. -They are wrong more often than they are right when predicting long-term violence.

What differentiates normal personality characteristics from personality disorders?

All the answers listed are correct: -the specific characteristics -the degree of inflexibility and maladaptiveness -the length of time one possesses the characteristics

Treatment outcome research

Also need to carefully assess just how effective are available therapeutic strategies? Treatment efficacy studies = lab-based, well controlled Careful selection of participants Brief interventions with specific outcome measures

Physiological response to stress

Sympathetic Nervous System Mobilizes resources during times of threat / danger With activation ...: heart beats faster blood flow increases respiration increases adrenal glands stimulated Hypothalamic-pituitary-adrenal (HPA) axis Hypothalamus → pituitary stimulate adrenal glands produce surge of epinephrine, cortisol Also note ... hippocampus sensitive to cortisol ... helps turn off stress response Higher cortisol levels may harm hippocampus, have adverse effects on cognitive abilities

Which of the following is a legal guideline in which insanity concerns an individual's inability to distinguish right from wrong in committing a crime?

The McNaughton rule

A class action suit was brought by the state of Alabama for not providing either mental patients or institutionalized developmentally disabled individuals with a minimum degree of treatment. Which of the following was the result of this suit?

The Wyatt v. Stickney rule

The degree to which substance use varies is dependent on all EXCEPT which of the following?

The addictive nature of the substance. ARE DEPENDENT: -the dosage of the drugs taken -the tolerance to the substance -the person's expectation of the substance's effect

Which of the following BEST describes the "right to refuse treatment" for those who are involuntarily committed?

There is no single "right to refuse treatment" protocol under all situations due to the complexities of the issue.

Internet Addiction and Gaming Disorder

Among potential challenges of increasing engagement with tech ... Under consideration for future editions of DSM: Internet Addiction "clinically significant" levels of interaction with tech Internet Gaming Disorder Preoccupation with internet games Tolerance ... need more such activity to achieve the same thrill Withdrawal symptoms when removed from such activity A variety of other symptoms similar to those seen with substance-related disorders

Overview: Cluster C Personality Disorders

Anxious / fearful Avoidant [AvPD], Dependent [DPD], Obsessive-Compulsive [OCPD] Central features ... Excessive worry; tend to hold feelings in Tend to be subdued Experience / express excessive concern about ethical guidelines

Cluster C Personality Disorders

Anxious / fearful Avoidant, Dependent, Obsessive-Compulsive Characterized by excessive worry, anxiety and by tendency to: ... hold feelings in ... be subdued ... experience / express excessive concern about ethical guidelines

Which of the following factors is NOT necessarily associated with increased gambling?

Are associated: stress, boredom, depression aren't: anxiety

What cultural differences are seen in people of Asian descent that makes them less susceptible to alcohol use disorders?

Asian groups have a deficiency in an enzyme that assists in the breakdown of alcohol during metabolism, causing unpleasant side effects.

Which of the following is assumed about the mental status of an individual awaiting trial?

They are competent to stand trial.

Hypertension (HTN) & psychosocial factors

Association with personality factors: negative emotions (e.g., anger, hostility), their suppression more likely in African Americans association stronger with increasing age -African American men: 43%, women: 47.5% -Mexican American men: 27.8%, women: 28.9% -White men: 33.9%, women: 31.3% -all men: 34.1%, women: 32.7% -Associated with social factors: loneliness, depression, uncontrollability

Which of the following statements is NOT generally true of those with antisocial personality disorder?

They care for no one's safety, except theirs and their children's. ARE TRUE: -They lie very frequently. -They are careless with money, and often do not pay their debts. -They have little regard for their own safety or the safety of others.

Which of the following is NOT a direct cause that may lead an individual with a mental disorder diagnosis to become involved in the criminal justice system?

They have been diagnosed with schizophrenia or bipolar disorder. ARE DIRECT CAUSES: -their disturbed behavior put others in danger -they have acted in ways that led others to doubt their ability to make their own decisions in life -their behavior may be a threat to themselves

Which of the following is the underlying concern regarding involuntary civil commitment?

Balancing the civil liberties of the individual and the concerns of the larger society.

Bereavement is a normal stress reaction

Bereavement is a normal stress reaction; grief, sadness, loss of appetite, and sleep disturbances are common parts of a typical grief response-so normal that we might consider the absence os such reactions after the unexpected loss of a loved one as abnormal.

Psychophysiological disorders

Best known: -Ulcers ... asthma ... insomnia ... headache ... coronary heart disease ... hypertension To this list you may add: -Ulcerative colitis ... fibromyalgia ... irritable bowel syndrome ... chronic fatigue syndrome (among others)

HIV: Prevention

Best to change high-risk behavior Needle exchange programs and prophylaxis also beneficial PEP: Post-Exposure Prophylaxis PrEP: Pre-Exposure Prophylaxis Effects of educational programs often short-lived Behavioral approaches that instill self-efficacy, control appear most effective Behavioral interventions at least moderately effective in producing changes about knowledge about HIV and risky behavior ... even among high-risk groups such as people with severe mental health disorder (e.g., Brady et al., 2008) and people who abuse club drugs (e.g., Mimiaga et al., 2014)

Causes

Biological Intrapersonal / Intrapsychic Interpersonal Environmental Cultural Societal Political? May not be able to specify relative influence Must acknowledge synergistic influences

biological cost of adapting to stress

Biological cost of adapting to stress = allostatic load Represents physiological consequences of chronic exposure May have implications for physical or mental health functioning

Durham v. United States (1954)

Broadened criteria for insanity: include presence of "mental disease or defect" based in part on belief that entire range of functioning should be considered Unfortunately, mental health professionals couldn't reliably assess cause of criminal behavior

Public perception of mental illness

Burden of mental health stigma is tremendous. Research suggests that many in general public view MI as: -Willful -Offensive -Personal / moral failing - Social stigma undoubtedly strengthened by media depictions of mentally ill.

Which is NOT a risk for the effects of long-term, extensive, and chronic alcohol abuse?

Cardiac arrhythmia ARE RISKS: hepatic cirrhosis, accumulation of fat in the liver, cardiac arrythmia

Categorical v Dimensional

Categorical: Both DSM- and ICD- Catalogue of behaviors, traits All-or-nothing Categorical strategy assumes: problematic traits present or absent PDs are displayed or not displayed Not troubled by personality traits outside target Personality Disorder

Original course goals

Challenge conceptions of "normal" and "abnormal" Challenge stereotypes about people living with MH disorders Examine biological, psychological and social contributions Examine assessment, classification strategies Examine treatment options and effectiveness

Child neglect and inadequate parental care

Child neglect and inadequate parental care can result in reactive attachment disorder and disinhibited social engagement disorder in children

Variations Civil versus Criminal Commitment

Civil: Treatment needed b/c of danger to self, others, or gravely disabled Criminal: Accused of crime, detained in MH facility to assess as fit / unfit to participate in legal proceedings Found NGRI (or similar) and referred to MH facility for treatment until "cured" Most with obvious, severe impairments never come to trial For those remanded for treatment, may remain longer than if found guilty and imprisoned

__________________ must complete doctoral level training leading to either the Ph.D. or Psy.D. degree, which generally require four to six years of school beyond the bachelor's degree.

Clinical psychologists

______________personality disorders tend to present symptoms that observers consider odd or eccentric.

Cluster A

most recent stress definitions include:

Condition where expectations do not match perceptions of internal or external environment Stress: operates at unconscious level Distress: conscious awareness of impact

Which of the following is one of the most important ethical responsibilities of psychologists that protect the privacy of the person seeking treatment?

Confidentiality

Ethical considerations

Confidentiality: Cannot share info gathered in treatment / assessment unless: With consumer's explicit permission Reporting back to referring clinician Consultation with clinical supervisor Required to facilitate patient care Exceptions: -duty to warn / potential for self-harm -evidence of grave disability -abuse / exploitation of dependent child, dependent adult, elderly

Controversies re: diagnosis

DSM-5 not beloved by all May lead to over-diagnosis, unnecessary treatment Could this lead to an increase in claims that mental illness lead to criminal behavior? NIMH launched Research Domain Criteria (RDoC) Project to transform diagnosis by incorporating genetics, imaging, & related information to facilitate development of a new diagnostic system

Amer Law Institute Rule (1962/1972)

Defendant not responsible if: ... due to mental disease, defect, lacks capacity to: ... appreciate wrongfulness of conduct, or ... conform conduct to requirements of the law Refined definition of mental disease / defect: Any abnormal condition of mind which: ... substantially affects mental / emotional processes ... impairs behavioral controls Included provisions for diminished capacity Comprehension, intent could be determined by MI Moral responsibility for criminal act presumed due to MI

Selye

Defined stress as... -biological syndrome -reaction to shock to organism's system -disruption of stable, internal balance (organismic homeostasis)

Schizotypal PD

Defining characteristic - pervasive social isolation / interpersonal deficits - cognitive / perceptual distortions, behavioral eccentricities Seem outwardly odd, unusual, bizarre Can appreciate their unusual experiences Diagnostic criteria include: Odd beliefs, thinking, speech, behavior, appearance Unusual perceptual experiences Suspiciousness / paranoia Inappropriate or constricted affect Lack of close friends / confidants; excessive social anxiety

Histrionic Personality Disorder

Defining characteristics: - Excessive emotionality & attention-seeking behavior Diagnostic criteria include: - Need to be center of attention - Lively, dramatic ... appearance used to attract attention - Superficial charm ... emotionally shallow, unstable - Highly suggestible ... easily influenced by others, fads - May act out roles in relationships

Narcissistic Personality Disorder

Defining characteristics: - Grandiosity, self-importance, need for admiration, lack of empathy Diagnostic criteria include: - Preoccupied w/ fantasies of importance / impact - Use / exploit others for own interests - Expect to be superior participant in relationships - Workaholics ... yet often fail to live up to expectations

Borderline Personality Disorder

Defining characteristics: - Intense, unstable relationships, self-image, affect Diagnostic criteria include: - Frantic efforts to avoid "abandonment" - Overly sensitive to risk of separation / rejection - Relationships marked by idealization / devaluation - Suicidal behavior / gestures / threats, or self-mutilation

Schizoid PD

Defining characteristics: - detachment from social relationships - restricted range of interpersonal emotional expression Diagnostic criteria include: Neither desires nor enjoys close relationships, intimacy Almost always chooses solitary activities Takes pleasure in few activities Indifferent to external praise, criticism Emotional coldness, detachment, flattened affect

Paranoid PD

Defining characteristics: - pervasive unjustified distrust - tendency to isolate, in part because of suspicions regarding others' motives Diagnostic criteria include: Questions other's loyalty Reads hidden meanings into others' actions Persistently bears grudges Perceives attacks on character / reputation

Defining characteristics: Personality Disorder

Defining characteristics: Insensitivity / indifference to others' rights Lying, stealing, cheating ... Constitute a major social, legal, and MH concern To meet diagnostic criteria: - behavior must be of long standing - must be > 18 y/o - must have substantial hx of conduct d/o (before 15 y/o)

Dependent Personality Disorder

Defining characteristics: pervasive need to be taken care of submissive / clinging behavior, fears of separation Diagnostic criteria include: Difficulty making decisions Passive ... others resp. for major / critical decisions Leans on parents / spouse for advice, emotional support Difficulty expressing disagreement Overly sensitive to disapproval Works to meet other's expectations

Obsessive-Compulsive Personality Disorder

Defining characteristics: pervasive preoccupation w/ orderliness, perfectionism, mental and interpersonal control Diagnostic criteria include: Tries to maintain sense of control Overly involved in process ... project often unfinished Excessive devotion to work, productivity May set unreasonably high standards for self, others Never satisfied with performance Reluctance to make decisions due to fear of mistakes

Avoidant Personality Disorder

Defining characteristics: social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation Diagnostic criteria include: Avoids activities involving significant conflict Avoids making new friends unless sure of acceptance Restrains / withholds intimate feelings Marked sensitivity to criticism / social rejection Reluctance to take risks / try new activities Often closely watch movements, expression of close contacts Fearful, tense manner may elicit ridicule; shy, timid, lonely, isolated

Homelessness and mental health: despite increasing advocacy

Despite increasing advocacy ... ... those who lack access to stable housing and with a history of mental illness struggle with: -Discrimination -Victimization -Financial / practical impediments to care Often, such resources are among the first casualties of budgetary shortcomings

Insanity defense difficulties

Difficulties ... determination of state when crime committed (difficult!) what to do when "sanity restored"? what prevents "temporary insanity" from recurrent? Not guilty by reason of insanity hospitalized, treated until "cured" ... may be longer than if found sane, guilty, and imprisoned (NOTE: John Hinckley conditionally released on Sep 12, 2016 ... after more than 30 years of evaluation and treatment following attempted murder of US President Ronald Reagan)

Big Five

Dimensional model of personality that emphasizes the mixture of five main factors: openness to experience, conscientiousness, extroversion, agreeableness, and neuroticism

Dimensional:

Dimensional: PD represents extreme variations of normal traits Focus on degree to which attributes may be present and have adverse impact of functioning Example: Emotional dependence -----------------------------------|---------------------------------- Dependent Independent

What are Personality Disorders?

Disorders of traits; enduring, maladaptive ways of: perceiving ... relating to ... thinking about ... the world and oneself Distinct from other major disorders in that ... suffering often outside of own awareness behavior does strike friends, family, others as odd, deviant, abnormal

Cluster B Personality Disorders

Dramatic / Emotional / Erratic Includes: Antisocial, Borderline, Histrionic & Narcissistic Central features: Inappropriate / extreme overt behavior Failure to conform to social norms Seen as self-centered

Overview: Cluster B Personality Disorders

Dramatic / emotional / erratic Antisocial [ASPD], Borderline [BPD], Histrionic [HPD], Narcissistic [NPD] Central features ... Inappropriate and/or extreme overt behavior Failure to conform to certain social norms May be seen by others as self-centered

Which conclusion does NOT support a behavioral explanation for drugs as reinforcers?

Drugs are generally not unconditional reinforcers and do not offer rewards. DOES: -Conditioned stimuli elicit craving -Discriminative stimuli set the occasion for use -conditioned reinforcers maintain the chain of behaviors which lead to drug ingestion

What did the ruling from the case of Tarasoff v. Regents of the University of California establish regarding limits to confidentiality?

Duty to warn someone whom your patient threatens to harm.

Review: general diagnostic criteria

Enduring patterns of perceiving / relating to / thinking about self / environment ... > 2 areas: a. Cognition b. Affect c. Interpersonal d. Impulse control Inflexible, pervasive Leads to significant distress or functional impairment Stable ... long duration Diagnosis primarily reserved for those > 18 y/o

Protection and Advocacy for Mentally Ill Individuals Act (1986)

Established series of protection, advocacy agencies -investigate charges of abuse, neglect -act as legal advocates Foundation for local, state, federal regulations for people: -involuntarily confined -about to be admitted -confined to detention facility -living in community settings

Perceived risks to others: events

Events such as these may lead one to suspect that all individual with a history of mental illness pose elevated risk for violent behavior Still ... most with a history of mental illness are never aggressive / violent Rather ... more likely to be victims than perpetrators

Confidentiality exceptions

Exceptions: - Insurance prior authorization - Internal peer review / treatment teams - Case presentation / grand rounds - Summary of assessment / treatment evaluation Special circumstances permit release of confidential info: - Risk to harm self, others - Inability to provide / seek care for self (grave disability) - Evidence of abuse / exploitation of child, dependent adult, elderly

Females tend to gamble for excitement, while males tend to gamble in order to "escape" from life.

False

Antisocial Personality Disorder

Features include: Superficial charm Lack of remorse or shame Self-centeredness Poor judgment Lack of emotional responsivity Absence of nervousness or anxiety Absence of delusional thinking

Treatment outcome research. findings

Findings: Efficacy ... differences in impact of options Effectiveness ... no advantage for specific options Why such different findings? Effectiveness methodology flawed problem = internal validity Efficacy methodology flawed problem = external validity

Treatment: Borderline PD

Focus on defensive style, interpersonal needs Dialectical Behavior Therapy (DBT) Combines individual, group (psycho-ed) tx Individual tx ... stresses development of interpersonal, self-regulation, distress tolerance skills Treatment frequently complicated by problems with substance abuse, suicidal thoughts / gestures, non-adherence

Patients' rights: Confidentiality

For those who do seek assistance ... Confidentiality is of paramount importance! With certain limitations ... clinical info not shared outside prof relationship w/o (written) permission Both ethical and legal guideline Health Insurance Portability and Accountability Act (1999) (HIPAA) limits transfer of any identifying / clinical data

Civil commitment: How does law fit circumstances?

How does law fit circumstances? -for Aaron Alexis (Maryland / Washington DC)? -for Stephen Paddock (Nevada)? -for Julie Tejada (MA)? -for Patrick Crusius (TX)? One can always request voluntary admission ... no guarantee does not represent civil commitment

Cardiovascular disease

Hypertension (HTN) Secondary: known cause (e.g., excess dietary salt) Essential: no verifiable physiological cause; assumed due to physiological and psychological factors > 33% population > 20 y/o have HTN Majority (~90%) have no verifiable physiological cause 20-64 y/o: male ≥ female 65+ y/o: female ≥ male

Competence to stand trial: incompetent

If determined incompetent to stand trial: lose authority to make decisions face commitment to a mental health treatment facility Most with obvious, severe impairment never come to trial After reasonable time, must be: found competent committed under civil law, or discharged

How did the U.S. Supreme Court ruling in Jackson v. Indiana (1972) affect the rights of legally incompetent individuals to be protected from unreasonable detention?

If it appears that the individual is not likely ever to be found competent to stand trial, then either civil commitment for involuntary hospitalization should be initiated or the person should be released.

Treatment: continued Rx

Is continued Rx development necessary? Dan Ariely & associates studied the effectiveness of "newly approved pain killer" among healthy research subjects. 85% in Full Price condition reported reduction in pain 61% in Low Price condition reported reduction in pain

Which defendant was found not guilty by reason of insanity?

John Hinckley Jr.

Differences in practice

Level of independence Greater independence in practice with higher degree Admitting privileges May be limited to MD; PhD in some settings Prescription privileges MD (CNS in some settings) Area of greatest recent change; psychologists gaining ground in select jurisdictions Therapeutic practice Decreased application of psychotherapy among psychiatrists in recent past

Recent changes in conceptual models

Throughout semester ... -reviewed causal evidence for specific disorders -models suggest behavioral, biological, cognitive, interpersonal, intrapsychic, social factors that cause disorder Recent emphasis on transdiagnostic approach -Causal models emphasize similarities of psychological processes across diagnostic categories Example: Unified Protocol (BU CARD) -Assumes common causal factors; applies across disorders -Helps patients learn new ways of responding -Combines elements of mindfulness, cognitive therapy and behavioral therapy

Competence to stand trial

Thus far, assumption that defendant able to understand charges and participate in trial. What if that is not true?

When is involuntary hospitalization based on rules governing civil commitment employed for mentally disturbed individuals?

To provide protection and treatment to unwilling persons who may be dangerous to self or others.

Treatment outcome research: effectiveness

Treatment effectiveness studies = real world Participants less carefully screened More treatment variability More global outcome measures

Prescription writing practices have increased and have spread from psychiatrists to non-psychiatric physicians, including family doctors and pediatricians.

True

Substances that are faster-acting tend to cause more problems with dependence, while slower-acting substances present less of a risk for dependence.

True

The American Law Institute issued a comprehensive standard that clarified the term "mental disease or defect" to exclude sociopathic behavior, conduct disorder, and antisocial personality disorder.

True

Efficacy vs. Effectiveness

Truth? Likely somewhere in between To date the American Psychological Association has endorsed treatment efficacy research as the gold standard model for future research to help identify the most effective strategies clinicians may offer, and to offer recommendations for how to best match treatment with disorder

Causal factors: ASPD (biological)

Twin studies: concordance for criminality Identical > fraternal twins Prenatal exposure and birth complications: maternal smoking during pregnancy, fetal alcohol exposure, low birth weight Physiological arousal / reactivity: slower, weaker responses to emotionally-charged cond lower resting heart rates, skin conductance responses less activity / lower response in frontal lobes

Psychological treatment of physical disorders

Unlike w/ exposure therapy (e.g., for Specific Phobia), when may not want to use such techniques ... Relaxation training, biofeedback, meditation, hypnosis, others beneficial against hypertension Alone and in combination these may also help with: -Headaches, insomnia, asthma, diabetes, chronic pain, irregular heartbeat, and others

Therapy for all: Vikram Patel (2012)

Vikram Patel (2012) -need to educate others in the community about mental health -Do you think the application of similar resources in a variety of contexts would change the degree to which available services are perceived as more or less attractive to or as potentially more or less useful for consumers? Would such a change in service delivery change patterns of treatment utilization? If so, in what settings and for what reasons would the potential perception of such services be influenced?

Competence to stand trial: cases

Washington v. Harper (1990) Involuntary antipsychotic medication only if danger to self / others Riggins v. Nevada (1992) Involuntary antipsychotic medication only if necessary to a government interest

Treatment: placebos

What they didn't (initially) know was that all study drugs were actually placebos! Ariely et al. argued that in clinical settings, similar effects may be observed for many reasons, including: - misdiagnosis - initial symptoms relief mistaken for "cure" - psychological distortion of reality Wonder ... how much should we continue to invest in further treatment development?

Dimensional approaches

Will review dimensional approaches - - including five factor model - - in discussion section. DSM-5 describes new, experimental, "five factor" dimensional approach that will be subject to additional review ("Personality Disorder Trait Specified").

The Wyatt v. Stickney (1971) decision forced state hospitals to provide ____________________.

adequate treatment

Recent HIV-related clinical and research findings indicate that _____________________.

all are true: -changing patterns of engagement in high-risk behavior is the most effective strategy for preventing its spread -the prevalence of mood, anxiety, and substance-related disorders is dramatically higher among adults living with HIV-spectrum disease than in the general population -behavioral treatment approaches may enhance patients' adherence to HIV medication regimens

majority of mental disorders

although the majority of those with mental disorders are not dangerous to others, the presence of a mental disorder is associated with a significant increase in the likelihood of violence. The link is strongest for those with substance use disorders.

confidentiality

an ethical obligation on the part of the therapist not to reveal sensitive information to others

diathesis-stress model

an model of mental disorders that proposes they develop when an individual with a predisposition (diathesis) experiences significant psychological stress

Buphrenorphine is a partial _________________ that blocks receptor sites that opiates activate, and as a result, may make relapse less likely by reducing the effects of the opiates when it is present.

antagonist

According to the Model Penal Code, which diagnosis would probably be disqualified for a "not guilty by reason of insanity" plea?

antisocial personality disorder

psychopath

antisocial personality involving characteristics such as lack of empathy or concern for others, frequent rule violations, impulsivity, and superficial charm

Cruelty to animals and people, destruction of property, and truancy before the age of 15 ____________________.

are characteristic of those later diagnosed with antisocial personality disorder

conditional taste aversion

aversion to a novel flavor, produced by pairing of that flavor with nausea or illness

All of the following could lead to PTSD except_________

bankruptcy COULD lead: combat, fire, tornado

The use of written materials that may have life significance is called________________.

bibliotherapy

Dialectical behavior therapy (DBT) is effective in treating which of the following?

borderline personality disorder

Lisa felt like she was on an emotional roller coaster. She felt angry and empty. Lisa's feelings are MOST similar to those of someone with ____________________.

borderline personality disorder

Extreme Risk Protection Orders (ERPO)

cal response to potentially elevated risk for harm to self or others 15 states and Washington DC have ERPO - - or "Red Flag" laws - - in effect (Hawai'i, Nevada: January 2020) Similar to civil commitment ... begins with petition to law enforcement, court Allows law enforcement officials to temporarily confiscate firearms for a brief period - - days or weeks - - until judicial hearing is held to determine degree of treat posed by subject Following judicial review, final orders may be in effect for months, years

Criticisms of the insanity defense point to all of the following EXCEPT that ____________________.

clinicians are biased to assume that people have free will and are responsible for their actions ARE: -in a given case, the testimony of clinicians is often not in agreement -clinicians are trying to evaluate the defendant's state of mind during a time that is long past -the insanity defense allows some dangerous people to escape punishment

One effect of the stress hormone______ is to suppress immune response.

cortisol

A psychologist wanted to accept a female client with whom he had previously had a sexual relationship. According to ethical guidelines, the psychologist ____________________.

couldn't see the patient

courts have established

courts have established a right to treatment for those hospitalized with mental disorders. Courts have also established a right to receive treatment in the least restrictive setting that is appropriate.

Which of the following are limitations on confidentiality except________

criminal activity

If a person accused of a crime is found "not guilty by reason of insanity", he or she is committed to a psychiatric facility for treatment. This is called ____________________.

criminal commitment

A person with a mental disorder could be civilly committed if he or she were___________.

dangerous to self or others

In the__________of mental disorders, the predisposition for a particular disorder is considered to be biological, genetic, or psychological in origin.

diathesis-stress model

The _________________ model that explained substance dependence was generally viewed as a progressive, degenerative condition.

disease

sympathetic nervous system

division of the autonomic nervous system primarily involved in stress or emergency reactions that, for example, produce an increase in heart rate and blood pressure

parasympathetic nervous system

division on the autonomic nervous system primarily involved in conservation of energy, such as increasing digestive processes

A therapist who broke confidentiality with a patient without the patient's consent because of fears that the person would harm someone else was likely acting according to the ethical principle of _____________.

duty to protect/duty to warn

effective treatments for stressor-related disorders

effective treatments for stressor-related disorders include stress management, exposure techniques such as systematic desensitization and cognitive-behavioral therapy, and some antidepressant medications such as SSRIs

The Cluster B personality disorders include individuals who may be described as_____________.

emotional or dramatic

Jevon constantly strives to be the center of attention, yet the ideas they so eloquently expresses are usually shallow and changeable. If they were diagnosed with a personality disorder, it MOST likely would be ____________________.

histrionic

Maintaining___________is a general term referring to equilibrium in a dynamic system.

homeostasis

homeostatic mechanism

in the autonomic nervous system also serve to restore equilibrium after imbalances have occurred-homeostasis is a general term referring to equilibrium in a dynamic system

privileged communication

information disclosed to a therapist that cannot be legally revealed without the written consent of the patient

People with avoidant personality disorder have difficulty ____________________ relationships, while people with dependent personality disorder have difficulty ____________________ relationships.

initiating; ending

A U.S. Supreme Court ruling (Atkins v. Virginia, 2002) prohibits execution of those who are__________

intellectually disabled

trauma

intense stressor involving threat of death, serious injury, or violence to self or others

Inferred emption

investigators usually infer emotions from three sources: verbal report (I'm angry), behavior (hitting another person), or physiological responses (increased blood pressure).

Behavioral Medicine

knowledge derived from behavioral science is applied to the prevention, diagnosis, development, and treatment of medical problems -it is interdisciplinary

If a patient is assigned to treatment at a community mental health center instead of inpatient treatment at a mental hospital, the decision makers are likely applying the principle of ____________________.

least restrictive environment

Irresistible impulse rule

legal guideline that insanity concerns a person's inability to resist committing the crime

McNaughton rule

legal guideline that insanity concerns an individual's inability to distinguish right from wrong in committing the crime

Durham rule

legal guideline that insanity concerns the extent to which the criminal act was a product of mental disorder

Although the sex ratio varies, _________________ are MORE commonly diagnosed with substance-related disorders than _________________.

males; females

mathematical studies of personality

mathematical studies of personality assessments tend to support a dimensional model of personality disorders rather than the current categorical model of personality disorders used by DSM-5

factor analysis

mathematical technique to analyze a matrix of correlations to reduce dimensions and identify factors that may simplify the relationships

In recent years, public advocates for those with mental disorders have turned their attention to the rights of ____________________ to receive treatment.

mental patients in the community

In _________________, the therapist presents information that may highlight the discrepancy of symptoms and likely outcomes of continued substance use but presents no arguments about the need for change.

motivational interviewing

Frank believes he is more important than he really is. He has a grandiose sense of self-importance and is preoccupied with fantasies about his own success and brilliance. Frank would best be described as having______________.

narcissistic personality disorder

Ty is fairly handsome, but not as handsome as he thinks he is. He doesn't care about anyone but himself, is sure that everyone around him feels the same way, and expects to be the dominant figure in all personal and business relationships. He is MOST likely experiencing ____________________.

narcissistic personality disorder

currently, most psychotropic medications are prescribed by______

nonpsychiatric physicians

The reduction in activity of the immune system when a person is under stress is related to the activity of the neurotransmitter ____________________.

norepinephrine

One similarity between those experiencing paranoid personality disorder and those experiencing schizoid personality disorder is that individuals in both groups tend ____________________.

not to have close ties to others

phrenologist

one who attempts to describe personality by feeling the bumps on a person's skull

psychometrician

one who studies the measurement, assessment, and testing of psychological attributes

To which of the following does competency refer?

one's ability to understand legal charges and assist in own defense

sanity refers to which of the following?

one's legal ability for criminal acts

_______________individuals initially diagnosed with schizotypal personality disorder go on to develop schizophrenia.

only a small percentage of

The most common personality disorder diagnosis is most likely_____________.

other specified personality disorder

Reese is distrustful of others and reacts quickly to perceived threats. Even though she has no evidence to support this claim, she is sure her wife is unfaithful. She finds it almost impossible to forgive those she thinks have wronged her. Reese displays the characteristics of ____________________.

paranoid personality disorder

Which of the following personality disordered individuals would have recurrent suspicions, without justification, regarding the fidelity of a spouse or sexual partner?

paranoid personality disorder

parasympathetic division

parasympathetic division functions to conserve and restore, rather than expend, bodily resources; thus activation results in slower heartbeat and dilation of skin and visceral blood vessels

The_________is the division of the autonomic nervous system that functions to conserve and restore, rather than expend, energy.

parasympathetic nervous system

____________is not one of the chronic stressors cited in this text.

pending surgery

personality disorder may affect 9% of the population

personality disorder may affect 9% of the population, within clinical samples, nearly half of persons receiving any DSM diagnosis also meet the criteria for some type of personality disorder diagnosis

personality disorder symptoms generally cluster in three groups

personality disorder symptoms generally cluster in three groups: those that are odd or eccentric; those that are dramatic, emotional, or erratic; and those that are anxious or fearful

The authors of DSM-5 have designed their own dimensional approach to diagnosing personality disorders for possible inclusion in future revisions of the DSM. The idea is that individuals whose traits significantly impair their functioning should receive a diagnosis of ____________________.

personality disorder trait specified

personality disorders are enduring

personality disorders are enduring and stable styles of thinking, perceiving, and behaving across many settings and situations that are evident at least since early adulthood and that cause distress for the person or for others

agreeableness

personality factor associated with a tendency to be caring, helpful, and cooperative

conscientiousness

personality factor associated with a tendency to be organized, self-disciplined, and responsible

openness to experience

personality factor associated with a tendency to show imaginativeness, independence, and preference for variety

extroversion

personality factor associated with the tendency to be outgoing or socially gregarious

neuroticism

personality factor associated with the tendency to experience negative emotions

Psychoticism

personality factor associated with the tendency to show aggressiveness and interpersonal hostility

The_______gland is often referred to as the master gland.

pituitary

norepinephrine

plays a part in the chemical transmission of nerve impulses in the brain and from the end of sympathetic nerves to the smooth muscles of the viscera and blood vessels

autonomic nervous system

portion of the nervous system that controls the functioning of many internal bodily processes, such as heart rate, digestive processes, and so on

post-traumatic stress disorders

post-traumatic stress disorders may be conceptualized as intense conditioned fear responses produced by unpredictable and uncontrollable traumatic events

Relaxation training, biofeedback, meditation, and hypnosis all illustrate the use of _______________.

psychological treatments for physical illnesses

psychologists have the ethical obligations

psychologists have the ethical obligations to maintain confidentiality and the legal responsibility to protect privileged communications, however there are special circumstances that limit confidentiality and privilege

A main issue in Wyatt v. Stickney (1971) concerned the right to____________

receive treatment

A model that emphasizes the interaction of likelihoods of monetary reinforcement and a tendency to value discounted delayed rewards is called _________________.

rule-governed behavior

People with____________are largely indifferent to criticism.

schizoid personality disorder

The disorder that appears to be MOST closely related to the schizotypal personality disorder is ____________________.

schizophrenia

verdicts in states

some states have included verdicts such as "guilty but mentally ill" in which the person must serve out a sentence while receiving whatever treatment seems appropriate

homeostasis

state of equilibrium or balance in a dynamic system

stressors and trauma

stressor- and trauma-related diagnosis in the DSM-5 range from normal response patterns (bereavement) to time-limited impairment (adjustment disorders) to severe, long-lasting, or delayed impairments (post-traumatic stress disorders)

stressors impairment

stressors can also impair the functioning of the immune system, through Pavlovian conditioning, neutral stimuli such as novel flavors can take on some of the immunosuppressive properties of drugs with which they have been paired. In stress studies, unpredictable or uncontrollable stressors appear to produce greater reduction in immune functioning.

prolonged stressors

stressors that are prolonged or intense can have damaging effects to health, stressors that are experienced as unpredictable or uncontrollable appear to have the most harmful health effects

strong emotions

strong emotions play a central role in many psychological disorders, responses of the autonomic nervous system are especially important physiological accompaniments of these emotions

Ader and Cohen's (1975) study of conditioned immunosuppression showed which of the following?

susceptibility to illness may be influenced by learning history

If you hear strange noises in the middle of the night and believe there is a burglar in your home, this stress would activate which division of the autonomic nervous system?

sympathetic nervous system

negative feedback loop

systems in which forces are set in operation by the original response and tend to dampen or reserve that response

U.S. Supreme Court ruling

the U.S. Supreme Court has ruled that persons who are labeled mentally ill cannot be confined against their will without treatment if they are not dangerous to themselves or others and are capable of surviving on the outside

Individuals with antisocial personality disorder frequently are able to talk their way out of difficult situations and may "con" others into believing their good intensions for the future, demonstrating their________.

the ability to make a good impression on others

the autonomic nervous system

the autonomic nervous system primarily regulates the internal environment of the organism by facilitating or inhibiting digestive and eliminating processes, distributing blood flow toward or away from the heart and skeletal muscles, increasing or decreasing oxygen intake, and so on.

involuntary commitment

the process of involuntary commitment involves a conflict between two social concerns: the right of society to protect itself from dangerous persons (and the desire to provide treatment for those who lack sufficient understanding to take care of themselves) versus the civil liberties of the individual

personality

the stable and enduring pattern of relating to oneself and the world

Psychoneuro-immunology

the study of neural effects of psychological events on the immune system

progressive relaxation

the systematic tensing and relaxing of specific muscle groups

institutionalization

the tendency for residents of an institution to become less able to function in the outside world the longer they remain within the institution

bibliotherapy

the use of selected written materials that may have particular life significance as an adjunct in psychotherapy

significant overlap between personality disorders

there is a significant overlap among the different personality disorders and between personality disorders and several other mental disorders; the degree of comorbidity raises questions about the validity of the personality disorder categories; diagnostic reliability also continues to be a problem for these conditions

Dr. Brown believes that personality is a collection of psychological characteristics, such as kindness or dependability, which can be identified and measured. She would be best described as a__________.

trait theorist

treatment of personality disorders in difficult

treatment of personality disorders in difficult; people diagnosed with these conditions often do not seek treatment and may be uncooperative patients; several psychological and pharmacological interventions have been attempted, but there is only limited evidence of their effectiveness

The Durham (1954) test judges a person NOT to be criminally responsible if he or she has acted ____________________.

under the influence of a mental disease or mental defect

The debate over whether someone should be involuntarily hospitalized based on rules governing civil commitment __________________.

varies from state to state

cause of personality disorders

very little is known about the cause of personality disorders, which are presumed to originate in adolescence. Family studies tend to support either weak or only moderate genetic influences.

voluntary competent patients

voluntary competent patients can refuse treatment for a mental disorder, it is not clear whether involuntary committed patients can refuse treatment, courts have supported emergency treatment of involuntary patients who are dangerous without their consent

A clear implication of the Tarasoff decision is that the therapist should do which of the following?

warn a person whom the client has specifically threatened to harm

general adaptation syndrome

which consists of three stages: the alarm stage, in which physical resources are mobilized following the recognition of the stress event; the resistance stage, involving coping responses to the ongoing challenge, and if the stress challenges persist long enough, the exhaustion phase, in which coping resources are depleted and the body suffers permanent damage or death.

The symptoms of _________________ are nearly always accompanied by craving for the substance, and the administration of the substances will reverse the symptoms.

withdrawal

In legal terms "competency" is to "sanity" as__________

"trial" is to "crime"

(Involuntary) civil commitment proceedings

(Involuntary) civil commitment proceedings Parens patriae Civil commitment authorized when person might be harmed because he / she is unable to secure basic necessities or is unable to recognize her / his need for treatment Permitted when several conditions met: person has "mental illness" and needs treatment, or person dangerous to self or others, or grave disability (person unable to care for self) Many states also allow for outpatient civil commitment

Triadic design

-Experimental subject (signaled or escapable shock) -Yoked subject (receives same shock as experimental subject but without warning or escape ability) -Control subject (No shock)

The DSM-5 lists_________different primary personality disorders.

10

According to Holmes and Rahe (1967), the death of a spouse was assigned a value of_________life change units.

100

sympathetic and parasympathetic response

-Heart: --sympathetic response: rate increases, force of contraction increases --parasympathetic response: rate decreases -Lungs: --sympathetic response: air passage dilate --parasympathetic response: air passages constrict -Blood vessels: from heart to skeletal muscles, from heart to viscera (stomach, intestines, colon) --sympathetic response: dilate: blood flow increases constrict: blood flow decrease --parasympathetic response: constrict: blood flow decreases dilate: blood flow increases -stomach: --sympathetic response: inhibits secretion of acid and pepsin --parasympathetic response: secretes acid and pepsin -salivary glands: --sympathetic response: inhibited --parasympathetic response: secrete saliva -liver: --sympathetic response: releases sugar --parasympathetic response: none -colon: --sympathetic response: inhibited --parasympathetic response: tone increases -rectum: --sympathetic response: inhibited --parasympathetic response: releases feces -genitals: --sympathetic response: ejaculation (males), blood vessel constriction (females) --parasympathetic response: erection (males), blood vessel dilation (females) -eyes --sympathetic response: pupils dilate --parasympathetic response: pupils constrict -sweat glands and palmar surfaces: --sympathetic response: secrete sweat --parasympathetic response: none -adrenal medulla glands: --sympathetic response: secrete epinephrine (adrenaline) and norepinephrine (noradrenaline) --parasympathetic response: none

acute stress disorder

-Key symptom: after exposure to intense trauma, recurrent recollection and distress related to the trauma with marked arousal. -Minimum duration of diagnosis: 3 days. -sex ratio: more common in females

Animals injected with saline

-Selye concluded that experimental procedures, conditions---->adverse outcomes -underlying cause...stress

Selye stages to chronic stress

-body goes through several stages in response to chronic stress...General Adaptation Syndrome --alarm reaction...body prepares to flight or flee --resistance...mobilize coping mechanisms --exhaustion..resulting in illness, even death

Stress

-brief exposure to stressors may enhance functioning -long-lasting exposure-->deterioration -biological..psychological..social stressors may have similar effects

stress

-how do you define stress? --Hans Selye (study of effects of chemicals on health of lab rats, test rats injected with chemical extracts, "control" rats injected with saline, and test animals develop ulcers, other physiological problems)

Personality disorders are difficult to treat because of all of the following reasons except their____________.

-medical basis ARE DIFFICULT: stability, chronicity, involvement in several life areas

stress and immune functioning

-prolonged or chronic stress can have a direct impact on immune function, one effect of the stress hormone cortisol is to suppress immune response, it is also likely that prolonged stress leads to a physical depletion, characterized by Selye's exhaustion stage, of resources and energies necessary for adequate immunological function

Health Psychology

-sub-filed of behavioral medicine -focus: factors that promote and maintain health -assist formulation of improvements to health care systems and health care policy

Which of the following is a diagnostic criteria category for substance use disorder?

-symptoms of impaired control -risky use of substances -substance dependence or abuse

Diagnostic criteria for adjustment disorder

A. The development of emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months of the stressor. B. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following: 1.Marked distress that is out of proportion with the severity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation. 2. Significant impairment in social, occupational, or other important areas of functioning. C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder. D. The symptoms do not represent normal bereavement. E. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months. -Specify whether: with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct, unspecified. -Specify if: --acute: if the disturbance lasts less than 6 months --persistent (chronic): if the disturbance lasts 6 months or longer

Perceived risk to others: cases

Aaron Alexis (Sep 2013): contractor with an apparent history of depression with psychotic symptoms, killed 12 DC naval station Stephen Paddock (Oct 2017): professional gambler with history of treatment for anxiety, killed 58 / injured 546 attending Route 91 Harvest Music Festival in Las Vegas, NV Julie Tejada (Jul 2019) ... 31 year-old with reported history of MI allegedly repeatedly stabbed Boston EMT during service call Patrick Crusius (Aug 2019) ... 21 year-old "loner" with unclear MH history reportedly shot / killed 23, wounded 23 others at El Paso, TX, Walmart ... allegedly after posting lengthy racist rant on web site popular within White supremacy circles

Homelessness and mental health

According to data from the National Alliance on Mental Illness (NAMI), approximately 26% of homeless adults residing in shelters live with one or more mental health disorders. This estimate is at least 30% higher than observed in general population. What factors contribute to this problem of elevated rates of mental illness among the homeless? When hospitalized, should we require certain patients to remain in a hospital setting for longer periods? If so, which patients and under what circumstances? Recent reforms: -Mental Health Systems Act of 1980 -Mental Health Reform Act of 2016

Which of these explanations MOST summarizes the present understating of the etiology of addiction?

Addiction involves the complex interplay of short-term and long-term behavioral consequences, biological systems, and environmental context.

_________________ have an incidence rate of 20% for college students, which is significantly higher than that of non-college-attending peers.

Alcohol use disorders

Insanity verdicts

By the numbers, by mid-2010's: Rules defining insanity defense M'Naghten Rule: 51% American Law Institute Rule: 40% Verdict options Not Guilty by Reason of Insanity: 60% Guilty but Insane / Guilty but Mentally Ill: 13% Treatment when incarcerated? Required: 36%

Right to refuse treatment

Controversial ... Clinicians believe patients with severe mental illness not capable of making: - informed decisions about treatment - decisions in own best interest Consumers, their advocates argue that: all people have right to decide about own treatment ... even if decision not in own best medical interests Outpatient: most settings, consumers clearly have choice some referrals are for mandatory participation Inpatient (voluntary): consumers may have say in treatment options Inpatient (involuntary): hearing may be required to determine if person can be forced to comply with treatment decisions 40 states + DC have laws allowing family, friend, caregiver to petition for court order requiring patient to take prescription medication Those who refuse court orders: - may be hospitalized (72 hour emergency evaluation) - may then be committed against will for longer treatment

NOTE: Antisocial Personality Disorder ≠ Criminality

Could meet criteria for Conduct Disorder / Antisocial Personality Disorder via: - deceitful behavior - irritability and aggressiveness - consistent irresponsibility - lack of remorse, social failings without performing acts that are grounds for arrest

Civil Commitment

Courts have significant influence over mental health system, including as regards civil commitment laws Late 1950's / early 1960's à early 1980's: Emphasis on individual rights and fairness Greater emphasis on localized, personalized, culturally-appropriate services through Community Health Centers

Accessing treatment: When?

Critical to remember that symptoms may interfere with the capacity to: -independently determine need for outside assistance -make well informed decisions regarding whether to seek assistance -provide sufficient information during assessment -feel that others can fully appreciate our concerns -trust that others have our best interests in mind

Duty to warm current controversies:

Current controversies: Should society at large receive warnings about people with a history of mental health disturbance who might pose a risk for violent behavior? When? By whom? Under what circumstances?

Generic Diagnostic Criteria: Personality Disorders

Generic diagnostic criteria: Experience / behavior deviates markedly from cultural expectations, > 2 areas: a. Cognition b. Affect c. Interpersonal d. Impulse control Inflexible, pervasive across situations Lead to significant distress or functional impairment Stable ... long duration Those <18 years old usually not diagnosed Children / adolescents may be given Personality Disorders diagnosis if: meet all criteria behavioral signs present for > one year Exception: Antisocial Personality Disorder Considerable dissatisfaction with DSM-IV Personality Disorders As late as 2011, DSM-5 Working Group proposed reducing number of Personality Disorders by 50%

Treatment: Antisocial PD

Goal: improve ability to feel empathy / identify with others Cognitive techniques focus on processing environmental cues "Positive practice," ... correcting negative behavior patterns, repeated practice of alternate responses

Hypertension (HTN) & Genetics

HTN runs in families those w/ family history show greater reactivity offspring 2x as likely to develop HTN elevated BP evident during first weeks of life

How did the Diagnostic and Statistical Manual state its position on the relevance of diagnoses in determining competency and criminal responsibility?

Having a DSM-5 diagnosis, in itself, does not demonstrate that a particular individual is, or was, unable to control his or her behavior at a particular time.

Treatment of Hypertension

Impact of cognitive-behavioral therapy, other non-drug therapies consistent with drug treatment effects

Remember Julie Tejada?

In August 2019, found not competent to go forward with criminal proceedings Remanded to Worcester based evaluation and treatment facility Was due back in court for further proceedings in early 2020; no updates on this case available

HIV: Population Factors

Initial impact in US most significant among gay males, intravenous drug users Increasing impact among women, minorities, heterosexual Worldwide ... unprotected heterosexual contact is primary mode of exposure Leading cause of death, 25 to 44 y/o

Because determining competency for those with intellectual disability is difficult, what did Atkins v. Virginia rule?

Intellectually disabled defendants who are judged as responsible for murder or other horrific acts cannot be executed

Causal factors: Personality Disorders

Long assumed: Cluster A Personality Disorders associated with psychotic spectrum disorders Cluster B Personality Disorders associated with mood spectrum disorders Cluster C Personality Disorders associated with anxiety and mood spectrum disorders Some evidence of ... ... psychological factors (e.g., emotional abuse, sexual abuse, neglect) ... genetic links (although heritability estimates higher for personality traits than for personality disorders) Emotional abuse, sexual abuse, neglect related to later development of Personality Disorders (e.g., Battle et al., 2004; Pereda, Gallardo-Pujol, & Padilla, 2011) Some behavioral genetics research suggests high heritability estimates for Personality Disorders ... still, findings are inconsistent. For example, heritability estimates for impulsivity (a critical component of Borderline Personality Disorder) is higher than for Borderline Personality Disorder itself. Otherwise ... ... limited evidence of biological / psychosocial causes for most PDs ... psychodynamic theories predominant models for most Primary exceptions: Borderline, Antisocial

Personality Disorders Assumptions

Long-held assumption: Personality not fully formed until adulthood Thought to originate in childhood / by adolescence Difficult to pinpoint onset Treatment not often sought for symptoms of Personality Disorder, complicating: study of Personality Disorders from onset development of comprehensive models

Causal factors: ASPD (psychosocial)

Loss of parent to desertion, divorce, separation not linked with ↑ risk if: discord between parents is minimal mother is affectionate, confident child is well supervised father is non-deviant Early witnessing of violence, exposure to abuse / neglect Deficit in response modulation

In response to a recommendation by the American Psychiatric Association regarding insanity pleas, current federal practice is MOST like the ____________________.

M'Naghten rule (McNaghten rule)

What if "clear" risk to others?

MH professionals duty to warn when identifiable person(s) at imminent risk for grave harm Based on: Tarasoff v. Regents of the University of California (1974) Generally interpreted that threats must be specific, target identifiable

Commonalities Personality Disorders

Many complain that Sx overlap → misdiagnosis or multiple diagnoses Examples: Relationship prob [all; central for SPD, SzPD, BPD, AvPD, DPD] Self-absorption [all but DPD; central for NPD] Depression / helplessness [all but SPD; central for none] Suspicion / distrust [all but SPD, HPD; central for PPD]

Insanity verdicts: Current variants

Many outraged at perceived frequency of defendants "beating the rap" via insanity defense -Grossly overestimated; successful < 1% of the time Guilty but insane (GBI), or Guilty but mentally ill (GBMI) Simple declaration defendant MI when crime committed Does not assure defendant will receive treatment

Technology & mental health

Many ways in which technology my be of utility: Administration of sensitive instruments Scoring of structured inventories Virtual reality (e.g., to assist exposure therapy) Distance assessment & treatment (e.g., via Skype, Zoom) Challenges: security of confidential information

How do psychoactive drugs affect the nervous system?

Repeated exposure to a drug affects the brain and alters the functioning of the neural circuits in which neurons operate.

Insanity defense

Roots in English case law (1843) Daniel M'Naghten killed secretary to Prime Minister (PM) Believed PM plotting against him Claimed that "voices of God" instructed him to kill PM Ruling: Not guilty by reason of insanity

Exposure to uncontrollable or inescapable stressors can impair future learning, an effect that led _______ (1975) to propose that uncontrollable events are the basis for depressive disorders.

Seligman

competence to stand trial: involuntary antipsych medication

Sell v. United States (2003) Involuntary antipsychotic medication only if: 1.Compelling government interest 2.Improvement without significant side effects 3.Medically necessary; alternative treatment would not produce same result 4.Medically appropriate (i.e.., no "experimental" treatment)

Which of the following takes place if an individual is declared unable to stand trial due to lack of competency?

The legal proceedings may be put on hold while the person receives treatment to restore competency.

What must be true before a person may be tried for a crime and potentially found guilty?

The person must be cognitively capable of helping to defending himself or herself in court.

Wyatt v. Stickney (1971)

Wyatt v. Stickney (1971) Helped establish standards for inpatient care, including: - minimum staff-patient ratios - physical requirements Required positive steps toward treatment goals Refined concept of least restrictive alternative for treatment - least confining / limiting environment available - appropriate to patients' condition

stressor

a challenge or demand requiring adjustment by an organism

General Adaptation Syndrome (GAS)

a generalized model of physical stress response that includes the alarm stage, the resistance stage, and (if stress continues) the exhaustion stage

treatment guardian

a person appointed by the court to make treatment decisions for another person who is not component to do so

Type A personality

a personal behavior pattern characterized by competitiveness, hostility, and time urgency

Type B personality

a personal behavior pattern that is more relaxed, less competitive, and less hurried

Hypertension is more common among African Americans than among White Americans. Psychosocial stressors that can explain this difference include all of the following EXCEPT __________________.

evolutionary factors making African Americans more susceptible to hypertension INCLUDE: -higher rates of poverty among African Americans -higher levels of crime in African American communities -racial discrimination

During the___________stage of the GAS, s coping responses to the ongoing challenge are depleted.

exhaustion

What does EMDR stand for?

eye movement desensitization and reprocessing

Behavior must be evident in > 3 different ways, including:

failure to conform to social / legal norms deceitfulness impulsivity / failure to plan irritability and aggressiveness reckless disregard for safety of others, self irresponsibility lack of remorse

ideas of reference

false interpretation of events in terms of special meaning for the self

A symptom of alcohol-induced persistent major neurocognitive disorder is confabulation, which involves _________________.

gaps in memory are filled with imaginary happenings

If your grandfather is diagnosed with essential hypertension, you know that the physician thinks your grandfather's hypertension ____________________.

has both physical and psychological causes

Support for the use of evidence-based forms of psychotherapy _______________.

has increased in recent years

If you believe that personality disorders are BEST understood as a matter of degree in difference from typical personality rather than as a specific diagnosis, you agree with ____________________.

the dimensional approach

In 1936, which of the following models of stress did Hans Selye develop?

the general adaptation syndrome

stress inoculation

the gradual introduction of a stressor in manageable doses to prepare for future encounters with that stressor

Who makes the determination of whether a defendant is competent to stand trial?

the judge

Legal concept of competency

the legal concept of competency to stand trial concerns a person's mental state at the time of legal proceedings--normally, a competent defendant understands the charges and their seriousness and can assist an attorney in a legal defense

legal concept of insanity

the legal concept of insanity concerns a person's mental state at the same time of the offense, although the legal criteria for insanity are still not clearly defined, there is general agreement that insanity involves an inability to distinguish right from wrong and an inability to form specific criminal intent due to a serious mental disorder

sanity

the mental ability to distinguish right from wrong and to form the intent to commit an act such as a crime

competency

the mental ability to handle one's own legal affairs and to understand and assist in legal proceedings

stress response

the physical, behavioral, and/or psychological effects of a stressor

Parens patriae refers to the state's right to make decisions that are in the individual's best interest, and to the idea that police power gives the state the right to protect society from harm. These principles have been used to support ____________________.

the process of civil commitment

HIV: Prevalence

≈ 38 million HIV+ worldwide ≈ 1.2 million HIV+ in US ≈ 14% are unaware of infection status In the United States: Majority (78%) are male African-American & Hispanic-American over-represented among newly infected Globally: 47% living with HIV / AIDS are male HIV / AIDS leading cause of death among women of reproductive age