Psychopathology Midterm (from Book)

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1

Duty to warn

Originated from Tarisoff v Regents of the University of California --> Student killed another student, Tarasoff, when she rebuffed his romantic advances. He hunted to his counselor that he was going to kill her. His therapist contacted police, they investigated, found no legitimate threat and let him go. Tarasoff’s family sued the university, the therapists, and the police saying they should have warned Tarasoff that she was in danger

  • **mental health professional’s responsibility to break confidentiality and notify the potential victim whom a client has specifically threatened**
2

civil commitment

Legal proceeding that determines a person is mentally disordered and may be hospitalized, even involuntary

Criteria:

  • Personal has a mental illness and is in need of tx
  • Person is dangerous to self/ others
  • Person is unable to care for self, a situation considered a grave disability
3

criminal commitment

Process by which people are held because:

  • 1. They have been accused of committing a crime and are detained in a mental health facility until they can be assessed as fit or unfit to engage in court proceedings'
  • 2. They have been found not guilty of a crime by reason of insanity
4

diminished capacity

  • Evidence of an abnormal mental condition in people that causes criminal charges against them requiring intent or knowledge to be reduced to lesser offenses requiring only reckless or criminal neglect
  • In other words: a person's ability to understand the nature of their behavior and therefore their criminal intent can be diminished by their mental disorder
  • It can impact a trial bc it is essentially saying that a person cannot be charged with a crime if the intent to commit the crime is not there (they are not responsible for the crime/ the consequences)
5

psychopathology

  • scientific study of psychological disorders
6

scientist-practitioners

mental health professional expected to apply scientific methods to his or her work. A scientist-practitioner must know the latest research on diagnosis and treatment, must evaluate his or her methods for effectiveness, and may generate research to discover information about disorders and their treatment

7

presenting problem

original complaint reported by the client to the therapist .The actual treated problem may be modification derive from the presenting problem

8

clinical description

details of the combination of behaviors, thoughts, and feelings of an individual that make up a particular disorder

9

prevalence

  • number of people displaying a disorder in the total population at any given time
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incidence

number of new cases of a disorder appearing during a specific period

11

course

pattern of development and change of a disorder over time

12

prognosis

predicted development of a disorder over time

13

etiology

  • cause or source of a disorder
14

psychosocial treatment

tx practices that focuses on social and cultural factors (such as family experience), as well as psychological influences. These approaches include cognitive, behavioral, and interpersonal methods

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moral therapy

psychosocial approach in the 19th c that involved treating patients as normally as possible in normal environments

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mental hygiene movement

mid 19th c. effort to improve care of the mentally disordered by informing the public of their mistreatment

17

psychoanalysis

assessment and therapy pioneered by Freud that emphasizes exploration of, and insight into, unconscious processes and conflicts

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behaviorism

exploration of human behavior, including dysfunction, based on principles of learning and adaption derived from experimental psychology

19

neurosis/ neuroses

obsolete psychodynamic term for a psychological disorder resulting from the unconscious conflict and the anxiety it causes

20

object relations

modern adaption of psychodynamic theory. Study of how children incorporate the memories and values of people who are cole and important to them

21

collective unconscious

  • accumulated wisdom of a culture collected/ remembered across generations; Jung
22

person centered therapy

method in which the client primarily directs the course of discussion, seeking self discovery, and responsibility

23

introspection

early, nonscientific approach to the study of psychology involving systematic attempts to report thoughts and feelings that specific stimuli evoked

24

three traditions in mental health

  • Three main traditions: supernatural, biological, and psychological traditions
  • Each tradition has its own way of treating individuals
    • Supernatural: exorcisms, blessings
    • Biological: physical care and medical cures (especially drugs)
    • Psychological: psychosocial treatments (begins with moral therapy and modern psychotherapy)
  • Psychoanalytic (Freud) → Humanistic and person centered → behavioral model (emphasis on science) → using an integrative approach today
25

diathesis stress model

  • One model to explain the interaction of genes and the environment; the idea that the environment can affect gene expression (turn them “on”)
  • Individuals inherit tendencies to express certain traits or behaviors, which may then be activated under conditions of stress
  • Each inherited tendency is a diathesis
  • Would not become prominent until certain environmental events occurred
26

Explain how a neuron works/ fires

  • 1. Within the cell body of a neuron, synthesis of neurotransmitter and formation of vesicles. This means that a neuron is receiving and reading a signal (via dendrites around the cell body) to release a certain kind of neurotransmitter (NT).
  • 2. The signal to release NTs much reach a certain threshold before being released. This is an Action potential. If the Action Potential threshold is med, the NT travels down the axon in vesicles (those blue circles in the figure) towards the synapse. This process is aided by myeline (a fatty substance which makes the signal send more quickly)
  • 3. The NT is released by the terminal button at the end of an axon
  • 4. NT are released into the synapse (the space between the axon of one neuron and the dendrites of another neuron) and find their receptors in the dendrites of the next neuron
  • 5. Not all NT are absorbed (find receptors) by the other neuron and free-float in the synapse
  • 6. The neuron that initially released the NT reabsorbed the free-floating NTs
  • 7. The now empty vesicles travel back up to the cell body
  • NT can be inhibitory (decreases the likelihood of the neuron firing/ reaching an action potential) or excitatory (increasing the likelihood of the neuron firing/ reaching an action potential)
27

learned helplessness

Seligman’s theory that people become anxious and depressed when they make an attribution that they have no control over the stress in their lives (whether or not they do in reality)

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components of emotion

  • Emotion is composed of behavior, physiology, and cognition
    • Behavior → idea that basic patterns of emotion differ from one another in fundamental ways (someone who is angry will communicate quickly with others via facial expressions, for example, that they are not to be messed with lolz)
    • Physiology → Emotion as primarily a brain function; you experience many emotions (Which are associated with more ancient and primitive parts of the brain) quickly without even realizing it
    • Cognition → making appraisals of situations
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emotion

pattern of action elicited by an external event and a feeling state, accompanied by a characteristic psychological response

30

mood

an enduring period of emotionality

31

affect

conscious, subjective aspect of an emotion that accompanies an action at a given time

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Circumplex model

a model describing different emotions as points in a 2 dimensional space of valence and arousal (time can also be considered as a 3rd dimension)

33

Anger and your heart results

  • Behavior and emotion may strongly influence biology
  • Negative emotions (like hostility and anger) increases someone’s risk for heart disease
  • Things like sustained hostility and anger outbursts do more damage to your heart compared to things like smoking and high blood pressure
  • Why??? → The heart physically becomes worse at effectively pumping blood through the body.
  • Adopting a forgiving attitude can neutralize the effects of anger on cardiovascular activities
  • BUT other factors also affect heart disease (like genetics, smoking, etc); must take a multidimensional approach
34

Equifinality meaning

  • Developmental psychopathology principle that a behavior or disorder may have several causes
  • There may be many paths to a given destination
35

Key concepts in assessment

  • Reliability → degree to which the measurement is consistent
  • Validity → degree to which the test actually measures what it is designed to measure
  • Standardization → application of certain standards to ensure consistency across measurements (looking at factors like age, SES, race/ ethnicity, gender, etc)
  • should include a physical exam, clinical interview, behavioral assessment
36

assessment can be compared to a ________________

Assessment is like a funnel → collect a lot of info across a broad range of person’s functioning to determine the source of the problem. Clinician then narrows the focus by ruling out problems in some areas and concentrating on areas of interest.

37

clinical interview

    • Mental Status Exam (appearance and behavior; thought processes; mood and affect; intellectual functioning; sensorium/ awareness of surroundings)
    • Semistructured clinical interview
38

behavioral assessment

Direct observation to formally assess the individual thoughts, feelings, and behavior in specific contexts

39

components of the mental status exam (MSE)

  • Appearance and behaviors → attire, overt behavior, appearance, posture, expressions
  • Thought processes → rate of speech, continuity of speech, content of speech
  • Mood and affect → main feeling-state; feeling state- accompanying what person says
  • Intellectual functioning → vocabulary, use of abstractions and metaphors
  • Sensorium → awareness of surroundings in terms of person, time, place
  • -- this is part of the clinical interview
40

the ABCs of observation

  • Antecedents → the events that incites the behavior; the event/ situation that precedes the behavior
  • Behavior → the action in question
  • Consequences → the positive and negative effects of the behaviors; the events that occur because of the behavior (may serve to reinforce the behavior)
  • A kind of behavioral assessment
41

Idiographic vs. nomothic strategy

  • Ways of diagnosing psychological disorders
  • Idiographic strategy → looking at an individual’s personality, cultural background. This information lets us tailor our treatment to the person
  • Nomothetic strategy → attempting to classify a problem; being able to determine a general class of problems to which the presenting problem belongs
    • Assigning a diagnosis; a personality profile from the MMPI, etc
42

Idiographic strategy

looking at an individual’s personality, cultural background. This information lets us tailor our treatment to the person

43

Nomothetic strategy

attempting to classify a problem; being able to determine a general class of problems to which the presenting problem belongs

44

Categorical vs Dimensional vs Prototypical

  • These are ways of classifying (psychological disorders); classification systems provide consistency and uniformity
45

Categorical

  • originates with Kraeplin. Assumes that every diagnosis has a clear underlying psychophysiological cause and that each disorder is unique/ fundamentally different from one another
46

Dimensional

note a variety of categories of cognitions, moods, and behaviors with which the client presents and we quantify them on a scale. Applied to psychopathology in the past but has largely been unsatisfactory

47

prototypical

  • increasing support in recent years; categorical approach but with a twist: identifies certain essential characteristics (so that it can be classified) but allows for certain other nonessential variations that do not necessarily change the classification… this means it can really be catered to the individual and more representative of peoples’ lived experiences of mental health disorders (DSM-5)
48

Patients Rights

  • Right to tx
  • Right to refuse tx
  • Rights of research participants= informed of risks and benefits
  • Evidence-based practice and clinical practice guidelines= types of interventions with clinical efficacy and utility
49

a review of diagnosis categories for substance use/abuse

  • Depressants
  • Stimulant- related disorders
  • Tobacco- related dx
  • Caffeine- related dx
  • Opioid- related disorders
  • Cannabis- related disorders
  • Hallucinogen- related disorders
  • Other drugs of abuse (inhalants)
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depressants

  • Alcohol- related disorders
  • Sedative-, hypnotic-, and anxiolytic- related disorders
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stimulants

  • Amphetamines → feelings of vigor and reduce fatigue
  • Cocaine → euphoria, insomnia, loss of appetite
  • Make you alert and energetic
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Tobacco- related dx

  • No intox info
  • Withdrawal symptoms→ depressed mood, insomnia, anxiety, irritability
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Caffeine- related dx

  • “Gentile stimulant”
  • Elevate mood, decrease fatigue, can cause insomnia
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opioid related dx

  • Includes natural opioids, synthetic opioids (heroine, methadone, hydrocodone, oxycodone), and comparable substances that occur in the brain (enkephalins, dynorphins)
  • Induce euphoria, drowsiness, slowed breathing. Are analgesics (pain relievers)
55

cannabis related dx

  • Marajuana
  • Reactions includes mood swings, dreamlike states where time stands still, heightened sensory experiences, seeing vivid colors, appreciating the subtleties of music
56

Hallucinogen- related disorders

  • LSD (synthetic)
  • Mescaline
  • Perceptual changes, subjective intensification of perceptions, depersonalization, hallucinations
57

benefits of AA

  • Notion that alcohol is a disease and alcoholics must acknowledge their disease
  • Those who regularly attend meetings and other AA activities follow its guidelines more carefully and more likely to have positive outcomes (reduced drinking and improved psychological health)
  • Helpful for those who are seeking to achieve abstinence
58

Community reinforcement approach (to substance abuse tx)

  • Way of treating substance abuse
  • Several facets of the drug problem are addressed to help ID and correct aspects of the person’s life that might contribute to the substance use or interfere in one’s efforts to abstain
  • 1. Spouse, friend, family member (not a substance user) is recruited to participate in therapy with the abuser (helps abuser start to improve relationship)
  • 2. Clients taught to ID the antecedents and consequences that influence their drug taking
  • 3. Clients given assistance with employment, education, finances, or other services to help reduce stress
  • 4. New recreational opportunities help person replace substance abuse with positive activities
59

problems with the controlled use approach

  • Controlled drinking/ use: an extremely controversial treatment approach to alcohol dependence, in which severe abuser are taught to drink in moderation
  • One study showed that those who were taught to drink in a controlled way were more successful than those who were taught abstinence= controlled drinking may be a viable option for alcohol users
  • Controversy comes from later research who talked to those them 10 years later- most had relapsed
60

impulse disorders

  • Irresistible impulses that one experiences. Usually this impulse is one that will be harmful to the person affected
  • Typically experiences increasing tension leading up to the act and, sometimes, pleasurable anticipation of action on impulse.
  • Difficult to resist
  • Intermittent explosive disorder
  • Kleptomania
  • Pyromania
61

types of tx for eating disorders

drug

psychological

prevention programs

62

drug tx for eating dx

  • Not effective for anorexia
  • some evidence that it can be effective for bulimia, especially during the bingeing, purging cycles= antidepressant medication (Prozac); alone, antidepressants do not have substantial long-lasting effects on bulimia (if they’re used, best if done with therapy)
63

psychological tx for bulimia

CBT-E (e is enhanced)= focus on structured schedule of 5-6 small meals a day, changing distorted thoughts, and teaching the ineffectiveness of vomiting/ purging/ using laxatives for weight- control.

64

psychological tx for binge eating dx

  • CBT had good outcomes with this population (obses individuals with BED, 41% abstained from bingeing, and 71% binged less frequently than before). Those who continued to binge gained weight while those who stopped actually lost weight. ‘
  • IPT (interpersonal therapy) has just as good outcomes as CBT
  • Self- help procedures may also be helpful for BED
65

psychological tx for anorexia

  • Most important goal is to get the person to a healthy weight but initial weight gain is a poor indicator of long-term health
  • CBT-E was effective in the short and long term
66

effective tx for obesity

  • Professionally directed behavior modification programs (combo of diet, exercise, and behavior therapy is the most effective tx)
  • Drugs can also be used in combination with diet, exercise, and behavior therapy (only in severe cases, usually)= drug treatments that reduce internal cues signaling hunger have some effect
  • Bariatric surgery will lead to people losing 20-30% of weight. Usually a last resort. But there are health risks, even a change of death. Some people regain the weight they lost or do not lose a significant amount of weight
67

ineffective tx for obesity

  • Self directed weight loss= very low success rates. Usually only lose a little bit of weight or no weight (and often regains weight)
  • Commercial self-help programs (weight watchers, etc). Marginally better than self-directed weight loss. Up to 80% of people are not successful in the long run
68

dyssomnias

  • Problems in getting to sleep or in obtaining sufficient quality of sleep
  • Includes:
    • Insomnia dx= difficulty falling asleep, staying asleep, or sleep that is not restful
    • Hypersomnolence dx= excessive sleepiness that results in sleeping for long periods of time or falling asleep during the day
    • Narcolepsy = uncontrollable attacks of refreshing sleep occurring daily. May also have cataplexy (loss of muscle tone)
    • Breathing-related sleep dx
    • Circadian rhythm sleep-wake dx
69

Insomnia dx

  • difficulty falling asleep, staying asleep, or sleep that is not restful
  • dyssomnia
70

Hypersomnolence dx

excessive sleepiness that results in sleeping for long periods of time or falling asleep during the day

dyssomnia

71

Narcolepsy

uncontrollable attacks of refreshing sleep occurring daily. May also have cataplexy (loss of muscle tone)

dyssomnia

72

Parasomnias

  • Abnormal behaviors such as nightmares or sleepwalking that occur during sleep
  • Includes:
    • Disorder of arousal= motor movements/ behaviors during NREM (sleepwalking, sleep terrors, incomplete awakening)
    • Nightmare dx= frequently waking up from extremely frightening dreams that cause distress
    • REM sleep behavior dx= episodes of arousal during REM sleep that cause behaviors that can be harmful to self/ others
    • Restless leg syndrome = irresistible urges to move leg as a result of unpleasant sensations
    • Substance-induced sleep dx
73

Disorder of arousal

  • Disorder of arousal= motor movements/ behaviors during NREM (sleepwalking, sleep terrors, incomplete awakening)
  • parasomnia
74

Nightmare dx

frequently waking up from extremely frightening dreams that cause distress

parasomnia

75

REM sleep behavior dx

  • episodes of arousal during REM sleep that cause behaviors that can be harmful to self/ others
  • parasomnia
76

restless leg syndrome

irresistible urges to move leg as a result of unpleasant sensations

parasomnia

77

types of treatment for sleep disorders

medical

environmental

psychological

78

medical tx for sleep dx

  • Benzodiazepines (short acting drugs-- allows people to fall asleep fast and wake up in the morning); cause excessive sleepiness, though
  • Medicines that work with the body’s melatonin system
  • Stimulants for hypersomnolence and narcolepsy (methylphenidate)
  • For breathing related disorders= weight loss, CPAP machine
  • Overall, medication is not the recommended first line of treatment
79

Environmental tx

  • Phase delays or phase advances (circadian rhythm)
  • Using bright light to readjust biological clock
80

psychological tx for sleep dx

  • Cognitive → changing unrealistic expectations/ beliefs about sleep. Therapist provides info about normal amounts of sleep, and person’s ability to compensate for lost sleep
  • Guided imagery relaxation → uses meditation or imagery for relaxation at bed time
  • Graduated extinction → used for kids with tantrums at bed. Instructs parents to check on child progressively after longer periods until child falls asleep on their own
  • Paradoxical intention → instructs individual to do opposite behavior from the desired outcome. Telling poor sleeper to lie in bed and stay awake as long as they can (relieves performance anxiety)
  • Progressive relaxation → involves relaxing muscles of the body to introduce drowsiness
81

Guided imagery relaxation

uses meditation or imagery for relaxation at bed time

82

Graduated extinction

used for kids with tantrums at bed. Instructs parents to check on child progressively after longer periods until child falls asleep on their own

83

Paradoxical intention

instructs individual to do opposite behavior from the desired outcome. Telling poor sleeper to lie in bed and stay awake as long as they can (relieves performance anxiety)

84

Progressive relaxation

involves relaxing muscles of the body to introduce drowsiness

85

treatment of ADHD

psychosocial

medical

combined approach

86

psychosocial tx for ADHD

  • Sets goals in increasing amount of time child remains seated, number of problem completed, etc
  • Reinforcement programs
  • Parental education
87

medical tx for ADHD

  • Stimulants and non stimulants helpful in reducing the core symptoms of hyperactivity and impulsivity and improving concentration on tasks
  • Stimulants help’s brain to focus durgin problem solving tasks
  • Concerns over stimulant use, especially in kids
88

tx for learning disorders

  • Primarily require educational intervention
  • Biological (drug) tx typically restricted to those who may also have comorbid ADhd
  • Categorized into:
    • Specific skills instruction (instruction on vocab., finding main idea, finding facts in reading)
    • Strategy instruction (efforts to improve cognitive skills through critical thinking and decision making)
  • Direct instruction → systematic instruction and teaching for mastery… teaching slowly and until students have mastered it
89

tx for autism spectrum disorder

  • Psychosocial tx
    • Naturalistic teaching settings→ teaching/ instruction (of language, etc) in home, school, community settings (instead of at a rigid setting/ office)
    • Use of peers who do not ASD as trainers or models for behavior
  • Biological tx
    • Medication has little positive impact on core symptoms of social and language difficulties
    • Meds to decrease irritation (tranquilizers, etc)
  • Integrating tx
90

treatment for delirium

  • Characterized by impaired consciousness and cognition during the course of several hours or days
  • Confusion, disorientation, deficits in memory
  • Addressing underlying causes (brain tumor, drugs, etc)
  • Psychosocial intervention= first line of tx; goal is to deal with agitation, anxiety, and hallucinations; inclusion of family can be helpful
91

treatment of neurocognitive disorders

  • Big barriers to tx advancement= disorders cause significant damage to the brain itself
  • Most caregivers of people with neurocognitive dx have anxiety disorders or symptoms consistent with anxiety disorders = its a very trying experience
  • biological
  • psychosocial
92

biological tx for neurocognitive disorders

  • Neurocognitive dx from infections, diseases, etc can be treated with medicine if caught early. No known tx exists for many neurocognitive dx, though.
  • Transplanting stem cells may help (currently doing research on this)
  • Glial cell- derived neurotropic factors may help regenerate
  • Drugs that prevent the breakdown of acetylcholine (btu gains are not permanent or long term, even if gains are great in the short term)
93

psychosocial tx for neurocognitive disorders

  • Ability to delay severe cognitive decline
  • Taught skills to compensate for lost abilities
  • cognitive stimulation- word games, tests of memory of faces, practice with numbers
  • teaching/ providing cues to person so they can safely navigate (if they get lost and are alone)