Psychopathology Midterm (from Lecture)

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1

Symptoms

what is reported by the client

2

Signs

what is observed by the clinician

3

Issues

how symptoms have affected their lives or vice versa

4

Reactivity

anytime you observe an individual, the action of making the observation results in changing behavior, interaction with a client, changes client’s behavior, speech, thought process, and mood. (different with you than with family)

5

diagnostic terms

  • reality testing- the ability to evaluate the external world objectively and to distinguish from inner experience (faulty reality testing, they cant do this)
  • psychosis- reality testing is grossly impaired
  • neurosis- a non psychotic and ego- dystonic syndrome (can distinguish reality, but are still uncomfortable)
  • ego-dystonic- experienced internally as distressful or alient
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reality testing

the ability to evaluate the external world objectively and to distinguish from inner experience (faulty reality testing, they cant do this)

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psychosis

reality testing is grossly impaired

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neurosis

a non psychotic and ego- dystonic syndrome (can distinguish reality, but are still uncomfortable)

9

ego-dystonic

experienced internally as distressful or alien

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factors that contribute to prognosis

  • natural course of dx
  • clients highest level of functioning prior to dx
  • duration is illness
  • abruptness of onset
  • age of onset
  • avaiablility of effective treatments
  • client's compliance
11

MMSE

mini- mental state exam

  • an example of formal cognitive testing and requires the use of cognitive screening tools
    • Tests cog. Functioning.
  • MSE includes the MMSE and ALL observations made during an interview
12

examples of MMSE questions

what were some of the words I asked you to remember?

- looks at orientation to time, to place, and immediate recall

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some ideas of etiology

  • neurons and NT
  • hormones
  • genetics
  • environmental biology
  • developmental theories
  • stress
  • family systems
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assessment

Time limited, formal process that collects clinical information from many sources in order to reach a diagnosis, to make a prognosis, to render a biopsychological formulation, and to determine treatment

  • goal: get info to develop diagnosis, prognosis, and tx plan; develop trust with client
15

steps for diagnosis

1. Collect data
́2. Identify psychopathology

́3. Evaluate reliability of data
́4. Determine the overall distinctive features ́5. Arrive at a diagnosis
́6. Check the diagnostic criteria
́7. Resolve diagnostic uncertainty

16

taxonomy

classification of entities for scientific purposes

17

nosology

applying a taxonomic system to psychological or medical phenomenon

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nomenclature

refers to names or labels that make up the nosology (e.g. mood disorder)

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Hippocrates

Considered the brain to be the seat of all wisdom, consciousness, intelligence and emotion.

–Therefore disorders involving these functions were located in the brain

–Coined the term hysteria – somatoform disorders

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Galen

Roman physician (150 A.D.)

–Humoral theory:

Sanguine – cheerful and optimistic; insomnia and delirium; too

much blood to the brain
–Melancholic – depressive; caused by black bile flooding the brain

–Melancholic – depressive; caused by black bile flooding the brain

–Phlegmatic – apathy and sluggishness, calm under stress; too little flow of bile

–Choleric – hot tempered; too much yellow bile

21

John Grey (1850s)

U.S. psychiatrist - position was that insanity was always due to physical causes and hence lead efforts to

humanize asylums – de-institutionalization; downsizing for more individual care

22

DO A CLIENT MAP

D = Diagnosis

O = Objectives of treatment
A = Assessments (neurological or personality tests)
C = Clinical characteristics
L = Location of treatment
I = Intervention to be used
E = Emphasis of treatment (level of directedness/support;

cognitive, behavioral or affective
N = Numbers (of patients in session)

T = Timing (frequency, pacing and duration)

M = Medications needed
A = Adjunct services
P = Prognosis

23

people at risk for negative effect in tx

Severe narcissistic, borderline, masochistic or oppositional defiant

disorder

24

people at risk for no response to tx

Poorly motivated, malingering or factitious disorder People likely to show spontaneous improvement ­(healthy people in crisis or with minor concerns) People likely to benefit from a no treatment strategy ­(oppositional patterns or ‘reverse psychology’)

25

common triggers for binges

Negative emotions
–depression, stress, anxiety, boredom, etc.

–Depersonalization
–Hunger
–Dietary restraint
–Presence of attractive “forbidden food” –Abstinence violation

–Having already eaten something fattening or diet-breaking –Ingestion of alcohol

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limits of confidentiality

  • Duty to warn
  • Mandatory reporting (child abuse, sexual abuse)
27

involuntary admissions process

  • Dr signs application must have personally examined the person within 7 days
    • Can be detained for 71 hours; released after that is admitted as voluntary patient or involuntary patient
  • Involuntary admissions required another dr to complete a certificate of involuntary admission
    • Allows involuntary detention and tx for 14 days; first renewal is at 1 months, then 2 months, then every 3 months
28

privileged communication

  • A LEGAL right of a client regarding their communication with a therapist
  • Prevents disclosure of confidential info without the client’s permission
29

fitness to stand trial

  • Accused person protected from conviction that could have resulted from a lack of participation or capacity to make proper judgment
    • Accused able to assist in defense of self
    • Understands role in the proceedings
    • Understand nature/ object of proceedings
30

the four ways of conceptualizing addiction

  • Biopsychosocial → symptoms are acquired habits that emerge from genetic, pharmacological, and behavioral factors;
  • Sociocultural → drinking/ drug taking considered disordered bc they deviate from accepted standards
  • Moral → drinking/ drug use are freely chosen acts for which individuals are responsible
  • Disease → drinking/ drug use are not freely chosen and individual isn’t responsible
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biopsychosocial perception of addiction

symptoms are acquired habits that emerge from genetic, pharmacological, and behavioral factors;

32

sociocultural perception of addiction

drinking/ drug taking considered disordered bc they deviate from accepted standards

33

disease perception of addiction

drinking/ drug use are not freely chosen and individual isn’t responsible

34

moral perception of addiction

drinking/ drug use are freely chosen acts for which individuals are responsible

35

Miller's addictive behavior and components

  • Addiction as consisting of 3 components: preoccupation, compulsion, relapse
  • Addictive behaviors → emphasis on acquiring drugs, continues to use drugs, and may stop but eventually resumes drug use
36

psychosocial interventions for substance use tx

AA

CBT

37

Factors in the Clinical Institute Withdrawal Assessment

  • Standardized assessment of alcohol withdrawal symptoms
  • Score 8-10 mild, 10--15 moderate, greater 15 severe (impending delirium tremens)
  • Vomiting and nausea
  • Tremor
  • Sweating
  • Agitation
  • Tactile dysfunction
  • Auditory disturbances
  • Headache
  • Orientation
38

Aspects of good prevention programs

  • Reduce Risk Factors
  • Enhance Protective Factors •Include Interactive Skills
  • Be Family-Focused
  • Involve the community and schools
39

Four stages of Pharmacokinetics

  • Absorption= oral, intramuscular, rectal, inhalation, etc
  • Distribution= blood/ brain barrier
  • Metabolism
  • Excretion

--> refers to the movement of drugs within the body

40

Biological half-life

the amount of time required for the concentration / amount of a drug in the body to be reduced by 1/2

41

Psychopharmacological Effects on Neurotransmitters

  • increase/ decrease NT production
  • increase/ decrease NT release
  • increase/ decrease Nt receptor binding
  • Increase/ decrease re-uptake
42

Know how drugs work; both as antagonists and agonists at the synaptic site

  • Antagonist → decrease activity by BLOCKING NT
  • Agonists → increase activity of the NT
43

antagonist

type of receptor, ligand, or drug that blocks or dampens a biological response by binding to and blocking a receptor rather than activating it like an agonist.

Definition:In neuroscience, a chemical substance that decreases or blocks the effects of a neurotransmitter.

44

agonist

chemical that binds to a receptor and activates the receptor to produce a biological response.

Definition:In neuroscience, a chemical substance that effectively increases the activity of a neurotransmitter by imitating its effects.

45

Common drugs for mood disorders

  • SSRIs
  • MAOIs (monoamine oxidase inhibitors, inhibits monoamine oxidase will increasing dopamine and serotonin)
  • SNRIs (serotonin and norepinephrine reuptake inhibitor)
  • Lithium (for bipolar dx)
  • Benzos (affects the GABA receptor)
46

Tardive dyskinesia

a condition affecting the nervous system caused by long term use of psychiatric drugs. Causes repetitive movements

47

types of sleep apnea

Obstructive and Central sleep apnea

48

obstructive sleep apnea

  • Obstructive- (1-10 % of pop.) upper airway obstruction leading to temporary loss of air
49

central sleep apnea

  • Central- cessation of ventilation when there is no obstruction CNS
50

Treatment for sleep walking

  • Safe environment to sleep
  • Healthy sleep patterns
  • Drugs not effective
51

Common Triggers for Binge eating episodes

  • Negative emotions
  • depression, stress, anxiety, boredom, etc.
  • Depersonalization
  • Hunger
  • Dietary restraint
  • Presence of attractive “forbidden food” –Abstinence violation
  • Having already eaten something fattening or diet-breaking –Ingestion of alcohol
52

Risk factors for eating disorders

  • –Societal obsession with a slim female body has been blamed for women’s widespread dissatisfaction with their bodies and a rise in the prevalence of eating disorders
  • Negative self-evaluation/low self-esteem is the most ubiquitous risk factor among eating disorder patients
  • A disturbance of serotonergic activity is associated with anorexia nervosa
53

Treating eating disorders with DBT

  • Dialectical behavioral therapy
  • DBT encourages commitment to and enactment of behavioral change while validating individuals’ emotions and treatment ambivalence, with a specific focus on building skills in emotional recognition and regulation
54

Stages of Alzheimer's

early, second, moderate, late

55

early stage of alzheimer's

  • 2-4 years
  • Recent memory loss, repeated questions, depression can occur, writing and using objects is difficult, personality changes
56

second Stage of Alzheimer's

  • 2-10 years
  • Cannot hide symptoms/ problems
  • Persistent memory loss across settings
  • Sleep disturbances, mood/ behavioral changes, slowness, rigidity, gait problems
57

moderate Stage of Alzheimer's

  • Increased memory loss and confusion
  • Trouble recognizing family/ friends
  • Can’t learn new things
  • Difficulty doing tasks with multiple steps (dressing)
58

late Stage of Alzheimer's

  • 1-3 years
  • Confusion about past and present; loss of recognition of familiar people
  • Incapacitated (loss of verbal skills too)
  • unable to care for self
  • Extreme mood and behavioral problems, even hallucinations and delirium
59

Interventions for dealing with agitation in Alzheimer's

  • 3 R’s- repeat, reassure, redirect
  • Simplify environment
  • Simplify tasks and routines
  • Use labels to cure/ remind person
  • Remove dangerous items
  • Use lights to reduce confusion
60

Contraindicated interventions in Autism

  • Several tx lack empirical support
    • Auditory integration therapy, vitamin supplements
  • Some pose a risk
    • Facilitated communication (another individual physically assists someone without verbal communication in using a keyboard or assistive tech. To communicate)
    • Secretin therapy
61

The 4 PTSD symptom clusters

  • Intrusions (intrusive memories, thoughts, feelings about the traumatic event)
  • Avoidance (avoidance of thoughts, feelings, and reminders of event)
  • Negative changes in cognition (lack of memory, distorted cognitions, - beliefs about self)
  • Increased arousal (irritability, stress, reckless behavior, hypervigilance)
62

Interventions for PTSD

  • Prevention approach
  • Treatment approach
  • Biological and pharmacological
  • Disrupting posttraumatic memory reconsolidation
  • Psychosocial interventions
  • Exposure based treatments
    • Prolonged exposure- involves real life and imaginal exposure to PTSD stimuli
    • Narrative exposure therapy- developed with refugees from diverse cultures, repeated exposure to memories of traumatic events across the lifespan
  • Cognitive treatments
  • Skills-based treatments
63

prevention approach to PTSD

attempt to prevent the development of psychopathology after trauma exposure

64

tx approach to PTSD

attempt to treat the psychopathology once it develops

65

biological/ pharmacological approach to PTSD

SSRIs or SNRIs

66

Disrupting posttraumatic memory reconsolidation approach to PTSD

weakens initial consolidation of trauma memories and alter their reconsolidation

67

Psychosocial interventions approach to PTSD

explicit focus on trauma memories and reminders are strongly supported

68

Exposure based treatments for PTSD

  • Prolonged exposure- involves real life and imaginal exposure to PTSD stimuli
  • Narrative exposure therapy- developed with refugees from diverse cultures, repeated exposure to memories of traumatic events across the lifespan
69

Cognitive treatments for PTSD

focus on changes in the person’s understanding of the trauma and its meaning in their life

70

Skills-based treatments approach to PTSD

  • targets such skills as enhancing coping, reducing emotional dysregulation, and reducing difficulties with interpersonal skills
71

Contraindicated interventions for PTSD

  • Single incident debriefing- encouraging emotional expression in a single session immediately after trauma (ineffective, harmful)
  • Cannabinoids and hallucinogens- active cannabinoid components may be useful therapeutically for trauma-related nightmares (can exacerbate anxiety, risk of misuse)
  • Recovered memory therapy- hypnotherapy and guided imagery to uncover “repressed” memories lead to generation of false-memories alone or in combination with recollections of actual events
72

Subtypes of ADHD and criticism of subtyping

  • Predominantly inattentive type
  • Predominantly hyperactive-impulsive type
  • Combined type
    • Criticisms of subtyping most children show subtype changes over time
    • Could be separate disorders
    • Defined by different cognitive styles rather than how well someone fits with different symptoms clusters
73

Why medications work with ADHD

  • 70-80% improvements in symptoms
  • Alleviates secondary behavioral problems
  • Stimulants like Ritalin
74

Differentiate ODD and Conduct Disorder

ODD- angry, irritable, argumentative, defiant, vindictive behavior (losing temper)

CD- violating the rights of others or major age appropriate societal norms or rules (aggressive, antisocial behaviors)

75

Differentiate subtypes of Conduct Disorder

  1. Aggressive conduct the threatens physical harm to other people and animals
  2. Nonaggressive conduct that causes property loss or damage
  3. Deceitfulness or theft
  4. Serious violation of rules
76

Gender differences in conduct disorders

Boys more likely (3.6% for boys, 1.5% for girls)

77

Tripartite model of anxiety

  • Lang
  • Anxiety is a product of physiological, cognitive, and behavioral responses
    • Physiological- increased heart rate, respiration
    • Cognitive- catastrophic and unhelpful thoughts
    • Behavioral- avoidance of situation
78

Psychosocial interventions for anxiety

  • CBT (most support)
  • Individual therapy (group can help)
  • 4 categories:
    • Exposure
    • Modeling
    • Contingency management
    • Cognitive interventions
79

Know how the major disorders change and effect older adults

  • Anxiety- developmental changes in social/ family role, some may experience less anxiety later in life
  • Mood- depressiom one of most common dx in later life; older men has elevated risks for suicide
  • Alcohol use- less common in late life (1-22%); DSM criteria not validated in older adults; pain, chronic medical conditions, and sleep difficulties might increase use
  • Schizophrenia- onset earlier in life
  • Personality dx- antisocial PD and borderline PD less common in older adults; schizoid an obsessive compulsive PDs more prevalent
  • Neurocognitive dx common (dementia, alzheimer’s)
  • Sleep dx- 35% of people 65+report trouble sleeping