Abnormal Psych (copy)

midterm

5 parts of mental status exam

1. appearance and behavior
2. thought processes
3. mood and affect
4. intellectual functioning
5. sensorium

Apperance and Behavior

* How they look, hair is a mess, clothing is dirty, they smell
* They cant maintain their normal daily functioning
* Slouched over, no eye contact, playing with hands, can't sit still
* Shows you are uncomfortable and not really present
* Can give you hints to a disorder (OCD, ADHD, depression, anxiety)

thought process

* How quickly someone talks
* Sequencing of speech
* Keep jumping from topic to topic
* Content of speech and paranoia

mood and affect

* Prolonged mood
* How the mood is expressed or manifested by the person
* When there is little to no affect

affect

How the mood is expressed or manifested by the person (opposite of mood)

intellectual functioning

* Type of vocabulary they use
* Can they understand the questions you ask
* Do they know basic information
* If they show a low intelligence - you would need to do a further assessment of that

sensorium

* Assessment of someone's awareness of their surroundings
* Orientation

3 types of orientation

person

place

time

oriented x2

oriented to person and place (knows 2 of the 3)

structured interview

* Follow a predetermined format
* Each question is structured in a manner so as to allow responses to be quantified or clearly determined
* (no follow up questions)

Semi-structured interview

Interviewer is required to ask questions in a specific order and in a specific way, but is free to ask follow-up questions to better determine if the interviewee actually has the symptom being assessed

(You have specific questions that are asked in a specific order but you can ask some follow-up questions if you think that is necessary if your question doesn't answer something you need to know you can ask it)

unstructured interview

Subjective and do not follow a predetermined set of questions

(You have no set format you can ask very broad open-ended questions about anything you want in any order you want)

What is a unstructured interview less helpful for?

for research purposes and data analysis

What is a unstructured interview more helpful for?

finding a diagnosis

main purpose of direct observation

learn more about the person's psychological functioning by attending to their appearance and behavior in various contexts

role playing

a type of analogue situation; a more controlled behavioral setting for conducting observations

self-monitoring

client's objective reporting of behavior, thoughts, and feelings as they occur in various natural settings

self-monitoring is known as

the ABCs of behavior

A (ABC's of Behavior)

Antecedent

B (ABC's of Behavior)

(target) behavior

C (ABC's of Behavior)

consequence

Reactivity

When you start recording your bad behavior sometimes it starts to decrease because you are recording it so sometimes when you first stop self-monitoring its less common in the beginning

rating scales

help both to organize information and to encourage reliability and objectivity

SUDS

Subjective units of distress scale (how distressed are you)

Intelligence tests include both

verbal and performance material

average IQ

100

WAIS

Wechsler Adult Intelligence Scale

3 different versions of WAIS

perschool , school -aged children, adults

projective personality tests

Unstructured and rely on various ambiguous stimuli such as inkblots rather than on explicit questions

Rorschach Inkblot Test

Uses 10 inkblot pictures, to which a subject responds to "what you see, what it makes you think of" and "what it means to you"

Thematic Apperception Test

uses a series of simple pictures about which a subject is instructed to make up stories

sentence completion test

designed for children, adolescents, and young adults; consists of the beginnings of sentences that clients are asked to complete

objective personality tests

Structured; questionnaires, self-report inventories, or rating scales

Minnesota Multiphasic Personality Inventory (MMPI)

* Prototype and standard for personality assessment; widely used in clinical and forensic (court-related) assessment
* Includes 10 clinical scales measuring tendencies to respond in psychologically deviant ways, as well as validity ,scales detecting honesty/straightforwardness of responses

Validity questions

Sometimes people answer questions in a way that they think will make them look good

why does the MMPI have validity questions?

If you have all positive answers in these questions that the tester might say that the testee did it with all the questions and not want to use their results (assess if this scale is valid for you to show if the rest of your test answers are valid)

physical examination

Physical examinations are particularly important for disorders that present with physical problems, such as panic disorder or conversion disorder

Neuropsychological assessment

* Various tests to measure a person's cognitive, perceptual, and motor performance
* Can provide important clues about the extent and location of brain damage

Electroencephalogram (EEG)

assesses brain wave patterns; changes in the brain can be recorded almost immediately after they occur

neurological approaches to assessment

EEG, CT, MRI, PET

computed temography (CT) scan

scan that can reveal images of parts of the brain that might be diseased

(Structural image)

Magnetic Resonance Imaging (MRI)

Magnetic Resonance Imaging (MRI): another technique used to provide images of the brain

what does an MRI tell us?

neuronal activity (the working brain)

Position Emission Tomography (PET)

radioactive agents are injected into a person to show how an organ is functioning

The two key moods involved in mood disorders are:

mania and depression

depression

involves feelings of extraordinary sadness and dejection

mania

often characterized by intense and unrealistic feelings of excitement and euphoria

Unipolar depressive disorder

a person experiences only depressive episodes

bipolar disorder

a person experiences both depressive and manic episodes

Depressive episode

when a person is markedly depressed or loses interest in formerly pleasurable activities for at least 2 weeks

Manic episode

markedly elevated, expansive, or irritable mood for at least 4 days

hypomanic episode

abnormally elevated, expansive, or irritable mood for at least 4 days; the person must also have at least 3 other symptoms similar to those involved in mania

Major Depressive Disorder

Diagnostic criteria for MDD require that a person must be in a major depressive episode and never had a manic, hypomanic, or mixed episode

relapse

the return of symptoms within a fairly short period of time

recurrence

the onset of a new episode of depression

what percent of people who experience a depressive episode have reccurence?

40-50

Specifiers

different patterns of symptoms or features

Anhedonia

inability to get pleasure from things you used to like to do

Avolition

inability to perform daily tasks

example of avolition

showering, cooking, walking the dog

Psychotic features

someone has major depression and experiences any of the psychotic symptoms

example of psychotic features

hallucinations and delusions

Major depressive episode with melancholic features

includes loss of interest, not reacting to usually pleasurable stimuli or desired events

Severe major depressive episode with psychotic features

depression is accompanied by psychotic symptoms

Major depressive episode with catatonic features

includes a range of psychomotor symptoms

Criteria for recurrent major depressive episode with a seasonal pattern (seasonal affective disorder) include

at least 2 episodes of depression in the past 2 years at the same time of year

postpartum blues symptoms

changeable mood, crying easily, sadness, and irritability, often intermixed with happy feelings

postpartum blues occuurs in what percentage of woman in what number of days after giving birth?

50-7- percent within 10 days

is postpartum blues the same as postpartum depression?

No

Are Women who have a history of depression are at higher risk for experiencing postpartum depression?

yes

genetic influences

Family studies have shown that the prevalence of mood disorders is about 2-3 times higher among blood relatives of persons with clinically diagnosed unipolar depression

One candidate for a specific gene that might be implicated is the

serotonin-transporter gene

serotonin-transporter gene is involved in

the transmission and reuptake of serotonin

One of the key transmitters involved in depression

serotonin-transporter gene i

the hypothalamic-pituitary-adrenal (HPA) axis

System of hormones

the hypothalamic-pituitary-thyroid axis

* Thyroid and adrenal glands release hormones that can affect mood
* There can be atypical feedback patterns in people who have depression on these different axis

do women have a greater genetic vulnerability?

inconsistent results

hormonal factors such as normal fluctuations in ovarian hormones for sex differences in depression?

inconsistent results

Beck's Cognitive Therapy

the cognitive symptoms of depression often precede and cause the affective or mood symptoms, rather than vice versa

The negative cognitive triad includes (becks cognitive theory)

negative thoughts about the self, the world, and the future

interpersonal effects of mood disorders

* lack of social support and social skill deficits
* depression effects those around the depressed person
* marraige and family issues

cyclothymic disorder

the repeated experience of hypomanic symptoms for a period of at least 2 years

(Less serious version of bipolar disorder—lacks the extreme mood and behaviour changes)

Genes account for what percent of the variance in the liability to develop bipolar I disorder?

80-90

increased or decreased levels of dopamine in manic symptoms?

increased

high or low serotonin activity in both depressive and manic phases?

low

are cortisol levels increased or decreased in bipolar depression but not manic episodes?

increased

Many bipolar patients have abnormalities in the functioning of the

hypothalamic-pituitary-thyroid axis

Thyroid hormone can

precipitate manic episodes in patients with bipolar disorder

3 different types of antidepressants

1. MAOI
2. TCA
3. SSRI

MAOI stands for

monoamine oxidase inhibitors

TCA stands for

tricyclic antidepressant

SSRI stands for

selective serotonin reuptake inhibitor

MAOI function

work by inhibiting monoamine oxidase (protein that breaks down serotonin) if you inhibit the protein that break it down the levels will be increased

problem with MAOI

there is a potential that there can be a reaction with food that contain tyramine (so you need to avoid foods are beer, cheese, wine...) and a number of cold medications interact

TCAs and SSRIs work by

ncreasing the level of serotonin by blocking reuptake of the sending neuron (making it more efficient by keeping it and making it more usable)

difference between TCA and SSRI

TCAs don't only break the serotonin receptors but they aren't specific so they might block other receptors

side effects of TCA

gastro effects, dry mouth, sexual disfunction, blurred vision

which are the first choice for antidepressants?

SSRI

how long do the drugs take to take effect?

3-5 weeks

what percent of patients don't respond to the first drug prescribed

50