PSY 242: Intro to Psychopathology Exam 2

MU OH

Some evolutionary psychologists view grief as adaptive because:

Grief reflects an ability to attach to others, which can increase the social cohesion of a group.

Who is best known for pioneering short-term dynamic therapy of stress syndromes?

Mardi Horowitz

The fight or flight response is controlled by the __________.

sympathetic nervous system

Since her car accident six weeks ago, Margaret has refused to drive. She's also experienced anxiety, flashbacks, and dissociative symptoms. Margaret's symptoms most closely resemble:

Posttraumatic stress disorder (PTSD)

Which of the following is true of posttraumatic growth?

It focuses on positive changes following crises, traumas, losses, and other stressful events.

Posttraumatic stress disorder (PTSD) is:

Much more common in females than in males

Which of the following is CORRECT?

Depersonalization and derealization are examples of disssociation.

The history of posttraumatic stress and posttraumatic stress disorder (PTSD) illustrates how:

The language and conceptualization of a psychological problem can change over time.

When it comes to treating posttraumatic stress disorder (PTSD), how do psychiatric drugs compare to psychological therapies in terms of their effectiveness?

Correct!

Psychological therapies are considered superior to drug treatments for PTSD.

Which of the following is a rare symptom of dissociation?

Identity confusion

Which physician is most associated with breaking the historical connection between female genital physiology and hysteria?

Briquet

Which of the following statements about dissociative identity disorder (DID) is TRUE?

DID is notoriously difficult to diagnose, and many clinicians don't believe in it.

It's when psychological problems are expressed in physical ways.

Somatization

Raj fakes a severe medical illness for one reason only: he wants 6 months of paid medical leave so that he can stay at home practicing magic tricks. Which would be the BEST diagnosis for Raj?

Malingering

Which is true about the 19th-century neurologist Charcot and his use of hypnosis to treat hysteria?

He was heavily criticized for using hypnosis, but his work nonetheless had a strong influence on Sigmund Freud.

The parietal cortex is responsible for:

Encoding and recalling negative information

Which is true about the relationship between stress and immune system functioning?

You Answered

Short-term stress boosts immune functioning, but long-term stress depletes it.

In the DSM-5, the disorder is called somatic symptom disorder. In the ICD-10, it is called somatization disorder. But in the ICD-11, they call it _____.

bodily distress disorder

Which is true about depersonalization/derealization disorder?

It's more likely to be diagnosed in clinical samples such as veterans with PTSD.

Ungula believes that depression results from a shortage of the neurotransmitters serotonin, norepinephrine, and dopamine. Further, he believes that antidepressants are the best method to treat depression. Dr. Ungula would probably endorse the ________.

monoamine hypothesis

Suicidal ideation is a term used to describe:

Suicidal thoughts or feelings

Discontinuation syndrome:

Can afflict those who stop taking SSRIs or SNRIs.

To be diagnosed with major depressive disorder, one must suffer:

One or more major depressive episodes but no manic or hypomanic episodes.

Which brain regions are being studied for their potential roles in suicidal behavior?

Hypothalamic-pituitary-adrenal (HPA) axis and certain areas of the prefrontal cortex

Depression can occur at any age, but people in this age group are at greatest risk.

Twenties

Who is credited with first conceptualizing mania and depression along a continuum?

Emil Kraepelin

For someone who supports the silencing of the self (STS) theory, what might concern them the most?

Antidepressants are being used as a form of oppressive control

What describes the main features of mania?

High energy and a euphoric mood

Which is associated with the glutamate hypothesis of depression?

Ketamine

Why is amphetamine psychosis important for the dopamine hypothesis?

Amphetamines increase dopamine in the brain.

Which area plays a role in decision-making, emotional regulation, goal-oriented behavior and speech?

Prefrontal cortex

Which of the following is NOT one of the five symptoms of psychotic disorders, according to the DSM-5?

A tendency to become aggressive without obvious cause or provocation

Repeating what someone just said is called:

Echolalia

The professor showed the class a video of a woman who didn't respond to verbal or physical prompts. She stood very still in a statue-like stance, with her arm raised rigidly. The purpose of this video was to illustrate:

Catatonia

What is psychosis?

A broad term used for people who appear to have lost touch with reality.

A double bind is:

A situation in which there are two mutually exclusive demands, neither one of which can be fulfilled or avoided.

Which would be an example of a family's expressed emotion?

hostility

When it comes to developing schizophrenia, what do adoption studies generally suggest about its causes?

Genes and environment interact to produce schizophrenia.

To examine the chromosomal defects associated with a disorder, one should conduct a(n) _______ study.

genetic marker

Which of the following factors may have played an iatrogenic role in the development of DID symptoms in Tammy?

Diane had certificates of expertise in DID prominently displayed in her office.

At the outset, Diane told Tammy that it was quite possible she had DID, and that she wanted to explore this possibility in treatment.

Diane warned Tammy of the potential for memory gaps, and told her "not to worry about it."

Diane gave Tammy literature on DID after their first session, and encouraged her to read about the disorder.

Which of the following factors were present in Tammy's case, and were likely related either to the diagnosis or case conceptualization?

Tammy was referred to the therapist, Diane, because of her expertise in dissociative disorders and DID.

Tammy was referred to treatment by her employer

Tammy had a significant legal history involving retail theft.

Tammy's family accused her of false abuse allegations

Why did Tammy and Diane take a two-month hiatus in the treatment?

Tammy was in jail for theft.

Although he did not diagnose her as such, Dr. Grande identified several traits of Borderline Personality Disorder that Tammy displayed. Which of the following were such symptoms?

Fear of abandonment.

Intense anger.

Emotion dysregulation.

Instability in relationship patterns; idealization and devaluation of partners.

According to Dr. Grande's analysis of the case, which of the following differential diagnoses should have received strong consideration (and assessment)?

Posttraumatic stress disorder (PTSD)

Antisocial Personality Disorder

Kleptomania

According to the case description, the client, Tammy, presented to psychotherapy with which presenting problem?

PTSD (Posttraumatic Stress Disorder)

What was Dr. Grande's final assessment of the quality of care that Diane provided to Tammy?

It was terrible. Diane did not set appropriate boundaries with Tammy, and interpreted all of her behavior within the framework of DID (rather than an alternate explanation).

All of the following statements are TRUE, regarding the differences between clients who truly have Dissociative Identity Disorder and individuals who are malingering, EXCEPT what? (Which of the following statements is FALSE?).

Individuals who are malingering tend to deny the diagnosis of DID, under report symptoms, and over focus on depression.

Which of the following factors support a hypothesis that Tammy's symptoms were faked (i.e., she was malingering) versus real?

The number of alters increased from 10 to 25 after the sessions were recorded and Tammy consented to a case study.

Tammy told Diane that she could "make up more [alters] if needed."

Tammy was recorded telling her sister that she was "faking" DID.

After Tammy consented to recording the sessions, there was no more theft from Diane's office

Tammy did not report significant gaps in memory.

Dr. Grande mentioned three viewpoints on the origin of Dissociative Identity Disorder. Which of the following assumes that DID is not a "real" disorder, and explains the etiology of DID as due to treatment, including clinician suggestion or encouragement?

Iatrogenic

Ideas of reference are thoughts that indicate two (or more) seemingly unrelated occurrences have special meaning. Which of the following examples illustrate the ideas of reference that Etta displayed?

Etta reported that when she heard a dog barking, it meant that Jesus was sending her a message.

What positive symptoms does Etta reveal in this interview?

Ideas (or delusions) of reference

Disturbed motor behavior

Disorganized thinking.

Auditory hallucinations

Which of the following describe emotional dysfunction common to schizophrenia as experienced by Etta?

It is unclear whether Etta is experiencing extensive emotional dysfunction. She does report feeling sad at times, but her affect does not indicate depression. More information is needed.

What negative symptoms does Etta reveal in this interview?

Emotional flattening

Etta reported that when the eagle appeared, she would receive her husband's pension check from General Motors. This is an example of what?

Disorganized thought content and incoherence.

During the interview, Etta refers to the eagle and the 25 of the clock. What is the most likely explanation for this association?

This may be an example of the disorganized thinking, but has some basis in reality. It appears that the postal truck (with an eagle on the side) delivered her mail at 25 minutes after some [undetermined] hour.

When asked why she was hospitalized, Etta explained that she had two young children who were "getting on her nerves." She is not able to fully discuss alternate reasons for her hospitalization. This suggests what?

Etta has limited insight into her condition.

In the video, several individuals discussed utilizing exercise as one strategy for managing depression. Josh reported including exercise such as cycling, going to the gym, or yoga as part of his self-care regimen for treating depression. Similarly, Kathleen discussed walking her dog regularly as a form of exercise that helped with depressed mood. These examples are consistent with what findings reported in the textbook?

These activities are consistent with Cognitive Behavioral Therapy (CBT), most specifically behavioral activation, which instructs clients to schedule particular activities that will bring them positive reinforcement. There is ample empirical evidence that behavioral activation helps reduce depression.

Eric and his partner, Patti, discussed how they work together to treat Eric's depression. Based upon Patti's report that she helps Eric address his depression by going back to work, giving him positive feedback, and remaining by his side to provide social support, we would assume what?

Eric and Patti appear to have participated in couples therapy, a variant of family-focused therapy (FFT), which focuses on psychoeducation, improving communication skills, problem-solving, and enhancing social support for the patient from family members

Nicole reported using a large arsenal of coping strategies, ranging from painting and creating artwork, to spiritual practices (i.e., prayer) and psychotherapy. She also reported dedicating about one hour a day to organizing her feelings and thoughts in a journal, with a focus on evaluating the validity, consequences, and outcomes associated with her thoughts. This latter practice is consistent with which form of psychotherapy?

CBT (Cognitive Behavior Therapy)

Eric, Kathleen, and Nicole discussed sharing their experiences with others, giving back to the community by sharing their struggles, and helping others to be happy and content (versus striving for perfection). David indicated that his efforts to explain his experiences with depression to others increased his insight into the condition. Together, these findings suggest what?

That recovery from depression has an important interpersonal element, and a focus on interpersonal relationships and experiences should be incorporated into all types of intervention.

When asked about the challenges that he faced in managing depression, what issue did Josh discuss?

His need to avoid substances and binge drinking, which induced psychotic symptoms.

Eric discussed his strategies to address depression. He mentioned the combination of psychotherapy and medication, particularly antidepressants, as being useful for his treatment. Based upon his description of his strategies to address depression, which psychotherapy do you believe Eric is likely involved in?

Eric appears to have engaged in Cognitive-Behavioral Therapy (CBT), which includes completing exercises such as the Daily Record of Dysfunctional Thoughts to identify and reframe depressogenic thoughts.

Both Josh and Eric discuss their use of antidepressant medications, and the combination of psychotherapy and medication as part of their treatment plan. Based upon their testimonials, and research on CBT and antidepressants, what might you conclude?

The experience of Eric and Josh is consistent with research suggesting that CBT plus antidepressants is equal, or superior to, antidepressants alone.

David described his experiences antidepressant medication for treatment. His experience is consistent with what research findings?

David's negative response to antidepressants is consistent with research that suggests between one-third and one-half of depressed patients are resistant to antidepressants (e.g., the drugs do not help this group of people).

David's negative experience is consistent with research indicating that side effects can lead people to discontinue use of antidepressants.

Which of the following characteristics is more typical among Type II versus Type I trauma?

Often in the context of an ongoing relationship (e.g., caregiver; partner)

Complex PTSD combines the core symptoms of PTSD plus includes 3 additional domains. Which of the following is not one of these domains?

dissociation

Affect dysregulation includes all of the following symptoms and behaviors, except what?

Feeling diminished, defeated, worthless

According to ICD-II, the core components of the PTSD syndrome involve three domains. Which of the following correctly identifies these three domains?

Sense of threat, re-experiencing, avoidance

According to the Venn diagram presented in the video, affect dysregulation is present in which disorders?

PTSD, depression, BPD, and CPTSD/DESNOS

When, and in what political context, was Posttraumatic Stress Disorder (PTSD) introduced to the DSM (Diagnostic and Statistical Manual)?

Although recognized as far back as World War I, in the form of shell shock, PTSD was first introduced into the DSM in 1980, based upon research prompted by the insistence and protests of Vietnam War veterans.

The DSM-5 formulation of PTSD focused extensively on the level of exposure, proposing specific requirements for direct and indirect exposure (as part of Criterion A). Which of the following is not one of these categories of exposure?

All of these are examples of indirect exposure meeting the Criterion A for PTSD in DSM-5.

Imagine your client expresses the following sentiments to you in therapy.

"No one can be trusted"

"All men are evil"

"It was my fault this happened"

"I am bad"

You note that these expressions are examples of which PTSD symptoms?

Negative beliefs about self, others, or the world. Distorted cognitions leading the person to blame self or others.

Arousal symptoms of PTSD are typically very prominent and interfere in the functioning of those with this disorder. All of the following are examples of arousal symptoms, except what?

negative emotional states, diminished interest in activities

In addition to PTSD, Louise is also experiencing depression, panic disorder and agoraphobia, social withdrawal, and self-defeating behaviors. She frequently experiences headaches, tension in her body, and fatigue. In contrast, Thelma also has PTSD, but she is not depressed. Instead, Thelma is confrontational, antagonistic, angry, and aggressive. She also has a SUD, with frequent use of cocaine, amphetamines, and cannabis. Which diagnostic conceptualization fits these two the best?

Louise has PTSD with internalizing comorbidities. Thelma has PTSD with externalizing comorbidities.

Exposure to traumatic events can elicit problems in several domains. The following traumatic reactions can be classified into which domain?

sleep disturbance, somatization, appetite change, immune suppression, fatigue

biological

Exposure to traumatic events can elicit problems in several domains. The following traumatic reactions can be classified into which domain?

impaired concentration; rumination; distorted time/space [i.e., dissociation]; memory problems; suicidal ideation; self-blame

cognitive

All of the following disorders are part of the Trauma- and Stressor-Related Disorders category in DSM-5, except what?

Dissociative Identity Disorder

I described my experience with a former client (I'll call her "Karen") who presented with panic disorder and generalized anxiety. Based on the information in the video, what do you think was the most significant error I made in my clinical work with her?

You did not inquire about the context in which the panic attacks were taking place and other stressors in her life.

In addition to PTSD, there are many other psychological diagnoses associated with exposure to traumatic events. All of the following are examples of this, except what?

All of these are trauma-related disorders.

Type II trauma is probably best represented by:

Being a prisoner of war.

Which of the following is the least likely to be considered a developmental trauma?

Combat exposure

Which of the following factors is the best predictor of traumatic stress?

Experiencing trauma while identifying as an ethnic, racial, sexual, gender, or cultural minority

True or False. Minority populations (or individuals from minority cultures) are more likely to experience a traumatic event (some type of trauma).

True

Bianca has experienced prolonged child abuse (including physical and emotional abuse by her caregivers), witnessed her parental figures physically assault one another, and was physically neglected by a substance-dependent parent beginning when she was 3 years old. These experiences continued until she ran away from home at age 18. After running away, she experienced sexual harassment, physical assaults, and was robbed before being accepted into a half-way house for runaway teens. Which of the following best describes the type of trauma Bianca experienced?

Complex trauma

Which of the following are symptoms of developmental trauma disorder (DTD)?

Trust issues, problems with identity, and psychosis

Symptoms include difficulties with emotional regulation, attachment issues, and problems with self-identity. Other symptoms may include dissociation, impaired relationships, and heightened anxiety.

True or False? Results of the Developmental Trauma Disorder (DTD) Field Trial for DSM indicated that DTD symptoms are not distinct from PTSD. 

False

Which of the following is a core factor in the diagnosis of Complex PTSD (CPTSD), versus PTSD?

All of these factors are really at the core of the CPTSD syndrome, distinguishing it from PTSD.

• CPTSD involves trauma in the context of early attachment relationships.

• CPTSD involves cascading effects leading to personality and behavioral problems, and difficulty trusting others.

• CPTSD shapes the person at their core, given that chronic trauma is hardwired into the nervous system and psyche.

What is a key factor that may explain why it is so hard to get CPTSD into the DSM even though the World Health Organization (WHO) advocated for, and included it in, the International Classification for Disease Manual (ICD-11)?

Insurance reimbursement is linked to DSM diagnoses in the U.S., and insurance companies will not want to reimburse or cover expenses for treatment that involves psychotherapy.

Critics of the Complex (CPTSD) diagnosis argue that the additional diagnosis is unnecessary since clinicians can just use the diagnosis of PTSD. However, this links to another issue related to limitations of the current PTSD diagnosis regarding the definition of trauma, or what is referred to as Criterion A. According to the video, which of the following is the primary concern pertaining to the definition of Criterion A events for the diagnosis of PTSD?

Criterion A would not cover certain forms of adverse childhood experiences, such as emotional abuse, neglect, or other ACEs such as having a substance-dependent parent.

True or False? In anticipation of the DSM-IV, the American Psychiatric Association funded a trial to examine the possibility of the Complex PTSD (CPTSD) diagnosis, and voted in favor of including CPTSD in the next iteration of the DSM. 

True

In the video, who was the person credited with the original conception of the diagnosis of Complex PTSD?

Judith Herman

What are the ramifications of omitting Complex PTSD (CPTSD) from the DSM?

Without a DSM-diagnosis, it is unlikely that clinical trials will be funded by federal agencies such as the National Institute of Health because those research grants must include treatments for a specific diagnosis.

According to the video, which of the following statements best explains what was motivating researchers to identify a syndrome or diagnostic entity for trauma that eventually became PTSD?

To convince the VA to cover treatment for combat veterans, the researchers needed to provide evidence that directly linked the symptoms to combat experiences, so they focused on intrusive memories, flashbacks, and nightmares, rather than symptoms considered pre-existing “character flaws” such as difficulty regulating emotions.

According to the National Child Traumatic Stress Network (NCTSN), which of the following disorders are more common than PTSD among children exposed to chronic trauma and adversity?

Borderline Personality Disorder, Bipolar Disorder, and Generalized Anxiety Disorder

What is the dopamine hypothesis of schizophrenia?

Schizophrenia results from too much dopamine in the brain.

The trainee told his supervisor that his client "barely talks during the session and only answers my questions with one or two-word responses." His supervisor responded that the client was experiencing:

Alogia

Which of the following is a positive symptom of schizophrenia?

Persecutory delusions

Which of these has been linked to schizophrenia?

physical or sexual abuse

When it comes to diagnosing psychosis, are there any ethnic or racial differences?

Yes. People belonging to an ethnic or racial minority group are more likely to be diagnosed with psychosis.