APP Unit 8

medical model

abnormal behavior is a treatable disease

diagnosis

distinguishing one illmess from another; labeling a disorder

etiology

cause of an illness

prognosis

forecast abt the probable cause of an illness

criteria of abnormal behavior

deviance:

Behavior that deviates from what society considers acceptable

\
Maladaptive behavior:

Behavior that interferes with daily life activities\*\*\*

\
Personal Distress:

Aversive, self-focused emotional reaction\*\*

the rosenhan study

diagnostic and statistical manual of mental disorders (DSM)

prevalance information, risk factors accociated with the disorder- catogones of disorders ( e g. anxiety disorders, depressive disorders, disassosiative disorders, etC) - Detailed description of each disorder including an overview of disorder (diagnostic feautrues) - speicifc symptoms required for fiagnosis (diagnostic criteria) - comorbitity rates

comorbidity

coexistence of two or more disorders 

\n

1. __Epidemiology__

the study of the distribution of mental or physical disorders in a population

\n

1. __Prevalence__

the percentage of a population that exhibit a disorder during a specific time period

\n

Mentak health and the law ( insanity )

**legal status** (not medical) indicating that a person cannot be held __legally__ responsible for his/her actions because of mental illness

\n

Mentak health and the law ( M’Naghten rule)

insanity must be needed (@ time of crime)

Involuntary Commitment

Legal system’s ability to hospitalize people in psychiatric facilities against their will. Used to help a person who may be mentally ill and harmful to self or others and refuses to seek treatment or whose judgment is so impaired they do not understand their need for treatment. (Commitment usually has a max. time)

mental health parity law

insurance coverage

GAD

marked by chronic, high levels of anxiety that is not tied to any specific threat 

\n

specific phobiad

excessive fear of a specific object or situation

\n

social phobia (social anxity disorder)

fear of social or performance situations where they are being scrutinized (evaluated) by others. (spotlight effect)

\n

agoraphobia

fear of going out to public places; fear of open spaces or leaving a safe place 

\n

C. __Panic Disorder__

\n

recurrent attacks of overwhelming anxiety that occur suddenly and unexpectedly

\n

1. __Obsessive-Compulsive Disorder (OCD)__

Obsession: __unwanted thoughts__ that are intrusive and will not go away 

\n

Compulsion: __ritualistic/repetitive behavior__ a person engages in to manage anxiety caused by the thoughts. *(Compulsive behavior is driven by obsessions)* 

\n

__Hoarding__

difficulty discarding or parting with possessions regardless of their actual value

\n

C. __Body Dysmorphic Disorder__\*

\n

preoccupation with one or more perceived flaws/defects in physical appearance that is not observable to others or appears slight

\n

D. Etiology of Anxiety & Obsessive-Compulsive Disorders

__***Biological Factors:***__

**Concordance rate**

% of twin pairs or other pairs of relatives who exhibit the same disorder

\n

**Neurotransmitter imbalance**

disturbances in neural circuits using GABA; high levels of norepinephrine (anxiety); serotonin & glutamate (OCD)

\
\
**Conditioning & Learning (Behavioral approach)**

Phobias: acquired thru CC & maintained through OC
OCD: maintained thru OC
Many of the disorders can be influenced by OL

\
**congnitive factors**

misinterpret harmless situations as threatening;
excessive attention on perceived threats; selectively recall
info that seems threatening; low self-efficacy or self-concept

1. __Post-traumatic Stress Disorder (PTSD)__

involuntary recollections of trauma/flashbacks, nightmares, intense/prolonged distress, persistent negative emotions, avoidance behaviors, dissociative symptoms.

\n B. Etiology

\n Significant/severe trauma or life stressors

\n

1. __Conversion Disorder__\*

temporary functional impairment (e.g. blind, deaf, paralyzed) with no physical cause

\n etiology:

trauma (form of repression?) or a psychological crisis (too much stress/anxiety)

\

B. __Somatic Symptom Disorder__ (AKA Illness Anxiety Disorder; formerly Hypochondriasis)\*

\n

preoccupied with concern they have a serious disease; may believe that minor complaints are signs of very serious medical problems

\
**etiology**:

cognitive: too much attention to bodily sensations, minor **symptoms** = catastrophic, unrealistic def. of healthy

learning: reinforced for being sick

1. __Major Depressive Disorder (MDD)__

persistent feelings of sadness, despair, loss of interest, etc.

that impairs everyday adaptive behavior for more than 2 wks

\- suicidal tendencies

\n

Anhedonia

diminished ability to experience pleasure

\n

B. __Persistent Depressive Disorder (PDD)__\*

\n

"mild depression" - symptoms of depression that come & go over a period of years, often with changing intensity

\n

VII. **Bipolar** Disorders

\n

formerly known as "manic-depression"; characterized by experience of one or more manic episodes as well as periods of depression

\n

mania

euphoric, elated state characterized by impulsiveness, racing thoughts (flight of ideas), delusions of grandeur, little sleep, & spending $

\n

Bipolar I\*

intense mania & intense depression

\n

Bipolar II\*

mild mania & intense depression

1. __Cyclothymic Disorder__\*

mild mania & mild depression

D. **Etiology** of Mood & Bipolar Disorders

\n

1. Genetic Vulnerability

concordance rates: identical twins = 65%; fraternal twins = 14%

\n \n


2. Biological (Neurochemical & Neuroanatomical)

abnormal levels of serotonin & norepinephrine

Ex: low levels of serotonin = depression;  fluctuation = bipolar

\n


3. Hormonal Factors

\-overactivity among the HPA axis in response to stress

\-elevated cortisol levels

\n 4. Cognitive Factors

\-learned helplessness (Seligman)
\-ruminating, irrational thinking, pessimistic viewpoint
\-globalized low self-efficacy; negative self-concept

\

5. Interpersonal Roots

inadequate social skills, lack of social support, lack of reinforcers

\n

Anorexia Nervosa

intense fear of gaining weight, disturbed body image, refusal to maintain normal weight, and use of dangerous measures to lose weight

\*highest fatality rate of any psychological disorder

1. __Bulimia Nervosa__

habitually engaging in out-of-control overeating followed by unhealthy compensatory efforts (purging, laxatives, excessive exercise)

\n

C. Etiology of eating disorders

\*Genetic Vulnerability - not much research

\*Personality (need for control & perfection)

\*Cultural Values (sociocultural perspective)

\*Critical mothers

\n

IX. **Personality Disorders**

\n

Defn: marked by extreme, inflexible personality traits that cause subjective distress or impaired social and occupational functioning

\n

1\. ANTISOCIAL PERSONALITY DISORDER \n

A deeply ingrained and rigid dysfunctional thought process that focuses on social irresponsibility with exploitative. delinquent, and criminal behavior with no remorse. \n

2\. BORDERLINE PERSONALITY DISORDER \n

Emotion dysregulation, impulsivity, risk-taking behavior, irritabili ty, feelings of emptiness, self-injury and fear of abandonment, as well as unstable interpersonal relationships. \n

3\. HISTRIONIC PERSONALITY DISORDER \n

Self-centeredness, attention-seeking behavior, over-dramatic emotions, seductive and sexually provocative behaviors. \n

4\. NARCISSISTIC PERSONALITY DISORDER \n

A strong need for admiration, act as superior and behave with grandiosity. They tend to exaggerate their achievements in front of others and have fantasies of unlimited success, power, and beauty.

personality dissorders Diagnostic Problems and Etiology

\n

Too much overlap with other disorders/each other

\n

* Concordance rate: identical twins 67%, fraternal twins 31%
* Antisocial - lack inhibitions
* Dysfunctional Family Systems

X. **Dissociative Disorders**

\n

loss of contact with portions of their consciousness

or memory, resulting in disruptions in their sense of identity

\n

1. __Dissociative Amnesia__

sudden loss of memory for important personal info (too extensive to be due to normal forgetting & NOT due to  physical damage to the brain)

\n

dissasosicative fugue

loss of memory of entire life/identity; often found in a new location

\n

B. __Dissociative Identity Disorder (DID)__

\n

\-Formerly known as "Multiple Personalities"

\-coexistence in one person of two or more different personalities

(each identity has own name, memories, traits, & physical mannerisms)

\n

C. **Etiology** of Dissociative Disorders

\n

* excessive stress (ALL)
* severe emotional trauma in childhood  (DID, specifically)
* severe repression -- psychoanalytic approach
* Lack of coping mechanisms

Psychotic Disorders

\n

psychotic disorders: a group of disorders marked by irrational ideas, distorted perceptions, deterioration of adaptive behavior & a general loss of contact with reality

\n

v__Schizophrenia__ & Its General Symptoms

a disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression (affect). 

\n

1. __Delusions__ & Irrational Thoughts

false beliefs that are maintained even though they clearly are out of touch with reality

\n

1. __Ideas of reference__\*

the belief that innocuous events have highly personal significance (usually in a negative or hostile manner)

\n

1. __Delusions of grandeur__\*

the belief that one possesses superior qualities such as genius, fame, omnipotence, or wealth

\n

1. Thought broadcasting, Thought blocking/withdrawal, &/or Thought insertion\*

beliefs that others can either hear your thoughts, can prevent you from having thoughts, or put thoughts into your head (= paranoia)

\n

__Hallucinations__

sensory perceptions that occur in the absence of real, external stimuli or are gross distortions of perceptual input

\n

\

2. Deterioration of Adaptive Behavior

\

deterioration of routine functioning in work, social relations, and personal care

\n

2. Disturbed Emotion

little emotional responsiveness (blunted/flat affect) or inappropriate emotional responses

\n

__Neologisms__

making up words 

\n

loose assosication

response does not relate to the question asked; sentence is not logically related to those before/after it

\n

1. __Clang associations__\*

association of words based on sounds rather than concepts (rhyming)

Asked: What is your job?

Response: I'm just there to make money. Isn't that funny? Bunny, hunny...

\n

1. __Word Salad__\*

mix of real words/phrases that don't make sense when put together

\n

6\. **Positive vs. Negative Symptoms**

\n

Positive: __presence__ of problematic behaviors

Negative: __absence__ of healthy behaviors

Onset

\*Usually emerges in very late adolescence or early adulthood + gradual onset (75% manifest by 30 yo)

B. **Etiology** of Schizophrenia

\n

1. Genetic Vulnerability

oncordance rate: identical twins = 48%, 

fraternal twins = 17%

two schizophrenic parents = child w/ 46% prob.

\n \n \n \n


2. Neurochemical factors (Biological)

\
excess dopamine activity

*(abnormal/excessive synaptic pruning)*

*(high frequency/high potency marijuana use causing episodes of psychosis)*

\
\n 3. Structural Abnormalities in the Brain (bio.)

\n \*enlarged brain ventricles 

\*reductions in gray and white matter

\n

\
4\. Neurodevelopmental Hypothesis (bio.)

Issues during prenatal development (disruptions in normal maturational process of the brain before or at birth)

\
5\. Diathesis Stress

\n \*Stress = key role in triggering 

\*High stress can trigger relapses

\n \n

Intellectual disability

\n

deficits in general mental abilities, impairments of adaptive functioning

\n

Autism spectrum (including Asperger’s)

lacking theory of mind; persistent deficits in social communication and social interaction across multiple contexts; Restricted, repetitive patterns of behavior, interests, or activities & inflexibility 

\n aspergers- less severe form of autism

Attention Deficit/Hyperactivity Disorder (ADD/**ADHD**)

persistent pattern of inattention and/or **hyperactivity**/impulsivity

insight therapies

talk therapy to gain increased insight and sort through possible solutions; individual or group

\n

Behavior therapies

\n

therapist makes a direct effort to alter problematic responses and maladaptive habits; want to change client's behavior; uses principles of learning (OC, CC, OL)

\n

Biomedical therapies

\n

interventions into a person's biological functioning; drug therapy and other treatments of structural or chemical abnormalities

\n

Psychologist

Ph.D., Psy.D., Ed.D.

\n \*specialize in diagnosis and treatment of psychological disorders (clinical) and everyday behavioral problems (counseling) 

\*Use **insight** or **behavioral** approaches

Psychiatrist

M.D. or D.O.\*diagnosis and treatment of psychological disorders

\-Focus more on severe disorders (schizophrenia, depressive disorders, bipolar)

\*Use **insight**, behavioral, and **biomedical** approaches

* Other mental health professionals:
* *****__**Clinical Social Workers**__**: ,**
* \
***Psychiatric Nurses:**
* \
***Counselors:**
* \
***Marriage and family therapists:**
* \

*****__**Clinical Social Workers**__**: MS,** work w/patients + their families to ease patient back into the community 

***Psychiatric Nurses: BS or MS**, hospitals + inpatient treatment 

***Counselors: MA**, schools, colleges, or community agencies

***Marriage and family therapists: MA,** couples and families

Psychoanalysis

Emphasizes the recovery of unconscious conflicts, motives, and defenses through techniques such as free association and transference 

\n

* Free association:

spontaneously expressing their thoughts and feelings exactly as they occur, with as little censorship as possible

\n

* Dream analysis:

therapist interprets the symbolic meaning (latent content) of the client's dreams

\n

* Hypnosis:

a trance-like mental state in which people experience increased attention, concentration, and suggestibility

\n

Transference

when clients unconsciously start relating to their therapist in ways that mimic critical relationships in their lives 

\n

Object Relations Therapy

emphasizes interpersonal relations in the family, esp between mom and child

\n

Which disorders are __best__ treated by psychodynamic therapy?

Somatoform Disorders & Dissociative Disorders

Some forms of PTSD (or other trauma disorders)

\n

Client-centered therapy 

\n \n

*(humanistic/*

*phenomenological approach)*

\n *what is the* __*goal*__ *of* this *type of therapy?*

\*The goal is to help you help yourself

\n

* What *was Carl Rogers’ guiding belief on therapy?*

providing a supportive emotional climate for clients; client plays a major role in determining the pace and direction of their therapy

\n

Incongruence

self-concept =/= reality   (actual, ideal, ought self)

perception of the world =/= reality

\n

* Genuineness:

\n \n

* Unconditional positive regard:

\n \n

* Empathy:

communicate honestly; doesn't act phony or defensive

\\n

\
complete, nonjudgmental acceptance of the client as a person; warm and caring

\
understanding the client's world from the client's point of view

\n

* Active listening & clarification:

\n \n \n

* Which disorders are __best__ treated by client-centered therapy?

\n \n

using verbal and non verbal cues to indicate to the client that you are listening (rephrasing/summarizing/asking for more info)

\n

\
Most disorders (none to specify)

"best practices" in psychotherapy

\n

Group therapy

Definition:

\n \n \n

* Participants’ roles:

\n \n \n

* Advantages of the group experience:

\n \n \n \n

* Which disorders are __best__ treated using group therapy?

* Definition:

\n simultaneous psychological treatment of several clients in a group

\n \n \n

* Participants’ roles:

\n -function as therapists for one another

\-describe problems, trade viewpoints, share experiences, and discuss coping strategies

\-provide acceptance and support for each other

\n \n \n \n \n

* Advantages of the group experience:

\-more affordable

\-just as effective as individual therapy for some people/problems

\-shared experience + social support 

\-social skills work in safe environment

\n \n \n \n \n

* Which disorders are __best__ treated using group therapy?

Eating disorders, addiction, anxiety disorders

\n

\

Counterconditioning

*(uses CC)*

\n

conditioning an unwanted behavior or response to stimulus into a wanted behavior or response by the association of positive actions with the stimulus  

\n

Exposure therapies

\n

*(uses CC)*

\n Systematic desensitization:

\n \n

* Flooding or immersion:

\n \n \n Which disorders are __best__ treated using systematic desensitization and exposure therapies?

* Systematic desensitization:

step by step process used to reduce __phobic__ clients' anxiety responses through using deep breathing & a hierarchy

\n \n \n

* Flooding or immersion:

clients are confronted with situations that they fear so that they learn that these situations are really harmless

\n \n \n \n Which disorders are __best__ treated using systematic desensitization and exposure therapies?

\
Anxiety, Phobias, OCD, PTSD

\n

Aversion therapy 

\n *(uses OC & CC)*

* OC:

**A form of positive punishment**   

\n \n \n

* CC:**CC: Using counterconditioning where a negative emotional/physiological association is formed instead of a positive one.**

\n

\n \n __Best__ treatment for:Addictions, bad habits

\n

Applied behavioral analysis (ABA)

\n

*(social skills training; uses SL & OC)*

\n

* Definition/info:

designed to improve interpersonal skills; child’s behavior is charted & analyzed

 -modeling: watch and learn (OL)

 -behavioral rehearsal: practice through role-play (OL)

\-shaping: slowly work toward complicated/delicate social situations (OC)

 

\n \n \n \n __Best__ treatment for:

\*Best treatment for: Autism, Social Phobia, & some others

Virtual Reality (VR) therapy

\n

(uses OC)

\n

* Definition/info:

\-used with Systematic Desensitization, Social Skills, etc.

\n -uses technology to give the patient a simulated experience

\n \n \n

* __Best__ treatment for:\*Best treatment for: PTSD, Phobias, anxiety, etc.

\n

Token economy 

\n

(OC: positive reinforcement)

\n

* Definition/info:

\n \n behavior modification based on the systematic reinforcement of a target behavior 

\n \n

* __Best__ used for:\*Best used for children & inpatient treatment

\n

Albert Ellis’ Rational-Emotive Therapy (RET) 

&

Aaron Beck’s Cognitive-Behavioral Therapy (CBT) 

\n

1. cognitive-behavioral

(verbal interventions + behavioral modification techniques to help clients change maladaptive patterns of thinking resulting in problematic behaviors)

Antianxiety drugs

\
* Which disorder(s) do they treat?

\n \n

* Definition:

(anxiolytics) relieve tension, apprehension, and nervousness

\n -Benzodiazepines: __Valium, Xanax__ (tranquilizers)

-fast acting, yet effects are short-lived

Antipsychotics

* Which disorder(s) do they treat?

\n \n

* Definition:

\n \n

* Tardive dyskinesia:

*(neuroleptics)*

\
* Which disorder(s) do they treat?

schizophrenia \n \n

* Definition:

gradually reduce psychotic symptoms by __decreasing dopamine activity__ - work for about 70% of patients

\
\- __clozapine, risperidone, haloperidol__

\n

* Tardive dyskinesia:A side effect of neuroleptics

neurological disorder: involuntary writhing and tic-like movements of the mouth, tongue, face, hands or feet

\n

Antidepressants

* Which disorder(s) do they treat?

\n \n

* Definition:
* SSRIs:

\n

* SNRIs:

* Which disorder(s) do they treat?

\n depressive Disorders, OCD, Anxiety

\n \n

* Definition:gradually elevate mood and help bring people out of a depression 

\n
* SSRIs:(serotonin) Prozac, Paxil, Zoloft  

\n

\n

* SNRIs:(norepinephrine) Effexor, Cymbalta

Mood stabilizers

* Which disorder(s) do they treat?

\n \n

* Definition:

* Which disorder(s) do they treat?

Bipolar \n \n

* Definition:control mood swings 

-__Lithium__, Valproate

* Electroconvulsive therapy (ECT)
* Which disorder(s) do they treat?

\n \n

* Definition:

* Which disorder(s) do they treat?

Major Depressive Disorder

\n \n \n

* Definition: electric shock is used to produce a cortical seizure accompanied by the convulsions

\*high relapse rate, short-term side effects 

\n \n \n

* Psychosurgery
* Which disorder(s) do they treat?

\n \n

* Definition:

* Which disorder(s) do they treat?

Personality Disorders,
Bipolar, OCD

\n \n

* Definition:

severing/disabling (lesioning) parts of the brain to treat mental illness