PSYCH 240 Final

Deviance

Deviance

Behavior is viewed as different, unusual, even bizarre Stray from one’s own societal standards of normal.

o Distress:

When a behavior causes anxiety, bad feelings or other negative feelings for either the person or others who come in contact with them  Ex. People swimming in lakes in February for some normal but most it would cause distress

o Dysfunction

According to abnormal behavior, the label dysfunctional cannot be used until it interferes with daily life functions  Ex. Guy quit his job and left family and prepared to withdraw from the life he once led.

Danger

Abnormal behavior may cause an individual to become dangerous to oneself or others  Careless, hostile, or confused. Often looked at as a feature of psych abnormality

• Why is the nature of abnormal behavior difficult to determine? Include examples and support for your statements.

 It is difficult to determine if a behavior is abnormal or not because each place/country has different societal norms. Things that we do in the US on a daily bases might seem like an abnormal behavior to someone who lives in japan.

o Some behaviors seem deviant until you look at the context in which they are occurring. Write about an example of a behavior could be viewed as deviant or not based on context.

 An example without context is you see a women with a heavy stack of brass rings around their neck walking down the street. In the US this would be a deviant behavior as it looks very weird and no one wears anything like that. On the flip side if you knew that the women was wearing it because in her culture having a long neck is a must it would make sense that she Is wearing it and in her culture it is a very normal thing that every women does.

o Somatogenic perspective

The abnormal functioning has physical causes

o Psychogenic perspective

The abnormal functioning has psychological causes

• How did pharmacologic discoveries in the 1950s effect institutionalization? Know the types of drugs that were developed.

o They reduced the number of institutionalizations that were happening o The drugs that were developed include Antipsychotics, Antidepressants, and Antianxiety drugs. These also helped lead to more outpatient care and a community mental health approach

o Reliability

the consistency of an assessment measure, 2 types test-retest and inter-rater reliability, always yield same result in same situation

Validity

the accuracy of a tool’s results, accurately measures what it is supposed to measure

3 main types of validity

Face, Predictive, concurrent

o Face Validity

appears to measure what it is supposed to measure

o Predictive validity

Accurately predicts future characteristics/behavior

o Concurrent validity

Results agree w/independent measures assessing similar characteristics or behavior

• What are the personality inventories we discussed in lecture? What are the strengths and limitations to these inventories?

o Minnesota Multiphasic Personality inventory (MMPI) – focus on behaviors, beliefs, and feelings. This is the most widely used  consists of more than 500 self-statements describing physical concerns; mood; morale; attitudes toward religion, sex, and social activities; and psychological symptoms that can be answered “true,” “false,” or “cannot say.” o Ten-Item Personality Inventory (TIPI) – measure of the big 5 personality dimensions, intended use is for research

• What are the types of response inventories (affective, social, cognitive) discussed in lecture and what do they assess for? What are the strengths and weaknesses of these inventories?

o Affective inventories: Measure severity of emotions; anxiety, depression, & anger o Social skills inventories: Respondents indicate how they would respond in a variety of social situations o Cognitive inventories: Reveal a person’s typical thoughts and assumptions  Strengths – good face validity  Weakness – Not all inventories subjected to careful standardization, reliability and/or validity procedures

• What are the three types of exposure therapy?

o Flooding – repeated/intense exposure o Modeling – therapist confronts feared event/object and client observes o Systematic Desensitization - Repeated exposure to small amounts of a fearful stimulus eventually weakens fearful responses

• Which neurotransmitter has been implicated in playing a role in panic disorder?

o Too little GABA paired with too much orexin

• Treatments for social anxiety disorder address two distinct features, what are they?

o Overwhelming social fears - Medications: Benzodiazepine or antidepressant drugs Cognitive-behavioral therapy: Exposure therapy and systematic therapy discussions o Lack of social skills – includes social skills and assertiveness training

• Case study – diagnose the anxiety disorder portrayed and determine a course of treatment using support from a theoretical perspective discussed in lecture. o Know the symptoms for generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsessive-compulsive disorder, and phobia - AND be able to apply your knowledge to fictional scenarios

 Diagnosing someone with GAD using the psychodynamic perspective- may be traced to early parent – child relationships, high use of defense mechanisms (repression), and may develop from early punishment or overprotectiveness.  How to Treat – free association, object-relations therapists can help patients identify and settle early relationship problems, and short term treatment works better than longer treatment types

• Discuss biological predispositions that may underlie or drive PTSD - Detail the various factors that put people at risk for developing a psychological stress disorder.

o Brain–body stress: increased levels if NE and cortisol o Brain’s stress circuit: includes such structures as the amygdala, prefrontal cortex, anterior cingulate cortex, insula, and hippocampus, among others. o Once a stress disorder sets in, further biochemical arousal and damage may also occur (especially in the hippocampus and amygdala). o Inherited predisposition: diathesis stress model

o Childhood experiences that increase risk for later PTSD

 Chronic neglect or abuse  Poverty  Parental conflict  Catastrophe/assault/abuse <10 yrs of age  Family members with psychological disorders

• Cognitive factors and coping styles for PTSD

o Some studies suggest that people with certain personalities, attitudes, and coping styles are particularly likely to develop stress disorders.  Pre-existing memory impairments, intolerance of uncertainty, inflexible coping style, and negative worldview versus resiliency and manageable stress exposure in childhood  A set of positive attitudes (called resiliency or hardiness) is protective against developing stress disorders.

• Social support systems and the severity and nature of the trauma of PTSD

o Weak family and social support systems o More severe or prolonged trauma o More direct exposure to trauma o Intentionally inflicted trauma o Mutilation, severe physical injury, or sexual assault

• What is the best treatment for PTSD?

o Exposure- based treatment is the best intervention for people with PTSD. o Earlier treatment: In vivo exposure more effective than covert exposure. o Today: Virtual reality exposure is now standard in PTSD treatment.  clients use wraparound goggles and joysticks to navigate their way through a computer-generated military convoy, battle, or bomb attack in a landscape that looks like Iraq or Afghanistan.

o Autonomic nervous system (ANS)-

sympathetic o An extensive network of nerve fibers that connect the central nervous system (the brain and spinal cord) to all other organs of the body.

Endocrine system

A network of glands throughout the body that release hormones.

• Discuss treatments for these disorders from the cognitive behavioral perspective.

o Cognitive processing therapy: accept experiences, things they’ve had to do, judge themselves less and learn to trust others o Mindfulness-based techniques: attend to thoughts/feelings & accept them o Exposure techniques; prolonged exposure: Very effective, clients confront trauma directly along with memories of traumatic experiences o Eye movement desensitization and reprocessing (EMDR): clients move their eyes in rhythmic manner (side-to-side) while imagining objections/situations they’d typically avoid

o Dissociative amnesia

Inability to recall important information, usually of an upsetting nature, about one’s life. Memory loss is much more extensive than normal forgetting and is not caused by physical factors. Often the amnesia episode is directly triggered by a specific upsetting event.

o Dissociative fugue

Extreme version of dissociative amnesia. People not only forget their personal identities and details of their past, but also flee to an entirely different location. May be brief or more severe

o Dissociative identity disorder (multiple personality disorder

Two or more distinct personalities (subpersonalities) develop. Each has a unique set of memories, behaviors, thoughts, and emotions. Sudden movement from one subpersonality to another is usually triggered by stress. Women are diagnosed three times more often than men.

• dissociative disorders: dissociative amnesia (including dissociative fugue) and dissociative identity disorder- Include psychodynamic explanations, behavioral explanations, state-dependent learning, and self-hypnosis

o Psychodynamic perspective  Dissociative disorders are caused by repression.  People fight off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness.  Dissociative amnesia and fugue are single episodes of massive repression.  DID results from a lifetime of excessive repression, motivated by very traumatic childhood events. o State-dependent learning: Cognitive-behavioral view  Link between state and recall  Learning can also be associated with mood states.  Arousal is an important part of learning and memory.  Particular level of arousal  attached set of remembered events, thoughts, and skills  If people learn something when they are in a particular situation or state of mind, they are likely to remember it best when they are again in that same condition o Self-hypnosis – self induced amnesia  Dissociate amnesia Parallel between hypnotic amnesia and dissociative disorders. People may hypnotize themselves to forget unpleasant events; fugue occurs when all memories of person’s past and identity are forgotten.  Dissociate identity disorders Children who experience early abuse or horrifying events may escape threat by self-hypnosis (mental separation through wish to become other person).

• Describe the biological, psychological, and sociocultural perspectives of depression.

o Biological – genetics, low activity of serotonin and norepinephrine, glutamate, hormones, brain circuit dysfunction, immune system all play a role in developing depression. o Psychological - Depression results when people's relationships leave them feeling unsafe and insecure (especially in early life). o Sociocultural - Depression influenced by social context and often triggered by outside stressors

• Which recreational drug has recently gotten attention for providing immediate relief in cases of treatment-resistant depression?

Ketamine

• What is the primary difference between bipolar I disorder and bipolar II disorder?

o BP 1 has manic episodes and BP2 does not

• What is the most effective treatment for bipolar disorder, according to the research?

o Lithium and antiseizure drugs

o MAO inhibitors

Increases activity level of neurotransmitters serotonin and norepinephrine

o Tricyclics

Inhibit neurotransmitter reuptake of key serotonin and norepinephrine

o Selective serotonin reuptake inhibitors

that increase serotonin activity without affecting other transmitters

o Antidepressant drugs

block the reuptake process, enabling norepinephrine or serotonin to remain in the synapse longer and bind to the receiving neuron.

• What are the characteristics of anorexia?

o A refusal to maintain more than 85% of normal body weight, Intense fear of becoming overweight, Distorted view of weight and shape

• What are the characteristics of bulimia?

o It is characterized by binges—repeated bouts of uncontrolled overeating during a limited period of time. also is characterized by inappropriate compensatory behaviors: Forced vomiting, Misusing laxatives, diuretics, or enemas, Fasting, Exercising excessively

• What are the characteristics of binge-eating?

o The binges are characteristically similar to bulimia, minus purging, Preoccupied with food, weight, & appearance, Base their self-evaluations on weight and shape, Struggle with depression, anxiety, self-disgust, and perfectionism

• The drugs receiving the most attention recently for reducing bulimia, binge eating, and purging behaviors are what?

o Antidepressants

• What are the parts of the hypothalamus that turn on and off hunger signals?

o The lateral hypothalamus produces hunger and the ventromedial hypothalamus reduces hunger

• The substances people misuse fall into 4 major categories, what are they?

o Depressants, Stimulants, Hallucinogens, and Cannabis.

substance use disorders - Sociocultural view

People who are most likely to develop these disorders: o Living in stressful socioeconomic conditions o Have families that value or tolerate drug use o Are confronted regularly by other kinds of stress

substance use disorders - psychodynamic views

People who are most likely to develop these disorders: o powerful dependency needs that can be traced to their early years - caused by a lack of parental nurturing o Some people may develop a “substance abuse personality” as a result o Limited research links early impulsivity to later substance use, but the findings are correlational and researchers cannot presently conclude that any one personality trait or group of traits stands out in substance use disorders.

substance use disorders - cognitive-behavioral views

o People who are most likely to develop these disorders:  Operant conditioned by tension-reduction, rewarding effects of drugs (self-medication)  Have rewards-produced expectancy that substances will be rewarding  Influenced by classical conditioning when cues or objects are present during drug use

substance use disorders -sociocultural therapies

Believe psychological problems emerge in a social setting and best treated in a social context.  Most common: AA, peer support, spiritual guidelines to stay clean – key here is abstaining vs other programs that argue for controlled use  Self-help: People formerly dependent on drugs live, work, and socialize in a drug-free environment while undergoing individual, group, and family therapies.  Culture- and gender-sensitive programs: account for situationism, poor, homeless, and women & men may require different interventions types.  Prevention programs – The most effective programs focus on multiple areas to provide a consistent message about drug use in all areas of life.

substance use disorders - psychodynamic therapies

Clients helped to become aware of and correct underlying needs and conflicts related to drug use Not highly effective; more useful when combined in multidimensional treatment program

Substance use disorders - cognitive-behavioral techniques

Clients are helped to identify and change behaviors and cognitions that contribute to patterns of substance misuse.  Interventions  Aversion therapy: A widely used behavioral treatment is aversion therapy, an approach based on classical conditioning principles  Pairing unpleasant stimuli with moment of drug use. After repeated pairings, they are expected to react negatively to the substance itself & to lose their craving for it.  These treatments help clients identify and change the patterns and cognitions contributing to their patterns of use.  Contingency management: offer incentives for clean urine samples – higher attendance record than other programs (alone as treatment this is moderately effective at best).

o Death seekers:

Clearly intend to end their lives (ex: shoot themselves)

o Death initiators:

Intend to end their lives because they believe that the process of death is already under way

o Death ignorers

Do not believe that their self-inflicted death will mean the end of their existence

o Death darers

Have ambivalent feelings about death and show this in the act itself

o Sub intentional death:

Indirect, covert, partial, or unconscious – died b/c of carelessness, but didn’t mean to

• Discuss the common precipitating factors in suicide.

o Stressful events o Mood and thought changes o Alcohol and other drug use o Mental disorders o Modeling

• Explain the role of biological factors in suicide, including the role of serotonin.

o Genetics, early twin studies point to genetic links to suicide o Brain development  Low serotonin activity abnormalities in depression related brain circuits contribute to suicide. Both aid in production of aggressive feelings and impulsive behavior

• Describe the interpersonal theory of suicide.

o A person must have a desire to die and the ability to do so  Perceived burdensomeness + sense of low belongingness or social alienation = desire to commit suicide this all leads to the ability to engage in lethal self injury ultimately ending in suicide  Fight with self – linked to pain tolerance and a history of painful and fearful experience

• 10 personality disorders are organized into three categories (clusters), what are they?

o Odd or eccentric o Dramatic, emotional, or erratic behavior o Anxious or fearful behavior

o Paranoid

Explanation  Psychodynamic: Linked to patterns of early interactions with demanding parents  Cognitive-behavioral: Tied to broad maladaptive assumptions  Biological: Genetic causes  Little systematic research – we don’t know much. o Treatments  They don’t see themselves as needing help  Few come to treatment willingly.  Those who are in treatment often distrust and rebel against their therapists.  As a result, therapy for this disorder, as for most of the other personality disorders, has limited effectiveness and moves slowly.  Psychodynamic: Object relations therapists; self therapists: see past the patient's anger and work on the underlying wish for a satisfying relationship.  Cognitive behavioral – restructure maladaptive assumptions/interpretations  Behavioral: Anxiety reduction and interpersonal problem-solving improvement  Cognitive: Development of more realistic interpretations of words and actions of others  Biological: Antipsychotic drug therapy

o Schizoid

Explanation  Symptoms resemble those of schizophrenia  Schizophrenic patterns often linked to family conflicts, parental psychological disorders, defects in attention and short-term memory  Poor performance displayed on backward masking  Some of same biological factors found in schizophrenia: high neurotransmitter dopamine activity, enlarged brain ventricles, smaller temporal lobes, gray matter loss  Linked to mood disorders, higher rate of relative depression o Treatment –  Helping clients to reconnect with world and recognize limits of their thinking and powers, increase positive social contacts, east loneliness, reduce overstimulation, increase awareness of personal feelings  Teaching clients to evaluate unusual thoughts and perceptions, using specific behavior methods and antipsychotic drugs

o Schizotypal

Explanations  Similar factors are at work in schizotypal personality disorder and schizophrenia and related disorders.  Symptoms are often linked to family conflicts and to psychological disorders in parents.  Schizotypal personality disorder is linked to some of the same biological factors found in schizophrenia, such as high dopamine activity.  Links to mood disorders, especially depression, have been found. o Treatments  Behavioral: Help the client reconnect to world and recognize thinking limits.  Cognitive-behavioral: Recognize unusual thoughts and magical predictions; speech lessons, social skills training, appropriate dress and manners recognition  Biological: Some patients benefit from low-dose antipsychotic drugs- reducing certain thought problems

o Antisocial

Explanation  Psychodynamic theorists: Absence of parental love leads to lack of basic trust; research links to childhood stress.  Cognitive-behavioral  Antisocial symptoms learned through operant conditioning, modeling, imitation  Difficulty recognizing others’ viewpoints or feelings o Treatments - Education; therapeutic community; psychotropic medication. Typically ineffective due to lack of conscience and desire to change.

o Borderline

Explanation  Psychodynamic: Early parental relationships (object relations theory)  Object relations theory: Lack of early acceptance or abuse/neglect by parents (some research support)  Biological: Genetic predisposition; lower brain serotonin activity; abnormal brain structure/circuit activity and anatomy  Sociocultural: Impact of rapidly changing cultures o Treatments  Psychodynamic: Relational psychoanalytic therapy; transference-focused therapy  Cognitive-behavioral: Primarily dialectical behavior therapy (DBT – social skills building)  Biological: Antidepressant, antibipolar, antianxiety, or antipsychotic drugs as adjuncts to psychotherapy

o Histrionic

Explanation  Psychodynamic: Unhealthy relationships with cold, controlling parents in childhood; feelings of being unloved and fear of abandonment; dramatic crisis invented for protection  Cognitive-behavioral: Lack of substance and extreme suggestibility tied to self-focused and emotional behavior; search for others to meet needs related to sense of helplessness  Sociocultural/multicultural: Partially influenced by cultural norms and expectations  To defend against deep-seated fears of loss, individuals have learned to behave dramatically, inventing crises that require people to act protectively.  Need to be loved or adored by others o Treatments  Cognitive-behaviorist theorists: Focus on lack of substance and extreme suggestibility found in people with the disorder  General assumption of helplessness to care for self, so individuals seek out others who will meet their needs.  Psychodynamic therapy/group therapy also used.  Each approach is useful, though some are less useful. `

o Narcissistic

Explanation  Psychodynamic: Focus on cold, rejecting parents; life spent feeling unsatisfied, rejected, unworthy, ashamed, and world wary  Object relations: Focus on grandiose self-presentation; self-sufficiency replaces warm relationships  Cognitive-behavioral: Propose narcissistic personality disorder may develop when people are treated too positively rather than too negatively in early life; overvalue self-worth  Sociocultural theorists: See a link between narcissistic personality disorder and eras of narcissism in society  In support of this psychodynamic theory, research has found increased risk for developing the disorder among abused children and those who lost parents through adoption, divorce, or death. o Treatments  One of the most difficult personality patterns to treat  Clients consult therapists usually because of a related disorder, most commonly depression  Individuals may try to manipulate therapists to support their sense of superiority; a love-hate relationship may evolve  Psychodynamic: Recognize and work through basic insecurities and defenses  Cognitive-behavioral: Focus on self-centered thinking and redirection  No major treatment approaches have had much success.

o Avoidant personality disorder

explanation  Theorists often assume avoidant personality disorder has the same causes as anxiety disorder; no clear research ties the two together.  Psychodynamic: Focus on shame and insecurity traced to childhood experiences.  Cognitive-behavioral: Harsh criticism in early childhood leads to expected rejection and failure to develop effective social skills. o Treatments  Therapy often sought for acceptance and affection.  The therapist gains the individual's trust and tends to treat the disorder in the same way as social phobia and anxiety.  Cognitive-behavioral: Group therapy provides practice in social interactions.  Antianxiety and antidepressant drugs are sometimes useful; symptoms return when medication is stopped.

o Dependent Personality disorder

explanation  Theoretical perspectives  Psychodynamic: Similar to explanations for depression  Freudian: Unresolved conflicts during oral stage  Object relations theory: Early parental loss or rejection prevents normal attachment and separation  Other psychodynamic: Overinvolvement or overprotection  Cognitive-behavioral  Behavior: Unintentional clinging and loyal behavior rewarded by dependent parents  Cognitive: Maladaptive behaviors; inadequate and helpless to deal with world; need to find person to provide protection o Treatment  Psychodynamic: Transference of dependency needs  Cognitive-behavioral: Often combines interventions; assertiveness training to cope; challenge and change incompetence and helplessness assumptions  Biological: Antidepressant drug therapy, when disorder is comorbid with depression  Group therapy format

• Discuss the “Big Five” theory of personality as it relates to personality disorders and the proposed disorder of “personality disorder—trait specified.”

o Large body of research conducted with diverse populations consistently suggests that the basic structure of personality may consist of five supertraits or factors:  Neuroticism  Extroversion  Openness to experience  Agreeableness  Conscientiousness o Personality disorder—trait specified  According to the proposal, five groups of problematic traits would be eligible for a diagnosis of PDTS: • Negative affectivity • Detachment • Antagonism • Disinhibition • Psychoticism  This dimensional approach to personality disorders may improve DSM-5-TR’s current categorical approach.

Male hypoactive sexual desire disorder:

marked by a persistent reduction or lack of interest in sex and hence a low level of sexual activity

• Female sexual interest/arousal disorder

marked by a persistent reduction or lack of interest in sex and low sexual activity, as well as, in some cases, limited excitement and few sexual sensations during sexual activity

• Erectile disorder

Causes include Biological: Hormonal imbalance, vascular problems, nervous system damage from disease, medication, substance abuse, Psychological: Severe depression, performance anxiety, spectator role. Sociocultural: Financial strain, job loss, relationship stress

• Discuss sexual pain disorders.

• Genito-pelvic pain/penetration disorders o Dysfunctions that do not fit into a specific phase of the sexual response cycle and are characterized by enormous physical discomfort during intercourse o Include vaginismus: the body's automatic reaction to the fear of some or all types of vaginal penetration

• Discuss treatments for sexual dysfunctions.

• General features of sex therapy • Modern sex therapy is short-term and instructive; typically lasts 15 to 20 sessions • Modern sex therapy foci • Techniques applied to particular dysfunctions o Disorders of desire: Male hypoactive sexual desire disorder and female sexual interest/arousal disorder are among the most difficult and complex to treat. o Typically a combination of techniques is used. o Affectual awareness: visualize sexual scenes in order to discover any feelings of anxiety, vulnerability, and any other negative emotions they have concerning sex o Self-instruction training: Patients receive cognitive self-instruction to help them change their negative reactions to sex o Biological interventions such as hormone treatments o Specifically designed pharmaceutical drugs – quite a few out there, not sure how effective each is

• Define paraphilic disorders and describe general behavioral treatment for such conditions.

o Paraphilic disorders: Repeated and intense sexual urges or fantasies in response to objects or situations that society deems inappropriate; may behave inappropriately

• Describe the positive, negative and cognitive symptoms of schizophrenia

o Positive – hallucinations, ideas of persecution, delusions of grandeur, general bizarre behavior o Negative - Social withdrawal, anhedonia, decreased movement, reduced motivation and emotional response o Cognitive - Cognitive deficits (core feature of illness/present in every case of schizophrenia); present before the onset of typical symptoms 3 phases prodromal, active, residual

o Type I schizophrenia

dominated by positive symptoms  Seem to have better adjustment prior to the disorder, later onset of symptoms, and greater likelihood of improvement  May be linked more closely to biochemical abnormalities in the brain

o Type II schizophrenia

dominated by negative symptoms.  May be tied largely to structural abnormalities in the brain

Summarize evidence from biological studies that supports the genetic view of schizophrenia.

o Genetic factors (diathesis-stress perspective) have research support.  Relatives of people with schizophrenia  Twins with schizophrenia  Direct genetic linkage research and molecular biology

• Discuss the dopamine hypothesis and evidence that both supports and fails to support it.

 Certain neurons using dopamine fire too often, producing symptoms of schizophrenia.  Messages traveling from dopamine-sending neurons to dopamine receptors on other neurons, particularly to the D-2 receptors, may be transmitted too easily or too often.  This theory is based on the effectiveness of antipsychotic drugs/medications.  Undesired reaction to these drugs provided insight into biology of schizophrenia; dopamine activity and Parkinson’s disease symptoms

abnormal brain structures seen in some cases of schizophrenia.

o This circuit includes the prefrontal cortex, hippocampus, amygdala, thalamus, striatum, and substantia nigra, among other structures.

• Describe the effectiveness of antipsychotic drugs

o Discovery of new group of antipsychotic drugs (atypical antipsychotic drugs) now called second-generation antipsychotic drugs o Bind to D-2 dopamine receptors and many D-1 receptors and other neurotransmitters (serotonin, glutamate, and GABA) o More effective than first-generation antipsychotic drugs o Schizophrenia may be related to abnormal activity or interactions of both dopamine and other neurotransmitters, rather than to abnormal dopamine activity alone.

• Discuss the side effects of antipsychotic drugs: Parkinsonian and related symptoms, neuroleptic malignant syndrome, and tardive dyskinesia.

o Extrapyramidal side effects (EPS) such as involuntary and repetitive movements (tardive dyskinesia). Due to blockade of D2 receptors in striatum. o Dry mouth, drowsiness, weight gain, dizziness  due to M1 muscarinic receptor antagonism, H1 histamine receptor antagonism, alpha1 noradrenergic receptor antagonism o Metabolic- Hyperlipidemia and hyperglycemia with Type 2 diabetes mellitus (worse with atypical antipsychotics) o Hematological - Agranulocytosis: decreased white blood cells (Clozapine), Myocarditis: inflammation of the heart (Clozapine) o Endocrinological - Hyperprolactinemia (typical antipsychotics + risperidone), Amenorrhea, galactorrhea

• Discuss the newer antipsychotic drugs

o Discovery of new group of antipsychotic drugs (atypical antipsychotic drugs) now called second-generation antipsychotic drugs o Bind to D-2 dopamine receptors and many D-1 receptors and other neurotransmitters (serotonin, glutamate, and GABA) o More effective than first-generation antipsychotic drugs o Schizophrenia may be related to abnormal activity or interactions of both dopamine and other neurotransmitters, rather than to abnormal dopamine activity alone.

o Enuresis

Repeated involuntary (or in some cases intentional) bed-wetting or wetting of one's clothes  Typically occurs at night during sleep, but may also occur during the day  May be triggered by a stressful event  Children must be at least 5 years of age to receive this diagnosis.  Most cases of enuresis correct themselves without treatment because it decreases with age.

o Encopresis

Soiling; defecation into clothing  Less common than enuresis and less well researched  Usually involuntary  Seldom occurs during sleep  Starts after the age of 4  More common in boys than in girls

o Attention- deficit/ hyper activity

 Children who display attention-deficit/ hyperactivity disorder (ADHD) have great difficulty attending to tasks, behave overactively and impulsively, or both  Primary symptoms of ADHD may feed into each other, but in many cases one of the symptoms stands out more than the other  Biological causes, particularly abnormal dopamine activity, and abnormalities in the frontal–striatal regions of the brain  Balance of Type 1 and Type 2 attention processes  Difficulty with focusing attention in ADHD is a result of type 2 attention processes and shutting down is type 1 process. Attention circuit; faulty interconnectivity. High levels of stress. Family dysfunctioning. Treatment - About 80 percent of all children and adolescents with ADHD receive treatment. Most commonly applied approaches are drug therapy, behavioral therapy, or a combination of the two

• Describe the symptoms of autism spectrum disorder. Discuss the various etiologies and treatments that have been proposed.

o Causes  Sociocultural causes: Family dysfunction; parent personality characteristics (refrigerator parents)  Research does not support this theory  Psychological causes: Central perceptual or cognitive disturbance  Theory of mind disorder (mentalization); mind-blindness  Biological causes: Genetic factors; prenatal difficulties or birth complications  Abnormal cerebellum structure; brain circuit dysfunction  MMR vaccine theory (not proven) o Treatments  Cognitive-behavioral therapy - Behavioral approaches teach new, appropriate behaviors while reducing negative behaviors; modeling and operant conditioning  Communication training - Speechless may be taught other forms of communication, including sign language and simultaneous communication; augmentative communication systems; child-initiated interactions; joint attention training  Parent training - Parent behavioral programs to train parents to apply behavioral techniques at home; individual therapy and support groups; parent associations and lobbies

• Describe the prevalence of the various types of intellectual disability, and discuss the environmental, genetic, and biological factors that contribute to intellectual disability. Describe and evaluate treatments and therapies for individuals with intellectual disability, including normalization programs and behavioral techniques.

o The quality of life attained by people with intellectual disability depends largely on sociocultural factors. o Intervention programs try to provide comfortable and stimulating residences, social and economic opportunities, and a proper education. o Free, appropriate educational program mandated by federal law; IEP. Early intervention; dependent of level of functioning. Special education versus mainstream (inclusion) classrooms. Teacher preparedness o Therapy needed - People with intellectual disability sometimes experience emotional and behavioral problems. Individual or group therapy. Psychotropic medication

o Depression - later in life

most common mental health problem in older adults -highest in women  As many as 20% of people experience depression at some point during old age.  More older = more likely to commit suicide  Treatment: Cognitive behavioral therapy, interpersonal therapy, antidepressants or a combo; 50%+ have improvement  Antidepressants metabolize differently in elderly people and increased risk of cognitive impairment  Around 1% of persons 65+ display bipolar disorder  70% have onset before old age.

Anxiety - later in life

common among the elderly.  At any given time, approximately 10% of elderly people in the U.S. experience at least one anxiety disorders.  Generalized Anxiety Disorder (GAD) is particularly common, experienced by up to 7% of all elderly persons.  Prevalence increases throughout old age, may be attributed to declining health  Treatment: Cognitive behavioral therapy, anti-anxiety medications (cautiously)

Substance misuse - later in life

 3 – 7% of older people (men) display alcohol-related disorders per/yr  Difference: Do not start problem drinking until their 50s and 60s (late-onset alcoholism)  Leading substance abuse: misuse of prescription drugs  Misuse of powerful medications at nursing homes

• Distinguish between short-term memory and long-term memory. Summarize the anatomy and biochemistry of memory.

o Short-term memory - Information held in short-term memory must be transformed, or consolidated, into long-term memory. o Long-term memory is the accumulation of information that we have stored over the years. Remembering information stored in long-term memory is called retrieval.

o Alzheimer’s

• Deterioration of one's memory and related cognitive faculties. Memory, attention, visual perception, planning and decision making, language ability, or social awareness. Changes in personality and behavior.

o Pick’s disease

Frontotemporal neurocognitive disorder. A rare disorder that affects the frontal and temporal lobes. Clinically similar to Alzheimer’s disease

o Huntington's disease

An inherited progressive disease in which memory problems worsen over time, along with personality changes, mood difficulties, and movement problems

o Parkinson's disease:

A slowly progressive neurological disorder marked by tremors, rigidity, and unsteadiness that can cause dementia