Abnormal Psych Exam 4

Personality traits
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Terms in this set (108)
rigid, enduring pattern of behavior and inner experiences that impair our sense of self, emotional experiences, goals, capacity for empathy, and capacity for intimacy
More extreme and dysfunctional than others
leads to significant problems and psychological pain
Difficult to treat
Usually recognizable in teen years
Limited research
Controversy about diagnosing
Cluster A
Suspicious and thinks others are out to harm them
Doubts loyalty of others
Afraid to confide in others because of consequences
Read hidden messages into benign remarks, events
Holds grudges
Thinks people are attacking them when it is not apparent to others
Suspicious of fidelity of spouse/partner
Most do not want treatment
If treatment occurs, it is often limited in outcomes and LT
Psycho: objects relations therapists: work on poor relationships
Self-therapists: work on a healthy, unified self
Cognitive: works on maladaptive thoughts; have patients see others point-of-view
Behavioral: improve relationship skills and lower anxiety through various techniques
Biological: drug therapy is of limited use
Schizoid Personality DisorderCluster A Does not Want or Enjoy close relationships, including family Chooses solitary activities Little interest in sexual experiences with another person Pleasure in few, if any, activities Lacks close friends/confidants other than 1st degree relatives appears indifferent to praise or criticism from others Shows emotional coldness, detachment, or flattened affect. May be confused w/ autism spectrum disorderPsychodynamic SchizoidPD Need for human contact no met in childhood; may have been abused Cope by avoiding all relationshipsCognitive SchizoidPD Deficiencies in thinking Thoughts are empty, vague and they have difficulty with perceptions Poor ability to read social cues; therefore, they do not respond appropriatelyTreatment Schizoid PDTypically do not enter treatment unless there is a specific issue Distant w/ therapist; do not really care about the process Limited progress Cognitive: Discuss emotions and present a list of emotions Have patient think about pleasurable experiences Behavioral: teach social skills through role-play, homework, exposure techniques Group therapySchizotypal Personality DisorderCluster A Ideas of reference Odd beliefs, magical thinking Unusual perceptual experiences, including bodily illusions Odd thinking and speech Suspicious or paranoid ideation Inappropriate or constricted affect Odd, peculiar, eccentric behavior or appearance Lack of close friends/confidants other than 1st degree relatives Excessive social anxiety even in familiar environments Related to paranoid fears, no negative judgments of selfResearchers SchizoidPD (not theoretical) There may be a link to schizophrenia Family conflict, psychological disorders in parents; deficits in attention and ST memory Also linked to mood disorders-50% of those with this disorder have major depressive disorder at some pointTreatment Schizotypal PDVery difficult to provide treatment Overall goals: increase social contract, ease loneliness, reduce overstimulation, help them understand personal feelings Cognitive: evaluate unusual thoughts or perceptions/ignore inappropriate ones Track odd/magical thinking and point out inaccuracies Speech lessons, social skills training, tips on appropriateness Biological: low doses of anti-psychotic drugs for cognitive distortionsAntisocial Personality DisorderCluster B Fails to conform to social norms w/ respect to lawful behaviors Deceitful-lying, conning Impulsivity Irritability and aggression--fights, assaults Reckless disregard for safety of self and others Consistent irresponsibility-work, financial obligations No remorse Aside from substance abuse, most closely linked to criminal behaviorPsychodynamic AntisocialPD Absence of parental love in childhood Leads to basic mistrust; they bond with power and destructivenessCognitive AntisocialPD Attitudes that other people's needs are unimportantBehavioral AntisocialPD Modeling from antisocial parents Rewards for aggressive behaviorBiological AntisocialPD Low serotonin--> impulsivity, aggression Deficient functioning in frontal lobes (executive functioning) Low arousal response and anxietyTreatment Antisocial PDIneffective treatments Patients do not want to change Most therapy is court-ordered or forced by school, workplace Cognitive: explore moral issues and needs of others Biological: psychotropic medications-atypical antipsychotic drugs MAy help Hospitals/prisons: therapeutic community model w/ emphasis on responsibilities to others Most do NOT workBorderline Personality DisorderCluster B Frantic efforts to avoid real or imagined abandonment Unstable, intense relationships with black and white thinking unstabel self-image or sense of self self-damaging impulsivity (sex, spending, substance) Recurrent suicidal behavior, gestures, threats OR self-mutilating behavior Mood instability Chronic feelings of emptiness Inappropriate, intense anger or difficulty controlling anger Transient, stress-related paranoid ideation or severe dissociative symptomsPsychodynamic BorderlinePD abandonment, neglect, or physical, sexual abuseBiological BorderlinePD overly active amygdala; underactive prefrontal cortex low serotonin Genetic-5:1 w/ close relatives w/ BPDSociocultural BorderlinePD Occurs in rapidly changing cultures-sense of not belongingBiosocial BorderlinePD Internal and external stress-trouble w/ feelings and parents nonresponsiveTreatment Borderline PDContemporary psychodynamic therapy better than traditional Cognitive: Dialectical behavior therapy Biological: Several types of psychotropic drugs are used, specific to symptoms, Best as adjunctDialectical Behavior TherapyDBT Developed by Marsha Linehan Borrows from many theories Emphasis on therapist/client relationship Empathy, find kernel of truth to work on, other optionsHistrionic Personality DisorderCluster B Needs to be center of attention Sexually seductive and provocative behavior Shallow emotional expressions Uses physical appearance to draw attention to self Excessively impressionistic speech, lacks details Dramatic, theatrical, exaggerated emotions Is suggestible Considers relationships to be more serious than they arePsychodynamic HistrionicPD Cold, controlling parents in childhood, felt unloved Invent crises to require others to be protectiveCognitive HistrionicPD Self-focused, limited concern about world at large May feel helpless to care for self Seek out others to care for themSociocultural HistrionicPD Society may encourage girls to be childlike and dependent May demonstrate exaggerate cultural beliefs (Hispanics vs. Asians acceptance of sexuality and provocative dress)Treatment Histrionic PDOften seek treatment on their own Must adhere to strict boundaries in therapy Therapy in general, including group format: recognize excessive dependency FInd inner self-satisfactions Become more self-reliant Cognitive: change belief of helplessness; problem solving Biological: Drug therapy for specific issues such as depressionNarcissistic Personality DisorderCluster B Grandiose sense of self-importance Preoccupied w/ fantasies of unlimited success, power, brilliance Believe that are special, only understood by high status people Requires excessive admiration Sense of entitlement Is interpersonally exploitive Lacks empathy or fails to recognize needs of others Is often envious or thinks others are envious of him or her Shows arrogant, haughty behaviors or attitudesPsychodynamic NarcissisticPD Cold, rejecting parents Spend life defending against feeling rejected, unworthy Repeatedly tell themselves they are perfect and desirableCBT narcissisticPD Too many rewards in life They now overvalue themselvesSociocultural NarcissisticCultures may produce some youths that are self-centered and materialistic Western cultures value self-expression, individualism Study showed that uS had highest rates of narcissistic scores; Middle East had lowestAvoidant Personality DisorderCluster C Avoids occupational activities, fear of criticism, rejection Unwilling involvement w/ people unless certain they are liked Restraint in intimate relationships, fear of shame, ridicule Preoccupied with being criticized, rejected in social situations Inhibited in new interpersonal situations, feels inadequate Views self as a socially inept, unappealing, or inferior Is unusually reluctant to take personal risks or engage in new activities, fear of embarrassmentPsychodynamic AvoidantPD Shame from childhood experiences (bowel, bladder) Negative self-image from parents who ridicule/punish often CHild feels unloved and distrustful of othersCognitive avoidantPD Expect rejection after harsh criticism, rejection in childhood They misinterpret actions, discount positive feedback, fear social involvementBehavioral AvoidantPD Fail to develop normal social skills; however, it may happen because they avoid social situationsTreatment Avoidant PDSeek therapy for acceptance and affection but then avoid sessions Overall key: gain trust Psychodynamic: recognize and resolve unconscious conflict Cognitive: change distressing beliefs, move forward in face of painful emotions, improves self-image Behavioral: social skills, exposure treatments to increase social contracts Biological: antianxiety and antidepressant medsDependent Personality DisorderCluster C Difficulty making everyday decision Need others to assume responsibility for most major areas of life Difficulty in expressing disagreement with others, fear loss of approval Difficulty initiating projects on own, lack of self-confidence Excessive lengths to obtain support for others, won't say no Feels uncomfortable or helpless when alone, fear of being incapable Urgently seeks another relationship when one ends Unrealistically preoccupied w/ fears of being left to care for selfPsychodynamic DependentPD unresolved conflict in oral stage leads to need for nurturance abandonment/rejection prevents attachment/separation overinvolved, overprotective parents increase dependenceCognitive dependentPD dichotomous thinking-if dependent, helplessBehavioral dependentPD Parents reward clingy and loyal behavior, punish independenceTreatment Dependent PDPatients place responsibility for treatment on therapists Psycho: explore transference of feelings onto therapist Cognitive: challenge assumptions of incompetence and helplessness Behavioral: assertiveness training Biological: antidepressants if depression Group Therapy: chance for a model; can receive support and practice skillsObsessive-Compulsive Personality Disorderpreoccupied with details, rules, lists, order, organization Shows perfectionism, interferes with task completion excessively devoted to work and productivity, excludes leisure Overconscientious, inflexible, about moral ethics, values Unable to discard worn out, worthless items, even if not sentimental Reluctant to delegate tasks to others unless they do it my way Miserly spending toward self/others, money is to be hoarded Rigidity and stubbornesspsychodynamic Obsessive-compulsivePD Anal regressive leads to rigidityanal regressiveanger develops during toilet training, feel overcontrolledCognitive obsessive-compulsivelimited thoughts about origin illogical thinking processes keep disorder going dichotomous thinking-leads to perfectionism may misread or exaggerate potential outcomes of mistakes or errorsTreatment Obsessive-compulsive PDdon't usually seek treatment until they have depression, anxiety Psychodynamic: patients respond well to this want patients to recognize and accept underlying feelings and insecurities Cognitive: help patients change dichotomous thinking Biological: patient's often respond well to SSRI's; research has not studied this directlygeropsychologyfield of psychology dedicated to mental health of elderlysignificant stressorsillness, fear of dying, loss of spouse and friends, retirement, health issuesDepressionsame symptoms as others highest rates in nursing homes higher rates of suicide than younger population (16% vs 11%) Higher risk of health problems difficulty using antidepressants in elderly ECT is used at timesAnxietyIt is common, especially GAD May be misdiagnosed due to physical symptoms Highest rates in elderly >85 yrs Treatments: CBT Anti-anxiety meds antidepressants Must use caution with medsSubstance usedecline in alcohol use after 65 years men under 30 4x more likely to use highest rates in mental health and general hospitals, nursing homes leading problem is prescription drug misuse Patients: high number of meds, may skip doses or overdose Nursing homes: antipsychotics used with 30% of patients, may overmedicate patients to sedate themPsychotic DisordersHigher rate than younger persons Typically psychosis from delirium or dementia Schoz-most improve with time Delusional disorder-increases in elderlyDeliriumDisturbance in attention and awareness develops over a short period of time may be caused by substance withdrawal, medication, medical conditions, multiple etiologies Frequently occurs with hospitalization or post-op treatable when diagnosed properly Study: 1 in 15 cases of delirium diagnosed properlyAlzheimer'sNeurocognitive disorder most common type insidious, gradua onset in cognitive domains (major/mild) decline in memory, learning from hx or neuropsych testing Prevalence: 65 years 1-2% >85 up to 50% onset to death is typically 8-10 years can only be diagnosed with certainty after death -senile plaque -neurofibrillary tanglesAlzheimer's causesearly onset (before 65): mutations in proteins that produce tangles and plaques Late-onset (sporadic Alzheimer's): ApoE gene is linked to plaque development, also environment, life-style, stress Brain structure-damage to brain structures that transfer ST memory to LT Biochemical changes-acetylcholine, glutamate, calcium linked to memory Other theories-high levels of zinc, lead; autoimmune responseMild alzheimermemory loss language probs mood swings personality changes diminished judgementModerate alzheimerBehavioral, personality changes unable to learn/recall new info long-term memory affected wandering, agitation, aggression, confusion require assistance with ADLSevere alzheimergait, incontinence, motor disturbances bedridden unable to perform ADL Placement in long-term care neededAlzheimer's treatmentDrug: slow memory decline (Aricept); Vitamin E Benefit vs risk Cognitive therapy: mental exercises research suggests these may prevent or delay onset Behavioral therapy: physical exercises to improve cognitive functioning Change maladaptive behaviors (wandering, personal care) Support for caregivers Sociocultural approaches -day-care, assisted livingVascular neurocognitive disorderrelated to cerebrovascular event (stroke, vascular probs) sudden, stepwise onset and gradual decline normal cognitive functioning in unaffected areasFront temporal neurocognitive disorderPick's disease Protein build-up affects temporal and frontal lobes rare initial symptoms-personality change, disinhibition, decline in speechLewy body neurocognitive disorderprotein build-up in brain fluctuating cognitions, visual hallucinations, features of Parkinson's can co-exist with a diagnosis of alzheimer's or parkinson'sPrion neurocognitive diseasetransmitted through prions- creutzfeldt- Jakob (mad cow) progresses rapidly to death (several months) initially-visual problems, fatigue, bizarre behavior Late stages-coma, paralysis, deathParkinson's Neurocognitive Diseaseunknown cause-genetic environment Dopamin cell death Chronic, progressive Motor movement involvement Treatments include L-dope, DBSHuntington's Neurocognitive DiseaseInherited, progressive disease (any age) symptoms-memory probs, personality change, motor movement Always fatalLegislative and judicial systemsthe legal field protects individuals and the public goodPsychology in Lawclinical practitioners/researchers work w/in legal system Jury selection ResearchLaw in PsychologyLegal system regulates certain aspects of mental health "court-ordered" Malpractice suitsForensic psychologyMental health professionals perform acts for courts Testifying in trials, criminal profiling, researching eye witness testimonyIncompetent to stand trialcommitted to mental health facility until competen to stand trialNot Guilty by Reason of InsanityNGRI Unstable at time of crime and innocent of wrongdoing Committed to mental health facility until improved enough to be released Originally, prosecutor's burden of proof, now defendant'sDusky v US1960-decided incompetence to stand trial set minimum standard of competence 60,000 competency evals/years 20% found to be incompetent Judge makes final ruling can remain incompetent for yearsJackson v Indiana1972 Can not be held incompetent indefinitely Must be tried, set free, or sent to mental health facility after "reasonable time"InsanityA legal term Having a mental disorder at time of crime is not evidence of this knowing right from wrong at time of crime determines thisM'Naghten Rule1843 Murder trial of Daniel M'Naghten Public outcry w/ verdict (NGRI) British court system defined "insanity"-unable to know right from wrong US adopted this test Eventually, some courts became dissatisfied with this testIrresistible Impulse testLate 19th century US dissatisfied with M'Naughten Rule New test emphasized inability to control one's action Crime of passion included State and federal courts chose which test to useDurham Test1954- product test Based on Durham v US Not criminally responsible if unlawful act was product of mental disease or mental disorder Too flexible any mental disorder could be a defenseAmerican Law Institute TestALI Combined M'Naghten, Irresistible Impulse Act, Durham Test Not criminally responsible if at time of crime: -had mental disorder that prevented them from knowing right from wrong-OR -had mental disorder that prevented them from being able to control self and follow law Test was too liberalAmerican Psychiatric AssociationArgued that M'Naghten rule was appropriate "knowing right from wrong" should be hallmark majority of state and federal courts use M'Naghten Some still use ALI some have abolished insanity plea Stricter M'Naghten Rule has reduced verdicts of NGRIGuilty but Mentally Ill14 states have adopted this verdict Says that mental illness not fully responsible for crime Allows mental health treatment while in jail Overall unsatisfactory no different from guilty verdict-name only mental health should be provided to all that need it Does not reduce NGRI'sGuilty with diminished capacitymental health may impact aspects of crime-intention may lead to lesser verdictSex OffenderMentally disabled category convicted of crime, housed in mental health facility Recent trend-abolishing this category -law is difficult to apply "sexually dangerous beyond reasonable doubt -must be good candidate for treatment -racial bias exists-whites 2:1 granted this status Primary reason: greater emphasis on victim -Sexually violent predator law-after prison, go to mental health facilityCivil commitmentinvoluntary commitment if need treatment and are dangerous to self/othersparens patriaeallows state to protect patients from self harmpolice powerallows police to protect society from a dangerous personprocedure for civil commitmentparents can request for child -mental health professional agrees For adults -court orders mental evaluation -patient can attend court with a lawyer Emergency commitment -certification by two health professionals -must include evidenceDangerous90% w/ mental illness are not 12% with schiz, depression, bipolar have assaulted; 2% w/out severe have Cannot be predicted well overestimate likelihood of violent behavior ST predictions are more accurate New assessment tools are being developedWyatt v Stickney1972 Right to treatment demanded treatment for those involuntarily committedO'Connor v. Donaldson1975 State cannot continue to hold patients against their will if not dangerous and can survive on their ownYoungberg v Romeo1982 Right to reasonable nonrestrictive confinement and reasonable care/safetyProtection and Advocacy for mentally ill individuals act1986 Public advocates can investigate abuse/neglect and correct problems legallyRight to refuse treatmentPatients have this right for psychosurgery some states allow to refuse ECT some states allow to refuse psychotropic medications If patients work in facility, must receive at least minimum wage Right to aftercare and appropriate community residence in lease restrictive facilityMalpractice suitsFailure to obtain informed consent, improper documentation Sexual activity with a patient improper termination of treatment wrongful commitment causing harm to patientProfessional boundariessome states allow psychologists to admit patients to hospital 2 states allow psychologists to prescribe psychotropic meds Army psychologists can prescribe psychotropic medsJury Selectionpsychologists help with jury selection Use surveys, analyze jurors backgrounds/attitudes, mock trialsResearch of legal topicseyewitness testimony mistaken eye witness testimony, witness may lie, problems with police line-up Patterns of criminality -profiling based on research -problems with profilingCode of Ethicspermitted to offer advice may not conduct fraudulent research, plagiarize work of others, or publish false data must acknowledge their limits may not take advantage of clients and students, sexually and otherwise must adhere to the principle of confidentialityWorkplaceEmployee Assistance Programs Seminars to teach coping, solving problems, handling and reducing stressEconomicsDeinstitutionalization Managed care programs Peer review systemsCybertherapyLD therapy between patients and therapists via skype internet based support groups video game treatments