Abnormal Psychology Exam 1

Terms in this set (220)

Neurotransmitters (NT)
-Mix of electric and bio-chemical processes
-Meds (psychiatric's) = help functions.
-Includes norepinephrine, serotonin, dopamine, and gaba
Demon Possession
-These were used as an attempt to cure people of mental illness
-Used during prehistoric times
-Was used in many places including Asia, South American, and Africa
Trephining
-Giving spirits a physical way to escape.
-Used during prehistoric times
--Ex: Drilling a hole in ones skull so demons will leave
Exorcism
-An attempt to get rid of demons
-Used during prehistoric times
Theory of the "Imbalance of Humors"
-Created by Hippocrates (Greece) (ca. 400 B.C.)
-Four humors (choleric, melancholic, phlegmatic, sanguinic)
-The imbalance of humors can bring about mental illness such as:
--Melancholia (Depression)
--Mania (Excessive enthusiasm)
--Hysteria (Emotionally out of control).
--Delirium (Hallucinating)
-He believed these things could be cured (or balanced) through applying heat, applying cold, draining blood, etc.
Hippocrates Also Recognized That...
-Mental illnesses has biological roots
-Heredity plays an important role in mental illness (He noticed it was running in families).
-Psychosocial factors can also play a role. (He noticed that some people who were removed from their family did better).
Hippocrates Oath
First do no harm
Dark Middle Ages (5th-10th Centuries)
Used things like waterboarding
Mass Madness (13th Century)
-Epidemics, such as the bubonic plague, which meant people were dying with no cure (Thus, people were easily suggestible).
-Also includes tarantism and lycanthropy
Tarantism
-Known as Dance Mania ("St. Vitus's Dance")
-These people couldn't stop dancing, so using music helped people re-regulate their movement.
Lycanthropy
Belief that one is turning into a wolf
Witchcraft (15th through 17th Centuries)
-Many people who were not welcomed, were burned.
-Mental people act differently (or "like the devil"), they were killed.
Renaissance and Rise of Humanism (Late 15th Century).
-"Bedlam": St. Mary's of Bethlehem in London. It was a psychiatric hospital.
-Gradual return to rational, scientific thought
-Emphasis on human welfare
"Bedlam"
-Today it is now a war museum
-The ill would just roam around free there and the upper class enjoyed watching them.
Phillipe Pinel
-Was a huge part of the moral treatment movement in Paris
-A few years after the French Revolution, he began to think about the rights of prisoners
-The prisoners were in horrible condition. He believed they should be taken off the walls and allowed to see the light.
-Others believed they'd be savages that would run around and cause havoc.
-The reality is they were shy and they would walk around the courtyard.
**Pinel's idea of kindness led to big reform
William Tuke
-Part of the Moral Treatment Movement in England
-He was a Quaker and had a friend who mysteriously died
-He made a retreat known as the "Retreat at York." He thought these people needed a break and a specific structure to their days.
-The results of this was that most people got better at short periods of time.
-In later years, this remained an asylum, but became a private one.
Benjamin Rush
-Known as the "Father of American Psychiatry" (1745-1813).
-Argued addiction was not a moral failing
-He created a psychiatric wing for the insane.
Dorothea Dix
-Another American reformer (1802-1887).
-A school teacher turned social reformer and advocate for the mentally ill.
-She originally came from an abusive family. She ran away and found an aunt to live with.
-She lobbied to create psychiatric hospitals using moral treatment.
-She also fought to reform the prison system.
1900-Mis 1950's: Mental Hospitals
-These mental hospitals or "state hospitals" really began to deteriorate.
-They became increasingly abusive and dehumanizing with overcrowding, poor care, abuse, and neglect of patients.
-A growing population means no moral treatment.
1900-Mis 1950's: New Medicalization of Treatment
-Hydrotherapy: Being confined to water for hours at a time
-Malaria Therapy: Infected patients because they thought the illness would cure them.
-Insulin Therapy: Giving people who don't need insulin, insulin.
-Lobotomy: Made people very easy to manage
-Early Electroshock Therapy (Assaulting the brain itself).
Deinstitutionalization: (Number of beds from 1955-2010).
-1955: 560,000 psychiatric beds in U.S. "State Hospitals." That's the largest number ever!
-1955-1975: At this time psychiatric hospitals were being shut down. Also, late 1950's working meds for mental illness were created. Led to rapid decrease in psychiatric beds, which leveled off in the 1980's.
-2005-2010: Further wave of hospital bed decreases due to economic crisis and related budget cuts. During this 5 year period alone, there was a 14% decrease in state beds, down to 43,300 state psychiatric beds (in the U.S.)
-In recent years, the situation has improved at least for California due to increased funds and new legislation.
Reasons for Closing of State Hospitals (Esp 1955-1975).
-Effective medications available starting mid 1950's: Making it possible to treat mentally ill on outpatient basis
-Civil Rights Movement: New legislation making involuntary hospitalization more difficult (This is because people were admitted for no reason and automatically lost their rights).
-Financial Concerns: Hospitalization is very expensive; community mental health centers (which were supposed to provide alternative outpatient care) were underfunded from the start. Left the truly mentally ill to be taken advantage of.
Consequences of Less Hospitals
-Homeless Mentally Ill
-Crimnalization of the Mentally Ill
-Emergency Room "Boarding"
-Increase in violence by untreated mentally ill individuals
Homeless Mentally Ill
-At least half of the chronically homeless individuals in the inner cities are severely mentally ill (i.e., schizophrenia, bipolar, or otherwise psychotic).
-For the statistics, 1/3 of the homeless are mentally ill and 2/3 are female.
Criminalization of the Mentally Ill
-Incarceration, mostly in county jails
-By bed population, the largest psychiatric inpatient facilities in the U.S. are housed in the county jails of L.A., Chicago, and New York City.
-Many of these people don't want help and will be arrested for minor crimes (sometimes more than once).
-There is no follow-up on these individuals.
Emergency Room "Boarding"
-Long waits
-Once they're given drugs to calm down, the patients can leave (until the meds ware off... "band-aid").
-People can also just leave after awhile.
The Two Forces Determining the Treatment of the Mentally Ill
-Medical/Biological Explanations
--Hippocrates and his "humors"
--Lobotomy's (And other body warping procedures)
--Medications
-Psychological Explanations
--Exorcisms (Demons taking over).
--Moral Treatment: Based on the environment/ psychological, not biology.
--Freud
Correlation
The degree to which events or characteristics vary along with each other
Correlational vs. Experimental Research
-Correlational: A research procedure used to determine how much events or characteristics vary along with each other.
-Experimental: A research procedure in which a variable is manipulated and the effect of the manipulation is observed
Independent vs. Dependent Variable
-IV: The variable in an experiment that is manipulated to determine whether it has an effect on another variable
-DV: The variable in an experiment that is expected to change as the independent variable is manipulated
Random Assignment
A selection procedure that ensures that participants are randomly placed either in the control group or in the experimental group.
Placebo
A sham treatment that the participant in an experiment believes to be genuine
Confounding Variables
In an experiment, a variable other than the independent variable that is also acting on the dependent variable
Blind Design
An experiment in which participants do not know whether they are in the experimental or the control group
Double Blind Design
Experimental procedure in which neither the participants nor the experimenter knows whether the participant has received the experimental treatment or the placebo
Internal Validity
The accuracy with which a study can pinpoint one of various possible factors as the course of a phenomenon
External Validity
The degree to which the results of a study may be generalized beyond that study.
Epidemiology Study
A study that measures the incidence and prevalence of a disorder in a given population
Incidence
The number of new cases of a disorder occurring in a population over a specific time period
Prevalence
The total number of cases of a disorder occurring in a population over a specific time period
Longitudinal Study
A study that observes the same participants on many occasions over a long period of time
Case Study
A detailed account of a person's life and psychological problems
Quasi Experiment
-An experiment in which investigators make use of control and experimental groups are already exist in the world at large.
-Also called a mixed design
Natural Experiment
An experiment in which nature, rather than an experimenter, manipulates an independent variable
Analogue Experiment
A research method in which the experimenter produces abnormal-like behavior in laboratory participants and then conducts experiments on the participants.
Models of Abnormal Behavior: Over the Years
-Late 1960's-1970's: Time change, civil rights, mental hospitals where people were locked up had come to light
-1980's and 1990's: Major focus on the brain
-Late 1990's: Less argument over nature vs. nurture.
Biological Models
-Genetics
-Endocrine (hormonal) system
-Brain structures
-Biochemistry
Genetics
-Some disorders have more genetic influence than others (addiction, schizophrenia, bipolar).
-Epigenetics: Never straight forward = lots of biological factors that play a role including nutrition, stress... (All determines if a person becomes this way or that way).
Endocrine (Hormonal) System
-Stress hormones, sex hormones, and so on.
-Depression = high cortisol levels and high stress.
-Also plays a role in diabetes, immune system disorders, etc.
-This can start as early as conception to birth. Maternal exposure (and a weakened immune system) can lead to antibodies that get passed to the placenta. This can make changes in the body (leading to schizophrenia and autism).
Brain Structures: Cortex
-Frontal Lobes: Abstract thinking, inhibiting impulsive.
-Temporal Lobes
**Many psychological disorders happen in the front brain
Brain Structures: Limbic System
-Amygdala:
-Hippocampus: Under permanent stress will shrink this.
-Thalamus:
-Hypothalamus:
-Cingulate Gyrus:
-Basal Ganglia:
Norepinephrine
-A very general neurotransmitters, its function depends on where in the brain it occurs
-Flight-or-fight response: alarm response of the autonomic nervous system (Amygdala specifically).
Serotonin
-Mood
-Sleep
-Regulation of impulses: Aggressive behaviors, self-destructive tendencies, suicidal urges, obsessive-compulsive behaviors.
-Lower serotonin levels are associated with greater vulnerability to the above.
Dopamine
-Outgoing, exploratory behavior
-All pleasure seeking behaviors (inc. addictions) involve the dopamine system
-Excess of dopamine in the brain can cause hallucinations and delusions.
GABA
-Inhibitory neurotransmitter, reduces overall arousal
-Benzodiazepines (like Valium, aka an anti-anxiety meds) facilitate the action of GABA
Psychotropic Medications work by:
-Increasing or decreasing the production of neurotransmitters.
-Triggering or blocking the release of neurotransmitters.
-Increase or decrease the production of a substance that deactivates the neurotransmitters.
-Trigger or block the release of a substance that deactivates the neurotransmitters.
-Block the reuptake of a neurotransmitter (ex: Prozac blocks the reuptake of Serotonin).
-Mimic the action of a neurotransmitter.
Psychotropic Medications: Main Classes
-Anti-Anxiety Drugs: These are the only drugs that are habit forming (they work fast = more likely to cause addiction).
-Antidepressants: People with anxiety also use these (those who are more depressed are more anxious). Not addicting.
-Mood Stabilizers: (Textbook: "Anti-Mania Drugs"). Usually taken by people with bipolar disorder: Can't just take anti-depressants = can trigger onset of a manic episode.
-Antipsychotic Drugs: Used for schizophrenia.
-Stimulant Drugs: ADHD (only).
Other Forms of Biological Treatment
-ECT (Eletroconvulsive Therapy): The old way of doing things.
-Psychosurgery
-Light Therapy
-TMS (Transcranial Magnetic Stimulation).
Founder of Psychodynamic Models
Sigmund Freud (1856-1939)
Psychodynamic Models Theories
-The Unconscious
-Defense Mechanisms
-Sexuality and Psychosexual Development
Psychodynamic Models: Theory of the Unconscious
-Not always knowing our true, motivations, we've been unaware of our wants, fears, and so on.
-Freud believed that people needed to come to terms with their unconscious and if not, they'd not live life to the fullest.
--Ex: A patient may be avoiding a rich relationship because of abuse, fear of being rejected, etc.
-Must recognize patterns or people will repeat them.
Psychodynamic Models: Theory of Defense Mechanisms
-Repression
-Projection
-Regression
-Denial
-Reaction Formation
-Intellectualization
**Not all of these are bad.
Psychodynamic Models: Therapy Concepts
-Free Association
-Interpretation
-Resistance
-Transference
-Countertransference
Transference
-Feelings the client has towards the therapist. Wants to be seen as good to the therapist.
--Normal therapists can use this to help the patients. While, narcissists will see this as a reflection on themselves, using the patient.
-Sexually assaulted women might believe sex is what they want....
Psychosocial Therapy Applications
-Dissociative disorders
-Paraphilias (Ex: Masochism)
-Some of the personality disorders (Ex: Borderline Personality Disorder)
-"Neuroses" (Guilt, Vague Anxiety).
**This is not for bipolar & schizophrenia patients (and even Freud knew this method couldn't help them).
Classical Conditioning Founders
-Ivan Pavlov
-John B. Watson
Classical Conditioning Principle
Associating events with naturally occurring reflexes
Classical Conditioning Therapy Applications
-Phobias
-Traumatic memories and flashbacks
-Chemical addictions
--Top two have to do with associations.
-Maladaptive sexual fantasies
Operant Conditioning Founders
B.F. Skinner
Operant Conditioning Principle
Associating behaviors with their consequences
Operant Conditioning: Therapy Applications
-Behavioral problems (Ex: Acting out behavior, inattentive behavior).
--Ex: Only pay attention to your child when he's having a temper tantrum, they will learn to always throw one to get your attention.
-Building of new skills (Ex: Autism, Mental Retardation).
Modeling Founders
Albert Bandura
Modeling Principle
Learning by watching others
Modeling Therapy Applications
-Animal phobias and other specific phobias
--Works by confronting fears gradually and facing them for a long time.
-Assertiveness training for social phobias
Humanistic-Existential Models Founders
-Humanistic Model: Abraham Maslow; Carl Rogers
-Existential ideas go back to European philosophers of 1800's & 1900's
-Positive psychology is kind of a revival of this
Humanistic-Existential Models: Principles & Concepts
-Develop one's full potential, live an authentic self-determined life
-New definition of "psychological health" (as more than the mere absence of psychiatric illness).
-Self-actualization, creativity, love, authenticity (focus on inner strength).
-Freedom of choice (vs. determinism).
-Take responsibility for one's life and choices
-Face fears, come to terms with the inevitability of death
-Establish meaning and purpose for oneself in one's life
Freedom of Choice (vs. Determinism).
-At least some kind of a choice (letting things get to you at times)
-You can change your reaction so it doesn't affect you (as well as walking away, ignoring it).
-All about perspective.
Carl Roger's "Client-Centered Therapy"
-Non-directive approach: Just listen as a kid calms down (instead of dragging them down). They will come up with a solution at times, so don't immediately hush them and tell them what to do.
-Unconditional positive regard
-Reflection (and validation) of feelings
-Active listening
-Empathy for client
Humanistic-Existential Models Therapy Application
-Individuals who are inhibited or have low self-esteem
-Individuals with no actual skill deficit
-"Growth Therapy" to develop one's full inner potential
-Less helpful for:
--Emergency situations requiring decisive action
--Psychotic conditions and other states of poor judgement
Cognitive Models: Basic Assumption
It is not what happens to us that causes us negative emotions but how we think about, and interpret, what happens to us. (How we view it = we came up with explanations).
Observed Causal Relationship
-Become depressed because you tell yourself that
-Fix by thinking about positives (what you've learned)
Founders of Cognitive Therapy
-Albert Ellis: Rational-Emotive Therapy (RET): Thoughts are more important than emotions
-Aaron Beck: Cognitive Therapy
Applications of Cognitive Therapy
-Depression (to correct negative thinking patterns = done by becoming aware of negative thoughts)
-Many anxiety disorders (esp. GAD, social phobia, panic disorder)
-Eating disorders (e.g. , to restructure distorted self and other perceptions = changing thoughts about food being "good" & "bad")
-Substance-related disorders (e.g., to restructure all or nothing thinking)
-Some personality disorders (e.g., to work on black and white thinking; re-frame irrational thinking)
Advantages of Group Therapy
-Group reduces sense of isolation
-Emotional support from group, group cohesiveness
-Interpersonal learning
-Practice new skills
-Education
--Also: cheaper than individual therapy
Applications of Group Therapy
-Panic disorder
-Eating disorders
-Substance abuse treatment
-Anger management
-Many other disorders
Aspects of Couple's Therapy
-Teach clear, direct communication
-Teach problem identification (the things people argue about) and problem solving
-Identify and understand mutual needs (needs being love, who's in charge, getting space etc. underneath there may be something else).
Family Systems Models: Basic Idea
Families are interdependent systems
Family Systems Models: Concepts
-Identified patient, scapegoat, symptom barer; pathological families
-Dysfunctional families (e.g., enmeshed and disengaged families)
Family Systems Models: Applications
-Anxiety disorders in children (e.g., separation anxiety)
-Eating disorders in adolescents
-Acting out behavior in children
Socio-Cultural/ Multi-Cultural Models: Idea
-To really understand abnormal behavior, a much larger historical, cultural, societal context is needed
--Important with different beliefs (can be applied).
Socio-Cultural/ Multi-Cultural Models: Implications and Interventions
-Prevention of psychological disorders in the first place
-Early interventions
-Community education
-Self-help and support groups
-Understanding the meaning of symptoms within a cultural context
-Identify social/cultural obstacles to recovery, for example, poverty, prejudice violence, misconceptions, lack of access to services.
Bio-Psycho-Social Model
Integration of the various approaches
Diathesis-Stress Model
Psychological disorders result from a combinations of predispositions that meet with stress factors.
Intake Assessment
-This is the first interview you have with a client (overall). Get big assessment for big picture.
-Reasons for Referral and Assessment: including "chief complaint."
-History of Current Problem: Including precipitants, stressors, symptoms, duration of symptoms, etc.
-Client Social History: Current living situation/ marital/ employment/ financial circumstances.
-Family History: Include history of abuse- physical, sexual; family psychiatric history.
-Legal History Support Network: Any friends or family? church membership? Are other agencies involved?
-Medical and Psychiatric History
-Substance Abuse History
-Mental Status Exam
-Diagnostic Impressions (DSM-V diagnosis)
-Recommendations: e.g., medication evaluation, further assessment, psychotherapy, hospitalization
Medical and Psychiatric History
-History of Medical Illnesses (incl. surgeries)
-Psychiatric History (inpatient/outpatient treatment?)
-All Current Medications (including dosage, effectiveness; side effects)
-All Past Medications (incl. dosage, effectiveness, side effects)
Substance Abuse History
-Assess for each substance and when substance was last used (including alcohol, coffee, cocaine, marijuana, prescription drugs, etc.)
-Former Alcohol/Drug Treatment?
Mental Status Exam: General Appearance and Behavior
-Grooming (neat, unkempt, odiferous)
-Facial Expression (happy, tense)
-Activity Level (overactive, underactive)
-Posture (erect, relaxed, slouched)
-Gait (natural, stiff, shuffling)
-Mannerisms (tics, grimacing, tremors)
-Attitude (friendly, aloof, hostile, dramatic).
Mental Status Exam: Characteristics of Speech
-Speech (softm loud, mute, stuttering)
-Quality (coherent, vague, rambling)
-Rate (even, slow, pressured, rapid)
-Content (clear, flight of ideasm rhyming, neologisms, circumstantial)
Mental Status Exam: Affect and Mood
-Affect (appropriate, depressed, flat, labile)
-Mood (cheerful, anxious, sad, angry)
Mental Status Exam: Characteristics of Thoughts
-Content (ideas of reference, obsessions, phobias, fantasies, grandiosity)
-Paranoid Ideation
-Delusions
-Hallucinations (auditory, visual, tactile, olfactory, gustatory).
Mental Status Exam: Orientation
-Oriented to: Place, Time, Self
-Consciousness (clear, clouded, confused)
Mental Status Exam: Memory (impaired/unimpaired)
-Immediate
-Recent Past
-Remote Past
-Attention Span
-Concentration
Mental Status Exam: Intellectual Functioning
-General Intelligence (average, above, below)
-Judgment (good, some, poor, none)
Mental Status Exam: Insight
-Awareness of Illness (aware, limited, denies).
-Motivation for treatment (yes, no, ambivalent)
-Knowledge of Illness (symptoms, medications, side effects)
Mental Status Exam: Somatic ("Vegetative") Symptoms
-Appetite (increase, decrease, no charge; any weight changes? how many pounds?)
-Libido (increased, decreased, no change)
-Sleep (increase, decrease, nightmares, early morning awakening, frequent awakening, trouble going to sleep).
Mental Status Exam: Suicidality
-Ideation? (In present/ in past/ current plan?)
-History of Attempts? (when? how? why?)
-Current suicide risk?
Mental Status Exam: Homicidality
-Ideation? (in present/in past/ current plan?)
-History of violence against others?
-Current homicide risk?
Main Data Collection Methods In Clinical Practice
-Clinical (diagnostic) Interview with the client
-Behavior Observation: Watch then see if they can improve!
--CBT uses self observation (writing moods and feelings).
-External Sources
--I.e: Psychiatric records, school records, legal records; interviews with family members, teachers, etc.
-Psychological Tests : (More for studies; helps pinpoint things in the brain).
-Neurological Tests
--Brain imaging scans like PET, CT, fMRI;
--EEG
Projective Personality Tests
-Subjects are asked to respond to ambiguous stimuli while being unaware of the true purpose of the test.
-Projective Hypothesis: Subjects will project aspects of their own personality (or something internal) into their responses.
-No right or wrong answers = ambigious
Rorschach Inkblot Test
-What do you see? Should be a simple answer
-If someone sees more details, something is wrong (probs schizophrenic)
-This can help fins psychopathy and diagnosing psychosis (today).
TAT (Thematic Apperception Test)
-Pictures of ambiguous scenes which patients are asked to tell a story of them.
-See what emerges (themes).
Sentence Completion Test
The words people say that first come to mind can tell them about themselves.
Draw-A-Person Test
-Is used in kids because kids like to draw and project their emotions through drawings.
-Also used with adults who have schizophrenia (they draw people with missing body parts, weird faces, etc).
House-Tree Person Test
Also used in kids because they can project their emotions through drawings.
Objective Personality Tests
Called "objective" because the scoring procedures are objective (i.e., true-false items)
MMPI-2 (Minnesota Multiphasic Personality Inventory)
-Most frequently administered objective personality inventory
-567 True/False questions
-10 clinical scales (e.g., depression, paranoia, hypomania, etc.) These are built-in checks in a number of questions
-Numerous sub-scales and indicators (e.g., for ego strength, suicidality, etc.) can show over or under reports.
-Validity scales (e.g., faking good, faking bad, random responding, etc.)
Intelligence Tests: WAIS-III
-Is widely used
-Standardized = good idea how each individuals score compares with a large population.
-Very reliable
-Can be unreliable in certain people because of low motivation or high anxiety (impair)
-Also, cultural bias is a possibility.
Neuropsychological Tests
-Most frequently given neuropsychological screening tests:
-Bender Gestalt Test
-Complex Figure Test
-Trail Making Test (Trails A and B)
-Stroop Color Word Test
Bender Gestalt Test
-Task where you see images and have to copy them
-Hard if you have a stroke
Complex Figure Test
-A more complex test then Bender Gestalt.
-It's a bit harder and can only be completed by planning ahead.
-The kind of errors can kinda tell what could be wrong.
Trail Making Test (Trails A and B)
-Following directions involving what to connect with what (looks a bit like connect the dots)
-This test is timed, 17-18 year old's do the best, then it declines.
Stroop Color Word Test
-Inhibiting reading
-Measure of automatic reading in kids
-See reaction (frontal damage = trouble with damage).
Culture-Bound Syndromes
-Cultures have mental illnesses that vary:
--Windigo = monster that possessed people to eat others (Algonquin Indians)
--Susto = Infants and young children having extreme anxiety, excitability, depression, loss of weight, weakness, and rapid heart beat caused by contact with super natural, scary strangers, or by bad air from cemeteries (Some Indian tribes and South Americans)
--Koro = fear that his penis will withdraw into his abdomen and he will die, caused by imbalance of yin and yan (Southeast Asia)
-DSM-V does offer guidence about this when making diagnoses in a multicultural environment: Diagnose with a narrative that describes
--The cultural identity of the client
--Cultural factors that may weigh into the individuals disorder and diagnosis
--Cultural differences between the client and clinician
--Cultural considerations that may influence treatment.
-Argued that it's not a very good source while others say it at least identifies them.
Definitions of Abnormality
-Deviance: Statistical deviation from the norms. Mentally ill doesn't mean deviance.
-Distress: Reporting upset and having anxiety, flashbacks. Not always present = can be situations plus, people with mania have no distress.
-Dysfunction: Some impairment in everyday life.
-Danger: Suicide or homicide (danger to self or others), mainly self! This can get one placed in a hospital).
DSM-V Diagnostic and Statistical Manual of Mental Disorders (Description and Versions).
-Descriptive organizing scheme of mental disorders (American Psychiatric Association)
-Versions: DSM (1952); DSM-II (1968); DSM-III (1980), DSM-IV (1994), 2000 revision; DSM-V (2013)
In Order to Qualify as a DSM V "Disorder:"
-A minimum number of specified symptoms for each disorder have to be met.
-Minimum duration of symptoms specified for each disorder.
-Symptoms cause either subjective distress (like trouble sleeping) or dysfunction (Can't go into work because you can't focus).
-Symptoms are not considered normal in individual's culture.
Mental Disorders in the U.S.
-Leading cause of disability
-One year prevalence of having a mental disorder: 26%
-Life time prevalence of having a mental disorder: 46%
-High "comorbidity" of mental disorders
Most Common Mental Disorders in the U.S.
-Anxiety Disorders
-Mood Disorders
-Substance Use Disorders
Anxiety Disorder (Facts)
-Anxiety is the predominant symptom
-Avoidance is almost always present
Diathesis-Stress
-The belief that certain individuals have a biological vulnerability toward developing the disorder- a vulnerability that is eventually brought to the surface by psychological and sociocultural factors.
--Child can have genes that easily arouse them but, if over the course of their lives, they face intense social pressures, interpret the world as a dangerous place, regard worrying as a useful tool, they may be candidates for developing GAD
--For phobias, certain infants are born with a style of social inhibition and shyness may increase their risk of developing social phobias.
-Treated by using cognitive techniques and relaxation training (stress management programs)
DSM-V Lists of Anxiety Disorders
-Panic Disorder
-Phobias
-Generalized Anxiety Disorder (GAD)
**Note that there is high comorbidity (2 things that occur together) among the anxiety disorders and OCD!
DSM-V Criteria for "Panic Attack"
-A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms develop abruptly and reach a peak within a few minutes.
-Pounding heart or palpitations
-Sweating
-Trembling
-Shortness of breath
-Feeling of choking
-Chest pain
-Nausea
-Feeling dizzy
-Depersonalization (= feeling detached from oneself)
-Fear of going crazy
-Fear of dying
-Numbness
-Chills or hot flashes
Etymology "Panic"
Pan: Greek & Roman god of nature, the wild, often associated with sexuality and fertility
DSM-V Definition of Panic Disorder Includes
-Repeated and unexpected panic attacks
-Fear of recurring panic attacks or losing control
-Avoidance of situations associated with prior attacks (avoid places, stop exercising, thoughts take over life).
-Symptoms must have been present for at least 6 months
-Symptoms cause significant distress or dysfunction
-Note: If Agoraphobia is present, it is coded as an additional diagnosis (Agoraphobia is fear of being in a place where escape is impossible or embarrassing).
Panic Disorder Prevalence
-One year prevalence: 2.7%
-Lifetime prevalence: 5%
Panic Disorder Gender Ratio
5:2 (female: male)
Panic Disorder Onset
15-35 years (Rarely before puberty)
Etiology of Panic Disorder
-Often biological predisposition (genetic; hypersensitive NS; oversensitive locus ceruleus)
-First panic attack may be triggered by street drugs, medications, medical condition, or trauma
--NS may be wired to get into a state of fright before one is aware.
--Occurs by misinterpreting bodily cues, thinking about what could happen (checking heart rate).
-Conditioning process
Treatment of Panic Disorder: Education About...
-Panic attack is a normal "flight-fight" response (it's a useful system).
-Conditioning process: Catastrophic thoughts to bodily sensations trigger panic attacks
-Encourage moderate aerobic exercise
-Regular eating (panic sufferers are often borderline hypoglycemics)
-Reducing caffeine intake
-Breathing exercises (to prevent hyperventilating)
-Relaxation training (to reduce overall stress)
**Note: Education can also be done in a group setting
Cognitive-Behavior Therapy: Cognitive Exercises to Restructure Thinking about Panic
-Identify negative thoughts and learn to combat them
-Devise coping statements (e.g., "I won't die"; "I can ride this out, it will pass.")
-Distraction techniques
-Humor, distanciation
Cognitive-Behavior Therapy: Behavioral Exercises to Eliminate Avoidance Behavior (Agoraphobia)
Exposure therapy / desensitization
Medications for Panic Attacks
-Antidepressants
--SSRI's (e.g., Paxil, Celexa); Effexor; Tricyclics (like Imipramine)
--They work preventively, start working after weeks of daily intake
--Not addicive
-Benzodiazepines: Antianxiety Drugs
--Ex: Xanax, Klonopin, Ativan
--Start working after 30-60 minutes
--High addiction potential
Phobia's: DSM-V Definition
-Persistent, unrealistic fears of specific objects or situations.
-Exposure to the feared stimulus produces intense fear or panic attacks.
-Avoidance responses are almost always present.
-Anxiety dissipates when the phobic situation is not being confronted.
-Symptoms must have been present for at least 6 months
-Symptoms cause significant distress or dysfunction.
--Specifier: "with panic attacks"
Three Subcategories of Phobias in DSM-V
-Agoraphobia
-Specific Phobia
-Social Anxiety Disorder (Social Phobia)
Agoraphobia: DSM-V Definition
-Excessive fear of being in public places or situations from which escape might be difficult or embarrassing or help unavailable if panic-like symptoms were to occur.
-The fear tends to be worse when alone.
-There is extensive avoidance behavior which can become very generalized (e.g., house-bound).
-Symptoms must have been present for at least 6 months
-Significant distress or impairment by the symptoms
Agoraphobia: Etymology
"Fear of the marketplace;" the "Agora" in ancient Athens was the center of public life.
Agoraphobia: Prevalence
-One year prevalence: 0.8%
-Lifetime prevalence: 5%
Agoraphobia: Gender Ratio
5:2 (female: male)
Agoraphobia: Onset
Ages 20-35
Treatment of Agoraphobia
-Exposure therapy (behavior therapy)
-Cognitive therapy
-Antidepressants (especially SSRI's)- also to treat any comorbid depression and panic disorder
Specific Phobia: DSM-V Definition Includes
-Excessive fears of particular objects or situations
-Immediate anxiety is usually produced by exposure to the object
-Avoidance of the feared object or situation (e.g., claustrophobia, dog phobia, acrophobia)
-Symptoms must have been present for at least 6 months
-Significant distress or impairment by the symptoms
Types of Specific Phobias
-Animal Type
-Natural Environment Type (lighting, fire, water)
-Situational Type (elevators, heights, flying): Today we can use virtual stimulation to help cure these.
-Blood-injection /Injury type: (fear of shots...) these are the only phobia's were one could be possibly faint. Most genetic and evolutionary it makes sense.
Specific Phobia Prevalence
-One year prevalence: 8.7%
-Lifetime prevalence: 11%
Specific Phobia Gender Ratio
2:1 (female: male)
Specific Phobia Onset
Usually in childhood but can start at any age
Specific Phobia Course
-Young children often have phobias, many of them are outgrown without therapy (e.g., animal phobias, fear of monsters under the bed, fear of the dark).
-Phobias later in life may be life-long if not confronted
Treatment of Specific Phobias: Behavior Therapy
-Extinction of avoidance behavior through exposure therapy:
-Flooding (keep going until anxiety goes away = not usually done).
-Systematic Desensitization (first step: relaxation training)
--See a picture, hold it, toy spider, dead spider, holding dead spider, seeing real spider, therapist handles spider, patient handles spider.
-Participant Modeling
-Virtual exposure
**Prolonged exposure better than short exposure intervals!
Treatment of Specific Phobias: Cognitive Therapy
-Usually straight behavior therapy works for simple, specific phobias.
-Add cognitive techniques for more generalized phobias.
Treatment of Specific Phobias: Medications
-Preferably none for specific phobias or only as an adjunct to behavior therapy
-Use antidepressant medications if phobias are complex, or if there is comorbidity with other anxiety disorders and/or depression
Social Anxiety Disorder (Formerly Social Phobia): DSM-V Definition
-Fear of social or performance situations (especially involving exposure to unfamiliar people)
-Concern about rejection, humiliation, or embarrassment
-Symptoms must have been present for at least 6 months
-Symptoms cause significant distress or dysfunction
--Specifier: "with panic attacks" & Specifier: "performance only"
Social Anxiety Disorder: Predisposition
Shyness, cautiousness, introverted temperament, sensitive NS
Social Anxiety Disorder: Onset
-10-20 years (early adolescence)
-Peak of onset around age 13
-Typically worse when young, but may also get worse over time and/or become chronic
Social Anxiety Disorder: Prevalence
-One year prevalence: 6.8%
-Lifetime prevalence: 9%
Social Anxiety Disorder: Gender Ratio
3:2 (female: male)
Treatment of Social Anxiety Disorder: Medications
-Antidepressants , especially SSRI's which are helpful for rejection sensitivity "feels like they've grown a protective skin"
-Beta blocker (antihypertensive, like Propanolol) my be helpful for performance situations
Treatment of Social Anxiety Disorder: Psychological Forms of Treatment
-Social skill training
-Assertiveness training
-Group therapy (if tolerated)
-Cognitive therapy
-Treat any comorbid disorders (panic attacks? depression? etc. )
-Explore if there are childhood issues of domestic violence, childhood abuse, shaming?
Generalized Anxiety Disorder DSM-V Definition
-Excessive anxiety and apprehension that is not limited to particular situations
-The worry is difficult to control
-Symptoms such as muscle tension, restlessness, difficulty concentrating, feeling "on edge"
-Symptoms must have been present for at least 6 months
-Symptoms cause significant distress or dysfunction
--Specifier: "with panic attacks"
**NOTE: GAD sufferers tend to go see family MD rather than psychologist (they go in because of their sleep issues, or pain, etc.)
Generalized Anxiety Disorder: Onset
0-20 years
Generalized Anxiety Disorder: Course
-Often onset in childhood/adolescence.
-Often a chronic course (like poverty, being a single mom).
-Worsened by increase in life stressors (normally anxious but this will make it really worse).
Generalized Anxiety Disorder: Prevalence
-One year prevalence: 3.1 %
-Lifetime prevalence: 5%
-Only anxiety disorder that is found at a higher rate in elderly than overall population
Generalized Anxiety Disorder: Gender Ratio
2:1 (female: male)
Generalized Anxiety Disorder: Etiology
-GAD tends to run in families:
--Modeling of anxious behavior by overprotective, anxious parents and/or
--Genetic factors (e.g., short serotonin transporter gene; abnormalities with GABA system)
Treatment of Generalized Anxiety Disorder: Psychological Forms of Treatment
-Cognitive Therapy: (obstacles are poor insight and somatization = help understand the special role worrying may play)
--Changing maladaptive assumptions
--New Wave Cognition
-Psychodynamic Therapies: (Free associations and interpretation) ~ modest help
-Humanistic: Client-centered therapy
-Biology: drug therapy, relaxation training, and biofeedback.
Treatment of Generalized Anxiety Disorder: Medication
-Antidepressants (they are not addictive!)
-Benzodiazepines (="antianxiety medication"), they're alright, depends on the person
-Buspar (=nonaddictive antianxiety medication which, by the way, is not helpful for panic)
-Neurontin (=gabapentin, an anti-seizure medication with antianxiety effects- non-addictive)
OCD Spectrum Disorders on the DSM-V List
-Obsessive-Compulsive Disorder
-Hoarding disorder (compulsive hoarding)
-Excoriation Disorder (skin picking disorder)
-Body dysmorphic disorder
-Other OCD type disorder (e.g. nail biting, lip biting, cheek chewing, obsessional jealousy).
-OCD type disorder induced by substance/ medication.
-OCD type disorder due to other medical condition
**Note: this is a new category in DSM-V, In DSM-IV, OCD was listed as one of the "anxiety disorders," hoarding was an OCD compulsion, trichotillomaina was an "impulse control disorder," and body dysmorphic disorder was a "somatoform disorder."
Obsession
Intrusive, repetitive anxiety-arousing thought or image
Obsession Common Themes
-Contamination: Catching or spreading germs
-Harming somebody: The fear you might harm someone (Ex: Thinking about slashing the throat of your children). = might start praying.
-Driving off bridges: Thoughts about doing so, so you might avoid driving on bridges.
-Sexual ideas (fear of doing something shocking): The idea that you're afraid of doing something that could be wrong like touching or saying something. = It's not fear but it's fear of yourself making a mistake.
-Order
-Symmetry
Compulsion
Need to perform acts to reduce anxiety
Compulsion Common Behaviors/ Rituals Involve
-Cleaning and washing
-Checking: Excessively checking (like 10, 20, or even 30 times). This can take over someone's life.
-Counting
-Ordering: an anxiety coping mechanism
-Touching: A need to touch things (like touching a fence as you walk).
-Licking: In animals that lick a spot until it's raw
-Praying: OCD about religious rituals
-Seeking verbal reassurances from others. Was helpful for survival of the species, not excessive however.
DSM-V Definition of OCD Includes
-Recurrent intrusive thoughts/images and/or compulsions
-Attempts are made to suppress the thoughts or behaviors
-Symptoms must have been present for at least 6 months
-Symptoms cause significant distress (embarrassing) of dysfunction (time consuming).
-Specifiers: good/fair insight; poor insight; absent insight/ delusional
OCD Onset
-4-25 years
-Rare after age 40 (Ruling out brain pathology, unless comorbid depression or pregnancy.
OCD Course
"Waxing and waning" chronic course if not treated.
OCD Prevalence
Lifetime prevalence: 2.5%
OCD Gender Ratio
1:1
OCD Comorbidity
-Depression (1/3 have OCD)
-Other anxiety disorders
-Alcohol and cannabis abuse
-PTSD: (Washing after being violated, counting things to try and escape reality...)
OCD Etiology
-Biological (genetic predisposition, etc.) = evidence in twins
-Conditioning process: Thinking thoughts through and realizing you'd never hurt them.
Treatment of OCD
-Behavior Therapy
-Cognitive Therapy
-Medications
Treatment of OCD: Behavior Therapy
-Exposure with response prevention (prohibiting OCD person from performing compulsions).
-Works best with compulsions, this behavior can be blocked.
Treatment of OCD: Cognitive Therapy
-Habituation training
-Works best with obsessions
--Ex: Pick a specific time everyday to obsess about what you're always obsessive about.
Treatment of OCD: Medications
-Medications increasing serotonin levels, like:
--Clomipramine (Anafranil)
--SSRI's, including Prozac, Paxil, Luvox, Zoloft, Celexa, Lexapro
Hoarding Disorder (Compulsive Hoarding): DSM-V Definition
-Strong need to accumulate possession regardless of value
-Persistent difficulty or distress associated with discarding them
-Leads to cluttering of the home, and associated physical safety and relationship problems.
-Person may feel a sense of emotional security from being surrounded by "stuff"
-Person may fail to recognize that the hoarding behavior is a problem.
Excoriation Disorder (Skin Picking Disorder): DSM-V Definition
-Compulsive or repetitive picking of skin, resulting in sores
-May involve scratching, picking, rubbing, or digging into the skin
-May attempt to remove slight skin imperfections or as a coping response to stress or anxiety.
Trichotillomania (Hair Pulling Disorder)
-Compulsive or repetitive picking of skin, resulting in hair loss
-Hair pulling may involve the scalp, eye brows, or other parts of the body and may result in noticeable bald spots.
-Hair pulling has soothing effects and is used as coping response to stress or anxiety.
Body Dysmorphic Disorder DSM-V Definition
-Preoccupation with an imagined or grossly axaggerated bodily defect (e.g: nose, teeth, ears, a mole, spots on skin, hands, breasts, etc.) = can also be anorexia.
-Compulsive checking in mirror, excessive grooming, etc.
Body Dysmorphic Disorder: Onset and Course
Usually begins during adolescence
Body Dysmorphic Disorder: Prevalence
-2% in U.S. Population
-4% in U.S College Students
Body Dysmorphic Disorder: Gender Ratio
1:1
Body Dysmorphic Disorder: Etiology
-Family history of anxiety disorders, esp. OCD
-Shyness and social phobia
-Cultural emphasis on perfection and beauty
Body Dysmorphic Disorder: Treatment
-SSRI Medication
-Exposure with response prevention
-Cognitive therapy
-Cosmetic surgery doesn't work
The Brain and Each Disorder (GAD, Panic Disorder, & OCD)
-GAD: The circuit in the brain that causes GAD includes the amygdala, prefrontal cortex, and the anterior cingulate cortex
-Panic Disorder: The circuit in the brain that causes panic reactions includes the amygdala, ventromedial nucleus of the hypothalamus, central grey matter, and locus cerules.
-OCD: Brain structures linked include orbitofrontal cortex, caudate nucleus, thalamus, amygdala, and cingulate cortex.
Acute Stress Disorder & Post-Traumatic Stress Disorder (PTSD).
-Both require that there was exposure to a life-threatning traumatic event (or that the event was perceived as life-threatening), or that there was threat to the physical integrity of self or others. (Ex of traumas: combat, rape, terrorist attack, accidents, natural disasters, childhood abuse, etc.).
-Their symptoms are roughly the same for acute and post-traumatic stress disorder
-Both disorders require that the symptoms cause significant distress or impairment
The Difference between Acute Stress Disorder and PTSD
-The length of time the symptoms have lasted
--Acute Stress Disorder: 2-30 days
--PTSD: More than 30 days
-40% of those with Acute Stress Disorder will develop PTSD
-50% of those with PTSD will recover within 3 months.
Post Traumatic Stress Disorder: DSM-V Criteria
-A person must have been exposed to a life-threatening traumatic event AND have developed symptoms for the following 4 categories.
-Re-experiencing the trauma
-Avoidance behavior
-Emotional distress, negative thoughts, and impaired functioning.
-Heightened arousal
PTSD Criteria: Re-experiencing the Trauma
-Recurrent and intrusive memories or dreams
-Feeling as if the traumatic event were recurring
-Dissociative flashbacks
-Strong psychological and physiological response to cues resembling trauma
PTSD Criteria: Avoidance Behavior
Avoid cues or situations associated with the trauma
PTSD Criteria: Emotional Distress, Negative Thoughts, and Impaired Functioning
-Persistent negative thoughts and emotions
-Feeling detached or estranged from others
-Feeling numb inside
-Not being able to remember (aspects of) trauma: pushing things out, not even just the trauma.
-Not functioning effectively
PTSD Criteria: Heightened Arousal
-Difficulty falling or staying asleep
-Irritability or outbursts of anger
-Difficulty concentrating
-Hyper vigilance (always on guard)
-Exaggerated startle response
-Reckless, self-destructive behavior
DSM-V "Specifiers" for PTSD
-With delayed expression: If full criteria are not expressed until at least 6 months after the trauma
-Delayed onset is especially likely when:
--The initial symptoms are of numbing (i.e., the initial trauma was repressed)
--Specific triggers are present that reactivate the trauma (ex: a mom might become over protective woman = when their child becomes the age when they were abused).
PTSD Prevalence
-One year prevalence: 2.5%
-Lifetime prevalence: 7.8%
PTSD Gender Ratio
-2:1 (female: male)
**But depends on specific socio-historic context (ex: war).
PTSD Onset
Variable, traumatization can occur at any age.
PTSD Symptoms in Children
-Overall the same as in adults (nightmares, detachment, sleep problems, etc.)
-Anxiety is likely to be more generalized
-More somatic symptoms are reported
-Prone to "act out" and play out the trauma through repetitive play and actions. (might touch a kid the way he's been touched or abuse a kid the way he's been abused).
Factors Linked to Developing PTSD: Trauma Factors
-Human-caused (vs. nature-caused) trauma. Ex: Being assaulted causes more PTSD than involvement with a flood.
-Severity of trauma
-Prolonged trauma with repeated exposures (vs. isolated trauma). Ex: constant physical abuse by a husband versus one fight.
-If person was/felt immobilized (vs. able to take some action).
Factors Linked to Developing PTSD: Person-Specific Factors
-Personal history of prior trauma (stuck in the same mode = conditioned to freeze).
-Preexisting psychological disorders (esp. anxiety and depression)
-Over-reactive, hyper-aroused nervous system
-Lack of coping skills
-Negative thinking style
Factors Linked to Developing PTSD: Social Factors
-Lack of social support (family, society at large).
-Lack of resources
-Further victimization through stigmatization
Medications for PTSD
-There is no specific PTSD medication but one can treat the symptoms
-Benxodiazepines: mat be perscribed in the first days after trauma occurred
-Beta blockers (Popranolol) and Alpha blockers (antihypertensives): Possibly even to prevent PTSD
-Antidepressants: For anxiety, panic, sleep, and depression
-Topomax (antiseizure medication): may be helpful for flashbacks and nightmares
-Antipsychotics and mood stabilizers to reduce anger
Psychological Treatment for PTSD
-Create safe space and rapport
-Facilitate the client talks about the event (to express feelings)
-Empower client (to shed the victim role)
-Teach coping skills (i.e: relaxation, breathing; coping statements)
-Desensitization procedures, including EMDR
-Cognitive therapy (i.e. to restructure thinking about trauma).
-Group therapy (may not be tolerated)
-Body therapies, movement therapies (complete the action that was interrupted during the trauma; "get unfrozen")
-With children: Art therapy and play therapy to help children communicate the trauma; physical exercises to help children regulate their emotions.
PTSD Comorbidity
-Other anxiety disorders (e.g., panic attacks are frequent)
-Depression
-Dissociative disorders
-Borderline personality disorder
-Alcohol and substance abuse
-Medical conditions (autoimmune diseases, heart disease)
-Suicide
Adjustment Disorders
Less severe stressors than with PTSD (e.g., move, loss of job, death of loved one, etc.)
Adjustment Disorders: Specify Whether
-With depressed mood
-With anxiety
-With mixed anxiety and depressed mood
-With disturbance of conduct
-With mixed disturbance of emotions and conduct
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