Abnormal Psychology (1) – Flashcards
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Historical overview
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Historically, theories have been either somatogenic (theories that stress physical etiology as causal) or psychogenic (theories that stress psychological or environmental etiology); 20th century paradigms/school of psychological thought - biological psychology/neuroscience, behavioral, psychoanalytic/psychodynamic, humanistic and cognitive
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Spirits and demons
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Demonology (used less often than we think), but is this a rational explanation?; common symptoms make this understandable; psychiatric symptoms such as auditory hallucinations lend themselves to this interpretation; normal experiences such as some sleep disturbances; something resulting in Cacodemonomania; interventions (exorcism) also seemed to "work"; we still see similar symptoms today
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Hippocrates/Galen
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Early approaches were not just based on demons; Hippocrates, the father of medicine (and psychology?) - Hippocratic oath (swearing to practice medicine honestly); proposed that the mind was separate from the body and resides in the brain (Aristotle thought the stomach)... and that mental illness has natural causes/humors (not spiritual); he identified psychological types of body fluids (blood, yellow bile, black bile, and phlegm); very similar to theories of neurotransmitters; he recommended both somatogenic and psychogenic treatments
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Early psychiatric institutions
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Hospitals and Asylums in Europe developed as the crusades end (c. 1200); the word "Bedlam" derives from the "Priority of St. Mary at Bethlehem," an early hospital near London; a source of entertainment, as well as respite
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Other forms of early treatment
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In the US - Benjamin Rush in Williamsburg (1780s)... treatments included: frightening, bleeding, alcohol and marijuana, and Rush's restraining chair; lunacy trials in English law emerged at the same time as some witch trials (a "progressive" practice); Paracelcus believed that the moon (from luna) influences behavior, a persistent belief today
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Institutionalization
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Institutions may be created with the best intentions but create their own problems; "iatrogenic effects" describes damage done by treatment, and not just psychological damage; "moral" treatment (treatment of emotions) - as a response - focuses on the curative effects of treating people humanely; emphasis is to create an environment with normal work roles and relationships to counteract iatrogenic institutionalization, an effort that persists today Pinel/Pussin in Paris, William Tuke in the UK, and Benjamin Rush in the US (moral treatment)... "treating people as people"
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Asylum growth in the 19th c.
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Dorothea Dix encourages asylum growth in the 19th century (a progressive move at the time); however, we see increased medicalization in institutions over time; problems begin to be seen as biological and less amenable to treatment; institutional focus becomes "warehousing" and research, not treatment and rehabilitation; population peaks during the first half of the 20th century, but the # of asylums rapidly falls after 1960 because of 1) major tranquilizers and 2) civil rights; her movement was known as the mental hygiene movement
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Somatogenic interventions/Mental illness in the 19th/20th c.
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Somatogenic (biological) theories in the 19th century benefit from advances in medicine; syndromes are elevated to diseases as underlying mechanisms (germs) are discovered; GPI (syphilis) provides powerful evidence that psychiatric symptoms can have biological roots, created expectation that this was generally true; these theories also benefit from our understanding of genetics; development of major tranquilizers (1950s) and minor tranquilizers (1960s) also spurred on those interested in biological explanations and treatments
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Early modern psychological interventions
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For millennia, rituals have been used to help affect cures; always know that behavior - a long walk, a good cry - can help resolve negative mood, depression, or anxiety; extreme environments can produce dramatic symptoms; Franz Anton Mesmer (18 c.) promotes "animal magnetism" (a presumed intangible or mysterious force that is said to influence human beings) to cure physical symptoms (that are stress related)... in fact, he was using hypnosis, but this does not make the cures less real or effective; Freud and Breuer formalize the medical use of hypnosis (still used) to successfully treat "conversion disorders" (causes patients to suffer from neurological symptoms, such as numbness, blindness, paralysis, or fits without a definable organic cause); Freud develops "talking cure" to bring about "catharsis" - an emotional release which resolves psychiatric symptoms, physical, behavioral, and emotional
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Scientific paradigms
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Science is always partly subjective; scientific methods are an attempt to reduce the subjective; scientific paradigms are conceptual frameworks and reflect underlying assumptions of the science (rarely questioned); paradigms dictate 1) what questions to ask, or can be asked, and 2) which methods to use/which facts to look at; historical examples of broad scientific paradigms include 1) rational methods focusing on logic, and 2) empirical methods focus on observation
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Paradigms in abnormal psychology
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Psychoanalytic/psychodynamic, biological/neuroscience, learning/behavioral, humanistic, cognitive; we can understand disorders and treatments in terms of any or all of these frameworks
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Principles of the psychodynamic paradigm
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Psychic determinism - everything has a reason; structure of the mind - id, ego, superego... develop sequentially and operate independently; id (pleasure) = primitive intense emotion/need, ego (reality) = awareness/abilities, and superego (conscience) = values/obligations; conflict results in compromise (personality); unconscious emotional forces are the most influential but never directly known, only inferred from
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Defense mechanisms
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Anxiety can be moral, objective, or neurotic, depending on the source - super-ego, reality, or id; we manage anxiety with defense mechanism - reaction formation, regression, denial (rejection), repression, rationalization, projection/projective identification; psychodynamic theory also explains - slips, humor, and dreams
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Psychodynamic development
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Freud's psychosexual stages of development follow unfolding biology - oral, anal, phallic, latency, genital... each stage is defined by demands and abilities; over and under-gratification results in "fixation" - return to behaviors of this period when under stress; Erikson's stages of development are based on Freud
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Psychosexual stages of development
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Oral stage - physiology (relate through the mouth); possible outcomes are dependence or gratification... trust vs. mistrust; anal stage - demands escalate (autonomic becomes voluntary), children master "will-control" as they develop autonomy... anal retentive (cheap) vs. anal expulsive (out of control)
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Psychodynamic treatment
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We sometimes cannot know ourselves as well as others, because our unconscious impulses are hidden from us; flexibility in defense mechanisms in adaptive (coping mechanisms); current impact on treatment, not research (therapists as a sounding board)... therapists as a sounding board; transference (unconscious redirection of feelings) vs. counter transference (emotional reaction); importance of unconscious material, interpretation and timely analysis of defenses; now the focus is more on the ego than the id; psychodynamic theory can be useful in thinking about depression and anxiety (less so psychosis)
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Psychodynamic paradigm
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Post-Freudians (neo-Freudians)... modified, desexualized; Jung... introversion; Adler... birth order, inferiority complex; psychodynamic, interpersonal, and ego-oriented therapies are among those descended from psychoanalysis
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Behavioral/learning paradigm
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Psychology must be the study of behavior; this paradigm rejects 1) Freud, 2) early research methods such as introspection, and 3) the increasing importance placed on biology, specifically genetics and its negative implications (eugenics); emphasizes 1) observable data and psychology as the study of behavior, 2) role of environment, and 3) Tabula Rasa - everybody is born with equal potential (we know now that at least some of this is incorrect)
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Behavioral/learning paradigm (cont'd)
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Classical conditioning - Pavlov (timing or contingency), UCS and UCR are paired by reflex (biology), repeated pairing of UCS with CS (e.g.: food with bell), produces a conditioned response (CS -> R); Watson (environment produces behavior)... Little Albert; stimulus generalization (the tendency to respond to stimuli that are similar to the original conditioned stimulus) vs. response generalization (occurs where an organism emits a different response to a stimulus which serves the same function as previously reinforced responses); not always repeated (preparedness, one trial learning... food aversion/eating something one time, never again); not always behavior (CERS/conditioned emotional responses... hearing a song that you initially didn't like but begin to); used in marketing
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Operant conditioning (behavioral paradigm)
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Reinforcement - positive, negative, punishment (Skinner emphasizes environmental feedback, which increases/decreases behavior); primary (biologically designed to find these reinforcing, such as food, social attention, etc.) and secondary reinforcers (classically conditioned to find these reinforcing, such as money, etc.)
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Meditational learning/two-factor learning and vicarious conditioning (behavioral paradigm)
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Meditational learning/two-factor learning - when we pair classical and operant conditioning; standing at a table when a traumatic event occurs, individual now scared of the table and runs away from it... vicarious conditioning/social learning/modeling - behavior acquired without direct experience, or in other words, via observation/learning
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Behavior therapy based on classical or operant methods
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Systematic desensitization, or gradual exposure therapy - phobias... a structured way of exposing people to their fears/fear hierarchy; shaping-successive approximation - taking things one step at a time/steps taken to achieve a certain behavior; counter-conditioning - conditioning intended to replace an unwanted behavior with a wanted behavior/pairing stimuli that evoke one response with an opposite response, so that the stimulus now evokes a new response
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Behavioral paradigm (cont'd)
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Learned helplessness - repeatedly exposed to unescapable, aversive stimuli; much conditioning occurs outside of awareness (unconscious conditioning
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Learned helplessness experiments (behavioral theory meets cognitive theory)
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Yoked controls are shocked every time the experimental dog gets shocked; experimental dogs learn to stop the shock; both groups experience identical rewards or punishment, but yoked dogs have more distress and fail to learn in the future (experimental dogs are capable of stopping the shock, while the yoked dogs are not; the group that does not have control acquires learned helplessness); learned helplessness - 1) more distress, and 2) fail to escape the shocks in the future
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Experience of control (behavioral theory meets cognitive theory)
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Experience of control, which is a cognitive concept, not behavioral; control and predictability impact mental health... the way we think about events/experiences affects how we feel about those experiences - individual to each person; the meaning and beliefs about a stimuli affect response... "man is disturbed not by things, but by the views he takes of them" - Epictetus (appraisal, e.g. identification with the aggressor/Stockholm Syndrome)
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Behavioral theory meets cognitive theory (cont'd)
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We are not always aware of what or how we think (unconscious conditioning); cognitive theory focuses on beliefs, expectations, and learned scripts
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Behavioral theory meets biology
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Garcia effect - one trial learning or over-learning (classical conditioning can occur with a single experience; mediated partly by the amygdala... some parts of learning are facilitated by biology); not all relationships are equally "condition able" (it's very easy for rats to associate lights with shock or taste with nausea, but not light with nausea or shock with taste)
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Modeling and preparedness (behavioral theory meets biology)
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Is there a genetic predisposition to learn (by observation) certain lessons that have survival value?; Susan Mineka - monkeys, trains and spiders (baby monkeys watching their mothers have aversive responses to trains and spiders - baby monkeys acquired aversive response to the spiders, but not the trains)
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Behavioral theory meets biology (cont'd)
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Great individual differences at birth, so no "tabula rasa" or blank slate (adult personality and emotions not determined entirely by experience); phobias are unique to some genetically predisposed individuals (ex: blood phobia); "might be a reinforcer for me, but a punishment for you"; token economics - where we have a system of reinforcements based on a reinforcers that is a bit like money, but we try to shape peoples behavior with it (e.g. gold stars in kindergarten, etc.)
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Humanistic paradigm
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A narrow but very important paradigm (therapy - but the impact is on practice, not on research); humanistic theory grew during the 60s and 70s; Carl Rogers (strived to see the good in people - explains healthy development through "conditions of worth"; when you're born, your parents love you unconditionally - eventually though, we love you... if (you get to sleep early, clean your room, etc.); expectations can have an effect on one's self-esteem -> depression or distorted sense of self; awareness of reality is the key to mental health; positive/optimistic paradigm
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Client centered therapy (humanistic paradigm)
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Non-directive therapy/answers not provided; rather the therapist empathizes with their clients point of view; requires "unconditional positive regard"; unconditioned acceptance; promotes self actualization (becoming the best person that we can possibly be, given the environments that we are in; individuation in Jungian terms); client is the best expert; healing comes from within, as is medicine (therapist does not fix their client's cognitions, simply provides space where healing is optimized); most widely used model of therapy; it works well, and risks are minimal
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Biological paradigm
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Genetics (rate knowledge acquisition/publication is faster in this paradigm than anywhere else - CAT scans, MRIs, etcetera); twin, family studies, adoptee studies, linkage studies; biochemistry - neurotransmitters, synaptic transmutation, and hormones; structure - CNS (brain and spine), PNS (everything else), autonomic (automatic vs. somatic/within your control), which I divided into sympathetic (fight and flight), parasympathetic (resets the sympathetic nervous process) - related to anxiety disorders and panic disorders; brain, forebrain, hindbrain, limbic system/emotions, hippocampus/memory, amygdala/emotions (again), etc.; treatment (blocking re-uptake, surgery, and electrical interventions
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Genetics
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Heritability coefficient (how much variability in a population is due to genetics; for instance, the heritability coefficient for "having arms" is very low); shyness or activity level 30-50% variance due to genetic factors, IQ 60%, and psychological disorders up to 50% (schizophrenia, bi-polar disorders, etc.) - most effects are polygenic (caused by multiple genes, but which genes?); genes and environments interact; diathesis stress model - genetic tendency/risk + environment/experience = observed behavior; Caspi (2003) looked at those with two short serotonin transporter alleles versus two long (people can have long/long, long/short, or short/short) - those with two short had twice the likelihood of depression after four life events in the last twelve months (life events are a fairly standard way of measuring stress); childhood abuse was mildly related to adult depression for those with long but strongly related for short; also suggesting a source of resilience (glass half full)
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Genetics interact with the environment
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Reciprocal gene environment models - genes "cause" people to seek out environments (genetic pre-disposition for extraversion = prompted to seek out people, and when you're with people, you'll interact with them; ex: extraverts seek out environments that make them look more extraverted; which 1) magnify the genetic tendency or 2) may activate other genetic dispositions (one trait pushing you into an environment where a second is expressed)
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Genetics interact with the environment (cont'd)
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Does sensation seeking activate blood phobia?; partly determined by genetics, likely to manifest with blood-injection phobia; the more opportunities you have to see blood, the more opportunities you have for the phobia to be activated); also "non genomic inheritance" (environment; genetic pre-dispositions can be overruled by environmental influences) - cross fostering shows anxious baby rats cross fostered to calm mothers... 1) becomes calm and 2) are later calm mothers themselves; only if cross fostering occurs at a specific time; there are likely many developmental windows during which behaviors may be acquired or expressed, ex: imprinting (becoming attached to the first object one sees, and thinking/assuming that object or animal is their mother
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Neurotransmitters
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Communicate between neurons, usually at the synapse (space between) - excitatory, inhibitory; agonists with mimic, antagonists which block; serotonin - SSRIs, mood impulsivity, implicated in many behaviors, "serotonin depletion", at least fifteen subtypes of receptor; GABA - inhibitory, often works with glutamate, suppresses anxiety responses, benzodiazepines; dopamine - drive, muscle control, hallucinations, nicotine; many receptor subtypes, lots of interaction between systems (current overall picture is the tip of the iceberg); also hormones function in a very similar manner (you think with your kidneys, or at least your adrenal glands)... "the biochemicals that are released from the axon of one neuron and transmit the impulse to the dendrite receptors of another neuron"
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Developmental and psychological experiences impact biology
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Monkeys in "learned helplessness" study (some monkeys systematically abused to produce depression/anxiety, other monkeys in control) - later given GABA inverse agonist (production of anxiety; behavioral and emotional response based on prior experience); depending on early experience, there were two very different reactions... anxious (learned helplessness group) vs. angry (no learned helplessness)
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Developmental and psychological experiences impact biology (cont'd)
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Early experience determines later reactions to the same neurotransmitter, Insel et al. (1986); do you have friends who have different responses to alcohol?; equivalence of neurochemical and psychological experience; opioids and placebos affect similar brain regions; also OCD therapy and Prozac have similar impacts
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Plasticity and priming
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Plasticity - structural flexibility in the brain; in rats, dendrite density associated with environmental stimulation (in young rats, stimulating environments = greater number of connection); historical and underestimation of adult plasticity; "the knowledge" demonstrates plasticity later in life - taxi drivers learning London street maps, and hippocampal growth associated with learning directions ("working out" the brain); priming, some experiences switch on traits - early smoking raises later risk of anxiety
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Paradigmatic framing should include gender, social, and cultural influences on behavior and pathology
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Gender matters; differing rates of the same disorder; differing symptoms for similar disorders; differing presentation of the same symptoms; social influences - social support, status, stigma (ex: social support as a huge buffer of stress and predictor of negative outcome); culture also has a significant impact - on disorder rate, type, and presentation; culture specific syndromes - Amok, Koro, etc.
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Integrating paradigms for O/C
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Psychodynamic - OC behaviors are defense mechanisms, maladaptively used; does OC stem from issues of independence and control (and what are its impacts)?; cognitive/behavioral - beliefs and self statements initiate fears or powerfully reinforcing behaviors; treatments - extinction, flooding; biological - genetics may partially dictate risk, symptom types; regions involved - caudate nucleus, frontal cortex, neurotransmitters, serotonin based treatments, cingulotomy; culture and gender affect symptoms; humanistic - conditions of worth (and impact on self actualization)?
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Overall nerve structure
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CNS; PNS - somatic and automatic (sympathetic vs. parasympathetic); hindbrain - reflexes, survival, sex, food... RAS, pons, cerebellum; midbrain - limbic system (emotion, learning, memory)... hippocampus, amygdala; forebrain - 80% of all neurons (planning, language, self-awareness... cortex, lobes, motor cortex, sensory cortex... Penfield studies)
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Comparing and contrasting behavioral/psychoanalytic theories
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Similarities - clients forced to relive and talk about past events that traumatize them today... through exposure, real or hypnosis exposure, the patient started to feel relief from anxiety... also, the relationship between the client and the therapist is important instilling a sense of trust between the two; differences - behavioral therapy uses reinforcement and punishment to change behavior; in psychoanalytic, there is usually an event we can connect out trauma and fears to... in behavioral therapy, reinforcement and punishment are widely used to correct or promote an undesired or desired behavior, whereas in psychoanalytic it is less scientific and is widely based off what the patient says is or is not true, and behaviors aren't corrected they are just talked about and worked through; psychoanalytic therapy (Freud) attempts to make unconsciousness motives conscious... behavioral conditioning can often occur without awareness but generally behaviorists do not really refer to mental processes so it does not revolve around the unconsciousness.
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Positive and negative effects of labeling (cont'd)
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Positive - helps identify treatment and diagnosis... self-acceptance; negative - stigmatization
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Acute
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Present or experienced to a severe or intense degree
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Chronic
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Persisting for a long time or constantly recurring
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Prognosis
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The likely course of a disease or ailment/prediction of possible outcome; the anticipated course of a disorder
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Galen
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Normal brain functioning related to bodily fluids... practiced bleeding
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Mesmer
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Hypnosis/animal magnetism (nothing more than a strong suggestion; therapy via large beds of chemicals
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Catharsis
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The recalling/reliving emotional trauma (that has been made unconscious) in order to purge emotions/release tension
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Transference
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How the patient feels toward their therapist
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Counter-transference
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How the therapist feels toward their patient
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Dopamine
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Neurotransmitter related to schizophrenia and addiction
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Operant conditioning example
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Exemplified in responses within social context; conditioning in which an operant response is brought under stimulus control by virtue of presenting reinforcement contingent upon the occurrence of the operant response
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Negative reinforcement
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Removal of an "obnoxious" stimulus
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Token economy
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Systematic reinforcement of a targeted behavior; a form of behavior therapy that has been used in some mental institutions; patients are rewarded with tokens for appropriate behavior and the tokens may be cashed in for valued rewards
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Plasticity
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Ability of brain to change as an adult; the quality of being easily shaped or molded
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Gene environmental reciprocal model
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Magnified genetic predisposition (extroversion); a theory of psychology that helps to explain how one gets a psychological disorder. It says that a person, who is predisposed to a certain disorder (like depression), will inadvertently create an unsuitable environment for themselves which will propagate the accumulation of the disorder
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Serotonin
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Neurotransmitter related to mood and behavior
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Re-uptake
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Neurotransmitter drawn back into same neuron from the synapse
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Rationalization
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"Additional studying won't do me any good anyway"; the cognitive process of making something seem consistent with or based on reason; conceals the true motivations for actions, thoughts, or feelings through elaborate reassuring or self- serving but incorrect explanations
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Iatrogenic effects
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Damages done in the process of treatment
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Sublimation
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Redirecting your stress into a more constructive outlet; directs potentially maladaptive feelings or impulses into socially acceptable behavior
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GABA
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Inhibitory neurotransmitter involved in the process of anxiety reduction
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Lunacy trials
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Civil procedure/temporarily taking control of one's estate
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Object relations
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The study of how children incorporate the images, the memories, and sometimes the values of a person who was important to them and to whom they were (or are) emotionally attached
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Displacement
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For example - did bad on a test, take it out on significant other; the moving of something from its place or position
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Reaction formation
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For example - treat someone you don't like very nicely; the tendency of a repressed wish or feeling to be expressed at a conscious level in a contrasting form; substitutes behavior, thoughts, or feelings that are the direct opposite of unacceptable ones
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Hippocrates (cont'd)
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Father of Western medicine; root of disorders is brain pathology
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Pavlov
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Trained dogs to salivate at the sound of a bell - unconditioned/conditioned responses
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Norms (deviance/definition of abnormal)
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Explicit and implicit rules for proper conduct... behavior that breaks legal norms is considered to be criminal; behavior, thoughts, and emotions that break norms of psychological functioning are considered to be abnormal; in short, behavior, thoughts, and emo- tions are deemed abnormal when they differ markedly from a society's ideas about proper functioning
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Dysfunction(al) (definition of abnormal)
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Interference with daily functioning; upsets, distracts, or confuses people that they cannot care for themselves properly, participate in ordinary social interactions, or work productively
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Danger(ous) (definition of abnormal)
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Individuals whose behavior is consistently careless, hostile, or confused may be placing themselves or those around them at risk; despite popular misconceptions, most people struggling with anxiety, depression, and even bizarre thinking pose no immediate danger to themselves or to anyone else
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Thomas Szasz's theory
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The whole concept of mental illness is invalid, a myth of sorts; according to Szasz, the deviations that society calls abnormal are simply "problems in living," not signs of something wrong within the person... societies, he is convinced, invent the concept of mental illness so that they can better control or change people whose unusual patterns of functioning upset or threaten the social order
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Etiology
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The cause, set of causes, or manner of causation of a disease or condition; the study of origins/why a disorder begins
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Incidence
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The occurrence, rate, or frequency of a disease, crime, or something else undesirable; how many new cases occur during a given period, such as a year
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Prevalence
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The fact or condition of being prevalent; commonness; how many people in a population, as a whole, have the disorder
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Trephination (early societies)
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A stone instrument, or trephine, was used to cut away a circular section of the skull (Europe/South America)
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Exorcism (early societies)
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The idea was to coax the evil spirits to leave or to make the person's body an uncomfortable place in which to live; a shaman, or priest, might recite prayers, plead with the evil spirits, insult the spirits, perform magic, make loud noises, or have the person drink bitter potions... if these techniques failed, the shaman performed a more extreme form of exorcism, such as whipping or starving the person
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More on Hippocrates
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Often called the father of modern medicine, taught that illnesses had natural causes; he saw abnormal behavior as a disease arising from internal physical problems... specifically, he believed that some form of brain pathology was the culprit and that it resulted-like all other forms of disease, in his view, from an imbalance of four fluids, or humors, that flowed through the body: yellow bile, black bile, blood, and phlegm; an excess of yellow bile, for example, caused mania, a state of frenzied activity... an excess of black bile was the source of melancholia, a condition marked by unshakable sadness; sought to correct the underlying physical pathology... he believed, for instance, that the excess of black bile underlying melancholia could be reduced by a quiet life, a diet of vegetables, temperance, exercise, celibacy, and even bleeding
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Mid 16th century/Renaissance and the rise of asylums
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Government officials discovered that private homes and community residences could house only a small percentage of those with severe mental disorders and that medical hospitals were too few and too small; more and more, they converted hospitals and monasteries into asylums, institutions whose primary purpose was to care for people with mental illness... these institutions began with every intention of providing good care; once the asylums started to overflow, however, they became virtual prisons where patients were held in filthy conditions and treated with unspeakable cruelty
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The spread of moral treatment
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Approaching 1800 - emphasized moral guidance and humane and respectful techniques, caught on throughout Europe and the United States; patients with psychological problems were increasingly perceived as potentially productive human beings whose mental functioning had broken down under stress... they were considered deserving of individual care, including discussions of their problems, useful activities, work, companionship, and quiet (Rush, in the US)
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Dorothea Dix
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Made humane care a public and political concern in the United States; in 1841 Dix had gone to teach Sunday school at a local prison and been shocked by the conditions she saw there... before long, her interest in prison conditions broadened to include the plight of poor and mentally ill people throughout the country; from 1841 to 1881, Dix went from state legislature to state legislature and to Congress speaking of the horrors she had observed at asylums and calling for reform... Dix's campaign led to new laws and greater government funding to improve the treatment ofpeople with mental disorders; each state was made responsible for developing effective public mental hospitals... Dix personally helped establish 32 of these state hospitals, all intended to offer moral treatment; similar hospitals were established throughout Europe
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The decline of moral treatment
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Around 1850 - one factor was the speed with which the movement had spread; as mental hospitals multiplied, severe money and staffing shortages developed, recovery rates declined, and overcrowding in the hospitals became a major problem... another factor was the assumption behind moral treatment that all patients could be cured if treated with humanity and dignity; for some, this was indeed sufficient... others, however, needed more effective treatments than any that had yet been developed; an additional factor contributing to the decline of moral treatment was the emergence of a new wave of prejudice against people with mental disorders... as more and more patients disappeared into large, distant mental hospitals, the public came to view them as strange and dangerous; in turn, people were less open-handed when it came to making donations or allocating government funds... moreover, many of the patients entering public mental hospitals in the United States in the late nineteenth century were poor foreign immigrants, whom the public had little interest in helping
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By the early years of the 20th century (the decline of moral treatment)
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The moral treatment movement had ground to a halt in both the United States and Europe; public mental hospitals were providing only custodial care and ineffective medical treatments and were becoming more overcrowded every year... long-term hospitalization became the rule once again
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The early 20th century (cont'd; somatogenic and psychogenic)
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As the moral movement was declining in the late 1800s, two opposing perspectives emerged and began to vie for the attention of clinicians: the somatogenic perspective, the view that abnormal psychological functioning has physical causes, and the psychogenic perspective, the view that the chief causes of abnormal functioning are psychological; these perspectives came into full bloom during the twentieth century
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Two factors responsible for the rebirth of the somatogenic theory
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One was the work of an eminent German researcher, Emil Kraepelin (1856-1926); in 1883 Kraepelin published an influential textbook arguing that physical factors, such as fatigue, are responsible for mental dysfunction... in addition, he also constructed the first modern system for classifying abnormal behavior; he identified various syndromes, or clusters of symptoms, listed their physical causes, and discussed their expected course... new biological discoveries also triggered the rise of the somatogenic perspective; one of the most important discoveries was that an organic disease, syphilis, led to general paresis, an irreversible disorder with both physical and mental symptoms, including paralysis and delusions of grandeur
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The downside of the somatogenic theory
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Despite the general optimism, biological approaches yielded mostly disappointing results throughout the first half of the twentieth century; although many medical treatments were developed for patients in mental hospitals during that time, most of the techniques failed to work... physicians tried tooth extraction, tonsillectomy, hydrotherapy (alternating hot and cold baths), and lobotomy, a surgical cutting of certain nerve fibers in the brain; even worse, biological views and claims led, in some circles, to proposals for immoral solutions such as eugenic sterilization, the elimination (through medical or other means) of individuals' ability to reproduce... not until the 1950s, when a number of effective medications were finally discovered, did the somatogenic perspective truly begin to payoff for patients
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The psychogenic perspective (history)
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The Roman statesman and orator Cicero (106-43 D.C.) held that psychological disturbances could cause bodily ailments, and the Greek physician Galen (c. 129-c. 200) believed that many mental disorders are caused by fear, disappointment in love, and other psychological events; however, the psychogenic perspective did not gain much of a following until studies of hypnotism demonstrated its potential
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The somatogenic perspective (history)
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The somatogenic perspective has at least a 2,400- year history - remember Hippocrates' view that abnormal behavior resulted from brain disease and an imbalance of humors?; not until the late nineteenth century, however, did this perspective make a triumphant return and begin to gain wide acceptance
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Hypnotism (psychogenic perspective)
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A procedure that places people in a trancelike mental state during which they become extremely suggestible; it was used to help treat psychological disorders as far back as 1778, when an Austrian physician named Friedrich Anton Mesmer (1734-1815) established a clinic in Paris... his patients suffered from hysterical disorders, mysterious bodily ailments that had no apparent physical basis; Mesmer had his patients sit in a darkened room filled with music... then he appeared, dressed in a colorful costume, and touched the troubled area of each patient's body with a special rod; a surprising number of patients seemed to be helped by this treatment, called mesmerism... their pain, numbness, or paralysis disappeared; several scientists believed that Mesmer was inducing a trancelike state in his patients and that this state was causing their symptoms to disappear... the treatment was so controversial, however, that eventually Mesmer was banished from Paris
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Josef Breuer (effects of hypnotism on hysterical disorders)
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This physician discovered that his patients sometimes awoke free of hysterical symptoms after speaking candidly under hypnosis about past upsetting events; during the 1890s Breuer was joined in his work by another Viennese physician, Sigmund Freud (1856-1939)... Freud's work eventually led him to develop the theory of psychoanalysis, which holds that many forms of abnormal and normal psychological functioning are psychogenic; in particular, he believed that unconscious psychological processes are at the root of such functioning
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Freud/psychoanalysis
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A form of discussion in which clinicians help troubled people gain insight into their unconscious psychological processes; he believed that such insight, even without hypnotic procedures, would help the patients overcome their psychological problems... Freud and his followers applied the psychoanalytic treatment approach primarily to patients suffering from anxiety or depression, problems that did not typically require hospitalization; these patients visited therapists in their offices for sessions of approximately an hour and then went about their daily activities - a format of treatment now known as outpatient therapy... by the early twentieth century, psychoanalytic theory and treatment were widely accepted throughout the Western world; the psychoanalytic approach had little effect on the treatment of severely disturbed patients in mental hospitals, however... this type of therapy requires levels of clarity, insight, and verbal skill beyond the capabilities of most such patients; moreover, psychoanalysis often takes years to be effective, and the overcrowded and understaffed public mental hospitals could not accommodate such a leisurely pace
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Psychotropic medications (1950s)
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Drugs that primarily affect the brain and alleviate many symptoms of mental dysfunctioning; they included the first antipsychotic drugs which correct extremely confused and distorted thinking, antidepressant drugs, which lift the mood of depressed people, and anti-anxiety drugs, which reduce tension and worry... when given these drugs, many patients who had spent years in mental hospitals began to show signs of improvement; hospital administrators, encouraged by these results and pressured by a growing public outcry over the terrible conditions in public mental hospitals, began to discharge patients almost immediately
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Deinstitutionalization (1950s)
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Releasing hundreds of thousands of patients from public mental hospitals; on any given day in 1955, close to 600,000 people were confined in public mental institutions across the United States... today the daily patient population in the same kinds of hospitals is around 60,000
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Where we're at today (in terms of institutionalization/deinstitutionalization)
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Outpatient care has now become the primary mode oftreatment for people with severe psychological disturbances as well as for those with more moderate problems; today when severely impaired people do need institutionalization, they are usually given short-term hospitalization... ideally, they are then given outpatient psychotherapy and medication in community programs and residences
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Where we're at today (cont'd)
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Emphasis on community care for people with severe psychological disturbances - a philosophy called the community mental health approach; the approach has been helpful for many patients, but too few community programs are available to address current needs in the United States... as a result, hundreds of thousands of persons with severe disturbances fail to make lasting recoveries, and they shuttle back and forth between the mental hospital and the community; only 40 percent of persons with severe psychological disturbances currently receive treatment of any kind... at least 100,000 individuals with such disturbances are homeless on any given day; another 135,000 or more are inmates of jails and prisons; their abandonment is truly a national disgrace
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Private psychotherapy (before the 1950s) and where we're at today (cont'd, cont'd)
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An arrangement by which an individual directly pays a psychotherapist for counseling services; this tended to be an expensive form of treatment, available only to the wealthy... since the 1950s, however, most health insurance plans have expanded coverage to include private psychotherapy, so that it is now also widely available to people with more modest incomes; in addition, outpatient therapy is now offered in a number of less expensive settings, such as community mental health centers, crisis interven- tion centers, family service centers, and other social service agencies... the new settings have spurred a dramatic increase in the number of persons seeking outpatient care for psychological problems; nationwide surveys suggest that nearly one of every five adults in the United States receives treatment for psychological disorders in the course of a year
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Prevention (today)
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Rather than wait for psychological disorders to occur, many of today's community programs try to correct the social conditions that underlie psychological problems (poverty or violence in the community, for example) and to identify and help individuals who are at risk for developing emotional problems (for example, teenage mothers or the children of people with severe psychological disorders)
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Positive psychology
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The study and enhancement of positive feelings such as optimism and happiness; positive traits like perseverance and wisdom, positive abilities such as interpersonal skill and other talents, and group-directed virtues, including altruism and tolerance; teaching people coping skills that may help protect them from stress and adversity and encouraging them to become more involved in personally meaningful activities and relationships... in this way, the clinicians are trying to promote mental health and prevent mental disorders
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Multicultural psychology
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Seeks to understand how culture, race, ethnicity, gender, and similar factors affect behavior and thought and how people of different cultures, races, and genders may differ psychologically
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Treatment/therapy
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Therapy is a systematic process for helping people overcome their psychological difficulties; it typically requires a patient, a therapist, and a series of therapeutic contacts
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Passage of time
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Prehistoric (evil spirits/demonology) -> Greeks and Romans (Hippocrates/bodily fluids) -> The Middle Ages (a return to demonology) -> Renaissance (care for people with disorders... until the 16th century/warehousing) -> 19th century (improvement... until the late 19th century/return to warehousing) -> early 20th century (somatogenic perspective/psychogenic perspective), etc.
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Psychopathology
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A psychological dysfunction within an individual associated with distress or impairment in functioning and a response that is not typical or culturally expected
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Phobia
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A psychological disorder characterized by marked and persistent fear of an object or situation
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John P. Grey
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The champion of the biological condition; causes of insanity always physical; conditions of hospitals greatly improved
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Projection
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Falsely attributes own unac- ceptable feelings, impulses, or thoughts to another individual or object
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Repression
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Blocks disturbing wishes, thoughts, or experiences from con- scious awareness
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Pinel, Poussin, and Tuke
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Founders of moral therapy
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Systematic desensitization
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Individuals were gradually introduced to the objects or situations they feared so that their fear could extinguish; that is, they could test reality and see that nothing bad happened in the pres- ence of the phobic object or scene.
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Shaping
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A process of reinforcing successive approximations to a final behavior or set of behaviors
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Psychological disorder
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(1) a psychological dysfunction within an individual that is (2) associated with distress or impairment in functioning and (3) a response that is not typical or culturally expected. All three basic criteria must be met; no one criterion alone has yet been identified that defines the es- sence of abnormality
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One-dimensional model of psychopathology
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To say that psychopathology is caused by a physical abnormality or by conditioning; attempts to trace the origins of behavior to a single cause; might hold that schizophrenia or a phobia is caused by a chemical imbalance or by growing up surrounded by overwhelming conflicts among family members
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Multi-dimensional model of psychopathology
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Multiple influences; a system, or feedback loop, may have independent inputs at many different points, but as each input becomes part of the whole it can no longer be considered independent... this perspective on causality is systemic, which derives from the word system; it implies that any particular influence contributing to psychopathology cannot be considered out of context... context, in this case, is the biology and behavior of the individual, as well as the cognitive, emotional, social, and cultural environment, because any one component of the system inevitably affects the other components
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Developmental critical period
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We are more or less reactive to a given situation or influence than at other times
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Genes
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Long molecules of deoxyribonucleic acid (DNA) at various locations on chromosomes, within the cell nucleus... the first 22 pairs of chromosomes provide programs or directions for the development of the body and brain, and the last pair, called the sex chromosomes, determines an individual's sex; in females, both chromosomes in the 23rd pair are called X chromosomes... in males, the mother contributes an X chromosome but the father contributes a Y chromosome; this one difference is responsible for the variance in biological sex... abnormalities in the sex chromosomal pair can cause ambiguous sexual characteristics; a dominant gene is one of a pair of genes that strongly influences a particular trait, and we only need one of them to determine, for example, our eye or hair color... a recessive gene, by contrast, must be paired with another (recessive) gene to determine a trait
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Genes (cont'd)
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Although all cells contain our entire genetic structure, only a small proportion of the genes in any one cell are "turned on" or expressed; in this way, cells become specialized, with some influencing liver function and others affecting personality... what is interesting is that environmental factors, in the form of social and cultural influences, can determine whether genes are "turned on"; specific genes or small groups of genes may ultimately be found to be associated with certain psychological disorders, as suggested in several important studies described later... but as discussed earlier, much of the current evidence suggests that contributions to psychological disorders come from many genes, each having a relatively small effect
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Diathesis-stress model
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Individuals inherit tendencies to express certain traits or behaviors, which may then be activated under conditions of stress; each inherited tendency is a diathesis, which means, literally, a condition that makes someone susceptible to developing a disorder... when the right kind of life event, such as a certain type of stressor, comes along, the disorder develops; for example, according to the diathesis-stress model, Judy inherited a tendency to faint at the sight of blood... this tendency is the diathesis, or vulnerability; it would not become prominent until certain environmental events occurred
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Caspi et al.
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Investigators identified the genetic makeup of the individuals and, in particular, a gene that produces a substance called a chemical transporter that affects the transmission of serotonin in the brain; serotonin, one of the four neurotransmitters we will talk about later in the chapter, is particularly implicated in depression and related disorders... but the gene that they were studying comes in two common versions, or alleles: the long allele and the short allele; there was reason to believe, from prior work with animals, that individuals with at least two copies of the long allele (LL) were able to cope better with stress than individuals with two copies of the short allele (SS)... In people with the SS alleles, severe and stressful maltreatment during childhood more than doubled their risks of depression in adulthood compared to those individuals carrying the SS alleles who were not maltreated or abused (63% versus 30%); for individuals carrying the LL alleles, on the other hand, stressful childhood experiences did not affect the incidence of depression in adulthood... 30% of this group became depressed whether they had experienced stressful childhoods or not; therefore, unlike this SS group, depression in the LL allele group seems related to stress in their recent past rather than childhood experiences
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Caspi et al. (cont'd)
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Second study: different set of genes from those associated with depression seems to contribute to violent and antisocial behavior in adults; but again, this genetic predisposition occurs only if the individuals were maltreated as children... that is, some children who were maltreated turned out to be violent and antisocial as adults, but they were 4 times more likely to do their share of rape, robbery, and assault if they had a certain genetic makeup than were those who didn't have the genetic makeup
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Reciprocal gene-environment model
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Some evidence now indicates that genetic endowment may increase the probability that an individual will experience stressful life events; for example, people with a genetic vulnerability to develop a certain disorder, such as blood-injury-injection phobia, may also have a personality trait—let's say impulsiveness—that makes them more likely to be involved in minor accidents that would result in their seeing blood... in other words, they may be accident prone because they are continually rushing to complete things or to get to places without regard for their physical safety; these people, then, might have a genetically determined tendency to create the very environmental risk factors that trigger a genetic vulnerability to blood-injury-injection phobia
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Cross-fostering
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A rat pup born to one mother is assigned to another mother for rearing; if the mothers were calm and supportive, their rat pups were less fearful and better able to tolerate stress... but we don't know if this effect results from genetic influences or from being raised by calm mothers; Francis et al. (1999) took some newly born rat pups of fearful and easily stressed mothers and placed them for rearing with calm mothers... other young rats remained with their easily stressed mothers; with this interesting scientific twist, Francis et al. (1999) demonstrated that calm and supportive behavior by the mothers could be passed down through generations of rats independent of genetic influences, because rats born to easily stressed mothers but reared by calm mothers grew up more calm and supportive
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Cross-fostering (cont'd)
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The environmental effects of early parenting seem to override any genetic contribution to be anxious, emotional, or reactive to stress
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Epigenetics
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It seems that genes are turned on or off by cellular material that is located just outside of the genome and that stress, nutrition, or other factors can affect this epigenome, which is then immediately passed down to the next generation and maybe for several generations; the genome itself isn't changed, so if the stressful or inadequate environment disappears, eventually the epigenome will fade
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CNS
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Processes all information received from our sense organs and reacts as necessary; it sorts out what is relevant, such as a certain taste or a new sound, from what isn't, such as a familiar view or ticking clock... checks the memory banks to determine why the information is relevant; and implements the right reaction, whether it is to answer a simple question or to play a complex Mozart sonata... this is a lot of exceedingly complex work; the spinal cord is part of the central nervous system, but its primary function is to facilitate the sending of messages to and from the brain, which is the other major component of the central nervous system (CNS) and the most complex organ in the body
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Neurons
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Nerve cells which control every thought and action; transmit information throughout the nervous system... contains a central cell body with two kinds of branches; one kind of branch is called a dendrite... dendrites have numerous receptors that receive messages in the form of chemical impulses from other nerve cells, which are converted into electrical impulses; the other kind of branch, called an axon, transmits these impulses to other neurons... any one nerve cell may have multiple connections to other neurons
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Synaptic cleft
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The space between the axon of one neuron and the dendrite of another
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Brain stem
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The lower and more ancient part of the brain; found in most animals, this structure handles most of the essential automatic functions, such as breathing, sleeping, and moving around in a coordinated way... the forebrain is more advanced and evolved more recently
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Hindbrain (brain stem cont'd)
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The lowest part of the brain stem which contains the medulla, the pons, and the cerebellum; regulates many automatic activities, such as breathing, the pumping action of the heart (heartbeat), and digestion... the cerebellum controls motor coordination, and recent research suggests that abnormalities in the cerebellum may be associated with the psychological disorder autism, although the connection with motor coordination is not clear
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Midbrain (brain stem cont'd)
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Coordinates movement with sensory input and contains parts of the reticular activating system, which contributes to processes of arousal and tension, such as whether we are awake or asleep
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Top of the brain stem
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The thalamus and hypothalamus, which are involved broadly with regulating behavior and emotion; these structures function primarily as a relay between the forebrain and the remaining lower areas of the brain stem... some anatomists even consider the thalamus and hypothalamus to be parts of the forebrain
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Limbic system (forebrain)
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At the base, just above the thalamus and hypothalamus; limbic means border, so named because it is located around the edge of the center of the brain... the limbic system, which figures prominently in much of psychopathology, includes such structures as the hippocampus (sea horse), cingulate gyrus (girdle), septum (partition), and amygdala (almond), all of which are named for their approximate shapes; this system helps regulate our emotional experiences and expressions and, to some extent, our ability to learn and to control our impulses... it is also involved with the basic drives of sex, aggression, hunger, and thirst
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Basal ganglia (forebrain)
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At the base/including the caudate (tailed) nucleus; because damage to these structures may make us change our posture or twitch or shake, they are believed to control motor activity
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Cerebral cortex (forebrain)
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Largest part; contains more than 80% of all neurons in the central nervous system... this part of the brain provides us with our distinctly human qualities, allowing us to look to the future and plan, to reason, and to create; the cerebral cortex is divided into two hemispheres... although the hemispheres look alike structurally and operate relatively independently (both are capable of perceiving, thinking, and remembering), recent research indicates that each has different specialties; the left hemisphere seems to be chiefly responsible for verbal and other cognitive processes... the right hemisphere seems to be better at perceiving the world around us and creating images; the hemispheres may play differential roles in specific psychological disorders
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Hemispheres/lobes
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Each hemisphere consists of four separate areas, or lobes: temporal, parietal, occipital, and frontal... each is associated with different processes: the temporal lobe with recognizing various sights and sounds and with long-term memory storage; the parietal lobe with recognizing various sensations of touch and monitoring body positioning... the occipital lobe with integrating and making sense of various visual inputs; these three lobes, located toward the back (posterior) of the brain, work together to process sight, touch, hearing, and other signals from our senses
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Frontal lobe (most interesting)
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The most interesting from the point of view of psychopathology; the front (or anterior) of the frontal lobe is called the prefrontal cortex, and this is the area responsible for higher cognitive functions such as thinking and reasoning, planning for the future, as well as long-term memory... this area of the brain synthesizes all information received from other parts of the brain and decides how to respond; it is what enables us to relate to the world around us and the people in it, to behave as social animals... when studying areas of the brain for clues to psychopathology, most researchers focus on the frontal lobe of the cerebral cortex, as well as on the limbic system and the basal ganglia
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The peripheral nervous system
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Coordinates with the brain stem to make sure the body is working properly; its two major components are the somatic nervous system and the autonomic nervous system... the somatic nervous system controls the muscles, so damage in this area might make it difficult for us to engage in any voluntary movement, including talking; the autonomic nervous system includes the sympathetic nervous system and parasympathetic nervous system... the primary duties of the autonomic nervous system are to regulate the cardiovascular system (for example, the heart and blood vessels) and the endocrine system (for example, the pituitary, adrenal, thyroid, and gonadal glands) and to perform various other functions, including aiding digestion and regulating body temperature
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The endocrine system (hormones)
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The endocrine system works a bit differently from other systems in the body; each endocrine gland produces its own chemical messenger, called a hormone, and releases it directly into the bloodstream... the adrenal glands produce epinephrine (also called adrenaline) in response to stress, as well as salt-regulating hormones; the thyroid gland produces thyroxine, which facilitates energy metabolism and growth... the pituitary is a master gland that produces a variety of regulatory hormones; and the gonadal glands produce sex hormones such as estrogen and testosterone
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Sympathetic nervous system (cont'd)
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Primarily responsible for mobilizing the body during times of stress or danger by rapidly activating the organs and glands under its control; when the sympathetic division goes on alert, the heart beats faster, thereby increasing the flow of blood to the muscles... respiration increases, allowing more oxygen to get into the blood and brain; and the adrenal glands are stimulated... all these changes help mobilize us for action; when you read in the newspaper that a woman lifted a heavy object to free a trapped child, you can be sure her sympathetic nervous system was working overtime
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Parasympathetic nervous system (cont'd)
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Takes over after the sympathetic nervous system has been active for a while, normalizing our arousal and facilitating the storage of energy by helping the digestive process
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Agonists
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Increase the activity of a neurotransmitter by mimicking its effects
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Antagonists
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Decrease, or block, a neurotransmitter
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Inverse agonists
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Produce effects opposite to those produced by the neurotransmitter
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Monoamines
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Norepinephrine (also known as noradrenaline), serotonin, and dopamine
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Amino acids
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Gamma-aminobutyric acid (GABA, generalized an inhibiting neurotransmitter... not just anxiety, also anti-convulsant, etc.) and glutamate
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Glutamate
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Excitatory transmitter that "turns on" many different neurons, leading to action
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Benzodiazepines
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Minor tranquilizers, makes it easier for GABA molecules to attach themselves to the receptors of specialized neurons; thus, the higher the level of benzodiazepine, the more GABA becomes attached to neuron receptors and the calmer we become (to a point)... because benzodiazepines have certain addictive properties, clinical scientists are working to identify other substances that may also modulate levels of GABA; these include certain natural steroids in the brain
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Serotonin (cont'd)
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Regulates our behavior, moods, and thought processes; extremely low activity levels of serotonin are associated with less inhibition and with instability, impulsivity, and the tendency to overreact to situations... low serotonin activity has been associated with aggression, suicide, impulsive overeating, and excessive sexual behavior; however, these behaviors do not necessarily happen if serotonin activity is low... selective-serotonin re-uptake inhibitors (SSRIs), including fluoxetine (Prozac) affects serotonin more directly than other drugs, including the tricyclic antidepressants; SSRIs are used to treat a number of psychological disorders, particularly anxiety, mood, and eating disorders
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Norepinephrine
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Seems to stimulate at least two groups (and probably several more) of receptors called alpha-adrenergic and beta-adrenergic receptors; someone in your family may be taking a widely used class of drugs called beta-blockers, particularly if that person has hypertension or difficulties with regulating heart rate... as the name indicates, these drugs block the beta-receptors so that their response to a surge of norepinephrine is reduced, which keeps blood pressure and heart rate down; in the central nervous system, a number of norepinephrine circuits have been identified
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Dopamine (cont'd)
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Major neurotransmitter in the monoamine class also termed a catecholamine because of the similarity of its chemical structure to epinephrine and norepinephrine; dopamine has been implicated in the pathophysiology of schizophrenia... new research also indicates it may play a significant role in depression; this drug and more modern antipsychotic treatments affect a number of neurotransmitter systems, but their greatest impact may be that they block specific dopamine receptors, thus lowering dopamine activity... thus, it was long thought possible that in schizophrenia dopamine circuits may be too active; Parkinson's disease
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Prepared learning
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We have become highly prepared for learning about certain types of objects or situations over the course of evolution because this knowledge contributes to the survival of the species
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(Implicit) memory
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Apparent when someone clearly acts on the basis of things that have happened in the past but can't remember the event (a good memory for events is called explicit memory); but implicit memory can be selective for only certain events or circumstances
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Emotion; mood; affect
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Short-lived, temporary states lasting from several minutes to several hours, occurring in response to an external event; persistent period of affect or emotionality; the momentary emotional tone that accompanies what we say or do
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Equifinality
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We must consider a number of paths to a given outcome
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The genetic contributions to psychopathology
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The genetic influence on much of our development and most of our behavior, personality, and even IQ score is polygenic - that is, influenced by many genes; this is assumed to be the case in abnormal behavior as well, although research is beginning to identify specific small groups of genes that relate to some major psychological disorders
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The genetic contributions to psychopathology (cont'd)
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In studying causal relationships in psychopathology, researchers look at the interactions of genetic and environmental effects; in the diathesis-stress model, individuals are assumed to inherit certain vulnerabilities that make them susceptible to a disorder when the right kind of stressor comes along... in the reciprocal gene-environment, or gene-environment correlation model, the individual's genetic vulnerability toward a certain disorder may make it more likely that the person will experience the stressor that, in turn, triggers the genetic vulnerability and thus the disorder; in epigenetics, the immediate effects of the environment (such as early stressful experiences) influence cells that turn certain genes on or off. This effect may be passed down through several generations
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