Psychology 2

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Mental Disorder
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“Any clinically significant syndrome reflecting a dysfunction in psychological, biological, or developmental processes, usually involving a disturbance in cognition, emotion regulation, or behavior that leads to significant personal distress and/or disability in social, occupational, or other important activities”
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Significant personal distress
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Internal emotions or experiences that are upsetting to the person. These emotions or experiences DO NOT have to be observable by other people.
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Impairment
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The state of being diminished, weakened or damaged, especially mentally or physically.
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Symptom
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any objective or subjective evidence of disease
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Factors that determine “normalcy”
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Culture, Group Tendencies
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Cultural Relativity
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Notion that cultural beliefs/attitudes/norms determine what is normal/abnormal. There is no one, universal definition of abnormality, only culturally-determined definitions.
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Diagnostic & Statistical Manual of Mental Disorders
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The “universal authority” for psychiatric diagnoses. Lists the diagnostic criteria for all mental disorders
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Anxiety Disorders
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Excessive fear that impairs function
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3 types of Anxiety Disorders
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Phobias, Generalized Anxiety Disorder, Panic Disorder
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Phobia Symptoms
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-Fear or anxiety of a specific object or situation lasting at least 6 months; -the object or situation almost always provokes anxiety symptoms; -out of proportion to the actual danger posed by the object or situation -the feared object or situation is actively avoided or endured with intense symptoms to the extent that functioning is impaired.
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Anxiety Symptoms
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Physiological symptoms: –Rapid/irregular heartbeat –Dry mouth Emotional/psychological symptoms: –Sense of worry, concern, or apprehension –Inability to concentrate Behavioral symptoms: –Disorganized speech –Motor incoordination
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Phobia Categories
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Animals Natural environment Blood-injection-injury Situational Other
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Cause of Phobias
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Observational learning (or modeling) Two-factor theory
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Two-factor Theory
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symptoms result from a combination of classical conditioning and operant conditioning
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Classical Conditioning
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learning through pairing a Neutral Stimulus with an Unconditioned Stimulus
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Operant Conditioning
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Learning through consequences
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Prevalence of Phobias
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Up to 15% of the population
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Treatment of Phobias
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Psychotherapy –Cognitive-behavioral therapy alone or in combination with exposure or systematic desensitization Psychopharmacology -Anti-anxiety medications —Benzodiazepines —Non-benzodiazepines -Selective Serotonin Reuptake Inhibitors (SSRIs)
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Anti-anxiety Medications
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Benzodiazepines -Mechanism GABA agonists Non-benzodiazepines -Mechanism- unclear
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Symptoms of GAD
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-Excessive worry more days than not for at least six months -difficult for the individual to control -three or more of the following symptoms: restlessness; fatigue; irritability; difficulty concentrating; muscle tension; sleep disturbance -significant distress or impairment -The symptoms of GAD are not situation or object specific.
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Cause of GAD
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Combination of: –biological (genes) –psychological (irrational thinking patterns) –sociocultural (stressful life experiences)
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Prevalence of GAD
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4-7% of population
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Treatment of GAD
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Psychotherapy –Cognitive-behavioral therapy to challenge cognitive distortions and teach coping behaviors Psychopharmacology –Anti-anxiety medications –SSRIs
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Panic Disorder Symptoms
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-Recurrent unexpected panic attacks followed by at least one month of: –Persistent worry about having additional attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”) –Significant maladaptive changes in behavior because of the attacks
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Panic Attack Symptoms
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-A period of intense fear in which 4 of the following symptoms rapidly develop: –Rapid Heart Rate –Sweating –Shaking –Shortness of Breath –Chest pain –Nausea –Chills –Feeling Faint/Dizzy –Fear of Death –Fear of Losing Control
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Cause of Panic Disorder
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Triple Vulnerabilities Model 1.Biological predisposition to anxiety (genes) 2.External locus of control 3.Hypersensitivity to signs of physical arousal -Though irrational, catastrophic thinking has also been linked to symptoms of panic disorder
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Prevalence of Panic Disorder
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2-3% of population
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Treatment of Panic Disorder
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Psychotherapy: -Cognitive-behavioral therapy about panic attacks and exposure therapy 1. Identifying irrational thoughts about the likelihood of experiencing additional panic attacks 2. Challenging those irrational thoughts 3. Replacing those irrational thoughts
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Anxiety Disorders Prevalence between sexes
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Diagnosed twice as often in women than men
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Obsessions
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Recurrent and persistent thoughts, urges, or images that are intrusive and unwanted
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Compulsions
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Repetitive behaviors or mental acts that an individual feels driven to perform
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Symptoms of OCD
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Obsessions, compulsions, or both –If obsessions are involved, the person must try to ignore or suppress the obsessions –If compulsions are involved, the thoughts or behaviors must be intended to prevent or reduce anxiety or distress Symptoms must cause: –Significant personal distress –Impairment in functioning
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Cause of OCD
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Largely unknown, theorized to be combo of biological predispositions, cognitive factors, and learning
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Prevalence of OCD
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-1-2% of pop -50% of cases considered “severe”
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Treatment for OCD
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Psychotherapy: -Cognitive behavioral therapy to recognize and challenge intrusive thoughts and exposure with response prevention -ERP Psychopharmacology: -Antidepressants
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Antidepressants
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–First Generation antidepressants —-MAOIs —-Tricyclic Antidepressants –Mechanism: Norepinephrine and Serotonin Agonists -Second Generation antidepressants –Mechanism: Dopamine-Norepinephrine Antagonists -SSRIs -Dual-Action Antidepressants
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Mood
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Sustained emotional state Ranges from: -Severe Mania -Hypomania -Balanced Mood -Mild to Moderate Depression -Severe Depression
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3 Types of Mood Episodes
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1. Depressive Episodes 2. Manic Episodes 3. Hypomanic Episodes
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Depressive Episodes
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Characterized by presence of at least 5 symptoms for at least 2 weeks that cause significant distress or impairment of functioning. Symptoms: -Depressed mood most of the day -Diminished interest/pleasure in activities -Significant weight loss/gain or change in appetite -Insomnia or Hypersomnia -Psychomotor agitation or retardation -Fatigue or loss of energy -Feelings of worthlessness, excessive guilt -Diminished concentration, indecisiveness -Recurrent suicidal thoughts or attempt/ plan
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Manic Episodes
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Characterized by: -At least 1 week of abnormally/persistently elevated, expansive, or irritable mood and abnormally increased goal-directed activity -At least 3 symptoms that are unusual for person -Impairment in social/occupational functioning -Hospitalization to prevent harm to self/others Symptoms: –Inflated self-esteem or grandiosity — Decreased need for sleep –More talkative than usual –Flight of ideas or racing thoughts –Distractibility –Increase in goal-directed activity –Excessive involvement in potentially painful activities
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Hypomanic Episodes
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Characterized by: -At least 4 days of abnormally elevated mood and increased activity or energy -At least 3 symptoms that are observable and signal change from usual behavior —Same symptoms as manic episode but to lesser degree -Symptoms not severe enough to cause marked impairment in social or occupational functioning
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Symptoms of Major Depressive Disorder
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At least one depressive episode Never had any manic or hypomanic episodes
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Prevalence of Major Depressive Disorder
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7% of population Females are 3 times more likely to be diagnosed than men
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Treatment of Major Depressive Disorder
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Psychotherapy -Cognitive-behavioral therapy to address cognitive triad of negative thoughts Psychopharmacology -Antidepressants
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Symptoms of Bipolar I Disorder
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At least one manic episode
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Prevalence of Bipolar I Disorder
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~0.6% of population
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Symptoms of Bipolar II Disorder
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-At least one hypomanic episode AND at least one major depressive episode -NEVER had a manic episode -Symptoms of depression of unpredictability of frequent alternation between depression and hypomania causes clinically significant distress
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Prevalence of Bipolar II Disorder
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~0.8% of population
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Treatment for Bipolar I and Bipolar II
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Psychotherapy -*primarily for support/ to promote medication compliance Psychopharmacology -Mood Stabilizers (i.e. Lithium) –Mechanism: Glutamate stabilizer (keeps glutamate within normal range)
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Causes of Mood Disorders
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Biological (important in all types) -Genetics -Neurotransmitters: –> Depressive: not enough serotonin & norepinephrine –> Hypomanic/Manic: too much serotonin & norepinephrine Psychosocial (Depressive Only) -Diathesis Stress model -Cognitive Triad
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Diathesis Stress Model
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Genetic Predisposition and Trauma contribute to vulnerability and likelihood for mental disorders –Lots of stressful life exp.= higher likelihood –Few stressful life experiences= lower likelihood
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Cognitive Triad
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Beck hypothesized that depressive symptoms are caused by how people think about: 1. Themselves (focus on personal defects) 2. Their situations (focus on helplessness) 3. The future (focus on unchanging conditions)
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Eating Disorder characterizations
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-Issues with eating/ eating-related behaviors… -Leading to alterations in consumption/absorption of food… -That significantly impairs health or functioning
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Anorexia Nervosa Symptoms
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-Persistent caloric restriction —has to result in “significantly low weight” that’s at least 15% below avg. for their age/sex/height, BMI below 17.5 -Intense fear of gaining weight/becoming fat —fears not relieved by weight loss -Disturbance in self-perceived weight or shape
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Prevalence of Anorexia Nervosa
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-0.4% of U.S. population is diagnosed -Highest rates among adolescents -90-95% of cases are female
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Treatment of Anorexia Nervosa
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-Hospitalization -Psychotherapy —Cognitive-behavioral therapy to question cultural beauty standards and to develop more accurate self-perceptions
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Symptoms of Bulimia Nervosa
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-Self-eval particularly based on weight/shape -Recurrent episodes of binge eating —at least once a week for 3 months -Behaviors intended to prevent weight gain —at least once a week for 3 months —Purging behaviors: vomiting, laxatives, enemas —Fasting, excessive exercise -Behaviors done in private, accompanying shame
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Prevalence of Bulimia Nervosa
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1-1.5% of U.S. population is diagnosed -highest rates among adolescents -90-95% of cases are female
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Treatment of Bulimia Nervosa
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Psychotherapy –Cognitive-behavioral therapy Psychopharmacology –Antidepressants (primarily to treat co-occuring depression)
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Causes of Eating Disorders
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Biological -Lower levels of serotonin Sociocultural -Hypercritical family -Modeling -Cultural norms Psychological -Negative self-beliefs -Perfectionism
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Personality Disorders
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Enduring patterns of inner experience/behavior that affect at least 2 of a person’s: –Thoughts –Emotions –Interpersonal functioning –Impulse control In general, these patterns are: –inflexible, long-standing, lead to significant distress or impairment in functioning
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Cluster A Personality Disorders
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Odd or Eccentric Behavior Paranoid Personality Disorder
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Symptoms of Paranoid Personality Disorder
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-General distrust/suspiciousness of others -Begins by early adulthood, present in a variety of contexts -4 or more symptoms: –Suspecting others are exploiting/deceiving –Preoccupied with unsubstantiated doubts about loyalty –Hesitant to confide in others –Reading hidden demeaning meanings into benign remarks –Persistently bearing a grudge –Perceiving attacks on character –Recurrent suspicions regarding spouse’s fidelity
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Prevalence of Paranoid Personality Disorder
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~2% of U.S. population
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Cluster B Personality Disorders
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Dramatic, Emotional or Erratic Behavior Borderline Personality Disorder
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Symptoms of Borderline Personality Disorder
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-Pattern of instability in interpersonal relationships, self-image, emotions, impulsivity -Begins by early adulthood, presents in a variety of contexts -5 or more symptoms: –Frantic efforts to avoid abandonment –Unstable and intense interpersonal relationships marked by alternating between idealization and devaluation –Impulsivity in at least two areas that are potentially self-damaging –Recurrent suicidal thoughts or behaviors –Emotional instability due to mood reactivity –Chronic feelings of emptiness –Inappropriate anger
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Prevalence of Borderline Personality Disorder
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~2-3% of U.S. population
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Cluster C Personality Disorders
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Anxious or Fearful Behavior Dependent Personality Disorder
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Symptoms of Dependent Personality Disorder
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-Continual, excessive need to be taken care of that leads to submissive/clinging behaviors, fears of separations -Begins by early adulthood, presents in a variety of contexts Symptoms: –Difficulty making everyday decisions without reassurance –Needing others to assume responsibility for major areas of life –Difficulty expressing disagreement because of fear of loss of approval –Difficulty initiating projects because of lack of self-confidence –Going to excessive lengths to obtain support from others –Feeling uncomfortable or helpless when alone –Urgently seeking another relationship when a relationship ends –Being preoccupied with fears of having to take care of self
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Prevalence of Dependent Personality Disorder
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~0.5% of U.S. population
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Causes of Personality Disorders
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Combination of: -Biological Factors –Genetics -Sociocultural Factors –Cultural background –Chaotic Home Environment –Abuse
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Treatment of Personality Disorders
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-Quite difficult to treat because of pervasiveness of symptoms and variability in presentations -Treatment typically guided by symptoms of client -Dialectical Behavior Therapy
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Dialectical Behavior Therapy
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Specific type of cognitive-behavioral therapy developed in late 1980s by Marsha Linehan –4 types of treatment: individual therapy, group therapy, phone coaching, therapist consultation –4 goals of treatment: -Mindfulness -Distress Tolerance -Interpersonal Effectiveness -Emotion regulation
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Psychosis
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“loss of contact with reality” meaning that people have issues perceiving whether or not things are real
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Symptoms of Schizophrenia
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-Continuous signs of disturbance for at least 6 months, during which time there is at least 1 month where 2 or more symptoms are present. At least one of these must be (1), (2) or (3): 1. Delusions 2. Hallucinations 3. Disorganized Speech 4. Grossly Disorganized or Catatonic Behavior 5. Negative symptoms
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Delusions
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“Fixed beliefs that are not amendable to change in light of conflicting evidence” -Persecutory Delusions -Erotomanic Delusions -Grandiose Delusions -Somatic Delusions
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Persecutory Delusions
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False belief that you are going to be harmed
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Erotomanic Delusions
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False belief that another person is in love with you
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Grandiose Delusions
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False belief that you have exceptional wealth, fame, abilities, etc.
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Somatic Delusions
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False belief that there is something wrong with your health
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Hallucinations
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“An experience involving the apparent perception of something not present” -Auditory (most common) -Visual -Olfactory -Somatic -Tactile
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Disorganized Speech
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-“Word Salad” -Clanging -Neologisms
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“Word Salad”
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Mixing seemingly random words and phrases into confused or unintelligible mixture
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Clanging
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Mode of speech characterized by association of words based upon sound rather than concepts
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Neologisms
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Speaking in made up words
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Grossly Disorganized or Catatonic Behavior
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-Maintaining a rigid or bizarre posture -Lack of verbal responses -Lack of motor responses -Purposeless and excessive motor activity -Stereotyped movements
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Negative Symptoms
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-Reductions in typical behaviors -Diminished emotional expressions —Reduced facial expressions and gestures —Reduced eye contact —Monotonous voice -Avolition —Alogia —Anhedonia —Asociality
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Avolition
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Decreased motivation to initiate and perform purposeful activities -Alogia- diminished speech output -Anhedonia- decreased pleasure in activities -Asociality- Lack of interest in social interactions
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Cause of Schizophrenia
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No Clear cause, best guess combo of: Biological Factors -Genetics –> supported through twin studies, 50% chance in identical twins vs. 14% in fraternal twins -Brain Structure –> enlarged ventricles consistently found in brain imaging scans -Neurochemistry –> higher levels of dopamine Sociocultural factors -Growing up in severely dysfunctional family environment -Chronic or prolonged poverty -Traumatic experiences -Diathesis Stress model
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Prevalence of Schizophrenia
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Diagnosed in ~1% of U.S. population Comparable rates in men/women (though men are diagnosed slightly more often)
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Course of Schizophrenia
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“Late onset” mental disorder -For men, symptoms begin in late teens/early 20s -For women, symptoms begin in mid 20s/early 30s
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Treatment of Schizophrenia
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Psychotherapy -Individual Therapy -Group Therapy -Family Therapy Psychopharmacology -Typical antipsychotics -Atypical Antipsychotics
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Typical Antipsychotics
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-Mechanism: Dopamine antagonist -Helpful in treating positive symptoms, lots of negative side effects including potentially tardive dyskinesia
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Tardive Dyskinesia
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A difficult to treat, incurable disorder resulting in involuntary, repetitive body movements
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Atypical Antipsychotics
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-Mechanism: function by blocking a broader range of neurotransmitter receptors -Comparatively helpful in treating positive symptoms, much lower chance of causing tardive dyskinesia
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Psychotherapy
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-Treatment of mental health problems by talking with a psychiatrist, psychologist, or mental health provider -Purpose is to help clients learn about their moods, thoughts, and behaviors so they can respond in more empowered/effective manner
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Types of Psychotherapy
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Individual Psychotherapy –one-on-one therapy Group Psychotherapy –One or two therapists and many clients Family Psychotherapy –subtype of group therapy; one or two therapists and several family members as clients
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Types of Theoretical Approaches
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Psychodynamic Approach Humanistic Approach Behavioral Approach Cognitive Approach
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Psychodynamic Approach
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-Symptoms are caused by material trapped in unconscious -Treatment aims to bring unconscious material into consciousness without arousing defense mechanisms —Free Association —Dream Interpretation —Transference -Therapists are curious, interpretive, inquisitive
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Humanistic Approach
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-Symptoms are caused by incongruence -Treatment aims to create an environment where unconditional positive regard can be experienced —Genuineness —Unconditional Positive Regard —Empathic Understanding -Therapists are non-judgemental, empathetic, genuine
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Behavioral Approach
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-Symptoms are learned -Treatment aims to help people unlearn maladaptive behaviors and replace them with adaptive behaviors —Applied Behavioral Analysis —Exposure Therapy —Systematic Desensitization -Therapists are directive, prescriptive, supportive
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Exposure Therapy
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-Literally “exposing” someone to a stimulus -Theory being that by exposing someone to the anxiety-producing stimulus, they will learn that the stimulus is not the cause of the feelings -Two-factor theory
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Systematic Desensitization
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-Identification of an anxiety inducing stimulus hierarchy -Learning relaxation or coping techniques -Exposure to anxiety-inducing stimulus hierarchy
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Cognitive Approach
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-Symptoms are caused by distorted thoughts -Treatment aims to help people identify, challenge, and replace distorted thoughts -Therapists are directive, instructive, supportive
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Distorted or Irrational Thoughts
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-Thoughts that are not based on evidence -Mental Filler–> focusing on negative aspects of a situation and ignoring the positives -Jumping to Conclusions–> Presuming we know reason why something occurred w/o evidence -Overgeneralization–> drawing a general conclusion based on a single incident -Catastrophizing–> Expecting the worst possible outcome -Personalization–> Relating external events to yourself -Dichotomous Thinking–> Thinking that does not allow for middle ground
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Common Factors Perspective
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-It is not the “specific ingredients” that make psychotherapy effective but rather “common factors” that cut across all types of treatment -Therapeutic Relationship –Most important predictor of outcomes -Therapist Characteristics –More effective if therapists are: warm, sensitive, responsive, competent, culturally aware -Client Characteristics –More likely to be effective if clients are: motivated to change, committed to and actively involved in treatment, hopeful that psychotherapy can alleviate their symptoms
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Psychopharmacology
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-Use of medications in treating mental disorders -Based on premise that mental disorders are (at least partially) caused by neurochemistry -Treatment involves the prescription of psychotropic medication in order to affect neurotransmitters in the brain
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Agonists
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-Stimulate or activate neurotransmitter release -Increase the amount of neurotransmitter in the synapse
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Antagonists
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-Prevent or reduce neurotransmitter release -Decrease the amount of neurotransmitter in the synapse
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Problems with Medication Compliance
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-Sometimes people can’t access medication (due to cost, etc.) -Sometimes the symptoms of the disorder are desirable -Sometimes the side effects of medication are undesirable

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