Abnormal final study guide PDF

Preview

Summary

Baker...

Description

Psychology 3082: Abnormal Psychology Bryan J. Gros, Ph.D. Final Exam study guide

By all means be prepared to answer questions based on small case examples.

Disorders seen first in childhood: ADHD: 

Symptoms and Criteria: o This is the most frequently occurring and diagnosed disorder. o There are 3 clusters of symptoms:  Inattention (lack of concentration, easily distracted, excessive daydreaming, disorganization, frequently loses items, things appear to go in one ear and out the other, needing repeated reminders)  Hyperactivity (“TOO MUCH”, can’t keep still, being fidgety and restless, can’t stay in their seat, an excessive amount of energy [always “on the go”], difficulty playing quietly)  Impulsivity (action without thinking, “no filter”, they act or react without thinking, they frequently interrupt others, can’t wait their turn, they push in line)  Several inattentive/hyperactive-impulsive symptoms were present before 12 yoa o IF in 5 wks Mary Doe comes into an office and has symptoms that look like ADHD but symptoms only present for a month and she is 30 yoa, then she does not have typical ADHD o The symptoms MUST affect one’s functioning. o The DSM put the second two clusters into one cluster. o There must be a significant number of symptoms from either cluster 1 and 2 must be present (a minimum of 6 from cluster 1 and/or 6 from cluster 2), older than 17 need 5 o Types of ADHD:  ADHD Combined Type – when you have 6 symptoms from both cluster 1 and cluster 2; most common  ADHD Inattentive Type (technically ADD, only from cluster 1) (a) Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities; (b) often has difficulty sustaining attention in tasks or play activities; (c) often does not seem to listen when spoken to directly; (d) often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace; (e) often has difficulty organizing tasks and activities; (f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort; (g) often loses things necessary for tasks or activities; (h) is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts); (i) is often forgetful in daily activities. 

ADHD Hyperactive-Impulsive type (only from cluster 2) (a) Often fidgets with or taps hands or feet or squirms in seat; (b) often leaves seat in situations when remaining seated is expected; (c) often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.) (d) Often unable to play or engage in leisure activities quietly. (e) Is often “on the go,” acting as if “driven by a motor.” (f) Often talks excessively. (g) Often blurts out an answer before a question has been completed. (h) Often has difficulty

waiting his or her turn. (i) Often interrupts or intrudes on others.





o SOME OF THESE SYMPTOMS MUST BE PRESENT PRIOR TO THE AGE OF 7 (ON TEST) o Best treatment: bio-psycho-social therapy Statisitics: o Occurs in 5% of school-aged children o Symptoms are usually present around age 3 or 4 o Children w/ ADHD have similar problems as adults o Boys outnumber girls 3:1 o Most commonly diagnosed in United States, prevalence is current worldwide Brain in regards to ADHD o In frontal cortex (most developed part of brain - Allows us to plan, problem solve, figure things out, pay attention, filter out details unimportant, area of executive functioning, higher order thinking  Those diagnosed with ADHD, there is less activity in this area of the brain, and over past 10 years more research that shows this part of the brain develops more slowly with those who have ADHD BUT catches up later

Learning Disorders: (previously called learning disabilities)  







Low IQ and school preparation; low grades (NOT AVERAGE) Scope of Learning Disorders… o Problems related to academic performance in reading, mathematics, and writing o Performance is substantially below what would be expected Reading Disorder: o Discrepancy between actual and expected reading achievement o Reading is at a level significantly below that of a typical person of the same age o Problem cannot be caused by sensory deficits (e.g., poor vision) o Reading rate and comprehension o Most common Mathematics Disorder: o Achievement below expected performance in mathematics o Calculation and reasoning Disorder of Written Expression: o Achievement below expected performance in writing o Grammar, spelling, clarity

Communication Disorders: 

 

Selective / Elective Mutism: o Persistent failure to speak in specific situations, such as school, despite the ability to do so Childhood Onset Fluency disorder: o Stutter, or replace hard words with easier words Language Disorder: o Limited language in all situations, you can understand it but have limited speech

Pervasive Developmental Disorders: o Share deficits in language, socialization, and cognitive o Pervasive-lasts a lifetime

Autism Spectrum Disorder – problems in language, socialization, and congnition o 25% of children diagnosed with autism have no kind of language abilities o symptoms must be present in early developmental period o (1) PRIOR TO THE AGE OF 3 (First Cluster) Problems in socialization and social function  Impairment in social interactions (bad at making eye contact. Any eye contact that may occur is usually coincidental)  They appear to not enjoy activities  They have poor nonverbal behaviors  They have no Emotional reciprocity  Emotional reciprocity – understanding someone else’s feelings  Lack of make-believe or spontaneous play o (2) Problems in communication  50% never acquire useful speech  Unusual speech; echolalia (repeating what they have just heard)  Poor ability to maintain communication with others o (3) Restricted patterns of behavior, interests, and activities (Stereotyped behavior)  Preoccupation with restricted patters of interest (abnormal in intensity)  May be inflexible in routines or rituals  Stereotyped motor movements or mannerisms  Preoccupation with parts of objects o Treatment: important to start early  Behavior and Communication Therapies (e.g., focusing on reducing problem behaviors and teaching new skills; focusing on teaching children how to act in social situations or how to communicate well with other people.)  Educational Therapies: offered special schooling  Family Therapies (e.g., family members learning how to play and interact with autistic children in ways that promote social interaction skills, manage problem behaviors, and teach daily living skills and communication)  Medications (e.g., no medication can improve the core signs of autism, but certain medications can help control symptoms)… SSRIs and tranquilizers decrease agitation  Integrated treatments focus on getting independent and integrating into society o Characteristic: tantrums o Sevantism: good at certain skills aka Gerard  Asperger’s Disorder: o No longer considered a disorder in its own right of DSM-5 o Don’t have problems with communication o Symptoms:  Problems in socialization and social function  Restricted patterns of behavior, interests, and activities  Deficits in communication are much less severe than in autism (speech is intact) o Treatment:  Psychosocial “Behavioral” Treatments  Address Behaviors  Skill building and treatment of problem behaviors  Communication and language problems  Address socialization deficits  Early intervention is critical  Biological and Medical Treatments Are Unavailable  Integrated Treatments: The Preferred Model  Focus on children, their families, parents, schools, and the home  Build in appropriate community and social support Both can range from mild to severe 

Intellectual Disability: 

Mental Retardation: o What was previously known as Mental Retardation is now known as Intellectual Disability. o It is considered a disorder of childhood (it begins in childhood or adolescence) o Previously DSM-IV axis II (chronic and may influence the presence of other mental disorders) o DSM-5 difficulties in 3 domains: conceptual (skills like language, knowledge, memory), social (making friendships and judgments), and practical (managing personal care, or a job) o Two chief criteria:  (1) Severe below average IQ (below 70)  (2) Significantly deficits in “adaptive functioning” (being able to function on your own, according to your age -> self-help skills [grooming, bathing, toileting], social skills [the ability to relate to others], day to day skills, and motor skills) o All of this must be present before the age of 18 o Classifications:  Mild…  IQ score between 50 or 55 and 70  These people need supervision, educable  Moderate…  IQ range of 35-40 to 50-55  These people can probably hold a simple job, trainable  Severe…  IQs ranging from 20-25 up to 35-40  These people are generally ambulatory  Profound…  IQ scores below 20-25  They are bedridden and can’t do much by themselves

Schizophrenia and Other Psychotic Disorders: Positive Symptoms: Active manifestations of abnormal behavior, distortions or excesses of normal behavior. This includes…  Delusions: Gross misrepresentations of reality that involve strongly held beliefs. The person holds on to these beliefs despite lack of evidence. o For types of delusions, see the “Delusions” printout at the end of Chapter 12  Hallucinations: Experience of sensory events without environmental input  Disorganized speech

Negative Symptoms: Deficits of people’s otherwise normal behavior [The A’s (apathy, alogia, anhedonia, flat affect]  Avolition (or apathy): Inability to initiate and persist in activities  Alogia: A relative absence of speech  Anhedonia: Inability to experience pleasure or engage in pleasurable activities  Flat affect: Show little expressed emotion, but may still feel emotion

Disorganized Symptoms: Include severe and excess disruptions in speech, behavior, and emotion 

Nature of Disorganized Speech o Cognitive Slippage: Illogical and incoherent speech o Tangentiality: “Going off on a tangent” and not answering a question directly

 

o Loose Associations or Derailment: Taking conversation in unrelated directions Disorganized Affect o Inappropriate emotional behavior (e.g., crying when one should be laughing) Disorganized Behavior o Includes a variety of unusual behaviors o Catatonia: Spectrum from wild agitation, waxy flexibility, to complete immobility

Schizophrenia: A type of psychosis with disturbed thought, perception, language, emotion, and behavior. It can only be diagnosed if the symptoms have been present for OVER 6 MONTHS.  Paranoid Type: o Intact cognitive skills and affect, and do not show disorganized behavior o Hallucinations and delusions center around a theme (grandeur or persecution) o best prognosis  Disorganized Type: o Marked disruptions in speech and behavior, flat or inappropriate affect o Hallucinations and delusions have a theme, but tend to be fragmented o This type develops early, tends to be chronic, lacks periods of remissions  Catatonic Type: o Show unusual motor responses and odd mannerisms (e.g., echolalia [echo voice], echopraxia [mirroring movement]) o This subtype tends to be severe and quite rare  Undifferentiated Type: o Major symptoms of schizophrenia, but fail to meet criteria for another type  Residual Type: o One past episode of schizophrenia o Continue to display less extreme residual symptoms (e.g., odd beliefs)

Schizophreniform Disorder:  

Schizophrenic symptoms for less than 6 months Associated with good premorbid functioning; most resume normal lives

Brief Psychotic Disorder:   

Experience one or more positive symptoms of schizophrenia Usually precipitated by extreme stress or trauma Lasts less than one month

Delusional Disorder: 

Delusional disorder is a type of schizophrenia with only delusions (no hallucinations)

Schizoaffective Disorder:   

symptoms of schizophrenia and mood disorder (ex: schizophrenia and bipolar disorder) prognosis is similar for people with schizophrenia such persons do no tend to get better on their own

Genetics: 



Family Studies o Inherit a tendency for schizophrenia, not a specific form of schizophrenia o Schizophrenia in the family increases risk for schizophrenia in other family members o You do not need to show symptoms in order to pass on a genetic predisposition of developing schizophrenia, can be recessive Twin Studies o Risk of schizophrenia in monozygotic twins is 48%

o

Risk of schizophrenia drops to 17% for fraternal (dizygotic) twins

Risk of Developing Schizophrenia:

Risk of Developing Schizophrenia Among Twins:

Personality Disorders: When personality traits become disorders, the traits become more inflexible and maladaptive and they interfere with the person’s life. Personality in general (and personality disorders) are thought to have their etiology in childhood. Personality disorders usually do not manifest themselves until early adulthood. Personality disorders are coded on axis II (along with mental retardation), because they are more stable, enduring, and more resistant to treatment.

Clusters:   

Cluster A: Odd or eccentric cluster (e.g., paranoid, schizoid, schizotypal) Cluster B: Dramatic, emotional, erratic cluster (e.g., antisocial, borderline, histrionic, narcissistic) Cluster C: Fearful or anxious cluster (e.g., dependent, avoidant, obsessive-compulsive)

Cluster A: odd or eccentric 





Paranoid Personality Disorder: o The way that the person relates to the world is that “people are just out to get me” o Great deal of mistrust of others o This causes impairment in daily functioning o The person is not hallucinating or delusional o Treatment: focus on trust, counter negative thinking Schizoid Personality Disorder: o These are loners by choice o Introverted but they do not enjoy relationships with others (not because they are anxious or nervous. They just don’t enjoy or want them); perfectly comfortable not interacting with other people o Their emotions are detached (don’t show much emotions) o They may have very few, if any, friends (they prefer this) o What makes it a disorder is other people that it effects (they usually don’t like that the person acts this way [e.g., family]) o Treatment: focus on relationships, build social skills Schizotypal Personality Disorder: o Behavior and dress is odd and unusual o Most are socially isolated and may be highly suspicious of others o Magical thinking, ideas of reference, and illusions are common o Risk for developing schizophrenia is high in this group o Treatment: main focus developing social skills, combat comorbid depression

Cluster B: Dramatic, emotional or erratic 





Antisocial Personality Disorder: o Failure to comply with social norms and violation of the rights of others o Conduct and ADHD, conduct disorder before 15? o Irresponsible, impulsive, and deceitful o Lack a conscience, empathy, and remorse o Many go to jail (more often seen in men) o Dissipate after 40 o Inconsistent parental support o The joker… treatment is practical consequences, prevention and rehabilitation Borderline Personality Disorder: o Patterns of unstable moods and relationships o Impulsivity, fear of abandonment, coupled with a very poor self-image o Self-harm and suicidal gestures are common o Most common personality disorder in psychiatric settings o Comorbidity rates are high--- depression o May improve with time o Preference in females o Treatment; antipsychotics, CBT teaching tolerance and acceptance Histrionic Personality Disorder: o Patterns of behavior that are overly dramatic, sensational, and sexually provocative

Often impulsive and need to be the center of attention (any kind of attention, good or bad) o Thinking and emotions are perceived as shallow o Common diagnosis in females o Madison, kkkrazy girls o Treatment: target relationships and behavior problems Narcissistic Personality Disorder: o Exaggerated and unreasonable sense of self-importance o Preoccupation with receiving attention (only good attention) o Lack sensitivity and compassion for other people o Highly sensitive to criticism o Tend to be envious and arrogant o May improve with time o Treatment; focus on behavior issues o



Cluster C: Fearful or anxious 





Avoidant Personality Disorder: o Extreme sensitivity to the opinions of others o Highly avoidant of most interpersonal relationships o Are interpersonally anxious and fearful of rejection o How do Schizoid and Avoidant PD differ from one another? (people that have Avoidant PD actually want to have social relationships, where Schizoid PD don’t) o Treatment: target social skills and anxiety, comorbid with social anxiety Dependent Personality Disorder: o Excessive reliance on others to make major and minor life decisions o Unreasonable fear of abandonment o Tendency to be clingy and submissive in interpersonal relationships o Treatment: foster independence Obsessive-Compulsive Personality Disorder: o Excessive and rigid fixation on doing things the right way o Tend to be highly perfectionistic, orderly, and emotionally shallow o Obsessions and compulsions, as in OCD, are rare o How are OCPD and OCD different from one another? (people with OCPD really don’t mind how they are, while people with OCD are really distressed with their situation) o Treatment: address needs of orderliness and fears of inadequacy

Less than 1%------- Narcissistic, Dependent, Borderline, Antisocial, Schizotypal More than 1%-------- Paranoid, Schizoid, Histrionic, Avoidant, Obsessive-Compulsive

Legal and Ethical Issues: Civil (involuntary) commitment: 



Criteria for involuntary hospitalization: o (1) Have to have a mental illness that needs treatment o (2) Must be a danger to self (suicide) or others (homicide) o (3) They are so out of touch with reality that they are unable to function alone or with their family There is something called a “72 hour hold”. The person is held against their will for 72 hours, they are then re-evaluated, and if need be, they will be held another 15 days, then be reevaluated.

Civil Commitment Process: 



Initial Stages… o Person fails to seek help, but others feel that help is needed o Petition is made to a judge on the behalf of the person o Individual in question must be notified of the civil commitment process Subsequent Stages… o Involve normal legal proceedings in most cases o Determination is made by a judge regarding whether to commit the person

The therapist…. Limits on Confidentiality Tarasoff: DUTY TO WARN AND TO PROTECT (in case of a patient with homicidal plans)  Duty to Warn: must tell the person that the patient wishes to kill (intended victim)  Duty to Protect: duty to protect the public (tell the police) o Must be dangerous to be committed whether its to oneself or another

Insanity Defense: 





Nature of the Insanity Defense Plea: o Legal statement by the accused of not guilty because of insanity at time of crime o Results in defendant going to a treatment facility rather than a prison (used in less than 1% criminal cases AND spend more time in mental hospital than jail) o Diagnosis of a disorder is not the same as insanity (“Insanity” is a legal term. Just because you are very schizophrenic doesn’t mean that you are legally insane.) John Hinckley Jr. -> he attempted to assassinate President Regan o Guilty of nothing o He was under the belief (delusions of the eratomanic type; he w...