Jessica

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jchampio
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111607
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Jessica
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2011-10-23 23:00:05
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Abnormal Psych
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  1. ·
    Distressing feelings apprehension and
    being in danger; strong physiological arousal that interferes with day-to-day
    functioning. No loss of contact with reality.
    • Anxiety
    • Disorders
  2. ·
    3 manifestations

    o Cognitive:
    disastrous thought, things so horrible, no true threat

    o Behavioral:
    avoidance, no sleep, change appetite

    o Somatic:
    changes in blood pressure, heart rate, sweating
    • Anxiety
    • Disorders
  3. ·
    Most Common group of disorders in US

    ·
    High co-morbidity (up to 67%) with other
    anxiety disorders, depression, and/or substance abuse
    • Anxiety
    • Disorders
  4. ·
    Symptoms: Chronic,
    excessive, free-floating anxiety (chronic worriers)
    • GAD (General Anxiety
    • Disorder)
  5. ·
    Statistics:

    o More Women (66%) than men (33%)

    o Onset usually 1st in childhood or adolescence
    • GAD (General Anxiety
    • Disorder)
  6. o Biological

    § Low GABA levels and/or 5-HT levels

    § Elevated NE levels

    § Genetics

    § Overactive amygdala

    ·
    RX: Benzodiazepines
    (Anti-anxiety, makes more GABA available), relaxation, biofeedback
    • GAD (General Anxiety
    • Disorder)
  7. o Psychodynamic (Freud)

    § Deeply repressed, unacceptable sexual and/or aggressive impulses.

    § Object relations: non-supportive or over protective
    parenting causes

    § Disintegration anxiety: can never by self-sufficient

    ·
    RX: address impulses,
    strengthen defenses
    • GAD (General Anxiety
    • Disorder)
  8. o Behavioral Theories:

    § Operant conditioning or modeling.

    ·
    RX: change
    contingencies, provide coping role models
    • GAD (General Anxiety
    • Disorder)
  9. o Cognitive Theories:

    § Irrational beliefs (Ellis); automatized thinking (Beck);
    faulty appraisals (Lazarus)

    RX:
    RET, SIT, analysis
    of appraisals
    • GAD (General Anxiety
    • Disorder)
  10. o Humanistic/existential Theories:

    § Harsh conditions of worth, non-participant in being-in-the-world,
    cannot accept non-being

    RX:
    examine COWs, discuss existential themes
    GAD (General AnxietyDisorder)
  11. o Social/Sociocultural:

    § Risk factors include unemployment, poverty, threatening
    environment, frequent changes in personal life or social world, no social
    supports, gender roles, race (rates twice as high among blacks)

    ·
    RX: lower poverty,
    increases social supports, address female stressors
    GAD (General AnxietyDisorder)
  12. Symptoms: intense,
    persistent, unreasonable fear intrudes in functioning
    Phobias
  13. ·
    Statistic:

    1.
    9-10% of adults each
    year

    2.
    Twice as many women as
    men for most phobias

    3.
    Onset for specific
    phobias usually childhood, for social phobias pre-mid- teens, for agoraphobia
    between 20s- 40s
    Phobias
  14. Categories: animal, natural environment,
    blood-injury, situational
  15. Specific Phobias Page
    124
  16. Categories: performance,
    limited interactional, generalized.
  17. Social phobias
  18. Biological

    a.
    Genetics

    b.
    Overactive amygdala with
    increased ANS activity

    c.
    Preparedness
    (evolutionary theory)

    d.
    Cyclical estrogen levels
    and lower testosterone

    e.
    Submissive role to avoid
    conflicts (evolutionary theory)


    i.
    RX: Beta blockers,
    anti-depressants, benzodiazepines
    phobias
  19. 1.
    Psychodynamic (Freud)

    a.
    Specific phobias:
    displaced unconscious sexual or aggressive conflicts.

    b.
    Social phobias:
    interjected images of rival family members transmitted to others.

    c.
    Agoraphobia: parents
    become anxious when child is anxious


    i.
    RX: allow expression of
    impulses
    phobias
  20. 1.
    Behavioral-classical,
    operant, and social learning

    a.
    RX:


    i.
    Systematic
    desensitization


    ii.
    Flooding with response
    prevention


    iii.
    Vicarious learning (role
    modeling)


    iv.
    KEY: actual contact with
    feared object; for social phobias, teach social skills.
    phobias
  21. 1.
    Humanistic/existential:
    incongruence between self-image and organism’s needs, powerful COWs, fear of
    being-in-the-world leads person to withdraw; withdrawal triggers fear of
    not-being

    a.
    RX: deal with
    incongruences, examine COW
    phobias
  22. 1.
    Cognitive: irrational
    thoughts of failure and humiliation linked to perfectionistic attitudes;
    castastrophizing

    a.
    RX: cognitive
    restructuring to challenge faulty attributions
    phobias
  23. 1.
    Social/sociocultural:
    parents discourage independence, displays of emotions, assertiveness. Parents
    use shame to control children, stress importance of others’ opinions

    a.
    RX: increase social
    supports, encourage independences.
    phobias
  24. ·
    Symptoms: severe,
    frightening episodes of apprehension, terror, and impending doom with sudden
    onset, last from few minutes to several hours but most peak after 10mins. Most
    develop anticipatory anxiety (worry about the next attack)
    Panic Disorders
  25. ·
    Statistics

    1.
    Women 2-3 times more

    2.
    Usual onset in late
    teens to mid 30s

    3.
    Chronic course (waxes
    and wanes) hangs out for awhile

    4.
    On average, see 10
    different specialists before correct diagnosis
    Panic Disorders
  26. 1.
    Biology

    a.
    Neural hijack of
    amygdala

    b.
    Abnormal levels of 5-HT
    and/or NE

    c.
    Genetics

    d.
    Malfunction of oxygen
    receptors

    e.
    Mitral valve prolapse

    RX: antidepressants
    Panic Disorders
  27. 1.
    Psychodynamic (Freud):
    attempts to repress forbidden ID impulses

    a.
    RX: allow expression of
    impulses
    Panic Disorders
  28. 1.
    Behavioral: conditioned
    responses; panic attacks are form of avoidance learning; modeling

    a.
    RX: change secondary
    gain, relaxation, symptom subscription

    -
    Primary
    gain: you get/gain something

    -
    Secondary gain: you get
    ATTENTION

    -
    Symptom subscription:
    “do it” on demand, help you realize you are in control
    Panic Disorders
  29. Cognitive: person catastrophizes anxiety
    symptoms, misinterpreting them as harmful, leading to worse thoughts and
    anxiety (anxiety sensitive, ROY-BYRNE
    Panic Disorders
  30. 1.
    Humanistic/existential:
    discrepancies between current functioning and potential, failure to accept
    choices and responsibility for self

    a.
    RX: challenge disprepancies…
    Panic Disorders

    • 1.
    • Humanistic/existential:
    • discrepancies between current functioning and potential, failure to accept
    • choices and responsibility for self

    • a.
    • RX: challenge disprepancies…
  31. 1.
    Social/sociocultural:
    role overload, gender roles; societal standards for perfection, inadequate
    support systems

    RX:
    increase supports, challenge norms for women
    Panic Disorders
  32. ·
    Symptoms: thoughts
    and/or actions repeated to avoid anxiety; patient
    knows they are irrational but feel no control to resist (ego-dystonic)
    • Obsessive-Compulsive
    • Disorder (OCD)
  33. o * Os and Cs are calming devices and persons develop own
    logic to support rituals

    *
    Often have a history of being excessively concerned with control and
    perfectionism or concerns that their actions will have negative consequences
    Obsessive-Compulsive Disorder (OCD)
  34. ·
    Statistics

    1.
    Equal rates with men and
    women but different onsets (men/boys get it sooner)

    2.
    Gradual onset with
    chronic course

    Common
    co-morbid diagnosis=ED(eating disorders) and MDD(manic depression disorder
    Obsessive-Compulsive Disorder (OCD)
  35. 1.
    Biological

    a.
    Low 5-HT levels

    b.
    Over activity of left
    hemisphere frontal cortex’s orbital region and caudate nucleus

    c.
    Genetics


    i.
    RX: SSRIs have 60-80%
    efficacy rate
    Obsessive-Compulsive Disorder (OCD)
  36. 1.
    Psychodynamic (Freud):
    substitution hypothesis; anal stage fixation (rage toward demanding parents)

    a.
    RX: address rage and
    types of defenses used
    Obsessive-Compulsive Disorder (OCD)
  37. 1.
    Behavioral

    a.
    Higher order classical
    conditioning

    b.
    Superstitions hypothesis

    c.
    Social learning


    i.
    RX: exposure and
    response prevention ,flooding; modeling
    Obsessive-Compulsive Disorder (OCD)
  38. 1.
    Cognitive:

    a.
    Irrational beliefs and
    unrealistic expectations

    b.
    Severe self-doubts about
    memories and judgments


    i.
    RX: habituation
    training, RET, vicarious modeling
    Obsessive-Compulsive Disorder (OCD)
  39. 1.
    Humanistic/existential:
    incongruence between self-image and organism’s needs, powerful COWs, fear of
    being-in-the-world leads person to withdraw; withdrawal triggers fear of
    not-being

    -
    RX: deal with
    incongruences, examine COW
    Obsessive-Compulsive Disorder (OCD)
  40. 1.
    Social/sociocultural
    (LEVENKRON): parents are overly concerned about wealth and family’s reputation
    and impose strict demands; fathers emotionally absent

    It is “self-soothing” due to
    emotional emptiness

    -
    RX: family therapy to
    address child’s needs
    Obsessive-Compulsive Disorder (OCD)
  41. ·
    Symptoms:

    Within
    1 month of exposure to an extreme traumatic stressor, experience intense fear,
    anxiety, dissociative amnesia, numbing, sense of horror and helplessness.
    Symptoms are experienced during or immediately after trauma, last for @ least 2
    days and either resolve within 4 weeks
    Acute Stress Disorder (ASD)
  42. 1.
    Carson (1988)- 3 stage
    “disaster syndrome” in face of cataclysmic events:

    a.
    Shock

    b.
    Suggestibility

    c.
    Recovery- when ASD or
    PTSD may occur
    Acute Stress Disorder (ASD)
  43. pretrauma personality traits, coping styles, appraisals about events, ANS sensitivity, amygdala and hippocampus functioning, etc.
    Individual Traits: for Diathesis-stress model: this can be a cause and effect of postraumatic cognitive processing
  44. degree and type of trauma
    Traumatic Experience: in the diathesis-stress model for ptsd this can be only a cause of posttraumatic cognitive processing
  45. for ex: overload as seen in intrusive thougths, avoidance as seen with withdrawal
    Posttraumatic Cognitive Processing: in diathesis-stress model for ptsd. this can cause adaptations, and be an effect from truamatic experiences. and be both cause/effect for individual traits, and recovery environment
  46. restabilizes for growth, destabilizs as in ptsd, psychoses, depression
    adaptation: in diathesis-stress model for ptsd. can be an effect from posttraumatic cognitive processing
  47. social support, community, culture, societal attitudes towards trauma, additional life stressors
    Recovery environment: in diathesis-stress model for ptsd. this is both cause and effect of posttraumatic cognitive processing
  48. ·
    Symptoms: ASD symptoms
    but longer than one month; often has delayed onset. Additional symptoms:
    survival guilt, self-destructive behavior, somatic complaints

    o Present label assigned after Vietnam War (1980) but
    diagnosis has been known for some time.
    • Posttraumatic
    • Stress Disorder (PTSD)
  49. ·
    Statistics

    1.
    Any age: severity,
    duration, proximity to trauma affect likelihood of occurrence

    2.
    Lifetime prevalence rate
    for ASD and PTSD is 14% for at risk groups

    3.
    2-3 times more women

    4.
    In kids, usually due to
    experiencing or witnessing abuse

    5.
    About 50% recover in 3
    months with RX: many cope through substance abuse

    6.
    Some risk factors:
    previous anxiety disorders, early separation from parents, lower cognitive
    skills, occupation
    Posttraumatic Stress Disorder (PTSD)
  50. ·
    Specifiers: acute if
    less than 3m duration; chronic if more than 3m duration. Delayed onset if at
    least 6m after event

    o In kids see marked changes in orientations to future
    (continuing school, having a family) and somatic complaints
    Posttraumatic Stress Disorder (PTSD)
  51. 1.
    Biological

    a.
    Genetics

    b.
    Higher levels of
    cortisol and NE (increased ANS activity with traumas cues eg. Heart rate)

    c.
    Elevated activity at
    locus ceruleus

    d.
    Elevated DA levels

    e.
    Elevated endorphins

    f.
    Hippocampus atrophy

    g.
    Amygdala hijacking

    RX: antidepressants (SSRIs),
    benzodiazepines
    Posttraumatic Stress Disorder (PTSD) AND Acute Stress Disorder (ASD)
  52. 1.
    Psychodynamic (Freud):
    high degrees of neuroticism; weakened ego leads to poor use of defenses;
    parents’ pathologies create dysfunctional home life so child dissociates to
    cope

    a.
    RX: strengthen ego
    boundaries, better use of defenses
    Posttraumatic Stress Disorder (PTSD) AND Acute Stress Disorder (ASD)
  53. 1.
    Behavioral:
    classical-conditioning, learned not thinking (repress) (feel reward for not
    thinking about it)

    a.
    RX: relaxation, EMDR,
    flooding, virtual reality
    Posttraumatic Stress Disorder (PTSD) AND Acute Stress Disorder (ASD)
  54. 1.
    Cognitive: sense of
    invulnerability and personal control, shattered, learned helplessness, negative
    self-schemas (self-blame and self-guilt)

    a.
    RX: redefine event to
    find meaning, increase sense of mastery, analyze self-talk
    Posttraumatic Stress Disorder (PTSD) AND Acute Stress Disorder (ASD)
  55. 1.
    Humanistic/Existential:
    self-image shaken by traumas, sense of being and being-in-the-world are
    affected

    a.
    RX: address guilt,
    purpose-in-life focus on the here and now
    Posttraumatic Stress Disorder (PTSD) AND Acute Stress Disorder (ASD)
  56. 1.
    Social/sociocultural:
    lack of social support, victim blame by society; acculturation stress

    a.
    RX: APA recommends
    establishing a disaster response network; normalize responses; diffuse
    anxiety and anger, teach self-help, provide community referrals.
    Posttraumatic Stress Disorder (PTSD) AND Acute Stress Disorder (ASD)
  57. ·
    Three manifestations, all involve physical
    symptoms:

    1.
    Faking illnesses- factitious and malingering
    disorders (voluntarily produced)

    2.
    Imaginary Illnesses but person truly believes
    they are physically ill : somatoform disorders (involuntarily)

    3.
    Disruptions in memory functions or perceptions:
    dissociative disorders (involuntarily) RARE**
    Somatoform and Dissociative Disorders
  58. ·
    Voluntary simulate physical or mental conditions
    or voluntarily induce symptoms. Unable to “control” selves. “Sympathy junkies”
    receive attention for “sick patient” role

    Best known is MÜnchausen syndrome
    • FACTITIOUS DISORDERS
    • Somatoform and Dissociative Disorders
  59. In sufficiently concern- ‘brave face

    2.
    Very knowledgeable about medicine

    3.
    Pseudologia fantastica

    4.
    If confronted, vehemently deny allegations

    5.
    Early onset adulthood, more men

    6.
    Some predisposing factors

    a.
    Extensive medical treatment in childhood

    b.
    Much attention during illnesses

    c.
    Significant relationships with medical field

    d.
    High dependency and exploitative traits
    MÜnchausen syndrome

    Characteristics:
  60. 1.
    Parent/guardians induce illness in others to
    gain sympathy and attention. Attacks are well-planned.

    2.
    Caretakers willing/eager to have victims undergo
    painful, invasive, even harmful procedures. 10-30% of victims will die, 8%
    permanently impaired

    3.
    Perpetrator traits: mostly women 25-40 yrs,
    health care background, emotionally needy, “martyrs”, few social supports;
    spouse physically or emotionally absent, high IQs vast medical knowledge.
    • ·
    • MÜnchausen Syndrome by proxy
    • (MSBP)
  61. Symptoms are voluntarily and deliberately
    produced and goals/external rewards clearly recognizable- can “turn off”
    symptoms when they are no longer useful
    As with factitious disorders, person who
    malinger deny they played any role in illness and do not seek psychological
    help. If forced to do so, they are very noncompliant
    • Malingering Disorders
    • Somatoform and Dissociative Disorders
  62. 1.
    Presence/complaints of physical symptoms
    suggestive of but not explained by medical condition
    • Somatoform
    • Disorders
  63. 1.
    Psych. Conflict enter physical realm- symptoms
    not intentionally produced

    a.
    Six Diagnostic categories (chart page 163)

    b.
    Characteristics:


    i.
    History of numerous physical complaints, one
    before age 30, chronic course


    ii.
    Risks: female not well educated, lower financial



    iii.
    Much “doctor shopping” attention seeking


    iv.
    Very difficult to “give up” symptoms, many
    suicide
    Somatoform Disorders
  64. 1.
    associated with psychological
    factors. (controversial) – complaints of severe pain that are:

    a.
    In absence of organic cause or

    b.
    In grate excess to what is expected for
    condition, or

    Is lingering long after healing
    • Pain disorder
    • Somatoform Disorders
  65. 1.
    1st major
    physical symptom significantly impairs function, yet most do not experience
    negative outcomes expected if disorder was “real” (blind, but still doesn’t
    trip around stuff)

    a.
    Once called craft palsies ( something to do with
    job, pianist hands wont work before big performance)

    b.
    La belle indifference (not upset)

    c.
    Symptom is symbolic of unconscious conflict,
    maintained by primary gain and secondary gain

    d.
    Acute onset in late child-early adulthood, more
    women, lower SES, rural groups. Most cases remint in 2 weeks.

    e.
    Mass psychogenic illness (assembly-line
    hysteria) rapid spread of unexplained
    physical symptoms due to power of suggestion (nocebo effect)
    • Conversion disorder:
    • Somatoform Disorders
  66. 1.
    persistent preoccupation and
    unrealistic concern about health. Person over-sensitive to routine body
    sensations and quickly misinterprets them

    a.
    Concern about health/illness central feature of
    self-image social disclosure

    b.
    Most “doctor shopping”

    c.
    Onset in late childhood-early adulthood, equal
    rates in men and women, chronic course

    d.
    Predisposing factors- high dependency needs; low
    pain thresholds, reinforcement for illness behavior
    • Hypochondriasis:
    • Somatoform Disorders
  67. 1.
    strong preoccupation with imagined or slight
    defect in appearance

    a.
    Embarrassment with “flaw” very strong, believes
    other mock/are repulsed by it

    b.
    Repeatedly seeks reassurance, and then discounts
    it.

    c.
    Onset adolescent-mid 20s; equal sex rates,
    chronic

    d.
    Anxiety, depression, social isolation (30%),
    suicidal ideation (17% attempt)

    e.
    If corrected,
    preoccupation, “transferred”
    • Body
    • dysmorphic disorder (BDD; aka dysmorphophobia):
    • Somatoform Disorders
  68. 1. Biological

    a. High arousal levels (hypervilgence)

    b. Over activity of Right Hemisphere parietal
    lobe

    c. Lower pain thresholds


    i.
    RX:
    biofeedback (computer to teach you to control heart rate, and muscle control),
    increase physical activity, SSRIs
    Somatoform Disorders
  69. 1. Psychodynamic (Freud)

    a. Repressed conflicts enter physical domain

    b. Failure to resolve ELECTRA COMPLEX
    (conversion disorder)

    c. Primary and secondary gain ( primary-gives
    you excuse why you don’t have to do something, work, school. And secondary
    gives you attention)


    i.
    RX:
    allow catharsis (getting rid of feelings by expressing them. the process of
    expressing strong feelings that have been affecting you so that they do not
    upset you anymore)
    Somatoform Disorders
  70. 1. Behavioral: primary and secondary gain,
    modeling significant others

    RX:
    exposure and response prevention, change reinforces (don’t give attention to
    them with they are “sick
    Somatoform Disorders
  71. 1. Cognitive: catastrophic thinking,
    communicate feelings via language of physical symptoms (says they are sick when
    they are stressed b/c they don’t know how to express feelings)

    a. RX: address irrational thinking, teach
    communication skills
    Somatoform Disorders
  72. 1. Social/sociocultural: few outlets for
    aggression, statistics are artifacts, doctors’ bias (women); more acceptable to
    report physical rather than psych. Symptoms (cultural groups)

    a. RX: empower women, address medical bias,
    family therapy
    Somatoform Disorders
  73. 1. Diathesis-Stress (kellner 1985):
    predisposing factors + stress produce symptoms that are misinterpreted.
    Maintain by primary and secondary gain.

    Caveat: somatoform disorders very difficult
    to treat as persons deny any psychological disorders.
    Somatoform Disorders
  74. No organic or physical causes symptoms are unconscious
    and involuntary produced

    Onset gradual or sudden, course transmit
    Dissociative disorders
  75. 1.
    inability to recall important person info.
    Usually due to trauma, recovery is sudden and complete

    Localized
    (circumscribed) most common: cannot recall any events during-specific time
    frame
    • Dissociative
    • amnesia:
    • Dissociative disorders
  76. 1.
    confusion over personal identity plus
    dissociative amnesia with unexpected travel

    a.
    Usually precipitated by personal stressor

    b.
    Recovery is sudden and complete
    • Dissociative
    • fugue:
    • Dissociative disorders
  77. 1.
    persistent, recurrent feelings of detachment
    from self; feels “unreal” and things seem “distorted”

    a.
    Fears is “going crazy” or as if watching self
    from outside

    b.
    Reality contact maintained
    • Depersonalization
    • disorder:
    • Dissociative disorders
  78. 1.
    2 or more distinct identities each with own
    pattern of perceiving, relating, thinking about self and the world.

    a.
    Onset almost always before 5, but rarely
    diagnosed then

    b.
    Switching usually abrupt, precipitated by
    triggers

    c.
    Identities may or may not be aware of others; in
    most alternates act as observers or make


    i.
    Host usually passive, dependent, depressed, prim


    ii.
    Alternate quite varied, all suffer lacunas
    (memory gaps)


    iii.
    90% females, usually victims of repeated,
    heinous abuse
    • Dissociative
    • Identity Disoder (DID):
    • Dissociative disorders
  79. 1.
    Biological: childhood traumas cause permanent
    structural changes (reduce volume in hippocampus, amygdala)
    Dissociative disorders
  80. 1.
    Psychodynamic (freud): incomplete repression of
    traumas due to weakened ego; encapsulation

    KLUFT found 4
    factors in DID (p159)

    -
    Child exposed to overwhelming stress

    -
    Child has capacity to dissociate and has no
    support

    -
    Child has ability to encapsulate experiences

    -
    Different memory systems developed
    Dissociative disorders
  81. 1.
    Cognitive/Behavioral:

    a.
    Primary gain (avoid stress)

    b.
    Role- playing due to selective attention

    c.
    Self-hypnosis

    d.
    State dependent learning (rigid memory links)
    Dissociative disorders
  82. 1.
    Dissociative amnesia and dissociative fugue:
    deal with patients reactions, teach coping.

    2.
    Depersonalization disorder: teach better coping,
    increase support networks

    3.
    Dissociative Identity Disorder (DID)
    hypnotherapy to integrate personalities, family therapy.
    Treatment for Dissociative Disorders
  83. Definition: response to events perceived as
    threatening/challenging and exceed present coping, requires adaptation
    stress
  84. Burnout-chronic stress
    that involves:
    • 1.
    • Emotional exhaustion

    • 2.
    • Depersonalization
    • (detached, robot)

    • 3.
    • Reduced accomplishments (can’t
    • concentrate)

    • Extreme
    • lethargy/fatigue
  85. 1. Selye
    (1976): General Adaptation Syndrome

    a. 3 stages


    i.
    Alarm and mobilization


    ii.
    Resistance (usually long term stressor, live with
    stressors)


    iii.
    Exhaustion (going to get sick, body breaks down)
    Physiological Response Models
  86. 1. Psychophysiological
    (psychosomatic) disorder: actual tissue damage due to stress response
    Physiological Response Models
    • H-P-A stress Pathway
    • (hypothalamus- Pituitary Gland - Adrenal Glands)
    • Physiological Response Models
    • READ HANDOUT!!!!!
  87. 1. Lazarus’
    transactional model (1984): perceive stressor>primary appraisal (am I in
    danger?)> if yes, HPA activated>secondary appraisal (what to do?)

    Coping
    styles: direct (face it head on fight), indirect (take care of yourself, sleep,
    exercise, talk, complain), avoidance (worse** just live with it)

    2. De la
    Fuente (1990): inability to deal with stress lead to psychological decompensating
    (primitive behavior-childlike) didn’t deal with stress as child
    Cognitive Response Models:
  88. 1. Stress
    increases susceptibility to infectious diseases

    2. Sudden
    death syndrome (coronary disease). Stress produces toxic amount of adrenaline,
    increased cortisol, changes in heart rhythm.

    3. Cancer: stress
    slows recovery, speeds up disorder (eg Peetingale 1985)

    4. AIDS: HIV+
    men with greater stress develop AIDS sooner

    5. Psychoneuroimmunology
    (PNI): specialty examines how immune systems affected by psychological factors
    Research findings on Stress
  89. -
    Role issues

    1. Conflicts: parent, job, etc

    2. Overload:
    often leads to burnout

    -
    Daily hassles (micro stressors)- affect short term
    health (men more)

    -
    Cataclysmic events disaster syndrome

    -
    Major life events/life changes (Holmes and Rahe): too
    many changes (positive and negative) in short time affect long-term health

    -
    Chronic circumstances-persistent aversive conditions
    Categories of Human Stressors
  90. ·
    Type A personality (Williams 1985) hostility is toxic!

    ·
    Type B personality- few stress disorders

    ·
    Hardy personality: control, commitments, challenges

    ·
    Type D personality: distressed, pessimistic,
    illness-prone
    Individual differences
  91. ·
    In DSM-IV psychological factors affecting medical
    condition- requires documented medical condition and one of the following

    1. Temporal
    relationship between psych factors and the onset, worsening

    2. Pysch
    factors interfere with treatment

    3. Pysch
    factors exacerbate condition by eliciting stress-related physiological
    responses

    Diagnosed on Axis 1 medical condition on Axis III
    Psychophysiological Disorders : Stress
  92. 1. Biological

    a. Genetics

    b. Somatic
    weakness hypothesis- stress attack “weakest”part (eg. Asthmatic as kid, now
    persistent cough when stressed)

    c. Autonomic
    response specificity- reactivity level shaped by childhood emotional
    experiences (eg. Couldn’t breathe when parents fought, now asthmatic)


    i.
    RX: medication, teach relaxation
    Psychophysiological Disorders : Stress
  93. 1. Behavioral:
    learned or modeled poor coping behaviors; secondary gain, reinforcement for
    illnesses

    a. RX:
    assertiveness training, change reinforcements
    Psychophysiological Disorders : Stress
  94. 1. Cognitive:
    irrational beliefs about dangers, hostile thoughts; self-perceptions about
    inability to cope; high pessimism

    RX:
    RET, SIT recognize faulty attributions
    Psychophysiological Disorders : Stress
  95. 1. Social/sociocultural-
    strained cultural ties, inadequate social support for stressors,
    non-traditional lifestyles, gender roles

    a. RX: provide
    social supports; fund prevention programs
    Psychophysiological Disorders : Stress
  96. 4 steps needed, provided the person values their health

    1. Inform
    person of dangers associated with their behaviors

    2. Person must
    believe they are personally at risk

    3. Inform
    person of alternative ‘doable’ behaviors ( self-efficacy)

    4. Person must
    believe new behavior will reduce/eliminate health risk
    • Prevention
    • Programs
  97. ·
    Pervasive and intense feelings that persist for
    long periods and/or occur for no apparent reason; hind ability to function
    effectively

    ·
    4 dimensions:

    1.
    Affective

    2.
    Behavioral

    3.
    Cognitive

    4.
    Physiological
    MOOD DISORDERS
  98. ·
    episodic state. Never occurs without depressive
    episode. Suicide rate 15-20%. Person seems “out of control”

    1.
    Chief clinical symptoms p.327-328

    a.
    Affective eg; elevated

    b.
    Behavioral eg; recklessness

    c.
    Cognitive eg: grandiosity

    d.
    Physiological eg: sleeplessness
    • Mania
    • MOOD DISORDERS
  99. a.
    Hypomania: energized but still functioning
    adequately

    b.
    Mania (acute mania) episode must last at least
    one week: can last 4-5 months; delusional

    c.
    Delirious mania: psychosis, danger to self and
    others.
  100. Degrees of Mania (for diagnosing bipolar disorders):
    Mood Disorders
  101. ·
    episodic state (unipolar if no mania). Suicide
    rate 15-26%

    1.
    Chief p 304-306

    a.
    Affective eg. Extreme sadness, anhedonia (loss
    of pleasure)

    b.
    Behavioral/motivational eg low energy

    c.
    Cognitive: eg selective abstraction (only focus
    on negative comments)

    d.
    Physiological eg weight loss or gain

    Most common symptom in children are social withdrawal, somatic complaints
    and irritability

    2.
    Specifiers: used to better describe features
    about episodes and/or course of disorder
    • Depression:
    • episodic state (unipolar if no mania
    • Mood Disorders
  102. single episode with postpartum onset related to
    little emotional and instrumental support
    • Major
    • depressive disorder
  103. marked delusions and hallucinations
    Dysthmic disorder: milder but more chronic form
    of depression (2 yrs for adults, 1 yr children) more prevalent form.
    • Major
    • depressive disorder with phychotic features
  104. always involves some manic episodes (usually
    delirious, but sometimes acute) 6 criteria sets based on current/most recent
    Bipolar I
  105. no history of mania, rather presence/history of
    one or more major depressive episodes and 1 or more hypomanic episodes
    • Bipolar 2
    • Mood disorder
  106. milder but more chronic form of bipolar disorder
    (2yrs adults, 1 yr children)
    • Cyclothymic
    • disorder
    • Mood Disorders
  107. 1.
    Biological

    a.
    Genetics (esp. for bipolar)

    b.
    Brain structures- in depression, decreased
    activity of prefrontal cortex

    c.
    Neurotransmitters


    i.
    Bipolar: lithium, high NE and/or low 5-HT


    ii.
    Depressive disorders: low NE and/or 5-HT, low DA


    a.
    Elevated cortisol (for depression)
    MOOD DISORDERS
  108. 1.
    Psychodynamic (Freud)

    a.
    Bipolar: not well addressed

    b.
    Depressive disorders: anger interjected due to
    actual or symbolic separation/loss
    MOOD DISORDERS
  109. 1.
    Behavioral:

    a.
    Bipolar: mania self-reinforcing

    b.
    Depressive disorders: reduced opportunity for
    reinforcement (due to separation?) Primary and secondary gains
    MOOD DISORDERS
  110. 1.
    Cognitive

    a. Bipolar: nothing

    b. Depressive disorders: negative
    attributions, irrational beliefs and negative self-statements


    i.
    Depression is a thinking
    disorder (BECK p 315-316)


    ii.
    Seligman:
    learned helplessness due to internal chronic and stable attributions


    iii.
    Children
    prevented from learning coping skills

    For
    beck and Seligman depressed person vulernable to faulty schemas that are then
    ‘brought to the surface’ by stressors
    MOOD DISORDERS
  111. 1. Social/sociocultural: Multipath
    model p. 310

    a. Bipolar:
    no explanation



    b.
    Depressive disorders:


    i.
    Diathesis-stress


    ii.
    Family relationships


    iii.
    Few social supports


    iv.
    Gender role issues- role conflicts, artifacts
    theory, victimization rates; self-blame
    MOOD DISORDERS
  112. 1.
    Biological (all discussed in ch 2)

    a.
    ECT

    b.
    Pharmacological treatments for depression;
    tricyclics, heterocyclics, MAO (avoid tyramine) SSRIs, SNRIs

    c.
    Pharmacological treatments for bipolar (avoid
    alcohol):lithium carbonate
    Treatments for Mood Disorders
  113. 1.
    Psychodynamic (Freud): explore unconscious grief
    (loss) and excessive dependency issues unresolved since childhood.
    Treatments for MOOD DISORDERS
  114. 1.
    Behavioral:

    a.
    For unipolar: increase social reinforcements,
    expressive behaviors, social skills

    b.
    For bipolar: social rhythm therapy (structured
    routines)
    Treatments for MOOD DISORDERS
  115. 1.
    Cognitive:

    a.
    For unipolar: 12-20 sessions spent recognizing
    and changing maladaptive thoughts

    Studies find CBT changes functioning in limbic and cortical
    areas of brain – same areas affected by medications
    Treatments for MOOD DISORDERS
  116. 1.
    Social/sociocultural:

    a.
    For unipolar: address cultural value
    subscription and lifestyle choices, increase connectedness

    Majority of studies: most effective treatments
    for depression, incorporate medication, cognitive
    Treatments for MOOD DISORDERS
  117. intentional,
    direct, conscious effort to end life
  118. Suicide
  119. ·
    Documented prevalence rate in US is 32000 annually,
    for every completed cases there are 9 attempts
    Suicide
  120. ·
    Primary motive: gain relief from perceived unbearable
    pain, feel very conflicted in decision over 67% communicated intentions with in
    3 months of act
    Suicide
  121. ·
    Correlates/characteristics (P337-343) ex, marital
    status, age, SES, religion (faith), culture, occupation, life stressors
    Suicide
  122. ·
    Psychological disorders- primary mood disorders
    (50-67%) due to felt helplessness, also schizophrenia and substance use
    disorders
    Suicide
  123. ·
    Robert (1992) found alcohol- induce myopia more
    important- impairs judgment, intensifies depression lowers inhibitions (60% of
    cases of suicide they had alcohol in system)
    Suicide
  124. o Suicide
    inherited

    o Suicide
    threats aren’t serious

    o Once an
    attempts fails, person will not try again

    o Mentioning
    suicide give the person the idea

    o When
    depression starts to recede, danger of suicide is over

    o Suicide
    happens with warning (predictors present in over 70%, but only 12-34% leave
    exit note)
    MYTHS OF SUICIDE
  125. 1. Biological:
    low levels of 5-HAA (serotonin), substance abuse
    Suicide
  126. 1. Psychoanalytic
    (Freud) : thanatos turned inward, murderous impulses felt toward interjected
    love objects leads to self-hatred
    Suicide
  127. 1. Behavioral:
    lack of reinforcement for living, modeling
    Suicide
  128. 1. Cognitive:
    problem-solving, usually some exit event
    Suicide
  129. 1. Humanistic
    loss of meaning or faith in self
    Suicide
  130. 1. Social/sociocultural:
    family inability, economic stress, social isolation, role pressures, cultural
    values
    Suicide
  131. 1. Children
    and adolescents (to age 24) rates up 40% in past ten years

    ·
    73% white males

    ·
    Fluctuating affect, aggressiveness

    ·
    Family traits: high economic stress, parents have
    medical and/or psychiatric problems, parents poor role models, history of abuse
    and domestic violence
    Victim characteristics of Suicide
  132. 1. College
    students: rates higher in Feb and Oct

    a. Risk
    factors: older, male, foreign-born, graduate school, student with high GPA and
    low in grad. School. Low competitions for academic
    Victim characteristics of Suicide
  133. 1. Elderly:
    highest risk group of suicide: Caucasian men over 65

    a. Risk
    factors: depression “feeling old” change in social support networks, illness,
    economic stress. More resolute in decision
    Victim characteristics of Suicide
  134. a. Establish
    positive relationship

    b. Obtain
    basic info while clarifying problem

    c. Assess
    suicide potential

    d. Assess and
    mobilize person’s resources

    Formulate
    a plan while negotiating a no-suicide clause
    • 1. Suicide
    • prevention centers: standard crisis intervention steps (comer 2004)
  135. the person makes a conscious decision to end his or her life due to the experience of or prospect of great pain and/or certain death from disease or injury
    Realistic type of suicide
  136. the person consciously commits suicide for the goals or ideals of some group in which he or she is very well-intergrated; the person is trading his or her life for a happier or remembered (honored) existence
    Altruistic type of suicide
  137. the person's suicide gesture goes too far. some persons here are classified as death darers. although they often have much ambivalence even while performing the act, they are quite interested in gaining attention from others. the method used may be planned to auarentee some rescue or that others will intervence, such as walking on a ledge outside of a building and waving to the crowd while rescue is summoned, or timing an overdose very near to the time a loved one is expected home
    Inadvertent (sometimes referreed to a parasuicide) Suicide
  138. the primary motive is vengeance; the person desires to get even with someone due to some perceived hurt or unfulfilled need, and will often leave a note blaming or acusing the other person of some perceived injustice. perception is key- the acused person may have no knowledge about the wrongs alleged by the suicider
    spite (dyadic) suicide
  139. the suicide act is prompt by psychotic-related delusions and/or hallucinations, or the person fears she or he is losing her/his mid
    Bizarre suicide
  140. this type deals with a person's relationships to their social world. two themes: 1. a person feels very disconnected to life and others; society has let them down or has consistently rejected them (an existential crisis of sort)
    2. person experience a sudden imbalance in their relationship to the world. their relationship may have been suddenly broaded (eg. achieving instant fame) or suddenly restricted(eg lost of wealth in a stock market crash)
    anomic (ageneratic) suicide
  141. Although in most suicide cases the person usually experiences some ambivalence in their intentions to suicide, usually there is some exit even that "decides it" for them
  142. the person is chronically depressed, perceives no support from others, is not integrated within social networks, in noreligious, does not care about societal norms, has much inner debate about whether to suicide and often makes many attempts until finally succeeds. Here again, perceptoin is key - family members and friends may be very loving and supportive, but the person contemplating suicide does not perceivethem as such
    Egoistic (negative self) suicide

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