developmental psychology test 4

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developmental psychology test 4
2013-11-20 20:18:33
developmental psychology test

developmental psychology test 4
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  1. Psychosis
    • ability to perceive and respond to the environment is significantly disturbed
    • functioning is impaired
    • symptoms may include hallucinations and/or delusions
  2. diagnosing schizophrenia
    • DSM5 calls for diagnosis of schizophrenia only after symptoms of psychosis continue for six months or more
    • individuals must show deterioration in their work, social relations and ability to care for themselves
  3. schizophrenia affects approximately 1 in ____ people in the world

    2.5 million americans
  4. schiizophrenia and socioeconomic groups
    • found in all groups however it is found more frequenctly in lower levels
    • argue that stress of poverty causes the disorder
  5. downward drift
    disorder causes victims from higher social levels to fall to lower social levels and remain at lower levels
  6. gender and schizophrenia
    • equal numbers of men and women are diagnosed
    • average age of onset is 23yrs old for men and 27 years old for women
  7. schizophrenia and marital status
    • 3% of divorced or separated people
    • 2% of single people
    • 1% f married people
  8. three groups of symptoms for schizophrenia
    • positive symptoms
    • negative symptoms
    • psychomotor symptoms
  9. positive symptoms
    • pathological excesses
    • delusions
    • disordered thinking and speech
    • loos associations (derailment)
    • neoglisms
    • perseveration
    • clang
    • heightened perceptions
    • hallucinations
    • inappropriate affect
  10. delusions
    • faulty interpretations of reality
    • delusions may have a variety of bizarre content, being controlled by others, persecution, reference, grandeur, control
  11. disordered thinking and speech
    may include loose association or derailments, neologisms, perservations, and clang
  12. loose associations
    • derailment
    • the problem is insects. my brother used to collect insects. he's not a man 5 foot 10 inches. you know 10 is my favorite number. I also like to dance, draw and watch TV.
  13. neologisms
    made up words
  14. perseveration
    patients repeat their words and statements again and again
  15. clang
    speak in rhymes
  16. heightened perceptions
    people may feel that their senses are being flooded by sights and sounds making it impossible to attend to anything else
  17. hallucinations
    • sensory perceptions that occur in the absence of external stimuli
    • most common are auditory (seem to be spoken to directly or overheard by the hallucinator)
  18. inappropriate affect
    emotions that are unsuited to the situation
  19. negative symptoms of schizophrenia
    • pathological deficits (lacking in individual)
    • poverty of speech
    • blunted and flat affect
    • loss of volition
    • social withdrawal
  20. poverty of speech
    • alogia
    • reduction of quantity of speech or speech content
    • may also say quite a bit but convey little meaning
  21. blunted and flat affect
    • show less emotion than most people
    • avoidance of eye contact
    • immobile, expressionless face
    • monotonous voice, low and difficult to hear
    • anhedonia
  22. anhedonia
    general lack of pleasure or enjoyment
  23. loss of volition
    • loss of motivation or directedness
    • feeling drained of energy and interest in normal goals
    • inability to start or follow through on a course of action
    • ambivalence-- conflicted feelings about most things
  24. social withdrawal
    • may withdraw from social environment and attend only to their own ideas and fantasies
    • seems to lead to a breakdown of social skills, including the ability to accurately recognize other people's needs and emotions
  25. psychomotor symptoms of schizopharenia
    • people with schizophrenia sometimes experience psychomotor symptoms
    • awkward movements, repeated grimaces, odd gestures
    • the movement seem to have magical quality
    • may take extreme forms collectively called catatonia (stupor, rigidity, posturing, or excitement)
  26. schizophrenia usually first appears between
    the late teens and mid-30s
  27. three phases of schizophrenia
    • prodromal
    • active
    • residual

    each phase of the disorder may last for days or years
  28. prodromal
    beginning of deterioration, mild symptoms
  29. active phase
    symptoms become apparent
  30. residual
    • a return to prodromal-like levels
    • one quarter of patients fully recover
    • three quaters continue to have residual problems
  31. a fuller recovery from schizophrenia is more likely in people:
    • with good premorbid functioning
    • whose disorder was triggered by stress
    • with abrupt onset
    • with later onset (during middle age)
    • who receive early treatment
  32. Type 1 schizophrenia
    • dominated by positive symptoms
    • seem to have better adjustment prior to the disorder
    • later onset of symptoms
    • greater likelihood of improvement
    • may be linked more closely to biochemical abnormalities in the brain
  33. Type II schizophrenia
    • dominated by negative symptoms
    • may be tied largely to structural abnormalities in the brain
  34. diathesis-stress relationship
    people with a biological predisposition will develop schizophrenia only if certain kinds of stressors or events are also present
  35. biological views of schizophrenia
    • genetic factors
    • biochemical abnormalities
    • abnormal brain structure
    • viral problems
  36. genetic factors of schizophrenia
    • believe some people inherit a biological predisposition to schizophrenia that could be triggered by later exposure to extreme stress
    • genetic linkage and moleculare biology studies have been used to pinpoint possible genetic factors
    • case of mistaken identity-- some genes sites do not contribute to disorder
    • different kinds of schizophrenia are linked to different genes or schizophrenia is a polygenic disorder caused by a combination of gene defects
  37. research proof for genetic disposition of schizophrenia
    • family pedigree studies have found that schizophrenia is more common amoung relatives of people with disorder (more closely related the greater the likelihood)
    • identical twins have found that if one twin develops it 48% chance of other twin
    • fraternal twins have a 17% chance
    • adoption studies show that biological relatives of adoptees with schizophrenia are more likely to display schizophrenic symptoms than are their adoptive relatives
  38. biochemical abnormalities that cause schizophrenia
    • dopamine hypothesis
    • investigators have located dopamine receptors which bind antipsychotic drugs
    • drugs are dopamine antagonists that bind to receptor preventing dopaming binding and neuron firing
    • in schizophrenia messages traveling from dopamine sending neurons to dopamine receptors may be transmitted too easily or too often
  39. dopamine hypothesis
    • Certain neurons using dopamine fire too
    • often, producing symptoms of schizophrenia
    • theory is based on effectiveness of antipsychotic medications
  40. research support for dopamine hypothesis
    • antipsychotic drugs (originally to treat allergies) were found to cause parkinson's disease-like tremor in patients
    • parkinson's patients have low levels of dopamine (caused shaking)
    • relationship between symptoms suggested that symptoms of schizophrenia were related to excess dopamine
    • research since 1960s has clarified hypothesis
    • if Parkinson's patients take too much L-dopa  they develop schizophrenic symptoms
    • people who take high doses of amphetamines (increase dopamine activity) may develop amphetamine psychosis
  41. amphetamine psychosis
    a syndrome similar to schizophrenia
  42. problems with dopamine hypothesis for schizophrenia
    • challenged by discovery of new type of antipsychotic drug (atypical) which are more effective than traditional antipsychotics and bind to D1 receptors and to serotonin receptors
    • schizophrenia is related to abnormal activity or interactions of both dopamine and serotonin and perhaps other neurotransmitters as well, rather than to dopamine activity alone
  43. abnormal brain structure and schizophrenia
    • during past decade researchers have linked schizophrenia (dominated by negative symptoms) to abnormalities in brain
    • many people with schizophrenia have enlarged ventricles (brain cavities that contain CSF)
    • enlargement may be sign of poor development or damage in related brain regions
    • also found to have smaller temporal and frontal lobes, smaller amounts of grey matter,  and abnormal blood flow to certain brain areas
  44. viral problems and schizophrenia
    • some evidence comes from animal model investigations and other is circumstantial
    • unusually large number of people with schizophrenia born in winter months
    • mothers of children of schizophrenia were more often exposed to influenza virus during pregnancy than mothers of children without
    • link between schizophrenia and antibodies to certain viruses (people had at some point been exposed to these viruses)
  45. biochemcial, brain structure, and viral findings are only partially the explanation to schizophrenia
    • some people who have these biological problems dont develop schizophrenia
    • might be because biology sets the stage for disorder but psychological and sociocultural factors must be present for it to appear
  46. psychological views of schizophrenia
    come from the psychodynamic and cognitive views
  47. psychodynamic explanations to schizophrenia
    • Freud believed that schizophrenia develops from 2 processes
    • regression to  pre-ego stage
    • efforts to re-establish ego control
    • proposed that when their world is extremely harsh, people who develop schizophrenia regress to the earliest points in development (primary narcissism) in which they recognize and meet only their own needs
    • regression leads to self-centered symptoms such as neologisms, loose associations, and delusions of grandeur
    • freuds theory posits that attempts to reestablish ego control from such a state fail and lead to further schizophrenic symptoms
    • years later another psychodynmaic theoris elaborated on Freud's idea of harsh parents
    • theory of schizophrenogenic mothers proposed that mothers of people schizophrenia were cold, domineering, and uniterested in their children's needs
    • both theories have received little research support and have been rejected by most psychodynamic theorists
  48. cognitive view of schizophrenia
    • biological factors produce symptoms
    • further features of disorder emerge because of faulty interpretation and misunderstanding symptoms (friends tell them there is nothing wrong with them)
    • little direct reasearch support for this view
  49. sociocultural views of schizophrenia
    • three main forces contribute to schizophrenia
    • multicultural factors
    • social labeling
    • family dysfunction
    • forces considered important in development of schizophrenia, research has not yet clarified what their precise causal relationships might be
  50. multicultural factors of schizophrenia
    • rates of disorder differ between racial and ethnic group
    • as many as 2.1% of african american are diagnosed compared to 1.4% caucasians
    • african americans are more prone to develop the disorder
    • clinicians from majority groups are unintentionally biased in diagnosis or misread cultural differences as symptoms of schizophrenia
    • rates of disorder differ between racial and ethnic groups
    • yet another explanation may lie in economic sphere
    • african americans are more likely to be poor and when economic differences are controlled for rates of schizophrenia become closer
    • consistent with economic explanation, hispanic americans who are also on average economically disadvantaged, appear to have a much higher likelihood of being diagnosed than white americans
    • course and outcome of schizophrenia differs between countries
    • psychosocial environments of developing countries tend to be more supportive than developed countries, leading to more favorable outcomes for people with schizophrenia
  51. social labeling of schizophrenia
    • many sociocultural theorists believe that the features of schizophrenia are influenced by the diagnosis itself
    • society labels people who fail to conform to certain norms of behavior
    • once assigned the label becomes a self-fulfilling prophecy
    • dangers of social labeling have been well demonstrated
  52. Rosenhan's 1973 pseudo patient study
    8 normal people presented themselves at various mental hospitals complaining that they were hearing voices

    • once they dropped their symptoms it was very difficult to get released
    • nurses and doctors acted like they were invisible
    • problems with social labeling
  53. family dysfunction and schizophrenia
    • linked to family stress
    • parents of people with schizophrenia often
    • display more conflict, have greater difficulty communication, are more critical of an over involved with their children than other parents
    • family theorists have long recognized that some families are high in "expressed emotion" family members frequently express criticism and hostility and intrude on each other's privacy
    • recovering patients are almost four times more likely to relapse if they live with such a family
  54. throughout much of the 20th century the label schizophrenia was assigned to most people with psychosis
    now realized that people with psychotic symptoms are instead displaying other disorders and were inaccurately diagnosed
  55. history of care for schizophrenia
    • for more than half 20th century people were institutionalized in public mental hospitals
    • pateints failed to respond to traditional therapies, primary goals of hospitals were to restrain them and give them food, shelter, and clothing
    • 1793 the move toward institutionalization began with practice of moral treatment
    • hospitals located in isolated ares to protect patients from stresses of daily life and offer healthful psychological environment
    • public mental institutions were required by state law for patients who cant afford private care (overcrowding and understaffing and poor patient outcomes led to loss of individual care and creation of back wards--human warehouses filled with hoplessness)
    • 1950s clinicians developed two institutional approaches that brought some hope (milieu therapy, token economies)
  56. Milieu therapy
    • premise is that institutions can help patients make clinical progress by creating a social climate that promotes productive activity, self respect and individual responsibility
    • milieu style programs have been set up in institutions throughout the western world with moderate success
    • research has shown that patients with schizophrenia in milieu programs often leave the hospital at higher rates than patients receiving custodial care
  57. token economy
    • based on operant conditioning principles, token economies are used in institutions to change the behavior of patients with schizophrenia
    • patients are rewarded when they behave in socially acceptable ways and are not rewarded when they behave unacceptably
    • immediate rewards are tokens that can later be exchanged for food, cigarettes, privileges and other desirable objects
    • acceptable behaviors likely to be targeted include care for oneself and one's possessions, going to a work program speaking normally following ward rules, and showing self control
    • token economies help reduce psychotic related behavior
  58. questions raised about token economies
    • many research studies have been uncontrolled instead of patients being randomly assigned to groups a whole ward will participate in program
    • patients may change overt behaviors but not underlying psychotic beliefs
    • token economies are no long as popular as they once were but still used in many mental hospitals along with medication
    • approach is also applied to other clinical problems
  59. antipsychotic drugs
    • discovered in 1950s
    • dates back to 1940s when researchers developed antihistamine drugs for allergies
    • one group of antihistamines, phenothiazines, could be used to calm patients about to undergo surgery
    • psychiatrists tested one of the drugs, chloropromazine, on 6 patients with psychosis and observed a sharp reduction in their symptoms
    • in 1954 chloropromazine (under trade name thorazine) was approved for sale in US as an antipsychotic drug
    • those developed throughout the 1960s, 1970s and 1980s are now refferred to as conventional antipsyschotic drugs
    • drugs are also known as neuroleptic drugs, because they often produce undesired movement effects similar to symptoms of neurological diseases
    • drugs develop in recent years are known as atypical or second-generation antipsychotics
  60. how effective are antipsychotic drugs
    • reduce schizophrenia symptoms in at least 65% of patients
    • drugs appear more effective than any other approach
    • drugs produce maximum level of improvement in first 6 months of treatment
    • symptoms will return if patient stop taking the drugs too soon
    • reduce positive symptoms more completely and more quickly than negative
    • although use of such drugs is now widely accepted patients often dislike the powerful effects of drugs and refuse to take them
  61. unwanted effects of conventional antipsychotic drugs
    • conventional antipsychotic drugs sometimes produce disturbing movement problems
    • extrapyramidal effects- because they appear to be caused by the drugs' impact on the extrapyramidal areas of the brain
    • parkinsonian symptoms
    • conventional antipsychotic drugs appear up to 1 year after starting medication (tardive dyskinesia)
  62. parkinsonian symptoms
    • reactions that closely resemble features of neurological disorder Parkinson's disease including
    • muscle tremor and rigidity
    • bizarre movements of the face, neck, tongue, and back
    • great restlessness, agitation, and discomfort in the limbs
  63. tardive dyskinesia
    • involves writhing or tic like involuntary movements usually of the mouth, lips, tongue, legs, or body
    • it affects more than 10% of those taking the drugs and patients over 50 years of age seem to be at greater risk
    • can be difficult sometimes impossible to eliminate
  64. what do doctors do to reduce unwatned effects of antipsychotic drugs
    • try to prescribe lowest effective dose
    • gradually reduce or stop medication weeks or months after the patient begins functioning normally
  65. newer antipsychotic drugs
    • clozaril, risperdal, zyprexa, seroquel, geodon, abilify
    • appear more effective than conventional antipsychotic drugs especially for negative symptoms
    • cause few extrapyramidal side effects and seem less likely to case tardive dyskinesia
    • do produce significant undesirable effects of their own
  66. psychotherapy and schizophrenia
    • cognitive behavioral therapy
    • family therapy
    • social therapy
  67. cognitive behavioral therapy and schizophrenia
    • seek to change how individuals view and react to hallucinatory experiences
    • provide education and evidence of biological causes of hallucination
    • help clients learn about comings and goings of hallucinations and delusions
    • challenge clients inaccurate ideas about power of hallucinations
    • teach clients to reattribute and more accurately interpret their hallucinations
    • teach techniques for coping with unpleasant sensations
    • new wave cognitive behavioral therapies also help clients to accept their streams of problematic thoughts
    • techniques help patients gain a greater sense of control, become more functional and move forward in life
    • studies indicate that these various techniques are often very helpful
  68. family therapy and schizophrenia
    • over 50% of persons recovering from schizophrenia and other severe disorder live with family members
    • creates significant family stress
    • those who live with relatives who display high levels of expressed emotion are a greater risk for relapse than those who live with more positive or supportive families
    • attempts to address such issues, create more realistic expectations, and provide psychoeducation about the disorder
    • families may also turn to family support groups and family psychoeducation programs
    • although research has yet to determine the usefulness of these groups, the approach has become popular
  69. social therapy and schizophrenia
    • include techniques that adress social and personal difficulties in the client's lives
    • include; practical advice, problem solving, decision making, social skills training, medication, management, employment counseling, financial assistance, and housing
    • research finds this approach reduces rehospitalization
  70. community approach and schizophrenia
    • broadest approach
    • in 1963 congress passed the community mental health act which provided that patients should be able to receive care within their own communities rather than being transported to institutions far from home
    • act led to massive deninstitutionalization of patients with schizophrenia
    • community care was inadequate for care (revolving door syndrome)
  71. coordinated services and schizophrenia
    • community mental health centers provide medications psychotherapy and inpatient emergency care
    • coordination of services is especially important for mentally ill chemical abusers MICAs or dual diagnosis patients
  72. assertive community treatment
    aka community care includes
    • medication
    • psychotherapy
    • help handiling daily pressures and responsibilities
    • guidance in making decisions
    • training in social skills
    • residential supervision
    • vocational counseling
    • coordinated services
    • short term hospilization
    • partial hospilization
    • supervised residences
    • occupational training and support
  73. short term hospitalization
    • if treatment on an outpatient basis is unsuccessful, patients may be transferred to short term hospital programs
    • after being hospitalized for up to a few weeks patients are released to aftercare programs for follow up in the community
  74. partial hospitalization and schizophrenia
    • patients needs fall between full hospitalization and outpatient care, day center programs may be effective
    • programs provide daily supervised activities and programs to improve social skills
    • another kind of institution that has become popular is the semihospital, or residential crisis center- houses or other structures in community that provide 24 hour nursing care for those with sever mental disorders
  75. supervised residences and schizophrenia
    • halfway houses provide shelter and supervision for those patients who are unable to live alone or with their families, but who do not require hospitalization
    • staff usually paraprofessionals
    • houses run with milieu therapy philosophy
    • help those adjust to community life and avoid rehospitalization
  76. occupational training and support and schizophrenia
    • paid employment provides income, independence, self-respect, and stimulation of working with others
    • many people recovering reveive occupational training in sheltered workshop (supervised workplace for employees who are not ready for competitive or complicated jobs)
    • alternative work opportunity for individuals with severe disorders is supported employment
  77. how community treatment fails
    • fewer than half of all people that need them receive appropriate community mental health services
    • 40-60% of people with schizophrenia receive no treatment
    • poor coordination of services
    • shortage of services
  78. poor coordination of services and community treatment
    • mental health agencies in a community often fail to communicate with one another
    • growing number of community therapists have become case managers for people suffering from schizophrenia
    • case managers offer therapy and advice, teach problem solving for their clients, guide them through the system and protect their legal rights
  79. shortage of services and community treatment
    • number of community programs available to people with schizophrenia falls woefully short
    • centers that do exist generally fail to provide adequate services for people with severe disorders
    • various reasons for these shortages the primary one is economic
  80. what are consequences of inadequate community treatment
    • 8% enter nursing homes
    • 18% placed in privately run residences where supervision is provided by untrained individuals
    • 34% placed in single room occupancy hotels, generally rundown evironments where they survive on disability payments
    • large number become homeless (1/3 of homeless people)
  81. personality
    • unique and long term pattern of inner experience and outward behavior
    • tends to be consistent and often described in terms of traits
    • personality is also flexible allowing us to learn and adapt to new enviornments
    • for those with personality disorders that flexibility is usually missing
  82. what is a personality disorder
    • enduring rigid pattern of inner experience and outward behavior that impairs sense of self emotional experience goals and capacity for empathy and or intimacy
    • rigid traits of people with personality disorders often lead to psychological pain for individual or others
  83. personality disorder typically becomes recognizable in...
    adolescence or early adulthood and symptoms last for years
  84. most dificult psychological disorder to treat
    • personality disorders
    • many sufferers are not even aware of their personality disorder
    • 9-13% of all adults may have personality disorder
  85. comorbidity
    • common for a person with a personality disorder to suffer from another disorder as well
    • reseach indicates presence of personality disorder complicates persons chances for successfuly recovery from other problems
  86. three clusters of personality disordes
    • Odd or eccentric behavior
    • dramatic, emotional or erratic behavior
    • anxious or fearfull behavior
  87. odd or eccentric behavior disorders
    paranoid, schizoid, and schizotypal personality disorders
  88. dramatic, emotional, or erratic behavior disorders
    antisocial, borderline, histrionic, and narcissistic personality disorders
  89. anxious or fearful behavior disorders
    avoidant, dependent, and Obsessive compulsive personality disorder
  90. categorial approach
    • problematic personality traits are either present or absent in people
    • personality disorder is either displayed or not displayed by an individual
    • person who suffers from a personality disorder is not markedly troubled by personality traits outside of that disorder
  91. problems with categorial approach
    it is hard to distinguish between the different disorders to diagnose
  92. dimensional approach
    • each trait is seen as varying along a continuum extending from nonproblematic to extremely problematic
    • problem is too many dimensions for reliable clinical use (table)
  93. odd personality disorders
    • display behaviors similar but not as extensive as schizophrenia, leaving the person isolated
    • related to schizophrenia and called schizophrenia spectrum disorders
    • rarely seek treatment, hard to study
  94. paranoid personality disorder
    • deep distrust and suspicion of others
    • suspicion is not usually delusional, ideas are not so bizarre or so firmly held as to clearly remove individual from reality
    • critical of weakness and fault in others, particularly at work
    • unable to recognize own mistakes and extremely sensitive to criticism
    • often blame others for things that go wrong in lives and repeatedly bear grudges
    • between 0.5% and 3% of adults are believed to experience this disorder, apparently more men than women
  95. explanations for paranoid personality disorder
    • received little systematic research
    • psychodynamic theory
    • cognitive theory
    • biological theory
  96. psychodynamic theorists and paranoid personality disorder
    trace the pattern back to early interactions with demanding parents
  97. cognitive theorists and paranoid personality disorder
    suggests that maladaptive assumptions such as people are evil and will attack you if given the chance are to blame
  98. biological theorists and paranoid personality disorder
    propose genetic causes and have looked at twin studies to support this model
  99. treatment for paranoid personality disorder
    • do not typically see themselves as needing help
    • few come to treatment willingly
    • those in treatment often distrust rebel against their therapists
    • therapy has limited effect and moves slowly
    • object relations therapists try to see past the patients anger and work on underlying wish for statisfying relationship
    • behavioral and cognitive therapists try to help clients control anxiety and improve interpersonal skills (cognitive therapists also try to restructure clients' maladaptive assumptions and interpretations)
    • drug therapy is of limited help
  100. Schizoid personality disorder
    • persistent avoidance of social relationships and limited emotional expression
    • withdrawn reclusive people with disorder do not have close ties with other people, genuinely prefer to be alone
    • focus mainly on themselves and are often seen as flat, cold, humorless, and dull
    • disorder is estimated to affect fewer than 1% of population (more often in men than women)
  101. theories for schizoid personality disorder
    • cognitive theorists propose that people with schizoid personality disorder suffer from deficiencies in thinking
    • thoughts tend to be vague and empty and they have trouble scanning the environment for accurate perceptions
  102. treatments for schizoid personality disorder
    • social withdrawal prevents people from entering therapy unless some other disorder makes treatment necessary
    • in treatment patients often remain emotionally distant from therapist, seem not to care about treatment and make limited progress
    • cognitive behavioral therapists have sometimes been able to help people with disorder experience more positive emotions and more satisfying social interactions
    • cognitive end focuses on thinking about emotions
    • behavioral end focuses on teaching of social skills
    • group therapy is apparently useful as it offers a safe environment for social contact
    • drug therapy is a little benefit
  103. schizotypal personality disorder
    • range of interpersonal problems
    • marked by extreme discomfort in close relationships, odd ways of thinking and behavioral eccentricities
    • ideas of reference and or bodily illusions
    • great difficulty keeping attention focused, conversation is typically digressive and vague even sprinkled with loose associations
    • has been estimated 2-4% of all people may have disorder (more males than females)
  104. explaining schizotypal personality disorder
    • similar factors as schizophrenia
    • linked to family conflicts and psychological disorders in parents
    • some of same biological personality disorder to some of same bioligical factors found in schizophrenia such as high dopamine
    • linked to mood disorders especially depression
  105. treatments for schizotypal personality disorder
    • hard to treat
    • need to help clients reconnect and recognize limits of their thinking
    • cognitive behavioral therapist further try to teach clients to objectively evaluate their thoughts and perceptions and provide speech lessons and social skills training
    • antipsychotic drugs appear to be somewhat helpful in reducing certain though problems
  106. dramatic personality disorder
    • so dramatic, emotional, or erratic that it is almost impossible for them to have relationships that are truly giving a satisfying
    • more commonly diganosed than other personality disorders
    • only antisocial and boderline personality disorders have received much study
    • causes of disorders are not well understood
    • treatments range from ineffective to moderately effective
  107. antisocial personality disorder
    • psychopaths or sociopaths
    • persistently disregard and violate others rights
    • aside from substance use disorders, most linked to adult criminal behavior
    • person must be at least 18 years old to recieve diagnosis
    • most patients displayed some pattern of misbehavior before age 15 years old
    • likely to lie repeatedly, be reckless, and impulsive
    • little regard for other people and can be cruel, sadistic, aggressive, and violent
    • 2-3.5% of people meet criteria for disorder (4 times more common in man than women)
    • higher rates of alchoholism and other substance use disorders among this group
  108. explaining antisocial personality disorder
    • behaviorists suggested that antisocial symptoms may be learned through modeling or unintentional reinforcement
    • cognitive view suggests people with disorder hold attitudes that trivialize importance of other peoples needs
    • biological factors may play role
    • low levels of serotonin (impact impulsivity and aggression)
    • deficient functioning in frontal lobes of brain
    • lower levels of anxiety and arousal, leading them to be more likely to take risks and seek thirlls
  109. treatments for antisocial personality disorder
    • ineffective
    • individual's lack of conscience or desire to change is a problem
    • most have been forced into treatment
    • some cognitive therapists try to guide clients to think about moral issues and needs of other people
    • hospitals and prisons have attempted to create therapeutic communities
    • atypical antipsychotic drugs also have been tried but systematic studies are still needed
  110. borderline personality disorder
    • display great instability including major shifts in mood an unstable self image and impulsivity
    • interpersonal relationships are also unstable
    • prone to bouts of anger, which sometimes result in physical aggression and violence
    • they direct their impulsive anger inward and harm themselves
    • many go to mental health emergency rooms after intentionally hurting themselves
    • form intense conflict ridden relationships while struggling with reccurrent fears of impending abandonment
    • 1.5-2.5% suffer from this (75% women)
    • instability and risk of suicide reach a peak during young adulthood and then gradually wane with advancing age
  111. impulsive self destructive behavior of someone with boderline personality disorder include
    • alcohol and substance abuse
    • reckless behavior including DUI and unsafe sex
    • self injurious or self mutiliation behavior
    • suicidal actions and threats
  112. explaining borderline personality disorder
    • psychodynamic theorists look to early parental relationships to explain disorder
    • object relations theorists propose lack of early acceptance or abuse/ neglect by parents
    • research has found some support for this view, including a link to early sexual abuse
    • also linked to biological abnormalities such as an overly reactive amygdala and an underactive prefrontal cortex
    • sufferers are particularly impulsive apparently have lower brain serotonin activity
    • relatives of those with disorder are 5 times more likely than general population to have disorder
    • others use biosocial theory- results from a combination of internal and external forces
    • some sociocultural theorists suggest that cases of borderline personality disorder are particularly likely to emerge in cultures that change rapidly
  113. treatments for borderline personality disorder
    • an integrative treatment approach called dialectical behavior therapy has received more research support than any other treatment for this disorder
    • comes from cognitive-behavioral treatment model and borrows heavily from humanistic and psychodynamic approaches
    • DBT is often supplemented by clients' participation in social skill-building groups
    • combination of drug and outpatient psychotherapy seems to be successful at reducing future hospitalizations
  114. histrionic personality disorder
    • extremely emotional and continually seek to be the center of attention
    • often engage in attention-getting behaviors and are always on stage
    • approval and praise are the lifeblood of these individuals
    • often described as vain, self centered and demanding
    • some make suicide attempts to manipulate others
    • equally found in males and females
    • 2-3% of adults have this personality disorder
  115. explaining histrionic personality disorder
    • cognitive theorists look at lack of substance and extreme suggestibility found in people with disorder
    • hold a general assumption that they are helpless to care for themselves so they seek out others who will meet needs
    • sociocultural and multicultural theorists believe disorder is caused in part by society's norms and expectations
    • vain dramatic and selfish behavior may be an exaggeration of femininity as our culture once defined it
  116. treatment for histronic personality disorder
    • more likely to seek treatment on own
    • working with them is difficult because their demands, tantrumsm, seductiveness, and attempts to please the therapist
    • cognitive therapists try to help people change belief that they are helpless and try to help them develop better, more deliberate ways of thinking and solving problems
    • psychodynamic therapy and group therapy have also been applied to help clinets deal with their dependency
    • clinical cases reports suggest that each of the approaches can be useful
    • drug therapy is less successful except to relieve depression
  117. Narcissistic Personality Disorder
    • generally grandiose, need much admiration, feel no empathy with others
    • exaggerate their achievements and talnets and often appear arrogant
    • seldom interested in feelings of others
    • take advantage of others to achieve their own ends
    • 1% of adults (75% men)
    • symptoms common among normal teens
  118. explaining narcissistic personality disorder
    • cognitive behavioral theorists propose that disorder may develop when people are treated to positively rather than too negatively in early life
    • taught to overvalue self worth
    • sociocultural theorists see link between narcissistic and earas of narcissism in society
  119. treatments for narcissistic personality disorder
    • one of the most difficult to treat
    • usually consult therapists usually do so because of a related disorder, most commonly depression
    • once in treatment the individuals may try to manipulate the therapist into supporting their sense of superiority
    • none of major treatment approaches have had much success
  120. anxious personality disorders
    • display anxious and fearful behavior
    • similar to anxiety and depressive disorders
    • reasearchers have found no direct links between cluster and anxiety and depressive disorders
    • research is very limited
    • treatments appear to be moderately helpful, considerably better than for other personality disorders
  121. avoidant personality disorder
    • very uncomfortable and inhibited in social situations, overwhelmed by feelings of inadequacy and extremely sensitive to negative evaluation
    • believe themselves unappealing or inferior and often have few close friends
    • similar to social anxiety disorder and many people with one disorder experience the other
    • both include fear of humiliation and low self confidence
    • difference is that people with social anxiety disorder mainly fear social circumstances while avoidant personality disorder tend to fear social relationships
    • 1-2% of adults
    • equal in men and women
  122. explaining avoidant personality disorder
    • assume the same causes as anxiety disorders
    • early trauma
    • conditioned fear
    • upsetting beliefs
    • biochemical abnormalities
    • research has not directly tied personality disorder to the anxiety disorders
    • cognitive theorists believe that harsh criticism and rejection in early childhood may lead people to assume that their environment will always judge them negatively
    • individuals reported memories that supported both psychodynamic and cognitive theories
    • behavioral theorists suggest that people with this disorder typically fail to develop normal social skills
  123. treatments for avoidant personality disorder
    • come to therapy seeking acceptance and affection
    • keeping them in therapy is challenging becatuse they soon begin to avoid sessions
    • key task is to gain individuals trust
    • therapist tend to treat the disorder as they treat social anxiety and other anxiety disorders
    • group therapy formats help by providing practice in social interactions
    • antianxiety and antidepressant drugs are also sometimes useful
  124. dependent personality disorder
    • have a pervasive, excessive need to be taken care of
    • clinging and obedient, fearing separation from loved ones
    • rely on others so much they cannot make smallest decisions for themselves
    • difficulty with seperation
    • feel distressed lonely and sad
    • dislike themselves
    • at risk for depression, anxiety and eating disorders, suicidal thoughts
    • 2% of population experience disorder (men and women equally)
  125. explaining dependent personality disorder
    • psychodynamic explanations are similar for depression
    • feudian theorist argue unresolved conflicts during oral stage gives rise to lifelong need for nurturance
    • object relations theorist say early parental loss or rejection prevents normal experiences of attachment and seperation (lingering fears)
    • parents overinvovled and overprotective increasing children's dependency
    • behaviorists propose that parents of patients unintentially rewarded children's clinging and loyal behavior while punishing acts of independence
    • some parents own dependent behaviors could have been models
    • cognitive theorists identify maladaptive attitudes as helping to produce and maintain disorder
    • i am inadequate and helpless to deal with the world
    • i must find a person to provide protection so i can cope
    • some thinking prevents sufferers of disorder from making efforts to be independent
  126. treatments for dependent personality disorder
    • place all responsibility for treatment and well being on clinician
    • key task to help patients accept responsibility for themselves
    • couple or family therapy can be helpful, both are often recommended
    • psychodynamic therapy focuses on many of same issues as therapy for people with depression

    • ·Cognitive-behavioral therapists try to
    • help clients challenge and change their assumptions of incompetence and
    • helplessness and provide assertiveness training

    • ·Antidepressant drug therapy has been
    • helpful for those whose disorder is accompanied by depression

    • ·Group therapy can be helpful because it
    • provides clients an opportunity to receive support from a number of peers and
    • because group members may serve as models for one another
  127. obsessive compulsive personality disorder
    • so preoccupied with order, perfection, and control that they lose all flexibility, openness and efficiency
    • set unreasonably high standards for themselves and others and fearing a mistake may be afraid to make decisions
    • tend to be rigid and stubborn
    • trouble expressing affection and their relationships are often stiff and superficial
    • 1-2% of population has disorder with white, educated, married and employed individuals most often
    • men 2 times more likely
    • believe closely realted to OCD
  128. explaining obsessive compulsive personality disorder
    • psychodynamic explanations (anal retentive) dominate and research is limited
    • borrow heavily from those of obsessive compulsive anxiety disorder
    • Freudian theorist suggest anal regressive
    • overly harsh toilet training causes people to become angry and remain fixated at this stage
    • to keep anger under control they resist both their anger and instincts to have bowel movements
    • become extremely orderly and restrained
  129. treatments for obsessive compulsive personality disorder
    • do not usually thing there is a problem and are unlikely to seek treatment unless also are suffering from another disorder or unless someone close to them insists that they got treatmenti
    • appear to respond well to therapy
    • SSRIs seem effective
  130. problems diagnosing personality disorders
    • some diagnostic criteria cannot be observed directly
    • diagnosis often rely heavily on impressions of individual clinician
    • clinicians differ widely in their judgements about when a normal personality style crosses the line and deserves to be called a disorder
    • personality disorders within a cluster or between clusters are often similar
    • people with quite different personalities may qualify for same DSM5 disorder diagnosis
  131. proposed methods to improve diagnosis of personality disorders
    • should be organized by severity of certain key traits or personality dimensions rather than presence or absence of specific traits
    • use the big 5
    • describe people with personality disorders as being high, low, or in between on the supertraits and drop the use of categories
  132. Big Five theory of personality and personality disorders
    • 5 supertraits or factors
    • neuroticism
    • extroversion
    • openness to experience
    • agreeableness
    • conscientiousness
    • everyones perosnality could be summarized by these 5 combination
  133. individuals whose traits significantly impair their functioning should receive a diagnosis of ____________________________________ under the dimensional approach
    personality disorder trait specified PDTS

    • When assigning this diagnosis, clinicians
    • would further identify and list problematic traits and rate the severity of
    • impairment caused
  134. five groups of problematic traits would be eligible for a diagnosis of PDTS
    • negative affectivity
    • detachment
    • antagonism
    • disinhibition
    • psychoticism
  135. when clinicians assign a diagnosis they must also...
    rate degree of dysfunctioning caused by each of the person's traits using a four oint scale ranging from minimally descriptive =0 to maximally descriptive =3
  136. problems with the new dimensional approach using the big 5
    • propsed changes gives too much latitude to diagnosticians
    • proposals are too cumbersome and complicated
  137. a particular concern among children and adolescents is that of being ____
    • 1/4 of students report being bullied frequently
    • more than 70% report having been a victim at least onece
  138. anxiety is a normal and common part of childhood
    since children have had fewer experiences than adults, world is often new and scary

    • –Children also may be affected greatly by
    • parental problems or inadequacies

    • –There also is genetic evidence that some
    • children are prone to an anxious temperament
  139. seperation anxiety disorder
    • begins in preschool years and displayed in 4% of children
    • feel extreme anxiety, often panic. whenever they are separated from home or a parent
    • can take form of school phobia or school refusal- children fear going to school and often stay home for a long period
  140. treatments for childhood anxiety disorder
    2/3s go untreated

    • ·Among children who do receive treatment,
    • psychodynamic, behavioral, cognitive, cognitive-behavioral, family, and group
    • therapies, separately or in combination, have been applied most often – each
    • with some degree of success
    • drug therapy in combination with psychotherapy
    • play therapy
  141. major depressive disorder
    • can be triggered by negative life events, major changes, rejection, or ongoing abuse
    • symptoms of headaches, stomach pain, irritability, and a disinterest in toy and games
    • much more common among teens
    • suicidal thoughts and atttempts
    • girls are twice as likely to be depressed by 16
    • below 13 there is no gender difference
  142. treatment of major depressive disorder
    cognitive behavioral therapy and antidepressant drugs

    • ·However, some recent studies and events
    • have raised questions about these approaches and findings, especially in
    • relation to the use of antidepressant drugs, highlighting again the importance
    • of research, particularly in the treatment realm
  143. bipolar disorder
    • ·For
    • decades, conventional clinical wisdom held that bipolar disorder is exclusively
    • an adult mood disorder, whose earliest age
    • of onset is the late teens

    • ·However,
    • since the mid-1990s, clinical theorists have begun to
    • believe that many children display bipolar disorder

    • ·Most
    • theorists believe that the growing numbers of children diagnosed with this
    • disorder reflect not an increase in prevalence but a new diagnostic trend
  144. disruptive mood dysregulation disorder
    • targeted for children with severe patterns of rage
    • new category in DSM5
  145. oppositional defiant disorder
    • argumentative and defiant, angry and irritable and in some cases violent
    • 10% of children
    • more common in boys than girls before puberty, equal in sexes after puberty
  146. conduct disorder
    • more severe problem, repeatedly violate the basic right of others
    • often aggressive and may be physically cruel to people and animals
    • steal from, threaten, or harm their victims, committing such crimes as shoplifting, forgery, mugging, and armed robbery
    • begins between 7-15
    • 10% of children, three quarters of them boys
    • mild conduct disorder may improve over time, severe conduct disorder turn into antisocial personality disorder
    • many kids are suspended from school, placed in foster homes, or incarcerated
  147. types of conduct disorder
    • overt-destructive- confrontational and aggressive
    • overt- nondestructive- openly offensive but nonconfrontational
    • covert- destructive- secretive destructive
    • covert-nondestructive- secretly commit nonaggressive behaviors
    • relational aggression- individuals are socially isolated and primarily display social misdeeds (more common in girls)
  148. causes of conduct disorder
    • genetic and biological factors
    • drug abuse
    • poverty
    • traumatic events
    • exposure to violent peers or community violence
    • tied to troubled parent-child relationships
    • inadequate parenting
    • family conflict
    • marital conflict
    • family hostility
  149. treatment for conduct disorder
    • ·Because
    • aggressive behaviors become more locked in with age, treatments for conduct
    • disorder are generally most effective with children younger than 13
    • combine several approaches
    • sociocultural treatments- parent-child interaction therapy, parent management training, treatment foster care, residential treatment in community and programs at school
    • institutionalization seems to strengthen delinquent behavior
    • child-focused treatments- problem solving skills training (combine modeling, practice, role-playing, and systematic rewards)
    • anger coping and coping power program- participate in group sessions that teach them to manage their anger more effectively
  150. prevention of conduct disorder
    • programs try to change unfavorable social conditions before disorder develops
    • work best when educate and involve family
  151. attention deficit/ hyperactivity disorder
    • ADHD
    • great difficulty attending to tasks, behave overactively and impulsively or both
    • one symptom stands out more than the other
    • half of children with ADHD also have learning or communication problems
    • poor school performance
    • difficulty interacting with others
    • misbehavior, often serious
    • mood or anxiety problems
    • 4-9% display ADHD, 70% boys
    • lessens in adolescence most time (35-60% continue to adulthood)
  152. identifying ADHD
    • childs behavior should be observed in several environmental settings, because symptoms must be present across multiple settings
    • important to obtain reports of childs symptoms from parents and teachers
    • commonly employ diagnostic interviews, rating scales, and psychological tests
  153. causes of ADHD
    • abnormal dopamine activity
    • abnormalities in frontal striatal regions of brain
    • diagnosis can create interpersonal problems and produce additional symptoms in child
  154. treating ADHD
    • 80% receive treatment
    • drug therapy- methylphenidate (ritalin)
    • worried that drugs being prescribed for kids without ADHD
    • behavioral therapy- apply operant conditioning techniques
    • combination
  155. mulitcultural factors and ADHD
    • african american and hispanic american children are less likely to be assessed for ADHD, receive diagnosis or undergo treatment for disorder
    • those who do get diagnosis are less likely to get interventions that are most helpful (expensive drugs)
  156. elimination disorders
    • repeatedly urinate or pass feces in clothes, bed or floor
    • reached age which are expected to control bodily functions
    • not caused by physical illness or medications
  157. enuresis
    • repeated involuntary bedwetting or wetting ones clothes
    • typically at night during sleep, can occur during day
    • triggered by stressful event
    • child must be 5
    • decreases with age
    • typically has close relative who has had or will have same disorder
    • most correct themselves without treatment
    • behavioral therapy can speed it up
  158. explaining enuresis
    • ·Psychodynamic theorists explain it as a
    • symptom of broader anxiety and underlying conflicts

    • ·Family theorists point to disturbed
    • family interactions

    • ·Behaviorists often view it as the result
    • of improper, unrealistic, or coercive toilet training

    • ·Biological theorists suspect a small
    • bladder capacity or weak bladder muscles
  159. encopresis
    • repeatedly defecating in one's clothing
    • less common then enuresis
    • usually involuntary
    • seldom occurs during sleep
    • starts after age 4
    • more common in boys than girls
    • causes intense social problems, shame and embarrassment
    • could stem from stress, constipation, improper toilet training, combination of all three
    • most common treatments are behavioral and medical approaches or combinations of the two, family therapy has also been helpful
  160. autism spectrum disorder
    • marked by extreme unresponsiveness to other people, severe communication deficits, highly rigid and repetitive behaviors, interests, and activities
    • symptoms appear before age 3
    • 10 yrs ago affected 1 in 2000 today its 1 in 600 and up to 1 in 88
    • 80% are boys
    • 90% remain sevely disabled into adulthood and unable to lead independent lives
    • show lack of responsiveness and social reciprocity- lack of interest in people
    • communication problems- echolalia- exact echoing of phrases spoken by others, pronominal reversal or confusion of pronouns
    • display highly rigid and very repetitive behaviors interests and activities (perservation of sameness)
    • self-stimulatory behaviors- include jumping, arm flapping, making faces
    • self injuioius behaviors
    • seem overstimulated or understimulated
  161. causes of autism spectrum disorder
    • cognitive limitations and brain abnormalities are primary causes of disorder
    • sociocultural causes
    • kanner argued personality characteristics of parents create unfavorable climate (research failed model)
    • high degree of social and environmental stress
    • psychological causes
    • individuals fail to develop theory of mind (awareness that other people base behaviors on their own beliefs, intentions and mental states)
    • biological causes
    • higher rates among siblings and highest among twins-- genetic
    • prenatal difficulties or birth dificulties
    • biological abnormality in cerebellum
    • postnatal events-- mmr vaccine (research goes against this)
  162. treatments for autism spectrum disorder
    • no treatment reverses
    • cognitive behavioral therapy
    • teach new appropriate behaviors, including speech, social skills, classroom skills and self help sills
    • communication training
    • teach sign language, and simultaneous communication (communication boards), child initiated interactions
    • parent training-- to apply techniques, help parents deal
    • community integration
    • self management, group homes, sheltered wrokshops
    • psychotropic drugs and vitamins help when combined with other approaches
  163. intellectual development disorder
    • mental retardation
    • 3 of every 100 people
    • 3/5ths are male and vast majority display mild level
    • display general functioning that is well below average in combination with poor adaptive behavior
    • IQ must be below 70
    • must have difficulty in communication, home living, self direction, work, safety
    • must appear before 18
    • for propper diagnosis clinicians should observe functioning of each individual in his or her everyday environment, taking both persons background and community standards into account
  164. features of IDD
    • person learns very slowly
    • attention difficulty
    • short term memory
    • planning
    • language
  165. four levels of intellectual developmental disorder have been distinguished
    • mild- IQ 50-70
    • moderate- IQ 35-49
    • severe- IQ 20-34
    • profound- IQ below 20
  166. mild IDD
    • 80-85% of IDD patients
    • IQ 50-70
    • educable level because the intellectual performance seems to improve with age
    • jobs tend to be unskilled or semi skilled
    • caused by poor and unstimulating environments
    • inadequate parent child interactions
    • insufficient early learning experiences
    • mothers moderate drinking or drug use or malnutrition during pregnancy to IDD
  167. profound IDD
    • 10% of IDD patients
    • IQ below 20
    • may learn to improve basic skills but they need a very structured environment with training
    • causes of profound moderate and severe IDD are biological, and could be affected by family and social environment
  168. severe IDD
    • iq 20-34
    • usually require careful supervision and can perform only basic work tasks
    • they are rarely able to live independently
  169. chromosomal causes of IDD
    • down syndrome- fewere than 1 of every 1000 live births, rate increasing with mothers age is over 35, trisomy 21
    • fragile X syndrome is second most common chromosomal cause of IDD
  170. metabolic causes of IDD
    • bodys breakdown or production of chemicals is disturbed
    • pairing of two defective recessive genes
    • one from each parent
    • Phenylketonuria (PKU)
    • Tay-Sachs disease
  171. prenatal and birth related causes of IDD
    • low iodine may lead to cretinism
    • alcohol use may lead to fetal alcohol syndrome
    • certain maternal infections during pregnancy may cause childhood problems
    • prolonged period without oxygen can also lead to problems in intellectual functioning
  172. childhood problems with IDD
    • certain injuries under the age 6 can affect intellectual functioning
    • poisoning
    • serious head injury
    • excessive exposure to x rays
    • excessive use of certain chemicals
    • minerals
    • drugs
    • infections like meningitis and encephalitis can lead to IDD if they are not diagnosed and treated in time
  173. interventions for IDD
    provide comfortable and stimulating residences, social and economic opportunities, proper education
  174. what is the proper residence for IDD patients
    • would send them to live in public institutions, state schools as early as possible (overcrowding caused residents to be neglected, abused and isolated)
    • deninstitutionalization began in 1960s
    • now small institutionas and other community residences that teach self sufficiency, devote more time, and offer education, and medical services
    • group homes, halfway houses, local branches of larger institutions, independent residences
    • try to make patients feel normal
    • children live at home and mild IDD can spend adult lives either in family home or community residence
  175. which educational programs work best with IDD
    • begin during early years
    • special education- children with IDD are grouped togeteher in seperate specially designed educational program
    • mainstreaming- places in regular classes with general population of studnets
    • neither approach is superior
    • teacher preparedness is factor that plays into decisions about mainstreaming
    • many teachers use opperant conditioning
    • communication, social skills and academic skills of individuals
    • token economy programs
  176. why is therapy needed for IDD
    • they sometimes experience emotional and behavioral problems
    • 30% or more have a diagnosable psychological disorder
    • suffer from low self esteem, interpersonal problems, and adjustment difficulties
    • helped by individual and group therapy and psychotropic medication
    • most likely to grow to by feelings if their communities allow them to grow and make many of their own choices
    • with proper training and practive, individuals with IDD can leanr to use contraceptives and carry out responsible family planning (dating skills programs)
    • holding a job allows them to feel financal security and personal satisfaction