Abnormal Psych notes
Abnormal Psych notes PSYC 2011
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Abnormal Psychology Chapter 1 I Introduction a Abnormal Psychology the study of mental disorders this includes psychological dysfunctions that the person experiences in terms of distress a complete de nition of abnormal behavior compares the behaviors and experiences in terms of those accepted in the person39s culture b Psychopathology the study of mental illness this I sin contrast with pathophysiology or pathology of our physiology c Mental disorders have been with us for all of human history i Descriptions are in Egyptian Greek Chinese Indian and other scriptures ii Movies novels plays and TV programs portray experiences of people with mental disorders d Descriptions of Mental Illness i Some describe with great energy and inability to sit still for days at a time ii Some describe with lack of control and loss of freedom or alternatively thinking iii Individuals with depression or schizophrenia have a dif cult time experiencing social interactions 1 When they talk to themselves they are usually thinking negative things iv Personal distress inability to get out of bed feeling a voice in your head with evil voices or food being a cause of instant weight gain and fat e Organizations i National Institute of Mental Health NIMH estimates that 262 of the American population experiences a diagnosable mental disorder during a given year ii World Health Organization WHO estimated that in the US and Canada mental disorders cause a greater loss in disability adjusted life years than heart disease or cancer II Stigma and Mental Disorders a Experiencing a mental disorder does not mean that one has to live a limiting life i Many individuals with mental illnesses have been told that they can never perform in a highlevel profession or have the types of relationships other people have ii Stigma negative attitudes and beliefs that cause the general public to avoid others including those with a mental illness 1 Ex Mark of disgrace 2 Stigma39s can come from inaccurate information concerning those with mental illness 3 Most people with mental illness do not show any more violence than seen in the general population 4 Stigma can also come from the belief that a person can control their mental illness lll Different Conceptions of Mental Illness a In older times there was an extreme difference in physical disorders and mental disorders i It is now seen that they interconnect ii The physical processes are made in the brain which if disturbed by mental disorders can cause differences in the body as well iii Psychopathology mental disorders mental illness refer to disorders traditionally described in scienti c and professional research and practice iv Psychopathology commonly used in neuroscience and something that is used in literature searches and clinical journals v Abnormal Psychology a research area with a long tradition in psychology IV The Three Major Themes of This Book a Behavioral and experiential perspective examines the behavior and experience observed in psychopathology especially the manner in which the signs and symptoms of a particular disorder are seen in a similar manner throughout the world i Examining current ways of classifying and describing abnormal behavior b Neuroscience perspective examines what we know about particular psychopathological experience from the standpoint of neuroscience including the structure and function of the brain the autonomic nervous system and a genetic and epigenetic consideration as it relates to psychopathology i The same brain network involved in physical pain are also involved in social rejection c Evolutionary perspective examines psychological disorders in terms of how certain ways of seeing or being in the world might be adaptive asking if there is any advantage to behaving and feeling in certain ways that others consider abnormal or if the disordered behavior is secondary to another process that is bene cial d Disorders can be protective of each other i Sickle cell anemia can help protect against malaria ii Schizophrenia is an old disorder that has existed since humans migrated over from Africa V Levels of Analysis a Levels of analysis examination of psychopathology ranging from culture and society at a higher level to the individual at a middle level and physiology and genetics at the lower levels i Higher level understanding of society and social relationships is what makes people individuals ii Levels can represent in uences on our behavior and experience iii Systems work in a series of networks with physiological processes b Biopsychosocial Approach i Biopsychosocial those with mental illness or even a medical disorder should not be understood from only a biological perspective they can also be related to social and emotional factors VI The Relation of Evolution and Culture of Psychopathology a Cultural Perspective examines the social world in which a person lives and from which a person learns skills values beliefs attitudes and other information i Culture is seen as an inheritance ii Humans learn many things from each other so culture is also formed in schools and various locations iii Spiritual experiences and artistic experiences in one culture may be considered normal and may be considered quotcrazy quot in another iv Universal ways of behaving feeling and thinking are assumed to be acquired by social learning v Genetics can in uence culture and increase body functions 1 Serotonin is associated with anxiety and depression 2 Lactose tolerance and intolerance vi Evolutionary process and cultural perspectives help answer questions about function and disorder vii Humans live less in nature and more in culture viii Evolutionary history is seen in psychology on how one relationship developed overtime to become another type of relationship Vll Humans and Their Environment a Main themes of evolution is the manner in which organisms are in close connection with their environment b Humans are born less fully developed than other animals and are sensitive to changes in their environment i We call a friend when lonely and put on a coat when it is cold ii Humans don39t only consider themselves they consider others allowing them to feel empathy iii Humans also have a sexual instinct allowing them to be attracted to a potential mate c When a human is not with a group they feel a sense of loss and negative effects such as depression d 5 ideas of psychopathology i Processes involved in psychopathology are maladaptive and not in the individual39s best interest ii The processes cause personal distress iii The processes represent a deviance from both cultural and statistical norms iv V The person has dif culty connecting with his or her environment and also with himself or herself There is an inability of an individual with a mental disorder to fully consider alternative ways of thinking feeling and doing VIII Is Psychopathology Universal a Some believed that mental illness was a myth created by Western society i View of mental illness was seen differently in industrial western society and other rural areas ii Studied different places to gure out whether the basis of mental illness was similar in both places saw results as true iii Affective disorders include feeling tense anxious and fearful of being with others IX Experiential Perspective a Experiences of people with disorders is very important to understanding the disorder Chapter 2 I Historical Considerations in Understanding Psychopathology a Ancient Greek and Roman In uences Mental Illness Involves the Brain V There was an emphasis on nding out the scienti c principles that accounted for all forms of behavior Pythagoras was one of the rst to see that the brain structure helped with human intellect and mental disorders Hippocrates saw that the idea of all disorders should be sought within the patient Greeks and their beliefs 1 Believed in complex processes and also believed in breaking those processes into simpler parts 2 Understood the world in terms of earth air re and water humors a Thought that the body had forms of the elements i Yellow bile re ii Blood air iii Phlegm water iv Black bile earth b When the humors were out of balance a person was said to be I so any cure consisted of the humors being in balance Galen was a physician who in uenced Western and Islamic thought 1 Representation in experimentation of medicine 2 Figured out a general understanding to the structure and function of the nervous system 3 Studied the cranial nerves involved in sight smell movement and other functions a The sympathetic nervous system that involves ght or ight reactions b Psychopathology in the Middle Ages i Mental diseases were seen as the devil possessing a person39s body ii It was believed that witches were people with mental illnesses c From the Renaissance to the 17005 the Beginning of Modern Science i Ideas about medicine and health were remaining stagnant because the church39s rule over the government ii The beginning of the 14th century ideas about art literature politics and science started to change 1 Leonardo da Vinci carefully studied the human body and performed dissections to learn more 2 15005 da Vinci started to take an interest in studying the structures of the brain iii Science and anatomy started to emerge because of artists renditions on the human body and its workings iv Descartes saw all human involuntary actions as mechanics v Behavior 1 Voluntary thinking or consciously performing an act 2 lnvoluntary actions that occur out of re exive motion vi Descartes bodymind theory 1 The mind and body work together and have a relationship ll Discovering the Function of the Brain in Behavior and Psychopathology a Introduction i Thomas Willis 16005 was interested in neurology and coined terms such as lobe hemisphere pyramid and corpus striatum 1 First person to use the word psychology 2 Was determined to combine the study of structure and function 3 Believed lower brain was responsible for basic functions and they were found across vertebrates 4 Higher brain parts were involved in more advanced processes 5 Noted how mania and depression could change into one another a Witch hunting was a problem at this point ii End of the 17005 nervous system had been completely dissected and the major parts were described in detail 1 Scientists started to learn the general pattern in all human brains and how the brains were structured b The 17005 to the 19005 i Galvani and BoisReymond were able to show that electrical stimulation would cause brain reactions 1 Nerves were thought of as wires that electricity would pass through i 18005 discovery of the idea that brain and muscle interact with each other 1 Many nerves are connections for both receiving and sending information i 17005 different functions could be localized to different parts of the brain iv Hierarchial lntegration through inhibitory control the various levels of the brain such as the brain stem the limbic system and the neocortex are able to interact with each other and the type of interaction from the higher levels is restricting or inhibiting the lower levels v Encephalization the principle by which more recently evolved higher level systems in the brain control the older lower level centers c The 18005 and Evolution i Charles Darwin started to spread the theory of evolution ii Variation the assumption that heritable variations can and do occur in nature iii Natural selection Darwin39s idea that if an individual has even a slight variation that helps it to compete successfully for survival then over time the species will be made up more and more of members with these characteristics and less and less of individuals lacking these features iv Sexual selection the manner in which males and females choose a mate 1 Competition to attract and nd a mate d A Search for Organization i Symptoms features observed by patient ii Signs features observed by the children iii Syndrome determination of which signs and symptoms go together iv Charcot is best known for describing brain disorder for many motorrelated disorders Parkinson39s ALS 1 Helped integrate disorders of both psychological processes and brain processes v Mental problems were seen as problems from natural causes 1 The speculation that they were from demons was slowly disappearing lll Care for Those With Mental Disorders a Introduction i 1330 convent of St Mary of Bethlehem was the rst institution for the mentally ill ii Alylums started coming into play 1 1814 about 96000 people visited an asylum iii 18005 a campaign arose in England to change the conditions for the patients iv Benjamin Rush Phillipe Pinel and Vincenzo Chiarugi were people who studied and created better environments in hospitals and various sites for the bene t of people with mental disorders 1 Rush created a wing in the Pennsylvania Hospital to help people with mental disorders 2 Pinel tried to change the way insane patients were treated and studied natural science and the beginnings of mental illness 3 Chiarugi director of a hospital in Italy that had facilities for the mentally ill v Others 1 Tuke visited asylums and wrote about making people happier in such unhealthy places 2 Dix helped teach many people with mental illnesses and encouraged the US government to nd places for these people with mental illnesses rather than torn up asylums IV From the Past to the Present a Introduction i 2 Perspectives in Mental illness 1 Mental illness is caused by supernatural forces or the devil a Rituals were used to get demons and supernatural forces out of a person 2 Using psychology and physiology in a broad sense a Uses science to understand the mechanisms that cause mental illness V The Psychological Treatment Perspectives in the 20th Century a Introduction i 2 Sides to people with mental disorders 1 How the person responds to their own symptoms 2 Compromises the treatments that mental health professionals have developed to treat the disorder ii 3 approaches for psychological treatment of mental disorders 1 Psychodynamic approach 2 Existentialhumanistic approach 3 Cognitive behavioral approach iii These treatments have all been made independently b Psychodynamic Perspectives on Treatment i Psychodynamic perspective emphasizes that behaviors and experience may be in uenced by internal processes that are out of awareness Our evolutionary history cultural in uences and personal experiences can lead to con icting reactions to an interaction with others and the environment ii Psychoanalysis treatment developed by Freud based on the search for ideas and emotions that are in con ict on an unconscious level this also includes the manner in which the person repeats negative relationships with other people based on past history rather than current interactions c ExistentialHumanistic Perspective vi vii Viii Existential humanistic perspectivethe existential humanistic approach focuses on the experience of the person in the moment and the manner in which he or she interprets the experiences it emphasizes processing and understanding both internal and external experiences of human life Selfrealization recognition of who one is and what one appreciates in terms of their connections with themselves and others Real self self includes who one is and what one appreciates Client centered therapy also called personcentered therapy an approach characterized by the therapist39s empathic understanding unconditional positive regard genuineness and congruence Hierarchy of needs Maslow39s theoretical concept for understanding the nature of human needs which states that one must meet lowerlevel needs hunger thirst and safety before attaining higherlevel needs belongingness and love esteem and selfactualization Being comfortable with self Unwillingness to reveal self Externalizes Wants to be different Freer description of feelings Recognition of con ict between feelings and thoughts Experience feelings without denial more willing to risk relationships 7 Comfortable with self and with having new feelings Selfactualization the situation in which one lives one39s life to the fullest Emotion focused therapy also known as process experiential therapy in this therapy emotion is viewed as centrally important in the experience of self as either adaptive or maladaptive and as the crucial element that brings about change and management of emotional experiences 5 principles of emotion focused therapy 1 Experiencing is the basis of thought feeling and action 2 Human beings are fundamentally free to choose how to construct their worlds 3 People function holistically while at the same time are made up of many parts 4 People function best and are best helped by a therapist who is psychologically present 5 People grow and develop to the best of their abilities in supportive environments P P PP NE x Mindfulness a meditation technique involving an increased focused nonjudgmental purposeful awareness of the present moment to observe thoughts without reacting to them in the present d Behavioral and Cognitive Behavioral Perspectives i Behavioral perspective an approach focused on the level of actions and behaviors ii Classical conditioning given that an unconditioned stimulus such as food results in an unconditioned response such as salivation classical conditioning is the pairing of the unconditioned stimulus with a neutral stimulus such as a bell a number of times then the neutral stimulus will produce the response such as salivation iii Extinction the process by which after a period of time the conditioned stimulus when presented alone will no longer produce the response iv Operant conditioning the idea that behavior can be elicited or shaped if reinforcement follows its occurrence v Reinforcement rewards that follow behaviors and increase their occurrence vi Observational learning also known as modeling when humans imitate the behaviors of others even without reinforcement vii Cognitive behavioral perspective a perspective that suggests that dysfunctional thinking is common to all psychological disturbances by learning in therapy how to understand one s thinking it is possible to change the way one thinks as well as one s emotional state and behaviors viii Beck39s cognitive triad 1 Negative views about the worldgt negative views about the future gt negative views about oneself circle connec on ix Cognitive behavioral therapy CBT a therapy based on the cognitive behavioral perspective directed at changing the individual39s faulty logic and maladaptive behaviors 1 Sought to understand how cognitions were disrupted in mental disorders Chapter 3 l Diagnostic Considerations of Psychopathology a Memory a process including speci c brain areas such as the hippocampus and the biochemical and structural changes among neurons as new information is retained b Categorical the situation in which objects or concepts are de ned as part of a category categorical de nition of a mental disorder results in the person either having the disorder or not can be contrasted with dimensional de nitions c Dimensional the situation in which objects or concepts are de ned along a continuous scale dimensional de nition of a mental disorder re ects that a person can experience the disorder in terms of differing degrees temperature is an example of a dimensional de nition whereas ice and steam represent categorical de nitions d Comorbid this refers to an individual having more than one disorder at the same time i More common than only having one disorder ii Tend to cooccur with each other e Internalizing disorder disorders that are experienced internally such as anxiety and depression f Externalizing disorders disorders that are manifested in the external world and include conduct disorder CD ODD antisocial personality disorder substance use and ADHD i Contrasts internalizing disorders Neuroscience Perspectives a Introduction i Diagnostic and Statistical Manual of Mental Disorders DSM publication of criteria for diagnosis by the American Psychiatric Association APA used in North America ii International Classi cation of Diseases ICD a publication of criteria for diagnosis by the World Health Organization WHO used in Europe 1 There has been a push to nd more objective markers to diagnose and treat mental disorders 2 Use of various levels of analysis such as brain imaging genetics biochemical and electrophysiological processes brain networks behavior and experience 3 Other researchers are looking at cognitive emotional and motor processes iii Reward system particular brain structures especially the nucleus accumbens part of the ventral striatum in uenced by an increase in dopamine during reward 1 Humans seek rewards from various sources including food sex power acclaim and af liation 2 Ex alcoholics receive this reward of dopamine with the use of alcohol iv The problem of using neuroscience to classify disorders is that some symptoms aren39t consistent between all people with the disorder v National Institute of Mental Health NIMH one large organization of the US government that advances the vi vii understanding and treatment of mental disorders NIMH emphasizes the utilization of neuroscience information to understand mental illness The NIMH developed 4 major objectives Research will 1 De ne the pathophysiology of disorders from genes to behavior 2 Map the trajectory of illness to determine when where and how to intervene to preempt disability 3 Develop new interventions based on a personalized approach to the diverse needs and circumstances of people with mental illnesses 4 Strengthen the public health impact of NIMH Research Domain Criteria RDoC ve domains established by the National Institute of Health to better clarify our understanding of psychopathology which are negative affect positive affect cognition social processes and regulatory systems 1 Negative affect includes fear distress and aggressions 2 Positive affect includes reward seeking learning and the creation of habits 3 Cognition includes how individuals conceptualize and think about themselves and their environment 4 Social processes includes how individuals experience and view others 5 Regulatory systems includes the variety of individuals regulatory systems ranging from the sleep wake cycle to the manner in which they regulate their emotions b What are Endophenotypes Endophenotypes patterns of processes that lie between the gene and the manifestations of the gene in the external environment 1 Cannot be seen unless with special equipment and computational analysis 2 Someone displaying the endophenotypes of a certain disorder may not actually have the disorder but may have relatives or another problem c Genes Genes form a blueprint for what an organism is supposed to be Speci c genes have been associated with different disorders 1 Ex there is a gene called SERT that has been associated with depression alcoholism eating disorders ADHD and autism Proteins do the work of the body and are involved in a variety of processes functionally proteins in the form of enzymes are able to make metabolic events speed up whereas structural proteins are involved in building body parts iv 5 major disorders seen with gene dysfunction 1 Autism Spectrum disorder 2 Schizophrenia 3 Bipolar disorder 4 Major depressive disorder 5 ADHD v Some research shows that the genes that associate with certain mental health problems schizophrenia can help those people refrain from certain physical disorders cancer vi Epigenetics study of the factors that turn the genes on and off and are passed on to the next generation these are largely in uenced by the environment of the organism vii Neurotransmitters chemicals which are involved in increasing or decreasing the potential for action potentials to be produced they also maintain the communication across the synapse 1 Ex MAOA gene makes the neurotransmitters serotonin norepinephrine and dopamine d Neural Networks i Networks have been studied in a variety of cognitive and emotional tasks ii Central executive network the neural network involved in performing such tasks as planning goal setting directing attention performing inhibiting the management of actions and coding of representations in working memory iii Salience network the neural network involved in monitoring and noting important changes in biological and cognitive systems iv Disorders such as schizophrenia depression anxiety dementia and autism have been associated with these networks being turned off and on lll Neuroscience Techniques and Levels of Analysis a There are various levels of analyzing behavior b One group of individuals with a disorder appear differently than another group without a disorder on certain traits and measures c To say that mental disorders are actual brain diseases there needs to be evidence that the brain is different to prove that psychopathology is actually associated with the brain d Electroencephalography EEG a technique for recording electrical activity from the scalp related to cortical activity which re ects the electrical activity of the brain at the level of the synapse IV The Brain a The brain works with neurons which are the building blocks of the brain systems i Cell contains DNA ii Axon comes from cell and conveys information iii Dendrites receive information from other cells b There are two types of synapses that connect axons i Chemical synapse ii Electrical synapse V How Does the Neuron Pass Information a Group of steps i Neurotransmitters need to be created and stored ii An action potential travels down the axon to the terminal iii Through a variety of processes a neurotransmitter is released into the gab between the two neurons iv The neurotransmitter then binds with speci c proteins in the next neuron v This either increases or decreases the possibility that the next neuron will create an action potential vi The gap between the two neurons must be made neutral at this point by any of a number of mechanisms including making the neurotransmitter inactive having it taken up by the rst neuron and removing it from the gap between two neurons VI Encoding Information a Introduction i Although there are a variety of sensory systems the neurons connected to these all produce similar action potentials to external stimuli This universality is seen across a variety of species ii The rate of spiking increases as the stimulus becomes larger iii If a given stimulus is continued for a long period of time the spiking will decrease b Unique Aspects of the Human brain i babies have the most neurons they will ever have 1 this is seen in the fact that babies can hear any sound in any language in the world but they lose these abilities as they grow up VII How do we observe the Brain at Work a Introduction i Major types of brain imaging 1 EEG 2 Positron emission tomography PET a measure related to blood ow in the brain that re ects cognitive processing PET systems measure variations in cerebral blood ow that are correlated with brain activity 3 fMRI based on the fact that blood ow increases in active areas of the cortex because hemoglobin which carries oxygen in the bloodstream has different magnetic properties before and after oxygen is absorbed by measuring the ratio of hemoglobin with and without oxygen the fMRI is able to map changes in cortical blood and infer neuronal activity 4 Magnetoencephalography MEG measures the small magnetic eld gradients exiting and entering the surface of the head that are produced when neurons are active 5 Diffusion tensor imaging DTI use of the magnetic resonance imaging MRI magnet to measure cortical connections in the brain a procedure for showing ber tracts white matter in the brain b Electroencephalography i EEG is a way of recoding eleccortial activity from the scalp ii First demonstrated by Hans Berger in 1924 and published 5 years later iii Measured by synapse connection activity iv EEG can use 2 electrodes or a high density system of more than 200 electrodes 1 The activity is measured from the difference between the signals at any two electrodes v Amplitude how large the signal is vi Frequency how fast the signal cycles measured in cycles per second vii Brain activity sleeping wake thinking stress are seen by the various wavelength frequencies in the brain 1 Drugs cocaine can cause changes in EEG frequency bands viii Event related potentials ERPs also known as evoked potentials EPs show electroencephalography EEG activity in relation to a particular event c Magnetoencephalography i MEG measures brain activity when neurons are active ii It uses SQUID to detect small magnetic activity that results from the activity of neurons iii Person puts their head slightly on a device that contains magnetic sensors iv MEG signals do not get disrupted when traveling through the skull unlike EEG d Functional Magnetic Resonance Imaging i fMRI is based off the fact that blood flow increases in active areas of the cortex ii Measurements are made by having a person lie on their back inside a large magnet and radio frequency device 1 Measures changes in blood oxygen levels e Spatial and Temporal Resolution i A researcher needs to know what kind of information they are looking for when they are picking their experiment VIII Networks of the Brain a Introduction i Researchers have been working to nd the certain networks in the brain that associate with particular cognitive emotional and motor processes 1 Resulted in seeing the turning on and turning off of certain parts of the brain Networks allow the brain to process information ef ciently b Neurons Connect in a Network iii iv Small world framework this is a model of brain connections based on the idea that the ability to socially contact any two random individuals in the world can be accomplished in a limited number of connections neurons have numerous shortdistance local connections which taken together can be considered as a hub or module from these hubs are more longdistance connections to other hubs39 the small world perspective suggests that the connections between any two nodes in the brain can be represented by only a limited number of connections Local hubs can be made up of neurons connected to each other at a short distance The default network is active for the person39s basic needs The central executive network is involved in higher level thinking and cognition c What is the Brain39s default intrinsic Network iv the mind is constantly working even when a person isn39t necessarily doing anything the mind jumping from one thought to another is called stream of consciousness default or intrinsic network neural network that is active during internal processing does not require external sensory information d Different Networks are Involved in Different Tasks V vi Executive and salience networks are dysfunctional in different psychopathologies Central executive network is involved in performing such tasks as planning goal setting directing attention performing inhibiting the management of actions and the coding of representations Executives functions cognitive functions involved in planning understanding new situations and cognitive exibility The three networks default executive and salience show disrupted behavior in people with depression schizophrenia anxiety dementia and autism Modularity describes how speci c areas of the brain are dedicated to certain types of processes Connectivity a concept that asks how different areas of the brain work together in speci c conditions e Major Neurotransmitters in the Brain Chemical synapse uses neurotransmitters critically 1 Neurotransmitters are chemicals that are involved in increasing or decreasing the potential for action potentials to be produced 2 Largely in uence a variety of processes including those associated with psychopathology In terms of structure neurotransmitters can be classi ed in terms of size 1 Small molecule neurotransmitters such as glutamate can be involved in rapid synaptic functions 2 Larger protein molecules referred to as neuropeptides can be made up of 3 to 36 amino acids In terms of function neurotransmitters can be categorized into three broad groups 1 The rst includes those that mediate communication between neurons GABA 2 Second includes those neurotransmitters which in uence the communication of informationopioid peptides 3 Third includes neurotransmitters that in uence the activity of a large population of neurons IX The Study of Genetics a Introduction Gregor Mendel started the study of genetics by studying plants and the characteristics they shared with their offspring Mendel39s rst law or the law of segregation for the trait to appear both nondominant elements must be present Mendel39s second law or the law of independent assortment the inheritance of the gene of one trait is not affected by the inheritance of the gene for another trait Chromosome a DNA molecule along with the proteins attached to it 1 23 different pairs of chromosomes b What Do Genes Do iv V vi vii C DNA Allele the alternative molecular form of the same gene Homozygotes or homozygous when a person has two copies of the same allele Heterozygotes or heterozygous when a person has two different alleles at the same location Different allele combinations allow for variation in the genetics allowing for more variation in the general population Encode to lay out the process by which a particular protein is made this is the job of a gene Only a limited amount of genetic information is expressed at a time Genes turn on and off relative to speci c events The discovery of DNA made it clear that genetic material can be copied Genotype genetic material Phenotype organism39s observable characteristics iv RNA information that determines the sequence of amino acids which are the building blocks of which are the building blocks of proteins it is made up of single strands rather the dual strands in DNA v DNA represents the chemical building blocks that store information X How do Genes In uence Behavior a The production of proteins can be transitory i Momentary and long term changes can change the behavior b Epigenetics i Epigenetic inheritance another form of inheritance by which factors largely in uenced by the environment of the organism that turn the genes on and off can be passed on to the next generation without in uencing DNA itself ii Epigenetic marks or tags that which in uences whether a segment is relaxed and able to be activated or condensed resulting in no action iii The environment can in uence the behavior and actions of certain genes c Mitochondria and Mitochondrial inheritance i Mitochondrial DNA mtDNA DNA of mitochondria structures within a cell because mtDNA does not recombine sections of DNA from the mother and father it is very stable and mutates sowy ii Mitochondrial inheritance generally mitochondrial DNA mtDNA is inherited only from the mother XI The Themes of Evolution a Organisms are in close connection with their environment allowing them to change by turning on and off genetic processes b Humans are born less developed than other animals so they are more sensitive to changes in their environment i We also develop societal and cultural perspectives ii Humans can also re ect on their thoughts and their ways of viewing the world c Ideas of connectedness happens on an external and internal IeveI XII Psychopathology from and Evolutionary Perspective a Schizophrenia is a disorder that has always been part of the human expe ence i Genes were carried in early human beings ii It is not understood to why it still exists if survival of the ttest were to occur iii Schizophrenia may be a protection against another disease causing it to continue to thrive sicklecell anemia and malaria b Evolutionary psychology heIps question and understand why a certain disease exists and why it is still about c AIso helps with developmental and social processes and how these processes are enveloped in the study of psychopathology d Evolutionary process of psychopathology in 6 parts Is the experience of the mental illness universal Is there an adaptive value to the behaviors and experiences displayed in psychopathology Look for evidence of psychopathology across human history Try to understand the nature of psychopathology Is it protective in some manner against other problems sickle cell and malaria ls psychopathology a recent process a Neuroethics a eld of ethical inquiry that is asking how brain processes are involved in making moral decisions as well as who should have access to your internal processes IV V vi Xlll Neuroethics Chapter 4 Introduction a Science a process of understanding the world through observation and research which includes developing theories b Hypothesis a formally stated expectation What is Science a Facts general conclusions drawn from observations b Scienti c knowledge the known facts about a particular subject derived from the scienti c method c Doubt to question our ideas and our research and ask whether factors other than the ones that we originally considered might have in uenced our results d Falsi cation the approach by which a claim is shown to be wrong in philosophy of science it is the position that a goal of science is to falsify hypotheses The Methods of Science a Introduction There are three stages for methods of science 1 First scientists begin with an idea or expectation hypothesis 2 Second scientists look to experience to evaluate the accuracy of their ideas or expectations about the world 3 Third scientists seek to draw conclusions or inferences about their ideas and expectations Science is the way of determining what we can infer about the world b Case Study Case study a method for studying individual participants This experiment type has a tradition of studying cases that are not ordinary or extremely rare Some ways of understanding the brain the most come from studying situations of injury Advantage is that you can present the clinical implications of a particular disorder 1 Describe processes that do not reduce to a single variable Phineas Gage39s brain 1 Got a railroad rod into his brain but survived 2 Fully recovered from his injury 3 His personality changed completely from sweet to ill tempered c Naturalistic Observation Just Looking Naturalistic observation observing and describing the phenomenon occurring naturally without manipulating any variables Used this technique to study children and adults as well as interactions between people at mental hospitals This observation type has four factors 1 Noninterference is of prime importance 2 This method emphasizes the invariants or patterns that exist in the world 3 This method is most useful when we know little about the subject of our investigation 4 The naturalistic method may not shed lights on the factors that directly in uence the behavior observed d Correlational Approach What Goes With What vi vii Correlational approach an approach designed to help us understand how speci c factors are associated with one another Looking at the correlation between psychological and physical heath Correlation coefficient a statistical technique to determine if an association exists in a relationship Positive correlation the correlation statistic is a technique to determine if two variables are related to each other a positive correlation is when two measures vary together Negative correlation the correlation statistic is a technique to determine if two variables are related to each other a negative correlation is when the two measures show an inverse relationship Few relationships are perfectly correlated Researchers in correlational studies are interested in asking whether there is an association between two variables e Experimental Method Making it happen Experimental method an approach in which the in uence of the independent variable on the dependent variable is determined with random selection and random assignment of participants Experimental group a group that receives the independent variable in a study V vi vii viii ix Control group a group that is treated exactly like the experimental group except for the independent variable factor being studied Operational definition the de nition of events in terms of the operations required to measure them which thus gives an idea a concrete meaning Independent variable the manipulated variable in an experimental study Dependent variable depends on or is in uenced by the independent variable Validity truth and capability of being supported Confounding variables unintended variables not chosen by the experimenter that in uence the independent variable Covary the degree to which variables are related to one another f Logic and Inference The detective work of Science lnference the process by which we look at the evidence available and then use logic to reach a conclusion Internal validity the ability to make valid inferences between the independent variables and dependent variables External validity also known as generalizability the possibility of applying the results from an internally valid experiment to other situations and other research participants Generalizability also known as external validity the possibility of applying the results from an internally valid experiment to other situations and other research participants g What Do I expect to happen V Demand characteristics bias that occurs when a participant39s response is in uenced more by the research setting than by the independent variable Placebo effect the phenomenon that some people show psychological and physiological changes from the suggestion that a change will take place Experimenter effects bias that occurs due to the experimenter39s expectation Double blind experiment research participants do not know whether they are in the experimental group or the control placebo group and the researchers involved in the study do not know whether the participants are in the experimental group or the control placebo either thus both the participants and the researchers are blind to the experimental conditions Blind controls research participants who do not know whether they are in the experimental group or the control group h Designing an Experimental Study 4 factors 1 Participant selection 2 Participant assignment 3 Design of the experiment vi vii Viii x xi xii 4 Interpretation of relation of Independent variable IV to dependent variable DV Population in a research study this is the larger group of individuals to which the results can be generalized Randomization a process that controls for both known and unknown potentially confounding variable randomization leaves soIer Match subjects design a design type in psychopathology research in which the closer a scientist can match individuals in the individual and control groups the stronger the logic of the de gn NuII hypothesis a statistical hypothesis that is tested to determine if there are differences between the experimental and control groups the null hypothesis states that there is no difference Confound hypothesis a conceptual question that asks if our results could be the result of a factor other than the independent variable IV Research hypothesis the formal statement of the manner in which the dependent variable DV is related to the independent variable IV Probability whether a set of results differed from what would be expected by chance Inferential statistics a study that concerns the relationship between the statistical characteristics of the population and those of the sample SampIe participants in a study Confound something that systematically biases the results of our research Developing a hypothesis gt designing an experimentgt performing the experiment gt interpreting the results i Single Subject Design Single subject design also referred to as smaIIN designs use the data from each participant without averaging it as part of a group of participants j Longitudinal Research Longitudinal design a research design that allows the researcher to follow a speci c group of individuals across a period of time to document any changes that take place during that time Ex One case followed children with ADHD for 9 years and noted changes in their speci c symptoms Advantages 1 Allows the study of natural history of the developmental disorder 2 We can note when and in what manner the changes in disorders take place k Epidemiological Research VI vii Epidemiology the study of the distribution and determinants of the frequency of a disorder in humans Helpful in determining the nature and prognosis of a given disorder Prevalence the proportion of individuals who have a particular disorder at a particular time period Lifetime prevalence the percentage of a speci c population that had the disorder at some point in their life even if they no longer show symptoms of the disorder currently Also allow psychologists to look at particular populations lncidence the number of new cases of a disorder that develop during a certain period of time Risk a way of thinking about incidence which asks how likely someone in a speci c population is to develop a particular disorder in a given time period I Research Involving Genetics vi vii viii Continued understanding links mental disorders to genetics Behavioral genetics the study of genetic and environmental contributions to organisms39 behavior Gene by environment interaction the possibility that individuals with different genotypes may respond to the same environment in different ways Gene by environment correlations how certain genotypes and certain environments occur together Twin studies a major paradigm of behavioral genetics involving examination and understanding of critical factors related to genetic in uences by studying twins Monozygotic MZ twins identical twins resulting from the zygote dividing during the rst two weeks of gestation Dizygotic DZ twins twins who arise from the situation in which two different eggs are fertilized by two different spermatozoa these are called fraternal twins since their shared genes are approximately 50 the same as that between any two siblings Adoption study the situation where dizygotic and monozygotic twins have been raised apart by studying those children who were twins and were raised in different environments it was possible to better determine the environmental and genetic in uences in terms of development 1 This helped see whether behavior was more genetically in uenced or environmentally in uenced Linkage analysis an examination or generations of families that looks for the association between particular DNA marker alleles and particular traits m Clinical and Statistical Signi cance i Statistically signi cant the probability that the independent variable in uences the dependent variable by chance by using statistics we ask if we performed the same experiment 100 times what is the probability we would obtain the results seen in the present study ii Clinically signi cant this refers to the question of whether the results of a study even if statistically signi cant would in uence clinical outcomes iii Effect size the measured magnitude that a treatment has on the dependent variable n Replication and MetaAnalysis i Replicated when a study is performed in different laboratories with different participants and obtains the same results 1 Scientists try to nd a number of different studies from different laboratories that answer the same research question ii Meta analysis statistical examination of the results of studies taken together and treated as one study lV Ethics and the Scienti c Experiment a Introduction i Ethics the study of proper action 1 Examines the relationship between human beings and provides principles regarding how we should treat each other 2 At the end of an experiment participants should not be affected in a way that would result in lower level of human functioning ii Questions to be asked 1 What are the responsibilities of the scientist toward the participant 2 What are the rights of the participant 3 Are there guidelines for reconciling con icts between the rights of the participant to pursue happiness and the rights of the scientist to pursue knowledge 4 What type of relationship or dialogue would be most productive for helping the scientist and participant to ful ll their needs and desires iii Belmont Report guidelines of psychopathological ethics 1 Respect for persons includes the ides that people can choose on their own 2 Bene cence is to be understood in a strong sense meaning that research should do no harm 3 Research should be available to all people and not just to special classes or groups b The Experiment as an Ethical Problem i Nazi Germany was not violating ethical code by doing the harm that they did they were violating code because they did not take the consent of their patients c Ingredients of the Initial Scientist Participant Dialogue i Voluntary participation a principle stating that a person should participate in an experiment only by free choice and should be free to leave an experiment at any time whether or not the experiment has been completed ii Informed consent the prospective participant must be given complete information on which to base a decision including information about what will be required of him or her during the study and about any potential harm that may come from participation d The Rights of the Research Participant and the Responsibilities of the Experimenter i Right to privacy the right to spend time by oneself or with others of one s choosing without being disturbed and the right to have private thoughts ii Private personality the private thoughts of a person iii Confidentiality a principle that requires that the scientist not release data of a personal nature to other scientists or groups without the participant39s consent iv Anonymity a principle that requires that the personal identity of a given participant be kept separate from his or her data e What is Harmful to a Research Participant i Institutional review board IRB a committee to determine whether the participants are adequately protected in terms of both welfare and rights and to determine when a risk is unreasonable ii Questions that may seem to cause harm 1 Is it harmful to show participants something that is true butnegaUve 2 Is it harmful to create situations in which participants feel negative emotions such as fear or anger f Institutional Review Board i Requires each scientist who receives federal funds to seek a review of the ethical considerations of research with human participants ii IRB determines whether the participants are adequately protected in terms of both welfare and rights 1 Any risks can include physical psychological or social 2 Committee also looks for possible long term effects on a patient Chapter 5 The Mental Status Exam a Mental status exam clinical interview organized into major categories designed to determine a person39s cognitive processes vi First major category of the exam is the individual39s appearance and behavior 1 This includes clothing movements activity 2 This can note different things such as if the person has depressive or manic movements eye contact The second category is the exam of move and affect 1 Affect refers to the emotions that the individual is expressing The third category is speech quality 1 How the person speaks and the quality in which they speak The fourth category is thought process 1 Flight of ideas responses that are not related to the question asked or that tell a narrative in which each sentence is not related to the one that came before it 2 Delusional thinking an unrealistic pattern of thoughts forming a theme 3 Obsessional thinking a pattern of repeated thoughts beyond the control of the person The fth category is perceptions and general awareness 1 Distortions of perceptions can include hallucinations Last category describes intellectual functioning and insight 1 Intellectual functioning is noted in terms of current vocabulary used II Structured Interviews a Structured Interview an interview that is highly structured in terms of the questions asked allowing for better consistency across interviewers and clients b Structured Clinical Interview for DSM Disorders Structured Clinical Interview for DSM Disorders SCID an interview that directly probes for the existence of the criteria for disorders within the current classi cation manual the Diagnostic and Statistical Manual of Mental Disorders DSM5 SCID helps determine if a type of behavior falls into a certain disorder as if it is either OCD or anxiety III Assessing Cultural Dimensions a There has been increasing awareness in mental illnesses in context of culture b CuIturaI Formulation Interview a set of questions developed to help mental health professionals obtain information concerning the person39s culture and its in uence on behavior and experience CuIturaI identity of the individual how does a person consider themselves immigrants CuIturaI conceptualizations of distress how they experience or express distress iii Psychosocial stressors and cultural features of vulnerability what are stressors that impact their ability to express distress iv Cultural features of the relationship between the individual and the clinician is there a particular relationship culturally between individual and clinician v Overall cultural assessment doing an overall assessment to nd out the diagnosis IV Reliability and Validity in Relation to Psychopathology a Introduction i quotfake goodquot behaving good to deny problems ii quotfake badquot behaving bad to get more disability payout iii Reliabilityconsistency of the instrument b Reliability i Internal reliability whether different questions asked on an instrument relate to one another ii Testretest reliability whether two measurement opportunities result in similar scores correlation in time behaving one way at one time and behaving the same way after a certain degree of time iii Alternative form reliability whether different forms of an instrument give similar results iv Interrater reliability how similar two or more individuals are when they observe and rate speci c behaviors one person agrees with the ndings of another person c Validity i Asks whether the instrument being used is accurate 1 Content validity the degree to which an instrument measures all aspects of the phenomenon 2 Predictive validity the degree to which an instrument can predict cognitions emotions or actions that a person will experience in the future 3 Concurrent validity the ability of an instrument to show similar results as other established measures of the construct 4 Construct validity the extent that an instrument measures what it was designed to measure 5 Ecological validity the manner in which data collected has been considered beyond the local context V Models of Assessment a Symptom Questionnaires i It is important to know what a person39s symptoms are and how they compare with other people39s symptoms ii Beck Depression Inventory BDI a questionnaire useful for determining the level of depressive symptoms that a person is reporting 1 Example a I am not particularly discouraged about the future b fee discouraged about the future c feel I have nothing to look forward to d feel the future is hopeless and that things cannot improve b Personality Tests i Minnesota Multiphasic Personality Inventory MMP a test with 567 items of a truefalse nature to help determine if a person endorses more or less of a category of experiences than the general population used to assess broad mental disorders 1 2 Composed of 500 items of truefalse nature Created it and then gave it to the University of Minnesota hosptal ii Clinical scale in the MMPI uses the following category 1 2 Hypochondriasis individuals who endorse these items show an excessive concern with bodin symptoms Depression individuals who endorse these items display characteristics of depression such as trouble sleeping loss of appetite feeling sad suicidal thoughts and loss of interest in positive events Hysteria individuals who endorse these items tend to view and experience the world in an emotional manner They may overdramatize their situation Psychopathic deviate individuals who endorse these items display antisocial tendencies and experience con icts with their environment Masculinityfemininity these items re ect the degree to which an individual endorses the traditional gender roles of males and females Paranoia individuals who endorse these items display suspiciousness of others Psychasthenia individuals who endorse these items display excessive anxiety and obsessive behavior Schizophrenia individuals who endorse these items display bizarre disorganized thoughts along with a lack of normal contact with reality including social aoofness Various sensory problems such as hallucinations may be present Hypomania individuals who endorse these items experience high energy states associated with poor judgment and impulse contro 10Social introversion these items re ect social introversion and extraversion c Projective Tests i Projective instruments ambiguous stimuli are used to elicit the internal cognitive and emotional organization of a person39s psychological processes Rorschach inkblot inkblots developed by Herman Rorschach they were made by dripping ink on a piece of paper and then folding it in half to create a symmetrical design it functions as a projective technique Thematic Apperception Test TAT a testing instrument composed of 30 blackandwhite drawings of various scenes and people by noting the content and emotionality of the individual39s responses it is possible to gain insight into his or her thoughts emotions and motivations including areas of con ict iv The developers of the RPAS state their goals as follows 1 Selecting and highlighting those variables with the strongest empirical clinical and response processbehavioral representational support while eliminating those with insufficient support 2 Comparing test takers39 scores to a large international reference sample using a graphic array of percentiles and standard score equivalents 3 Providing a simpli ed uniform and logical system of terminology symbols calculations and data presentation in order to reduce redundancy and increase parsimony Describing the empirical basis and psychological rationale Providing a statistical procedure to adjust for the overall complexity of the record 6 Optimizing the number of responses given to the task in order to ensure an interpretable and meaningful protocol 7 Developing new and revised indices by applying contemporary statistical and computational approaches 8 Offering access to a scoring program on a secure encrypted web platform from any device that can interface with the internet TAT is composed of 30 blackandwhite drawings of various scenes and people 91 d Neuropsychological Testing Wechsler Adult Intelligence Scale WAIS a common intelligence test with a number of subscales designed to measure verbal and performance tasks 1 Include measurements of acquired knowledge verbal reasoning and comprehension of verbal information Wisconsin Card Sorting Test WCST a test that requires that an individual sort cards into four piles each card has a speci c shape on it such as a circle or square and each card has a speci c number of these shapes and each card is printed in a speci c color thus you could sort the cards by shape by number or by color Continuous performance test CPT a test that measures attentional characteristics 1 ADHD children may not do well on this test e Using Neuroscience Techniques to Identify Mental Illness i There have been many ways of utilizing neuroscience to describe psychopathology 1 Identifying certain genes 2 Looking at epigenetics 3 Structural and functional descriptions of brain processes ii Neuroscience techniques offer another level of analysis VI Classi cation a Introduction i Nomenclature the purpose here is to present a way for mental health professionals to describe and discuss the clients they see ii Basis of information retrieval this allows for individuals who may not be professionals to search for information concerning mental disorders iii Descriptive system this is the case in which the name of the disorder summarizes the behaviors thoughts and emotions of individuals with the disorder iv Predictive system in this case the classi cation allows one to know the course of the disorder if untreated and particular treatments that may be effective v Basis for a theory of psychopathology the focus in this case is to use classi cation to understand the disorder b Classi cation Systems for Mental Disorders i Numerous systems have been developed ii APA and DSM and ICD i Used primarily in Europe and is managed by the WHO i Used in America ii All mental disorders i Updated every few years to compensate for new information and classi cation fMRI based on the fact that blood ow increases in active areas of the cortex because hemoglobin which carries oxygen in the bloodstream ahs different magnetic properties before and after oxygen is absorbed by measuring the ratio of hemoglobin with and without oxygen the fMRI is able to map changes in cortical blood and infer neuronal activity Chapter 10 I Overview of Anxiety Disorders Introduction a vi vii Viii XI When feelings of anxiety and stress become chronic the situation becomes and anxiety disorder rather than just anxiety Generalized anxiety disorder GAD characterized by excessive anxiety and worry that has been present for more than 3 months Social anxiety disorder SAD characterized by marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others Anxieties toward one speci c situation or object snakes sh spiders etc is considered a phobia Panic attack comes quickly and carries with it an intense feeling of apprehension anxiety or fear happens without an actual situation that would suggest danger Separation anxiety disorder a situation where children as they develop do not show a normal sense of independence and continue to feel distress when not with their caregivers 1 Moved from DSM category of childhood disorder to anxiety disorder Obsessive Compulsive Disorder OCD characterized by repetitive thoughts and feelings usually followed by behaviors in response to them Anxiety in general is the fear of what may happen 1 What if I don39t get the job 2 What if they get mad 3 What if I get germs on my hands if I go to a public restroom Anxiety and fear involve high level as well as primal brain processes 1 Cognitively people make themselves anxious by thinking terrible possibilities of the future Evolutionarily being fearful in the presence of danger is adaptive Fear can be evoked in four different ways 1 Painful stimuli 2 Pair cues with aversive stimuli xii 3 Present evolutionarily important cues that have a survival rate for that species 4 Create a frustrating situation Individuals with anxiety disorder see negative alternatives for the future and believe nothing will work out b Cognitive Processes in Anxiety Evolutionary psychology has suggested that fear mechanisms evolved to aid our ability to disengage from the task at hand to pay attention to threats or potential danger Cognitive bias having more sensitivity than others to the possibility of potential threat Stroop test a psychological test used to study cognitive bias the traditional stroop test has color names in ink of a different color 1 Ex the word green would be in red ink it should take longer for the person to name the color of the ink because they are inclined to read the word then it changes to threat words failure rejection and the color is replaced by the emotions associated with the word c Neurobiology of Anxiety Disorders Research suggests that fear and anxiety stem from different parts of the brain Gammaaminobutyric acid GABA the major inhibitory neurotransmitter in the brain and one of the major neurotransmitters involved in anxiety 1 Individuals with anxiety disorder are said to have less GABA activity so they cannot respond to threats as well Anxiety is said to be seen as a developmental problem involving both environmental and genetic factors Genetic contribution to anxiety is 3040 1 Panic disorder is 48 2 Phobias of animals is 47 blood injury is 59 and situational 46 3 Social Phobia is 51 Anxiety disorder relates to four brain networks 1 Salience or cinguloopercular network important in detecting errors and con icts 2 Executive control or frontoparietal network network that implements increased cognitive control 3 Ventral attentional network involved in detecting new stimuli rather than the task at hand 4 Default network involved in internal processing including selfinspection future planning and emotional regulation d Developmental Aspects of Anxiety Fears are often seen in relation to immediate experiences The earliest anxiety disorder to develop is separation anxiety disorder 1 Next is speci c phobias iii The National Comorbidity Replication Adolescent Supplement is a US survey of adolescents 13 to 17 years old 1 Anxiety disorders were more prevalent in adolescents than mood disorders behavior disorders or substance abuse e Anxiety Disorders Around the World i Anxiety disorders are prevalent around the world in many people ll Major types of Anxiety Disorders a Separation Anxiety Disorder i With normal development children will be scared at rst to leave their caregiver but then they react normally ii Some children grow up without the ability to feel independent and continue to feel distress when away from their caregivers 1 Concerned that something could happen to their caregiver iii Separation anxiety disorder in DSM 5 requires that the symptoms last for at least 4 weeks in children and adolescents iv 3 of 8 symptoms must be present 1 Person experiences distress when he or she is not at home or with major attachment gures 2 Person worries about the wellbeing of their attachment gure 3 Person worries that an event such as being kidnapped or getting lost could happen to them Unwillingness to leave home for fear of separation Fear of being along Unwillingness to sleep alone or outside the house Having nightmares related to separation Having complaints of physical symptoms such as headaches or stomachaches v More commonly seen in girls than boys b Generalized Anxiety Disorder i GAD is characterized by excessive anxiety and worry that had been present for more than 3 months ii Symptoms 1 Avoiding activities that can have negative outcomes 2 Overpreparation for activities that can have negative outcomes 3 Marked procrastination in behaviors due to worries 4 Repeatedly seeking reassurance due to worries iii Most frequently diagnosed mental disorder along with depression iv Cognitive avoidance model a theoretical model that proposes that worry is the manner in which an individual with GAD attempts to reduce the negative emotional experiences associated with GAD v Treatment of GAD 5 Pquot39gt UJN 5 6 Identifying the anxietyassociated thoughts images beliefs Discussing these to bring out their causal role Leading clients to question the validity of thoughts or beliefs and to search for evidence Helping clients develop alternative less anxietyarousing assumptions or interpretations Testing alternative viewpoints in homework assignments or experiments Teaching the above methods as selfhelping coping devices to be used in real life c Social Anxiety Disorder i SAD is the severe fear of social situations ii Evaluation can take many forms 1 2 3 First is social interactions Second is one in which the person could be observed such as eating or drinking Third is one in which the person is performing in front of others iii Individuals with social anxiety fear that they will be humiliated embarrassed or rejected iv Neuroscience Aspects of Social Anxiety 1 2 3 PFC amygdala ACC and the insula are regions involved in social and emotional processing Social brain regions are also involved in social anxiety It is suggested that people with anxiety have original evolutionary systems v Treatment of Social Anxiety Disorder 1 2 3 d Agoraphobia CBT type therapies and medications are used effectively with SAD Medications seem to show a faster reduction in anxiety initially Social skill training teaches individuals how to be practical in various social situations i Agoraphobia the condition in which a person experiences fear or anxiety when in public ii Can involve public transportation open spaces places with a number of individuals or being in a crowd iii In some people panic disorder and agoraphobia go together e Speci c Phobia i Speci c phobia the condition in which an individual experiences fear or anxiety to a particular condition or object 1 Common phobias are fear of snakes spiders ying height blood injections and the dark ii Various ratios 1 Animal phobia 3357 2 Natural environment 49116 3 Situational phobia 5284 4 BII Phobia 3245 blood injection injury Treatment of Speci c Phobias 1 Rapid gradual exposure treatment helps people get over their fears f Panic Disorder iv Panic attacks come quickly and carries an intense feeling of apprehension Physiological symptoms of panic attacks include shortness of breath trembling heart palpitations dizziness faintness and hotcold ashes People may experience symptoms or full on panic attacks but it has to be recurring to be diagnosed as a panic disorder Panic attacks involve different areas of the brain Ill ObsessiveCompulsive Disorder a introduction VI vii viii xi xii Xiii xiv Obsessions generally unwelcomed thoughts that come into one s head Compulsions behaviors that one uses to respond to obsessive thoughts 0CD can include problems with contamination aggressive impulses sexual content somatic concerns and the need for order 1 May wash their hands often or scratch certain things Characterized by two symptoms 1 First is obsessions in which unwanted intrusive and recurrent thoughts enter the mind 2 Second is compulsions or behavioral rituals Usually characterized as DSM anxiety disorder OCD can be shown with differences with control in terms of eating disorders impulse control and substance abuse Over 90 of people with 0CD experience both obsessions and behavioral rituals 0CD has an adulthood prevalence of 23 and a childadolescence prevalence of 12 About 40 of people with childhood 0CD report continuing symptoms into adulthood Not performing routine rituals may cause people with 0CD to get anxiety and panic attacks Hoarding an excessive acquisition of objects and an inability to discard these objects Those with 0CD centered on aggressive sexual or religious content were more likely to also have anxiety disorder Those with 0CD centered on symmetry and ordering were more likely to have tic disorders bipolar disorders panic disorder or agoraphobia Hoarding is associated with comorbid personality disorders b Brain Processes Associated with ObsessiveCompulsive Disorder i People with OCD have problems shifting from one idea to another c Treatment of ObsessiveCompulsive Disorder i Psychopharmacological and behavioral therapies have been shown to be effective for OCD ii Discussions can be focused on what the person needs to do to prevent the expected negative outcome Chapter 9 Psychological Stress and Psychopathology a Psychological stress experienced when an individual is confronted with a situation that is beyond their responses to control b Some disorders have a clear relationship with stress and trauma i These include PTSD possibly cause depression ii Causes can be war crime childhood abuse and neglect alcohol abuse Does Trauma Produce Mental Illness a Children show differential responses to environmental in uences b The monoamine oxidase A MAOA gene is located on the X chromosome and makes certain neurotransmitters inactive i Gene encodes the enzyme MAOA that makes serotonin norepinephrine and dopamine inactive ii Ex boys who were mistreated at children had a different form of the MAOA gene and were more likely to be violent and engage in antisocial activities 1 People without this form of MAOA did not have the same behaviors c Positive intervention can in uence later outcomes for the better ls Social Pain Like Physical Pain a Pain system alerts individuals to tissue or nerve damage or times in which our physical systems are not functioning normally b The processing of social pain appears to have coopted the basic brain structures involved in physical pain c Two separate experiences to pain i Sensory experience involves the somatosensory cortex and the posterior insula ii Experienced unpleasantness associated with the anterior cingulate cortex ACC The physiological Mechanisms Related to Stress and Trauma a Immune system the body s system to recognize foreign agents in the body and then destroy them b Hypothalamic pituitary adrenal HPA axis the hypothalamus pituitary and adrenal pathway which is activated in times of stress c Autonomic nervous system ANS a brain pathway that innervates a variety of organs including the adrenal medulla that results in the release of catecholamines norepinephrine and epinephrine from the terminal of sympathetic nerves V Trauma Changes Our Genes Through Tagging Epigenetics a Epigenetics modi es the tags on a gene i DNA is wrapped around clusters of proteins called histones ii Histones are further bundled into structures called chromosomes iii These are tightly packed to prevent access to processes that turn genes on iv When action is needed another DNA unfurls and the gene turns on v Histone Acetylation tends to promote gene activity and is called a writer vi Histone methylation and DNA methylation tend to inhibit it and are called erasers b Ex the offspring of more attentive mothers tend to be less anxious and produce less stress hormones i Less nurturing mothers had offspring that were more sensitive to stress c Another example is women who are pregnant and experience partner violence tend to have offspring with increased stress hormones i Children of mothers who didn39t suffer partner violence or it happened before or after pregnancy did not show that effect ii Mothers experiences during pregnancy can have long term effects on their children d Epigenetic changes are involved in mental illnesses i Strongest evidences is in schizophrenia and bipolar disorder Vl Psychological Stress and the Immune System a Ex People tend to get sick during big examines because stress causes their immune systems to go down b The immune system has evolved to compensate for a variety of pathogens and attacks them during later exposure c Psychoneuroimmunology the study of how psychological factors can in uence the immune system i The form of loss or trauma suppresses the immune system ii Negative emotions can change immune responses and delay heaHng iii Psychological factors that can in uence the immune system include loneliness poor social support negative mood disruption of marital relationships bereavement and natural disasters iv Close relationships and friendships can enhance immune system functioning d The immune system can be involved in mental illness i Cytokinesis can lead certain individuals to develop depression Vll What Makes You Run From Bears Stress and the HypothalamicPituitary Adrenal Axis a ANS network of hypothalamic pituitary and adrenal responses b The cardiovascular system metabolism and the immune system are mechanisms that are particularly sensitive to changes in the environment i These systems prepare the body for action ii Almost all stressors use the same physiological systems to save yourl e iii These pathways store energy to use in lifedeath situations iv No longer store energy pay attention to sexual matters or have your immune system worry about longterm disease c The rst pathway is the ANS which innervates a variety of organs which releases catecholamines d Second pathway involves cells in the hypothalamus that are released into the blood stream and cause the pituitary gland to release hormones that in uence other hormones e Hypothalamus pituitary and adrenal pathway a stress pathway referred to as the hypothalamicpituitaryadrenal HPA axis i Studied under a variety of psychopathologies including schizophrenia autism and depressions f The brain through the hypothalamus produces a substance called CRH g Fight or ight response the overall stress reaction in which the body prepares you either to ght or to leave the scene h HPA axis has been linked to anxiety and depression i HPA axis over activity was seen in individuals with severe forms of depression i HPA has been associated with the development of psychosis in adolescence i 1 behavioral studies have shown that clinical symptoms can be exacerbated by exposure to stress ii 2 medical disorder are associated with increased psychosis iii 3 unmedicated patients with psychosis show abnormalities in the HPA axis and a positive correlation between cortisol levels and symptoms iv 4 the hippocampus which plays a role in regulating the HPA axis is smaller in patients with psychosis VIII The Autonomic Nervous System a ANS has three functions i To maintain homeostatic conditions within the body ii To coordinate the body s response to exercise and stress iii The manner in which the ANS helps the endocrine system regulate reproduction b Sympathetic division the element of the autonomic nervous system that connects with its target organs through the middle part of the spinal cord responsible for the ght or ight response c Parasympathetic division the element of the autonomic nervous system involved in the restoration of bodily reserves and the elimination of bodily waste it connects through the upper and lower parts of the spinal cord d Various systems that have evolved to help the body manage changes in the environment IX The Study of Stress a Introduction vi vii Borrowed the term quotstressquot from physics Used the term to organize physiological responses to a variety of challenges including heat cold pain noise hard work General adaptation syndrome GAS the body reacts similarly to a variety of different stressors in three stages the alarm stage the resistance stage and the exhaustion stage 1 Alarm an initial reaction to the stress that involved increase of heart rate sympathetic nervous system reactions and adrenal activity 2 Resistance an adjustment to the stress that includes the availability of additional energy resources and mechanisms for ghting infection and tissue damage 3 Exhaustion bodily resources are depleted Allostasis refers to the body s ability to achieve stability through an active process of change often involving the brain This is in contrast to the older term quotstressquot in which responses to change were seen as passive and xed 1 Allostatic systems are systems designed to adapt to change Stress is studied to be stronger in humans than other animals because of higher cognitive response Tend and befriend response a response to stress associated with the tendency of females to take care of others and form social connections at times of stress Allostatic load cumulative wear and tear on the body by responding to stressful conditions four particular situations 1 Allostatic load can be increased by frequent exposure to stressors 2 Allostatic load can be increased when an individual does not adapt or habituate to the repeated occurrence of a particular stressor 3 Not all individuals responds the same to changing situations 4 A nonresponse to stress produces an overreaction in another system b Does Fight or Flight Apply equally to Males and Females Many stressors humans face today do not in ict a ght or ight response ii Females and males tend to have different responses to stressful situations 1 Females a Females behave in a way to better themselves AND their offspring b Nurture offspring as well as display behaviors that protect them from harm c These behaviors are associated with particular neuroendocrine responses although different hormones are involved d Release of oxytocin which makes people calmer e Produce parasympathetic reponses 2 Males a Have hormones that become organized to give aggressive responses b Release of testosterone c Produce sympathetic responses 3 Example Mothers and Fathers after a stressful work day a Father i Tend to be isolated and to themselves ii Associated with friends for comfort less often b Mother i Become more nurturing and caring ii Seek other women for comfort c Does Social Stress Produce a Similar Reaction to Physical Stress i Children who experience extreme problems as children may respond to stress worse than others ii PTSD and dissociative disorders result from a pathway with psychological stress and trauma X Trauma and Stressor Related Disorders in DSM5 a Introduction i Adjustment disorders disorders in which reactions to events are out of proportion to the severity of the event 1 Does not require a traumatic event only a distressing one ii Acute stress disorder a short term reaction to traumatic events that lasts from 3 days to 1 month 1 Along with PTSD requires speci c symptoms b Adjustment Disorders i Emotional reactions can have long term issues ii These can interfere with social functioning and jobs iii Seen higher in females than males iv Same treatments used as anxiety and PTSD c Acute Stress Disorder i If clinical symptoms continue longer than a short period of time it is considered PTSD ii Five categories 1 lntrusion ashbacks memories 2 Negative mood inability to experience happiness iv v vi 3 Dissociative symptoms feeling in a fog 4 Avoidance symptoms avoiding situations people 5 Arousal symptoms sleep disturbance angry outbursts Highest rates occur in traumatic events such as assault rape or shooUngs Other rates can occur with car accidents burns assault or other accidents Higher for females than males They can develop anxiety depression suicidal thoughts d PostTraumatic Stress Disorder VI vii viii Experiences from war have been called quotshell shockquot quotcombat fatiguequot and quotwar neurosisquot After the Vietnam war brain trauma became more apparent PTSD is produced from intense fear helplessness or horror 1 Highest risk is assaultive violence 2 Cumulative stress can also result in PTSD Twice as common in women as men Important in studying and helping veterans PTSD criteria includes a variety of traumatic experiences 1 Individual exposed to aversive experiences 2 The individual experiences intrusions 3 Individual avoids stimuli involved with traumatic events 4 The individual experiences changes in cognitive processes Physiological Aspects of PostTraumatic Stress Disorder 1 CRF activates the HPA and causes a release of ACTH results in a lessened stress response 2 Exposure to severe and chronic stress can damage hippocampal formation 3 Hippocampus amygdaIa and PFC are all effected 4 There is evidence that people with PTSD have smaller hippocampal volume than those without PTSD PTSD treatment 1 Feelings of having quotno way outquot 2 Goal is to have individuals move quothotquot traumatic associations to quotcoldquot nonreactive memories 3 People with PTSD usually have comorbidity with things like depression substance abuse anxiety 0CD panic disorder 4 Pharmacological treatments include antidepressants anxiolytics adrenergic inhibitors mood stabilizer and anticonvulsants 5 Exposure therapy for PTSD a therapy designed to have the individual with PTSD reexperience the original trauma the person confronts her fears and expectations such that they are reduced 6 EMDR is a form of therapy in which a person imagines the traumatic situation while moving his or her eyes a Reactivates stored unprocessed memories Chapter 11 I Introduction a Dissociation the common experience of quotspacing outquot shared by most people overall this is the situation in which there is a disruption in our normal ability to integrate information from our sensory and psychological processes such as memory and awareness b Dissociative amnesia the main diagnostic element is an inability to recall important autobiographical information c Dissociative identity disorder DID a developmental disorder where one consistent sense of self does not occur that is the person does not experience her thoughts feelings or actions in terms of a well developed quotIquot or sense of self or rather the person experiences different quotpersonalitiesquot at different times previously referred to as multiple personality disorder d Depersonalization the experience of not experiencing the reality of one s self this experience can include feeling detached or observing one s self as if you were an outside observer e Derealization the experience that the external world is not solid one39s world is experienced with a sense of detachment or as if in a fog or a dream or in other ways distorted or unrea II Dissociative Disorders a Introduction i Introduced by Janet to describe symptoms such as repetitive behaviors and the presentation of different personality characteristics ii Freud saw disassociation as a result from a strong ego iii Women seek help more than males iv Examples of dissociation 1 Someone would walk through town and then quotwake upquot standing in line at a store39s cash register with random things in her hand 2 Someone reported that they zoned out and watched their body leave the room quotwaking upquot an hour later 3 Everything looks uid and the person cannot tell what is real and what is fake v They can occur with disruptions in the organization of identity memory perception or consciousness vi Pathological symptoms are connected with trauma and experiences beyond control such as torture or rape b DepersonalizationDerealization Disorder i Depersonalization can make someone fee detached or seem like they are observing themselves as if they were outside of their body 1 Seem like they are in a fog or dream 2 No gender differences with this order ii Both are a normal response to many types of acute distress 1 They may be a difference in hardwired response to stress that increases survival by reducing arousal and anxiety c Dissociative Amnesia iv The inability to recall important autobiographical information Dissociative fugue a sudden unexpected travel away from one39s home or place of work with an inability to recall one39s past Interacting with people is completely normal unless this person is asked about their personal history Many people do not adopt a new name and lifestyle identity they just forget who they are d Dissociative Identity Disorder vi vii Previously referred to as multiple personality disorder A consistent image and sense of self does not occur 1 Does not experience thoughts feelings or actions in terms of a welldeveloped sense of self 2 Trauma occurring before the age of 5 can cause this because this is the time children form a sense of developmental self Gender differences 1 Females are most likely to be seen in an adult clinical settings 2 Males are more likely to deny their symptoms and trauma history SCIDD a screening device for dissociative disorders developed by Marlene Steinberg Alters the alter personalities of a person 1 These personalities can have their own names traits memories and behavioral patterns 2 It is possible for one alter not to know the existence of the other 3 quothostquot alters may experience the alters arguing with each other 4 The alter can take control of the quothostquot with the quothostquot knowing it DID was historically seen as being possessed or taken over DID patients had hippocampal volume 192 smaller and amygdala volume 316 smaller compared to a healthy control group e Treatment of Dissociative Disorders Some disorders resolve on their own and others require long term treatment DID therapy focuses on a relationship between the client and therapist It improves the most stable alter and tries to build a full relationship Common thread is the loss of normal integration in cognitive functioning III Somatic Symptom and Related Disorders a Introduction Somatic symptom and related disorders situation in which individuals are certain something is wrong with them they may continue to search for organic problems or may feel anxiety that the simple symptoms they have are really something serious Conversion disorders the situation in which a person shows the signs of a disorder but the disorder does not follow what we know to be the underlying physiology previously referred to as hysteria Represent an interface between psychological processes and medical ones Factitious disorder the situation in which a person creates the symptoms seen by the health care professional Malingering faking disorders to avoid work or other activities that a person may not want to do b Somatic Symptom Disorder iii iv Condition in which a person39s somaticbodily symptoms cause distress or disruption in their mental health Individuals may go from physician to physician to be told they have a medical disorder they don39t agree with the diagnosis 1 They become unsatis ed when a professional cannot nd the cause of their symptoms Prevalence is about 57 Females tend to report symptoms more than males so there is a gender difference c Illness Anxiety Disorder vi Illness anxiety disorder occurs when a person is preoccupied with the possibility of having a serious illness however the person experiences few if any symptoms previously referred to as hypochondriasis Unlike somatic symptom disorder where people actually experience symptoms people will illness anxiety disorder experience little to no symptoms Anxiety is focused on health issues Ex person may read an article about symptoms of cancer and feel that they have cancer Individuals with illness anxiety disorder conceptualize bodily processes differently than normal functioning people Those with illness feel that all symptoms are incompatible with good health d Conversion Disorder Used to be called hysteria Person reports sensory or motor symptoms such as not being able to hear or see or feel pain or move a part of the body Glove anesthesia a speci c example of the general phenomenon in which the person reports sensory or motor symptoms such as not being able to hear or see or feel pain or move a part of the body but the symptoms do not follow known physiological or neurological patterns iv Symptoms include paralysis seizures tremor blindness anesthesia and problems with movement v High comorbidity with anxiety depression and personality disorders vi Historically assumed to be only seen in women vii Conversion reaction refers to Freud39s idea that psychic energy was converted into physical symptoms the basic concept is that painful memories or trauma are not consciously experienced in an emotional manner but rather converted into physical processes viii Functional neurological symptom disorder common term in neurology adopted by the DSM5 to refer to conversion disorder ix Psychogenic disorders or functional disorders terms used in medical literature in reference to conversion reactions x Neurology 1 Neuroscience mechanisms associated with conversion disorder are still not fully understood 2 Activation or deactivation of motor processes based on emotional experiences 3 In a person with numbness in one side the correlating side would not be stimulated but when both sides of the brain were stimulated it would start to show activity 4 Mirror movements in brain ex if we see someone move their left arm the part of the brain that moves the left arm is stimulated 5 Gono go task is to see the motor response and how it transmits to the movement and feelings in various body parts in people with somatic disorders e Factitious Disorder i When someone creates symptoms to see a medical professional 1 Ex takes laxatives or injects insulin ii Attempt to manipulate the health care system iii Factitious disorder imposed on self a type of factitious disorder in which the person produces symptoms in himself or herself historically referred to as Munchausen syndrome iv Factitious disorder imposed on another a type of factitious disorder in which typically a caregiver such as a parent would produce symptoms in her child historically referred to as Munchausen syndrome by proxy f Treatment of Somatic Symptom Disorders i The most useful treatment option is an educational one ii Health care professionals discuss aspects of the patient s stress and suggest that the symptoms will improve iii Three existing approaches Chapter 15 1 Antidepressant medications 3 Other nonspeci c interventions Introducing Personality Disorders a What is a personality Disorder Personality disorder represents an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individuals culture the pattern is in exible stable and generally begins in adolescence and leads to distress or impairment characteristics of these disorder are especially apparent when these individuals nd themselves in situations that are beyond their ability to cope There are 10 personality disorders that are organized into three 1St cluster is Cluster A which includes odd or eccentric disorders including a Schizoid personality disorder characterized by pervasive pattern of detachment from social relationships and a restricted range of emotional expressions these individuals are traditional loners others see them as unavailable aloof or detached Paranoid personality disorder characterized by a pervasive distrust and suspiciousness of others the interpersonal style of these individuals is often quarrelsome stubborn and rigid in their own beliefs which can create a selfful lling prophecy Schizotypal personality disordercharacterized by odd beliefs and behaviors and individual may show excessive social anxiety as well as show unusual ideas 2 2nCI cluster is Cluster B which includes dramatic emotional or erratic disorders including a Antisocial personality disorder the criteria include acts since the age of 15 such as repeated participation in illegal acts deceitfulness impulsiveness hostility and aggression engagement in dangerous acts irresponsible behavior and absence of remorse Borderline personality disorder BPD characterized by an instability in mood interpersonal relationships and a sense of self these three factors interact with each other in such a manner that the person with borderline personality disorder experiences a changing world without a solid sense of self c Histrionic personality disorder characterized by a pervasive pattern of excessive emotionality and attention seeking being the center of attention is one key element and the person may use a number of means for gaining attention if they are not the center of attention they become uncomfortable d Narcissistic personality disorder characterized by a pervasive pattern of grandiosity a need for admiration a sense of privilege or entitlement and a lack of empathy for others individuals often think about how special they are and the ways in which they will succeed in all types of ways including business love competiveness and so forth they may also make unreasonable demands on others in relation to their view of themselves in doing so they ignore the experiences or need of others 3 3rd cluster is Cluster C which includes anxious or fearful disorders including a Avoidant personality disorder characterized by a pervasive pattern of social inhibition feelings or inadequacy and hypersensitivity to negative evaluation individuals avoid many social interactions especially those involving close relationships with other people one key feature is the fear of being criticized or evaluated by others b Dependent personality disorder characterized by a pervasive pattern of clinging and being submissive the person has dif culties making everyday decisions without reassurance from others resulting in a desire for others to assume responsibility for most areas of one s life their lack of experiencing a self who can plan and direct their behavior leaves them in a position that requires that they always be with another otherwise they tend to feel anxious and helpless when alone c Obsessive compulsive personality disorder characterized by a pervasive pattern of preoccupation with orderliness perfectionism and control of one39s environment individuals would be described as workaholics they themselves would iii iv v see little need for taking time off or just spending time with other people in dealing with others they may appear rigid and use standards not called for in the current situation Personality disorders are found in 913 Similar numbers of males and females Prevalence 1 Cluster A 57 2 Cluster B15 3 Cluster C6 b Comorbidity of Personality Disorders Comorbidity mostly with anxiety mood and substance abuse People with personality disorders have a greater chance of having anxiety than the vice versa c Personality Disorders and Normal Personality Traits The personality disorders also showed considerable overlap with traits found in normal personalities There can be both maladaptive and healthy personality styles Extraversion as a personality trait it is associated with sociability cheerfulness energy and a sense of fun as a dimension in the vefactor model the dimension ranges from being passive quiet and innerdirected to being active talkative and outerdirected d The Characteristics of a Healthy Self Healthy seIf one conceptualization suggested in the fth edition of the DSM5 is to consider the healthy self in terms of a quotself and interpersonal functioning continuumquot which includes the aspects of identity selfdirection empathy and intimacy Identity one aspect of a healthy self this includes seeing oneself as a unique person with stable boundaries between herself and others having a history that the person understands having an accurate sense of who she is and what she can accomplish and appreciating her abilities Selfdirection one aspect of a healthy self it re ects the ability to have both meaningful shortterm and longterm goals consistent with one s identity as well as a sense of what would be productive for society and how to interact with others internally healthy selfdirection also includes the ability to re ect on one s life in a productive manner Positive interpersonal relationships one aspect of a healthy self characterized by interpersonal relationships in which the person relates to others in an intimate and empathetic manner Intimacy one aspect of a healthy self and positive personal relationships it includes having a relationship with another person that includes mutual connectedness and a valuing of that other person it values closeness and seeks it when appropriate vi Not having an intimate and empathetic relationship with others is a part of a personality disorder e Normal Personality Traits i Fivefactor model FFM a model of personality based on a factor analytic approach to personality developed by McCrae and Costa which suggested ve major personality dimensions extraversion neuroticism openness agreeableness and conscientiousness OCEANopenness conscientiousness extraversion agreeableness neuroticism 1 Extraversion associated with sociability cheerfulness energy and a sense of fun ranges from being passive quiet and interdirected to being active talkative and outerdirected Neuroticism associated with a tendency to express distressing emotions and dif culty experiencing stressful situations ranges from being calm eventempered and comfortable to being worried temperamental and self conscious Openness associated with curiosity exibility and an artistic sensitivity including imaginativeness and the ability to create a fantasy world ranges from inventive and curious to cautious and conservative Agreeableness associated with being sympathetic trusting cooperative modest and straightforward ranges from being friendly and compassionate to being competitive and outspoken Conscientiousness associated with being diligent disciplined wellorganized punctual and dependable ranges from being ef cient and organized to easygoing and careless ii Consistency of results across a variety of cultures iii Research suggests that people ages 1830 decline in neuroticism extraversion and openness and increase in agreeableness and conscientiousness f Evolution and Different Personality Characteristics i Each dimension has a particular advantage given certain environmental conditions 1 2 Extraversion success in mating having social allies and exploration of the environment Neuroticism greater vigilance and labeling situations as dangerous II Personality and Personality Disorders a Introduction i The 10 disorders can be understood as maladaptive variants of FFM One characteristic of disorder is the stable occurrence of the personality structure b Categories and Dimensions There are 79 descriptive criteria for the 10 personality disorders Each FFM has a genetic component and is seen worldwide c Environmental and Genetic Studies of Personality Disorders Emotional abuse sexual abuse and neglect are related to the later development of personality disorder Childhood mistreatment was particularly common among individuals with BPD Heritability for personality disorders are in the 4060 range Except for BPD other personality disorders show more environmental factors than genetic lll OddEccentric Personality Disorders a Oddeccentric personality disorders Cluster A a grouping of personality disorders within the fth edition DSM5 these include schizoid personality disorder paranoid personality disorder and schizotypal personality disorder feel uncomfortable or suspicious of others or restrict their relationship b Paranoid personality disorder vi Characterized by a pervasive distrust and suspiciousness of others Ex saying people are planning to exploit of deceive you Unwilling to con de in others Interpersonal style of these individuals is quarrelsome stubborn and rigid in their own beliefs Prevalence 1 44 survey on alcohol related conditions 2 23 in national comorbidity survey Four of these speci c characteristics should be present 1 Believing that others are exploiting or deceiving the person 2 Having a preoccupation with unjusti ed doubts about the trustworthiness of a friend or colleague 3 Being reluctant to con de in others 4 Seeing simple statements and believe they have hidden meanings 5 Bearing grudges 6 Seeing others as attacking the person39s reputations 7 Not trusting one39s sexual partner as being faithful c Schizoid Personality Disorder Characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression Traditional loners seem aloof and detached Not desire close relationships lacking friends and seeking solitary activities Prevalence 1 31 survey on alcohol and related conditions V 2 49 national comorbidity survey Four of these speci c characteristics should be present Not desiring or enjoying social relationships Mainly engaging in solitary activities Showing littler interest in sexual activities with others Finding little pleasure in activity Having no close friends Showing indifference to both praise and criticism Showing emotional coldness or detachment Newewwe d Schizotypal Personality Disorder I ii iii iv v vi vii viii Characterized by odd beliefs and behaviors Show excessive social anxiety as well as unusual ideas Ex magical thinking a person believing thinking about an event can actually make it happen Noted that rstdegree relatives of those who had schizophrenia had this De ned by odd behavior cognitive distortions and inappropriate affect Similar to those with schizophrenia but still in touch with reality unlike with schizophrenia Prevalence 1 33 national comorbidity survey Five of these speci c characteristics should be present 1 Makes connections between ideas that are not related to one another 2 Holds odd beliefs or engages in magical thinking such as a belief in telepathy Experiences unusual perceptual experience Engages in odd thinking and speech ls suspicious Shows inappropriate affect Appears odd to others Does not have close friends Shows excessive social anxiety that does not become less as the situation becomes more familiar PWNQP PPquot lV Dramatic Emotional Personality Disorders a Dramatic emotional personality disorders Cluster B include antisocial personality disorder borderline personality disorder histrionic personality disorder and narcissistic personality disorder individuals with these disorders show a wide diversity of patterns of social and emotional interactions with others 55 in general population b Antisocial Personality Disorder and Psychopathy Introduction 1 Psychopathy a disorder characterized by showing emotional detachment with a lack of empathy for the experiences of others also showing impulsive behavior and a callousness concerning their actions 2 Many people in prisons quality for this disorder 3 Only about 1015 of people with antisocial personality disorder have psychopathy ii Antisocial Personality disorder 1 Begins with individuals at least 18 years of age 2 Would meet requirements for child conduct disorder before the age of 15 3 Child conduct disorder includes aggression toward animals or people destruction of property deception or stealing and serious rule violation 4 Antisocial personality disorder includes acts since the age of 15 including a Repeated participation in illegal acts b Deceitfulness c lmpulsiveness d Hostility e Aggression f Engagement in dangerous acts g Irresponsible behavior h Absence of remorse 5 Prevalence a 3 more in males than females b Comorbidity around 80 with substance abuse vice versa is not the case c Those in courts mandated for sexual offences usually qualify for antisocial personality disorder 6 Three speci c characteristics should be present including a Failure to observe social norms which can result in a legal arrest b Deceitfulness including lying to and using others c Failure to plan ahead d lrritability and aggressiveness that leads to physical ghts e Reckless disregard for the safety of others f lrresponsibility such as a failure to pay debts g Lack of remorse when another person is hurt in Psychopath 1 Show emotional detachment from a lack of empathy for the experiences of others 2 Also coined under the term quotmoral insanityquot 3 Incapacity of love cannot care for other people 4 Psychopaths vs sociopaths 5 There are 16 diagnostic criteria that can be put into 3 categories including a Positive adjustment super cial charm absence of delusions and other signs of irrational thinking 6 b Chronic behavioral deviance motivated antisocial behavior unreliability sex life being impersonal trivial and poorly integrated c Emotionalinterpersonal deficits untruthfulness and insincerity lack of remorse or shame 2 factors describing psychopathology including fearlessness and externalizing vulnerability iv The Brain Involvement in Psychopathy 3 4 1 Amygdala seems to be larger 2 Larger white matter volumes in the parietal occipital and left cerebellar lobes Gray matter reductions in frontopolar orbitofonral and anterior temporal cortices superior temporal sulcus region and insula 2 major brain areas affecting psychopathology a lnvolves frontal lobes lack of development b lnvolves temporal regions including hippocampus and amygdala c Borderline Personality Disorder i Introduction 1 2 BPD is characterized by an instability in mood interpersonal relationships and sense of self Person experiences a changing world without a solid sense of self May feel rejected and abandoned due to a misinterpretation of an event and lash out in anger Estimated that 75 of BPD patients engage in self injuring behavior most common are cutting and burning Selfharm is closely related with an attempt to regulate one s emotions Three aspects of a relationships a First is acute negative affect precedes selfinjury b Second is that after selfinjury individuals report relief c Third is that individuals engage in selfinjury as a means to reduce their experience of negative effect Selfharm is different from suicide Successful suicide is estimated to be about 9 of BPD and suicide threats occur 90 in BPD View of self and others is described as quotsplittingquot in which things are all good or all bad a One day you love someone and the next day you hate them 10lntense need for attention and closeness but also a deep fear of rejection and abandonment 11Around 70 of people report sexual or physical abuse 12BPD is related to heightened risk from chaotic family life 13Disorder is related to attachmentgt most individuals show insecure patterns of detachment 14Five speci c characteristics should be present including a Frantic effort to avoid abandonment whether real or imagined b A pattern of unstable and intense interpersonal relationships characterized by alternating idealization and devaluation c An unstable selfimage and sense of self d Impulsivity in areas that can be damaging such as sexual relations substance abuse reckless driving and binge eating Recurrent suicidal behaviors or selfmutilating behaviors Emotional instability lasting only a few hours Chronic feelings of emptiness Inappropriate anger and ability to control anger Shortterm stressrelated dissociative experiences or paranoid ideation 15There are 150 ways someone can receive a diagnosis based on the criteria combinations 16ndividuas with BPD are high consumers of emergency room services crisis lines and referrals from health professionals 17ndividuas with BPD represent 20 of inpatients and 10 of outpatients in mental health clinics Brain Studies of Those with Borderline Personality Disorder 1 Less volume in a number of brain areas a nsua the middle and superior temporal cortex the fusiform gyrus anterior cingulate cortex the hippocampus parahippocampus and the amygdala b Individuals with BPD showed different responding from the right insula in the case of emotional empathy and greater arousal when performing empathy tasks Trust and Borderline Personality Disorder 1 Ex a game in which money is exchanged is played People with BPD do not trust the situation and invest less money than normal controls 2 People have different brain reactions given more or less risk associated with the transaction a People with BPD do not have a different reaction based on the side of the transaction 3 Ex a game where you are throwing a ball with two people and the three of you are going back and forth D T39D39LQ h a People with personality disorders will feel distress and feel rejected when the other people just throw to each other 4 The experience of social distress parallels that of physical pain d Histrionic Personality Disorder vi vii Characterized by a pervasive pattern of excessive emotionality and attention seeking Being center of attention is a key element quotI want you to notice me because I want you to like mequot May be highly dramatic dress provocatively be seductive and make up stories to draw attention Become uncomfortable when they are not the center of attention Prevalence is 18 based on substance abuse survey 8 possible facets include 1 Uncomfortable in situations in which he or she is not the center of attention 2 Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior 3 Displays rapidly shifting and shallow expression of emotions 4 Consistently uses physical appearance to draw attention to self 5 Has a style of speech that is excessively impressionistic and lacking in detail 6 Shows selfdramatized theatricality and exaggerated expression of emotion 7 Is suggestible easily in uenced by others 8 Considers relationships to be more intimate that they actually are e Narcissistic Personality Disorder Characterized by a pervasive pattern of grandiosity a need for admiration a sense of privilege or entitlement and a lack of empathy for others Often think about how special they are and ways they will succeed in all types of ways such as business love competiveness and so forth Five speci c characteristics should be present including 1 Having a grandiose sense of selfimportance 2 Being preoccupied with ideas of unlimited success or attractiveness 3 Seeing one s self as special and being understood by only other exceptional individuals Needing excessive admiration Having a sense of entitlement Taking advantage of others for his or her own needs P P P 7 Lacking empathy 8 Being envious of others or believing that others envy him or her 9 Being arrogant iv The word Narcissism comes from the Greek myth of Narcissus when he saw himself in a pool of water and fell in love with his image IV Anxious Fearful Personality Disorders a Anxious fearful personality disorders Cluster C a grouping of personality disorders within the DSM5 including avoidant personality disorder dependent personality disorder and obsessivecompulsive personality disorder the behaviors of individuals with these disorders is one of fearfulness and avoidance b Avoidant personality disorder i Characterized by a pervasive pattern of social inhibition feelings of inadequacy and hypersensitivity to negative evaluation ii Avoid many social interactions or anything involving close relationships with other people iii Prevalence 1 23 substance abuse survey general population 2 51 comorbidity survey iv Four speci c characteristics including 1 Avoidance of occupational activities 2 Unwillingness to be involved with others unless it is certain that the person be liked 3 Restraint within an intimate relationship for fear of being ridiculed 4 Preoccupation with being criticized or rejected in social situations 5 Inhibition in new interpersonal situations because of feelings of inadequacy 6 View of one s self as socially inept unappealing or inferior 7 Reluctance to take personal risks or engage in new activities for fear of being embarrassed c Dependent Personality Disorder i Characterized by a pervasive pattern of clinging and being submissive ii Has dif culties making everyday decisions without reassurance from others iii Feel anxious and helpless when alone iv Prevalence 1 4 substance abuse survey 2 6 comorbidity survey v Five speci c characteristics including 1 Inability to make everyday decision without an excessive amount of advice and reassurance from others d 2 A need for others to assume responsibility for one39s life 3 Dif culty to disagree with another person 4 Dif culty to begin projects 5 Need to work hard to receive support from others 6 Uncomfortable feeling when alone resulting from the idea that the person cannot take care of him or herself 7 Beginning a new relationship when an old one is over as a source of care 8 Feeling fearful that one cannot take care of one s self ObsessiveCompulsive Personality Disorder i Characterized by a pervasive pattern of preoccupation with orderliness perfectionism and control of one s environment ii Described as workaholics and not wanting to take time off or just spend time with other people iii Different from 0CD because the main obsession is the person39s self and their personality 1 Need for control in every domain of that person39s life and expe ence iv Prevalence 1 24 in comorbidity survey 2 78 in substance abuse survey 3 Highest prevalence rate of any personality disorder v Four speci c characteristics including 1 Preoccupation with details rules lists order or schedules 2 Perfectionism that interferes with task completion 3 Excessive preoccupation with work rather than fun and friendships 4 ln exibility concerning morals and values 5 Inability to discard worthless objects even when having no emotional connection to it 6 Reluctance to delegate tasks to others unless performed in a speci c way 7 Hoarding of money 8 Rigidity and stubbornness Treatment of Personality Disorders a b One particular disorder may show signs of symptoms of another Dif culty treating because people with personality disorders have trouble connecting to their therapists Psychotherapy for personality disorders is more focused individually than on the disorder Dialectical behavior therapy DBT one of the rst researched treatment approaches for BPD developed by Linehand and is a blend of behavioral science dialectical philosophy and Zen practice the cornerstone is based on problem solving and acceptance of the experience of the moment teaches four skills distress tolerance mindfulness emotion regulation and interpersonal skills i Effective decreased dropouts decrease suicide attempts ii Anger towards therapist is not uncommon iii iv May be impulsive Suicidal considerations e Stages of therapy f g iv V Pretreatment client and therapist agree to work together and learn about each other First stage helping client develop a stable life which includes reducing suicide related behaviors and other behaviors that interfere with everyday life 1 Four speci c goals include reducing suicidal ideation reducing behavior that interferes with therapy achieving a stable lifestyle and developing skills in emotional regulations Second stage processing previously experienced traumatic events can only occur when a person39s life is stable 1 Four speci c goals include remembering and accepting the facts of earlier trauma reducing the intrusive material associated with the earlier trauma reducing any self blame involving the trauma and resolving dialectical tensions associated with blame for the trauma Third stage helping the person develop a sense of self that allowed them to live independently Fourth stage ability to sustain joy and be part of the ever changing world Dynamic deconstructive psychotherapy DDP developed for clients who nd therapy dif cult as well as for those who may have substance abuse problems designed to help individuals with borderline personality disorder develop a coherent sense of self iv 1St stage identify the client39s dif culties and establish goals 2nCI stage developing the client39s ability to maintain complex ideas related to his relationships with others 3rCI stage better understanding of selflimitations and an idealized image of himself and his abilities Final stage how the person will experience the termination of therapy Transferencefocused psychotherapy TFP a twiceweekly therapy based on Kernberg39s object relations model TFP seeks to reduce symptoms of BPD especially selfdestructive behaviors First year behaviors involving selfharm are limited and a therapy contract is developed Vl Treatment for the other personality disorders Most treatments above are set for BPD given that it has the most research Other treatment is found by experiences of health care professionals case studies or simple descriptions of treatments a b Chapter 8 a L Depressive Disorders Introduction i Most people do not have their moods interfere with their daily lives ii Manic depression now known as bipolar disorder a mood disorder characterized by the experience of both depression and mania iii Bipolar disorderpreviously known as manic depression quot iv Unipolar depression the mood disorder characterized by the experience of depression without mania vSuicide to kill oneself often tied to mood disorder vi Greek writers have descried depression for 2000 years and called it melancholia LMelancholia now known as depression described by ancient Greek writers in terms of despondency dissatisfaction with life problems sleeping restlessness irritability dif culties in decision making and a desire to die mMania described in terms of euphoria excitement cheerfulness grandiosity and at times anger ix All individuals experience depressed moods for brief periods that are accompanied by sadness loss of energy social withdrawn and often negative thoughts x 1 in 4 females and 1 in 10 males experience major depressive disorder MDD xi Major depressive disorder MDD a mood disorder characterized by depressed mood in which one feels sad or empty without any sense of pleasure in one s activities LMost commonly diagnosed mental disorder LLifetime prevalence is 299 and 86 for a 12 month prevalence 75 of people who are diagnosed with MDD are also diagnosed with LAnxiety disorder59 LOCD 319 LSubstance abuse 24 MDD is seen as the most economically costly mental disorder xii Xiii Mood Disorders Around the World lnitial episode of depression has strong environmental components while later ones are related to internal physiological changes ii Major life stress can be associated with the development of depression iii Pathway from chronic stress to depression includes LReduction in size of brain regions that regulate mood such as prefrontal cortex PFC and hippocampus iv Cortisol a hormone which is released in response to stress 1 More cortisol is produced with those with depressive disorder v Intergenerational transmission of depression the idea that depression in an individual is in uenced by having one or more parents who are depressed L23 times more likely to develop depression between ages of 1520 with a depressive parent cDeveopmenta Aspects of Depression i Mood disorders are common in adolescents due to social emotional hormonal and brain changes ii Estimated that clinical depression iii Environmental factors are a critical factor in the development of depression LStudy showed that over 90 of episodes of depression were related to stressful events LCognitive Model of Depression i Cognitive model of depression a model that suggests that individuals with depression display a bias in the way they search for information and process this information ii Bias takes place out of awareness and represent internal schemas that in uence what a person sees iii Cognitive model is a learning theory that suggests that events lead to development of depression iv Negative cognitive triad the self the personal world and the future as they contribute to a negative schema v Brain imaging techniques have progressed greatly ad helped nd underlying reasons for depression vi When thinking of positive things normal brains have a stimulated ACC but those with depression have a ACC that goes towards negative thoughts LAre Depression and In ammation Related i Similarity between symptoms of physical sickness and depression ii Macrophage theory of depressionthe suggestion that cytokines malfunction may be involved in depression iii First studies showed that hospitalized patients with depression also displayed signs of immunosuppression fDoes Depression Run in Families iChronic severe depression has been shown to be familial ii Threefold to vefold increased risk of developing MDD if that person is a child of a person with MDD iii Familial depression tends to have an earlier onset and be more severe iv There may be relationships between the de cits and the magnitude of cortical thinning and white matter hypoplasia gThe Evolutionary Perspective Concerning Depression i Various hypothesis for the existence of depression 1 2 1 2 3 h Depression is a result of a mismatch between the current demands of society and the brain and nervous system Depressed state represents a risk management strategy in response to a situation that has a low probability of success Three broad models for depression In terms of resource conservation suggestions that depressive mood protects the organism by conserving energy by reducing energy expenditure the organism can both protect itself in the present situation and conserve energy that can be used in future productive situations In terms of social competition suggestion that depression is seen in the context of hierarchies as an involuntary de escalating strategy which signals to the other individual that he has won In terms of attachment suggestion that depression is a protective mechanism that prevents further critical losses as depressed mood reduces the desire of the individual to immediately enter a social relationship in which there could be an adverse outcome and secondly as the outward signs of depressed mood including changes in voice tone reaction time eye contact and facial expression signal to others signs of submission and helplessness Prevention and Treatment of Depression Treatment for depression LTechniques for direct manipulation of brain activity L L 4 5 6 7 Electrical or magnetic stimulation of the brain Psychotropic medication in uence neurotransmitters which inhibit or facilitate brain processes Brain may be in uenced indirectly through cognitive emotional or motor changes Some techniques use exercise and meditation as alternative ways of modifying internal processes Problem with treatment is that even when symptoms go away in one situation they can easily relapse CBT and medications have been shown to be more 8 9 effective in comparison to placebo treatment CBT and medications work through different brain pathways Antidepressant medication decreases amygdala activation Medications for Depression L First effective depression medications were introduced in 19505 and 605 a lmipramine tricyclic antidepressant Llproniazid monoamine oxidase inhibiter L1980s had a second generation of medications a Prozac was an instant hit and was given to many individuals b Prozac was connected with thoughts of suicide in people under 18 years old c Associated with less sexual desire and symptoms such as headaches and join pain d Prozac is referred to as a SSRI because it effects at the synapse LThe effectiveness of antidepressants are at about 50 iii Electroconvulsive Therapy ECT LECT a treatment for depression in which electrical current is passed through the brain for a brief period 2 The electrical activity triggers a brief seizure that changes the brain chemistry and networks of the cortex 3 Studies show that this works especially for people that other treatments do not work for 4 ECT was introduced as a potential treatment for schizophrenia a It was not effective for schizophrenia but ended up being extremely effective for depression 5 ECT today has a person under anesthesia and muscle relaxing drugs to prevent discomfort and broken bones from the seizure aGiven 23 times a week for 612 weeks LSuicidal ideation thinking often about suicide aThis is the kind of reason someone would use ECT iv Vagal Nerve Stimulation VNS LVNS treatment for depression in which an electrical stimulator is surgically implanted next to the vagus and then connected to a pulse generator in the person39s chest like a pacemaker in the heart the pulse generator can be programmed to deliver electrical pulses at desirable frequencies and currents 2 1997 approved by FDA as a treatment for epilepsy LVNS is seen as a safe alternative for people who do not respond to antidepressants LEffectiveness ranged from 031 vTranscrania Magnetic Stimulation TMS LTMS treatment for depression in which an electromagnetic coil is placed on the scalp from the coil a magnetic eld induces a small electrical current in the rst few centimeters of the brain which depolarizes the neurons vi Deep Brain Stimulation DBS 1 DBS placing an electrode in the brain LPulse generator and battery are implanted in the person39s 3 chest and connected through wires to the brain electrode Used as a treatment in movement disorders L1860 of people with depression with this treatment nd SUCCESS i Psychological Treatments for Depression i Cognitive Therapy for Depression LAaron Beck created cognitive treatment for depression in 2 3 4 5 the 19605 Cognitive therapy model suggests that depression is maintained by negative information processing Therapy should help a depressed person process the negative information Described as a cognitive triad a First component is the individuals negative view of self b Second component is the individual39s tendency to interpret experiences in a negative manner c Third component is that the person regards the future in a negative way CBT is a form of cognitive therapy known as quotnew wavequot or quotthird wavequot treatments a Focus less on changing thoughts and focus more on changing the person39s relationship with those thoughts b Some approaches of quotnew wavequot therapy are acceptance and commitment therapy ACT and mindfulnessbased cognitive therapy MBCT c All have been seen to be effective for the treatment of depression ii Emotion Focused Therapy for Depression EFT LEFT for depression is an empirically supported therapy 2 3 4 developed by Leslie Greenberg and colleagues Client is able to identify his maladaptive emotions and understand emotional needs in the present a Allows person to discover new ways of satisfying his current needs Treatment begins with the person experiencing the weak or bad sense of self a EFT the client must fully experience sense of self so change can take place EFT seeks to develop emotional intelligence LCIients worked best with those who were able to parent work or go to school although they found little or no satisfaction iii Psychodynamic Therapy for Depression 1 One focus is how depressive symptoms develop and how past experiences affect them 2 Some common themes with depression include feeling helpless and having an overdeveloped sense of responsibility 3 Transference important mechanism in which the client tends to see the therapist in terms of signi cant others in their life 4 Past situations can leave people with unrealistic expectations ll Bipolar Disorder aBipolar Disorders i Previously referred to as manicdepressive disorder in which mania and depression were both seen iiChanges in mood are important 1 Including intense sense of wellbeing alone with high energy seen in mania and the exact opposite seen in depression 2 Maniathoughts seem to flow easily perceptions and sensations are heightened 3 Depressive person experiences a bleak outlook low energy wish to do nothing iii Hippocrates saw both mania and melancholia as separate disorders produced by underlying conditions LDiagnosis of Bipolar Disorder i DSM5 classi es the disorder in terms of both manic and depressive traits ii Bipolar l requires the presence of one or more manic episodes but does not require any depressive symptoms 1 prevalence iii Bipolar ll requires an episode of MDD along with a hypomanic episode cannot have a manic episode 1 prevalence iv Rapid cycling going through the phases of depressionnormalcy and maniahypomania can get as bad a schizophrenia psychotic epEode v Distinctions are related to severity and duration of the manic phase vi Bipolar l Disorder needs to display 3 of the following duration 1 week or more DIGFAST distractibility in ated selfesteem grandiosity ight of ideas activity sleep none talkatiVE go back to normal in between manic episodes Lln ated selfesteem or grandiosity LDecreased need for sleep LMore talkative than usual or pressure to keep talking LFlight of ideas or subjective experience that thoughts are racing 5 Distractibility 6 Increased in goaldirected activity LExcessive involvement in activities that have high potential for painful consequences vii Bipolar ll Disorder LPresence of MDD the same as regular diagnosis for depression LRequires at least one hypomanic episode hypoess mania a Observable symptoms are the same as mania but doesn39t cause as much impairment in social and occupational functioning b Hypomanic episodes last for 4 days or less rather than a week viii Cyclothymic Disorder LCharacterized by mood changes that are not as severe as would be required for criteria for manic and depressive episodes LPrevalence a24 prevalence LLifetime prevalence for bipoar is 383 c Gender difference is similar LMajority of patients only havereport a few bipolar episodes per year e 40 of the individuals with more episodes reported a history of physical and sexual abuse versus 241 in the fewer episodes group cGenetics of Bipolar Disorder iHeritabiity is about 510 for rstdegree relatives ii 4070 for monozygotic twins compared only 1724 for fraternal twins LUnipolar Depression MDD for monozygotic twins is 311476 compared to dizygotic 251426 iii A rst degree relative of someone with bipolar disorder has approximately 10 times the risk of having the disorder compared with a random person iv Relatives of people with MDD are not at risk for mania but relatives of those with bipolar disorder are at risk for depression LBipolar Disorder and Creativity i Plato and Aristotle referred to bipolar as divine madness which they associated with creativity ii People who excel in philosophy poetry and artists tended to be associated with melancholicdepression and bipolar iii The link between bipolar and creativity is related to the mania aspect iv Not everyone with bipolar is seen to be artistic but the extremeness of mood can be associated with artistic abilities e Brain Imaging of Bipolar Disorder iDifferences in brain function have been found between the depressive and mania phases of bipolar disorder LDuring depressive phase there is a decrease activity in prefrontal activation LDuring manic phases there is a decrease activity in the activation of the ACC iiBrain processes underlying the symptoms of bipolar disorder involve the anterior limbic brain network LThe system is responsible for three important aspects LThe perception of emotional stimuli LThe generation of an emotional state LThe production of autonomic responses associated with the emotional state fNeurotransmitter Dysregulation iThe three neurotransmitters that are related to bipolar disorder are norepinephrine dopamine and serotonin iiSensitivity at the postsynaptic receptor site plays an important role in bipolar disorder organisms exposed to repeated doses of stimulants become more responsive to their effects gEnvironmental Factors ilndividuals who experience stress were 45 times more likely for a relapse in a 2year period than those who did not iilt was found that if a person with bipolar disorder returned from a hospitalization with a family situation in which criticism hostility or emotional overinvolvement were present the person would be more likely to have a relapse iii 94 of those in a negative emotional environment showed a relapse within 9 months as compared with 17 of those without a negative emotional environment LTreatment of Bipolar Disorder iNo accepted treatment other than medication ii Symptoms vary from depression to mania occurs in irregular patterns and cannot be controlled regularly LA large number of individuals are misdiagnosed LMany professionals recommend psychotherapy medication family support vMost therapies depend on both educational and psychological perspective LCBT developed for bipolar disorder which is based on medication management and individuals symptoms as well as social relationships iMedications for Bipolar Disorders iThere is typically a minimum of 5 or 10 years between the beginning of the illness and the initiation of treatment LPeople with bipolar illness typically seek treatment during depressive phase ii Acute treatment continuation treatment and maintenance treatment LAcute refers to the period from the beginning of a manic or depressive episode to remission of the symptoms a Lasts 612 weeks 2 Continuation the period from the remission of the symptoms to the time that they would not be expected to recur a 6 months for depressive and 4 months for manic 3 Maintenance designed to prevent or reduce future episodes of mania and depression iii Early onset before 18 have the most severe form of the disease more psychotic features and poor lithium response iv Anticonvulsantsvalproate carbamezine atypical antipsychoticsolanzapine risperidone clozapine benzodiazepines antidepressantscan make mania worse risks v Other medications include tegretol Depakote xyprexa thorazine vi Lithium is the most common treatment for bipolar disorder LFirst used in the 18005 to treat mental disordersnot used as much due to side effects 2 More effective for the mania aspect more than the depressive aspect 3 2030 of people don39t respond to lithium LCompliance issuegt lithium needs to be tracked by blood levels because high useover use can be poisonous lll Suicide alntroduction i Suicidal behaviors can be seen as existing on a continuum ranging from thinking about suicide and attempting suicide ii Suicidal ideation some individuals think about suicide without actually attempting to harm themselves iii Rate of suicide attempts between 1990 and 2000 didn39t change but actual successful suicides declined by 15 iv Mental illness has a strong connection with suicide v Of the suicide attempts that led to death 90 adults and 67 youth meet diagnostic criteria for mental disorders vi Most common disorders associated with suicide are depression bipolar depression substance use disorders personality disorders and schizophrenia vii In older adults mental disorders are often comorbid with physical disorders viii More people die from suicide than from homicide ixn 2000 815000 people died from suicide around the world b Cultural Differences in Suicide i Hungary has the highest national suicide rate followed by Finland ii Countries like Mexico that have a low national suicide rate are predominantly Catholic or Muslim LThe religious aspect means that they have strong family ties and have a younger population iii In the US and Europe suicide is associated with depression and alcohol use disorder Lin Asia suicide is associated with impulsiveness cGender Differences in Suicide and the Type of Attempts iFemaes attempt suicide more often than males ii Males are 3 to 4 times more likely to die because their methods are more lethal 79 of suicides iii Men rearms and hangings iv Students 912th grade more Hispanic F students 135 reported attempting suicide than Black nonHispanic F students 88 and White nonHispanic female students vReasons suicides are not always reported LReligious or attitudes condemn suicide LAutomobile suicides LLack of success LEndophenotypes and Suicide i Characteristics related to one s genetics may increase the probability of suicidal ideation and attempts ii These traits include aggression and impulsivity iii Another factor is the ability to make disadvantageous choices iv Examples LFor those who consider suicide the serotonin system in the PFC may not function normally 2 Hopelessness has been shown to be in uenced by TPH2 gene variation 3 Two HPA axis genes have been shown to interact with childhood trauma and increase suicidal behavior LShortTerm and LongTerm Factors Related to Suicide iLong term LFamily history of suicide LGenetics LMental disorders that run in families LPersonality traits and children who received negative feedback or abuse 5 Greater risk of suicide if a person39s direct family member shows abuse iiShort term LRecent life events LCurrent mental illness LFeelings of hopelessness f Preventing Suicide i Suicide prevention programs seek to reduce the factors that increase the risk for suicidal thoughts and behaviors iiWork on at least four levels LThe individual LThe individual39s relationships LThe community LThe society LSuicide prevention began in 19505 LMany communities have hotlines for 24 hours v National focus on groups that are at higher risk for suicide including Native Americans and veterans Chapter 13 l Historical Perspectives a Humans have always depicted sexual activities in paintings and carvings i Ceramic plates from Pompeii and Herculaneuom from 2500 years ago b Became negative around the 18th and 19th centuries in Europe and the US i Sexual stimulation especially masturbation were seen as mental illness ii Unsweetened corn akes and graham crackers were seen as cures for sexual desire iii John Kellogg was a physician against masturbation iv His brother added sugar to corn akes and sold them under the Kellogg company c In the 18005 scientists started to see sex in a scienti c perspective i Darwin presented the ideas of sexual selection and self preservation ii Freud emphasized the idea that sexuality was an important driving force in humans iii Ellis was one of the rst to study human sexuality itself 1 Published a serious of books called Studies in the Psychology of Sex 2 Went against the common notion and suggested that females also have sexual desires and seek enjoyment in sex 3 Suggested that gay and lesbian orientation was a normal variation on human sexuality and should not be seen as a disorder d Kinsey produced a survey on unbiased views of sex i Focused on 6 different outlooks to sexual orgasms 1 Masturbation 2 Petting 3 Nocturnal dreams 4 Heterosexual coitus 5 Homosexual behaviors 6 Bestiality ii 6 outlets were related in terms of frequency to various socioeconomic variables such as age education marital status occupation and religious identi cation ll Sexual Activities of Americans a Prevalencemales and females between 2544 i Vaginal intercourse 1 Males 97 2 Females 98 ii Oral sex with opposite sex 1 Males90 2 Females88 iii Anal sex with opposite sex 1 Males40 2 Females35 iv Samesex contact 1 Males7 2 Females11 b About 8 of men and 7 of women identify as gay lesbian or bisexual lll Sexual Arousal and Sexual Drive a Introduction i Desire for sex has been described with terms such as drive arousal need desire obsession and motivation b Your Brain and Sexual Activity i Blood ow changes in sexual organs with arousal ii There are brain changes when both males and females achieve orgasm iii When a male experiences an ejaculation PET studies show the same areas of the midbrain display activity as when a person takes heroin iv In females parts of the brain involving controlling thoughts and emotions becomes silent c Sexual arousal psychological term that refers to the internal experience of both cognitive and emotional processes and refers to the hormonal changes brain changes and changes in sexual organs related to blood flow lV Normal Sexual Functioning a 1960 rst time human sexual response was studied by William Masters and Virginia Johnson b Discovered a similarity in how men and women experienced the sexual expedence c Four phases to sexual response i Excitementblood ow increases in the genital region both a psychological and physiological state iii iv Plateau individuals pay little attention to external stimuli as internal experiences continue Orgasmmuscular contractions and muscle spasms occur Resolution both return to prearousal levels V Sexual Dysfunction Disorders duration 6 months or more a Introduction iv Sexual dysfunction disorders a category of the fth edition of DSM5 in which there are problems in sexual functioning the condition exists for at least 6 months and it causes signi cant distress or impairment 3 perspectives to understand disorders 1 Medical and biological factors diabetes and vascular disorders can lead to interfere in sexual functioning 2 Psychological childhood abuse can lead to performance anxiety anxiety substance abuse and depression can inhibit abilities 3 Relationship ghts or distress in a relationship can inhibit sexual response Sexual dysfunctions are common 1 43 of women and 31 of men reported sexual dysfunctions Sexual dysfunction are thought in terms of four categories 1 They relate to desire arousal orgasm and pain b Erectile Disorder iv v vi Erectile disorderrequires that a male has a problem in one of three areas 1 he cannot obtain erection during sexual activity 2 he cannot maintain an erection until the completion of sexual activity and 3 he has a decrease in the rigidity of the penis n a way that interferes with sexual activity further the experience of erectile problem produces signi cant distress Lifestyle factors can in uence erectile dysfunction such as not exercising smoking being obese abusing alcohol Medical condition can in uence it including diabetes hypertension and atherosclerosis as well as psychotropic medications Etiology 1 Biological hormonal imbalance more commonly vascular problems 2 Psychological cognitivegt performance anxiety 3 Socioculturalsocietal stressmarital stress NPT monitor a nighttime erection MedicationViagra Levitra cialis c Female Orgasmic Disorder Female orgasmic disorder the condition in which a woman either does not experience an orgasm or has reduced intensity of the sensation of the orgasm this causes signi cant distress ii Orgasm in males is closely tied to puberty but orgasm in females may follow puberty after many years Delayed Ejaculation i Delayed ejaculation the situation over a 6 month period in which a male shows a delay in ejaculation or shows a lack of ejaculation and this causes signi cant distress ii No clear argument on what is considered delayed Early Ejaculation i Early ejaculation diagnosed when a man experiences an ejaculation within approximately the rst minute of sexual activity and this causes signi cant distress over a 6 month pe od ii Seen mainly as a psychological disorder and was treated with psychoanalytic techniques iii Certain SSRls are used for this because they may delay ejaculation Female Sexual InterestArousal Disorder i Female sexual interestarousal disorder requires signi cant distress or impairment along with at least three speci c symptoms including a reduction or absence of interest in sexual activity sexual fantasies excitement or pleasure during sex and internal or external sexual cues or sexual sensations Male Hypoactive Sexual Desire Disorder i Male hypoactive sexual desire disorder refers to the situation in which a male has little desire for sexual activity or even erotic thoughts for 6 months and this condition causes signi cant distress ii About 15 of men around the world lack interest in sexual activities Genitopelvic painpenetration disorder i Genitopelvic painpenetration disorder refers to conditions associated with dyspareunia or vaginismus or the fear of anxiety associated with these conditions ii There are two types 1 Dyspareunia type of pain experienced during intercourse cause can be varied 2 Vaginismus when penetration is attempted and muscles of the vaginal wall begin to spasm a Can occur with penetration of anything such as a nger a speculum by a gynecologist a tampon iii DSM5 includes these and any fear or anxiety associated with these conditions lV Treatment Approaches for Sexual Dysfunction Disorders a b Important to understand the patient39s sexual behavior and his or her understanding of the problems Successful treatment includes teaching the individual the basis of sexual activities and lling any of the gaps i Ex directed masturbation c Find if any medical problems are associated with the disorder d Understand any psychological disorders such as family or cultural prohibitions toward sexual practices e In order to a have a separated distinguish between nontraditional sexual activities and sexual disorders the DSM5 has a section for paraphilia and paraphilic disorder i Paraphilia refers to nontraditional sexual practices that exist alongside the traditional expressions of love ii Paraphilic disorders for a sexual behavior to qualify as a disorder it must cause distress to the person involved and may cause distress or harm to others in general they are also long term in nature iii These disorder include behaviors such as exposing oneself to others being sexually aroused by children being sexually aroused by inanimate objects being aroused by touching or rubbing against others gaining sexual arousal by making another person suffer gaining sexual arousal from cross dressing and gaining sexual arousal by watching unknowing individuals disrobe or engage in sexual activities V Paraphilic Disorders a Exhibitionistic Disorder i Exhibitionistic disorder the case in which a person becomes sexually aroused by exposing his genitals to an unsuspecting stranger ii Gender neutral but barely displayed by women iii Flasher male exhibitionist who will nd places where women are expected to be iv May use asher experiences to be part of later sexual fantasies v Known as a crime in the US as indecent exposure vi Diagnosed with disorder if they engage in exhibitionist behavior for 6 or more months b Frotteuristic disorder i Frotteuristic disorder the condition in which an individual gains sexual arousal from touching or rubbing against another nonconsenting person ii This disorder has only been seen in men iii Some subway cars in Tolqo are for women only during rush hour iv Requires two conditions to be diagnosed 1 Sexual arousal resulting from touching or rubbing against a nonconsenting person that has lasted for 6 months 2 Marked distress or impairment in the individual39s functioning v Few people seek treatment without being court ordered c Fetishistic Disorder i Fetish an erotic xation on an object or body part that is not sexual in nature Fetishistic disorder involves an erotic xation on an object or body part that is not sexual in nature and that lasts for more than 6 months and results in clinically signi cant distress or impairment in important areas of functioning Object creates a quotspellquot over a person d Pedophilic Disorder V vi vii Viii Pedophilic disorder involves a persistent sexual interest in prepubescent or early pubescent children the clinical de nition of pedophilic disorder does not require an actual sexual act although that can be the case There are individuals who have this disorder but do not act on it Some quotgroomquot a certain child by giving them gifts and slowly lead into behaviors that they found sexually arousing 3 different criteria 1 Person gains more sexual arousal from children than adu s 2 Person has acted on these urges or these urges have caused a problem in their functioning 3 The condition has lasted more than 6 months Some may use child pornography while others may actually seek out children Both men and women can abuse children but pedophilia only occurs in men Part of the emotional reaction to pedophilia exists in the fact that these children have yet to experience their own sexuality Treatment approaches include trying to control his sexual attraction to children as well as selfregulation skills e Sexual Masochism Disorder vi Sexual Masochism Disorder present when the person experiences sexual arousal from the act of being humiliated beaten bound or otherwise made to suffer as manifested by fantasies urges or behaviors for more than 6 months and these urges or behaviors cause distress or impairment in the person39s life May include being restrained by ropes blindfolded humiliated dominated as well as being whipped or beaten 510 of men and women nd this pleasurable on an occasional basis Both sexual stimuli and pain stimuli can heighten central nervous system states of arousal and motivation There is an overlap of neuroanatomical pathways and mechanisms of pain and sex Criteria also asks if asphyxiation is present which is the process by which a person puts a plastic bag over his or her head or a rope around their neck to cut off oxygen temporarily and enhance the sexual experience especially during masturbation f 1 A tragic number of people lose consciousness before they remove the bag or noose and die Sexual Sadism Disorder Sexual sadism disorder involves deriving sexual pleasure from in icting pain or humiliation on others it is required that the person has acted out these impulses with a nonconsenting individual or experienced distress or impairment from these impulses and it must have been present for at least 6 months This may include restraining blindfolding humiliating or dominating another Believed to be more common in males than females Some individuals require a nonconsenting person to experience the sexual arousal Comorbid with impulse control disorders antisocial personality disorder and borderline personality disorder g Transvestic Disorder Transvestic disorder characterized by recurrent and intense sexual arousal from crossdressing as manifested by fantasies urges or behaviors that last for a period of at least 6 months and cause distress or impairment Research mainly examined heterosexual men who crossdressed 1 Half the individuals began crossdressing before puberty Transsexual the situation in which a transgendered individual has sought medical intervention such as hormone treatment and sexual reassignment surgery to change his or her body into the opposite sex h Voyeuristic Disorder ii iii iv v vi Voyeuristic disorder involves obtaining sexual arousal from watching unsuspecting people when they are undressing performing sexual acts going to the bathroom it lasts for a period of at least 6 months and causes distress or impairment Seen almost exclusively in men and starts before the age of 15 Also called quotpeeping tomsquot Usually not interested in meeting or having a relationship with the person rather use the watching for sexual arousal Risk of being caught is an additional source of excitement Many don39t go to places nude beaches where nudity is acceptable because it39s not quotas funquot Other Paraphilic Disorders Two additional categories 1 First is referred to as quotspecified paraphilic disorderquot which includes symptoms that cause signi cant distress or impairment in important areas of one39s life but do not satisfy the criteria in any of the disorders previously desc bed a Include sexual arousal from making obscene phone calls corpses animals feces urine enemas or other sexually arousing events for that individual 2 Second is referred to as quotunspeci ed paraphilic disorderquot which includes symptoms for the rst but has insuf cient information which makes a less speci c diagnosis ii Sexually related crimes rape are usually not seen as people having a disorder but as crimes only V Treatment Approaches for Paraphilic Disorders a b c d e Many people do not seek treatment so sound research is lacking Treated in terms of other comorbid problems 3 sources of seeking treatment i Court mandated ii Partner or spouse encourages it iii Person nds his or her fantasies or behaviors distressing or afraid of being caught Psychopharmacological treatments have been used to reduce sexual drive and SSRls have also been used CBT is used to focus on how the person interprets his thoughts and emotions in relation to others Vl Gender Dysphoria a b f g Gender Roles typically de ned by one s culture in terms of the kinds of activities boys and girls are expected to engage in Gender identity the internal experience of knowing that you are male or female People with gender dysphoria have a gender identity that does not match their sexual anatomy at birth Gender dysphoria the situation where individuals feel that they are in the wrong body they may have been born as a male in terms of their body but their internal experience is that they feel like a female a smaller number of those born in a female body feel that they are really a male Diagnosis includes 6 of the following 8 for children I A strong desire to be the other gender ii A strong preference for wearing clothes of the opposite gender iii A strong preference for crossgender roles in makebelieve play iv A strong preference for toys games or activities associated with the opposite gender v A strong preference for playmates of the opposite gender vi A strong rejection of toys and games associated with one s phy calgender vii A strong dislike of one s sexual anatomy viii A strong desire to have the physical sexual anatomy of the opposite gender Not all children who show gender dysphoria in childhood will continue to show it in adolescence or adulthood Diagnosis includes 2 of the following 6 in adolescents and adults 9339 Chapter 14 i A marked incongruence between one s experienced gender and one s anatomical sex characteristics ii A strong desire to be rid of one s primary sex characteristics because of a marked incongruence with one s experience iii A strong desire for the sex characteristics of the other gender iv A strong desire to be of the other gender v A strong desire to be treated as the other gender vi A strong conviction that one has the typical feelings and reactions of the other gender Transgender common term for individuals who have the anatomy of one sex and the gender identity of the other Question arises whether the clinical and scienti c exists for claiming that gender dysphoria is a mental disorder No treatment has been seen to show change in gender dysphoria or sexual orientation If a person does not receive support they will possibly develop other disorders Brain develops differently in cases of gender identity Fiber pathways change Some adults seek gender transition surgery Drug Use in the United States a b As many as 315 million US citizens over 18 or older regularly use illegal andlegaldrugs Over 50 of Americans over 18 regularly use alcohol where 18 regularly use tobacco Tobacco a plant that originated in the Americans with native populations smoking or chewing its leaves About 225 million Americans over the age of 12 used an illicit drug in the p st month i These include marijuanahashish cocaine crack heroin hallucinogens inhalants amphetamines and prescription drugs ii Hallucinogens drugs that are able to alter perception mood and cognitive processes in often unpredictable also called psychedeHcs iii Amphetamines stimulants produced in the laboratory which result in positive feelings a burst of energy and alertness iv College age students show the highest percentages in illicit drug use v Opioids substances derived from the opium poppy that have been used for thousands of years to control pain and bring on euphoric feels more common opioids are heroin opium morphine methadone and oxycodone vi Cannabis a plant species also referred to as marijuana the resin is referred to as hashish main psychoactive ingredient is THC e Addiction the situation of using psychoactive substances in which individuals experience a stronger motivation that results in an active wanting and seeking of the substance as opposed to a simple choice of when and where to have the experience ll Substance Abuse Dependence and Addiction a introduction i Many motivations to the desire to use drugs and alcohol 1 Liking the experience associated with using drugs and alcohol 2 Addiction ii Binge drinking de ned by the NIAAA as consuming enough alcohol in a 2 hour period to have a BAC of 08gdL iii Dependence way to describe addiction to a substance three major parts 1 The desire to seek and take a certain substance 2 The inability to avoid or limit the intake of the substance 3 The experience of negative emotional states when the substance is not available iv Substance abuse and addiction is a burden to the person39s family and society b Substance Disorders in DSM5 and lCDlO i lntoxication refers to the effects of the psychoactive substance on the individual effects are substancerelated but typically involve psychological changes and behavioral abilities ii Withdrawal the symptoms experienced when a psychoactive substance is reduced or no longer used iii Disordered use the condition in the use of the psychoactive substance in which the person experiences signi cant impairment or distress iv Impairment or disorder can be related to Taking more of the substance than intended Not being able to reduce the use of the substance Spending time trying to obtain the substance Not being able to do work or keep up with other onga ons Having the substance interfere with social relationships Reducing one s activities because of the substance Substance creating medical problems Engaging in hazardous activities on substance driving v Both books discuss withdrawal in terms of alcohol caffeine cannabis hallucinogens opioids sedatives stimulants and tobacco 1 Caffeine a substance that acts as a stimulant although there are bene cial effects beyond stimulation c Who Becomes Addicted PWF 99 vi vii One factor can be related to the timing of the rst use 1 Alcohol using before the age of 15 are 4 times more likely to become addicted than those who begin at 20 or older 2 European children are introduced to alcohol use at a younger age than American youth and have fewer problems Drugs have a direct in uence on the frontal lobes of the brain for aHages Another factor is genetics 1 4060 vulnerability can be attributed to genetic factors 2 Some drugs are more addictive than others to people with different genetic makeup Environmental factors 1 Stress or low socioeconomic factors are associated with drug use and addiction 2 Epigenetics also play a role Common underlying between drug addiction bulimia nervosa pathological gambling and sexual addiction 1 Pathological gambling a disorder in which gambling continues even despite negative consequences such as consistent losses and an inability to control one s gambling behavior Other mammals besides humans have psychological changes when taking an addictive substance Psychoactive substances use the same networks in the brain that are associated with a feeling of social wellbeing d Pattern of Addiction The positive experience of taking the drug leads to a compulsion to seek and take a given substance An be experienced as a rush or sense of wellbeing Craving a step in the addiction pattern in which the individual loses control of the ability to limit intake of the drug Intoxication impaired selfawareness gt bingeing loss of control gt withdrawal amotivation and anhedonia gt craving drug expectation and attention bias gt intoxication e Can Drugs Change Your Brain Someone who is addicted can produce psychological changes in their brain even when looking at that drug39s paraphernalia Rewarding effects of drugs include the ability to increase dopamine Important pathway to addiction is the mesolimbic dopamine system 1 Begins in the ventral tegmental area VTA which is by the base of the brain 2 Connects with the nucleus accumbens prefrontal cortex dorsal striatum and amygdala 3 This structure releases dopamine iv Nicotine the addictive substance in tobacco it is a stimulant substance found in plants of the nightshade family it can have varied effects on the body which makes it function as both a stimulant and a depressant v Dopamine plays an important role in motivation III Alcohol a DSM5 Alcohol Related Disorders i Alcohol use Disorder 1 Pattern of alcohol use that leads to signi cant impairment or distress 2 Requires two or more other factors such as a an e f g the person taking more of the substance than intended and not being able to reduce the use of the substance spending time trying to obtain the substance not being able to do one s work or other obligations having the substance interfere with other social relationships reducing one s activities because of the substance having the substance create medical problems engaging in hazardous behaviors such as drunk driving 3 in the US 125 males and 5 females would meet the criteria in a given year 4 lifetime prevalence is 42 for males and 20 for females ii Alcohol Intoxication Disorder 1 One of more of the following signs after alcohol use 0qu9 f Slurred speech lncoordination Unsteady gait Nystagmus Impairment in attention or memory Stupor or coma iii Alcohol Wit drawal 1 Two or more symptoms several hours or days after heavy use of drinking 0qu9 f g h Autonomic hyperactivity Increased hand tremor Insomnia Nausea or vomiting Transient visual tactile or auditory hallucinations or illusions Psychomotor agitation Anxiety Generalized tonicclonic seizures iv Alcohol is consumed throughout the world 1 Cultural differences a Irish celebrations and funerals use alcohol b Islamic tradition bans alcohol v Used in many social situations because of its effects of the central nervous system vi As an addictive substance it can lead to social legal and medical problems vii Alcohol related problems cost the US 185 billion annually 1 Includes injuries violence cancer cardiovascular disease b Effects of Alcohol on the Human Body i Alcohol is absorbed directly through the blood stream without digestion ii Food causes the alcohol to absorb more slowly iii When sent to the lungs it vaporizes and is exhaled 1 Reason for breathalyzer tests iv Absorbed faster than it can be metabolized by the liver v Alcohol dependence runs in families 1 4060 of variance in dependence can be accounted for by genetics 2 Common genetic component in alcohol tobacco and cannabis use 3 Increases from adolescence to adulthood c Moderate Heavy and Binge Drinking i Light drinking a glass of wine actually has health bene ts and is better for people than those who don39t drink at all ii Moderate drinking is de ned as no more than 4 drinks per day or no more than 14 drinks per week for men iii Moderate drinking form women is de ned as no more than 3 drinks per day or 7 drinks a week iv People who drink more than moderate are at risk for being considered heavy drinkers 1 De ned by NIAAA as drinking enough to have a BAC of 08 in a 2 hour period 2 Comes with many health problems v 08 is de ned in all 50 states as the legal limit for being intoxicated d Rates of Drinking i About 23rds of all Americans over 18 years old have had at least one drink in the past year ii Binge drinking is highest in collegeage populations e Do People who Drink More Like It More i Some individuals who crave alcohol might not even like it ii Studied this by following 104 weekly binge drinkers and 86 light drinkers for 2 years 1 Heavy drinkers wanted alcohol more 2 Light drinkers found less stimulation from alcohol IV Cannabis a Introduction i Plant species also referred to as marijuana ii Easily cultivated indoors and outdoors V iii iv v vi vii Used worldwide as a psychoactive drug for the past 4000 years Used as a religious and recreational substance History begins in China India Middle East and Europe 1 Moved to Americas in 19605 and became popular Small doses produce enjoyable positive feelings feeling high Main ingredient is THC 1 Affects receptors in the hippocampus 2 Releases GABA b Cannabis and Psychosis Larger doses can produce hallucinations and delusions Higher uses of cannabis can be seen in relation to psychotic symptoms and schizophrenia Genetic factors may play a role in individuals who use cannabis and end up developing psychotic symptoms c Hallucinogens I ii iii iv vi vii viii xi Opioids Drugs that alter perpetual experiences LSD begins with a grain fungus ergot 1 First made in a laboratory Other laboratory drugs include ecstacy MDA and PCP Hallucinogens can cause 1 Somatic symptoms dizziness weakness tremors 2 Perceptual symptoms altered shapes and colors dif culty in focusing 3 Psychic symptoms alterations in mood tension distorted time sense Extremely unpredictable and based on the experiences of the user Do not produce dependence and relatively safe Dependence is based on the dopamine system quotbad tripquot experience including extreme anxiety and fearful psychoticlike experiences Mescaline is least potent and was used in Native American religious services Psilocybin comes from a fungus and is referred to as quotmagic mushroomsquot 1 Produces heightened sensory experiences 2 Relatively safe in terms of dependence Brain blood ow increases in the frontal areas of the brain the insula and the anterior and posterior cingulate a Introduction Derived from the opium poppy and has been used for thousands of years to bring on euphoric feelings and control pain Most common include heroin opium morphine methadone and oxycodone Variations are currently used as pain medication and pain experienced with types of cancer b Do you have Opium receptors in your brain VI V C i You do have receptors that are sensitive to opioid drugs ii Bodies make naturally occurring substances that reduce pain and makes us feel good iii Endorphins are produced at times of stress and allow individuals to continue in combat or a sports activity even when they hurt Cocaine i Comes from the coca plant ii Individuals chewed the leaves for the psychoactive experiences iii Heightens experience of sensory processes such as sound touch and sight iv Produces physiological effects such as increased heart rate and blood pressure 1 Administered through smoking snorting injecting v Smoked cocaine is referred to as crack vi Cocaine interferes with this natural process resulting in an increase of dopamine vii Parts of the brain involved include the striatum amygdala hippocampus and other areas of the brain Amphetamines a b j k Stimulants that result in positive feelings a burst of energy and alertness First developed in the 18805 and was introduced as a medicine in form of an inhaler in the 19305 Prescribed by doctors for disorders including epilepsy Parkinson39s disease schizophrenia migraine and behavioral problems in children Also prescribed to reduce other addictions including alcohol morphine and tobacco People began to abuse it as they felt the effects people believed it would help them enhance performance and help them feel good Amphetamines can be manufactured anywhere with an advanced knowledge of chemistry Affect the dopamine system i Create brain changes including development of compulsive patterns negative changes in relation to brain injuries and changes in cognitive functioning Cognitive de cits show problems with motor activities and abilities to shift attention i Memory attention and decisionmaking problems ii Makes it dif cult for people to see their addiction Also known as speed crystal meth or crank Both have been seen to be toxic to dopamine and serotonin neurons Caffeine and Tobacco a b Caffeine is described as a stimulant but there are more bene cial effects other than stimulation Comes from many sources including seeds of plants tea leaves coffee beans cocoa beans The average 8 02 cup of coffee has about 100 milligrams of caffeine VI th0 Added in energy drinks weight loss drugs sodas and drugs for colds Estimated that 85 of children and adults consume caffeine daily Consumption of coffee was seen with people having less risk of heart disease but possibility of stomach problems trouble sleeping anxiety irritability and nervousness Large doses of caffeine can be diagnosed with caffeine intoxication Tobacco originated in the Americas with Natives smoking or chewing theleaves Associated with cancer and addictive substance is nicotine Nicotine has various effects on the body including i Decrease in appetite ii Boosts in mood and may relieve minor depression iii Raises blood sugar level iv Increase heart rate and blood pressure v May cause sweating and nausea Withdrawal effects include i lntense craving for nicotine ii Anxiety tension restlessness iii Dif culty concentrating iv Drowsiness or trouble sleeping v Headaches vi Weight gain vii Depression Gambling a b DSM5 considers pathological gambling an addictive disorder At least four of the following i Has a need to gamble with increasing amounts of money ii Has tried to cut down on gambling iii Thinks about gambling iv Gambles when feeling distressed v Tries to recoup loses vi Lies to conceal involvement in gambling vii Jeopardizes signi cant opportunities viii Relies on others to supply money lost in gambling Individuals with both substance use disorders and gambling show substance tolerance i Substance tolerance the situation in which the individual must consume more of the drug to have the same effect or with gambling the individual must bet more to keep the same level of excitement Four cognitiveemotional processes playing a role in pathological gambling i Behavioral conditioning 1 Those who win relate winning to their behavior so they behave that way ii Cognitiveemotional processing 1 Experience of cues brings forth the urge to gamble iii lmpulsivity 1 More impulsiveness iv v Impaired executive functioning 1 Ignore long term consequences over shortterm expe ences Treatment of SubstanceRelated Disorders a Principles of Effective treatment Vl vii viii xi xii Xiii Addiction is complex but treatable and affects brain function and behavior No single treatment is appropriate for everyone Treatment needs to be readily available Effective treatment attends to multiple needs of the individual not just his or her drug abuse Remaining in treatment for an adequate period of time is crucial Behavioral therapies including individual family or group counseling most commonly used forms of drug abuse treatment Medications are an important element of treatment for many patients especially when combined with and other behavioral therapies An individual39s treatment and services plan must be assessed continually and modi ed as necessary to ensure that it meets his or her changing needs Many drugaddicted individuals also have other mental disorders Medically assisted detoxi cation is only the rst stage of addiction treatment and by itself does little to change longterm drug abuse Treatment does not need to be voluntary to be effective Drug use during treatment must be monitored continuously as lapses during treatment do occur Treatment programs should test patients for the presence of HIVAIDS hepatitis B and C tuberculosis and other infectious diseases b Psychosocial Therapies and Addiction CBT for individuals and couples helps a person understand their issue c The 12step program 12 step program a community in which individuals with addiction problems meet and follow the principles described in the 12 steps forms the basis for AA Admitted powerlessness over alcohol Came to believe that a power greater can restore to sanity 3 Made decision to turn lives over to the care of god 4 Made a searching and fearless move 5 Admitted to God we were wrong 6 Entirely ready to have God remove all these defects 7 8 9 1 Nl 39 Humny asked Him to remove over shortcomings Made a list of all persons we harmed Made direct amends to those people 0Continued to take personal inventory d Chapter 8 11Sought through prayer and meditation to improve our conscious contact with God 12Having a spiritual awakening as the result of these steps Medications i Agonist drug as treatment for addiction substance that binds to the receptor in the brain and produces cellular activity that mimics the function of the iict drug without producing the high ii Antagonist drugblocks receptor site in the brain so that the illicit drug does not produce an effect iii Aversive drug aversive when the drug is taken interferes with metabolism of alcohol and produces unpleasant reactions Introduction a C d e Schizophrenia a debilitating psychotic disorder in which individuals may hear voices see images not seen by others believe that others wish to harm or control them and have bizarre thoughts Psychotic disorders disorders that involve a loss of being in touch with reality and are characterized by abnormal thinking and sensory processes i Schizophrenia is included in psychotic disorders Delusions beliefs without support for their occurrence and which are at odds with individual39s current environment People have different symptoms of schizophrenia Schizophrenia a Affects about 1 of the population b c d Similar symptoms regardless of culture or geographical location Symptoms are not constantly present Positive symptoms uctuate while negative symptoms stay more constant thought time Positive and Negative Symptoms a b Positive symptoms hallucinations delusions disorganized thinking and disorganized behavior i 4 types of delusions 1 Persecution someone is going after you FBI 2 Grandeur you believe you are a high ranking gure Uesus 3 Control something is controlling your mind and reading your thoughts 4 Speciality god is speaking directly to you because you are special Negative symptoms lack of affect in situations that call for it poor motivation and social withdrawal i Avolition lack of will or volition VI ii Alogia lack of interest in talking with others or answering questions with more than one or two word answers iii Anhedonia the inability to experiences pleasure c Hallucinations sensory experiences that can involve any of the senses and that are at odds with the individual39s current environment Course of Schizophrenia a Generally begins in adolescence or young adulthood b Four stages of schizophrenia i Premorbid phase cognitive motor of social de cits ii Prodromal phase briefattenuated positive symptoms andor func onaldecHne iii Psychotic phase orid positive symptomsfull blown positive symptoms iv Stable phase negative symptoms cognitivesocial de cits func onaldecHne c Lifespan is shorter i Abbreviated life span can be due 25 to suicide and 10 to accidents Historical Perspective a Disorders with psychotic symptoms have been described for thousands of years b Medical texts have been found to suggest that psychosis is present in all cultures Paranoid idea that someone felt that they themselves were in danger Catatonic the unusual stiffness associated with unusual postures e Series of characteristics to describe schizophrenia i Affect blunted or diminished emotional response ii Associations loosening or inability to think in a logical manner iii Ambivalence inability to make decisions iv Autism social aloofness and an inability to remain in contact with the external world f Levels of symptoms i First eve includes delusions hallucinations or disorganized speech ii Second level functioning and a reduction of functioning iii Third eve duration of interpersonal relations and selfcare Subtypes of Schizophrenia a Four types are paranoid disorganized catatonic undifferentiated and residual b Paranoid a type of schizophrenia characterized by delusions whose themes generally center on idea of grandiosity or persecution c Disorganized a type of schizophrenia characterized by disorganized speech patterns and behavior d Catatonic a type of schizophrenia characterized by nonnormal activity of the motor system e Undifferentiated a type of schizophrenia that does not t any of the above subtypes with a combination of symptoms across the board an VII VIII f Residual individuals who had schizophrenic episodes but no longer display the tradition positive symptoms but may still display strange or odd behaviors Schizophrenia From and Evolutionary Perspective 0qu9 Individuals with schizophrenia have fewer children than others These people can be highly creative and gifted Schizotypal traits schizophrenic like traits Understand as a disorder of the social brain rather than language Also seen as a disordered connection between the frontal and temporal areas to the frontal and parietal areas Factors in the Development of Schizophrenia a b Usually rst noted in the transition from late adolescence to adulthood Children who seem to develop schizophrenia later in life show different traits in childhood than those who will not Negative events in a fetus including infections and malnutrition can be a risk for developing schizophrenia Imaging shows that ventricles are larger and greater gray matter loss in the parietal and frontal areas in children who develop schizophrenia before puberty Environmental factors such as life adversity growing up in an urban environment and cannabis use has been associated with developing schizophrenia Genetic Factors in Schizophrenia a b Schizophrenia tends to run in families all around the world The more similar the genes of one person with schizophrenia is to another the chances that the other person will develop schizophrenia is high Studies show that there can be about 1000 different gene combination contributing for the disorder Individuals with schizophrenia compared to people with no abnormalities in their DNA have deletions or duplications Not totally inherited because in cases of identical twins both twins having schizophrenia is not always present i 48 rate that both identical twins will develop schizophrenia Adolescents who did not have schizophrenia but had parents that did have dysfunctional interactions within cortical networks involved in emotional processing Endophenotypes Associated with Schizophrenia a Introduction i Endophenotypes are found in 5 major areas 1 Minor physical anomalies including differences in head size or motor movements 2 Physiological abnormalities based on membrane theory of schizophrenia Neuropsychological measures such as attentional abilities Neuromotor abnormalities such as eye movement Sensory processing and eventrelated potentials WP XI XII XIII XIV b Ventricle Changes in Schizophrenia i Four ventricles in the brain that contain brospinal uid ii Schizophrenic patients tend to have larger ventricles iii Some areas such as the ACC are smaller than normal functioning brains Schizophrenia and Brain Functioning a Manifests on a variety of levels including abnormal sensory experiences such as hallucinations problems in cognitive processes such as delusions and disordered thoughts lack of expression and problems with language b Five levels of analysis in the neuroscience perspective i Anatomical changes such as loss of brain volume in areas ii Functional processes such as the manner in which cortical areas and networks process information iii Neural oscillations that underlie the cortical networks iv Changes in neurotransmitters such as dopamine GABA glycine and glutamine 1 Dopamine a neurotransmitter in the brain 2 Glutamate an excitatory neurotransmitter in the brain c Cortical networks in the brain during development in the fetus are not consistently developing What Brain Changes are seen in Schizophrenia a Gilmore performed studies before and after birth i Using ultrasound there was no difference in children with schizophrenic mothers and normal mothers in their brain ii After birth males with schizophrenic mothers had more gray matter and increased cerebrospinal uid and larger ventricles iii After birth females with schizophrenic mothers didn39t show much difference b Brain volume does not change due to medication alone c Gray matter reduction may be due to the dying of neurons in the brain d White matter changes have also been noted Schizophrenia and Brian Networks a fMRl research looked at default mode network b network is activated when individuals are not performing a task and letting their mind wander c healthy individuals greater suppression of the default network during a task is associated with better performance on that task d schizophrenic individuals do not show normal suppression of the default network when performing tasks e they show fewer connections between frontal and temporal areas of the brain while performing tasks Treating Individuals with Schizophrenia a Until 19605 they were put in the mental hospitals b Medications have come out to show more positive mental health behaviors c Some individuals continue to work or continue their education d Caregivers and antipsychotic medications Antipsychotic Medications a Drug reduces agitation hostility and aggression as well as reducing positive symptoms b First generation antipsychotics in uence dopamine receptors c Second generation antipsychotics known as atypical antipsychotics that also in uence dopamine receptors Psychosocial Interventions for Schizophrenia a Family interventions include Provide practical emotional support Provide information about schizophrenia Help the family develop a model of schizophrenia Modify beliefs about schizophrenia that are unhelpful or inaccurate Increase coping for all familymembers Enhance problemsolving skills Enhance positive communications Involve everyone in a relapse prevention plan b CBT therapy includes XV XVI I ii iii iv v vi vii viii I ii iii iv v vi vii Chapter 6 Develop a therapeutic alliance based on the client39s perspective Understand the client39s interpretation of past and present events Develop alternative explanations of schizophrenia symptoms Normalize and reduce the impact of positive and negative symptoms Educate the client in terms of the role of stress Teach the client about the cognitive model including role between thoughts feelings and behaviors Offer alternatives to the medical model to address medication adherence I Introduction to Childhood Development a Introduction vi Unlike other animals humans cannot be born and then survive alone Human infants display an amazing ability to form connections with their caregivers and maintain a close connection with others 1 They talk and establish emotions at different rates Criteria for diagnosis of a developmental disorder are in terms of severity duration pervasiveness and degree of impairment Psychological problems can be related to attachment 1 Attachment the infant mother relationship Negative trauma can in uence the brain development and epigenetics causing developmental disorders Three groupings of disorders vii 1 Trauma and stressor related disorders a category of childhood disorders including disorders of attachment 2 Neurodevelopmental disorders a category of childhood disorders including autism spectrum disorders ADHD disorders of learning intelligence and communication and motor disorders such as tics and Tourette s disorder a ADHD a disorder of childhood that includes two major dimensions inattention and hyperactivity and impulsivity 3 Disruptive impulse control and conduct disorders a category of childhood disorders referred to as externalizing disorders They can be diagnosed in a few ways 1 lnternalizing disorders depression internal problems anxiety 2 Externalizing disorders substance abuse doing something on the outside drugs drinking b Brain Development Two critical periods in brain development 1 Gestation and the early years of life when the brain is establishing its cortical connections a Children develop the ability to process sensory information language and cognitive skills 2 Adolescence a Brain is rewiring itself as the person s brain develops Any disruptions external or internal can lead to physical and mental disorders c Effects of Early Life Stress Early Life Stress re ects the situation in which the child in unable to cope given the demands of life they experience Child abuse and neglect is around 10 and about 58 of all adolescents report experiencing some type of adversity during their lifetime Stress can have more of an impact during this age than in adu hood d Theories of Attachment John Bowlby developed a theoretical understanding of interpersonal relationships based on the interactions of a child with his or her parents Rooting re ex an infant begins sucking when their cheek or mouth is touched early emotional relationship between mother and her child Bowlby suggests 5 universal attachment behaviors for infants 1 Sucking 2 Clinging 3 Crying 4 Following 5 Smiling iv Experiment in which monkeys were to feed off a wire mother or a terry cloth mother 1 Assumed that they would just go to the place where they would receive food regardless of the material 2 More went to the terry cloth mother and they realized that this was a study of comfort rather than nutrition v Four patterns of attachment vi vii 1 Secure attachment pattern an attachment style characterized by the following pattern in the strange situation the infant 1 engages in active exploration 2 is upset when the mother leaves and 3 shows positive emotions when the mother returns 2 Avoidant attachment patter an attachment style in which the infant shows more interest in the toys than the mother and show less distress when the mother leaves and less positive emotion when she returns 3 Anxiousambivalent attachment pattern an attachment style in which the infant appears preoccupied with having access to the mother and shows protest on her separation when she returns the infant may show anger or ambivalence to her 4 Disorganizedcontrolled attachment pattern an attachment style in which the infant shows disruptions in processing during a strange situation Mothers of children who have secure attachment patterns tend to have a mothering style of caregiving while those children who have avoidant patterns tend to have mothers who are more rejecting and rigid Anxious patterns are associated with children who have mothers who are not there and then are intrusive e Imitation Learning Mirror neurons neurons in your brain that re as if you had performed the same actions as you observe Imitation learning on a brain level each time an individual sees an action done by another the neurons that would be involved in that action are activated creating a motor representation of the observed action essentially turning a visual image into a motor plan 1 Each time an individual sees an action done by another the neurons that would be involved in that action are activated Creates a motor representation of the observed action We see an action and consider how we might make it ourselves although we don39t do this consciously UJN 4 The observer s brain turns a visual image into a motor plan f Theory of Mind i Theory of mind the study of one s ability to understand one s own or another person39s mental state ii If there was a cereal box you would say there is cereal in it 1 Young children may say something else is in the box iii Cereal box pg 171 g Adolescence i Adolescence is a time of one s body awakening of new interests associated with brain changes ii Adolescence also marks the peak onset of many psychopathologies including anxiety mood disorders eating disorders personality disorders substance abuse and psychosis iii These ages usually see disorders such as panic generalized anxiety disorder PTSD substance abuse mood disorders and schizophrenia iv Hormonal changes can bring about depression and anxiety v Relationships are changing from family oriented to peer related vi Rislq behaviors are more likely in presence of peers h Brain Systems involved in Social Relations i Three processes 1 Involves higherlevel neocortical regions in the processing of sensory information 2 Our affective system helps us predict what people will do sociay 3 Involves higher cortical regions of the neocortex involved in cognitive understanding and regulation ii Prefrontal cortex has been shown to be activated during humor socialnorm transgressions resulting in embarrassment 1 Also involved with social relationships social cooperation mora behavior and social aggression II Attachment Disorders a Reactive attachment disorder RAD a disorder that is the result of inadequate caregiving which may include institutional settings i Usually results in young children exposed to neglect before being placed in foster care ii Alternatives may be that there is another psychopathology present such as autism b DSM5 describes a child with RAD as one who does not seek comfort or support from a traditional attachment gure when distressed i The child doesn39t accept comfort when offered ii Negative emotions can be seen in interactions with adults c Disinhibited social engagement disorder a disorder in which the child is willing to accept strangers who are not attachment gures i They may include going off with strangers and being overly familiar ii Assumed to be rare and little data on prevalence d When children are moved from institution to foster home the families are put in therapy to develop healthy attachments and attachment habits e Conduct disorder CD a disorder in which individuals display more extreme behaviors that re ect little regard for those around them they actively violate the rights of others f Maltreatment also leads to developmental delays in areas such as language and speech lll Autism Spectrum Disorders a Introduction i Autism spectrum disorders ASD a group of neurodevelopmental disorders individuals with autism spectrum disorders have dif culty in connecting and communication with others and with behavioral processes often displaying stereotypical behaviors and the desire to engage in the same behavior in a repetitive manner ii Difficulties in 3 separate areas 1 Social interactions do not connect with other children or adults in the manner that other children do 2 Communication communication patterns do not show the give and take of most conversations 3 Behavioral processing do not display stereotypical behaviors and the desire to engage in the same behavior in a repetitive manner iii Individuals with autism spectrum disorders may show other complications such as seizure disorder intellectual disabilities of various kinds and gastrointestinal problems iv DSM5 includes what were separate disorders 1 Autistic disorder 2 Asperger39s disorder milder situation in which developmental language delays may not be present and above average cognitive skills a lCDlO considers Asperger39s to be a separate disorder 3 General pervasive developmental disorder disorder in which the full criteria for autism is not met v Asperger39s syndrome individuals with this syndrome tend to be more intelligent and display higher functioning in terms of social processes than those diagnosed with autism which can include social impairment in the form of egocentricity a narrowing of interests compulsive need for introducing routines speech and language peculiarities nonverbal communication in the form of limited facial and gesture expression and motor clumsiness this category is used in the lCDlO but not the DSM5 vi Specialized thinking has three parts 1 Visual thinking allows one to view the world and even words in terms of images 2 Pattern thinking the thinking in terms of patterns such as those seen in music and mathematics 3 Word and fact thinking the individual displays an ability to know a large number of facts such as baseball scores of or the names of lms vii Strong genetic component 1 69 to 95 that identical twins will both have autism 2 024 that fraternal twins will both have autism viii Autism was originally seen to be mostly dependent on environmental factors 1 Suggested that bad parenting was related to developing autism spectrum disorders 2 Also suggested that vaccinations led to autism which is stupid and untrue ix There are dysfunctions in the amygdala speci c areas of the frontal lobes and areas of the temporal lobe x Characteristic of autism is the desire to have a stable set of routines which results in a problem shifting attention xi Empathizingsystemizing theory of autism coupled with the inability to empathize is the superior ability to systemize in autism xii Many people with autism focus on people s mouths rather than their eyes which may be a predictive factor in which young child will develop autism and who will not xiii People with autism display problems in three areas behaviorally 1 Social functions 2 Communications 3 Restrictions in behaviors and interests xiv A recent theory of autism centers on problems related to empathy and suggests that an individual with autism fails to develop the theory of mind xv In the 19605 and 19705 people with autism were considered to have a form of psychosis similar to childhood schizophrenia xvi About 1 in every 100 children has an Autism Spectrum Disorder b Special Talents i About 10 of individuals with autism spectrum disorder have special abilities in terms of music art calculation or memory c Treatment for Autism Spectrum Disorders i Parents turn to many professionals for help 1 These professionals include kindergarten teachers special education teachers speech pathologists child clinical psychologists psychiatrists and pediatricians ii UCLA Young Autism Project reported about 50 quotrecoveryquot rate of young children with autism based on behavioral principles iii 5 major stages in the Lovaas treatment program 1 Establishing a teaching relationship which lasts 24 weeks 2 Teaching foundational skills in terms of following directions imitating behaviors and identifying objects which lasts 14 months 3 Focus on beginning communication which lasts around 6 months 4 Continuing the communication processes such as labeling colors and shapes and developing basic concepts of language which lasts about 1 year 5 Continue communication processes and help the child adjust to school situations and peer interactions which lasts about 1 year lV Attention De citHyperactivity Disorder a Introduction i ADHD is a disorder that develops before the age of 12 ii Two major dimensions 1 lnattention let their mind wander or not paying attention 2 Hyperactivity and impulsivity show these symptoms in a behavioral or motor realm iii Externalizing disorders such as conduct disorder and oppositional de ant disorder iv lnternalizing disorders such as anxiety and mood disorders v Oppositional de ant disorder ODD a disorder in which individuals mainly show anger and de ance but do not act aggressively toward other people or animals or destroy property vi Should be present before the age of 7 b Treatment for ADHD i Majority of ADHD medications are stimulants ii Psychosocial treatments are often used in combination with medication 1 Best treatment is a combination of medication and behavioral therapy a Behavioral therapy includes classroomcontingency management programs and social skillssocial problem solving training iii CBT training involves 10 components 1 Get an overview of the characteristics of ADHD 2 Review behavioral management techniques and the problems associated with escalating negative interactions with the child 3 Increase positive attention to the child s desired behaviors and ignore certain negative behaviors 4 Learn how to help the child to comply with simple requests and present requests clearly 5 Set up a home reward system 6 Add costs for minor rule violations 7 Learn how to manage behavior in public 8 Use timeout period for serious ruIe violations 9 Consider potential problems in the future and the removal of the home reward system 10Have a booster session to review progress and troubleshoot situations XI Conduct Disorder a Display extreme behaviors that re ect little regard for those around them b They violate the rights of others including bullying and threatening others c As these people grow up their behavior can become more of a sexual nature d Difference between Conduct Disorder and Antisocial Personality Disorder is the CD is for children and AS personality disorder i Adults with Antisocial personality disorder had Conduct Disorder as a child e Different types of Conduct Disorders i Socializedaggression as part of a group ii Unsocialized aggression on their own f Leads to problems in adulthood i Antisocial personality disorder ii Marital and occupational maladjustment iii Early involvement with alcohol and illegal drugs iv Adult criminals XII Oppositional De ant Disorder a Introduction i Children who mainly show anger and de ance but do not act aggressively toward other people or animals or destroy property ii Lose their temper easily and often argue with adults iii Prevalence of the disorder is 33 iv Requires 4 of 8 characteristics in three categories 1 Angry or irritable mood a Losing one39s temper b Being easily annoyed c Being resentful and angry often 2 Being argumentative and de ant a Include arguing with authority gures b Refusing to do what they say and blaming others 3 Being vindictive b Treatment for Conduct Disorder and Oppositional De ant Disorder i Treatment usually involves the community and law enforcement rather than just an individual39s family and themselves ii Parents are taught to use behavioral techniques 1 Parent child interaction therapy to develop a secure attachment between the parent child 2 PRIDE a Praising b Re ecting c Imitating d Describing e Enthusiasm iii Older children relate better to clinical settings and problem solving skills iv Training in social and cognitive skills v Curriculum interventions for aggressive behavior vi Parent management training 1 Parents learn to establish rules and consequences 2 Most effect treatment combined with cognitive and social skills V Learning Disabilities a Learning disabilities the situation in which a child39s achievement is lower than that expected from his or her scores on achievement or intelligence tests b Individuals with Disabilities Education Act IDEA the act by which the Department of Education in the US de ned the services required to be provided to students with learning disabilities c Speci c learning disorder a disorder in which a child shows problems in one of the major school tasks VI Intellectual Developmental Disorder a Introduction i Mental retardation a disorder in which the person shows intellectual disabilities term no longer used in the DSM5 ii Intellectual developmental disorder IDD a disorder characterized by intellectual disabilities in which the person does not meet normal developmental milestones 1 De ned by 3 aspects a De cit in mental abilities such as reasoning problem solving planning abstract thinking judgment and ability to learn in both academic and practical settings b Lack of adaptive functioning in relation to one39s age and sociocultural background c Onset of the disabilities took place prior to adolescence iii Ex A person who is high school aged but functions at the level of an elementary school aged child iv Most forms of IDD can be traced to biological causes b Intellectual Developmental Disorder related to Chromosomes i Down syndrome a disorder resulting in both physical and intellectual problems found in individuals with an extra copy of chromosome 21 ii Cardiovascular problems are often found in children with down syndrome iii Disorder occurs during pregnancy with cell division and an extra copy of chromosome 21 iv Fragile X syndrome a chromosome disorder that results in intellectual development disorder due to the FMRl gene producing too little of a protein needed for brain development c Intellectual Developmental Disorder Related to Metabolism i PKU is a situation where a particular liver enzyme does not function correctly ii Can lead to IDD by preventing myelination of the neurons in the brain d Intellectual Developmental Disorder Related to Gestation i Fetus experiences can lead to problems such as a mother who engages in substance abuse experiences malnutrition or has an infection ii FAS fetal alcohol syndrome iii Crack babies the use of cocaine in the pregnant woman e Treatment of Intellectual Developmental Disorder i Depending on the level of functioning treatment varies 1 2 Residential and community programs for those who can39t function on a regular basis There are caregiver programs to help manage a child with IDD 3 Special education programs at schools 4 5 Medications are not usually given unless there is an Life skills training to live on their own aggression problem
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