Abnormal Psychology Class Notes
Abnormal Psychology Class Notes 2209
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Date Created: 01/19/15
October 7 2014 Abnormal Psychology Notes OCD and Trauma Related Disorders a In DSMlVTR ObsessiveCompulsive and Related Disorders and TraumaRelated Disorders were included with Anxiety Disorders 1 Some common symptoms risk factors and treatments with anxiety disorders b DSM5 creates new chapters for Obsessive Compulsive and Related Disorders and TraumaRelated Disorders c ObsessiveCompulsive Disorder OCD 1 Repetitive thoughts and urges obsessions 2 Repetitive behaviors and mental acts compulsions 3 Thought that increases anxiety and impulse that relieves it d Body Dysmorphic Disorder 1 Repetitive thoughts and urges about personal appearance e Hoarding Disorder 1 Repetitive thoughts about possessions ll ObsessiveCompulsive Disorders a Obsessions 1 Intrusive persistent and uncontrollable thoughts or urges 2 Experienced as irrational 3 Most common i Contamination sexual and aggressive impulses body problems III Video Chuck 1 OCD a What s the obsession Obsession leads to Anxiety b OCD 1 What is the compulsion An impulse 2 Compulsion temporarily reduces anxiety caused by obsession 3 Obsession 9 Anxiety 9 Compulsion i Results in decreased anxiety ii Negatively reinforcing a ObsessiveCompulsive Disorders 1 Compulsions repetitive behaviors or thoughts that the person feels compelled to perform to prevent i Impulse to repeat certain behaviors or mental acts to avoid distress ex cleaning counting touching checking The person feels driven to perform the repetitive behaviors or thoughts in response to obsessions or according to rigid rules ii Extremely difficult to resist the impulse iii May involve elaborate behavioral rituals The obsessions or compulsions are time consuming ex at least one hour perday iv Compulsive gambling eating etc Not considered compulsions since pleasurable 2 Obsessions recurrent persistent intrusive unwanted thoughts urges or images i The person attempts to ignore suppress or neutralize the thoughts words or images IV Videos Chuck 2 amp Chuck 3 a 2 Scared he d touch girls from his church flashes of images in his head 1 Reduce anxiety contamination fear b 3 Make sure bird isn t out of cage 1 Not always rational 2 Are they your own thoughts Yes i OCD not psychotic c Restless leg syndrome obsession or compulsion d Anxiety or mood disorders more common in women e Panic disorder equally common in men and women women have a genetic predisposition f ObsessiveCompulsive Disorder OCD 1 Develops either before age 10 or during the late adolescenceearly adulthood 2 More common in women 15 times more common than in men 3 0CD often chronic only 20 complete recovery 75 have comorbid anxiety disorder 66 have major depression 33 have hoarding symptoms substance abuse is common 4 Numbers overlap over half will get OCD as well as 2 other disorders over the course of a lifetime contributes to burden of the iHness 5 Man couldn t do his job because the skin on his hand was so dry from washing them so often and kept peeling his skin i Exposure and response prevention prevent him from doing compulsion to alleviate anxiety or else he ll never realize he won t get sick unbuckle his gloves then take them off then unbuckle his gloves and leave them on the couch then go to bathroom and stare at sink but not wash his hands and come back He didn t get a cold However if he had gotten a cold it would ve been a backslide in his treatment ii Change the operant conditioning of his condition 6 Have people slowly go and check their activity once but make them do it slowly and fully V Body Dysmorphic Disorder a Preoccupied with an imagined or exaggerated defect in appearance 1 Perceive themselves to be ugly or monstrous 2 Women focus on skin hips breasts and legs 3 Men focus on height penis size body hair and muscularity 4 In general focus on aspects of the body Western society values 5 Engage in compulsive behaviors check their appearance in mirrors often camouflage their appearance picking at cuts or sores or red spots i People get dark spots or scars on their faces from picking at it 6 High levels of shame anxiety and depression 7 Occurs slightly more often in women 8 2 prevalence rate 57 o for women seeking plastic surgery i Nearly all have another comorbid disorder 9 Someone who desires surgery may never be happy with the results i Disphobia in their cognitions they view themselves differently from the rest of the world surgery can t correct that b Criteria for Body Dysmorphic Disorder 1 Think one part of their body is deformed somehow not restricted to concerns about weight or fat more related to eating disorder i Ex my forearms are too big the checking behavior usually alleviates the anxiety for the time being 2 Preoccupation with a perceived defect or markedly excessive concern over a slight defect in appearance 3 The person has performed repetitive behaviors or mental acts in response to the appearance concerns 4 Problematic not all plastic surgeons are very good at assessing this in their clients people might slip through the cracks and get a lot of surgery Vl Hoarding Disorder a Persistent difficulty discarding or parting with possessions regardless of their actual value 1 Ex toilet paper Woman kept asking for free toilet paper at the nursing center b Getting rid of items is highly distressing 1 The thought is I won t have something which creates an anxiety the obsessive thought is I ll be without something I need i Ex I ll be lonely the animals will be uncared for etc c Perceived need to save items d People accumulate too much stuff that their homes don t serve the intended purpose 1 Pictures shown to class woman used shower to store clothing she s not using her bathroom at all not washing her hair showering etc Hoarding dolls and doll clothing personified the dolls and thought they d be lonely or uncared for in thrift stores bags full of clothing for them 2 No place for sleeping on guest bed couch is covered left side of bedroom covered one part of apartment able to still use didn t even get under covers House is simply too crowded e Cannot part with acquired objects f Most objects are worthless 1 Extremely attached to objects 2 Resistant to relinquishing objects g 66 are unaware of the severity of a problem lack of insight woman didn t realize she should buy clothes for her grandkids 1 Insight when one understands what they are doing is irrational some people have lack of insight woman with dolls example Insight into how disorder is affecting their lives h 33 engage in animal hoarding 1 Animals often receive inadequate care allows for improper care and ultimately more victims i Severe consequences j Squalid living conditions k Negatively impacts relationships woman viewed dolls as her peers rather than other people Turns out she was somewhat estranged from family her focus on dolls could ve been coping with a lack of relationship with her family members 1 She wasn t showering so it made it difficult for her to interact with others very shy about her lack of cleanliness 2 Type of therapy exposureresponse prevention ERP Made her bring a grocery bag of dolls every session i Why is it better she did this herself Rather than have her son just clear the place out a More secure in control responsibility Having someone else do it won t help maybe she would go to thrift store and buy 10 more to reduce anxiety By doing it herself she experiences the anxiety she usually tries to alleviate and can habituate to it ii Instructor would drive dolls to thrift store on the other side of the city so she wouldn t see them in the store she would goto iii Goal was for her to not replace dolls iv Before pictures trace piles of rooms covered tracked process of the floor becoming clearer monitor the process I How do you distinguish hoarding from someone who is old and can t clean up for himself Doesn t obsess over items Doesn t needthe items m Behavioral observation can they do daily activities Is there interference n Is there difference in treating them therapeutic way or just clean out whole house Depends on if the patient does it or not 1 Focused on depriving oneself of negative reinforcement shows on TV with 1day interventions are getting it wrong would like to see the patients after a year Vll Posttraumatic Stress Disorder PTSD a Trauma has to involve actual death or fear b lntrusively reexperiencing the traumatic event 1 Can see person in room with you nightmares thoughts or images 2 Reliving of experience while you re awake c Avoidance of stimuli 1 Avoiding things that remind her of her son dying hospitals schools i Ex refuse to walk on street where rape occurred 2 Other signs of mood and cognitive changes 3 Increased arousal and reactivity i lrritability aggressiveness recklessness etc d Look at chart in textbook goes through 4 categories Vlll Acute Stress Disorder a Symptoms similar to PTSD b Duration shorter i Symptoms occur between 2 days and 1 month after trauma ii After that is considered PTSD c DSM5 removes dissociation as a symptom d As many as 90 of rape victims experience ASD e ASD predicts higher risk of PTSD with 2 years i If 90 of people experience PTSD who are raped why diagnose it as a disorder ii Only want to diagnose it if it s chronic and interfering with their life quite a bit lX Watch Video Exposure Can use Virtual Reality on your own END OF NOTES October 2nd 2014 Abnormal Psychology Notes I Specific Phobia a Announcements 1 Instructor dislocated her shoulder by falling down the stairs exam is on same date if we don t get to everything then it will just cover less material More office hours available b Video provides critical concepts Phobia Pt 2 1 The strong belief in the catastrophe that s what s causing the avoidance anxious behavior 2 Don t prepare patients with preparation or deep breathing 3 Deep breathing masks anxiety doesn t help condition only if Marion hyperventilates 4 Marion s anxiety soars when she sees the snake It was horrible I thought it was stronger than me Marion 5 Lets him turn around after 3 minutes she stands and smiles as her anxiety level goes down 6 Stay exposed to the situation long enough anxiety goes down i After 15 minutes she sits down some anxiety returns ii Breathe slowly and calmly with stomach c Catastroohic relief at one point from last time she worried she d have a heart attack or need to leave the room 1 What is the maintaining factor of the phobia Maintaining to keep having anxiety negative reinforcement of anxiety by avoidance 2 What effect does deep breathing have on the efficacy of the exposure treatment If you do the deep breathing you don t experience the anxiety doesn t help 3 What effect does motivation to succeed have on treatment It allows her to deal with the anxiety even though she s extremely uncomfortable doing everything but running out of the room d Phobia Pt 3 1 She decides to approach the snake 2 Psychological principles that account for improvement confidence increasing accepting to take in new information positive reinforcement and modeling 3 Doctor knows it s going to work e Osts Research 1 Specific phobias i 80 improvement astronomical no treatment that is that effective almost curative ii Results are incredibly strong 2 Marion names the snake Alph after awhile touches him progress is uneven but challenges belief Alph is placed on her lap 3 The snake didn t do a lot of things she predicted it would 4 She took a picture with the snake helped untangled him from doctor 0 anxiety at that point 5 Recommendation maintenance watch nature films go to park and zoo 6 2 months after treatment I have dreams with snakes but I didn t have any anxiety I really feel confident that if I see a snake I won t be scared I watch movies and see pictures with them f Habituate and extinction counter conditioning 1 New association between snake and calm is established counter conditioning 2 Old association snake and panic 3 Selfefficacy belief you can conquer a challenge 4 Phobias are innate tendencies some degree genetic 40 o g What are the pros and cons of the intense treatment compared with more gradual treatment 1 Pros get better with phobia over a few weeks you may have to start again from square 2 1 0 steps forward 5 steps back backsliding between sessions 2 Maintenance keep exposing yourself to phobia i Facing your worst fear in 3 hours ll Social Anxiety Disorder a Two factor model in addition to flat out avoiding the phobia which is a social situationinteraction safety behaviors 1 Negative reinforcement avoidance 2 Cognitive factors very unique to social interactions I m not socially skilled assume that others will judge them the same This can become true if one avoids a lot of social interactions doesn t get a lot of practice can develop and not learn social skills that are age appropriate 3 Social skill training may occur i Help people to just cope with the shyness the fact that they may be nervous or awkward in a social interaction still may be worth doing 4 Excessive attention to internal cues i lmagine shaking someone s hand for the first time when you know it s sweaty amplify the anxiety b 2 social anxiety disorder 1 1 Avoidant personality disorder 2 Generalized social phobia 3 Nongeneralized social phobia 4 No social anxiety diagnosis 2 Psychological treatment of phobias i Exposure ii Social phobia iii Cognitive therapy 3 Strike up a conversation with a random stranger at a coffee shop do it everyday document evidence of habituation 4 Might do something called a hierarchy i Thinking about snake for an hour walk in room with snake with back turned slowly turned around but her eyes were closed etc low level at which they start Habituation with low level of stimuli Patient is always in control of how slowly this occurs ii Give client control of which step of hierarchy they are on much more confident 5 Virtual reality treatment is occurring exposed to dangerous animated spiders better than real reality 6 At what point in development will social anxiety most likely occur Adolescence right around puberty time lot more sex hormones which are affiliated to the nature attraction to opposite sex and people outside of family when social interaction becomes more prevalent and important lll Panic Disorder frequent panic attacks unrelated to specific situations a Panic attack sudden intense episode of apprehension terror feelings of impending doom reach peak intensity within 10 minutes more like 24 1 Physiological response dizziness labored breathing etc 2 Nothing s actually going on with the heart unless person has a condition they just notice their heartbeat b Intense shock or anxiety 1 Depersonalization not a real person anymore not really there 2 Derealization nothing is real i Suicide close to you life feels like it should stop unreal that it is continuing on and you don t feel part of it c Difference between real panic attack and I totally panicked on the exam not full on sense of impending doom or fear of going crazy no real physiological symptoms 1 Magnitude of cognitions 2 Time 3 Physiological symptoms d Video Steve panic disorder e Panic disorder 1 Uncued attacks no idea how it happened 2 Cued attack ex driving over a bridge I know I m fearful of bndgesf f Panic disorder with agoraphobia avoidance of situations in which escape would be difficult or embarrassing 1 Problem with getting out i Example of agoraphobia instructor s father had to endure a belly dance because he was surrounded by people ii Elevators subways trains places this can occur 2 Very high burden of illness people are unemployed for 5 years because of it 3 Difficult to fulfill roll obligations i Examples Being interviewed not acceptable to leave job trapped at work place just going outside can be hard campus is crowded traffic during rush hour places where a lot of people are going to school or work ii Working at home can help iii Seen in children and older adults hard for them to hold a job g lnteroceptive conditionind classical conditioning of panic in response to bodily sensations 1 Being aware of things going on in the body 2 Aware of how one s doing physiologically focusing on sweaty palms heart rate breathing rate etc signs of anxiety 3 Maybe I m going to have a panic attack increase anxiety and symptoms upward spiral of attention to physiological signs which exasperates them h Diathesis preexisting psychological and biological vulnerability to anxiety 1 Belief that somatic symptoms due to fightorflight response are dangerous can help cause panic attack 2 Start to worry about next panic attack increase anxiety worrying about future events increase somatic symptoms keeps going in a loop IV Etiology of Panic a Lack of perceived control b Fear of bodily changes feel shakiness light headedness feel more anxious because they think they re passing out c Beliefs increase anxiety and arousal creates vicious cycle i ex friend with interoceptive conditioning thinks they will have a panic attack if they go up a couple flights of stairs in the Cathedral Steps Challenge V CognitiveBehavioral Therapy a lnvivo exposure interoceptive exposure to agoraphobic situations 1 Breathing retrainind breathe through straw to experience discomfort exposing yourself to physiological sensations 2 Cognitions may change b Agoraphobia fearof fear hypothesis fearoffuture fear I m afraid I ll become afraid 1 Embarrassment of feeling afraid and not able to leave situation c Panic Control Therapv exposure to somatic sensations associated with panic attack in a safe setting 1 Add relaxation and deep breathing just to reduce anxiety level over the course of the day d Panic Disorder Exposure Therapv 1 Airlines would rather a person not have a panic disorder in the air allow them to board early or sit somewhere comfortable e Generalized Anxiety Disorder Mr Worry 1 lnvolves worry chronic excessive uncontrollable worry 2 Increased signs of agitation 3 Constant higher level of anxiety tension is held in neck i Fatigue and sleep difficulties restlessness 4 Worries about every area of life not just elevators etc 5 Often begins in adolescence empirically supported isn t personality disorder chronic lifelong persistent 6 Worry negative reinforcing because it distracts from negative emotions and images 7 Never address one issue or worry long enough to have it habituate get to medium anxiety with one topic then switch then just keep going with moderate anxiety level if you think about one long enough you can cancel it out put anxiety aside 8 Habituation never occurs worry is negatively reinforcing worry removes that heightened anxiety you d get by focusing on one stimulus 9 Maintain anxiety never habituate to stimulus END OF NOTES November 18 2014 Abnormal Psychology Notes Personalitv Disorders longstanding pervasive inflexible extreme and persistent patterns of behavior and inner experience There isn t an area of life that isn t affected a Announcements Personality Disorders Quiz due Friday night now Remember to not come to class the Tuesday of Thanksgiving week week from today This Thursday the TA will be teaching the class instructor will be out of town b Unstable sense of self and unable to sustain close relationships They don t have a sense of who they are they feel worthless on their own merit just on their own in general c If you have 1 personality disorder there s a 50 chance you have another one d Even if you get within a category of diagnosis there s still a lot of variability 2 people within the same category can still be very different Many people who seem to have serious personality problems do not fit any of the personality disorder diagnoses e TestRetest Stability for Personality Disorders and Major Depressive Disorder Around 40 meet the same diagnostic criteria f Avoidant Personality Disorder 12 prevalence in the community 147 prevalence in treatment setting They just avoid people at all costs They are pushed into treatment because of the symptoms not able to survive with the disorder g Cluster A some similarly to but on any given day less severe than schizophrenia 1 Schizotypal Personality Disorder overlapping genetic factors Similar to schizophrenia individuals with schizotypal PD show problems similar to those found in schizophrenia 2 Unusual and eccentric thoughts and behaviors psychoticism doesn t go to level of hallucinations just illusions Interpersonal detachment suspiciousness and odd beliefs or magical thinking telepathic ideas of reference Senses someone in the room with them but cannot actually see or hear anybody Oddeccentric behavior or appearance wears strange clothes talks to self Affect is flat aloof from others 3 Criteria presence of ideas of reference peculiar beliefs or magical thinking few or no pleasurable activities Not a priority to engage in social activities lack of enjoyment desire Lack of friends little interest in sex indifference to praise or criticism from others Doesn t feed off of other people Least extraverted person you can imagine 4 Instructor recommended that students come up with an anagram for it 5 Paranoid Personality Disorder presence of four or more of the following signs of distrust and suspiciousness beginning in early adulthood and shown in many contexts pervasive unjustified suspiciousness of being harmed deceived or exploited Unwarranted doubt about the loyalty or trustworthiness of friends or associates Paranoia suspicion distrust No suspicions of aliens though i Guy instructor worked with believed his niece was dealing drugs because she would drive back and forth between towns to see her boyfriend 6 What s the difference between Schizophrenia and Schizotypal Personality Disorder Much more severity in Schizophrenia Schizotypal is premorbid could lead to Schizophrenia Personality disorders are stable and enduring Schizophrenia may be episodic A lot of similarities and times when it s hard to distinguish i Similarities paranoid ideation magical thinking social avoidance and vague or digressive speech ex David Koresh believed he was the final prophet Randy and Vicki Weaver were suspicious of the government h DramaticErratic Cluster 1 Antisocial Personalitv Disorder pervasive disregard for the rights of others really critical they just don t feel bad about it Pattern of irresponsible behaviors won t show up for work Use to require Conduct Disorder to be diagnosed before age 15 to meet criteria that was dropped due to sometimes lack of information i Psychopathy sociopathy focuses on internal thoughts and feelings as opposed to external poverty of emotion impulsivity Lack of shame remorse and anxiety without these they will not learn from their mistakes lmpulsivity behave irresponsibility for thrills ii Referring to old video empathy for those who don t survive What role does crime play in his life Is it a disregard for the rights of others or another reason I have never followed mans laws iii Video seanAntisocial a The family had a little puppy Sean was playing with it upstairs Sean had dropped the puppy and it broke its paw and Sean just didn t tell anyone Paid no attention iv Problems with research conducted with mostly with criminals different measurements v Similar genes as other disorders Familv environment lack of warmth high negativity and parental inconsistency or neglect aren t around and able to coach their children in moral development Poverty exposure to violence Family environment interacts with genetics A person who has a high genetic risk but grows up in an area with resources and attentive parents don t hit your sister there is a protective effect High number of antipersonality traits among CEOs GTC vi Fearlessness lack of fear or anxiety low baseline levels of skin conductance less reactive to aversive stimuli lmpulsivity lack of response to threat when pursuing rewards Deficits in empathv not in tune with the emotional reactions of others They actually experience less arousal when they see others in distress They just don t feel it the way we would feel 2 Borderline Personalitv Disorder BPD i Impulsive selfdamaging behaviors Unstable stormy intense relationships Emotional reactivity angels and devils Therapist can be thrown into this makes therapy difficult Sense of trust between therapist and client can be eroded Frantic efforts to avoid abandonment and the natural flow of a relationship Unstable sense of self angercontrol problems chronic feelings of emptiness recurrent suicidal gestures sometimes they re more than just gestures not less important just because they don t lead to death Sometimes they re accidentally successful Transient psychotic or dissociative symptoms ii Later in life most no longer meet diagnostic criteria iii Neurobiolooical factors Borderline is the first ne where we see significant treatment ability Highly heritable 60 may play a role in impulsivity and emotional dysregulation iv Social environment factors high rate of parental separation verbal and emotional abuse during childhood Linehan s DiathesisStress Theory individuals with BPD have difficulty controlling their emotions emotional dysregulation parents misinterpret this or aren t available family invalidates or discounts emotional experiences and expression interaction between extreme emotional reactivity and invalidating family END OF NOTES October 9 2014 Abnormal Psychology Notes I Mood Disorders a Announcements Review session today office hours available test 1 week from today Mainly going to focus on major depressive disorders today b 2 broad types 1 Involves only depressive symptoms 2 Involves manic symptoms bipolar disorders c Check out major features column of Table 51 Diagnoses of Mood Disorders 1 Clarify the continuum along the spectrum d Episodes we ll discuss Unipolar Bipolar l amp ll e Disorders 1 Unipolar MDD depressive episodes only 2 Bipolar ll depression and hypomania 3 Bipolar l depressive and manic episodes more severe on spectrum than hypomania f Episodes severe mania hypomania mild to moderate mania normalbalanced mood mild to moderate depression severe depression 1 Cross out major depressive disorder and write major depressive episode in your notes g Criteria for Major Depressive Disorder 1 Sad mood or loss of interest 2 Won t experience is as depressed mood as much as anhedonia none of your classes seem interesting anymore reading and TV going out with friends etc more common in men 3 Symptoms are present nearly every day i Symptoms include sleeping too much or too little psychomotor retardation or agitation restless on edge unable to sit still that kind of thing poor appetite and weight loss loss of energy pretty pervasive never heard of someone say they don t have that difficulty concentrating just kind of make decisions should wait until they recover to make significant decisions 4 Suicidal intent intend to hurt themselves with the purpose being death at some point Usually see recurrent thoughts of death or suicide ex think about swerving into tree 5 Pneumonic symptoms in addition to depressed mood for MDE i SIGECAPS come up with your own don t need to memorize verbatim a Sleep disturbance increased or decreased b Interest reduced not enjoying anything ll Video Barbara a Depression lethargic not wanting to leave bed stay in bed for days on end arms are so heavy they cannot be lifted moving yourself to couch big deal won t get up to go get remote or change channel 1 Talking slowly psychomotor retardation 2 Thinking of hurting yourself when you drive driving off side of road afraid of not dying and just being hurt and that would be worse for your family 3 Pulled over on shoulder of road and cried i Cries all the time uncontrollable cries about stupid things 4 Systematically getting rid of friends and family 1 by 1 over the past several years will not answer phone or door don t need to answer them if you don t need to afraid you ll be asked to do something movies show shopping and you ll be obligated to do can t derive pleasure from anything there isn t anything I want to do not afraid of social embarrassment just not interested 5 Social avoidance similar from social anxiety disorder cause is very different b Persistent Depressive Disorder combines two disorders formerly named Dysthymia and Major Depressive Disorder chronic subtype 1 Depressed mood for at least 2 years 2 Calling them two separate things not helpful c Dysthymia Persistent Depressive Disorder 1 What is psychomotor retardation Felt heavy Didn t really move her head around stayed in same position whole time just less movement hand in hand with fatigue talk much more slowly 2 Dysthymia is premorbid what comes before major depressive disorder d Premenstrual Dysphoric Disorder 1 In most menstrual cycles during the past year at least five of the following symptoms were present in the final week before menses and improved within a few days of menses onset i Because it happens every month must look at it as a diagnosis might be related to hormonal changes ii Affective lability affect can go from one extreme to another unstable not a stable as it is when they re not in an episode iii Overwhelmed or moods and emotions are all over the place isn t necessarily seen in major depressive disorder e Epidemiology amp Consequences 1 Depression is common 2 Gender discrepancy very significant 1 in 10 men and 1 in 5 women 3 Prevalence varies across cultures retrospective research places under conflict is where people will experience major traumatic life events death in the family etc more likely to experience depression 4 People who move to the US from Mexico have lower rates than people of Mexican descent who were born in the US i Similar genetic makeup ii Occurs because if you grow up in the US you experience the implications of being a minority cultural discrimination in the US identity crisis born in America but not treated as an American disenfranchisement iii People who are immigrants might be stronger people have ability to pick their lives up and restart new most confident competent people iv Research found more about culture growing up in in Mexico the family unit has more significance placed into it US focuses on the individual don t have the support of a tight family network more vulnerable to depression Need social support network 5 Have you been exposed to hardship 6 Symptom variation across cultures i More stomach irritation in US ii Symptom variation across life span 7 Median age of MDD onset by generation gotten a lot younger i Increasing rates of obesity not sure how related divorce rates have risen from 30 to 50 over last 50 years one of those there s a lot much device and computer and TV use at night interrupts sleep lll Bipolar Disorders a Three forms Bipolar l amp II and Cyclothymia 1 Mania defining feature of each 2 Differentiated by severity and duration of mania b Criteria for manic and Hypomanic episodes 1 People don t spend enough time on activities to experience goal achievement 2 Highly pressured speech talking quickly may not understand flight of ideas tangentially related fast pace not linear jumping from one idea to the other 3 Sleep for 4 hours and feel not well rested 4 Excessive involvement in activities that are likely to have undesirable consequences 5 More interested in sexual gratification more risktaking and less care use less protection c Video Ann Bipolar 1 Manic and Hypomanic episodes mostly More on Manic Hypomanic end 2 What does it actually feel like to be manic i Feels very tense mind is racing unusual connections can t sleep at night a lot of energy to do a lot of projects 3 Designed new horse in 1 summer got married along with many other things goaldirected activities 4 Try and pace life a little better 5 Feel tension in body 6 Difficult to concentrate and get out of bed during depressive state 7 Taking antidepressants 8 Psychotic times extremely frightening 9 Manic state is fun but alienates people 10 Too rushed and hectic 11 Physical tension lV Cvclothvmic disorder milder chronic form of Bipolar Disorder numerous periods with Hypomanic and depressive symptoms a Epidemiology and consequences no gender differences women experience more depressive episodes severe mental illness b Video Mary depressive episode 1 Thought I was fat and ugly didn t want to live anymore in this world 2 Feelings lasted for a year 3 Won t even make eye contact with interviewer poverty of speech won t elaborate on anything very few words she s using 4 Manic episode i Delusion of grandeur seen in mania imaging she s stronger more powerful more capable than usual ii People feel so great so confident but it s very disconnect and no coherent threat of thought iii Too much confidence pressured speech a little bit psychotic thoughts 5 Bipolar l amp Schizophrenia worst two behavioral disorders i Takes over life ii Suicidal 6 Figure 53 Rapid Cycling Subtype of Bipolar Disorder i Not Cyclothymia V Etiology of Mood Disorders a Involves Amygdala b Diminished activity in the Hippocampus ability to learn new things is minimized c Only figured out a couple of the genes involved in the disorders d Reward functioning how much response do you have from your coffee or a sugary breakfast cereal People just aren t getting a lot of pleasure from what they re enjoying when they re depressed e How Antidepressants work 1 There is no absolute serotonin level that causes depression commonly thought low levels cause it 2 Refer to drug action on synaptic activity model don t need to memorize terms like pre and postsynaptic 3 Reuptake inhibitors 4 Increase in serotonin in Synapse should really only take hours to occur not days 5 How sensitive are receptors Sensitivity of postsynaptic sensors the most important 6 People with family history of depression more susceptible i Postsynaptic sensors less receptive VI The JAMA Network Graph and Questions a Dots are different research studies metaanalysis b Yaxis how much their scores improved over the course of treatment c White dots for placebo effects grey points for antidepressant medication d Antidepressants improve depression around 66 e Placebo drugs improve depression around 50 1 Why do you think there might be so great of a placebo response in these studies END OF NOTES October 23rd 2014 Abnormal Psvcholoov Notes I Announcements a For exams and quizzes put your own experiences aside Only focus on what s in the textbook and what we talk about the class Depersonalize it Don t diagnose your friends and family b Next exam is November 6 Review session is a week before c Optional extra credit opportunity those who are really interested in delving into specific disorders are the ones who commonly do this 7 pages with 5 primary sources Talk about what we wish could happen when someone is diagnosed optimal treatment Must fail anyone who copies more than 4 words in a row via the dean s orders Every semester the teacher finds one d Make sure you go over the slides from the last lecture since it was canceHed II The Western Beauty ldeal a 1950s rise of eating disorders b Body size c quot0 Body fat d Determines selfworth happiness e They look the best in clothing emancipated in reality f Celebrities have waist sizes that are well below the average woman J Lo etc g Bodv mass index ratio of height to weight h Since 1920s body mass index has decreased every year that soon Miss America will cease to exist lll Eating Disorders a Anorexia Nervosa AN 1 Fear of obesitydrive for thinness 2 Food restriction body weight significantly below normal 3 Body image disturbance b Distorted Body Image 1 A lot of body comparisons 2 A lot of checking in every mirror they come in contact with 3 Before they even begin eating they ll already feel like they re full 4 Unrealistically low ideal body size c Criteria 1 Restriction of behaviors that promote healthy weight body weight is significantly below normal 2 BMI less than 185 for adults 3 lntense fear of gaining weight and being fat i Can t be too thin d Perfectionism scale only outstanding performances are acceptable in my family hate being less than the best at things don t want to disappoint my parents common in people with eating disorders 1 Confused about the emotions they re feeling not sure if they re actually hungry unable to judge their bodily signs e Figure 91 Assessment of Body Image respondents indicate their current shape their ideal shape and the shape they think is most attractive to the opposite sex The high scorers overestimated their current size and ideally would be very thin 1 Perfectionism 2 Trying to exert control f Body parts satisfaction scale 1 Torso is often rated very low lV Anorexia Nervosa a The lower and lower ages of girls of boys engaging in dieting behavior is concerning means the disorder could start earlier on b Onset early to middle teen years c Usually triggered by dieting stress d Suicide rates high 1 5 completing 2 Some individuals get their body weight so low that they have a heart attack most risky disorder but not as common as some of the others 3 Physical changes cause high risk of death e Physical changes in anorexia brittle bones loss of bone mass loss of nails lanuga soft downy body hair depletion of potassium and sodium can cause tiredness weakness f Disturbance of what you see when you look in the mirror g Heart failure common h Prognosis 5070 of people recover if they get the correct treatment relapse is common really difficult to modify that distorted view of the self need to change what they see in the mirror and what they identify as fat V Bulimia Nervosa a Eating entire pizza one night not a binge Don t worry b Binge an excessive amount of food consumed in less than 2 hours occur at least 2x per week for 3 months often in secret 1 Uncontrollable eating binges followed by compensatory behavior to prevent weight gain 2 Types purging vomiting laxatives nonpurging fasting excessive exercise c Bulimia vs Anorexia bingeeatingpurging type 1 Extreme weight loss in anorexia 2 At or above normal weight in bulimia d Uncontrollableeating binges followed by compensatory behavior to prevent weight gain e Feeling of a loss of control over eating 1 As if one cannot stop continues until uncomfortably full 2 Can deny that the binge ever happened f Body shape and weight are extremely important for selfevaluation g Binge eating great amount of variability 1 Unusually large amount of food 2 Typically desert and snack foods foods you crave when a person is at home or alone h Purging behaviors that attempt to compensate for the binge eating and prevent weight gain 1 Selfinduced vomiting laxative misuse i Physical changes in bulimia 1 Menstrual irregularities 2 Potassium Vl BingeEating Disorder a Associated with obesity and history of dieting b Not all obese people meet criteria for binge eating disorder c Risk factors include 1 Childhood obesity early childhood weight loss attempts having been taunted about their weight low selfconcept depression and childhood physical or sexual abuse d Equally prevalent among Euro African Asian and Hispanic Americans Vll Etiology of Eating Disorders a Genetics 1 Family and twin studies support genetic link 2 These psychological constructs focus on body size being part of self worth are heritable 3 Body dissatisfaction b Neurobiological Factors 1 Low levels of endogenous opioids 2 Roman soldiers would carry around small doses of opiates to increase their energy and decrease pain 3 Serotonin related to feelings of satiety feeling full 4 Dopamine related to feeling pleasure and motivation c Cognitive Behavioral View 1 Anorexia focus on body dissatisfaction and fear of fatness certain behaviors negatively reinforcing perfectionism and personal inadequacy lead to excessive concern about weight feelings of self control brought about by weight loss are positively reinforcing i Misperception about how others view them 2 Bulimia selfworth strongly influenced by weight low self esteem d Low selfesteem and high negative affect 9 dieting to feel better about self 9 food intake is restricted too severely really committed to diet and do it too much 9 diet is broken get really hungry 9 binge 9 compensatory behaviors purging dietary restraint people go thru negative mood 9 low self esteem and high negative affect circle 1 Oscillation between days of low calories and high calories 2 If they had the same amount of calories everyday they might actually lose weight Vlll Treatment of Eating Disorders a Most individuals don t receive treatment b Anorexia immediate goal is to increase weight to avoid medical complications and avoid death 1 Second goal is long term maintenance of weight gain 2 Hospitalization is common c CBT after allornothing thinking reductions in symptoms through 1 yeah lX CognitiveBehavioral Therapy a Nutrition interventions psychoeducation distraction amp alternative behaviors X Quiz is due Sunday night END OF NOTES November 13 2014 Abnormal Psychology Notes I Treatment of AlcoholRelated Disorders 1 Medications to block desire to drink a Antabuse become sick when you ingest alcohol b Operant conditioning punishment 2 Medications to lower side effects of acute withdrawal 3 Psychological treatment approaches a Want to eliminate contingencies Classical conditioning route home passes a bar When someone smells smoke they want to drink Associations 4 Controlled drinking rather than abstinence a Downsides of shooting for abstinence isolate them if their social circle is dependent upon drinking Spend some time developing a social circle that s not drinking That s an advantage of Alcoholics Anonymous culture Nondrinking social support 5 Alcoholics Anonymous a Narcotics Anonymous in bigger cities 6 Instructor recommends everyone attend an open AA meeting in his or herHves 7 Success rates of alcoholism treatments a Project MATCH success rates NlAAA b Motivational enhancement therapy success i More focused on getting a person to say I m going to lessen my drinking and this is how I m going to do it Motivation enhancement techniques c Relapse prevention programs 8 Cognitive and Behavioral Treatments a ContingencyManagement Therapy i Patient and family reinforce behaviors inconsistent with drinking ex avoiding places associated with drinking ii Teach problem drinker how to deal with uncomfortable situations ex refusing the offer of a drink Uncomfortable telling people you just met that you re not going to drink b Relapse prevention i Strategies to prevent relapse c Motivational interventions designed to curb heavy drinking in coHege 9 Nicotine is by far the most addictive substance Closely followed by amphetamines Caffeine and cocaine considered almost the same in addictiveness ll Narcotics 1 Opium and Its Derivatives First drugs that truly dulled pain pain management and could be used in surgeries so people didn t die from the pain alone a People experience such a profoundly positive experience that they seek out the drug on the black market 2 Immediate effects of narcotics alleviation of physical pain relaxation and pleasant reverie alleviation of anxiety and tension euphoric spasm 3 Longterm effects of narcotics building up a tolerance 4 Other characteristics endorphins Antisocial Personality Disorder narcotics subculture a Person who wasn t previously a lawbreaker becomes one due to physiological craving for drug which can t be accessed elsewhere b Why do you think a high incidence of antisocial personality features has been associated with heroin addiction People might engage in behaviors that don t regard others turning back to drug using might be easier if you don t have a prosocial network 5 Treatment 9 Initially similar to that for alcohol addiction 9 Methadone and buprenorphine program a Not as vulnerable to overdoses from using narcotics Any physiological craving is substituted Recommended for pregnant women b First line of treatment for withdrawal from Narcotics 6 Questions write down your answer a Which drugs are the most addictive i Nicotine Methamphetamines b Compare and contrast the acute vs chronic or longterm effects of Narcotic use c How would taking buprenorphine or methadone help a person addicted to Narcotics i Keeping the bulk of them from having this physiological craving is the best move 7 Cocaine and Amphetamines Stimulants a Cocaine and amphetamines i Increased confidence b Longterm amphetamine use psychologically and physically addictive may result in brain damage and psychopathology i Physically addictive actual effects on a cell level Cognitive functions increase End up just as alert and cognitively functional on nicotine after building up a tolerance as they were before they started smoking When they re not ingesting nicotine their alertness is worse than it was before they began smoking 8 Methamphetamine highly addictive stimulant drug a Rate prolonged use and treatment substantial increased use in last 10 years structural changes in brain with prolonged use resistant to treatment 9 Barbiturates sedatives central nervous system depressants that are similar to depressant effects of alcohol help with sleep and anxiety problems a You can either die or have a psychological or physiological dependence to it b Barbiturate users and withdrawal dependence tends to be middleaged people withdrawal is a key treatment issue 10 Nicotine and Cigarettes a Prevalence of Tobacco Use decreased since the 1960s increased again in the 1990s white and Hispanic youth are more likely to smoke than African American teens b Treatment of Nicotine Dependence peer behavior important if others in social network stop smoking increases likelihood that individual will also stop physician s advice by age 65 most smokers have quit scheduled smoking reduce nicotine intake gradually over a few weeks i Nicotine replacement treatments gum patches inhalers reduce craving for nicotine combining patch with antidepressants Wellbutrin improved success rate ii Association between time of day and smoking smoke breaks Cues that trigger craving to smoke stressful experiences increased confidence and alertness can help that going to house or car 1 Patch breaks up this schedule Reduces craving over time c Smoking Prevalence and Health Consequences i 440000 Americans die prematurely each year ii Cigarettes kill 1100 people every day iii Lung cancer is most common cancer linked to smoking iv Cigarettes also cause or exacerbate Emphysema cancers of larynx esophagus pancreas bladder cervix stomach sudden infant death syndrome and pregnancy complications and cardiovascular disease which was not normally associated with smoking END OF NOTES November 11 2014 Abnormal Psychology Notes I Announcements 1 1114 Substance Use Disorders II a Quiz on SUDs Due Sunday Night 2 1118 Personality Disorders Chapter 15 a Quiz Due Wednesday Night 3 1125 No Class on Tuesday This Week 4 1126 Thanksgiving Recess 11261130 5 124 Exam lV regular room regular time 6 125 Last Day of Fall 2014 Undergraduate Classes a Due Date of Extra Credit Paper ll Substance Use Disorders 1 Goals for today what are the most commonly abused substances What is a binge 2 You are encouraged to break out of the stereotypes you may have about who a substance abuser is Can t necessarily tell from the outside who s at risk for abusing substances 3 ECigarettes a Video Vapor Boomtown The New York Times i Vaping ii Nurse Practitioner used to smoke 4 packs a day iii If people want to quit smoking why not help them and get paid to do it iv How dangerous would you rate cigarettes Ecigarettes There is still nicotine in ecigarettes Calls to Poison Control for nicotine poisoning have increased v Ecigarettes are currently unregulated by the FDA Should they be 4 What do you think is the most addictive substance 5 Addictive Behavior behavior based on pathological need for substance or activity 6 DSMlVTR pathological use of substances divided into two categories a Substance abuse b Substance dependence 7 Pathological use resulting in a Potentially hazardous behavior ex Driving too fast b Continued use despite persistent social relationship problems psychological depression anxiety occupational or health problems c Physiological need for increasing amounts of a substance high tolerance Do we actually see this in gambling 8 Criteria for Substance Abuse Disorder a Two or more symptoms within a 1 year period i Failure to meet obligations repeated use in situations where it is physically dangerous repeated relationship problems continued use despite problems caused by the substance tolerance withdrawal substance taken for a longer time or in greater amounts than intended ii Only need two of these to meet criteria 9 Potentiallv hazardous behaviors driving and getting into an accident after drinking Social problems friends won t go to bars that allow smoking Psvcholooical problems alcohol use leads to insomnia in the middle of the night and increases depression Occupational problems late to work from being hung over 10 Alcohol Abuse and Dependence a Alcoholic person with serious drinking problem whose drinking impairs health personal relationships and occupational functioning b Lifetime prevalence for alcohol abuse in US is 134 More than 37 of alcohol abusers suffer from at least one coexisting psychological disorder c What s a binge We don t often think of ourselves as binge drinkers Binge a pattern of excessive alcohol use NIAAA defines a binge as BAC 008 or higher i Men about 5 drinks in 2 hours ii Women about 4 drinks in 2 hours iii Different for men and women because of blood volume Blood alcohol concentration will be higher if you have less blood iv Binge drinkers do so about 4 times a month v The largest number of drinks per binge is on average 8 vi Heavy drinking is about 2 or 3 times a week Heavy alcohol use is more than 2 or 3 times a week d At higher levels alcohol depresses brain functioning At lower levels alcohol stimulates certain brain functioning e Alcohol is a CNS depressant doesn t mean it makes you depressed Acutely all functions of the brain including social inhibition are depressed Some people don t get depressed at all when they drink f Alcohol is depressing Chronic alcohol use can lead to increased feelings of anhedonia depressed mood and fatigue 11 Interim Review Questions discussed these with the people sitting next to us a Describe the difference between the acute effects of alcohol at low vs high levels on the brain i Motor control and reflexes are depressed What happens when you depress an inhibitory function It s like taking your foot off the brakes Part of our brain is involved in getting us to not do certain things say what s on your mind etc Inhibiting certain outputs That s the first thing to go when you use alcohol Saying things you won t normally say doing things you wouldn t normally do b Describe the difference between the effect of alcohol on the CNS and the comorbidity of alcohol use disorders and mood disorders depressant vs depressing i When we say something is a depressant it relates to the functioning of neurons Depressing relates to an emotional response Can offer an emotional escape c Explain how a CNS depressant like alcohol can lead to social disinihibition First define social disinihibition i Social Disinihibition diminishes neural activity in the brain 12 The Clinical picture of AlcoholRelated Disorders a Differ by degree to which negative consequences are present b Malnutrition cirrhosis of liver stomach pains 9 physical effects of chronic alcohol use Lining of stomach can be eroded in chronic alcohol use c Chronic fatigue oversensitivity depression impaired reasoning personality deterioration 13 Biological Causal Factors in the Abuse of and Dependence on Alcohol a The Mesocorticolimbic Pathwav prefrontal cortex nucleus accumbens ventral tegmentral area All 3 of these areas of the brain are affected by alcohol b Causal factors genetics learning factors c Psvchosocial factors those that have to do with your psychology personality or social environment d People who are high in harm avoidance take fewer risks 14 Sociocultural Causal Factors religion geographic location cultural factors etc a Ex Caucasians of Eastern European descent are more likely to carry genetic factors increasing risk for alcoholism But the Latter Day Saints Caucasians have religious views prohibiting the use of alcohol b Two enzymes act when you drink alcohol First creates obnoxious byproduct second enzyme breaks it down into compounds that have no effect and can be exerted from the body Three phases before first enzyme when pleasurable effects are in play after enzyme 1 after enzyme 2 The first could be fast or slow the second could be fast or slow By combining the effects of these 2 enzymes you can change the regarding effects of alcohol on a person lll Etiology of SubstanceRelated Disorders Sociocultural Factors 1 Social network social influence or social selection Bullers et al 2001 found evidence for both 2 Advertising and media countries that ban ads have 16 less consumption than those that don t END OF NOTES November 20 2014 Abnormal Psychology Notes I Chapter 16 Legal and Ethical Issues a Announcements TA taught lecture today in place of absent instructor Reminder that there is no class on Tuesday Nov 25 b Why talk about laws and ethics C i Legal concepts of insanity and insanity defense ii Ability to stand trial iii Hospital admission under civil law iv Rights to receive and refuse treatment v Ethics in research and therapy Today s lecture 1 Criminal Commitment 2 Protecting the Rights of People with Mental Illness 3 Ethical Dilemmas in Therapy and Research i As a psychologistpsychiatrist what should you do in a given situation Especially when situations vary ii What does it mean when someone is considered mentally unfitincompetent to stand trial Or acquittal by reason of insanity Common phrases that many people have heard before but don t fully understand When and where is it applicable lnsane vs Mentally III II Criminal Commitment a b C Mens rea guilty mind and No crime without an evil intent Concepts of insanity a disordered mind can t be a guilty mind People with mental illness who are alleged to have broken the law are subject to criminal commitment i A procedure that confines a person to a mental hospital either for determination of competency to stand trial or after acquittal by reason of insanity Insanity Defense i Insanity a legal term not a psychiatricpsychological concept Based on mental state of the accused at the time the crime was committed If the person has gone insane since the incident that doesn t count in court ii Important mental illness and crime do not go hand in hand a person can be diagnosed as mentally ill and be held responsible for a crime iii Defendant not responsible for an illegal act if it is attributable to mental illness or not knowing right from wrong iv Pleaded in less than 1 of cases Rarely successful Montana Idaho Utah US states that do not allow insanity defense v Requires judgments by lawyers judges jurors and clinicians e Landmark Cases i Irresistible Impulse 1834 a defense by excuse in this case some sort of insanity in which the defendant argues that they should not be held criminally liable for their actions that broke the law because they could not control those actions ii The M Naughten Rule 1843 criminal defendants who are found to be legally insane can t be convicted of charges arising from that particular mental defect or disability Courts use one of several legal tests to determine whether a defendant actually is legally insane depending on the jurisdiction f Insanity Pleas 2 Types i Not duiltv bv reason of insanitv NGRII no dispute over guilt accused not responsible for the crime because of mental illness indefinite commitment to a forensic hospital 1 Only released when no longer mentally ill It depends 2 Ex John Hinckley Jr a 1981 attempted to assassinate President Ronal Reagan He has never been released from St Elizabeth s hospital He has been in St Elizabeth s since 1981 33 years which is longer than he would have been jailed Lead to Insanity Defense Reform Act in 1984 tougher to be given NGRI Guiltv but mentallv ill GBMI found guilty and responsible for the crime mental illness plays a role in sentencing 1 Can be committed for treatment until no longer mentally ill then sent to prison to serve remainder of sentence But most are incarcerated and may or may not receive any psychiatric care 2 Ex Jeffrey Dahmer In 1991 killed 15 bots necrophilia Borderline PD andor paraphilia Intoxicated while murdering took efforts to prevent witnesses premeditated concealed bodies Deemed sane but mentally ill legally responsible for the murders Given treatment but incarcerated for length of sentence only released if safe and no longer mentally ill Killed by another inmate in 1994 g Competency to stand trial accused must be able to participate in hisher defense 1960 US Supreme Court decision ability to consult with his lawyer with reasonable degree of rational understanding has a rational as well as a factual understanding of the proceedings against him Courts don t want a person to be brought to trial in absentia Determination of competency made before individual is tried prosecutor judge or defense attorney can raise issue Synthetic sanity rarely used if medication can produce rationality trial can be held even if discontinuation of the drug would again render the defendant incompetent e Insanity Intellectual Disability amp Capital Punishment US Supreme Court unconstitutional to execute individuals who are insane or have an intellectual developmental disorder Execution would constitute cruel and unusual punishment Eighth Amendment Definition of mental retardation varies from state to state Ill Protecting the Rights of People with Mental Illness a Civil Commitment Parens Patriae Power of the state It s the duty of government to limit freedoms for people s protection An individual committed to a psychiatric hospital against hisher wishes if person is mentally ill and is a danger to self or others Commitment should end when person is no longer dangerous Formal Commitment requires a court order Informal Emerdencv Commitment initially no court involvement is needed 2PC two physician certificate Further detrainment requires formal judicial commitment b Predicting Dangerousness Contrary to widespread beliefs stigma when substance abuse is not a factor mentally iii are no more likely to commit violent crimes than the average person only 3 of violent crimes linked to mentally iii If violent target is usually family or friends not strangers Stranger homicide by people with mental illness is extremely rare Factors that influence accuracy of violence prediction 1 Repeated violent acts in the past 2 Individual returns to same environment in which past violent acts were committed and individual s personality hasn t changed 3 Person is on the brink of committing a violent act Medication noncompliance outpatient commitment c Protecting Patient Rights i Courts try to balance patient rights and the right of the public to be protected Supreme Court ruled that evidence for commitment must be clear and convincing Danger must be imminent ii Least restrictive alternative required to be provided when treating mentally ill Right to treatment state required to provide treatment after civil commitment Right to refuse treatment unless person is a danger to self or others d Deinstitutionalization Civil Liberties amp Mental Health i Deinstitutionalization 1 1960s many states released patients from state psychiatric hospitals community treatment preferred Many cities lack sufficient community mental health facm es ii Transinstitutionalization 1 Many mentally ill end up in nursing homes hospitals and prisons Justice department survey found that 162 of prison population is mentally ill iii Police officers increasingly called on to work with mentally ill new laws provide funding for special training lV Ethical Dilemmas in Therapy and Research a Most but not all of the time what is unethical is also illegal Mental health professionals and researchers also have ethical constraints Code of Ethics APA 2002 b Ethical restraints of research scientists seek knowledge and pose important questions that could be answered by choosing a proper study design Protecting participants from unnecessary harm risk humiliation invasion of privacy c Research Ethics Today 1 week 2012 Facebook manipulated the news feed of 5 million random users changed the number of positive and negative posts they saw The people who saw more positive posts responded by writing more positive posts seeing more negative content prompted the viewers to be more negative in their own posts Group Discussion discussed in groups did Facebook do something illegal Did they cross an ethical boundary Beyond academia do we still need to regulate human subjects research Informed Consent a core component of ethical research Must provide sufficient information to enable people to decide if they want to be in a study Even minor risks associated with participant should be disclosed Being mentally ill does not necessarily mean incapable of giving informed consent d Ethics and Therapy Confidentialitv psychiatrists and clinical psychologists reveal nothing to a third party exceptions specified by law Privileded communication communication between parties that is confidential and protected by law however the client s rights to privileged communication are limited under certain conditions Private therapv adult pays a fee for help with a personal problem This has nothing to do with the legal system END OF NOTES December 2 2014 Abnormal Psychology Notes I Personality Disorders ll 1 Announcements Office hours Panera 330530 Exam lV 124 regular room regular time 125 last day of fall 2014 undergraduate classes due date of extra credit paper 2 Description of BPD Marsha Linehand PhD encourages clients to decide what they want out of treatment 3 Linehan s DiathesisStress Theory of BPD biological diathesis 9 emotional dysregulation in the child behavioral model 9 great demands of the family 9 invalidation by parents through punishing 4 Video ObsessiveCompulsive Disorder a Loneliness trouble holding relationships woman had been hospitalized for trying to overdose before 2 week diagnostic period Very impulsive decision just decided to swallow a bottle of pulls 5 Criteria for Borderline Personality Disorder presence of five or more of the following in many contexts beginning in early adulthood frantic efforts to avoid abandonment unstable interpersonal relationships in which others are either idealized or devalued unstable sense of self self damaging impulsive behaviors in at least two years such as spending sex substance abuse reckless driving binge eating 6 Histrionic Personality Disorder included with the dramaticerratic cluster feeling that they will fade into irrelevance if they are not the center of attention Presence of five or more of the following signs of excessive emotionality and attention seeking shown in many contexts by early aduHhood a Strong need to be the center of attention b Inappropriate sexually seductive behavior 7 Narcissistic Personality Disorder a Grandiose view of self preoccupied with fantasies of success An act of coping mechanism designed to overcome a sense of worthlessness 8 SelfCentered demands constant attention and adulation lack of empathy feelings of innocence Preoccupation with one s success brilliance beauty belief that one is special and can be understood only by other highclass people 9 A lot of overlaps between Histrionic Personality Disorder and Narcissistic Personality Disorder individuals with the latter feel at the core that they are special Sensitive to criticism enraged when not admired 10 Kohut sm SelfPsychology if they can only get appraisal from their parents are parental emotional coldness that kid won t receive the emotional support he needs Sports parents so invested in their child s winning or losing 11 Kohut s SelfPsychology Model characteristics make low selfesteem Matter of emphasis is what you re trying to teach your child 12 AnxiousFearful Cluster a Avoidance response first with no for literally any proposition b Dependent seem like depression c Avoidant Personality Disorders fears criticism rejection or approval No anxiety about social interactions because they re flat out avoided pretty much universally i A pervasive pattern of social inhibition feelings of inadequacy and hypersensitivity to criticism 13 Dependent Personality Disorder an excessive need to be taken care of or dependence on others a Taking on unpleasant tasks around the household 14 Excessive need to be taken care of as shown by the presence of at least five of the following beginning in early adulthood and shown in many contexts 15 ObsessiveCompulsive Personality Disorder no true obsessions or compulsions A perfectionist preoccupied with rules details schedules and organization can make people feel pretty uncomfortable Overly focused on work little time for leisure family and friends a Imagine a person with a really perfect home b Reluctant to make decisions or delegate Delegation and micromanaging might be hard c What s the difference between OCD axis 1 early adulthood or later and OCPD Compulsions and obsessions 16 Avoidant obsessive compulsive if people know the real me they will reject me I know what s best People should do better and try harder Since I am special I deserve special rules I am better than others 17 Treatment of Borderline PD difficult to treat interpersonal problems play out in therapy Attempts to manipulate therapist Medications antidepressants Mood stabilizers Dialectic Behavioral Therapy Linehan 1987 acceptance and empathy plus CBT Emotionregulation techniques Social skills training a Metallizationbased therapy fail to think about their own and other s feelings Schemafocused cognitive therapy identify maladaptive assumptions that underlie cognitions 18 Treatment of Borderline PD can help people ride that wave one of the harsher treatment strategies Put levels into a more manageable range Antidepressants can be helpful 19 Schizotvoal PD antipsychotic and antidepressant medications 20 Avoidant PD same treatments as social anxiety disorders Antidepressant medications social skills training Not developing social skills the same way people who are avoiding it less are 21 Psychopathy psychotherapy either CBT or psychodynamic Antisocial Personality disorder We have seen some evidence that psychotherapy can help people with antisocial personality disorder a way that can utilize an under Psychopaths can be trained to fake empathy for others END OF NOTES October 28th 2014 Abnormal Psychology Notes I Announcements 1 October 30th Chapter 9 Schizophrenia a 130230 Exam lll Review in the Martin Room 2 November 4th Chapter 13 Disorders of Childhood 3 November 6th Exam III II Chapter 8 Somatic Symptom Disorders 1 Questions How can someone end up experiencing painblindnessseizurestics in the absence of a physical explanation 2 Excessive concerns about physical symptoms or health a Soma means body 3 Is it physical or psychological That s nearly impossible to discern 4 Three major somatic symptom disorders a Somatic symptom disorder b lllness anxiety disorder c Conversion Disorder 5 Criteria for Somatic Symptom Disorder a Distressing or disrupts daily life b Excessive thoughts feelings and behaviors related to somatic symptoms or health concerns as indicated by at least two of the following i Healthrelated anxiety ii Disproportionate concerns about the medical seriousness of symptoms and excessive time and energy devoted to health concerns c 6 month duration d Specify predominant somatic complaints predominant health anxiety or predominant pain 6 Criteria for Illness Anxietv Disorder a Preoccupation with and high level of anxiety about having or acquiring a serious disease b Excessive behaviors ex checking for signs of illness seeking reassurance or maladaptive avoidance ex avoiding medical care or ill relatives 0 No more than mild somatic symptoms are present d Not explained by other psychological disorders e Preoccupation lasts at least 6 months lll Conversion Disorder 1 Sensory or motor function impaired but no known neurological cause a Vision impairment or tunnel vision b Partial or complete paralysis of arms or legs c Seizures or coordination problems d Aphonia 2 Whispered speech a Anosmia loss of smell 3 Onset typically adolescence or early adulthood a Often follows life stress 4 Prevalence less than 1 a More common in women than men 5 Often comorbid with a Other Somatic symptom disorders b Major depressive disorder 0 Substance use disorders 6 Criteria for Conversion Disorder 1 One or more neurologic symptoms affecting voluntary motor or sensory function 2 The physical signs or diagnostic findings are internally inconsistent or incongruent with recognized neurological disorder 3 The symptoms are incompatible with recognized medical disorders 4 Symptoms cause significant distress or functional impairment or warrant medical evaluation lV Etioloov of Somatic Svmptoms Disorders 1 Neurological Factors a No support for genetic influence i Concordance rates in M2 twin pairs do not differ from DZ twin pairs a Why are some people more aware and distressed by bodily sensa on i Anterior insula and anterior cingulate hyperactive ii Somatic symptoms influenced by emotions and stress 2 Cognitive Behavioral Factors a Two important cognitive variables i Attention to bodily sensations interoceptive conditioning b Automatic focus on physical health cues ii Attributions interpretation of those sensations c Overreact with overly negative interpretations d Two important consequences i Sick role limits healthy life alternatives ii Helpseeking behaviors reinforced by attention or sympathy 3 Questions for class Do you have any superstitions What superstitious behaviors have you had Do you remember how you got them What did you do the last time your friendfamily member got injured or sick 4 Social and Cultural Factors a Decrease in incidence of conversion disorders since last half of 19th century i Higher incidence may have been due to more repressed sexual attitudes or low tolerance for anxiety symptoms b More prevalent in rural areas in individuals of lower SES and in nonWestern cultures V Factitious Disorder 1 Includes Factitious Disorder Imposed on Self and Factitious Disorder Imposed on Another 2 Criteria for Factitious Disorder a Fabrication of physical or psychological symptoms or disease b Deceptive behavior is present in the absence of obvious external rewards c Behavior is not explained by another mental disorder d In Factitious Disorder Imposed on Self the person presents himself or herself to others as ill impaired or injured e In Factitious Disorder Imposed on Another the person fabricates symptoms in another person and then presents that person to others as ill impaired or injured VI Le Roy Mystery Illness 1 Video Mystery illness More Girls a still no real answers 2 Why is a diagnosis of Conversion Disorder what s now called Functional Neurological Disorder not considered an answer to patients and parents 3 NY State Department of Health a Ruled out environmental or infectious causes 4 Are they faking it a Dr Gail Saltz They re not faking it They re real symptoms They need a psychiatric or psychological treatment Treatment does work b How do we know they re not faking it 5 Video Medical mystery Conversion Disorder a Conversion Disorder the manifestation of psychological symptoms in a physical form b Lifetime of many stressors that build up that bring it out ex seizures fainting spells blindness ticks c Causes anxiety depression 6 Mystery Illness a Questions Any evidence of medical illness Any evidence of stress trauma Any attribution of sensations to illness Vll Treatment of Somatic Svmptoms Disorders 1 Few controlled treatment outcome studies 2 Cognitive Behavioral Treatment a Identify and change triggering emotions b Change cognitions about symptoms c Replace sick role behaviors with more appropriate social interactions 3 Antidepressants a Tofranil 4 Effective even at low dosages that do not alleviate depressive symptoms 5 Treatment of Pain a Antidepressants Tofranil i Effective even with low dosages that don t alleviate depressive symptoms b Components of psychotherapy for pain disorder i Validation of patient s pain ii Relaxation training iii Reinforce shift of focus away from pain iv Help patient develop ability to cope with stress and gain sense of control over pain v Reverse restactivity cycle VIII The class answered some questions regarding scenarios presented on the PowerPoint Don t forget about the Exam Review Session END OF NOTES October 30 2014 Abnormal Psychology Notes I Announcements 1 Exam on November 6 ll Schizophrenia 1 1 prevalence maybe less amongst the population 2 Thought faulty perception and attention 3 Emotion more a lack of expression of emotion its not that they don t experience joy or sadness its just their outward expression of it is diminished Squinting of the eyes on the side of the face to reveal happiness Diminished facial expression 4 Behavior disheveled appearance 5 Interpersonal relationships and the ability to live independently are seriously disturbed 6 Diagnosed most frequently among African Americans 7 Need at least 2 symptoms to be diagnosed a There s no one symptom that everyone with schizophrenia has to have There s no hallmark They can have schizophrenia without disorganization for example 8 Three major clusters of symptoms a Positive i Delusions firmly held beliefs that are contrary to reality and resistant to disconfirming evidence Ex The CIA is watching me really hard to prove The CIA wouldn t admit that anyway ii Tvpes of delusions persecutory delusions 65 have these most common delusions the person is under threat or someone is after them thouoht insertion other people are putting thoughts into your mind thouoht broadcastind people can see what you re thinking outside control controlled by outside voices grandiose delusions ideas of reference hallucinations experience voices in the very same way we re hearing the instructor right now being created in the absence of actual outside auditory stimulation sensory experiences in the absence of sensory stimulation sensation of hearing something in their minds b Negative i Avolition absence of volition the desire to do something lack of interest apathy never initiate goaldirected behavior not too depressed the initiation just fails to occur asociality inability to form close personal relationships anhendonia inability to experience pleasure never expect or anticipate to experience pleasure so don t partake in activities blunted m exhibits little or not affect in face or voice m reduction in speech diminished in negative symptoms of schizophrenia c Disordanized sometimes schizophrenic people laugh at very sad stories Or they have sad emotions in response to really positive things d Instructor s example schizophrenic man saw what he thought was a 7 foot tall blue bunny in his yard in the morning turns out it was just a regular rabbit and his mind made up the rest lll Disorganized Symptoms 1 Disordanized soeech incoherence ability to organize ideas loose associations derailment rambles difficultly sticking to one topic 2 Disordanized behavior odd or peculiar behavior ex wearing multiple layers in July wearing a tshirt to a formal event 3 Word Salad not making sense might have a coherent thought in their head but it s not coming out Ex tissues without a triangular head lice be it with controller is the noodle man of ice pops and radio yes thanks 4 Loose associations overly vague responses lack of meaning to speech can t create a specific response random associations talk about irrelevant topics Not necessarily premeditated or intentional or organized 5 Movement Symptoms a Catatonia immobility when a person assumes very weird postures for long periods of time ex stand on one leg controlled by medications now wavy flexibility lV Disorders 1 Schizoaffective disorder delusions or hallucinations for at least 2 weeks in absence of symptoms meeting mood disorder criteria instead of prominent mood symptoms 2 Brief Psychotic Disorder 1 day 1 month Schizophreniform 1 6 months same symptoms as schizophrenia Schizophrenia gt 6 months 3 Delusional Disorder jealousy erotomania and somatic delusions the affected person believes that another person usually a stranger is I love with him or her a The assassination attempt of Ronald Reagan by John Hinckley Jr was reported to have been driven by an erotomanic delusion that the death of the president would cause actress Jodie Foster to publicly declare her love for Hinckley b David Letterman was stalked by Margaret Mary Ray Ray first made the news in 1988 when she was arrested for driving Letterman s Porsche stolen from his driveway with her 3yearold son She claimed she was Letterman s wife and that her son was their child 4 Heritability of schizophrenia is quite high DZ twins 1208 with schizophrenia MZ twins 4430 o profound genetic influence on schizophrenia but the majority won t get it Social environmental and developmental factors that only happen to one twin and not the other 5 Adopted Offspring of Mothers with Schizophrenia both parents with schizophrenia 273 incidence of schizophrenia V Video Schizophrenia 1 Gather evidence of delusions and hallucinations 2 Georgiana thinks members of her family are vampires and the devil tries to get her to eat food She hears voices others can t hear and perceives watermelon as blood Catatonic episodes ignores her own personal care needs 3 What is schizophrenia When things get really bad I couldn t handle it so I just escaped l was escaping so often that pretty soon I couldn t control it and was always gone Things got dangerous at first it was comfortable But after awhile I couldn t come back l was still here but things were happening like I wasn t here The pressure got too much the stress I couldn t handle it 6 example of poverty of speech not a lot of information or concrete statements creating speech but not a lot of content Slight hint of delusions of persecution 4 I just couldn t think right My family lied to me you re okay This is supposed to happen 6 ideas of reference might think family is lying to cover up that they re vampires 5 Video Larry a Recovered person lingering symptoms but more insight on positive symptoms from the past b Occasionally I hear voices in my head I have all sorts of companions some fictional some nonfictional 6 straight face blended affect speaking quietly c I occasionally talk to myself I invented names of baseball players because I loved baseball I had my first difficulties when l was in 7th grade I heard my fictional friends more so than saw them Others didn t hear them d The voices went unnoticed for many years l was able to function When I was a senior in high school it manifested itself in a large way I was hospitalized and the diagnosis was a mental breakdown e I had friends some from history some with names I had invented 6 may not know who s real and who s not partial insight Vl Etiology of Schizophrenia 1 Genetic Factors a Association studies two genes associated with schizophrenia DTNGP1 NGR1 Two genes associated with cognitive deficits COMT BDNF 2 Neurotransmitters a Dooamine Theorv main theory surrounding schizophrenia Disorder due to excess levels of dopamine drugs that alleviate symptoms reduce dopamine activity i Mesocortical pathway dopamine neurons underactive in prefrontal cortex 9 negative symptoms of schizophrenia and mesolimbic pathway release of mesolimbic dopamine neurons from inhibitory control 9 positive symptoms of schizophrenia ii Dopamine theory doesn t explain everything antipsychotics block dopamine rapidly but symptom relief takes several weeks To be effective antipsychotics must reduce dopamine activity 3 Brain Structure and Function a Psychological Risk Factors Twins that share 100 of their DNA with someone with schizophrenia only have a 44 chance of getting it Environmental factors are important b Developmental Factors diminished stimulation in areas that are important prefrontal cortex matures c Enlarged ventricles implies loss of brain cells this brain damage occurs early in life 4 Psychological Stress a Increased stress in a family with schizophrenia Highest rates of schizophrenia among urban poor i Sociooenic hVDothesis stress of poverty causes disorder ii Social selection theorv downward drift in socioeconomic status Research supports this 5 Family Factors a Schizoohrenoqenic mother cold domineering conflict inducing No support for this theory This led to a lot of stigma against the disorder and prevented getting treatment b Communication deviance CD hostility and poor communication inconclusive at this time The idea is that this may exasperate symptoms 6 Families and Relapse a Family environment impacts relapse b Exoressed Emotion hostility critical comments and emotional overinvolvement Ex if a mother is overly critical with her comments this may exasperate her son s schizophrenic thoughts c Bidirectional association unusual patient thoughts 9 increased critical comments Increased critical comments 9 unusual patient thoughts Vll Treatment of Schizophrenia Medications 1 Firstgeneration antipsychotic medications neuroleptics 1950s 2 Secondgeneration antipsychotics clozapine impacts serotonin receptors fewer motor side effects less treatment noncompliance reduces relapse 3 Nearly threequarters stopped taking the medications before study ended 4 Secondgeneration antipsychotics have serious side effects 5 Psvcholoqical Treatments a Patient Outcomes Research Team PORT treatment recommendation Medication PLUS psychosocial intervention b Coonitive behavioral therapv recognize and challenge delusional beliefs Vlll Remember quiz on Sunday night END OF NOTES
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