Psychopathology Exam Study Guide: Neurodevelopmental disorders, anxiety, phobias, ADHD, panic attacks, and agoraphobia
Psychopathology Exam Study Guide: Neurodevelopmental disorders, anxiety, phobias, ADHD, panic attacks, and agoraphobia 20732
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This 8 page Study Guide was uploaded by Kenedy Ramos on Saturday January 30, 2016. The Study Guide belongs to 20732 at Gonzaga University taught by Dr. Fernandez in Spring 2016. Since its upload, it has received 168 views. For similar materials see Psychopathology in Psychlogy at Gonzaga University.
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EXAM 1 STUDY GUIDE PSYCHOPATHOLOGY 390 MW Spring 2016 Dr. Fernandez ***NOTE AREAS THAT INDICATE *** “MAY CHANGE:” HOW TO USE STUDY GUIDE The study guide is intended to be a supportive tool in reviewing material for the exam. The questions listed can help you know what sections and ideas are most important and where to place special efforts in attending to detail and acquiring a conceptual understanding. It is important to have done assigned readings, attended class or requested information presented in class if you were absent. The questions listed below and related answers were attained from class (lectures, Power Point material & group presentations) and assigned readings from your text. Always feel free to contact me with any questions. Abnormal Behavior in Clinical Terms Describe how a psychological disorder is defined/understood and what is psychopathology? A psychological disorder is a psychological dysfunction (refers to a breakdown in cognitive, emotional, or behavioral functioning) within an individual associated with distress or impairment in functioning and a response that is not typical or culturally expected. Psychopathology is the scientific study of psychological disorders. How do you go about giving a clinical description of a client (e.g., presenting problem, onset of disorder, course, prognosis) – understand each term? To do this, you must first present the problem in which you indicate why the person came to the clinic. After you would find the onset of the disorder or why and how long the disorder had been occurring. This would include determining if the disorder was an acute or insidious onset (began suddenly or developed gradually over an extended period of time). Finding the course of the disorder would entail determining if the disorder was following a chronic or episodic course (long term or sporadic short episodes here and there). A prognosis is indicating whether the disorder has a good or guarded outcome (whether the patient will be able to recover or that the outcome is not good and they will need extended care of some sort) Describe the varying practices of psychopathology (e.g., psychologist, counselor, etc.). Professionals such as clinical and counseling psychologists, psychiatrists, psychiatric social workers, psychiatric nurses, marriage/family therapists, and mental health counselors are included in this study. Biological & Psychological Tradition Understand concepts of catharsis Catharsis is the idea that it is therapeutic to recall and relive emotional trauma that has been made unconscious and to release the accompanying tensions Describe object relations and classical conditioning. Object relations is the study of how children incorporate the images, memories, and sometimes the values of a person who was important to them and to whom they were (or are) emotionally attached to Classical conditioning is a type of learning in which a neutral stimulus is paired with a response until it elicits a response. Integrative Approach to Psychopathology Understand the difference between one-dimensional vs. multidimensional approaches and define each. Multidimensional approach models may include behavioral, cognitive, emotional, social, cultural and environmental influences. This approach concludes that no influence operates in isolation and that each dimension is strongly influenced by the others and weave together in various complex/various ways to create a psychological disorder. Most scientists believe in this approach in contrast to a 1-D approach. One-dimensional approach concludes that psychopathology is caused by a physical abnormality or by conditioning and attempts to trace the origins of the behavior back to a single cause. Describe the role of genes on our development in terms of degree of influence. Genes seldom determine the physical development of an individual in any absolute way. Best estimates attribute about half of our enduring personality traits and cognitive abilities to genetic influences. Understand the differences/similarities of diathesis-stress model and the reciprocal gene-environment model. The diathesis-stress model states that individuals inherit tendencies to express certain traits or behaviors, which may then be activated under conditions of stress. This model says that people can have an inherited tendency that makes them susceptible to developing a disorder and that when put in the right situation, that person will develop the disorder. Example: Jack and Holly both have the genes to become alcoholic, Jack gets stressed out about college and Holly deals with her stress by practicing yoga. Jack is constantly anxious and chooses to drink to get over it. Jack becomes an alcoholic and Holly doesn’t. The reciprocal gene-environment model says that genetic endowment may increase the probability of an individual experiencing stressful life events. This models says that people have the ability to develop a disorder because of a personality trait that leads them to be in those type of situations. Example: person who is impulsive and likes driving fast, keeps getting into car accidents and therefore develops a phobia of blood or PTSD from getting into so many car accidents Review the structures of the brain that are discussed to play a role in abnormal psychology (e.g., role of limbic system)? Endocrine glands produces their own chemical messengers called hormones. Chemicals released from the axon of one nerve cell and onto another are called neurotransmitters; these are how medications and hormones are pulsed through the brain. The CNS includes both the brain and the spinal cord and the PNS coordinates with the CNS to ensure that the body is working properly. The limbic system includes structures such as the hippocampus septum and amygdala which help regulate emotional experiences and expressions. Agonists are substances that increase the activity of a neurotransmitters by mimicking its effects while antagonists are substances that block/decrease the activity of neurotransmitters. Low levels of serotonin has been associated with aggression, suicide, impulsive overreacting and excessive sexual behavior. Extremely low levels of serotonin are associated with less inhibition and with instability, impulsivity and the tendency to overreact to situations. How has cognitive science (e.g., prepared learning, learned helplessness, social learning) contributed to the understanding of abnormal behavior? Cognitive science studies how we acquire and process information and how we store and ultimately retrieve it. This type of learning enables us to develop working ideas about the world that allow us to make appropriate judgments. Learned helplessness occurs when beings encounter conditions over which they have no control. Social learning is a way for beings to learn by observing others. Prepared learning is the idea that beings have become highly prepared for leaning about certain types of objects or situations over the course of evolution because this knowledge contributes to the survival of the species. How does social support impact health? The greater number and frequency of social relationships and contacts, the longer you are to live. Social isolation increases the risk of death about as much as smoking cigarettes and more than physical inactivity or obesity. Assessment & Diagnosis Describe common concerns with the DSM-5 (e.g., role of comorbidity and definition of comorbidity)? The DSM-5 still has fuzzy edges around definitions of disorders and therefore patients can sometimes be diagnoses with more than one psychological disorder, which is called comorbidity. Due to this, scientists are unable to conclude anything definite about the course of a disorder, the response to a treatment, or the likelihood of associated problems if they are dealing with a combination of disorders. What is a mental status exam (MSE) and how is it used (may review handout)? / Understand what are common features of an MSE. A MSE is a way to organize information obtained during an interview. This allows a clinician to record crucial observations about a patient throughout the interview. Key factors such as physical appearance (whether the patient is groomed or unkempt, mentally aware/coherent or slipping in and out of consciousness), behavior (twitching, shaking, mumbling), thought processes (unrecognizable speech, slurring), mood and affect (anxious, depressed, tired), intellectual functioning (vocabulary used, accurate metaphors/analogies), and finally sensorium (awareness of surroundings, time, place). Understand the basic organization of the three sections in the DSM-5 and what is included in each section. The clinical interview involves psychologists, psychiatrists and other mental health professionals gathering information about the patients’ behavior, attitudes, emotions, a detailed history of the individual’s life in general and of the presenting problem. This includes the MSE. The physical examination involves a physician examining medical conditions of the patients, especially those in particular that can be associated with psychological disorders. The behavioral assessment takes the information and processing of the MSE a step further by using direct observation to formally assess the patient’s thoughts, feelings, and behavior in specific environments or contexts. Neurodevelopmental Disabilities Why is it important identify developmental disorders as early as possible? Because problems in early development will more than likely create even larger issues in further development. Describe the basic features and different types of ADHD; identify the areas symptoms need to be present in for a diagnosis of ADHD. Central features include inattention, over activity and impulsivity and are associated with numerous impairments (behavioral, cognitive, social & academic problems, and emotional). ADHD with predominantly inattentive presentation, with predominantly hyperactive/impulsive presentation, with predominantly combined presentation, (also ADHD with other specified and unspecified where it causes clinically significant distress but does not meet sxs criteria and the clinician chooses to either list a specific reason or chooses not to specify). Sxs must have persisted for at least 6 months, are inconsistent with development level, caused impairment before age 12, sxs present in multiple settings ie school, work, home etc), sxs interfere with or reduce the quality of social, academic or occupational functioning. What is the extent of the role of genetics in contributing to ADHD? ADHD seems to run in families. Endophenotypes: “inhibitory control” may be one genetic marker that has been found. Inactivity of the frontal cortex and basal ganglia along with abnormal functioning of the frontal lobe. Studies show a decreases blood flow to the prefrontal regions and pathways connecting these regions to the limbic system. Describe the pros and cons associated with stimulant versus non-stimulant medication in the treatment of ADHD? Stimulants reduce the core symptoms of ADHD in about 70% of the cases but side effects include loss of appetite, weight loss, insomnia, irritability and drowsiness. Non Stimulants are effective for some, and they avoid the related “highs” of stimulants. Each medications’ goal is to improve compliance and decrease negative behaviors in many children. It’s been shown that beneficial effects generally do not last following drug discontinuation. What approaches are implemented in the treatment of ADHD? Psychosocial interventions with parent (education related to structure and how to respond) and social skills training and behavioral treatment (aim to increase appropriate behaviors and decrease inappropriate behaviors). Education interventions include classroom accommodations, behavior modification programs as well as special education services. Describe how a learning disorder is diagnosed (understand “substantially and quantifiably below”); how is intelligence and academic functioning used in this diagnosis? Learning disorders are diagnoses with difficulties in learning and using academic skills by one or more of the following sxs: inaccurate or slow and effortful word reading, difficulty understanding the meaning of what is read, difficulties with spelling, difficulties with written expression, difficulties mastering number sense, number facts, or calculation, difficulties with mathematical reasoning. Academic skills are also substantially and quantifiably below those expected and cause significant interference. The child begins to show symptoms during school-age years but may not become fully manifest until demands exceed limited capacities and are not better accounted by intellectual disabilities or any other disorder. Describe available interventions for specific learning disorders and what the best method for developing knowledge/removing a specific learning disorder is. Early intervention is best and it requires intense educational interventions like “Direct Instruction” (systematic instruction and teaching for mastery). It’s also necessary to treat comorbid emotional and attentional problems. Identify and understand the features of Autism Spectrum Disorder. Encompasses autism, Asperger’s, rett’s and childhood disintegrative. Language impairments can be included in Asperger’s. They all combine social interaction and communication deficiencies (need all 3) : deficits in social-emotional reciprocity (abnormal social approach, failure of normal back-and-forth conversation; reduced sharing of interests, emotions or affect/limited or absent joint attention; failure to initiate or respond to social interactions), deficits in nonverbal communicative behaviors used for social interaction (poorly integrated verbal/nonverbal communication; abnormalities in eye contact and body language or deficits in understanding and use of gestures), deficits in developing, maintaining, and understanding relationships (ranging from difficulties adjusting behavior to suit various social contexts; difficulties in sharing imaginative play; absence of interest peers). Also restricted, repetitive patterns or behavior, interests or activities manifested by at least 2 of the following: stereotypes and repetitive motor movements, use of objects, or speech (simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases), insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal/nonverbal behavior (extreme distress at small changes, difficulties with transitions, rigid thinking patterns, need to take same route, eat same food), highly restricted, fixated interests that are abnormal in intensity or focus (strong attachment to or preoccupation with usual objects, excessively circumscribed or perseverative interests), hyper/hyporeactivity to different input or unusual interest in sensory aspects or the environment (apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights/movement). Must all be present in early developmental period and cause significant impairment in social, occupational or other important areas of current functioning and cannot be better explained by an intellectual disability or global developmental delay. Understand what factors are assessed in helping to determine prognosis in Autism Spectrum Disorder. Environmental factors like advanced parental age, maternal age, low birth weight, fetal exposure to valproate (chemical). Families with one child with ASD have a 20% chance of having another child with ASD (studies are finding that lower levels in blood are consistent with ASD). Environmental factors are likely to combine with and increase genetic susceptibility (advanced age of fathers, low birth weight or small for gestational age, mother’s exposure to pesticide or air pollution, obesity in the mother). Describe available interventions for the Autism Spectrum Disorders and the effectiveness of these interventions; what outcomes are associated with optimal intervention? Psychosocial “behavioral” treatments that target language and social interaction problems (involve discrimination training and shaping). UCLA intervention 40 hours per week showed a large improvement in subjects, and reduced negative behaviors. Early intervention is critical. Describe the basic features for diagnosing Intellectual Disabilities. Onset during the developmental period with deficits in the intellectual functioning. Range of impairment varies greatly across persons. Deficits in intellectual functions (reasoning, judgment), and in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Anxiety Disorders Understand the concepts anger, fear and anxiety. Fear is a present-oriented mood state that involves the immediate fight or flight response to danger or threat (marked negative affect). Anxiety is the future-oriented mood state that involves the apprehension about future danger or misfortune and includes somatic symptoms of tension (marked negative affect). What are the main theories in the biological considerations for the etiology of anxiety disorders? Genetic vulnerability to these feelings and disorders. Depleted levels of GABA in the body (anxiety and brain circuits). The corticotropin releasing factor (CRF) and HPA axis increase the release of cortisol (stress hormone) and therefore activate the anterior pituitary gland, metabolic effects and the brain directly causing an individual to feel anxious. The limbic and septal-hippocampal systems don’t work properly as well as the behavioral inhibitory systems. What are common characteristics & treatments for Generalized Anxiety Disorder (GAD)? What are the risks and benefits of medication use for GAD? GAD includes excessive anxiety (apprehensive expectation) and worry occurring more days than not for at least 6 months about numerous events and activities. Includes (3+), restlessness or feeling keyed up, being easily fatigued, difficulty concentration, irritability, muscle tension, and/or sleep disturbance (muscle tension as well). Treatments include psychological interventions like cognitive behavioral therapy and meditation, medication like SSRI’s (selective serotonin reuptake inhibitors), or combination treatments depending on short or long term outcomes. What are common characteristics & treatments for specific phobias? Marked fear or anxiety of a specific object or situation (in children it may be expressed by freezing up, crying tantrums, clinging). Fear or anxiety is usual immediately, actively avoided or endured with intense fear or anxiety and is clinically significant distressing or causes impairment. Treatments include cognitive behavior therapies, which are highly effective, like exposure therapy. Describe the different categorical types of specific phobias (not individual names such as claustrophobia). Animal, natural environment, blood-injury-injection, situational and other. Describe the varying presentations, features and treatment of social anxiety disorder. Marked fear or anxiety of 1+ social/performance situations in which individual exposed to possible scrutiny by other. Fears acting in a way or show anxiety sxs that will be negatively evaluated. Social situations almost always provoke fear or anxiety and are avoided or endured with intense fear or anxiety. The fear/anxiety is out of proportion to actual threat posed by social situation and to sociocultural context. It causes clinically significant distress or impairment. Treatment includes psychological treatment, cognitive behavioral therapies are highly effective. Medications like SSRIs Paxil and Zoloft and Effexor help but individuals can relapse high with medication discontinuation. Describe the general presentation, diagnostic features and treatment of panic disorder and the nature/features of panic attacks specifically. Recurrent unexpected panic attack involves an abrupt surge of intense fear or discomfort that reaches peak within minutes and during which time 4+ sxs occur: palpitations, pounding heart or accelerated heart rate; sweating; trembling or shaking; sensations or shortness of breath or smothering; feelings of choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, light headed or faint; chills or heat sensations, paretheisas (numbness or tingling sensations); derealization (feelings or unreality) or depersonalization (being detached from oneself); fear of losing control ot “going crazy”; fear of dying. At least one attack has been followed by 1+: persistent concern or anxiety about additional panic attacks or their consequences, significant maladaptive change in activities related to the attacks. Can be situationally bound, unexpected or a mixture of both. Treatments include psychotherapy which is very effective. Recognize and identify sensations and triggers, teaching or more effective coping strategies, behavioral approach emphasizing graduated exposure, cognitive-behavioral therapy discussing irrational fears (Panic Control Treatment or PCT), relaxation, breathing, and mind-body awareness/meditation. Medications include SSRIs (Prozac, Paxil) which take longer to make an effect but overall may reduce panic attacks and severity of attacks and anxiety. Benzos may have the same effect but some have experience reports of cognitive impairment. Antidepressant can also be used to treat panic attacks but the therapy and treatment without drugs seem to be more beneficial. Describe the general presentation and features of Agoraphobia. Marked fear or anxiety about 2+ of the following: using public transportation, being in open spaces (parking lots, marketplaces, bridges etc.), being in enclosed places (shops, theaters etc.), standing in line or being in a crowd, being outside of the home alone. Situations are feared or avoided because of the thoughts that escape might be difficult or help might not be available in event of developing panic-like sxs. Situations almost always provoke dear or anxiety. Agoraphobic situations are actively avoided and require presence of a companion or endured with intense fear or anxiety. Sxs last for 6 or more months and the fear/anxiety is out of proportion with the actual danger.
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