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PSY 350 Notes for Exam #1

by: Kathryn Chaffee

PSY 350 Notes for Exam #1 PSY 35000

Marketplace > Purdue University > Psychlogy > PSY 35000 > PSY 350 Notes for Exam 1
Kathryn Chaffee

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These are all of my lecture notes covering topics included on the first exam.
Abnormal Psychology
Douglas Samuel
Study Guide
Abnormal psychology
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This 15 page Study Guide was uploaded by Kathryn Chaffee on Thursday February 4, 2016. The Study Guide belongs to PSY 35000 at Purdue University taught by Douglas Samuel in Spring 2016. Since its upload, it has received 38 views. For similar materials see Abnormal Psychology in Psychlogy at Purdue University.


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Date Created: 02/04/16
PSY 350 – Abnormal Psychology 01/14 What is “normal”? -Lack of statistical deviation?  Have to be careful not to distinguish it as what is common or average in the population  The frequency in the population cannot be the sole reason it is “normal” -Non (or less) pathological? Adaptive?  We all have something that is less than adaptive  No person is purely adaptive  Negative emotions serve a purpose – important to keep us healthy -A “non-broken” aspect of a system?  How could you diagnose a “broken” brain?  Some aspect of brain function is “broken” Definition of mental disorder -Wakefield: “Harmful Dysfunction”  There is some dysfunction = something natural system is not working properly  It causes harm = negative consequences, distress, role failures Key terms of definition of mental disorder in DSM-5:  “Syndrome”: collection of symptoms  “Clinically significant disturbance”: you need clinical care to help with the symptoms  “Dysfunction…in processes underlying mental functioning”: something is not working the way it should work, or it was working and it became altered by something in the environment (PTSD)  “usually associated with distress…”: Sometimes the disorder isn’t accompanied with distress (autism)  “…or disability in important activities”: can’t do certain activities  “Expectable or culturally approved response to common stressors is NOT a mental disorder”  “Societal deviance is NOT necessarily a disorder” Culture/Society & Psychopathology  Homosexuality was considered a mental disorder until 1973  There remains a disorder called “Gender Dysphoria” - “Marked difference between expressed/experienced gender and gender others would assign; for at least six months” AND “presence of clinically significant distress” DSM-5 is not the only game…  International Classification of Diseases (ICD)  Some degree of crosstalk, but not perfect symmetry DSM-5 is arranged hierarchically:  19 “classes” of disorders  Individual diagnoses  Diagnostic criteria Prevalence – the number of active cases in a population during any given period of time  Prevalence is typically expressed as percentages  Different types of prevalence estimates include point prevalence, one-year prevalence, and lifetime prevalence Incidence – the number of new cases in a population over a given period of time  Incidence figures are typically lower than prevalence figures, because they exclude already existing cases Most common mental disorder: major depression 01/19 Mood Disorders 1: Depression  Emotion: a fleeting experience; a wave (short term)  Affect: another word for emotion; the emotional basis for behavior; how emotion drives behavior; Ex- facial features  Mood: emotion that sticks around for a long time Depression is a mood disorder because it is an emotion that sticks around for a long time. Depressive Disorders  DSM-IV “Mood Disorders”  DSM-5 “Depressive Disorders” separated from “Bipolar and Related Disorders” Depression  Can refer simply to a mood: “I’ve been depressed lately”  Or a clinical Syndrome: Major Depressive Episode/Disorder Symptoms of Depression  Cognitive: feelings of worthlessness, guilt, hopelessness  Somatic: bodily sensations such as sleep disruption, insomnia/hypersomnia, no energy, physical aches and pain  Behavioral: psychomotor retardation (all movements are slowed down – walking, talking, ect.) What is Depression?  Major Depressive Episode - Must last two weeks - Depressed mood most of the day, every day - Diminished interest in pleasure or activities - Weight loss or weight gain (+/- 5% in a month) - Disrupted sleep (sleep all day or insomnia) - Psychomotor retardation - Feelings of worthlessness - Diminished ability to think/concentrate - Recurrent thoughts of death - Fatigue/loss of energy Disorder (MDD) Epidemiology  16% lifetime prevalence  Age of onset in late 20s/30  Course: episode may last 4-9 months (if untreated)  Recurrent: Single episode – rare or never  Median number of episodes = 4  Painful & disabling  Potentially fatal via suicide  Increasing rates, especially among youth  Earlier onset (before 21) – more chronic, poorer response to treatment, familial transmission Depression or Dysthymia  Depression includes a major depressive episode  Dysthymia (Persistent Depressive Disorder) - More chronic (at least 2 years), but less severe Depression is very severe for at least 2 weeks. Dysthymia does not have a major depressive episode but lasts longer. Premenstrual Dysphoric Disorder  Symptoms must occur around menstruation and abate afterward, in a majority of cycles  Must be clinically significant impairment  Must be confirmed by prospective ratings  Prevalence = 1.8-5.8% of menstruating women Disruptive Mood Dysregulation Disorder  Temper and mood outbursts  Applies to children up to 12 years of age  Aimed at reducing diagnosis of bipolar disorder Treatments for Depression  Cognitive Behavioral Therapy - Corrects Distorted or maladaptive thoughts - Prescribes behavioral activation  Antidepressant medications - Most common on SSRI’s  In practice, most treatments use both 01/21 Mania  Manic episode: “persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy” - Last at least 1 week, most of day, nearly every day - Sufficiently severe (hospitalization, psychotic)  Hypomanic Episode: “persistently elevated, expansive, or irritable mood and abnormally and persistently increased energy” - At least 4 consecutive days - Noticeable to others  Symptoms (must have 3) - Inflated self-esteem or grandiosity - Decreased need for sleep - Talkative or pressured to keep talking - Flight of ideas or thoughts are racing - Distractibility - Goal directed activity or psychomotor agitation - Excessive involvement in activities with high potential for painful consequences (buying sprees, sexual indiscretions, foolish investments) Bipolar and Related Disorders Bipolar I  At least one manic episode - 7 days or more - Severe enough for hospitalization  People tend to enjoy the manic state  Lifetime prevalence = 1.3%  No gender differences  Mean age of onset = 18  Tends to be chronic  Among most heritable  Suicide common – 17% attempt Bipolar II  At least 1 hypomanic episode - 4 days or more - But never a manic episode  At least 1 major depressive episode Cyclothymia  Fluctuation in mood, but not enough for depressive or hypomanic episode at any point of time  Lasts at least 2 years for adults (1 for kids) and half of the days  Not without symptoms for >2 months Treatment  Lithium carbonate (often just lithium)  Anticonvulsants - Depakote - Lamictal - Neurontin, Topamax  Psychotherapy With depressive episode and 7 days or more manic episode – Bipolar 1 With 4-7 days manic episode with depressive episode – Bipolar II Suicide Definitions  Ideation: the desire or wish to die  Intent: intention on acting on ideation  Plan: having a plan on how to commit suicide  Attempt: actually trying to commit suicide  Completion: the person has deceased because of suicide Suicide  15-20% of all people with mood disorders will complete suicide  35,000 per year complete suicide  2 ndleading cause of death among college students Risk Factors  Gender, veteran status, age (women are more likely to attempt, men are more likely to succeed)  Hopelessness, isolation, “burden”  Unbearable emotional pain  Recent death of someone close (particularly by suicide)  Identified method (plan)  Past Attempts  Access to means (weapons, drugs, ect.) 01/26 Schizophrenia Spectrum and other Psychotic Disorders  DX=diagnosis  SXs=symptoms  Tx=treatment  Rx=prescription “Schizophrenia”  Eugene Blueler (1908)  Two Greek terms - Phren=mind - Schiz=split Myths about Schizophrenia  “Split personalities” – you can hear voices, but not various personalities  Dangerous – they are just as likely to commit a crime as anyone else, however, they are more likely to be the victim of a situation  Can’t be treated – there are ways to manage the symptoms and people are able to live relatively independent lives  Defined solely by hallucinations Psychosis: Positive Symptoms (adding something beyond normal life)  Hallmark symptom – Significant departure from reality  Hallucinations – sensing something that is not there  Delusions – strong belief that is a misrepresentation of reality or simply untrue - Not just odd or unusual beliefs Negative Symptoms  Perhaps the most debilitating and resistant to treatment  “Blunted affect” – diminished emotional expression  “Anhedonia” – inability to experience pleasure; flat affect  “Avolition” – lack of will; apathy  “Alogia” – poverty of speech Disorganized Symptoms  Thought disturbances and disorganized speech  Irrelevant responses to questions  Disconnected ideas  Peculiar word choice Thought/speech disturbances  Loose associations – the sentences make sense, but the organization does not  Neologisms – inventing new words or combining  “Word salad” – stringing together nonsensical words Motor disturbances  Catatonic behavior – immobility; reduced responsiveness  Inappropriate affect – incongruous with content; Ex- watching a funny movie and start crying Phases of Schizophrenia  Prodromal – some negative symptoms may appear; start having peculiar experiences; no hallucinations; drifting towards positive and negative symptoms  Active – experience of psychosis; experience positive symptoms; doesn’t last too long  Residual – the negative symptoms still occur and but the positive symptoms may go away DSM-5 Schizophrenia Diagnosis  Two or more: delusions, hallucinations, disorganized speech, disorganized motor behavior, negative symptoms  Significant impairment (functioning markedly below typical before onset)  At least 6 months (>1 month of sxs/active)  Depression, bipolar, and schizoaffective are ruled out  Not better accounted for by autism – but can have both if + sxs are present Epidemiology  1% of population  Across all cultures  More likely in men (4:3 ratio)  Males may have more negative sxs and longer duration; could account for difference  ~20% attempt suicide  5-6% die from suicide  Most are diagnosed around ages 15-25 Causes of Schizophrenia  Biological factors - Genetics – play a big part in schizophrenia - Family studies – Risk is related to genetic similarity - Twin studies – identical twins share the same likelihood - Adoption studies - Specific genes – not likely that it is because of a certain combination of genes; no specific gene that codes for schizophrenia  Differences in the brain Structural - Smaller total brain volume - Enlarged ventricles Functional - Dysfunction in frontal cortex - Dysfunction in temporal lobes - These are not diagnostic tools Pharmacological Treatments  Antipsychotics (e.g. Thorazine) - First in the 1950s, showed success - Had serious side effects (distorted muscle movement, weird mouth movements)  Second-generation antipsychotics (Risperdal) - Targets positive symptoms; difficult to target negatives - Much fewer major side effects; but still some (Ex- weight gain) 01/28 Traumatic Stress and PTSD Dissociation  The disruption of normally integrated mental processes involved in memory, consciousness, identity, and perception  Common thread to all the diagnoses we’ll talk about today Traumatic Stress Disorders  Can be controversial, particularly for dissociative and somatoform disorders, but much traumatic stress disorders… What is traumatic stress?  Exposure to actual or threatened death, serious injury, or sexual violence by: - Direct experience - Witnessing event occur to others - Learning of traumatic event to family member or close friend - Experiencing repeated or extreme exposure to aversive details of traumatic events (cannot be from a movie or on TV) Acute stress disorder  Appears AND resolves >3 days < 1 month Post-traumatic Stress Disorder  Appears and lasts longer than 1 month  Difference is ONLY with regard to course Traumatic stress disorders A. Acute stress B. Intrusive symptoms after the event - Dreams, memories, re-experiencing, flashbacks, distress at external cues C. Avoidance of associated stimuli - People/events or memories, ect D. Negative alterations of cognition or mood - Amnesia, distorted ways of thinking about the world, depression, detachment E. Alterations in Arousal - Hypervigilance, destructive behavior, sleep disturbance Adjustment Disorder  Fairly non-specific symptoms  Begins within 3 months of a stressor  Out of proportion to actual event  Significant impairment  Ex: breakups, fired, natural disaster, death of a loved one History of PTSD  Reactions to trauma are of interest to military  World War I “Shell Shock”  Vietnam Era – “Delayed” reactions to combat were/are common  First part of DSM, in 1980 (DSM-III) What is a traumatic stressor?  “Exposure to actual or threatened death, serious injury, or sexual violation”  Learning of violence to a loved one  Repeated exposure to trauma  Addition of ASD – May be predictive of future PTSD PTSD Epidemiology  ~7% of US population  Frequency of trauma (and thus PTSD) depends on lots of factors  Most common is unexpected death of a loved one Certain traumas are more likely to lead to PTSD than others. What is EMDR?  Eye Movement Desensitization Reprocessing  Includes back and forth eye movements while reprocessing the event  Does it work? Yes it works, but not any better than any other method Prevention and Treatment  Antidepressant Medication  Antianxiety medications - Traditional antianxiety medications are not effective in treating PTSD - Only 30% fully recover Dissociative Disorders  Dissociative Identity Disorder - Formerly called “multiple personality syndrome”  Controversial What are dissociative disorders?  Psychologically produced amnesia  Confused travel of long distances  Existence of two or more personalities within a person DID: formerly called Multiple Personality Disorder Depersonalization: feeling detached from yourself Derealization: Feels “unreal” or detached from environment Dissociative amnesia: loss of recall for events or period of time Sybil  Popular book and movie in the 1970s about a woman with multiple personalities  After the movie, the number of cases increased rapidly  But, the real Sybil, Shirley Mason, admits it was a fake Somatic Disorders  Persistent worry about physical conditions, despite negative medical evidence  Illness Anxiety disorder – replaces hypochondriasis (always feels like you are sick)  Malingering – the purposeful exaggeration or faking of symptoms for some external gain  Factitious Disorder – “Munchausen’s Syndrome”; likes being in the patient role, has a desire to be the patient and everyone focusing on your health  Biproxy – desire to be the caretaker (mother poisoning her daughter in order to take care of her) Psychogenic/Somatoform  More on the “controversy” with DID, ect. - They are “disjointed” senses of identity, not distinct fully formed personalities  Somatoform Example: Conversion Disorder - Psychogenic Non-epileptic Seizures - Phase 1 monitoring 02/02 Anxiety Disorders and OCD Anxiety Disorders  Anxiety vs. Fear  Generally quite persistent (>6 months)  High degree of distress  The most prevalent CLASS of mental disorder - More common in women  High degree of comorbidity with depression Anxiety Disorders  Primary Diagnoses - Specific Phobia - Social Anxiety Disorder (Social Phobia) - Panic Disorder - Agoraphobia - Generalized Anxiety Disorder Anxiety Disorders 1. Intense fear of ________ 2. Happens always, or almost always when faced… 3. Actively avoided, or endured with intense anxiety 4. OUT of proportion to the actual danger 5. Persistent Across Time 6. Significant Distress or Impairment Specific phobia: arachnophobia (fear of spiders) Panic Disorder  Panic Attack - “Abrupt surge of intense fear…during which time FOUR or more of the symptoms are present” - Palpitations, sweating, trembling, shortness of breath, feeling of choking, chest pain, nausea, dizzy or light-headed, chills or heat, parasthesis (numbness or tingling), fear of losing control “going crazy”, fear of dying Generalized Anxiety Disorder  Excessive Anxiety and worry >50% of days for at least 6 months  Worry is pervasive and difficult to control  Three or more: - Restlessness - Easily fatigued - Difficulty concentrating - Irritability - Muscle tension - Sleep disturbance Treatment of Anxiety Disorder  What do you think would be the key to treating anxiety?  Think of something you’ve been afraid of before, how did you overcome it?  Ironically, this entails having patients do the thing that they fear the most… Specific Treatments  Psychoeducation - “Create” mini-panic attacks or elevate physiological symptoms - Panic ≠heart attack Treatment of Anxiety Disorder  “Avoiding Avoidance”  Systematic Desensitization - Hierarchy: working up to the anxiety  Paired with relaxation/deep breathing exercises - “SUDS” ratings: subjective units of distress  Mindfulness: idea that one should be more aware of surroundings (inner and outer experiences)  Cognitive Behavior Therapy  Identifying and Correcting thoughts - Catastrophic appraisal Realistic appraisal  PMR: used to locate where you are holding tension Pharmacological Treatment  Treatment for acute anxiety is largely benzodiazepines - Valium, Xanax, ect - Overall relaxing effect; some describe it as feeling more numb - These can be highly addictive, particularly for those using opiates  Do you think those would help in the type of treatment I just described? - You almost need a level of anxiety in order to treat it using the cognitive treatment. When you are taking the medication, you aren’t facing the anxiety, instead you are treating it with medication, you have a higher likelihood of relapse. 02/04 OCD and Related Disorders Obsessive Compulsive Disorder  “OCD”  Among the most debilitating disorders in the world  Used to be an Anxiety Disorder, now a separate “class”  Obsession - Unwanted thoughts, impulses, or images that cause extreme anxiety and are experienced as intrusive  Compulsions - Repetitive behaviors or mental acts that neutralize obsessions - But are irrational and nonsensical Examples of obsessions: germs, forgetting to turn off the oven Examples of compulsions: washing your hands multiple times, turning around to check the oven multiple times OCD Diagnosis  Presence of Obsessions OR Compulsions (most have both)  Differentiating from Normality - 13% of population have “moderate” symptoms that are nondiagnostic - 1.6% lifetime prevalence - Must cause marked distress - Interfere with functioning Treatment of OCD  Given what you know about treatment of anxiety disorders, how do you think we might treat OCD? - Avoid taking part in the compulsion - Normalizing the compulsion; focusing on the fact that nothing terrible will happen if they do not do the compulsion CBT Treatment for OCD  Key factor is response prevention in face of obsessions - Exposure and Response Prevention (ERP)  Imaginal Exposure: imagine not acting on a compulsion  Exposure in vivo: Make them experience avoiding the compulsion  Ritual Prevention: don’t have to do the ritual to calm their anxiety  Cognitive Interventions OCD and Related Disorders Hoarding  New addition to DSM-5  Defined by unrelenting difficulty to…  Key aspects of diagnosis are: - Distress at thought of discarding - Items have little value/are broken - Clutter interferes with intended use of objects - Causes considerable distress or impairment Trichotillomania  Pulling out hair  Tried many times to stop pulling out hair Excoriation  Recurrent skin picking resulting in lesions  Repeated attempts to stop  Distress or impairment  Not attributed to a medical condition Body Dysmorphic Disorder  Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others  Repeated behaviors  NOT having to do with fat/weight  Muscle dysmorphia: not being able to perceive your body the way other people see it


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