PSY 240 - Abnormal Psych Exam #3 Study Guide
PSY 240 - Abnormal Psych Exam #3 Study Guide PSY 240
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1 PSY240 Exam #3 Study Guide Chapter 11‐ Substance and Impulse Disorders 1. Understand the meaning, differences and relationship among: substance intoxication, use, tolerance, and withdrawal. ● Substance intoxication:reversible substance specific syndrome or problematic psychobehavioral change shortly after use; physiological reactions, such as impaired judgment and motor ability, as well as mood changes, resulting from the ingestion of psychoactive su bstances. ● Use:taking psychoactive substances in moderate amounts that don’t significantly interfere with social, educational, or occupational functioning. ● Tolerance: a diminished effect with continued use of the same amount; requiring increasingly greater amounts of the drug to experience the same effect. ● Withdrawal: substance specific behavioral, cognitive, physiological changes after ending heaving use causing significant distress/impairment [not all drugs lead to this]; severely negative physiological reaction to removal of a psychoactive substance, which can be alleviated by the same or a similar substance. 2. Understand negative reinforcement and drug use. Negative reinforcement: ● Drugs reduce anxiety ● Increase in GABA activity in septum‐hippocampus of limbic system ○ ‐> Anxiolytic effect ■ Reduction of anxiety provides negative reinforcement ‐ Motivation to continue drug use to: ‐ Avoid anxiety ‐ Avoid withdrawal symptoms 3. What effects (e.g., depression of inhibitory centers in the brain) and neurotransmitter(s) are involved with alcohol? ● Immediate Effects of alcohol: o It first inhibits inhibitory centers. o Impairs judgment, motor coordination, reaction time, vision, and hearing. o Disinhibits norms of aggression, sex, etc. o Expectation effect: a person expects the alcohol to have a certain effect on them, so they act that certain way anyway (placebo effect) ▪ Example: “I’m drinking so no one expects me to be in control of my actions!” → “Since I’ve been drinking, then I can punch that person because I have alcohol in my system so no one expects me to be in control!” ● Effects of Chronic Over Use of Alcoho: o Alcohol Black Out: the person is drunk but awake, and has no memory of what happened. o Intoxication o Withdrawal: delirium, hallucinations, body tremors, autonomic hyperactivity, hand tremors, insomnia, nausea/vomiting, anxiety, seizures. o Dementia: general loss of intellectual abilities o Wernicke‐Korsakoff’s Syndrome/Alcohol Amnesia Disorder : amnesia with confabulation, loss of muscle coordination, unintelligible speech (Does not go away once the brain is damaged.) o Hepatitis, Cirrhosis of the liver o Pancreatitis o Cardiovascular disorder o Brain damage o Fetal Alcohol Syndrome: growth retardation, mental retardation, facial abnormalities. o Death ● Neurotransmitters: 1. GABA: agonist (fires neuron response), inhibitory, makes it difficult for neurons to communicate with one another, anti‐anxiety because of interaction with GABA system 2. Glutamate: antagonist (blocks neuron response), excitatory, impairs cognitive abilities, specifically learning and memory 2 PSY240 Exam #3 Study Guide 3. Serotonin: it affects everything (mood, sleep, eating behavior, etc.), it is responsible for alcohol cravings ‐ Interacts w. serotonin in blood stream & creates desires for more alcohol (cravings) 4. What are the effects of using cocaine? ● Effects of cocaine: o Effects from Intoxication: ▪ Euphoria ▪ Short term feelings of power and confidence ▪ Affective blunting (Emotional numbness) ▪ Anxiety ▪ Anger ▪ Tension ▪ Confusion ▪ Hypervigilance ▪ Paranoia ▪ Insomnia ▪ Decreased appetite ▪ Dilated pupils ▪ Tachycardia (faster than normal heart rate) ▪ Very high or very low blood pressure ▪ Nausea ▪ Seizure ▪ Coma ▪ Death ▪ Chronic hallucinations of all types of a very frightening nature. Dependence: ● Highly addictive, but usually develops slowly ● First, growing inability to resist taking more ● Later, sleep disruption, paranoia, social isolation Withdrawal: ● Apathy, boredom, anhedonia ● Sometimes anger/anxiety/depression, fatigue, nasty dreams, insomnia/hypersomnia, psychomotor retardation/agitation, or increased appetite Cyclical pattern: ● Increased tolerance ● Consumption of more cocaine to get high ● Vicious cycle 5. What are the effects of using marijuana? ● Effects of marijuana: o Effects from Intoxication:(Effects are variable and individual.) ▪ Euphoria ▪ Sense of enhanced creativity ▪ Heightened sensory experience ▪ Sense of time slowing ▪ Intellectual impairment ▪ Tachycardia ▪ Read eyes ▪ Everything is funny or increase whatever mood already experiencing o Effects from Dependence: (Heavy Use and Long, Chronic Use) ▪ Mood swings including anxiety disorders ▪ Dizziness ▪ Paranoia ▪ Hallucinations ▪ Has triggered schizophrenia in those with genetic predisposition ▪ Impaired memory, concentration, relationships ▪ Greater risk of lung cancer and heart attack o Effects from Withdrawal: (Uncommon, but happens) 3 PSY240 Exam #3 Study Guide ▪ Irritability, anxiety, sleep difficulties, reduced appetite (weight loss) restless, depressed mood, abdominal pain, sweating, fever, chills, headaches 6. What are the effects of using anabolic steroids? How are they different from other recreational drugs? ● Different b/c it's used to produce increased muscle mass & not for getting high ● Anabolic steroids: synthetic variants of the male sex hormone testosterone o They work very differently from other drugs of abuse (they don’t have the same acute effects on the brain. The most important difference is that steroids do not trigger rapid increases in the neurotransmitter dopamine, which is responsible for the rewarding “high” that drives the abuse of other substances. o “Cycling” and “Stacking” patterns of use: ▪ Cycling: pattern of taking and stopping so you can grow without side effects. ▪ Stacking: different steroids same time ● Effects of Anabolic Steroid: o Increased body mass o Long‐term mood disturbancesaggressive/hostile) o Shrinking of testes 7. What is the most commonly used and most commonly addicted substance in the United States? Caffeine 8. Which two substances are most likely to lead to dependence? ● Nicotine ● Methamphetamine 9. How likely is it for a person to become dependent on marijuana? ● Not very likely! (21 out of 100) 10. What is the typical rate of development of cocaine dependency? ● It’s highly addictive, bvery slow rateof development. ● Cocaine dependency happens, insidious onset ● Usually takes a long time to get dependent. 11. What is fetal alcohol syndrome? ● Fetal alcohol syndrome:a congenital syndrome caused by excessive consumption of alcohol by the mother during pregnancy, characterized by retardation of mentaldevelopment and of physical growth, particularly of the skull and face of the infant. o Correlation not causation! o How much should you drink when pregnant? It’s best not to drink any alcohol while pregnant. o Ethnic differences in susceptibility. ● Characterized by: o Growth retardation o Mental retardation o Facial abnormalities 12. What is the initial effect of drinking alcohol? ● Depresses/inhibits inhibitory centers and prevents communication of neurotransmitters (GABA neurons have difficulty firing) 13. What is binge drinking? Nationally, what percent of college students binge drink? ● Binge drinking is the consumption of an excessive amount of alcohol in a short period of time. o More than 5 drinks on one occasion for men. 4 PSY240 Exam #3 Study Guide o More than 4 drinks on one occasion for women. ● 43% of college students binge drink ● According to DeWitt, drinking at an early age (11‐14 years old) is predictive of later alcohol use disorders. 14. What factors determine whether drinking alcohol might lead to aggression? ● Factors: o Quality and timing of alcohol consumed o Person’s history of violence o Expectations about drinking o What happens to the individuals while intoxicated 15. What differentiates people who use alcohol from those who become dependent on alcohol? ● People who are dependent on alcohol are: o Typically early drinkers o Genetically predisposed o Influenced by peers/family o Influenced by social and cultural expectation of drug use ● Also, people who are dependent on alcohol exhibit the following severe consequences: 1. Strong desire for alcohol 2. Increased consumption 3. Extreme behavior while drinking 4. Black outs or blanks 5. Hallucinating after being drunk 6. Needing a drink in the morning. 7. Increased drinking of alcohol when stressed or under pressure 8. Ability to tolerate more alcohol 9. Unable to “party” without alcohol. 10. The person becomes annoyed when others talk about his or her drinking. 16. How do expectancies about alcohol affect its apparent effects? ● Expectation effect: a person expects the alcohol to have a certain effect on them, so they act that certain way anyway o Someone might have not even consumed enough alcohol to be drunk, but their expectancy causes them to lower their inhibitions subconsciously & behave as if they were drunk ● Expect to have positive benefits from drinking alcohol (placebo effect) o Example: “I’m drinking so no one expects me to be in control of my actions!” → “Since I’ve been drinking, then I can punch that person because I have alcohol in my system so no one expects me to be in control!” 17. Differentiate, understand, and know the efficacy of different treatments (e.g., Antabuse, AA, SMART Recovery, etc.) for alcohol dependence. ● Treatment for those who are alcohol dependent: 5 PSY240 Exam #3 Study Guide 1. Biologicaltreatment: show promise for those who are willing to eliminate drug habit o Agonist treatment: substitution of a safer drug with a similar chemical composition ● Example: methadone, nicotine gum, nicotine patch o Antagonisttreatment: blocks/counteracts pleasurable effects; decreases cravings; doesn’t work alone also needs therapy; many stop taking these drugs because they kill the high ● Ex: Acomprosate o Aversivetreatment: makes ingesting abused substance unpleasant; runs into problem of noncompliance, person able to resume drinking after skipping dosage of medicine; works better with in‐patients to ensure compliance ● Ex: Antabuse; Disulfiram o Medications to cope with withdrawal symptoms. o Efficac: Limited use when used alone, better with psychosocial treatment; SSRIs can help withdrawal. 2. Psychologicaltreatment: o Inpatient FacilitiVERY expensive, helps with withdrawal ● Efficacy: equal to outpatient o Alcoholics Anonymous (AA): 12 steps; most popular treatment; research on efficacy is hard because it’s anonymous; high social support; demands complete abstinence; infused with heavy beliefs in god; very high dropout rate ● Efficacy: effective for person who is highly motivated and who stay in the program o SMART Recovery : ● Based on cognitive‐behavioral principles and evolves with new research o Focuses on underlying factors in addiction ● Teaches absence through choice and self management/recovery ● Based on a Four Point Program 1. Building and Maintaining Motivation 2. Coping with Urges 3. Managing Thoughts, Feelings and Behaviors 4. Living a Balanced Life ● A person participates through any or a combination of: ▪ Reading the website: www.smartrecovery.org ▪ Interacting with others online ▪ Purchasing reading material ▪ Attending meetings ● Efficacy:About the same as AA, very high dropout rate o Controlled Use: ● Moderation is goal. o Reframe relapse: one relapse isn’t a catastrophe, doesn’t make the person a failure o Learn social skills o Deal with stress o Personal responsibility and control ● Limited research: o Popular in UK o Short‐term outcome is good o Remain controversial o Efficacy:Long term very limited efficacy (about the same as with abstinence‐based) o About same efficacy as other treatments Comprehensive Treatments ● Individual & group therapy ○ Confront positive beliefs about use ○ Emphasize negative consequences of use ● Aversion therapy ● Covert sensitization ● Contingency management ○ Stay away from cues prompting use ● Community reinforcement ○ Involvement of collateral (spouse, child, etc.) help them stay away from drugs ○ ABC model of behavioral analysis of social contingencies for use ○ Social service assistance 6 PSY240 Exam #3 Study Guide ○ New recreational activities ● Reframe relapse: ○ Failure of coping skills, not the person ● Skills training ● Strategies for drug avoidance & self control of drinking + ● Community involvement ○ "If he drinks too much & gets in an accidenouare responsible." ○ Not serve too much at parties & bars ○ Enforcement of DUI laws ■ Increasing consequence less effective ■ Increasing enforcement more effective ● Promising preliminary results NIAA Project MATCH ● Prevention approaches ○ Education‐based (DARE, Red Ribbon, etc.) ■ Not effective ● Cultural/Media change 18. Understand what the agonist treatment for drug abuse is and how methadone and the nicotine gum and patch are examples of this approach ● Agonist treatment: substitution of a safer drug with a similar chemical composition. o Has the same effect but with a safer drug. o Avoids immediate withdrawal symptoms o Similar chemical composition ● Examples of agonist substitutio: methadone, nicotine gum, nicotine patch o Methadone (used for heroine) and nicotine (used for cigarettes) because it is not as addictive, don’t give as much as their respective drug, and you do not get the “high” as much. 19. What does your textbook say about controlled drinking versus abstinence as a treatment goal? ● Controlled drinking is controversial. ● Controlled drinking may be viable alternative to abstinence for some alcohol abusers, but it isn’t a cure. o 85% success in controlled drinking and 42% success in abstinence after 1 year; not a clear cure but there is a significant difference! 20. Be able to recognize each of the disruptive, impulse control, and conduct disorders from a definition or description. ● Disruptive, Impulse‐Control & Conduct Disorders Behavioral and emotional dysregulation involving the violation of rights of others or conflict with norms or authorities. Linked to dis‐inhibition and somewhat to negative affectivity. ○ Impulse Control Disorders: ■ Intermittent Explosive Disorder : Frequent, unpremeditated verbal & physical aggressive outbursts occasionally involving damage or destruction that are very out of proportion to any provocation ■ Pathological Gambling ○ Conduct Disorder: Frequent violations of the rights of others & of norms & rules. Cruel, bullying or aggressive behavior, steals, destroys property, runs away or is truant and similar behavior. ■ Violation of the rights of others and of norms and rules: ● Bullies ● Steals from others ● Forces others into sexual activity ● Deliberately set fires or destroyed others’ property in another way ● Broken into homes or cars ● Lies to get what he and/or she wants ● Often truant from school or stays out past curfew (before age 13) ■ Specify if with limited prosocial emotions: ● lack of remorse/guilt, ● callous ● lack of empathy, 7 PSY240 Exam #3 Study Guide ● unconcerned about problems, or ● shows only shallow/superficial emotions ■ Must occur before 10. If after 10 → unknown diagnosis ○ Oppositional Defiant Disorder: Angry/irritable mood, argumentative, defies rules & authorities, deliberately annoys others, blames others, & is spiteful/vindictive ○ Kleptomania: Following tension/arousal, unable to resist stealing unneeded things. Relieved/gratified while stealing ○ Pyromania: Following tension/arousal, deliberately sets fires & is gratified while doing so. Fascinated with fire & associated phenomenon 8 PSY240 Exam #3 Study Guide Chapter 12‐ Personality Disorders 1. Know and be able to distinguish the three clusters of personality disorders. 1. Cluster A‐ Odd or Eccentric Disorders :paranoid, schizoid, schizotypal 2. Cluster B‐ Dramatic, Emotional, or Erratic Disorders :antisocial, borderline, histrionic, narcissistic 3. Cluster C‐ Anxious or Fearful Disorders :avoidant, dependent, obsessive‐compulsive 2. Know and be able to distinguish the ten personality disorders. A: Odd or eccentric disorders: 1. Paranoid personality disorder :a pervasive distrust and suspicion of others such that their motives are interpreted as malevolent. ● Main belief: “I cannot trust people.” o Mistrust & suspicion that is: ▪ Pervasive ▪ Unjustified o Few meaningful relationships o Volatile (set off easily) o Tense o Sensitive to criticism 2. Schizoid personality disorder :a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. ● Main belief: “Relationships are messy and undesirable.” o Appear neither to enjoy nor desire relationships o Limited range of emotions ▪ Appear cold, detached o Appear unaffected by praise/criticism ▪ Unable or unwilling to express emotion o No thought disorder 3. Schizotypal personality disorder :a pervasive pattern of social and interpersonal deficits marked by acute discomfort with reduced capacity for close relationships, as well as by cognitive or perceptual distortions and eccentricities of behavior. ● Main belief: “It’s better to be isolated from others.” o Psychotic‐like symptoms: ▪ Magical thinking ‐ believe what they want to believe ▪ Ideas of reference ‐ everything going on in the world is directed at them ▪ Illusions ‐ distorted thinking/perception/sense of things that are there but are really not (semi‐hallucinations) o Odd/unusual: ▪ Behavior ▪ Appearance o Socially isolated o Highly suspicious B: Dramatic, emotional, erratic disorders: 4. Antisocial personality disorder: a pervasive pattern of disregard for and violation of the rights of others. ● Main belief: “I am entitled to break rules.” o Noncompliance with social norms o Social predators: ▪ Intentionally violate rights of others ▪ Irresponsible ▪ Impulsive ▪ Deceitful o Lack remorse o Cannot make diagnosis before 18 yrs old but: ▪ Look for signs by 15 yrs old 9 PSY240 Exam #3 Study Guide ▪ Typically show very extreme defiance of authority by 6 yrs old o Basically psychopaths 5. Borderline personality disorder:a pervasive pattern of instability of interpersonal relationships, self‐image, affects, and control over impulses. ● Main belief: “I deserve to be punished.” o Lack coherent sense of self o Patterns of instability ▪ Labile, intense moods (extreme, change frequently) ▪ Turbulent relationships o Fear of abandonment o Very poor self‐image o Impulsivity o Self‐mutilation o Suicidal gestures ▪ I.E. Make an attempt & call friends to get them to intervene for "rescue" o Ego dystonic psychotic features ▪ Say they hear voices or have some hallucination, but can still recognize they are imaginary o Tend to have comorbid disorders ▪ Bipolar ▪ Depression ▪ Eating disorders ▪ Substance abuse ▪ Suicide 6. Histrionic personality disorder:a pervasive pattern of excessive emotion and attention seeking. ● Main belief: “People are there to serve or admire me.” Clinical Description: ● Overly dramatic ● Sensational about everything (act like telenovela characters) ● Sexually provocative ● Impulsive ● Attention‐seeking ● Appearance‐focused ● Impressionistic, easy to influence ● Vague, superficial speech ● Common diagnosis in females 7. Narcissistic personality disorder:a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy. ● Main belief: “Since I am special, I deserve special rules.” Clinical description: ● Exaggerated & unreasonable sense of self‐importance ● Require attention ● Lack sensitivity & compassion ● Sensitive to criticism ● Envious ● Arrogant ● Believe they deserve the best of everything ● Exploitive C: Avoidant or fearful disorders: 8. Avoidant personality disorder :a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. ● Main belief: “If people knew the ‘real’ me, they will reject me.” Some believe this isn't a valid diagnosis & that it's just an extreme form of social phobia ● Extreme sensitivity to opinions ● Avoid most relationships ● Interpersonally anxious ● Fearful of rejection 10 PSY240 Exam #3 Study Guide ○ Japan: Taijin kyoufu ○ Fear of rejection & criticism ○ Fear that body odor or ugliness will offend others 9. Dependent personality disorder :a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. ● Main belief: “I need people to survive, be happy.” o Rely on others for major & minor decisions (pretty much everything) o Unreasonable fear of abandonment o Clingy o Submissive o Timid o Passive o Feel inadequate o Sensitive to criticism o High need for constant reassurance o Don't have many friends 10. Obsessive‐compulsive personality disorder :a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency. ● Main belief: “People should do better, try harder.” o *Has nothing to do with OCD o Fixation on doing things the "right way" o Rigid o Perfectionistic o Orderly o Preoccupation with details o Poor interpersonal relationships 3. What general problems exist with the current categorical system of personality disorders and what advantages might there be for a dimensional approach? • Current Categorical System: 1. Reifies concepts ● Mere act of using categories lead clinicians to reify them (view disorders as real “things”) 2. Less flexible (seems like all or nothing) 3. Sometimes arbitrary • Advantages of a imensional Approach: 1. Retain more information about each individual 2. Are more flexible 3. Avoid arbitrariness 4. Consistent with researchers’ understanding 4. What is the FFM or Big 5 theory of personality? What are its dimensions? ● Five Factor Model of Personality (“Big Five”/ “FFM”/“OCEAN”) refers to five broad dimensions used by some psychologists to describe human personality. ● The five factors have been labeled: 1. Openness to experience ● Curious, receptive to new ideas & perspectives, emotionally expressive 2. Conscientiousness ● Organized, reliable, committed to personal goals, cautious 3. Extraversion ● Social, optimistic, cheerful, energetic 4. Agreeableness ● Cooperative, compassionate, warm 5. Neuroticism (Emotionality) ● Prone to psychological distress, impulsive, moody 11 PSY240 Exam #3 Study Guide 5. What is the relationship between antisocial personality disorder and psychopathy? How are they the same and how are they different? ● Antisocial personality disord: focuses on observable behaviors (impulsivity and repeated changes in employment, residence, or sexual partners) o “Antisocial personality disorder is a type of chronic mental condition in which a person's ways of thinking, perceiving situations and relating to others are dysfunctional — and destructive. People with antisocial personality disorder typically have no regard for right and wrong and often disregard the rights, wishes and feelings of others.” ● Psychopathy: focuses on underlying personality traits: (1) glibness/superficial charm, (2) grandiose sense of self‐worth, (3) proneness to boredom/need for stimulation, (4) pathological lying, (5) conning/manipulative, and (6) lack of remorse o “Psychopathy, now distinguished from sociopathy, is traditionally defined as a personality disorder characterized by enduring antisocial behavior, diminished empathy and remorse, and disinhibited or bold behavior. ● Different: Some psychopaths are more manipulative and insightful but don’t display the aggressiveness and criminality characterized by antisocial personality disorder. ● Same:Antisocial personality disorder patients and patients that have the nature of a psychbothh have similar outlook on others and personality traits. 6. If a person under 18 is showing signs of antisocial personality disorder what diagnosis is he or she most likely to receive? Conduct Disorder 7. Know the underarousal, fearlessness, BIS/reward, and interactive‐integrative theories for antisocial personality disorder. ● Underarousal: a theory that when the body is underaroused, a person will look for things to do to get more arousal. o Low levels of cortical arousal tend to experience negative affect and perform poorly in many situations. o Primary cause of antisocial and risk‐taking behavior (seek stimulation to boost low levels of arousal) ● Fearlessness: a theory that a person doesn’t get anxious at all; the person doesn’t have the anxieties that the rest of us might have; the person doesn’t respond to danger cues o Possess higher threshold for experiencing fear than most other individuals, gives rise to all other major features of the syndrome. ● Gray’s Model of Brain Functioning: o Behavioral Inhibition System (BIS )/Reward System (REW)BIS is responsible for ability to stop/slow down when we are faced with impending punishment, nonreward, or novel situations, reward system is responsible for how we behave (or approach to positive rewards) and is associated with hope and relief; imbalance between BIS and reward system make fear/anxiety less apparent and positive feelings more prominent. ● Interactive‐Integrative Theorie: link differences in neurotransmitter function and neurohormone function to genetic and environmental influences. 8. Know which words a person with borderline personality disorder is more likely to remember compared with other people. ● Words that might be relevant to the disorder, such abandon, suicidal, andemptiness. ● Example: When presented with words projected on a computer screen, individuals with borderline personality disorder are more likely than individuals without the disorders to remember the word “abandon”. 9. Recognize and understand Linehan’s Diathesis‐Stress model of borderline personality disorder. 12 PSY240 Exam #3 Study Guide Linehan's Diathesis‐Stress Model ● Biological vulnerability to emotional dysregulation ● Emotional dysregulation in the child ○ Great demands on the family ○ Parental invalidation, punishing, or ignoring reasonable demands ○ Child has emotional outbursts ○ Parents attend to outburst & reward child with attention that is negative & punitive ○ Vicious cycle ● Vulnerability → emotional dysregulation → high demands on family → parents invalidate with punishment → child has emotional outburst 10. Understand Barlow & Durand’s possible integration of the causes of borderline personality disorder. Barlow & Durand's Possible Integration: ● Biological vulnerability: ○ More emotionally reactive to stress ○ Have a tendency toward impulsivity ○ Interaction of impulsivity & stress reactions ● Psychological vulnerability: ○ View the world as threatening ○ Strongly react to perceived threats ● Specific experience ○ Traumatic childhood experience ● Biological vulnerability (emotion reactivity to stress, impulsivity) → psychological vulnerability (view world as threatening, react strongly to perceived threats) → specific experience (childhood sexual/physical abuse, immigration/other trauma) 11. Which treatment for borderline personality disorder seems to be effective? 1. Antidepressant medications 2. Linehan’s Dialectical Behavior Therapy:Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard psychological treatment for this 13 PSY240 Exam #3 Study Guide population. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post‐traumatic stress disorder (PTSD), and eating disorders. o Helping people cope with stressors that seem to trigger suicidal behaviors. o Therapist fully accept client. o Goals: ▪ Reduce self harm ▪ Stop splitting ▪ Moderate extreme emotions ▪ Tolerate distress ▪ Trust own emotions ▪ Individual Therapy: ● Identify stressors and feelings that lead to difficulties ● Teach how to stand apart from those feelings ● People have good & bad qualities simultaneously ▪ Group Therapy: ● Engage in social situations constructively 12. What’s up with antisocial and histrionic personality disorders? o ¿→Sex‐typed alternative expression? o Histrionic personality disorder: need to be center of attention; exaggerates, impulsive, vague, superficial speech, overdramatized, common diagnosis in females – irritated when not given attention. o Causes: little research, traditional psychodynamic theory [controlling parents → fear of abandonment] o Links with antisocial personality; can be comorbid depression. o 2/3rds of ppl qualifying for histrionic also qualify for antisocial personality disorder o Criterion bias: o Histrionic = extreme "stereotypical female" o Yet there is no "macho" disorder o Assessment bias o Decision bias 13. What special problem do therapists treating people with dependent personality disorder face? ● Caution that the patient will become dependent on therapist. 14. Why do people with narcissistic personality disorder become depressed? ● People with narcissistic personality are sensitive to personal criticism and often fail to live up to their own expectations, so they become depressed. 15. How are avoidant and schizoid personality disorders distinguished? ● People with schizoid personality disorder are indifferent, apathetic, affectively flat, and relatively uninterested in interpersonal relationships. o Can’t bring themselves to befriend anyone! ● People with avoidant personality disorder are sensitive and anxious to criticism, opinions, and rejections. o Don’t want to be friends with anyone! 16. How are avoidant and dependent personality disorders similar? ● Feelings of inadequacy, sensitivity to criticism, and need for reassurance (avoidant avoid relationships, dependent cling to relationships) ● Basically, both fear rejection that may have been caused by early parental rejection. 17. Which personality disorder most resembles social anxiety? Avoidant Personality Disorder 14 PSY240 Exam #3 Study Guide 18. What are the differences between obsessive‐compulsive personality disorder and obsessive‐compulsive disorder? ● Obsessive‐Compulsive Disorderis an anxiety disorder, rather than a personality disorder, where a person experiences recurrent obsessions and compulsions. ● Meanwhile, people with Obsessive‐Compulsive Personality Disorderare perfectionists and fixated on doing things the “right way”. 19. How does the alternative DSM 5 model of personality disorders differ from the traditional, “official” model? Criterion A: Impairment in overall personality functioning Elements of Personality Functioning: 1. Identity‐ clear boundaries, stable self esteem, accurate self‐appraisal, able to regulate wide range of emotions 2. Self directio‐ coherent & meaningful short‐term & life goals, constructive & pro‐social internal standard, able to self‐reflect Interpersonal functioning: 1. Empathy ‐ understands & appreciates others' motivation & experience, accepts others' point of view, understands how one's behavior affects others 2. Intimacy‐ has deep & enduring connection with others, capacity & desire for closeness, behavior shows regard for others Scaled: ● 0 = no impairment ● 1 = slight impairment ● 2 = moderate impairment ● 3 = severe impairment 2 or more of the 4 elements must be given a 2 or 3 to diagnose a personality disorder Criterion B: Pathological Personality Traits ● Negative Affectivity ‐ experiencing negative emotions frequently & intensely ● Detachment ‐ withdrawal from other ppl & emotion experience ● Antagonism ‐ put self at odds with other ppl (I.E. callousness or grandiosity) ● Disinhibition ‐ impulsive/immediate gratification w.o regard to consequences ● Psychoticism ‐ wide range of culturally weird behavior & cognition 6 specific personality disorders defined in terms of the 4 elements, 5 domains, & 25 facts: ● Antisocial (specify if psychopathic features) ● Avoidant ● Borderline ● Narcissistic ● Obsessive‐compulsive ● Schizotypal If criterion A met but person doesn't match any of the 6 disorders, diagnosed: ● Personality Disorder ‐ Trait Specified (PD‐ST) 15 PSY240 Exam #3 Study Guide Chapter 10‐ Sexual and Gender Identity Disorders 1. How consistent around the world are "normal" sexual practices? ● Not consistent at all! ● Sexual practices change everywhere based on culture, generation, and individuals. ● If it feels reasonable and enjoyable, then it’s “normal”. 2. In sexually permissive Sweden, how does the percent of women who use contraception the first time they have coitus compare with women in the USA? ● 73.7% of Swedish women use contraception their first time. ● 56.7% of American women use contraception their first time. ● This difference is very odd because Sweden is so sexually permissive! 3. Compare and contrast transsexual, and gender dysphoria disorder. Be able to recognize a description of someone who has gender dysphoria disorder. ● Transsexual: person feels trapped in the body of the wrong gender and/or strongly wants to assume the identity of other gender. o If there is NO distress, then it is referred to as transsexual. ● Gender dysphora disorder: person feels trapped in the body of the wrong gender and/or strongly wants to assume the identity of other gender, plus distress. o Strong incongruence btwn one's experienced gender & one's anatomic gender o Person feels trapped in the body of the wrong gender &/or strongly wants to assume identity of other gender ▪ If no distress, referred to as transsexual o Must distinguish from: ▪ Transvestic fetishism ‐ dressing as the other gender to feel sexually aroused ▪ Disorders of sexual development (growth disorders of reproductive parts) 4. What is currently the standard treatment for gender dysphoria disorder? Psychosocial treatment: attempts to increase adaptation, but it is ineffective. Passing as the Preferred Gender: 1‐2 years in opposite sex role ● Emotional stability in passing as new gender o Therapy at least a year ● Hormone therapy ● Surgery o Therapist must approve individual as a candidate for surgery o 2nd mental health assessment for approval of surgery 5. Given a brief description, be able to say what type of sexual disorders or paraphilias the person has. Or given a sexual disorder or paraphilia, be able to say what signs, symptoms and qualifiers are important. Also be able to recognize what is reasonably normal and not a disorder. ● Sexual Disorders: ‐ Female sexual interest/arousal disorder:woman with no or low interest in sex, unreceptive to sex, no or low sexual arousal or genital response ● No or reduced interest in sex, lack of erotic thoughts, lack of sexual response to erotic cues, lack of pleasure in sexual activities, lack of genital/bodily sensation ● Risk factors: negative attitudes about sex, diabetes, thyroid dysfunction, relationship problems, partner sexual dysfunction ‐ Genito‐pelvic pain/penetration disorder: difficult vaginal penetration, fearful of or actual vulvovaginal or pelvic pain during coitus or attempted coitus or strong tensing of vaginal floor muscles during attempted coitus ‐ Female orgasmic disorder:very delayed, rare, or absent orgasm or much less intense orgasm in woman ‐ Male hypoactive sexual desire disorder:few or no sexual thoughts or feelings of sexual desire in men ● Little or no interest in sexual activity and decreased frequency in masturbation, sexual fantasies and intercourse ● Risk factors: mood/anxiety disorders, alcohol use, endocrine disorder (ex: diabetes, hypothyroidism) ‐ Erectile disorde:difficulty in obtaining or maintaining a rigid erection more than 75% of sexual activity 16 PSY240 Exam #3 Study Guide ‐ Premature (early) ejaculatio: man ejaculates within 1 minute of beginning coitus and before he wants to more than 75% of occasions ‐ Delayed ejaculation:very delayed or no ejaculation more than 75% of partnered sexual activity ● Man's ejaculation is absent, infrequent, or greatly delayed ○ NOT retrograde ejaculation: orgasms with no excretion ● Paraphillic Disorder: To be a disorder: acts on urges or extremely distressed or impaired by urges ‐ Transvestic disorde:sexual arousal from cross‐dressing (only if causes distress, otherwise just transvestic fetish). Only applies to men. ‐ Voyeuristic disorde:sexual arousal from watching unexpected naked or disrobing person, or unsuspecting person having sex. Risk is necessary for arousal. ‐ Exhibitionist disord:sexual arousal from genital exposure to unsuspecting person. Urges or fantasies to expose one’s genitals to unsuspecting strangers. ‐ Fetishistic disord:sexual arousal from nonliving objects or extreme focus on non‐genital body parts ‐ Pedophilic disorde:sexual activity with a prepubescent child. Specify if incest only. ‐ Sexual masochism disorder:sexual arousal from being humiliated, hurt, or bound. Urges to suffer bondage, pain, or humiliation. ‐ Sexual sadism disorder:sexual arousal from the suffering of somebody else. Inflicting pain or humiliation.To be a disorder the person acts on these urges with a nonconsenting person or experiences extreme distress or impairment from them ‐ Frotteuristic DisorderSexual arousal or urges from fantasies of touching or rubbing against a non‐consenting person. 6. Which sexual disorder is most common in older men? Erectile Disorder 7. How common is comorbidity among sexual disorders? ● Very common (not certain, but fairly likely) ● If you have one, you’re likely to develop another one. 8. Know and fully comprehend the causes of the sexual disorders or paraphilias as they are currently understood. (For example, masturbation, myths, spectatoring, etc.) Sexual Dysfunctions Sociocultural: ● Media exposure, attitudes conveyed by peers, etc. ● Medical problems ● Relationship ● Medication ● Lifestyle ● Comorbidity: Having 1 sexual dysfunction can cause another sexual dysfunction ● Negative scripts ○ Thinking of all the things one shouldn’t be doing ○ Schemas or story's in one's mind of anticipations for how "things should go" ○ Expectations which harm sexual functioning ○ Erotophobia ■ Discomfort talking about sex ● Negative or traumatic experiences ● Poor interpersonal relationships ● Lack of communication Biological: ● Physical disease ● Medical illness ● Prescription medications ● Alcohol & drugs Psychological Contributions: ● Anxiety, depression, etc. ● Distraction ● Lack of information/misinformation ● Anxiety: ○ Excitement vs. evaluation 17 PSY240 Exam #3 Study Guide ○ Evaluation exasperated by: ■ Unrealistic standards/expectations ■ Spectatoring ■ Extreme/punitive focus on one's own sexual performance during intercourse *Sexual dysfunction is almost always due to more than one cause Paraphilias Inappropriate sexual associations: ● Often comorbid with anxiety, mood, & substance abuse disorders ● Inappropriate sexual associations ○ Possible inadequately developed consensual adult arousal patterns ○ Possible inadequately developed social skills for relating to adults ○ Possible high sex drive ○ Possible weak behavior inhibition system ○ Inappropriate fantasies repeatedly associated w. masturbation ■ Weak behavior inhibition ■ High sex drive ■ Attempts to inhibit undesired arousal & behavior creates anxiety ‐> arousal ■ Arousal is misattributed to the paraphilia ■ Resulting paraphilia 9. Know the basic strategies and techniques for successfully treating each of the sexual disorders and paraphilias. (For example, masturbation, orgasmic reconditioning, sensate focus, squeeze technique, etc.) Sexual Dysfunction Psychotherapeutic strategies: ● Give accurate information ● Guided exercise: ○ Body exploration ○ Masturbation ○ Sensate focus (partner exercise pairing off toucher & receiver of every body part) ■ Non‐genital exploration ■ Genital exploration ■ Non genital pleasuring ■ Simultaneous pleasuring Cognitive behavior therapy: ● Alter maladaptive thoughts & scripts ● Address non‐sexual psychological disorders (usually anxiety or depression) Couple counseling: ● Communication & conflict resolution ● Increase relationship positive behaviors Erectile Dysfunction ● Viagra, Levitra, Cialis ○ Combined with CBT ● Vasodilating drug injection ○ Papaverine or prostaglandin ● Penile prosthesis or implants ● Vascular surgery ● Vacuum device therapy Premature Ejaculation ● SSRIs ○ Disrupt sexual functioning ○ May interfere w. orgasming ■ Helps men last longer ○ Works around ~40% of the time Low Desire ● Some ppl take testosterone Female Sexual Dysfunctions ● Hypoactive sexual desire disorder medication ○ Very low success rate ○ Many side effects Paraphilias 18 PSY240 Exam #3 Study Guide Psychosocial interventions: ● Behavioral ● Target deviant & inappropriate sexual associations ● Covert sensitization ○ Vivid imagery of consequences & rejection/anger of others ○ Have client masturbate & then imagine vivid imageries of consequences when inappropriate arousals occur ● Orgasmic reconditioning ○ Replace inappropriate w. appropriate fantasies right before ejaculation & then work backwards all the way to arousal ● Family/marital therapy ● Coping ● Relapse prevention Efficacy: ● 70 ‐ 98% improve ● Poorest outcomes = rapists/multiple paraphilias ○ Chronic course ○ High relapse rates ● Prevention efforts: ○ CBT intervention Medications ● For dangerous sexual offenders: chemical castration ○ Inability to perform/function sexually while taking the drug ○ Must ensure medical compliance ■ Cypoterone acetate ■ Medroxyprogesterone acetate ■ Triptoretin ● Efficacy: ○ Greatly reduced desire, fantasy, arousal ○ Some few men able to still have sex while on drug ○ High relapse when discontinued 10. Roughly what percent of men with erectile dysfunction who take Viagra are able to maintain an erection sufficient for coitus? Why is Viagra a popular treatment choice? ● 61% of men are able to maintain an erection (works 50‐80% of the time) ● It is a population treatment because it is the least invasive and easiest to use. 11. What is erotophobia? What is an important consequence of having it? ● Erotophobia: sense of shame or anxiety about being a sexual person (can’t talk about it) ● Knowledge in the back of one's mind that it can be a pleasant experience, but: ● Interfering phobias, fears, complete avoidance of discussion about it o Harms sexual functioning o It can cause sexual dysfunction. o It can also result in bad communication, which results in bad sex and not using a condom. 12. How much physical force do adults who molest children typically use? ● Most child molesters are not physically abusive. o Typically induce children with endearment or gifts (ice cream cones, etc.) ● 50% use physical force 13. How successful are treatment procedures for paraphilias? ● Psychosocial treatments: o 70‐98% improve o But, rapists and multiple paraphilias have worst outcomes and highest relapse rates. ● Medication: o Greatly reduces desire, fantasy, and arousal o But, high relapse when discontinued. 19 PSY240 Exam #3 Study Guide Chapter 14‐ Neurodevelopmental Disorders 1. Understand the concept and implications of sequential skill development. ● Sequential skill development: any disruption in the development of early skills will, by the sequential process, disrupt the development of later skills. o Simply, you have to have one skill set before you can develop the next. ● Snowball effect of accumulating difficulties if developmental deficiencies are not addressed 2. Recognize and distinguish symptoms and difficulties for people with ADHD, learning disabilities, autistic spectrum disorder, and intellectual disability. ● ADHD :inattentive: hyperactive & impulsive, careless mistakes, can't sustain attention, doesn't seem to listen, starts tasks & quickly loses focus, difficulty organizing, loses things, distracted, forgetful. Hyperactive: fidgets, leaves seat inappropriately, feels restless, always revved up, answers, interrupts, difficulty waiting in linetalks excessively, blurts out. High comorbidity. ● Learning disabilities:deficit in learning & using academic skills not due to sensory difficulty. The skills are very below age‐level. Specify impairment in reading, written expression and/or mathematics o Performance substantially below expected levels based on: ▪ IQ ▪ Age ▪ Education o Based on synthesis of history, school reports, & psychological testing, child has: ▪ Difficulties learning & using academic skills ● Despite specific interventions targeting the difficulties o NOT due to: ▪ Sensory deficits ▪ Inadequate education ▪ Being a non‐native speaker of the school's language ▪ Neurological or another mental health disorder ● Autism Spectrum Disorder :deficits in communication & social interaction: social‐emotional reciprocity, nonverbal communication, developing/understanding relationships. Stereotyped, repetitive movements, inflexible routines, restricted, intense interests, hyper or hypo sensory reactivity o Impairment in social communication & interactions w. respect to age such as: ▪ Social‐emotional reciprocity problems ▪ Problems in nonverbal communication ▪ Problems with relationship fundamentals o Babies with ASD: ▪ Don't develop socially at the same pace ▪ Don't learn to smile, respond, follow eye contact at typical developmental stages o Restricted, repetitive patterns of interests or activities (at least 2): ▪ Stereotyped, repetitive movements (spinning, rocking, etc.) ▪ Inflexible adherence to routines or ritualized movements, extreme distress if changes ▪ Preoccupation w. unusual objects, perserverative interests ▪ Hyperreactivity or hyporeactivity to sensory stimuli, or indifference to pain or temperature extremes ● Intellectual disabilit:deficits in intellectual & adaptive functions. Typically IQ < 70 & limiting functioning in daily life ● Deficits in reasoning, problem solving, abstract thinking, planning, academic learning, learning from experience ● Deficits in adaptive functioning to meet developmental & cultural standards & social judgment ● Practical (difficulties managing personal care, hygiene, or job responsibilities) Below average intellectual functioning: ● Using individually administered, validated standardized tests: ○ Scoring 2 or more standard deviations below the mean ○ 70 or less on IQ 3. What happens with ADHD as a person grows into adulthood? 20 PSY240 Exam #3 Study Guide ● 50% still experience ADHD as adults ● Many adults have learned to compensate, but they still have it. o Inattention persists o Hyperactivity, impulsivity decline ● 90% of adults have high comorbidity. ● Lower level jobs ● 2.5 fewer years of education ● More likely to be divorced, have substance use problems, or antisocial personality disorder ● High risk behaviors 4. What has research shown about the affect of toxins and food additives on ADHD? ● There’s a controversial theory that food additives have been a cause of ADHD. ● But, toxins and food additives show no evidence of influencing or curing ADHD. ● No empirical evidence supporting claim 5. What type of medications are Ritalin and Cylert? What effect do they have on people with ADHD? ● Ritalin and Cylert are stimulants. ● Their effect on people with ADHD: increase arousal levels without outside sources to where they should be because people with ADHD don’t have enough dopamine. ● Idea that stimulants help bring body to baseline level of arousal & help patients focus ● Ritalin tends to wear off 6. What is “combined treatment” for ADHD and what have studies found about its efficacy compared with medication alone? ● “Combined Treatment” is a combination of medication and behavioral therapy. o Initial results stequivalent efficacy for combined and medication o.ly o For treatment beyond specific ADHD symptoms, combined showed slight advantag. 7. What are the causes of learning disorders? 1. Genetic and neurobiological contributio: familial component (polygenetic influence), cortical structure/activation 2. Psychosocial contributio: expectancies, child management practices ADHD Genetics most important influence: ● Copy number variants ‐ CNVs (pairs of genes) ● Dopamine ○ DRD4, DAT1, DRD5 genes ● Norepinephrine ● GABA ● Serotonin Neurobiological contributions: ● Slightly smaller brain volume ○ 3‐4% ● Executive function pr
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