Study Guide for Exam 4: Covers Chapters 14-17
Study Guide for Exam 4: Covers Chapters 14-17 2500
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This 20 page Study Guide was uploaded by Jenna Janssen on Tuesday March 1, 2016. The Study Guide belongs to 2500 at University of Denver taught by Dr. Jennifer Joy in Fall 2015. Since its upload, it has received 32 views. For similar materials see Abnormal Psychology in Psychlogy at University of Denver.
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Date Created: 03/01/16
▯ Chapters 14-15 Schizophrenia ▯ Psychosis Psychosis is a state of loss of contact with reality May be substance-induced or caused by brain injury, but most psychosis appears in the form of schizophrenia ▯ Schizophrenia 50x higher risk of attempting suicide 1 in 100 people in the world An increased risk of suicide and physical- often fatal- illness Appears in all socioeconomic groups, but is more frequent in the lower levels o Downward drift theory That it is not more prominent in lower socioeconomic groups, but that people in higher socioeconomic groups get it, and then fall down in socioeconomic group status. Equal numbers of men and women are diagnosed ▯ What are the symptoms of Schizophrenia? Symptoms can be grouped into three categories: o Positive symptoms- bizarre additions to a person’s behaviors Includes: Delusions Disordered thinking and speech Loose associations (derailment) Neologisms (made-up words) Perseveration (being stuck on a word or thought) Clang (rhymes) Heightened perceptions Hallucinations Inappropriate affect (inappropriate emotion, face doesn’t tell that it is suppose to be a joke) (flat affect) o Negative symptoms- “pathological deficits”, characteristics that are lacking in an individual Includes: Poverty of speech Restricted (flat) affect Loss of violation (loss of motivation or directedness) Social withdrawal o Psychomotor symptoms- Awkward movements Repeated grimaces Odd gestures These symptoms may take extreme forms, collectively called catatonia ▯ What is the course of Schizophrenia? Schizophrenia usually first appears between the late teens and mid- 30s Many sufferers seem to experience three phases: Prodromal, Active, Residual Each phase of the disorder may last for days or years. A fuller recovery from the disorder is more likely in people; o With good premorbid functioning o Whose disorder was triggered by stress o With abrupt onset o With later onset (during middle age) o Who receive early treatment ▯ Diagnosing Schizophrenia Symptoms of psychosis continue for 6 months or more Deterioration in their work, social relations, and ability to care for themselves o Type I Schizophrenia is dominated by positive symptoms o Type II Schizophrenia is dominated by negative symptoms ▯ How do theorists explain Schizophrenia? Biological explanations have received the most research support A diathesis-stress relationship may be at work Psychological perspective is explained by behavioral and cognitive stances. Biological views o The more closely related they are to the person with Schizophrenia, the greater their likelihood for developing Schizophrenia o Biochemical abnormalities Dopamine hypothesis This theory is based on the effectiveness of antipsychotic medications o Support for dopamine hypothesis Parkinson’s patients People who take high doses of amphetamines (which increase dopamine)- similar psychosis o Challenges to dopamine hypothesis Challenged by discovery of new type of antipsychotic drug (atypical); more effective than traditional antipsychotics Other studies suggest negative symptoms may be related to abnormal brain structure rather than excessive dopamine. o Viral problem Possible that biochemical and structural brain abnormalities seen in Schizophrenia result form exposure to viruses before birth. Psychological Views o The cognitive view Agree that biological factors produce symptoms Furthered by faulty interpretation and a misunderstanding of symptoms Research support is limited o The behavioral view Operant conditioning and reinforcement This view is considered (at best) a partial explanation. Sociocultural views o Sociocultural theorists believe that 3 main social forces contribute to Schizophrenia Multicultural factors Nature? Nurture? Although the overall prevalence is stable, the course and outcome of Schizophrenia differs between countries o Genetic differences from population to population? o Psychosocial environments of developing countries tend to be more supportive than developed countries? Social labeling People are what they are labeled as. Family dysfunction Double-blind ▯ Treatments for Schizophrenia and other severe mental disorders It is important to keep in mind that throughout much of the 20 th century, the label “Schizophrenia” was assigned to most people with psychosis 1950s: institutional approach’s o Milieu therapy The premise is that institutions can help patients make clinical progress by creating a social climate (“milieu”) that promotes productive activity, self-respect, and individual responsibility o Token economy Patients are awarded when they behave in socially acceptable ways and are not rewarded when they behave unacceptably. Not ethical- some people are unable to act “acceptably” o ANTIPSYCHOTIC DRUGS Phenothiazine Conventional antipsychotic drugs Research has shown that antipsychotic drugs reduce symptoms in at least 65% of patients diagnosed with Schizophrenia In addition to reducing psychotic symptoms, they sometimes produced disturbing movement problems Newer antipsychotic drugs o In recent years, new antipsychotic drugs have been developed o These new drugs are called ‘atypical’ because their biological operation o They do however have serious problems as well Carry risk of agranulocytosis, a life threatening drop in white blood cells Weight gain, dizziness, and significant elevations in blood sugar. Psychotherapy o Helping to relieve their thought and perceptual disturbances o The most helpful forms of psychotherapy include cognitive- behavioral therapy, and two broader sociocultural therapies: family therapy and social therapy Often combined o Cognitive behavioral- Seek to change how individuals view and react to their hallucinary experiences New-wave cognitive-behavioral therapies also help clients to accept their streams o Family Live with relatives = high levels of expressed emotion= at risk for relapse Attempts to address emotional and stress related issues, create more realistic expectations, and provide psych education about the disorder. o Social Practical advice, problem solving, decision making, social skills training, medication management, employment counseling, financial assistance, and housing Reduces hospitalization o New practices Music therapy Social skills training through therapy GUEST SPEAKER Dissociative Identity Disorder (DID): Characteristic and defining features Controversy o Is DID iatrogenically created? Whether it is created by a therapist, the media, or a friend o Is DID culture-bound (I.E. North America) o Are cases misdiagnosed other conditions? o Is DID more common than rare? o Is DID related to trauma? What is Dissociation? o Symptom/ phenomenology (continuum model) Continuum model (phenomenology based) Helps understand severity and proposes that pathological dissociation is merely a quantitative extension from non-pathological dissociation Fugue State = flight leave their old life and create a new life by developing new personality and identity and. o Process (breakdown in integrative functioning), corollary defense o Structure of the personality/ identity/ mind o Dissociative Disorders Dissociative Amnesia With or without fugue Depersonalization Disorder Dissociative Fugue With amnesia Dissociative Disorder NOS Other specialized dissociative disorders. Dissociative Identity Disorder (DID) Formerly known as multiple personality disorder, this disorder is characterized by alternating between multiple identities. A person may feel like one or more voices are trying to take control in their head. Often these identities may have unique names, characteristics, mannerisms and voices. People with DID will experience gaps in memory of every day events, personal information and trauma. Onset for the full disorder at can happen at any age, but it is more likely to occur in people who have experienced severe, ongoing trauma before the age of 5. Gender Women are more likely to be diagnosed, as they more frequently present with acute dissociative symptoms. Men are more likely to deny symptoms and trauma histories, and commonly exhibit more violent behavior, rather than amnesia or fugue states. This can lead to elevated false negative diagnosis. Core features of DID o The existence of 2 or more personalities/ identities that take recurrent control of behavior o Psychogenic amnesia for seemingly unforgettable autobiographical events DID Phenomenology o Amnesia o Depersonalization (e.g. body detachment) o Derealization (e.g. dream-like) o Identity Confusion o Identity alterations (e.g. alters) Other DID Characterizations o Prior treatments failures (=6 years) o Patient uses “we” o Notable changes in behavior DID aetiology o Childhoods trauma and abuse o Severe childhood sexual or physical abuse by a family member. o Abuse during developmental window (birth-7 or 8) o Environmental factors, especially family o Primary care-giver attachment-disorganized o Lack of support & nurturance following trauma. Chapter 16- Personality Disorders American Psycho Obsessive Compulsive Disorder Antisocial Personality Personality is a set of uniquely expressed characteristics that influence our behaviors, emotions, thoughts, and interactions. Flexible, allowing us to learn and adapt to new environments Personality Disorder An enduring, rigid pattern of inner experience and outward behavior that impairs sense of self, emotional experience, goals, and capacity for empathy and/or intimacy Comorbidity is common Classifying Personality Disorders Three groups or “clusters”” o Odd: Suspiciousness, withdrawal, isolation: Paranoid personality disorder Schizoid personality disorder Schizotypal personality disorder o Dramatic: problems with impulse control and emotional regulation Antisocial personality disorder Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder o Anxious: high level of anxiety, fear, and inadequacy. Avoidant personality disorder Dependent personality disorder Obsessive-Compulsive personality disorder Given the inadequacies of a categorical approach and the enthusiasm for a dimensional one, the DSM ODD Disorders: Suspiciousness, withdrawal, isolation: Paranoid Personality Disorder: o Defined: Deep distrust and suspicion of others Inaccurate, usually not delusional As a result of their mistrust, people with paranoid personality disorder often remain cold and distant. o How do theorists explain? Psychodynamic: demanding parents Cognitive: assumptions such as “People are evil and will attack you if given the chance” Biological: propose genetic causes/ twin studies o Treatments Do not think they need help Result= limited results and moves slowly Approaches: object relations, cognitive-behavioral, drugs Schizoid Personality Disorder: o Defined: Persistent avoidance of social relationships and limited emotional expression Do not have close ties with other people Genuinely prefer to be alone Focus mainly on themselves Often seen as flat, cold, humorless, or dull o How do theorists explain? Psychodynamic: unsatisfied need for human contact Cognitive: deficiencies in their thinking o Treatments: Cognitive-behavioral: attempt to increase positive emotions and satisfying social interactions Group therapy Schizotypal Personality Disorder o Defined: Range of interpersonal problems Extreme discomfort in close relationships Odd (even bizarre) ways of thinking Behavioral eccentricities Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitious, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations). o How do theorists explain? Symptoms resemble those of schizophrenia, so researchers believe the disorders are similar Family dysfunction High dopamine activity o Treatments: Help clients ‘reconnect’ and recognize the limit of their thinking and powers Cognitive-behavioral: teach clients to objectively evaluate their thoughts and perceptions and teach social skills training Antipsychotic drugs- reduce certain thought problems. DRAMATIC Disorders: problems with impulse control and emotional regulation Antisocial Personality Disorder o Defined: Sometimes described as “psychopaths” or “sociopaths”, people with antisocial personality disorder persistently disregard and violate others’ rights Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. Impulsivity or failure to plan ahead. Irritability and aggressiveness, as indicated by repeated physical fights or assaults. Reckless disregard for safety of self or others. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. Lack of remorse, as indicated by being indifferent to or rationalizing. o How do theorists explain? Psychodynamic: absence of parental love, leading to a lack of basic trust Behaviorist: modeling or unintentional reinforcement Cognitive: sufferers hold attitudes that trivialize the importance of other people’s needs Biological factors: low serotonin, low arousal o Treatments: Typically ineffective Lack of conscious or desire to change Some cognitive therapists try to guide clients to think about moral issues and the needs of other people. Borderline Personality Disorder o Defined: Great instability Major shifts in mood Unstable self-image Unstable interpersonal relationships Impulsivity Impulsive, self-destructive behavior can include: Alcohol and substance abuse Reckless behavior, including driving and unsafe sex Self-injurious or self-mutilation behavior Suicidal threats and actions. o How do theorists explain? Psychodynamic: fear of abandonment from early parental relationships; lack of early acceptance or abuse/ neglect by parents Biological: over o Treatments: Focuses on the patient’s central relationship disturbance, poor sense of self, and pervasive loneliness and emptiness Dialectical behavioral therapy (DBT) Particularly efficacious w/ patients with BPD Validate the patient’s behavior and beliefs while informing him that some of them are maladaptive Core skills include mindfulness, interpersonal communication, and tolerating emotions/ self-reflection Antidepressant, antibipolar, antianxiety, and antipsychotic drugs have helped some patients reduce their behaviors. Histrionic Personality Disorder o Defined: Extremely emotional Continually seek to be the center of attention Excessive need for approval and praise Often described as vain, self-centered, and demanding People with this disorder are often quite flirtatious or seductive, and like to dress in a manner that draws attention to them. They can be flamboyant and theatrical, exhibiting an exaggerated degree of emotional expression. Yet simultaneously, their emotional expression is vague, shallow, and lacking in detail. This gives them the appearance of being disingenuous and insincere. Moreover, the drama and exaggerated emotional expression often embarrasses friends and acquaintances as they may embrace even casual acquaintances with excessive ardor, or may sob uncontrollably over some minor sentimentality. o How do theorists explain? Psychodynamic: unhealthy child-parent relationships/ cold parents left them feeling unloved and afraid of abandonment Cognitive: lack of substance, extreme suggestibility Sociocultural and multicultural: society’s norms and expectations. o Treatments: Likely to seek treatment Working with them can be difficult because of their demands, tantrums, seductiveness, and attempts to please the therapist Cognitive: decrease helplessness, teach problem solving skills Psychodynamic therapy and group therapy help with their dependency. Narcissistic Personality Disorder o Defined: Generally grandiose Need much admiration Feel no empathy with others Exaggerate their achievements and talents Often appear arrogant. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements). Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high- status people (or institutions). Requires excessive admiration. Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations. Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others. Is often envious of others or believes that others are envious of him or her. Shows arrogant, haughty behaviors or attitudes. o How do theorists explain? Psychodynamic: cold, rejecting parents Cognitive-behavioral: people are treated too positively rather than too negatively in early life Sociocultural: “eras of narcissism” in society o Treatments: One of the most difficult to treat May come for a related disorder Try to manipulate the therapist None of the major treatment approaches have had much success. ANXIOUS Disorders: high level of anxiety, fear, and inadequacy. Avoidant Personality Disorder o Defined: Very uncomfortable and inhibited in social situations Overwhelmed by feelings of inadequacy Extremely sensitive to negative evaluation Often have few close friends o How do theorists explain? Similar to anxiety disorders, including Early trauma Conditioned fears Upsetting beliefs Biochemical abnormalities Psychodynamic: focus on shame Cognitive: harsh criticism and rejection in early childhood may lead people to assume their environment will always judge them harshly Behavioral- fail to develop normal social skills. o Treatments: Group therapy formats, with cognitive-behavioral principles, provide practice in social interactions Antianxiety and antidepressant drugs are also sometimes useful. Dependent Personality Disorder o Defined: Pervasive, excessive need to be taken care of Described as clinging and obedient Rely on others to make their decisions The central feature of the disorder is a difficulty with separation. o How do theorists explain? Behaviorists; unintentionally rewarded their children’s clinging and “loyal” behavior while punishing acts of “disobedience” Psychodynamic: explanations similar to those for depression Cognitive: two maladaptive attitudes “I am inadequate and helpless to deal with the world” “I must find a person to provide protection so I can cope” o Treatments: Treatment can be at least modestly helpful Psychodynamic therapy focuses on depression Cognitive-behavioral challenge feelings of helplessness and provide assertiveness training Antidepressant drugs when depression is present Group therapy can be helpful Support from peers Models of success. Obsessive-Compulsive Personality Disorder o Defined: So preoccupied with order, perfection, and control that they lose all flexibility, openness, and efficiency They set unreasonably high standards for themselves and others Rigid and stubborn Trouble expressing affection and their relationships. o How do theorists explain? Borrow heavily from those of obsessive- compulsive disorder, despite doubts concerning a link between the two Freudian theorists- anal regressive Cognitive theorists have little to say about the origins of the disorder, but they do propose that illogical thinking processes help maintain it. o Treatments: Do not usually believe there is anything wrong with them. Often appear to respond well to psychodynamic or cognitive therapy A number of clinicians report success with SSRIs (Selective serotonin reuptake inhibitors) Are there better ways to classify personality disorders? The leading criticism of DSM 5’s approach to personality disorders is that the classification system uses categories rather than dimensions of personality. FOR A LIST OF FLASHCARDS ON QUIZLET- Copy and past the link below: https://quizlet.com/124743212/psych-chapters-6-141516-flash-cards/
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