Psych Materials 121B
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This 31 page Study Guide was uploaded by Sieva Kozinsky on Monday September 15, 2014. The Study Guide belongs to 121B at University of California Santa Barbara taught by Jim simmon in Fall2014. Since its upload, it has received 213 views. For similar materials see Math in Math at University of California Santa Barbara.
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Date Created: 09/15/14
Anxiety Disorders Obsessive compuIsive Disorder 0 Persistent thoughts ideas impulses or images that seem to invade a person s consciousness When obsessions or compulsions feel excessive or unreasonable cause great distress take up much time or interfere with daily functions Usually begins by young adulthood and typically persists for many years Risk Factors 0 Children come to fear their own id impulses and use ego defense mechanisms to lessen the resulting anxiety 0 Behaviorists assume it happens randomly In a fearful situation one ma wash their hands and then they link improvements to that particular action People who do not ignore their intrinsic thoughts who are more depressed than other people who have exceptionally high standards of conduct and morality and have an inflated sense of responsibility in life and belief that their intrusive negative thoughts are equivalent to actions and capable of causing harm Signssymptoms compulsions repetitive behavior to ward off anxiety or an unwanted impulse 0 People with obsessions typically are quite aware that their thoughts are excessive 0 Excessive wishes repeated impulses images ideas rituals doubts Fear or dirt or contamination Compulsions seem to represent yield to obsessive doubts ideas etc Compulsions sometimes serve to help control obsessions as well Course There are a variety of views on OCD they are behavioral cognitive psychodynamic and biological The course is different based on each view More about it in Risk Factors Brains go into a loop and they can t get out Treatments 0 Exposure and response prevention or exposure and ritual prevention in which clients are repeatedly exposed to objects or situations that produce anxiety obsessive fears and compulsive behaviors and they are told to resist performing the behaviors they feel so bound to perform Individual and group formats Proven to improve considerably with this technique but it doesn t work on everyone Clinical therapy helps them to think about how they are having misinterpretations of thoughts A combination of behavioral and clinical works best For biological view antidepressant drugs that raise serotonin activity are a useful form of treatment Brain areas involved in OCD Biological researchers tied OCD to low serotonin activity and abnormal functioning in the orbitofrontal cortex and in the caudate nuclei The Basal Ganglia and Frontal Cortex are involved Over activity in the basal ganglia and frontal cortex This kind of brain problem desire for balance involves the basal ganglia The basal ganglia is part of the extraperamital nervous system We thought it had only to do with smooth movements but now we know that they play a role in smooth transitions in thinking PAN DAS Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections Seen in school aged children who develop strep throat or strep rash usually with fever and urinary incontinence OCD following strep infection Sudden onset of tic disorder or OCD signsymptoms most commonly handwashing and preoccupation with germs Rapid remission of symptoms usually occurs with antibiotic therapy PANDAS account for only a small of childhood OCD but may point to a possible mechanism involved in OCD autoimmunity neurotoxicitiy Infections may be a possible risk factor of OCD OCD Spectrum Disorders including Body Integrity Identity Disorder HOCD and nonpsychotic stalking Hoarding disorder a disorder in which individuals feel compelled to save items and experience significant distress if they try to discard them resulting in an excessive accumulation of items and possessions Hair pulling disorder A disorder in which people repeatedly pull out hair from their scalp eyebrows eyelashes or other parts of the body Also called trichotillomania Excortiation disorder a disorder in which people repeatedly pick at their skin resulting in significant sores or wounds Also called skinpicking disorder Body dysmorphic disorder a disorder in which individuals become preoccupied with the belief that they have certain defects or flaws in their physical appearance The perceived defects or flaws are imagined or greatly exaggerated From Text Addendum Body Integrity Identity Disorder BIID Risk factors Signssymptoms Course Prognosis Treatments Controversy Tourette s Syndrome signs symptoms position in OCD spectrum Stress Disorders Reactions to extreme Trauma Stress and arousal the fightorflight response Hypothalamus Intrustive recollections daytime flashbacks nightmares illusions and acute distress upon cues suggestive of the trauma Dissociative symptoms psychic numbing emotional detachment being in a daze dropping out of usual activities avoidance of topics related to trauma forgetting or fogginess re key aspects of trauma feeling that the current setting is not real derealization feeling detached from one s body depersonalization chronic hyperarousal you can t relax exaggerated startle insomnia hypervigilance motor restlessness lrritability and aggressiveness esp males 9Surviva guilt Acute Stress Disorder and PTS Acute Stress Disorder If the symptoms begin within 4 weeks of the traumatic event and last for less than a month PTS9 If the symptoms continue longer than a month Symptoms for both include reexperiencing the traumatic event avoiding activities related thoughts and conversations about the event reduced responsiveness detachment from other people feeling dazed derealization etc and increased arousal negative emotions and guilt Unlike anxiety disorders that are triggered typically by situations that most people would not find threatening the situations that cause acute stress disorder and PTSD combat rape earthquake an airplane crash would be traumatic for anyone Risk factors Can occur at any age even in childhood May also experience depression other anxiety disorders suicidal thoughts and substance abuse with this disorder Women are at least twice as likely as men to develop stress disorders around People with low incomes are twice as likely as people with higher incomes to experience one of the stress disorders Any traumatic event can trigger a stress disorder however some are particularly likely to do so Among the most common are combat disasters and abuse and victimization Biological and Genetic Factors Personality 0 Childhood Experiences Social Support Multicultural Factors Severity of Trauma Treatment 0 Half of cases improve in 6 months Treatment varies trauma to trauma Drug therapy behavioral exposure techniques possibly more look in notes Critical incident stress Debriefing Basic Steps 0 Fact phase Ask victims to tell their story 0 Reaction phase Ask victims to report their thoughts and feelings about the incident Symptom phase Solicit symptomatology and suggest coping strategies Teaching phase Educate victim regarding traumas and typical reactions to trauma Reentry phase Wrapup answer Q s provide referrals develop plan of ac on Dissociative Disorders and see Question ll Nature of dissociation typical manifestations of dissociation 0 One part of the person s memory or identity seems to be dissociated or separated from the rest When change in memory or identity is significant and lacks a clear physical cause it s a dissociative disorder Many clinicians believe they are rare Possible relationship of anxiety to dissociative disorders Normal 9 Anxiety 9 Dissociation 0 May dissociate during a fight I don t know I don t want to talk about it I can t handle it It is in some ways very normal but it can be very dysfunctional 0 People can differ in their ease of dissociation Experiences of depersonalization and derealization Transient depersonalization and derealization reactions are fairly common One third of all people say they on occasion feel like they were watching themselves in a movie Also 13 of people who confront a lifethreatening danger experience feelings of depersonalization or derealization People sometimes have feelings of depersonalization after practicing meditation and individuals who travel new places often report a temporary sense of depersonalization Young children may also experience depersonalization from time to time when they are developing their capacity for selfawareness In most cases individuals are able to compensate for the distortion and continue to function with reasonable effectiveness until the temporary episode eventually ends Typical signssymptoms and the course of each Dissociative Amnesia People are unable to recall important information usually of an upsetting nature about their lives The loss of memory is much more extensive than normal forgetting and is not caused by physical factors Often triggered by an upsetting event but can be triggered under more normal circumstances loss of a loved one through rejection or death or guilt over certain actions Ex husband s wife dies in a boat accident he goes to funeral talks to people and a few days later doesn t remember anything after the boat accident no funeral no people etc May be localized selective generalized or continuous Generalized not being able to remember events that occurred earlier in life in addition to the past few days In extreme cases people may not remember who they are or fail to recognize relatives and friends Selective the second most common form remembering some but not all the events that occurred during a period of time Ex remembering certain conversations but not the event Localized the most common type which the person loses all memory of events that took place within a limited period of time almost always beginning with some very disturbing occurrence Continuous forgetting continues into the present A person may forget new and ongoing experiences as well as what they forget about the tragedy This kind is rare in dissociative amnesia Dissociative Amnesia wfugue An extreme version of dissociative amnesia where persons not only forget their personal identities and details of their past lives but also flee to an entirely different location Some fugues are brief a few days while others may last travel far from home take a new name and establish a new identity new relationships and even a new line of work Only 02 of the population suffer from dissociative fugue some adolescent runaways Usually affects personal memories rather than encyclopedic knowledge Fugues tend to end abruptly and in some cases people awaken in a strange lace surrounded by unfamiliar faces with their last memories being right before they ran away The majority of people who experience this regain all their lost memories and never have a recurrence Depersonalizationl derealization disorder Persistent episodes of depersonalization the sense one s own mental functioning or body are unreal or detached or surroundings are unreal or detached People feel they have become separated form their body are are observing themselves from outside They often feel like their minds are floating a few feet above them Derealization objects may seem to change shape or size other persons may seem removed mechanical or even dead The symptoms of this disorder are persistent or recurrent cause considerable distress and may impair social relationships and job performance It occurs most frequently in adolescents and young adults hardly ever in people over 40 It usually comes on suddenly and is triggered by extreme fatigue physical pain intense stress or recovery from substance abuse People most vulnerable are those caught in lifethreatening situations Dissociative identity disorder AKA multiple personality disorder When a person develops two or more distinct personalities often called subpersonalities or alternate personalities At any given time one of the subpersonalities dominates the person s functioning Usually switching between personalities is sudden and dramatic twisting face growling cussing Many clinicians consider it rare but it may be more common than thought Symptoms begin in early childhood after episodes of abuse Women 3x as likely to have it than men POSSIBLY HOW DO SUBPERSONALITIES INTERACT AND DIFFER Predominant explanation of DID Psychodynamic view dissociative disorders caused by repression It is the most basic ego defense mechanism people fight off anxiety by unconsciously preventing painful memories thouhts or impulse from reaching awareness Behavioral View StateDependent Learning SelfHypnosis View of DID as an iatrogenic illness It is argued that many or all cases of DID are iatrogenic They believe therapists create this disorder by subtly suggesting the existence of other personalities during therapy or by explicitly asking a patient to produce different personalities while under hypnosis A therapist who is looking for multiple personalities may reinforce these patterns by displaying greater interest when a patient displays symptoms of dissociation These arguments are supported by the fact that many cases of dissociative identity disorder first come to attention while the person is already in treatment or a less serious problem But not is always true some people seek treatment because they have noticed time lapses throughout their lives or because relative and friends have observed their subpersonalities False Memory Syndrome and Memory Recovery Movement Sometimes memories may just be illusions or false images created by a mind that is confused Memory is often flawed but memories of child abuse are often Powerful case of suggestibility causes some therapists to make diagnosis without enough evidence Certain therapists use specific recovery techniques Perhaps repeating stories may make them believe what they came up with For biological reasons some people may be prone to false memories more than others Either of childhood abuse or other kinds of events Experts who question do not deny the stories but they recognize the problem of childhood abuse is all too real Preferred Treatments for DID People with DID do not typically recover without treatment Treatment for this pattern is complex and difficult much like the disorder Therapists usually try to help clients 1 Recognize fully their nature of their disorder 2 Recover the gaps in their memory and 3 Integrate their subpersonalities into one functional personality Sometimes personalities are introduced to each other through hypnosis or group therapy may help Psychodynamic therapy hypnotherapy and drug treatment It works slowly though because some subpersonalties may keep denying experiences others recall or one may become the protector Integration is a continuous process Onces the subpersonalities are integrated further therapy is typically needed to maintain the complete personality Personality Disorders see question ll Typical signs and symptoms for each type of personality disorder Cluster A Odd eccentric where people have always been socially somewhat withdrawn Some research suggests that these are weak forms of schizophrenia Paranoid PD hypervigilent distrustful they overlap so much that clinicians find it difficult to distinguish one disorder from another Schizoid PD hypervigilant distrustful removed from social relationships and demonstrate littler in the way of emotion they like to be alone loners Schizotypal PD discomfort in relationships anxious around others seek isolation feel intensely lonely sometimes often bland and indifferent or unmotivated Some people think they have extrasensory abilities Similar to schizophrenia Cluster B Dramatic emotional unstable Histrionic PD drama queenking extremely emotional Narcissistic PD grandiose need admiration feel no empathy with others Antisocial PD often described as psychopaths or sociopaths most closely linked to adult criminal behavior kids with conduct disorder and ADHD are more likely to develop it Borderline PD major shifts in mood great instability impulsivity unstable selfimage very depressive anxious irritable states hurting themselves Cluster C Anxious apprehensive Avoidant PD very uncomfortable and inhibited in social situations overwhelmed by feelings of inadequacy extremely sensitive to negative evaluation fearful of being rejected Dependent PD always clinging onto someone but person may not reciprocate this Must consult people before all decisions pervasive and excessive need to be taken care of obedient ObsessiveCompulsive PD everything must be done to perfection these people are huge procrastinators they lose all flexibility openness and efficiency tend to be rigid and stubborn General personality disorder treatment Symptomatic treatment Paranoid PD they do not typically see themselves needing help so therapy for this has little effect and moves very slowly Object relations therapists try and see past patient s anger and work on what they view as satisfying relationships Selftherapists focus on need for healthy and unified selftry and help clients reestablish sef cohesion Integrated cognitivebehavioral approach also by helping individuals master anxietyyO reduction techniques improve skills at solving problems develop more realistic interpretations of other people s words and actions and become more aware of other people s points of view Drug therapy offers limited help Schizoid PD presenting clients with a list of emotions to think about or having them write down and remember pleasurable experiences Also teaching social skills to such clients using roleplaying exposure techniques and homework assignments as tools Group therapy is useful when it offers a safe setting for social contact although they may resist pressure to take part Drug therapy offers limited help Schizotypal PD therapists agree on need to help clients reconnect with the world and recognize the limits of their thinking and powers Therapists try and set clear limits and work on helping clients recognize where their views end and those of the therapist begin Also goals are increase positive social contacts ease loneliness reduce overstimulation and help individuals become more aware of their personal feelings Cognitive and behavioral techniques include ingoring inappropriate perceptions speech lessons social skills training tips on appropriate dress and manners blending better in public Antipsychotic drugs have been given to people with Schizotypal in low doses Antisocial PD typically ineffective treatments individuals lack of conscience and desire to change makes it hard Most in therapy have been forced to participate Some therapists try and get them to think about moral issues and needs of other people Hospitals try to create an environment that teaches responsibility toward others Most people do not respond to treatment Sometimes psychotropic medications are used and can reduce certain features of disorder Borderline PD psychotherapy can lead to some improvement It s difficult for the therapist however to find a balance between empathizing with the dependency and anger and challenging their ways of thinking Clients may have difficulty tolerating interpretations because they experience them as attacks Most effective therapy is contemporary psychodynamic in which therapists take a more supportive and egalitarian posture DBT dialectical behavior therapy Drug therapy is controversial because many with borderline disorder will try and commit suicide Histrionic PD Cognitive therapists try and help them change their belief that they are helpless and also try to develop better ways of thinking and solving problems Try to help them find inner satisfaction Problem is they are likely to deploy through demands and tantrums Or they may pretend things to please the therapist Drug therapy unsuccessful unless a patient is depressed then it may help that Narcissistic PD Psychodynamic therapists seek to help people recognize and work through their basic insecurities and defense cognitive therapists redirect cient s focus onto opinions of others and increase ability to empathize People are unable to acknowledge weaknesses or appreciate the effect of their behavior on others making it hard to treat No approach has clear success Avoidant PD they often come to therapy in search of acceptance and affection Often they distrust the therapist s sincerity however A key task is to gain their trust Therapists tend to treat people with this disorder like they treat people with social anxiety disorder and other anxiety disorders They may try to resolve unconscious conflicts distressing beliefs and thoughts and provide social skills training as well as exposure treatments Group therapy can also provide practice Antianxiety and antidepressant drugs are sometimes useful in reducing the social anxiety of people with this disorder although when medication is stopped symptoms may occur Dependent PD Clinicians try and help the clients to take control of their lives The therapists often provide assertiveness training to help the individuals better express their own wishes in relationships Cognitive therapists try and help clients challenge and change their assumptions of incompetence and helplessness Usually place all responsibility for treatment and well being on the clinician Antidepressant drug therapy has been helpful for people with depression along with the personality disorder Obsessive Compulsive PD They do not usually believe anything is wrong with them They often respond well to psychodynamic treatment or cognitive therapy where therapists try and help them recognize experience and accept their underlying feelings and insecurities and take risks or focus on helping the clients to change their all or nothing thinking perfectionism indecisiveness and chronic worrying OCD personality disorder respond well to SSRl s like those with OCD For borderline personality disorder also know Risk Factors early parental relationships early lack of acceptance early sexual abuse overly reactive amygdala underactive prefrontal cortex lower brain serotonin activity for those that are aggressive Etiological Hypotheses page 491 Selfmutilation and dissociation They are prone to bouts of anger which sometimes result in physical aggression and violence Just as often they inflict their anger inwardly on themselves Many feel troubled by deep feelings of emptiness Many of the patients who go to mental health emergency rooms are individuals with this disorder who have intentionally hurt themselves Their impulsive selfdestructive activities may range from alcohol and substance abuse to delinquency unsafe sex and reckless driving Many engage in so called selfinjurious behaviors such as cutting or burning themselves of banging their heads Those with this disorder often believe physical discomfort offers relief from their emotional suffering It may serve as a distraction from their emotional or interpersonal upsets Snapping them out of an emotional overload Scars and bruises may also provide the individuals with a kind of documentation or concrete evidence of their emotional distress Many try to hurt themselves as a way of dealing with their chronic feelings of emptiness boredom and identity confusion Transient psychotic episodes and Splitting SCHIZOPHRENIA and see question ll Dementia Praecox Emile Kraepalin thought that schizophrenia was a type of premature dementia dementia praecox it is now known that schizophrenia is not dementia General Manifestations Prodromal Phase symptoms not yet obvious individual is beginning to deteriorate May withdraw socially speak in vague or odd ways develop strange ideas or express little emotion Active phase symptoms become apparent This phase can be caused by stress or trauma in person s life 0 Generally 0 Loss of previous level of functioning o Disturbance of language and communication 0 formal thought disorder altered thought boundaries thought broadcasting insertion removal hallucinations usually auditory delusional experiences delusional beliefs Disordered emotionally flat paranoid or silly effect Disturbances of the will Social withdrawal and autistic thinking Motor abnormalities Reduced spontaneity or Bizarre or stereotypical gestures and postures OOOO Residual phase return to a prodromal like level of functioning Symptoms of active phase lessen but some negative symptoms such as blunted emotions remain Phases can last days or years Risk Factors Genetic predisposition 0 Some believe that people inherit a biological predisposition to schizophrenia and develop the disorder later when they face extreme stress usually during late adolescence or early adu hood o Schizophrenia is more common among relatives of people with this disorder However this could be because close family members are often exposed to similar environmental influences 0 identical twins have much higher chance of being concordant for schizophrenia while fraternal twins have a lower chance Factors other than genetics may explain this Ex virus infection injury Both twins are likely to be exposed to the same dangers 0 Adoption studies biological relatives of adoptees with schizophrenia are more likely than their adoptive relatives to experience schizophrenia or a schizophrenialike disorder Abnormal brain structure o Many people with schizophrenia have enlarged ventricles brain cavities that contain cerebrospinal fluid o Linked especially to cases dominated by negative symptoms Viral Problems 0 Exposure to viruses before birth viruses could enter fetus brain and interrupt proper brain development or perhaps viruses remain quiet until puberty or young adulthood They are then activated by changes in hormones or by another viral infection and help bring about schizophrenic symptoms 0 Other infectious agents that may be involved Rubella german measles Maternal exposure to influenza virus Toxoplamosis spores greater prevalence of cat ownership among parents of schizophrenics Endogenous retroviruses eg herpes simplex ll Birth complications Maternal malnutrition Old sperm 0 The older the father s sperm the more likely to have a schizophrenic child Seasonality effects in schizophrenic births Unusually large numbers of people with schizophrenia were born in the winter MZ twin types and implications 0 Monochorionic twins two twins same placenta Dichorionic twins two placentas Occurs when zygote splits earlier 0 Monochorionic twins have a much higher concordance rate Exposed to same environment Marijuana and psychotogenicity Use of marijuana can increase risk of schizophrenia More frequent usage higher risk especially at younger age Risk is enhanced with certain genotypes DSMIV Classical schizophrenia subtypes and problems Disorganizedhebephrenic Catatonic Undifferentiated Paranoid 0 Residual Problems o Individuals can change subtypes over time o Subtypes may instead reflect course and intensity of illness 0 Treatment not specific to subtypes Positive vs Negative signssymptoms of schizophrenia range of symptoms 0 Positive symptoms pathological excesses or bizarre additions to a person s behavior 0 Most often found 0 Delusions ideas that they believe whole heartedly but have no basis in fact 0 Delusions of persecution most common in schizophrenia believe that they are being plotted or discriminated against spied on threatened attacked etc o Delusions of reference attach special and personal meaningto the actions of others or to various objects or events 0 Delusions of grandeur believe themselves to be great inventors religious saviors or other specially empowered persons 0 Delusions of control believe their feelings thoughts and actions are being controlled by other people Disorganized thinking and speech schizophrenics may not be able to think logically and may speak in peculiar ways 0 Formal thought disorders cause sufferer great confusion and make communication very difficult 0 Loose associations rapidly shift from one topic to another 0 Neologisms made up words that only have meaning to the person using them o Perseveration repeat words and statements over and over again 0 Clang rhyming to express themselves Heightened perceptions and hallucinations 0 Person may feel that all the sights and sounds that surround them are flooding their senses o Auditory hallucinations most common kind in schizophrenia 0 Hear sounds and voices that seem to come outside their heads Voices may talk directly to the hallucinatory perhaps giving commands or warnings or may be experienced as overheard Inappropriate affect emotions that are unsuited to the situation Ex smiling when making a somber statement Negative symptoms pathological deficits characteristics that are lacking in an individual Poverty of speech alogia reduction in speech or speech content Some think and say very little but others say quite a bit but are unable to convey much meaning Restricted affect blunted affect They show less anger sadness joy and other feelings than most people Some show almost no emotions at all a condition known as flatt affect o This may be caused by anhedonia lack of pleasure and enjoyment o Other cases the restricted affect may reflect an inability to express emotions as others do still feel the emotions but don t express them Loss of volition avolition apathy feeling drained of energy and of interest in normal goals Unable to start or follow through on a course of action 0 Many display ambivalence conflicting feelings about most things Social withdrawal attend only to their own ideas and fantasies which are illogical and confused Breakdown of social skills Differences in Positive type 1 vs negative symptompredominant type II schizophrenias People with type one display more positive symptoms people with type II display more negative symptoms Typel 0 Later age of diagnosis age 2025 0 Females gt males 0 Better prognosis o Dopamine abnormalities dopamine is overactive o Responds to classical antipsychotic meds 0 Less chance of observable brain damage Type II 0 Earlier age of diagnosis 1618 Males gt females Worse prognosis No Dopamine abnormalities Poor response to classical antipsychotic meds Greater chance of observable brain damage OOOOO Classicalatypical antipsychotic medications effects side effects major classes of medications Classical antipsychotics treat mainly positive symptoms 0 Include Thorazine Haldol Stelazine Prolixin Atypical 2 39 generation antipsychotics treat both positive and negative symptoms 0 Include Abilify Zyprexa Clorazil lnvega Risperdal Seroquel Geodon 0 Side effects of antipsychotic meds Drowsiness sedation Metabolic syndrome Weight gain esp in abdomen 0 Elevated blood lipids cholesterol and triglycerides Diabetes Motor side effects greater with classical antipsychotics like thorazine and Haldol Akathisia cruel restlessness eg rocking thorazine shuffe Acute dystonias lock jaw oculogyric crisis Pseudoparkinsonism o Resting tremor o Slowness of movements 0 Muscular rigidity Tardive dyskinesia rare with 2 generation medications 0 Early rabbit sign 0 Eventually tongue and limb writhing 0 Does not unfold until after a person has taken conventional antipsychotic drugs for more than a year Advantages of atypical antipsychotic medications Appear to be more effective than the conventional drugs Reduce both positive and negative symptoms Cause fewer extrapyramidal symptoms and seem less likely to produce tardive dyskinesia First line of treatment for schizophrenia Role of psychotherapy in schizophrenia 0 Before antipsychotic drugs psychotherapy was not an option for people with schizophrenia because they were so removed from reality Antipsychotic drugs now help people to learn about their disorder participate actively in therapy think more clearly about themselves and their relationships make changes in their behavior and cope with stressors Two most helpful forms of therapy 0 Cognitive behavioral therapy 0 O O Seeks to change how individuals view and react toward their hallucinatory experiences Patient learns how to monitor which kinds of events and situations trigger the voices in their heads Therapists challenge cient s ideas about the power of the hallucinations Clients begin to adopt and apply idea that it s not a real voice it s my illness Teach clients techniques for coping with unpleasant sensations Does not eliminate hallucinations allows patient to accept negative thoughts as harmless events of the mind 0 Family Therapy 0 O O 0 Many people suffering from schizophrenia live with their families Creates special pressures Persons who feel positively toward relatives do better in treatment Family therapy provides family members with guidance training practical advice pscyhoeducation about the disorder and emotional support and empathy Relatives develop more realistic expectations and become more tolerant less guilt ridden and more willing to try new patterns of communication Also helps the person with schizophrenia cope with pressures of family life make better use of family members and avoid troublesome interactions Social Therapy 0 Offers practical advice work with clients on problem solving decision making social skills makes sure that clients are taking medications properly and may even help them find work financial assistance appropriate health care and proper housing 0 Helps keep people out of the hospital Compliance Rates with antipsychotic medications 0 Patients often dislike the powerful effects of the drugs both intended effects and side effects and some refuse to take them Motor and Metabolic Side effects of antipsychotic medication 0 Extrapyrimidal effects appear to be caused by the drugs impact on the extrapyramidal areas of the brain areas that help control motor activity These undesired effects include Parkinsonian and related symptoms neuroleptic malignant syndrome and tardive dyskinesia Parkinsonian and related symptoms 0 OOOO 0 Reactions that closely resemble the features of the neurological disorder Parkinson s Disease Resting tremor Slowness of movements Muscular rigidity Half of the patients that take conventional antipsychotic drugs experience muscle tremors and rigidity at some point in their treatment Result of medication induced reductions of dopamine activity in the basal ganglia and the substantia nigra Neuroleptic Malignant Syndrome O O 1 of patients particularly elderly ones experience neuroleptic malignant syndrome neuroleptic malignant syndrome a severe potentially fatal reaction consisting of muscle rigidity fever altered consciousness and improper functioning of the autonomic nervous system Tardive Dyskinesia O 0 Does not unfold until after a person has taken conventional antipsychotic medication for more than a year Includes involuntary writhing or ticlike movements of the tongue mouth face or whole body involuntary chewing sucking and lip smacking and jerky movements of the arms legs or entire body Sometimes accompanied by memory difficulties Most cases are mild and involve only a single symptom Can be very difficult to eliminate More than 10 of people who take conventional of people who take conventional antipsychotic drugs for an extended time develop tardive dyskinesia Other side effects Drowsiness sedation Metabolic syndrome weight gain esp in abdomen elevated blood lipids cholesterol and triglycerides diabetes blood glucose dysregulation Acute dystonias lock jaw oculogyric crisis Other disorders often treated with antipsychotic medications Major depression Bipolar disorder several antipsychotic medications such as ability and are approved for both schizophrenia and bipolar disorder 0 Paranoid schizoid and schizotypal personality disorders Borderline personality disorder Acute and post traumatic stress disorder Anxiety with psychotic features eg brief psychotic episodes depersonalizationderealization disorder drug related pscyho Worldwide trends in schizophrenia incidence and possible causes World wide incidence of schizophrenia appears to be declining perhaps due to better infant nutrition and childbirth methods rule of thirds and newer outcome estimates in schizophrenia 13 improve 13 stay the same 13 deteriorate 0 Now outlook is considered more dismal On a 30 year followup o 20 show good adjustment 0 35 show fair adjustment 0 45 incapacitated Prognosis worse for negative symptom schizophrenia EATING DISORDERS and see Question ll Prevalence as a function of sex and Westernization and explanations Overwhelmingly female disorder 0 Men more likely to be obese less likely to care 0 Mass media emphasizes dieting and body shape in women s magazines fitness and body building in men s magazines 0 Men in sports that emphasize thinness or weight control or in competitive body building rather than agility or strength show rates of disordered eating comparable to females 0 Gay men appear to have elevated rates of eating disorders Overwhelmingly found in western countries 0 Apparently related to Western cultural conceptions about food and femininity Increasing in nonWestern countries as they Westernize 0 As cultures Westernize more females join workforce o Thinness replaces obesity as a sign of wealth and status 0 In several studies of nonwestern cultures disordered eating attitudes have been associated with exposure to television Types of Males Who are especially susceptible to eating disorders See above Eating disorders be able to define or identify from brief case descriptions Effectiveness of dieting as a weight loss method 95 of diets fail as a means of weight loss They can produce transient weight loss but the weight is almost always quickly regained and more The only effective long term weight loss method is a lifelong pattern of healthy food selection meal planning good sleep and consistent exercise Anorexia Nervosa Nature of Body Distortion 0 People with anorexia usually have a low opinion of their body shape and consider themselves unattractive Likely to overestimate their actual proportions Most women in western society overestimate their body size Susceptible Populations Disorder can appear at any age but the peak age of onset is between 14 and 18 0 May be more frequent in women athletes and dancers ballet 0 Runs in families 0 MZDZ concordance rates 44 vs 12 o Relatives of family members with anorexia nervosa have a 1012x chance of developing the disorder themselves Altered Eating Habits Obsessive thinking about food spend considerable time thinking about and planning meals Establishing irrational rules about food Food rituals 2 of all anorexics binge and purge although binges are usually small and the purging is most often via excessive exercise Two P s of Anorexia Powerlessness Perfectionism if I can control my body then I can have a perfect body and a perfect life How anorexia nervosa is treated and typical treatment outcome 0 immediate aims of treatment are to help individuals regain their lost weight recover from malnourishment and eat normally again Requires individuals to make psychological and perhaps family changes to lock in those gains 0 Several treatment methods to help anorexia patients gain weight quickly Life threatening cases clinicians may need to force tube and intravenous feedings on a patient who refuses to eat May breed distrust in the patient Behavioral weight restoration approaches clinicians use rewards whenever patients eat properly or gain weight No rewards when they eat improperly or fail to gain weight Most popular weight restoration technique of recent years combination of supportive nursing care nutritional counseling and a relatively high calorie diet Diet is gradually increased to more than 3000 calories a day Patients must overcome underlying psychological problems to achieve lasting improvement 0 Cognitive behavioral therapy designed to help clients appreciate and alter the behaviors and thought processes that keep restrictive eating going Behavioral side clients required to monitor feelings hunger levels and food intake and the ties between these variables Taught ways of coping with stress and solving problems Changing Family interactions Family therapy therapist meets with family as a whole points out troublesome family patterns and helps members make appropriate changes As many as 90 of patients continue to show improvement either full or partial when interviewed several years later Death rate from anorexia seems to be falling However as many as 25 of persons with anorexia nervosa remain seriously troubled for years Recovery is not always permanent anorexic behavior recurs in at least 13 of recovered patients usually triggered by new stresses 0 About half of those with anorexia nervosa continue to experience emotional problems particularly depression obsessiveness and social anxiety years after treatment commonly in those who had not succeeded in reaching a fully normal weight by the end of treatment The more weight the person had lost and the more time that had passed before they entered treatment the poorer the recovery rate Individuals with psychological or sexual problems before the onset of the disorder tend to have a poorer recovery rate than those without such a history Teenagers have a better recovery rate than older patients Bulimia Nervosa Susceptible Populations Adolescents and young adults 90 females Peak ages 1519 in females 1826 in males College students point prevalence of bulimia nervosa may be 10 or higher High prevalence may be due to the freshman 15 Types of Compensatory behavior among bulimics After binge eating try to compensate and undo its effects Many resort to vomiting but vomiting actually fails to prevent the absorption of half the calories consumed during a binge Use of laxatives and diuretics Using enemas diet pills or drugs to reduce fluids Severe dieting excessive exercise or both Some patients follow bingeing only with fasting and exercise Bodily damage suffered in bulimia nervosa Most is due to repeated vomiting Rupture of stomach or esophagus Heard damage from loss of electrolytes mainly potassium Erosion of teeth gums and fingernails Broken blood vessels in the eyes Swollen salivary glands chipmunk faces Menstrual irregularities and higher risk of pregnancy complications Also associated with High rates of ETOH and or drug abuse Smoking to maintain weight Other impulsive behavior sexual promiscuity cutting kleptomania How bulimia nervosa is treated and typical treatment outcome Cognitive behavioral therapy 0 Patients keep diaries of eating behavior changes in sensations of hunger and fullness and the ebb and flow of other feelings o Helps clients observe eating patterns more objectively and recognize the emotions and situations that trigger their desire to binge 0 Reinforcement and encouragement for the treatment goals they had been able to achieve that day 0 Exposure and response prevention consists of exposing people to situations that would ordinarily raise anxiety and then preventing them from performing their usual compulsive responses until they learn that the situations are actually harmless and their compulsive acts unnecessary o Therapists teach individuals to identify and challenge the negative thoughts that precede urge to binge Ex I look fat I have no self control 0 Guide clients to recognize question and eventually change their perfectionistic standards sense of helplessness and low self concept 0 Other forms of psychotherapy o Interpersonal psychotherapy seeks to improve interpersonal functioning o Psychodynamic therapy 0 These various forms of psychotherapy are often supplemented by family therapy Antidepressantmedication 0 Sometimes used to help treat bulimia o Helped considerably by these drugs in contrast to anorexics 0 Help as many as 40 of patients reducing binges and vomiting 0 Works best in combination of with other forms of therapy Outcome 0 Left untreated can last for years 0 Treatment produces immediate significant improvement in approximately 40 of clients they stop or greatly reduce their bingeing and purging eat properly and maintain a normal weight 0 Another 40 show a moderate response at least some decreasing in bingeing and purging 0 As many as 20 show less immediate improvement 0 Follow up studies have concluded that as many as 75 of persons with bulimia nervosa have recovered either fully or partially o Relapses can be triggered by new life stresses SUBSTANCE ABUSEDEPENDENCE Moral vs Medical disease views of Addiction Moral view 0 Addicts are morally weak choose to yield to temptation and are consciously self destructive and uncaring about the damage they cause to others Need to get their act together Medical disease view 0 Possibly aided by genetic predisposition and or social learning addicts begin using voluntarily but then have their brains biologically hijacked by the addictive substances They need treatments to block the hijacking restore normal brain function and thereby give them back their will Use vs Abuse and sociocultural norms Every culture has norms about ingestion of substances that dictate what when who how much should be consumed and what range of reaction is permissible 0 Use ingesting a drug in accordance within those sociocultural norms 0 Abuse taking a drug outside of sociocultural norms causing personal and social problems as a result Abuse may lead to dependence Substance Use Disorder General diagnostic criteria DSM 5 Substance use disorder 0 Maladaptive pattern of substance use leading to significant impairment or distress Presence of two or more specific characteristics within a twelve month period Physical vs Psychological dependence Effects of Alcohol ETOH ingestion neurochemical behavioral cognitive O O O O O Carried in the blood stream to CNS where it acts to depress or slow functioning by binding to various neurons Binds to GABA receptors GABA carries inhibitory messages when it is received at certain neurons When alcohol binds to these receptors it helps GABA shut down the neurons relaxing the drinker At first depresses the areas of the brain that control judgment and inhibition Feel more relaxed and confident When more is absorbed it slows down additional areas in the CNS leaving drinker less able to make sound judgments their speech less careful and coherent and memory weaker Many become highly emotional and perhaps loud and aggressive Extent of effect of alcohol is determined by concentration O6 relaxed and comfortable O9 intoxication 55 death Risk Factors for ETOH dependence LR and predisposition to dependence Younger drinking predicts later problems 0 People who begin drinking before age 15 are 4X more likely to become alcoholic Males 4x more likely to have alcohol problems as women Level of response LR to alcohol 0 People with low LR react less than people with high LR to a given amount of alcohol 0 People with low LR are much more likely than people with high LR to become alcoholic 0 LR is related to genetic markers on chromosome 15 which may be involved in the production of certain kinds of GABA receptors 0 Family history 0 More than 2 of current drinkers have a family history of alcoholism 0 Children of alcoholics are 4x more likely to be alcoholic themselves even when reared by nonalcoholic adoptive problems Ethnicity o Asians have very low rates of ETOH abusedependence because about 2 of Asians have a genetic variation that complicates the metabolism of ETOH and causes an unpleasant facial flushing response 0 Native americans Alaskan natives and Mexican Hispanics have the highestst rates of alcoholism but the rates vary tribally and by community Personality o Impulsive sensation seeking 0 History of conduct disorder gt antisocial personality disorder Educa on 0 College students drink more than same age people not in college 0 Being a member of a GLO may be a risk factor for later alcoholism Consequences of College binge drinking Related to alcohol each year college students ages 1824 face 0 1700 accidental deaths injuries eg motor vehicle accidents 0 600000 accidental injuries 0 700000 assaults 0 97000 sexual assaultsdate rapes 0 400000 instances of unprotected sex Alcohol accounts for o 83 of all campus arrests o 28 of college dropouts Consequences of ETOH use physiological damage and fetal effects 2 o all traffic fatalities and 13 of all traffic injuries are alcohol related Untold costs in accidents and death criminal behavior community and domestic violence marital and family strife work performance and absenteeism Personal damage due to disease and premature death 0 Gastric irritation and bleeding Liver testicular and pancreatic disease Oral and intestinal tract cancer Anxiety depression and suicide peripheral neuropathy nerve degeneration causing weakness and sensory loss 0 Dementia with chornic heavy use Korsakoff s syndrome fetal damage Fetal alcohol spectrum disorders 0 Associated with heavy drinking during pregnancy Craniofacial deformities Physical and mental retardation Learning disabilities and behavioral disorders ADHD Skeletal esp hand and finger malformations OOO O O O O ETOH withdrawal symptoms and management Shakes weakness sweating nausea and vomiting Alcoholic seizures Alcoholic hallucinosis vivid unpleasant auditory hallucinations Withdrawal delirium confusion disorientation agitation vivid visual hallucinations Withdrawal is much more severe than opiate withdrawal and can be fatal if unsupervised Use of benzodiazepines to treat shakes and delirium Use of antipsychotics to treat hallucinosis Use of anticonvulsants for seizures Korsakaoff s Syndrome Alcohol related deficiency of vitamin B Marked by extreme confusion memory loss and other neurological symptoms People with this disease cannot remember the past or learn new information and may make up for their memory losses by confabulating reciting made up events to fill in the gaps 0 Long term excessive drinking makes people feel full and lowers their desire for food causing the malnourishment General Modalities of Addiction treatment acute and rehabilitation phases Acute management usually in inpatient detox facility 0 Treatment of acute withdrawal symptoms often with physiologically similar medications o In ETOH dependence use of benzodiazepines for shakes and delirium antipsychotics for hallucinosis and sometimes anticonvulsants for seizures o During inpatient stay group and family therapy Rehabilitation outpatient outcomes guarded and complicated by denial 0 Treat comorbid conditions depression anxiety pain 0 Refer patient to Therapyeducation program focusing on coping strategies and relapse prevention 12 step program ex Alcoholics Anonymous 0 refer family to support group for education and issues of co dependency General philosophy and operation of 12 step recovery groups based in great part on the moral view of addiction first 12 step group was AA founded by Bill Wilson and Robert Smith 0 Protestant inspired group 0 Today AA encompasses 2000000 members across 110000 groups world wide Groups are self supporting and dependent upon dona on 0 AA teachings including the 12 steps are contained in the big book which stresses Frank and total admission of one s alcoholism Confessing inability to handle one s alcoholism by himself Vow to stay abstinent clean and sober one day at a time Make personal amends for all the damage one has caused Help others to achieve sobriety 12 step abstinence groups are a mainstay of treatment for many substance abusers Pharmacological Addiction treatment 0 Campral and Revia for alcohol dependence O Campral seems to reduce glutamate surge that accompanies alcohol withdrawal and produces cravings and so promotes abs nence Revia blocks endogenous opiates in the brain and reduces pleasure associated with drinking Chantix for nicotine addiction also nicotine gums lozenges and patches and Wellbutrin Suboxone or methandone for narcotics addiction Experimentally Provigil for cocaine and amphetamine addiction Overall evidence is that these treatments are not cures but are moderately successful in reducing relapse General Effectiveness of treatment for common addictions Treatments are not cures but are moderately successful in reducing relapse Trends in Addiction treatment with examples of pharmacological treatments 0 Overall in the US ETOH has leveled off tobacco and most illicit drug use is declining but addiction to marijuana and to prescription drugs mostly narcotics and stimulants is increasing 12 step abstinence groups remain a mainstay of treatment Greater willingness to treat co morbid mental disorders even while the patient is using although most common practice is still detox first More emphasis on early education detection and community and school prevention programs the path to addiction is set by high schooV Greater emphasis on pharmacological treatments Antagonists Prescribed dose controlled substitutes for abused substances EARLY AND LATE ONSET DISORDERS ADHD and see question II ADHD types with general features of each lnattentive type need 6 or more 0 O O O 0 Poor attention to detail careless mistakes in schoolwork Can t sustain attention to normal range of tasks Doesn t listen when spoken to directly Doesn t follow through on instructions fails to finish assignments Has difficulty organizing tasks and activities Avoids dislikes tasks requiring sustained mental effort Often loses things necessary for tasks Easily distracted Frequently forgetful Hyperactive impulsive type need six or more Frequent fidgeting and squirming Leaves seat frequently Runs around or climbs excessively in adolescence feelings of restlessness Difficulty at quiet play Excessive talking Blurts out answers before Q is finished Has difficulty waiting hisher turn Frequently interrupts and butts in activities 0 O O O O O O OOOOO Who is affected by ADHD risk factors sex differences family and genetic contribution Found in every culture and socioeconomic level 35 of preadolescents have ADHD males gt females 31 ratio for hyperactive type but for inattentive type females gt males Probable genetic link concordance of 05 for MZ and 04 for DZ twins 40 50 of people with ADHD have at least 1 first degree relative with ADHD Infants with prenatal complications premature births low birth weight Infants whose mothers had high levels of anxiety during weeks 1222 of pregnancy Children with high blood levels of lead Children who have had frequent changes of residence whose parents have divorced or whose fathers are irresponsibleantisocial cause or effect Hypothesis about defects that may occur in ADHD Comorbidity of ADHD 5090 of ADHD individuals also have at least one of the following o bipolar disorder new pediatric diagnostic fad conduct disorder depression OCD Oppositional defiant disorder Specific learning disorders Tourette s Syndrome OOOOOO Consequences of ADHD Poor school grades and conduct 20 of students with ADHD have a concurrent learning disability 4060 of ADHD children develop conduct disorder delinquency andor drug abuse Teenagers with hyperactive impulsive ADHD are much more likely to have traffic accidents get pregnant develop and STD commit arson run away from home 50k of imprisoned felons and 50 of adolescents in juvenile facilities have untreated ADHD up to 80 of ADHD children retain symptoms through adolescence and beyond Only about 5 of college students with untreated ADHD graduate Accepted Treatments for ADHD 80 of ADHD children are helped by stimulant drugs Not addictive when used for ADHD Frequent side effects include insomnia headache nausea These are all controlled drugs 0 Ritalin most common ADHD med 0 Adderall amphetamine o Dexadrinedextroamphetamine o Cylert now considered risky because of liver problems Stimulant drugs leave children shorter in stature at high doses but this is alleviated with drug holidays Patient goes off of drugs for summer Christmas time etc and catches up in growth Use of stimulant lowers rate of substance abuse in ADHD Nonstimulant alternatives not controlled drugs 0 Wellbutrin esp in ADHD adults 0 Straterra often as effective as stimulants for ADHD but much less insomnia o ProvigilNuvigil originally intended to treat narcolepsy and other types of daytime somnolence may improve focus in some ADHD inattentive patients Some SSR s or antimanic drugs are helpful Available Medications effectiveness advantages drawbacks and side effects See above topic Behavioral Treatments Structuring school and home environments 0 Consistent daily scheduling 0 Breaking tasks into small chunks 0 Clear immediate rewards and punishments for target behavior 0 Best punishment is time out or withdrawal of privilege spanking is ineffective and disruptive o Minimizing of distractions Comparative effectiveness of accepted ADHD treatments See above Common signs of adult ADHD 4 of US population Male female ratio approaches 11 Seeks noisy busy places in order to get work done 0 Frequent changing of TVradio stations listening to only parts of songs Difficulty waiting in lines Tuning out conversations and intimate moments Blurting inability to withhold unwelcome remarks Preference for highly stimulating situations Often o lntuitiveness 0 Novel out of the box approaches to problems
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