Popular in Abnormal Psychology
Popular in Psychlogy
This 10 page Class Notes was uploaded by Alexandria Gonzales on Wednesday March 2, 2016. The Class Notes belongs to 2500 at University of Denver taught by Dr. Jennifer Joy in Fall 2015. Since its upload, it has received 23 views. For similar materials see Abnormal Psychology in Psychlogy at University of Denver.
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Date Created: 03/02/16
Schizophrenia Monday, February 22, 2016 4:22 PM Psychosis • A state defined by a loss of contact with reality • May be substance-induced or caused by brain injury but most appears in the form of schizophrenia Schizophrenia • 1 in 100 people in the world • An increased risk of suicide and physical -often fatal- illness • Appears in all socioeconomicgroups, but is more frequently in lower levels ○ Downward drift theory(textbook) • Equal numbers of men and women are diagnosed Symptoms • 3 categories ○ Positive Delusions □ Persecution-"someoneis out to get me" Disordered thinking and speech □ Looseassociations(derailment) □ Neologisms(made-upwords) □ Perseveration □ Clang(rhymes) Heightened perceptions □ Being very keyed in to somesort of sensory stimuli and not able to Hallucinations □ Sensory Inappropriate affect, Flat affect □ Inappropriate emotionresponse ○ Negative- "pathological deficits" characteristics that are lacking in an individual Povertyof Speech Restricted(flat)affect Loss of volition(lossof motivationor directedness) Social withdrawal ○ Psychomotor Awkward movements,repeated grimaces, odd gestures □ Symptomsmay take extremeforms, collectivelycalled catatonia Causes • Usually first appears between 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 • Rare cases of childhood schizophrenia are usually most severe • A fuller recoveryfrom the disorder is more likely in people: ○ W good premorbid functioning ○ Whose disorder was triggers by stress ○ With abrupt onset ○ With later onset Who receive early treatment ○ Who receive early treatment Diagnosing Schizophrenia • Symptomsof psychosis continue for 6 months or more • Deteriorationin their work, social relations, and ability to care for themselves ○ Type I is dominated by positive symptoms ○ Type II is dominated by negative symptoms How Do Theorists Explain Schizophrenia? • Biological explanations have received most research support • A diathesis-stress relationship may be at work • Psychologicalperspectiveis explained by behavioral and cognitive stances Biological Views • The more closely related they are to the person with schizophrenia, the greater their likelihood for developing the disorder ○ General population 1% • Biochemicalabnormalities ○ Dopamine hypothesis ○ Theory is based on effectivenessof antipsychotic medications Support for dopamine hypothesis • Parkinson's patients • People who take high doses of amphetamines(whichincreases dopamine) -similar psychosis Challenges to dopamine hypothesis • Challenged by the discoveryof a new type of antipsychotic drug ("atypical") moreeffective that traditional antipsychoticsand bind to D-1 receptors Abnormal Brain structure/negativesymptoms • Brain scans found people with schizophrenia have enlarged ventricles • Smaller amounts of grey matter • Abnormal blood flow to certain brain areas Viral Problems • Possible biochemical and structural brain abnormalitiesseen in schizophrenia result from exposure to viruses before birth PsychologicalViews • Cognitive view ○ Agree that biological factors produce symptoms ○ Furthered by faulty interpretation and a misunderstanding of symptoms ○ Research support is limited • Behavioral View ○ Operant conditioning and reinforcement ○ This view is considered (at best) a partial explanation Sociocultural Views • Theorists believe that three main social forces contribute to schizophrenia: • Multicultural factors:Nature? Nurture? ○ Overall prevalence is stable, the course and outcomeof schizophrenia differs between countries • Social labeling • Family dysfunctioning Treatments • Throughout much of the 20th century most people with psychosis were assigned the label of "schizophrenia • 1950s:institutional approaches ○ Milieu therapy Creating a social climate that promotesproductive activity,self-respect, and individual responsibility ○ Token economy Patients rewarded when they behave in socially acceptable ways and are not Patients rewarded when they behave in socially acceptable ways and are not rewarded when they behave acceptably • Antipsychotic Drugs ○ 1950s ○ Conventionalantipsychotic drugs ○ Research has shown that antipsychotic drugs reduce symptomsin at least 65% of patients diagnosed with schizophrenia ○ Unwanted side effects Conventionalantipsychotic drugs sometimesproduce disturbing movement ○ Newer drugs have been developed Called atypical because their biological operation differs from that of conventional Have serious problems as well □ Carry a risk of agranulocytosis □ Also may cause weight gain, dizziness, and significant elevations in blood sugar Psychotherapy • Helping to relieve their thought and perceptual disturbances • Cognitive-behavioraltherapy ○ Seek change in how individuals view and react to their hallucinatory experiences ○ New wave cognitive-behavioraltherapies also help clients the accept their streams of problematic thought • Family therapy ○ Those who live with relatives who display high levels of expressed emotionare at greater risk for relapse ○ Attempts to address emotional • Social therapy ○ Practice advice, problem solving, decision making, social skills training, medication management,employmentcounseling, ○ Reduces rehospitalization • New practices ○ Music therapy ○ Social skills training through poetry Trauma and Stress/ Dissociative Disorder Wednesday, February 24, 2016 4:10 PM Controversy • Is DID iatrogenically created? • Is DID culture-bound(i.e., North American) • Are cases misdiagnosed other conditions? • Is DID more commonthan rare? • Is DID related to trauma? What is dissociation? • Symptom/phenomenology(Continuum Model) • Process(breakdown in integrative functioning), corollary defense • Structure of the personality/identity/mind ○ ID Holds primary drives Drives us to be fulfilled and satisfied Instinctual drive □ Sex □ Aggression ○ Ego Bring in reason ○ Superego Guilt ○ When trauma occurs your personality split into 2 very distinct, disconnected structures • Continuum Model (phenomenologicallybased) ○ Helps understand severity and proposes that pathological dissociation is merely a quantitative extension from non-pathological dissociation Amnesia Depersonalization Fugue Identity alterations/DID • DID ○ 2 or more distinct personality/identitystates that take recurrent control of behavior ○ Psychogenicamnesia Recurrent gaps in the recall of everyday events that are inconsistent with ordinary forgetting (existence of amnesia) Prevalence • Turkey 1.1% • Canada 3.1% • US 1.5 Inpatient • European .4%-4.7% • US/Canada 1%-12% Paradigm Shift in Psychiatry • Freud's Topographical (vertical) Dissociativeidentities DID Phenomenology(Symptoms) • Amnesia • Depersonalization(body detachment) • Derealization(dream-like) • Identity confusion • Identity alteration(alters) • Identity alteration(alters) • Bodily symptoms-Concurrentpsychiatric & somaticsymptoms ○ Pain ○ Psuedoneuro ○ Headaches ○ Blindness ○ Deafness • Schneiderian 1st rank symptoms ○ Made thoughts made behaviors Auditory hallucination, dissociation and psychosis • Depression and anxiety('phobia' for past Other diagnostic characteristics • Prior treatment failures(~6 years) • Patient uses 'we' DID aetiology • Personality Disorders Monday, February 29, 2016 4:15 PM • 3 clusters, 10 Personality Disorders Personality • A set of uniquely expressed characteristics that influence our behaviors, emotions,thoughts, and interactions • Flexible, allowing us to learn and adapt to new environments ○ Situational Personalitydisorder • An enduring, rigid pattern of inner experience and outward behavior that impairs sense of self, emotionalexperience, goals, and capacity for empathy and/or intimacy • Comorbidityis common • Inability to adapt and be flexible effectivelyto new environments Classifying Personality Disorders 3 Clusters • Odd ○ Suspiciousness, withdrawal, isolation ○ Paranoid Personality Disorder 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 Theorist explanation □ Psychodynamic demanding parents □ Cognitive assumptions such as people are evil and will attack you if given the chance □ Biological genetic causes/twinstudies Treatments □ Do not typically think they need help □ Result = limited results and movesslowly □ Approaches: object relations, cognitive-behavioral,drugs ○ Schizoid Personality disorder Persistent avoidance of social relationships and limited emotionalexpression □ 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 Theorists explanations □ Psychodynamic Unsatisfied need for human contact □ Cognitive Deficiencies in their thinking Treatments □ Cognitive-behavioral Attempt to increase positive emotionsand satisfying social interactions □ Group therapy ○ Schizotypal Personality disorder Range of interpersonal problems □ Extremediscomfortin close relationships □ Odd (even bizarre) ways of thinking □ Odd (even bizarre) ways of thinking □ Behavioral eccentricities □ Magical thinking (separates from other disorders in this cluster) Theorist explanations □ Symptomsresemble those of schizophrenia, so researchers believe the disorders are similar Family dysfunction High dopamine activity Treatments □ Help clients "reconnect"and recognize the limits of their thinking and powers Cognitive-behavioral ◊ Teach clients to objectivelyevaluate their thoughts and social perceptions and teach social skills training Antipsychotic drugs ◊ Reduce certain thought processes • Dramatic ○ Antisocial Personality Disorder Sometimesdescribed as "psychopaths" or sociopaths",people with antisocial personality disorder persistently disregard and violate others' rights Theorist explanations □ Psychodynamic Absence of parental love, leading to lack of basic trust □ Behaviorists Modeling or unintentional reinforcement □ Cognitive Sufferers hold attitudes that trivialize the importance of other people's need □ Biological factors Low serotonin, low arousal Treatments □ Typically ineffective □ Lack of conscienceor desire to change Some cognitive therapists try to guide clients to think about moral issues and the needs of other people ○ Borderline Great instability Major shifts in mood Unstable self-image Unstable interpersonal relationships Impulsivity □ Impulsive, self-destructivebehavior can include: Alcohol and substance abuse Reckless behavior, including driving and unsafe sex Self-injurious or self-mutilation behavior Suicidal threats and actions Theorist Explanations □ Biological Overly reactive amygdala and underactive prefrontal cortex □ Psychodynamic Fear of abandonment from early parental relationships: lack of early acceptance or abuse/neglect by parents Treatments □ Focuses on the patient's central relationship disturbance, poor sense of self, and pervasive loneliness and emptiness pervasive loneliness and emptiness □ Dialectical behavior therapy □ Antidepressant, anti-bipolar, antianxiety DBT □ Marsha Linehan Particularly efficacious w/patients BPD Validate patient's behavior and beliefs while informing him that someof them are maladaptive Core skills include mindfulness, interpersonal communication,and tolerating emotions/self-reflection ○ Histrionic Extremelyemotional Continually seek to be the center of attention Excessiveneed for approval and praise Often described as vain, self-centered, and demanding Theorist Explanations □ 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 Treatments □ Likely to seek treatment □ Working with them can be difficult because of their demands, tantrums, seductiveness,and attempts to please the therapist □ Cognitive Decreasehelplessness, teach problem-solvingskills □ Psychodynamictherapy and group therapy help with their independence ○ Narcissistic Generally grandiose Need much admiration Feel no empathy with others Exaggerate their achievementsand talents Often appear arrogant Theorist Explanations □ Psychodynamic Cold, rejecting parents □ Cognitive-behavioral People are treated too positively rather than too negatively in early life □ Sociocultural "Eras of narcissism" in society Treatments □ One of the most difficult to treat May come for a related disorder(depression) Try to manipulate therapist □ None of the major treatment approaches have had much success • Anxious ○ Fear or inadequacy ○ Avoidant Personality Disorder Very uncomfortableand inhibited in social situations Overwhelmedby feelings of inadequacy Extremelysensitive to negative evaluation Extremelysensitive to negative evaluation Often have few close friends Theorist Explanations □ Similar to anxiety disorders, including: Early trauma Conditioned fears Upsetting beliefs Biochemicalabnormalities □ Psychodynamic Focus on shame □ Cognitive Harsh criticism and rejection in early childhood may lead people to assume that their environmentwill always judge them negatively Behavioral ◊ Fail to develop Treatments □ Group therapy formats,with cognitive principles, provided practice in social interactions □ Antianxiety and antidepressant drugs are also sometimesuseful ○ Dependent Personality Disorder Pervasive,excessiveneed 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 Theorist Explanations □ Psychodynamic Similar to those for depression □ Behaviorists Unintentionally rewarded their children's clinging and "loyal" behavior while punishing acts of independence □ Cognitive 2 maladaptive attitudes ◊ I must find a person to provide protection so I can cope ◊ I am inadequate and helpless to deal with the world Treatment □ Can be at least modestlyhelpful Psychodynamictherapy focuses on depression Cognitive behavioral ◊ Challenge feelings of helplessness and provide assertiveness training ◊ Antidepressant drugs when depression is present ◊ Group therapy Support for peers Models of success ○ Obsessive-compulsivePersonality Disorder So preoccupied with order, perfection, and control that they lose all flexibility, openness and efficiency They set unreasonably high standards for themselvesand others Rigid and stubborn Theorist Explanations □ Borrow heavily from those of obsessivecompulsivedisorder, despite doubts of concerning a link between the two □ Freudian theorists- anal regressive □ Cognitive theorists have little to say about the origins of the disorder, but they □ Cognitive theorists have little to say about the origins of the disorder, but they do propose that illogical thinking processes help them Treatments □ Do not usually believe there is anything wrong with them □ Often appear to respond well to psychodynamicor cognitive therapy □ A number of clinicians report success with SSRIs • Are there better ways to classify personality disorders? ○ Leading criticism of DSM-5s approach to personality disorders is that the classification system uses categoriesrather than dimensions-of personality
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