Disorders- Treatments PSY 100-001
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This 0 page Class Notes was uploaded by Nysheba Carter on Friday November 6, 2015. The Class Notes belongs to PSY 100-001 at Northern Kentucky University taught by Douglas Krull in Fall 2015. Since its upload, it has received 39 views. For similar materials see Introduction to Psychology - SB in Psychlogy at Northern Kentucky University.
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Date Created: 11/06/15
Psychological Disorders and Treatments Psychologists vs psychiatrists revisited Diagnosis What is Abnormaldistressing dangerous to self or others Difficult to define perfectly and varies by culture and time Q Infrequent and detrimental eg distressing dangerous to self or others Most people in psychotherapy are not there because anyone has declared their behavior abnormal but because they themselves are unhappy Alloy amp colleagues 1999 Q Psychologists or other mental health professionals gather information eg clinical interview MMPI and often use the DSM Diagnostic and Statistical Manual of Mental Disorders to make a diagnosis 0 Mental health professionals are people too Bosenhan 1973 Beware of lntern s Syndrome 0 Models of Psychological Disorders 1 Biological genes neurotransmitters 2 Cognitive dysfunctional thoughts 3 Behavioral learning conditioned fear reaction 4 Psychodynamic unconscious conflicts 5 Sociocultural poverty dysfunctional family systems 6 Humanistic self distorted to gain regard from others Norcross amp colleagues 2005Psychodynamic was most widely endorsed by clinical psychologists in 1960 cognitivecognitivebehavioral in 2003 Sayette amp colleagues 2011Cognitivecognitivebehavioral is dominant in clinical psychology PhD programs Many psychologists are eclectic Norcross amp colleagues 2005 Q Diathesis predispositionStress environment Model 0 BioPsychoSocial Model Anxiety Disorders 1 Phobia spiders heights needles Causes include 0 Biological eg overactivity in the hypothalamicpituitaryadrenal H PA axis reactions to stress 0 Behavioral eg conditioned fear reaction observational learning phobias held in place by negative reinforcement 0 Cognitive stimuli related to the phobia receive extra attention spiders Gerdes amp colleagues 2009 Purkis amp colleagues 2011 and interpretations are biased people with social phobia see faces as less friendly Stevens amp colleagues 2008 Treatments for phobia 0 Biological benzodiazepines SSBls Q Behavioral exposure therapy is the treatment of choice for phobia and most anxiety disorders flooding systematic desensitization 0 Cognitive cognitive restructuring for social phobials it true that others won t like you 2 Panic Disorder chest pains shortness of breath sweating fear that one is dying depersonalization feeling separated from one s mind or body agoraphobia Causes include 0 Biological genes GABA dysfunction 0 Cognitive anxiety sensitivity fear of physical or social consequences of anxiety interoceptive sensitivity changes in heart rate and catastrophic misinterpretations heart attack 0 Behavioral interoceptive conditioning symptoms become associated with attacks negative reinforcement can produce agoraphobia Treatments for panic 0 Biological benzodiazepines SSBls Q Behavioral interoceptive exposure hyperventilating 0 Cognitive cognitive restructuring of catastrophic misinterpretations 3 Posttraumatic Stress Disorder intrusive memories flashbacks nightmares guilt exaggerated startle reaction difficulty sleeping avoiding situations related to the trauma Might move to trauma and stressorrelated disorders Causes include 0 Sociocultural traumatic event sexual assault combat serious accident natural disaster 0 Biological genes 0 Cognitive rumination previous anxiety Treatments SSRls and CBT 4 ObsessiveCompulsive Disorder Might move to obsessivecompulsive and related disorders Obsessions unwanted intrusive thoughtsdesiresimages that provoke anxiety Compulsions behaviors washing checking or thoughts counting undoing a bad thought also called a neutralizing act that temporarily reduce anxiety Causes of OCD include 0 Biological genes dysfunction in brain areas associated with intrusive thoughts and anxiety glutamate 0 Cognitive inflated responsibility what if someone dies because I left germs on the table thoughtaction fusion unwanted thoughts of stealing are as bad as stealing overestimation of threat thought of pulling into opposing traffic means I might do it Q Compulsions and suppressing thoughts backfire and make one hypersensitive to obsessionrelated stimuli eg germs Treatments SSRls exposure with response prevention EBP is treatment of choice Schwartz s CBT can alter brain function cool down and free the gears Mood Disorders 1 Major depressive disorder MDD for 2 weeks or more depressed mood lack of interest in activities sleep problems psychomotor retardation thinking and moving slowly feelings of worthlessness suicidal thoughts executive deficits Subtypes include seasonal affective disorder SAD dysthymia is less intense but longer lasting Risk is twice as high for women eg stress rumination Might be moved to depressive disorders Causes include 0 Biological genes atrophy of some brain areas neurotransmitter dysfunctions 0 Social poverty death of a loved one social isolation 0 Cognitive Beck s cognitive model negative cognitive triad self world future cognitive distortions negative automatic thoughts Ellis rationalemotive behavior therapy A activating event B dysfunctional beliefs C consequences D disputation core musts I must be good at everything or I m worthless Beformulated learned helplessness model Abramson amp colleagues 1978 learned helplessness Seligman amp Maier 1967 internal stable global attributions depressive attributional style Treatments 0 Biological SSRls light therapy for SAD ECT if all other options fail and person is suicidal 0 Cognitive cognitive restructuring attribution retraining Q Behavioral change sleep or work schedule spend more time with familyfriends 2 Bipolar l disorder Periods of depression and periods of mania Mania 1 or more weeks of unjustified elevated mood and increased energy increased activity reduced need for sleep grandiosity selfimportance pressured speech talking fast flight of ideas racing thoughts irresponsible behavior impaired executive functioning Bipolar ll disorder has hypomanic episodes shorter and less intense Might be moved to bipolar and related disorders Subtypes eg seasonal pattern cyclothymic disorder is less severe but longer lasting euthymia normal mood Causes include 0 Biological highly heritable deterioration or dysfunction of certain brain areas 0 Social negative life events predict depression events that involve goal attainment predict maniaperhaps because bipolar is associated with reward sensitivity social rhythm disruptions predict mania expressed emotion criticism emotional overinvolvement predicts relapses Treatments include mood stabilizers lithium anticonvulsant medication CBT for depression interpersonal and social rhythm therapy for mania and family focused therapy can help both Schizophrenia Schizophrenia is a psychotic disorder Symptoms are often divided into positive and negative Positive symptoms include Hallucinations auditory is most common but can involve any sense Delusions persecution grandeur reference events such as police sirens refer to me Disorganized thinkinglanguage loose associations aka derailment or knight s move clanging word salad neologisms Abnormal motor behavior unusual gait or actions catatonic behavior and waxy flexibility Negative symptoms include 0 Flat affect Q Alogia aka poverty of speech infrequent speech 0 Avolition lack of motivation In addition to positive and negative symptoms people with schizophrenia also have cognitive deficits Like many disorders schizophrenia can be understood with a diathesisstress model Schizophrenia is highly heritable Environmental factors include prenatal exposure to infection maternal stress stress use of marijuana People with schizophrenia have larger ventricles perhaps due to brain atrophy 1 Dopamine hypothesis l Schizophrenia due to overactivity of dopamine 2 Dopamine hypothesis ll Negative symptoms due to underactivity of dopamine in the frontal lobes positive symptoms due to overactivity in the striatum part of the basal ganglia associated with reward 3 Dopamine hypothesis lll Psychosis not just in schizophrenia is due to dopamine dysfunction in the striatum suggests this dysfunction affects how stimuli are evaluated irrelevant stimuli might seem important attention might be drawn away from family friends goals suggests problem begins with presynaptic accumulation of dopamine thus blocking it later might not solve the problem and might even make it worse 0 Schizophrenia is very debilitating and costly 0 Prior to the 1950s patients were simply housed in state psychiatric institutions First generation antipsychotic medication FGAs became available in the 1950s chlorpromazine thorazine Deinstitutionalizationmovement of patients from large state institutions into community based care unfortunately care was not always adequate and many patients ended up homeless Schizophrenia Q FGAs can also cause extrapyramidal symptoms dystonia uncontrollable muscle contractions dyskinesia uncontrollable movements akathisia restlessness Parkinsonism eg trembling symptoms that appear later called tardive can be irreversible More recent second generation antipsychotics SGAs are less likely to produce extrapyramidal symptoms 0 FGAs and SGAs are approximately equally effective and both work better on positive symptoms than negative Other treatments can also be helpful Family therapy psychoeducationteach family members reduce expressed emotion Social skills trainingteach conversational and occupational skills Cognitive remediationaddress cognitive deficits Cognitive behavior therapymodify thoughts eg about delusions Dissociative Disorders 1 Dissociative amnesia Can be accompanied by dissociative fugue Unlike organic amnesia typically no anterograde amnesia and retrograde amnesia typically pertains to personal information only Unlike ordinary forgetting dissociative amnesia can involve the loss of particular time periods last six months only and can include information that people usually remember places they went people they saw own name 2 Depersonalizationderealization disorder people might feel detached from their minds or bodies other people or objects might seem unreal 3 Dissociative identity disorder multiple identities including a host and some number of alters Identities can be very different eg age gender handedness gestures possible brain differences Trauma model suggests symptoms caused by traumatic stress escape psychologically Sociocognitive model suggests symptoms caused by culture multiple personality in the media and therapists inducement of symptoms by therapists is called iatrogenesis in combination with other psychopathology Rodewald amp colleagues 2011People with DlD or a related disorder had an average of five other disorders People might seize upon DlD to explain their symptoms Attention DeficitHyperactivity Disorder Can be inattentive hyperactive or both Associated with several impairments eg social dysfunction poor academic performance 23 times more frequent in boys Often persists into adulthood Causes include highly heritable maternal smoking and alcohol use during pregnancy perhaps poor family functioning not diet Dysfunctions in prefrontal cortex and poor executive functioning Treatment Stimulant medication improves executive functioning and behavior therapy eg train parents Personality Disorders Dysfunctional self and interpersonal functioning and maladaptive personality traits Six subtypes 1 Borderline PD poorly developed self conflicted relationships emotional instability risk taking 2 ObsessiveCompulsive PD inflexibility compulsiveness perfectionism 3 Avoidant PD avoiding relationships low esteem social anxiety 4 Schizotypal PD eccentricity inappropriate emotion suspiciousness 5 Narcissistic PD preoccupation with oneself self can be elevated diminished or variable 6 Antisocial Personality Disorder Focus on personal desires lack of concern for others impulsiveness risktaking manipulativeness aggression Related to psychopathy arrogance low empathy impulsiveness social deviance ASPD is related to violence Edwards amp colleagues 2003 sexual murder Spehr amp colleagues 2010 bullying Vaughn amp colleagues 2010 and cruelty to animals Vaughn amp colleagues 2009 More common among men Grant amp colleagues 2004 Much more common in the prison population 47 of men 21 of women Fazel amp Danesh 2002 Causes include 0 genes abuse prefrontal dysfunction impaired executive functioning Regarded as very difficult to treat psychopaths often see nothing wrong in their behavior and might convince staff members that they are improving when they aren t Hare 2006 people with ASPD are more likely to drop out of treatment Larochelle amp colleagues 2011 However little work has been done on treatments researchers have called for more attention on psychopathy and ASPD Peters 2010 suggested that early intervention is needed and can be successful