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Abnormal Psychology Lecture Notes Chapter 1
Abnormal Psychology Lecture Notes Chapter 1
Chapter 1:
Loss = anxiety
Coping strategies include:
o Displacement
o Denial
o Rationalization
o Reaction formation
o Projection
o Repression
o Sublimation
Stages of psychosexual development
Patterns of gratifying basic needs
o Oral – babies put everything in their
mouth/most developed sense
o Anal – potty training/elimination/pleasure out
of controlling bowel movements, anal people =
control freaks
o Phallic – boys realize they have phallus and girls
realize they don’t
o Latency – nothing really happens for a while
erupts in puberty
o Genital – puberty/everything is about genitals
Conflicts at each stage must be resolved
Adult personality reflects childhood experience
Later developments
Self-psychology
o Anna Freud
o Ego defines behavior
Object relations theory
o Melanie Klein and Otto Kernberg
o Children incorporation of objects
Freud’s students de-emphasize sexuality
Carl Jung
o Collective unconscious
o Enduring personality traits
Intro vs. extroversion
Emphasis on life-span development
Unearth intrapsychic conflicts
Long-term treatment model
Techniques:
Free association – stream of words, what first comes to
mind
Dream analysis
Transference – all therapeutic relationships taking on role
of patient (putting yourself in their shoes)
Chapter 2:
Diathesis:
o Inherited tendency to express
traits/behaviors/pathology
o Genetic
o Triggered by stress
Stress:
o Life events or contextual variables
o Environmental
o Triggers certain traits/behaviors/pathology
o Combining both yields activation under right conditions
o Gene-environment correlation model
o Genes shape how we create our environments
o Inherited predispositions or traits that increase one’s likelihood to
engage in activities or seek out situations
o Example: divorce
Neuroscience and contributions to psychology
o Role of nervous system in disease and behavior
o Central nervous system
CNS
Brain and spinal cord
o Peripheral nervous system
PNS (everything that comes from spinal cord, ect.)
Somatic
o Voluntary muscles and movement
Autonomic branches
o Sympathetic (activating)
o Parasympathetic (normalizing)
o Both divisions regulate:
Cardiovascular system/body temp
Endocrine system/digestion
Neuron = basic building block
Soma
Dendrites
Axon Soma
Axon terminals
Synaptic cleft
o Space in
between
neurons (in
between ends of
axon terminals)
Function: electrical
Communication: chemical
Neurotransmitters (packaged in vesicles) – fast acting,
complex subsystems, implicated in anxiety
o Serotonin (5HT)
Widespread, complex circuits
Regulates behavior, moods, thought
processes
Low levels and vulnerabilities
Implicated in several psychopathologies
o Norepinephrine
Respiration, reactions, alarm response
Implicated in panic
o Dopamine
Switch function in brain circuits
Interacts with other neurotransmitters
Implicated in schizophrenia
Parkinson’s disease
o Glutamate
Excitatory – saying GO
o GABA
Inhibitory
o Structure of brain:
Hindbrain
Midbrain
Thalamus and hypothalamus
Relays between brain stem and forebrain
Behavioral and emotional regulation
o Pituitary gland – release of hormones
Limbic system
Emotions, basic drives, impulse control
Associated structures and psychopathology
Basal ganglia
Caudate nucleus
Motor activity
Forebrain (cerebral cortex)
Most sensory, emotional, and cognitive processing
Two specialized hemispheres
o Left = verbal, math, logic
o Right = perceptual
Lobes of cerebral cortex: ******************
Frontal
o Thinking and reasoning, memory
Parietal
o Touch recognition
Occipital
o Integrates visual input
Temporal
Chapter 3:
Projective
o Presentation of ambiguous stimuli
o Projection of personality and the unconscious
o Psychoanalytic roots
o Examples:
Rorschach Inkblot – what do you see?
Thematic apperception – what’s going on
in the picture?
o Criticisms
Scoring/interpretation
Reliability and validity
o Strengths
Qualitative data
Icebreakers
Standardization efforts
Personality
o Face vs. construct validity
o Empirically based
o Minimally ambiguous stimuli
o Minimal inference
Scoring/interpretation
o Minnesota Multiphasic Personality Inventory
(MMPI)
T/F
Takes a long time ~ 3 hours
o PAI
Similar to MMPI but shorter
Intelligence
o Initial purpose academic prediction
o Intelligence quotient (IQ)
Mental vs. chronological age
Deviation IQ – cohort comparison
o Domains
Verbal
Performance
o IQ vs. intelligence
o Examples:
Stanford-Benet (adults)
WAIS-III (adults)
WISC-IV (children)
WPPSI-III (preschoolers)
o All contain verbal scales
Vocab
Knowledge of facts
Verbal reasoning
o Psychophysiological assessment
Emotional or psychological events reflected by ???
Other bodily responses
Electrodermal
o Galvanic skin response
Biofeedback: assist individual with regulating biological
responses (blood pressure, respiration, ect.)
Limits:
High skill level needed
Inconsistent result
Assessing response to stimuli is useful in disorders strong
emotional component
Diagnosing:
Approaches:
o Idiographic – unique to one individual
o Nomothetic – applicable to large groups of
people
Diagnostic classification
o Categories based on commonalities
Terminology of classification systems
o Taxonomy – scientific classification
o Nosology – taxonomy in psychological contexts
o Nomenclature – nosological labels (panic
disorders, eating disorders, ect.)
Classification issues
Nature and forms of approach
o Classical (or pure) categorical approach
o Dimensional approach
o Prototypical approach
Two widely used classification systems:
o ICD-10 (international)
o DSM
Critical issues
Reliability
o Decreases bias
Validity
o Improved coherence
Purposes
o Communication
o Prognosis
o Treatment planning
Diagnosis before 1980
DSM I&II
o Low precision
o Based on unproven theories
o Poor reliability
DSM-III & IIIR
o Atheroretical
o Introduces axis
o Low reliability
o Reliance on consensus
DSM-IV & IV-TR
o Comprehensive
o Boundaries are clearer
o Broad categorization headings
o Empirically grounded
o Prototypic approach
DSM-V
o ICD-10 – General consensus is DSM-V is largely
unchanged from DSM-IV although some new
disorders are introduced and other disorders
have been reclassified
Divided into 3 main sections:
How to use the manual
Disorders
Descriptions of disorders
o Introduces cross-cutting dimensional symptom
measures
Evaluating global sense important
symptoms that are often present across
disorders in almost all patients such as
anxiety
o Comorbidity
o Emphasize reliability sometimes at expense of
validity
o Complexity of categorizing psychopathology
Caution about labeling and stigma
Problems and pitfalls with labels
o Negative connotations
o Stigmas
o Reification (treating concept as object)
o Beyond DSM-V: dimensions and spectra
New findings on brain circuits, cognitive processes, and
cultural factors that affect our behavior could date diagnostic
criteria relatively quickly
Chapter 4:
Research methods
o Basic components
Question based theory
Hypothesis
Minimizing confounds
o Control groups
o Randomization
o Analog models (similar to phenomenon)
Generalizability
Research design
Dependent variable
Independent variable
Internal validity
External validity
o Statistical (.5/5% chance of happening) vs. clinical (clinically
significant) significance
Chance?
Meaningful?
Does one mean other?
Effect size and social validity
o Studying individual cases
Extensive observation
Detailed description – tons of note taken
Foundation for early developments
Freud
Unique problems
Contributions/challenges to theories
Limitations – reactivity
o Research by correlation
Statistical relationship
No manipulated independent variable
Directionality
Correlation coefficient
Correlation does NOT imply causation.
o Research by experiment
Manipulate independent variable
Observe effects on dependent variable
Attempt to determine causality
Premium on internal validity
Control groups
Matched control group
o Age, gender, SES, ect.
Placebo control groups
Single-blind control
o They know one aspect
Double-blind control
o No one knows who’s getting the treatment
Minimizes allegiances effects
o Genetics and research across time and cultures
Adoption studies:
Sibling pairs separated after birth
Parcels out effects of environment
Observed frequency vs. chance
o Studying behavior over time
Prevention research treatment and services
Universal prevention – broadly applied
Selective prevention – individual
Indicated prevention – not exactly certain
Time-based research strategies
Cross-sectional designs
o Cohorts (college students, ect.)
o Retrospective info
Longitudinal designs
o Cross-generational effect
o Sequential design
o Research ethics
Institutional review boards
Informed consent
o Competence
o Voluntarism
o Full info
o Comprehension
APA ethics
o Ethical principles of psychologists and code of
conduct
Involving consumers
Participatory action research
Design
Running
Interpreting research
Relevance of research
Chapter 5:
*go over diagnostics in book on disorders, along with causes and symptoms?
Pharmalogical
Benzodiazepines (BZD; sedative)
o Benefits
Short-term, modest
relief
o Risks
Cognitive/motive
functioning
Fall risk
Dependence
Antidepressants
o Paxil, Effexor, valium
Psychological
CBT
o Confronting anxiety
provoking images
o Coping strategies
Acceptance & meditation
(mindfulness)
o Similar benefits
o Better long-term results
Panic disorder and agoraphobia
o Clinical description
Unexpected panic attacks
Anxiety, worry, or fear of another attack
Persists for 1 month or more
Agoraphobia
Fear or avoidance of
situations/events
o Acute onset
o In children
Hyperventilation
Cognitive development
o ~ ¾ w/ agoraphobia are female
o Similar prevalence rates globally
o Variable symptom expression
Somatic symptoms
o Nocturnal panic
60% experience nocturnal attacks
non-REM sleep
Delta wave
Caused by deep relaxation
Sensation of letting go
Sleep terrors
o Causes
Dizziness
Expected (cued) phobia
Unexpected (uncued) panic disorder
o Trauma and stressor–related disorders
PTSD
Clinical description
o Trauma exposure
o Extreme fear, helplessness, or horror
o Continued re-experiencing
o Avoidance
Conversation of situation or PTSD
Similar places of occurrence
o Emotional numbing
o Reckless or self-destructive behavior
o Interpersonal problems
o Dysfunction
o One month
Most common traumas
o Sexual assault
o Accidents
o Combat
Causes
o Trauma intensity
o Generalized biological vulnerability
Twin studies
Reciprocal gene-environment interaction
o Generalized psychological vulnerability
Uncontrollability and unpredictability
o Social support – contributing factor to resiliency
o Neurobiological model
Threatening cues activate Corticotrophin
Releasing Factor system
CRF activates fear and anxiety
Amygdala (central nucleus)
Increased HPA axis activation
Cortisol
Treatment
o CBT
Exposure Psychoanalytic therapy,
catharsis
Imaginal
Graduated or massed
Increase positive coping skills
Increase social support
Highly effective
o Treatment
Medications
SSRIs
Adjustment disorders
Clinical description
o Anxious or depressive reactions to life’s
stressors
Attachment disorders
Clinical description
o Disturbed and developmentally inappropriate
Reactive attachment disorder
Clinical description
o Child won’t seek out???
Obsessive-Compulsive Disorder (OCD)
Clinical description
o Obsession
Intrusive can’t be stopped and
nonsensical
Thoughts, images, or urges
Attempts to resist or eliminate
60% of people have multiple obsessions
Need for symmetry
Forbidden thoughts or actions
Cleaning and contamination
Hording
o Compulsions
Thoughts or actions
Suppress obsessions
Provide relief
Four major categories
Checking
Ordering
Arranging
Washing/cleaning
Association with obsessions
Body Dysmorphic Disorder (BDD)
Preoccupation with some imagined defect in
appearance by someone who actually looks reasonably
normal
o Comorbid with OCD 10%
o Course: lifelong
o Onset – early adolescence through 20s
o Reaction to horrible or grotesque feature
o Two treatments:
SSRIs
Chapter 6:
o Low SES
o Limited disease knowledge
o Family history of illness
Treatment:
Similar to somatic symptom disorder
o Attending to trauma
o Remove secondary gain
o Reduce supportive consequences
o Reward positive health behaviors
No cures
Cognitive-behavioral interventions
o Initial reassurance
o Stress-reduction
o Reduce frequency of help-seeking behaviors
Gatekeeper physician
o Reduce visits to numerous specialists
o Types of disorders
Depersonalization/derealization
Severe alterations or detachments to normal perceptual
experiences
Significant impairments with:
o Identity
o Memory
o Consciousness
Depersonalization
Derealization
Dissociative amnesia
Generalized type
Localized or selective type
Dissociative identity disorder (DID)
Clinical description
o Amnesia – recurrent, ordinary events
o Discontinuity of personality
o Adopt several new identities or alters
2 – 100 personalities
Unique characteristics
Host – typically main personality
Switch - ?
Controversy:
o Malingering?
Real vs. fake memories
Suggestibility
Hypnosis studies
Simulated amnesia
Demand characteristics
Physiological measures
Eye movements
EEG
Popular media
Cinema
Television
Mass hysteria
Escape responsibility
Iortrogenic – caused by therapist
Real memories and false
Stats:
o Female : male = 9:1
o Onset – childhood
o Course: chronic, lifelong
o Time to diagnosis
o Suicide attempt rates are high
Comorbidities:
o PTSD
o Depressive disorders
o Trauma and stressor-related disorders
o Conversion disorder
o Somatic symptom disorder
o Eating disorders
o Substance-related disorders
o OCD
o Sleep disorders
o Personality disorders (BPD)
Causes:
o Biological vulnerability
Reactivity
Hippocampal and amygdalar volume
o Severe childhood abuse/trauma history
o Links with PTSD
o Highly suggestible
Autohypnotic model
Treatment:
o Similar to PTSD
Reintegration of identities
Identify and neutralize cues/triggers
Visualization
Coping
Hypnosis
o Antidepressant medications?
Benzodiazepines (minor tranquilizers)
o Accumulated clinical wisdom
Chapter 7:
o Bipolar I disorder
Alternating major depressive and manic episodes
Single manic episode
Recurrent
Symptom free for two months
Onset – 15-18
o Bipolar II disorder
Alternating major depressive and hypomanic episodes
Onset – 19-22
o Cyclothymic disorder
Alternating manic and depressive episodes
Less severe
Persists longer
Chronic symptoms
Risks for bipolar disorders
Rapid – cycling specifier
o Prevalence of mood disorders
Children and adolescents
Similar to adults
Adolescence
o Female disorder
Misdiagnosis
o ADHD
Older adults
Diagnosis difficulty
Across cultures
Similar among U.S.
o Exceptions
Native Americans
Physical or somatic symptoms
Comparability
Among creative
Higher prevalence
o Melancholia
o Mania
Gender differences
o Causes of mood disorders: biological
Familial and genetic influences
Family studies
Twin studies
o Bipolar
o Unipolar
Higher heritability for females
Neurotransmitter systems
Serotonin – depression
Risk factors:
Family history
Neurobiology
Preexisting disorder
Alcohol/drugs
Stressful life event
Shameful/humiliating stressor
Suicide publicity and media coverage
Treatment
Importance of assessment
o Suicidal desire – ideation
o Suicidal capability – past attempts
o Suicidal intent – plan
No suicide contract – assessing for suicidal ideation;
creating a list of things to do, if you become on the verge
of following through, if none work, THEN you can follow
through controversial
Hospitalization
o Complete or partial
CBT – learning how to cope and interrupt feelings and
thoughts
Population specific
Caucasians
Native Americans
Increasing rates
Adolescents
Elderly
Chapter 8:
Sociocultural origins
Westernized views
Cross-cultural considerations
North American minority populations
Immigrants to western cultures
o Increase in eating disorders
o Increase in obesity
Cultural values are different
Standards for body image
Obesity
Rates are increasing
BMI vs. weight
Health risks
Developmental considerations
Adolescent onset
Weight gain
Interaction with social ideals
Causes
Social dimensions
o Cultural imperatives
Thinness = success, happiness
o Ideal body size standards
Change rapidly
o Media
o Social and gender standards
Internal and perceived
o Dieting
o Perceptions of fat
Family influences
o Typical family
Successful
Driven
Concerned about appearance
Maintains harmony
o History of dieting, eating disorders
Mothers
Biological dimensions
o Hereditability studies
o Inherited tendency to be emotionally responsive
to stress eat impulsively
o Perfectionism
o Hypothalamus
Serotonin
Psychological dimensions
o Low sense of personal control
o Low self-confidence
o Perfectionistic attitudes
o Distorted body image
o Preoccupation with food and appearance
o Mood intolerance
Treatment
o Drugs
Anorexia
No demonstrated efficacy
Bulimia
Antidepressants
o May enhance psychological
treatment
o No long-term efficacy
o Bulimia
CBT
Treatment of choice
Target problem eating behaviors
Target dysfunctional thoughts
Interpersonal psychotherapy (IPT)
Improve interpersonal functioning
Similarity effective, long-term
CBT may work quicker
o Binge-eating
Similar to bulimia
o Anorexia
Weight restoration
May require hospitalization
Target dysfunctional attitudes
Body shape
Control
Thinness = worth
Family involvement
Communication about eating/food
Attitudes about body shape
Long-term prognosis
Poorer than bulimia
More people die from anorexia
Prevention
o Identify specific targets
Early weight concerns
o Screening for at-risk groups
o Provide education
Normal weight limits
Effects of calorie restriction
Healthy weight
Chapter 12:
Personality disorders
o Broad overview
Personality disorders: persistent pattern of cognitions,
emotions, and behavior resulting in enduring emotional
distress for person affected and/or for others and may cause
difficulties in work and relationships
Highly comorbid
Poorer prognosis
Therapist reactions
Countertransference – therapist becomes more
interested in client’s disorder than helping him/her
10 specific personality disorders
3 clusters
o Categorical and dimensional models
Big Five (OCEA[N/E])
Openness
Conscientiousness
Extraversion
Agreeableness
Emotional stabilityused to be neuroticism
Cross-cultural research establishes universal nature of five
dimensions
o Clusters
Cluster A: intense, odd, eccentric, (paranoid schizoid,
schizotypal)
Paranoid personality disorder:
o Mistrust and suspicion
Pervasive
Unjustified
i.e. foil hats so no one can
penetrate their thoughts
o Few meaningful relationships
Volatile
Tense
Sensitive to criticism
o Causes
Possible relationship to schizophrenia
(weak)
Possible role of early development
experience
Trauma
Schemas
Ideas of reference
Illusions
o Odd and/or unusual
Behavior
Appearance
o Socially isolated
o Suspicious
o Causes
Schizophrenia phenotype?
Lack full biological or
environmental contributions
Cognitive impairments
Left hemisphere
More generalized
o Treatment
Highly comorbid with depression
Multidimensional approach
Social skill training
Antipsychotic medications
Community treatment
Cluster B:
Antisocial personality disorder
o Noncompliance with social norms = going
against society
o Social predators
Violate rights of others
Irresponsible
Impulsive
Deceitful
o Lack of conscience, empathy, and remorse
o Nature of psychopathology
Glibness/superficial charm
Grandiose sense of self-worth
Pathological lying
Conning/manipulative
Lack of remorse
Callous/lack of empathy
o Developmental considerations
Early histories of behavioral problems
o Conduct disorder
Childhood onset type
Adolescent onset type
o Family histories of:
Inconsistent parental discipline
Variable support
Criminality
Violence
o Causes
Gene-environment interaction
Genetic predisposition
Environmental triggers
Arousal hypothesis
Under-arousal
Fearlessness
Borderline personality disorder
o Patterns of instability
Intense moods
Turbulent relationships
o Impulsivity
o Very poor self-image
o Self-mutilation
o Suicidal gestures
o Mood goes to opposite side of spectrum at any
time
o Comorbidities
Depression
Suicide
Bipolar
Substance abuse
Eating disorders
Bulimia
o Causes
Genetic/bio components
Serotonin
Limbic network
Cog. biases
Early childhood experience
Neglect
Trauma
Abuse
o Treatment
Highly likely to seek treatment
Antidepressant medication
Dialectical behavior therapy (DBT) *made
specifically for this disorder
Really in your face, harsh, to the
point, etc.
Reduce interfering behaviors
o Self-harm
o Treatment
o Quality of life
Outcomes
Histrionic personality disorder
o Attention seeker
o Sexually provocative
o Shallow/shifting emotions
o Physical appearance-focused
o Impressionistic
o Overly dramatic
o Suggestible
o Misinterprets relationships and social cues
o Causes
Little research
Links with antisocial personality
Sex-typed alternative expression
o Treatment
Helping individual problematic
interpersonal relationships
Attention seeking
Long-term consequences of
behavior
Little empirical support
Narcissistic personality disorder
o Like histrionic, but on steroids*
Difference = narcissists don’t care about
offending people, thinks they are THE
best in everything, always over the top,
everyone else is beneath them
o Exaggerated and unreasonable sense of self-
importance
Grandiosity
o Require attention
o Lack sensitivity and compassion
o Sensitive to criticism
o Envious
o Arrogant
o Causes
Deficits in early childhood learning
Altruism
Empathy
Sociological view
Increased individual focus
Me generation
o Treatment focuses on:
Grandiosity
Lack of empathy
Hypersensitivity to criticism
Cluster C: fearful/anxious, avoidant, dependent,
Avoidant personality disorder
o
o Causes
o Treatment
Dependent personality disorder
o
o Causes
Limited empirical research
o Treatment
Obsessive-Compulsive personality disorder (what’s the
difference between OCD and this [OPCD])***
o Fixation on doing things the right way
o Rigid
o Perfectionistic
o Orderly
o Preoccupation with details
o Poor interpersonal relationships
o Obsessions and compulsions are rare
o Causes
Limited research
Weak genetic contributions
Predisposed to favor structure?
o Treatment
Similar to OCD
CBT
Address fears related to need for
orderliness
Limited efficacy data
o Stats
Origins and course:
Childhood
Chronic
o Can remit but replaced by other personality
disorder
Highly comorbid
o Gender differences
Man diagnosed with personality disorder tend to display traits
characterized as more aggressive, structured, self-assertive,
and detached
Chapter 13:
o Speech
production/contribution
Prosody
Negative – absence of something that already exists (i.e.
flat affect)
o Symptom cluster
Avolition (or apathy)
Alogia – absence of speech
Anhedoinia – low, feeling down/lack of
feeling pleasure
Affective flattening
Disorganized symptoms
Erratic behaviors that affect many domains
Disorganized speech
o Cognitive slippage
o Tangentially
o Loose association/derailment
Inappropriate affect/emotional expression
Unusual behavior
o Catatonia
Wild agitation, waxy flexibility (putting
someone in a certain position/pose and
they’ll keep it, regardless of how hard it is
to hold), immobility
o Prevalence and cause of schizophrenia
Four causes:
Possible genes involved
Chemical action of drugs that help many people with
this disorder
Abnormalities in working of brains of people with this
disorder
Environmental risk factors that may precipitate onset of
symptoms
Course = chronic
Moderate – to – severe lifetime impairment
Life expectancy = less that average
o Suicide
Female : male ~ 1 : 1
Females
o Later age of onset
o Better outcomes
Development
Early childhood clinical features
o Typically difficult to diagnose children
o Mild physical abnormalities
Double-bind communication
Expressed emotion (EE)
Criticism, hostility, emotional over involvement
o Treatment
Biological interventions
Historical treatments (30s – 40s)
o Insulin coma therapy
o Psychosurgery
Prefrontal lobotomies
o Electroconvulsive therapy
Antipsychotic medications (neuroleptics)
o First line treatment
o Began in 50s
o Decrease positive symptoms
o Side effects: common, acute, permanent
Extrapyramidal (motor issues: feet
shuffling, drooling, etc.)
Parkinson-like
Tardive dyskinesia
o Compliance problems
Transcranial magnetic stimulation
o Magnetic fields
o Possible benefits
Auditory hallucinations
Effects last less than a month
Psychosocial interventions
Historical approaches
o Focus on role of early personal histories
Psychodynamic
Psychoanalytic
o Little benefit, possible harm
Psychosocial approaches
o Behavioral
Token economy – given a token to turn
in for a prize like object[s] (in assisted
living)
Inpatient units
o Community care programs
o Social and living skills training
o Behavioral family therapy
o Vocational rehab
Necessary adjunct to medication
Virtual reality technology
o Simulation of multiple cognitive tasks
o Diagnosis
Chapter 14:
Neurodevelopmental disorders
o Overview
Neurodevelopmental disorders new combo of disorder in
DSM-5
What is normal? Abnormal?
Psychopathology
Developmental impact of early skill impairments
First diagnosed = infancy, childhood, adolescence
o Developmental disorders
Attention deficit hyperactivity disorder (ADHD)
Central features
o Inattentive
o Hyperactive
o Impulsivity
DSM-5 differentiates two categories of symptoms
o Problems of inattention
o Problems of hyperactivity and impulsivity
Impairments
o Behavioral
o Cognitive
o Social
o Academic
Stats
o Children with ADHD
Onset = 3 or 4
Boys : girls = 3 : 1
Males are more externalized
Females are socialized to
internalize
Possible cultural construct
o Adults with ADHD
Lower level jobs
Less education
More likely to be divorced, have
substance use problems and antisocial
personality disorder
High risk behaviors
o High comorbidity
ODD – oppositional defiant disorder
Mood disorders
Causes
o Genetics
Familial component
o Psychosocial
Behavioral approaches
Skill building
Reduce problem behaviors
Communication and language
training
Increase socialization
Naturalistic teaching strategies
Early intervention is critical
o Biological
Medical intervention has had little
positive impact
Decrease agitation
o Tranquilizers
o SSRIs
o Integrated
Preferred model
Multidimensional, comprehensive focus
Children
Families
Schools
Home
Community and social support
Intellectual disability (ID)
Evident in childhood as significantly below-average
intellectual and adaptive functioning
o Measured by standardized tests
o IQ of 70 – 75 or below
o Adaptive problems
Communication
Self-care
Home living
Social and interpersonal
Use of community resources
Self-direction
Functional academic skills
Work
Leisure
Health and safety
o Level of disability
Mild
50 – 55 to 70
Moderate
35 – 40 to 50 – 55
Severe
20 – 25 to 35 – 40
Profound
Below 20 – 25
o Other classification systems
American association of intellectual and
developmental disabilities (AAIDD
Based on assistance required
o Intermittent
o Limited
o Extensive
o Pervasive
Stats
o Chronic course
o Highly variable individual prognosis
Causes
o Hundreds of known causes
Environmental –
pollutants/poisons/toxins
Genetic
Prenatal
o Fetal alcohol syndrome
o Disease
o Chemicals
o Poor nutrition
o Lack of oxygen (anoxia)
during birth
o Malnutrition
o Head injuries
Perinatal
Postnatal
Multiple genes
Chromosomal disorders
o Down syndrome
Increases Alzheimer
risks
Mitochondrial disorders
Multiple genetic mutations
GENES & ENVIRONMENT
Treatment
o ID parallels that of people with more severe
forms of autism
o Goals
Skill building community life, school,
job, social relationships, etc.
Chapter 15:
Neurocognitive disorders
o Perspectives
Affect multiple cognitive processes
Learning
Memory
Consciousness
Most develop later in life
Three classes
Delirium
Mild
Major
o Delirium
Clinical description
Global impairments
o Consciousness
Confusion, disorientation, can’t focus
o Cognition
Memory and language deficits
ACUTE – RAPID ONSET
o Several hours
o Days
Stats
Highest prevalence
o Older adults
o AIDS patients
o Cancer patients
o Medical patients
Full recovery = several weeks
Vital signs
Subtypes
Delirium due to a general medical condition
Substance-induced delirium
Delirium due to multiple etiologies
Delirium not otherwise specified
Causes
Drug intoxication
o Medications
o Illicit drugs
Ecstasy
Poisons
Withdrawal from drugs
Infections
Head injuries
o Swelling
High fever
Older age
Sleep deprivation
Immobility
Excessive stress
fMRI scanning used to monitor/locate potential sources
of delirium
Ethical concerns
Treatment
Treat underlying medical or withdrawal problems
Acute delirium
o Haloperidol or olanzapine
First line of treatment – psychosocial intervention
o Education
o Reassurance
o Coping strategies
Prevention
Proper medical care
Proper medication use
o Major and minor neurocognitive disorders
Clinical description
Gradual deterioration of brain functioning that affects
o Memory
o Judgment
o Language
o Other advanced cognitive processes
o INSIDIOUS – GRADUAL ONSET
Initial symptoms
Memory impairment
Visuospatial skills deficits
o Clumsy – running into things when you are
consciously aware
Agnosia
o Facial agnosia
Delusions
Depression
Agitation
Aggression
Apathy
Later symptoms
Continued cognitive decline
Assistance with activities of daily living
Death = inactivity + other illnesses
o Pneumonia
Stats
Onset = any age, but most commonly later on
Prevalence
o Longer lifespan
Etiology
Dementia of Alzheimer’s type
o Multiple cognitive deficits
Memory
Orientation
Judgment
Reasoning
o Insidious and progressively gets worse
o Confusion
o Agitation/combativeness
o Depression
o Anxious
o Sundowner syndrome
End of notebook – she starts
remembering, then snaps, forgets again,
and gets aggressive towards him
o Significant social and occupational impairments
o Definitive diagnosis = autopsy
o Brain scans can be helpful
o Spinal fluid testing
o Mental status exam – only helpful if client is wise
to Alzheimer’s
o Range of cognitive
deficits***********************
Aphasia – language impairment or loss
Apraxia – voluntary movement
impairment
Agnosia – inability to recognize and name
objects
Executive functioning
o Stats
Nature and progression of disease
Deterioration
o Early and later stages =
slow
o Middle stages = rapid
Post-diagnosis survival = 8 years
Onset = 60s and 70s
o Early onset = 40s and 50s
Prevalence
Higher:
o Poorly educated
o Women
Estrogen?
Lower:
o Higher education
Cognitive reserve
theory
o American Indians
Vascular injury - veins, capillaries, arteries
o Progressive, common cause of neurocognitive
deficits
o Blockage or damage to blood vessels
o Cognitive disturbances
Speed of info processing and executive
functioning
Greater motor problems
Weakness in limbs
o Severe impairments
o Prevalence
Men > women
Higher rates of cardiovascular
Most will require formal nursing care
Death from infection
Pneumonia
Weak immune system
o Cause
Frontotemporal degeneration
Traumatic brain injury
Lewy body disease
Parkinson’s
HIV
Substance abuse
Huntington’s disease
Prion disease
Normal pressure, hydrocephalus
(excessive water in brain)
Head trauma
Accidents most common cause
Memory loss is primary symptom
Chronic traumatic encephalopathy
(CTE)
o Sports
Frontotemporal degeneration
Anxiety
Depression
No aphasia
Substance use
o Drug use, plus poor diet
Alcohol, inhalants, sedatives, hypnotics,
anxiolytics
o Brain damage may be permanent
o Symptoms similar to other neurocognitive
disorders
Aphasia – language
Apraxia – movement
Agnosia – memory
Executive function impairments
Huntington’s disease
o Genetic autosomal dominant disorder
o Early onset = 40s and 50s
o Motor symptoms
Chorea – jerky movements
o Sub-cortical
Prion disease
o Always fatal
o Not contagious in humans
Cannibalism
Blood transfusions
o Linked to mad cow disease
Causes
Early, unsupported views
o Smoking
Alzheimer’s most common cause
Neurobiological influences
o Neurofibrillary tangles
Tau
o Amyloid plaques
Plaque
Spinal fluid
Genetic influences
o Polygenetic
o Chromosomes
Psychosocial/social factors
o Drug use
o Diet
o Exercise
o Stress
Cultural
o Ethnicity
o Economic conditions
Treatment
Chapter 16:
Substance-related
disorders
o Not synonymous with a
psychological disorder
Subjective
Flexible
Dangerousness
o Self or others
o Mental illness generally increases
likelihood of future violence
o Central to commitment
proceedings
o Questionable links to mental
illness
o Specific symptoms raise risk
Hallucinations
Delusions
Personality disorders
o Gender and ethnic biases
Role of mental health professionals:
Brain blame
Assessment tools
o Psychopathy checklist-revised
(PCL-R)
Best at identifying persons
low at risk of being violent
o Drug or alcohol dependence
o Cannot predict whether an
individual will become violent
Procedural changes:
Supreme court
o Restrictions on involuntary
commitment
o Insufficient grounds
Non-dangerous person
Need for treatment alone
Gravely disabled
Consequences of supreme court
o Criminalization of mentally ill
o Deinstitutionalization and
homelessness
o Transinstitutionalization
Reactions to strict commitment
procedures
o Return to broader procedures
o Easier commitment
o Increase in involuntary
commitments
Dangerous and non-
dangerous
Need for treatment alone
o Special cases of sex offenders
Treatment vs. punishment
o Periodic change in laws is a sign of
a healthy system
o Criminal commitment
Nature:
Accused of committing crime
Detainment in mental health facility
o Evaluation
Fitness to stand trial
Findings
o Guilty
o Not guilty by reason of insanity
Insanity defense: legal
statement/definition,
insanity at time of crime,
treatment facility vs. prison,
and/or diagnosis of
disorder doesn’t equal
insanity
Don’t know what you’re
doing; don’t know it’s
wrong
Ethical vs. legal considerations
o Therapeutic jurisprudence:
Integrating knowledge of behavior change
Problem solving courts
Address unique needs
Focus on specific problems
o Example – delayed sentencing if
job for six months
o Competence to stand trial:
Requirements
Understand legal charges
Ability to assist in defense
Essential for legal processes
Burden of proof = defense
Consequences
Loss of decision-making authority
Results in commitment
Psychologists’ role in legal matters
o Duty to warn:
Professional responsibility to inform those in
danger
Right to confidentiality
Threat must be specific
Consultation is imperative
Tarasoff vs. Cali
Therapist knew of danger, did not warn,
got sued
o Mental health professionals as expert witness
Psychologists’ roles
Specialized knowledge and expertise
Competency determinations
Assess risk – dangerousness
Reliable DSM diagnoses
Advise the court
o Psychological assessment
o Diagnosis
o Assess malingering
Patient and research subject rights
o Patients’ rights and clinical practice guidelines
Right to treatment
Must treat if involuntarily committed
Reduce symptoms
Provide humane
o Clean and sanitary environment
Least restrictive alternative
o More to less structure living
o Large to small facilities
o Large to smaller living units
o Group to individual residences
o Segregated from community to
integrated into community
o Dependent living to independent
living
Right to refuse treatment
o One of most controversial issues
o Medical or drug treatment
o Cannot force competence
o Individual participant rights
Practice standards
o Evidence-based practice and clinical practice guidelines
Effective health care practices
Empirical support
Systematic
Agency for healthcare research and quality
Patient protection and affordable care act
Mental health services
o Efficient
o Cost-effective
Dissemination of state-of-the-art info
o Practitioners
o General public
o APA practice guidelines
Standards fro clinical research
Efficacy
o Is it effective vs. alternative or
placebo?
Utility
o Does it make a difference?
o Can we apply if in real world?
Feasibility
Generalizability
Mental health care evolution