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Psych ch. 10

What are the person’s specific symptoms? Why is she/he having the symptoms? How long will they last? And how can she/he be helped? A branch of psychology that focuses on these questions is ..which is an integration clinical, theory and clinical knowledge...understand, treat, and prevent psychological disorders.
deviation from the norm is the common misconception that an abnormal behavior is one that occurs very infrequently
Another aspect to consider when determining abnormality is whether the behavior is a deviation from the social norm (culturally speaking
Problem behaviors exist along a...which is a spectrum of... continuum...behavior ranging from mild to severe, infrequent to constant, controllable to uncontrollable, with no clear dividing line to indicate when normal becomes abnormal.
indicators of personal distress and functional impairment include indicators of personal distress and functional impairment
These indicators of personal distress and functional impairment are important criteria for a psychological disorder, according to the APA
Although personal distress is a...that varies from person to person, it is typically characterized by... subjective state....emotional pain and suffering
Functional impairment occurs when a person is unable to fulfill school or work obligations, sustain social relationships, or take care of oneself or children
Further, the symptoms must stem from dysfunction that may be biological, psychological, or both
etiology origin of the cause
Over the past 200 years, this medical model has become the predominant force in industrialized societies to explain ...and has resulted in a large body of... abnormal behavior...scientific knowledge about psychological disorders based on the medicine-based field of psychiatry
The medical model suggests that each type of psychological disorder has a specifiable cause (etiology), a common set of behavioral indicators (symptoms), and a predictable course over time (prognosis).
This model further implies that we have sufficient scientific knowledge to identify causes and indicators of a disorder and make predictions about what is likely to happen, with and without treatment.
Today, the most useful framework to understand abnormal behavior is the biopsychosocial approach.
The diathesis-stress model proposes a mechanism for explaining how psychological disorders can develop
According to the diathesis-stress model, the development of a mental disorder (sometimes referred to as psychopathology) requires the presence of P factors (the diathesis) and E factors (the stressor) in order to manifest itself
A diathesis is a predisposition, biological and/or psychological, that increases a person’s chance of developing a disorder
These diatheses, however are not sufficient in and of themselves to produce a psychological disorder. (need stress triggers)
stressors may range from major traumatic events (e.g., moving away from home to go to college, surviving a hurricane, divorce), to sociocultural inequities (e.g., poverty, discrimination), to daily hassles (e.g., losing keys, getting stuck in traffic).
The key feature of the diathesis-stress model is that both diathesis and stress are necessary in the development of disorders
The diathesis-stress model also highlights the point that psychopathology is unlikely to result from the impact of any single factor.
In the study of abnormal behavior, classification serves not only to...but also to... describe and categorize disorders...predict their course (prognosis), guide appropriate treatment, facilitate communication among professionals, and stimulate research on causes and treatments.
The most comprehensive and widely adopted classification system for psychopathologies is the Diagnostic and Statistical Manual of Mental Disorders (DSM),
DSM-IV-TR focuses on the but not the why—it describes the symptoms and explicit criteria that must be met to make a diagnosis, without any suggestion about the etiology of a disorder
Research confirms that stigma(...)is widespread in the U.S. and other industrialized countries negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with psychopathology
First, DSM-IV-TR is based on categorical classification
Therefore, most psychopathologies may be better described by a dimensional, rather than categorical, classification
The co-occurrence of two or more disorders is known as comorbidity
Third, while some disorders (e.g., schizophrenia, depression) are known to occur worldwide, many of the other DSM–IV-TR diagnoses do not exist in non-Western cultures.
Epidemiology is the study of the frequency and distribution of disorders within specific populations over a specified period of time
Epidemiological research usually takes the form of a large-scale survey and tends to be descriptive in the sense that it attempts to provide details mainly about the prevalence of disorders.
Severe mental illness affects 3-6% of the population
Treatment is provided by a variety of mental health professionals who aim to provide clients with relief from distress caused by their symptoms, medically and/or through self-awareness and insight into their problems, and/or coping and problem-solving skills
There are two major forms of such treatments: biomedical therapy and psychotherapy
Based on the medical model, biomedical therapy attempts to correct the specific biological defects underlying disorders and alleviate symptoms, often using drugs.
In psychotherapy, a trained clinician interacts with a client to help her/him feel, think, and behave differently. People seek psychotherapy for a variety of reasons—to cope with grief, major life transitions, or “tough time” at school, work, or home—and not all who seek psychotherapy can be said to have a psychological disorder.
For example, biomedical therapy is an essential component in helping people with schizophrenia, where biological diatheses play a major role
Furthermore, over the past decade, the mental health field has come to promote ...where clinicians incorporate... evidence-based practice...1) the best available research evidence with (2) clinical expertise and (3) knowledge of the client
eclecticism is when The majority of psychotherapists today do not rigidly adhere to a single theoretical perspective, but instead draw from a variety of techniques.
A widely used integrative approach...aims to alter.. cognitive-behavioral therapy...both thoughts and behavior
CBT is regarded as an evidence-based and cost-ective treatment that can be successfully applied to a wide range of psychopathologies and diverse client populations.
Yet objective assessment of treatment effectiveness is not as simple as you might think. When participants in a therapy study get better, the following three scenarios are possible: 1) the treatment indeed had an effect, (2) their symptoms improved or returned to normal level simply with the passage of time (spontaneous remission), or (3) their symptoms improved because they expected to get better (placebo effect).
Two popular and rigorous methods for evaluating the effectiveness of treatments are randomized controlled trials (RCTs) and meta-analyses
In RCTs, scientists control for the confounding variables using a control group and random assignments.
Ideally, treatments should be evaluated in double-blind RCTs, in which neither the client nor the researcher/therapist is aware of which intervention the client is receiving.
Meta-analysis is a statistical procedure to combine, or pool, the strength of a particular finding across a number of studies investigating the same or similar topics.
One caveat is that meta-analyses often rely only on published studies, and published studies are far more likely to have significant results than non-significant results
Without including unpublished data, meta-analyses may end up in an overestimation of effects of certain treatments
A phobia is a strong or irrational fear of a specific object or situation.
One example of such non-specific factors is the therapeutic alliance (bond between therapist and client), which has been found to be the key aspect of effective therapy.
Specific phobia is characterized by an an excessive and irrational fear of a specific object or situation that interferes with a person’s everyday functioning.
Pathological anxiety and fear are irrational, persistent, maladaptive, and uncontrollable, may strike without a specific threat, and cause significant personal distress and functional impairment
Triggers for specific phobia generally fall into the following four categories (1) animals or insects, (2) natural environments (e.g., heights, water, lightening), (3) situations (e.g., flying, tunnels, enclosed places), or (4) blood or injury
Individuals with GAD (generalized anxiety disorder) worry about anything and everything—constantly—and find their worrying uncontrollable.
Social phobia (or social anxiety disorder), on the other hand, involves a severe and persistent fear of being embarrassed, humiliated, or negatively evaluated in social or performance situations
social phobia is far more debilitating than ordinary shyness
Persons suffering from panic attacks are frequently overwhelmed by such intense fear— often without actual danger.
When panic attacks occur frequently panic disorder is diagnosed
Some individuals with panic disorder develop agoraphobia, debilitating fear and avoidance of situations in which getting help or escape might be difficult in the event of having a panic attack.
Ataque de nervios (see Box 10.4) may be considered a cultural variant of panic disorder
In OCD, such thoughts and actions dominate a person’s life, causing significant distress and impairment in everyday functioning
Obsessions are repeated, intrusive, and uncontrollable thoughts or mental images
Common obsessions take the form of pathological doubts or an irrational fear of contamination, of harming someone, or of acting on some sexual or violent impulse
Compulsions are repetitive, ritualized behaviors that the person feels driven to perform to reduce the anxiety caused by the obsessions.
Common compulsions include checking, cleaning/washing, and counting.
People with PTSD are plagued by chronic anxiety that has developed after experiencing or witnessing an extremely frightening—often life-threatening—traumatic event
PTSD is marked by three core symptoms 1) unwanted, intrusive re-experiencing of the traumatic event, (2) numbing of emotions and avoidance of situations that might trigger memories of the event, and (3) increased arousal
increased arousal, which includes being easily startled, hyper-vigilance, difficulty sleeping, irritability or outbursts of anger, and difficulty concentrating
According to the behavioral perspective, irrational anxiety and fear are learned
through stimulus generalization, she/he may develop a phobia of all kinds of bugs after being stung by a bee (classical conditioning)
Operant conditioning, on the other hand, may explain how avoidance behavior and compulsions are maintained
Finally, pathological fear may be learned via modeling; for example, children who observe their parents “freak out” over small insects may exhibit the same behavior.
Psychological diatheses can also involve misperceptions and unfounded beliefs
The cognitive perspective of irrational anxiety and fear focuses on the involvement of a cognitive bias toward processing threatening information or interpreting ambiguous information negatively
some individuals may be biologically inclined to heightened physiological arousal (rapid heart rate, shortness of breath, sweaty palms, dizziness, etc.).
Second, anxiety disorders run in families. Paired with a traumatic event high-strung temperament (which is largely genetically determined) may result in pathological anxiety
Third, neurochemical imbalance in the brain has been linked to some anxiety disorders
Recall that the behavioral perspective assumes that if anxiety disorders were learned through classical conditioning, they could be “unlearned” by disrupting the association between conditioned stimulus (CS) and conditioned response (CR).
Counterconditioning pairs CS (e.g., a wasp) with a new response that is incompatible with anxiety (e.g., relaxation
The principle of counterconditioning is behind which... exposure therapy...the client directly and repeatedly confronts anxiety-provoking objects and situations until they are no longer threatening.
One widely used exposure therapy is systematic desensitization
systematic desensitization. It involves three basic steps (suppose you were the client): you and therapist work together to develop hierarchy of feared situations (least to most distressing), learn to relax deeply, actual desensitization
Cognitive therapy uses a principle technique called cognitive restructuring, where the client is taught to recognize her/his automatic, biased ways of thinking that lead to anxiety and other negative emotions, and to interpret the same information in more realistic and healthy ways.
CBT of anxiety disorders combine exposure therapy with cognitive restructuring
In terms of biomedical therapy, antianxiety drugs help reduce symptoms of anxiety and stress.
most widely prescribed antianxiety drugs are benzodiazepines (e.g., Valium, Xanax), a type of tranquilizer that produces rapid effects by increasing the level of GABA
Antidepressants (medications that help lift mood) are increasingly being used to successfully treat anxiety disorders
criteria for mood disorders are met when a person experiences a pattern of moods that lie at either extreme, causing significant distress or impairments in everyday functioning
In major depression, symptoms of depressed mood persist for at least two weeks
Dysthymia is characterized by chronic, low-grade depression. It shares many of the characteristics of major depression, albeit in milder forms.
Women’s risk of depressive disorders, therefore, is double that of men’s, and consistent... gender difference...cross culturally
DSM-IV-TR defines two main types of bipolar disorder. The more severe type is...and the other type is... bipolar I disorder...bipolar II disorder
bipolar I disorder, where individuals alternate between episodes of major depression and mania.
In bipolar II disorder, episodes of major depression alternate with periods of hypomania (mild mania).
Biological diatheses are illustrated in research on families, twins, and adopted children. These studies suggest a strong genetic diathesis, with heritability of major depression estimated to be around 40%.
Another biomedical diathesis for mood disorders may involve abnormal brain activity
neurochemical deficiencies in...may play a major role in the... NE and serotonin...etiology of depression
Psychological diatheses provide a powerful explanatory mechanism of the onset and maintenance of depression
The cognitive perspective assumes that depression results when individuals develop a cognitive schema that biases them toward negative views of the self, the world, and the future (negative triad).
The negative triad is a cognitive distortion that leads to a number of systematic cognitive biases
negative triad further influences the way people explain their behavior and the events that happen to them which is called...and is often...rather than... attributional style...internal...external
attributional style is also...rather than...and...rather than...
We must also consider sociocultural factors (diatheses and stressors) that may play a role in the etiology and course of depression
Research confirms that women are significantly more likely than men to use ruminative coping when depressed (focusing on negative emotions)
Rumination tends to fuel the negative schema, intensifying hopelessness and helplessness.
Yet another explanation is that women tend to experience more stress in the form of sexism and discrimination, violence and abuse, too much workload, and less satisfying work and family lives
Low socioeconomic status is also a risk factor for depressive disorders, and women are more likely to experience poverty
Psychotherapy for depression is influenced by assumptions about the causes of depression
In cognitive restructuring clients are often asked to monitor their automatic negative thoughts
clients are often asked to monitor their automatic negative thoughts using a form that allows them to connect their automatic thoughts with their depressive symptoms, to examine the evidence for and against their automatic thoughts, and to come up with alternative, more balanced thoughts
According to Cognitive Behavior Therapy (CBT), thoughts, feelings, and behaviors are interrelated
Another type of psychotherapy that has been shown to be effective in treating major depression is interpersonal therapy
A variant of short-term psychodynamic therapy, interpersonal therapy aims to help clients to identify and better understand their current interpersonal problems and to develop more adaptive ways of relating others
Interpersonal therapy is highly structured and focuses on the following interpersonal problem areas 1) role transitions, 2) unresolved grief, 3) interpersonal dispute and 4) interpersonal deficits
Biomedical treatment, particularly...are an essential part of the... prescription medicines...medical management of severe mood disorders
Bipolar disorder is treated with mood stabilizers such as lithium and Depakote
Antidepressants block the breakdown or reabsorption of serotonin and/or norepinephrine to enhance synaptic transmission
Tricyclics (e.g., Tofranil, Elavil) increase the amount of both NE and serotonin
Among the most widely used antidepressants today are selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil, and Zoloft
which has a greater effect? placebo or antidepressants? according to randomized controlled trials, antidepressants are slightly better
In ECT, electric currents are passed through the brain, producing a brief seizure
The risk of suicide among those with major depression is about...taht of the general pop 20 times
those experiencing psychosis lose their grip on reality and exhibit severe disturbances in thought, language, sensory perception, emotion regulation, and behavior
According to DSM-IV-TR, schizophrenia is diagnosed (i.e., criteria for schizophrenia have been met) when two or more of the following five central features are present for at least one month, with signs of the disorder persisting for at least six months
signs of the disorder persisting for at least six months: (1) delusions, (2) hallucinations, (3) disorganized speech, (4) grossly disorganized or catatonic behavior, and (5) negative symptoms (e.g., flat affect, apathy, poverty of speech)
(1) delusions, (2) hallucinations, (3) disorganized speech, (4) grossly disorganized or catatonic behavior are considered positive symptoms because they reflect an excess or distortion of normal functions
negative symptoms reflect diminution or absence of normal functions.
Delusions are false beliefs that are firmly held
Hallucinations are false perceptions, e.g., seeing or hearing things that are not there
Disorganized speech reflects difficulties in organizing thoughts and focusing attention.
During a conversation, people with schizophrenia often display loose associations, word jumble, neologisms (made up words) and clanging (meaningless use of rhyming words)
individuals with schizophrenia may engage in grossly disorganized and bizarre behavior
catatonia motor disturbances characterized by muscle rigidity or a marked decrease in all movement, or excessive stereotyped movements
Present in two-thirds of people with schizophrenia, flat affect is a lack of emotional expression, often manifesting in a vacant stare, lack of eye contact, and monotonous voice tone.
Apathy represents passivity and an inability to carry out normal day-to-day goal-oriented activities.
Poverty of speech refers to brief, empty replies to questions.
Negative symptoms also include anhedonia an inability to experience pleasure
the following subtypes of schizophrenia have been identified: paranoid type, catatonic type and disorganized type
paranoid type is characterized by prominent delusions and/or auditory hallucinations
catatonic type is characterized by immobility and stupor or agitated, purposeless motor activity
most severe type of schizophrenia is...which features... disorganized type...disorganized speech and behavior as well as flat or inappropriate effect
On the biochemical side, the dopamine hypothesis— the theory that symptoms of schizophrenia result from excessive dopamine activities
antipsychotics act by blocking dopamine receptors
amphetamines and cocain increase dopamine activity
Modern neuroimaging techniques reveal some some functional and structural brain abnormalities associated with schizophrenia
An increased risk of developing schizophrenia has also been associated with maternal exposure to influenza virus during pregnancy, which may disrupt fetal brain development and lead to the kinds of brain abnormalities discussed above.
The lifetime prevalence of schizophrenia is 1%, affecting men and women equally, and this rate seems to be similar across different cultures
The course of psychosis is also best understood in terms of the diathesis-stress model. That is, schizophrenia results when internal predisposition is coupled with environmental and psychosocial stressors
tardive dyskinesia, characterized by stereotyped, involuntary movements of the face and mouth
atypical antipsychotic drugs such as Clozaril, Risperdal, and Zyprexa—target both dopamine and serotonin
deinstitutionalization moving patients out of public hospitals into the community.
As a number of public hospitals closed, a network of community mental health centers (CMHCs) were established to provide emergency care as needed, but primarily outpatient treatment and assistance in community living
One of the most well-defined and well-researched treatment models for people with severe mental illness,..., is an... assertive community treatment(ACT)...intensive team approach first developed in the 1970s
Recent research on therapeutic lifestyle change demonstrates that maintaining...can effectively combat depression (1) aerobic exercise, (2) diet rich in omega-3 fatty acid, (3) adequate sleep, (4) meaningful social engagement, (5) natural sunlight exposure, and (6) anti-rumination
Created by: handrzej
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