Psych final II

• Long-standing patterns of thought, behavior, and emotions that are maladaptive for the individual or for people around him/her.
• Person must have shown symptoms since adolescence and early adulthood
• Comorbidity - people are often diagnosed with Axis I disorder at some time
• Axis II

• Cluster A - Odd-Eccentric Personality Disorders
• Cluster B - Dramatic Emotional Personality Disorders
• Cluster C - Anxious-Fearful Personality Disorders

• Schizoid personality disorder
• Paranoid personality disorder
• Schizotypal personality disorder

• Chronic lack of interest in and avoidance of interpersonal relationships, emotional coldness towards others
• Therapy - increase social skills and awareness of own feelings, group therapy to practice social skills in a safe environment

• Chronic, pervasive mistrust and suspicion of others that is unwarranted and maladaptive
• Differs from schizophrenia - no bizarre delusions
• Cognitive theories - results from dysfunctional beliefs about the deceptiveness of others, you're an incapable person
• Difficult to treat - highly sensitive to challenge paranoid thinking
• CBT
• Increase self-efficacyIdentify mistrustful thoughts, emotions, increase adaptive thoughts and responses

• Chronic pattern of inhibited or inappropriate emotion and social behavior, aberrant cognitions, disorganized speech
• Similar to schizophrenia, not as severe - maintains basic contact with reality
• Positive symptoms - paranoia or suspiciousness, ideas of reference, magical thinking, illusions
• Negative symptoms - tangential, vague or circumstantial speech; inappropriate/no emotional response

• Biological - some genetic contribution, dysregulation of dopamine and abnormalities of brain structure similar to people diagnosed with schizophrenia, family members with schizophrenia
• Treatment - same drugs as schizophrenia
• CBT - identify and evaluate bizarre thoughts, build social contacts and social skills

• Antisocial personality disorder
• Borderline personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder

• Odd-Eccentric personality disorder
• Symptoms similar to milder versions of those in schizophrenia, including flat/inappropriate affect, odd thought and speech, paranoia
• Maintain grasp on reality

• Dramatic Emotional personality disorder
• Manipulative, volatile, uncaring in social relationships
• Impulsive, sometimes violent behavior that show little regard for their own safety or the safety/needs of others

• Anxious-Fearful personality disorder
• Extremely concerned about being criticized or abandoned by others and thus have dysfunctional relationships with them

• Pervasive pattern of criminal, impulsive, callous, or ruthless behavior; disregard rights of others, no respect for social norms
• Behaviors:
• Repeated unlawful behavior
• Deceitful behavior
• Impulsivity
• Agressiveness/fighting
• Reckless disregard for safety of others
• Consistent irresponsibility
• Lack of remorse
• Antisocial in childhood - conduct disorder
• Likely to have low level of education
• 80% drugs/alcohol abuse

• Biological: Genetic predisposition, testosterone, serotonin deficiency leads to impulsivity
• Attention-Deficit Hyperactivity Disorder - impulsivity
• Cognitive: Executive functions - deficits in abstract reasoning, concentration, goal formation, self-monitoring
• Low baseline arousal - need higher levels of excitement
• Social:
• Hostile/violent upbringing, modeling
• Biological: lithium and atypical antipsychotics
• Psychotherapy: anger management, work towards goals
• Empathy therapy - counterproductive

• Core personality
• Superficial charm
• Grandiose sense of self worth
• Need for stimulationDeceptivenessManipulativ
• eLack of empathy or remorse

Rapidly shifting moods, unstable relationships

Grandiose thoughts and feelings of one's owb self worth. Obliviousness to other's needs

• Related to comorbid diagnoses - depression
• Biological theories - overactive amygdala, impulsivity from low serotonin
• Dialectical Behavioral Therapy (Marcia Lineham)Theory of etiology - biological vulnerability and environmental component, emotional reactivity and environmental invalidation
• Process: relationship between client and therapist important, learn skills for solving problems, regulating intense emotions, social skills
• Validation - maintain relationship in face of intense emotion, help client gain realistic and positive sense of self
• Dialectical component - correct dichotamous thinking, slowly build people's ability to integrate dichotomy
• Coaching Calls

• Avoidant personality disorder
• Dependent personality disorder
• Obsessive-compulsive personality disorder

• Pervasive anxiety, a sense of inadequacy, and a fear of being criticized, which leads to the avoidance of social interactions and nervousness\
• Overlaps with social phobia - avoid social situations to avoid embarrassment, general sense of inadequacy
• CBT:Correct cognitive distortions
• Exposure therapy - exposure to social situations, self-efficacy
• Teach social skills

Pervasive selfishness, need to be cared for, fear of rejection, leading to total dependence on and submission to others. 

Pervasive rigidity in one's activities and interpersonal relationships, including emotional construction, extreme perfectionism, and anxiety about even minor disruptions in one's routine.

Physiological or behavioral symptoms resulting from cessation or reduction of substance use, which results in distress or functional impairment

Experience of significant behavioral and psychological symptoms due to the effect of a substance on the central nervous system

When repeated substance use leads to significant consequences to the person and the person's life

When substance use leads to physiological dependence (withdrawal, tolerance), as well as causing significant impairment/distress

• Alcohol
• Benzodiazepines and barbiturates (anxiety, insomnia)
• Inhalants

• Activate CNS
• Cocaine/crack
• Amphetamines
• Nicotine
• Caffeine

• Derived from opium poppy
• Imitates actions of endogenous opiates - endorphins which decrease pain when body is injured
• Initial euphoria
• Followed by - host of issues
• Morphine, heroin, codeine, methadone, oxycontin, vicodin

• Cause perceptual changes, even in small doses
• Intoxication can look like psychosis
• LSD, MDMA (ecstasy), peyote, PCP

• Genetic factors, esp alcohol
• Modeling
• Stress

Motivational interviewing - client centered approach, non-judgmental, build person's internal motivation to change

• Ability to assist attorney in defense
• Rational/factual understanding of the preceedings
• Not severity of psychiatric problem but deficit in trial relevent information, rationale, and decision making

• IST ranges 10-30%
• Less serious crimes, charges dropped
• Inpatient restoration
• Medication - necessary to continue with trial
• Clinician determines time frame if held

• Product of mental defect/mental illness
• Cannot be - antisocial, induced by drugs/alcohol, personality disorders
• Burden of proof on defense

• Danger to self - intent, plan
• Danger to others - identified victim, intent, plan
• Imminent danger

Psychologists have little more predictive accuracy than chance, especially for violence

• Duty to respect patient's rights and autonomy
• Duty to ensure patient safety - involuntary hospitalization, mandating reporting
• Duty to protect the public - duty to warn