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"normal", vs. "abnormal"
- 4 criteria
- 1. Distress- emotional pain, difficult to function.
- 2. Impairment-can't function at an optimal or average level.
- 3. Risk to self of others- committing suicide or abusing others.
- 4.Socially/ Culturally unacceptable behaviors- yelling a dead person's name, looking for them in the middle of the night.
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Prevalence of mental disorders in U.S.
21 % of Americans have experienced a mental disorder during the perceding year. A Life time prevalence of mental disorder = 32%.
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Comorbid
co-existing psychiatric condition. 54% (just remember that number)
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Psychiatrists
Medical Doctors (MDs) with advanced training in treating people with psychological disorders.
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Psychologists
Trained in either type of doctoral program. Some counseling some normal development.
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Issues of reliability of a diagnostic system.
A given diagnosis will be consistently applied to anyone showing a particular set of symptoms.
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Issues of validity of a diagnostic system.
The diagnoses represent real and distinct clinical phenomena.
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How DSM developed: theoretical assumption of the first edition. What year?
(1952)- Theoretical assumptions that emotional problems or "reactions" causes the disorders it described.
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Definition of "mental disorder". (When it is clinically significant.)
Distress or disability, significant risk, Not acceptable behavior.
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4 Assumptions of DSM.
- 1.Classification system based on medical model (patient)
- 2.Atheoretical Orientation -
- 3. Catergorical Approach
- 4. Multiaxial system- allows clients to be characterized in a multidemensional way.
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Neurosis
behavior that involves distressing, unacceptable symptoms that are enduring and lack any physical basis. (not a modern term diagnostic term)
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Psychosis
Various forms of behavior involving a loss of contact with reality, such as delusions (false beliefs) and hallucinations (false perceptions). (Not a formal diagnostic category, psychotic is retained in the DMS as a descriptive term.) NOT USED AS PART OF THE OFFICIAL NAMING SYSTEM.
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Within the Categorical approach, the recent movement to the dimensional model.
There is difficulty of establishing clear boundaries between psychological conditions so they are considering adopting a dimensional model. (EX. MILD, MODERATE, SEVERE,.. etc..)
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5 Axes
- Axis 1- Clinical disorders - collection of symptoms that constitute a particular abnormality.
- Axis 2- Personality Disorders + Mental Retardation- sets of disorders that represent enduring characteristics of an individual's personality or abilities.
- Axis 3- General Medical Condition- for documenting a client's mental conditions, keep in mind when developing a treatment plan.
- Axis 4- Psychosocial and Environmental Problems - documents events that may affect the diagnosis, treatment or outcome of a client's psychological disorder. (stressors) p. 48
- Axis 5- Global Assessment of Functioning (GAF) Scale- overall rating of psychological health.
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Determining the best approach to treatment. (p. 60-61) and current idea of empirically-supported treatment (EST). GOALS
- Immediate Goals- addresses most processing needs at the moments.
- Short-term Goals- change in behavior, thinking and emotions.
- Long-term Goals- depply rooted alternative in relationships and personality.
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Components of mental status examination.
- Obsession- unwanted thoughts.
- Overvalued idea- Thoughts that have an odd and absurd quality: not usually bizzare.
- Magical thinking- Connections between two non-related events, (Drying clothes causes disaster)
- Affect- an individual's outward expression of emotion. VS Mood- refers to a person's experience of emotion, the way a person feels inside.
- -Thought disorder in speech- incoherence, loosening of associations.
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Fear VS Anxiety
- Fear- innate, almost biologically based alarm response to dangerous of life-threatening situation.
- Anxiety-is more future-oriented and global, referring to the state in which an individual is inordinately apprehensive, tense, and uneasy about the prospect of something terrible happening.
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Symptoms of Anxiety disorder
incapacitated by chronic and intense feelings of anxiety, feelings so strong that they are unable to function. Anxiety becomes a matter on clinical concern when it reaches a day- to-day unable to function. enters maladaptive state (extreme physical and psychological reactions.) 28% of U.S.
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Treatment of Anxiety Disorder
Psychotropic medications (Zoloft, BuSpar, Paxil, Effexor)
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Somatoform disorders- How they were important in history?
- - include a variety of conditions in which psychological conflicts become translated into physical problems or complaints that cause distress or impairment in a person's life.
- (history)- ANNA O.
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Charcot and his discovery though the use of hypnosis.
Used hypnosis to show that psychological factors played a role in the physical symptoms or hysteria.
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Various somatoform disorders
- Somatization disorder- involves the expression of psychological issues through bodily problems that cannot be explained by any medical condition, or substance.
- -Body Dysmophic Disorder (BDD)- preoccupied, almost to point of being delusional, with the ideas that a part of their body is ugly or defective...
- -Hypochonriasis- believe or fear that they have a serious illness, when in fact they are merely experiencing normal bodily reactions.
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Malingering and factitious disorders.
- Malingering- deliberately feigning the symptoms of physical illness or psychological disorder for an ulterior motive.
- -Factitious Disorder- people fake symptoms or disorders, not for the purpose of any particular gain but because of an inner need to maintain a sick role.
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Munchausen Syndrome by Proxy
a person induces physical symptoms in another person who in under that individual's care. (baby video)
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Primary and secondary gain in Somatoform disorders.
- Primary gain- the avoidance of burdensome responsibilities because one is "disabled".
- -Secondary gain- sympathy and attention the sick person receives from other people.
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Psychological factors affecting medical conditions
includes situations in which psychological or behavioral factors have an adverse effect on a medical condition. (EX. Axis 1 disorders, psychological symptoms, personality traits, maladaptive health behaviors, stress-related physiological responses and less specific psychological factors.)
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Stress and Stressors
- Stress- the unpleasant emotional reaction a person has when they perceive an event to be threatening.
- -Stressors- the event itself.
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Types of Coping Strategies. (Problem vs. emotional focused)
- -Problem-focused strategies- taking care of the problem and overcoming the anxiety. These people find that simply making plans to deal with the problem makes them feel better than doing nothing.
- -Emotion-focused strategies- reduce the emotional distress that accompanies the problem.
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Field of Psychoneuroimmunology.
Psychoneuroimmunology- the study of the connections among stress, nervous system functions and the immune system.
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Mood States: Dysphoria and Euphoria
- Dysphoria- emotion of sadness.
- -Euphoria -emotion of elation.( more cheerful than average person)
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Classification of mood disorders. LOOK IT UP
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Types of depression (melancholy and seasonal pattern.)
- Melancholy- lose interest in most activities or find it difficult to react to events in their lives that would normally bring pleasure.
- -Seasonal pattern- develope a depressive episode at about the same time each year, usually about 2 months during the fall or winter, but then they return to normal functioning.
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Issues with the referral of young children.
Some children just have temper tantrums, or disobey the rules. It is not a reason to think they have a disorder.
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Mental Retardation: criteria for diagnosis
IQ below 70. 1% of population, more common in males.
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The range of mental retardation.
From mild to Profound.
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Common forms of mental retardation and their causes.
- Down Syndrome- caused by an extra twenty-third chromosome.
- -PKU- inability to utilize phenylalanine, which builds up in the body's tissues and blood, leading to severe neural damage.
- -Tay-Sacks- a metabolic disorder caused by the absence of a vital enzyme, which leads to the accumalation of lipid in nerve cells, leading to neural degeneration and early death, usually before the age of 5.
- -Fragile X- on X chromosome, severe forms of retardation (mostly in males).
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Environmentally related mental retardation; Fetal Alchohol Syndrome and the oterh examples...
- 1. Prenatal Disease-
- 2. Difficult delivery
- 3. Premature birth
- 4. Prenatal substance abuse
- 5. Failure to thrive
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Pervasive developmental disorders definition...
Conditions that begin in childhood and have a major impact on social and cognitive functioning; involving serious deficits in social interaction and communication skills, as well as odd behavior, interests, and activities.
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Pervasive disorders. (Rett)
Rett's disorder- only in females, child develops normally until between 5 months to 4 years, then begins to show neurological and cognitive impairments,(deceleration of head growth, stereotyped movements of hand, a lack of bodily coordination, language impairments, and social withdrawal.
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Pervasive disorders. (Disintegrative)
-develops normally for 2 years, but before age 10 starts to lose language and motor skills as well as other adaptive functions, including bowel and bladder control.
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Pervasive disorders. (Asperger)
-maintain cognitive and language development but become severly impaired in social interaction.
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Symptoms of Autism
- Apparent before age 3, usually in infancy.
- -Clinicians assign the diagnosis based on symptoms that fall in three groups:
- 1. Impaired social interaction.
- 2. Impaired communication.
- 3. Oddities of behavior, interests, and/or activities.
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Theories about autism's source (heritability) & evidence for it.
- Patterns of family inheritance.
- - Concordance among identical twins.
- - Chromosomal abnormalities.
- - Structural brain abnormalities.
- - Functional brain abnormalities.
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Interventions in mental retardation and autism- (mainstreaming)
Mainstreaming- (develope motor abilities, coordination, language usage, and social skills.) People with cognitive and physical disabilities are integrated with non-disabled individuals, they participate in ordinary school classrooms, where they are provided with assistance geared to their particular needs.
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Interventions in mental retardation and autism- (Behavior modification techniques)
Behavior modification techniques- rewarding the child for good behavior
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ADHD
- inattentiveness and hyperactivity-impulsivity.
- -Causes- growing up in disturbed family environment, and biological factors.
- -Treatments-Medications (Ritalin), let them understand the disorder.
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Conduct Disorder
a condition characterized by the repetitive and persistent violation of the rights of other people
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Oppositional defiance disorder
show a pattern of negative, hostile, and defiant behavior that results in significant family or school problems.
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Separation Anxiety disorder (in general)
intense and inappropriate anxiety concerning separation from home or caregivers.
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