Exam 3 Flashcards

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1
Q

The term, “Insanity” is used in what context?

A

Mental Disorder – Psychological Term

Insanity – Legal Term

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2
Q

Know the types of insanity pleas

A

o Not guilty by reason of insanity (NGRI)- Not guilty of crime, Indefinite commitment to a forensic hospital, Released when no longer mentally ill
o Guilty but mentally ill (GBMI)- Found guilty and responsible for the crime , Can be committed for treatment until “No longer mentally ill”, then sent to prison for remainder of sentence, Most are incarcerated and may or may not receive any psychiatric care

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3
Q

Is the insanity plea commonly used? Is it effective?

A

o Pleaded in fewer than 1% of cases, Rarely successful (26%)

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4
Q

Understand competency to stand trial

A

o Person has mental illness at time of trial, Accused must be able to participate in his or her defense, Determination of competency is made before individual is tried, Most receive treatment and then are returned to court, If medication can produce rationality, trial can be held, Even if discontinuation of drug would render defendant incompetent

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5
Q

Understand CA Involuntary Commitment Law (5150)

A

o A Person is: A danger to oneself, A danger to others; OR Gravely disabled (inability to obtain food, clothing, and/or shelter, due to mental illness). Requires documentation by police officer or clinician

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6
Q

Understand Confidentiality and exceptions to confidentiality

A

o Requires therapists to keep information from clients private, unless a release of information is provided., This includes the fact that the client is seeing the therapist.
o Duty to warn
o Duty to report child/dependent adult/elder abuse
o Suicidal/homicidal
o Legal subpoena (but don’t disclose more than needed)

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7
Q

What are dual relationships and what is therapists responsibility regarding them?

A

o Therapists refrain from entering into a multiple relationship if it could reasonably be expected to impair the psychologist’s objectivity, competence or effectiveness
o Therapists do not enter into sexual relationships with clients, students, supervisees, research assistants, research participants, family members of clients, etc.

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8
Q

Define Obsessions

A

Recurrent thoughts, urges, or images
o Intrusive and unwanted
o The individual attempts to suppress or neutralize them with another thought or action (sometimes compulsions)

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9
Q

Most common obsessions:

A
o	Contamination 
o	Aggressive impulses 
o	sexual impulses 
o	symmetry/order
o	doubt
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10
Q

Define Compulsions

A

o Repetitive behaviors or mental acts that must be performed in response to an obsession or rule
o Aimed at reducing anxiety or preventing a calamity
o Behaviors are not connected realistically to what they are trying to prevent or are clearly excessive
o Short Definition: Impulse to repeat certain behaviors or mental acts to avoid distress

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11
Q

Common Examples of compulsions:

A
o	Washing and cleaning, 
o	checking
o	Counting
o	Touching 
o	Mental
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12
Q

Define Obsessive Compulsive Disorder

A

o Presence of obsessions, compulsions, or both
o The obsessions or compulsions are time consuming (e.g. 1 hr per day) or cause clinically significant distress or impairment in functioning
o Recognition that obsessions or compulsions are unreasonable (not for children)

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13
Q

Understand the maintenance of OCD as explained in lecture

A

o Association of certain objects/ideas with fear
o Develop obsessions to process and suppress fear
o Perform compulsions in order to help reduce the fear
o Compulsions began randomly, then become associated with anxiety

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14
Q

Define Body Dysmorphic Disorder

A

o Preoccupied with a real or imagined defect in appearance – excessive.
o Person’s concern is excessive
o Engage in compulsive behaviors
o Checking, comparing, seeking reassurance, or trying to change their appearance
o High levels of shame, anxiety, and depression
o Not due to symptoms of an eating disorder
o Can have serious effect on functioning – in some, inability to work.

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15
Q

Understand the maintenance of Body Dysmorphic Disorder as explained in lecture.

A

o Biased attention to detail
o Self-objectification and more value on physical appearance
o Focus on specific “defective” features rather than overall appearance

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16
Q

What is often misunderstood about people’s self-evaluation in BDD?

A

.Often misunderstood – People with BDD often “lack a normative self-enhancing bias” Show more accurate self-evaluation.

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17
Q

Define Hoarding Disorder

A

o Perceived need to save the items, and distress about to discarding regardless of value.
o Accumulation of possessions clutters living areas and substantially compromises their intended use.
o If no cluttering, it is due to third party intervention (e.g. family)
o 66% are unaware of severity of problem

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18
Q

Define Trichotillomania. What do people typically feel before and during pulling. What emotions can trigger the behavior?

A

o Recurrent pulling out of one’s hair, and repeated attempts to stop.
o Causes loss of hair and significant distress/impairment.
o A feeling of tension prior to pulling or when trying to resist the behavior.
o Pleasure, gratification, or relief while engaging in the behavior.
o Can be triggered by stress but also other emotions such as boredom.
o Average age of onset is 11.
o Female to male ratio is 10:1

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19
Q

Define Excoriation Disorder

A

o Recurrent skin picking resulting in lesions
o Repeated attempts to stop
o Causes distress or impairment
o Most common among women between the ages of 30 and 45
o New disorder in the DSM-5

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20
Q

Understand Exposure Plus Response Prevention (ERP) for treating OCD

A

o Exposure
o Not perform compulsions.
o Results in the extinction of the conditioned response (the anxiety)

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21
Q

What term was the pre-curser to PTSD? When was the term introduced?

A

Shell shock, Charles Myers, WWI

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22
Q

When did PTSD did become a disorder? Veterans of what war supported this?

A

1980 PTSD established as a diagnosis in the DSM 3 as a result of a political movement supported by Vietnam Veterans, the Women’s Movement and other cultural groups.

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23
Q

What is Posttraumatic Stress as defined in lecture.

A

Traumatic Stress
o Extreme form of stress – from overwhelming incident(s).
o Fight, flight, freeze and submit responses.
Posttraumatic Stress
o Traumatic Stress that is ongoing.
o Not relieved by a nervous system response at the time
o Or later by natural or therapeutic means.

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24
Q

What is trauma as an event? (As defined in lecture)

A

o Distressing situations - overwhelming, creating sense of powerlessness.
o Often threatens life, safety and sense of security.
o Trauma as a Response
o Symptoms that are considered “normal” reactions to trauma.
o Subjective response to an event
o Common symptoms: Shock, denial, and feelings of overwhelm.
o Sometimes symptoms can be ongoing for a long time.

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25
Q

Know PTSD Criteria A: Event

A

o DSM Criteria A: Exposure to real or threatened death, serious injury, or sexual violence
o Exposure can be: Directly experiencing it. Witnessing it, in person, occurring to others. Learning that it happened to a close family/friend. Experiencing extreme exposure to details of the events (e.g. police exposed to child abuse)
o Know the PTSD intrusion symptoms

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26
Q

PTSD Criteria B. Presence of 1 or more:

A

o Recurrent distressing memories of the event.
o Nightmares related to the trauma
o Flashbacks
o Intense distress in response to reminders of the trauma
o Physiological reactions to reminders of the trauma

27
Q

Generally understand the difference between hyperarousal and hypoarousal

A

o Hyperarousal- Increased activation, Sweating, shaking, shallow breath, agitation, high energy, trembling voice, tightening muscles, jerky movements, widening eyes, increase in vigilance.
o Hypoarousal- Body slows down, Flat affect, cognitive confusion, dissociation, collapse in posture, stilling of movement, loss of visual focus, glazing over.

28
Q

Know the PTSD Avoidance Symptoms

A

Criteria C. Presence of 1 or more:
• Efforts to avoid distressing memories, thoughts, feelings, about the event
• Avoidance to of external reminders about the event

29
Q

Know the PTSD Cognitive and Mood Symptoms

A

o Criteria D. Presence of 2 or more:
• Inability to remember an important aspect of event
• Negative beliefs about self, others, world
• Distorted sense of blame for self or others related to event
• Persistent negative state (e.g. fear, anger, guilt, shame)
• Reduced interest in significant activities
• Feelings of detachment or estrangement from others
• Inability to experience positive emotions

30
Q

Know the PTSD Arousal and Reactivity Symptoms

A
o	Criteria E. Presence of 2 or more:
•	Irritable behavior and angry outbursts
•	Reckless or self-destructive behavior
•	Hypervigilance
•	Exaggerated startle response
•	Problems with concentration
•	Sleep disturbance
•	Know that PTSD involves having symptoms for more than 1 month
31
Q

Know time frame for Acute Stress Disorder (ASD)

A

o 3 days-1 month after trauma

32
Q

If a person is diagnosed with ASD, is it predicted that they will have a lower or higher risk of PTSD?

A

Higher, within 2 years

33
Q

What is the effect of treating ASD on PTSD?

A

o May prevent PTSD, benefits even 5 yrs post event

34
Q

What poses a higher risk for PTSD -natural disasters or traumas of human design?

A

o Human design

35
Q

What is the relationship between avoidance coping and memory supression and the development of PTSD?

A

Look up in notes

36
Q

PTSD female to male prevalence? What is the main influence on this rate?

A

o 2:1, sexual abuse

37
Q

Know that PTSD affects different social groups:

A

o Directly: hate crimes, gender, culture and race-based violations,
o Indirectly: poverty, gender, race, culture as a risk factor for exposure to violence.

38
Q

Know that Race Based Traumatic Stress is

A

when a racially motivated interpersonal or institutional stressor causes symptoms of intrusion, avoidance, and arousal in response to racism.

39
Q

Define multigenerational trauma

A

o Multigenerational Trauma – Trauma experienced in one generation can effect generations to come.

40
Q

3 Phases of Phase Oriented Treatment of PTSD:

o Name and treatment goals of phase 1

A
    1. Safety/ Stabilization
  • Support safety and everyday functioning. Assess for resources.
  • Teach control over dysregulated states.
  • Treatments Hyperarousal – Grounding and Centering
  • Treatments Hypoarousal – Alignment, stomping, standing
  • For both – orienting and pushing.
  • Teach awareness of sensory experience when person is ready.
  • Goal of therapy: help client to engage in daily life with greater ease and comfort and to feel more of a sense of control over one’s life
41
Q

• Name of phase 2 of PTSD Treatment? What to do if person becomes hyperaroused or hypoaroused during this phase?

A

o Remembrance and Mourning
o CBT
o Exposure to memories and reminders
o Process event and how it is internal template for organizing world.
o Challenge distorted beliefs about self and world.
o Memories can be uncertain – Therapist does not lead or clarify with absolute statements.
o As arousal increases, go back to Phase 1 and stabilize

42
Q

Name of phase 3 of PTSD Treatment?

A

o Reconnection
o Assisting person to reconnect with meaningful relationships
o Helping person to engage in life activities.

43
Q

What are the 3 things that trauma therapy should include according to the lecture?

A

o Help client remain present throughout the session.
• Use orienting and focus on self-awareness. Stopping client when there is too much arousal and stabilize.
o Build up coping mechanisms
• Work with client on relaxation strategies, charting symptoms and restoring eating and sleeping cycles.
• Working on grounding and centering at the end of every session.
o Transition from the session back to life in a healthy way

44
Q

• Define Eye Movement Desensitization Reprocessing (EMDR).

A

o Pair eye movements with cognitive processing of traumatic memories
o Controversial among researchers
o Research shows that it is effective
o When compared to exposure therapy there is no difference in outcomes.
o Are the eye movements necessary?

45
Q

• Define Psychological Debriefing. What are long-term effects?

A

o A single session from 1-3 hours during the days following the event.
o Shown to be helpful in the short-term.
o In long-term, associated with increased PTSD symptoms relative to no treatment (Van Emmerik et al., 2002)
o May be because interferes with natural recovery process to traumatic event.
o Different than short-term CBT sessions offered about 2 weeks following event
o Research shows these to be very effective.

46
Q

Effect of prolonged treatment by Benzodiazapines on PTSD symptoms?

A

o Short-term administration of Benzodiazapines (Study showing administering for 5 nights was found to improve sleep and PTSD symptoms) Shalev 2002
o Prolonged treatment by Benzodiazapines (2-18 days) was associated with higher incidence of PTSD at six months.
o Interfere with learning, integration and adaptation.

47
Q

Know the following definition of Dissociation

A

Experiences are not integrated but stored in isolated fragments. An adaptive defense in response to trauma. Characterized by memory loss and a sense of disconnection from oneself or one’s surroundings.

48
Q

Define Dissociative Amnesia

A

o One or more episodes of inability to recall important personal information, beyond ordinary forgetfulness
o Usually related to trauma or personal stress

49
Q

Characteristics of Dissociative Amnesia Memory loss:

A

o Memory intact for non-personal information
o Memory gap of a few minutes, days or longer periods
o Usually aware that they have “lost time.”
o Amnesia is typically anterograde and localized or selective.

50
Q

Define Dissociative fugue

A

o Personal identity change/confusion
o Sudden travel, with inability to recall past
o Often little/no distress during fugue
o End suddenly – resolves without treatment
o Rare

51
Q

Define Depersonalization/ Derealization Disorder

A

o Not involving memory problems
o Persistent feeling of being separated from one’s mental processes or body
o Experience of unreality or detachment from surroundings
o Treatment
o CBT
o Grounding Techniques
o Treating underlying disorder or stressor– depression, trauma

52
Q

Define Dissociative Identity Disorder

A

o More than 2 identities/personality states
o Control of behavior assumed by these identities
o Cannot recall daily personal information; beyond normal forgetfulness
o Previously Multiple Personality Disorder (MPD)

53
Q

Understand causes and development of DID

A
  • Response to overwhelming childhood trauma
  • If dissociation isn’t strong enough defense, diff personalities emerge to handle trauma
  • 3 Stages: 1) trauma 2) imaginary companions 3)Alters
  • Person develops primary ID and different alters
  • Alters have different psychological and physical traits
  • Transitions often in times of stress
  • Increased Risk: Earlier age of trauma, severity, # of perpetrators
54
Q

Name the three Phases of Treatment for DID

A
  • Phase 1: Establishing Safety, Stabilization, and Symptom Reduction
  • Moderate Arousal levels
  • Coping skills
  • Phase 2: Treatment of Traumatic Memories
  • Remember, tolerate, process, integrate
  • CBT Therapy
  • Phase 3: Reintegration and Rehabilitation
  • Continue to fuse identities
  • Learn to deal with everyday life without dissociating
55
Q

Define Somatic Symptom Disorder

A

o One or more somatic symptoms that are distressing or significantly affect life functioning
o At least one of:
• Excessive thoughts about situation
• High anxiety about situation
• Excessive time and energy devoted to the concerns.
• Symptomatic for 6 months
• Predominant pain specifier

56
Q

Define Illness Anxiety Disorder

A

o Preoccupation with acquiring a serious illness
o Preoccupation is out of proportion to any symptoms
o High anxiety about health in general
o Excessive health related behaviors
o For at least 6 months

57
Q

Define Conversion Disorder

A

o One or more symptoms of altered motor or sensory function.
o No medical explanation.
o Examples: blindness, paralysis, numbness, inability to speak
o More about the disorder:
o Often triggered by trauma or stress and other psychological factors.
o Comes on suddenly.
o Psychological symptoms improve after symptom appears.
o Many display relative lack of concern about symptoms.
o MMPI-2 Profile

58
Q

Examples of types of symptoms of conversion disorder?

A

o blindness, paralysis

59
Q

What happens to psychological symptoms when physical symptoms appear?

A

o psych symptoms go away, converted into physical symptoms

60
Q

Define Factitious Disorder

A

o Person feigns or induces physical or psychological symptoms in order to assume the sick role
o Imposed on self
o Imposed on another

61
Q

Define Munchausen Syndrome

A

o Classified as Factitious Disorder

• Specifically when the person causes the symptoms on self or another

62
Q

Define Malingering

A

o Intentionally feigning illness or disability in order to achieve a recognizable goal (e.g., money, time off, drugs)
o NOT a disorder in the DSM

63
Q

What are somatic disorders illness behaviors and environmental reinforcement for these behaviors (will be discussed in lecture on 4/13).

A

o Illness behaviors- staying home, going to see doc, checking in with other people, getting care