final 2 Flashcards
Anorexia Nervosa
Eating disorder
- fear of being fat, though not fat
- 90% female
- bone loss, heart strain, stops menstruation
Bullmia Nervosa
Eating disorder
- self induced vomiting
GABA
inhibitory transmitter
Amphetamines
reduce fatigue and appetite
increase dopamine
Endorphins
painkillers
Androgens
Sexual desire
Serotonin
feelings of happiness
Depression
mood disorder
Suicide
rate is reduced in worst stage of depression due to apathy
- Social support can help prevent
Bipolar disorder
depression with periods of mania
Manic state - grandiose plans, no limits to what can be done. Speech rapid and unstoppable
Causes of mood disorders
- Biological
Reserpine induces depression by depleting
monoamines (norepinephrine, dopamine, and serotonin
// environmental/learning - decrease in positive reinforcement from environment
// personality-based vulnerability - Freud believed early losses, rejection create vulnerability for later depression
Brown and Haris found that women who lost their mom before
age 11 were 3x more likely to become depressed because of a recent loss than women who didn’t
// Humanistic - this generation focuses too much on personal attainment instead of others and react more strongly to their own failures
// Cognitive process
Depressive cognitive triad
Depressive attributional pattern
// Sociocultural - much less depression in collectivist cultures, strong connections in family
In North American, depression = guilt/personal inadequacy
• In Chinese/African/Latin cultures, depression = fatigue, loss of appetite, sleep problems
• Women are no more likely than men to be depressed in developing countries
Learned helplessness theory
Causes of mood disorders
- depression happens
when people expect bad events and believe that there is
nothing they can to prevent them
• Negative attributions are personal, stable and global:
Its my fault, I’ll always be this way, I’m a total loser
Depressive cognitive triad
// Cognitive
causes of mood disorders
negative beliefs about world, oneself and future
- victimize themselves
- remember their failures, not successes
Depressive attributional pattern - bad things are personal,
good things are situational (opposite of self-severing bias)
Cycle of depression
stressful experiences ➡ negative
explanatory style ➡ depressed mood ➡ cognitive and
behavioral changes ➡ stressful experiences
• Breaking the negative explanatory style breaks the cycle
Depressive attributional pattern
Cognitive process
factors that cause mood disorders
- bad things are personal,
good things are situational (opposite of self-severing bias)
Somatoform disorders
complaints of physical symptoms that aren’t physiologically possible
Conversion disorder
Somatoform disorder
erious neurological symptoms
(blindness, paralysis, sensation loss) suddenly occur
• Strange lack of concern about symptom
Glove anesthesia
losing sensation only below wrist, not neurologically possible
- caused by traumatic event
- psychodynamic: ego represses conflict by converting anxiety into physical symptom
Hypochondriasis
Somatoform disorder - being alarmed about any physical symptom, convinced they have serious illness
Pain disorder
experience
intense pain for no reason or out
of proportion
Psychogenic Amnesia
Dissociative disorder
- Person responds to a stressful event with
extensive but selective memory loss
Psychogenic Fugue
Dissociative disorder - person loses all sense of personal identity, gives up customary life, wanders to a new faraway location, and establishes a new identity - Typically ends what person suddenly remembers original identity, mystified
Dissociative Identity Disorder (DID)
Dissociative disorder
multi personality 92% female
Trauma-Dissociation Theory
(DID)
- new personalities occur in response to severe stress, usually from childhood
Schizophrenia
Severe disturbances in thinking, speech, perception,
emotion and behavior
• Schizophrenia means split-mind, but it is not same as
DID
Delusions, hallucinations, paralogic, overinclusion
Delusions (schizophrenia)
Schizophrenia
- false beliefs sustained in face of opposing evidence
• Delusions or persecution (out to get me) or delusions of
grandeur (extreme importance)
Hallucinations (schizophrenia)
Schizophrenia
- false perceptions of reality (auditory mostly, also
visual or tactile)
Paralogic
Schizophrenia
California has water and sand so its the promised land
Overinclusion
Schizophrenia
- “fruitful year” means pears and apples
Schizophrenia types 1
Paranoid, disorganized, catatonic
- motor disturbances: muscle
rigidity or random/repetitive movements.
• Alternate between stuporous states - oblivious to
reality, can be molded and stay that way for hours
• And agitated excitement - can be dangerous to
others)
Schizophrenia types 2
Type 1 - positive symptoms: delusions, hallucinations, disordered speech/thoughts possibly treatable Type 2 - Negative symptoms: lack of emotion, loss of motivation, absence of normal speech rarely treatable
Causes of schizophrenia
// Biological factors exist
- problems with DISC 1, protein that guides new neural connections
Abnormalities in thalamus (responsible for sensory input)Structural differences in type 2, so hard to recover,
Dopamine hypothesis
// Psychological
Freud
- schizophrenia is extreme regression
Cognitive
- Defect in attention mechanism, overwhelmed by stimuli
// Sociocultural
• Social causation hypothesis - higher rates of
schizophrenia in poor areas due to the higher
stress that low income cause
• Social drift hypothesis - schizophrenia causes
lower occupational functioning, so schizophrenic
people move to low-cost urban housing populations
// Environmental
Stressful life events play important roll
• More likely to relapse if returning to home that is high in expressed emotion
Dopamine hypothesis
Biological
Causes of schizophrenia
- positive symptoms are produced by an over activity of dopamine in motivation, emotion and cognitive function areas
Antisocial Personality disorder
Personality disorder - irresponsible and antisocial, impulsive needs, lack of empathy, highly manipulative, no conscience // Causes - Biological, amygdala or prefrontal cortex dysfunction causes lower heart rates under stress - Psychological/environmental - lack of conscience (no superego)
Histrionic
Personality disorder - dramatic, attention seeking, promiscuous, highly impressionable, out of touch with negative feelings
Narcissistic
Personality disorder - grandiose fantasies, lack of empathy, need for admiration from others, proud self-display
Borderline Personality disorder
Personality disorder
- severe instability
of self- image, relationships,
emotions. Extreme love and
hate of same person.
Manipulative and suicidal
// causes
sexual/physical abuse, parenting problems
• Splitting - failure to integrate positive and negative aspects of another person’s
behavior into a coherent whole
• Biological: problem with neurotransmitter system that regulates emotion
Avoidant
Personality disorder - extreme social discomfort, fear of being negatively evaluated
Dependent
Personality disorder
- Extremely submissive and dependent, fear of separation
Obsessive-compulsive
// Personality disorder
perfectionism,
orderliness,
inflexibility
Schizoid
Personality disorder
- indifferent to social
relationships, restricted range
of emotions
Schizotypal
Personality disorder
- odd thoughts,
appearance, behavior.
Discomfort in social situations
Paranoid
Personality disorder
- unwarranted
tendency to interpret
behavior as threatening
Autistic disorder
- Extreme unresponsiveness to others
- Poor communication
- Repetitive and rigid behavior patterns
Psychotherapy
• Therapy through psychological techniques, not drugs
• Most therapists are eclectic therapists - use all different kinds of therapies
• “Psychologist” is a protected term. To call yourself one you must be licensed.
Usually have PhD or Masters.
• Therapist, counselor, psychotherapist and hypnotist are not protected terms,
so anyone can call themselves these
Psychodynamic therapy
Psychoanalysis, brief psychodynamic therapy
Insight
Psychoanalysis
conscious awareness of underlying problems
Resistance
- defensive mechanism against therapy, sign of a sensitive topic
• Patient becomes angry, avoids topic, misses appointments
• Analyzed to promote insight and prevent therapy dropping
Psychoanalysis
Psychodynamic therapy
- goal is to achieve insight
Free association, Dream interpretation, resistance, transference, interpretation
Brief Psychodynamic therapy
Psychodynamic therapy
Brief version of psychoanalysis
Clients face the therapist directly, meet less often
• Focus on life problems rather than rebuilding
personality
• Inter-personal therapy
• 15-20 sessions max
• Focus on marital conflict, loss, or social skills
- find solutions to these problems
• Effective therapy for depression
Humanistic therapy
• Focus on future and present, rather than past
• We need to find out what is preventing you from realizing full potential
- Client-centered therapy (carl rogers)
- Gestalt therapy (perls)
Client-centered/person-centered therapy
Humanistic therapy
Carl rogers
• Relationship develops between client and therapist to foster selfexploration
• A Rogerian refers to the person as client, not patient
• Therapist attributes:
• Unconditional positive regard - trust, acceptance, nonjudgement
• Empathy - willing to view the world through their eyes,
“reflecting” (repeating) what they say
• Genuineness - therapist expresses honest feelings, positive or
negative
• Job is not to interpret your life, it is to let you talk
• Pioneered filming of sessions
Gestalt therapy
Humanistic therapy
• Patient is ignoring the background - important feelings,
wishes thoughts that are blocked
• Bring them into awareness, get in touch with inner self
• Often done in groups
• Much more confrontational than client-centered therapy
• Often involves role playing
• Empty-chair technique - imagine mom sitting in
chair and talk to her (playing both roles)
• Perls was much less scientific than Rogers, didn’t test his
therapy
• Others tested empty-chair technique and its quite
successful
Cognitive therapy
• Concerned with present rather than past
• Very directive, tell you exactly what is wrong and what to do about it
- Ellis’ Rational-Emotive therapy
- Beck’s Cognitive therapy
- Meichenbaum’s Self-Instructional training
Ellis’ Rational-Emotive therapy
Cognitive therapy - Therapy seeks to identify irrational thought patterns, and help change underlying belief system - People make unrealistic demands on themselves - Often assigns homework ABCD Model • Activating event • Belief system • Consequences of that appraisal • Disputing the erroneous belief system
Beck’s Cognitive Therapy
Cognitive therapy
• Treated depressed patients very effectively (97%
improvements, 75% non-recurrence)
• Helps them realize that their thoughts, not their
situation makes them depressed
Meichenbaum’s Self Instructional Training
Cognitive therapy
-stress and coping
Exposure
Behaviour therapy
Classical conditioning treatment
- assumes phobias are learned
- Flooding: extreme exposure
Aversion therapy
Behaviour therapy
Classical conditioning treatment
- pair unwanted behaviour, often fails to generalize, works best when paired with other treatments
Systematic dessensitization
Behaviour therapy
Classical conditioning treatment
- starts from low anxiety scenes to high
- not as effective as flooding but less stress
Operant Conditioning treatments
Positive reinforcement
Punishment
• Works well for schizophrenics, disturbed children, mental retardation
Positive reinforcement
Operant conditioning treatment token economy (currency)
Punishment
Operant conditioning treatment
Modeling and Social Skills Training
- Using modeling to teach social skills and resisting peer pressure
- Increases self efficacy
Third wave cognitive therapies
Mindfulness Based Treatments
• Mindfulness is mental state of awareness, focus, openness and acceptive of experience
• Learn a meditation technique to focus on your sensations, thoughts and feelings and
overcome them without struggle
• Used for stress, depression, drug relapse prevention
Acceptance and commitment therapy
Acceptance - accept all thoughts and feelings
Commitment - examine one’s life and set goals for whats important, committing to achieve them
Dialectical Behaviour Therapy
Used to treat Borderline Personality Disorder
• Package of cognitive, behavioral, psychodynamic and humanist therapies
• Goal is to be able to calmly recognize situations, thoughts and their impacts rather than being overwhelmed by them
• effective in controlling self destructive behavior
Cultural and gender issues
• Psychotherapy used much less often by minorities, and they
drop out of treatment more
• Cultural norm against asking other cultures for help
• Language barrier
• Less access due to unemployment
• Therapists have little familiarity with other cultures
Solutions to cultural barriers
Need therapists with cultural competence
• Doesn’t matter if therapist is same culture as patient,
matters if therapist has been given ethnic training
Evaluating Psychotherapy
Psychoanalysts believe recovery would not happen without therapy
Dodo bird verdict
- all therapies appear to be equally effective
Factors that influence outcome of psychotherapy
Techniques Dose response effect Quality of Relationship Client Variables • Openness to therapy Self-relatedness - - ability to understand self Nature of problem - - does it fit the therapy
Dose response effect (evaluating psychotherapy)
relationship between amount
of treatment and outcome
Common factors of all types of therapy
• Faith in therapist • Alternative way of looking at their problem • Insight into self • Protective setting, supportive relationship • Opportunity to practice new behaviors • Increased optimism and self-efficacy • Emotional defusing - reduce fear • Interpersonal learning - play it out with therapist
Drug therapies
// Biological/somatic treatment
Anti-anxiety drugs, antidepressant drugs,
Anti-mania drugs,
Antipsychotic drugs
Anti anxiety drugs
Drug therapy
- reduce anxiety without disturbing alertness, prone to dependency
• Tranquilizers, Xanax, Valium
• Symptoms return after drugs stop being taken
• BuSpar is slow acting, causes less fatigue, and is
less prone to abuse. It works by enhancing GABA.
• Should not used chronically and should include
other therapy
Antidepressant drugs
Drug therapy
• Relapse is more likely for drugs alone than drugs with therapy
// Tricyclics
• Prevent reuptake of
norepinephrine and serotonin
• Clomipramine - a tricyclic
used for OCD, depression
// Monoamine Oxidase (MAO)
Inhibiters
• More severe side effects than tricyclics
• Need daily use, special diet, 4 weeks
for effectiveness
// Selective serotonin reuptake inhibitors (SSRIs)
• Milder side effects, more effective that other options
• Seen as a wonder-drug
Anti-Mania drugs
Drug Therapy
Lithium Carbonate
• For bipolar disorder: eliminate manic
phase and depression does not return
• Correct dosage is critical
• Seems effective but some patients report
that they miss the initial “high” of mania.
Some stop taking it so they can get it back.
• Need talking therapy too for complete
effectiveness
Antipsychotic Drugs
“major tranquilizers”, decrease dopamine
• Reduce positive symptoms of schizophrenia, not negative ones
• Quick relapse if patient stops taking them
• Main one is Thorazine, doesn’t work for everyone
Risk of tardive dyskinesia - uncontrollable movements
- Clozaril is alternative that doesn’t cause duskiness and reduces both positive and negative symptoms, however causes fatal blood disease in 1-2% of people
Electroconvulsive therapy (ECT)
Schizophrenia and epilepsy don’t happen together, so use shock to induce seizures to treat schizophrenia
- currently given to right hemisphere to lessen damage to verbal memory
- not useful for anxiety disorders, or schizophrenia
• Does work for depression
• Safety concerns - can cause brain damage, relapse very likely
• Approved by the APA for use in cases of major depression that doesn’t
respond to drugs
• 2.5% of depression patients receive this treatment
• May somehow increase monoamines, but scientists aren’t sure exactly why it
works
Psychosurgery
remove brain tissue to change disordered behaviour, in absence of obvious organic damage
• Used to be done very often, but stopped due to safety
concerns and increased availability of drugs
Cingulotomy
Psychosurgery
surgeon cuts corpus callosum
- treats depression and ocd as last resort
- can cause seizures
Disorders and society
first there was push to put everyone into asylums, then deinstitutionalization, but if community is unprepared, revolving door phenomenon occurs. Prevention programs are difficult to justify because its hard to tell when they are working
deinstitutionalization
- Movement to transfer focus of treatment from mental institutions to the community as a whole
Revolving door phenomenon
Disorders and society
repeated hospitalizations and homelessness for mental patients
Situation focused prevention
- reduce environmental
causes of disorders and enhance the factors that prevent them
• Reduce unemployment, discrimination, poverty
• Increase education, family functioning, sense of connection
to community
Competency focussed prevention
- increase personal
resources and coping skills
• Increase stress resistance, social and vocational
competencies, self esteem
• Ex. US Army Battlemind program prevents PTSD, sleep
probs, depression
