Test Review Flashcards
1
Q
Characteristics of “abnormal” behavior
A
- level of suffering (neither sufficient nor necessary condition for diagnosis
- Maladaptiveness–maladaptive for or toward society
- stat. deviancy–statistically rare, undesireable
- Violation of the standards of society–failing to follow the conventional social and moral rules of their cultural group
- Social discomfort
- Irrationality, unpredictability (can person control their behavior?)
- Dangerousness
2
Q
DSM-V definition of Mental Disorder
Sarah’s summary
A
biological, psychological, developmental dysfunctionin indiviudal, clinically significant disturbance in behavior, emotional regulation, cognitive function, associated with distress or disability, biological
3
Q
Role of culture/society/history plays in defininf what is abnormal
A
dominant social, economic, religious view have profound impact of what people view as abnormal behavior
4
Q
Diagnostic system: Pros and Cons
A
Pros:
- nomenclature (schema, naming for tracking, recording, research, sharing/discussing with other researchers and professionals, etc.)
- Learn more about not just what stuff is but how to treat it
- defines domain/range of problems mental health professionals can address
Cons:
-can lead to stigma, stereotyping, labeling, oversimplification of people
5
Q
Epidimiology
A
the branch of medicine that deals with the incidence, distribution, and possible control of diseases and other factors relating to health.
6
Q
Emergence of Contemporary views on abnormal behvaior
A
Four major themes:
- biological discoveries
- development of a classification system for mental disorders
- emergency of psychologicla causation views
- experimental psychologicla research developments
7
Q
Butcher Chapter 2
A
History
8
Q
Prevalence
A
Number of active cases in population at a given time
9
Q
Point Prevalence
A
estimate proportion of actual, active cases of the disorder in a given populaiton at a given point in time
10
Q
Incidence
A
number of new cases that occur over a given period of time (typically 1 year)
11
Q
Comorbidity
A
presence of 2+ disorders in same person. its especailly high in people who have severe forms of mental disorders
12
Q
Outpatient Treatment
A
patient visits mental health practitioner but doesnt have to be admitted to hospital or stay over night
13
Q
Acute
A
shortin duration
14
Q
chronic
A
long in duration
15
Q
etiology
A
causes of disorders
16
Q
National comorbidity Study
A
o
17
Q
Most common Indiv mental disorders in US
A
MDD Alcohol Abuse Phobia Social phobia conduct disorder
18
Q
Comorbity is high in…
A
…people who have severe forms of mental disorders
disorders dont occur in a vaccum, build off of each other
19
Q
recurrence
A
new occurence of a disorder after a remission of symptom
20
Q
remission
A
marked improvement or recovery appearing in the course of a mental illness, may or may not be permanent
21
Q
relapse
A
return of symptoms of a disorder after a fairly short period of time
22
Q
Cause
A
How do we go about defining and finidng cause? What are necessary, sufficient, contributing causes? Logic? non-specific nature of symtpoms? Butcher’s treatment of “causes”?
23
Q
risk factors
A
variables correlated with an abnormal outcome
24
Q
etiology
A
causal pattern
25
necessary cause
condition that must exist for a disorder to occur, (very few in mental disorders)
-low in humans
26
Sufficient cause
condition that guarantees the occurence of a disorder
-e.g. hopelessness is sufficient cause of depression
-not the same as necessary cause. other things besides hopelessness can cause depression
low in humans
27
contributory cause
increases probability of disorder but is neither necessary nor sufficient for the disorder to occur. these are what are studied most in psychopathology research
-more common in humans
28
Distal causal factors
causal factors that occur relatively early in life whose effects may not be felt for many years
29
Proximal causal factors
other causal factors operate shortly before the occurence of the symptoms of a disorder (e.g. giant loss triggering depression).
Proximal cause now may become distal cause for something else later
30
Reinforcing contributory cause
condition that tends to maintain maladaptive behavior that is already occuring (ie if someone was sick and got tons of sympathy)
31
Historical figures, etc. in classifying psychopathology
Emil Kraepelin-helped establish importance to brain pathology in mental disorders
32
Jones paper
role of culture
non-specificity of symptoms
final conclusions
33
Diathesis-Stress Model
view of abnormal beahvior as the result of stress operating on an individual who has a biological, psychosocial, sociocultural predisposition to developing a specific disorder
34
Diathesis
vulnerability/predisposition toward developing a disorder (can be derived from biological, psychological, or sociocultural causal factor)
35
stress
response or experience of an dividual to demands that he or she perceives as tacing or exceeding his or her personal resources
36
addtive model
individuals who have a high level of diathesis may need only a small amount of stress before a disorder develops, but those who have a very low level of diathesis may need to experience a large amound of stress for a disorder to develop
37
interactive model
some amount of diathesis must be present before stress will have any effect (ie somone with diatheiss will never develop the disorder, no matter how much stress they experince and vice versa)
38
protective factors
influences that modify a person's repsonse to an environmental stressors, making it less liklely that the person will experience adverse consequences of the stressors
39
How protective factors work:
normally protective factors operate only to help resisit against the effects of a risk factor rather than provide any beenfits to people without risk. they dont have t be pleasan texperiences (like having to frow thick skin early in life can be a protective factor for more difficult thigns later in life)
40
Protective factors
must lead to resilience, ability to adapt succesfully to even very difficult circumstances
41
diathesis-stress models need to beconsidered:
in a broad framework of multicausal developmental models. ie in the course of development a child may acquire a variety of cumulative risk factors that may inreract in determining his or her risk factor for psychopathology
42
Bipolar I vs Bipolar II
BPI: mania and depression
BPII: hypomania and depression
43
Crosd-cultural literature on mood disorders
depression in all culturas (studied so far) but how it expresses itself varies greatly bc culturals are different in how emotions conceptualized, expressed
prevalecne rates vary
44
homosexuality
Removed from DSM in 1973
1950s studies done, could distinguish psych results between gy/straight subjects
social movement and pressure
45
Paraphilias
paraphilias are only paraphilic disorders if they cause harm/non-consensual
46
What are the 8 paraphilias in DSM? (6 mo)
```
fetishism
tranvestic fetishism
voyeurism
exhibitionism
sexual sadism
sexual masochism
pedophilia
frotteurnism
```
47
NOS Paraphilias (6 mo)
```
scatologia (phone calls)
necrophilia
zoophilia
apotemnophilia (limb amputated)
coprophilia (poops)
```
48
Paraphilia Criterion A
distinct to pedophilia
16 yo+ and 5 years older than child
recurrent, intense arousing fantasties, urges, behaivors involving sexual activity with prepub. child (
49
Gender dysphoria vs. transvestic fetishism vs. sexual variance
transvestic fetishism: heterosexual male, sexually aroused by idea of dressing as female
gender dysphoria: persistent discomfort about one's biological sex or sense that gender role of the sex is inappropriate
sexual variance: unconventional sexual behaviors
50
conversion disorder vs. facticious disorder cs. malinger
o
51
somatic symptom disorders
involve physcial symptoms combined with abnormal thoughts, feelings, behaviors in response to perceived symptoms
physical symptoms medically unexplained, clients have no contol over their symptoms
52
facticious disorder
person fakes it intentionally to get sympathy but NO external reward
53
malingering
fakes it with intent for external incentive like avoiding work, evading criminal prosecution
54
DSM V: Somatic Symptom Disorder criteria
one+ somatic symptoms that are distressing/significant disruption of daily life
excessive thoughts, feelings, beahviors related to symptom or associated health concerns as manifested by at least 1 of:
disproportionate, persistent thoguhts about seriousness of symptoms
persistent, high levels of anciety about health symptoms
excesive time, energy devoted to symptoms or health concerns
state of being symptomatic is persistnty (6 mo +)
55
DSM V: Illness Anxiety Disorder
preoccupation w having/acquiring serious illness
somatic symptoms arent present or are mild
if another med conidtion is present/high risk of developinng it, the preoccupation is clearly excessive/disproportionate
high anxiety about helth, infiviaul alarmed about personal health status
performs excessive health-related beahviors
illness preoccupation must be present for 6 mo+, specific feared illness may change
illness-related preoccupaiton notbetter explained by another mental disorder
56
Conversion Disorder
pattern in which symptoms, deficits affecting senses or motor behavior strongly suggest patient has med/neurological condition...but they dont
symptoms usually either start/exacerbated by preceding emotional/interpersonal stress
primary gain: continued escape/avoidance of stressful situation (but its unconsciously done)
secondary gain: external circumstances that reinforce maintenance of disability
57
DSM V: Conversion Disorder
one+ symptoms of altered voluntary motor, sensory funtion
clinically findings show that it can't be the suspected neurological, medical condition
symptoms not explaned by other medical, mental disorder
symptoms cause clinically significant distress, impairment in social, occupational, other importnatn areas of functioning
4 categories: sensory, motor, seizures, mixed presentation of first 3 categories
58
pain disorder
acute: less than 6 mo.
chronic: more than 6 mo.
59
dissociative disorders
share a common element: inability to integrate memories and experiences into awareness. being unaware of or unable to recall important incidents is major symptom
60
Dissociative Identity Disorder (DID)
Essential feature is presence of 2+ distinct identities
61
DID Description
cant integrate aspects of identity, memory, awareness
often unable to recall important personal info
2 most common roles: inadequate, confused protectors; terrified children, persecutors who violently act out
Symptoms: inability to recall important personal info, headaches, erractic behavior, PTSD, other types of memory loss/fugue symptoms
onset in childhood after sever trauma or accompanying negtive and abusive experiences
90% report histories of childhood abuse, neglect, highly disorganized parental approaches that resulted in disorganized attachment
females more likely diagnosed
29-35
average time from appearance of symptoms to diagnosis: 6 yearss
62
DID Client Characteristics
significant memory gaps, distinct manner of speaking, use of 3rd person, abrupt changes in tone, traumatic flooding
degree of impariment varies
symptoms that accompany it include: substance misuse, self-mutilation, suicial and aggressive impulses, eating and sexual difficulties, sleeping problems, time lapses, disorientation, phobias, hallucinatory experiences, feeligns of being influenced or changed, mood swings
typically have 2+ other disorders, e.g. depression, PTSD, substance use disorder, personality disorders (BPD)
severity of symptoms linked to onset--more severe symptoms w earlier onset
63
Dissociative Fugue
common feature of dissociation
when the state is fone people dont understand what happened, hard to digest
more common in women
64
dissociative amnesia
common feature of dissociation
5 types of amnesia, localized, selective, generalized, continuous, systematized
more common in women
65
depersonalization disorder
common feature of dissociation
feeling of detachment or estrangement from one's self
delusions, hallucinations not present, reality testing in tact
frightening for individual
brief of chornic, persistent or episodic
more common in women
66
Dissociative disorders: Typical clients characteristics
Common among adolescents
more prevalent among those with substance-related, anxiety, somatization disorders
other co-occuring may be depression, avoidant, borderline, OCD
Important to look at culture--> trances
2 clusters of symptoms:
1) visual derealization, altered body experiences, emotional numbing, subjective feelings of memory loss
2) heighted self-observation, atlered experiences of time, being able to entertain thoughts of visualizations
more prevalent among highly suggestible, easily hypnotized people, report symptoms of depression, anxiety
67
Butcher text: Dissociative disorders
o
68
What do dissociative disorders and somatic symptoms have in common?
both appear mainly to be ways of avoiding anxiety, stress of managing life problems that threaten to overwhelm person's usual coping resources
both also allow person to deny personal responsibiliy for unaccaptable behavior
69
PTSD: controversises, reining in diagnosis
misdiagnosis is bad: treating someone with MDD, GAD with PTSD intervenions is not helpful
hard to diferentiate between symptoms and normal responses
50% chance to resolve itself in 2 years +/-
70
PTSD: lifetime risk of exposure vs likelihood of developing full PTSD
Traumatic exposure: 50-60% of US; 7-9% prevalence
person to another person trauma: more likely to develop PTSD
majority of people exposed to trauma can be ok, recover without therapy
71
DSM V: PTSD
A: exposure to actual or threatened death, serious injury, sexual violence
B: re-experiencing symptoms
C: avoidance symptoms
D: negative alternations in cognitions and mood symptoms
E: marked alterations in arousal and reactvity symptoms
F: symptoms last at least one month
G: cause clinically significant distress or impairment
H: not attributable to effects of substance use or medical condition
72
PTSD: cardinal symptoms and unique characteristics
Intense intrusions and intesnse avoidance
| Flashback
73
PTSD: non-specific symptoms
o
74
PTSD: history
showed up in 1980 with rape survivors, vietnam vets, commonalities between
75
PTSD: Causes
one of the only diagnoses in DSM with cause built into definition (e.g. PTSD was caused by this specific event)
cause: trauma, something that has shattered one's world; qualitatively different
76
PTSD: Flashback
like a memory but dissociative, actually get sensation as if occuring again
look for physiological aspect (I smell it, etc.)
often confused with distressing memories
usually last 5-10 minutes, people know where they are
77
PTSD: Criterion A
A: exposure to actual or threatened death, serious injury, sexual violence: must directly experience it, witness in person, learn about it happen to close fmily member or firend (violent or accidental), experience repeated or extreme exposure to aversive details of event (ie first responders) or relate to job (ie drone operator)
78
PTSD: Criterion B
reexperiencing symptoms: traumatic event is persistently re-expereinced in these 1+ ways: recurrenty, involuntary, intrusive distressing memories of event; recurrent distressing dreams in which content and/or affect of dream are related to traumatic event; dissociative reactions; intense, prolonged psychologicla distress at exposure to internal or external cues that symbolize or resemble an aspect of traumatic event; marked physiological reactions
79
PTSD: Criterion C
avoidance symtpoms: must have one: avoidance or efforts to avoid distressing memories, thoughts, feelings about or closely associated with traumatic event OR avoidance or efforts to avoid external reminders that arouse distressing memories
80
PTSD: Criterion D
Negative alternations in cognitions and mood symptoms: there is a lot of "noise" in this cluseter and its not totally indicative of PTSD
81
PTSD: Criterion E
Marked alterations in arousal and reactivity symptoms: must have at least 2: irritable beahvior/angry outsburts; reckless or self-destructive behavior; hypervigilance; exaggerated startle response; problems with concentration; sleep disturbance
82
PTSD: Criterion F
Symptoms must last at least on month
83
PTSD: Criterion G
Must cause clinically significant distress or impairment
84
PTSD: Criterion H
not attributable to effects of substance use or medical condition
85
Lifetime prevalence rate for PTSD
7-9% lifetime rate; point prevalence 1-4%
86
Acute Stress Disorder
occurs within 4 weeks after a traumatic event, lasts for minimum of 2 days-maximum of 4 weeks
87
MDD: Description and Prognosis
depressed mood, at least 4 (nearly everyday for 2+ weeks): sig. weight loss/gain, app. change, hyper/insomnia, psychomotor retardatio/agitation, fatigue, loss of energy, guilt/worthlessness, reduced ability to think/concentrate, thoughts of death, suicide; disress or impairment in functioning; 1+ MDE; determine of 8 factors: severity, psych features, chronicity, melancholic features, atyp features, postpartum onset, interepisode recovery, seasonal pattern
Prognosis: 70% remission within 1 year, recurrence (esp w psychotic fetures); personality disorders have poor treatment repsonse intervention beside CBT;
88
MDD: Client Characteristics
dysphorbia, anxiety, develop over several days/weeks, onset can be sudden
w/o treatment, runs course 6 mo-1 yr, residual symptoms for 2+ years, recurrence possible, other emo/family problems; coexisting disorders, substance-related, eating disorder, anciety disorder, personality disorder,
stressor/depression prone personalit high correlation; rumination about behavior worsens, early trauma alter neurobio stress respon, increase susceptibility to MDD
89
Dysthymic: Description and Prognosis
mild-moderate impairment, limitations due to depression; tend to maintain acceptable level of social and occupaitonal functioning; small percentage seek treatment
chronic depression, most days for 2 years
atleast 2: poor appetite, overeating, insomnia orhypersomnia, low energy, fatigue, low self-esteem, difficulty in concentrating or decision making, sense of hopelessness
suicidal ideation, less common; no hypo/mania; age, onset, presence; average length 10 yr, to 20+, half +/- relapse in 2 years, mostly women
Prog: viable goals are reliefe of depression and anxiety, amelioration of somatic, physio symptoms, increased optimism and sense of control, improved social and occupational functioning
without treatment, prognosis is poor
90
Dysthymic: Client Characteristics
prior comorbid, familial mental disorders common
freq accompanied by personality disorder, physical or mental disorder
elevated risk for development of MDD
personality similar to MDD
divoered, deparated, lower SES
children show irritability, complaining (like MDD kids)
91
Bipolar: Descriptions and Prognosis
Prognosis: 90% recurrence rate
risk of recurrence highest in first year
worse if person with bipolar has multiple prior episodes or has co-occuring substance use disorder, rapid cycling, negative family affective style
primary goal of treatment to ensure mood regulation maintained
with hard work, compliance, good prognosis
92
Bipolar: Client Characteristics
Bipolar I: highly heritable (more than bipolar II or MDD), 100% comorbid with another, usually impulse, personality, anxiety, affect regulation
II: hypomania: ppl are goal-focused, productive, cheerful, enthusiasm is usually out of proportion to event
Both I and II: exacerbated or tiggered by stresypomania: ppl are goal-focused, productive, cheerful, enthusiasm is usually out of proportion to event
most likely Axis I for co-occuring substance use
treatments of co-occuring disorders complicate diagnosis, exacerbate symptoms
1/3 has employment-related losses
20% ppl are able to work at expected levels 6mo. following episode
Top 3 disabilities in US
Families with Bipolar: high criticism, emotion, overprotectiveness, lack of problem-solving skills, problems with intimacy
93
Bipolar I:
Depression and mania
must include at least 1 manic episode reflecting extremely elevated mood (also depression and hypomanias)
typically includes disturbances of mood, cognition, behavior, possibly psychotic symptoms
94
Bipolar II:
Depression and hypomania
psychotic features not found in bipolar II
90% people treated have bipolar II
fewer, milder psychotic symptoms
fewer hospitalizations, higher episode frequency, more likely rapid cycling
more deibiltating than bipolar I, more family dysfunction, more suicide, increased frequency of co-occuring disorders?
95
Cyclothymia
longer but milder version of bipolars (::dysthemia:MDD)
2 year period, numerous episodes of hypomania/mild-mod depression
symptom free for no longer than 2 months
mood change abrupt without cause
.
0.6% population
late adolescence/early adulthood, chronic course, equally common entre male and female
no significant symptom-free phase
CLIENT CHARACTERISTICS:
mood swing, sleepless,libido, racing thoughts, creative, optimistic, high-risk behaivors, hypersomnia, atypical depression, *sleep disturbance, disrupt circadian, social rhythms; sometimes accompanied by disorders, 1/3 precurosr to other mood disorder (BDII)
symptom reduction prognosis good, full recovery unlikely
96
Bipolar NOS
when it does not fall within the other established sub-types. Bipolar disorder NOS is sometimes referred to as subthreshold bipolar disorder.
97
Bipolar: manic episode
period of abnormally and persistently elevated, expanisive, irritable mood
At least 3: grandiosity, reduced need for sleep, increased talkativeness, racing thoughts, distractibility, increased activity, excessive pleasure seeking, potentially self-destructive extent
during mania, people have little insight into potentail risks of their behavior or into the feeligns of others, may become hostile and threatening if challenged
anger and aggression when others set limits
frequently result in hypoersexuality, promiscuous behavior, excessive spenings
judgement, impulse control is low
may have delusions, hallucinations
98
Bipolar: hypomanic episodes
partial mania, similar to mania but without loss of reality resting, without psychosis, without significantly imparied functioning
hypomanic episodes are by definition part of bipolar II, can sometimes be in bipolar I as well
may not always present as a good mood, may include anger and irritabiltiy
99
Bipolar: depression phase
people with bipolar spend over half of life depressed, only 10% in mania/hypomania
phase resembles MDD, usually entails less anger, comatizing, more oversleeping, psychomotor retardation, higher rates of suicide, may include psychotic features
100
Bipolar: Duration of Episodes
average duration of dysfunctional mood 2.5-4 months; may be as short as a few days
depressive phase tends to be longest 6-9 months, manic phase is 2-6 weeks; episodes end abruptly
without treatment, people with BD typically have 10+ episodes over course of their lives, vary 3/yr to 1/10yr
101
Bipolar: specifiers
clinician should indicate severity of current episode, list appropriate specifiers
for all episodes: presence/absence of seasonal pattern, psychosis, catatonic features, postpartum onset, rapid cycling, interepisode recover
for depressive episodes: specify presence of melancholic features or atypical features
presence of rapid cycling (4+ discrete episodes in single year)
102
Bipolar: prevalence
lifetime prevalence for BDI=.8%, BDII=.5%
50% of people with bipolar disorder attempt suicide
both genders equally represented among people with BDI and BDII, women more likely for BDII
103
Bipolar mood disorders descriptions
episodes of dysfunctional mood separated by periods of moderately normal mood
men first episode typically manic, women depressive
104
Primary Symptoms of Depression
feelings of discouragement, hopelessness, dysphoric mood, less energy, worthlessness, excessive guilt, change in appetite, sleep
105
MDD Subtypes
melancholic features, atypical, catatonic
106
Melancholic features
absence of pleasure, interest; accompanies endogenous depression; more bio based; later age onset; family history of depression; veg symptoms; more likely to involve delusions, hallucinations, psychomotor retardation, agitation, extremem guilt, worse in am; no SSRI
107
Depression: Basics
first episode young/middle adulthood
earlier in women
men have in midlife
often coexists with personality disorder
childhood depression looks like agitation vs. sadness
earlier onset, worse prognosis and worse severity
onset often follows trauma(s)
stressors involving loss (vs stressors involving threat=anxiety)
interpersonal factors predict depression chronicity
Depressed people have negative self-view, seek negative feedback
genetic, familial component (esp w mother)
108
Depression: Client characteristics
pessimism, learned helplessness
discord with family, spouses
decreased problem solving
couples therapy is a good idea
109
atypical features
earlier onset, greater chronicity, depressed women, overeating, oversleeping
higher rates of paternal depression, childhood neglect, sexual abuse, suicidal thoughts, attempts, disability, co-occurring disorders such as substance misuse, panic, anxiety
110
catatonic features
2 or more during present episode: catalepsy (motor immobility), purposeless/excessive motor function, exterme negativity to instructions, posturing as a statue, echolalia, echopraxia; symptoms wax and wane, stupor-excitement, found in bipolar disorder and in schizophrenia, dementia, conversion disorder; referred to med exam; ECT and benzos
111
postpartum onset
within 4 weeks of giving birth; rapid intervention for baby and mother safety
112
Seasonal recurrence
SAD due to available natural light, biological phenomena as light sensitivity, melatonin secretion, more common in women, young people, north people
113
Double Depression
chronically moderately depressed (dysthymia), increased problems occasionall (MDE)
aka, persistent depressive disorder, dysthymia with MDE, or chronic MDD with melancholic features
114
Suicide Rates
Men have spike in suicidality in early 20s (testosterone)
| white dudes always more likely to commit suicide, increases with age, spikes at 65
