Unit 1 Flashcards
psychology
studies interplay of behavior, mind and brain
abnormality
deviance, distress, danger, and dysfunction- presence of these 4 doesn’t predict mental illness
deviance
different, unusual, or bizarre- statistical connotations
dysfunction
interfering with ability to carry out daily activities
danger
to oneself/ others
distress
upsetting or unpleasant mental states
DSM V assumptions
1- a behavioral syndrome/ psych pattern occurs in the individual AND
2- the symptoms have psych and or bio cause AND
3- the consequence of the symptoms is either: clinically significant distress or dysfunction
4-the symptoms are above and beyond what would be normal response to stressors (CONTEXT)
5-BUT the perceived mental illness is not primarily a result of social deviance or conflict with society
therapy
any process/ procedure that alleviates symptoms- includes bio, psych, and combinations
3 major views on mental illness
1- spiritual/ supernatural- demon possession, etc
2- humanitarian- result of cruelty, stress, and poor living conditions
3- scientific- search for quantifiable causes
trephination
earliest supernatural type treatment
-6500 BCE; focused on demon possession and sorcery
Ancient Greek and roman
500 BCE-500 CE; philosophers and physicians rejected supernatural explanations
hippocrates
did not believe mental illness was shameful or that mentally ill individuals should be held accountable for their behavior
-illness as imbalance of 4 humors
middle ages
500-1350 CE; demonology returns
- Roman Catholic rejected scientific research; religious beliefs dominate; exorcisms (st. Martin)
- care of mentally ill became family based bc of shame; idea of contagious nature of mental illness and physical punishment to teach better behaviors
renaissance
1400-1700 CE; demonological views decreased; medical views returned; Johann Weyer (German physician) believed that the mind was as susceptible to sickness as the body
Asylums
first in the 1400s- for “lunatics”- primary purpose was care of mentally ill, conditions deteriorated over time
mid 16th century
conditions decline in asylums, no treatment or supply for demand; individuals with mental illness were institutionalized alongside undesirables and no one improved or left
- most against will
- demonstrated to public for a fee
- treatments= purges, bleeding, emitting
colonial america
1st asylum (1773)= Williamsburg VA- chained to wall of small room, one bed etc… soon overcrowded and deteriorated to filth and mistreatment
late 1700s europe
moral treatment
-William tuke (England), Philippe pinel (france), and dorthea dix and Benjamin rush (US)
=patients in asylums are sick and should be treated with sympathy and kindness
tukes retreat at Yorke
was run as a strict, well-run household
- sanity was to be restored via self control in family environment- rules and expectations and contributions (paternalistic)
- given support and advice
- critics claimed it encouraged dependency- replacing visible chains with less clear ones
moral treatment vs asylums
freedom to move about, well-lit rooms, seen as potentially productive beings, engagement in activities
19th century
moral treatment spread to US- some patients were able to leave, but not most
Dorothea dix
American advocate for moral treatment (1840-1880) researched conditions in asylums throughout US- successfully lobbied US congress to pass bill that established a system of state hospitals to care for mentally ill
-32 hospitals (state) throughout country are credited to her
state hospitals
meant to be self-supporting (somewhat) institutions
- patients engaged in “therapeutic work”- staff lived on premises to reduce cost
- patients worked on farm and did chores
- overcrowding eventually occurred due to lack of treatments
- public prejudice against patients in institutions led to reduced funding (many patients were poor immigrants)
the somatogenic perspective (early 20th century)
abnormal functioning has physical causes. two factors were responsible for this rebirth
1) Emil Kraepelin= physical factors (fatigue) are responsible for mental dysfunction
2) bio discoveries on link between untreated syphilis and “general paresis”
- common somato treatments=hydrotherapy, radiation, sedatives, ECT, psychosurgery (lobotomies), insulin-induced comas
- improvements in treatment came in 1950s
the psychogenic perspective
abnormal functioning has psychological causes
- rise in popularity of this was based in Friedrich Mesmer’s work on hypnosis and later Sigmund freud’s theory of psychoanalysis (early childhood and unconscious)
- by early 20th century, psychoanalytic theory was well accepted
- provided either out-patient or in-private psychiatric hospitals
- less likely to be part of therapy at state hospitals
psychotropic medication
1949- introduction of lithium to treat extreme mood fluctuation
- in 1950s= antipsychotic drugs for schizophrenia, antidepressant drugs and anti anxiety drugs
- finally allowed discharge from hospitals
deinstitutionalization
trend in which people with mental disorders were released from hospitals into communities
-caused by 1) medications, 2) public outcry on conditions, 3) JFK signed (1963) funding for community mental health centers (agency to meet with psychiatrists) and out patient treatment for formerly hospitalized patients
current LESS severe MI treatment (US)
outpatient care is preferred mode of treatment
- private psychotherapy and psychiatry (med mngmt)
- non residential programs for subs abuse
- community based MH clinics
current SEVERE MI treatment (US)
outpatient care is primary mode
- usually short hospitalization with discharge into community based care
- *lack community programs for current pop
- significant number do not receive treatment of any kind
- needs of this pop= community programs are insufficient
- funding cuts continue
- 250,000 with severe MI are incarcerated or homeless
SAMHSA survey
- 5% of all US adults had mental illness
- of that, 4% had severe MI
- 1/3 of severe receive no help
Insurance with MI
- no coverage pre-WWII
- historically policies didn’t cover MI to the same extent as physical illness
Parity laws
laws that say insurance companies must cover physical and psych illness at the same rate of reimbursement
- 2011= law went into effect
- some insurance companies solved by discontinuing all funding for MH
biopsychosocial approach
integrates 3 areas of influence when considering causes of MI and their treatment
- bio= brain structure, chemistry, etc
- psych= trauma, cognition, stress
- social= culture, peers, family
MH clinician
anyone who provides services to people with psych problems
theoretical models
describe how MI forms and how it differs from the unaffected population
-models can conflict
-isolating a cause is very difficult (complex behavior)
== X is a RISK for Y (not a cause)
necessary causes
factors that must be present for disorder to occur
- have not been identified for most MI
- exceptions= general paresis (due to syphilis) and HD
contributory causes
factors that increase the risk of developing a MI, but don’t guarantee
distal risk factors
event occurs early in life, disorder appears later
proximal risk factors
event occurs shortly before signs of disorder
diathesis- stress model
person has predisposition, then with sufficient life stressors, may develop the disorder
protective factors
decrease the likelihood of developing MI
- actively buffer against the risk
- can also be personality factors
- most common= one loving adult in life
inoculation effect
dealing successfully with stressful experience can enhance your confidence in dealing with new stressors
resilience
experiences that give sense of mastery over difficulties
-responsive relation ship with 1+ adult
psychoanalytic/ dynamic model
behaviors/ psych problems are determined by the influence of the unconscious mind
- when conflict arises between id, ego, and superego, leads to increased anxiety
- function of ego defense mechanisms is to distort reality to avoid feelings of anxiety
- goal= make unconscious more conscious to deal with issues
psychodynamic model
includes Freud’s early 20th century psychoanalytic model
- in dysfunctional personality, the id and others are in excessive conflict
- type of treatment= minimal interaction between patient and therapist, couch, time intensive
today’s psychodynamic perspective
human functioning is shaped by unconscious dynamic forces
-specific emphases and seeks to uncover internal conflict from youth
contemporary trends in psychoanalysis
- more interactive with therapist
- short-term therapy
- no couch= face to face
- relationships (therapist, family, etc)
- focus on internal dynamics
behavior model
concentrates on behaviors and environmental factors
- believe all behavior is learned; maladaptive is due to faulty learning experiences
- operant (skinner) and classical (pavlov and Watson)
modeling
we can learn behaviors by watching another perform them
operant conditioning
behaviors and acquired if they are reinforced
- more apt to continue if rewarded, less apt with aversive consequences
- therapy focus= rewarding good behavior, rather than punishing the bad
generalization
stimulus simular to CS begins to produce CR… even though this new stimulus has never been paired with the US
contingency management
client is rewarded for desired behaviors; undesired behaviors are ignored
-token economy
systematic desensitization
phobias- client is methodically introduced to frightening stimulus, while remaining relaxed
-learn relaxation skills> construct fear hierarchy> confront feared situation
flooding
client is immediately placed in anxiety producing situation
- high drop out rates
- for job situation or time constraints
cognitive model
psych disorders are the product of disturbed thinking- illogical thoughts can produce painful/ dysfunctional emotions and behaviors
- clinically investigate client’s cognitions
- overcome problems via new ways of thinking
Beck’s cognitive therapy= cognitive restucturing
therapist guides clients to challenge dysfunctional thoughts, try out new interpretations, and apply new ways of thinking in daily life
-used widely in depression treatment
reframing
technique of changing attitude surrounding a maladapt thought
-Albert Ellis= irrational emotive therapy
cognitive behavior therapy
therapists use behavior and cognitive approaches- impacting thought patterns and maladaptive behaviors
pro/ con- Cognitive model
pro- broad appeal, clinically useful, effective therapies and useful in research
con- not helpful for everyone, some disorders cannot be improved cognitively (bio)
humanistic approach
humans have inherent worth and motivation for growth, to strive for self fulfillment and meaning in life
- more positive views of human nature= humans are basically good and oriented in positive directions
- maladapt behaviors/ disorders= when potential for living life to the fullest is blocked
roger’s theory
basic human need is for unconditional positive regard
-if not received, leads to incongruence= mismatch between one’s view of oneself and reality of themselves
client- centered view
unconditional positive regard
accurate empathy
strong emphasis on therapist- client relationship
genuineness
-therapist’s role is to listen deeply, accept and understand, while providing input
pro/ con humanistic
pro- major impact on therapist-client relationship= therapeutic alliance; established optimal healing environment; optimistic view of human nature
con- abstract issues and difficult to research
sociocultural model
consider social and cultural influences on MH
-family therapy, couples counseling, group therapy, community MH
family therapy approaches
direct participation of family members in the session- the initial client will be either child or adult, but rest of family will also attend
- therapist looks to influence communication among members in a way that strengthens and supports the entire system
- viewing how families interact
community MH treatment
allow clients to receive treatment in familiar social surroundings as they try to recover
-fills deinstitutionalization needs
pro/con social cultural model
pro- added elements of interaction and can be successful where other therapeutic forms fail
con- difficult to interpret research
biopsychosocial model
integrative therapy that understands MH as stemming from multiple causes and issues
eclectic approach
integrative= taking strengths from each model and using them in combination for a particular individual
**most common
biological model
abnormalities associated with the body are associated with the symptoms of MI
1) genetics
2) abnormalities in brain structure
3) chemical imbalance
4) infections and autoimmune
polygenic model of inheritance
often several genes combine to produce such characteristics, creating a genetic predisposition (diathesis) towards MI deviance
temperment
infantile personality- children can have basic personality differences- innate
biological treatments
drugs, ECT, psychosurgery
4 drug classes
antianxiety, antipsych, antidepressants, mood stabilizers
clinical assessment
interviews, observations, and psych tests= summary of clients symptoms
diagnosis
classification of client’s symptoms- results in label for treatment and insurance
reliability
consistency of results obtained by assessment measure
-test-retest and interrater
validity
accuracy of tool’s result
-face, predictive, and concurrent
clinical interviews
most common measurement- obtain: background info, description of symptoms, direct observations
SCID-5
structured clinical interview for DSM 5- widely used for diagnosis and research- ensures DSM diagnoses are systematically evaluated
mental status exam
structured clinical interview- evaluates client’s current level of functioning
- content of thought= what client thinks and believes
- affect and mood= what they feel inside vs what they express outwardly
- orientation= time and location
TAT
describe a story to describe a picture- psychodynamic
neuropsych assessments
asses brain functioning- tells about cognitive functioning- bender visual motor, Gestalt, MoCA
TBI on cognitive functioning
- memory
- attention
- executive function
- length of time to process info
- insight about one’s condition
ABC assessment
antecedent-behavior-consequence
= what happened before the targeted behavior occurred and what happened after= what causes this response
clinical observations
- naturalistic
- analog= contrived/ lab
- self-monitoring
DSM
includes clinical features and related features, along with stats- does not cover treatment and theories on causation
1) categorical info= name of disorder indicated by symptoms
2) dimensional info= rating of how severe symptoms are
comorbidities
psych disorders that are co-existing 1+ diagnosis
differential diagnosis
the process of ruling out alternative diagnoses
clinical significance
symptoms are not fleeting in duration and not of little concern to the client
inpatient
most restrictive option -short term= hospitalization for danger to oneself and others
specialized inpatient
various inpatient centers- subs abuse and eating disorders
group home
smaller institutional setting in community with 24/7 staff- for clients that need regular monitoring
day treatment
day time program of structured activities
outpatient
majority of clients- client lives in community and receives services via appts with clinicians
