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Unformatted text preview: SPARKCHARTST" SPARK CHARTS1 INTRODUCTION f Abnormal psychology: the study of abnormal behavior, including theories and research g about causes, assessment, and treatment 3, Psychopathology: an abnormal pattern of behavior that is unusual, distressing, t dysfunctional, and that may cause the sufferer to be dangerous to self or others A. Criteria for defining abnormal behavior include: ‘ 1. Personal distress: subjective experience of suffering 2. Statistical rarity: has unusual behaviors (e.g., binge eating) 3. Maladaptive behavior: has impaired functioning (e.g., insomnia, poor reality testing) 4. Violation of social norms: exhibits behavior that is socially undesirable 5. Danger to self or to others: usually dangerous to self via poor judgment o No single criterion is adequate; need to consider cultural norms in defining abnormality The official definition of abnormal behavior stresses: ' ‘l. Impairment: difficulty in carrying out everyday functions (e.g., work, maintaining relation- ships) in an adaptive manner 2. Distress: emotional suffering (e.g., anxiety, depression) 3. Significant risk of pain, death, or important loss of freedom (e.g., selfemutiliation) j C. No sharp dividing line between normal and abnormal MAIN THEORIES OF ABNORMAL B AVIOR BIOLOGICAL THEORY eficits or defects in the structural or functional integrity of the nervous system lead to abnormal ehavior. Types of biological abnormalities include: . Defective genes: each chromosome contains thousands of genes (carriers of DNA) that influ» ence psychological and physical development. Defective genes may adversely affect develop- ment (e.g., trisomy causes Down syndrome). - Behavior genetics: the study of individual differences in behavior that are caused by differences in genotype (a person’s genetic makeup). Typically, it takes a combination of several altered genes to cause a disorder. . Structural brain abnormalities: occurs when areas of the brain have not developed optimally or have undergone pathological changes (e.g., the ventricles, which are the fluid—filled portions of the cortex, often are larger in schizophrenics). , Neurotransmitter imbalances: the 100 billion neurons in the central nervous system (CNS) communicate by chemical messengers called neurotransmitters, which can become imbal- anced. Biological approaches to treatment focus mainly on medications that address neuro- transmitter imbalances. T. Neurotransmitters (e.g., serotonin, dopamine, norepinephrine, GABA) are released into the synaptic cleft (the small gap between the axon of one and the dendrites of the receiving or postsynaptic neuron). They regulate level of mood, anxiety, and cognitive functioning. Factors affecting imbalance include: a, Number, distribution, and functioning of receptors on the dendrites (the receiving branches of the neuron) b. Reuptake: the amount of neurotransmitter in the synaptic cleft, or vesicle, that is reab- sorbed by the releasing neuron c. Degradation: the process by which a neurotransmitter is broken down by enzymes 1 released by the receiving neuron E D. Hormones: chemicals secreted by the endocrine glands (e.g., pituitary). They play a role in ‘ the functioning of the nervous system and in the regulation of behavior (e.g., during adoles» cence, changes in the hypothalamic»pituitaryeadrenal [HPA] axis are involved in the increase in cortisol, a stress-related hormone). - Functioning of neurotransmitters and endocrine glands is based on both biological factors , and environmental stressors. E. Methods used to assess the contribution of biological factors: ‘ 1. Twin studies: concordance rates in monozygotic (100% genes in common) and dizygotic twins (50% genes in common) allow researchers to tease apart genetic causes. If the con- cordance rate (the rate at which one twin has the disorder and the other does, too) is higher in monozygotic vs. dyzgotic twins, then the argument is made for a stronger genetic component to the illness. 2. Studies of family history: a researcher identifies those people with the disorder (pro- bands), examines family trees, and compares that information with controls, to see what percentage of firstedegree relatives also have the disorder. The problem is that one cannot tease apart genetic and environmental causes. 3. Adoption studies: comparisons of rates of the disorder in the adoptive relatives vs. biologi- cal relatives of the adoptees. This helps tease apart genetic and environmental causes. PSYCHOLOGICAL THEORIES 3A. Psychodynamic: refers to the conflict of forces in the mind. Sigmund Freud, the father of ‘ psychoanalysis, was the founder of modern psychodynamic therapy. T. Key assumptions include: a. Psychic determinism: mental life is lawful (i.e., the apparently random sequences of thoughts are not really random but are guided and connected by underlying motives). b. Unconscious motivation: most of mental life, particularly wishes, operates outside of awareness 2. The mind is organized on the basis of conflicts between: a, Id: the unconscious wishes b. Ego: coping and defense mechanisms c. Superego: the conscience 3. Instinctual drives: Freud posited that sex (broadly defined as physical urges) and aggres- sion are the two main instinctual drives 4. Defenses: if a person has wishes, desires, and fantasies (based on these drives) that he/ she regards as unacceptable and that arouse anxiety, he/she deals with them by means of defense mechanisms - Defense mechanism: any mental process or behavior can be used to ward off negative feelings (see chart, above right) Defense Mechanism Description Repression Keeping unacceptable wishes from consciousness Projection Attributing unacceptable wishes to someone else (e.g., "I don’t hate youiyou hate me") Reaction formation Transforming unacceptable wishes into their opposite (e.g., being saccharine-sweet rather than hostile) Displacement Redirecting a feeling from one person to another Regression Reverting to behavior from an earlier stage in development to avoid anxiety Rationalization Presenting a socially acceptable reason for behavior as a way of avoiding the real reason Denial Disavowing an action, thought, or feeling; refusing to admit to an aspect of reality lntellodualization Avoiding unpleasant feelings by adopting a highly ideational approach isolation of affect Keeping ideas and their feelings they excite separate in one's mind Sublimation Redirecting unacceptable impulses to socially desirable behavior 5. Symptoms arise when threatening wishes are too strong and/or defenses are too weak. , 6. Freud described four psychosexual stages of development: oral, anal, phallic, and genital. ,- Excessive gratification or deprivation at a given stage can result in: ' a, Fixation: stagnation at that stage _ b. Regression: a return to aspects of a given stage at times of stress (e.g., reverting to 3 thumbesucking following the birth of a sibling) ‘ B. Behavioral: focus on observable behavior rather than on the person's inner mental lifef Abnormal behavior is based on learning and environmental experiences. I 1. Classical conditioning (Pavlov): the pairing of contiguous events makes organisms learn 1 associations between things, creating involuntary responses to stimuli ‘ Elements of classical conditioning: , o UCS (unconditioned stimulus, food) :> UCR (unconditioned response, salivation to food) 2 b, UCS (food) + CS (conditioned stimulus, bell):> UCR (salivation to food) c. CS (bell) => CR (conditioned response, salivation to bell) , - Extinction of the conditioned response happens when, over the course of many trials, the sound of the bell is not followed by food , 2. Operant conditioning: the shaping of behaviors via reintorcers (i.e., rewards and ‘ punishments). a, Positive reinforcers: rewards that increase the probability of behavior b. Negative reinforcers: the removal of aversive stimuli that increase the probability of behavior (e.g., a social phobic feels relieved of anxiety when she avoids parties, so she continues to avoid) Punishment: negative consequences that decrease the probability of behavior d. Thorndike’s law of effect: behaviors followed by punishment are weakened; behaviors I followed by rewards are strengthened. ‘ e. Extinction is more difficult with a partial, in comparison with a continuous, reintorce- 3 ment schedule. I 3. Modeling: learning based on observing others. Even in the absence of obvious reinforcers, 3 we learn and behave by watching and imitating others. We are influenced by the rewards l and punishments others receive for their actions. ‘ C. Cognitive: one’s misconceptions of the world and misinterpretations of experience lead to beliefs and thoughts that cause negative feelings and behaviors, making one more vulnerable to abnormalities 1 1. Dysfunctional ideas and causal attributions are distorted, self—defeating, . and irratio- t nal. These incorrect thoughts are based on faulty schemas (organizations of beliefs and assumptions). ‘ 2. Beck and Ellis are major proponents of the cognitive view. Ellis focuses on common irratioe ‘ nal beliefs that must be overcome (e.g., “Everyone must love me"). Beck emphasizes the ‘ cognitive triad in depressed patients (having a negative view of themselves, the world, and 1 their future). D. Humanistic/existential views: focus on man's mortality, responsibility for decision—making, ‘ and his search for meaning in life. Proponents believe that disorders arise when people feel I compelled to conform to parental/societal demands instead of acting with authenticity in the ‘ pursuit of their own true values and goals. Authencity is more apt to promote self-actualiza- ‘ tion (the fulfillment of one’s potential). E. Sociocultural perspectives T. Focuses on the impact of social forces, family and cultural influences, and failures of society on individual mental health 2. Failure of support system: family, friends, community in times of stress (e.g., poverty, gender or racial discrimination, lack of opportunity) BIO-PSYCHO-SOGIAL INTEGRATION Abnormality is a function of the interaction of these three sets of factors and the vulnerability ' they create in the individual. THE DIATHESIS—STRESS MODEL Individual differences in vulnerability (diathesis), due to biological and psychological factors, ' interact with stressors in the environment. Proponents believe that particular combinations of diathesis and stress cause abnormal behavior. - High stress and low diathesis or low stress and high diathesis both can lead to psychological 3' disturbance. l" SPARKCHARTSm ABNORMAL psvcuomav CLASSIFICATION OF MENTAL DISORDERS CLASSIFICATION I A. DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, 4th ed.. Text Revision (DSM»IV—TR), published by the American Psychiatric Association (2000). I. This is the current classification system of mental disorders used for insurance, research, and record-keeping. Researchers use the DSM-IV»TR to classify: 0 Dimensions: quantitative (e.g., a matter of degree of the disorder) b. Categories: qualitative (e.g., presence vs. absence of a disorder) 2. Contains information on inclusion criteria, exclusion criteria, duration of disorder, and asso ciated features . Includes a classification system that classifies via five axes . Each axis includes categories that describe syndromes—sets of symptoms. Each general category consists of a number of subcategories #93 Axis I All categories of clinical syndromes (a configuration of symptoms), except personality disorders and mental retardation Axis II ‘ Personality disorders (long-standing patterns of maladaptive behavior) and mental retardation (deficient cognitive functioning) Axis III General medical conditions Axis W Psychosocial slressors (recent stressors, social resources, sociocultural background) and environmental problems 7 Axis v Global level of current functioning (overall clinical rating of degree of impairment) . _ I‘ clinical Assessment: sampling of behavior in different domains to arrive at a diagnosis, case I formulation, and treatment plan. A. Methods of assessment 1. Interview a. Structured: preeset format of questions b. Unstructured: open‘ended set of questions. Format depends on purpose of interviewer (i.e., research vs. treatment) and on the theoretical orientation of the interviewer. 2. Psychological tests and questionnaires a Performance-based measures i. Intelligence tests (e.g., Wechsler Adult Intelligence ScaleeRevised, or WAIs-R): used to derive Intelligence Quotient (IQ) based on verbal (e.g., abstract thinking, vocabue Iary) and nonverbal (e.g., visual-spatial ability, information processing speed) function, ing. IQ of 90-110 Is considered average. ii Neuropsychological tests (e.g., HalsteadeReitan Test): used to assess cognitive/ perceptual, emotional, and behavioral deficits and disturbances caused by brain dysfunctions (e.g., the Bender Visual-Motor Gestalt Test requires the reconstruction of and memory for designs, and can aid in the diagnosis of organic brain impairment). TYPES OF DISORDERS ANXIETY DISORDERS b. Psychosocial/affective measures 1 I. Praiective tests (e.g., Rorschach; Thematic Apperception Test, or TAT): tests are based I on the theory that the person’s interpretation of ambiguous stimuli is a good way to I uncover feelings and conflicts. particularly unconscious ones. I Ii. Self-report inventories: structured questionnaires and rating scales - BDI (Beck Depression Inventory): 21-item questionnaire; responses indicate severity of depressive symptoms ‘ - MMPI (Minnesota Multiphasic Personality Inventory): most popular personality I inventory; tests for symptoms of personality disorders c Behavioral assessments i Observation by others: observations of nonverbal or verbal behaviors ; II Self-observation: patient tracks aspects of own behavior (e.g., eating, smoking), a pro- I cess called self-monitoring I d Physical assessments i Physiological (EEG, EKG, EMG) - EEG: electrodes on the scalp record the electrical activity of brain areas ii, Neuroirnaging - Structural imaging (e.g., CT scan, MRI) - Functional imaging (e.g., fMRI, PET, SPECT): provide a picture of the structure and functioning of the brain a MultI-method assessment: integration of several or all other types of assessments Pros and cons of formal diagnosis using DSM-IVPR: A. Pros: 1. Facilitates research, recordekeeping, and statistical information : 2. Helps one search for etiology, implications for treatment and case management decisions, 3 and prognosis I 3. Provides a common language for clinitbians B. Cons: 'I. Stigmatizing 2. Categories not homogeneous 3. Condensed format leads to a loss of information RESEARCH METHODS A. Case study: a detailed history of an individual's life and psychological problems I B. Correlational study: examines strength of the relationship between events or characteristics C. Epidemiological studies: study of the frequency and distribution of disorders within a I population in relation to demographic factors ‘ 1. Incidence: number of new cases ofa disorder that appear in a population in a specific time period. ‘ 2. Prevalence: number of active cases in a population at a specific time a, Lifetime prevalence: proportion of people in population affected at some point In their lives ‘ b. Point prevalence: number of people who have the disorder at one given point in time D. Experiment: controlled manipulation of a variable and the observation of its effect Anxiety: 0 slate of unpleosoni apprehension and tension in which a person fears some type of future negative experience TYPES OF ANXIETY DISORDERS I A. Phobias: Characterized by disruptive and intense, Irrational fears of specific objects or situa» tions. These fears are disproportionate to the actual danger of the object or event. 1. Specific phobias: excessive, irrational fear caused by a particular object or event (e.g., anie mals, blood, injections, heights) 0 Agoraphobia: fear of open, public spaces or being unable to escape a public situation if one is incapacitated, especially by a panic attack b claustrophobic: fear of closed spaces c. Acrophobia: fear of heights 2. Social phobia: constant, irrational fear of specific or general situations that involve other people; fear of social performance and being judged by others. Sufferer avoids social situations that could be embarrassing, result in a negative evaluation, or show that he/she is anxious. B. Panic disorder: characterized by intermittent anxiety and by a sudden onslaught of symptoms called panic attacks. People with panic disorder can fear losing control, going crazy, or dying, and experience depersonalization and derealization. Can occur with or without agoraphobia. 1. Panic attacks: episodes of intense fear and four or more symptoms (e.g., heart palpitations, nausea, chest pain, dizziness, sweating, trembling, choking sensations, difficulty breathing, terror, intense apprehension). Attacks tend to be brief but are recurrent and unexpected. 2. Depersonalization: state of feeling estranged from one’s body 3. Derealization: state of feeling as if the world or surroundings are not real C. Obsessive-compulsive disorder (OCD): sufferer is compelled to repeat acts (compulsions) and/or is flooded with uncontrollable and persistent thoughts (obsessions), which cause dis, tress and interfere with daily functioning 'l. Obsessions: uncontrollable, intrusive. and repetitive thoughts, images, and impulses that cause anxiety 2. Compulsions: repetitive behavior or mental act that is performed to counteract the dis- tress of the obsessive thoughts (e.g., hand-washing, counting) D. Generalized anxiety disorder (GAD) l. sufferer experiences chronic, uncontrollable, and pervasive Iow»level anxiety and worry 2. Symptoms include: difficulty concentrating and sleeping, irritability, muscle tension, pounding heart, sweating, restlessness, and upset stomach E. Post-traumatic stress disorder: intense fear in reaction to a traumatic event I. Sufferers experience all of the following categories of symptoms: a, Rte-experiencing the event through intrusive memories, nightmares, or flashbacks b. Avoidance of reminders of the event or other, unrelated people and activities c Persistently increased arousal (e.g., anger, trouble sleeping, hypervigilance) CAUSES OF ANXIETY DISORDERS A. Biological: 1. Neurotransmitter dysregulation (e.g., deficiency of GABA in generalized anxiety disorder) 2. Increased physiological sensitivity (some people are more reactive and easily aroused) 3. Genetic factors B. Behavioral: 1. Learned alarms (e.g., mild physical cues become linked with panic attacks) 1 2. Classical conditioning creates fear of non-dangerous events/objects; operant conditioning I maintains avoidance of feared stimuli ‘ 3. Modeling (observational learning) C. Cognitive: 1 1. Misinterpretations (e.g., overestimate probability of negative event, underestimate own I ability to cope) 3 2. Sense of unpredictability and lack of safety/control, magical thinking (e.g., thinking that I worrying or performing compulsion may superstitioust prevent feared event) ‘ TREATMENT FOR ANXIETY DISORDERS A. Drug therapy: benzodiazepines, beta blockers, antidepressants I B. Cognitive therapy: helps patients Identify and change negative, irrational thoughts associA I ated with their anxieties I C. Behavior therapy: focuses on extinguishing fear by exposing patient to the feared object or I situation, gradually (e.g., systematic desensitization) or intensely (e.g., flooding) I 0 Modeling: therapist models behavior that the patient fears and then encourages the I patient to do so D. Psychodynamic therapy: addresses underlying, often unconscious conflicts associated with various anxieties I ABNORMAL PSYCHOLOGY w DISSOCIATIVE DISORDERS Aspects of one's identity, consciousness, or memory become split off from one B. Dissociative fugue: person loses all memory ofhis/her identity, moves to a new place, and another, These disorders usually follow heightened stress or trauma assumes a new identity. Can last for days or years; usually occurs during adulthood, C. Dissociative amnesia: loss of memory for significant personal facts, usually related to a 1 : TYPES traumatic experience 3 A. Dissociative identity disorder (formerly known as mulfip'e personality dimmer): sepa_ i. Localized amnesm: failure to recall events about the first few hours or days after a ‘ rate personalities coexisting in the same person. A given personality may or may not be trauma": eXper'e'me _ aware of the existence of alters (the other personalities). 2- filed”? amnefla: fallUl’e t0 recall some of these events I r - Alters have different names, different ways of speaking and relating to others, and even 3' Genem'Fedanffl'"? fallure F0 recall anything abOU’E one'S DrlOr llfe , may have different phy5i0|ogica| reactlons (93' "child," "persecutonn and "helper" per_ D. Depersonalization disorder: feelings of detachment, as though one is an outside observe ‘ sonaiitiesy er of one's self or mental processes MOOD DISORDERS Mood disorders include changes in emotional state, motivation, cognition, THEORIES OF MOOD DISORDERS and somatic state. About a 6% of Americans [13714 million} experience major A_ Biologimnheories depression each year, The lifetime prevalence for adults is to 2%, with roughly a 1. Generic predisposition 2 I ratio of females to males a stronger for bipolar disorders b Genetic contribution determined by twin and adoption studies TYPES 2. Neurotransmitter dysregulation A. Unipolar disorders 0 Catecholamine hypothesis: depression results from decreased levels of ‘ 1. Major depression: women 273 times more likely than men to get this diagnosis norepinephrine a Main symptoms: for more than two weeks, five or more symptoms (e.g., depressed b lndoleamine hypothesis: depression results from decreased levels of serotonin mood [persistent periods of feeling down, sad, depressed]; crying; sleep problems; c Antidepressants act to reduce the reuptake of these neurotransmitters weight loss or gain; psychomotor agitation or retardation; suicidal ideation; poor con» 1 B. Behavioral views centration; low self-esteem and feelings of worthlessness or guilt; fatigue) l 1. Life stress => soaal withdrawal :> reduction in positive reinforcements :> depression b Several subtypes: melancholic, catatonic, or psychotic features; postpartum onset; i 2. Seligman’s learned helplessness theory: derived from dogs’ reactions to inescapable seasonal pattern (e.g., seasonal affective disorder, or SAD) electric shock. States that one gives up after learning that one’s efforts are futile in 2. Dysthymic disorder: similar symptoms at a much milder level for at least two years avoiding pain and frustration. 3. Double depression: major depressive episode superimposed on dysthymic disorder C. Cognitive views: faulty thinking 8. Bipolar disorders (manicrdepression): mood swmgs from extreme highs to extreme laws. 1. Cognitive triad (Beck): negative View Of self. Others. and future I. Bipolar I (manic episode): elevated mood; inflated, grandiose self»image: more talk- a Schemas (set of stable, organized rules and assumptions about oneself and the ative; little sleep; flight of ideas; pressured speech; high risk-taking (e.g., foolish busie world) are rigid, negative, dysfunctional ness ventures, excesswe spending sprees, sexual promiscuity). Patient meets criteria b Schemas show indications of: overgeneralization, excesswe sense of responsibility, for mania and, at some paint, for major depression. Episodes of mania and depression alleorrnothing thlnkil'lg. may alternate in more or less rapid cycles or be mixed. c Negative automatic thoughts and cognitive distortions promote and maintain 2. Bipolar ll (hypomanic episode): same but much milder; no history of a manic episode. depreSSion Alternating periods of major depressive episodes and hypomanic episodes (which D. Psychodynamic view: Freud's essay Mourning and Melancholia have similar symptoms to manic episodes, but may be shorter and are less severe and 1. Differentiates normal process of grieving from depression. impairing). 2. Both processes involve loss: key symptom in depression is self-reproach, and in 3. Cyclothymic disorder: alternation of depressive symptoms (in the dysthymic range) depression anger is turned against the self 3 and hypomanic episodes for at least two years. 3. Combination of poor selfeesteem, unconscious selfrpunishment, and sense of loss and abandonment make one vulnerable to depression 3 _ Suicide is the third leading cause of death in people 544, often via drug overdose Alcoholism often is correlated to suicide as well, The elderly are more A. Biological likely to commit suicide than any other age group. Up to 70% of all suicides result 1. Tricyclic antidepressants. MAO inhibitors. SSRIS from a mood disorder 2. Electroconvulsive therapy (ECT) ‘ A. Warning signs: social withdrawal, decline in school functioning, loss of appetite, sleep 3' ngm therapY for SAP ‘ problems. More apt to occur when depression has lifted somewhat. 4- L'th'um for b'DOIar {isomers 'I. Stressful life events also contribute to serious illness. Important losses lead to sense of 3‘ PSYCh°'°_9'°°' 'heraP'es _ _ hopelessness and negative expectations, depression. 1- Benavior therapy (Increase posnive reinforcers) ‘ 2. Suicide does not necessarily occur because someone is psychotic 2' cogn't've therapy (Change negat've mmkmg) 3 8. Three types of suicide (Durkheim) c: P‘Y‘hwymm'c “PP'°°Ches_ _ 1. Egoistic: people who are alienated and are unconcerned with societal norms 1' Analyze sources a”_d confl'Cts “"ke‘j mOOd disorder _ 2. Anomic: people who feel let down by society and/or have experienced major Change 1 2. Help clients deal With loss, role tranSItions, deflCltS in interpersonal skills ‘ 3. Altruistic: believe it will benefit society I C. Main interventions for those at high risk: medication, crisis intervention, hospitalization, psychotherapy . EATING DISORDERS TYPES B. Bulimia nervosa: repeated episodes of binge eating with repeated compensatory behave I A. Anorexia nervosa: 90795% or more are females who try to starve themselves to become i°f5 (98-: se'f’induced vomiting! “59 0i 'axathesr diurems: enemas? faStlngi eXCESSlVe ‘ as thin as possible, dread weight gain, and are convinced that they are not thin enough. exefC'Sel? 9V9rf0CUS 0“ body Image; feelings of loss of controlaround food More common in middle, and upper»class, educated families and in athletes, dancers, and ' “95‘1"” hum": “mural emphas's 0” th'nnessi fam'IY dynamlcs (Pressure for models_ achievement, enmeshed families, deficits in sense of self, distorted body image) 1. Diagnostic criteria: refusal to maintain healthy body weight (at least 85% of expected weight). intense fear of weight gain, distortion of body image, amenorrhea. TREATMENTS FOR EATING DISORDERS 2. Two types A. Cognitive-behavioral therapies to correct attitudes and behaviors about eating a Restricting: no binge eating or purging B. Some cases of anorexia nervosa require hospitalization and forced feeding 1 b Binge/purge: regular bingeing and/or purging C. Medication: antidepressants (SSRIs) I SUBSTANCE-RELATED DISORDERS f 3 A psychoactive drug is a synthetic or natural chemical that affects mental 3. Types of substances used: depressants (e.g., alcohol, barbiturates), stimulants (e.g., I functioning [e g, alters mood, cognitions, motivation, or states of consciousness). amphetamines. Cocaine» ODiOIdS (6.8” heroin), hallucinogens (e.g., LSD, PCP) : TYPES 4. Substance-induced disorders: psychosis, sleep disorder ‘ A. Substance use disorders 1. Substance dependence: involves three or more of the following symptoms: 0 Physiological dependence indicated by tolerance (increasingly less effect from the same dose or increasing dose needed to produce the same effect) or withdrawal (unpleasant and possibly dangerous physical reactions that can occur when a person reduces or stops intake of a drug) b Strong focus on obtaining the substance A. Biological: genetic vulnerability B. Psychological: cognitive factors (e.g., expectation of relief from anxiety and stress) C. Behavioral: substance use is reinforcing; stopping use leads to negative consequences (e.g., increased anxiety, withdrawal) . . . TREATMENTS c Impaired functioning due to use of the substance , _ . , , _ d Inability to curtail or control use of the substance A' B'OIOQICOI: SSRIS’.d'SUIfIram (antabuse) fOIaICOhO'Ism . . . . . . 2. Substance abuse: maladaptive pattern due to substance use as seen by one or more B. Cognitive-behaworal treatments: averswe clas5ical conditioning, covert senSItization of the following, therapy, relapse prevention programs, Alcoholics Anonymous (AA) 0. Continued use despite interpersonal difficulties, legal problems, or physically hazards ous situations (e.g., drunk driving) b, Continued use despite interference with major responsibilities (e.g., work, school). CONTINUED ON OTHER SIDE — SLEEP DISORDERS Dyssomnias Symptoms Parasomnias Symptoms Primary insomia Difficulty falling 65'699 or staying asleep Nightmare disorder Repeated awakenings due to nightmares Primary hypersomnia Excessive sleepiness Sleep terror disorder Repeated episodes of sudden awakening with a Narcolepsy Falling asleep, often suddenly, with either cotaplexy Pan'CKed scream: along W'th autonom'c arousalland (episodes of bilateral loss of muscle tone) or repeated "Hens? fear: “Qt CmeOFFed by effort? 0f Others' intrusions of some REM (rapid eye movement) sleep l amneSIa of the entire episode, Including the dream 7 during the shift between sleep and wakefulness Sleepwalking disorder Repeated episodes of getting out of bed during sleep Breathing-related sleep Breathing disturbances that disrupt sleep in the form of and wa'k'"_g around W'th, a blank Sta”? re'at've'y disorder hypersomnia or insomnia unresponSIve to others, Including their attempts to . . ' . ' . . W . ' awaken the Sleepwalker Circadian rhythm sleep Pattern of sleep disruption leading to hypersomnia or disorder insomnia; due to a disturbance in circadian rhythm (e.g., due to jet lag or shift in work schedule) SEX L DISORDERS Problems in desire, arousal, and/or performance that cause interpersonal problems and distress; deviant sexual activrly lparophilias) Parop as Symptoms ‘ Exhibitionism Genital exposure to strangers _ oiIe-gihigh often to the exclusion of other sources of arousal sgxual Des're sympmms Frotteurism Rubbing against a nonconsenting person for erotic Disorders , stimulation 7 :YEMZt'Ve sexual LaCk 0f sexual des're Pedophilia Sexual contact with a prepubescent child esire Isor r 1 r ' . . .. . ' . f' Sexual masochism Sexual arousal In response to experiencmg hurt, humIlIar Sexual aversmn Marked averSIon to and avaidance of sex “on, bondage, or other suffering in a sexual encounter disorder _ > .c. . , I _ _ g a w r 7 Sexual sadism Sexual arousal In response to the partner 5 humiliation orisuffering sexual Arousal Symptoms Transvesth fetishism Need or deSIre to cross-dress in order to feel aroused Disorders _ _ . I c , .. , _ Voyeurism Sexual arousal Via looking at naked or sexually engaged, Female sexual arousal Inability to become aroused or to maintain adequate unsuspechng person sexual arousal ‘ r . . r r a disorder . _ , I r 7 a ; _ _ ‘ Gender identity Wishing to be the other sex In manner of dress, playmate Male erectile disorder Difficulty In attaining or sustaining erection necessary disorder preferences, preference for sex ro'es of the opposite gen. for 'ntercourse r der; feeling trapped in the wrong body Orgasmic disorders Early, delayed, or absent orgasm (e.g., premature fl ejaculation, ejaculation after minimal stimulation) THEORIES AND TREA MEN 1 Sexual pain disorders Dyspareunia (genital pain); vaginismus (involuntary Sexual disorders are caused by interaction of biological, psychological, and social factors. i vaginal spasm that prevents adequate intercourse) Treatments include medication (e.g., Viagra), sex therapy, couples and individual therapy; for l gender identity disorder, counseling and possibly gender reassignment. Treatments for paraphilr ias include cognitiveabehavioral strategies (e.g., aversion therapy) and chemical castration. PSYCHOTIC DISD DERS SCHIZOPHRE A 2. Disorganized (formally called hebephrenic): severe disorganization of behavior and ‘ The most severe disorder of all, schizophrenia IS a complex, severely disabling mfarked lnCOhe’ence 0f thougm am? 599931 (9-3-1 the patiem might “59 a W°"d salad 3 disorder that takes many forms, all of which involve disturbances in reality testing [bizarre stream of words} or neologisms lmadeaup wordsD; Inappropriate or flat affect; I A. History odd mannerisms. One often observes poor self»care as well. ‘ l. Dementia pruecox: Kraeplin believed the disorder was due to premature brain deterior 3- c°‘°‘°"i51 at least tWO 0‘ the fOIIOWln83 _ 3 ration that was progressive and irreversible a Stupor (remaining motionless for long periods of time, as though comatose) or 3 2. Bleuler comed term schizophrenia (“split mind") I motoric immobility (e.g., waxy flexibility: patient sits in rigid, often strange posture 3 3. Prevalence: affects about 1% of the US. population in any given year; found across cultures and lema'l‘s DESS'Ve 'f the examiner alters hlS/her 903mm) ‘ l. Schizophrenia typically develops in late adolescence/early adulthood (late teens, early , b Excneme'“: a'm'essi excesswe mom’ aCth'tY 205). Can develop later, especially with women. Often develops over time and has a long C- Ma'ke‘l "ega'iVlsm course or duration. Also may have an acute onset. d S'mngel SfefeOlYPed mOVementS, mannerismS. EGSIUfeS C. Symptoms e Echolalia (automatic repetition of voices) or echopraxia (automatic repetition of 1. Four domains; another person’s movements) 3 o Disorganized behavior: chaotic functioning, bizarre behavior, odd motor movements 4~ undifie'enlimed SChlmPhl’enim D095 “0t me“ Cmerla for any 0f the Other three ‘ or posturing types, but does meet criteria under diagnostic criteria for schizophrenia (see above). b Disturbances in thought and speech: delusions, disorganized thinking, and/or bizarre communication characterized by nonsensical words and phrases OTHER PSYCHDTlc DISORDERS 3 - Delusions: false, unrealistic belief held with conviction (e.g., delusions of referr A. Schizophreniform disorder: meets criteria for schizophrenia for fewer than six months, ‘ ence, grandeur, control) but more than one month c Perceptual disturbances 8. Brief psychotic disorder: one or more of the following symptoms for at least one day but 3 - Hallucinations: projection of internal sensory experiences onto the outside world less than one month, with eventual full return to premorbid functioning: deIUSIons, hallucir (e.g., auditory, visual) nations, disorganized speech, or behavior 1 d Emotional disturbances: very socially isolated and withdrawn, marked decreases in C. Shared psychotic disorder (fol/e a deux): two people in a close relationship who share the motivated, goaladirected behaVIor, disturbance in the sense of self, poor self/other same delusion differentiation; flat or inappropriate affect D. Schizooftective disorder: meets criteria for both schizophrenia and a mood disorder. Has 2. Two types of symptoms delusions or hallucinations for at least two weeks in the absence of significant mood sympr a Positive symptoms (Type I): delusions, hallucinations, speech and thought incoherr ‘ toms. Can be either bipolar type or depressive type. ence (errors of commission) E. Substance-induced psychotic disorder: hallucinations or delusions due to a substance ‘ b Negative symptoms (Type II): flat affect, avolition/apathy, social Withdrawal, anhedo- F. Delusional disorder: for at least one month, clear delusions but not bizarre (e.g., j nia (errors of omission) erotomania: delusional belief that a person of higher status is in love With one). No indie 3 D. Diagnostic criteria for schizophrenia cation of the main schizophrenia symptoms. Behavior outside delusional beliefs is not 1. Two or more of the followmg five symptoms must be present in a significant way for at grossly impaired. 3 least one month during a period of six months: delusions, hallucinations, markedly disorr l ganized or catatonic symptoms, and negative symptoms ‘ 2. The patient must have symptoms continuously for at least six months, With at least one A_ Biological: month 0f acme Symptomsi as "Oted abOVe 1. Genetic factors: degree of risk correlates with degree of shared genes, but concordance 3 3. If the symptoms are present for at least one month but less than six months, the diagnoa rates for identical twins leave room for ehwonmemaj and other factors Sis Of “himph'enlfwm disorder (595‘ Other PSYChOUC Disorders. DEIOWl ‘5 made 2. Structural brain abnormalities (e.g., reduction in gray matter or low metabolic rates in l 5' Phases Of SChlZ°thenl° the prefrontal cortex and larger cerebral ventricles implies a loss of brain cells) 1‘ Pr°dl°mal Phase: early Signs Of d9ter'0rati0ni Wh'Ch may 'aSt for years- Typical 5'9“ 3. Dopamine hypothesis: pOSItive symptoms ofschizophrenia related to excess dopamine ments of a prodromal phase are: activity in the brain 0 Decreased were“ in 3003' aCthlt'es 4. Pregnancy complications, espeCIally maternal Influenza during gestation b Difficulty meeting reqUIrements of daily liVIng (e.g., lapses in work at home/school) 8' psychological: ‘ C some Straflge bEhaVlor (e-g-r feeling like anOthe' person is in an empty room) 1. Adverse family environment (e.g., high "expressed emotion”: negative criticism by hos» 2- Acme Phase: “0”le psi/Cl“)th lfUll'b'C’W” hal'UCinat'O'lS and/0f GQIUS'OnS deVe'Op)? tile, overinvolved family members) leads to increased stress and higher relapse rates very difficult to understand or communicate with the person 2. Communication deviance (e.g., double-bind message: inconsistent, contradictory 3. Residual phase: behaVIor returns to prodromal level, but patient still shows difficulty messages, as when a parent encourages patient to be Closer and men is rejecting) meet'ng demands 0f 509ml ’0'95 3. BehaVIoral theories stress that schizophrenics have not learned appropriate social F. Subcategories of schizophrenia l. Paranoid: characterized by deIUSIons and hallucmations, With themes of persecution ‘ and/or grandiosity; often no gross disorganization of speech and behavior, no prominent ‘ negative symptoms skills and acceptable somal repsonses. Cognitive theories focus on the patient’s delusional beliefs as ways of understanding their peculiar perceptions, which were biologically caused. PSYCHOTIC DISORDERS (CONTINUED) A. Medical 1. In 1950s, major tranquilizers (called neuroleptics or antipsychotic drugs leg, chlorpromar zinej) discovered to control positive symptoms. These drugs block dopamine receptors in 3 the brain. Side effects include tardive dyskinesia. a. Tordive dyskinesia: movement disorder that affects face, mouth, neck, extremities. 2. New drugs called atypical antipsychotics have been introduced (e.g., clozapine, which seems to help both positive and negative) 1 B, Psychological approaches: social skills training; family therapy; community treatment pro— grams (e.g., halfway houses); psycho-education of the family CHILDHOOD DISORDERS TypEs G. Learning disorders: performance in reading, math, or writing is below that expected for age, A. Attention-deficit hyperactivity disorder (ADHD) 1. Symptoms: inattention, hyperactivity, and impulsivity 2. Biological factors: often occurs if there are prenatal and birth complications, or immature 3 brain development. Disorder runs in families. 3. Psychological factors: adverse psychological environment (e.g., disrupted families) 4. Treatment 0 Medical: Ritalin b Behavioral: therapy in which teachers and parents reward patient’s selfecontrol and attentiveness . Conduct disorder and oppositional defiant disorder 1. Characteristics a Conduct disorder: person violates rights of others and societal norms for appropriate, rule-bound behavior. b Oppositional defiant disorder: negative, Irritable, uncooperative, argumentative; less 3 severe than in conduct disorder sion and uninvolvement, serotonin imbalances, lower physiological arousal to punishment, 1 Increased testosterone levels, genetic predisposition 3. the affected child _ Separation anxiety disorder: excessive fear and distress on separation from caregivers 1. Causes: parental behaviors that encourage fear; childhood traumas; behavioral inhibition (an innate Inhibited and fearful temperament) 3 D. Elimination disorders: disturbances in bladder and bowel control 1. Enuresis: unintended urination at least twice per week for more than three months in a child over five 2. Encopresis: unintended defecation at least once per month for three months in a child over four . 3 E. Motor skills disorder (developmental coordination disorder): developmental delays or difficule 3 3 ties, especially with motor skills F. Communication disorders: deficits in verbal communication (e.g., stuttering) - Expressive language disorder: difficulty learning or retrieving words DELIRIUM, DEMENTIA, AMNESTIC, AND OTHER COG A. Delirium: disturbance in conscious experience, with attentional/perceptual and memory defi— CIts caused by a medical or physiological condition (e.g., due to substance intoxication or with- drawal) 3 B. Dementia: .Contributing factors: difficult temperament, parental violence, poor parental supervi- Treatments: behavioral and cognitiveebehavioral techniques involving both the parents and 1 . grade, or IQ H. Mental retardation 1. Poor intellectual functioning: IQ below 70 a 5040: mild b 35750: moderate ( 20—35: severe d Below 20: profound 2. Maladaptation in at least two important areas of functioning (e.g., selfrcare, communica tion) 3. Biological causes a Phenylketonuria (PKU), a genetically transmitted metabolic disorder b Down syndrome (trisomy 21) c Tay-Sachs disease a Fetal alcohol syndrome 4. Treatment includes social programs (e.g., group homes) and behavioral Interventions aimed at self»care and language development I. Pervasive developmental disorders: severe impairment in several areas of functioning 1. Autistic disorder: severe impairment in social interaction, in communication, and In interests and activities 2. Asperger’s disorder: impairment in social interaction (e.g., nonverbal behavior defICIts, lack of peer relationships) and restricted behaviors and interests (e.g., intense preoccupation with a certain subject or object, repetitive movements) 3. Rett’s disorder: decline of acquired developmental milestones (e.g., language or coordina tion skills) J. Feeding and eating disorders of infancy or early childhood 1. Pica: ingestion of nonnutritive substances 2. Rumination disorder: rechewing and regurgitation of food instead of normal chewing and swallowing K. Tic disorders - Tourette’s syndrome: frequent motor and/or vocal tics (rapid, stereotyped, nonrhythmic action) NITIVE DISORDERS 3 2. Vascular dementia: progressive dementia like Alzheimer’s disease, but unlike Alzheimer's, 3 symptoms begin abruptly, often due to stroke. Cognitive dysfunction may be more localized 3 rather than pervasive. 3 C. Amnestic disorders: disorders of an organic natures involving loss of memory; may be ‘ transient or chronic and caused by drug use or medication 1. Alzheimer type: memory impairment, cognitive impairment (e.g., planning and object recr ognition, or agnosia; motor dysfunction, or apraxia; language disturbance, or aphasia) not due to other factors that can cause these deficits 3 PERSONALITY DISORDERS 3 Described on Axis II, chronic patterns of maladaptive, pervasive, stable, and distressing I behaVIor and inner experience They are clustered into three main categories TYPES Cluster A: Odd/ Eccentric Symptoms Paranoid Suspicious, sees hidden meanings in innocent remarks, ‘ fears betrayal r 7 7 Schizoid No close friends, aloof and detached Schizotypal Social/interpersonal deficits with five (or more) of the following: suspicious thinking, strange beliefs, strange speech, eccentric behavior, unusual perceptions, ideas of reference, marked social anxiety 3 Cluster B: Dramatic/Erratic Symptoms Antisocial Irresponsible, deceitful; poor regard for rights of others; lack of empathy and remorse; Violates social norms; exploitative Seeks center of attention, often using physical appear: ance; often sexually provocative/seductive; emotion, ally shallow; quickly assumes more intimacy than exists early in relationships; impressionistic thinking Inflated sense of self, arrogant, deficient in empathy, sees self as special, sense of entitlement Strong and chronic feelings of emptiness, mood instabili- ty, disturbance in identity, fears abandonment; unstable, impulsive interpersonal relationships, suicidal gestures, selfAmutilation Histrionic Narcissistic Borderline Cluster C: Anxious/Fearful Symptoms Avoidant Inhibited with others; limits social contact; fears criticism and rejection Dependent Wants others to make decisions; fears taking care of self; passive Rigid, preoccupied with details, perfectionistic; has diffi- culty delegating responsibility; hoards money, objects Obsessive—compulsive IMPULSE-CONTROL DISORDERS Impulse-Control Disorders Symptoms Intermittent explosive disorder Episodes of aggressive, poorly controlled, over—reactive outbursts that lead to assaultive behavior and/or destruction of property Stealing objects not needed for personal use, prey ceded by a sense of rising tension and followed by a sense of relief and gratification; presumably not motivated by anger Deliberate setting of fires, accompanied by a cycle of tension, fascination, gratification, and relief Repeated, compulswe gambling of clearly maladaptive proportions Repeated pulling out of clumps of one's hair, result: ing in noticeable hair loss; preceded by rising tension and followed by gratification and relief Kleptomanio Pyromania Pathological gambling Trichotillomania SOMATOFORM DISORDERS The experience of physical symptoms for which there is no apparent physical basis A. Conversion disorder: symptom(s) or deficit(s) in sensory or motor function, often sugges: tive of a neurological condition, but without physical basis (e.g., hand paralysis) Somatization disorder: history of bodily complaints with no apparent physical basis Pain disorder: history of complaints about pain, not fully explained by physical cause Hypochondriasis: chronic worry that one has a physical illness without physical evidence Body dysmorphic disorder: excessive preoccupation with a part of one’s body that one believes is defective B. C. D. E. ADJUSTMENT DISORDERS This overall category refers to a variety of relatively milder, but clinically significant, disturbances in mood, anxiety, and/or conduct that are reactions, within three months, to environmental stressors that do not meet criteria for an Axrs | disorder, TREATMENT TREATMENT OF ABNORMAL BEHAVIOR , A. Drug therapy (psychopharmacology) i. Anxiolytics: used primarily to reduce anxiety (e.g., benzodiazepines like Valium, Xanax, Ativan, Klonopin). Not useful for all anxiety disorders (e.g., panic disorder). Used along With SSRIs for 0CD. 2. Antidepressants: medications to relieve symptoms of depresstve disorders. 0 Tricylics (TCAs such as Elavil, Tofranil, Pamelor, Anafranil): reduce the reuptake of norepinephrine and serotonin b Selective serotonin reuptake inhibitors (SSRIs such as Prozac, Paxil, Zoloft, Luvox): reduce reabsorption of serotonin that has been released into the synapse. Can cause agitation c Monoamine oxidase inhibitors (MAOis such as Nardil, Parnate): prevents the break: down of neurotransmitters like serotonin and dopamine by inhibiting the enzyme MAO. Bad side effects if taken with cheese, red wine, and other foods. 3. Mood stabilizers: (e.g., Lithium, Tegretol, Depekene Ivalproic acid]) for bipolar disor: ders 4. Antipsychotic agents (neuroleptics such as Thorazine, Haldol, Stelazine): used to quiet positive symptoms of schizophrenia. Also used to treat acute mania. Prolonged use can cause tardive dyskinesia (involuntary, often ticrlike, movements of limbs and face, smacking of lips, tongue protrusion) in about 20% of cases. Sovcailed atypical antipsy- chotics include Risperadal, Zyprexa, and Clozaril. About 75% of patients relapse within a year if medication is discontinued. B. Electroconvulsive therapy (ECT): effective for serious depression in many cases that have been refractory to medication. Brain seizure is induced via electrical current to patient's brain. Usually requires 6—12 treatments. Some studies report that 60% improve, but there is a high relapse rate. C. Light therapy: exposure to bright light can reduce depressive symptoms in some cases of SAD pschoLooicA T MENTS I, A. Behavior therapy 1. Application of learning principles from classical and operant conditioning 2. Main approaches: 0 Systematic desensitization: helping the client practice relaxation while confronting stimuli based on a progressive hierarchy of anxiety/fear, from low to high b In vivo exposure or flooding: presentation of the feared stimulus c Aversion therapy: pairs the undesirable behavior with punishment . d. Token economy: shapes behavior via positive reinforcements ‘ B. Cognitive-behavioral therapy (CBT) I 'i. Modification of cognitions that are linked to maladaptive behavior 2. Main approaches: a. Rational-emotive therapy (RET) (Ellis): Focuses on altering irrational beliefs (e.g., one must be perfect or loved by everyone) b Cognitive therapy (Beck): identifies the client's automatic beliefs and negative assumptions; encourages client to be objective in gathering information relevant to their maladaptive views so that disconfirmation is possible C. Psychodynamic/interpersonal therapies i. Aim is to promote positive personality change via insight and the healing properties of a good relationship With the therapist. 2. Main approaches: a Psychoanalysis and psychoanalytic therapy: interpretations of the patient's transference (emotional reliving of past, core conflicts and relationships, via the therapist) and resistance (reluctance to become aware of wardedeoff mental contents and to institute changes based on insights). Therapeutic alliance between client and therapist is very important. 1 A. Most studies that combine data from individual research projects (meta-analyses) find , that therapy works but that no one approach is consistently superior. f B. Efficacy vs. effectiveness: key unresolved issue in psychotherapy research ‘ 1. Efficacy studies show that certain treatments can provide a benefit. Studies used include the following: a Randomized clinical trials (RCTs) b. Patients who do not have comorbid conditions I A. Legal issues ‘ i. Competence to stand trial: can the person participate in his own defense? 2. insanity defense: was the person so mentally incapacitated at the time he/she com- mitted the crime that he/she is not responsible for the act? . B. Mental hospital commitment i. involuntary commitment: criteria for being placed in a mental hospital include: a. Imminent danger to self or to others b Diagnosable mental disorder c. Profound disability 0 Approximately 25% of inpatients are hospitalized involuntarily. f- Abnormal psychology: the study of the development of abnormal behavior Acute: relatively sudden or of short duration i Anhedonia: the condition of not being able to feel pleasure 3 Chronic: of long duration Comorbidity: meeting the diagnostic criteria for more than one disorder Diagnosis: the decision that an individual’s particular symptoms, problems, or issues can be labeled as a specific disorder Diathesis: an individual's propensity or vulnerability toward having a particular abnormal» ity or disease Etiology: the causes of a disorder Prevalence: at a given time, the percentage of people in a population who have a particu» Syndrome: a set of symptoms that occur together b Supportive therapy: does not explore the transference or analyze the client's defenses; instead, offers calm support, guidance, and a focus on current problems. acceptance, and search for meaning 1. Person-centered therapies: developed by Carl Rogers, this approach aims to create conditions that enable the client to resume thwarted efforts at selfPactualization. The conditions include unconditional positive regard by the therapist, conveyed by empathic reflection of what the client is saying and feeling. 2. Gestalttherapy: developed mainly by Fritz Perls, this approach focuses on gaining con- D. Existential-Humanistic therapy: aim is to promote client's personal growth, self- I scious access to blocked emotions and bodily sensations; uses the empty chair tech: ‘ nique, in which the client addresses someone with whom he or she has a conflicted 3 relationship. 3. Existential therapy: focuses on issues of alienation, personal responsibility, meaning of ‘ life, authenticity, mortality major approaches to best meet the therapeutic needs of a given client of therapy into a much shorter period of time tims, suicidal individuals, runaways). GROUP PSYCHOTHERAPIES E. Eclectic/integrative therapies: various attempts to borrow techniques from several of the F. Brief psychotherapies: a variety of time-limited approaches that try to condense the work i G. Crisis intervention: deals with immediate problem (e.g., telephone hotline for rape vic- A. Family therapy: treats the family as the unit, based on the idea that the identified client 3 often expresses the fact that there are significant psychological problems in the patterns of family interaction 1. Structural family therapy (Minuchin): assumes that changes in the patterns of interac- tions (e.g., rigidity, overprotectiveness, enmeshment, faulty communication) will facill: i tate less pathological functioning for each family member B. Couples therapy: variety of approaches, but common goals are improving communica: 3 tion, identifying unproductive power struggles and incompatibilities, increasing each partner’s awareness of and respect for the other partner's issues and vulnerabilities. i Homework assignments, contracts, and videotaped playback of the session are some of i the techniques used. MILIEU THERAPY AND OTHER COMMUNITY INTERVENTIONS Focus is on the social context of psychopathology , A. Creation of therapeutic communities for schizophrenic patients; residential psychiatric 3 hospitals for those with severe emotional or substance abuse problems; halfway houses; 3 day treatment centers potential mental illness B. Primary and secondary prevention programs: aim at prevention or early detection of 1. Primary prevention: programmatic efforts in the general population to forestall behave j iors that have a high psychiatric risk (e.g., educational programs to prevent teenage i pregnancy) 2. Secondary prevention: identification of high risk populations followed by interventions (e.g., having college students serve as buddies or mentors to children at risk, such as 3 those from abusive family environments) RESEARCH IN PSYCHOTHERAPY c, Patients treated for a specified time period d Patients randomly assigned to different treatments conducted according to a manual to which the therapists adhere 2. Effectiveness refers to whether results from the efficacy studies can be generalized to the real world of clinical practice I PSYCHOPATHOLOGY AND SOCIETY I 2. Shorteterm commitments do not require a court order, but longer ones do. Patients have a right to be treated as well as a right to refuse treatment. C. Clinicians 'i. Clinictans are required to protect patient confidentiality except: a. When involuntary commitment is necessary b To take steps to protect a client and others from physical harm c. To report suspected cases of child abuse or elder abuse lar disorder or disease Proband (also known as the index case): the individual who has the genetic trait or diag nosis that a researcher or psychiatrist wants to investigate Prognosis: an estimation of how a disorder or disease will develop and what its outcome will be Psychopathology: behavioral, emotional, or thought patterns that are deemed deviant or atypical because they cause personal distress, are statistically rare, cause impaired functioning, and are a violation of social norms ...
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