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Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION Models in Explaining Abnormal Behavior Cognitive Theory  Dysfunction Schema for Personality...

Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION Models in Explaining Abnormal Behavior Cognitive Theory  Dysfunction Schema for Personality Disorders 1. Stress Diathesis Model Diathesis + Stress = Disorder (inherited tendencies) ( stressors) 2. rGE Model ( Gene- Environment Model) Passive: parents pass on genes and provide the environment Evocative: heritable traits influence the reactions and environment provided by others Active: heritable traits influence one’s choice of environment Family Systems (Interpersonal Boundaries) 3. Neuroscience  How the brain works is central to any understanding of our behaviors, emotions, and cognitive processes Lobes of the Brain  Frontal: thinking and reasoning, planning, Parental Hierarchy and long term memory  Parietal: Various sensations of touch and monitoring body positioning  Occipital: Integrating and making sense of visual inputs  Temporal: sights and sounds with long term memory storage Human Growth Model ( Communication Stances) 5. Social Causation Hypothesis o Social Causation Hypothesis: experiencing economic hardship increases the risk of subsequent mental illness o Selection/ Drift Hypothesis: mental illness can inhibit socioeconomic attainment and lead people to drift into to the lower social class 4. Psychological Model 6. Narrative Model (Discourses)  Dominant Discourses: broad societal stories, sociocultural practices, assumptions, expectations about how we should live  Local discourse: occur in our heads, our closer relationships, and marginalized communities Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION Distress or Impairment  The criterion is satisfied if the individual is extremely upset 7. BioPsychoSocial Model Atypical or not culturally expected  Deviates from average Five Ds 1. Dysfunction - cannot function well 2. Distress - cannot accomplished what you want to do 3. Deviance - Deviates from average 4. Duration - how long na persist ang nafeel 5. Danger - suicidal tendencies The Science of Psychopathology Psychopathology - is the scientific study of psychological disorders. Within this field are specially trained professionals, including:  Clinical psychologists and counseling psychologists  receive the Ph.D., doctor of philosophy, degree (or sometimes an Ed.D., doctor of education, or Psy.D., doctor of psychology)  conduct research into the causes and treatment of psychological disorders and to diagnose, assess, and treat these disorders Chapter 1: Abnormal Behavior in Historical Context Counseling Psychologists - tend to study and treat adjustment and vocational issues encountered by What Is a Psychological Disorder? relatively healthy individuals Clinical Psychologists - usually concentrate on more Psychological Disorder - a psychological dysfunction severe psychological disorders. within an individual associated with distress or impairment in functioning and a response that is not  Psychiatrists typical or culturally expected  first earn an M.D. degree in medical school and then specialize in psychiatry during residency Psychological Dysfunction training that lasts 3 to 4 years  investigate the nature and causes of Psychological dysfunction - refers to a breakdown in psychological disorders, often from a cognitive, emotional, or behavioral functioning. biological point of view; make diagnoses; and offer treatments. emphasize drugs or other Ex. if you are out on a date, it should be fun. But if you biological treatments, although most use experience severe fear all evening and just want to go psychosocial treatments as well home, even though there is nothing to be afraid of, and the severe fear happens on every date, your emotions are  Psychiatric social workers not functioning properly. However, if all your friends  typically earn a master’s degree in social work agree that the person who asked you out is unpredictable as they develop expertise in collecting and dangerous in some way, then it would not be information relevant to the social and family dysfunctional for you to be fearful and avoid the date. situation of the individual with a psychological disorder  treat disorders, often concentrating on family problems associated with them.  Psychiatric nurses  have advanced degrees, such as a master’s or even a Ph.D., and specialize in the care and treatment of patients with psychological Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION disorders, usually in hospitals as part of a Incidence rate - normally expressed as the treatment team. number of cases  Course - the length of time a disorder  Marriage and family therapists and mental typically lastsa health counselors  Prognosis - a prediction of the course,  typically spend 1 to 2 years earning a master’s duration, severity and outcome of condition degree and are employed to provide clinical (forecast of diagnosis ) services by hospitals or clinics, usually under the supervision of a doctoral-level clinician episodic course - in that the individual is likely to recover within a few months only to suffer a recurrence The Scientist-Practitioner of the disorder at a later time. This pattern may repeat throughout a person’s life  Many mental health professionals take a scientific approach to their clinical work and time-limited course - meaning the disorder will improve therefore are called scientist-practitioners without treatment in a relatively short period with little or no risk of recurrence. Mental health practitioners may function as scientist- practitioners in one or more of three ways acute onset/ insidious onsent - meaning that they begin 1. they may keep up with the latest scientific suddenly; others develop gradually over an extended developments in their field and therefore use period the most current diagnostic and treatment procedures  developmental psychology - the study of 2. scientist-practitioners evaluate their own changes in behavior over time assessments or treatment procedures to see  developmental psychopathology - the study of whether they work. They are accountable not changes in abnormal behavior only to their patients but also to the  life-span developmental psychopathology - government agencies and insurance companies Study of abnormal behavior across the entire that pay for the treatments age span 3. might conduct research, often in clinics or hospitals, that produces new information about disorders or their treatment, thus becoming immune to the fads that plague our field, often Causation, Treatment, and Etiology Outcomes at the expense of patients and their families  Etiology - the study of origins, has to do with why a disorder begins (what causes it) and includes biological, psychological, and social dimensions.  Treatment - is often important to the study of psychological disorders. If a new drug or psychosocial treatment is successful in treating a disorder, it may give us some hints about the nature of the disorder and its causes. Historical Conceptions of Abnormal Behavior The driving forces behind the supernatural model  Divinities  Demons Clinical Description  spirits  other phenomena such as magnetic fields or the  Presenting Problem moon or the stars Presents - is a traditional shorthand way of > mind has often been called the soul or the psyche indicating why the person came to the clinic. Two traditions of thought about abnormal behavior:  Clinical - refers both to the types of problems Biological Model and Psychological Model or disorders that you would find in a clinic or hospital and to the activities connected with assessment and treatment. The Supernatural Tradition > deviant behavior has been considered a reflection of  Prevalence - the total number of cases existing the battle between good and evil. in the population ( how many people in the > When confronted with population as a whole have the disorder? ) unexplainable, irrational behavior and by suffering  Incidence - new cases occur during a given period, such as a year Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION and upheaval, people have perceived evil Mob Psychology - If someone nearby becomes > all physical and mental disorders were considered the frightened or sad, chances are that, for the moment, you work of the devil also will feel fear or sadness. Moon and Stars Demons and Witches Paracelsus - a Swiss physician who lived from 1493 to > People increasingly turned 1541 to magic and sorcery to solve  rejected notions of possession by the devil, their problems. suggesting instead that the movements of the > During these turbulent moon and stars had profound effects on times, the bizarre behavior of people’s psychological functioning people afflicted with psychological disorders was This influential theory inspired the word lunatic, which seen as the work of the devil is derived from the Latin word luna, meaning “moon.” and witches. The Biological Tradition Treatments > Physical causes of mental disorders have been sought  Exorcism - which various religious rituals since early in history. were performed in an effort to rid the victim of evil spirits Important to the biological tradition : man,  shaving the pattern of a cross in the hair of Hippocrates; a disease; syphilis the victim’s head and securing sufferers to a wall near the front of a church so that they Hippocrates and Galen might benefit from hearing Mass. Hippocrates - greek physician  hanging people over a pit full of poisonous snakes might scare the evil spirits right out of  considered to be the father of modern their bodies (to say nothing of terrifying the Western medicine. people themselves).  He and his associates left a body of work called  the Hippocratic Corpus, written between 450 and 350 b.c. (they suggested that psychological disorders could be treated like any other disease) Stress and Melancholy  they suggested that psychological disorders could be treated like any other disease > during this period, reflected the enlightened view that insanity was a natural phenomenon, caused by mental or  considered the brain to be the seat of wisdom, emotional stress, and that it was curable consciousness, intelligence, and emotion. > Mental depression and anxiety were recognized as Therefore, disorders involving these functions illnesses. (although symptoms such as despair and would logically be located in the brain lethargy were often identified by the church with the sin  recognized the importance of psychological of acedia, or sloth) and interpersonal contributions to psychopathology, such as the sometimes- Treatments negative effects of family stress; on some  Rest occasions, he removed patients from their families.  Sleep  a healthy and happy environment. Galen - roman physician  Baths  adopted the ideas of Hippocrates and his  ointments and various potions. associates and developed them further Mass Hysteria Humoral Theory of Disorders  One of the more interesting and influential >Another fascinating phenomenon is characterized by legacies of the Hippocratic-Galenic approach large-scale outbreaks of bizarre behavior  the first example of associating psychological > run out in the streets, dance, shout, rave, and jump disorders with a “chemical imbalance,” an approach that is widespread today. Four bodily fluids or humors Modern Mass Hysteria 1. Blood - came from the heart 2. Black bile - from the spleen (too much > dizziness, headache, nausea, and stomach pains. Some black bile was thought to cause melancholia were vomiting; most were hyperventilating (depression). > Mass hysteria may simply demonstrate the 3. Yellow bile - from the brain phenomenon of emotion contagion, in which the 4. Phlegm - from the liver experience of an emotion seems to spread to those around us Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION The four humors were related to the Greeks’ conception Asylum Reform and the Decline of Moral Therapy of the four basic qualities: 1. Heat Dorothea Dix (1802–1887) - The great crusader 2. Dryness  campaigned endlessly for reform in the 3. Moisture treatment of insanity. 4. cold  A schoolteacher who had worked in various institutions, she had firsthand knowledge of the  sanguine (literal meaning “red, like blood”) deplorable conditions imposed on patients with describes someone who is ruddy in complexion insanity, and she made it her life’s work to  Melancholic means depressive (depression was inform the American public and their leaders of thought to be caused by black bile flooding the these abuses. Her work became known as the brain) mental hygiene movement  phlegmatic personality (from the humor phlegm) indicates apathy and sluggishness but Psychoanalysis - The first major approach can also mean being calm under stress  based on Sigmund Freud’s (1856–1939)  choleric person (from yellow bile or choler) is elaborate theory of the structure of the mind hot tempered and the role of unconscious processes in > Hippocrates also coined the word hysteria to describe a determining behavior. concept he learned about from the Egyptians, who had identified what we now call the somatic symptom Behaviorism - second major approach disorders  associated with John B. Watson, Ivan Pavlov, and B. F. Skinner, which focuses on how Syphilis learning and adaptation affect the development of psychopathology. advanced syphilis - a sexually transmitted disease caused by a bacterial microorganism entering the brain, include Psychoanalytic Theory believing that everyone is plotting against you (delusion Breuer and Freud had “discovered” the unconscious of persecution) or that you are God (delusion of mind grandeur)  its apparent influence on the production of psychological disorders. psychosis— psychological disorders characterized in part  This is one of the most important developments by beliefs that are not based in reality (delusions), in the history of psychopathology and, indeed, perceptions that are not based in reality (hallucinations), of psychology as a whole. or both  A close second was their discovery that it is therapeutic to recall and relive emotional Consequences of the Biological Tradition trauma that has been made unconscious and to Grey and his colleagues ironically reduced or eliminated release the accompanying tension. This release interest in treating mental patients, because they thought of emotional material became known as that mental disorders were the result of some as-yet catharsis. undiscovered brain pathology and were therefore incurable. The only available course of action was to psychoanalytic model - the most comprehensive theory hospitalize these patients. yet constructed on the development and structure of our personalities Emil Kraepelin (1856–1926) - was the dominant figure during this period and one of the founding fathers of psychoanalytic theory -Although most of it remains modern psychiatry. unproven, it has had a strong influence, and it is still  He was extremely influential in advocating the important to be familiar with its basic ideas; what follows major ideas of the biological tradition, but he is a brief outline of the theory. was little involved in treatment Psychological Tradition We focus on its three major facets: 1. the structure of the mind and the distinct  psychosocial treatment approaches to the functions of personality that sometimes clash causation of psychopathology, which focus not with one another; only on psychological factors but also on social 2. the defense mechanisms with which the mind and cultural ones defends itself from these clashes, or conflicts 3. the stages of early psychosexual development Moral Therapy - a strong psychosocial approach to that provide grist for the mill of our inner mental disorders conflicts William Tuke (1732–1822) followed Pinel’s lead in The Structure of the Mind The mind, has three major England parts or functions Benjamin Rush (1745–1813), often considered the 1. The id founder of U.S. psychiatry, introduced moral therapy in  is the source of our strong sexual and his early work at Pennsylvania Hospital aggressive feelings or energies. It is, basically, Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION the animal within us; if totally unchecked, it ego can continue its coordinating would make us all rapists or killers. function  operates according to the pleasure principle, with an overriding goal of maximizing pleasure  Denial: Refuses to acknowledge some aspect and eliminating any associated tension or of objective reality or subjective experience conflicts. that is apparent to others  The goal of pleasure, which is particularly  Displacement: Transfers a feeling about, or a prominent in childhood, often conflicts with response to, an object that causes discomfort social rules and regulations, as you shall see onto another, usually less-threatening, object or later. person  The id has its own characteristic way of  Projection: Falsely attributes own processing information; referred to as the unacceptable feelings, impulses, or thoughts to primary process, this type of thinking is another individual or object emotional, irrational, illogical, filled with  Rationalization: Conceals the true motivations fantasies, and preoccupied with sex, for actions, thoughts, or feelings through aggression, selfishness, and envy elaborate reassuring or self serving but incorrect explanations 2. Ego  Reaction formation: Substitutes behavior,  The part of our mind that ensures that we act thoughts, or feelings that are the direct opposite realistically of unacceptable ones  it operates according to the reality principle  Repression: Blocks disturbing wishes, instead of the pleasure principle. thoughts, or experiences from conscious  The cognitive operations or thinking styles of awareness the ego are characterized by logic and reason  Sublimation: Directs potentially maladaptive and are referred to as the secondary process, as feelings or impulses into socially acceptable opposed to the illogical and irrational primary behavior process of the id. Psychosexual Stages of Development 3. Superego also theorized that during infancy and early childhood we  The third important structure within the mind pass through a number of psychosexual stages of  what we might call conscience, represents the development that have a profound and lasting impact. moral principles instilled in us by our parents and our culture. The stages—oral, anal, phallic, latency, and genital—  It is the voice within us that nags at us when represent distinctive patterns of gratifying our basic we know we’re doing something wrong. needs and satisfying our drive for physical pleasure Because the purpose of the superego is to Fixation counteract the potentially dangerous aggressive  if we did not receive appropriate gratification and sexual drives of the id, the basis for during a specific stage or if a specific stage left conflict is readily apparent. The role of the ego a particularly strong impression is to mediate conflict between the id and the  an individual’s personality would reflect the superego, juggling their demands with the stage throughout adult, fixation at the oral stage realities of the world. might result in excessive thumb sucking ) If it is unsuccessful and the id or superego becomes too the phenomenon of castration anxiety- strong fears strong, conflict will overtake us and psychological develop that the father may punish that lust by removing disorders will develop. Because these conflicts are all the son’s penis—thus within the mind, they are referred to as intrapsychic  this fear helps the boy keep his lustful impulses conflicts toward his mother in check Oedipus complex.  The battle of the lustful impulses on the one hand and castration anxiety on the other creates a conflict that is internal, or intrapsychic,. Electra complex  The counterpart conflict in girls is even more controversial. F  reud viewed the young girl as wanting to replace her mother and possess her father. Defense Mechanisms Central to this possession is the girl’s desire for - unconscious protective processes that a penis, so as to be more like her father and keep primitive emotions associated brothers—hence the term penis envy. with conflicts in check so that the Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION disorders neuroses/neurotic disorders - from an old  He postulated a hierarchy of needs, beginning term referring to disorders of the nervous system. with our most basic physical needs for food and sex and ranging upward to our needs for Later Developments in Psychoanalytic Thought selfactualization, love, and self-esteem. Anna Freud (1895–1982)  Social needs such as friendship fall somewhere  Freud’s daughter between.  concentrated on the way in which the defensive  Maslow hypothesized that we cannot progress reactions of the ego determine our behavior. In up the hierarchy until we have satisfied the so doing, she was the first proponent of the needs at lower levels. modern field of ego psychology. Carl Rogers (1902–1987) Heinz Kohut (1913–1981)  from the point of view of therapy, the most  focused on a theory of the formation of self influential humanist concept and the crucial attributes of the self  Rogers (1961) originated client centered that allow an individual to progress toward therapy, later known as person-centered health, or conversely, to develop neurosis. This therapy. In this approach, the therapist takes a psychoanalytic approach became known as passive role, making as few interpretations as self-psychology possible. The point is to give the individual a chance to develop during the course of therapy, Object relations - is the study of how children unfettered by threats to the self. incorporate the images, the memories, and sometimes the  Unconditional positive regard, the complete values of a person who was important to them and to and almost unqualified acceptance of most of whom they were (or are) emotionally attached. the client’s feelings and actions, is critical to the humanistic approach.  Empathy is the sympathetic understanding of Psychoanalytic Psychotherapy the individual’s particular view of the world. free association - in which patients are instructed to say The Behavioral Model whatever comes to mind without the usual socially required censoring.  intended to reveal emotionally charged  which is also known as the cognitive- material that may be repressed because it is too behavioral model or social learning model painful or threatening to bring into consciousness Pavlov and Classical Conditioning dream analysis (still quite popular today) - in which the therapist interprets the content of dreams, supposedly reflecting the primary-process thinking of the id, and systematically relates the dreams to symbolic aspects of classical conditioning unconscious conflicts  a type of learning in which a neutral stimulus is paired with a response until it elicits that response. The word conditioning (or  Psychoanalyst - the relationship between the conditioned response) resulted from an therapist accident in translation from the original Russian.  Transference - patients come to relate to the therapist much as they did to important figures in their childhood, particularly when their parents.  Countertransference - therapists project some of their own personal issues and feelings, usually positive, onto the patient. Humanistic Theory Self-actualizing - was the watchword for this movement.  The underlying assumption is that all of us could reach our highest potential, in all areas of functioning, if only we had the freedom to grow Abraham Maslow (1908–1970)  was most systematic in describing the structure of personality. Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION  STANDARDIZATION - Application of certain standards to ensure consistency across different measurements ASSESSING PSYCHOLOGICAL DISORDERS  CLINICAL ASSESSMENT- Systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder.  DIAGNOSIS - Process of determining whether the particular problem afflicting the individual meets all criteria for a psychological disorder, as set forth in the DSM-5 General Appearance (patient at rest) - Age/gender, younger/older than stated age, body habitus, type of clothing, hygiene (e.g., smelling of alcohol, urine, feces, cigarette smoke, etc.), grooming, physical abnormalities (e.g., pupil size, bruises, needle marks/tracks, cuts, teeth, etc.), tattoos, body piercings Behavior (patient in action) - Posture, eye contact, mannerisms, tics, activity level, psychomotor retardation/activation.  Akathisia: Inner restlessness with inability to stay still. Structured - naay set of questions daan ( structures  Automatism: Spontaneous verbal or motor interview – evidence based na questionaires) behavior without patient awareness. Semistructured - mixed of guidelines and follow up  Catatonia: Extreme motor inactivity or questions hyperactivity. Unstructured - ask whatever comes to ur mind  Choreoathetosis: Involuntary combination of chorea (irregular migrating contractions) and athetosis (twisting/writhing).  Dystonia: Twisting/repetitive movement or The ABCs of Observation abnormal fixed posturing. Antecedent ( what happened just before the behavior Behavior ( behavior that was observed  Tremor: Unintentional, rhythmic, oscillatory Consequence ( what happened afterward movement Attitude (patient interaction) - Cooperative/uncooperative, seductive, flattering, charming, eager to please, entitled, controlling, hostile, guarded, critical, antagonistic, childish Mood: Patient reported emotional tone in quotations. Equivalent of chief complaint. Affect: Physical expression of a person’s immediate feeling state, typically focusing on facial expression  Congruency: Affect may or may not be congruent with mood.  Range: Affect can be described as within MENTAL STATUS EXAM: DEFINITIONS GABA normal range, constricted, blunted, or flat. (General Appearance, Behavior, Attitude) (ex. Ana sya depress sya (mood) tapos ang naobserve  Snapshot during the time of assessment nimo (affect) kay happy sya)  Involves systematic observation of an individual’ behavior Type:  Euthymic: Normal display of emotion. KEY CONCEPTS IN ASSESSMENT  Hyperthymic: Intense display of emotion.  RELIABILITY - Degree to which a Elevated/euphoric: In an excited state of measurement is consistent intense happiness.  VALIDITY - Degree to which a technique  Dysphoric: In a profound state of unease or measures what it is designed to measure dissatisfaction. (Accuracy)  Irritable: Easily annoyed or angry. Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION  Anxious: Feeling worried or nervous, typically over an uncertain future outcome. Thought Content  Poverty of thought: A global reduction in the quantity of thought. Perception  Overabundance of thought: A global increase  Perceptual disturbances,: hallucinations and in the quantity of thought. illusions, can be experienced in reference to the  Delusions: Fixed, false beliefs that do not self or the environment. change even when presented with evidence  This can be sometimes inferred also when the counter to them, and are outside of cultural, patient clearly responds to internal stimuli (and societal or religious norms can be described as such)  Primary delusions: are unrelated to other  The sensory system involved (e.g., auditory, disorders. Examples include thought insertion, visual, taste, olfactory, or tactile) and the thought broadcasting, and beliefs about world content of the illusion or the hallucinatory destruction experience should be described.  Secondary delusions: are based on other  Feelings of depersonalization and derealization psychological experiences. These include (extreme feelings of detachment from the self delusions derived from hallucinations, other or the environment) are also part of this delusions, and morbid affective states. section.  Somatic delusion: Delusion that one’s bodily function, sensation or appearance is abnormal. Speech Delusion of grandeur: Delusion of possessing Rate > Pressured > Rapid > Regular > superior qualities such as fame, wealth or  Slowed Pressured speech: Rapid, frenzied supernatural powers. speech driven by an internal sense of urgency.  Paranoid delusion: Delusion of mistreatment,  Rhythm: prosody, cadence, latency (pauses usually persecution (e.g., being spoken about before speaking), spontaneity (ability to make behind one’s back, “people are out to get small talk) me”).  Articulation: dysarthria, stuttering  Delusion of reference: Delusion where an Accent/dialect, tone, volume/modulation otherwise insignificant event is misconstrued (loudness/softness) as having special significance specifically to  Dysarthria: A mechanical dysfunction with oneself. speech.  Delusion of thought insertion: Delusion  Echolalia: Meaningless repetition of another where one believes one's thoughts to be person’s spoken words. externally placed from an outside party.  Neologism: Making up new words.  Delusion of thought control: Delusion where one believes one is being controlled by an  Clang associations: Groupings of words outside party or parties, and self-control is lost. (usually rhyming), based on similar-sounding sounds, regardless of logical grouping.  Delusion of thought broadcasting: Delusion where one's thoughts are made known to Thought Process everyone in the outside world.  Erotomanic delusion: Delusion where one  Goal-directed/logical: Linear progression of believes that prominent figures or superstars thought without veering from the subject at are in love with or in a relationship with hand. oneself, when that is not the case in reality.  Circumstantial: Inability to answer a question  Nihilistic delusion: Delusion where one without giving excessive, unnecessary detail. believes that nothing is real. This is in contrast Does eventually return to the original point. to derealization or depersonalization, which have more to do with an altered reality, not the  Tangential: Wandering from the topic and lack of it. never returning to it or providing the information requested.  Depersonalization: Loss of all sense of identity, wherein one's thoughts and feelings  Loosening of associations: Incoherent are no longer felt to be one's own. slippage of ideas further and further from point of discussion.  Derealization: A change in the perception or experience of the external world to where it  byFlight of ideas: Rapid shift from one topic feels unrealistic. to another.  Perseveration: Repetition of a particular  Illusion: A misinterpretation of existing stimuli. response (e.g., word or phrase), regardless of the absence or cessation of a stimulus.  Hallucination: A perception perceived in the absence of any existing stimuli.  Thought blocking: Abrupt cessation of speech without explanation in the middle of a sentence  Hypnagogic hallucination: A hallucination Goal-directed, logical, circumstantial, experienced before falling asleep. tangential, loosening of associations, flight of  Hypnopompic hallucination: A hallucination ideas, perseveration, thought blocking, experienced upon waking up from sleep. echolalia, neologisms, clang associations Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION  Obsession: Repeated intrusive and unwanted of goal-directedness. The words make thoughts, images or urges. sentences, but the sentences do not make  Compulsion: Repetitive behavior or mental sense. acts in response to obsessions.  Word Salad : Incoherent or incomprehensible  Phobia: Persistent fear or an object or connections of thoughts (most severe thought situation. disorganization)  Suicidal ideation: Thoughts of, or  Flight of ideas : A succession of multiple preoccupation with, suicide. associations so that thoughts seem to move abruptly from idea to idea; often (but not  Homicidal ideation: Thoughts of, or invariably) expressed through rapid, pressured preoccupation with, homicide speech.  Clang associations : Thoughts are associated by the sound of words rather than by their Types of delusions meaning (e.g., through rhyming, or  persecution of jealousy assonance).  of guilt  Neologism : The invention of new words or  of love phrases or the use of conventional words in  of poverty idiosyncratic ways.  and of nihilism.  Perseveration : Repetition out of context of The most common are persecutory delusions, in which words, phrases, or ideas. one believes, erroneously, that another person or group  Thought blocking : interruption of the train of of persons it trying to do harm to oneself. thought before an idea has been completed; the patient may indicate an inability to recall what was being said or intended to be said.  Note that this is often referred to as a paranoid delusion, but that is a misuse of the word Abstractions and conceptualization - higher paranoid, which is a more generic meaning intellectual functions (involves the ability to think and does not imply a specific type of delusion. beyond concrete details and grasp more complex generalized ideas, understanding metaphors or idioms Part of a delusion include: that convey abstract meanings)  ideas of reference : are erroneous beliefs that  miniCog an unrelated event in fact pertains to an  Orientation individual. > (Ask them who they are, where Thus, if a patient observes a car on a street they are, why are they there, what is make a sudden turn, and assumes that it is this place) because the driver is following the patient, that  3 word recall (They are asked to would be an idea of reference. Such ideas can remember and recall 3 words after a become even more improbable, such as a belief period of time) that something an announcer is saying on the television is actually a coded message intended  concentration (spell WORLD backwards or serial 7s) for the patient >If impairment is suspected a MMSE and/or a  ideas of influence: are similar in that the MOCA is most appropriate (bedside test that patient may believe that somehow they caused can test memory) an unrelated event to happen (for example, believing that through one’s will one was able  MMSE (Mini-Mental Status Exam) - useful for tracking cognitive changes over time to cause an accident, even though one was not commonly used in clinical setting (tracking directly involved in any way). cognitive impairment: Dementia or Alzheimers) Formal Thought Disorders  Naay scoring  MOCA (Montreal Cognitive Assessment) - Visual and spatial of a patient.  Circumstantiality : Overinclusion of trivial or  Use for detecting early stages of irrelevant details that impede the sense of cognitive decline and often use in getting to the point. research setting and clinical practice to provide a more detailed  Tangentiality : In response to a question, the assessment of cognitive abilities patient gives a reply that is appropriate to the general topic without actually answering the INSIGHT question. Example: – Doctor: “Have you had any trouble sleeping lately?” – Patient: “I  A patient's degree of awareness and usually sleep in my bed, but now I'm sleeping understanding about being ill on the sofa.”  patients may exhibit complete denial of their  Derailment : (Synonymous with loose illness and blame others associations) A breakdown in both the logical Level of Insight connection between ideas and the overall sense A summary of six levels of insight follows: Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION 1. Complete denial of illness that is not directly relevant to the 2. Slight awareness of being sick and needing questions being asked. help, but denying it at the same time PHYSICAL EXAMINATION 3. Awareness of being sick but blaming it on  Many problems presenting as disorders of others, on external factors, or on organic behavior, cognition and mood may have a clear factors relationship to a temporary toxic state. 4. Awareness that illness is caused by something BEHAVIORAL ASSESSMENT unknown in the patient  Using direct observation to formally assess an 5. Intellectual insight: admission that the patient individual's thoughts, feelings, and behavior in is ill and that symptoms or failures in social specific situations or contexts adjustment are caused by the patient's own  May be more appropriate than an interview in particular irrational feelings or disturbances terms of assessing individuals who are not old without applying this knowledge to future enough or skilled enough to report their experiences problems and experiences 6. True emotional insight: emotional awareness of the motives and feelings within the patient SELF-MONITORING and the important persons in his or her life, which can lead to basic changes in behavior.  Observing own behavior to find patterns  More formal and structured way to observe behavior through checklist and behavior rating Sample MSE scales Refer to video for mania PSYCHOLOGICAL TESTING Ms. Catie Holmes is a 32 y.o female who appears her  To assess psychological disorders must meet stated age. Appearance is remarkable for wearing the strict standards we have noted revealing and likely designer clothes with excessive  Include specific tools to determine cognitive, makeup. Behavior is hyperactive and agitated at times. emotional, or behavioral responses that might Speech is pressured and with an increased rate, often be associated with a specific disorder and more loud. Mood is described as ‘happy and on top of the general tools that assess long standing world’ and affect is elevated and euphoric. Not personality features, such as a tendency to be appropriate to situation. It is also irritable in parts and suspicious. quite labile. Thought process is disorganized with apparent flight of ideas connected to grandiose PROJECTIVE TESTING delusional themes. There is no suicidal or homicidal  A variety of methods in which ambiguous ideation. Thought content has grandiose delusions. stimuli, such as pictures of people or things Perception appears normal. Insight is poor and  ex. : Rorschach inkblot test, and Thematic Judgment is quite poor – wants to fly to Milan in this Apperception test state which can lead to unfortunate outcomes. Also, pt. is exercising poor judgment with finances. PERSONALITY INVENTORIES  ex. : Minnesota Multiphasic Personality Abstractions and conceptualization - higher inventory intellectual functions (involves the ability to think beyond concrete details and grasp more complex INTELLIGENCE TESTING generalized ideas, understanding metaphors or idioms that convey abstract meanings)  ex. : SB-5, WAIS-IV, WISC-V JUDGEMENT NEUROPSYCHOLOGICAL TESTING  Person's capacity to make appropriate decision  Assesses brain dysfunction by observing the and appropriately act on them in social effects of the dysfunction on the person's situations ability to perform certain tasks  Patients can be given a situation and they  Measure abilities in areas such as receptive and would make a decision about the scenario expressive language, attention and given or assigned to them concentration, memory, motor skills, perceptual abilities, such ways that the  unimpaired - if there is no safety issues clinician can make educated guesses about the  Impaired - if there is a safety issue person's performance and and the possible existence of brain impairment SEMI-STRUCTURED CLINICAL INTERVIEWS  Made up of questions that have been carefully NEUROIMAGING (Pictures of the Brain) phrased and tested to elicit useful information  The ability to look inside the nervous system in a consistent manner and take accurate pictures of the structure and > Disadvantage function of the brain - It robs the interview of some of the  Procedure to examine the brain spontaneous quality of two people talking about a problem  Procedure that examine the actual functioning of the brain by mapping blood flow and other  The patient might inhibit themselves metabolic activity from volunteering useful information Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION PSYCHOLOGICAL ASSESSMENT  Attention - refers to the ability to focus and  Measurable changes in the nervous system that direct one’s cognitive function in a reflect emotional or psychological events physiologically aroused state.  May be directly from the brain or peripherally  Concentration - refers to the ability to from other parts of the body. maintain attention for a period. STANDARDIZED TESTS  assessment that is administered and scored in a 4. Memory - refers to the process of learning involving consistent, uniform manner the registering of information, the storage of that  Achievement test - assess specific knowledge information, and the ability to retrieve the information or skills in particular subjects (school exam or later. quizzes)  Aptitude Test - Measure general cognitive abilities or potential often used for educational  Registration refers to the ability to repeat or employment (predict the future performance information immediately. It is usually limited of a person based on their abilities, skill base in capacity to about seven bits of information. and college entrance exam) Registration is usually tested by asking a patient to repeat a series of items (for example,  three unrelated words). If the patient cannot do on the first try, the words should be repeated The Cognitive Exam until the patient can do it, and the number of Cognition: tries should be recorded (more than 2 trials for the ability to use the higher cortical functions: 3 words would be abnormal).  thinking,  logic  reasoning  Short-term memory refers to the storage of  and to communicate these thoughts to others. information beyond the immediate Unlike the rest of the mental status examination, (registration) period, but prior to the examinations of cognition often involve administering consolidation of memory into long-term specific tests of cognitive abilities. memory. Practically speaking, it lasts from a few seconds to a few minutes, and may or may not be temporary (depending on the purpose of the memory). The cognitive examination is usually divided into the following domains:  Long-term memory is usually divided into 1. Consciousness - should be assessed early on. procedural and declarative memory. Consciousness may range from normal alertness to  Procedural memory refers to the ability to stupor and coma. Obviously, this affects the rest of the remember a specific set of skills. As one thinks examination and should be noted early on. of any task one has learned–say, driving a car– it is clear that there is a point at which one no 2. Orientation - refers to the ability to understand one’s longer has to think about the specific steps in situation in space and time. Generally, orientation to the task—it has become unconscious and place and time is tested. automatic. Procedural memory is generally not  Orientation to time - is tested by asking a assessed during a standard mental status person to give the day and date. (Though an ill examination, but can be specifically tested person who has spent a good deal of time when indicated. For example, a person may be convalescing may not be clear on the exact asked to act out a specific task (“show me how date, a cognitively intact person generally can you brush your teeth”). give an approximate date, and it would be  Declarative memory refers to the retention of unusual for a cognitively intact person to not data or facts, which can be verbal or nonverbal know the month or year, or what part of the (i.e., sounds, images). In contrast to short-term month they are in.) memory, it is not temporary (though it can  Orientation to a person - generally remains decay over time), and it has no known limit. intact except in the most severe of cognitive Long-term (declarative) memory is usually tested by disorders. asking a patient to recall past details. These details may In fact, a patient who presents disoriented to a be personal (wedding dates, graduations, past medical person, but otherwise cognitively intact almost history–all of which would have to then be independently assuredly is almost never displaying a confirmed), or historical (important historical dates that cognitive disorder, but is most likely suffering a patient would reasonably be expected to know, based from some other problem (for example a on their own upbringing and culture). dissociative disorder, or perhaps malingering). 5. Visuospatial ability - refers to the ability to recognize 3. Attention and Concentration the relationship of different objects in the world. Though occasionally neglected during cognitive testing, it is of great practical significance, particularly if a Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION person wishes to drive, or live alone. Constructional tasks require reasonable vision, motor coordination, strength, praxis and tactile sensation, and in cases in which patient’s appear to have a deficit in this ability, these other domains should be tested as well. 6. Abstractions and conceptualization - refer to higher intellectual functions.  Abstraction involves the ability to understand the meanings of words beyond the literal interpretation.  Conceptualization involves a number of intellectual functions, including the ability to be self-aware: of one’s existence, one’s thoughts, and one’s behaviors. Deficits in these areas may be inferred during an examination, especially from overly concrete answers to questions (example: doctor: “what brought you to the hospital” patient: “an ambulance.”). Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION Prevention NEURODEVELOPMENTAL DISORDERS  Genetic counseling  Biological screening  Maternal Care Intellectual Disability - is a disorder evident in childhood as GLOBAL DEVELOPMENTAL DELAY significantly below-average intellectual and adaptive functioning  This diagnosis is reserved for individuals under Difficulties in Three Domains of ID: the age of 5 years when the clinical severity 1. Conceptual level cannot be reliably assessed during early  (skill deficits in areas such as language, childhood. reasoning, knowledge and memory )  This category is diagnosed when an individual 2. Social fails to meet expected developmental  ( problems with social judgment and the milestones in several areas of intellectual ability to make and retain friendship) functioning, and applies to individuals who are 3. Practical unable to undergo systematic assessments of  ( difficulties managing personal care or job intellectual functioning, including children who responsibilities) are too young to participate in standardized testing. This category requires reassessment To be diagnosed with ID, a person must have after a period of time. significantly subaverage intellectual functioning, a determination made with one of several IQ tests with a Unspecified Intellectual Disability: cutoff score set by DSM-5 of approximately 70. (Intellectual Developmental Disorder) F79  mild F70 - IQ score bet. 50-55 and 70  moderate F71 [ 318.0] - 35-40 to 50-55  This category is reserved for individuals over  severe F72 [318.1] - ranging from 20-25 to 35- the age of 5 years when assessment of the 40 degree of intellectual disability (intellectual developmental disorder) by means of locally  profound F73 [318.2] - iq scores below 20-25 available procedures is rendered difficult or impossible because of associated sensory or Causes: physical impairments, as in blindness or Environmental - deprivation, abuse, and neglect prelingual deafness; locomotor disability; or Prenatal - exposure to disease or drugs while still in the presence of severe problem behaviors or co- womb occurring mental disorder. Perinatal - difficulties during labor and delivery Postnatal - infections and head injury  This category should only be used in exceptional circumstances and requires reassessment after a period of time Chromosomal Influences 1. Down Syndrome - type of intellectual disability caused by the presence of an extra 21st chromosome Attention-Deficit/Hyperactivity Disorder (ADHD) 2. Fragile X Syndrome - caused by a chromosomal abnormality of the tip of the X Primary Characteristics chromosome  a pattern of inattention, such as being 3. Phenylketonuria (PKU) - caused by a disorganized or forgetful about school or work- recessive gene that prevents the child from related tasks, or of hyperactivity and metabolizing the amino acid phenylalanine, impulsivity which is found in many foods Treatment of Intellectual Disability Diagnostic Criteria for Attention  Biological treatment of ID is currently not a Deficit/Hyperactivity Disorder viable option.  For individuals with mild ID, intervention is A persistent pattern of inattention and/or hyperactivity- similar to that for people with learning impulsivity that interferes with functioning or development, disorders. Specific learning deficits are as characterized by (1) and/or (2): identified and addressed to help the student 1. Inattention: Six (or more) of the following improve such skills as reading and writing. At symptoms have persisted for at least 6 months to a the same time, these individuals often need degree that is inconsistent with developmental additional support to live in the community. level and that negatively impacts directly on social and academic/occupational activities:  For people with more severe disabilities, the Note: The symptoms are not solely a manifestation of general goals are the same; however, the level oppositional behavior, defiance, hostility, or failure to of assistance they need is often more extensive. understand tasks or instructions. For Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION older adolescents and adults (aged 17 and older), at least  Often blurts out an answer before a question five symptoms are required. has been completed (e.g., completes people’s  Often fails to give close attention to details or sentences; cannot wait for turn in conversation). makes careless mistakes in schoolwork, at work,  Often has difficulty waiting his or her turn or during other activities (e.g., overlooks or (e.g., while waiting in line). misses details, work is inaccurate).  Often interrupts or intrudes on others (e.g.,  Often has difficulty sustaining attention in tasks butts into conversations, games, or activities; may or play activities (e.g., has difficulty remaining start using other people’s things without asking or focused during lectures, conversations, or lengthy receiving permission; for adolescents or adults, reading). may intrude into or take over what others are  Often does not seem to listen when spoken to doing). directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).  Combined presentation: If both Criterion A1  Often does not follow through on instructions (inattention) and Criterion A2 (hyperactivity- and fails to finish schoolwork, chores, or duties impulsivity) are met for the past 6 months. in the workplace (e.g., starts tasks but quickly  Predominantly inattentive presentation: If loses focus and is easily sidetracked). Criterion A1 (inattention) is met but Criterion  Often has difficulty organizing tasks and A2 (hyperactivity-impulsivity) is not met for activities (e.g., difficulty managing sequential the past 6 months. tasks; difficulty keeping materials and belongings  Predominantly hyperactive/impulsive in order; messy, disorganized work; has poor time presentation: If Criterion A2 (hyperactivity- management; fails to meet deadlines).  Often avoids, dislikes, or is reluctant to engage impulsivity) is met and Criterion A1 in tasks that require sustained mental effort (inattention) is not met for the past 6 months. (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, copy number variants - mutations occur that either completing forms, reviewing lengthy papers). create extra copies of a gene on one chromosome or  Often loses things necessary for tasks or result in the deletion of genes activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, or Causes mobile telephones). o considered to be highly influenced by genetics  Is often easily distracted by extraneous stimuli o The strong genetic influence in ADHD does (for older adolescents and adults, may include not rule out any role for the environment unrelated thoughts). o Maternal stress, and alcohol use, and parental  Is often forgetful in daily activities (e.g., chores, marital instability and discord running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments). TREATMENT OF ADHD 2.Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 1. Psychosocial Interventions 6 months to a degree that is inconsistent with  Child: reinforcement programs, developmental level and that negatively impacts social skills training directly on social and academic/occupational  Adult: cognitive-behavioral activities: interventions Note: The symptoms are not solely a manifestation of 2. Biological Interventions oppositional behavior, defiance, hostility, or failure to  Stimulant medications understand tasks or instructions. For older adolescents and 3. Combined Approach to Treatment adults (age 17 and older), at least five symptoms are  a study suggested that the combination of required. behavioral treatments and medication and medication alone were superior to behavioral  Often fidgets with or taps hands or feet or treatment alone and community intervention squirms in seat. for ADHD symptoms  Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in Specific Learning Disorder place).  Often runs about or climbs in situations where - characterized by performance that is it is inappropriate. (Note: In adolescents or substantially below what would be adults, may be limited to feeling restless.) expected given the person’s age,  Often unable to play or engage in leisure intelligence quotient (IQ) score, and activities quietly. education.  Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for an extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).  Often talks excessively. Abnormal Psychology TACLOB, VANESSA | PSYCH 3A UNIVERSITY OF THE IMMACULATE CONCEPTION 1. With impairment in reading: Diagnostic Criteria for Specific Learning Disorder o Word reading accuracy o Reading rate or fluency o Reading comprehension  Clinicians can use the specifiers for disorders of reading, written expression, or mathematics to highlight specific problems for remediation 2. With impairment in expression: o Spelling accuracy  Difficulty learning and using academic skills, as o Grammar and punctuation accuracy indicated by the presence of at least one of the o Clarity or organization of written following symptoms that have persisted for at expression least 6 months, despite the provision of interventions that target those difficulties: 3. With impairment in mathematics:  Inaccurate or slow and effortful word reading o Number sense (e.g., reads single words aloud incorrectly or o Memorization of arithmetic facts slowly and hesitantly, frequently guesses words, o Accurate or fluent calculation has difficulty sounding out words).  Difficulty understanding the meaning of what o Accurate math reasoning is read (e.g., may read text accurately but not understand the sequence, relationships, Communication disorders - A group of disorders inferences, or deeper meanings of what is read). loosely identified seems closely related to specific  Difficulties with spelling (e.g., may add, omit, or learning disorder. substitute vowels or consonants). - these disorders can appear  Difficulties with written expression (e.g., makes deceptively benign, yet their multiple grammatical or punctuation errors within presence early in life can cause wide sentences; employs poor paragraph organization, ranging problems later. For a brief written expression of ideas lacks clarity). overview of these disorders, which  Difficulties mastering number sense, number include childhood-onset fluency facts, or calculation (e.g., has poor understanding disorder (previously called of numbers, their magnitude, and relationships; stuttering) and language disorder counts on fingers to add single-digit numbers (which combines DSM IV-TR instead of recalling the math fact as peers do; gets expressive and mixed receptive– lost in the midst of arithmetic computation and expressive language disorders), may switch procedures. CAUSES  Difficulties with mathematical reasoning (e.g., has severe difficulty applying mathematical  GENETIC concepts, facts, or procedures to solve quantitative  NEUROBIOLOGICAL  problems).  ENVIRONMENTAL FACTORS  The affected academic skills are substantially and quantifiably below those expected for the individual’s chronological age and cause TREATMENT significant interference with academic or occupational performance, or with activities of  EDUCATIONAL INTERVENTION daily living, as confirmed by individually  BIOLOGICAL (DRUG) TREATMENT IF AN administered standardized achievement measures INDIVIDUAL MAY ALSO HAVE and comprehensive clinical assessment. For COMORBID ADHD individuals aged 17 years and older, a  BEHAVIORAL INTERVENTIONS documented history of impairing learning difficulties may be substituted for the standardized assessment.  The learning difficulties begin during school- age years but may not become fully manifest Autism Spectrum Disorder until the demands for those affected academic skills exceed the individual’s limited capacities - a neurodevelopmental disorder that, (e.g., as in timed tests, reading or writing lengthy, at its core, affects how one perceives complex reports for a tight deadline, excessively heavy academic loads). and socializes with others  The learning difficulties are not better accounted Rett disorder- a genetic condition that affects mostly for by intellectual disabilities, uncorrected visual females and is characterized by hand wringing and poor or auditory acuity, other mental or neurological coordination, is diagnosed as ASD with the qualifier disorders, psychosocial adversity, lack of “associated with Rett syndrome” or “associated with proficiency in the language of academic MeCP2 mutation” (the gene involved in Rett syndrome). instruction, or inadequate educational instruction. The four diagnostic criteria are to be met based on