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Psych1X03Week10(Psychopathology2).docx

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Department
Psychology
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PSYCH 1X03
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Joe Kim

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Psychopathology 2 11/13/2011 3:59:00 PM SCHIZOPHRENIA SYMPTOMS Positive Symptoms  Behaviours that increase in someone with schizophrenia.  Disorders of thought is schizophrenic thinking that is characterized by loose associations; the individual‟s thought may consist of ideas that are often only loosely related to each other. Their speech is often vague and abstract.  Delusions are a belief that is irrational, or unsupported by external evidence; involve the idea that the individual is being persecuted by others, or events or objects have a special significance. Associated with thought broadcast, thought withdrawal, and thought insertion.  Hallucinations are perceptions of things that are not really there. Auditory hallucinations are more common than visual hallucinations. Negative Symptoms  Behaviours that decrease in the individual‟s engagement with the outside world. They become less and less interested in people and events and are more concerned with internal ideas or fantasies.  Affect is associated with emotional responsiveness.  Flat Affect is the problem with a range of emotion, it is especially common and usually characterized by the person‟s face appearing immobile and unresponsive, with exceptionally poor eye contact and reduced body language.  Inappropriate Affect is disturbances in emotions in inappropriate situations; relatively rare. Catatonic Symptoms  Consist of movement behaviours that an individual exhibits which are not in response to any event in the environment. Example: extreme rigidity.  Catatonic rigidity or catatonic stupor is when an individual dramatically reduces their movement, sometimes to the point of ceasing to move at all. It also can involve a „waxy flexibility‟.  Catatonic Excitement is when an individual is very active, or frantic. These movements are usually repeated and stereotyped motor movements that seem to have no purpose at all and are unrelated to what is going on. SUBTYPES OF SCHIZOPHRENIA IN THE DSM Paranoid  The dominant symptom is delusions or auditory hallucinations.  The individuals thinking may be relatively coherent with no disturbed affect or psychomotor disturbances.  Often shows anger or anxiety related to the disturbing content of the delusions.  Thought, affect, and motor behaviour are normal. Catatonic  The dominant symptoms are psychomotor disturbances. This may include catatonic stupor, catatonic excitement, or alternation between the two. There may be stereotyped postures or mannerisms, together with waxy flexibility. Disorganized  Most severe and disruptive.  Thought and speech are markedly incoherent, with very loose associations and disorganized behaviour.  Often shows flat or inappropriate affect and delusions present are incoherent and fragmentary.  Psychomotor disturbance and profound social withdrawal are common. Undifferentiated  Used to categorize cases which do not fit into any of the other three categories. CAUSES OF SCHZIOPHRENIA - Diathesis-stress hypothesis thinks that there is genetic predisposition for the disorder and some environmental stress that triggers the symptoms. - Schizophrenia is more common in biological relatives of adoptees than in non-related members from their adoptive families. - Some researchers believe that it is abnormalities in brain structure or changes in levels of neurotransmitters. - Environmental events that trigger schizophrenic symptoms are usually stress and problems with relationships with others. TREATMENT - Chronic care; Pharamcological treatment is now the most common therapy. However drugs are not equally successful with all patients, or with all types of symptoms. They have severely unpleasant side effects. - Psychotherapy doesn‟t help much. - Cognitive Behaviour Treatment teaches the patient how to think about the psychosis in way that all them to cope better; they also learn how to identify and avoid triggers or learn positive ways to react to these triggers. DISSOCIATIVE DISORDERS - Involve symptoms that distance the individual, either physically or psychologically from anxiety-producing events or memories. Dissociative Identity Disorder (DID)  A single individual has several distinct personalities, or alters.  At any time, one of these alters dominates and takes charge of the person‟s behaviour.  Alters can differ in many ways. They can be different ages, sexes, and of racial or ethnic backgrounds. They may have different vocabularies, tastes in music, clothes and hair styles. They may even score different on intelligence tests, and reactions to drugs.  Believed it is caused by childhood trauma, specifically prolonged sexual abuse. This disorder usually appears in childhood (age 9) and usually in females.  The alter‟s purpose was to shield the main personality from trauma by carrying away the memory of abuse. The main personality then has no memories of abuse. This is a coping strategy which allows the main personality to function by dissociating traumatic memories into independent personalities.  However, alternate personalities can be created without traumatic events, and personalities can be implanted by suggestion. PERSONALITIY DISORDERS - Listed in Axis II of the DSM Three Clusters Odd & Eccentric - Have symptoms similar to those who have schizophrenia. Anxious & Fearful - Have symptoms similar to those who have anxiety disorders. Dramatic & Erratic  Antisocial Personality Disorder - Psychopathic personality. - A history of erratic and irresponsible behaviours that being in childhood/early adolescence and continue into adulthood. - As a child, a person with an antisocial personality may have been a frequent liar, a truant from school, or a thief. As an adult they may fail to honor financial obligations. As an employee he may often be late for work, or be drunk when he does show up. - Selfish and self-centered. - Trouble with postponing gratification and planning ahead. - Willing to use, mistreat others to get what they want. - Trouble sustaining jobs or close relationships with others. - Sexually promiscuous. - Aggressive. - Often a sensation seeker who likes to take risks and do dangerous things with little concern for the safety of others or for his own. - Usually caused by biological and environmental factors. - Biological model says that the sensation-seeking and antisocial behaviour may be ways of bringing the level of brain arousal back to normal. - Psychodynamic model suggests that the antisocial personality lacks an superego due to faulty resolution of the Oedipus complex.  Borderline Personality Disorder - Highly unstable and highly changeable emotions and behaviours. - Have frequent mood changes – they are irritable, impulsive, sarcastic, easily angered, and unpredictable. - Often insecure because they have an unstable view on themselves. - Demand a lot of attention and do not like to be left alone. - Engage in self-mutilation and are at high risk of suicide.  Histrionic Personality Disorder - An attention seeker and is overly dramatic. - Often self-centered, shallow, obsessed with their attractiveness and uncomfortable when not in the centre of attention. - High rates of depression and poor physical health.  Narcissistic Personality Disorder - “Full of themselves” - Never dates anyone for a long time. - Only dates people who she thinks admires her a lot, but then dumps them when she is convinced they are not good enough. - Hard to keep a steady job. - Cannot stand criticism from anyone. DIVERSITY OF TREATMENT CONSUMERS - It is difficult to treat a disorder when there is such a big diversity of disorders. - Conceptualization of a psychological condition (accurate and comprehensive clinical diagnosis of a psychological disorder), is an important precursor to choosing an appropriate treatment. - Ego syntonic disorders are those in which the symptoms of the disorder are perceived by the individual with the disorder as valued or advantageous (the individual thinks their disorder is good). Example: Obsessive-Compulsive Personality Disorder is ego syntonic because they individual views their character traits as positive. - Ego dystonic disorders are those in which the symptoms are perceived by the individual as undesirable. Example: Obsessive-Compulsive Disorder is ego dystonic because the individual knows that their obsessive thoughts and compulsive behaviours are irrational. - Stages Of Change st  1 Stage – Precontemplation; identified by an inability or unwillingness to acknowledge the existence of a problem. nd  2 Stage – Contemplation; the individual acknowledges the existence of the problem but may be unsure or unwilling to change the problem.  3rdStage – Preparation; associated with recognition of the problem and preparation for change. th  4 Stage – Action; involves taking active steps to change the behaviour. th  5 Stage – Maintenance; the continuation of healthy habits formed at the action stage, watching out for potential stressors that may trigger re-emergence of unhealthy behaviours. DIVERSTIY OF TREATMENT PROVIDERS - Licensed psychologists are psychologists with specific training and certification in clinical or counseling psychology. - Psychiatrists are medical doctors who have advanced training and certification in the psychological treatment. - One key factor that has been shown to have an important effect on treatment outcome is the therapeutic relationship between the therapist and patient. - Relationship qualities shown to be “demonstrably effective” include, the degree to which the patient and therapist can form a working alliance (individual therapy), or show group cohesion (group therapy), the degree which the therapist is able to demonstrate empathy. - Qualities shown to be “probably effective” include positive regard (therapist views the patient as a fundamentally good person), goal consensus, and collaboration. DIVERSITY OF TREATMENT OPTIONS - Can be broken up into two categories: psychological and biomedical treatments. Not uncommon to be combined. - Psychological treatments are influenced heavily by the evidence-based practice movement. It proposes that: 1) Patient care is enhanced by the use of up-to-date knowledge. 2) There is a gap between advances in knowledge and individual clinicians‟ abilities to keep up with these advances. 3) Summaries of evidence presented by experts will bridge this gap and enable clinicians keep up with important advances. - This would set up decision rules for evaluating evidence for specific treatments, and applied these rules to create lists of empirically supported therapies for specific psychological disorders. Concerns with this are:  the extent to which clinicians would be forced to restrict their practices to treatments on the list, either by manages care companies, or by the threat of potential malpractice lawsuit.  The existence of the list would prevent clinicians from using treatments they had previously found useful, but lacked formal research support, and prevent them from trying new and potentially innovative strategies.  Questions the validity of the process by which treatments were deemed to be empirically supported.  Addressed the issues of treatment efficacy and effectiveness. - Efficacy  The ability of a treatment to produce a desired effect in highly controlled settings.  Efficacy studies are designed to demonstrate that a medication has a desirable effect on a medical condition of interest.  Randomized controlled trails are used to achieve this.  Efficacy studies are complicated to implement. Issues faced are: identifying patients with a single, specific condition of interest, operationalizing the new treatment, selecting appropriate “placebos”, “blinding” both the participants and the researcher, and evaluating treatment outcomes.  Often criticized for failing to differentiate between statistical significance and clinical significance. - Effectiveness  The ability of a treatment to produce a desired effect in real-world settings.  Effectiveness studies attempt to gauge the utility of a treatment for a real patient in an ordinary treatment settings.  Prevalence of comorbidity of psychological disorders is high.  Effectiveness studies of psychological treatments relax many of the methodological controls of efficacy studies, in order to study treatment in a more naturalistic setting.  The degree of symptom improvement was not different depending on whether individuals reported receiving psychotherapy alone, or plus medication.  Issues with effectiveness studies are: the respondents may be a representative sample of the population of individuals who seek out and persist with treatment for psychological disorders, but may not be a representative sample of the entire population. The absence of a control group of similar individuals who did not receive treatment, doesn‟t allow us to differentiate the effects of psychotherapy from “placebo” effects. Further issues are the potential bias in the self-report data and limitations of the scale by which improvement was measured. HISTORICAL PSYCHOLOGICAL TREATMENTS PSYCHOANALYTIC - Psychotherapy is the process of treating mental and emotional problems through verbal communication between a patient and therapist. - In classic pscyhoanalysis, psychological distress is thought to arise from the presence of internal unconscious conflicts, usually rooted in psychological trauma associated with child development. - The mind (psyche) has three levels of awareness. Conscious (containing the thoughts and feelings that you have access to at any given moment), the preconscious (the contents of which can be actively brought to mind as needed) and the unconscious (where a vast repository of inaccessible thoughts, repressed traumatic memories and primitive urges resides). - Unsuccessful management of the conflicting urges of the id, ego, and superego, taking place at the unconscious level is thought to drive unhealthy behaviours and cause anxiety and distress. - The goal of psychotherapy is to resolve suffering by bringing unconscious conflicts into conscious awareness, providing the patient with insight, and enabling them to go deeper in search of further unconscious conflicts. - The process of resolving of conflicts brought into conscious awareness is though to relieve psychological distress through catharsis and free the patient to develop more adaptive patterns of behaviour. - Bringing in thoughts, emotions, memories and actions of the unconscious can be difficult because of ego defense mechanisms. - Free association is where the patient is encouraged to let their mind wander, reporting the content to the therapist without self-censorship. The analyst attends to the content with minimal verbal feedback, so that the patient can feel alone with their thoughts. - Dream analysis is used because when you are dreaming, this is when the defenses of the ego are relaxed. Two levels of content are revealed in drean analysis.
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