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Midterm

Notes Post-Midterm PSY240 (2).docx

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Department
Psychology
Course Code
PSY240H5
Professor
Hywel Morgan

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Somatoform disorders • general symptoms o not to be confused with malingering o not to be confused with psychosomatic disorders, physical disorder caused by psychological  ailment, asthma etc. usually initiated by stress o symptoms suggest a physical disorder but cannot be adequately explained physiologically o symptoms are often described in dramatic ways o frequently comorbid with anxiety and mood disorders • somatization and conversion o somatization, also Briquet's syndrome  many physical complaints, diverse  beginning before the age of thirty, often presented young  must include:  four different pains  two gastrointestinal symptoms  one sexual symptom  one pseudoneurological symptom, e.g. headache, fainting, memory loss  much more frequent in women than men, used to be thought as women only disorders  used to be called hysteria, uterus in latin, sexist term not used anymore  symptoms are unfounded and  o conversion disorder  significant loss of physiological function with no clear organic causes, usually within  one system e.g. visual  physical symptoms suggesting neurological problems  sensory impairment any modality  paresthesia and paralysis  sudden  onset, sudden termination, sudden reappearance  mostly women and men in combat, frequent comorbid with PTSD but not to be  confused with it  often misdiagnosed or overpathologized  la belle indifference, not particularly concerned with their disorder, 1/3 of cases  • pain and hypochondriasis o pain disorder  pain is the main symptom, physician calls it neuralgia, treated pharmacologically  may be exacerbated by psychosocial factors  may be maintained by gain, you get something positive from it, theory is operant  conditioning  primary gain, sex, cake, attention, something we're hardwired to seek out  secondary gain, something that represents primary one, money o hypochondriasis  characterized by excessive preoccupation of ones health and an incessant worry about  developing physical illness  misdiagnosed as OCD   preoccupied with the possibility that normal sensations are symptoms of serious  disease  frequent visits to physicians, persists despite medical reassurance  over report bodily sensations • body dismorphic disorder o BDD  often misdiagnosed as eating disorders, often comorbid with anorexia or other eating  disorders PSY240 Abnormal Psychology Notes - Aaron Wang @2013  excessive concern with real or imagined defects in appearance especially facial marks  or features  frequent visits to plastic surgeons  culturally influenced  but not culture bound  may be a symptom of more pervasive disorders: obsessive compulsive or delusional  disorders etc.  exposure therapy  is commonly used  • not somatoform disorders o malingering o factitious disorder  personal, injuring themselves to get attention, Munchausen's syndrome  by proxy, attention by making someone else sick, mothers and children etc o undifferentiated somatoform disorders o somatoform disorder not otherwise specified(NOS)  Dissociative disorder • definition: types of disorder where people lose contact with portions of consciousness or memory, results  in a disruption in their sense of identity • dissociative amnesia and fugue o two types of amnesia: retrograde(inability to remember past events) and anterograde(can't  form new memories) o common cause is trauma o selective lost of memory for important personal information that's too extensive to be  due to  normal forgetting o fugue=amnesia + flight, loss of memory for an entire life and personal identity, do remember  how to talk and drive, procedural memories intact, episodic gone • dissociative identity disorder o the coexistence in one person  of two or more largely complete and different personalities o typically  not at the same time o also thought to be due to trauma, 80% severely abused in childhood o remains controversial, don’t see it other than Europe and north America o CBT for treatment, challenge the person to integrate the personalities o child, protector, persecutor o criticism being false memory syndrome o *missed a part here o this condition is not a psychotic condition, they are still in touch with reality, just dealing with  it in different ways o regression therapy, controversial, when they relive past experiences, not really reliable SCHIZOPHRENIA Overview • most devastating, all cultures recognize this disorder, minor changes made in DSM 5 • psychopathology in psychoses category, psychotic disorder, lost touch with reality, not experiencing  sensory phenomena/information like most other people are  • among others, autism and dementia, are other psychotic disorder • diagnosis is controversial o stigma and label of schizophrenic o symptoms  often look like other disorders  severe depression can look psychotic • experience acute symptoms, chronic not as common, symptoms come and go away • defining characteristics o delusions and hallucinations PSY240 Abnormal Psychology Notes - Aaron Wang @2013 o hallucination, most commonly auditory, sensory experience that  doesn’t exist in other people  reality, visual and somatosensory(differentiate from substance abuse disorder, particularly with  stimulants) are common, less common in olfactory and gustatory o delusions, disordered thoughts, not rooted in reality, I AM JESUSS CHRIST • delirium, caused by trauma, young people version of dementia, temporary • schizophrenia is a brain disorder! organic dysfunction, generally • diagnostic o in past six months, over one month, reliability o severe deterioration from previous functioning o gross impairment of reality testing o affects several psychological processes, thought and perception, also emotion and  communication, usually • effective treatments, but not curable, symptoms go away and people go functional again Course of schizophrenia • prodromal o usually in adolescence, decreased level of functioning, social with drawl, peculiar behaviors,  neglect hygiene(maladaptive), changes in emotion o weird that symptoms late ado and early adulthood, hmm hormonal? NOPE  • active o full spectrum of psychotic symptoms • residual o return to prodromal but may also be  mild delusions and hallucinations and continuing  negative symptoms(affective and adaptive behaviors) Symptoms and features • negative symptoms mean things that should be there but aren’t, positive vice versa o schizo don’t get happy affect, negative symptom o poor hygiene, poor movement(too little OR too much), poverty of speech o catatonia, too little and too much movement and stuff, too little movement could be  misdiagnosed as severe depression • usually show both positive and negative, but positive symptoms are easier to treat • positive o hallucinations  auditory, insulting or instructing  tactile, crawling under skin  somatic, alien in stomach o delusions  persecutory, others are spying on me  reference, radio announcer is mocking me  grandeur, I am Jesus o our culture usually electronic or religious • negative o affective disturbance  flat, no emotion...  inappropriate  anhedonia, cant experience pleasure o social and linguistic deficits  apathy, don't care not interested, poor adaptive behavior  avolition, inability to make decisions  alogia, make up words and or put words together in sentences that makes no sense • disorganization o thinking  thought disorder PSY240 Abnormal Psychology Notes - Aaron Wang @2013  disorganized speech  neologisms o behavior  catatonia  stupor  robot­like movements Contemporary perspective DSM 4 • emphasis on 3 types of symptoms • during a one month period, two or more of the following o delusions o hallucinations o disorganized speech o grossly disorganized, catatonic behavior o negative symptoms • subtypes (taken away on 5) o catatonic  stupor  excitement  pacers runners  posturing  onset quite sudden, alternates between excite and  motionlessness o disorganized  inappropriate silliness and incoherence  disorganized garbled speech, "crazy" behavior, wildly inappropriate affect, appears to  be happy, quite bizarre  delusions and hallucinations are often focused on own bodies, lack appreciation for  environment, bad personal grooming o paranoid  extensive auditory hallucinations, persecutory in nature, or grandiose, remarkably  complex, not an intellectual disability  significant affect component  behavior NOT disorganized nor catatonic  e.g. conspiracy theorists, quite coherent!  not flexible or subject to reason, can’t convince them otherwise o undifferentiated  hodgepodge of psychotic symptoms or changing patterns over time  most people used to go in this category, hence DSM 5 o residual  not acute or overt symptoms, no active phase symptoms, minor symptoms like  social  isolation, continuing negative symptoms  subclinical symptoms o POOR VALIDITY BETWEEN THESE, eliminated for DSM5  Other psychotic disorders • delusional disorder o just delusions o also, non­bizarre delusions  Followed, poisoned... • schizoaffective disorder o mix of schizophrenia and mood disorder o watered down delusions and hallucinations • schizophreniform PSY240 Abnormal Psychology Notes - Aaron Wang @2013 o less than 6 months • brief psychotic disorder o typically trauma, environmental cause rather than a biological cause Epidemiology • gender o women later onset and better response to treatment,  hmm hormones? o similar prevalence • culture o cross consistency o improved prognosis in developing countries Etiology • genetics o biological has to occur first for psych treatment to work after o several lines of evidence o family prevalence, much higher than 1 % o Gottesman 1991 twin concordance  monozygotic 48%  dizygotic 17%  GENETICS  but also environmental factors like stress • neurological impairments o structural and functional anomalies in frontal and limbic  enlarged ventricles, hmm brain shrinking, cause or result?  decreased hippocampal  asymmetry in temporal cortex processing, less left more right • neurochemical irregularities o dopamine hypothesis  excess active dopamine in synapses  treatment today block receptors, dopamine antagonists, neuroleptic drugs, blocking  effect o interactions of multiple neurotransmitters GABA serotonin norepinephrine • other potential o correlation with season of birth o viral infection dependent on season, much more common in fall o so...utera infection? flu during third trimester, when neurons are specializing and migrating, oops  virus interferes with that process, stop them from moving to the right places, schizo don’t see clear  neuron layers! Treatment • medical o antipsychotic o extra pyramidal side effects, movement disorder and lasts after wards o atypical, clozapine. side  effect death • psychosocial treatment o social skills training o CBT Substance Related Disorders • related to anxiety and depression, self­medicating • what is a drug? o something you take that alters mind and behavior o but glucose? sugar isn’t a drug though o too much water can kill you, could get you high by changing pH levels, drug? PSY240 Abnormal Psychology Notes - Aaron Wang @2013 o substance other than food or water that affects mind and behavior, brain functioning in the  realm of psychology o intoxication, temporary state of being poisoned, poor judgment mood change irritability poor  speech and coordination • substance abuse o beginning stage •  substance dependence o repeated self­administration, with tolerance and withdrawal, severe stage of substance use o usually from negative emotions unwanted, self­treatment, substance flattens negative  emotions, stimulates the rew
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