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PS 280 abnormal psych exam review

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John Stephens

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Abnormal: defined by several characteristics- statistical infrequency, violation of norms, personal distress, dysfunction or disability, unexpectedness Romanow report: we don’t attend to mental health, suggestions like home care, support of informal support networks (family, friends) Ridges of brain called gyri, depressions called sulci. Most of brain made of white matter (mylinated sheaths that connect to spinal cord). Four masses deep within each hemisphere; basal ganglia. Cavities are called ventricles and are filled with cerebrospinal fluid. Diencephalon contains thalamus and hypothalamus. Midbrain: nerve fibre tracts that connect cerebral cortex with pons. Brain stem: made of pons (tracts that connect cerebellum with spinal cord), medulla oblongata (main line of traffic), reticular formation (important in arousal and alertness). Cerebellum: related to posture, balance and equilibrium. Limbic system: visceral and physical expressions of emotion, contains cingulate gyrus, septal area, hippocampus and amygdala. Neurotic anxiety: is fear without rational cause Defense Mechanisms: Repression, denial, projection, displacement, reaction formation (converting one feeling into the opposite), regression, rationalization, sublimation (converting sexual or aggressive impulses into socially acceptable ones such as sports). Ego analysis: places greater emphasis on person’s ability to control the environment and select the time and means of satisfying instinctual drives. Interpersonal Psychodynamic Therapy: interactions between patient and their social environment. Humanistic and existential therapies: insight focused, emphasis on freedom of choice that can bring joy and suffering. Focus on current phenomenon and not history of patient. Roger’s humanistic: client-centred, people can only be understood from their perceptions, therapist accepts the person for who they are (unconditional positive regard. Existential therapy: anxiety is inevitable in important choices. Therapists help examine what is meaningful in life. Gestalt therapy: people have innate good nature but become frustrated when it is stifled. Focus on what is here and now, use “I”statements, speaking to empty chair to project a significant other,projectionof feelings on a partner to see how emotion changes situation Ch 3 Classification and diagnosis DSM-IV 1994. Axis I: all diagnostic categories except personality disorders and mental retardation. Axis II: personality disorders and mental retardation. Axis II: general medical conditions that may relate. Axis IV : psychosocial and environmental problems. Axis V: level of functioning. Epidemiology: frequency and distribution of a disorder in a population Ch 4 clinical assessment procedures Inter-rater reliability: extent to which multiple judges agree Test-test reliability: observed twice or taking the same test Alternate form reliability: two forms of test are consistent Internal consistency reliability: items on a test related to one another should have similar answers Content validity: measures adequate sample for the test Criterion validity: whether it is related in an expected way to another measure at the same point (concurrent) or in the future (predictive). Construct validity: extent to which study measures what it is supposed to measure Behavioural assessment: four sets of variables S- stimuli, O-organismic psychological or physicological factors, R-overt responses, C-consequent variables (events that reinforce or punish). Problem list: includes difficulties patient is having, the diagnosis is created, working hypothesis (describes relation among problems), strengths and assets and finally a treatment plan. Direct observation and contrived observation occurs. Self-observation can be in the form of ecological momentary assessment EMA (collecting data in real time) though reactivity mayt change behavior when subject knows their behavior is being tracked. Self-report inventories such as Dysfunctional Attitude Scale DAS are used. Articulated thoughts in Simulated Situations (ATSS) have the person pretend to be in a situation, complete with audio and video, and react to it. Thought listing: a person writes down thoughts prior to an event of anxiety- this may give cognitive insight. Videotape reconstruction: person is videotaped in a task and then narrates their thoughts afterward. Family can also be monitored in the Family Environment Scale, Family adaptation and Cohesion Scale, or the Parental Bonding Inventory. Biological assessment: Computerized axial tomography (CT scan) shows structural brain abnormalities giving two dimensional cross-sections. Magnetic resonance Imaging (MRI) uses a circular magnet and more recently FMRI or functional MRI can show metabolic changes or show the brain at work in real time. Positron emission tomography (PET) is more invasive, using a radioactive isotope injected into the blood stream to measure metabolic rates. Neuropsychological assessment: tests are based on the idea that different tasks are located in different areas of the brain, finding a deficiency can help find where in the brain damage is located. Psychophysiological assessment: concerned with bodily changes that accompany psychological events; heart rate, tension in muscles, blood flow etc. Electrodermal responding: tests skin conductance to measure sweat. EEG measures brain activity. Event Related Potential: specific brain wave potentials in response to standardized test, can show when a paralyzed person is still capable of cognition, show cognitive strategies used by the individual, very useful when brain damage is diffuse rather than local. Chapter 5 research methods in study of abnormal behavior: Internal validity: when the results are confidently attributed to independent variable. External validity: extent to which results can be generalized to other instances Analogue experiment: bringing a related phenomenon into the laboratory, behavior rendered temporarily abnormal by experimenter manipulation Reversal design (ABAB): behavior is taken at base rate, with manipulation, and then returned to base conditions and then back to being manipulated Moderator variables: factors such as gender that may influence the results in a large way Chapter 6 anxiety disorders: most common psychological disorder Phobia: fear and avoidance of objects that do not present realistic danger Psychoanalytic theory: due to repressed ID impulses, fear is displaced to object or situation with symbolic connection Behavioural theory: fear is learned by classical conditioning and avoidance is rewarded by lessened fear. Fear may be learned by modeling. Prepared learning: humans are more apt to fear certain things- dogs, snakes and not flowers. Flooding: therapeutic technique where client is directly exposed to source of phobia at full intensity. Cognitive: peoples thought process can be a diathesis Biological: overactivity of autonomic nervous system, heritable component. Drugs that are anxiolytics such as benzodiazepines Panic disorder: Biological: genetic diathesis, overactivity in noradrenergic system GABA, hypersensitivity to cholecystokinin (CCK). Generalized Anxiety disorder: persistent uncontrollable worry, often about minor things Obsessive-Compulsive disorder: uncontrollable thoughts, impulses or images followed by the need to do certain actions to dispel them Primary obsessional slowness: when the time spent on tasks such as checking, becomes the problem Psychoanalytic: overly harsh toilet training, Post-traumatic Stress disorder:. Anxiety, depression, anger, guilt, substance abuse, marital problems, poor physical health and occupational impairment may follow. Acute stress disorder: symptoms the same as PTSD but last 4 weeks or less CH7 somatoform and dissociative disorders Somatoform disorders: individual complains of body symptoms that suggest a physical illness when there is none Pain disorder: pain that causes impairment and distress, may have temporal connection to some conflict or stress, centers within the frontal brain, grey matter is different. Body dysmorphic disorder: person is preoccupied with an imagined or exaggerated defect, Hypochondria health related anxiety (health related fears or misconceptions of bodily signs and symptoms) as this includes hypochondria (fear of being ill) with illness phobia (fear of becoming ill). Conversion disorder: physiologically normal people experience sensory or motor symptoms; sudden loss of vision, paralysis, seizures, coordination deficits, sensation of prickling, insensitivity to pain (anaesthesias), loss of voice and all but whispered speech (aphonia), loss or impairment of sense of smell (anosmia). Can appear suddenly in stressfull situations. Usually develop in adolescence or early adulthood after a life stress, may begin and end abruptly Malingering: when disability is faked and under voluntary control. Sometimes tested when there is la belle indifference- many actual conversion patients seem indifferent and want to talk at length about their symptoms. Factitious disorder: patients intentionally produce symptoms, as far as injuring themselves. Factitious disorder by proxy or Munchausen disorder by proxy: intentionally making the child ill. Somatization disorder: recurrent, multiple somatic complaints, no apparent physical cause for which medical attention is sought, four pain symptoms in different locations, two gastrointestinal symptoms (vomiting), one sexual symptom other than pain, one pseudoneurological symptom. Symptoms of the disorder may vary across cultures. Begins in early adulthood, Dissociative disorders: Dissociative amnesia: unable to recall important personal information, it is not permanently lost Five factors in dissociation: depersonalization, derealization, disengagement, emotional constriction, identity dissociation, memory disturbance, Dissociative fugue: person is totally amnesic, suddenly leaves home and work Depersonalization disorder: person’s perception or experience of self is altered, triggered by stress they lose sense of self. Derealization: things aren’t real, desomatization: body does not feel like it belongs Dissociative Identity Disorder: the person has one or more personalities or alters that exist independently of each other, CH 8 Psychophysiological disorders: characterized by genuine physical symptoms caused by or worsened by emotional factors. Ex asthma, headaches, hypertension, gastritis Coded in DSM IV as “other conditions that may be a focus of clinical attention” “stress” by Hans Selye (GAS- general adaptation syndrome Phase 1: alarm reaction, Phase 2: resistance damage occurs or adapts to stress, Phase 3: Exhaustion organism suffers irreversible damage). Distress- bad stress, ustress- good stress Autonomic nervous system: endocrine glands, heart, smooth muscles, digestive system. Sympathetic: alarm reaction Parasympathetic: calm, reversal Allostatic load: impact of too much stress or poor coping strategies. Coping: Problem focused coping: taking direct action to solve the problem Emotion focused coping: efforts to reduce the negative emotions of stress Goodness of fit hypothesis: a match between the response and where it fits best to the situation Coping with health injury problems: emotional preoccupation, distraction, instrumental coping (task- oriented), palliative coping ( attempts to feel better via self-soothing, and self-help by doing things like staying in bed or resting when tired) Social support -structural basic network -functional social support- quality of relationships, higher levels are linked to better health -emotional support -instrumental support- concrete action Stress on the body: Somatic-weakness theory: weakness in a specific body organ (genetically) can cause stress to have an effect on it Specific reaction theory: given one stressor someone reacts differently than to another Prolonged exposure to stress hormones: this has a significant impact on the immune system. Psychoanalytic theory: anger-in, repressed anger can make a person ill Hypertension-high blood pressure without evident biological cause Angina: periodic chest pains due to constriction of oxygen supply to heart (one cause is cholesterol) Myochardial infarction: heart attack, permanent damage to the heart. Ch 10 Mood disorders: disabling disturbances in emotion, Depression:10 times more common than mania, most common complaint of those seeking mental health treatment. Emotional state marked by great sadness and feelings of worthlessness and guilt, withdrawal from others, loss of sleep, appetite, sexual desire and interest and pleasure in usual activities. Affective- depressed mood, dejection, excessive and prolonged mourning, worthlessness, lack of joy Cognitive- pessimism, decreased energy, disinterest, loss of motivation Mania: (not diagnostic disorder) intense but unfounded in elation accompanied by irritability, hyperactivity, talkativeness, flight of ideas, distractibility and impractical, grandiose plans, comes on suddenly and lasts a period of a day or two. MDD (major depressive disorder) needs five of the following symptoms for at least two weeks, depressed mood or loss of interest must be one of the five: sad, depressed mood, most of the day, loss of interest and pleasure, difficulties sleeping, shift in activity level- lethargic or agitated, poor appetite and weight loss or increased and weight gain, loss of energy- fatigue, negative self-concept, self- reproach, self-blame, feelings of worthlessness and guilt, difficulty concentrating, recurrent thoughts of death or suicide. Twice as common in women Freud: needs insufficiently or over sufficiently gratified as a child, anger turned inward, Beck: (beck depression inventory most widely used psychological tool) thinking is biased toward negative interpretations, negative triad: negative views of self, world and future. Arbitrary inference- conclusion with no evidence, selective abstraction- conclusion based on only one element of a situation, overgeneralization- sweeping conclusion based on only one event, magnification and minimization- exaggerations in evaluating performance. Sociotropy: dependent on others, avoiding disapproval, pleasing others. Autonomy: achievement-related construct, unrealistically high goals, self-critical. Martin Seligman: positive psychology, A- adverse situation, B-belief about why it happened C- consequence ,what you chose to do about it D-dispute, denial E-energy, overcoming all these steps Learned helplessness: individual’s passivity Hopelessness theory: expectation of helplessness creates anxiety. Biology: norepinephrine, serotonin and dopamine most studied. Tricyclic drugs: three ringed molecules, prevent some uptake of the three leaving more of the neurotransmitter in the synapse Monoamine Oxidase Inhibitors (MAO): keep the enzyme monoamine oxidase form deactivating the neurotransmitters and increasing levels of the neurotransmitters in the synapse. (has worst side effects so least prescribed) Selective serotonin reuptake inhibitors (SSRIs): most commonly prescribed. Specifically inhibiting the reuptake of serotonin. Because this works it provides a strong link between serotonin and depression. -after several days of these medications the levels of neurotransmitters return to normal, but it takes up to 14 days for them to have an emotional effect -recurrent depression related to decreased hippocampal volume, induction of dysphoria in healthy volunteers increases glucose metabolism Bipolar I disorder: episodes of mania, or mixed episodes of mania and depression, average onset is in the 20’s, equally often in men and women and likely to recur; full range of symptoms almost every day. Bipolar II disorder: major depression accompanied by hypomania, less extreme than full blown mania Lithium- treats both the manic and depressive symptoms; may have to do with the G-proteins. May have serious, even fatal side-effects. Post-partum depression: predicted by levels of depression in pregnancy period and reported warmth of parents in childhood, Cyclothymic disorder: frequent periods of depressed mood and hypomania, separated by periods of normal mood lasting as long as two months Dysthymic disorder: chronically depressed, more than half the time for at least two years, many people also have periods of major depression, in conjunction this is referred to as double depression. Therapies: IPT (intrapersonal therapy), CBT to change negative patterns of thought, MCBT (mindful based Cognitive behavioural therapy), social skills therapy,, ECT (electroconvulsive therapy) works faster than other treatments, used for resistant types of depression, used to be bilateral (through both hemispheres), now unilateral (only right hemisphere) reduces metabolic activity and blood circulation to the brain and may inhibit unusual brain activity, may cause confusion and memory loss, no detectable difference in brain structure. Suicidal ideation- thoughts and intentions, relatively common Suicidal attempts- do not result in death, protracted suicide attempts- like nicotine addiction, longterm Suicide gestures- cry for help, no intent of death Suicide- the actual result of self-caused death -when someone starts to feel better is when they are most likely to commit an act, most are ambivalent Durkehim’s theories of suicide: Egotistic: committed by people who have few ties to family, community or society Altruistic: response to societal demands, sacrifice themselves Anomic: sudden change, no longer see a way to live their life Predisposing factors: enduring factors that make a person vulnerable (disorder, abuse) Precipitating factors: acute factors creating a crisis (job loss) Contributing factors: increase exposure to precipitating or predisposing (personal resilience) CH 9. Eating disorders: appeared for the first time in DSM 1980 Anorexia Nervosa (AN): restricting type -refuses to maintain normal body weight Blood pressure often falls, heart rate slows, kidney and gastrointestinal problems, lower bone mass, skin dries out, nails get brittle, hormones change, some lose hair and develop laguna a fine hair on the body. Tiredness, weakness, cardiac arrhythmias, brain size declines. Recovery takes six or seven years. Binge eating-purging type: More psychopathological- more personality disorders, impulsive behavior, stealing, alcohol and drug abuse, social withdrawal, suicide attempts. Binge: eating excessive amount of food within less than two hours, typically occur in secret, may be triggered by stress, feels a loss of control over amount of food being consumed, following binge there is a feeling of disgust, discomfort and fear of weight gain that lead to the binge Binge eating disorder: recurrent binges- twice a week for at least six months. Loss of control, absence of weight loss and absence of compensatory behaviours. More prevalent than AN or BN. Drugs not useful in treating. Operant conditioning in the short-ter
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