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Psychological Disorders

Chapter 14
I. How Are Psychological Disorders Conceptualized and Classified?
A. Intro 1. Psychopathology - literally sickness or disorder of the mind a) Earliest views explained apparent madness as possession by demons (demonology) b) Hippocrates (400BCE) classified psychopathologies --> sense that there was a physical basis (1) mania, melancholia, and phrenitis c) Middle ages emphasis on wrath of God for sinful moral transgressions B. Psychopathology Is Different from Everyday Problems 1. Psychological disorders comprise the the greatest proportion of disability in developed countries 2. Some statistics a) 1/4 Americans over the age of 18 diagnosed with a mental disorder each year b) 1/2 of all Americans will suffer from a mental disorder at some point in lifetime (1) most likely either a mood, anxiety, impulse, or substance abuse disorder c) Range in severity (only 7% of population has a severe form of the disease) 3. Sex differences a) some disorders more common in women (depression, anxiety) and other more common in men (antisocial personality and autism) b) reflect biology and culture 4. Psychological Disorders are Maladaptive a) Important to consider: does the behavior deviate from cultural norms, is the behavior maladaptive (prevent individ. from responding appropriately in dif. situations), self-destructive, or cause discomfort or concern to others b) Working definition of psychopathology: thoughts and behaviors that are maladaptive rather than deviant C. Psychological Disorders Are Classified into Categories 1. Etiology - factors that contribute the the development of the disorder 2. Emil Kraepelin identified mental disorders via symptoms that occur together a) i.e. separated mood disorders from cognition disorders (schizophrenia) 3. 1952 APA published Diagnostic and Statistical Manual of Mental Disorders (DSM) a) currently, disorders are described by symptoms (observable) b) Patients classified via multiaxial system (1) Axis I - major clinical disorders (a) Schizophrenia, depression, anxiety disorders (2) Axis II - mental retardation and personality disorders (typically persist across lifespan (3) Axis III - medical conditions that alter psychological functioning (4) Axis IV - environmental/psychosocial problems (5) Axis V - overall assessment of how well a person is functioning based on a 100-pt scale 4. Problems with DSM a) very black and white - either a person has a disorder or does not (cant tell diff in severity) (1) known as categorical approach (2) people dont neatly fit into categories 5. Alternative Approach a) Dimensional approach considers disorders along continuum so people can vary in degree 6. DSM - V (due May 2013) should make improvements, include for range, greater attn to how disorders function in daily lives D. Psychological Disorders Must Be Assessed (pp.623)

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Assessment aims to diagnose on basis of persons mental functions and psychological health a) leads to prognosis, or course and probable outcome b) doesnt stop w/diagnosis --> ongoing process c) initial assessment = mental status exam - provides snapshot of patients mental functioning (1) behavioral observations d) clinical interview 2. Structured Versus Unstructured Interviews a) For the most part, unstructured, as it allows the interviewer to prove the patients problems (1) highly flexible (2) dependent on skill of interviewer b) Structured interviews require clinicians to ask standardized questions (1) diagnosis based on specific patterns of responding (2) answers are coded and converted (3) example: What kind of work do you do? (4) valuable because results from one group could apply to other patients diagnosed with same disorder 3. Observation and Testing Types a) Observation of behavior can provide clues regarding the disorder b) Psychological testing -- assessing personality (1) Minnesota Multiphasic Personality Inventory (MMPI) (created 1930, updated 1990) (a) Most widely used questionnaire for psych. assessment (b) Has 10 clinical scales that generates a profile (could indicate mental disorder) (c) Limitations: self-report i) Faking good, faking bad (d) Correction: validates scales in addition to clinical scales --> indicates truthfulness (e) IMPORTANT: Although generally reliable in North America, criticized as inappropriate in other countries/among poor, elderly, racial minorities b/c normal scores are based on studies in which people of these groups were inadequately represented c) Neuropsychological testing (1) employs tasks that require planning, coordination, and memory skills --> highlight troubled brain region 4. Evidence Based Assessment a) Encompasses all methods mentioned above to make a diagnosis (methods alone are somewhat subjective/inefficient) (1) Comorbidity - the state in which more than one mental disorders occur together Psychological Disorders Have Many Causes 1. Diathesis-Stress Model - individuals can have underlying predispositions to mental disorders (can be environmental/biological) that are alone not enough to trigger the disorder, but given a stressful circumstances under which the individ. cannot cope, then the disease is likely to be triggered. 2. Biological Factors a) Genetics b) Disorder may arise from prenatal problems (1) malnutrition, teratogens, maternal illness (2) Affects CNS c) Brain functioning d) Neurotransmitters 3. Psychological Factors a) Family Systems Model - behavior must be considered in social context, esp. within fam. (1) families can either be helpful or detrimental b) Sociocultural Model - psychopathology = result of interaction b/w individ. and culture

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(1) differences arise via dif lifestyle, expectations, opportunities (2) behaviors exhibited by wealthy may be viewed as disorders if exhibited by poor Cognitive-Behavioral Factors a) Cognitive Behavioral Approach - abnormal behavior is learned b) Behaviorists argues that mental disorders arise from systems of classical and operant conditioning (1) thoughts, beliefs and behavior can be studied empirically. How? (a) Thoughts can produce maladaptive behaviors and emotions (b) INDIVIDUALS ARE AWARE Sex Differences In Mental Disorders a) Differences are both biological and environmental (as always) b) Internalizing Disorders (negative emotions, reflect distress and fear) (1) major depression, gen. anxiety disorder, panic disorder (2) More common in females c) Externalizing disorders (disinhibition) (1) alcoholism, conduct disorders, antisocial behavior (2) More common in males Culture and Mental Disorders a) Manifestations are different cross-culturally, depending on the strength of the biological component b) culture-bound syndromes --> these disorders occur in specific cultures or regions (1) PAGE 629 FOR CHART

II.

Can Anxiety Be the Root of Seemingly Different Disorders? (14.2)


A. There Are Different Types of Anxiety Disorders 1. Intro (1) 1/4 Americans will develop some form of anxiety disorder (2) Characteristics (a) feel anxious, tense and apprehensive. often depressed and irritable, constant worry (b) High levels of autonomic arousal --> restless and pointless motor behaviors, exaggerated startle response judgement problems (3) Can cause atrophy in hippocampus 2. Phobic Disorder a) Fear of a specific object/situation b) exaggerated and out of proportion to potential danger c) Social phobia (social anxiety disorder) - fear of being negatively evaluated by others (1) one of the earliest forms of anxiety to develop (2) likely to develop depression and substance abuse problems 3. Generalized Anxiety Disorders a) GAD is always present. Ppl are constantly affected exhibit hypervigilance (1) restless, easily distracted, fatigued, irritable, etc. 4. Post Traumatic Stress Disorder (PTSD) a) Serious mental health disorder that involved frequent and recurring unwanted thoughts related to trauma (includes nightmares, intrusive thoughts, flashbacks) b) women more likely to develop 5. Panic Disorder a) Panic Disorder = sudden, overwhelming attacks of terror b) characterized by shortness of breath, racing heart, sweat, trembling, dizziness, tingling, chest pain c) ppl w/panic disorders are more likely to develop other disorders in adulthood d) Agoraphobia - fear of being in situations in which escape is difficult or impossible --> fear is sometimes so strong that leads to panic attacks

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Obsessive-Compulsive Disorder (OCD) a) OCD involves frequent intrusive thoughts and compulsive actions b) more common in women and generally begins in adulthood c) Obsessions - recurrent thoughts/ideas/mental images d) Compulsions - acts sufferers feel compelled to perform over and over e) anticipate catastrophe and loss of control Anxiety Disorders Have Cognitive, Situational, and Biological Components (pp. 635) 1. Cognitive Components a) Anxious individuals perceive normal situations as threatening, focus attention on perceived threats, and recall these instances more frequently in exaggerated form 2. Situational Components a) Observing someones fear could generate own fear, and then generalize fear 3. Biological Components a) inhibited temperament style (shy) show greater activation of amygdala while viewing novel faces (1) Aspects of childhood temperament preserved in adult brain 4. Causes of Obsessive-Compulsive Disorder a) Results from conditioning (1) conditioned behavior reduces anxiety and is therefore reinforced through operant conditioning (2) reduction of anxiety = reinforcing chances of persons engaging in behavior again b) Etiology of OCD is in part genetic (1) runs in families (2) not clear yet, but involves glutamine (neurotransmitter) --> major excitatory neuro in brain c) Caudate (brain structure involved in suppressing impulse) smaller + abnormalities in OCD patients d) Overactive prefrontal cortex e) Triggered by environmental factors --> LINKED TO IMMUNE SYSTEM IN CHILDREN f) Cognitive-behavioral factors interact to produce the symptoms of OCD There Are Two Categories of Mood Disorders 1. Mood, or affective disorders can either be excessive elation or extreme sadness a) Depressive disorders = pervasive sadness, b) bipolar disorders involve radical mood fluctuations 2. Depressive Disorders a) Major depression, according to DSM, requires a loss of interest in pleasure for two weeks and have appetite changes, weight changes, sleep disturbances, energy disturbances, difficulty concentrating, feelings of self-reproach/guilt and thoughts of death b) Women are twice as likely as men to be diagnosed with MD c) Dysthymia is mild to moderately severe depression (1) less intense form, not diagnosed with MD (2) can last 5-10 years, as long as 20 years --> considered a personality disorder. Can precede MD 3. The Roles of Culture and Gender in Depressive Disorders a) Depression is the leading cause of disability worldwide (1) leading risk factor for suicide (2) among top 3 causes of death for ppl ages 15-35 (3) Twice as many women as men suffer from the disease, more prevalent in developing countries b) Why are the rates so high for women? (1) Overwork, lack of income, family issues

III. Are Mood Disorders Extreme Manifestations of Normal Moods?


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c) Theory: Men externalize stressful events, and women internalize Bipolar Disorder a) Bipolar Disorder is characterized by extreme fluctuations of mood. b) Manic episodes - elevated mood, increased activity, diminished need for sleep, grandiose ideas, racing thoughts, extreme distractibility. (1) elation leads to out of character activities c) Hypomanic episodes - heightened creativity and productivity d) equally prevalent in males and females e) emerges late adolescence/early adulthood 5. A Case Study of Bipolar Disorder a) Jamisons A Unique Mind (1) association b/w bipolar disorder and artistic genius (2) Lithium (drug) blunts positive feelings Mood Disorders Have Biological, Situational, and Cognitive Components (pp. 641) 1. Biological Components a) Concordance rates (i.e. percentage who share the same disorder) is 2-3 times higher with identical twins than the rates between fraternal twins (70% in identical twins vs. 20% fraternal) b) Bipolar disorder and schizophrenia have higher concordance rates than does depression c) DISPLAYS POLYGENIC INHERITANCE d) Genetic anticipation (successive gen. have more severe form, earlier ages of onset) e) Correlation to monoamines (neurotransmitters that regulate emotion, arousal, motivate behavior) f) Selective Serotonin Reuptake Inhibitors (SSRIs) (1) Selectively increase the monoamine serotonin 4.

g) Left prefrontal cortex linked to depression


h) 2. Seasonal Affective Disorder (SAD) results in periods of depression that correspond to the shorter days of winter in northern latitudes Situational Components a) Stress (1) Interpersonal loss (death of love one, divorce) b) Likely in the face of multiple negative events (1) Usually occur the year before the onset of depression c) People with close relationships are more likely to be protected by the extreme effects of depression (quality, not quantity of rltnshp) Cognitive Components a) Cognitive Triad - negative thoughts about self, situation, future b) Ppl with depression make errors in logic c) Learned Helplessness model - ppl come to see themselves as unable to have any effect on events in their lives (a) Attributions (explanations) - stable, global, and personal factors as opposed to temporary (2) ^^causation, not consequence

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IV. What Are Dissociative Disorders? (14.4)


A. Intro 1. Dissociative Disorders are extreme versions of situations in which our thoughts and experiences can become dissociated from the external world a) Identity, memory, conscious awareness b) result from extreme stress, prone to PTSD Dissociative Amnesia and Fugue Involve Loss of Memory

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Dissociative Amnesia involves forgetting an event that happened or loss of awareness of a substantial time block 2. Dissociative Fugue - rarest and most extreme form of dissociative amnesia, involves loss of identity a) sometimes involves assuming a new identity and travel go another location b) Ends suddenly Dissociative Identity Disorder is a Controversial Diagnosis 1. Dissociative Identity Disorder (DID) consists of two or more distinct identities for the same individual a) Formerly multiple personality disorder 2. Most common in women abused as children a) Theory: to cope with abuse, pretend its happening to someone else (1) dissociate mental states from physical bodies 3. Identities differ substantially 4. Most commonly diagnosed after someone commits a crime --> raises possibility that ppl could be pretending to have the disease Intro 1. Schizophrenia - split between thought and emotion. Literally splitting of the mind a) psychotic disorder - alterations in thought, perceptions, consciousness b) disconnection from reality - psychosis Schizophrenia Has Positive and Negative Symptoms 1. Positive Symptoms are excesses 2. Negative Symptoms are deficits in functioning 3. Positive Symptoms of Schizophrenia a) Delusions - false beliefs based on incorrect inferences about reality (1) cognitive process misinforms them about what is real and what is not (2) Delusions of grandeur - believing much more powerful and important than you really are (3) Delusions of harassment - belief that being slandered by others (a) Culture and current events can affect types of delusions, b) Hallucinations - false sensory perceptions that are experienced without an external source c) Loosening of Associations - shifting between unrelated topics as the person speaks, making it difficult/near impossible to follow train of thought d) Clang Associations - stringing together of word that rhyme but have no other apparent connection e) Disorganized Behavior - VERY unusual behavior f) Catatonic schizophrenia - mindlessly repeat heard words... known as echolalia (1) extreme fear response --> person literally scared stiff 4. Negative Symptoms of Schizophrenia a) Isolation and withdrawal b) avoid eye contact and seem apathetic c) dont express emotion d) monotonous tone, speech slowed e) negative symptoms harder to fix, thought to be related to abnormal brain anatomy --> lead researches to believe negative symptoms prompts a different disorder altogether Schizophrenia Is Primarily a Brain Disorder 1. Mutations in DNA (3-4 more times than avg) a) Abnormal brain development b) Polygenic inheritance 2. 3. Ventricles enlarged in people with the disease --> actual brain tissue is reduced Abnormalities occur throughout many brain regions

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What is Schizophrenia? (14.5)


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leads researchers to believe that schizophrenia is a problem of connection between brain regions 4. Involves dopamine (neurotransmitter-related) a) increase leads to increased symptoms, decrease vice versa 5. Abnormalities in glial cells in myeline sheath --> would impair neurotrans in brain 6. Five factors predict the onset of the disease a) family history b) social impairment c) higher levels of suspicion/paranoia d) substance abuse history e) higher levels of unusual thoughts D. Environmental Factors Influence Schizophrenia 1. Growing up in dysfunctional family increases risk 2. Growing up in urban environments --> doubles risk of getting the disease 3. Virus hypothesis

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VI. Are Personality Disorders Truly Mental Disorders? (14.6)


A. Personality Disorders Are Maladaptive Ways of Relating to the World 1. Three groups personality disorders last throughout life span a) First group (1) Paranoid (2) Schizoid (3) Schizotypal (4) ---> reclusive, suspicious, difficulty forming relationships, aloof, strange behavior b) Second Groups (1) characterized by anxious/fearful behavior (2) Avoidant, dependent, obsessive-compulsive c) Third Group (1) characterized by dramatic, emotional, erratic behaviors (a) Histionic, narcissistic, borderline, antisocial personality disorders 2. Controversial b/c a) they seem to be extreme versions of normal personality traits b) Overlapping among traits of dif personality disorders (1) people could fit the criteria for more than one disorder c) less stable over time than has been assumed Borderline Personality Disorder Is Associated with Poor Self-Control (pp. 658) 1. Borderline personality disorder - disturbances in identity, affect, impulse control a) borderline b/w normal and psychotic 2. twice as common in women than men 3. self-mutilation 4. Lack a strong sense of self, intense fear of abandonment, cant be alone 5. EMOTIONAL INSTABILITY 6. IMPULSIVITY Antisocial Personality Disorder Is Associated with a Lack of Empathy 1. Intro a) Antisocial Personality Disorder (APD) - catchall for people who behave in socially undesirable ways b) VERY DIFFERENT FROM PSYCHOPATH c) APD very concentrated in prison population 2. Assessment and Consequences

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Only those with a lifetime history of antisocial behaviors can be diagnosed with APD

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b) Must also display illegal acts, repeated ling, show reckless disregard for own safety/others safety c) punishment has little effect on them, often repeat problem behaviors Etiology of Antisocial Personality Disorder a) Slower alpha waves --> lower level of arousal --> engage in sensation-seeking behavior b) Amygdala abnormalities (smaller and less responsive to negative stimuli) c) Deficits in frontal lobe functioning (lack of forethought) d) Genetics more important for psychopathy, but environment (malnutrition among others) also plays a role

VII. Should Childhood Disorders Be Considered a Unique Category? (14.7)


A. Autistic Disorder Involves Social Deficits 1. Intro a) Autism (autistic disorder) - deficits in social interaction, impaired communication, restricted interests b) Males outnumber females with the disease 3-1 c) Increase in # of cases due to awareness and changes in diagnosis d) Varies in severity, so psychologists use the term autism spectrum disorders (1) Aspergers syndrome- high functioning degree of autism (a) underdeveloped theory of mind 2. Core Symptoms of Autism a) Seemingly unaware of others b) Deficits in communication (1) verbal and nonverbal Echolalia - mindless repetition of words/phrases someone else said (2) pronoun reversal - replace I with you c) Restricting activities and interests (1) focus on inconsequential details of a situation d) changes in routine or placement of something is very upsetting 3. Autism is Primarily a Biological Disorder a) b) c) Environmental factors are also important --> concordance rates somewhat lower for identical twins than dizygotic twins gene mutations play role --> may affect neural networks brain dysfunction -- grow unusually large until age 2, then grows slowly until age 5 (1) dont develop normally during adolescence d) Exposure to antibodies in womb e) impairments in mirror neuron system Attention Deficit Hyperactivity Disorder Is a Disruptive Impulse Control Disorder 1. Intro a) ADHD - restless, inattentive, impulsive, directions need to repeated multiple times b) 2. behavior similar to those with frontal lobe damage Etiology of ADHD a) Unknown

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Treatment of Psychological Disorders


Chapter 15
I. How Are Psychological Disorders Treated?
A. Intro 1. Psychotherapy (generic name for formal treatment) can be psychological or biological a) Biological Therapies - medical approaches to illnesses/diseases (1) Abnormalities in neural and bodily processes exist (2) Psychopharmacology - use of medications that affect brain of bodily functions (a) can be effective on a short-term basis b) Combination of biological therapies + other approaches = best treatment Psychotherapy is Based on Psychological Principles 1. Intro a) Therapist-Patient relationship IMPORTANT in outcome of therapy 2. Psychodynamic Therapy Focuses on Insight a) Freud --> first to really address treatment (1) Free association --> client says whatever comes to mind, look for unconscious conflicts (2) Dream Analysis --> interpret hidden meanings of clients dreams b) insight --> increasing clients awareness of unconscious psychological processes + how affects functioning c) NOW KNOWN AS psychodynamic therapy - therapist aims to help patient examine needs, defenses, motives as a way of understanding why the patient is distressed (1) talking therapy (a) conversational (2) INCREASINGLY CONTROVERSIAL (a) expensive, time consuming, weak for treating most disorders (but +for borderline personality disorder) (b) dropout rates are high (c) To fix, trying to focus on current relationships, shorten sessions 3. Health Benefits of Talking and Expressing Emotion a) Can reduce blood pressure, muscle tension, skin conductance, improves immune functioning b) Explanation? --> reinterprets events in less threatening ways 4. Humanistic Therapies Focus on the Whole Person a) Goal: treat persona as a whole b) Client-centered therapy - encourages ppl to fulfill individual potentials for personal growth through greater self0understanding (1) creates a safe and comforting setting for clients to access feeling (2) therapists helps client focus on subjective experiences (a) reflective listening c) Motivational interviewing uses client-centered approach over short period (1-2 interviews) (1) good for alcohol/drug abuses + increasing healthy eating habits + exercise 5. Cognitive and Behavioral Therapies Target Thoughts and Behaviors a) Behaviorist therapy - behavior learned + can be unlearned through use of classical + operant conditioning (1) desired behaviors rewarded, undesired punished b) social skill training elicits the desired behavior (1) First step = modeling --> therapists acts out appropriate behavior c) Cognitive Therapy -distorted thoughts can produce maladaptive behaviors and emotions

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Cognitive restructuring - clinician seeks to help client recognize maladaptive thoughts/patterns + replace with ways of viewing world that are more in tune w/reality (1) Rational-emotional therapy - therapist acts as a teacher, explaining clients errors in thinking and demonstrating more-adaptive ways to think + behave (a) maladaptive behav. stems from individual belief systems + ways of thinking e) Interpersonal therapy focus on circumstances the client attempts to avoid (1) developed via psychodynamic ideas f) mindfulness-based cognitive therapy (1) prevents relapse of psych disorders (2) meditation (3) EFFECTIVE in preventing relapse from depression g) Cognitive-behavioral therapy uses techniques from cog therapy + behav therapy by correcting faulty cognitions + training engagement in new behaviors (1) one of the most common/effective forms of psychotherapy h) Cog-behav therapies often focus on exposure to anxiety-producing stimulus (1) exposure and prevention therapy (2) VERY EFFECTIVE for OCD i) Systematic desensitization - gradual form of exposure therapy, expose client to increasingly anxiety-producing situations 6. Group Therapy Builds Social Support a) not costly, effective for bulimia, OCD (when structured) b) less structured, focused on social support 7. Family Therapy Focuses on the Family Context a) critical to long-term prognoses b) expressed emotion - pattern of (-) actions by fam members of schizophrenics (1) corresponds to relapse rates c) Culture also has an effect C. Culture Can Affect The Therapeutic Process 1. China cultural stigma --> not many therapists, but govt now sending more 2. India --> also stigma, re-labeled terms to tension and strain 3. Plays a role in availability of psychotherapy D. Medication is Effective for Certain Diseases 1. Psychotropic Medications affect mental processes by changing brain neurochemistry 2. Anti-anxiety Drugs (tranquilizers) used for short-term anxiety treatment

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a) benxodiazepines - increase GABA activity, an inhibitory transmitter


3. b) induce drowsiness and are addictive Anti-depressants - used to treat depression and some anxiety disorders a) Monoamine oxidase inhibitors (MAO) - first antidepressants (1) stop monamine oxidase from breaking down serotonin in the synapse --> more available in synapse (2) raise levels of norepinephrine and dopamine b) tricyclic antidepressants inhibit reuptake of certain neurotransmitters c) selective serotonin reuptake inhibitors (SSRIs) (Prozac) inhbit serotonin reuptake and act on other neurotransmitters (1) can lead to sexual dysfunction Anti-psychotics (neuroleptics) treat schizophrenia and other disorders that involve psychosis a) reduce delusions/hallucinations by binding to dopamine receptors/blocking b) side effects (1) tardive dyskinesia --> involuntary muscle twitching, esp. in neck/face

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c) not useful in treating negative symptoms (apathy and social withdrawal) d) CLOZAPINE --> WORKS for a lot of ppl, but severly affect white blood cells 5. Lithium - effective treatment for bipolar 6. Anticonvulsants stabilize moods + prevent seizures Alternative Biological Treatments are Used in Extreme Cases (pp.684) 1. Electroconvulsive Therapy a) ECT involves placing electrodes on patients head and administering electrical current to produce a seizure b) effective for severe depression, but is not without risks 2. Transcranial Magnetic Stimulation a) interrupts neural functioning in region below coil 3. Deep Brain Stimulation a) implanting electrodes in brain, applying electricity, like pacemaker b) used to treat symptoms of Parkinsons 4. Therapies Not Supported by Scientific Evidence Can Be Dangerous (pp. 686) a) i.e. encouraging people to describe experience following major trauma, scaring adolescents from committing crime, DARE (drug education program), hypnosis, simulating birth 5. A Variety of Providers Can Assist in Treatment for Psychological Disorders a) Clinical Psychologists - have doctoral degrees (4-6 yrs for Ph.D), design + analysis research +treatments with empirical support. work in academic/hospital settings. typically not allowed to prescribe meds b) Psychiatrists - have a medical degree + 3-4 years of specialized residency. Work in hospitals/ private practice. ONLY mental health practitioners legally authorized to prescribe drugs in the U.S. c) Counseling psychologists - deal with adjustment/life stresses that do not involve mental illness d) Psychiatric social workers - work in hospitals + visit people in homes where problems arise from those environments e) Psychiatric nurses - hospitals/residential treatment programs f) Paraprofessionals - limited advanced training and work under supervision. Assist in daily living g) Technology-based treatment uses iPhone apps so that the patient can record moods. (1) SUCCESSFUL for treating addiction problems Effectiveness of Treatment is Determined by Empirical Evidence 1. To test the validity of a treatment, compare treatment group with control group 2. Randomized clinical trials - client-participants should be randomly assigned to conditions 3. psychological treatments vs. psychotherapy a) psych treatments proven by scientific research to be effective 4. Characteristics of psychological treatments a) adjust to specific disorder/specific symptoms b) techniques must have been develop. in laboratories by psychologists c) No grand overall theory guides treatment Treatments that Focus on Behavior and on Cognition are Superior for Anxiety Disorders 1. Specific Phobias a) Systematic Desensitization - a form of behavioral therapy that involves the client making a fear hierarchy --> list of situations that arouses fear, in descending order (1) relaxation training (2) Exposure therapy (a) Virtual environment (virtual reality) - computer simulations of feared object (b) (3) ***purpose: relaxation eventually replaces fear response

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What Are the Most Effective Treatments? (15.2)


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(4) --->proven SUCCESSFUL and capable of altering the brain processes the feared stimulus Tranquilizers (1) help handle immediate fears, but they dont extinguish them 2. Panic Disorders a) Treatment based on cognitive-behavioral therapy just as effective, if not more than, medication (1) Client identifies fear, estimates how many panic attack he/she has experienced, (2) Point out tat patients dont faint when have panic disorders, racing heart = opposite of fainting 3. Obsessive-Compulsive Disorder a) Traditional anxiety drugs are completely ineffective b) SSRIs are effective c) Cognitive-behavioral therapy also effective (1) Exposure and response prevention (a) client exposed to stimulus that provokes compulsions, but prevented from doing so d) CLOMIPRAMINE - drug of choice for OCD e) Deep brain stimulation --> VERY promising (1) significant reduction of symptoms and increased daily functioning in 2/3 of participants Many Effective Treatments are Available for Depression (pp. 697) 1. Pharmacological Treatment a) MAO inhibitors (scan be toxic b/c effects on various psychological systems) (1) consequently, usually just reserved for patients who dont respond to other antidepresants b) Tricyclics effective in relieving clinical depression (1) ...but many unpleasant side effects (2) could be beneficial for more serious forms of depression c) Prozac and SSRIs --> more commonly used (1) fewest side effects 2. Questions About the Pharmacological Treatment a) Causation vs. Correlation b) Effectiveness of placebos? (1) patients must believe treatments will work for effective treatments (2) evidence suggests it leads to changes in brain functioning (3) not in most severe cases though... 3. Cognitive-Behavioral Treatment a) Just as effective as antidepressants in treating depression b) Goal: help client think more adaptively (1) improves mood and behavior c) patterns are identified, monitored d) Combined with medication,c an be very effective e) Therapy is a more permanent/long-lasting treatment + can lead to change in brain activation 4. Alternative Treatments a) Patients with Seasonal Affective Disorder (SAD) respond to phototherapy --> exposure to high-intensity light source for a part of each day b) Aerobic exercise --> releases endorphins c) Electroconvulsive Therapy (ECT) (1) effective for the severely depressed and dont respond to anything else (2) works quickly (3) Problems/limitations: (a) High relapse rate (b) Substantial memory loss to day f treatment b)

Transcranial Magnetic Stimulation over left frontal cortex region can significantly reduce depression 5. Deep Brain Stimulation a) Used for treating OCD and depression when all else has failed b) initially used to treat Parkinsons symptoms c) Crazy good results 6. Gender Issues in Treating Depression a) Women more likely to develop disorders, could be due to violence, reduced economic resources, inequities at work, etc. b) Difficult to treat men for depression, because many refuse they have the disorder D. Lithium is Most Effective for Bipolar Disorder (pp.. 705) 1. Medications are the best treatment 2. the drug seems to modulate neurotransmitter levels, balancing excitatory and inhibitory levels 3. unpleasant side-effects (thirst, hand tremors, excessive urination, memory problems) 4. Patients w/bipolar disorder may stop taking meds b/c they miss the highs of their hypomanic and manic phases E. Pharmacological Treatments are Superior for Schizophrenia 1. Patients with schiz. didnt improve from lobotomies, as did patients suffering from anxiety/depression 2. Pharmacological Treatments a) Reserpine (1) sedative effect, antipsychotic, reduced (+) symptoms of schix b) Chlorpromazine - synthetic version that acts as as a tranquilizer (1) reduces anxiety and sedates without inducing sleep, c) Haloperidol has less of a sedating effect d) Later two drugs mentioned revolutionized treatment of schiz. e) SIDE EFFECTS SEVERE (1) both cause motor impairment that resemble Parkinson's (2) Tardive dyskinesia (irreversible) f) Clozapine (late 1980s) (1) acts on dopamine, serotonin, norepinephrine, acetylcholine, and histamine receptors (2) can treat both negative and positive symptoms (3) SIDE EFFECTS (a) ...eh... major reduction in white blood cell count 3. Psychosocial Treatments a) The drugs must be combined w/other treatments for successful living b) Social skill training -- helps schizophrenics with social functioning (1) modifying thinking patterns, coping with auditory hallucinations, training in specific cognitive skills has been LESS effective c) Intensive Cognitive-behavioral therapy can be effective 4. Prognosis in Schizophrenia a) Most improve over time, as they grow older (not sure why) b) Depends on age of onset, gender, culture (1) diagnosed later in life have more favorable prognosis, women tend to have better prognoses b/c appears later than in men, more severe in developed countries (a) more extensive family networks in developing countries provide more social support for suffers

d)

III. Can Personality Disorders Be Treated? (pp. 709)


A. Dialectical Behavior Therapy is Most Successful for Borderline Personality Disorder 1. VERY challenging

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Dialectical behavior therapy combines elements of behavioral/cognitive treatments with a mindfulness approach based on eastern meditative practices a) Three stages (1) 1. therapist targets most extreme + dysfunctional behaviors to replace with more appropriate behaviors (2) therapist helps patient explore past traumatic experiences that may be at the root of the emotional problems (3) therapist helps patient develop self-respect and independent problem solving (a) IMPORTANT Antisocial Personality Disorder is Extremely Difficult to Treat 1. Therapeutic Approaches a) anti-anxiety drugs reduce some symptoms (aggression) b) VERY VERY DIFFICULT, NEAR IMPOSSIBLE TO TREAT 2. Prognosis a) poor b) Usually improve after age 40, not sure why, but it may be due to a reduction in biological drives c) Conduct disorder = childhood precursor. keep on look out, make sure your child doesnt develop The Use of Medication to Treat Adolescent Depression is Controversial 1. Intro a) For ages 12-17, suicide = 3rd leading cause of death (5,000/year) b) SSRIs = treatment to depression, but later found that they induce suicidal thoughts 2. TADS (Treatment for Adolescents with Depression Study) a) Research by NIH that proved SSRI Prozac is effective in treating adolescent depression b) SSRI Prozac DOES slightly increase risk of suicide 3. Further Thoughts on Treatment Approaches a) should combine medication with some form of CBT. b) Psychotherapy effective, expensive, time consuming, and not enough to treat everyone Children with ADHD Can Benefit from Various Approaches 1. Pharmacological Treatment of ADHD a) Methylphenidate (Ritalin) - Nervous system stimulant b) Aderall c) Have under-active brains, hyperactivity just increases arousal level 2. Behavioral Treatment of ADHA a) Medication + Behavioral therapy = best solution b) Psychological treatment = longterm, medical = short-term Children with autism Benefit from Structured Behavioral Treatment 1. Behavioral Treatment for Autism a) Applied Behavioral Analysis (Lovaas ABA) - based on operant conditioning b) behaviors that are reinforced should increase in frequency. (1) successful if implemented early in life
c) IF THE FAMILY INCLUDES OTHER CHILDREN, THEY MAY FEEL NEGLECTED OR JEALOUS BECAUSE OF THE AMOUNT OF TIME AND ENERGY EXPENDED ON THE CHILD WITH AUTISM

IV. How Should Childhood Disorders and Adolescent Disorders be Treated? (15. 4)
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3.

Biological Treatment for Autism a) Selective serotonin reuptake inhibitors (1) evidence that children have abnormal serotonin functioning b) Could have something to do with a deficit in oxytocin Prognosis for Children with Autism a) Long-term prognosis is poor (1) difficulty generalizing from therapeutic setting to the real world

Personality
Chapter 13
I. How Do We Know Our Own Personalities?
A. Our Self-Concepts Consist of Self-Knowledge 1. Intro a) self-concept is everything you know about yourself... thought of as a cog. structure 2. Self-Awareness a) Objectified self is knowledge the subject holds about itself (i.e. best and worst qualities) b) Self-awareness = sense of self as object of attention. I thinks about me c) Objective Self-Awareness THEORY = self-awareness makes people act in accordance with values d) Self-Discrepancy theory - strong emotions result from differences b/w personal standards and goals e) Connected to frontal lobe 3. Self-Schema a) information processed deeply about himself or herself (1) cocktail party phenomenon b) cognitive aspect of the self-concept c) helps us organize, perceive, interpret, and use information about the self d) Middle, frontal lobe connected 4. Working Self-Concept a) immediate experience of the self (1) sense of self varies from situation to situation (2) Optimal levels of distinctiveness (avoids standing out too much in front of one could Perceived Social Regard Influences Self-Esteem 1. Intro a) Self-esteem is the evaluative aspect of the self-concept (1) indicates emotional response to personal characteristics (2) reflected appraisal - self esteem based on how others perceive individual 2. Sociometer Theory a) self esteem = sociometer - internal monitor of social acceptance/rejection b) self-esteem = mechanism for monitoring the likelihood of social exclusion c) fundamental need to belong 3. Self-Esteem and Death Anxiety a) Terror management theory - self-esteem protect ppl from horror associated w/knowing they will eventually die, gives meaning to life 4. Self-esteem and life outcomes a) Weakly related to objective life outcomes We Use Mental Strategies to Maintain Our Views of Self 1. Intro a) Better than average effect - we tend to rate ourselves better than average 2. Evaluative Maintenance a) people can feel threatened when those close to them outperforms them on a task that is personally relevant b) not true for superstars in the respected field --> inspirational factor 3. Social Comparisons a) when people evaluate themselves by contrasting with others (1) to know where they stand (2) also use downward comparison

B.

C.

Self-Serving Biases a) Self-serving bias = when ppl w/high self-esteem take credit for their successes but blame failure on outside factors D. There Are Cultural Differences in the Self 1. Culture and Self-Serving Bias a) More common in western cultures than eastern cultures b) those in individualist cultures are more connected to self-enhancement (1) ... or maybe those in eastern cultures are just hesitant to admit it

4.

Social Psychology
Chapter 12
I. How Do We Form Our Impressions of Others? (pp. 515)
A. Nonverbal Actions and Expressions Affect Our First Impressions 1. Nonverbal behavior = body language (facial expressions, gestures, mannerisms) a) Thin slices of behavior - powerful cues for impression formation (1) Often accurate judgements b) gait - provides info about affective state (walk) 2. Facial Expressions a) First thing we usually notice about a person, communicates emotions b) Eye contact important - but perceptions vary from culture to culture B. We Make Attributions About Others 1. Attributions are explanations for events/actions (self and others behaviors) a) Part of the just world hypothesis - victims must have done something to justify what happened to them 2. Attributional Dimensions a) Personal attributions - ability, moods, efforts of people b) Situational attributions - outside events (luck, accidents, actions of others) 3. Attributions About the Self a) We tend to attribute failures to external (situational) factors and successes to personal factors 4. Attributional Bias a) Fundamental Attribution Error - we tend to overemphasize the importance of personal traits, underemphasize the importance of situation b) Correspondence bias - we expect others behaviors to correspond to our expectations c) Actor/observer discrepancy - when interpreting our behavior, we focus on situation, when others behaviors focus on dispositions (1) i.e. when late we blame traffic, but when others late we blame laziness d) doesnt change much cross-culturally, but they do in how much they emphasize the situation C. Stereotypes Are Base on Automatic Categorization 1. Stereotypes allow for quicker mental processing of social information a) affect impressions b) We tend to place examples who debunk the stereotype in special groups, known as subtyping, rather than alter or abandon the stereotype 2. Self-Fulfilling a) Self-fulfilling prophecy = peoples tendency to behave in ways that confirm their own/others expectations D. Stereotypes Can Lead to Prejudice 1. Prejudice - negative feelings, opinions associated w/stereotype 2. Discrimination - unjustified treatment of people as a result of prejudice 3. Ingroup/Outgroup Bias a) groups to which we belong = ingroups, ones to which we dont belong = outgroups b) were more wary of others who do not belong to our own group c) outgroup homogeneity effect - we tend to view outgroup members as less varied than ingroup members d) ingroup favoritism = consequence of categorizing people in ingroup/outgroup (1) more likely to do favors/forgive ingroup members --> power of group membership 4. Inhibiting Stereotypes a) We can consciously alter automatic stereotyping

E. II.

b) FRONTAL LOBES INVOLVED, so need much self-control Cooperation Can Reduce Prejudice 1. Superordinate Goals reduce hostility b/w groups by requiring them to cooperate How Do Attitudes Guide Behavior? Groups Influence Individual Behavior 1. Social Facilitation a) The presence of others enhances performance (bicyclists pedal faster when in a group) 2. Social Loafing a) When people work less hard in a group than individually (1) When people know their efforts cant be monitored, 3. Deindividuation a) People lose their individuality when they become part of a group -- happens when ppl are not selfaware and therefore are not paying attention to their personal standards b) More likely when aroused, anonymous and when responsibility is diffused c) i.e. stanford experiment d) not really self-aware 4. Group Decision Making a) Risky-shift effect - groups often make riskier decisions than individuals do. b) group polarization - when a group becomes more cautions as a result of some members c) When groups make decisions, they tend to assume the course of action that was initially favored by the majority of individuals in the group d) groupthink - groups tendency to think together can lead to a bad decision, just for the sake of making a decision together (1) Typically occurs under pressure We Conform to Others 1. Normative influence - when we go along w/crowd to avoid looking foolish 2. Informational influence - assume that behavior of crowd is the correct way to respond 3. auto-kinetic effect - when stationary light appears to move in totally dark environment 4. Social Norms a) social norms are expected standards of conduct b) Basic need to conform to social norms (a) will reject social norms depends on i) group size (small number of confederates ~ low conformity) ii) Lack of unanimity We Are Obedient to Authority 1. Milgram shock experiment a) Ordinary people can be coerced into obedience by insistent authorities Many Factors Can Influence Aggression 1. Biological Factors a) Amygdala, linked to aggression (1) Kluver-Bucy syndrome - behavior associated with damage to region b) Serotonin plays a role (low levels) (1) interferes with decision making in face of danger/social threat 2. Situational Factors a) Frustration-aggression hypothesis - the extent to which ppl feel frustrated predicts the likelihood that they will be aggressive (1) elicits negative emotions (cognitive-neossociationistic model)

III. How Do Others Influence Us?


A.

B.

C.

IV. When Do We Harm or Help Others?


A.

Social and Cultural Factors a) Culture of honor - men primed to protect reputations through physical aggression (1) i.e. men in southern US B. Steroids May Play a Role in Some Violent Behavior 1. Fuller case 2. Testosterone linked to aggression a) more likely related to social dominance though C. Many Factors Can Influence Helping Behavior 1. Prosocial behavior - act for the benefit of others 2. altruism - providing help when needed, without any apparent reward 3. HAMILTONS RULE OF KIN ALTRUISM/SELECTION --> maximize number of common genes that will survive into future generations 4. Reciprocal helping - one animal helps another because the other may return the favor in the future a) benefits must outweigh costs D. Some Situations Lead to Bystander Apathy 1. Bystander intervention effect - failure to offer help by those who observe someone in need a) Diffusion of responsibility (expect other bystanders to hep) b) People fear making social blunders in ambiguous situations c) Less likely to help if anonymous and can remain so d) Costs vs. Benefits

3.

V.

What Determines the Quality of Relationships?


A. Situational and Personal Factors Influence Friendships 1. Proximity - how often people come in contact. People like familiarity. Proximity promotes friendship 2. Neophobia - tendency of humans to fear anything novel 3. We tend to form friendships out of our own groups. We like ppl similar to us. Love is an Important Component of Romantic Relationships 1. Passionate love - state of intense longing and sexual desire. typical of early relationships 2. Compassionate love - strong commitment to care

B.