Categorical Classification

+

-Familiar and Conveinent

-Ease in Communication

-Consistent with clinical diagnosis

Categorical Classification

-

-low inter-rater reliablilty

-very high comorbidity

-high overlap among symptom criteria

-not based on a theoretical model

-ambiguity occurs regarding the presence vs. absence of Pds

-most commonly diagnosed PD is PD-NOS

-looks at a continuum of normal to abnormal psychology

-all individuals have some form of these traits, but people with PDs have it in maladaptive levels

Dimensional Model

+

-theoretical basis

-retention of information

-leads to less sterotyping

-adaptive traits are also highlighted

-flexible

-resolution of a variety of classification dilemmas

-avoids arbitrary assignment decisions

-addresses problems with comorbidity

-high inter- rater reliablity

DM

-

-less familiar

-lacks clinical application

-may be too complex

-disagreement exists about preference of which dimensional model to use

-more stable than Axis I

-etiologies can be the same as Axis I

-some PDs are treatable

-plays a large role in determining what is appropriate or acceptable at a given time and place

-culture differes in

-degree of emotional expression

-individualism vs. collectivism

-doesnt desire or enjoy close relationships

-prefers solitude

-takes pleasure in few things

-is indifferent to praise and criticism

-ideas of reference

-magicial thinking

-bodily illusions

-suspicious/paranoid thinking

-inappropriate affect

-lack of close friends

-soical anxiety

Schizotypal Prev Rate

-individuals with Schizotypal PD are susceptible to Schizophrenia, sometimes have a history of trauma and most often childhood maltreatment

-some have relatives with schizophrenia

-preoccuplied with fantasties

-associates only with high status individuals

- has a strong sense of entitlement

-is interpersonally exploitative

-is envious and thinks others are envious of them

CBT

-improve empathy and coping with criticism

-depression therapy also

-inappropriately seductive or provacative

-impressionistic style of speech

-suggestible and easily influenced by others and circumstances

-considers relationship to be more intimate than they are

behavior therapy to focus on interpersonal realtions

-has poor prognosis

-fears of abandonment

-sucidal gestures or self mutilation

-chronic feelings of emptiness

-stress related paranoid ideation or severe dissociative symptoms

69-75 BPD

4 population

14 college students

Why do people engage in parasucidal behavior?

- under CBT umbrella, with empahsis on zen and mediation

-marsha linehan for those with BPD and parasuicidal behavior

-multiple theraputic components

-deceptiveness of duplicity

-absence of empathy compassion or remorese towards the victims of the pschopaths explotative self interest

-can often be charming and appear sociall well adjusted

-may or may not engage in criminal behavior

-some overlap

-ASPD is in DSM

-psychoathy is personality traits nad ASPD is behaviors

-limited range of behavioral skilss

-engage in risky behaviors like drug addiction, can be drop outs, and have criminal record

Hypothesis 1: they can ignore the effects of punishment

Hypothesis 2: they have trouble shifting their attention

-avoids interpersonal job activities

-wont get involved with others

-is preoccupied with criticism and rejection

-view self as sociall inept personally unappealing or inferior to others

-wont try new things in cause they are embarassing

social phobia-> generalized social phobia -> APD

-has difficulty making everday and major decisions

-wont express disaggreement

-fails to initiate projects on own

-feels uncomfortable and helpless when alone

-urgently seeks another relationship when one ends

-preoccupied with rules, lists, detailes

-neglects faimly and firends because of devotion to work

-is overconsientious about rules ethics and values

-cannot discard worthless objects

-hoards money in case of disaster

-refuses to delegate tasks to others

-orgniate in childhood and become ingrained by early adulthood

- 10 -14 percent

-prognosis poor

heightened sensory perceptionsthat are not due to external stimuli

-experienced by 5 senses but the most common is auditory

-rigdly held beliefs that are inaccurate or inconsistent with how people experience reality

-5 types - persecutory, referential, grandiose, somatic relgious 

-can be bizzare or non bizzare

tangential speech ,very difficult to follow

conveys little meaning due to poor context maintence (world salad)

-in attention

-working memory

-executive funcitioning

Prodromal

Active

Residual

Must have impairment in function in two or more of the following

-delusions, diorganized speech grossly disorganizedd or catanoic behaviors, hallucinations, negative symptoms

-mood disorders with psychotic symptoms

-schizoaffective disorder

-schizophreniform disorder

-brief pscyhotic disorder

-delusion disorder

Schizophrenia with mood symptoms

(Schizoprhenia vs. mood disorders with psychotic symptoms)

Mood Disorder wtih psychotic symptoms

(Schizoprhenia vs. mood disorders with psychotic symptoms)

Schizophrenia with mood symptoms

(Schizophrenia vs. Schizoaffective Disorder)

Schizoaffective Disorder

(Schizophrenia vs. Schizoaffective Disorder)

-mood symptoms must be present for a substanial portion of the psychotic disturbance

-delusions and hallucinations must be present for at least 2 weeks without prominent mood symptoms

-non - bizaree delusions are the prominet psychotic symptom

-other schiozphrenic symptoms such as hallucinations disorganized speech and negative symptoms are largely absent

1/3 improve

1/3 stay the same or relapse

1/3 have significatn chronic distress

Rarely engage in violent behaviors

- much more likely to be a victum

-family factors

-low ses

is there a genetic influnce in Schizo??

How do we know?

-low number of dopamine receptors in frontal lobe can hint at Schizo

-also increased production of Schizo

-more tolerant

-low levels of EE

-importance of community giving roles

--higher expectations of people with schizo in society

-target dopamine receptorms (Thorazine)

-work well with positive symptoms (75% of patients)

-side effects

-extrapyramidal symptoms

-tarditive Dsykensia

Better at treating negative symptoms

-Risperdal, Zprexa, Seroquet

- side effects (Clozapine has 1 % chance of lethan blood condition)

-affect other neurotrasmitters like serotonin and norepinphrine

-relapse rates are high if medication stops some relapse even ifthey continue to use medication

-long term stategies to improve quality of life

-improves social competence, housing stability, employment etc

-cant remove pscyhotic symptoms

-family therapy

-social skills training

-vocational rehabilitation

-assertive community treatment

-most effective if family is high in EE

-family coping skills

-eliminating unrealistic expectations

-improving communication and problem solving

-Team works together to meet needs

-psychiartists, nurses, social workers, vocational counselors, recreational counselors

-good outcomes

-Goals- decrease conviction of delusional beliefs

-promote more effective coping stratgies

-reduce distress

-highlight imprtance of taking medication

-teaches skills to challenge and modify behaviors

-effectivness - supeiror to control contition in clinical settings, significantly decreases positive symptoms, 6 month followup have continued improvement

-elimination of food

-self induced vomiting

-laxative diuretics, enemias

-pscyhopathy and famillial dsyfunction

MOST COMMON

Bulimia Nervosa Non-purging characteristics

-fasting

-excessive exercise

LESS COMMON

-self esteem weight, diet, apperance

-sensitive to others comments

-depression

-anxiety disorders

-BPD

-substance abuse

-refusal to maintain a normal body weight

-fear of weight gain

-amenorrhea

-distorted body shape and image

-women rate themselves heavier than they actually are

-men perfer a larger women

-most men they they are more muscular then they actually are

-self evaluation,body weight influence

-deny problems with weight

-pride in ability to restrict

-OCD OCPD, depression

-limit amount of food

-rarely or never binge

-eat or purge

EQUALLY COMMON

-regular binge eating and purging

EQUALLY COMMON

Onset of Eating disorders

Why?

-late teen and early adulthood

-because of hormonal changes

-autonomy struggles

-sexuality problems

-reaction to normal changes in weight

- less body dissatisfactions, fewer weight concers, positive self image

-they think they are thinner then they are

23 MZ

9 DZ

-CBT to interrupt bheavior

-cues for behavior are identified

-nutritional ed

-monitor eating (self) 3 to 4 meals a day

-coping with expected relapse

-situational relapse is identified

-high risk exposure

-weight gain

-inpatient forced feeding

-address difficulties

-theraputic alliance is a challenge

-defensive

-health prof a threat

-psychological apects

-defuse unproductive blaming and form mutual support

-changes in family function

legal to illegal drugs also perscription

-more than 1 drug is not unsual

-functional impairment

-harmful results without tolerance withdrawal compulsive drug use

12 months

1 or more significant impairments

in

role obligations

hazardous situations

legal problems

social or occupational problems

-take pscyhoactive substance to allieviate negative moods and avoiding withdrawal

for public speaking ro writing

12 m 3 or more

-somtimes tolerane and withdrawl

-larger amounts longer periods of time

failer efforts to reuce use

-time sepnt to recover and recover from effects

-social or occupational activities given up

-know consequences but still continue to use

-level of impariment of SD is much more sever

-Type 1 later onset with absence of criminal behavior

Type 2 early onset with presence of criminal behavior

-culture and religion

-initial experimentaion

-parent who encourage use

unpleasant enviromnets

-low parental mointoring

-most do not seek treatment because they do not think they have a problem

-compliance with low dropout in highschool

-comorbid with personality disorders so it makes it hard

-all treatments are equally efective

-abstinence vs. moderation

-relapse is not uncommon

-12 step program works well (AA)

if individuals have a lot of social support, coping resources, and stress situations

-substance abuse opposite of CBT, non confrontational procedure

-goal to get client ot recognize what their long term goals are and current behavior

typical symptom with trauma

-persistent rembering of the stressor through intrusive flashbakcs and vivid memories or recurring dreams

-experiencing distress when reminded of the distressing images or thoughts of the incident

-symptom with trauma

-avoidance of thoughts, feelings, activities conversations places or people associated with the stressor

-inability to recall, diminished interest, detachment from others, restricted affect, sense of foreshortened future

-associated with trauma

-sleep disturbance, irritability

-exaggerated startle response

-associated with trauma

-disruption of normally integrated mental processes involved in memory, consciousness, identity, or perception

-depersonalization, derealization and dissociative amnesia

ASD and PTSD are different from most disorders because...

-exposure to a traumatic event

-reexperiencing trauma

-anxiety or increased arousal

-avoidance of reminders of trauma

-dissociative symptoms

-symptoms occur within 4 weeks of exposure to event

-exposure to traumatic event

-reexperiencing trauma

-anxiety or increased arousal

-avoidant and numbing

-signicant distress/impairment

-symptom during is great than a month

15 percent currently have PTSD

30 lifetime prev

-personality disorders

-psychiatric disordrs

-lack of social support

-cognitive abiliity

-social history

-nature of traumatic event

-step one is classical conditioning

step two is operant condition

- no drugs

-antidepressants and anticonvulsants provide symptom relief, which goes away after stopping medication

-eye movement desensitization and reprocessing

-controversial

-exposure with rapid eye movements

-traumatic scene and focus on thoughts and feelings

-follow the herapists moving fingers with their eyes as they associate positive thoughts with the traumatic scene

-establishing a trusting therpeutic relationship

-educationg clients abou the process of coping with trauma

-stress manegment training

-enocouring clients to reexperience and integrate the traumatic vent into their lies nd self schemas

-dissociative fugue

-dissociative amnesia

-depersonalization disorder

true

due to under diagnosis

irotogensis

more prone

-no gentic component

-crietiera rule out those caused by biological factors

-both abusive and loving

-disorganized attachment

-role of trauma

-state dependent thinking

-antidepresseant and anti anxiety medications reduce distress not symptoms

-intergration of different personalities and memories as a whole persona

-no scientific research about how this is done