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Documenti di Cultura
Delusional Disorder
Bizarre delusions for at least one month
No full blown schizophrenia
Apart from the delusions, the individuals functioning in not markedly impaired
Delusions - examples
I am the son of George W Bush
and a Somali woman. They were on holiday there and left
me behind.
grandeur
persecution
ABNORMAL PSYCHOLOGY
DESCRIBE DIAGNOSTIC CRITERIA
EXPLAIN - MODELS
TREATMENT MODALITIES
PREDICT - PROGNOSIS
Psychopathology
Pathos - suffering
Disease - impairment
Abnormal - deviation
Danger
Affective symptoms
Behavioral symptoms
Cognitive symptoms
Somatic symptoms
Psychopathology
Sources
Somatogenic
Psychogenic
SSS
SIGNS
SYMPTOMS
SYNDROME
M&M
21
Etiology: Origin
Cognitive factors
Judgments of perceived threat
Personality
Neuroticism
Stressa precipitator
MODELS
BIOMEDICAL
GENETICS
NERVOUS SYSTEM BRAIN
BODY CHEMICALS
Cerebral Cortex
HPA Axis
Limbic system
PSYCHODYNAMIC VIEW
ANAL RETENTIVE
ANAL EXPULSIVE
BEHAVIORAL VIEW
MALADAPTIVE LEARNING
FAULTY HABITS
DIATHESIS-STRESS MODEL
Cognitive Models:
Important People:
Carl Rogers, Abraham Maslow (Humanistic)
Rollo May, Irving Yalom, Victor Frankl
(Existential)
Sociocultural Model
Abnormalities can be influenced by social experiences
and cultural values
Important People:
BIOPSYCHOSOCIAL MODEL
34
Clinical disorders
Axis II
Personality disorders
and Mental retardation
Axis III
General medical
conditions
Axis IV
Psychosocial and
environmental
problems
Axis V
Global assessment of
functioning
PREDISPOSING VS.
PRECIPITATING
DETERMINANTS
1.Biological Determinants
a. Predisposing hereditary
*Factor (genes)
*Body Constitution
* Body chemicals
b.Precipitating
*Accident
*Virus/Bacteria (disease) or
Neurotoxins
2. Psychological Determinants
a.Predisposing psychological
factors
Examples:
b.Precipitating factors
FRUSTRATION
STRESS
DEFENSE MECHANISM
3. Socio-cultural Determinants
a. Precipitating factor
WAR
UNEMPLOYMENT
POVERTY
RESIDENTIAL MOBILITY
RURAL AND URBAN
DSM-IV-TR
DSM-5
Intellectual
disability
(intellectual
developmental
disorder
Limited understanding of
risk situations
MODERETE
SEVERE
PROFOUND
Understands simple
instructions and gestures
COMMUNICATION DISORDERS
DILA CO
DIfficulties In LAnguage,
Communication (SPEECH)
Pyromania
The impulse to set fires for no reason
Treatment
Case Study
Carol, a 16 year old, could not control pulling her hair, including her scalp,
eyebrows and eyelashes
Felt an itch in her hair and proceeded to pull it to get relief
Results
Achieved moderate success with cognitive behavioral
treatment in weeks 3-4
Used to pull hair 10-15 times a night, and now does it
only 5-6 times
In weeks 5-9, Carol used numbing topical cream (could
only apply to eyebrows). She stopped pulling her
eyebrows, and was pleased, but still continued to pull
her eyelashes 2-3 times a month
Four month follow-up Carol did not continue to pull her
eyebrows anymore, but still was pulling her eyelashes
Scientific Study
A study conducted by Marc N. Potenza, MD, PhD, of Yale
University and colleagues showed that pathological gamblers
have decreased activeness in brain areas
Two groups were used: Pathological gamblers (10) and
participants without PG (11)
They used functional magnetic resonance imaging on participants
while they viewed videos of happy, sad and gambling occasions
Case 2
Eating Disorders:
Eating Disorders:
Look in the mirror. What do you see? Is it the real you or just another
"me"?
Anorexia Nervosa:
Bulimia Nervosa
Bulimia Nervosa is an
eating disorder in which
one starts to consume
large amounts of food at
once and then is followed
by purging, using laxatives,
or overexercising to rid
themselves of the food
they ate.
Factors to consider
Psychological
Interpersonal
Social/Cultural
Biological
Psychological factors
Low self-esteem
Feelings of inadequacy or failure
Interpersonal Factors
Troubled family and personal relationships
Difficulty expressing emotions and feelings
History of being teased or ridiculed based on size or weight
History of physical or sexual abuse
Biological Factors
Eating disorders often run in families (learn coping skills and
attitudes in family)
Genetic componentresearch about brain and eating in
taking place (certain chemicals in the brain control hunger,
appetite and digestion have been found unbalanced).
LANGUAGE DISORDER
Vocabulary, comprehension,
sentence structure
CHILDHOOD-ONSET FLUENCY
DISORDER (STUTTERING)
SOCIAL (PRAGMATIC)
COMMUNICATION DISORDER
ASD
Deficit in nonverbal
communication, conversation,
relationships
ASD
Autism is a neurodevelopmental
disorder characterized by
impaired communication, social
interaction, and repetitive
behaviors.
ADHD
Symptoms: Impulsiveness
Symptoms: Hyperactivity
Restlessness,
Often characterized by an inability to sit
still,
Fidgeting,
Climbing on things,
Restless sleep
Symptoms: Inattention
Easily distracted,
Day-dreaming,
Not finishing work,
Difficulty listening
Motor clumsiness
Repeated, Persistent,
Negative and
Hypervigilant
91
Sexual assault
92
PART 2
Vincent
van Gogh
TROUBLED GENIUS ?
Scary guy?
EXTREME
SUBCULTURE
Celebrity Excess:
Britney Spears
STRESS OVERLOAD?
Celebrity Excess:
Charlie Sheen
NARCISSISTIC
RELIGIOUS EXTREMIST
DSM5 Disorders
12 Sleepwake disorders
13 Sexual dysfunctions
14 Gender dysphoria
15 Disruptive, impulse-control, and conduct disorders
16 Substance-related and addictive disorders
17 Neurocognitive disorders
18 Personality disorders
19 Paraphilic disorders
20 Other Mental Disorders
21 Medication-Induced Movement Disorders and Other Adverse Effects of
Medication
22 Other Conditions That May Be a Focus of Clinical Attention
Panic Disorder: Im
Dying
A panic attack is not just an anxiety
attack. It may include:
many minutes of intense dread or
terror.
chest pains, choking, numbness, or
other frightening physical sensations.
Patients may feel certain that its a
heart attack.
a feeling of a need to escape.
Panic disorder refers to repeated and
unexpected panic attacks, as well as a
fear of the next attack, and a change in
behavior to avoid panic attacks.
Specific Phobia
A specific phobia is more than just a
strong fear or dislike. A specific phobia is
diagnosed when there is an
uncontrollable, irrational, intense
desire to avoid the some object or
situation. Even an image of the object
can trigger a reaction--GET IT AWAY
FROM ME!!!--the uncontrollable,
irrational, intense desire to avoid the
object of the phobia.
Specific Phobias
Unreasonable or irrational fears of specific objects or situations
Categories according to DSM-5
Animal type
Natural environment type
Situational type
Blood-injection-injury type
111
Agoraphobia
People fear:
Places where they might have trouble escaping or getting help if they
become anxious
That they will embarrass themselves if others notice their symptoms or
efforts to escape
113
Theories of Phobias
Behavioral
Negative reinforcement: Reduction of Anxiety reinforced by the avoidance
of the feared object
Prepared classical conditioning: Conditioning of fear to certain objects or
situations
Biological
Related people share phobias
114
Treatment of Phobias
Behavioral treatments
Use exposure to extinguish the persons fear of the object or situation
Systematic desensitization
Modeling
Flooding
115
116
117
Mindfulness-based interventions
118
Panic Disorder
Occurrences of panic attack become common without being
provoked
Panic attacks: Short but intense periods during which people experience
many symptoms of anxiety
People begin to worry about having these attacks and change behaviors as a
result of this worry
119
Psychodynamic/
Freudian: repressed
impulses
Observational
learning: worrying
like mom
Classical
conditioning:
overgeneralizing a
conditioned response
Cognitive appraisals:
uncertainty is danger
Operant conditioning:
rewarding avoidance
Evolutionary:
surviving by avoiding
danger
Mood Disorders
Major depressive disorder [MDD] is:
more than just feeling down.
more than just feeling sad about
something.
What is Mania?
High Self-Esteem
Euphoria
High Energy
No Sleep
Extravagant Plans
Optimism
Hyperactive
Rapid Talking
Impaired Judgment
Excessive Gambling
Excessive Spending
Sexually Reckless
Excessive Drug and Alcohol Use
Depression: LEWIS
Lethargic
Excessive (sleep/eat)
Withdrawn
Inability to think clearly
Suicidal thoughts
Inflated ego
Excessive talking
Shopping sprees
Fearlessness
Too much sleep
Genetics:
Strong evidence
There is a huge difference
between the concordance rates
between identical and fraternal
twins.
So.. There may be some
predisposition here with
environmental factors
precipitating the symptoms.
Neuro-chemical:
Abnormal levels of
norepinephrine and
serotonin. (low and high
levels)
This may be hereditary
Drug therapy is very effective
Bipolar Disorder
Bipolar disorder was once called manic-depressive
disorder.
Bipolar disorders two polar opposite moods are
depression and mania.
Contrasting Symptoms
Depressed mood: stuck feeling down, Mania: euphoric, giddy, easily irritated,
with:
with:
exaggerated pessimism
exaggerated optimism
social withdrawal
hypersociality and sexuality
lack of felt pleasure
delight in everything
inactivity and no initiative
impulsivity and overactivity
difficulty focusing
racing thoughts; the mind wont settle
fatigue and excessive desire to sleep
down
little desire for sleep
1.
a.
b.
c.
d.
b. Dopamine.
c. Betacarotine.
d. Acetylcholine.
b. Norepinephrine.
c. Dopamine.
d. Acetylcholine.
b. Become homeless.
c. Inability to hold down a job.
d. All of the above.
b. Misperceptions
c. Delusions
d. Avolition.
b. Delusions of persecution.
c. Delusions of control.
d. Nihilistic delusions.
b. Delusions of control
c. Delusions of reference
d. Nihilistic delusions
b. Nihilistic delusions.
c. Delusions of reference.
d. Delusions of persecution.
b. Olfactory
c. Gustatory
d. All of the above
Evolutionary
Genetic
Brain /Body
Interpersonal:
Misery
you insist that the weight of the
world
should be on your shoulders
Misery
there's much more to life than what
you see
my friend of misery
Genetics
Evidence of genetic influence on depression:
1. DNA linkage analysis reveals depressed gene regions
2. twin/adoption heritability studies
Low Self-Esteem
Depression is
associated with:
Rumination
Depressive
Explanatory
Style
Stuck focusing on whats bad
167
168
169
170
172
173
Biological treatments
Benzodiazepine drugs
Tricyclic antidepressant imipramine and the selective serotonin reuptake
inhibitor paroxetine
174
175
176
177
Obsessive-Compulsive Disorder
Obsessions: Thoughts, images, ideas, or impulses that are
persistent
Uncontrollably intrude upon consciousness
Cause significant anxiety or distress
Obsessive-Compulsive Disorder
Common type of obsession in OCD
Thoughts and images associated with aggression, sexuality, and/or religion
Symmetry and ordering
Contamination and a cleaning compulsion
179
Obsessive-Compulsive Disorder
Hair-pulling disorder
Recurrent pulling out of hair resulting in noticeable hair loss
Called trichotillomania
Skin-picking disorder
180
181
182
Cognitive-behavioral treatments
Exposure and response prevention: Exposes the client to the focus of the
obsession, preventing compulsive responses to the resulting anxiety
Challenges individuals moralistic thoughts, excessive sense of
responsibility, and maladaptive cognitions
183
184
3rd Day:
Topics:
Schizophrenia
Dissociative Disorders
Personality Disorders
Neurocognitive Disorders
Gender Dysphoria
Drills
Lets Recall
Anxiety Disorders
Agoraphobia Ayoko ng masikip! (thinking the escaping might be
difficult)
GAD Kahit Ano, Kahit Sino! free-floating anxiety (6 months
duration)
OCD:
BOTHER
OCD
Trichotillomania Buhok ko Yan! (recurrent pulling out of ones
hair)
Hoarding Disorder Ipon Ko To! (difficulty discarding with
possessions)
Excoriation Balat Ko Yan! (recurrent skin picking resulting to skin
lesions)
Related Disorder: Body Dysmorphic-like with actual flaws.
DEPRESSIVE DISORDERS
DISRUPTIVE MOOD DYSREGULATION DISORDER: Grrrr! Severe
recurrent temper outbursts manifested verbally.
Eating
Disorders
Anorexia nervosa
Bulimia nervosa
Binge-eating disorder
Definition
Anorexia Nervosa
Bulimia Nervosa
Binge-Eating Disorder
Neurodevelopmental Disorders
Intellectual disability: Deficits in intellectual functions
Communication Disorders:
Neurodevelopmental Disorders
Communication Disorders:
Social (Pragmatic) Communication Disorder difficulty
understanding social cues.
Autism Spectrum Disorder repetitive patterns of behavior and
deficit in social interaction across multiple contexts.
ADHD persistent inattention and/or hyperactivity-impulsivity
that interferes with functioning and development.
Specific Learning Disorder- difficulties learning and using
academic skills
Neurodevelopmental Disorders
Communication Disorders:
b. Low self-esteem
c. High levels of depression
d. All of the above
30. In animal research, lesions to which part of the brain have been
shown to cause appetite loss, resulting in a self-starvation
syndrome?
a. Lateral hypothalamus
b. Cerebrum
c. Amygdala
d. Basal ganglia
b. Low self-esteem
c. High levels of responsibility
d. Narcissism
b. Narcissism
c. Extraversion
d. Introversion
Schizophrenia:
Psychosis refers to a
mental split from
reality and rationality.
Introduction: SCHIZOPHRENIA
Schizophrenia translates to
split mind.
This is not to be confused
with split personality.
Schizophrenia
History
Emil Kraepelin: Dementia praecox
Eugen Bleuler: He renamed Kraepelins
dementia praecox as schizophrenia (1911);
splitting of mind.
Schizophrenia
About 1% of people are diagnosed with
schizophrenia.
Symptoms of Schizophrenia:
1.Disorganized thinking.
2.Disturbed Perceptions.
3.Inappropriate Emotions and Actions.
4.Deterioration of Adaptive Behaviors.
The thinking is
fragmented, bizarre,
and cannot filter out
information.
Distorted Perception:
Hallucinations are the most common.
seeing other people, smells
These voices often make rude comments or
can even be in the form of a running
commentary on their lives.
Disturbed Emotions:
Some patients show a
flattening of emotions no
response
Others show inappropriate
emotional responses these
may not fit with the situation
or with what they are saying.
They may also become
emotionally volatile. (erratic
or unpredictable)
1.
2.
3.
4.
Hallucinations
Distortion of perception
Delusion
Illusion
Positive Symptoms
Presence of inappropriate symptoms
Negative Symptoms
Absence of appropriate ones.
Negative absence of
healthy
behaviors
Delusional thinking
Incoherent speech
3.
4.
5.
Hyper-excitability
Hearing voices
Flat affect
Types of Schizophrenia
Paranoid Schizophrenia
Paranoid Schizophrenia:
Believe they have many
enemies who will harass and
oppress them.
They become suspicious of
friends and family. (being
watched)
Catatonic Schizophrenia:
People with catatonic
schizophrenia display extreme
inactivity or activity that's
disconnected from their
environment or encounters with
other people (catatonic
behavior).
These episodes can last for only
minutes or up to hours.
Catatonic Schizophrenia
Flat emotion.
Waxy flexibility.
Little movement, activity
or speech.
Negativism (resistance to
instructions)
Mutism & Stupor (lack of
verbal and motor
responses)
Catatonic Schizophrenia
Excessive mobility
(excitement), Physical
immobility (stupor)
peculiar movements,
mimicking speech
/movements(echolalia,
and echopraxia)
Disorganized Schizophrenia
Disorganized speech or behavior, or flat or
inappropriate emotion.
Clang associations: speaking in rhyme.
Im the worst
systematic, sympathetic
quite pathetic, apologetic, paramedic.
Word salad: nonsense talk.
Its all over for a squab true tray and there aint
no music. Ive got to travel all the time to keep
my energy alive.
Disorganized Schizophrenia:
Describes a severe deterioration of
adaptive behavior.
Person may become emotionless social
withdrawal.
Undifferentiated Schizophrenia
Many varied symptoms.
"Undifferentiated
schizophrenia" is used as a label
for cases of schizophrenia that
don't match any of the
established types of
schizophrenia.
Undifferentiated Schizophrenia:
This is very common because
many schizophrenics display
multiple types of
schizophrenia.
Residual Schizophrenia
This subtype is diagnosed when the
patient no longer displays prominent
positive symptoms (i.e. hallucinations).
The person does show some negative
symptoms like speaking little or being
apathetic.
Phases of Schizophrenia
Acute/Reactive Schizophrenia In reaction to stress, some people develop positive
symptoms such as hallucinations.
Recovery is likely.
Predicting Schizophrenia:
Early Warning Signs
Social/psychological factors
which tend to appear before
the onset of schizophrenia:
Genetics
Understanding Schizophrenia
Whats going on in the
brain in schizophrenia?
Understanding Schizophrenia
Are there biological risk factors
affecting early development?
Environmental Factors:
Stress can bring out schizophrenic symptoms such as
delusions and hallucinations
Schizophrenia more often surfaces when the body is
undergoing hormonal and physical changes, such as those
that occur during the teen and young adult years.
Schizophrenics cant
shift attention to other
criterion
Subtypes of Schizophrenia
Paranoid
Plagued by hallucinations, often with negative messages, and
delusions, both grandiose and persecutory
Disorganized
Primary symptoms are flat affect, incoherent speech, and random
behavior
Catatonic
Rarely initiating or controlling movement; copies others speech
and actions
Undifferentiated
Many varied symptoms
Residual
Withdrawal continues after positive symptoms have disappeared
Other Disorders
Dissociative
Disorders
Personality
Disorders
Dissociative Disorders
Disorders in which the
sense of self has become
separated (dissociated)
from previous memories,
thoughts, or feelings.
Dissociative
Disorders
Examples:
Dissociative
Amnesia:
Dissociative
Fugue
Running away state; wandering away from ones life, memory, and
identity, with no memory of these
Dissociative
Identity
Disorder
(D.I.D.)
Dissociative Amnesia
Dissociative Fugue
Dissociative Identity Disorder
Localized Amnesia:
Localized amnesia is present in an individual
who has no memory of specific events that
took place, usually traumatic.
Example: a survivor of a car wreck who has
no memory of the experience until two days
later is experiencing localized amnesia.
Selective Amnesia:
Selective amnesia happens when a person
can recall only small parts of events that took
place in a defined period of time.
Example: An abuse victim may recall only
some parts of the series of events around the
abuse.
Generalized Amnesia:
Generalized amnesia is diagnosed when a
person's amnesia encompasses his or her
entire life.
Example: I dont know who I am.
Systematized amnesia
Systematized amnesia is
characterized by a loss of
memory for a specific
category of information.
Example: A person with this
disorder might be missing all
memories about one specific
family member.
Organic Amnesia
(not a dissociative disorder)
Results from other medical trauma (e.g. a blow to the head, stroke,
alcoholism).
Dissociative Fugue
A form of dissociative amnesia characterized by physical
relocation and the assumption of a new identity with amnesia
for the previous identity. (Traveling amnesia).
These journeys can last hours, even several days, months or years.
Conditions:
Four conditions for diagnosis:
Presence of two or more distinct
personalities
At least two take control of persons
behavior
Inability to recall important
personal information
Not related to drugs or medical
condition
Causes:
Little is known
Stress
Intentional role playing (stemming from
inferiority)
Media reinforcement (Before Sybil, 1973 (2
or 3 alters, now 15 or more)
Most common cause: Severe physical,
sexual, emotional abuse, or rejection
(usually during childhood)
More likely to occur in females
Controversy:
Controversy
Only 200 cases before 1970
Now may run as high as 5% of inpatient
hospital admissions
- Some Psychologists think this is becoming
a cultural phenomenon
Somatoform Disorders
Disorders in which symptoms take a bodily
form without apparent physical cause.
Two types
Hypochondriasis
Characterized by imagined
symptoms of illness.
They usually believe that
the minor issues
(headache, upset stomach)
are indicative of more
severe illnesses.
Hypochrondriasis:
Hypochrondriasis - Patient
unrealistically interprets physical
signs such as pain, lumps, and
irritations as evidence of
serious illness.
Headache = brain tumor
They show excessive anxiety
about one or two symptoms.
Conversion Disorder
Loss or impairment of
some motor or sensory
function due to a
psychological conflict
or stress.
Formerly known as
hysteria.
Sigmund Freud
Conversion Disorder:
Patient will lose control of bodily
functions such as: becoming blind,
deaf, or paralyzed.
Anxiety will bring on these
symptoms.
THE FINALE!!!!!
PSYCHOPATHOLOGY
DR. JOSEPH C. FRANCISCO, RP, RPm
Personality Disorders
Personality
Disorders
Personality Disorders:
Personality disorder person has
longstanding, maladaptive thought and
behavior patterns that are troublesome to
others, harmful, or illegal.
Key Fact these patterns may impair a
persons social functioning BUT they usually
do not create anxiety, depression, or
delusions.
Paranoid Unwarranted
suspiciousness and mistrust,
overly sensitive, often envious
Schizoid Shy, withdrawn
behavior, poor capacity for
forming social relationships
Schizotypal Odd thinking, often
suspicious and hostile
adulthood:
criminal behaviour
little adherence to societal norms,
little anxiety
conflicts with others
callous/exploitive
Psychopathy
Egocentric, deceitful, shallow, impulsive individuals who use and
manipulate others
Callous, lack of empathy
Little remorse
Thrill-seeking
human predators (Hare, 1993)
No conscience
Deceitfulness
Disregard for safety of self or others
Aggressiveness
Failure to conform to social norms
Lack of remorse
Impulsivity and failure to plan ahead
Irritability
Irresponsibility regarding jobs, family, and
money
Antisocial PD Criminality
Criminals: people
who repeatedly
commit crimes
People with
antisocial
personality
disorder
Obsessive-Compulsive
Personality Disorder
excessive control and perfectionism
inflexible
preoccupied with trivial details
judgmental/moralistic
workaholic/ignore family members
often humourless
b. Contaminated dopamine
c. Excess dopamine activity
d. Allergic sensitivity to dopamine
b. Intelligence
c. Self-esteem
d. Sense of self
b. Antisocial PD
c. Paranoid PD
d. Schizotypal PD
b. Feelings of inadequacy
c. Hypersensitivity to negative evaluation
d. All of the above
b. Feelings of shame
c. Feelings of guilt
d. Feelings of superiority
NeuroCognitive Disorders
Neurocognitive disorders
Dementia:
REALIZE
386
387
Being right doesnt necessarily translate into
a good outcome for both of you
388
Its the relationship that is MOST critical
NOT the outcome of any one encounter
389
As part of the disease people with dementia
tend to develop typical patterns of speech,
behavior, and routines.
These people will also have skills and abilities
that are lost while others are retained or
preserved.
What is it NOT
NOT Normal Aging
NORMAL Aging
Slower to think
Slower to do
Hesitates more
More likely to look before you leap
Know the person but not the name
Pause to find words
Reminded of the past
390
391
DEMENTIA
Alzheimers
Disease
Early - Young Onset
Normal Onset
Vascular
Dementias
(Multi-infarct)
Lewy Body
Dementia
FrontoTemporal Lobe
Dementias
Other Dementias
Genetic syndromes
Metabolic pxs
ETOH related
Drugs/toxin exposure
White matter diseases
Mass effects
Depression(?) or Other Mental
conditions
Infections BBB cross
Parkinsons
Delirium
Disturbance in attention (hours to a few days)
Memory deficit, disorientation, language
Specify whether:
Substance intoxication delirium
Substance withdrawal delirium
Medication-induced delirium
Alzheimers
396
Vascular Dementia
Sudden changes
Can have bounce back & bad days
Judgment and behavior not the same
Spotty losses
Emotional & energy shifts
397
398
Fronto-Temporal Dementias
Many types
Frontal impulse and behavior control loss
Says unexpected, rude, mean, odd things to others
Dis-inhibited food, drink, sex, emotions, actions
Temporal language loss
Cant speak or get words out
Cant understand what is said, sound fluent nonsense words
399
What is Dementia?...
It is BOTH
So
Sometimes they can & sometimes they cant
400
401
402
403
Learning & Memory
Center
Hippocampus
BIG CHANGE
404
405
Sensory Strip
Motor Strip
White Matter Connections
BIG CHANGES
Automatic Speech
Rhythm Music
Expletives
PRESERVED
Formal Speech & Language
Center
HUGE CHANGES
407
Executive Control
Center
Emotions Behavior
Judgment
Reasoning
408
Early
Alzheimers
Late
Alzheimers
Child
409
So What is Dementia?
It
It
It
It
It
It
410
415
Build activities
Get active
Socialize
De-Stress
Get enough sleep
Get sleep apnea & depression treated
Control blood pressure & diabetes
Take meds CAREFULLY
417
Care Partners
419
420
Deinstitutionalization:
Serious overcrowding became a problem in the 1950s (neglect)
With creation of better meds, less hostile patients were placed
back in regular communities.
Treatment Approaches:
No approach is ideal
Psychoanalysis
Behavioral
Humanistic
Cognitive
Biological
Psychoanalysis Terms:
Old terms:
Free association, manifest content, latent content, Hypnosis
New terms:
Resistance Blocking of anxiety-provoking feelings, coming
late for sessions (problem)
Transference Client learns to see therapist as significant
person in their life (open up)
Catharsis The release of emotional tension after reliving an
emotionally charged experience from the past.
Behavioral Terms:
Old terms:
Behavioral therapy, systematic desensitization, flooding, token economy,
primary/secondary reinforcers, behavior modification, aversive
conditioning
New terms:
Anxiety hierarchy Create a hierarchy of fears from least feared to
most (start small and work up)
Social skills training Treat patients using modeling, rehearsal, and
shaping
Biofeedback Giving immediate physiological feedback when treating a
patient this can lesson arousal (heart rate, blood pressure)
Cognitive Approach:
New Terms:
Cognitive restructuring Turning the distorted thoughts
into more realistic thoughts
Rational emotive therapy aims at eliminating selfdefeating thoughts. (Albert Ellis)
Cognitive triad Looks at what a person thinks about his
self / world / future (Aaron Beck)
Biological Terms:
Old Terms:
Tolerance, stimulants
New Terms:
Psycho pharmacotherapy The use of psychotropic to treat
mental disorders
Electroconvulsive shock treatment is given to treat mental
disorders (shocks impaired region of the brain to get it to
work more or less efficiently)
Psychosurgery the removal of brain tissue
Gender Dysphoria
Introduction..
Gender Dysphoria...
Gender Dysphoria...
Sex
Gender
identity
Gender
role
Whether someone
Environmental ..
Social learning theory (SLT) could also play
a part with an absence of or inappropriate
role models to imitate.
(nurture)
By the way ..
Transvestites are content with their gender identity but enjoy the fantasy
of pretending to be a member of the opposite sex.
Biological Explanations
Substance Related
Disorders
Substance Abuse & Substance Dependence
Inhalants
Nicotine
Opioids
Phencyclidine
Sedatives, hypnotics, or
anxiolytics
Polysubstance
Introduction
Two primary groups:
Substance-use disorders (primarily dependence
and abuse)
Substance-induced disorders (intoxication,
withdrawal, and mental health consequences
of abuse)
Clinical syndromes
Substance dependence: a maladaptive pattern
of substance use that has led to clinically
significant impairment or distress.
The diagnosis is based on having at least three
symptoms occurring at any time during the same
12 month period.
Clinical syndromes
Tolerance (physiological)
Withdrawal (physiological)
Loss of control (psychological)
Cravings
Time spent around substance activity
Preoccupation
Continuation of usage.
Clinical syndromes
Substance abuse includes at least one of the following
symptoms:
Stress
Insomnia
Anxiety
Depression
Acute psychotic states
Impaired cognition
Violent behavior
Social Problems
Marital and family problems
Legal difficulties
Loss of employment
Financial deterioration
Suicide risk is frequently present in a substance abusing
client particularly as health and psychosocial deterioration is
present.
Careful screening for self-destructive thoughts and/or
impulses is imperative with this population.
b. Contaminated dopamine
c. Excess dopamine activity
d. Allergic sensitivity to dopamine
b. Intelligence
c. Self-esteem
d. Sense of self
b. Antisocial PD
c. Paranoid PD
d. Schizotypal PD
b. Feelings of inadequacy
c. Hypersensitivity to negative evaluation
d. All of the above
b. Feelings of shame
c. Feelings of guilt
d. Feelings of superiority
NeuroCognitive Disorders
Neurocognitive disorders
Dementia:
REALIZE
497
498
Being right doesnt necessarily translate into
a good outcome for both of you
499
Its the relationship that is MOST critical
NOT the outcome of any one encounter
500
As part of the disease people with dementia
tend to develop typical patterns of speech,
behavior, and routines.
These people will also have skills and abilities
that are lost while others are retained or
preserved.
What is it NOT
NOT Normal Aging
NORMAL Aging
Slower to think
Slower to do
Pause to find words
Reminded of the past
501
Delirium
Disturbance in attention (hours to a few days)
Memory deficit, disorientation, language
Specify whether:
Substance - induced delirium
Medication-induced delirium
Alzheimers
New information lost
Recent memory worse
Problems finding words
Mis-speaks
More impulsive or indecisive
Gets lost
Notice changes over 6 months 1 year
505
Vascular Dementia
506
507
Fronto-Temporal Dementias
Many types
Frontal impulse and behavior control loss
Says unexpected, rude, mean, odd things to others
Temporal language loss
Cant speak or get words out
Cant understand what is said, sound fluent nonsense words
508
What is Dementia?...
It is BOTH
So
Sometimes they can & sometimes they cant
509
510
511
Learning & Memory
Center
Hippocampus
BIG CHANGE
512
Sensory Strip
Motor Strip
White Matter Connections
BIG CHANGES
Automatic Speech
Rhythm Music
Expletives
PRESERVED
Formal Speech & Language
Center
HUGE CHANGES
514
Executive Control
Center
Emotions Behavior
Judgment
Reasoning
515
Care Partners
516
517
Tolerance, as defined by
either of the following:
markedly diminished effect
with continued use of the
same amount of the
substance.
Introduction
Two primary groups:
Substance-use disorders (primarily dependence
and abuse)
Substance-induced disorders (intoxication,
withdrawal, and mental health consequences
of abuse)
Clinical syndromes
Substance dependence: a
maladaptive pattern of substance
use that has led to clinically
significant impairment or distress.
Clinical syndromes
Substance abuse includes at least one of the
following symptoms:
Failure to fulfill major role obligations
Recurrent use of substance despite physical hazards
Repeated substance related legal problems
Persistent use despite social or relational problems
Stress
Insomnia
Anxiety
Depression
Acute psychotic states
Impaired cognition
Violent behavior
Social Problems
Marital and family problems
Legal difficulties
Loss of employment
Financial deterioration
Suicide risk is frequently present in a substance abusing
client particularly as health and psychosocial deterioration is
present.
Careful screening for self-destructive thoughts and/or
impulses is imperative with this population.
NON-SUBSTANCE-RELATED DISORDERS
GAMBLING DISORDER PROBLEMATIC GAMBLING BEHAVIOR (12
month period) restless or irritable when attempting to cut down or
stop gambling, often gambles.
b. Disorganized
c. Paranoid
d. Undifferentiated
57. Hearing voices that are not really there would be called a(n)
a. Hallucinations
b. Delusions
c. Auditory regression
d. Depressive psychosis
b. Paranoid episodes
c. Manic episodes
d. Borderline episodes
59. Robert was found wandering naked in the campus parking lot,
proclaiming himself to be Father Time. He shows evidence of a(n)
___ disorder.
a. Anxiety
b. Psychotic
c. Personality
d. Affective
64. The fact that the prevalence of eating disorder has increased in
the last few decades most supports which of the following
etiological theories:
a. Biological
b. Cognitive
c. Family systems
d. Socio-cultural
b. Anhedonia
c. Disorganized speech
d. Hallucinations
b. Borderline
c. Obsessive-compulsive
d. Paranoid
b. Senile dementia
c. Depression
d. Delusional disorder
70. Bob has never met Madonna but he is convinced that she is
deeply in love with him. Bob is suffering from ___
a. Grandiose delusions
b. Jealous delusions
c. Obsessive-compulsive disorder
d. Erotomanic delusions
b. Disorganized
c. Catatonic
d. Paranoid
78. Roger has been extremely anxious for much of the past year, but
cant explain why. There is a good chance that he is experiencing
a. A generalized anxiety disorder
b. Sociopathy
c. Psychosis
d. A nervous breakdown
SLEEP-WAKE DISORDERS
SLEEP DISORDERS
Key Terms
Apnea:The temporary absence of breathing. Sleep apnea consists of
repeated episodes of temporary suspension of breathing during sleep.
Cataplexy: Sudden loss of muscle tone (often causing a person to
fall), usually triggered by intense emotion. It is regarded as a
diagnostic sign of narcolepsy.
Circadian rhythm: Any body rhythm that recurs in 24-hour cycles.
The sleep-wake cycle is an example of a circadian rhythm.
Dyssomnia: A primary sleep disorder in which the patient suffers
from changes in the quantity, quality, or timing of sleep.
Electroencephalogram (EEG): The record obtained by a device that
measures electrical impulses in the brain.
What is Sleep?
Sleep is a physical and mental
resting state in which a person
becomes relatively inactive and
unaware of the environment.
In essence, sleep is a partial
detachment from the world,
where most external stimuli are
blocked from the senses.
Dyssomnias
primary sleep disorders in which the
patient suffers from changes in the
amount, restfulness, and timing of
sleep.
Types of dyssomnias
Primary Insomnia
Difficulty in falling asleep or remaining asleep
that lasts for at least one month.
can be caused by a traumatic event related to
sleep or bedtime, and it is often associated
with increased physical or psychological arousal
at night
People who experience primary insomnia are
often anxious about not being able to sleep
usually begins when the person is a young adult
or in middle age
Primary Hypersomnia
a condition marked by
excessive sleepiness during
normal waking hours.
Narcolepsy
Narcolepsy
3 major symptoms:
1. Cataplexy is the sudden loss of muscle tone and
stability ("drop attacks")
2. Hallucinations may occur just before falling
asleep (hypnagogic) or right after waking up
(hypnopompic)
3. Sleep paralysis occurs during the transition from
being asleep to waking up.
Jet lag
sleepiness and alertness that occur at
an inappropriate time of day
relative to local time, occurring
after repeated travel across more
than one time zone
Shift work
PARASOMNIAS
primary sleep disorders in which the patient's behavior is affected by specific
sleep stages or transitions between sleeping and waking. They are
sometimes described as disorders of physiological arousal during sleep.
Nightmare Disorder
a parasomnia in which the patient is
repeatedly awakened from sleep by
frightening dreams and is fully alert on
awakening.
The child is usually able to remember
the content of the nightmare and may be
afraid to go back to sleep.
Nightmare disorder is most likely to
occur in children or adults under severe
or traumatic stress.
Sleepwalking disorder
sometimes called somnambulism
occurs when the patient is capable of complex
movements during sleep, including walking.
If the patient is awakened during a sleepwalking
episode, he or she may be disoriented and have
no memory of the behavior.
In addition to walking around, patients with
sleepwalking disorder have been reported to
eat, use the bathroom, unlock doors, or talk to
others. It is estimated that 10-30% of children
have at least one episode of sleepwalking.
However, only 1-5% meet the criteria for
sleepwalking disorder.
The disorder is most common in children eight
to 12 years old.
SUBSTANCE-INDUCED
The
use of drugs, SLEEP DISORDERS
alcohol, and caffeine
frequently produces
disturbances in sleep
patterns. Alcohol abuse
is associated with
insomnia.
ELIMINATION DISORDERS
Mike has always been a loner. He has never much cared for being
with other people. He does not form relationship easily. He appears
to be without emotion. Mike may be exhibiting the ____ personality
disorder.
a. Schizoid
b. Paranoid
c. Histrionic
d. narcissistic
b. Become delusional
c. Result in anger
d. Involve those with whom they work
b. Somatization disorder
c. A traumatic disorder
d. An obsession
When Sara returned from combat in the Gulf War, she began
experiencing high anxiety that has persisted without any
improvement. This example illustrates which anxiety related
disorder?
a. Panic
b. Post-traumatic stress
c. Phobia
d. Obsessive-compulsive
Gregory has been homeless for the past 3 years. The stress of being
homeless seems to have contributed to the onset of psychosis. This
example illustrates what risk factor for mental disorders?
a. Social
b. Family
c. Psychological
d. Biological
b. Disorganized
c. Paranoid
d. undifferentiated
b. Delirium tremens
c. Schizotypical psychosis
d. General paresis
b. Delusions of grandeur
c. Delusions of influence
d. Delusions of persecution
Hearing voices that are not really there would be called a(n)
a. Hallucinations
b. Delusions
c. Auditory regression
d. Depressive psychosis
b. Paranoid schizophrenia
c. Manic episodes
d. Borderline schizophrenia
b. Antisocial
c. Narcissistic
d. Paranoid
b. Hallucinations
c. Delusions
d. Affect episodes
Sexual Disorders
Paraphilias, Gender Dysphoria, and Sexual Dysfunctions
DR. JOSEPH C. FRANCISCO
Paraphilias
Para meaning abnormal and philia meaning
attraction, Literally, Abnormal Attraction
Paraphilia
These are disorders in which an individual
has recurrent, intense sexually arousing
fantasies, sexual urges or behaviors
involving (1) Non-human objects, (2)
Children or other non-consenting persons
and (3) suffering or humiliation of ones self
or partner
Examples of Paraphilias
Telephone Scatologia- making obscene phone
calls, such as describing ones masturbatory
activity, threatening to rape the victim, or trying
to find out the victims sexual activities.
Necrophilia- deriving sexual gratification from
viewing or having sexual contact with a corpse.
Zoophilia- having sex with animals or having
recurrent fantasies of sex with animals.
Examples of Paraphilias
Coprophilia- deriving sexual pleasure from contact with
feces.
Urophilia- deriving sexual pleasure from contact with
urine.
Autagonistophilia- having sex in front of others.
Somnaphilia- having sex with a sleeping person.
Stigmatophilia- deriving sexual pleasure from skin
piercing or a tattoo.
Autonepiophilia- wearing diapers for sexual pleasure.
Pedophilia
Pedophilia is where an adult has uncontrollable
sexual urges to sexually immature children (13
below)
Persists from months to even years.
Forms of sexual acts against children include
kidnapping, sexual abuse, fondling, and
penetration or intercourse.
Types of Pedophilia
Situational Molesters
Normal Sexual development and interest. But when stress calls for it, they
sometimes want to become sexual with a child
Preference Molesters
Pedophillic behavior is already ingrained in the individuals lifestyle, clear
preference for children, esp. Boys, and will do anything (even marry) to
hide his behavior, and clearly sees nothing wrong with his unusual behavior.
Child Rapist
A violent childabuser whose behavior is an expression of hostile sexual
drives.
Fetishism
Fetishism is where a person feels a strong recurrent
sexual attraction to a nonliving object.
People with this are always preoccupied with the object
of desire, and they become dependent to it as an object
for sexual gratification.
Objects include shoes, gloves, underwear, stockings,
swimsuits, etc.
Partialism
Another variant of Fetishism.
Characteristics of Fetishism
They do unusual actions to the desired object, like
sucking, smelling, fondling, rubbing, burning and cutting.
Have no desires to intercourse with the partner with the
desired object, rather, they would masturbate to the
desired object.
Frotteurism
Derived from the word Frotter meaning To rub
Refers to the masturbation that involves rubbing
against another person.
Frotteur has recurrent sexual desires on rubbing
into people. Targets of Frotteurs are not
consenting people, rather they target strangers.
Characteristics of a Frotteur
Obsessed with the rubbing of selves to
unsuspecting strangers, finding it sexually
pleasurable.
Often acts quickly, or undetected.
Fantasizes that they are in an intimate
relationship with the stranger.
Treatment includes extinction and covert
conditioning.
Sexual Masochism
A Masochist is someone who seeks
pleasure from being subjected to
pain.
Sexual Sadism
Is about obtaining sexual enjoyment
from inflicting cruelty.
Sexual Masochism
Disorder marked by an attraction to achieving
sexual gratification by having painful stimulation
applied to ones own body, either alone or with a
partner.
Sexual Sadism
The converse of Sexual Masochism. Seeing or imagining
anothers pain excites the sadist. In contrast to Sexual
Masochism, which does not require a partner, sexual
sadism clearly requires a partner to enact sadistic
fantasies.
Transvestic Fetishism
A syndrome found only in males.
A disorder in which a man has an uncontrollable urge to
wear a womans clothing, as primary means of achieving
sexual gratification.
This sexual gratification has a compulsive quality, and
consumes a lot of emotional energy.
Sometimes accompanied by masturbation.
Voyeurism
The word comes from the term voir, meaning To
See
A sexual disorder where an individual
compulsively seeks sexual gratification from
observing nudity or sexual activity of others who
are unaware that they are being watched.
This disorder is more common in men.
The term Peeping Tom usually refers to voyeur.
Gender Dysphoria
Gender Identity refers to the individuals selfperception as a male and female.
Gender Identity
The term gender identity refers to the
individuals perception as a male or female.
Gender role refers to the persons behaviors
and attitude that are indicative of his
gender.
Gender Dysphoria
A condition which involves a discrepancy
between an individuals assigned sex and
the persons gender identity.
Characteristics of GD
Transsexualism
Refers to this phenomenon in which a
person has an inner feeling of belonging to
other sex.
People involve in this situation wishes to
live as members of the other sex.
Transvestites are content with their gender identity but enjoy the fantasy
of pretending to be a member of the opposite sex.
Sexual Dysfunctions
Refers to an abnormality in an individuals
sexual responsiveness and reactions
Premature Ejaculation
79. Irrational and very specific fears that persist even when there is
no real danger to a person are called ___
a. Anxieties
b. Dissociations
c. Phobias
d. Obsessions
b. Statistical
c. A matter of subjective discomfort
d. Related to conformity
81. Three year old Shawn ate lead paint which was chipping off the
walls in an older home. Consequently, he developed a psychosis
based on brain damage due to lead poisoning. Shawns psychosis
would be called a(n)
a. Functional psychosis
b. Organic psychosis
c. Neural psychosis
d. Neo-cortical psychosis
82. False beliefs that are held even when the facts contradict them
are called
a. Fantasies
b. Hallucinations
c. Illusions
d. Delusions
83. Mary believes that she is the Queen of England. She is having
a. Depressive delusions
b. Delusions of grandeur
c. Delusions of reference
d. Delusions of persecution
b. Obsessive-compulsive
c. Schizoid
d. Avoidant
b. Mood disorders
c. Anxiety disorders
d. Personality disorders
b. Schizophrenia
c. Parkinsons
d. Personality Disorders
b. Sign
c. Psychosis
d. Disease
99. The presence of more than one condition within the same time
period is known as
a. Twin diagnosis
b. Misdiagnosis
c. Comorbidity
d. Confounded morbidity
REMINDERS:
XOX
(eXtreme-Overly-eXagerrated)
HELP
(Hiding, Evolving, Lying, Prolonged)
US
(U and Society)
TIPS:
TIPS:
Anxiety Disorders, Eating Disorders, Somatoform disorders, Impulse
control disorders
Intermittent Explosive Disorder, Conduct disorder vs Oppositional
Disorder
Body dysmorphic, Conversion disorder, Acute stress disorder
B. Retardation of ideas
C. confabulation
D. Amnesia
B. Bipolar 1
C. Bipolar II
D. Dysthymia
B. Relapse
C. remission
D. residual