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-psychotropic medication which reduce tension and worry better known as anxiety. (pg.16) Mechanism action#2: “Increasing receptor sensitivity”, main action is with gaba and glutamate. May have strong rebound and risk of addiction.
system of health care coverage in which the insurance company largely controls the nature, scope, and cost of medical or psychological services. (pg.19)
the total number of cases in the population during a given time period; prevalence includes both existing and new cases. (pg.35)
The tiny space between the nerve ending of one neuron and the dendrite of another also known as the synaptic cleft. (pg.49)
A structure in the brain that plays a key role in emotion and memory. (pg. 138)
The central nervous system’s physiological and emotional response to a serious threat to one’s well-being. (pg. 122)
Definition: Anxiety is the psychological experience of fear: apprehension, tension, fear itself, sense of danger, hypervigilance, uneasiness that stems from the anticipation of danger (an actual fear-provoking stimulus need not be present)
• The source of anxiety may be external or internal.
the most common group of anti-anxiety drugs, which includes Valium and Xanax. (pg. 123)
(a treatment to help patients gain awareness of many physiological functions.) a treatment technique in which a client is given information about physiological reactions as they occur and learns to control the reactions voluntarily. (pg. 125)
a severe and persistent fear of a specific object or situation (other than agoraphobia and social phobia). (pg. 134)
problem of stress in the workplace. About 20 percent of corporate employers now offer some kind of stress reduction program, such as this regular yoga class at Armani.
-An approach to treating GAD’s that teaches clients techniques for reducing and controlling stress (p. 158).
lingering anxiety reactions to unusually traumatic events and last less than one month.
when a person has 2 or more disorders, simultaneously
different, extreme, unusual, perhaps even bizarre
o Abnormal behavior, thoughts, and emotions are those that differ markedly from a society’s ideas about proper functioning
o Behavior, thoughts and emotions that break norms of psychological functioning
§ Norms are based on society’s culture & specific circumstances
interfering with the person’s ability to conduct daily activities in a constructive way
o Abnormal behavior upsets, distracts, or confuses people that they cannot care for themselves properly, participate in ordinary social interactions,, or work productively
Actually the exception of abnormal psychological functioning
o Most people struggling with anxiety, depression and even bizarre thinking pose no immediate danger to themselves or to anyone else
The view that a person must first have a predisposition to a disorder and then be subjected to immediate psychosocial stress in order to develop that disorder.
♥-disorders present themselves after periods of stress: 3 P's
¤predisposing- capacity for mental illness
¤precipitating- cause of stress (drugs, divorce)
¤perpetuating- reasons for length of disorder (homelessness)
Middle ages: “Not surprisingly, some of the early demonological treatments for psychological abnormality reemerged during the Middle Ages. Once again the key to cure was to rid the person’s body of the devil that possessed it.” (Exorcism)
Renaissance: mentally ill were kept in private homes and community residences until the government realized that they could not house everyone with mental disorders. Soon, hospitals and monasteries converted to asylums. Asylums were widely used until the late 1700’s.
19th century: Asylum reform; spread of moral treatment ushered in by Benjamin Rush and Dorothea Dix; rise in state hospitals, or public mental health hospitals
Bloodletting- is the withdrawal of often small quantities of blood from a patient to cure or prevent illness and disease
Lobotomy- Surgical procedure in which the nerve pathways in a lobe or lobes of the brain are severed from those in other areas
exorcism- the act of driving out, or warding off, demons, or evil spirits, from persons, places, or things, which are believed to be possessed
Trepanning/trephination- Brain surgery using stones to drill holes through the human skull, to “treat” health problems/mental disorders.
Risk- the probability of occurrence of negative outcomes
-similar to the concept of danger
Resilience- successful adaptation under the adverse conditions and the ability to recover/cope from stressors or trauma
-most people don’t know if they are resilient because first you must have experienced extreme adversity
women more likely to fear physical attacks, and gender discrimination in the workplace, outside threat
men tend to have different kind of pressures: be lucrative & successful, less “emotional”
free-floating anxiety, excessive anxiety under most circumstances and worry about practically anything
feel restless, keyed up, or on edge; tire easily; have difficulty concentrating; suffer from muscle tension; have sleep problems
Symptoms last at least six months
Systematic desensitization- a client learns to relax and calm themselves in stressful situations while facing the objects or situations they fear by using relaxation training and fear hierarchy* *(this is more for specific phobias)
Sedative hypnotic drugs- can calm people if given in low doses, can help sleep if given in high doses*
Stress inoculation training*-
- cognitive behavioral therapy which changes maladaptive assumptions by replacing negative thoughts with positive thoughts
anti anxiety drug therapy (benzodiazepine)
People with physical ailments have sometimes been taught new attitudes or cognitive responses toward their ailments as part of treatment.
Stress inoculation training- teaches people to identify and eventually rid themselves of unpleasant thoughts that keep emerging during pain episodes (so-called negative self-statements) and to replace them with coping self-statements (183-84)
psychodynamic therapies- is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension, relies on the interpersonal relationship between client and therapist
• humanistic/existential therapy- a system of therapy that tries to help clients look at themselves accurately and acceptingly so that they can fulfill their positive inborn potential
behavioral therapy- a therapeutic approach that seeks to identify problem-causing behaviors and change them (behavior modification)
• cognitive therapies- a therapy developed by Aaron Beck that helps people identify and change maladaptive assumptions and ways of thinking that help cause their psychological disorders
• biological therapies- the use of physical and chemical procedures to help people overcome psychological issues
Humanistic-existential model:It is hard to scientifically research humanistic approaches. Treating most mental disorders require a combination of the humanistic approach and of others, alone it doesn’t always suffice.
Behavioral: Focus on excessive or deficient behaviors and looks at single symptoms as units of analysis
Biological: What the brain itself does, how the neurons react based on different disorders. Genetics, evolution & mutations, viral infections, treatment includes medication, surgery, ECT- very cut and dry medical approach to illnesses. This model is incomplete, some medication can actually produce negative side-effects, it is hard to explain everything about a medical illness based on the biological approach alone.
must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the person.
Cultural difference is NOT considered mental disorder.
All mental disorders create difﬁculty for a “signiﬁcant” period of time. this time period usually exceeds two weeks of dysfunction, often longer
a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress, or disability, or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. (from lecture slide)
alteration or loss of voluntary motor or sensory functioning that suggest general medical or neurological disorder, psychological factors are associated with the symptoms or deﬁcits because the initiation or exacerbation was preceded by conﬂict or stress. The symptoms of the disturbance are not intentionally produced, and cannot be explained by any physical disorder or any pathophysiologic mechanism.
Freud used what was called hysteria , where people were having physical ailments that medical doctors couldn't find a biological origin. Freud found that talk therapy was leading to relief of these symptoms.
The development of emotional or behavioral symptoms in response to an identiﬁable stressor(s) occurring within three months of the onset of the stressor(s). These symptoms or behaviors are clinically signiﬁcant as evidenced by either of the following: marked distress that is in excess of what would be expected from exposure to the stressor signiﬁcant impairment in social or occupational (academic) functioning
disorder characterized characterized by depressed mood or anxiety in response to significant stressors - childs parents going getting a divorce or starting college
NCS:The National Comorbidity Study evaluated the prevalence of the 14 most common adult DSM IIIR mental disorders. The study found that the following disorders, in order, are most prevalent in the US: anxiety disorder, substance abuse, affective disorder, and major depression.
Important findings:The NCS found that mental disorder is rather normative in the US and that urbanization is related to higher rates. It also found that major depression was the third most important cause of disease burden worldwide in 2004.
Gender differences: Women showed significantly higher rates for major depression and anxiety disorders while men showed higher rates for substance dependence and antisocial personality disorder.
Inaccuracy:The conductors of this study did not interview prisoners, the homeless or anyone without an address. They also used a small sample size. This could have led to inaccuracy in the results because only a small number of people were accounted to represent the entire country.
6. Describe four principal aspects of a good clinical diagnostic interview. What is the
purpose of a mental status examination (MSE)? Describe five categories of a MSE.
The four principal aspects of a good clinical diagnostic interview:
1. Observation: seeing how a person presents/behaves
2. Conversation: engaging with the person verbally.
3. Exploration: go into a topic in depth.
4. Testing: possible personality/aptitude test.
MSE: to assess functioning and determine next steps.
THe five categories of a MSE:
1. Appearance: see how they look
2. Behavior: verbal, nonverbal, inaction
3. Mood/Affect: what are their emotions
4. Perception: if it’s hot in the room are they dress appropriately
5. Sensorium: consciousness, orientation, concentration
Anti-anxiety medications (benzodiazepines) Mechanism: increased receptor sensitivity so more gaba can be absorbed by postsynaptic neuron Therapeutic effects are decreased anxiety, higher doses aid sleep.
2) drowsiness, dizziness
4) negative rebound effect - when taken off medication neurotransmitters do not go back to original functionality, whey are lower than when the medication was started
Anxiety is the psychological experience of fear:
•apprehension, tension, fear itself, sense of danger, hypervigilance, uneasiness
•that stems from the anticipation of danger (an actual fear-provoking stimulus need not be present)
•Panic is an extreme alarm reaction that can result when a real threat suddenly emerges
•Agoraphobia:Fear of leaving home, fear of being in locations from which escape might be difﬁcult or help unavailable, fear of unfamiliar or regularly-visited places, crowds, situations
•Speciﬁc Phobia: marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a speciﬁc object or situation (e.g., ﬂying, heights, animals, seeing blood).
Generalized anxiety disorder (GAD): excessive anxiety and worry (apprehensive expectation)
•the person ﬁnds it difﬁcult to control the worry.
•the anxiety and worry are associated with three or more Sx:
•the anxiety, worry, or physical symptoms cause signiﬁcant distress or functional impairment.
Panic is an extreme alarm reaction that can result when a real threat suddenly emerges
•but some people have panic disorder:
•having panic attacks repeatedly, unexpectedly, and without apparent reason
•also involves the experience of dysfunctional changes in thinking and behavior as a result of the attacks, including
•persistent worries about having an attack;
•planning behavior around possibility of future attack
•Agoraphobia is the fear of leaving home, fear of being in locations from which escape might be difﬁcult or help unavailable, fear of unfamiliar or regularly-visited places, crowds, situations
People with panic disorder are afraid to leave the house or travel to public places where it might be difficult to escape or get help if a panic attack were to occur
Treatment for panic: benzodiazepines help people with panic disorders by indirectly reducing the activity of norepinephrine throughout the brain
Treatment for agoraphobia: desentization, simply learning to relax while gradually facing places or situations where escaping might be difficult
Specific Phobia- marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, seeing blood).
Agoraphobia- fear of public places
Hydrophobia- fear of water
Zoophobia- fear of animals
Homophobia-fear/discomfort of homosexuality
• exposure to the phobic stimulus almost invariably provokes an immediate anxiety response.
he fear is excessive or unreasonable; the anxiety &/or distress interfere significantly with the person's functioning.
• the phobic situation is avoided, or else endured with intense anxiety or distress.
systematic desensitization - a behavioral treatment in which clients with phobias learn to react calmly instead of with intense fear to the objects or situations they dread by increasing the intensity of the stimulus over time
Flooding - clients are exposed repeatedly and intensively to a feared object and made to see it is actually harmless.
•a marked and persistent fear of one or more social or performance situations
•exposure to the feared social stimulus almost invariably provokes an immediate
Origins according to behavioral theory-classical conditioning or modeling
One treatment option is social skills training, a combination of several behavioral techniques to help people improve their social functioning. Therapist provides feedback and reinforcement
Why does it go untreated? early age of onset, people with social phobia fear therapy that involves social interactions
Antianxiety medications increase receptor sensitivity
before 1950’s barbituates
After 1950’s: benzodiazepines
Provide temporary, modest relief. very pleasant, calming, and soothing. Help with sleep and dreams.
act on GABA receptors (GABA = inhibitory neurotransmitter) which reduces activity of exitatory neurotransmitters
Rebound anxiety with withdrawal and cessation of use - very unpleasant.
Physical dependence is a problem, benzodiazepines are the primary drug of choice in prescription drug abuse
Multiply the effects of other drugs (especially alcohol)
After 1980s: azapirones (BuSpar)
Different receptors and neurotransmitters, same effectiveness, fewer problems
Reexperiencing the traumatic events-recurring thoughts, dreams, memories, nightmares
Avoidance- avoid activities that remind them of the traumatic event
Reduced Responsiveness- feel detached from people; lose interest in activities
Associated difficulties: People with PTSD also develop feelings of Increased arousal, anxiety, and guilt, they feel overly alert, easily startled, have trouble concentrating, develop sleep problems
experience severe anxiety, depression, and stress symptoms, which include flashbacks, night terrors, and persistent thoughts and images
Victims of sexual assault develop symptoms of anxiety, suspiciousness, depression, and flashbacks, sleep problems, and sexual dysfunction
1) recurrent obsessions or compulsions
2) past or present recognition that the obsessions or compulsions are excessive or unreasonable
3) significant distress or impairment , or disruption by symptoms for more than one hour a day
- Biological explanation (pg 146): low serotonin activity, also glutamate, Gaba and dopamine, and abnormal functions in other regions of the brain such as the orbitofrontal cortex.
Therapies - combination of antidepressants, cognitive and behavioral therapies have shown markedly reduced symptoms of OCD
Ignores the cultural/social aspects of an illness
*The DMS labels individuals based on their diagnosed mental disorders, which can have a negative effect on both the individual and how others view and treat them.
*Being diagnosed and stigmatized with a disorder can remove the individual’s responsibility- either implying that the individual may be hopeless to their disorder “Oh, well I’m depressed so there’s nothing I can do.”- Often times the process of dealing with and/or recovering from a mental disorder involves more than accepting the label but of working towards dealing with it, improving one’s life, etc.
Individuals can use the labelling of the DSM as an excuse to not work towards managing and dealing with their diagnosed disorder.
*Leads to overmedication: A pill cannot always directly solve a problem, many disorders require work and commitment.
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