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254 Cards in this Set
- Front
- Back
• Developmental Psychopathology
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– Study of how disorders arise and change with time
– Childhood is associated with significant developmental changes – Disruption of early skills will likely disrupt development of later skills |
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• Developmental Disorders
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– Diagnosed first in infancy, childhood, or adolescence
– Attention deficit hyperactivity disorder (ADHD) – Learning disorders – Autism and Asperger’s Disorder – Mental retardation |
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most frequently diagnosed disorder; wrestles; problems in school;
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ADHD
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• Nature of ADHD
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– Central features – Inattention, hyperactivity, and impulsivity
– Associated with behavioral, cognitive, social, and academic problems |
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• DSM-IV and DSM-IV-TR Symptom Clusters
– Cluster 1 |
– Symptoms of inattention
Someone who is easily distracted by the environment, excessive daydreaming, in one ear out the other, frequently misplacing things, disorganized, inattentive symptoms. Children and adults day dream excessively. |
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• ADHD
DSM-IV and DSM-IV-TR Symptom Clusters – Cluster 2 |
– Symptoms of hyperactivity and impulsivity cluster
• Difficulty waiting ones turn, too much activity, running and climbing excessively, impulsivity leads into more behavior problems. • Impulsivity- difficulty mediating actions with forethought. React or act and think afterwards if at all. • Frequently intrusive verbally • Tends to lead to behavior problems, impulsivity can lead to physical fighting. • Cluster 2 is the reason why parents are worried, cause most problems |
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• DSM-IV and DSM-IV-TR Symptom Clusters (ADHD)
– Either cluster 1 or 2 must be present for a diagnosis |
– symptoms must be present prior to age 7-TEST QUESTION
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– ADHD inattentive type
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(predominantly) inattentive type- previously ADD): only cluster 1 symptoms
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– ADHD predominantly hyperactive
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- impulsive type: sufficient/severe enough symptoms from cluster 2
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– ADHD combined type
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(common)
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Prevalence of ADHD
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– Occurs in 4%-12% of children who are 6 to 12 years of age; for valid ADHD
– Symptoms are usually present around age 3 or 4 – 2/3 of children with ADHD have problems as adults – Occurs more frequently in males – Decreased need for sleep is a symptom of mania, not ADHD. |
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• Gender Differences ADHD
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– Boys outnumber girls 4 to 1
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• Cultural Factors of ADHD
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– Probability of ADHD diagnosis is greatest in the United States
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• Genetic Contributions of ADHD
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– ADHD runs in families
– Familial ADHD may involve deficits on chromosome 20 |
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• Neurobiological Contributions: Brain Dysfunction and Damage for ADHD
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– Inactivity of the frontal cortex and basal ganglia- slower to develop, catch up several years later******
– Right hemisphere malfunction – Abnormal frontal lobe development and functioning – Yet to identify a precise neurobiological mechanism for ADHD |
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• The Role of Toxins in ADHD
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– Allergens and food additives do not appear to cause ADHD
– Maternal smoking increases risk of having a child with ADHD |
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• Psychosocial Factors Can Influence the Disorder Itself (ADHD)
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– Constant negative feedback from teachers, parents, and peers
– Peer rejection and resulting social isolation – Such factors foster low self-image |
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Biological Treatment of ADHD
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• Stimulant Medications
– Reduce the core symptoms of ADHD in 70% of cases – Examples include Concerta, Adderall, Metadate, Ritalin, Dexedrine, etc. • Other Medications – Imipramine and Clonidine (antihypertensive) have some efficacy – Straterra (inattention) |
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• Goal of Biological Treatments of ADHD
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– To reduce impulsivity/hyperactivity and to improve attention
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Medications (test questions)
ADHD |
**Increase ability to think before they act. Does not change their personality. Can be abused.
**Stimulates the frontal lobe and cortex, allowing a person to focus better. |
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• Behavioral Treatment
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– Involve reinforcement programs
– Aim to increase appropriate behaviors and decrease inappropriate behaviors – May also involve parent training |
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• Combined Bio-Psycho-Social Treatments
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– Are highly recommended
– Non-medical treatments not nearly as effective if not combined with medication |
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-in order to diagnose goes under psychological testing
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Learning Disorder
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• Scope of Learning Disorders
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– Problems related to academic performance in reading, mathematics, and writing
– Performance is substantially below what would be expected given their intelligence and IQ, age and upbringing – Dyslexia is a specific type of reading disorder. – Reading disorders are most common type of learning disorder |
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• Reading Disorder
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– Discrepancy between actual and expected reading achievement
– Reading is at a level significantly below that of a typical person of the same age – Problem cannot be caused by sensory deficits (e.g., poor vision) |
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• Mathematics Disorder
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– Achievement below expected performance in mathematics
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• Disorder of Written Expression
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– Achievement below expected performance in writing
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If someone has a below average IQ, and making C’s and D’s in school…what disorder are you thinking? (Test Question)
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No you will expect below average grades. (Expect someone with their IQ to be making the grades they should be
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• What is expected of learning disorders
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– given child’s age, educational level, intelligence (IQ), and environmental factors
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• Incidence and Prevalence of Learning Disorders
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– 1% to 3% incidence of learning disorders in the United States
– Prevalence rate is 10% to 15% among school age children – Reading difficulties are the most common of the learning disorders – About 32% of students with learning disabilities drop out of school |
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How many school many school children classified disabled have learning disabilities?
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Half
Twenty years ago the proportion was 25% |
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• Genetic and Neurobiological Contributions (Autism)
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- can be environmental but mostly neurobiological
– Reading disorder runs in families, with 90% +concordance rate for identical twins – Overall, genetic and neurobiological contributions are unclear |
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Biological and Psychosocial causes of learning disorder
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• Genetic and Neurobiological Contributions
• Psychological and motivational factors seem to affect eventual outcome • Can have concurrent ADHD, academic tutoring can treat this. |
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• Nature of Pervasive Developmental Disorders
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– Problems occur in language, socialization, and cognition
– Pervasive – Means the problems span the person’s entire life |
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Autistic
3. Restricted patterns of behavior, interests, and activities (Stereotyped behavior) |
• preoccupation with restricted patters of interest (abnormal in intensity)
• may be inflexible in routines or rituals • stereotyped motor movements or mannerisms (repeated behaviors) • preoccupation with parts of objects |
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• Examples of Pervasive Developmental Disorders
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– Autistic disorder
– Asperger’s syndrome |
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• Prevalence and Features of Autism
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– Affects 2 to 20 persons for every 10,000 people
– More prevalent in females with IQs below 35, and in males with higher IQs – Autism occurs worldwide – Symptoms usually develop before 36 months of age |
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• Autism and Intellectual Functioning
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– 50% have IQs in the severe-to-profound range of mental retardation
– 25% test in the mild-to-moderate IQ range (i.e., IQ of 50 to 70) – Remaining people display abilities in the borderline-to-average IQ range – Neurobiologically – Children with autism are at a higher risk for medical problems. – Genetic influence of it – Cerebellum- substantially reduced in persons with autism |
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• Pervasive- meaning it affects many aspects of life
• Can be nonverbal, very gifted in certain areas |
Persuasive Developmental Disorders
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Very particular to schedules.
-being much more accurately diagnosed than it ever was, recognized earlier and more accurately. -More education helps with this -Males with autism have higher IQs. And women have lower IQs. Below 35. |
Autistic Disorder: Facts and Statistics
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• Autism
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– Significant impairment in social interactions and communication
– Restricted patterns of behavior, interest, and activities – onset usually prior to age 3 |
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Causes of Autism: Early and Most Recent Contributions
• Historical Views |
– Bad parenting
– Unusual speech patterns – Lack of self-awareness |
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• Three Central Features of Autism
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Problems in socialization and social function
Problems in communication Restricted patterns of behavior, interests, and activities (Stereotyped behavior) |
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Causes of Autism: Early and Most Recent Contributions
• Current Understanding of Autism |
– Medical conditions – Not always associated with autism
– Autism has a genetic component that is largely unclear – Neurobiological evidence for brain damage – yet also unclear – Cerebellum size – Substantially reduced in persons with autism |
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Asperger’s have problems in?
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socialization and social function
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– 1. Problems in socialization and social function
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– Difficulty socializing with others, and is neurobiological. Very poor or no eye contact.
• poor eye contact, little, if any, interest in relationships- solitary • loners, lack of enjoyment in activities- may enjoy fixating. • poor use of nonverbal behaviors- very off, facial expressions • lack of emotional reciprocity- unable to empathize, become obsessed with little things |
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Asperger’s have restricted patterns in?
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behavior, interests, and activities
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Asperger’s deficits in _______ are much less severe?
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Communication
Speech is intact |
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Asperger’s was once thought of ____?
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mild autism
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– 2. Problems in communication
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• 50% never acquire useful speech; mute and do not speak
• unusual speech; echolalia; may repeat some words over again; may shriek • Echolalia- repeating what you said • poor ability to maintain communication with others • lack of make-believe or spontaneous play |
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– 3. Restricted patterns of behavior, interests, and activities (Stereotyped behavior)
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• preoccupation with restricted patters of interest (abnormal in intensity)
• may be inflexible in routines or rituals • stereotyped motor movements or mannerisms (repeated behaviors) • preoccupation with parts of objects |
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• Prevalence and Features of Autism
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– Affects 2 to 20 persons for every 10,000 people
– More prevalent in females with IQs below 35, and in males with higher IQs – Autism occurs worldwide – Symptoms usually develop before 36 months of age |
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• Autism and Intellectual Functioning
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– 50% have IQs in the severe-to-profound range of mental retardation
– 25% test in the mild-to-moderate IQ range (i.e., IQ of 50 to 70) – Remaining people display abilities in the borderline-to-average IQ range – Neurobiologically – Children with autism are at a higher risk for medical problems. – Genetic influence of it – Cerebellum- substantially reduced in persons with autism |
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Autistic Disorder: Facts and Statistics
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-Very particular to schedules.
-being much more accurately diagnosed than it ever was, recognized earlier and more accurately. -More education helps with this -Males with autism have higher IQs. And women have lower IQs. Below 35. |
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• Historical Views of Autism
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– Bad parenting
– Unusual speech patterns – Lack of self-awareness |
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• Current Understanding of Autism
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– Medical conditions – Not always associated with autism
– Autism has a genetic component that is largely unclear – Neurobiological evidence for brain damage – yet also unclear – Cerebellum size – Substantially reduced in persons with autism |
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Asperger's have problems in?
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socialization and social function
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Ppl have restricted patterns of______?
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behavior, interests, and activities
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Deficits in ______ are much ________ severe?
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Communication; less
Speech is intact |
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Asperger's once thought of ?
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mild autism
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Ppl with Asperger's tend to be?
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loners
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Ppl with asperger's have obsessive behaviors or interests can be _____?
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severe
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Ppl with asperger's tend to gravitate towards ?
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restricted activities or interests, where people may seen them as obsessed
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High functioning autism =?
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Asperger's
2 of the 3 things are that of autism |
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• “weirdos” or “supernerds”
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Asperger’s
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Asperger’s can be severe which is ____ to mild which ______?
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autism
asperger's |
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Ppl with asperger's can ____ and ____ in school?
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finish; excel
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• Can maintain employment, jobs that is less interaction with others
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Asperger's
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• Ask someone with moderate aspergers what “don’t cry over spilt milk”
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they would take it very literally. They couldn’t interpret it.
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Do ppl grow out of asperger's or autism?
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No, but you can train social skills
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Treatment of Pervasive Developmental Disorders
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-no treatment for this
-but social skills training -address nonverbal behaviors- In autism you can use speech therapy. -Family needs education on disorder -linking families up with appropriate educational, support groups. |
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• Psychosocial “Behavioral” Treatments
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– Address Behaviors
• Skill building and treatment of problem behaviors • Communication and language problems • Address socialization deficits • Early intervention is critical |
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• Biological and Medical Treatments Are ?
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unavailable
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• Integrated Treatments:
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: The Preferred Model
– Focus on children, their families, parents, schools, and the home – Build in appropriate community and social support |
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Communication skills is a charecteristic in aspergers ____ share with autisitc disorder?
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Do not
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-may differ state to state
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Mental Retardation (MR)
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• Nature of Mental Retardation
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– Disorder of childhood
– Below-average intellectual and adaptive functioning – Range of impairment varies greatly across persons |
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• Mental Retardation and the DSM-IV and DSM-IV-TR
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– Significantly subaverage intellectual functioning (IQ below 70)
– Concurrent deficits or impairments two or more areas of adaptive functioning (adaptive functioning- being able to take care of yourself, self help skills, ability to communicate, appropriately navigate in the community) – MR must be evident before the person is 18 years of age – IQ below 70, adaptive skills, this MUST BE EVIDENT BEFORE THE AGE 18!!!!!!!!!!!! |
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YOU HAVE TO KNOW THIS BASED ON THE IQ NUMBER
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BASED ON THE ASSUMPTION OF ADAPTIVE DEFICITS
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• Mild MR
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– Includes persons with an IQ score between 50 or 55 and 70
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• Severe MR
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– Includes people with IQs ranging from 20-25 up to 35-45
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• Profound MR
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– Includes people with IQ scores below 20-25
– Tube fed, diapers, mute, no self help skills, can’t point |
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**overlap determination is based on the ______?
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adaptive deficit
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– Educable mental retardation
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(i.e., IQ of 50 to approximately 70-75)
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– Trainable mental retardation
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(i.e., IQ of 30 to 50)
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– Severe mental retardation
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(i.e., IQ below 30)
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• Standardized measures of intellectual potential
• Mean score is |
100 (90-100 is average)
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Mean score 70 =?
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2nd percentile
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Mean score 85=?
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16th percentile
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Mean score 115 =?
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84th percentile
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Mean score 130 =?
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98th percentile
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– Wechsler Scales is _________?
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most frequently used
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– Verbal IQ
– Performance (nonverbal) – Full Scale (overall) IQ |
• WISC-IV, WAIS-III, WPPSI-III
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– Stanford - Binet- IV
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similar to Weschler scale
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What are the two main intelligence tests?
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Wechsler Scales and Stanford
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Wechsler Scales and Stanford are ______?
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The two major tests, but there are others
frequently go under revisions, they normalize the data with the general population. |
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• IQ test may be administered to _____ people to see how a population as a whole would score?
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10,000
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Your performance score leads to____?
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a score
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full scale IQ
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most ppl are familiar with
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What IQ percent is a 100?
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50%,meaning half the people that will/have taken the IQ test will score better and half will score below.
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• 70%--second percentile
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will score better than you
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Mental Retardation prevalence
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– About 1% to 3% of the general population
– 90% of MR persons are labeled with mild mental retardation – IQ is about stable around 8 or 9 – Environmental can lead to IQ, exposure to world can increase an IQ |
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• Gender Differences- Mental Retardation
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– MR occurs more often in males, male-to-female ratio of about 1.6:1
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• Course of MR
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– Tends to be chronic, but prognosis varies greatly from person to person
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• Genetic Research of mental retardation
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involves multiple genes, and at times single genes
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• Chromosomal Abnormalities and Other Forms of MR
(down syndrome) |
Trisomy 21
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• Chromosomal Abnormalities and Other Forms of MR
Fragile X chromosome) |
Abnormality on X chromosome
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• Maternal Age and Risk of Having a Down’s Baby
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Mental Retardation (MR): Biological Contributions
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• Nearly 75% of cases of MR___________?
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cannot be attributed to any known biological cause
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coded on 2 axis
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Treatment for Mental Retardation (MR)
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• Parallels Treatment of Pervasive Developmental Disorders
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– Teach needed skills to foster productivity and independence
– Educational and behavioral management – Living and self-care skills via task analysis – Communication training – Often most challenging treatment target! – Community and supportive interventions |
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What is the most difficult thing to teach someone with mental retardation?
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Communication skills
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• Oppositional Defiant Disorder- favorite word
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"no"
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• Oppositional Defiant Disorder
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– central feature is defiance
– irritable, blames others, annoys others – tantrums, often loses temper – spiteful, argumentative – different from child that likes to test limits – Oppositional likes to test limits and then some |
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• Conduct Disorder
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– delinquent behavior is central feature
– aggression to people or animals – destruction of property – deceitfulness or theft – serious violations of rules |
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• Reactive Attachment Disorder
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– marked disruptions in attachment to others
– primary caregivers – child either: – 1) attach indiscriminately to others or, – 2) fails to attach to primary caregivers and others, no bonds – often associated with early separation from primary caregivers or significant neglect or abandonment |
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• Attention Deficit Hyperactivity Disorder
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– Deficits in inattention, hyperactivity, or impulsivity
– Disrupt academic and social functioning |
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• Learning Disorders
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– All share deficits in performance below expectations for IQ and school preparation
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• Pervasive Developmental Disorder
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– All share deficits in language, socialization, and cognition
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• Mental Retardation
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– Subaverage IQ, deficits in adaptive functioning, onset before age 18
– Prevention and Early Intervention Are Critical for Developmental Disorders |
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Causes of mental retardation(Environmental)
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neglect, abuse
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Causes of mental retardation(prenatal)
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exposure to disease or drugs
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Causes of mental retardation (perinatal)
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difficulties during labor or delivery
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Causes of mental retardation (postnatal)
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infections and head injuries
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• Mild MR
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(70-50)—educatable MR; still able to hold a job, maybe life on their own (but with assistance)
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• Moderate MR
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(35-55)—trainable MR
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• Severe MR
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20-25 & up to 35-40
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• Profound MR
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(below 25)—not really able to function in everyday life independently; unable to feed, walk, speak, use the bathroom
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• Civil Involuntary Commitment
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– legal proceeding that determines a person is mentally disordered and may be hospitalized, even involuntary.
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o In order for civil commitment to proceed, three conditions must be met:
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The person has a “mental illness” and is in need of treatment
The person is dangerous to self or others The person is unable to care for himself, a situation considered a “grave disability” |
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• Duty to Warn
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mental health professionals responsibility to break confidentiality and notify the potential victim whom a client has specifically threatened.
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o Tarasoff v. regents of the university of California
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– poddar told a mental health professional that he had intentions of killing tarasoff and mental health profession told police and he was let go after denying. Weeks later, he killed her.
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o Mental Health Professionals must
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tell authorities and that specific person the threat is being made to – the clien’ts potential victims
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o Three things that must be done if person is in danger of suicide or homicide:
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report to authorities
the specific victim voluntary commitment – if not voluntary may have grounds for involuntary commitment. |
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Not guilty by reason of insanity
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insanity – mental illness alters not only a person’s cognitive abilities but also that persons emotional functioning, and mental health professionals believed the entire range of functioning should be taken into account when a person’s responsibility was determined.
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o The Durham rule broadened the ?
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criteria for responsibility from knowledge of right or wrong to include the presence of a “mental disease or mental defect”
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o The ALI (American law institute) concluded that people are
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are not responsible for their criminal behavior if, because of their mental illness, they cannot recognize the inappropriateness of their behavior or control
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o The ALI also included provisions for the?
concept of diminished capacity |
which holds that people’s ability to understand the nature of their behavior and therefore their criminal intent can be diminished by their mental illness
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o Diminished capacity
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– evidence of an abnormal mental condition in people that causes criminal charges against them requiring intent or knowledge to be reduced to lesser offenses requiring only reckless or criminal neglect.
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o Not guilty by reason of insanity
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is used rarely – used in less than 1% of cases
o Spend more time in treatment facilities than jail |
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• Personality Disorders
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enduring maladaptive patterns for relating to the environment and self, exhibited in a range of contexts that cause significant functional impairment or subjective distress
They are chronic, originate in childhood and continue throughout adulthood, these chronic problems pervade a person’s life. They are inflexible and maladaptive, and can cause significant functional impairment or subjective stress |
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• Personality disorders are thought to originate in?
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childhood and continue into the adult years. They are also thought to be so ingrained that an onset is difficult to pinpoint.
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• Personality disorders are _____ to treatment
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resistant
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Personality disorders (cluster A)
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– odd or eccentric cluster
Paranoid, schizoid, and schizotypal personality disorders |
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Personality disorders (Cluster B)
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– dramatic, emotional, and erratic cluster
Antisocial, borderline, histrionic, and narcissistic personality disorders |
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Personality disorders (cluster C)
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– is the anxious and fearful cluster
Avoidant, dependent, and obsessive compulsive personality disorder |
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Borderline personality disorder is diagnosed more often in?
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females than in males who make up about 75% of the identified cases
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Gender difference has been criticized by other authors on the grounds that histrionic personality disorder, like several other personality disorders, is?
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biased against females
Many features of histrionic disorder such as over dramatization, vanity, seductiveness, and over concern with physical appearance, are characteristic of the western stereotypical female. This disorder may simply the embodiment of extremely “feminine” traits |
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o ***In the clinical population – less than 1% are?
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schizotypal and histrionic
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• Cluster A disorders
o Paranoid personality disorder |
– involves pervasive distrust and suspicious of others such that their motives are interpreted as malevolent. They assume other people are out to harm or tick them, they tend to not confide in others
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• Cluster A disorders
o Schizoid Personality Disorder |
– features pervasive pattern of detachment from social relationships and a restricted range of expression of emotions. They seem cold and indifferent to other people
Seem neither to desire nor enjoy closeness with others including romantic or sexual relationships |
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• Cluster A disorders
o Schizotypal personality disorder |
– involves a pervasive pattern of interpersonal deficits featuring acute discomfort with, and reduced capacity for, close relationships, as well as cognitive or perceptual distortions and eccentricities of behavior.
Considered to be on a continuum of disorders with schizophrenia |
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• Cluster B disorders
o Antisocial personality disorder |
– involving a pervasive pattern of disregard for and violation of the rights of others. Greater emphasis on overt behavior than on personality traits.
A history of failing to comply with social norms Characterized as being aggressive because they take what they want, indifferent to the concerns of other people, lying and cheating seem to be second nature to them, they show no remorse or concern about the affects of their actions Substance abuse is common Conduct disorder is a precursor to ADP. |
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• Cluster B disorders
o Borderline personality disorder |
– personality disorder involving a pervasive pattern of instability of interpersonal relationships, self-image, affect, and control over impulses
They usually have poor self image, their moods and relationships are unstable DBT is effective for Borderline PD |
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• Cluster B disorders
o Histrionic personality disorder |
– personality disorder involving a pervasive pattern of excessive emotionality and attention seeking
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• Cluster B disorders
o Narcissistic personality disorder |
– personality disorder involving a pervasive pattern of grandiosity in fantasy or behavior, need for admiration, and lack of empathy
They fell that they are special, an exaggerated sense of self importance |
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• Cluster C disorders
o Avoidant personality disorder |
– personality disorder featuring a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to a criticism.
Extremely sensitive to the opinions of others and therefore avoid most relationships. Their extremely low self esteem, coupled with fear of rejection, causes them to be limited in their friendships and dependent on those they feel comfortable with |
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• Cluster C disorders
o Dependent personality disorder |
– personality disorder characterized by a person’s pervasive and excessive need to be taken care of, a condition that leads to submissive clinging behavior and fears of separation.
They rely on others to make ordinary decisions as well as important ones, which results in a an unreasonable fear of abandonment |
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• Cluster C disorders
o Obsessive-Compulsive personality disorder |
– personality disorder featuring a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficacy
Fixation on things being done a “right way” – prevents them from completing much of anything |
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• Schizophrenia
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– devastating psychotic disorder that may involve characteristic disturbances in thinking (delusions), perception (hallucinations), speech, emotions, and behavior
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• Schizophrenia is characterized by?
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broad spectrum of cognitive and emotional dysfunctions, including delusions (irrational beliefs) and hallucinations (sensory experiences in the absence of external events), disorganized speech and behavior, and inappropriate emotions.
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• Psychotic behavior
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– severe psychological disorder category characterized by hallucinations and loss of contact with reality, delusions, or both.
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• Psychotic behavior
o Positive symptoms |
include the more active manifestations of abnormal behavior or an excess or distortion of normal behavior; these include delusions and hallucinations
– more overt symptom, such as delusion or hallucination, displayed by some people with schizophrenia – between 50-70% of people with schizophrenia experience delusions, hallucinations, or both. |
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• Psychotic behavior
o Negative symptoms |
involve deficits in normal behavior in such areas as speech and motivation
less outgoing symptom, such as flat affect and or poverty of speech, displayed by some people with schizophrenia. Indicate the absence or insufficiency of normal behavior, they include emotional or social withdrawal, apathy, and poverty of thought or speech and approx 25% of people with schitzo have negative symptoms. |
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• Psychotic behavior
o Disorganized symptoms |
include rambling speech, erratic behavior, and inappropriate affect.
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Positive symptoms of psychotic behavior - Delusions
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– a belief that would be seen by most members of society as a misrepresentation of reality is called a delusion, or a disorder of thought content. The basic characteristic of madness
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• Believing they are famous like Jesus or napoleon
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a delusion of grandeur
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• Believing that people are out to get them
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– delusions of persecution
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catard syndrome
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in which people believe they are dead.
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Positive symptoms of psychotic behavior Hallucinations
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the experience of sensory events (someone called your name, or something moved by you) without any input from surrounding environment.
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What senses are involved with hallucinations?
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although hearing things that aren’t there, auditory hallucinations, is the most common form experienced by people with schizophrenia.
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o Negative Symptoms
Avolition |
– the inability to initiate and persist in activities – show little interest in performing even the most basic day-to-day functions, including those associated with personal hygiene.
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o Negative Symptoms
Alogia |
refers to the relative absence of speech. A person with alogia may respond to questions with brief replies that have little content and may appear uninterested in the conversation.
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o Negative Symptoms
Anhedonia |
– inability to experience pleasure, associated with some mood disorders and schizophrenic disorders – indifference to activities that would typically be considered pleasurable, including eating, social interactions, and sexual relations.
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o Negative Symptoms
Affective flattening |
– apparently emotionless demeanor (including toneless speech and vacant gaze) when a reaction would be expected.
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ppl with alogia may have trouble with?
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finding the right words to formulate their thoughts, takes form of delayed comments or slow responses to questions
relative absence of speech or regular speech |
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ppl that have affective flatness do what?
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stare at you vacantly, speak in a flat and toneless manner, and seem unaffected by things going around them.
show little expressed emotion emotion, but still has emotion |
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• Szciphophrenia
Paranoid Type |
– Intact cognitive skills and affect, and do not show disorganized behavior
– Hallucinations and delusions center around a theme (grandeur or persecution) – best prognosis – could have weeks or months where they are not paranoid |
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– Paranoid Szchio suffer from?
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- paranoid or grandeous delusions
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Szciphophrenia
• Disorganized Type |
- poor relative to the paranoid type; chronic, lack periods of remission
– Marked disruptions in speech and behavior, flat or inappropriate affect – Hallucinations and delusions have a theme, but tend to be fragmented – This type develops early, tends to be chronic, lacks periods of remissions – Loose association of speech; slurred speech – Thoughts are loosely disorganized, difficulty to follow; unlike someone with paranoid schzio whose thoughts/speech is easy to follow |
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Szciphophrenia correlation with mental retardation
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there is no correlation
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when in active stage of schizophrenia the IQ will most likely ?
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drop
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Schizophrenia
• Catatonic Type |
– Show unusual motor responses and odd mannerisms (e.g., echolalia, echopraxia)
– Disorganized BEHAVIORS; agitation, psychomotor agitation, immobility, standing still for hours of time, lasting flexibility – This subtype tends to be severe and quite rare – Sometimes difficult to distinguish types of schizophrenia; what he will do on the test is in the descriptions he will be very straightforward; DON’T READ INTO THE QUESTIONS |
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Schizophrenia
• Undifferentiated Type |
– Major symptoms of schizophrenia, but fail to meet criteria for another type
– Cant neatly diagnose it; extremely difficult to differentiate on which type they have |
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Schizophrenia
• Residual Type |
– One past episode of schizophrenia but symptoms they are currently experiencing are mild, for example: older Nash has battles and symptoms, he probably could be diagnosed with residual type
– Continue to display less extreme residual symptoms (e.g., odd beliefs) |
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GENES PLAY A ROLE IN SCHZIOPHRENIA, VERY PROMINENT ROLE, BUT NOT ALL GENETIC
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True
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• Schizophreniform Disorder lasts for?
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– Schizophrenic symptoms for less than 1-6 months
Schizophrenia is chronic (disorganized type) |
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• Schizophreniform Disorder associated with?
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good premorbid functioning; most resume normal lives
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Do Schizophreniform Disorder symptoms clear up?
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Yes,either because of medicine or on their own, the group has better premorbid functioning of a life. There is a definite distinguished between both groups. You would treat both groups, but then wait.
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• Schizoaffective Disorder
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– Symptoms of schizophrenia and a mood disorder (e.g., bipolar disorder, depressive), occurring concurrently
– Prognosis is similar for people with schizophrenia – Such persons do not tend to get better on their own |
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• Delusional Disorder
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– Delusions that are contrary to reality without other major schizophrenia symptoms
– Many show other negative symptoms of schizophrenia – Type of delusions include erotomanic, grandiose, jealous, persecutory, and somatic – extremely rare – another psychotic disorder – you ONLY HAVE delusions, may have negative symptoms of schizophrenia – Delusions: firmly held beliefs that seems to be out of touch with reality through reasoning despite the evidence to the contrary. |
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Delusion of reverence
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an individual incorrectly believes himself or herself to be the direct object of casual remarks or incidents or of external events. Delusion of reference is more irrational sometimes absurd.
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Delusions of Jealousy
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jealous delusions are unjustified and irrational beliefs that an individual’s spouse or significant other has been unfaithful.
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Erotomanic delusions
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out of touch with reality, often a stranger or celebrity is in love with them. David letterman. Involving celebrity.
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Somatic delusions
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beliefs that can be confused with hypochondriasis, something is physically wrong with the person, or body dysphmoric disorder…look up definition.
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Difference between bipolar and schizoaffective disorder
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someone with bipolar will go through cycles with a large duration of time between. In schizoaffective, when the mood disorders lifts, the schizophrenia is still there and still be psychotic.
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• Brief Psychotic Disorder
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(0-1month)
– Experience one or more positive symptoms of schizophrenia even when one develops schizophrenia. – Usually precipitated by extreme stress or trauma – Lasts less than one month |
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• Shared Psychotic Disorder
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– Delusions from one person manifest in another person, often in family have very similar delusions often the exact same delusions.
– Little is known about this condition |
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• Schizotypal Personality Disorder
|
– May reflect a less severe form of schizophrenia
interpersonal deficits marked by acute discomfort in social situations reduced capacity for close relationships |
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• Onset and Prevalence of Schizophrenia worldwide
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– About 0.2% to 1.5% (or about 1% population)
– Usually develops in early adulthood, but can emerge at any time (18-24) – Doesn’t necessarily gets worse with age, when reaching midadulthood things can get better. |
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• Schizophrenia Is Generally
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Chronic
– Most suffer with moderate-to-severe impairment throughout their lives • Schizophrenia Affects Males and Females About Equally |
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• Schizophrenia Appears to Have a Strong ______ __________?
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Genetic Component
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Schizophrenia: Genetic Influences
• Family Studies |
– Inherit a tendency for schizophrenia, not a specific form of schizophrenia
– Schizophrenia in the family increases risk for schizophrenia in other family members |
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Schizophrenia: Genetic Influences
• Twin Studies |
– Risk of schizophrenia in monozygotic twins is 48%--identical twins .48 one twin has schizophrenia then the other one has a .48 chance*****
– Risk of schizophrenia drops to 17% for fraternal (dizygotic) twins |
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Schizophrenia: Genetic Influences
• Adoption Studies |
– In schizophrenia the more closely related by blood or genes with someone with schizophrenia that is higher the risk of developing schizophrenia. The most closely related is identical twins.
– If your twin has schizophrenia and you don’t your offspring can still be affected. |
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Schizophrenia: Genetic Influences
• Summary of Genetic Research |
– Risk of schizophrenia increases as a function of genetic relatedness
– One need not show symptoms of schizophrenia to pass on relevant genes – The closer you are related genetically the closer your risk. |
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(monozygotic) =
& (Dizygotic)= |
.48, .17
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Schizophrenia: Neurobiological Influences
• Neurobiology and Neurochemistry: The Dopamine Hypothesis |
– Drugs that increase dopamine (agonists), result in schizophrenic-like behavior
– Drugs that decrease dopamine (antagonists), reduce schizophrenic-like behavior – Examples include neuroleptics and L-Dopa for Parkinson’s disease |
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Schizophrenia: Other Neurobiological Influences
• Structural and Functional Abnormalities in the Brain |
– Enlarged ventricles and reduced tissue volume
– Hypofrontality – Less active frontal lobes (a major dopamine pathway) – Large scale brain dysfunctions |
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Schizophrenia: Other Neurobiological Influences
• Viral Infections During Early Prenatal Development |
– The relation between early viral exposure and schizophrenia is inconclusive
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Schizophrenia: Other Neurobiological Influences
• Conclusions About Neurobiology and Schizophrenia |
– Schizophrenia is associated with diffuse neurobiological dysregulation
– Structural and functional abnormalities in the brain are not unique to schizophrenia |
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Schizophrenia: Psychological and Social Influences
• The Role of Stress |
– May activate underlying vulnerability and/or increase risk of relapse
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Schizophrenia: Psychological and Social Influences
• Family Interactions |
– Families of people with schizophrenia show ineffective communication patterns
– High expressed emotion in the family is associated with relapse |
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Schizophrenia: Psychological and Social Influences
• The Role of Psychological Factors |
– Psychological factors likely exert only a minimal effect in producing schizophrenia
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Medical Treatment of Schizophrenia
• Antipsychotic (Neuroleptic) Medications |
– Medication is often the first line of treatment for schizophrenia
– Began in the 1950s (targeted dopamine) – Most medications reduce or eliminate the positive symptoms of schizophrenia (hallucinations and delusions) – Acute and permanent extrapyramidal and Parkinson-like side effects are common; involuntary movements – Poor compliance with medication is common – People were on the medicine for years or months at a time |
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Psychosocial Treatment of Schizophrenia
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• Psychosocial Approaches: Overview and Goals
– Behavioral (i.e., token economies) on inpatient units – Community care programs – Social and living skills training – Behavioral family therapy – Vocational rehabilitation • Psychosocial Approaches Are Usually a Necessary Part of Treatment |
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Psychosocial Treatment of Schizophrenia
• Atypical Anti- psychotics |
– Abilify, Ztrixa, Risperdal- targets positive and negative, side effects are much less
– Medicine isn’t the only treatment – Family therapy is often needed – Education and being straightforward and honest to the family. |
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• Myths of Schizophrenia:
|
– Vast majority lives in functioning communities (NOT HOSPITALS), they can manage symptoms better this week.
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• The Nature of Personality Disorders
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– Enduring and relatively stable predispositions (i.e., ways of relating and thinking)
– Predispositions are inflexible and maladaptive, causing distress and/or impairment; when you are 14 and an extrovert when you turn 40 you will still be one. – Cause trouble such as impairments in relationships with others and the world: includes employment. – Coded on Axis II of the DSM-IV and DSM-IV-TR- on mental retardation and personality disorders are on axis II***** • Mental Retardation and Personality on axis II because enduring engraving characteristic and difficult to treat and resistant to treatment******* |
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• DSM-IV and DSM-IV-TR Personality Disorder Clusters
– Cluster A |
– Odd or eccentric cluster (e.g., paranoid, schizoid, schizotypal)
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DSM-IV and DSM-IV-TR Personality Disorder Clusters
– Cluster B |
– Dramatic, emotional, erratic cluster (e.g., antisocial, borderline, histrionic, narcisstic)
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• DSM-IV and DSM-IV-TR Personality Disorder Clusters
– Cluster C |
Fearful or anxious cluster (e.g., dependent, avoidant, obsessive-compulsive)
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• Prevalence of Personality Disorders
|
– Affect about 0.5% to 2.5% of the general population
– Rates are higher in inpatient and outpatient settings |
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• Origins and Course of Personality Disorders****
|
– Thought to begin in childhood****
• manifested in adulthood **** – Tend to run a chronic course if untreated |
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• Paranoid Personality Disorder (A)
|
– Pervasive Odd or eccentric structure
– Paranoid Personality disorder – Pervasive pattern of distrust – Belief that others are out to get them – Always on guard, highly suspicious – Very negative and unjustified mistrust and suspicion |
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The casues of personality disorder are?
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– Biological and psychological contributions are unclear
– May result from early learning that people and the world is a dangerous place |
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• Treatment Options for personality disorders?
|
– Few seek professional help on their own
– Treatment focuses on development of trust – Cognitive therapy to counter negativistic thinking – Lack good outcome studies showing that treatment is efficacious |
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Cluster A: Schizoid Personality Disorder
• Overview and Clinical Features |
– Pervasive pattern of detachment from social relationships
– Very limited range of emotions in interpersonal situations – Little emotion in inner personal relations – May talk to people, but detached and little emotion – Neither desire or enjoy close relationships with others – May look like autism, social phobia – Very little interest in relationship – Very few seek help; they are ok with how they live their life. – Loners by choice |
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Cluster A: Schizoid Personality Disorder
The causes |
– Etiology is unclear
– Preference for social isolation in schizoid personality resembles autism |
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Cluster A: Schizoid Personality Disorder
Treatment options |
– Few seek professional help on their own
– Focus on the value of interpersonal relationships, empathy, and social skills – Treatment prognosis is generally poor – Lack good outcome studies showing that treatment is efficacious |
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Cluster A: Schizotypal Personality Disorder
• Overview and Clinical Features |
– Behavior and dress is odd and unusual
– Most unusal group behavior/mannerisms are odd (girl could tell the status of her day based on how license plate numbers added up) |
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Cluster A: Schizotypal Personality Disorder
• The Causes |
– Schizoid personality – A phenotype of a schizophrenia genotype?
– Left hemisphere and more generalized brain deficits |
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Cluster A: Schizotypal Personality Disorder
Treatment options |
– Main focus is on developing social skills
– Treatment also addresses comorbid depression – Medical treatment is similar to that used for schizophrenia – Treatment prognosis is generally poor |
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selective mutism****
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– developmental disorder characterized by the individuals consistent failure to speak in specific social situations despite speaking in other situations
Identified as verbal or communication disorder- these disorders can appear deceptively benign, yet their presence early in life can cause wide ranging problems later. Persistent failure to speak in specific situations – such as school – despite the ability to do so Most often occurs between the ages 5-7, more prevalent among girls than boys – anxiety is a possible cause |
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General differences in overall prevalence of personality disorders
Narcissistic PD |
In clinical populations 2.3%
more common in males In general populations.1% no difference |
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General differences in overall prevalence of personality disorders
Avoidant personality disorder |
In clinical populations14.7%
no difference In general populations 5.0-5.2% no difference |
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General differences in overall prevalence of personality disorders
Dependent personality disorder |
In clinical populations 1.4%
no difference In general populations0.6-1.5% no difference |
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General differences in overall prevalence of personality disorders
Obsessive Compulsive Disorder |
In clinical populations 8.7%
more common in males In general populations2.0-2.4% no difference |
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hallucinations are ?
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perceptions
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ppl having a hallucintation experience what?
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sensory experiences in the absense of external events
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Hallucinations
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– the experience of sensory events (someone called your name, or something moved by you) without any input from surrounding environment.
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• Hallucinations can involve many of the___?
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senses, although hearing things that aren’t there,
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auditory hallucinations are what?
|
is the most common form experienced by people with schizophrenia.
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Schizophrenia: The “Positive” Symptom Cluster
|
o Active manifestations of abnormal behavior, distortions or excesses of normal behavior
o Examples include delusions, hallucinations, and disorganized speech |
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Schizophrenia: The “Negative” Symptom Cluster
|
behavioral or cognitive deficits
o Absence or insufficiency of normal behavior o Examples are emotional/social withdrawal, apathy, and poverty of thought/speech • Spectrum of Negative Symptoms- think of the 4 A’s (Avolition, Alogia, Anhedonia, flat effect) |
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o Avolition ****
|
(or apathy) – Inability to initiate and persist in activities
-more than just a person who looks severely depressed |
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o Alogia ****
|
– A relative absence of speech or meaningful speech
|
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o Anhedonia
|
– Inability to experience pleasure or engage in pleasurable activities
|
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o Flat Affect
|
Show little expressed emotion, but may still feel emotion
-person’s affect is completely void of emotion |
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Schizophrenia: The “Disorganized” Symptoms
|
• The Disorganized Symptoms
Include severe and excess disruptions in speech, behavior, and emotion • Nature of Disorganized Speech Cognitive slippage – Illogical and incoherent speech Tangentiality – “Going off on a tangent” and not answering a question directly Loose associations or derailment – Taking conversation in unrelated directions |
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• Nature of Disorganized Speech
Cognitive slippage |
– Illogical and incoherent speech
|
|
Nature of Disorganized Speech
Tangentiality |
“Going off on a tangent” and not answering a question directly
|
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Nature of Disorganized Speech
Loose associations or derailment |
– Taking conversation in unrelated directions
|
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Catatonia
|
(Disorganized behavior)
– Spectrum from wild agitation, waxy flexibility (standing completely rigid- recall demo in class), to complete immobility |