REVIEW CENTER FOR ALLIED PROFESSIONS ABNORMAL PSYCHOLOGY (UNDERSTANDING NORMALITY AND ABNORMALITY) Ms. Amor Mia Arandia RP,RPm I. Understanding Abnormality Normal and Abnormal Criteria for Normality Normality is average. This means that what is accepted by the majority is considered normal. The problem here is that majority behavior is not always acceptable. Normality is Social Conformity. Anyone who conforms to social norms is normal. Normality is Social Comfort. If a person feels comfort or pleasure, then it is normal Normality is Ideal. What is good, what is socially acceptable and something that causes personal comfort. Normality is a Process. No one is instantly normal, we undergo certain processes and undergo adjustment. Example, coping Cultural Relativism -the view that there are no universal standards or rules for labeling a behavior as abnormal -behaviors can only be abnormal relative to cultural norms 1. 2. 3. Culture and gender can affect ways how people express their symptoms. Culture and gender can influence people’s willingness to admit certain types of behavior. Culture and gender can influence the types of treatments deemed acceptable or helpful for maladaptive behaviors Unusualness – Behaviors that are deviant, or unusual, are considered abnormal Distress – behaviors should be considered abnormal only if the individual suffers distress and wishes to be rid of the behaviors Mental Illness – Behaviors are not abnormal unless a part of a mental illness. The Four D’s of Abnormality 1. Dysfunction 2. Distress 3. Deviance 4. Dangerousness II. Recognizing Psychopathology • Typical Signs and Symptoms of Psychopathology Sadock, B.J., & Sadock, V.A. (2007). Kaplan & Sadock’s Synopsis of Psychiatry (10th ed.) Philadelphia, USA: Lippincott Williams & Wilkins Sign – Objective; Based from a clinician’s observation Symptom – Subjective; Experiences of the patient SYNDROME – constellation of signs and symptoms that make up a recognizable condition, is often used to show the overlap of the two DISTURBANCES OF CONSCIOUSNESS Consciousness – state of awareness Apperception – perception modified by one’s own thoughts and emotions Sensorium – sometimes used as another term for consciousness; refers to the state of functioning of the special senses Disorientation – disturbed orientation regarding time, place, or person. Delirium – patient exhibits confusion, restlessness, bewilderment, and a disoriented reaction that is usually associated with hallucinations and fear. Clouding of consciousness – state of perceptual and cognitive confusion. Stupor – a general condition wherein the patient exhibits extreme unresponsiveness and loss of orientation to the environment. Twilight state – a disturbance in consciousness, with hallucinations. Dreamlike state – another term for psychomotor epilepsy or complex partial seizure. Distractibility – the inability to concentrate or focus attention because patient is easily drawn to irrelevant external stimuli. Selective attention – blocking out of anxiety-causing stimuli. Hyper vigilance – excessive focus and attention is given to all internal and external stimuli due to paranoia. DISTURBANCES OF SUGGESTIBILITY Suggestibility - uncritical and compliant response to influence or an idea. Folie a deux (or folie a trois) – emotional/mental illness shared between two (or three) persons also called shared psychosis between two (or three) persons. Hypnosis – artificially induced consciousness characterized by heightened suggestibility DISTURBANCES IN EMOTION Emotion – a complex feeling or state related to mood and affect with psychic, somatic, and behavioral components. Affect – the expression or outward manifestation of emotion Appropriate affect – a normal condition wherein emotional tone is in harmony or is consistent with the accompanying thought, idea, or speech. It is also described as broad or full affect wherein a full range of emotions is appropriately expressed. Inappropriate affect – Inconsistency between the emotional tone and the idea, thought, or speech accompanying it. Blunted affect – characterized by a severe reduction in the intensity of the externalized feeling tone. Restricted or constricted affect – reduction in the intensity of feeling tone – It is less severe than blunted affect. Flat affect – the absence or near absence of any signs of affective expression. – It can be characterized by an immobile face and a monotonous voice. Labile affect – rapid and abrupt changes in the emotional feeling tone which is unrelated to an external stimuli Euphoria – intense elation with feelings of grandeur. Ecstasy – feeling of intense rapture or delight. Depression – the psychopathological feeling of sadness. Anhedonia – loss of interest and withdrawal from all regular and pleasurable activities. Often associated with depression. Grief or Mourning – sadness that is appropriate to a real loss. Alexithymia – the inability or difficulty in describing one’s moods or emotions. Anhedonia – loss of interest and withdrawal from all regular and pleasurable activities. Often associated with depression. Agitation – motor restlessness associated with severe anxiety. Tension – unpleasant increased motor and psychological activity. Panic – acute, episodic, intense anxiety attack associated with overwhelming feelings of dread. Apathy – dulled emotional tone associated with indifference or detachment Ambivalence – presence of two opposing impulses toward the same thing, in the same person, at the same time. PHYSIOLOGICAL DISTRUBANCES ASSOCIATED WITH MOOD Physiological disturbances associated with mood – Signs that refer to the somatic (usually autonomic) dysfunction of a person, which are most often associated with depression; also known as vegetative signs. Anorexia – loss of or decrease in appetite. Hyperphagia – increase in appetite and food intake. Hypersomnia – excessive sleeping. Insomnia – difficulty or lack the lack of ability to fall asleep. Initial – difficulty in falling asleep. (early onset) Middle – difficulty in sleeping through the night without waking up; difficulty in going back to sleep if awaken in the middle of the night. (middle onset) Terminal – early morning awakening. (late onset) Diurnal variation – mood is regularly worst in morning, immediately after awakening, and improves as the day progresses. Diminished libido – decreased sexual interest, drive, and performance. – Increased libido is usually associated with manic states. Constipation – inability or difficulty in defecating DISTURBANCES IN MOTOR FUNCTIONING Echopraxia – the person’s pathological imitation of movements of another person. Catatonia – motor anomalies in non-organic disorders (as opposed to disturbances of consciousness and motor activity secondary to organic pathology) Negativism – motiveless resistance to all instructions or to all attempts to be moved. Catalepsy – general term used to describe an immobile position that is constantly maintained. Catatonic Excitement – agitated, purposeless motor activity that is uninfluenced by external stimuli. Catatonic Stupor – noticeable slowed motor activity, often to a point of immobility and seeming unawareness of surroundings. Catatonic Rigidity – voluntary assumption of a rigid posture, held against all efforts to be moved. Catatonic Posturing – voluntary assumption of an inappropriate or bizarre posture which is generally maintained for long periods of time. Cerea Flexibilitas (Waxy Flexibility) – a condition wherein the person can be molded into a position that is then maintained. When the examiner moves the person’s limb, the limb feels as if it were made of wax. Cataplexy – temporary muscle weakness and loss of muscle tone precipitated by a variety of emotional states. Stereotypy – repetitive fixed pattern of physical action or speech. Mannerism – deep-seated/ingrained and habitual involuntary movement. Automatism – automatic performance of an act or acts generally representative of unconscious symbolic activity. Command Automatism – automatic following of suggestions. (automatic obedience) Mutism – voicelessness that is not caused by structural abnormalities or physical conditions. Overactivity – abnormality in motor behavior that can manifest itself as psychomotor agitation, hyperactivity, tic, sleepwalking, or compulsions Psychomotor Agitation – excessive motor and cognitive overactivity, usually nonproductive and in response to inner tension. Hyperactivity (Hyperkinesis) – restless, aggressive, and destructive activity, often associated with some underlying organic pathology. Tic – involuntary, spasmodic motor movement. Sleepwalking (Somnambulism) – motor activity during sleep. Akathisia – subjective feeling of muscular tension secondary to antipsychotic or other medication, which can cause restlessness, pacing, repeated sitting and standing; can be mistaken for psychotic agitation. Compulsion – uncontrollable impulse to perform an act repetitively Dipsomania – compulsion to drink alcohol. Kleptomania – compulsion to steal. Nymphomania – excessive and compulsive need for coitus in a woman. Satyriasis – excessive and compulsive need for coitus in a man. Trichotillomania – compulsion to pull out one’s hair. Ritual – automatic activity compulsive in nature, anxiety-reducing in origin. Hypoactivity (Hypokinesis) – decreased motor and cognitive activity, as in psychomotor retardation; visible slowing of thought, speech and movements. Mimicry – simple, imitative motor activity of childhood. Aggression – forceful goal-directed action that may be verbal or physical; the motor counterpart of the affect of rage, anger, or hostility. Acting out – direct expression of an unconscious wish or impulse in action; unconscious fantasy is lived out impulsively in behavior. DISTURBANCES IN THINKING Thinking – the goal-directed flow of ideas. – Symbols and associations initiated by problem or task and leading toward a reality-oriented conclusion. o GENERAL THINKING DISTURBANCES IN THE FORM OF Mental disorder – clinically significant behavioral or psychological syndrome that is associated with distress or disability, and not just an expected response to a particular event. Psychosis – inability to distinguish reality from fantasy. Impairment in reality testing, with creation of a new reality. Reality testing – the objective evaluation and judgment of the world outside the self. Formal though disorder – disturbance in the form of thought instead of the content of thought. – Thinking is characterized by loosened associations, neologisms, and illogical constructs. – Thought process is disordered and the person defined psychotic. Illogical thinking – thinking containing erroneous conclusions or internal contradictions. It is considered psychopathological only when it is marked and when not caused by cultural values or intellectual deficit. Dereism – mental activity not concordant with logic experience. SPECIFIC DISTURBANCES THOUGHT IN THE FORM OF Autistic Thinking – thinking that gratifies unfulfilled desires but has no regard for reality – a preoccupation phase in children in which thoughts, words, or actions assume power. Magical thinking – a form of dereistic thought; thinking similar to that of the preoperational phase in children (Jean Piaget), in which thoughts, words, or actions assume power (e.g., to cause or to prevent events). Primary process thinking – general term for thinking that is dereistic – illogical and magical – normally found in dreams, abnormally in psychotics. GENERAL DISTURBANCES PROCESS OF THINKING IN THE FORM OR Neologism – new word or phrase whose derivation cannot be understood – often seen in schizophrenia – it has also been used to mean a word that has been incorrectly constructed but whose origins are nonetheless understandable (e.g., headshoe to mean hat), but such constructions are more properly referred to as word approximations. Word Salad – incoherent, essentially incomprehensible, mixture of words and phrases commonly seen in far-advanced cases of schizophrenia (See also incoherence.). Circumstantiality – disturbance in the associative thought and speech processes in which a patient digresses into unnecessary details and inappropriate thoughts before communicating the central idea – observed in schizophrenia, obsessional disturbances, and certain cases of dementia. Tangentiality – oblique, digressive, or even irrelevant manner of speech in which the central idea is not communicated. Incoherence – thought that, generally is not understandable – patient never gets from desired point to desired goal. Perseveration – pathological repetition of the same response to different stimuli, as in a repetition of the same verbal response to different questions – persistent repetition of specific words or concepts in the process of speaking. – Seen in cognitive disorders, schizophrenia, and other mental illness. Verbigeration – meaningless and stereotyped repetition of words or phrases, as seen in schizophrenia – also called cataphasia. Echolalia – a person’s psychopathological repeating of words or phrases of by another – tends to be repetitive and persistent – Seen in certain kinds of schizophrenia, particularly the catatonic types. Condensation – mental process in which one symbol stands for a number of components. Irrelevant answer – answer that is not in harmony with question asked. Loosening of associations – characteristic schizophrenic thinking or speech disturbance involving a disorder in the logical progression of thoughts – manifested as a failure to communicate verbally adequately – unrelated and unconnected ideas shift from one subject to another. Derailment – gradual or sudden deviation in train of thought without blocking – sometimes used synonymously with loosening of association. Flight of ideas – rapid succession of fragmentary thoughts or speech in which content changes abruptly and speech may be incoherent. Clang association – association or speech directed by the sound of a word rather than by its meaning – words have no logical connection – punning and rhyming may dominate the verbal behavior. – Seen most frequently in schizophrenia or mania. Blocking – abrupt interaction in train of thinking before a thought or idea is finished after brief pause, person indicates no recall of what was being said or was going to be said. Glossolalia – unintelligible jargon that has meaning to the speaker but not to the listener – occurs in schizophrenia. Poverty of content – thought that gives little information because of vagueness, empty repetitions, or obscure phrases. Overvalued idea – false or unreasonable belief or idea that is sustained beyond the bounds of reason; it is held with less intensity or duration than a delusion, but is usually associated with mental illness. Delusion – false belief, based on incorrect inference about external reality, not consistent with patient’s intelligence and cultural background that cannot be corrected by reasoning SPECIFIC DISTURBANCES IN THE CONTENT OF THOUGHT Bizarre delusion – false belief that is patently absurd or fantastic (e.g., invaders from space have implanted electrodes in a person's brain), common in schizophrenia. Systematized delusion – group of elaborate delusions related to a single event or theme. Mood-congruent delusion – delusion with content that is mood appropriate (e.g., depressed patients who believe that they are responsible for the destruction of the world). Mood-incongruent delusion – delusion with content that has no association to mood or is mood-neutral. Nihilistic delusion – depressive delusion that the world and everything related to it have ceased to exist. Delusion of poverty – false belief that one is bereft or will be deprived of all material possessions Somatic Delusion – delusion pertaining to the functioning of one's body. Paranoid delusions – includes persecutory delusions and delusions of reference, control, and grandeur Delusion of persecution Delusion of grandeur Delusion of reference Delusion of self-accusation – false feeling of remorse and guilt. Seen in depression with psychotic features. Delusion of control – false belief that a person's will, thoughts, or feelings are being controlled by external forces. Thought withdrawal Thought insertion Thought broadcasting Delusion of infidelity – false belief that one's lover is unfaithful. Sometimes called pathological jealousy. Erotomania – delusional belief, more common in women than in men, that someone is deeply in love with them (also known as de Clérembault syndrome). Pseudologia fantastica – a type of lying, in which the person appears to believe in the reality of his or her fantasies and acts on them. Preoccupation of thought – centering of thought content on a particular idea, associated with a strong affective tone, such as a paranoid trend or a suicidal or homicidal preoccupation. Egomania – morbid self-preoccupation or self-centeredness. Monomania – mental state characterized by preoccupation with one subject. Hypochondria – exaggerated concern about health that is based not on real medical pathology, but on unrealistic interpretations of physical signs or sensations as abnormal. Obsession – persistent and recurrent idea, thought, or impulse that cannot be eliminated from consciousness by logic or reasoning – obsessions are involuntary and ego-dystonic. Compulsion – pathological need to act on an impulse that, if resisted, produces anxiety – repetitive behavior in response to an obsession or performed according to certain rules, with no true end in itself other than to prevent something from occurring in the future. Coprolalia – involuntary use of vulgar or obscene language. Observed in some cases of schizophrenia and in Tourette's syndrome. Phobia – persistent, pathological, unrealistic, intense fear of an object or situation – the phobic person may realize that the fear is irrational but, nonetheless, cannot dispel it. Simple phobia Social phobia Acrophobia Algophobia Claustrophobia Xenophobia Zoophobia Noesis – a revelation in which immense illumination occurs in association with a sense that one has been chosen to lead and command. Unio mystica – feeling of mystic unity with an infinite power. DISTURBANCE IN SPEECH Speech – ideas, thoughts, feelings as expressed through language; communication through the use of words and language. Pressure of Speech – rapid speech that is increased in amount difficult to interpret. Volubility (logorrhea) – copious, coherent, logical speech – excessive talking observed in manic episodes of bipolar disorder. – (also known as tachylogia, verbomania) Poverty of Speech – restriction in the amount of speech used; replies may be mono-syllabic. Dysarthria – difficulty in articulation, not in word finding or in grammar. Excessively loud or soft speech – loss of modulation of normal speech volume – may reflect a variety of pathological conditions ranging from psychosis to depression to deafness. Stuttering – frequent repetition or prolongation of a sound or syllable, leading to markedly impaired speech fluency. Cluttering – erratic and dysrhythmic speech, consisting of rapid and jerky spurts. APHASIC DISTURBANCES Dysarthria – difficulty in articulation, not in word finding or in grammar. Excessively loud or soft speech – loss of modulation of normal speech volume – may reflect a variety of pathological conditions ranging from psychosis to depression to deafness. Stuttering – frequent repetition or prolongation of a sound or syllable, leading to markedly impaired speech fluency. Cluttering – erratic and dysrhythmic speech, consisting of rapid and jerky spurts. Syntactical Aphasia – inability to arrange words in proper sequence. Jargon Aphasia – words produced are totally neologistic – nonsense words repeated with various intonations and inflections. Global Aphasia – combination of a grossly non-fluent aphasia and a severe fluent aphasia. DISTURBANCES OF PERCEPTION Perception – process of transferring physical stimulation into psychological information; the mental process by which sensory stimuli are brought into awareness. Illusion – misperception or misinterpretation of real external sensory stimuli. Hallucination – false sensory perception not associated with real external stimuli – there may or may not be a delusional interpretation of the hallucinatory experience – hallucinations indicate a psychotic disturbance only when associated with impairment in reality testing Hypnagogic Hallucination – false sensory perception occurring while falling asleep; generally considered a non-pathological phenomenon. Hypnopompic Hallucination – false perception occurring while awakening from sleep – generally considered non-pathological. Auditory Hallucination – false perception of sound, usually voices but also other noises such as music; most common hallucination in psychiatric disorders. Visual Hallucination – false perception involving sight consisting of both formed images(e.g. people) and unformed images (e.g. flashes of light) – most common in organically determined disorders. Olfactory Hallucination – false perception in smell – most common in organic disorders. Gustatory Hallucination – false perception of taste, such as unpleasant taste caused by an uncinate seizure – most common in organic disorders. Tactile (Haptic) Hallucination – false perception of touch or surface sensation, as from an amputated limb (phantom limb), crawling sensation on or under the skin (formication). Somatic Hallucination – false sensation of things occurring in or to the body, most often visceral in origin (also known as cenesthetsic hallucination). Lilliputian Hallucination – false perception in which objects are seen as reduced in size (also termed micropsia). Mood-congruent Hallucination – a kind of hallucination wherein the content of which is consistent with either a depressed or manic mood (e.g. a depressed patient hears voices saying that the patient is a bad person – a manic patient hears voices saying that the patient is inflated of worth, power, knowledge, etc.) Mood-incongruent Hallucination – Hallucination whose content is not consistent with either depressed or manic mood (e.g. in depression, hallucinations not involving such themes as guilt, deserved punishment, or inadequacy – in mania, hallucinations not involving such themes as inflated worth or power) Hallucinosis – Hallucinations, most often auditory, that are associated with chronic alcohol abuse and that occur within a clear sensorium. Trailing Phenomenon – perceptual abnormality associated with hallucinogenic drugs in which moving object are seen as a series of discrete and discontinuous stages. DISTURBANCES ASSOCIATED MENTAL DISORDER WITH ORGANIC Anosognosia – inability to recognize illness as occurring to oneself. Autotopagnosia – inability to recognize a body part as one’s own. Visual Agnosia – inability to recognize objects or persons. Astereognosia – inability to recognize objects by touch. Prosopagnosia – inability to recognize faces. Apraxia – inability to carry out specific tasks. DISTURBANCES ASSOCIATED WITH CONVERSION AND ASSOCIATIVE DISSOCIATION Astereognosia – inability to recognize objects by touch. Prosopagnosia – inability to recognize faces. Apraxia – inability to carry out specific tasks. Somatization of repressed material or the development of physical symptoms and distortions involving the voluntary muscle or special sense organs not under voluntary control and not explained by any physical disorder DISTURBANCES ASSOCIATED WITH CONVERSION AND DISSOCIATIVE PHENOMENA Hysterical Anesthesia – loss of sensory modalities resulting from emotional conflicts. Macropsia – state in which objects seem larger than they are. Micropsia – state in which objects seem smaller than they are (both macropsia and micropsia can also be associated with clear organic conditions such as complex partial seizures). Depersonalization – a subjective sense of being unreal, strange, or unfamiliar to oneself. Derealization – a subjective sense that the environment is strange or unreal – a feeling of changed reality. Fugue – taking on a new identity with amnesia for the old identity – often involves travel or wandering to new environments. Multiple personality – one person who appears at different times to be in possession of an entirely different personality and character. DISTURBANCES OF MEMORY Memory – function by which information stored in the brain is later recalled to consciousness Amnesia – partial or total inability to recall past experiences; may be organic or emotional in origin. Paramnesia – falsification of memory by distortion of recall. Fausse reconnaissance – false recognition. Retrospective falsification – memory becomes unintentionally (unconsciously) distorted by being filtered through patient’s present emotional, cognitive, and experiential state. Confabulation – unconscious filling of gaps in memory by imagined or untrue experiences that patient believes but that have no basis in fact; most often associated with organic pathology. Déjà vu – illusion of visual recognition in which a new situation is correctly regarded as a repetition of a previous memory. Déjà entendu – illusion of auditory recognition. Déjà pense – illusion that a new thought is recognized as a thought previously felt or expressed. Jamias vu – false feeling of unfamiliarity with a real situation one has experienced. False memory – a person’s recollection and belief by the patient of an event that did not actually occur. Hypermnesia – exaggerated degree of retention and recall. Eidetic image – visual memory of almost hallucinatory vividness. Screen memory – a consciously tolerable memory covering for a painful memory. Repression – a defense mechanism characterized by unconscious forgetting of unacceptable ideas or impulses. Lethologica – temporary inability to remember a name or a proper noun. Blackout – amnesia experienced by alcoholics about behavior during drinking bouts – usually indicates that reversible brain damage has occurred. o LEVELS OF MEMORY Immediate – reproduction or recall of perceived material within seconds to minutes. Recent – recall of events over past few days. Recent past – recall of events over past few months. Remote – recall of events in distant past. o DISTURBANCES OF INTELLIGENCE Intelligence – the ability to understand, recall, mobilized, and constructively integrates previous learning in meeting new situations. Mental Retardation – Lack of intelligence to a degree in which there is interference with social and vocational performance Mild – I.Q. of 50 or 55 to approximately 70 Moderate – I.Q. of 35 or 40 to 50 or 55 Severe – I.Q. of 20 or 25 to 35 or 40 Profound – I.Q. below 20 or 25 Dementia – organic and global deterioration of intellectual functioning without clouding of consciousness Pseudodementia – clinical features resembling a dementia not caused by an organic mental dysfunction – most often caused by depression. Concrete thinking – literal thinking – limited use of metaphor without understanding of nuances of meaning – one dimensional thought. Abstract thinking – ability to appreciate nuances of meaning – multidimensional thinking with ability to use metaphors and hypotheses appropriately. ABNORMAL PSYCHOLOGY (DETERMINANTS AND PERSPECTIVES) Ms. Amor Mia Arandia RP,RPm I. DETERMINANTS OF PSYCHOPATHOLOGY o o o BIOLOGICAL DETERMINANTS PSYCHOLOGICAL DETERMINANTS SOCIO-CULTURAL DETERMINANTS CONSIDER THE FOLLOWING: – – – PREDISPOSING FACTORS A factor that makes someone prone or susceptible to a certain pathology Remote Effect does not come out at an early stage only when triggered – – PRECIPITATING FACTORS Factors that trigger the onset of a certain disorder Immediate Effect – BIOLOGICAL DETERMINANTS OF BEHAVIOR Can be predisposing or precipitating factor A. B. C. D. E. F. GENETIC FACTOR BIOLOGICAL DEPRIVATION OBNOXIOUS AGENTS ACCIDENTS BODY CONSTITUTIONS BIOCHEMICAL FACTORS 1. Genetic Factors – hereditary Ex. Huntington’s disease – transmitted through a dominant gene; directly transferred from a parent to a child; progressive disease Symptoms: chorea – abnormal contractions of large groups of muscles which appear like dancing Dementia – intellectual deterioration 2. Biological Deprivation – such as nutrition, minerals, vitamins Ex. In ortomolecular medicine: a schizophrenic patient is given a massive dose of vitamins – lack of sleep Ex. The german sleep experiments 3. – – Obnoxious Agents toxichemicals (toxic chemicals) like lead poisoning or carbon monoxide poisoning psychoactive drugs like alcohol or methametamine 4. – – Accidents those that damage the brain brain injury leading to abnormal behavior 5. – Body Constitutions biological make-up of the person ex. Condition of the receptors (any organ that responds to any stimulus) Ex. Conversion Disorders – a somatoform disorder, eyes: conversion blindness, when eyes are weak and the person is subjected to a traumatic event Ears: conversion deafness: one experiences deafness w/o any biological source/condition Defense to anxiety/avoid anxiety provoking stimuli related to the trauma 6. Biochemical factors – in some cases of neurotransmitters Ex. Dopamine hypothesis: lower dopamine level in the brain is associated with parkinson’s disease High levels = schizophrenia Norepinephrine: depression PSYCHOLOGICAL DETERMINANTS OF BEHAVIOR Can be predisposing or precipitating factor SOCIO-CULTURAL DETERMINANTS OF BEHAVIOR precipitating factor A. B. C. D. E. POVERTY/UNEMPLOYMENT WAR RACIAL DISCRIMINATION RURAL-URBAN SETTING RESIDENTIAL MOBILITY II. PERSPECTIVES IN EXPLAINING THE CAUSE OF ABNORMAL BEHAVIOR Note: Review the different theories. o o o BIOLOGICAL PERSPECTIVES PSYCHOLOGICAL PERSPECTIVES SOCIOCULTURAL PERSPECTIVES A. BIOLOGICAL PERSPECTIVE NEUROBIOLOGICAL PERSPECTIVES – Nervous system controls our behavior – Ex.: Generalized Anxiety Disorder (GAD)GABA System is less functioning A. B. C. D. STRESS FRUSTRATION OVER-USE OF DEFENSE MECHANISMS PSYCHOLOGICAL DEPRIVATION A. – – Stress – precipitating factor A person who is more stressed is more prone to disorders Psychoneuroimmunology; diathesis-stress model B. – Frustration – precipitating factors can be personal (personal inadequacies) or environmental BRAIN DYSFUNCTION Biochemical imbalance Genetic Abnormalities C. Over-use of defense mechanisms – Defense mechanisms- protect the ego (why do we need to protect the ego? Executive of the personality) – there should only be moderate use – over-use can lead to defense mechanisms being symptoms of psychopathology Ex. Denial – can lead to conversion symptoms (tunnel vision: eccentric, narrowing field of vision bec of the denial of a large part of reality) Regression – disorganized schizophrenic Reaction Formation – a mother who experienced rejection during childhood may become overcaring and overprotective “the lady doth protest too much, methinks” OCD Isolation – isolating and idea from affect, so as not to feel guilty. pathological gambling Rationalization – giving justification for one’s unacceptable reality to make it acceptable Sour graping, sweet lemoning, rat. By comparison, by procrastination, by predestination (using destiny), by exception (first time, only time), sympathism (seeking sympathy for the ego, putting one’s self in a low position/underdog) D. – – – Psychological Deprivation - lack of attention, affection parental rejection abandonment need for achievement, prestige and recognition can lead to narcissistic behavior o Cause is disordered motivation which refers to: 1. Excessive negative motivation – guilt that leads to depression then to suicide Guilt which leads to OCD = ablutomania compulsive washing of hands 2. Excessively weak or strong motivation Persons with weak need for independence will Dependent personality disorder Anorexia nervosa – weak or loss of apettite Phobic reaction zoophobia vs. zoophilia OCD a. b. c. d. develop BRAIN DYSFUNCTION BIOCHEMICAL IMBALANCE GENETIC ABNORMALITIES • • • Note: Review the parts and functions of the brain. Review the different neurotransmitters. – – – – Result of Injury From diseases that cause deterioration Ex. Schizophrenia – cerebral cortex does not function effectively or normally. Role of Neurotransmitter Systems Malfunctioning of Neurotransmitter systems Psychological symptoms may be the consequence of malfunctioning in neurotransmitter systems; psychological experiences also may cause changes in neurotransmitter system functioning • Role of Receptors on the Dendrites – Few Receptors or not sensitive enough • the neuron will not be able to make adequate use of the neurotransmitter available in the synapse – Too Many Receptors or oversensitive • the neuron may be overexposed to the neurotransmitter that is in the synapse. • The amount of a neurotransmitter available in the synapse can be affected by two processes. • The process of reuptake occurs when the initial neuron releasing the neurotransmitter into the synapse reabsorbs the neurotransmitter, decreasing the amount left in the synapse. • Another process, called degradation, occurs when the receiving neuron releases an enzyme into the synapse that breaks down the neurotransmitter into other biochemicals. The reuptake and degradation of neurotransmitters happen naturally. • When one or both of these processes malfunction, abnormally high or low levels of neurotransmitter in the synapse result. • • • Example: o Arithmomania – uncontrollable urge to count, involves the frontal lobe (prefrontal cortex) Feedback Loop – controls our behavior,diminished serotonin sensitivity, over-arousal happens, causes dysfunction n the feedback loop and there is lack of control in behavior The Role of the Endocrine System – Hormones – Pituitary Gland and Hypothalamus • Stress Response – corticotropin release factor (CRF) • HPA Axis – anxiety and depression Other biochemical theories of psychopathology focus on the body’s endocrine system. This system of glands produces chemicals called hormones, which are released directly into the blood. A hormone carries messages throughout the body, potentially affecting a person’s moods, levels of energy, and reactions to stress. Pituitary Gland – master gland PG and Hypothalamus illustrates the relationship of the Nervous System to the Endocrine System CRF is carried from the hypothalamus to the pituitary through a channel-like structure. The CRF stimulates the pituitary to release the body’s major stress hormone, adrenocorticotrophic hormone (ACTH). ACTH, in turn, is carried by the bloodstream to the adrenal glands and to various other organs of the body, causing the release of about 30 hormones, each of which plays a role in the body’s adjustment to emergency situations anxiety and depression suggest that these disorders result from dysregulation, or malfunctioning, of a system called the hypothalamicpituitary- adrenal axis BEHAVIORAL GENETICS – – – Study of the genetics of personality and abnormality Alteration in the gene structure can cause abnormalities Genes and the Environment B. PSYCHOLOGICAL PERSPECTIVE • • • • BEHAVIORAL PERSPECTIVE COGNITIVE PERSPECTIVE PSYCHODYNAMIC PERSPECTIVE HUMANISTIC PERSPECTIVE • Psychodynamic Perspective – all behavior, thoughts, and emotions, whether normal or abnormal, are influenced to a large extent by unconscious processes • Need and Motives, conscious or unconscious • Conflicts • Defense mechanisms Kleptomania: unconscious need for affection and attention Ablutomania: guilt for wrong doing Thanatomania-urge to go to funerals Ego-dystonic - unacceptable to the ego Ego syntonic- acceptable Depression: Psychodynamic: lost of self-esteem Anger turned inward Feeling of helplessness Conversion blindness – denial • • • • • • • • • • • Behavioral Perspective – Influences of punishments and reinforcements in producing behavior • Classical Conditioning • Operant Conditioning • Modeling • Observational Learning • Cognitive Perspective – Thoughts or beliefs shape our behaviors and the emotions we experience – causal attribution • Specific answers to “why” questions – global assumptions • Broad beliefs • Dysfunctional beliefs 1. 2. 3. I should be loved by everyone for everything I do. It is better to avoid problems than to face them. I should be completely competent, intelligent, and achieving in all I do. I must have perfect self-control. 4. • Humanistic Perspective • Assumption that humans have an innate capacity for goodness and for living a full life. • humanistic theorists recognized that we often are not aware of the forces shaping our behavior and that the environment can play a strong role in our happiness or unhappiness • Self-actualization • People often experience conflict because of differences between their true self—the ideal self they wish to be—and the self they feel they ought to be to please others. This conflict can lead to emotional distress, unhealthy behaviors, and even loss of touch with reality. o SOCIO-CULTURAL PERSPECTIVES o suggest that we need to look beyond the individual or even the family to the larger society to understand people’s problems (1) socio-economic disadvantage is a risk factor for a wide range of mental health problems (2) the upheaval and disintegration of societies due to war, famine, and natural disaster are potent risk factors for mental health problems (3) Social norms and policies that stigmatize and marginalize groups (4) societies may influence the types of psychopathology their members show by having implicit or explicit rules about what types of abnormal behavior are acceptable ABNORMAL PSYCHOLOGY (CLINICAL ASSESSMENT AND DIAGNOSIS) Ms. Amor Mia Arandia RP,RPm ASSESSMENT – Gathering information regarding people’s symptoms and the possible causes of these symptoms. DIAGNOSIS – A label for a set of symptoms that often occur together – process of determining whether the particular problem afflicting the individual meets all criteria for a psychological disorder CLINICAL ASSESSMENT – the systematic evaluation and measurement of psychological, biological, and social factors in an individual presenting with a possible psychological disorder Assessment Tools – Tools have been developed by clinicians to gather information – Assessment tools need to be Valid, Reliable and Standardized Validity – Accuracy of a test to measure what it is supposed to measure FACE VALIDITY – Based from face value, it can measure what it purports to measure CONTENT VALIDITY – Extent to which a test assesses all the important aspects of a phenomenon that it purports to measure CONCURRENT VALIDITY – extent to which a test yields the same results as other, established measures of the same behavior, thoughts, or feelings PREDICTIVE VALIDITY – good at predicting how a person will think, act, or feel in the future CONSTRUCT VALIDITY – extent to which a test measures what it is supposed to measure and not something else altogether • • BEHAVIORAL OBSERVATIONS AND SELFMONITORING • Behavioral Observation • to assess deficits in skills or ways of handling situations • looking for specific behaviors and what precedes and follows these behaviors • Advantage: not relying on self-reports • Disadvantage: changing of behavior when observed; different conclusions/observer • ABCs of Observation • Antecedents • Behavior • Consequences • Self-Monitoring • Keeping track of behaviors • Disadvantage: bias of the individual to report behaviors • Advantage: discovery of triggers of certain behaviors • PERSONALITY INVENTORIES • Questionnaires meant to assess people’s typical ways of thinking, feeling, and behaving • Part of an assessment procedure to obtain information on people’s well-being, self-concept, attitudes and beliefs, ways of coping, perceptions of their environment and social resources, and vulnerabilities • MMPI – Minnesota Multiphasic Personality Inventory • MMPI-2: 567 items • INTELLIGENCE TESTS • In clinical practice, intelligence tests are used to get a sense of an individual’s intellectual strengths and weaknesses, particularly when mental retardation or brain damage is suspected • Wechsler Adult Intelligence Scale , the StanfordBinet Intelligence Test , and the Wechsler Intelligence Scale for Children • NEUROPSYCHOLOGICAL TESTS • Useful in detecting specific cognitive deficits such as a memory problem • Used when impairment in neurological functioning is suspected • Paper-and-pencil • Bender-Gestalt Test (Bender Visual Motor Gestalt Test, BVMGT), Strength of Grip Test • BRAIN IMAGING TECHNIQUES • To identify specific deficits and possible brain abnormalities • To determine if there is brain injury, tumors, or damage • Brain Activity and Structure • COMPUTERIZED TOMOGRAPHY (CT) • Enhanced x-ray procedure • Brain structure • POSITRON-EMISSION TOMOGRAPHY • Brain activity ASSESSMENT RELIABILITY Reliability – Consistency of a test in measuring what it is supposed to measure TEST-RETEST RELIABILITY – Consistency of the test results over time ALTERNATE FORM RELIABILITY – Results on a similar version of the test are similar INTERNAL RELIABILITY – Similarity in people’s answers among different parts of the same test INTERRATER RELIABILITY – Interjudge Reliability Standardization – A way to improve validity and reliability DIFFERENT KINDS OF ASSESSMENT TOOLS CLINICAL INTERVIEW SYMPTOM QUESTIONNAIRES BEHAVIORAL OBSERVATIONS AND SELFMONITORING 4. PERSONALITY INVENTORIES 5. INTELLIGENCE TESTS 6. NEUROPSYCHOLOGICAL TESTS 7. BRAIN IMAGING TECHNIQUES 8. PSYCHOPHYSIOLOGICAL TESTS & PHYSICAL EXAMINATION 9. PROJECTIVE TESTS 10. CLINICAL INTERVIEW • Much of the information is gather through an initial interview • May include a Mental Status Exam • Person’s general functioning • Mental Status Exam • Appearance and Behavior • Thought Processes • Speech • Mood and Affect • Intellectual Functioning • Memory and Attention • Orientation/Sensorium • Time, place, person, object 1. 2. 3. • Structured Interviews • Series of questions asked about a particular symptom that is currently experienced or experienced in the past • format of the questions and the entire interview is standardized, and the clinician uses concrete criteria to score the person’s answers SYMPTOM QUESTIONNAIRES • Quick way to identify symptoms • Questionnaires can cover a wide variety of symptoms representing several different disorders • Focus on the symptoms of specific disorders • Beck Depression Inventory (BDI), Trauma Symptom Inventory (TSI), Harvard T Scale Requires injecting the patient with a harmless radioactive isotope, such as fluorodeoxyglucose SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY (SPECT) • Similar to PET but different tracer substance, lesser accuracy, cheaper MAGNETIC RESONANCE IMAGING Detailed structure of brain anatomy fMRI - functions • • • • • • • PSYCHOPHYSIOLOGICAL TESTS & PHYSICAL EXAMINATION • alternative methods to CT, PET, SPECT, and MRI used to detect changes in the brain and nervous system that reflect emotional and psychological changes • Electroencephalogram (EEG) – electrical activity along the scalp produced by the firing of specific neurons in the brain • By Physician • Can show the medical condition • Rule out medical conditions • Conditions associated with medical conditions PROJECTIVE TESTS • PROJECTIVE HYPOTHESIS • When people attempt to understand an ambiguous or vague stimulus, their interpretation of the stimulus reflects their needs, feelings, experiences, prior conditioning, thought processes and so forth (L. K. Frank, 1939) • People are thought to project these issues onto their description of the “content” of the stimulus • Useful in uncovering the unconscious issues or motives of a person or in cases when the person is resistant or heavily biasing the information he or she presents to the assessor • Rorschach Inkblot Test, Thematic Apperception Test, Sentence Completion Tests, HTP, DAPT o o • PSYCHODIAGNOSIS • Full evaluation of the patient’s personality structure and functioning • Give emphasis on the specific behavior patterns of the patient • PSYCHODIAGNOSIS • Classify the disorder of the patient • Do differential diagnosis • Psychodiagnostic impression can change • Consider other factors such as duration APPROACH IN DIAGNOSIS • • DIAGNOSIS Syndrome: Label that is attached to a set of symptoms that occur together. Observe humans and identify syndromes based on frequently co-occurring symptoms Several symptoms make up a syndrome, but people differ in which of these symptoms they experience most strongly List of symptoms that co-occur within the individual PHASES OF DIAGNOSIS • • • • • o o o o o o o o Symptomatic Diagnosis: Aimed to remove the symptoms Characterological Diagnosis: Aimed at identifying the personality dynamics – character Look into the typical signs and symptoms manifested by the individual With the symptoms, one can identify the disorder Look into the personality dynamics, personality, psychodynamics, or behavior dynamics Needs, motives – satisfied or unsatisfied Conflicts Unresolved conflicts Fixations DESCRIPTIVE PHASE • Give a battery of psychological tests • Interview • Organogenic vs. Psychogenic 2. INFERENTIAL PHASE • Interpretative Phase • Makinginferences • Making interpretations • Formulating theories Classification • referring simply to any effort to construct groups or categories and to assign objects or people to these categories on the basis of their shared attributes or relations—a nomothetic strategy. Taxonomy • which is the classification of entities for scientific purposes Nosology • applying a taxonomic system to psychological or medical phenomena or other clinical areas Nomenclature • describes the names or labels of the disorders that make up the nosology CLASSIFICATION ISSUES • CATEGORICAL vs. DIMENSIONAL APPROACHES – Categories: all or nothing; clearly differentiate – Dimensions: quantifying attributes and coming up with a composite score • Classical Categorical Approach • Categories • Criteria Dimensional Approach • note the variety of cognitions, moods, and behaviors with which the patient presents and quantify them on a scale • Personality Disorders (Axis II) Prototypical Approach • identifi es certain essential • characteristics of an entity so that it can be classified, but it also allows certain nonessential DIAGNOSIS o Idiographic Approach • Specific to the patient Nomothetic Approach • Universal or global GOALS OF DIAGNOSIS • Aimed at treatment rather than classification • Prognosis • Development of Insight • CHALLENGES IN ASSESSMENT • Resistance – Does not want to provide information • Inability to Provide Information • Assessing Children • Assessing Individuals Across Cultures • Avoiding Barnum Effect Coping mechanisms Defense mechanisms • • variations that do not necessarily change the classification Diagnostic and Statistical Manual of Mental Disorders • Official Manual for Diagnosing Psychological Disorders • American Psychiatric Association • DSM : 1952 • DSM-II: 1968 • DSM-III: 1980 • DSM-IIIR: 1987 • DSM-IV: 1994 • DSM-IV-TR: 2000 • DSM-V: 2013 • Uses a Multi-axial System – 5 axes or dimensions used to evaluate an individual – First two are actual diagnosis of disorders; the 3 are criteria required for such diagnosis • Axis I • • Axis II • Axis III • Axis IV • Axis V • • • • Axis III General Medical Conditions • Current general medical condition that are potentially relevant to the understanding or management of the mental disorder • Can be related to mental disorders • May be directly etiological to the development or worsening of mental symptoms and that the mechanism for this effect is physiological • • Axis IV Psychosocial and Environmental Problems • Clinical Disorders & Other Conditions That May Be a Focus of Clinical Attention • Personality Disorders & Mental Retardation General Medical Conditions • Psychosocial and Environmental Problems Global Assessment of Functioning ONE NEEDS TO REVIEW DSM IV-TR IN ORDER TO SEE THE CHANGES MADE IN THE DSM V. THE AXIS IS NO LONGER USED IN THE DSM V. Axis I Clinical Disorders and Other Conditions That May Be a focus of Clinical Attention • When an individual has more than one Axis I disorder, all of these should be reported. If more than one Axis I disorder is present, the principal diagnosis or the reason for visit should be indicated by listing it first • • • • Axis II Personality Disorders & Mental Retardation • Also used for noting prominent maladaptive personality features and defense mechanisms • All should be reported when the individual has more than one Axis II disorder • • • • If an Axis II diagnosis is deferred, pending the gathering of additional information, this should be coded as 799.9 If no Axis II disorder is present, this should be coded as V71.09 If there are no Social or Environmental problems with the patient code “none” on Axis 4 Axis V Global Assessment of Functioning (GAF) If no Axis I disorder is present, this should be coded as V71.09 If an Axis I diagnosis is deferred, pending the gathering of additional information, this should be coded as 799.9 • May be a negative life event, an environmental deficiency or difficulty, a familial or other interpersonal stress, an inadequacy of a social support or personal resources or other problem relating to the context in which a person’s difficulties have developed So called positive stressors should be listed only if they constitute or lead to a problem Should only include those that have been present in the year preceding the current evaluation. However, the clinician may choose to note the problems occurring prior to the previous year if these clearly contribute to the mental disorder or have become a focus of treatment Categories: 1. Problems with primary support group 2. Problems related to the social environment 3. Educational problems 4. Occupational problems 5. Housing problems 6. Economic problems 7. Problems with access to health care services 8. Problems related to interaction with the legal systems/crime 9. Other psychological and environmental problems • Principal Diagnosis – condition established after study to be chiefly responsible for occasioning the admission of the individual *Reason for visit – when more than one diagnosis is given for an individual in an outpatient setting, this is the condition that is chiefly responsible for the ambulatory care medical services received during the visit • When the individual has both Axis I and Axis II disorder, the principal diagnosis or the reason for visit will be assumed to be in Axis I unless the Axis II diagnosis is followed by the qualifying phrase “Principal Diagnosis” or “Reason for visit” If there are no General Medical Conditions to report, code “none” for Axis 3 If the diagnosis for a General Medical Condition is deferred, pending due to gathering information , code “deferred” on Axis 3 • • • Clinician’s judgment of the individual’s overall level of functioning This information is useful in planning treatment and measuring its impact and in predicting outcome Tracks clinical progress in global terms using a single measure Has 10 ranges of functioning and has 2 components – symptom severity and functioning When the 2 components are discordant, the final GAF rating always reflects the worse of the two 100-91 = Superior functioning in a wide range of activities, life’s problems never seem to get out of hand, is sought out by others because of his/her many positive qualities. No symptoms 90 – 81 Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns 80 -71 If symptoms are present, they are transient and expectable reactions to psychological stressors, no more than slight impairment in social, occupational, or social functioning • • • • • • • • 70- 61 Some mild symptoms or some difficulty in social, occupation, or school functioning but generally functioning well, has some meaningful interpersonal relationships 60 – 51 Moderate symptoms or moderate difficulty in social, occupational, school functioning 50 – 41 Serious symptoms or any serious impairment in social, occupational, school functioning 40 – 31Some impairment in reality testing or communication or major impairment in social, occupational, school functioning 30 -21 Behavior is influenced by delusions or hallucination or serious impairment in communication or judgment or inability to function in almost all areas 20 – 11 Some danger of hurting self or others or occasionally fails to maintain minimal personal hygiene or gross impairment in communication 10 – 1 Persistent danger of severely hurting self or others, or persistent inability to maintain minimal personal hygiene or serious suicidal act with clear expectation of death 0 inadequate information Axis I: 309.81 Post Traumatic Stress Disorder, Chronic, With Delayed Onset 296.34 Major Depressive Disorder, Recurrent, Severe without Psychotic Features 300.02 Generalized Anxiety Disorder (provisional) Axis II: V71.09 No Diagnosis Axis III: None Axis IV: Occupational Problems: Inability to establish ties with coworkers Axis V: GAF=65 (Intake) GAF=75 (Current) ABNORMAL PSYCHOLOGY (ETHICS IN ABNORMAL PSYCHOLOGY) Ms. Amor Mia Arandia RP,RPm • • • • SAMPLE CASE • Case 1: A person is reported to have a major depressive disorder, single episode, severe without psychotic features, coupled with alcohol abuse. This person also suffers from having a dependent personality disorder, and the use of denial a defense mechanism. This was manifested after being given a memo from work stating that he could lose hi job. • Case 2 A woman has been observed to have a dysthymic disorder. When she was younger she was diagnosed to have a reading disorder. A medical doctor also diagnosed her with recurrent otitis media, while a social worker found out that she was a victim of child neglect • Case 3 A man was diagnosed to have a mood disorder due to his hyperthyroidism, resulting to a severe depression. It was also found out by a doctor that he had chronic angle-closure glaucoma Case 4: A man never had a long term relationship with any person of the opposite sex. Some of his former partners told the psychologist that they left this man due to his inability to hold a job. Dangers of Diagnosis 1. The person labeled as abnormal is treated differently by society and this treatment can continue long after the person stops exhibiting the behaviors labeled normal. 2. Another danger in labeling people is the idea of stimatization. Avoiding Dangers of Diagnosis • DIAGNOSIS is important, however, clinicians and researchers need to communicate regarding definitions of disorders. • When a system of definitions of disorder is agreed on, then can communication about disorders be improved. • • • • • • • • Behaviors ranging from murder to public profanity to therapists touching their clients. all have legal and ethical implications. Mental health decisions involve legal issues when psychologists consider a client on: • defendants claim of insanity, • competence to stand trial, • need for involuntary hospitalization, • dangerousness to others, or rights as a patient. In court: • An individual accused must have a reasonable degree of rational understanding of the charges against him or her and the proceedings of the trial and must be able to participate in his or her defense. (Noelen-Hoeksema, 4th edition) • Individuals who do not have an understanding of what is happening to them in a courtroom and who cannot participate in their own defense are said to be incompetent to stand trial. • Defendants may be judged to be incompetent to stand on trial if proven with: • histories of psychotic disorders, • who have current symptoms of psychosis, or • who perform poorly on tests of important cognitive skills Criminal law assumes individual actions are based on free will. Criminal commitment is the incarceration of an individual for having committed a crime is the consequence of criminal acts. Insanity defense acknowledges that individuals may not always be held accountable for their criminal actions. The Kenneth Bianchi case highlights the need for psychologists to be on guard against those faking mental illness. The M'Naghten Rule defines insanity as not knowing right from wrong. The irresistible impulse test or volitional insanity says that insanity is also involved when a person could not control his or her actions. (e.g. vengeance) The Durham standard argues that insanity must be a product of mental disease. The American Law Institute (ALI) code (1962) combines earlier definitions. In some regions, the concept of diminished capacity has been added, allowing that a mental disease or defect may reduce a persons specific intent to commit a crime. The American Psychiatric definition of insanity is that people cannot be held responsible for their conduct if, at the time they commit crimes, as the result of mental disease or mental retardation they are unable to appreciate the wrongfulness of their conduct. After the successful insanity defense by John W. Hinckley, Jr., the man who attempted to assassinate President Ronald Reagan, the definition of insanity changed to the individual not understanding what he or she did. The plea of guilty, Xbut mentally ill was developed as well by some states, to separate mental illness and criminal responsibility. Thomas Szasz argues against both the insanity defense and involuntary commitment as being contrary to individual liberty and responsibility. Competency to stand trial assesses the individual's mental state at the time of the trial. There are several criteria for competence. If individuals are found incompetent, they are committed, but only for finite periods (Jackson v. Indiana, 1972), thereby protecting due process. Insanity defense reflects the general notion that persons who cannot appreciate the consequences of their actions should not be punished for criminal acts. The judge in court, may instruct the jury whether to consider the defendant insane when the crime was committed. • Expert Testimony by psychologists and psychiatrists are needed in court to justify this. CIVIL COMMITMENT • A procedure through which a person may be committee for treatment in a mental institution against his or her will. • CRITERIA: • Grave disability to care for self • Danger to self or others • Inability to make responsible decisions (Understanding Abnormal Behavior, Sue) • Unmanageable levels of panic (Understanding Abnormal Behavior, Sue) • Assessment of Danger is difficult because of • Rareness • Is influenced by specific situations • Best predicted by evidence inadmissible by courts • And is ill defined • Involuntary commitment of clients can happen when a client does not consent or agree to hospitalization and it follows procedures that include a concern person, professional testimony, formal hearings, a set periods of treatment. • Controversy exists over the helpfulness of committing people for treatment against their will. Mental patients can be committed only with a level of proof that is clear and convincing (Addington v. Texas, 1979). • Treatment should be provided in the least restrictive environment, confining people. to hospitals only when they cannot care for themselves in less structured settings. Wyatt v. Stickney (1972) established the concept of right to treatment and stipulated minimal living conditions for care. O'Connor v. Donaldson (1975) also affirmed the right to treatment, although there is debate about who defines treatment. • Several cases have supported the patient's right to refuse treatment and to receive treatment that takes the least intrusive form possible. • DEINSTITUTIONALIZATION is the discharge of patients from mental hospitals that started in 1960. • REASONS FOR DEINSTITUTIONALIZATION • Living in institutions are harmful • Mainstreaming patients back into the community can be accomplished • Insufficient public funds necessitate early discharge • PROBLEMS IN DEINSTITUTIONALIZATION • Homelessness • Lack of addressing basic needs • DUTIES OF MENTAL HEALTH PROFESSIONALS TO THEIR CLIENTS • Duty to provide competent care • Avoid multiple relationships with clients • Uphold Confidentiality • Duty to warn people whom their client is threatening • Report child and elder abuse • Provide ethical service to diverse populations CASES • The Tarasoff case vs. Board of Regents case (1976) established the duty-to-warn principle. This raises questions about therapists responsibility to potential victims versus their obligation not to breach confidentiality. • There are criticisms about duty to warn principle. • The Tarasoff case vs. Board of Regents case (1976) established the duty-to-warn principle. This raises questions about therapists responsibility to potential victims versus their obligation not to breach confidentiality. • There are criticisms about duty to warn principle. Issues with Multiple Relations among Mental Health Professions • Avoid being involved in business with clients • Not treat members of their own family • Avoid sexual involvement with clients • Not become intimately involved with a client for at least 2 years after the therapeutic relationship has ended CULTURAL COMPETENCE IN WORKING WITH CULTURALLY DIVERSE POPULATIONS • Psychologists educate their clients to the process of psychological intervention such as goals expectations, the scope and where appropriate, legal limits of confidentiality and the psychologists orientation. • Psychologists are cognizant of relevant research and practice issues as related to the population being served. • Psychologist recognize ethnicity and culture as significant parameters in understanding psychological processes • Psychologist respects client’s religious and/or spiritual beliefs and values, including attributions and taboos, since they affect the client’s worldview, psychosocial functioning, and expressions of distress. • Psychologists interact in the language requested by the client, and if this is not feasible, make an appropriate referral. • Psychologists consider the impact of adverse social, environmental and political factors in assessing problems and designing interventions. • PsycholoAgists attend to, as well as work to eliminate, biases, prejudices, and discriminatory practices. • Psychologist respects the roles of family members and community structures, hierrchies • Psychologists are cognizant of relevant research and practice issues as related to the population being served. • Help clients increase awareness their own cultural values and norms, and they facilitate the discovery of ways clients can apply this awareness to their own lives and to society at large. • Seek to help a client determine whether a “problem” stems from racism or bias in others, so that the client does not inappropriately personalize problems. • Acknowledge how ethnicity and culture impact behavior • Seek out educational and training experiences to enhance their understanding and thereby address the needs of these populations • Recognize limits of their competencies and experience • Consider the validity of a given instrument or procedure and interpret resulting data, keeping in mind the cultural and linguistic characteristics of the person being assessed. • Help clients increase awareness their own cultural values and norms, and they facilitate the discovery of ways clients can apply this awareness to their own lives and to society at large. • Seek to help a client determine whether a “problem” stems from racism or bias in others, so that the client does not inappropriately personalize problems.
