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Kosslyn works hard allergy medicine high buy 4mg aristocort fast delivery, but not every waking moment; his hobbies are bass guitar (he has played rock-and-roll and blues with the same group for many years) and French (he has struggled with the language ever since living in France for a year in 1996) allergy medicine zantac aristocort 4 mg with visa. Dropouts Dysthymic Disorder Understanding Depressive Disorders Neurological Factors Psychological Factors Social Factors Feedback Loops in Action: Depressive Disorders Researching Treatments That Target Psychological Factors Common Factors Specific Factors Controlling Possible Confounding Variables with Analogue Studies Is Therapy Better Than No Treatment Cyclothymic Disorder Feedback Loops in Action: the Placebo Effect x i i Contents Understanding Bipolar Disorders Neurological Factors Psychological Factors: Thoughts and Attributions Social Factors: Social and Environmental Stressors Feedback Loops in Action: Bipolar Disorders Treating Bipolar Disorders Targeting Neurological Factors: Medication Targeting Psychological Factors: Thoughts allergy forecast mobile al order aristocort 4mg mastercard, Moods allergy shots chicago 4mg aristocort visa, and Relapse Prevention Targeting Social Factors: Interacting with Others Feedback Loops in Treatment: Bipolar Disorder 224 224 226 226 226 228 228 229 230 230 232 232 232 234 235 236 236 237 239 239 241 241 241 241 Generalized Anxiety Disorder What Is Generalized Anxiety Disorder Understanding Generalized Anxiety Disorder Neurological Factors Psychological Factors: Hypervigilance and the Illusion of Control Social Factors: Stressors Feedback Loops in Action: Understanding Generalized Anxiety Disorder 252 252 254 254 256 256 256 257 257 258 260 261 262 262 263 266 267 268 269 271 271 273 273 273 275 276 277 278 278 281 281 283 284 284 Treating Generalized Anxiety Disorder Targeting Neurological Factors: Medication Targeting Psychological Factors Targeting Social Factors Feedback Loops in Treatment: Generalized Anxiety Disorder Suicide Suicidal Thoughts and Suicide Risks Thinking About, Planning, and Attempting Suicide Risk and Protective Factors for Suicide Understanding Suicide Neurological Factors Psychological Factors: Hopelessness and Impulsivity Social Factors: Alienation and Cultural Stress Feedback Loops in Action: Suicide Panic Disorder (With and Without Agoraphobia) the Panic Attack-A Key Ingredient of Panic Disorder What Is Panic Disorder Understanding Social Phobia Neurological Factors Psychological Factors Social Factors Feedback Loops in Action: Understanding Social Phobia Anxiety Disorders. The Fight-or-Flight Response Gone Awry Comorbidity of Anxiety Disorders 248 248 249 251 Contents x i i i Treating Social Phobia Targeting Neurological Factors: Medication Targeting Psychological Factors: Exposure and Cognitive Restructuring Targeting Social Factors: Group Interactions Feedback Loops in Treatment: Social Phobia 285 286 286 287 288 289 289 290 290 290 291 291 291 292 292 293 294 294 296 296 296 297 297 299 299 302 302 305 305 306 308 308 308 309 309 Posttraumatic Stress Disorder Stress Versus Traumatic Stress What Is Posttraumatic Stress Disorder Animal Type Natural Environment Type Blood-Injection-Injury Type Situational Type Other Type Treating Posttraumatic Stress Disorder Targeting Neurological Factors: Medication Targeting Psychological Factors Targeting Social Factors: Safety, Support, and Family Education Feedback Loops in Treatment: Posttraumatic Stress Disorder Specifics About Specific Phobias Understanding Specific Phobias Neurological Factors Psychological Factors Social Factors: Modeling and Culture Feedback Loops in Action: Understanding Specific Phobias Howard Hughes and Anxiety Disorders Treating Specific Phobias Targeting Neurological Factors: Medication Targeting Psychological Factors Targeting Social Factors: A Limited Role for Observational Learning Feedback Loops in Treatment: Specific Phobias Obsessive-Compulsive Disorder What Is Obsessive-Compulsive Disorder Understanding Dissociative Fugue 332 332 332 333 333 334 334 335 337 337 339 x i v Contents Depersonalization Disorder What Is Depersonalization Disorder Understanding Depersonalization Disorder Dissociative Identity Disorder What Is Dissociative Identity Disorder Comorbidity Polysubstance Abuse Prevalence and Costs Somatoform Disorders Somatoform Disorders: An Overview Somatization Disorder What Is Somatization Disorder Diagnosing Body Dysmorphic Disorder Versus Other Disorders Understanding Body Dysmorphic Disorder Is Somatoform Disorder a Useful Concept Treating Somatoform Disorders Targeting Neurological Factors Targeting Psychological Factors: Cognitive-Behavior Therapy Targeting Social Factors: Support and Family Education Feedback Loops in Treatment: Somatoform Disorders Depressants What Are Depressants Alcohol Sedative-Hypnotic Drugs Understanding Depressants Neurological Factors Psychological Factors Social Factors Follow-up on Anna O. Social Factors: Responses From Others 474 475 477 477 478 478 479 480 480 480 481 482 482 484 Understanding Sexual Dysfunctions Neurological and Other Biological Factors Psychological Factors: Predisposing, Precipitating, and Maintaining Sexual Dysfunctions Social Factors Feedback Loops in Action: Sexual Dysfunctions Assessing Sexual Dysfunctions Assessing Neurological and Other Biological Factors Assessing Psychological Factors Assessing Social Factors Treating Gender Identity Disorder Targeting Neurological and Other Biological Factors: Altered Appearance Targeting Psychological Factors: Understanding the Choices Targeting Social Factors: Family Support Treating Sexual Dysfunctions Targeting Neurological and Other Biological Factors: Medications Targeting Psychological Factors: Shifting Thoughts, Learning New Sexual Behaviors Targeting Social Factors: Couples Therapy Feedback Loops in Treatment: Sexual Dysfunctions Paraphilias What Are Paraphilias Distinguishing Between Histrionic Personality Disorder and Other Disorders Understanding Histrionic Personality Disorder Treating Histrionic Personality Disorder 608 609 609 610 610 611 612 613 613 613 614 615 615 616 617 617 618 619 619 621 Narcissistic Personality Disorder Understanding Narcissistic Personality Disorder Treating Narcissistic Personality Disorder 577 Treating Personality Disorders: General Issues 579 Targeting Neurological Factors in Personality Disorders 579 Targeting Psychological Factors in Personality Disorders 579 Targeting Social Factors in Personality Disorders 580 Fearful/Anxious Personality Disorders Avoidant Personality Disorder What Is Avoidant Personality Disorder Distinguishing Between Avoidant Personality Disorder and Other Disorders Odd/Eccentric Personality Disorders Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder What Is Schizotypal Personality Disorder Distinguishing Between Schizotypal Personality Disorder and Other Disorders 581 581 583 585 585 587 588 588 588 589 589 590 592 592 594 594 595 597 599 602 602 605 608 Dependent Personality Disorder What Is Dependent Personality Disorder Distinguishing Between Dependent Personality Disorder and Other Disorders Obsessive-Compulsive Personality Disorder What Is Obsessive-Compulsive Personality Disorder Distinguishing Between Obsessive-Compulsive Personality Disorder and Other Disorders Understanding Odd/Eccentric Personality Disorders Neurological Factors in Odd/Eccentric Personality Disorders Psychological Factors in Odd/Eccentric Personality Disorders Social Factors in Odd/Eccentric Personality Disorders Feedback Loops in Action: Understanding Schizotypal Personality Disorder Understanding Fearful/Anxious Personality Disorders Treating Fearful/Anxious Personality Disorders Follow-up on Rachel Reiland Treating Odd/Eccentric Personality Disorders Dramatic/Erratic Personality Disorders Antisocial Personality Disorder the Role of Conduct Disorder Psychopathy: Is It Different Than Antisocial Personality Disorder Understanding Learning Disorders Neurological Factors Psychological Factors Social Factors Treating Learning Disorders Treating Dyslexia Treating Other Learning Disorders Disorders of Disruptive Behavior and Attention What Is Conduct Disorder Normal Versus Abnormal Aging and Cognitive Functioning Cognitive Functioning in Normal Aging Memory Processing Speed, Attention, and Working Memory 680 682 683 683 684 685 685 686 686 686 686 687 688 688 What Is Oppositional Defiant Disorder Dangerousness: Legal Consequences Evaluating Dangerousness Actual Dangerousness Confidentiality and the Dangerous Patient: Duty to Warn and Duty to Protect Maintaining Safety: Confining the Dangerously Mentally Ill Patient Criminal Commitment Civil Commitment Sexual Predator Laws Treating Dementia Targeting Neurological Factors Targeting Psychological Factors Targeting Social Factors Diagnosing Mrs. Research on the entire range of psychological disorders has blossomed during the last decade, yielding new insights about psychological disorders and their treatments. Research increasingly reveals that psychopathology arises from a confluence of three types of factors: neurological (brain and body, including genes), psychological (thoughts, feelings, and behaviors), and social (relationships and communities). Moreover, these three sorts of factors do not exist in isolation, but rather mutually influence each other. We are a clinical psychologist (Rosenberg) and a cognitive neuroscientist (Kosslyn) who have been writing collaboratively for many years. Our observations about the state of the field of psychopathology-and the problems with how it is sometimes portrayed-led us to envision an abnormal psychology textbook that is guided by a central idea, which we call the neuropsychosocial approach. This approach allows us to conceptualize the ways in which neurological, psychological, and social factors interact to give rise to mental disorders. These interactions take the form of feedback loops in which every type of factor affects every other type.
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Treatments that target psychological factors are designed to change cognitive distortions about the predatory sexual behaviors allergy shots zyrtec generic 4 mg aristocort mastercard, especially the Summary of Sexual Dysfunctions Sexual dysfunctions are psychological disorders marked by problems in the human sexual response cycle allergy treatment breastfeeding buy aristocort 4 mg overnight delivery. The response cycle traditionally has been regarded as having four parts: excitement allergy medicine 6 year old generic 4 mg aristocort overnight delivery, plateau allergy shots or drops buy discount aristocort 4mg, orgasm, and resolution-but it is now commonly regarded as beginning with sexual attraction and desire. Sexual dysfunctions fall into one of four categories: disorders of desire, arousal, orgasm, and pain. Neurological (and other biological) factors include disease, illness, surgery or medications, and the normal aging process. Psychological factors are divided into predisposing, precipitating, and maintaining factors. An assessment of sexual dysfunctions may evaluate neurological (and other biological), psychological, and social factors. Treatments that target neurological (and other biological) factors are medications for erectile dysfunction and for analogous arousal problems in women. Treatments that focus on one type of factor for a given patient can create complex feedback loops, which sometimes have unexpected-and perhaps negative-consequences for the couple. There was no joy or love in their sexual relations, and most of the time Chi-Ling was barely aroused and lubricated; she rarely had orgasms anymore. She just wanted Yinong to hurry up and ejaculate, and he was finding it increasingly difficult to do so. Based on what you have read, do you think that Chi-Ling or Yinong has any sexual dysfunctions, and if so, which one(s) If you could obtain additional information before you decide, what would you want to know and why This set of quadruplets (or quads) was also remarkable in two other ways: All four developed from a single fertilized egg and so basically were genetically identical. In addition, all four went on to develop symptoms of schizophrenia as young adults. In the psychological literature, the quadruplets came to be known by pseudonyms they were given to protect their privacy: Nora, Iris, Myra, and Hester Genain. By the time the quads were in their early 20s, three had been hospitalized for schizophrenia at least once, and the fourth was exhibiting symptoms of schizophrenia. Genain was recovering from bladder surgery, and it was becoming increasingly difficult for her to care for the young women. At the facility, the sisters were treated, studied, and written about extensively. The fact that all four of the Genain sisters developed symptoms of schizophrenia was by no means an inevitable result. For identical quads, the odds of all four developing schizophrenia are about one in six, or 16% (Rosenthal, 1963). In this chapter, we discuss the symptoms of schizophrenia, what is known about its causes, and current treatments for this disorder. All four suffered from schizophrenia, although this outcome is statistically unlikely. The symptoms and course of the disorder were different for each sister, illustrating the range of ways it can affect people. Schizophrenia is a psychological disorder characterized by psychotic symptoms- hallucinations and delusions-that significantly affect emotions, behavior, and most notably, mental processes and mental contents. Instead, like depression (see Chapter 6), schizophrenia is a set of related disorders. Research findings suggest that each variant of schizophrenia has different symptoms, causes, course of development, and, possibly, response to treatments. Schizophrenia A psychological disorder characterized by psychotic symptoms that significantly affect emotions, behavior, and mental processes and mental contents. Positive symptoms Symptoms of schizophrenia that are marked by the presence of abnormal or distorted mental processes, mental contents, or behaviors. Positive Symptoms Positive symptoms are so named because they are marked by the presence of abnormal or distorted mental processes, mental contents, or behaviors. Courtesy of Genain family Miss Edna Morlok Schizophrenia and Other Psychotic Disorders 5 2 1 Table 12.
A range of problem checklists is available to guide the assessment of possible stressors allergy testing vancouver island purchase 4mg aristocort visa. Clinicians can amend checklists to include areas not represented or ones unique to their patient populations allergy treatment and breastfeeding buy cheap aristocort 4 mg on-line. If moderate to severe or severe symptomatology is detected through screening allergy treatment dog dander buy aristocort 4mg online, individuals should have further diagnostic assessment to identify the nature and extent of the depressive symptoms and the presence or absence of a mood disorder allergy zone cheap aristocort 4 mg without a prescription. As a shared responsibility, the clinical team must decide when referral to a psychiatrist, psychologist, or equivalently trained professional is needed. Such would be determined using measures with established reliability, validity, and utility. For optimal management of depressive symptoms or diagnosed mood disorder use pharmacological and/or non-pharmacological interventions. These guidelines make no recommendations about specific antidepressant pharmacological regimens being better than another. The choice of an antidepressant should be informed by the side effect profiles of the medications, tolerability of treatment, including the potential for interaction with other current medications, response to prior treatment, and patient preference. Offer support and provide education and information about depression and its management to all patients and their families, including what specific symptoms and what degree of symptom worsening warrants a call to the physician or nurse. If an individual has comorbid anxiety symptoms or disorder(s), the route is usually to treat the depression first. Some people have depression that does not respond to an initial course of treatment. Use of outcome measures should be routine (minimally pre and post treatment) to a) gauge the efficacy of treatment for the individual patient; b) monitor treatment adherence; and, c) evaluate practitioner competence. Recommendations: Treatment and Care Options for Depressive Symptoms It is common for persons with depressive symptoms to lack the motivation necessary to follow through on referrals and/or to comply with treatment recommendations. If compliance is poor, assess and construct a plan to circumvent obstacles to compliance, or discuss alternative interventions that present fewer obstacles. After 8 weeks of treatment, if symptom reduction and satisfaction with treatment are poor, despite good compliance, alter the treatment course. All patients should be screened for distress at their initial visit, at appropriate intervals and as clinically indicated, especially with changes in disease status. Screening is suggested at initial diagnosis, start of treatment, regular intervals during treatment, end of treatment, post-treatment or at transition to survivorship, at recurrence or progression, advanced disease, when dying, and during times of personal transition or re-appraisal such as family crisis, during post-treatment survivorship and when approaching death. Screening should identify the level and nature (problems and concerns) of the distress as a red flag indicator. Screening should be done using a valid and reliable tool that features reportable scores (dimensions) that are clinically meaningful (established cut-offs). It is recommended that patients be assessed for generalized anxiety disorder, as it is the most prevalent of all anxiety disorders and it is commonly comorbid with others, primarily mood disorders or other anxiety disorders. Clinicians can amend the checklists to include additional key problem areas or ones unique to their patient populations. As with depressive symptoms, consider special circumstances in screening/assessment of anxiety including using culturally sensitive assessments and treatments and tailoring assessment or treatment for those with learning disabilities or cognitive impairments. Recommendations: Assessment of Anxiety Specific concerns such as risk of harm to self and/or others, severe anxiety or agitation, or the presence of psychosis or confusion (delirium) requires referral to a psychiatrist, psychologist, physician, or equivalently trained professional. When moderate to severe or severe symptomatology is detected through screening, individuals should have a diagnostic assessment to identify the nature and extent of the anxiety symptoms and the presence or absence of an anxiety disorder or disorders. As a shared responsibility, the clinical team must decide when referral to a psychiatrist, psychologist or equivalently trained professional is needed. Assessments should be a shared responsibility of the clinical team, with designation of those who are expected to conduct assessments as per scope of practice. A patient considered to have severe symptoms of anxiety following the further assessment should, where possible, have confirmation of an anxiety disorder diagnosis before any treatment options are initiated. Facilitate a safe environment and one-to-one observation, and initiate appropriate harm-reduction interventions to reduce risk of harm to self and/or others. It is suggested that the clinical team making a patient referral for the treatment of anxiety review with the patient in a shared decision process, the reason(s) for and potential benefits from the referral.
This woman is exhibiting signs of tardive dyskinesia-involuntary lip smacking and odd facial grimaces that can be an enduring side effect of long-term use of traditional antipsychotic medication allergy guidelines generic aristocort 4 mg with amex. Such side effects can persist even after the antipsychotic medication is discontinued allergy forecast wheaton il discount aristocort 4mg with visa. Atypical antipsychotics A relatively new class of antipsychotic medications that affect dopamine and serotonin activity but create fewer movementrelated side effects than do traditional antipsychotics; also referred to as secondgeneration antipsychotics allergy symptoms in 7 month old order aristocort 4 mg fast delivery. A unique study set out to investigate the side effects of antipsychotic medications in healthy participants allergy medicine green cap generic aristocort 4 mg with mastercard, who took a single dose of each of the following, in random order: a traditional antipsychotic (haloperidol), an atypical antipsychotic (risperidone), and a placebo. Both types of antipsychotic medication caused some side effects that were similar to the negative symptoms of schizophrenia, particularly, but not limited to , alogia, which in this case was due to drowsiness (Artaloytia et al. Clearly, there is a need for medications that can reduce symptoms while not creating side effects that lead people to stop taking the drug. Discontinuing Medication Given how often patients stop taking their medication, we need to understand the effects of discontinuing medication. When people with schizophrenia discontinue their medication, they are more likely to relapse. One study found that among those who were stable for over 1 year and then stopped taking their medication, 78% had symptoms return within a year after that and 96% had symptoms return after 2 years (Gitlin et al. With enough relapses, though, some people begin to understand the need for treatment: I thought I could live my life without taking medication, but I ended up in the hospital again. Acute episodes of psychosis appear to create long-lasting disturbances in brain activation, cognitive functioning, and social relations. In addition, research suggests that pharmacological treatment administered soon after the first psychotic episode is associated with a better long-term prognosis, compared to treatment begun later (Harris et al. Some clinicians and researchers are investigating whether early and aggressive use of antipsychotic medication can prevent or minimize the long-term damage that psychotic episodes appear to inflict (Lieberman, 1999). Moreover, as noted in Chapter 3, some researchers are exploring whether people who have prodromal symptoms of schizophrenia (but not enough symptoms to meet the diagnostic criteria for the disorder) can reduce the likelihood of a later psychotic episodes by taking antipsychotic medication preemptively (McGorry & Edwards, 2002; McGorry et al. That is, researchers have asked whether preventive medication can help children and adolescents who have some symptoms but for whom the number and intensity of those symptoms do not meet the criteria for a psychotic disorder (Gosden, 2000; Gottesman & Erlenmeyer-Kimling, 2001; Warner, 2002). Small pilot studies of early intervention with risperidone with at-risk groups have found some benefits, such as decreased positive symptoms (Cannon et al. However, some researchers are concerned about whether adolescents or children, whose brains are still undergoing rapid development, should be given antipsychotic medications in the absence of a psychotic episode. All four of the Genain sisters were treated with medication; only Myra had long stretches of time when she did not need medication (Mirsky & Quinn, 1988). By 1995, Nora, Iris, and Hester were continuing Schizophrenia and Other Psychotic Disorders 5 5 9 to take traditional antipsychotics; Myra was on a low dose of an atypical antipsychotic. Patient and therapist work together to implement new coping strategies and monitor medication compliance. Cognitive Rehabilitation Once psychotic symptoms have subsided, people with schizophrenia often continue to struggle with neurocognitive deficits that limit their ability to function. Cognitive rehabilitation (also called neurocognitive remediation or cognitive mediation) Cognitive rehabilitation A form of psychological treatment that is designed to strengthen cognitive abilities through extensive and focused practice; also called neurocognitive remediation or cognitive mediation. Researchers have reported that such practice enhances the abilities to shift attention voluntarily, to sustain attention, and to reason, and increases mental flexibility (Krabbendam & Aleman, 2003; McGurk et al. However, this treatment is expensive, and some studies find that its effects do not generalize beyond the specific tasks that are practiced (Silverstein et al. Research efforts are under way to determine which specific rehabilitation techniques work to improve the general life skills of people with schizophrenia. Treating Comorbid Substance Abuse: Motivational Enhancement Because many people with schizophrenia also abuse drugs or alcohol, recent research has focused on developing treatments for people with both schizophrenia and substance-related disorders; motivational enhancement is one facet of such treatment. As we discussed in Chapter 9, patients who receive motivational enhancement therapy develop their own goals, and then clinicians help them meet those goals.