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变态心理学讲义
Abnormal
Psychology
Department of Psychology ,
Prof. Geng Wenxiu
3 Credits
East China Normal University
PH.D
Chapter 1
Abnormal Psychology in Historical Context
Chapter 2
An Integrative Approach of Psychopathology
Chapter 3
Research Methods, Clinical Assessment and Diagnosis
Chapter 4
Life Stress and Coping
Chapter 5
Anxiety Disorders
Chapter 6
Mood Disorders
Chapter 7
Developmental Disorders
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Chapter 8
Schizophrenia
Chapter 9
Eating and Sleep Disorders
Chapter 10
Personality Disorders
Chapter 11
Aging and Cognitive Disorders
Chapter 12
Substance-Related Disorders
Chapter 13
Homosexualism, Gender Identity Disorder and Sexual Deviation
Chapter 1
I
II
Abnormal Psychology in Historical Context
Definitions of Abnormal Behavior
Abnormal http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bBehavior in
Historical Context
III
IV
I
Reform and Revolution
Humanistic and Scientific New Age
Definitions of Abnormal Behavior
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Psychological disorder or abnormal behavior: It is a psychological dysfunction within
an individual associated with distress or impairment in functioning and a response
that is not
typical or culturally expected.
DSM-IV-TR:
Abnormal
Behavioral, emotional, or cognitive dysfunctions that are unexpected in their
cultural
context and associated with personal distress or substantial impairment in
functioning.
1) Social norm violation,
1.
2) impairment in functioning (dysfunction),
Social-Cultural Norms (
3) distress
Ideal Model )
Social-Cultural Norms： ―Deviating from the average‖， Atypical or not culturally
expected
，
Cultural
Difference
and
Sex
Differences
rejehttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bcting
，
Disgusting,
&
persecuting
the
―deviant‖ within our society
Ideal Model ：Advocated by the government, Praised & accepted by the mainstream
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Accepted & imitated by the most people, Self-accept & conform to the model
A more democratic and humanistic society is more tolerate the ―deviation‖.
Most of our behavior is shaped by norms-cultural expectations about the right and
wrong way to do things.
2.
Statistic Standard
﹡ Psychometrics & SD
﹡ Frequency of the disorder or dysfunction episode
﹡ Duration of the disorder or dysfunction episode
﹡ Items of the disorder or dysfunction episode
A convention selected (arbitrarily) by scientists is to see people falling beyond
2
standard deviations as abnormal (95.4% falls within the 2sd boundaries).
3.
?
Functional Standard:
Physiological,
?
Psychological,
?
Social
adaphttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bting
Psychological dysfunction refers to a breakdown in cognitive, emotion, or behavioral
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functioning.
Distress may not always be a bad thing.
II
1.
Abnormal Behavior in Historical Context
The Supernatural Tradition
Trephining in Renaissance, Exorcism, Witch Burning, Witch Drowned, Persecution of
―Charming‖ Ladies
Society and people believe in the reality and power of demons and witches. The
individuals possessed by evil spirits were probably responsible for any misfortune
experienced by other people, which inspired drastic action against the possessed.
The conviction that sorcery and witches are causes of madness and other evil continued
into 15th century, and evil continued to be blamed for unexplainable behavior.
2. The Biological Tradition
Hippocrates
(460-377
B.C),
the
Greek
physician,
fathttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bher of modern medicine
Hippocratic Corpus 希波克拉底大全，about 450-350 B.C
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―Humoral Theory‖, blood–heat (comes from heart), black bile-dryness ( from
spleen-melancholy, depression), yellow bile-moisture (choler, from liver), phlegm
– cold
(from brain, )
Claudius Galen ( 138~2001, A.D), Roman (Greek) physician. He believed that
psychological disorders could have either physical causes, such as injuries to the
head, or
mental causes, such as disappointment in love
Bleeding (bloodletting), the extraction of blood from patients, was intended to
restore
the balance of humors in the body.
3. The Psychological Tradition
Anton Mesmer (1734-1815), a Viennese physician, The Influence of Planets, 1766,
magnetism, Mesmerism
麦斯麦术，催眠术
James Braid ( 1795 – 1860 )，an Scotch physician，hypnotism
睡眠之神）， mesmerized
://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bparHypnosis
催眠术（hypnosis
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Jean-Martin Charcot ( 1825 –1893 ), an esteemed neurologist in Paris, testing
hypnosis in La Salpêtrière hospital and influenced Freud to consider psychosocial
approaches to psychological disorders.
Nacy School
南希学派
Ambrose-Auguste Liébault ( 1823 – 1904 ), a French doctor, Nacy, France
Hippolyte-Marie Bernheim ( 1837 – 1919 ), Spokesman
of Nacy School
Sigmund Freud (11856– 1939 )
(Catharsis）Cathartic method —→ Psychoanalysis，free association
Bertha Pappenheim (1859 - 1936) famous as O. Ana，was described as hysterical
Josef Breuer (1842-1925).
4.
Social-Cultural Evolution
Poorhouse / Lunatic Asylum —→ Hospital —→ Community
III
1.
Reform and Revolution
Asylum Reform
by
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Phillips Pinel (1745-1826), A hospital physician, 1792, then the director of La
Salpêtrière
http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bhospital,
chain- breaking reform. 1796, Pinel was allowed to break 49
psychopathics‘ chain in Paris.
Emil Kraepelin（1856-1926), German psychiatrist, One of the founding fathers of
modern psychiatry, One of the first to distinguish among various psychological
disorders.
2. The Rise of Behaviorism
John B. Watson (1878-1958), with his student Rosalie Rayner to develop phobia on a
11-moth- old boy named Albert
Behavioral Therapy Technique
Mary Cover Jones
(1896-1987) , one of Watson‘s students, who was one of the first
psychologists to use behavioral techniques to free a child from animal phobia.
Joseph Wolpe
(1915-1997), a pioneering psychiatrist from South Africa,
in 1950s,
developed systematic desensitization to diminish excessive fears, involving gradual
exposure
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to
the
feared
stimulus
paired
with
a
positive
experihttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bence,
coping
usually
relaxation.
3. Deinstitutionalization Movement
Thomas Szasz (1920-
)
(1961, 1974), Hungarian-
American Psychiatrist, strongly against Psychiatry
―On Being Sane in Insane Places‖, David L. Rosenham, Jan.19, 1973, Science
magazine, eight pseudo-patients were diagnosed as schizophrenia and taken into
hospital,
who were hospitalized for 7~52 days.
4.
American Reform
Benjamin Rush ( 1745 – 1813 ), the father of American Psychiatry
Dorothea Dix ( 1802 –1887 ), 1841, a Boston retired schoolteacher
1844, a group of 13 hospital administrators formed the Association of Medical
Super-intendents of American Institutions for the Insane,
the
American Psychiatry Association.
the predecessor of APA,
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1900s, Mental Hygiene Movement
IV
1.
Humanistic and Scientific New Age
Human
Dignity
http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2band
Privacy
Clifford Beers, 《A Mind Found Himself 》，1908
2.
Tolerance and Loving Care
3.
Developing New Psychotherapeutic Medicine
4.
Mental Health Services
Chapter 2
I
II
III
IV
An Integrative Approach of Psychopathology
Genetic Contributions to Psychopathology
Neuroscience and Its Contributions to Psychopathology
Behavioral and Cognitive Science
Emotion
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V
Cultural, Social, and Interpersonal Factors
I
Genetic Contributions to Psychopathology
1.
The Nature of Genes
Genes are the carriers of genetic information that we inherit from our parents and
other ancestors.
James Dewey Watson (1928 ~
) American biologist, with Francis Crick（1916 ~
2004，7，28）proposed the double helix for the molecular structure of DNA in 1953
and
shared a 196http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b2 Noble Prize.
2.
New Developments in the Study of Genes and Behavior
Much of our development, and interestingly, most of our behavior, personality, and
even IQ is probably polygenic.
3.
The Interaction of Genetic and Environmental Effects
For psychological disorders, the evidence indicates that genetic factors make some
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contribution to all disorders, but account for less than half of the explanation.
No individual gene has been identified that contributes substantially to the major
psychological disorders.
The Diathesis-Stress Model
Diathesis：inherited tendency,
or vulnerability
Individual inherit , from multiple genes, tendencies to express certain traits or
behaviors,
which may then be activated under conditions of stress.
Each inherited tendency is
a developing a disorder.
The
smaller
the
vulnerability,
the
ghttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2breater the life stress
required to produce the disorder,
conversely, with greater vulnerability, less life stress is required.
The Reciprocal Gene-Environment Model
Social, interpersonal, psychological, and environmental factors play major roles in
whether we say ―to be or to be not‖, but, just possibly, our genes contribute to
how we create
our own environment.
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4.
Non-Genomic ―Inheritance‖ of Behavior
― The environment even working subtly, can still mold and hold its own in the
biological
interactions that shape who we are.‖—Sapolsky, 2000
A very complex interaction between genes and the environment plays an important role
in every psychological disorder.
II
1.
The
Neuroscience and Its Contributions to Psychopathology
Brain, and the Nervous System
brain
uses
average
of
140
billion
nerve
cells
–
neurons,
to
controhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bl our every
thought and action.
Eric Kandel, neuroscientist , Nobel Prize Winner, 1983 : the process of learning
affect
more than behavior --- the very genetic structure of cells may actually changes as
a result of
learning.
such a
If genes that were inactive or dormant interact with the environment in
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way that they become active.
The environment may occasionally turn on genes. This
type
of mechanism may lead to changes in the number of receptors at the end of a neuron,
which,
in turn, would affect biochemical functioning in the brain.
Dendrite 树突 – Axon 轴突,
2.
Synaptic cleft 突触间隙,
Receptor 受体
Neurotransmitters: Ach, 5-HT, DA, NE, GABA…the Second Messengers
The biochemical neurotransmitter in the brain and nervous system that carry messages
from one neuron to another.
The
chemicals
that
are
released
from
the
axon
of
one
nhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2berve cell and transmit the
impulse
to the receptors of another nerve cell are called neurotransmitters.
①
Synthesis of neurotransmitter and formation of vesicles ，
② Transport of neurotransmitter down axon，
③
④
Release of neurotransmitter ，
Interaction of neurotransmitter with receptor ， exciting or inhibiting
postsynaptic neuron，
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⑤
Separation of neurotransmitter molecules from receptors ，
⑥
Reuptake of neurotransmitter to be recycled，
⑦
Vesicles without neurotransmitter transported back to cell body。
3.
Implications for Psychopathology
4.
Psychosocial Influences on Brain Structure and Function
Neural and Behavioral Plasticity
The formation of new neural connections (or synapses) after birth is dramatically
affected by the experience a young organism has. Neural plasticity continues to some
extent
throuhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bghout the life span.
Human infants should be exposed to highly enriched environments. Normal rearing
conditions with caring parents are perfectly adequate.
III
Behavioral and Cognitive Science
1.
Conditioning and Cognitive Processes
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2.
Learned Helplessness: Martin Seligman (1942--
3.
Social Learning: Albert Bandura(1925--
)
)- Modeling or Observational Learning,
(prepared learning)
Albert Bandura stressed that people learn more by internal than external
reinforcement.
They can visualize the consequences of their actions rather than rely exclusively
on
environmental reinforcements.
Human beings regulate behavior by internal symbolic processes – thoughts.
4.
Cognitive Science and Unconscious
IV
Emotion
1.
The Physiology of Fear and Anger: fight or flight response
Walterhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b
B.
Cannon
(1871-1945), American Physiologist.
2.
Emotional Phenomena (mood, affect)
Emotion is an action tendency; that is to behave in a certain way (for example,
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escape),
elicited by an external event (a threat) and a feeling state (terror), accompanied
by a (possibly)
characteristic physiological response.
3.
The Components of Emotion
Emotion has three important and overlapping components: behavior, cognition and
physiology.
4.
Emotion and Psychopathology
for example:
Anger affects the heart through decreased pumping efficiency.
Early psychological experience affects the development of nervous system and thus
determines vulnerability to psychological disorders later in life.
The greater the number and frequency of social relationships and contacts, the longer
you are likely to live.
V
Cuhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bltural, Social, and
Interpersonal Factors
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1.
Gender: female‘s unique response to stress – ―tend and befriend‖
Gender roles have a strong and sometimes puzzling effect on psycho-pathology.
2.
Social Effects on Health and Behavior
3.
Social Stigma
With far less social support than for physical illness，there is less chance of full
recovery of
4.
Global Incidence of Psychological Disorders
Chapter 3
I
II
III
IV
psychological disorders.
Research Methods, Clinical Assessment and DSM-IV
Research Methods
Clinical Interview
Physical Examination, Behavior Assessment and Psychological Testing
Multi-Axis Classification -- DSM-IV
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I
Research Methods
1.
The Basic Components of Research Study
hypothesis,
research
design
(dependent
variable,
independent
variable)
,
ihttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bnternal &
external validity
2.
Case Study
Sigmund Freud expanded the case of O. Ana into psychoanalytic model ―free
association‖.
Joseph Wolpe (1915-1997) work with his more than 200 clients and developed
Systematic Desensitization.
3.
Experiments
Watson with his student Rosalie Rayner developed phobia on an 11-moth-old boy
named Albert.
4.
Research Ethics
Informed Consent / Informed Choice --- Accurately Describe Risks to Subjects;
Protect the Welfare and Dignity of the Participants --- Protect the Participants from
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both Physical & Psychological harm;
Maintain Confidentiality;
Debrief --- Remove any Misconceptions Caused by Deception (Use Deception only
when Absolutely Necessary ); Provide Results and Interpretations to Participants
5.
Ethics of Mental Health Service
Informedhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b
Consent
/
Informed Choice
Accurately describe the nature of the mental health service, the possible risk and
profit
to Clients.
Maintain Confidentiality / Duty to Warn
Balance the two, Maintaining Confidentiality is the first and the last obligation
of
psychologist, only could be violated by the emergence that the client would endanger
himself
or others.
Clients Have Rights to Reject the Intervention of Mental health Service Transfer
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We should transfer the client who has serious mental disease, such as schizophrenia
or
major
depression; or any inconvenience to the psychologist.
The Insanity Defense
Freedom of choice/free will is constrained and distorted by mental illness - the
person
acts under duress and is therefore not
responsible.
With most crimes, conviction requires proof of the particular act (actus reus 犯
http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b 罪行为 )
plus proof of a particular mental state (mens rea 犯意).
In other words, in addition to showing that the person did the crime, it must also
be shown
that the person had a conscious objective to commit the act.
II
Clinical Interview
The interview is the clinician‘s basic technique for both assessment and
psychotherapy.
The interview is a conversation with a purpose.
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1.
Interview Essentials:
Settings (Safe, privacy, quiet, comfortable and relaxed) ―the physical setting
should bear out the clinician‘s assurance of safety,
confidentiality ， and
protection from
interruption, soundproofing, free of distraction.
The office is fairly neutral yet tasteful.
Both should have comparable chairs of
the
same height and similar style, neither so close as to intrude on each other‘s personal
space
nor
so
distant
as
thttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bo
suggest fear of contagion.
Rapport, An attitude of acceptance, understanding, and respect for the
integrity
of
the client.
An attitude of understanding, sincerity, acceptance, and empathy.
Communication,
* Beginning a session：to begin an assessment interview with a casual conversation
to
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relax things before plunging into the client‘s reasons for coming.
* Language: Of extreme importance is the use of language that the client can understand
* Silence: To assess the meaning and function of silence in the context of the specific
interview. The clinician‘s response to silence should be reasoned and responsive
to the goals
of the interview rather than to personal needs or insecurities.
* Listening: The skilled clinician is who has learned how and when to be an active
listener.
*Self-confidence
Interview:
://www.wendangwang.com/doc/406f55ffacce48902d1d0f2barListening — catharsis
Leading — self-analysis
Inspiriting — Cognitive change
Guiding — behavior modify
Questioning
2.
Types and Strategies of Interview
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Open-ended:
To give client responsibility and latitude for responding.
Facilitative:
Clarifying:
Confronting:
Direct:
Encourage client‘s flow of conversation
Encourage clarity or amplification.
Challenge inconsistencies or contradictions
Once rapport has been established and client is taking responsibility for
conversation, such questions can be efficient and useful.
3.
Information Collecting
4.
Observation and Assessment
5.
Intervention and Treatment
III
1.
The
Physical Examination, Behavior Assessment and Psychological Testing
Physical Examination
medical
evaluation
is
necessary
to
rule
out
the
possibilihttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bty that physical
abnormalities may be causing or contributing to psychological problem.
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2.
Behavior Assessment
3.
Psychological Testing
4.
Mental Status Examination
1). Intellect and thought processes
2). Disorders of Perception: Hallucinations, Illusions, Delusion, or more simple
misperceptions
3). Attention and Orientation
4). Emotional expression
5). Insight and self-concept
6). Behavior and appearance
5．Crisis Assessment
IV
Diagnosis and Multi-Axis Classification -- DSM-IV
ICD-10
( International Classification of Disease)，published by WHO, widely used
in
Europe and many other countries.
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Compromise and comprehensive
CCMD-3 《中国精神障碍分类与诊断标准》，2001 年颁布，尽量引用 ICD-10 名词解释.
DSM-Ⅳ-R 《精神障碍诊断统计手册》 the standard guide for the USA,
2000， 1952, I，
1968Ⅱ，1980 Ⅲhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b
Axis I:
Clinical Syndromes
Clinical syndromes, disorders usually first diagnosed in infancy, childhood, or
adolescence.
Axis II:
Personality Disorders, Mental Retardation (principal diagnosis)
Axis III:
General Medical Conditions
Axis IV:
Axis V:
GAF
0
Psychological and Environment Problems
Global Assessment of Functioning
( Global Assessment of Functioning )
insufficient information
1 – 10， 11- 20， morbid
21- 30， 31- 40， maladjusted
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41- 50， 51- 60， 61- 70
difficult
71- 80， 81- 90，
91- 100
Adjusted to wellbeing
Chapter 4
Life Stress and Coping
I
Stress and Burn-out
II
Coping with Stress
III
IV
Ⅴ.
PTSD: Posttraumatic Stress Disorder
Crisis & Suicide- Intervention
Positive Psychology & Resilience
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I
Stress and Burn-out
1.
Stress
Hans Selye (1907 - 1982)
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GAS: General Adaptation Syndrome --- Stress Stages
1)
The Physiology of Stress
The pioneering work of Cannon (1915)
SNS (sympathetic nervous system):
When the organism is faced danger, the SNS
discharges adrenaline to prepare the organism for ―flight or fight‖.
2)
Contributions to the Stress Response
HPA: Hypothalamic-pituitary-adrenal
The extreme importance of the immune system
Stress can also act through the HPA glands to produce a serious endocrine
imbalance that takes a major toll on the person‘s immune system.
CFS:
Chronic Fatigue Syndromes
GAS: General Adaptation Syndrome --- Stress Stages
Cognitive Assessment
Intervention
↓
ⅠAlarm & Mobilization
↓
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↓
↓
http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b ↓
↗Positive
Stressors → Response ⅡResistance→ → Effect
↓
↘Negative
↓
↑
Ⅲ Exhaustion
←——
Intervening Variables
↑
——→
Ⅰ Alarm & Mobilization
Emotional arousal, increased tension, heightened sensitivity,
greater alertness
(vigilance), and determined efforts at self-control
Ⅱ
Resistance
Try to find means of dealing with the stressful events and thus to maintain adjustment
to life
Ⅲ Exhaustion
One‘s adaptive resources are depleted and the coping patterns developed during the
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resistance stage fail.
2. Burn-out: Exhaustion
Burnout has been defined as a syndrome comprising three factors: (Maslach, Jackson,
&
Leiter, 1996)
1)
Emotional exhaustion,
2)
Lack of professional efficacy, and
3)
Cynicism
MBI:
Maslachhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b
Burnout
Inventory
3. Stressors
Stressors stem from three categories:
(1). Frustrations --- A wide range of obstacles, both external or internal, can lead
to
frustrations.
(2). Conflicts
Approach-avoidance conflicts
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Double-approach conflicts
Double-avoidance conflicts
(3). Pressures
to achieve specific goals or to behave in particular ways
Stressors or come from:
(1) Occupational Stressors:
Job responsibility, time-manage, interaction in the office or working place,
performance or working efficiency……
(2)
Family Events:
family development, marriage, giving-birth, child -caring, children education
and accident or disease attack……
(3) Environmental Stressors
4.
LCU: Life Chang Units
Thomas
Holmes
and
Richard
Rahe （ 1967 ） Developed
Social
Ratinghttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b
Readjustment
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Scale
Connected the link between major life changes and development of disease. The
more specific the changes in one‘s life the greater the chance of illness.
Life changes —any life change, even if it is positive and anticipated, brings about
stress.
Anticipated / Unexpected / Accumulating life events
People with LCU scores of 300 or more for recent 12 months were at significant risk
for
getting a major illness within the next 2 years.
150 ~ 300
at 50% risk,
＜ 150
healthy
1. Coping:
The process by which people try to manage the perceived discrepancy between the
demands and resources they appraise in a situation.
May manage by correcting or mastering the problem, or by changing perception of it.
Involves transactions with the environment.
Involves
a
dynamic
series
of
appraisals
and
reappraisalshttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b of the person
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- environment.
2.
Coping Strategies
* Task-oriented coping:
making changes in one‘s self, or surroundings, retreating from the problem, or
attacking it directly, or trying to find a workable compromise ……
* Defense-oriented coping
1).
function as psychological damage-repair:
crying, mourning, repetitive talking ……
2).
ego-defense or self-defense:
denying, distorting, or restricting a person‘s experience
reducing emotional or self-involvement
counteracting threat or damage
* Emotional-Focused Coping:
Reducing Significance of the Trauma, Catharsis, Tearing to Sublimate Pains
*
Emotion-focused (or palliative) coping refers to thoughts or actions whose goal
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is to relieve the emotional impact of stress.
*
These
are
apt
to
be
mainly
palliative
in
the
sense
that
such
strategieshttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b of coping
do not actually alter the threatening or damaging conditions but make the person feel
better.
Monat and Lazarus (1991)
Types of emotion-focused coping
* seeking social support - emotional support
* distancing:
making cognitive efforts to detach
from the situation or create a positive outlook.
* escape-avoidance:
wishful thinking or escaping/ avoiding situation through
sleeping or drugs.
* self-control:
attempts to modulate feelings or actions regarding the problem.
* accepting responsibility:
* positive reappraisal:
acknowledging role in the problem.
creating a positive meaning in terms of personal growth.
* Problem-Focused Coping: Confronting & Trying to Dealing with the Trauma
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* P-focused coping refers to efforts to improve the troubled person-environment
relationship
by
changing
things,
fohttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2br example, by seeking
information about what to do, by
holding back from impulsive and premature actions, and by confronting the person or
persons responsible for one‘s difficulty.‖
Monat and Lazarus (1991)
Types of problem-focused coping
planful problem-solving -analyzing situation and taking direct action.
confrontive coping - taking assertive action.
seeking social support - seeking information.
* Self-Focused Coping: Promoting One‘s Own Coping-Skills
* Help-Seeking Coping: Seeking Help from Others
III
PTSD: Posttraumatic Stress Disorder
1. Acute Stress Disorder (DSM-IV-TR),
DSM-IV-TR:
PTSD
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* Acute Stress Disorder
Occurs within 4 weeks of the traumatic event and last for a minimum of 2 days and
a
maximum of 4 weeks.
*
PTSD:
recurrent
and
intrusive
distressing,
re-experienced
ohttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bf the traumatic event,
persistent avoidance of stimuli associated with the trauma.
The symptoms last for at least 1 month.
2.
Diagnosis: Traumatic Experience, Flash-back, persistent avoidance of stimuli
associated with the trauma
1).
Exposure to a traumatic event during which one feels fear, helplessness, or
horror. Afterward, victims re-experience the event through the memories and
nightmares.
2).
Flash-back: re-experiencing the traumatic event day and night
3).
Avoiding anything that reminds them of the trauma
Victims typically are chronically over-aroused, easily startled, and quick to anger,
difficult sleeping, recurring intrusive nightmares
3.
Treatment of PTSD
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*
Post-disaster debriefing sessions --- introducing the victims or survivors to
discuss their experiences with others to share their experiences and support each
others.
://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bpar* Direct-exposure therapy
--- either in vivo or in the imagination to expose to the
stimuli with the traumatic event for the purpose of reducing fear and anxiety.
* Telephone hotlines
* Psychotropic medication
IV
Crisis & Suicide- Intervention
1.
Components of Crisis-Intervention:
*
Defusing & Debriefing 舒缓（降低应激反应）
a brief group process that typically occurs within a very short time (3 or 4 hours)
after a critical incident. The purpose is to process initial reactions and make victim
or survivor aware of what might follow for them personally or others.
The intention is to ―normalize‖ reactions and provide increased awareness of the
impact of the event.
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This is a formal group process that typically occurs within 24 to 72 hours after a
traumatic incident.
The
group
integrates
crisis
intervention
strathttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2begies and educational
techniques. Its
goal is to mitigate （缓解）the psychological trauma and speed recovery.
On-Scene Crisis-Intervention / Support
On-site, One on one: most effective in response to an acute crisis
(1)
Focus on the critical problem to guarantee safety.
(2)
Not psychotherapy,
(3)
Should be provided only by those trained and skilled.
(4)
Will not solve all the person‘s problems.
not a substitute for psychotherapy.
*
Education --- Integrates crisis intervention with education
*
Follow-up --- Assists the victim or survivor in recovering as quickly as possible.
2.
Risk Factors：Family History，Neurobiology，Existing Psychological Disorders
Stressful Life Events:……
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3.
Awareness of High Risk Group
low social-economical, alcoholic, addictive, unemployed, widow or widower,
disabled…
4.
Assessmenhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bt of Crisis &
Strategies of Crisis intervention
5.
Network and System to Prevent Suicide
Intervention Team:
policeman, physician, psychologist, social worker…….and the individual‘s parents
or spouse, or close and important friends join to be involved in the intervention……
6.
Social Support System
1)
Physical and material resources
2)
Believing in Truth, Goodness & Beauty
3)
Loving in Family, Friends & Neighbors
4)
Career, Profession, Social Status & Honors……
5)
Social Support Facilities
Ⅴ.
Positive Psychology & Resilience
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1.
Positive Psychology
The positive psychology movement began in 1999, launched during Martin
Seligman‘s term as president of the American Psychological association. It
emphasizes happiness, leadership, creativity, strength, and virtue and so on.
2.
Positive Therapy://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b
Positive Psychotherapy was established in Germany in 1968 by Prof. Dr. med.
Peseschkian and has spread to more than 25 different cultures with 40 centers.
Positive Psychotherapy is an important member of the so called brief psychotherapies.
The outlook of Positive Psychotherapy is a positive one, i.e. it seeks to avail itself
of
the existing positive aspects, talents and experiences of the client.
The method of Positive Psychotherapy is based on a Psychodynamic method under the
transcultural approach.
3.
Resilience
Resilience is the human ability to adapt in the face of tragedy, trauma, adversity,
hardship, and ongoing significant life stressors.
Resilience is the ability to bounce back after encountering difficulties, negative
events, hard times or adversity and to be able to return to the original level of
emotional
wellbeing.
It
is
the
capacity
to
maintain
http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2band
despite adversity.
a
fulfilling
healthy
life
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Young people who have the skills to be resilient have a lower likelihood of becoming
depressed or suicidal and a higher likelihood of maintaining emotional wellbeing.
Self efficacy, optimistic and helpful thinking, and maintaining a success orientation
are all important skills in being resilient.
Chapter 5
Anxiety Disorders
I
Anxiety, Fear, and Panic
II
GAD: Generalized Anxiety Disorder
III
IV
V
Panic Disorder
Phobia
Obsessive- Compulsive Disorder
I
Anxiety, Fear, and Panic
1.
Anxiety is a negative mood state characterized by bodily symptoms of physical
tension, and apprehension about the future. (APA)
* Subjective sense of unease,
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* A set of behaviors,
* Physiological response
Anxiety
is
a
future-oriented
state
characterized
by
neghttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bative affect in which a
person focuses on the possibility of uncontrollable danger or misfortune.
Fear is a present-oriented state characterized by strong escapist tendencies and a
surge in the sympathetic branch of the autonomic nervous system in response to current
danger Panic: The sudden overwhelming reaction to terrified fright.
They also share the same vulnerabilities, biological and psychological, to develop
anxiety and panic
2.
Comorbidity of Anxiety
The co-occurrence of two or more disorders in a single individual is referred to as
co-morbidity.
All of those disorders (anxiety disorders and depression) share the common features
of anxiety and panic.
They also share the same vulnerabilities, biological and psychological, to develop
anxiety and panic.
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II
GAD: Generalized Anxiety Disorder
Excessive
anxiety
worryhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b
and
(Apprehensive
Expectation ), occurring more days than not for at least 6 months, about a number
of events or activities ( such as work or school performance).
Free- floating Anxiety
Difficult to control the worry
Functional impairment
(Only one item is required in children)
1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying
sleep)
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III
1.
Panic Disorder
Panic Attack: (Agoraphobia, about 50% )
The sudden overwhelming reaction to terrified fright came to be known as panic.
An abrupt experience of intense fear (of dying) or acute discomfort, accompanied by
physical
symptoms
that
usually
include
heart
palpitations,
chest
paihttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bns, shortness of breath,
trembling or shaking, and, possibly, dizziness, fear of dying…..
*
Panic and anxiety combine to create different anxiety.
unexpected panic attack
*
develop substantial anxiety over the possibility of having another attack or
about the implications of the attack or its consequences.
*
2.
worry about each attack being a sign of impending death or incapacitation.
Anticipatory Anxiety and Avoided behavior
In phobic disorder the individual avoids situations that produce severe anxiety
and/or panic.
In panic disorder anxiety is focused on the next panic attack.
3.
Depression and Suicide
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4.
Treatment
Panic and anxiety combine to create different anxiety.
IV
1.
Phobia
Agoraphobia
Agoraphobia: PDA --- Panic Disorder with agoraphobia (coined in 1871, and in the
original Grehttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bek, refers to
fear of marketplace, the very busy and bustling area)
Anxiety about being in places or situations from which escape might be difficult or
embarrassing, or in which help may not be available in the event of an unexpected
or situationally predisposed panic attack or panic-like symptoms.
In PDA, anxiety and panic are combined with phobic avoidance in an intricate
relationship.
Many people who have panic attacks do not necessarily develop panic disorder.
Similarly, many people experience anxiety and panic without developing agoraphobia.
2 ． Social Phobia------A marked and persistent fear of being around others,
particularly in situations that call for some kind of ―performance‖ in front of
other people.
Exposure to the feared social situation almost invariably provokes strong anxiety
and avoid such social situation or endure with intense anxiety or distress.
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*
Social phttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bhobia, is an
intense fear of social situations. This fear arises when the individual believes that
they may be judged, scrutinized or humiliated by others.
*
Individuals with the disorder are acutely aware of the physical signs of their
anxiety and fear that others will notice, judge them, and think poorly of them.
*
In extreme cases this intense uneasiness can progress into a full blown panic
attack. *
Social phobia usually begins during adolescence with a peak age of onset
at about 15 years, later than specific phobias but earlier than panic disorders.
*
Social phobia also tends to be more prevalent in people who are young (19-29 years),
undereducated, single, and low socioeconomic class.
*
Alarmingly, the number of young people with social phobia seems to be increasing
somewhat.
3． Special Phobia
Blood-injection-injury phobia
Situational
phobia
(
planes,
elevatohttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2brs,
or
enclosed
places……)
Natural environment phobia ( heights -- Acrophobia,
Animal phobia
storms,
water…… )
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Separation anxiety disorder
4． Treatments to Anxiety & Phobia
*
Medication
*
Psychological Intervention
CBT- Cognitive Behavior treatment
Panic Control treatment
Systematic Desensitization: First, you should do it easily, then you can help your
client.
Rehearsing or role-playing
*
Combined Treatment
Panic Disorder & Phobia
We all have some genetic vulnerability to stress, and many of us have had a
neurobiological overreaction to some stressful event—that is, a panic attack.
Individuals who develop panic disorder then develop anxiety over the possibility of
having another panic attack.
In phobic disorder the individual avoids situations that produce severe anxiety
and/or panic.
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http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bIn panic disorder anxiety
is focused on the next panic attack.
V
1.
Obsessive- Compulsive Disorder
OCD
(1 ) Obsessions are intrusive and mostly nonsensical thoughts, images or urges that
the individual tries to resist or eliminate.
Thoughts about contamination, for example, when an individual fears coming into
contact with dirt, germs or "unclean" objects
Persistent doubts, for example, whether or not one has turned off the iron or stove,
locked the door or turned on the answering machine;
Extreme need for orderliness;
Aggressive impulses or thoughts, for example, being overcome with the urge to yell
'fire' in a crowded theater
Fear of germs
Fear of dirties…..
Thinking that something bad is going to happen to me…….
Thinking something bad is going to happen to whom I love…..
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Thinking
that
I
might
harm
someone
evenhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b I don‘t want to…..
(2 ).
Compulsions
Compulsions are the thoughts or actions used to suppress the obsessions and
provide relief.
Compulsions are repetitive behaviors or rituals performed by the OCD sufferer,
performance of these rituals neutralize the anxiety caused by obsessive thoughts,
relief is only temporary.
Cleaning. Repeatedly washing their hands, showering, or constantly cleaning their
home.
Repeating. Some repeat a name, phrase or action over and over.
Checking. Individuals may check several or even hundreds of times to make sure that
stoves are turned off and doors are locked.
Slowness. Some individuals may take an excessively slow and methodical approach to
daily activities, they may spend hours organizing and arranging objects.
Hoarding. Hoarders are unable to throw away useless items, such as old newspapers,
junk
mail,
appliances.
even
brohttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bken
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(3 ) OCD
OCD is the devastating culmination of the anxiety disorders.
It is not uncommon for someone with OCD to experience severe generalized anxiety,
recurrent panic attacks, debilitating avoidance, and major depression, all occurring
simultaneously in conjunction with obsessive-compulsive symptoms.
OCD characterized by uncontrollable obsessions and compulsions which the sufferer
usually recognizes as being excessive or unreasonable.
2.
Causes of OCD
Obsessive- Compulsive Disorder focuses on avoiding frightening or repulsive
intrusive thoughts (obsessions) or neutralizing these thoughts through the use of
ritualistic behavior (compulsions).
As with all of the anxiety disorders, biological and psychological vulnerabilities
seem to be involved in the development of OCD.
PET scans indicate differences in brain activity of OCD patients versus
norhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bmal.
It
shows
high
energy use in the brain of a typical person with OCD.
4.
Treatment
Drug treatment seems to be only modestly successful in treating OCD. The most
effective treatment approach is exposure and response prevention.
Psychosurgery（neurosurgery for a psychological disorder）--- a last resort
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Chapter 6
I
II
III
Mood Disorders
Depressive Disorder
Bipolar Disorder / Cyclothymiaq
Prevalence and Etiology of Mood Disorders
IV
Treatment of Mood Disorders
I
Depressive Disorder
1.
Clinical descriptions
Major Depression Three Lows: low spirits (depressed mood), diminished ability to
think, Psychomotor retardation.
* The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
* The symptoms are not duehttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b
to the direct physiological effects of a substance or a general medical condition.
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DSM-Ⅳ-R Criteria for Major Depression Episode
Five or more of the following symptoms have been present during the same 2-week period
and represent a change from previous functioning; at least one of the symptoms is
either (1) depressed mood most of the day, nearly everyday, as indicated by either
subjective report (e.g., feels sad or empty) or observation made by others (e.g.,
appears tearful). Note: in children and adolescents can be irritable mood.
(2) Markedly diminished interest or pleasure in all, or almost all, activities most
of the
day, nearly everyday (as indicated by either subjective account or observation made
by others .)
(3). Significant weight loss when not dieting or weight gain (e.g., a change of more
than 5% of body weight in a month）, or decrease or increase in appetite nearly
everyday.http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b
Note:
in
children, consider failure to make expected weight gains.
(4). Insomnia or hypersomnia nearly everyday
(5). Psychomotor agitation or retardation nearly everyday (observed by others, not
merely subjective feelings or restlessness or being slowed down)
(6). Fatigue or loss of energy nearly everyday
(7). Feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional ) nearly everyday (not merely self-reproach or guilt about being sick).
(8). Diminished ability to think or concentrate, or indecisiveness, nearly everyday
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(either by subjective account or as observed by others )
(9). Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing suicide
2.
Anxiety and Depression
Pure
Anxiety
Symptoms
Pure
Depression
Symptomhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bs
? apprehension
? helplessness
? tension
? depressed mood
? edginess
? loss of interest
? trembling
? lack of pleasure
? excessive worry
? suicidal ideation
? nightmares
? diminished libido
Mixed Anxiety and Depression Symptoms
3.
Learned Helplessness
Martin E. Seligman :
*
(Negative Affect)
Learned Helplessness Theory of Depression
People become anxious and depressed when they make an attribution that they
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have no control over the stress in their lives.
*
The depressive attributional style is
1) internal
2) stable
3) global
*
Learned Helplessness Model
Certain forms of depression may be due to a person having learned to be helpless.
http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bWhen they are confronted
with difficulties and stress, they become depressed
because they believe they have no control over the situation.
In other words, their
belief in their own helplessness predisposes them to develop depression.
4.
from Grief to Depression, Major Depression
A normal grief response may develop into a pathological grief reaction or impacted
grief reaction.
Particularly prominent symptoms include intrusive memories and distressingly strong
yearnings for the loved one, and avoiding people or places that are reminders of the
loved one.
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5.
II
1.
Biological and Social-Cultural Causes
Bipolar Disorder / Cyclothymiaq
Manic Episode
Three Highs: high spirits, Flight of ideas or thoughts are racing, Psychomotor
exciting
A person in a manic state feels euphoric and high, eager to be involved with others
and with life in generalhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b.
This expansive and elevated mood may have an infectious quality for the uninvolved
observer, but for those who know the person well, the mood is recognized as excessive.
Manic: During the period of mood disturbance, three (or more) of the following
symptoms have persisted (four if the mood is only irritable) and have been present
to a significant degree:
(1). Inflated self-esteem or grandiosity
(2). Decreased need for sleep, only 3 hours a night, or stays awake for 3 or 4 days
at a time
(3). More talkative than usual or pressure to keep talking
(4). Flight of ideas or subjective experience that thoughts are racing (racing ideas)
(5). Distractibility (i.e., attention too easily drawn to unimportant or irrelevant
external stimuli )
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(6). Increase in goal-directed activity or psycho-
(7).
Excessive
involvement
in
pleasurable
motor agitation
activities
http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2ba
high
that
potential
have
for
painful consequence ( high degree of risk taking )
2.
Bipolar I Disorder --- full manic episode
both full-blown manic and major depressive episodes
3.
Bipolar II Disorder --- hypomanic
major depression
major depressive episodes alternative with hypomanic episodes rather than full
manic episodes
4.
Cyclothymic disorder --- a chronic alternation of mood elevation and depression
that does not reach the severity of manic or major depressive episodes.
III
1.
Prevalence and Etiology of Mood Disorders
Depression in Children
Children should experience challenging and difficult situations so they can learn
that their responses do have an effect.
A child who is overprotected, or who grows up in a chaotic or abusive environment
will learn that his or her actions have no power to bring about good things. They
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have http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2blearned to be helpless
and depressed.
The child who is depressed is more likely in tantrums, irritable, angry, aggressive,
or psychomotor agitated.
2.
Depression in Adolescents
3.
Depression in Elderly
4.
Depression in Women
Women are taught to be passive, unassertive, and dependent, behaviors which can be
seen as a form of learned helplessness.
In contrast, men are taught to be assertive, competent, and in control.
It has been
suggested that these socialization differences predispose women to be depressed when
under stress, while men are more likely to become alcoholic.
Women, children or the elderly in general have limited access to power and resources.
The disadvantaged are more likely to develop learned helplessness.
5.
*
Etiology of Mood Disorders
There is complex set of psycho-social variables that have an impact on the genesis
anhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bd course of Mood Disorder.
These include personality, early experiences, cognitive processes, and social
factors.
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* Biology and heredity seem to "set us up" for certain disorders, but psycho-social
input is necessary for the program to run. Indeed, cognitive processes can play an
important role in guiding and moderating the physiological processes that ensue in
a mood disorders.
IV
Treatment of Mood Disorders
1.
Medications: Prozac
Lithium Therapy
Lithium therapy has now become widely used as mood stabilizer in the treatment of
both depressive and manic episodes of bipolar disorders. About three-quarters of
manic patients show at least a partial improvement.
Lithium therapy has some unpleasant side effects.
2.
ECT: Electroconvulsive Therapy
ECT is a safe, effective and important form of treatment. In fact, it is the only
way of dealing with somehttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b
severely depressed and suicidal patients. In addition, it is often the treatment of
choice for severely depressed women who are pregnant, as well as for the elderly.
Virtually every neurotransmitter system is affected by ECT. However, exactly how ECT
works is still not fully clear.
3.
Bright Light Therapy
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The non-pharmacological biological method is used in the treatment of seasonal
affective disorder, but now it has been shown to be effective in non-seasonal
depression as well.
4.
Psychosocial Treatments:
Aaron T. Beck developed cognitive-behavioral therapy for dealing with faulty
attributions and attitudes associated with learned helpless and depression.
5.
Preventing Relapse
6．Prognosis
*
For more severe cases, prognosis is poor in terms of ‘curing‘ the illness, as
most
people need to remain on medication for their entire lives.
*
The manic ephttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bisodes may
slow down as a result of the natural aging process. With
medication, the illness can be kept at a minimum level, with some people not
experiencing any overt symptoms for months and even years.
*
However, there are definitely varying degrees of this illness and it is not
difficult to misdiagnose due to it's similarity to other mood disorders.
*
in
If the illness is not severe, often times medication and therapy can do very well
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terms of treatment.
And, life experience, strong support, and an openness to improve
can be enough sometimes to make a difference in outcome.
Chapter 7
Developmental Disorders
I
Mental Retardation
II
Autistic Disorder
III
ADHD:
Attention Deficit / Hyperactivity Disorder
IV
Learning Disorder
I
Mental Retardation
特奥运动员参赛的“7088”：智商在 70 以下，年龄在 8 岁以上，经过 8 周以上的体育训练 比
赛 http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b 规则:按智障高低进行分
组:降低高度、简化难度、安全第一
奖牌发放:人人都有奖，前三名获得金、银、铜牌,第四到第八名运动员获得绶带。
颁奖仪式不奏国歌、不升国旗：国籍不重要，重要的是体现和谐、融合、参与
1.
Aetiology of MR:
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genetic,
brain damage, environmental malnutrition, social deprivation…
MR represent 1%~3% of the general population.
Approximate 80% of MR are mild & moderate.
Causes: Environment – Deprivation, Abuse, Neglect….
Prenatal: such as exposure to disease or drugs while still in the womb,
Infections ― Syphilis or HIV;
toxic agents ― Plumbism（铅中毒)；thalidomide (反应停)；crack
baby;
smoking, FAS….
Perinatal: such as difficulties during labor and delivery
Postnatatl: such as infections, head injury，malnutrition...
Fetal Alcohol Syndrome
*
Alcohol abuse in pregnant women is the third-leading cause of birth defects (the
first two being Down Syndrome and spina bifida 脊柱裂).
*
http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bFAS is a set of birth
defects caused by heavy consumption of alcohol during
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pregnancy. Children with this condition typically have a misproportioned head,
facial deformities, mental retardation, and behavioral problems.
Phenylketonuria – PKU
*
affects 1 of every 12000 newborns, special diet until age 6 or 7.
*
A rare hereditary disease in newborns in which the enzyme（?enzaim 酶） that
processes the amino acid （氨基酸）phenylalanine （苯丙氨酸）is defective or missing,
leading to the accumulation of phenylalanine in an affected child‘s blood shortly
after birth. Down Syndrome:
*
First described by the British physician Langdon Down in 1866. The disorder is
caused by the presence of an extra 21st chromosome and is therefore sometimes
referred to as trisomy 21.
*
Chromosomal disorder that results in mild to severe learning disabilities and
physihttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bcal
symptoms
that
include a small skull, extra folds of skin under the eyes,
and a flattened nose bridge. Muscle tone throughout the body is usually low.
Fragile X Syndrome
*
affects the developing brain, while the baby is still a fetus. 1843, Martin-Bell
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*
In 1991, researchers found that people with Fragile-X have an altered version of
a gene that makes a brain protein.
*
This DNA variant causes the gene to be switched off, so it no longer makes any
protein.
*
Scientists don't yet know how this protein usually functions in the developing
brain. It affects male most.
2.
Diagnosis of MR:
DSM-Ⅳ-TR:
―significantly sub-average general intellectual functioning …. That
is accompanied by significant limitations in adaptive functioning‖ in certain skill
areas such as self-care, work, health, and safety...
before 18 years old, Ihttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bQ
Social Adaptive Function:
Communication,
Self-Care,
Home-Living,
Social-Interpersonal
Skills,
Use
of
Community Resources, Self-Direction, Functional – Academic Skills, Work, Leisure,
Health, and Safety
*
Up to now we have no way to raise the IQ of MR, what we can do is to train and
train again patiently.
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3.
Degree of Severity
Degree
Mild:
IQ
Comparable to
50~55–70,
―educable‖,
9~12 years,
can adjust socially, master simple academic and occupational skills
Moderate:
35~40–49~54,
―trainable‖
6~9 years,
can achieve partial independence in daily self-care, acceptable behavior
Severe:
20~25–34~39,
―dependent‖
3~6 years,
can develop limited skills sensory defects and motor handicaps are common
Profound:
remain
in
custodial
care
all
their
lhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bives
4．
Training and Prevention
*
Institutionalization:
*
Special training:
severe MR accompanied with physical impairment
step-by-step training can bring MR repeated experiences of
success and lead to substantial progress.
*
Mainstreaming:
Mild MR children attend regular classes for much of the day
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--- requires careful planning,
a high level of teacher skills, and facilitative
attitudes.
II
Autistic Disorder
Autism was first described by Leo Kanner in 1943 as early infantile autism.
Characteristics of Autism: children seem to be locked within themselves.
1.
Characteristics of Autism
DSM- IV-R:
Impairment in social Interactions
Impairment in Communication
Restricted behavior, Interests, and Activities
Stereotyped and Ritualistic Behaviors
*
About
2
to
20
per
10,000
peoplhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2be (APA , 2000), and
when combined with other pervasive developmental disorders may be as 1 in each 500
births.
*
The vast majority of people with autism develop the associated symptoms before
the age of 36 months
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*
One of hallmarks of autism is lack of social interaction
1).
Impaired use of nonverbal behavior
2).
Lack of peer relationships
3).
Failure to spontaneously share enjoyment, interests, etc. with others
4).
Lack of reciprocity
Autistic Sensory & Movement Disorders
* Over- or under-sensitive to sensory stimuli
* Abnormal posture and movements of the face, head, trunk, and limbs
* Abnormal eye movements
* Repeated gestures and mannerisms
* Movement disorders can be detected very early – perhaps at birth
* Change in routine is very stressful
*
May
insist
on
particular
furniture
arrangement,
http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bat meals, TV shows
* Symmetry is often important
food
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2.
Autistic Savants
3. Other Pervasive Developmental Disorders
Asperger‘s Disorder
*
Hans Asperger first described in 1944 and Lorna Wing in the early 1980s
recommended that Asperger‘s disorder be reconsidered as a separate disorder from
Autism, with an emphasis on the unusual and circumscribed interests displayed by
Asperger‘s disorder.
* Asperger’s disorder involves significant impairment in the ability to engage in
meaningful social interaction along with restricted and repetitive stereotype
behaviors but without the severe delays in language or other cognitive skills
characteristic of people with autism. (APA,2000)
People with Asperger‘s Disorder display impaired social relationships and
restricted or unusual behaviors or activities, but unlike individuals with Autism
they can quite verbal.
://www.wendangwang.com/doc/406f55ffacce48902d1d0f2brThey show few severe cognitive
impairments and usually have IQ scores within the average range. They often exhibit
clumsiness and poor coordination.
Some researchers think Asperger‘s Disorder may be a milder form of Autism rather
than a separate disorder.
4. Theories and Treatment
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Treating focus on enhancing their communication and daily living skills and on
reducing problem behaviors such as tantrums and self-injury.
Communication
Socialization
*
In general, majority of individuals with autism are also identified as having
mental retardation – 75% below 70
*
Verbal and reasoning skills are difficult
*
Autism was caused by abnormalities in brain development, neurochemistry, and
genetic factors.
*
Diagnosed based on presence of symptoms
*
No definitive medical test or medical cure.
Up
to
now,
absence
standahttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2brdized
tools for
of
diagnostic
children under 24 months, absence of diagnostic criteria for children
under 24 months.
The precise causes of autism are still unknown today, yet most investigators agree
that a fundamental disturbance of central nervous system is involved
*
Treating focus on enhancing their communication and daily living skills and on
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reducing problem behaviors such as tantrums and self-injury.
Communication
Socialization
*
Prognosis
The prognosis for autistic children, particularly for children showing symptoms
before the age of 2, is poor. Commonly, the long-term results of autism treatments
have been unfavorable. The outcome in autism, particularly in more severe cases, is
usually not as positive.
A great deal of attention has been given to high-functioning autistic children (such
as functional speech….)
What can we do to helphttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b the
parents:
*
Understand their child
*
Improve their ability to understand their child‘s behavior
*
Give them more effective ways of interacting and relating to their child
*
Help with behavioral management issues
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III
ADHD:
Attention Deficit / Hyperactivity Disorder
1. Clinical Description：Inattention, Hyperactivity, Impulsivity
Inattention:
Impulsivity
Doesn‘t seem to listen
Hyperactivity
Rushing into things
Fails to finish assigned tasks
Restlessness
Careless errors
Often loses things
Risk taking
Can‘t concentrate
Taking dares
Easily distracted
Accidents/injuries
Daydreams
Can‘t sit still
Talks excessively
Fidgeting
Always on the go
prone
Easy
arousal://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b
Requires frequent redirection
Can be very quiet & missed
*
Impatience
Lots of body movement
Interruptions
Children with ADHD are described as overactive, impulsive, and having a low
tolerance for frustration and an inability to delay gratification.
*
Many hyperactive children retain ADHD into early adulthood or go on to have other
psychological problems, such as overly aggressive behavior or substance abuse, in
their late teens and early adulthood.
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DSM-Ⅳ-R:
ADHD
Six (or more) of the following symptoms of inattention have persisted for at 6 months
to a degree that is maladaptive and inconsistent with developmental level:
Inattention
Hyperactivity
Impulsivity
Some hyperactive-impulsive or inattentive symptoms that caused impairment
were present before age 7 years old;
Some
impairment
from
the
symptoms
is
presenthttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b in two or more
settings (e.g., at
school work or at home)
There must be clear evidence of clinically impairment in social, academic, or
occupational functioning.
2.
Statistics: 4% to 12% of children who are 6 to 12 years of age,
3.
Causes: genetic, mild brain damage, environmental factors….
4.
Treatment: Biological & Psychosocial Intervention
boys:girls=4:1
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Stimulant Medication: Methylphenidate (Ritalin), 利他林, Pemoline (Cylert) 匹莫林
D-amphetamine (Dexedrine), 右旋苯丙胺
Behavior Intervention & Parents Training: Psychologist for 8 -12 weeks; specific CBT,
goal oriented behavior changes in child and family.
School intervention through IEP
Parents Training
Over/Under-Diagnosed?
Combined Intervention
Tourette‘s
IV
Syndrome
Learning Disorder
DSM-
IV-R:
Learning
Disorder
is
in
readinghttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b, mathematics, and
written expression
— all characterized by performance that is substantially bellow what would be
expected given the person‘s age, IQ, and education.
reading disorder (Dyslexi) , disorder of written expression, mathematics disorder
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1. Dyslexia
One with dyslexia has problems with word recognition, spelling, and reading
comprehension. Dyslexic person routinely omit, add, and distort written words, and
their reading is typically painfully slow and halting.
Dyslexia is the best known and mostly widely researched.
MRI has suggested that dyslexic children may have a deficiency of physiological
activation in a brain center believed to be involved with rapid visual processing.
Children with reading disorders have poorly developed skills in recognizing words
and comprehending written text.
Children
with
Dyslexia
have
decodinghttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b words.
difficult
Words may
thus become blurry, fuse together, or seem to jump off the page.
Dysgraphia (refers to handwriting problems – partial inability to remember how to
make certain alphabet or arithmetic symbols in handwriting.
2. disorder of written expression
3. Dyscalculia (mathematics disorder):
lack of ability to perform math functions
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Very conservatively, there is a 1% to 3% incidence of learning disorders in the United
States. Among school-age children, the prevalence rate is estimated at 10% to 15%,
currently believed to include nearly 4 million children in the United States.
Difficulties with reading are the most common of the learning disorders and occur
in
approximately 5% to 15% of the general population. Mathematics disorder appears in
approximately 6% of the population.
A
learning
disorder
can
lead
to
a
number
of
different
outcomes,
dependihttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bng on the extent
of the disability and the extent of available support.
4. Aetiology & Treatment of Learning Disorder
Genetic, Neurobiological, Environmental
Educational Intervention:
Behavior Skills
Cognitive Skills
Visual & Auditory Perception Skills
Chapter 8
Schizophrenia
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I
History of the Concept of Schizophrenia
II
Symptoms of Schizophrenia
III
Types of Schizophrenia
IV
V
Aetiology of Schizophrenia
Treatment and Prognosis
Vincent van Gogh (1853-1890), Dutch postimpressionist painter whose works include
numerous self-portraits and a series of sunflower paintings (1888). He cut off his
right ear to present to a street-girl. van Gogh shot himself and died two days later
in 1890.
I
History of the Concept of Schizophrenia
1.
Emil Kraepelin (1http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b859 -
1926),
German psychiatrist, 《Textbook of Psychiatry》，1883, Dementia Praecox
He defines two major groups of mental disorders: the manic-depressive psychoses, and
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dementia praecox (ie schizophrenia).
2.
Eugen Bleuer (1857 - 1939)
Swiss psychiatrist , Coined Schizophrenia in 1911, identified,
4A syndromes ：
Association, Affect, Ambivalence, Autism
3.
Kurt Schneider: first rank symptoms
4.
Contemporary Diagnostic Practices
II
Symptoms of Schizophrenia
1.
Disturbances in Thought, Speech and Communication
2.
Emotional Disturbances: Affective Flattening
3.
Disturbances of Motivation: Avolition
4.
Perceptional Disturbances: Hallucinations, Delusions
Delusion --- Disorder of thought content: A belief that would be seen by most member
of a society as a misrepresentation of reality.
Hallucination
---
Thttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bhe
experience of sensory events without any input from the surrounding environment.
5.
Disturbances in Sense of Self and Interpersonal Relating Ability
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Schizophrenia, a class of psychological disorders that is perhaps the ultimate in
psychological breakdown.
The individual typically has marked breaks with and distortions of reality.
Schizophrenia "strikes at the very heart of what we consider the essence of the person".
Schizophrenia affects all areas of functioning: thought, perception, emotion,
behavior
III
Types of Schizophrenia
Positive Symptoms:
Delusions, Hallucinations
Negative Symptoms:
Avolition (inability to initiate and persist activities)
Alogia (relative absence of speech)
Anhedonia (presumed lack of pleasure)
Affective flattening
1.
Catatonic Schizophrenia
The
is
serious
motohttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2br
behavior
disturbance.
essential
feature
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Posturing (voluntary assumption of inappropriate or bizarre postures, often for
extended periods of time).
Unusual motor responses of remaining in fixed position (waxy flexibility 蜡样屈曲)
Odd mannerisms with their bodies and faces, including grimacing
Repeat or mimic the words of others (echolalia 模仿言语) or the movements of others
(echopraxia 模仿动作)
2.
Paranoid Schizophrenia
Preoccupation with one or more delusions or frequent auditory hallucinations.
Their cognitive skills and affect are relatively intact.
They generally do not have disorganized speech or flat affect, and they typically
have a better prognosis than people with other forms of schizophrenia.
Characterized by delusions that have themes of suspiciousness, persecution, or
grandeur. The individual with Paranoid Schizophrenia may become extremely suspicious
that
everyonhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2be at work is trying
to kill him, or that he possesses some profound or even divine powers.
Hallucinations will often accompany these delusions, often reinforcing the false
beliefs.
3.
Disorganized Schizophrenia
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A particularly severe (although also less common) type of Schizophrenia,
characterized by incoherent behaviors, thoughts, and affect. There is extreme
loosening of associations.
Marked
disruption
in
their
speech
and
behavior,
―associative
splitting‖, ―cognitive slippage‖
Flat or inappropriate affect (such as laughing in a silly way at the wrong times)
Unusually self-absorbed (may spend considerable amounts of time looking at themselves
in the mirror)
Hebephrenic （Hebe, the goddess of youth)-- tend to show symptoms early,
problems are often chronic,
4.
and their
lacking the remissions.
Undifferentiated Schizophrenia
A "waste basket" category://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bpar
People who do not fit neatly into any other subtypes of
people who have the major symptoms of
schizophrenia
schizophrenia,
including
but who do not meet the criteria
for paranoid, disorganized, or catatonic types.
5.
Residual Schizophrenia
People who have had at least one episode of schizophrenia but who no longer manifest
major symptoms.
Although they may not suffer from bizarre delusion or hallucination, they may display
residual or ―leftover‖ symptoms.
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IV
Aetiology of Schizophrenia
1.
Genetic Influences: Family Studies, Twin Studies
2.
Neurobiological Influences: Dopamine, Brain Structure, Viral infection
3.
Psychosocial Influences
Perhaps one of the most consistent social factors associated with later onset of
schizophrenia is marked social withdrawal and generally poor interpersonal
relationships.
The family http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2benvironment as a
source of chronic stress has been hypothesized to be a critical provoking factor in
schizophrenic disorders.
V
Treatment and Prognosis
1.
Biological Intervention:
2.
Psychosocial Intervention
3.
Prognosis of Schizophrenia
* Benign
pharmacological approaches
* Malign
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onset acutelylurking, slowly
episodicchronic
manic-depressiveAffective Flattening
onset lately
married or having a family
emerge early
single or divorced
psychosexual normalpsychosexual deviational
employed
having friends, relatives…
Strong social support
4.
unemployed
withdraw, isolated….
weak social support
Relapse of schizophrenia appears to be triggered by hostile and stressful
environments.
Thhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2be
negative
emotional
climate (eg: hostility and criticism) in these families raises the patient's arousal
and stress beyond his or her already impaired coping mechanisms.
5.
Prevention of Schizophrenia
Interventions that teach family members more adaptive communication methods have lead
to substantial reductions in relapse rates.
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Indeed, family based communication skills training appears more effective than
individual psychotherapy or drug treatment in reducing relapse rates over a 1 year
period.
Chapter 9
I
II
III
IV
I
Eating and Sleep Disorders
Eating Disorders
Causes and Treatment of Eating Disorders
Dyssomnias
Treatment of Dyssomnias
Eating Disorders
1．Bulimia --- Out-of-control eating episodes are followed by self-induced vomiting,
excessive
use
of
laxatives,
or
other
attempts
to
purge
(get
ridhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2be of ) the food.
The binge eating and inappropriate compensatory behaviors both occur, on average,
at least twice a week for 3 months.
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Chronic bulimia with purging has a number of medical consequences, such as salivary
gland enlargement caused by repeated vomiting, dental enamel eroded, electrolyte
imbalance, cardiac arrhythmia (disrupted heartbeat), renal (kidney) failure……
2．Anorexia --- eat nothing beyond minimal amounts of food, so body weight sometimes
drops dangerously.
The
chief
characteristic
of
these
related
disorders
is
an
overwhelming,
all-encompassing drive to be thin. People with anorexia have an intense fear of
obesity and relentlessly pursue thinness.
A key criterion of anorexia is a marked disturbance in body image.
Medical consequences:
? Lowered metabolism
? Dehydration and anemia
? Reduced blood pressure and body temperature
://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b? Development of lanugo, a pale,
downy hair, on face and trunk
? Electrolyte imbalances
? Cessation of menstrual cycle
? Possible permanent damage to bones and reproductive system
3．Binge-Eating Disorder – Obesity
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People with BED experience marked distress due to binge eating but do not engage in
extreme compensatory behaviors and therefore cannot be diagnosed with bulimia.
BED is in the appendix of DSM- IV-R as a potential new disorder requiring further
study.
4．Other Eating Disorder
Pica:
Repeated eating of non-nutritive substances, such as paint, plaster, string,
hair or cloth; and occurs in infants and people with mental retardation or dementia.
Pica poses serious health problems. The risk of death is quite high.
II
1.
Causes and Treatment of Eating Disorders
Causes of Eating Disorder
Social attitude --- http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bbody
image
Family influences
Biological factors
Psychological factors
Cultural Considerations
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2.
Adolescents and Eating Disorder
The overwhelming majority of cases begin in adolescent. Bulimia and anorexia are
strongly related to development.
As the ideal look is tall and muscular for men and thin and prepubertal for women,
physical development brings boys closer to ideal and takes girls further away.
3.
Treatment
Drugs --- antidepressant medications
Psychological treatment --- cognitive-behavioral therapy (CBT), behavioral therapy
(BT), interpersonal psychotherapy (IPT)
Preventing Eating Disorders --- early concern about being overweight was the most
powerful predictive factor of later symptoms.
III
Dyssomnias
Somnus
–
Rom.
Myth:
the
God
of
sleep,
Identified
with
Hypnos.://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bar
Dyssomnias (disturbances in the amount, timing, or quality of sleep)
1.
Primary Insomnia
the
Greek
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difficulty initiating or maintaining sleep, or sleep that is not restorative (person
not feeling rested even after normal amounts of sleep).
2.
Primary Hypersomnia
Complaint of excessive sleepiness that is displayed as either prolonged sleep
episodes or daytime sleep episodes.
Excessive Daytime Sleepiness Syndrome 醒觉不全综合征
* Sleeping too much !
People with hypersomnia sleep through the night and appear rested upon
awakening, but still complain of being excessively tired throughout the day.
3.
Narcolepsy(发作性睡病)--- sudden and irresistible sleep attacks
Irresistible attacks of refreshing sleep occurring daily, accompanied by episodes
of brief loss of muscle tone (cataplexy 猝倒)
4.
5.
Breathing-Related Sleep Disorder
Parasohttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bmnias ( 睡 眠 异
常)
Parasomnias：Disturbances in arousal and sleep stage transition that intrude into
the sleep process)
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Nightmare Disorder (Dream Anxiety Disorder,恶梦障碍) --- repeated awakening with
detailed recall of extented and extremely frightening dreams, usually involving
threats to survival, security, or self-esteem.
Sleep Terror Disorder (睡眠恐怖障碍)--- recurrent episodes of abrupt awakening from
sleep, usually occurring during the first third of the major sleep episode.
Sleepwalking Disorder (睡行障碍)--- Repeated episodes of arising from bed during
sleep and walking about usually occurring during the first third of the major sleep
episode.
IV
1.
Treatment of Dyssomnias
Medical Treatment:
Benzodiazepine (BDZ), Long-acting drugs, Short-acting drugs
Dependence of drugs
2.
Environmental Treatment
3.
Psychological Treatment
4.
Preventinghttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b
Sleep
Disorder
* Good Sleep Habits
Establish a set bedtime routine, Develop a regular bedtime and a regular time to wake
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Try drinking milk before bedtime
Go to bed only when sleepy and get out of bed if are unable to fall asleep or back
to sleep after 15 minutes
Increase exposure to natural and bright light during the day
Avoid extreme temperature changes in the bedroom (not too cold or too hot)
Chapter 10
I
Aging and Cognitive Disorder
Psychological Disorders Related to Aging
II
Delirium
III
Dementia
IV
Treatment and Caring of Senile Dementia
I
Psychological Disorders Related to Aging
Aging is associated with a reduction in the efficiency of just about every physical
process in the body……The general intellectual decline can be linked to physical
decline.
Aging
affects
many
complex
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thhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2boughts and activities.
1.
Cognitive Changes in Later Life
2.
Anxiety Disorders and Aging
3.
Depression and Aging
4.
Sleep Problems and Aging
Brain weight declines more after age 60; loss may be 5 to 10% by age 80, due to death
of neurons and enlargement of ventricles (spaces) within the brain.
Neuron loss in the cortex:
In the visual, auditory, and motor areas, as much as 50%
But not parts responsible for integration of information,
judgment, and reflective
thought
The cerebellum (balance and coordination) loses about 25%
Neuroglia （神经胶质） cells decrease as well, contributing to diminished
efficiency
of the central nervous system
Life span - the upper boundary of life, the maximum number of years an individual
can live.
The maximum life span of human beings is approximately 120 years of age.
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Life
expectancy
-
thhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2be
number of years that will probably be lived by the average individual born in a
particular year.
The life expectancy of individuals born today in the U.S. is over 77 years.
Sex Differences in Longevity
Beginning at age 25, females outnumber males, and the gap continues to grow.
By the time adults are 75 years of age, more than 61% of the population is female.
These differences are due to health attitudes, habits, lifestyles, and occupation.
Biological factors play a role, too, as females outlive males in virtually all
species.
II
1.
Delirium
Clinical Description
Delirium is a temporary state of confusion and disorientation that can be caused by
brain trauma, intoxication by drugs or poisons, surgery, and a variety of other
stressful conditions, especially among older adults.
As
many
as
44%
of
people
with
dementia
leashttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bt
delirium.
one
suffer
episode
at
of
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Delirium is a true medical emergency, and its underlying cause must be identified
and managed. Treatment involves medication, environmental manipulations, and family
support.
A.
DSM- IV-R:
Disturbance of consciousness (i.e, reduced clarity of awareness of the
environment)
with reduced ability to focus, sustain, or shift attention.
B.
A Change in cognition (such as memory deficit, disorientation, language
disturbance)
or the development of a perceptual disturbance that is not better accounted for by
a
preexisting, established, or evolving dementia.
C.
The disturbance develops over a short period of time (usually hours to days) and
tends to days) and tends to days) and tends to ctuate during the course of the day.
D.
There is evidence from the history, physical examination, or laboratory findings
that
the disturbahttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bnce is caused
by the direct physiological consequences of a general
medical condition.
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2.
Statistics: As many as 44% of people with dementia suffer at least one episode
of
delirium
3.
Treatment
4.
Prevention
III
Dementia
Dementia is a gradual deterioration of brain functioning that affects judgment,
memory, language, and other advanced cognitive processes.
Dementia is a progressive and degenerative condition marked by a gradual
deterioration of a broad range of cognitive abilities including memory, language,
and planning, organizing, sequencing, and abstracting information.
Although delirium and dementia can occur together , dementia has gradual progression
as opposed to delirium‘s acute onset, people with dementia are not disoriented or
confused in the early stages, unlike people with delirium.
Dementia
can
occur
at
almost
any
ahttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2blthough the
age,
incidence of
it highest in older adults.
1.
Alzheimer‘s Disease
Alois Alzheimer, the German psychiatrist first described the disorder that bears his
name in 1906.
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Alzheimer‘s Disease include multiple cognitive deficits that develop gradually and
steadily. Predominant is the impairment of memory, orientation, judgment, and
reasoning. The inability to integrate new information results in failure to learn
new associations.
Alzheimer's: Brain Deterioration
*
Inside neuron:
Neurofibrillary tangles appear. (细胞内纤维缠结)
*
Outside neurons (intercellular):
Plaques (老年斑)
Symptoms and Course of Alzheimer's
Severe memory problems
Recent memory is impaired first; recall of distant events eventually fades,
forgetting names, place, date….
Faulty judgment (e.g., drive when not competent)
Personality changes appear.
Lohttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bss
increased anxiety, angry outbursts, reduced initiative, and
social withdrawal……
Depression
of
spontaneity,
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Skilled and purposeful movements disintegrate.
Course of Alzheimer's varies: About 8 to 10 years is average.
Loss of neurons is central to the disease
Alzheimer's: Brain Deterioration
Inside neuron: Neurofibrillary tangles （神经纤维缠结）appear
Outside neurons (intercellular) :
Senile Plaques (老年斑— Debris (垃圾碎片）left
from dead cells coheres （黏附），contains amyloid
（淀粉状蛋白）, a protein
deposited in tissue ， with reduced immunity which may destroy
surrounding cells.
Both conditions are normal in older people but far
more abundant in Alzheimer's victims.
The PET scan of the brains with Alzheimer‘s Disease shows significant tissue
deterioration in comparison with the normal brains.
The average suhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2brvive time is
estimated to be about 8 years, although many
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individuals live very dependently for more than 10 years.
2.
Vascular Dementia
Permanent deterioration due to blocked or damaged blood vessels in the brain (stroke);
symptoms identical to Alzheimer's and may also include problems with walking and
weakness of limbs.
The onset of vascular （血管性） dementia is typically more sudden than for Alzheimer's
type, probably because the disorder is the result of stroke, which inflicts brain
damage immediately.
3.
Substance-Induced Persisting Dementia
4.
Parkinson‘s Disease
Motor problems are characteristic among people with Parkinson‘s disease, who tend
to have stooped posture, slow body movements, tremors, and jerkiness in walking.
Some people with Parkinson‘s disease develop dementia, conservative estimates place
the
rate
at
twice
that
found
in
the
general
populhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bation.
Parkinson‘s Disease is a degenerative brain disorder that affects about 1 out of
every
1000 people worldwide.
The voice is also affected, afflicted individuals speak in a very soft monotone.
The changes in motor movements are the result of damage to dopamine pathways.
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IV
Treatment and Caring of Senile Dementia
1.
Keeping Social Attachment
2.
Psychological and Social Support
3.
Encouraging the Elderly Self-Caring
4.
Respect and Service-Offering
5.
Successful Aging
*
Expert Survivors
≥ 100,
Master Survivors ≥ 80
*
Strong but not inflexible characters
*
High level of cognition, demonstrating skill in everyday problem solving and
learning.
*
Enjoy a strong social-support system, maintaining a connection with the world,
with younger people, keeps their outlook youthful.
Misdhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2biagnosed
Reversible Dementia
Depression is often misdiagnosed as dementia
and
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A depressed older adult is likely to exaggerate mental difficulties; demented person
minimizes and is not fully aware of cognitive declines.
Depression rises with age, often related to illness and pain.
Important role of acceptance or adjustment to what they expected from life.
Aging Mental Health
Elderly are unlikely to seek mental health services.
Diseases and drug side effects can resemble dementia.
Environmental changes and social isolation can trigger mental declines
Chapter 11
I
Substance-Related Disorders
Classification of Substance- Related Disorders
II
Alcohol
III
Psychotropic Drugs Abuse
IV
Treatments and Outcomes
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I
Classification of Substance- Related Disorders
Psychoacthttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bive Substance
*
Which alter mood and / or behavior – to become intoxicated or high.
*
Individual lifestyles and personality features are thought by many to play
important roles in the development of addictive disorders and are central themes in
some types of treatment.
1.
Substance Abuse and Dependence
Substance abuse generally involves a pathological use of a substance resulting in
(1) potentially hazardous behavior, such as driving while intoxicated, or (2)
continued use despite a persistent social, psychological, occupational, or health
problem.
*
Substance dependence includes more severe forms of substance use disorders and
usually involves a marked physiological need for increasing amounts of a substance
to
achieve the desired effects.
*
Dependence occurs when an individual develops a tolerance for the substance or
exhibits
withdrawal
symptoms
when
substahttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bnce
available.
the
is
not
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*
Tolerance – the need for increased amounts of a substance to achieve the desired
effects – results from biochemical changes in the body that affect the rate of
metabolism and elimination of the substance from the body.
*
Withdrawal symptoms are physical symptoms, such as sweating, tremors, and tension,
that accompany abstinence from the substance.
1.
Addiction, physiological Dependence, and Psychological Dependence
2. Pathways to Dependence
3. Intoxication
4. Withdrawal Syndromes
II
Alcohol
1.
Physical Health and Alcohol--- Fetal Alcohol Syndrome
2.
Psychological Effects of Alcohol
FAS
Sociocultural Factors
In a general sense, our culture has become dependent on alcohol as a social lubricant
and a means of reducing tension.
Europe
and
6
countries
that
have
been
Europeanhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b
influenced
by
culture
—
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Argentina, Canada, Chile, Japan, the United States, and New Zealand — make up less
than 20% of the world‘s population yet consume 80% of the alcohol.
The incidence of alcoholism among Muslims, Mormons, and orthodox Jews, whose
religious values prohibit social drinking, is minimal.
Orthodox Jews traditionally limit alcohol use.
3.
Alcoholism
Alcohol Effects
After alcohol is ingested, it passes through the esophagus (1) and into the stomach
(2), where small amounts are absorbed. From there most of it travels to small intestine
(3) , where it is easily absorbed into the bloodstream. The circulatory system
distributes the alcohol throughout the body, where it contacts every major organ,
including the heart (4). Some of the alcohol goes to the lungs, where it vaporizes
and it exhaled, a phenomenon that is the basis for the breath analyzer test that
measures
levels
of
intoxication.http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b As alcohol
passes through the liver (5) it is broken down or metabolized into carbon dioxide
and water by enzymes.
Such as psychological vulnerability, stress, and the desire for tension reduction
--- and disturbed marital relationships are also seen as important etiological
elements in alcohol abuse.
Chris Farley:
American comic actor died in 1997 at age of 33, ―one drug binge too
many‖--- morphine and cocaine, his liver was heavily scarred by heavy drinking.
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4.
Ethnicity and Alcohol Abuse
Intoxication is often involved in cases of domestic violence
5. Treatment and AA (Alcoholic Anonymous)
AA Alcoholics Anonymous Movement, Self-help Counseling program
AA was started in 1935 by two men, Dr. Bob and Bill W., in Akron, Ohio. Bill W. recovered
from alcoholism through a ―fundamental spiritual change‖ and immediately sought
out
Dr.
Bob,
who,
with
Bill‘s
assistance,
achiehttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bved recovery. They in
turn began to help other alcoholics.
Alcoholics Anonymous operates primarily as a self-help counseling program in which
both person-to-person and group relationships are emphasized.
III
Psychotropic Drugs Abuse
Classification
Sedatives
Drug
Alcohol
镇静剂、抑制剂
Stimulants
兴奋剂
Effect
Reduce tension
facilitate social interaction
Amphetamines
Ecstasy (MDMA)
Increase confidence
Increase aggression
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cocaine (coca)
Narcotics
Stimulate sex drive
Opium and its derivatives
麻醉剂
Alleviate physical
Opium
pain, induce relaxation
Morphine
and
pleashttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bant reverie.
Codeine
Alleviate anxiety and
Heroin
tension.
Hallucinogens
剂
1.
Marijuana
LSD
induce changes in mood,
致幻
thought, and behavior
Opioids
Narcotics: Opium and its Derivatives
Opiates induce euphoria, drowsiness, and slowed breathing. High does can lead to death
if respiration is completely depressed. Opiates are also analgesics, substances that
help relieve pain.
The use of opium derivatives over a period of time generally
results in a physiological craving for the drug.
When people addicted to opiates
do not get a dose of the drug within approximately 8 hours, they start to experience
withdrawal symptoms.
2.
Opium poppy →Opiate →Morphine →Heroin
Stimulants: Amphetamine, Cocaine, Nicotine, Caffeine
Stimulants
are
consumed
commonlhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2by,
most
including
caffeine (in coffee, chocolate, and many soft drinks), nicotine (in tobacco products
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such as cigarettes), amphetamines, and cocaine.
For centuries, Latin Americans have chewed coca leaves to get relief from hunger and
fatigue.
3.
Hallucinogens：Marijuana, LSD
Hallucinogens, such as marijuana and LSD, essentially change the way the user
perceives the world. Sight, sound, feelings, taste, and even smell are distorted,
sometimes in dramatic ways.
Marijuana contains over 80 varieties of the chemicals called cannabinoids(大麻脂),
which believed to alter mood and behavior.
Reactions to marijuana usually include mood swings.
4.
Sedative-Hypnotics and Antianxiety Drugs
―Pleasure Pathway‖
Most psychotropic drugs seem to produce positive effects by acting directly or
indirectly on the dopaminergic mesolimbic system (the “pleasure pathway”). In
addition,
psychohttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bsocial
factors such as expectation, stress, and cultural practices interact with the
biological influences to influence drug use.
IV
Theoretical Perspectives and Treatment
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1.
Biological Dimensions & Biological Approach
Treating people who have substance-related disorders is a difficult task. Because
of the combination of influences that often work together to keep people hooked, the
outlook for those who are dependent on drugs is often not very positive.
Agonist substitution provides the user with a safe drug that has a chemical makeup
similar to the addictive drug.
Methadone Substitutional Treatment
Antagonist treatment block or counteract the effects of psychoactive drugs.
2. Treatments and Prevent
Substance dependence is treated successfully only with a minority of those affected,
and
the
best
results
reflect
the
motivation
andhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b
of
the
a
drug
combination
user
of
biological and psychosocial treatments.
Programs aimed at preventing drug use may have the greatest chance of significantly
affecting the drug problem.
Chapter 12
I
Homosexualism, Gender Identity Disorders and Sexual Deviation
Homosexualism
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II
Transsexualism Vs Gender Identity Disorder
III
Paraphilia / Sexual Deviation
IV
Assessment and Treatment
I
Homosexualism
A natural sexual orientation, in hopes to allow sexual behavior between persons of
the same gender。
Homosexual Behavior: Sexual activity with members of the same
gender.
Homosexuality was officially removed form the DSM (where it had previously been
classed as a sexual deviation) in 1973 and today is no longer regarded as a mental
disorder.
One plausible explanation is that homosexual people have higher rates of
sohttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bme
problems such as anxiety disorders and depression which result
stigmatizing of homosexuality.
1.
Ancient fashion:
2.
Modern fashion
from social
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3.
Adaption of Homosexualist
4.
Sexual Orientation Continuum
The term bisexual is used to describe some level of sexual activity with or affectional
interest in both sexes.
Bisexuality describes people who have the ability to be sensual and intimate with
both women and men.
Sigmund Freud first suggested that human beings are essentially bisexual at birth,
but that
most often the homosexual component is blocked during psychosexual
development and by social pressures.
……←——————————--—→……
-5 -4
-3 -2 -1
0
1
Heterosexuality
II
2
3
4
5
Bisexuality
Homosexuality
Transsexualism Vs Gender Identity Disorder
1.
Gender Dhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bifferences
2.
Cultural Differences
3.
The Development of Sexual Orientation
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4.
Gender Identity Disorder
Gender Identity Disorder or transsexualism, also called transgenderism, refers to
a person who is a biologically normal- appearing male or female who believes that
a biological mistake has been made and that he or she was born with the wrong body
for his or her feeling, which is the feeling of being ―trapped ‖in the body of the
wrong sex.
Many transsexual people seek sex-change surgery with the goal of changing their body
to
fit their feelings.
A person feels his / her physical gender is not consistent with his / her sense of
identity.
A person with GID always feel trapped in a body of the wrong sex.
Research has yet to uncover any specific biological contributions to GID. At least
some
evidence suggests that GID firms up between 18 months and 3 years
ohttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2bf age and relatively fixed
after that.
III
Paraphilia / Sexual Deviation
The paraphilias are a group of persistent sexual behavior patterns in which unusual
objects, rituals, or situations are required for full sexual satisfaction.
The DSM-Ⅳ recognizes 8 specific paraphilias (1) fetishism,
(2) transvestic
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fetishism,
(3) voyeurism,
(4) exhibitionism,
(5) sexual sadism,
(6) sexual
masochism,
(7) pedophilia, (8) frotteurism (rubbing against a nonconsenting person )
Most people with paraphilias do not seek treatment for their conditions.
1.
Fetishism
The individual has recurrent, intense sexually arousing fantasies, urges, or
behaviors involving the use of some inanimate object to obtain sexual gratification.
The range of fetishistic objects includes hair, ears, hands, underclothing, shoes,
perfume,
and
similar
objects
associated
with
the
oppositehttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b sex.
Heterosexual men experience recurrent, intense sexually arousing fantasies, urges,
or behaviors that involve cross-dressing as a female.
Typically, the onset of transvestism is during adolescent and involves masturbation
while wearing female clothing or undergarments.
Studies have shown that men who cross-dress may actually feel less anxiety and
shyness when in their female roles.
2.
Voyeurism and Exhibitionism
Voyeurism is the practice of observing an unsuspecting females who are undressing
or couples engaging in sexual activity. Frequently, such individuals masturbate
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during their peeping activity.
Peeping Toms, as they are commonly called, commit these offenses primarily as young
men.
In contrast to voyeurism, exhibitionism is achieving sexual arousal and gratification
by exposing one‘s genitals to unsuspecting strangers.
Exhibitionism,
whichhttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b
usually begins in adolescence or young adulthood, is the most common sexual offenses
reported to the police in the United States, Canada, and Europe, accounting for about
one-third of all sexual offenses.
3.
Sadism and Masochism
Sadism is derived from the name of the Marquis de Sade (1740-1814), who for sexual
purposes inflicted such cruelty on his victims that he was eventually committed as
insane. In his will, de Sade wished
that his remains be scattered, and his memory
effaced from the minds of men.
Masochism is derived from the name of the Austrian novelist Leopold V. Sacher-Masoch
(1836-1895), whose fictional characters dwelt lovingly on the sexual pleasure of
pain.
4. Pedophilia
Pedophilia is a sexual attraction to prepubertal children (or very young adolescents).
Pedophilia frequently involves fondling or manipulation of the child‘s genitals and,
not
uncommonly,
penetration.
Ahttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2blthough penetration and
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associated force are often injurious to the child, injuries are usually a by-product,
rather than the goal they would be with a sadist.
Nearly all pedophilias are male, and about two-thirds of their victims are girls,
typically between the ages of 8 to 11.
If the victim is the offender‘s relative, the pedophilia takes the form of incest.
Culturally prohibited sexual relations between family members, such as a brother and
sister or a parent and child, are known as incest.
In our own society, the actual incidence of incest is difficult to estimate, because
many victims are reluctant to report the incest. It is almost certainly more common
than is generally believed.
IV
Assessment and Treatment
1.
Assessing Sexual Behavior
2.
Medical Examination
3.
Medical Treatment
4.
Psychological Treatment
In many caseshttp://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b, an inability
to develop adequate social relations with the appropriate people for sexual
relationships seems to be associated with a developing inappropriate sexual outlets.
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