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文档下载 免费文档下载 http://www.wendangwang.com/ 本文档下载自文档下载网,内容可能不完整,您可以点击以下网址继续阅读或下载: http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ ―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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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, 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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, 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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, 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 http://www.wendangwang.com/doc/406f55ffacce48902d1d0f2b I Stress and Burn-out 1. Stress Hans Selye (1907 - 1982) 文档下载 免费文档下载 http://www.wendangwang.com/ 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 ↓ 文档下载 免费文档下载 http://www.wendangwang.com/ ↓ ↓ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ - 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ * 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 文档下载 免费文档下载 http://www.wendangwang.com/ * 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 文档下载 免费文档下载 http://www.wendangwang.com/ * 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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:…… 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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, 文档下载 免费文档下载 http://www.wendangwang.com/ * 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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) 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ * 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…… ) 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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….. 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ (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 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ (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 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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 ) 文档下载 免费文档下载 http://www.wendangwang.com/ (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 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ * 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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: 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ * 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ --- 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 文档下载 免费文档下载 http://www.wendangwang.com/ * 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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) 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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, 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ * 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 — 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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 文档下载 免费文档下载 http://www.wendangwang.com/ 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. 文档下载 免费文档下载 http://www.wendangwang.com/ 文档下载网是专业的免费文档搜索与下载网站,提供行业资料,考试资料,教 学课件,学术论文,技术资料,研究报告,工作范文,资格考试,word 文档, 专业文献,应用文书,行业论文等文档搜索与文档下载,是您文档写作和查找 参考资料的必备网站。 文档下载 http://www.wendangwang.com/ 亿万文档资料,等你来发现