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EDUCATIONAL PSYCHOLOGY FINAL EXAM|||QUESTIONS AND
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Horowitz stress response theory (Bi phasic) - CORRECT ANSWERS-
individual oscillates between attempting to suppress the traumatic memory (constriction) and (intrusion) in which it is involuntarily re experienced. The memory as a result continues to be intrusive and remain in active memory the longer it isn't processed into a schema.
Shattered Assumptions - CORRECT ANSWERS-the world is benevolent
the world is meaningful the self is worthy
- Extreme internal conflict is felt when trauma occurs contradicting core beliefs. Especially when the person is harmed by another person it is difficult to later reclaim these assumptions.
Mowers 2-factor learning theory - CORRECT ANSWERS-initial fear
functions through classical conditioning (object comes to illicit fear because of prior association) avoidance of conditioned stimuli functions as operant conditioning (avoidance is reinforced by reduction of anxiety which further reinforces behavior)
Foa and Kozak, information processing - CORRECT ANSWERS-•feared
situation->reinforced by meaning of the stimulus and response of the structure-> reinforced by verbal and physiological behavior responses •arousal, intrusion , avoidance •interferes with disconfirmatory information •demolish this by activation of fear memory --------habituation of fear reducing it •providing new information, countering beliefs
Dual representation theory - CORRECT ANSWERS-Verbally accessible
memory VAM -autobiographical memories, retrieved when required, only refer to what consciously happened before and after, high levels of arousal reduce ability to recall these things Situationally accessible memory SAM -only accessed via situational reminders, obtained from lower level processing, also records bodily response, flashbacks come from this -Biology of SAM-non hippocampal dependent thus not as subject to being disturbed by high stress, emotionally based -to help- reducing negative emotions, prevent continued automatic reactivation of trauma, rein code the systems into one
A Car Wreck, Dylan, 17 - CORRECT ANSWERS-Symptoms- he couldn't
sleep, his heart was racing, visualizing oncoming headlights, couldn't concentrate or complete homework, super anxious pulling out of driveway at an intersections, quickly left a movie because noises were to loud (reminded him of crash) Diagnosis- Acute Stress Disorder Discussion- ASD requires 9 of 14 symptoms in DSM5, clinically significant distress, impairment in social functioning, disengagement from current developmental tasks, recurrent intrusive distressful memory, physiological reactions to reminders, efforts to avoid thinking or having feelings, avoiding external behaviors, distressing dreams and irritable behavior, only 2 weeks ago but eventually should check for PTSD
Eric Reynolds, 56 years old, married war veteran - CORRECT ANSWERS-
Primary issues: chief complaint- "Having a short fuse", being "easily triggered", Symptoms began 3 decades earlier,uncontrollable rage when startled, recurrent intrusive thoughts, weekly vivid nightmares, isolation, vigilance and anxiety, loss of interest in hobbies, excessive distractibility. He was most disturbed by his anger outburst that he had expelled on coworkers as well as physicians, no visions but it reminded him of dosing off and waking up to an incoming Mortar round. His personality quickly changed when he was drafted and on duty one of his friends was killed. He switched from happy go lucky to a kill or be kill mentality. Diagnosis- PTSD
Men more likely to have OCD T or F - CORRECT ANSWERS-F, equal
likelihood
Does OCD run in families? - CORRECT ANSWERS-Yes
OCD comorbid with - CORRECT ANSWERS-GAD, panic disorder, hoarding,
depression, body dysmorphic disorder, eating disorder, hypochondriasis
OCD criterion - CORRECT ANSWERS-- obsessions, compulsions or both
- time consuming, clinically significant distress -good insight, poor insight, delusional, tic related
Samuel King, 52 year old, never married janitor - CORRECT ANSWERS-
Primary issues-Mr. King self reported that his mood was low, he was unable to enjoy things, he had insomnia, feelings of hopelessness, low energy and difficulty concentrating, thought of committing suicide (Depressive). Worried about contracting diseases HIV, said he could smell chemicals, washed his hands with bleach when nearing something potentially contaminated, had issues with physical contact, or shopping for groceries in public, relationships etc. other compulsions included constantly being worried about offending someone and replaying conversations over and over in his head, keeping diaries to record convos, and apologizing for sounding offensive (OCD). Diagnosis- OCD with good or fair insight, MDD Discussion- •dysphoria, anhedonia, insomnia, hopelessness, anergia, difficulty concentrating and recent suicidality. Have lasted much longer than the required 2 weeks, his quality of life is effected •Has recurrent persistent thoughts, urges or images that are intrusive or unwanted. Tries to ignore, suppress or neutralize these symptoms through thought or action. •causes distress in multiple spheres of life (bleaching his hands and wearing gloves constantly effects time working, socializing etc.
Trevor Lewis, 32 year old single man, Germs - CORRECT ANSWERS--he
had been concerned with germs since childhood which led to long
standing hand washing and showering rituals. Over the past 6 months his symptoms had worsened significantly. Obsessed with the fact that he may contract and HIV he spent his days cleaning not only himself but also his clothing and his linens and expected family to do the same, in the past was concerned about safety and constantly checked stove etc. Diagnosis- OCD, tic related, absent insight Discussion- completely convinced that his house was contaminated by HIV, feels obliged to constantly perform tasks to reduce this fear.
Personality disorder criterion - CORRECT ANSWERS--Longstanding,
relatively stable pattern (since adolescence or earlier) of inner experience and behavior that causes problems and differs from expectations of individuals' culture -pervasive thinking impacts more than one domain- thinking, emotional, interpersonal, impulse control -Pattern is rigid and influences range of situations
- causes clinically significant distress
Cluster A, withdrawn, cold, suspicious, irrational - CORRECT ANSWERS--
paranoid -schizotypal -schizoid Cluster B, dramatic, emotional seeking, shallow, often intense
interpersonal conflic - CORRECT ANSWERS--BPD
-histrionic -narcissistic -antisocial
Cluster C anxious, tense, overcontrolled - CORRECT ANSWERS--OCDPD
-AvPD -Dependent
- ex. someone depressed anticipates as situation to be depressing in order to moderate they act in a depressive manner which makes people respond negatively which further maintains their prediction.
A feminist Critique of personality disorders - CORRECT ANSWERS-- white
male behavioral characteristics perceived as what is normal healthy functioning -institutionally reinforced by studies that show bias in favor of males more likely to get funding and be published -Machosistic personality disorder- essentially battered women's syndrome was published without looking at women's history of abuse and based upon studies that purely asked psychologist if they thought it was real and why making it more biased. -When psychiatric hospital was research they found that 43% of patients had been abused and 37% sexually abused SASB model- takes into account the interpersonal situation and cultural/social structure of women cultural means of learning would mean changing biases in place such as seeing an African American acting assertively and labeling it as just that rather than finding it racist or aggressive. Personality Conflicts, Frazier Archer, called because a friend said he was
borderline - CORRECT ANSWERS-Primary concerns- Constant feeling that
he was being lied to deceived, he thought psychologist were manipulators of the human mind, focused excessively on rules, lists and small details which inhibited his work. He only spoke with a handful of individuals superficially, defended his lack of work ethic also saying he understood quality over quantity. Got angry when speaking about certain topics, affect was inappropriate, irritated and argumentative with staff, said he would document his personal efforts. Diagnosis -Paranoid personality disorder, Obsessive compulsive personality disorder Discussion- • Inflexible, longstanding, dysfunctional pattern in dealing with the world, enduring pattern of distrust and suspiciousness. •Believes that others are deceiving him, bears grudges and mistrusts the fidelity of sexual partners •Perfectionism and control, excessively focused on rules •Seems that he could fit most of cluster of personality disorders
Oddly isolated, Gregorz Buchalski, 87 year old white man - CORRECT
ANSWERS--his 90 yr old sister had died some days earlier and he delayed
reporting her death •had become increasingly disorganized since her death, worried he would get evicted for mess, he recognized what he did was wrong but he was worried about his mess almost more and his years of research on bioluminescence •had never had romantic or sexual relationship, intellectual interests made him happy, continued to talk about his bioluminescent research Diagnosis- Schizoid personality disorder Discussion- His aloof, tacturn and asexual lifestyle certainly fit the diagnostic criteria for schizoid personality disorder. His obsession with bioluminescence and lack of interested in friends showed more of his inward pre occupation flat affect even with sisters death
Worried and Oddly Preoccupied, Henry, 19 - CORRECT ANSWERS-Primary
Concerns- Suspicious of classmates, believing they were undermining his abilities. Said two students flipped a coin over if he was straight or gay. His said his parents sent him on an agenda to hang with girls and go to parties. Henry's mom said he had been quiet and shy since childhood, never had close friends, never dated He was obsessed with ghosts, telepathy and witchcraft fascinated him Diagnosis- Schizotypal, paranoid Discussion- pattern of social and interpersonal deficits, eccentricities and cognitive distortions. Delusional symptoms like magical thinking, suspiciousness, ideas of references, grandiosity, avoidance of social contact. -Suspicion that others are undermining him, hidden meaning in benign activities, over sensitive to perceived attacks on character.
Unfairness 18.4, Ike Crocker, 32 year old man - CORRECT ANSWERS-
Primary issues- on paper had high level of skill and training, supervisors noted frequent arguments, absentees, poor workmanship, dangerous errors. Said it was "cheap wood", "bad management". Said he was ADHD
feelings of emptiness, and transient stress related behaviors, feelings of emptiness, and transient stress related paranoia. -Her depressive attitude, anergia, overeating was disabling for 6 months, but her manias and accusation of others rather than self are uncommon for depression -identity confusion ( thinks she lacks capability for her job but also thinks its her bosses fault for being incompetent Painful Suicidality, Karmen Fuentes, told her outpatient psychiatrist that
she was thinking of overdosing on Advil - CORRECT ANSWERS-Primary
concern- Said her back had been killing her since falling several days ago, the fall had left her downcast and depressed. She felt abandoned by her neurosurgeon who only said it was a sprain. Said suicide was a threat to her husband to teach him a lesson because he isn't compassionate. She described being an early bloomer sexually that enjoyed men jumping through hoops to sleep with her. Diagnosis- Histrionic personality disorder Discussion- Depression and suicidiality is not as prevalent as her need for attention and excessive emotionality, She was seductive with the interviewer, She talks about how important her image is even in the ER
Larry Goranov was 57y old, single, unemployed - CORRECT ANSWERS-•
He had low grade depressed mood and decreased energy, He was embarrassed he still lived with his 80 year old grandmother. Would not work with female therapist because they were "too competitive and envious." Thought psychiatry residents were not educated, cultured, or sophisticated enough for him."I was the best broker they had ever seen", then said it was beneath him to sell cars. Says he has given up on women, he found them to be under appreciative and only in it for the free meals. Super concerned about maintaining his body. He was constricted dismissive, slightly depressive, wearing clothes that appeared to be by a hip hop designer. Diagnosis- Narcissistic personality disorder Discussion- Not depression type symptoms because of his focus on outward appearance, clothes and manner of grandiosity, conviction that he is "special" and deserving Shyness, Mathilda Herbert, 23 year old, wanted help to break out of her
shell - CORRECT ANSWERS-Primary concern- She said she was prescribed
for anxiety but her main problem was shyness, she felt everyone in school was constantly criticizing her and would avoid being called on because she thought she would say something stupid, she kept few friends and faked a happy demeanor to keep them around, • Described her family as a brother who was hyperactive, sisters who were perfect and hypercompetitive and a dad who pointed out the ways his kids did not live up to his expectations Diagnosis- Avoidant personality disorder Discussion-persistent pattern of social inhibition, feelings of inadequacy, and hypersensitivity to evaluation Lack of Self- Confidence, Nate Irvin, 31 year old white man, sought help
for "lack of self confidence" - CORRECT ANSWERS-Primary concern-
Described his job as dead end, felt stuck, He felt burdened by work decisions would only complete projects when he was given instruction, the situation was depressing but nothing new. Dissatisfaction with relationships, has had a series of several long relationships over the prior 10 years, he said they ended despite doing everything he could. He tried to make a relationship with an opera singer last doing things he didn't enjoy because he wanted to stay with her. He said being single made him depressed but the depression also made it harder to get a girl friend.
- his use of alprazolam had escalated and he was now getting it prescribed from 3 different physicians. Cutting back led to anxiety and the shakes. Diagnosis- Dependent Personality disorder Discussion- Excessive need for someone to take care of him. Difficult making decisions independently. Cant initiate projects on his own. Feels uncomfortable being alone. Goes to desperate lengths to continue relationships, reluctant to disagree even on minor matters. 6-10 criteria for dependent personality disorder Ogden Judd and his boyfriend Peter presented for couples therapy.
Escalating conflict involved with them moving in together. - CORRECT
ANSWERS-Initial concern- Had crazy rules about where items could be
placed. Judd never threw anything away because he was terrified of losing something important. Constantly organizing and wouldn't come home from work until really late because he had to complete his to-do list. Employees said he was over critical, rigid and perfectionistic. Diagnosis- Obsessive Compulsive personality disorder Discussion-• OCPD is characterized by a maladaptive pattern of behavior marked by excessive control and inflexibility of, OCD is characterized by
Peter Winters 46 years old, white minister, referred by primary care doctor
for depressive symptoms and opioid abuse. - CORRECT ANSWERS-
Primary concern- Had knee injury 17 months prior was given meds by his mother and the hospital. Continued to feel pain and was given my hydros but had to up his dosage, also felt dysphoric and achy when not on medication. Began desperately seeking out opioids. -had history of depressive episodes, alcohol use disorder and smoked 2 packs of cigarettes a day Diagnosis- opioid use disorder, tobacco use disorder, alcohol use disorder, in remission, MDD Discussion- had personal and family history of addiction, current heavy tobacco use, history of depression.
Schizophrenia basic criteria - CORRECT ANSWERS--Two or more for at
least one month: delusions hallucinations disorganized speech grossly disorganized or catatonic behaviors negative symptoms -social and occupational disfunction -duration of some symptoms for 6 or more months
- Emotionally disturbed Felicia Allen, she tried to steal a bus and appeared
to be emotionally disturbed - CORRECT ANSWERS-Interview- She
threatened the driver with a knife, took control of a city bus and crashed it. Mrs. Allen got mad fidgeting for her card so she pulled out a knife, she was twitching and mumbling to herself in the waiting room. Only responded to one question and said "sorry sorry." Her psychiatrist said that was her first bus ride without a staff member, social remediation. She had child hood onset, treatment resistant schizophrenia that started at the age of 5. Because of her large build and psychosis she was hospitalized almost always since she was 11. Her hallucinations were auditory and critical of her. She had been taking clozapine for 1 year and had gained a lot of weight. Diagnosis- Schizophrenia, multiple episodes, currently in active phase Discussion- Schizophrenia requires at least two to five symptoms, delusions, hallucinations, disorganized speech, disorganized or abnormal behavior and negative symptoms. it must persist for at least 6 months.
Childhood onset deprives the child of critical social learning and cognitive development. It seems that she is not depressed because she is so action driven and paranoid schizophrenia no longer in DSM. Subject: Hakim Coleman: 25 year old army vet, community college student who was presented with his girlfriend and sister. Said he had several days of migraines and hallucinations of a spiritual nature that persisted for 3
months. - CORRECT ANSWERS-Interview- He joined an evangelical church
ad shortly after became consumed in these voices and riddled with guilt. He thought it was because of alcohol withdrawl was drinking sevel beers a day but didn't have other symptoms. According to his sister and mom he had gone from out going and social to isolated and quiet, grades had gone down, all scans came out normal Diagnosis- schizophreniform disorder: provisional Discussion-Differs from schizophrenia in two substantial was, 1. duration is greater than one month but less than 6 months, 2. there is no social or occupational impairment criteria. While he described hallucinations and negative symptoms he does not have delusions, disorganized speech or behavior. Schneiderian symptoms, kinesthetic hallucinations, ideas of reference. He thinks they are due to alcohol but his drinking is modest and his blood count was entirely normal. His cannibas use very sporadic as well. PTSD possibility and dissociative disorder.
Schizophrenia and suicide - CORRECT ANSWERS-5-10%
schizophrenia rate
women to men ratio - CORRECT ANSWERS->1%
same but higher prevalence among low SES
Genetic distribution for schizophrenia - CORRECT ANSWERS-46%
concordance between MZ twins, 9% concordance between DZ twins.
Neuroanatomy and Neurobiology - CORRECT ANSWERS-- enlarged
ventricles in prefrontal cortex
The traumatic neurosis of war- Judith Herman - CORRECT ANSWERS--
Post world war 1 men began breaking down in shocking numbers, acted like hysterical women, represented 40% of war casualties. -Yealland- used shock therapy and telling them that they should be more manly after battle Rivers- Made two advancements after helping a man work through his PTSD, 1. Men of great bravery could succumb to fear and sadness 2. a powerful way to come over this was the love of brotherhood Kardiner- the importance of understanding displayed by physician -Operation outreach started by anti war veterans
PTSD categories 3 - CORRECT ANSWERS-hyperarousal, intrusion,
constriction
Hyper arousal - CORRECT ANSWERS-autonomic nervous system- source
of irritability, hyper alertness Sympathetic nervous system- anxiety and psychological preparedness
Intrusion - CORRECT ANSWERS--Ex. when looking at children at a young
age who had experienced trauma at 1 1/2 they could not verbally recall the incidence but 18/20 reenacted the abuse in their play. Horowitz- our mind wants to restore what happened and put it into a schema, thus it continues to replay
Constriction - CORRECT ANSWERS-•State of detached calm, paralyzation
•Rape survivor describes this as being a shell on the bed, being numb •Truncated memory, void from emotion and meaning did not allow themselves to think •Victims of being taken hostage Truncates future hopes, risk taking, deprived themselves of new opportunities because they don't want to mitigate the traumatic experience, defense against emotional states
Disconnection - CORRECT ANSWERS-Effect on systems of attachment,
loss of basic safety and trust
High Locus of Control - CORRECT ANSWERS-only 1/10 children showed
the capacity to handle highly adverse situations
Those who didn't have PTSD after vietnam showed what traits - CORRECT
ANSWERS-Active, task oriented coping strategies
Calm judgment, high morals, sense of meaning, deciphered a reasonable purpose for their actions, non expressed hateful vengeance towards the enemy
