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What is the difference between primary, secondary and tertiary prevention?

Primary...prevent onset and therefore reduces incidence of d/o.
Furthest from illness. Before onset.
Vaccination, prenatal nutrition for low SES ppl,sex Ed, parenting class, community wide Aids education, head start

Available for all members of all members vs secondary...identify hi risk individuals (primary is identify high risk populations!)

Secondary..early identification and prompt tx of d/o already exists.
Goal cure or improve illness.
Mammogram. Often identify hi risk group and then screen. Suicide hotlines, crisis intervention. Keep from getting worse.

Tertiary.. reduce residual effects or optimize pt fx with chronic d/o . Closest to illness. Prevent recur, reduce long term consequences.
After onset and tx
AA, day tx, social skills after rehab, half way house..


What is the incidence of child abuse in the USA?

2 to 4 thousand children die per year
Over one million mistx per yr by parents
1/22 murders in our country is a child killed by a parent
Once returned from hospital 1/2 end up dead.


What are the characteristics of abused children?
Re sexual abuse

Younger more abused. Ie. 63 percent under 2yrs old; ave age admitted to hospital 15.5 mo

Boys more abuse in early childhood and girls more in teens.

Sexual abuse the trend is reversed.

Overall, girls victims of sexual abuse 2x to 3x more; boys and girls physically abused at same rate

Premature or difficult births linked to higher rates of child abuse.

Physically abused kids ..poorer achievement, cognitive delays, aggressive, behavior problems, fewer friends own age more problems on relationship w adults.

Ho...mildly rejecting parents offer intermittent reinforcement that strengthens dependency behavior


What is secondary prevention and give some examples.

Early detection and treatment to prevent a full blown illness.
Keep from getting worse.

Examples...suicide hotlines, screening tests when have no symptoms, walk in crisis intervention


What is the best predictor of AiDS risk behavior among high school and college kids?
How does this compare to homosexual men?

Community Ed regarding AIDS is a primary prevention strategy.

High school and college kids...perceived peer norms, which is perceived at risk behaviors and attitudes of ones peers, are a better predictor of risk behaviors (vs Knowledge)
Homosexual men hi knowledge equals less risky behavior
Suggests education should target peer norms (peer education, meet peers with aids, peer discussion grps).


What are the risk factors for suicide?

History of attempts is risk for completed suicide.
Over 65 increase risk
Over 85 highest rate
Greatest increase among 15 to 24 yr olds, especially males
Greater number of attempts for younger ppl (100 to 200 per completed) vs 4:1 attempts for elderly


Suicide risk differences between males and females?

Males commit 4 times more.
Males use more lethal means (gun, hanging) vs females (od, poisen)

Females try 3 times more


Who commits suicide more often?

Whites. But peaks after 65
Rates for nonwhites is increasing, especially in 15 to 24 yr olds..
For Native American males..highest rate 15 to 24 age grp. For Black..highest rate is 15 to 44 males.


How does marital status impact suicide?

Marriage lessens risk.
Single, never married higher risk
Even higher for widows..greatest after first ur of loss.
Higher still for divorced.


How does mental health status impact suicide?

Past attempt increases risk of completion.
40 percent of depressed who commit made a previous attempt
Family hx of suicide increases risk
95 percent commit have dx
Dx in order who complete..depressive, substance, schizophrenia.
15 percent with mood do commit.
Mood with psychotic features 5x risk to commit vs other mood do
Highest risk when sx improve


Other suicide risk factors.

State intention to commit.
More if specific plan and means
Behaviors consistent with decision to die..will, give away
Hopelessness central factor
Recent life stress, loss person, job
Lack support
Elderly..physical illness most common reason.


What are the factors regarding adolescent suicide?

Rate has increased among 15 to 19 year olds.
Now second leading cause of death after accidents.
Most often use firearms...increases with intoxication and availability in the home.
Teen boys 3 to 5 times more likely to complete
Teen girls 4 times likely to attempt.

Teens..depression, substance use, antisocial behavior increase risk.
Previous suicidality, exposure direct or indirect to suicide, loss (especially humiliation)
Often impulsive and attempt at manipulation, for attention, express anger, or benefit (avoid obligation).
Most ominous signs..talking about own death, reunion with dead person, giving prized possessions.
Plus withdrawal, poor coping, self destructive behaviors.


What are the factors of suicide among older adults?

Rates increase 65 to 85. 85 yr old white men 4 times more likely than 65 yr olds.
Less likely communicate intent, more likely use violent means, less likely for attention or help.
Risk factors...poor health (70 percent visit doc within month of committing).
Depression sx in 60 to 80 percent who commit but they don't report and docs didn't detect.
Schizophrenia, alcohol depend, organic brain do
Warning signs..recent death of spouse, relative, or friend; self destructive behaviors, alter will, negative/hostile interpersonally


When is hospitalization indicated re: suicide?

Hi risk, psychotic, intoxicated, debilitating medical condition, no support system


What are the differences between supervision and consultation?

Supervision- continuous, administrative authority, focus on supervises work related problems

Consultation- voluntary, ad hoc basis (time limited, as needed) can reject suggestions, not usually member of organization, focus on specific problem, voluntary relationship that can be terminated at any time. Help providers give better services.


What are the forms of mental health or psychodynamic consultation?

Client centered case consultation--
Help consultee (tx) w plan for pt
Ie. difficult case..discuss or examine ct

Consultee centered case consultation --focus on bring about change in the consultee (not pt)
With one or across cases
Lack knowledge, ability, skill, emotional issues. Theme interference (transference)

Program centered administrative --
Work w administrators to suggest actions for clinic program

Consultee centered administrative--
Focus on consultee (tx) that limit ability to administer program or change or organizational effectiveness


What are the rates of inpatient hospitalization?

Females have more mental illness.
Males higher rates of county inpt hospitalization bc act out.

Both men and women..most inpt are 25 to 44.
Then males 18 to 24.
Females second grp 45 to 64.

Never married highest rate inpt
Then divorced/separated, married, widowed.

Majority white but minorities overrepresented.


What is involuntary commitment based on?

Parens patriae or rt of state to regulate life if incapable of doing

Wyatt v Stickney-- federal court ruled if commit then must give tx

Supreme ct--expanded to need for treatment is no longer enough. Mental illness alone not enough. Donaldson v oconner.

2 pc--2 physician certificate. Pts have rights.


What is the most common legal issue that psychologist input is requested?
Insanity defense
Fact witness

Competency to stand trail.
Dusky v US--set guidelines
--must understand nature of proceedings and able to cooperate

Of those evaluated, 30 percent found incompetent
Then committed usually 6 mo in order get tx and back to trial.
Jackson hearing--not expected to regain competency in foreseeable future. Drop charges and can only be retained on civil commitment procedures.


Describe not guilty by reason of insanity.

From MNaghten test--must have known wrongfulness at time of offense to be sane. Later added act result of irresistible impulse.

Durham test said product of mental illness...overturned and replaced by
AIL rule. American institute rule..unable to appreciate criminality (cognitive) and unable to conform to law (behavioral).
Later clear and convincing evidence.
Successful less than 1 percent of cases.


What are the characteristics of abusive parents?
Parent hx
Psychological characteristics

Lower ses some say reporting bias
Rich can hide abuse
White (3:1 w:b). Other study found non white but may be due to poverty and reporting factors
Hx of abuse themselves(deprivation or loss of parent)
Wide range of disorders (10% psychotic)
Low tolerance for infant behaviors, ignorant normal development, interpret negatively, harsh punishment to control

Increased risk with stress..poverty,
Isolation, marital problems

Puts kids risk for pathology and abusive themselves

One parent abuser. One passive

Sexual abuser..known to victim


Use of anatomically correct dolls is recommended with whom:
First go through drawing exercise of private parts.

Mentally retarded, preverbal, embarrassed, unable to discuss.

Sex abuse victims respond different to dolls ...more aggressive, more private part touching

Dolls facilitate memory for details but not forgotten incidents
Dolls don't increase likelihood of stories.

Many questions not answered like how many dolls to use, ethnically matched, # sessions...need to justify what tx does


What is the cycle of violence?

Wide range of estimates of spousal abuse. 2 to 12 million and 26 to 30 million.

Tension building..batterer is moody;victim on eggshells; minor incidents occur

Acute battering..can't predict/control

Honeymoon...remorse, apology. Difficult for ppl to leave. Professionals tend to be involved.

Battered women 3 times more likely to be pregnant


What are the stats on rape?

10 percent report
1 in 30 prosecuted
1 in 50 convicted


What are the 4 categories of male rapists?

Sexual sadists (like pain )
Exploitative predators (impulsive gratification)
Inadequate men obsessed w sex
Displaced anger/rage

Most planned and in rappers neighborhood. Performance impaired during. Often married.
Rapists between 25 and 44. Alcohol 34 percent of cases. Often w other crimes like assault.


What are the characteristics of rape victims?

15 to 24
Same race as offender
Low ses

Get back on feet 6 mo to yr but often lasting effects. Best w immediate support. If withdraw it may be worse (can't extinguish the fear).


Discuss teen pregnancy in US:
Decline due to sex prevention programs
Decline of 20 percent
Decline by 15 percent
Decline due to reduced sexual activity

Highest of any industrial nation
Declined by 15 percent due to decrease in sex activity, condoms, other contraceptives

Sex prevention doesn't effect activity they do but did increase contraceptive use and decrease prego. Best if contraception knowledge, sex Ed and skills training.

Sex Ed and HIV info has not increased activity

Abstinence only ineffective. No increase in HIV w Ed.


What r the characteristics of married people?
Dissatisfaction happens for women when children are born
U shapes relationship between length of time married and satisfaction with marriage
Unhappily married more depressed, drink more, feel more isolated and report more physical illness

All true...

Married are satisfied and more healthy than non married. Except if unhappily married...they r less happy then those not married.

U shaped relationship between length of marriage and satisfaction with marriage. Satisfaction declines for 10 yrs, men show earlier. Satisfaction increases later when kids leave and at retirement.

Marital break up..increase risk of pathology, illness, suicide. Divorced, separated overrep among inpt. Distress worse amongst elderly, especially men.


What is economic status associated with?

Unemployment increases risk of alcoholism, homocide, violence, suicide, mental illness.
Medical do..more cardiovascular and higher mortality rate. Cigs, obesity and hypertension more prevalent.
Alcoholism and mood do more in lower ses. May be due to drift. Other do equal across classes.

Adequacy of how to cope with stress may be third variable.


Is child sexual abuse more or less severe when a stranger commits the abuse?

Less severe when committed by a stranger.

More severe if by family member or other familiar person.


Redesigning an assisted living community to enhance interaction is an example of:
1. Primary prevention
2. Secondary
3. Tertiary
4. Preventive intervention



Asked to help address theme interference problems. U would:
A. Client centered case consultation
B. consulted centered case consult
C. Consultee centered administrative consult
D. Program centered administration consult.



Child sexual abuse:
No consistent outcome differences regarding gender
Worse for females than males in regard to outcome, if difference found
Less severe when committed by family member
Less severe the younger they are

A. True
B. tries
C. False ...less severe if dont know them.
D. No data re: this


Divorce mediation:
A. Replaces the legal adversarial process
B. uses expert data to improve adjustment
C. Like an arbitrator, give view
D. Helps resolve problems

A, d. True
Don't impose view


Insanity defense includes:
A. Inability to understand charges against them
B. mental state at time of crime
C. Knowledge of difference between right and wrong
D. Didn't know the nature of the consequences of the act at the time.

A. Incompetency to stand
B. true
C. True
D. True


Social economic status:
A. High ses ppl have lower physical and psychological disorders
B. high ses then lower psychological issues only
C. High ses then lower medical issues only
D. No impact on either

A correct. Lower physical impact but not necessarily true of psychological disorders.
Lowered ses and unemployment increase the risk of psychopathology, admissions to mental hospitals, type of tx, length of hospitalization, alcoholism, violence and suicide. Mood do in lower ses.

Lower ses more predictive of medical problems like cardiovascular disease and higher rate of mortality.

Cigs, obesity, hypertension re in low ses grps and less educated grps. May be why blacks have more hypotension.

D. Some mental do like schizophrenia equally occur in ses grps. Eventually lower ses but due to drift...don't start there.


Community psychology:
A. Commitment to social change
B. focus on environment
C. Focus on advocacy of values consistent w liberalism
D. Community mental health act is its driving force

All. Also views psychologist as consultant and collaborator rather than just a direct provider.

Strong reliance on ecological and epidemiological research.


In general, suicide rates are:
A. Higher among whites than nonwhites
B. higher in low ses
C. Higher among older ppl and males
D. Higher in single ppl

B is the only incorrect one!


A. Is an act of sexual gratification
B. act of violence
C. 1/3 of cases victim is known
D. Victim known in 1/2 cases
E. half rapists are married
F. 1/3 rapists married
G. Sexual performance impaired during rape.

B,c,e,g correct


In general:
A. On average married ppl are healthier physically and psychologically than non married.
B. marital break up increases the risk of pathology and physical illness.
C. Break up increases the risk of pathology, physical illness, and suicide.
D. Childbirth is associated w 40 percent mild and 10 percent clinical depression.

A. True
B. correct but c is better
C. Yes!
D. Wrong 50 percent mild, 10 percent clinical.


The community mental health act established in 1963 and revised in 1980 set:
A. Funding for community mental health centers
B. guidelines for cmhc
C. Government assumes a major role in promoting mental health
D. Such efforts have not created great change in the service delivery of mental health.



Examples of tertiary prevention:
A. Supervised apartments, AA, day hospitals
B. hotlines, walk in clinics
c. Crisis intervention
D. Halfway houses, sheltered workshops, job skills training programs.
E. head start, drug education, parenting classes, prenatal nutrition for low ses women

A, d are tertiary

B, c are secondary

E primary


The rate of suicide among teens:
A. Increased in the last 20 years
B. deceased
C. Most common method for boys is firearms
D. Most common method for boys and girls is firearms ESP if intoxicated and available in the home.
E. dx most often of depression, substance use, and antisocial behavior
F. Loss often before an attempt and exposure to suicide in some way
G. Teen suicide attempts often way to manipulate, seek attention, express anger or obtain some benefit.
H. Sometimes occur in clusters

A, d, e, f, g, h correct


Prevention of teen suicide requires early identification of signs:
A. Talking about reunion w deceased
B. giving away possessions
C. Withdrawal and poor coping skills
D. Self destructive behaviors
E. talking about ones own death
F. Terminal illness

All but f


Regarding suicide Older adults:
A. 85 yr old white men commit suicide 4 x more than 65 yr olds.
B. just as likely to communicate intent and give away possessions
C. More likely to use violent means
D. Less likely as a way to gain help
E. warning sign is loss of loved one

All but B. may change their will
Don't communicate intent.

Concern about health most frequent precipitant. 70 percent went to PCP. 60 to 80 percent had depressive sx but didn't report it nor was it detected by doc
Other do that increase suicide risk are schizophrenia, alcohol dependence, organic brain do


Systems consultation or process consultation:
A. Improve satisfaction among members
B. satisfaction among individuals and subsystems is important
C. Focus on improving interpersonal skills
D. Entire organization viewed as consultee and targeted for change
E. focus on norms and roles to improve subsystems



Educational consultation
A. Performed to further the goals of a disenfranchised group
B. Bring about institutional change
C. Bring about change through behavioral methods
D. Examples include instruction, rehearsal, modeling, homework

C, d correct. Also called behavioral consultation

A, b. are advocacy consultation


A decrease in psychiatric hospitalization:
A. Due to use of meds
B. due to lack of funding
C. Called deinstitutionalization and has to do w govt policy
D. Has resulted in a revolving door phenomenon

All but b in research

Up to 80 percent were readmitted within 2 years of discharge.
This problem is due to poor coordination. Between hospital and community mental health system, inadequate follow up, and govt lack of support for residential programs.

Resulted in poor living for them and decrease In physical and emotional well being. Usually increases sx bc no support.


Wyatt v Stickney and
Donaldson v oconner ruled:

A. Finding of mental illness alone can not justify institutionalization against their will and keep them indefinitely.
B. must have clear behavioral criteria like dangerousness to justify commitment
C. Right of the state to regulate someone's life if they are incapable.
D. If commit person then must provide adequate tx.

A. Donaldson v Oconner
B. just a result
C. Parens patriae...historical principle
D. Wyatt v Stickney


M MNaghten test:
Durham test
American law institute rule

A. Declare guiltless acts where defendant was unable to appreciate the criminality of his act and unable to conform his actions to the law
B. criminal act product of mental illness
C. Wrongfulness due to result of irresistible impulse
D. Dependent must know wrongfulness of the act at the time of the offense to be sane

A. American Law institute rule
Later added that this must be proven by clear and convincing evidence.
B. Durham. Overturned and replaced by ALI
C. Behavioral criteria added
D. M MNaghten cognitive criteria

Reason of insanity only found less than 1 percent of the time. Usually committed involuntary until no longer dangerous. Renew retention orders regularly.


Characteristics of abusive husbands
A. Inadequate, low self esteem
B. drug users
C. Stereotyped male role
D pathological jealousy, blame others, emotional dependence
E. poor impulse control, family hx violence
F unrealistic marital expectations

All but b. do drink. Some say is an effect or excuse for what they do.


Battered wives:
A. Alcohol problems
B. stereotypical female role
C. Low self esteem, guilt, no one can help, believe provoke
D. Martyr
E. psychophysical complaints
F. Emotional or economic dependence
G. Family hx violence, isolation from family of orgin
H. Pregnancy risk factor (3x more likely)

All but A


What increases the severity and frequency is spouse abuse?
A. Presence of infants or teenagers
B. increases w number of kids
C. Pregnancy
D. Financial problems
E. holidays
F. Televised sporting events

All but b.

D is not named. However unemployment increases it.

Tx...only empirical support for arrest and prosecuting offenders. If cop mediates, allows cool off of not as good.



Those who terminate an unwanted pregnancy have responses similar to other stressors
Abortion and risk increases if lack support, previous psych conflicts, blame self or 2nd trimester abortion
Spontaneous miscarriage result in a negative depressive rx that lasts up to 1 year

All true