Abmormal Psych.: Ch. 10, 11, 12: Suicide, Mood Disorders, Personality Disorders

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suicide -- general definition

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the purposeful taking of ones own life

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death seekers

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someone who simply wants to end their life; this condition may be present for a long period; people may prepare for their death by giving away possessions, writing a will, buying a gun, etc.; if they are prevented from suicide they may be ambivalent about it.

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death initiators

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have a clear intention to die, often the person has a serious illness and simply believes that they are speeding up the process

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death ignorers

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believe that death will only lead the onto to a better existance (ex: cult members, suicide bombers -- mass suicides)

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death darers

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these people are ambivalent about dying; they take actions that greatly increase their chance of death; (ex.: taking a bunch of pills and then calling a friend to tell them); they usually do it for attention or to make someone else feel bad

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subintentional deaths

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the person unconsciously is leading themselves to death (ex: a heart patient who continues to smoke although he knows it will eventually kill him)

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suicide rates

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suicide rates could potentially be highly underestimated; suicide is a lot more common than most people think; there are differences in genders, cultural groups, etc.

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gender differences in suicide rates

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there is a higher rate of suicide in women than in men

women are 3x more likely to attempt suicide, but men are more likely to actually complete it

men are more likely to kill themselves by more lethal methods (i.e.: shooting, stabbing, etc.)

men are likely to be in suicide situations that involve guns and alochol

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ethnic in cultural differences in suicide rates

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nationalities with the highest rates:

1. european american
2. native american (closely following): tied to poverty, discrimination, lack of education

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suicide rates in children and adolescents

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adults often do believe children would commit suicide and early clinicians thought that children were not vulnerable b/c they didnt understand the concept

boys are 6x more likely then girls to commit suicide

high rates of suicide in early adolescents -- probably b/c psychopathy tied to suicide increases in adolescence and they are more likely to have the means than children are

risk factors: drug probs., current depression, interpersonal probs., insecure relationships, appetite probs., a suicide attempt by a friend, agression, hopelessness, etc.

many more adolescents attempt suicide than die from it

may use it to get attention

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suicide in college students

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college years are full of pressures and changes; people may feel that they cannot measure up to higher standards or meet goals and contemplate suicide; 9% contemplate it and 1% attempt it; only 20% of all those people actually seek help

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suicide in older adults

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there has been a 50% decline in older adults in the past few decades

older people are much more likely then younger people to be successful

highest risk is among euro. americans over age 85

rates are highest the year after a loss but still remain high for years after

the elderly (esp. men) are likely to commit suicide due to illness and/or disability

refusing food or meds. is a form of suicidal behavior

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suicide notes

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only about 1 in 4 leave a suicide note -- but this provides only a glimpse into their motives normally

often they describe only the obvious - that suicide is driven by anguish and loss of control

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social perspectives on suicide

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economic hardship

serious illness

loss and abuse

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Durkheim's theory

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Emil Durkheim focused not events that lead up to suicide, but on mindsets of certain societies that can lead to suicide; proposed 3 types of suicide:

1. egoistic suicide
2. anomic suicide
3. altruistic suicide

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egoistic suicide

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committed by people who feel alienated from others, empty of social contacts, alone in the world;

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anomic suicide

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committed by those are very disoriented due to severe changes in their lives and in their relationships with society; (ex.: a man who loses his job after 20 yrs.)

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altruistic suicide

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committed buy those who believe that their deaths will benefit society (ex.: monks during the Vietnam War)

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suicide contagion

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people "catch" suicidal intentions from whoever commits suicide; this may be b/c the person makes the idea of suicide more acceptable; this could also be b/c suicidal people are more likely to gravitate to one another;

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suicide cluster

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when 2 or more random attempted suicides appear bunched in a space or time or a series of suicides in response to the death of a celebrity; usually occur among those who know the person who first committed suicide

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psychodynamic theories of suicide

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people may commit suicide b/c they are angry at others and turn it on themselves and the part of that person or people that are in their ego and eventually want to annihilate themselves for this reason;

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mental disorders and suicide

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over 90% of people who committed suicide probably suffered from a mental disorder -- probably a mood disorder; major depression is also a huge risk, among others; bipolar is another; substance abuse is another

overall, most common reason is to escape intolerable distress and to relieve others of the burden

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impulsivity and suicide

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general tendency to act upon ones impulses rather than inhibit them; when it is paired with psych. problems, that is when suicide is an extreme risk;

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cognitive theories

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cognitive variable most often coupled with suicide is hopelessness; this is also a contributor to people not seeking treatment; ]

also dichotomous thinking -- seeing everything as either or

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genetic theories of suicide

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suicide tends to run in families; children of parents who committed suicide are 8x more likely to do so; it can be due to environmental factors, but twin studies suggest that it is strongly genetic

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neurotransmitter theory of suicide

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there is a link b/t suicide and low levels of serotonin; this is even true in people who are not depressed; low serotonin is linked to impulsive and violent suicides;

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crisis intervention programs

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help people who are suicidal to deal with their feelings short term and referring them to specialists for long term; the specialist will often make the person enter into a contract saying that they will not commit suicide, make them recontact them if they suicidal feelings, or teach them ways to cope and people to go to;

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drug treatments for suicide

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lithium - known to reduce the risk of suicide;

selective serotonin reuptake inhibitors (SSRIs): alternative to lithium; these drugs can reduce impulsive or violent behaviors;

antipsychotics

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psych. treatments of suicide

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dialectical behavior therapy: cog.-berhavioral; originally developed to treat ppl. with borderline personality; focuses on managing negative emotions and helps to increase problem solving skills, interpersonal skills, etc.; can include spouses, partners and families in the treatment;

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psychosis

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being unable to tell the difference b/t the real and unreal

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schizophrenia

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people with this disorder can be lucid and normal one minute and unable to function the next with garbled speech and loss of touch with reality; high rate in african americans and more common in men; women develop it later than men do;

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positive symptoms of schizophrenia -- Type I symptoms

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delusions, hallucinations, disorganized thought and speech, cataonic behavior; these are also present in other disorders which can make is hard to seperate from mood disorders;

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delusion

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part of Type I/postive; ideas that a person believes to be true but are highly unlikely and often impossible;

difference b/t delusion and self deception:
- self deceptions are not completely implausible, while delusions are
- people with self deceptions think about them occasionally, while people with delusions think about the a lot
- people with self deceptions realize they could be wrong, while delusional people are completely resistant

people with delusions take actions based upon them, try to find evidence supporting them, and often often try to convince people of them; they may see arguments against them as conspiracies; delusions can differ across cultures

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persecutory delusions

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people believe that they are being secretly watched or tormented by people they know

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delusion of reference

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people think that random events or comments of others are directed at them; can be part of grandiose thinking

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grandiose delusions

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person may believe that he or she is a special person of posseses special powers; may believe they are a diety or that they or the most intellegent, creative person on earth, or that they can find the cure for some major disease

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delusion of thought insertion

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belief that ones thoughts are being controlled by outward forces;

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hallucinations

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unreal perceptual experiences of people -- schizophrenics tend to experience more bizarre ones than normal people do

types vary with cultures

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auditory hallucination

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hearing voices; one of the most common types; more common in women than in men; voices in schizophrenics can be threating and often they will talk back to the voices

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visual hallucination

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the second most common; can be accompanied by auditory hallucinations;

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tactile hallucinations

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involve perception of what is happening outside of someones body; ex: ants crawling on their skin

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somatic hallucination

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perception that something is happening inside of ones body;

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formal thought disorder

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disorganized thinking of people with schizophrenia

people will switch topics with very little transition

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disorganized speech

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word salad -- when words and sentences are incoherent

neologisms--person makes up words that mean something only to themselves

clangs--rhyming words that mea nothing

often caused by their difficulty with simple cognitve tasks (smooth pursuit eye movement); also working memory deficits: have trouble identifying thoughts relative to what is going on, men have more speech probs.

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catatonia/ catonic exitement

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extreme unrepsonsiveness to the outside world;
catatonic exitement: person becomes agitated and angered for no apparent reason and they are hard to subsdue

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negative symptoms -- Type II

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losses or deficits in certain domains; include:
affective flattening
alogia
avolition

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affective flattening

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reduction of emotional repsonses to the environment; aka blunted effect; persons face and mannerisms never change to match the emotions that they should be experiencing about something; they still may experience emotion but just not show it at all

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alogia

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reduction of speaking; may be caused by lack of motivation to speak rather than lack of thinking

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avolition

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inability to persist in goal oriented activities such as school or work; person may sit around doing nothing all day and withdraw from their life;

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other effects of schizophrnia

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inappropriate effect
anhedonia
impaired social skills

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inappropriate effect

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person has inappropriate emotional responses to things (laughing at something sad, crying at something funny); this could be due to them responding to what is going on in their head rather than in reality or b/c brain processes that match emotion to stumuli arent working right

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anhedonia

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severe loss of interest in life and inability to feel anything;

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impaired social skills

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people become less connected with the world, but this is due more to the negative symptoms than the postive ones b/c the postive ones are more treatable

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diagnosis of schizophrenia

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kreaplin: considered schizophrenia to be early deterioration of the brain; europeans followed this definition for a while

bleuler: came up with a more broad definition was accepted by americans in 20th century

according DSM, person must show as least 6 schizophrenic behaviors for at least 6 months; at least 1 month must be severe enough to effect the persons life;

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predromal symptoms and residual symptoms

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pre. is present before people go into acute phase of schizophrenia and resid. present after; may express beliefs that are weird during this time but not delusional; may speak in somewhat disorganized way but still be coherent; negative symptoms are more prominent during this time

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schizoaffective disorder

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mix of mood disorders and schizophrenia

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Type I schizophrenia

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positive symptoms are more prominent

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Type II schizophrenia

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negative symptoms are more prominent

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DSM types of schizophrenia

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paranoid
disorganized
catatonic

also:
residual
undifferentiated

^^less defined then the 1st 3

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paranoid schizophrenia

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prominent delusions involving persecution and grandiosness, lucid and articulate but with elaborate stories; highly resistant to anyone who tells them their beliefs are wrong; people may be arrogant or aloof; often suicidal or violent; better prognosis than people with other types; more likely to be able to live on their own; tends to be later in life

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disorganized schizophrenia

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people do not have well formed hallucinations or delusions; instead thoughts and behaviors are extremely disorganized; may be emotionless or have completely opposite or unrelated emotions; one of the most disabling types; early onset; not very treatable

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catatonic schizophrenia

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very rare

criteria:
1. catatonic stupor: remaining motionless for long periods
2. catatonic excitement: increased motor activity
3. rigid posture of mutism for long periods;
4. odd mannerisms
5. echolalia(senseless repetition of words spoken by others) or echopraxia(repetitive imitations of movements of another person)

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undifferentiated schizophrenia and residual schizophrenia

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undiff.: people have symptoms that meet the descriptions, but do not fall under and specific category; set on later in life
residual schizophrenia: person has had at least one acute episode but otherwise experiences residual symptoms only

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age and gender factors of schizophrenia

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women have a more favorable course than men do

schizophrenia becomes more controlled with age

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sociocultural factors of schizophrenia

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developing countries have less of problem with it then developed ones partly due to differences in family networks

women can often cope better or their behavior is more accepted

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genetic contributors schizophrenia

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family, twin, and adoption studies all show that it is genes are somewhat involved, h/o the gene is unknown; person may carry a risk but many factors affect how it manafests;

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structural brain abnormalities of schizophrenics

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enlarged ventricles: suggest atrophy or deterioration in brain tissue; may indicate structural abnormalities in othe areas of the brain; this causes social and behavioral detriments long before schizophrenia is developed; more severe symptoms and less repsonsive to medicine;

prefrontal cortex and other key areas: connects to the limbic system

causes: could be due to brain injury, head injury, birth injury, nutrition deficits, and little cognitive stimulation, also genetics

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birth complications and schizophrenia

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often schizophrenics suffer from prenatal or birth difficulties, which can lead to structural abnormalities; this can combine with family history and lead to schizophrenia;

prenatal hyproxia: deprivation of oxygen during birth and delivery;

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prenatal viral exposure

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high rate in people who were exposed to influenza while in the womb; esp. during the second trimester;

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nuerotransmitters in schizophrenics

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excess dopamine was thought to be caused by schizophrenia;
phenothiazines: decrease dopamine but cause symptoms similar to parkinson's;