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144 Cards in this Set

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DSM-IV criteria for a Mental Disorder
::SVI'S MD::

“A mental disorder is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (suffering) (a painful symptom) or disability (impairment in one or more areas of functioning) (maladaptiveness) or with significantly increased risk of suffering death, pain, disability, or important loss of freedom….”

1) Suffering
2) Maladaptiveness
3) Deviancy — away from normal
Violation of the standards of society
4) Social discomfort (being around them)
5) Irrationality and unpredictability

Descriptive; do not mention‘cause’; not merely deviant behavior; beyond just different from expectable or culturally sanctioned behavior
Etiology describes the causal pattern of abnormal behavior. It is a developmental process that always involves both biological and psychological components (no dualism). Environment shapes outcome. Recognizes that each individual is uniquely constructed.
Reliability, Validity
Reliability: consistency in date results for a set groups of people

Validity: measures what it intends to

Ex: Handedness - can measure it & it's reliable, but not valid for any psych. hypothesis
Categorical, Dimensional, Prototypical
Categorical: discrete types, not on a continuum. Must have all criteria before diagnosis can be made.

Dimensional: On a continuumm, look at individual's strengths/weakness and characteristics. Use statistical criteria to determine what's normal.

Prototypical: method of DSM-IV . Acknowledges that people will stray from diagnostic criteria, but outlines symptoms.
Limits of DSM-IV
-waste-basket categories
-sub-thresholds: some people don't fit diagnostic criteria, should they be withheld from treatment?
Five Axes of DSM-IV
Axis I - Clinical syndromes (secondary to gross destruction of brain tissue)
Axis II - Personality disorders
Axis III - General medical conditions
Axis IV - Psychosocial/environmental problems
Axis V - Global assessment of functioning
Study of the distribution of diseases, disorders, or health-related behaviors in a given populations (rates of illness)
-Occurrence, or ONSET RATE of a given disorder for a certain time period; ie, NEW cases
-Often seen as cumulative ratio of onsets per unit, population, e.g., 2/1000 per year
-measures number of ACTIVE cases in a given population @ a given time or time period
ABA Design
-Withdraw txt temporarily have behavior return to pre-txt
Analogue Studies
1) Animal research: use data results from animals to see how they react, how it might relate to people's functioning. ADV: can have very controlled design.

2) Stress studies: make people do stressful things (eg, Stroop test) in the lab to examine physiological changes
Retrospective/Prospective studies
Retro: take people with diagnosis and try to reconstruct subject's history. Prone to many biases.

Prospective: take a large sample of people at risk and see what factors are in common for those who develop disorder.
Necessary Cause
If disorder Y occurs, then X must have preceded it.

The factor MUST exist for the disorder to be present. (Trauma in PTSD)
Risk Factor
Variable correlated with emergence/outcome of a disorder
Sufficient Cause
If factor X occurs, then disorder Y will occur.

Disorder Y can exist without factor X.
Contributory Cause
If factor X occurs, then the probability of disorder Y increases.

Neither necessary nor sufficient to cause disorder.
Distal Causal Factor
Factor that occurs early in life, but doesn't show effects for years.

Eg, parents divorce before child is 10 years old.
Reinforcing Contributory Cause
A condition that maintains maladaptive behaviors that are occurring
Mutual, 2 way Influences
An individual's schema can confirm their biases: first, they project negative view, are greeted with negativity, and their biases are confirmed.

Are prevalent in causal patterns, where many factors can contribute to the cause.
Predisposition to developing disorder. Can be biological, gnetic, psychosocial, sociocultural, etc.

Can be distal necessary or contributory factor.

A vulnerability.
Diathesis-Stress model
1. Additive: total “sum” reached to develop disorder (if low disposition, need high levels of stress to develop)
2. Interactive view: must have diathesis for disorder to occur
Overcoming the odds – MI SPEC
Motivation to achieve/drive
Protected from stress
Effective parenting

-diathesis doesn't develop into disorder
-functioning reflects adaptation systems
Cognitive development
Associated with mood, cognitions, depression
Associated with anxiety
Associated with Schizophrenia

-excess levels in schizophrenia
Assoc. with Schizophrenia
What are gene-environment correlations?
-Passive effect: kids of smart parents raised in stimulating environment

-Evocative effect: evoke rxn in others (smiley baby)

-Active effect: niche building, create suitable environments

-hard to determine where environmental influences ends/starts
Emotional/arousal responses & reactions in individuals, and how they differ
-baby-temp thought to be correlated with adult temp

Positive Affect (→extraversion = pos. emo later on)
Activity level (→extraversion = positive emo later)
Frustration (→neuroticism = neg emo later on)
Attentional persistence (→constraint = agreeable)
Irritability (→neuroticism = neg emo later on)
Neural Plasticity
Ability of brain to make changes in organization and functioning of the brain on a neurological level.

Eg, rats reared in rich environments have thicker cell development, stress in pregnant mothers produce infants that are more fearful
Freud's Model of Mental Functioning
Dimensions of personality:
Id: libido and death drive, pleasure principle, primary process thinking, “I can do that!”
Ego: mediator between the two, secondary thinking, in touch with reality, executive branch
Superego: internalization of parental figures, cause of individual’s drive to please others

Anxiety: MR.N
Reality anxiety: fear of reality
Neurotic anxiety: intra-psychic conflict
Moral Anxiety: pt with punitive SuperEgo

Defense Mechanisms: coping mechanism for anxiety
-Repression: suppressing info from cs
-Reaction formation: trying to deny emotions and overcompensate by exhibiting opposite behaviors
-Displacement: of emotion
-Projection: take feelings and attribute to someone else so there is less emotional responsibility
Object relations theory
Object (symbolic of a person) are internalized and interactions of self and other objects give us sense of who we are
-engages introjection
Interpersonal Perspective
Similarities to behavioral perspective
-doesn’t include intra-psychic conflict
-observe socio-cultural patterns (as part of learning)
-relationship/behavioral patterns are learned from others
Process where child symbolically internalized people intro own personality
Attachment Theory
-early childhood attachment relationships lay down framework for later functioning
Instrumental Condiotioning
-has element of reinforcement
-individual learns to act in a certain manner to achieve desirable goal/avoid undesirable
-tendency to generalize initial phobia-object to fear of similar types of things
-lack discrimination of stimuli
-by itself, can cause psychopathology
-usually thought of as "stress" part of diathesis-stress model
-only some go on to develop disorder from the experience of stress
1) Adjustive demands places on an organism, leads to...
2) Individual Psychological makeup (schemas, etc.), leads to...
3) Stressors (effects created within the individual)
3 Categories of Stressors
1) FRUSTRATIONS: goals are thwarted by internal/external factors,
a. internal (realizing you lack talent),
b. external (having no money to go to college)

2) CONFLICTS (conscious): incompatible needs/motives
a. approach/avoidance - want/don't want something
b. double-approach - 2+ desirable goals (2 grad schools)
c. double-avoidance - 2+ undesirable options (terminating fetus or own health)

3) PRESSURES: cause person to speed up/intensify, change to goal-oriented behavior; develops from frustration and conflicts
Risk Factors for Stressful responses
1) Nature of the stressor (duration, # other stressor, magnitude, crisis/trauma)

2) Life Changes (commonly involved); can be tested by Rating scales, but not accurate (items, failure to consider sub-groups, relies on memory & current mood)

3) Perception of Stressor: sense of control/anticipation can lower stress

4) Stress Tolerance: ability to withstand stress w/o becoming seriously impaired - can depend on past experiences

5) Lack of External resources & social support

3 Inter-related levels of coping
1) Biological: SNS activated, immunological & damage repair systems shut down

2) Psychological/IP: learned coping patterns, support form

3) Socio-cultural: organizations, support groups, etc.
Selye's Model for Stress
1) Alarm & Mobilization: SNS activated (blood flow/rate/press increase, pupils dilate, skin constricts), resources are altered and mobilized

2) Resistance: bodily resources maximized, not yet overwhelmed

3) Exhaustion: further stress would be harmful, can lead to death; resources being depleted, coping mechanisms fail, psychological disorganization (hallucinations), decompensation (lowering of adaptive function
Balanced, basic biological state
process of adaptation or achieving stability through change
Allostatic load
frequent mobilization of thewse stress response systems; results in wear and tear of the body
-To define so that a concept can be measured

-Operational definition: definition of a concept on the basis of a set of operations that can be observed and measured
Diagnostic criteria for Adjustment Disorder
-symptoms last less than 6 months
-inability to function normally
-least stigmatizing
-occurring w/in 3 months of the event
Diagnostic criteria for Acute Stress Disorder
-min 2 days, max of 4 weeks
-reaction w/in 4 months
Diagnostic criteria for Post Traumatic Stress Disorder
-minimum of 4 weeks
-acute: less than 3 months
-chronic: more than 3 months

-persistently re-experience the traumatic event by recurring thoughts or nightmares
-avoid stimuli associated with trauma
-chronic tension/irritability
-impaired concentration & memory
-feelings of depression
Innoculation Therapy
Try to prepare person for stressor.

-prepare for what's coming
-role playing
-Source of danger consciously recognized
-Fear/panic involves activation of the fight/flight response
-Cognitive level: I feel afraid
-Physiological: heightened arousal (preparation for threat)
-Behavioral level: strong urge to escape stimulus/situation
What is anxiety? (vs. Fear)
-Diffuse, complex blend of negative emotions
-Cognitive level: negative mood, worry,unable to predict or control future
-Physiological level: state of chronic tension and arousal
-Behavioral level: tendency to avoid situations where might encounter what seems dangerous
Prevalence for Anxiety
-25–29% life time risk for any anxiety disorder, men and women
-Most common disorder for women, 2nd most common disorder for men (for men, historically, substance abuse & anti–social personality disorder)
-12–month prevalence rate: 23% of women, 12% of men will reach criteria for a DSM–IV anxiety disorder
Mediate vs. Moderate
Mediate: transitional stage

Moderate: person who negotiates between 2 stages
Similarities across Anxiety
1) The basic biological factors of these disorders:
Modest genetic influence
Limbic system
Neurotransmitters GABA, norepinephrine, serotonin

1) The basic psychological causes of these disorders
Perception of lack of control (schema)
Classical conditioning/envi

3) The effective treatments for these disorders
Graduated exposure (desensitization)
Medications (except for specific phobias)
-Persistent & disproportionate fear of same specific object/situation
-Most common anxiety disorder
-5 subtypes: Animal, Environment, Blood/Injection, Situational, Other (pain, choking)
-onset early for animal/envi, adolescence for agoraphobia

-Treatment: gradual exposure, NO meds
Traumatic Conditioning
-related to specific phobias
-based on classical conditioning
-can be related to a context/situation
Etiology of Phobias
Who develops phobias depends on
1)Experience before, in control
3)Prior good experience
Comprehensive Learning theory of Panic Disorder
Initial panic attack becomes associated with neutral internal and external cues (HR, shopping mall)
Anxious states become conditioned/associated with these external and internal cues, antcip anxiety
Interoceptive/learning/conditioning model
panic is triggered by unc interoceptive or exteroceptive cues
Cognitive Theory of Pani
1) Trigger Stimulus (internal/external)
2) Perceived Threat
3) Apprehension or worry
4) Body sensations (influenced by trigger stimulus)
5) Interpretaiton of sensations as catastrophic

6) back to perceived threat
Treatment of Panic Disorder
1) Medications: Benzos (tranquilizers) or SSRIs

2) Behavioral & cognitive-behavioral:
a. interoceptive exposure (hyperventilating, exercise)
b. learn about adaptability of reaction
c. controlled breathing
d. automatic throughts/decatastrophize
-Persistent images, ideas, thoughts, experienced as inappropriate and disturbing, usually contamination worries, fears of harming self or others, pathological doubt
-Like GAD; 'what if’ illness, but more extreme/debilitating
-Acts (also mental acts) done to neutralize unpleasant feelings, try to reduce or prevent stress/anxiety or prevent event from occurring
-Eg, Cleaning, checking, repeating, ordering/arranging, counting
OCD from Cognitive, Behavioral perspective
-Cognitive: proposes Thought-Action fusion, that thinking is as bas as doing, feel much more responsible/accountable
-Behavioral: 2 process theory (Mowrer) - that neutral object paired to anxiety, ritual relieves anxiety
Abnormalities in Brain Function in OCD
-PET suggest abnormally active orbital frontal cortex
-too much serotonin
Aversion Therapy
-type of Behavior therapy
-form of punishment (not used a lot)
-try to disrupt behavioral patterns with noxious stimuli (antabuse & drinking)
-do not necessarily promote learning of new coping skills
Systematic Reinforcement as a therapy
-eg, token economies
-reward desired behavior
-focus is on reward vs. the accoplishment
-not used a lot
-eliminate re-inforcers like paying attention to screaming kid (can't get anything w/o token-behavior)
Cognitive Behavioral Therapy Approaches
-self-monitor negative schemas
-test out hypothesis (negative)
-have DIS-confirming experiences
-discover bias in schemas
-therapy as an experiment
Analysis of Transference (Psychoanalytic)
-focus on ucs conflict
-analyze transference: pick up on their projected relationship templates - consider past lives to be replicated in therapy
Principles of IPT
-assumes that depression is triggered by interpersonal difficulties in one or more of the following problem areas:
1) Grief: death of a person significant to the patient
1. Facilitate mourning process
2. Help establish interest in new relationships

2) Interpersonal disputes: disagreements (overt/covert)
1. Identify dispute
2. Choose plan of action
3. Modify expectations

3) Role transitions (life changes)
1. Mourn loss of old role
2. See positive aspects of new role
3. Develop skills to master new role
4) Interpersonal Deficits (loneliness, social isolation)
1. Reduce isolation
2. Encourage formation of new relationships
Therapist's role in IPT
-Active: asks lots of questions, helps consider/suggest options, empathetic
-Focus on interpersonal area
Interpersonal Inventory
-part of IPT
-gether information about important people in a patient's life
-ask questions about the person:
-how often do you see,
-what do you like/not like
-what has changed, do you want it different, etc.
5 basic trait dimensions used to define personality
Openness to experience
Cluster A Personality Disorder
Odd, eccentric types

Paranoid: Suspiciousness, mistrust of others; tendency to see self as blameless & blame others; on guard for perceived attacks by others, can be very hypersensitive, often quick to anger

Schizotypal: social deficits, peculiar thought patterns; oddities of thought/perception and speech that interfere with communication and social interaction
-e.g., believe in telepathy, ideas of reference
-Some loosening of ties to reality
-3% prevalence rate;
-Genetic link to schizophrenia

Schizoid: Impaired social relationships, inability and lack of desire to form attachments; seen as loners, introverts with solitary interests and occupations; in general not very emotionally reactive, with either positive or negative emotions; can appear aloof, cold, distant
Cluster B Personality Disorders
Dramatic, emotional, erratic

BARNARD metaphor

Histrionic:High drama, high emotion & Self dramatization; over-concern with attractiveness; tendency to irritability and temper outbursts if attention seeking is frustrated
-Often do charm people and get attention, but leads to unstable relationships as others tire
-Impressionistic speech
-3% prevalence

Narcissistic: Grandiosity; preoccupied with being admired; self promoting; lack of empathy
-Overestimate their abilities and underestimate others’
-believe others are envious
-Underneath grandiosity, low self esteem
-Kohut (psychoanalytic): need parental mirroring to get out of narcissistic phase in c-hood
-Million (social learning): spoiling kids gases them up

Antisocial: Lack of moral or ethical development; inability to follow approved models of behavior; deceitfulness; shameless manipulation of others; hx of conduct problems as a child
-Continually violate rights of others; no remorse, no loyalty
-Behavioral pattern set by age 15

Borderline: Impulsiveness, inappropriate anger; drastic mood shifts; chronic feelings of boredom and emptiness; attempts at self mutilation and suicide
-Chronic instability in interpersonal relationships, self image, and mood;transient psychotic symptoms
-Do anything to avoid feelings of abandonment
-Move from idealizing to de–idealizing people
-8% may suicide
-2% prevalence in population; more common in women
-50% qualify for a mood or anxiety disorder
Cluster C Personality Disorders
Anxiety and fearfulness

C - cluster C
Avoidant: Hypersensitivity to rejection or social derogation; shyness; insecurity in social interaction and initiating relationships
Extreme social inhibition, introversion
-Desire relationships but afraid of rejection, criticism; very insecure; DO NOT like their aloneness

Dependent: Difficulty in separating in relationships; discomfort at being alone; subordination of needs in order to keep others involved in a relationship; indecisiveness
-Need to be taken care of; show clingy and subordinate behavior

Obsessive: Excessive concern with order, rules and trivial details; perfectionistic; lack of emotional expressiveness and warmth; difficulty in relaxing, having fun
Often unable to finish projects due to focus on details
Common Principles of Eating disorders
1. Once initiated, behaviors become persistent
2. Factors that initiated are not the same factors that maintain it
3.Disordered eating behavior has physical and psychological consequences
4. Very difficult to separate out causes from consequences of disordered eating
5. Disordered eating behavior appears to have multiple origins and multiple effects. It can also be viewed through multiple levels of understanding.
i.e., biological, psychological, social
Klein's model for Anorexia
1. Heredity, Stress, Personality, and culture influence and are influenced by

2. Disordered Eating/Starvation, which is influenced by and influenced

3. Family, Medical Problems, Social Difficulties, Role Dysfunction, Psychological disturbance
Risk Factors for Anorexia Nervosa
1. Heredity (genes & environment)
2. Anxiety/Mood disorder, perfectionism
3. Developmental (puberty, stress)
4. Certain athletic endeavors
5. Socio-cultural influences
Associated Behaviors of Bulimia Nervosa
-food restriction in between binges
-depressed mood
-binges often follow stress/low mood
-abnormal hunger & satiety sensations
-medical abnormalities: dental erosion, salivary gland enlargement
-gastrointestinal abnormalities: larger than normal stomach capacity, abnormal release of satiety hormones; delayed gastric emptying (bloating, fullness)
How is an assessment different than a diagnosis?
Assesment: more than diagnostic label, assessment of general functioning, inlcuding developmental history, intellectual functioining, personality, stressors

Diagnosis: need to fill criteria to get the label, directs treatment methods
What are the 5 ways of neurologically assessing someone?
*note: this is not yet routine, only used when suspect brain injury; and focus on cognitive & motor-perceptual skills

EEG: electrical brain wave patterns
Anatomical brain scans: CAT, MRI, look at magnetic fields caused by varying amounts of water content of various organs and brain

PET scans: metabolic portrait (find site a seizure)

Assessment interviews
-have structured(accurate, objective)/unstructured (understanding, rapport) types
Methods for Clinical observation of behavior1
1. Rating Scales: standardized comparison with other patients looking at somatic issues (anxiety, guilty, emotional withdrwal)
2. Self-monitoring (CBT)
3. Transference templates, look at therapy relationship as microcosm/stencil of their functioning
Projective Personality Test
-projective: patient projects their feelings, therapist tries to analyze what they put out there
-concerns for validity/reliability, interpreted subjectively

-several types:
1. Rorschach - inkblots
2. Thematic Apperception Test (TAT) - tell a story
3. Sentence completion
Objective Personality tests
-structured, based on quantified tests, increased reliability
-*note: criticized for being a superficial self-report, assumes person can know themselves and obsserve themselves

-several types:
1. Minnesota Multiphasic Personality Inventory (MMPI): ask questions about life and compare results to controls
Clinical Description:
-Disregard and violate rights of others, repeatedly
Deceitful, aggressive
Life–long pattern of unsocialized and irresponsible behavior
-Repeated conflicts with society and often the law
-No regard for own safety or that of others
-Affective and interpersonal traits such as lack of empathy, inflated, arrogant self appraisal, glib and superficial charm
-occurring since 15
-have to be 18 to make dx, with at least 3 cases of deviant behavior
Hare proposed two dimensions:
1)Affective/interpersonal dimension: little remorse, callousness, selfishness, exploitative, charm callousness, grandiose sense of own worth, lying
2) Behavior: antisocial, impulsive, deviant, irresponsible lifestyle (DSM-IV emphasizes this aspect)

-do not necessarily fill all the deviant behavior, or intentionally defy the law - more being selfish and not having a conscience, can get what they want & don't respect the law
Special vulnerabilities of young children
-At the whim of their environment (shaping them, getting help or not)
-Lack realistic/complex view of themselves
-Lack coherent world view
-No stable sense of self, less sense of what is expected of them
-Little sense of past/future so threats take on greater significance, no context
-Dependent on other people so very vulnerable to others’ availability, coping, vulnerable to rejection, can blame themselves (take responsibility, want to please parent to get love)
Clinical picture of ADHD
Difficulties that interfere w/effective task–oriented functioning
Impulsive, excessive motor activity;
Intrusive, socially immature
Difficulties sustaining attention
Often lower intelligence, 7-15 IQ pts below norm
(similar ‘breeder vs drift hypothesis’ here)
3-5% of school age children
Most common referral
6-9% more common in boys than girls
Greatest frequency before age 8
Conduct disorder
-Onset at age 9
-Most had Oppositional Defiant Disorder
-Persistent, repetitive violation of rules and a disregard for the rights of others
-Overt or covert hostility, disobedience, physical and verbal aggressiveness, vengefulness, destructiveness
Lying, solitary stealing, temper tantrums
-Sexual aggressiveness
-Some may engage in fire setting, vandalism, robbery
-often co-morbid for substance abuse or depressive symptoms
Causal factors in conduct disorder
1) Genetic risks
1. difficult temperament
2. low verbal intelligence
3. mild neurological problems (may be associated with difficulties of self-control, planning, self-monitoring)
2) insecure attachment: can't engage parent
Causal Factors for Anxiety in Childhood anxiety
-easily conditioned to aversive stimuli
-early traumatic events can make them feel insecure
-parents with anxiety/worrying style can setup negative schemas
-inadequate parenting leading to lack of skills
-overall experience of lack of control
eSeparation Anxiety
-Most common overall; more common in girls
-One estimate 2–4% of pop
-Unrealistic fears, oversensitivity, self consciousness, chronic anxiety, immature, scared of new situations, nightmares
-Cope by depending on their parents
-During separation have morbid fears
-Most recover w/o symptoms; some develop school refusal
Selective Mutism
-Persistent (1 month duration) failure to speak in social situations in context of child having the ability to speak
-treat with SSRIs and family therapy
Attachment theory for Childhood Depression
-mother-child interaction in the transmission of depressed affect
ADHD - DSM-IV subtypes
1) Attention–Deficit/Hyperactivity Disorder, combined: 6 or more symptoms of inattention, 6 or more symptoms of hyperactivity, impulsivity that have persisted for 6 mos

2)Attention–Deficit/Hyperactivity Disorder, inattentive type 6 or more symptoms of inattention, fewer than 6 of hyperactivity and impulsivity, persisted for 6 mos MAJORITY OF CHILDREN

3) Attention–Deficit/Hyperactivity Disorder, impulsive type: 6 or more symptoms of hyperactivity, fewer than 6 symptoms of inattention persisted for 6 mos
Underlying representation of the world that guides information processing, shaped by personal biases
Attribution theory
Assign cause to things that happen
-pts with depression = more negative self attributions; healthy people = self-serving biases
Early Deprivation/trauma
Psycho-social causal factors of Mental Disorder
-affects basic trust skills/schema/acquiring skills
-separation makes people prone to deprivation
-abuse/neglect can lead to disorganized attachment (laughing while whimpering)
Inadequate parenting
Psycho-social causal factors of Mental Disorder
-if parents have psychopathologies, see inability to devote attention to kids, exhibit insecure attachment, increased life stress
What are differences in parenting styles?
When goes wrong, Psycho-social causal factor
-Authoritative: friendly, competent, securely attached
-Authoritarian: conflicted, irritable, moody, aggr.
-Permissive/Indulgent: spoiled, selfish, impatient, inconsiderate, demanding
-Neglectful/Uninvolved: moody, low self-esteem, conduct problems
Marital Discord
In comparison, these kids have less edu, lower incomes & life satisfaction, welfare, get divorced
-correlation unclear
-Amato’s studies show that effects are minimal
Maladaptive peer relationships
Psychosocial causal factor
Evidences reinforcing contributory factors, feedback
-withdrawn kids may become more withdrawn
Bleuler, Swiss shrink terms it “split mind” – mind is divorced from consensual reality
Exhibit Psychosis: loss of contact with reality
1% lifetime prevalence
Positive symptoms
-easier to treat with medication
Negative symptoms
-emotional flattening
-poverty of speech
-harder to treat
Disturbances in content of thought
-Delusions of Reference: find sig. in things
-Thought insertion: believe thoughts are inserted
-Thought broadcasting: believe others can read their thoughts
-Thought withdrawal: believe thoughts are being taken away from them
Sensory experiences in absence of external stimulus
-auditory most common; Broca’s area is activated
-coherent, persecutory delusions
-delusions of grandeur
-auditory hallucinations
-higher adaptive, coping skills (recover most easily)
-no evidence of disorganized speech
alternates between stuporous and excitement
-Exhibits echopraxia: imitation of gesture
-exhibits echolalia: imitation of speech
Delusional disorder
-believes delusions, sometimes act on them
-pt exhibits NO other symptoms
Residual schizophrenia
-pt recovering from schizophrenia, no active symptoms
comorbidity w/ schizophrenia and mood disorder
schiz-like symptoms, but less than 6 mo.
Shared psychotic disorder
delusion develops in the context of a close relationship
Brief psychotic disorder
disorganized/catatonic behavior for less than 1 mo.
Evidence for Genetic Causal Factors of schizophrenia
-prevalence for 1st degree relative is 10%, 2nd is 3%
-Mono twins show 28% concordance, dizy show 6%
-16.6% of children of schiz mother develop it
-Wahlberg study: showed that high Communication deviance in families at risk developed schiz; see gene-environment interaction
-while family concordance exits, it’s not 100% = schiz is not purely genetic
Neurodevelopmental factors in Schizophrenia
-Dutch Hunger winter
-Flu outbreak in Finland 1957
-Complicated deliveries
-Walker’s home videos: ppl who develop schiz have decreased facial/emo expr & motor skills as children
-Brain areas are abnormal:
-enlarged ventricles
-decreased brain volume
-frontal lobe dysfunction (=neg symp & attn deficit?)
-reduced thalamus
-abnormalities in temporal lobe, incl: hippocampus, amygdala (memory & emotions)
NT abnormalities in Schizophrenia
Dopamine: see excess amounts, due to excess production or too many dopamine receptors?
-Glutamate: dopamine receptors inhibit release of glutamate, which is excitatory NT. Less glutamate = less glutamate receptors, which can lead to cell death. Pts with schiz have less glutamate.
Neurocognitive deficits
-eye tracking test: 54-86% of pts with schiz couldn’t
-50% of 1st degree relatives also couldn’t track
-would indicate that there is a genetic vulnerability
-interestingly, controls administered glutamate inhibitors also showed an inability to track
Psychosocial/Cultural aspects
-Expressed emotion: feelings of hostility, criticism… is especially stressful to pts with schiz, and may trigger cortisol release, which signals dopamine
-lower SES = higher levels of schizophrenia
-sociogenic (breeder) hypothesis
-social drift hypothesis
Sociogenic (breeder) hypothesis
diathesis-stress model
-poverty = extreme stressor, so predisposed @ high risk
Social Drift hypothesis
-feedback & mutual influence
-inability to function makes performance worse, and this cycles until lose job/daily routine/etc.
Treament & Clincal outcome in Schizophrenia
Antipsychotics: have two kinds, 1) conventional neuroleptics and 2) novel antipsychotics (better, but rel. to weight gain and extrapyramidal side effects)
-Psycho-social approaches (rapport, rel involved):
-Case-management: make sure pt has job, house, etc.
-Social Skills training: develop interpersonal skills
-CBT: examine evidence for delusions
-Family therapy: try to create low CD/EE environment
Unconditional positive regard for pt during session
Mood disorder (DSM-IV)
Intense, persistent disturbances in mood shown to be mal-adaptive
-DSM-IV: 5 or more in 2 wks, with 1 of those being depressed mood/loss of interest
-depressed most of the day
-weight gain/loss
-diminished intrest
-psychomotor agitation/retardation
-feelings of worthlessness/guilt
-diminished ability to concentrate
-recurrent thoughts of death
-Lifetime prevalence for uni 13% males, 21% females
-lifetime prevalence for bipolar 0.4-1.6%
Subtypes of Major Depression
-MD episode with psychotic: mood congruent delusions and hallucinations, feelings of worthlessness/guilt; distinguished from schizoaffective b/c hallucinations are mood congruent
-MD episode with melancholic: (need 3)
-early morning awakening
-depression is worse in the morning
-loss of appetite
-excessive guilt
-pscyho-motor agitative
-qualitatively different sadness (punitive, despair)

-MD episode with atypical: (need 2)
-mood reactivity (can brighten, but not to normal)
-leaden paralysis (body is heavy)
-weight gain/increase in appetite
-pronounced sensitivity to interpersonal rejection
-Chronic: lasts more than 2 years
-Seasonal: recurrent during (winter) season
-Dysthymia: milder but longer-lasting symptoms of depression
Beck's Cognitive Model
-Early experience
-Formation of dysfunctional beliefs
-Critical incidence (stressors)
-Negative beliefs/schemas activate
-Negative automatic response cascades
-Symptoms of depression (keep schemas active)
Negative Cognitive Triad
-part of Beck’s model, about Self, Future, and Others
-all or none reasoning
-selective abstraction: only take negative data
-arbitrary inference: seek negative data to support idea despite contrary evidence
Helplessness Theory
-developed from animal studies
-when animals/humans are unable to control their environment, learn helplessness
-humans learn helplessness with attributional style, too
-internal/external: attribute blame to self/others
-global/specific: belief in temporary state/not
-stable/unstable: belief in ability for things to change
Hopelessness Theory
-similar to helplessness theory but includes expectancy of hopelessness
-in attributional criteria, disregards internal/external in favor of hopeless expectancy
1. pessimistic attributions
2. life stressor
3. sureness that other negative events will occur
Suicidal Ambivalence
-communication of suicidal intent, exhibits a desire to communicate with others, perhaps a drastic cry for help
-30-40% make implicit communication
-40% make explicit communication
Warning Signs of Suicide
-lack of interest
-change in mood
-marked self-esteem
-deteriorating hygiene
-interpersonal problems (also acts as proximal stressor)
Biological Factors in unipolar depression
-genetic contribution: mono zygotic twins are 2x likely to have depression than dizygotic (30-40% variance)
-non-shared environmental factors show more variance than shared environmental factors
-5-HTT gene combo include 1 or 2 short alleles correlated with higher rates of depression
-Dysregulated thyroid functioning: show sim symptoms
-low levels of activity in left pre-frontal cortex
-Dexamethasone: usually suppresses cortisol, but isn’t functioning, so depressed pts have extra-high levels of cortisol, indicating that HPA is dysfunctional
Suicide - prevalance rates
-among top 10 leading causes death in West
-attempts most common 18-24, completed in elderly over 65
-rates for younger attempts increasing
-40-60% completed suicided performed by people in recovery phase
-1% risk for pts with depression, 15% for pts with chronic depression
-15% risk in recurrent mood disorders, 10% in schizophrenia, 1% general
-10% of children/adolescents have attempted
-2nd leading cause of death in college students
-3rd leading cause of death in young
Risk Factors for Suicide
-drug/alcohol abuse
-sensitivity to lack of control
-conduct disorder
-exposure to media
-academic/ID pressures
Bipolar disorder
-Distinguished from unipolar depression by presence of manic/hypomanic symptoms that show themselves for at least 1 week
-medications for depression can send manic-depressive sufferers into manic state; need for correct diagnosis!
Cyclothymic disorder
-cycles through hypomanic and depressed states, but less severe than bipolar disorder
-lasts 2 years
-elations, expansiveness, grandiosity, eupohira, irritable
-flight of ideas, goal-directed behavior for foolish endeavors
-need to have 1 week of manic state for bipolar disorder
Subtypes of bipolar
-Bipolar I: 1 full on manic episode and depression
-Bipolar II: hypomanic and depression
-Bipolar with seasonal patterns
Biological Causal for Bipolar
-Genetic: greater genetic contribution than in unipolar
-8-9% of 1st degree relative concordance, gen 1%
-mono have 60% concordance, di have 12%
-estimated that genes account for 80-90% variance
-NTs: norep, serotonin, and dopamine dysfunctions
-not well-understood
-think there are abnormalities in the way ions are transported across neural membrane
-perhaps that’s why lithium is effective, it works like sodium to pass down neural impulses down axon
-Hormonal: cortisol, disturbances in bio rhythm?
-Neuro: shifting patterns of blood flow to the left and right prefrontal cortex
Psychosocial causal factors of bipolar
-stressful life events
-personality variables (high self-standards, neuroticism)
-psychodynamic think manic = coping mech for depr