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144 Cards in this Set
- Front
- Back
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DSM-IV criteria for a Mental Disorder
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::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 |
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Etiology
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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.
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Reliability, Validity
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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 |
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Categorical, Dimensional, Prototypical
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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. |
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Limits of DSM-IV
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-waste-basket categories
-sub-thresholds: some people don't fit diagnostic criteria, should they be withheld from treatment? |
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Five Axes of DSM-IV
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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 |
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Epidemiology
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Study of the distribution of diseases, disorders, or health-related behaviors in a given populations (rates of illness)
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Incidence
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-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 |
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Prevalence
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-measures number of ACTIVE cases in a given population @ a given time or time period
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ABA Design
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-Withdraw txt temporarily have behavior return to pre-txt
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Analogue Studies
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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 |
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Retrospective/Prospective studies
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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. |
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Necessary Cause
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If disorder Y occurs, then X must have preceded it.
The factor MUST exist for the disorder to be present. (Trauma in PTSD) |
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Risk Factor
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Variable correlated with emergence/outcome of a disorder
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Sufficient Cause
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If factor X occurs, then disorder Y will occur.
Disorder Y can exist without factor X. |
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Contributory Cause
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If factor X occurs, then the probability of disorder Y increases.
Neither necessary nor sufficient to cause disorder. |
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Distal Causal Factor
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Factor that occurs early in life, but doesn't show effects for years.
Eg, parents divorce before child is 10 years old. |
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Reinforcing Contributory Cause
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A condition that maintains maladaptive behaviors that are occurring
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Mutual, 2 way Influences
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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. |
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Diathesis
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Predisposition to developing disorder. Can be biological, gnetic, psychosocial, sociocultural, etc.
Can be distal necessary or contributory factor. A vulnerability. |
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Diathesis-Stress model
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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 |
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Resilience
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Overcoming the odds – MI SPEC
Motivation to achieve/drive Intelligence Self-regulation Protected from stress Effective parenting -diathesis doesn't develop into disorder -functioning reflects adaptation systems Cognitive development |
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Serotonin
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Associated with mood, cognitions, depression
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GABA
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Associated with anxiety
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Dopamine
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Associated with Schizophrenia
-excess levels in schizophrenia |
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Norepinephrine
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Assoc. with Schizophrenia
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What are gene-environment correlations?
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-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 |
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Temperament
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Emotional/arousal responses & reactions in individuals, and how they differ
-baby-temp thought to be correlated with adult temp ::PAFAI:: 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) |
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Neural Plasticity
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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 |
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Freud's Model of Mental Functioning
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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 |
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Object relations theory
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Object (symbolic of a person) are internalized and interactions of self and other objects give us sense of who we are
-engages introjection |
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Interpersonal Perspective
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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 |
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Introjection
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Process where child symbolically internalized people intro own personality
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Attachment Theory
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Bowlby
-early childhood attachment relationships lay down framework for later functioning |
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Instrumental Condiotioning
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-has element of reinforcement
-individual learns to act in a certain manner to achieve desirable goal/avoid undesirable |
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Generalization
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-tendency to generalize initial phobia-object to fear of similar types of things
-lack discrimination of stimuli |
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Stress
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-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 |
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Stressor
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1) Adjustive demands places on an organism, leads to...
2) Individual Psychological makeup (schemas, etc.), leads to... 3) Stressors (effects created within the individual) |
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3 Categories of Stressors
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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 |
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Risk Factors for Stressful responses
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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 6) |
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3 Inter-related levels of coping
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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. |
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Selye's Model for Stress
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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 |
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Homeostasis
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Balanced, basic biological state
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Allostasis
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process of adaptation or achieving stability through change
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Allostatic load
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frequent mobilization of thewse stress response systems; results in wear and tear of the body
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Operationalize
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-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 |
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Diagnostic criteria for Adjustment Disorder
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-symptoms last less than 6 months
-inability to function normally -least stigmatizing -occurring w/in 3 months of the event |
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Diagnostic criteria for Acute Stress Disorder
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-min 2 days, max of 4 weeks
-reaction w/in 4 months |
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Diagnostic criteria for Post Traumatic Stress Disorder
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-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 |
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Innoculation Therapy
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Try to prepare person for stressor.
-self-talk -prepare for what's coming -role playing |
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Fear/Panic
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-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 |
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What is anxiety? (vs. Fear)
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-Diffuse, complex blend of negative emotions
-Future-oriented -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 |
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Prevalence for Anxiety
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-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 |
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Mediate vs. Moderate
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Mediate: transitional stage
Moderate: person who negotiates between 2 stages |
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Similarities across Anxiety
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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 Neuroticism Perception of lack of control (schema) Classical conditioning/envi 3) The effective treatments for these disorders Graduated exposure (desensitization) Medications (except for specific phobias) |
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Phobias
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-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 |
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Traumatic Conditioning
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-related to specific phobias
-based on classical conditioning -can be related to a context/situation |
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Etiology of Phobias
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Who develops phobias depends on
1)Experience before, in control 2)After-experience 3)Prior good experience |
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Comprehensive Learning theory of Panic Disorder
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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 |
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Interoceptive/learning/conditioning model
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panic is triggered by unc interoceptive or exteroceptive cues
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Cognitive Theory of Pani
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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 |
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Treatment of Panic Disorder
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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 |
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Obsessions
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-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 |
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Compulsions
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-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 |
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OCD from Cognitive, Behavioral perspective
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-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 |
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Abnormalities in Brain Function in OCD
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-PET suggest abnormally active orbital frontal cortex
-too much serotonin |
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Aversion Therapy
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-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 |
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Systematic Reinforcement as a therapy
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-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) |
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Cognitive Behavioral Therapy Approaches
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-self-monitor negative schemas
-test out hypothesis (negative) -have DIS-confirming experiences -discover bias in schemas -therapy as an experiment |
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Analysis of Transference (Psychoanalytic)
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-focus on ucs conflict
-analyze transference: pick up on their projected relationship templates - consider past lives to be replicated in therapy |
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Principles of IPT
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-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 |
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Therapist's role in IPT
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-Active: asks lots of questions, helps consider/suggest options, empathetic
-Focus on interpersonal area |
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Interpersonal Inventory
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-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. |
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5 basic trait dimensions used to define personality
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::COANE::
Conscientiousness Agreeableness/antagonism Openness to experience Neuroticism Extraversion/introversion |
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Cluster A Personality Disorder
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Odd, eccentric types
::PaSS:: 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 |
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Cluster B Personality Disorders
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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 |
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Cluster C Personality Disorders
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Anxiety and fearfulness
::CADO:: 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 |
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Common Principles of Eating disorders
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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 |
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Klein's model for Anorexia
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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 |
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Risk Factors for Anorexia Nervosa
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1. Heredity (genes & environment)
2. Anxiety/Mood disorder, perfectionism 3. Developmental (puberty, stress) 4. Certain athletic endeavors 5. Socio-cultural influences |
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Associated Behaviors of Bulimia Nervosa
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-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) |
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How is an assessment different than a diagnosis?
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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 |
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What are the 5 ways of neurologically assessing someone?
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*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) \ |
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Assessment interviews
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-have structured(accurate, objective)/unstructured (understanding, rapport) types
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Methods for Clinical observation of behavior1
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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 |
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Projective Personality Test
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-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 |
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Objective Personality tests
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-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 |
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Sociopathy
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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 |
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Psychopathy
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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 |
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Special vulnerabilities of young children
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-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) |
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Clinical picture of ADHD
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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 |
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Conduct disorder
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-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 -pre-meditated |
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Causal factors in conduct disorder
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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 |
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Causal Factors for Anxiety in Childhood anxiety
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-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 |
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eSeparation Anxiety
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-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 |
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Selective Mutism
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-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 |
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Attachment theory for Childhood Depression
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-mother-child interaction in the transmission of depressed affect
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ADHD - DSM-IV subtypes
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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 |
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Schema
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Underlying representation of the world that guides information processing, shaped by personal biases
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Attribution theory
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Assign cause to things that happen
-pts with depression = more negative self attributions; healthy people = self-serving biases |
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Early Deprivation/trauma
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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) |
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Inadequate parenting
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Psycho-social causal factors of Mental Disorder
-if parents have psychopathologies, see inability to devote attention to kids, exhibit insecure attachment, increased life stress |
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What are differences in parenting styles?
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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 |
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Marital Discord
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In comparison, these kids have less edu, lower incomes & life satisfaction, welfare, get divorced
-correlation unclear -Amato’s studies show that effects are minimal |
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Maladaptive peer relationships
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Psychosocial causal factor
Evidences reinforcing contributory factors, feedback -withdrawn kids may become more withdrawn |
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Schizophrenia
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Bleuler, Swiss shrink terms it “split mind” – mind is divorced from consensual reality
Exhibit Psychosis: loss of contact with reality 1% lifetime prevalence |
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Positive symptoms
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-hallucinations
-delusions -easier to treat with medication |
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Negative symptoms
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-emotional flattening
-poverty of speech -harder to treat |
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Delusions
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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 |
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Hallucinations
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Sensory experiences in absence of external stimulus
-auditory most common; Broca’s area is activated |
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Paranoid
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-coherent, persecutory delusions
-delusions of grandeur -auditory hallucinations -higher adaptive, coping skills (recover most easily) -no evidence of disorganized speech |
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Catatonic
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alternates between stuporous and excitement
-Exhibits echopraxia: imitation of gesture -exhibits echolalia: imitation of speech |
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Delusional disorder
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-believes delusions, sometimes act on them
-pt exhibits NO other symptoms |
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Residual schizophrenia
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-pt recovering from schizophrenia, no active symptoms
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Schizoaffective
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comorbidity w/ schizophrenia and mood disorder
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Schizophreniform
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schiz-like symptoms, but less than 6 mo.
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Shared psychotic disorder
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delusion develops in the context of a close relationship
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Brief psychotic disorder
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disorganized/catatonic behavior for less than 1 mo.
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Evidence for Genetic Causal Factors of schizophrenia
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-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 |
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Neurodevelopmental factors in Schizophrenia
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-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) |
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NT abnormalities in Schizophrenia
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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. |
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Neurocognitive deficits
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-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 |
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Psychosocial/Cultural aspects
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-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 |
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Sociogenic (breeder) hypothesis
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diathesis-stress model
-poverty = extreme stressor, so predisposed @ high risk |
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Social Drift hypothesis
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-feedback & mutual influence
-inability to function makes performance worse, and this cycles until lose job/daily routine/etc. |
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Treament & Clincal outcome in Schizophrenia
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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 |
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Rapport
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Unconditional positive regard for pt during session
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Mood disorder (DSM-IV)
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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 -hypersomnia/insomnia -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% |
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Subtypes of Major Depression
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-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 -hypersomnia -pronounced sensitivity to interpersonal rejection -Chronic: lasts more than 2 years -Seasonal: recurrent during (winter) season -Dysthymia: milder but longer-lasting symptoms of depression |
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Beck's Cognitive Model
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-Early experience
-Formation of dysfunctional beliefs -Critical incidence (stressors) -Negative beliefs/schemas activate -Negative automatic response cascades -Symptoms of depression (keep schemas active) |
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Negative Cognitive Triad
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-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 |
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Helplessness Theory
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-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 |
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Hopelessness Theory
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-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 |
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Suicidal Ambivalence
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-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 |
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Warning Signs of Suicide
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-lack of interest
-change in mood -marked self-esteem -deteriorating hygiene -interpersonal problems (also acts as proximal stressor) |
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Biological Factors in unipolar depression
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-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 |
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Suicide - prevalance rates
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-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 |
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Risk Factors for Suicide
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-drug/alcohol abuse
-sensitivity to lack of control -conduct disorder -exposure to media -academic/ID pressures |
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Bipolar disorder
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-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! |
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Cyclothymic disorder
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-cycles through hypomanic and depressed states, but less severe than bipolar disorder
-lasts 2 years |
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Mania
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-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 |
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Subtypes of bipolar
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-Bipolar I: 1 full on manic episode and depression
-Bipolar II: hypomanic and depression -Bipolar with seasonal patterns |
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Biological Causal for Bipolar
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-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 |
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Psychosocial causal factors of bipolar
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-stressful life events
-personality variables (high self-standards, neuroticism) -psychodynamic think manic = coping mech for depr |
