Abnormal Psychology 12

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Psychotic Disorder

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It's effects in altering perception, thoughts or conciousness: these alterations are called hallucinations or delusions. - May also include disorgainized speech and behavior. - Have difficulty thinking in an orgainized rational way.

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Schizophrenia

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Of all psychotic disorders it has the most severe impact on people's lives and on the health care system.
More than 2million people or 1% of the pop. suffer from this chronic and disabling disease in any given year.

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What % of people with Schizophrenia will become severly and permanently disabled and dependent on public assistance funding?

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50%

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What % of ppl with Schizo. make up the permanitly and totally disabled pop. and consitiute a goo %age of the homeless pop.

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10%

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About how many people with Schizo. try to kill themself and about how many succeed

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About 1 in 4 will try and about 1 in every 10 who try will succeed.

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How to catagorize Schizo.

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Into Subtypes 1. paranoid 2. catatonic 3.disorgainized 4. undifferentiated type 5)residual

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Two Groups os symptoms that mark individuals with schizophrenia.

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Positive- reflect a distortion or excess of normal fuctions and tend to be most frequent in the 1st stages or early episodes of schizo.
negative- are behavioral deficits or the loss or decrease of normal funct., tens to be infrequent at the begining of the disorder but may be more prominent later. In the early stages of Schizo. both + and - symptoms are likley to fluctuate in serverity and may respond to treatment. In later stagtes the - sympt. usually dominate ti be quite stable.

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When does most of the deterioration in behavior take place in Schizo.

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The first year after symptoms appear and after 3-5 years the symptoms reach a plataeu or may even decrease.

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Paranoid Schizophrenia

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Marked by dellusions and sustained, extreme suspiciousness.

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Delusional Disorder

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Well-defined systems of delusional paranoid thinking with people who show well-integrated behavior. Illness, drugs, damage to the brain, some effects of ageing, and the experience of severe stress can also produce signs of paranoid thinking even when no disorder is present.

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Catatonic Schizophrenia

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Characterized by psychomotor disturbances that may range from immobility or stupor to excessive motor activity that seems purposeless and unconnected to what is going on in the enviornment- may refuse to speak, may remain stiffly immobile or may be extremely aggitated. Waxy Flexibility

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Waxy flexibility

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An extreme form of immobility in which the persons leg or arm remains passivley in the position in which it's placed, part of Catatonic Schizo.

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Person with agitated catatonic behavior

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shows extreme psychomotor excitment, talking and shouting almost continuously.

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Disorgainized Schizo.

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Shows incoherance in expression, grossly disorgainized behavior, and either flat or extremely innappropriate emotional reactions. Behave actively bu aimlessly, and may show childish disregard for social conventions and may resist wearing clothes, or urinate or defecate in inappropriate places. - usually long term outlook is poor.

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Residual

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When someone has perviosuly met the dianostic criteria for schizo. and no longer has prominent + symp., but still continues to have - sympt. or very mild residual + sympt....may represent; a transition between an active psychotic episode and a complete remission, an interlude between psychotic episodes, or a long-term state that may last many years.

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Undifferentiated Type of Schizo.

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Does no meet criteria for other types, but has characteristic sympt. of schizo. - include either bizarre delusions or hallucinations, or some combination of disorgainized speeech, disorgainized behavior, and flattened affect, and at least one other sympt.

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Delusions

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A faulty interpretation of reality that cannot be shaken despite clear evidence to the contrary. Bizarre delusions are very charicteristic of Schizo. Delusions can result in violent behavior that harm others.

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The content of delusional belief's often contain...

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contradictions, and the relationship between delusionsal belifs and any action that might flow from them is unpredictable.

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Types of delusions

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Bizarre (people can hear their thoughts)
Referential (person believes that certain gestures, comments, songs passages in books and etc... are specifically intended for him/her.
Occur less often - Belief of being persecuted, grandiose thoughts about being an extremely important person, and ideas with a religious theme.

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Hallucinations

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Are projections of internal impulses amd experiences onto perceptual images in the external world. Only in Schizo. doe these occur when the person is in a clear conscious state- cant be associated with any of the senses, auditory is the most common, smell is less common

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Broca's area

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During auditory hallucinations blood flow to this part of the brain ( the brain's speech center) was significatly greater during the time the hallucination was occuring than when it was not. In people w/o schizo., this area is activated when they silently talk to themselves.- this suggests it is hard for schizo.'s to determine their own silent speech and hearing words that ome from others.

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Wernicke's Area

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The brain hearing center; Activity decreased in thhis area during hallucinations

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Transcranial stimultion

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An electromagnetic coil shaped like a figure 8 is held to the patients head. the coil produces a magnetic field the size of a quarter, which is then rapidly turned on and off, inducing an electrical field in the cerebral cortex 's grey matter(380)

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Disordered Speech

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Loosening of associations, in which the speaker's ideas shift from one topic to another in a way that seems unrelated to the listener. When the loosening is severe the person's speech becomes incomprehensible. Not all people with Schizo. display peculiar speech. It is found as frequently in other patients as much as those with Schizo.

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Perseverative Speech

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Repetition of words or phrases, often by inserting them in subsequent statements.

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Disorgainized Behavior

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Unpredictable. May be due to hallucinations, experiences that the observer does not share. Sudden, unpredictable, outburts of anger may also occur.

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Negative Symptoms

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Behavior deficits, and include such behaviors as flattened affect, poverty of speech and of speech content, and lack of directedness. - more common in schizo than in other diagnositc groups.

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Schizophrenic Spectrum Disorders

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Include conditions that share some characteristics with schizo. but do not fully meet the diagnostic criteria for Schizo. - they include sum personality disorders.

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Schizotypal Personality Disorder

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Closest genetically related to Schizo. Odd Speech patterns, social dysfunction and aloofness, odd communication, and suspiciousness all suggest milder forms of schizo. Also includes eccentricity, constricted affect or emotion, and excessive social anxiety.

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Paranoid personality disorder and schizoid personality disorder

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Occur more frequently in the families of ppl who have been diagnosed with Schizo.

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Schizo-affective disorder

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a category including individuals who show significant depression or manic sympt. along w/ the development of thought disorder and other types of psychotic disorders

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Genteics

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Schizo. is correlated with the closeness of the genetic relationship or genetic overlap with the index case- term used in the study of genetics to indicate the individual with a disorder whose heredity is under study.
The more genes that 2 people have in common the higher the risk

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Genetic Overlap

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percentage of genes that the relative has in common with the index case- ranges from 100% for identical twins to 12.5% fir great grandchildren, 1st cousins and great-nieces and great nephews.

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__ % of ppl who are diagnosed with Schizo. have no known realitive w/ that disorder

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89%

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Monogenic Model

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One gene pair is all that is needed to determine a particular characteristic. This is called the Mendelian pattern of heredity.

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Dominant Gene

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Member of the gene pair that determines wheather the individual will show the trait controlled by that gene. Other member of the gene pair may be the same (dominant) or different (recessive)

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Recessive Gene

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Member of a gene pair that determines the characteristic trait or appearance of the individual only if the other member of the pair matches it.

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Expressed Trait

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A trait that dominates in the individual and is determined by either at least 1 dominant gene or a pair of recessive genes. If only 1 recessive gene is present, the individual has the potential to pass a genetic characteristic, but that characteristic is not observable in the person him-or herself

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Polygenic model

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Assumes that several gene pairs found at specific locations on particular chromosomes must interact to produce a trait or a disorder.

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Multifactorial Polygenic models

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Theory that a # of genes from a variety of Loci(locations) may combine to produce a particular characteristic or disorder.

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In stuides have shown to have higher risks of Schizo. when Born in

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Jan-March and in urban not rural areas.1 possible cause is the seasonal effect, might be the increased prevalience of influenza and other viral diseases during winter and spring.

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Mednick; the flu epidemic

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The risk of the first n thrid trimesters of the pregnancy was the same for those involved in the flu epidemic and the control group. Those born 4-6 months after the epidemic and exposed to the flu in the 2nd trimester had risk of a diagnosis ofschizo. and was mich higher than the control group.

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What occurs in the 2nd trimester of pregnancy may be implicated in ______ of Schizo.

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vulnerability

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In 1939 the Russian Army invaded Finland and a little over 3 months later 25,000 Finland soilders had been killed (Huttunen & Niskanen)

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Significantly more cases of Schizo. among the children of widowed women, and all of these cases occured in the children who had been in the 2nd trimester when recieved the news.

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Birth complications

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suggest possible damage to the brain or nervous system.

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Distributions of neurons in patients with Schizo.

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More cells were in the deeper layers of the cortex and fewer toward the surface. - suggests neurons failed to migrate as far as they should have.

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Synaptic Pruning

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A developmental process in which neurons selectivley reduce the # of branches of thier dendrites. Starts in late childhood. Sci. believe Process is essential in handleing the explosive growth of info. to which children are exposed, esp during adolecent years. Readies brain for the morecomplex mental activities demanded of adults.

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If Synaptic Pruning occurs abnormally

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It can result in either too many or too few synapeses, and consequent probs in cognitive function, an important difficulty in Schizo.

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Neurodevelopmental Model of Schizo.

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The brain of individuals who develop Schizo. may either experience overaggressive pruning or, because of developmental probs during the 2nd trimester of pregnancy, their brains may have fewer dendrite branches to begin with.

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Physical Anomalies

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Prenatal developmental abnormalities are often reflected in minor physical abnormalities, that can be detected after birth. These include minor abnormalities of the head, feet, hands or face. Many infants have a single anomaly, but those who are later diagnosed as Schizo.'s may have several.

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Children who may later develop Schizo show...

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Unusual expressions of emotion and motor behaviors- the development of the neuromotor system also seems to be affected.

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Cerebral Vetricals

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Cavities that contain cerebrospinal fluid. In general people's ventricals become larger with age.

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Cerebral Ventricals and Schizo.

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Some individuals have significatly larger ones than those found in the brains of ppl w/o the diagnosis. However,some enlargement occurs naturally.Enlarged ventricales are also found in things such as alcoholism, tramatic head injuries, and severe mood disorders involving psychosis.- Occus in about 1/3 of ppl with Schizo. whose brains have been studied.

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Linked to vulnerability for Schizo.

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Shallower corticalfolds or creases, which means there is less cortical area.

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Dopamine Hypothesis

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States that excess dopamine at certain synapeses in the brain is associated with Schizo.

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Antipsychotic Drugs

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Their effectness depends on their ability to block dopamine receptors. (chlorpromazine was the first of these medications)

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Recent Research has demonstrated 2 things

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1) There are actually 5 types of dopamine receptors, whiuch differ in cerebral distrabution
2) Biochemical processes (and substances) other than those involving dopamine may also play an important role in Schizo and treatment - such as serotonin, glutamate (most widley distributed transmitter in the brain)

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Common first step in studying genetics of any disorder

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Is to determine wheather relatives of an affected person are more likley to have the same disorder than are members of the general population.

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Way to begin a family study

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Construct a diagram of the family going back several generations. Next, all ppl in tree who showed symp. of the disorder being studied are identified- helps to see any particular pattern over generations. The pattern can then be matched with predictions based on theoretical models

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Spectrum Concept

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if several disorders all typically occur in the same family, this suggests that those disorders may be genetically similar and may represent a spectrum of disorders that are closely associated.

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Assortative mating

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Refers to the tendency to choose a mate who is genetically similar more frequently than would be expeted by chance. Occurs with physical traits, psychological traits, and behavior disorders, and is sometiems seen in patients with Schizo. B/c of this, spouses of ppl who have Schizo are more likely than members of the general pop. to have genes associated with that same diagnosis. - Children of these marriages may get "double doses" fo genes associated with Schizo.

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% lifetime risk of developing Schizo. for children with only 1 parent affected

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17%

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Twin Studies

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Provide a way to focus on the enviornmental factors that contribute to Schizo. while controlling for heredity factors.

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Dizygotic Twins

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Produced from 2 fertilized eggs. As a result have the same genetic relationship as any pair of siblings.

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Monzygotic Twins

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Produced from same fertilized egg, and as a resukt can be expected to begin life with identical genetic makeup.Much greater chance of being concordantfor Schizo than DZ twins have. Concordance rate for Schizo in MZ twins is less than 50%

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Discordant

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Term often used in twin studies to describe particular characteristics on which the twins differ. Characteristics that are the same for both are refered to as concordant.

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6 year study of MZ twins who were discordant for Schizo carried out by National Institute of Mental Health

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1/4 of the twin pairs discordant for schizo. were already seen as different by age 5. The remaineder didnt show differences till age 13 or later. Most likely age for a diff. to emerge was around 14 -16 a time when symp. of Schizo are likely to 1st appear.

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Adoption Studies

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Clearer understanding of roles of enviornment and heredity may play in Schizo. Compares adopted kids whos biological parents were diagnosed as having Schizo w/ adopted kids whose parents did not have the disorder. The 2nd examines incidence of Schizo. in the biological and adoptive families of adopted kid who later develop the disorder. (394) *

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Seymour Kety and the Dutch

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Found that adoptees who developed schizo. were 2ce as likley to have bio. relatives who were diagnosed woth Schizo. as to have adopted relatives thus diagnosed.

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Seymour Kety and Half bros and sisters

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Also found half siblings share 25% of their genes, rather than 50% as full siblings do.More important 1/2 siblings w/ a common father do not share the enviorn. or uterus be4 birth, nor do they share the same early mothering experience. Both a paternal 1/2 bro and sis were found to have greater risk for Schizo. and Schizo. spectrum disorders than control group. have increased weight to importance of genetic factorsin Schizo. as compared to prenatal factors.

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Vunerability

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Each person has a level to schizo. determined both by genetic inheritance and by prenatal and postnatal factors. This level interacts with stressful events or conditions in a persons life.If combo exceeds a certain critical level or wellness/illness threshold, schizo behavior will occur.

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If one identical twin has Schizo. than the others chances of getting it are...

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slightly less than 50% likely

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Markers

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Biological or behavioral characteristics that may make it possible to identify ppl who are vulnerable to certain disorders. The knowledge of markers (such as prenatal, biochemical, genetic, and cognitive deficits observed early in life) could be important in primary prevention.

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Primary Prevention

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An intervention that may help keep the disorder from developing.

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High risk studies

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Although these types of studies have sum disadvantages, they have a great advantage over other types of studies b/c they are prospective- that is they select and begin to study be4 sympt. appear. Also encourage study of gene-enviornment interactions.

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Danish High Risk Studies

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Most predective characteristic= impaired attention. Social dysfunc. and behavioral deviance reported by teachers were also reliable predictors of schizo. Other charact. that increased risk of developing Schiz= mother's influenza during 2nd trimester, birth complications, and childs early seperation from mother- suggests they add to the risk only in those who already have a genetic vulnerability

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New York High Risk Project

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studied 2 groups of children selected so that researchers could investigate whether parental mood disorder and schizo. had similar or different effects on the kids involved. An imortant longitdinal finding was that children of a parent with a mood disorder didnt share the sympt. of the kids who had a parent with schizo.

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Cognitive deficits

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Shown to be present in individuals who later devlop schizo.

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New York High Risk Project measures

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Used the Digit Span Subtest from the Wechsler Intelligence Scale for Children, the Continious Performence Test (CPT)

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Digit Span Subtest from the Wechsler Intelligence Scale for Children

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this subtest requires children to repeat a series of #'s either forward or backward. The longer the series the child can repeat correctly, the higher the score. Low scores on this test were associated with later development of Schizo.

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Continious Performence Test (CPT)

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Measures the sustained visual attention for periods up to 20 min. The person tested is instructed to respond to one particular type of stimulus by pressing a key, and is then exposed to a series of different stimuli.2 kinds of errors are recorded

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2 Errors recorded in the CPT

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if person being tested fails to press the button after the correct series in the middle position = error of omission
2) if they press the response button after a different sequence of #'s in the middle position, or after the correct sequence of #'s appears in the L or R position rather than the middle= error of commision (397)

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Results of the CPT with the NY High Risk Project

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Children of Mothers who had a diagnosis of Schizo.scored more poorly on the CPT than either children of mothers who were seriously depressed or children in the control group w/ no disorder.- suggests that the attention difficulties the CPT measures are trait linked charac. that are not a funct. of a current psychotic process. - showed CPT scores can be markers to determine which kids are most at risk for Schizo.

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Smooth-pursuit eye movements

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Eye movements that are not believed to be under voluntary control. A way to measure vulnerability to Schizo. Tests of patients diagnosed with Schizo showed about 85% of them exhibited abnormal patterns of this. (the third measure that can be used other than digit span and CPT)

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What theraputic approaches seem to be most promising for Schizo.

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Biological, behavioral, cognitive and family centered approaches.- They don't cure, but they do decrease symptoms, particularly + sympt., allowing them to funct. more effectivley. Relapse and a worsening of sympt. may occur periodically even if treatment is not interrupted.

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Prodromal Period

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A Greek word that means running ahead.Typical in cases of 1st-episode schizo, treatment begins a year or more afterthe 1st clearly psychotic sympt. and prodromal Period is wat it is sometimes called.

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Hospitalization has several advatages (3)

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1) Opportunity to observe how the patient funct.
2)ready opportunities for avoiding or dealing w/ emergencies
3)Provision of security and support for an individual who might be very upset.

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Israeli Draft Board Registry

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Found they could accuratly identify 88% of those who later develop Schizo. by subtle differences in intellectual and social funct. on screening tests. Tests dealt w/ personal relationships, ability to orgainize life activities, and evidence of maturity by asking ?'s like How many friends do you have.

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Antipsychotic Medications/Drugs

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Mainstay of treatment for Schizo. and reflect the importance of bio. perspective in understanding and treating the disorder- very helpful in prevnting relapse and improving social funct.

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1st effective anti. drugs

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Introduced more than 40 years ago. (such as Chlorpromozine)- they surpressed delusions and hallucinations and reduced bizarre distructive behaviors. - reduced # of schizo patients in hospitals.

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2 Disadvantages of blocking dopamine receptors

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1) the neg effect of the drugs on individuals motivation, and numbing of their sensory input. - people who used the old or conventional meds often became drowsy, constipated, and mouths would get dry, and vision was blurred. may even get dizzy
2) Tardive dyskenesia

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Tardive dyskensia

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Involuntary movements of mouth, lips, tounge, legs or body- about 1/3 of patients treated over long periods with this develop at least a mild form of it.

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New antipsychotic drugs develped because of - effects

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First was Clozaril or Chozapine- lessened some of the probs of the traditional antipsychotic drugs b/c more selective in types of receptors it affected.- up 2 10% of those given it had a potentially fatal effect on production of white blood cells, only safe to use if blood samples are monitored regularly.

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When should antipsych. drug treatment occur

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As soon as diagnosis is made b/c each psychotic episode may heighten.

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A major problem in carrying out treatment of Meds

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Is the patient competent enough to agree or refuse meds.

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Various psychotherapies that are useful

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Problem solving, reality testing, psychedu, and supportive and cog. behavioral techniques anchored on empathetic theraputic alliance w/ patient

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Goals of psychosocial interventions

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to improve adherance to perscribed meds, enhance social and occupational funct., and prevent relapse

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Aim of cog.behavioral approaches

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To diminish the psychological distress associated with psychotic sympt. by increasing coping stratagies, decreasing tension, and increasing self esteem - want to decrease chronic auditory hallucinations to make less upsetting. Focus on hallucinations that they are misattributed by him/her to an external source.

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Patients with Schizo have skill deficits in what areas

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cog. skills, social interations,; self care and symptom identification skills related to independent living; and coping with stress in general

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Three general catagories of social skills training

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Basic skills, social prob solving, and cognitive effectivness- a broad approach to social skills includes management of meds, management of sympt., basic convo, and self care skills

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Cognitive Skills, general characterisitics of those at risk

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Impairments in attention, memory and planning

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Skill training with stress

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Focus on each person's charactoristic response to stress rather than to any specific category of stress in general

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Family Programs

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When combined with meds, these programs have been demonstrated to reduce relapse rates (405)

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Family interventions usually include: (4)

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1) Edu about what Schizo is
2) Info on how its treated
3)identification of probable cause
4)Instruction in prob-solving and crisis management

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A major goal of Family programs

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To decrese the guilt feelings of family members who think that there behavior in some way caused the illness

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Expressed Emotion

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is a measure of the attitude expressed by family members when talking about the person whose behavior is disturbed- Warmth and + remarks have + effects on patients, neg comments have - effects

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Negative expressed emotion

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includes criticism, hostility, abd emotional overinvolvement

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Residential Facilities

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Halfway houses or group homes; provide a sheltered setting that reduces the residents' need to cope with many of the social and financial stressor they would face if they were trying to funct. alone in a community.- also offer a theraputic homelike enviornment that provided support and protection for residents, along with sum structure on day-tod-day living.

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revolving door syndrome

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The affected person shuttles back and forth between living in the community and hospitalization and experiences little coordination in treatment from diff. agencies and other service providers

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Schizoaffective Disorder

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Seperate category from either schizo. or affective disorders for the individuals who show depressive or manic sympt. as well as those of thought disorder- dellusions or hallucinations must occur even wen deperssed of manic mood are not present- mood chatacter. must be present during both the acute or active periods and in periods when they have subsided.

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Estimated lifetime prevalience of schizoaff.

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Between .5% and .8%

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Schizoaff. typically beings in

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late adolecence or early adulthood, in schizoaff, the outcome is more favorable than ppl withh schizo.

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Bio. treatments of Schizoaff.

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Antipsychotic meds and lithium- most often used if there are clear manic sympt

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Delusional disorder

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Cause is unknown, 1 to 3 new cases per 100,000 persons; the presence of a persistant but not bizarre delusion that is not due to any other mental disorder such as schizo.. Apart frim the delusion, the persons behavior is not obviously unusual.Relativley Rare

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What is effective for ppl with Delusional Disorder

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A tricyclic antidepressant, clomipramine, effective in some cases, esp those of the somatic type.
Psychosocial treatments in. cog therapy, and general supportive therapy to enhance the fragile self-esteem common of these individuals

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Delusional Disorder commonly affects

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Older adults- may be related to stress created by increasing sensory impairment and feelings of social isolation.

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Shared psychotic Disorder

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Sometimes referred to as folie á deux- delusions seem to be transferred from 1 person to another- typically both ppl affected by this almost always from same family, live together in relative isolation. 1 seems to play a dominate role and the other (often lower intell, more passive & gullible) takes on beliefs of 1st.