Dsm/adult Psych--Some Basics

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schizophrenia: DSM criteria (briefly):

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1. 2+ of char sxs: delusions, A/VH, disorg. speech, grossly disorg. or catatonic bx, negative sxs
2. social/occup. dysfx: in work, interpersonal relationships, self-care
3. duration = continuous disturbance for 6+ mos., w/ 1+mo. of sxs (or less if being treated)
4. r/o schizoaffective, mood d/o, substance-induced, or general medical condition-induced
5. if rel. to a PDD, sz is only dx if prominent delusions or A/VH also present for 1+mo.

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diff dx. sz vs. brief psychotic disorder

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sx have been present less than 1 mo. in brief psychotic disorder

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diff dx. sz vs. schizophreniform d/o

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schizophreniform d/o same as sz but duration less than 6 mos.

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schizophrenia: biological view

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genetics: prevalence in gen. pop. is 1%; ident. twin 48%; offspring of two parents with sz 46%; fraternal twin 17%; sibling 9 %; half-sib 6 %; first cousin 6%; s
-evidence also found in adoption studies
-poss. defects on several chromosomes

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schizophrenia: biological view (cont.)

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Dopamine hypothesis: excessive dopamine; neuroleptics block dopamine receptors; amphetamines can block reuptake, and indivs. on amph. can display sxs of sz.
-brain irregs: smaller frontal and temporal lobes (partic. amygdala, hippocamp., parahippocampal gyrus); irreg. in limbic system and basal ganglia; enlarged ventricles esp. in type II; smaller amts. cortical gray matter; abnormal blood flow esp. in frontal lobes

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schizophrenia: viral problems in utero

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higher incidence of sz in indivs who were born in winter; also more frequent exposure to pestiviruses (found in 40% of indivs w/ sz); viral exposure might help explain why fraternal twin more likely to dev. than a sibling)

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Name good prognostic factors for schizophrenia

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availability of social support; good premorbid adjustment; acute onset; late onset; female; precipitating events; co-occurring mood disturbance; good interepisode fx; minimal residual sxs; normal neurological fx; family hx of mood d/o; no family hx of sz

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Following Crow’s schema (1980), name symptoms, NP profile and px in Type 1 Schizophrenia:

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-Type I: positive sxs dominant
-essentially normal brain structure
-most are fairly intact neurocognitively (but refer to cards on NP fxs in sz later)
-rel. good response to treatment

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Following Crow’s schema (1980), name symptoms, NP profile and px in Type II Schizophrenia:

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-Type II: neg. sxs dominant
-structural brain abnormalities
-impaired cog. fxs
-poor treatment response

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in terms of therapy, individual tx for schizophrenia less effective than:

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reality-adaptive support or family counseling

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most effective tx for sz:

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family therapy and medication

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which is considered more significant prognostically in schizophrenia: loosening of associations or circumstantiality?

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loosening of associations is considered worse than circumstantiality in schizophrenia

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NP fxs in schizophrenia:

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frontal lobe dysfx:
-impaired attention—diffs. w/ filtering, dist. relevant from irrel. info, selective attn. under increased info. load, sustained & focused attn.
-diff. w/ abstraction
-problem solving deficits on WCST, CST
-poor planning on clock drawing, 2ary to verbally mediated planning
-on FAS/COWA/Letter-Word Frequency, produce more phonemic responses than category words.

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NP fxs in schizophrenia (cont.):

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memory dysfx:
-impaired CVLT-II, WMS-III, BVRT
-CVLT research shows impairment in learning, recall, recognition measures, but equal-to-normal retention of info. over the delay (i.e., that which is encoded is stored at normal levels)
response time: slower rx time to both A/V stimuli on RT

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name different types of personality change due to GMC

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labile type, disinhibited type, aggressive type, apathetic type, paranoid type, unspecified/combined type

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name medical causes of catatonic d/o:

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TBI, cerebrovascular disease, encephalitis, metabolic conditions

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hallucinogen persisting perception disorder:

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occurs when not using hallucinogens, but experience hallucinogen flashbacks

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name several origins of organically-based mood sxs:

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substance induced mood sxs (e.g. PCP, hallucinogens); endocrine d/o (hypothyroidism); carcinoma of pancreas; viral illnesses; structural disease of brain

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DSM criteria of manic episode (briefly)

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1. elevated, expansive, or irritable mood lasting 1+wks.
2. 3+ of following, or 4 if mood is only irritable: inflated self-esteem or grandiosity; decr. need for sleep; more talkative, or pressured speech; flight of ideas or racing thoughts; distractibility; incr. in goal-directed activity; excessive involvement in pleasurable activities that have high potential for painful consequences
3. signif. stress or impairment
4. meet r/o preconditions: not due to other psych., med., subst-induced d/o

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Bipolar I vs. BP II vs. Cyclothymia vs. Dysthymia (briefly)

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BP I: presence of 2+ manic episodes, or 1 manic episode and 1 depressed or mixed episode
BP II: hypomania rather than mania as in BP I
Cyclothymia: 2+yrs mood cycles, but less severe episodes, shorter mood swings; don’t meet criteria for mania/depr.
Dysthymia: depression for 2+ years (milder than major depression in severity)

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duration required for dx of mania; hypomania:

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1 week+ (mania); 4+days (hypomania)

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what percent of individuals with bipolar illness complete suicides?

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10-15 %

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etiology of bipolar illness: biological model

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1. structural brain abnormalities (ventricular enlargement)
2. genetic factors
-poss. irreg. on chromosomes 11 and X
-1% incidence in gen. pop.
-40% chance in MZ twin
-5-10% chance in close rel.
3. Neurotransmitters: high NE, poss. low serotonin
4. Improper transport. of NA+, K+ ions b/w outside and inside of neurons’ membranes

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Bipolar Illness: NP fxs

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1. Gen. intell. fx. largely preserved
2. When present, impairments gen. limited to acute episodes, affecting performance scores
3. Abnormalities in attn. seen in symptomatic pts and persist in remission in measures of sust. attn. and inhibition
4.Verbal mem. can be impaired even in euthymic pts, while vis. memory deficits vary dep. on the tasks used.
5. Exec fxs (e.g. plan, abstract, shift set, form concepts) impaired in symptomatic pts but may be normal in recovered pts.

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acute stress d/o vs. PTSD

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acute stress d/o up to 4 weeks past event, then viewed through lens of PTSD

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treatments for PTSD include:

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crisis intervention (when applied immed., shown to prevent dev. of delayed or chronic sx and reduce distress); CBT; bx interventions (systematic desensitization); brief psychdyn tx; hypnosis and relaxation tx (reduce motor tension and ANS arousal); antidepr. (imipramine) to help with nightmares and flashbacks; short-term tx preferred; px better if onset is sooner after trauma

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etiology of panic disorders:

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development of PA and high levels of sodium lactate; genetics

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tx for panic disorders:

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meds: (antidepr.—imipramine, MAOIs, Alprazolan); train not to hyperventilate

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theories re-- etiology of phobias: psychodynamic:

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psychodynamic: unacceptable sexual/aggressive impulses toward person/object—unconsciously associated with feared objects; Freud—phobia erected as a “frontier fortification” against anxiety

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theories re-- etiology of phobias: behavioral

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phobia is a learned bx, developed through classical conditioning

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theories re-- etiology of phobias: biological (this is associate with which psychologist?)

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Seligman: certain stimuli are “biologically prepared stimuli”—it is adaptive to fear them

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phobia tx; social phobia tx:

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antidepressants (imipramine);
for social phobia—MAOIs and beta blockers;
flooding; meds and BT most effective for relapse

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OCD: DSM criteria (briefly)

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1. either obs. or compulsions
2. Insight at some point (if not, then subtype “poor insight”)
3. marked distress, time consuming (>1 hr/day), or signif. impairs fxing
4. If other Axis I d/o present, O-C sx not restricted to it
5. Not due to substance use or GMC

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OCD: biological model

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1. structural abnormalities include following regions: frontal/prefrontal regions (esp. orbital frontal cortex); basal ganglia (esp. caudate nucleus); limbic system; cingulate gyrus
-less agreement re: impairment being lateralized, e.g. in frontal lobes; pathophysiological connections; impact of developmental phases and concomitant cognitive and affective conditions
2. neurochemical: poss. down-regulation in both numbers of serotonin receptors and release of serotonin

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OCD: NP fxs

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in addition to being overly deliberate in timed tasks (e.g. Coding), some research suggests that slowed speed of processing info may be seen

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recent research suggests what about demographics of OCD?

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greater prevalence among higher SES and IQ

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OCD onset tends to be earlier in which sex? Gender ratio in adulthood?

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OCD onset earlier in boys, so more boys with OCD than girls. Adult ratio 1:1. F onset peaks in 20s.

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theories re-- etiology of OCD: Freudian

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ego and superego dev. outstripped libido dev. in those disposed toward obsessional neurosis (reaction formation and displacement)

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theories re-- etiology of OCD: CBT’s two factor theory:

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person 1st acquired anxiety response to previous neutral stimulus as result of classical conditioning; then engages in compulsive rituals to avoid stimulus; O associated with S

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OCD responds best to which medications?

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SSRIs, e.g. Fluoxetine, and the tricyclic clomipramine

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conversion d/o: dx criteria (briefly)

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1. 1+ sx affecting motor/sens. fxs
2. psych factors suggested b/c sx initiated/exacerbated by stressors
3. sxs not explicable by GMC, substance, culture-based syndrome
4. not limited to pain or sexual dysfx
5. r/o Somatization d/o

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conversion d/o: 1ary vs. 2ary gain

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1ary gain: sx serve to reduce anxiety and keep internal conflict out of conscious awareness; 2ary gain: sx help one avoid noxious activity or obtain otherwise unavailable support from env.

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somatization d/o: sx criteria

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minimum reqs: 4 pain sxs, 2 GI sxs, 1 sexual sx, & 1 pseudoneurological sx; many complaints occur before 30 y.o. over several years; treatment seeking, fx impairments

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somatization d/o: misc. info

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vague complaints, onset before 30 (usu. in teens), chronic course, often referred to as Briquet’s syndrome

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somatization d/o: common mood features

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often see anxiety, depression, and suicide attempts (rare success)

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Hypochondriasis is associated with what mood features and behaviors?

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depression, anxiety and O.C. sx, associated with “doctor shopping”

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Factitious Disorder

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-need to assume sick role
-with psych vs. physical sx (latter may be Munchausen Syndrome if induce sx)
-Factitious Disorder by Proxy—Munchausen Syndrome by Proxy; mother/caretaker with this overemphasizes role as caretaker, denies own needs, risk for child abuse, may be actual illness, family config. may include uninvolved husband and passive/dependent kids

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personality d/o’s: typical features in development if severe PD:

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hx. of dev. probs. in childhood—e.g. poor ability to cope; poor ego fx; low IQ; disorganized families

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genetic components are found particularly in which PDs?

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-antisocial PD (5-10x more prevalent in 1st degr. relatives)
-schizoid
-schizotypal
-paranoid
-possibly borderline

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which factor is most predictive of PD?

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-poor adaptive childhood bx; more predictive than ed., SES, or alcoholism

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best tx for paranoid PD:

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supportive tx, with CBT to lessen anxiety, oversensitivity to criticism, and to strengthen interpersonal skills

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Kernberg on Narcissistic PD:

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chronically envious, protean sense of self, thwarted as child (unsympathetic/unresponsive 1ary caregiver), libido turned inward; grandiose; compensatory self-importance and anger

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Kohut on Narcissistic PD:

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-arrested development rather than defense; age-appropriate infantile grandiosity not neutralized by mother’s presenting reality

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success rate for Borderline PD suicide attempts:

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8-10%

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Borderline PD: ego psych./ obj. relations theorists:

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-mother withdraws “libidinal availability”; child lacks resources for separation/individuation, resulting in lack of differentiation b/w self and object-world
-mother does not help child metabolize primitive emotions, learn to modulate
-defense mechs: splitting, idealization, projective identification

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Borderline PD: cognitive theorists

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can’t acknowledge wants and discriminate b/w wants & needs; catastrophizing, all/nothing thinking

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Borderline PD: tx

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DBT: includes CBT, social skills training, social skills exercises, work on group dynamics
CBT: focuses on reducing self-destr. bx, improving problem solving skills, dev. more accurate schemas of self/others/world
meds: neuroleptics, lithium, antidepr., anxiolytics

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Antisocial PD: etiology

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genetic link, more common in those with XYY, gen. lower levels of arousal/anxiety to noxious stimuli, reduced activity in certain prefrontal regions

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Antisocial PD: tx

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Behavioral: withdraw reinforcement and punish for improper bxs; model approp. bx; gradually fade external rewards/reinforces, increase internalized self-control and responsibility; help with anger, impulsivity

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2 types of Reactive Attachment Disorder

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Inhibited, disinhibited

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SIDS prevalence, age group

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1:500 births, occurs 1-3 mos.

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etiology of anorexia: bio theory

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-low serotonin; response to SSRI tx
-genetics
-endocrine, hypothalamus dysfx

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Bulimia medications

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imipramine, SSRIs

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Gasner’s syndrome

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-syndrome of approximate answers
-may be assoc. with halluc., amnesia, lack of insight
-classified under Dissociative d/o NOS

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Which are associated with REM sleep, and which with non-REM?
sleepwalking, nightmares, night terrors, paralysis

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REM: sleep paralysis, nightmares
non-REM: night terrors, sleepwalking

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Selye’s General Adaptation Model w/r/t stress:

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Stages include Alarm, Resistance, Exhaustion

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CT: Beck—types of cognitive distortions

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arbitrary inference, selective abstraction, overgeneralization, magnif./minim., personalization, dichotomous thinking

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depression vs. anxiety (Beck; CT)

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1. depression (cognitions—hopelessness, low s-e, failure); anxiety (anticipation of danger/harm)
2. depression (negative themes); anxiety (uncertainty of future events)
3. both display demoralization, self-absorption, reduced cog. capacity for prob. solving and task performance

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RET vs. CT

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-RET holds irrational thoughts lead to maladaptive bx; CT holds thoughts are dysfx when they interfere w/ normal cog. processing (can be rational); RET more bx focus; RET therapist more likely to challenge pt’s dysfyx beliefs; in CT pt. encouraged to test out these beliefs on his/her own

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CT: stimulus control -- narrowing

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narrowing : restricting target bx to a limited set of stimuli (e.g. overweight person—only eat when at kitchen table, at mealtimes)

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CT: stimulus control -- cue strengthening

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cue strengthening: linking a bx that’s targeted for increase to a specific cue or cue set (e.g., student who rarely studies encouraged to study in specified location, being in that loc. will trigger studying bx)

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CT: stimulus control -- competing responses

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competing responses: identifying and eliminating responses that block desirable bxs, or encouraging responses that block undesirable bxs (e.g. poor studier asked to i.d. interference to studying—talking—targeted for elimination)

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CT: stress inoculation training:

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1. cognitive preparation:(ed. on how his/her faulty cogs. prevent approp./adaptive coping)
2. skills acquisition (learning and rehearsing new skills, such as relaxation)
3. practice (application of learned skills to real/imagined situations)
-research shows stress inoc. training useful in remediating aggressive bx, impulsive anger

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CT: paradoxical intention

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instruct cts. to “do or wish for the very things they fear; used to circumvent anticipatory anxiety; helpful in insomnia

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operant conditioning: (Skinner)

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mnemonic aide: mnemonic: if a scenario uses the term “followed by”, you are likely dealing with o-c

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operant conditioning: what is used to increase a bx?

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reinforcement

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operant conditioning: what is used to decrease a bx?

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punishment

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operant conditioning: positive [reinf./punish.]

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apply s.t.

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operant conditioning: negative [reinf./punish.]

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remove s.t. --
remove s.t. obnoxious to reinforce; s.t. pleasant to punish

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operant conditioning: positive reinforcement

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= reward ; applying a pleasant stimulus to increase a bx

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operant conditioning: negative reinforcement

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= removing a neg. stimulus to incr. a bx, e.g. seatbelt stops buzzing if you buckle up

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operant conditioning: positive punishment

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= applying unpleasant stimulus to decr. a bx

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operant conditioning: negative punishment

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= withholding/removing a positive stimulus to decr. a bx, e.g. a speeding ticket diminishes speeding by taking your money; “time-outs” are also a negative punishment

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operant conditioning: what is a possible problem with punishment?

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punishment can increase aggression, lead to extinction bursts