• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/198

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

198 Cards in this Set

  • Front
  • Back
What is personality?
Unobservable influence on behavior
What are the two main theories regarding the stability of personality across the lifespan?
1. Stability: ex. Trait Theories (we are born with an inherited personality that remains stable)
2. Change: ex. Stage Theories (personality develops in stages)
What did Freud believe about the stability of personality?
Though personality development was mostly complete by age 6, did not think change was possible after 50
What does Erikson's Ego Development Theory propose regarding personality?
1. Epigenetic principle: each stage sets the ground plan for unfolding of later stages
2. Personality development continues throughout lifespan
What is ego psychology?
The view that the ego plays a central role in actively directing our behavior
What are the 3 basic tenets of Loevinger's Ego Development Theory?
1. Ego: Structure within personality that attempts to synthesize and interpret experiences
2. Involved in ability to regulate impulses, relate to others, achieve self-understanding, think about what is going on around us
3. Primary source of individual differences at all ages past infancy
What are the 6 stages in Loevinger's Ego Development Theory?
1. Conformist
2. Conscientious-conformist
3. Conscientious
4. Individualistic
5. Autonomous
6. Integrated
What are the 4 dimensions along which the 6 stages vary in Loevinger's Ego Development Theory?
1. Character development (CD) - reflects standards and goals
2. Interpersonal style (IS) - pattern of relating with others
3. Conscious preoccupations (CP) - most important things on mind
4. Cognitive style (CS) - characteristic way in which you think
What is the conformist stage in Loevinger's Ego Development Theory?
1. CD - conformity to rules accepted by group
2. IS - superficial need to belong
3. CP - concerned with appearance and social acceptance
4. CS - prone to stereotyping and cliches
What is the conscientious-conformist stage in Loevinger's Ego Development Theory?
1. CD - individual can separate personal from societal
2. IS - Person recognizes their impact on others
3. CP - concerned with personal adjustment and focus
4. CS - awareness of group standards

Includes:
a. Increase in self-awareness of an inner life
b. Ability to see alternatives and exceptions to rules
What is the conscientious stage in Loevinger's Ego Development Theory?
1. CD: person shows greater understanding of complexity
2. IS: mutual sharing
3. CP: developing internal standards
4. CS: thinks in polarities, beginning more complex thought

Includes:
a. Long-term personal goals and ideals, sense of responsibility, and internalization of rules
b. May choose to break law if it violates personal standards
c. Complex inner life and ability to understand emotions of self and others
What is the individualistic stage in Loevinger's Ego Development Theory?
1. CD: respect for individual
2. IS: increased tolerance
3. CP: concern for social problems
4. CS: recognition of complexity; projects causes on the environment
What is the autonomous stage in Loevinger's Ego Development Theory?
Includes:
a. Ability to think about and cope with inner conflict
b. Sees reality as complex and multidimensional
c. Recognizes others' need for autonomy but cherishes personal ties
d. Holds to broad, abstract, social ideas and ambiguity
What is the integrated stage in Loevinger's Ego Development Theory?
Includes:
a. Strong sense of identity and ability to achieve complete expression of true, inner self
What stage in Loevinger's Ego Development Theory do most adults fall into?
Conscientious-Conformist Level
What is Vaillant's Ego Development Theory?
1. Ego defense mechanisms become increasing adaptive, helping us to cope with life's challenges as we move through our adult years. When we are younger, we tend to use less mature, and more maladaptive defenses such as acting out or denial.
What are the 4 categories of defences identified by Vaillant?
1. Psychotic
2. Immature
3. Neurotic
4. Mature
What are the 3 psychotic defense mechanisms?
1. Delusional projection - attribution one's own bizarre ideas and feelings to others
2. Denial - disclaiming the existence of a feeling, action or event
3. Distortion - significantly exaggerating and altering the reality of feelings or events
What are the 3 immature defense mechanisms?
1. Projection - attributing unacceptable feelings and ideas to others
2. Hypochondriasis - expressing psychological conflict as exaggerated physical complaints
3. Regression - engaging in destructive behavior that expresses inner conflicts
What are the 3 neurotic defense mechanisms?
1. Displacement - transferring unacceptable feelings from the true to a safer object
2. Repression - forgetting about a troubling feeling or event
3. Reaction formation - expressing the opposite of one's true feelings
What are the 3 mature defense mechanisms?
1. Altruism - turning unacceptable feelings into behavior that is helpful to others
2. Sublimation - expressing unacceptable feelings in productive activity
3. Humor - being able to laugh at and unpleasant or disturbing feeling or situation
How do older adults manage emotions using defense mechanisms compared to younger adults?
1. Use of mature defense mechanisms to control negative emotions or trying to put situation in perspective
2. Less tendency to react in self-destructive or emotional ways
3. More likely to understand a situation or figure out a way around it
4. When stressed, suppress feelings or channel them into productive activity
What are gender differences in defense mechanisms and coping strategies?
1. Women:
a. Avoid unpleasant situations
b. Blame self
c. Show empathy and tolerance of emotional ambiguity

2. Men
a. More likely to externalize feelings
What are 3 critiques of stage theories?
1. Fail to deal with individual differences
2. Heuristics - may exceptions
3. Empirical validation difficult and contradictory
How does attachment anxiety vary with age?
1. Few anxiously attached adults in older age groups
2. Tendency for older individuals to lower their emotional attachments to other people
What is a trait?
A stable, enduring attribute that characterizes one element of an individual's personality. Based on the assumption that the organization of specific personal dispositions guides behavior.
Why might traits be genetic?
Constitutional basis for personality that endures through life and is at least partially inherited
What are the 5 major dimensions to personality in Costa and McCrae's Five Factor Model?
1. Openness to experience: receptiveness to new ideas, approaches, and experiences
2. Conscientiousness: organization, ambitiousness, self-discipline
3. Extraversion: preference for social interaction and lively activity
4. Agreeableness: selfless concern for others, trust, and generosity
5. Neuroticism: tendency to experience psychological distress, overreactiveness, and instability
What is the consistency of Five Factor Model traits over the lifespan?
1. Traits tend to be stable over time
2. Conscientiousness tend to increase with age
3. Neuroticism tends to decrease with age
4. Agreeableness tends to increase
What are 6 critiques of the Five Factor Model?
1. Circular
2. Methodological problems
3. Doesn't assess core aspects of human nature
4. Not predictive of behavior
5. Ignores sociocultural context
6. Assumes people can rate their own personality characteristics
What is socioemotional selectivity theory?
1. Throughout adulthood, we structure the nature and range of our relationships to maximize gains and minimize risks
2. We change gradually over the years of adulthood and into old age with regard to the functions that interactions with others serve for our sense of well-being - from informational to emotional
According to socioemotional selectivity theory, what is the difference between informational and emotional rewards?
1. Informational: learning practical things from other people that help us operate more effectively in the world
2. Emotional: emotional regulation with a few close relationships
What is the possible selves model?
Individual's view of the self, or self-schema, guides the choice and pursuit of future endeavors (older adults oriented toward possible selves that revolve around health)
What is coping?
How we attempt to manage stress by changing the environments or ourselves in order to enhance adaptation to our environments
What is Levinson's Life Structure theory of midlife crisis?
1. Adult personality development due to periods of stability and transitions
2. Midlife transition most critical (age 40-45) - focus on overcoming disillusionment with life and reevaluating priorities and aspirations
According to Levinson, what are the 3 themes of the midlife crisis?
1. Overcoming disillusionment
2. Making life structure decisions
3. Resolving polarities of personality
What are 3 critiques of the Levison study?
1. Heavy reliance on age
2. Problems in sample
3. Bias in ratings procedures
What did McCrae and Costa's study of Five Factor personality traits and midlife crisis find?
1. Midlife crisis scores should predict peak in neuroticism, openness to experience, or extraversion at age 40-45, but this pattern does not occur
2. Midlife crisis are higher for men with consistently high neuroticism scores
What is a midlife "correction"?
Positive changes that occur in mid-adulthood
Although it is not empirically defensive, why does the idea of the midlife crisis still exist?
Makes a good story that is exciting to think about
How many Americans are married? How many have been married? How old are people when they get married?
1. 56% of US population currently married
2. 75% of all adults have been married
3. 96% of adults have been married by age 55
4. Asians have highest marriage rates, Blacks lowest
What is the effect of marriage on happiness and mortality risk?
Married adults 9-15% reduction in mortality risk as well as higher levels of happiness
Why does the gender distribution of marriage change over time?
More young women than men are married, but opposite in older adults because husbands die earlier
What is the cohabitation effect?
1. Asks how people who cohabitate before marriage are different than those who do not
2. Factors:
a. Less religious
b. Higher rates of previous divorce
c. High rates of parental divorce/conflict
What are 3 risks for divorce?
1. Immaturity:
a. Women who married before age 20 3x more likely to divorce than GP, and are 6x more likely to divorce than if they married after age 30
2. Lack of homogamy: similarity of goals and interests
3. Lack of equality:
a. Exchange theory: partners need to perceive a fair exchange across all dimensions of relationship
b. Problems often emerge around balancing work and family
What are 2 reasons for increasing divorce rates?
1. Liberalization of divorce laws
2. People have higher expectations of marriage
a. Paradoxically lowered the quality of marriage
b. May be uniquely western phenomenon (due to women's economic power)
What are gender differences in adjustment to divorce?
1. Men:
a. More likely to be surprised
b. More likely to be blamed for cause
c. More likely to be initially depressed
2. Women:
a. More likely to file
b. Greater difficulty forming new relationships (due to custody)
c. Greater risk for financial difficulties
Why are remarried people 2x more likely to divorce, even when satisfaction levels are equal to those in first marriages?
1. More critical of marriage
2. More likely to have had family problems in early years
How prevalent is widowhood in late adulthood?
1. Almost half (44%) of women over 65 widows
2. Only 14% men over 65 widows
What are 3 implications of theory for marriage in older adults?
1. Socioeconomic selectivity theory: older adults would prefer to spend time with partner rathe than new people to gain emotional rewards
2. Because older adults are better able to control their emotions, they get along better with their partner
3. If older adults can experience strong feelings, affection should not fade
How has the composition of families changed over time?
1. Decrease in couples living with own children
2. Increase in men living alone
3. Decline in number of households of married living with children
How has motherhood changed over time?
1. Average age higher - 27-29
2. Women with high income, college education, being in labour force, more likely to have first child after 30
What is the difference between over 30 mothers and under 30 mothers?
More likely to:
a. Breast feed
b. Be affectionate and sensitive to child's needs
c. Spend time with baby
d. Seek fertility treatment
e. Over 45 - higher multiple birth rates
f. High risks of complications

Less likely to:
a. Regard birth as mistimed
b. Smoke while pregnant
What happens to the risk for having a Down's baby with increased maternal age?
1. 1 in 33 risk when mother 45+
2. 1 in 50 risk when mother 40-44
What are variations in fathers' involvement with children?
1. Higher involvement is related to occupation and income
2. 20% of fathers provide primary care, especially when required by economic circumstances
3. Men over 30 spend more time with children than younger fathers
4. Fathers now spend less time with their children due to divorce and long work hours
When does stepfather involvement increase?
1. Have biological children of their own
2. Became stepfathers early in stepchildren's lives
3. Have good relationship with ex-wife or partner
4. Have good relationship with biological father
What are problems in single-parent households?
1. Many parents report frustration, guilt, ambivalence about children because they may serve as reminders of failed relationships and hinder new relationships
2. Financially, single mothers hardest hit
3. Emotionally, single fathers hardest hit (high rates of depression, problems with sleep, work, peers)
How do gay parents differ from straight parents?
1. Mostly, no differences in adjustment or sexual identity of children
2. Gay men more concerned about being nurturing
3. Lesbian mothers have greater parenting awareness
Why might there be a drop in marital satisfaction during parenting years?
1. Cross-sectional studies - unhappy couples divorced after children left home
3. Birth of child changes allocation of household tasks toward more traditional roles
a. Difficult when expectations were of equal sharing
b. Worse when couples have less time for joint activities
What are 3 modern work patterns (ex. unionization, industry, type of employment)?
1. 1/3 workers unionized
2. Increased emphasis on service vs. goods
3. Full-time replaced with part-time, temporary, self-employed
How has gender in the workplace changed over time?
1. Women now 71% of workforce (44% in 1971)
2. Men now 82% of workforce (85% in 1971)
3. Age 25-54 - 91% of men in labour force, 79% women
What are the work patterns of women with young children?
1. 70% of women with children under 12 are in workforce
2. 68% with children 3-5
3. 62% with children under age 3
What is the relationship between mothers who work and life satisfaction?
Women with children who work have higher rates of marital and life satisfaction than if they stay at home
How many licensed childcare spaces are there in Canada?
Only spaces for 12% of children under 12
What 2 factors predict high quality childcare?
1. Low staff-child ratios
2. Teacher qualifications
What factors are the most predictive of child success?
Family factors (maternal sensitivity, quality of home environment, income)
How does higher levels of education affect the gender difference in workforce involvement?
Gender difference disappears when workers have university degrees
What 3 factors influence a position on a hierarchy?
1. Required training
2. Prestige
3. Income
What are the three occupational levels?
1. Professional - "white collar"
2. Service - "pink collar"
3. Labourer - "blue collar"
Which occupational level is the fastest growing?
Professional - 2/3 women
Most in service industry
What are the 3 industries?
1. Service
2. Manufacturing
3. Financial
What are sex differences in industry employment?
Men:
1. Construction, manufacturing, transportation
2. 30% in service industry
3. More likely to be unemployed

Women:
1. 70% in service industry
2. Female doctors/dentists rose from 44% in 1987 to 54% in 2002
What factors influence the gender gap (Men $20/hr, Women $16.88/hr) in income?
1. Education - women earn 96% of men's salaries with university degree
2. Executive position - CEO glass ceiling
3. Service level occupations (higher in women)
4. Unionization (higher in men)
Why might women earn less than men for the same job?
Because women take time off for maternity leave and their salaries suffer from the break
Which countries have the highest labour force equality rankings?
Iceland, Norway, Sweden
Canada 9th, US 10th
How is income affected by education?
Income steadily rises with increase in education
What are the 6 categories of vocational satisfaction in Holland's RIASEC model?
1. Artistic
2. Social
3. Enterprising
4. Investigative
5. Realistic
6. Conventional
What 6 factors are related to vocational satisfaction?
Intrinsic:
1. Factors inherent in work itself
2. Engage sense of identity
3. Allow expression of autonomy
4. Intellectually challenging

Extrinsic:
5. Features that accompany job
6. Conditions of work
How do vocational satisfaction measures differ in older adults?
1. Older adults may focus more on extrinsic involvement (may be cohort effect)
2. Peak job level and salary reached by 40s-50s
3. Older workers retain commitment to company
4. Readjustments in identity occur in relation to career achievements
What are the 3 models of the relationship between work and family?
1. Spillover model: feelings from one domain affect feelings in the other (most empirical support)
2. Compensation model: high involvement in one domain leads to low involvement in the other
3. Segmentation model: people are able to compartmentalize their lives
What 4 factors affect the age-performance relationship?
1. Quality of performance measures
2. Greater education of younger cohorts
3. Variations within cohorts in health, cognition and previous experience
4. Selective withdrawal of less capable workers (it is the survivors who get old)

THEREFORE, NO CLEAR RELATIONSHIP
What is Warr's Model of Age and Job Performance?
Asks 2 questions:
1. Are basic capacities of job exceeded by age?
2. Is performance enhanced by experience?

To determine relationship of age and job performance
How do older workers respond to shift work, absentee rates, and injuries?
1. Shift work more difficult for older workers
2. Younger workers have higher voluntary absenteeism
3. Older workers have lower rates of injury, but injuries lead to longer time off work
What are the 5 stages of retirement?
1. Anticipatory period
2. Decision to retire
3. Retirement
4. Continual adjustment
5. Changes in activity patterns
What are the 3 types of retirement?
1. "Crisp" - formal retirement (10%)
2. "Blurred exit" - bridge employment (15%)
3. Never retire - 33%
What are the 3 criteria for the definition of retirement?
1. Collecting government benefits or pension
2. Considers self retired
3. Does not spend time at work
How has retirement changed in Canada since 1970?
1. Early (under 60) retirees have doubled - 25% of retirees 55-59, avg. age 61.7
2. Mandatory retirement age at 65
What are the 3 theories of the effect of retirement on the individual?
1. Role theory: roles provide a source of fulfillment, therefore the loss of work role is harmful to the individual
2. Continuity theory: retirees maintain positive sense of identity, retirement not a crisis
3. Life course perspective: normative timing of events helpful to adjustment, retirement is stressful only when unexpected

THEORY IS DEPENDENT ON INDIVIDUAL AND CIRCUMSTANCES
What is are the 4 components of retirement self-efficacy?
1. The belief that one will retire successfully
2. See self as active agent in adjustment and have time to adjust
3. Engagement in rewarding activities
4. High self-esteem and perception of self as competent
What are three ways retirement interacts with family?
1. Social support protects against role loss
2. Enjoyment of activities with spouse protects
3. Leaving high stress job reduces family conflict
What is the continuity perspective regarding relationships?
1. Well-adjusted couples may retire early to enjoy each other's company
2. Unhappy couples will be negatively affected by the presence of a spouse
What factors mitigate the effects of retirement?
1. High SES
a. Orderly career
b. More resources, but also greater work involvement (role theory)
2. Income
a. More resources
b. Better healthcare and amenities
What are 4 risk factors for unsuccessful retirement?
1. Retiring before age 62 (b/c less social contact leads to social isolation)
2. Retiring "off-time"
3. Loss of control over retirement decision
4. Amount of time for retiring (best min. 2 years)

1/3 OF RETIREES SUFFER STRESS AFTER RETIREMENT
Why is retirement NOT a cause of poor health?
1. Poor health is often the reason for retirement (therefore death happens shortly after)
2. Some individuals improve health after retirement
What are 3 findings of the Cornell Retirement and Well-Being Study of Women on gender differences in the retirement experience?
1. Women more likely to retire for family reasons
2. More likely to spend time in non-work activities
3. Adjustment affected by health of spouse and other family considerations

May be better adjustment because women tend to have more roles and stronger social support
How does the fear response demonstrate the reciprocal relationship between thinking and feeling?
In fear response, the amygdala becomes activated in response to fear, then the cortex processes the stimulus as a threat or not a threat and communicates back to the amygdala
What are the 3 components for the diagnostic process in the DSM-IV?
1. Match symptoms to those in manual
2. Must meet specific criteria
3. Develop treatment plan
What are the 5 axes in the DSM-IV?
1. Axis I - Clinical syndromes or disorders
2. Axis II - Personality disorders and mental retardation
3. Axis III - Medical conditions
4. Axis IV - Psychosocial stressors
5. Axis V - General evel of functioning
What are the 4 main categories of mood disorders?
1. Depressive disorders
2. Bipolar disorders
3. Mood disorders due to a general medical condition
4. Substance-induced mood disorders
What are the 4 main symptoms of depression?
1. Affective: depressed mood, feelings of worthlessness or guilt, recurrent thoughts of death/suicide
2. Behavioral: social withdrawal, agitation
3. Cognitive: difficulty concentrating and making decisions
4. Somatic: insomnia or hypersomnia, weight loss/gain
How long must symptoms be present to be diagnosed with a depressive disorder?
2 weeks
What are 5 ways in which depression is presented differently in older adults?
1. More likely to report traditional mood symptoms
2. More likely to seek treatment for bodily complaints
3. May seek treatment for disorders other than mood
4. Depletion syndrome - lack of energy, hopelessness, loss of appetite
5. Significant cognitive deficits
Why must a clinician consider dementia as a differential diagnosis before diagnosing depression in older adults?
1. Base rates for dementia are much higher than base rates for depression in the elderly (1-4% depression)
How prevalent are depressive symptoms in older adults?
1. 8-20% have depressive symptoms (may not be depression)
2. Rates increase in institutionalized population (17-35% - but may be institutionalized because of dementia)
3. Elderly suicide risk 2-3x higher, more lethal, less likely to report suicidal ideation
Is depression more difficult to treat in older adults?
Yes. Most studies support a combination of psychotherapy and pharmacology.
What are 3 potential causes of depression in the elderly?
1. Widowhood (40% increase in mortality)
2. Medical conditions
a. Women with B-12 deficiency
b. Hypothyroidism
c. Metabolic (UTI, uremia)
3. Medications that have depression as a potential side effect
What two conditions must first be ruled out before diagnosing an older adult with depression?
1. Dementia (12% over 65, 20-50% over 85)
2. Hypothyroidism (many of same symptoms and prevalent in 10-20% of over 60)
What are 4 ways dementia and depression be related?
1. Depression may be reaction to dementia
2. Late-life depression may be precursor for dementia
3. Pathological brain changes may be associated with both
4. Depression may really be apathy toward dementia
What did the Van Reekum study find about the link between late onset depression and dementia?
1. The risk of developing Alzheimer's Disease was 2:1 in the late-onset depression sample
2. Risk was higher in patients with cognitive impairments at admission
3. Recommended cognitive testing for all depressed elderly
What is the link between depression and stroke?
1. After ischemic stroke, 40% show symptoms of depression due to disruption in left prefrontosubcortical circuits
2. All stroke patients recommended to take antidepressants
What are 4 ways suicide presents in older adults?
1. Older adults account for 17% of all suicides, although only 11-12% of population
2. 90% have diagnosable psychiatric disorder
3. Most frequent diagnoses major depression, alcohol abuse or dependence, and schizophrenia
4. Older adults more likely to commit suicide if depressed
What are 7 risk factors for suicide in older adults?
1. Avoidant and schizoid personality disorders
2. Low openness to experience
3. Presence of physical disease
4. Living alone
5. Being male
6. Loss of spouse
7. Failing health
What are 7 symptoms of mania?
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. Pressured speech
4. Flight of ideas
5. Highly distractible
6. Increase in goal-directed activity
7. Excessive involvement in pleasurable activities that have a high potential for painful consequences
How does bipolar disorder present in older adults?
1. Rare - .1 of older adults
2. Related to vascular disorders when it first appears in later adulthood
3. White matter hyperintensities more likely to be present
What are 7 clinical features of bipolar disorder (ex. prevalence, age of onset, presentation)?
1. Age of onset: early 20s
2. 1-2% of population
3. Unipolar depression 5x more common
4. Equal between genders
5. 60-80% of cases begin with mania
6. 4-18% of those with depression later have mania
7. Alcohol and substance abuse
What are the 3 types of unipolar mood disorders?
1. Unipolar single episode: single major depressive episode
2. Unipolar recurrent: recurrent major depressive episodes
3. Dysthymia: chronically low mood
What are the 4 types of bipolar mood disorders?
1. Bipolar I - manic and depressive episodes
2. Bipolar II - hypomanic and depressive episodes (less severe than Bipolar I)
3. Cyclothymia: rapidly cycling mood
4. Unipolar-Hyperthymic: Depressive episodes and slightly elevated mood
What treatments are used for mood disorders?
1. Best: medication + psychotherapy
2. For mild depression, psychotherapy alone (because SSRIs difficult to wean off of)
How do antidepressants alter neurochemistry?
1. Enhance monoamine neurotransmission (SSRIs, SNRIs)
2. Disrupt cortisol regulation
What neurotransmitter is implicated in mania?
Increased dopamine neurotransmission
What are the 3 major symptoms of anxiety disorders?
1. Excessive anxiety
2. Tense, apprehensive and uneasy about future
3. Focusing inward on unpleasant feelings
What is the prevalence of anxiety disorders?
1. 12% of adults
2. 2x as many women as men
3. More common under age 65
What are the 7 types of anxiety disorders and their prevalence?
1. Generalized Anxiety Disorder: 5% of adults, 2% of adults 65+ (17-21% show symptoms)
2. Panic Disorder: 1.5-3%, 15% have had panic attack
3. Agoraphobia: 5%; more common in older adults
4. Specific phobia: Most common in older adults
5. Social phobia: 3% of adults (13% symptoms)
6. Obsessive-Compulsive Disorder: 2%; 0.8% of 65+
7. PTSD
What are 2 treatments for OCD?
1. Medication (beta-blockers) and psychotherapy
2. Sensitivity training
What are the 2 main treatments for anxiety disorders? How effective are they?
1. Medications (best for short term; medication alone increases chance of relapse)
2. Psychotherapy: may have greatest role in relapse prevention
What are the 3 criterion for schizophrenia?
Criterion A: Delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms
Criterion B: Significant impairment in daily life
Criterion C: Duration of symptoms greater than 6 months
What is the prevalence of schizophrenia?
1. 1% lifetime prevalence
2. Peak of 1.5% between 30-44 (prevalence, not incidence)
3. 0.2% for 65+
What is the age of onset for schizophrenia?
1. Majority under 40
2. Women 5 years later average onset than men
3. Late onset (over 60-65) is controversial
What are the 5 types of schizophrenia?
1. Catatonic: bizarre motor behavior
2. Paranoid: delusions of persecution
3. Undifferentiated: no consistent theme (harder to treat)
4. Disorganized: flat affect, disorganized speech and behavior
5. Residual: no longer meet criteria, but still show symptoms
What is the difference between positive and negative schizophrenia symptoms?
1. Positive: reality distortion (easier to treat)
2. Negative: cognitive deficits, blunted affect, amotivation (less responsive to medications; core feature of schizophrenia)
What are 5 common delusions?
1. Thought insertion, withdrawal, broadcast (First Rank Symptom)
2. Control - made will, made acts, made affect (FRS)
3. Somatic passivity - belief of insertion of something in body (FRS)
4. Delusional perception (FRS)
5. Persecution etc.
What are 3 common hallucinations?
1. Third person auditory (communicating, discussing); audible thought (most common FRS)
2. Second person auditory
3. Olfactory, visual, tactile
What is the current theory of the cause of schizophrenia?
1. A neurodevelopmental disorder
2. Long-term consequence of an early (most likely prenatal) abnormality in neural development
3. Lies silent until affected brain regions (most likely dorsolateral prefrontax cortex) are called upon to function in late adolescence/early adulthood
What is the genetic risk for schizophrenia?
1. Prevalence among siblings 8%, parents 12%
2. Concordance rates for MZ twins 45%, 14% DZ
3. 60-70% of liability genetic (polygenic model)
What is the vulnerability stress model of schizophrenia?
1. Neurodevelopmental factors (non-genetic stressors) interact with a genetic predisposition (total number of schizophrenia-relevant genes)
What is the typical course of schizophrenia?
1. 20-25% improve completely
2. 10% remain impaired
3. 50-70% show some improvement
4. Most evolve into nonpsychotic state with chronic negative symptoms
5. Most function in the community
6. 10% commit suicidue
What are 4 childhood predictors of later schizophrenia?
1. Academic difficulties
2. Low IQ
3. Proneness to substance abuse
4. Bizarre behavior
How prevalent is substance abuse in older adults?
1. Most common disease in adults
2. 38% of patients 65+ use any substance (mostly alcohol)
3. 16% of 65+ outpatients abuse prescription drugs
4. Cocaine use in 2% of 60+ emergency visits
5. 14% of hospital visits in older adults due to alcohol abuse
What is a personality disorder?
Stable personality traits that are inflexible and maladaptive and cause dysfunction in a person's life across a broad range of situations
What are the 3 clusters of personality disorders?
1. Cluster A - schizoid, schizotypal, paranoid
2. Cluster B - borderline, histrionic, narcissistic, antisocial
3. Cluster C - avoidant, dependent, obsessive-compulsive
What is the maturation hypothesis?
Aging is associated with decrease in "immature" personality types (cluster B)
Why might obsessive-compulsive personality disorder, schizoid personality disorder, and paranoid personality disorder get worse in later adulthood?
People with these personality types push people away during their lifespan, and thus lose social support by old age
What are 2 considerations in prescribing psychotherapeutic medications to older adults?
1. Take longer to clear excretory system because kidneys and liver are less effective, which increases side effects
2. Polypharmacy risk
How effective are psychotherapeutic medications in treating older adults?
50-70% effective, particularly when combined with psychotherapy
What are 3 reasons ECT is useful for treating depression in the elderly?
1. More rapid response
2. Fewer side effects
3. No interaction with other medications
What are 2 problems with ECT in older adults?
1. High relapse rate unless readministered after 6 months
2. Memory loss (better with unilateral ECT)
What are cognitive effects of ECT?
1. Acute effects: confusion and delirium up to 72 hours
2. Subacute effects: memory, language, psychomotor (1-4 weeks)
3. Long-term effects: autobiographical memory (6 months post)
Why doesn't a return to cognitive baseline after ECT mean ECT has no effect on memory loss?
1. Because depression causes memory loss, so ECT should increase memory because it alleviates depression
2. Cannot conclude ECT does not cause memory loss because we do not know the patient's pre-depression baseline
What are 4 concerns with psychotherapy with older adults?
1. Older adults more skeptical about process
2. Sensory and cognitive impairments in client
3. Therapist younger than client
4. Older take longer to benefit
How do reports of subjective distress change with age?
The presence of serious subjective distress and mental illness both decline with age
What is the definition of death?
1. Irreversible cessation of circulatory and respiratory functions
2. All structures in the brain have ceased to function
What consideration requires a more flexible definition of death?
Organ transplant
What is the definition of death complicated by?
Persistent vegetative state, where subcortical areas are intact but there is a lack of conscious awareness
What are 8 physical symptoms of imminent death?
1. Asleep most of the time
2. Disoriented
3. Irregular breathing
4. Hallucinations (loss of peripheral vision, light in centre of vision)
5. Reduced vision
6. Changes in autonomic bodily functions
7. Anorexia-cachexia syndrome: loss of appetite and muscle atrophy
How have mortality rates changed over time?
1. Decreases in under 5 rates
2. Increases in over 65 rates
3. Resulting equation of death with old age
How have mortality rates in the least-developed countries changed over time?
1. Fewer under 5 deaths, more deaths over 65, causes greatest world shift
How have mortality rates in developed countries changed over time?
Over 65 death rate already high, but now even higher
Middle-aged show greatest decrease
What is compression of morbidity?
Period of disability before death
What are age-adjusted mortality rates?
1. Used to compare relative mortality risk across groups and over time taking into account the fact that death rates are higher in increasingly older groups
2. The lower this rate, the healthier the population
What factor is associated with shorter period of disability before death?
Healthy lifestyle (no smoking, physically active, normal weight) close to 0
What is a death ethos?
Prevailing philosophy of death that can be inferred from cultural practices
What are the 5 cultural attitudes about death in Western society?
1. Tame death (early middle ages): natural part of life neither avoided or exalted
2. End of self (later middle ages): indication that people start to fear death and that death is a reckoning with God
3. Remote death (1700s): scientific view of death as a break from life; attempts to avoid and deny death
4. Beautiful death (1800s): death as noble if for a cause, rewards of good death
5. Invisible death (1950s+): medicalization of dying process; comparison of death to old age; fear of aging and old; death and mourning private
What 5 media representations of death are Western societies preoccupied with and why?
1. Disasters
2. Death of famous people
3. People with terminal illness
4. Sentimental deaths
5. Horror films

Preoccupation due to inadequate mourning practices and inability to communicate about death
What are 3 religious convictions that help us cope with death?
1. Belief in afterlife
2. Death as a test of faith
3. Death as blessed relief
What 3 Western attitudes about death have occurred because of changes in healthcare?
1. Death associated with later life
2. Death "invisible"
3. People rely on media images
What are 4 fears associated with ageism?
1. Fear of aging
2. Fear of loss of capacity
3. Fear of social death
4. Terror management theory: people terrified of end of life so engage in defense mechanisms to deal with threat
What are 2 concepts related to death with dignity?
1. Physician-assisted suicide
2. Euthanasia
What are Kubler-Ross's 5 stages of dying?
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
What are 4 criticisims of Kubler-Ross's 5 stages of dying?
1. 5 stages interpreted as steps that must be followed
2. Theory written about young patients
3. Ignores other emotions that might be experienced
4. Researchers unable to establish existence of stages
What were the 3 main findings of the SUPPORT study?
1. Majority preferred to die in home but died in hospital
2. Dying patients suffered from pain (40%), difficulty breathing, and confusion
3. Majority preferred palliative care but instead were giving life-sustaining over-treatment
Why might dying patients suffer pain?
Doctors fear giving addictive substances to patients
What is the difference between physician-assisted suicide and euthanasia?
1. Physician-assisted suicide: doctor can give lethal mixture to dying patient, but the patient must be well enough to take it - individual chooses, physician assists
2. Euthanasia: physician's action causes death (active or passive)
What is the difference between active and passive euthanasia?
1. Active: deliberate action to end the life of a dying patient to avoid further suffering (illegal - can be voluntary or involuntary)
2. Passive: deliberate disconnection of life support equipment, or cessation of any life-sustaining medical procedure, permitting the natural death of the patient
What is "snow"?
Administering heavy doses of opiate drugs to completely sedate a person who is dying painfully. Person dies while unconscious.
What is negotiated death?
A formal agreement made between family, physicians, hospital management etc. that life support systems to an incompetent person are better disconnected in the best interests of the patient (legal in Canada)
What is DNR?
A Do Not Resuscitate order on the patient's medical chart advising heath care professionals that extraordinary measures should not be used to attempt to save this person's life
What are advance directives?
Include:
1. Living will: AD where patient requests physician not to connect, or to disconnect, life-supporting equipment if procedure is merely delaying inevitable death
2. Durable Power of Attorney for Health Care: AD made where patient nominates another person to make health care decisions if and when he/she becomes incompetent

In BC, under the BC Adult Guardianship Legislation (Living Will or Advance Directive and Representation Agreement)
What are the arguments for and against physician-assisted suicide and euthanasia?
For:
a. Individual's right to make decision
b. Need to relieve suffering
c. Life can be extended beyond point of meaning due to modern technology

Against:
a. Promotes death as a solution to society's ills
b. Day to day variation in desire to end life
c. People who wish to end life are suicidally depressed
d. Fear that people will be convicted by doctors to commit suicide because of resource-based decisions
What are the 4 requirements of Oregon's Death with Dignity Act?
1. Must be 18
2. Resident of Oregon
3. Capable to make and communicate healthcare decisions
4. Diagnosed with terminal illness that will lead to death in 6 months
Of the lethal medication prescriptions given under the Death with Dignity Act, how many were taken?
46 or 85 took medication, 26 died of disease, 13 alive
What are the 6 characteristics of PAS patients under Oregon's Death with Dignity Act?
1. Mostly equal between genders
2. Median age 70, range 25-96
3. Majority white (97%)
4. Mostly married (45.5%), widowed (21.6%), divorced (25.3%)
5. Mostly had BA or higher (41.4%)
6. Most had cancer (81.5%), ALS (7.9%)
What were 7 end-of-life concerns cited by patients under Oregon's Death with Dignity Act?
1. Losing autonomy (87.2%)
2. Decreasing ability to participate in activities that make life enjoyable (86.8%)
3. Loss of dignity (80.4%)
4. Losing control of bodily functions (57.3%)
5. Burden on family/friends/caregivers (38.2%)
6. Inadequate pain control (26.4%)
7. Financial implications of treatment (2.4%)
What is a hospice?
Palliative care focusing on needs of dying patients
What are 4 main desires of dying patients?
1. Obtaining adequate pain control
2. Avoiding extended period of dying
3. Achieving sense of personal control
4. Relieving burden on others
On what 3 dimensions did the MacArthur Foundation Study measure successful aging?
1. Absence of disease
2. Maintain engagement with life
3. High physical and cognitive functioning

Problem: Many older adults do not meet this criteria
What is the social indicator model of well-being?
1. Proposes that social indicators (age, gender, marital status, income) account for well-being
2. Since older adults are lower on these indicators, they should have lower well-being
What is the paradox of well-being?
Older adults are lower on social indicators but they generally have high levels of well-being
What were 3 findings of the MIDUS study on subjective well-being?
1. Well-being varied as a function of gender, personality and marital satisfaction
2. Women: positive affect highest in oldest groups
3. Men: highest positive affect scores in later life only for introverted (extroverted were higher throughout)
What is set-point perspective?
1. Theory that well-being reflects personality traits
2. Biologically-determining temperament sets boundaries for levels of well-being
3. Traits are more stable than states; states will only affect satisfaction for about 6 months before returning to set point
What did Lehman find about the relationship between age and creativity?
1. Analyzed significant contributions by age and discipline
2. Found peak productivity between 30-35
3. Peak varies by discipline (higher in diplomacy, lower in sciences, athletics)
What are 2 problems with Lehman's study?
1. No inclusion of artists who died before becoming "old"
2. Compositional fallacy - average productivity rates do not describe the productivity of individuals in that group
What is Simonton's model of the relationship between age and creativity?
4 Factors:
a. Creative potential (m): number of works in unlimited lifespan
b. Ideation (a): production of new ideas for new products
c. Elaboration (e): transforming ideas into products
d. Creative products (p)

Calculated on basis of Career Age
What are the 4 trajectories in Simonton's model of the relationship between age and creativity?
1. Low creative potential with early career onset: early last work
2. High creative potential with early career onset: last work later (~60)
3. Low creative potential with late career onset: approximately 20 year career
4. High creative potential with late career onset: have the latest last work
What are the implications of high creative potential for career length and productivity?
1. High potential = high rate of productivity early and later in career
2. High potential = longer span between first and last works
What did Lehman's "best paintings" study find about the relationship between age and creativity?
Possible to have surge in creativity at the end of lifespan
What are the characteristics of last works for artists, musicians, and scientists?
1. Artists ("old age style"):
a. Eliminates fine details
b. Presents essence of work's meaning
c. More subjective (emotional), less objective

2. Musicians ("Swan Song"):
a. Shorter main themes
b. Simpler melodies
c. More dramatic

3. Scientists:
a. Integration and synthesis
b. Studies of aging
c. Research on aging
What are 3 reasons for the unique characteristics of last works?
1. Proximity to death
2. Desire to leave legacy
3. Reaction to age-related changes
What is the optimal diet for health?
Low fat, low carb
Body can heal itself