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142 Cards in this Set
- Front
- Back
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Psychosis:
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alteration of thoughts and perceptions, loss of contact with reality, delusional beliefs, hallucinations
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Positive symptoms of schizophrenia:
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medications are most helpful with these symptoms
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Delusions:
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thought content disturbances in the content of thoughts that usually involve certain standard types of delusions
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Delusions of control:
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belief that others are inserting into your mind thoughts, or others are removing thoughts from your mind. Belief that persons thoughts and feelings are being controlled by an external force
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Delusions of reference:
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Attaches personal significance to other peoples’ actions, events, or objects in their environment. Also might think their thoughts are being broadcast throughout the world so that anyone could hear them
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Delusions of persecution:
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Fear that a person or group or the gov. are out to get you
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Delusions of grandeur:
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Being an important person, head of a oompany or CEO, greatest scientist etc.
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Disorganized thinking and speech: form of thought:
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Structure / organization of thoughts
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Loose associations:
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Speakers ideas shift from one topic of conversation to another which are not related
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Clang associations:
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They rhyme words in sentences
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Incoherence:
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"word salad", they predominantly use disorganized speech
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Perseveration:
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repeating the same word or idea for a very long time, Rorschach ink blot test, 80 or 90 answers
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Neologisms: “pretigitis”
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Make up new words that only have meaning to them
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Heightened perceptions and hallucinations:
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Hearing voices, most dramatic form, may issue commands, serve as a protection from discomforts
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Negative symptoms (what is meant):
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medication doesn't work
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Poverty of speech / alogia:
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ending a sentence with a word that doesn't make sense or not finishing it. Poverty of content, amount is adequate but vague / repetitive
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Blunted or flat affect:
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Don't care what others think, lack of emotion
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Disturbances in volition:
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Person is apathetic, feeling drained, slow thoughts, inability to carry through on course of action
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Disturbed relationships:
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May be so involved in their inner fantasies that they are in withdrawal, autism can be a symptom (also poor hygiene)
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Psychomotor symptoms: catatonia:
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little movement or excessive movement
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Catatonic stupor:
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Has catatonic rigidity (resists being moved), catatonic posturing (stay in a specific / bizarre posture for several hours), waxy flexibility (can be repositioned by someone else)
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Catatonic excitement:
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wave the arms, walk very fast, hard to control, can harm themselves or others in that state,
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Phases of illness: Prodromal
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Person starts to deteriorate from normalcy, socially withdrawn, strange habits
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Phases of illness: Active-florid symptoms:
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Full-blown symptoms, may be precipitated by stress
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Phases of illness:Residual:
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Person returns to prodromal level, aren't out of touch with reality. 25% have a good recovery, 50% active phase symptoms reoccur
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Disorganized type (hebephrenic):
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Immature mind / thinking / behavior, severe disintegration of personality, have delusions and hallucinations w/o a theme, extreme social impairment, flat/innapropriate affect, word salad, talk to themselves, facial grimaces
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Catatonic type:
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excitement / stupor features, symptoms appear with dramatic suddenness, bizarre posture, urinate and defecate in place, suicidal, self-mutilation
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Paranoid type:
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beyond irrationality, preoccupation with delusions with an organized theme, themes of grandeur, vivid auditory hallucinations may accompany delusions, violent, age: 30's - early 40's, trust no one
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Undifferentiated type:
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symptoms that don't fit with other categories they are mixed, rapidly changing indicators of schizophrenia (confused, delusions of reference, autism, excitement)
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Residual type:
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one episode at least but currently free, flattened affect, social isolation, unusual thinking and eccentricities, psychotic symptoms are absent but continuing evidence of disorder
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Socio-cultural causes of schizophrenia:
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self-fulfilling prophecy, expectations lead to a development of symptoms. The rate of schizophrenia is inversely related on socioeconomic statuses (lower class = higher rate of schizo's)
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David Rosenhan’s study:
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Study of Being Sane in Insane Places
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Family studies:
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Convincing evidence there is a biological explanation, closer relative = greater concordance rate. Parent / sibling = 10% while cousin / aunt / uncle = 2%. If biological parent had schizophrenia there is a much greater % likelihood that the child would have it (biological child not adopted child)
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Twin studies:
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Fraternal = 17%, identical = 48%.
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Structural abnormalities for schizophrenia:
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a lot of disorders come from a single gene, in Schizophrenia, many genes are involved, depending on the mixture of genes, the person's vulnerability goes from low to high. Person may have a predisposition to the disorder, but their environment may tip them over the line to actually getting it.
ENLARGED VENTRICLES IN THE BRAIN. |
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Biochemical, dopamine hypothesis for schizophrenia:
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Delusions, hallucinations and attention deficits can be attributed to deficits in dopamine. Serotonin, glutamate, and GABA all contribute to Schizophrenia
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Viral theory:
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Prenatally, the fetus may be exposed to a virus that is slow-acting and doesn't manifest itself until young adulthood. Majority of schizophrenics born in the winter.
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Freud (primary narcissism):
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Regress to stage called primary narcissism, and fulfill only their own need and when the real world is too harsh, they regress to a period of earlier functioning and meet their own needs where they are safer
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Schizophreogenic mother:
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Mother-child relationship where the mother is cold, rejecting, over protective and uses child to satisfy emotional needs.
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Double bind communications:
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Parent presents feelings and demands that are mutually incompatible (feelings of love and anger)
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Milieu therapy: therapeutic community
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Environment --> patients on the psychiatric word try to act out what a normal day / routine would be like
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Token economy:
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Positive reinforcement is used. Reward system for desirable behaviors.
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Neuroleptics (antipsychotic drugs):
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Side effects similar to neurological diseases. Antihistamines have a calming effect on people, and if sedative power were increased, might be useful on schizophrenics. Most commonly used drugs work by blocking dopamine receptors (D1 - D5)
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Cloropromazine (thorazine):
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First used, aka thorazine, initially used to sedate patients before surgery, also works to prevent vomiting, puts people in a mental fog and deadens emotions, negative side effects include uncontrollable shaking, eye movement, contraction of muscles
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Side effects with long term usage, Tardive dyskinesia:
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Side effect from taking schizophrenic meds: affects 20% of people, uncontrollable movements in body, can impair persons ability to walk. Permanently impaired.
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Side effects with long term usage, Dystonia:
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Side effect from taking schizophrenic meds: involuntary muscle contractions that cause bizarre movements in face, neck, and back. Back can go into twisted positions that make it difficult to walk.
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Risperidone
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another atypical drug, equally effective but no problem with granulocytes.
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Clozapine (clozaril):
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Atypical drug, No evidence that it causes any disorders, blocks serotonin, helps patients who weren't helped by other drugs, does have side effects (great weight gain, seizures), agranulocytosis (stops production of white blood cell, granulocytes help fight infection)
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Freud:
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Thought a schizophrenic was incapable of forming a close personal relationship
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Harry Stack Sullivan:
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Set up a ward of schizophrenic men, thought schizophrenia had a fragile ego and couldn't handle the stress of interpersonal relationships, patients had to learn adult forms of communication (worked with patients in nonthreatening ways), gradually patients did develop trust
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Frieda Fromm-Reichman:
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Tried a similar approach to Sullivan's. Aloofness of schizophrenic was their way of avoiding childhood problems, told them they could stay in their own worlds until they trusted her enough to come to the real world.
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Family therapy for schizophrenics:
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Used with good results, family supports patient
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Cluster A:
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odd / eccentric behaviors
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Cluster A: Paranoid personality disorder:
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Suspicious, argumentative, envious, rigid, mistrust others. See evil motives in people, envious of people in high places, brief periods of delusions but frequently are in clear contact with reality.
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Cluster A: Schizoid personality disorder
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Reserved, socially withdrawn, lack the capacity to have warm, closer relationships, self-absorbed with flat and cold emotional responses, inability to form attachments. More males than females.
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Cluster A: Schizotypal personality disorder
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Oddities in thinking, communicating, etc. Emotionally shallow, socially unskilled, deteriorate and become delusional during stress, strange behaviors, some develop schizophrenia, more males than females.
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Cluster B:
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Dramatic, emotional, or erratic behavior.
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antisocial personality disorder
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Person goes against the norms of society: Disloyal, irresponsible, no guilt about behavior, disregard and violate the rights of others, superficially fun and charming, lack of remorse, gratification MUST be immediate, most serious type of PD.
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Pinel:
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noted antisocial personality disorder as "manie sans delire", which means "as a violently insane person who does not show cognitive symptoms that other insane people show"
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Pritchard:
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On antisocial PD: Called it moral insanity
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Mercier:
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On antisocial PD: called it moral perversion
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Freud:
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On antisocial PD: psychopathic PD: "psychopath"
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Cluster B: Sociopathic personality disturbance (not considered a disorder but part of cluster B / antisocial personality disorder)
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"sociopath", antisocial PD:
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Cluster B: Borderline personality disorder
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The border between personality disorders and extreme mood disorders, difficulty w/ personal relationships: impulsivity and instability, aware of surroundings but may have short episodes of delusions. Unpreditable and suffer from chronic boredom, narcissistic, may self-mutilate, dramatic mood shifts, erratic self-destructive behavior. Mostly female.
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Cluster B: Histrionic personality disorder
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Exaggerated expression of emotion, very dramatic. Self-centered and need immediate gratification, constantly seeking praise and approval, most uncomfortable whent hey aren't the center of attention, concerned with physical attractiveness, behave in ways other than the way they actually feel. Equal in males / females.
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Cluster B: narcissistic personality disorder
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Self-absorbed, need praise and compliments, demand attention and self-importance, preoccupied with fantasies of success, can't accept criticism, suck up, create plausible but inaccurate reasons for their frustrations, more common in males.
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Cluster C
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anxious and fearful bheavior
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Avoidant personality disorder (tied to social phobias and depression)
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Socially withdrawn, very shy, fear of criticism, hyper-sensitive to being rejected, exaggerate their short comings, no close friends (socially isolated and depressed), might be linked to social phobias, equal # of males / females
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Dependent personality disorder
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Passively allow others to make important decisions in their lives, lack self-confidence, fear separation, obedient, clingy, submissive, dominant person in the relationship may behave abusively. Battered women --> some have dependent PD and accept repeated abuse.
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Obsessive compulsive personality disorder
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Sometimes called living machines, unusually serious, overly conscientious, inflexible, perfectionists, focus on lists and small details, rule making, neatness. Disturbed by anything out of place. Can't express warm or tender feelings. INsist their way of doing things be followed. Differences in OCD / OCPD: OCD see their behavior as distressing but can't help it, OCPD: rigid and restricted but don't have obsessional thinking / don't have rituals
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Pyromania
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can't help but set fires
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Kleptomania
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can't help but steal small objects
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Pathological gambling
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preoccupation with gamblimg, frequently results in great financial loss and can't provide for themselves / family, become alienated and depressed, suicidal.
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Trichotillomania
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recurrent pulling out of one's hair, pick at skin, 90% female, some of them eat hair --> digestive problems
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Intermittent explosive disorder
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rare, uncontrollable anger, episodes of violent behavior that result in the destruction of property or injury to others, more common in males.
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Childhood anxiety disorder: Separation anxiety disorder
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Panic when separated from parents, unable to stay in a room alone, refusal to leave house, complaints of stomach ache / headache, exaggerated fears. Normal children experience fears but this is an excessive reaction for at least 4 weeks that can diminish and return a few years later. Develops after a life stress. Treatments include family therapy, play therapy, systematic desensitization (work on relaxing during stress), hypnosis
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Childhood depression
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2% of children have this, 8% of adolescents. Withdrawal, crying easily, avoid eye contact, low self esteem, suicidal thoughts, Most antidepressants not approved by the FDA for people under 18. Use cognitive therapy / see psychiatrist (but there aren't many child psychiatrists)
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Childhood bipolar disorder
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1 million children have it, child often misdiagnoses with ADHD or oppositional defiant disorder. Are ultra-rapid cyclers (go back and forth in mood multiple times per day). Too much activity in the amygdala (regulated emotion), too little activity in the prefrontal cortex (rational thoughts), 1 parent has it: 30% chance, both parents: 75%.
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Disruptive behavior disorders
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oppositional defiant and conduct (2 diff disorders)
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Oppositional defiant disorder
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At least 6 months of signs are shown with at least 4 of the following symptoms: easily arguing with adults, defying rules, annoying others, being easy to annoy, losing temper, spiteful, vindictive, later develop conduct disorder
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Conduct disorder
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Repetitive behavior that violates the rights of others and social norms, anti-social acts: regularly lying, cheating, stealing, pyro, klepto, cruelty to animals / people, some develop anti-social PD, others develop schizophrenia
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ADHD
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5% have it, 90% are males. Lessens as the child gets older, 30% carry it into adulthood
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ADHD, predominantly hyperactive type
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80% have this type, social difficulties with parents / peers / teachers. Can't concentrate, co-morbid, dopamine levels and premature / exposed to alcohol during pregnancy - causes
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drug treatment options for ADHD
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Ritallin, Speed, Cylert. Causes release of dopamine from pre-synaptic neurons and prevents the re-uptake of dopamine (more released but can't be absorbed). Increase in impulse control but there are side effects: positive short-term effects (facial tics, psychotic symptoms, explosive talking, headaches), long term use: insomnia, weight loss. Aderrol (new form of time release drug), behavior therapy, Stratera (increases level of norepinephrine).
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ADHD, predominantly inattentive type
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20% have this type, cognitive impairment, impulsivity with behavior, poor grades, impulsiveness, inattention, hyperactivity
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Pervasive Developmental Disorders
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(Rhett's and Aspergers) infantile autism (most common) 80% are males, autism spectrum- unresponsive, poor communication, bizarre reaction to environmental, 1:2,000 (1998), 1:150 (2008), 1:110 (2010), cause is not known, major disruption in relationship, bond from mom and child is deficient, lifelong neurological problem
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eneuresis
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wets bed at night, failure to control urination. Most children will outgrow it because of the stress it causes. Don't scold child, bell & pad, restrict the amount of liquid, alarm to use bathroom during the night, disposable underwear
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encopresis
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quite rare, passage of feces onto floor / clothing
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Rhett's disorder
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female and deadly
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Asperger's disorder
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child has high mental capacity but low social functioning (unresposiveness to others, poor communication skills, limited skills for playing, odd or bizarre reactions to environement)
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Kanner - refrigerator parents
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lack of a bond of warmth and closeness btwn. mother and child
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autism: failure to develop social relations
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don’t care if they are held, when picked up they wire arch the back to stay away from body, don’t look at care taker, don’t seek comfort when distressed children don’t seek comfort, not comfortable around a stranger, pictures of mother and pictures of stranger, don’t smile, no social play
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autism:language and communication deficits
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50% never learn to speak, some are mentally retarded, isolated skills
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autism:savant
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Mentally retarded but a genius at a certain thing
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autism:echolalia
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repeat phrases spoken by others, delayed, don’t repeat knowing what they are saying
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Delayed echolalia
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repeated words / phrases can be said days later
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Pronominal reversal
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Reverse / confuse pronouns in sentences
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Neologisms
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Make up words that only make sense to them
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Self-stimulating behavior
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Spinning all the time, hand flapping, walking on tip-toe, body rocking, grimacing
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Self-injurious behavior
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Head banging, pull out their hair, bite at themselves
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Movement
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Fascinated by movement, can stare at things for hours
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Preservation of sameness
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Speak to child in the same way, have to have the same plate each day
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Pica
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The persistent eating of non-nurtitive substances: dirt, clay, paint chips, plaster, paper, occurs before age 6 for at least 1 month. Nutritional deficiencies, will persist until corrected.
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Rumination disorder
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Infants between 3 mos. - 1 yr. Bring up partially digested food into the mouth, chews it again, and then re-swallows it. Encourage the caretaker to be close to the child and they will stop doing it.
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Mental retardation, Axis II
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general adaptive functioning and intelligence below normal, especially vulnerable to social problems by dealing with people who out perform Under 18, Defects in behavior, Subaverage intellectual functioning
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IQ ranges
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Mild- 85%
Moderate- 10% Severe – 3-4% Profound- 1-2% |
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Down syndrome
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small hands / fingers / genitals, serious physical defects to heart, moderate IQ, average lifespan = 75 yrs. By age 40, patients frequently show signs of Alzheimer
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Phenylketonuria
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Inability of amino acid found in liver to metabolize tyrosine (itself is an amino acid), causes it to build up in blood and cause acid to damage nerve cells in blood, causes retardation, is preventable.
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Tay-Sachs
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Comes from 2 recessive genes, enzyme missing from baby's nerve cell, die of seizures, blindness, retardation / loss of motor control by age 3 / 4.
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Depression
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after 65 rare to develop bipolar disorder, worry, feeling of uselessness, sadness, pessimism, fatigue, no sleep, experienced many losses, last of their siblings, give up a home, frequency fail to diagnose, sometimes medication can get aggravated, dosage-dizzy, might fall
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Delirium
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clouded consciousness, deviating from one's usual state. High temperature, nutritional imbalance, stress of having to change ones surrounding, surgery, 1-4 weeks to clear, but if not treated can be permanent
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Sensory memory
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raw stimulus, brief in duration
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Short term memory
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Holds information for 15-25 seconds, 7 chunks +/- 2.
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Long term memory
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Declarative memory, episodic (personal information), semantic and procedural
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Causes of downs syndrome:
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Down syndrome- 3 number 21 chromosomes- Trisomy 21, 12 or 15 fused chromosomes- translocation, 2 number 21’s and 3 number 21’s- mosaic; if 35 or older 1:100, if under 1:1,000
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Semantic
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meanings and understandings, factual information
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Procedural
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how to do something
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Alzheimer's
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SEE NOTES!!
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Pick's disease
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progressive, degenerative that affects the frontal and temporal lobes. Memory problems, socially disinhibited, apathetic, unemotional, personality changes first, then memory problems surface, rare (200,000 in US), caused by the abnormal form of a protein called "picks" in brain cells. Aderoll may help for awhile but it is a fatal disorder.
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Creutzfeldt - Jacobs disease
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Very rare, caused by infectious disease, prion stays in the body for decades before it shows symptoms: fatigue, sleep problems, appatite problems, jerky spasms --> death
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Dementia
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away from mind, defects in memory, judgment, new information, 70 types, at age 85-50% have dementia
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Huntington's Disease
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Deterioration of basal ganglia / parts of frontal lobes / corpus collosum, hereditary, always fatal, loss of GABA neurons lead to degenerative problems, jerky movements, mood disturbances, change in personality, sexually inappropriate, severe memory loss
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Parkinson's disease
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Degeration of basal ganglia and sub-cortical structures that control muscle movement, occurs in 60% of people who have Parkinson's, bobble head symptoms then tremors in hands, too little dopamine
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dyssomnias
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Disturbances in the quality, amount, timing of the person's sleep
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insomnia
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Most common, 3 patterns: difficulty falling asleep initially, difficulty remaining asleep, persistent early morning awakening.
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Narcolepsy
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Suddena nd irresistible onset of sleep during the waking periods, person goes immediately into REM sleep, dangerous condition, can fall asleep anywhere.
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Sleep apnea
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Frequent gasping for air that awakens the person and disturbs the sleep. Common in older, overweight men who snore. Lasts 15-20 seconds starts causing damage to lungs, heart and brain
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Parasomnias
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Unusual behaviors and abnormal physiology
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Sleep terrors
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Very abrupt awakening from non-REM sleep. Intense autonomic arousal with sympathetic system in arousal, happens during low-wave sleep, person sits upright and screams, then goes right bak to sleep. Most common in children ages 4 - 12.
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Nightmares
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Anxiety-arousing dreams that lead to waking up out of REM sleep. Remembers the dream vividly and finds it difficult to go back to sleep.
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Sleep walking
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Most common in children but outgrown by age 15. Freudian view is that the person is acting out their dream, but it occurs during non-REM sleep so Freud was wrong.
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Criminal commitment
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judged mentally unstable, commitment to mental hospital long enough not to be a threat to society mentally unstable of the time of the trial, until considered competent. Not guilty by reason of insanity- not able to stand trial
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Not guilty by reason of insanity
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before trial takes place to be competent for trial to take place
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M'Naughten rule - 1843
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Scotland, shot Edward Drummond, he didn’t know which man was Drummond so shot the wrong guy, morbid delusions, pursued by spies, the Tory part was persecuting him for not voting for him, not liable for punishment, not capable of distinguishing, sent to Bedlam
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Irresistible Impulse test - 1834
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Ohio, possible to know nature and why wrong but will do it anyways due to the lack of emotional control, irresistible vs. irresistible impulse test
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Durham test - 1954
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plumber in DC, burglary. New test of criminal responsibility states that an accused person is not responsible if the unlawful act is a product of mental illness / defect, jury doesn't have to be concerned with M'Naughten or Irresistible Impulse Act, the clinical psychologist determines the persons mental state. Thrown out in 1972.
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ALI test (1955) - American Law Institute
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American Law Institute- guidelines more specific to jurors 1. Person is not responsible as a result of mental disease or concept conducts as requirement of law 2. Mental disease does not include antisocial personality disorder
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Insanity Defense Reform Act - 1984
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1984- assassinate Reagan to impress Jodie Foster, John Hinkley- not guilty by reason of insanity, only wrongfulness criteria be detained, person changed should be innocent if diseased or retarded and not understand wrongfulness
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Diminished Responsibility Defense (Guilty with diminished capacity)
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alternative to insanity, guilty with… abnormal behavior, didn’t posses state of mind defend with crime, manslaughter not murder, Dan White- Twinkie defense- Vietnam war vet, fire and policeman- resigned as city supervisor, can’t have position back, got a gun, went back to back of building through and open window, upstairs and shot people, he snapped, manslaughter, committed suicide
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Competence to stand trial
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When sent to trial, everyone has to believe the criminal is competent to testify. Have to be sent for evaluation is it's suspected they aren't competent. Afffects more people than does the insanity defense, , person's civil rights must be maintained.
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Legal limits to confidentiality
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Legal issues that arise when clients confedentiality gives rise to suspicion that their behavior is dangerous to others. Right of confidentiality btwn patients and themselves.
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Tarasoff case: Prosenjit Podder
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Indian graduate student at Berkley, joined folk dancing, danced with Tarasoff, Tania gave Podder a kiss on the cheek, took as being engaged, not engaged, depressed, worsened, referred to clinical psychologists returned in 19690, told psychologist, buy a gun and kill Tania, phone and sent a letter, he denied medical record, gun and knife, he stabbed to death, guilty of voluntary manslaughter
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