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128 Cards in this Set
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Symptoms of schizophrenia:
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(1) Disturbed cognitions leading to a loss of contact with reality
(2) Extreme excess (positive symptoms) or deficits (negative symptoms) in: perception, affect, behavior, (3) Disorganized/Inappropriate |
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Speech and thought cognitive symptoms of schizophrenia:
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loose associations, poverty of content, neolgisms, clanging, blocking, echolalia, alogia
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Positive symptoms of schizophrenia:
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reflect the excess or distortion in normal behavior.
Examples: hallucinations, delusions, wild/flamboyant behavior. |
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Negative symptoms of schizophrenia:
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reflect an absence or deficit of behaviors that are normally present.
Examples: perceiving, flat affect, emotional flattening, poverty speech, asociality, apathy, and anhedonia. |
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Loose Associations (name both of the 2 types):
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derailment, word salad. 2 types:
tangential=doesn't make any semantic sense. preservation= see the same thing in everything |
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Neolgisms:
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speed disturbance, take real world and define new egotistical meanings and expect people to know
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Clanging:
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speech disturbance, irresistible urge to come up with rhyming words, cascading of words
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Blocking:
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speech disturbance, just stop talking in the middle of sentence and people don't know what they were saying
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Echolalitia
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speech disturbance, talking like a parrot, repeating (like in autism)
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Alogia
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speech disturbance, loss of speech, mute
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Delusions:
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false IDEAS about reality
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Hallucinations:
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false EXPERIENCES
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7 Types of Delusions:
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persecution (someone is going to get me),
control (I am god, I have powers assoc with ego and fear), nihilistic (belief in great tragedy, apocalypse), religious (I'm Jesus, I'm Muhammad, religious theme), grandiose (overlap w/ religions and controls), thought broadcasting (someone reading my mind, or I have telepathy), insertion (someone is putting thoughts in my head), somatic (grotesque, insect laid eggs in brain) |
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Shattered sense of self:
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loss of ego boundaries, sometimes confuse delusions w/ themselves
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Deficit in Perception:
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blunted, not tuned in or aware of what is going on
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Excess of Perception:
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hyper-vigilant, hallucinations
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6 Types of Hallucinations:
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auditory (hearing voices, most common, 75%),
visual (see a person who is not there, 2nd most common), tactile (external feelings, I feel people grope my body), somatic (internal feelings, feel insects eating my organs), gustatory (I can taste the poison in my food), olfactory (smelling rotten bodies under floor boards) |
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Do delusions and hallucinations occur together?
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Yes, in most cases they do occur together. Example: paranoid schizophrenia
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Positive affect symptoms in schizophrenia:
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excess, flamboyant or wild
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Negative affect symptoms in schizophrenia:
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deficit, blunted, flat
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Inappropriate affect in schizophrenia:
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affect inconsistent with the communication.
Excess example: describing cake with anger. Deficit example: describe trauma with flat affect. |
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Behavior in schizophrenia (deficit and excess):
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deficit: catatonic stupor or posturing,
excess: catatonic excitement (similar to a manic episode) or stereotyped movements or grimacing |
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Odd/Eccentric behavior in schizophrenia:
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mannerisms or behaviors
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Disorganized behavior:
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can't initiate goal directed behavior (volition), loss of motivation, inability to care for self, debilitating ambivalence, loss of social interest
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Phases of Schizophrenia:
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(1) Pre-morbid
(2) Prodromal (3) Active (4) Residual (5a) Remission (5b) Most people cycle between active and residual |
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Pre-morbid phase of schizophrenia:
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where the person is functioning before the symptoms start to appear
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Prodromal phase of schizophrenia:
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symptoms include: deterioration in functioning, social withdrawl, communication difficulties, and odd or peculiar behavior.
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Active phase of schizophrenia:
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full psychotic phase that lasts at least 1 month with 2+ of the following symptoms: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, alogia, avolition,
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Residual phase of schizophrenia:
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more in touch with reality, returns to prodromal level of functioning or + or -
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Remission phase of schizophrenia:
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free of symptoms, really rare.
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Why don't most people go into remission (2 reasons)?
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(1)Most people cycle through residual and active phases. They get more and more active phases that last longer and involve lower functioning. So generally there is more of a decline in functioning rather than improvement.
(2) They hold a special belief that their hallucinations are a special form of enlightenment. Thus, they don't want to "get better." |
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Famous examples of people with schizophrenia:
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John Nash ("thought" his way out),
Louis Waln (never recovered from active phase, painted cats), David Marsh (currently in remission, paints outer space pictures which he finds theraputic) Hieronymus Bosch (painter from1400's, bizarre paintings, people argue he was schizophrenic) |
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History of the naming of schizophrenia
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-1810: first detailed clinical description by John Haslam
-1860: called demence precoce (mental deterioration at an early age) Belgian psychiatrist Benedict Morel -1896: dementia praecox, group of conditions that all semed to feature mental deterioration beginning in early in life, Emil Kraepelin -1911: schizophrenia, Swiss psychiatrist Eugen Bleuler |
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Psychosis:
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the hallmark of schizophrenia, significant loss of contact with reality
the split within the intellect, between the intellect and emotion, and between the intellect and external reality. |
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Prevalence of schizophrenia:
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1% of the population that survive until at least age 55 will develop this disorder
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Peak time of onset of schizophrenia:
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15-19 years old to 25-29 years old
males have a greater risk at this time, but this sharply declines after age 35 Women's risk rises from ages 40-50 years old |
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Risk factors for schizophrenia (6):
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-being male (though pretty equal between men and women),
-people whose fathers were 45-50 years old at the time of their birth, -identical twin with schizophrenia (concordance rate=50%) -traumatic event/ very stressful event may activate genetic component/vulnerability -people of afro=caribbean origin, -being 15-29 years old. |
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Disorganized symptoms of schizophrenia:
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Bizarre behavior, disorganized speech
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Diagnostic criteria for schizophrenia:
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(1) deterioration from pre-morbid level of functioning
(2)symptoms for at least 6+ months (Prodromal, active, residual) (3)active phase for 1+ months |
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Single psychotic episode:
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1 time in active phase then stay in residual, 12-22% of the cases
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Recurrent psychotic episodes:
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cycling through active and residual, spend more time in active phase and are in less touch with reality in residual phase, 78-88% of the cases
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Burned out schizophrenics:
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been in positive symptoms/active phase for so long/so much, that it all becomes too much and their affect then becomes really flat
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Positive predictors for developing schizophrenia:
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(1) onset:
-more positive level of pre-morbid functioning (esp. social function) = less likely to have severe schizophrenia -females=tend to do better than males (social functioning) -rapid onset=faster the onset greater chance of bouncing back -later age of onset= less severe -significant precipitating events=traumatic event makes recovery less likely (2) positive symptoms: -coherent but sometimes bizarre delusions if organized and internally consistent= better prognosis -excessive/inappropriate= better chance for higher level of functioning than flat affect (3) family/culture: -minimal family history of schizophrenia -family communication style -tradition culture, less industrialized (2) |
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Paranoid schizophrenia:
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shows a history of increasing suspiciousness and of severe difficulties in interpersonal relationships.
Symptoms: coherent delusions, auditory hallucinations, not appropriate affect, incoherence, catatoria or disorganized behavior |
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Disorganized schizophrenia:
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usually occurs at an earlier age and has a gradual insidious onset.
Symptoms: incoherent/loose thought, grossly disorganized behavior, flat or inappropriate affect (often silly) |
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Catatonic schizophrenia:
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pronounced motor signs, either of an excited or a stuporous type. Some of the patients are highly suggestible and will automatically obey commands or imitate the aciotns of others (echoparaxia), or mimic their phrases (echolalia).
Symptoms: motor disturbances, not moving or posturing |
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Undifferentiated schizophrenia:
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waste basket category. Meets the usual criteria for schizophrenia but does not clearly fit into one of the other subtypes because of a mixed-symptom picture.
Like schizophrenia N.O.S. and is the largest category, sufferers are inconsistent |
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Residual schizophrenia:
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category used for people who have suffered at least one episode of schizophrenia but do not now show any prominent positive symptoms, instead mainly composed of negative symptoms (flat affect) although some positive symptoms (odd beliefs, eccentric behavior) may also me mild and present.
While in active phase diagnose one of the other types, while in residual phase diagnose "residual schizophrenia" |
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Schizoaffective disorder:
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hybrid that it is used to describe people who have features of schizophrenia and severe mood disorder
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Schizophreniform disorder:
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category reserved for schizophrenia-like psychoses that last at least a month but do not last for 6 months and so do not warrant a diagnosis o schizophrenia
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Delusional Disorder:
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like many with schizophrenia, holds beliefs that are considered completely false and absurd by those around them, but otherwise are quite normal
non-bizarre delusions 1+ months with no other psychotic symptoms |
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Brief psychotic disorder (BPD):
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involves sudden onset of psychotic symptoms or grossly disorganized or catatonic behavior. Episode only lasts a few days usually, then person returns to normal functioning.
1+ positive symptoms for less than a month |
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Folie a deux:
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shared psychotic disorder, shared delusion, usually paranoid
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How does excess activity in Dopamine (D2) receptors in the basal ganglia have a part in schizophrenia?
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Thought to cause abnormalities in movement and balance
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How does deficiency in Dopamine (D1) receptors and 5HT receptors in prefrontal cortex have a part in schizophrenia?
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Thought to cause abnormalities in thoughts and reasoning
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How does suppressed glutamate transmission, especially NMDA receptors have a part in schizophrenia?
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NMDA is related to arousal and synaptic plasticity, so deficits could explain lower functioning as seen in schizophrenia
PCP blocks NMDA receptors and this is thought to cause both positive and negative symptoms. |
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Anti-psychotic effectiveness: ratings of improvement for those on treatment or placebo:
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treatment:
-20-30% little or no improvement in a psychotic phase -25-35% partial improvement -45-55% marked improvement placebo: -no change or deterioration -maybe those who deteriorated would have just remained the same (the group with little or no improvement from medication) |
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What qualifies for marked marked changes in Schizophrenia?
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-residual status
-fewer problem behaviors -possible improvement in social functioning -able to benefit from therapy (can't be done in active phase) |
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Personality disorder:
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Chronic interpersonal difficulties and problems with one's identity or sense of self that are pervasive, inflexible, stable, and of long duration.
There must be a clinically significant distress or impairment in functioning and be manifested in at least 2 of the following areas: cognition, affect, interpersonal functioning, impulse control. Can be found on AXIS II. |
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Cluster A Personality Disorders:
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Personality disorders that are odd or eccentric.
Includes paranoid, schizoid, and schizotypal personality disorders. |
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Cluster B Personality Disorders:
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Personality disorders that are dramatic, emotional, and erratic.
Includes histrionic, narcissistic, and borderline personality disorder. |
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Cluster C Personality Disorders:
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Personality disorders that are anxious or fearful.
Includes avoidant, dependent, and obsessive-compulsive personality disorder. |
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How does the distress or impairment in functioning created by personality disorders manifest itself?
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People suffering from personality disorders are not distressed by the characteristics of their personality but rather the effects or consequences of personality.
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Why do personality disorders come to therapy?
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Not to fix personality, but to achieve goal associated with their personality.
Looking for transference, for the therapist to enable them. |
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Problems with epidemiological studies in personality disorder research:
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There hasn't really been a really large epidemiological study on personality disorders.
But six small epidemiological studies have found that 10-13% of population have 1 or more personality disorders. These are based on self-report so self-report bias and non-participation are a problem. |
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Are personality disorders made up of discrete or continuous traits?
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Continuous traits.
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How is inter-rater reliability for personality traits?
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Very poor because the criteria is very subjective and personal biases of the therapist may get in the way.
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Is there high co-morbidity among personality disorders?
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Yes, about 50-80%
Examples: -anti-social and paranoid -borderline and histrionic |
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Is there low co-morbidity among AXIS I disorders?
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No, there is a very high co-morbidity because maladaptive traits and behaviors can create stress, rigidity to traits (charactersitic of personality disorders) increases stress vulnerability, and traits lead to poor coping strategies
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Paranoid personality disorder:
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Individuals with a pervasive suspiciousness and distrust of others, leading to numerous interpersonal difficulties.
Bears grudges, reluctant to confide in others, perceives hidden meanings 0.5 - 2.5% of the population Greater prevalence in men. |
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Do people with Cluster A personality disorders have hallucinations or delusions?
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No, Cluster A disorders are more like the "middle" of prodomal phase of schizophrenia. There is a lower level of functioning but it remains constant and doesn't reach active phase.
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What is the difficulty of therapy with Paranoid personality disorder?
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Paranoid personality disorders are too suspicious to go into therapy for themselves. They will however go into therapy to follow a partner who entered therapy because they are so suspicious.
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Schizoid personality disorder:
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Impaired social relationships; inability and lack of desire to form attachments to others
Characterized by NEGATIVE symptoms such as: flat affect, restricted facial expression, little or no pleasure in life or sex, indifferent to praise or punishment. Greater than 1% of the population Greater prevalence in men. |
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Schizotypal personality disorder:
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Individuals that are excessively introverted and have pervasive social and interpersonal deficits.
Characterized by POSITIVE symptoms such as: odd or peculiar ideas (ideas of reference, magical thinking), unusual perceptions, communication difficulties, constrained or inappropriate affect, odd social disturbances. 3% of the population Greater prevalence in men. |
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Ideas of reference:
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Draw conclusions that things that are completely unrelated to oneself have personal significance or messages.
Example: draw conclusions that people on the radio/TV are speaking directly to you. |
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Magical thinking:
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beliefs that one has special kinds of powers, like magical powers.
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What is the difference between ideas of reference and magical thinking and delusions?
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Ideas of reference and magical thinking are not delusions, just like them. They are not considered delusions because they are not as severe. That is that people suffering from the first two can have their beliefs confronted and understand they are not real, but you can't do that with delusions.
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Histrionic personality disorder:
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Self-dramatization; over concern with attractiveness; tendency to irritability and temper outbursts if attention seeking is frustrated.
2-3% of the population Equal prevalence between men and women. |
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Narcissistic personality disorder:
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Grandiosity; preoccupation with receiving attentional self-promoting lack of empathy, self-centered, and self-serving.
<1% of the population Greater prevalence in men. |
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Borderline personality disorder:
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Impulsiveness; inappropriate anger; drastic mood shifts; chronic feelings of boredom attempts at self-mutilation or suicide.
Manipulative out of desperation and fear of rejection. 2% of the population Greater prevalence in women. by a 3:1 ratio |
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Avoidant personality disorder:
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Hypersensitivity to rejection or social derogation; shyness; insecurity in social interaction and initiating relationships.
Desires acceptance and fears rejection. 0.5 - 1% of the population Equal prevalence between men and women |
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Dependent personality disorder:
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Difficulty in separating in relationships; discomfort at being alone subordination of needs in order to keep others involved in a relationship; indecisiveness.
Clinging and passive and do anything to maintain relationships and violate own person, self form of manipulation. 2% of the population Equal prevalence between men and women |
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Obsessive-compulsive personality disorder:
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Excessive concern with order, rules, and trivial detail; perfectionist lack of expressiveness and warmth, difficulty in relaxing and having fun.
Disapproving style, rigid. 1% of the population Grater prevalence in men, by a 2:1 ratio |
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Narcissistic and/or antisocial take advantage of which personality disorder?
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Dependent personality disorder. They have symbiotic relationship where they reinforce one another's maladaptive thoughts and behaviors.
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What AXIS I disorder does avoidant personality disorder most resemble?
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Generalized social phobia.
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What might typical parents of an antisocial personality disorder be like?
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Mother: inconsistent, distance, with substance abuse
Father: antisocial personality History of abuse in the family |
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What is the most distinguished feature of antisocial personality disorder?
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A lack of conscience or remorse. This leads to lying, violating the rights of others, disregarding the safety and welfare of others, and irresponsibility.
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Do all antisocial personality disorders demonstrate the same level of disregard for the rights of others?
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No. It is a continuum: Instrumental to Sadistic
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Why is there a drop off in criminal behavior of antisocial personality disorders in middle age (5 explanations)?
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(1) "Burn out"
(2) learn to hide deviant behavior better/run a better con (possibly though therapy or prison) (3)Substance dependence leading to just spending more time at home being under the influence of a drug or alcohol. (4) More violent offenders already in jail before they are older (5)Victims change from public to family (physical/sexual abuse) |
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What is the difference between antisocial personality disorder and psychopaths?
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Antisocial personality disorder is only behavior, psychopathic adds affective and interpersonal traits.
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Characteristics of Psychopathy:
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callousness, superficial charm, inflated self-worth, arrogant, lack of empathy and glib.
Do not engaging in same kind of impulsive acts as ASPD, more structured and manipulative. |
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Types of careers that people with psychopathic tendencies enter into:
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Business executives, Evangelists, politicians.
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The impulsiveness of borderline personality disorder leads to self-destructive behaviors such as:
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(1) Self destruction/mutilation to extort continuation of relationship.
(2) High risk sex to attract a relationship (3) Drugs (4) Eating disorders, specifically Bulimia, out of control binging and purging. |
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Christine Collins is an example of how _____ used to be done with very little judicial review.
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involuntary commitment
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Where can the legal basis for commitment be found?
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In the US constitution police power and parens patriae (people's father) justified the right and responsibility of the government to look out for the people's welfare.
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Criteria for commitment:
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A mental illness that causes a person to be either a danger to their self or others, or have a grave disability that they are unable to cure themselves of.
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Changes in the 1960's in mental hospitals:
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- Availability of medications
- Changing attitudes of mental institutions and the right/wrong way to treat patients. |
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Deinstitutionalization:
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the movement to close down mental hospitals and to treat persons with severe mental disorders in the community.
Followed the 1978 US Supreme Court decision (O'Conner v. Donaldson) that you can't involuntarily confine patients capable of living in the community on their own. |
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Jimmy Carter's plan for Deinstitutionalization:
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- Shrink state hospitals
- Put patients on short term stabilizers for when they are in a psychotic phase -Help them transition into the community - Develop community based services to help maintain residual phase |
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Community Mental Health Center services:
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- Counseling for the entire community
- Day treatment/activities - Medication management - Liaison with hospitals |
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Alternative community services for mental health:
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- financial support (social security, Medicare/medicade, federal grants, states reallocate savings for hospitals)
- supervised living - half way houses |
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Consequences of Deinstitutionalization:
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- Hospital beds cuts dramatically (from 500,000 - 50,000, 90% decrease)
- Change in political environment (i.e. Reagan was elected and took away federal funds for services and states followed suit) - Downgrading of community services led to a shift of responsibility to law enforcement |
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With out mental hospitals and the community services proposed by President Carter where do mentally ill people with out help go?
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-Boarding houses
- Jails/prisons - Homeless |
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How many homeless people were previously hospitalized?
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38% (Fisher, 1986)
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How many homeless people were previously arrested?
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58% (Fisher, 1986)
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How many homeless people have a mental disorder or disability?
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35% (Fisher, 1986)
33% (Ross, 1990) 24% (Whatcom County Census 2009) |
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What categories overlap in characteristics of homeless?
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- previously hospitalized and previously arrested
- mental disorders and substance dependent |
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How many homeless are women and children?
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- Women = 44%
- Minors = 36% |
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How many homeless in Whatcom country were discharged from an institution in the last 6 months?
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21%
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The seriously mentally ill die 25 years earlier than the average person. This gap has widened by ___ years since the early 90's.
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10-15
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Why do the mentally ill have shorter lifespans than the general population?
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- poor treatment and health care
- accidents are 3.8x more likely -diabetes are 3.4x more likely -heart disease is 3.4x more likely -obesity and its side effects -respiratory problems like pneumonia |
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The Insanity Defense:
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AKA the NGRI plea (not guilty by reason of insanity)
an attempt to escape legal consequences of ones crimes by claiming they were not responsible because they didn't know it was wrong because of lack of full mental capacity to comprehend that. |
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Mens rea:
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"know what one was doing"
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Dusky v. United states found (1960):
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A person must understand the charges against them to be put on trial. They also must be able to participate in their own defense.
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"Insane" but competent to stand trial:
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If only insane at the time of the crime or if only insane during the trial.
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If a defendant is found competent then:
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they go to trial.
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If a defendant is not found to be competent to stand trail then (1 of 2 options):
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(1) Involuntarily committed until found to be competent if they ARE DANGEROUS
(2) Set free until they are found to be competent if they are NOT DANGEROUS |
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In terms of determining competency to stand trial with whom does the burden of proof lie?
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With the defense.
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The M'Nagthen Rule (1843):
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a person may use the NGRI defense if they prove that they didn't know right from wrong.
Thought of as the harshest rule because any planning, hiding, etc proves that you understood your actions. |
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The Irresistible Impulse Rule (1887):
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NGRI even if they knew it was wrong because they lost the power to chose between right and wrong at the time of the crime.
This is thought to be too easy and is not really used anymore. |
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The Durham Rule (1954):
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NGRI for their crimes if the criminal act was the product of mental disease or mental defect.
Not useful because then people tried to argue that ANY mental disorder could be responsible for criminal behavior. AKA the "product test" |
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The American Law Institute Standard (1962):
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Combines the "knowing right from wrong" of the M'Naghten rule and with the violation focus of irresistible impulse rule.
A persons mental disorder or defect must impair them from appreciating the criminality of the act and/or control their actions. AKA the "substantial capacity test" |
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Was John Hinckley's NGRI successful?
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Yes, he now lives in a mental institution.
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Was Jeffery Dahmer's NGRI successful?
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No, he was found guilty and killed in prison.
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What are the federal standards for NGRI?
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Reinstated the M'Naghten Rule and placed the burden of proof that the defendant is insane on the defendant.
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What are the state standards for NGRI?
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It varies by state:
- 5 states abolished it all together - 19 states (and DC) use American Law Institute criteria - 24 states use the M'Naghten Rule - 2 states use their own variations |
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What is the standard for WA for NGRI?
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WA uses the M'Naghten Rule.
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Frequency and outcomes of the insanity defense:
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- Rarely used
- Seldom works - Possible longer confinement (in state hospital rather than prison) |
