Chapter 14 Flashcards
What 3 things are criteria for abnormal behavior?
- Deviance from social norms of acceptability
- what we consider abnormal changes across cultures, time in history
- GD- no one threw anything away. Now called hoarding - Maladaptive for the individual
- interferes with at least one large sphere of life- work, relationships, etc. - Causes personal stress
There are 2 types of mental disorders. What are they?
- Clinical disorders- generally more sever, can be temporary or long lasting, low level of functioning
- Personality disorders- milder disorders, longstanding, high level of functioning
What is the challenge of diagnosing Clinical disorders?
largely based on self-reports rather than brain scans
What is the Rosenhan study?
- 8 people falsely reported hearing voices and got admitted, then behaved normally
- took 19 days
- other patients suspicious, but physicians weren’t
- doesn’t happen anymore
- now they have behavioral observation
What are three ways to diagnose clinical disorders?
- structured clinical interviews- questions about symptoms. If answer yes, follow up and assess for disorder. If answer no, move on.
- behavioral observation- in past, didn’t do this. So Rosenhan study
- Tests- MMPI, self report survey only works for diagnosing personality disorders
What is the DSM5?
- diagnostic manual for diagnosing clinical disorders
- used today
- manual organizes types of mental orders, clustering them by different symptoms
What is Schizophrenia and when does it occur?
- “split mind”- disturbances of thought that affect perceptual, social, emotional processes
- emerges in late teens and 20s
- rarely in young kids
What are some characteristics of Schizophrenia that are in the DSM5?
- irrational thought- delusional beliefs
- Deterioration in function
- Hallucinations- more auditory than visual
- Disturbed emotional responses- flat effect and emotional volatility
Explain the characteristic of Schizophrenia: disturbed emotional responses
- flat effect- no matter the strong emotional event, have little emotional response
- emotional volatility- express emotion and intense emotion. Includes mood changes and moods that aren’t appropriate to certain situations
Explain positive and negative symptoms to Schizophrenia.
- excess behavior (positive) v deficits in behavior (negative)
- ex- hallucinations are positive, flat effect is negative (deficit of emotions)
- positive symptoms easy to treat, negative more challenging
What are the different categories of Schizophrenia that are no longer in DSM-5?
- paranoid
- catatonic
- disorganized
- undifferentiated
PUCD
Explain the Paranoid category of Schizophrenia.
- delusions of grandeur and/or persecution
- not always shown, sometimes triggered
- vary across cultures. Someone says people are following me. In US, because I’m so important. In Japan, because I’m repulsive
Explain the Catatonic category of Schizophrenia.
- severe motor disturbance
- muscular stupor- frozen in place
- repetitive movement
- mutism- can’t speak
- Ecolalia- repeats other person’s spoken words
- “waxy flexibility”- move frozen person like a mannequin
Explain the Disorganized category of Schizophrenia.
- severe maladaptive behavior- interferes with at least one large sphere of life
- Babbling, disorganized thought and speech, loosened associations
- ex- painting has a headache
Explain the undifferentiated category of Schizophrenia.
- Has multiple symptoms from each cluster. Not in one category
What are the 5 Risk factors of Schizophrenia?
- can show you have this vulnerability
- Genetic factors
- Brain abnormalities
- Attention Deviance
- Prenatal Environment
- Postnatal Environment
Explain genetic factors’ role in having an increased likelihood of causing Schizophrenia
- hereditary predisposition
- 1% likelihood of developing it
- if identical twin develops it, other twin has 50% chance
- higher chance in identical twins
Explain brain abnormalities’ role in having an increased likelihood of causing Schizophrenia.
- overabundance of dopamine
- differences in structure- larger ventricles
- inefficient neurotransmission- abnormality in glial cells/myelin sheaths
Explain attentional deviance’s role in having an increased likelihood of causing Schizophrenia
- inability to filter out irrelevant stimuli and poor attention span
- Stroop task- naming the lettering color while ignoring the name of the word. We all take a long time to do this
- People with Schizophrenia take a much longer time with this task because they have difficulty filtering out stimuli- a risk factor.
Explain the prenatal environment’s role in having an increased likelihood of causing Schizophrenia
- virus hypothesis. Correlation between flu suffered by mother in second trimester and higher likelihood of schizophrenia in kid
Explain the postnatal environment’s role in having an increased likelihood of causing Schizophrenia
- stress is a factor in onset and relapse of disorder
- being raised in stressful/urban environment doubles risk
Explain depression. Which gender has it more? Is it the most prevalent?
- most prevalent disorders.
- 15% have major depression, 50% have any depressive disorder
- women more likely to develop than men. Men diagnosed more often with depression as a symptom of substance abuse
- men try to self-medicate for depression, so that’s why they end up with substance use disorder rather than depression diagnosis
What are the characteristics of depressive disorders?
- negative emotional state
- slow cognitive processing, difficulty concentrating
- fatigue or insomnia
- decreased interest in anything pleasurable- food and sex
What are the risk factors for moderate to major depression?
- Genetic vulnerability
- situational and cognitive factors
- loss of control/learned helplessness
- unhealthy attribution style for events
Explain genetic vulnerability as a risk factor for moderate to major depression.
- norepinephrine and serotonin disturbances
- lead to over attention to negative stimuli
Explain situational factors as a risk factor for moderate to major depression.
- something bad happening to you out of your control
- ex- learned helplessness
Explain loss of control/learned helplessness as a risk factor for moderate to major depression.
- dogs who didn’t escape shock box developed MDD. Learned helplessness when they could escape. Didn’t try to escape shocks after
- level of learned helplessness correlated with serotonin drop
- SSRIs antidepressants given to dogs to block link between loss of control and depression
Explain unhealthy attribution styles for events as a risk factor for moderate to major depression.
- negative event: someone with depression attributes it to internal, stable, global factors. “I’m stupid”
- positive event: someone with depression attributes it to external, unstable, specific factors. “It was an easy exam and had nothing to do with my abilities”
- w/out depression- healthy attribution style. Good things happen because I worked hard and I’m smart
What is seasonal affective disorder (SAD)?
- special case of depression can be severe (SAD) or mild (winter blues)
- occurs when days get shorter in fall
- loss of light leads to “phase delay” in circadian rhythms and depressive symptoms
What is the risk factor of seasonal affective disorder and how is it treated?
- risk factor- living far north of equator
- bright light exposure 30 min in morning, 10,000 lux to reset circadian rhythms
- medication
Explain cognitive factors as a risk factor for moderate to major depression.
- when the way you are thinking about events in your life make you more likely to interpret them in a way that makes you feel hopeless about bad things continuing to happen
- unhealthy attribution styles
What is postpartum depression?
- Onset of mood symptoms during pregnancy or within 4 weeks after birth
- different than “baby blues”- mild negative mood affects 80% of new mothers in first 2 weeks after birth
- 10% of moms suffer PD
- 50% of PD begins in pregnancy
What are the risk factors of Postpartum depression?
- family history or prior history of depression (increases risk to 25%)
- prior history of PD (increases risk to 50%)
Why is Postpartum depression hard to diagnose?
- symptoms of disorder (sleep disruption, exhaustion) are symptoms of caring for newborn
- women feel ashamed at being depressed at a joyful time
What is postpartum depression with psychosis?
- rarer, 1 in 1000
- danger to themselves and infant- depression with delusions
- delusions- “baby is possessed” “I’m a bad mother so the baby is in danger”
- Think that hurting the baby is saving them
What are the risk factors of postpartum depression with psychosis?
- prior history of bipolar disorder
- some cases caused by autoimmune encephalitis
What is the treatment of postpartum depression like?
- PD with or without psychosis is easily treated
- greater than 90% of moms make full recovery within few months
What is bipolar disorder?
- experience depression and mania
- much rarer than depression, 4% of people have it
What are the symptoms of mania in depression?
- feelings of elation
- racing thoughts, faster speech than normal
- grandiosity/inflated self esteem
- hyperactive/lack of sleep, hyper social, overspending, increased sex drive
What are the two varieties of bipolar disorder?
- bipolar 1- one full episode of mania lasting a week or longer, requires hospitalization, altering with depression
- bipolar 2- Hypomania (jr. mania, subclinical mania), alternating with depression. Can lead to full mania if not medicated.
Why is bipolar 2 harder to diagnose?
- hypomania person is functional and it’s pleasurable
- patients not seen until they’re depressed, where they’re treated for their depression instead of bipolar
- less likely to continue medical treatment because of pleasant aspects of hypomania
What are anxiety disorders?
- characterized by severe, irrational fear or worry that disrupts functioning
What are the different types of anxiety disorders?
- generalized anxiety
- phobia
- social anxiety
- panic disorder
GPSP
What is generalized anxiety?
- type of anxiety disorder
- chronic high level of anxiety without a specific focus, trigger, or target
- “free floating”
- Hypervigilance- attentional bias toward potential threats or threat words.
- Doctor measures Helen’s growth. Thinks of tumor instead of height
What are phobias?
- type of anxiety disorder
- specific fear of an object or action, irrationally exaggerated, interferes with life
- simple phobias- most common. Due to evolutionary preparedness. Most common: animals, heights, blood, flying, closed spaces
Is Wendi Gardner’s fear of bears considered a phobia if she lives in Chicago?
No. Because her fear doesn’t interfere with her life, it is not a clinical phobia. However, if she were to go camping where there are bears, this would be a phobia
What does social anxiety have to do with our ancestors?
In the past, if we didn’t have a social group, we were considered dead.
What is social anxiety?
- type of anxiety disorder
- the fear of speaking, eating, or performing in public, or of more social interaction
- not a simple phobia
- most prevalent phobia
When does social anxiety emerge and what are the risk factors?
- emerges in teen years
- risk factor is inhibited temperament- shy
What are the different types of social anxiety?
- general- all social situations
- performance situations- ex public speaking
- interactional situations- casual conversations
What is panic disorder?
- type of anxiety disorder
- recurrent attacks of overwhelming anxiety or terror
- the fear of attacks is more debilitating than attacks themselves
What are the risk factors of panic disorder?
- moderately heritable (40%)
- triggered by life stressor
- result from “anxiety sensitivity”- oversensitivity to one’s own physiological responses leads to panic feelings.
Because of this, avoid activities where central nervous system- sympathetic fight/flight response triggered. Avoid caffeine and smoking- can emphasize sensitivity
What is Obsessive Compulsive Disorder?
- intrusive thoughts with uncontrollable urges (rituals) to reduce anxiety
- aware of irrationality
What are the obsessions of OCD?
- intrusive thoughts focused on
- cleanliness/order
- safety of home/family
- harm to others
- not that harm with befall them, but carelessness of their actions will lead to harm of others
What are OCD compulsions?
- ritualistic actions that reduce anxiety. Lead to obsessions
- washing hands or reordering object is cleanliness obsessions, checking locks is safety obsession
What are the risk factors/development of OCD obsessions?
- damage to caudate nucleus through autoimmune disease or virus. Leads to intrusive thoughts
- PANS- pediatric autoimmune neuropsychiatric disorder. Sudden onset of OCD almost overnight triggered by strep (common), Lyme, Mono, mycoplasma, and flu virus (H1N1)
What are the risk factors of OCD compulsions?
- result from operant conditioning- negative reinforcement
- compulsive behavior reduces or takes away anxiety, so it becomes reinforcing
What is negative reinforcement?
- removal of unpleasant stimulus to increase probability of behavior being continued
What is positive reinforcement?
- administration of stimulus to increase probability of behavior being continued
What is the history of hoarding disorder?
- used to be thought of as subtype of OCD
- first recognized as its own disorder in DSM5
What is hoarding disorder?
- excessive acquisition of inability to throw away things
- disrupts functioning- risks health and safety, strain personal relationships, interfere with financial security
- 2-5% population. Hard to estimate because people are ashamed
What’s the relationship between OCD and Hoarding disorder?
- hoarders unaware that behavior is problematic, OCD patients are aware
- may or may not be related to OCD
- When hoarding arises because of intrusive thoughts/OCD, it’s hard to treat
- When OCD/intrusive thoughts arise because of hoarding, it’s easy to treat
Explain the development of hoarding.
- manifest in childhood
- between 11-20, but sometimes earlier
- increases severity with age
- we don’t know what causes hoarding
- may have problem with over identification/ attachment to objects. Because of this, we shouldn’t treat area (like in hoarders they clean the room), but the person
What is the treatment for hoarding?
- cognitive behavioral therapy
- exposure therapy
What was the old view psychologists had of substance use disorder?
1994
- substance use
- Substance dependence- physical, physiological symptoms. Tolerance to drug, withdrawal
- Substance abuse- social interpersonal symptoms, missing role obligations, legal problems
What is the new definition of Substance use disorder?
- DSM5, 2013
- social, interpersonal, physical, physiological symptoms mixed in together
- labelled mild, moderate, or severe based on number of symptoms and level of distress/disfunction
What is the prevalence of substance use disorder (SUD)?
- 20.8 million 12 or older have SUD
- alcohol, illicit drugs, marijuana most popular
- opioid drug overdoses quadrupled
What does neuroplasticity have to do do with Substance use disorder?
- dopamine reward pathway adapts to chronic drug stimulation
- reward system altered to motivate, reward drug use
- ignore all other behavior, even if it previously gave you happiness
- unpleasant withdrawal symptoms need to be alleviated by more drug use
- negative reinforcement- take drug to alleviate bad withdrawal symtpoms
Why do some substance users become addicted and others don’t?
- genetics- 30-70% heritable
- addictive personality
- neurotic, less conscientious, less agreeable
- more impulsive- because they have less function in orbits-frontal cortex (OFC). Addiction impairs OFC function
- cycle- less OFC function–impulsivity—drug use—less OFC function
- not all people who have addictive personalities get addicted to drugs
What does Alexander’s Rat Park study show about addiction? Why do people use substances? Who gets and stays addicted?
- social mice put in cage, self-administer morphine until they die
- social mice in park stop taking morphine- even though there’s laced water, and they’re addicted
- similar: in war, soldiers addicted to opiates. When they return to family and good environment, stop using
- anxious, terrified, isolated rats cope with situation with morphine
- people in “deaths of despair” die from morphine because isolated from jobs, family, meaning
- if you have intellectual/social activities, don’t want to take opiates and withdraw from enivironment
What are dissociate disorders?
Disorders that involve disruptions of identity, memory, or of conscious awareness.
Result from extreme stress
Describe Dissociative Amnesia
a person forgets that an event happened or loses awareness of a long block of time
Describe Dissociative Fugue
- rare and extreme form of dissociative amnesia
- involves loss of identity and travel to another location where sometimes assume new identity
- fugue state ends suddenly, people don’t know what happened
Describe Dissociative Identity Disorder (DID)
- occurrence of two or more distinct identities in an individual
- memory gaps- person doesn’t recall everyday events
- often women who were abused as kids have this because of repeated dissociation, different identities develop to cope with different traumas
Describe the personality disorders in Cluster A group of DSM-5
- characterized by odd or eccentric behavior
- paranoid, schizoid, schizotypal disorders
- characteristics: reclusive, suspicious, difficulty forming relationships
Describe the personality disorders in Cluster B group of DSM-5
- characterized by dramatic, emotional, erratic behavior
- Histrionic (theatrical), narcissistic, borderline disorders
Describe the personality disorders in Cluster C of DSM-5
- characterized by anxious or fearful
- avoidant, dependent, obsessive-compulsive disorders
Describe Borderline personality disorder
- disturbances in identity and impulse control
- lack strong sense of self
- fear of abandonment
- episodes of depression, anxiety, anger, irritability, impulsivity
- many have experienced abuse and extreme violence
Describe antisocial personality disorder (psychopath)
- deceitful, irresponsible, lack of remorse, manipulative, large sense of self-worth, lack of emphathy
- slower alpha- wave activity, so lower arousal
- amygdala abnormalities or deficits in frontal lobe functioning
- malnutrition and environmental factors may contribute to development
What is autism
characterized by deficits in social interaction, by impaired communication, and by restricted interests or repetitive behaviors
What are the symptoms of autism?
- extreme end: unaware of others
- Deficits in communication Even if they vocalize, it is often not with any intent to communicate.
- acutely aware of their surroundings
What are the causes of autism?
rare mutations involve cells having an abnormal number of copies of DNA segments
- affect the way neural networks formed
- exposure to antibodies in the womb may a ect brain development.
What are the symptoms of ADHD?
restless, inattentive, and impulsive
- trouble making and keeping friends because they miss subtle social cues and make unintentional social mistakes
What are the causes of ADHD?
- don’t know
- more likely than other children to come from disturbed families
- genetic component
- connection between the frontal lobes and the limbic system is impaired. Less activation
