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Abnormal Psychology > Chapters 9 & 10: Personality Disorders and Schizophrenia > Flashcards

Chapters 9 & 10: Personality Disorders and Schizophrenia Flashcards

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1
Q

What are the three “Odd-Eccentric Personality Disorders?”

A
  • Schizoid
  • Paranoid
  • Schizotypal
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2
Q

Symptoms of Schizotypal Personality Disorder

A
  • Ideas of reference (excluding delusions of reference)
  • Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural normals
  • Unusual perceptual experiences, including bodily illusions
  • Odd thinking and speech
  • Suspiciousness or paranoid ideations
  • Inappropriate or constricted affect
  • Behavior or appearance that is odd, eccentric or peculiar
  • Lack of close friends or confidants other than first-degree relatives
  • Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative fears rather than negative judgements about self
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3
Q

Causes of Schizoid Personality Disorder

A

Related to schizophrenia because of reductions in temporal lobe volume. Can actually lead to full-blown schizophrenia.

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4
Q

Treatments of Schizotypal Personality Disorder

A

Cognitive Behavioral Therapy

  • Objective observation and thinking without subjective responses
  • Establishing a safe social network

Drugs

  • Antipsychotics: clozapine, olanzapine
  • Fewer short-term side effects but still unknown for long-term

-Treating people with Schizotypal Personality -Disorder does help prevent schizophrenia

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5
Q

Schizoid Personality Disorder

A

Like schizotypal except with stronger symptoms of antisocial behavior.

  • Indifference to both praise and criticism
  • Insensitivity to the feelings of others
  • Extreme introvertedness
  • Perceived as cold, aloof or distant
  • No abnormal ideas or perceptions
  • Simply at the extreme end of the continuum of introversion
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6
Q

Prevalence of Schizoid Personality Disorder

A

Prevalence and causes

.4-.9% of the population, more common in men than in women

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7
Q

Treatment of Schizoid Personality Disorder

A

CBT
-Increase social interaction and decrease isolation

Group Therapy
-Good for social connection and interaction and establishing a social network for schizoid individuals.
-Setting for disclosure and social feedback
Can be taught how to handle positive and negative and neutral reactions from others

Role-playing

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8
Q

Paranoid Personality Disorder Symptoms and DSM

A
  • Pervasive distrust and suspicious of others.
  • Motives are seen as malevolent, beginning by early adulthood and present in a variety of contexts as indicated by four or more of the following
  • Suspects without sufficient basis that others are exploiting, harming or deceiving them
  • Doubts of loyalty and trustworthiness of others
  • Reluctant to confide in others for fear that information will be used against them
  • Reads hidden meaning or threatening meanings into benign remarks or events
  • Persistently bears grudges, i.e., is unforgiving of insults, injuries or slights
  • Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack
  • Recurrent suspicions without justification, regarding fidelity of spouse or sexual partner
  • Does not occur exclusively during the course of schizophrenia, a mood disorder with psychotic features, or another psychotic disorder and is not due to the direct physiological effects of a general medical condition
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9
Q

Prevalence of Paranoid Personality Disorder

A
  • .4-1.8% of the population

- More men than women

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10
Q

Treatment

A

CBT

  • Self-disclosure and trust
  • Objectivity
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11
Q

Dramatic-Erratic Disorders

A
  1. Antisocial Personality Disorder
  2. Histrionic Personality Disorder
  3. Narcissistic Personality Disorder
  4. Borderline Personality Disorder
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12
Q

Overview of Antisocial Personality Disorder

A
  • Most widely studied personality disorder in the laboratory
  • Previously called “sociopathy” and “psychopathy”
  • Overlap on antisocial, psychopathy and criminality disorders
  • Criminal disorders are characterized as the intent to get rich quick and gain respect amongst peers
  • In antisocial disorder, the acts are aimless, random and impulsive.
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13
Q

Characteristics of Antisocial PD

A
  • Pervasive patterns of disregard and violation of the rights of others occurring since age 15.
  • Basis for it in conduct disorder
  • Takes form of truancy, petty theft, and rule violating behavior.
  • Failure to conform to social norms with respect to lawful behavior as indicated by repeatedly performing acts that are grounds for arrest
  • Deceitfulness as indicated by repeated lying, use of aliases or conning others for personal profit or pleasure
  • Impulsive or failure to plan ahead
  • Irritability and aggressiveness as indicated by repeated physical fights or assaults
  • Reckless disregard for safety of self or others
  • Consistent irresponsibility as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
  • Lack of remorse as indicated by being indifferent to or rationalizing having hurt, mistreated or stolen from another
  • Individual is at least 18 years of age
  • Conduct disorder with onset before age 15
  • Occurrence is not exclusively during a course of schizophrenia or manic episode.
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14
Q

Prevalence of Antisocial Disorder

A
  • 2-3% with men accorded the diagnosis as much as four times more often than women
  • Females with same symptoms seen as histrionic, whereas men with symptoms are labeled as antisocial.
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15
Q

Causes of Antisocial Disorder

A

Prenatal and birth complications
-Smoking and alcohol exposure, low birth weight, early maternal rejection

Physiological dysfunctions

Broken families
-Arguments, instability, neglect, all contribute to antisocial personality disorder

Defects in learning

  • People with APD were deficient in avoidance learning.
  • Low arousal level
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16
Q

Treatments and Preventions of Antisocial Disorder

A

Early intervention

  • Paying special attention to neglected children
  • Prevention programs that are tailored to the unique needs of various groups of children
  • Accessible resources for at-risk youth and their families.
  • Change the environment of at-risk youth
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17
Q

Histrionic Personality Disorder

A
  • Is uncomfortable in situations where they are not the center of attention
  • Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
  • Displays rapidly shifting and shallow expression of emotions
  • Consistently uses physical appearance to draw attention to self
  • Has style of speech that is excessively impressionistic and lacking in detail
  • Self-dramatization, theatricality and exaggerated expression of emotions
  • Easily influenced by others or circumstances
  • Considers relationships to be more intimate than they actually are.
  • Once they form relationships, they become demanding, inconsiderate, egocentric and self-absorbed.
  • 1.3-3% of the population
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18
Q

Narcissistic Personality Disorder

A

-Grandiose sense of self-importance
-Preoccupied with fantasies of unlimited success, power brilliance, beauty or ideal love
-Believes that he can or she is special and unique and can only be understood by or should associate with other special or high status people
-Requires excessive admiration
Sense of entitlement, unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
-Is interpersonally exploitative
-Lacks empathy, unable or unwilling to recognize or identify the feelings and needs of others
-Often envious of others or believes that others are envious of him or her
-Shows arrogant, haughty behavior or attitude.
->.5% of the population

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19
Q

Causes of Histrionic and Narcissistic Personality Disorders

A
  • Failure to develop empathic relationships with caregivers fails to develop, resulting in a fragmented sense of self that is especially vulnerable to feelings of emptiness and low self-esteem and the compensatory behaviors that these generate.
  • Expects too much from others.
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20
Q

Borderline Personality Disorder

A
  • Frantic efforts to avoid real or imagined abandonment
  • Pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
  • Identity disturbance, markedly and persistently unstable self-image or sense of self
  • Impulsivity in at least two areas that are potentially self-damaging
  • Recurrent suicidal behavior, gestures, threats or self-mutilating behavior
  • Affective instability due to a marked reactivity of mood
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or difficulty controlling anger
  • Transient, stress-related paranoid ideation or severe dissociative symptoms.
  • High likelihood of suicide (8%)
  • Equally prevalent in men and women.
  • Disorder becomes less severe as the person ages: erratic behavior decreases, interpersonal relationships improve
  • Likely to misremember or misinterpret social interactions, to be manipulative and enter into destructive relationships
  • Unusual perceptiveness and insight into the feelings of other people.
  • Higher than average education level and come from upper class families
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21
Q

Etiology of BPD

A

Psychodynamic View

  • Sufferers dichotomize the world.
  • Causes person to behave in extreme, erratic ways
  • Early childhood abuse and trauma

Biological

  • Reduced serotonin activity
  • Brain trauma
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22
Q

Treatment of BPD

A

Dialectical Behavioral Therapy

  • Systematic treatment that includes weekly individual psychotherapy and group skills training.
  • Based on motivational skills deficit model that presumes that people with borderline personality disorder lack important interpersonal, self-regulation and distress tolerance skills

Psychodynamic Approach

  • Transference Focused Psychotherapy
  • To bring patient’s unconscious reactions and conflicts to the surface so that they can be discussed and worked through within a structured therapeutic setting.
  • Aimed to help control impulses that can undermine therapeutic process.

Drugs
-Antipsychotic drugs, SSRIs,

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23
Q

Anxious Fearful Disorders

A
  1. Avoidant Personality Disorder
  2. Dependent Personality Disorder
  3. Obsessive Compulsive Personality Disorder
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24
Q

Symptoms of Avoidant Personality Disorder

A
  • .4-1.3% of population
  • Can be an overlapping of generalized social phobia
  • Axis I diagnosis

DSM-IV

  • Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval or rejection
  • Is unwilling to get involved with people unless certain of being liked
  • Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
  • Is preoccupied with being criticized or rejected in social situations
  • Is inhibited in new interpersonal situations because of feelings of inadequacy
  • Views self as socially inept, personally unappealing or inferior to others
  • Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
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25
Q

Treatment for Avoidant Personality Disorder

A
  • Progressive exposure

- Social skills training that emphasizes the development of intimate relationships

26
Q

Symptoms of Dependent Personality Disorder

A
  • 7% of population
  • More in women than men

DSM-IV
-Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
-Needs others to assume responsibility for most major areas of his or her life
-Has difficulty expressing disagreement with others because of fear of loss of support or approval
Has difficulty initiating projects or doing things on his or her own because of a lack of self-confidence in judgement or abilities rather than a lack of motivation or energy
-Goes to excessive lengths to obtain nurturance and support from others to the point of volunteering to do things that are unpleasant
-Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for him or herself
-Urgently seeks another relationships as a source of care and support when a close relationship ends
Is unrealistically preoccupied with fears of being left to take care of him or herself

27
Q

Obsessive Compulsive Personality Disorder Symptoms

A
  • 1% of population
  • More common amongst men

DSM-IV

  • Pervasive pattern of preoccupation with orderliness, perfectionism and mental interpersonal control at the expense of flexibility, openness and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four of the following:
  • Preoccupied with details, rules lists, order, organization or schedules to the extent that the major point of the activity is lost
  • Shows perfectionism that interferes with task completion
  • Excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by economic necessity)
  • Is overconscientious, scrupulous and inflexible about matters of morality, ethics or values not accounted for by cultural or religious identification
  • Is unable to discard worn-out or worthless objects even when they have no sentimental value
  • Is reluctant to delegate tasks or to work with other unless they submit to exactly his or her way of doing things
  • Adopts a miserly spending style toward both self and others; money is viewed something to be hoarded for future catastrophes
  • Shows rigidity and obstinance.
28
Q

Emil Kraeplin’s (1856-1926) theory of schizophrenia

A

Not until 1880 when schizophrenia was properly differentiated from other forms of madness
-Called it dementia praecox, meaning “early deterioration.”
-Hypothesized that it was caused by malfunctioning glands that interfered with the nervous system.
Therefore, a biomedical procedure would be the cure.

29
Q

Adolf Meyer’s (1866-1950) view of schizophrenia

A
  • Said that it was a cognitive and behavioral disorganization associated with schizophrenia arose from inadequate early learning and reflected “adjustive insufficiency” and habit deterioration
  • Individual maladjustment rather than biological malfunction lay at the root of the disorder.
  • Meyer gave impetus to a tradition that focused on learning and interpersonal processes.
30
Q

Schizophrenia’s Five Types of Delusions

A

1) Delusions of Grandeur
2) Delusions of Control: one’s thoughts and behaviors are being controlled from the outside.
3) Persecution: higher powers at work and are out to get them.
4) Ideas of reference: involve beliefs that certain events or people have special significance for the person, such as newscaster speaking to them
5) Somatic delusions: Something seriously wrong with their body

31
Q

Schizophrenia’s Auditory Hallucinations

A

Auditory
-Either a running voice giving commentary on the individual’s behavior, or two voices conversing with each other about the patient.

Visual
-Like dreams except there is no mechanism in the brain to tell the person they are dreaming.

32
Q

Schizophrenia’s Disorganized Speech

A
  • “Word salads”
  • Derailment: speech that drifts from one topic to the other
  • Tangential: bearing little or no relationship to the question asked
  • Loose association
  • Clang associations: rhyming words
  • Neologisms: new words that have a private meaning
  • Repetition
33
Q

Schizophrenia: Grossly disorganized

A
  • Quickly polarizing behavior

- Disheveled, poor hygiene, inappropriate clothes or excess clothing.

34
Q

Schizophrenia: Catatonic Behavior

A
  • Little to no movement, frozen in space, sometimes in an uncomfortable or awkward position
  • Amount of this has decreased, likely due to the effective medications being used to treat schizophrenia
35
Q

Diagnosis Process for Schizophrenia

A

1) 6 or more months with one month of characteristic symptoms
2) Schizoaffective and Mood Disorder exclusion:
- No major depressive, manic or mixed episode have occurred concurrently with active-phase symptoms or
- If mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods
3) Substance or general medical condition exclusion
4) Relationship to a pervasive developmental disorder

36
Q

Subtypes of Schizophrenia: Paranoid

A
  • Delusions of persecution are complex and coherent
  • Either intensely emotional or very formal
  • No severely disorganized behavior, incoherence or loose associations.
  • No blunted or inappropriate emotions
  • Often attracted to prominent places
37
Q

Subtypes of Schizophrenia: Disorganized

A
  • Inappropriate reaction or emotion to external stimuli
  • Voluble, bursting into meaningless conversation for long periods of time.
  • Sometimes involves delusions or hallucinations
  • Often center on patient’s own body
  • Poor hygiene and grooming, sometimes -incontinence
38
Q

Subtypes of Schizophrenia: Catatonic

A
  • Either enormously excited or strikingly frozen: occasionally may alternate between the two states.
  • Danger to self and others in state of excitability and needs prescriptions to control them
  • Frozen states: often done because of hallucinations of death and destruction and the tiniest amount of movement will cause enormous catastrophe
39
Q

Subtypes of Schizophrenia: Undifferentiated

A
  • Undifferentiated Schizophrenia
  • When the type of schizophrenia does not fit into any other categories but there is still the presence of psychotic symptoms and interpersonal maladjustment
40
Q

Subtype of Schizophrenia: Residual Schizophrenia

A
  • Delusions, hallucinations, incoherence or grossly disorganized behavior.
  • Social isolation
  • Withdrawal
  • Marked impairment in role functioning
  • Very peculiar behavior
  • Serious impairment of personal hygiene and grooming
  • Blunt, flat, inappropriate or emotional expression
  • Odd, magical or bizarre thinking
  • Unusual perceptual experiences
  • Apathy or lack of initiative
  • Can occur after a period of paranoid or differentiated schizophrenia
41
Q

Acute Schizophrenia

A

-Sudden onset of very florid symptoms caused by a precipitating event.

42
Q

Chronic schizophrenia

A
  • Prolonged and gradual period of decline
  • No specific stressor or crisis can be identified
  • Childhood history gives evidence of interpersonal problems, poor school adjustments and social withdrawal
43
Q

Positive vs. Negative Symptoms

A

Type I/Positive
-Delusions, hallucinations, certain forms of thought disorder

Type II/Negative

  • Flat affect, poverty of speech, social withdrawal, loss of volition
  • Reflect absence of diminution of normal functions

-Most patients have positive and negative

44
Q

Prevalence of Schizophrenia

A

-1% of population
-Varies among countries, though differences are not significant
-Surprisingly rates between countries are
similar.
-Onset is in late adolescence and adulthood
-Mainly men before age of 25, with majority at
age 24
-Women have better prognosis since they better retain social skills:
-Estrogen reduces severity of symptoms.
-Children rarely diagnosed
-Rarely past age of 35

45
Q

Schizophrenia: Cognitive deficits

A

1) General intelligence, reasoning, memory and attention
2) Inclusiveness: Related unrelated ideas to a concept
- Patient illustrated a person’s hair as caterpillar heads, fingers and worms
3) Memory: both implicit and explicit
4) Lack of abstract reasoning
5) Communication
6) Perceptual Deficits

46
Q

Schizophrenia: Perceptual Deficits

A

1) Spatial distortions
- Spaces are smaller, objects farther away
2) Backward masking: patients with schizophrenia require longer time period between the presentation of the target and the mask in order to identify the target

-Even patients with 20/20 vision have these deficits, therefore, a faulty neuron processing might be to blame.

47
Q

Schizophrenia: Motor Deficits

A

1) Movement abnormalities
2) Spontaneous movement: motor efficiency and coordination deficits
3) Slower reaction times

48
Q

Schizophrenia: Emotional Deficits

A
  • Less likely to be able to correctly identify emotions
  • Therefore offer impractical solutions to interpersonal problems because of a lack of ability to read or interpret social motives.
  • May have something to do with visual perception deficits
49
Q

Birth complications leading to schizophrenia

A

1) Swelling of the limbs during pregnancy
2) Hypoxia
3) Viral infections
4) Stress

50
Q

Early Onset Indicators

A

1) Impeded neurological development: cognitive, motor, attention and focus, perception and senses,
2) Emotional instabilities
3) Abnormal temperament

51
Q

Predating Schizophrenia: Schizotypal Personality Disorder

A

1) Abnormal thoughts and unusual ideas
2) Social withdrawal
3) Axis I disorders
4) Involuntary movement of the upper limbs, face and trunk

52
Q

Neurochemistry of Schizophrenia: The Neuotransmitters involved

A

1) Dopamine: treated with L-Dopa.
- Schizophrenia patients who take it sometimes end up with symptoms of Parkinson’s
- People with Parkinson’s who take it are at risk of psychosis.
- Greater release of dopamine by neurons in the striatum, a subcortical region of the brain.
- Increased cortisol increases dopamine activity.
2) Decrease in GABA
3) Increased serotonin levels

53
Q

Schizophrenia: Brain Structure

A

1) Larger ventricle areas
2) Decrease in size of:
- Frontal lobes (Also a decrease in activity)
- Temporal lobes
- Amygdala
- Hippocampus (most common)

54
Q

Treatment of Schizophrenia: Drug

A

1) Chlorpromazine and haloperidol
- Has decreased the average hospital stay to two weeks rather than months, years to lifetime.

Side-Effects

  • Dystonia
  • Muscle rigidity
  • Akathisia: peculiar itchiness in the muscles that results in an inability to sit still and an urge to pace
  • Parkinsonism
  • Hypotension
  • Constipation
  • Dry mouth
  • Blurred vision
  • Sleepiness
55
Q

Treatment of Schizophrenia: Antipsychotics

A
  • Ameliorate thought disorders and hallucinations
  • Only treats negative symptoms

Side Effects
-Dry mouth and throat, drowsiness, visual disturbances, weight gain or loss, menstrual disturbances, constipation, depression, Parkinson’s like movements and spasms
-Akathisia: peculiar itchiness in the muscles that results in an inability to sit still and an urge to pace the halls continuously and energetically.
-Tardive dyskinesia: sucking, lip-smacking, tongue movement that seem like fly-catching.
Affects 24% of patients and does not always go away.
Increases with age

56
Q

Treatment of Schizophrenia: Clozapine

A
  • Agranulocytosis: deficiency in white blood cells, leading to infection, severe fever and even death
  • As a consequence, Clozapine must be monitored closely, making it very expensive
57
Q

Treatments for Schizophrenia: Interpersonal Therapy

A

1) Interpersonal Therapy
- Discussion of social experiences, role playing of social interactions and various didactic procedures intended to improve social problem solving.
- Beneficial, especially with medication
- Education, stress-management and skills training
- Treatment is lengthy, lasting sometimes three years.

58
Q

Treatments for Schizophrenia: Cognitive Rehabilitation

A

2) Cognitive rehabilitation: Attention, memory and executive function
- Although it is debatable that it works since these are just the symptoms of the illness, not the illness itself
- Shows no signs in improving reasoning deficits.

59
Q

Treatments for Schizophrenia: Integrated Psychological Therapy

A

3) Integrated Psychological Therapy
- Set of structured intervention programs that are derived from both cognitive rehabilitation and principles of social skills training.
- Attempts to remedy the cognitive and behavioral dysfunctions that are characteristic of schizophrenia

60
Q

Treatments for Schizophrenia: Ideal Treatment

A

4) Ideal Treatment
- Carefully monitored psychopharmacological intervention, psychological intervention into a framework of community program.

61
Q

Treatments of Schizophrenia: PACT Treatment

A

5) Program of Assertive Community Treatment
- Recipients receive the multidisciplinary, round-the-clock staffing of a psychiatric unit, but within the comfort of their own home and community

Abnormal Psychology (13 decks)

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