Dissociative Disorders / Schizophrenia Flashcards
Dissociation
Dissociation of consciousness from experience, often hitting peak in early adolescence
Dissociation Prevalence
Unknown. M=F. Depression: 2%(life). Amnesia: 1.8%(12mo). DID: 1.5%(12mo)
Dissociative Amnesia
Can’t recall important important info, often of a traumatic or stressful nature
Generalized Amnesia
General amnesia, not necessarily of a certain event/experience
Localized Amnesia
Most common form of dissociative amnesia. Amnesia around trauma.
Selective Amnesia
Only amnesia around specific parts about trauma
Continuous Amnesia
Loss of past memory and inability to form new memories
Dissociative Amnesia’s contrast with organic memory loss
Organic: slow onset, not trauma related. D.A: Fast onset, trauma related
Fugue state
very rare; person has amnesia, and will leave and go somewhere else with a completely new identity; length of time varies; heavy alcohol use can contribute
Depersonalization Disorder
Feels like an outside observer of own body. Belief (not just sensation) that outside world seems offset. Robotic, sensory anathesia, etc.
Depersonalization Onset
Rapid with gradual disappearance, often in mid-teens
Transient Depersonalization
Short-term, temporary loss of identity
Dissociative Identity Disorders
Lack of unified identity (2+ distinct identities)
Dissociative Alter
Distinct and unique identities of an individual with DID that takes turns controlling body. Different alters often can’t recall important personal info of the main identity. May just be perception of different personas. Common identities: child, self-mutilating, suicidal, helper.
DID Onset
Childhood. Often not diagnosed until adolescence/early adulthood
Mutually Amnesic Alters
Alters are unaware of each other
Mutually Cognizant Alters
Alters are aware of each other and may interact
One-way Amnesic Alters
Some alters aware of others
History of DID Diagnosis
By 1972: 100 reported cases. DSM III added DID, raised counts of diagnosis either on account of clinician induced or faked DID. No good epidemiological studies.
DID Controversy
Could be clinician induced or faked
DID Co-Morbidity
PTSD, Depression, Substance Abuse, Self-Harm
Trauma and DID
97% of cases of DID had reported trauma. 79-92% sexual abuse. 75-90% repeated physical abuse. 68% incest. 95% either physical or sexual abuse. High suggestibility of DID patients implies defense mechanism from trauma
DID Reliability/Validity
Equal to that of more common disorders
Dissociation Etiology
Major Trauma, possibly from inescapable abuse which led to dissociation as coping mechanism.
Post-Traumatic Etiological Model of D.D.
Psychoanalytic. One part of the person is dissociated as trauma is repressed. Amnesia/Fugue is an episode of massive repression, thus D.D is a lifetime of repression.
Memory Dysfunction (State Dependent Memory) in DID
Memory of severe trauma lost because the trauma becomes associated with an elusive mood, thus transition to mood becomes a transition to the alter.
Self-hypnosis Etiological Model of D.D.
Self-Hypnosis helps as a coping mechanism to forget the trauma
DID Brain Research
Possibly smaller hippocampus/amygdala
Childhood Onset PTSD Model of D.D.
<age 9 extreme abuse leads to D.D.
Amnesia Treatment
Not commonly treated in therapy, rather the clients resolve it on their own.
Depersonalization Treatment
Therapy alleviates anxiety and addresses trauma/stressors. Still often resolved by client on their own.
DID Treatment
Long-Term therapy, which is still not very helpful as trust is required. Psychodynamic/hypnosis used to uncover memory, and skill building used to integrate different aspects of the self.
Schizophrenia Prevalence
1% lifetime. 5% in hospitals, 6% in jail, 1/3 live independently. M=F, equal across races/industrialization (slightly higher in urban, low income areas)
Psychotic Disorders
Loss of contact with reality. Inability to distinguish stimuli from internal or external.
5 Areas:
Delusions (beliefs that others can’t see)
Hallucinations (major distortions in perception)
Disorganized Thoughts/Speech (Incoherent/loose associations)
Grossly Disorganized/Abnormal Motor Behavior
Negative Symptoms (Flat affect, apathy)
Schizophrenic Spectrum
Schizophrenia: Disturbances for 6+ mos, 2 ** for 1+ mo.
Schizophreniform: 1-6 mos
Brief Psychotic Disorder: Sudden onset, < 1 mo, no negative symptoms
DSM V Diagnostic Criteria
2+ symptoms for 1 mo (active phase) [delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, negative symptoms]. At least one must from 1st three symptoms. Impairment in a major area of functioning. Symptoms must persist for 6+ mos.
Deterioration of Function in Schizophrenia
Notable in all cases
Positive Symptoms of Schizophrenia
(Type I) First 4 symptoms from list. Inappropriate affect or inappropriate emotional expression.
Negative Symptoms of Schizophrenia
Alogia: “Poverty of Speech”. Little speech or little content of speech.
Avolition: Lack of interest, motivation.
Anhedonia: Without pleasure. Inability to feel.
Flat Affect
Impaired Social Relationships: Social withdrawal, poor social skills (therapy can help).
Psychomotor Symptoms of Schizophrenia
Facial twitches, tremors, sensory gating, eye tracking issues
Phases of Schizophrenia
Prodromal: Before active phase. Notable drop in functioning, change in personality. Can be gradual or rapid.
Active phase: Can be activated by psychological stressors
Residual Phase: Positive symptoms drop off, negative may persist
Social Drift Hypothesis
Theory of prevalence of schizophrenia in lower SES. Individuals drift into poverty because of their illness
Environmental Hypothesis
Environment creates illness through stress.
Comorbidity of Schizophrenia
Anxiety Disorders:
Panic: 15%
PTSD: 29%
OCD: 23%
Depression: 50% (Associated w/ lower life quality)
Sub Abuse: 50-60% (4x higher than general populace. 90% of Schizophrenics smoke. Marijuana can aggravate symptoms)
Suicide: 10% successful, 25% attempted.
Life Expectancy of Schizophrenics
Shorter, likely as a result of suicide, poor institutional care, low SES, Health problems associated with poverty.
Aggression and Violence in Schizophrenics
Most are not more violent, but some are (likely substance related). Higher rates of victimization.
Age of Onset for Schizophrenia
Late adolescene/early adulthood. Males: 21-23, Females: 27-28.
Rare in childhod, after 45 years.
Gender Patterns
Females typically respond better to medication and spend less time in hospitals, have better social interaction.
Prognosis - Rule of Thirds
1/3 improve significantly, 1/3 stay the same (episodic relapses in functioning), 1/3 chronically, severely disabled.
Bleuler (1908) Theory of Schizophrenia
Originated term of schizophrenia: “splits between associations in thoughts and emotions”
Freud’s Theory of Schizophrenia
Schizophrenia related to regression
Fromm-Reichman (1948) Theory of Schizophrenia
“Schizophrogenic Mother”. Cold, domineering and overprotective mother leads to schizophrenia as she uses childr to satisfy own needs.
Bateson (1956) Theory of Schizophrenia
“Double-Bind” Family communication. Result of being in situation where verbal + nonverbal messages from loved ones conflict, and you cannot escape situation.
RD Laing (1959-60s) Theory of Schizophrenia
Radical Psychiatry. Schizophrenia not a disease but “sane way to deal with an insane world”. Used by people with difficult life to find meaning in world.
Behavioral Theory of Schizophrenia
Learned behavior of patient ** can’t respond to social stimuli and ignores social cues. Reinforced by **
Family Conflict and Communication Research
Conflict and communication with family affects the course of the disease.
Revealed Differences Approach in Family Research
Family given issue (previously disagreed upon) to discuss and reach agreement. 3 patterns emerge: more conflict, more communication difficulties, or more critical yet over-involved.
Expressed Emotion Approach in Family Research
Combination of criticism and emotional over-involvement in recovering patients. Relapse rates higher (3-4x) with higher EE. EE as stressor, not causal.
Cognitive Deficits in Schizophrenia
Attention, verbal meaning, memory, executive function, spatial working memory, processing speed all deficient. Likely associated with prefrontal lobe. Selective attention.
Attention Deficits in Schizophrenia
Selective attention which can lead to more symptoms. Type I (Positive): Overattention. Type II (Negative): Underattention
Nicotine Studies in Schizophrenia
Nicotine releases DA in frontal cortex, improves cognitive functioning, specifically attention and spatial working memory
Genetic Predisposition
Disease not directly inherited, but predisposition is by unknown genetic mechanism. Children of fathers age 50+ at higher risk. Cannot be prevented, but can be watched for. Vulnerability: MZ twins > both parents > fraternal twins > one parent > sibling. Negative symptoms more inheritable.
Twin Studies in Schizophrenia
Monozygotic twins: 50% chance that both will have it if one develops it. Dizygotic: 17% chance. Offspring of MZ have same risk as parent.
Adoption Studies in Schizophrenia
Still high risk w/ schizophrenic biological parent
Irregular Eye Tracking
Majority of clients have irregular pursuit/ extraneous eye movements. Relatives have worse than control groups
Sensory Gating
Ability to filter auditory signals is lessened in schizophrenic clients.
Diathesis Stress Model
Disease brought on by environmental triggering of a biological predisposition by a specific or persistent (family) stressor, pre or post natal.
Dopamine Hypothesis
Indirect evidence that like in Parkinsons, Phenothiazines block DA as they bind to D2 receptors, and amphetamine psychosis has similar symptoms as Type 1 Schizhophrenia.
Revised Dopamine Hypothesis
Excess number of DA receptors/oversensitive DA receptors. Evidenced by PET scans, brain autopsies, and animal studies.
Flaws: Timing: drugs that block DA receptors only affect pos. symptoms and don’t work for weeks. Also, neuroimaging shows less frontal lobe and BG function
Mesolimbic Dopamine Pathway and Schizophrenia
Neuron connections in VTA, Limbic system. Excess DA -> Pos symptoms.
Mesocortical Dopamine Pathway and Schizophrenia
Neuron connections in VTA and midbrain to prefrontal cortex. Underactive DA neurons in PFC fail to inhibit limbic DA -> negative symptoms.
Other NTs in Schizophrenia
Serotonin: Mediator NT, regulates DA in mesolimbic pathway.
Glutamate
GABA
Brain Structure and Schizophrenia
Enlarged ventricles (empty spaces of cerebrospinal fluid) -> less grey matter in frontal/temporal lobe yet no reduction in # of neurons (denser in some regions). Causes unknown.
Adolescent Onset
Indicated by writhing, excess infant crying. Possibly caused by maturation of PFC (new synapses/pruning), more DA activity, genetics, prenatal stressors (poor nutrition/vitamin D deficiency, maternal infection, birth complications like hypoxia).
Phenothiazines
Traditional drug therapy. Blocks D2 receptors which helps pos symptoms (not neg). Averse Effects: motor (extrapyramidal) problems, sedative, low blood pressures, constipation, urinary problems. Ex: Thorazine, Stelazine, Mellaril, Haldol (similar)
Effects of Phenothiazines on Extrapyramidal System
Parkinsonian symptoms, Dystonia (body twitching), Akathesia (motor restlessness [pacing, fidgeting]), Tardive Dyskinesia
Tardive Dyskinesia
Involuntary contractions as result of use of phenothiazines. Type IIs and 55+ F w/ mood disorders more vulnerable. Either breakthrough (not reversible, after long heavy use of phenos) or withdrawal from phenos.
Atypical Antipsychotics
D4 and serotonin blockers
Clozapine (Clorazil)
Atypical Antipsychotic released in 89. Reduced positive and negative symptoms with fewer extrapyramidal issues. Averse effects: agranulocytosis (reduced white blood cell count -> infection. Clozapine must be taken in conjunction w/ regular blood tests), weight gain, sedation, increased risk of Type II Diabetes
Risperidone
Affects serotonin and is a weak blocker of some DA’s (more D1 and D4 than D2). Fast onset. Less severe averse affects, but does lower prolactin levels
Efficacy of 1st vs 2nd Generaton Antipsychotics
Dubious findings as research funded by drug companies. 2009 meta-analysis: among 4 new drugs, some were more effective (Clozapine mostly) and some were not.
Averse Effects of 1st vs 2nd Generation Antipsychotics
Extrapyramidal problems in heavy dose 1st gens, risperidone
Short-term vs Long-term
Short term (6-10 mo): Patients on meds do better than patients off meds. Long term: Mixed results. In some cases, better off meds (personal variability)
Social Skills Training
Improve skills of relating to cope with social interaction/daily living
Family Therapy
Educate family about illness/med, improve communication
CBT and ACT
Accept (not eliminate) negative thoughts, but stop acting on them. Reduces rehospitilization by 50%
Cognitive Training (Cognitive Enhancement Therapy)
Improve attention, problem solving, memory, cog. skills. Usually computer based.
Prognosis
Used to be very negative (only hospitalized patients studied). Today, rule of thirds used as prognosis (1/3 improve significantly, 1/3 stay the same (episodic relapses in functioning), 1/3 chronically, severely disabled.)
History of Hospitilization
Overcrowded state mental hospitals and poor drug therapy. 1955 - 600K in state mental hospitals. Today - 40K. Milieu Therapy. Token Economy
Milieu Therapy
Humanistic theory of schizophrenic treatment. People do better when given respect and meaningful work. Still used in some situations
Token Economy
Patients work on projects to earn tokens which can be redeemed for things/privileges. While issues in that there is no real world token economy, still useful in keeping off hospitilization
Hospitilization Today
Only used for acute phases (short term) and stabilization when danger to self/others
Community Mental Health Act of 1963
Moved ill out of hospitals into community. Provided network of services (community mental health centers, short-term/partial (day) hospitilization, group homes, workshops)
Success of Community Treatment
40-60% have no treatment. Shortage of beds, CMH centers, day programs, residences, and workshops. Funding has increased, but mostly goes to meds, disability income, and patients w/ less severe symptoms. Rural care has increased, but still shortages. NAMI state evals: most states got C or D. Causes: insufficient funding, worker preference (easier to treat nonpsychotics), NIMBYism
Homeless and Prison Populations
1/3 of homeless and 1/2 of prison inmates have severe mental illness
Social Policy
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