Dysfunction w/ Psychiatric Disorders

Question 1

What are the 4 motivating factors for classifying psychiatric illnesses?

Answer 1

1. to guide treatment choices
2. to allow clinicians to communicates
3. to serve parties who require a diagnosis (ie. insurance, CFA, legal system)
4. To permit research (via categorization - into causes, treatment responsiveness, prognosis)

Question 2

What are 3 components a condition must have to be included in the DSM?

Answer 2

1. disturbance in individual’s cognition, emotion regulation, or behaviour
2. dysfunction in the psychological, biological, or development processes underlying mental functioning
3. significant distress/disability in social, occupational, or other important activities

Question 3

What are some criticisms of the DSM criteria?

Answer 3

Heterogeneity of Criteria:

1. Level of detail: almost 24000 possible symptom combinations for panic disorder VS 1 combination for social phobia)
2. Overlap: for many diagnosis, 2 ppl diagnosed w/ no overlapping symptoms & some high overlap)
3. Authority: who judges distress/impairment? clinician vs self vs unclear
4. Comparator: compare to self (ie. more talkative than usual), normative (ie. excessive/inappropriate guilt)

Question 4

What are normative assumptions?

Answer 4

Evaluation of right or wrong (ie. ought, should)

Question 5

What are 3 examples of normative assumption in historical examples?

Answer 5

1. Masturbation (19th c.): threat to societies health, morality, future
2. Drapetomania: “illness” causing black slaves to attempt to escape
3. Homosexuality: classified as disorder in DSM-1/2

Question 6

What is deinstitutionalization?

Answer 6

movement (1950s-60s) to replace long-stay psychiatric facilities w/ community mental health services

possible w/ antipsychotic drugs (ie. chlorpromazine)

Question 7

What are some normative assumptions &
deinstitutionalization in historical examples & trends?

Answer 7

with less people in mental hospitals, more people were in prison

Question 8

What is the relationship b/w mental illness & violence?

Answer 8

if no substance use disorder, ppl with mental illness is NOT more violent than others from their neighbourhoods

what is responsible for violence among ppl with/without mental illness may be same

Question 9

What is the main criteria that goes into a diagnosis of schizophrenia?

Answer 9

2+ of the following

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized/catatonic behaviour
5. Negative symptoms

Question 10

Define positive symptoms. What are the positive Symptoms of Schizophrenia?

Answer 10

mental phenomena that do not occur in healthy people

• hallucinations: perceptions without sensory cause (often auditory
• delusions: beliefs that are not realistic or culturally appropriate (ie. i am being closely watched)

Question 11

Define negative symptoms. What are the negative symptoms of schizophrenia?

Answer 11

resulting from an impairment of normal function

• blunted emotional responses (affective flattening)
• impoverished content of thought & speech (disturbed attention)
• reduced social motivation

Question 12

What are the cognitive symptoms of schizophrenia?

Answer 12

impaired working memory & executive function

impaired source monitoring - tendency to misattribute own actions & thoughts to external causes, errors confusing imagination & real memory

Question 13

What are some risk factors for schizophrenia?

Answer 13

1. Genetics
2. Urban Environment
3. 1st/2nd trimester maternal infection/malnutrition
4. Perinatal complications
5. Cannabis/stimulant use
6. Paternal age >35years

Question 14

What is the non-pharmacological treatment for schizophrenia?

Answer 14

Cognitive Behavioural Therapy (CBT) shown some promise for management of +/- symptoms WHEN COMBINED with medication

Question 15

What is the pharmacological treatment for schizophrenia? What are typical & atypical drugs?

Answer 15

for + symptoms = antipsychotic drugs

typical drug: act on dopamine, can have movement disorder side affect (ie. chlorpromazine, haloperidol)

atypical drug: act on dopamine, serotonin, & other receptors, can have metabolic side affects (ie. olanzapine, aripiprazole)

**less luck treating negative symptoms

Question 16

What are the similarities/differences of the efficacy of the various nonpharmacological & pharmacological treatments of schizophrenia?

Answer 16

They both use medication/antipsychotic drugs to help manage schizophrenia

Question 17

What are the 2 theories of schizophrenia?

Answer 17

1. dopamine theory
2. glutamate hypofunction theory

Question 18

What is the dopamine theory of schizophrenia? What 3 findings was this based on?

Answer 18

schizophrenia caused by too much activity at dopamine receptors

1. antipsychotic drugs produce symptoms that are similar to parkinson’s disease
2. drugs known to increase dopamine levels produce symptoms of schizophrenia
3. efficacy of antipsychotic drug is correlated with degree to which it blocks activity at dopamine D2 receptors

Question 19

What were some problems w/ the dopamine theory of schizophrenia?

Answer 19

1. newer “atypical” antipsychotic drugs produce a wide variety of changes in brain & were just as good as traditional antipsychotics
2. takes 2-3 weeks for antipsychotic drugs to work, yet affects on dopamine receptor activity are immediate
3. most patients show no significant improvement to first antipsychotic they are given

Question 20

What are the findings of the Glutamate Hypofunction Theory?

Answer 20

phencyclidine (PCP) and ketamine can induce negative symptoms & psychosis & act antagonistically upon NMDA receptors (specific receptor for glutamate)

Question 21

What is a depressive state?

Answer 21

New/worsened, daily, for 2 weeks in a row:

depressed mood, loss of interest/pleasure, appetite changes, sleep changes, agitated/slowed, tiredness, fatigue, low energy, sense of worthlessness/guilt, impaired ability to think, recurrent thoughts of death, suicidal ideation, suicide attempts

Question 22

What is a hypomanic state?

Answer 22

abnormal, persistent elevated, expansive, or irritable mood & increased goal-directed activity/energy, at least 4 days

increased energy & activity, persistent mild elevation of mood, marked feelings of well-being, increased sociability & talkativeness, increased sexual energy, decreased need for sleep

Question 23

What is a manic state?

Answer 23

abnormal persistent elevated/expansive mood & increased goal-directed activity or energy, at least 1 week

inflated self-esteem/grandiosity, decreased sleep, more talkative than usual, flight of ideas/subjective experience, distractibility, increase in goal-directed activity/ psychomotor agitation, excessive involvement in activities that have high potential for painful consequences

Question 24

Compare Bipolar Disorder I and II.

Answer 24

Bipolar I: full mania, very intense (may hospitalize), can cause psychosis, delusions, risky behaviour

Bipolar II: no manic episodes, only hypomania, has major depressive episodes, still functional no psychosis

Question 25

What is Bipolar Disorder in terms of prevalence & life course?

Answer 25

prevalence: 0.6% Bipolar I, 0.4% Bipolar II Life course: 1. Pre-prodrome (asymptomatic) 2. Prodrome 3. Possible indication of BD 4. Probable indication of BD 5. Presentation of BD (diagnosable)

Question 26

What is the reward hypersensitivity model of Bipolar Disorder? Evidence?

Answer 26

being hypersensitive to reward = trait predisposes someone developing BD goal attainment = excessive reward states & (hypo)mania goal non-attainment = excessive reward deactivation & depressive state evidence: emotionally stable individual w/ BD - show excessive activity in frontal-striatal reward-related areas in response to reward-related cues, more risky choices than controls Prodomal features: - hypomania & mania: excessive goal setting & increased success expectancies - depressive episodes: decreased motivation & goal setting & low self-confidence teenagers who score high on reward sensitivity are more likely too develop bipolar disorder

Question 27

What are structural brain changes associated with Bipolar Disorder?

Answer 27

structural reduction in grey matter (similar to function areas) driven by time spent in manic episodes which are associated w/ neuroinflammation, stress hormones

Question 28

What are functional brain changes associated with Bipolar Disorder?

Answer 28

increased responsiveness in limbic & para-limbic areas (ie. amygdala, VLPFC, Ventral ACC) decreased responsiveness in areas associated w/ cognitive control (ie. Dorsal ACC, DMPFC, DLPFC)

Question 29

What are Bipolar Disorder treatment options?

Answer 29

mood stabilizers (lithium - valproate, lamotrigine) atypical antipsychotics (quetiapine, aripiprazole, asenapine, lurasidone, cariprazine) psychotherapy - CBT, health education, family-focused treatments all have some evidence antidepressants ALONE not recommended >50% of patients do not adhere to treatment

Question 30

What are the 3 components of the tripartite model? What is a test for each?

Answer 30

1. WORKING MEMORY - Holding & mental working w/ information "in mind" (digit/pointing span, how many can you remember?) 2. INHIBITORY CONTROL - Resisting temptations, not acting impulsively/prematurely, over-riding automatic behaviour (stroop test, say colour of text) 3. COGNITIVE FLEXIBILITY - fluidly changing perspectives/approaches to solving a problem, adjusting to new demands, switching b/w priorities/tasks (ie. trail making w/ alternating letters & numbers)

Question 31

What is the orbitofrontal subdivision of the prefrontal cortex (traits)?

Answer 31

1. impulsive 2. socially inappropriate 3. poor safety judgement 4. difficulty evaluating anticipated rewards & punishments 5. don't "learn from mistakes" due to diminished guilt & regret

Question 32

What is the dorsolateral subdivision of the prefrontal cortex (traits)?

Answer 32

1. distractible 2. disorganized 3. perseverative 4. difficulty multitasking 5. poor time management & prioritization

Question 33

What are the consequences of a major frontal lobe damage?

Answer 33

poor problem-solving ability, dramatic change in social behavior

Question 34

What are the major symptoms of ADHD?

Answer 34

extreme inattention, hyperactivity, impulsivity

Question 35

What is the neurobiology of ADHD?

Answer 35

reduced activity & volume of PFC, slower maturation of PFC (normal cortical thinning is slower; this is correlated w/ hyperactivity/impulsivity)

Question 36

What is the treatment for ADHD?

Answer 36

medications that act upon dopamine & norepinphrine systems in PFC & subcortical structures

Question 37

What is stigma?

Answer 37

Social disapproval shown through negative attitudes, beliefs, or behaviours toward someone because of who they are or their situation

Question 38

How does stigma impact individuals with ADHD?

Answer 38

barrier to care & social support, increased social difficulties & social rejection, social isolation, less self-compassion, lower self-esteem

Question 39

How do gender & ADHD intersect in DIAGNOSIS?

Answer 39

Diagnosis rates: Childhood - 3:1 boys to girls Adulthood - 1:1 men to women

Question 40

How do gender & ADHD intersect in PRESENTATION?

Answer 40

girls struggle socially more

Question 41

How do gender & ADHD intersect in COMORBIDITIES?

Answer 41

women have a greater presence of comorbid disorders

Question 42

How do gender & ADHD intersect in IMPAIRMENTS?

Answer 42

women have greater severity of impairment than men

Question 43

What are some factors that contribute to girls & women w/ ADHD being under/mis-diagnosed?

Answer 43

- lack of knowledge of gender difference in ADHD - gender bias in research - higher rates of comorbidities in women with ADHD - individuals with externalizing symptoms more likely to be recognized/referred - higher threshold for symptom severity in women for referral & diagnosis

Question 44

What is self-compassion?

Answer 44

practice of being kind to oneself in times of suffering (ie. experiencing failure or personal difficulty)

Question 45

What are the 2 main types of self-responding?

Answer 45

1. Uncompassionate self-responding (self-judgement & criticism, over-identification with negative thoughts, emotions & experiences, feelings of isolation in suffering) 2. Compassionate self-responding (self-kindness & understanding, mindfulness, acknowledging common humanity in suffering)

Question 46

What are some potential benefits of self-compassion for individuals with ADHD?

Answer 46

1. improved psychosocial wellbeing & emotional regulation 2. improved resilience, self-efficacy & healthy coping 3. reduced comorbid symptoms, negative thinking & stress

Question 47

What are 2 examples of culturally-specific perceptions around mental health?

Answer 47

1. Asian Cultures: mental illness seen as personal weakness/ failure of self-control (ie. fear of "losing face" bring shame to family) 2. African Cultures: mental illness attributed to supernatural causes like curses/evil spirits

Question 48

What are 2 potential strategies to address mental health stigma?

Answer 48

1. public awareness campaigns: educating public to correct myths & misconceptions about mental health 2. cultural competency training for healthcare professionals: teaching healthcare providers to understand and respect cultural differences in how mental illness is perceived.