final exam Flashcards
Myers-Briggs Test
- Widely used but not by psychologists
- Not supported
- Appeal in generic descriptions, capitalizing on the Barnum Effect
o Viewing vague personality descriptions as specific to them (e.g., “Aries, you are going to have a gangbuster of a day!!”
What is the five factor model
Openness
Conscientiousness
Extraversion
Agreeableness
Neuroticism
What is a personality disorder?
o Persistent pattern of emotions, cognitions, behaviour resulting in enduring emotional distress for affected person and others
What is Cluster A
odd or eccentric
What disorders fall into Cluster A
- Paranoid Personality Disorder
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
Paranoid Personality Disorder Description
o Suspicious, mistrustful, argumentative, complain, quiet, hostile towards others, suicidal
Causes of Paranoid Personality Disorder
o Genetics (Kendleretal.,2015)? Relatives with schizophrenia
o Mistreatment in childhood–be vigilant against Those who could cause harm
o Schema of being on guard– vigilance and confirmatory bias
o Cultural: second language, immigration, hearing impairments, prisoners–prone to interpret ambiguity in a suspicious way, e.g., people laughing must be laughing at you
Schizoid Personality Disorder Description
o Detachment from social relationships, no desire to enjoy closeness with others, cold, aloof
Causes of schizoid personality disorder
o Childhood shyness, abuse and neglect, low density dopamine receptors – aloofness also found in those with schizophrenia
Schizotypal Personality Disorder description
o Social deficits, psychotic-like symptoms, paranoia, ‘magical thinking’, hypersensitive to criticism as children
Causes of schizotypal personality disorder
o Genetics – lots of overlap with schizophrenia?
o Left hemisphere damage – memory and learning deficits in some?
What disorders fall into cluster B
- Antisocial personality disorder
- Borderline personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
Antisocial Personality Disorder Description
o Aggressive, lying, cheating, no remorse, substance abuse, unnatural death in boys with this disorder
causes of antisocial personality disorder
o Gene-environment interaction: kids with convict moms offend in their adopted homes but less so if they spent less time in an interim foster situation
o Under arousal of cortex? U shed distribution, theta in wake
o Defective x chromosome (gets canceled out by the y in girls)
o Fearlessness: less reactivity to shocks
o They are impervious to reward info – they don’t stop when reward is unlikely
o Coercive parenting: yell at kid then back down when kid escalates
o Trauma leads to turning off emotions
borderline personality disorder description
o Turbulent relationships, fear abandonment, self-mutilating behaviours, no control over emotions
borderline personality disorder causes
o Genetics: higher concordance with monozygotic twins
o Early trauma (76-91% reporting trauma); 20-40% have no reported trauma
o Invalidating parental styles “you’re not hungry”
Parents deny them and invalidate them of emotional experiences
o There is an attentional bias for words like abandonment, emptiness
histrionic personality disorder description
o Dramatic, theatrical, self-centred, seek constant reassurance
o Hugging, excessive emotional displays, vain, impressionistic
causes of histrionic personality disorder
o Overlap with antisocial personality disorder–sexist notion that women are HPD (wandering uterus) and men are antisocial – both appear as charming and manipulative to get what they want
narcissistic personality disorder description
o Unreasonable sense of self-importance, grandiosity, no compassion for others, envious, arrogant
causes of narcissistic personality disorder
o Failure of empathic “mirroring” in parents?
o Lots of overlap with psychopathy
what disorders fall into cluster c
- Avoidant personality disorder
- Obsessive compulsive personality disorder
- Dependent personality disorder
avoidant personality disorder description
o Interpersonally anxious, fear rejection, pessimistic about future
causes of avoidant personality disorder
o Born with difficult temperament, parental rejection, uncritical love
obsessive compulsive personality disorder description
o Rigidity, poor interpersonal relationships, quest for perfectionism
cause of obsessive compulsive personality disorder
genetics
dependent personality disorder description
o Interpersonally dependent, anxious
causes of dependent personality disorder
o Disruptions in early childhood lead to fears of abandonment
Emil Kraepelin on the categorization of schizophrenia
o Combined previously distinct disorders of insanity:
o Catatonia: immobile at times; agitated excitation at others – Hebephrenia: immature emotionality
o Paranoia: delusions of grandeur/persecution
Dementia praecox and manic depressive illness
used to capture this cluster of symptoms; thought that had the same underlying cause; later added hallucinations, delusions, negativism, and stereotyped behavior
Eugin Bleuler
Introduces the term Schizophrenia
o “splitmind”
o They can’t connect one idea/experience/perception to the next
o “Associativesplitting”ofpersonalityfunctions–thereisadisconnection/a “breaking of associative threads”
o Associations allow us to think and function efficiently, if there is a breakdown, there is a breakdown of thought and other processes
Difference between Kraeplin and Bleuler
Kraeplin was someone who focused on early adverse experiences and Bleuler: this is a thought disorder that connects all the symptoms into a heterogeneous presentation
polytheistic disorder
- Several behaviours or symptoms not shared by all people given diagnosis of schizophrenia
- Clusters of symptoms identified: Positive symptoms(include delusions and hallucinations); negative symptoms (deficits e.g., diminished emotional expression), disorganized symptoms or catatonia (rambling speech, erratic behavior).
Positive negative and disorganized symptoms of schizophrenia
- Positive symptoms: delusions and hallucinations
- Negative symptoms: avolition
- Disorganized symptoms: inappropriate affect
Positive symptoms of schizophrenia
- 50%–70%people with schizophrenia experience positive symptoms: hallucinations, delusions, or both
Positive symtom: delusions
o A disorder of thought content
o Delusion of grandeur
o Delusions of persecution
o Cotard’s syndrome
Believe part of body has died or been removed (often brain)
o Capgras syndrome
Believe that someone has been replaced
Positive symtom: hallucination
o Experience of sensory events without input from surrounding environment
o Auditory hallucinations: hearing things that aren’t there
Associated with listening to own thoughts
Abnormal activation of primary cortex
Increased metabolic activity in left auditory cortex
negative symptoms of schizophrenia
- Absence or insufficiency of normal behaviour
- Seen in approximately 25% with schizophrenia
- Avolition: inability to initiate/persist in activities
- Alogia: absence of speech; brief replies
- Anhedonia: lack of pleasure experienced
- Asociality: lack of interest in social interactions
- Affective flattening: no open reaction to emotional situations
disorganized symptoms of schizophrenia
- Disorganized speech: communication problems
- Inappropriate affect and Disorganized behaviour: laughing or crying at inappropriate times
- Catatonic immobility: keeping body and limbs in the position they are put in by someone else
Prevalence of schizophrenia
o 0.2% to 1.5% in general population
o Less than average life expectancy
o Men and women affected at same rate
genetic influence of schizophrenia
o Multiple gene variances combine to produce vulnerability Family Studies
o Children of schizophrenic parents likely to have it too
o Seen within families
o Predisposition may be inherited
dopamine (neurobiological) influence of schizophrenia
o Dopamine
Clues to the role of dopamine in schizophrenia:
* Neuroleptics (dopamine antagonists) effective in treating
* Neuroleptics produce negative side effects
* L-dopa (agonist) produces schizophrenia-like symptoms
* Amphetamines, which activate dopamine, can worsen some symptoms in schizophrenia
Brain structure (neurobiological) cause of schizophrenia
Abnormally large lateral and third ventricles in people with schizophrenia
Hypofrontality (less active frontal lobe)
* Associated with negative symptoms
Brain damage
Viral infections (neurobiological) cause of schizophrenia
In utero events may be associated with schizophrenia
Prenatal brain damage
stress cause of schizophrenia
o Stress
Retrospective and prospective approaches to examine impact of stress
Tendency for people with schizophrenia to be found in lower social classes
Sociogenic hypothesis
Social selection hypothesis
families and relapse cause of schizophrenia
Schizophrenogenic: mothers with cold, dominant, rejecting nature
Double bind: conflicting messages
Expressed emotion (EE): disapproval, animosity, intrusiveness
Predictor of relapse
biological treatment of schizophrenia
o Neuroleptics: dopamine antagonists
o When effective, neuroleptics help people think more
o clearly
o Reduce or eliminate delusions and hallucinations
o Effective for 60%–70% persons who try them
o Newer antipsychotics have fewer side effects (TD)
o Help in improving cognitive functioning
o Psychosocial interventions include medication- taking compliance
o Transcranial magnetic stimulation(TMS)treatment for hallucinations
o TMS also improves auditory hallucinations: effect is brief
psychosocial intervention of schizophrenia
o Psychoanalytic approach: not beneficial; maybe harmful
o Behavioural family therapy: must be ongoing if patients and families are to benefit from it
o Multilevel treatments reduce relapses
Impact of dementia
- 46.8 million people worldwide were living with dementia in 2015
o 75 million by 2030 - As of 2016, there are 564,000 Canadians living with dementia
o 937,000 by 2031 - Incidence: 25,000 cases every year
- In Canada 1 in 20 individuals over age 65 and around ¼ of those over age 85 has AD
Alzheimer’s type
- Multiple cognitive deficits that develop gradually and steadily
- Cognitive impairments
o Aphasia, apraxia, agnosia, anomia
Speak differently(aphasia), difficulty with motor behaviour (apraxia), can’t recognize objects (agnosia), being able to name things
o Mini mental state examination
o Clock test
Draw analog clock; loss of understanding what a clock is, numbers, where the numbers go
Sporadic or late-onset AD
- Accounts for more than 95% of all AD cases
- Environment and lifestyle and their interaction with Apolipoprotein E )Apo E) gene on chromosome 19
o ApoE gene has 3 different isoforms, e2, e3, e4
o Around 20% of the population has at least one copy of ApoE4
o Half of individuals who have sporadic AD
familial or early onset AD
- Accounts for 1-5% of all AD cases
- Autosomal-dominant genetic disease
- Due to mutations in 1 or more of the following genes
o Amyloid precursor protein (APP gene on chromosome 21)
o Presenilin 1 gene (chromosome 14)
o Presenilin 2 gene (chromosome 1)
Atrophy for AD
o Atrophy due to neuronal loss (neurons have died)
o Extracellular amyloid plaques
o Intracellular neurofibrillary tangles
Beta-amyloid plaques
- Amyloid precursor protein (APP) is a transmembrane protein
o Play roles in growth and repair of neurons
o Normally it is cleaved with alpha and y-secretase
o Cleared with beta and y secretase under unknown conditions
o Leading to beta amyloid plaques formation
Neurofibrillary tangles
- Outside the neurons, the microtubules disintegrate and the proteins get tangled and strangle the neuron
Specificity of tangles and plaques
- There is evidence that pathology of plaques and tangles can be present in an individuals brain without the individual ever showing symptoms of AD
- Can this be due to higher level of reserve
- In a study by Stern (2012), those with higher reserves (high cognitive test scores) are resilient longer in the presence of these tangles
o A lot more connections so they can stand to lose more and more neuronal loss
Cholinergic hypothesis
- Cholinergic neurons in the basal forebrain degenerate
o Acetylcholine neurotransmission is reduced in the cerebral cortex - The cholinergic dysfunction interferes with attentional processing
o Causes cognitive impairment
Neurotoxicity
- There is evidence also for glutamate-mediated neurotoxicity in the pathogenesis of AD
- Glutamate receptors N-methyl-D-aspartate (NMDA) are overactive
Neuroinflammation
- There is evidence also for glutamate-mediated neurotoxicity in the pathogenesis of AD
- Glutamate receptors N-methyl-D-aspartate (NMDA) are overactive
mild cognitive impairment
- An impairment in memory and/or non-memory domains more than normal, but not sufficient to cause impairment in functional abilities
o Amnestic MCI
o Non-Amnestic MCI
o 15-20% of people age 65 or older have MCI
o Contradictory results in relation to sex differences
o MCI looks like an early stage of AD
vascular dementia
- Caused by a stroke or a large vessel cerebral vascular accident
- Caused by cerebral small vessel disease
- Damage to small arteries, arterioles, capillaries and small veins in the brain ‘white matter lesions’
Fronto Temporal dementia: behavioural type
- Socially inappropriate behaviours
- Personality changes
- Apathy
- Impulsiveness
- Odd behaviours
- Inability to concentrate
- Inability to make plans
Fronto Temporal dementia: language type
- Non-fluent aphasia
- Primary progressive aphasia
- Memory impairment occurs later in disease progression
Lewy Body
- Progressive cognitive impairment initially affecting attention and executive function
- Learning and memory impairment at later stage
- Visual hallucinations
- Delusions
- Sleeping difficulties
- Fluctuations in cognitive abilities
- Repeated falls
Alcohol-related dementia
- Excessive and chronic use of alcohol permanent damage to the structure and function of the brain
- Uncertainty of the exact pathophysiological profile
o Thiamine (vitamin B1) deficiency
o Neurotoxicity
o Nutritional deficiencies
o Co-morbidities such as psychiatric illness
o Cerebrovascular disease related to alcohol
o Head injury from fall
o Abusing other substances - If cognitive deficits are recognized early, they may be reduced or reversed if the individual stops drinking alcohol
Somatic symtom
- Preoccupation with health or body(“soma” meaning body)
- Exaggeration of slightest symptoms
dissociative disorders
o Loss of identity due to an intense or an extreme experience
Somatic symptom disorder
- Pain or other physical symptom complaints exacerbated by psychological factors
- May not be a clear physical reason for complaint, or the complaint is far in excess of the problem
o Leads to anxiety and distress
o Secondary/coping behaviours
o They seek reassurance and sympathy
o The support from others reinforces the situation
illness anxiety disorder
- Formerly known as “hypochondriasis”
o Physical symptoms are absent or mild
o They detect a benign physical sensation, misinterpret it as dangerous, become obsessive monitors for physical sensations and become anxious – they then misinterpret the physical symptoms of anxiety as evidence of illness and so on.
o Concern is “idea” of being sick
o Reassurance from physicians is not helpful
causes of somatic symptom disorder and illness anxiety disorder
- Enhanced perceptual sensitivity to illness cues
- Interpret ambiguous stimuli as threatening
o Genetic causes
o Negative life events
o Attention seeking through illness
Conversional disorder
- Clinical description: Physical malfunctioning: paralysis, blindness but can avoid something coming at them, difficulty speaking (aphonia) but without damage, seizures without EEG activity
o Unconscious conflicts expressed through (converted to) physical symptoms
o ‘Functional’: severe physical dysfunction without an organic cause
o Comorbidity
Especially somatization disorder
o Low SES, women, men under stress
Causes of conversional disorder
o Traumatic event leads to conflict = anxiety
o Repression of conflict (unconscious)
o When anxiety becomes conscious person converts it to physical symptoms
o Person gets attention
o Interpersonal factors: conflict
o Social and cultural factors: associated with religious experiences
differential diagnosis
- It is important to distinguish between conversions Disorder and closely related disorders:
- Malingering (i.e faking): secondary gain, often not an identifiable stressor
- Factitious disorder: fakes symptoms with no obvious secondary gain
- Factitious disorder imposed on another: Munchausen
depersonalization derealization disorder
- Severe feelings of detachment
o Outside observer of own body or mind - Significant distress or impairment
o Emotion, perception - Rare; onset usually in adolescence
- No conclusive evidence regarding effectiveness of psychological and drug treatments
o We treat stress reactions and tend to use treatments similar to CBT for panic
dissociative amnesia
- Generalized: inability to remember anything, including identity
- Localized: inability to remember specific events (usually traumatic)
- Usually adult onset
- Often resolves when stressors resolves
o Therapy attempts to retrieves lost info
dissociative identity disorder
- Several identities (alters) co-exist simultaneously; the average number of alters in a client with DID is 15
- Aspects of a person’s identity are dissociated
- Host identity: asks for treatment
- Switch: instantaneous transition from one personality
o 37% report changes in handedness to another
causes of dissociative identity disorder
o Childhood abuse: physical and sexual
Take on different identities as escape is not possible
Escape sought from physical and emotional pain
o DID sub-type of PTSD?
o Temporal lobe epileptic seizures can be associated with dissociative symptoms
o Sleep deprivation
DID: Real and False memories
o Memories could be a result of suggestions from therapists
o False memories can be created
o Severity of trauma related to severity of amnesia
criterial for civil commitment
- Mental disorder
- Danger to themselves or others
- In need of treatment
- Differences in definition/interpretation
- Varies across provinces
o Conservative definitions can delay treatment and expose patient to risk and poorer prognosis
o Liberal definitions can infringe on liberties
laws designed to protect
designed to protect
o People who display abnormal behaviour and
o Society
o Family with a child with delusions who wants them committed to protect them, but they are seen as not being an imminent threat
defining mental illness
o Legal concepts: severe emotional or thought disturbance
o Mental illness is not synonymous with mental illness
o Some provinces have a functional definition: effect of illness on the person (and their behaviour)
o Ontario is broad: ‘ a disease or disability of the mind’
Receiving DSM5 diagnosis does not mean that the person fits the legal definition
o Various definitions, ambiguity leading to flexibility
civil commitment: dangerousness
- Dangerousness
o Hallucinations, delusions, comorbid personality disorder
o Risk assessment
Traditionally not great at this but incremental improvements
Example, in those who have committed a violent offence: unmarried, high psychopathy score and a lapse on a previous release, predict violent reoffending
Example, predictors of suicide in the hospital include: aggression towards others in hospital, history of self-harm, suicidal or self harm behaviour in the two weeks before the admit
o Suicide, self-harm
two major influences on commitment are:
- Deinstitutionalization (closures of mental hospitals) and increased homelessness
- poor economic conditions
when can the government go against someone’s will
- Parens patriae the government can act as a surrogate parent when it appears the person cannot act in their own best interest
o If they are refusing or not understanding the need for their treatment, or they arnt’ capable of securing food, shelter, etc - Police power: the government is responsible for public safety so you can take people into custody
- People can request to enter a facility voluntarily too
criminal commitment
- Criminal commitment is the process by which people are held because
o They have been accused of committing a crime and are detained in a mental health facility until fit to participate in legal proceedings, or
o They have found not criminally responsible due to a mental disorder (NCRMD)
Formerly not guilty by reason of insanity
the insanity defence
o Not criminally held responsible on account of mental disorder (NCRMD)
o M’Naghten rule: they have to know right from wrong
o If someone is suffering from delusions and believe they are meant to kill someone they believe to be a devil, should they be jailed or treated?
o Differences between not guilty by reason of insanity and not criminally responsible due to a mental disorder
Term insanity replaced by mental disorder
Defendant now considered not criminally responsible instead of not guilty
Wrong actions legally or morally wrong
Not fit to stand trial
o Conditionally discharged
o Detailed in hospital
o Ordered to receive treatment
Fitness interview rest-revised
o Do they understand the nature of proceedings
o Do they understand the possible consequences of the proceedings
o Can they participate in their defence, e.g. communicate with lawyers
duty to warn
o Client’s potential victims (Tarasoff)
o Limits to confidentiality: imminent harm to self or others, child abuse
o Risks to patient
psychologists ethics to protect children
- Boundary issues
o Psychologists to avoid dual relationships
o Psychologists should not exploit relationships with clients - Do not harm
o Minimize harm to clients - Recognizing limits of competence
o Practice within limits of competence
rights of patients
- Right to treatment
- Least restrictive setting possible - Right to refuse treatment
- Must be competent to make decision
- Drugs side effects
- E.g anti psychotics
- Controversial
the rights of research participants
- Dignity of participants
- Informed consent: lots of horrific tales of violation
o Psychic driving put them in coma and play subliminal messages: “experimental treatment’ but patients thought they were part of care as usual
No consent from these patietns family
what is cluster B
dramatic, emotional, erratic
what is cluster C
anxious, fearful
