lecture 11 + ch6+11(some) Flashcards
what % of ppl aged 65+ in Canada have a psychological disorder? also, who specifically in this age group has higher rates?
20%
people living in health care and social institutions
__% of older adults report mental health problems get treatment
50%
cognitive declines and other changes occuring with age
cognitive declines:
- perceptual speed
- episodic memory
- spatial visualization
- reasoning
changes in structure and functioning in areas associated w executive control (hippocampus, PFC)
older adults recruit more brain regions than do younger adults, so may need additional executive resources to perform the same task
delirium
acute state of confusion
disoriented and impaired attentional skills and consciousness
onset is abrupt with a short duration, and symptoms may fluctuate throughout the day
what % of those in urgent care facilities (esp intensive care) experience delirium?
10-30%
delirium causes
- fever, malnutrition, severe dehydration, acute infection
- meds and subtances
- brain trauma/injury
- brain changes due to neurocognitive disorder
- environmental stressors
delirium treatment
first step is identifying underlying cause
rapid treatment= better longterm outcome
acute delirium (triggered by substance withdrawal) treated with antipsychotics
psychosocial treatment is used to help ppl cope with anxiety and hallucinations
major neurocognitive disorder
previously called dementia
gradual deterioration of brain functioning that impacts judgement, memory, language and other processes that interfere w independence
mild neurocognitive disorder
new to dsm5
focus on early stages of cognitive decline
modest decline that does not interfere with independence yet
causes of major/mild neurocognitive disorders
alzheimers
vascular disease
traumatic brain injury
parkinsons
substance abuse
huntingtons disease
prion disease
neurocognitive disorder due to alzheimers disease symptoms
initial memory + learning issues that develop gradually and slowly get worse
irritable and social withdrawal
aphasia (cant think of words they wanna say), apraxia (loss of fine motor skills, ex; gestures) , and anomia (cant recognize and name objects u used to known/name)
difficulty planning, organizing, sequencing or abstracting info
what is the most prevalent neurodegenerative disorder
neurocognitive disorder due to alzheimers disease
causes of neurocognitive disorder due to alzheimers disease symptoms
there is widespread synaptic and neuronal loss
specifically, there are 2 specific structural abnormalities that affect this:
- neurofibrillary tangles: Tau fibres twist
- neuritic (beta amyloid) plaques: plaque made of beta amyloid that aggregates in spaces between neurons
these 2 things can be caused by gene mutations in genes that code for proteins that typically clear beta amyloids from the brain. obvi when this gene is mutated, it won’t do this action properly (resulting in the plaque). can also be caused by environmental factors like smoking!
can gene mutations be inherited?
yes
what are Tau fibres?
proteins that help transport nutrients in the nerve cell
neurocognitive disorder due to vascular disease
cognitive decline due to reduced blood flow to brain
this can be a one time event (stroke) or ongoing
cognitive issues have abrupt onset, like sudden numbness in face/arm/leg, confusion or trouble speaking, trouble seeing, etc
what is the 2nd most frequent cause of neurocognitive disorders after alzheimers disease?
vascular disease
causes of neurocog. disorder due to vascular disease
atherosclerosis, which is thickening or arteries due to plaque build up. the arteries narrow and blood flow is reduced.
neurocognitive disorder due to traumatic brain injury cause+ symptom
results from hit to the head
ranges from mild to severe
symptoms + duration range depending on what brain area affected
(concussion= not too serious, cerebral contusion= bruised brain, cerebral laceration= brain is pierced, chronic traumatic encephalopathy= repeated concussions over time)
neurocognitive disorder due to parkinsons disease symptoms + cause
4 main symptoms
1. tremor of hands/arms/legs/jaw/face
2. rigidity of limbs and trunk
3. slowness in initiating movement
4. drooping posture or impaired balance and coordination
occurs due to damage to neurons in substantia nigra
- dopamine loss
- dopamine neurons are dying due to accumulation of Lewy bodies (plaque build up INSIDE of neuron)
substance induced neurocognitive disorder
delirium associated w substance intoxication, withdrawal, use of multiple substances, or inhalants
symptoms of this are common in those w history of heavy substance use
exposure to environment toxins can also cause this
neurocognitive disorder due to huntingtons disease (causes, symptoms, treatment)
rare, genetically transmitted, degenerative disorder
(kids have 50% chance of getting this from a parent who has it)
symptoms: cognitive, emotional, and physical disturbances
no treatment + death usually happens 15-20 years after it starts.
neurocognitive disorder due to prion disease (cause)
Prions make spongy holes in the brain, which give it a sponge-like texture and causes neurocognitive symptoms
ex; mad cow disease
what are prions?
infectious pathogens structurally different from other pathogens
list + give examples of neurocognitive disorder treatments
FIRST any underlying medical issues are treated.
THEN other treatments can be used:
- rehab services (physical/speech therapy)
- biological treatment (medications for symptoms)
- psychological treatment (address emotion changes)
- lifestyle changes (exercise)
- environmental support
define personality disorders
enduring pattern of inner experience and behaviour that deviates markedly from expectations of the individuals culture
the pattern is stable and does not change
starts in adolescence
pattern leads to distress or impaired functioning
state the names of the 2 approaches to personality disorders
dimensional approach
DSM-5 approach (categorical)
dimensional approach to personality disorders (state the criteria and then explain each one) .. long card sorry :(
says that personality disorders involve 2 things:
1. a disturbance in continuum of healthy self
disturbance in continuum of healthy self can be…:
- disturbance in self direction (normal self direction: goals consistent with ur identity/societys norms, appropriate self reflection)
- disturbance in their identity (normal identity: seeing yourself as a unique identity from others, accurate self perceptions)
- disturbance in positive interpersonal relationships
(normal relationship: having empathy and intimacy)
AND
- presence of 1 or more pathological personality traits
ex:
- negative affectivity (instead of emotional stability) , like depressed/anxious, emotional
- detachment (instead of extraversion) , like withdrawal
- antagonism (instead of agreeableness), which is like being manipulative and hostile
- disinhibition (instead of conscientiousness), like being irresponsible/impulsive
- psychoticism (instead of lucidity) , like having unusual beliefs and experiences
categorical approach to personality (dsm-5)
the dsm5 identifies 10 personality disorders that are organized in clusters:
cluster A: odd or eccentric disorders
cluster B: dramatic, emotional or erratic disorders
cluster C: anxious or fearful disroders
causes of personality disorders (generally)
genetic: heritability ranges from 40-60%
environmental: early emotional/physical/sexual abuse
general treatments for personality disorders
structure
treatment alliance
consistency
validation
motivation
metacognition
paranoid personality disorder + treatment
cluster A disorder
excessive mistrust and suspicion of others without justification
they are also reluctant to trust bc they expect to be exploited
psychotherapy (like cognitive therapy) that focuses on reducing paranoia
2 perspectives on causes of paranoid personality disorder
psychodynamic perspective:
- disorder results from projection (the id is making hostile/aggressive thoughts abt others, so ego uses projection as defense mech.), so the person believes that the other ppl want to be aggressive to them even though its actually the opposite
cognitive behavioural perspective:
- person has adapted maladaptive schemas/thinking patterns, so they assume that others have negative intentions always + thus mistrust them
schizoid personality disorder
cluster A disorder
pervasive pattern of detachment from social relationships + restricted range of expression of emotion
have a history of social isolation, emotional coldness, and seeking solitary activities
show social deficiencies similar to other cluster A disorders, but not the unusual thought process
causes + treatment of schizoid personality disorder
not much known abt causes besides childhood shyness, abuse or neglect
treatments: psychotherapy that focuses on teaching value of relationships and social skills (ex; role playing)
schizoTYPAL personality disorder
odd, eccentric, paranoid or weird thoughts and behaviours combined with discomfort and less capacity for relationships
does NOT involve breaks with reality, despite it being more common among those related to someone w schizophrenia
causes + treatment of schizoTYPAL personality disorder
genetic/biological causes: may be linked to schizophrenia
treatment: 1.psychotherapy focused on developing social skills
2.sometimes meds, but the side effects reduce compliance to meds
antisocial personality disorder (ACCORDING TO THE DSM-5)
cluster B disorder
criteria (according to dsm5):
pattern of disregard for and violation of rights of others, occurring since age 15 (ex: failure to conform to social norms/laws)
evidence of conduct disorder before age 15
however it is only diagnosed at 18+
is antisocial personality disorder the same as psychopathy?
NO!
psychopathy + criteria
NOT INCLUDED IN DSM-5
internal functioning issues like emotional detachment, impulsiveness, etc
Hervey Cleckley published the diagnostic criteria for psychopathy, which includes 16 criteria organized in 3 categories:
- positive adjustment (ex; suicide threats)
- chronic behavioural deviance (ex: recklessness)
- emotional interpersonal deficits (ex: lack of remorse)
dimensional approach to personality disorders (ASPD example)
disturbances:
1. disturbance in self direction: personal gratification, failure to confirm to legal/ethical standards
- disturbance in identity: egocentric (they r the main star of their life lol)
- disturbance in positive relationships: lack of concern for others feelings, exploitative
causes of antisocial personality disorder + different perspectives of causes
gene-environment interactions
underarousal hypothesis:
- abnormal brain structure/function
- low lvls of cortical arousal lead to sensation and stimulation seeking
fearlessness hypothesis:
-higher threshold for experiencing fear
treatment for antisocial personality disorder
intervening in childhood
cognitive therapy (guide client away from self focus)
CBT (target inappropriate behaviors + teach them consequences of norm violates)
borderline personality disorder
Cluster B
pattern of volatile unstable emotional reactions, instability in relationships, poor self image / unstable self image and impulsive responding
hypersensitive to social cues
fearful preoccupation ( always suspicious of partners n cues that they dont love them)
what % of borderline personality ppl engage in self injurious behaviours? what % die by suicide?
75% do the self harming behaviours
10% die by suicide
what is the most commonly diagnosed personality disorder
borderline
borderline personality disorder causes
biological:
- genetic (impulsive trait)
- brain struc/func (less brain volume + acitivity differences in areas for emotional regulation)
psychological
- negative cognitions ( I’m worthless)
social
- early childhood abuse/neglect
GENERALLY, what are 2 treatment options for borderline (will go into more specific on another card cuz hard 2 remember)
medications and psychotherapy
medication treatment for borderline
antidepressants, lithium, antipsychotics
psychotherapy treatment for borderline
dialectical behaviour therapy
- for those with suicide ideation/behaviour
- stage1: develop a stable life
- stage2: address trauma
-stage 3: self respect
dynamic deconstructive psychotherapy
- for those who find therapy difficult or have comorbid conditions
- focus on forming a coherent sense of self
transference focused psychotherapy
- good for reducing self destructive behaviours
- focus on forming a coherent sense of self
histrionic personality disorder (what is it, causes, treatment)
Cluster B
pattern of excessive emotionality and attention seeking
engage in self dramatization, exaggerate emotions, flirtatious behaviours
causes:
- autonomic or emotional excitability
- parental reinforcement
treatment:
- psychodynamic therapies that focus on finding out why they want attention (ex; CBT)
narcissistic personality disorder (what is it, cause, treatment)
Cluster B
pattern of grandiosity, need for admiration, lack of empathy
require constant attention/approval, not good w criticism, entitled
starts in early adulthood
cause:
- possibly psychological factors like parental model
treatment:
- little success, but may focus on building empathy and reducing self involvement
avoidant personality disorder
Cluster C
pattern of social inhibition, feeling inadequate, hypersensitive to -ve evaluations
intense fear of humilitation/rejection and low self esteem
cause:
-maybe interaction bw childhood environment and temperament
treatment:
- behavioural therapies that teach social skills in groups
what is the debate around avoidant personality disorder?
ppl wonder if its a continuum of social anxiety disorder
dependent personality disorder (what it is, cause , treat)
Cluster C
excessive need to be taken care of that leads to submissive and clinging behaviour and fear of separation
lack self confidence, cant take responsibility
causes:
-psychodynamic perspective: maternal deprivation leading to fixation at oral stage
-behavioural perspective: family environment rewarded dependent behaviours
- cognitive perspective: development of distorted beliefs that encourage dependency
treatments: no clue! but possibly to develop self confidence
obsessive compulsive personality disorder (wht is it, cause, treat)
cluster C
preoccupation w orderliness, perfectionism, at the expense of efficiency
very preoccupied with details
cause:
- not sure! but occurs in families so maybe genetic
treatment:
- possibly cbt
list the names of all the disorders under each cluster
cluster A:
- schizotypal personality disorder
- schizoid personality disorder
- paranoid personality disorder
cluster b:
- antisocial pers. dis.
- borderline
- histrionic
- narcissistic
cluster C:
- avoidant pers. dis.
- dependent pers. dis.
- obsessive compulsive pers. dis.
what disorder is considered a psychotic disorder AND a cluster A personality disorder?
schizotypal personality disorder
