mental illness - personality and schizophrenia Flashcards
1
Q
what is a personality disorder? formal diagnosis? (adolescence, stable, variet, distress)
A
- deeply ingrained and inflexible pattern of thinking, feeling and relating to others or controlling impulses that cause distress or impaired functioning
- Adolescence: symptoms appear in adolescence – if they appear in adulthood you don’t have PD
- Inflexible
- Stable: stable pattern of reacting
- variety of situations: behave the same way in different places, to strangers, etco
- Distress/impairment
2
Q
3 categories of personality disorders to know?
A
- Odd/eccentric: others exploiting them, trying to harm them or lying to them, trustworthiness so can’t relationships, introversion, hidden meanings in everything, weird ways of speaking and dressing, strange beliefs
- Dramatic/erratic: disregards social norms, illegal things, lies ,lack of remorse, unstable moods, attention seeking, inflated ego, physical fights not uncommon, high risk for substance abuse, alcoholism
- Anxious/inhibited: obsessive compulsive, avoid interpersonal contact because they are afraid of criticism, rejection, disapproval]
3
Q
Borderline Personality Disorder - what? growing up?
A
- instability in mood, identity and impulse control
o calm and pleasant one moment, aggressive the next - Self-destructive: cutting themselves, suicide attempts
- Dangerous promiscuity – numerous sexual partners, over eat, over indulge in drugs and alcohol
- While growing up, had cold unempathetic mothers or overreacting mothers & difficulty with emotions made them angry and frustrated, left with no coping skills
4
Q
Antisocial Personality Disorder (APD) - what? characteristics?
A
- pervasive pattern of disregard for & violation of others’ rights that begins in childhood or early adolescence & continues into adulthood
- aggressive, violent, dangerous
- constant lying, lack of remorse, narcissism, bored very easily, need constant stimulation, violent tendencies
- So impulsive, hard to hold down a job
- But can appear to be very charming
- Dangerous because of complete disregard for safety
5
Q
APD: diagnose how? %? biological cause? risk factors?
A
- To be diagnosed: have to have symptoms arise in adolescence
- History of conduct disorder before age 15: aggression, destruction of property, rule violations, lying, stealing, setting fire, cruelty to animals
- Diagnosis of APD if at least 3/7 signs: illegal behaviour, deception, impulsivity, physical aggression, recklessness, irresponsibility, lack of remorse
- Characteristics: constant lying, lack of remorse, narcissism, bored very easily, need constant stimulation, violent tendencies
o So impulsive, hard to hold down a job
o But can appear to be very charming
o Dangerous because of complete disregard for safety
o American Psycho video clip example
o “sociopath”, “psychopath” - 3.6% of general population, male rate three times higher
- No clear biological cause but suggested by early onset and lack of success in treatment
o Less sensitivity to fear: psychopaths show less activity in amygdala and hippocampus in response to negative emotional words
o - Risk factors: substance abuse, ADHD, conduct disorders, childhood abuse or neglect, antisocial peers, antisocial or alcoholic parents
6
Q
Psychopathy - what? combination of? characteristics?
A
- specific form of APD, a controversial category
- like a stronger, more extreme APD
- combination of antisocial behaviours and lack of remorse or guilt
- Guiltless, dishonest, manipulative, unempathetic, self-centered, highly paranoid but at the same time: charming, personable & engaging
7
Q
Schizophrenia - what? not the same as?
A
- psychotic disorder marked by severely impaired thinking, emotions and/or behaviours
- profound disruption of basic psychological processes – distorted perception of reality, altered or blunted emotion, disturbances in thought, motivation and behaviour
- “Split mind” not split identity
- not the same as dissociative identity disorder
8
Q
Schiz - % canadians? living where? gender? develops when?
A
- 1% population over 18 in Canada is schizophrenic
- One half of schizophrenics live at home/group home, one quarter are in jail, and the other quarter live on the streets
- Slightly more common in men
- Rarely develops before early adolescence - first episode usually late adolescence/early adulthood
9
Q
Schiz - DSM requirements?
A
- DSMIVTR: diagnosed when two or more of the following symptoms emerge during a continuous period of at least one month, with signs of disorder persisting for at least 6 months:
o Delusions, hallucinations, disorganized speech, grossly disorganize behaviour or catatonic behaviour, and negative symptoms
10
Q
Schiz - Positive Symptoms?
A
- doesn’t mean good or nice, present in the schizophrenic mind but not in a normal mind
- Aka the “haves” – things added to a normal mind
- Delusions, paranoia, persecution, thought broadcasting, thought disorder, grandiose thinking, mind reading, being controlled/controlling, movement problems: motionless, clumsy, repetitive actions, hallucinations,
- anosognosia: lack of insight, not denial
11
Q
Schiz - Hallucinations?
A
- False perceptual experience that has a compelling sense of being real despite absence of external stimulation
- sensory in nature, when you see/hear something that’s not there
- Most common form of hallucination is not visual but auditory (65%)
12
Q
Schiz - Delusions - persecution? grandeur? control? jealousy? identity?
A
- Patently false belief system, often bizarre and grandiose, that is maintained In spite of its irrationality
- unusual thought process – ex thinking that the neighbour’s dog is controlling your mind
- persecution: person thinks that other people are out to get them
- grandeur: thinks that he/she is destined to do something incredibly important alike saving humanity
- control: someone else is controlling their mind or behaviour – recurrent obsessive thoughts because someone is controlling their mind
- jealousy: absolutely convinced that their loved one is cheating on them, conspiring against them, loving someone else
- identity (think that they’re some famous person)
13
Q
Schiz - negative symptoms?
A
14
Q
Schiz Types - Paranoid
A
- preoccupied with delusions and hallucinations that revolve around a common organized theme, usually one of persecution
- great deal of time thinking about how to protect themselves
- impairs critical judgment -> erratic, unpredictable and occasionally dangerous behaviours
- Most highly functioning of all schizophrenics – can have a job, attend university, very intelligent
15
Q
Schiz Types - Catatonic?
A
- mmobility/ stupor or agitated/purposeless motor activity
- psychomotor disturbance
- alternating periods of extreme withdrawal and extreme excitement
- Withdrawal: sudden loss of all animation, tendency to remain motionless in a single position
- Abrupt change to excitement: shouting, pacing, uninhibited, impulsive and frenzied behaviour =potentially dangerous
16
Q
Schiz types - disorganized?
A
- disorganized speech, behaviour, flat/inappropriate emotion
- Usually occurs at an earlier age, most severe
- Emotional distortion and blunting: inappropriate laughter and silliness, peculiar mannerisms, bizarre and obscene behaviour
- Disorganized thinking: illogical thoughts, nonsensical thinking process
- Clang associations: when they talk they spew out a bunch of words that have nothing in common except they rhyme
17
Q
Schiz Types - undifferentiated? residual?
A
- U: don’t fall into any category
- Pattern of symptoms with a rapidly changing mixture of all of most of the primary indicators of schizophrenia
- R: recovering but with lingering symptoms
18
Q
Schiz - genetic factors?
A
- Probably a strong genetic component
- 48 vs. 17% MZ vs DZ twins concordance rates
- Closer genetic relatedness to schizophrenic = greater likelihood of developing S
- Genetics a strong predisposing role, but prenatal/perinatal environment also affects it
19
Q
Schiz - biochemical?
A
- Biochemical factors
o Discovery that lowering levels of dopamine (NT) reduces symptoms
o Dopamine hypothesis: idea that schizophrenia involves an excess of dopamine activity
o Amphetamines increase dopamine levels, usually aggravate symptoms
o Evidence that this hypothesis is inadequate
Too much dopamine in schizophrenics – too much activity
Excessive dopamine is the cause of positive symptoms in the mesolimbic pathway
Too little dopamine in the mesocortical pathway associated with negative symptoms
Drugs that block dopamine receptors help - Neuroanatomy
20
Q
Schiz - neuroanatomy?
A
- Ventricles : abnormally larger (hollow areas filled with CSF)
- Suggests loss of brain tissue mass, maybe from prenatal development anomalies
- Brain tissue loss in adolescent S: parietal areas continuing on to most of the cortex
21
Q
Dissociative Disorders
A
22
Q
Dissociation - depersonalization and derealization?
A
Depersonalization: problem with self-awareness – a feeling of watching yourself act, you have no control, your body is acting and you are just watching, numbness to sensory qualities
o Derealization: feeling that the external world is not quite real, dream like quality to everything, characterized by feeling of emotional flatness, greyness, like real world is 2D,
23
Q
Dissociative Identify Disorder (DID) - what? prevalence %? genders?
A
- presence of two or more distinct identities within one person that can control the person’s behaviour at different times
- 0.5-1.0% Canadians have it
- Female:male= 9:1
- Most patients diagnosed in 20s or 30s but actual onset probably during childhood
24
Q
Dissociative Amnesia
A
- sudden loss of memory for personal information - name, address, life events but otherwise, you’re still you
- memory loss is typically for traumatic specific events or a period of time, but can involve extended periods of a person’s life too – like months or years
25
Dissociative Fugue
* Like DA, but more severe: loss of memory of personal history and sudden departure from home followed by assuming of a new identity
* Fugue states don’t typically last very long – hours, weeks, months
