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Psychopathology > Midterm 2 (Final) > Flashcards

Midterm 2 (Final) Flashcards

1
Q

What’s suicide?

A
  • Death resulting from intentional self-injurious behavior, associated with any intent to die as a result of the behavior
  • To have something count as a suicide, the outcome has to be death and it is driven by intent or desire to die
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2
Q

What’s a suicide attempt?

A
  • Nonfatal self-directed potentially injurious behaviour with any intent to die as a result of the behaviour
  • Intent to die is there but the end result isn’t death
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3
Q

What’s an interrupted attempt?

A

A person takes steps toward making a suicide attempt but is stopped by another person prior to any injury or potential injury

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4
Q

What’s a self-interrupted/ aborted attempt?

A

A person takes steps to injure self but stops self prior to any injury or potential for injury

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5
Q

What are preparatory acts or behaviour with regard to suicide?

A
  • Acts or preparation toward making a suicide attempt
  • Ex: planning on jumping off a bridge -> preparatory act would be visiting the bridge
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6
Q

What’s suicidal ideation?

A
  • Thoughts of suicide
  • Extremely common
  • Thinking about suicide, planning suicide or just broad thoughts of death or thinking that the world would be better off without them or wishing they were dead
  • Suicidal ideation comes in many different ways of thinking
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7
Q

What’s a common misconception regarding suicide and suicide attempts?

A
  • That you can decide how serious someone’s suicide is based on lethality of method of suicide
  • We never infer intent based on lethality of method used
    -> can be based on many factors including what resources someone has access to
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8
Q

What’s non-suicidal self-injurious behaviour (NSSI)?

A
  • Behaviour that’s self-directed and deliberately results in injury or the potential for injury to oneself
  • Without the intent to die
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9
Q

Describe the prevalence rates of suicide in Canada

A
  • In 2016, 9th leading cause of death across all age groups in Canada
  • In terms of fatalities, suicide is a bigger problem than homicide in Canada
  • Suicide is a relatively rare event
  • Almost 4,000 people
  • In Quebec: almost 900 people (slightly higher than average rates of suicide in Canada)
  • More deaths in men and boys than in women and girls (more than 3x more)
  • Suicidal thoughts: 3.4 million -> 1.1 million between 18-34 (more commonly reported in women and girls than men and boys)
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10
Q

What are the key elements of suicide according to the World Health Organization?

A
  1. Agency: something that is self-initiated, but doesn’t necessarily need to be self-inflicted (ex: provoking a cop with intent to die or not taking insulin if diabetic)
  2. Intent: some desire or intent for death
    - This differentiates NSSI from suicide attempts (ex: skydiving and drunk driving are non-intent attempts)
  3. Outcome: actual/perceived potential for death
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11
Q

Identify the appropriate suicide term for this prompt: A 12 yr old girl is grief-stricken after her father died in a car accident. In the months after, she states multiple times that she wants to go to heaven and be with him. One afternoon she watches a Lifetime movie in which a teenager dies from overdosing on sleeping pills. She then takes 20 melatonin tablets that she knows her mother takes to help her sleep.

A
  • Suicide attempt
  • Even if you can’t overdose on melatonin, the intent is there so it’s considered a suicide attempt
  • She believes the melatonin could have a fatal outcome
  • Low lethality event -> still suicidal attempt
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12
Q

Identify the appropriate suicide term for this prompt: a man put a gun to his head because he wanted to kill himself. He pulled the trigger, and the gun failed to fire.

A
  • Suicide Attempt (because he goes through with the behaviour that leads to suicide)
  • Interrupted Attempt
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13
Q

Identify the appropriate suicide term for this prompt: A man is drinking near a lake with a group of friends on Victoria Day. On a dare, he and his buddy decide to play Russian Roulette with a loaded gun. He puts the gun to his head, pulls the trigger, and dies instantly from a gunshot wound to the head.

A
  • No suicide term is applicable to this
  • We have no evidence that this person’s intent was to injure himself
  • Extremely risky behaviour
  • Him being intoxicated affects our understanding
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14
Q

Describe Suicide and NSSI in the DSM

A
  • Prior to DSM-5, suicide and NSSI were listed as symptoms of Depression and BPD
  • DSM-5 now includes under “conditions for further study”: Suicidal Behavior Disorder and Nonsuicidal self-injury disorder -> these are not diagnoses but behaviours
  • We need more info about these before categorizing them
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15
Q

What are the challenges for research in suicidality?

A
  • Rare: worldwide, fewer than 1% of adults make a suicide attempt each year
  • Etiologically complex: a lot of our data on suicide comes from small samples, clinical samples and western samples
  • Difficult to study longitudinally: need massive samples to study longitudinally
  • Stigma/legal constraints: different laws on what’s considered suicide and what’s not, different places defining suicide in different ways
  • Replication: not much replication for research on this
  • Also, most studies will look at suicidal ideation and suicidal attempts, but won’t look at transition from ideation to attempt
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16
Q

What are the common research methods used to study suicide?

A
  • Archival → data is obtained from pre-existing records and databases. Look at how variables relate to each other at any given moment
  • Ex: looking at death records and trying to identify which deaths were by suicide
  • Psychological Autopsy → reconstruct what a person was like before the suicide through interviews with family, friends, co-workers, etc.
  • Big Data → passively collect data from individuals (ex: geolocation, social media, activity trackers, phone calls, purchasing history, etc.)
  • Ex: social media has data from users and maps patterns to identify suicide attempts -> looking at correlates that may or may not be meaningful
  • Experimental → compare individuals’ responses to tasks, manipulations, etc.
  • Treatment Studies → randomly assign people to different conditions (or treatments) and compare outcomes -> Waitlist Control, Placebo, Alternative Treatment
  • Meta-analysis → pools results from separate but similar studies to get a more accurate estimate of the effect
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17
Q

Describe gender differences in suicide and suicide attempts

A
  • Women attempt suicide at significantly higher rates than men in North America
  • 77% of deaths by suicide are male in North America
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18
Q

What are the proposed explanations for gender differences in suicide and suicide attempts

A
  • Base Rates
  • Lethal means: men tend to use more lethal means (most common means = hanging and firearms), while most common suicide means of women = toxic substances and drowning
  • Access
  • Greater Intent: idea that men have greater intent
  • Mental Health Care: women use mental health services at a higher rate than men
  • Cultural acceptance: seeking help is attributed to more feminine qualities -> barrier for men seeking help for suicidality (seen as weak)
  • Reactions from others: if a woman commits suicide and doesn’t die, she will receive more support than men who attempt and don’t die
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19
Q

Describe race/ethnicity differences in suicide

A
  • Suicide rates are highest in North America in White people and First Nations (highest in First Nations)
  • Exception: among young children (5-12), Black children are at much higher risk of dying by suicide
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20
Q

Describe suicide within Canadian First Nations Populations

A
  • Canadian First Nations people have among the highest rates of suicide in the world
  • Not equally distributed across first nation populations
  • Durkheim’s theory of “anomie” -> feeling of being disconnected from the community, lack of belonging
  • Anomie can account for population-wide attempts to suicide
  • Among youth living in First Nations with close proximity to community and greater knowledge of language -> have significantly lower risks of suicide (language and community cohesion)
  • Higher community rates of a number of risk factors (ex: poverty, substances)
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21
Q

What are country differences in rates of suicide (highest to lowest rates)?

A
  • Japan (highest)
  • France
  • United States
  • Germany
  • UK
  • Italy (lowest)
  • Rates for Japan and France have been decreasing overtime
  • Rates for US started increasing in early 2000s (surpassing France)
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22
Q

What are the most common methods used in North America to attempt suicide (in order)?

A
  • Poisoning
  • Cutting
  • Stabbing
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23
Q

What are the most common reasons for death from suicide (in order) in the US?

A
  • Firearm suicides
  • Suffocation
  • Poisoning
  • Fall
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24
Q

What are the most common reasons for death from suicide (in order) in Canada?

A
  • Hanging
  • Suffocation
  • Poisoning
  • Firearm
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25
Q

Describe risk factors for suicide

A
  • Risk factors are things that indicate a group or community at higher risk of developing a disorder
  • Risk factors are not warning signs
  • Some are modifiable (ex: depression, access to lethal means), and some are not (ex: race, genetic predisposition, family history of suicide)
  • There are many risk factors for suicide -> even with identifying all of the risks we can’t predict accurately who will commit suicide
  • The risks don’t tell us how much each of them are linked to suicidal ideation and for moving from ideation to attempt
  • Belief that reducing risk factors and increasing protective factors can help prevent suicide
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26
Q

What are proximal risk factors to a suicide attempt?

A
  • Intoxication -> ~ 25-50% of adults who die by suicide are intoxicated at the time of death. Usually alcohol, but sometimes other substances
  • When people are taking these substances, they’re at greater risk
  • Rates are higher in younger people
  • Access to means -> people who have greater access to lethal means are more likely to die by suicide (treatment = means restriction)
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27
Q

What are protective factors for suicide?

A
  • Treatment: psychosocial or pharmaceutical
  • Lithium and clozapine (for bipolar and psychosis, respectively)
  • Preventative interventions in communities (ex: working to reduce aggressive behaviours in early elementary school seems to delay or prevent the onset of suicidal behaviours in young adulthood)
  • Culturally-influenced coping strategies (ex: values reflecting strong moral objections to suicide and high family support = lower incidence of ideation and attempts among Latinos)
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28
Q

Describe Suicide Contagion in the Media

A
  • Exposure to the suicide or suicidal behavior of one or more persons influences others to engage in these behaviours
  • Suicide clusters in communities -> suicide clusters following the death by suicide of an important figure in the media
  • Exposure can occur via multiple channels (ex: newspaper/tabloids, internet, television, fiction)
  • Rates of suicide/suicidal behaviors appear to be influenced by: frequency of media reporting (dose-dependent), content of media reporting (ex: dramatic headlines, front page, explicit about suicide methods), positive/negative reporting biases (ex: attitudes toward
    suicide, portrayal of suicide completers, consequences -> if the media doesn’t mention the negative consequences of death by suicide, then suicide is more likely)
  • Unclear how suicide contagion occurs
  • Evidence that people are more likely to get suicide contagion if more demographically similar to person who died
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29
Q

Describe the research by Ayers et al. (2017) on 13 Reasons Why and suicide contagion in the media

A
  • People were against the show claiming it was glamorizing suicide attempts and would lead to an increase in suicide attempts
  • Research studied how much suicide-related words were searched above the usual amount after the release of the show
  • Found that suicide searches were higher after the release of the show
  • Most searches focused on suicidal ideation/suicidal thoughts
  • Also see increase in searches for suicide hotlines
  • Found that the show had 2 broad general effects:
  • Increasing searches on suicidal ideation
  • Increasing awareness on suicide
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30
Q

Describe the biological factors of suicide

A
  • Evidence from twin studies that suicidal behaviors are genetically-influenced
  • Adoption studies: rates of suicide in biological relatives of adoptees who died by suicide higher than rates in adopted families
  • Impulsivity and Fearlessness are inherited (2 phenotypes) -> a lot of what’s inherited isn’t necessarily the behaviours themselves but the risks that make individuals more vulnerable to suicide
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31
Q

Describe Impulsivity and Fearlessness in suicide

A
  • Impulsivity has many dimensions: poor premeditation, sensation-seeking, lack of perseverance, negative urgency (tendency to act without a lot of forethought because of negative emotions)
  • Negative Urgency higher in both ideators and attempters (compared to controls)
  • Poor premeditation higher in suicide attempters
  • Neither suicide ideators nor suicide attempters are higher in sensation-seeking or lack of perseverance
  • Fearlessness and reduced pain sensitivity appear to characterize attempters and not ideators
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32
Q

What are the different Ideation-to-Action theories?

A
  • Thomas Joiner’s Interpersonal Psychological Theory
  • 3-Step Theory (Klonsky & May)
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33
Q

Describe Thomas Joiner’s Interpersonal Psychological Theory of suicide

A
  • Exposure to painful and fearsome stimuli reduces innate fears of pain and death, making it easier to approach attempting suicide
  • Habituation
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34
Q

What’s critical to move from Ideation to Action in suicide?

A

Reduced fear of pain and death

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35
Q

What did Weinberg et al. find differentiated patients who have attempted suicide from non-attempters with current ideation?

A

Decreased neural response to threat-related pictures

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36
Q

What are some environmental influences on the capacity to commit suicide?

A
  • Capacity can arise through practice, habituation, experience
  • Playing more hours of violent video games correlated with greater capacity, even when controlling for previous painful life events
  • Among veterinary students, greater exposure to euthanasia is associated with increased fearlessness
  • Among physicians, greater exposure to provocative work experiences (performing surgeries or treating traumatic injuries), is associated with increased capacity
  • Probable that these exposures are not the only thing driving suicide (gene environment correlation) -> people who are less fearful may be seeking these environments
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37
Q

Describe the traits that May et al. (2016) found distinguishes Attempters from Ideators

A
  • Meta-analysis of 27 studies comparing 12 sociodemographic and clinical variables between suicide attempters and ideators (Depression severity, PTSD, Depressive disorder, Hopelessness, Anxiety disorder, Drug use disorder, Alcohol use disorder, Sexual abuse, Marital status, Race, Gender, Education)
  • These 12 have all been correlated with suicidality
  • Findings:
  • 3 of 12 correlates were more common in suicide ideators vs nonsuicidal individuals (depression severity, PTSD, depressive disorder)
  • None of the 12 correlates help us differentiate who is at greater risk of attempting suicide
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38
Q

Describe the course and prevalence rates of NSSI

A
  • Like suicide attempts, NSSI onset tends to peak during adolescence/young adulthood
  • NSSI has slightly earlier age of onset (~13) compared to suicide attempts (~16)
  • Rates of NSSI may decrease with middle age -> seems to be a phenomenon that people age out of (however, haven’t been enough longitudinal studies of NSSI, may be cohort effects)
  • Lifetime prevalence of NSSI: 13-28% worldwide -> in clinical samples as high as 80%
  • Prevalence fairly stable in all regions of the world that have been studied
  • Few epidemiological studies of NSSI because of stigma around it
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39
Q

What’s personality?

A
  • Enduring patterns of perceiving, relating to and thinking about the environment and oneself
  • A person’s range of possible behaviours
  • Traits and behaviors that characterize a person
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40
Q

What are the “Big Five” Factors (FFM)

A
  • Neuroticism
  • Extraversion
  • Openness to Experience
  • Agreeableness
  • Conscientiousness
  • Temperament begins very early on
  • Stable and enduring way of being in the world
  • These traits or expressions of these traits may vary across situations (ex: people can be much more extroverted in some situations)
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41
Q

What are personality disorders?

A
  • Personalities that are inflexible and maladaptive to the person’s circumstances
  • Introduced in 1980, in DSM-III -> largely ignored by researchers until 1980
  • DSM-III devoted Axis II to these conditions
  • Means of distinguishing longstanding maladaptive ways of relating to the world from phasic clinical “syndromes”
  • Personality disorders are not thought of as diathesis stress disorders -> not that exposure to a stressor leads to development of a personality disorder, the idea is that it’s part of development and develops overtime
  • At the severe end, personality disorders can dramatically interfere with a person’s ability to relate to other people -> interferes with normal functioning
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42
Q

What’s the DSM-5 definition of a personality disorder?

A
  • An enduring pattern of inner experience and behavior that:
  • Deviates markedly from the expectations of the individual’s culture
  • Is pervasive and inflexible (personality disorders are often best described by one prominent characteristic that causes problems)
  • Has an onset in adolescence or early adulthood
  • Is stable over time
  • Leads to distress and impairment (many with this disorder experience extreme distress, but not all of them -> some cause distress and harm to others)
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43
Q

Describe the egosyntonic and egodystonic differences in distress and suffering with personality disorders

A
  • Egosyntonic: functioning doesn’t cause distress to the individual
  • Egodystonic: functioning does cause distress to the individual (ex: in OCD)
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44
Q

What are the 3 categories of personality disorders?

A
  • Cluster A: Odd/Eccentric
  • Cluster B: Dramatic/Emotional/Erratic
  • Cluster C: Anxious/Fearful
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45
Q

Describe the Cluster A (Odd/Eccentric) category of personality disorders

A
  • People who seem to other people as odd or eccentric with unusual behaviour
  • Includes Paranoid PD, Schizoid PD, Schizotypal PD
  • Least well-studied of the PD clusters
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46
Q

Describe the Cluster B (Dramatic/Emotional/Erratic) category of personality disorders

A
  • People characterized by impulsive and antisocial behaviours
  • Includes Antisocial PD, Borderline PD, Histrionic PD and Narcissistic PD
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47
Q

Describe the Cluster C (Anxious/Fearful) category of personality disorders

A
  • People in this cluster more likely to seek help for anxiety
  • Includes Avoidant PD, Dependent PD, and OCPD
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48
Q

Describe the prevalence of personality disorders

A
  • Varies hugely, depending on study and population
  • 4-15% in the general population
  • Much higher in inpatient settings
  • Comorbidity rates are extremely high -> with other PDs (the norm) & with major disorders (mood, anxiety, substance use, etc.)
  • More typical to have 2 personality disorders than only one
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49
Q

What’s a problem in research regarding Personality Disorders?

A
  • Lack of research on a lot of the different PD diagnoses
  • Since the DSM-III, more research on PDs
  • However, many of these conditions are poorly researched
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50
Q

What are some controversies regarding Personality Disorders?

A
  • Is there a difference between Axis I and II conditions?
  • Are personality disorders a difference of degree or a difference of kind?
  • What does it mean to be diagnosed with 2+ personality disorders?
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51
Q

What are Cleckley’s Criteria for Psychopathy?

A

○ Superficial charm and good “intelligence.”
○ Absence of delusions and other signs of irrational thinking.
○ Absence of “nervousness” or psychoneurotic manifestations. Unreliability.
○ Untruthfulness and insincerity.
○ Lack of remorse or shame.
○ Inadequately motivated antisocial behavior.
○ Poor judgment and failure to learn by experience.
○ Pathological egocentricity and incapacity for love.
○ General poverty in major affective reactions.
○ Specific loss of insight.
○ Unresponsiveness in general interpersonal relations.
○ Fantastic and uninviting behavior with drink and sometimes without.
○ Suicide rarely carried out.
○ Sex life impersonal, trivial, and poorly integrated.
○Failure to follow any life plan

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52
Q

What are the Items on the Psychopathy Checklist–Revised (PCL-R)?

A
  • Glibness/superficial charm
  • Grandiose sense of self‐worth
  • Need for stimulation
  • Proneness to boredom
  • Pathological lying
  • Conning/manipulative.
  • Lack of remorse or guilt
  • Shallow affect
  • Callous/lack of empathy
  • Parasitic lifestyle.
  • Poor behavioral controls
  • Promiscuous sexual behavior
  • Early behavior problems.
  • Lack of realistic, long‐term goals
  • Impulsivity.
  • Irresponsibility.
  • Failure to accept responsibility.
  • Many short‐term marital relationships
  • Juvenile delinquency.
  • Revocation of conditional release
  • Criminal versatility
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53
Q

Describe the DSM I diagnosis of Substance Use Disorder

A
  • A symptom of “sociopathic personality disorder”
  • Alcoholism and drug dependence
  • No classes of drugs specified
  • No specific criteria
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54
Q

Describe the DSM II diagnosis of Substance Use Disorder

A
  • Still a personality disorder
  • Alcoholism and drug dependence
  • Specifies some classes (barbiturates, cannabis, etc.)
  • Barbiturates, cannabis, cocaine, hallucinogens, opioids
  • Some criteria specified
  • “…the inability of the patient to go one day without drinking…”
  • “…habitual use or a clear sense of need for the drug…”
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55
Q

Describe the DSM III diagnosis of Substance Use Disorder

A
  • 1980
  • “Substance use disorders” separated from personality
  • Each class of substance recognized as a distinct disorder
  • Sets of diagnostic criteria established
  • Abuse vs. dependence
  • Abuse: pattern of pathological alcohol use
  • Dependence: require that the patient experienced withdrawal symptoms when they stopped using the substance
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56
Q

Describe the DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000) diagnosis of Substance Use Disorder

A
  • Minor tweaks from DSM III
  • The word “addiction” doesn’t appear anywhere
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57
Q

What are the 4 general groupings of indicators for SUD?

A
  • Impairment of control
  • Social Impairment
  • Risky Use
  • Pharmacological Dependence (tolerance & withdrawal)
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58
Q

What’s substance abuse?

A

*A maladaptive pattern of substance use leading to distress or impairment
* One or more of:
* Failure to fulfill role obligations
* Physically hazardous situations
* Legal problems
* Social problems

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59
Q

What’s substance dependence?

A
  • A maladaptive pattern of substance use leading to distress or impairment
  • 3 or more of:
  • Tolerance
  • Withdrawal
  • Take more than intended
  • Failure to cut down
  • Time spent
  • Give up on activities in order to engage in consumption of substances
  • Physical or psychological problems
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60
Q

What are the top 3 most addictive substances?

A
  1. Nicotine (most)
  2. Meth
  3. Crack
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61
Q

What are stimulants?

A
  • Most widely consumed and abused class of drugs
  • Amphetamines
  • Cocaine (crack = crystallized form of cocaine used by poorer people)
  • Nicotine
  • Caffeine
  • Increase alertness, energy
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62
Q

What’s an opiate?

A
  • Natural chemical in opium poppy
  • Narcotic effects (i.e., pain relief)
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63
Q

What are opioids?

A
  • Broader term that refers to a class of natural & synthetic substances with narcotic effects
  • Activate endogenous opioid receptors
  • They’re working on endorphins
  • Euphoric sensations that come with release of endorphins
  • Endorphins often have inhibitory affect
  • Morphine was developed as a treatment for intense and unbearable pain
  • Civil war soldiers were addicted to morphine
  • Morphine become addicted after a few
  • Heroin acts more rapidly than morphine and is more addictive
  • Methadone was then developed
  • Withdrawal from heroin, morphine, methadone is very intense
  • Nausea, intense anxiety, insomnia
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64
Q

What are the physiological effects of alcohol?

A
  • Both a stimulant and a depressant
  • While drinking: stimulant
  • Drinkers report increases in elation, excitement and extroversion; decreases in fatigue, restlessness, depression and tension
  • Stimulation: increases in Norepinephrine
  • Increased Norepinephrine associated with increased impulsivity -> low PFC activity and high limbs system activity
  • After drinking: depressant
  • Decrease in vigor and an increase in fatigue, relaxation, confusion, and depression
  • Alcohol is a GABA agonist -> when drinking alcohol it can mimic GABA effects -> inhibits dopamine neurons
  • Alcohol intake leads to reduced activity in PFC and hippocampus (explains black outs when drinking)
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65
Q

Genes governing what kind of activity are implicated in risk for AUD?

A

Genes governing GABA activity implicated in risk for AUD

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66
Q

There are decreases in what with heavy sustained drinking?

A

Decreases in white matter

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67
Q

Describe the differences in methods, lethality and frequency between suicide attempts and NSSI

A
  • Suicide Attempts: often highly lethal methods (ex: hanging or ingestion of toxic substances -> most common methods)
  • NSSI: low-lethality behaviors that result in minimal damage (ex: cutting (most common and typically used on low lethality areas of the body), skin abrading, interfering with wound healing, banging/self-hitting, burning)
  • Most people who endorse repeated NSSI use more than one method (average of 4)
  • People endorsing Suicide Attempts often use the same method, but increase the lethality
  • NSSI can have some addictive properties that change overtime -> people that use NSSI require higher doses overtime to achieve the initial effects of NSSI
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68
Q

Describe sexuality and gender differences in NSSI

A
  • Male-female inconclusive -> common perception that it’s more common among girls and women
  • Rates of NSSI higher in LGBTQ individuals than heterosexual
  • Risk for NSSI (and suicide attempts) peaks during the coming-out process -> somewhat more pronounced for males than females
  • Almost no longitudinal studies of NSSI across populations
  • These findings often come from retrospective self-report
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69
Q

According to Klonsky & Glenn what are the interpersonal functions of NSSI?

A
  • Autonomy (sense of independence)
  • Interpersonal boundaries
  • Interpersonal influence
  • Peer Bonding (contagious)
  • Revenge
  • Sensation seeking
  • Toughness
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70
Q

According to Klonsky & Glenn what are the intrapersonal functions of NSSI?

A
  • Affect Regulation (one of the more frequently endorsed functions of NSSI -> people use NSSI to help reduce NA and distress)
  • Anti-dissociation
  • Anti-suicide
  • Marking distress
  • Self-punishment
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71
Q

Describe Nock et al. (2009) study of NSSI in real-time

A
  • Used ecological momentary assessment: repeatedly assessing the same variables across the day and across various days
  • Looked at frequency, duration and intensity of NSSI-related thoughts
  • If participants had intense but brief thoughts about self-harming, they were more likely to do it
  • Thoughts about NSSI were more likely to occur when participants were feeling overwhelmed or scared/anxious
  • Feeling rejected, holding anger towards oneself or others, self-hatred, feeling numb/nothing predicted NSSI
  • Function of NSSI: most common reason was to decrease/distract from negative thoughts/feelings (64.7% of episodes)
  • Negative reinforcement -> if when engaging in NSSI, negative affect decreases, then most likely to continue using NSSI
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72
Q

Describe Muehlenkamp et al. (2009) study on NSSI in real-time

A
  • 131 females with bulimia nervosa
  • 19 with NSSI and 112 without NSSI
  • Collected EMA over 2-week period
  • Reported engagement in NSSI (“I cut myself”, “I scratched myself”, “I burned myself”, “I hit myself”, and “I banged my head”) as well as positive and negative affect
  • Findings:
  • In the hours preceding NSSI, there is a decrease in positive affect and increase in negative affect
  • After NSSI, negative affect decreases and positive affect increases
  • Positive affect is significantly increasing the most after NSSI
  • These data further support the idea that engaging in NSSI may lead to change in levels of affect (affect regulation)
73
Q

Describe the relationship of NSSI to Suicide

A
  • Up to 85% of people attempting suicide have a history of NSSI
  • Increasing capacity through practice experiences with NSSI can increase likelihood of suicide
  • College students with a history of NSSI 8x more likely to have suicidal ideation and 25x more likely to have attempted suicide than students with no NSSI
  • But many people with a history of NSSI don’t go on to attempt suicide (more than 60%)
  • Repetitive and/or severe NSSI seems to be a particularly strong predictor increasing risk in suicide attempts
74
Q

Describe Dementia Praecox

A
  • Emile Kraepelin
  • First to propose groupings of psychotic syndromes
  • Dementia (dementia) Praecox (early)
  • Form of dementia characterized primarily by very disorganized thinking
  • A disorder with progressive deterioration; unlike other dementias, begins at an early age
  • BP and Schz distinct disorders -> evidence for common genes and continuum of dysfunction
75
Q

Describe the history of Schizophrenia

A
  • Eugen Bleuler
  • Swiss Psychiatrist, contemporary of Kraepelin
  • Did not always deteriorate, could emerge at later age
  • 1911 used term “schizophrenia”
  • “Schizo” (to split, or crack) “phren” (mind) -> splintered or shattered mind
  • Disorder characterized primarily by disorganization of thought processes -> loose associations
  • Split from reality
  • Distinction from “multiple personality disorder” or dissociative identity disorder
  • Considered Schizophrenia a group of disorders, not a single disease state
  • Led to very broad definition, more subjective
76
Q

Describe Schizophrenia

A
  • Among the most devastating forms of psychopathology
  • Chronic
  • Often begins in adolescence
  • Early onset is part of what contributes to the pernicious course
  • Used to be institutionalized * Characterized by 6 Major Signs/Symptoms
77
Q

What are the 6 Major Signs/Symptoms of Schizophrenia?

A

○ Disturbances in perception
○ Disturbances of content of thought
○ Disturbances of form of thought
○ Disturbances in affect
○ Disturbances in psychomotor
○ Disturbances of relating

78
Q

Describe perception in schizophrenia

A
  • Hallucinations
  • Continuum from illusions (when stimulus is present but misperceived -> disconnect between sensations and interpretation) to hallucinations
  • Can occur in all sensory modalities:
  • Visual (most common), olfactory, tactile, somatic, gustatory
  • Audible thoughts (auditory hallucination, perceiving external voices to thoughts)
  • Voices conversing about patient (often derogatory of the person)
  • Voices commenting on your behavior
  • Somatic passivity experiences (ex: people will describe an x-ray entering a part of their body and perceive a tingling sensation where they feel it)
79
Q

What are hallucinations?

A
  • When either no stimulus is present but a perception occurs (seeing things/people who aren’t there) or negative hallucinations -> stimulus is present but no perception occurs (less common)
  • Hallucinations take place in the same time and physical place as our other perceptions -> makes it difficult to make a distinction between real objects and hallucinated objects
80
Q

Describe Johns & McGuire’s study on the misattribution of self-talk in schizophrenia

A
  • 3 groups: controls (super healthy controls), non-auditory hallucinating schizophrenic patients, schizophrenic patients with auditory hallucinations
  • All read out a series of single words that could be complementary, derogatory, or neutral words
  • They spoke these words in an amplifier and the amplifier altered the sound of their voice
  • Researchers altered the pitch of their voices which altered the perception to the participants
  • Looking for misattribution of their own speech
  • Findings:
  • Patients with schizophrenia and auditory hallucinations were much more likely to positively misattribute the voices as being spoken by someone else -> this was especially found when the voices were saying derogatory things
81
Q

Describe content of thought in schizophrenia

A
  • Delusions (high-end of continuum)
  • False belief based on an incorrect inference
  • Firmly believed despite contradictory evidence
  • People act on the delusions
  • People with schizophrenia typically have multiple delusions
  • Mild end: over-valued idea -> false belief, but willing to entertain the idea that it’s false, common in schizotypal PD, also common in prodromal schizophrenia
82
Q

What’s prodromal schizophrenia?

A

Showing signs of schizophrenia but have not yet met criteria for schizophrenia

83
Q

What are different types of delusions?

A
  • Controlled by outside force
  • Grandiose delusions
  • Delusions of jealousy
  • Nihilistic delusions (belief that oneself or the world doesn’t exist)
  • Persecutory delusions (belief that people are out to get you)
  • Delusions of reference (belief that some event, person, or object is trying to signal something to you)
  • Somatic delusions (belief that something is terribly wrong with the body -> ex: looking at hands and believing those are not your hands)
  • Thought withdrawal (belief that thoughts are being extracted from your head)
  • Thought insertion
  • Thought diffusion/ broadcasting (can’t necessarily hear their own thoughts but others can hear their thoughts, belief that their thoughts are being played in other people’s minds)
  • Made impulses (external force is causing one to do things)
  • Made feelings (affective experiences are being forced of being inserted in you)
  • Made volitional acts (belief that something is controlling the activity of your body in some way)
84
Q

Describe form of thought in schizophrenia

A
  • Formal thought disorder/ speech disorder (thought and speech appear so profoundly disorganized in people with schizophrenia)
  • Derailment/loose associations (typically not the same firehose of ideas we see in BP)
  • Word salad (saying words that have no grammatical, logical structure, some may be in different languages -> just saying words)
  • Alogia (poverty of speech, speaking in low monotonous way and not conveying any information with words)
  • Neologisms (inventing new words or giving an existing word a novel creative meaning)
  • Blocking (someone is speaking and then stops speaking, often accompanied with thought removal)
  • Illogical thinking
85
Q

Describe affect in schizophrenia

A
  • Blunted/flat -> anhedonia is a pervasive symptom
  • The way that they’ll describe their emotional feelings is not blunt (describe them in affective details)
  • Inappropriate
  • Can be chilling (ex: talking about how their parent just died and saying it with smile on face)
  • Problems perceiving others’ emotions
86
Q

Describe psychomotor problems in schizophrenia

A
  • Catatonia (much rarer now than 100 yrs ago) involves:
  • Catalepsy/waxy flexibility (patients are immobile but are surviving)
  • Stupor (patients who are immobile, conscious, and not responding in any way to the environment)
  • Posturing (patients going in strange positions themselves)
  • Mutism
  • Catatonic excitement (moving rapidly without any purpose)
  • Catatonic negativism (patient is immobile and unwilling to move -> resisting attempts to be moved
  • Echolalia (non-volitional repetition of things others say)
  • Echopraxia (imitating movements that they see)
87
Q

Describe problems of relating in schizophrenia

A
  • Very withdrawn
  • Preoccupied with a fantasy world only they can see
  • Disordered volition (disturbances in goal directed activity, no sense of will or volitional action)
  • Anhedonia
88
Q

Positive VS Negative symptoms in schizophrenia

A
  • Positive: the presence of symptoms that shouldn’t be there, that present a clear break of reality (ex: hallucinations, delusions, inappropriate affect) -> defining features of most psychotic episodes
  • Negative: absence of something that should be there (ex: blunted affect, alogia, avolition)
  • Positive tend to respond better to medications
  • Negative symptoms often very hard to treat
  • Used to use positive/negative to classify -> but very few people have only negative
  • Many people have a mix of both positive and negative symptoms
89
Q

What are some issues with schizoaffective disorder?

A
  • Poor reliability (inter-rater and test-retest reliability)
  • Controversial since introduction in 1933 -> a lot of debate about whether this exists/whether it’s a valid diagnostic category
  • Not clearly a distinct diagnosis
  • Also not clearly an atypical form of Mood disorder/ Schizophrenia
  • Prognosis is somewhere between schizophrenia and mood disorders
  • Long-term prognosis for Schizoaffective > Schizophrenia
90
Q

Describe prevalence rates of Schizophrenia

A
  • Average prevalence rate ~0.7% to 1%
  • M:F ratio about 1.4:1
  • Women tend to present with more sx of depression, often misdiagnosed with depression (more of the affective symptoms than the cognitive symptoms) -> may explain imbalance in diagnoses
  • Female sex hormones (estrogen) may also be protective -> postmenopausal, estrogen decreases
  • Late-onset schizophrenia more common in Women
  • Schizophrenia onsetting in childhood is very rare -> rarely see it before age 13
  • Prevalence rates increase for both boys and girls in the teens -> increase much more for the boys
  • Bump in 40s for women is related to postmenopausal
91
Q

What’s the Dopamine Hypothesis for schizophrenia?

A
  • Antipsychotic drugs work on DA system -> Block D2 receptors
  • Cocaine, amphetamines boost DA activity -> can result in psychosis, paranoia, distorted sense of reality
  • Best evidence seems to be: excess DA transmission in striatum, reduced DA transmission in frontal lobes
  • Aberrant salience: increased DA may cause pts to attend more to irrelevant stimuli and pts may struggle to make sense of everyday experiences
  • Failure to respond to meaningful reward cues (anhedonia and negative symptoms)
  • Abnormal movements (Oral-facial and Upper limb dyskinesias)
  • Movement abnormalities also present throughout premorbid period -> could identify schizophrenia abnormalities emerging in early life
  • DLPFC (Dorso-lateral prefrontal cortex) -> activity heavily regulated by DA
  • Important region of the brain for working memory -> a lot of findings that working memory is impaired in patients with schizophrenia
  • All of these have led people to pursue dopamine as a large player in schizophrenia
92
Q

Describe findings linking cannabis to schizophrenia

A
  • People with Schizophrenia 2x more likely to smoke weed -> Correlate or Cause?
  • Evidence that it predicts onset of Schizophrenia -> significant even controlling for childhood sx of psychosis
  • THC increases DA synthesis (increased levels of dopamine and dopamine hypersensitivity is linked to some of the ways schizophrenia presents itself)
  • Cannabis use exacerbates cognitive sx in people with Schizophrenia
  • Patients with schizophrenia who are using cannabis show a significant decrease in gray matter compared to patients with schizophrenia who aren’t using marijuana and healthy controls -> correlational evidence
93
Q

What are some risk factors of schizophrenia?

A
  • Lower SES (ex: social causation (social causes exert forces on the individual increasing chances of developing schizophrenia) -> immigrants tend to have higher rates of schizophrenia -> immigrate to a country and become a lower minority within new country) (ex: diagnostic bias -> black patients more likely to be diagnosed with schizophrenia)
  • Advanced paternal age at conception: increases risk for offspring having schizophrenia
  • Birth complications (ex: breech delivery, prolonged labor, umbilical cord around neck -> all can result in hypoxia/anoxia (anoxia at birth can result in DA supersensitivity)
  • Prenatal exposure (ex: viral infections (esp. during 2nd trimester), antibodies during pregnancy)
  • Season of birth (small but significant increase for people born in late winter, early spring, stronger further from equator, # of Viruses can cause fetal damage which are more common in fall and early winter -> 2nd trimester of pregnancy)
  • Malnutrition in pregnancy (decrease in caloric intake and folate and iron -> critical for the developing brain and nervous system, ex: Dutch Hunger Winter)
94
Q

What’s a possible endophenotype in schizophrenia?

A
  • Eye-tracking abnormalities in schizophrenia
  • ~50% of schizophrenic individuals won’t have this eye movement pattern
  • We also see this eye movement pattern in some non-schizophrenic relatives of those with schizophrenia
  • This is relatively specific for schizophrenia
  • Bipolar disorder patients on lithium will sometimes show this kind of eye-tracking abnormality
95
Q

Describe the importance of neurodevelopment in 2nd trimester

A
  • Neural migration an important task of 2nd trimester
  • Disruptions can affect neural connectivity
  • Particularly cortical connectivity
  • Could result in decreased gray matter (cortical matter)
  • Also could result in cell death
96
Q

What are the 5 Main Categories of Substances

A
  • Depressants (ex: alcohol)
  • Stimulants (ex: cocaine, nicotine)
  • Opiates (ex: heroin)
  • Hallucinogens
  • Other drugs of abuse (ex: inhalants)
97
Q

What addictive disorder is the only in the new category of behavioural addictions?

A
  • Gambling disorder (hypothesized to be similar in terms of clinical expression, neural origins, comorbidity, physiology, and treatment)
  • Internet gaming disorder is included in category for future consideration
98
Q

What’s the Gateway Theory of SUD?

A
  • Alcohol and marijuana are “gateways” -> increase the likelihood of use of other drugs
  • Doesn’t rule out general tendency towards substance abuse
  • Alcohol and marijuana are just easier to get
  • Study: Mz and Dz twins
  • In adolescence, we tend to segregate into groups -> someone who smokes weed may end up in a social circle that smokes weed
  • Could be social correlates that have an impact more than genetics
  • Minimal genetic effect
99
Q

Describe Dr. George Vaillant’s study of the course of AUD

A
  • Study of 724 men, all originally recruited as healthy controls for other studies during late 1930s and early 1940s
  • Of the 724, 181 (25%) eventually developed SUD
  • By age 70:
  • ~ 50% of these had chronic course
  • Between 25 and 30% had recovered
  • 10% had controlled drinking (no problems with alcohol)
  • If abstinent for 5 years, unlikely to relapse
100
Q

Describe Witkiewitz and colleagues study of the course of AUD

A
  • N= 694; 70% Male, 79% White
  • Look at functioning 3, 7, and 9 years after treatment (either active naltrexone, placebo, combined behavioural dimension)
  • Identified 4 groups: low‐functioning frequent heavy drinkers (13.9%), low‐functioning infrequent heavy drinkers (15.8%), high‐functioning heavy drinkers (19.4%), high‐functioning infrequent drinkers (50.9%)
  • Looking at outcomes like hospitalizations, relationships, health, life satisfaction, and other indices of functioning (ex: employment)
  • Shows that abstinence as the only goal of treatment may not be necessary and may not be effective for everyone
101
Q

What are some vulnerability factors of AUD?

A
  • Early drinking (before the age of ~15)
  • Family history of AUD (lifetime risk of AUD in relatives of AUD is 30% vs 14%, relatives of AUD higher rate of abuse of multiple substances, higher rate of APD (8% vs 5%), increased risk for almost all other psych disorders)
  • Tolerance: if you have to drink more, then you’re slower to recognize the effects (drink more, build up tolerance, drink more, spiral)
102
Q

Describe adoption studies for AUD

A
  • Individuals whose biological parent(s) had AUD but adopted by non-AUD non-relatives
  • Look at frequency of AUD in these individuals in adulthood
  • Increased probability of AUD in adopted children
  • Suggests biological predisposition; de-emphasize role of environment
  • But: Biology ≠ Destiny
103
Q

Describe Jacob et al. (2003), JAMA study of offspring of Mz and Dz twins with and without AUD

A
  • Group 1: Offspring of all twins (Mz and Dz) with dx of AUD -> high genetic/high environmental risk
  • Group 2: Offspring of Mz twins who do NOT meet criteria for AUD but co-twin does -> high genetic risk, low environmental risk
  • Group 3: Offspring of Dz twins who do NOT meet criteria for AUD but co-twin does -> moderate genetic risk, low environmental risk
  • Group 4: Offspring of twins (Mz and Dz) who do not meet criteria for AUD -> low genetic risk, low environmental risk
  • Findings:
  • Group 1 is more likely to meet criteria for AUD than group 4 (more risk)
  • Group 2 was not more likely to meet criteria for AUD than group 4 (more risk)
  • Group 3 was not more likely to meet criteria for AUD than group 4 (more risk)
  • Genetics are not deterministic -> being raised in environment without parent with AUD serves as protective factor
104
Q

Describe findings of studies on tolerance in sons of AUD fathers

A
  • In study gave alcohol to both sons of AUD fathers and sons of non-AUD fathers
  • Sons of AUD fathers: balance and coordination after drinking better than in sons of controls
  • May start out less sensitive to the effects of alcohol (subjective and physiological)
  • Performance on lab tasks predictor of development of AUD
  • People seem to inherit a higher tolerance for alcohol
  • If you gave alcohol to non-alcoholic sons, these sons have better balance and coordination after drinking
  • Sons of fathers with AUD are coming into the world with higher tolerance to alcohol
105
Q

Alcohol dependence develops through what?

A
  • Reinforcement
  • Positive reinforcement: it feels great to be drinking
  • Positive Affect Regulation Theory: for many people, drinking increases positive affect -> feel more confident, happier
  • Some evidence that people who are high on reward-seeking or sensation- seeking, more vulnerable to AUD
  • Negative Reinforcement: for many, it feels bad to not drink
  • Alcohol withdrawal becomes reinforcing -> physiological negative reinforcement process
  • Negative Affect Regulation Theory: self-medication theories of AUD, decreases anxiety, sadness, self- consciousness, forget your worries (ex: people may feel the need to drink before a party to reduce anxiety)
  • Some evidence that people with more trait negative affect (ex: depression, anxiety) vulnerable to AUD
  • For many, both paths can lead to increased alcohol consumption
106
Q

Describe Catherine Fairbairn et al. study on the Effects of Alcohol on Social Smiling

A
  • Many men report that majority of their bonding w/ other males occurs in the context of drinking
  • Some evidence that the effects of alcohol more rewarding for males -> why?
  • Test 720 participants (M & F)
  • Group of just women drinking, just men drinking and combined drinking
  • Both M & F show positive effects of alcohol on mood
  • Men experienced an increase in reciprocal smiling
  • The duration of men’s smiles increased (compared to placebo and women) -> making contagion more likely
  • More interpersonally rewarding for men (getting more positive reinforcement from male friends)
  • Women in placebo group shared same number of social smiles
107
Q

Where does reinforcement learning occur in the brain?

A
  • Reinforcement learning studies occur in the mesocorticolimbic pathway
  • Studying this pathway to understand, relapse, choice, control
  • Dopamine plays an important role in pleasure and reinforcement learning
  • Dopamine largely produced in VTA
108
Q

Describe the study on monkeys and dopamine, reinforcement and cravings

A
  • Electrodes implanted in midbrains of monkeys
  • Training monkeys to press a bar when they see one stimulus and squeeze juice in their mouths when they get it correctly
  • When no prediction as to which cues will give reward, we see increased production and transmission of dopamine after reward
  • When monkeys predict reward, we see increased production and transmission of dopamine before reward
  • People talk about getting cravings when they get triggered by a cue
  • One mechanism for the maintenance of AUD and SUD
109
Q

Describe the Deviance Proneness theory of SUD

A
  • SUD arises not from attempts to regulate affective states or because of any particular vulnerability to drugs
  • SUD is part of a more general, deviant pattern that has its roots in childhood and is attributable to deficient socialization
  • Maybe you’re raised in an environment that has no rules
  • Maybe you’re engaging with peers that use substances
110
Q

Describe the Effects of Amphetamines

A
  • Produce elation, vigor, reduce fatigue (pleasure)
  • Similar to the effects of adrenaline
  • Followed by a “crash”
  • Chronic use can lead to fatigue, sadness, intense anger
  • Enhance release of dopamine and norepinephrine, while blocking reuptake
  • Can cause psychotic symptoms
  • High risk of dependency and withdrawal
  • 6% of Canadians age 15+ report lifetime usage
  • Methamphetamines -> often amphetamine of choice for poorer people
  • Methamphetamines are highly addictive and lead to structural changes in the brain (rewiring)
  • Criminal consequences for methamphetamines are much more extreme than other classes of drugs
111
Q

Genes governing GABA activity are implicated in risk for what?

A
  • AUD
  • Decreases in white matter associated with heavy sustained drinking
112
Q

Describe effects of opioids

A
  • Low doses - euphoria, drowsiness, slurred speech, memory impairment, & slowed breathing
    *High can be sustained 4 to 6 hours
    *High doses can result in death (respiratory complications)
    *Withdrawal symptoms can be lasting (1 week) & severe
    *Less than 1% of Canadians report ever having tried heroin
    *Prescription opioids more prevalent
    *8% of adults use codeine, morphine, or Demerol
113
Q

Describe the effects of cocaine

A
  • Short lived sensations of elation, vigor, reduce fatigue
  • Effects result from blocking the reuptake of dopamine
  • Cocaine is highly addictive, but addiction develops slowly (after 2 to 5 years)
    *Withdrawal (boredom, tolerance, paranoia)
  • Crack: crystallized form of cocaine that is smoked; acts faster
  • Also more often consumed by poorer people
  • Prevalence: about .7% past year (Cocaine OR Crack)
114
Q

Describe the course/risk of AUD

A
  • Heavy drinking associated with increased rates of:
  • Vulnerability to injury
  • Marital discord
  • Intimate partner violence
  • Illness (e.g., diabetes, cirrhosis of the liver)
  • Neurocognitive impairments (e.g., brain shrinkage -> white matter decreases)
  • Decreased lifespan: As much as a 12-year decrease * Suicide (proximal predictor of suicide attempt)
115
Q

Describe the cross-cultural prevalence of AUD

A
  • Rates typically higher in White and Native American/ First Nations populations
  • Typically lower in Black and Hispanic populations -> can vary by study
  • East Asian and Jewish populations tend to have lower rates
  • Due to genetic polymorphism (ADH2*2) that deals with alcohol and influences how alcohol reaches the brain
  • Rates of abuse of other substances similar or higher
116
Q

Describe the Proposed Revision to DSM-5 for personality disorder

A
  • Winnow list of PDs from 10 to 6
    Keep:
  • Antisocial/ psychopathic
  • Avoidant
  • Borderline
  • Narcissistic
  • Obsessive-Compulsive
  • Schizotypal
    Eliminate:
  • Dependent, Histrionic, Schizoid, Paranoid -> these 4 were proposed for elimination because we have very little research on these
  • The DSM ignored this proposal and kept these 4 categories that were requested to be eliminated
117
Q

We find low levels of what Five-Factor Model Traits in personality disorders

A
  • Agreeableness
  • Conscientiousness
  • High levels of neuroticism (highest), extraversion, openness to experience
118
Q

Describe Paranoid PD

A
  • Pervasive Suspiciousness -> paranoia
  • Tendency to see self as blameless -> lots of conflicts with others
  • On guard for perceived attacks by others
  • Occurs more commonly in the families of people with Schizophrenia
  • Viewed as a related disorder– a “cousin”
  • Primary difference is in the severity and disconnect from reality
  • Often a very fine line between the two
  • Significant diagnostic overlap with avoidant and BPD
  • Tends to be more commonly diagnosed in men
119
Q

Describe Schizoid PD

A
  • Near total lack of interest in intimate involvement with others
  • Limited emotional responsiveness -> report rarely experiencing intense emotional responses
  • “Loners”
  • Perceived as cold, indifferent
  • Often oblivious to social cues
  • Most don’t have the skills for interpersonal functioning -> don’t care to gain these skills
  • Diagnostic criteria overlap with Schizotypal Personality Disorder
  • Recent data suggest it may be more related to asocial disorders (ex: Autism spectrum)
  • One of those proposed for exclusion
120
Q

Describe schizotypal PD

A
  • Cognitive and perceptual
    distortions
  • Eccentricity of thought or
    behavior
  • Odd beliefs, odd speech -> not psychotic
  • Magical thinking
  • Telepathy, clairvoyance
  • Ideas of reference
  • Contact with reality maintained
  • Great deal of overlap with Schizophrenia
  • Severity and quality of symptoms
  • Eccentric and odd, but not delusional
  • Some argue a mild or prodromal Schizophrenia
  • Familial co-aggregation
  • Found in both Schizophrenia spectrum Disorders and Personality Disorders in DSM
  • Similar laboratory deficits (ex: eye-tracking deficits)
  • People with schizophrenia and schizotypal PD have a “herky-jerky” eye movement pattern
121
Q

Describe the study on the associations within Cluster A between paranoid PD and Schizotypal PD

A

○ Twin study on these disorders
○ First found the 2 disorders were very stable overtime (had the disorder after 10 years)
○ Huge amount of genetic overlap between these disorders (more overlap in Mz than Dz)

122
Q

Describe Histrionic PD

A
  • Highly dramatic, lively, extraverted
  • High excitement seeking
  • Low self-consciousness
  • Preoccupation with physical appearance
  • Irritability and temper outbursts if attention seeking is frustrated
  • Abt 2-3% prevalence
  • Sex differences: almost exclusively women
  • People with HPD tend to be very dependent on other people and may see attempts to achieve closeness through sexual behaviours
  • People with HPD are very emotionally expressive
  • Often comorbid with Bipolar disorder -> having this comorbidity causes more negative outcomes
  • Using their appearance to get positive attention from other people
123
Q

Describe Narcissitic PD

A
  • Grandiosity
  • Preoccupation with receiving attention
  • Self-Promoting
  • Lack Empathy
  • Easily offended
  • Highly variable clinical presentation
  • Complicates treatment -> increased likelihood of dropout and slow symptom change
  • Hypercritical and retaliatory if they are not validated
  • Male students w/ high narcissistic tendencies
  • < 1%
  • May be more common in males than females
  • Etiology:
  • Grandiose associated with parental overvaluation
  • Vulnerable associated with emotional, physical, sexual abuse/ intrusive, controlling, cold parenting styles -> lack of sensitivity towards the child
124
Q

There is some evidence that there are what 2 sub-types of narcissistic PD?

A

Grandiose and vulnerable

125
Q

Describe Avoidant PD

A
  • Pervasive pattern of inhibition and inadequacy that results in avoiding interpersonal contact
  • Extreme sensitivity to criticism and disapproval
  • Avoid intimacy, though they desire it
  • Extreme Loneliness, low self-esteem, excessive self- consciousness
  • Contrast with Schizoid: want interpersonal contact and intimacy and tend to be much more emotionally expressive
  • Differential Dx with Generalized Social Phobia aka SAD very difficult
  • Substantial overlap
  • Can find SP without Avoidant
  • Very rare to find avoidant without SP
  • Shared genetic vulnerability
  • Fear of evaluation is also heritable
  • Distinct diagnoses may not be warranted
126
Q

Describe Dependent PD

A
  • Inability to function independently
  • Adopt a submissive role in relationships
  • Allow other people to assume responsibility for multiple important aspects of their lives -> ex: jobs, classes, clothes, hair styles
  • Some data to suggest more likely to be involved in abusive relationships (limited)
  • Relatives of male DPD: increased depression
  • Relatives of female DPD: increased panic
  • Very culture-specific:
  • More prevalent in individualistic cultures
  • Much less prevalent in collectivist cultures
  • Chopping Block
127
Q

Difference between OCPD and OCD

A
  • No true obsessions or compulsive rituals in OCPD
  • Not always associated with anxiety and/or extreme distress
  • Can be egosyntonic
  • About 20% of OCD pts comorbid OCPD
  • About 20% of Panic Disorder comorbid OCPD
  • OCD more likely to be comorbid with avoidant or dependent pd
  • Perfectionism, preoccupation with details, hoarding
128
Q

Describe OCPD

A
  • Inflexibility and a desire for perfection
  • Preoccupation with rules and order -> ex: making lists and schedules (spend more time doing these but sometimes don’t even do the tasks)
  • Often moralistic and judgmental
  • Viewed by others as rigid, stubborn, cold
  • Most stable features: rigidity, stubbornness, perfectionism, reluctance to delegate most common and stable features
  • Are often cheap and have a hard time giving things away
  • VERY limited research since 1980
  • OCPD tends to be more common in men
129
Q

Why is the notion of a personality disorder clinically compelling?

A
  • Clinically, difficult patients present with problems that primarily appear to arise from problems in interpersonal relationships
  • They may have anxiety, depression, etc -> but these appear to be secondary to problematic ways of interacting with the world
  • Complicates treatment -> clients will often have interpersonal challenges with the therapists themselves
130
Q

Clinicians are typically reluctant to diagnose women with what PD and men with what PD

A
  • Women with ASPD
  • Men with Histrionic PD
131
Q

What are comorbidities of PDs with Axis 1 disorders

A
  • Avoidant, dependent highly comorbid with anxiety and depression
  • BPD comorbid with unipolar, bipolar, PTSD
  • Substance use disorder comorbid with ASPD, BPD, NPD
  • Avoidant comorbid with all Eating Disorders (ED)
  • Highest comorbidity for AN-R and BED = OCPD
132
Q

Describe the history of the term BPD

A
  • Origins in the psychoanalytic tradition
  • Stern (30s)
  • Inordinately hypersensitive, problems with reality testing, and experienced negative reactions in therapy
  • Between the psychoses and neuroses; border line
  • Continued for several decades: “pseudo-neurotic schizophrenia”
  • Typically referred to patients who were extremely challenging to treat
133
Q

How does the WHO International Classification of Diseases (ICD-10) refer to BPD?

A

Uses the term “Emotionally Unstable Disorder”

134
Q

Describe Baskin-Sommers’ study on BPD and emotional reactivity

A
  • 13 female adults with BPD and 11 without BPD
  • Allowed comorbid disorders (5 of them also had depression and some had PTSD)
  • Presented a target for 30milliseconds -> level below conscious awareness
  • Emotional face immediately masked by a neutral face for 170 msec
  • Neutral, happy, fearful faces
  • People with BPD are showing more activation than people without BPD
  • Happy and fearful faces shows increased activation in amygdala in BPD patients vs healthy controls
  • Aren’t consciously aware of having seen these emotional faces
  • Pattern of hyper-vigilance that may play out to make them hyper-sensitive to fluctuations
  • May be able to respond to micro-expressions more than others
135
Q

Describe the neurochemistry of BPD

A
  • Some evidence for low 5-HT (low serotonin) activity in BPD
  • BPD treated with SSRIs show improvements in aggressive impulsivity
  • Not overall reduction in symptoms
  • Some evidence for DA dysfunction
  • Primarily b/c antipsychotic meds moderately effective in treating BPD
  • Also inferred through behaviors:
  • Impulsivity, sensation-seeking, emotion dysregulation
136
Q

Describe suicide and BPD

A
  • Suicidal ideation very common -> almost all will report
  • Suicide attempts: as many as 70%
  • With an average of 3-4 attempts
  • As many as 1/10 die by suicide
  • Reasons for suicide attempts:
  • To get away, or escape
  • To punish self
  • Revenge -> rare
  • To make others better off
137
Q

Describe BPD comorbidity

A
  • Very high
  • About 60% comorbid MDD
  • About 35% comorbid PTSD
  • 20% bipolar
  • 17% Eating disorders (more commonly binging)
138
Q

Describe Marsha Linehan’s Biosocial Theory of BPD

A
  • People with BPD are born with biological predisposition towards difficulty regulating emotions
  • Emotions more intense
  • More sensitive to variations in emotional stimuli
  • Take longer to return to baseline
  • Chronically invalidating family environment: environment where parent or parents are invalidating emotional responses of child (ex: punishment when child gets upset)
  • Child’s communications of their internal experiences are met by responses from parents that are dismissive, erratic or out of touch with what the child is feeling
  • Results in inability to regulate strong emotional responses
139
Q

Describe BPD treatment

A
  • Chronic (PD)
  • But evidence that as many as 88% can be successfully treated
  • Often most severe in younger pops
  • With treatment, suicidal and impulsive behaviors decrease
  • Mood reactivity often persists, but patients will be better able to cope
  • DBT common treatment method -> Marsha Linehan developed dialectical behaviour therapy
  • DBT is a form of cognitive behavioural therapy that’s focused on practicing both acceptance and change
  • Because people with BPD have experienced lots of rejection this is important for them -> helps patients validate themselves but also recognize that their behaviours are hurting themselves and others
  • Promising recent study that showed that all forms of treatment were effective for BPD
140
Q

Evidence that BPD may be a variant of what disorders

A
  • A variant of depression:
  • Chronic form
  • Evidence for distinct neural signatures
  • A variant of PTSD:
  • Can develop BPD without experiencing trauma
  • Trauma not unique to either PTSD or BPD
141
Q

Describe Bipolar 2

A
  • HYPOmania and depression
  • Hypomania same symptoms as mania, milder
  • No hospitalization
  • No psychosis
  • Mood is out of normal range, but not necessarily distressing
  • Often very fun
  • Stimulus-seeking
  • Causes some impairment, but not so extreme
142
Q

What’s Bipolar I?

A

Mania plus episodes of MDD

143
Q

What’s Cyclothymia?

A
  • Hypomania and short depressive episodes
  • Chronic pattern, less severe
  • Lots of highs and lows
  • More extreme than normal mood fluctuations
  • 2 year period
  • M=F
  • Often don’t seek treatment -> women more likely
  • At increased risk for Bipolar I
  • Antidepressant meds can be a trigger
144
Q

Describe Rapid Cyclers

A
  • 4 or more episodes within a year
  • Can be either kind of episode
  • More likely to be female
  • Predicts poor response to treatment
  • Mood stabilizers often ineffective
  • NOT a stable trait– rather a phase that some will pass through
145
Q

What are some mood incongruent psychotic symptoms in mania?

A
  • Thought insertion
  • Mind control
146
Q

What are some mood incongruent psychotic symptoms in depression?

A
  • Anything happy
  • This is rare
147
Q

Current DSM-5 resolution for psychotic symptoms in bipolar and mood disorder

A
  • If psychotic symptoms occur during a manic or depressive episode, then qualifies as a MOOD DISORDER (w/ psychosis)
  • If occur outside mood episode, usually schizoaffective diagnosis
148
Q

What are some mood congruent psychotic symptoms in mania?

A

Delusions of grandeur: thinking you’re a billionaire or prince or god

149
Q

What are some mood congruent psychotic symptoms in depression?

A
  • People will experience extreme themes of guilt and confess to things they didn’t do
  • Nihilistic
150
Q

Describe suicide in Bipolar

A
  • Risk of death by suicide are 15 X the general population
  • 4 X patients with major depressive disorder
  • Some estimates of inpatients with bipolar suggest 11% die by suicide
  • Risk factors for death by suicide:
  • younger age
  • recent illness onset
  • male gender
  • prior suicide attempts (SAs)
  • a family history of suicide
  • comorbid alcohol or substance abuse
  • rapid cycling course
  • social isolation
  • MOST of these are associated with increased risk for death by suicide across all populations, not specific to Bipolar
151
Q

What are the particular class of stressors important in mania that Sheri Johnson found?

A
  • Goal-attainment events
  • Significantly associated with manic episodes
  • When achieve a goal, become very happy; subsequently dysregulated; spiral into mania
152
Q

Describe how Robert Post applied Kindling theory to Bipolar Patients

A
  • 1st episode of Bipolar requires a lot of stress (severe stress exposure)
  • 2nd episode requires less stress
  • 3rd episode even less
  • Eventually, don’t need stressors– episodes occur on their own
153
Q

Sleep deprivation is a powerful predictor of what?

A
  • Sleep deprivation a powerful predictor of mania
  • Less sleep on day N predicts increases in manic symptoms on day N+1
  • Exposure to bright light, which can change circadian rhythms, can trigger onset of manic symptoms
154
Q

Describe stress and adversity in Bipolar

A
  • Stress appears to increase in the 1st 6 months prior to an episode
  • Frequently relapse following a stressful experience
155
Q

What are some poor prognostic indicators of bipolar?

A
  • Mixed states
  • Rapid cycling
156
Q

What are some predictors of history of depression converting to bipolar

A
  • Younger age
  • Heightened guilt
  • Psychomotor retardation
  • Family history of bipolar
157
Q

Describe epidemiology of CD

A
  • Boys 4x more likely to be diagnosed
  • Girls diagnosed at a later age
  • In girls, may have different correlates, outcomes -> teen pregnancy, suicidal behavior
  • More pronounced with CD partner
  • Assortative mating: idea that people with CD tendencies may have a tendency to date and marry and mate with other people with CD tendencies
  • Associated with more severe negative behavior, discord, poor parenting
  • Kids already have heightened genetic load
158
Q

ASPD vs Psychopathy

A
  • Cleckley advanced view that psychopath appears normal on the surface
  • Under the mask is a very fundamental, very severe deficit
  • More psychologically- than behaviorally- focused -> Behaviourally, a psychopath may be fine they may not be coming into conflict with the law
  • Criminal behavior is only one piece
159
Q

Describe the Factor analysis of Hare’s checklist

A

Factor 1: Emotional-Interpersonal
* charm, grandiosity
* lying, manipulation
* lack of remorse
* shallow emotional depth
* low empathy

Factor 2: Behavioral Deviance
* child behavior problems
* juvenile delinquency
* boredom, impulsivity
* irresponsibility
* violent behavior

160
Q

Describe Patrick (2015) study on prison inmates with ASPD vs Psychopathy

A
  • In a sample of prison inmates:
  • 70 - 80% qualified for ASPD diagnosis
  • 25-30% met criteria for psychopathy (PCL)
  • Sub-group of prisoners who also met criteria for psychopathy tended to be the worst offenders -> 2-4x more likely to reoffend and create ~2x as many crimes as people with ASPD but no psychopathy
  • ASPD misses non-criminal psychopathy
  • Individuals show more affective/interpersonal features, but fewer antisocial behaviours, and are rarely criminalized
161
Q

Describe psychopathy and recidivism

A
  • Psychopathy single best predictor of violence and recidivism among prison pop.
  • Up to 4x more likely to reoffend (violently) than other prisoners (Hemphill, 1988)
  • Same trend seen in adolescents
  • Study found that high PCL individuals are more likely to have violent reoffences than the other groups and more likely to have them sooner after release from prison
162
Q

Describe the findings of the study on MAOA activity, childhood maltreatment and antisocial behaviour

A
  • Under conditions of no childhood maltreatment, people with low MAOA activity and people with high MAOA activity look pretty similar to one another (not much difference in terms of how much antisocial behaviour they’re engaging in)
  • Under conditions of probable childhood maltreatment, people with low MAOA activity and people with high MAOA activity start to look different in terms of antisocial behaviour
  • Under conditions of severe childhood maltreatment, people with low MAOA activity and people with high MAOA start to look very different from one another in terms of antisocial behaviour
    -> People with low MAOA activity have very high levels of antisocial behaviour
  • This suggests that this MAOA activity may represent a diathesis or vulnerability for exposure to different environments
163
Q

What are some Prenatal Factors and Birth Complications linked with ASPD

A
  • low birth weight
  • malnutrition (possible protein deficiency) during pregnancy
  • lead poisoning
  • mother’s use of nicotine, marijuana, other substances during pregnancy
  • maternal alcohol use during pregnancy
  • Smoking during pregnancy -> CD
164
Q

Describe findings for Christopher Blattman, Julian Jamison, Margaret Sheridan study on Sustainable Transformation of Youth in Liberia

A
  • Persistent reduction in antisocial behaviours was present only in the group who got both cash and therapy
  • The people conducting the therapy noted that the men often underwent a change in appearance overtime (ex: would get haircuts, dress slightly differently)
  • Therapy alone was not enough to affect these long term changes
  • The cash gave them material opportunities where they could make these changes possible
  • The cash gave them a venue to exercise the skills they learned in therapy
165
Q

Describe Watson and Clarke’s Tripartite Model

A
  • Common: general distress and negative affect
  • Specific to depression: anhedonia (lack of positive affect, psychomotor retardation, lack of drive)
  • Specific to anxiety: physiological hyperarousal (mainly applies to panic models)
166
Q

Describe findings of McGuffin Study on mood disorders

A
  • Of monozygotic Bipolar twins, 67% of co-twins had a mood disorder
  • Of dizygotic Bipolar twins, 19% of co-twins had a mood disorder
  • Suggests a 96% heritability
  • Of monozygotic Bipolar twins, 40% of co-twins had Bipolar
  • Of dizygotic Bipolar twins, 5% of co-twins had Bipolar
  • 70% heritability
  • Of monozygotic MDD twins, 46% of co-twins have MDD
  • Of dizygotic MDD twins, 20% of co-twins had MDD
  • 52% heritability
  • BUT, to date, no reliable/ specific genetic differences identified
  • Both MDD and Bipolar appear to be heritable -> Bipolar appears slightly more heritable
167
Q

Kendler Twin Study findings

A
  • For MDD concordance rates for male twins and female twins
  • In both male and female twins we see higher agreement rates among monozygotic twins
  • Female twins have higher agreement rates among monozygotic twins than boys Mz
168
Q

PBI findings

A
  • Two dimensions of caregiving:
  • Care,nurturance
  • Overprotection,control
  • Depressed patients frequently report parents lower in care
  • Lessconsistently: higher in overprotection
  • This interaction poses a heightened risk for depression
169
Q

Most powerful stressors related to themes of loss

A
  • Loss of a loved one
  • Loss of a job
  • Loss of a cherished ideal or goal
170
Q

Describe Skinner, Ferster, Lewinsohn Reward and Positive Reinforcement model of depression

A
  • Depression related to a reduction in
    behaviors that are positively reinforced
  • Receive less positive reinforcement, mood declines
  • Become less likely to engage in behaviors that receive positive reinforcement
  • Experience a serious reduction in positive events in the environment
  • Vicious cycle
171
Q

Describe Aaron Beck’s Cognitive Triad

A
  • Negative views about the world
  • Negative views about the future
  • Negative view about the self
  • 2 factors interfere with depression:
  • You have negative views about yourself and believe that you can’t do things you need to do
  • Looking at schemas
  • These schemas contribute to negative automatic thoughts
  • Experience the world through these negative schemas
  • Use of schemas to understand things happening to self
172
Q

What are the 3 attribution styles associated with depression?

A
  • Internal
  • Global
  • Stable
173
Q

What are the 3 dimensions of attributions in the Revised Learned Helplessness?

A
  • external vs internal
  • global vs specific
  • Stable vs unstable (temporal)
174
Q

Cognitive schemas in depression are linked with what kind of biases?

A
  • Memory biases: our negative schemas will result in better memory for negative information than positive info since these memories are schema-consistent
  • Schemas filter the info that we encode (attentional biases)
175
Q

Describe the findings of the Self Referent Encoding Task (SRET) for memory biases in depression

A
  • List of adjectives and ask them to rate the degree to which the adjectives describe them or not
  • Then asked to state the words which they remember seeing
  • Depressed people more likely to endorse negative words than positive words (describe themselves with them)
  • Depressed people more likely to remember negative words they endorse about themselves than positive words they endorse
  • You see this same kind of bias with PTSD
176
Q

Attention biases for depression and anxiety

A

People with depression and anxiety will be much faster to find the snake in the mushroom group than control groups and much slower to find the mushroom in the snake group than control groups

177
Q

Stroop task findings for depression

A

For people with depression, we particularly see this delay of colour identification with threatening or sad words (attentional bias, attending so much by the content of the word)

178
Q

Difference in attention biases in anxiety and depression

A
  • Attentional biases evidence in depression not as strong as memory biases
  • Sad faces often do a better job capturing attention for depression
  • Fearful faces tend to capture attention more in anxiety
  • Sometimes the most powerful group differences occur when we use ambiguous stimuli because people with depression are more likely to interpret these as threatening
179
Q

Findings for dichotic listening task and depression

A
  • Task relevant info in one ear (person has to say what they hear in this ear) and distractor info in other ear (person has to inhibit info from this ear)
  • Difficult task and even more difficult if the content is very salient
  • People with depression will make a lot more errors in what’s happening in task relevant info if the distractor ear is reporting negative info

Psychopathology (6 decks)

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