PSY311 Midterm 3 Flashcards
What was personality disorder before DSM-5?
There was classification (like most common mental health disorder, medical issues) and they were not well investigated
- What is the definition of personality?
2. When does a disorder occurs?
1.Characteristics that describe how a person behaves and thinks.
2. Interferes with a person’s relationships and
Causes distress or impairment in daily life activities
What is a personality disorder?
A persistent pattern of emotions, cognitions, and behaviors that results in enduring emotional distress for the person affected and/or others and may cause difficulties with work or relationships
-> This is a global definition, there is more than 1 personality disorder (there are 10 in total)
What is the chronic course of a personality disorder?
Stems from childhood and continues on (difficult to treat something chronic ). also it does not mean they are diagnosis at childhood (very rare because you do not know if it is persistent or not) - the signs can be there. A major hint is childhood environment.
Personality disorder is comorbid with…?
depression (very important) and anxiety. This is why this is difficult to see betond that, that there is a pathology.
Name all the personality disorder of cluster A ‘‘odd cluster’’ eccentric cluser’’
→ social awkwardness, distorted thinking
paranoid personality disorder
schizoid personality disorder
schizotypal personality disorder
Name the key terms of paranoid personality disorder
Unjustified distrust
Suspicious unfounded
Can be argumentative and sensitive to criticism
Can be short-tempered: able to attack someone if needed
what is the etiology of paranoid personality disorder? they are common…
- Biological contribution
- Psychological contribution
- Sociocultural contribution
Biological contribution
Weak genetic contribution
Psychological contribution
Weak-moderate contribution
Early traumatic childhood experiences → distorted schemas that develop in childhood when ask about it
Sociocultural contribution
Prisoners, refugees, people with hearing impairments more likely to develop this disorder
We don’t really know why
little research about it, not much
What is the treatment for paranoid personality disorder?
Unlikely to seek professional help
Difficulty in developing a trusting relationship with the therapist
Usually present to clinic following a crisis or for other disorders
Cognitive therapy
Change distorted schemas “everyone is untrustworthy”
No documented effectiveness
Name the key terms of schizoid personality disorder
“Loner”
Detached and lack emotional expression
Do not appear affected by praise or criticism
“Observers” - they are not team work player, prefer to observe then participate
Do not have unusual thought processes: not like paranoid personality
Schizoid personality disorder rtiology: 2 key points different from other personality disorder
- connexion with Autism spectrum disorder (little evidence)
- Low dopamine receptors (when underdeveloped)~ detachment: low reward, low motivation
What is the treatment for schizoid personality disorder?
Rarely seek treatment Psychotherapy Increase value of social relationships Social skills training No documented effectiveness
Schizotypal personality disorder is possibly on a continuum with…
Schizophrenia BUT in less severe form.
Schizotypal personality disorder: etiology
Breakdown biological contribution
Weak genetic contribution
Connection with Schizophrenia
E.g. Catechol-O-methyltransferase (COMT) → enzyme involved in breakdown of various NT such as dopamine, norepinephrine. alteration in the COMT genes.
the brain region that runs on dopamine seems to be overactive in limbic region, that is why most of the time, when you think about schizophrenia, the major treatment is an antipsychotic . but not overactive in the frontal regions, not enough dopamine - not much regulation…
Brain alterations
E.g. deep in temporal lobe (volume is reduce) → Odd speech, odd beliefs
What are the treatments for Schizotypal personality disorder.
30-50% of individuals seeking help for other symptoms
Psychotherapy:
Social skills training: Modestly effective
Medication
Antipsychotics
Not always effective- more effective for schizophrenia
High drop outs
Negative side effects
Huge difficulties with medication compliance
What are the personality disorder in cluster B which is characteristic ‘‘dramatic, emotional thinking and behavior, impredictable’’
Antisocial personality
Borderline Disorder
Histrionic Personality
Narcissistic Disorder
What are some criteria of antisocial personality disorder?
A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by ≥3 of the following:
- Failure to conform to social norms with respect to lawful behaviors -Deceitfulness, - Impulsivity or failure to plan ahead - Irritability and aggressiveness -Lack of remorse,
The individual is at least age 18 years.- adulthood
There is evidence of conduct disorder with onset before age 15 years.
The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.
What is a conduct disorder? what does it precedes?
It precedes antisocial personality disorder. It develops in childhood.
- agression to people and animals
- destruction of property
- deceitfulness or theft
- serious violations of rules
what is psychopathy subset?
Stats among prisionner
Psychopathy: subset of individuals with antisocial personality disorder with all of the following additional characteristics
Glibness -smooth talk, work people-, superficial charm
Grandiose sense of self-worth
Proneness to boredom, need for stimulation
Pathological lying
Conning, manipulative
Lack of remorse
80% of prisonnier are diagnosed with antisocial disorder but out of the 80%, only 20% display are the characteristics of psychopathy
what is the etiology of antisocial personality?
- genetic influences
- Gene x environment
- Neurobiological influences
- Neuropsychological influences
- Psychological influences
- Social influences
Moderate genetic influences (32% higher than other disorder)
Family, twin, adoption studies support a genetic link
↑ ASPD rate in adopted children of biological mothers with criminal history
Gene x environment
↑ ASPD rate in adopted children of biological mothers with criminal history x who spent more time in an orphanage (a year or two there)
Neurobiological influences
Underarousal hypothesis (not enough)
Low levels of arousal - to get to the proper level, they need to have more stimulation.
Need more stimulation 🡪 sensation-seeking and risk-taking (+ lack of long term planning so just jumping into stuff, not much restrain, inhibition)
Fearlessness hypothesis
Higher threshold for experiencing fear (it takes them much more to feel fear). Inability to learn and respond from negative consequences. No remorse, no empathy
Neuropsychological influences
BIS-BAS disbalance
Weak Behavioral Inhibition System vs Overactive Behavioral Activation System. ↓ prominent anxiety and ↓behavioral inhibition (impulsivity)
Psychological influences
Do not let go of goals
Emotionally distant and mistrustful ~ ↑ violent crime
Social influences Parental attitudes early in life (psychodynamic theory) Low parental involvement Inconsistent discipline Stress
what are the treatment about antisocial personality disorder?
Few documented treatments
CBT
Violent acts reduced 5 years later, except for those who are particularly “selfish, remorseless”
Psychotherapy in childhood
Parent training
Children less responsive to treatment if high stress and family dysfunction
what are Borderline personality disorder?
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts
- Frantic efforts to avoid real or imagined abandonment - A pattern of unstable and intense interpersonal relationships - Identity disturbance - Recurrent suicidal behavior - Chronic feelings of emptiness
More common than other personality disorders
Worldwide lifetime prevalence: ~2%
More common in women Prognosis better than other personality disorders 88% remission after 10 years of therapy Core: impulsivity, emotional instability High comorbidity with mood disorders
Bordeline personality disorder have high comorbidity with…?
mood disorder
what is the etiology about antisocial personality disorder?
Biological influences
Psychological influences
Social influences
Biological influences
Moderate genetic influences
Possible shared link with mood disorders
Psychological influences
Memory bias
Social influences Early trauma (more common in women)
what are the treatment for antisocial personality disorder?
Few studies on treatment efficacy
Complicated by comorbidity
Medication
Lithium
Antidepressants
Antipsychotics
Dialectical Behavior Therapy (DBT)
Identify and regulate emotions
Cope with stressors that trigger suicidal ideation
Name some of the histrionic personality disorder: criteria
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood
- Is uncomfortable in situations in which he or she is not the center of attention
- Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
- Displays rapidly shifting and shallow expression of emotions.
- Consistently uses physical appearance to draw attention to self.
- Has a style of speech that is excessively impressionistic and lacking in detail.
- Shows self-dramatization, theatricality, and exaggerated expression of emotion.
- Is suggestible.
- Considers relationships to be more intimate than they actually are
- More common in women: Uterus used to be blamed
Histrionic personality disorder: treatment
Few studies on treatment efficacy
Psychotherapy:
Try to minimize attention-getting behaviors
Try to improve interpersonal relationships
Name some of the narcissistic personality disorder: criteria
A pervasive pattern of grandiosity, need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by ≥5 of the following:
- Has a grandiose sense of self-importance.
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people or institutions.
4.Requires excessive admiration.
5.Has a sense of entitlement.
6.Is interpersonally exploitative.
7.Lacks empathy: is unwilling to recognize or identify with the
feelings and needs of others.
8.Is often envious of others or believes that others are envious of him or her.
9.Shows arrogant, haughty behaviors or attitudes.
Narcissistic personality disorder: etiology
Weak genetic influences
Psychological influences
Failure of empathetic mirroring
Self-centered
Stemming early in life
Social influences
Parenting (overindulgent or over-controlling) attitudes
Societal pressure on individualism, competitiveness, and successNarcissistic personality disorder: treatment
Psychotherapy
Address grandiosity, sensitivity to evaluation, and lack of empathy
Remove fantasies
Treat and prevent depression
How can you describe the avoidant personality disorder?
anxious, fearful cluster.
Inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood
What is the etiology for avoidant personality disorder?
Biological influences: Moderate genetic influences &
behavioral inhibition temperament
Psychological influences: Behavioral inhibition temperament & low self-esteem
Social influences: Parenting (rejecting, neglecting, unaffectionate) attitudes → no attachment
Connection with social anxiety disorder?
- Similar characteristics, shared traits
- Ego platonic: seems normal…so it is normal that -people judge you - avoidant personality.
- It distress, know it is not normal - anxiety disorder:
What are the treatment for avoidant personality disorder?
Psychotherapy
- Address thoughts of rejection through exposure to feared situation
- Improve social skills
- Role playing
- CBT: 50-60 % useful but high relapse
Dependent personality disorder, what are some criteria?
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation
such as…
Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others. Has difficulty initiating projects or doing things on his or her own.
Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
Urgently seeks another relationship as a source of care and support when a close relationship ends.
Is unrealistically preoccupied with fears of being left to take care of himself or herself.
What is the etiology for dependent personality disorder?
Moderate genetic influences
Psychological influences:
- Personality trait of sociotropy→traits characterized by excessive investment in positive social interactions (strong needs for acceptance of others)
- Opposite of independent, no autonomy
- Social influences: Trauma in childhood
What are the treatments for dependent personality disorder?
Few studies on treatment efficacy
Psychotherapy
- Increase independence
- Client can be dependent of the therapist
What is OCPD?
Obsessive-compulsive personality disorder
preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.
Only slightly related to OCD: Generally, lacking specific obsessive thoughts and
compulsions (like symmetry, washing hands, etc)
What is the etiology for OCPD?
More often in men
Biological influences weak
Psychological influences:Perfectionism
Potential social influences: Trauma faced during childhood- ex. If you do THIS then THIS will happen
What are the treatments for OCPD?
Few studies on treatment efficacy
Psychotherapy: Changing maladaptive behaviors into healthier productive behaviors
What are psychoactive substances for substance use and addictive disorder? what are some reasons to use it?
Psychoactive substances
Chemical compound
Altering mood, behavior, consciousness…
Reasons: medical, recreational (euphoria, to feel that high), entheogen (spiritual reason, spiritual experience, yoga, ritual, etc. meditation -not relaxation), purposeful (performance-related, it overlap with medical… ex.steroids ), research
Substance use and addictive disorder
what are the levels of involvement?
Use
Intoxication
Abuse
Dependence
Substance use and addictive disorder
define use and intoxication
Levels of involvement: use
Ingestion of psychoactive substances that does not significantly interfere with social, educational, or occupational functioning
Levels of involvement: intoxication
Intoxication
-Slang terms: getting high, booze, tipsy
-Reactions to use substances: more extraverted, trouble to speak,
-Includes changes, varying according to substances and individuals, in:
Mood
Speech
Energy
Heart rate: morphin, heroin…
Motor ability
Substance use and addictive disorder
define abuse
Levels of involvement: abuse
Substance abuse
How significantly it interferes with the user’s life
E.g.
Driving drunk
Unable to get a job
Do not attend class
in DSM-4: different point of view. you could say that
the person is displaying substance abuse as soon as
you see harmful consequences OR dependence
(you can have both).
Substance use and addictive disorder define dependence (4 points)
- Dependence (negative effect but keep doing it to avoid the negative symptoms. for addiction = compulsive use. The reason: you take it for the positive effect - the rush, adrenaline…you ready to do anything for it) .today with DSM-5, you won’t have substance dependence it would be : you name the substance in the disorder
- Psychological dependence → emotional-motivational withdrawal symptoms (dysphoria, anxiety, anhedonia, dissatisfaction)
- Physical dependence → physical-somatic symptoms (faitgue. vomiting, chills, pain diarrhea)
- Drug-seeking behaviors of dependence/addiction
- Repeated use of a drug
- Desperate need to ingest more
- Likely to resume the use after a period of abstinence
What are some changes in DSM concerning substance abuse?
Changes DSM-IV → DSM-5 include:
DSM-IV separated substance abuse and substance dependence → combined in DSM-5 as substance use disorders
DSM-IV 1 symptom for substance abuse and ≥2 symptoms for substance dependence → described in DSM-5 in terms of severity: mild (2-3), moderate (4-5), severe (≥6)
DSM-5: each specific substance addressed as a separate
use disorder: cannabis dependence…
Substance and addictive disorder have some comorbidity with…?
Comorbidity: mood disorders, anxiety disorders, etc.
1. Intoxication and withdrawal cause other symptoms
Depression, anxiety, or psychosis
Increases risk taking behaviors
2. Mental health disorders cause the substance use disorders
Substance use disorder: diagnostic criteria
- often taken in larger amounts or over a longer period
- persistent desire or unsuccessful efforts to cut down or control substance use.–> lack of success
- time is spent in activities necessary to obtain the substance use the substance, or recover from its effects.
- Craving, or a strong desire or urge
- use despite having persistent or recurrent social or interpersonal problems
- Activities are given up or reduced because of the substance use.
- Use is continued despite knowledge
- Tolerance
- Withdrawal,
Substance use disorder: classification in DSM-5
Sedatives, hypnotics, or anxiolytics Inhalants Alcohol Stimulants Tobacco Caffeine Opioids Hallucinogens Cannabis Other substances
What are the sedatives, hypnotics and anciolytics about substance use disorder:?
Decrease activity of Central Nervous System
E.g. Promoting GABA (it calms you down)
Relieving anxiety, insomnia
Include: barbiturates, benzodiazepines (very common)
Inhalants/inhaling th(e.g. aerosol, glue): depressant
effect, and potential precursor for alcohol (mis)use
in adulthood.
What are the alcohol effect about substance use disorder:?
Predominantly, depressant property
Various factors influence the extent of alcohol-related effects, including
– Prenatal alcohol exposure
– Family history
– Age when a person first started drinking and for how long a person has been drinking
– How much and how often individual drinks
– Blood alcohol content (BAC) (0.08 = can drive a car - muscle coordination and attention which you need both the drive)
(BAC increases, so does impairement)
what is Cirrhosis? what are the brain damage of alcohol effects?
Cirrhosis: body cannot to replace its tissue due to abuse
Brain damage: lot of effect on the frontal lobe
what is Wernicke-Korsakoff syndrome?
Wernicke’s encephalopathy:
- Mental confusion
- Oculomotor disturbances: trouble with eyes nerve
- Difficulty with coordination
Korsakoff’s psychosis:
- Learning and memory impairments: trouble with new , antego amnesia (new). some with that walking to your apartment might not be able to go back to his place because they won’t remember how they got there in the first place
- both condition goes hand in hand, don’t have to but they do
what are the alcohol statistics?
Most drink in moderation
Men drink more than women
16% men vs. 4% women heavy drinkers
~9% drinkers report some problem with alcohol
Most likely to have alcohol problems are single males with lower income + of younger age
Worldwide lifetime prevalence of alcohol use disorder:
~18-21%
Most people’s drinking pattern fluctuates
~20% of individuals with alcohol abuse present spontaneous remission
Progressive pattern through levels of involvement
Might lead to violence
what are some stimulants?
- Increase CNS activity: Blocking the reuptake of dopamine, norepinephrine (NT related to motivation, reward, rush)
- Increases levels of alertness, energy
- Include: (meth)amphetamine (more dangerous than cocaine), cocaine
amphetamine: it is prescribed a lot, also commonly use to treat ADHD
- Include: (meth)amphetamine (more dangerous than cocaine), cocaine
- Nicotine from tobacco plants, with mild stimulant and depressant properties→ increase heart beat, increase alertness, BUT could be used to reduce stress, relaxant properties… It has a class of its own.
- Caffeine (like coffee, tea, chocolate…everywhere, so where is the line?), a “gentle” stimulant; no officially recognized related disorder: it is a class; there is no official disorder for it because it is everywhere. It is an exception in DSM-5
what are Opiod?
From the opium poppy
Relieve pain, along with euphoria and relaxation: E.g. promoting the activity of opioid receptors
Include: heroin, opium, morphine
if too much of it: affect the breathing (decrease.. can lead to coma or even death),
Increased risk for HIV infections due to needle use, not the only use but it is highlighted
what are hallucinogens?
– Alter sensory perception
–Include: psilocybin(the magic mushroom), LSD (acid), PCP
– Use in clinical because: Low to no withdrawal symptoms
– Tolerance builds slowly
– emotion, dilated pupils, mystical experience…
– Some of them are used in clinical trials → often
combined with psychotherapy (psilocybin, MDNA-
cocaine) short term because it alters sensory
perception. It may lead the patient to talk about
traumatic experience without experience the
emotional trauma that comes with it (PTSD) - it helps
the process.
– common site of action: Chemical similarity to serotonin (partial agonist of serotonin receptor)
– there is a cannabis disorder that is recognized
– acts on cannabinoid that is in our body
what is cannabis?
it is complex
more psychological addiction rather then physical
– No part of hallucinogens
– From Cannabis sativa
feeling the ‘’high’’ = THC
feeling relaxe = CBD
– Low to no withdrawal symptoms
– Tolerance builds quickly (useful in the war, less
appetite, less fatigue)
– Endocannabinoid system
– Depressant, stimulant, hallucinogenic effects
– More adolescent, young adult mostly use it
– Medicinal purposes
what are other substances?
E.g.: anabolic steroids: synthetic hormones, develop muscle growth of muscle, use to weight loss, use illegally by athletes, induce puberty (it helps people late on puberty), therapeutic use: chronic condition, cancer…
– various side effect after heavy use: nausea,
abdominal pain, insomnia, hair loss, liver & kidney &
heart trouble
what are the biological approach for substance use disorder?
Genetic and hereditary influences (esp. for alcoholism)
Twin, family, and adoption studies support this claim
High genetic influence in men
gene and environment play both an important role
No single gene determining substance use → contribution of endophenotypes- characteristic that has a genetic basic, ex impulsivity- and combination of genes
Impulsivity, seeking high activity
Low sensitivity to alcohol
Shared genetic background with antisocial
personality disorder,
mood disorders, schizophrenia
major inhibitory GABA receptor gene, Dopamine
receptor gene, ALDH gene(alcohol metabolize
enzyme) = a lot involved at the same time.
Neurobiological influences
Substances affect brain reward pathways (euphoria,
rush)
Cause pleasurable experience
a lot of substance affect levels of dopamine
tolerance will build over time, desentization if
agonist
what are the psychosocial approach for substance use disorder?
Behavioral conditioning
Positive reinforcement: The “high” of the drug -
addiction
Negative reinforcement: Remove pain, unpleasant
feelings- dependence (maybe you’ll increase the
dose to take away the pain)
Cravings
Influenced by cues = conditioned stimuli
cues: getting into a bar and look at the bottles
(seeing = crave starts, temptation)… external cue
mood: fatigue, anxiety, wanting to celebrate,
conflict… the feeling = internal cues
what are the social approach for substance use disorder?
Exposure to substances through: family peers, media (seeing drinking, smoking..) now sensitization in high shool
Poor adult supervision: neglect, no support, no awareness (not limited to parents or immediate family)
Societal views:
–Ex. drinking can be perceived as something very bad
–past what ages it can be consumed
–what excessive means
–Brain disease theory vs. Moral weakness theory
there is a research saying that the way you phrase certain words can lead to stigma to… the group of the dependence believed more about the brain disease but the group called drug abuser believe more in the moral weakness (their fault) that is why we use the term substance use disorder (and then to precise it: heroin…) and not abuse or dependant it is to prevent stigma
Integrated model - important for exam
image on page 25
what are biological treatment for substance use disorder?
- agonist substitution
Safer drug with similar makeup, working on the same receptors, stimulate
E.g. Methadone (opioids) instead of heroine
it works on the same receptors… Some can stay on methadone for life, some might decrease gradually where it is no longer needed (it takes years to get there).
antagonist treatment
Block or counteract the effects of a substance
E.g. Naloxone for heroin abuse
it is in the paramedic kit… if someone is in an overdose = you use naloxone to overcome it. you want to be quick on that, you cannot use it in the long run.
block on the BBB
aversive treatment
Make ingesting the drug unpleasant
E.g. Disulfiram’s Antabuse effect= it comes in a form of a powder, easily solvable in alcohol, it inhibited the LDA (enzyme that metabolize alcohol).. so alcohol is not breaking down and the effects will accumulate and you are going to feel hungover right away, immediately. Headache, nausea, vomiting… it makes the digestion of alcohol quite unpleasant
least popular one: rare that the patient will stick to that treatment.. might start it but it won’t last.
what are psychosocial treatment for substance use disorder?
Biological treatments alone usually insufficient
Inpatient facilities: Help with initial withdrawal, control environment
Expensive, not everyone can make it there. Rehabs
Alcoholics Anonymous and its variations (e.g. NA (narcotic anonyme = any other drugs)–> AA = 12 steps for it
Aversive therapy: Substance use paired with an unpleasant stimulus: control use, control environment, pharmacological - rare
Contingency management
-Make goals and rewards for attaining those goals
-Frequent monitoring of the target behavior
control environment
-Social support is important when the patient is with their family… how was your behavior outside of the hospital let’s say. the more closer to the target behavior = more reward (more family visit)
-reinforce behavior
-a lot of it at the hospital
Community reinforcement approach and family training (CRAFT)
Family-based therapy- major component. Give them knowledge. How to support the individual which will help to prevent a relapse
ABCs of substance abuse
Antecedents (triggers), behavior (drug use), consequences
Relapse prevention
- Target positive beliefs about drug use
- Target consequences of drug use
- Develop strategies to deal with cravings: medication, avoiding certain places, distress management, social support, etc. Keep going even if you relapse
- Relapse seen as something that individual can recover from
Harm reduction
Main goal is to minimize harm
–unlike ‘’say no to drugs’’ compain in the US
–More promising than ‘’say no to drugs’’
can end in abstinence
Relapse prevention
- Target positive beliefs about drug use
- Target consequences of drug use
- Develop strategies to deal with cravings
- Relapse seen as something that individual can recover from
Gambling disorder: Statistic (only addictive disorder is official in the DSM-5)
-Prevalence: ~2%
-More prevalent in men than in women
- AOO: 20s
Consequences:
14% experience job loss
19% declared bankruptcy
21% arrested
Considered a behavioral addiction or an addictive
disorder
Gambling disorder: Criteria
Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress
- —restless or irritable when attempting to cut down or stop
- —made repeated unsuccessful efforts to control, cut back
- —often preoccupied with gambling.
- — gambles when feeling distressed.
- —-After losing money gambling, often returns
- —Relies on others
- —jeopardized or lost
B. The gambling behavior is not better explained by a manic episode: impulsivity (excessive spending)
what about internet use?
Internet use is not a recognized disorder in DSM-5 but maybe in DSM-6. (around 10 years gap between each DSM)
SCZ: early descriptions
Kraepelin’s and Bleuler
Kraepelin’s form of psychosis (1856-1926)
—Manic-depressive illness
—-Dementia praecox– .precautious
madness, or precocious dementia =
cognitive deterioration(speak and talk)
later it is set as schizophrenia
(delusional belief, motor disturbances)
—-
Bleuler (1857-1939)
–Did not believe in early onset
–Did not believe in inevitable progress
towards dementia
–Coined term Schizophrenia
SCZ in the media
“People with schizophrenia are dangerous”
Not true
Individuals with schizophrenia are not more likely to commit future crimes than individuals with no schizophrenia
Complex psychotic disorder characterized by major disturbances in thinking, perception, emotion, language, and/or behavior, disconnected
Diagnosing SCZ
Heterogeneity
People with schizophrenia can differ from each other more than do people with other disorders
Contribution of comorbid disorders: depressive, substance use, anxiety… apathie?
Statistics SCZ
Onset: late adolescence or early adulthood
Course: chronic -> Typically, several acute episodes of their symptoms, with
less severe symptoms in between
Full recovery is rare
Comorbidity: MDD, substance use disorders, anxiety disorders
Also: almost 10% commit suicide
Development SCZ
Children show abnormal signs before they develop SCZ, but difficult to know.. (ex. imaginary friend)
Older adults show fewer positive symptoms
SCZ diagnostic criteria
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms
disturbance persist for at least 6 months
Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out
The disturbance is not attributable to the physiological effects of a substance or a medical condition
Aside SCZ…
Schizophreniform disorder
Same criteria as schizophrenia, except:
Symptoms for fewer months → then disappear
“Why” mostly unknown
SCZ: clinical symptoms
positive symptoms
Presence of too much of a behavior
Experienced by 50%-70% of individuals with SCZ
- Delusions
- Hallucinations
Erroneous beliefs despite clear contradictory evidence
Usually involves misinterpretation of reality
Can also occur during manic episodes, during depressive episodes with psychotic features, etc.
what are the delusions types?
persecution
reference
body control
delusion of Grandeur
delusion about one’s own thoughts (broadcastin, insertion and withdrawal)
Capgras syndrome: Belief that someone a person knows has been replaced by an imposter
Cotard’s syndrome: Belief that one has lost body parts or even that one has died
what are the hallucinations types?
Most dramatic distortions of perception
Sensory experiences in the absence of stimulation from the environment
Types: auditory*, visual, gustatory, olfactory, or tactile (e.g. formication)
Like delusions, hallucinations can be very frightening experiences
SCZ: clinical symptoms
disorganized symptoms
Least studied and understood
Prevalence is unclear
Includes
Inappropriate affect
Disorganized speech
SCZ: clinical symptoms
disorganized symptoms -> inappropriate affect
Emotional responses are out of context: Likelihood to shift rapidly from one emotional state to another for no discernible reason
This symptom is quite rare, but its appearance is of considerable diagnostic importance because it is relatively specific to SCZ
SCZ: clinical symptoms
disorganized symptoms -> disorganized speech
Include: Loose associations & Incoherence
Evidence indicates that the speech of many people with SCZ is not disorganized and that the presence of disorganized speech does not discriminate well between SCZ and other psychoses
Loose associations or derailment
1. “I was going down to the store because it is October and the people near the street didn’t tell me what was happening since I don’t like to walk too fast. So, after the time when it was happening I decided that no one knew who I was and needed to buy some kind of bicycle or other type of train.”
Incoherence or “word salad”
2. “Well, lettuce is a transformation of a dead cougar that suffered a relapse on the lion’s toe. And he swallowed the lion and something happened. The… see, the… Gloria and Tommy, they’re two heads and they’re not whales. But they escaped with herds of vomit, and things like that.”
Catatonia
Several motor abnormalities
Unusual increase in overall level of activity: Can gesture repeatedly
Unusual decrease in overall level of activity
Stupor: total immobility
Catalepsy: unusual postures
Waxy flexibility: limbs can be
manipulated into strange positions
SCZ: clinical symptoms
negative symptoms
Present in 25% of individuals with SCZ
Behavioral deficits
Avolition: lack of will, energy
Alogia: poverty of speech or content
Anhedonia: lack of interest, pleasure
Asociality: few friends, poor social skills
Flat (or reduced) Affect*: lack of emotional expressiveness
Alogia
“Why do you think that people believe in God?”
“Well, first of all, because, he is the person that is the personal savior. He walks with me and talks with me. And uh, the understanding that I have, a lot of people, they don’t really know their personal self. Because they just don’t know their
personal self. They don’t know that he uh, seems to like us. A lot of them don’t
understand that he walks and talks with them.
And uh, show’em their way to go…”
what are the 4 subtypes of SCZ in DSM-4 ?
Paranoid Disorganized (hebephrenic) Catatonic Undifferentiated Residual
SCZ Dsm-4 to DSM5, what about it?
DSM-5 work group proposed:
Removing all of the subtypes
Major argument for discontinuing the subtypes
Low reliability and poor validity (APA, 2013)
Instead, DSM-5 enables clinicians to consider the heterogeneity in symptom expression
SCZ: Etiology
Biology approach
Twin studies
Role of genes and environment in the development of SCZ
Identical twins do not always both have the disorder
“Genain” quadruplets
All developed SCZ → Genetics
Different time, severity → Non-shared environment?
Nora Iris Myra Hester- all four had SCZ by 24 years old (quadruplet). Different course, severity → same family environment but what else? Non-shared environment? peer pressure?
Adoption studies
Even when raised away from biological parents, adopted children have an increased risk for developing SCZ
Good home environment lowered these risks
Genetic linkage and association studies
Several genes implicated in the development of SCZ
E.g. 5-HT2A gene, DRD3 gene
Dopamine theory: System may be too active in individuals with SCZ
Brain
Larger ventricles observed in some individuals with SCZ
Larger in individuals who have had SCZ longer.
Less brain tissue, less space for frontal lobe
SCZ: psychosocial and social influences
tress
Stressful life events appear to precipitate the onset of the disorder
↑ Life stress ~ ↑ relapse
Sociogenic hypothesis: living in lower social class is stressful
Social support: Appears to be a protective factor and improve prognosis
Transcranial magnetic stimulation (TMS), page30
SCZ psychosocial intervention
Social learning ward Milieu-therapy ward Routine hospital management Social skills training Family therapy
Social learning ward
- token economy
- addressing aspects of living
Milieu-therapy ward
- therapeutic community
- acting responsibily
- kept busy 85% of the time
Routine hospital management
- Regular custodial care
- Antipsychotics
Social skills training
- Learn skills in various domains
- Does not necessarily improve global functioning
Family therapy
- Goal: reduce emotional expressivity
- Communication skills
- Education
Psychodynamic therapy: insight into the role of the past
Cognitive behavioral therapy (CBT): decrease symptom intensity, relapse, reduced more negative symptoms
Early intervention affects prognosis
