PSYC 3607- Exam Flashcards
schizophrenia
- disorders in: thinking, communication, and emotion
- heterogenous in presentation
- symptoms may be positive (too much of a behaviour) or negative (absence of a behaviour)
positive schizophrenia symptoms**
- too much of a behaviour
- disorganized speech and behaviour (tangentiality and derailment), delusions, hallucinations
tangentiality
tendency to talk about a topic unrelated to the main topic of discussion
derailment (loose associations)
lack of connection between ideas
delusions
- implausible beliefs, typically based on misinterpretations of experiences of perceptions
- beliefs persist despite evidence they are faulty
- may reflect: persecutory, referential, somatic, religious, or grandiose themes (persecutory is the most common)
persecutory delusions
- most common
- delusions of paranoia
referential delusions
- belief that ordinary events and human behaviour have hidden meanings that relate to the individual
- individual believes they’re receiving special messages (e.g. song lyrics, newspapers)
somatic delusions
individual believes that something is wrong with all or part of their body
religious delusions
religious stories provide insight into how to destroy or save the world
grandiose delusions
unfounded or inaccurate beliefs that one has special powers, wealth, mission, or identity
hallucinations
- misinterpretations of sensory perceptions while awake
- see, smell, hear, or feel things that aren’t really present (auditory is the most common)
- affects 70% of patients
- involves brocas area (speech production)
disorganized behaviour
complex movements, manic limb flailing, catatonia, waxy flexibility
negative schizophrenia symptoms
- absence of a behaviour that should be evident in most people
- behavioural deficits
behavioural deficits (5)
- avolition- lack of energy
- alogia- poverty of speech
- anhedonia- lack of interest in recreation activities, relationships, etc.
- flat affect- important for early detection
- asociality- few friends, poor social skills
subtypes of schizophrenia
- paranoid- delusions and/or hallucinations with absence of cognitive or affective impairment
- disorganized- disorganized speech or behaviour and flat or inappropriate affect
- catatonic- psychomotor disturbance, extreme negativism and rigidity
- undifferentiated- when criteria A is met but cannot be effectively classified
schizophrenia and violence/self harm
- schizophrenics are not more violent than the general population
- schizophrenics are more likely to self harm and commit suicide
schizophrenia age of onset and course
- 20-24 for M, 25-29 for F
- 22%
- stress, recreational drug use, etc. have been tied to the initial experience of the disorder (like a trigger)
excessive pruning hypothesis
excessive pruning of the prefrontal cortex
schizophrenia and SES
- no difference in occurrence between SES groups, but individuals diagnosed with schizophrenia tend to drift towards low SES groups
- once afflicted, less likely to finish education or maintain employment
- social drift vs social causation
dopamine theory
- schizophrenia is thought to be related to increased activity of dopamine receptors
- drugs effective in treating schizophrenia decrease dopamine activity and produce similar side effects to Parkinson’s which is caused by too little dopamine
- amphetamines increase dopamine and can result in schizophrenia- like symptoms
substantia nigra
- critical brain region for the production of dopamine, which affects the CNS (movement, executive functioning, limbic activity)
- neuronal death in the substantia nigra leads to Parkinson’s symptoms
brain structure and function and schizophrenia
effects ventricles (enlarged- implies loss of subcortical brain cells), hippocampus, and prefrontal cortex (responsible for speech, decision making- reduced grey matter and neural connections)
schizophrenia treatment
- shock and psychosurgery (prefrontal lobotomy)
- drug therapy (neuroleptics and antipsychotics)
phenothiazines
- produces antipsychotic effects
- blocks post-synaptic receptor sites for dopamine (D2)
neurocognitive disorders
- significantly reduced mental abilities relative to one’s prior level of functioning
- changes in cognitive functioning are the primary set of features and are often associated with increased anxiety and depression as secondary features
- must be: compared to a person’s prior functioning and distingue from normal age related changes
three types of neurocognitive disorders
- delirium, amnestic disorder, dementia
- all three mainly affect older adults
two sets of abilities of intelligence
crystallized and fluid
crystallized intelligence
- ability to apply prior knowledge
- improves with age
fluid intelligence (executive functioning)
- ability to reason quickly and indepently of past experiences
- assessed with visual motor skills, problem solving, and perceptual speed
- declines after the age of 55
amnestic disorder
- difficulty storing new information and recalling stored information, more severe than expected for normal aging
- other mental processes (consciousness, attention, etc.) remain intact
- may be transient (lasting a few days to a month, may result from seizures) or chronic (longer than a month)
- tend to confabulate
confabulate
- creating stories to fill in gaps in memory
- family members are usually the best source of information as the patient may be a poor historian
neurological factors of amnestic disorder
- substance use
- general medical conditions (e.g. damaging brain areas involved in memory- hippocampus, mammilary bodies, fornix)
treating amnestic disorder
- no cure; partial or full memory function can return over time
- goal of treatment is rehabilitation
- help the patient learn to function as well as possible
- techniques and strategies to compensate for memory problems (e.g. mnemonics, writing info down, etc.)
- organizing the environment to aid memory
delirium
- impaired cognition (trouble concentrating, focussing, and maintaining a coherent and directed stream of thought) and marked change in awareness (illusion, hallucinations, perceptual disturbances)
- swings in activity (erratic to lethargic) and mood (depression, euphoria, anger, irritability)
- may have lucid intervals and become alert and coherent
what causes delirium?
drug intoxication and withdrawals, metabolic and nutritional imbalances, infections, fevers, neurological disorders, changing a person’s surroundings, severe or chronic illness
unique symptoms of delirium
- rapid onset
- symptoms fluctuate within a 24hr period
- hallucinations are frequent and tend to be visual
- symptoms often gradually improve
- person is not alert or focused
unique symptoms fo dementia
- gradual onset
- symptoms do not fluctuate
- no hallucinations
- symptoms rarely improve
- person is consistently alert
medical factors that affect cognition
- head injures (blunt force trauma to the head, stroke)
- prescribed and illicit substances (older adults are more sensitive to medications)
- other medical conditions (encephalitis, brain tumours, arthritis, chronic pain)
- hearing loss or vision problems may mimic deficits in cognitive functioning
stroke
- interruption of normal blood flow to or within the brain resulting in neuronal death
- cognitive, emotional, and behavioural consequences depend on which specific group of neurons was affected
aphasia**
problems in producing or comprehending language
broca’s aphasia**
- problems in producing speech
- damage to the left frontal lobe
wenicke’s aphasia**
- problems in comprehension of language and meaningful utterances
- may speak fluently but non sensical
- damage to the left temporal lobe
synesthesia
brain routes sensory information through multiple unrelated senses, causing you to experience more than one sense simultaneously
capgras delusion
- believing someone known to you is an imposter
- that person looks like my mother but is not my mother
- recognizing people: vision ->fusiform gyrus (faces)-> amygdala (emotion towards the face) -> limbic system (arousal)
- damage of this connection limits arousal and changes visual perception
hemi-neglect
- disruption of the left side of the visual field due to damage of the right parietal lobe (magnocellular pathway)
- people only put the right side of their clothes on, shave the right side of their face, draw only the right side of an image
somatic remapping
unused somatosensory regions are taken over by neighbouring regions
anosognosia
patient is unaware of their neurological deficit or psychiatric condition
6 cognitive domains in deficits for dementia
- complex attention- focusing and sustaining attention
- executive functions- planning and decision making
- learning and memory- learning and remembering new skills
- language- speaking or understanding
- perceptual motor- hand eye coordination
- social cognition- recognizing emotions in others
dementia
- deficits in learning new information or recalling information already learning
- involves one of: aphasia (over use of “it” or “thing”), apraxia (motor tasks), agnosia (recognition), executive functioning problems
- patients may behave inappropriately, misperceive reality, wander trying to get “home”
- mild symptoms may go unnoticed in those with high cognitive baseline functioning
onset of dementia
- most people are over the age of 65 when symptoms emerge
- early onset is before the age of 65
- late onset is after the age of 65
progression of Alzheimers
- difficulties in concentration/memory for newly learned material, may appear absent minded and irritable
- blames others for personal failings and may have delusions of being persecuted
- memory continues to deteriorate and the person becomes increasingly disoriented and agitated
working memory
- frontal cortex
- requires keeping information activated while operating on it in a specific way (counting backwards from 100 by 3s)
- relies on the frontal lobes which operate less effectively in older people
normal aging and memory
- problems in recall
- slower mental processing
- difficulty sustaining high levels of attention
- difficulty dividing attention
- problems in working memory
older adults and processing speed
- older adults tend to have a slower processing speed so they:
- learn new information at a slower rate
- need more exposure to the to-be-learned material
- needs more practice in retrieving learned material
multitasking
- sustaining attention or dividing attention sequentially among multiple tasks
- likely to decline with age
implicit memories
- unconscious stored information that guides a person to behave in certain ways
- well learned tasks, like driving or typing
- not affected by age
explicit memories
- can be voluntarily brought to mind
- words, mental images, names, facts
- recall is more difficult than recognition for people over 65
neurofibrillary tangles
- mass created by tau proteins becoming twisted together and destroying microtubules, leaving the neuron without a distribution system for nutrients
- may also contribute to the death of neurons
amyloid plaques
- fragments of protein that accumulate on the outside surfaces of neurons, particularly in the hippocampus
- not yet determined whether these are the causes or by products
vascular dementia
- caused by reduced or blocked blood supply to the brain
- plaque builds up on artery walls
- clotted blood blocks the inside of arteries
- HIV/AIDS, huntingtons, parkinsons, Lewy bodies
genetic evidence for Alzheimers
risk of Alzheimers is increased in first degree relatives of afflicted individuals
protective factors of Alzheimers
environmental factors, non steroidal anti inflammatory drugs, nicotine, exercise
cognitive reserve hypothesis
the notion that high education levels delay the clinical expression of dementia because the brain develops backup/reserve structures as a form of neuroplasticity
treating dementia
- no treatments can return cognitive functioning to normal for Alzheimers and vascular dementia
- antiretroviral medications can reduce dementia symptoms caused by HIV
- treatment consists of rehabilitation for more dementia types
alzheimer medication
- mild to moderate- cholinesterase inhibitors increase acetylcholine, little support for efficacy
- moderate to severe- memantine affects glutamate levels
- psychotic symptoms and behaviour disturbances- antipsychotics (can be problematic)
psychological and social factors of dementia
- aim to maintain high quality of life
- treatment may focus on comorbid disorders
- early dementia is often associated with anxiety and depression
- reality orientation therapy- focusing on the here and now
- reminiscence therapy- stimulate memories least affected by dementia
- elder day care
- education, support, and treatment for caregivers
depression in older adults
- older adults are less likely to be diagnosed with depression (3% prevalence) by are estimated to account for half of admissions of older adults to acute psychiatric care
- depression symptoms differ from those of younger adults
- more anxiety and agitation, which affect attention, concentration, mental processes, memory
- depression may be caused by cognitive disorders
under diagnosis of depression in older adults
- use of the standard DSM-V may lead to under diagnosis
- older adults are less likely to demonstrate impaired social and occupational functioning since they are less than younger people to be working
- many older adults in poor physical health are depressed
cause of depression in older adults
- increase in life events that could cause depression
- bereavement after the loss of a loved one in one of the most important risk factors for depression in the elderly
- risk is greater in the first 6 months for widowers and in the second year for widows
nursing homes and death rates
- relocation is stressful and plays a role in increased mortality
- the extent and nature of care discourages rehabilitation and maintenance of self care skill and autonomous activities the resident is capable of
responsibility and control
- responsibility induced group- emphasized responsibility for themselves, given a plant to take care - comparison group- emphasized responsibility of nurses, given a plant that the nurses watered
- responsibility induced group showed improvement in alertness, behavioural involvement, sociable, and active and were rated as healthier
- death rate of comparison group was 30% compared to 15% in responsibility induced group
Canadian disorders and the law
- Canadian law assumes that people typically think and act in a reasoned, deliberate manner
- people may be treated differently when it can be established that their thinking is irrational or their behaviour is involuntary
- must not be reflected in situational factors, not a transient state, and not self induced
- some DSM disorders are note recognized under the legal definition of mental disorder (e.g. substance use)
law
a set of rules and procedures designed to regulate the behaviour of people
civil commitment
- a mentally ill and dangerous person, who may not have broken a law, can be deprived of liberty and incarcerated in a psychiatric hospital
- more common
criminal commitment
a procedure that may confine a person in a mental institution, either for determination of competency to stand trial or after a verdict of not criminally responsible, on account of mental disorder
community treatment commitment (CTO)
an order issued by a physician that allows the individual to receive care and treatment in the community in lieu of detention in a hospital or psychiatric facility
patient rights with CTO
- right of review with appeal to the courts each time a CTO is issued or reviewed
- a mandatory review every second time a CTO is reviewed
- a right to request a re-examination by the issuing physician to determine if the CTO is still needed in order for the person to live in the community
- a right of review of finding of incapacity to consent to treatment
involuntary hospitalization (civil commitment)
- public safety issue
- can be done on 2 grounds:
- parens patriae (power to act as a guardian of mentally ill)
- police power to control threats to public
reasons for civil commitment
- individual suffers from a mental disorder
- individual is unwilling or unable to consent to hospitalization on their own
- must be at risk of causing harm to self or others
involuntary treatment
- formal/judicial commitment or informal/emergency commitment
- involves a substitute decision maker (usually a physician), use of the best interest principle (maximize good for patient), and use of the cable wishes principle (the wishes of the patient when they are or were capable those wishes should be given the greatest weight)
judicial commitment
- order of a court
- can be requested by any responsible citizen (usually police, relatives, or friends)
- judge orders mental health examination and if the individual meets the certification criteria, they may be held for longer periods
emergency commitment
- commitment of a mentally ill person without the initial involvement of the courts
- e.g. if a hospital administrative board believes that a voluntary patient requesting discharge is too dangerous to be released, they can detain the patient
dangerousness
- legal term that refers to someone’s potential to harm self or others
- broken down into:
- severity- how much harm?
- imminence- how soon?
- frequency- how often?
- probability- how likely?
actual dangerousness
- criminal behaviour among the mentally ill is no more common than in the general population- most mentally ill people are not violent
- there are 2 sets of circumstances that increase dangerousness:
- a mental illness that involves psychosis
- a mental illness that is combined with substance abuse
victimization
sexual victimization is more common among individuals with intellectual disabilities than typical adults and children
perpetration
- pedophilia increases with reduction in IQ
- lower IQ decreases exclusivity of sexual interest in girls
teaching sexual relationships in individuals with intellectual disabilities
use CLASP (consensual, legal, adult, safer, private) to teach about healthy sexual relationships
evaluating risk of violence
may be discretionary (clinical) or non-discretionary (actuarial)
discretionary
- clinicians make informed decisions
- e.g. use of HCR-20 to consider historical, clinical, and risk management factors that reflect potential adjustment problems to the patient’s future plans
non-discretionary
clinicians must adhere to strict guidelines as to what info they can use to make decisions
tarasoff rule**
- mental health professionals have a duty to protect individuals who are being threatened with bodily harm by a patient- shift from duty to warn to duty to protect
- when mental health professionals decide a patient is about to harm a specific person, they can:
- warm the intended victim or someone else who can warn the victim
- notify law enforcement
- take other reasonable steps (e.g. have the patient committed to a psychiatric facility)
privileged communication
- the legal right of a client to require that what goes on in therapy remain confidential
- an important protection, but not an absolute
legality of privileged communication in canada
- courts have not established that it is the duty of psychologist to warn or protect others
- code of ethics by professional organizations stipulate clearly that psychologists must breach confidentiality when there is reason to suspect that a third party is at risk
false confessions
- an admission of guilt in a crime in which the confessor is not responsible for the crime
- can be induced through coercion, mental disorder, or incompetency of the accused
fitness to stand trial
- associated with the accused’s present condition, not how they were functioning at the time of the alleged offence
- defendants found incompetent may be given medication to reduce symptoms and allow them to stand trial
not criminally responsible for reason of mental disorder (NCRMD)
- involves the legal argument that a defendant should not be held responsible for an otherwise illegal act if it is attributable to mental illness that interferes with rationality or that results in some other excusing circumstance
- mental disorder operates to: render the act involuntary (actus reus) and negate the mental element (mens rea- the person doesn’t know what they’re doing is wrong because of their mental illness)
MacArthur adjunctive competence study
- DA felt that 15% of clients may have impaired competence
- those with diminished competency were much less helpful to their attorneys, but attorneys still did not always refer them for evaluation
americal legal institute test (NCRMD)
- person must lack substantial capacity to appreciate the behaviour was wrong (mens rea)
- person has diminished ability to make their behaviour conform to the law (irresistible impulse-actus reas)
John hinckley case
- knew it was wrong to shoot the president, but couldn’t restrain himself
- this case motivated lawmakers to remove the “irresistible impulse” aspect
frontal lobe
- recognizes future consequences of actions, chooses between good and bad, overrides and suppresses unacceptable social responses, determines similarities and differences
- huge implications for inhibition
frontal lobe and crimes
more crimes are committed by youth (individual with undeveloped frontal lobes) and individuals with frontal lobe damage
frontal lobe and death row
in a study done in the 1980s, 100% of the sample had a history of severe head injury
consequences of the removal of the irresistible impulse component
people with frontal lobe damage know the rules but can’t control their behaviour
findings of NCRMD
- the insanity defence is rare
- it is usually only successful when applied to severely disordered individuals
- people who are found to be insane are still typically detained for long periods of time that may greatly exceed the otherwise appropriate sentence
- it is important to note that being found not criminally responsible does not result in an acquittal
