psychopathology

Question 1

psychopathology

Answer 1

generally defined as mental illness

Question 2

schizophrenia

Answer 2

Generally thought to be from a disease of the brain, but much more still to be understood

Considered a chronic condition that cannot be cured, but can be managed
- Accounts for half of all admissions to psychiatric hospitals

Often manifests in late adolescence or early adulthood; requires clinical management from that point forward

Approximately 1 in 200 people affected at any given time

Question 3

symptoms and features of schizophrenia

Answer 3

Diagnosis based on observable behavioral and psychological features
Diagnostic criteria include at least 2 of the following lasting for at least one month in duration:

hallucinations
delusions
disorganized speech
grossly disorganized or cataonic behaviour (disrupts a persons behaviour of the world around them)
negative symptoms

Question 4

positive symptoms of schitzophrenia

Answer 4

excesses or distortions of normal behavior
E.g., presence of hallucinations, delusions, and disorganized thought

Question 5

negative symptoms of schitzophrenia

Answer 5

the absence of normal behavior

E.g., apathy (lack of motivation), flattened affect (lack of emotional responsiveness), failures of volition or self-directed behavior

Associated with a poorer prognosis and are less easily treated

Question 6

enlargement of the ventricles in schitzophrenia

Answer 6

Enlargement of the lateral and third ventricles is one of the first-noted and most reliable pieces of evidence

Larger ventricles reflect brain atrophy

Brain atrophy can continue up to 20 years after diagnosis

Question 7

studying schizophrenia

Answer 7

Two main cognitive neuroscience approaches:

1. Comparing cognitive deficits in schizophrenia to deficits in patients with known brain damage.
2. Using neuroimaging and brain functioning measurements to identify areas of difference between schizophrenics and control groups.

Both demonstrate involvement of the frontal and temporal lobes.

Question 8

frontal lobe disruption

Answer 8

Many cognitive functions disrupted in schizophrenic patients are dependent upon the frontal lobe:

Working memory
E.g. Activity is abnormal in the dorsolateral prefrontal cortex when manipulating held information, the ventrolateral prefrontal cortex is underactive during the encoding phase of working memory

Self-monitoring
E.g. Abnormalities in structure and function of medial regions of the frontal lobe including ACC, Abnormal ERN responses to errors

Attention
E.g. Deficient smooth-pursuit eye-movements, fail to activate the frontal eye fields as much as controls

Cognitive control
E.g. frontal lobe mechanisms involved in inhibiting behavior are disrupted

Behavioral flexibility
E.g. impaired on tests of planning and tests of mental flexibility

Question 9

hypofrontality in schizo

Answer 9

Frontal hypoactivation is evident in schizophrenia both when the person is quietly resting and when engaged in tasks that normally activate the frontal lobe.

Question 10

temporal lobe disruption in schizo

Answer 10

Reduced volume of gray matter in the left and right middle temporal gyrus, left posterior superior temporal gyrus, and left angular gyrus

Sensory gating effect for auditory stimuli is absent or substantially reduced

Abnormalities in semantic priming (linked to temporal lobe processing):
ERP component sensitive to the degree of semantic relatedness between items (reduced when the target word is semantically related to the prime) do not differentiate as well between concepts that are highly related versus unrelated.

Question 11

genetic link to schizo

Answer 11

The risk of developing schizophrenia depends on relatedness to someone with the disorder.

Linked to schizophrenia:
Genes related to synaptic pruning during development, immune function, dopaminergic transmission or glutamate function, and more

Question 12

treatment of schizo

Answer 12

Most common form of treatment – antipsychotic drugs that affect the dopamine systems of the brain (especially D2 dopamine receptor):

Effective in reducing positive symptoms

Relatively ineffective at reducing negative symptoms

Can have unwanted side effects

Question 13

depression

Answer 13

One of the most common mental illnesses

Impacts around 1 in 10 adults within any 12-month period

Twice as common in women than in men

Timing in relation to life stressors

First episode of is often tied to a severe life stress, such as bereavement or job loss

Subsequent episodes may appear to be decoupled from discrete life stressors

Question 14

symptoms of depression

Answer 14

In general, depression is a mood disorder characterized by:
Chronic feelings of sadness and hopelessness
Loss of interest or pleasure in once pleasurable activities

Other common symptoms include:
Change in appetite and/or sleeping patterns
Low energy
Low self-esteem
Poor concentration and difficulty making decisions
Suicidal thoughts

Question 15

subtypes and variations of depression

Answer 15

Subtypes of depression depend on factors such as severity of symptoms, onset, etc. Some of the more well-recognized are:

• Major Depression (main focus in class)
• Dysthymia
• Seasonal depression
• Bipolar disorder (technically in a separate diagnostic category)

Question 16

cognitive characteristics of depression

Answer 16

Memory and attention are biased toward negative events and interpretations (creating a self-perpetuating cycle)

Poor performance on standard tasks of executive functions

Trouble shifting mental sets (reduced activity in the DLPFC and dorsal anterior cingulate cortex)

Inability to respond adaptively to performance errors or negative feedback (disruption in functional connectivity between cingulate and DLPFC regions)

Poor performance on spatial tasks that depend on the right hemisphere

Question 17

disruptions during emotional regulation

Answer 17

A. Instruction to regulate emotions does not increase activity in DLPFC

B. During emotion regulation, there is no heightened functional connectivity between the DLPFC and the amygdala

C. Effects of prior emotional regulation upon subsequent amygdala response was absent

Question 18

subgenual cingulate cortex

Answer 18

Highly interconnected with other regions involved in emotion

May be especially related to the somatic and vegetative symptoms of depression

Shows increased activity in depressed compared to non-depressed people

Activity decreases when therapeutic interventions (e.g., antidepressant drugs or electroconvulsive therapy) are effective

Question 19

therapeutic interventions

Answer 19

Both cognitive therapy and antidepressant medication are relatively effective for many people.

Cognitive therapy: client works to identify and alter self-defeating and pessimistic thoughts

Antidepressant Drug treatment: affects the monoamines (serotonin, norepinephrine, or dopamine)
- Antidepressants reduce the amygdala’s response to negative information, while increasing PFC’s responses

Question 20

novel treatments for depression

Answer 20

Used for treatment-resistant depression:

A. Repetitive transcranial magnetic stimulation: magnetic coil over DLPFC alters activity of the brain below the coil

B. Deep brain stimulation: subgenual anterior cingulate cortex is stimulated by electrodes within the brain (very invasive procedure)

C. Vagus nerve stimulation: device placed in the chest cavity stimulates the vagus nerve as it enters the brain

Question 21

anxiety disorders

Answer 21

5–20% of the population affected at any given time.

Anxiety disorders are more common among women than men.

Depression and anxiety are often comorbid.

There are many types of anxiety disorders, involve nervousness and fear that interferes with daily life.

Question 22

diagnostic categories of anxiety ddisorders

Answer 22

Phobias
Panic disorder
Posttraumatic stress disorder (technically in a separate diagnostic category)
Generalized anxiety disorder
Obsessive-compulsive disorder

These differ in the object, cause, and manifestation of the fear.

Question 23

phobias

Answer 23

Fears centered on specific objects or situations,
E.g., spiders, closed spaces, or social settings
Irrational and interfere with normal functioning

Question 24

panic disorder

Answer 24

Involves repeated panic attacks
Sensations of extreme bodily hyperarousal, dizziness, shortness of breath, elevated heart rate, and a sense of losing control

Question 25

posttraumatic stress disorder (PTSD)

Answer 25

Clear origin of a deeply traumatic experience such as combat, assault, torture, a natural disaster, or other life-altering experience.

Symptoms include extremely vivid and intrusive recollections of the traumatic situation, avoidance of situations related to that experience, chronically elevated bodily arousal, and feelings of survivor guilt and suicidal thoughts.

Question 26

generalized anxiety disorder

Answer 26

Free-floating and chronic experience of anxiety, not tied to any specific triggering event or object

Question 27

obsessive-compulsive disorder (OCD)

Answer 27

Obsessive thoughts

Engages in repeated, compulsive actions intended to ward off a negative outcome

Question 28

emotional stroop task

Answer 28

Cognitively, individuals with anxiety have exaggerated attentional bias to threatening information in the world.

Emotional Stroop task
Identify the ink color of words
Anxious people slower naming ink color of emotionally threatening words because attention automatically captured by word’s emotional meaning

Question 29

dot probe task

Answer 29

Cognitively, individuals with anxiety have exaggerated attentional bias to threatening information in the world.

Dot probe task
Indicate the presence of a dot flashed on a screen
Anxious people respond faster when dot appears in location where a threatening word appeared, indicating attention shifted to the threatening word

Question 30

anxiety and the amygdala

Answer 30

Amygdala functions relevant to anxiety:
Crucial for the acquisition of learned fears
Provokes the body’s fight-or-flight response to stimuli
Directs attention to emotionally salient or urgent stimuli

Activity in the amygdala increases when anxious people are confronted with their fear-inducing triggers and in times of uncertainty.

Question 31

anxiety and the frontal lobe

Answer 31

Parts of the frontal lobes involved with:
Emotion regulation: Regions exert top-down control over subcortical emotion structures (ex. amygdala)

Fear extinction: Reduced activation of the vmPFC in anxious people leads to difficulty remembering that feared situations are actually safe

Self-monitoring: Overactive ACC reflects increased emotional salience of actions
Controversial therapy: cingulotomy

Question 32

verbalization and worry

Answer 32

Anxious apprehension (worry) is typically a verbal process, implicating the left frontal region (which generates speech)

Appears inconsistent with approach-withdrawal model of frontal lobe asymmetry (left frontal involvement in approach emotions)

fMRI data resolve this inconsistency:
A region in left inferior frontal gyrus is more activated in worriers.
A left dorsolateral frontal region is more active for positive vs. negative words, consistent with approach-withdrawal model.

Question 33

posterior regions and anxious arousal

Answer 33

Anxious arousal (panic) associated with right-hemisphere systems governing attentional vigilance and autonomic arousal.

Experiences of heightened anxious arousal or panic activate the posterior right hemisphere.
e.g., among people who scored high on a measure of anxious arousal, or panic, a region of the right inferior temporal gyrus became activated by negative words.

Question 34

action systems in OCD

Answer 34

Circuits that initiate and inhibit actions may be disrupted in obsessive-compulsive disorder (OCD).

Disruptions in control loops that link orbitofrontal cortex with the basal ganglia
- Basal ganglia appear to have increased activity
- Orbitofrontal cortex also shows abnormalities

Imbalance between systems supporting habitual action (basal ganglia), and those supporting goal-directed action (frontal)

Question 35

substance abuse and addiction

Answer 35

In any 12-month period, 5-10% of Americans grappling with substance use disorders

Defining feature of abuse:
Unable to control drug-seeking behavior even when consequences are severe; desire for drug outweighs consequences

Two main brain systems have been related to drug abuse:
Dopaminergic reward pathways
Orbitofrontal cortex

Question 36

addiction and reward pathways

Answer 36

Most drugs of abuse appear to activate the reward pathways that stretch from the midbrain to the nucleus accumbens in the basal forebrain.

Long-term changes in neurons within the reward system in response to the ongoing presence of the drugs.

Question 37

addiction and orbitofrontal cortex

Answer 37

The orbitofrontal cortex (OFC) is important in generating expectancies about the outcomes of behavior which guide decision making.

Research shows that the OFC region is dysfunctional in addicts.

Substance-dependent individuals perform poorly on gambling tasks that involves learning consequences of choices.

Question 38

addiction changes and the brain

Answer 38

Changes in dendritic spine density following chronic exposure to amphetamines

Question 39

other bran regions implicated in addiction

Answer 39

Insula
Amygdala
ACC
DLPFC

Reinforces major cognitive neuroscience theme:

Pathology may be best understood as disrupted relationships among interacting brain areas, rather than simple under-activations or over-activations in certain areas

Question 39

psychopathy

Answer 39

“Psychopath” is not an official diagnosis. It is an informal term often used for antisocial personality disorder (ASPD).

Characterized by shallow emotional responses, lack of empathy, disregard for others, impulsivity, and an increased likelihood for antisocial behavior (behavior that conflicts with social norms).

ASPD is more common in men than women.

Question 40

psychopathy diagnosis

Answer 40

In order to receive a diagnosis of ASPD, a person must show a pattern of disregard for and violation of the rights of others. This is indicated by three or more of the following criteria, according to the DSM-5:

failure to conform to social norms concerning lawful behaviors, such as performing acts that are grounds for arrest

deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit

impulsivity or failure to plan

irritability and aggressiveness, often with physical fights or assaults
reckless disregard for the safety of self or others

consistent irresponsibility, failure to sustain consistent work behavior, or honor monetary obligations

lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person

Question 41

psychopathy reasons

Answer 41

Dysfunction in both amygdala and prefrontal cortex regions including orbitofrontal cortex (OFC)
Studies have shown reduced brain volume in these areas

Reasons for this dysfunction remain unknown

Some genetic contribution: research estimates that between 38 and 69 percent of cases may be hereditary

Environmental contribution: triggers may include childhood neglect, abuse, and/or other adverse experiences

Psychopathy is notoriously resistant to treatment, therapeutic intervention and rehabilitation strategies often prove to be ineffective