Sectional 4 Exam Flashcards
Define psychosis.
Psychosis: inability to tell the difference between what is real and what is unreal
Psychotic Disorder: when that inability is distressing and impairing
Distinguish between the positive, negative, and disorganized symptoms that fall within the psychotic spectrum of disorders.
Positive Symptoms (+)Adding symptoms they didn’t have before
- Hallucinations
- Delusions
Negative symptoms: losses/deficits in normal functioning
Negative = absence of behaviors, feelings, experiences, etc. that were there before the onset of the disorder
Disorganized Symptoms:
- Disorganized thoughts/speech
- Disorganized behaviors
- Catatonia (disturbance or absence of motor movement)
Name the most common type of hallucination (which sensory modality) and describe the content (themes) of common types of delusions.
Positive Symptoms: Hallucinations
- Unreal perceptual experiences (i.e. perceptual experiences without external source)
- Hallucinations in schizophrenia are bizarre and are typically extremely distressing & impairing.
Hallucinations (+)unreal perceptual experiences like hearing, seeing, or feeling things that aren’t there
- Auditory -> most common
- Visual
- Tactile (when something is on top of someone’s skin or body, can be under skin)
- Somatic (when things are affecting your organs, or something has happened to your internal organs)
Positive Symptoms: Delusions
Delusions: beliefs/ideas that an individual believes are true, but are highly unlikely or simply impossible
- “fixed beliefs that are not amenable to change in light
of conflicting evidence”
- Outside cultural norms
- MUST take culture into account
- Bizarre vs. Non-Bizarre
- Persecutory: Being persecuted, watched, conspired against
- Reference: Random events are directed at oneself
- Grandiose: Great power, knowledge, talent, or a famous or powerful person
- Guilt or Sin: Committed a terrible act or responsible for a terrible event
- Somatic: Appearance or part of body is diseased, altered
- Being controlled: Thoughts, feelings, behaviors are being imposed, controlled by external force
Describe common negative and disorganized symptoms.
Negative Symptoms:
- Negative symptoms: losses/deficits in normal functioning
- Negative = absence of behaviors, feelings, experiences, etc. that were there before the onset of the disorder
- Affective Flattening: Reduction or absence of emotional expression
- Alogia: Reduction or absence of speech
- Avolition: Reduction or absence of self-initiated goal-directed activities
- Negative symptoms are less obvious, but…
- Negative symptoms are associated with more impairment
- Negative symptoms are less responsive to medication
Disorganized Symptoms:
- Disorganized thoughts/speech
- Disorganized behaviors
- Catatonia (disturbance or absence of motor movement)
Disorganized Thought & Speech:
- Loosening of associations (derailment): shifting from one topic to another seemingly unrelated topic with little coherent transition
- Word salad: speech so disorganized that it is totally incomprehensible
- Clang associations: stringing together of words that rhyme but have no other apparent link
- Neologisms: made-up words
Disorganized: unpredictable & seemingly untriggered
Shouting, swearing, pacing
Repetitive speech and movements
- Echolalia (parroting) and/or echopraxia (repetitive movement)
Catatonic Behavior
Catatonia- group of disorganized behaviors that reflect extreme lack of responsiveness.
- no psychomotor activity
- passively holding single posture
- stereotyped movements
Catatonic Excitement – wild agitation that is difficult to subdue.
Explain the three phases that make up the course of schizophrenia and identify the kinds of symptoms that are likely to characterize each phase.
Prodromal Phase – before onset of full syndrome (psychosis warm-up)
- Often largely consisting of
negative symptoms
Acute – active phase of syndrome (psychosis)
- All: Negative, positive, &
disorganized symptoms
2+ symptoms for at least 1 month:
1. Hallucinations
2. Delusions
3. Disorganized speech
4. Disorganized behavior or catatonia
5. Negative symptoms
At least 1 of them MUST be Hallucinations, Delusions, or Disorganized.
- This is criterion A
Residual Phase – after acute phase (psychosis cool-down)
- Often largely consisting of
negative symptoms
At least 6 months w/ marked impairment
Describe the DSM-5 criteria for Schizophrenia.
A. Acute Phase - 2+ symptoms for at least 1 month:
1. Hallucinations
2. Delusions
3. Disorganized speech
4. Disorganized behavior or catatonia
5. Negative symptoms
At least 1 of them MUST be Hallucinations, Delusions, or Disorganized.
B. Impairment in social, occupational, self-care.
C. Disturbance persists for at least 6 months.
D. Disturbance is not attributable to physiological effects of a substance.
E. Disturbance not better explained by other psychopathology.
Describe the prevalence, demographics, and course of schizophrenia.
Course:
Chronic & episodic
- Most people diagnosed with
schizophrenia experience
multiple psychotic episodes
over the course of the disorder
- High relapse rate (85% have
residual and/or active
symptoms)
Life expectancy is shorter than average
- Higher rates of infectious &
circulatory diseases
- More likely to be victims of
crime
- 10 – 15% die by suicide
Prevalence & Demographics
- 1 to 2% lifetime prevalence
- Twice as common in men vs. women
- Age of onset: 16-24 (men), 20-35 (women)
- Women have better prognosis
& fewer cognitive deficits
- Women have better prognosis
- Black Americans (2-3X) more often diagnosed than white Americans (Bresnahan et al., 2007)
Identify the factors that are associated with better/worse prognosis.
Factors predicting better prognosis:
- Better functioning before disease onset (i.e. better premorbid functioning)
- Acute onset (short prodromal phase prior to first acute episode)
- Later age of onset
- Being female
- Treatment with antipsychotic medications
- Especially during critical period
- Medication compliance
- Better inter-episode functioning
- No family hx of schizophrenia or mood disorders
- Higher SES
Distinguish between (and identify the core criteria of) the different disorders on the psychotic spectrum, namely: Schizophrenia, Schizoaffective disorder, Schizophreniform disorder, brief psychotic disorder, and delusional disorder.
Schizophrenia: 6+ months
Brief Psychotic Disorder: 1 day-1 month
Schizophreniform Disorder: 1-6 months
Delusional Disorder: delusions only (1+ month(s))
Schizoaffective Disorder: schizophrenia plus mood episodes.
- MUST include some psychotic
symptoms outside of a mood
episode.
- If they only ever become psychotic in
the context of a mood disorder, they
are given the diagnosis of that mood
disorder with psychotic features
(e.g., MDD with psychotic features).
Explain biopsychosocial theories of Schizophrenia.
Biological Factors: Genetics ***
Clear genetic component
Concordance rate much higher among MZ twins than DZ twins
- MZ 31%, DZ 6.5%
- Heritability is HIGHER THAN most medical conditions like hypertension and diabetes
- BUT, 63% of people with
schizophrenia have no known family
history of disorder
- Polygenic risk shared with bipolar disorders
Biological Factors: Brain Structure & Functioning
- Enlarged ventricles (fluid-filled spaces in brain)
- Smaller brain volume (reduced grey matter/tissue)
Biological Factors: Neurotransmitters
Dopamine Hypothesis
Mesolimbic pathway
- Excess or overactive dopamine = positive symptoms
- Connects motivation and reward areas
Mesocortical pathway
- Low dopamine = negative and disorganized symptoms
- Connects executive control areas to reward areas
Other Biological Factors
- Birth complications
- Perinatal hypoxia
- Prenatal virus exposure
- 2nd trimester = CNS development
- Drug use as a teenager or young adult (primarily marijuana & hallucinogens)
Social Factors
- Social Drift: Individuals with schizophrenia more likely to drift into lower SES throughout life
- Urban Birth: people with schizophrenia tend to be born in cities
- Low SES associated with chronic stressors (poor nutrition, security) that slightly increase risk for psychosis
Apply the diathesis-stress model to Schizophrenia.
Vulnerability + Stress = Psychological Disorder
*Remember… the stronger the diathesis, the less stress is needed for development of a psychological disorder
Describe the “two-hit” theory and the social drift vs. urban birth theories/explanations.
Birth complications –> Marijuana Use —> Schizophrenia
you have to have two stressful life events to be diagnosed
- Social Drift: Individuals with schizophrenia more likely to drift into lower SES throughout life
- Urban Birth: people with schizophrenia tend to be born in cities
- Low SES associated with chronic stressors (poor nutrition, security) that slightly increase risk for psychosis
Identify biological and psychological treatments for Schizophrenia.
Biological Treatments: Medications
Neuroleptics revolutionized treatment of schizophrenia (1950’s)
- “Typical” (“traditional”) antipsychotics
- E.g., Thorazine, Haldol, Navene
- Dopamine antagonists decrease dopamine activity
- Reduction of positive symptoms
Various issues
- 25% don’t respond
- Only effective for positive symptoms
- Lifelong neuroleptic use
- Side effects
Atypical Antipsychotics:
- (e.g., Clozapine, Olanzapine, Risperidone)
- Act on several NT’s
- Beneficial in treating the positive and negative symptoms of schizophrenia
- Fewer neurological side effects (no akinesia or tardive dyskinesia ),
- BUT still have side effects that include dizziness, nausea, sedation, weight gain, irregular heartbeat, Type II diabetes, seizure, heart arrhythmias…
- Supplement biological treatments
- Cognitive Therapies
- Help individuals recognize and change attitudes
- Help individuals challenge delusions & hallucinations
- Increase medication adherence
- Social Interventions
- Behavioral Therapies
- Social & Living Skills Programs
- Token system
Describe issues with medications (side-effects, effectiveness, factors influencing non-compliance, etc.).
Typical Antipsychotics Side Effects:
Side Effects (of typical antipsychotics)
- Grogginess, dry mouth, blurred vision, drooling, sexual dysfunction, weight gain, depression, etc.
Akinesia:
- Muscle rigidity –> lack of facial
expression
- Reduced speech, monotonous
speaking
Tardive dyskinesia:
- involuntary, repetitive body
movements
- Tics, tremors, spasms
- Irreversible, long-term side-effect
- 20% of individuals
- 25% of people don’t respond
- No good way to predict who will respond to which medication
- Overall, more effective with positive than negative symptoms
- Negative side effects, cost of medication, lack of social support – all contribute to issues with medication compliance
- Discontinuation = 78% relapse
Describe how “personality” differs from “personality disorder.”
Personality
- Personality: style of perceiving, thinking, feeling, and behaving that make each of us unique
- Personality is made up of various personality traits, and it’s the combination of our different personality traits that makes us, us.
- Relatively stable across time and situations
Personality Disorders
- A long-standing pattern of problematic attitudes, thoughts, emotions, and behavior
- Present in a variety of contexts (e.g., romantic relationships, work settings, friendships)
- Maladaptive, socioculturally deviant
- Distress/impairment
- Pattern must appear in adolescence or early adulthood
Explain factors that bring people with personality disorders in to seek treatment.
Overall prevalence 10-15% of American adults
Treatment-Seeking:
- Most people experience their “way of seeing the world” as normal….
- Comorbid psychopathology
- Romantic relationship is at a breaking point
- Vocational problems
- Arrested or hospitalized
Identify the three main clusters of personality disorders and describe their characteristics.
Cluster A: Odd/eccentric
Cluster B: Dramatic/emotional
Cluster C: Anxious/fearful
Describe the problems with personality disorder diagnoses.
- High Comorbidity
- Arbitrary thresholds
- The way we determine if someone has a PD is if they meet for half the symptoms plus one
- Why? No reason, someone arbitrarily decided this
- The way we determine if someone has a PD is if they meet for half the symptoms plus one
- Heterogeneity (diversity amongst sxs between people with the same PD)
- comorbidity, arbitrary cutoffs, and heterogeneity Poor reliability = poor validity
- Gender bias
- Women:
- borderline
- dependent
- Men:
- Antisocial
- Paranoia
- OCPD
- Racial/ethnic bias
- Paranoid and antisocial PDs are diagnosed at higher rates in Black individuals
Describe the defining features of each Cluster A Personality Disorder.
- Unusual behaviors or perceptual experiences
- Sub-threshold psychotic symptoms
- No full-blown psychosis, delusions, or hallucinations
Understand similarities and differences among Cluster A personality disorders.
Paranoid PD
- Mistrustful & suspicious of others
- Interpret motives as malevolent or malicious
- Present across many contexts
- High comorbidity
- Chronic course, poor prognosis
- High treatment resistance
4+ sxs:
- Suspects others are exploiting, harming, etc. without basis
- Pre-occupied with unjustified doubts
- Reluctant to confide
- Reads hidden threats from benign remarks
- Bears grudges
- Perceives attacks on character
- Recurrent suspicions regarding fidelity
Schizoid PD
- Pervasive detachment from social relationships
- Restricted range of emotional expression (flattened affect)
- Less self-reported experience of enjoyment
- Present across context, apparent by at least early childhood
4+ sxs:
- Does not enjoy close relations
- Chooses solitary activities
- Little interest in sex
- Little pleasure in activities
- Lacks close friends
- Appears indifferent to criticism or praise
- Emotional coldness, detached, flattened affect
Schizotypal PD
- Odd/unusual beliefs, speech, behavior
- Paranoia (social anxiety)
- Cognitive or perceptual illusions (sometimes distressing)
- Ideas of reference
- Inappropriate or constricted affect
- Oddness may make it difficult to establish and maintain friendships
5+ sxs:
- Ideas of reference
- Odd beliefs or magical thinking
- Unusual perceptual experiences
- Odd thinking & speech
- Suspicious & paranoid
- Inappropriate or constricted affect
- Odd appearance or behavior
- Lack of close friends
- Excessive social anxiety
- all have social isolation: though for schizoid it’s because they don’t want close friends and like solitary, though for schizotypal its their oddness that that makes them socially isolated
- subthreshold delusions are with Schizotypal and Paranoid
- all more common in men
Describe how Cluster A personality disorders are similar to and different from psychotic disorders.
Differential Diagnosis: since symptoms are similar to psychotic disorders, how do we tell the difference?
- Psychotic disorder diagnosis trumps personality disorder diagnosis
- Subthreshold psychotic symptoms, chronic
- Very brief psychotic episodes
- Minutes to hours
- Can have both
- PD present before first psychotic episode AND continues when psychotic symptoms are in “remission”
Describe issues with treatment for Cluster A personality disorders.
- High treatment resistance, sus of the therapist (PPD)
- Social Isolation
- this is their “normal”
Describe the defining features of each of the Cluster B Personality Disorders.
- Dramatic, impulsive behavior
- Unstable emotions
- Lack of concern for others
Understand similarities and differences among Cluster B personality disorders.
Borderline PD
- Unstable emotions
- Unstable relationships & fear of abandonment
- Unstable self-image
- Marked impulsivity
- Suicidal behavior
5+ sxs:
- Frantic efforts to avoid abandonment
- Unstable & intense relationships
- Unstable self-image or sense of self
- Impulsive spending, sex, substance use, binge eating, etc.
- Recurrent suicidal behavior &/or NSSI
- Affective instability due to marked reactivity of mood
- Chronic feelings of emptiness
- Inappropriate and intense anger/difficulty controlling anger
- Stress-related paranoid ideation or severe dissociation
Antisocial PD
- Law-breaking without remorse
- Lacking empathy
- Aggression & irritability
- Lying, conning
- Impulsivity, irresponsibility
3+ sxs:
- Illegal Activities
- Lying, use of aliases, conning
- Impulsive Behavior
- Irritability & Aggression
- Disregards Safety
- Not Responsible
- Lack of Remorse
Describe the etiological theories of ASPD and BPD.
BPD
- Much more common in women
- Very high rates of comorbidities
- SUDs, depression, anxiety disorders, PTSD
- Chronic, distressing course, though remission is achievable
- Seek treatment
ASPD
- Uncommon in general population, VERY common in prisons
- Much more common in men than women
- Covert antisocial features?
- Much more common in men than women
- High rates of comorbidities, especially SUDS (80%)
- ADHD, gambling disorder, mood disorders
- Which feature do you think contributes?
- Lower levels of education, low-status jobs, incarceration
- Most resist/do not believe they need treatment
Describe components of treatments used for ASPD and BPD; identify the main skills targeted in Dialectical Behavioral Therapy.
Dialectical Behavior Therapy
Builds skills in four main areas:
1. Mindfulness
2. Distress Tolerance
3. Emotion Regulation
4. Interpersonal Effectiveness
- Core assumptions: people are doing the best they can given their background and people need to improve; all behaviors, emotions, thoughts have a cause; people may not have caused all their problems, but they are responsible for fixing them; etc.
Explain how psychopathy is similar to ASPD and how it is different from ASPD.
Psychopathy:
- Fearlessness
- (can be if not ASPD) Successful psychopathy
ASPD:
- Emotionally reactive aggression
Both:
- Disinhibition
- Callousness
- Instrumental aggression
Identify the defining features of each of the three cluster C personality disorders. Compare and contrast each.
- Fear & anxiety
- Conscientiousness
Avoidant PD
- Social inhibition & avoidance
- Feelings of inadequacy
- Hypersensitivity to negative evaluation
- Fear of rejection
4+ sxs:
- Avoids occupations with social contact
- Avoids relationships unless certain they will be liked
- Restraint in intimate relationships
- Preoccupied with being criticized or rejected
- Inhibited in new interpersonal situations
- Views self as socially inept or inferior
- Reluctant to take personal risks
Dependent PD
- Need to be taken care of
- Submissive
- Clingy
- Fears of separation
5+ sxs:
- Difficulty making decisions
- Needs others to assume responsibility for most major life areas
- Difficulty initiating projects or doing things on own
- Difficulty expressing disagreement
- Goes to excessive lengths to get nurturance and support from others
- Feels uncomfortable or helpless when alone
- Urgently seeks another relationship when close relationship ends
- Preoccupied with fears of being left to take care of oneself
Obsessive-Compulsive PD
- Inflexible perfectionism & control
4+ sxs:
- Preoccupied with details, rules, lists, order, etc. so much that productivity is lost
- Perfectionism that interferes with task completion
- Devotion to work to exclusion of leisure activities
- Over-conscientious and inflexible about morality, ethics, or values
- Unable to discard worn-out or worthless items
- Reluctant to delegate tasks or to work with others
- Miserly spending habits
- Rigid and stubborn
Describe how cluster C personality disorders are similar to and different from related anxiety/OC spectrum disorders.
- Avoidant PD is more of a broader avoidance than social anxiety disorder
- OCPD is a broad + general need for perfection, there is not any obsessions or compulsions/intrusive thoughts though there is a general need for perfection
Describe components of treatments used for Cluster C personality disorders.
CBT (cognitive-behavioral therapy)
- rooted in assertiveness, identity, detachment + self-sufficiency (related to Dependent PD)
