Self Made Flashcards
What are the four main objectives of abnormal psychology?
Describing what behaviours are evident Explaining why it is evident Predicting outcome Managing behaviours that are considered abnormal #Lecture 1
What is the difference between incidence and prevalence?
Incidence = number of new cases of a disorder in a population in a specific time period Prevalence = total number of active cases in a given population during specific period of time #Lecture 1
What changes in psychology did the psychoanalytic revolution bring about?
Psychological factors affect behaviour
Talking treatment more effective than harsh physical and moral treatments
Behaviour influenced by thoughts, impulses and wishes (unaware of)
Non-psychotic disorders are worthy of treatment
#Lecture 1
What did the biopsychosocial framework (Meyer, 1940s) consider abnormal behaviour to be a combination of?
Biological factors (genetics, disease) Psychological factors (feelings) Social factors (family, social support structure) Environmental factors (quality of food and schooling, smog) Note: Posits that no single model can fully explain abnormal behaviour #Lecture 1
When were psychotropic drugs introduced, and how were they discovered?
When did deinstitutionalisation begin?
1930s and 1940s, and accidentally
1970s. Led to out-patient psychiatric clinics and community mental health centres
#Lecture 1
What is a symptom?
A manifestation of pathological condition. In some uses of the term it is limited to subjective complaints – also includes objective signs of pathological conditions (mood) #Lecture 1
What is a syndrome?
A group of symptoms that occur together that constitute a recognisable condition
In DSM-V most disorders are syndromes
Classification that lists a series of symptoms, like a checklist that must be met
#Lecture 1
What is the purpose of a classification system? What is the major problem with this approach?
Enables clinicians to diagnose a person’s problem as a disorder
Information retrieval
Facilitates research
Facilitates communication
Facilitates treatment selection (sometimes, not as straightforward as with other kinds of illnesses)
What are the major criticism of diagnostic practice?
Distinct entity vs continuum approach Results in labels and associated stigmas Issues with reliability and validity Affected strongly by bias #Lecture 1
List the types of clinical assessments and an example of each
Projective tests (Rorschach, Thematic Apperception); Personality inventory (Minnesota Multiphasic Personality Inventory (MMPI), California Psychological Inventory, Eysenck Personality Inventory); Intelligence Tests; Neuropsychological tests (CAT scan, EEG); Behavioural assessment (direct observation, self monitoring); Physiological assessment (skin conductance, sweat, etc) #Lecture 1
What is the scientist-practitioner approach of psychology
Psychologists use research findings to guide assessment, diagnosis and treatment of people with mental health disorders. Models are used to explain origins of abnormal behaviour, how to treat it and how to prevent it. #Lecture 2
What are the main five models of psychology?
Biological Psychodynamic Humanistic/existential Behavioural Cognitive #Lecture 2
What methods are used to determine if genetics plays a role in aetiology? (Biomedical model)
Pedigree (family history) Twin study (monozygotic and dizygotic comparison) Adoption studies Molecular genetics (is one allele more frequent in people with disorder?) #Lecture 2
What does serotonin do?
Serotonin system regulates behaviour, mood & thought processes
Low serotonin activity associated with Aggression, Suicide, Impulsive overeating, Hyper-sexual behaviour
#Lecture 2
What does Gamma Amniobutyric Acid (GABA) do?
Inhibits a variety of behaviours & emotions
Seems to reduce overall arousal (Anxiolytic effects)
Benzodiazepines make it easier for GABA molecules to attach themselves to the receptors of specialized neurons
#Lecture 2
What does noradrenaline do?
Induces alarm responses in dangerous situations #Lecture 2
What does dopamine do?
Merge and cross with serotonin circuits, relays messages to control movements, mood and thought processes #Lecture 2
In what situations could the endocrine system function aetiologically?
Prolonged stress- Hypothalamic-pituitary-adrenal-cortical axis is where hypothalamus and endocrine system interact and controls stress reactions, responsible for signalling prediction of adrenalin and cortisol #Lecture 2
What are the arguments against pharmacotherapy?
Peter Gøtzsche claims that they are a leading cause of death due to dishonesty in research and marketing, that few benefit from medications and that randomised control trials are bad. People with serious psychological issues tend to do better in developing countries than in developed countries #Lecture 2
What do the id, ego and super ego do?
Id: Biological instincts, pleasure principle and wish fulfilment Ego: reality principle, achieve what id wants in socially acceptable way, has defense mechanisms Super Ego: Conscience and ego ideal, what is the right thing to do #Lecture 2
How does the psychodynamic model suggest symptoms form and are removed?
Traumatic childhood experience leads to defence mechanisms that become symptoms over time Free association leads to recovery of material, then awareness and interpretation #Lecture 2
What is the Acceptance and Commitment Therapy (ACT) theory of change?
ACT uses mindfulness and acceptance process to produce greater psychological flexibility
Psych. problems originate from thought and language, triggering emotional pain and pysch. discomfort.
#Lecture 2
How does the humanist theory explain psychological disorders?
A lack of unconditional positive regard leading to self-deception and a distorted view of one’s experiences. #Lecture 2
What are Eugene Bleuler (1911)’s four core disturbances of schizophrenia?
Affect Ambivalence Associations Preference for fantasy over reality #Lecture 3
What is the average age of onset for male and female schizophrenic patients, and what percent of them attempt suicide?
Male: 15-25
Female: 25-35
50% attempt suicide
#Lecture 3
What are the characteristic symptoms of schizophrenia in the DSM-5 and what specific requirements are there?
- Delusions
- Hallucinations
- Disorganised speech
- Grossly disorganised or catatonic behaviour
- Negative symptoms (affect flattening, alogia, avolition)
Have to have two or more during one month, and one of them has to be 1, 2 or 3
#Lecture 3
What are the non-characteristic criteria for schizophrenia in the DSM-5?
Social Occupational Dysfunction
Duration continuous signs for 6 months
Schizoaffective & Mood Disorder Exclusion (Can’t also be schizophrenic)
Substance/general Medical Condition Exclusion (can’t also be schizophrenic)
Relationship to Autism Spectrum Disorder or a communication disorder
#Lecture 3
What are the different forms of association loosening?
Neologism (using words that are not words, made up) Perseveration (repeat a particular point over and over) Word salad (all the words being said are being jumbled together, unintelligible) Circumstantiality (going off topic and losing the point) Tangentiality (never get back to the point) #Lecture 3
What are the three different types of changed affect?
Restricted affect (less emotional expression) Blunted affect (more) Flat affect (none) #Lecture 3
What is the difference between catatonic stupor and catatonic rigidity?
Catatonic stupor (slowing or reduction in movement, may persist for long periods of times, may resist attempts to be made to move) Catatonic rigidity (adopt a singular position for a very long period of time; waxiflexibility is where a limb is moved and they stay where it has been moved.) #Lecture 3
What is the difference between the two types of schizophrenia?
Type I: (Sudden onset, Normal intellect, No brain damage, No negative symptoms, Good drug response) Type II: (Slower onset, Intellectual deterioration, Brain abnormality, Prominent negative symptoms, Poor drug response) #Lecture 3
What are the three phases of a schizophrenic episode, and their characteristics?
Prodromal phase
A minority have an abrupt onset, with rapid deterioration
Typically a long prodromal phase, gradual onset of symptoms
Some snap out, but with schizophrenia the person continues to deteriorate until it is seriously interfering with their life
Active phase
Active features of psychosis
Normal function is affected seriously
Potentially danger to themselves
Can be hospitalised until they improved
Residual phase
Some symptoms still present, less serious
#Lecture 3
What is the prognosis for a diagnosis of schizophrenia?
~ 20-30% are able to lead “normal” lives
~ 20-30% experience moderate symptoms
~ 40-60% remain significantly impaired
#Lecture 3
What did social skills training for schizophrenics have a moderate effect size for (3 things)?
Performance based measures of social and daily living skills
Community functioning
Negative symptoms
#Lecture 3
What is the difference between anxiety and fear?
Anxiety: Associated with the anticipation of future problems, Involves more general or diffuse emotional reactions, The emotional experience is out of proportion to the threat Fear: Experienced in the face of real, immediate danger, Usually builds quickly in intensity, Helps behavioral responses to real threats #Lecture 4
What are the essential features and specifiers for specific phobia?
Marked fear or anxiety about a specific object or situation
Exposure to the phobic stimuli invariably provokes immediate fear or anxiety
Phobic stimuli is actively avoided or endured with intense fear or anxiety
Fear or anxiety is out of proportion to the actual danger posed
Specifiers: Animal, Natural Environment, Blood-Injection, Situational
#Lecture 4
What are the essential features and clinical features of social anxiety disorder?
Essential Features:
Marked fear or anxiety about one or more social or performance situations in which the person is exposed to possible scrutiny by others
Fears that he or she will act in a way or show anxiety that will be negatively evaluated (humiliation, embarrassment, rejection, offend)
Other features:
Belief that others see them as inept, stupid, foolish
Often demonstrate a vicious cycle of anxiety social deficits anxiety; Hypersensitive to criticism; Non-assertive; Low self-esteem; Comorbid anxiety common; Safety behaviours common; Take ‘observer perspective’ vantage point for social memories; Information processing biases
#Lecture 4
What are the DSM-5 criteria for panic disorder?
Recurrent unexpected panic attacks
At least one attack has been followed by one month or more of the following:
1. Persistent concern about additional attacks or their consequences
2. Significant maladaptive change in behaviour (avoidance)
Rule out specific phobia/other conditions/attacks that are the direct result of a substance (i.e., drug abuse)
#Lecture 4
What are the features of a panic attack?
An abrupt surge of intense fear or discomfort, in which four or more of the following develop rapidly, and peaks within minutes: Palpitations/pounding heart, Sweating, Trembling/shaking, Sensation of shortness of breath, Feelings of choking, Chest pain or discomfort, Nausea or abdominal distress, Dizziness/lightheadedness, Chills/Hot flushes, Paresthesias (numbness/tingling), Derealisation (unreality)/Depersonalization (detached), Fear of losing control or going crazy, Fear of dying. #Lecture 4
What are the essential features of agoraphobia
Marked fear or anxiety about two or more of the following: 1. Using public transport 2. Being in open spaces 3. Being in enclosed places 4. Standing in line or being in a crowd 5. Being outside of the home alone Anxiety about being in places from which escape might be difficult or embarrassing in the event of having a panic attack #Lecture 4
What are the DSM-5 criteria for generalised anxiety disorder?
Excessive anxiety & worry about numerous events or activities
Difficulty in controlling worry
Experience three (or more) of the following:
1. Restlessness/on edge
2. Easily fatigued
3. Difficulty concentrating / mind blank
4. Irritability
5. Muscle tension
6. Sleep disturbance
Anxiety, worry or physical symptoms cause significant interference
#Lecture 4
List a couple obsessive-compulsive and related disorders.
Body dysmorphic disorder (fixated on one specific part of their body that they believe is flawed)
Hoarding disorder (as it sounds)
Trichotillomania (hair pulling disorder)
Excoriation
Substance/medication-induced obsessive-compulsive and related disorder
Obsessive-compulsive and related disorder due to another medical condition
Other specified obsessive-compulsive & related disorder
Unspecified obsessive-compulsive & related disorder
Obsessive-compulsive disorder (OCD)
#Lecture 4
What is an obsession, and what is a compulsion?
Obsessions
Thoughts, images or impulses
Repetitive, intrusive - uncontrollable (rebound effects)
Not just excessive worries about real life problems
Cause anxiety or distress
Compel the person to ignore, suppress or neutralize the obsessions in some way
Compulsions
Repetitive overt behaviors (handwashing, ordering, checking) or covert mental acts (praying, counting, repeating words)
Goals are usually to “undo” obsession, to prevent harm associated with obsession, or to alleviate anxiety.
However, these obsessions are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
#Lecture 4
What are the DSM-5 Criteria for obsessive compulsive disorder?
Either obsessions, compulsions, or both
Obsessions or compulsions cause distress, are time consuming (>1 hour/day), or significantly interfere
Content of obsession or compulsion is not restricted to another Axis I disorder (e.g., food obsession in an eating disorder)
Not due to a substance or medical condition
Specify if with good or fair insight, with poor insight, with absent insight/delusional beliefs
#Lecture 4
What are the three forms of obsessions, and the three most common contents of obsessions?
Forms: Thoughts, images, impulses Content: contamination, pathological doubt, somatic obsessions #Lecture 4
What are the four most common compulsions?
Checking, washing, counting and need to ask/confess #Lecture 4
What are the DSM-5 Criteria for post-traumatic stress disorder?
Exposure to actual or threatened death or serious injury, or sexual violence via:
1. Directly
2. Witnessing
3. Learning about it happening to someone close or
4. Experiencing repeated or extreme exposure to aversive details (e.g., first responders)
Presence of one or more of the following intrusions:
1. Involuntary and intrusive distressing memories
2. Distressing dreams
3. Dissociative reactions e.g. flashbacks
4. Distress or reactivity to cues that resemble traumatic event
Avoidance of stimuli associated with the event
Negative alterations in cognitions and mood
Physiological arousal symptoms (two or more)
1. Irritability or anger outbursts
2. Reckless or self-destructive behaviour
3. Hypervigilance
4. Exaggerated startle response
5. Difficulty concentrating
6. Sleep disturbance
What are the DSM-5 Criteria for acute stress disorder?
Duration - symptoms last from three days to one month following exposure to traumatic events
Nine or more symptoms from any of the five categories:
Intrusive symptoms
Negative mood
Dissociative symptoms
Avoidance symptoms
Arousal symptoms
Clinically significant distress or impairment
#Lecture 4
What are the DSM-5 Criteria for adjustment disorder?
Marked emotional or behavioural symptoms in response to an identified stressor occurring within three months of onset of stressor
Distress is out of proportion to the severity or intensity of the stressor
Significant impairment in functioning
Does not meet criteria for another mental disorder
Not normal bereavement
Once stressor or consequences have terminated, symptoms do not persist for more than an additional six months
#Lecture 4
How does the psychodynamic perspective explain anxiety aetiology?
Anxiety arises from psychic conflict between unconscious sexual or aggressive wishes, and corresponding threats from the superego #Lecture 4
What is the evolutionary perspective of anxiety aetiology?
Anxiety developed as a means of enabling protective behaviour to be activated at appropriate times; anxiety part of an adaptive system
Anxiety disorders – problems in regulation of system which evolved to deal with particular threat
#Lecture 4
How heritable are anxiety disorders?
Moderately to modestly heritable across different disorders. Agoraphobia highest. #Lecture 4
What is the current psychological perspective on anxiety disorder aetiology?
Classical conditioning explains development, operant conditioning explains maintenance; modelling explains some development not caused by experience. Maladaptive cognitive processes cause people to misinterpret ambiguous situations as dangerous, bias attention to threat. Begin to fear fear. #Lecture 4
How is anxiety treated?
SSRIs (antidepressants helping increase serotonin levels)
Interpersonal psychotherapy targeting interpersonal conflicts (for social anxiety and PTSD)
CBT: psychoeducation, relaxation, cognitive techniques, exposure therapy
#Lecture 4
What is mood?
“A pervasive and sustained emotional response that can color perception” (APA, 2013)
What are the symptom domains of bipolar disorder?
Manic mood and behaviour Psychotic symptoms Dysphoric/negative mood and behaviour Cognitive symptoms #Lecture 5
What are the criteria for a manic episode?
Distinct period of abnormally and persistently elevated, expansive or irritable mood & goal-directed activity, energy – at least one week
Three or more of the following:
1. Inflated self-esteem/grandiosity
2. Decreased need for sleep
3. Increased speech, talkativeness, or pressure of speech
4. Flight of ideas or racing thoughts
5. Distractibility – reported or observed
6. Increased goal-directed activities or psychomotor agitation
7. Excessive involvement in pleasurable activities with high potential for painful consequences
Marked impairment in functioning or needs hospitalization or psychotic features
Not due to effects of substances or another medical condition
#Lecture 5
What are the criteria for a hypomanic episode?
Meets most of the criteria for Manic episode, except not as severe:
1. Lasts only for four consecutive days
2. Associated with a change in functioning that is uncharacteristic
3. Observable to others
4. Not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalisation, and no psychotic features
#Lecture 5
What are the criteria of a major depressive episode?
Five (or more) present during same two week period and represents change from previous functioning; at least one of the symptoms is either (I) depressed mood or (II) loss of interest or pleasure
1. Depressed mood
2. Diminished interest or pleasure
3. Significant weight loss
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue
7. Feelings of worthlessness or excessive/inappropriate guilt
8. Diminished ability to concentrate/indecisiveness
9. Recurrent thoughts of death/suicidality
Cause clinically significant distress or impairment in functioning
Not attributed to substance or another medical condition
#Lecture 5
What are the differences between bipolar I and bipolar II?
BIPOLAR DISORDER I
Most recent episode: Hypomanic, Manic, Depressed or Unspecified
BIPOLAR DISORDER II
One or more Major Depressive episodes accompanied by at least one Hypomanic episode; Never had a manic episode
#Lecture 5
What is cyclothymic disorder?
A mild form of bipolar disorder
At least a two year period (one in children/adolescents): hypomanic symptoms and depressive symptoms but do not reach episodes
Not without symptoms for two months in the two year (one year) period
1/3 develop a major mood disorder (Bipolar I)
#Lecture 5
What are good prognosis for bipolar disorder?
Short duration of manic episodes Older age of onset Few suicidal thoughts Few co-existing psychiatric/medical problems No depressed/mixed symptoms #Lecture 5
What are the criteria for persistent depressive disorder?
A. Present for at least two years (one year in children & adolescents)
B. Presence, while depressed, of two or more of the following
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness
C. Not without symptoms for a two month period
D. MDD may be present for two years
E. Never met manic episode, hypomanic or cyclothymic disorder
F. Not better accounted for by another disorder
G. Not attributed to substance or another medical condition
H. Causes clinical significant distress or impairment
#Lecture 5
What is the suicide risk for those with unipolar or bipolar mood disorders, and how many times the general population risk is this?
15%, 30x general population #Lecture 5
What disorders are frequently comorbid with depression?
Eating disorders Personality disorders Schizophrenia Alcohol and drug abuse Anxiety disorders #Lecture 5
How long does a typical treated and untreated depressive episode last?
Treated: ~3 months
Untreated: 6-13 months
#Lecture 5
How does the reduced positive reinforcement theory (1975) explain depression?
Depression occurs as a result of a reduction in response-contingent positive reinforcement
This reduction may occur when:
The probability that the individual’s behaviour will be followed by reinforcement is low OR
The probability that the individual will be reinforced when he does not emit the behaviour as high
Three ways in which insufficient reinforcement may occur:-
Environment produces a loss of reinforcement
Lack of requisite skills
Unable to enjoy or receive satisfaction from reinforcement
#Lecture 5
What is Beck’s cognitive model (1979) and how does it explain mental illnesses (e.g. depression)?
Negative Triad (Pessimistic view of self, world, & future) ↓ ↑ Negative Schemata or Beliefs Triggered by Negative Life Events (e.g., the assumption that I have to be perfect) ↓ ↑ Cognitive Biases (e.g., arbitrary inference) ↓ DEPRESSION #Lecture 5
How do the neurochemical theories of depression explain it aetiologically?
Excess (especially noradrenaline) causes mania and too little causes depression, serotonin also linked. Too simple a hypothesis to explain various differences in expression. #Lecture 5
Why has elector-convulsive therapy for treating depression declined, and when is it still used?
An invasive procedure, Past abuses, Medical complications, Effectiveness of antidepressants
Used when:
Prominent psychotic or melancholic features
Severe depression doesn’t responded to medication
Severe life-threatening situations require rapid response
Prior clinical response to ECT +ve
#Lecture 5
What are the major psychological treatments for bipolar disorder?
Group Therapy Psychoeducation Family Therapy Cognitive Behaviour Therapy Interpersonal Therapy #Lecture 5
What are the limitations of psychological treatments for bipolar disorder?
Lack of controlled blind clinical trials
Some studies report negative results
Interventions often show efficacy with respect to the psychosocial consequences of the order
Results are less definite with respect to medication compliance and relapse
Relapse prevention seems to be most effectively gained via increases in medication compliance
#Lecture 5
What are the major psychological treatments for major depression disorder?
Cognitive-Behaviour Therapy
Interpersonal Relationship Therapy
#Lecture 5
What is the difference between antidepressant treatment and CBT/IPR treatment of depression
No significant difference in treatment. #Lecture 5
What are the essential features of somatic symptom disorders?
Physical symptoms suggest a physical disorder but there are no demonstrable organic findings or known physiological mechanisms Positive evidence, or a strong presumption, that the symptoms are linked to psychological factors or conflicts #Lecture 6
How long must the symptomatic state last in order to be classified as somatic symptom disorder?
Longer than six months #Lecture 6
What are the criteria for illness anxiety disorder?
Preoccupation with having or acquiring a serious illness
Somatic symptoms are not present or if present are only mild in intensity
High level of anxiety about health and the individual is easily alarmed about personal health status
Performs excessive health-related behaviours or exhibits maladaptive avoidance
Illness preoccupation present for at least six months
Belief that one has an illness is sustained despite evidence to the contrary
Somatosensory amplification
~78% experience comorbidity with anxiety disorder or major depression
#Lecture 6
How does the psychodynamic perspective explain somatic symptom disorders?
Negative feelings repressed and converted into physical symptoms
Poor self awareness and ability to self regulate
Less psychologically minded
#Lecture 6
How does the cognitive perspective explain somatic symptom disorders?
Somatoform symptoms are a form of communication
Misinterpretation of body sensations and/or signs as indicating severe illness
Negative Affectivity (NA)
NA linked to worry, pessimism, fear of uncertainty, guilt, fatigue, poor self esteem, shyness & depression
Greater NA- particularly worry and pessimism - predicts increased severity of somatization
#Lecture 6
How are somatic symptom disorders treated?
Primarily through CBT (especially exposure, reinforcement strategies, relaxation training and cognitive restructuring). Preliminary evidence for antidepressants #Lecture 6
Define: Depersonalisation Derealisation Amnesia Identity confusion Identity alteration
Depersonalisation – feeling detached from one’s body e.g., outer body experience
Derealisation – feeling of unfamiliarity or unreality about one’s physical or interpersonal environment
Amnesia – inability to remember personal information or significant period of times
Identity confusion – unclear or conflicted about one’s personal identity
Identity alteration – overt behaviour indicating that one has assumed an alternate identity
#Lecture 6
What is the difference between dissociative amnesia and organic amnesia?
Dissociative Amnesia:
Loss of past both recent and remote
Personal identity is lost, store of general knowledge intact
Events that happen after the moment amnesia starts are remembered well
Amnesia often reverses abruptly
Organic Amnesia:
Distant past remembered well, recent past remembered poorly
Both personal and general knowledge is lost
This aspect of memory is lost and is the primary symptom
Memory gradually returns for retrograde memories and seldom returns for memories since the brain damage and memory of trauma is never revived
#Lecture 6
What is dissociative fugue?
Sudden, unexpected travel away from home/work locale with assumption of a new identity and an inability to recall one’s previous identity
Following recovery - no recollection of events that took place during the fugue
Usually fugue is brief and ends suddenly
Fugue may be extensive - person establishes a well integrated new identity
#Lecture 6
How does the psychodynamic view explain dissociative disorder aetiology?
Extreme use of repression with roots in childhood #Lecture 6
How does the behavioural view explain dissociative disorder aetiology?
Patients play social role learned via: Modelling, Exposure to information about the disorder, Operant conditioning Selective reinforcement of personalities: Non-clinical research participants can adopt role of a person with DID (Spanof et al, 1985) #Lecture 6
How is hypnosis similar to dissociative disorders?
Material is forgotten for period of time yet later recalled
Forgetting without insight
Events more readily forgotten than basic knowledge
#Lecture 6
What is a biological explanation for dissociative disorders?
Fragmented sleep-wake cycle helps explain dissociative symptoms; sleep disturbance is associated with dissociation. Improved sleep decreases dissociation in experimental situations. #Lecture 6
What is a social explanation for dissociative disorders?
DD manufactured by therapists/treatment, but it has been diagnosed in countries without public awareness of DID #Lecture 6
What are the principles of treatment of dissociative identity disorder?
Integrate sub-personalities into one
Each sub-personality is helped to understand that he/she is part of one person
All sub-personalities should be treated with fairness and empathy
Therapist should encourage empathy and co-operation among personalities
Recover gaps in their memory
Help patient to recognise breadth of their disorder
#Lecture 6
Define personality
Enduring patterns of thinking and behavior that define the person and distinguish him or her from other people (traits) #Lecture 7
What are the general features of personality disorders?
Occur when personality traits are rigid, inflexible and maladaptive, producing either behavioural impairment or emotional distress
Long-term, chronic, enduring, pervasive pattern
#Lecture 7
What proportion of patients with a personality disorder DON’T have a comorbid personality disorder?
11% #Lecture 7
What are the three Ps of personality disorders?
Persistent – over time
Pervasive – across people and situations
Pathological – clearly abnormal
#Lecture 7
What are the general diagnostic criteria for personality disorders?
A. Enduring pattern of inner experience and behaviour that deviates markedly from expectations of the individual’s culture which manifests in two (or more) areas: (Cognition, Affect, Interpersonal, Impulse control)
B. Enduring pattern is inflexible and pervasive across a range of situations
C. Leads to distress, or social/occupational impairment
D. Pattern is stable and of long duration
Exclusion criteria:
E. Not better accounted for by another mental disorder
F. Not due to effects of substance or medical condition
#Lecture 7
Why is motivation critical to understanding human personality?
Affiliation (the desire for close relationships with other people) and power (the desire for impact, prestige or dominance) are strong motivators for humans, and maladaptive variations of these social motivations are the symptoms of PDs. #Lecture 7
What are the three clusters of personality disorders?
Cluster A: Paranoid, Schizoid, and Schizotypal
Cluster B: Borderline, Antisocial, Histrionic and Narcissist
Cluster C: Avoidant, Dependent and Obsessive Compulsive Personality
#Lecture 7
What characterises Schizoid Personality Disorder?
Pervasive pattern of detachment from social relationships and a restricted range of emotional expression Little interest in being involved with others #Lecture 7
What characterises Schizotypal Personality Disorder?
Pervasive pattern of social and interpersonal deficits marked by acute discomfort
Offbeat, peculiar, paranoid beliefs and thoughts
Many features of schizophrenia
#Lecture 7
What characterises Histrionic Personality Disorder?
Pervasive pattern of excessive emotion and attention-seeking behaviour
Histrionic means dramatic or theatrical
Flamboyant, can’t tolerate being ignored
Persistently draw attention to themselves
Emotionally over-responsive to insignificant events
Manipulative
#Lecture 7
What characterises Avoidant Personality Disorder?
Pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation
Avoidance of new experiences and meeting new people
Pervasive pattern of social discomfort
Sensitive to criticism
Fear of rejection, criticism, or disapproval
#Lecture 7
What characterises Dependent Personality Disorder?
Point out own inadequacies so others will look after them
Pervasive pattern of submissive and clinging behaviour
Difficulty communicating disagreement for fear of being rejected
#Lecture 7
What characterises Obsessive Compulsive Personality Disorder?
Pervasive pattern of perfectionism, inflexibility, orderliness
Preoccupied with details and rules
Extreme devotion to productivity to exclusion of leisure activities
#Lecture 7
Of the limited aetiological knowledge of personality disorders, what relationships have been discovered?
Cluster B PDs are related highly with child abuse and neglect #Lecture 7
What is the nature/nurture perspective on antisocial personality disorder?
Nurture was moderated by nature (Those raised in difficult adoptive homes were more aggressive as adults, but this effect was more pronounced for those with ASPD biological parents) #Lecture 7
What is the Under Arousal Hypothesis (for psychopathy)?
Psychopaths have abnormally low levels of cortical arousal
Yerkes-Dodson curve: arousal level linked to NA
Engage in stimulation seeking?
#Lecture 7
What is the Fearlessness hypothesis (for psychopathy)?
Higher threshold for experiencing fear
More difficult to socialise using typical methods
Eye blink startle effect
Lack of startle potentiation while viewing unpleasant versus neutral pictures
#Lecture 7
What three factors make the study of effective treatments for people with PDs difficult?
Most people with PDs don’t seek treatment (Ego-syntonic not ego-dystonic)
Premature termination of treatment
High co-morbidity
#Lecture 7
How do the psychoanalytic approach, and CBT attempt to help manage personality disorders?
Psychoanalytic Approach Focus on the transference relationship Cognitive-Behaviour Therapy Social skill training, exposure, problem solving etc. #Lecture 7
What is DBT and how does it attempt to treat Borderline PD?
Dialectical Behaviour Therapy (DBT)
Empathy
Mindfulness and acceptance
Matter-of-fact way of dealing with crises
Problem-solving and social skills training
#Lecture 7
What are the criteria for substance use disorder?
Problematic pattern of substance use, leading to clinically significant impairment or distress, as manifested by two of the following, occurring in a 12-month period:
Impaired Control:
Larger amounts consumed over time unintentionally
Persistent desire or unsuccessful efforts to control drug use
Great deal of time invested in drug activities
Craving
Social Impairment:
Continued use despite persistent problems in roles in relationships, work, family caused or exacerbated by the drug
Abandonment of important social, occupational, or recreational activities for the sake of drug use
Risky Use
Continued drug use despite serious drug-related problems
Use of drug in hazardous situations
Pharmacological
Tolerance: Need for more of the drug to achieve desired effect; Markedly diminished effect with continued use
Withdrawal: Withdrawal symptoms characteristic of the drug used
#Lecture 8
Which substance cannot produce a substance use disorder?
Caffeine #Lecture 8
What are the core syndromes of substance disorders?
Acute intoxication
2. Hazardous use (no obvious problems/dependence but intake above recommended levels)
3. Harmful use (clinical or functional problems
but no dependence)
4. Dependence syndrome
5. Withdrawal state
#Lecture 8
What is the comorbidity of alcohol dependence with anxiety/mood disorders?
~20% with anxiety
~24% with mood disorder
#Lecture 8
What is the heritability of risk for alcoholism?
~66% #Lecture 8
What are the biological explanations of alcohol aetiology (excluding genetics)?
People may become dependent on psychoactive drugs because they stimulate “reward pathways.”
Endorphin Compensation Hypothesis: Alcohol increases the production of endorphin (endogenous opioids) causing addiction
Serotonin Hypothesis: Alcohol increases serotonin to average levels
#Lecture 8
What are the three mechanisms that tolerance (for drugs) reflects?
Metabolic tolerance: liver produces more enzymes
Pharmacodynamic tolerance: enzymes in the brain adapt to the continuing presence of the drug
Behavioural conditioning mechanisms: cues function as conditioned stimuli and elicit a conditioned response
#Lecture 8
What are the main treatment methods for substance use disorders?
Abstinence vs Harm minimisation Detoxification treatment (medical vs non-medical) Psychological interventions Pharmacological treatments Self-help groups Therapeutic communities #Lecture 8
What are the four phases in the sexual response cycle?
Appetitive (desire) Excitement (arousal) Orgasm Resolution #Lecture 9
What is dyspareunia?
Persistent or recurrent pain during or after sexual intercourse #Lecture 9
What is vaginismus?
Involuntary spasms of the outer third of the vagina to such a degree that intercourse is not possible #Lecture 9
What proportion of women report pain with sex?
72% #Lecture 9
How does the psychoanalytic view explain sexual dysfunction aetiology?
Caused by unresolved, unconscious conflict #Lecture 9
How does the behavioural view explain sexual dysfunction aetiology?
Sexual feelings are paired with anxiety which blocks sexual responsiveness #Lecture 9
How does the cognitive view explain sexual dysfunction aetiology?
Thoughts produce anxiety
Blocks parasympathetic responding that is the basis of the human sexual response
#Lecture 9
What is format treatment for sexual dysfunctions?
Mutual responsibility/couple therapy
Co-therapists
Intensive residential or weekly sessions
#Lecture 9
What are the major treatment strategies for sexual dysfunctions?
Sex education Directed masturbation Skills and communication training Change attitudes and cognitions Anxiety reduction techniques Shifts in routines Marital therapy Medical & physical procedures #Lecture 9
What are the criteria for gender dysphoria in children?
A. Marked incongruence between one’s experienced/ expressed gender and assigned gender, for at least 6 months, manifested by at least six of the following:
Strong desire to be other gender
Boys – strong preference for cross-dressing. Girls – strong preference for wearing only typical masculine attire
Strong preference for cross-gender roles in make believe or fantasy play
Strong preference for toys, games, or activities stereotypically used or engaged by other gender
Strong preference for playmates of the other gender
Boys – strong rejection of masculine toys, games, activities, Females – strong rejection of feminine toys, games, activities
Strong dislike for one’s sexual anatomy
Strong desire for the primary and or secondary sex characteristics that match one’s experienced gender
B. Associated with clinically significant distress or impairment
#Lecture 9
What is paraphilia?
Any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with a phenotypically normal, physically mature, consenting human partner #Lecture 9
What are the criteria for paraphilic disorders?
The erotic preoccupation must have lasted at least six months
The urges lead to clinically significant distress or impairment
#Lecture 9
What is the common aetiological factor to all paraphilics?
The presence of early experiences which may limit the ability to form intimate adult relationships. #Lecture 9
How are developmental disorders identified?
Have to discriminate from normal cognitive development. #Lecture 10
How does Behavioural Family Therapy help treat oppositional defiant disorder?
Teaches parents to be very clear and specific about their expectations
Closely monitor children’s actions
Systematically reward positive behavior, while ignoring or mildly punishing misbehavior
#Lecture 10
How does multisystemic therapy help treat conduct disorders?
Delivered in the natural environment
Treatment plan is family-driven
Considerable attention on factors in the adolescent and family’s social networks that are linked with antisocial behaviour
Several hours of treatment per week
~ Half of children with ODD or CD continue into a problematic adulthood
#Lecture 10
What is Oppositional defiant disorder, and conduct disorder?
Oppositional defiant disorder
Pattern of angry, defiant, vindictive behaviour
Conduct disorder
Persistent and repetitive pattern of serious rule violations
#Lecture 10
What is language disorder, and speech sound disorder?
Language disorder
Difficulty in acquisition & use of language
Reduced vocabulary
Limited sentence structure
Discourse impairments
Language abilities below those expected for age
Speech sound disorder
Interference with speech intelligibility
Limitations in effective communication
#Lecture 10
What is childhood-onset fluency disorder; and social communication disorder?
Childhood-onset fluency disorder (stuttering)
Disturbance in normal fluency and time patterning of speech
Anxiety about speaking or limitations in effective communication
Social (pragmatic) communication disorder
Difficulties in social use of verbal and nonverbal communication
Functional limitations in effective communication in social, academic, occupational roles
#Lecture 10
What is pica?
Eating of non-nutritive/ non-food substances
Inappropriate to the developmental level
Not part of culturally or socially normative practice
Sufficiently severe to warrant additional attention if in context of another disorder
#Lecture 10
What is rumination disorder?
Repeated regurgitation of food
Not the result of a gastrointestinal or other medical condition
Not exclusively during the course of another feeding or eating disorder
Sufficiently severe to warrant additional attention if in context of another disorder
#Lecture 10
What is avoidant/restrictive food intake disorder?
Eating or feeding disturbance – persistent failure to meet appropriate nutritional and/ or energy needs
Not due to lack of available food or cultural practice
Not due to anorexia or bulimia nervosa, no disturbance in body perception
Not due to medical condition/ not explained by other mental disorder
#Lecture 10
How is binge eating disorder defined?
Recurrent binge-eating
DSM-5 definition: (Eating an amount of food that is clearly larger than most people would eat under similar circumstances in a fixed period of time; Sense of lack of control over eating at the time)
Marked distress
Frequency ≥ 1 per week; duration ≥ 3 months
No recurrent compensatory behaviour
#Lecture 10
What are the symptoms of bulimia?
Binge Eating: Inappropriate Compensatory Behavior
Excessive emphasis on weight and shape
Comorbid psychological disorders and medical complications
#Lecture 10
What are the psychological causes of anorexia and bulimia?
Perfectionism Lack of interoceptive awareness Low self-esteem likely related to women being preoccupied with their social self Negative Body Image #Lecture 10
What is the Maudsley model of anorexia treatment?
Parents put in charge of ‘re-feeding’ their child
Anorexia is externalised
Once ‘re-feeding’ has occurred, treatment focus shifts:
Gradual transfer of age- and developmentally appropriate levels of control and responsibility
#Lecture 10
What are the factors that affect eating disorder prognosis?
Better for younger patients than older ones Family support Shorter duration of illness Better for bulimia than for anorexia #Lecture 10
What are the three phases of stress in the response model?
Alarm phase (fight or flight) Resistance phase (ready to respond) Exhaustion phase (damage to body) #Lecture 11
What is the stimulus model of stress?
Stress defined in terms of stimuli, or events, assumed to influence most people similarly Measured stress by identifying stressful life events #Lecture 11
What is the transactional model of stress?
Stress occurs when a situation is appraised as exceeding the person’s adaptive resources: Perception of stressor; Access to resources; Type of coping strategy used
Accounts for IDs in how people respond to the same event #Lecture 11
How are stress and the immune system linked?
Body responds to imminent danger first by depriving the immune system which can lead to immunosuppression #Lecture 11
What are the seven generic key adaptive tasks that cut across most illness types?
Maintaining emotional equilibrium
Maintaining a sense of self (e.g., competence, mastery)
Maintaining relationships with family and friends
Preparing for the future
Dealing with the physiological and medical aspects of illness (e.g., symptoms, pain)
Dealing with treatment and medical care environments (e.g., hospitals)
Establishing and maintaining effective relations with health care professionals
#Lecture 11
What is the difference between type A and type B personalities, and how does it affect coronary heart disease?
Type A
Time urgency
Strong competitive drive
Prone to experiencing anger and hostility
Type As have much higher risk of CHD but lower mortality rate. #Lecture 11
What percentage of patients have significant difficulty adapting to illness?
~30% #Lecture 11
How was HIV/AIDS successfully combated through prevention programs?
Peer based education Actively infiltrated communities and informal networks Change of social norms Modelling Social reinforcement of behaviour change #Lecture 11
How do you distinguish dementia and delirium?
Delirium is sudden, brief, fluctuating, has hallucinations and lucid interval, and disturbed sleep. Dementia is slow, lifelong, stable with downward trajectory, no hallucinations, consistently poor insight and less disturbed sleep #Lecture 12
What is major neurocognitive disorder?
DSM V term for dementia, substantial cognitive decline that interferes with independence #Lecture 12
What is minor neurocognitive disorder?
Must exhibit modest cognitive decline that does not interfere with independence #Lecture 12
How is ‘probable’ Alzheimer’s Disease diagnosed?
Primarily through exclusions Clinical/neuropsychological evaluation Progressive worsening of memory & other mental functions No disturbances of consciousness Onset 40-90 Rule out other possibilities Memory loss is diagnostic hallmark (all kinds of memory) #Lecture 12
What is aphasia?
Loss or impairment in language #Lecture 12
What is apraxia?
Difficulty performing purposeful movements in response to verbal commands #Lecture 12
What is agnosia?
Perception without meaning
Can be visual, auditory or tactile
Anosognosia common
#Lecture 12
What is dyskinesia?
Involuntary muscle movements #Lecture 12
What are the general stages of Alzheimer’s and their characteristics?
Preclinical: brain changes start before visible symptoms
Mild: increasing plaques/tangles; memory problems, subtle personality changes, difficulty with daily living tasks
Moderately severe: increasing neuropathology
Severe: complete dependence, lose ability to speak, seizures, coma, death
#Lecture 12
What is Frontotemporal Neurocognitive Disease?
Dementia associated with atrophy of the frontal and/or temporal lobes
Memory often relatively unaffected in the early stages
Behavioural/frontal variant
Changes in behaviour, personality and emotional responses
Semantic/temporal variant
Decline in language abilities
#Lecture 12
What is Neurocognitive Disease with Lewy Bodies?
Rounded deposits found in nerve cells
Differentiation from AD: Presence of recurrent and detailed visual hallucinations; Parkinsonian features; More rapid progression
#Lecture 12
What is Vascular Neurocognitive Disease?
Dementia associated with problems of circulation of blood to the brain #Lecture 12
What is Huntington’s disease?
Dementia variant with: Relatively early onset Autosomal dominant genetic disorder Defective gene leads to the gradual destruction of neurons, particularly in the basal ganglia Movement disorder (chorea, dysarthria) Emotional changes Cognitive impairments #Lecture 12
What is Parkinson’s disease?
Dementia variant with:
Degeneration of specific area of brain stem
Reduced production of dopamine
Physical symptoms: Tremors, rigidity, postural abnormalities, and reduction in voluntary movements
NCD due to PD: Occurs in context of established PD; Memory, attention and executive control
#Lecture 12
What is the prevalence of dementia in people between 65 and 69; 75 and 79; and 90+?
~1%
~6%
~40%
#Lecture 12
What are the causes of neurocognitive disease?
Genetic predisposition, Huntingtons gene (full heritability).
Lifestyle (diet and risk taking behaviour)
Age
#Lecture 12
What are plaques and tangles (Alzheimer’s)?
Plaques: made of beta-amyloid; protein fragments snipped from amyloid precursor protein, attracts remnants of other cells Tangles: tau proteins that have lost capacity to bind to microtubules, become tangled, microtubule disintegrates and neuron dies #Lecture 12
What are the essential features of intellectual disability?
Significant deficits in intellectual functioning Significant deficits or impairments in adaptive functioning Onset before age 18 (during developmental years) #Lecture 13
What is the problem with emotional disturbance and intellectual disability?
Emotional difficulties overshadowed by intellectual & adaptive problems ~15-20% of Intellectually Impaired people suffer from emotional disturbances Dually diagnosed Intellectually Disabled fall through service delivery cracks #Lecture 13
What proportion of autistic children never speak?
50% #Lecture 13
What are the neurological factors of ASD aetiology?
Abnormal brainwave patterns in some EEG studies
Autistic symptoms in children correlated with epileptic seizures
Prevalence of autism in children whose mother had rubella during pre-natal period is ~10 x higher
Portions of the cerebellum underdeveloped
#Lecture 13
What are the challenges in treating autistic children?
They do not adjust normally to changes in routines
Their behaviour problems and self-stimulatory movements may interfere with effective teaching
Difficult to find reinforcers
Over selectivity of attention
Inability to generalise learning
#Lecture 13
How does Applied Behaviour Analysis attempt to treat ASD?
Training in cognitive skills, language and social behaviour Acquiring specific learning skills Reducing rigid and stereotyped behaviour Eliminating maladaptive behaviour Alleviating family distress #Lecture 13
