Test 3 Flashcards
what is the general criteria for a personality disorder in the dsm-5-tr?
- enduring pattern of inner experience/behaviour that deviates markedly from cultural expectations
- manifested in 2 or more areas:
- cognition
- affectivity
- interpersonal functioning
- impulse control
what is personality?
person’s characteristic set of behaviours, emotionals patterns
according to the dsm-5-tr, a personality disorder’s pattern is …
- inflexible and pervasive acorss a broad range of personal and social situations
- leads to clinically significant impairement or distress
- stable and of long duration; onset is traced to adolescence
what are some other/misc common features of personality disorders?
- little insight
- ego syntonic
- interpersonal problems
- initially difficult to diagnose and difficult to treat
- persistent
what is cluster A of a personality disorder? provide some examples.
- characterized by odd or eccentric behaviours
- paranoid, schizoid, schizotypal
what is cluster B of a personality disorder? provide some examples.
- characterized by dramatic, emotional, or erratic behaviour
- histrionic, narcissistic, antisocial, borderline
what is cluster C of a personality disorder? provide some examples.
- characterized by fearful or anxious behaviours
- avoidant, dependent, obsessive compulsive
what is paranoid personality disorder?
- pervasive distrust and suspicion
- believe that others are constantly trying to demean, harm, or threaten them
what is schizoid personality disorder?
- very little, if any, interest and ability to form relationships with others
- restricted range of emotions
how is schizoid different from austism spectrum disorder?
- in that there is no interest in relationships
- no evidence of restricted interest/behaviours, sensory issues as in ASD
what is schizotypal personality disorder?
- acute discomfort with close relationships / reduced capacity for it
- cognitive or perceptual distortions and eccentricities
- odd beliefs/thinking, magical, ideas of reference, illusions, suspiciousness, dress is unsual
what is the etiology of schizotypal personality disorder?
- genetic variation of or precursor to schizoprenia
- expressed to lesser degree and less impairment
- neurobiology: left hemisphere (memory and learning centres) and more generalized brain deficits
what are treatments to schizotypal personality disorder?
- medical treatment similar to schizoprenia (antipsychotics) and/or depression (SSRIs)
- social skills development
- treatment of comorbid for major depressive disorder
what is histrionic personality disorder?
attention-seeking, often provocative/dramatic behaviour, and exaggerate emotion
what is antisocial personality disorder?
disregard for, and violation of, the rights of others, often marked by deceitful, manipulative, and aggressive behaviours
what is borderline personality disorder?
- emotions: dysregulated, mood swings, intense anger
- behaviour: impulsive, risky, self-harm, suicide
- interpersonal: fear of abandonment, rejection sensitive, idealization and devaluation
- sense of self: poor self-image, lack of identity, feeling of emptiness
how is thinking affected in a borderline personality disorder?
- polarized; all or nothing, good or bad
- how we think/behave when our threat system is activated and we need to act quickly - indicative of trauma response
what is borderline personality disorder’s etiology?
heightened emotional arousal (increased emotion dysregulation –> inaccurate expression –> invalidating responses –> pervasive history of invalidating responses –> emotional vulnerability (sensitivity, reactivity, slow return to baseline)
about 75% of people diagnosed with borderline personality disorder are ?
women
men with similar characteristics to borderline personality disorder are commonly diagnosed with what? why?
- anti-social personality disorder
- socialization: men taught to externalized intense feelings thru behaviours, women taught to express thry emotional appeals
- clinician bias: studies where clinicians read same scenarios with varying pronouns (gender minority -> BPD, man -> APD)
borderline personality disorder’s symptoms overlaps with what?
- ptsd, bpd symptoms may be better understood as cPTSD
- led to an emphasis on trauma-informed care and treatment that addresses underlying trauma + symptomatic manifestations
what are treatments to borderline personality disorder?
- SSRISs and mood stabilizers (tegretol)
- crisis intervention
- dialectical behaviour therapy: focuses on skill building/mindfulness
- trauma processing
- attachment-based therapy
what is narcissistic personality disorder?
- grandiose view of own uniqueness and abilities
- crave constant attention, excessive admiration
- lack of empathy
- arrogant, exploitative, entitled
what is the etiology of narcissistic personality disorder?
- developmental experiences: rejecting/neglectful parents
- low self-esteem
- personality traits: high extraversion, low agreeableness
- cultural factors
what are treatments for narcissistic personality disorder?
- psychodynamic has shown to help: unconscious conflicts and vulnerabilities, fragile self-esteem masked by grandiosity, develop a more stable and realistic sense of self
- CBT: building self-esteem through mastery of realistic goals, help with comorbid depression
limited research
what is avoidant personality disorder?
- social inhibition
- feelings of inadequancy
- hypersensitivity to negative evaluation
what is dependent personality disorder?
- need to be taken care of
- leading to submissive and clinging behaviour
- separation anxiety
what is obsessive compulsive personality disorder?
- pervasive, excessive, and rigid fixation on doing things the ‘right way’
- highly perfectionistic, orderly, and rule-bound
- controlling tendencies
NOTE: different from OCD
what are the causes of obsessive-compulsive personality disorder?
- personality: perfectionistic, preference for structure and order
- genetic links to anxiety, need for control
- possible attachment issues leading to sense of instability in life
what are treatments to obsessive compulsive personality disorder?
- relaxation techniques for anxiety
- exposure to spontaneity, doing things a different way
- developing theory of mind - seeing others’ perspective
- encouraging ‘big picture’ thinking to move away from arbitrary rules
limited research
what is the argument for dimensional model of personality disorders?
- currently conceptualized as categories: either u have it or u don’t
- research supports continuum
- allow for a more personalized and accurate understanding of a person’s traits and their associated difficulties
- offer more tailored treatment plans
in the early 1900s, ADHD was considered to be due to poor what?
- poor “inhibitory violation”
- “defective moral control”
the encephalitis epidemic of 1917-18 gave rise to what concept?
“brain-injured child syndrome”: associated with mental retardation (intellectual developmental disorder
in the 1950s, what was ADHD referred to as?
- hyperkinetic impulse disorder
- motor overactivity seen as a primary feautre
in the 1970s, what was ADHD referred to as?
deficits in attention and impulse control + hyperactivity
what did the DSM-III introduce?
introduced the term ADD with or without hyperactivity: revised to ADHD in DSM-III-R
most recently, ADHD focuses on?
- self-regulation
- behavioural inhibition
what is the diagnositc criteria for ADHD?
- persistent pattern of either inattention and/or hyperactivity-impulsivity that is maladaptive or inconsistent with developmental level and persists for atleast 6 months
- symptoms present** prior to age 12**
- symptoms of impairement present in two or more settings
- clear evidence of interference with developmentally appropriate functioning
what is inattention in the diagnostic criteria for ADHD?
- must show 6+; if over 17, only 5+
- failure to attend to detail/careless mistakes
- difficulty sustaining attention in tasks or play
- difficulty listening, following instructions
- avoids/dislikes tasks that require systained mental effort
- easily distracted
- forgetful, poor organizational skills
what is hyperactivity in the diagnostic criteria for ADHD?
- must show 6+ years, if over 17 only 5+
- fidgety + squirms
- leaves seat in classroom/other situations
- runs about or climbs excessively in situations where inappropriate
- runs/climbs in places where inappropriate
- talks excessively
- is “on the go” and acts if “driven by a motor”
what is impulsivity in the diagnostic criteria for ADHD?
- blurts out answers before question is finished
- has difficult waiting turns
- interrupts or intrudes on others (e.g., convos)
what are the substypes in ADHD?
- hyperactivity + impulsivitiy
- inattentive
- combined
for ADHD, what is the associated presentation?
- elevated rates of leanring disorders, academic underachievement
- cognitive deficits (exectutive functions, applying intelligence, academic delays in reading, spelling and math)
- distorted self-perceptions
- speech and language impairments
in ADHD, what are some examples of impaired executive functions?
- organization
- focus
- regulate alertness, effort and processing speed
- manage frustration and modulate emotions
- working memory and accessing recall
- monitor and regulate action
what are medical and physical concerns with ADHD?
- sleep disturbances
- associated with accident-proneness and risky behaviours
what are social problems with ADHD?
- peers accept less/peer rejection
- family problems
what is ADHD prevalence?
- 2-10% in school-aged children
- 1-6% in adulthood
- 2:1 (boys to girls)
- 50% diagnosed with ADHD have comorbid ODD or CD
what other disorders are associated with ADHD?
- mood disorders
- learning d
- communication d
- anxiety d
- tic d
- coordination d
how to genetics play a role in the causes of ADHD?
- heritability estimates 70-90%
- higher concordance fo MZ twins than DZ twins
- 11-32% of siblings will also develop ADHD
- the dopamine transporter gene and the dopamine receptor gene appear to be implicated
what is ADHD’s etiology?
- prenatal risk
- pregnancy, birth, and early development
how is the neuroanatomical affected in ADHD?
smaller corpus callosum, right front lobes, basal ganglia, volume of cerebellum
how is the neurophysiology affected in ADHD?
abnormal event related potential (erp) recordings in right frontal and parietal regions
how is the biochemical affected in ADHD?
dopaminergic pathway abnormalities
does family have an effect on ADHD’s etiology?
no
what are the treatments for ADHD?
- medication
- parent management training (pmt)
- educational intervention
- intensive/combined treatments
- additional interventions
what types of medication treats ADHD?
- stimulant medications for management of symptoms and impairments
- dexotroamphetamine (dexedrine, adderall, vyvanse) and menthylphenidate (ritaline, concerta)
- nonsimulants (strattera), antidepressants or bp meds
- alter activity in the frontostriatal brain region by affecting important NTs
what is parent management training (pmt) for ADHD?
- provdes parents with skills to help manage child’s behaviour (e.g., behaviour modification (defining problem, setting reasonable goals and consequences) and environmental modification (increase predictability, structure and clarity)
- reduce parent-child conflict
- cope with difficulties of raising a child with ADHD
what is educational intervention in ADHD?
- focus on managing behaviours that interfere with learning
- provde classroom environment that capitalizes on child’s strengths to improve academic performnance
what are additional interventions for ADHD?
- intensive interventions: combines meds, pmt and educational interventions
- family counseling, support groups, individual counseling
- controversial treatments: provide false hope, delay other treatments
how is the austism spectrum disorder described in the dsm-5-tr?
- severely impaired socialization andn communication (pragmatic language)
- Restricted, repetitive patterns in behaviour
- impairments present in early childhoos: limit daily function
how is the austism spectrum disorder categorized in 3 levels of severity in the dsm-5-tr?
- requiring support
- requiring substantial support
- requiring very substantial support
in autism spectrum disorder, how is impairment in social communication and interaction described?
- failure to develop age-appropriate social relationships, communication and social reciprocity
- inability to engage in joint attention
- less interest in social relationships with peer
- deficits in nonverbal communication
- lack prosody
in autism spectrum disorder, how is restricted, repetitive patterns of behaviour/interests/activities described?
- stereotyped and ritualistic behaviours (maintainence of sameness)
- rituals are often complex
- if rituals are interrupted or prevented, person has a severe tantrum
in autism spectrum disorder, what are savant skills?
- exceptional mental abilities found in 1/3 of ASD individuals
- important not to value individuals with ASD soley based on these
in autism spectrum disorder, what is echolalia?
repeating a word or phrase spoken by another person
in autism spectrum disorder, what is stimming?
self-stimulating/regulating behaviours that involve repetitive behaviours or sounds
in autism spectrum disorder, what are sensory sensitivities?
difficulties interpreting and organising input from sense
in autism spectrum, how is it protrayed? linear? colours?
it is a pie chart spectrum
in autism spectrum disorder, what are the general statistics?
- 1 in 66 canadian children
- generally more prevalent in boys
- universal phenomenon; increased awareness among professionals
- 31% have intellectual disabilities
- better language skills generally mean better prognosis
what are the genetic causes of autism spectrum disorder?
- genetic component; many genes implicated
- moderate genetic heritability
- child with ASD has older parents
what are the neurobiological causes of autism spectrum disorder?
- neuronal connectivity: hyperconnectivity in sensory and motor regions, underconnectivity in areas responsible for social communication and excecutive function, few neurons in amygdala
- oxytocin deficits: lower oxytocin levels in individuals with autism have been linked to difficulties in socila bonding, emotion recognition, and eye contact
what are the psychological and social dimensions of autism spectrum disorder?
in the past, what did people assume to be the cause of ASD?
- in the past, autism was incorrectly viewed as the result of bad parenting (cold, aloof)
- parents of individuals with ASD do not differ substantially from parents of children without disbailities
what are the psychosocial treatments to autism spectrum disorder?
- “nothing about us without us”
- behavioural interventions focus on skill building to improve communication, socialization, and independent living
- creating ASD-friendly environments (break areas, fewer people, more space, parallel play)
what are the biological treatments for autism spectrum disorder?
- medical intervention has little success
- one drug does not work for all ASD
- current approved medications treat irritability: risperidone and aripiprazole (antipsychotics)
what are the integrating treatments for autism spectrum disorder?
- social education, supports for communication and socialization, parental support
- community integration
substances that produce a change in what?
- thinking
- feeling
- behaving
- physiological functioning
problems realted to using ‘psychoactive substances’
what is the difference between use and intoxication?
- use: occasional ingestation
- intoxication: effects of substance on central nervous system lead ot reversible psych or behavioural changes
what is the difference between abuse and dependence?
- abuse: interefernce with life
- dependence:
- physiological: withdrawal and/or tolerance
- psychological: drug-seeking behaviours
what are the two physiological responses to extended substance use?
- tolerance: ↑ amount of substance necessary for same high and ↓ effect with same amount of substance
- withdrawal: substance specific syndrome due to cessation or reduction of heavy, prolonged substance use
- symdrome causes clincially significant distress or impairment in important areas of functioning
a pattern of substance abuse leading to …
- significant impairment or distress as indicated by at least two of the following
- occuring within a 12-month period
in the dsm-5-tr, substance-related and addictive disorders are described to be what?
- substance taken in larger amounts or over a longer period than intended
- persist desier or unsuccessful efforts to cut down/control
- craving or strong desire or urge to use
- important social, occupational, or recreational activities are impaired/reduced
- recurrent substance use in situations in which it is physically hazardous
- tolerance
- withdrawal
what are the 10 categories of substances?
Aurora Clucked Cockily However Inflammable Stockbrokers Honked Absentmindedly Since Turkeys Overslept Grumpily
- alcohol-related
- caffeine-related (not caffeine use)
- cannabis-related
- hallucinogen-related
- inhalant-related
- sedative, hypnotic, or anxiolytic-relatied
- stimulant-related
- tobacco-related
- other (or unknown) substance-related
- gambling
which 3 substances have addictive potential?
- nicotine
- ice, glass (methamphetamine smoked)
- crack (cocaine)
easy to get hooked on and difficult to quit
what are the specifiers for substance use disorders?
- mild: 2-3
- moderate: 4-5
- severe: 6+
- in early remission: no symptoms for 3-12 months
- in sustained remission: no symptoms for 12+ months
- in a controlled environment: e.g., rehab or prison
e.g., opioid use, severe, in early remission
what about a person who gets sober?
- if a person is not currently experiencing a SUD, ther history of SUD remains relevant due to relapse risk
- if someone stays substance-free for life, they would still be documented as “in sustained remission”, rather than as if they never has SUD
what is the prevalence for substance abuse disorder?
- 22% have met criteria for a substance abuse disorder at some point in their lives
- alcohol use d: most common, meeting criteria at some point in thier lives
- cannabis use: about 7% of canadians have experienced
- nicotine dependence rate: 10-15% of canadians
what are the similarities between substance and behavioural addictions?
- both activate reward centre in brain (dopamine mainly)
- intense cravings or urges
- tolerance and withdrawal
- impairment
what are the differences between substance and behavioural addictions?
- intoxication vs thrill
- withdrawal (psychological vs physiological)
- treatment (behavioural vs medical)
gambling disorder is the only behvaioural addiction listed in DSM-5-TR
substance abuse disorder is not caused by…
- moral failings
- lack of willpower
how do addictive substances impact the brain?
- euphoria (pleasure + reward)
- tolerance (needing more for the same effect)
- withdrawl (the crash after stopping)
what is euphoria in substance use disorders?
- drugs flood the brain with dopamine, activating the reward system
- VTA -> nucleus accumbens -> prefrontal cortex
what is tolerance (brain activity-wise) in substance abuse disorders?
- brain adapts by reducing dopamine production and receptor sensitivity
- user increases doses to feel the same high
what is withdrawal (brain activity-wise) in substance abuse disorders?
- dopamine drops, tiggering anxiety, cravings, and physical discomfort
- severity varies (e.g., opioid –> pain, alcohol –> seizures, nicotine –> irritability)
what are the genetic causes for substance use disorder?
- much of the focus gas been on alcoholism
- having at least one alcoholic parent -> higher risk
- genetic differences in alcohol metabolism (more efficient metabolism of alc without unpleasant effect can lead to a greater riks of AUD due to more drinking and greater tolerance
what are the learning factors associated with substance abuse disorder?
- play an important role in the development of substance use
- observing caregivers/family use substances (normalizing)
- social reinforcement: inhibits negative affect/anxiety in social settings, peer encouragement
what are the opponent-process theory in substance abuse disorder?
- brain attempts to balance out high with crash
- less intense highs and more intense crashes occur over time
- need more of the drug to elicit a high and make-up for the crash
what are the cultural factors associated with substance abuse disorder?
- cultural attitudes towards substance use
- higher rates of substance use in uni
- lower rates of SUDs among religious groups that prohibit use
- argentina, child, canada, japan, us, new zealand make up < 20% of the world population but consume 80% of the alcohol
how is stress and coping associated with substance abuse disorder?
- chronic stress and trauma can lead to self-medication
- high stress jobs (e.g., healthcare and military) show higher substance use rates
how is economic and housing instability associated with substance abuse disorder?
- poverty and unemployment increase relience on subtances as an escape
- homlessness strongly correlated with alcohol and opioid dependence
- lack of access to other coping mechanism, helathcare
how is availability associated with substance abuse disorder?
- easier access = high use (liquor stores, dispensaries, prescriptions)
- regions with high alcohol and drug availability report increased misues
what are the biological treatments for substance use disorder?
- agonist substitution: safe drug with a similar chemical composition as the abused drug (e.g., methadone for heroin; nicotine gum or patch)
- antagonistic treatment: drugs that block the positive effects of substances (e.g., naltrexone for opiate and alcohol problems)
- aversive treatment: drugs that make the use of abused substances extremely unpleasant (e.g., antabuse (disulfiram) for alcoholism, sulver nitrate for nicotine addiction)
what is the efficacy for biological treatments in substance use disorder?
- such treatments are generally not effective when used alone
- greater efficacy when used with psychological treatment
what is the harm reduction v. complete abstinence as a goal in substance use disorder?
best treatment goal is the one that is tailored to the person’s situation and results in greater well-being
what is the impatient vs. outpatient care in substance use disorder?
data suggest little difference in terms of overall effectiveness
what are some examples of community support programs for those with substance use disorder?
- alcoholics anonymous and related
- seem helpful and are strongly encouraged
- free, available widely (online, 24/7)
- provide recovery community/social support
what are psychological treatments for those with substance use disorder?
- components of comprehensive treatment and prevention programs
- individual and group therapy (motivational interviewing: helps individuals resolve ambivalence by increasing change talk, enhancing self-efficacy)
- aversion therapy
- contingency management
- rewards for abstinence (5 year chip, etc)
- relapse prevention
how can accessible healthcare and prescription medications help those with substance use disorders?
- ensure affordable mental health and addiction
treatment (e.g., therapy, rehab, harm reduction) - provide safe access to prescription medications to
reduce illicit drug use
how can social inclusion and recreation help those with substance use disorders?
- expand housing-first programs to stavlize vulnerable populations
- inc. public funding for sports, arts, and community programs as positive outlets
- provide safe social spaces for youth and at-risk populations
what is schizophrenia?
- different classes of symptoms (positive, negative and disorganized)
- braod spectrum of cognitive, emotional, and behavioural dysfunctions
what are the positive symptoms of schizophrenia?
- active manifestations of abnormal behaviour or an excess or distortion of normal behaviour
- e.g., delusions, hallucinations (one or both experienced by 50-70% of people with the disorder)
in schizophrenia, what are delusions?
- beliefs that are gross misrepresentations of reality
- various types:
- bizarre: clearly implausible, not understandable, not derived from ordinary life experiences (e.g., all organs removed by aliens)
- non-bizzare: involve situations that can conceivably occur in real life but aren’t happening (e.g., being followed by FBI)
what are the 6 types of delusions?
- of guilt or sin (usually bizarre)
- somatic (b or non b)
- persecutory (b or non b)
- of reference (usually b)
- grandiose (b or non b)
- of being controlled (usually b)
what are hallucinations in schizophrenia?
- experience of sensory events without input from surrounding environment
- e.g.,
- auditory (most common)
- visual (second most common)
- tactile
- somatic
- olfactory
what are the negative symptoms of schizophrenia?
absence or insufficiency of typical behaviour
what are the types of negative symptoms in schizophrenia?
- avolition: initiate/persist at basic activities
- alogia: amount of speech
- anhedonia: pleasure or interest
- affective flattening: emotional expression
- asociality: social relationships/skills
what are the disorganized symptoms of schizophrenia?
- erratic speech, motor behaviour, and emotions
- inappropriate affect
- disorganized behaviour: acting in usual ways, unsual dress
- catatonia: motor dysfunctions that range from agitation to immobility: waxy flexibility
- disorganized speech: tangentiaty, loose associations, derailment
according to the dsm-5, what are the schizophrenia criteria?
- 2 or more of the following, each present for a significant portion of time during a 1-month period:
- delusions, hallociantions, disorganized speech (must include one of these) and disorganized or catatonic behaviour and negative symptoms
- impaired functioning
- continuous disturbance for 6 months
what are the biological influences for schizophrenia?
- inherit a tendency for psychosis, not a specific schizophrenia disorder
- close genetic relatives of people with schizophrenic disorders are at increased risk for schizophrenia
- risk is 48% in MZ twins and 17% for DZ twins
who are the genain quadruplets?
- genetic link: all identical twins developed schizophrenia
- varied severity: youngest has the most, third the mildest and later in remission
- family influence: grandmother had paranoid schizo, father was also disturbed and possibly abusive
- cognitive stability: testing over decades showed stable or improved cogntive, progressive decline challenged
how do viral infections play a part in schizophrenia?
- prenatal exposure inc. risks
- maternal flu infection in the second trimester can triple risk
- other infections (rubella, toxoplasmosis, and cytomegalovirus) also implicated
- immune system activatoin and neuroinflammation affected fetal brain development
what are the psychosocial influences for those with schizophrenia?
- stress: activate underlying vulnerability and/or inc. risk of relapse
- family interactions - expressed emotion associated with relapse
- social drift: people in urban areas have higher rates of schizophrenia
what is the sociogenic hypothesis for schizophrenia?
stressors having low income contribute to onset of schizophrenia
what is the social-selection theory for schizophrenia?
those with the disorder move to impoverished areas of city due to lack of resources or to access to social services
how is cannabis linked to the onset of schizophrenia?
- cannabis use more than doubles risk of developing schizophrenia
- young men were more than 6x mroe likely to develop schizophrenia from heavy use
- can dysregulate dopamine channels
- directionality of relationship
- other vulnerabilities interact: geentic predisposition, stage of brain development
how are cigarettes linked to the onset of schizophrenia?
- prevalence of smoking: 80% vs 20 % general population
- dopamine for negative symptoms
what are the biological treatments for schizophrenia?
- medication: antipsychotic (neuroleptic) but compliance issues (increased negative symptoms and tardive dyskinesia)
- transcranial magnetic stimulation: exposure to magnetic fields that up and down regulate brain regions (over front lobes for neg sx and temporal lobes for hallucinations)
what are the psychosocial treatments for schizophrenia?
- early intervention programs (coping skills, stress management, medication compliance and psychoeducation)
- social skills training
- commiunity care and vocational programs
- cbt: reality testing, behaviour activation, recognizing triggers
for schizophrenia, what is the prognosis/outcomes?
- 50-80% of people who have one episode will have another
- 38% recovery rate (significantly reduced symptoms and restoration of function)
- life expectancy shortened 10 years (smoking/substance use, less access to healthcare, unemployment, social isolation, lack of housing)
