Unit 3 (Final Exam) Flashcards
Chapters 12-14
positive symptoms of schizophrenia
- excesses of thought, emotion, and behavior
- includes delusions, hallucinations, disorganized thoughts/speech, heightened perceptions, inappropriate affect
delusions (schizophrenia)
delusions of persecution, delusions of reference, grandiose delusions
hallucinations (schizophrenia)
- auditory most common, visual, tactile, smell, and taste very rare
- PET scans show heightened activity in corresponding part of the brain during hallucination
- people who are hallucinating seem to hear sounds produced by their own brains, but the brainss cannot recognize the sounds are actually coming from within
disorganized speech (schizophrenia)
- loose association: derailment
- neologisms: made-up words
- preservation: patients repeat their words and statements again and again
- clang: use of rhyme to think or express themselves, sound-alike associations
heightened perceptions (schizophrenia)
feeling that one’s senses are being flooded by sights and sounds, making it impossible to attend to anything important
inappropriate affect (schizophrenia)
emotional response doesn’t “fit” the situation
negative symptoms of schizophrenia
- deficits of thoughts, emotion, and behavior
- included affective flattening, alogia, avolition, anhedonia
affective flattening (blunted affect) (schizophrenia)
severe reduction or complete absence of effective (emotional) response to the environment
alogia (schizophrenia)
severe reduction or complete absence of speech
avolition (schizophrenia))
inability to persist at common, goal-oriented tasks
anhedonia (schizophrenia)
loss of pleasure in everything, indifference, social withdrawal
psychomotor symptoms of schizophrenia
- unusual movements or gestures
- includes awkward movements, repeated grimaces, odd gestures, catatonia
catatonia (schizophrenia)
pattern of extreme psychomotor symptoms which may include catatonic stupor, rigidity, or posturing
core symptoms of schizophrenia (per DSM-5 criteria)
at least two of the following for a period of at least a month
- delusions
- hallucinations
- disorganized speech
- grossly disorganized or catatonic behavior
- negative symptoms
social/occupational function of schizophrenia (per DSM-5 criteria)
significant impairment in work, academic performance, interpersonal relationships, and/or self-care
duration of schizophrenia (per DSM-5 criteria)
continuous signs of disturbance for at least 6 months; at least 1 month of this period must include core symptoms
multilevel diagnosis of schizophrenia
involves analysis of symptoms, functioning, and duration, along with elimination/ruling out of other causes
course of schizophrenia
- from childhood past adolescence/young adulthood
- premorbid phase: cognitive motor or social deficits
- prodromal phase: brief/attenuated positive symptoms and/or functional decline, ends in first psychotic episode
- psychotic phase: florid positive symptoms
- stable phase: negative symptoms, cognitive/social deficits, functional decline
onset and prevalence of schizophrenia
- about 0.2-1.5% of the world
- often develops in early adulthood but can emerge whenever
gender differences of schizophrenia
- affects males and females about equally
- females tend to have a better long-term prognosis
- onset differes
do genetics play a role in schizophrenia?
strong genetic component
pre-DSM-5 subtypes of schizophrenia
- paranoid
- disorganized
- catatonic
- undifferentiated (i.e.other)
- residual (i.e. left over)
schizophrenia is chronic
- most suffer with moderate-to-severe lifetime impairment
- life expectancy is slightly less than average
paranoid schizophrenia
- intact cognitive skills and affect
- do not show disorganized behavior
- hallucinations and delusions (Grandeur or persecution)
- best prognosis of all types of schizophrenia
disorganized schizophrenia
- marked disruption in speech and behavior
- flat or inappropriate affect
- hallucinations and delusions (tend to be fragmented)
- develops early, tends to be chronic, lacks remissions
catatonic schizophrenia
- show unusual motor response and odd mannerisms
- examples include echolalia and echopraxia
- “waxy flexibility”
- tends to be severe and quite rare
undifferentiated schizophrenia
- wastebasket category
- major symptoms of schizophrenia
- fail to meet criteria for another type
residual schizophrenia
- one past episode of schizophrenia
- continue to display less extreme residual symptoms
Type I schizophrenia
primarily positive symptoms, responds to drug therapy, better prognosis
Type II schizophrenia
primarily negative symptoms, often not responsive to drugs, prognosis poorer, but some newer drugs do seem more helpful for negative symptoms
schizophreniform disorder
schizophrenic symptoms for one to six months
schizoaffective disorder
- symptoms of schizophrenia together with depression and/or mania
- both disorders are independent of one another
- at least 2 weeks only schizophrenic symptoms
- prognosis is similar for people with schizophrenia
- people do not tend to get better on their own
delusional disorder
- delusions, but not bizarre ones
- types include erotomanic, grandiose, jealous, persecutory
- lack other positive and negative symptoms
- extremely rare
- better prognosis than schizophrenia
brief psychotic disorder
- one or more positive symptoms of schizophrenia for less than 1 month
- usually precipitated by extreme stress or trauma
- tends to remit on its own
family studies of schizophrenia
- inherit a tendency for schizophrenia
- do not inherit specific forms of schizophrenia
- risk increases with genetic relatedness
twin studies of schizophrenia
- monozygotic twins: 48% risk
- fraternal (dizygotic) twins: risk drops to 17%
- adoption studies: risk remains high
- cases where a biological parent has schizophrenia
genetic research for schizophrenia
- risk increases with genetic relatedness
- risk is transmitted independently of diagnosis
- strong genetic component does not explain everything
- likely polygenic
- smooth-persuit eye movement
how can birth complications and prenatal viral exposure lead to schizophrenia?
- particularly those involving loss of oxygen that could damage the brain
- effects of perinatal hypoxia interact with genetic vulnerability
- prenatal viral exposure (second-trimester flu)
neural differences in schizophrenics
- pre-/perinatal insult: genetic and epigenetic factors impair electric, rhythmic activity and lead to the malformation of cortical circuits
- reorganization of cortical networks confers vulnerability: increase in high-frequency oscillations fn long-range synchrony during late adolescence is associated with a transient destabilization of network functions
- large-scale disintegration of network activity leads to emergence of psychosis
dopamine hypothesis for schizophrenia
- excess dopamine in the brain is associated with schizophrenia
- drugs that increase dopamine result in schizophrenic-like behavior
- drugs that decrease dopamine reduce schizophrenic-like behavior
- problems: not everyone not all symptoms respond, and timing of response is delayed
new biological theories for schizophrenia
- excess dopamine activity in mesolimbic system
- unusually low dopamine activity in prefrontal area of the brain
- other neurotransmitters may be important (serotonin, glutamate, GABA)
- likely that imbalances in levels or receptors for dopamine and interactions with other neurotransmitters
brain structure in relation to schizophrenia
- enlarged ventricles, often associated with negative symptoms
- gray matter reductions
- less suppression of the default network than non-schizophrenic people
psychological factors of schizophrenia
- Freud: overwhelming rejection leads to regression, cant’ distinguish reality
- “schizophrenic” mothers
- communication deviance in family may cause stress for at-risk children
- families with high expressed emotion are over involved and over protective, at the same time critical and hostile
role of stress in schizophrenia
- may activate underlying vulnerability
- may also increase risk of relapse
- concept of “social (downward) drift”
- unlikely single stress reaction will lead to schizophrenia
behavioral perspective of schizophrenia
- suggest cause is faulty operant conditioning, especially in attention and social responses
- not widely accepted, but behavioral techniques for treatment are effective (token economies)
cognitive perspective of schizophrenia
- focus on attention problems, probably key issue in schizophrenia
- cognitions and social response based on attention problems leads to withdrawal from outside and elaboration of the inner world
early treatments for schizophrenia
- insulin coma therapy
- electroconvulsive therapy
- prefrontal lobotomies
- “warehousing” common
- 1950s introduced phenothiazines (Thorazine
biological treatment for schizophrenia
- neuroleptics: block D1 and D2 dopamine receptors; extrapyramidal side effects; more effective for positive symptoms
- “atypical” antipsychotics: clozapine, abilify, seroquel, risperdal; more effective and fewer side effects; “first line” treatment; also treat negative symptoms
cognitive-behavioral therapy for schizophrenia
- help patient change how they view and react to their hallucinatory experiences
- new-wave: therapy helps clients to accept their streams of problematic thoughts, gain a greater sense of control, become more functional, and move forward in life
family therapy for schizophrenia
- over 50% live with family members; creates significant family stress, are at greater risk for relapse when living with relative who display high levels of expressed emotion
- attempts to address such issues, create more realistic expectations, and provide psychoeducation about the disorder
- may also involve family support groups and family psychoeducation programs
social therapy for schizophrenia
- addresses social and personal difficulties in the clients’ lives
- includes practical advice, problem solving, decision making, social skills training, medication management, employment counseling, financial assistance, and housing
- reduced hospitalization
attention-deficit/hyperactivity disorder (ADHD)
marked by the inability to focus attention, or by overactive and impulsive behavior, or both
overview of ADHD
- “dis-inhibition” disorder, the normal facility to inhibit one’s behavior or actions are disabled by the frontal lobe’s sluggishness to respond
- once the individual considers their behavior, there is usually some recognition of the inappropriateness of it
- impaired executive functioning unified understanding of ADHD (includes working memory, internalization of self-directed speech, emotional control)
DSM-5 symptom criteria for ADHD
- essence of “attention deficit”: inattention to details, careless work, poor sustained attention to tasks, etc
- hyperactivity and impulsivity: fidgetiness and squirming, difficulty being quiet when expected, always on the go, etc
genetic factors contributing to ADHD
- immaturity of the brain (frontal lobes, caudate nucleus, and corpus callosum)
- dopamine is primary neurotransmitter involved
- genetic predisposition
- prenatal and birth complications (maternal alcohol, low birth weight, exposure to lead)
how may families cause ADHD?
- associated with frequent disruptions and parents with control problems
- child abuse and neglect, brain injuries, chaotic family life
- chicken-and-egg problem with difficult behavior and response from others
treatment for ADHD
behavioral, pharmacological, and combined drug, behavioral, and family treatment associated with best results
behavioral treatment for ADHD
- reinforcing attentive, goal-directed, prosocial behaviors
- extinguishing undesired behaviors
- training parents and family therapy
- challenges: very labor intensive, require high levels of consistency to effect change over time, behavioral modification is in competition with neurochemistry
parent management training for ADHD
- establish effective contingencies
- use clear and direct commands
- differential attention (reinforce target behaviors)
- contingent reinforcement (positive consequences)
- response cost (negative consequences)
- time out
collaborative and proactive solutions for ADHD
- define the problem
- ask the child about their perception of the problem in the broadest terms and at length
- clarify the child’s concerns
- clarify parent concerns
- invite the child to collaborate on a solution that meets both the child’s and parents’ goals
- assess and review collaboration as needed
medication treatment for ADHD
- most common is stimulant drugs like Ritalin
- stimulate the sluggish functioning of the frontal lobes that are responsible for “executive functioning” such as planning and inhibition
- some blood pressure meds, tricyclic antidepressants, mood stabilizers, anti-psychotics
conduct disorder
behaviors that violate the basic rights of others and the norms for social behavior
oppositional defiant disorder
- argumentativeness, negativity, irritability, defiance, but behavior is not as severe as in conduct disorder
- often result of inconsistent response to a child’s behaviors
- frequently comorbid with ADHD
autism spectrum disorder
marked by substantial unresponsiveness to others, significant communication deficits, and highly repetitive and rigid behaviors, interests, and activities
autism defined
- a complex brain disorder that inhibits a person’s ability to communicate and develop social relationships
- often accompanied by extreme behavioral challenges
- affects four times as many boys as girls
- persistent deficits in social communication and social interaction across multiple contexts
diagnostic criteria for autism
- qualitative impairment in social communication and social interaction
- not just being shy or being anxious
- stereotypic behaviors, rigidity, restricted interests, hyper-hypo reactive to sensory stimuli
- levels 1-3 increasing in severity
diagnostic tests for autism
- autism diagnostic interview-revised
- prelinguistic autism diagnostic observation schedule
- childhood autism rating scale
- autism behavior checklist
- autism diagnostic observation schedule
- the higher the functioning the individual, the harder to ascertain their being autistic using tests
diagnosis for autism
- can be diagnosed as early as 1 year and is commonly diagnosed by age
- diagnosis is based on specific observations of the developmental milestones (social and language) as well as of stereotypic behaviors
autism spectrum disorder
- matter of degree
- language: from no functional language to complete reciprocal communication skills
- stereotypes: severe (including self injury) to very mild self absorbed sensory stimulation
- social relationships: from an inability to even notice another person in a room to good eye contact and interest in social reciprocity
comorbid diagnoses: autism and…
- intellectual disability
- seizure disorders
- genetic disorders (including fragile X)
- other: phobias, OCD, ADHD, anxiety disorders, depression
high-functioning autism
- formerly known as “Asperger’s disorder”
- mild autism
- still a spectrum disorder
- there can be a large disparity between intellectual and adaptive skills
theories on the increasing incidence of autism
- decrease in childhood mortality
- diagnosis shifting: would previously be diagnoses as “childhood schizophrenia”
- no research supports thimerosal, the mercury compound used in many childhood immunizations
concordance studies on autism
- 90% for identical twins
- 35 times more likely for a sibling to have autism
- assuming 1:91, the incidence is 0.01
- 4 times as likely in boys than in girls
- significant genetic component
treatment strategies for autism
- medication used to treat many behavioral symptoms
- applied behavioral analysis: science of behavioral modification; painstaking objective observation, cataloging, and analysis of behavior; strong focus on positive reinforcement of appropriate behaviors; applies principles of operant and respondent conditioning to change behavior of social significance
- parent management training
- collaborative proactive solutions
- commonalities to successful behavioral and educational success
personality
- long-standing patterns of thought, behavior, and emotions
- big five: openness to experience, conscientiousness, extroversion, agreeableness, neuroticism
personality disorders
- an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture
- pattern is inflexible, stable, and generally begins in adolescence
- appears when individuals find themselves in situations that are beyond their ability to cope
biopsychosocial model of personality disorders
biological predisposition to a difficult temperament –> parenting that is harsh, critical, or unsupportive or is alternatively overprotective and indulgent –> behavioral and emotional dysregulation; maladaptive beliefs about the self –> negative reactions from peers and adults –> worsening of temperamental difficulties in controlling emotions and behaviors
prevalence of personality disorders
- 0.5-2.5% of the general population
- higher in inpatient and outpatient settings
comorbidities of personality disorders
- often seen in people who also meet criteria for anxiety, mood, and substance use disorders
- those with one personality disorder are very likely to have another
- high co-occurrence of disorders occurs within each cluster
“odd” personality disorders (DSM-5 cluster A)
- people typically have odd or eccentric behaviors, including extreme suspiciousness, social withdrawal, and peculiar ways of thinking and perceiving things
- paranoid, schizoid, schizotypal
schizoid personality disorder
- chronic lack of interest in and avoidance of interpersonal relationships, emotional coldness toward others
- limited range of emotions
- causes unclear
- preference for social isolation resembles autism (genuinely want to be alone)
paranoid personality disorder
- chronic and pervasive mistrust and suspicion of other people that is unwarranted and maladaptive
- biological and psychological causes unclear
- early learning: world is a dangerous place
“dramatic” personality disorders (DSM-5 cluster B)
- clients experience behaviors that are so dramatic, emotional, pr erratic that it is almost impossible for them to have relationships that are truly giving and satisfying
- includes borderline, antisocial, histrionic, and narcissistic
schizotypal personality disorder
- chronic pattern of inhibited or inappropriate emotion and social behavior, aberrant cognitions, disorganized speech
- magical thinking, ideas of reference, and illusions
- most are socially isolate, highly suspicious
- many meet criteria for major depression
- causes: potentially phenotype of a schizophrenia genotype, more generalized brain deficits
antisocial personality disorder
- pervasive pattern of criminal, impulsive, callous, or ruthless behavior
- disregard for right of others
- no respect for social norms
- one of the most common personality disorders and one of the most difficult to treat
diagnostic criteria for ASPD
must be at least 18 and showed signs of conduct disorder before age 15
- noncompliance with social norms
- violates rights of others
- irresponsible, impulsive, and deceitful
- careless disregard for safety or self or others
- no regret for hurting or mistreating others
- failure to behave responsibly in spheres of work or finances
- lack of remorse
ASPD overlap with psychopathy/sociopathy
- about 10-25% have psychopathy, involving emotional detachment, lack of empathy, impulsive behavior and callousness, with apparently no conscience
- Cleckley (1941/1988): the mask of sanity
relationship between ASPD and early behavioral problems
- early histories of behavioral problems
- families often have inconsistent parental discipline and support
- families often have histories of criminal and violent behavior
theories of ASPD
- genetic predisposition
- deficits in brain structure and functioning
- low levels of arousability
- harsh and inconsistent parenting
- physical abuse
- two key factors: fearlessness and low cortical arousal
treatment for ASPD
- few seek treatment on their own
- poor prognosis
- emphasis is placed on prevention and rehabilitation
- often incarceration is the only viable alternative
borderline personality disorder
- rapidly shifting and unstable mood, self-concept, and interpersonal relationships
- impulsive
- display pronounced, wide ranging, unstable and impulsive patterns in relationships, sense of self, and emotions
diagnosis of BPD
at least 5 symptoms
- desperate efforts to avoid perceived abandonment
- fluctuations between idealizing and integrating family, friends, and coworkers
- highly changeable self concept
- self-damaging displays of impulsivity
- significant fluctuations in moods and emotions
- repeated self-mutilating or suicidal acts or gestures
- long-term sense of emptiness
- experiences of extreme and often uncomfortable anger
- periodic, short-term paranoid ideas or dissociation during times of stress
treatment for BPD
- issues in therapy: developing a therapeutic alliance, transference and countertransference, change is slow and hard won
- antidepressant medications: some short-term relief
- dialectical behavior therapy: comprehensive treatment approach that includes both individual therapy and group therapy sessions (treatment of choice)
- synthesizing acceptance and change
histrionic personality disorder
- rapidly shifting moods, unstable relationships, and intense need for attention and approval; dramatic, seductive behavior
- thinking and emotions are perceived as shallow
- impulsive and need to be center of attention
narcissistic personality disorder
- grandiose thoughts and feelings of one’s own worth; obliviousness to others’ needs
- exaggerated/unreasonable sense of self-importance
- preoccupation with receiving positive attention
- lack sensitivity and compassion for other people
- sensitive to criticism, envious, and arrogant
avoidant personality disorder
- characterized by consistent discomfort and restraint in social situations, overwhelming feelings of inadequacy, and extreme sensitivity to negative evaluation
- highly avoidant of interpersonal relationships
- similar to social anxiety disorder
“anxious” personality disorders (DSM-5 cluster C)
- patterns of anxious and fearful behavior
- extremely concerned about being criticized or abandoned by others and thus have dysfunctional relationships with them
- includes avoidant, dependent, obsessive-compulsive personality disorders
dependent personality disorder
- characterized by pattern of clinging and obedience, fear of separation, and an ongoing need to be taken care of
- reliance on others to make major life decisions
- unreasonable fear of abandonment
- clingy and submissive in interpersonal relationships
problems with DSM-5 diagnostic system for personality disorders
- diagnostic overlap and reliability
- gender and ethnic/racial biases in construction and application
- dimensional approach would be better
obsessive-compulsive personality disorder
- marked by such an intense focus on orderliness, perfectionism, and control that the person loses flexibility, openness, and efficiency
- highly perfectionistic, orderly, and emotionally shallow
- excessive and rigid fixation on doing things the right way
five-factor model of personality
- trait models attempt to analyze personality into its basic dimensions
- maintain that personality can be described adequately with the five higher-order traits identified
- agreeableness, conscientiousness (constraint), openness to experience, extraversion (positive emotionality), neuroticism (negative emotionality)
interpersonal circumplex model
- psychological model for conceptualizing, organizing, and assessing interpersonal motives, dispositions, and interactions
- dominance, nurturance, submissiveness, cold-heartedness
