Week 3

Question 1

What is schizophrenia?

Answer 1

Umbrella term for a number of disorders involving some loss of contact with reality, typically including delusions and hallucinations.

Basic functions of the mind; Perceptions, thoughts, feelings and behaviour

Schizophrenia represents a disruptions between these mental functions

Lifetime prevalence: ~4 per 1,000

But not everyone who experiences delusions and/or hallucinations has schizophrenia

Question 2

What’re the symptoms of hallucinations?

Answer 2

Perceptions in the absence of sensory stimulation

•Auditory hallucinations
~ Voices commenting
~ Voices conversing
•Somatic/tactile hallucinations 
•Olfactory Hallucinations
•Visual Hallucinations

It’s like actually hearing voices, not not imagining them.

Question 3

What’re symptoms of delusions

Answer 3

Strange beliefs that are maintained despite evidence to the contrary

• Persecutory delusions
• Grandiose delusions
• Religious delusions
• Somatic delusions
• Delusions of reference
• Delusions of being controlled
• Delusions of mind reading
• Thought broadcasting
• Thought insertion
• Thought withdrawal

Delusions may be well-formed and held with unyielding conviction or fragmentary and weakly held

Question 4

What’re thought disorder symptoms?

Answer 4

Tendency of thought to move along associative lines, rather than being controlled, logical or purposeful
Some examples:
-Derailment - ideas slip off track onto obliquely related areas
-Circumstantiality - speech stays on track but very delayed in reaching goal
- Distractible speech - speech changed mid-sentence in response to a stimulus
-Clang associations - sounds rather than meaning govern word choice

Question 5

What are negative symptoms?

Answer 5

Symptoms that reflect a reduction or disappearance of abilities, emotions or drives that are usually present

Some examples:

• ‘Blunting’ - unchanging expression
• Alogia - Poverty of speech, increased latency of response
• Avolition - poor hygiene, low motivation
• Anhedonia - loss of enjoyment / interest

Question 6

When does schizophrenia usually begin?

Answer 6

Typically begins in early adulthood (males = 18 years old females 25 years old)

Question 7

What is the lifetime course of schizophrenia?

Answer 7

The lifetime course of schizophrenia varies greatly – some have a few episodes then recover, for others it occurs for entire adult life.

Question 8

What is the dopamine hypothesis, as a theory of schizophrenia?

Answer 8

Dopamine is a neurotransmitter - a chemical that occurs in the brain and is involved in transmitting messages by moving from one neuron (brain cell) to another. Appears to influence thought, emotions, motivation and behaviour.

A drug that reduces dopamine (Chlopromazine) was found to reduce some symptoms. So is schizophrenia caused by too much dopamine?

Not that simple – when chlorpromazine was used, only positive symptoms were reduced. Negative symptoms were made worse.

Dopamine imbalance? do some pathways have too much dopamine and others not enough?
Or is it something about the way the neurons ‘collect’ dopamine?

Question 9

What is the diathesis stress model as a theory of the development of schizophrenia?

Answer 9

Suggests that people with an underlying biological vulnerability may develop schizophrenia either directly or as a result of experiencing additional stressors

Question 10

Normal verses “disordered” variations in personality

Answer 10

• Culturally determined expectations of “normal” E.g. Introversion vs. extraversion
• Need to consider context of behaviour
Is it consistent, or only in some contexts?
• Need to observe longitudinally, not cross-sectionally
• Issues with self-report
Social desirability bias, lack of insight
Difficulties defining “disordered” personality traits means low reliability in diagnosis

Question 11

Personality disorders should only be diagnosed if:

Answer 11

• Personality traits first appear by adolescence
• Traits are inflexible, stable, and expressed in a wide variety of situations (although more pronounced when under stress)
• Traits lead to distress or impairment for individual/others
• Rarely diagnosed before age 18 years
Show substantial comorbidity with other disorders such as anxiety, depression, etc.

Question 12

10 types of Personality Disorder listed in the DSM, grouped into three “clusters” based on broad symptom types

Answer 12

1. Cluster A - Odd, eccentric cluster: most common disorder is paranoid personality disorder
2. Cluster B - Dramatic, emotional, erratic cluster: most common disorder is borderline personality disorder
3. Cluster C - Anxious, fearful cluster: most common disorder is dependent personality disorder

Question 13

What’re some current issues in personality disorders?

Answer 13

High levels of comorbidity: There is some debate regarding the distinction between some disorders – often a high level of co-morbidity (presence of 2 or more PDs)

Frequency of unspecified diagnosis: Often several criteria are met for a number of PDs, but the person doesn’t meet sufficient number of criteria for one PD (eg 3 symptoms of borderline, 3 paranoid personality disorder)

Question 14

What is cluster A: paranoid personality disorder?

Answer 14

Pervasive distrust and suspiciousness of others. Assume others’ intentions are malevolent. Requires at least 4 of the following:
• Unfounded suspicion of others – assumes others intend to deceive, harm or exploit
• Preoccupied with doubts about loyalty or trustworthiness of friends/family
• Unwilling to confide in others
• Interprets positive or neutral remarks as being offensive or
threatening
• Constantly bears grudges
• Perceives personal attacks where others do not, and is excessively defensive/aggressive in response
• Constant unjustified suspicions that partner is unfaithful

Question 15

What is the prevalence of cluster A: paranoid personality disorder?

Answer 15

Prevalence: 0.5 – 2.5% of general population; 10-30% of inpatients; 2-10% outpatients

• Increased prevalence if have relatives with schizophrenia or delusional disorders
• No sex differences in prevalence

Question 16

What are the behaviours of cluster A: paranoid personality disorders?

Answer 16

• Expect to be ignored in times of needs (leads to confusion and increased suspicion)
• Any deviation from expectations seen as proof of mistrust
• Reactions to real slights are out of proportion
• Reluctant to confide/Refuse to provide personal information
• Jokes don’t go down well
• Honest mistakes overblown e.g. Being short-changed
• React with anger to perceived insults
• Pathologically jealous – e.g. Interrogate partner
• Compliments misinterpreted as criticisms eg - well done = do better
20

Question 17

Cluster B - Borderline Personality Disorder people have Long term instability of relationships, self-image and mood. Requires presence of at least 5 of the following:

Answer 17

• Frantic efforts to avoid abandonment (real or imaginary)
• Unstable, intense relationships that swing between
idolising and devaluing the other person
• Unstable sense of self
• Impulsive in at least two areas (eg spending, sex,
substance use, binge eating)
• Recurrent self harm and/or suicidal behaviour
• Emotionally volatile – extreme mood swings and find it difficult to regulate emotions, particularly anger, sadness, fear.
• Chronic feelings of emptiness
• Anger problems (inappropriate anger, inability to control
anger)
• Short term paranoid thoughts and/or severe dissociative
symptoms

Question 18

General factors about cluster B: borderline personality disorders

Answer 18

• 2% general population
• Mostly diagnosed in females
• High co-morbidity with mood disorders and substance disorders
• Thought to often be associated with childhood abuse and/or trauma
• Tendency to improve in midlife

Question 19

Cluster B - Antisocial Personality Disorder

Long-term disregard for, and violation of, the rights of others, with at least 3 of the following:

Answer 19

• Failure to conform to social norms, demonstrated by recurrent engagement in illegal activities
• Repeated lying
• Impulsivity/inability to plan
• Irritability and aggressiveness
• Disregard for own or others safety
• Consistent irresponsibility, eg incapacity to sustain a job, failure to honour financial obligations
• Lack of remorse – indifference to or rationalising inappropriate behaviour

Question 20

Prevalence traits of cluster B: antisocial personality traits

Answer 20

Prevalence: estimates vary from .2 – 3.3% of general population Most common in males
Can diminish in later adulthood

Note: Psychopathic/sociopathic personality is similar, but not identical. The key distinction is that for ASPD to be diagnosed there needs to be a long record of illegal behaviour.

Question 21

Cluster B: antisocial personality disorders - psychopathic traits

Answer 21

lack of guilt/remorse, disregard for others feelings, manipulative. But this is often covered by a veneer of charming and personable behaviour.

Note: Antisocial Personality Disorder ≠ Serial Killer!

Question 22

Cluster C - Dependent Personality Disorder

Constant and extreme need to be taken care of, that leads to submissive/clingy behaviour and fear of separation. Requires five or more of following:

Answer 22

• Difficulty making everyday decisions without advice or reassurance
• Wants others to assume responsibility for major life choices
• Fears disagreeing with others even when chance of anger/retribution minimal
• Lacks confidence to initiate activities
• Takes extreme steps to get support/approval from others (eg volunteer for unpleasant tasks)
• Feels uncomfortable when alone because scared they will need to look after themselves
• Frantically seeks new relationships when one ends
• Preoccupied with fears of being left to look after themselves

Question 23

Prevalence rate of cluster C: dependent personality disorder

Answer 23

• Prevalence: 0.4 - 0.6% of population

•More frequent in females, although also evident in males–
socialisation?

• Most frequently reported Personality Disorder in clinical settings
• Need to consider developmental appropriateness of diagnosis – children are dependent on caregivers, but this is not a PD

Question 24

Dissociative disorders

Answer 24

Dissociative disorders involve disruptions in:
• Consciousness
• Memory
• Identity
• Perception
Which can disrupt awareness and/or sense of self.

Derealisation: The feeling your surroundings are not real, or that familiar places are new/unknown

Depersonalisation: The feeling you are not real, living in a dream or movie, or are watching yourself from the outside.

Relatively common experience (more that 50% of general population), but disorder itself not common

Question 25

What is depersonalisation disorder?

Answer 25

Depersonalisation Disorder: recurrent experience derealisation and/or depersonalisation, often associated with panic attacks

• May feel detached from self, emotions, thoughts, or specific parts of the body
• May feel robotic or as if lacking control
• May be impairment to sensation or sense of time
• To be diagnosed, the person must be experiencing clinically significant distress and or impairment in daily functioning

Question 26

What is dissociative amnesia?

Answer 26

Dissociative Amnesia: the forgetting of personal information, particularly surrounding a stressful event

Some criticism of this diagnosis:
• Intentional forgetting vs amnesia
• We have gaps in memory normally
• Little empirical support – many cases better attributed to organic brain damage, suppression of thoughts etc.

Question 27

What is dissociative fugue?

Answer 27

Dissociative Fugue: combination of forgetting personal life, and actively removing oneself from the setting (eg move to a new town). Can last from hours to years.

Need to rule out organic damage/other cause
Escape to avoid unpleasant situation vs genuine amnesia.

Question 28

What is dissociative identity disorder (DID)?

Answer 28

Formerly Multiple Personality Disorder: Experiencing two or more discrete identity/personality states, which alternate in control of behaviour.

Typically there is a primary ‘host’ personality and one or more ‘alters’ that are often extremely different to the ‘host’ in traits and behaviours.

Often portrayed as having no shared memory or awareness, however this has been questioned.

Evidence of physiological changes (EEG variation, voice patterns, handedness)

Question 29

THere are two explanations for Dissociative identity disorder, one being post traumatic model: describe it.

Answer 29

1. Posttraumatic Model: suggests that an early trauma such as abuse has lead the person to develop multiple personalities to cope with stress (eg mistreatment happens to ‘someone else’)

Question 30

There are two explanations for Dissociative identity disorder, one being the sociocognitive model: describe it.

Answer 30

2. Sociocognitive Model: Questions the validity of having numerous personalities, suggests DID develops as a result of psychotherapeutic techniques. This is evidenced by the findings that:

• Most DID cases show few, if any, signs prior to therapy, with number of identities increasing with length of time in therapy
• Therapy often reinforces the idea that there are multiple personalities
• A small number of therapists are responsible for the majority of diagnoses

Question 31

Controversies about dissociative identity disorders?

Answer 31

• DID cases in 1970 = 79
• 1973 & 1976– release of best seller
book then movie – ‘Sybil’
• DID cases in 1986 6000+, and now in tens of thousands

So, is DID influenced by social and cultural factors?

NOTE: social impact ≠ ‘faking’. There is clearly high levels of distress and impairment that has resulted in changes to cognitions and behaviour, that require care and treatment.