WEEK 3 - Clinical disorders 3 & 4

Question 1

What is schizophrenia?

Answer 1

• Umbrella term for a number of disorders
• Includes some loos of contact with reality
• Involves delusions and hallucinations
• Disruptions in perception, thoughts, feelings and behaviour

Question 2

What is the lifetime prevalence of schizophrenia?

Answer 2

4 per 1000 (Saha et. al, 2005)

Question 3

Not everyone who experiences _______ and/or ________ has schizophrenia.

Answer 3

1. Delusions

2. Hallucinations

Question 4

What is included in the hallucination symptoms of schizophrenia?

Answer 4

Perceptions in the absence of sensory stimulation

Question 5

What are the different types of hallucinations that can be experienced with schizophrenia?

Answer 5

• Auditory
• Commenting
• Conversing
• Somatic/tactile
• Olfactory
• Visual

Question 6

What is included in the delusional symptoms of schizophrenia?

Answer 6

Strange beliefs that are maintained despite evidence to the contrary

Question 7

What are the types of delusions that someone with schizophrenia may have?

Answer 7

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

Question 8

What may classify a thought disorder?

Answer 8

Tendency of thought to move along associative lines, rather than being controlled, logical or purposeful

Question 9

What are some symptoms of a thought disorder?

Answer 9

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 10

What are negative symptoms?

Answer 10

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

Question 11

What are some examples of negative symptoms in relation to schizophrenia?

Answer 11

Blunting: unchanging expression

Alogia: poverty of speech, increased latency of response

Avolition: poor hygiene, low motivation

Anhedonia: loss of enjoyment/interest

Question 12

How does schizophrenia effect people throughout the course of their lives?

Answer 12

• Typically begins in early adulthood
• males = 18
• females - 25
• The lifetime course of schizophrenia varies greatly - some have a few episodes and recovers, for others it occurs their entire adult life.

Question 13

What is the dopamine hypothesis in relation to the development of schizophrenia?

Answer 13

• A drug that reduces dopamine (Chlopromazine) was found to reduce some symptoms.
• When chloprozamine was used, only positive symptoms were reduced. Negative symptoms were worse

Question 14

What is the diathesis-stress model of schizophrenia development?

Answer 14

• People who are biologically vulnerable may develop schizophrenia either directly or as a result of experiencing additional stressors

Question 15

What are personality disorders?

Answer 15

Normal vs disordered variations in personality

Question 16

What needs to be considered when diagnosing personality disorders?

Answer 16

• Culturally determined expectations of normal
• Introversion v extraversion
• Consider context of behaviour eg. is it consistent or only in some contexts?
• Observe longitudinally, not cross-sectionally
• Issues with self-report
  eg. social desirability bias/lack of insight

Difficulty defining disordered personality traits means low reliability in diagnosis

Question 17

When should personality disorders be diagnosed?

Answer 17

• Personality traits first appear by adolescence
• Traits are inflexible, stable and expressed in a wide variety of situations
• Traits lead to distress or impairment for themselves/others
• Rarely diagnosed before age 18

Question 18

How many personality disorders are listed in the DSM-5

Answer 18

10, grouped into 3 ‘clusters’ based on broad symptom types

Question 19

What is cluster A of personality disorders?

Answer 19

‘Odd, eccentric cluster’

Most common disorder is paranoid personality disorder

Question 20

What classifies cluster B of personality disorders?

Answer 20

‘Dramatic, emotional, erratic’

Most common disorder is borderline personality disorder

Question 21

What classifies cluster C of personality disorders?

Answer 21

‘Anxious, fearful cluster’

Most common disorder is dependent personality disorder

Question 22

What are some current issues involved with personality disorders?

Answer 22

• High levels of comorbidity: debate regarding the distinction between some disorders - often high level 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

Question 23

How many symptoms need to be met to be diagnosed with cluster A personality disorders?

Answer 23

4

Question 24

Maggie has an unfounded suspicion of others and assumes everyone intends to deceive, harm or exploit her. She constantly bears grudges, has unjustified suspicions that her partner is unfaithful, and she is unwilling to confide in others. What cluster of personality disorders may she be diagnosed with?

Answer 24

Cluster A.

Question 25

Debbie is preoccupied with doubts about loyalty or trustworthiness of friends/family. She constantly interprets positive or neutral remarks as being offensive or threatening, she perceives personal attacks where others do not and is excessively defensive and aggressive in response. What cluster of personality disorders may she be diagnosed with?

Answer 25

Cluster A -Paranoid personality disorder

Question 26

What is the prevalence of cluster A personality disorders?

Answer 26

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

• increase prevalence if have relative with schizophrenia or delusional disorders
• No sex differences

Question 27

What are some behaviours involved in Cluster A personality disorders (Paranoid personality disorder)?

Answer 27

• Expect to be ignored in times of need
• Jokes do not go down well
• Pathologically jealous
• Reluctant to confide/refuse to provide personal information

Question 28

How many symptoms need to be identified in order for someone to be diagnosed with cluster B personality disorders?

Answer 28

5

Question 29

Jenny goes to frantic efforts to avoid abandonment, she constantly has unstable and intense relationships that swing from idolising someone, to devaluing them. She is impulsive in at leat 2 areas and constantly self harms/participates in suicidal behaviour. What cluster of personality disorders may she be diagnosed with?

Answer 29

Cluster B- Borderline personality disorder

Question 30

What is borderline personality disorder?

Answer 30

Cluster B - Long term instability of relationships, self image and mood

Question 31

What is paranoid personality disorder?

Answer 31

Cluster A - Pervasive distrust and suspiciousness of others. Assume others’ intentions are malevolent.

Question 32

Mark has an unstable sense of self, he is emotionally volatile with extreme mood swings and he cannot regulate emotions. He has chronic feelings of emptiness and anger problems. He also had short term paranoid thoughts and/or severe dissociative symptoms. What would you diagnose him with?

Answer 32

Cluster B - Borderline personality disorder

Question 33

What are some characteristics of Cluster B - borderline personality disorder?

Answer 33

• Mostly diagnosed in females
• High comorbidity with mood disorders and substance disorders
• Thought to be associated with childhood trauma
• Tendency to improve midlife

Question 34

What is the prevalence of borderline personality disorder in the general population?

Answer 34

2%

Question 35

What is antisocial personality disorder?

Answer 35

Long-term disregard and violation of the rights of others.

Question 36

How many symptoms need to be identified for cluster B - anti social personality disorder?

Answer 36

3