PSYCH257 TEST 3

Personality

characteristic set of behaviours, cognition, emotional patterns, debatably consistent

General Criteria for a PD

societal deviance in 2+: cognition, interpersonal functioning, affectivity, impulse control

inflexible and pervasive pattern across multiple situations

clinically significant impairment/distress

stable and long-term w onset traced to childhood

Common Features of PDs

little insight and ego syntonic, interpersonal problems, initially difficult to diagnose and difficult to treat (from lack of insight)

Cluster A disorders

odd/eccentric; paranoid, schizoid, schizotypal

Cluster B

dramatic/emotional/erratic; histrionic, narcissistic, antisocial, borderline

Cluster C

fearful/anxious; avoidant, dependent, obsessive-compulsive

Paranoid PD

pervasive distrust and suspicion towards others and their intentions (believe intent to harm/threaten)

Schizoid PD

little interest/ability to form relationships w restricted range of emotions

Schizotypal PD

discomfort and reduced capacity for close relationships; cognitive/perceptual distortions, odd beliefs, ideas of reference, suspiciousness, magical thinking, illusions, odd behaviour/dress

Causes of Schizotypal

Genetic/precursor to schizophrenia (lesser degree/impairment), differences in left hemi (memory/learning), generalized brain deficits

Schizotypal Treatment

antipsychotics, SSRIs, social skills development, treat comorbid MDD

Histrionic PD

attn-seeking, dramatic/provocative behaviour, exaggerated emotions, discomfort when not centre of attention

Antisocial PD

disregard/violation of rights of others, deceitful/aggressive/manipulative behaviours, often involved in crime

Borderline PD

emotional dysregulation; mood swings, intense anger, paranoia, fear of abandonment/rejection sensitive, emptiness feeling

impulsive/risky; self-harm/suicide

cognition; dissociation, idealization/devaluation of others, poor self-image/lack of identity

Splitting

BPD term; all or nothing thinking

BPD Causes

predisposition to anxiety, sensitivity, reactivity, pervasive history of invalidating responses, heightened emotional arousal, inaccurate expression, invalidating responses from parents/others

75% of BPD cases are women. Why are men more commonly DXed w APD?

differences in socialization (internalized vs externalized emotional expression) and clinician bias (gender minorities more likely to be DXed with BPD)

How are BPD and C-PTSD linked?

overlapping symptoms (some better recognized as C-PTSD), early trauma relates to development of BPD

BPD Treatments

SSRIs, mood stabilizers, crisis intervention, trauma processing, attachment-based therapy, DBT; emotional regulation, distress tolerance, balanced thinking, interpersonal effectiveness

Narcissistic PD

grandiose view of themselves, crave attention/admiration, lack empathy, arrogant/exploitative/entitled

NPD Causes

rejection, neglectful parents/lack of guidance, low self-esteem, high extraversion/low agreeableness, western individualistic thinking/competitive institutions

NPD Treatment

psychodynamics targeting unconscious conflicts/vulnerabilities/low-self esteem; develop realistic sense of self through CBT

NPD barriers to help-seeking

lack of insight, no motivation to seek treatment

Avoidant PD

social inhibition, feelingso f inadequacy, hypersensitive to negative evaluation

Dependent PD

submissive.clinging behaviour, fears of separation, need to be taken care of as an adult

Obsessive-Compulsive PD

rigid fixations on order, highly controlling, perfectionism, doing things the right way

OCPD Causes

perfectionist, preference for structure/order; genetic links to anxiety and need for control, attachment issues from unstable upbringing

OCPD Treatment

relaxation techniques for anxiety, exposure to spontaneity, develop theory of mind, encourage big picture thinking

PDs Dimensional Model

view personality traits as continuum, allows personalized understanding of a client and offers tailored treatment focusing on specific areas

ADHD

6+ symptoms/5+ if 17+, inattn and/or hyperactivity-impulsivity that’s maladaptive/inconsistent w developmental level, lasts 6+ months prior to 12 y.o, presents in 2+ settings w/ evidence of interference w developmentally appropriate functioning

ADHD inattention symptoms

lacks attn to detail, difficulty sustaining attn in tasks, doesn’t seem to listen, doesn’t follow through/finish tasks, difficulty w organization, avoids/dislikes tasks that require sustained mental effort, loses items, easily distracted by extraneous stimuli, often forgetful in daily activities

ADHD Hyperactivity-Impulsivity symptoms

fidgets/squirms, leaves seat in expected situations, runs/climbs in inappropriate scenarios, difficulty playing quietly, acts as if driven by a motor, talks excessively, difficulty waiting for turn, blurts out answers before q is finished, interrupts others

3 subtypes of ADHD

hyperactive/impulsive (children), inattentive (teens/adults), combined (hyperactive child turned inattentive adult)

When was ADHD first added to the DSM?

1980: ADD in DSM-3, later revised to ADHD in DSM-3-R in 1987

Before being seen as deficits in attention, impulse control and hyperactivity, what was the term used to describe ADHD in the 1950s and its primary symptom?

Hyperkinetic Impulse disorder; motor overactivity

What was one of the earliest accounts of ADHD in the form of a nursery rhyme?

Fidgety Phil, 1845

ADHD Associated Presentations

learning disorders/academic underachievement; executive dysfunction, difficulties applying intelligence/academic delays; high/low self-esteem, speech and language impairments

What executive function tasks are inhibited by ADHD?

organization, prioritization, understanding directions; focus/shift/sustaining attn; alertness, effort and processing speed regulation; emotional/action regulation; memory/recall

Physical deficits of ADHD

sleep disturbances and injuries; accident-prone, risky behaviours

Social concerns of ADHD

peer rejection/less accepting, familial issues

ADHD prevalence

2-10% in school-age children, 1-6% in adulthood; 2:1 ratio males/females, most common referral problem in NA and half of ADHDers have comorbid disorders

Causes of ADHD

70-90% heritability, pregnancy complications/prenatal exposure to alcohol/tobacco, dopamine transmission issues (DAT, DRD4), abnormal frontal lobe/basal ganglia/corpus callosum/cerebellum

ADHD Biological Treatment

Dextroamphetamine (dexedrine, adderall, vyvanse), methylphenidate (Ritalin, Concerta), nonstimulants (strattera), antidepressants (Wellbutrin), blood pressure meds (clonidine, guanfacine)

Parent Management Training (ADHD)

provides parents the tools to raise an ADHD child, focus in behaviour redirection via goal-setting and modification of physical enviro w structured routine implementation

ADHD psychological treatments

educational intervention, tailored treatment combo, counseling/support groups, avoiding controversial/misinformed ‘treatments’ (supplements/dieting fads)

Autism Spectrum Disorder

severely impaired socialization and communication (pragmatic language); restricted, repetitive patterns of behaviour; present in early childhood w lifelong daily dysfunction

According to the DSM-5 there are ___ levels of severity of ASD, which describe how much support is needed

3

examples of ASD socialization impairments

failure to develop age-appropriate social relationships/comms/social reciprocity; lack of joint attn; less interest in social relationships; deficits in nonverbal comms; lack of prosody

ASD examples of restricted/repetitive behaviours

special interests/hyperfixations, ritualistic behaviours that are complex and create sense of stability; intense distress if rituals are interrupted

ASD other clinical descriptors

savant skills in 1/3 of ASD ppl, echolalia/stimming, sensory issues leading to overstimulation (hard to tune out background info)

ASD is a spectrum which focuses on the individuals abilities/deficits in:

social differences; interests; repetitions; sensory issues; emotional regulation; perception; executive functioning

Despite the increased awareness of ASD among professionals, it’s still being DXed more in ___ than ___ in Canada (4.5:1)

boys, girls

about ___% of ppl w ASD have intellectual disabilities/IQ <70

31%

ASD ppl with better language skills usually have a better ___ since they can communicate and find support easier

prognosis

ASD biological causes

moderate heritability, usually have older parents; hyperconnectivity in sensory and motor regions w underconnectivity in comms and executive function areas, less neurons in anygdala; oxytocin deficits

Autism was previously viewed as a resulting of ________ because of their cold and aloof nature.

bad parenting

ASD Psychosocial Treatments

behavioural intervention w focus on comms, socialization and independent living; creating ASD-friendly enviros; school/community integration w parental support

There’s no biological treatments for Autism but Risperidone and Aripiprazole (anti-psychotics) are approved to treat ___

irritability

Substance-Use Disorder

2+ symptoms within 1 yr; substance taken in large amount’over long period, desire to cut down use w no success, strong cravings, social/occupational impairments, many activities given up bc of use, recurrent use in physically hazardous situations, high tolerance, experience withdrawal

use vs intoxication (SUD)

occasional ingestion vs effects on CNS leading to psychological/behavioural changes

abuse vs dependence (SUD)

interferes w life vs the psychological and physiological effects (withdrawal, tolerance, drug-seeking)

tolerance (SUD)

amount of substance needed to get high, changes over time

withdrawal (SUD)

substance-specific syndrome from cessation/reduction of prolonged use, causes distress/impairment in important functioning areas

__ is the most addictive substance behind meth, crack, alcohol, etc.

Niccotine

SUD Criteria Specifiers

Mild (2-3 symptoms), moderate (4-5), severe (6+)

SUD prognosis specifiers

in early remission (no symptoms 2-12 mo), in sustained remission (1+ yr), in controlled enviro

SUD canadian prevalence

22% met criteria for SUD, most common is alcohol-related, 7% have weed dependence, 10-15% have nicotine-use disorder

behavioural vs substance use disorders

substance use gives intoxication, physiological withdrawal and medical treatment, behavioural doesn’t

how addictive substances affect brain

floods dopamine, adjusts by reducing dopamine production/receptor sensitivity (must increase dose and frequency), withdrawal causes dopamine drop, anxiety, craving and physical discomfort

genetic causes for alcohol-use disorder

alcoholic parents, better alcohol metabolism, impulse control (ADHD)

psychological causes SUD

observation/normalization in family, social reinforcement, opponent-process theory (compromise btwn high and crash to make the high worth the crash)

cultural causes of SUDs

party culture (uni), normalization of alcohol use

Environmental causes SUD

self medication for stress and trauma, poverty/unemployment, lack of access to healthcare and easy access to substances

SUD biological treatment

agonist substitute (same chemicals different drug), antagonistic (block positive effects), aversive (make substance unpleasant)

psychosocial treatment SUD

harm reduction, abstinence, inpatient/outpatient care, support programs (contingency and relapse prevention), solo/group/aversion therapy, motivational interviewing

social treatments SUD

accessible healthcare/prescriptions, social inclusion and recreation for vulnerable populations

main difference btwn psychotic disorders

length of time and variation in symptoms

Schizophrenia

2+ Symptoms present for 1 mo, delusions/hallucinations/disorganized speech, catatonic/disorganized behaviour, negative symptoms

schizophrenia - positive symptoms

delusions and/or hallucinations

schizophrenia - negative symptoms

absence/insufficiency of avolition (initiation/persistance of basic activities), alogia (speech), anhedonia (pleasure), affect (flattening), asociality

schizophrenia - disorganized symptoms

erratic speech/motor/emotions, situationally inappropriate affect, unusual action/dress, catatonia/waxy flexibility, disorganized speech

types of delusions

bizarre (of guilt/sin, of reference, of being controlled), non-bizarre (somatic, persecutory, grandiose)

types of hallucinations

auditory/visual (most common), tactile, somatic, olfactory

schizophrenia biological causes

inherit psychosis, increased risk from close relatives/identical twins, maternal flu in 2nd trimester 3x risk, immune system activation/neuroinflammation affect fetal brain

schizophrenia psychosocial causes

stress, family interactions, social drift (urban areas, low income/sociogenic theory, poverty and lack of access/social-selection theory), substance use (weed 2+x risk, men 6x more likely to develop schizophrenia)

schizophrenia biological treatment

antipsychotics (increased negative symps, tardive dyskinesia, tms (frontal lobe = negative symps, temporal = hallucinations)

schizophrenia psychosocial treatment

early intervention (coping skills, stress management, med compliance, psychoeducation), social skills training, community care/vocational programs, CBT (reality testing, behaviour activate, recognize triggers)

schizophrenia prognosis

50-80% will have another ep after 1st, 38% recovery/reduced symptoms = early intervention/social support, lifespan shortened by 10 yrs (substance use, unemployment, lack of healthcare/housing, isolation)