abnormal psych- exam 4

personality

characteristic way a person behaves and thinks across multiple situations

big 5 traits

conscientiousness
agreeableness
neuroticism
openness
extraversion

conscientiousness low score

spontaneous

conscientiousness high score

disciplined

agreeableness low score

oppositional, suspicious

agreeableness high score

empathetic, eager to please

neurotiscism low score

showing calmness in crisis

neurotiscism high score

anxious, moody, easily stressed

openness low score

practical, concrete

openness high score

imaginative

extraversion low score

reserved

extraversion high score

outgoing, enthusiastic

neurological determinant of personality

Phineas Gage

genetic determinant of personality

20-50% heritability

environmental determinant of personality

cogntive and behavioral
attachment theories

personality disorder

personality characteristic that are inflexible and maladpative
causes functional impairment and/or subjective distress

inflexible and maladpative- personality disorders

enduring pattern on behavior
orgininate in childhood

functional impairment- personality disorders

required
crosses areas of life

subjective distress- personality disorders

not required
often family and friends are distressed

personality disorders- DSM 5

an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individuals culture
pattern is manifested in 2+ areas (cognitive, affectivity, interpersonal functioning, impulse control)

prevalence of personality disorders

.5%-2.5% of population

gender differences of personality disorders

men: antisocial PD
women: histrionic and borderline PD

comorbidities of personality disorders

other PD
other psychiatric disorders

PD cluster A

odd or eccentric
paranoid, schizoid, schizotypal

PD cluster B

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

PD cluster C

fearful or anxious
avoidant, dependent, obsessive-compulsive

paranoid personality disorders

A pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent

causes of paranoid personality disorders

possible role of early experiences
cultural factors (prisoners, refugees, people with hearing impairments, older adults)
possible relationship to schizphrenia

treatment for paranoid personality disorder

unlikely to seek on their own
focus on developing trust
cognitive therapy
no empirically-supported treatments (poor improvement rates)

schizoid personality disorder

a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions

neither desires nor enjoys relationships
no unusual thought process like paranoid

causes of schizoid PD

limited research
precursor: childhood shyness
connection with ASD?
lower density of DA receptors
social skills therapy

schizotypal PD

a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as cognitive or perceptual distortions and eccentricities of behavior

ideas of reference, odd beliefs, unusual perceptual experiences, odd behavior

magical thinking

attribution of casual relationships between actions and events which cannot be justified by reason and observation

schizotypal PD causes

schizphrenia phenotype
genetic and environmental

schizotypal PD treatment

multidimensional
social skills training, antipsychotic meds, community treatment
treatment for comorbid depression: 30-50%

antisocial personality disorder

pervasive pattern of disregard and violation of the rights of others and evidence of conduct disorder before age 15

ASPD and legal consequences

80-90% of inmates fulfill criteria for ASPD while only 15-25% score for psychopathy

ASPD video

tommy lynn sells
killer who lost count of how many people he killed

ASPD causes- under arousal hypothesis

patients have abnormally low cortical arousal
seek stimulation to boost arousal
physiological correlates: dec, skin conductance, lower resting HR, more slow-frequency brain-wave activity

ASPD causes- fearlessness hypothesis

higher threshold for experiencing fear
leads to all other major features of aspd

acquired psychopathy

phineas gage
previous to brain injury: most efficient/capable forman
after injury: disrepectful, profanity, impatient, stubborn

aspd treatment

rarely identify themselves as needing treatment
incarceration: prevents further antisocial acts
parent child interaction training

borderline personality disorder

a pervasive pattern of instability of interpersonal relationships, self-image, affect and control over impulses

fear of abandonment
self-destructive behaviors
impulsivity

splitting- BPD

defense mechanism
all or none thinking

BPD video

ever changing and extreme views/reactions
difficulty with relationships

BPD prevalence

most common personality disorder
1-2% of population
15% of psychiatric settings

BPD comorbidities

depression- 20%
suicide- 6%
bipolar- 40%
subtance abuse- 67%
eating disorders- 25% of people with bulimia have BPD

BPD causes

genetic/biological vulnerability (high sensitivity, high reactivity, slow return to baseline)
invalidating social environment- high rate of abuse
chronic emotional dysregulation

treatment for BPD

DBT
structured skills training
prioritize treatment based on behavior severity

treatment for BPD- marsha linehan

psychologist that created DBT

BPD- dialectical behavior therapy

mindfulness, distress tolerance, emotional regulation, interpersonal effectivness
reduces: suicide attempts, dropouts from treatments, hospitalizations

effectiveness of DBT for BPD

1 yr follow up
less suicidal, less angry, better socially adjusted

narcisstic personality disorder

a pervasive pattern of grandiosity, need for admiration, and lack of empathy

causes and treatment of narcissistic personality disorder

deficits in early childhood learning
-lack of empathy and altruism development
-remain self-centered
sociological view
-increased indidvidual focus
comorbid depression
-experience of what the deserve doesnt match with reality
-treatment attempts to replace fantasies with focus on attainable day-to-day pleasures
-focus on others feelongs

histrionic personality disorder

a pervasive pattern of excessive emotionality and attention seeking

causes of histrionic PD

little research
links with ASPD
sex-typed alternative expression

treatment of histrionic PD

problematic interpersonal relationships
-attention seeking
-long-term consequences
-little empirical support

avoidant personality disorder

disorder characterized by social discomfort and avoidance of interpersonal contact

causes of avoidant personality disorder

child or infant with difficult temperament--parental rejection/lack of uncritcal love
report childhood isolation, rejection, conflict

treatment for avoidant personality disorder

well-studied
behavioral interventions focus on anxiety and social skills issues
treatment similar to social phobia
therapeutic alliance is key to success- collaborative connection

dependent personality disorder

pervasive and excessive need to be taken care of
leads to submissve and clinging behavior and fears of seperation

causes of dependent PD

little research
early experience (death of a parent, rejection, attachment, genetics)

treatment for dependent PD

limited empirical support
caution: dependence on therapist
gradual increases in independence, personal responsibility, confidence

obsessive-compulsive personality disorder

pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersoanl control, at the expense of flexibility, openness, and efficiency

causes of obsessive compulsive personality disorder

limited research
weak genetic contributions

treatment for obsessive compulsive personality disorder

similar to OCD
address fears related to need for orderliness
limited efficacy data

old age

65+
12% of population (36 mill)

old age by 2030

20% of population

old age gender ratio

women: men
3:2

jeanne calment

122 yrs old- longest confirmed living lifespan
smoked for 96 yrs (2 cigarettes a day)
not a necessarily healthy lifestyle

cognitive changes in normal aging

mild
slower processing speed
novel tasks are more difficult
recalling names are particularly difficult
does not impact everyday functioning

benign senescent forgetfulness

age-related memory decline that is distinct from memory impairment due to known neurological damage or disease

age associated memory impairment

normal part of aging
executive functionng actually declines faster than memory

paradox of aging

well-being increases with age

hartshorne and germine

wexler test results
how cognitive abilities change with age
plenty abilities start decline at age 30
some do increase until 50

socioemotional selectivity theory (carstensen and colleagues)

-motivational theory
-suggests that secondary to understanding of constraints on life longevity, olrder adults alter their strategies for emotional regulation
-older adults focus on and demonstrate a bias towards positively valenced material
-reduced time horizons prompt older adults to prioritize achieving emotional gratification and thus exhibit increased positivity in attention and recall

positivity bias

emotional memory
older adults remember positive images more than younger adults

barrier task

director and matcher
goal is to verbally match tangrams as quickly as possible

normal aging of the brain

aging does not equal dementia
increased age is primary risk factor for dementia
every 10 years prevalence of dementia doubles
normal aging is associated with variable degrees of cognitive weakness, cortical atrophy, accumulation of alzheimer-type pathology, and reduced cerebral blood flow

cognitive reserve

individuals with higher _____ make more efficient use of the brains resources in the presence of pathology
use/challenge of the brain can lead to higher resilience toward aging

mild cogniyive impairment

older adult with weakness in one cognitive domain
subjective and objective memory problems, but otherwise intact cognition and ADLs
progresses to dementia at a rate of 15-20% per year

amnesic MCI

transitional stage of cognitive impairment preceding alzheimers dementia

dementia

acquired impairments in mulitple aspects of cognition
severe enough to impair normal activties
not a specific disease
consequences of several diseases

warning signs of dementia

memory loss that affects normal activties
excessive word finding problems
difficulty performing familiar tasks
disorientatiom to time or place
changes in mood, behavior, personality
poor judgement and decision making

common causes of dementia

alzheimers disease
vascular disease
parkinsons disease
picks disease
medication side effects
depression
alcohol/drugs
brain tumors
hydrocephalus

young onset dementia

Alzheimer's
vascular disease
frontotemporal dementia
alcohol-related dementia
dementia with Lewy bodies
Huntington's disease

late onset dementia

alzheimers diease
vascular disease
other

alzheimers disease

age-related, irreversible brain disorder that develops gradually and results in memory loss, decline in thinking ability and changes in behavior and personality
these deficits and changes are due to the breakdown and dealth of brain cells

neurofibrillary tangles

twisted protein fibers (tau) found within cells
causes abnormal neuronal functioning
leaves behind a "tombstone" cell

neuritic (senile) plaques

deposits of beta-amyloid protein that form in spaces between cells
interfere with communication between cells
causes neurons to breakdown and die

treating alzheimers (or any other dementia)

slow decline but do not stop the degeneration of the brain
no treatment has been proven to arrest, reverse, or prevent AD

declarative long-term memory

memory for facts and events
medial temporal lobe
diencephalon

anterograde declarative long-term memory

learning and memory formation of new material

retrograde declarative long-term memory

recall of previously acquired memories

procedural long-term memory

memory for a behavioral response
not conscious recall
learned through repeated exposure or practice
preserved in amnesia and AD
based on different brain structures than declarative memory
striatum, cerebellum, motor cortex

alzheimers patient video

socially graced (conversation) and knows her husband
could not remember that she talked to the doctor earlier, her last name, her birthday, doesnt remember words he gave, poor word finding (confrontational)

bi-temporal-parietal hypometabolism

bilaterally (r and l hemisphere) there is low metabolism in both temporal and parietal
*key feature of AD on PET scan*

inducing a mood in patients with severe anterograde amnesia

each mood induction elicited appropriate modd for over 15 min
in patients with severe amnesia the mood endured beyond their ability to recall the induction

prevalence of intellectual disability

1% both in US and worldwide

intellectual disability

significanly subaverage general intellectual functioning existing corrently with deficits in adapative behavior and manifested during the developmental period