psych exam 2

what are some severe medical problems from bulimia nervosa

erosion of dental enamel, electrolyte imbalance, kidney failure, cardiac arrhythmia, seizures, intestinal problems, permanent colon damage

Stice's Dual-Pathway model of bulimic pathology

cultural differences used to serve as protective factors

equivalent rates across ethnic groups in US, LGBTQ+ higher rates of ED, food insecurity higher rates of bingeing

who is Emil Kraepelin

coined the term dementia praecox, focused on subtypes of schizophrenia, recognized it as a disease of the brain, recognized that several distinct symptoms appeared to be part of a broader syndrome, differentiated "dementia praecox" from manic-depressive illness

who is Eugen Bleuler

introduced the term schizophrenia, "splitting of the mind"; inability to keep a consistent train of thought, described "positive" and "negative" symptoms (negative symptoms cause more distress)

delusions

distortion in thought content, erroneous beliefs that usually involve a misinterpretation of perception or experiences.

what is persecutory delusions

most common; "the FBI is after me"

what is referential delusions

"when madonna waved to the audience, she was really singing to me"

what is erotomaniac delusions

"madonna is in love with me"

what is somatic delusions

my liver is dead and rotting inside me

what is nihilistic delsuions

the world is ending

what is grandiose delusions

I am president of the entire world

what are "bizarre" delusions

thought insertion, thought withdrawal, outside forces are controlling one's body or actions

what are hallucinations

experience of sensory events without environmental input; can experience in any sensory mode

what is the most common type of hallucination

auditory, usually in the form of "voices" familiar or not, that are heard as being distinct from own thoughts

what are the finding from imaging studies for hallucinations

subtle structural damage in parts of brain associated with auditory processing, thinner cortex

what does fMRI show

activation of auditory regions during auditory hallucinations

what are the disorganized symptoms of schizophrenia

include severe and excess disruptions; speech, behavior and emotion

schizophreniform disorder

schizophrenic symptoms for a few months (less than 6; more than 1); impaired functioning not required; some never progress on to schizophrenia but more do (or schizoaffective disorder)

schizoaffective disorder

symptoms of schizophrenia and mood disorder (unlike a mood disorder with psychotic features); prognosis is similar for people with schizophrenia; such persons do not tend to get better on their own

what is bipolar type schizoaffective disorder

if mania is part of the presentation

what is a depressive type schizoaffective disorder

if only major depressive episodes are part of the presentation

what is delusional disorder

presence of one or more delusions that persist for 1 month or more; lack other positive or negative symptoms; rare (0.2%), better prognosis than schizophrenia

what are the types of delusional disorder

erotomaniac ( someone else is in love with person), grandiose, jealous (spouse or partner is unfaithful), persecutory, somatic (involved bodily functions or sensations), bizarre content ( clearly implausible, not understandable)

brief psychotic disorder

one ore more positive symptoms of schizophrenia (delusions, hallucinations, disorganized behavior/speech, lasts at least 1 day but not longer than 1 month), not due to substance use, usually precipitated by extreme stress or trauma, tends to remit on its own

schizotypal personality disorder

may reflect a less severe form of schizophrenia

process vs reactive distinction

process - insidious onset, biologically based, negative symptoms, poor prognosis
reactive - acute onset (extreme stress), notable behavioral activity, best prognosis

good vs poor premorbid functioning in schizophrenia

focus on functioning prior to developing schizophrenia, no longer widely used

type 1 vs type 2 distinction

Type 1 - positive symptoms, good response to medication, optimistic prognosis, and absence of intellectual impairment
type 2 - negative symptoms, poor response to medication, pessimistic prognosis, and intellectual impairments

paranoid subtype of schizophrenia

presence of prominent hallucinations and delusions (usually persecution or grandeur) but have relatively intact cognitive skills and affect; organized around coherent theme; do not show disorganized behavior, later onset, the best prognosis of all types of schizophrenia

disorganized subtype of schizophrenia

marked disruption in speech and behavior (flat or inappropriate affect, hallucination and delusions, if present, tend to be fragmented, develops early, tends to be chronic, associated with a continuous course without remissions)

catatonic subtype of schizophrenia

show unusual motor response and off mannerisms (immobility, excessive motor activity, motor negativism, waxy flexibility), tends to be severe and quite rare

what is echolalia

mimic or repeat words

what is echopraxia

mimic movements

undifferentiated subtype of schizophrenia

wastebasket category, major symptoms of schizophrenia, fail to meet criteria for another type

residual subtype of schizophrenia

past diagnosis of schizophrenia, absence of prominent delusions, hallucinations, disorganized speech and behaviors, continue to display less extreme residual symptoms

family studies for schizophrenia

inherit a tendency for schizophrenia, do not inherit specific forms of schizophrenia (different subtypes and different forms of psychotic disorders), risk increases with genetic relatedness

twin studies for schizophrenia

monozygotic twins - risk for schizophrenia is 48%
fraternal twins - risks drops to 17%
both parents schizophrenia - 46%
on schizophrenic parent - 16%

adoption schizophrenia studies

risk for schizophrenia remains high in cases where a biological parent has schizophrenia, appears to be significant overlap in the genes that contribute to schizophrenia, schizoaffective disorders and manic syndromes

summary of genetic research for schizophrenia

risk of schizophrenia increases with genetic relatedness, risk transmitted independently of diagnosis, strong genetic component does not explain everything, can be a 'carrier" of schizophrenia genes but does not display disorder

structural abnormalities in the brain

brain dysfunction appears before onset of schizophrenia

children and structural and functional abnormalities in the brain with schizophrenia

lower intelligence and achievement scores than healthy siblings as children, abnormalities in social behavior, less socially responsive, show less positive emotion, poorer social adjustment, delays and abnormalities in motor development

adolescents and structural and functional abnormalities in the brain with schizophrenia

subclinical signs of psychosis (unusual ideas and sensory experiences; eccentric behavior - signs of schizotypal personality disorder)

tardive dyskinesia

involuntary movements of the tongue, face, mouth and jaw (tongue sticking out, chewing motions), irreversible

agranulocytosis

severe reduction in white blood cells - caused by Clozaril

cognition for general criteria for all personality disorders

ways of perceiving and interpreting self, other people and events

affectivity for general criteria for all personality disorders

range, intensity, lability, and appropriateness of emotional response

general criteria for all personality disorders

cognition, affectivity, interpersonal functioning, impulse control

which personality disorders did they try to get rid of

paranoid PD, schizoid PD, histrionic PD, dependent PD

paranoid PD

a pattern of distrust and suspiciousness such that others motives are interpreted as malevolent

schizoid PD

a pattern of detachment from social relationships , and a restricted range of emotional expression

schizotypal PD

a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior

what is another name for Cluster A of PD

the weird w

what PD are in cluster A

paranoid, schizoid and schizotypal

what is another name for cluster B

the wild

what PD are in cluster B

antisocial, borderline, histrionic, narcissistic

antisocial PD

a pattern of disregard for, and violation of the rights of others

borderline PD

a pattern of instability in interpersonal relationships, self-image, and affects and marked impulsivity

histrionic PD

a pattern of excessive emotionality and attention seeking

narcissistic PD

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

what is another name for cluster C

the worried

what PD are in cluster C

avoidant, dependent , and OCPD

avoidant PD

a pattern of social inhibition, feelings of inadequacy, and hypersensitive to negative evaluation

dependent PD

a pattern of submissive and clinging behavior related to the excessive need to be taken care of

OCPD

a pattern of preoccupation with orderliness, perfectionism and control

dimensional versus categorical

using a general model of personality is very clearly a dimensional approach - no attempt to delineate normal from "disordered"

comorbidity of PD

# of PD diagnoses patients typically receive varies: 2.4 and 4.6

narcissism and antisocial _____ be comorbid given the string shared component of antagonism

SHOULD

gender differences of PD

gender differences in prevalence rates of PDs should be consistent with gender differences in general personality functioning (men lower in agreeableness: antisocial narcissistic; women higher in neuroticism: borderline, dependent)

coverage of PD

most common PD diagnosis in clinical practice- personality disorder not other specified

identity self impairment

experience oneself as unique, with clear boundaries between self and others; stability of self-esteem and accuracy of self-appraisal; capacity/ability to regulate emotional experience

self-direction self impairment

pursuit of coherent and meaningful short and long term goals; use of constructive and prosocial internal standards of behaviors, ability to self-reflect

empathy interpersonal impairment

comprehension and appreciation of others experiences and motivations; tolerance of different perspectives, understanding the effects of one's own behavior on others

intimacy interpersonal impairment

depth and duration of connection with others, desire and capacity for closeness, mutuality or regard reflected in interpersonal behavior

antisocial PD impairment

geocentricism, goal setting based on personal gratification; lack of concern for others; exploit, deceive, dominant, coerce others

traits of antisocial PD

manipulativeness, callousness, deceitfulness, hostility, risk taking, impulsivity, irresponsibility (6 or 7)

overview and clinical features of paranoid PD

pervasive and unjustified mistrust and suspicion

what are the causes of paranoid PD

biological and psychological contribution are unclear, early learning that the world is a dangerous place, evidence unclear whether it is a variant of psychotic disorder; research suggests "maybe"

treatment options for paranoid PD

few seek professional help on their own, treatment focuses on development of trust, cognitive therapy to counter negativistic thinking, lack good outcome studies

overview and clinical features of schizoid PD

pervasive pattern of detachment from social relationships (not interested in close relationship, little interest in sexual experiences, no close friends, indifferent to praise or criticism), very limited range of emotions in interpersonal situations (takes pleasure in few things, flattened affectivity - appear cold, detached)

causes of schizoid PD

etiology is unclear, preference for social isolation resembles autism, an extreme variant of shyness/introversion?

treatment options for schizoid PD

few seek professional help on their own, focuses on the value of interpersonal relationships, building empathy and social skills, lack good outcome studies

overview and clinical features of schizotypal PD

odd and unusual behavior, appearance and cognition, most are socially isolated, highly suspicious, magical thinking, ideas of reference and illusions, unusual perceptual experiences, many meet criteria for major depression

causes of schizotypal PD

a phenotype of a schizophrenia genotype? diagnosis came about a result of research on family members of schizophrenics; higher rates of schizotypal PD in family members of schizophrenic

treatment options for schizotypal PD

main focus is on developing social skill, treatment also addresses comorbid depression, medical treatment similar to schizophrenia - use of antipsychotics, treatment prognosis is generally poor

overview and clinical features of antisocial PD

noncompliance with social norms, violate rights of others, irresponsible, impulsive and deceitful, lack empathy and remorse, lack concern for safety of self or others, must be evidence of conduct disorder before age 15

symptoms of borderline PD

frantic efforts to avoid real or imagined abandonment, a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation, identity disturbance, impulsivity in a least 2 areas that are potentially self-damaging, recurrent suicidal behavior, gestures, or threats or self-mutilating behavior, affective instability due to marked reactivity of mood, chronic feelings of emptiness, inappropriate, intense anger or difficulty controlling anger, transient, stress-related paranoid ideation or severe dissociative symptoms

causes of borderline PD

runs in families, early trauma and abuse seem to play some role, major theory is biosocial

what is biosocial theory

emotionally vulnerable individual (excessive reaction to stress, long recovery rate following stressor), invalidating environment (broadly conceived, being told feelings aren't ok or reasonable, being told perceptions are wrong; physical or sexual abuse - invalidates one's autonomy, sense of boundaries, privacy)

overview and clinical features of histrionic PD

overly dramatic, sensational, and sexually proactive, impulsive and need to be the center of attention, thinking and emotions are perceived as shallow, common diagnosis in females

causes of histrionic PD

etiology is largely unknown, sex-typed variant of anti-social personality?

treatment options of histrionic PD

focus on attention seeking/ long-term consequences, address problematic interpersonal behaviors, little evidence that treatment is effective

overview and clinical features of narcissistic

exaggerated/unreasonable sense of self-importance, preoccupation with receiving attention, lack sensitivity and compassion for other people, sensitive to criticism, envious and arrogant, mainly causes social impairment

causes of narcissistic PD

link with early failure to learn empathy as a child because of parents failure to effectively "mirror" a child, parents are spiteful and cold but find 1 talent or quality in the child to reward, child over-valued - parents provide non-contingent praise, attention and tribute to the child, appears that over OR under evaluation can cause it r

treatment options for narcissistic PD

focuses on grandiosity, lack empathy, little evidence that treatment is effective

overview and clinical features of avoidant PD

extreme sensitivity to the opinions of others, highly avoidant of most interpersonal relationships, interpersonally anxious and fearful of rejection, "Look like" schizoid individuals

causes of avoidant PD

numerous factors have been proposed, difficult temperament and early rejection, recall feeling isolated and rejected in childhood, extreme variant of introversion

treatment options for avoidant PD

several well-controlled treatment outcome studies exist, treatment is similar to that used for social phobia, treatment targets include social skills and anxiety-reduction

overview and clinical features of dependent PD

reliance on others to make major and minor life decisions, unreasonable fear of abandonment, clingy and submissive in interpersonal relationships, focused on maintenance of supportive/nurturing relationships

causes of dependent PD

largely unclear (may be due to feelings of incompetence and low self-efficacy), linked to early disruptions in learning independence, early disruption of important attachment relationships, temperamental differences in negative emotionality