UCLA Psych 127A Final

Borderline Personality Disorder (BPD)

Better accepted and understood as Emotional Intensity Disorder.

NOT a borderline between neurosis and psychosis

Symptoms of BPD

Poor regulation of emotions, impulsivity, impaired perception/reasoning, unstable personal relationships

Prevalence of BPD

2%

Is BPD more common in males or females?

Females

Age of onset of BPD?

Usually late adolescence and early adulthood

Comorbidity and patient settings of BPD

Comorbid with mood, eating, anxiety, and substance use disorders.

Most patients are seen in inpatient settings.

How heritable is BPD?

Modestly heritible

Which hormone is low with BPD?

Low serotonin: serotonin transporter gene, unable to control impulsive behavior.

Which part of the brain is overreactive in BPD?

Amygdala

What is the typical temperament of people who have BPD?

Neuroticism and Impulsivity

What are the "Big 5"?

Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness.

Family factors of BPD?

Child (sexual) abuse, neglecting

an emotionally uninvolved family

stressful events

an invalidating environment (rejection, dismiss, criticism, and punishment)

Treatment (medications) of BPD

Anti-depressants SSRI to regulate depression

mood stabilizers to regulate emotions and reduce impulsiveness and anger

atypical antipsychotics to reduce impulsive and reckless behavior

Treatment (therapy) of BPD

Dialectical Behavior Therapy (DBT)

-is a form of CBT adapted for borderline personality disorder

-encourages patients to accept negative affect without engaging in maladaptive behaviors

-increases coping skills

-reduces self hard behaviors and feelings of anger and depression

Anti-Social Personality Disorder (ASPD)

A less violent version of psychopathy

Psychopathy

Predicts violence and recidivism

Grandiose sense of self worth, pathological lying, manipulate others, lack of empathy, etc

Symptoms of ASPD

Failure to conform to social norms

Deceitfulness and lying

Breaking the law impulsively

Irritability and aggressiveness

Consistent irresponsibility

Lack of remorse to hurting others

Is antisocial behavior a symptom of another mental disorder (i.e. manic episode)?

NO!!

Prevalence of ASPD

1-3%

Is ASPD more common in males or females?

Males

Comorbidity and early signs of ASPD

Comorbid with substance use disorder and higher rates of suicidal attempts

Usually preceded by childhood disorders (Conduct Disorder, Oppositional Defiant Disorder, and ADHD)

The number of delinquent behaviors during childhood is the best predictor

How heritable is ASPD?

High heritability

Are the rates of conviction, arrests, and ASPD higher or lower in adopted offspring of felons.

HIGHER

What are the low bodily activities seen in ASPD?

Low activity of MAO-A (increased aggression)

Low activity in amygdala when viewing sad or frightened faces (only for some people)

Low levels of fear, anxiety, and empathy

Low reactivity to images of distress

Poor conditioning of fear

Familial factors of ASPD

Ineffective parenting (discipline and supervision)

Deviant peers

Divorce of parents

Stressful events

Treatment (Medications) of ASPD

Minimal improvement, does NOT lead to remission

Medications facilitate aversive conditioning therapy

Treatment (Therapy) of ASPD

CBT offers some promise

-many drop out

-effects do not generalize

-treatment is very difficult because they don't believe they need treatment

Schizophrenia

Loss of contact with reality (psychosis)

Oddities in perception, thinking, behavior, sense of self, relating to others

Age of onset: late adolescence or early adulthood

Persecutory Delusions in Schizophrenia

They believe that someone is following them and will harm them

Delusions of Reference in Schizophrenia

News has a direct reference to them, music and TV is played for them

Grandiose Delusions in Schizophrenia

They have an exceptional power or talent and is famous

Erotomanic Delusions in Schizophrenia

Someone (a celebrity/someone important to them) is in love with them or sexually involved with them

Thought insertion, withdrawal, control, or broadcasting delusions in schizophrenia

Someone/Alien is putting thoughts into their mind, removing/controlling their thoughts, or broadcasting their thoughts for everyone to hear

Auditory Hallucinations in Schizophrenia

A voice comments on what they are doing (most common)

Visual Hallucinations in Schizophrenia

Can be clear, vague, or distorted and frightening

Olfactory Hallucinations in Schizophrenia

Often unpleasant smell and they believe the odor is coming from their body

Tactile Hallucinations in Schizophrenia

Snakes are crawling on their body or an invisible hand is touching them

Gustatory Hallucinations in Schizophrenia

Strange taste in something they are eating or drinking

Disorganized speech and thought in schizophrenia

-Failure to make sense despite they are educated and know rules of speech

Incoherence (Disorganized Speech)

Their sentences don't make any sense

Neologism (meaningless words that are not in the dictionary)

Understanding is concrete (Disorganized Speech)

They don't understand the meaning behind the proverb, they only understand the superficial meaning of it

Disorganized and catatonic behavior in schizophrenia

Impairment of goal-directed activity

Display of silly or unusual behavior

Unpredictable agitation/repetitive behaviors

Catatonia (not speaking or moving for a long period of time)

Negative symptoms of Schizophrenia

Flat Affect: they don't show their emptions

Alogia: they reply with poor speech although they are perfectly capable of normal speech

Asocial: they are more comfortable alone

Avolition: they are unable to initiate or continue in routines

Anhedonia: loss of pleasure from daily events

Prevalence and Age of Onset of Schizophrenia

Prevalence: 0.7-1%

Age of onset: 18-30 years old

Is Schizophrenia more common in males or females?

Males (more severe form in males)

Commonly Associated Features of Schizophrenia

Neuropsychological Testing

-poor executive functioning (unable to understand information and make decisions)

-have trouble focusing or paying attention

-have problems with working memory (unable to use information after learning it)

Schizoaffective Disorders

Both psychotic symptoms and severe mood symptoms

Schizophreniform

like schizophrenia but less than 6 months

Delusional Disorder

has delusions but behaves quite normally

Brief Psychotic Disorder

at least 1 day but not past a month

Heritability of Schizophrenia

High Heritability

Twin Study Results: Schizophrenia

Higher rates in monozygotic twins

Higher rates of schizophrenia in biological relatives

What causes at risk youth to develop schizophrenia?

Being raised in an adverse adoptive environment

Biological Factors of Schizophrenia

The gene COMT (one of many genes that contribute to schizophrenia)

-Involved in dopamine metabolism (located on chromosome 22)

-People with COMT are more likely to become psychotic if they used cannabis in adolescence

Brain Vulnerabilities in Schizophrenia

Neurotransmitter Systems Abnormalities

-Dopamine Hypothesis: drugs that increase dopamine can cause schizophrenic behaviors// drugs that reduce dopamine can decrease schizophrenic behaviors

-Dopamine Hypothesis is simplistic; need to consider sensitivity of dopamine receptors

-Overactive dopamine system can cause low level of glutamate and schizophrenic behaviors

(low levels of glutamate cause degeneration of neurons in hippocampus and PFC)

-Dopamine dysregulation: people pay more attention to irrelevant stimuli

Anatomical Differences in Schizophrenia

Enlarged brain ventricles

Men are more likely to have enlarged brain ventricles

decreased brain volume (reduction in gray matter), frontal lobe and temporal lobe (amygdala and hippocampus), thalamus, and white matter disruptions (affects how the nerve fibers communicate)

Prenatal factors in schizophrenia

Prenatal infection

-elevated schizophrenia in children born to moms with flu 4-7 months of gestation

Rhesus incompatibility in schizophrenia

Rh-negative mom carrying Rh-positive fetus leads to blood disease

-oxygen deprivation

-dopamine supersensitivity

-increased risk

Perinatal birth complications in schizophrenia

Breech delivery and prolonged labor can affect oxygen supply

-hippocampus is susceptible to damage from hypoxia

-hypoxia can cause dopamine supersensitivity

Psychological factors of schizophrenia

role of stress (traumatic event) may activate underlying vulnerability

-stress--> dysregulated cortisol--> dysregulated dopamine release--> schizophrenia

Family interactions relevant to relapse

-high expressed emotion (criticism, hostility, and emotional overinvolvement)

Early indications of vulnerability in schizophrenia

more motor abnormalities including unusual hand movements

less positive facial emotion and more negative facial emotion

delayed speech and delayed motor development at age 2

Treatment (medications) of schizophrenia

Antipsychotic drugs reduce positive symptoms and block dopamine receptors

Schizophrenia: 1st generation antipsychotics

Haldol, Thorazine

Side effects: tardive dyskinesia, muscle spasms, body rigidity

Schizophrenia: 2nd generation antipsychotics

Clozaril, Seroquil, Olanzapine, Risperidone

Side effects: increased risk of stroke, sudden cardiac death, blood clots, diabetes

Treatment (therapy) of schizophrenia

behavioral family therapy

social and living skills training

cognitive remediation: improve memory, attention, executive functioning

CBT

Outcomes of treatment of schizophrenia

combination of medication and social skills training and family stress management is the best

most common is chronic pattern of relapse and recovery

Schizophrenic symptoms are not expressed until brain maturation reveals them; reason why use of cannabis can significantly increase risk for schizophrenia and why we see it in age 18-30

Disorders of Childhood Adolescence

Separation Anxiety Disorder

Selective Mutism

Separation Anxiety Disorder

Extreme anxiety, often panic, when they are separated from their attachment figure

Can impair parents (child wants to be with parent but parent needs to work)

Selective Mutism

Children may not talk to anyone who is NOT close to them

they might look down, withdraw, or whisper if they do speak

it interferes with educational or occupational achievement

failure to speak is NOT due to lack of knowledge or lack of language

some kids go on to have social phobia

Disruptive Behavior Disorders

Oppositional Defiant Disorder (ODD)

Conduct Disorder (CD)

(externalizing disorders)

Oppositional Defiant Disorder (ODD)

defiant behaviors that are less severe than those with conduct disorders

ODD Prevelance

Age of onset: around age 8

About 30% develop conduct disorder

Conduct Disorder (CD)

Continued pattern of violating the basic rights of others or breaking societal rules

CD Prevelance

Age of onset: around ages 10-12

About 25-40% develop ASPD as adults

Is CD more commonly seen in boys or girls?

Boys

Difference between ODD and CD

CD predicts behavioral outcomes

ODD shows stronger prediction to emotional disorders in early adult life

Biological Factors (mainly for CD)

Genetics: heritable

Difficult temperament that leads to insecure attachment

Psychological factors of ODD & CD

Family/Peer patterns

-rejection and neglect/ineffective parenting/poor monitoring

-child abuse

-poor relationship with peers

Social Factors of ODD & CD

Low SES and difficult neighborhood contexts

Treatment (medications) of ODD and CD

SSRI for depression

atypical antipsychotics to reduce symptoms of aggression

unsuccessful when used alone

Treatment (therapy) of ODD and CD

Behavioral

-parent management training, classroom modification, social skills training

-rewarding prosocial behaviors

-token systems to shape behaviors so they become habits and automatic

Neurodevelopmental Disorders

ADHD (Attention Deficit Hyperactivity Disorder)

Autism Spectrum Disorder

ADHD

inattentiveness, hyperactivity, and impulsivity

diagnosed in early elementary school (around age 5)

more common in boys

higher rate in the US because of over-diagnosis or unrealistic standards set by parents

Biological factors of ADHD

Genetics

- DAT1 and other dopamine genes cause sluggish dopamine

Prenatal exposures

-maternal smoking and alcohol exposure in utero interact with genetic predisposition

Brain vulnerability

-executive function deficit (frontal lobe reduction)

-brain appears to mature 3 years slower

Psychosocial factors of ADHD

ADHD children are often viewed negatively by others (peer rejection and isolation)

lack of discipline and permissive parenting do NOT cause ADHD

Treatment of ADHD (Medication)

Stimulant medication

-improve attention controlling

-increases dopamine and norepinephrine in frontal areas

-no increased risk for substance use disorders

Treatment of ADHD (therapy)

Behavioral treatment

-may involve parent training

-teach children organizational and planning skills and techniques for decreasing distractibility

Combined biopsychosocial treatment: HIGHLY recommended

Autism Spectrum Disorder

Affects how one perceives and socializes with others

characterized by deficits in social communication and interaction and restricted, repetitive and stereotyped patters of behavior, interests, and activities

Autism levels of severity

Level 1- Requiring support

Level 2- Requiring substantial support

Level 3- Requiring very substantial support

Prevelance of Autism

More common in boys

age of onset: by age 3

parents usually recognize something is wrong around 12-18 months of age

W/ or W/o accompanying intellectual impairment

-some have average or above average IQ

-repetitive use of language (echolalia)

Biological factors of Autism

Genetics

-high heritability

-higher rates in monozygotic twins

-under activated fusiform gyrus (perceptions of emotion in facial stimuli)

-unusually accelerated head and brain growth

Autism Gene Project

Glutamate neurotransmitter dysfunction: lower levels of glutamate

Oxytocin receptor genes involved in bonding and social memory: lower levels of oxytocin

Environmental factors of Autism

Advanced paternal age (babies born to father older than 35) linked with higher risk for autism

-no data to support causal role for vaccine

Treatment (medication) for Autism

Atypical antipsychotics help manage aggressive behavior and self injury

Stimulants reduce hyperactivity

are not effective for social or communication benefits

Treatment (therapy) for Autism

applied behavioral analysis (ABA)

-skill building, communication training, increase socialization

Substance Use Disorder

Causes temporary changes in behavior, emotion, or thought

May result in substance intoxication (poisoning)

Substance can also lead to long-term problems such as tolerance and withdrawal reactions

Types of SUD

Depressants (behavioral sedation)

Opiates (produce analgesia and euphoria)

Stimulants (increase alertness and elevate term-97mood)

Hallucinogens (alter sensory perception)

Other drugs: Inhalants, anabolic steroids

Criteria Symptoms

Impaired control

social problems

risky

Depressant Substances

Slow the activity of the Central Nervous System (CNS)

-reduce tension and inhibition

-interfere with judgment, motor activity, and concentration

Example: alcohol, barbituates (helps people sleep or calm down), benzodiazepines (tranquilizers)

SUD and Alcohol

Alcohol facilitates GABA (anxiety reduction) and dopamine (pleasure)

Biphasic

At lower levels, alcohol activates brain's pleasure areas

At higher levels, alcohol depresses brain functioning

Women need lower alcohol level to have same negative consequences compared to men