personality, schizophrenia spectrum and neurocognitive disorders

five factor model of personality

openness

conscientiousness (organization)

extraversion

agreeableness

neuroticism (even-tempered vs. moody)

clusters of personality disorders

a - odd or eccentric

b - dramatic, emotional, erratic

c - fearful or anxious

cluster a disorders

paranoid, schizoid, and schizophrenic

paranoid personality disorder

pervasive and unjustified mistrust and suspicion

few meaningful relationships, sensitive to criticism

poor quality of life

often found in people with experiences that lead to mistrust (i.e. refugees, prisoners, people with hearing impairments)

treatment focuses on development of trust

schizoid personality disorder

detachment from social relationships, may resemble autism

very limited range of emotions in interpersonal situations (appearing cold and detached)

treatment focuses on the value of interpersonal relationships and building empathy and social skills

schizotypal personality disorder

odd behavior and dress, socially isolated and suspicious

magical thinking, ideas of reference, and illusions

many meet criteria for major depression

some conceptualize as resembling a milder form of schizophrenia (can test thoughts with this, not schizophrenia)

treatment focuses on developing social skills, overall similar to treatment for schizophrenia

cluster b personality disorders

antisocial

borderline

histrionic

narcissistic

antisocial personality disorder

lack of conscience, empathy and remorse

failure to comply with social norms, violation of other’s rights

seen in other families with inconsistent parental discipline and support or criminal/violent behavior

conduct disorder might be a precursor

incarceration often the only viable alternative

arousal theory (apd)

people with apd are chronically under-aroused and seek stimulation from types of activities that would be too fearful or aversive for most

psychological and social influences

psychopaths less likely to give up when a goal becomes unattainable

neurobiological theories of apd

fearlessness hypothesis - fail to respond to danger cues

gray’s model - inhibition signals outweighed by reward signals

cortical immaturity hypothesis - cerebral cortex not fully developed

borderline personality disorder

unstable moods, behaviors, and relationships

impulsivity, depression, fear of abandonment, poor self-image

self-mutilation and suicidal gestures

comorbidity rates high with other mental disorders, particularly mood

therapy focuses on accepting difficulties and needing change, interpersonal effectiveness, and distress tolerance to decrease reckless/self-harming behavior

triple-vulnerability model of anxiety applies to this too

histrionic personality disorder

overly dramatic and sensational, may be sexually provocative

impulsive and need to be center of attention

thinking and emotions perceived as shallow

more common in females

treatment focuses on attention-seeking and long-term consequences and problematic behaviors (not usually effective)

narcissistic personality disorder

exaggerated and unreasonable sense of self-importance

preoccupation with receiving attention

lack sensitivity and compassion for others

highly sensitive to criticism; envious and arrogant

treatment focuses on grandiosity, lack of empathy, unrealistic thinking, and coping skills for criticism

cluster c personality disorders

avoidant

dependent

obsessive-compulsive

avoidant personality disorder

extreme sensitivity to opinions of others, avoidant of interpersonal relationships (anxious and fearful of rejection)

low self-esteemm

treatment similar to that of social phobia; focuses on social skills, entering anxiety-provoking situations, and increasing social contact

dependent personality disorder

reliance on others to make major life decisions

unreasonable fear of abandonment, avoiding disagreements

clingy and submissive in interpersonal relationships

treatment focuses on skills to foster confidence and independence

obsessive-compulsive personality disorder

excessive and rigid fixation on doing things the right way

orderly, emotionally shallow

difficulties delegating to others and with spontaneity, often having interpersonal problems

treatment focuses on addressing fears related to need for orderliness, rumination, procrastination, and feelings of inadequacy

positive symptoms of schizophrenia

positive is abnormal behavior being added; active manifestations, distortions or exaggerations of normal behavior

include delusions and hallucinations

**broca’s area is involved in speech production and active during auditory hallucinations

negative symptoms of schizophrenia

normal behavior is subtracted

four a’s:

avolition - lack of initiation or persistence (aka apathy)

alogia - relative absence of speech

anhedonia - lack of pleasure or indifference

affective flattening - little expressed emotion

disorganized symptoms of schizophrenia

cognitive slippage - illogical and incoherent speech

tangentiality - going off on a tangent

loose associations - conversation in unrelated directions

disorganized affect (inappropriate emotional behavior)

disorganized behavior (variety of unusual behavior)

catatonia subtypes

stupor (like a statue)

mutism

waxy flexibility (maintain positions after being placed in them by someone else)

mimicking

sterotypy (repetitive movements)

excited (bizarre, non-goal directed hyperactivity; only one not stuporous)

schizophreniform disorder

psychotic symptoms lasting between 1-6 months

relatively good functioning, with most patients resuming their normal lives

schizoaffective disorder

symptoms of schizophrenia and additional experience of a major mood episode (manic or depressive)

psychotic symptoms must occur outside the mood disturbance

not the same as depression with psychotic specifier

delusional disorder

delusions that are contrary to reality

lack other positive and negative symptoms

types of delusions

erotomanic, grandiose, jealous, persecutory, and somatic

brief psychotic disorder

positive symptoms of schizophrenia or disorganized symptoms lasting less than a month

typically precipitated by trauma or stress

attenuated psychosis syndrome

refers to individuals at high risk of developing schizophrenia; label to focus attention on individuals who could benefit from early intervention

tend to have good insight into own symptoms

prodromal phase of schizophrenia

initial symptoms, 1-2 years before serious symptoms

expreience ideas of reference, magaical thinking, isolation, marked impairment in functioning (similar to schizotypal disorder)

dopamine hypothesis

schizophrenia is partially caused by overactive dopamine

thought to be cause due to dopamine agonists increasing schizophrenic behavior and antagonists reducing it

neurobiological influences on schizophrenia

enlarged ventricles and reduced tissue volume

hypofrontality (less active frontal lobes)

viral infections during prenatal development

medical treatment of schizophrenia

antipsychotic/neuroleptic medications

most reduce or eliminate positive symptoms

acute and permanent side effects are common (tardive dyskinesia)

medication compliance is often an issue; injectable medication may improve this

high expressed emotion

criticism, hostility and emotional overinvolvement/responsiveness in families that can lead to relapse of symptoms

delirium

temporary confusion and disorientation, developing rapidly over several hours or days

marked memory and language deficits

full recovery often occurs within several weeks

treatment focuses on addressing precipitation medical problems (UTI, head injury, drug usage, etc.)

major neurocognitive disorder

gradual deterioration of brain functioning that affects memory, language, judgment, and other cognitive processes

must represent a decrease from previous functioning

memory and visuospatial skills impairments in initial stages

neurocognitive disorder due to alzheimer’s

cause of nearly half of neurocognitive disorders

develop gradually and steadily, significant atrophy in the brain

slightly more common in women

education may provide a buffer period of better initial coping

three a’s of cognitive deficits

aphasia - difficulty with language

aphraxia - impaired motor functioning

agnosia - failure to recognize objects (includes facial agnosia)

vascular neurocognitive disorder

caused by blockage or damage to blood vessels (like from a stroke); obvious neurobiological signs of brain tissue damage

second leading cause of neurocognitive disorder

risk slightly higher in men, who tend to have more strokes

frontotemporal neurocognitive disorder

refers to damage to frontal or temporal regions of the brain, affecting personality, language, and behavior

leads to a decrease in appropriate behavior and language

includes neurocognitive disorder due to Pick’s disease, occurring relatively early in life (abnormal substances inside nerve cells, damaging the brain)

neurocognitive disorder due to traumatic brain injury

accidents are the leading cause

symptoms last for at least one week after head injury, with memory loss being more common

neurocognitive disorder due to lewy body disease

lewy bodies = microscopic protein deposits that damage the brain over time

gradual onset of symptoms including impaired attention and alertness and esp. visual hallucinations

neurocognitive disorder due to Parkinson’s disease

dopamine pathway damage lead to motor problems (tremors, posture, walking, etc.)

not all with PD will develop dementia

ND due to HIV infection

HIV-1 can cause neurological impairments and dementia in some individuals

leads to apathy and social withdrawal

occurs later in disease stages

HAART decreases risk

ND due to Huntington’s disease

genetic autosomal dominant disorder

manifests initially as chorea (involuntary limb movements) later in life

ND due to prion disease

misfolded proteins in the brain reproduce and cause damage

no known treatment, always fatal

can only be acquired through cannibalism, mad cow disease, or accidental transmission

substance/medication induced ND

results from prolonged drug use, especially in combination with poor diet

may be caused by alcohol, sedative, hypnotic, or inhalant drugs

symptoms similar to alzheimer’s

brain damage may be permanent

features of alzheimer’s disease

neurofibrillary tangles (strandlike filaments, tangled and disrupting brain messages)

amyloid plaques (gummy protein deposits between neurons)

atrophy in brain

genetic influence of alzheimer’s

chromosomes 14 and 19 associated with early and late onset

19 especially more likely to produce decline in a stressful environment

deterministic genes inevitably lead to alzheimer’s, while susceptibility genes make it more likely

medical treatment of neurocognitive disorders

ginkgo biloba may improve memory

other drugs such as cholinesterase inhibitors

any gains in a person’s abilities are only temporary, improving to the same point where a patient was 6 months prior to treatment