psyc236 midterm 2

personality disorder

inflexible and maladaptive patterns of behaviour that deviate from social norms and cause significant impairment/distress

pervasive and chronic across a broad range of situations

cluster A disorders

odd-eccentric, includes paranoid, schizoid, and schizotypal

cluster B

dramatic-erratic, includes antisocial, borderline, histrionic, and narcissistic disorders

cluster C

anxious-fearful, includes avoidant, dependant, and obsessive-compulsive

paranoid personality disorder

distrust and suspiciousness

interpret others motives as malicious

hypervigilant and hold grudges

low extraversion, openness, and agreeableness

schizoid personality disorder

detachment from social relationships and restricted range of emotional expression

lack a desire for close relationships

prefer solitary activities

appear emotionally cold

low extraversion

schizotypal personality disorder

acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behaviour

considered part of the schizophrenia spectrum

unusual experiences that are below the threshold of a psychotic episode

high neuroticism and openness, low extraversion

antisocial personality disorder

disregard for and violation of the rights of others

evidence of conduct disorder since age 15

deceitfulness, impulsivity, lack of remorse

low agreeableness and conscientiousness

psychopathy

overlaps with antisocial PD but focuses more on callous-unemotional traits, fearlessness, superficial charm and lack of conscience

borderline personality disorder

profound instability in interpersonal relationships and self-image

marked impulsivity

frantic efforts to avoid abandonment, chronic feelings of emptiness, recurrent self-harm and suicidal behaviour

alternating between idealizing and devaluing others

high neuroticism and extraversion, low agreeableness and conscientiousness

histrionic personality disorder

excessive emotionality and attention seeking

high extraversion, neuroticism, and openness

low conscientiousness

narcissistic personality disorder

grandiosity, need for admiration, and a lack of empathy

grandiose (entitlement and dominance) presentation or vulnerable (hypersensitivity to evaluation and coldness) presentation

high neuroticism, extraversion, and conscientiousness

low agreeableness

avoidant personality disorder

social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation

desire social affection but inhibited by intense fears

low extraversion, high neuroticism

dependant personality disorder

submissive and clinging behaviours related to an excessive need to be taken care of

underlying fear of abandonment

high neuroticism and agreeableness

obsessive-compulsive personality disorder

preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility and efficiency

individual does not view as a problem (egosyntonic)

high neuroticism and agreeableness, low extraversion and openness

alternative DSM-5 model for PDs

dimensional approach that defines personality disorders by impairments in personality functioning and pathological traits

symptoms as extreme versions of normal traits

drops schizoid, paranoid, histrionic, and dependent disorders due to high comorbidity and limited research

normal eating

responding to internal hunger and satiety cues, eating for pleasure

disordered eating

preoccupation with calories and weight

self-worth dictated by body size

anorexia nervosa

restriction of energy intake leading to a significantly low body weight

intense fear of gaining weight

disturbance in how one perceives their own body

restricting type: weight loss achieved through dieting and/or extreme exercise

binge/purge type: individual also engages in binging and purging behaviours

can lead to amenorrhea, lanugo, and cardiac problems

frequently co-occurs with OCD (restricting type)

bulimia nervosa

recurrent episodes of binge-eating followed by inappropriate compensatory behaviours

self-induced vomiting, misuse of laxatives, excessive exercise to prevent weight gain

typically not underweight

can lead to esophageal tears, dehydration, dental erosion

co-occurs with borderline personality disorder

binge-eating disorder

recurrent episodes of binge eating

lack of control, feelings of guilt and shame

no compensatory behaviours

associated with obesity and significant distress

eating disorder etiology

serotonin dysregulation in anorexia and bulimia

dopamine dysregulation in BED (reward sensitivity)

internalization of thin ideal leads to body dissatisfaction

risks include perfectionism, low self-esteem, difficulty managing emotions

eating disorder treatment

cognitive behavioural therapy and interpersonal therapy

media literacy can be preventative

personality disorder etiology

generally understood through diathesis-stress model

genetics play a significant role

childhood trauma and parenting styles

biosocial model of BPD

disorder emerges from transaction between biological emotional vulnerability and an invalidating environment

child learns to inhibit emotions or escalate to extreme levels to get a response

dialectal behaviour therapy

gold standard for BPD

based on a dialectic and balancing radical acceptance of the client and the necessity for change

involves individual and group therapy to teach mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerancet

operant behaviour: learned/maintained by consequences

respondent behaviour: habitual response/reaction to a circumstance

treatment barriers for personality disorders

high comorbidity with other PDs and mental disorders

high dropout rates

clinicians can hold negative biases

lack of research into treatments

psychosis

a broad clinical term referring to a disconnection from reality, typically as hallucinations or delusions

schizophrenia

specific type of psychosis characterized by significantly disturbed thought, emotion, language, and behaviour

criterion A schizophrenia

core symptoms, 2 or more for at least one month

delusions

hallucinations

disorganized speech

disorganized or catatonic behaviour

negative symptoms

at least one symptom must be delusions, hallucinations, or disorganized speech

criterion B schizophrenia

significant social or occupational dysfunction in areas like work, self-care, or interpersonal relationships

criterion C schizophrenia

continuous signs of disturbance must persist for at least six months including one month of active-phase symptoms

positive symptoms

represent an addition or excess of normal functioning, include hallucinations and delusions

negative symptoms

represent a deficit in normal functioning

strong predictors of poor outcomes

include lack of motivation, anhedonia, asociality, alogia, and affective flattening

primary symptoms are core to schizophrenia

secondary symptoms are effects of comorbid depression, medication, or social isolation

disorganized symptoms

disorganized speech and abnormal motor behaviour

cognitive symptoms

most patients experience impairments in attention, memory, and executive function which are present even before the onset of psychosis

schizoaffective disorder

symptoms of schizophrenia co-occuring with a major mood episode (depressive or bipolar type)

schizophreniform disorder

identical to schizophrenia but lasting 1-6 months

delusional disorder

presence of delusions for at least one month without other core symptoms

brief psychotic disorder

psychotic symptoms lasting at least one day but less than one month

eventual return to normal functioning

schizophrenia etiology

strong genetic component

dopamine hypothesis: symptoms result from dysregulated dopamine

excess in subcortical regions, deficit in prefrontal cortex

enlarged ventricles indicating reduced brain volume

hypofrontality

schizophrenia treatment

antipsychotics are the primary treatment

first-generation meds target D2 receptors but have high motor side effects

second-gen meds are more effective but require monitoring for blood disorders

CBT for psychosis, cognitive remediation, therapy, skills training

personality factors

neuroticism vs emotional stability, extraversion vs introversion, openness vs closedness, agreeableness vs antagonism, and conscientiousness vs disinhibition

health psychology

the study of how psychological factors affect the origins and response to disease and the determinants of good health

psychological factors affecting other medical conditions

a category in the DSM

must have documented medical condition that is adversely affected by psychological or behavioural factors in at least ¼ ways:

factors influence course of disease, interfere with treatment, pose additional health risks, or influence underlying pathophysiology

general adaptation syndrome

trajectory of stress

alarm, defence, and exhaustion

transactional model of stress

stress as an ongoing series of transactions between individual and environment

relies on primary appraisal (determining if something is a threat) and secondary appraisal (determining if one has the resources to cope)

psychosocial determinants of health

social status, controllability of stressors, social support, personality factors

endocrine system

primary stress response mechanism is the HPA axis (hypthalamic-pituitary-adrenal)

the hippocampus usually turns off stress response once threat has passed

chronic high cortisol can kill cells in the hippocampus leading to dysregulated stress response

autonomic nervous system

controls immediate physical changes

sympathetic nervous system: fight/flight

parasympathetic nervous system: rest/digest

stress response is the SAM axis (sympathetic-adrenal medullary axis)

sympathetic nervous system tells adrenal medulla to release epinephrine and norepinephrine

the immune system

chronic activation of stress response can suppress immune system function making the body more susceptible to disease

premorbid development

primary brain insults and/or pathological processes that occur long before clinical manifestation of schizophrenia

deviations from bilateral symmetry

minor physical anomalies usually the result of second trimester abnormalities (critical time for neuronal migration)

prodromal phase

period of escalating problems with adjustment

schizotypal symptoms

acute or gradual onset

acute has better prognosis

active phase

psychotic episode

onset is earlier in males

remission

mild or less on all psychosis items

moderate or less on all negative items

sustained at least two years

intact functioning and everyday living skills

recovery

convergence of remission and improvement of functional performance, lead meaningful and rewarding life