Clinical disorder

How do we define psychological disorders

1. behavior → emotional, cognitive, thoughts,

2. severity, dysfunction, prolonged vs acute

3. deviates from cultural norm

4. statistical deviance

culturally normative definition

does normal behavior violate cultural norms

distress

• feelings of deep despair and emotioal turmoil

impairment in functioning

• reduction in an individuals ability to function

• may be caused by feelings of distress

• not all individuals that are impaired feel emotional distress

Defining psychological disorders

• dysfunction in cognition, emotion, or behavior

• distress or impairment in functioning (felt by them or others around)

• atypical or culturally unexpexted behaviots

all 3 are necessary

The purpose of diagnosis

• help professional communicate

• inform the patient

• inform the public

Positive symptoms

Distorted reality ; more obvious signs of psychosis; delusions(70%) and hallucinations (60-80%)

Psychotic disorders in the DSM-5

schizophrenia, schizophreniform disorder, schizoaffective disorder, brief psychotic disorder, delusional disorder, psychotic disorder due to a medical condition, substance induced psychotic disorder

psychoses

psychoses involves disturbed thoughts, perception, language, emotion, and behaviors. psychoses does not equal schozophrenia

Schizophrenia

2+ of any of the following and 1+ of the first three for 6 mon; delusions, hallucinations, disorganized speech, disorganied/catatonic behavior, neative symptpms

hallucinations

sensory experiences w/out enviormental stimuli

types of hallucinations

visual, auditory, tactile, gustatory, olfactory

delusions

beliefs contrary to reality, despite evidence to the contrary

types of delusions

bizzar and non bizzar

disorganized speech

indicates thought disorder, loose association, neologisms, clang

neologisms

new words made by combining existing words

clang

shift of ideas based on sounds of words

negative symptoms

behavior deficts, avolition, alogia, anhedonia, asociality

avolition

lack of energy and persistence in routine in activities

alogia

reduced amount of content of speech, answer questions with brief or no replu, results from negative sumptoms of thoughts disorder, not from inadequate communication skills

anhedonia

inability to experience pleasure

asociality

severe impairment in social relationships

flat affect

avoids eye contact, immobile expressionless fface, little emotion when relating emotional material, apathetic/unintrested, monotonous voice thats low and difficult to hear

catatonia

symptoms dominated by 3+ of the following: stupor (no psuchomotor activity), cataplexy (passive induction of posture held, facial grimace), waxy flexibility (slight resistance to positioning), mutism, negativism, posturing, mannerism, sterotype (repetive, frequenct movements), agitation, grimacing, echolalia (mimicking speech), echopraxia (mimicking movements)

epidemiology of schizophrenia

male and females equal prevalence, onsent in adolecence, early adulthood, earlier in men, usally chronic, moderate to sever impairment, reduced life expectancy, females tend to have better prognosis

negative symptoms are ___ to treat

harder

universe of psuchotic sumptoms

drug reactions, brief stress reactions, mood disorders, schizophrenia/schixophreniform disorder

Psychotic disorders in DSM-5

schixophrenia, schizophreniform disorder, brief psychotic disorder, schizoaffective disorder, delusional disorder, psychotic disorder due to a medial condition, substance-induced psychotic disorder

schizophreniform disorder

schixophrenic symptoms for less than 6 mos, associated with good premorbid functoning, most resume normal lives, 2+ symptoms of schizophrenia, duration of more than 1 month, less than 6

brief psychotic disorder

symptoms of schizophrenia (excluding negative symptoms) lasting more than 1 day but less than a month, often in response to stressor, not better explained by MDD, bipolar, rx

schizoaffective disorder

symptoms of schizophrenia and a mood disorder, depressive episodes must include depressed mood, 2 weeks of more when not having mood episode

delusional disorders

delusiosn without other major schizophtenia symptoms, delusions for 1+ month, other functoning relatively unimpaured, mood episodes are brief compared to delusions, not due to medical cause or drug

grandiose delusions

belief that one is famous, god, extremely powerful

Erotomaniac delusions

the affected person believes that another person, usually someone famous or of high status, is in love with them

persecutory delusions

being conspired against, harrasied, attacked, followed

somatic delusions

strange things go one with their body, missing body part etc

jealous delusions

partner is cheating

genetic studies of schizophrenia

identical twins have higest rates, but not over 50%. no one single genetic markers but c4 seems to appear a lot and regulates synaptic pruning

markers of Schizophrenia

eye tracking, abnormalities in function (hypofrontality, neurotransmitter function,) structural abnormalities

eye tracking

tracking deficents in persons with schizophrenia and their relatives

outdated dopamine theory of schizophrenia

agonist drugs, increased dopamine activity, increased schizophrenia like symptoms (amphetamine related psychosis) → antagonish drugs, decreased dopaminea ctivity, decreased schixophrenic-like symptoms (anti-schizophrenic drugs block doppamine receptors)

why dopamine theory is outdated

excessive dopamine activy generates symptoms (especially positive)

is it dopamine levels or specific dopamine receptors

underactuve D1 activity in prefrontal cortex (hypofrontality) and overactive D2 receptors in striatum (associated with positive symptoms)

dopamine theory problems

time lag between blocking dopamine receptors and clinical benefits, other neurostrasmitters likely involved (glutamate: PCP induces schizophrenia like symptoms, serotonin: atypical anti-psychotics also work on serotonin (clozapine), medications don’t do a lot for negative symptoms

sesonality effects

children born during late winter and early spring are more likely to develop schizophrenia → mother more likely to be getting sick during 2nd trimester (more in urban areas

diathesis stress model

psychological disorders result from gentic vulnerability and real life stress interacting

low socioeconomic status as possible schizoprenia stressor

low SES is a stressor that generates schizophrenia, urbanicity findings (especially during early development) downward drift: low SES consequences of poor funciting of individuals with schizoprenia

Schizophrenia risk factors

low IQ, divorced or single, race (african-american), cat (ages 9-12)

protective factors

owning a dog during childhood (birth to 2)

family risk factors of schizophrenia

communication deviance, expressed emotions, criticism, emotional over-involvement, hostility, high expressed emotion in the family is associated with relapse

treatment of schixoprenia in the past

often inpatient, shock treatment, insulin coma therapy, lobotomy (remove frontal cortex)

modern treatment

antipsychotic medication (thoraine - older) (clozaril - younger), reduces positve symptoms agitation violent behavior

antipsychotic weaknesses

little effect on negative symptoms, 30% of pts don’t respond, poor compliance common, side effects, tardive dyskinesia

tardive dyskinesia

bizarre facial and tonge movements, involuntary tonic muscles spasms of extremitites, potentially irreversible

side effects of antisychotic medications

tired, zombie, weight gain, type II diabetes

outpatient treatment for Schizophrenia

social skilss traning, family therapy to reduce expressed emotion, combined psychological and drug treatment, early intervention critical

relapse predictors

medication non compliance, high expressed emotion, life events/stressors, poor social skills/social incompetence, improverished social network, cognitive impairments

eating disorder

a psychotic disgnaosis involving pathological eating behaviors

body image

a person’s preception and evaluation of their physical apperance

body satisfaction

how satisfied a person is with their apperance

ed

severe disruptions in eating behaviors, distrubed body image, excessive concern with shape and weight

ating disorder diagnosises

anorexia nervosa, belumia nervosa, binge eating diorder, avodiance restrictive eating disorder (AFRID), Pica, rumination disorder, other specificed feeding or eating disorder (OSFED), other unspecified feeding/eating disorder

bulimia nervosa

eating excessive amounts of food, rapid consumption, preceived lack of control of eating, inapproptirat compensatory behaviors, often normal or over weight, must be at least one time a week for at least 3 mos

inappropriate compensitory behaviors for bulima

vomiting, laxitives, diuretics, excessive exercise, fasting, insulin manipulation, chewing and spitting

bulima medical consequences

vomiting (swolleb salivary glands, enam degradation, esophgeal tears, electrolyte imbalances = cardiac arrhythmiasm seizes, renal failures), dependent use of laxitivesm insulin manipulation dangerous highs and lows

anorexia nervosa

significantly underweight (BMI), intense fear of fat/ganing weight, disobance of body image perception, lack of awareness of severity of low weight, shape/weight excessivley influecne sense of self

two types of anorexia nervosa

restricting, binge eating/purging (typically small amounts/regular purging)

medical consquences of anorexia

amenorrhea (stopping menstruation), dry skin, brittle hair/nails, lanugo (downy air covering body), cardiovascular problems, bone density loss, highest suicide risk

anorexia morality rates

20% as result of disorder, 5% within 10 yrs, 31x higher sucide rate than general population

binge eating disorder

excessive amounts of food, rapid consumption, perceived lack of control of eating, guilt and shame, no purging or other compsensiton, 1+ binge per week for 3+ months

causes of eating disorders

relatives of ed patients 4-5x more likel to develop, ½ of causes of ED is genetics → shared environment/shared genetics

obesity

30+, 42.4% of the us population, estimated 173 billion in healthcare costs,