Dr. C (ASU) PSY 366 Exam #3

Dr. C ASU

Schizophrenia IS NOT_____

Split Personality

Schizophrenia is___

A severe form of psychosis (loss of contact with reality)

__ % of the general public is affected by schizophrenia

1%

The 4 categories of positive psychosis symptoms (excesses) are______

1) Delusions 2) Hallucinations 3)Disorganized thought and speech 4) Inappropriate affect 

Delusions are____

Beliefs that are not rooted in reality, FIXED beliefs

The 4 types of delusions are___

1) Persecutory 2) Grandiose 3) Ideas/Delusions of Reference 4) Delusions of Control 

Persecutory

Fixed false beliefs one is being targeted or harmed:

Ex: “The aliens are out to get me”

Grandiose

False belief of being better then you are

“I know the cure to cancer”

Ideas/Delusions of Reference

The false belief that external events or behaviors of other are directly connected to oneself

“sees Fear Farm billboard → believes its a sign from god saying my house is haunted”

Delusions of Control

An individual believes their thoughts, feelings, and behaviors are being controlled/manipulated by an external force 

ex: The aliens are controlling/making me do it

The 6 types of Hallucinations are______

1) Auditory 2) Visual 3) Tactile (outside) 4) Somatic (inside) 5) Olfactory 6) Gustatory

Auditory Hallucinations 

Hears sounds coming from outside of the body 

ex: name being called 

Visual Hallucinations

Sees things that don’t exist

Tactile Hallucinations

Sensation on OUTSIDE of body

ex: bugs crawling over skin 

Somatic Hallucinations

Sensation on INSIDE of body

ex: watermelon bush growing inside of me

Olfactory Hallucinations

Detect smells that are NOT present in their environment

ex: yummy pizza smells like garbage 

Gustatory Hallucination

Tasting something that is NOT present 

ex: randomly tasting something bitter in mouth

The 5 Disorganized thoughts and speech

1) Loose Associations (Derailment) 2) Word Salad 3) Neologism 4) Perseveration 5) Clang

Loose Associations

Ideas are expressed lacking cohesions and logical flow. Often jumping from one idea to another with little or no connection

ex: “I got to store → stores have lights → space has star lights → I like chickens”

Word Salad 

A jumble of words that are put together in a way that makes no coherent sense

ex: “time flies baby sock; fruit flies box”

Neologism

An individual expresses either made-up words or altered versions of existing words

ex: The “glinderam” had a “perpertaum”

or

ex: "Flufmpy:" A combination of "fluffy" and "lumpy," used to describe something that is both soft and uneven.

Perseveration

Can’t get an individual off a topic. Repetition of the same word or phrase

ex: “What did you do this weekend? “I went to park.”

“Did you go with anyone?” “I went to park, park, park.”

Clang

The use of similar sounding words that don’t make sense together

ex: “Here she comes with a cat catch a rat match.”

Inappropriate Affect

What they are talking about does NOT match the way they are expressing it

ex: ☹ “I won the Super Bowl.”

      😄 “My goldfish passed away”.

The 4 Negative Symptoms (deficits) of Psychosis

1) Restricted/blunted (or flat) affects 2) Avolition (aka Apathy) 3) Alogia (poverty of speech) 4)Catatonia

Restricted/Blunted (flat) Affects 

Severe reduction or complete absence of emotional responses to the environment 

• No facial expressions:  “I am so very happy, truly :|”

• Can experience Anhedonia (inability to feel pleasure)

Avolition (aka Apathy)

Inability to persist at common, goal-oriented tasks at work, school, or home (lack of motivation to start or complete tasks)

ex: Bob picking up the cigarette buds sooooo slow, barely moves 

Alogia (poverty of speech)

Severe reduction or complete absence of speech (brain is overactive, and nothing is happening)

ex: Therapists asks a set of open-ended questions, client answers “fine” “no” “yeah”

ex” Therapists asks a set of open-ended questions, client responds with a nod, shake of the head, or no response at all

Types of Catatonia

Stupor, Posturing, Excessive movements

Stupor

sits very still with zero movement

ex: Dr. C on desk

Posturing

hold a dramatic pose for minutes or hours CAN be positioned and controlled

Catatonia- Excessive movements

Crazy excessive movements for minutes/hours

ex: Dr. C wild robot walk 

DSM-5 Criteria for Schizophrenia: at least ___ of these 5 categorical symptoms for ___ month(s)

at least 2 for 1 month:

Delusions, Hallucinations, Disorganized Speech, Significantly Disorganized or Catatonic behavior, &/or Negative Symptoms  

DSM-5 Criteria for Schizophrenia: Significant impairment in _____ and/or _______

Social and/or Occupational Functioning 

Schizophrenia Type I mostly ____ Symptoms

Positive +

Schizophrenia Type II mostly ____ Symptoms

Negative -

Schizophrenia: At least ____ months of continues signs of disturbance

at least 6 months of continues signs of disturbance

Brief Psychotic Disorder

Sudden onset of delusions, hallucinations, disorganized speech and/or behaviors lasting 1-30 days

• looks exactly like schizophrenia

• Julia smith example: call from friend, dr c check, few days later she’s fine - doesn’t think she was psychotic for a bit 

Schizophreniform Disorder

Active schizophrenic episode for at least 6 months

Schizoaffective Disorder

Active schizophrenic symptoms + recurrent major depression or bipolar disorder

Delusional Disorder

Non-bizarre delusions lasting more than 1 month; no other significant impairment

• ex: a women believes a famous celebrity is in love with her thought the tv and lyrics in song despite never meeting this person irl:

  • non-bizarre: it’s possible for someone to fall in love with another person 

  • delusion: there’s no evidence, and the belief persists despite proof

Shared Psychotic Disorder (Folie a deux)

Delusion develops from a relationship with another person who has the delusion

• ex: heterosexual couple believes they are having an alien baby 

DSM-5: ___PD divided into ___ clusters

10pd- 3 clusters:

a) Cluster A: Odd, Eccentric (3)

b) Cluster B: Dramatic Erratic (4)

c) Cluster C: Anxious, Fearful (3)

Cluster A: Odd- Eccentric PD

1) Paranoid (weakest relationship to schizophrenia)

2) Schizoid

3) Schizotypal (strongest relationship to schizophrenia)

Paranoid PD

Chronic pervasive (widespread) mistrust & suspicion of other people that unwarranted and maladaptive

ex: random person: “have a nice day!” PD person: “yeah, YOU would want that”

ex: PD person: “you are a liar!” “always out to get me!”

Schizoid PD: 

Chronic lack of interest in & avoidance of interpersonal relationships; emotional coldness towards others.

ex: “the more I meet people, the more I prefer my goldfish”

ex: “people - 1/5 stars, would not recommend’

Schizotypal PD

Chronic pattern in inhibited or inappropriate emotion and social behavior, aberrant conditions, disorganized speech

ex: Dr. C to the student - “we have a mind body connection” → breaks space bubble and can’t tell the person is uncomfortable 

Cluster B: Dramatic & Erratic PD

1) Antisocial PD 

2) Borderline PD

3) Narcissistic PD

4) Histronic PD

Antisocial PD

Pervasive pattern of criminal, impulsive, callous, or ruthless behavior; disregard for rights of others; no respect for social norms

ex: cheating man → no regard for wife and women’s husband. “her husband is in the way of our love”

ex: father says Santa took everything bc kids were “bad"→ laughed when they were upset

ex: man pet sits women’s beloved and respected parrot → man taught the parrot to cuss → man also had a wife and two kids

Borderline PD

Unstable sense of self- rapidly shifting and unstable mood; impulsive; Chronic emptiness; troubled relationships

ex: I can’t live without you! You have I leave :( ? Fuck you >:( ! Wait don’t leave :(

Narcissistic PD

Grandiose thoughts and feelings of one’s worth; strong sense of entitlement , oblivious to others needs

Ex: “my husbands passed out, but do you know how stressful it was for me?!

Ex: doesn’t ever admit faults that make them look bad

Ex: “I cheated, but it’s my wife’s fault bc she wasn’t having enough sex with me”

Histrionic PD

Excessive (shallow) emotionality and attention-seeking; dramatic, seductive behavior, considers relationships more intimate than they actually are

Ex: “you are soooo pretty!” “OMG I love you!” → to sister in law for first time

Ex: “all these guys like me, but I want him as well!”

Cluster C PD: Anxious Fearful

1) Avoidant PD

2) Dependent PD

3) Obsessive-Compulsive PD

Avoidant PD

Pervasive anxiety, a sense of inadequacy, & a fear of being criticized, which leads to the avoidance of social interactions& nervousness. Worried they will smile weird, get on bus weird, talk weird-

Ex: random person: “ your shoes are ugly” Person: “I need to throw these shows away and never come back here”

Dependent PD:

Pervasive selflessness, needs to be cared for, fear of rejection, leading to total dependence on & submission to others

• chronic “yes” person

Ex: therapist: have you thought of selling your house? Person: “I need to sell my house!!!”

Obsessive-Compulsive PD

Pervasive rigidity in ones activities & ineroersonalrelationships, including: emotional construing, extreme perfectionism, & anxiety about even minor disruptions in ones routine

• everything as a right way t do it

• Everything is A → B → C

Ex: women who had to do everything in order and was late to take mom to doctor

Why do we incarcerate people?:

1) Rehabilitation

2) Deterrence

3) Incapacitation

4) Retribution

What is Rehabilitation?

A process designed to help an individual improve their personal life

Why is Deterrence?

A way to send a message to the outside world by instilling fear

What is Incapacitation?

The act of preventing an offender from committing further crimes by restricting their freedom 

What is Retribution?

A way to punish offenders for their crimes based on the principle of moral accountability.

In order to be found guilty, a person must:

Actus Reus (guilty act) and Mens Rea (guilty mind) must be established.

What is Actus Reus?

The voluntary commitment of a wrong doing (guilty act)

What is Mens Rea?

The knowledge of ones wrong doings (guilty mind)

Definition for insanity defense:

A person is so mentally incapacitated that they did not have mens rea when they committed the act (drugs/alcohol intococation excluded)

Insanity is a ____ term, not a ____/_____ term

LEGAL, Psychological/Medical

The 5 Insanity Defense Rules

1) M’Naghton/McNaughton Rule (1843)

2) Irresistible Impulse Rule (1934)

3) Durham Rule (1954)

4) American Legal Institution (ALI) Rule (1962)

5) Insanity Defense Reform Act (1984)

M’Naughten/McNaughten Rule 

(1843): At the time of the crime, the individual was so, “affected by a disease of the mind",” that they didn’t know what they were doing or didn’t know it was wrong.

Irresistible Impulse Rule

(1934): At the time of the crime, the individual was driven by an “irrespirable impulse” to perform the act or could not resist performing the act

Durham Rule

(1954): The crime was a product of a “mental disease or defect”

mental disease ✔ → cause of crime 

American Legal Institute (ALI) Rule

(1962): At the time of the crime → as a result of a “mental disease or defect” the person was unable to either 

1) know their behavior was wrong

or

2) Control their actions

Insanity Defense Reform Act

(1984): At the time of the crime, as a result of a “mental disease” OR intellectual disability, the person did not know their behavior was wrong 

Guilty but Mentally I’ll (GBMI) 

(Az & other states use): Defendants incarcerated normal term for crime, but their mental illness is recognized 

ALSO: no guarantee defendant receives treatment for their mental illness.

Psychologists help with determining competence to stand trial, after evaluation there are 3 possible outcomes…

1) Competent to stand trial: trial continues 

2) Competent AFTER Restoration

3) Incompetent to Stand Trial (IST)

Civil Commitment Pre and Post 1969

pre: the need for treatment was sufficient cause for civil commitment

post: the need for treatment is no longer a sufficient cause 

The 4 criteria’s for Involuntary Commitment: (need to meet at least 1)

1) Danger to Self

2) Danger to others

3) Persistently or acutely disabled - the person is significantly suffering due to an untreated mental health disorder 

4) Gravely Disabled - can’t take care of themselves 

Civil Commitment PROCESS 

1) 72h emergency hospitalization for observation & evaluation

2) Evaluated by 2 independent psychiatrists 

3) Public hearing before judge 

4) released, changed to voluntary status, or petitioned to receieve court ordered treatment 

Symptoms of NCDs

memory impairment, aphasia, apraxia, agnosia, disturbance in executive functioning, changes in emotion and personality functioning 

Aphasia

1) Expressive Aphasia (broca’s area) : dfficultity PRODUCING written or spoken words

2) Receptive Aphasia (wnick’s area) → diffuculity UNDERSTANDING written or spoken words

ex: difficulity to find or understand their language

Apraxia

difficulty coordinating muscles/ sequencing the movements

ex: wants to brush teeth → can’t sequence the movements correctly

Agnosia

failure to recognize or identify objects despite intact sensory functions

ex: pic of lock → doesn’t know what it is 

Disturbance in executive functioning 

difficulty planning, initiating, monitoring, & stopping complex behaviors

ex: going to make pasta and meatballs → foegets the meatballs → when questioned, replies with, “what?”

Types of NCD’s 

1) Alzheimer’s 

2) Parkinson’s disease 

3) Lewy Body Disease 

4) Huntington’s Disease 

5) HIV Infection 

5) Vascular Disease 

6) Traumatic Brain Injury