Exam 3 Full Ver.

Psychosis

a state defined by a loss of contact with reality,

Symptoms may include hallucinations (false sensory perceptions) and/or delusions (false beliefs)

Schizophrenia Diagnosis

Only after symptoms of psychosis continue for six months or more

Individuals must also show a deterioration in their work, social relations, and ability to care for themselves

Schizophrenia gender differences

Average age of onset for men is 23 years, compared to 28 years for women

Women’s symptoms tend to be less severe

Schizophrenia Socioeconomic Status

More prevalent in low-SES groups

The Clinical Picture of Schizophrenia

The symptoms, triggers, and course of schizophrenia vary greatly

Some clinicians have argued that schizophrenia is actually a group of distinct disorders that share common features

3 categories of Schizophrenic symptoms

Positive symptoms (additions), Negative symptoms (lacking), Psychomotor symptoms

Schizophrenia: Positive Symptoms

Delusions, Hallucinations, Heightened perceptions, Inappropriate affect, derailments, neologisms, perseverations, and clang

Delusions

Delusions of persecution: Others are plotting against them

Delusions of grandeur: Believing one is destined for incredible greatness

Delusions of reference: Believing unrelated events are tailored to them specifically

Delusions of persecution

Others are plotting against them

Delusions of grandeur

Believing one is destined for incredible greatness

Delusions of reference

Believing unrelated events are tailored to them specifically

Hallucinations

sensory perceptions that occur in the absence of external stimuli

Heightened perceptions

People may feel that their senses are being flooded by sights and sounds, making it impossible to attend to anything important

Inappropriate affect

emotions that are unsuited to the situation

Loose associations (derailment)

Disconnected sentences that seem logical to the speaker but have no clear connection

Neologisms (made-up words)

ex. It is an amorition law

Perseveration

Patients repeat their words and statements again and again

Clang

speaking in rhyme

Schizophrenia: Negative Symptoms

Alogia: speech poverty, Restricted (flat) affect, Avolition: Loss of volition, Social withdrawal

Alogia: Poverty of speech

Reduction of quantity of speech or speech content (may say a lot but with little meaning)

Restricted (flat) affect

Show less emotion than most people; or immobile, expressionless face

Anhedonia – general lack of pleasure or enjoyment; avoidance of eye contact

Monotonous voice, low and difficult to hear

Avolition: Loss of volition (loss of motivation or directedness)

Feeling drained of energy and interest in normal goals

Inability to start or follow through on a course of action

Ambivalence – conflicted feelings about most things

Social withdrawal

May withdraw from social environment and attend only to their own ideas and fantasies

Schizophrenia: Psychomotor Symptoms

Awkward movements, repeated grimaces, odd gestures

Catatonia

marked psychomotor disturbance

Catatonic Stupor

Not moving for hours, unresponsive to environment

Catatonic Posturing

Not moving for hours with an awkward or bizarre position

Catatonic Rigidity

Not moving for hours with rigid and upright posture (standing)

Catatonic Excitement

Move excitedly, waving arms and/or legs

Schizophrenia: Courses

i. Prodromal

ii. Active

iii. Residual

Prodromal

beginning of deterioration; mild symptoms

Active

symptoms become stronger, more obvious to other

Residual

a return to prodromal-like level

A fuller recovery from the disorder is more likely in people:

With good premorbid functioning

Whose disorder was triggered by stress

With abrupt onset

With later onset (during middle age)

Who receive early treatment

Type I schizophrenia

is dominated by positive symptoms, Seem to have better adjustment prior to the disorder, later onset of symptoms, and greater likelihood of improvement, closely to biochemical abnormalities in the brain

Type II schizophrenia

is dominated by negative symptoms

May be tied largely to structural abnormalities in the brain

Schizophrenia: Causes

Biological explanations have more research support than other theorists

Biological explanations strongly support a diathesis-stress relationship, biological predisposition will develop schizophrenia only if certain kinds of stressors or events are also present

Biological Views

Genetic Predisposition, triggered by later exposure to extreme stress

Schizophrenia appears to be polygenetic and a single gene is not implicated

Biological View: Dopamine Hypothesis

certain neurons using dopamine fire too often, producing symptoms of schizophrenia

Antipsychotic medications

relationship suggested that symptoms of schizophrenia were related to excess dopamine, research support

dopamine receptors to which Antipsychotics bind

in schizophrenia, messages traveling from dopamine-sending neurons to dopamine-receptors (particularly D-2) may be transmitted too easily or too often

Atypical Antipsychotic Drugs Binds

bind to D-1 receptors and to serotonin receptors (reducing the activity of both), suggesting that it may be a combination of neurotransmitters which cause symptoms, More effective than traditional antipsychotics,

Brain Circuitry

Dopamine is indeed highly involved in this brain circuit, however, the existence of the brain circuit suggests that it is part of a larger system driving the symptoms, rather than the driving force

Biological View: Abnormal Brain Structure

Smaller temporal and frontal lobes

Smaller amounts of grey matter

Less blood flow to certain brain areas

Biological View: Viral Problems

biochemical and brain abnormalities result from exposure to viruses before birth, Mothers of children with schizophrenia were more often exposed to the influenza virus during pregnancy than mothers of children without schizophrenia

Biological Treatment

Typical Antipsychotic drugs serve as dopamine antagonists (better for positive symptoms), Atypical antipsychotics (both symptoms)

Antipsychotic drugs Side Effects:

parkinsonian symptoms (involuntarily motor movements resembling Parkinson’s)

Tardive dyskinesia -> More severe involuntary motor movement involving the face, mouth, tongue, limbs, and trunk

Atypical antipsychotics

Treat positive and negative symptoms about equal, develop agranulocytosis (a life-threatening drop in white blood cells)

Biological Treatment: Estrogen?

Positive symptoms decreased significantly for experimental group of women who wore estrogen patches

Developmental Psychopathology View

Individual’s genetic predisposition causes dysfunctional in a specific brain circuit, This may eventually lead to schizophrenia if, over the course of the person’s development, he or she experiences significant life stressors, difficult family interactions, and/or other negative environmental factors

Expressed Emotion

Emotional overinvolvement, criticism, and hostility.

Doesn’t predict development, but repeatedly shown to predict relapse

Psychotherapy

Psychotherapy alone is NOT helpful.

Psychotherapy as an adjunct to Medication is very helpful and prevents

relapse

Most supported: CBT, Family Therapy, and Social Skills Training

CBT seek to change how they view and react to their hallucinations

Provide education and evidence of the biological causes of hallucination

Help clients learn about the “comings and goings” of their own symptoms

Challenge clients’ inaccurate ideas about the power of their hallucinations

Teach clients to reattribute and more accurately interpret their hallucinations

Teach techniques for coping with their unpleasant sensations

Two categories of sexual disorder

Sexual dysfunctions and Paraphilic disorders

Sexual dysfunctions

Problems with sexual responses

Criteria for diagnoses: must cause significant distress to the individual for diagnosis

Paraphilic disorders

Repeated and intense sexual urges and fantasies in response to socially inappropriate objects or situations

4 phases of sexual response

Desire, excitement, orgasm, and resolution

Desire

Sparked by anything that prompts sexual interest

Excitement

Noticing physical changes in one’s body

Orgasm

Involves muscle contraction

Resolution

Positive feelings after orgasm

Sexual dysfunctions

affect one or more of the first three phases, 30% of men and 43% of women in the U.S.

Impact of Sexual Dysfunction

Typically very distressing, and often lead to sexual frustration, guilt, loss of self-esteem, and interpersonal problems

dysfunctions are interrelated; many patients with one dysfunction experience another as well

The Normal Sexual Response Cycle

female and male cycles

Disorders of Desire

Male hypoactive sexual desire disorder and Female sexual interest/arousal disorder

Male hypoactive sexual desire disorder

Characterized by a lack of interest in sex and little sexual activity

Not repulsed by sexual activity at all, and physical responses tend to be normal

Prevalent in about 16% of men

Female sexual interest/arousal disorder

Characterized by a lack of normal interest in sexual activity and physical responses tend to be abnormal

Rarely initiate sexual activity and may experience little excitement during sexual activity

Low sexual desire: Biological Causes

Hormones, Neurotransmitters, medications

Hormones related to a low sex drive

Low testosterone levels

low or high estrogen levels

High prolactin levels (prolactin -> best known for helping produce breast milk)

Neurotransmitters

Excessive activity of the NTs serotonin and dopamine lowers sexual desire

Medication that may lower sex drive

Birth control pills, Pain medication, Psychotropic drugs, Illegal drugs

Low sexual desire: Psychosocial Causes

increase in anxiety, depression, or anger

Fears, attitudes, and memories may contribute to sexual dysfunction

Certain psychological disorders, including depression and OCD

Low sexual desire: Social Causes

Situational Pressures, such as divorce or work stress

Trauma: Sexual molestation or assault is especially likely to produce aversion to sexual activity or hypoactive sexual desire

Excitement Phase of Desire

Marked by changes in the pelvic region, general physical arousal, and increases in heart rate, muscle tension, blood pressure, and rate of breathing

In men: erection of the penis

In women: swelling of the clitoris and labia and vaginal lubrication

erectile disorder: excitement

involves dysfunction in the excitement phase only

Disorders of Excitement: Erectile Disorder

Characterized by persistent inability to attain or maintain an erection during sexual activity, affects 50% of men, result from an interaction of biological, psychological, and sociocultural processes

Erectile Disorder: Biological Causes

Hormonal imbalances

Most commonly, vascular problems are involved

Damage to the nervous system from various diseases, disorders, or injuries

Medications and substance abuse may interfere with erections

Diagnosing biological causes of ED

measuring nocturnal penile tumescence (NPT)

“snap gauge” band

measuring nocturnal penile tumescence (NPT)

Men typically have erections during REM sleep - abnormal or absent nighttime erections usually indicate a physical basis for erectile failure

“snap gauge” band

If the man wakes up in the morning and it is unbroken, his ED likely has a physical basis

Erectile Disorder: Psychosocial Causes

Performance Anxiety and the spectator role,

Up to 90% of men with severe depression experience some degree of ED

Job and marital distress are particularly relevant

Performance Anxiety and the spectator role

Once a man begins to have erectile difficulties, he becomes fearful and worries during sex; instead of being a participant, he becomes a spectator and judge

Orgasm phase of the sexual response cycle

Sexual pleasure peaks and sexual tension is released as the muscles in the pelvic region contract rhythmically

For men: semen is ejaculated

For women: the outer third of the vaginal walls contract

Three disorders of phase of Orgasm

Premature ejaculation

Delayed ejaculation

Female orgasmic disorder

Disorders of Orgasm: Ejaculation Disorders

Premature ejaculation and Delayed ejaculation

Premature ejaculation

Ejaculation within one minute of beginning of sex and before he wishes

As many as 30% of men experience rapid ejaculation at some time

Unlike ED, common in men throughout the lifespan

Delayed ejaculation

Repeated inability to ejaculate or very delayed ejaculation during sex 75% of the time, without the individual desiring delay

Biological causes of delayed ejaculation

low testosterone, neurological disease, and head CNS injury

Medications, that slows down sympathetic NS (i.e. antidepressants) may have an effect

Psychological causes of delayed ejaculation

Appears to be performance anxiety and cognitive factors involved in ED

Another psychological factor may be past masturbation habits

Disorders of Orgasm: Female Orgasmic Disorder

Characterized by persistent failure to reach orgasm, experiencing orgasms of very low intensity, or delay in orgasm

Women who reach orgasm during masturbation but not during sex do not have this disorder

Disorders of Orgasm: Female Orgasmic Disorder Statistics

24% of women appear to have problems experiencing orgasm at least

to some degree.

10% or more have never reached orgasm

An additional 9% reach orgasm only rarely

More common in single women than in married or cohabiting women

Women who are more sexually assertive and more comfortable with masturbation tend to have orgasms more regularly

Female Orgasmic Disorder (FOD) sociocultural theory

Female orgasmic problems occur due to society’s sexual double standards against women

Research does not support these ideas

Biological causes Female Orgasmic Disorder (FOD)

diabetes and multiple sclerosis

The same meds/drugs, and hormones that affect ED may be responsible in FOD

FOD: Psychological Causes

Same as causes interfering with arousal, including depression

Memories of childhood trauma (such as sexual assault) and relationship

• A mother and father who were affectionate with each other

• Mother’s positive personality

• Mother’s open expression of positive emotions

• Dependable father

• Overall, a happy childhood

aspects of women who have healthy orgasm report

Genito-pelvic pain/penetration disorder (GPPD)

Enormous physical discomfort (not necessarily pain) during intercourse

Experienced by women much more often than men

Vaginismus

involuntary contractions of the muscles of the outer third of the vagina

Severe cases can prevent a woman from having intercourse

This problem has received relatively little research, but estimates are that it occurs in fewer than 1% of all women

Dyspareunia

Severe pain during intercourse (no muscle contractions)

As many as 14% have this

GPPD: Causes

Vaginismus: Most clinicians agree that this is a learned fear response from classical conditioning

Dyspareunia: Usually has a physical cause, most commonly from injury sustained in childbirth; but also possibly from infection or disease

Dyspareunia

Usually has a physical cause, most commonly from injury sustained in childbirth; but also possibly from infection or disease

Modern sex therapy is short-term and instructive

Therapy typically lasts 15 to 20 sessions

It is centered on specific sexual problems rather than on broad personality issues