exam 4 study guide

IMPULSE CONTROL DISORDER

disruptive, impulse control, and conduct disorders.

PYROMANIA

involves having an irresistible urge to set fires

PYROMANIA TREATMENT

treatment usually focuses on identifying urges and practicing incompatible behaviors

KLEPTOMANIA

failure to resist the urge to steal unnecessary items

INTERMITTENT EXPLOSIVE DISORDER

frequent aggressive outbursts leading to injury and/or destruction of property

PERSONALITY DISORDER

persistent pattern of emotions, cognitions, and behavior that results in enduring emotional distress for the person affected and/or for others and may cause difficulties with work and relationships.

AGONIST SUBSTITUTION

a safer drug with similar chemical composition, like gum for nicotine

ANTAGONIST DRUGS

drugs that block/counteract the effects of substances

AVERSIVE TREATMENT

drugs that make substances extremely unpleasant

CONTINGENCY MANAGEMENT

a behavioral therapy that uses rewards to encourage positive behavioral change

CONTINUUM MODEL (DIMENSIONAL)

Individuals are rated on the degree to which they exhibit various personality traits

CATEGORICAL MODEL

Personality disorders have traditionally been assigned as all-or-nothing categories

PERSONALITY DISORDER DIAGNOSIS

general criteria: an individual's personality pattern must deviate markedly from the expectations of his or her culture, be pervasive and inflexible across situations, be stable over time, have an onset in adolescence or early adulthood, lead to significant distress or functional impairment

PERSONALITY DISORDER CLUSTER A

odd or eccentric: paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder

PERSONALITY DISORDER CLUSTER B

dramatic or erratic: antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder

PERSONALITY DISORDER CLUSTER C

anxious or fearful: avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder

PARANOID PERSONALITY DISORDER

pervasive and unjustified mistrust and suspicion. the belief that other people try to deceive or exploit them and even events unrelated to them are construed as personal attacks

PARANOID PERSONALITY DISORDER SYMPTOMS

-few meaningful relationships
-behave aggressively or antagonistically
-sensitive to criticism
-excessive need for autonomy

PARANOID PERSONALITY DISORDER ETIOLOGY

-genetic predisposition (related to schizophrenia spectrum of disorders)
-psychological factors may involve early learning that people and the world are dangerous or deceptive
-cultural factors: more often found in people with experiences that lead to mistrust of others

PARANOID PERSONALITY DISORDER TREATMENT

focuses on development of trust; cognitive therapy to counter negativistic thinking

SCHIZOID PERSONALITY DISORDER

pervasive pattern of detachment from social relationships

SCHIZOID PERSONALITY DISORDER SYMPTOMS

-social isolation
-very limited range of emotions in interpersonal situations
-limited experience and expression
-indifference to other people.
-low interest to sexual experiences

SCHIZOID PERSONALITY DISORDER ETIOLOGY

inhibitory dysfunction, childhood shyness, may have significant overlap with autism spectrum disorder

SCHIZOID PERSONALITY DISORDER TREATMENT

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

SCHIZOTYPAL PERSONALITY DISORDER

-behavior and beliefs odd and unusual
-socially isolated and highly suspicious
-magical thinking, ideas of reference, and illusions
-many meet criteria for major depression
-some conceptualize this as resembling a milder form of schizophrenia

SCHIZOTYPAL PERSONALITY DISORDER ETIOLOGY

-mild expression of "schizophrenia genes"
-may be more likely to develop after childhood maltreatment or trauma, especially in men
-more generalized brain deficits may be present

SCHIZOTYPAL PERSONALITY DISORDER TREATMENT

address comorbid depression +
main focus is combination of medication, cognitive behavior therapy, and social skills training

ANTISOCIAL PERSONALITY DISORDER

-failure to comply with social norms
-violation of the rights of others
-irresponsible, impulsive, and deceitful
-lack of a conscience, empathy, and remorse -"sociopathy," "psychopathy*" typically refer to very similar traits
-may be very charming, interpersonally manipulative

CONDUCT DISORDER + ANTISOCIAL PERSONALITY DISORDER RELATIONSHIP

antisocial Personality Disorder often show early histories of behavioral problems, including conduct disorder

CONDUCT DISORDER

-a separate diagnosis for children who engage in norm-violating behaviors.
-childhood-onset vs. adolescent-onset subtypes.
-callous-unemotional" type of conduct disorder more likely to evolve into antisocial PD
-predominantly boys

ANTISOCIAL PERSONALITY DISORDER ETIOLOGY

genetic influences:
-more likely to develop antisocial behavior if parents have a history of antisocial behavior or criminality
-interaction between genetic predispositions and environmental influences

neurobiological influences:
-neurobiological alterations influencing behavior may exist

psychological and social influences:
-in research studies, psychopaths are less likely to give up when goal becomes unattainable - may explain why they persist with behavior (e.g. crime) that is punished

developmental influences:
-high-conflict childhood increases likelihood of APD in at-risk children

AROUSAL THEORY (for APD)

people with APD are chronically under-aroused (cortical arousal low) and seek stimulation from the types of activities that would be too fearful or aversive for most

IMPAIRED FEAR CONDITIONING (for APD)

children who develop APD may not adequately learn to fear aversive consequences of negative actions (e.g., punishment for setting fires)

GREY'S MODEL (for APD)

inhibition signals are outweighed by reward signals

ANTISOCIAL PERSONALITY DISORDER TREATMENT

-emphasis is placed on prevention and rehabilitation
-often incarceration is the only viable alternative
-may need to focus on practical (or selfish) consequences (e.g., if you assault someone you'll go to prison)

BORDERLINE PERSONALITY DISORDER

-unstable moods and relationships
-impulsivity, fear of abandonment, very poor self-image
-self-harm and suicidal gestures

BORDERLINE PERSONALITY DISORDER ETIOLOGY

-strong genetic component
-high emotional reactivity may be inherited
-may have impaired functioning of limbic system
-hyperattentive to negative emotional stimuli in the environment
-early trauma/abuse increase risk

"TRIPLE VULNERABILITY MODEL" (BPD)

generalized biological vulnerability; generalized psychological vulnerability; specific psychological vulnerability

BORDERLINE PERSONALITY DISORDER TREATMENT

-antidepressant medications provide some short-term relief
-dialectical behavior therapy* is most promising treatment

DIALECTICAL BEHAVIOR THERAPY (BPD)

-focus on dual reality of acceptance of difficulties and need for change
-focus on interpersonal effectiveness
-focus on distress tolerance to decrease reckless/self-harming behavior

HISTRIONIC PERSONALITY DISORDER

-overly dramatic and sensational
-may be sexually provocative
-often impulsive and need to be the center of attention
-thinking and emotions are perceived as shallow
-more commonly diagnosed in females

HISTRIONIC PERSONALITY DISORDER ETIOLOGY

-etiology unknown due to lack of research
-often co-occurs with antisocial PD, suggesting it may be a sex-typed variant

HISTRIONIC PERSONALITY DISORDER TREATMENT

-focus on attention seeking and long-term negative consequences
-targets may also include problematic interpersonal behaviors
-little evidence that treatment is effective

NARCISSISTIC PERSONALITY DISORDER

-exaggerated and unreasonable sense of self-importance
-preoccupation with receiving attention
-lack sensitivity and compassion for other people
-highly sensitive to criticism; envious and arrogant

NARCISSISTIC PERSONALITY DISORDER ETIOLOGY

causes are largely unknown
• failure to learn empathy as a child
• sociological view (Lasch)- product of the "me" generation

NARCISSISTIC PERSONALITY DISORDER TREATMENT

• focus on grandiosity, lack of empathy, unrealistic thinking
• emphasize realistic goals and coping skills for dealing with criticism
• little evidence that treatment is effective

AVOIDANT PERSONALITY DISORDER

• extreme sensitivity to the opinions of others • highly avoidant of most interpersonal relationships
• interpersonally anxious and fearful of rejection
• low self-esteem

AVOIDANT PERSONALITY DISORDER ETIOLOGY

• may be linked to schizophrenia; occurs more often in relatives of people with schizophrenia
• experiences of early rejection
• childhood experiences of neglect, isolation, rejection, and conflict with others

AVOIDANT PERSONALITY DISORDER TREATMENT

• similar to treatment for social phobia (benzodiazepines or SSRIs)
• focus on social skills, entering anxiety-provoking situations
• good relationship with therapist is important

DEPENDENT PERSONALITY DISORDER

• reliance on others to make major and minor life decisions
• unreasonable fear of abandonment
• clingy and submissive in interpersonal relationships

DEPENDENT PERSONALITY DISORDER ETIOLOGY

not well understood but may be linked to failure to learn independence

DEPENDENT PERSONALITY DISORDER TREATMENT

therapy typically progresses gradually due to lack of independence

OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

• excessive and rigid fixation on doing things the right way
• highly perfectionistic, orderly, and emotionally shallow
• unwilling to delegate tasks because others will do them wrong
• difficulty with spontaneity
• often have interpersonal problems
• obsessions and compulsions are rare

OBSESSIVE-COMPULSIVE PERSONALITY DISORDER ETIOLOGY

causes are not well known
• moderate genetic contribution

OBSESSIVE-COMPULSIVE PERSONALITY DISORDER TREATMENT

• treatment targets include cognitive reappraisal techniques to reframe compulsive thoughts
• target rumination, procrastination, and feelings of inadequacy

WHAT IS DELUSION?

• beliefs that are highly unlikely
• they are often impossible.
• people tend to be preoccupied with delusions.
• delusional patients express and defend their beliefs with utmost conviction.
POSITIVE SYMPTOM

DELUSIONS OF GRANDEUR

beliefs that one is a special being or possesses special powers.

DELUSIONS OF PERSECUTION

beliefs that others watch or torment them

DELUSIONS OF THOUGHT INSERTION

beliefs that one's thoughts are being controlled

DELUSIONS OF REFERENCE

beliefs that random events or comments by others are directed at the individual

CAPGRAS SYNDROME

beliefs that someone they know has been replaced by an imposter

COTARD'S SYNDROME

believes that they are dead

WHAT ARE HALLUCINATIONS?

• sensory experiences that are not caused by actual external stimuli.
• these experiences are persistent and real.
• they can vary in terms of both duration and severity.
POSITIVE SYMPTOM

AUDITORY HALLUCINATIONS

the most common hallucinations
-the perception of sounds that are not there, such as voices or noises

VISUAL HALLUCINATIONS

the second most common form of hallucination
-an experience of seeing things that are not there, such as objects, people, animals, or lights

TACTILE HALLUCINATIONS

perceptions outside of the person's body

SOMATIC HALLUCINATIONS

perception inside the person's body

NEGATIVE SYMPTOM CHARACTERISTICS

• they involve the loss of certain qualities of the person
• they may initially be more subtle or difficult to recognize than the positive symptoms
• the presence of strong negative symptoms is associated with poor outcome
• they tend to be persistent and more difficult to treat.
• negative symptoms improve over time.

AVOLITION

inability to initiate and persist in activities
NEGATIVE SYMPTOM

ALOGIA

absence of speech
NEGATIVE SYMPTOM

ASOCIALITY

lack of interest in social interactions
NEGATIVE SYMPTOM

ANHEDONIA

presumed lack of pleasure
NEGATIVE SYMPTOM

AFFECTIVE FLATTENING

do not show emotions when emotions would normally be expected
NEGATIVE SYMPTOM

DISORGANIZED SYMPTOMS

symptoms of schizophrenia that do not fit easily into either the positive or negative type
(understudied)

DISORGANIZED SPEECH

ERRATIC SPEECH AND EMOTIONS
• include giving irrelevant responses to questions, expressing disconnected ideas, and using words in peculiar ways.
• may reflect a disturbance in the thought patterns that govern verbal discourse.
• loose associations (Derailment): tendency to slip from one topic to an unrelated topic with little coherent transition,
• responding tangentially: replying to a question with an irrelevant response
• perseveration: repeating the same word or phrase over and over.
• word salad: totally incoherent speech

INNAPROPRIATE AFFECT

incongruity and lack of adaptability in emotional expression.
-They may show laughter or tears at inappropriate moments.

DISORGANIZED BEHAVIOR

peculiar or "unconventional" behaviors

CATATONIA

unusual motor responses, particularly immobility or agitation, and odd mannerisms

MAY INCLUDE:
• stupor, mutism, maintaining the same pose for hours
• opposition or lack of response to instructions
• repetitive, meaningless motor behaviors
• mimicking others' speech or movement

WHAT IS THE AGE ONSET OF SCHIZOPHRENIA?

the risk increases between the ages of 15 and 35

more severe symptoms = late adolescence or early adulthood

early childhood indications can be present like mild physical abnormalities, poor motor coordination, mild cognitive and social difficulties.

WHAT ARE THE STAGES OF SCHIZOPHRENIA?

prodromal stage
active stage
residual stage

PRODOMAL STAGE

less severe yet unusual behaviors begin to manifest
• daily functioning deteriorates
• ideas of reference, magical thinking, illusions, social isolation, lack of interests, or energy, unusual perceptual experiences, outbursts of anger, increased tension, and restlessness.

ACTIVE STAGE

psychotic symptoms start to occur

RESIDUAL STAGE

symptoms (mainly negative symptoms) similar to prodromal stage.
• dramatic symptoms of psychosis have improved.

SCHIZOPHRENIFORM DISORDER

psychotic symptoms lasting between 1 to 6 months (>6 months would be diagnosed as schizophrenia)
**if the person does not recover after six months, the diagnosis would be changed to schizophrenia. **

SCHIZOAFFECTIVE DISORDER

• symptoms of schizophrenia + additional experience of a major mood episode (depressive or manic)
• psychotic symptoms must also occur outside the mood disturbance

DELUSIONAL DISORDER

characterized by delusions that are contrary to reality
lack other positive and negative symptoms

BRIEF PSYCHOTIC DISORDER

characterized by positive symptoms of schizophrenia (e.g., hallucinations or delusions) or disorganized symptoms
lasts less than one month

ATTENUATED PSYCHOSIS SYNDROME

refers to individuals who are at high risk for developing schizophrenia or beginning to show signs of schizophrenia
• label designed to focus attention on these individuals who could benefit from early intervention

identified as a condition in need of further study in DSM-5

GENETIC FACTORS OF SCHIZOPHRENIA

genes contribute to the schizophrenia
• no single gene

twin studies show monozygotic twins have greater concordance than dizygotic twins
• in the genetically identical individuals who developed schizophrenia, specific symptoms, onset, course, and outcomes varied substantially.

adoption studies show adoptee risk for developing schizophrenia is high if a biological parent has schizophrenia
but risk is lower than for children raised by their biological parent with schizophrenia

NEUROBIOLOGICAL CAUSES OF SCHIZOPHRENIA

the dopamine hypothesis: schizophrenia is partially caused by overactive dopamine

structural and functional abnormalities in the brain
• enlarged ventricles and reduced tissue volume
• genetic and environmental factors.
• reduced white matter
• frontal lobe dysfunction
• hypofrontality - less active frontal lobes
• a major dopamine pathway
• the prefrontal cortex, related cortical areas, and subcortical circuits like the thalamus and striatum
• cognitive dysfunctions

prenatal and perinatal factors
• viral infections during early prenatal development
• findings are inconsistent
• pregnancy and delivery complications: bleeding or asphyxia
• interactions with genetic predisposition
• marijuana use

THE ROLE OF STRESS IN SCHIZOPHRENIA

may activate underlying vulnerability and may also increase risk of relapse

FAMILY INTERACTIONS AND SCHIZOPHRENIA

high expressed emotion (EE) - associated with relapse

EXPRESSED EMOTION AND SCHIZOPHRENIA

communication style characterized by high levels of criticism, hostility, and emotional over involvement from family members

MEDICAL TREATMENT OF SCHIZOPHRENIA

antipsychotic medication
• The first line treatment for schizophrenia

WHY IS COMPLIANCE AN ISSUE WITH MEDICAL TREATMENT OF SCHIZOPHRENIA?

compliance with medication is often a problem due to aversion to side effects

AKINESIA

antipsychotic medication side effect that causes lack of facial expression, sluggish motor function, and monotone speech.

TARDIVE DYSKINESIA

antipsychotic medication side effect that causes involuntary movements of the tongue, face, mouth, or jaw

PSYCHOLOGICAL TREATMENT OF SCHIZOPHRENIA

traditional psychotherapy was not effective in positive symptoms
• psychosocial approaches: preventing drug non-compliance, increasing (rewarding) adaptive behavior, behavioral methods like the token economy*, social and living skills training, vocational rehabilitation

THE TOKEN ECONOMY

a behavioral therapy technique where patients with schizophrenia are given tokens as rewards for performing desired behaviors, like maintaining personal hygiene or actively participating in therapy

WHAT IS CIVIL COMMITMENT?

when a person can be legally declared to have a mental illness and be placed in a hospital for treatment