Psychopathology: Unit 4 content (for final)

Schizophrenia

Psychological disorder characterized by disruption in thinking, emotion, and social functioning; chronic or persistent course lasting 6+ months

Onset of Schizophrenia

late adolscence to early adulthood

Prevalence of schizophrenia

~1% worldwide, reduces life expectancy by 15-20 years

Positive symptoms of schizophrenia

Excess or distortion of normal functions

hallucination

perceptions without external stimuli that are often recurrent or persistent; auditory are most common

Delusions

fixed, false beliefs that are resistant to evidence and reflect disturbed thought content

Negative symptoms of schizophrenia

loss or reduction of normal functions that are the strongest prediction of long-term functional impairment

Anhedonia

reduced ability to experience pleasure

Blunted affect

diminished emotional expression

Alogia

reduced speech output

Avolition

Decreased motivation for goal-directed behavior

Asociality

Social withdrawal and reduced desire for social contact

disorganized symptoms of schizophrenia

symptoms that do not neatly fit into positive or negative categories

Disorganized speech

Disrupted flow of ideas, loose associations, word salad

disorganized behavior

unpredictable or goal-incoherent behavior

Stupor

reduced responsiveness and immobility

Catalepsy

rigid posturing

Echolalia and echopraxia

repeated others' words and mimicking others' movements

Active phase of schizophrenia

requires functional impairment and at least two other major symptoms

Prodromal and residual phases of schizophrenia

Phases during which symptoms are less severe, negative symptoms or mild positive symptoms are more common, similar profile to schizotypal personality disorder

Men and schizophrenia

earlier age of onset, worse premorbid social functioning, more negative symptoms, poorer response to treatment

Women and schizophrenia

Later age of onset, better premorbid functioning, better response to treatment, more favorable course

Twin studies for schizophrenia

MZ concordance = 48%, DZ concordance = 17%, implying high heritability

Early risk factors of schizophrenia

maternal infection, malnutrition, obstetric complications

two-hit model of schizophrenia

early brain disruption causes subtle vulnerability, a later stresser triggers the onset of schizophrenia

Expressed emotion

High criticism, hostility, and emotional overinvolvement that increase relapse risk for schizophrenia

Psychosocial risk factors

Cannabis use, migration and minority stress, urban risk, and childhood adversity

Antipsychotics for schizophrenia

Primary treatment, effective for many, 25% have a poor response, significant side effects, 2nd generation atypical antipsychotics cause fewer side effects

Psychosocial treatments for schizophrenia

Used with medication to improve functioning and reduce relapse

Brief psychotic disorder

on the schizophrenia spectrum, fully psychotic symtoms that last less than one month

Schizophrenia heritability

~80% heritability with polygenic risk

Schizophreniform disorder

Psychotic disorder with the same symptoms profile as schizophrenia that lasts 1-6 months

Dopamine hypothesis

More dopamine increases positive symptoms, less dopamine increases negative and cognitive symptoms

Glutamate

Neurotransmitter that matches full picture of schizophrenia

Neurocognitive disorders

cognitive decline that affects one or more cognitive domains, such as memory, learning, and executive functioning

Delirium

a confusional state that develops acutely, fluctuates, and is often short lived if treated properly

Delirium symptoms

agitation, hyperactivity, disorganized thinking, poor attention, visual hallucinations, and delusions

Major Neurocogntive disorder

overall decline in memory and other cognitive skills severe enough to reduce a person's ability to perform everyday activities

Retrograde amnesia

Loss of memory for events prior to illness

Anterograde amnesia

inability to learn or recall new material, most obvious problem during the beginning stages of dementia

Alzheimer's Disease

Abnormal deposits of proteins from amyloid plaques and tau tangles throughout the brain

Frontotemporal dementia

Abnormal amounts of Tau and TDP-43 proteins in neurons in the frontal and temporal lobes

Lewy Body dementia

abnormal deposits of Lewy Bodies, affecting the brain's chemical messengers

Vascular dementia

Conditions that disrupt blood flow to the brain

Parkinson's disease

loss of dopamine in the substantia nigra that causes tremors, slow movement, and neural functioning deficits

Huntington's disease

inherited with memory problems, personality changes, and mood difficulties

Dementia Co-occurence

~25% of patients with dementia also exhibit symptoms of major depressive disorder

Mild Neurocognitive disorder

slight decline in memory and other cognitive skills that does not significantly interfere with independent daily living activities

Medication for neurocognitive disorders

not a cure, but helps to slow disease progression

Psychosocial interventions for neurocognitive disorders

Treating neurocognitive disorders by staying active and intersted in everyday events via cognitive stimulation and structured routines

Insomnia

dissatisfaction with sleep and difficulty falling or staying asleep that causes clinically significant distress or impairment

Insomnia prevalence

~30% of adults report symptoms, ~10% meet requirements to be clinically diagnosed

Insomnia co-occurance

Associated with a 2-3x increased risk of depression; also co-occurs with anxiety, PTSD, substance use, psychosis, and pain

Bidirectionality of insomnia

Insomnia predicts new disorders and is worsened by them

3P model of insomnia

predisposing (trait vulnerability) --> precipitating (trigger) --> perpetuating

Perpetuating factors of insomnia

conditioned arousal, time-in-bed extension, sleep effort, safety behaviors

CBT-I

Cognitive behavioral therapy for insomnia; works through stimulus control, sleep restriction, and cognitive restructuring

Pharmacology for insomnia

Benzos, Z-drugs, DORAs, and Melatonin; worse long-term effects than CBT-I

Paraphiliac disorder

Atypical sexual interest that causes distress or harm

Paraphilia

atypical sexual interest

Criterion A for Paraphiliac Disorder

Requires a paraphilia interest

Criterion B for paraphiliac disorder

Paraphiliac interest causes distress or harm to nonconsenting persons

Voyeuristic disorder

arousal from observing unsuspecting persons

frotteuristic disorder

arousal from touching or rubbing a nonconsenting person

Sexual sadism disorder

arousal from causing suffering

Fetishistic disorder

arousal from and obsession of specific objects or body parts

Exhibitionistic disorder

arousal from exposing genital

sexual masochism disorder

arousal from being humiliated

Pedophilic disorder

arousal from prepubescent children

Transvestic Disorder

arousal from cross-dressing

Childhood ADHD

Childhood disorder characterized by predominant inattentiveness, predominant hyperactivity, or combined presentation that causes cross situational impairment

Onset of childhood ADHD

Before age 12 (pre-adolescence)

Heritability of ADHD

74%, very high heritability

Neurological changes in children with ADHD

Prefrontal cortex changes cause executive functioning deficits along with stimulation of dopamine pathways

Prenatal risk factors for ADHD

Maternal smoking, alcohol use, and low birth weight

Domain 1 of ASD

Social communication and interaction deficits

Domain 2 of ASD

Restricted and repetive behaviors and interests

ASD in DSM-5

ASD is a spectrum disorder with different severity levels

ASD prevalence

1 out of 36 children are diagnosed, 4:1 male to female ratio

Early signs of ASD

Reduced joint attention and language delays, often observable by age 2

Oppositional defiant disorder

Childhood disorder characterized by irritability, argumentative personality, and vindictiveness

Conduct disorder

Childhood disorder characterized by aggression, deceitfulness, property destruction, serious rule violations, and limited prosocial emotions

Conduct Disorder onset

onset before age 10 indicates more severity and has stronger link to antisocial personality disorder; onset after age 10 has better prognosis long-term

Civil commitment

To be committed to a mental health instituion, a person must have a mental illness AND be either a danger to self, others, or have a grave disability

Competence to stand trial

A person's ability to stand trial is about their current mental state, not about their state at the time of the crime; requires factual and rational understanding of the situation and ability to consult with counsel

Dusky vs US

foundation for competency to stand trial

John Hinckley Jr

Man who shot president reagan and was found not guilty for insanity; after his case, rules were passed saying insanity by defense (rather than sanity by prosecution) must be proven

Therapeutic jurisprudence

the court acting as part of mental health treatment; requires voluntary participation, collaboration and an incentive structure

Parens partia

justifies intervention when a person cannot care for themselves

Police power

justifies intervention when a person poses a danger to others

Mandated reporting

Major exception to confidentiality that includes child abuse and neglect, elder abuse, and dependent adult abuse

ASD interventions

Applied behavior analysis, speech and social skills training, Early Start Denver Model

Intellectual disabilities

deficits in intellectual functioning or adaptive function that have onset during the developmental period

Disruptive mood regulation disorder

severe and recurrent temper outburts that last 12+ months in at least 2 settings

childhood depression

predominant mood is irritability, prevalence rises in adolesence, more common in women

treatment for childhood disorders

cogntive behavior therapy, parenting management training, and school-based interventions