week 20 - psychopathology II

anhedonia

Loss of interest or pleasure in activities one previously found enjoyable or rewarding.

attributional style

The tendency by which a person infers the cause or meaning of behaviors or events.

chronic stress

Discrete or related problematic events and conditions which persist over time and result in prolonged activation of the biological and/or psychological stress response (e.g., unemployment, ongoing health difficulties, marital discord).

early adversity

Single or multiple acute or chronic stressful events, which may be biological or psychological in nature (e.g., poverty, abuse, childhood illness or injury), occurring during childhood and resulting in a biological and/or psychological stress response.

grandiosity

Inflated self-esteem or an exaggerated sense of self-importance and self-worth (e.g., believing one has special powers or superior abilities).

hypersomnia

Excessive daytime sleepiness, including difficulty staying awake or napping, or prolonged sleep episodes.

psychomotor agitation

Increased motor activity associated with restlessness, including physical actions (e.g., fidgeting, pacing, feet tapping, handwringing).

psychomotor retardation

A slowing of physical activities in which routine activities (e.g., eating, brushing teeth) are performed in an unusually slow manner.

social zeitgeber

Zeitgeber is German for “time giver.” Social zeitgebers are environmental cues, such as meal times and interactions with other people, that entrain biological rhythms and thus sleep-wake cycle regularity.

socioeconomic status (SES)

A person’s economic and social position based on income, education, and occupation.

How can you best distinguish between a manic episode and a hypomanic episode?

• By the duration and level of impairment.

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• By the age at which the person experiences symptoms.

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• By determining whether the symptoms are a side effect of a medication.

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• By the presence or absence of depressive symptoms.

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• By looking at whether or not the symptoms have an identifiable trigger or came “out of the blue.”

by the duration and level of impairment

Dr. Scarcliff is seeing a patient with symptoms of euphoria and grandiosity. What question should he ask to determine if the correct diagnosis is bipolar I or bipolar II disorder?

• Is this patient experiencing a manic episode or a hypomanic episode?

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• Is there any indication that this patient is currently taking recreational substances?

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• Has this patient had the symptoms for more or less than two weeks?

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• Does there seem to be any recent history of a major depressive episode?

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• Has this patient suffered from these symptoms in the past?

is this patient experiencing a manic episode or a hypomanic episode?

The way in which a person infers the cause or meaning of behaviors or events around them is called their ______style.

•  thinking

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• causational

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• ruminative

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• personal-bias

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• attributional

attributional

Karla takes antidepressants but has been advised that she should stay away from “anything that has tyramine” such as wine, soy sauce, and aged cheese. What kind of drugs does Karla take?

• a monoamine oxidase inhibitor (MAOI)

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• a tetracyclic antidepressant (TTCA)

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• a tricyclic antidepressant (TCA)

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• a selective serotonin reuptake inhibitor (SSRI)

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• neuroleptic mood stabilizer (NMS

a monoamine oxidase inhibitor (MAOI)

When someone with bipolar disorder is prescribed lithium, the expected changes include:

• a decrease of dopamine and glutamate and increase of GABA neurotransmitters

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• an increase in adrenaline and a decrease in the noradrenaline hormones.

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• a decrease adrenaline and an increase in noradrenaline hormones.

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• the release of both agonist and antagonist enzymes in synaptic clefts.

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• an increase of dopamine and glutamate and a decrease of GABA neurotransmitters.

lithium

alogia

A reduction in the amount of speech and/or increased pausing before the initiation of speech.

catatonia

Behaviors that seem to reflect a reduction in responsiveness to the external environment. This can include holding unusual postures for long periods of time, failing to respond to verbal or motor prompts from another person, or excessive and seemingly purposeless motor activity.

delusions vs. hallucinations

False beliefs that are often fixed, hard to change even in the presence of conflicting information, and often culturally influenced in their content.

vs. Perceptual experiences that occur even when there is no stimulus in the outside world generating the experiences. They can be auditory, visual, olfactory (smell), gustatory (taste), or somatic (touch).

disorgnaized behaviour

Behavior or dress that is outside the norm for almost all subcultures. This would include odd dress, odd makeup (e.g., lipstick outlining a mouth for 1 inch), or unusual rituals (e.g., repetitive hand gestures).

episodic

The ability to learn and retrieve new information or episodes in one’s life.

flat affect

A reduction in the display of emotions through facial expressions, gestures, and speech intonation.

functional capacity

The ability to engage in self-care (cook, clean, bathe), work, attend school, and/or engage in social relationships.

MRI vs. positron emission tomography

Magnetic resonance imaging

A set of techniques that uses strong magnets to measure either the structure of the brain (e.g., gray matter and white matter) or how the brain functions when a person performs cognitive tasks (e.g., working memory or episodic memory) or other types of tasks.

Positron emission tomography

A technique that uses radio-labelled ligands to measure the distribution of different neurotransmitter receptors in the brain or to measure how much of a certain type of neurotransmitter is released when a person is given a specific type of drug or does a particularly cognitive task.

working memory

The ability to maintain information over a short period of time, such as 30 seconds or less.

Karl has been suffering from the symptoms of schizophrenia for about a year. He has a reduction in his responsiveness to events in his surroundings, and his motor behavior is often slow or aimless. Which of the following best describes these symptoms?

• hallucinations

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• anhedonia

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• catatonia

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• flat affect

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• delusions

catatonia

Of the following, which type of delusion is most commonly experienced among those suffering from a psychotic disorder?

• delusions of reference

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• thought control

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• delusions of guilt

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• persecutory delusions

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• erotomanic delusions

persecutory delusions

What is one of the biggest problems with the negative symptoms of schizophrenia?

• They may not be apparent to others and thus not get appropriate attention.

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• They show up very suddenly.

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• They are not seen frequently enough to be included in DSM-5.

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• The medications used to treat these symptoms have stronger side effects.

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• They are always accompanied by severe mood symptoms.

they may not be apparent to tohers and thus not get appropraite attention

Which of the following parts of the brain normally activate when important, aka “salient,” events happen? (These areas may under-perform in those with schizophrenia.)

• the anterior cingulate and the locus coeruleus

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• the dorsal amygdala and the posterior postfrontal cortex

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• the ventral striatum and the anterior prefrontal cortex

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• the ventromedial hippocampus and the inferior amygdala

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• the superior putamen and the lateral hypothalamus

the ventral striatum and the anterior prefrontal cortex

Both “typical” and “atypical” antipsychotic medications work by blocking a specific type of ______receptor in the brain.

• glutamate

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• norepinephrine

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• gamma-aminobutyric (GABA)

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• serotonin

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• dopamine

dopamine

Tyler, who suffers from schizophrenia, has recently developed a series of symptoms that his physician calls “metabolic syndrome.” What type of medication is he likely to be taking?

• benzodiazepines

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• beta blockers

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• tetracyclic antidepressants

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• selective serotonin reuptake inhibitors

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• atypical antipsychotics

atypical antipsychotics

major depressive episode

• Major Depressive Episode – marked by at least one of the following symptoms: depressed mood, anhedonia - and at least four other symptoms, for at least two weeks

• Cannot have history of any manic or hypomanic episodes

• Must cause significant distress or impair everyday functioning

what is persistent depressive disorder

feeling depressed more days than not for at least two years

what’s the diagnosis for Persistent depressive disorder

• Marked by at least two of the following symptoms: o Poor appetite or overeating o Insomnia or hypersomnia o Low energy or fatigue o Low self-esteem o Poor concentration or difficulty making decisions o Feelings of hopelessness

• Cannot be asymptomatic for more than two consecutive months

what is mania and hypomania

distinct period of abnormally and persistently elevated, expansive, or irritable mood and persistently increased goal-directed activity or energy

how do you diagnose mania or hypomania?

distinct period of abnormally and persistently elevated, expansive, or irritable mood and persistently increased goal-directed activity or energy

how do you diagnose mania or hypomania?

• Marked by at least three of the following symptoms (at least four with an irritable mood) o Inflated self-esteem or grandiosity o Increased goal-directed activity or psychomotor agitation o Reduced need for sleep o Racing thoughts or flight of ideas o Distractibility o Increased talkativeness o Excessive involvement in risky behaviours

• Mania – requires at least one week of symptoms

• Hypomania – requires at least four days of symptoms

what’s the difference between bipolar I and bipolar II?

• Bipolar I Disorder – characterized by at least one manic episode, with no depressive episode necessary for diagnosis

• Bipolar II Disorder – characterized by at least one hypomanic episode and at least one depressive episode

cyclothymia

alternating periods of hypomanic and depressive episodes for at least two years

what’s the criteria to diagnose cyclothymia?

• Symptoms are less severe than major depressive disorder

• Must experience symptoms for at least half the time without being asymptomatic for more than two consecutive months

early adversity

acute or chronic stressful events that occur during childhood like abuse or neglect

attributional style

the way in which individuals tend to infer the cause of behaviours or events

what are the three attributions? give an example of each?

Internal attributions – “I didn’t get into Harvard and it’s my fault” o Global attributions – “I didn’t get into Harvard because I’m stupid” o Stable attributions – “I didn’t get into Harvard so I will never get into University”

social zeitbeber theory

disruption of circadian rhythm can trigger a manic or depressive state

what are the pharmalogical treatments for major depressive order?

• Tricyclic Antidepressants – increase levels of norepinephrine, serotonin, and dopamine by blocking reabsorption at the synapse

• Monoamine Oxidase Inhibitors – block the enzyme monoamine oxidase ▪ Increase dopamine, norepinephrine, and serotonin levels

• Selective Serotonin Reuptake Inhibitors – attaches to the presynaptic autoreceptor to block the reuptake of serotonin

what are the biological treatments for major depressive order?

• Deep Brain Stimulation – electrodes surgically implanted into the brain that deliver pulses to disrupt neural activity

• Electroconvulsive Therapy – apply brief electrical current to the brain to induce a temporary seizure ▪ Effective for cases of severe depression

what are the psychosocial treatments for major depressive disorder?

• Cognitive-Behavioural Therapy – focuses on identifying and changing patients’ distorted thought process

• Interpersonal Therapy – focuses on improving interpersonal relationships by targeting problem areas, interpersonal role disputes, role transitions, and interpersonal deficits

• Short-Term Psychodynamic Therapy – focuses on a limited number of important issues

what is the treatment for bipolar disorder?

• pharmacological: lithium (Reduces levels of excitatory neurotransmitters like dopamine and glutamate), anticonvulsant medications

• psychosocial: Interpersonal and Social Rhythm Therapy – focuses on addressing sleep disruption and increasing regularity in the circadian rhythm cycle

what are the three criteria to diagnose shcizophrenia?

Criteria A – two or more of the following symptoms (must have at least one of the first three symptoms): delusions (of which there are different types), hallucinations (of which there are different types), disorganized speech, disorganized behaviour, or any negative symptoms

Criteria B – pervasive pattern of major social or occupational dysfunction

Criteria C – continuous signs of disturbance persist for at least six months

schizophreniform disorder

briefer version of schizophrenia

shcizoaffective disorder

mixture of psychosis and mood disorder

delusional disorder

the experience of only delusions

brief psychotic disorder

psychotic symptoms that last only a few days or weeks

attenuated psychotic syndrome

individuals who show milder symptoms of psychosis and experience distress or disability because of these symptoms but do not meet diagnostic criteria for full-blown psychotic disorders

what are some obersvations that might be made in neuroimaging that would denote schizophrenia?

• Reduced white matter connectivity and brain volume

• fMRI and PET scans indicate problems with the dorsolateral prefrontal cortex

  • Changes in working memory and cognitive control

  • Decreased connectivity to other brain regions, including the posterior parietal cortex, anterior cingulate, and temporal cortex

  • Contributes to deficits in episodic memory

how does the course of shizophrenia go?

premorbid, prodromal (in which there is acute onset and gradual onset), active

what’s the treatment for schizophrenia?

• cognitive enhancement therapy: – aimed to improve cognition, functional outcome, and social cognition by protecting against grey matter loss

• antipsychotic medications

  • typical: – drugs that block D2 dopamine receptors o Can help reduce hallucinations, delusions, and disorganized speech o Do not significantly improve cognitive deficits or negative symptoms

  • atypical: drugs that have mixed mechanisms of action but tend to influence D2 receptors o Associated with fewer motor side effects

what are the risk factors for shizophrenia?

genetic factors: Involves the interaction of genes and genetic susceptibility to the mental illness

Environmental factors: Problems during pregnancy including malnutrition, stress, infection, and diabetes • Complications during birth, especially hypoxia (lack of oxygen) • Associated with cannabis use

clinical high-risk research: Follows individuals who are at high risk for developing a psychotic disorder • Over time, 35% of individuals develop a psychotic disorder like schizophrenia