Psychopathology Final

What is a neurocognitive disorder?

A group of psych disorders with primary symptoms of significantly reduced mental abilities relative to one’s prior level of functioning

What are some possible changes in neurocognitive disorders

Changes in cognitive functioning

Possible unusual behavior

Possible mood changes

Unusual mental contents

What is important to distinguish when diagnosing neurocognitive disorders?

Normal cognitive changes associated with aging

Must compare cognitive functioning to prior abilities

What is crystallized intelligence?

Using knowledge from previous experience to reason in familiar ways

Remains stable and increases with age

What is fluid intelligence?

Creates new strategies to solve new problems using executive functioning, abstract reasoning, planning and good judgement

Begins to decline with age

What skills tend to decline with age?

Processing speed, attention and memory

(all relying on executive functioning and frontal lobe)

What are older adults less likely to be diagnosed with?

Depression

What symptoms present in older adults with depression?

direct: impaired cognitive functioning

indirect: anxiety, agitation, memory, concentration

What is aphasia?

Problems using language

What is Broca’s aphasia?

Problems producing speech

• Speak slowly, choppy, telegraphic (only using main words, omitting “and, or, of”

• Damage to left frontal lobe

What is Wernicke’s aphasia?

Problems in comprehending language and producing meaningful sentences

• Speaks fluently, but what they say does not make sense → “word salad”

• Sentences can be out of order/made up words

What is agnosia?

Problems understanding what is perceived

• No impairment in sensory abilities or knowledge about objects

• Prosopagnosia

What is prosopagnosia?

The inability to recognize faces

What is apraxia?

Problems with carrying out movements

• Problems with voluntary movements (walking, using your fingers)

• Muscles are not impaired, the issue is in the brain

What is delirium?

Disturbance in attention, awareness and a disruption of at least 1 other aspect of cognitive functioning

What groups is delirium most common in?

Elderly, terminally ill, and post-surgical patients

What are symptoms associated with delirium?

Decreased awareness of surrounding environment

Issues paying, maintaining and shifting attention

Seem distracted, out of it, unable to concentrate

What are some perceptual alterations associated with delirium?

Misinterpretations

Illusions

Hallucinations

What is dementia?

A general term for a set of neurocognitive disorders characterized by deficits in learning new info or recalling learned info plus one other type of cognitive impairment

What medical conditions can dementia arise due to?

Alzheimer’s, Parkinson’s, HIV Infection, Huntington’s, Head Trauma, Substance Induced

What is the most common medical condition leading to dementia?

Alzheimer’s (3/4 dementia cases)

What are some symptoms associated with alzheimer’s?

Irritability, personality changes, wandering, confusion

• Difficulty remembering new info

• Later: difficulty walking, talking and with self-care

How long after the onset of alzheimer’s does death occur?

8-10 years

What is a neurofibrillary tangle?

A mass created by tau proteins that twist together and destroy microtubules → no nutrient supply system

What is a amyloid plaque?

Protein fragments that accumulate on the outside of neurons, especially in the hippocampus

What is Parkinson’s disease?

Slow, progressive loss of motor function

What are some symptoms associated with Parkinson’s?

Trembling hands, shuffling walk, muscular rigidity

What percentage of people will develop dementia due to Parkinson’s disease?

Approximately 50% of people

What neurotransmitter is damaged by Parkinson’s disease and what does this affect?

Dopamine-releasing neurons in the substantia nigra, leading to executive functioning deficits

How does HIV infection lead to dementia?

Destroys white matter and subcortical brain areas, leading to impaired memory, concentration problems, tremors and behavioral changes

What can be used to slow/reverse brain damage?

Antiretroviral medications used to treat HIV

What is schizophrenia?

Psychotic symptoms that significantly affect emotions, behavior, mental processes and mental contents

What are positive symptoms of schizophrenia?

The presence of distorted mental processes, contents or behaviors (Intrusive and extensive)

• Hallucinations

• Delusions

• Disorganized speech

• Disorganized behavior

What are hallucinations?

Sensations so vivid that they are perceived as real

• Auditory hallucinations are most common, but there can be hallucinations associated with any sense

What are delusions?

Incorrect beliefs that persist despite evidence they don’t and follow a particular theme

What are paranoid delusions?

Belief of being persecuted by others

What are delusions of control?

Belief of being controlled by other people (or aliens) who put thoughts in their heads (thought insertion)

What are delusions of grandeur?

Belief of being more powerful, knowledgeable or capable than they really are

What are delusions of reference?

Belief of external events unrelated to self having a special meaning to them

What is disorganized speech?

Speaking incoherently

• Word salad (random stream of seemingly unconnected words)

• Neologisms (made up words)

What is disorganized behavior?

Behavior that is unfocused and disconnected from the goal of a person so they cannot accomplish basic tasks

• Large range of inappropriate behavior for the situation

• Catatonia

What is catatonia?

A person does not respond to the environment/remains in an odd posture/position with rigid muscles for hours

How many of the DSM-5 schizophrenia criteria relate to positive symptoms?

4/5 symptoms

What are negative symptoms of schizophrenia?

The absence of normal mental processes, contents and behaviors

• Flat affect

• Alogia

• Avolition

What is flat affect?

A narrowed range of emotional expression

• Emotionally neural: they experience emotions, but you couldn’t tell by looking at them

What is alogia?

Speaking less than other people and responding slowly and minimally to questions

• Poverty of speech

What is avolition?

Difficulty initiating/following through with activities

• Sitting for hours due to difficulty getting up and doing something

• Different from catatonia (which is the presence of a disorganized behavior rather than being physically unable to move)

What is schizophreniform disorder?

symptoms that meet all the criteria for schizophrenia but have only been present between 1-6 months

What is brief psychotic disorder?

sudden onset of positive/disorganized symptoms lasting between 1 day - 1 month followed by a full recovery

What is schizoaffective disorder?

Presence of both schizophrenia and a depressive/manic episode

What is delusional disorder

The presence of non-bizarre but incorrect beliefs that last more than 1 month

What is shared psychotic disorder?

Developed delusions due to a close relationship with another person who has a psychotic disorder

What are the phases of schizophrenia in order?

Premorbid phase → prodromal phase → active phase

What is the premorbid phase?

People who go on to develop schizophrenia tend to be odd/eccentric and have difficulty interacting with others appropriately

What is the prodromal phase?

Precedes the onset of a psych disorder, when symptoms do not yet meet all criteria for the disorder

What is the active phase?

When an individual meets all criteria for a psych disorder (a psychotic episode)

What gender is more likely to develop schizophrenia?

Men

What gender is more likely to develop schizophrenia earlier in age?

Men (18-25)

What factors make women more likely to have a child with schizophrenia?

Experiencing famine, winter or infection during pregnancy

What type of schizophrenia makes someone more likely to commit suicide?

Paranoid Schizophrenia

What areas is schizophrenia more common?

Urban areas and areas with low SES

What is the relationship between schizophrenia and violence?

Most with schizophrenia do not engage in violent behavior

More likely to be victims of violence

What brain abnormalities are associated with schizophrenia?

Enlarged ventricles (brain size is reduced even before development of the disorder)

Impaired frontal lobe functioning → positive symptoms like auditory hallucinations

Smaller thalamus

Smaller hippocampus

What is pruning hypothesis?

Excessive pruning during adolescence eliminates many neural connections to the frontal cortex

Dopamine hypothesis

Schizophrenia arises from an overproduction of dopamine or an increase in number/sensitivity of dopamine receptors (especially in frontal lobes) which triggers flooding of unrelated thoughts, behaviors and feelings

What is a criticism of dopamine hypothesis?

It is an overcomplication and overlooks that many neurotransmitters interact to create structural and functional abnormalities in schizophrenia

How does serotonin relate to schizophrenia?

Medications that affect serotonin levels can decrease positive and negative symptoms. Serotonin enhances glutamate and this excess can cause disruptions in neuron activation in the frontal lobe

What are the steps in treating schizophrenia?

1. When actively psychotic, reduce positive symptoms

2. Reduce negative symptoms

3. Improve neurocognitive functioning

4. Reduce disability and increase ability to function

What must someone have to be diagnosed with schizophrenia?

At least 1 positive symptom

What is confidentiality

Ethical requirement NOT to disclose any info about a patient to others unless legally compelled to do so

What is privileged communication?

Legal term that refers to confidential info that is protected from being disclosed during legal proceedings

What is informed consent?

Potential participants must be capable of understanding what they are consenting to

What is the legal term of insanity?

Addresses whether someone was criminally responsible at the time they committed the crime

What is criminally responsible?

A defendant’s crime was the product of both an action (attempted action) and the intention to perform that crime

What is the M’Naghten test of 1843?

Test for insanity that determines whether a defendant at the time of committing the crime

1. Knew what they were doing and if so,

2. They knew it was wrong

   If they did not know this, it was due to a defect of reason from disease of the mind

What must the defendant be able to do to be competent to stand trial?

• Understand proceedings that will take place

• Understand the facts in the case and legal options

• Consult with a lawyer

• Assist the lawyer in building a defense

What is competency to stand?

The mental state during the time leading up to the trial that enables the defendant to participate in their own defence

What is dangerousness?

Legal term that refers to someone’s potential harm to self or others

What is severity? (measuring dangerousness)

How much harm a person might inflict

What is imminence? (measuring dangerousness)

How soon a potential harm might occur

What is frequency? (measuring dangerousness)

How often a person is likely to be dangerous

What is probability? (measuring dangerousness)

How likely the harm is to occur

What are the two situations a person may remain incarcerated/hospitalized?

1. When they have not yet committed a violent crime but is perceived to be at imminent risk to do so 

2. When they have served a prison term or received mandated treatment in a psych facility and is about to be released but is perceived to be at imminent risk of behaving violently

What does the Tarasoff rule do?

It extends the duty of psychologists and mental health clinicians from a duty to warn to a duty to protect, forcing them to violate confidentiality to protect the victim

According to the Tarasoff rule, mental health clinicians who decide a patient is about to harm a specific person must:

1. Warn the intended victim or someone else who can warn the victim

2. Notify law enforcement

3. Take other reasonable steps such as having the patient in/voluntarily to a psych facility for evaluation

What is criminal commitment?

Involuntary commitment to a mental health facility of a person who has been charged with a crime either before/after trial

Why might someone be criminally committed before trial?

To evaluate competency to proceed with the legal process or to provide treatment to become competent to stand trial

Why might someone be criminally committed after trial?

Due to insanity

What is civil commitment?

Involuntary commitment to a mental health facility when a person has not committed a crime but is deemed to be at significant risk of harming self/others

When might someone have the right to refuse meds/treatment?

When a person has been civilly committed -> normally relating to antipsychotics with adverse side effects

Ex) Tardive Dyskinesia

When can the right to refuse be overridden?

• The patient is physically threatening to others

• The proposed treatment has a small risk of irreversible side effects

• There are no less restrictive treatments available

• The patient has a severely diminished capacity to decide relationally about certain treatments

What is the goal of mandated outpatient care?

to develop less restrictive alternatives to inpatient care, preventing the cycle of being discharged, stopping meds, becoming dangerous, ending up back in jail or hospital

What treatment does mandated outpatient commitment include?

Medication, psychotherapy, periodic monitoring by a mental health clinician

What did one study related to outpatient treatment focus on?

Involuntary hospitalized patients who were invited to use psychosocial treatment and services voluntarily upon treatment or those who were court ordered to obtain outpatient treatment

What did the study find for those were court-ordered?

• Decreased need for hospitalization and went for shorter periods of time

• Were less violent

• Less likely to be victims of crimes

• More likely to take meds or obtain other treatment even after the mandated treatment ended