Abnormal Psychology - Final Exam

schizophrenia (from diagnosed people)

- average age 44 of those interviewed

- stigma fear

- accepting diagnosis

Schizophrenia

- umbrella term for a group of psychotic disorders involving disturbances of behavior, thinking, emotions and perceptions

- typical onset is late adolescence

- affects more men than women, affects men earlier in life than women, and tends to be more severe in men

Schizophrenia - Gradual

- onset may be gradual, or may be sudden

- gradual includes prodromal (period between onset of symptoms and full development) phase of decreasing social engagement

- after acute episodes, person may return to a residual phase of behavior similar to that of the prodromal

History of Schizophrenia - Kraeplin

- dementia praecox

- loss of inner unity of thought, feeling and acting

History of Schizophrenia - Eugen Bleuler

- coined schizophrenia as "split brain"

- split is between aspects of personality, not a split into different personalities

symptomology of four A's: (Bleuler)

- disconnected ASSOCIATIONS

- flat or inappropriate AFFECT

- AMBIVALENCE toward others

- AUTISM - living in a private fantasy world

History of Schizophrenia - Kurt Schneider

- thought bleuler's explanation was too vague

- tried to define diagnostic criteria

- first-rank symptoms: central to diagnosis / incl. hallucinations and delusions

- second-rank symptoms: found in schizophrenia and other disorders / disturbances in mood

Schizophrenic Spectrum disorders - DSM 5

Characteristic symptoms: two or more of the following (in 1 month period):

Note: at least ONE of the first three much be present

- delusions

- hallucinations

- disorganized speech

- grossly disorganized or catatonic behavior

- negative symptoms (alogia, avolition, affective flattening

Schizophrenia DSM 5: social/occupational dysfunction

for a significant portion of time since the onset of the disturbance, one or more major areas of functioning (work, interpersonal relations, or self care) are markedly BELOW the level achieved prior to the onset

Schizophrenia DSM 5: Duration

- continuous signs of the disturbance persist for at least 6 months

- must include at least one month of symptoms that meet criteria A

- may include periods of prodromal or residual symptoms

- during the periods, signs of the disturbance may be manifested by only negative symptoms

Major Symptoms of Schizophrenia

positive symptoms: presence of something abnormal

negative symptoms: absence of normal behavior

Disturbances in Thought in Schizophrenia

delusions: false beliefs

- persecution

- reference

-of being controlled

-grandeur

delusions may reflect themes/values of local culture

Delusions may reflect themes/values of local culture

1. Ireland - delusions of sainthood- 2. Japan - slander and public humiliation

3. Nigeria - witches or ancestral ghosts

4. Industrial societies - monitoring via technology

Thought disorder

breakdown in logical associations, organizations and processing of thoughts

can be reflected in poor language:

- neologisms: made-up words

- perseveration: repetitions of words or syllables

- clanging: connection of words that rhyme (may lead to word salad)

- blocking: abruptly stopping speech

disturbances of Thought: attentional deficiencies

- difficulty filtering from the informational stream

- hypervigilance: too much attention to unimportant stimuli

(have high event-related potentials - initial brain-level response to new stimuli)

- eye movement dysfunction: problems with jerky eye motion when tracking

Disturbances of Perception

Hallucinations: false perceptions

- exist across all senses, though auditory and tactile are the most common

Command Hallucinations: voices that command to act

- 80% obey these, and most hallucinations inv. committing harm

-Broca's area in the brain shows elevated activity when hearing voices

voices vary by culture (people from INDUSTRIALIZED countries had the violent thoughts)

Schizophrenia: other Disturbances

Emotion:

- often display inapr. emotional response

- can also display no affective response

- may manifest as schizoaffective disorder (class. with features of schizophrenia and bipolar disorder)

Behavior:

- may be excessively wild

- may be completely lacking

subtypes of Schizophrenia

DSM used to include distinct subtypes of schizophrenia

- disorganized, catatonic, paranoid, undifferentiated

Eliminated in DSM-5 as often not stable

- some practitioners continue using them

Theoretical perspective (Schizophrenia): Diathesis-Stress model

- biological vulnerability triggered by environmental stressors

Theoretical perspective (Schizophrenia): Biological Vulnerabilities

- strong genetic influence on the likelihood of developing schizophrenia

- adopted children w/ bio history of schizophrenia are more likely to develop the disease than those without

- shared environments are also a factor, since concordance rates between identical twins are not 100%

Theoretical perspective (Schizophrenia): genetic vulnerabilities and Positive symptoms

what G.V. affect:

neurotransmitters and positive symptoms

- dopamine receptors are overactive in schizophrenia (dop. affects movement, emotional response, pleasure responses)

- norepinephrine (tied to emotional response, subdues logical thought

- GABA (low levels lower inhibition of inappropriate behavior

Theoretical perspective (Schizophrenia): genetic vulnerabilities and Negative symptoms

neurotransmitters and negative symptoms

- lower dopamine sensitivity and overproduction of GABA may lead to negative symptoms

Brain Abnormalities in Schizophrenia

- enlarged ventricles (via loss of brain matter) - may happen during synaptic pruning in adol.

- stem cell res. suggests faulty development of neuronal structure in first trimester of development

- lower PFC activity (diff. in communication between cortex and limbic system)

Theoretical perspective (Schizophrenia): Environmental stressors

- role of illness (exposure to viruses before birth) - influenza and toxoplasmosis

- communication deviance in the parents (pattern irregular comm. within families)

- family may also show high levels of expressed emotion (more hostile, critical; less emp. & tolerant)

Familial Factors in Schizophrenia

Distinguishing discerning cause and effect is difficult

- CD and EE may be symptoms of possible schizophrenic tendencies among the parents themselves

- alternative: CD and EE may be a neg. response to emerging scizo. in the child

- NOTE: familial behavior has not been known to cause schizo. in people w/out a family history

Theoretical perspective (Schizophrenia): Role of Culture

- progress of disease is more severe in industrialized countries

1. extended family places less exp. on ind.

2. lesser impact of lost income leads to lower stress

- socioeconomic status

1. can provide numerous stressors, as well as a delay in diagnosis

Treatments (Schizophrenia): Biological Treatments

1. antipsychotic drugs

- neuroleptics/phenothiazines (thorazine, mellaril, stelazine, prolixin)

- work via blocking dopamine rec.

- primarily address pos. symptoms

- potential side effect: tardive Dyskinesia:

a. may arise after 6 months of use

b. invol. tics (blinking, lip smacking, chewing)

c. often irreversible

- atypical antipsych offer promise, but control

Treatments (Schizophrenia): Learning Therapies

- use of selective reinforcement & token economies can incr. appropriate behavior in some cases

- cog.-beh. training can help with some delusions

- intensive approaches in hospital settings have had some success

Treatments (Schizophrenia): Milieu Therapy & family therapy

Milieu: Humanists emphasize creation of an adaptive social milieu in which schizophrenics can develop sense of self respect and individual responsibility

Family: may also be used to address family communication problems

Disorders relating to Gender and Sexuality: Court Cases

- prosecution of Alan Turing

- Bowers v. Hardwick (1986)

- Lawrence v. Texas (2003)

Disorders relating to Gender and Sexuality: Defining Abnormal

-Sexuality and sexual behavior are domains where normality tend to change in perception over time

- homosexualiy classified as disorder in DSM until 1973

- incr. in heterosexual anal intercourse highlights rapid shifts

Disorders relating to Gender and Sexuality: Kinsey's Study

the first major studies of Am. sexual att. and prac.

- interviewed over 11,000 part. (1948 and 1953)

- 67-98% of males reported sex before marriage (varied by SES; int. of 13 for lowest SES group)

- 50% of females reported sex before marriage

- but in 1994, 5% (F) and 2% (M) reported waiting until marriage before having sex for 1st time

Disorders relating to Gender and Sexuality: Normal vs. Abnormal

perceptions of normality and abnormality are tied to culture

- but we also see trends that vary substantially within culture (i.e. by age and sex)

Gender Dysphoria

Disorder in which a person thinks that their physical sex is inconsistent with their gender identity, leading to personal stress

- may incl. attempts to deny their own sex, pass as opposite sex, disgust at own sexual body parts

- can fade by adolescence, continue into adulthood, develop into amore settled sense of gender identity

- est. to be found 5x more in males than females

- ICD-11 using label Gender Incongruence

Gender Dysphoria: DSM

A marked incongruence between one's experienced/expressed gender and their assigned gender, lasting at least 6 months, as manifested by at least two of the following:

- incongruence between one's gender and primary sex char.

- strong desire to rid oneself of primary sex characteristics

- strong desire for opposite sex's primary sex char.

- strong desire to be of the other gender

- strong convictions that one has the typical feelings and reactions of the other gender

Gender Dysphoria: Treatments

Treatments may incl. affirmations at various levels:

- social (e.g. name / pronouns

- legal

- medical / biological: post-op adjustment after gender confirmation surgery tends to be better for those who have undergone fem. to male reassignment

Gender Dysphoria: Psychodynamic

- theorists attribute this to parent-child relationship issues

Gender Dysphoria: Learning theories

- theorists attribute it to socialization patterns and reinforcement

- study of family histories provide no substantiation for Learning and Psychodynamic theories

- biological factors are believed to play the defining role

Paraphilias

- person who experiences frequent sexual urges involving objects, inappropriate or nonconsenting partners, or humiliating or painful situations

- many more than just these

Paraphilias: Exhibitionism

- urges to expose oneself for the purpose of shocking or sexually arousing the victims

- usually not interested in actual sex, though may masturbate during encounter

- response may boost low self-image

Paraphilias: Fetishism

- urges and fantasies surrounding inanimate objects, often using clothing items

- may not be able to achieve arousal w/out item

- may be tied to associations with early sexual experiences or fantasies

Paraphilias: Partialism

- involves sexual arousal by certain body parts, such as feet

Paraphilias: Orgasmic reconditioning

- treatment in which the fetishist can become aroused by the object, but must have orgasm only when exposed to a 'normal' stimulus

Paraphilias: Voyeurism

- sexual urges to reach arousal by watching people who don't know they're being watched

- possibility of being caught can enhance the excitement

Paraphilias: Frotteurism

- sexual urges to briefly rub or touch nonconsenting individuals in public (normally crowded) places

Paraphilias: Sexual Sadism and Masochism

- sexual urges involving inflicting or receiving pain or humiliation

- may center on fantasy play, partners may switch roles

- extreme examples might include: sadistic rape or hypoxyphilia (or autoerotic asphyxiation)

- choking/aggression often glamorized in pornography

Paraphilias: Pedophilic Disorder

- sexual urges and fantasies related to prepubescent children

- person must be at least 16 years and interested in children at least 5 years younger

- can be limited simply to observation, or can extend to undressing, exhibitionism, fondling, oral or anal sex, or vaginal intercourse

- most are middle-aged men, with children of their own, who know their victims

Paraphilias: Pedophilic Disorder (situational molesters)

- generally behave normally, but can act on powerful pedophilia urges during certain situations (e.g. time of high stress)

Paraphilias: Pedophilic Disorder (Preference molesters)

- pedophilia is deeply ingrained in their personality

Paraphilias: Learning theory

- theorists attribute them to early learning and association, incorporated into subsequent fantasies

Paraphilias: Multifactorial approach

- suggests abuse in childhood affects normal sexual development

Treating Paraphilias

- may not seek treatment if experiences don't feel maladaptive (e.g. sadomasochism, fetishism, transvestic fetishism)

- treatment often comes only if caught (e.g. pedophilia, voyeurism)

- Some treatments administered based on treatments for OCD (e.g. fetishism)

Covert sensitization

- pairs fetishistic object with aversive stimuli (e.g. discovery by police)

- type of aversive conditioning

Treating Pedophilia: biological treatments

Treating Pedophilia: radical treatments

- may involve castration and removal of part of the hypothalamus

- used to treat hyperactive sexual desire

- regardless of treatment, PD can be very difficult to control, although stats on recidivism hard to quantify

Abnormal Psychology and Law: Cody Cousins

- entered a Purdue classroom and viciously murdered the TA

- lawyers attempted to build case for mental illness based on past treatment

- undermined at sentencing

- received maximum sentence

- committed suicide in prison shortly thereafter

Abnormal Psychology and Law: Civil Commitment

- people deemed dangerous to themselves or others are taken into psychiatric care

- usually, but not always, driven by family

- increasingly used to detain sex offenders after their sentence is completed

- SCOTUS has upheld for rehab, not for punishment

Abnormal Psychology and Law: Legal Commitment

- taken into psychiatric care as a consequence of criminal acts

Abnormal Psychology and Law: Kansas v. Hendricks

- congenital or acquired condition affecting the emotional or volitional capacity which predisposes the person to commit sexually violent offenses to the degree that such person is a menace to the health and safety of others

- ruled the act is not punitive if it fails to offer treatment for an untreatable condition

Challenges of Involuntary Commitment

can we predict danger to self or others?

- important to gauge as we deprive people of liberty

both APAs say professionals cannot reliably predict this (but states persist in asking them to do so)

- doctors tend to over predict the likelihood that people are dangerous

Involuntary Commitment: Problems in Predicting Danger

- erring on side of caution

- general tendencies may not predict specific acts

- danger may be limited to everyday recklessness as opposed to being criminally dangerous

- clients are unlikely to overtly disclose their plans even if they have them

- base rates very low even with incr. likelihood

- being in hospital may cause different behavior

Right to Treatments: Rouse v. Cameron

- treat or release

- established right to treatment under DC statutory law

Right to Treatments: Wyatt v. Stickney

- est. right to treatment as a constitutional right

1. humane psych and physical env.

2. qual. staff in #'s sufficient to admin. adequate treatment

3. individualized treatment plans

4. services in the last restr. environ.

- prior to this, patients involuntarily committed often warehoused w/out care & treatment

Right to Refuse Treatment: Rogers v. Okin

- est. right to refuse treatment against one's will

- invol. treatment is "not nec. to protect the general public, since the patient has already been quar. by commitment"

- can be overridden in emergency

- applies when person is deemed competent to make decisions

Right to Refuse Treatment: Sell v. United States

- est. that a suspect could be medicated in order to be competent to stand trial only under certain circumstances

1. medically appropriate

2. VERY unlikely to have side effects

3. necessary to stand trial

4. important to "significantly" further "important government interests" in a narrow band of areas

Limits to Commitment: Lessard v. Schmidt

- first case to establish that there were limits on the ability of states to involuntarily commit people

- Alberta Lessard was committed after a suicide attempt

- District court established standard of"dangerousness... based upon finding of recent overt act"

- court also established right to due process parallel to that for criminal suspects

Limits to Commitment: O'Connor v. Donaldson

- Donaldson's father had him committed on the basis that he was paranoid "delusional"

- Refused all treatment, petitioned courts for release for 15 years

- SCOTUS: "A finding of 'mental illness' alone cannot justify a State's locking a person up against his will and keeping him indefinitely in simple custodial confinement...

Insanity Defense

- term insanity is a legal term more than a clinical terms

- popular (mis)understanding tends to be driven by high-profile cases

Insanity Defense: David Berkowitz "Son of Sam"

- claimed delusions

- was found capable to stand trial

- later admitted to making up the delusions

Insanity Defense: Kenneth Bianchi "Hillside Strangler"

- claimed MPD

- found guilty

- later admitted to making it up

Insanity Defense: Mark Chapman (killed John Lennon)

- claimed to hear voice of God

- had delusions of grandeur

- found guilty

Insanity Defense: John Hinckley (att. assassination of Pres. Reagan)

- did it to impress Jodie Foster (found NGRI)

- marked a turning point in usage of the verdict

since verdict, more states have implemented verdicts of "guilty but mentally ill" or "guilty but insane"

- verdict often ends up more pop. than NGRI

Insanity Defense: Jeffrey Dahmer (serial killer)

- tried to lobotomize victims to create zombie companions

- dismembered for eating

- found guilty

Insanity Defense: Lorena Bobbitt

- cut off husbands penis

- claimed "irresistible impulse" after years of abuse and drunken rape that day

- found NGRI (temporary insanity)

- treated and released within months

Insanity Defense: Daniel M'Naghten (not guilty by reason of insanity) - NGRI

- claimed voice of God told him told him to kill the prime minister

- court acquitted, said person cant be held responsible if they don't know what they're doing is right or wrong

Insanity Defense: Durham v. United States (NGRI)

- the standard was replaced with more modern "mental disease or defect" standard

- however this description was just cumbersome and vague

Insanity Defense: American Legal Institute Guidelines

- person is not responsible for criminal conduct if the person as a result of mental disease or defect, that person was unable to appreciate the wrongfulness of such conduct

standard mental illness refers to:

i. impairments of mind, whether enduring or transitory or

ii. mental retardation

Insanity Defense: duration of commitment (Jones v. United States)

- constitution permits the gov. on the basis of insanity, to confine him to a mental inst. until such time that he has regained his sanity or is no longer a danger

- insanity ind. is not entitled to his release merely b/c he has been hospitalized for a period longer than he could have been incarcerated if convicted

- purpose of commitment is to treat the mental illness

Reality of Insanity Defense

- used in 0.9% of cases, successful in only 0.2%

- 90% of successful NGRI are plea deals

- people acquitted rarely set free

- those who fail spend receive 22% longer sentences than those who plead guilty

Insanity and the courtroom: Jared Loughner

- encompasses many issues

1. competency to stand trial

2. forced medication

3. history of mental illness

4. AZ has GBI, but no NGRI

- very high-profile case

Criticisms of Insanity Defense

- Szasz argued that insanity defense strips people of responsibility of their actions

- moreover, denies them due process when it comes to getting out of state custody later

- often comes down to dueling expert witnesses and their credibility

- GBI often leads to brief, token treatment followed by imprisonments without care