psychopathology and mental health exam 3

positive symptoms of schizophrenia

delusions and hallucinations; psychotic symptoms

hallucinations

sensory experiences that seem real to the person having it, but ocurs in the absense of any external perceptual stimulus

auditory hallucinations

most common; hearing sounds and voices; often someone insulting you

visual hallucination

seeing things that aren't there; second most common type of hallucination; can be small glances or concrete things you believe are there

tactile hallucinations

experiencing things on your skin

somatic hallucinations

feel as if something is happening inside the body; ex: electricity going through your body

olfactory and gustatory hallucinations

largely negative; ex: smelling decaying bodies

delusions

rigidly held inaccurate beliefs or misrepresented versions of reality

types of delusions

persecutory, referential, somatic, religious, grandiose, delusion of control

persecutory delusions

believing you are being persecuted or attacked

referential delusions

believing something you see or hear is specifically meant to send you a message

somatic delusions

the theme of the delusion involves bodily functions or sensations; ex: thinking that there's a chip in their brain

religious delusions

the context of the delusion is religious in nature

grandiose delusions

people thinking that they have a specual role/power/talent

delusion of control

believing that someone or somethign is controlling them in some way

non-bizarre delusions

delusions that could theoretically occur in real life

cotard delusion

the belief that you are dead (either literally or figuratively)

capgras delusions

the belief that a loved one has been replaced by an identical looking imposter

schizophrenia negative symptom categories

diminished verbal and nonverbal expression and diminished motivation and pleasure

components of diminished verbal and nonverbal expression

blunted affect and alogia

blunted affect

lack of range in tone or expression (verbal and nonverbal)

alogia

a reduction in the amount that someone speaks

components of diminished motivation and pleasure

avolition, asociality, and anhedonia

avolition

lack of goal-directed activity

asociality

spending less time with others

anhedonia

reduction of pleasure and enjoyment

anticipatory pleasure

wanting; thinkign about pleasure from future activities and how much pleasure you think you'll feel

consummatory pleasure

liking; the in-the-moment pleasure

disorganization symptoms of schizophrenia

reflects bizarre behaviors and disturbances in thinking

components of dizorganization symptoms

disorganized speech, catatonic behavior, and grossly disorganized behavior

disorganized speech

difficult to follow, conveys little meaning, goes on tangents, can include word salad, common in largely stable patients

catatonic behavior

decreased awareness of and reactivity to environment; associated with severe cases; immobility and muscle rigidity

grossly disorganized behavior

bizarre or inappropriate behavior; distinguished from aimless or reasonably agitated behavior

cognitive impairments with schizophrenia

working memory, executive function, social cognition, facial emotion recognition

phases of schizophrenia

prodromal phase, active phase, and residual phase

prodromal phase

negative symptoms with less severity

active phase

most severe phase; full symptoms

residual phase

not as extreme, but symptoms still pop up

schizophrenia diagnostic criteria

A: 2+ for at least a month of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms; B: impairment; C: disturbance for at least 6 months; D: rule out related disorders

schizophrenia in differential diagnoses

longest duration and lowest ratio of mood to psychotic symptoms

schizophreniform disorder

1-6 months of active stage; impairment to the degree of schizophrenia is not necessary

brief psychotic disorder

1 day to 1 month of active stage; needs 1 of delusions, hallucinations, or disorganization; associated with better outcomes

schizoaffective disorder

between schizophrenia and mood disorders in terms of mood to psychotic symptom ratio; requires delusions or hallucinations for 2 weeks without any other mood symptoms

mood disorder with psychotic features

highest ratio of mood to psychotic symptoms; psychotic symptoms only occur during a mood episode; mood congruent psychosis

delusional disorder

presence of 1+ delusions for at least 1 month; criteria A for schizophrenia isn't met and functioning is not as broadly impaired

lifetime prevalence of psychotic disorders

4%

lifetime prevalence of schizophrenia

1%

biological factors of schizophrenia

heritability (50% if both parents or identical twin has it), polygenic (several genes involved), reduced gray matter in the temporal lobe, reduced brain volume, dysconnectivity disorder, reduced PFC activation (associated with negative symptoms), neurochemical imbalance in dopamine system

hyperactive dopamine transmission in mesolimbic area

associated with positive symptoms

hypoactive dopamine transmission in PFC

associated with negative symptoms

environmental factors of schizophrenia

prenatal complications, birth complications, early adversity, stressors, drug abuse, living in urban areas, migration

psychosocial and environmental factors of schizophrenia

negative environmental exposures, social exclusion/deprivation, acute or prolonged stressors

1st generation/typical antipsychotics

invented in 1950s; causes extrapyramidal symptoms and tardive dyskinesia

extrapyramidal symptoms

movement dysfunctions

tardive dyskinesia

repetitive involuntary movements

2nd generation/atypical antipsychotics

invented 1990s; causes weight gain/obesity and slight risk of tardive dyskinesia

SZ relapse rates

65-70% in 1st year after hospitalization without medication, 40% with antipsychotics

high expressed emotion (family)

negative, critical and hostile attitudes on the part of the family; emotionally over-involved and intrusive; higher relapse rates for people living with a high EE family member

types of psychosocial treatment for schizophrenia

individual therapy, assertive community treatment, family-based treatment, social skills training

steps of individual therapy for schizophrenia

engagement, information gathering and formulation, intervention, and relapse prevention

working with delusions

need to decide whether to target cognitively or non-cognitively; collaborative empiricism, investigative analysis worksheets

working with hallucinations

may be able to target in conjunction with delusions; tracking, identifying associated thoughts/feeling/behavior, coping skills/distractions, questioning the voice, selective attention exercises

working with disorganized/negative symptoms

antipsychotics don't tend to be as effective; target the functional disruption; identification of barriers and motivators

psychological dependence

the urge to take a psychoactive substance for reasons such as alleviating a negative mood, avoiding withdrawal symptoms, and preparing for an activity

physiological dependence

a state of physical dependence on a drug caused by repeated usage that changes body chemistry (tolerance and withdrawal experienced)

tolerance

through the ongoing use of any susbtance the nervous system becomes less sensitive to the physiological effects of that drug over time

withdrawal

physiological symptoms a person experiences when drug is stopped; depends on the type of substance

nicotine withdrawal symptoms

drowsiness, muscle tremors, nausea

severe alcohol withdrawal symptoms

delirium tremens (life threatening, agitation, confusion, tremors, and psychotic symptoms)

psychoactive substance

a chemical substance that alters mood, changes perception, or changes brain functioning

polysubstance abuse

abusing more than one substance

9 classes of drugs

alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, stimulants, tobacco

factors deciding addictive potential

how the drug works, dosage to achieve effect, route of administration, and potential for harm

what percentage of people prescribed opioids develop a substance abuse disorder?

up to 12%

what counties look like with the highest opioids per resident

smaller cities/larger towns, high % white residents, higher number of dentists and primary care physicians, more people uninsured or unemployed, more residents with diabetes/arthritis/disabilities

naloxone

substance that rapidly reverses the effects of an opioid overdose

fentanyl

a synthetic opioid significantly stronger than morphine; illegally produced and added to other substances to increase potency; fentanyl laced drugs are more likely to cause overdose/death

DSM-IV substance abuse

a person's ability to function becomes impaired; no tolerance, withdrawal, or compulsive use; less severe than dependence

DSM-IV substance dependence

repeated use of a drug often resulting in tolerance, withdrawal, or compulsive use; commonly called addiction

DSM-IV substance abuse diagnostic criteria

1 of the following: recurrent substance use: resulting in failure to fulfill role obligations, in hazardous situations, resulting in susbtance-related legal problems, continued use despite continued social or occupational problems caused by the drug

DSM-IV substance dependence diagnostic criteria

3+ of the following in 12month period: tolerance, withdrawal, substance taken in larger amounts or for longer periods of time than intended, persistent desire or failed efforts to reduce drug use, great deal of time spent trying to obtain the drug or recover from effects, social or occupational activities given up or reduced, continuous substance use despite knowledge of consequences

DSM-V alcohol use disorder diagnostic criteria

2+ symptoms in a 12-month period

classes of symptoms of alcohol use disorder

impaired control, social impairment, risky use, and tolerance and withdrawal

impaired control symptoms of AUD

substance taken in larger amounts or for longer periods than intended, persistent desire/failed efforts to reduce use, great deal of time spent obtaining/using/recovering, craving

social impairment symptoms of AUD

failure to fulfill role obligations, continued use despite persistent social or interpersonal problems, social/occupational/recreatiomnal activities given up because of use

risky use symptoms of AUD

recurrent use in physically hazardous situations, continued use despite knowledge of a persistent physical or psychological problem likely caused or exacerbated by substance

cannabis withdrawal symptoms

decreased appetite, decreased mood, taking cannabis to relieve withdrawal symptoms

gambling disorder

new; activated the reward systems; behavioral symptoms can be similar to substance abuse

short-term effects of alcohol

impaired speech and vision, poor coordination, interference in complex thought, loss of balance

long-term effects of alcohol

malnutrition, cirrhosis of the liver, stomach pains, chronic fatigue, oversensitivity, depression, poor judgment, Korsakoff syndrome

Korsakoff syndrome

severe syndrome that can occur following many years of heavy alcohol use; symptoms are memory deficit, confabulation, hallucinations, and vitamin b-1 deficiency

prevalence of comorbid AUD and PTSD

34-55%

prevalence of AUD in adolescents with ADHD

19-26%

prevalence of AUD in adults with ADHD

33%

nicotine receptor targets

nicotinic acetylcholine/dopamine

alcohol and sedative-hypnotics receptor target

GABA

marijuana receptor targets

dopamine and cannabinoid

methamphetamine and cocaine receptor target

dopamine

hallucinogen receptor target

serotonin

opponent process theory

an increase in positive feelings is followed by an increase in negative feelings