PSYCH 223 Exam 4 Study Guide

Dissociative disorders

involve experiencing a disconnection between thoughts, identity, memories, actions, and surroundings

3 Types of dissociative disorders

Dissociative Identity Disorder, Dissociative amnesia, & Depersonalization/derealization disorder

Depersonalization / Derealization Disorder

Recurrent experiences of depersonalization, derealization, or both

Depersonalization

a sense of own self and own reality temporarily lost. ex. As if dreaming or watching self detached. Distorted sense of time, absent self

Derealization

a sense of reality of the external world temporarily lost. Ex. Experiences of unreality/detachment from surroundings. People and objects seem unreal, dreamlike, foggy, lifeless

Dissociative Amnesia

Most common dissociative disorder. The person becomes unable to recall important personal information in a way that cannot be accounted for by simple forgetfulness. Memory loss is not due to an organic cause. Memory loss is reversible

5 Types of dissociative amnesia

Localized amnesia, selective amnesia, generalized amnesia, continuous amnesia, and systematized amnesia

Localized amnesia

events tied to a period are gone

Selective amnesia

only disturbing details are gone

Generalized amnesia

forget your entire life but can retain your own habits. Very rare

Continuous amnesia

from 1-time point to now is gone.

Systematized amnesia

category of info is gone. Someone that has the memory of everything else but doesn't know who their parent is (for ex.)

Dissociative Fugue

Rare subtype of dissociative amnesia. Sudden, unexpected, travel away from one's home or typical place of activities with the inability to recall some or all details. That person is unable to recall any past information of themselves, they're confused but they continue to move throughout their days. You are conscious but the "you" is missing and are acting normally to others. Might be caused by trauma. (remember the vid from class)

Dissociative Amnesia Prevalence

7% of gen pop. More females than males.

Depersonalization/derealization prevalence

0.8% of gen pop. More males than females

Dissociative Identity Disorder

Disruption of identity characterized by 2 or more distinct personality states. There may be one core dominant personality and other supporting personalities (called alters). Alters are different from your "self", and have different behaviors, consciousness, memory, perception, cognition, etc. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.

Alters can have

different traits such as allergies, the need for glasses, etc.

Alter switches usually occur

during moments of high stress and negative emotions

DID is

rare and some professionals doubt its existence, some don't, and believe its from trauma

Sybil

book made in 1973 and turned into a movie. It was about multiple personality disorder. DID cases tripled after that

The prevailing view of DID

Identity disruption stems from trauma or disordered caregiver and child relationships during development. Dissociation is used to cope with traumatic experiences. Relies on "diathesis-stress model

DID Prevalence

1.5% More males than females. Higher prevalence in psychiatric in and outpatients

Psychodynamic perspective of DID

Use of repression. Protects ego from anxiety/fear of traumatic memories or other sources of unresolved conflict.

DID Biological perspective

Differences in brain areas involved in memory and emotion. Brain metabolic activity. Hippocampal volume (decreased). Amygdalar volume (decreased)

Treatment for DID

Very little is known about what works!! Typically, treatment is psychodynamic. The goal is to integrate alters! Give each a voice rather than get rid of them. Hypnosis used to uncover and work through trauma. NO suggestibility during questioning to bring out something that doesn't exist

To treat their moods, not their personalities for DID patients use these meds

Antidepressants, SSRIs, etc.

Recovered memory

A memory of a traumatic event (such as sexual abuse) experienced typically during childhood that is forgotten and then recalled many years later that is sometimes held to be an invalid or false remembrance generated by outside influence

Schizophrenia

Misrepresentation of reality that causes distress. At least one must be either #(1) (2) or (3). 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior 5. Negative symptoms (blunted affect, anhedonia, etc) Continuous disturbance for 6 months. Symptoms present for a significant portion of time during a 1-month period.

Anhedonia

problems with feeling pleasure

Psychosis

a group of symptoms that involve a "break" from reality. Include solely Hallucinations and Delusions. It is different from schizophrenia!

Various other conditions that can cause psychosis

Stress, sleep deprivation, trauma, Drug use, Brain injury / neurological problems

Positive Symptoms of Schizophrenia

Atypical excesses of behavior involving a break with reality. Positive symptoms adds something such as adding delusions • E.g., hallucinations and delusions

Negative Symptoms of Schizophrenia

An absence of normal behaviors that affect one's ability to function in daily life Neg symptoms remove something such as motivation • E.g., blank expression, loss of motivation, withdrawal, limited verbal expression

Positive symptoms Schizophrenia are

less persistent and more responsive to drug treatment than negative symptoms

Delusions

An erroneous belief that is fixed and firmly held despite clear contradictory evidence.

Common types of delusions

delusions of persecution, delusions of reference, delusions of being controlled, and delusions of grandeur

Delusions of persecution or paranoia

Believing someone is out to get you. e.g., "The CIA is out to get me"

Delusions of reference

"People on TV are making fun of me"

Delusions of being controlled

believing own thoughts, feelings, impulses, and actions are controlled by external forces

Delusions of grandeur

believing to be Jesus or have grand but illogical plans for saving the world

Thoughts of Delusions

thought broadcasting, thought withdrawal, and thought insertion

Thought broadcasting

"As I think, my thoughts leave my head on a mental ticker tape. Everyone around has only to pass the tape through their mind and they know my thoughts." People can access your thoughts

Thought insertion

"The thoughts of [a man's name] come into my mind. He treats my mind like a screen and flashes his thoughts on it like you flash a picture." Someone else thoughts in your mind

Thought withdrawal

"I am thinking about my mother, and suddenly my thoughts are sucked out of my mind by a phrenological vacuum extractor, and there is nothing in my mind, it is empty." Think mind is empty because of some force with the power to extract everything from your mind

Hallucinations

Sensory perceptions experienced in the absence of any external perceptual stimulus

Common types of hallucinations

auditory, tactile, somatic, visual, olfactory, and gustatory

auditory hallucinations

hearing voices

Tactile

tingling, electrical, burning sensations. (feeling things not there)

Somatic

Feeling things in your body that aren't there. e.g., feeling like snakes are crawling inside body

Visual

seeing things that are not there

Olfactory

smelling odors that are not there

Gustatory

tasting things that aren't present

Disorganized speech

A breakdown in the organization, processing, and control of thoughts

Looseness of associations

words combined incoherently; jumping from one topic to another. Its not making sense but you can see where the sentence is going

Neologisms

made up words "geshinker"

Perseveration

persistent repetition of the same word or same trained though

Clanging

Stringing together words or sounds based on rhyming

Blocking

Involuntary, abrupt, interruption of speech or thought

Incoherence

(word salad you can't get anything out of them. Therapist can't decipher anything

Disorganized behavior

avolition and cataonia

Avolition

apathy, lack of interest or engagement in goal-directed behavior. Can't convert desires into actions. Unable to carry out plans or duties.

Catatonia

state of unresponsiveness to external stimuli. Odd gestures & facial expressions (ex. Holding a split for hours). They may become stuck in odd postures. You can try to talk to them but they just won't respond.

Types of Negative Symptoms Schizophrenia

Loss of normal motivation, disinterest, social withdrawal, blunted affect

Blunted/flat affect

absence of emotional expression in the face and voice "Im angry"... but there's no emotion on the face

Exaggerated or inappropriate affect

e.g., laugh for no reason or giggle at bad news. Internal experience of emotions doesn't seem to match the external expression of emotions

Phases of Schizophrenia

1. prodromal, 2. acute, 3. residual

Prodromal phase

early, subtle signs of deterioration e.g., subtle unusual thoughts or abnormal perceptions but they're not outright hallucinations/delusions. Ppl will stop taking care of their physical appearance, change in personality,

Acute phase

Apparent psychotic symptoms present. Behavior becomes increasingly odd over time.

Residual phase

Return to prodromal-like levels. Behavior stabilizes (i.e., obvious psychotic symptoms gone). Cognitive, social, emotional impairment remains that makes it hard to function in social, occupational roles

Schizophrenia Prevalence

1% world

Sex difference schizophrenia

Males have more cog deficits, more severe schiz, neg symptoms, typical features of schiz. Females are hospitalized less and respond better to treatment, more depressive symptoms.

Patterns of schizophrenia

Chronic condition --->occasional acute psychotic episodes & continued cognitive, emotional, and motivational impairment. With continued drug treatment, 60%+ have long periods of remission. Many improve significantly over time but low likelihood of returning to pre-morbid levels of functioning

Schiz has more biological causes including

1) Genes; one of your parents,siblings has schiz you are more likely. Multiple genes at play. it's not genes alone but genes AND stressful environment that contribute to the brain abnormalities in schizophrenia (diathesis stress model). Offspring of older fathers are at higher risk for schizophrenia and autism (older sperm more prone to variations) 2) Biochem factors; Dopamine hypothesis [overactivity of dopamine transmission in the brain]

Two sources of evidence for biochemical schiz factors

1)Neuroleptics; block dopamine receptors. Reduce hallucinations & delusions. 2) Amphetamines; increase concentration of dopamine. In high doses, cause schizophrenia-like symptoms

Abnormalities in Brain Structure in Schiz (3)

Many people with schizophrenia have abnormally enlarged ventricles. Especially in the prefrontal cortex. Deficits are regulating attention, organizing thoughts, formulating goal, planning action

Treatment schizophrenia

1)Antipsychotic drugs which are effective but may not help everybody. They Have side effects.2)Assertive community treatment which is a team based approach. 24/7 approach. Help person address every aspect of life. Social support. For people who have been transferred out of an impatient hospital and need similar levels of care. 3) Social skills training

Related Disorders of Schiz

Brief psychotic disorder, schizophreniform disorder, delusional disorder, and schizoaffective disorder

Brief Psychotic Disorder

at least one of the symptoms (delusions, hallucinations, disorganzied speech, catatonic behavior) and lasts from a day to a month

Schizophreniform Disorder

Similar to schizophrenia but symptoms occur for a shorter period of time (1 to 6 months)

Delusional Disorder

Bizarre delusions but no other odd behavior •

Schizoaffective Disorder

"Mixed bag" of symptoms. Mood disorder + schizophrenia

Personality disorder

Overly rigid and maladaptive patterns of behavior and ways of relating to others that reflect extreme variations on underlying personality traits

Personality

set of distinctive traits that make us unique

Symptoms of personality disorders. clusters a.b.c--->

Cluster A

Odd, eccentric thinking or behavior 1. Paranoid personality disorder 2. Schizoid personality disorder 3. Schizotypal personality disorder

Cluster B

Dramatic, overly emotional, unpredictable thinking or behavior 1. Antisocial personality disorder 2. Borderline personality disorder 3. Histrionic personality disorder 4. Narcissistic personality disorder

Cluster C

Anxious, fearful thinking or behavior 1. Avoidant personality disorder 2. Dependent personality disorder 3. Obsessive-compulsive personality disorder

Cluster A

Paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder

1)Paranoid Personality Disorder

Excessive suspiciousness and hostility to others. Are guarded and secretive because they think others are bad and have bad intentions. Untrustful of others and would thus do everything themselves. Pervasive distrust and suspiciousness,

2) Schizoid Personality disorder

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, Blunted neutrality, distant, they're indifferent to criticism or praise from others. They're not disconnected from reality, they're just not interested in reality. Males with this are unlikely to marry. Women will marry passively "ok". Lack an interest in social relationships with other people. SHORT ANSWER-->CONTENT WITH BEING ALONE. DISTANT, DONT CARE TO MINGLE AND BE SOCIAL

3) Schizotypal.Personality disorder

Bizarre behaviors. Odd thought patterns or behaviors but not as severe for someone with schizophrenia. Their oddness makes it hard to interact with other people. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts. Really uncomfy in social situations because they feel they don't know how to interact with other people. Odd beliefs and odd behaviors. SHORT ANS ---> Odd thought patterns and behaviors that make it hard to connect with others, make friends, and make you uncomfy in social situations.

Cluster B

antisocial, borderline, histrionic, and narcissistic

Antisocial

They violate the rights of others or disregard social norms or conventions. Show a lack of concern towards the rights of other people if it means they can personally gain. Lack of guilt when theyve done something wrong. Punishment doesnt matter to them. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years. More prevalent in males. Might participate in fighting, stealing, sexual assault,. Diagnosis is at 18, if you have this younger you have conduct disorder. Irresponsible, aggression, lack of remorse, don't care how their behaviors effect others

Borderline

On the border between two diagnoses. A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, Features of a deep emptiness and instability with relationships. Self injurious behaviors and suicidal behaviors. Have a hard time regulating their emotions. They feel intense emotional pain when they're distressed. Very socially isolating. Empty feeling inside. Impulsivity. Deficit of considering consequences. Strong fears of rejection and they will lash out if they feel that person is leaving them Goes from liking someone to hating them because they felt rejected. Small thing makes you feel rejected. Inappropriate emotion. When they feel irritated they feel anger. (remember vid from class)

Histrionic

overwhelming need to be the center of attention. Tend to demand that other people should meet their needs for attention. "If I want something I want it now". Overly flirtatious and seductive but they're too wrapped up in themselves to develop relationships with other people. Men dress more macho, women dress more femme. Lack self esteem. They want attention because they want validation of their self worth. They want to feel better about themselves. A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts. More prevalent in women. Dressing provocatively, think the minor interaction with someone is deeper than it actually is if someone doesn't confirm how great they are, they feel super rejected, HAVE LOW SELF ESTEEM

Narcissistic

extreme need for admiration. Expect praise. Will brag about themselves. Lack empathy because theyre focused on themselves. Have an inflated view of themselves and think they're great. Usually successful in their careers but its hard to form relationships with others. Preoccupied with fantasies of power. A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts,. Gravitate to careers like modeling to be the center of attention. They are jealous of anyone they suspect is more successful than they are. Feel entitled to other people. Game playing style in romantic relationships See partners as sexual desires. HAVE HIGH SELF ESTEEM, they don't care if you don't confirm how great they are.

Cluster C

avoidant, dependent, and obsessive compulsive personality disorder

Avoidant

so afraid of rejection or being rejected by others that they avoid social activities. Comorbid with social phobia. They have interest in interacting with other people but they're so afraid of rejection that they can't do it.

Dependent

overly submissive and clingy in relationships. Find it difficult to do things on their own. Need reassurance for making ordinary decisions. Might agree to do something they don't want to do or they know it's wrong because they dont want to lose a person. Comorbid with mood disorders, social phobia, and hypertension.

Obsessive-compulsive personality disorder

overwhelming need for order and unwillingness to give responsibility to others. Fixation with work, detail, and perfection. Lack generosity. More prevalent in males. Can have this without having OCD. Concerns related to daily tasks. Interpersonal dysfunction, "Less" distress than OCD. They don't feel like they need treatment. "This is how things should be done". Cant form proper situations.