abnormal psychology exam #4

parts of depressive disorders, bipolar disorders, and psychotic disorders

social perspective of depressive disorders: parental depression

passive gene environment correlation; heritability and genetic factors

parents themselves with depression will model depressive behaviors onto their children

social perspective of depressive disorders: major childhood stressors

traumatic event or other sources of stress—excessive cortisol desensitizes a person

social perspective of depressive disorders: interpersonal stressors

caused by friendships and relationships

grief, loss, rejection, humiliation, etc…

social perspective of depressive disorders: low social support

no support structure and lack of help from others

evocative environment correlation: depressive disorders

vulnerable individuals may increase their own stress through things like catastrophizing, withdrawal from social interaction, etc…

sociocultural factors of depressive disorders: prejudiced individuals and those in poverty

increased risks against individuals who are prejudiced or those in poverty due to learned helplessness and a lack of a sense of control

sociocultural factors of depressive disorders: gender differences

genetic and biological differences (e.g. hormones), stress of gendered prejudice, gender roles, interpersonal roles, cognitive emphasis on rumination, and higher rates of traumas and sexual maltreatment

bipolar I disorder

0.6% 12-month prevalence; 0.6% lifetime prevalence (signifies lifetime condition); usually onsets in adolescence or early adulthood; 1:1 gender ratio

at least one manic episode; commonly comorbid with depressive disorders—precedes manic episodes

symptoms in bipolar disorders

severe impairment in judgement and insight, but no inherent distress in periods of mania due to grandiosity; increase in risk of suicidality and impulsivity

suicidality in bipolar disorders

60x greater risk of suicide in those with bipolar disorders

for every 3 attempts, there is one death due to suicide

suicide completion is higher in bipolar II disorder because focus inhibition is greater in bipolar I disorder

specifiers for bipolar 1 disorder: anxious distress

bipolar 1 disorder comorbid with anxiety disorders

specifiers for bipolar 1 disorder: mixed features

comorbid with depressive disorders simultaneously; most dangerous due to suicidal ideation in depression and impulsivity in mania

specifiers for bipolar 1 disorder: rapid cycling

four or more episodes within a year

bipolar II disorder

at least one hypomania episode, no manic episodes, and at least two major depressive episodes

0.8% 12-month prevalence; once you have a bipolar disorder, the condition is permanent

10% of those with this condition go on to have bipolar I disorder

cyclothymic disorder

0.4% - 1% prevalence; 15-50% of those with this disorder go on to have one of the bipolar disorders; precursor to BPDs

at least one hypomanic episode, no manic episode, and mild depression where hypomania or depression is always present

biological causes of bipolar disorder: heritability

71% heritability; very commonly heritable disorder with risks increasing with closer relatives

biological causes of bipolar disorder: neurotransmitters

dysregulation of serotonin (high in mania, low in depression)

elevated glutamate activity (excitatory neurotransmitter)

biological causes of bipolar disorder: genetic association

bipolar disorders are more genetically associated with schizophrenia than unipolar disorders

biological causes of bipolar disorder: brain activity

excessive brain activity in the amygdala (emotion), striatum (movement, reinforcement, learning), and thalamus (possibly causes hallucinations)

psychological causes of bipolar disorder

high sensitivity to rewards (goal attainment), lack of insight, high value on creative output, which causes low compliance with treatment

bipolar disorders are purely genetic

biological treatment for bipolar disorders: lithium

most effective form of treatment for bipolar disorders in about 67% of cases; brings individuals out of mania, decreases suicide risk, and prevents future manic episodes

biological treatment for bipolar disorders: other medications

atypical antipsychotics (risperdal, abilify, geodon)

anticonvulsants/anti-seizure medication (lamictal, divalproex sodium, trileptal)

antidepressants and bipolar disorders

tricky when providing individuals during a depressive disorders because giving somebody with a bipolar disorder antidepressants can cause mixed-features specifier for bipolar disorders, increasing suicide risk

psychological treatment for bipolar disorders: CBT, Interpersonal, & social rhythms therapy

cannot treat bipolar disorders

therapies to help individuals get on a steady schedule to reduce future relapses of manic/depressive episodes

biological treatment for bipolar disorders: LEAP

cannot treat bipolar disorders

therapy for lack of insight and medication compliance

stands for Listen, Empathize, Agree, and Partner

biological treatment for bipolar disorders: behavior & supportive therapy

support medication compliance, and help patients adjust and cope with bipolar disorder diagnosis

suicide

intentionally kills oneself

died of/by suicide preferred over committed suicide

non-suicidal self-killing

euthanasia: voluntary ceasing of one’s life early due to terminal conditions and illnesses that would end life regardless

suicide attempt

self harm with some intent to die some lethal consequence

completed suicide is preferred over successful suicide

suicidal ideation

thoughts about suicide

non-suicidal self-injury

intentional physical self-harm with no intent to die

suicidality demographics: attempted suicide

females > males; adolescents and young adults

suicidality demographics: completed suicide

males > females; older adults older than 65 y.o.

frequency of suicide

34,000 americans die every year due to suicide; percentage may be higher 25-35% due to underreporting or misinterpreting deaths as non-suicide

2x as many firearm deaths are caused by suicide rather than homicide

suicide is the 3rd leading cause of death in adolescents in teens and young adults (increased risk as people grow older) than it is for the elderly

characteristics of suicide: marital status

widowed or divorced individuals are at higher risk of suicide

characteristics of suicide: occupation

certain occupations like law enforcement, doctors, and dentists are more likely to die by suicide due to access of means to kill oneself and desensitization

characteristics of suicide: socioeconomic status

loss in socioeconomic status (such as dropping in status)

characteristics of suicide: methods

50% of completed suicides are caused by firearms

70% attempts are caused by drugs

characteristics of suicide: religion

reported suicide rates are lower in catholic and islamic countries; may be due to underreporting or misinterpreting deaths due to suicide being taboo

characteristics of suicide: race & ethnicity

suicide rates higher in American Indians > White Americans > People of Color (based on access to community)

characteristics of suicide: historical/political

suicide rates lower in strife due to increase in community, and rates are higher during social or political change

characteristics of suicide: intent

never always ambivalent—10% of attempters die

causes of suicide: biological

suicidality risk factors are 30-55% heritable

low levels of serotonin is associated with depressed and non-depressed suicidal ideation and reduces access to adequate depression treatment

causes of suicide: antidepressants

those with mental illnesses often take anti-depressants to treat it

not all symptoms dissipate at the same rate when receiving treatment; natural remission may occur as well

antidepressants in depressive episodes of bipolar disorders can increase suicidality due to mix-features

causes of suicide: psychological

>90% of completed suicides have at least one of these disorders: depressive disorders, bipolar disorders, substance use disorders, and schizophrenia

depression: slight mood increases causes higher suicidality due to slightly improved motivation; hopelessness is the strongest predictor for suicide

tunnel vision and inability to consider alternatives to obvious solutions

alcohol reduces inhibition, and inhibition is key preventing self-harm

social causes of suicide: painful social emotions

loneliness, shame, rejection, grief, relationships, distress, etc.

social causes of suicide: joiner’s interpersonal-psychological theory

perceived burdensomeness to others, thwarted belongingness in communities and social circles, and overcome inhibitions/acquired means of suicide

social causes of suicide: interpersonal maltreatment

abuse, bullying, shunning, etc.

causes of suicide: copycat suicides

romanticization of suicides and detailed descriptions of methods of suicide

causes of suicide: “post-vention”

reduce grief of immediate members of an individuals who commit suicide to reduce risks of secondary traumatization and “copying” the suicide

causes of suicide: contagion

exposure to mental illness can cause individuals to mimic abnormal behaviors and mental illnesses, and lead them to believe they have mental illnesses

papageno effect

media depictions that reduces suicide risk

werner effect

media depictions that increases suicide risk

sociocultural perspective of suicide: access to firearms

easy access to firearms mean greater risks of completed suicides

67% of firearm deaths are caused by suicides, and 50% of suicides are caused by firearms

firearms are lethal, and non-firearm attempters are savable

sociocultural perspective of suicide: elderly

attitudes toward the elderly increases suicidality

higher in white american elderly, but lower in japanese elderly

sociocultural perspective of suicide: immigrants

first-generation immigrants are at greater risk of suicidality due to lower social connectedness with the culture and surrounding community

sociocultural perspective of suicide: LGBT

risk of interpersonal stress and lack of connectedness to the predominately straight community

sociocultural perspective of suicide: cultural beliefs

beliefs about death and dying (e.g., cultural stigma)

suicide prevention: tertiary prevention

“post-vention” to help those affected by an individual who completed suicide like immediate family members and friends

preventative measures such as counseling to prevent copycat suicides and reduce risk of further traumatization

suicide prevention: secondary prevention

early detection, prevention, and treating individuals who have mental illnesses, are at risk of suicidal ideation, or following significant stressors/crises

suicide prevention: primary prevention

preventative measures to stop suicidal ideation before they occur, general community initiatives to reduce stigmas and education about suicide, and preventative means to stop suicide access (e.g., firearms)

psychotic and related disorders: delusions

fixed false beliefs that can be influenced by culture and be described as bizarre/non-bizarre

these beliefs are often “immune to logic” and cannot be disputed

types of delusions: persecutory

false beliefs that one is being persecuted against (e.g., being watched by the government, being stalked by assassins, etc.)

types of delusions: referential

false belief that neutral environmental factors, events, objects, and behaviors of others are of significance to oneself (e.g., interpreting other people talking as them speaking secret messages to you)

types of delusions: grandiose

false beliefs consisting of overtly confident ideas like extreme riches or supremacy over others (e.g., believing oneself to be wealthy)

types of delusions: erotomaniac

false belief that someone of note is in love with oneself

types of delusions: nihilistic

false belief that oneself, the world, or others are dead, do not exist, or are decaying

types of delusions: somatic

false beliefs that one’s internal or external bodily functions are abnormal

types of delusions: thought withdrawal/insertion

false beliefs that one’s thoughts are not their own and are given to them in their brain or being stolen from them by an entity

types of delusions: control

false beliefs where one believes someone is taking control of their actions, thoughts, and autonomy

psychotic and related disorders: hallucinations

experiencing sensory stimulation despite a lack thereof (no stimuli; they do not exist)

non-psychotic individuals can hallucinate through drug use

five senses: hearing, sight, touch, taste, and smell

psychotic and related disorders: disorganized speech

not correlated with disorganized thought

loose associations of different topics in a string of words

clang associations (words that rhyme), word salad (incoherent words), and abstract language (usually nonsensical)

psychotic and related disorders: disorganized behavior

acting in ways that is grossly and actively bizarre or illogical, typically never achieving anything and contradictory

e.g., barefoot in the snow, clapping and cheering at nothing, and excessive mail “sorting” that doesn’t really sort it

hypocatatonia

speech and movement drastically decreased; waxy flexibility

hypercatatonia

movement drastically increased with no clear goal

e.g., pacing, waving arms frantically, jumping up and down excessively

psychotic and related disorders: negative symptoms

removal of existing functions; alternatively, a lack of normal, pre-existing functions

“subtract, remove, negative”

often very impairing more than positive symptoms

negative symptoms: diminished emotional expression

constricted, blunted, or flattened expression of emotions in social scenarios that warrant them

e.g., not feeling sad at a funeral of a loved one

negative symptoms: avolition

little or no motivation

negative symptoms: alogia

little or no speech

negative symptoms: anhedonia

little or no ability to enjoy pleasurable activities

negative symptoms: asociality

little or no desire for social contact

psychotic disorders: cognitive impairment

not exclusive to psychotic disorders but very common in it

deficits in executive functioning (planning and higher functions), learning and memory, working memory and attention, logic and abstract thinking, verbal skills, and general intelligence

sharp cognitive decline after the first psychotic episode

brief psychotic disorder

1 day to 1 month; any longer would upgrade the diagnosis

brief symptoms of psychosis that goes into remission shortly afterward with no significant cognitive impairment

caused by major stressors

schizophreniform disorder

1 - 6 months; any longer would upgrade the diagnosis; usually more prevalent in women

67% of individuals go on to have schizophrenia

schizophrenia

6 months or more; M > F (differs in onset only); 0.7% prevalence

5-6% die by suicide due to the impairing and distressing nature of the disorder; 20% attempt

schizoaffective disorder

0.3% prevalence; generally M = F

combination of schizophrenia and bipolar I disorder (mania/depression); the “in-between” of the two disorders

delusional disorder

<0.1% prevalence; F = M; difficulty in diagnoses and people getting diagnosed due to lack of severity

consists of ONLY delusions and delusions that are non-bizarre; most people go on to live normal lives depending on severity and type of delusions

anosognosia

belief that oneself is not ill (physiologically and/or psychologically); a person is not in denial but rather believes logically they are healthy despite obvious symptoms

present in half of all schizophrenic, schizoaffective, and bipolar I disorders

effects of anosognosia

effects are permanent and caused by neurological factors that must be worked around with by caretakers

not responsive to evidence proving illness and correlated with cognitive impairment

denial

emotional, temporary response to learning of diagnoses that is correlated with emotional distress or poor personality function

can be treated with talk therapy

course of schizophrenia & related disorders

prodome → 1st psychotic episode → 1 of 3 scenarios:

• severe and chronic disability caused by schizophrenia

• few or residual symptoms in between episodes; function still limited

• permanent residual symptoms and periodic relapses; function supported independently

prodrome

precursor symptoms to psychotic episodes/disorders; negative symptoms first, then positive symptoms

the mentally ill, violence, and crime

the mentally ill are more susceptible to crimes than being the perpetrator of crimes

crimes committed by the mentally ill are usually non-violent, and even if they were, they are usually committed against known persons; insanity plea is rare and most go on to suffer

precursors to committing violent crimes include previous tendency of violence and psychopathy, untreated individuals, comorbid substance abuse, and the male gender

biological factors for schizophrenia: heritability

80% heritability; likelihood increases if relatives have schizophrenia

biological factors for schizophrenia: brain abnormalities

loss of white and grey matter (brain matter) especially in frontal lobes and enlarged ventricles

biological factors for schizophrenia: brain chemistry abnormalities

dysregulated dopamine activity; dopaminergic pathways are affected

biological factors for schizophrenia: early developmental delays

children have higher rates and signs of neurological “soft signs;” signs and symptoms that show increased risk for schizophrenia

e.g., missing claps excessively during childhood

dopaminergic pathways: mesolimbic

dopamine increases result in positive symptoms

dopaminergic pathways: mesocortical

dopamine increases result in negative symptoms

dopaminergic pathways: nigrostriatal

dopamine increases result in movement issues