Psychopathology Exam 3

Schizophrenia

A chronic psychotic disorder that makes one out of touch with reality. Is not a disorder that typically resolves, involves disturbed behavior, thinking, emotional perceptions, attentional deficits, an inability to filter out irrelevant stimuli. Characterized by a range of cognitive, behavioral, perceptual and emotional dysfunction.

Positive Symptoms (schizophrenia)

Additional “things” that are added that are not “typical” or part of the normal experience. Involves a break with reality, hallucinations and delusions

Negative Symptoms (schizophrenia)

Involve the “lack of” or “less than typical” of something, absence of something to function in daily life. Lack of emotion, loss of motivation/pleasure, social withdrawal, limited speech output.

Delusions (positive symptom)

False beliefs that are are not rational or based in a societally acceptable belief system, beliefs that are clearly inaccurate but person still holds to these strongly, not amenable to change, even with evidence that beliefs are false, involves disturbed thought content.

Persecutory delusions

Belief that one will be harmed or harassed by a group or person, but there is no rational idea for that belief.

Referential delusions

Belief that certain gestures comments and environmental cues are directed at the individual (i.e. someone looking at the person from across the room is thinking something offensive about them)

Grandiose delusions

One believes that they have exceptional abilities, wealth, or fame that they in reality do not have.

Erotomaniac delusions

One believes that another person is in love with them when they are in fact not.

Nihilistic delusions

One has the conviction that a major catastrophe will occur, express behavioral expression based of this belief.

Somatic delusions

One who has preoccupations with health and organ functioning in particular odd ways.

Thought broadcasting delusions

The belief that one’s thoughts are transmitted to the external world without the person outwardly communicating.

Thought insertion delusions

Belief that one’s thoughts have been planted in one’s mind from an external source.

Thought withdrawal delusions

Belief that thoughts have been removed from one’s own mind by an external source.

Hallucinations

False sensory perception-like experiences that occur without an external stimulus. Tend to be vivid and clear, not under voluntary control.

Auditory hallucinations

Hearing voices that may be familiar or unfamiliar, perceived as distinct from person’s own thoughts.

Visual hallucinations

Seeing things/people that are not actually there.

Olfactory hallucinations

Experiencing smell when there is no aroma.

Gustatory hallucinations

Hallucinations involving taste

Tactile hallucinations

Skin sensations/feelings

Command hallucinations

Experiences that they are being “told” to behave in a particular way.

Somatic hallucinations

Belief that there is feelings within the body, something is in the body or some bodily function is going on that is not really there (i.e. snakes inside the abdomen).

Thought disorder

A disturbance in thinking characterized by the breakdown of logical association between thoughts that is related. Related to attentional deficits and an inability to filter out stimuli.

Derailment or loose associations

Switches from one topic to another when topics don’t go together logically.

Tangentiality

Conversations and answers to questions don’t have to do with question that is asked, goes off on tangents.

Incoherence/” word salad”

Saying mixed up words that don’t go together in any way

Catatonia

Resistance to instruction (negativism), bizarre rigidity of structure and posture with little movement, does not take in or react to information, possible result of too much stimuli or having trouble filtering out stimuli.

Stereotyped movements

Repetitive movements that have no apparent purpose, staring, grimacing, echoing speech, moving body parts with no real reason.

Diminished emotional expression (negative symptoms)

“Flat affect”, poor eye contact, lack of gesturing and intonation

Lack of volition (negative symptoms)

Decrease in self-initiated purposeful activity. Little interest in work/social activity, no interest in engaging in any kind of activity. 

Diminished speech output

Lack of normal quantity of speech

Anhedonia

Lack of pleasure for engaging with activities

Asociality

Lack of interest in engaging with social activities

Diagnostic Criteria of Schizophrenia

Exhibiting of the two or more of the following symptoms:

o   Delusions

o   Hallucinations

o   Disorganized speech

o   Grossly disorganized or catatonic behavior

o   Negative symptoms

o   Impairment in important areas of life

Symptoms present for at least 6 months, rule out substance use or medical condition as causal.

Onset of schizophrenia

Late adolescence to early adulthood

Prodromal phase (schizophrenia)

A gradual deterioration with somewhat subtle symptoms, no hallucinations/delusions apparent, one is just beginning to develop the disorder. May neglect hygiene, has behavior that is different than what is typical.

Acute phase (schizophrenia)

Has delusions, hallucinations, illogical thinking, incoherent speech, bizarre behavior.

Residual phase (schizophrenia)

A return to symptoms that were present in the prodromal phase, but lacking the obvious psychosis of the acute phase. May be improvement seen in symptoms which depends on level of severity/compliance in treatment.

Psychodynamic theory of schizophrenia

Ego is overwhelmed by primitive sexual/aggressive drives, impulses from the id, demands immediate gratification, threatens ego, leads to intra-psychic conflict, leads individual to regress back to oral stage.

Learning theory of schizophrenia

A person learns to exhibit certain behavior, may be reinforced, may learn psychotic behaviors through modeling.

Family theory of schizophrenia

Parent who has schizophrenia is responsible for its onset, their cold aloof or domineering can cause this to also occur in their children.

Genetic evidence

Concordance rates, seen that a twin would have a higher chance of also developing disorder

Dopamine hypothesis (schizophrenia)

There are irregularities in the brain’s use of dopamine in neural networks, individuals with schizophrenia have over-reactivity of dopamine transmission.

Evidence supporting dopamine hypothesis

Individuals with schizophrenia do experience reduction in psychotic symptoms of hallucinations/delusions when taking medication that acts on dopamine.

Viral infections theory (schizophrenia)

Possible link between prenatal infections and development of schizophrenia.

Brain abnormalities theory (schizophrenia)

Abnormalities with prefrontal cortex, enlarged ventricles resulting in less brain tissue and brain matter.

Brain damage or improper brain development leading to abnormalities with brain circuitry.

Diathesis Stress Model

Diathesis + Potential Stress Factors →Schizophrenia

Potential Protective Factors for Diathesis Stress Model

Any type of resources, coping skills, etc. that help to block the occurrence of schizophrenia.

Antipsychotic medications

Medication that works to block dopamine receptors

Has side effect of tardive dyskinesia

Tardive dyskinesia

Occurs in individuals who use antipsychotic medications over long period of time.

Frequent eye blinking, chewing, eye movement, lip smacking, grimacing, trunk/limb movements, tremors.

Selective reinforcement treatment

Operant conditioning to selectively reinforce appropriate behaviors.

Token economy

Behavioral modification that is used in institutional setting, reinforced with smaller rewards for appropriate behavior, can be saved up for larger rewards.

Social skills training

Develop more appropriate communication, ways to monitor themselves/behavior.

Psychosocial Rehabilitation

Multiple types of supports and intervention to strengthen cognitive skills, memory, individualized care to make people as functional and independent as possible.

Family Intervention

Understand the disorder, how best to communicate, improving communication skills, reduce stress within family environment, enhance quality of communication.\\

Brief Psychotic Disorder

Experiences psychotic symptoms duration of 1 week – 1 month. Arises after major stressor, not a chronic disorder.

Schizophreniform Disorder

Lasts less than 6 months, schizophrenic like symptoms but resolves after 6 months.

Delusional Disorder

Persistent delusional beliefs, typically paranoid in nature, primary symptom without other characteristics of schizophrenia.

Schizoaffective Disorder

Chronic psychiatric disorder that involves schizophrenic features and severe mood disturbances.

Erotomania

Rare delusional disorder in which the individual believed that they are loved by someone that they are in fact not. 

When is personality believed to be fully formed?

After adolescence

When is personality believed to be relatively stable?

After adulthood

Personality Disorder

An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture.

Is pervasive (in every aspect of their life) and inflexible (unable to change).  

Has an onset in adolescence or early adulthood.

Diagnosis can’t be made until person is 18. Is stable over time. Leads to distress or impairment.

Paranoid Personality Disorder

Suspects others are exploiting, harming, or deceiving. Distrust and suspiciousness of other people and their motives  

Preoccupation with unjustified doubts re: loyalty and trustworthiness of friends and associates

Reluctant to confide in others. Reads hidden meanings in benign remarks/events. Don’t believe that someone could be genuine and kind.

Persistently bears grudges (feels one as mistreated, even if it was accidental). Perceives character attacks by others.

Recurrent, unjustified suspicions of partner’s fidelity, even no reason to do so. Lapse of trust, desire to be self-sufficient, paranoia could briefly get to a psychotic level.

Schizoid Personality Disorder

Does not desire or enjoy close relationships.

Lacks close friends.

Chooses solitary activities.

Little or no interest in sexual experiences with others.

Takes pleasure in few, if any, activities.

Appears indifferent to praise or criticism.

Emotional coldness, detachment, or flat affect.

Schizotypal Personality Disorder

Odd beliefs or magical thinking influence behavior, with the belief that they possess powers.

Unusual perceptual experiences

Odd thinking and speech (vague communication)

Suspiciousness or paranoia

Inappropriate or constricted affect

Odd, eccentric, peculiar behavior, and appearance

Lack of close friends

Excessive social anxiety

Antisocial Personality Disorder

Failure to conform to social norms re: lawful behavior.

Deceitfulness

Impulsivity

Irritability and aggressiveness

Reckless disregard for safety of self or others

Consistent irresponsibility

Lack of remorse

At least 18 years of age

Evidence of Conduct Disorder before age 15

Callous, cynical, full of contempt

Opinionated, can be charismatic and charming.

Borderline Personality Disorder

Frantic efforts to avoid real or imagined abandonment.

Pattern of unstable and intense interpersonal relationships

Identity disturbance

Potentially self-damaging impulsivity

Recurrent suicidal behavior, gestures or threats or self-mutilating behaviors

Affective instability due to mood reactivity

Chronic emptiness

Anger issues

Transient paranoia or dissociation

Histrionic Personality Disorder

* Uncomfortable when not center of attention.
* Sexually seductive or provocative behavior.
* Rapid shifts in emotion; shallow emotion
* Uses physical appearance to draw attention to self, may pay a lot of attention to appearance.


* Style of speech may be vague, lacks detail, very impressionable.


* Dramatic, theatrical, exaggerated emotional expression, highly emotional.
* Very suggestible, very influenceable by fads, thoughts of other people, can be overly trusting of others without developed strong relationship,


* Inaccurate evaluation of relationships’ intimacy, can overestimate the closeness of a relationship.

Narcissistic Personality Disorder

* Grandiose sense of self-importance, is exaggerated.
* Preoccupied with fantasies of success, power, beauty, etc.
* Belief is “special” and unique.
* Requires excessive admiration.
* Sense of entitlement, using people to enhance sense of self.
* Interpersonally exploitative
* Lacks empathy
* Often envious or believes others to be, posses arrogant behaviors and attitudes.

Avoidant Personality Disorder

* Avoids occupational activities involving interpersonal contact (fears)
* Avoids involvement with others unless being liked is certain.
* Fears of shame or ridicule by others, is very sensitive to negative evaluation.
* Preoccupied with being criticized/rejected.
* Feelings of inadequacy leads to feeling inhibited in social situations.
* Sees self as socially inept, unappealing or inferior. Reluctant to engage due to embarrassment fears, need lots of reassurance that they are indeed wanted.

Dependent Personality Disorder

* Requires excessive advice from others in decision making.
* Needs others (tends to be one single person) to assume life responsibilities.
* Difficulty expressing disagreement with others, fears loss of support/approval. A lack of confidence leads to difficulty with independent actions.


* Excessive need to obtain nurturance and support.
* Feels uncomfortable or helpless when alone.
* Urgently seeks replacement relationships.
* Unrealistic preoccupation with fears of having to take care of self.

Obsessive-Compulsive Personality Disorder

* Preoccupied with details, rules, lists, order, organization, or schedules.
* Perfectionism that interferes with task completion. Nothing can ever be good enough, so it can never be finished.
* Excessive work/productivity to exclusion of leisure and friendships. They tend to be workaholics, difficult to delegate work.
* Over-conscientious, scrupulous, and inflexible with morality, ethics or values
* Unable to discard worthless or worn-out objects.
* Reluctant to delegate.
* Hoards money.

Freud theory with Psychodynamic Perspectives

Problems occur during the phallic stage, process of identification with same sex parent does not occur, child lacks development of the superego and ego.

Hans Kohut theory with Psychodynamic Perspectives

Early experiences of the individual not being able to develop a cohesive sense of self (done with narcissistic personality disorder, is façade to cover up deep feelings of inadequacy), lack of healthy support.

Otto Kernberg theory with Psychodynamic Perspectives

Theory with BPD, fails to develop sense of consistency and unity between themselves and other people, have shifting views of themselves and other people which causes instability in relationships, lack self-image and sense of identity.

Margaret Mahler theory with Psychodynamic Perspectives

Theory of BPD, the process of child separating developing individuation goes awry, meshing with another personality in an unhealthy way.

Focusing on maladaptive behaviors (learning perspective)

How to change these maladaptive behaviors to help the person be more functional.

Belief that childhood experiences shape personality (learning perspective)

Environment is what is the primary reason in how it shapes the person.

Family Perspectives

Disturbances in family relationships cause of disorders.

Genetic factors

Possible genetic link, relatives with genetic similarities imply a suggestion that may there may be possible genetic factors.

Brain abnormalities

Problems with prefrontal cortex functioning where impulse control is processing, moderating activity of amygdala (process anger and fear). 

Individuals with Antisocial Personality Disorder….

Have lack of emotional responsiveness and respect for people’s rights.

Have exaggerated cravings for stimulation, engaging in risky behavior to experience more stimulation.

Sociocultural perspectives

Suggests that social conditions may contribute to development of Personality Disorders. These rates are higher in lower socioeconomic status groups, and more stress leads to more difficulty to control with.

Impulse Control Disorders

Category of disorders characterized by failure to control impulses, temptations, or drives, resulting in harm to oneself or others.

Kleptomania

repeated acts of compulsive stealing

Intermittent Explosive Disorder

repeated episodes of impulsive, uncontrollable aggression

Pyromania

repeated acts of compulsive fire setting

Separation Anxiety Disorder

Persistent, developmentally inappropriate fear or anxiety concerning separation from attachment figures.

Causes significant distress/impairment, thereby refuses to separate or be apart in different locations, reluctance to go out due to this fear, worry that they will be harmed while they are away from home.

Depression in childhood symptoms

·      Irritability or low mood

·      Feelings of Hopelessness

·      Low self-esteem, self-confidence, self-efficacy

·      Insomnia, fatigue, poor appetite

·      Distorted thinking patterns

Intellectual Disability

Deficits in intellectual functioning, IQ score approximately 2 standard deviations or more below mean.

Deficits in adaptive functioning (reasoning, problem solving, accurate judging, learn from experience, academic setting, skills needed to become independent (self-care skills). 

Down syndrome (cause of intellectual disability)

Extra chromosome on 21st pair, different physical presentations, cardiac/respiratory issues, causes lower life expectancy.

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Fragile X syndrome

Genetic mutation on single X chromosome, can cause intellectual disability.

Phenylketonuria (PKU)

Very rare (1 in 10,000 births), caused by recessive gene, prevents metabolization of amino acid, leads to accumulation in the CNS, lead to intellectual disability.

Fetal alcohol syndrome

Physical and behavioral disabilities caused by this alcohol consumption during pregnancy.

Lead

Ingesting lead causes intellectual disability

Least restrictive environment intervention

Have children with intellectual disabilities be mainstreamed into classrooms as appropriate, receive special education services in other classrooms only if necessary.

Autism Spectrum Disorder

Disorder is evident between 18-30 months, diagnosed around age of 6, noted. as more common in males than females (4x), increased risk with older fathers. Persistent deficits in social communication and social interaction across multiple contexts.

Deficits in social-emotional reciprocity (autism spectrum disorder)

Difficulty with taking turns, speaking then listening, reduced sharing of interests/emotions.

Deficits in nonverbal communication behaviors used for social interaction (autism spectrum disorder)

Difficulty with gestures, eye contact, facial expressions, body orientation, intonation of speech, understanding relationships.

Deficits in developing, maintaining, and understanding relationships (autism spectrum disorder)

Preference for being alone, not very interested in peers or making friends.