psychopathology final short answer

what does it mean for a disorder to be ego-syntonic or ego-dystonic?

• ego-syntonic = symptoms feel in line with person’s self-image; don’t see behavior as problematic!

  • EX: narcissistic PD

• ego-dystonic = symptoms are distressing and don’t match self-perception; recognize behavior as problematic!!

  • EX: OCD

• most PDs are ego-syntonic, making treatment challenging

discuss treatment of BPD + most effective treatment

• difficult to treat

  • intense emotions

  • unstable relationships

  • fear of abandonment

  • impulsive behavior

• DIALECTICAL BEHAVIOR THERAPY (DBT)!!!!!

  • developed Marsha Linehan

• other treatments

  • medication to target mood symptoms (antidepressants, mood stabilizers) but no meds directly treat BPD

  • schema-focused therapy and mentalization-based therapy

  • DBT has strongest evidence base!!!!

what are the 4 focuses of DBT

DIME

1. distress tolerance

2. interpersonal effectiveness

3. mindfulness

4. emotion regulation

what is the structure of DBT?

• weekly individual therapy sessions

• weekly group skills training

• phone coaching for crisis

what are the goals of DBT?

• reduce self harm and suicidal behavior

• improve emotional regulation and interpersonal relationships

• help client build life worth living

why is BPD controversial?

• stigma = stigmatized even by mental health professionals bc don’t want to deal w/ behaviors like self-harm and intense emotional reactivity

• gender bias = over diagnosed in women, under diagnosed in men

• overlap = shares symptoms with mood disorders, so hard to distinguish; high rates of comorbidity complicates diagnosis

• subjectivity = based on patterns and clinician interpretation, not bio tests and can be interpreted differently

what makes BPD hard to diagnose?

• symptoms fluctuate

• some clinicians hold bias against treating those w/ BPD

• intense emotions resemble other disorders (EX: bipolar disorder) —> misdiagnosis

• criteria isn’t culturally generalizable to non-WEIRD samples

how does bias toward racial and sexual identities relate to BPD diagnoses?

• cultural misunderstanding = emotional expression, coping mechanisms, communication styles vary by culture

• gender + sexuality bias = LGBTQ+ > experience trauma, linked to BPD symptoms; distress may be dismissed as identity struggle rather than possible PD

• systemic + structural inequalities = exposure to racism, homophobia, etc —> emotional dysregulation and identity instability resembling BPD symptoms

schizotypal PD vs. prodromal phase schizophrenia

prodromal phase = period before full-blown psychotic symptoms appear; mild version of schiz. symptoms: social isolation, odd thinking, decreased functioning

schizotypal PD = cluster A PDs (odd/eccentric); functions better than someone w/ schiz.; NO full psychosis

similarities:

• odd beliefs/magical thinking

• paranoia

• unusual perceptual experiences (NOT full hallucinations)

• eccentric behavior/appearance

• social withdrawal/awkwardness

• disorganized/tangential speech

differences:

• ppl w/ schizotypal PD usually do NOT progress to schiz., unless family history of schiz. or start to show worsening symptoms

grandiose vs. vulnerable narcissism

grandiose

• inflated self-esteem

• overconfidence and arrogance

• charm/charisma

• seek attention and admiration

• dismiss criticism or react w/ anger

• manipulate for personal gain

• ego-syntonic!!!

vulnerable

• fragile self-esteem

• sensitive to rejection and criticism

• feel shame, anxiety, insecurity

• appear shy, but harbor fantasies of superiority

• crave validation, fear rejection

• passive-aggressive/overly self-protective

• ego-dystonic!!!! - aware of emotional distress, but NOT narcissistic traits causing it

3 differences between OCD and OCPD

1. ego-syntonic vs ego-dystonic

   1. OCD: ego-dystonic = distressed by obsessions + compulsions and want them to stop

   2. OCPD: ego-syntonic = see behavior as appropriate and cannot see perfectionism as a problem

2. focus

   1. OCD: involves obsessions and compulsions aimed at reducing anxiety

   2. OCPD: general personality traits like perfectionism, orderliness, and need for control; NOT driven by anxiety or rituals

3. insight + flexibility

   1. OCD: have insight that behaviors are irrational

   2. OCPD: lack insight and believe their way is the best/right way (rigid and inflexible)

3 problems w/ current PDs

1. high overlap (comorbidity)

2. poor reliability + subjectivity

   1. diagnosis relies on clinician judgment —> bias

3. cultural and gender bias

   1. weird in one culture, normal in another

   2. women more often diagnosed w/ BPD, men more diagnosed w/ ASPD

why might rates of narcissistic PD be higher in U.S?

• highly individualistic society (value confidence and assertiveness)

• confidence, competitiveness, standing out —> rewarded

• cultural reinforcement can normalize/encourage narcissistic tendencies

why might rates of narcissistic PD be higher among young adults?

• self-focused individualism heavily reinforced

• rise of social media

  • encourage self-image curation

  • comparison

  • validation

• stage of identity transformation: self-focus is typical but can tip into narcissism if not balanced by empathy and accountability

what effects do depressants have on GABA and glutamate?

• depressants INCREASE GABA activity

  • slows down brain activity

  • produce calm effect

  • reduce anxiety, impair coordination and reaction time

• depressants DECREASE glutamate activity

  • slow down brain function

  • memory problems, poor judgment, cognitive impairments

how do STIMULANTS operate in central nervous system?

• increase activity in CNS by boosting levels of NT (esp. dopamine, norepinephrine, serotonin)

• increase alertness, attention, energy

• elevate heart rate and blood pressure

• reduce appetite

• in high doses: euphoria, restlessness, anxiety

how do AMPHETAMINES operate in CNS?

• stimulate release of dopamine and norepinephrine into synapse

• block reuptake, keep NT active longer

• heightened energy and concentration

• euphoria + increased motivation

• used medically for ADHD and narcolepsy

• in high doses: risk of addiction, paranoia, heart problems

how does COCAINE operate in CNS?

• blocks reuptake of dopamine, norepinephrine, serotonin

• causes NT to accumulate in synapse —> intensifying effects

• intense euphoria + confidence

• increased energy and alertness

• effects are short-lived —> high addiction potential

MDMA (molly/ecstasy) affects levels of which NT in brain?

1. serotonin - MAINLY AFFECTED

   • levels are less than half of those of non-users

in DSM-5 criteria for SUDs, severity of the SUD is determined by…

# of criteria met out of 11

• mild: 2-3 symptoms

• moderate: 4-5 symptoms

• severe: 6+ symptoms

which drug has most uncomfortable pattern of withdrawal?

opioids

• flu-like withdrawal symptoms

  • chills/sweating

  • vomiting

  • diarrhea

  • fever

  • insomnia

pleasure pathway of brain + its structures

pleasure pathway of brain = circuit sensitive to dopamine

brain structures involved:

• starts in VENTRAL TEGMENTAL AREA (VTA) in midbrain

• NUCLEUS ACCUMBENS in limbic system

• FRONTAL CORTEX

how do some drugs DIRECTLY increase dopamine, while others INDIRECTLY increase dopamine?

DIRECTLY increase

• stimulants

  • cocaine: blocks reuptake of dopamine, causing it to build up in synapse

  • amphetamines: increase dopamine release and block reuptake

INDIRECTLY increase

• drugs influence other NT that affect dopamine release

  • GABA inhibits dopamine from firing in VTA

  • opiates inhibit GABA, allowing dopamine to flow freely

what are tolerance and withdrawal?

tolerance = when person needs more of a drug to achieve same effect/experiences reduced effects with continued use of same amount

• brain adapts to drug’s present by reducing receptor sensitivity and producing less of the natural NT

withdrawal = when person stops/reduced drug use after becoming dependent

• symptoms arise bc brain adjusted to drug and now struggles to function w/o it

• often opposite of intoxication symptoms

what is an agonist treatment for SUDs and what is an antagonist treatment?

agonist = mimics drug by activating same receptors in brain, but in safer/controlled way

• GOAL: reduce cravings and withdrawal without producing same high/harmful behavior

• EX: nicotine patches/gum provide nic in safer form to quit smoking

antagonist = blocks receptor sites that the drug normally activates

• GOAL: prevent drug from having desired effect, helps reduce use and relapse

• EX: narcan is opioid antagonist used in overdoses to reverse respiratory depression

abstinence violation effect (2 parts)

abstinence violation effect = psychological response a person may have after a slip or relapse during recovery from an SUD

1. guilt and shame after a slip

   1. after using again, person feels intense guilt, shame, failure

2. all or nothing thinking

   1. believe one mistake = total failure, leads to might as well give-up attitude

   2. can trigger full relapse