Psychopathology Final Exam

Female sexual interest/arousal disorder

• lack of or significantly reduced sexual interest/arousal

• manifests in:

- reduced sexual interest

-reduced sexual activity

-fewer sexual thoughts

-reduced arousal to sexual cues

-reduced pleasure or sensation during almost all sexual encounters

• causes significant distress

• researchers suggest 7-46% of women experience low sexual desire

Male Hypoactive Sexual Desire Disorder

• little or no interest in any type of sexual activity

• masturbation, sexual fantasies, & intercourse are rare

• affects approximately 5% of men

Genito-Pelvic Pain/Penetration Disorder

• in females, difficulty with vaginal penetration during intercourse, associated with one or more of following:

-pain during sex or penetration attempts

-fear/anxiety about pain during sexual activity

-tensing of pelvic floor muscles in anticipation of sexual activity

Erectile Disorder

• difficulty achieving or maintaining an erection

• sexual desire usually intact

• most common problem for which men seek treatment

• prevalence increases with age

-50% of men over 60 experience erectile dysfunction

Reasons why healthcare professionals are less inclined to bring up sexual health with patients

• they were exposed were not exposed to sexual health education

• they are uncomfortable asking about it

• they make assumptions about their patient

• they don’t think the patient wants to talk about it

Psychological disorders that make someone more vulnerable to SD

• anxiety disorder

• mood disorder

• trauma

• somatic disorders

• substance use disorders

Identify social/cultural influences on sexual functioning

• learned negative attitudes toward sex and sexuality (erotophobia)

• negative sexual experiences

• relationship challenges; dissatisfaction with romantic relationships

Sexual Disorder Treatments

• education

• Masters & Johnson’s psychosocial intervention

-sensation focused and nondemand pleasuring- sexual activity with the goal of focusing on sensations without trying to achieve orgasm

• use of dilators to help women with painful intercourse

• exposure to erotic material for problems with low sexual desire

• medications (oral, injectable), vacuum-pump devices for ED

• referral to appropriate medical professionals (PCP, PT)

Substance Use

taking moderate amounts of a substance in a way that doesn’t interfere with functioning

Substance Abuse

use in a way that is dangerous or causes substantial impairment (e.g. affecting job or relationships)

Tolerance

• needing more of a substance to get the same effect

• reduced effects from the same amount

withdrawal

physical symptom reaction when substance is discontinued after regular use

5 categories of substances

1. depressants

2. stimulants

3. opiates

4. hallucinogens

5. other drugs of abuse

depressants

• behavioral sedation

• decrease CNS activity

• influences GABA system

• helps one relax

• increase inhibitory effects

• makes neural cells slower in firing

• e.g. alcohol, sedative, anxiolytic drugs

stimulants

• increase alertness and elevated mood

• e.g. cocaine, nicotine

opiates

• produce analgesia and euphoria

• e.g. heroin, morphine, codeine

hallucinogens

• alter sensory perception

• e.g. marijuana, LSD

clinical features of substance use disorders

• pattern of substance uses leading to significant impairment and/or distress

Symptoms of Substance Use

-need 2+ within a year

• taking more of the substance than intended

• desire to cut down

• excessive time spent using/ acquiring/recovering

• craving for the substance

• role disruption (e.g. can’t perform at work)

• interpersonal problems

• reduction in important activities

• use in physically hazardous situations (e.g. driving)

• keep using despite causing physical or psychological problems

• tolerance

• withdrawal

Delirium Tremens (DTs)

• long term effect of heavy drinking in very severe cases

• complication of alcohol withdrawal involving sudden and severe changes in mental or nervous system

Standard Drink

Beer:

• 12 fl oz

• 5% alcohol

Wine:

• 5 fl oz

• 12% alcohol

Liquor:

• 1.5 fl oz

• 40% alcohol

Moderate/ heavy/ binge drinking

Moderate-

• men: no more than 2 drinks/day

• women: no more than 1 drink/day

Heavy-

• men: consuming >4 drinks in any day or more than 14/week

• women: >3 drinks on any day or more than 7/week

Binge-

• men: 5+ drinks within 2 hr period

• women: 4+ drinks within 2 hr period

Prescription drug misuse/abuse

• prescription drug misuse and abuse is when someone takes a medication inappropriately (NIDA)

• adolescents are particularly vulnerable

• most of the prescription drugs that are pain-relieving drugs

Why people may not seek substance use treatment

• stigma

• no support

• scared to admit they need help

• don’t think they need help

Biological Treatments for opioid use and alcohol use disorder

Naltrexone

• FDA-approved for opioid and alcohol use disorders

• block pleasant effects of drugs; reduces craves

• patients must complete detox (medically managed withdrawal) prior to initiating

Methadone

• FDA-approved for opioid use disorders

• blocks pleasant effects of drugs; reduces cravings

• potentially addictive

Positive outcomes of medication - assisted treatment for opioid abuse disorder

• lower the risk of fatal overdose by approximately 50%

• lower the risk of non-fatal overdoses

• reduce drug-injecting

• reduce HIV transmission

• reduces criminal activity by opioid users

General nature of personality disorders

• enduring, inflexible predispositions

• maladaptive, causing distress and/or impairment

• high comorbidity

• poorer prognosis

Personality Clusters

Cluster A

• odd or eccentric cluster

• includes paranoid, schizoid, schizotypal

Cluster B

• dramatic, emotional, erratic cluster

• includes antisocial, borderline, histrionic, narcissistic

Cluster C

• fearful or anxious cluster

• includes avoidant, dependent, obsessive-compulsive

Treatment options for Cluster A PD

• focus on interpersonal skills

• building trust where paranoia is a factor

• address comorbid condition

Clinical features of antisocial PD

• violation of the rights of others

• irresponsible, impulsive, and deceitful

• lack of a conscience, empathy, and remorse

• may be very charming, interpersonally manipulative

• most often diagnosed in males

• failure to comply with social norms

Early/family history of antisocial PD

• relation with early behavior problems and conduct disorder

• early histories of behavioral problems and conduct disorder

• “callous-unemotional” type of conduct disorder more likely to evolve into antisocial PD

• families with inconsistent parental discipline and support

• families often have histories of criminal and violent behavior

Development of Antisocial PD

genetic influences

• more likely to develop antisocial behavior if parents have history of antisocial behavior or criminality

developmental influences

• high-conflict childhood increases likelihood of APD in at-risk childhood

arousal theory

• people with APD are chronically under-aroused and seek stimulation from the types of activities that would be too fearful or aversive for most

psychological and social influences

• in research studies, psychopath is less likely to give up when goal becomes unattainable - may explain why they persist with behavior (e.g. crime) that is punished

Borderline PD

• unstable moods and relationships

• impulsivity, fear of abandonment, poor self-image

• self-mutilation and suicidal gestures

Borderline PD treatments

• antidepressant medications provide some short-term relief

• dialectical behavior therapy is most promising treatment; 4 components:

-mindfulness: the practice of being fully aware and present

-distress tolerance: how to tolerate pain in difficult situations

-interpersonal effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others

-emotional regulation: how to decrease vulnerability to painful emotions and change emotions that you want to change

Obsessive-compulsive PD

• excessive and rigid fixation on doing things the right way

• highly perfectionistic and orderly

• obsessions and compulsions are rare

DSM-5 criteria for Schizophrenia

A. 2+ of the following, each present for a significant portion of time during a 1-month period:

-delusions

-hallucinations

-disorganized speech

-grossly disorganized or catatonic behavior

-negative symptoms

B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset

C. continuous signs of the disturbance persist for at least 6 months

Hallucinations

• experience of sensory events without environmental input

• can involve all sense

• most common: auditory

types:

• auditory

• visual

• olfactory

• tactile

Delusions

• gross misrepresentations of reality

Delusions of grandeur:

• believing that you are famous

• feeling as though you have special powers

Delusions of persecution:

• believing that co-workers are hacking your email to get you fired

• believing in dangerous conspiracy

Clusters of Schizophrenia

Positive

• hallucinations

• delusions

Negative

• absence or insufficiency of normal behavior

• examples:

-avolition (or apathy)- lack of initiation and persistence

-alogia- relative absence of speech

-anhedonia- lack of pleasure, or indifference

-affective flattening- little expressed emotion

Disorganized

• disorganized speech

- tangentiality- “going off on a tangent”

- loose associations- conversation in unrelated directions

• disorganized affect

  -inappropriate emotional behavior

• disorganized behavior

  - includes a variety of unusual behaviors

  - catatonia- considered a psychotic spectrum disorder on its own right, or when occurring in the presence of schizophrenia, a symptom of schizophrenia

Schizophreniform

• psychotic symptoms lasting between 1-6 months

• need 2+ symptoms (delusions, hallucinations, disorganized or catatonic behavior, negative symptoms)

Brief psychotic disorder

• psychotic symptoms lasting less than 1 month

• need 1+ symptoms (delusions, hallucinations, disorganized or catatonic behavior, negative symptoms)

Schizoaffective disorder

• symptoms of schizophrenia + additional experience of a major mood episode (depressive or manic)

• psychotic symptoms must also occur outside the mood disturbance

• prognosis is similar for people with schizophrenia

• such persons do not tend to get better on their own

Catatonia

• unusual motor responses, particularly immobility or agitation, and odd mannerisms

• tends to be severe and rare

• may be present in psychotic disorders or diagnosed alone

may include

• stupor, mutism, or maintaining the same pose for hours

• opposition or lack of response to instructions

• repetitive, meaningless motor behaviors

• mimicking other’s speech or movement

Diagnoses to rule out before schizophrenia

• mood disorders with psychotic features (bipolar, major depressive disorder)

• induced psychotic experiences (substance use disorder)

• medical conditions

• schizoaffective- includes mood disturbances

• personality disorders with delusions, mistrust, and suspicion (borderline PD, paranoid PD)

• PTSD- hallucinations or paranoia

• autism spectrum disorder- odd and unusual beliefs, presents in childhood

• brief psychotic disorder- less chronic case

Prevalence Rate of Schizophrenia

worldwide

• about 1% of the population

• often develops in early adulthood

• can emerge at any time; childhood cases are rare

tends to follow chronic course

• most with nod-severe impairment

• lower life expectancy (due to increased risk of suicide, accidents, and poorer self-care)

Demographics of Schizophrenia

• affect male and females about equally

-onset slightly earlier for males

• cultural factors: found at similar rates in cultures

Causal Factors of Schizophrenia

genetics vs. environment

• degree of genetic relatedness matters

• adoption studies

  - adopted children whose bio parents have schizophrenia are still at risk for developing schizophrenia

• BUT for healthy environment is a protective factor

Dopamine Hypothesis

• schizpphrenia is partially caused by overactive dopamine

  - drugs that increase dopamine (agonist) result in schizophrenia-like behavior

  - drugs that decrease dopamine (antagonist) reduce schizophrenic-like behavior

Neurobiological

• structural and functional abnormalities in the brain

  - hypofrontality - less active frontal lobes

  - enlarged ventricles and reduced tissue volume

• viral infections during early prenatal development

  - findings are inconclusive

Correlates of Schizophrenia

• stress may activate underlying vulnerabilities (diathesis-stress) and may increase risk of relapse

• cold parenting - unsupported theory

• high expressed emotion within families- associated with relapse

Treatment for Schizophrenia

• typically involves antipsychotic medications plus psychosocial interventions such as

  - social skills/living skills training

  - family therapy

  - vocational rehabilitation

• noncompliance with medication is common issue

• meds can have major permanent side effects

  - e.g. Tardive dyskinesia

Diagnostic features of ADHD

nature of ADHD

• central feature- inattention, overactivity, and impulsivity

• associated with various impairments

  - behavioral

  - cognitive

  - social and academic problem

• several symptoms must be present prior to age 12

• symptoms present in 2+ settings

• not better explained by another condition

Inattention in ADHD

• not giving close attention to details

• dificulty maintaining attentions

• trouble with follow through

• avoids tasks that require sustained mental effort

• often loses things necessary for tasks

• easily distracted and/or forgetful

Hyperactive/Impulsivity in ADHD

• fidgeting in seat

• often unable to engage in leisure activities quietly

• “driven by motor”

• running/climbing in situation where inappropriate (or feelings of restlessness in adults)

• blurting out answers before question is completed

• difficulty waiting their turn

Prevalence rates of/trends of ADHD

• occurs in approximately 11% of school-age children

• symptoms are usually present around age 3 and 4

• children with ADHD have similar problems as adults

• boys outnumber girls 3:1

• ADHD is most commonly diagnosed in the US but also worldwide (2-7% prevalence rate)

• white (78.8%), hispanic (9.1%), black (6%), asian (3.2%), other (3%)

Prevalence rates/trends in Autism Spectrum Disorder

• 1 in 44 children in the US meet criteria

• more commonly diagnosed in males

• IQ interaction

  - approx 35% show intellectual disabilities

• worldwide= 1%

• boys outnumber girls 4:1

Main Areas of Impairment in ASD

• communication and social interaction

  - deficits in social communication and social interaction, including:

  • social-emotional reciprocity

  • nonverbal communication behaviors

  • developing, maintaining, and understanding relations

  - restricted, repetitive patterns of behavior, interests, or activities, including:

  • stereotyped or repetitive motor movements

  • insistence on sameness; inflexible adherence to routines

  • highly restricted, fixated interests

  • hyper - or hypo-reactivity to sensory input

ASD vs. intellectual disability

• ASD can have a wide range of IQs

• ID is evident in childhood as significantly below-average intellectual and adaptive functioning

ADHD risk factors

Genetic Contributions

• ADHD seems to run in families

• DAT1- dopamine transporter gene has been implicated

• some ADHD dugs work by inhibiting DAT1

Neurological Correlates

• smaller brain volume

• inactivity of the frontal cortex and basal ganglia

• abnormal frontal lobe development and functioning

ASD risk factors

Genetic Contributions

• familial component: if one child with autism, the chance of a second with autism is 20% (100x greater risk than general population)

• possible link between autism and oxytocin receptor genes

• older parents associated with increased risk

Neurological Correlates

• amygdala

  • larger size at birth= higher anxiety, fear

  • elevated cortisol

  • neural damage in the amygdala results from high stress, which affect processing of social situations

• oxytocin

  • lower levels

ADHD Treatments

Biological

• simulant medications

  • currently prescribed approximately 4 million American children

  • low doses of stimulants improve focusing abilities

  • examples include Ritalin, Dexedrine, Adderall

  • Problem: may increase risk for later substance abuse

Behavioral

• reinforcement problems

  • to increase appropriate behaviors/decrease inappropriate behaviors

  • may also involve parent training

• combined bio-psycho-social treatments

  • often recommended

  • may be superior to medication or behavioral treatments alone

ASD Treatments

Biological

• medical intervention had little positive impact on core dysfunction

• some drugs decrease agitation

  • tranquilizers

  • SSRIs

• indicators of good prognosis

  • high IQ, good language ability

Behavioral

• skill building

• reduce problem behaviors

• communication and language training

• increase socialization

• early intervention is critical- may “normalize” the functioning of the developing brain