Frala- Abnormal Psych Final

define psychosis

reality contact is impaired

list the 3 types of psychosis

-mood disorders(w psychotic features)

-schizophrenia

-delusional disorder

define mood disorders with psychotic features

group of disorders involving severe and enduring disturbances in emotionally ranging from elation to severe depression

define schizophrenia as a type of psychosis

startling disorder characterized by a broad spectrum of cognitive and emotional dysfunctions including delusions and hallucinations, disorganized speech and behavior, and inappropriate emotions

define delusional disorders as a type of psychosis

psychotic disorder featuring a persistent belief contrary to reality but no other symptoms of schizophrenia

describe the role of Emil Kraepelin in schizophrenia

-1896

-German psychiatrist who unified the distinct categories of schizophrenia under the name dementia praecox

-Focused on early onset & poor outcomes

define dementia praecox

"premature mental deterioration" from manic-depressive illness.

describe the role of Eugen Bleuler in schizophrenia

-1911

-Swiss psychiatrist

-proposed the term schizophrenia (split mind)

-Believed that a difficulty keeping consistent train of thought characteristic of all people w this disorder led to the many & diverse symptoms they displayed

List the diagnostic criteria for schizophrenia

2+ of these for at least a month :

delusions

hallucinations

disorganized speech

grossly disorganized or catatonic behavior

negative symptoms

social/ occupational dysfunction

at least 6 months duration of "disturbance"

describe the negative symptoms of schizophrenia

absence or insufficiency of normal behavior

avolition (apathy)

alogia

anhedonia

affective flattening (flat affect)

define avolition (apathy)

inability to initiate or persist in activities

define alogia

poverty of speech

define anhedonia

lack of pleasure/ interest

define affective flattening (flat affect)

lack of emotional expression

describe the positive symptoms of schizophrenia

excess or distortion of normal functions/ more obvious signs of psychosis

delusions

hallucinations

list the types of delusions

of grandeur

of persecution

bizarre delusions

define delusions of grandeur

mistaken belief that the person is famous or powerful

define delusions of persecution

mistaken belief that others are out to get them

describe Capgras syndrome

believes he/ she has been replaced by a double

describe Cotard's syndrome

person believes they are dead

list the types of hallucinations

auditory

visual

olfactory

tactile

Define delusions

irrational beliefs

Define hallucinations

sensory experiences in the absence of external events

describe auditory hallucinations

hearing things that aren't there

describe visual hallucinations

seeing things that aren't there

describe olfactory hallucinations

detects smells that aren't present

describe tactile hallucinations

sensation of physical contact with an imaginary object

List disorganized symptoms of schizophrenia

-Disorganized speech

-include a variety of erratic behavior and emotional reactions

-Cognitive slippage

-Tangentially

-Inappropriate affect

-Disorganized behavior

define Cognitive slippage

"word salad"

define Tangentially

going off on a tangent rather than answering question directly

define Inappropriate affect

laughing or crying at improper times

Identify examples of disorganized speech

-Word salad

-Tangentiality

Identify examples of disorganized behavior

-Catatonia

-Child-like sickness

-Unpredictable/inappropriate behavior

-Unpredictable agitation

-Markedly disheveled appearance

-Dress in unusual manner

-Clearly inappropriate sexual behavior

define catatonia

motor dysfunction that ranges from wild agitation to immobility (DSM 5) now considers it a schizophrenia disorder on the spectrum)

List the prevalence, sex ratio, and age of onset (men and women) for schizophrenia

-Prevelance: about 1%

-Sex ratio: slightly more prevalent in men

-Men: 18-25

-Women: bimodal

Discuss evidence of cultural bias in this diagnosis and sociocultural factors that might contribute to prevalence differences among ethnic groups

-In the US: more African Americans receive this diagnosis;

-Both US and England suggest people from devalued ethnic minority groups may be victims of bias and stereotyping/ more likely to receive the diagnosis

-May be a result of misdiagnosis rather than the result of any real cultural distinctions

List criteria for catatonia

2 or more for at least a month:

stupor

waxy flexibility/catalepsy

mutism

negativism

posturing

mannerism

stereotypy

agitation

grimacing

echolalia

echopraxia

describe stupor

no psychomotor activity

describe waxy flexibility/catalepsy

being able to move someone into a posture like molding wax

describe mutism

no or very little verbal response

describe posturing

spontaneous holding of a posture against gravity initiated by the individual

describe mannerism

odd or circumstantially different from norms

describe stereotypy

persistent repetition of an act for no obvious purpose.

describe echolalia

repetition or echoing of a person's speech

describe echopraxia

involuntary imitation of the movement of another person

Identify schizoaffective disorder

Combination of mood and psychotic disorder

define Schizophreniform

same criteria for schizophrenia; symptoms for more than a month but less than 6 months

define Brief Psychotic Disorder

characterized by the presence of 1+ positive disorganized symptoms; symptoms for less than a month

list the 3 most common phases experienced in schizophrenia

prodromal

active

residual

describe the prodromal phase of schizophrenia

1-2-year period before symptoms occur; when symptoms start to show up they include: ideas of reference, magical thinking, and illusions. Isolation, impairment of functioning, and lack of cognitive interest or energy.

describe the active phase of schizophrenia

positive, negative, cognitive, and mood symptoms

describe the residual phase of schizophrenia

positive, negative, and cognitive symptoms

list the 4 possible courses of the schizophrenia

-premorbid

-prodromal

-onset/deterioration

-chronic/residual

describe the frequencies of the premorbid course of schizophrenia

15% have only a single episode of illness with no subsequent impairment

describe the frequencies of the prodromal course of schizophrenia

25% have repeated episodes of illness between episodes

describe the frequencies of the onset/deterioration course of schizophrenia

30% have repeated episodes of illness with some impairment between episodes

describe the frequencies of the Chronic/residual course of schizophrenia

30% have repeated episodes of illness with gradually declining impairment between episodes

what % of schizophrenia patients fully recover

appx. <15%

what % of schizophrenia patients continue to have residual/active symptoms

appx. 85%

what % of schizophrenia patients receive disability/welfare benefit or are economically dependent

90% +

what % of schizophrenia patients are homeless

6%

what % of schizophrenia patients are unmarried

75% +

what % of schizophrenia patients die by suicide

appx. 10%

Describe the evidence for twin studies and schizophrenia

48% concordance among monozygotic twins; 17% concordance among dizygotic twins

Describe the evidence for family studies and schizophrenia

severity of schizophrenia; psychotic disorders spectrum; inheritable tendency

Describe the evidence for adoption studies and schizophrenia

children with parents of schizophrenia have a much higher chance of having it but there seems to be a protective factor if the children grow up in healthy/supporting homes (gene- environment interaction)

describe the evidence for the dopamine hypothesis of schizophrenia

-Antipsychotic drugs that are dopamine antagonists are often effective (partially blocking brains use of dopamine)

-Neuroleptic medications can produce negative side effects similar to those in Parkinson's (insufficient dopamine)

-L-Dopa Parkinson's disease- produces schizophrenia like symptoms in some people

-Amphetamines: activate dopamine, can make psychotic situations worse

-SUMMARY: increase of dopamine (agonists) causes increase in schizo behaviors; decrease of dopamine (antagonist) causes decrease in schizo behavior; schizo attributable to excessive dopamine

describe the evidence against the dopamine hypothesis of schizophrenia

-Many go not helped by dopamine antagonists

-Although the neuroleptics block reception of dopamine quickly, the relevant symptoms subside after several days or weeks, more slowly than expected

-Only partially helpful in reducing the negative symptoms

Discuss the season-of-birth effect and its implications

Born in winter months; particularly in march- more likely to develop schizophrenia

Describe the possible role of Enlarged lateral & 3rd ventricles in schizophrenia

shows adjacent part of brain either has not fully developed or atrophied

Describe the possible role of Hypofrantality in schizophrenia

frontal lobes may be less active in people with this disorder

Describe the possible role of Obstetrical complications in schizophrenia

influenza, pregnancy complications, and delivery complications

Describe the possible role of Marijuana in schizophrenia

chronic and early use

Describe the previous theories for schizophrenia including the term "schizophrenogenic mother"

mother with cold, dominant, rejecting nature that caused schizophrenia in children

Describe the previous theories for schizophrenia including the term "double bind communication"

communication style that produced conflicting messages that causes schizophrenia to develop

describe conventional antipsychotics in the treatment of schizophrenia

Hadol, Thorazine

60% respond

describe atypicals in the treatment of schizophrenia

newer medications

-cloazapine, risperidone, olanzapine

-May be less binding to D2 site

-Fewer side effects

discuss Behavioral approaches in schizophrenia

-Set up an elaborate token economy; earn access to luxuries by behaving correctly or fined for being disruptive

-Patients here did better than others on social, self-care, and vocational skills, more were discharged from the hospital

-Shows they can learn to perform some skills they need to live more independently

discuss Education& skill building treatments in schizophrenia

-reduce hospitilaztaion

-Social skill training

-Independent living skills programs

-Vocational rehabilitation

list the key components of psychosocial treatment of schizophrenia

-Behavioral approaches

-Education& skill building

-Behavioral Family therapy

-Community Care Programs

-CBT

what % of schizophrenia patients have severe mental illness receiving no treatment

50%

what % of schizophrenia patients don't know there's a problem

55%

what % of schizophrenia patients know there is a problem but aren't receiving treatment

45%

what % of schizophrenia patients wanna solve the problem by themselves

32%

what % of schizophrenia patients thought the problem would get better by itself

27%

what % of schizophrenia patients say its too expensive

20%

what % of schizophrenia patients are unsure about where to get help

18%

what % of schizophrenia patients say help probably wouldn't help

17%

what % of schizophrenia patients say health insurance wouldn't cover the treatment

16%

Discuss why delays in early childhood can so significantly impact later skill development

-Disorders arise and change within time

-Childhood is associated with developmental changes

-Disruption in the development of early skills will disrupt the development of later skills

List criteria for attention deficit hyperactivity disorder (ADHD)

-Either inattention and/or hyperactivity/impulsivity

-during at least 6 months

-impairment in at least 2 settings (ex. school and home)

Describe criteria for inattention subtype of ADHD

6+ of these:

-poor attention to details or careless mistakes

-difficulty sustaining attention

-doesn't listen when spoken to

-doesnt follow through on instructions/fails to finish tasks

-difficulty organizing tasks and activities

-avoids, dislikes, reluctant to engage in tasks that require sustained mental effort

-loses things necessary for tasks

-easily distracted

-forgetful in daily activities

Describe criteria for hyperactivity subtype of ADHD

6+:

-fidgets/ squirms in seat

-leaves seat in classroom and other settings

-runs about or climbs excessively

-difficulty playing or engaging in leisure activities quietly

-"on the go"/ "driven by a motor"

-talks excessively

-blurts out answers before question is completed

-difficulty waiting turn

interrupts or intrudes on others

List prevalence , sex ratio, age of onset and prognosis of ADHD

-Prevalence: mainly found in children (3-7% of school aged children)

-Sex ratio: boys are 3x more likely to be diagnosed

-Prognosis: can be first identified at age 3 or 4

Explain evidence regarding the D4 dopamine gene and dopamine transporter

-Strong evidence of association with the D4 dopamine receptor gene, DAT dopamine transporter gene, and D5 receptor gene

-The drug Ritalin acts of the DAT transporter gene

Discuss the implications of maternal smoking for ADHD

-One of the more consistent findings in this era

-3 times more likely to have a child with ADHD

-May not be a direct link, there's also a link with ADHD and other prenatal issues

-DAT-1 genotype- gene-environment interaction

Describe the findings regarding brain volume and ADHD

-People with this disorder have a brain that is 3-4% smaller than people without the disorder

Describe the findings regarding toxins and ADHD

-Food additives and ADHD is a highly controversial topic

-Pesticides

Discuss the role of negative self-image as a maintenance factor of ADHD

-Negative responses by parents, teachers, and peers to the child to child's attention deficit & hyperactivity can cause low self esteem

-This needs to be addressed when developing treatments

Describe stimulant treatments of ADHD including their positive effects on symptoms and negative side effects

-Ritalin, Adderall, vyvanse/ Dexedrine

-Increase concentration and focus

-Reduce hyperactive and impulsive behavior