Untitled Flashcards Set

Psychosis and schizophrenia

An inability to differentiate what is real and unreal

Positive symptoms: delusions, hallucinations, disorganize speech, disorganized behavior. Negative symptoms: lack of expected or normal emotions, behaviors, and motivations.

Schizophrenia

severe form of psychosis divided into two groups: 1) clear thinking and communication with an accurate view of reality, and proper functioning of daily life; 2) active phase of illness: psychosis — loss of touch with reality (characterized by disorganized thinking and speech, difficulty performing daily activities, including self-care)

Schizophrenia spectrum: schizophrenia - most severe

Positive symptoms: unusual perceptions, thoughts, behaviors; delusions; hallucinations - can affect any of the five senses, most common - AUDITORY, VISUAL; formal thought disorder (disorganized thinking); disorganized behavior; catatonia - disorganized behavior that reflects unresponsiveness to the environment

Negative symptoms: restricted affect (lack of emotional expression); avolition - inability to initiate a common goal-directed activities; cognitive deficits like attention, memory, processing new info

DSM-5 - must show 2 or more symptoms of psychosis (at least 1 or 2 should be positive symptoms) Acute phase - at least 1 month.

Prognosis

It’s one of the most severe illnesses. Rehospitalization is very common (50-80%); 10-15% commit suicide.

Other psychotic disorders

schizoaffective disorder - mix of schizophrenia and a mood disorder

schizophreniform disorder - present for less than 6 month

brief psychotic disorder - up to 1 month

delusional disorder - only delusions regarding real life situation, at least 1 month

Theories

biological: genetic predisposition; structure in specific brain areas (different brains and brain activity, some abnormality); excess levels of dopamine - higher risk of schizophrenia

psychosocial: drift downward socially comparing to the class of one’s family; highly intrusive

cognitive: difficulties in attention; delusions; hallucinations

treatments

Typical antipsychotic drugs (older medication) - often cause negative side effects, used to reduce positive symptoms: chlorpromazine

Atypical antipsychotics (newer medication) - influence neurotransmitters like serotonin; both negative AND positive symptoms

Psychological and social treatments: behaviors - teach appropriate behaviors; cognition - recognize demoralizing attitudes; social deficits - teaching problem solving skills for every day social interactions; family therapy - educate on illness and teach to understand and reinforce behaviors, provide support

Personality disorders

Personality determines how we feel, interact with others and perceive events

5 factor model: personality id organized along 5 personality traits

1) negative emotionality vs emotional stability 2) extraversion vs introversion 3) openness vs closedness to experience 4) agreeableness vs antagonism 5) conscientiousness vs undependability

Diagnosing a personality disorder: determine level of functioning → determine whether the individual has any pathological personality traits → determine whether the individual meets the criteria for personality disorders

Personality disorders typically start at young adulthood (~17-23); pattern must be chronic across different settings and environment (for example not just being depressed)

Cluster A: Odd-Eccentric Personality Disorder

May exhibit mild symptoms of schizophrenia

• Paranoid personality disorder: a pattern of distrust and suspiciousness of others often misinterpret situations + motives to fit their suspicious

• Schizoid personality disorder: a pattern of detachment from social relationships and a restricted range of emotional restriction. the emotions are decreased; they typically don’t desire being with other people, want to be a loner

• Schizotypal personality disorder: milder symptoms of schizophrenia; discomfort of close relationships, cognitive or perceptual distortions and eccentric behavior; paranoia; magical thinking; illusions

Theories:

genetically transmitted

Treatments:

• same as schizophrenia: neuroleptics; antipsychotics and antidepressants

• cognitive therapy: psychological therapies

Cluster B: Dramatic-Emotional Personality Disorder

• Antisocial personality disorder: person shows a pattern of disregard for others (engage in criminal behavior; may lie to others for their own gain; don’t have empathy)

• Borderline personality disorder: the person displays a pattern of unstable self-image, emotions and relationships; great deal of impulsive behaviors; hypersensitive to abandonment; criticize themselves; history self-harm (attention; SUICIDE); depression, anxiety, anger; clinging to others; MOOD SWINGS

Theories:

• cognitive: childhood abuse; neglect

• psychoanalytic: very reactive to opinions of others

• neurobiological: smaller amygdala and hippocampus - difficulty in regulating moods; abnormalities in prefrontal cortex - impulsive behavior; runs in families

Treatments:

• Dialectical behavior therapy: focuses on gaining more realistic and positive sense of self; problem-solving skills

• Psycho-dynamically oriented therapies:

transference-focused therapy: uses the relationship between the patient and the therapist

Mentalization-based treatment: provides validation and support

• Mood stabilizers and antipsychotics

• Histrionic personality disorder: pattern of attention seeking behavior (seductiveness; dramatic emotionality) display a lot of sexualized behaviors, flirting; seek constant approval of others; mimic others behavior, sayings

Theories:

• cognitive: over-evaluated by others during childhood; develop a belief of being unique as a defense against rejection by important people in their lives

Treatments: there are no really effective treatments

• cognitive: teaching realistic expectations, sensitivity to the needs of others

Majority don’t seek treatment

Cluster C: Anxious-Fearful personality disorders

• Avoidant personality disorder: pattern of social inhibition (extremely socially shy), low self-esteem, severe anxiety in social situations (avoided because of the fear of being criticized by others); crave social interaction but avoids because of being criticized

Theories:

• biological: same genes involved as in social anxiety disorder; no strong relationship to abuse in childhood

• cognitive: formed because of rejection

Treatments:

• cognitive and behavioral therapies: exposure to social settings; social skills training; challenging negative thoughts

• serotonin reuptake inhibitors

Not very effective - this is who the person is, can’t really change that

• Dependent personality disorder: one can’t care for one-self; willing to endure abuse to feel connected and cared for by that person; low self-esteem; difficulties in making their own decisions

• Obsessive compulsive personality disorder: excessive concern with perfection; upset when rules are unfollowed

Theories:

• cognitive: strong rigid beliefs

• biological: genetic factors similar to OCD; history of physical neglect (when needs are not met)

Treatments:

• supportive therapies

• behavioral therapies: decrease compulsive behaviors

Integrated Model of the Personality Disorders:
Biological predisposition → harsh, critical, unsupportive parenting → behavioral and emotional dysregulation → negative reactions from peers and adults → worsening difficulties of controlling emotions and behaviors

Somatic symptoms

Somatic symptoms: experiencing significant physical symptoms for which there is no ORGANIC cause (as a result of psychological factors) hard to diagnose!!! - if the doctors don’t find anything they often send patients to psychologists

DSM-5 criteria:

• 1 or more somatic symptoms that are distressing or result in disruption of daily life

• excessive thoughts, feelings or behaviors related to the somatic symptoms or associated health concerns

• although 1 symptom may not exist continuously, the state of being symptomatic is persistent

Illness anxiety disorder

- worry that one will develop or have a serious illness but does not experience any of the symptoms → when experiencing physical complaints one becomes very alarmed and seeks IMMEDIATE medical help

DSM-5 criteria:

• preoccupation with having or acquiring a serious illness

• no physical symptoms, however, if you had an illness that is now cured the preoccupation with getting it again is excessive (more than it should be)

• high anxiety about health + easily alarmed about health status

• excessive health related behaviors (often going to a doctor)

• preoccupation present for > 6 months (could be concern about different illnesses)

Theories:

Cognitive: dysfunctional beliefs about illnesses; pay too much attention to physical change and catastrophize symptoms

PTSD influences those who have experienced a stressor

Treatments:

Psychodynamic therapies: insight into emotions that link to physical symptoms

Behavioral therapies: learn and eliminate reinforcements that individual gets from symptoms

Cognitive therapies: learn and challenge physical symptoms

Conversion disorder:

Dramatic type of somatic symptom disorder that causes patients to lose neurologic functioning in a certain part of the body with no medical cause

Glove anesthesia - loss of a feeling in the hand as if one was wearing a glove that wiped out physical sensation

DSM-5 criteria:

• 1 or more symptoms of altered voluntary motor/sensory function

• clinical evidence of incompatibility between symptoms and recognized medical//neurological conditions

• symptom deficit is no better explained by any disorder

• symptom deficit causes clinically significant distress or other areas of functioning

Theories:

Freudian: disorder is a result of the transfer of psychic energy attached to repressed emotions; primary gain; secondary gain

Behavioral: alleviates stress by removing individual from the environment

Treatments:

• Psychoanalytic therapy: helps express painful emotions or memories that are linked to symptoms

• Behavioral therapy: relieving the anxiety centered on the trauma that caused conversion symptoms + reducing benefits from the symptoms

Factitious disorder

Faking an illness to gain medical attention (called Munchhausen’s syndrome) some people will harm themselves to fake an illness (poisoning, infected injuries)

Malingering: faking the symptoms to get attention

Factitious disorder imposed on another: falsifying illness in another person

Dissociative disorders

dissociation - out of body experience

Dissociative Identity Disorder (DID):

having more than 1 personality state taking control of the individuals behavior

DSM-5 criteria:

• disruption of identity - 2 or more personalities

• recurring gaps in the recall of everyday events, personal information, and/or traumatic events

• symptoms cause significant distress or impairment

• disturbance is not a normal part of a broadly accepted cultural or religious practice (not possessed by demons)

• symptoms are not attributable to the direct physiological effects of a substance or another medical condition

Theories:

DID is a result of coping strategies used by person faced with trauma

Socio-cognitive model - alternate identities are created to adopt an idea that fits patients life

Treatment:

integrate all alters into one coherent personality

Help rebuild the capacity to trust healthy relationships

DSM-5 criteria:

• AMNESIA inability to recall important autobiographical information, usually of a traumatic/stressful nature (not like ordinary forgetting)

• symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning

• disturbance is not attributable to the direct physiological effects of a substance or a neurological or other medical condition

• disturbance is not better explained by DID, PTSD, ASD (acute stress disorder), somatic symptom disorder, or mild neurocognitive disorder

Types of dissociative AMNESIA:

• organic amnesia: caused by brain injury; anterograde amnesia - organic amnesia + inability to remember new information

• psychogenic amnesia: psychological causes (no brain injury)

• retrograde amnesia: inability to remember information from the past; organic + psychological causes

Dissociative Fugue

person moves away from home and assumes an entirely new identity (don’t remember any previous identity); occurs in response to stressor

Treatment:

Psychotherapy to identify the stressor leading to the fugue state and earn better coping skills

Depersonalization/Derealization Disorder

episodic feeling of detachment from one’s own mental processes or body, like an outside observer of oneself

causes: significant stressor, sleep deprivation or the influence of drugs

diagnosis: episodes frequent and distressing and interfere with the ability to function; more in people who have a history of childhood emotional, physical, or sexual abuse

Eating disorders

Anorexia nervosa:

People starve themselves for long period of time and remain convinced they need to lose weight

Amenorrhea: women/girls stop having menstrual periods (one of the consequences)

Restricting type of anorexia nervosa: refusing to eat; engage in excessive exercise to lose weight

Binge/purge eating type of anorexia

Atypical anorexia nervosa: same as anorexia nervosa, but weight is within the normal range

Bulimia Nervosa:

Bingeing followed by behaviors designed to prevent weight gain from the binges

Behaviors to prevent weight gain: vomiting; medicine abuse (laxatives, diuretics, etc.); fasting; excess exercise (usually average weight)

Binge-Eating Disorder:

Resembles bulimia nervosa, but the person doesn’t regularly engage compensating binges

People are significantly overweight, more common in women (>3 months)

Is chronic and results in high rates of depression

Obesity:

BMI > 30; increased risk of heart disease; type 2 diabetes; cancer

Biological factors:

• genetic predisposition

• changes of puberty in girls

• lowered functioning of the hypothalamus

Cognitive factors:

• low self-esteem

• social pressure

Treatments:

• CBT, cognitive; behavioral

• Family therapy

• Interpersonal therapy: client and therapist discuss interpersonal problems related to disorder

• Biological therapies: SSRIs; antidepressants; antipsychotics - some cases