Psychiatric Disorders and APA Lecture Notes
Administrative Guidance on the 'Lurking' Paper and Academic Formatting
Guidance on Interview Subjects: - Generally, if an interview subject has limited information, it is encouraged to ensure the paper includes two other people to broaden the source base. - However, individuals should not be excluded solely because their information is limited. - A ratio of two robust/healthy subjects is sufficient; if a subject is considered "sketchy" or limited, aiming for three subjects total is recommended.
Citing Social Media (TikTok) and Digital Sources: - For sources like TikTok accounts (OABF), writers should cite the entire account rather than every individual video. - In text, it may be useful to mention as an offhand comment that there are different videos for clarification, but the formal citation should point to the account. - Citation Format: Use the username (or real name if provided as Last Name, Comma) and the year (e.g., "Username, "). - Reference Page: List each unique account once. If three different accounts are cited, there should be three distinct entries in the reference section.
Writing and Formatting Standards: - General Philosophy: The instructor looks for a "college try" and legitimate effort regarding references rather than strict adherence to the APA manual (acknowledging many students are not psychology majors). - Paragraph Spacing in Microsoft Word: Since approximately , Microsoft Word has defaulted to inserting extra spaces between paragraphs. This is against APA and MLA styles. Writers should remove the default setting to ensure a normal space exists between lines and paragraphs with no extra padding. - APA Cover Pages: - Professional Version: Includes a "running head" at the top. - Student Version: Focuses on class, instructor, and identifying info; does not require a running head. - Students are permitted to use the student version for simplicity.
Recommended Resources: - The Purdue OWL (Online Writing Lab): This is the premier recommended source for APA style guidance outside of the official APA manual. - Warning: Avoid library-supplied handouts from specific institutions, as they are often inaccurate hybrids of APA and MLA styles.
Prognostic Indicators for Schizophrenia
Gender Factors: - Women generally have a better long-term prognosis than men. - This improvement is often tied to a later age of onset and a longer duration of functioning before symptoms appear.
Active Phase Characteristics: - The briefer the active phase, the better the prognosis. - A shorter duration of the most severe symptoms indicates a more positive long-term outcome.
Functioning and Course Variability: - Approximately (%) of individuals with schizophrenia can be fully functioning. - "Frequent Flyers": A term used for individuals who cycle in and out of psychiatric institutions, often due to medication non-compliance rather than symptom severity alone. - Schizophrenia is categorized as both episodic (occurring in active phases) and chronic (lasting a lifetime).
Subtype Prognosis (Paranoid vs. Others): - Of the types (Catatonic, Paranoid, and Disorganized), Paranoid Schizophrenia generally has the best prognosis. - Reasoning: In paranoid types, the nature of the symptoms is more organized and systemic. Cognitive functioning and logic remain largely intact outside of specific persecutory delusions. - Example of Organization: A person believing in a complex government conspiracy involving breaking codes from World War II magazines to assist the CIA is highly organized compared to someone experiencing chaotic, unorganized visions (like "seeing little blue men" or angels).
Social and Clinical Factors: - Supportive Family: A major factor in functioning levels as an individual ages. - Treatment Adherence: Behavioral compliance with medication leading to a better prognosis. - Early Intervention: Treatment received early in the disorder’s course is significantly more beneficial than treatment started after or years.
Brain Volume and Biology: - Substance Abuse: Individuals who do not abuse substances have better outcomes. - Brain Integrity: Better prognosis is correlated with higher brain volume and intact white and gray matter. Substance abuse is known to contribute to brain volume reduction.
Schizotaxia: - Refers to early indications of the onset of schizophrenia, now often considered part of the prodromal phase. - Historical Context: In prior DSM editions, it was a designation (not a diagnosis) based on the belief that medicating early signs could manage the disorder better. - Modern Finding: Research shows we are not reliable at identifying these premorbid symptoms, and there is little biological benefit to early antipsychotic treatment in this stage.
Comparative Overview of Other Psychotic Disorders
Brief Psychotic Disorder: - Characterized by positive symptoms (delusions and hallucinations) lasting less than month. - Remission occurs within the month. - Etiology: Often brought on by significant stress or trauma. - Dopamine Storm: A sudden rush of dopamine causing acute, temporary symptoms. - Brain Plasticity: Younger brains possess a greater ability to compensate for deficits (analogous to a starfish growing back a limb).
Schizophreniform Disorder: - Considered essentially the same as schizophrenia but with a duration between and months. - Onset is typically sudden with no clear residual phase. - Diagnosis is cautious; if symptoms persist beyond months, the diagnosis is updated to Schizophrenia.
Schizoaffective Disorder: - Includes symptoms of schizophrenia combined with a Major Depressive or Manic episode. - Differentiation from Bipolar with Psychotic Features: To qualify for Schizoaffective Disorder, there must be a period of at least weeks where psychotic symptoms are present without mood symptoms.
Delusional Disorder: - Characterized by "non-bizarre" delusions. These individuals are often highly functional and may never enter a psychiatric unit. - Nature: Persistent but often isolated to specific paranoid or persecutory themes. - Treatment Resistance: Harder to treat then Schizophrenia. - Distinction from Somatic Disorders: Somatic disorders are rooted in fear and anxiety; delusions in Delusional Disorder are simply "wrong" fixed beliefs not necessarily derived from anxiety.
Introduction to Personality Disorders (Cluster A, B, and C)
Historical Multiaxial System: - Previously, the DSM used five axes. Axis I held major mental illnesses, while Axis II was reserved for "Mental Retardation" (now IDD) and Personality Disorders. - Shared Characteristics (IDD and PD): Both were historically viewed as chronic, lifelong, and treatment-resistant conditions present before age . - Modern view: Personality disorders can remit or diminish as people age, often significantly by age .
Definition and Prevalence: - Prevalence: Approximately of the population as a group. - Nature: Enduring, rigid patterns of personality that impair thinking, behavior, and feelings. - Distress: Often the individual feels no distress; rather, the people around them suffer the negative consequences.
The Clusters: - Cluster A: Odd or eccentric behavior (Paranoid, Schizoid, Schizotypal). - Cluster B: Dramatic, emotional, or erratic behavior (Antisocial, Borderline, Narcissistic, Histrionic). - Cluster C: Anxious or fearful behavior.
Detailed Breakdown of Cluster A Personality Disorders
General Characteristics: Sometimes called "thought disorders" or part of the "Schizophrenia Spectrum."
Paranoid Personality Disorder: - Requires or more symptoms (e.g., unjustified doubts about loyalty, reading meaning into benign events). - Vs. Schizophrenia: No hallucinations; beliefs are not "fixed" delusions but automatic suspicious responses that can be influenced by contrary evidence. - Example: A librarian believing a patron is "screwing with them" by not finding a book, but accepting the book was just hard to find once presented with proof. - More common in men.
Schizoid Personality Disorder: - Characterized by indifference to social relationships. - They do not dislike people; they simply treat them like objects (e.g., a chair or a parakeet). - They prefer solitude because it is "easier" and they feel no need for connection. - They are indifferent to both praise and criticism.
Schizotypal Personality Disorder: - Closest to Schizophrenia; involves peculiar ideas and distorted reality. - Differentiation from Schizoid: They actually care about relationships and want connection, but they are too "odd" to maintain them, leading to social anxiety. - Examples of Odd Behavior: Collecting -liter bottles of urine to cure cancer or possessing library books. - Client Example (Steve): A bright man who wore jeans to his neck and a pocket protector; he wanted to get married but misread minor bus interactions as deep romantic interest. He had flattened affect and saw his therapist as his only friend.
Cluster B Personality Disorders: The Dramatic and Erratic Types
Overview: Referred to as the "Party Cluster." Individuals are often engaging and charismatic at first but toxic in long-term relationships.
Clinical Profile: Highest level of treatment resistance; characterized by emotional dysregulation.
Antisocial Personality Disorder (ASPD): - Requirements: Must be at least years old with characteristic behaviors present before age . - Core Traits: "Lie, cheat, and steal." - ASPD vs. Asocial: "Asocial" refers to being withdrawn (e.g., scrolling on a phone at a party). "Antisocial" individuals seek interaction to manipulate or gain power, money, or sex.