abnormal psych unit 3 lecture notes

psychosis: severe loss of contact or highly distorted reality with hallucinations and delusions

hallucinations: sensory experiences without external stimuli

delusions: rigidly-held beliefs with pervasive focus

disorders with psychosis

  • schizophrenia

  • dementia

  • delirium

  • schizo-affective disorder

  • substance use disorders

schizophrenia

  • syndrome or group of psychotic disorders

  • major disturbances of thought, emotion, and behavior

  • means splintered or spilt from reality

- heterogeneous —→ many features/types

  • catatonia

  • hebephrenia

  • paranoia

diagnostic criteria for schizophrenia

  • criteria A: two or more of symptoms, each present during a 1 month period

- delusions

- hallucinations

- disorganized speech’

- grossly disorganized/catatonic behavior

- negative symptoms

  • criteria B: social/occupational dysfunction

  • criteria C: lasting at least 6 months, including prodromal and residual symptoms

  • criteria D: exclude mood disorders w/ psychotic features

  • criteria E: rule out other conditions

  • criteria F: if communication disorder of childhood or ASD, requires delusions and hallucinations

other psychotic disorders

  • schizophreniform disorder

- schizophrenic symptoms

- doesn’t meet 6 month criteria

- associated w/ good premorbid functioning

- most resume to normal lives

  • delusional disorder

- delusions contrary to reality

- lack positive and negative symptoms

- rare, better prognosis than schizophrenia but worse than other psychotic disorders

- later age of onset

- average age —→ 40 to 49

- female > male, 55% to 45%

- types

a) erotomaniac: frequently the focus is a celebrity, belief that they are suppose to be with that celebrity/suppose to be their life partner

b) grandiose/grandiosity: belief one is some sort i of figure imbued with special powers or messenger from God

c) jealous and persecutory: oriented around the body in some way

history of schizophrenia

  • stable across time & place

- identified in ancient Egypt

- supernatural paradigm

  • dr. emile kraeplin, 1887 mental illness: “dementia praecox”

- combination of symptoms and the 3 types; cataonia, hebephrenia, paranoia

- distinct from mania of bipolar

  • swiss psychiatrist dr. eugen bleuler 1911

- “schizophrenia” as it doesn’t always lead to dementia, though could occur later

- described symptoms as “postive” and “negative”

- “

  1. catatonia refers to disturbances in…

a) motor function

  1. which describes the gender difference in schizophrenia?

a) men develop earlier and more severe

  • indivduals don’t recover from schizophrenia

LECTURE 11

disorders of childhood are important to study because:

  • many childhood problems have lifelong consequences for the child and for society

  • adults disorders are rooted in early childhood conditions and/or experiences

  • understanding of childhood disorders provides the basis for designing

  • caveat: mostly diangosed and studied in boys (may be underserved/presentation may be different in girls)

disorders of childhood are common

  • prevalence

- more severe forms 8% - 10% of all children

  • disorders don’t go away with age, although the ways they are expressed may differ

  • social changes may place children at greater risk for more severe problems

issues with assessment and diagnosis

  • distinguishing abnormal childhood behavior requires developmental psychology knowledge:

- what is normal for a child at a particular age or stage

  • children differ from adults:

- somaticize: having physical symptoms when experiencing distress

- consistency is important for functioning

a) children are sensitive to dysregulation and can easily fall apart

neurological development is affected by adverse childhood experiences (ACE)

  • stressors in the environment has consequences for functioning

  • ACE leads to cognitive & emotional development problems, which turns into long-term physical health consequences

  • children typically show developmental regression during times of stress:

- don’t follow normal developmental trajectory

- experience developmental delays

- during transitions may experiences temporary regression

internalizing vs externalizing

  • over controlled (internalizing):

- when a child takes their psychological distress/emotions and directs it inward

- more likely to happen in children who are behaviorally inhibited, temperamentally introverted

- depressive disorders, anxiety disorders, somatic complaints and teenage suicide

- high prevalence in girls

  • under controlled (externalizing):

- when a child takes their psychological distress/emotions and directs it outward

- children show excessive behaviors

- higher prevalence in boys

ADHD (under controlled)

  • attention-deficit/hyperactivity disorder (excessive or inappropriate deficits in attention for the situation)

  • inability to concentrate in task for an appropriate period of time, difficulties in controlling motor movements in class and other situations

  • inattentive type: no psychomotor agitation, but problems with attention & distractibility and maintaining focus

- under-diagnosed because not behavioral problem

attention deficit hyperactivity disorder

  • observed behavioral functioning problems, relatively immature for their age

  • inattention, hyperactivity, and impulsivity

  • persistent pattern and/or hyperactivity-impulsivity that interferes with functioning or development

- difficulty in establishing peer relations

- aggressive ADHD children have different social goals (being disruptive)

ADHD epidemiology

  • most common childhood disorders —→ 15% american children

  • diagnosed when school-aged but presumed to be present at birth/early age

  • hypothesized large increase in diagnosis includes intolerance for normal childhood behavior

  • comorbidites: 66% have at least one comorbid psychiatric disorder usually:

- learning disorders —→ 56%

- sleep disorders ——→ 23%

- oppositional defiant disorder ——→ 20%

- internalizing disorders ——→ 12-25%

- mood disorders ——→ 15% - 75%

ADHD etiology: biological

  • genetics

- family & twin studies show genetic transmission

  • frontal lobe issues

- under-responsive to stimulation

- smaller in size

- children w/ ADHD perform poorly on psychological tests that measure functioning in the frontal lobe

  • brain damage during prenatal or postnatal development

  • teratogens including drug/alcohol exposure

treatment for ADHD

  • stimulants ——→ ritalin, adderal, concerta, etc.

- improves sluggish prefrontal cortex, increases functioning/focus/attention, cognitive control

- improves attention but not necessarily performance

- some antidepressants and antihypertensives

  • behavioral programs ——→ skill training

- parent management training

- classroom management programs based on operant-conditioning techniques

therapeutic treatment for ADHD

  • skill training for ADHD are cognitive behavioral

- antecedent

- behavioral

- consequence

  • behavioral programs for child

- postive reinforcement

disruptive behavior disorders

  • oppositional defiant disorder (ODD) : persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness

- less severe than CD

- lasting at least six months

  • conduct disorder (CD) : persistent pattern of violating social norms, rules, and the rights of others

- severe

- more common in boys

- externalizing, under controlled

- CD is the precursor to having antisocial personality disorder

etiology of conduct disorder

  • genetic factors play a great role in aggressive behavior, but a lesser role in delinquency-related behaviors

  • psychological factors:

- impulsivity

- deficiencies in moral training and awareness (difficulty reading emotions)

- social learning: modeling of aggressive behavior

- cognitive distortions: ambiguous actions are interpreted as hostile

treatment for conduct disorder

  • family intervention: training parents to reward prosocial behaviors in their children (operant conditioning)

  • multisystem treatment targets the child, the community, the school, and family

  • cognitive approaches

- anger control training

- teaching moral development reasoning

intellectual developmental disorder (intellectual disability)

  • deficits in intellectual functions (reasoning, problem solving, planning, abstract thinking, judgement)

- confirmed by clinical assessment & individualized, standardized testing

  • deficits in adaptive functioning resulting in failure of meeting developmental/sociocultural standards for personal independence and social responsibility

  • onset during the developmental period (before age of 5

  • IQ score under 70

intellectual disability epidemiology

  • 2 to 3% of population

- either intellectual disability by itself, part of a syndrome, or a broader disorder

  • causes could be genetic or environmental

- 30-50% we don’t know the cause

  • severity refers to level of required support

intellectual disability 2 areas of impaired adaptive functioning

  • conceptual (intellectual): where we talk about the intellectual disability

  • practical (adaptive): daily living and taking care of themselves

intellectual disability etiology

  • genetic anomalies/chromosomal disorders (like down syndrome)

- syndrome: mild to moderate intellectual and developmental disabilities

  • recessive-gene diseases like PKU

  • infectious diseases such as Rubella and HIV

  • teratogens ——→ alcohol, environmental hazards

  • abuse and neglect ——→ shaken baby syndrome, orphanage

  • developmental abnormalities: neural tube

  • normal genetic variation

  • anoxia during delivery, other birth trauma

assessment of intellectual disability

  • missing developmental milestones

  • gestational age vs developmental age (underdeveloped compared to their gestational age

  • bayley scales of infant development

- birth to age 3-5, 45 minute assessment

- subscales include:

  1. language

  2. motor

  3. social-emotional

  4. adaptive behavior

pervasive developmental disorders

  • characteristics:

- impaired social interaction

- impaired cognition

- restrictive and stereotyped behaviors

- sensory deficits

- self injury

- savany performance (rare)

  • in teen years and young adulthood, high co-morbidity with anxiety and depression

autism spectrum disorder (ASD)

  • neurodevelopmental disorder

  • onset in first three years of life (18 months)

  • deficiencies in social relationships & communication

  • restricted, repetitive, stereotyped patterns of behavior

  • may not be detected until later

- due to minimal social demands or support from parents in early years

three categories of symptoms

  • trouble social interaction

  • restricted interests

  • communication

autism spectrum disorder

  • two domains

  1. persistent deficits in social communication & social interaction

- how kids interact non-verbally, the social component

  1. restricted, repetitive patterns of behavior, interests, or activities

- highly restricted, fixated interests abnormal in intensity or focus

ASD epidemiology

  • symptoms before age 3 (ideally 18 months)

  • 3-4 times more boys than girls (girls are more subtle)

  • rates

- used to be 4 in 10,000 children

- blew up in 1990s and 2000s

a) reason could be new environmental ——→ microparticulate pollution

b) another reason could be older fathers

c) another reason could be genetics

d) another reason could be broaden diagnostic criteria

discredited etiologies

  • social factors like “refrigerator mothers”

- cold, distant mothers were responsible for autism

  • vaccines

- data made up, showing fallacy

ASD etiology

  • biological basis

- genetics

- neurological problems

- comorbid seizure activity

ASD treatment

  • early intervention leads to better outcomes

  • early diagnosis necessary

  • intensive behavioral programs (reinforcement & extinction)

- applied behavior analysis 30-40 hrs/week

- recently under fire due to the harsh use of punishment, causing harm

  • social skills training

- may include group therapies as children get older

applied behavior analysis

  • positive reinforcement only, no harmful consequences

  • emphasizing communication to meet child’s wants/needs

  • tailored to the indivudal’s likes and sensory issues

ASD treatment (continued)

  • there isn’t a particular medical treatment (drug) for ASD, the medicine treats the symptoms ——→ drug treatment for behavior and atypical antipsychotics

  • haloperidol and atypical antipsychotics

- reduces social withdrawal & motor behaviors

- doesn’t alter the course of the disorder

  • facilitated communication (debunked)

tic disorders

  • motor tics: repetitive motor activity

- like blinking

  • vocal tics: sounds

- humming, clearing the throat, yelling

  • simple tics: few parts of the body

  • complex tics: several different parts of the body & can have a pattern

  • course:

- symptoms: age 5-10

- often decreases during adolescence and adulthood (may disappear)

- worsens with stress, reduces with calm or focus

  • epidemiology

- 5x more likely in boys

- comorbidity: 86%

  • therapies:

- comprehensive behavioral intervention for tics

- medication to manage tics

  • heritability

- inherited as a dominant gene (so yes heritable)

- 50% chance of parents passing the gene on their children

- boys are 3-4x more likely than girls to display symptoms

- may be triggered by abnormal metabolism, infection, and other biological causes

learning disabilities

  • inadequate development in specific area of academic language or motor skills

- IQ is normal but achievement is below expected age level

specific learning disorder

  • difficulties learning and using academic skills

  • begins during school-age years

  • difficulty can appear in listening, thinking, reading, writing, and spelling

- impairment in reading (dyslexia): problems with word recognition, poor decoding, and poor spelling

- impairment in writing expression (dysgraphia): difficulty in spelling, grammar, clarity/organization of written thought

- impairment in math (dyscalculia): developmental arithmetic disorder, impaired numbers, accurate math reasoning

communication disorders include:

  • child-onset verbal fluency disorder (stuttering)

- disturbances in normal fluency and time patterning of speech

- problem in verbal fluency

- includes anxiety about speaking or limited social participation

  • personality disorders are challenging because they are egosyntonic

  • the most common cause of intellectual disability is trisomy 21

  • 50% is the % of autism who also have ID

  • schizotypal personality disorder shares cognitve characteristics of and heritability with schizophrenia

LECTURE 12

personality dimensions

  • neuroticism: experience of negative emotions

  • extraversion: interest in interacting w/ other people; postive emotions

  • openness: willingness to consider and explore unfamiliar ideas, feelings, and activities

  • conscientiousness: persistence in pursuit of goals; organization; dependability, and achievement motive

  • agreeableness: willingness to cooperate and empathize with others

personality tests

  • the minnesota mutiphasic personality inventory (MMPI)

- assists in identifying personality structure and psychopathology

  • personality inventory for DSM-5 (PID-5)

- designed to asses DSM personality trait criteria

personality disorder (DSM-5-TR defintion)

cluster A: enduring pattern of inner experience and behavior that differs markedly from cultural expectations

  • in at least 2 or more of the following areas:

- cognition: ways of perceiving and interpreting self, other people, and events

- affectivity: range, intensity, lability, and appropriateness of emotional response

- interpersonal functioning

- impulse control

cluster B: enduring pattern is inflexible and pervasive across a broad range of personal and social situations

cluster C: enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas

cluster D: pattern is stable and of long duration, and its onset can be traced back at least to adolescence of early adulthood

overview of DSM personality disorder clusters

  • cluster A: odd or eccentric

- paranoid, schizoid, schizotypal

  • cluster B: dramatic, emotional, erratic

- antisocial, borderline, histrionic, narcissistic

  • cluster C: fearful or anxious

- avoidant, dependent, obssessive-compulsive

cluster A

what is the difference between personality disorder and just someone’s personality?

  • dysfunction, the tendency to have challenges with daily social aspects. Rigidity and extreme nature

  • personality: enduring patterns of thinking and behavior that define us and distinguish us from others

ego-syntonic and ego dystonic

  • personality disorders are ego-syntonic ——→ sync with the ego (its who they are)

  • other disorders are ego-dystonic

  • difficult to treat

- often lacking insight (people w/ insight typically have better outcomes)

other conceptualizations of personality disorders

  • impairments in social motivation: desires/goals for interaction are dramatically different or extreme

  • social motivations are extreme, exaggerated, or different for people with personality disorders

  • affiliation: motivation to associate with others, have and maintain close relationships

  • power/dominance: motivation for impact, prestige, to be well regarded, to have one’s will done

  • people with personality disorders are at extremes in personality traits and behaviors

distortions in cognition and self-image

  • due to distortions in their cognitions and their misperceptions of people’s actions they aren’t reliable reporters on their own behavior or behavior of others this makes it hard to diagnosis and treat

- this makes it hard to diagnosis and treat

- “unreliable narrator”

  • they also lack insight about their condition they don’t recognize that they have a disorder

- resistant to change

DSM-5-TR personality disorder diagnosis criteria

  • description of symptoms (features) characteristic of the disorder

  • few paragraphs describing features of those with the disorder

problems regrading PDs

  • clinicians are cautious it may take more than one interview to determine a PD is present

  • often overlaps with other categories

PD epidemiology

  • prevalence: overall 10.5%

- cluster A: 3.6%

- cluster B: 4.5%

- cluster C: 2.8%

  • high comorbidity over ½ those who are diagnosed w/ 1 PD comorbid with another PD

  • gender prevalence: equal between men and women

- paranoid and obessive-compulsive personality disorder are more common among men

PD diagnosis is based on standard diagnostic protocol

  • interview

  • observation

  • case history

  • particular diagnostic tools

critiques of current understanding of PD

  • lack of reliability

  • borderline violates assumptions of stability in the very definition