PSY 240 - Abnormal Psych 2nd Exam Study Guide
PSY 240 - Abnormal Psych 2nd Exam Study Guide PSY 240
Popular in Abnormal Psychology
Popular in Psychlogy
This 27 page Study Guide was uploaded by Elliana on Tuesday February 9, 2016. The Study Guide belongs to PSY 240 at University of Miami taught by Dr. Foote in Fall 2015. Since its upload, it has received 199 views. For similar materials see Abnormal Psychology in Psychlogy at University of Miami.
Reviews for PSY 240 - Abnormal Psych 2nd Exam Study Guide
Report this Material
What is Karma?
Karma is the currency of StudySoup.
You can buy or earn more Karma at anytime and redeem it for class notes, study guides, flashcards, and more!
Date Created: 02/09/16
PSY 240 Abnormal Psychology Study Guide for Exam #2 Chapter 7‐ Mood Disorders and Suicide Given a brief description, be able to say what type of mood disorder or episode the person has. Or given a disorder, be able to say what signs, symptoms and qualifiers are important. a. Depressive Disorders : Sad, empty or irritable mood with cognitive and somatic changes that significantly reduce a person’s function i. Major Depressive Disorder 1. Depressed mood and/or loss of interest or pleasure + change in weight, sleep or motor activity, or fatigue, poor concentration, indecisiveness, feels worthless, or frequent thoughts of death or suicide 2. Criteria: a. Depressive episode b. No mania/hypomania c. Single episode d. Recurrent i. More likely ii. 4 is average e. Last 4‐5 months 3. Onset: a. Early teen‐ middle age ii. Persistent Depressive Mood Disorder (Dysthymia) 1. > 2 years of depressed mood most days; in addition to mood, extremes of appetite &/or sleep, fatigue, low self esteem, poor concentration, indecisive, feels hopeless. No manic or hypomanic episode 2. Criteria: a. Slightly fewer symptoms b. Longer than 2 years c. Chronic d. Persistant 3. Double Depression a. Major Depressive episode + Dysthymic DIsorder i. Dysthymic first b. Severe pathopsychology Disruptive Mood Dysregulation Disorder 1. Starting between 6 & 10 years old, extreme temper outbursts > 3 times/week, inconsistent with developmental level in at least 2 settings. Generally irritable or angry between outbursts. Lasts > 12 months; No bipolar, intermittent explosive, or oppositional defiant disorder 2. Criteria: a. Between ages 6‐10 severe verbal and/or physical temper outbursts i. at least 3/week ii. developmentally inappropriate b. Child is angry and irritable between outbursts c. Outbursts in 2+ locations d. Continues for 12mos, less than 3mos b/w outbursts e. Cannot qualify for bipolar disorder or intermittent explosive disorder remenstrual Dysphoric Disorder 1. In the week before menses, better within days of beginning menses & minimal a week after marked mood swings, irritable, depressed, or anxious. + decreased interest, concentration difficulties, lethargy, being overwhelmed, breast tenderness, feeling bloated, change in appetite or sleep. Significant distress or impairment 2. Criteria: a. At least one of the following: i. decreased interest in usual activities ii. Poor concentration iii. easily fatigued iv. major change in appetite/sleeping v. feeling overwhelmed/out of control b. Present for at least 2 cycles b.Bipolar and Related Disorders: Peaks of high energy & euphoric or highly irritable mood but also depths of despair & lethargy. High suicide risk iBipolar I Disorder 1. At least one manic episode, probably also major depressive episode, may have hypomania. May mix manic & depressive features and/or have anxious distress Bipolar II Disorder 1. At least 1 hypomanic episode and at least 1 major depressive episode, but no manic episode Cyclothymia 1. No major depressive ,manic, or hypomanic episodes, but many times have hypomanic symptoms and other times depressive symptoms. Lasts > 2 years for at least half the time & < 2 months without symptoms Hypomanic Episode 1. Similar to manic episode, but lasts only 4 consecutive days or less severe symptoms Manic Episode 1. Unusually elevated or irritable mood and persistent & highly increased goal‐directed behavior for > 1 week with grandiosity, little sleep, very talkative, flight of ideas, distractibility, agitation, excessive high risk behavior. Significant impairment Major Depressive Episode 1. Depressed mood and/or loss of interest or pleasure + change in weight, sleep or motor activity, or fatigue, poor concentration, indecisiveness, feels worthless, or frequent thoughts of death or suicide What laboratory test reliably and accurately detects depression? [HINT: trick question] None What do anhedonia, catatonic, and melancholic mean? Anhedonia: Inability to feel pleasure or gain pleasure from normally pleasurable activities Catatonia: Immobile or unresponsive stupor (doesn't move at all), or very agitated & moving all the time Melancholy: Loss of all pleasure, barely responds to any stimulus, despondent & morose, lots of weight loss, lots of guilt Understand the overlap between anxiety and depression. ● Almost all depressed persons are anxious, though not all anxious persons are depressed ● Twin studies: same genetic factors contribute to both (overlap) ● Common symptoms of negative affect for both anxiety & depression: ○ Pessimistic about future ○ Guilt ○ Irritability ○ Crying ○ Hyper‐vigilance ○ Poor memory ○ Poor concentration ○ Poor sleep Know and fully comprehend the causes of each of the mood disorders as they are currently understood. 2. Depressive Disorders: a. Biological: i. Familial and genetic influences 1. Family studies 2. Twin studies a. Identical 2x more likely to both be depressed 3. Higher heritability for females 4. Higher concordance with higher severity ii. Neurotransmitter systems: 1. Low Serotonin = depression 2. “Permissive” hypothesis: a. Dopamine i. Mania b. Norepinephrine iii. Endocrine System: 1. Stress Hypothesis a. Overactive HPA axis i. Cortisol destroys the hippocampus, which is supposed to control cortisol ii. Hyperconnectivity iii. Dexamethasone suppression test 1. Tests for suppression of cortisol a. Much less suppression in depressed iv. Sleep and Circadian Rhythms : 1. REM sleep a. short period between falling asleep and REM b. increased intensity 2. Decreased slow wave sleep 3. Sleep deprivation effects a. Cause temporary improvement in depressed people v. Brain Wave Activity: 1. Indicator of vulnerability? a. Greater right side anterior activation b. less alpha wave activity 3. Psychological: a. Learned Helplessness (Sleigman) : i. lack of perceived control = anxiety → hopelessness b. Attributional Style i. Internal‐Stable‐Global 1. Internal: attribute negative events to personal failings 2. Stable: Even after bad event passes, person feels that all future bad things will always be their fault 3. Global: The negative mindset is eventually applied to everything ii. Depressive Style v. Normal Style iii. Also characterizes anxiety c. Sense of Hopelessness: i. lack of perceived control ii. will not regain control iii. Pessimism 1. Before or after onset of depression? d. Cognitive Theory of Depression (Beck): i. Negative schemas 1. an enduring negative cognitive belief system about some aspect of life a. Stems form a series of unfortunate events in childhood ii. Destructive automatic thoughts 1. negative interpretations a. Make the worst of everything, think the smallest things are the end of the world iii. Types of cognitive errors : 1. arbitrary inference a. emphasize negative aspects rather than the positive aspects of a situation 2. overgeneralization a. Taking one negative comment/aspect, and applying it to your whole life 3. all‐or‐nothing thinking 4. Catastrophizing iv. Treatment Implication Cognitive Theory : 1. Correct the errors e. Cognitive Vulnerability for Depression : i. pessimistic explanatory style ii. negative cognitions iii. hopelessness attributions iv. Interactions with: 1. biological vulnerabilities 2. stressful life events f. Stress i. Stressful life events: 1. Context 2. Meaning 3. Timing ii. Effects of Stress 1. Poorer treatment response 2. delayed remission 3. trigger for episode or relapse iii. Reciprocal‐Gene Environment Model: 1. Stress triggers depression 2. Depressed individuals create or seek out stressful situations g. Social and Cultural: i. Marriage and interpersonal relationships 1. relationship disruption precedes depression a. Strongest effect for males 2. Marital conflict v marital support ii. Gender differences in causal direction iii. Social Support 1. related to depression a. Lack of support i. Late onset depression 2. Substantial support: a. predicts recovery for depression i. NOT mania 4. Bipolar Disorders: a. Biological i. High genetic correlation ii. Excessive Dopamine activity 1. Possibly b. Stress c. Sleep i. Possibly What is the permissive hypothesis? ● The permissive hypothesis states that the control of emotional behavior results from a balance between noradrenaline and serotonin. ● Serotonin thought to moderate other neurotransmitters ● Hypothesis that there is not enough serotonin to regulate other neurotransmitters such as: ○ Dopamine ○ Norepinephrine Know about attributions and hopelessness with respect to depression. ***See psychological causes (question 5) ● Learned helplessness: lack of perceived control ○ Idea that one will never regain control ○ Pessimism becomes eternal state ■ Explains depression ^^ ● Attributional style: ○ Internal‐Stable‐Global ○ Depressive style ○ Also characterizes anxiety Know Beck's cognitive triad. What does he say about cognitive errors and negative schemas? Beck's cognitive triad represents three types of negative thoughts present in depression, as proposed by Aaron Beck in 1976 The triad forms part of his cognitive theory of depression: ‐ The triad involves negative thoughts about: ○ The self (i.e., the self is worthless) ○ The world/environment (i.e., the world is unfair), and ○ The future (i.e., the future is hopeless) Cognitive Theory of Depression: ‐ Depressed ppl have negative schemas ‐ Leads to destructive automatic thoughts ‐ Leads to negative interpretations Types of Cognitive Errors: ‐ Arbitrary interference: Making up correlations btwn circumstances & failure that aren't actually related ‐ Overgeneralization ‐ All‐or‐nothing/perfectionistic thinking ("I'm either 100% perfect or a complete failure") ‐ Catastrophizing events What are the likely reasons for the higher rate of depression in women compared with men? Gender Roles: ● Perceptions of uncontrollability ○ Women have less control over their circumstances in most cultures ○ Tend to have less access to resources & rights ● Socialization ○ Men socialized to behave more "macho" ○ Not allowed to exhibit emotions or express depression ● Access to resources ○ Women more likely/more acceptable to seek help ○ Men are to be stoic, not feel pain/emotion ■ Don't ask for help/ treatment Know the basic strategies and techniques for successfully treating each of the mood disorders. Changing Brain Chemistry: ● Medications ○ Tricyclics (tofranil, elavil) ■ Frequently used for severe depression ■ Block reuptake/down regulate ■ Norepinephrine ■ Serotonin ■ 2‐8 weeks to work, many negative side effects which may lead to more depression ○ Anti‐depressants ■ Block Monoamine Oxidase (MAO) inhibitors ■ Higher efficacy ■ Fewer side effects ■ Interacts w. foods & other medicines (many limitations & severe side effects) ○ Selective Serotonin Reuptake Inhibitors (SSRIs) ■ Leaves serotonin hanging around in synapse ■ Many negative side effects ● Electromagnetic ○ Transcranial magnetic stimulation ■ Electromagnetic coil overhead stimulates prefrontal cortex ■ Efficacy ~ ECT, seems effective ■ Headaches Bipolar Disorder Lithium ● Until recently, primary treatment ● Relapse significantly lower than with other meds ● Works well for depression ● Unsure of mechanism of action ● Doses too large can be fatal ● Narrow window between too little for improvement & too much at a toxic level ○ Need to have blood levels checked regularly Anti‐Convulsants ● Seizure disorders often comorbid ● Carbamazepine ● Valproate ○ Now most frequently prescribed ○ Efficacy = lithium ○ Fewer side effects ○ Works well for mania Psychological Treatment ● Increase medication compliance (taking meds correctly) ● Interpersonal & Social Rhythm Therapy (ISRT) ○ Helping patient to develop a routine daily schedule for sleeping, eating, exercising, etc. ○ Assistance coping with stressors ● Family‐focused treatment Understand and be able to distinguish how to treat depression using the behavioral, cognitive, cognitive‐behavioral, and interpersonal forms of psychotherapy. 5. Behavioral Therapy: a. Behavioral Activation i. Be active for the sake of being active 1. Reinforce being active 2. Focus on immediate activity, not your thoughts ii. Exercise iii. Reintroduce pleasurable activities 1. Schedule and record 2. Attempt to extinguish depressive behavior iv. Exposure to anxiety provoking situations b. Social skills training c. Efficacy: i. As good as the other stuff 6. Cognitive Therapy : a. Identify negative, self critical automatic thoughts i. Recognize these thoughts cause depression b. Examine support and utility for automatic thoughts i. Replace negative automatic thoughts with constructive thoughts c. Correct underlying negative schemas d. Specific Techniques: i. Automatic thought record (the first extra credit) ii. Socratic Questioning 1. Why don’t you think you’ll get into FIU? iii. experiments 1. Thoughts 2. In vivo 7. Cognitive‐Behavioral Therapy (CBT): a. Combines behavior therapy and cognitive therapy b. Reduces rumination i. Incessant repetitive thoughts ii. Reduce by: 1. distraction 2. Accept negative thoughts w/o: a. analyzing them b. answering them c. Efficacy: i. Comparable to medication ii. More effective than: 1. Placebo 2. Brief psychodynamic treatment 8. Interpersonal Psychotherapy: a. Address interpersonal issues in relationships i. Role disputes ii. Loss 1. The interview with the widow feeling guilty enjoying decorating for Christmas 2. Interview with the sighing guy iii. New relationships or other transitions iv. Social skill deficits b. Efficacy: i. Comparable to medication ii. More effective than: 1. Placebo 2. Brief psychodynamic treatment 9. Antidepressant Medications : a. Tricyclics: i. USed for severe depression ii. Block reuptake/down regulate 1. Norepinephrine 2. Serotonin iii. 2‐8 weeks to work iv. Many negative side effects b. Monoamine Oxidase (MAO) Inhibitors: i. Block MAO ii. High efficacy iii. fewer side effects c. Selective Serotonin Reuptake Inhibitors i. Fluoxetine (Prozac) ii. first treatment choice iii. Block presynaptic reuptake iv. Many negative side effects d. Other Medications : i. Venlafaxine 1. similar to tricyclics ii. Nefazodone 1. Similar to SSRIs iii. St. John’s Wort 1. Questionable e. Issues: i. Efficacy in special populations 1. Children 2. Elderly ii. Preventing relapse 1. Maintaining benefits What is a major problem with medication and patients with bipolar disorder? The main problem is that giving up drugs between episodes or skipping dosages during an episode significantly undermines treatment. Therefore, increasing compliance with drug treatments is important. What is ECT and when is it most likely to be used? Electroconvulsive Therapy ● Brief electrical current ran thru the brain ○ Temporary partial‐body seizure ○ Temporary amnesia ○ 6‐10 treatments ● Higher efficacy for severe depression when nothing else works ● Few side effects ● Relapse is common Know about the connection between bipolar disorder and creativity Suggestion that genes contributing to Mood Disorders are linked to genes contributing to creativity. Inheriting one increases the likelihood of inheriting another Which ethnic group has the highest suicide rate in the USA? North American Caucasians What differences exist between men and women with respect to suicide? Males commit suicide more than females Tend to use more effective/violent methods like guns Females attempt more often than males Tend to use less effective methods like pills ‐ More men commit suicide during old age ‐ More women commit suicide during middle age, partly because most attempts by older women are unsuccessful. What neurotransmitter process is related to suicide? Serotonin levels What are the major risk factors and the major protective factors for suicide Diatheses/Predisposing factors: ● Genetic/family history ● Biological factors (I.E. perinatal factors, 5HIAA/low serotonin levels) ● Personality traits (impulsivity, borderline personality disorder/instability) ● Social modeling Risk factors: ● Environmental factors/suicide exposure ● Vulnerability for suicidal behavior ● Precipitating life events such as rape, molestation, robbery, assault, etc. ● History of suicide in the family ● Detailed plan ● Lethal means ● Socially isolated ● Impulsive/reckless Precipitating factors: ● Availability of method ● Humiliating precipitating life event Protective factors: ● Cognitive flexibility ● Strong social support ● Proven coping skills ● Strongly religious ● Has dependents ● Lack of precipitating life events ● No losses ● Hopefulness ● Mental health resources ● Treatment of psychiatric disorder ● Treatment of personality disorder What should you do and say or not do and not say to someone you think might be suicidal? 1. Take them seriously, treat them as a normal person 2. Express concern, Ask direct questions "Have you thought about hurting/killing yourself?" 3. Pay attention, Show you care even if you don't know them well 4. Acknowledge the person's feelings in a nonjudgmental way 5. Reassure the person that things can get better, help find alternatives 6. *DO NOT promise confidentiality "I have to tell someone that you are thinking about killing yourself" 7. Get help (Therapist, suicide hotline, 911, etc.) 8. If possible, don't leave the person alone until they're with a professional 9. Take care of yourself, find help dealing with stress What are suicide contracts? Do they work as intended? No‐Suicide contracts are forms that say "I _______ will not try to kill myself without talking to my therapist, _____" & then signed by the patient ● Somewhat works (helps a little bit) ● Many ppl who commit suicide worry about what others think of them, signing a contract can help hold them accountable for upholding their word & not committing it Chapter 8 Feeding and Eating Disorders Given a brief description, be able to say what type of eating disorder the person has. Or given a disorder, be able to say what signs, symptoms and qualifiers are important. Including being able to distinguish key features from somewhat less important ones. 1. Feeding and Eating Disorders : Eating that changes the amount or type of food consumed and impairs health or psychosocial functioning. a. Pica: Frequently eats nonnutritive things that are not food (e.g., dirt); neither developmentally nor culturally appropriate i. Dirt is most common ii. Criteria: 1. No problem eating real food 2. Cannot be diagnosed <2years old iii. Prevalence: unknown iv. Onset: childhood b. Rumination Disorder : Often brings previously swallowed food back into the mouth without nausea, retching or disgust i. Criteria: 1. Must happen 2+ times/week 2. No apparent gastrointestinal difficulty 3. Shows satisfaction ii. Prevalence: unknown iii. Onset: 3‐12mos c. Avoidant/Restrictive Food Intake Disorder : Avoids or restricts eating resulting in weight loss (or failing to meet expected weight gains) or deficient nutrition i. Criteria: 1. Lack of eating is NOT related to desired weight loss/body image ii. Leads to: 1. deficient nutrition a. feeding tube b. supplements c. Possible death in infants 2. Impaired psychosocial functioning d. Binge Eating Disorder : Binges at least 1/week for less than 3mos. Person is very distressed by binging i. Criteria: 1. NO PURGING 2. Eats in <2hours: a. rapidly b. past comfortably full c. huge amounts even if not hungry d. alone because of embarrassment 3. Feels disgusted, depressed, or guilt afterward 4. Very distressed by binging 5. Most are obese a. BUT not all obese have BED 6. Binge to alleviate bad mood ii. Onset : Young adulthood, or any age e. Obesity: BMI greater than 30. Not a mental health disorder, but lifestyle behaviors, emotional comforting, advertising, medications and some mental health disorders are factors. f. Bulimia Nervosa : Frequent binge eating and inappropriate compensatory behaviors. Evaluates self based on perceived weight and shape. SUICIDE RISK. i. Criteria: 1. Binge eating : a. excess amounts of food in < 2 hours b. out of control 2. Compensatory behaviors: a. Purging b. Excessive exercise c. Fasting 3. Binging and compensation 1+ times/week for > 3mos 4. Self esteem closely tied to weight/body shape 5. Most w/in 10% of normal weight g. Anorexia Nervosa : Deliberately loses and maintains weight less than minimally normal (or fails to meet expected weight gains). Fears being fat and evaluates self based on perceived weight and shape. Restriction and Binging/Purging subtypes. SUICIDE RISK. i. Subtypes: 1. Restrictive 2. Binge eating/Purging ii. Criteria: 1. Intense fears : a. Weight gains b. losing control of eating 2. Relentless pursuit of thinness 3. Often begins with dieting 4. Disturbance in way in which one’s body weight or shape is experienced 5. Lack of recognition of seriousness of weight loss 6. Food rituals What percent of people with anorexia die as a result of the disorder or through suicide? Death by malnutrition/cardiovascular problems: 10% Death by suicide: 10% Know and fully comprehend the causes of anorexia, binge‐eating, and bulimia as they are currently understood. 2. Social Dimensions: a. Cultural Imperatives: i. Thinness = success, happiness b. Ideal/Media Body Size Standards: i. Change over time 1. Marilyn Monroe was a 14, models nowadays are a 2 c. Western Culture : i. Immigrants to Western Culture: 1. increase in eating disorders 2. increase in obesity ii. Cultures Exposed to Western Media : 1. Increase in eating disorders 3. Family Influences: a. “Typical” Family: i. Successful ii. Driven iii. Concerned about appearance iv. Maintain harmony 1. Even if there isn't any v. History of dieting/ eating disorders 4. Biological Dimensions: a. Heritability studies: i. .56 correlation b. Inherited tendency to be emotionally responsive to stress, eat impulsively c. Perfectionism d. Hypothalamus i. Serotonin 5. Psychological Dimensions: a. Low sense of personal control b. Low self confidence c. Perfectionistic attitudes d. Preoccupation with food and appearance e. Mood intolerance f. Distorted body image In which cultures are eating disorders most prevalent? Caucasian, middle to upper class Why are eating disorders so much more prevalent in women than men? ‐ Societal/Media images that promote the idea that a thin woman is most attractive and will be most successful. ‐ Contrastingly, men are pressured to be big and buff. Be aware of some of the indicators that increasing levels of thinness are considered the norm in Western society. Cultural imperatives: ● Thinness = success, happiness ● Ideal/media body size standards change over time How do the body images of men and women differ? Males tend to see themselves as ideal (perceived body image, actual body shape, & ideal all very close together) Females tend to want to be more slender (perceived body image far off from actual body shape) Women : ‐ Greater disparity between their actual image and their ideal image (3.6 v 2.7) ‐ Female idea of attractive is thinner than male idea of attractive (2.9 vs. 3.3) Males : ‐ Little disparity between their actual image and their ideal image ‐ Male idea of attractive is heavier than female idea of attractive (4 vs. 3.7) How do the body images of normal college women and college women with distorted body image differ? : ormal ‐ Ideal, Attractive, Other Attractive and Current are closely clustered ‐ Range of .75 Distort d: ‐ Ideal, Attractive, Other Attractive and Current have greater disparity ‐ Range of 1.75 a. Ideal is much thinner in comparison to normal b. ideal is much thinner than Attractive and Other Attractive c. Current is much heavier than the others Know indicators that a person might develop an eating disorder. 1) Excessive exercise 2) Severe dieting 3) Obsession with food/calories 4) Obsession with weight loss 5) Not eating 6) Going to the bathroom immediately after eating 7) Secretiveness over exercise/eating routine Know the basic strategies and techniques for successfully treating each of the eating disorders. Which are most successful? What are the basic goals of all these strategies? ● Anorexia ○ Drug Treatments: ■ None ○ Psychological Treatments: ■ Weight restoration ● hospitalization ■ Psychoeducation ■ Target dysfunctional attitudes ● Body shape ● Control ● thinness = worth ■ Family Involvement ● Communication about eating/food ● Attitudes about body shape ○ Long term prognosis: ■ Worse than bulimia ■ Typically hospitalized around 3 times before actually recovering ● Bulimia: ○ Drug Treatments: ■ Antidepressants ● May enhance psychological treatment ● No long term efficacy ○ Psychological Treatment: ■ SEE NEXT QUESTION ● Binge ‐ Eating Disorder: ○ Drug Treatments: ■ Meridia ● Possibly ○ Cognitive Behavior Therapy: ■ Similar format to Bulimia ○ Interpersonal Psychotherapy ■ As effective as CBT ● Obesity: ○ Less fattening foods, increase nutrient‐dense food consumption, more exercise ○ Physician counseling, dieticians, doctors ○ Attitudinal adjustment, self‐help programs, behavioral programs ○ Bariatric surgery ○ "Twinkie tax" ‐ food getting taxed on how much fat & sugar it has (not so likely to work) ○ Removal of junk food from public schools (actually worked) ‐ lower availability ‐> lower junk food consumption ○ Educational programs ‐ Michelle Obama's initiative Know the results of the study comparing CBT, IPT, and BT for treating bulimia (Fairburn, Jones, Peveler, Hope, & O'Connor, 1993). Bulimia: ● Antidepressants may enhance psychological treatment but no long‐term efficacy for bulimia CBT: ● Target problem eating behaviors ● Target dysfunctional thoughts Interpersonal psychotherapy: ● Improve interpersonal functioning Both about equally effective long‐term, CBT may work quicker How does the fact that a person with anorexia has gained weight rapidly while in treatment affect the person's prognosis? It is a poor predictor of long term success as the weight gain alone does not address the psychological issues that led to the initial weight loss.. For this reason, CBT is most effective for long term success Know the patterns of disordered eating often seen in people who are obese. ‐ Binge Eating Disorder ‐ Eating determined by external cues ‐ Night Eating Syndrome: ⅓ of daily calories consumed Patients are awake NOT binge eating Correlates to increasing severity of obesity The most obese do it the most Chapter 13 Schizophrenia and other Psychotic Disorders Be able to recognize and distinguish the types of schizophrenic symptoms, and the other psychotic disorders. ● Schizophrenia Spectrum and Other Psychotic Disorders: Delusions, Hallucinations, Disorganized Thinking (Speech), Abnormal Motor Behavior, and Negative Symptoms, avolition, diminished emotional expression ○ Schizophrenia : For> 1 month delusions, hallucinations, or disorganized sp perhaps also grossly disorganized (or catatonic) behavior, or negative symptoms . Some signs of these must exist for> 6 months. Specify if with catatonia (also used with other disorders) and, after 1 year, course. Severity of each of 8 primary symptoms is rated on a 0 to 4 scale ■ Positive Symptoms : Extra or excessive in comparison to normal people ● Active manifestations: ○ Delusions : Disorder of thought or content. A belief that most would say is a misrepresentation of reality ■ Grandeur ■ Persecution ■ Thought insertion ■ Capgras and Cotards Syndromes ● Capgras: believe that you are an imposter ● Cotards : believe that you are dead ○ Hallucinations ■ Sensory experiences in the absence of environmental stimuli ● Can involve all senses ● Most common: auditory ■ Negative Symptoms : Absence or insufficiency of normal behavior ● 25% experience these ● Symptom cluster: ○ Avolition (apathy) ○ Alogia ○ Asociality ○ Anhedonia ○ Affective flattening ■ Disorganized Symptoms : Erratic behaviors that affect many domains ● Disorganized speech ○ Cognitive slippage ● Inappropriate affect ● Unusual behavior ○ Catatonia ● May come from cognitive deficits ○ attention deficit ○ working memory deficit ○ executive function deficit ■ 90% also qualify for another DSM5 diagnosis ● 80% bipolar or depressed ■ 10%‐15% commit suicide ● Highest for: ○ paranoid subtype ○ More positive than negative symptoms, high relapse rate, high intelligence, aware of symptoms ○ Schizophreniform Disorder: Similar to schizophrenia, continuous signs have lasted only 1 to 6 months. ■ Good premorbid functioning ■ Most resume normal lives ○ Brief Psychotic Disorder : Similar to schizophrenia, buneed only 1 symptom and duration is 1 day to < 1 month. ■ Positive or disorganized symptoms ■ Precipitated by : ● extreme stress ● trauma ■ Typically return to normal ○ Schizoaffective Disorder :Same as schizophrenia, but also a major depressive (including depressive mood) or manic episode + delusions or hallucinations > 2 weeks without mood episodes , but mood episode is present for most of the duration of the schizophrenic symptoms. ■ Disorders are independent! ● Don’t occur together ■ Persistent ■ No improvement w/o treatment ○ Delusional Disorder : Never schizophrenic, but> 1 delusio. Other than impact from the delusion, functioning is okay. Specify erotomanic, grandiose, jealous, persecutory, somatic, mixed or specified type and if bizarre content. Specify course if > 1 year. ■ Delusions contrary to reality but not bizarre ■ Lack other positive and negative symptoms ■ Types : ● Persecutory ● Jealous ● Erotomanic ● Somatic ● Grandiose ■ Late onset ■ High rate of suicide ● Prognosis better than schizophrenia, but worse than other psychotic disorders Recognize delusions of grandeur and persecutory delusions. Delusions of Grandeur: Psychotic symptom involving people’s unfounded belief that they are more important than is true. Persecutory Delusions: Belief one is being pursued by authorities, police, etc. / People’s unfounded belief that others seek to harm them. Disorder of thought content: A belief most members of society would say is a misrepresentation of reality Thought insertion: Belief an outer source is inserting thoughts into one's mind Capgras: Belief they have been replaced by a double Cotard's Syndrome: Belief they are dead Know the deficit and motivational views of delusions. Motivational: ○ Extreme distress ○ Delusions avoid confrontation of stress Deficit: ○ Damage in brain functioning In what part of the brain do auditory hallucinations originate and what does this suggest? Hallucinations: ○ Sensory experience in absence of environmental stimuli ○ Auditory most common (hearing voices) Metacognition theory: ○ Broca's area more active during hallucinations ■ Broca's area produces speech ■ Patient's own brain area is producing speech, though the individual is unaware that the sounds are coming from their own thoughts Recognize: Affective flattening: Range of emotional expression is diminished and reduced body language Alogia: Lack of additional unprompted content seen in normal speech Avolition: Decrease in motivation to initiate and perform self directed purposeful activities Catatonia: Disorder of movement involving immobility or excited agitation. Waxy flexibility: Person remains in bodily postures positioned by another person Catatonic Immobility: Disturbance of motor behavior in which the person remains motionless, sometimes in an awkward posture for extended periods Cognitive slippage: Loose cognitive and verbal associations on which the person fails to answer questions. Inappropriate Affect: emotional displays that are inappropriate to the situation Loose Associations : Deficits in logical continuity of speech, with abrupt movement between ideas Prodromal Phase :Schizophrenia usually starts with this phase, when symptoms are vague and easy to miss. They are often the same as symptoms of other mental health problems, such as depression or other anxiety disorders. They may not seem unusual for teens or young adults. Residual Phase :Patient no longer displays prominent symptoms. Which class of medication reduces positive symptoms but does not have much impact on negative symptoms? Antipsychotic With what neurochemical have positive symptoms of schizophrenia been associated? What evidence supports this association? Dopamine & excessive activity ● Agonists increase schizophrenic‐like behavior ● Antagonists (minimizers) of dopamine reduce schizophrenic‐like behavior ○ Ex: Neuroleptics What is the concordance rate among identical twins? ~48% Understand the results of research on degree of relationship and probability for having schizophrenia. ● Current theory: several neurotransmitters interacting ○ Stratial D receptors (excess) 2 ○ Prefrontal D 1 ceptors (deficit) ○ Glutamate receptors also associated w. some symptoms ■ Unsure on relationship with dopamine ● About 1/2 of schizophrenic patients have brain ventricles larger than average ● Prenatal complications ○ Influenza viral infection during pregnancy ○ Complications like bleeding, Rh incompatibility ○ Delivery complications: anoxia ● Likely interaction of genetics & environment Psychological factors: ● Stress ○ Usual cause of sudden onset ○ Activates vulnerability ○ Increases relapse risk Hallucinogens: ● Mushrooms ● LSD ○ Can onset schizophrenia (diatheses‐stress model) Know about the Genain sisters and the concept of unshared environments. ‐ 4 identical quadruplets ‐ All 4 had schizophrenia ‐ Same genes, same upbringing, same environment Differences: ● Ages of onset ● Symptoms ● Differ on the 8 dimensions ● Courses ● Outcomes Importance of unshared environments: ● Very minor differences in experiences created significant changes in manifestations of schizophrenia Know and understand the research and theory on expressed emotion (EE). High expressed emotion in families: ● Critical, hostile, emotionally over‐involved ○ But 1 member of the family tends to exhibit self‐sacrificing/martyr attitude ● Related to relapse risk, NOT initial occurrence All these factors^ do not cause schizophrenia but are related to relapses/episodes ● Generally accepted but some controversy remains ● Varies w. culture What are extrapyramidal symptoms? What about tardive dyskinesia? Side effects of antipsychotics/neuroleptic medications: ● Extrapyramidal symptoms: ○ Parkinson‐like symptoms from deficiency of dopamine (shaking, drooping shoulders, etc.) ○ Tardive dyskinesia: involuntary movement of mouth, tongue, jaw, face, etc. ■ More serious due to risk of dyskinesia becoming permanent What is deinstitutionalization and what are its effects on people with schizophrenia? In exchange for medications being considered effective: ● Patients with schizophrenia removed from hospitals & supposedly provided medications ● Results in huge increase of homeless population (large portion of this population has schizophrenia) ○ Psychosocial interventions are a necessary adjunct to medication How successful is social skills training with patients who are schizophrenic? Paul & Lents 1977 study: ● Placed portion of patients w. schizophrenia into token economy in the hospital ○ Earned tokens to watch TV, buy cigarettes, etc. ● Social skills training: Received training in communication & problem solving ○ Social learning group showed more improvement than control groups ■ Fewer symptoms ■ Needed less medication ■ Faired better when released back into general community What is needed to have an integrated approach for treating schizophrenia? ● CBT ● Community care programs ● Social & living skills training ● Family therapy ● Vocational rehabilitation ○ Need regular booster sessions What is Theory of Mind and what does it have to do with schizophrenia? Theory of mind: The ability to explain other peoples' behavior in terms of their mental states ● People with schizophrenia tend to lack theory of mind ○ Increased stress due to not knowing what's going on What is assertive community treatment ? ● Multidisciplinary teams ○ Medication management ○ Psychosocial treatment ○ Vocational rehabilitation ● Staff visits home at any time ● Integrated elements increase efficacy ○ Some will need residential/halfway housing program ● Treatment across culture ○ Adapting treatment to cultural values & beliefs ○ Culturally sensitive & appropriate What is the relationship between schizophrenia and dissociative identity disorder? There is no relationship. If there was a relationship, schizophrenia and DID would not have been identified as two completely separate diagnoses within DSM‐V. Chapter 9 Physical Disorders and Health Psychology What percent of deaths in the USA can be attributed to lifestyle choices? What are these negative lifestyle choices? ● 50% of deaths from the 10 leading causes of death in the United States can be traced to behaviors common to certain lifestyles. ● Negative lifestyle choices: smoking, poor eating habits, lack of exercise, and insufficient injury control (for example, not wearing seat belts) Know the General Adaptation Syndrome (GAS). Phase 1 ‐ Alarm response Sympathetic arousal Phase 2 ‐ Resistance Mobilized coping & action Phase 3 ‐ Exhaustion Chronic stress, permanent damage Know about the process involving CRF, HPA, and cortisol. CRF ‐ Corticoprofen Releasing Factor HPA axis activation ‐> Hypothalamic pituitary adrenocortical axis Hypothalamus connects to pituitary gland Pituitary gland stimulates cortical part Arenal glands We become energized by surges of epinephrine released ‐> Limbic system activation
Are you sure you want to buy this material for
You're already Subscribed!
Looks like you've already subscribed to StudySoup, you won't need to purchase another subscription to get this material. To access this material simply click 'View Full Document'