Abnormal Psychology Final Exam STUDY GUIDE Exam Date: 12/12/2017 at 7:45AM
What are the main signs, symptoms, and life course patterns of schizophrenia?
∙ What most people think of when they hear the word “crazy”. ∙ Serious psychotic disorder characterized by major disturbances in thought, speech, emotion, and behavior.
o Usually progressive with an exacerbating- remitting course
∙ Usually first diagnosed in adolescence/ young adulthood. o May be seen earlier/ childhood forms.
∙ Diagnosed by a combination of positive and negative symptoms.
What are the positive and negative symptoms of schizophrenia?
Schizophrenia POSITIVE symptoms
∙ Delusion= A false belief
o Persecutory (someone is after you)
o Grandiose (fantastical, wealth, fame, importance) o Erotomatic/Jealous (believing someone famous is in love with you/ your significant other is cheating on you)
o Delusions may include:
Thought insertion: Someone else inserted your thoughts into your head.
Thought broadcasting: Others can hear what you’re thinking.
Thought stealing: People are spying on you and stealing your thoughts.
External control: Some external being (someone else) is controlling your actions.
∙ Hallucinations= a false perception
o Usually auditory, involving voices; occasionally visual or somesthetic.
o Often persecutory and frightening
o Usually congruent with delusions. Don't forget about the age old question of Who is robert merton?
o Hallucinations may include hearing:
One’s own thoughts spoken by another’s voice; may be related to thought broadcasting.
Two or more voices fighting (known or unknown) Accusatory or other commentary voices
Schizophrenia NEGATIVE symptoms
∙ Usually more stable than positive symptoms If you want to learn more check out What type of energy does the fizz have when it emerges from the bottle on its way up?
We also discuss several other topics like What is the meaning of domestic animals?
o Avolition- poverty of “will” and goal-directed
o Alogia- poverty (lack of) of speech.
o Anhedonia- lack of interest in pleasurable activities. o Affective flattening- bland, unvarying emotional expressiveness.
o Asociality- lack of interest in other people.
What is the difference between a delusion and a hallucination. What are some examples of each? (See answer above)
What are the characteristics of the major subtypes of schizophrenia: disorganized, catatonic, paranoid, and undifferentiated?
Schizophrenia: DIAGNOSTIC SUBTYPES
∙ Paranoid Type- predominance of persecutory delusions and hallucinations, may include command hallucinations. o Most cognitive intact subtype
∙ Disorganized Type (when people think of “CRAZY” person)- disorganization of speech and behavior, lack of goal-directedness, flat or inappropriate affect, odd
behavior, fragmented and disorganized delusions and hallucinations.
∙ Catatonic Type (RARE)- Characterized mainly by abnormal movement, ranging from immobility with waxy flexibility, to bizarre limb and facial posturing, to If you want to learn more check out What kind of fatty acid is produced by soluble fiber?
idiosyncratic mannerisms, to excessive stereotyped or aimless activity.
∙ Undifferentiated Type- Presence of delusions, hallucinations, and/or disturbed thought, mood, speech, and/or behavior, but not meeting the criteria for the above categories, or representing a combination of types.
What are some of the major ddx rule-outs, i.e syndromes that may resemble
∙ Organic Brain Syndromes- Temporal Lobe Epilepsy, delirium, dementia. Don't forget about the age old question of What are the elements that architects need to consider?
o Look for neurocognitive signs and symptoms that may replicate negative, but not positive
∙ Bipolar Disorder- Pay attention to time course o Usually not pronounced negative symptoms in bipolar disorder
∙ Substance Intoxication- especially amphetamine psychosis; may mimic some psychotic signs and symptoms
o Check for presence of substance
o NOTE: Both manic and pchizophrenic patients may use substances to either enhance or reduce their symptoms
∙ Personality Disorders- Schizoid, schizotypal, paranoid, borderline. Don't forget about the age old question of What order do you prepare financial statements?
What are the main biological, psychological, and sociocultural theories of schizophrenia, and how might they be integrated?
∙ Genetics: Family aggregation of schizophrenia and related disorders; multiple comorbidities.
∙ Biochemistry: Abnormalities in dopamine metabolism and transmission in the mesolimbic dopamine system o May account mainly for positive symptoms
∙ Brain Structure: may account mainly for negative symptoms and include:
o Dilated ventricles.
o Lack of normal cerebral asymmetry.
o Reduction in cortical volume in frontal and temporal lobes.
o Abnormal neuronal organiazation in cortical columns. o Increased or decreased synaptic pruning at crucial developmental stages.
∙ Family Factors
o Refrigerator mother: Lack of maternal warmth; not a very loving mother.
o Double-bind Theory: Distressing dilemma in which an individual receives two or more conflicting messages and one message negates the other.
o Expressed emotions: The emotions that are
expressed by the family.
∙ Social Factors
o Poverty and discrimination
o Social drift: Having a mental illness causes one to have a downward shift in social class.
o Assortive mating: social- genetic
Describe the main treatment modalities for schizophrenia? Schizophrenia: TREATMENT
o Neuroleptics- antipsychotics
o Targets dopamine system
o Side effects: Tardive dyskinesia- stiff, jerky movements of your face and body that you cant
o Newer, 3rd generation antipsychotics: target several neurotransmitters.
o Treatment usually more effective for positive
Because negative symptoms are mostly due to the actual structure of the brain.
∙ Cognitive-behavioral & supportive psychotherapists o Manage symptoms
o Deal with stressors
o Model and practice adaptive behaviors
o Social skills training
o Employment coaching
o Residential treatment and communities
∙ Family Therapies
o Family education
o Patient management
o Therapist as resources and guide
o Dealing with crisis- suicide, violence, substance abuse o Interface with legal system
What are some of the ways schizophrenic patients become involved in the legal system?
Schizophrenia and THE LEGAL SYSTEM
∙ Rate of criminal behavior among schizophrenic population= 11-12%
o General population: 4-5%
∙ Schizophrenic subjects are far more likely to be victims of crime than perpetrators.
∙ Most crimes committed by schizophrenic subjects are misdemeanors and nuisance crimes.
∙ Factors that increase violence risk in psychotic disorders:
o Presence of persecutory delusions and/or command hallucinations.
o Comorbid substance abuse.
o Comorbid antisocial personality disorder.
o Possession of weapons.
o Commission of illegal acts that escalate to violence with police confrontation.
∙ Aggression and violence committed by schizophrenic subjects usually occurs under the following
o Persecutory delusions and fear of attack (direct aggression)
o Nihilistic delusions (filicide(parent killing own child) and familicide (killing your own family or close family members)
o Command hallucinations : but MOST resist.
o Comorbid substance abuse and anti social personality. ∙ The mere presence, absence, or severity of any mental state, condition or disorder does NOT by itself make a legal determination.
o Competency to stand trial
o Insanity defense
o Risk of future offending
o Right to refuse treatment
What are the signs and symptoms of mania, hypomania, and depression?
Bipolar Disorder: MANIA AND HYPOMANIA
o Increased enthusiasm, motivation and mental stamina, decreased need for sleep.
o Increased talkativeness, fast pace of everything. ∙ Cognition:
o Extreme hyper focus varies with distractibility and impulsivity, grandiosity, sharpening of perception and memory, BUT impaired judgement, flight of ideas, tangential and circumstantial speech.
o Euphoric, expansive, but may later cycle into anxiety, irritability, and paranoia (Mean Mania) ∙ Vegetative signs:
o Decreased sleep, increased sex drive, increased or decreased appetite.
∙ Psychotic symptoms:
o Delusions and hallucinations= True Mania
∙ Hypomania: person doesn’t become overtly psychotic (but have all the other symptoms of mania)
Describe the clinical feature of major depressive disorder, dysthymia, bipolar disorder, and cyclothymia. Mood Disorders: MAJOR DEPRESSIVE DISORDER
∙ Symptoms often worse in the morning, improve throughout the day.
∙ Depressed mood:
o Hopeless, helpless, worthless, fearful, foreshortened future.
o Anhedonia: lack of interest in pleasurable activities/ inability to experience pleasure.
o Impaired vegetative signs: appetite, sleep, sex, socialization.
o Impaired motivation, energy, and stamina: simple tasks require extraordinary effort; everything slows down; sometimes alternates with restlessness and agitation.
∙ Impaired cognition
o Attention, concentration, memory, thinking, response latency: time span between a stimulus and response or reaction (slower for people who suffer from M.D.D.)
o Cognitive symptoms may precede, co-occur, or occur w/o mood symptoms (Masked depression)
Anxiety disorders, panic disorder, somatic
symptom disorders (EX: Chronic pain), substance abuse.
With or w/o psychotic features
Cyclical and episodic course: episode
typically lasts several months.
Mood Disorders: BIPOLAR DISORDER
∙ More rapid cycling than M.D.D. ( days to weeks)
∙ In between highs and lows, patient may have durations of normal mood (or not); “brittle” bipolar.
o Cluster B personality disorders (Antisocial, histrionic, borderline, and narcissistic)
o Substance abuse (especially stimulants)
∙ Bipolar 1: cycles of mania and depression
∙ Bipolar 2: cycles of hypomania and depression, or mostly depression
∙ As the patient ages, manic episodes decrease in frequency and depressive episodes become more prevalent. (Cycles length= days and weeks)
OTHER MOOD DISORDERS
∙ Dysthymic Disorder (Persistent Depressive Disorder in DSM-5)
o Less severe, but more stable and persistent course than M.D.D.
o “Walking depression”: usually doesn’t prevent normal daily activities.
o Chronic low mood, low energy, pessimism, and self deprication.
∙ Cyclothymic Disorder (Less Severe form of Bipolar) o Person often described as “moody”
o Hypomania episodes characterized by
overenthusiasm, increased motivation, increased activity (pumped up feeling)
Depressed episodes usually milder than in full blown bipolar disorder.
o Usually does not significantly impair social or occupational functioning, and may actually bean advantage in certain professions.
Describe the clinical features of generalized anxiety disorder, panic disorder, phobic disorder, and obsessive compulsive disorder.
GENERALIZED ANXIETY DISORDER
∙ Continual, uncontrollable worrying over seemingly “minor” matters, or with no subject at all (“free-floating anxiety”) ∙ Most common subjects: health and relationships. ∙ GAD= Persistent and difficult to treat.
∙ Biological Model
o Genetic basis: runs in families, comorbid with other anxiety & mood disorders.
o High threat sensitivity: hyperactive catecholamine system in limbic and other brain areas.
o Possible paucity or insensitivity of GABA receptors. o Treatment: benzodiazepines, SSRI mood stabilizers ∙ Psychological Model
o Psychodynamic: anxiety represents unconscious conflict between sexual and aggressive urges and moral prohibitions.
Treatment: uncover & work through conflicts via exploration of patient’s developmental history.
o Behavioral: fear conditioning to multiple
Treatment: relaxation, counterconditioning.
o Cognitive: distorted or dysfunctional thoughts & beliefs.
Treatment: learn new ways of reconceptualizing perceived
threats, e.g. cognitive restructuring.
∙ Recurrent, short (usu. 10-30 min.) unexpected, uncontrollable attacks of intense fear & dread, with high physiological arousal.
∙ Symptoms include:
o Cardiorespiratory hyperactivation.
o Perceptions of fear & doom.
o Depersonalization & derealization.
o Physiological activation: tingling, stomach churning, muscular tremors, etc.
∙ Biological Model
o Familial/genetic diathesis (predisposition).
o Amygdalar threat perception elicits norepinephrine surge from the locus coeruleus: nucleus in the pons of the brain stem involved with the physiological
response to stress and panic.
Treatment: mood stabilizers for long-term control, benzodiazepines for breakthrough panic.
∙ Psychological Model
o Psychodynamic: symbolic significance of triggering stimuli reflects repudiation of unconscious forbidden urges & impulses (reaction formation), especially issues around maternal bonding.
Treatment: exploratory psychotherapy.
o Behavioral: fear conditioning.
Treatment: relaxation & counterconditioning.
o Cognitive: Overreaction to irrational beliefs.
Treatment: thought-stopping, self-talk.
∙ Phobia = an excessive, unreasonable, persistent fear & avoidance of an object or situation.
∙ Avoidance conditioning often results in greater & greater restriction of activities.
∙ Phobias can be singular or multiple.
∙ Comorbidities: panic disorder, mood disorders, substance abuse, obsessive-compulsive disorder, somatic symptom disorders.
∙ Biological Model:
o genetic diathesis & relationship to other anxiety & mood disorders.
Treatment: nonspecific mood stabilization.
∙ Psychodinamic Model:
o phobic object symbolically represents unconscious defense against forbidden impulse.
Treatment: exploratory psychotherapy
∙ Cognitive-behavioral Model:
o avoidance conditioning, also modeling.
Treatment: counterconditioning, exposure
hierarchy, response prevention.
∙ Evolutionary Model:
o exaggeration of otherwise adaptive avoidance of naturalistically dangerous circumstances: “once bit, twice shy.”
OBSESSIVE-COMPULSIVE DISORDER (OCD)
∙ Obsession = a recurrent, persistent, unwanted thought or impulse.
∙ Compulsion = repetitive physical or mental activities (rituals) that the person feels compelled to do
∙ Usually at least partially ego-dystonic: patient may feel “enslaved” to the compulsion.
∙ Obsessions & compulsions occur as components of other syndromes, e.g. mania & psychotic disorders.
∙ Obsessions & compulsions are sometimes seen in certain organic brain syndromes.
∙ Comorbidities include anxiety & mood disorders, somatic symptoms disorders & sleep disorders.
∙ Approximately 40% comorbidity with obsessive-compulsive personality disorder.
∙ 3 catergories of OBSESSIONS and COMPULSIONS o Contamination-cleanliness
Underlying dynamic for ALL appears to be intense goal-directed drive to achieve control.
o genetic diathesis. Heightened dopamine activation & reduced serotonin modulation in caudate-cingulate cortex circuits, also limbic system.
Treatment: antipsychotic & SSRI medications, surgical cinglulotomy.
o unresolved unconscious psychosexual conflicts, e.g. fixation at the anal stage of development.
Treatment: exploratory psychotherapy.
o obsessions & compulsions as learned strategies for binding anxiety.
Treatment: exposure & response prevention
What are the main treatment modalities for anxiety and mood disorders?
Mood Disorders: PHARMACOLOGICAL TREATMENT ∙ Tricyclics (TCC)- anti depressant
∙ Monoamine oxidase inhibitors (MAO-I)
∙ Selective serotonin reuptake inhibitors (SSRI’s)
∙ Lithium carbonate
∙ Antiparoxysmal medications
∙ Psychostimulant medications
o ALL are useful for treating symptoms NOT behaviors
Mood Disorders: ELECTROCONVULSIVE THERAPY ∙ Discovered serendipitously (by accident) in patients suffering from insulin shock.
∙ Now involves series (6-12) of electrical pulses to the brain, producing grand mal convulsive seizures (with protections) ∙ Not fully know how ECT exerts its therapeutic effects. ∙ Side effects: Impaired memory and cognition; can be minimized by soaring of treatments and unilateral ECT
Describe the main facts about dealing with suicide. SUICIDE FACTS
∙ Suicide crises tend to be short.
∙ Most completed suicides are carried out by people suffering from stress-triggered, untreated clinical depression, often complicated by alcohol use.
∙ With appropriate treatment, 70% of depressed, suicidal people respond favorably within a matter of weeks.
∙ Most effective treatments combine antidepressant medication w/ psychotherapy.
RESPONSE TO AN ONGOING SUICIDAL CALL
∙ Evaluate suicidal risk.
o Intent: remote (later) vs. immediate (right now) o Plan: Vague vs. detail.
o Means: Availability and lethality.
∙ Give LOTS of reassurance
∙ Try to determine the main problem
o Anger: no magic replay
o Hopeless/helpless: consider alternatives.
Which of the mood disorders is most likely to become involved in the legal system? How?
Mood Disorders: FORENSIC ASPECTS
∙ Bipolar Mania
o Impulsivity and irritability.
o Impaired judgement
o Grandiosity and sense of entitlement
ALL THIS MAY LEAD TO:
o Assault and battery
o Sex offenses
o Financial crimes
o Despondency (state of low spirits cause by loss of hope or courage)
o Projection of blame
ALL THIS MAY LEAD TO:
o Domestic violence
o Hostage/barricade scenarios
o Suicide pact homicides.
What are the main clinical features of posttraumartic stress disorder (PTSD)?
PTSD DIAGNOSTIC CRITERIA
∙ Criterion A – Precipitating Traumatic Stressor: The person has been exposed to a traumatic event in which he/she was confronted with death or injury to self or others and which involved the experience of intense fear, helplessness, or horror.
∙ Criterion B – Persistent Re-experiencing Symptoms: The person persistently or repeatedly re-experiences the traumatic event through waking recollections, disturbing dreams, dissociative reliving experiences (“flashbacks”), and/or psychological or physiological
hyper-reactivity to stimuli that directly or symbolically resemble the traumatic experience.
∙ Criterion C – Persistent Avoidance Symptoms: The person: (1) behaviorally avoids a range of situations which remind, resemble, or symbolically represent the traumatic event, leading to a constriction of social activity; and/or (2) experiences a psychological numbing to outside stimuli which constricts his/her emotional responsiveness and interpersonal interaction.
∙ Criterion D – Negative Alterations in Cognition and Mood:
The person experiences impaired concentration or memory, exaggerated negative mood states, persistent and distorted ideas or feelings about the event (personal guilt, paranoia), emotional detachment from others, loss of enjoyment of life
activities, and inability to experience positive emotions. ∙ Criterion E – Marked Alterations in Arousal and Reactivity:
The person experiences increased anxiety, hypervigilance, irritability and anger, exaggerated startle response, difficulty sleeping, and/or impaired attention, concentration, and/or memory.
Onset of PTSD may be acute (duration les than 3 months), chronic (duration more than 3 months), or delayed ( onset is 6 months or more following the traumatic stressor).
Describe the clinical features of dissociative amnesia, dissociative fugue, and
∙ Dissociative Amnesia = inability to recall aspects of personal information, not due to another medical or mental disorder.
∙ Categorical: specific, often sharply delimited time periods, specific people, events, or items of personal identity. ∙ Global: affects all areas of memory in an otherwise healthy looking person.
∙ Onset often abrupt & may follow specific traumatic event. ∙ Symptoms may fluctuate in quality or severity over time.
∙ Dissociative Fugue = short- or long-term change in behavior or identity.
∙ May occur in response to traumatic stressor, for other causes, or spontaneously.
∙ Typically persists for hours to days.
∙ Usually recovers with partial or total amnesia for the fugue episode.
∙ Depersonalization Disorder = change in perception ∙ or experience of self (depersonalization) or surroundings (derealization).
∙ Symptoms include:
o Loss of sense of self: “am I real?”
o Unusual sensory experiences: body changes, different voices, etc.
o Usually no disturbance of memory for the event, although
o memory may be variable.
∙ Autoscopy = “out-of-body experience”
o Usually occurs in states of extreme stress or danger, including:
o Accidents & disasters.
o First responder emergencies (police, firefighters). o Severe physical or sexual abuse, esp. in childhood. ∙ Autoscopic perceptions include:
o Self looking down from above, watching the action unfold,
o then being drawn back into their body.
o Moving through a tunnel: “near-death experience.” o Watching self engage in critical self-preserving and other-rescuing activities, as if “on automatic.”
o Cultural, religious, and personal influences.
o May be ego-dystonic, or result in reaffirmation of faith &
Describe the clinical features and etiological theories regarding dissociative identity disorder (DID, or “multiple personality disorder”).
DISSOCIATIVE IDENTITY DISORDER
∙ Dissociative Identity Disorder = presence of two or more “alter” personalities seeming to inhabit the same person.
∙ “Multiple personality disorder”: a staple theme of many books & movies.
∙ Association with concepts of supernatural “possession.” ∙ Still a subject of considerable diagnostic and scientific controversy.
∙ In case reports, alters have been reported to range in number from two to dozens.
∙ Alters may or may not know about one another. ∙ One alter may be dominant, and alters may compete for dominance.
∙ There may or may not be a “true” personality.
∙ Alters have been reported to have different
o Age, sex, voice and speech patterns, handedness, and handwriting
o Memories, behaviors, medical history, blood pressures, EEG patterns, allergies.
∙ Adult DID often associated with history of severe, prolonged physical and/or sexual abuse in childhood.
∙ Theory: traumatic abuse forces child to dissociate to cope with the trauma. Evidence? Cause & effect?
∙ DID risk factors:
o High suggestibility.
o High hypnotizability.
o High fantasy-proneness.
What is the main distinguishing psychological feature that distinguishes somatoform disorders from factitious disorder and malingering.
∙ Somatoform: Report symptoms and show findings that don’t make sense from an anatomical point of view (physical change that cant be explained medically)
o Person is fooling themselves; they really believe they are ill.
∙ Factitious/ Malingering: person may show symptoms BUT these are symptoms that they brought upon them selves or made up;
o “playing sick”; manipulation.
Describe the clinical features of somatization disorder, conversion disorder, pain
disorder, hypochondriasis, and body dysmorphic disorder. SOMATIZATION (SOMATIC SYMPTOM) DISORDER ∙ Somatic Symptom Disorder (Somatization Disorder) = history of
∙ multiple, unexplained physical symptoms & complaints, beginning before age 30, and often traced back to childhood or adolescence: “professional patient.”
∙ Symptoms vary widely in number and type, may occur in clusters, and wax & wane over time.
∙ Symptoms may mimic real medical syndromes or be bizarre in nature, confounding medical diagnosis.
∙ Symptoms are typically described in dramatic, florid terms. ∙ Patients may undergo many unnecessary medical and surgical procedures.
∙ Comorbidities include anxiety & mood disorders, histrionic & borderline personality disorder, medication abuse. ∙ Underlying dynamic: quest for support & reassurance, manipulation of significant others, satisfaction of
dependency needs by reliance on caretakers and protective role of medical authority.
∙ Conversion Disorder = presence of sensory or motor deficits that appear to suggest a neurological or medical illness or injury.
∙ Typical conversion symptoms include sensory impairment (vision, somesthesis),motor impairment (weakness, paralysis),genitourinary & sexual dysfunction. May also include unexplained chronic pain syndromes.
∙ Hallmark of conversion disorder is inconsistency of reported symptoms with actual neuroanatomical pathways (e.g. complete hemianesthesia, single limb paralysis, global amnesia), although medically sophisticated patients (e.g. nurses) may replicate veridical syndromes).
∙ Sometimes marked changeability of symptoms from examination to examination, with heightened
∙ Underlying dynamic: attempted resolution of unconscious psychological conflicts by channeling, or “converting” them into a bodily impairment. Resolution of conflict in this way accounts
∙ for the other hallmark of conversion disorder: “la belle indifference,”(blindly unconcerned) although this is not always seen.
∙ Not deliberate faking: patient is absolutely convinced of the reality of the impairment. Often can appear quite veridical (e.g.imperviousness to pain) – brain mechanisms involved?
HYPOCHONDRIASIS (ILLNESS ANXIETY DISORDER) ∙ Illness Anxiety Disorder (Hypochondriasis) = conviction that one has a serious illness or injury, despite numerous negative medical findings. ∙ Patients are preoccupied with the fear of disease or disability and tend to misinterpret normal bodily signals as symptoms of dire pathology.
∙ Typically focus on one or a few chosen symptoms or syndromes at a time, but these may change over time. ∙ Underlying dynamic: deflection of anxiety over unconscious conflicts or conscious stressor, onto fear of illness to “bind” the anxiety to something seemingly more comprehensible & controllable.
BODY DYSMORPHIC DISORDER
∙ Body Dysmorphic Disorder = preoccupation with an imagined flaw or defect in appearance or behavior, or excessive concern over a real, but minor defect.
∙ In DSM-5, this syndrome has been reclassified as a type of obsessive-compulsive disorder.
∙ Patients may avoid socialization & other activities due to their self-perceived ugliness or defectiveness.
∙ Underlying dynamic: conscious or unconscious feelings of guilt or self-loathing are projected onto a more objectifiable physical impairment.
What is factitious disorder? What is malingering? FACTITIOUS DISORDER
∙ Factitious Disorder (Munchausen’s Syndrome) = deliberate production, manipulation, or feigning of illness symptoms in order to assume the sick role.
∙ Not unconscious; patients know they are faking or exaggerating their symptoms.
∙ May involve simple manipulations (self-brusing, blood in urine) or potentially lethal self-harm (self-induced insulin shock or septicemia)
∙ Symptoms may be veridical or bizarre, depending on the medical sophistication of the patient.
∙ Underlying dynamic: achieve attention and care by assuming the sick role; also express hostile-dependency by fooling the so-called “expert” doctors.
∙ When such manipulation is done to others (e.g. children), it becomes factitious disorder by proxy.
∙ Malingering = deliberate production, manipulation, or feigning of illness symptoms for some material gain. ∙ Motivations typically involve achieving undeserved monetary compensation (workers compensation or insurance fraud), access to unneeded narcotic drugs (phony pain syndrome), or avoiding consequences of illicit acts (adjudicative competency, exculpation or mitigation).
∙ Not an actual diagnosis in the DSM system, although it may be associated with other diagnoses, such as antisocial personality disorder & substance abuse.
∙ Factitious disorder vs. malingering: psychodynamic concepts of primary vs. secondary gain.
∙ 4 Types of Malingering
o Fabrication = subject has no symptoms or
impairments, but fraudulently pretends that he has. Least common type.
o Exaggeration = subject does have symptoms or impairments caused by the injury, but presents them as worse than they really are.
o Extension = subject did experience symptoms or impairments caused by the injury, and these have now improved or resolved (normal recovery curve), but he falsely represents them as continuing or even
o Misattribution = subject has symptoms or
impairments that preceded or are unrelated to the index injury, but he falsely attributes them to that injury.
What is the main difference between the diagnostic categories of somatoform disorders and
psychophysiological disorders (or “psychological disorders associated with a general medical condition”)? ∙ MAIN DIFFERENCE: There is some actual physical change or medical disorder in which psychological factors are thought to influence the onset, severity, and/ or course/ resolution (how long it takes to get better) of the disorder (In regards to psychophysiological disorders)
o There is NO doubt that there is an actual medical syndrome.
In which illnesses have psychological factors been implicated in the predisposition, onset, severity, and/or course of the disorder?
∙ Essential hypertension, peptic ulcer, ulcerative colitis, rheumatoid arthritis, bronchial asthma, and hyperthyroidism. ∙ Later theorist posited unconscious conflicts and contemporary stressors as influencing the following: o Chronic fatigue, fibromyalgia, tension headaches, irritable bowel syndrome, ectopic dermatitis, dermal warts, Type- A personality pattern (competitive,
ambitious, impatient, highly aware of time
management and/or aggressive)
How do personality and coping style affect one’s physiological and psychological
response to stress?
∙ Focus on reducing effects of stressor, on feeling better, without necessarily addressing the cause
∙ Constructively deal with the cause of stress
o Thought to be more mature/healthy than emotion focused coping, but both may have a role to play in the adaptive response to stressful circumstances.
What are some effective therapies for dealing with psychophysiological disorders?
PSYCHOPHYSIOLOGICAL DISORDERS: TREATMENT ∙ Abreactive therapy.
∙ Psychodynamic exploration.
∙ Behavioral medicine.
∙ Lifestyle changes.
∙ Cognitive-behavioral therapy.
∙ Coping skills training: self-efficacy.
∙ Family & psychosocial modalities.
∙ Role of MH professionals in medical treatment.
What are the main sleep cycles we all go through most nights?
1. NREM Stage 1 (1-10 min)
∙ Occurs after you decided to sleep and your eyes are closed.
∙ Eyes roll a little, blood pressure and brain temperature decreases.
Describe the sleep disorders of insomnia, nightmares, night terrors, somnambulism, REM sleep behavior
disorder, sleep apnea, narcolepsy, and the alpha-delta polymyositis syndrome.
∙ Not getting enough sleep of the right kind.
∙ Usually spend disproportionate time either awake or in lighter sleep stages.
∙ May be associated with trait anxiety or situational stress. ∙ Drug and medication effects.
∙ DFA, MNA, EMA, or any combination.
∙ Occurs during `
∙ May involve relatively simple actions, sitting up in bed (confusional arousals), or sleep-talking.
∙ May involve leaving the bed and wandering, i.e. sleepwalking, and other behaviors: eating, dressing, cooking, etc.
∙ Eyes are often open during episode, but facial expression is blank, and subject is nonresponsive (asleep).
∙ Usually never coordinated, complex behaviors of long duration; c.f. fugue states.
∙ Violence during sleepwalking is rare.
∙ More common in children than adults; in adults, may be ∙ secondary to new pathology.
REM SLEEP BEHAVIOR DISORDER (RSBD)
∙ Occurs during REM sleep in association with dream content. ∙ Impaired REM paralysis; disinhibition of REM movements. ∙ Subject’s eyes are closed; facial expression corresponds to dream events.
∙ Patient essentially acts out ongoing dream; can usually recall dream if awakened.
∙ Danger of injury to self or others.
∙ RSBD may be associated with Parkinson’s disease, Lewy body dementia, some drugs, or be idiopathic.
∙ Vivid, scary dreams with recallable content.
∙ Occur during REM sleep.
∙ Intense emotional and ANS reactions predominate. ∙ Relative paucity of recallable content.
∙ Occur during slow-wave sleep.
∙ May be associated with somnambulism, PTSD, etc.
∙ Obstructive and central apnea: mixed syndromes. ∙ Periodic cessation of rhythmic breathing during sleep. ∙ Stereotypical hand movements.
∙ Ranges from mild to severe.
∙ Usually associated with daytime sleepiness.
∙ Brain affected by impaired sleep + anoxia.
∙ May be neurologically related to SIDS and other syndromes. ∙ Treatment with CPAP device.
ALPHA-DELTA POLYMYOSITIS SYNDROME
∙ Nonrestorative sleep; easy fatiguability; anxiety, irritability, and depression.
∙ Chronic, widespread and variable musculoskeletal aching and stiffness, localized areas of tenderness.
∙ Name: EEG findings of high rate of alpha superimposed on delta.
∙ Etiology unknown.
∙ New name: fibromyalgia syndrome
∙ and/or chronic fatigue syndrome.
∙ Narcolepsy: sleep disorder (possible genetic autoimmune etiology) characterized by multiple, brief, irresistible attacks of daytime sleep,
characterized by immediate REM onset.
∙ Most attacks preceded by a feeling of overwhelming fatigue and occur when the patient is bored, safe, and physically comfortable.
∙ Alternatively, attacks may occur without warning when the patient is exposed to a sudden, emotionally-arousing stimulus.
∙ Nighttime sleep is typically disturbed, with chronic daytime ∙ sleepiness.
∙ Narcoleptic Tetrad (Gelineau syndrome): only 10% of patients have all 4 components.
o Sleep attacks.
o Cataplexy: sudden loss of muscle tone, transient flaccid a-reflexive paresis (mimics muscle paralysis seen in REM sleep). Often precipitated by sudden emotional arousal. May co-occur with sleep attack or independently, with preserved wakefulness.
o Sleep paralysis: hypnogogic or hypnopompic.
o Sleep hallucinations: hypnogogic or hypnopompic. o
What are the clinical similarities and differences between anorexia nervosa and bulimia nervosa?
∙ Anorexia nervosa: deliberate maintenance of low body weight by means of food restriction.
o Loss of 15% or more of body weight.
o Intense fear of gaining weight.
o Preoccupation with amounts and types of food
o Distorted sense of body size and shape (they FEEL fat, even though they can see how skinny they look)
o Amenorrhea (absence of monthly menstrual periods) with persistent starvation.
o Paradoxically increased energy level (may be spent exercising for hours)
o Difficult to treat and potentially life threatening (up to 30% mortality rate.
∙ Anorexia Nervosa: 2 subtypes
o Simple food restriction, often increased exercise. o Binge/purge type (usually more severe)
∙ Bulimia Nervosa: cycles of excessive binging alternating with compensatory behavior (Purging, fasting, exercise).
∙ Comorbidities: borderline personality disorder, body dysmorphic disorder, mood disorders, substance use disorders, impulse control disorders.
∙ Less risk of mortality than anorexia, but risk of other health effects:
o Dental, cardiac, to gastrointestinal.
What are the main types of gender identity disorders, paraphilic disorders, and sexual dysfunctions? What is the difference between a paraphilic disorder and a sex crime? GENDER IDENTITY DISORDERS
∙ Conviction that one’s psychosexual identity is different from their body gender.
o More common in males
o Not usually associated w/ homosexuality.
o Transgender: assumes the clothing and roles of the identified gender.
o Transsexual: some who transitions from one sex to another (through hormones or surgical procedures.)
∙ Paraphilias: sexual attraction to, and or,
preoccupation with specific, unusual objects and/ or sexual activities.
o Think about family, culture, religion, ect. When thinking about what is “usual” or “unusual”
∙ Fetishism: sexual attraction to, and/ or preoccupation with specific objects, body parts, activities.
o Single or multiple; animate or inanimate; emphasis on part vs whole.
∙ Transvestism: sexual arousal achieved by wearing opposite sex clothing.
∙ Pedophilia: exclusive or predominant sexual interest in children
o Pre-pubescent (pedophilia) vs. post-pubescent (ephebophilia) interest.
o Subjects usually male
o Often does not involve actual sex with children, but use of fantasy materials.
o Pedophilia is not a crime but child sexual assault is (also child pornography).
o Motives: mixture of sex and power.
∙ Incest: sexual relations between biological relatives. o usually opportunistic or exploitive rather than
preferential, but exceptions.
o Most common: brother-sister; next: father-Daughter; other pairings less common.
o Not necessarily a crime if between two consenting adults.
∙ Frotteurism: sexual arousal by touching or rubbing one’s pelvic area against a non-consenting person for sexual pleasure.
∙ Voyerism: Exclusive or predominant sexual arousal by watching others have sex.
o Consent vs. illicit spying (thrill of the hunt)
o Viewing a component of normal sexual activity.
o Mostly males, but many women.
∙ Exhibitionism: Exclusive or predominant sexual arousal by exposing one’s genitals typically to a stranger.
∙ Sadomasochism: exclusive or predominant sexual arousal by inflicting or receiving pain.
o Sometimes one or the other or can be both in the same person.
o Dominance and submission fantasies in normal love making.
∙ Sexual Desire Disorders
o Hypoactive Sexual Desire disorder: lessened interest in sex
o Sexual Aversion Disorder: active avoidance of sex. o Sexual Arousal Disorder: male erectile disorder (“impotency”)
∙ Orgasmic Disorders
o Ejaculatory Disorder: “retarded ejaculation”
o Premature Ejaculation
o Female Orgasmic Disorder
∙ Sexual Pain Disorders
o Male Sexual Pain Disorder
o Dyspareunia: pain upon intercourse.
Describe the impulse control disorders or pyromania, kleptomania, trichotillomania, pathological gambling, and intermittent explosive disorder.
∙ Intermittent Explosive Disorder (IED) OR Episodic Dyscontrol Syndrome (EDS)
o Seizure-like disorder characterized by paroxysmal attacks of extreme violent rage, with features of
overkill, diminished awareness of surroundings or actions, poor recall of the events.
∙ Kleptomania: compulsive urge to steal.
o Items often of little value (not about the object more about the thrill of stealing)
o Mostly females
∙ Pyromania: compulsive urge to set fires or watch fires burn. o Not for profit or return
o Mostly males.
∙ Pathological Gambling: compulsive urge to gamble. o Males and females
∙ Trichotillomania: compulsive hair-twirling and pulling o Can occur alone or alongside other tic disorders or obsessive-compulsive disorders.
What are the main subtypes of adjustment disorder and how do they differ from other disorders?
∙ Milder form of traumatic response
o Symptoms for anxiety, depression, conduct disorder, ect. in response to identifiable stressor. o Doesn’t produce long term disability
∙ A person with an adjustment disorder/stress response syndrome develops emotional and/or behavioral symptoms as a reaction to a stressful event. These symptoms generally begin within three months of the event and rarely last for longer than six months after the event or situation.
From your knowledge of abnormal psychology, which clinical syndromes would a forensic psychologist be most likely to deal with?
∙ Antisocial personality disorder
∙ Bipolar disorder
∙ Any of the Impulsivity disorders
∙ Conduct disorder
∙ Sexual Disorders