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This 21 page Study Guide was uploaded by Jennifer Hwang on Wednesday January 28, 2015. The Study Guide belongs to PSY 350 at Purdue University taught by Rollock in Fall. Since its upload, it has received 79 views. For similar materials see Abnormal Psychology in Psychlogy at Purdue University.
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Date Created: 01/28/15
0 Schizophrenia Spectrum and other psychotic disorders 0 Schizophrenia brief psychotic DO without stressor post partum Schizophreniform DO Schizoaffective DO Delusional DO Schizotypal Personality o Other psychotic DO Substance medication induced Psychotic DO due to medical conditions without delusions hallucinations Catatonic DO with another mental DO due to a medical condition unspeci ed 0 Key features de ning psychotic DO Delusions Hallucinations Disorganized thinking Abnormal motor behavior Negative symptoms 09 Diagnosis of Schizophrenia o 2 characteristics psychotic syndrome Delusions esp bizarre Hallucinations Disorganized thinking speech Grossly disorganized or abnormal motor behavior included catatonia Negative symptoms 0 Flat affect Avolition Alogia Anhedonia Asociality Decline in socialadaptive functioning Continued signs of disturbances for 6 months and at least 1 month of active phase positive or negative symptoms RO mood DO Autism Organic pathology Substance Use DO 3 Positive psychotic negative cognitive symptoms 0 Schizophrenia symptoms fall into 3 categories Positive symptoms 0 Cognition added exaggerated or made up 0 Without any external impetus Neg ive symptoms 0 Emotions motivation social ability atten diminished Decreased or taken away Cog tive symptoms 0 Problem with working memory and process w attention w understanding facial expressions and de cits w Iang function use and comprehension 00 Positive symptoms Delusions o Delusions False beliefs held despite overwhelmingly contrary or absent evidence 0 Major types of delusions Grandiose Persecutory often linked to grandiosity Erotomanic often linked to grandiosity Z Nihilistic Somatic o Other Classical Delusional Contents Kurt Schneider Thought Insertion Thought Withdrawal External Control of Feeling and Behavior Thought broadcasting 0 Positive symptoms Hallucinations o Hallucinations Sensory experiences in the absence of environmental stimuli May be caused by increased dopamine activity oAuditory hallucinations I Commonly reported 3 in 4 schizophrenia patients Tacticle visual gustatory olfactory 0 Common hallucination contents include Voices commenting on person s behavior Voices talking to each other Commands less common dangerous 00 Positive symptoms Disorganized Thinking Abnormal Motor Behavior 0 Disorganized Thinking Determinedinferred from individuals speech Derailedloose association Tangentiality lncoherenceWorld Salad oAbnormal Motor Behavior Manifest itself in of ways from child like silliness to unpredictable agitation Catatonic behavior 0 Negativism 0 Stupor lmmobility 0 Catatonic excitement 00 Negative symptoms 0 Accounts for a substantial portion of the morbidity associated with schizophrenia Diminished emotional expression Avolition Alogia Annedonia Associality 3 Other dimensions of Scz positive vs negative symptom patterns Positive Negative Cognitive Social Delusions Halluc Withdrawal Avolition Beh Affect Inappropriate Flat Biological features Chemical Structural Drug Response Good Poorer Premorbid Fair to Good Poor adjustment Prognosis Fair Poor 3 Functional Consequents of Schizophrenia Symptoms oCognitive symptoms Affects working memory ability to understand social facial and nonverbal cues o Declines in adaptive spheres Selfcare Social relatedness functioning Making educational progress maintaining employment are frequency impaired by avolition or other disorder manifestation 0 Heterogeneity Comorbidity o Heterogeneity Symptoms dimension all with different characteristics Rarely all present in one individual Symptom dimensions present in variety of other DO as well 0 Comorbidity Substance DO I Mood Anxiety DO OCD Panic DO I Personality DO 3 Problems Diagnosing Schizophrenia o No single characteristics is this a single DO 0 Negative symptoms may mask full extent of DO 0 Many other conditions with similar symptoms eg Drug intoxication or substanceinduced psychosis Brain injurydamage Disease PTSD Bipolar DO Other psychotic DO brief reactive schizoaffective schizphreniform 0 Ethnic cultural and social issues Differentially more disorganized presentation of African Am Overrepresentation of lower SES Diagnostician Criterion bias Different manifestations in different cultures 0 Schizophrenia Spectrum DO oTo better describe and explain heterogeneity and comorbidity of schizophrenia DSM5 changed classi cation of schizophrenia from a categorical to a dimensional spectrum approach 0 Got rid of paranoid disorganized catatonic subtypes o This spectrum is now composed primarily of schizotypal schizoaffective schizophreniaform schizophrenia DO 0 Schizotypal DO Prodromal or attenuated symptoms of schizophrenia o Schizophreniform Mild form of schiz at least 2 positive or negative symptom have been experienced for at least 1 month less than 6 o Schizoaffective Bridges schizophrenia bipolar D0 major depressive DO Must include one major mood episode that occurs concurrently with delusions or hallucinations for at least 2 weeks 0 Potential Risk factorscause o A of potential risk factors Genetics Scz rate in US population 1 Concordance for DZ twins 12 M2 44 Neuroanatomy 0 Evidence of enlarged ventricles degeneration of key brain structures Genes environment 0 Season of bird winter early spring 0High EE CD low SES higher rate of immigrants in England from Carribean countnes 00 Cultural Impacts on Risk Factors and DO outcomes 0 EE High EE does not have same effect on Mexican and African Americans as on AngloAmericans High EE connected with were associated with some positive outcomes 0 Perception of disease US schizophrenia in stigmatized and seen as permanent Hispanic countries mental illness is more often attributed to nervios or ataques de nervios This may affect attributions and levels of control for individual families may support individuals more which might affect outcomes positively 0 Etiology of Schizonhrenia Diathesis Stress Approach 0 Dopamine Hypothesis Schizophrenia positive symptoms as a result of excess dopamine 0 Amphetamines stimulant increases dopamine activity produces similar hallucinations and delusions as a characteristics of schizophrenia 0 Some neuroleptics reduce schizophrenia positive sx apparently by blocking dopamine receptors 0Therefore schizophrenia can be reduced by decreasing dopamine transmission by either 0 Preventing dopamine release 0 Blocking dopamine receptors 0 Breaking down dopamine before release 09 Factors in Schizophrenia Treatment that in uences course o Antipsychotics decrease positive symptoms by limiting excess signal transfer model scz as signal overload or overactivity Alter speedamount of release or reuptake Fewer side effects if 0 Medication is more site selective Different neurotransmitter balance 0 However there are issues with dopamine hypothesis Relapse while using neuroleptics do not work Do not cure schizophrenia do not address some of the functional social and occupational differences still present 0 Neuroleptics do work Esp on type 1 symtpoms Affect dopamine sites and neurotransmitter balance 0 But Individuals and Family treatment needed with medications Long term use or overdose of neuroleptics tardive syskinesia Environmental stress gt quotdecompensationquot after leaving quotsafequot hospital Negative symptoms historically not well treated with drugs but early psychosocial tx effective varies by country Social support crucial to maintain medication regiments 0 DSM5 Personality BID 0 Stable pattern of affect cognition impulse control interpersonal behavior experience Longstanding enduring and in exible 0 Evident from adolescence early adulthood Pervasive or stylistic across situations Deviating from cultural norms Maladaptive distressing disruptive etc o Grouped in 3 descriptive clusters I Cluster A 0 Odd eccentric behavior Cluster B Dramatic erratic or emotional Cluster C o Anxious or fearful styles 0 Cluster A o Diagnoses only when not part of Delusional D0 or Schizophrenia I Paranoid PD Pervasive distrust and suspicious of others 0 Views others actions as deliberately threatening exploitative deceitful 0 Guardedness unwillingness to trust quick to anger Distinguished from ethno cultural minority quotwarinessquot Schizoid PD 0 Pervasive indifference to social relationships and restricted emotional life 0 Neither desires or enjoys close relationships including families 0Emotional coldness detachment or attened affectivity Schizotypal PD 0Pervasive pattern of o Peculiar ideation Odd beliefs or magical thinking that in uences behavior Unusual perceptual experiences 0 Related de cits in interpersonal relationships and social behaviors Eccentric appearance Vague or overelaborate speech Social anxiety no friends 0 Less commonly diagnosed Cluster B PD o Narissistic PD pervasive pattern of grandiosity in fantasy or behavior need for admiration lack of empathy I Exaggerates ahievements talents selfimportance I Need for admiration hypersensitivity to others evaluations Lack of empathy and sense of entitlement NB Some researchers distinguished quotvulnerablequot negativistic fragile self esteem from quotgrandiosequot disagreement extroverts o Histrionic PD pervasive pattern of excessive emotionally and attentionseeking Exaggerated dramatic emotional expression Shallow and rapidlyshifting emotions Attentionseeking consistently uses physical appearance to draw attention to self Unlike narcissistic PD willing to be seen as weak fragile dependent in order to get attention 0 Cluster C o Avoidant PD pervasive pattern of Social discomfort social inhibition Fear of inadequacy and negative evaluation Shrink from most interpersonal contacts unless acceptance certain anticipate rejection More social monitoring and patterns of extreme avoidance than social phobia o Dependent PD pervasive pattern of Marked submissive and clinginess Inability to decide or do things on own cultivate relationships for reassurance Linsessive Compulsive PD Preoccupation with orderliness perfectionism and mental and interpersonal control 0 Preoccupied w details rules lists organizations or schedules 0 Insistence on personal and interpersonal control and doing things own way 0 Sacri ce on exibility openness ef ciency 0 Distinguished from OCD by Lower anxiety levels Non intrusiveness of thought Less social impairment 0 Most Common cluster B PDs Borderline Personality DO 0 Borderline PD pervasive pattern of Instability in mood selfimage interpersonality relationships Marked by 5 or more of the following o Frantic effort to avoid abandonment Unstable and intense relationships swinging from idealization to devaluation 0 Identity disturbance unstable sense of self 0Potentiay selfdamaging recklessness o eg repeated suicidal attempts or threats self mutilation often due to intense emotional reactions inapprop Anger orr different controlling it chronic feelings of emptiness brief stressrelated paranoia or dissociation 3 Etiology of Borderline PD Psychoanalytic Psychodynamic ADD 0 Weak ego boundaries from chaotic abusive unpred Early enviro o Childlike emotional reactions primitive and wishful thinking 0 Unstable sense of self and feeling of eptiness o Inability to reconcile intense con icting emotions in self or others esp seeing people inc self as all good or all bad 0 Social neediness 00 Etiology of Borderline PD CognitiveBehavioral Linehand39s DialecticalBehavioral Treatment Approach 0 BPD as a disorder of emotional disregulation Individuals with unsuualy strong emotionsreactivity Invalidating environemnts do not provide the kind of support individuals need Individuals have de cient skills to manage this mismatch 0 Unable sense of self stems from Not trusting own perceptions of reality Desperately trying others oversimpli ed approaches to the subjective problems of life oTx emotion and cognitive management skills DBT difference from traditional CBT accept and validate clients subject realities central dialectic of DBT 3 Most common Cluster B PDs Antisocial Personality DO oAntisocial PD pervasive pattern of Disregard for social rules transgression of other s rights disregard for personal or other s safety Roots seen before 15 esp Conduct DO dx gt 18 Multiple areas of violation including 3 of the following 0 Repeated unlawful behavior eg theft Deceitfulness esp habitual lying cheating for pleaure or pro t 0 Physical or sexual aggression irritability lmpulsivity substance use gambling unsafe sex 0 Reckless disregard for selfothers 0 Social irresponsibility parenting nances sexual delity 0 Lack of remorseconscience gt rationalize social violations oz Distinctions between APD and Psychopathy 0 Diagnostic focus DSM 5 diagnoses APD centers on behavior Psychopathy based on inferred personality traits o Eg many quotcon menquot also may be super cially charming manipulative and explotative but not as reckless as APD 0 High prevalence in incarcerated populations Confounded dx due to behavior Cf low SES Psychopath s style may not include behavior likely to get them arrested 0 Distinct from sociopathy dissocial psychopathy Socialization into a deviant subculture gangs Greater capacity for empathy and prosocial rehabilitation o3 APD Diagnostic 8 Etiological issue Antisocial pd vs simple criminality I Criminals I Antisocial PD Motivated for material gain motivation unclear or impulsive Responsive to punishment Slow response to most punishment Criminal ways learned to meet History of impulsivity and poorly needs crime as means to end motivated cruelty Normal passion and meaningful Lack of deep social attachments relations or remorse conscience 3 APD Diagnostic and Etiological lssues Under arousal as an Etiological factor 0 In usuallystressful situations APDs show Lower selfreported anxiety Lower skin conductance reduce startle Improved performance with adrenaline Frequency substance abuse and thrillseeking Some family patterns suggest biogenesis 0 However Increased HR anticipating aversive stimuli Improved learning when losses tangible or personally o CautionsLimitations Crimanility is sometimes a proxy for APD or psychopathy also has cross generalized pattern 0 Sociopathy 0 Mistake social deviances for individual psychopathy Studies suggest other environmental and genetic factors Evidence of selective attention gt difficulty anticipating some punishment 0 Typical social vs personally gt meaningful money I Psychopaths simply nd emotions easier than others anger 0 Borderline PD vs Antisocial PD Similarities o Impulsiveness oManipulations oUnpredictability o Selfdefeating behavior patterns 0 Frequent Interpersonal Con icts 0 Borderline PD vs Antisocial PD Differences BORDERLINE PD ANTISOCIAL PD Emotionally ability inc bouts of lack or arousal of real emotion suicidality at least empathic emotion intense relationships esp Shallow relationships lack of deep swinging between idealization and attachment devaluation Motivated by extreme inadequate motivation or neediness fear of abandonment material gain vs concern about others or what they think Often confused with mood or Often confused with simple psychotic disorders criminality Greater dx among women Greater dx among men 3 Problems with the Personality Disorders Category 0 Distinctions among Personality Disorders gt include problems of comorbidity how useful is other PD diagnoses Many individuals have overlapping features of PD gt1 o Distinctions from other abnormal patterns Mood disorders PTSD substance abuse DO Coping responses to situational stressors 0 Cultural norms and sex rations for sx like Dependency Aggressiveness Abandonment concern Emotional dimensions 0 Individual differences normal personality Dimensionstraits may describe better than categories Egosyntactic vs egodystonic traits 0 Dimensional Approach to Personality and Personality Disorders 0 Big 5 Dimensions in basic personality research Openness Conscientiousness Extroversion Agreeableness amp Neuroticism Broken down into facets 0 PBS extreme scores and combinations I Maladaptive variants of normal traits No xed cutoffs to identify discrete categories Eg avoidant PD low E high N 09 Mood or affective disorders Depressive DOs Bipolar Related Dog 0 Two main classi cations of primary disturbances of emotional intensity or balance Depressive Disorders 0 Major Depressive Disorder MDD oDysthymia aka Persistent Depressive DO 0 Low grade chronic depressed mood o Depressive style or personality Disruptive Mood Dysregulation DO 0 Premenstrual Dysphoric DO Bipolar and Related Disorders Bipolar 1 at least one full manic episode Bipolar 2 at least one hypomanic episode 0 Cyclothymia mild depression and hypomania Related diagnoses under each classi cations Substanceinduced Due to general medical conditions 0 Other and unspeci ed 00 Contrasting Deviations from Euthymia Depression Mania Sad mood sometimes irritable Elevated expansive or irritable often anxious mood Apathetic hopeless helpless Expansive ideas Low self esteem inappropriate Grandiosity annoying activity guilt worthlessness suicidal levels eg work school sex ideation poorjudgement Changes in appetite weight sleep Decreased sleep needs patterns insomnia hypersomnia Low energy psychomotor Racing thoughts quot ight of ideasquot retardation agitation excessive energy gt high activity pressured speech restlessness distractability Social withdrawal loss of interest Excessive pleasurable activity in formerly pleasant activities without regard for consequences quotanhedoniaquot eg spending sprees bad business deals 0 Key Risk and Protective Factors for Major Depressive Disorders oRisk factors Female Adverse Life ecents Low SES Hx of Disorders Family history genetics Seasonal patterns 0 Protective Factors Married males Employed Financial Prosperity Good health care Effective social network 3 Two additional new controversial DSM5 Depressive Dos o Disruptive Mood Dysregulation Dos 618 year olds recurrent tantrums outburst 3x a week inconsistent with developmental levels angryirritatiable bw outbursts dif cult differential diagnoses o Bipolar more episodic Odd fewer ourburst less moodiness 0 Rarely not comorbid Premenstrual Dysphoric Dos 0 Mood swings liability 0 Anger irritability anxiety 0 Neurovegetative symptoms Some issues 0 Prevalence of 155 but unknown origins course prevalence gt sexist Comoborbidity with major depressive epsiodes PMS no mood symptoms required 00 Controversies with Depressive Dos o Endogenous Exogeneous distinctions gt weak Confouned with serious medical responses Absence of real difference in precipating events 0 Lack of change in mental health contact hoHdays 0 Low correlations bw severity of stressors and symptoms 0 often unclear whether stressors are causes or added Prevalence by sex women 1025 men 510 Biological hormonal differences 0 NB No gender difference in bipolar rates 0 Actual life events in culture helplessness conditioning by society 0 Men externalizing behavior and self medication for dysphoria o Biased criteria or diagnosticians Other concerns 0 MDD can be diagnosed even 2 weeks after death of loved one o Suicide as an inevitable result of depression 0 Prozac and other newer generation medication danger of behavioral side effects use among children and overprescribing 0 Lower diagnoses in blacks higher suicides in whites 0 lsues with Bipolar dx oAmong children differential dx from Disruptive behavior DO esp ADHD Physical illnesses 0 General factors complicating dx Psychotic symptoms Eg differential dx of bipolar mania schizophrenia schizoaffective DO or even acute intoxication Frequent substance abuse 0 Selfmedication Trigger for manic episodes oDifferential dx from substance induced mood DO I Subtly of hypomanic sx vs full blown mania oDifferential diagnoses bw cyclothymia and borderline PD Relative infrequency of mania sx in bipolar Depressive sx most prominentmost of time o Eg quotrapid cyclingquot gt only 4 times per year 0 Illustration of problems in bipolar dx 0 Relative infrequency of manic symptoms in bipolar Only one manic episode required for diagnoses 1 week minimum Regardless of number of depressive episodes 0 Depressive symptoms most prominent Eg quotrapid cyclingquot gt only 4 times a year 0 Subtlety of hypomanic symptoms 39 Hypomania vs other energetic creative or quothyper phases 0 Criteria only 4 days no psychotic symptoms Eg cyclothymia vs borderline PD differential Dx 00 Psychogenic Models of Depression o Psychoanalytic inability to resolve a real or symbolic loss I Depression like pathological mourning 0 Cognitive behavioral mutual in uence of thoughts feelings amp behavior Eg Iewinsohn negative events predisposition lead to a vicious cycle of thoughts behaviors and affect 0 CognitiveBehavioral model of depressive affect Clarke Lewinsohn Hops 1990 0 Negative life events and predisposition gt 0 Reduce behavior and decrease reinforcement gt E Negative selffocus and cognitions gt 0 Sad mood and hopelessness gt o More negative events feeding back into cycle 0 Key Cognitive Approaches to Depression 0 Beck Cognitive triad of negative thoughts about Self 0 Experience 0 Future Logical errors arbitrary inference selective abstraction overgeneralization magni cation and minimization personalization o Seligman quotlearned helplessnessquot as a model explanatory style atributational style interalexternal 0 stability 0 globality eg selfstatements after bad exam oz Biological Approaches to Depression 0 Family and twin studies higher incidence in probands Vs very clear genetic transmission of bipolar symptoms 0 Depleted levels imbalances of neurotransmitters serotonin ie 5 HT amp norepinephrine among depressed subjects Major classes of drugs increase availability of thee neurotransmitters at synapses Action of supplemental serotonin reuptake inhibitors SSRls and nextgeneration meds SSRs black reuptake of serotonin at particular receptor sites 0Unlike tricycles blocks general reuptake of some neurotransmitters and slow down norepinephrine transmission Unlike MAOls inhibits breakdown of norepinephrine serotonin Unlike lithium unknown action mood swing stabilizer not antidepressant 0quotcleanerquot molecule more speci c receptors gt fewer side effects Indirect simplistic evidence PLUS absence of endogenous exogenous distinction gt diathesis stress as best account Best actions of SSRIs 0 Chemical signal travels via neurons 5 HT produced near end of sending neuron 5 HT released across synapse 5 HT received by specialized receptors of receiving neurons to continue transmission 5 HT not binding gets reabsorbed not quotusedquot 0 SSRIs Block reuptake so More 5HT available to work 00 Treatment of Depressive Disorders 0 Drug Tricyclics SSRIs begin to work in 12 weeks Behavior and energy increase rst then thoughts and moods Typical trial of drugs 4 months or so 0 CBT usually 1520 sessions Change dysfunctional cognitions eg via cognitive restructuring Increase pleasant activities including exercise 0 Effectiveness Drugs work quicker and most clearly in severe cases of schizophrenia CBT more enduring bene ts and no sexual side effects withdrawal CBT amp drug combinations very effect regardless of quotcausesquot Neither treatment guarentees happy mood but improve sx 0 Usually unilateral ECT for clients whose depression is Severely dangerous Intractable or untreatable by drugs due to side effects NB unknown why this works risk of ST memory loss 0 Watch for suicidal behavior going into or out of depression Note danger inherent in pattern of improvement during drug treatment 0 Dealing with Suicide 0 Warning signs Danger period intoout of depression Suicidal ideation especially with plan Arranging affairs disposing of possessions 0 Friends and relatives Engage person be sympathetic affective Avoid trivializationdenigration take hints seriously Suggest practical alternatives cognitive Eg permanent solutions to a temporary solution Assess intent remove any means behavioral Seek professional help ideal escort person to help 0 Professionals Hospitalize ONLY when danger to selfothers Plan and intent or ability to commit to safety plan Access to planned means 392 Putting this all together some tough questions 0 Postpartum Depression and Psychosis DSM5 diagnoses Major Depressive Disorder with peripartum onset Andrea Yates case outcomes under treatment laws 0 General agreement Yates psychotic not malingering 2002 jury rejected insanity defense gt life sentence 0 2006 new jury accepted insanity defense gt hospital commitment Assessment of dangerousness Legal vs professional de nition of psychological Dos Patient rights Ethical and legal considerations of psychologist s roles OOOO oz Understanding Predicting and Acting on Dangerousnesi o Abnormal diagnoses lt evidence of significant impairment in life roles experience 0 Cultural answers to when to intervene and deprive individuals of rights based on selfother danger Eg many suicides be justifiable and not abnormal What justi es depriving someone of choiceliberty Best predictor past behavior 0 Problems Speci c cases incidences factors De ning dangerousness Baserateissuesfrequency Ecological validity of behavioral predictors Disclosure rates and posthoc explanations O Reasons for elevated risks in some diagnoses categories oz Key approaches to psychological disorders in criminal proceedings 0 1843 M Naghten Test Mental defect gt unable to recognizeappreciate rightwrong o Irresistible impulse Temporary context not just general quotdefectivequot appreciation of rightwrong gt impaired control 0 Eg lorena Bobbitt acquittal o 1962 American Law institute ali model statute quotdiminished capacity to appreciatequotconform behavior 0 1984 Insanity Defense Reform Act defendant must have been unable to appreciate behavior 0 due to severe disturbances psychotic nonPD o diminished capacity quotirresistibility arguments at tatutologicalquot 0 vs earlier Dan White s quottwinkle defensequot John Hinckley 0 NB insanity rarely pleaded and rarely successful 393 Other continuing problems consideringpsychological DOs in Legal Proceedings 0 quotGuilty but mentally illquot plea some jurisdiction Dos not severe enough to completely explain behavior Involuntary commitment to treatment facility for a period of time at least equal to standard sentence 0 Problems 0 Treatment vs punishment 0 Avoids judgejury responsibility to decide criminal responsibility 0 Competency to stand trial Capacity to understand and assist in own defense Not same as GBMI determined prior to plea If not competent Postpone trial for speci ed period to determine improvement 0 Commitment if unlikely to become competent in time
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