Obtain the Thevenin and Norton equivalent circuits of the circuit in Fig. 4.114 with respect to terminals a and b.
Psychopathology Weekly Notes: Personality Disorders DSM 5 General Symptoms A. An enduring pattern of inner experiece & behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas: (1) Cognition (2) affectivity (3) interpersonal functioning (4) impulse control B. Enduring pattern is inflexible & pervasive across broad range of personal/social situations C. Enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning D. Pattern is stable & of long duration & onset can be traced back at least to adolescence or early adulthood E. Enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder F. Enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma) DSM-5 Personality Disorder Clusters • Cluster A – odd or eccentric cluster • Paranoid, schizoid, schizotypal • Cluster B – dramatic, emotional, erratic cluster • Antisocial, borderline, histrionic, narcissistic • Cluster C – fearful or anxious cluster • Avoidant, dependent, obsessive-compulsive Cluster A: Paranoid PD Pervasive & unjustified mistrust & suspicion Prevalence rates between 2.3%-4.4%; in clinical samples diagnosed more in males Etiology Some evidence for increased prevalence in relatives of probands with SX Learning at early age that people & world are a dangerous place Treatment Few seek treatment Focuses on development of trust Cognitive therapy to counter negativistic thinking A pervasive distrust & suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood & present in a variety of contexts, as indicated by four (or more) of the following: (1) suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her (2) is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates (3) is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her (4) reads hidden demeaning or threatening meanings into benign remarks or events (5) persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights (6) perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack (7) has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner Cluster A: Schizoid PD Pervasive pattern of detachment from social relationships Very limited range of emotions in interpersonal situations Prevalence ranges from 3.1%-4.9%; diagnosed slightly more in males Etiology Unclear Schizoid PD may have increased prevalence in the relatives of individuals with SX or schizotypal PD Treatment Few seek professional help on their own Focus on the value of interpersonal relationships Building empathy & social skills A pervasive pattern of detachment from social relationships & a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood & present in a variety of contexts, as indicated by four (or more) of the following: (1) neither desires nor enjoys close relationships, including being part of a family (2) almost always chooses solitary activities (3) has little, if any, interest in having sexual experiences with another person (4) takes pleasure in few, if any, activities (5) lacks close friends or confidants other than first-degree relatives (6) appears indifferent to the praise or criticism of others (7) shows emotional Cluster A: Schizotypal PD Behavior & dress is odd & unusual Socially isolated & highly suspicious Magical thinking, ideas of reference & illusions Many meet criteria for major depression Prevalence 1.9% - 4.6%; slightly more common in males Etiology A phenotype of a SX genotype More prevalent among first-degree biological relatives of individuals with SX Treatment Main focus is on developing social skills Address comorbid depression Medical treatment similar to that used for SX Prognosis generally poor A pervasive pattern of social and interpersonal deficits marked by acute discomfort with & reduced capacity for, close relationships as well as by cognitive or perceptual distortions & eccentricities of behavior, beginning by early adulthood & present in a variety of contexts, as indicated by five (or more) of the following (1) ideas of reference (excluding delusions of reference) (2) odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations) (3) unusual perceptual experiences, including bodily illusions (4) odd thinking & speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped) (5) suspiciousness or paranoid ideation (6) inappropriate or constricted affect (7) behavior or appearance that is odd, eccentric, or peculiar (8) lack of close friends or confidants other than first-degree relatives (9) excessive social anxiety that does not diminish with familiarity & tends to be associated with paranoid fears rather than negative judgments about self Cluster B: Antisocial PD Overview Failure to comply with social norms Violation of the rights of others Irresponsible, impulsive & deceitful Lack of a conscience, empathy & remorse Substance abuse very common (up to 60%) Psychopathy & APD Pathological lying, manipulative vs bullies, fights, cruel to animals Relation with conduct disorder Prevalence 0.2%-3.3%; more common in males Etiology Adoption studies suggest both genetic & environmental factors contribute to the risk of developing APD Underarousal hypothesis Fearlessness hypothesis Gray’s model of behavioral inhibition system & reward system Coercive family process Treatment (few seek) Prognosis poor Emphasis placed on prevention & rehabilitation Often incarceration is only viable alternative A. There is a pervasive pattern of disregard for & violation of the rights of others occurring since age 15 years, as indicated by 3 (or more) of the following: (1) failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest (2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure (3) impulsivity or failure to plan ahead (4) irritability & aggressiveness, indicated by repeated physical fights or assaults (5) reckless disregard for safety of self or others (6) consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations (7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another B. The individual is at least age 18 years. C. There is evidence of bipolar disorder with onset before age 15 years Cluster B: Borderline PD Overview Unstable moods & relationships Impulsivity, fear of abandonment, very poor social skills Self-mutilation & suicidal gestures Every culture; 1-2% of population Prevalence 1.6%-5.9% Up to 20% among psychiatric inpatients Diagnosed 75% in females Etiology About 5x more common among first-degree biological relatives Early trauma & abuse seem to play some role A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following: 1. frantic efforts to avoid real or imagined abandonment 2. pattern of unstable & intense interpersonal relationships characterized by alternating between extremes of idealization & devaluation. 3. identity disturbance: markedly and persistently unstable self-image or sense of self. 4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. 5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior 6. affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). 7. chronic feelings of emptiness 8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) 9. transient, stress-related paranoid ideation or severe dissociative symptoms Treatment: few good outcome studies Antidepressant medications provide some short-term relief Dialectical behavior therapy is validated treatment Cluster B: Histrionic PD Overview Overly dramatic, sensational & sexually provocative Often impulsive & need to be the center of attention Thinking & emotions are perceived as shallow Prevalence about 1.8% In clinical settings dx more frequently in females; however, other reports suggest similar rates among males and females Etiology Largely unknown: Variant of APD Treatment Focus on attention seeking & long-term negative consequences May also target problematic interpersonal behaviors Little evidence that treatment is effective A pervasive pattern of excessive emotionality & attention seeking, beginning by early adulthood & present in a variety of contexts, as indicated by five (or more) of the following: 1. is uncomfortable in situations in which he or she is not the center of attention 2. interaction with others is often characterized by inappropriate sexually seductive or provocative behavior 3. displays rapidly shifting & shallow expression of emotions 4. consistently uses physical appearance to draw attention to self 5. has a style of speech that is excessively impressionistic & lacking in detail 6. shows self-dramatization, theatricality & exaggerated expression of emotion 7. is suggestible, i.e., easily influenced by others or circumstances 8. considers relationships to be more intimate than they actually are Cluster B: Narcissistic PD Overview & clinical features Grandiose & unreasonable sense of self-importance Preoccupation with receiving attention Lack sensitivity & compassion for other people Highly sensitive to criticism, envious & arrogant Prevalence 0-6.2% in community samples; 50-75% are male Etiology Failure to learn empathy as a child Sociological view: product of the “me” generation Treatment Focus on grandiosity, lack of empathy, unrealistic thinking May also address co-occurring depression Fail to live up to their own perfectionistic views Little evidence that treatment is effective