Module 5

7. What is the average age of onset for the eating disorders and the gender distribution of each.

a. Anorexia nervosa i. 16-20 years old ii. Prevalence: 0.9% women and 0.3% men (US) b. Bulimia nervosa i. 21-24 years old ii. Prevalence: 1% world wide 1. US: 1.5% women and 0.5% men c. Binge eating disorder i. 30-50 years old ii. Most prevalent 1. World wide: 2% 2. US: 3.5% women and 2 % in men 3. Obese: 6.5-8% d. 3 females for every male with an eating disorder

11. What has meta-analysis shown us about the impact of cultural on prevalence for eating disorders?

a. Being Caucasian places individuals at higher risk for developing eating disorders i. Body dissatisfaction, dietary restraint, and a drive for thinness

3. Define amenorrhea

a. Cessation of menstration

5. List the essential features (symptoms A and B and C) of Bulimia Nervosa

a. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following i. Eating, in a discrete period of time (e.g., within any 2 hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. ii. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating) b. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. c. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months

6. Define Binge Eating Disorder and list the 3 (A,B and C) criteria for this disorder.

a. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: i. Eating, in a descrete period of time, an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances ii. A sense of lack of control over eating during the episode (eg., a feeling that one cannot stop eating or control what or how much one is eating) b. The binge-eating episodes are associated with 3 or more of the following i. Eating much more rapidly than normal ii. Eating until feeling uncomfortably full iii. Eating large amounts of food when not feeling physically hungry iv. Eating alone b/c of feeling embarrassed by how much one is eating v. Feeling disgusted with oneself, depressed, or very guilty afterward

. What is the recommended treatment regimen for conduct disorder?

1. Behavioral techniques teaching self control and providing tools for social and academic success has been shown to be effective 2. Parent effectiveness training has a positive impact 3. Specific management of aggressive behavior with cognitive-behavioral intervention also improves prognosis

. List the essential features of AD/HD.

1. Inattention (shifting attention, distractible, task incompletion) and/or 2. Hyperactivity/impulsivity (impulsive acts, heightened motor activity, interrupting) Or Both

4. Name and define the 2 sub-types of anorexia.

a. Restricting type i. Every effort is made to limit the quantity of food consumed ii. Caloric intake is tightly controlled iii. Try to avoid eating in the presence of others iv. May eat excessively slowly, cut their food into very small pieces, or dispose of food secretly b. Binge-eating/purging type i. Binge: out of control consumption of an amount of food that is far greater than what most people would eat in the same amount of time and under the same circumstances ii. Purge: Remove the food from their bodies by self-induced vomiting, misuse of laxatives, diuretics and enemas. iii. Other behaviors excessive exercise or fasting

15. What is thought to be the common characteristic of Neurodevelopmental disorders?

A group of conditions characterized by early onset and pervasive course that are thought to be the result of disruptions to normal brain development Attention Deficit/Hyperactivity Disorder (ADHD) Autism Spectrum Disorder Other Neurodevelopmental Disorders The DSM 5.0 lists a group of disorders that comprise about 3.3 % of cases seen in inpatient settings. These all are presumed to reflect structural differences in the brain and include Tic Disorders, Intellectual Disability, and Specific Learning disabilities. Problems best addressed in a course on neurology.

2. List the core essential features (A, B and C symptoms) of Anorexia Nervosa

a. Restriction of low energy intake relative to requirements, leading to a significantly low body weight in context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or , for children and adolescents, less than that minimally expected. b. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. c. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Cite the DSM-5 criteria for Schizophrenia

A. 2 or more of the active phase symptoms below (& one has to be either 1-2-3) for at least 1 month 1. Delusions •an erroneous belief that is fixed and firmly held despite clear contradictory evidence - disturbance of content of thought •you can have delusions even if you're not schizophrenic 2. Hallucinations - •any sensory experience (auditory, visual, smell, tactile, gustatory) that seems real to the person having it but occurs in the absence of any external perceptual stimulus •ex: "Ugly bitch, you're stupid, no one likes you, get milk" etc... •research shows that these hallucinations are formed when patients misinterpret their own self-generated and verbally mediated thoughts since brain scans shows Broca's area is involved when they hear things •you can have hallucinations even if your not schizophrenic, such as by drinking too much coffee or lots of stress •illusion - misperception of a stimulus that actually exists; so not a hallucination 3. Disorganized speech /derailment or incoherence •cognitive slippages •words and word combos sound communicative but the listener is left with no understanding and it makes no sense 4. grossly disorganized catatonic behavior •there is no goal-directed behavior, there is impairment in daily routine and functioning •catatonia: show virtual absence of all movement and speech and hold unusual posture for long time without discomfort 5. negative symptoms •disorganized symptoms: bizarre behavior, disorganized speech •positive symptoms: hallucinations, delusions •negative symptoms: o emotional flattening = blunted emotional expressiveness o poverty of speech o asociality o alogia = very little speech o avolition = inability to initiate or start goal directed activities o apathy o anhedonia B. level of functioning in life, work, self-care, etc. is way below than before C. Continuous signs of disturbance persist for 6 months or more, and during this 6 months there's at least 1 month of symptoms states in A D. Schizoaffective and depressive or BP disorder are ruled out because no manicphase or no major depressive episodes

What are the 2 essential areas and type of deficits that are found in autism spectrum disorder?

A. Autism in the DSM 5.0 presents with varying degrees of deficiency in social communication and interpersonal interactions as illustrated by 1. Deficits in social-emotional reciprocity 2. Defects in nonverbal communication (e.g. eye contact, body language) 3. Deficits in developing or understanding relationships B. Restrictive, repetitive patterns of behavior or interest such as (illustrative) • Repetitive motor movements or speech (echolalia) • Insistence on sameness (extreme distress with small changes) • Highly restrictive and fixed levels of interest that are of abnormal intensity • Hyper- or Hypo sensitivity to sensory input (indifference to pain or temperature, adverse reactions to sounds, texture or fascination with lights or movement

. List the additional symptom requirements (B - E) for AD/HD

B. Symptoms present before age twelve C. Symptoms present in at least two settings D. symptoms cause clear disruption in social and/or academic functioning (could indicate by not being challenged) E. not accounted for by another disorder (autism etc.)

What is the etiology of Conduct Disorder according to:

Biological Theory • Biological perspectives see a strong genetic pattern with conduct disordered boys tending to have anti-social parents (especially fathers) and concordance .53 for MZ twins with.3 for DZ twins • Traits of mild neuropathology, low verbal intelligence and difficult temperament in infancy are identified risk factors Sociocultural Theory? Both ideas focus on parental influences. Sociocultural theory sees conduct disorder as representing faulty parent/child dynamics. In particular the disorder is associated with parents who 1. Fail to monitor a child's activities 2. Are inconsistent disciplinarians 3. Fail to use positive parenting techniques 4. Fail to teach skills for academic success 5. Come from families with high levels of conflict

What is the prevalence for autism spectrum disorder?

Current Prevalence is 1% with profound cases being relatively rare (2-5 in 10,000 births .05%) and diagnosed 4 times more often in males.

What 3 sub-types are listed in the DSM 5.0 for ODD?

DSM 5.0 presents 3 sub-types: 1. angry/irritable mood 2. Argumentative/defiant behavior 3. vindictiveness

What are the defining symptoms of Conduct Disorder

DSM 5.0 requires 3 of 15 criteria that are grouped into 4 categories 1. Aggression toward people or animals 2. Destruction of Property 3. Deceitfulness or theft Serious violations of rules

1. State the general description of schizophrenia

Disorder characterized by hallucinations, delusions, disorganized speech and behavior, as well as problems in self-care and general function

Define Separation Anxiety Disorder noting the essential characteristics and incidence of this disorder.

Has as the essential feature a pervasive feeling of terror associated with the idea of being separated from the caregiver manifested for at least 4 weeks. • Nightmares with separation themes are common • 4% incidence has been reported (1 yr. prevalence)

What are the 4 severity ratings for autism spectrum disorder in the DSM 5.0?

In diagnoses we specify severity of the disorder based upon social and communication deficiency and repetitive behavior patterns. Rated as Mild, Moderate, Severe, or Profound based upon the child's match to DSM-5 descriptions.

What is the prevalence of ODD and the male/female distribution?

National Survey data suggest a prevalence rate of 11% in males and 9% in females. Onset is typically about age 8. Children with ODD have a risk of developing Conduct Disorder (conduct disorder is always preceded by a diagnosis of ODD but not all ODD evolves into conduct disorder)

Describe Conduct Disorder in terms of prevalence and relationship to ODD and to later adult adjustment.

Prevalence 1-10% mostly diagnosed in males with onset in childhood or adolescence Can be a prelude to adult anti-social personality disorder (25-40%). Prognosis is better for adolescent onset (after age 10). Later adjustment in relationships and occupational settings is typically poor (80%). Negative outcome is more true if child has been aggressive.

. Describe AD/HD with respect to prevalence, course and prognosis.

Prevalence is 3-7 % of population with males likely than females (13% vs. 4%) Approximately 30 - 50% of AD/HD children have symptoms persisting into adulthood Most are diagnosed as they enter school but symptoms can be seen in the preschool years Often Co-morbid with oppositional defiant disorder or conduct disorder

What symptoms characterize Oppositional-Defiant Disorder

Repetitive and persistent pattern of behavior characterized by a negative, argumentative and hostile pattern of behavior. These children lose their tempers often and defy adults, even when compliance would be in their best interests.

Define each of the following "other" psychotic disorders and list the appropriate DSM-5 criteria for each:

Schizoaffective (467) A hybrid of schizophrenia and mood disorders •They have psychotic symptoms that meet criteria for schizophrenia but also changes in mood for long time •Reliability of this disorder is poor •Criteria: 1. An uninterrupted period of illness during which there is a major mood episode depressive or manic, in conjunction with Criterion A of schizophrenia 2. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode during the lifetime duration of the illness 3.Symptoms that meet criteria for a major mood episode are present for majority time of the illness Schizophreniform (467-468) it's a schizophrenia-like psychosis that lasts min a month, but no more than 6 months and so it does not warrant diagnoses for schizophrenia •Criteria: o 2+ of the following have to be met: 1. Delusions 2. Hallucinations 3. disorganized speech 4. Catatonic behavior 5. negative symptoms o an episode of the disorder last between 1-6 months o there is no depressive or manic episodes, and if mood symptoms did occur they did just for a bit not for the whole time Delusional Disorder (468) •Hold beliefs that are absurd •Main difference between schizophrenia and this: Delusional disorder folks behave quite normally! •Criteria: o Presence of one or more delusions with duration of 1 month or more o Criterion A for schizophrenia has never been met o Apart from impact of delusions, functioning is not really impaired and behavior is not obviously bizarre or odd o They may have had brief manic or depressive episodes, but super brief relative to the delusional period Brief Psychotic Disorder (468-469) It's simply a sudden onset of psychotic symptoms and the episode is SUPER short lived (days). After this the person returns to their former level of normalness. Often triggered by stress •Criteria: A. (1+) of the following symptoms (and has to be one of 1, 2 or 3): 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior B. Duration of an episode of disturbance is at least 1 day but less than 1 month

9. What are the likely course and health concerns for each of anorexia and bulimia?

a. The mortality rate for people with anorexia nervosa is more than five times higher than the mortality rate for young females ages 5 to 34, second most common cause of death is suicide (18x more likely) b. Approximately 3% of people with anorexia nervosa die from the consequences of their self-imposed starvation i. Hair and nails become thin and brittle ii. Skin becomes very dry, and downy hair ("lanugo") starts to grow on the face, neck, arms, back and legs iii. Trouble coping with cold temperature iv. Low blood pressure v. Thiamin deficiency: depression and cognitive changes vi. Increased risk for osteoporosis in later life vii. Can die from heart arrhythmias 1. Caused by major imbalances in key electrolytes such as potassium (low K+ can also cause kidney damage viii. Laxative Abuse 1. Can lead to dehydration, electrolyte imbalances, kidney disease, damage to the bowels and GI tract ix. Bulimia Nervosa 1. Much less lethal than anorexia nervosa 2. Still associated with mortality rate that is 2x higher than comparable age of people in general population 3. Purging a. Electrolyte imbalances and low potassium, puts patient at risk for heart abnormalities b. Damage to heart muscle, which may be due to the use of ipecac syrup c. Tears to the throat from using objects like toothbrushes to induce vomiting d. Tooth damage from throwing up a lot e. Puffy cheeks from swollen parotid glands (saliva) due to throwing up 4. Binge Eating Disorder a. High rates of clinical remission

Externalizing disorders:

conduct disorder and odd

10. What is diagnostic crossover and how common is this?

i. It is quite common for someone who is diagnosed with one form of eating disorder bo be later diagnosed with another eating disorder ii. Bidirectional transitions between the two subtypes of anorexia nervosa (restricting and binge eating/purging) were especially common iii. Shifts from anorexia nervosa to bulimia nervosa in about 1/3rd of patients iv. No cross over bn binge eating disorder and anorexia nervosa

• How does dopamine induce psychosis?

o Aberrant salience Dysregulated dopamine transmission may actually make us pay more attention to and give more significance to stimuli that are not especially relevant or important If dopamine creates aberrant salience, the person will struggle to make sense of everyday experiences that were previously in the background but that now have become inappropriately important and worthy of attention

What is the possible etiology of eating disorder according toBrain abnormality

o Animal studies Lesions in a part of the hypothalamus called the ventromedial hypothalamus (VMH) cause animal to behave as if starved • They eat voraciously and become obese • When VMH is electrically stimulated, food intake is inhibited and animal loses weight • VMH is satiety center Stimulating the lateral hypothalamus triggers eating Animals with lesions in lateral hypothalamus will stop eating Lateral hypothalamus is the appetite center o No evidence that obvious abnormalities in the hypothalamus play a central role in eating disorders • Damage to the frontal and temporal cortex did seem to be linked to the development of anorexia nervosa in some cases and bulimia in others o Temporal cortex is known to be involved in body image perception o Orbitofonta cortex also play a role in monitoring the pleasantness • Set points o Biologically determined weight that body tries to defend o Patients with anorexia nervosa may think about food constantly as they go below their set point o Patients with bulimia nervosa may get hunger-driven impulses (from going below set point)that escalate into uncontrollable binge eating • Serotonin o Anorexia nervosa Low levels of serotonin b/c not getting enough food (tryptophan) to make it o Bulimia nervosa Normal amounts of serotonin o When patients resume normal eating, they have higher than normal levels of serotonin o Does serotonin activity cause dieting (reducing tryptophan) to reduce amount of serotonin? Neurotransmitters do not work in isolation and process is complicated

List and describe the typical treatment interventions for Bulimia Nervosa using • CBT-E- Enhanced Cognitive Behavior Therapy

o Reformulated Cognitive Behavior Treatment for bulimia and for any pathological eating o Default form focuses on eating issues, concerns about shape and weight, extreme dieting, purging and binge eating o Broader form that also addresses perfectionism, low self-esteem, and relationship problems o 66% of patients were in remission from this treatment in a study

define psychosis

severe impairment in the ability to tell what is real and what is not real. Psychosis is the hallmark of schizophrenia

What is the possible etiology of eating disorder according to Family dynamic model

• 1/3rd of anorexia nervosa patients state that Family dysfunction is a factor in them developing an eating disorder • Perceive their families as more rigid. Less cohesive, and as having poorer communication than healthy controls • Parents have perfectionistic tendencies • Bulimia nervosa- high parental expectations, other family member's dieting, degree of critical comments from other family members about shape, weight, or eating o The strongest prediction for bulimic symptoms was the extent to which family members made disparaging comments about the woman's appearance and focused on her need to diet. • Disordered eating attitudes, however, may predate parent-child conflict and be the cause of negative family functioning

What has been the general clinical outcome for treatment of schizophrenia?

• 15 - 25 years after developing schizophrenia, ~38% of patients have a generally favorable outcome and can be thought of as being recovered (although they do no return to how they were before they became ill) o Therapy and medications, patients can function quite well o More stringent criteria recovery rates are only 14% • 12% of patients, long term institutionalization is necessary • About a third of patients show continued signs of illness, usually with prominent negative symptoms • No cure for schizophrenia

. List and describe the typical treatment interventions for Binge Eating Disorder using Other therapies

• 3 types o Interpersonal Therapy o CBT in the form of a self-help book o Behavioral Weight Loss Treatment Exercise and restriction of calories • No difference after 6 months of treatment • After a 2 year follow-up o IPT or guided CBT were doing better than those in the behavioral weight loss group o Dropout rate lower for IPT group (7% vs 30% for CBT group vs. 28% behavioral weight loss) o Dropout rate for minorities was very high

What is the average age of onset for men and women?

• Age onset: Late adolescence to early adulthood (18-30 years) o Men onset peak is 20-24; after about age 35, the number of men developing schizophrenia falls markedly o Women also onset peak is 20-24; but have 2nd peak around age 40; and a 3rd peak in their early 60s (perhaps due to menopause)

12. List and describe the typical treatment interventions for Anorexia Nervosa using Medication

• Antidepressants are sometimes used, but there is no evidence that they are expecially effective. • Treatment with antipsychotic medication called olanzapine o Helps with distorted beliefs about body shape and size o Weight gain is a side effect

What brain structure problems are thought to be associated with schizophrenia? Note structural problems in 2 primary brain areas.

• Brain Ventricles o Schizophrenics have larger brain ventricles (esp. males) than controls o Also characteristic of patients with Alzheimer's disesase, huntington's disaease, and chronic alcohol problems o Reduction in brain volume o 3% reduction in whole brain volume relative to that in controls o Brain volume reduction progressively gets worse with time. 3% reduction in 1 year • Reductions in the volume of regions in the frontal and temporal lobes o Play critical roles in memory, decision making, and in the processing of audio • Reductions in volume of Medial temporal areas as the amygdala (emotion), hippocampus (memory), Thalamus (sensory input) • White Matter o Schizophrenics have reductions in white matter volume as well as structural abnormalities in the white matter itself o Causes dysconnectivity Abnormal integration between distinct brain regions, particularly those involving the frontal lobes Eg: auditory hallucinations can be thought of as arising from a disconnection between language production and language comprehension areas. This could make self-talk seem as if it is being heard. • Brain Functioning o Impaired functioning of the frontal lobes during cognitive tasks for patients in the early stages of schizophrenia as well as in people at high risk for developing the disorder Patients show abnormally low frontal lobe activation ("hypofrontality") Other patients hyperactivation in frontal brain area is found, suggesting that they are having to work harder to be successful on the task. Abnormal brain functioning not characteristic of all patients o People with schizophrenia may have trouble getting brain out of "default mode" to perform tasks

What etiological factors appear to be related to AD/HD?

• Brain anomaly appears to be involved with under activity of frontal cortex indicated in some studies. Possible dopamine deficiency also suggested. but we need carefully controlled studies • Genetic influences appear likely with higher concordance rates for identical twins and first vs. second generation relatives. • No "regular" environmental factors have been reliably shown to cause AD/HD but family pathology seems to be a contributing factor

How are the second generation antipsychotic drugs better than the first generation drugs?

• Cause fewer extrapyramidal symptoms than the earlier antipsychotic medications • Drowsiness and considerable weight gian are very common. Diabetes is also a very serious concern • Also block D2 receptors • Current antipsychotic medications may actually contribute to the progressive brain tissue loss we see in schizophrenia

How is schizophrenia reflected in neuro-cognition?

• Cognitive impairment is a core feature of schizophrenia o Perform much worse than healthy controls on a broad range of neuropsychology tests, including attention, language, and memory o People with lower IQs may have a higher risk for developing schizophrenia o Slow reaction time o Deficits in continuous performance test, o Problems with working memory o Eye tracking dysfunction o Smooth-pursuit eye movement (ability to track a moving target such as a pendulum) 50% of 1st degree relatives of paitents with schizophrenia also show eye-tracking problems even though they do not have schizophrenia o Any preexisting cognitive impairments become more prominent and extensive as the illness progresses. o Auditory information processing - poor P50 suppression 2 clicks heard in close succession- the brain resoponse to the second click is less marked than the response to the first click b/c the normal brain dampens, or "gates" responses to repeated sensory events. This is what causes habituation to a stimulus. • Patients with schizophrenia respond almost as strongly to the second click as to the first.

How does quality of adoptive family interact with genetic vulnerability for schizophrenia...in particular communication deviance? (473)

• Communication Deviance is a measure of how understandable and "easy to follow" the speech of a family member is. Vague, confusing, and unclear communication reflects high communication deviance • Children who were at genetic risk and lived in families where there was high communication deviance showed high levels of thought disorder at the time of follow-up • Control adoptees who had no genetic risk for schizophrenia showed no thought disorder, regardless of whether they were raised in a high- or low-communication-deviance family • High-risk children who were raised by adopted families low in communication deviance. These children were healthier at follow-up than any of the other three groups. • Only children who were raised in dysfunctional families and had high genetic risk for schizophrenia went on to develop schizophrenia-related disorders themselves. • Children at high genetic risk who were raised in healthy family environments did not develop problems any more frequently than did children at low genetic risk • Suggests that our genetic makeup controls how sensitive we are to certain aspects of our environments

12. List and describe the typical treatment interventions for Anorexia Nervosa using Family Therapy

• Considered to be the treatment of choice • Maudsley Model o Blames neither the parents nor the child for the anorexia nervosa o 10-20 sessions spaced over 6-12 months o 3 phases Refeeding phase • Therapist works with the parents and supports their efforts to help their child to eat healthily once more • Family meals observed by the therapist • Efforts are made to guide the parents as a functioning support team for their daughter's recovery Negotiations for a new pattern of relationships phase • Family issues and problems begin to be addressed Termination phase of treatment • Focus is the development of more healthy relationships between the patient and her parents o After 1 year patients who have family therapy do better than control treatment o After 5 years, 75-90% of patients show full recovery o More helpful for patients who develop A. N. before 19 and have been ill for fewer than 3 years

How is risk of developing an eating disorder related to Childhood sexual abuse

• Controversial association • A meta-analysis of 53 studies also revealed a weak- but positive- association b/n childhood sexual abuse and an eating pathology • Abuse is likely a general risk factor for psychopathology rather than a specific risk factor

Define cytoarchitecture and how does this differ in the normal vs. schizophrenic brain?

• Cytoarchitecture o Overall organization of cells in the brain o Schizophrenia - brain development- dirsruption of the migration of neurons in the brain. Some cells will fail to arrive at their final destination. o Patients with schizophrenia are missing aparticular types of neurons known as "inhibitory neurons" GABA interneurons and they are responsible for regulating the excitability of other neurons (tell other neurons to calm down. Suggests that brains of schizophrenia may be less able to regulate or dampen down overactivity in certain key neural circuits. o The process that goes on during adolescence in brain development (synaptic pruning, reduction in gray matter volume, increase both in white matter and the volume of the hippocampus and amygdala, number of excitatory synapses decreases, number of inhibitory synapses increases) may go awry in people with schizophrenia

6. Define Delusion

• Delusion- False belief about reality maintained in spite of strong evidence to the contrary

Define the symptoms of disorganized speech/thought/behavior and define cognitive slippage and neologism

• Disorganized speech/thought/behavior o Disorder in thought form • Cognitive slippage o An affected person fails to make sense despite using language in a conventional way o • Neologism o New words; a feature of language disturbance in schizophrenia • Formal Thought Disorder o A term clinicians use to refer to problems in the way that disorganized thought is expressed in disorganized speech

What is the dopamine hypothesis and what evidence supports the role of dopamine in schizophrenia?

• Dopamine hypothesis- hypothesis that schizophrenia is the result of an excess of dopamine activity at certain synaptic sites. • Evidence for dopamine hypothesis o Chlorpromazine a drug effective in treating schizophrenia- is able to block dopamine receptors. o Amphetamines are drugs that produce a functional excess of dopamine and abuse of amphetamines leads to a form of psychosis that involved paranoia and auditory hallucinations (which looked a lot of schizophrenia) o Treatment of Parkinson's disease is using a drug called L-DOPA (by increasing dopamine). Psychotic symptoms are a significant complication of treatment with L-DOPA

How is risk of developing an eating disorder related toInternalizing the thin ideal

• Duchess of Windsor- never be too rich or too thin • Buying into the notion that being thin is highly desirable • The more people internalize the thin ideal the higher the risk factors are for eating disorder o Body dissatisfaction, dieting, and negative affect

List the essential features of eating disorders.(

• Eating Disorders- disorders of food ingestion, regurgitation, or attitude that affect health and well-being, such as anorexia, bulimia, or binge eating o Persistent disturbance in eating behavior

Define Endophenotypes and explain their relationship to vulnerability for schizophrenia

• Endophenotypes- discrete, measurable traits that are thought to be linked to specific genes that might be important in schizophrenia or other mental disorders • Researchers are interested in people who score high on certain tests or measures that are thought to reflect a predisposition to schizophrenia (perceptual aberration and magical ideation). • By studying these traits rather than the disorder itself, researchers hope to speed up progress in the search for the genes related to schizophrenia. • Eye tracking?

What three characteristics define Expressed Emotion and how is this social factor related to schizophrenia?

• Expressed Emotion (EE)- type of negative communication involving excessive criticism and emotional overinvolvement directed at a patient by family members o Three main factors: criticism (most important), hostility, and emotional overinvolvement o High EE environments more than doubled the risk of relapse in the 9 - 12 months after hospitalization o Schizophrenics are highly sensitive to stress, high EE means high stress for the patient (cortisol release from stress affects dopamine and glutamate transmittors)- increases chance for relapse o Hearing criticism or being exposed to emotionally overinvolved comments leads to different patterns of brain activity in ppl who are vulnerable to psychopathology compared to healthy controls

To what degree is life expectancy shortened for men and women with schizophrenia?

• For men, they die 14.6 years earlier and women with schizoaffective disorder die 17.5 years earlier • Factors: long-term use of antipsychotic meds, obesity, smoking, poor diet, use of illicit drugs, and lack of physical activity, and high risk of suicide

Define the term "functional Outcome" and explain how therapists are trying to improve this in treating schizophrenia.

• Functional outcome (as opposed to clinical outcomes) o How well the patients do in their everyday lives, including forming friendships, finding and keeping a job, and living independently o Social skills training Employment skills, relationship skills, self-care skills, and skills in managing medications or symptoms, conversational skills o Social cognitive skills training Designed to improve deficits in social cognition, like recognizing emotion in faces or social hints

. What is the role of genetics in vulnerability to schizophrenia?

• Genetic factors are clearly implicated in schizophrenia. Many genes, each having a small effect, are likely involved, as well as some rare alleles. Having a relative with the disorder significantly raises a person's risk of developing schizophrenia. •

What is Glutamate and how might glutamate be related to symptoms of schizophrenia?

• Glutamate- an excitatory neurotransmitter that is widespread throughout the brain • PCP ( angel dust) and ketamine (anesthetic) blocks glutamate receptors and induces symptoms (+ and -) that are very similar to schizophrenia o Also exacerbates symptoms of schizophrenic patients o Ketamine does not affect children • Diminished activity of certain glutamine receptors (NMDA receptors) trigger schizophrenia-like symptoms and cause degeneration of neurons in key brain areas • Glutamate and Dopamine hypotheses work in tandem with each other.

Define Hallucination

• Hallucination- False perception such as things seen or heard (or other sensory experience) that that are not real or present • In schizophrenia- auditory hallucinations are by far the most common (75% of patients) o Visual- 39% o Olfactory, tactile, and gustatory (1-7%) • Schizophrenics often incorporate their hallucinations into their delusions

. List and describe the typical treatment interventions for Binge Eating Disorder using Medication

• High comorbidity between binge-eating disorder and depression, antimedications are sometimes used to treat this disorder • Appetite suppressants and anticonvulsant medications

12. List and describe the typical treatment interventions for Anorexia Nervosa using Cognitive Behavioral Therapy

• Involves changing behavior and maladaptive styles of thinking • 1-2 years of treatment • Focus on modifying distorted beliefs concerning weight and food, and self (People with reject me unless I am thin) • Only 17% of patients who received CBT showed full recovery • Need new treatments, especially for older patients with more long-standing problems

Trace the history of this disorder and note the contributions of John Haslam, Benedict Morel, Emil Kraeplin and Eugen Bleuler

• John Haslam o 1810- the apothecary at the Bethlem Hospital in London, England o Described a case of a patient who appears to have suffered from a variety of symptoms, including delustions, that are typical of schizophrenia • Benedict Morel (Belgian psychiatrist) o ~1860 o Described the case of a 13 year old boy who was previously the most brilliant pupil in school, but gradually lost interest in his studies and became increasingly withdrawn, lethargic, reclusive, and quiet. Had forgotten everything that he had learned "demence precode"- mental deterioration at an early age • Emil Kraeplin (1856-1926) (german psychiatrist) o Best known for his careful description of what we now regard as schizophrenia o Kraeplin used the Latin version of Morel's term (dementia praecox) to refer to a groups of conditions that all seemed to feature mental deterioration beginning early in life • Eugen Beluler (1857-1938) (Swiss psychiatrist) o Coined the term, "schizophrenia" o Split of the mind- b/n intellect and emotion

What is the overall pair wise concordance rate for MZ vs. DZ twins?

• MZ (monozygotic twins) percentage concordance rate is 28% and for Dizogotic twins is 6%. • It suggests that shared genes, especially 100%, increases risk of schizophrenia substantiall • A reduction in shared genes from 100% to 50% reduces the risk of schizophrenia by nearly 80% • It suggests that although risk is relatively low (6%), it is still substantially higher than the general population (<1%)

List and describe the typical treatment interventions for Bulimia Nervosa using Medication

• Many patients with bulimia nervosa also suffer from mood disorders, and so is commonly treated with anti-depressants o Usually will improve within 3 weeks o Fewer binge-eating, improve mood and preoccupation with shape and weight

Differentiate between monochorionic and Dichorionic MZ twins and explain what this tells us about vulnerability to schizophrenia.

• Monochorionic- the twins share a placenta and blood supply • Dichorionic- they have separate placentals and separate fetal circulations • The higher concordance rate for schizophrenia in MZ than in DZ twins might therefore be a consequence, at least in part, of the greater potential for monochorionic MZ twins to share infections. MZ twins who are monochorionic are much more likely to be concordant for schizophrenia (60% concordance) than dichorionic MZ twins (11% concordance)

How is risk of developing an eating disorder related to: Gender

• Much more frequently found in women than men o Esp. anorexia and bulimia nervosa • Greatest risk period is adolescence (except for binge eating, also many more men have binge eating disorder than other disorders) • For men, sexual orientation is a risk factor for disordered eating o Being in a relationship may moderate risk for disordered eating

How is risk of developing an eating disorder related to Dieting

• Nearly all instances of eating disorders begin with the "normal" dieting routine in our culture (at any one time 39% of women and 21% of men are trying to lose weight) • The combination of dieting, low self-esteem, and symptoms of depression create additional risk than dieting alone

What are Neuroleptic drugs, what do they do and what are their side effects?

• Neuroleptics are first generation antipsychotic drugs (typical) • They are dopamine antagonists (block dopamine D2 receptors) • Work best for positive symptoms of schizophrenia • Side effects: drowsiness, dry mouth, and weight gain, extrapyramidal side effects: involuntary movement abnormalities (muscle spasms, rigidity, shaking) that resemble parkinson's disease o Tardive dyskinesia- marked involuntary movements of the lips and tongue (sometimes hands and neck) 56% when taking neuroleptics for 10 years or more, females especially susceptible • Neuroleptic malignant syndrome- rare toxic reaction to meds that involves high fever and extreme muscle rigidity, can be fatal if left untreated

Is family therapy helpful in treating schizophrenia?

• Patients do better clinically and relapse rates are lower when families receive family treatment • helps families with skills to deal with the patient's illness and it helps reduce high levels of EE • Despite this, still not a routine element in treatment • Other psychosocial approaches o Case management o Social-skills training o Cognitive remediation o Cognitive-behavior therapy o Individual treatment o Psychoeducation o

What appears to be the origination of auditory hallucinations?

• Patients with auditory hallucinations have a reduced volume of gray matter in the left hemisphere auditory and speech perception areas. o This could lead to failure to correctly identify internally generated speech, erroneously tagging it as coming from an external source • Hallucinating patients show increased activity in Broca's area o Broca's area- an area of the temporal love that is involved in speech production o Auditory hallucinations similar to when healthy ppl imagine someone is talking to them • Overall, auditory hallucinations occur when patients misinterpret their own self-generated and verbally mediated thoughts (inner speech or self-talk)

How does the level of a country's industrialization relate to treatment outcomes for schizophrenia and why?

• People who live in less industrialized countries tend to do better overall than patients who live in more industrialized nations • This may be bc level of EE is much lower in nonindustrialized nations

. How might cannabis abuse related to onset of schizophrenia?

• People with a particular variant of the COMT gene (one or 2 copies of the valine or val allele) are much more likely to become psychotic as adults if they use cannabis during adolescence • When compared to people who have never used cannabis before, people who were havy cannabis users by the time they were 18 were more than 6 times more likely to have developed schizophrenia 27 years later • 10.3% who used cannabis by age 15 were diagnosed with signs of schizophrenia by age 26 • THC increases dopamine production in several areas of the brain • Cannabis may accelerate the progressive brain chanes that seem to go along with schizophrenia

Differentiate between positive and negative symptoms of schizophrenia

• Positive Symptoms o Reflect an excess or distortion in normal repertoire of behavior and experience Delusions, hallucinations, Disorganized thinking (revealed by disorganized speech) • Negative Symptoms (Worse for the patient's outcome) o An absence of deficit of behaviors that are normally present Reduced expressive behavior • Blunted affect or flat effect (more extreme than blunted) or alogia (very little speech) Reductions in motivation or in the experience of pleasure • Avolition o The inability to initiate or persist in goal-directed activity (may stare into space or at tv for hours with no interest in outside work or social activities) • Anhedonia o Diminished ability to experience pleasure

What role might prenatal exposure play in affecting vulnerability to schizophrenia?

• Prenatal exposure to viruses (one possibility-mother's antibodies to the virus cross the placenta and somehow disturb brain development in the fetus. Another possibility- influenza causes an increase in the production of inflammatory cytokines that cause neurodevelopmental damage. Influenza could also have a direct and damaging effect on the developing brain., • rhesus incompatibility, o Rh incompatibility - Rh negative mother carries an Rh positive fetus Incompatibility increases risk from 0.8 to 2.1% o How? Mechanism may involve oxygen deprivation or hypoxia. May increase the risk of brain abnormalities of the type knownto be associated with schizophrenia • pregnancy and birth complications, o breech delivery, prolonged labor, umbilical cord around baby's neck o Affect oxygen supply of the newborn Damage to the brain at a critical time of development • early nutritional deficiencies, o Dutch hunger Winter during WWII from a Nazi Blockade o Many died of starvation o Those who were conceived at the height of the famine had a two-fold increase in their risk of later developing schizophrenia Early prenatal nutritional deficiency seems to be the cause • maternal stress, o If a mother experiences an extremely stressful event late in her first trimester of pregnancy or early in the second trimester, the risk of schizophrenia in her child is increased Ex of stress: Death of a close relative: 67% increase risk of schizophrenia for the child Stress hormones that pass to the fetus via the placenta might have negative effects on the developing brain • maternal inflammation

Based upon Walker's studies of home movies, what early indicators have been identified in the prodromal stage of schizophrenia?

• Preschizophrenia children showed motor abnormalities including unusual hand movements o Less positive facial emotion and more negative emotion o Subtle differences noticed as early as 2 years old • Other studies showed adolescents who later developed schizophrenia had more movement abnormalities (facial tics, blinking, tongue thrusts) • Prodromal- very early clinical signs of schizophrenia

What is the possible etiology of eating disorder according to: Genetic model

• Risk of individuals with anorexia nervosa was 11.4 times greater than for the relatives of the healthy controls o Bulimia nervosa 3.7 xs higher • Major depressive disorder are found in the relatives of patients with anorexia nervosa, bulimia nervosa nd binge-eating disorder • Have problems with alcohol and drug dependence • Anorexia nervosa o Family members more likely to have OCD and OCPD • Both anorexia nervosa and bulimia nervosa are heritable disorders o The contribution of genetic factors to the development of eating disorders may be about as strong as the contribution of genetic factors to bipolar disorder and schizophrenia

List and describe the primary characteristics of the 3 sub-types of schizophrenia and note the usefulness of this classification on theory, research and treatment. (467) (sub-types of schizophrenia no longer included in DSM-%)

• Schizophrenia, catatonic type o Pronounced motor symptoms, of either an excited or a stuporous type, which sometimes make for difficulty in differentiating this condition from a psychotic mood disorder • Schizophrenia, disorganized type o Usually begins at an earlier age and represents a more severe disintegration of the personality than in the other types of schizophrenia • Schizophrenia, paranoid type o A person is increasingly suspicious, has severe difficulties in interpersonal relationships, and experiences absurd, illogical, and often changing delusions • Schizophrenia, residual type o People who have experienced a schizophrenic episode from which they have recovered enough to not show prominent symptoms but are still manifesting some mild signs of their past delusion • Schizophrenia, undifferentiated type o Mixed symptoms of subtypes

List and describe the typical treatment interventions for Bulimia Nervosa using Cognitive Behavioral Therapy

• Seems to be the best treatment option o Focuses on normalizing eating patterns (behavior) Meal planning, nutritional education, and ending binging and purging cycles by teaching the person to eat small amounts of food regularly o Challenges dichotomous thinking and other dysfunctional thoughts (cognitition) Eg: "good" or "bad" food • Demonstrate to themselves that ingesting "bad" food does not inevitably lead to a total loss of control over eating o Effective in eliminating 30-50% of cases

How is schizophrenia reflected in social cognition?

• Significant impairments in social cognition • Fail to spot subtle and not so subtle social hints that most of us can detect without difficulty • They have difficulties recognizing emotion in faces and emotion being conveyed in speech • Less able to recognize when someone has made a social error (such as someone forgetting a bday party was supposed to be a surprise

How is risk of developing an eating disorder related to Negative body image

• Sociocultural pressure young girls and women develop highly intrusive and pervasive perceptual biases regarding how "fat" they are • Discrepancy b/n the way many young women perceive their own bodies and the "ideal" female form represented in the media o Leads girls and women to believe that men prefer more slender shapes than they in fact do o Also feel judged by their female peers • People, on average, are getting fatter (29 pounds heavier than in 1960) but the ideal of attractiveness is getting thinner. 70% of Playboy magazine centerfolds have a BMI of less than 18.5 • Children's toys promote unrealistic slender ideals (Valeria Lukyanova)

What is recommended as optimal treatment for children with AD/HD?

• Stimulant medication appears to reduce symptoms in 75-90% of cases. • All drugs increase frontal lobe functioning . • Behavior therapy is ALSO needed as pharmacology alone merely reduces symptoms but does not address concomitant problems (social interaction, self-esteem problems) • Non-pharmacological treatments are also very helpful and create no side effects (meditation)

What does the research on offspring of discordant schizophrenic twins suggest?

• The age-corrected incidence rate for schizophrenia in offspring of MZ twins without schizophrenia is 17.4% o Age-corrected incidence rate Incidence is the number of new cases that develop. An age-corrected incidence rate takes into account the predicted breakdowns for subjects who are not yet beyond the age of risk for developing the disorder • Not significantly different than from the offspring of the twins with schizophrenia in discordant pairs or from that for offspring of DZ twins with schizophrenia. • Impressive support for the genetic hypothesis • Indicate that a predisposition to schizophrenia may remain "unexpressed" unless "released" by unknown environmental factors.

How is risk of developing an eating disorder related to Perfectionism

• The pursuit of unattainably high standards combined with an intolerance of mistakes • Important risk factor for eating disorders • Much more likely to subscribe to the thin ideal and relentlessly pursue the "perfect body" • Women who were anorexic scored higher on perfectionistic measures than did a sample of controls without an eating disorder • Men with eating disorders are generally less perfectionistic than women with eating disorders

What is the possible etiology of eating disorder according to Sociocultural model

• Thinness became a deeply rooted ideal in the 1960s • An ideal especially in higher socioeconomic backgrounds • Glamorization of anorexia: "rexy" • Fiji- Anne Becker o Many who were overweight with respect to western culture o Fijan culture being fat is highly valued as it is associated with being strong, being able to work, and kind and generous o Being thin is associated with being sickly, incompetent, or have somehow received poor treatment o Dieting viewed as offensive o Eating disorders absent o After television- cultural climate changed o Women expressed body dissatisfaction and wished to lose weight to emulate actors on television • The more women are exposed to Western media, the more dissatisfied they are with their bodies • Nigeria won first Miss World beauty pageant in 2001 bc they had selected a contestant who was not considered to be beautiful by local standards on account of being too thin

List typical delusions found in Schizophrenia

• Typical Delusions found in Schizophrenia o Made feelings or impulses One's thoughts feelings, or actions are being controlled by external agents o Thought broadcasting One's private thoughts are being broadcast indiscriminately to others o Thought insertion Thoughts are being inserted into one's brain by some external agency o Thought withdrawal Some external agency has robbed one of one's thoughts o Delusions of Reference Example: television program or song on the radio is believed to have special and personal meaning intended only for the person o Delusions of bodily changes (e.g., bowels do not work) o Removal of organs o Sometimes delusions become elaborated into a complex delusional system

How is risk of developing an eating disorder related to Negative Affect

• When we feel bad, we tend to become very self-critical • Ppl with eating disorders tend to show distorted ways of thinking and of processing information received form the environ (similar to folks with depression) o Example of cognitive distortions: "I'm fat; I'm a failure; I'm useless" • Negative affect may work to sustain binge eating o Binge eating is a distraction from negative feelings o Afterwards patients feel disappointed or even disgusted with themselves • Negative affect predicts dietary restrain in anorexia nervosa o Negative affect likely the trigger for dietary restriction

What is the prevalence of Schizophrenia

• less than 1% of population (0.7%), begins earlier in men than women (typical late adolescent/early adulthood), in men it's overall more severe symptoms, women have long term better outcome • Why? Female sex hormones play protective role (estrogen- delayed onset and more favorable clinical course) o When estrogen levels get low or are falling, psychotic symptoms in women with schizophrenia often get worse • The male to female ratio 1.4:1 (for every 3 men who develop the disorder, only 2 women develop it)