ABNORMAL FINAL

Psychodynamic Schizoid Personality

- link disorder to an unsatisfied need for human contact; parents of those with the disorder are believed to have unaccepting or abusive of their children (attachment style) (used to not having it)

Cognitive Schizoid Personality

- suffer deficiencies in their thinking- their thoughts tend to be vague and empty, and they have trouble scanning the environment for accurate perceptions.. social cues.. etc.

2.3. TREATMENT for Childhood Anxiety Disorders

-2.3.1.Despite the high prevalence of these disorders, around 2/3's of anxious children go untreated 2.3.2.among kids who do receive treatment, psychodynamic, behavior, cog, cog-behav, family, and group therapies, separately or in combo have been helpful.. **** 2.3.3.Clinicians have also used drug therapy in some cases, often in combo with psychotherapy, but it has begun only recently to receive much research attention 2.3.4.Because children typically have difficulty recognizing and understanding their feelings and motives, may therapists.. psychodynamic.. use play therapy as part of treatment -cognitive-behavioral therapy (CBT) is the best antianxiety drugs as well as antipsychotics and antidepressants "play therapy" children play with toys, draw and make up stories, in order to reveal conflicts in their lives and the feelings related to them - hypnotherapy

Schizophrenia: Symptoms

-3 categories: positive symptoms, negative symptoms, psychomotor symptoms

i.Psychodynamic Paranoid Personality

-: trace patterns back to early interactions with demanding parents -early interactions with demanding parents, particularly distant and rigid fathers/overcontrolling, rejecting mothers

Alzheimer's Disease

-Alzheimer's Disease - -Around 5 million people in the U.S. currently have this disease (expected to triple by 2050 if no treatment/cure is found) -Sometimes appears in middle age (early onset), but the vast majority of cases occur after age 65 (late onset) -Around 17% also experience major depressive disorder -A gradually progressive disease in which memory impairment is the most prominent cognitive dysfunction -Mild neurocognitive diagnoses during the early and middle stages and then major diagnoses during later more severe stages -Named after Alois Alzheimer who formally discovered the disease in 1907 -Some people may live up to 20 years with the disease, but typically the time between onset and death is 8-10 years -Usually begins with mild memory problems, lapses of attention, and difficulties in language and communication. As symptoms worsen, the person has trouble completing complicated tasks or remembering important appointments. Eventually sufferers also have difficulty with simple tasks, distant memories are forgotten, and changes in personality often become very noticeable. As the symptoms intensify, people show less and less awareness of limitation, may withdraw from others, may become more confused about time and place, wander, and show very poor judgment, and eventually become fully dependent on other people -Many at first deny that they have a problem, but then become anxious or depressed about their state of mind -Prone develop pneumonia in the later stages when activity levels decrease -Diagnosis - -In most cases the disease cannot be fully diagnosed until after death when structural changes in the person's brain can be fully examined -Senile Plaques - sphere-shaped deposits of a small molecule known as the beta-amyloid protein that form in the spaces between cells in the hippocampus, cerebral cortex, and certain other brain regions, as well as in some nearby blood vessels - Normal part of aging, but is exceptionally high in people with Alzheimer's -Neurofibrillary Tangles - Twisted protein fibers found within the cells of the hippocampus and certain other brain areas - Also a normal part of aging, but people with Alzheimer's form an extraordinary number —> Scientists do not yet fully understand what roles these excessive plaques and tangles play, but suspect that they are very important —> This is the leading explanation for Alzheimer's disease

Assessing and Predicting Alzheimer's Disease:

-Brain scans -Several research teams are currently trying to develop tools that can identify persons likely to develop Alzheimer's and other types of neurocognitive disorders -Important to diagnose early or even before the onset of symptoms for the most effective interventions

CAUSES and TREATMENT Autism Spectrum Disorder

-CAUSES -sociocultural.. overemphasized; personality characteristic of the parents created an unfavorable climate for development and contributed to the child's disorder; high degrees of social and environmental stress -more work in psychological and biological spheres.. cognitve limitations and brain abnormaliities primary causes; ue to a central perceptual or cognitive disturbance that makes normal communication and interactions impossible; failure to develop theory of mind (an awareness that other people base their behaviors on their own beliefs, intentions, and other mental states, not on information that they have no way of knowing; a sense of "mindblindness" -biological explanation.. not yet been developed.. leading that way.. mom has rubella -some studies linked the disorder to prenatal difficulties or birth complications -cerebellums.. biological abnormalities in that part of the brain -some theories.. vaccines producing autism in kids.. but research not showing that.. TREAT -adapt better to environment.. through cognitive-behavioral therapy, (teaching new, appropriate behaviors, including speech, social skills, classroom skills, and self-help skills, and reducing negative, dysfunctional ones learning experiences...an alternative program: 4 autistic children are integrated with 10 normal children in a classroom cognitive social integration therapy: children are taught to be more flexible with regard to social rules, problem solving, and behavioral choices) communication training, parent training (teach parents how to be parents in home and support groups for parents.. and deal with emotions and needs), and (even after CBT, 1/2 of autistic people remain speechless; they may learn augmentative communication systems (ie communication boards or computers that use pictures, symbols, or written words to represent objects or needs) -parent training: train parents so they can apply behavioral techniques at home community integration (school based helpe teach self-help and self-management, as well as living, social, and work skills.. greater number of group homes and sheltered workshops are available for teens and young adults.. help individuals become a part of their community) -help the children function better in their communities, group homes and sheltered workshops -psychotropic drugs and certain vitamins have sometimes helped when combined with other approaches

CAUSES AND TREATMENT ADHD

-Causes of ADHD -parents with ADHD are more likely to have children who also have ADHD -biological factors --> abnormal activity of dopamine and abnormalities in the frontal-striatal regions of the brain -also linked to high levels of stress and family dysfunction -Treatment of ADHD -most common are drug therapy, behavioral therapy, or a combination -drug therapy -methylphenidate (ritalin) = stimulant drug; has a quieting effect on children; helps them focus, solve tasks, perform better at school, and control aggression -concerns --> ADHD is generally overdiagnosed in the US, so some children probably don't need to be taking ritalin; also it has been used recreationally as of late -behavior therapy and combination therapies -parents and teachers learn how to reward attentiveness or self-control in children -children who receive both therapy and drugs require lower levels of the drugs (good because they are less exposed to any potentially negative effects of the drug) --Multicultural Factors and ADHD -racial differences in prognosis and treatment -african american and hispanic american children with the same symptoms are less likely to be diagnosed, treated, or treated with the best, long-acting medication -some of this is tied to economic disparities -- poorer children are less likely to be identified as ADHD -but some of it may be social bias and stereotyping -white children's symptoms are attributed to a medical issue -black and hispanic children's symptoms are attributed to poor parenting, lower IQ, substance use, or violence -white children's parents are more likely to identify their child as having ADHD

Psychotic Disorders in Later Life

-Elderly people have a higher rate of psychotic symptoms than younger people -Usually due to underlying medical conditions such as delirium and dementia, but some suffer from schizophrenia or delusional disorder -Schizophrenia is actually less common in older adults and can symptoms can lessen in later life (ex. John Nash in A Beautiful Mind) -It is uncommon for new cases of schizophrenia to occur in later life (however, in the ones that do, women outnumber men 2:1) -In delusional disorder individuals develop beliefs that are false but not bizarre - May develop deeply held suspicions of persecution, may become irritable, angry, or depressed or pursue legal action because of such beliefs -Delusional Disorder •Develop beliefs that are false but not bizarre oRare in most age groups but its prevalence appears to increase in the elderly population •Rise related to the deficiencies in hearing, social isolation, greater stress, or heightened poverty experienced by many elderly persons

How does brain structure relate to Alzheimer's Disease?:

-Important brain structures related to memory - Research indicates that cases of Alzheimer's disease involve damage to or improper functioning of one or more of these brain areas -Working memory -> prefrontal lobes -Long-term memory -> temporal lobes (hippocampus and amygdala) and the diencephalon (mammillary bodies, thalamus, and hypothalamus)

What biochemical changes in the brain relate to Alzheimer's Disease?:

-In order for new information to be acquired and stored, certain proteins must be produced by key brain cells — acetylcholine, glutamate, RNA, calcium are all responsible for the production of memory linked proteins -Abnormal activity of these proteins may lead to improper production of these key proteins

Call for Change: DSM-5

-MAYBE NO MILIOIN TYPES •Taskforce recommended eliminating 5 subtypes of schizo because clinicians and research have indicated features overlap greatly for most patients and few individuals qualify for one diagnosis alone •Proposed that those who fit diagnosis receive the straightforward diagnosis of schizo and then diagnosticians rate how severely the individuals experience the 9 symptoms: hallucinations, delusions, disorganization, abnormal movements, restricted emotional expression, avolition, impaired cognition, depression, and mania •Also proposed new category be added to list of psychotic disorders called attenuated psychosis syndrome oReceive this diagnosis if display hallucinations, delusions, or other symptoms that are problematic but clearly weaker than the full blown psychotic symptoms found in schizo

Disorders of Aging and Cognition

-Nuerocognitive Disorder (dementia): Significant cognitive deterioration (many types of disorders, Alzheimer's disease is the most common) Old Age: Defined in our society as 65+ -36 million in the U.S., about 12% of the total population -It's estimated that by 2030 this will increase to 20% of the population -The number of people over 85 will double in the next 10 years -As people age they become more prone to illness and injury -At least half of elderly people experience some measure of insomnia or other sleep problems -Likely to experience the stress of loss -Best to seek social contacts and maintain a sense of control over lives •Caused by pressures that appear at that time of life, others by traumatic experiences, and other by biological abnormalities • Old age is usually defined as 65+ (36 millions in US are "old"; 12% of pop and growing) o Older women outnumber older men by 3 to 2 • Old age brings special pressures, unique upsets, and profound biological changes • As many as 50% would benefit from mental health services, but fewer than 20% receive them o Geropsychology is the field of psych dedicated to the mental health of elderly people • Psych problems of elderly persons divided into two groups: o Disorder that my be common in people of all ages but are connected to process of aging • Depressive, anxiety, substance abuse o Disorders of cognition from brain abnormalities • Delirium, Alzheimer's

residual schizo

-Return to prodromal-like level of functioning •Symptoms of active phase lessen, but some negative symptoms may remain o¼ recover from schizophrenia, majority have some residual problems for their entire lives

What are the genetic causes of Alzheimer's Disease?:

-Role of proteins - Abnormal activity by the beta-amyloid protein is key to the repeated formation of plaques and abnormal activity by the protein tau is key to the excessive formation of tangles —> A leading theory holds that the many plaques formed by beta amyloid proteins cause tau proteins in the brain to start breaking down, resulting in tangles and the death of many neurons -Early-Onset — Typically runs in families -Can be caused by genes responsible for the production of the beta-amyloid precurspr protein (beta-APP) and the presenilin protein -Some families transmit mutations of one or both of these genes -Late-Onset — Typically do not run in families, often called sporadic -Seems to develop from a a combination of genetic, environmental, and lifestyle factors -Genetic component - Apolipoprotein E (ApoE) gene located on chromosome 19 -This gene comes in various forms, about 30% of the population inherit the form called ApoE-4 and are subsequently particularly vulnerable to the development of Alzheimer's disease

Other Explanations of Alzheimer's Disease:

-Some research has suggested that certain substances found in nature may act as toxins, damage the brain, and contribute to the development of Alzheimer's -High levels of zinc have been observed to trigger a clumping of beta amyloid protein -Lead may contribute to development as well -Autoimmune Theory — On the basis of certain irregularities found in the immune systems of people with Alzheimer's, researchers have speculated that changes in aging brain cells may trigger an autoimmune response that helps lead to the disease -Viral Theory - no such virus has been detected, but since the disease resembles Creutzfeldt-Jakob disease (which is caused by a virus) researchers have proposed the same mechanism for Alzheimer's

What Treatments are Currently Available for Alzheimer's Disease and Other Neurocognitive Disorders?:

-Treatments have been at best moderately helpful -Drug Treatment — -Current drugs for Alzheimer's are designed to affect acetylcholine and glutamate — some patients improve slightly in short-term memory and reasoning ability, use of language and ability to cope with pressure —> Although the benefits are limited and the risk of harmful effects sometimes high these have been approved by the FDA (best used on early/mild stage) -Vitamin E -These drugs are administered after development of disease -Some studies suggest that the long-term use of non steroid anti-inflammatory drugs (ibuprofin, advil) mey help reduce risk (mixed findings) -Cognitive Techniques — Temporary success, best to stay mentally stimulated -Behavioral Therapies — Some success, physical exercise improves cognitive functioning -regular exercise may help reduce the risk of developing Alzheimer's, some cases have tried behavioral therapy for specific symptoms (wandering) therapists use a combination of role-playing, modeling, and practice -Support for Caregivers — Can take a heavy toll on family members, make sure they are educated about the disease, psychotherapy, time outs -Some institutionalize patient once caregiving becomes too overwhelming -Sociocultural Approaches — Day-care facilities have begun (outpatient), assisted-living facilities

Other Types of Neurocognitive Disorders:

-Vascular Neurocognitive Disorder — follows a cerebrovascular accident (stroke) when certain areas of the brain are damaged due to the cut off of blood flow -Progressive, but symptoms begin suddenly rather than gradually -Unaffected areas of the brain may continue to have normal functioning -Frontotemporal Neurocognitive Disorder — (Pick's disease) a rare disorder that affects the frontal and temporal lobes, similar to Alzheimer's (distinguished through autopsy) -Creutzfeldt-Jakob Disease — due to prion disease, symptoms include spasms of the body, cause by a slow acting virus that may live in the body for years before the disease develops, rapid course once launched -Due to Huntington's Disease — Inherited progressive disease in which memory problems worsen over time, along with personality changes and mood difficulties, movement problems, -Parkinson's Disease — Slowly progressive neurological disorder marked by tremors, rigidity, and unsteadiness, which can result in neurocognitive disorder due to Parkinson's in advanced cases -Can also be due to HIV infections, traumatic brain injury, substance abuse, or other medical conditions such as meningitis or advance syphilis

Behavior Antisocial Personality

-antisocial symptoms may be learning through modeling or unintional ..

Elimination Disorders

-children repeatedly urinate or pass feces in their clothes, in bed, or on the floor -they have reached an age where they are expected to control these bodily functions, and their symptoms are not caused by physical illness Enuresis

Conduct Disorder (worse than oppositional defiant disorder)

-children repeatedly violate the basic rights of others; often aggressive and may be physically cruel to people or animals; steal; forge; mug -begins around 7-15 yrs of age; 10% of kids diagnosed (3/4 boys) -as they grow older they may commit rape or homicide mild conduct disorder can improve over time -Kids with conduct disorder are suspended from school, placed in foster homes, or incarcerated -more severe disorder can continue into adulthood and develop into antisocial personality disorder, etc. -usually oppositional defiant disorder is first, and then conduct disorder develops -more than 1/3 also have ADHD -many also experience depression/anxiety -different patterns of behavior -overt-destructive pattern: openly aggressive and confrontational -overt-nondestructive pattern: openly aggressive and non confrontational -covert-destructive pattern: secretive destructive behaviors such as violating another's property, breaking and entering, and setting fires covert-nondestructive pattern: -secret nonaggressive behaviors, such as being truant from school -could also include relational aggression: individuals are -socially isolated and primarily display social misdeeds such as slandering others, spreading rumors, and manipulating friendships (more common in girls) -Causes of Conduct Disorder often linked to genetic and biological factors; also tied to drug abuse, poverty, traumatic events, and exposure to violence -most common link is to parent-child relationships, inadequate parenting, family conflict, marital conflict, and family hostility parents with mental issues are more likely to produce children with conduct disorder

Attention-Deficit/Hyperactivity Disorder

-children who display ADHD have great difficulty attending to taks, beahave overactively and impulsively, or both --symptoms usually appear before kid starts school -the primary symptoms may feed into one another, but in many cases one of the sympoms stands out more than another -ADHD -learning or communication problems -poor school performance -difficulty interacting with other children -misbehavior, often serious -mood or anxiety problems -around 4-9% kids display.. 70% of them boys -those how parents have had ADHD are more likely than others to hav eit -disorder persists through childhood -b/t 35% and 60% continue to have ADHD as adults -Difficult disorder to assess -ideally, the child's behavior should be observed in several environmental settings, because symptoms must be present across multiple settings for a diagnosis -it also is important to obtain reports of the child's symptoms from their parents and teachers -clinicians also commonly employ diagnostic interviews, rating scales, and psychological tests

Psychodynamic Borderline Personality

-early parental relationships (early childhoods of people with disorder more often than not consistent with view) -because fear of abandonment tortures so many people with disorder.. look to early parental relationships to explain the disorder 1.Object-relations theorists propose a lack of early acceptance or abuse/neglect by parents; research has found some support for this view, including a link to early sexual abuse a.Healthy object relationships... go find mommy touch her.. if she isn't physically there or not emotionally.. hard to establish healthy object relationships.

Treatment Major Depressive Disorder

-for years CBT was best for both childhood and teenage depression -recent study revealed that a combination of antidepressant drugs and CBT is best for teenage depression (also, antidepressants alone are better than CBT alone) -but it's also possible that antidepressants increase the risk of suicide in 2 to 4 percent of depressed children -proves the importance of research on treatment --> lots of questions on what's best for children

Biology Antisocial Personality

-impulsivity and aggression linked to low serotonin; deficient functioning in their prefrontal cortex 1.Lower levels of serotonin, impacting impulsivity and aggression 2.Deficient functioning in the frontal lobes of the brain 3.Lower levels of anxiety and arousal leading them to be more likely than others to take risk and seek thrills

Intellectual Development Disorder

-in DSM term mental retardation has been replaced by intelelctual development disorder -IDD whent hey display general intellectual functioning that is well below average, in combo with ppor adaptive behavior -IQ must be 70 or lower... (normal is 100) -ther person must have difficulty in such areas as communication, home living, self-direction, work, or safety -symptoms must appear before 18 -4 levels -Mild 50-70 -80 to 85% of all people fall in Mild -Educable, can benefit from some schooling -intellectual performance seems to improve with age -their jobs tend to be unskilled or semiskilled (grocery bagger) -Moderate 35-49 -around 10% of persons IDD -they can care for themeslev, benefit from vocational training, and can work in unskilled or semi-skilled jobs -Severe -20-34 -usually require careful supervision can perform basic tasks, rarely able to work indepently -Profound (below 20) -1 to 2% -training they may learn or improve basic skills but they need a very structured environment -severe and profound levels of intellectual development disorder often appears as part of larger syndromes that include severe physical handicaps CAUSES -mild... primary causes environmental.. although biological factors may be operating in some cases (something mother was taking in utero) -moderate, severe, and profound.. are biological.. although people who people who fucntion at these levels are affected by environment, faily etc. -Chromosomal causes -chromosmal abnormality.. Down Syndrome -fewere than 1 out of 1/1,000.. but after mother 35... increases.. 3.1.3.6.5.3.1.2. several types of crhomosal abnormlaities may cuase Down syndrome, but the most common is trisomy 21 -.fragile X sympom is seoncd most common -Metabolic causes -in metabolic disordres, the body's breakdown or production of chemcials is disturbed -the metapbolic disorders that affect intelligence and development are typically caused yby the pairing of two defective recessive genes, one from each parent -exampels inclue -phenlytonur -tah sacks.. **** -Prenatal and birth-related causes -as a fetus develops, mjaor problems int he pregnant mother can threaten child's healthy development --low iodine may lead to cretinism -alchol fetal alchol syndrome -certain material infections during pregnacy.. **** -Childhood problems -after birth, particularly up to age of 6, certain injuries and accidents can affect intellectual functioning -examples include positing, serious head injry, excessive exposure to x-rays, and excessive use of certain chemcials, minerals, and or drugs lead paint -certain infections, such as meningitis, and encephalities, can lead ti IDD if they are not diagnosed and treated in time -Interventions -proper residence? -would send them to live in public institution, state schools, .. became overcrowded that provided basic care.. but neglect and bad shat.... -.During 60s and 70s.. public become more aware of bad treatment... let people out.. and where do they go? -Community residences and small institutions.. halfway houses.. group homes... follow principle of normalization, they try to provide living conditions similar to those enjoyed by the rest of society -vast majority of children with IDD live at home.. and with mild IDD live at community residence or with relative -Educational Programs - can be given during early years -.special education vs. mainstream schools... (can get additional support) -neither approach seems constantly superior -Therapy -people w/IDD sometimes experience emotional and behavioral problems -around 30% or more hav ea diagnosable psychological disorder other than IDD -some suffer from low self esteem, interpersonal problems, and adjustment difficulties - These problems are helped to some degree by individual or group therapy two new categories --> "disruptive mood dysregulation disorder" (a pattern of recurrent temper outbursts and persistent negative emotions that begins before the age of 10) and "non-suicidal self-injury" (a pattern of intentional self-inflicted body damage, usually in teenagers)

How do theorists explain schizophrenia?

-lots of sides.. -~Mainly research points to biology, but a diathesis-stress relationship may be at work: people with biological predisposition will develop schizo only if certain kinds of event or stressors are also present~

Cognitive Paranoid Personality

-maladaptive assumptions such as "people are evil and will attack you if given chance" are to blame

LONG-TERM DISORDERS THAT BEGIN IN CHILDHOOD

-many childhood disorders change or subside as the person ages -these two are likely to continue unchanged throughout life

2.Paranoid Personality Disorder

-marked by a pattern of deep distrust and suspiciousness of others i.Although inaccurate, the suspicion is usually not delusional- the ideas are not so bizarre or so firmly held as to clearly remove the individual from reality (like conspiracy theorists) ii.As a result of their mistrust, people with this often remain cold and distant iii.Critical of weakness and fault in others, particularly at work 1.They are unable to recognize their own mistakes and are extremely sensitive to criticism 2.Often blame others for things that go wrong in their lives and bear grudges repeatedly iv.Between .5 and 3% of adults believed to experience the disorder, more men than woman... typicalllll

Autism Spectrum Disorder

-marked unresponsiveness to other people, severe communication deficits, and highly rigid and repetitive behaviors, interests, and activities -appear early in life, before age 3 -just a decade ago.. austism spectrum 1 in 2000 children, now 1 in 600, 80% in boys -as many as 90% of children with the disorder remain severly disabled into adulthood and are unable to lead independent lives -even highest functioning adults with autism.. have problems in social interactions and communications, and have restricted interests and activities -lack of responsiveness and social reciprocity- extreme aloofness and lack of interest in people-has long been considered a central feature of the disorder -communication problems take various forms -one common speech is echolalia, the exact echoing of phrases spoken by other people -another is pronouns reversal or confusion of pronouns -limited imaginative play and very repetitive and rigid behavior -preservation of sameness -many sufferers become strongly attached to particular objects- plastic lids, rubber bands, buttons, water- and may collect, carry, or play with them constantly -the motor movements of people with this disorder may be unsual -often called "self-stimulatory" behaviors; may include jumping, arm flapping, and making faces -some individuals with autism spectrum disorder may engage in self-injurious behaviros -children may at times seem overstimulated (new carpet texture.. too much) and or underestimated by their environments -Asperger's disorder --> children display significant social impairments yet manage to maintain relatively high levels of cognitive function and language; experience kinds of social deficits, impairments in expressiveness, indiosyncratic interests, and restricted and repetitive behaviors that characterize individuals with autistic disorder, but at the same time they have normal, intellectual, adaptive, and language skills; results in people appearing awkward and unaware of conventional social rules -three subtypes -rule boys = need to have s et of rules that govern their lives -logic boys = primarily interested in the reasons behind rules -emotion boys = run by their feelings

Treatment for Conduct Disorder

-most effective when dealt with under 13 yrs of age b/c it gets more locked in with time -combining treatments seems to be best, but no one treatment is directly the answer -sociocultural treatments -family intervention (focused on improving relationship with family) -parent-child interaction therapy = parents are taught to work with their children positively; child is taught better social skills; goal is to improve the relationship and thus improve the child's behavior -video-modeling = same goals as above, but with video tools -parent management training = parents are taught to more effectively deal with their children; parents and children meet together in behavior-oriented family therapy; parents taught to identify problem behaviors, and reward the proper behaviors; *pretty successful -treatment foster care -delinquent boys and girls with conduct disorder are assigned to a foster home in the community; while they're there, the children, foster parents, and biological parents all receive training and treatment interventions; therapy with both sets of parents; treatment and support continues after they leave foster care as well; *pretty successful if all parts are applied -juvenile training centers = often strengthen delinquent behavior rather than resocialize young offenders; *not very successful -child-focused treatments (focus directly on child) -particularly cognitive-behavioral interventions -problem-solving skills training = combination of modeling, practice, role-playing, and systematic rewards; goal is to teach constructive thinking and positive social behaviors -anger coping and coping power program = group sessions that teach children to more effectively manage their anger, use perspective, build social skills, set goals, and handle peer pressure; *successful at preventing substance use and reducing aggressive behaviors -stimulant drugs = helpful in reducing aggressive behaviors prevention -might be the greatest hope -begin in earliest stages of childhood; try to change unfavorable social conditions before the disorder can develop

Oppositional Defiant Disorder

-often hostile and disobedient -10% of kids diagnosed with this; more common in boys before puberty but even after puberty

Cognitive Antisocial Personality

-people with the disorder hold attitudes that trivialize the importance of others people's needs

Biological Paranoid Personality

-propose genetic causes and have looked at twin studies to support this model

Psychodynamic Antisocial Personality

-propose that this disorder begins with an absence of parental love, leading to a lac of basic trust -absence of parental love during infancy, leading to lack of basic trust (become emotionally distant growing up)

Enuresis

-repeated involuntary (or in some cases intentional) bed-wetting or wetting of one's clothes -typically occurs at night during sleep -usually triggered by stressful events or abuse -prevalence decreases with age -different explanations -psychodynamic: enuresis is a symptom of of broader anxiety and underlying conflicts -behavioral: the result of improper, unrealistic, or coercive toilet training -family: due to disturbed family interactions -biological: a small bladder capacity or weak bladder muscles -treatment -usually corrects itself without treatment -behavioral therapy can speed up the process -bell-and-battery technique (classical conditioning) = a bell and a battery are wired to a pad consisting of two metallic foil sheets, and the entire apparatus is placed under the child at bedtime; a single drop of urine sets off the bell, awakening the child as soon as he or she starts to wet; the bell paired with the sensation of a full bladder produces the response of waking; eventually, a full bladder awakens the child -dry-bed training = training in cleanliness and retention control, awakened periodically during the night, practice going to the bathroom, and reward correct behavior

Encopresis

-repeatedly defecating into one's clothing -less common than enuresis and less well researched -usually involuntary, starts after the age of 4, much more common in boys than girls -leads to intense social problems, shame and embarassment -may stem from stress, biological factors such as constipation, improper toilet training, or a combination treatment -behavioral and medical approaches -biofeedback training to help children detect when their bowles are full -family therapy

Biological Borderline Personality

-such as overly reactive amygdlaa.. responsible for emotion.. (?) and an underactive prefrontal.. (takes until 25) 1.Sufferers who are particularly impulsive apparently have lower brain serotonin activity 2.Close relatives of those with borderline personality disorder are 5 times more likely than the general population to have the disorder -5-HTT gene (serotonin transporter gene = linked to major depressive disorder, suicide, aggression, and impulsivity)

DSM 5

-the diagnoses often rely heavily on the impressons of the individual clinician -clinicans differe widely in their judgment about when abnormal personality sytpe crosses the line and desevers to be called a disorder -the leading critism of the DSM 5's approach to persaonlity disorders is that the classifcaiton -a growing number of theroists now belive that personality disorders actually differ moer ein DEGREE tan in type of dysfunction they propose that htye disorders should be organized by the severity of key traits, or personality dimensions, rather than the presence or absence of specific traits -Each key trait would be seen as varying along a continuum in which there is no clear boundary between normal and abnormal "Big Five" Theory of Personality -a large body of research conducted with diverse personality... supertraits or factors... neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness... -each of these factosr.. -theroetically everyones' personality can be sumarzied by acombo of the b.Barely any multicultural research! i.Some think borderline comes from reaction to persistent feelings of marginality, powerlessness, and social failure ii.More Hispanics than whites or blacks with borderline

Issues Affecting the Mental Health of the Elderly:

1. Discrimination because of race and ethnicity 2. Many older people require long-term care, many elderly people fear being "put away" in nursing homes 3. Clinical scientists suggest that the current generation of young adults should take a health-maintenance, or wellness promotion, approach to their own aging process — Do things that promote both physical and mental health

Personality disorders

1. Odd or eccentric behavior: Paranoid, schizoid, and schizotypal 2. Dramatic, emotional, or erratic behavior: antisocial, borderline, narcissistic, and histrionic personality disorders 3. Anxious or fearful behavior: avoid ant, dependent, and obsessive compulsive personality disorder

1.Childhood and Adolescence

1.1. Beyond these common concerns and psychological difficulties, at least -one-fifth of all children and adolescents in North America also experience a diagnosable psychological disorder 1.1.1.Boys with disorder outnumber girls, even though most of the adult psychological disorders are more common in women 1.2. Some disorders of children- childhood anxiety disorders and childhood depression- have adult counterparts 1.3. Other childhood-disorders- elimination disorders.. for example.. usually disappear or radically change form by adulthood 1.4. There are also disorders that begin in birth or childhood and persist in stable forms into adult life 1.4.1.autism spectrum disorder and intellectual development disorder.. previously called mental retardation

Dramatic, emotional, or erratic behavior personality disorders

1.Antisocial, borderline, narcissistic, and histrionic personality disorders a.Start in early adolescence/adult hood... how experience themselves and others.. b.All about drama.. emotional, erratic that is almost impossible for them to have relationships that are truly giving and satisfying c.These personality disorders are more commonly disagnosed than the others i.Only antisocial and borderline personality disorders have received much study d.More commonly diagnosed with others i.Only anticosial and borderline personality disorders e.Causes not well understand.. not good treamtent

iii.Anxious or fearful behavior personality disorders

1.Avoidant, dependent, and obsessive-compulsive personality disorders a.Typically display anxious and fearful beavhior b.Similar to anxiety and depressive dirsodres.. researcher found no direct link.. c.As with most of personality disrodres.. research is very limited i.Treatmetns for this cluseter appear to be modestly to moderately helpful

i.Psychodynamic Narcissistic Personality

1.Begins with cold rejecting parents 2.Argue that some people with this background spend their lives defending against feeling unsatisfied, rejected, unworthy, and wary of the world. 3.Object relations theorists, interpret the grandiose self-image as a way for those people to convince themselves that they are totally self-sufficient and without need of warm relationships with their parents or anyone else -1. Research has found increased risk for developing the disorder among abused children and those who lost parents thorugh adoption divorce... death...

ii.Cognitive-Behavioral Narcissistic Personality

1.Develop when people are treated too positively rather than too negatively in early life -"overvalue self'worth"

iii.Sociocultural Narcissistic Personality

1.Link between narcissistic personality disorder and "eras of narcissism" in society 2.Family values and social ideals in certain societies periodically break down, producing generations of youth who are self-centered and materialistic (Western society)

Cognitive Histrionic Personality Disorder

1.Look at lack of substance and extreme suggestibility a.See the individual as becoming less and less interested in knowing about the world at large because they are so self-focused and emotional. b.Propose that people with this disorder hold a general assumption that they are helpless to care for themselves, and so they constantly seek out others who will meet their needs

iv.Treatments Histrionic Personality Disorder

1.More likely than those with most other personality disorders to seek out treatment on their own 2.Working with them can be very difficult because of the demands, tantrums, and seductiveness they are likely to deploy a.May pretend to have drastic change to please therapist as well 3.Cognitive therapists tried to help people with this disorder to change their belief they are helpless and also to develop better, more deliberate ways of thinking and solving problems 4.Psychodynamic therapy formats have been applied

Treatment Narcissistic Personality

1.Most difficult personality patterns to treat because the clients are unable to acknowledge weaknesses 2.Psychodynamic- work through basic insecurities and defenses 3.Cognitive- focus on the self-centered thinking and try to redirect the clients focus onto others.. increase ability to empathize

i.Psychodynamic perspective Histrionic Personality Disorder

1.Originally to help explain cases of hysteria 2.As children, people with this disorder experienced unhealthy relationships in which cold and controlling parents left them feeling unloved and afraid of abandonment 3.To defend against deep-seated fears of loss, the individuals learned to behave dramatically, inventing crises that would require other people to act protectively

Sociocultural/Multicultural Histrionic Personality Disorder

1.Produced in part by cultural norms and expectations 2.The vain, dramatic, and selfish behavior of the histrionic personality may actually be an exaggeration of femininity as our culture once defined it 3.Less diagnosed in Asian and other cultures that discourage overt sexualization and more often in Hispanic and Latin American cultures that are more tolerant of overt sexualization

Treatment for schizo.. overview

1.Schizophrenia is still extremely difficult to treat, but clinicians are much more successful today than they were in the past a.Much of this credit goes to antipsychotic drugs i.Help those with schizophrenia and other mental disorders, to think clearly and profit from psychotherapies that previously would have had little effect on them 1.(At least half of schizophrenic patients today, do not receive adequate care)

i.Cognitive-Behavioral Therapy Schizo

1.Thought cause from this perspective; biologically triggered sensations (delusions etc.) 2.Individuals try to make sense of sensations and conclude incorrectly that the voices are coming from external sources 3.This practice, goes to change how individuals view and react to their hallucinatory experiences a.Provide clients with education and evidence about biological causes of hallucinations b.Monitor what events and situations trigger voices c.Push clients to challenge voices d.Teach clients how to interpret delusions/voices e.Teach copings for unpleasant sensations.. special breathing, relaxation technqiues, etc. 4.The techniques help schizophrenic individuals gain a greater sense of control over their halluincations and reduce their delusional ideas.. but don't eliminate hallucinations 5.Helpful to clients of schizophrenia.. in that feel less distressed and some individuals able to shed the diagnosis.. and rehospitalization decreases by 50 percent

2.Childhood Anxiety Disorders

2.1.1.Anxiety is, to a degree, a normal and common part of childhood 2.1.1.1.since children have had fewer experiences than adults, their world is often new and scary 2.1.1.2.children also may be affected greatly by parental problems or inadequacies 2.1.1.3.there is also genetic evidence that some children are prone to an anxious temperament 2.1.2.Anxiety disorders of young children are dominated by behavioral and somatic symptoms 2.1.2.1.they tend to center on specific, sometimes imaginary, objects and events 2.1.2.2.they are more often than not triggered by current events and situations -regular anxiety disorders like GAD and social anxiety disorder don't manifest until age 7 (because kids need to develop cognitive, physical, and emotional skills) -under 7, anxiety disorders are characterized by... -behavioral and somatic symptoms (ie clinging, sleep difficulties, and stomach pains) -center on specific object and events (ie monsters, ghosts, or thunderstorms) -triggered by current events

2.2. Separation Anxiety Disorder

2.2.1.one of the most common childhood anxiety disorder, follows this profile and is displayed by 4 to 10% of all children 2.2.1.1.sufferers feel extreme anxiety, often panic, whenever they are separated from home or a parent 2.2.1.2.A separation anxiety disorder may further take the form of a school phobia or school refusal- a common problem in which children fear going to school and often stay home for a long period 2.2.1.2.1. (somatic.. tummy ache.. don't want to go) -but at a hint of separation, their symptoms set in motion temper tantrums, crying, or pleading to keep their parents from leaving

3.1.1.Major Depressive Disorder

3.1.1.1.Very young children lack some of the cognitive skills that helps produce clinical depression, thus accounting for the low rate of depression among the very young 3.1.1.2.depression in the young may be trigggered by negative life events (particularly losses), major hnages, rejection, or ongoiong abuse 3.1.1.2.1. symptoms don't cognitively come out.. could be more physical... don't eat.. irritability 3.1.1.3.commonly characterized by such symptoms as headaches, stomach pain, irritability, and a disinterest in toys and games 3.1.1.4.clinical depression is much more common among teenagers than among young children 3.1.1.4.1. suicidal thoughts and attempts are particularly common 3.1.1.5. Before age of 13, boys more depressed... but by age of 16.. girls two times as likely... 3.1.1.5.1. hormonal changes... estrogen... increased stressors, increased emotional investment in social and intimate relationships 3.1.1.5.2. another factor that received attention is teenage girls' growing dissatisfaction with their bodies 3.1.1.6. Recently, antidepressants drug.. lead to higher chance of suicide.. need more research etc.

3.1.2.Bipolar Disorder and Disruptive Mood Dysregulation Disorder

3.1.2.1.For decades... thought bipolar exclusively adult mood... 3.1.2.2.However, since mid-1990;s.. begin to believe kids have it too.. 3.1.2.3.Most theorists thinking growing number... some people think the diagnosis is currently being overapplied to children and adolescents 3.1.2.3.1. they suggest the label has become a clinical "catchall" that is being applied to almost every explosive child 3.1.2.4.The DSM 5.. said overapplied.. so called Disruptive Mood Dysregulation Disorder, which is targeted for children with severe patterns of rage... not just moody kids Treatment 40% of children receive psychotherapy, most receive antipsychotics, antibipolars, antidepressants or stimulants or a combination of the above

7.People with schizophrenia live

a.34% unsupervised living b.25% with family member c.18% supervised living d.8% Nursing homes e.6% jails and prisons i.135,000 iiin CA, nearly 4 times more people with serious mental illness are housed in jails and prisons than in hospitals.. nationally 16 to 20% of prisoners are mentally ill iii.people in jails not trained to deal with that... ughhhh iv."We have too many untreated mentally ill people who are getting criminalized because of the absence of resources" v.Mental health treatment court- give people meds in jail.. f.5% Hospitals g.5% Homeless i.400,000-800,000 homeless in US

1.What is personality?

a.A set of uniquely expressed characteristics that influence our behaviors, emotions, thoughts, and interactions i.Particular characteristics- called traits- lead us to react in fairly predictable ways as we move through life b.Personality is also flexible, allowing us to learn and adapt to new environment i.For those with personality disorders, however, that flexibility is usually missing

2.What is a personality disorder?

a.An enduring rigid pattern of inner experience and outward behavior that impairs sense of self, emotional experience, goals, and capacity for empathy and/or intimacy b.The rigid traits of people with personality disorders often lead to psychological pain for the individual or others a.Typically becomes recognizable in adolescenc oe rearly adulthood.. 17-18 i.These are among the most difficult psychological disorders to treat ii.Many suffers are not even aware of their personality disorders iii.Estimated from 9% to 13% of all adults may have a personality disorder b.Common for a person with a personality disorder to also suffer from another disorder, a relationahips called comorbility i.Whatever the reason for this relationhips, research indicates that the presence of a personality diosroder complicates a person's chances for a successful recovery from their psychological problems 1.What brings them into therapy is other thing.. and find out also have personality disorder PERSONALITY DISORDER DIAGNOSIS: 1.Deviates markedly from the expectations of the individual's culture (at least two of following: cognition, affectivity, interpersonal functioning, impulse control) 2.Pattern is inflexible and pervasive across a broad range of personal and social situations 3.Pattern is stable and long-lasting, and its onset can be traced back at least to adolescence or early adulthood 4.Significant distress or impairment •"Odd" personality disorders: consist of paranoid, schizoid, and schizotypal personality disorders that typically display odd or eccentric behaviors that are similar to but not extensive as those seen in schizophrenia

2.Avoidant Personality Disorder

a.Are very uncomfortable and inhibited in social situations, overwhelmed by feelings of inadequacy, and extremely sensitive to negative evaluation. They are so fearful of being rejected that they give no one an opportunity to reject them- or to accept them either b.Avoid occasions for social contact.. dread of disapproval c.Timid and hesitant in social situations d.Believe themselves to be unappealing or inferior to toehrs e.Seldom take risks or try out new activities f.Similar to social anxiety disorder i.Same fear of humiliation and low confidence ii.Key differences- social anxiety disorder fear social circumstances, while people with the personality disorder tend to fear close social relationships g.1-2% of adults have.. men and women equal..

5.Psychotherapy Schizo

a.Before antipsychotic drugs, those with schizophrenia couldn't benefit from psychotherapy because were too out of touch with reality for it to be beneficial b.Most helpful forms are cognitive therapy and two sociocultural interventions-family therapy and social therapy

2.Institutional Care in the Past

a.For more than half of 20th century, most people diagnosed with schizophrenia were institutionalized in a public mental hospital i.Patients failed to traditional therapies, so 1.Primary goal of establishment was to fed, give shelter, and cloth patients 2.Patients rarely saw therapists and were neglected and many abused b.In 1793, Philippe Pinel, began practice of moral treatment, patients were viewed as humans who should be cared for with sympathy and kindness i.Led to large mental hospitals, instead of asylums ii.States required by law to establish public mental institutions, state hospitals, for patients who could not afford private ones iii.State hospital system encountered serious problems, began rapidly becoming overcrowded, with too many people needing to enter 1.Too much of treatment had to come from nurses and attendants and their knowledge was limited 2.Shift of mindset from humanitarian to keeping things in order 3.Staff members relied on straitjackets and handcuffs to deal with difficult patients.. and lobotomy.. (destroy brain tissue.. thought to fix all problems.. especially w/mentally ill/depressed.. and in time of over crowding no one questioned.. though wasn't as effective or safe.. and was wiped out when anti-psychotics came in)and less individual care 4.Most patients didn't improve 5.The most common pattern of decline was called the social breakdown syndrome: "extreme withdrawal, anger, physical aggressiveness, and loss of interest in personal appearance and functioning.. usually became worse than originally were

3.Borderline Personality Disorders

a.Great instability, including major shifts in mood, and unstable self-image, and impulsivity i.Interpersonal relationhips are also unstable ii.People with borderline personality disorder are prone to bouts of anger, which sometimes result in phsycial aggression and violence -swing in and out of very depressive, anxious, and irritable states (emotions seem to always be in conflict with the world around them); complex disorder; impulsive, self-destructive activities iii.Just as often , however, they direct their impublisve anger inward and harm themselves (cut themselves.. or bulihimia.. shopping.. gambling.... Part of reliving pain and attention getting) iv.Border of psychotic and narcotic (can be confused with bipolar 11) v.Impulsive, self-destructive behavior can include: 1.Alcohol and substance abuse 2.Reckless behavior, including driving and unsafe sex 3.Self-injurious or self-mutilation heavier 4.Suicidal threats and actions vi.People with the disorder frequently form intense conflict-ridden relationships while struggling with recurrent fears of impending abandonment vii.Walking on eggshells... viiiBetween 1 and 2.5% pop ix.Close to 75% is women x.The course of the disorder varies 1.In most common pattern, the instability and risk of suicide reach a peak during young adulthood and then gradually wane with advancing age

3.Institutional Care Takes a Turn for the Better

a.In 1950s, developed two institutional approaches that brought some hope. They helped improve the personal care and self-image of patients, which had been worsened by institutionalization before -MILIEU AND TOKEN i.Milieu Therapy 1.Based on humanistic principles 2.Thought institutionalized patients deteriorate because they are deprived of opportunities to exercise independence, responsibility, and positive self regard and to engage in meaningful activities 3.Institutions can't work unless they can somehow create a social climate, or milieu, that promotes productive activity, self-respect, and individual responsibility 4.Pioneer was Maxwell Jones.. in London converted ward into a therapeutic community... treated as capable of own lives and making own decisions.. had community government and made rules as a community, patients could take on special projects and recreational activities 5.This style has been set up since then, trying to encourage interactions, between patients and staff to keep patients active and to raise patients expectations of what they can accomplish 6.Research shows those with severe mental disorders often improve and leave the hospital at higher rates than patients in programs offering primarily custodial care , though many of the people do remain impaired. 7.Continued to be a practice today, though usually with other hospital approaches ii.Token economy program 1.Based on behavioral principles 2.Through years of experience, found use of operant conditioning techniques could help change the behaviors of these individuals 3.In these programs, patients are rewarded when they behave acceptably and are not rewarded when they behave unacceptably. The immediate rewards for acceptable behavior are often tokens that can later be exchanged for food cigarettes, hospital privileges, and other desirable items, creating a "token economy" 4.Research shows this does help reduce psychotic and related behaviors.. in a study after 4 years, 98% of schizo patients had been released, when in mileu programs only 71% were 5.Limitations: sometimes limit food, furniture, and movement as rewards... yikes.. 6.Ways of measuring success are limiting.. and may not necessarily help with psychotic thoughts.. just change behavior.. and if rewards aren't offered anymore.. goo ****ing luck 7.This has been applied to mental retardation, delinquency and hyperactivity as well

4.Anti-psychotic Drug came along..

a.In the 1950s, anti-psychotic drugs discovered, and revolutionize treatment i.These drugs eliminate many of its symptoms and today are almost always a part of treatment 1.The discovery came from research developed antihistamine drugs in the 1940s a.Henri Laborit found that a group of antihistamines, phenothiazines, could be used to help calm patients about to undergo surgery i.After experimenting with different kinds of antihistamines, most impressed w/ chlorpromazine 1.Thought may have calming effect on those with psychological disorders a.Tested on 6 patients.. and then approved for sale in US.. called Thorazine ii.Since then, other kinds of antipsychotic drugs have been developed 1.In 1960s, 70s, and 90s are now referred to as conventional antipsychotic drugs, and there are atypical antipsychotics (also called second generation) 2.Antipsychotics reduce psychotic symptoms at least in part by blocking excessive activity of the neurotransmitter dopamine, particularly at the brain's dopamine D-2 receptors

3.Schizoid Personality Disorder

a.Persistent avoidance of social relationships and limited emotional expression i.People with this disorder do not have close ties with other people, they genuinely prefer to be alone ii.Focus mainly on themselves and are often seen as flat, cold, humorless, or dull iii.The disorder is estimated to affect fewer than 1% of the population 1.Slightly more common in men than in woman

2.Antisocial Personality Disorders

a.Psychopaths or sociopaths, people with antisocial personality disrodre persistently disregard others rights i. Self-centered and have trouble maintaining close relationships a. b. Knack for gaining personal profit i.Aside from substance-related disorders, this is the disorder most lined to adult criminal behavior ii.The DSM 5 stipulates that a person be at least 18 years of age to receive this diagnosis 1.Most people with an antisocial personality disorder displayed some patterns of misbehavior they were 15 years old iii.People with the disorder are likely to lie repeatedly, be reckless, and impulsive 1.They have little regard for other individuals, and can be cruel, sadistic, aggressive, and violent iv.Surveys indicate 2 to 3.5% of people in the US meet the criteria for this disorder 1.The disorder is 4 times more common in men than in women

Why? Psychodynamic/cognitive/behavorial Avoidant Personality

a.Same an anxiety disorders.. early traumas, conditioned fears, upsetting beliefs, or biochemical abnormalities b.Not tied together c.Psychodynamic- focus mainly on the general sense of shame felt by people with disorder.. some trace it to childhood experiences such as bladder accidents.. especially if parents ridicule child for that.. d.Cognitive theorists- harsh criticism and rejection in early childhood may lead certain people to assume that others in their environment will always judge them negatively. These individuals come to expect rejection, misinterpret the reactions of others to fit that expectation, discount positive feedback, and generally fear social involvements e.Behavioral- typically fail to develop normal social skills, a failure that helps maintain the disorder

1.Paranoid, schizoid, and schizotypal personality disorders

a.Show symtpoms similar to schizo.. but schizo.. (split mind... in a different reality.. or universe...) BUT with this.. behavior similar but haven't crossed over b.Behaviors include extremem suspiousness, social withdrawal, and peculiar ways of thinking and perceiving things c.Such behaviors leave the person isolated d.Some clinicans believe that these disorders are actually related to schizophrenia.. and thu called them schizo spectrum disorders... BUT we gonna focos on personality part

Treatment Avoidant

a.Therapist must gain clients trust, otherwise they fear rejection and also avoid coming (shocking) i.Come to therapy seeking acceptance and affection 1.Keeping them in therapy can be challenging because they soon begin to avoid sessions... (avoid social relationships) 1.Beyond building trust, therapists tend to treat the disorder as they treat social phobia and anxiety a.These treatments have had modest success b.Psychodynamic-recognize and resolve the unconscious conflicts that may be operating c.Cognitive- help them change their distressing beliefs and thoughts, carry on in the face of painful emotions, and improve their self image d.Behavioral- provide social skills training as well as exposure treatments to gradually increase social interaction..group therapy too.. e.Anti-depressant and antianxiety drugs are sometimes used

1.Histrionic Personality Disorder (once called hysterical personality disorder)

i.Are extremely emotional- they are typically described as "emotionally charged" - and continually seek to be the center of attention. Their exaggerated moods can complicate life considerably ii.Are always "on stage," use grandiose language to attract and impress an audience. They keep changing themselves to attract and impress an audience, they change not only their surface characteristics, but also their opinions and beliefs.. according to approval/praise/latest fads iii.Speech is actually scanty in detail and substance, seem to have lack a sense of who they really are iv.Vain, self-centered, demanding, and unable to delay gratification for long.. some make suicide attempts, often to manipulate others v.May behave provocatively and try to achieve their goals through sexual seduction.. vi.2-3% of adults have this.. males and females equally affected

4.Narcissistic Personality Disorders

i.Generally grandiose, need much admiration, and feel no empathy with others ii.Exaggerate their achievements and talents, expecting others to recognize them as superior, and often appear arrogant iii.Choosey about friends and associates.. because of charm, often make favorable first impressions, yet can rarely maintain long-term relationships iv.Seldom interested in the feelings of others v.React to criticism or frustration with bouts of rage, humiliation, or embitterment.. some may react with cold indifference vi.1% of adults experience, 75% men -v.This type of behavior is common among normal teenagers and does not usually lead to adult narcissism

3.Dependent Personality disorder

i.Have a pervasive, excessive need to be taken care of. -Clinging and obedient, fearing separation from their parent, spouse, or other person with who they are in a close relationships.. can not make smallest decision ii.Have difficulty initiating relationships and separation iii.Feel devasted when a close relationship ends and immediately seek out another one to replace it iv.Many cling persistently to relationships with partners who physically or psychologically abuse them v.Low confidence, rarely disagree, feel distressed, lonely, and sad, often they dislike themselves.. thus at risk for depressive, anxiety, and eating disorders vi.2% of population.. equally men and women

a.Conventional Antipsychotic Drugs

i.Known as neuroleptic drugs 1.Because they often produce undesired movement effects similar to the symptoms of neurological diseases a.Best known are: i.Thioridazine (Mellaril)/Fluphenazine (prolixin)/Trifluoperazine (Stelazine)/Haloperidol (Haldol) ii.Conventional reduce the positive symptoms of schizophrenia, such as hallucinations/delusions more completely, or at least more quickly than the negative symptoms.. (those who have positive symptoms usually recovery better than those with mainly negative) iii.Sometimes produce disturbing movement problems, called extrapyramidal effects (impact extrapyramidal areas of the brain that help control motor activity) 1.These undesired effects so common have separate category of disorders 2.Parkinsonian and Related Symptoms a.Similar to parkinson's disease, half of patients on conventional drugs experience muscle tremors and muscle rigidity, show little facial expression, move slowly, may shake, restlessness and discomfort in the limbs b.Result of medicaotin induced reductions of dopamine activity in the basal ganglia.. coordinate movement and posture.. c.Can be reversed with anti-parkinsonian drug w/antipsychotic 3.Neuroleptic Maligant Syndrome a.1% of patients/mainly elderly b.Fatal reaction, fever, altered consciousness, improper function of autonomic nervous system.. take off anti-psychotic 4.Tardive Dyskinesia a.Usually doesn't unfold until person has taken conventional drug for over a year i.Involuntary writhing or ticlike movements of tongue, mouth or face, or whole body, jerky movements, involuntary chewing, memory difficulties ii.Can be severe or only 1 symptom iii.Can be difficult to eliminate, it eventually disappears in most cases iv.Today clinicians try to prescribe the lowest effective dose and gradually reduce or even stop the medication

Atypical Antipsychotic Drugs

i.Most widely used: 1.Clozapine (Clozaril) 2.Risperidone (Risperdal) 3.Olanzapine (Zyprexa) 4.Quetiapine (Seroquel) 5.Ziprasidone (Geodon) 6.Aripiprazole (abilify) ii.The atypicals are received at fewer dopamine D-2 recoptors and more D-1, D-4, and serotonin receptors than the others iii.More effective than conventional drugs iv.Clozapine, most effective drug out of atypical v.Reduce not only the positive symptoms, but also the negative ones vi.Cause fewer extrapyramidal symptoms and seem less likely to produce tardive dyskinesia vii.Many bipolar patients also use 1.Those who take clozapine, have 1% chance of developing agranulocytosis, a life threatening drop in white blood cells (other atypical don't produce this) 2.Some atypical drugs cause weight gain, particularly among women, dizziness, and elevations in blood sugar 3.African Americans and Hispanic Americans are more likely than whites (should be European American in the textbook) to be prescribed conventional antipsychotic drugs... book says could be due to atypical more expensive.. and AA and HA go to family physicians more who are more inclined to prescribe conational.. so that group has more side effect problems that conventional drugs create 4.Research has shown that antipsychotic drugs reduce symptoms in at least 65% of patients diagnosed with schizophrenia a. More effective than milieu, psychotherapy, or electroconvulsive therapy 5. In most cases, drugs produce maximum level of improvement within the first 6 months.. and will go down or may with end of taking

Treatment Paranoid Personality

i.People with paranoid personality disorder do not typically see themselves as needing help (think everyone at fault) 1.Few come to treatment willingly 2.Those who are in treatment often distrust and rebel against their therapists ii.As a result, therapy for this disorder, as for most of the other personality disorders, have limited effect and moves slowly ii.Object relations therapists: try to see past anger and work on what they view as his or her deep wish for a satisfying relationship iii.Self-therapists: help client reestablish self-cohesion

Treatment Obsessive Compulsive Personality Disorder

i.People with this, don't think anything is wrong, so not likely to seek treatment unless come in for another disorder ii.Respond well to psychodynamic (help recognize and accept underlying feelings and insecurities)or cognitive therapy (help change dichotomous "all or nothing" thinking, perfectionism, indecisiveness, procrastination, and chronic worry iii.Respond well to SSRIS.. serotonin enhancing antidepressant drugs

5.Obsessive Compulsive Personality Disorder

i.Preoccupied with order, perfection, and control that they lose all flexibility, openness, and efficiency ii.Has trouble seeing bigger picture, become so focused on organization and details that they fail to grasp the point of activity iii.Set unreasonably high standards for themselves and others , never satisfied with their performance, iv.Unreasonably high standards for themselves and others, never be satisfied with their performance, but they typically refuse to seek help or to work with a team 1.Convinced that others are too careless or incompetent to do the job right. Because they are so afraid of making mistakes, they may be reluctant to make decisions v.Rigid and stubborn, particularly in morals, ethics, and values.. live by a strict moral code and use it as a yardstick to measure others vi.May have trouble showing affection .. and relationships sometimes stiff and superficial vii.1 to 2%.. white, educated, married, and employed most.. men twice as likely viii. anxiety disorder closely related..

Why? Obsessive Compulsive Personality Disorder

i.Psychodynamic dominate.. anal regressive.. overly harsh toilet training during the anal stage.. filled with anger and remain fixated at this stage.. becom extremely orderly and restrained.. 1.Early struggles with parents with control and independence may ignite impulses ii.Cognitive.. illogical thinking process.. dichotomous thinking

WHY? PSycho/behavioral/cognitive Dependent Personality

i.Psychodynamic-unresolved conflicts during the oral stage of development can give rise to a lifelong need for nuturance.. 1.Object relations theorists say that early parental loss or rejection may prevent normal experiences of attachment and separation, leaving some children with fears of abandonment that persist throughout their lives 2.Also could have been overinvolved and overproductive, increasing their children's dependency, insecurity, and separation anxiety ii.Behaviorists- parents rewarded children's clinging and loyal behavior iii.Cognitive- two maladaptive attitudes: "I am inadequate and helpless to deal with the world" or "I must find a person to provide protection so I can cope"

TREATMENT Borderline Personality

i.Psychotherapy can eventually lead to some degress of improvement for people with this disorder 1.Is is extraordinarily difficult, though, for a therapist to strike a balance between empathizing with a patients dependency and anger and challenging his or her way of thinking 2.Contemporary psychodynamic therapy has been somewhat more effective than traditional psychodynamic approaches when it focuses on the patient's central relationships disturbance, poor sense of self, and pervasive loneliness and emptiness ii.Over past 2 decades.. Dialectual Beahvior Therapy.. research for any other treamtne tfor this disorder 1.This approach grows largely from the cognitive-behavioral treatment model and borrows heavily from humanistic and psychodynamic approaches 2.DBT is often supplemented by the clients participations in social skill building groups... DO NOT put more than one borderline in a group. iii.Anti-depressant, antiboplar, antianxiety, and antipsychotic drugs have helped some individuals to calm their emotional and aggressive storms 1.Given the numerous suicide attempts by these patients, their use drugs on an outpatient basis is controversial iv.Many clients seem to have benefited from a combination of psychotherapy and drug therapy

4.Schizotypal Personality Disorder

i.Range of interpersonal problems, marked by extreme discomfort in close relationships, odd (even bizarre) ways of thinking, and behavioral eccentricities ii.These symptoms may include ideas of reference and or bodily illusions iii.People with the disorder often have great difficulty keeping their attention focused; conversation is typically digressive and vague, even sprinkled with loose associations.. iv.Most like schizo v.Man who had this.. talked to tree... had intimate relationship with tree.... (didn't talk back.. otherwise schizophrenia) vi.They tend to drift aimlessly and lead an idle, unproductive life, choosing undemanding jobs in which they are not required to interact with other people vii.IT has been estimated that 2 to 4% of all people (slightly more males than females) may have this disorder b.Explain i.Schizotypal resemble those of shzioprhenia.. similar factos are at work ii.Schizotypal symptoms are often linked to family conflicts and to psychological disorders in parents iii.Researchers have alos begun to link schizo to same bio of schizophrenia.. AHHHH

Treatment Schizoid Personality

i.Their social withdrawal prevents most people with this disorder from entering therapy unless some other disorder makes treatment unneccesary 1.Even then, patients are likely to remain emotionally distant from the therapist, seem not to care about treatment, and make limited progress at best ii.Cognitive Behavioral therapist have sometimes been able to help people with this disorder experience more positive emoitns and more satisfying social interactions 1.The cognitive and focuses on thinking aobut emotions 2.The behavioral end focuses on the teaching of social skills 3. present client with list of emotions to think about/write down positive emotional experiences iii.Group therapy is apparently useful as it offers a safe environment for social contact iv.Drug therapy is of little benefit.. comorbidity.. will help other thang.. but not personality disorder -behavioral: teaching social skills using role playing, exposure techniques, and homework assignments as tools

c.Treatment Schizotypal Personality

i.Therapy is as difficult in cases of schizotypal .. as in 2 above ii.Most therapist agree on need to help clients reconnect and recognize limits of their thinking and powers iii.Cognitive behavioral therapists further try to teach client to objectively evaluate heir thoughts and perceptions and provide speech lessons and social skills training iv.Anti-[psychotic drugs appear to b somewhat helpful in reducing certain thoughts and problems

Treatments: Antisocial Personality

i.Typically ineffective ii.A major obstacle is the individual's lack of conscience or desire to change 1.Most have been forced to come to treatment iii.Some cognitive therapists try to guide clients to think about moral issues and the needs of other people 1.Hospitals and prisons have attempted to create therapeutic communities iv.Atypical antipsychotic drugs also have been tried by systematic studies are still needed

TREATMENT Dependent Personality

i.Usually place all responsibility for treatment on the clinician ii.Important to help patients accept responsibility for themselves iii.Psychodynamic- focus on transference of dependency needs onto the therapist iv.Cognitive-behavioral- help people better express own wishes in relationships, and challenge their assumptions of incompetence and helplessness v.Group therapy can be helpful, so clients can receive support

Sociocultural schizo

ii.Family Therapy 1.Over 50% of people with schizophrenia living with family.. in general, people with schizophrenia who feel positively toward their relatives do better in treatment a.Recovered patients living with relatives with high levels of expressed emotion: relatives who are very critical, emotionally overinvolved, and hostile.. have higher relapse rate than those living with more positive and supportive relatives b.Family members may be greatly upset by behaviors and social withdrawal of the relative with the disease c.Family therapy, helps relatives develop more realistic expectations and become more tolerant, less guilt-ridden, and more willing to try new patterns of communication d.Also helps person with schizophrenia cope with pressures of family life, avoid troublesome interactions e.Research shows family therapy, with drug therapy.. helps reduce tensions within family and helps relapse rates go down f.Family support groups, family psychoeducation programs great too iii.Social Therapy 1.Include techniques that address social and personal difficulties in the clients' lives 2.Clinicians offer practical advice; work with clients on problem solving, decision making, and social skills, make sure clients taking meds, help find work, financial assistance, health care and proper housing 3.Help get people out of the hospital.. those taking meds and doing social therapy.. very successful iv.Community Approach 1.In 1963, in response to terrible conditions in public mental institutions a. Congress passed Community Mental Health Act i.stipulated that patients were to receive a range of mental health care services- outpatient therapy, inpatient treatment, emergency care, preventative care, and aftercare, in their communities 2.Thus began 4 decades of deinstitutionalization 3.Patients recovering from schizophrenia and other disorders profit greatly from community programs 4.Those communities that help meet peoples needs and make greater progress are: a.Coordination of patient services i.Treatment facility that would supply medication, psychotherapy, and inpatient emergency care to people.. make significant progress when this is available b.Short-term hospitalization i.Few weeks in hospital if combo of antipsychotics and psychotherapy doesn't work.. go to aftercare after released, which is follow up care and treatment in the community c.Partial hospitalization i.Day centers slash day hospitals.. daily supervised activities, therapy, programs to improve social skills d.Supervised residencies i.When can't live alone or without family, halfway houses.. group homes.. shelter.. receive training and ongoing supervisor.. milieu philosophy usually.. usually helps and avoid rehospitalization.. self government in program.. e.Occupational Training i.Job provides income, independence, and self respect, and work with others.. so preparing and training can help with schizo and other disorders be very helpful ii.Not as available, supported employment.. another option to help ease into full time job 5.Fewer than half of people who need community treatment don't get it 6.40 to 60 percent of people with schizo receive no treatment at all , and this can be due to poor coordination of services and shortage of services. Due to money.. most money goes to help with drugs.. less on community treatment .. social security disability income..

iii.Biosocial theory/Sociocultural Borderline Personality

iii.Biosocial theory: combination of internal forces and external sources iv.Sociocultural: likely to emerge in cultures that change rapidly (loss of structure and stability leads to it)

•Course of schizophrenia

oAppears between late teens and early 30s o3 phases: prodromal, active, and residual -Each phase of the disorder may last for days or years -a fuller recovery from the disorder is more likely in people: -with good premorbid functioning -whose disorder was triggered by stress -with abrupt onset -with later onset (during middle age) -who receive early treatment -The DSM 5 calls for a diagnosis schizo after 6 months.. or more... -impacted individuals to live lifes.. academic social functioning.. etc.. work, ability to care for themselves

•Diagnosing schizophrenia

oCan diagnose only after symptoms continue for 6+ months oMust show deterioration in their work, social relations, and ability to care for themselves o5 types of schizophrenia: disorganized, catatonic, paranoid, undifferentiated, and residual •Disorganized features: confusion, incoherence, and flat or inappropriate affect •Catatonic features: psychomotor disturbance of some sort •Paranoid features: organized system of delusions and auditory hallucinations that may guide their lives •Undifferentiated: cannot go into any one of the categories neatly, leads to being overused •Residual: symptoms of schizo lessen in strength and number yet remain in a residual form oAlso Type-I and Type-II to predict course of schizo •Type-I: dominated by positive symptoms •Better adjustment prior to disorder, later onset of symptoms, and greater likelihood of improvement •More closely linked to biochemical abnormalities •Type-II: dominated by negative symptoms •More closely linked to structural abnormalities

Biology Schizo

oGenetic factors • Some people inherit biological predisposition and develop the disorder later when they face extreme stress •Relative studies •More common among relatives of people, and more closely related, greater likelihood of developing the disorder •3% among second-degree relatives (half-sibs, uncles, aunts, nephew, nieces, grandchildren) and 10% among first-degree relatives (parents, siblings, children) •Doesn't give definite explanation; close family members exposed to same environmental influences and those influences may lead to disorder •Identical vs. fraternal twins •Identical twins have a higher concordance rate for disorder than fraternal twins •If identical, 48% chance both twins have it; if fraternal, 17% chance both have it •Also exposed to same environment especially prenatally, but identical twins should still have higher condordance •Adoptive •Biological relatives of adoptees with schizo are more likely than their adoptive relatives to experience schizo or schizo-like disorder •Genetic linkage and molecular biology •Identified possible gene defects on chromosomes 1, 6, 8, 10, 13, 15, 18, 20, 22 and on X chromosome •Indicate that some suspected gene sites are cases of mistaken identity and do not actually contribute to schizo •May also be a polygenic disorder, disorder caused by combination of gene defects •Biochemical and structural abnormalities in brain oBiochemical abnormalities •Electrical impulses/messages transmitted between neurons in neurotransmitters •Dopamine hypothesis: certain neurons that use the neurotransmitter dopamine (particularly in striatum region) fire too often and transmit too many messages, thus producing the symptoms of the disorder •Began with discovery of antipsychotic drugs, drugs that help remove symptoms of schizo •Phenothiazines were first to be discovered in 1950s, meant to be antihistamine drug to combat allergies but found to be effective in reducing schizo symptoms •Strength of dopamine-schizo link? •Most research supports this theory •Ex. People w/Parkinson's develop schizo-like symptoms if take too much L-dopa which then produces psychosis •Also, those who take high doses of amphetamines experience amphetamine psychosis, which is reduced by antipsychotic drugs •Phenothiazines and other psychotic drugs bind to many dopamine rich receptors in the brain oDrugs are dopamine antagonists—bind to dopamine receptors, prevent dopamine from binding there, and prevent neuron from firing o5 dopamine receptors: D-1, D-2, D-3, D-4, D-5, bind most strongly to D-2 •Precise role of dopamine •Messages from dopamine-sending neurons to dopamine receptors may be transmitted too easily or too often •People with schizo have larger than usual number of dopamine receptors (mainly D-2) or receptors operate abnormally •Theory does have problems: •1. Recent discovery of new antipsychotic drugs called atypical antipsychotic drugs which are more effective than originals oBind not only to D-2 dopamine receptors but also to many D-1 receptors and receptors for other neurotransmitters like serotonin oThus, schizo related to abnormal activity or interactions of both dopamine and serotonin and maybe other neurotransmitters like glutamate and GABA rather than dopamine alone •2. Excessive dopamine activity contributes to positive symptoms of schizo oPositive symptoms respond well to conventional drugs (bind to D-2) and negative symptoms respond well to atypical antipsychotic drugs (bind less strongly to D-2) oAbnormal brain structure •Mainly linked to negative symptoms •One is the enlargement of ventricles—brain cavities that have cerebrospinal fluid •Fewer positive symptoms •Tend to experience poorer social adjustment prior to disorder, greater cognitive disturbances, and poorer responses to conventional antipsychotic drugs •Enlarged ventricles may be a sign that parts of the brain have not developed properly or have been damaged, leading to schizophrenia •May have smaller temporal lobes and frontal lobes, less gray matter, and reduced or heightened blood flow in certain areas of the brain •Also have linked schizo to abnormalities of the hippocampus, amygdala, and thalamus oViral problems •Biochemical and structural abnormalities may come from genetic factors, poor nutrition, fetal development, birth complications, immune reaction, and toxins •May also result from exposure to viruses before birth that enter fetus' brain and interrupt proper brain development •Virus may also remain dormant until puberty or young adulthood and activated by hormones or another viral infection •Comes from animal investigations and unusually large number of people with schizo born in the winter •Winter birth rate of people w/schizo is 5-8% higher than other persons oIncrease in fetal or infant exposure to viruses •Evidence also from fingerprints •People with schizo often have significantly more or fewer ridges than their nonschizo identical twins (usually have almost identical fingerprints) •Fingerprints form in the fetus during the 2nd trimester of pregnancy when fetus is most vulnerable to viruses → fingerprint abnormalities could reflect viral infection contracted during prenatal period •Evidence that mothers of people with schizo were more likely to have been exposed to influenza virus during pregnancy than mothers of people without schizo •Evidence from studies that found antibodies to certain viruses in the blood of 40% of research participants with schizo, thus they were exposed to virus

oPsychomotor symptoms

•Awkward movements, repeated grimaces, odd gestures (private purpose) •Extreme form is catatonia •Catatonic stupor: stop responding to environment, remaining motionless and silent for long stretches of time •Catatonic rigidity: maintain rigid, upright posture for hours and resist efforts to be moved •Catatonic posturing: assume awkward, bizarre positions for long periods of time •Catatonic excitement: move excitedly, sometimes with wild waving of arms and legs

oBehavioral view- Schizo

•Cite operant conditioning and principles of reinforcement as cause of schizo •Most people learn to read and respond to social cues, and are better able to satisfy their own emotional needs and achieve their goals •Some not reinforced for their attention to social cues because of unusual circumstances or important figures in their lives are socially inadequate → stop attending to cues and focus on irrelevant cues → responses become increasingly bizarre, which are rewarded wit attention or other reinforcement so repeated again •Support is circumstantial •Considered a partial explanation at best -May help explain why a person displays more psychotic behavior in some situation than in others

Cognitive Aging Disorders

•Cognitive mishaps are common and normal features of stress or aging oAs move through middle age, memory difficulties and lapses of attention increase and may occur regularly by age 60-70 oSometimes people experience memory and other cognitive changes that are far more extensive and problematic •While problems in memory and related cognitive processes can occur without biological processes, more often cognitive problems have organic roots when they appear later in life oLeading cognitive disorder in elderly are delirium and neurocognitive disorders -Delirium, Alzheimer's, Neurocognitive

Aging Disorders: Anxiety

•Common in elderly •6% of men and 11% women in US (elderly) oGAD is particularly common, experienced by up to 7% of all elderly persons oPrevalence of anxiety increases throughout old age •Loss of independence •Many things about aging that may heighten anxiety levels, including declining health oResearchers not able to determine why certain individuals who experience such problems in old age become anxious while others who face similar circumstances reamin relatively calm •Older adults with anxiety disorders are often treated with psychotherapy of various kinds, particular CBT oMany receive antianxiety medications •All such drugs must be used cautiously with older people

Delirium

•Delirium is a major disturbance in attention and orientation to the environment oAs a person's focus becomes less clear, he or she has great difficulty concentrating and thinking in an organized way → misinterpretations, illusions, and on occasion, hallucinations •State of massive confusion typically develops over a short period of time (hours/days) oMay occur in any age group but most common in elderly •Fever, certain diseases, infections, nutrition, head injuries, strokes, stress, and intoxication by certain substances all cause delirium

Aging Disorders: Depression

•Depression is one of the most common mental health problems of older adults •Features of depression are same for elderly people as for younger people oAs many as 20% of people experience their disorder at some point during old age, more so in women •Studies suggest that depression among older people raise chances of developing significant medical problems •Elderly persons are also more likely to die by suicide than younger ones, and often their suicides are related to depression Studies suggest that depression raises an elderly person's chances of developing significant medical problems (ex. older depressed people with high blood pressure are almost 3 times as likely to suffer a stroke as older non depressed people with the same condition) Recover more slowly from surgeries, infections, and other illnesses Elderly suicide rate in the U.S. is 16 per 100,000 •Older people who are depressed may be helped by CBT, interpersonal therapy, antidepressant medications, or a combo •More than half of older patients improve with treatments •May be difficult for elderly people to use antidepressant drugs effectively and safely because the body's metabolism works differently in later life •Among elderly people, antidepressant drugs have a higher risk of causing some cognitive impairment -Treatments - Cognitive-behavioral therapy Interpersonal therapy Antidepressant medications - not as successful with older patients (body breaks medication down differently, may lead to cognitive impairment) ECT Combination of these approaches

oCognitive view

•During hallucinations and related perceptual difficulties the brains of people with schizo are actually producing strange and unreal sensations, triggered by biological factors •Further features of the disorder emerge when individuals attempt to understand their unusual experiences •Turn to friends/family to help with voices or troubling sensations who deny the sensations and sufferers begin to reject all feedback and develop delusions that they are being persecuted •"Rational path to madness" •Not enough research to support the cognitive notion that misinterpretation of such sensory problems produce syndrome of schizophrenia

oPsychodynamic view schizo

•Freud believed that it developed from 2 psych processes: (1) regression to a pre-ego stage and (2) efforts to reestablish ego control •When world has been harsh and withholding, some individuals regress to the earliest point in their development to the pre-ego stage of primary narcissism where they recognize and meet only their needs •Near total regression leads to self-centered symptoms, then try to reestablish ego control and contact with reality → More psychotic symptoms then arise •Studies do suggest that those with schizo experienced severe stress or trauma early in their lives •Fromm-Reichmann (clinician) came up with schizophrenogenic mothers, a type of mother supposedly cold, domineering, and uninterested in the needs of others, who was once thought to cause schizophrenia in her child •Very little research •Most have rejected these views and believe biological abnormalities leave certain persons prone to extreme regression or other unconscious acts that can contribute to schizo

oSociocultural view schizo

•Multicultural factors •Rates differ between racial and ethnic groups (African American and white American) o2.1% of AA receive diagnosis vs. 1.4% of WA oOverrepresented in hospitals and more likely to be assessed for symptoms •AA may be more prone to develop disorder •Another explanation is that clinicians from majority groups are unintentionally biased in their diagnoses of AA or misread cultural differences as symptoms of schizo •Also, AA more than WA are more likely to be poor oAlso Hispanic Americans also more likely to be economically disadvantaged have much higher rates of schizo than WA •Also differs by country oCourse and outcome of disorder vary although prevalence is stable (~1%) oSchizo patients who live in developing countries have better recovery than patients in Western and other developed countries oMay reflect genetic differences or that the psychosocial environment of developing countries tend to be more supportive and therapeutic than developed countries → better outcomes •Social labeling •Features of schizo are influenced by diagnosis itself •Once labeled is assigned, justified or not, it becomes a self-fulfilling prophecy that promotes the development of many schizophrenic symptoms •Expectations of others may subtly encourage individuals to display psychotic behaviors → accept assigned role and play it convincingly •Rosenhan experiment: normal people presented themselves at mental hospital complaining they had been hearing voices and were diagnosed with schizo oStaff members were authoritarian, did not interact, and responded uncaringly to patients oPatients described feeling powerless, bored, tired, and uninterested oDemonstrated that label "schizophrenic" can have negative effect on how people are viewed and how they themselves feel and behave •Family Dysfunctioning •Certain patterns of family functioning can promote/ sustain schizophrenic symptoms •Double-bind communications oDouble-bind hypothesis: some parents repeatedly communicate pairs of mutually contradictory messages that place children in so-called double-bind situations: the children cannot avoid displeasing their parents because nothing they do is right oSymptoms of schizo represent child's attempt to deal with double-binds oMessages consist of verbal communication (primary) and a contradictory nonverbal type of communication (metacommunication) •Saying, "I'm glad to see you." Then frowning and avoiding eye contact oChild who is repeatedly exposed to this develops special life strategy for coping with them and progress to paranoid schizophrenia oClosely related to psychodynamic schizophrenogenic mother oPopular in clinical field but investigation have not supported it •Role of family stress oParents of people with disorder display more conflict, have greater difficulty communicating with one another, and are more critical of and over involved with their children than other parents oSome families high in expressed emotion, members frequently express criticism, disapproval, and hostility toward each other and intrude on one another's privacy oMay also be the case that individuals with schizo disrupt the family life so may help produce family problems •RD Laing's View •Controversial and untested •Clinical theorist RD Laing argued that schizo is actually a constructive proves in which people try to cure themselves of the confusion and unhappiness caused by their social environment •Human beings must be in touch with their true selves to give meaning to their lives and it is hard to do in present day •We develop a false self from people's expectations, demands, etc. •Those with schizo have especially difficult obstacles to deal with: lifetime of confusing communications and demands form their families and community •Undertake inner search for strength and purpose and withdraw from others, increasingly paying attention to only their own inner cues •Argued that these people would emerge stronger and less confused if allowed to continue inner search but society and clinicians tell people they are sick, manipulate them into role of patient, and subject them to treatments that produce further psychotic symptoms •Not supported by research

oNegative symptoms

•Pathological deficits, lacking in an individual •Poverty of speech, blunted and flat affect, loss of volition, and social withdrawal •Poverty of speech—also called alogia, reduction in speech or speech content •Either say very little or say a lot with no content •Blunted/restricted and flat affect—show less anger, sadness, joy, and other feelings; flat affect is showing no feelings at all •Still faces, poor eye contact, monotonous voices •May have anhedonia or a general lack of pleasure and enjoyment •Inability to express emotions -avoidance of eye contact •Loss of volition—avolition or apathy, feeling drained of energy and of interest in normal goals and unable to start or follow through on a course of action •May display ambivalence or conflicting feelings about most things •Social withdrawal—withdraw from social environment and only attend to their own ideas and fantasies •Ideas are illogical and confused, so withdrawal has effect of distancing them from further reality •Leads to breakdown of social skills.. inapporiapate social interaction.. recognize other peoples needs and emotions

Positive symptoms

•Pathological excesses or bizarre additions to someone's behavior •Delusions, disorganized thinking and speech, heightened perceptions and hallucinations, and inappropriate affect •Delusions-ideas that they believe but have no basis in fact, faulty interpretations of reality •Delusions of persecution are most common, believe they are being plotted or discriminated against, spied on, threatened, attacked, or victimized •Delusions of reference: attach special and personal meaning to the actions of others or to various objects or events •Delusions of grandeur: believe themselves to be great inventors, religious saviors, or other specially empowered persons •Delusions of control: believe their feelings, thoughts, and actions are being controlled by other people •Disorganized thinking/speech—illogical and peculiar •Formal thought disorders can cause great confusion and make communication very difficult •Take form of loose associations, neologisms, perseveration, and clang oLoose associations—rapidly shift from one topic to another, believing their incoherent statements make sense oNeologisms—made-up words that only have meaning to the person using them oPerseveration—repetitive words and statements oClang—use rhyme to think or express themselves •Heightened perceptions and hallucinations—intensified senses, flooded by sights and sounds that are around them •Problems of perception and attention among people with schizophrenia •Deficiencies in smooth pursuit eye movement •Hallucinations—perceptions that occur in the absence of external stimuli oAuditory are most common, hear sounds and voices •Produce the nerve signals of sound in their brains, then believe that external sources are responsible •Increased blood flow to Broca's area (speech production) and auditory cortex when hearing hallucinations oTactile—tingling, burning, or electric-shock sensations oSomatic—feel as if something is happening in the body (snake in stomach) oVisual—vague perceptions of colors or clouds or distinct visions of people or objects oGustatory—food or drink tastes oOlfactory—smell odors no one else does oHallucinations and delusions usually occur together •Inappropriate affect—emotions that are unsuited to the situation oAlso inappropriate shifts in mood

Aging Disorders: Substance Misuse

•Prevalence of such patterns actually appears ot decline after age 60 -Surveys have found that 4-7% of older people, particularly men, have alcohol use disorder in a given year oAccurate data about the rate of substance abuse among older adults is difficult to obtain because many elderly persons do not suspect or admit they have such a problem •A leading kind of substance problem in the elderly is the misuse of prescription drugs, most often unintentional oGet confused, don't know when to take it •Yet another drug-related problem is the misuse of powerful medications at nursing home •Higher rate of psychotic symptoms than younger persons oAmong aged, symptoms due to underlying medical conditions like delirium and Alzheimer's oHowever, some elderly persons suffer from schizophrenia and delusional disorder -Older people who are institutionalized display high rates of problems drinking -People who don't start this behavior until their 50's or 60's typically begin abusive drinking as a reaction to the negative events and pressures of growing older -Treatments - detoxification, Antabuse, AA, and cognitive-behavioral therapy -A leading kind of substance problem is the misuse of prescription drugs (often unintentional) - take so many pills that they have a high risk of confusing medications or skipping doses -To combat this physicians and pharmacists often try to simplify medications, educate older patients, clarify directions, and teach them to watch for undesired effects -Another issue that is apparently on the increase is the misuse of powerful medications in nursing homes

Schizophrenia: Demographics

•Previous normal functioning, deteriorate into unusual perceptions, odd thoughts, disturbed emotions, and motor abnormalities •Experience psychosis—loss of contact with reality, ability to respond to environment is so disturbed that they cannot function; may be substance induced or caused by brain injury, but most psychosis appears in the form of schizophrenia •1/100 people suffer from schizophrenia •Increased risk of suicide (25% attempt) and physical illnesses •Most in lower SES level—already in poverty or maybe the illness lowers someone to the lowest class, downward drift theory •Occur equally in genders, but male onset is about 21 and female onset about 27 •3% of divorced may experience, 1% married, 2% single

Neurocognitive Aging disorder

•Significant decline in at least one area of cognitive functioning—memory, learning, attention, visual perception, planning, decision making, language, social awareness oIndividuals may also experience changes in personality and behavior •At any time, around 3-9% of the world's adult population are suffering from a neurocognitive disorder •If deficits impinge significantly on a persons life, it is a major neurocognitive disorder oIf decline is modest and does not interfere with independent functioning the appropriate diagnosis is mild neurocognitive disorder -Major - If the person's cognitive decline is substantial and interferes significantly with his or her ability to be independent -Mild - If the decline is modest and does not interfere with independent functioning -Alzheimer's Disease -

active schizo

•Symptoms become apparent •May be triggered by stress or trauma

prodromal schizo

•Symptoms not yet obvious, but individuals beginning to deteriorate •May withdraw socially, speak in vague or odd ways, develop strange ideas, express little emotions