Psych 303 Exam 3

Schizotypal

- They are excessively introverted and have pervasive interpersonal and SOCIAL deficits like Excessive social anxiety associated with paranoid fears - But in addition, they have oddities in speech and behavior and cognitive and perceptual distortions: like Ideas of reference, Odd beliefs or thinking / speech, and Unusual perceptual experiences Looks alot like prodrome of schizophrenia CONTACT WITH REALITY IS NORMALLY MAINTAINED oddities in thinking, speech and behavior are the most stable characteristics of this disorder!

How does adolescent brain development appear to play a role in schizophrenia?

1) Adrenal hormones are high which can make you more vulnerable to stress Stressors that happen during adolescence could have a bigger impact on your brain than if they happened during another life period. Sensitivity to stress Then stress can affect hormones even more, can also be influencing normal brain development. 2) Big moment for your brain → a ton of changes are happening in your brain Such as progressive changes (things increasing) You also have some regressive changes in your brain, some synapses are pruning One finding in schizophrenia is that there may be too much synaptic pruning in this period

How is avoidant PD different from schizoid PD in terms of limited social relationships?

1) Avoidant PD -- patients show extreme social inhibition and introversion, leading to lifelong patterns of limited social relationships and reluctance to enter into social interactions BUT they desire affection and are often lonely and bored. They are shy, insecure and hypersensitive to criticism. 2) Patients with schizoid personality disorder often enjoy their aloneness These people tend to be rather aloof, cold and relatively indifferent to criticism

(Briefly) describe the proposed hybrid dimensional-categorical assessment model for PDs. Why was it abandoned by the DSM task force?

1) Combined categorical and dimensional components -- categories and did ratings of traits 2) Kept 6 of the personality disorders, cut 4 3) Including a set of general criteria for all personality disorders 4) Dimension for rating personality dysfunction 5) set of overall traits Why was abandoned: 1) New system was very complicated 2) It was not very intuitive or user friendly 3) Too cumbersome and judged too time consuming for overworked clinicians to learn and use 4) Rating people on dimensions is foreign to the way clinicians have been taught to think

Describe the Hearing Voices movement. What initial evidence suggests this approach may be helpful?

1) Encourages people who hear distressing voices to identify them, to learn about them, and to negotiate with them 2) There is some evidence that people using the Hearing Voice approach have diminished voices and the voices become kinder and may even disappear altogether 3) Patients who had six week trial of therapy who practiced speaking to computer animated avatar that represented their voices and they were encouraged to challenge the voices and the therapist using avatars voice responded in such a way that avatar shifted from persecuting them to supporting them , had less frequent, less intense and less disturbing hallucinations

What are the overall criteria for personality disorders (i.e., the criteria that are not disorder-specific)?

1) Enduring pattern of experience / behavior that deviates markedly from cultural expectations in at least two areas Cognition, affectivity, impulse control, interpersonal functioning, Mood regulation in affectivity usually 2) Consistent over time and across settings 3) Enduring / inflexible across wide range of situations 4) Clinically significant distress / impairment 5) Goes back to adolescence / early adulthood

What are the two types of narcissistic PD (under causal factors) suggested by your book? How might they relate to parenting styles?

1) Grandiose: manifested by traits related to extreme grandiosity, aggression, and dominance 2) Vulnerable presentation is not as clearly reflected in the DSM criteria but nevertheless represents a subtype long observed by researchers and clinicians. They have fragile and unstable sense of self esteem, and for these individuals, arrogance and condescension is merely a facade for intense shame and hypersensitivity to rejection and criticism. They may be completely absorbed and preoccupied with fantasies of outstanding achievement but at the same time experience profound shame about their ambitions. parenting: 1) Grandiose: has NOT been associated with childhood abuse, neglect or poor parenting, think it is associated with parental overvaluation 2) Vulnerable: intrusive, controlling and cold parenting styles and emotional, physical and sexual abuse

In what types of situations is neurosurgery still used today to treat psychological disorders?

1) It is a last resort for patients who have not responded to any other form of treatment for a period of 5 years and who are experiencing extreme and disabling symptoms 2) Patients with debilitating OCD, treatment-resistant severe self injury, or intractable AN

How do these callous-unemotional children seem different from those with ADHD or CD?

1) Kids with ADHD are impulsive but still feel guilty when they get caught / punished callous -unemotional children are unrepentant Kids with ADHD are disruptive and hard to control, CU kids show a capacity for mayhem They are able to manipulate kids CD kids are "hot blooded" and are impulsive Cold blooded is more like psychopathy It is a mix of impulsivity, aggression, manipulativeness and defiance -- and these overlap with other disorders Lack of empathy

Describe the research findings on ASPD and MAO-A.

1) MAO-A is the monoamine oxidase A gene which is involved in the breakdown of neurotransmitters like norepinephrine, dopamine and serotonin. MAO-A is involved in this breakdown, and they are all affected by stress and maltreatment that can lead to aggressive behavior. 2) Researchers found that individuals with low MAOA activity were more likely to develop ASPD if they experienced early maltreatment THAN individuals with low levels of MAOA activity and early maltreatments and individuals with low levels of MAOA activity without early maltreatment

Describe the research evidence for the link between schizotypal PD and schizophrenia.

1) Oddities in thinking, speech and behaviors are most stable characteristics of schizotypal personality disorder and are similar to those seen in patients with schizophrenia 2) They have the same deficit in ability to track a moving target visually that is found in schizophrenia 3) And they also show numerous other mild impairments in cognitive functioning including deficits in working memory and in ability to sustain attention -- both common in schizophrenia 4) They also show deficits in their ability to inhibit attention to a second stimulus that rapidly follows the presentation of first

What environmental or prenatal factors seem to increase the risk for schizophrenia?

1) Prenatal: Nutritional deficiency Blood type incompatibility Oxygen deprivation in the womb Mother having diabetes Low birth weight Maternal weight Emergency C section All types of maternal infections 2) Environmental: Urban births Father being older at the time of your birth Season of birth Maternal stress

Describe/explain the common criticisms of the concept of personality disorders and their diagnosis.

1) The criteria is often pretty vague 2) How do we know that it is "qualitatively different from normal?" everyone has traits they wish they could change about their personality. How do we change from this and moving into saying your personality is a disorder Less clear what this looks like for personality disorder 3) Do we really have the information to properly and accurately diagnose personality disorders in people? We do not know actually how consistent behavior is Has the person always felt this way? When you are struggling or experiencing certain emotions, the way you think of your past is more colored 4) The overlap is huge and comorbidity is ridiculous 5) Diagnostic heterogeneity -- there are 126 ways to diagnose BPD Even more than depression 6) Reliability -- interclinical ratings are often super inconsistent 7) Pejorative / discrimmination issues 8) By definition of being personality, these disorders should be pretty stable but they are not 9) Huge room for bias Racial bias in diagnosis of paranoid disorder Bias related to socioeconomic status

When experiencing hallucinations, where do people with schizophrenia show elevated brain activity? What does this suggest about the nature of hallucinations?

1) They have a reduction of gray matter volume in the left hemisphere auditory and speech perception areas. This could mean they are erroneously tagging the internally generated speech as coming from another source. 2) Neuroimaging studies reveal that hallucinating patients show increased activity in Broca's area -- an area of the frontal lobe that is involved in speech production. They are NOT having increased activity in the areas of brain involved in speech comprehension, which further increases support for this idea. These suggest that auditory hallucinations are actually internally generated speech that they are misunderstanding.

What are the characteristics of a therapeutic alliance?

1) a sense of working collaboratively on the problem 2) agreement between patient and therapist about the goals and tasks of therapy 3) an affective bond between patient and therapist the client expects and wants to be helped, therapist provides a new perspective, therapy situations offer the client a safe setting in which they can practice new ways of feeling, acting and developing courage and ability to take responsibility

What are some indicators that point toward a high risk for developing psychosis?

1) attenuated positive symptoms: example: starting to get in realm of delusions or unusual thinking, magical thinking 2) Negative symptoms 3) Disorganized symptoms 4) Decline in functioning 5) Cognitive changes

What two possible "neural abnormalities" associated with psychopathy are described in this article?

1) there is abnormality in the limbic system - the set of brain structures involved in processing emotions. Less gray matter, it's "like a weaker muscle" Psychopaths may understand what they are doing wrong but they do not "feel it" Experts specifically point to the amygdala, a part of the limbic system as a physiological culprit for coldhearted or violent behavior They fail to recognize distress in others and they may not feel it themselves 2) they have an overactive reward system, especially when primed for drugs, sex or anything else that delivers a ping of excitement Their brakes do not work For example, they will keep playing a gmabling computer game until they lose everything Faulty brakes, per say, may help explain why psychopaths commit brutal crimes -- their brains ignore cues about danger and punishment

Describe the 5 different ways of measuring success in therapy, and the weaknesses or strengths of each of these methods. (Note: this overlaps substantially with the "reasons why it's hard to evaluate therapy" that we'll discuss in class.)

1. Client ratings Weaknesses: A client is not necessarily a reliable source of information on therapeutic outcomes They may report they are feeling better to please therapist or they do not want to admit it has been useless Biased towards themselves Dissonant idea that therapy has been useless after spending a lot of time, money and distress over it → may want to convince themselves it was a good use of time Example: Beck Depression Inventory: a self report measure of depression severity 2. Clinician ratings Strengths: more objective than client Weaknesses: Clinician may be more objective than patient, but they also may not be the best judge of clients' progress because they may be biased in favor of seeing themselves as competent and successful They only have a limited observational sample from which to make judgements of overall change Clinicians can inflate improvement averages by deliberately or subtly encouraging difficult clients to discontinue therapy Example: Hamilton Rating Scale for Depression used by clinicians to measure the severity of a patient's depression 3. Third party ratings -- ratings by people not involved in treatments Trained independent evaluators -- trained to conduct clinical interviews and to rate the amount of clinical change that has occurred in a patient Seem to be more realistic than client or therapist Weaknesses: relatives may be inclined to see improvement they hope for Example: family members or trained independent evaluators 4. Objective measures Weaknesses: Some of the changes that such tests show may be artifactual where in high or very low scores tend on repeated measurements to drift toward the average of their own distributions Yields a false impression that real change has been documents Also more likely to focus on theoretical predictions of therapist or researcher Without follow-up assessment, they provide little info on how enduring any change is likely to be Example: performance on psychological tests, measured before and after therapy Not valid 5. Overt behaviors -- observed behavior directly Strengths: It is objective and difficult to fake Often reflective of precisely the change that is intended in treatment Weaknesses: May be less appropriate for problems that are less easily observed Example: if a patient has a bug phobia, the clinicians can observe the client's ability to approach and hold bugs before, during and after the treatment to see if the behavior has changed

Describe the major approaches to behavior therapy (exposure, aversion, modeling, systematic reinforcement, token economies).

1. Exposure therapy, Guided exposure to anxiety provoking stimuli Patient is confronted with fear producing stimulus in therapeutic manner Very controlled, slow, gradual way (systematic desensitization) or in more extreme manner (flooding) Systematic is thought to relax or behave in some other way that is inconsistent with anxiety while in presence of anxiety producing stimulus Can be real -- in vivo exposure Imaginary -- imaginal Starts by being in a state of relaxation Then therapist and client have made anxiety hierarchy and could start slow 2. Aversion -- modifying undesirable behavior by the old fashioned method of punishment Example: antabuse- induces nausea and vomiting when person drinks alcohol and has taken it Or snapping a rubber band on your wrist when temptation arises 3. Modeling Client learns new skills by imitating another person, such as a parent or therapist who performs the behavior to be acquired Behavior could also be modeled when therapist thinks out loud about everyday choices 4) Systematic reinforcement: systematic programs that use reinforcement to increase the frequency of desired behavior Typically used in institutional settings Suppress problematic behavior by removing the reinforcements that support it as long as they can be identified Therapy can be administered to establish desired behaviors that are missing Response shaping -- positive reinforcement is used to establish by gradual approximation, a response that is actively resisted or is not initially in an individual's behavioral repertoire Token economics 5) Token economics -- started in long term stays in psychiatric hospitals Patients earned tokens when they behaved properly Could use tokens to receive rewards or privilege Token economy resembles outside world, where individual is paid for his or her work in tokens (money) that later can be exchanged for desired objects and activities Still relevant for individuals with serious mental illness and developmental disabilities

What types of factors suggest that the effectiveness of psychotherapy might be overstated (based on meta-analyses of RCTs)? (also in Jacobson)

2 pieces -- one from Jacobson We may be overstated it because people are expecting clinical significance and we are giving them statistical significance May call a drug successful in an RCT Not being clear about amount of change we are offering Meta Analyses do not include sketchy therapies, types of therapies that are least likely to be effective People who are not feeling good / feeling harm from it tend to quit → makes it seem better than it did Average goes up in tests for example, because lowest test scores for test one leaves But also maybe some people do better

What is a delusion? What are delusions of reference?

A patently false belief. People can have delusions but not have schizophrenia Example: the idea that bleach is not an effective treatment for covid: not a delusion Delusion example: your dog is listening to you at work through a telephone. They are super resistant to disconfirming evidence Delusions of reference: you think things refer to you that actually do not

Is there strong evidence linking BPD to childhood adversity/abuse? Explain.

Although the two have been linked, child adversity though cannot be regarded as a specific risk factor for ONLY borderline pathology, it is reported at relatively high rates by people with all of the other personality disorders as well. We should also keep in mind that childhood abuse nearly always occurs in families with various other problems such as poverty, marital discord, parental separations, parental substance abuse, and family violence BUT it does not take away from findings that childhood adversity is commonly found in people with BPD

What is the most common type of hallucination? What are other types of hallucinations?

Auditory hallucinations are the most common So much media makes it seem like most common is visual Other types: visual, tactile (feeling like something is crawling on you), olfactory: smell hallucinations

Avoidant

Avoids occupational activities that involve significant interpersonal contact Unwilling to get involve with others unless certain being liked Shows restraint in intimate relationships Preoccupied with being criticized / rejected in social situations Views self as inferior

Why might treating these children with Ritalin be dangerous?

Because it suppresses their impulsive behavior and might enable them to plan crueller and more surreptitious reprisals

What are the key features of borderline PD?

Biggest: instability in mood, unstable sense of self, instability in interpersonal relationships Hypersensitivity to criticism etc!!!! Sometimes this shows up in people with BPD clinging to other people --- Inability to self soothe A lot of love and hate Serious distress Some say it is not an actual personality disorder, but that it is just mood disorders

Explain the findings regarding enlarged brain ventricles and schizophrenia.

Brain ventricles are fluid filled spaces that lie deep within the brain. Patients with schizophrenia have enlarged brain ventricles. They are important because they are an indicator of a reduction in the amount of brain tissue. In addition, decrease in brain volume is present very early on in the illness and even patients with a recent onset of schizophrenia have lower brain volumes than controls which shows that brain abnormalities likely predate the illness!!!! Brain volume changes can be seen in genetically high risk individuals as the illness develops. It has been suggested these changes may play a causal role in onset of symptoms

How is psychopathy typically assessed?

Checklist -- score of 30 of more to be labelled as psychopath Done with an in depth clinical interview Not just like you are going online and filling out an assessment online

Explain the difference between clinical and statistical significance. Why is this difference relevant to research evaluating whether psychotherapy is effective? (also discussed in lecture)

Clinical significance refers to the extent to which clients feel that therapy has given them something approximating what they came for or has made a meaningful difference in their lives. This difference is relevant to research evaluating whether psychotherapy is effective because people can feel different (clinically significant) but the therapy may not show statistically significant. The two have no relation -- " the size of the statistical effect tells you little or nothing about its clinical significance". Not sure statistical effectiveness translates to clinical effectiveness in treatments. A lot of our effects are really small - about what we are expecting

Explain what the scientist-practitioner gap is and the basic evidence for this gap. How might some therapists respond to criticism suggesting that they are not using scientific findings to guide their therapy?

Concrete manifestations -- diff schools Two different types of doctoral programs More ab providing treatments v research PhD versus Psyd (?) Most dropped Psyd Now just a handful PhD -- exclusively focused on research Professional organizations that made a big split Accreditation -- APA did not focus on empirically supported therapies Now accredited by both at NU Other was focused on science Clinicians are not using scientific supported therapies, continue to use therapies that do not have scientific groundings Each person is complex, experience is a valuable source of information Scientists are not meeting these clients and speaking with them Ones we know work but are not used as frequently Failure on part of scientists Left APA because they were concerned that APA was not scientifically grounded Thinking we are the scientists etc We have seen a break off -- one more focused on practice and one more on science

Dependent

Difficulty making everyday decisions without advice and reassurance from others Needs others to assume responsibility for major areas of life Difficulty expressing disagreement due to fear of loss of support Lack of confidence/ starting things themselves Feels helpless when alone

Antisocial

Failure to conform to social norms regarding lawful behaviors Deceitfulness Impulsivity Irritability and aggressiveness Lack of remorse Shown symptoms of conduct disorders before age 15

What are the major differences between first generation and second generation antipsychotics? Are antipsychotics effective in the treatment of schizophrenia? Explain.

First generation were given in big dosages which made them seem tranquilizing You can get tardive dyskinesia Second generations block a broader range of dopamine receptors Same mechanism Some people thought better for negative some do not Side effects are a little better Hospitalizations are a little better → preventing them Not a huge difference generally They are effective, but can change how your brain responds to dopamine / makes your brain more sensitive to dopamine ¼ of people are not helped at all by antipsychotics She would call them effective from a clinical standpoint Diabetes, weight gain More unpleasant than antidepressants Do not help as much over the long term → prolong issue by making your brain more sensitive to dopamine compliance is low

Borderline

Frantic efforts to avoid real or imagined abandonment Pattern of unstable and intense relationships characterized by alternating between idealization and devaluation INSTABILITY Recurrent suicidal gestures or threats or self harm Emptiness Difficulty w anger

One of Jacobson's arguments is that therapists should be more like physicians in terms of how they present treatment options. Explain this.

Give all treatment options and explain pros and cons Explain costs, benefits and risk of each one Not keep going with treatment after clearly it is not helping

Narcissistic

Grandiose sense of importance Fantasies of unlimited power, success, brilliance, beauty Believes they are special and can be only understood by other high status Sense of entitlement Lacks empathy

Does experience/training have an impact on the effectiveness of therapists? Explain.

He argues that the psychotherapy outcome is not improved by either years of clinical experience or by professional training. There was a study that compared therapists with an average of 25 years of experience to college professors with no therapy training, experience or supervision. Professors did as well as trained professionals. He argues the only advantage is that the experienced therapists have a lower drop out rate

What are the four main dimensions of psychopathy? How does psychopathy differ from a diagnosis of antisocial PD?

Interpersonal Affective Lifestyle Antisocial Antisocial is much more narrow-- it is more behavioral and focused on people acting out Psychopathy has this emotional dimension, it includes emotional and relationship functioning piece You do not have to be "callous unemotional" to get ASPD diagnosis Antisocial is much more focused on "antisocial behaviors" Behaviors that violate rights of others Not so much concerned with Some lack of remorse but not as broad Psychopathy - has antisocial behaviors, but also has issues with cold and manipulation No empathy Successful psychopaths typically are less impulsive

What are some of the reasons it is so difficult to determine whether therapy is effective?

It can be hard to answer whether it was effective even with science Alot of people may feel the need to inaccurately say it helped even if it did not because they want to justify their effort They spent a lot of money Hard to go to therapy! Emotionally Compliance "Therapists are nice" effect. If you really like your therapist and get along well with them, it would feel weird to be like it does not help Statistical artifact -- there is a regression towards the mean People wait to go often until they feel really awful. Then they return towards mean--s Is it because therapy helped? Or is it because they had a natural return to the mean

Describe dialectical behavior therapy.

Like CBT, but with extra components CBT → such as challenging automatic negative thoughts Mindfulness Rogerian acceptance -- focused on the idea we have capacity for growth Distress tolerance -- working on it by individual therapy, phone coaching, skills training group, team approach Mentalization -- learning to distinguish what is in your head and what is in other people's heads Goal hierarchy 1) self harm 2) decreasing behaviors that interfere with therapy 3) decreasing escapist behaviors 4) emotional regulation and distress tolerance 5) last, anything patients choose

What is manualized therapy? Why was it developed?

Manualized therapy is the standardization of psychosocial treatments (as in development of a manual) to fit the randomized clinical paradigm. Manualized therapy represents one way researchers have tried to minimize the variability in patients' clinical outcomes that may result from characteristics of therapists themselves. They originated to standardize psychosocial treatments to fit the RCT paradigm.

What types of methodologies have linked maternal flu to schizophrenia in offspring?

More gennerallyBIG ONE: A psychiatrist got access to data of samples of thousands of pregnant woman at diff stages of pregnancy. Compared mothers of 64 children who went on to develop schizophrenia with blood samples of similar mothers who did not. Women who had higher levels of flu antibodies in 1st or second trimester of pregnancy had offspring who were 3-7 times more likely to develop schizophrenia. He calculated that 14 percent of schizophrenia cases could have been prevented had the women not had the flu. Animal research: pregnant rodents given flu infections seem more likely to have offspring that show behavioral symptoms of schizophrenia AND when effect of maternal antibodies is blocked, the offspring do not go on to develop such symptoms More generally: Children of women who were pregnant during widespread flu epidemics seem to have a higher risk for schizophrenia Particularly bad flu seasons → more rates of schizophrenia

How has research attempted to explain the less-than-perfect concordance rate between monozygotic twins? (address mutations and epigenetics)

Mutations: Everyone has mutations: deletions, copies, etc In discordant MZ twins (what is this? A set of identical twins with one having sch and one does not), twin who has schizophrenia tends to have more mutations in their DNA Maybe every mutation in key areas increases risk in tiny way, working in concert Epigenetics (changes in expression of genes): Environment can change how your genes are expressed (turning off and on), your DNA is not actually changing If you take rats and make them obese, epigenetic changes they experience have been passed on to their off spring Looking at discordant MZ twins, they do not look the same epigenetically What this suggests: something is going on at the level of genetics that is being inherited for one? Maybe the reason why one developed schizophrenia? 2 key periods of brain development: Puberty Infancy Same periods where we see epigenetic changes! Prenatal development and adolescence Prenatal is astonishing

How would you sum up our current research findings with respect to cannabis use and psychosis risk?

NOT A CAUSE, JUST A RISK 1) Smoking weed can raise your risk for schizophrenia, but does not mean that everyone who smokes will develop schizophrenia 2) Maybe someone has a high risk due to genetics and then uses weed and develops psychosis 3) We think the causation could go both ways -- people who are at greater risk for developing schizophrenia use weed more 4) We do not know whether it is a risk factor or if we see elevated levels of use because they are trying to cope 5) As symptoms get worse, increased use in weed use 6) Is attitudes changing affecting how people use it?

Schizoid:

Neither desires or nor enjoys close relationships Always chooses solitude Little interest in sex No close friends usually / lacks Coldness, detachedness

Are treatments for ASPD (or psychopathy) typically effective? Explain.

No medications help these Cognitive strategies MAYBE can help But typically not super effective, it is not looking good Teaching empathy is thought to maybe make things worse ASPD-- just convincing people to channel energies into behaviors that are not antisocial,, doing more neutral or prosocial things

Describe the research findings with respect to P50 suppression.

P50 is the response to hearing two clicks in close succession, because the response occurs 50 milliseconds after the click. Normal subjects -- the response to the second click is less marked than the response to the first click because the normal brain "dampens or gates" responses to sensory events. Many schizophrenia patients respond almost as strongly to the second click as the first. This is called poor P50 suppression. Patients with schizophrenia have problems with both basic and higher level cognitive processing

Describe the different positive and negative symptoms of schizophrenia, along with features of impaired thought/language (discussed in class) associated with schizophrenia.

Positive: new, negative: loss of functioning you used to have etc Positive: Hallucinations: sensory experiences that do not correspond with reality It is split from reality, it is not as though you are just sensitive to a certain sense Tactile : Feeling something is crawling on you Olfactory: smelling something that is not there Most common is auditory Delusions: Patently false beliefs as described by researchers Idea bleach is an effective for covid -- not "delusion" More like your dog is listening to you through the phone at work Delusions are resistant to disconfirming evidence Conspiracy theories -- you normally think its true because you are finding evidence that supports it There are diff types: grandiosity, persecutory, sin/guilt, somatic, could think it is about thought insertion (things being inserted into your head) Belief your intestines have been removed or something Disorganized symptoms (sometimes lumped in with positive, sometimes not) People are hard to understand Could be disorganized thinking / symptoms Formal thought disorder -- how someone's thoughts are coming out are the problem Content is not disturbed, how it is coming out is the problem For example: loose association -- you just go from one idea to the next and it's unclear the connection (most common marker of schizophrenia), sometimes called derailment Or neologisms- incorporate new words in your speech that sound similar to actual words but are not Clangs -- respond based on rhymes but not what said etc Usually in severe cases Disorganized behavior - could be like super inappropriate, or you could have grossly impaired motor skills and movements Email: great example of disorganized speech Lot of distress and paranoia Disorganized behavior: inappropriate behavior Wearing coats in summer Having trouble with day to day hygiene Catatonic behavior: grossly impaired motor skills Positive get more attention, disrupt people more Negative: Emotional / affective flattening Sometimes called blunted affect Just expression of emotion not actually feeling it Alogia: poverty of speech Still talk but brief, empty replies Do not carry on convos as you used to Avolition: you do not have sense of being able to pursue your goals No sense of pursuing your goals Lost sense of will Hygiene etc Anhedonia: loss of ability to feel pleasure :( People with negative tend to feel multiple of them Asociality: social withdrawal, shows up super early Shows up early usually, before positive symptoms Negative tend to be less disruptive but they cause the most impairment and have the worst prognosis Having a lot of negative = worse prognosis

Obsessive Compulsive

Preoccupied with details, rules, lists, schedules Perfectionism that interferes with task completing Excessively devoted to work and productivity Overly conscientious and inflexible ab matters or morality Reluctant to delegate Rigidity

What are the components of this "new" type of treatment? (new way to treat people after first schizophrenia episode)

Provided people years of "coordinated speciality care" which includes psychotherapy, medication, supported employment and education, help for families of the mentally ill person, and case management Also described as coordinated, sustained services that can be provided in a typical community mental health settings The most critical element of treatment may be starting it as quickly as possible after a first psychotic episode Found a substantial difference in effect for patients who began treatment less than 74 weeks after their first symptoms

How do arousability and stimulation-seeking play a role in psychopathy?

Psychopaths often have lower resting heart rates and low levels of arousability Low fear in threatening situations They are constantly seeking stimulation -- not thinking of fear or consequences

Describe the findings regarding psychopaths and fear conditioning/fear-potentiated startle.

Psychopaths showed deficient conditioning of skin conductance responses when anticipating an unpleasant or painful event and they were slow at learning to stop responding in order to avoid punishment. Psychopaths presumably fail to acquire many of the conditioned reactions essential to normal avoidance of punishment, to conscience development and to socialization. Psychopaths are deficient in conditioning of at least subjective and certain physiological components of fear. They do learn at a cognitive level that conditioned stimulus predicts the unconditioned. Psychopaths do not show a larger startle response if a startle probe stimulus is presented when subject is in an anxious state. The psychopaths showed SMALLER rather than larger startle responses when viewing unpleasant and pleasant slides than when watching neutral slides

Describe characteristics of an RCT for psychotherapy and how these characteristics differ from how therapy is typically practiced in the "real world." (Don't memorize them - just understand them and be able to give examples.)

RCT Random assignment to treatment and control conditions Manualized treatments with fidelity ensured Make sure therapist are doing what they are supposed to be doing Structured sessions Recording sessions etc Fixed number of settings Outcomes are well operationalized Example: you are treating patients for depression - what outcomes would you be looking for? Do they meet criteria for disorder? Person giving you therapy should not be evaluating whether its working Patients meet criteria for a single disorder Real world You do not get randomly assigned Not of fixed duration Self correcting in terms of technique Often if something is not working, you and your therapist switch directions There is active shopping by patients Comorbidity is the norm

Describe the treatment approach at Mendota.

REWARDS REWARDS REWARDS stable, decompression, always keeping calm and being there Run by psychologists and psychiatric - care technicians

What are the methodological critiques of those who find the Dodo Bird verdict invalid or over-stated?

Research is well done but not without limitations Researchers do not mess up Meta-analysis -- combining results is the whole point, you have to lump studies together even if they are a little bit different There is collapsing across families of treatments Not a necessarily bad choice Like collapsing between psychodynamic and other type treatment Putting a ton of therapies in like one metaanalysis Collapsing 6 types of therapy, half work super well half do not work at all -- see issue Collapsing across diagnoses Depression, OCD and GAD together for example But those diagnoses have super diff treatments For example there are also findings that for anxiety and mood disorders, behavior and cognitive approaches are more effective than many treatments. In addition, you need exposure for phobias, insight oriented therapies do not work well. But for childhood behavior disorders, behavioral treatment is preferable. Depression is more flexible than anxiety Only include bona fide therapies Potentially harmful therapies often were not included And people most harmed are most likely to drop out of trials (also true about mainstream therapies)

Describe the findings regarding cold-blooded behaviors and the brain.

Researchers have linked cold-blooded behaviors to low levels of cortisol and below normal function in the amygdala, the portion of the brain that processes fear and other aversive social emotions

How does schizoaffective disorder differ from schizophrenia (in terms of diagnostic criteria)?

Schizoaffective disorder: a hybrid between schizophrenia and severe mood disorders conceptually Diagnostic difference #1: you must have an uninterrupted period of illness during which there is a major mood episode concurrent with Criterion A of schizophrenia You have to have delusions or hallucinations in absence of mood disorder Major mood episode symptoms are present during majority of the active and residual portions of illness

How does schizophreniform disorder differ from schizophrenia (in terms of diagnostic criteria)?

Schizophreniform disorder: schizophrenia like psychosis that last at least a month but do not last for 6 months and so do not warrant a diagnosis of schizophrenia Same thing where you have to have 2 or more of the following with 1 being 1, 2, or 3: Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior Negative symptoms Episode only has to last 1 month, and less than six In Schizophrenia, disturbance persists for at least 6 months (1 month of active symptoms and may include periods of prodromal or residual symptoms)

What are some risks associated with labeling a young child as a psychopath?

Some argue that it is almost impossible to diagnose accurately in children or teenagers because their brains are still developing AND because normal behaviors at this age can be misinterpreted as psychopathic Other fear that even if such a diagnosis can be made accurately, the social cost of branding a young child a psychopath is simply too high No one is sympathetic to the mother of a psychopath There are indications the trait may be innate

How could these findings offer an alternative explanation (i.e., non-genetic) for the concordance rates for schizophrenia found in monozygotic vs. dizygotic twins?

Some of the increased risk among identical twins may be a result of maternal infections during pregnancy since twins who share a common placenta (and therefore are more likely to receive the same maternal cytokines) have a higher risk of schizophrenia than identical twins who do not share a common placenta

Paranoid

Suspects without evidence that others are exploiting, harming or deceiving them Preoccupied with unjustified doubts about loyalty and trustworthiness of others Reads hidden meanings in benign remarks Drugs Quick to criticism

Explain the "Dodo Bird Effect" and what might account for this effect.

That every therapy works the same Common factors -- Instilling empathy Giving attention Someone listening to you Instilling hope Only bona fide therapies are included

What's the main point of this article? In other words, what do the flu and flu vaccines have to do with schizophrenia?

That studies show an increased risk for schizophrenia is linked to maternal infections during her first and second trimesters of pregnancy -- especially flu infections And that the symptoms may be only the very last stage in a long progress

Be able to briefly describe the findings of the clinical trial for the treatment of schizophrenia that we discussed in class (also covered in your "a new way to treat" reading).

That talk therapy focused on building social relationships and managing symptoms and mood symptoms along with lower levels of antipsychotics has better outcomes

When researchers reviewed home videos of individuals who later developed schizophrenia, what factors seemed to predict the disorder?

The children had motor abnormalities including unusual hand movements (more than their healthy siblings), and they also showed less positive facial emotion and more negative facial emotions.

How might maternal flu lead to schizophrenia in offspring? In other words, what is the proposed mechanism here?

The immune reactions to either the flu or the vaccine, and the risk is increased as a result of maternal antibodies Just seems to be immune response, rather than the flu itself

Describe the authors' main concern and their recommendations to address it.

The main concern that we are too focused / credulous towards scientifically implausible treatments. Believing in blind allegiance to randomized control trials. Recommendations: Says authorities in mental health need to move beyond randomised control trials alone and adopt broader science based criteria that consider plausibility of therapeutic rationals and proposed changed mechanisms. Consider all scientific evidence that might influence an intervention Treatments whose rationales contradict well-established findings do not merit the same evidentiary standing as other interventions Second, journal reviewers and editors should adopt these recommended criteria and be skeptical of therapeutically plausible hypothesis

Explain the findings regarding cardiac reactivity in successful vs. unsuccessful psychopaths.

The successful psychopaths showed greater heart rate reactivity under stress than the controls or the unsuccessful psychopaths did. This could be because greater heart rate reactivity serves them well in processing what is going on in risky situations and perhaps facilitating them making decisions that may prevent them from being caught. They both have completed similar and same number of crimes but successful often are not convicted

What differences were found between the voices heard by those with schizophrenia in the U.S. vs. India?

The voices heard by patients in India are considerably less violent than those heard by patients in California In US -- it is something like telling them to torture people or cut someone's head off Or speaking of war Of suicide India -- commanding voices often instructred patients to do domestic chores or distigusting things like -- drinking toilet water, but horrible voices often seemed more focused on sex Local culture may shape the way people with schizophrenia pay attention to the complex auditory phenomena generated by disorder and shift what voices say and how they say it

How does brief psychotic disorder differ from schizophrenia?

There is a sudden onset of psychotic symptoms or disorganized speech or catatonic behavior. There is great emotional turmoil, but episode only lasts a matter of days which is too short to warrant a diagnosis of schizophreniform disorder. Similar to schizophrenia in that have to have of Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior And one must e 1, 2 or 3 Duration is from 1 day to less than 1 month and you have an eventual return to premorbid level of functioning.

Explain the research findings with respect to the offspring of non-diagnosed discordant MZ twins. (This section is right above Figure 13.3.)

These scientists found that schizophrenia was just as likely to show up in offspring of the twins without schizophrenia in discordant pairs as they would be to show up in the offspring of the twins with schizophrenia, which. may be surprising. Scientists found an age-correlated incidence rate for schizophrenia of 17.4 percent for the offspring of the MZ twins without schizophrenia. Far exceeds normal expectancy.

In what ways could you argue that most therapists are not engaging in fully informed consent?

They are not giving patients the full range of options, cost and benefits They often have patients continue even if progress is not being seen/made

Histrionic

Uncomfortable when not center of attention Interaction characterized by inappropriate sexually seduction or provocative behavior Rapidly shifting and shallow expressions of emotions Highly suggestible Speech is excessively impressionistic Considers relationships more intimate than they actually are

What does it mean to say that schizophrenia is likely a "neurodevelopmental disorder?"

We do not think that your brain is fine and then one day you just develop schizophrenia But rather, there are things that seem to increase risk / things that seem to maybe predate the onset of it For example -- genetic risk because family member Prenatal factors increase risk There are also things like adolescence increases your risk because there are so many things going on in your brain Home video study -- odd motor movements There were things going on even before we could see any serious symptoms from schizophrenia Schizophrenia is resulting from things happening unusually in the development of the brain Prenatally yes, but also infancy and adolescence

What is the evidence for the "virus" theory of schizophrenia? Explain how the difference between monochorionic and dichorionic twins is relevant to this theory (text around Figure 13.5).

We know that new genetic research is linking schizophrenia to the presence of genes involved with immune function. So then we can think schizophrenia might result from some kind of virus (not a new idea). Evidence: 1) people that are born between January and March are more likely than expected by chance to get schizophrenia. 2) There was a major flu epidemic in Finland, and that year there were elevated rates of schizophrenia in children born to mothers who were in their second trimester of pregnancy at the time of the influenza epidemic. 3) In california, flu exposure during the first trimester of pregnancy was associated with a sevenfold increased risk of schizophrenia or schizophrenia spectrum disorders in offspring and flu exposure in first half of pregnancy was associated with a threefold increase in risk. 4) Other maternal infections such as German measles and a very common parasitic infection that occur during pregnancy have also been linked to increased risk for later development of schizophrenia. Twins-- All DZ twins and some MZ twins do not have equally similar prenatal environments. Meaning that the higher concordance rate for schizophrenia in MZ than in DZ twins might therefore be a consequence, at least in part, of the greater potential for monochorionic MZ twins to share infections (MZ twins that share a placenta and blood supply)

What is tardive dyskinesia?

Weird movements above the neck Abnormal movements in tongue, lips, neck, head All above the neck

what is attenuated positive syndrome?

experiencing attenuated positive symptoms a few times a month and it is starting to interfere with daily life In clinical range, never have reached a 6 on her level

What are the guidelines with respect to diagnosing personality disorders in children?

ou can only diagnose a personality disorder in children under unusual circumstances: 1) For example, you cannot diagnose antisocial personality disorder in children, you get conduct disorder 2) Consistent symptoms for a year → trying to rule out that it is not a phase

What is brief intermittent psychosis syndrome?

someone is above the threshold on one symptom, maybe once or twice a month they have one psychotic symptom but it only lasts a short time

what is genetic risk and functional decline syndrome?

when you have a familial risk and you see a decline in social functioning