schizophrenia and personality disorders
dramatic, emotional, or erratic behavior
Antisocial, borderline, narcissistic, and histrionic personality disorders - problems make it almost impossible to establish relationships - disorder causes not well understood
B. produce greater improvement and fewer rehospitalizations.
Compared with long-term institutionalization, short-term hospitalization that includes aftercare is more likely to:
A. cognitive restructuring approaches; hallucination reinterpretation and acceptance approaches
Exercises that boost attention, memory, planning, and problem-solving are classified as _____, whereas exercises that train people how to understand and neutralize the voices in their head are classified as _____.
neuroleptic drugs; atypical antipsychotic drugs
First-generation antipsychotic drugs are to _____, as second-generation antipsychotic drugs are to _____.
a reinforcer
In behavioral terms, what is a token?
coordinating services
In the treatment of schizophrenia, a case manager's primary goal is to help with:
antipsychotic medication
Individuals who were institutionalized for schizophrenia during the first half of the twentieth century probably received all of the following EXCEPT:
D. teaching residents to recognize when they engage in inappropriate behavior.
Milieu therapy includes all of the following components EXCEPT:
big five super traits
Neuroticism Extroversion Openness to experience Agreeableness Conscientiousness
negative affectivity, detachment, antagonism, disinhibition, psychoticism.
The five traits to be included in future revisions of the DSM-5 that utilize a dimensional approach in diagnosing personality disorders are:
schizophrenia; dissociative identity disorder
The phrase split mind is to _____ as the phrase split personality is to _____.
delusions
The symptom of schizophrenia most likely to be relieved by antipsychotic drugs is:
before birth
The viral explanation for schizophrenia suggests that brain abnormalities, and therefore schizophrenia, result from viral exposure:
social breakdown syndrome
Throughout much of the twentieth century, long-term institutionalized mental patients developed additional symptoms as a result of their institutionalization. The most common pattern of decline was:
operant conditioning
Token economies use the principles of _____ to treat people with schizophrenia.
biosocial explanation for boderline
combo of internal and external forces ,ex: social skill deficit -children have intrinsic difficulty identifying and controlling emotions, parents teach them to ignore their feelings - theory similar to leading explanation for eating disorder
object relations therapists: paranoid personality disorder
try to see past the patient's anger and work on what they view as his or her deep wish for a satisfying relationship
paranoid personality disorder
type of personality disorder characterized by extreme suspiciousness or mistrust of others - 4.4% of us adults, more common in men - limited close relationships
family therapy
helps relapse rates for schizophrenia
cormobidity
the appearance of multiple simultaneous psychological disorders in the same person
object relations for narcissits
theorist believe narcissists have a grand self image as a way to convince themselves as self sufficient, and dont need their parents
developmental psychopathology borderline
theorist believe that the central deficit in boderline PD is the inability to mentalize( capacity to understand their own mental states and those of others) - to recognize needs, desires, feelings - studies found relationships b/w poor parent - child attachments
cognitive behavioral theory for narcissits
theorist propose disoder develops when people are treated too positively rather than too negatively in early life overvalue of self worth
psychodynamic explanation for borderline
object relations theorist propose early lack of acceptance, or abuse there is some research
semi hospitals
24 nursing care for severe mental disorders
sociocultural views schizophrenia
-Multicultural factors: 2.1% are black, 1.4% are non white hispanics. Black are over represented in state hospitals -Social labeling -Family dysfunction: may studies show schizophrenia is linked to family stress parent often display more conflict, have difficulty communicating and are more critical of and over involved with their children
psychodynamic treatment for boderline
1) dialectical behavior therapy: weekly individual therapy and group skill. building session that last ~1 year. most successful treatment 2) relational psychoanalytic: therapist focuses on therapist- patient relationship. work to provide empathic setting, clients can explore unconscious conflicts, may help reduce suicide attempts
cognitive behavior therapies schizophrenia
1)cognitive remediation: focuses on the cognitive impairments that often characterize ppl w shizo such as difficulties w memory, attention, and planning studies show moderate improvement 2)hallucination reinterpretation and acceptance
problematic personality traits are either present or absent.
The categorical approach to personality disorders assumes that:
developmental psychopathology view
2 key points: schizophrenia starts to unfold long before the actual onset of the disorder in young adulthood, and dysfunction by schizophrenia related brain circuits leads to repeated overreactions by the HPA pathway in the face of stress
schizophrenia is triggered by many factors that operate together in a developmental sequence.
A developmental psychopathology theorist would be MOST likely to claim that:
gustatory
A hallucination involving the perception of taste (usually unpleasant).
social therapy
A patient who receives help in finding work, in finding a place to live, and in taking medication correctly is probably receiving:
partial hospitalization
A person who lives at home but spends the day at a mental health facility would be using which service?
dependent personality disorder
A personality disorder characterized by a pattern of clinging and obedience, fear of separation, and an ongoing need to be taken care of. - affects fewer than 1 % of people
culture
According to the DSM-5, a pattern diagnosed as a personality disorder must deviate substantially from the norms and expectations of the individual's:
aftercare
After Julian was released from a short stay in the psychiatric ward of a hospital, he would regularly visit a therapist who made sure that he was taking his medication and monitored how well he was adjusting to living in the community. This example illustrates the features of:
personality disorder
An enduring, rigid pattern of inner experience and outward behavior that impairs the sense of self, emotional experiences, goals, capacity for empathy, and/or capacity for intimacy is termed:
antipsychotic drugs
If one could use only a single treatment for schizophrenia and wanted the MOST effective treatment, one should choose:
cognitive behavioral therapy
If you are being treated for schizophrenia and are learning to distract yourself from the voices you hear and to reinterpret them as just a symptom of your disorder rather than reality, you are MOST likely receiving:
borderline
People with _____ personality disorder are emotionally unstable, impulsive, and reckless.
biological and psychological treatments
Research suggests that an effective treatment plan for schizophrenia should include:
research opportunities
The Community Mental Health Act stipulated that patients with mental disorders should receive all EXCEPT _____ without leaving their communities.
stressful events
The HPA pathway becomes activated when people experience:
malicious traits that work together to produce offensive behavior
What is the dark triad?
institutionalization
What was the dominant way of treating people with schizophrenia during the first half of the twentieth century?
antisocial
Which personality disorder is marked by a general pattern of disregard for, and violation of, other people's rights?
C. Schizophrenia has been linked to overactivity of some brain structures and underactivity of other brain structures.
Which statement BEST describes the relationship between brain circuits and schizophrenia?
. People with different diagnoses can exhibit psychosis; it is not limited to schizophrenia.
Which statement accurately reflects current thinking about psychosis and schizophrenia?
they were overcrowded and understaffed
Which statement is true of state mental hospitals in the United States in the mid-twentieth century?
Milieu therapy
a humanistic approach to institutional treatment based on creating a climate that promotes self respect, responsible behavior, and meaningful activity - started by Maxwell jones -patients reffered to as residents -often improves pts and they leave at higher rates
schizoid personality disorder
a personality disorder characterized by persistent avoidance of social relationships and little expression of emotion - individual focus primarily on self and is unaffected by praise of criticism - lack of intimacy interest, often family or marital problems - present in 3.1 % of us adults - slightly more common in men
Neuroleptic Malignant Syndrome
a severe, potentially fatal reaction consisting of muscle rigidity, fever, altered consciousness, and improper functioning of the autonomic nervous system - 1% who are elderly
10%
about how many people with schizophrenia experience catatonia?
first generation antipsychotics
aka neuroleptics - produce undesired movement affects similar to parkinsons - block excessive activity of dopamine - reduces symptoms in 70% of patients - reduce positive symptoms better than negative
token economy
an operant conditioning procedure in which people earn a token of some sort for exhibiting a desired behavior and can later exchange the tokens for various privileges or treats - is effective, 98% had been released compared to milieu(71%) - no control group, legal concern about human rights, also can't tell if patients are initiating normal behavior
catatonic posturing
assuming awkward, bizarre positions for long periods of time
delusions of reference
attach special and personal meaning to the actions of others or to various objects or events
second generations
atypical - received at fewer dopamine receptors and more D1, D4, and serotonin receptors - just as effective as 1st gen - reduced pyramidal symptoms - risk of 1.5 % of developing agranulocytosis: a life threatening drop in WBCs, when using clozapine - may cause weight gain, sexual dysfunction, dizziness
anxious or fearful behavior
avoidant, dependent, obsessive-compulsive
self theorists
believe biological deficiencies cause people with schizophrenia to develop a fragmented rather than integrated self
delusions of control
believe their feelings, thoughts, and actions are being controlled by other people
delusions of grandeur
believe themselves to be great inventors or saviors
biological control for boderline
biological: antidepressants, anti bipolar, antianxiety, or antipsychotic. many clinicians believe use of outpatient drugs is unwise
cognitive behavioral explanations: misinterpreting unusual sensations
brains produce unusual sensations triggered by biological factors - when individuals try to interpret their unusual sensations, more features of their disorders emerge - schizophrenics take a rational path to madness: zimbardo 1976
Avoidant Personality Disorder
characterized by constant discomfort and restraint in social situations, overwhelming feeling of inadequecy and extreme sensitivity to negative evaluation - similar to social anxiety - fear of social relationships (social anxiety=fear of social circumstances) - 2% of adults, equally in sexes
boderline personality disorder
characterized by instability, including major shift in mood, unstable self image, and impulsivity - psychopaths, sociopaths - unstable interpersonal relationships - prone to bouts of anger which sometimes result in physical aggression and violence - may harm themselves - found in 5.9% of us adults, most are women - fast becoming more common, most also have other disorders - 75% attempt suicide - typically have dramatic identity shifts, have have dissociation, may violate boundaries of relationships
schizotypal personality disorder
characterized by range of interpersonal problems, marked by extreme discomfort in close relationships, odd and bizarre ways of thinking and behavioral eccentricities - more severe than paranoid and schizoid PD - individuals believe unrelated events pertain to them in important ways(ideas of reference) - bodily illusions(sensing external force) - some see themselves as having extrasensory abilities - difficulty keeping attention focused, conversation typically digresive and vague, loose associations - affects 3.9% of adults, slightly more common in men
type 2 schizophrenia
dominated by negative symptoms 15-20% of cases
Type 1 Schizophrenia
dominated by positive symptoms 80-85% of cases
catatonia
extreme forms of psychomotor symptoms
tactile hallucinations
false feelings of burning tingling, electric shock
course of schizophrenia
first appears late teen's and mid 30s sufferers typically go through 3 phases: prodromal, active, and residual phase
self therapists: paranoid personality disorder
focus on the need for a healthy and unified self help clients reestablish self cohesion
psychodynamic explanations
frieda reichmann and sigmund freud: cold or unurturing parents may set schiozphrenia in motion (1948)
biological explanation for borderline
genetic predisposition, lower brain serotonin activity, abnormal brain structure/circuit activity, and anatomy - 35% of twins also have - hyperactive amygdala - under active hippocampus and prefrontal cortex - brain circuits believed to have poor interconnectivity
somatic hallucinations
hallucinations of feelings inside the body. ex: snake inside stomach
tardive dyskinesia
involuntary movements of the facial muscles, tongue, and limbs, chewing, sucking or lip smacking - late appearing, 6 month after taking first generations - jerky movements - over 15% of people who take 1st gens
psychosis
loss of contact with reality may have hallucinations most commonly is in form of schizophrenia
Neoglisms
made up words
catatonic rigidity
maintain a rigid, upright posture for hours and resist efforts to be moved
Histronic Personality treatment
more likely than other disorders to seek out help
catatonic excitement
move excitedly, sometimes wildly waving their arms and legs
psychomotor symptoms
moving slowly, making awkward movements, and odd gestures that seem to have a private purpose
Histronic Personality
once called hysterical PD - extremely emotional, continually seek to be center of attention - approval and praise are lifeblood - some make suicide attempts to manipulate others - affects men and women equally
cognitive behavioral explanations
operant conditioning: some people are not reinforced for their attention to social cues. they stop attending to social cues and focus on irrelevant cues such as brightness of light
odd or eccentric behavior
paranoid, schizoid, schizotypal - people w these disorders display behaviors similar to but not as extensive as schizophrenia
L-dopa
parkinson's medication that raises patients dopamine levels - when patients take too much it may develop schizophrenia like symptoms
extrapyramidal effects
parkinsonian and related symptoms neuroleptic malignant syndrome tardive dyskinesia
catatonic stupor
people stop responding to their environment, remaining motionless and silent for long stretches of time
loose associations
rapid shifts from one topic to another aka derailment
disorder of perseveration
repeat their words and statement again and again
schizotypal explanations
researchers have linked high activity of dopamine - linked to disorders ofmood, 2/3 have depression or bipolar disorder
downward drift theory
schizophrenia causes its sufferers to fall from higher to lower economic status
psychodynamic theory for dependent PD
similar to depression freudian: unresolved conflicts during oral stage of development object relations: early parental loss or rejection other: over involvement of parents