Module 43(Schizophrenia & Other Disorders)

Those suffering from anorexia nervosa are drastically underweight, while those suffering from bulimia nervosa are within or above the normal range.

Despite having several features in common, what is the primary distinction between anorexia nervosa and bulimia nervosa?

impaired theory of mind

Difficulty reading other peoples' facial emotions and states of mind

His condition is likely to deteriorate over time.

Donald is a 35-year-old man with schizophrenia. He has struggled with mental illness since childhood, when he had anxiety and impaired judgment. He began experiencing psychotic symptoms at age 19, which have been only partially controlled by medication. What is Donald's prognosis?

Flat effect

Emotionless, a state of no apparent feeling

a positive symptom

Frank was seen laughing inappropriately in the library as if he was responding to internal stimuli. On the bus home, he was crying uncontrollably and suddenly became angered when a fellow passenger offered him a tissue. His excess of inappropriate behavior is:

anorexia nervosa

Raquel was initially excited to make the cheerleading squad. However, her parents noticed that she stopped eating dinner with them after making the squad and dropped from 115 to 90 pounds. This case demonstrates symptoms of:

narcissistic

Stacy has to be the life of the party. She has to be the center of attention, even with her married friends' husbands. This behavior has upset a number of her friends, especially when she monopolizes all conversation to focus on herself. Stacy may be considered to have _____ personality disorder.

antisocial

Steve has never been able to keep a job. He has been in and out of jail for theft, sexual assault, and spousal abuse. Steve would most likely be diagnosed as having _____ personality disorder.

disorganized thoughts

Thirty-year-old Nellie has been diagnosed with schizophrenia. Her selective attention is deficient, she is unable to ignore irrelevant stimuli, and she often gives her undivided attention to minute stimuli such as a spotlight shining in a window. This type of attention problem contributes to:

•Personality disorders: Inflexible and enduring behavior patterns that impair social functioning. •These disorders forms three clusters, characterized by: -anxiety, that predisposes the withdrawn avoidant personality disorder -eccentric or odd behaviors, such as the emotionless disengagement of schizotypal personality disorder -dramatic or impulsive behaviors as seen in borderline personality disorder, narcissistic personality disorder, and antisocial personality disorder

WHAT ARE THE THREE CLUSTERS OF PERSONALITY DISORDERS? WHAT BEHAVIORS AND BRAIN ACTIVITY CHARACTERIZE THE ANTISOCIAL PERSONALITY?

delusions

false beliefs

antisocial anxiety disorder

-A person with antisocial personality disorder displays: •Lack of conscience for wrongdoing, even toward friends and family members •Often impulsiveness, fearlessness, irresponsibility -Criminality is not an essential component of antisocial behavior—and many criminals do not fit the description of antisocial personality disorder (since they show responsible concern for their friends and family members).

dissociative disorder

-Controversial, rare disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings

brain abnormalities

-Dopamine Overactivity •Resulting hyper-responsive dopamine system could intensify brain signals, creating positive symptoms -Abnormal Brain Activity and Anatomy •Often low activity in frontal lobes •Vigorous activity in thalamus and amygdala when experiencing hallucinations •Enlarged, fluid-filled areas and corresponding shrinkage and thinning of cerebral tissue •Smaller-than-normal cortex and corpus callosum

Prenatal Environment and Risk

-Low birth weight -Maternal diabetes -Older paternal age -Lack of oxygen during delivery -Maternal prenatal nutrition -Midpregnancy viral infection (factors examined include flu incidence, population density, season of birth)

schizophrenia

A psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression. •The word itself means "split" (schizo) "mind" (phrenia). •Schizophrenia is the chief example of a psychotic disorder, which is marked by irrationality, distorted perceptions, and lost contact with reality. •With treatment and a supportive environment, over 40 percent of people with schizophrenia will have periods of a year or more with normal life experience. But just 1 in 7 of those diagnosed will make a complete and enduring recovery.

negative symptoms

Absence of appropriate behavior

anorexia nervosa

Although she is underweight, Lindsey is extremely afraid of becoming obese. She often checks her body in the mirror for any signs of fat and refuses to eat most foods because she insists they are fatty or high in calories. Lindsey MOST clearly demonstrates symptoms of:

Genetic Influences -Odds of being diagnosed with schizophrenia are nearly 1 in 100; 1 in 10 for those with diagnosed family member -Risk for adopted children is related to biological parent -Schizophrenia influenced by many genes •Some influence the activity of dopamine and other brain neurotransmitters •Others affect the production of myelin Epigeneticfactors influence gene expression

HOW DO GENES INFLUENCE SCHIZOPHRENIA?

personality disorders

Inflexible and enduring behavior patterns that impair social functioning.

narcissistic

Jack was called into his boss' office last week for once again overstepping the boundaries of his position. Jack had told the director of research that he was the one running the show and that it would only be a matter of time before he was in his boss' position. When confronted, Jack admitted having said that, explaining that no one seems to understand that he is the one in charge. Jack may have a(n) _____ personality disorder.

borderline

Jeremy talks nonstop and behaves in ways that make everyone notice him, even strangers walking down the street. Jeremy would most likely be diagnosed as having _____ personality disorder.

antisocial personality disorder

Kyle is extremely manipulative. He can look anyone in the eye and lie convincingly. His deceit often endangers the safety and well-being of those around him, but he is indifferent to their suffering as a result of his actions. His behavior BEST illustrates:

antisocial

Low levels of anxiety are most characteristic of _____ personality disorder.

Is much higher than average

Marcus' twin brother and maternal grandmother both have been diagnosed with schizophrenia. This means that Marcus' risk for developing schizophrenia:

hallucinations

Michael complains that threatening voices are constantly telling him he is so evil he should kill himself. Michael is experiencing:

avoidant

Monel is extremely afraid of rejection. Because of this, she has always been withdrawn. Her inflexible and enduring behavior patterns have impaired her social functioning, and she would likely be considered to have a(n) _____ personality disorder.

delusions

Mr. Harlan incorrectly believes that people are constantly laughing at him and that FBI agents are trying to steal his savings. Mr. Harlan is suffering from _____.

delusions

Mr. James incorrectly believes that people are constantly laughing at him and that FBI agents are trying to steal his savings. Mr. James is suffering from:

schizophrenia

Mrs. Higgins believes that aliens from another planet have removed her stomach and are watching to see how long it takes her to grow another. Mrs. Higgins is MOST likely suffering from:

bulimia nervosa

Person alternates binge eating (usually of high-calorie foods) with purging (by vomiting or laxative use), sometimes followed by fasting or excessive exercise

positive symptoms

Presence of inappropriate behavior

•Increased dramatically in the late twentieth century. •Is rarely found outside North America. •DID may reflect role playing by people who are vulnerable to therapists' suggestions. •Some psychodynamic theorists view this disorder as a manifestation of feelings of anxiety. •Some learning theorists view this disorder as a response learned when behaviors are reinforced by anxiety-reduction. •Some clinicians include dissociative disorders under the umbrella of posttraumatic stress disorder.

understanding dissociative identity disorder

chronic schizophrenia

•(also called process schizophrenia) -Form of schizophrenia in which symptoms usually appear by late adolescence or early adulthood -As people age, psychotic episodes last longer and recovery periods shorten

acute schizophrenia

•(also called reactive schizophrenia) -Form of schizophrenia that can begin at any age, frequently occurs in response to an emotionally traumatic event, and has extended recovery periods Often positive symptoms that respond to drug therapy

dissociative identity disorder

•(formerly called multiple personality disorder) -Rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities

Disorganized Thinking and speech

•Delusions: False beliefs •May have paranoid tendencies •Word salad (senseless speech) and a breakdown in selective attention

understanding eating disorders

•Family environment for those diagnosed with anorexia is often competitive, high-achieving, protective •Those with eating disorders often have low self-evaluations, set perfectionistic standards, and are intensely concerned with how others perceive them •Heredity: Disorders seen more in identical twins than in fraternal twins •Cultural pressures: Ideal body shapes vary across cultures and time •Other influences: Low self-esteem, and negative emotions interact with stressful life experiences •Prevention programs have had success; especially effective when interactive and focused on girls over age 15

diminished and inappropriate behaviors

•Flat affect: Emotionless, a state of no apparent feeling •Impaired theory of mind: Difficulty reading other peoples' facial emotions and states of mind •Emotional deficiencies occur early in illness and have a genetic basis •Inappropriate motor behavior, with motionless catatonia or senseless, compulsive actions

Disturbed Perceptions

•Hallucinations: Seeing, feeling, tasting, smelling things that exist only in the mind

abnormal brain activity and anatomy

•Often low activity in frontal lobes •Vigorous activity in thalamus and amygdala when experiencing hallucinations •Enlarged, fluid-filled areas and corresponding shrinkage and thinning of cerebral tissue •Smaller-than-normal cortex and corpus callosum

anorexia nervosa

•Person (usually an adolescent female) maintains a starvation diet despite being significantly underweight -People with anorexia nervosa continue to diet and sometimes exercise excessively because they view themselves as fat.

Dopamine Overactivity

•Resulting hyper-responsive dopamine system could intensify brain signals, creating positive symptoms

binge-eating disorder

•Significant binge eating, followed by distress, disgust, or guilt, but without the compensatory purging or fasting that marks bulimia nervosa •American rates: 0.6% anorexia, 1% bulimia, and 2.8% binge-eating