Abnormal Psychology Exam 3
Schizophrenia: Psychological Perspective: Freud
A state of deep regression, the ID is in control
Psychological and Social Treatments: Family Therapy
- Basic education about the disorder - Training of family members - Inappropriate behaviors - Disorder's impact on caregivers
Personality and Abnormality: Personality characteristics are abnormal when they:
- Are inflexible and maladaptive AND Cause significant functional impairment, OR cause subjective distress*
Dissociation: Earnest Hilgard (1904-2001)
'The hidden observer' • Active and passive mode of consciousness
Disorganized Speech
(formally thought disorder) - Tangentiality - Loose associations - "word salad" (rare) POSITIVE SYMPTOM
Borderline Personality Disorder: Object Relations: Otto Kernberg (1928-) Melanie Klein (1882-1960)
- 'second generation' psychodynamic theories - Borderline Personality Organization - A child interacts with his/her mother via aggression - the mother does not process the aggression but return in to the child - the child develops defense mechanisms that are primitive - Split, Denial, projective identification Borderline - Adult that us these low level defense mechanisms fearing annihilation
Borderline Personality Disorder Prevalence
- 1.6-5.9% - lifetime = 2-3% - 20% of psychiatric inpatients - women account for 75% of cases - 6-8% commit suicide
Why are developing countries better for people with schizophrenia?
- 14% of cases are given medications in developing countries opposed to 98% in the US are immediately given medications. - Developing countries are more connected and live more closely. They will adjust to make it work for them, they understand you have an issue
Avoidant Personality Disorder treatment
- 3 randomized, controlled clinical trials have been conducted - surprise! Cognitive-behavorial treatments used in social phobia works well - Not to be confused with Schizoid PD
Avoidant Personality Disorder
- Extreme sensitivity to the opinions of others - Highly avoidant of most interpersonal relationships - Interpersonally anxious and fearful of rejection - Nearly Indistinguishable from severe, generalized type of social phobia - "There appears to be a great deal of overlap between Avoidant Personality Disorder and Social Phobia, Generalized Type, so much so that they may be alternative conceptualizations of the same or similar conditions." DSM-IV, p. 720
Schizoid Personality Disorder Treatments
- Few seek professional help - Focus on the value of interpersonal relationships - Building empathy and social skills - Very little is known - # clinical trials: 0
Paranoid Personality Disorder: Treatment
- Few seek professional help • Why would they? it's terrifying for them. - Treatment focuses on development of trust- Cognitive therapy for inaccurate thinking- Very little is known- # clinical trials: 0
Histrionic Personality Disorder treatment
- Focus on problematic interpersonal behaviors - Little evidence that any treatment is effective • No clinical trials have ever been conducted
Disorganized or Catatonic Behavior
- Includes a variety of unusual behaviors - from childish behavior to unpredictable agitation - Catatonia POSITIVE SYMPTOM
Schizotypal Personality Disorder: Treatment
- Main focus is on social skills - Prognosis is generally poor - # clinical trials: 1 (antipsychotic meds)
Components of Dialectical Behavior Therapy
- Mindfulness: practice of being fully aware and present in this one moment - Distress Tolerance: how to tolerate pain in difficult situations, not change it - Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others - Emotion Regulation: how to change emotions that you want to change - Other classic cat components: cognitive restructuring, exposure therapy, behavioral analysis
Schizophrenia: Twin Studies
- Monozygotic twins - Risk for schizophrenia is 46% - Fraternal (dizygotic) twins - Risk drops to 14%
Antisocial Personality Disorder
- Noncompliance with social norms - violate rights of others - irresponsible, impulsive, and decitful - lack a conscience, empathy, and remorse Diagnosis of ADP requires evidence of conduct disorder before age 15 - Aggression to people and animals - destruction of property - deceitfulness or theft - serious violation of rules
Schizotypal Personality Disorder
- Odd and unusual behavior and appearance - Most are socially isolated, highly suspicious - Magical thinking, ideas of reference, and illusions - but not delusions • Ideas of reference vs. delusions • Illusion vs. hallucination Causes - Relationship with schizophrenia - A phenotype of a schizophrenia genotype?
Histrionic Personality Disorder
- Overly dramatic, sensational, and sexually provocative - impulsive and need to be center of attention - thinking and emotions are perceived as shallow - mostly females
Borderline Personality Disorder
- Patterns of unstable moods and relationships - Impulsivity, fear of abandonment, very poor self-image - self-mutation and suicidal gestures are common - most common PD in clinical settings - commodity rates are high
Paranoid Personality Disorder
- Pervasive and unjustified mistrust and suspicion - Motto: "don't forgive, get even" - Hypersensitivity, hostility, detachment • Causes - Mostly unclear, some genetic evidence - Learning that the world is a dangerous place and that others can'tbe trusted (?)
Schizoid Personality Disorder
- Pervasive detachment from social relationships - Limited range of emotions around others - Indifferent about relationships (not fearful of them) • Causes - Etiology is unclear - Preference for social isolation resembles autism? - The case of Hikikomori
Conversion Disorder: Etiology
- Psychodynamic view is popular but scientifically unsupported • Focus on past trauma and conversion of psychological issues to physical symptoms - Biology - Motor and sensory areas affected by anxiety (not supported) - Behaviorism - Secondary gain and negative reinforcement (changes the focus of the actual trauma or anxiety)
Somatic Symptom and Related Disorders: Related Terms
- Psychosomatic symptoms - Conversion/Hysteria - Factitious - Hypochondriasis - Primary and secondary gains
Conversion Disorder: Epidemiology
- Rare condition - estimated 2-5/100,000 - Although transient conversion symptoms are common (5% in neurology clinics) - Primarily females
Dependent Personality Disorder
- Reliance on others to make major and minor life decisions - Unreasonable fear of abandonment - Clingy and submissive in interpersonal relationships
The Dopamine Hypothesis of Schizophrenia
- Severe stimulant abuse, (and increase in DA activity) results in psychotic symptoms - Thus: neuroleptic medication that is a DA antagonist (blocks DA receptors) should reduce symptoms of schizophrenia • And this is how the Dopamine hypothesis for Schizophrenia was born • However there is a debate, and ample evidence that the DAhypothesis is too simplistic.... - "Any simple, exclusive pathology of the dopamine system in schizophrenia was, and is doubtful" (Jocaite and Nyberg, 2012) • Moreover, this was a post hoc rationalization But... (first generation) antipsychotics did not improve (andactually exacerbated) negative symptoms In fact, these first generation antipsychotics caused significant neurological, and endocrine side affects • Along came the 'atypical' antipsychotics • They block mesolimbic dopamine, but also block serotonin • Blocking serotonin → increases DA in prefrontal areas
Personality Traits
- Suspiciousness ( Completely Trusting -> paranoid/Mistrusting) - Sociability ( Very Extraverted -> Painfully shy) - Empathy ( Overly Caring -> Not at all caring)
Chlorpromazine/Thorazine
- Was synthesized in 1951 in France as part of an attempt to develop a potentiator for general anesthesia - They found that people that took Thorazine to undergo operation also experienced 'disinterest' but not lack of consciousness - The first paper published in 1952 had the title "A new vegetative (autonomic)stabilizer:4560 R.P." - This drug was never intended to 'cure' schizophrenia, just to control the symptoms of active psychosis - The frequently used term 'anti-psychotic' - instead of the taxonomic class of drugs called neuroleptics - was adopted as a marketing strategy
Narcissistic Personality Disorder causes
- early failure to learn empathy as a child? - product of the "me" generation?
Narcissistic Personality Disorder
- exaggerated/unreasonable sense of self-importance - preoccupation with receiving attention - lack sensitivity and compassion for other people sensitive to criticism, envious, arrogant In clinical settings: - Will expect special consideration and care with no regard for other patients or staff -- will push limits because they "deserve extra" - if they do not get special treatment, staff is "incompetent" and they will become furious (Narcissistic rage) - need compliments and admiration, or they will feel wounded
Obsessive-Compulsive Personality Disorder
- excessive and rigid fixation on doing things the right way - highly perfectionistic, orderly, and emotionally miser - stringent about money - moto "its my way or... my way!" - relationship to OCD (comorbidity, perhaps genetic) - But, As opposed to OCD, true obsessions and compulsions are very rare
Borderline Personality Disorder Treatment
- few good treatment outcome studies - Antidepressants medications - some short-term relief - Dialectical Behavior Therapy - (DBT) Most promising treatment, considered only-evidence-based treatment for BPD - Developed by Marsha Linehan - DBT was initially developed to help people for suicide
Treatment of Antisocial Personality Disorder
- few seek treatment on their own - very poor prognosis - empathy training? NOPE - incarnation is often the only option
Narcissistic Personality Disorder treatment
- focuses on grandiosity, lack of empathy - little evidence that treatment if effective no clinical trials have ever been conducted
Histrionic Personality Disorder causes
- largely unknown - sex-taped variant pf antisocial personality? - who decided this was a disorder? - what would be the queilivant disorder in men?
Obsessive-Compulsive Personality Disorder treatment
- little is known - addresses fears related to the need for orderliness and perfection and procrastination
Dependent Personality Disorder causes and treatment
- little is known - no clinical trials have ever been conducted
Borderline Personality Disorder causes
- run in families - early trauma and abuse seem to play some role - emotional reactivity coupled with an invalidating environment - there are functional brain imaging findings, mainly frontal cortex, but.... correlation does not mean causation
Avoidant Personality Disorder causes
- similar to social phobia
Antisocial personality disorder prevalence
1-3%
Negative Symptoms: The 4 A's
1. Affective Flattening /Restricted Affect 2. Avolition/Asociality (or Apathy) 3. Alogia 4. Anhedonia
Symptoms of Schizophrenia: Negative Symptoms
1. Affective flattening/Restricted affect 2. Avolition/Asociality (apathy) 3. Alogia 4. Anhedonia
Symptoms of Schizophrenia: Positive Symptoms
1. Delusions 2. Hallucinations 3. Disorganized thought (speech) 4. Disorganized or catatonic behavior
Schizotypal Personality Disorder: Items from Perceptual Aberration Scale:
1. Sometimes I have had the feeling that I am united with an object near me. 2. I have sometimes felt that some part of my body no longer belongs to me. 3. I have sometimes had the feeling that my body is decaying inside. 4. My hands or feet seem far away. 5. Occasionally it has seemed as if my body had taken on the appearanceof another person's body.
Histrionic Personality Disorder prevalence
1.8%
Kappa
100 people
Paranoid Personality Disorder Prevalence
2.3-4.4%
Dissociation
A disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment
Somatic Symptom Disorder
A new DSM-5 disorder; Estimated prevalence 7% Experiencing significant physical (somatic) symptoms (usually pain) with anxious preoccupation and worry - As a result of psychological factors - There may or may not be a medical finding/reason - Regardless, the preoccupation, attention, worry, burden and suffering is excessive ! Hard to detect or diagnose a psychosomatic disorder among people with a real physical disorder Real pain, but someone is overreacting to a minor pain, sometimes someone with a history of cancer will have this
Dissociative Identity Disorder (DID): DSM 5 Criteria
A) Disruption of identity characterized by two or more distinct personality states involving marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning B) Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting
Conversion Disorder: DSM 5 Criteria
A) One or more symptoms of altered voluntary motor or sensory function B) Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions C) The symptom or deficit is not better explained by another medical or mental disorder D) The symptom of deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation
Illness Anxiety Disorder: DSM 5 Criteria
A) Preoccupation with having or acquiring a serious illness B) Somatic symptoms are not present; In case of pre-existing medical condition preoccupation is excessive, the preoccupation is clearly excessive or disproportionate C) High level of anxiety about health, and the individual is easily alarmed about personal health status D) Individual performs excessive health related behaviors or exhibits maladaptive avoidance E) Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time F) Illness-related preoccupation is not better explained by another mental disorder
Factitious Disorder: DSM-5
A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception. B. The individual presents himself or herself to others as ill, impaired, or injured. C. The deceptive behavior is evident even in the absence of obvious external rewards. D. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.
Residual Symptoms
After acute psychotic episode, mostly negative
Psychogenic amnesia
Amnesia due to a psychological reason with no neurological cause (rarely anterograde)
Personality and Abnormality: Personality
Appears early in life, and is somewhat stable and chronic
Personality and Abnormality: Personality Disorders
Appears early in life, and is somewhat stable and chronic
Criterion gender bias (Ford & Widiger, 1989):
gender dramatically effects which personality disorder is diagnosed
Prodromal Symptoms
Before the active psychotic episode, mostly negative
Illness Anxiety Disorder & Somatic Symptom Disorder: Treatment
Behavioral therapies • Learn and eliminate reinforcements that individuals get from symptoms; increasing positive reward for 'healthy' behaviors • Searching for an answer brings relief (positive reinforcement) Cognitive therapies: • Help to learn and challenge physical symptoms to avoid catastrophizing them • Medications - modest effects, CBT - better results!
Schizophrenia: Sociocultural Factors
Better prognosis, better functioning, less revolving door in developing countries
Atypical antipsychotics (e.g., Risperidone):
Bind to the D4 dopamine receptor, and influences several other neurotransmitters like serotonin - Side effects • Dizziness, nausea, sedation, seizures, hyper-salivation, weight gain, and tachycardia • Agranulocytosis
Can a personality disorder be 'treated'?
Can be managed
Biological Treatments: Typical Antipsychotic Drugs
Chlorpromazine: Blocks DA receptors Effective in reducing positive symptoms Calms agitation and reduces hallucinations and delusions Do not alleviate negative symptoms Side effects- - Blurred vision, sexual dysfunction, weight gain or loss, constipation, menstrual irregularities in women, and depression. - Extrapyramidal Symptoms such as Akinesia • Tardive dyskinesia
Genetic predisposition + biological and environmental factors (Schizophrenogenic family?) influence manifestation of the disorder
Consider that people that have a parent or two with schizophrenia and have a genetic predisposition for it, they have a higher risk of developing schizophrenia
DID - Etiology and Treatment
DID is probably a result of coping strategies used by persons faced with trauma Sociocognitive model: Alternate identities are created to adopt an idea that fits the patient's life More of a deep role playing (with a secondary gain) • Treatment - Integrate all alters into one coherent personality - Help rebuild the capacity to trust healthy relationships - No medications indicated
Agranulocytosis
Deficiency of granulocytes, substances produced by the bone marrow to fight infection
1896 - Emil Kraeplin coined the term __________________, indicating premature brain degeneration
Dementia Praecox
Personality Disorders and the DSM
Diagnoses disappear (and reappear) at a much higher rate in the personality disorder section than elsewhere in the DSM
Negative Symptoms: Anhedonia
Diminished ability to experience pleasure
Negative Symptoms: Affective Flattening /Restricted Affect
Diminished emotional expression; or little expressed emotion
Dissociation: Pierre Janet (1859-1947)
Dissociation: A process where components of mental experience are split from consciousness but remain accessible through dreams and hypnosis
Schizophrenia: Psychological Perspective: Gregory Bateson
Double Bind: children cannot comprehend critical thinking. Mothers with schizophrenia will come to children with paradoxical thoughts and they cannot cope with that. They learn to use "crazy talk".
Conversion Disorder
Dramatic type of somatic symptom disorder that causes patients to lose neurologic functioning in a certain part of the body with no medical cause Can affect numerous bodily systems Can be associated with a traumatic event La belle indifference
Cluster B:
Dramatic, Emotional, Erractic - Antisocial -Borderline -Histrionic -Narcissistic
Organic amnesia
Due to brain injury or neurological illness
Conversion Disorder: Treatment
Dynamic/Psychoanalytic • Helps express painful emotions or memories that are linked to symptoms - No evidence for effectiveness Behavioral - Focuses on: • Relieving the person's anxiety centered on the initial trauma that caused the conversion symptoms • Reducing any benefits the person is receiving from the conversion symptoms • Research shows that Conversation Disorder is associated 23 with increased suggestibility - Some studies demonstrate effectiveness of hypnosis
Schizophrenia: Neurobiology - Structural
Enlarged ventricles Reduced volume in some areas Reduced white matter and grey matter in some areas especially prefrontal cortex Correlation does not mean causation!
Depersonalization/Derealization Disorder
Episodic feelings of detachment from one's own mental processes or body, like an outside observer of oneself • Causes - Significant stressor, sleep deprivation or the influence of drugs
DID : Video: Project Eve (The Three Faces of Eve)
Eve White, Eve Black Complete change in personality Experienced a headache and all the sudden she changes She was aware there's a different figure there Eve Black is allergic to Nylon
Classifying Antisocial Personality Disorder
Excessive variation within the diagnosis - 2 people with Antisocial Personality Disorder (allows us to identify two totally different people with the same disorder)
Malingering
Faking a symptom or a disorder in order to avoid an unwanted situation or due to primary gains
Schizophrenia: Ventral tegmental area
High DA Atypical antipsychotics Block mesolimbic DA (Amygdala, Hypothalamus, Hippocampus)
Wandering Womb
Historically rooted in the belief about Hysteria
Illness Anxiety Disorder: Henry Video Example
Illness Anxiety Disorder can be a debilitating disorder that may become the focus of most daily activities and thoughts It's on his mind all the time 60-70 doctors since his early 20s Finally finds someone to remove the bump on his face Money related, practice, he doesn't take into consideration that he maybe doesn't have a problem, he blames it on the doctor Do what I can do to get over the anxiety
Illusion vs. hallucination
Illusion (perceptual, shadow of the street is a ghost or dragon) VS. hallucinations (will actual see the dragon)
Anterograde amnesia
Inability to remember new information
Retrograde amnesia
Inability to remember the past
What can we learn from problematic evolution of personality disorder diagnoses in DSM?
It's not reliable
Negative Symptoms: Avolition/Asociality (or Apathy)
Lack of initiation and persistence
Glove anesthesia
Loss of all feeling in the hand
Schizophrenia: Prefrontal Cortex
Low DA Atypical antipsychotics increase DA via blocking 5HT (Serotonin)
Personality disorders in DSM-5?
Massive overhaul of entire section originally planned Final version of DSM-5: no changes whatsoever
Personality over lifetime
Maturation, the older you get the more you become like yourself
Can people change their personality?
Maturing Environmental factors
Can a trait be 'abnormal'? Can one's personality? If so, how can we define 'abnormal trait' or 'abnormal personality' ?
Multiple traits are extreme or negative Difficult to function suffering
Tardive dyskinesia
Neurological disorder involving involuntary movements of the tongue, face, mouth, or jaw
Psychopathy
Not a disorder, it's a trait not diagnosable - Superficial charm - Egocentricity, extreme self centered - Grandiose sense of self-worth - Boredom/need for stimulation - Pathological lying - Absence of anxiety - Conning/manipulative - Poor judgment - Lack of remorse Psychopathy and antisocial personality disorder are similar, but ALL psychopaths lack empathy
Cluster A:
Odd or Eccentric - Paranoid - Schizoid - Schizotypal • Exhibit attenuated schizophrenia-like symptoms
Somatic Symptom Disorder: DSM 5 Criteria
One or more somatic symptoms that are distressing or result in significant disruption of daily life Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns and is manifested by: • Disproportionate and persistent thoughts about the seriousness of one's symptoms • Persistently high level of anxiety about health or symptoms • Excessive time and energy devoted to these symptoms or health concerns Although any one symptom may not be continuously present, the state of being symptomatic is persistent Specify if somatic symptoms predominantly involve pain
Delusional Disorder
Only or primary delusions; R/O SCZ
Schizophrenia: Course
Onset: Early adulthood, Mid 20s for Males; late 20s for Females 20% will see favorable outcome (remission); small number will recover completely More medical illnesses Up to 15% suicide rate (lifetime) Shorter life span Revolving door - 50-80% multiple hospitalizations
Dissociative Fugue
People are found far away from home with amnesia to their identity and essential autobiographic information
Schizophrenia: Psychological Perspective: Social Drift
People with SCZ have low socio-economic status
Ego Syntonic
Perceived as a natural part of the self, does not invoke anxiety or cause distress. Symptoms perceived as rational and natural. Example: OCPD
Ego Dystonic
Perceived as external to the self, something you have, not something you are; may cause anxiety and distress. Example: OCD
Disorganized Speech: Tangentiality
answers questions that are loosely or completely unrelated - Incoherence POSITIVE SYMPTOM
Somatic Symptom
Physiological symptoms with psychological origin somatic is a bodily experience (Example: Irritable Bowel Syndrome or IBS)
Schizophrenia: Epidemiology
Point prevalence 0.3-0.7% Lifetime -1-2% Gender: - Males > Females for SCZ that is more chronic and with strong negative symptoms - Males = Females for more brief presentation and mixed affective symptoms- Females tend to have a better long-term prognosis
Personality Disorders: Epidemiology
Prevalence - 0.5% to 2.5% in the general population - 2% to 10% in outpatient settings - 10% to 30% in inpatient settings
Schizoid Personality Disorder Prevalence
Prevalence - 3.1-4.9% (two latest US national surveys) From the textbook 0.8-1.7% (Lenzenwegner, 2008)
Psychological and Social Treatments: Comprehensive rehabilitative approach that targets: Social deficits
Problem-solving skills applicable to common social situations
Schizophrenia: Psychological Perspective: Stressful life events, criticism?
Psychopathology in general, stressful life events could cause anything
Schizoaffective Disorder
Psychotic symptoms only WHILE in a depressive or manic episode.
Psychological and Social Treatments: Comprehensive rehabilitative approach that targets: Cognitive
Recognize and change demoralizing attitudes
Negative Symptoms: Alogia
Relative absence of speech
Schizophrenia: Family Studies
Risk increases with genetic relatedness
Myths about Schizophrenia:
SCHIZOPHRENIA IS NOT: - ...A "split personality" or multiple personality - ...Untreatable and unmanageable (in most cases) - ...Psychosis: People with schizophrenia present psychoticsymptoms; but psychosis ≠ schizophrenia - ...Associated with unusually dangerous and violent behavior More people without schizophrenia commit homicides • People with severe mental disorders are between 2 to 9 fold risk of being a victim of homicide (Webb, 2013) - Controlling for people with drug addictions, the risk was still more than double (Webb, 2013)
Schizophrenia: Gerald Video Example
Scared of people Sometimes the voices in his head: greatly distress him because they either tell him to do things or say he did things he didn't do Kept answering things that were unrelated People are out to get him Exaggerating, agitated easily Hair twirling (disorganized behavior) You don't know if the things he's saying are true... it's probably not real... (being stabbed and raped)
1911: Paul Eugen Bleuler, a Swiss Psychiatrist coined the term ________________ (Split Mind).A split between mental processes
Schizophrenia He was convinced that it is a medical problem that would be cured by medical means
Schizophreniform Disorder
Similar to SCZ, but no more than 6 months, and no functional impairment required
Brief Psychotic Disorder
Similar to SCZ, but remits after no more than 30 days
Psychological and Social Treatments: Comprehensive rehabilitative approach that targets: Behavioral
Social learning theory and operant conditioning
Disorganized Speech: Loose associations
Talk in unrelated directions POISITVE SYMPTOM
Schizophrenia: Etta Video Example
Talking nonsense Delusions (answering to Jesus) Spent all her time writing messages to Jesus Adodonia Disorganized behavior
DID: A Critical Perspective
Therapists 'lead' patients to construct DID? Piper, 1988 - Most patients manifesting alters only after therapy began Media influence - Before the book and movie Sybil - 75 cases in the US - Since then tens of thousands, mostly in the US All DID patients are highly suggestible Some people believe that they are faking it and they are just roll playing (like actors for movies)
Thinking outside the box
They live outside the box Bizarre SOCIAL ISOLATION: CLUSTER A
Psychosis: Delusions
are fixed, false beliefs that are not amenable to change in light of conflicting evidence - Types e.g., Grandiose, Persecutory • Must be unrelated to drugs, sleep deprivation, or severe stress POSITIVE SYMPTOM
Schizophrenia DSM-5
Two or more of the following , each present r a significant portion of time during 1 month period (or less if successfully treated), at least one of these must be (1), (2), (3) 1. Delusions 2. Hallucinations 3. Disorganized Speech 4. Grossly Disorganized or Catatonic Behavior 5. negative Symptoms *Negative Symptoms are not necessary or sufficient for disgnosis*
Illness Anxiety Disorder
Worry that one will develop or have a serious illness but does not experience severe physical symptoms - When experiencing physical symptoms one becomes very alarmed and seeks immediate medical care • It is subject to a lot of jokes and is often ridiculed in comedies • The main differential diagnostic factor from Somatic Symptom Disorder is that individuals with IAD do not actually experience the symptom • If a person with somatic complaints would stop feeling the symptoms, they would be considered remitted • When a physician rules out all illnesses, a person with IAD would still be suffering Worrying that they might have an illness, there is no major symptom, worried they might get something
Are personality disorders "problems" from which people "suffer," like anxiety or depression?
Yes, they suffer
Psychosis: Hallucinations
are the experience of stimuli that are not there - Usually these are auditory or visual and have accompanying behaviors indicating hallucinations - Auditory are the most common, followed by tactile, visual and olfactory/gustatory Example: Command hallucinations - Orders for action from the auditory hallucinations POSITIVE SYMPTOM
Why do people with Schizophrenia have more medical illnesses?
because the first thing that goes away is hygiene, they don't take care of themselves
Schizophrenia is both...
chronic AND an episodic disorder Functionally impairing condition; more so when negative symptoms are prominent
Ideas of reference vs. delusions
everything that happens refers to me (it's not fixed, thinks people are whispering about them) VS. Delusions are fixed beliefs (the FBI is after me)
Catatonia
from agitation to rigid and bizarre posture to complete immobility (mutism and stupor) POSITIVE SYMPTOM
Obsessive-Compulsive Personality Disorder causes
largely unknown
Schizophrenia: Psychological Perspective: Expressed emotions (enmeshed families)
may account for lower relapse rates in developing countries
Hikikomori
not associated with schizoid, they are not interested in humans, stay away from society.
Antisocial Personality Disorder/ Histrionic Personality Disorder Gender differences?
stereotypically male, stereotypically female
Literature on Personality Disorder Treatments
• # randomized, controlled clinical trials for: - Paranoid PD = 0 - Schizoid PD = 0 - Schizotypal PD= 1 - Histrionic PD = 0 - Narcissistic PD = 0 - Avoidant PD = 3 - Dependent PD = 0 - Obsessive-Compulsive PD = 0 - All Cluster C PDs combined = 1 - There are no FDA-approved medications for any personality disorder
Personality Disorders - Course
• Begins in childhood • Run a chronic course • Comorbidity rates are high
Problems with DSM Personality Disorders
• Categorical vs. dimensional approach • Problems with the categorical approach • Reliability and validity of "personality disorders"(very low Kappa, usually <0.6) • Personality science vs. DSM-defined personality disorders
Illness Anxiety Disorder & Somatic Symptom Disorder: Cognitive Factors
• Cognitive factors play a prominent role - Dysfunctional beliefs about illnesses (e.g., catastrophize symptoms) - Paying too much attention to physical changes
DID - Psychophysiological Findings
• DID identities may differ on - Visual acuity - Blood pressure - Allergies - Heart rate - Laterality - Muscle tension Compared to simulated multiple identities, DID identities exhibit more variability
Factitious Disorder
• Deliberate faking of an illness to gain medical attention - AKA Munchhausen's syndrome - Malingering
Factitious Disorder by Proxy
• Factitious disorder imposed on another: Falsifying or causing an illness in another person • AKA Munchhausen's syndrome by Proxy • Usually parents, that will poison, injure, and hurt their children to bask in the medical attention their 'proxy' receives
Dissociative Identity Disorder (DID)
• Having more than one distinct identity or personality statetaking control of the individual's behavior • One of the most fascinating and controversial conditions • 0.1%-1.5% prevalence rate; f/m ratio 10:1 • DID is 5 times more prevalent among psychiatric outpatient samples • Some evidence for much higher percentages among prostitutions and exotic dancers (Ross et al., 1990) • The vast majority of people diagnosed with DID were abused in childhood (mostly sexual abuse)
Dissociative Amnesia
• Loss of specific (trauma-related) information, or general loss of memory due to a non-neurologic reason • In general, amnesia is associated with past trauma and traumatic events • It is highly criticized and difficult to prove (nearly half of all murder trials deal with claims of amnesia)
Causes of Antisocial Personality Disorder
• Prevailing etiological hypotheses/findings - Gene-environment interaction (genetics not a major factor) - Chronically low arousal (low heart rate, low GSR) - Higher threshold for becoming fearful - Deficit in learning via punishment - People with APD were found to have higher instances of all types of abuse in childhood, parents who went to jail and/or that were abusing drugs
What is 'Personality' ?
• The nature of personality - Comprised of different traits - Characteristic ways of thinking and behaving - Generally stable across situations - Exist on a continuum
Illness Anxiety Disorder & Somatic Symptom Disorder: Epidemiology
• The two disorders in their current form are new to the DSM • Looking at DSM-IV: - Hypochondriasis: 2-7% - Somatoform Pain Disorder: 8%- No gender differences • May change using DSM-5 definitions, and in referred samples
Schizophrenia: Neurobiology - Functional
• ↑ Increased activity in mesolimbic dopamine circuits • ↓ Reduced activity in frontal and prefrontal areas at rest • May be more complex than that...