psych303-3

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psych303-3
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psychopathology 3
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  1. somatoform disorders
    • individuals complain of bodily symptoms/defects but there is no organic basis to it (no physical cause)
    • could be a psychological cause/contribution
  2. malingering disorder
    feign symptoms for external incentives like getting out of work, get more money
  3. factitious disorder
    • intentionally produces psychological/physical symptoms but there are no external symptoms
    • do it for the attention
  4. 3 disorders that fall under complex somatic symptom disorder
    • hypochondriasis
    • sompatization disorder
    • pain disorder
  5. hypochondriasis
    • a fear of physical ailment - primary feature is worry
    • misinterpretation of normal physical states
    • not reassured by results of medical tests
    • must be for 6 months minimum
    • 2-7%
    • equal in men and women
  6. cognitive distortions in hypochondriasis
    • attentional bias for illness information - percieve situation as more dangerous than it really is
    • confirmational bias
    • skewed perception of probability (see probability of getting better to be low, see probability of getting it is higher)
  7. perceptional distortions of hypochondriasis
    • misinterpret bodily sensations
    • like a panic disorder but in hypochondriasis this worry is put out to the long term - not just owrry about havin a panic attack
  8. culture specific health concerns
    • koro - shrinking genitals
    • dhat - negative efects of semen depletion
    • Africa - something crawling in their head
    • pakistan/India - burning in hands/feet
  9. hypochonrdiasis treatment
    • CBT - modify beliefs and interpretations - reconstruct their thoughts
    • response prevention
    • selective attention excercises

    Antideressants (not as effective)
  10. somatization disorder
    • many complaints of physical ailments
    • chronic
    • not actually due to physical injury
    • minimum of 8/33 different physical symptoms (four pain, two gastro, one sexual, one pseudoneuro)
    • their symptoms are their identity
    • multiple symptoms compared to just a few in hypochondriasis
    • in adolescence, more in women than men
    • abotu 0.2% prevalence
  11. somatization disorder causes
    • runs in families - familial linkage
    • linked with antisocial personality disorder
    • have problems controlling impulses
    • high neuroticism
    • selectively attend to bodily sensations as symptoms
    • elevated levels of cortisol
    • because of vicarious and direct learning
    • distortions in perception
  12. somatization treatment
    • hard to treat
    • medical gatekeeper - one physician will integrate the patient's care by seeing them and providing exams based on their complaints - monitors their health concerns
    • CBT - promotes appropriate behavior
  13. pain disorder
    • experience of persistent and severe pain in one or more areas of body that is not intentionally produced/feigned
    • there may be a medical reason but psychological factors play a large role too
    • CBT
    • antidepressants
  14. conversion disorder
    • problem with motor/sensory functoning that looks like a neurological problem but there is no medical cause
    • could be a reaction to stress (more stress more severity)
    • more woman than men
    • functional neurological disorder
    • 1-3% prevalence
    • low SES, don't know about medicine
    • could be in families with history of health problems (create symptoms that you know)
  15. functional neurological disorder
    the symptoms of conversion disorder may be functional as a way to provide a plausible bodily excuse for the individual to escape/avoid something

    • primary gains: avoidance/escape - not my fault - rxn to stressful situation
    • secondary gains: external circumstances like attention or financial gain
  16. conversion disorder symptoms
    • sensory (vision, hearing, touch)
    • motor (paralysis, aphonia - can only whisper but can cough normally, mutism)
    • seizure- can be differentiated from epileptic seizures
  17. treatment of conversion disorder
    • hypnosis, stress reduction, behavioral treatment with reinforcement
    • CBT
  18. body dysmorphic disorder
    • obsessed with perceived or imagined flaw in appearance
    • social avoidance/phobia
    • relation to OCD - engage in compulsive checking behaviors to curb their obsessive thoughts
    • no sex differences - but men more concerned with body build, hair loss genitals, women more with butt, thights, legs, stomach
    • seek reassurance but it doesn't help them
  19. causes to body dysmorphic disorder
    • related to the emphasis on appearance
    • genetic based personality predisposition (high neuroticism maybe)
    • history of ridicule/emphasis on looks
    • perceptual processing biases - attend to appearance related words
    • differences in visual proessing of faces/apeparance
    • in people with attention to aesthetics
  20. BDD treatment
    • CBT - most effective - change distorted perceptions of body during exposure to anxiety provoking situations
    • SSRI's - need high dose
    • resistant to treatment
  21. dissociative disorders
    • cognition is split off from conscious awareness
    • disruption in memory, identity, perception, consciousness
    • unable to access info
    • appear to avoid stress/anxiety
    • detached from self/surroundings
  22. depersonalization disorder
    • persistent feelings of detachment from self, body, experiences
    • males and females equally likely
    • easily distracted, slow to process new information, reduced emotional responding

    depersonalization and derealization (sense of reality with outside world is lost)
  23. dissociatie amnesia/fugue
    • failure to recall previously stored personal information
    • can be local (specific period) or selective (some but not all) amnesia
    • if it was because of brain pathology the loss of memory would be the inability to retain new info and experiences but in psychogenic amnesia it is the inability to recall stuff
    • Fugue: change of scene (take on different lifestyle form previous one)

    • selective for traumatic (episodic) events/autobiographical information
    • intact implicit/semantic memory
  24. dissociative identity disorder
    • 2+ distinct personalities (host and alter identities) - changes in cosciousness between them
    • usually starts in childhood
    • comorbid with other disorders
    • selective amnesia
    • identities are so fragmented that they don't have a signle identity
    • more females than males
  25. DID switch changes
    • physical changes (like in vision/alltergies), emotional changes,
    • personality, changes,
    • neural chages,
    • memory issues
    • carryovers in implicit memory though (none in explicit memory), emotional reactions can crryover too
  26. DID causees
    • traumatic childhood abuse? - but score high on suggestibility/autohypnosis
    • lack of social support
    • starts in early childhood
  27. 4 controversies with DID
    • is DID real or faked?
    • how does it develop? - post-traumatic theory, or sociocogntiive theory (suggestible person adopts identities b/c clinicians induced it in them)
    • are recovered memories of abuse in DID real or false?
    • does abuse play a causal role in DID?
  28. iatrogenic memories
    • a product of treatment
    • DID may be induced into patients!
    • may have caused this sociocultural explosion (more cases and more alters)
  29. treatments of dissociative disorders
    • hard to know treatment - not much systematic controlled research
    • dissociate amnesia/fugue: removal from bad situation/environment
    • hypnosis somtimes, some drugs
    • DID - integration of alters as ultimate goal, psychodynamic, insight-oriented, hypnosis
  30. psychosis definition
    loss of contact with reality
  31. schizophrenia
    • type of psychosis
    • diverse symptoms
    • disturbed thought/emotion/behavior
    • 1% with schizophrenia
    • more males than females slightly
    • schizo - split, phrenia - mind
    • usually begin in late adolescence/early adulthood
    • begins ealrier in males
    • women's sex hormones may be protective
  32. historical background
    • Morel - identified it as labeled disorder (demence precoce - early loss of mind)
    • Kraepeling (dementia praecox - integrated the diverse set of symptoms - believed to have underlying organic cause)
    • Bleuler - schizophrenia (split of mind, the four A's), assumed biological etiology
  33. Bleuler's four A's to classify fundamental symptoms
    • Autism
    • Association disturbances
    • affect
    • avolition/attention/ambialence
  34. Positive symptoms (hallmark ones)
    • delusions: - fixed erroneous belief (certainty, incorrigibility - won't change belief even with evidence), impossibility or falsity of content)
    • hallucinations: sensory experience without external stimulus
    • disorganized speech: (disruption in form of thought not content) cognitive slippage, tangentiality, loose associations, word salad, neologisms (new words)
    • disorganized affect: inappropriate emotional behavior
    • disorganized behavior: variety of unusual behaviors, catatonia
  35. capgras syndrome
    the delusional belief that your mother was replaced with someone else
  36. cotard's syndrome
    delusional belief that they are dead
  37. negative symptoms
    • absence/insufficiency of behaviors that are normally present
    • Asociality
    • Avolition (apathy)
    • alogia (absence of speech/impoverished speech)
    • anhedonia - diminished pleasure
    • affective flattening (little EXPRESSED emotion)
  38. diagnostic criteria for schizophrenia
    • delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative symptoms)
    • duration of 6 months!
  39. subtypes of schzophrenia (5)
    • paranoid: history of suspiciousness/difficulties in interpersonal relationships, preoccupation with delusions/auditory hallucinations
    • disorganized: earlier age, more gradual, disorganized speech/behavior, flat affect, fragmented delusions (hebephrenic)
    • catatonic: motor signs (excited/stuporous), imitate/mimic others actions/phrases, violent reactions
    • undifferentiated: meets criteria but doesn't match the others
    • residual: have had one episode of schizophrenia but do not show any prominent positive symptoms or disorganized symptoms - mostly negative symptoms
  40. shizoaffective disorder
    • another psychotic disorder
    • hybrid of schizophrenia and severe mood disorder (bipolar and depressive subtypes)
    • independent symptoms
    • 2 concurrent illnesses almost
  41. schizophreniform disorder
    • at least a month but not 6 months so don't get schizophrenia diagnosis
    • good premorbid functioning
    • impaired social/occupational functioning is not required
    • no residual symptoms
  42. brief psychotic disorder
    • sudden onset of psychotic symptoms/disorganized/catatonic behavior
    • only a matter of days (no more than a month)
    • extreme stress/trauma
    • spontaneous remission
  43. delusional disorder
    • does not have disorganization/performance deficiencies characteristic of schizophrenia
    • rare behavioral deterioration
    • no other positive/negative symptoms
    • delusions are NOT bizarre
    • middle to late adulthood
    • B/c of hearing deficiencies, low SES, severe stress
  44. types of delusional disorder
    • erotomania - believe that other person loves them (usually a person of higher status)
    • gradiose - that they have some great talent/special relationships, etc.
    • jealous
    • persecutory - believe being conspired against, cheated on, simple or elaborate
    • somatic - delusion about the body in some way (bad smell)
  45. schizotypal personality disorder
    less severe form of schizophrenia
  46. shared psychotic disorder
    • folie a deux
    • delusion that develops in someone who has a very close relationship with another delusional person
    • more likely in females
    • in dependent people
  47. causes of schizophrenia
    • diathesis-stress model
    • Genetic vulnerability
    • environmental issues
    • early beahvior as indicators!
  48. genetic research and schizophrenia
    • family studies - 50% heritability, Genain quadruplets - each had schizophrenia
    • inherit a tendency for schizophrenia
    • but do not inherit specific forms
    • twin studies/adoption studies
    • its the gene that underly the predisposition, not the fact that you have a schizphrenic parent
    • hypothesis that there is a deletion of genetic material (missing chunk of genetic code!)
  49. neurodevelopment and schizophrenia
    prenatal factors may increase risk -- nutritional deficiency, blood type incompatibility (Rh), oxygen deprivation, diabetes, low birth weight, emergency c-sections, maternal infetions
  50. other causes to schizophrenia
    older fathers, maternal stress, urban birth,
  51. brain abnormalities in schizophrenia
    • enlarged brain ventricles (deficit in amount of brain tissue) - this will probably get worse over tiem with the disease (neurodevelopmental AND neurodegenerative disorder)
    • hypofrontality - less active frontal lobes ( a major dopamine pathway)
    • smaller thalamus volume
  52. neurotransmitters and schizophrenia
    • dopamine hypothesis: excess of dopamine (drugs that increase dopamine result in schizphrenic behavior)
    • BUT this is simplistic - current hteories emphasize many neurotransmitters - maybe glutamate?
  53. psychological/social influence on schizophrenia
    • Stress - activates an underlying vulnerability/increase relapse (high incidence in immigrants)
    • Family interactions - ineffective communication patterns, high negatively expressed emotion is related with relapse (intrusive, critical, nagging), see disorder as the individuals fault
    • having psychotic/very ill person in the family
    • raised in urban environment
    • smoking cannabis
  54. development of antipsychotic medications
    • first line of treatment for schizophrenia
    • in 1950s
    • reduce/eliminate positive symptoms
    • bad at getting rid of negative symptoms
    • acute/permanent side effects are common (extrapyrimidal - look like Parkinsons)
    • compliance with medication is a problem!!!
    • these were the first generation antipyschotics
  55. 2nd generation antispychotics
    don't have the negative side effects that hte first generation does really!
  56. tardive dskinesia
    involuntary movements of lips and tongues - side effect of 1st geneartion antipsychotics
  57. neuroleptic malignant syndrome
    high fever/extreme muscle rigidity - side effect of 1st generation antispychotics
  58. extrapyrimidal side effects
    involuntary movement abnormalities - seen with first generation antipsychotics
  59. psychosocial treatments of schizophrenia
    • traditional psychotherapy not effective
    • case management
    • behavioral (token economies)
    • community care programs
    • social/living skills training, (improve funcational outcomes not just clinical outcomes)
    • cognitive remediation - improve cognitive defects
    • CBT
    • behavioral family therapy, vocational rehabilitation

    teach the skills! to make them better even if they're not taking medication

    most effective is pairing drugs with fmaily skills
  60. predictors of positive outcomes with schizophrenia
    • hisotry of depression
    • female
    • later age of onset
  61. predictors of negative outcome for schizophrenia
    • insidious onset (creeping onsets)
    • presence of aggression
    • substance abuse
    • prominent negative symptoms
    • family members with schizophrenia
  62. outcome/prognosis of schizophrenia
    • outcomes determiend by circumstances under which the illness developed, premorbid personality (more likely to be better)
    • social functioning (the better you have the better off you are) - related to length of episodes and length of hospitalizations
  63. personality disorders
    • chronic interpersonal difficulties and problems with one's identity or sense of self
    • chronic pattern of inner experience, behavior, and predispositions
    • deviates from cultural expectations
    • inflexible and maladaptive
    • range of situations
    • onset in adolescence
    • stable over time
    • causes distress
  64. problems with diagnosing personality disorders
    • its on a continuum with normal activities - its an issue of degree, not kind
    • few clear/distinguisihng markers/signs
    • overlap between categories
    • not much empirical resarch done
  65. problems with studying causes of personality disorder
    • overlap between categories
    • huge comorbididty (75% have comorbid with Axis 1)
    • also may have more than 1 personality disorder
    • infant's temperatment may be involved
    • and the family psychopathology/parenting may also be involved
  66. differences of personality disorder from other disorders
    • its pervasiveness
    • its duration - very chronic, lifelong patters!
  67. prevalence of ersonality disorders
    abotu 10-12% of the general population - but that number is way high in treatment settings (more than 25%)
  68. the three clusters of personality disorders
    • cluster a: tend to be odd/eccentric - paranoid, schizoid, schizotypal
    • cluster b: tend to be dramatic, emotional, and erratic - histrionic, narcissistic, antisocial, borderline personality disorders
    • cluster c: show anxiety/fearfulness - avoidant, dependent, OC personality disorder
  69. the disorders under cluster A
    paranoid, schizoid, schizotypal personality disorders
  70. paranoid personality disorder
    • pervasive/unjustified mistrust and suspicion (not a delusion so not psychosis)
    • suspcicious about being deceived/harmed
    • doubts loyalty/trustworthiness of others - particularly friends
    • reluctance to confide in others
    • look for hidden meanings in benign remarks
    • holding grudges
    • counter attacks to perceived attacks on character
    • suspicious about fidelity of sexual partner
  71. causes of paranoid PD
    • genetic element - high leels of antagonism and neuroticism
    • parental neglect/abuse
    • exposure to violent adults
  72. schizoid personality disorder
    • detachment from social relationships (unable/don't want to)
    • lack of desire for/enjoyment of close relationships
    • preference for solitary activities
    • few friends
    • lack of interest in sexual activity
    • little pleasure in most activities
    • aloofness
    • colness, detachment, flattened affect (like autism)
    • limited range of emotions
  73. causes of schizoid personality disorder
    • modest heritability
    • maladaptive underlying schemes that lead them to think of themselves as loners and view others as intrusive
    • not much is known!
  74. schizotypal personality disorder
    • more like schizophrenia
    • cognitive/perceptual distortions (magical thinking, ideas of reference, unusual perceptual experiences (illusions),
    • odd thinking/speech,
    • paranoid ideation,
    • inapprorpriate afect,
    • odd/eccentric behavior/affect,
    • lack of close friends,
    • social deficiits
    • highly suspicious
  75. causes of schizotypal PD
    • lots of research on this
    • about 2% of hte population
    • moderate heritability,
    • associated iwth schizophrenia
    • do not have the ability to inhibit attention to a second stimulus that rapidly follows a first
    • on spectrum with schizophrenia
  76. cluster A disorders - do each have positive psychotic symptoms/negative symptoms?
    • paranoid - yes positive, yes negative
    • schizoid - no positive, yes negative
    • schizotypal - yes positive, no negative

    • positive : ideas of reference, magical thinking, etc.
    • negative: social isolate, poor rapport, constricted affect
  77. disorders in cluster B
    histrionic, narcissistic, antisocial, borderline personality disorder
  78. histrionic personality disorder
    • excessive emotionality/attention seeking
    • needs to be center of attention
    • inappropriate sexual/provocative behavior
    • rapidly shifting, shallow emotional expression
    • physical appearance to draw attention
    • impressionistic speech (lackign in deatil)
    • self-dramatization (but low feelings of emotions)
    • high suggestibility
    • thinking/emotion are shallow - just exaggerated display
    • no stable relationships, shallow relationships
    • much more common for females - gender bias in diagnosing?
  79. causes of histrionic disorder
    • little research
    • link with antisocial disorder
    • extreme neuroticism/extraversion
    • maladaptive schemas needing attention to validate self-worth
  80. narcissistic personality disorder
    • grandiose sense of self-importance
    • preoccupied with fantasies of power, beuty, love
    • beleive that they are special - high status
    • requires excessive admiration
    • sense of entitlement
    • interpersonally exploited
    • lacks empathy
    • envious of others
    • arrogant
    • low sense of self-esteem and they're just trying to cover it up??
  81. causes of narcissistic PD
    • parents neglectful, devaluing, or unempathetic (little empirical support to this one)
    • maybe overrealistic parent overvaluation
  82. Antisocial PD characteristics
    • must be older than 18 and had history of conduct disorder before 15
    • noncompliance with social norms
    • deceitful
    • impulsivity/failure to plan
    • reckless disregard
    • irritability/aggressiveness
    • lack of remorse
    • irresposible
  83. early behavior problems for antisocial PD
    • always occurs with antisocial PD people
    • oppositional defiant disorder - kids defy authority
    • conduct disorder - little fear
    • progression from one to the next

    also seen with ADHD kids!
  84. families and antisocial PD
    • inconsistent parental support/discipline
    • families are uninvolved when it matters and then are all of a sudden there because of the repercussions to hteir behaviors
    • history of criminal/violent behavior

    have a positive role model in adolescence = a lot better, won't have antisocial PD!!
  85. neurobiology and ASPD
    • brain damage - little support
    • under-arousal hypothesis (too low cortical arousal)
    • cortical immaturity (cortex is not fully developed)
    • fail to respond to danger cues
    • lack of response in fear response
  86. treatment of APSD
    • few seek treatment on their own
    • poor prognosis of any disorder
    • emphasis placed on prevention/rehabilitation
    • traditional psychotherapy makes it worse

    some emphasis on CBT - could be effective
  87. pyschopathy
    • focus on traits instead of on behaviors (ASPD does behaviors)
    • focus on two dimensios - affective/interpersonal factor and the behavior factor
  88. affective and interpersonal factors to psychopathy
    • aggressive narcissism
    • glibness/superficial charm
    • grandiose
    • pathological lying
    • manipulative
    • lack of remorse/guilt
    • shallow affect
    • lack of empathy
  89. behavioral factors to psychopathy
    • socially deviant lifestyle
    • need for stimulation/prone to boredom
    • parasistic lifestyle
    • poor behavioral control
    • lack of realistic long term goals
    • impulsivity
    • irresponsibility
    • juvenile delinquency
    • early behavior problems
  90. borderline personality disorder
    • instability in interpersonal relationships, self image, affect,
    • impulsivity
    • efforts to avoid abandonement
    • unstable/intense relationships
    • unstable self-image
    • impulsivity in areas that are self-damaging
    • recurrent suicidal gestures/threats/self-mutilating
    • affective instability
    • chronic feelings of emptiness
    • inappropriate, intense anger
    • stress related paranoid ideation
    • high comorbidity
  91. causes of borderline personality disorder
    • runs in families
    • early trauma plays a role
    • lowered functioning of serotonin
    • hyperresponsibve noradrenergic system
  92. treatment of borderline personality
    • few good treatment outcome studies
    • antidepressants - short term relief
    • dialectical behavior therapy - promising treatment
  93. Cluster C disorders
    anxiety - fearfulness

    avoidant, dependent, obsessive-compulsive personality disorders
  94. avoidant personality disorder
    • cluster c
    • social inhibition - avoidant of relationships, fearful of rejection, lonely bored, shy
    • feelings of inadequcy - fear of being inappropriate/foolish
    • extreme sensitivity to opinions of others
    • desire affection/acceptance but lack ability to relate comfortably
  95. avoidant PD causes
    • inhibited termperatment
    • heritability of fear of being negatively ealuated
  96. dependent personality disorder
    • need help from others to make decisions
    • need others to assume responsibility for parts of hteir lives
    • hard to express disagreement
    • hard to initiate projects (lack of confidence)
    • go to excessive lengths to get nurturance/support
    • feels uncomfortable/helpless when alone
    • needs relationships
    • fearful of being alone
  97. causes of dependent personality disodrer
    • modest genetic influence
    • authoritarian/overprotective parents
  98. obsessive compulsive personality disorder
    • preoccupied iwth details, rules, lists, schedules
    • perfectionsism - can't finish tasks
    • devoted to work/productivity
    • conscientious/inflexible about morality/ethics/values
    • hoard
    • miserly - hoard money for future ctastrophes
    • rigid/stubborn
  99. causes of obsessive compulsive pd
    • high conscientiousness
    • high assertiveness
    • low compliance
    • low novel seeking, low reward dependence
    • high harm avoidance
  100. provisional categories of personality disorders
    • passive aggressive disorder - passive resistance to demands
    • depressive personality disorder - depressive cognitions/behaviors
  101. dialectical behavior therapy
    • developed to deal specificaly with borderline personality disorder
    • encourage patients to accept negative aafect without engaging in self-destructive/maladaptive behaviors
    • problem focused treatment (decrease suicidal behaviors, decrease behaviors that interfere iwth treatment, decrease escapist behaviors, incrase behavioral skills)
    • individual and group components
  102. 5 factor model to personality disorders
    • neuroticism
    • extroversion
    • openness to experience
    • agreeableness
    • conscientiousness
  103. Westen and Schedler model
    • psychological health
    • psychopathy
    • hostility
    • narcissism
    • emotional dysregulation
    • dysphoria
    • schizoid orientation
    • obsessionality
    • thought disroder
    • oedipal conflict
    • dissociated consciousness
  104. issues with personality disrorder
    • suggests something fundamentally wrong with the person
    • vague criteria
    • heterogenous behaviors
    • overlap in criteria
    • negative connotations of diagnosis
    • gender bias
  105. gender bias in personality disorders
    interpret things differently based on their gender
  106. kaplan and gender bias
    a lot of features of histrionic disorder are just empahsized characteristscs of stereotypical western female

    thought of independent eprsonality disorder (characteristic of hard working dads)

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