Final Fair Game Sheet - Psychopathology | PSY 103, Study notes of Psychopathology

Download Final Fair Game Sheet - Psychopathology | PSY 103 and more Study notes Psychopathology in PDF only on Docsity! Schizophrenia 06/08/2009
Dementia praecox: “early dementia” Latin
Schizophrenia: “split mind” Greek  Fragmented thoughts; splits between thoughts and emotions; withdrawal from reality
General manifestations  Positive symptoms: pathological excesses—delusions, disorganized thinking and speech, heightened perceptions and hallucinations; inappropriate affect o Delusions: false belief—delusions of reference, grandeur and control o Formal thought disorders/disorganized thinking/speech loose associations (rapid shift from one subject to another) o Neologisms: made up words  perseveration: repeating words & statements o Clang: rhyme to think/express oneself o Hallucination: mostly auditory, experiencing of sights, sounds or other perceptions in the absence of external stimuli o Inappropriate affect: display of emotions unsuited to the situation  Negative symptoms: pathological deficits  poverty of speech; blunted and flat affect, loss of volition, social withdrawal o Poverty of speech (alogia): reduction in speech or speech content o Blunted affect: show less anger, sadness, joy etc. than most people o Flat affect: show almost no emotion at all o Loss of volition (avolition / apathy): feeling drained of energy and interest in normal goals and unable to start/follow through on a course of action o Social withdrawal—withdrawal into their own ideas and fantasies and further from reality  Psychomotor symptoms: awkward movements; repeated grimaces and odd gestures o Catatonia   Catatonic stupor: stop responding to their environment: motionless and silent  Catatonic rigidity: maintain rigid upright posture for hours, resist help to move  Catatonic posturing: assuming awkward bizarre posturing for long periods of time  Catatonic excitement: move excitedly with wild waving limbs
Risk Factors  Genetic predisposition o 1% general population; 3 % among second degree relatives; 10% first degree relatives; MZ twins 48%; DZ twins 17%  twin concordances MZ= ~.55 DZ=~.15  Non-genetic risks: o Birth complications; maternal malnutrition; maternal exposure to flu virus or rubella (German measles); herpes; toxoplasmosis spore; old sperm
DSM-IV-TR classification subtypes:  Disorganized type of schizophrenia  confusion, incoherence, and flat or inappropriate affect  Catatonic type of schizophrenia  psychomotor disturbance of some sort (i.e. catatonic stupor/excitement)  Paranoid type of schizophrenia  organized system of delusions and auditory hallucinations that may guide their lives  Undifferentiated type of schizophrenia  vague; overused  Residual type of schizophrenia  continue to display blunted affect or inappropriate emotions; social withdrawal; eccentric behavior and illogical thinking but in less strength and number
Positive versus negative symptom schizophrenia  POSTIVE: Childhood oddity, irritability, aggressiveness  dopamine abnormalities  later age of diagnosis (20-25)  female > males  better prognosis  respond to classical antipsychotics  less chance of observable brain damage o Versus: o Establishing irrational rules about food; development of obsessive thinking; food rituals (sipping water between bites); OCD; small binge with exercise purge  Treatment o Medical for physical illness (hospital re-feeding when 75% of body weight) o Inpatient-outpatient family therapy  Parents control of eating and a Program of re-feeding o Medication: symptomatic depression. Anxiety, etc. but for anorexia, only Zyprexia shows promise  Prognosis: o 10-15% mortality rate from suicide, illness or cardiovascular complications o less than 50% ever achiever normal body weight o poor social and occupational functioning
Bulimia Nervosa (binge-purge syndrome):  Recurrent episodes of binge eating recurrent inappropriate compensatory behavior in order to prevent weight gain; symptoms continue at least twice a week for three months; undue influence of weight or shape on self-evaluation  Non-purging type bulimia nervosa: compensate by fasting or exercising  Purging-typing bulimia nervosa: compensate by forced vomiting or misuse of laxatives, diuretics or enemas o Damage from repeating vomiting: rupture of stomach or esophagus; heart damage; erosion of teeth, gums and fingernails; broken blood vessels in the eyes; swollen salivary glands; menstrual irregularities and higher risk of pregnancy complications o Drug abuse, nicotine use, impulsive behavior—such as sexual promiscuity and cutting and kleptomania  Susceptible populations o College students; 15-18 females and 18-26 males (90% female)  Treatment o SSRI’s reduce bingeing by ~70% and vomiting by ~60% o Therapy support groups, cognitive-behavior therapy o Treatment over several years is usually successful (70-90%), but relapse is common, and patients should not expect “cures”
Binge-Eating Disorder  Frequent episodes of eating what others would consider an abnormally large amount of food with bingeing at least two days a week for six months Eating Disorder NOS  Infrequent binge-purging episodes; repeated chewing and spitting of food without swallowing; anorexia-like behavior at normal weight
Dissociative Disorders 06/08/2009
Nature and manifestations:  Emotions detachment; being in a “daze”; dropping of usual activities; avoidance of topics related to trauma; forgetting key aspects of trauma; de-realization (feeling the current setting is not real) depersonalization (feeling detached from one’s body)
Anxiety spectrum    increasing anxiety  Anxiety disorders: anxiety is felt  OCD: anxiety is ritualized and warded off by obsessions and compulsions   dissociative disorders: anxiety is isolated and denied
Dissociative amnesia: inability to recall important information about their lives and is more extensive than normal forgetfulness  Brief episode may be due to drug or medication side-effects  Often confined to a period of time following a stressful event (PTSD); only retrograde loss, rarely anterograde amnesia  Stress-related hormones in brain may block memory consolidation and retrieval  More likely with a traumatic history  Often ends with in hours or days  Treatment involves anxiolytic meds and supportive psychotherapy (sometimes with sedative-hypnotic meds)
Dissociative Fugue: DSM-IV  Confusion about persona identity, or assumption or a new identity  Person usually travels to a new location and forgets their past  Same treatments as above
Depersonalization Disorder  Experience of being outside one’s own body, or having distorted perceptions of oneself  Patient is not psychotic  Patient has significant stress or impairment  Not due to general medical conditions, schizophrenia, meds./drugs, panic disorder or acute stress disorder
Dissociative Identity Disorder: a dissociative disorder in which the person develops two or more distinct personalities  Structuring school and home environments with scheduling; minimal distraction; clear immediate rewards/punishment for target behavior; punishment: time-out or withdrawal of privileges.
Adult ADHD signs  Seeks noisy/busy place to get work done; Frequent changing of the tv/radio stations; Difficulty waiting in line; Tuning out in conversation and intimate moments; Blurting; Intuitiveness: out of the box approaches to problems  DAT: Alzheimer’s Disease 06/08/2009
Risk Factors:  increasing age; being female; history of heart injury; having heart disease, stroke, or hypertension; periodontal (gum) disease; possibly: small head circumference and simplistic early writing  genetics and family history o MZ twins 40-60% concordance o Some early onset DAT: mutated genes on chromosomes one or 14 o Almost all Down’s syndrome who live 40-50 will have DAT— maybe some DAT are Trisomy 21 mosaicism
Brain and neurotransmitter changes  Cell death and loss of acetylcholine  Senile (amyloid) plaques- cell debris and beta-amyloid peptide  Neurofibrillary tangles – tau protein
Early Signs/Symptoms  Recent memory loss affection job skills; difficulty performing familiar tasks; language and naming problems; time and place disorientation problems with abstract thinking; personality/mood changes; loss of judgment/initiative; misplacing things
Late signs/symptoms (FAST slide)  Assistance in dressing, bathing and toileting  Urinary and fecal incontinence  Speech ability declines  Progressive loss of abilities to walk, sit up, smile, and hold head up
Course of illness  Early onset DAT due in 1 to 2 years  DAT functional assessment staging normal adult to severe DAT o Usually live normal life expectancy
Treatments  Assisted living in dementia facility with a structured, labeled environment  Estrogen for women  Acetylcholine boosters will delay the progression of the illness
Prevention  Estrogen for women  NSAIDs (Advil, Ibprophin)  Folate (B-vitamin) and possibly vitamin E and ginko biloba extract  Amyloid blockers and nicotine  Vaccine to prevent amyloid accumulation in 3-5 years
Nun Study  Very homogeneous lifestyle; are mostly teachers  Lower rates of DAT: o Higher education level; fewer strokes; greater number of words expressing positive emotions o Higher “idea density” in early autobiographical writings (predicted Alzheimer’s 60 years later with 80-95% accuracy)