Psy 103 Fair Game Sheet Final

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PSY 103

Fair Game Sheet Final 9/16/2013 11:51:00 PM Personality disorders (and see Question II)- Typical signs and symptoms for each type of personality disorder- “A”- odd, eccentric people thinking disorders Paranoid P.D.: think people are out to get them, personally targeted by society Schizoid P.D.: socially estranged, generally prefer to be alone. Focus on themselves. Unaffected by others commentary “schizOID= avOID relationships” Schizotypal P.D.: voices, aloof, eccentric behaviors, extreme discomfort in close relationships “B”- dramatic, emotional, unstable Histrionic: Blanche-Dubois World is a stage/ audience Steal focus Narcissistic: Usually male Entitled to power, respect Male form of histrionic “God’s gift to women” Borderline Antisocial “C”- anxious, apprehensive Avoidant: Fine by themselves, but can Want to be apart of group but fearful of rejection Uncomfortable/ inadequate in social situations Dependent: Extreme clinginess Turn to others for help Obsessive- Compulsive: Closely resemble anal-retentive theory (Freud) Things have to happen their way Very hypercritical, stingy, humorless, perfectionists Very unproductive, tends to be a procrastinator General personality disorder treatment: Symptomatic treatment- General: Possession of chronic lifelong maladaptive traits Exaggerations of normal character traits Traits either: Preclude satisfying life Alienate others, estrangement, loneliness Lay on both ends of the personality bell curve (dependency) Coded on Axis II: Aka “character disorders” Borderline Personality Disorder- 2% of pop, ¾= F Symptoms: unstable, chaotic and intense relationships self-damaging behavior inappropriate, intense anger and marked mood shifts transient psychotic episodes “splitting”: idealization/ devaluation, instantaneous fusion intolerance of being alone w/ deep abandonment depressions emptiness and void (internal) repeated suicidal gestures, self-mutilation (cutting) Possible Etiology- “dissociative state”- method of coping with panic induced by self mutilation acute abandonment depression some related to early physical or sexual abuse Psychoanalytic Theory: Failure to master separation and individualization PTSD: Irritability, transient psychotic episodes Common differential dx: bipolar II disorder Treatment: Meds for symptoms: Antimanics, antidepressants, and/or anxiolytics Sometimes antipsychotics Long term therapy: Highly structured, psychodynamic therapy or dialectical behavior therapy Short hospital stays for abandonment depressions Risk factors??? Antisocial Personality Disorder- 3% men, 1% women continual violation of rights of others, no guilt/ remorse Relationship between Psychopathy and APD- Sociopath: Have a conscience Molded by society to think what they are doing is okay Loyal to a cause or group Socialized to crime Psychopaths: Cold, not loyal Smart/ intelligent: can become socio-politcal leaders, charismatic, all walks of life, manipulative Not intelligent: Impulsive, get caught, no remorse They get caught, labeled as “antisocial” personality disorder Linked to deprivation, incompetent parenting Tend to have concrete morality: Don’t do it if you’re going to get caught Strong genetic contribution Most likely from dad Clinical studies show that psychopaths can think one thing but do something else Accounts for 20% of all prisoners, 50% of all crimes Risk factors Diagnosed only after age 18 Before 18- “conduct disorder” 25% of boys w/ ADHD will be APD cortical immaturity- prefrontal area dysfunction low, slow or hypervariable arousal hypothesis >insensitivity to reward and punishment frequently EtOH/drug abuse treatment: incarceration no medial or therapy 3 strikes law: many offenders are repeaters and classify as psychopaths Etiological hypotheses – Begins w/ possible absence of parental love during infancy Become emotionally distant and have lack of basic trust Antisocial symptoms might be learned through imitation of parents Display lower serotonin activity than other individuals Deficient functioning in frontal lobes Anxiety and physiological arousal- Experience less anxiety Lack drive for learning Respond to warnings or expectations of stress with low brain and bodily arousal. More likely to seek thrills and take risks Course of disorder through childhood, adolescence and adulthood- Usually children with conduct disorder and ADHD have heightened risk of developing APD Persistently lie, violate rules and rights of others, lack foresight, judgment and fail to learn from experience Continues through adolescence Truancy, lying, theft Diagnosed at 18+ yrs old as APD Relationship between OCD and Obsessive-compulsive personality disorder- Closely related in similar features but OCDPD embrace symptoms and rarely wish to avoid them OCD do not want/ like symptoms OCDPD= suffer from major depressive disorder, GAD or substance related disorder “Ego-dystonic” vs. “ego-syntonic” symptoms Schizophrenia (and see Question II)- Dementia praecox- Termed by Emil Kraepelin 1898 Dementia- loses ability to have cognitive and mental functions Loss of mental powers that came around later ages Incorrect assumptions ^ General manifestations- Loss of previous level of functioning Does okay in early years Begin to act eccentrically, socially withdrawn, more disturbed By late adolescence, usually diagnosed Disturbances of body language and communication Bizarre associations Stops speaking or responding “formal thought disorder” altered thought boundaries: thought broadcasting: people are listening to their thoughts insertion: experiencing thoughts that don’t belong to you and believe something has been implanted in brain, forcing certain thoughts removal: something that causes forgetfulness and loss of thoughts hallucinations (usually auditory): often accusatory: You’re a shit command: voices tell you what to do delusional experiences: feelings that there are internal forces controlling the body world is distorted delusional beliefs: often conspiratorial disordered emotionality: flat: monotone, straight paranoid: suspicious, nervous, things aren’t what they appear to be find meanings in questions silly affect: goofy giggles, not at appropriate times disturbances of the will: inertial: stay where they are. Can’t summon will to perform a movement lack of initiative social withdrawal and autistic thinking: become eccentric on one hand or withdrawn on the other motor abnormalities: reduced spontaneity: flat affect no animation or vitality bizarre or stereotyped gestures and postures: “schizophrenic float”- specific gait Risk factors: Genetic predisposition, consanguinity and concordances, infectious agents, birth trauma, Sperm, etc- Non- genetic Risk factors- Birth complications: protracted labors: forceps deliveries: caused contusions on the cortex Maternal malnutrition Seasonality of birth: Born in winter months: more likely to be diagnosed Geographic clusters of 4-6% incidence: Suggests contagious ediology Maternal exposure to influenza virus: Risk greatest at 6 thmonth of gestation Viral exposure may explain MZ/ DZ difference Other infectious agents: Rebella (german measles) Toxoplasmosis spores: + prevalence of cat ownership among parents of schizophrenics Endogenous retrovirus (herpes) Old sperm: odds of schizophrenic child are: About 1 in 200 if father is 25 About 1 in 120 if father is 40 About 1 in 70 if father is 50 Use of street drugs: Especially cannabis: risk is enhanced with certain genotypes Do not use weed if it has given you a psychotic reaction or if there is psychosis in your family consanguinity odds of a child becoming schizophrenic are: 15% if 1 parent is schizophrenic (vs 1% baseline) 46% if both parents are schizophrenic (vs 1% rate) above risk applies even if children are adopted early into new homes MZ twin types and implications- twin concordances (MZ= ~.55, DZ= ~.15) epigenesis, womb environment and post birth environment, viruses that can turn genes on and off which accounts for the 50% chance 2 types of monozygotic twins: monochorionic and dichorionic twins Marijuana and psychotogenicity DSM-IV classical schizophrenia subtypes and problems with subtypes- Positive- symptom Schizophrenia (Type I)- Psychotic features: Hallucinations Delusions Disorganized features: Paranoid or silly affect Bizarre or disorganized behavior Disordered thought processes Negative- symptom schizophrenia (Type II, Deficit Syndrome)- Flat affect Psychomotor retardation Mutism/ blocking Poor grooming Social withdrawal Positive vs. negative signs/symptoms of schizophrenia (range of symptoms)- + symptom- childhood oddity, irritability, aggressiveness later age of diagnosis (20-25) F>M Better prognosis DA abnormalities Responds to classical antipsychotic meds Less chance of observable brain damage - symptom- childhood withdrawal, passivity earlier age of diagnosis (16-18) M>F Worse prognosis No DA abnormalities Poor response to classical antipsychotic meds Greater chance of observable brain damage Changes mandated by DSM-5 Classical / atypical antipsychotic medications (effects, side effects, major classes of medications)- Acute: sedation and “chemical restraint” Chronic: normalizaiton of cognition and behavior Overall, compliance <30% Antipsychotics, Major Tranquilizers, Neuroleptics Classical Antipsychotics: Treat mainly + symptoms EX: Thorazine, Haldol, Stelazine, Prolixin nd Atypical (2 generation) antipsychotics: Treat both + and – symptoms EX: Abilify, Zyprexa, Clorazil, Invega, Risperdal, Seroquel, Geodon Abilify and Geodon= weight neutral Advantages of atypical antipsychotic medications- Less weight gain Treat both + and - symtpoms Role of psychotherapy in schizophrenia – Individual Psychotherapy (adjunctive) Adjustment to illness Family Friends Work Love Deal w/ secondary depression, anxiety Symptom self- monitoring Building compliance w/ meds Seeks to change how individuals view and react to their hallucinatory experiences Provide education about bio causes of hallucinations Motor and metabolic side effects of antipsychotic medications- Extrapyramidal effects Parkinsonian symptoms: shake, move slowly, shuffle feet, show little facial expression Dystonia: involuntary muscle contractions Bizarre uncontrollable movements of face, neck, tongue and back Akathisia: restlessness, agitation and discomfort of limgs Neuroleptic Malignant Syndrome: muscle rigidity, fever, altered consciousness, improper functioning of ANS Tardive Dyskinesia: involuntary writhing or ticlike movements of tongue, mouth, face or whole body Other disorders often treated with antipsychotic medications- Parkinson’s: might have to do with the dopamine levels Amphetamine Psychosis Bipolar Disorder and severe mental disorders World-wide trends in schizophrenia incidence and possible causes- Overall prevalence is stable but course and outcome varies In developing countries: More likely to recover from disorder Less likely to experience continuous or episodic symptoms, display impaired social functioning Don’t usually require heavy antipsychotic drugs or require hospitalization Possible causes: Psychosocial environment of developing countries= more supportive and therapeutic Provide more social and family support, less judgemental and critical, more available care “Rule of thirds” and newer outcome estimates in schizophrenia Eating Disorders- Prevalence as a function of sex and Westernization, and explanations: Females overwhelming majority 90% of all cases related to Western ideas about food and feminity emphasize weight loss, dieting, body shape in media (women) emphasize weight control, muscle definition (men) Types of males who are especially susceptible to eating disorders- Athletes: Men in sports Worry about thin-ness/ weight control Competitive body building Gay Males: Subject to same pressures in physical appearences as hetero women Eating disorders: be able to define or identify from brief case descriptions Anorexia nervosa: self-starvation to precariously low body weight Bulimia nervosa: recurrent binge eating accompanied by compensatory behavior (“purging” via vomiting, laxatives, emetics, or non-purging behavior such as fasting and/or exercise) Binge-eating disorder: Recurrent binge eating without compensatory behavior >20% over ideal body weight most common eating disorder occurance rising amidst current obesity epidemic Consequences: Same costs as obesity High BP, heart disease, stroke Diabetes, acid reflux, cancer, sleep apnea Treatment: Similar to that of Bulimia Eating Disorder NOS (not otherwise specified): disorders that do not fit either category infrequent purge- binge cycles repeated chewing and spitting out food anorexia-like behaviors but normal weight Effectiveness of dieting as a weight-loss method- ~5% success rate transient weight loss weight always gained back quickly and then some Anorexia nervosa- “nervous loss of appetite” refusal to maintain normal weight: less than 85% of idea body weight intense fear of gaining weight/ becoming obese Nature of body distortion- Person feels fat even when severely underweight Sees images of oneself as 20% heavier than actual weight Susceptible populations- Women athletes/ dancers Adolescent girls (13-20) MZ Twins (44%) Relative of family members with AN have 10-12X chance of being diagnosed Early Warning Signs- Falling off growth curve (rapid, excessive weight loss) No longer eating w/ family Negative comments about self image Very anxious/ depressed but guarded about why Diet needlessly Altered eating habits- Development of obsessive food thoughts How much did I eat? How much can I eat? Establishing irrational rules about food Only eat green foods, X% on plate, insides of fruits Food rituals Sipping water before eating Chewing X amount ½ binge and purge binges small purging normally exercise Risk Factors- Hypothalamic and Pituitary abnormalities Abnormalities in serotonin that may inhibit eating Emotional reactivity and obsessive personality traits "Two P's" of anorexia- Powerlessness Perfectionism “If I can control my body, then I can have a perfect body and perfect life” Treatment and typical treatment outcome- Inpatient  Outpatient family therapy Cognitive- Behavioral Therapy Reassert parents control of eating Begin a program in re-feeding Change attitudes about eating and weight Educate about body distortions and recognizing it Outcome: Weight is quickly restored ~83% show continued improvement after initial recovery ~25% full, ~58% partial menstruate again ~20% remain troubled for years with relapses Meds- Ineffective in treating Anorexia semi effective in treating accompanying depression/ anxiety Bulimia nervosa- “ox appetite” binge eating, 2x a week for 3+ months compensatory behavior to maintain or lose weight
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