CLP4143 Exam 4 Psychotic Disorders 1 Psychosis inability to tell the difference between what is real and unreal Three main types of psychotic symptoms o Positive or behaviors o Negative Characterized by the presence of unusual perceptions thoughts Refers to the fact that symptoms are salient added experiences Include delusions hallucinations Characterized by losses or deficits in certain domains Refers to the absence of behaviors feelings experiences etc Core negative symptoms affective flattening alogia avolition Less obvious than positive symptoms but are associated with more impairment and are less responsive to medication o Disorganized thought and speech Shouting swearing pacing Echolalia and or echopraxia Disorganized unpredictable and seemingly untriggered Can explain disheveled appearance Word salad Neologisms Catatonia group of disorganized behaviors that reflect extreme Loosening of associations or derailment lack of responsiveness Catatonic excitement wild agitation that is difficult to subdue Phases of schizophrenia 1 Prodromal phase before onset of full syndrome often negative 2 Acute active phase of syndrome negative positive and disorganized symptoms symptoms 3 Residual phase after acute phase Schizophrenia prevalence and prognosis o 1 2 lifetime prevalence in US o 5 2 lifetime prevalence worldwide o More common in men o Lifetime expectancy 10 years shorter than average o High relapse rate 85 have residual and or active symptoms o Higher rates of infectious and circulatory diseases o More likely to be victims of crime o 10 15 die by suicide Factors predicting better prognosis o Better functioning before disease onset CLP4143 Exam 4 2 o Acute onset o Later age at onset o Taking antipsychotic medications throughout disease o Better inter episode functioning estrogen affects dopamine o No family history of schizophrenia or mood disorders Biological theories of schizophrenia o Genetics 50 concordance rate MZ twins vs 14 DZ twins 50 likelihood of having schizophrenia if both parents have the disorder o Structural brain abnormalities Enlarged ventricles Smaller prefrontal cortex o Birth complications Perinatal Hypoxia oxygen deprivation Prenatal virus exposure high rates of schizophrenia associated with mom getting the flu in second trimester o Neurotransmitters Overactive dopamine in mesolimbic pathway Underactive dopamine in prefrontal areas o Other biological risk factors Drug use as a teenager or young adult primarily marijuana and hallucinogens Family history of epilepsy Psychosocial theories for schizophrenia throughout life o Urban birth o Social drift individuals with schizophrenia more likely to fall to lower SES Moms more likely to be exposed to infectious diseases during pregnancy Low SES associated with stressors nutrition security that slightly increase risk for psychosis Two hit hypothesis Biological treatments for schizophrenia o Medication treatments o 1st hit before development womb o 2nd hit adolescence early adulthood stress substance use illness Neuroleptics revolutionized treatment of schizophrenia Dopamine antagonists Reduction of positive symptoms Examples Thorazine chlorpromazine Haldol butyropheones and Navene thioxanthenes Issues CLP4143 Exam 4 3 25 of people don t respond at all More effective with positive symptoms than negative symptoms Discontinuation 78 relapse Side effects Grogginess dry mouth blurred vision drooling sexual dysfunction weight gain depression etc Akinesia slowed motor activity monotonous speech lack of facial expression Parkinson s like symptoms Dopamine connection Tardive dyskinesia Involuntary repetitive body movements Irreversible long term side effect 20 of individuals o Atypical antipsychotics Generally bind to dopamine receptors but also influence other neurotransmitters Fewer neurological side effects but still have side effects that include dizziness nausea sedation weight gain irregular heartbeat type II diabetes and serious diseases Examples clozapine olanzapine risperidone Psychological treatments for schizophrenia o Cognitive treatment Help individual recognize and change attitudes o Behavioral treatment Social skills training Problem solving skills Somatic and Dissociative Disorders Somatic Key features o Real or imagined somatic physical symptoms o Related abnormal thoughts feelings or behaviors Example Accrual of 12 000 in ER bills for visits ending in diagnosis of normal gas and bloating Biopsychosocial Model o Biological Factors o Social Factors Physical symptom may be present Greater cultural acceptance of physical than psychological problems Sick role reinforcers Social support CLP4143 Exam 4 4 o Psychological factors Fear of illness Extreme stress Avoidance via selective attention Reinforcement Cognitive Behavioral therapy Poor recognition of emotional distress Sensitivity to bodily sensations o Identify reinforcers and eliminate or replace them o Change catastrophic thoughts o Identify and challenge misinterpretations about physical sensations Biological treatment o Antidepressants can reduce somatic symptoms Dissociative Dissociation disturbances in memory identity or consciousness Dissociation on a continuum o Mild dissociation is common Daydreaming Forgetting a conversation you had o More extreme end Frequently forgetting important events Depersonalization Derealization Key features of Dissociative Identity Disorder DID formerly known as Multiple Personality Disorder o Presence of two or more distinct personalities o Each identity has its own memories attitudes and perceptions and do not recall memories from other personalities o Identities alternate control Controversies in DID diagnosis o 1970 79 cases o 1986 6 000 cases o 1998 40 000 cases o Average number of personalities also increased from 3 to 12 o People with DID tend to be more suggestible hypnotizable o Nearly everyone with DID symptoms has been exposed to information about DID before symptoms developed o Therapist induced symptoms iatrogenic therapist can induce or worsen symptoms i e by asking questions acting interested in correlated symptoms Role of reinforcement in development of DID o Social theory Severe past stress or trauma CLP4143 Exam 4 5 Can be reinforced through selective social support Psychological treatment may worsen symptoms Psychological treatments for DID o Very little known o Helpful o Hurtful Resolve precipitating stressors Focusing on remembering forgotten info leads to recovering repressed memories worsens symptoms
View Full Document
Unlocking...