What did Emil Kraeplin contribute to psychology?
Kraeplin created one of the first textbooks of co-occurring mental disorders, which he grouped together and classified with common symptoms. He also created the term "dementia praecox" for schizophrenic symptom clusters.
This became the ancestor to our modern Diagnostic and Statistical Manual of Mental Disorders (DSM).
Who was Philippe Pinel?
Pinel was one of the first mental health professionals to treat his patients with compassion and kindness. The model set by the Parisian hospital he ran was adopted by many other asylums.
Which American activist fought for asylum reform in the mid-1800s?
Who wrote The Myth of Mental Illness?
What is The Myth of Mental Illness about?
This book espouses the belief that labeling people as mentally ill makes them conform to the norms of society, rather than examining the societal roots of their mental problems. Szasz also espoused the belief that "mental illness" is a social construction.
To hear an excerpt of a speech by Szasz, please go here.
To what do the terms incidence, prevalence, and lifetime prevalence refer?
- Incidence is the number of new cases that appear in a population in a given period of time.
- Prevalence is the total number of active cases (old and new) present in a population in a given period of time.
- Lifetime prevalence is the total proportion of people who will meet criteria for diagnosis at some point in their lives.
What is comorbidity?
Comorbidity is another term for co-occurrence.
For instance, if an individual meets diagnostic criteria for both obsessive-compulsive disorder (OCD) and alcohol dependence, then that person could be said to have comorbid OCD and alcohol dependence.
Comorbidity is very common in clinical settings, and high rates of comorbidity suggest that many mental disorders are not clear-cut categories.
Diagnosis and Causes:
What is a necessary cause?
A necessary cause is something that must be present for a particular illness to occur:
If illness X occurs, then A must have been present.
Diagnosis and Causes:
What is a sufficient cause?
A sufficient cause is something that by itself may cause a particular illness to occur:
B, in the absence of other factors, can result in illness X.
Diagnosis and Causes:
What is a contributing cause?
A contributing cause is something that makes it more likely that a particular illness either will occur or will continue:
If C is present, then illness X is more likely to happen or continue.
What does ICD stand for?
What is the ICD-10?
The ICD-10 is the International Classification of Diseases. The ICD currently is in its tenth edition.
(The ICD-11 is expected to be released in 2018. Some of the revisions in the DSM-5 were made to make it more consistent with the ICD.)
The ICD is a system of classifying diseases; it is published by the World Health Organization.
The U.S. and Canada use the DSM system for diagnosing mental illnesses; most of the rest of the world uses the ICD system.
What are 3 important factors to consider when determining whether or not an individual's behavior is abnormal?
- Whether the behavior causes subjective distress or suffering to the individual
- Whether the behavior causes impairment or dysfunction
- Whether the behavior is atypical or deviant with respect to the individual’s current cultural context
Clinicians use signs and symptoms when diagnosing mental illness. What is a symptom? What is a sign?
Signs: perceived by the clinician (e.g., patient appears disheveled, patient speaks unusually slowly, patient does not make eye contact)
Symptoms: perceived by the patient (e.g., patient feels hopeless, patient experiences intrusive thoughts, patient has suicidal thoughts)
Describe the diathesis-stress model of mental illness.
This is a model in which a person has a diathesis (i.e., a vulnerability, which may be a distal necessary cause or a contributory cause) to mental illness which can be activated by a stressor/stressors (i.e., an experience or experiences that overtax an individual’s resources), thus precipitating mental disorder.
Using MDD, provide an example of a diathesis.
Using MDD, provide an example of a stress.
Diathesis example: Having a short short (ss) allele for the serotonin transporter gene is a diathesis for depression.
Stress example: Getting divorced is a stressor.
What is primary prevention?
Primary prevention refers to attempts to prevent disease or disorder onset, i.e., reducing the incidence of preventable illnesses.
Primary prevention is not (yet) achievable for mental illness. Challenges include identifying what factors encourage the precipitation of mental illnesses (only some have been identified) and attempting to prevent these situations before they happen, via good public mental health practices (some may not be preventable). However, some are preventable. For instance, because prenatal malnutrition doubles the risk for an individual developing schizophrenia in adulthood, providing universal prenatal care may help reduce the incidence of schizophrenia.
An unusually high level of negative mood
An unusually low level of positive mood; inability to feel pleasure.
Describe what David Rosenhan reported in his classic 1973 Nature article, "On Being Sane in Insane Places."
Rosenhan and several other confederates were admitted into mental health facilties presenting with illnesses. The confederates all received diagnoses and had a difficult time being released, because the staff began to classify their regular behaviors as indicative of illness. Rosenhan interpreted the results to mean that diagnoses exist in the minds of the observers.
To read the original Rosenhan article, go here.
To see a brief interview with Rosenhan, go here.
What were the implications of David Rosenhan's experiment?
Rosenhan reported that the pseudopatients, rather than being released as never having been ill, were released with a diagnosis of schizophrenia in remission. Rosenhan noted that being labeled "insane" can persist throughout the life-span, which is dangerous. Rosenhan concluded that psychiatric diagnoses exist in the minds of observers: By naming something, we behave as if it is real (so yes, symptoms are real, but how we understand illnesses may be wrong.)
Perhaps the most disturbing finding was that pseudopatients averaged less than seven minutes of direct therapeutic care per day, suggesting that patients in general received inadequate clinical care.
What are some limitations or critiques of Rosenhan?
Among other issues:
- The diagnosis of schizophrenia in remission was (and is) quite rare, suggesting that the psychiatrists were aware that these patients' cases were not standard cases.
- Because symptoms, which are not externally visible, are used to determine diagnosis, in most situations, treaters must depend on patients to be honest to the best of their ability. The ability to fake an illness does not mean that the illness does not exist.
To read Spitzer's critique of Rosenhan, go here.
From what school of thought are Beck's cognitive therapy (for depression) and Ellis's rational-emotive therapy?
They are forms of Cognitive Behavioral Therapy (CBT).
One of the important strengths of CBT is that it has empirical support. Empirical support means that is has been scientifically tested in clinical trials and found to be beneficial for patients.
What are the components of Beck's Negative Cognitive Triad?
Negative views of the self: e.g., "I suck."
Negative views of the world: e.g., "Everybody hates me."
Negative views of the future: e.g.," My life will always suck."
What is Beck's theory of depression? In other words, according to Beck, how does depression happen?
Negative early experiences can lead to the formation of dysfunctional beliefs or schemas, which may lay dormant until a critical incident of some kind occurs (e.g., losing a job or breaking up with a significant other).
The individual then experiences cognitive distortions about the critical incident (or incidents). These cognitive distortions lead to negative, dysfunctional automatic thoughts and self-talk, which can turn into a negative feedback loop and cause the individual to experience depressive symptoms. Cognitive errors reinforce negative schemas.
Describe the experiment Martin Seligman designed that developed his theory of learned helplessness.
He would place dogs in cells with high walls, then electroshock the floor, causing the dogs to try to jump out of the cells. Eventually, the dogs stopped trying to escape: they had learned to be helpless. This is much like people with depression who eventually feel powerless to escape their problems.
What are the steps of CBT?
- Identify situations that are troubling
- Become aware of relevant thoughts and beliefs
- Identify inaccurate, negative thinking
- Challenge inaccurate, negative thinking
Repeat until cognitive errors are reduced and adaptive thinking patterns become habitual.
What are some of the benefits of the Cognitive Behavioral paradigm?
What are some of the strengths of CBT?
Empirically validated treatments!! Research supports that CBT works for treating many disorders, such as anxiety and unipolar mood disorders.
For depression, CBT treatment is as successful as SSRIs; plus patients who do CBT have a significantly lower recurrence rate!
Versatility-- CBT has successfully been adapted for use with patients from a variety of cultures. Also, CBT has been successfully used for a variety of uses, such as helping individuals develop healthier sleeping habits.
CBT is empowering: Patients do homework and actively collaborate on their treatment.
The cognitive behavioral paradigm has many strengths. However, it also has limitations. What are some of the limitations?
CBT may not adequately address biological factors
Therapists need special training; relatively few patients have access to CBT services. Needs better dissemination!
Research focuses on patients without comorbidity, so short length of treatment may not be realistic for patients in the community
It is challenging, so high drop out rates can be problem
According to the DSM-5, what are the two types of mood disorders?
There are two major types of mood disorders are:
1) Bipolar and Related Disorders
Bipolar I Disorder; Bipolar II Disorder; Cyclothymic Disorder...
2) Depressive Disorders:
Major Depressive Disorder; Persistent Depressive Disorder (Dysthymia); Premenstrual Dysphoric Disorder...
In order to met criteria for Major Depressive Disorder (MDD), one must have 5 or more symptoms for two or more consecutive weeks; the symptoms must be a change from previous functioning, there must be no history of mania or hypomania, and must not be attributable to another medical condition.
Name the 9 possible DSM-5 MDD symptoms, and note which 2 are cardinal symptoms.
(One or both cardinal symptoms must be present to qualify for MDD.)
- depressed mood (dysphoria) *
- general lack of interest in once enjoyable activities (anhedonia) *
- low sense of self-worth
- hypersomnia or insomnia
- possible suicidal ideation
- significant weight loss/gain
- loss of energy
- diminished ability to concentrate
* Symptom 1 (dysphoria) and Symptom 2 (anhedonia) are the cardinal symptoms; one or both must be presnt for a DSM-5 MDD diagnosis.
What is a difference between the DSM-IV and DSM-5 criteria for Major Depressive Disorder (MDD)?
In the DSM-IV, there was a grief/loss exclusion for diagnosing Major Depressive Disorder (MDD). This exclusion has been removed in the DSM-5.
The exclusion originally was included to avoid pathologizing grief. However, MDD often is triggered by exposure to significant stressors. A compelling reason to remove the exclusion is that in a treatment study, treatment seeking individuals who otherwise met criteria for MDD responded to treatment as successfully as did treatment seeking individuals who met the full criteria. Thus a grief exclusion may have been an unintended barrier to beneficial treatment.
What are the diagnostic criteria for Persistent Depressive Disorder (Dysthymia)?
***Depressed mood for most of the day for more days than not for at least 2 years (in children and adolescents, at least 1 year).
***Presence (while depressed) of at least 2 of the following symptoms: Poor appetite or overeating; Insomnia or hypersomnia; Low energy or fatigue; Low self-esteem; Poor concentration/difficulty making decision; or Feelings of hopelessness.
***During the 2 year period, the individual has never been free from these symptoms for more than 2 months at a time.
***Symptoms cause clinically significant distress or impairment in functioning.
(Also, no history of mania, and the disorder is not better accounted for by schizoaffective, schizophrenia, delusional disorder, or another psychotic illness; not caused by a substance or medical condition)
Is Persistent Depressive Disorder (Dysthymia) just a milder form of Major Depressive Disorder?
No. Persistent Depressive Disorder (Dysthymia) is no longer considered a milder form of depression than Major Depressive Disorder (MDD).
The DSM-5 explains that although there can be wide variation in how the disorder impacts social &/or occupational functioning, "effects can be as great or greater than those of major depressive disorder"
Although the symptoms may be less severe, their longstanding nature can lead to significant impairment as well as an even higher risk for suicide than MDD.
This mental disorder is characterized by periods of depression and mania.
Annie has been hospitalized. Over the last week, she has exhibited increased self-esteem, a lack of sleep, rapid-fire ideas, increased promiscuity and risk-taking behavior. What mental disorder does she have?
bipolar disorder type I
What are the major characteristics of cyclothymic disorder?
one or more periods of hypomanic symptoms interspersed with one or more periods of depressive symptoms.
Who first introduced electroshock therapy as a cure for seizures?
Cerletti and Bini
These doctors introduced electroshock therapy in 1938. The spasms from this treatment were often so severe that their patients were often seriously injured during the therapy.
However, electroshock therapy can now be performed safely and is used as a treatment for some severely depressed patients. (It is reserved for patients who are severely depressed and are not responding to or are unable to take other forms of treatment.)
What is an iatrogenic treatment?
An iatrogenic treatment is one which makes a condition worse.
Although most therapies are helpful, some treatments (e.g., debriefing for PTSD; psychoanalysis for schizophrenia) have been found to worsen outcomes. The possibility of iatrogenic treatment is one of the reasons that clinical research trials are very important.
Is insane a psychological term?
No, insane is a legal term.
Mental health professionals and medical doctors cannot diagnose people as being insane. Determinations of sanity are a legal matter.
Diagnosis with a mental disorder may be used as evidence in determining a defendant's fitness to stand trial, but in and of itself, diagnosis is not sufficient to determine sanity.
(Sane also is a legal term.)
Do most people who try an addictive substance, such as alcohol, become addicted?
No. Most people who experiment with addictive substances do not become addicted.
However, a minority will, and it is not possible to know for certain in advance whether or not one has a brain that is especially vulnerable to developing addiction.
Should Alcoholism be considered a disease?
What are the disadvantages of conceptualizing alcoholism as a disease?
Disadvantages of Disease Model:
reduces addicted individual's accountability
removes incentive to abstain
places addicted individual in victim role
inconsistent with data that say "controlled" use may be achieved
In the development of addicition, what are the key
distinctions between early stage drug use
and late stage drug use?
In early stage, the drug use is pleeasure-based and goal-driven, i.e., drug taking behavior
In late stage, the drug use is compulsive and habit-driven, occuring even if there are significant negative consequences, i.e., drug seeking behavior
In addiction, as time goes on, the individual likes or enjoys the drug less, but craves the drug more and more.
Should Alcoholism be considered a disease?
What are the advantages of conceptuallizing alcoholism as a disease?
Advantages of using a Disease Model:
brought the problem to public awareness
achieved funding to study alcoholism
promotes treatment development and funding
What is Alzheimer's disease?
What changes in the brain are associated with Alzheimer's disease?
Alzheimer's disease is a lethal neurodegenerative disorder. Individuals with Alzheimer's disease experience dementia, progressive losses in memory and cognition, social withdrawal, lapses in judgement, and eventually lose their ability for self care.
Post mortem (after death) examination of the brains of people with Alzheimer's disease reveal neurofibrillary tangles, amyloid plaques, and reduced brain volume.
Currently there is no way to cure or to prevent Alzheimer's disease.
Which diagnosis is the most lethal?
(In other words, which diagnosis has the highest risk for the patient dying due to the illness?)
Anorexia nervosa (AN).
According to the DSM-5, the majority of the AN deaths are due either to medical complications (e.g., multiple organ failure) or to suicide.
What Feeding and Eating Disorders appear in the DSM-5?
- Rumination Disorder
- Avoidant/Restrictive Food Intake Disorder
- Anorexia Nervosa (AN can be restricting type OR can be binge-eating purging type)
- Bulimia Nervosa
- Binge-Eating Disorder
- Other Specified Feeding or Eating Disorder
- Unspecified FEeding or Eating Disorder
A patient presents at your clinic; she is severely underweight from excessive control over her body. The patient believes that she weighs too much, even though she is 20 pounds underweight, and is severely malnourished. Her body weight is less than 85% of what one woulld expect someone her height to weigh. What mental disorder does she likely have?
In bulimia nervosa, someone will have multiple large eating binges and then compensate for the binges with: _______, ________, or __________.
purging; excessive exercise; fasting
However, if the individual also meets criteria for anorexia nervosa, you diagnose anorexia nervosa (binging and purging subtype) instead.
The DSM-5 addresses temperamental, environmental, genetic, and physiological risk factors for developing anorexia nervosa (AN). (There are others, but the DSM-5 addresses some significant, well-established risk factors).
List the risk factors for AN identified in the DSM-5:
1) Having developed an anxiety disorder as a child or having had obsessional traits as a child.
2) Environmental--Being in a culture or setting in which thinness is valued/idealized (e.g., modeling).
3) Genetic--Having a first degre relative with AN. Monozygotic (identical) twins have a higher concordance rate than dizygotic (fraternal) twins.
4) Possibly brain abnormalities, but it is unclear if abnormalities are the result of or a cause of AN.
In addition, being female, being Caucasian or Asian, negative affect (neuroticism), dieting, body dissatisfaction, dieting, and perfectionism also are individual risk factors. Childhood sexual abuse also has been implicated in some research.
Is there a gender difference in the incidence of anorexia nervosa?
Yes! Anorexia nervosa is much more common among females. It is estimated that for every 1 male with AN, there are 10 females.
Another mental disorder often diagnosed in early childhood is _______, which is characterized by sensitivity to sensory stimuli, impaired communication skills, few facial expressions, and repetitive behaviors.
Is Asperger's Syndrome a valid DSM-5 diagnosis?
In the DSM-IV, the diagnosis Asperger's Syndrome (a very high functioning form of autism,) has been subsumed into the diagnosis of Autism Spectrum Disorder.
Do all people who have autism also have an intellectual disability?
No. Although it is common for people who have autism to have an intellectual disability, many individuals who meet criteria for autism do not meet criteria for an intellectual disability.
In the DSM-5, the term mental retardation has been replaced by the term _________ _______.
What is Down syndrome? What causes Down syndrome?
Down syndrome is a condition associated with moderate to severe intellectual disability. In addition, individuals with Down syndrome seem to age more quickly, have increased risk for developing dementia/Alzheimer's disease, and have shortened average lifespans. There is a high rate of cardiovascular problems. Also, there are distinctive physical features (e.g., almond shaped eyes) associated with Down syndrome. Down syndrome is caused by a trisomy (three copies instead of two) of chromosome 21.
What is Phenylketonuria (PKU)?
Phenylketonuria (PKU) is a disorder in which a baby lacks a liver enzyme necessary to process phenylalanine, an amino acid found in many foods, including breast milk and cow's milk. It is a recessive disorder, occuring in approximately 1 in 12,000 births. In most cases, if it is detected soon after birth, special diet can allow the individiual with PKU to have a normal life. If it is not caught and addressed early in life, severe brain damage and intellectual disability occurs.
A disorder characterized by the pervasive expression of extreme, abnormal personality constructs that interfere with normal social functioning.
What is the relationship between childhood abuse/neglect and personality disorders?
Abuse and neglect are risk factors for developing personality disorders.
People who experienced abuse and/or neglect as children are 4 times more likely to develop a personality disorder than are people who were not abused or neglected (Johnson, et al., 1999). This relationship is especially pronounced in Histrionic Personality Disorder, Narcissistic Personality Disorder, Borderline Personality Disorder, and Antisocial Personality Disorder.
Which personality disorder is characterized by a blatant disregard for the rights or interests of others which is usually manifested through repeated illegal acts and aggression towards others?
antisocial personality disorder
Antisocial personality disorder (ASPD) and psychopathy are overlapping constructs. ASPD appears in the DSM-5; psychopathy does not. Yet researchers tend to prefer to use psychopathy as a construct. Why?
Important critiques of ASPD include that it has good reliability but lacks validity and that a diagnosis of ASPD in many cases is just a diagnosis of criminality, not mental illness.
Psychopathy is more challenging to consistently diagnose/quantify, but it is more predictive of recidivism, especially violent recidivism.
What therapy is showing promise as a treatment for individuals who meet criteria for psychopathy?
Approximately 1% of the population meets criteria for psychopathy. Approximately what percentage of crime is committed by people who are psychopathic?
For more information on decompression therapy and psychopathy, please read: http://cicn.vanderbilt.edu/images/news/psycho.pdf
What measure is commonly used to assess psychopathy?
Who developed this measure?
What is an important limitation of this measure?
The Psychopathy Checklist -Revised (PCL-R)
Hare developed the PCL-R for use with caucasian men, and it lacks validity when used to assess Latino or Black men, or when used to assess women. This is highly problematic because PCL-R scores often are used in making legal determinations, such as sentencing and parole.
What are the key features of narcissistic personality disorder?
Exaggerated self importance
Excessive, constant need for others' admiration
Lack of empathy for others
borderline personality disorder
This personality disorder is one of the more volatile personality disorders; it is characterized by interpersonal issues, identity problems, fear of abandonment, and often self-injurious behavior.
According to the DSM-5, in order to meet criteria for diagnosis with Borderline Personality Disorder, an individual must have five or more of nine symptoms. What are the nine symptoms of Borderline Personality Disorder?
- Frantic efforts to avoid real or imagined abandonment.
- A pattern of unstable and intense interpersonal relationships characterized by alternating betwen extremes of idealization and devaluation (This is referred to as splitting).
- Identity disturbance--markedly, persistently unstable self-image
- Impulsive behavior in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, driving, eating)
- Recurrent suicidal or self-mutilating behavior
- Affective instability/marked reactivity of mood
- Chronic feelings of emptiness
- Inappropriate, intense anger/difficulty controlling anger
- Transient stress-related psychotic-like symptoms (paranoid ideation, severe dissociation)
What empirically-validated treatment for
Borderline Personality Disorder
reduces the risk of suicide?
Dialectical Behavioral Therapy (DBT).
Marsha Linehan developed DBT in order to help severely suicidal patients. DBT combines elements of CBT and eastern philosophy with acceptance therapy.
A substantial body of research supports DBT as significantly reducing the risk of suicide for individuals who have Borderline Personality Disorder.
If a patient exhibited excessive emotional reactions to normal, every-day stimuli, and was preoccupied with the constant need for attention, what personality disorder would you most likely diagnose?
histrionic personality disorder
__________ personality disorder is characterized by extreme distrust and suspicion of others.
Which personality disorder is associated with little emotional expression and a lack of social interactions?
schizoid personality disorder
What is the defining characteristic of dependent personality disorder?
the need to be cared for
Describe the active phase of schizophrenia.
This is the period of time (usually 6 months or more) in which the patient exhibits a mixture of positive and negative schizophrenic symptoms.
What is a delusion?
A fixed belief that is not amenable to change in light of conflicting evidence
If a patient believes he is supernaturally powerful, wealthy, or famous, what may he be suffering from?
delusions of grandeur
What is a delusion of persecution?
The unfounded belief that you are being or will be harmed, these delusions usually involve the mentally ill person believing they are the center of a plot.
A bio-psycho-social approach may be the best way to treat schizophrenia. In other words, including biological, psychological, and social components in one's approach to treating schizophrenia.
What might a bio-psycho-social approach to therapy for schizophrenia include?
Biological: Antipsychotic medication, either typical or atypical (atypicals are generally better tolerated)
Psychological: CBT to address hallucinations and delusions; social skills training; supportive therapy
Social: Family counseling; psychoeducation about schizophrenia
(Avoid psychoanalysis/psychodynamic treatment for schizophrenia because it can be iatrogenic!!)
This was the original name for schizophrenia, which literally means early dementia.
List some examples of positive symptoms associated with schizophrenia.
- disorganized behavior
- disorganized speech
- catatonic behavior
Is schizophrenia curable?
Currently schizophrenia is not curable, but good early intervention can help individuals who have schizophrenia have longer periods between episodes, and for the episodes to be less severe. Also treatment can help people function better between episodes.
What is Expressed Emotion (EE)?
Expressed Emotion (EE) helps explain the role of stress in the home environment in relapse for people who have schizophrenia. EE is measured by interviewing a patient's family member with whom she or he lives. A one-on-one interview is conducted by a researcher. The researcher assesses criticism (disapproval) of, hostility (animosity) towards, and emotional over-involvement (intrusiveness) with the patient. High levels of EE, especially criticism, is a risk factor for relapse High EE also is predictive for relapsee in other disorders.
(For additional information on EE, consult work by George Brown and work by Jill Hooley).
Restricted emotional range, blunted emotional expressions, restricted thought production, lowered speech fluency, and inability to engage in goal-directed behaviors are all examples of _________ symptoms of schizophrenia.
One way to remember negative symptoms is to think of them as something that should be present that is missing.
avolition, anhedonia, alogia, flattened affect, & asociality
What is the lifetime prevalence for schizophrenia?
Slightly over 1 %.
The diagnosis _______________________ is used to describe individuals who have features of both schizophrenia and severe mood disorder
Name the two phases of schizophrenia
Not all _______ are a sign of mental illness. For example, if you have a migraine, you may see spots in your field of vision.
What is the distinction between a non-bizarre versus a bizarre delusion?
A non-bizarre delusion is one which (although highly improbable) is possible, or seemingly possible, in the context of the individual's culture. For instance, a persecutory delusion in which the individual thinks that the CIA is watching him or that someone is trying to poison him.
A bizarre delusion is one which is implausible and not understandable to same-culture peers and does not derrive from ordinary life experiences. For instance, a delusion in which the individual thinks aliens are inserting or withdrawing thoughts from his or her head.
What is a neologism?
Literally, a neologism is a new word. (New words do arise in living languages.) However, in clinical and psychological research, the word neologism is used to describe non-words that seem word-like. Use of neologisms can be a symptom of some types of brain damage or of thought disorder. Thought disorder is a common symptom of schizophrenia.
Loose associations often can be heard in the speech of people experiencing schizophrenia. What are loose associations?
Loose associations occur when an individual speaks in such a way that his or her sentences have semantic connections but lack logical connection.
For instance: "It's cold today. My cold is better, but I got it from the nurse. She is a big blonde who drinks Manhattans. I live in Manhattan with famous people."
Loose associations, also referred to as cognitive slippage or derailment, are a sign of thought disorder. Thought disorder is a symptom of disorganized behavior in schizophrenia spectrum disorders.
What is the most common type of hallucination?
Auditory hallucinations are the most common types of hallucinations, such as hearing voices, but hallucinations can occur in any of the five sensory modalities.
What is the aberrant salience hypothesis? How would it explain delusions?
Often, dopamine is misunderstood as being primarily pleasure-related. Evolutionarily, dopamine is better understood as marking that something is important and needs our attention, motivating us to address survival needs (food, partner, etc.) According to the aberrant salience hypothesis: release of excess dopamine in the striatum of some individuals leads them to experience a false sense of salience/meaningfulness—ascribing importance to unimportant stimuli, then their brains try to construct a narrative to explain the feeling that the stimulus has meaning—an attempt at meaning-making. Thus, Delusions are a post hoc explanation to make sense of assignment of salience.
The periods of time in an individual with schizophrenia in which s/he is not actively psychotic, but has already had a schizophrenic episode are usually called ________.
In__________ schizophrenia, the symptom onset is usually sudden and deep, but the prognosis is usually good.
Describe the prodromal phase of schizophrenia.
The prodromal phase is a period before meeting criteria for diagnosis of a schizophrenia spectrum illness, in which the individual is begining to exhibit some symptoms, such as social withdrawal and odd behavior.
Sam presents at your office claiming symptoms that have lasted for about six months. He presents with hallucinations, delusions, disorganized speech, and flat affect. What mental disease does he have?
What are three common features of schizophrenic disorders?
disturbed or innapropriate emotional responses to environmental stimuli
If Jim's schizophrenia has a slow and insidious onset, what is this called and what is his prognosis?
process schizophrenia; his prognosis is poor, as it shows a long-term deterioration
Catatonia can occur in a variety of disorders, such as neurodevelopmental, psychotic, bipolar, and depressive, as well as in some other medical conditions.
Catatonia involves marked psychomotor disturbance, and requires any 3 (or more) of the 12 possible symptoms.
Be able to recognize the symptoms of catatonia and know what they mean!
The 12 symptoms of catatonia are:
1) Stupor 2) Catalepsy 3) Waxy flexibility
4) Mutism (do not count toward diagnosis is the individual has aphasia)
5) Negativism 6) Posturing 7) Mannerism
8) Stereotypy 9) Agitation not influenced by external stimuli
10) Grimacing 11) Echolalia (mimicking another's speech)
12) Echopraxia (mimicking another's movements)
Who coined the term schizophrenia?
Bleuler identified the lack of coherence between emotion and thought and the breaking away from reality characteristic of psychotic illness.
What is waxy flexibility?
Waxy flexibility is a catatonia symptom in which the body can be moved into new positions and will stay there instead of going limp.
______ affect is characterized by very few expressions of affect and ______ affect is characterized by consistently manifesting socially unacceptable emotional expressions.
What is the suicide risk for individuals who have schizophrenia?
What is the suicide risk for individuals who have schizoaffective disorder?
The lifetime risk for completed suicide for individuals who have schizophrenia or schizoaffective disorder is approximately 5%.
In other words, 1 in 20 people who have schizophrenia or schizoaffective disorder die by suicide.
(Approximately 20% will attempt suicide one or more times)
What learning mechanism may help explain how compulsions arise in OCD?
(Hint: Operant conditioning)
Intermittently, an individual who has OCD will experience temporary spontaneous reduction of obsessive thoughts. Whatever action the individual was taking at the time, typically an action aimed at reducing the distress or preventing the feared harm/negative consequence, will be associated with the temporary alleviation of the symptom, i.e., negative reinforcement. (This leads to the development of habit-driven rituals.)
If a patient presented with involuntary, uncontrollable, intrusive thoughts that she unsuccssfully tried to control through repetitive behaviors or rituals, which disorder would she have?
Is checking and rechecking an effective way for someone with OCD to reassure himself or herself?
No. Research indicates that the more times one checks, the less certain one is! (Did I lock the door? Did I unplug the toaster?). This seems to be the case because the more times one checks, the distinctive the memory is for having checked!
What is Body Dysmorphic Disorder (BDD)?
BDD is an OCD-spectrum disorder in which:
The individual is preoccupied with an imagined defect in appearance (or if there is a real appearance-related issue, the individual's concern is out of proportion to the issue),
The preoccupation results in impairment in occupational/social functioning.
The preoccupation is not better accounted for by an eating disorder
(Individuals with BDD often have multiple cosmetic surgeries.)
What is the cardinal symptom of trichotillomania?
Pulling out one's hair.
In the DSM-5, trichotillomania is recognized as an OCD-spectrum disorder. (Previously it was considered an impulse control disorder.)
What is fear?
What is anxiety?
Fear is a negatively-valenced, basic emotion. Fear focuses one's attention on a specific stimulus. Fear activates the sympathstic nervous system, readying the body for fight, flight, or freeze responses, so one can respond quickly to a potentially dangerous situation.
Anxiety also is negatively-valenced. It is a mood, so it is of longer duration than an emotion. Also, it is future-oriented, focusing on potential future harm, rather than addressing an immediate threat.
Name two cognitive mechanisms that contribute to the anxious apprehension experienced by people who have an anxiety disorder:
Feelings of dread and worry, along with constant autonomic nervous system arousal, characterize which disorder?
generalized anxiety disorder
People who have been exposed to high levels of violence, such as soldiers in war, are at risk for developing which disorder, characterized by recurring thoughts and anxiety linked to that trauma?
post-traumatic stress disorder
An individual has an enduring fear of public speaking that is so severe that it causes him clinically significant distress. He fears that because of his anxiety symptoms he will be humiliated or will unintentionally offend others.
What is his likely diagnosis?
Social Anxiety Disorder
(previously called social phobia)
Social Anxiety Disorder is one of the Anxiety Disorders
Agoraphobia is an anxiety disorder, and it is characterized by FEAR, ANXIETY, and AVOIDANCE.
What are the primary features of Agoraphobia?
The individual has marked fear or anxiety about 2 or more of the following:
1) Using public transportation; 2) Being in open spaces; 3) Being in enclosed spaces; 4) Standing in line/being in a crowd; 5) Being outside of the home alone
The individual avoids such situations/must have a companion to do/or are endured only with great distress; these situations almost always provoke fear or anxiety; fear is out of proportion both with actual risk and sociocultural norms; symptoms cause clinically significant distress or impairment.
If a medical disorder co-occurs (e.g., IBS, the fear, anxiety, or avoidance is clearly excessive), and the condition is not better explained by symptoms of another disorder.
Agoraphobia often co-occurs with Panic Disorder, though not always.
Claustrophobia, cynophobia, and homophobia are all examples of ________.
specific phobias: specific objects or situations that provoke anxiety.
In order for a fear of common events or objects to be considered a phobia, it must be both __________ and __________.
Does everybody who has a panic attack go on to develop Panic Disorder?
No. Most people who have had a panic attack do not develop Panic Disorder.
3-6% of people have had a panic attack.
What are some common experiences of someone experiencing a panic attack?
Shortness of breath, sensation of heart beating too quickly, fear of death, sharp pain in chest or stomach, nausea, depersonalization, fear of going crazy, shaking, sweating, and dizziness.
What is a panic attack?
What are the symptoms of a panic attack?
The DSM-5 describes panic attacks as "an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes."
The individual experiences 4 or more of the following 13 symptoms: 1) Palpitations/pounding heart/accelerated heart rate; 2) Sweating; 3) Trembling/shaking; 4) Short of breath/feel as if being smothered; 5) Feel as if choking; 6) Chest pain/chest discomfort; 7) Nausea or abdominal distress; 8) Feeling dizzy/unsteady/light-headed/faint; 9) Chills or snsations of heat; 10) Parasthesias (numbness/tingling); 11) derealization/depersonalization; 12) fear of losing control/fear of going crazy; or 13) Fear of dying
What symptoms characterize Panic Disorder?
1. The individual experiences recurrent, unexpected panic attacks.
2. For at least 1 month following one of the panic attacks, the individual has experienced significant worry/concern about future panic attacks (having them &/or their significance) and/or makes a significant maladaptive change in behavior related to the panic attacks (e.g., avoiding going to unfamiliar situations or avoiding exercise)
What is a diagnostic hallmark of conversion disorder?
symptoms affecting the motor or sensory body systems that are real to the patient but have no apparent medical cause
This is now a rare diagnosis, though it was a relatively common diagnosis during the first part of the twentieth century
This is a mental illness in which the patient may feel as though s/he is living outside his/her body, but still retains contact with reality.
What is Factitious Disorder Imposed on Another (Munchausen's Syndrome by Proxy)?
In this disorder, an individual seeking medical help or attention for another person in his or her care has intentionally, deliberatelly caused or simulated symptoms of an illness or of illnesses in the other person. Typically, it is a parent causing symptoms in her or his own child.
It is a very dangerous disorder; an estimated 10% of children who are victims of someone who has Factitious Disorder Imposed on Another die from the abuse (Hall et al., 2000).
Hidden camera evidence often is required in order to diagnose the disorder.
An individual sincerely frequently misinterprets bodily symptoms and so honestly believes himself or herself to be ill. This individual frequently seeks medical treatment. What is a likely diagnosis for this individual?
Which psychological disorder is characterized by physical symptoms without root in actual physical causes?
Hypochondriasis, factitious disorders, and malingering involve someone who is not ill behaving as if ill, yet there are very different motivations for each. What are the motivations for hypochindriasis, for factitious disorders, and for malingering?
Hypochondriasis –Person actually believes he or she has an illness (based on bodily symptoms)
Factitious Disorders –Motive is internal; to assume the role of a sick person (or to do so by proxy); to gain the attention (and sympathy) of medical professionals
Malingering –Motive is external; e.g., to obtain compensation, to evade police or legal action; the individual can stop having symptoms if having symptoms is no longer useful
Conversion disorder and hypochondriasis both are what type of disorder?
What are some common examples of paraphilias?
- zoophilia is sexual attraction to animals
- pedophilia is sexual attraction to children
- fetishism is sexual arousal stemming from objects or situations
Paraphilia (or psychosexual disorder) is marked by the sexualization of objects, people, or activities that are not generally considered sexual.
What is the lethality scale?
The lethality scale is a set of criteria used to assess the likelihood of an individual committing suicide.
Dissociative disorders are characterized either by a __________ of memory or a(n) __________ sense of identity.
When someone is unable to remember things, but there is no physiological basis for the memory disruption, he is said to be afflicted with what kind of amnesia?
In a dissociative fugue state, one first experiences a sudden and complete loss of identity which contributes to a sudden move far away from their place of origin. What happens after this loss?
the sufferer will assume a new identity because he (or she) does not remember his (or her) old identity
__________ is characterized by the appearance of __________ or more distinct identities in one individual. The identities may or may not be aware of each other, and the personality manifested may be dependent on environmental or social context.
Dissociative Identity Disorder (DID); two
Is the validity of the diagnosis of Dissociative Identity Disorder (DID: previously known as Multiple Personality Disorder,) universally accepted?
The validity of DID is highly controversial. Some psychologists do not consider DID a true disorder, but rather a culture-bound manifestation of one or more other disorders.
Who was Sybil?
How does Sybil's case call into question the validity of the diagnosis Dissociative Identity Disorder (DID)?
The most famous DID case is a patient known as Sybil. There was a best selling book (and later, a very popular movie) about Sybil. It was after the release of the book that DID (then Multiple Personality Disorder) became a common diagnosis, and even then, a small minority of therapists made the vast majority of the diagnoses of DID.
Many years later, it was revealed that the book was inaccurate and the case not as described. This is a truly shocking case of ethical misconduct. For further information on the Sybil scandal, please see:
List some of the characteristics of attention-deficit/hyperactivity disorder (ADD/HD)
often diagnosed in childhood
inability to focus on demanding tasks
lack of organization
problems adhering to instructions
Tourette's disorder is characterized by ______ and ______.
motor tics; vocal tics
What is the difference between retrograde and anterograde amnesia?
With retrograde amnesia, one loses memories that occurred before the traumatic event; with anterograde amnesia, one loses memories occurring after the traumatic event.
What are the two main types of amnesia?