Suicidal self-injury
Deliberate, self-inflicted injury with any intent to die
Nonsuicidal self-injury (NSSI)
Deliberate, self-inflicted tissue damage with no intent to die
Aborted attempt
Steps taken toward suicide but stops SELF
Interrupted attempt
Steps taken toward suicide but stopped/prevented by OTHER
Motivation of NSSI (most common)
To decrease sadness, anxiety, and anger
Motivation of suicide (most common)
To escape- unpleasant emotions or negative life events
Interpersonal theory of suicide (2 factors)
- Desire for suicide
2. Capable of suicide
What groups are at high-risk for suicide?
- YA Native American males
- Older white males
Protective factors against suicide
- Mental health treatment
- Social support and connectedness
- Parental monitoring
- Means restriction
- Fear of death
Which types of treatments aren’t very helpful for suicide prevention?
Group only interventions and brief interventions
Safety plan for suicide (6)
- Warning signs
- Internal coping strategies
- People and places that provide distraction
- People that provide help
- Professionals/agencies that can be contacted in a crisis
- Making the environment safe
Effective treatments for suicide
- Individual therapy + family therapy + parent training
- Skills training (CBT and DBT)
- Target other problem behavior
- Intensive early treatment and maintenance for at least 1 year
Schizophrenia
Significant loss of contact with reality
Emil Kraepelin (1899)
Used term Dementia Praecox to describe SZ
- Dementia: progressive deterioration of thought, affect, and behavior
- Praecox: precocious or early ripening, showing up early in adulthood
Eugen Bleuler (1908)
Introduced term “schizophrenia”, “associative splitting”, believed that some could recover (~25%)
Organic pathology
Caused by neurochemical, structural, or physical impairment or change
Lifetime prevalence of SZ
About 1%
What is the hallmark of SZ?
Psychosis- significant loss of contact with reality
SZ DSM-5 Criteria
Two (or more) of the following for 1-month (one symptom but be 1, 2, or 3): 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior 5. Negative symptoms • Continuous signs for at least 6 months • Functioning is significantly impaired
Delusions
- Erroneous belief
- Fixed and firmly held despite clear contradictory evidence
- Disturbance in content of thought
- Occurs in 90% during course of SZ
Hallucinations
- Sensory experience
- Seems real but occurs in absence of any external perceptual stimulus
- Auditory more common (75%) than visual (39%)
Disorganized speech
- Disturbance in form (not content) of thought
- “cognitive slippage” or “loosening” of associations
Disorganized and Catatonic behavior
- Impairment of goal-directed activity
- Occurs in areas of daily functioning
- Catatonia: abnormality of movement and behavior
Positive symptoms of SZ
Excess or distortion in normal repertoire of behavior and experience (ex: delusions and hallucinations)
Negative symptoms of SZ
Absence or deficit of normally present behaviors (eg: affect, speech, motivation) (ex: apathy, lack of emotion, nonexistent social functioning)
Schizoaffective disorder
Features of SZ and severe mood disorder
Schizophreniform disorder
SZ-like psychoses lasting at least 1 month but less than 6 months
Delusional disorder
Delusional beliefs with otherwise normal behavior
Brief psychotic disorder
Sudden onset of psychotic symptoms or disorganized speech and catatonic behavior
Endophenotypes
Stable and measurable traits thought to be under genetic controls, can be controlled/measured or inherited
Brain areas reduced by SZ
- Prefrontal grey matter
- Superior temporal gyrus grey matter
Brain area increased by SZ
Ventricles
Disruption to medial prefrontal cortex in SZ
- Confusion about what’s real vs imaginary (delusions)
- Confusion about what’s internally generated (inner speech) vs externally generated (hallucination)
Premorbid phase of SZ
1st, cognitive motor or social deficits
Prodromal phase of SZ
2nd, brief/attenuated positive symptoms and/or functional decline
Psychotic phase of SZ
3rd, florid positive symptoms
Stable phase of SZ
4th, negative symptoms, cognitive/social deficits, functional decline
What do antipsychotics do in SZ?
Block dopamine
Social skills training
For SZ, skills broken down into discrete steps (ex: how to have a conversation), works best for negative symptoms
Social cognition and interaction training (SCIT)
For SZ, directly train the social processes underlying social skills, such as emotion perception and ToM
Neuroplasticity-based social cognitive training
For SZ, target neural mechanisms subserving social cognitive processes with computer training
What treatment works best for positive symptoms of SZ?
CBT
What is autism spectrum disorder? (2 components)
Difficulties in social communication + restricted and repetitive interests and behaviors
Autism deficits (3)
- Social-emotional reciprocity
- Nonverbal communication
- Initiating and maintaining relationships
Autism has presence of (4)
- Repetitive motor movements
- Insistence of sameness
- Highly restricted/fixated interests
- Unusual sensory interests or aversions
Cognitive theories of ASD
Deficits in underlying cognitive functions –> ASD (ex: deficits in ToM)
Weak Central Coherence (WCC)
ASD has limited ability to see big picture, detail-focused (ex: state map explanation)
Applies behavior analysis (ABA) for ASD
Targets communication and cognitive abilities, skills broken down into small steps and taught with diminishing prompts
Addictive behavior
Behavior based on pathological need for substance or activity
Levels of substance involvement (2)
- Intoxication
2. Use- abuse and dependence (tolerance and withdrawal)
Physical effects of chronic alcohol use (3)
- Malnutrition
- Cirrhosis of liver
- Brain damage
What is drug use strongly influenced by?
Environment
What is drug abuse/dependence strongly influenced by?
Genetic vulnerability
Positive reinforcement for substance use
Subjective pleasure and dopaminergic activation
Negative reinforcement for substance use
Escape from pain, stress, anxiety, and depression
Medications to block desire to drink (2)
- Disulfiram (antabuse)
2. Naltrexone
Medication to lower side effects of acute withdrawal
Valium
Negative effects of marijuana
- Cognitive impairment (memory)
- Amotivation
- Hallucinations and paranoia
- Respiratory consequences
2 types of anorexia
- Restricting type
2. Binge-eating/purging type (out of control from normal restricting diet)
Anorexia
Fear of gaining weight, refusal to maintain normal weight, marked disturbance in body image
Bulimia
Frequent episodes of binge eating, lack of control (dissociate), recurrent inappropriate compensatory behavior
Medical complications in anorexia
- Death from heart arrhythmias
- Kidney damage & renal failure
- Downy hair
- 3% mortality rate
Medical complications in bulimia
- Electrolyte imbalances
- Hypokalemia (low K+)
- Damage to hands, throat, & teeth
Binge eating disorder
Frequent episodes of binge eating, typically overweight or obese, no compensatory weight loss behaviors
Age of onset of anorexia
16-20 years old
Age of onset of bulimia
Women ages 21-24
Age of onset of BED
30-50 year olds
Where are brain abnormalities in eating disorders?
Hypothalamus, temporal, and frontal regions + low serotonin
Treatments for anorexia
- Emergency procedures to restore weight
- Antidepressants or antipsychotic meds
- Family therapy
- CBT
Treatments for bulimia
- Antidepressants
- CBT
- Unified treatment for disordered eating
- DBT
Treatment of BED
- Antidepressants
- CBT and interpersonal therapy
Mesocorticolimbic pathway structures (3)
- Ventral tegmental area
- Nucleus accumbens
- Prefrontal cortex
What are personality disorders?
- Inflexible and maladaptive traits and behavior patterns
- Distorted perceiving, thinking about, and relating to the world
Personality disorder contexts (4)
- Cognition
- Affectivity
- Interpersonal functioning
- Impulse control
Personality disorder cluster A
Odd or eccentric (4%): (paranoid, schizoid), schizotypal
Personality disorder cluster B
Dramatic, emotional, erratic (4%): (histrionic), narcissistic, antisocial, borderline
Personality disorder cluster C
Anxiety and fearful (7%): avoidant, (dependent), obsessive-compulsive
What is the lifetime prevalence of all personality disorders?
10-12%
Schizoid personality disorder
Cluster A, Impaired social relationships, inability and lack of desire to form attachments to others, prevalence 1%, males > females
Schizotypal personality disorder
Cluster A, peculiar thought patterns, oddities of perception and speech that interfere with communication and social interaction
Histrionic personality disorder
Cluster B, attention seeking behavior, extreme concern with attractiveness and approval
Narcissistic personality disorder
Cluster B, grandiosity, self-promoting, preoccupation with receiving attention, lack of empathy, subtypes: grandiose & vulnerable
How many symptoms are needed to diagnose borderline personality disorder?
5 or more out of 9, can have very different symptoms in patients (heterogeneous disorder)
Dialectical Behavior Therapy
Marsha Linehan, change: emotion regulation & interpersonal effectiveness, acceptance: mindfulness & distress tolerance
Antisocial personality disorder
Cluster B, disregard for and violation of others’ rights, lack of moral or ethical development, deceitful and shameless manipulation
2 dimensions of psychopathy
- Affective and interpersonal core- lack of remorse
2. Behavior-antisocial or impulsive acts
Psychopathy causal factors
• Heritable traits
• Fearlessness and fear conditioning deficits
• Less reactive to distress and punishment cues
• Aberrant reward processing
• Underarousal hypothesis
• Cortical immaturity hypothesis
• Parental factors: rejection, inconsistent
discipline
Big 5 factors related to personality disorders
- Negative affectivity (neuroticism)
- Detachment (extreme introversion)
- Antagonism (low agreeableness)
- Disinhibition (extreme low conscientiousness)
- Psychoticism