Module 4: Psychotic and Personality Disorders

Question 1

Psychosis

Answer 1

Severe mental condition characterized by a loss of contact with reality

Question 2

Hallucinations

Answer 2

false sensory perceptions

Question 3

Delusions

Answer 3

false beliefs

Question 4

Understand the different situations where we might see psychosis and how that does not mean there is a psychotic disorder present

Answer 4

we might see them with other psychological disorders like bipolar, or depressive disorder

Question 5

Schizophrenia

Answer 5

a severe psychological disorder characterized by disorganization in thought, perception, and behavior. They do not think logically, perceive the world accurately or behave in a way that permits everyday life and work.

Question 6

4 types of delusions with schizophrenia

Answer 6

SIPS
Influence: Beliefs that behavior or thoughts are controlled by others. Or mind reading by another person.
Self-significance: Thoughts or grandeur, reference, religion, guilt, or sin.
Persecution or paranoid: Thoughts that others are out to harm the person.
Somatic: Belief that one’s body is rotting away or has been taken over by an outside source.

Question 7

Dissociative identity disorder (DID)

Answer 7

Dissociative identity disorder. Considered to have two or more distinct personalities each with their own thoughts, feelings, and behaviors.

Question 8

Key criteria for schizophrenia

Answer 8

Two or more of the following, each present for a significant portion of time during a 1 month period. At least one of these must be the first three.
- Delusions
- Hallucinations
- Disorganized speech.
- Grossly disorganized or catatonic behavior
- Negative symptoms
(b)For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).
(c ) Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
(d) Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
(e ) The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
(f) If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms

Question 9

five types of hallucinations present in schizophrenia

Answer 9

Good Animals Oink Very Soon

Auditory: Noises or voices, perhaps speaking to or about the person.
Visual: Visions of religious figures or dead people
Olfactory: Smells
Gustatory: Tastes
Somatic: Feelings of pain or deterioration of parts of one’s body or feeling that things are crawling on or in the skin or the body.

Question 10

What is the most common kind of hallucination

Answer 10

auditory, then visual

Question 11

Loose associations

Answer 11

thoughts that have little or no logical connection to the next thought.

Question 12

Example of a loose association

Answer 12

(I once worked at an army base. The middle east- I like to travel, my favorite place is arizona)

Question 13

Thought blocking

Answer 13

Exemplified by unusually long pauses in the patient’s speech that occur during a conversation.

Question 14

Clang associations

Answer 14

in which speech is governed by words that sound alike rather than words that have meaning.

Question 15

example of clang association

Answer 15

I have bills, summer hills, bummer, drum solo.)

Question 16

catatonia

Answer 16

a condition in which a person is awake but is nonresponsive to external stimulation.

Question 17

Diminished emotional expression

Answer 17

describes reduced or immobile facial expressions and a flat, monotone voice that does not change even when the topic of conversation becomes emotionally laden.

Question 18

anhedonia

Answer 18

lack of capacity for pleasure. They feel no joy or happiness.

(late 19th century: from French anhédonie, from Greek an- ‘without’ + hēdonē ‘pleasure’.)

Question 19

avolition

Answer 19

or apathy, is an inability to initiate or follow through with plans.

away from

Question 20

alogia

Answer 20

decreases quality and/or quantity of speech
(comes from the Greek words meaning “without speech”)

Question 21

cognitive impairments

Answer 21

impairments in visual/verbal learning, attention problems, decreased processing speed, impaired abstract thinking, and deficits in executive functioning.

Question 22

Why do schizophrenia presentations look different?

Answer 22

since the diagnosis only requires the presence of two of five of the symptoms people can appear very differently.
For example, one person may have paranoia and hallucinations and another may have catatonia and mutism.

Question 23

Relationship between substance use and schizophrenia

Answer 23

“90% of people with schizophrenia smoke cigarettes, and smoking is associated with poorer physical health outcomes in this group as well as poorer treatment outcomes, higher depression rated, and lower quality of life.”

Question 24

Brief psychotic disorder

Answer 24

the sudden onset of any psychotic symptom, such as delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior. This disorder may resolve after 1 day and does not last for more than one month.

Question 25

schizophreniform disorder

Answer 25

Identical to those of schizophrenia with two exceptions. **First, the duration of the illness is shorter, ranging from at least 1 month to less than 6 months. In a few instances, the symptoms seem to disappear** In other instances, a person is treated successfully and never has another episode.

Question 26

schizoaffective disorder

Answer 26

might be considered to have both schizophrenia and an affective disorder. That is, in addition to having the symptoms of psychosis, the patient also experiences major depressive, manic, or mixed episode disorder at some point during the illness.

Question 27

delusional disorder

Answer 27

consists of the presence of a nonbizzare delusions (defined as an event that might happen) They do not have other psychotic symptoms except perhaps hallucinations that are directly related to the delusion

Question 28

shared psychotic disorder (folie à deux)

Answer 28

Begins when one person develops a psychotic disorder with delusional content. The inducer is the dominant person in the relationship and over time imposes the delusional system on the second person, who then adopts the belief system and acts accordingly.

Question 29

how can schizophrenia and its symptoms cause functional impairment for an individual and their loved ones?

Answer 29

“Its social and economic burden makes it one of the 10 most debilitating conditions in the world in terms of disability-adjusted life years, and this level of health burden has remained high across the past three decades.” “Life expectancy for people with schizophrenia is reduced by 13-15 years.”

Question 30

factors that can lead to better outcomes for schizo personality disorders

Answer 30

Older age at onset, no family history, stable personality prior to diagnosis, and motivation can all lead to better outcomes.

Question 31

factors that can lead to worse outcomes for schizo personality disorders

Answer 31

Co-occurring medial conditions, EOS, family history, and substance use can all lead to worse outcomes.

Question 32

What population is diagnosed with schizophrenia the most?

Answer 32

black men

Question 33

do developed nations or developing nations have better outcomes with schizophrenia?

Answer 33

people who live in developing nations often have a more positive treatment outcome.

Question 33

Understand how outcomes differ for those diagnosed with early-onset Schizophrenia (EOS) compare to those with adult-onset

Answer 33

The consequences of schizophrenia are more serious and longer lasting when the disorder begins in childhood, a condition known as early onset schizophrenia (EOS). Children with EOS lose more cortical gray matter than children without a psychological disorder. Few children with EOS ever achieve full symptom remission. Patient with EOS are typically more impaired. EOS= WORSE OUTCOMES

Question 34

Biological factor in the development in schizophrenia

Answer 34

Neurotransmitters, the three different symptom categories that make up schizophrenia might suggest abnormalities in different neurotransmitter systems. Family history

Question 35

dopamine hypothesis

Answer 35

too much or too little dopamine can contribute to symptoms of schizophrenia. emerged from clinical observations that chemical compounds such as amphetamines and levodopa increase the amount of dopamine available in the neural synapse, which, in turn, can lead to the development or worsening of psychotic symptoms.

Question 36

environmental factor in the development of schizophrenia

Answer 36

The concept known as expressed emotion (EE) describes a family’s emotional involvement and critical attitudes toward people with a psychological disorder, in this case schizophrenia. Patients who live in family environments that are high on EE variables are more likely to relapse and have higher rates of hospitalization.

Question 37

Electroconvulsive therapy and transcranial magnetic stimulation

Answer 37

applying a brief electrical stimulation to the brain while the individual is under general anesthesia. ECT was initially used in the treatment of schizophrenia but is also effective for severe depression.

Question 38

5 personality traits in the five-factor model

Answer 38

OCEAN openness, conscientiousness, extraversion, agreeableness, neuroticism

Question 39

openness

Answer 39

imagination, feelings, actions, ideas

Question 40

conscientiousness

Answer 40

competence, self discipline, thoughtfulness, goal driven.

Question 41

extroversion

Answer 41

sociability, assertiveness, emotional expression

Question 42

agreeableness

Answer 42

cooperative, trustworthy, good natured.

Question 43

neuroticism

Answer 43

tendency towards unstable emotions, emotional stability

Question 44

3 p's (in distinguishing a personality trait vs a personality disorder)

Answer 44

persistence (over time), pervasiveness (across people and situations), pathological (clearly abnormal)

Question 45

clinical state vs. personality trait

Answer 45

state refers to the expression of a personality characteristic that is related to a specific circumstance, clinical condition, or period of time.

Question 46

ego dystonic

Answer 46

behavior that is distinctly different from the person’s self-image.

Question 47

ego syntonic

Answer 47

Behavior that is consistent with the individual’s self-image. (ego syntonic makes it a lot harder to treat.)

Question 48

Cluster A classification

Answer 48

odd or eccentric

Question 49

Cluster B classification

Answer 49

dramatic, emotional, or erratic

Question 50

Cluster C classification

Answer 50

anxious or fearful

Question 51

Categorical approach

Answer 51

The categorical approach considers illness as being either present or absent

Question 52

Dimensional approach

Answer 52

The dimensional approach regards that symptoms of disorder exist on a continuum from normal to severely ill.

Question 53

Key diagnostic criteria for all personality disorders

Answer 53

A. An enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture. This is manifested in two or more of the of the following areas: - Cognition (perceiving and interpreting self, other people, and events) - Affectivity ( range, intensity, lability, and appropriateness of emotional response.) - Interpersonal function - Impulse control. B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.

Question 54

functional impairment of personality disorders

Answer 54

“Functional impairment typically includes individual, social and occupational functioning. Only recently have we started to observe how personality disorders affect and individuals’ response to a large scale stressor, such as a global pandemic.

Question 55

disorders within cluster A

Answer 55

PaSS on the party 1. paranoid personality disorder 2. schizoid personality disorder 3. schizotypal personality disorder

Question 56

paranoid personality disorder

Answer 56

**A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.** People with this disorder: - suspects without sufficient basis that others are exploitation, harming or deceiving them. - Preoccupied with unjustified doubts about the loyalty of friends or associates - Reluctant to confide in others because of unwarranted fear the information will be used maliciously against them, - Reads hidden or demeaning or threatening meanings into benign remarks or events. - Persistently bears grudges - Perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily to counterattack.

Question 57

schizoid personality disorder

Answer 57

A pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings. People with this disorder: - Neither desires nor enjoys close relationships, including being part of a family. - Almost always chooses solitary activities. - Has little, if any interest in having sexual experiences with another person. - Takes pleasure in few, if any, activities - Lacks close friends or confidants other than first degree relatives. - Appears indifferent to the praise or criticism of others. - Shows emotional coldness, detachment of flattened affect.

Question 58

Schizotypal personality disorder

Answer 58

A pervasive pattern of social and interpersonal deficits marked by acute discomfort, reduced capacity for close relationships cognitive or perceptual distortions, and behavioral eccentricities. People with this disorder: - Have ideas of reference (incorrect interpretations of casual incidents.) - Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms. (telepathy, sixth sense) - Unusual perceptual experiences, including body illusions (e.g., sensing another person present). - Odd thinking and speech. - Suspiciousness or paranoid ideation. - Inappropriate or constricted affect. - Behavior or appearance that is odd, eccentric, or peculiar. - Lack of close friends or confidants other than first degree relatives. - Excessive social anxiety that does not diminish.

Question 59

disorders within cluster B

Answer 59

BAHNed from the party. 1. Antisocial personality disorder 2. Narcissistic Personality disorder 3. borderline personality disorder 4. histrionic personality disorder

Question 60

Antisocial personality disorder

Answer 60

A pervasive pattern of disregard for an violation of the rights of others, occurring since age 15 years. - Failure to conform to social norms. - Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. - Impulsivity or failure to plan ahead. - Irritability and aggressiveness repeated physical fights or assaults. - Reckless disregard for safety of self or others. - Consistent irresponsibility - Lack of remorse.

Question 61

Narcissistic personality disorder

Answer 61

A pervasive pattern of grandiosity, need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts. - Grandiose sense of self importance - Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. - Believes that he or she is “special” and unique. - Requires excessive admiration. - Has a sense of entitlement - Is interpersonally exploitative - Lacks empathy - Often envious of others or believes that others are envious of them. - Shows arrogant, haughty behaviors, or attitudes.

Question 62

Borderline Personality disorder

Answer 62

A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked by impulsivity beginning by early adulthood and present in a variety of contexts. - Frantic efforts to avoid real or imagined abandonment. - Pattern of unstable and intense interpersonal relationships characterized by alternation between extremes and idealization and devaluation. - Identity disturbance: markedly and persistently unstable self-image or sense of self. - Impulsivity in at least two areas that are potentially self-damaging. - Recurrent suicidal behavior, gestures, or threats, or self-mutilation behavior. - Affective instability due to a marked reactivity of mood. - Chronic feelings of emptiness. - Inappropriate, intense, anger or difficulty controlling anger. - Transient, stress related paranoid ideation or sever dissociate symptoms.

Question 63

disorders within cluster C

Answer 63

party is Dead On Arrival 1. Avoidant personality disorder 2. dependent personality disorder 3. obsessive compulsive disorder

Question 63

Histrionic personality disorder

Answer 63

*(in the sense ‘dramatically exaggerated, hypocritical’): from late Latin histrionicus, from Latin histrio(n- ) ‘actor’.* **A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts.** - Uncomfortable in situations in which they are not the center of attention. - Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior. - Displays rapidly shifting and shallow expression of emotions. - Consistently uses physical appearance to draw attention to self. - Has a style of speech that is excessively impressionistic and lacking in detail. - Shows self-dramatization, theatricality, and exaggerated expression of emotion. - Is suggestible. - Considers relationships to be more intimate than they are.

Question 64

avoidant personality disorder

Answer 64

**A pervasive pattern of social inhibitions, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and parent in a variety of contexts.** - Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection. - Is unwilling to get involved with people unless certain of being liked. - Shows restrain within intimate relationships because of the fear of being shamed or ridiculed. - Is preoccupied with being criticized or rejected in social situations. - Is inhibited in new interpersonal situations because of feelings of inadequacy. - Views self as social inept, personally unappealing, or inferior to others. - Is unusually reluctant to take personal risks or engage in any new activities.

Question 65

dependent personality disorder

Answer 65

**A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation.** - Difficulty making everyday decisions without an excessive amount of advice and reassurance from others. - Needs others to assume responsibility for most major areas of their life. - Difficulty expressing disagreement with others because of fear of loss of support or approval. - Difficulty initiating projects or doing things on their own. - Goes to excessive lengths to obtain nurturance and support from others to the point of volunteering to do things are unpleasant. - Feels uncomfortable or helpless when alone because of exaggerated fears og being unable to take care of themselves. - Urgently seeks another relationship as a source of care and support when a close relationship ends. - Is unrealistically preoccupied with fears of being left to take care of themselves.

Question 66

obsessive compulsive personality disorder

Answer 66

I MURDER? Intrusive Mind based Unwanted Resistant Distressing Ego-dystonic* Recurrent *inconsistent with their self image A pervasive pattern of preoccupation with orderliness perfectionism, and mental and interpersonal control and the expense of flexibility, openness, and efficiency. - Preoccupied with details, rules, lists, order organization, or schedules to the extent that the major point of the activity is lost. - Shows perfectionism that interferes with task completion. - Excessively devoted to work and productivity to the exclusion of leisure activities and friendships. - Overconscientious, scrupulous, and inflexible about matters of morality/values. - Unable to discard worm out or worthless objects. - Reluctant to delegate tasks or to work with others unless they submit to exactly their way of doing things. - Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes. - Shows rigidity and stubbornness.

Question 67

How does the gene–environment Interaction work with attachment and personality disorders?

Answer 67

Specific genetic effects on phenotypes may be conditional on specific environments and thus be undetected in other environments.

Question 68

Why can treating personality disorders be difficult?

Answer 68

They involve well established behaviors that can be an integral part of the clients self-image.

Question 69

How is medication used for treatment of personality disorders?

Answer 69

medications are rarely necessary to treat personality disorders and should be viewed as an adjunct to psychotherapy. However, some medicines may help with symptoms.

Question 70

Describe dialectical behavior therapy (DBT) and how it helps those with borderline personality disorder.

Answer 70

The focus of DBT is on helping the client learn and apply skills that will decrease emotion dysregulation and unhealthy attempts to cope with strong emotions. This helps reduce BPD symptoms.