Final exam sg - Based on Barlow Abnormal psychology textbook 8th edition PDF

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Based on Barlow Abnormal psychology textbook 8th edition...

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FINAL EXAM SG- CHS 13, 8, 9, 16

Chapter 13- Schizophrenia Spectrum and Other Psychotic Disorders 

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Video: o Jasper was a relatively normal kid o Patients hear voices even when alone o Voices in head sound like they come from somewhere else o Can be muffled and not understandable o Hallucinations – can be scary, see faces in windows, shadows  Can be involved in hallucinations or be watching hallucinations  Hallucinations became a daily occurrence o False perceptions, disorganization of thinking, withdrawal from social interaction, loss of emotions, and false thoughts/beliefs/delusions are key characteristics of schz o Jasper’s parents chalked it up to teenage moodiness o Jasper felt relieved once diagnosed bc it acknowledged it was real o While taking his meds, he doesn’t have reoccurring sxs for the most part o Large stigma around schz, brought upon the parent and child o Jasper felt a loss to a degree once the voices disappear due to meds, lost artistic ability and creativity o Video diary provides inner glimpse: insomnia is big part of his life, lonely o Relapses usually causes hospitalization, can’t recover as they did the first time  Patients can prevent relapses by regularly taking their meds and staying off other illicit drugs (especially weed, cocaine, LSD)  Best chance of recovering is from the first episode only  Over time and relapses, a decline is evident and irreversible Overview of Schizophrenia o Schizophrenia= disorder characterized by a broad spectrum of cognitive and emotional dysfunctions including delusions and hallucinations, disorganized speech and behavior, and inappropriate emotions. It interrupts a person’s thought, perception, speech, and movement. o 1/100 individuals experience schz sxs o Early signs/sxs, progresses into more interfering experiences requiring hospitalization, therapy, and medication management o Psychotic disorders= break/disconnect from reality resulting in a spectrum of dysfunctions (thinking, reasoning, organization of thoughts, emotion expression)  Affects cognitive, emotional and behavioral domains o Must experience and report 2+ positive, negative, and disorganized sxs, present for at least 6 months o Prevalence= ~1% o Demographics= 1:1 M: F o Onset/course= young adult onset, chronic course  Starts w/ mild sxs that increase over time and persist o Symptoms:  Positive sxs:  Behaviors/experiences on top of (added on) to normal experiences

FINAL EXAM SG- CHS 13, 8, 9, 16 

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Delusions: conceptions not rooted in reality- ex: grandeur (one is important of has important mission, has control) or persecution (beliefs that relate to feeling/experience of having someone out to get them)  Hallucinations: experience of sensory event w/out any sensory stimuli in reality (auditory, tactile, or visual hallucinations)  auditory hallucinations most common & olfactory hallucinations are rare & indicates a more acute brain issue (brain tumor) Negative sxs (HARDEST TO TX):  Refer to a lack/lessening of a normal experience or behaviors  Avolition= lack of will/motivation to do things  Asociality= lack of socialization, social skills/adaptations, ID appropriate social behaviors in context, reciprocal social interactions  Affective blunting= lessening of one’s overall affect or emotion, flat range of emotions, “flat or restricted affect”  Alogia= lack of speech, difficulty articulation  Anhedonia = inability to derive pleasure from things that used to be or would expect to be pleasurable Disorganized sxs:  Erratic speech/emotions= illogical, hard to follow speech, emotions that don’t fit situation o Cognitive slippage= articulation is illogical and incoherent speech (“word salad”) o Tangentially- going off on a tangent after tangent o Loose associations- conversation in unrelated directions (whole portions of convos, but unrelated)  Inappropriate affect/disorganized bxs= patients would laugh when nothing was funny, urge, involuntary smile rxn, bxs that aren’t aligned with situations. o Inappropriate affect- describing something sad while uncontrollably laughing o Behaviors:  Varied  Catatonia  Immobility, agitation, odd/quirky Auditory hallucinations (AHs)  Research shows there is high activity in Broca’s speech area (associated with producing speech-not comprehensive) o Neuroimaging shows high activity during AHs o Many have hypothesized AHs are the misinterpretation of one’s internal speech/cognitive processes that gets processed as external speech o Since Broca’s area involves speech production and not comprehension, this makes sense  Described to start as whispers, get louder over time

FINAL EXAM SG- CHS 13, 8, 9, 16

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o Patients often use art to express their feelings about their disorder o Stages/natural history of schz  Premorbid= mild motor, cognitive, and social impairments  Causes wonder, speculation, but no indication of outward psychotic disorders- present in many other disorders  Prodromal= unusual psychotic-like bxs  Begins to look more like psychotic episodes, starting to have more unusual sxs, starting to hear whispers. More insight/awareness that what’s happening isn’t rooted in reality  Onset/deterioration= positive, negative, cognitive, and mood sxs  Psychotic breaks/episodes, experiencing sxs, late adolescence, adulthood, beginning to deteriorate and not able to recognize what is rooted in reality or not.  Chronic/residual= positive, negative, and cognitive sxs  Some dips/episodes, but usually decrease over time (positive and cognitive), negative sxs usually persist and are hardest to treat Other Psychotic Diagnoses o Schizophreniform  How we ID early stage of schz  2+ psychotic sxs for 1-6 months (no longer than 6 months schz)  Prevalence= 0.2% (maybe this low bc we aren’t usually diagnosing as early as we should be & lack of recognition of sxs)  Prognosis good- better than tx for schz o Brief Psychotic  Presence of 1+ sxs for 1 day – 1 month  Specify: with or without marked stressor associated w/ onset of sxs  Consider diatheses-stress, genetic vulnerability o Delusional Disorder  1+ delusion  Erotomanic delusions- beliefs that someone is in love with you but they just don’t know it (often celeb)  Grandiose delusions Jealous delusions- believing someone is cheating when there is no evidence  Persecutory delusions  Somatic delusions- belief something is happening in one’s body when there’s no evidence  Mixed delusions- any combo of delusions listed above, no core delusion that is most prominent  1+ month  cannot be a schz diagnosis present  very rare; onset around 33-55 y/o o Schizoaffective Disorder  Prevalence= 0.3%- rare  Schz sxs + manic or depressive episode  Psychotic sxs must occur outside the mood episode

FINAL EXAM SG- CHS 13, 8, 9, 16

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Causes of Schz Disorders o Genetics  48% risk of developing for identical twins  17% risk of developing for fraternal twins  not the single cause (genetic nor environmental)  all other causes must be considered with the inherited genetic risk o Neurobiological  Excess dopamine theory- causes some sxs, implicated, but not whole story  Excess in some areas, lack in others  Dopaminergic dysregulation- some areas have elevated dopamine activity (reward pathways) and decreased activity in other areas (prefrontal cortex)  Over time, schz associated with gray matter loss o Gray matter (neurobiological cont.)  Packed with cell bodies, loss of gray matter leads to schz  Thompson and colleagues did MRI mapping of adolescent’s brain to try to understand early childhood onset of schz.  Mapped healthy and schz children, followed into later adolescents to view progression of gray matter  A greater average gray matter loss over 4-year study in adolescents with schz when compared to control  Parietal frontal to temporal region loss  Some loss is consistent with an accelerated rate in the brains of schz adolescents. o Environmental  Social determinants of health/stressors combine with genetic and NB risk factors  Early facing adversity  Obstetric complications- problems related to pregnancy, growth of fetus, LBW infants, malformations at birth, complications during delivery  associated with ^ risk for (early childhood onset) schz  Birth season- winter/early spring birthed babies associated with higher incidence of schz than those born during other times of year (access to daylight, exposure to viruses around that time, temp changes = early stresses)  Maternal well-being- mother’s health, malnutrition during pregnancy, smoking, diabetes can ^ incidence of schz  Paternal death while mother is pregnant= ^ risk of schz among children (6x higher of developing)  Hunger/famine- decline in food intake in overall population, food deprivation during early pregnancy may ^ risk of babies developing schz  Adverse child-rearing- inconsistent or child abuse ^ risk of schz  Later life

FINAL EXAM SG- CHS 13, 8, 9, 16 

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Substance use/abuse (meth and cannabis)- Those who used methamphetamines had a higher chance with a genetic predisposition increased risk of developing. Cannabis: people had first psychotic break after smoking weed (skip prodromal phase and moving right into psychotic phase and sxs) can trigger earlier episode of psychotic break. Those who started using cannabis at age 15 were 4x more likely to be diagnoses with schizophreniform.  Migration- those who have migrated from a native land have a slight increase of developing schz. Those who were born in Caribbean (move to UK) have higher risk of schz. Another study showed those who moved from Greenland  Danish mothers have 4x risk of schz. Idea of moving can be stressor that triggers underlying predisposition  Urban environment- density of an area associated with other risk factors (toxins, low SES, overcrowding) can drive risk of schz  Social adversity- stressful events (lack of job, education, wealth, single) can predispose. Single people have higher chance of psychosis when live in a population of a lot of non-single people. o Family processes  Family processes- Expressed Emotion (EE)= 5 min speech sample in which a family member is asked to speak about another family member that is ill (schz or other disorders). Trying to assess the extent to which family members express speech that is linked to criticism, hostility, emotional over-involvement.  EE measured in the 5-min free speech, prompt to find out how they feel about the sick individual, monologue is transcribed and coded to look for negative processes.  High EE  3.7x risk of relapse vs low EE  relapse= represents worsening of sxs and ^ risk of rehospitalization  Can use results from EE tests to target family stressors and how family manages stress in addition to individual management  Family management offered better results in treating sxs rather than just individual management Treatment of Schz Disorders o Early intervention is best  Not always possible with the stigma surrounding schz  Associated with inability to function, hold a job, and be successful in life o Pharm- first line of tx!!!  1st generation- early meds associated with more problematic outcomes; “conventional”  target dopamine receptors (haloperidol): interfered and reduced availability of dopamine to neurological system (related to dopaminergic system); address +, but not – sxs.  Extrapyrimidal sxs (EPS- bradykinesia, dystonia, tardive dyskinesia): unusual motor activities: restlessness, retardation,

FINAL EXAM SG- CHS 13, 8, 9, 16 repetitive contractions/twitching of muscles, jerky movements in face  Very low compliance rates, cease using meds due to sxs, neg outcome over time  2nd generation – “atypicals”; not associated with same side fx as 1st gen  Abilify, Clozaril, Zyprexa, Seroquel, Risperdal, Geodon  Do not impose EPS  Some side fx: weight gain, ^ risk for diabetes (2x risk than gen pop)  These side effects not as problematic as 1st gen  Compliance still low- sxs manifest and impair cognitive functions like memory, problem solving, etc. o Psych: adjunct to pharm!!  Early- expand on Freud: psychodynamic, explore unconscious root of psychosis  NOT EFFECTIVE for positive outcomes, can be counterproductive; result in agitation  Current approaches:  Behavior interventions- inpatient units (hospitalizations), token economy of inpatient facilities person earns privileges for manifesting goal/target behaviors during tx, motivational management o Hospitalizations warranted when person becomes danger to oneself and others  Social & living skills/vocational rehab- psych rehab= moving away from tx model and including a recovery model perspective (idea we don’t want to just tx sxs, but want to instill rehab skills so the patient can eventually be as independent as they can be) o Club house model- club houses/ day drop in centers for patients, work with case managers, learn a skill, operated on a peer leader model (patients with experience are involved in running club house)  Cognitive remediation- recognition and exercises cognitive deficits in areas of neurological functioning (attention, memory, executive functioning, etc.) to improve these deficit areas. o Seem to consistently produce medium effect sizes o Psychosocial functioning- job skills, obtain and maintain, improve interpersonal relationships and problem o Uses coaching for learning purposes (chunking)  Family therapy- important adjunct especially younger and older patients requiring support o Targets family stress levels, coping, psychoeducation, understand and know the disorder and medications o For patients receiving tx in inpatient facilities  Illness management and recovery- chronic, yet one can still manage healthy, doesn’t have to involve complete detrition, manage sxs, ID triggers of psychotic episodes (ceasing meds)

FINAL EXAM SG- CHS 13, 8, 9, 16 

Early intervention programs that target the first episode try to find effective adjunct therapy to prevent relapse and improve prognosis (quality of life)

Chapter 8- Eating & Sleep Disorders 

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Overview o Disproportionally affect woman more than males (can sometimes be overlooked in males) o Main eating disorders= Bulimia Nervosa (BN), Anorexia Nervosa (AN) and Binge Eating Disorder (BED) o Key Features:  Disturbed self-image  Severe disruptions in eating behavior  Self-concept/esteem strongly influenced by weight/shape/type  Extreme fear of weight gain o Facts from Video:  Begin in adolescents, sometimes even in children  20 million women and 10 million men will have an ED  AN= persistent restriction of energy intake relative to BW, intense fear of weight gain/getting fat, disturbance in way weight is experienced, and persistent behavior that interferes with weight gain  BN= binging large amounts of foods, followed by purging  BED= binge eating with the absence of purging  People can exhibit parts of some dxs and some of others, not always fitting one category Bulimia Nervosa o Clinical Criteria  Recurrent binges= over-consumption of food; discrete period, sense of lack of control, recurrent compensatory bxs (purging).  Must be recurrent 1x/week for 3+ months  Self-evaluation strongly influenced by weight/shape/type  Sxs cannot occur solely during AN episode, if it does, it is not BN o Other clinical features  10% of normal weight (purging is not an effective weight loss method 50% cals absorbed before purge)  Medical Problems: Dental problems w/ enamel & salivary glands damaged/swollen to the point of visibility, electrolyte imbalances (Na/K), organ damage (kidney/heart)  Psychological Problems: comorbidities!! 50-70% those with BN will also have a mood disorder sxs, 80% will have anxiety disorder sxs, and 40% will have SUD sxs o Stats:  Prevalence: 1%  Demographics: women 3x rates than men (higher in college aged women)  Incidence among males is increasing  Onset: adolescence (middle-high school)

FINAL EXAM SG- CHS 13, 8, 9, 16 

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Anorexia Nervosa o Clinical criteria:  Failure to maintain weight/ or make expected gains in developmental periods  Intense fear of weight gain  Perceptual disturbance (strongest in AN) body dysmorphia??  Undue influence on self-evaluation (influenced by weight/shape)  Lack of recognition of seriousness of the disorder  Restrictive subtype- most familiar, restricting caloric intake  Binge-eating/Purging subtype- purging bxs include excessive exercise  Difference btwn this and BN, the binge-eating sxs cannot exist in a pre-existing AN episode, or restriction of cals for it to be BN. If there is extreme caloric restriction paired with binging and purging, it’s this subtype of AN  Clinical difference, AN binges tend to be smaller amounts of food than BN  Less common than BN  Peer-support chat room lingo:  (current weight) CW= always too much  (lowest weight) LW= always too much  (ultimate goal weight) UGW= want to essentially disappear o Additional Clinical Features  Medical problems: CV problems, organ damage, electrolyte imbalance, cold sensitivity, dry skin, brittle hair/nails  Lanugo- type of AN in which one develops “downy/soft/ feathery quality of hair”  Amenorrhea- for women with AN, interruption of menstrual cycle, eliminated from diagnostic category for AN why o Stats:  Prevalence= 0.6%  Comorbidities: depression, SUD, and OCD  Higher rates among white non-Hispanic (WNH) women in upper SES  Onset= early adolescents  Course= more chronic in course than BN o Cultural considerations:  Association of more AN with immigration to western countries  Consider context and diathesis-stress model Binge Eating Disorder o Binge eating w/out compensatory bx o Episodes associated with 3+ eating bxs:  Much more than usual  Until uncomfortable full  Large amounts when not hungry  Eating alone to avoid embarrassment  Disgust/guilt afterward o Other features:

FINAL EXAM SG- CHS 13, 8, 9, 16

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 Concern about the body does not need to be present for diagnosis  Better treatment response o Stats:  Prevalence= 2.8% in general populations  Prev. ~20% in individuals in weight control programs  Prev.~50% in candidates for bariatric surgery  Demographics= higher in females  Onset= later, older ages than those who experience AN/BN Causes of Eating Disorders o Biological:  4-5x ^ risk if 1st degree relative has an ED o Psychological:  Need for personal control, perfectionism  Tendency for body image distortion  Mood/distress intolerance: having a difficult time with intense emotions. High mood intolerance: people may feel like they need to get rid of the disturbing mood by any means necessary harmful bxs to distract o Social/cultural:  Family environment risk when they place large value on achievement, physical appearance, and avoid conflict  Dieting among adolescence have 8x risk of developing  Dieting/restriction behaviors leads to stress/withdrawal and leads to cravings  “Thin ideal”  idea that body must be thin in western cultures  body dissatisfaction  Dieting at ages 14-16 leads to eventual increased risk of obesity in later years  On body image & race/ethnicity:  Kronenfeld & collegues took a sample of 4,023 women aged 25-45 who were Asian American, Euro American, and African American  Subjects examine silhouettes increasing in size and explained which silhouette size was closest to their real size, and what was their ideal size  Compared to white women: Asian and African American women chose sizes smaller than their current size. African Americans and others preferred a larger size (than whites). African Americans had lower body dissatisfaction than other groups, but is rising. Treatments for Eating Disorders o Pharm interventions= limited support  Limited efficacy for AN  SSRIs beneficial for BN (reduces binge-purge cycle overall) o Psychological=  CBT effective for BN disturbances  CBT & IPT effective for BED  Interpersonal therapy= focuses on the ways disturbed relationship patterns affect sx experiences

FINAL EXAM SG- CHS 13, 8, 9, 16 

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CBT (FBT for adol.), weight restoration, and p...