PSYC 235 Lecture Notes PDF

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Summary

Abnormal PsychologySelf-CareThis is the practice of taking an active role in protecting our own well-being and happiness - in particular during times of stress. - Proactive - Self-care should be engaged in before we start feeling bad. - Persistent - Self-care should be done regularly to keep ourselv...

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Abnormal Psychology Self-Care This is the practice of taking an active role in protecting our own well-being and happiness - in particular during times of stress. - Proactive - Self-care should be engaged in before we start feeling bad. - Persistent - Self-care should be done regularly to keep ourselves well. - Personal - Different things work for different people.

The 8 Dimensions of Self Care - Emotive o How we express ourselves. - Luminescent o How we illuminate our inner truth. - Financial o How we allocate our resources. - Cognitive o How we think. - Attitudinal o How we contribute to the world. - Relational o How we connect with others.

- Environmental o How we harmonize with nature. - Systemic o How we move, eat, and rest.

Self-Care Myths Self-care is an indulgence. Meaningful self-care includes making mindful changes in patterns of thoughts and behaviour which don’t contribute to our well-being.

Self-care is selfish. When we make time for ourselves and get sufficient rest and exercise, we feel more energetic and will be able to do more for ourselves and others.

Self-care is a onetime experience. Looking after ourselves is an ongoing practice in building resilience to face hardship and in preventing burnout.

Self-care is time consuming. Self-care doesn’t require a large amount of time.

Psychotic Disorders This refers to a condition in which psychotic symptoms meet specific diagnostic criteria for a disease. Psychoses can be categorized into three broad groups: - Idiopathic Psychoses. - Psychoses due to Medical Conditions - Toxic Psychoses

Abnormal Behaviour The DSM-5 defines this as "behaviour that violate a norm in society, is maladaptive, rare (given the context of the culture and environment) and causes the person distress in their daily life."

Symptoms Positive (Added) Hallucinations, delusions, disordered thinking, and disordered behaviour. Catatonia requires a number of symptoms such as stupor, catalepsy, mutism, odd mannerism, waxy flexibility and stereotypic movements.

Negative (Taken Away) Avolition, affective flattening, and alogia.

Delusions These are false beliefs not generally held by other members

of the culture and held onto despite contrary evidence. Paranoid delusions are the most common.

Types of Delusions - Paranoid o This is the belief that someone is seeking to harm you. - Grandiose o This is the belief that you are particularly famous or important. - Somatic o This is the belief your body is diseased, abnormal, or altered. - Erotomania o This is the belief that someone is in love with you despite contrary evidence. - Capgras Syndrome o This is the belief that someone you know has been replaced by a clone. - Cotard’s Syndrome o This is the belief that you are dead. - Fregoli’s Delusion o This is the belief that a person (who is after you) adopts different appearances. - Lycanthropy

o This is the belief that you are a werewolf. - Persecutory o This is the common belief that other people are out to get you.

Hallucinations This is the experience of sensory events without any input from the surrounding environment. Auditory are the most common and are thought to be intrusive thoughts perceived as coming from someone else.

Risk Factors Genetic Factors Two general hypotheses have been proposed:

Autoimmune and Inflammatory Disorders There is a special category of psychoses that develop with autoimmune and inflammatory disorders, in which autoantibodies stimulate or block neurotransmitter function in the brain.

Environmental Factors Low socio-economic status and aversive intrusive events are linked to persecutory beliefs. Increased proportion of paranoia in migrant populations. Deafness and sensory deprivation.

Common Disease– Common Allele Hypothesis

Course of Illness

Prevalent genes with low penetrance act additively and through epistasis with other such genes to confer a risk of schizophrenia and psychotic mood disorders.

This is the presence of risk factors prior to the onset of any symptoms.

Common Disease–Rare Allele Hypothesis Rare genes are inherited, de novo mutations, or copy-number variants but are highly penetrant.

Neurodevelopmenta l Factors Exposure to prenatal environmental insults, birth complications, postnatal trauma, and other forms of deprivation at critical development stages. These are thought to interact with genetic factors and increase susceptibility.

Premorbid Phase

Prodromal Phase This is a preliminary period of decline in mental state and functioning prior to onset. This emphasizes early detection of those at risk, and intensive intervention to prevent progression. There is evidence that the use of anti-psychotics in combination with cognitive behavioural therapy is helpful.

Acute Phase This has active positive and negative symptoms. Individuals in this phase need 24-hour access to treatment or hospitalization. The use of psychoeducation, pharmacological approaches, and psychosocial approaches have been shown to be effective.

Early Recovery Phase This phase is associated with depression and anxiety.

Later Recovery Phase Challenges with reintegrating into social, recreational, and vocational pursuits.

Relapse Prevention Relapse rates are high, especially if medication is discontinued. Psychological support for both individual and family is important. The cognitive model of relapse helps patients to have a sense of control over their symptoms. Group-based interventions can encourage social support and reintegration into society. Family interventions reduce high expressed emotion have been found to be effective in reducing relapse rates.

Enduring Psychosis Alternative anti-psychotics, pharmacotherapy and cognitive behavioural therapy are effective. The consumer recovery model replaces 'patient' with 'consumer' to raise awareness of civil rights and personal choice, and highlights principles of hope, personal responsibility, empowerment, resilience of the consumer, respect for the broader community, and importance of peer support.

Limitations A 2011 Australian report found that 90% of people with a psychotic disorder reported deterioration in their ability to function. There is poor access to

mental health treatment, and treatments are often narrow. There is also ongoing stigma and associated limited access to housing, employment and education support for people with psychotic disorders.

Diagnosis The diagnosis is based predominantly on the patient’s history, observed behaviour, and subjective reports, and results of a mental status examination. Diagnostic tests are performed in patients presenting with a first episode of psychosis or psychotic symptoms associated with preexisting neurodegenerative diseases, other medical conditions, or substance abuse.

Neuroimaging Patients with schizophrenia, schizoaffective disorder, and bipolar disorder with psychosis have focal volume reductions in the temporal, frontal, and parietal lobes and reduced cortical thickness in these and other brain regions. In schizophrenia, PET scans show increased synaptic dopamine levels in the ventral striatum and decreased levels in the frontal cortex. In schizophrenia, MRI shows increased glutamate levels in the prefrontal and medial temporal regions.

Neurophysiological Tests Electroencephalographic (EEG) assessment may be performed when psychotic symptoms first appear in patients when there are reasons to suspect a seizure

disorder, causative medical condition, neurodegenerative disease, or substance abuse. These show differences between groups of unaffected and affected persons and offer insight.

Serologic Tests Although the risk of tertiary syphilis of the brain is low in developed countries, serologic screening for syphilis is recommended in the evaluation of a first episode of psychosis. Immunologic conditions should be considered in cases of a sudden onset of psychotic symptoms associated with or following a systemic viral infection or occurring at an age that is outside the typical age range for the onset of the psychotic disorders.

Treatment Pharmacologic Treatment Antipsychotic medications are effective in treating psychotic symptoms, although this depends on their safety profile. The older medications tend to cause extrapyramidal neurologic side effects, whereas the newer drugs are more likely to induce weight gain and disturbances in metabolism (except clozapine). Most patients are treated with short-acting oral or injectable agents requiring daily administration, but long-acting, injectable formulations are available and useful.

Neuromodulation Electroconvulsive Therapy This is effective for catatonia and mood disorders with psychotic symptoms.

Transcranial Magnetic Stimulation (TMS) Transcranial magnetic stimulation can control psychotic auditory or verbal hallucinations. Transcranial direct-current stimulation applied over the region of the auditory cortex has led to reductions in hallucinations and in persistent negative symptoms of schizophrenia, such as apathy and social withdrawal.

Deep-Brain Stimulation Deep-brain stimulation has been used for psychotic states when all other treatments have failed. The procedure entails surgically implanting an electrode into target brain regions and stimulating them with highfrequency electrical pulses.

Psychosocial Approaches to Treatment The most widely studied is social skills training, where people are told about appropriate modes of behaviour and communication with others and practical life skills that may have been impaired by psychotic disorders. Another psychosocial treatment is family psychoeducation, which enables family members to help support the persons recovery.

Cognitive behavioural therapy (CBT) may also be useful for psychotic symptoms. Specific approaches used in treating patients with schizophrenia include cognitive restructuring (engaging people to change beliefs about their hallucinations and delusions),

behavioural exposure to stimuli that trigger psychotic symptoms to enhance reality testing, selfmonitoring, and graded coping skills. This can also help to reduce the distress caused by hallucinations or delusional beliefs.

Capgras Syndrome This is the belief that close family members have been replaced by identical looking imposters and may result in violent behaviour. This often follows a head injury and may be seen in patients with dementia.

Explanations Freud He thought this occurred through some trauma which had activated the repressed child's sexual attraction to one of their parents. The subsequent anxiety causes the child to reject their parents as imposters.

Neuropsychology When we look at familiar faces, two areas in the brain become

especially active. One area is dedicated to identifying the face, the other allocates an emotional response. Either of these two pathways may be damaged. When the facial identity pathway is disrupted, we're unable to recognize the face but it may still feel familiar. This is known as prosopagnosia. When the emotional pathway is disrupted, we're unable to recognize the face (which may be the case in Capgras Syndrome). However, the reasoning behind why those with Capgras syndrome draw such a bizarre conclusion is unknown.

Schizophrenia Symptoms Positive Symptoms Hallucinations, delusions, disordered thinking, and disordered behaviour.

Negative Symptoms Avolition (a lack of motivation), affective flattening, and alogia (difficult with speaking).

Delusions These are false beliefs not generally held by other members of the culture and held onto despite contrary evidence. Paranoid delusions are the most common. The belief may be bizarre and must be foreign to most members of the culture.

Disorganized Thinking Also known as ‘formal thought disorder’. Disturbances in logical sequencing and coherence of thought.

Disorganized Behaviour Grossly disorganized, abnormal or catatonic behaviour. Catatonia requires a number of symptoms such as stupor, catalepsy, mutism, odd mannerism, waxy

flexibility and stereotypic movements.

Early Features Some children exhibit early clinical features which sometimes pre-empts the development of schizophrenia, including mild physical abnormalities, poor motor coordination, mild cognitive problems, and social problems.

Prodromal Phase This occurs 1-2 years before serious symptoms and includes ideas of reference, magical thinking, illusions, increased anxiety/irritability, attention problems, social withdrawal, and obsessive behaviour.

Risk Factors Prenatal and Perinatal Events Those who experience an excess of complications in foetal life and at birth have an increased risk of developing schizophrenia. These early-life risk factors have an effect on the neural connectivity of the developing brain.

Paternal Age There is an association between late fatherhood and schizotypal personality.

Sex Schizophrenia is generally reported to be slightly more frequent and more severe in men than in women, with a risk ratio of 1.4/1. Men also tend to develop severe schizophrenia earlier than women. The peak age of onset is 20–24 years in men, but 25-30 in women.

Urban Environment Schizophrenia is most common in disadvantaged areas of inner cities. There is an increased incidence of schizophrenia in people born or raised in urban areas compared with those born or raised in rural areas.

Migration Status There is an increased incidence of schizophrenia in migrant groups. Lack of social support or increased exposure to discrimination might operate to increase the risk of developing the disorder, especially in areas with only a small minority population.

Drug Abuse Persistent abuse of amphetamine, methamphetamine and cocaine can produce a near identical state to paranoid schizophrenia. Experimental administration of cannabis or its active ingredient tetrahydrocannabinol can precipitate transient psychotic symptoms. Smoking cannabis is known to exacerbate existing psychotic illness. Young people who heavily use cannabis have an increased risk of subsequent schizophrenia. This relationship is dose dependent.

The risk is greater in those who start cannabis use in early adolescence than in those who start use later in life and in those using high-potency varieties of cannabis.

Social Adversity Childhood adversities (abuse, maltreatment, bullying) increase the risk of schizophrenia.

Other Factors Head injuries, epilepsy, autoimmune diseases and severe infections increase the risk of developing schizophrenia.

Pathophysiology Some aspects of schizophrenia have been associated with specific underlying neurobiology and the involvement of the prefrontal cortex in specific cognitive deficits. Subtle reductions in grey matter and abnormalities of white matter have been reported in many brain regions and circuits. The reduction of grey matter, especially in the temporal lobe, progresses with the duration of illness and seems to be associated with antipsychotic treatment. There is dysfunction of dopaminergic neurotransmission in the genesis of psychotic symptoms.

Diagnosis The criteria for schizophrenia from the DSM-V include two or more of the following symptoms for at least1 month: - Positive symptoms - Negative symptoms

- Significantly impaired functioning. - Symptoms last around 6 months. - Exclusion of other disorders. - Symptoms cannot be attributed to the use of drugs or medication. In the case of autism, at least 1 month with prominent hallucinations or delusions.

Screening and Prevention Prediction and Prevention of Psychosis Currently available pharmacological treatments for schizophrenia are limited and sometimes poorly tolerated. Most patients show substantial deficits in social, cognitive and occupational functioning throughout their lifetime. The primary challenges for realizing a prevention strategy include: - Developing reliable and efficient means to predict psychosis so that we can identify populations at the greatest risk. - Elucidating changes at the neural and molecular levels that participate mechanistically in functional decline and the onset of symptoms. - Developing and testing interventions that target the molecular signalling pathways that contribute to schizophrenia.

Risk Syndrome Ascertainment The onset of psychotic symptoms is often preceded by the emergence of subtle changes in belief, thought and perception that seem to represent attenuated forms of delusions, formal thought disorder and hallucinations, respectively. Approximately 80–90% of patients with schizophrenia experience this which lasts about 52 weeks. Psychotic symptoms emerge without an appreciable prodrome in the remaining 10–20%.

Clinically High-Risk Cases This is a potent predictor of psychosis and occurs in 36% of cases. Clinically high-risk patients are generally distressed and seeking help (typically for mood or anxiety issues and/or school failure) and often keep their changing thoughts and perceptions to themselves until specifically asked about these experiences. About 80% remain in the schizophrenia spectrum. The remaining 20% have mood-related and atypical forms of psychosis.

Prevention Studies Any targeted intervention, whether biological or psychological in approach, is associated with better outcomes. Psychosocial interventions such as cognitive–behavioural therapy and family-focused psychoeducation might be beneficial in deflecting the course of illness severity and chronicity.

Depressive Disorders These can be categorized as unipolar (depression) and bipolar (depression and mania). Depressive disorders are a type of mood disorder and include: - Disruptive Mood Dysregulation Disorder

- Major Depressive Disorder - Persistent Depressive Disorder (Dysthymia) - Premenstrual Dysphoric Disorder - Substance/Medication Induced Depressive Disorder

- Depressive Disorder due to another Medical Condition - Other Specific Depressive Disorder - Unspecified Depressive Disorder The common features of all depressive disorders are the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function.

Disruptive Mood Dysregulation Disorder Diagnostic Criteria The following symptoms must have been present for at least one year and must be present in at least two of three settings (at school, at home, and with friends) and must be severe in at least one of these. - Severe recurrent temper outbursts manifested verbally and/or behaviourally that are out of proportion. - These may occur in response to frustration. - Temper outbursts are inconsistent with developmental level. - The temper outbursts occur, on average, three or more times per week. - The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others. - The behaviours are not better explained by another mental disorder.

- The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition. - The individual must not have had no symptoms present for a period lasting three or more consecutive months and must never have experienced a manic or hypomanic episode.

Prevalence The prevalence among children and adolescents is around 2 - 5%. Rates are expected to be higher in males and school-age children.

Development and Course The age of onset is generally before 10. The diagnosis shouldn’t be made before 6 years old or after 18 years old. About half of those with severe, chronic irritability will ...