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clinical psych
| Question | Answer |
|---|---|
| defining psychopathology | -deviation from statistical norm -violation of and deviation from social norms -maladaptive behavior/disability -distress -dysfunction |
| where to find definitive terminology | DSM-5 and ICD10/11 |
| Psychopathology | psyche = spirit, soul; pathos = experiencing or suffering; logia = study of |
| Abnormal psychology | abnormal = deviating from what is usual, psyche = spirit, soul, logia = study of |
| Mental disorder | mens = mind, related to the entity which enables to experience and be aware of the world -ordinatus = set in order, arranged, dis- = prefix meaning apart |
| Mental Disease | dis- = prefix meaning apart, ease = free from pain or worry |
| Mental Illness | poor health |
| Psychiatry | psyche – spirit, soul; iatrikos = "healing" |
| Clinical Psychology | klinike – bedside, clinic, treatment at the bedside |
| Syndrome vs Symptom | something which systematically occurs together) vs (expression or sign |
| deviation from the statistical norm _____ ____ always imply psychopathology | does not |
| psychopathologic behavior | rare and not norm, most common disorders prevalence rate of 1-25% |
| problems deviating from social norm | different cultures -behaving in a way that is not socially acceptable does not always imply underlying psychopathology -can be used as means of stigmatizing individuals who don't conform |
| slow progressing schizophrenia | relied heavily on the occurrence of negative symptoms and covered nearly every psychological problem and problematic behaviour |
| cultural concept of distress | -defined as ways cultural groups (1) experience, (2) understand, and (3) communicate suffering, behavioral problems, or troubling thoughts and emotions |
| DSM-5 | emphasizes that all mental distress is culturally framed and acknowledges that different populations carry varying and culturally determined ways of communicating distress along with coping methods and help-seeking behaviors |
| Ataque de Nervios or Puerto Rican Syndrome | Primary symptoms include: • trembling • attacks of crying • screaming uncontrollably • becoming verbally or physically aggressive • panic attacks |
| cultural concept of distress | suggest that psychological disorders are possibly based on underlying physiological responses to stress which are similar across cultures, and which are further modulated by culture typical display rules |
| distress | associated with feelings of Hopelessness • Loneliness • Emptiness • Suicidal ideation • Feeling of guilt • Anxiety |
| what are not associated with distress | Conduct disorder & Psychopathy |
| disabilities/maldaptive behavior | specific phobias, social phobia, panic disorder, schizophrenia, depression |
| disorder exist when | evolutionary formed mental functions are impaired and when this negatively impacts the wellbeing of the individual, counterpart, or society |
| characteristics of mental disorders | violation of statistical norm -violation of social norm -personal distress -disability/maldaptive behavior -harmful disfunction |
| classification models | -International Classification of Diseases, Injuries and Causes of Death - Developed by World Health Organization (WHO) -Diagnostic & Statistical Manual (DSM) • Developed by American Psychiatric Association (APA) |
| classification systems provide the following info | • Essential Features of the Disorder • Associated Features • Diagnostic Criteria (a list of symptoms that must be present for diagnosis) • Information on Differential Diagnosis (how to differentiate the disorder from other disorders) |
| problems with classifying disorders | -not classified according to cause. The extensive catalogue of criteria makes the classification system highly reliable, but does not answer the question of validity -DSM and ICD defines disorders as discrete entities rarely like this in practice |
| other problems s with classifying disorders | • Comorbidity is the norm rather than the exception. • Both DSM 5 and the ICD 11 are evolving classification systems that take into account criticisms of previous versions and both try to incorporate recent research. |
| -Roman Catholic doctrine states angels are spiritual beings with intelligence and will -demons are able to demonically process individuals without the victims knowledge or consent, leaving them morally blameless | |
| book on demonology | De exorcisms et supplicationibus quibusdam -of exorcisms and certain supplications |
| cardinal Hoffner 1978 | Catholic theology adheres to existence of devil and demonic powers. There is no reason to deny the work of satan and evil, or to perceive statements about is absurd. The church teaches tradition god created invisible beings with knowledge and will |
| symptoms of demonic posession | -loss or lack of appetite -cutting, scratching and biting of skin -unnatural bodily postures -lack of self control -intense hatred to all religious objects or items |
| Michel demonic possession | Diagnosis at age 16: • Temporal lobe epilepsy • Depression • Anorexia Diagnosis at age 20: • Depression (strong suicidal ideation) • Anorexia • Schizoaffective disorder • Hallucinations [voices] • Delusions [threatened by religious items] |
| -identified as clinical entity in 1870s -1911 identified as last stage of untreated syphillis -occurrence 10-15 years after bacterial infection with treponema pallidum | |
| first signs of dementia paralytica | -slow progression affecting attention and concentration -memory deficits increased anxiety |
| late mental symptoms of dementia paralytica | Behavior deviates more from normal to frontal lobe syndrome: • Careless about dress and personal appearance • Careless about money, extravagances and ill-judged speculations • Sexual aberrations • Depressed • Agitated • Manic, euphoric and delusional |
| physical symptoms of dementia paralytica (late stage of disease) | -50% have epileptic seizures -mask-like face -weakness, voluntary power impaired --slurred speech --unsteady gait --ataxia --reflexes exaggerated, diminished, or lost |
| pathology of dementia paralytica | -caused by chronic bacterial meaning-encephalitis -atrophic changes in brain confined to anterior two-thirds of hemisphere(frontal and temporal lobes) -enlarged ventricles |
| MMSE | mini-mental state exam -orientatioin -attention -memory -naming -apraxia -construction |
| what brain disorders have predominant motor impairments and associated psychopathologies | -huntingtons -parkinsons |
| brain disorders with predomant psychopathologies | -picks -alzheimers |
| problems with medical model | -not all psychopathologies have a physical cause -if neuroanatomical correlate, biological changes might be triggered by psychological events releasing cortisol, destroying vulnerable nerve tissue leading to emotional and cognitive impairments |
| different treatments | -electroconvulsive therapy -neurosurgery for mental disorders -antipsychotics -antidepressants |
| electroconvulsive therapy (ECT) | -initially unselectively applied to a variety of psychopathologies -effective for depression |
| neurosurgery for mental disorders | • Cutting/coagulation of fiber tracts and nuclei • Frontal lobectomy (variety of psychopathologies) • Anterior cingulotomy (OCD, depression) • Amygdalotomy (aggressive behaviour) • Deep brain stimulation ( Parkinson’s disease, OCD, Depression) |
| antipsychotics | -1950s( chlorpromazine, haloperidol) -development of typical and atypical antipsychotics (dopamine antagonists) -schizophrenia (tardive dyskinesia) -schizoaffective disorder -bipolar disorder (manic phase-together with lithium) -psychotic depression |
| typical and atypical | -distinction between the two related to extrapyramidal side effects of the typical antipsychotics |
| antidepressants | -1950s -development of tricyclic antidepressants and ssris |
| tricyclic antidepressants | act on serotonin and noradrenaline metabolism, rarely prescribed today |
| SSRIs | act on serotonin metabolism |
| psychoanalysis | clinical method for treating psychopathology through dialogue between patient and psychoanalyst |
| basic assumptions of psychoanalysis | -personality shaped by 3 psychological forces (id, ego, superego) -often in conflict and psychological health is maintained only when in balance |
| fixation | due to lack of or too much gratification |
| major contributions to understanding psychopathology | -discovery of unconscious -early childhood experience and how infants relate to significant other form schemas of interaction -repression of emotions can lead to maladaptive behavior and psychological suffering |
| discovery of the unconscious | humans are driven by schemas and motives they are not aware of |
| basic assumptions of the behavioral model | -psychopathology is often learnt in response to life experiences -based on two principles of conditioning: classical and operant |
| example of classical conditioning | -bell rings when bone is present -dog hears bell ring and expects bone |
| operant conditioning (B.F. Skinner) | -based on reward and punishment -reward: increase frequency of behavior, add pos or take away neg -punishment: decrease frequency of behavior, add neg or remove pos |
| positive reinforcement | -adding something positive to situation |
| negative reinforcement | -removing something negative from situation |
| positive punishment | -adding something negative to situation |
| negative punishment | removing something positive from a situation |
| problems with using punishment | -punishment is not forgotten, suppressed --behavior returns when punishment is not present -causes increase in aggression to cope with problems -does not necessarily guide to desired behavior |
| behavior therapies include | -exposure therapy -functionl analysis -token economy |
| aversion therapy | classical conditioning |
| flooding | exposure to treating stimulus without chance to evade |
| systematic desensitization | client is brought step by step towards threatening situation, first by imagining, then by seeing stimulus, then by touching -paralleled by cognitive restructuring |
| Functional analysis (ABC) | -antecedent, behavior, consequence ---antecedents of undesired behavior, behavior itself and reward of characteristics of the consequence |
| token economy | -reward system which involves participants receiving tokens for engaging in certain behaviors which at a later time can be exchanged for a variety of reinforcing or desired items |
| what situations can token economy be used in | school, hospital, and family |
| SORC analysis (Kanfer and Saslow 1969) | -provides a structure by which you can analyze the pattern of antecedent and consequent events which maintain problem behavior -used to develop general understanding of dysfunctional behavior, guides cognitive-behavioral therapy |
| SORC (ABC) structure | (S) stimulus(a-antecedents) (O) organism (Diathesis - biologically fixed and socially flexible (R) response (behavior): motor, cog. emotional, physiological (C) consequence (C-consequence); in short and long run |
| Cognitive models rational emotive therapy (Albert Ellis 1955) | -all serious emotional problems result from irrational beliefs, dysfunctional thinking and biased information processing |
| examples of irrational and dysfunctional thoughts | • “I must be loved by everyone.” • “I am incapable of doing anything worthwhile.” • “I am worthless.” • “Bad things always happen to me.” • “I am never going to achieve anything.” |
| ellis schema (ABC-schema) | -Activating event: something unpleasant happens -Belief system: you have a belief about the situation -Consequences: you have an emotional reaction to the belief |
| common irrational beliefs that upset is the most | -I must do well and win approval or I am no good --leads to anxiety, depression, shame guilt -others must treat me well, if not they are no good and deserve punishment --rage, passive-aggression, violence -I must get what I want, --self pity |
| rational emotive therapy(Albert Ellis 1955) | A-active engagement B-beliefs (irrational and rational) C-consequence D-disputing E-more effective ways to think, feel and behave |
| humanistic approach (Carl Rogers 1950s) | -attempt to resolve psychopathology through self-actualization -result in a rally functioning person living in harmony with their feelings and impulses -development of the self-concept in childhoot |
| self-actualization | innate striving to reach our full human potential |
| self-concept | image of -what we are -what we should be -what we would like to be as an expression of developing our full human potential |
| research designs in clinical psychology | -coorelational designs -experimental designs -meta analysis -qualitative methods |
| coorelational method | -do variables x and y very together, are they related in a systematic way? |
| basic features of experimental designs | -manipulated independent variable -participants allocated to condition by random assignment -researcher measures a dependent variable |
| features of randomized controlled trial | -hypothesis -IV -random assignment -DV -doubke blind (if possible |
| correlational design types | -cross sectional -longitudinal |
| experimental design types | -group studies -single case studies |
| disadvantages to explanatory power | -does not imply casualty -variable x may cause variable y -variable y may cause x -or another factor may cause both --directionality is not always a problem |
| ABA experimental design | -initial baseline stage measured without intervention -followed by treatment or manipulate. and effect on behavior observed and measured -final return to baseline observing absence of treatment |
| analogue experiments | -not always possible in clinical psych because of ethical or practical constraints |
| epidemiological research | -study of the distribution of disorders in a population |
| three features of a disorder | -prevalence -incidence -risk factors |
| meta-analysis (glass 1976) | -identify relevant studies -compute effect size, transform results to a common scale |
| meta analysis (smith et al 1980) | -result psychotherapy is effective |
| qualitative methods | -raw material is ordinary language rather than quantifiable data -use participants own descriptions of their experiences, feelings, and thoughts -enables researchs to gain insight into the full experience of psychopathology |
| quantitative methods | -numerical scale and data |
| ethical issues in clinical research | -informed consent -distress -privacy and confidentiality |
| informed consent forms contain | -details on purpose of study -description of procedures -duration of study -who will know nd will confidentiality remain -participation is voluntary |
| causing distress | -by asking participants to disclose distressing or embarrassing information or treating questions to self image or esteem -presenting physically or emotionally aversive stimuli |
| withholding of participant benefits | -researchers ty to overcome this by using wait listing controls |
| privacy and confidentiality | -have right to decide not to provide info to researcher -right to expect information is treated confidentiality -info should be destroyed after a specific period of time |
| methods of clinical assessment | -clinical interviews -personality interviews -psychological tests -biologically based assessments -clinical observation |
| aims of clinical assessment | -describe client's problems -determine potential causes -arrive at diagnosis -develop treatment strategy -monitor treatment progress |
| clinical interview | -probably first form of contact client to clinician -questions relate to symptoms, history, and current conditions -interviewer needs to develop trustful relationship |
| structured interview | -structured clinical interview for DSM-5 (SCID) -structured interviews provide good agreement on diagnosis between clinicians |
| personality structure and experience | -personality inventories -specific trait inventories -projective tests |
| cognitive tests | -intelligence tests -neurological impairment tests |
| intro psychological tests | -assess client on one or more specific dimensions -rigid response and some requirements scores can be standardized to provide norms that individuals can be compared with -more tests are valid and reliable |
| Minnesota miltiphasic personality inventory (MMPI) | -most popular -characteristics --567 items on 14 measurement scales -includes validity scales -include hypochondriasis, depression, paranoia, schizophrenia ect |
| specific inventories | -developed to measure functioning in one very specific area of psychopathology -BDI: Beck's depression inventory -HADS: Hospital anxiety and depression scale |
| Beck's depression inventory | -21 question survey completed by patient, score 0-3 on answers -8-14: mild depression -15-30:moderate depression -more than 30: severe depression |
| projective tests | -present a fixed set of stimuli that are ambiguous enough to allow a variety of interpretations -open ended, less reliable |
| other tests still used in clinical practice | -thematic apperception tests (TAT): asked to produce a fantasy story for images provided, gives insight to motivation and needs -rohrschach test: ink blot test |
| rationale behind TAT | -present series of pictures and encourage individuals to tell a story invented on the spur of the moment -reveals specific component of personality because of the tendency to interpret ambiguous information in conformity |
| intelligence tests | -IQ tests are used by clinicians --diagnose intellectual and learning disability --used to measure neurological impairment |
| other intelligence tests | raven's progressive matrices test -wechsler adult intelligence scale (WAIS) |
| variations of wechsler adult intelligence scale tests | -verbal tests -preformance tests: picture completion, block design test, picture completion test, object assembly test, picture arrangement test |
| what are the problems with IQ tests | -many are culturally based on limited views of what is adaptive -current concepts of intelligence may be too narrow -do not measure an individuals capacity to learn |
| neurological impairment tests | -designed too measure cognitive ability and deficits -can determine whether deficits are the result of brain or neurological damage -used in addition to physiological measures such as EEG and MRI |
| examples of neurological impairment texts | Digit span and Corsi block tapping RBMT – Rivermead behavioural memory test FEEST – Facial expression of emotion (stimuli and tests) WCST – Wisconsin Card Sorting Test BADS – Behavioural assessment of the dysexecutive syndrome REY – OSTERRIETH figure |
| riverbed behavioral memory test | -assess in an ecologically valid way different aspects of memory -name learning -prospective learning -verbal memory -visual memory -visuo-spacial memory -orientation |
| clinical observation of behavior | -collecting clinical information by direct observation of a clients behavior -info on -frequency of behavior -context of events that precede a behavior -behavior itself -events that follow the behavior |
| ABC charts for case formulation | -measures A-antecedents of behavior B-behavior itself C-consequences of behavior |
| clinical assessment issues reviewed | assessments are used to address many questions -precisely what problem does the person have -what has caused the problems -did the treatment work |
| different tumors in the brain | • Meningioma • Astrocytoma/oligodendroglioma • Pituitary tumours • Metastatic tumours • Medulloblastoma- common pediatric malignant primary brain tumor |
| different neurodegenerative diseases | • Huntington’s disease • Parkinson’s disease - affecting dopamine containing neurones in the substantia nigra, targeting striatal and cortical regions. • Pick’s disease • Fronto-temporal lobe degeneration • Alzheimer’s disease |
| different cerebrovascular accidents (strokes) | • Ischemia (lack of blood flow) • Haemorrhage (bleeding) |
| psychiatric symptoms of huntingtons | -irritability --apathy -anxiety -depressed mood -OC behavior -psychosis |
| epidural hematoma | -rupture of middle meningeal artery caused by accident (rapid) |
| subdural hematoma | -rupture of bridging veins (slow) |
| subarachnoidal hematoma | ruptured aneurism (2-3% have aneurism, only .5-1% rupture |
| thalamic (intracerebral) hemorrhage | -inside brain vessel |
| angioma | -tumor of the vascular system |
| ischemic stroke | -interruption of the blood supply to any part of the brain resulting, if longer than a few seconds, damaged brain tissue -due to blood clots, seldom air bubbles, or fatty residuals |
| clinical syndromes | -frontal lobe deficits -brocas (non fluent )and wenicke (fluent) aphasia -memory Alexia without a-graphic -agnosia -neglect |
| frontal lobe tests | -trail making test -weigl color form sorting test -wisconsin card sorting test (WCST) -behavioral assessment of the dysexecutive syndrome (BADS) -rigidity and preservation |
| broca's aphasia | -displays speech which varies from muteness to slow delivery characterized by impaired articulation, flat intonation, and simple grammar |
| what tests memory components in retrograde amnesia | -rotary pursuit task (HM Corkin 1968) |
| Alexia without agraphia (disconnection syndrome) | -ability to write on command or form a sentence, but being unable to read words just written or placed -due to separation of visual processing areas from cortical and subcortical regions associated with language |
| associative agnosia | -inability to recognize objects despite an apparent perception of the object -patient can copy accurately, but cannot identify by vision -identification by acoustic cues or touch is impaired |
| neglect | -patient unaware of meaningful stimuli in space outside of lesion -left visual field or in severe cases left side of body is ignored -deficits in auditory, visual, and somesthetic domain -not attributed to motor or sensory deficits |
| sensory | hemianopia |
| motor | hemiplegia |
| behavioral inattention test (BIT) | conventional subtests -line crossing -letter. cancellation -star cancellation -figure and shape -copying -line bisection -representational -drawing |
| behavioral subtests for BIT | -picture scanning -telephone dialing -menu reading -article reading -telling and setting time -coin sorting -address and sentence copying -map navigation -card sorting |
| specific phobias (DSM-5) | -marked fear about a specific object or situation -phobic object of situation almost always provides immediate fear or anxiety -actively avoided/ endured with marked fear or anxiety -out of proportion to actual danger posed -persistent -sig distress |
| most prevalent specific phobias | -social -blood-injury-injection -animal -dental -water -height -claustrophobia |
| cognition of specific phobias | -develop a set of dysfunctional beliefs -rarely challenged due to phobic avoidance -beliefs maintain phobic fear and motivate response to avoid contact |
| Mowrer's two-factor model | -pairing of aversive with cs lead to cr (bite, appearance of dog, fear of dogs) -fear response maintained through avoidance of dog, neg reinforcement |
| disgust | -food rejection emotion whose propose is ti prevent the transmission of illness and disease -differences in disgust sensitivity is a risk factor for developing specific phobias |
| high levels of disgust sensitivity has been associated with | -small animal phobias -spider phobia -blood-injury-injection phobia |
| many animals may acquire a disgust relevance by | -directly speaking disease -possessing features that resemble natural disgust stimuli -by signaling disease, contamination, or illness |
| different phobias may be acquired in different ways | -classical and operant conditioning -biological preparedness -disgust emotion |
| exposure therapy most effective treatment to phobias | -systematic desensitization -flooding -CBT |
| Major depression (MDD) | -extended periods of clinical depression which cause significant distress to individual and impairment in social or occupational functioning |
| bipolar disorder | -periods of mania that alternate with periods of depression |
| Schizo-affektive disorder | -periods of mood changes and psychotic signs |
| what symptoms may be present during the same two weeks for major depressivee disorder | -depressed most of day -diminished interest -significant weight loss or gain -insomnia or hypersomnia -agitation or retardation -fatigue -feeling of worthlessness -diminished ability to think or concentrate -suicidal thoughts |
| MDD domains of impairment | -psychological: feeling sadness, hopeless, dejection, discouragement -motivational:lack of ambition and spontaneity -physical: sleep disturbance, weight gain or loss -cognitive:memory and executive functions |
| Bipolar I and II symptoms | -severe mania -hypomania -balanced mood -mild or moderate depression -severe depression |
| what bipolar is more common | Bipolar I |
| criteria for depressive phase during hypomanic and manic phases | (1) inflated self-esteem or grandiosity (2) decreased need for sleep (3) increased talkativeness (4) flight of ideas or racing thoughts (5) distractibility (6) increase in goal-directed activity or psychomotor agitation (7) increase in risky behavior |
| behavioral features of (hypo)mania | -racing thoughts -high sex drive -making grand and unattainable plans -poor judgement -inflated self-esteem or grandiosity -increased reckless behavior |
| hypomania | -An uninterrupted period of psychotic illness during which there is a mood episode -bipolar type: manic episode part of presentation depressive type: only major depressive episode present |
| delusions | grandeur:become famous historical figure or deity -persecution: others trying to harm them -control: thoughts controlled by external forces -reference: radio or television speaking directly to them |
| hallucinations | -affect visual, auditory, olfactory, and somatosensory domain -hearing voices moist common |
| medical treatment for MDD | -tricylic antidepressants -SSRI |
| medical treatment for bipolar disorder | lithium (mood stabilizer) |
| medical treatment for schizoaffective disorder | -lithium -tricylic antidepressants and SSRI -antipsychotics |
| biological theories of depression | • Genetic factors • Neurochemical factors • Brain abnormalities & depression • Neuroendocrine factors & stress |
| psychological theories of depression | • Behavioural Approach (Lewinsohn) • Negative triad (A. T. Beck) • Learned helplessness (Seligman) |
| what neurotransmitter levels is depression associated with | seretonin -norepinephrine/noradrenaline |
| what abnormalities in the brain is depression associated with | -prefrontal cortex -anterior cingulate cortex -hippocampus -amygdala -cerebellum |
| depression is associated with high levels of | cortisol |
| lewinsohn's activation theory | -suggested that depression is caused by a combination factors in a person's environment which A) deprives a person from positive reinforcers, and B), a lack of personal skills to cope with this situation. |
| negative cognitions and self schemas | -Aaron Beck (1967): depression is maintained by negative views of themselves, the future, and the world |
| addressing Beck's negative triad | -identifying: help clients recognize neg thoughts -linking: helping clients see how neg thoughts activate mood states -modifying: helping clients generate alternate ways of thinking |
| Learned helplessness (Seligman) | theory of depression, argues people become depressed following negative life events, events give rise to a cognitive set that makes individuals learn to become ‘helpless’, lethargic and depressed. -Derived from observation of animal behaviour. |
| biological treatments of depression | -drug therapy -electroconvulsive therapy -neurosurgery |
| psychological treatments of depression | -social skills training -behavioral activation therapy -cognitive therapy |
| behavioral activation therapy | -daily monitoring of both pleasant and unpleasant events -increasing clients access to pleasant events and rewards -improving social skills |
| cognitive therapy | -helps individuals identify neg beleifs -assisting clients to challenge beliefs -replace neg and dysfunctional thoughts with adaptive and rational beliefs |
| what is the history of schizophrenia | -Emil Kraeplin used term dementia praecox -Eugen Bleuler Wurst used term schizophrenia |
| what was the picture of dementia praecox according to kraeplin | -reduced cognitive abilities -blunting of affect -apathy and impaired goal oriented behavior (not mandatory delusions and hallucinations) |
| clinical picture of schizophrenia according to Bleuler | -impaired coherence of thought content/flight of ideas -blunting of affect and indifference/ anhedonia -autism (not mandatory but delusions and hallucinations) |
| delusions seen in schizophrenia | -grandeur -persecution -reference -control |
| hallucinations in schizophrenia | -perception in the absence of external stimuli -most common hearing voices |
| disorganized thinking/ speech and behavior | -deficits in organizing thoughts coherently or connecting them logically -associated with poor executive functioning and disorganized behavior |
| negative systems of schizophrenia | -affective flattening: limited range and intensity of emotions -anhedonia: inability to experience joy or pleasure -asociality: withdrawal into an inner world reduced emotional involvement with others |
| DSM-5 diagnostic criteria | -delusions -hallucinations -disorganized thinking/speech -negative symptoms |
| course of disease | 1%, adolescence and early adulthood acute: early psychotic phased shorter than 3 months, directly start positive symptoms 17% -sub-acute onset: early psychotic phase between 3 months and 1 year 18% -slow onset: 65% of patients |
| earliest signs of slow onset schizophrenia | -restlesness -depression -anxiety -worries -lack of self-confidence -loss of energy -impaired work performance -social withdraw |
| outcome after disease onset | -22% symptom free after first psychotic episode -35% multiple episodes of variable duration but end symptom free -35% recurrent psychotic episode increasing worsening of symptoms, full criteria of Kraeplin's dementia Praecox |
| biological theories of schizophrenia | -family, twins, and high risk adoption studies -dopamine hypothesis -altered brain structures and neuropsychology |
| psychological theories of schizophrenia | Fromm-Reichmann (schizophrenogenic mother) -expressed emotions |
| socio-cultural theories | -social causation or socio-genetic theory -downward frift |
| high-risk adoption studies | -give insight into genetic and environmental contribution for developing schizophrenia (Tienari et al., 2004) -high risk children developed significantly more schizophrenia in adverse rearing conditions than rearing conditions |
| findings leading to the dopamine hypothesis | -amphetamine elevates availability of dopamine in frontal lobe and striatum by inhibiting dopaminenre uptake. can in high doses can create schizophrenia like psychoses -giving people with schizophrenia dramatically increases symptoms |
| parkinson patients | show psychosis-like symptoms when high levels of dopamine one is increased above normal, giving high levels of L-dopa |
| dopamine hypothesis | -assumes that the dopaminergic system in schizophrenia is overactive and that the limbic portion of this system is central for producing positive symptoms |
| brain anatomy in manifest schizophrenia | Lawrie & Abukmeil (1998) 3 % overall brain reduction 6 to 9.5 % temporal lobes 6.5 % amygdala hippocampus complex 14 % parahippocampus Shenton et al. (2001) reduc. • frontal lobes, temporal lobes, limbic structures, basal ganglia and cerebellum. |
| neurophysiological deficits | -attention -information -processing/efective functions -planning -memory -working memory -social cognition -emotion recognition |
| psychodynamic theory (Fromm-Reichmann 1948) | -suggested early childhood trauma in form of schizophrenogenic mother as a possible reason |
| expressed emotions (brown, 1972) | -anecdotal observations suggest that the quality of social interaction after discharge from hospital had influence on relapse rate of people with schizophrenia |
| Camberwell family interview looks at | -critique isards patient -hostility towards patient |
| social causation or socio-genetic theory | -poor people in these areas are exposed to continuous stress and experience less social closeness/ more isolation |
| downward drift | -explains findings in reverse: premorbid maladaptation leads to social decline - especially caused by negative symptoms |
| hospital treatment for schizophrenia | -approach in western countries uo to 1970s -untrained attendants and nurses did most of the work resulted in social breakdown syndrome |
| what is social breakdown syndrome | -confrontational and challenging behavior -physical aggressiveness -lack of interest in personal welfare and hygiene |
| Milieu therapy | -to counter social breakdown -wards now formed therapeutic community with the aim to create feeling of self respect and responsibility based on mutual respect between staff and patients -occupational/recreational activities -stresslow, discharge sooner |
| what can also be used for schizophrenia patients | token economy -patients improved significantly compared to those in traditional wards -better groomed -more active -spent less time in bed -shoed more appropriate behavior -discharged earlier |
| psychosurgery | transorbital lobotomy (freeman and watts 1946) -used In disruptive and agressive patients -results in apathy and mutism -fatality between 1.5-6% -severely affected intellectual abilities |
| antipsychotic schizophrenic medications | -class of psychiatric medication used to treat positive symptoms -neuroleptic medication predominantly blocks receptors in brains dopamine pathways |
| short term side effects of antipsychotic medications | -oculomotor and tongue cramps -restlessness -depression -weight gain -low blood pressure -parkinsonism --shuffling gait --no arm swing --tremor |
| long term side effects of antipsychotic medication | -negative symptoms -tardive dyskinesia after 5 yr -limb tremor -involuntary tics -lip smakcing -chin wiggling -emotionless expression |
| social skill training for patients with schizophrenia | -conversational skills -physical gestures -eye contact -appropriate facial expressions |
| cognitive behavioral approaches for schizophrenic patients | -personal therapy -family intervention |
| personal therapy | -helps to adapt to living outside of the hospital, group and individual setting aims: learn ti identify signs of relapse -relaxation methods -identifying inappropriate responses and dysfunctional thoughts -resolving interpersonal conflict -medication |
| family intervention | -stresses importance of medicine -current state of patient -training aimed at reduction of dysfunctional communication -therapy focuses on actual family and current problems -support of families to develop self help-strategies -wellbeing of family |
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