Leerdocument D&H 2

Lecture 1
What is psychopathology?
The study of abnormal thoughts, behaviour and feelings.

By what four dimensions is abnormality influenced/ described?

1. Dysfunction:
2. Distress
3. Deviance
4. Dangerousness

Biological versus supernatural versus psychological theories on abnormality?

Biological: Abnormal behaviour is similar to phyisical diseases, explainable by systems in the body.
Supernatural: Divine intervention, demonic possesion or sin.
Psychological: Results of trauma or chronic stressf

What states the deinstitutionalization movement?

In 1960 the patients rights movement argued that mental patients can recover more fully or live
more satisfying lives if they are integrated into the community, supported.

What was a downside from the institutionalization movement?

There were not enough halfway houses built or community mental health centers funded to serve
those who were formerly institutionalized or would have been. As a aconsequence, many people
who suffered from mentalhealth problems were left helpless/ untreated.

What includes managed care?

A collection of methods for coordinating care that ranges from simple monitoring to total control
over what care can be provided and paid for.
 Goal: coordinate services for an existing medical problem, and preventing future medical
problems.
Assessment:
The process of gathering info about peoples smptoms and the possible causes of these symptoms.

3 interviews + explaination:
1. Structured interview: clinicians and researchers ask the respondent a series of questions
about symptoms he or she is experiencing or has experienced in the past, entirely
standardized with concrete scoring criteria.
2. Semi-structured: Standardized and open-ended questions are combined, which allows for
the gathering of more personalized information.
3. Unstructured: The questions are open-ended and directed by the clinician based on the
clients response.

4 brain imaging techniques + explaination + cons

1. CT-scan: x-ray beams are passed through the persons head, showing a 3d image of the brain.
Con: Can be harmful, plus brain structure rather than activity is being shown.
2. PET: shows brain activity by injecting a substance that accumulates active brain parts.
3. MRI: Not harmful, shows static images of brain structure. fMRI even shows activity.
4. EEG: Measures electrical activity through the firing of specific neurons in the brain.

Lecture 2

What does the diathesis-stress model state?

A risk factor may not be enough to lead a person to develop severe psychological symptoms and it
may take some other experiences or triggers for psychopathology to develop.

What is electroconvulsive therapy?

An alternative to drug therapies, it’s commonly used for treating severe mood disorders. It contains a
series of treatments in which a brain siezure is induced by passing an electrical current through the
brain.

Tell me about psychosurgery

Used rarely, it remains controversial even though it has become saver, due to lesions or destroying
areas of the brain.

Pros and cons of biological approaches:

Pro’s: Remarkebly effective, succesful treatment.
Con’s: Does not work for everyone and sometimes psychotherapy works better.
- They often ignore the role of environmental and psychological processes.
- Ppl who attribute their mental health issues to biological causes are more pessimistic about
the outcome.

Of what does Freud’s iceberg consist?

1. Id: unconscious: Primitive drives, libido, pleasure (max plaeasure, minimal pain)
2. Ego: conscious
3. Superego: the moral standards.

Where do psychodynamic therapies focus on?

Uncovering and resolving the uncounscious processes that are thought to drive psychological
symptoms to help clients recognize their maladaptive coping strategies and the sources of their
unconscious conflicts.
 Free the patient from their past.
Lecture 3: Anxiety disorders

2 systems that get activated in fight or flight response, by what organ?

The hypothalamus.

What are the two systems that get activated in a f-o-fr?

1. The sympathic division of the autonomic nervous system: Fast system, to release extra sugar,
increase heart rate, blood pressure, and breathing rate.
2. The adrenal-cortical system: Signals the pituitary gland to secrete the body’s major stress
hormone, that hormone stuimulates the adrenal glands and this releases cortisol.

What is the body’s major stress hormone and what does it do>
It’s adrenocorticoptropic hromone, it releases stress hormones like cortisol .

What brain part turns of the fight or flight?

The hippocampus.

What is selective mutism?

The failure to speak in specific social situations. Usually develops in early childhood.
 Result of various genetic, environmental, temperamental and developmental factors.

What is the DSM-V definition of trauma?

Events in which individuals are exposed to actual or threatened death, serious injury, or sexual
violation.

What 4 symptoms are needed to get PTSD diagnosis?

1. Reexperiencing the traumatic event
2. Avoidance
3. Negative changes in thought and mood
4. Hypervigilance and chronic arousal.

When do people get diagnosed with PTSD ‘with prominent dissociative symptoms’’?
When dissociative symptoms in PTSD are especially prominent and persistent.

When is ‘’acute stress disorder’’ diagnosed?

In response to traumas similar to those involved in PTSD, but is diagnosed when symptoms arise
within 1 month of exposure to the stressor and last no loner than 4 weeks.  It’s a risk factor for
developing PTSD.

What is adjustment disorder?

Emotional and behavioural symptoms that arise within 3 months of a stresoor, is a diagnosis when
ppl do not meet the criteria for PTSD or any other anxiety disorder.

Difference between adjustment disorder and PTSD/ acute stress disorder?

The stressors of adjustment disorders can be of any severity, while the trauma’s that lead to PTSD or
acute stress disorder are more extreme.

What is Reactive attachment disorder? (RAG)

Occurs as a result of severe neglect, abuse, or maltreatment in early childhood, and usually represent
between 9 months – 5 years.
Symptoms:
- Difficulty forming close relationships with anyone
- Do not seek out or respond to comfort in times of distress.
- Significant emotional dysregulation.

Disinhibited social regulation disorder?

Schildren develop inappropriate and overly familiar behaviour with adult stranger.
 Makes them vulnerable to abuse.

What is a simility between RAG and disinhibited social regulation disorder?

Both are associated with severe neglect in childhood.

What are the 2 environmental and social factors that increase the likelihood for PTSD?
1. The severity and duration and proximity of a trauma.
2. The availability of social support.

What are the 2 psychological factors that increase the likelihood for PTSD?
1. People who already experience increased symptoms of anxiety and depression before
trauma occurs are more likely to devevelop PTSD.
2. People that dissociate shortly after a trauma are increased risk to develop PTSD.

What are gender influences on developing PTSD?

1. Women are more likely than men to be diagnosed with PTSD, as well as most other
anxiety disorders.
 Because the trauma’s they experience are more stigmatized (SA).

what shows neuroimaging?  What brain parts are different in pTSD?

The brain parts that regulate emotion, fight-or-flight and memory:
Amygdala, hippocampus, prefrontal cortex.

What is up with the cortisol levels on PTSD patients? And why?

Resting levels of cortisol seem to be lower than with people without pTSD. Cortisol acts to reduce
sympathethic nervous system, so lower levels may result in the prolonged activity of this system
which then concludes in stress and conditioned fear of stimuli associated with the trauma.

What 3 therapies are used to treat PTSD?

1. Cognitive behavioural therapy
2. Stress Management theray
3. Biological therapy’s

What does cognitive behavioural therapy do?

Systematic desensitization: so the client identifies thoughts and situations that create anxiety and
puts them in hierarchy. The client learns to habituate the feared events so their reaction will become
less powerful, and to distinguish memory from present reality.

What are 2 types of CBT for PTSD?

1. Prolonged exposure therapy: focueses on repeated exposure to trauma reminders
2. Cognitive processing therapy: Focuses on the reinterpretation of the traua

What are specific phobias + the five categories?

Unreasonable or irrational fears of specific objects or situations and are grouped by the DSM-V into 5
categories:
 1. Animal type
2. Natural environment type
3. Situational type
4. Blood-injection- injury type
5. Others.

What is the key symptom of a specific phobia + diagnosis criteria?

A fear or anxity about a specific situation or thing that is disproportionate to the actual danger.
- The individual actively avoids the object or the situation, or endures it with intense fear or
anxiety, for atl. 6 months.

What is agoraphobia?
Fear of places where they might have trouble escaping or getting help if they become anxious. They
fear that they will embarrass themselves if others notice their symptoms or their efforts to escape
during an attack.
 Panic attacks often preceed to develop agoraphobia.

Freuds theory on phobia?

Unconscious anxiety is displaced onto a neutral or symbolic object. Ppl don’t have real fear of the
object or situation, but they displace their anxiety over other issues onto them.

what states the two-factor theory?

Classical conditioning leads to the fear of the phobic object, and operant conditioning helps maintain
it.  So they avoid the feared object. When suddenly confronted, they run away, whch reduces
their anxiethy: negative reinforcement.

What states the theory of ‘prepared classical conditioning?’

Evolution may have been selected for rapid conditioning of fear to certain objects or situations.
Those who quickly learned to fear objects or events that may be dangerous were more likely to
survive and bear offspring.

What do behavioural treatments for phobias do?

They use exposure to extinguish the person’s fear of the object or situation. They cure the majority of
phobias.

What are the 3 basic components of behaviour therapy for phobias?

1. Systematic desensitization:
2. Modeling
3. Flooding: Exposing a client to his or her feared object until anxiety is extinguished.

What are biological treatments for phobias?

Benzodiazepines to reduce the anxiety but the phobia remains. So behavioural techniques are more
effective.

Social anxiety disorder?

People with social anxiety disorder become so anxious in social situations and are so afraid of being
rejected, judged, or humiliated in public that they avoid them and it causes severe disruption.

How does social anxiety and gender interfere?

Women are more likely to develop it, but men seek treatment more often.

What are two treatments of SAD?

 - SSRI’S or SNRI’s
- Cognitive behavioural therapy

Why would one choose CBT over medication?

It’s just as effective in reducing symptoms, but is much more effective in preventing relapse.

What are panic attacks?

Short but intense periods during which one experiences many symptoms of anxiety. They arise in
certain situations but not every time, and usually without enviromental trigger.

What are diagnostic criteria for panic disorder?

- Panic attacks become common
- Not provoked by a particular situations but unexpected
- Worry/ changing behaviour from the person

What are common thoughts by a person with a panic disorder?

Fear that they have a life threatening illness and will die of this.
Fear they are going crazy or losing control

Where are differences in the limbic isystem found in ppl with panic disorder?
The amygdala, hypothalamus, and hippocampus. Also dysregulation in the locus coeruleus (part of
brain stem) which regulates the limbic system and lowers the threshold for the activation of anxiety.

What are cognitive issues that makes people prone to panic attacks?
They pay very close attention to their bodily sensations, negatively misinterpret these sensations,
and engage in snowballing catastrophic thinking, exaggering symptoms and the consequences.

What is anxiety sensitivity?

The unfounded belief that bodily symptoms have harmful consequences. This is higher in people with
panic disorder.

What is interoceptive awareness?

A heightened awareness of bodily cues that may signal a coming panic attack. They have occurred
previously before a panic attack and became a conditioned stimuli: Interoceptive conditioning.

what is ‘conditioned avoidance response’?

Some people begin to associate certain situations with symptoms of panic and tend to avoid these
places to reduce their symptoms. Thereby they reinforce their avoidance behaviour. This can lead to
agoraphobia.

Two types of treatment in panic disorder?

- Biological treatments: Medication affectin serotonin and norepinephrine, like SSRI’s.
Benzodiazepines are also sometimes prescribed, they work quickly reductant, but are
addictive and have significant withdrawal symtpoms.
- Cognitive behavioural therapy:
o Identifying and challenging the catastrophizing cognitions they have about changes
in bodily sensations, practicing relaxation and breathing exercises.
o Systematic desensitizations: Expose the client gradually to the situations they fear
the most while helping them maintain control.

What is a generalized anxiety disorder?

Diagnosed if people are anxious all the time, in almost all situations; uncontrollable worry.
 More women than men, and its chronic. 90% of ppl have another mental disorder.

What are cognitive aspects of GAD?

- More intense negative emotions, high reactivity to negative events
- Emotions are uncontrollable or unmanagebale
- Chronically elevated activity of their sympathetic nervous system, hyperreactivity to
threatening stimuli.

What is the cognitive avoidance model?

Suggestst that by worrying about possible threats, people with GAD maintain a constant level of
anxiety that is more tolerable than leaving themselves open to sudden sharp increases in negative
emotion.

What is the biological process of GAD?

The greater activity in the sympathetic nervous system and amgydala are associated with
abnormalities in the GABA system. GABA prevents the neuron from firing and people with GAD may
have a GABA deficiency  neurons fire excessively in particularly the limbic system.

Treatments for GAD?

CBT: confront most worrisome issues, challenge negative thoughts and develop coping strategies.
ERT: emotion regulation therapy focuses on emotional awareness and regulation.
Biological: Benzodiazpine is a short term release but has side effects/ addictive.
SSRI and SNRI work better than a placebo in GAD.

Seperation anxiety disorder:

Children continue to be extremely anxious when they are seperated from their caregivers, even into
childhood and adolescence.

What are symptoms of Seperation disorder?

- Refusing to go to school
- Stomach aches, headaches, nausea and vomiting when forced to leave from caregivers.
- Worries that something bad will happen to the caregiver like accidents.
- Diagnosed if this lasts for atl. 4 weeks and impairs the childs functioning.

What are biological factors in seperation anxiety?

- Family history of anxiety and depressive disorders.
- Behavioural inhibition may be inherted: shy feraful, cautious, quiet and are clingy with their
parents.

Psychological and sociocultural factors in seperation anxiety?

Parents tend to be more controlling and intrusive, and more critical and negative in communication
with their child.

How is seperation anxiety disorder treated?

With CBT, by teaching coping skills and while the therapy progressess, the number and duration of
seperation from their parents is increased.
- Sometimes parents are taught to model non-anxious reactions in seperations from their
children.
With drugs like SSRI’s are then mostly used.

What are obsessions?

Obsessions: Thoughts, images, ideas or urges that are persistent, uncontrollably intrude on
consciousness and usually causes significant anxiety or distress.

What are compulsions?

Compulsions: Repetitive behaviors or mental acts that an individual feels they must perform.

What is OCD?
Diagnosed when either obsessions or compulsions or both are present to a significant degree.
- Anxiety is experienced as a result of obessisonal thought aswell as being unable to carry out
compulsive behaviour.
- People know that their thoughts and behaviours are irrational but they cannot control them.

What is hoarding?
Compulsive behaviour that is closely related to OCD. They show emotional attachments to their
possessions, equating them with their identity or humanly characterize them.

Body dysmorphic disorder?

Being excessively occupied with a part of their body that they believe is defective but others see as
normal. Symptoms:
- Checking themselves in mirror
- Attempting to hide or change the body part
- Seeking reassurance from others abt the body part.

What brain circuit is involved in the biological process of OCD and related disorders?
- Involving motor behavior, cognition and emotion: Frontal cortex  striatum (part of basal
ganglia)  basal gangla  thalamus  back to frontal cortex.

What are cognitive-behavioural differences between ‘normal’ people and OCD?

They’re unable to turn off negative, intrusive thoughts, that are attributed to distress (in normal ppl
to). They may be distressed most of the time so even minor negative events can invoke intrusive,
negative thoughts.
Compulsion develops largerly through operant conditioning.

What CBT helps people with OCD?

Therapies that use exposure and response prevention where the aim is to repeatedly expose the
client to the focus of the bosession whie preventing compulsive responses to the resulting anxiety.
This learns the client that acting on the obsession with compulsive behaviour does not lead to the
terrible result they fear.

Where does CBT for skin picking or hair pulling disorder focus on?
Habit reversal training.

Lecture 4: Sexual and gender identity disorders

Of what 5 phases does the human sexual respons cycle exist?

1. Sexual desire: the urge to engage in any type of sexual activity
2. Arousal phase: Psychological experience of pleasure and physiological changes (increased
blood flow and muscular tension in pelvic area)
3. Plateau phase: Excitement remains at a high but stable level
4. Orgasm: The discharge of the neuromuscular tension built up during the arousal and plateau
phases
 5. Resolution: Entire musculature of the body rleaxes, deep state of relaxation.

What are sexual disfunctions?

A set of sexual disorders in which people have difficulty responding sexually or experiencing sexual
pleasure.
When does one get diagnosed?
The difficulty must be more than occasional or transient and must cause significant distress or
interpersonal difficulty. They must occur for atl 6 months and not be due to another psychiatric
problem; substance or medication; a general medical conditon; a stressor.

What is Male Hypoactive Sexual Desire disorder?

These men have little desire for sex and have (almost) no sexual thoughts or fantasies. In these cases,
a man used to enjoy sex but lost interest in it. Can be generalized to all partners and situations, or
specified to certain partners or types of stimulations.
 Higher among older men.

What is female sexual interst/ arousal disorder?

A woman must report at least 3 of the following symptoms for atl. 6 months. Absent or significantly
reduced interest in:
1. In sexual activity
2. In sexual or erotic thoughts or fantasies
3. In initiating of sex or receptiveness to sex
4. In excitement or pleasure in most sexual encounters
5. In sexual responsiveness to erotic cues
6. In genital or non-genital responses to sexual activity.

What is erectile disorder?

The recurrent inability to attain or maintain an erection until the completion of sexual activity or a
marked decrease in erectile rigidity.
 These problems are common, in order for it to be a disorder it has to be persistent and
significantly interfere with a man’s interpersonal relationship/ cause him distress.
 Can be cause of result in relationship problems

What is the female orgasmic disorder?

Markedly induced intensity of orgasm, delay or absence of orgasm, after having the reached the
excitement phase of the sexual response cycle in atl. 75% of sexual encounter.

Early or premature ejaculation disorder?

Men persistently ejaculate with minimal sexual stimulation before they wish to ejaculate.

When can a men get diagnosed for early ejac. Disord?

A man must ejaculate within 1 minute of penetration in partnered sexual activity and before the man
wishes it on 75% of the occasions over a period of 6 months.

What is genito-pelvic pain/ penetration disorder?

When women approx. 6 months recurrently experience either pain or muscle tightening during sex
or have marked fear or anxiety abt such pain.

What are biological causes of sexual dysfunctions?

Diabetes: It can lower sexual drive, arousal, enjoyment, and satisfaction, esp in men.
Cardiovascular diseases, MS, kidney failure, vascular disease, spinal cord injury are also causes of
sexual dysfunction.
In what two ways can cardiovascular disease in men cause sexual dysfunction?
1. By the reduction of blood flow in the penis
2. Psychological: The presence of the disease.

What are 3 psychological causes of sexual dysfunction?

1. Mental disorders: Themselves or the medications.
2. Attitudes and cognition: Negative attitudes may cause lack of desire.
3. Trauma: Could be any trauma, doesn’t have to be a sexual trauma.

What is performance anxiety?

It makes people worry about whether they are going to be aroused/ have an orgasm, which
interferes with their sexual functioning.
 Spectatoring: When people anxiously attend to reactions and performance during sex.

What are interpersonal and sociocultural factors in sexual dysfunction?

Interpersonal: Sometimes intimate relationships problems are the consequences of sexual
dysfunctions, or the cause.
Cultural: It differs. Western women mostly seek out help for sexual pleasure issues and women from
other cultures more for vaginismus.

How does individuals & couples therapy work? Overeenkomst en tegenstellingen

In indivdual therapy: Individuals explore the thoughts and previous experience that impede them
from ejoying a positive sexual life.
Couples therapy: Helps couples develop more satisfying sexual relationships.
Overeenkomst: Behavioural techniques are used to teach people skills to enhance their sexual
experiences and to improve communication with their sexual partners. Preference goes to couples
therapy when dealing with sexual dysfunction.

What is sex therapy?

It teaches skills and helps partners develop a regular pattern of engaging in satisfying sexual
encounters. Includes teaching and encouraging clients to masturbate to discover their body and
become less inhibited. And talk about this with their partners.

What is sensate focus therapy? 2 phases + what is it effective for?

First phase: Partners are instructed not to be concerned about or even to attempt intercourse. They
are told to focus on the pleasure created by the exercises to reduce performance anxiety. The goal is:
spending intimate time together communicating, without pressure for intercourse.
Second phase:
Partners spend time stimulating eachothers private parts, but without attempting intercourse. Focus
= enhancing and sustaining pleasure rather than an orgasm or performance.
Effective for: disorders of desire, arousal and orgasm.

Two types of technieques for treating early ejaculation:

1. Stop start technique:
a. First phase: Man is told to stop stimulation just before he is about to ejaculate. He
then relaxes until arousal declines and then can resume stimulation.
b. Second phase:
c. Third phase:
2. The squeeze technique: The man’s partner stimulates him to an erection and

How can pelvic muscle tightening be treated?

By deconditioning the woman’s automatic thightening of her vaginal muscles by first inserting
fingers, then dilators which gradually get larger. During this the woman practices relaxation
excercises.

What is a paraphilic disorder?

Atypical sexual preferences, that is currently causing the individual significant distress or impairment
or entails personal harm or risk of harm to others.

What is fetishistic disorder?

Using nonliving objects or non-gential body parts for sexual arousal or gratification.

What is transvestic disorder? When is it diagnosed?

A variation on fetishism, which is dressing in the clothes of the other sex, as a means of becoming
sexually aroused.
 It’s diagnosed when this cross-dressing behaviour gives the individual significant distress or
impairment.

What is gynephillia?
When men with transvestic disorder are sexually aroused by thoughts of being a woman.

What are sexual sadism disorder and sexual masochism disorder + the differences?
Sexual sadism: A persons sexual fantasies, urges, or behaviours involve inflicting pain and humiliation
on his or her sex partner.
Sexual masochism: A persons sexual fantasies, urges, or behaviours involve suffering from pain or
humiliation during sex.

What are the similarities between sexual sadism and sexual masochism disorder?
Distress may manifest as guilt, shame, loneliness or intense sexual frustration.
They typically engage in sadistic or masochistic behaviour as their preferred form of bevrediging.

What is voyeuristic disorder?

Sexual arousal by wathcing another person undress, do things naked, or have sex without them
noticing. For a diagnosis this behaviour must be +6 months and be compulsive. It has to cause the
person significant distress/ impairment in functioning, or the voyeur must have acted on these urges
with a non-consenting person.

What is an exhibitionistic disorder?

A person who obtains sexual gratification by exposing their genitals to involuntary observers. In order
to get diagnosed, a person must:
- Act on their urges to engage in the behaviour or:
- The behaviour must cause significant distress or impairment.

Where does the arousal in exhibitionistic disorder come from?

Their arousal comes from observing the victim’s surprise, fear, or disgust, or from a fantasy that his
victim is becoming sexually aroused.

What is frotterustic disorder?

When a person gains sexual gratification from rubbing against and fondling parts of the body of a
nonconsenting person. In order to get diagnosed: Acted on these urgers or the urges must cause
significant distress or impairment.
What is pedophilic disorder?
These people have sexual fantasies, urges, and behaviours focused on children. Mostly men attracted
to girls.

How do behavioural theories explain paraphilias?

They’re due to an initial classical pairing of intense early arousal with a stimulus. This may be
followed by intensive operant conditioning in which the stimulus is present during masturbabtion. So
association between stimulus and sexual arousal due to conditioning.

What are ‘risk factors’ so to say, for paraphilias?

- Children who grew up in aggressive circumstances are more ikely to engage in impulsive,
sexualized acts towards others.
- Childhood sexual abusa is a strong predictor of pedophilia.

What do cognitive theorists state about people with paraphelia?

That they have distortions and assumptions about their own behaviour and the behaviour of their
victims.

What is biological prove for paraphelia?

Alterations in the development of the brain and hormonal systems may contribute to paraphilia

what are biological interventions for parahelia and what are they targeted at?
Eg. Surgical castration or chemical castration through drugs, are aimed at reducing the sex drive in
order to reduce parahilic behaviour.
The aim is to reduce the production of androgens and testosterone.

What is aversion therapy used for?

It’s used to extinguish sexual responses to objects or situations a person with paraphilia finds
arousing.  By exposed to painful electric shocks/ loud noise while viewing photographs or touching
the arousal.

What are desensitization procedures in paraphilia used for?

To reduce the person’s anxiety about engaging in normal sexual encounters with other adults.

What is gender dysphoria?

A new DSM-5 diagnostic category that replaces gender identity disorder. It is diagnosed when there
is a discrepancy between individuals’ gender identity and their biological sex.
 The diagnosis requires significant distress or impairment associated with it.

What does the term transgender refer to?

Refers to the broad spectrum of individuals who transiently or persistently identify with a gender
different from their natal sex.
 may or may not be diagnosed with dysphoria, depending on if it causes them distress or not.

what is the cause of gender dysphoria?

Most theories suggest: exposure to unusal levels of hormones which influence later gender identity
and sexual orientation by influencing the development of brain structures involved in sexuality.
 In female to male: Prenatal exposure to high androgen levels
 Patterns in certain brain area’s that are more like those in people of the other sex.
It’s quite weak!!!
3 principal treatments for gender dysphoria?
1. Cross-sex hormone therapy
2. Full-time real-life experience in the desired gender role
3. Sex reassignment surgery.

Why might cross-sex hromone therapies and surgeries not be it for some people?
For most children and adolescents not, because of their long term consequences and childrens
inability to give full consent.

Lecture 5: Substance related disorders

What are substance use disorders?

Disorders that involve chronic difficulties in resisting the desire to drink alcohol or take drugs.

What are gambling disorders?

The inability to resist the impulse to gamble.

What is a substance?
Any natural or synthesized product that has psychoactive effects – it changes perceptions, thoughts,
emotions, and behaviours.

What 4 conditions are used to define substance use disorders?

1. Intoxication
2. Withdrawal
3. Abuse
4. Dependence.

When is the diagnosis ‘intoxication’ given?

When the behavioural and psychological changes due to a substance are significantly maladaptive.

What is substance withdrawal?

A set of physiological and behavioural symptoms that result when people who have been using
substances heavily for prolonged periods of time stop or greatly reduce their use.
 Symtoms typically opposite of intoxication

What is substance abuse according to the DSM-V?

A person’s recurrent use of a substance resulted in significant harmful consequences comprising one
of four categories within a 12-month period.
1. Individual fails to fulfill important obligations at work, school, or home.
2. The individual repeatedly uses the substance in situations that are physically hazardous (like
driving).
3. The individual repeatedly has legal problems as a result of the substance use.
4. The individual continues to use the substance despite repeated social or legal problems as a
result of use.

What is substance dependence?

Looks like addiction. Sufferers show tolerance and show severe withdrawal symptoms when they
stop using it.
What is physiological substance dependence?
(Not a dsm requirement) A person needed only to use a substance compulsively despite experiencing
significant social, occupational, psychological, or medical problems as a result.

What do the DSM-5 criteria for substance use disorder include?

1. Impaired control
2. The continued use of substances despite negative social, occupational, and health
consequences
3. Risky use
4. Evidence of tolerance and withdrawal.
Two or more of these symptoms + using the substance for 12+ months.

How is the severity of substance use disorder measured?

1. Mild (2/3 criteria)
2. Moderate (4/5 criteria)
3. Severe (6+ criteria).

What 5 substance classes are there?

1. Depressants
2. Stimulants
3. Opioids
4. Hallucinogens & Phencyclidine
5. Cannabis

What do depressants do?

They slow the central nervous system.

What 2 depressants are there?

1. Alcohol
2. Benzodiazepines and barbiturates

What 3 stages of alcohol withdrawal are there?

1. First phase: within a few hours after drinking: Tremulousness, weakness, profuse
perspiration. Anxiety, headache, nausea and cramps.
2. Second phase: Convulsive seizures after 12 hours- 2/3 days.
3. Delirium tremens: Auditory, visual and tactile hallucinations occur, little sleep, agitation and
disorientation. Fever, profuse perspiration and irregular heartbeat. They are fatal in app.
10%.

What is the infleunce of age on alcohol abuse? + 4 reasons

Strong age differences in alcohol use disorders decline with age.
1. With age, the liver metabolizes alcohol slower, and the lower body water % increases the
absorption of alcohol; older people become intoxicated faster and experience the hangovers
worse.
2. Older = maturing in choices (less excess drinking).
3. Older people have grown up under stronger prohibitions against alcohol use and abuse than
younger people.
4. People who have used alcohol excessively for many years may die from alcohol-related
diseases before they reach old age.

what are the long term effects of alcohol misuse?

 - Toxic effects on body systems: stomach, slokdarm, pancreas, liver.
- Low-grade hypertension: Increase in blood rate and cholesterol, which puts abusers at an
increased risk for heart disease.
- Increase risk of cancer
- Dementia/ paranoia.

What do benzodiazepines and barbiturates do?

Intoxication is similar to alcohol intoxication. Initally euphoria, but then experience depressed mood,
lethargy, perceptual distortions, bad coordination and other signs.
Xanax, valium. They are anxiety and insomnia medications. Benzodiazepines also anti-seizure.

What do stimulants do?

They activate the CNS, causing feelings of energy, happiness and power: decreased desire for sleep
and diminished appetite

5 types of stimulants:
1. Cocaine
2. Amphetamine
3. Nicotine
4. Caffeine
5. Prescribed stimulants: Ritalin

What are the effects of cocaine? (normal + high dosis)

Intense euphoria, heightened self esteem, alertness, energy, feelings of competence and creativity
High dose: Grandiosity, impulsivness, hypersexuality, compulsive heaviour, agitation and anxiety 
reaching to panic and paranoia.

What are the effects of cocaine on the brain?

Activates reward + pleasure brain areas.  Cocaine blocks dopamine reuptake  Dopamine
accumulates in the synapse.

What are frequent medical conditions due to cocaine?

Heart rhythm disturbances; heart attacks; respiratory failure; neurological effects like:
Strokes, seizures, headaches. And abdominal pain/ nausea.

Physical symptoms of (too much) cocaine use?

Chest pain, blurred vision, fever, muscle spasms, convulsions, coma.

What are amphetamines/ methamphetamines?

Stimulants prescribed for the treatment of attention problems, narcolepsy, and chronic fatigue.
 Illegal and legal.
 Pills, injection, snorting, smoking.

What do amphetamines do in the brain?

They release the neurotransmitters dopamine and norepinephrine and block their reuptake.

What are the symptoms of intoxication?

Euphoria, self confidence, alertness, agitation, and paranoia.

What are withdrawal symptoms from (meth)amphetamines?

Mood instability, memory loss, confusion, paranoid thinking, long lasting perceptual abnormalities.
To what medical issues can abuse lead to?
Rapid/ irregular heartbeat, increase blood pressure, stroke-producing damage to small blood vessels.
Elevated body temp and convulsions can lead to death while using.
What does nicotine do to the brain?
Operates on the central and peripheral nervous syhstem by helping release several biochemicals in
the brain: dopamine, norepinephrine, serotonin and natural opioids.

What are the physiological effects of nicotine?

Resemble the fight-or-flight response  Arousal of sev. Systems.

What are the health risks from smoking nicotine?

Lung cancer, bronchitis, coronary heart disease. High mortality rates. Pregnant women give birth to
smaller babies.

What are withdrawal symptoms from nicotine?

Depressed mood, irrtation, anger, anxiety, frustration, restlessness, hunger.
 Directly cleared by smoking: Physiological dependence.

What does caffeine do?

Stimulates the CNS by increasing the levels of dopamine, norepinephrine and serotonin. It increases
metabolism, body temperature and blood pressure.

What does caffeine do in high doses?

Restlessness, nervousness, hand tremors, upset stomachs, heart beating irregularly.

What are opioids?

Morphine, heroin, codeine and methadone.
They are from sap from a plant and suppress pain.

What are the symptoms of opioids?

- Euphoria, tingling sensation, pervasive sense of warmth
- State of drosiness, pain reduction
- Clouded mind, slurred speech.

What can severe opioid intoxication lead to?

Unconsciousness, coma, and seizures. They can suppress breathing and vascular systems to the point
of death esp when combined with depressants.

What do opioid withdrawal symptoms include?

Dysphoria, ache in back and legs, increased pain sensitivity, craving.
Nausea, vomiting, profuse sweating and goosebumps, fever.

What are hallucinogens and PCP?

They produce perceptual changes. Hallucinogens are a mixed groups of substances, incl LSD and
shrooms.

What is a symptom of LSD?

Synesthesia, the overflow from one sensory modality to another ‘’hearing colors’’.
Feeling one with the surrounding
Time doesn’t exist.
Moods can shift  can become anxious.
Feeling of detachment, sensitivity for art, music and feelings.

What is PCP?
Phencyclidine aka angel dust is a powder.
Lower doses: sense of intoxication, euphoria or affective dulling, talkativeness, lack of concern, slow
reaction time, abnormal involuntary movements.
Intermediate doses: Disorganized thinking, distortions of body image, depersonalization, feeling
unreal.
High doses: Amnesia and coma, seizures, ademhalingsproblemen, bodily thermostate problems. -
can last a couple days.

When is hallucinogen use disorder diagnosed?

When individuals repeatedly fail to fulfill major role obligations at school, work or home due to
intoxications.

What are common cannabis symptoms?

Feeling of wellbeing, relaxation and tranquility.
 Dizzy, sleepy, dreemy, everything is funny.
 anxiety, depressed or anger can be induced if this is already the case.

What are health risks for using cannabis smoke?

Chronic cough, sinusitis, bronchitis, cancer.
Lower sperm count in men, irregular ovulation in women.

What do moderate/large doses do to cannabis users?

Perceptual distortions, feelings of depersonalization, paranoia, severe anxiety  psychose.

What do withdrawal symptoms of cannabis use include?

Irritability, difficulty sleeping, loss of appetite, hot flashes, runny nose, sweating, diarrhea, hiccups.

What are inhalants?

Volatile substances that produce chemical vapors. They depress the central nervous system.
 Chemicals rapidly enter lungs, bloodstream and brain.
 Lachgas en lijm.

What are the health risks from inhalants?

Permanent damage to the CNS; degeneration and brain lesions that can lead to cognitive deficits.
Can cause hepatitis and liver/kidney diseases.

What is the effect of ecstasy?

Heightened energy, restlessnss, decrease of social inhibition, increase of affection.

What are health risks for ecstasy use?

Cardiac problems, liver failure, increase in anxiety, depression, psychotic symptoms and paranoia.
Also teeth grinding.
What is GHB and what does it do?
A CNS depressant approved for treatment of narcolepsy. Relieves anxiety, promotes relaxation.
High doses: sleep, coma or death.

What are side effects of GHB?

High blood pressure, wide mood swings, liver tumors, violent behaviour, sweating, headache, decr.
Heart rate, nausea, vomiting impaired breathing, loss of reflexes, and tremors.  and associated
with SA.

What is ketamine and what does it do?

A rapid acting anesthetic that produces hallucinations from paranoia to rapture to boredom. Can elict
an out of body or near death experience.

What is the ‘pleasure pathway’ in the brain?

Ventral tegmental area in the midbrain  nucleus accumbens in the limbic system  frontal cortex.
It contains a lot of dopaminergic neurons.

What are the effects of amphetamines/ cocaine on the brain?

They directly increase the vailability of dopamine in this pathway, producing a strong reward sense.

How do some drugs increase the availability of dopamine more indirectly?

By inhibiting the neurons in the ventral tegmental area from firing by GABA neurons. Inhibiting GABA
stops the GABA neurons from inhibiting dopamine  so that becomes more available.

What might be a brain risk factor for substance abuse?

Individuals whose reward network overpowers their control network.

How does chronic use of psychoactive substance change the reward centers?
It creates a craving for this substances. Dopamine receptors in the brain become less sensitive and as
the brain produces less dopamine, more of the drug is needed to produce the desired effects and
withdrawal symptoms occur if the individual stops taking the drug  Sad and unmotivated due to
less dopaminen production.

What are 3 provocations for cravings?

1. Cues: like locations
2. Stress: Activates reward systems creating cravings
3. Chronic drug use seems to lead to dirsupted activity in frontal regions of the brain involved in
impulse control.

What are 2 psychological factors for starting substance use behaviours?

1. Modeling of parents/ other important others.
2. Personality: Behavioural undercontrol: tendency to be impulsive, sensation-seeking, and
prone to antisocial behaviours.
 genetic

What are 3 socialcultural risk factors for starting substance abuse and why?
1. Poverty
2. Abusive relationships
3. Fighting parents, violently and frequently.
Why: The effects of substances may be reinforcing and they might think they have little to lose.

What are gender differences in substance abuse?

It’s more acceptable for men than for women, women carry less risk factors for SUD.
- For men: SUD as reason for socializing.
- For women: Intimate relationships

How does benzodiazepine as a treatment for alcohol work?

It has depressent effects simular to those of alcohol. The dosage is decreased each day. The patient
qithdraws slowly from the alcohol this way but does not become dependent on the diazepine.

What do antagonist drugs do?

They block or change the effects of the addictive drug, reducing the desire for it.

What does disulfiram do?

It’s an antagonist. It can make alcohol punishing, it makes people feel sick and dizzy/ vomit, blush
and faint if they consume a drink.
 but they do become dependant.

What is the technique of disulfiram called?

Aversive conditioning. Learning through operant conditioning to reduce alcohol consumption.

What two general approaches are used in the pharmalogical treatment of nicotine?
1. Nicotine replacement therapy (patch, gum) which prevents withdrawal effects
2. Prescription medication: Reduces the craving for nicotine and decreases pleasurable effects.

What is a methadone?
An opioid that has less effects than heroin when taken orally. Used to reduce extreme negative
withdrawal symptoms from heroin dependence and blocks heroin’s intense psychological effects by
blocking the receptors for heroin.

What are the 5 main goals of behavioural and cognitive treatments for substance abuse?
1. Motivating the individual to stop using the addictive drug
2. Teach patients new coping skills to replace the use of substances to cope with stress and
negative feelings.
3. Change the reinforcements for using substances (Like social circles eg).
4. Enhance the individuals support from non-using friends and family members.
5. Bevorderen van therapietrouwheid in combinatie met psychotherapie

What are behavioural drug treatments based on?

Aversive classical conditioning are sometimes used alone or in combination with biological or other
psychosocial therapies.

What does covert sensitization therapy do?

It uses imagery to create associations between thoughts of alcohol use and thoughts of highly
unpleasent consequences.

What are cognitive treatments based on?

Interventions based on the cognitive models of alcohol abuse and dependency. They help clients
identify situations in which they are most likely to drink and lose control over their drinking, as well
as their expectations that alcohol will help them cope in those situations.

what do therapists in cognitive treatments do?

- They challenge the client in changing their expectations about alcohol and their behaviour
- They help clients learn to handle stressful situations in adaptive ways and help clients learn
to say no when they are offered a drink, accompanied by learning how to deal with social
preasure.

What is motivational interviewing?

It’s developed to elicit and solidify clients’ motivation and commitment to changing their substance
use.
 Interviewer has empathic interaction style, looking for desire, ability, reasons, need, and,
ultimately, commitment to change.

What is the abstinence violation effect? 2 components.

1. It consists of a sense of conflict and guilt when an abstinent alcohol abuser or dependent
violates abstinence and has a drink, which leads to continue to drink.
‘’I already failed so might just fully fail’’.
2. A tendency to attribute a violation of abstinence of willpower and self-control rather than to
situational factors. ‘’I’m addicted, can’t do anything about it’’

What do relapse prevention programs focus on?

They focus on teaching alcohol abusers to view slips as temporary and situationally caused.
Combined with training in mindfulness and nonjudgemental acceptance of one’s state, this reduces
craving and relapse.

What is the philosphy of Alcoholic anonymous?

An organization created by, and for people, with alcohol-related problems. The only way to control
alcohol intake is to abstain completely, by admitting the dependence and. Encourages their members
to seek help from a higher power, admit weaknesses, aks forgiveness.

Lecture 6: Schizofrenia

What is psychosis?
Being unable to tell the difference between what is real and what is unreal.

What is schizophrenia spectrum?

Has psychosis as its core symptom. There are 5 domains of symptoms that define psychotic
disorders, differatiting between number, severity and duration.

What are the 4 positive symptoms of schizophrenia?

1. Delusions
2. Hallucinations
3. Disorganized thought/ speech
4. Disorganized or abnormal motor behaviour (catatonia).

What are the negative symptoms of schizoprenia?

Restricted emotional expression/ affect
Cognitive deficits (not a diagnostic criteria).

What are delusions?

Ideas that an individual believes are true but that is highly unlikely/ impossible.
The DSM-V: ‘’Erroneous bliefs that are not amenable to change in light of conflicting evidence’’
Onjuiste overtuigingen die niet vatbaar zijn voor verandering in het licht van tegenstrijdig bewijs

What are delusional people often characterized by?

- Highly resistant to arguments or compelling facts that contradict their delusions
- Look for evidence to support their beliefs
- View others who are against their beliefs as conspiracys.
9 types of delusion.
1. Persecutory delusions
2. Deulsion of reference
3. Grandiose delusions
4. Delusions of thought insertion
5. Thought broadcasting
6. Thought insertion
7. Thought withdrawal
8. Delusions of guilt or sin
9. Somatic delusions.

What are persecutory delusions?

Believing they’re being watched or tormented by people they know or by persons in authority like
the FBI.

What is the delusion of reference?

People believe that random events or comments by others are directed at them. (eg newsman/
people in bus are talking about them).

What are grandiose delusions?

Beliefs that one is a special being or possesses special powers.

What are delusions of thought insertion? + 2 types

Beliefs that one’s thoughts, feelings or behaviour are bing controlled by outside forces.
Thought insertion: Are inserted by another person or object
Withdrawal: They are bing removed from one’s mind by an external force.

What is thought broadcasting?

The belief that one’s thoughts are being broadcast for others to hear.

What are delusions of guilt or sin?

Beliefs that one is responsible for a terrible event.

What are somatic delusions?

False belief that a part of one’s body has been diseased/ altered.

What are hallucinations?

Unreal perceptual experiences.

4 types of hallucinations?
1. Auditory
2. Visual
3. Tactile
4. Somatic

What are auditory hallucinations? + 3 ways

Most common hallucinations. Can come from inside the persons head or from somewhere otusdie,
often negatively and critizicing.
1. Avoice speaking the individuals thoughts aloud or running a commentary on the persons
behaviour.
2. A collection of voices speaking about the individual in the third person.
3. Voices issuing commands and instructions.
What are tactile hallucinations?
The perception that something is happening to the outside of the person’s body, like bugs crawling
up their back.

What are somatic hallucinations?

The perception that something is happening inside the person’s body, like worms eating intestines.

What is formal thought disorder? + 4 different one.s

The disorganized thinking of people with schizophrenia.
1. Loose associations/ derailment
2. Incoherence
3. Neologisms
4. Clangs

What is derailment/ loose association?

Slipping from one topich to a seemingly unrelated topic with little coherent transition.

Incoherence:
Answering questions with unrelated/ barely related comments: Word salad.

What are neologisms?

Making up words that mean something only to him or her.

What are clangs?

A person making associations between words based on the sound of the words rather than on the
content.

What is catatonia?
Disorganized behaviour that reflects unresponsiveness to the environement. Such as sudden
shouting or swearing or socially unacceptable behaviour.

What involves the negative symptoms of schizo?

1. Restricticted affect: Absence of emotional expression.
2. Avolition: An inability to initiate or persist in common, goal-directed activities.

What is anhedionia?
The loss of the ability to experience pleasure, seen in schizophrenia.

What is the connection between cognitive deficits and schizo?

Deficit in attention, maemory and processing speed. This makes it difficult for them to pay attention
to relevant information/ suppress irrelevant info.
Cognitive deficits are shown before they develop acute symptoms of the disorder a lot of the times.
It’s an early marker of risk for schizoprhenia.

What are the DSM-V criteria for a schizophrenia diagnosis?

1. 2+ symptoms of psychosis, with atl. 1 being delusions, hallucinations or disorganized speech.
2. Presence of these symptoms atl. 1 month: acute phase
3. Some disorder symptoms atl. 6 months that impairs functioning.

What are prodromal symptoms versus residual symptoms?

Prodromal: before the acute phase
Residual: after the acute phase.
They’re often negative symptoms, like withdrawal and uninterest.
How is untreated schizophrenia both chronic and episodic?
After the first onset of an acute episode, individuals may have chronic residual symptoms punctuated
by relapses into acute episodes.

What has a worse prognosis, positive or negative symptoms?

Negative symptoms, they have lower levels of educational attainmant and less succes holding jobs,
poorer performance on cognitive tasks. They’re also less responsive to medication.

How does the course of schizophrenia go?

Most onsets are marked by a prodromal stage with mild positive and negative symptoms,
generalized functional decline. Remission is there when symptoms no longer interfere with daily
functioning. Psychosis tends to diminish over the course, possibly related to a decline in dopamine
activity.

What is the connection between gender and schizo?

Women have a better prognosis, and a better social adjustment. They also show milder negative
symptoms. This might be because mailes with schizo show greater abnormalieities in brain structure.
And due to hormones or other sex differences in the brain.

What is schizoaffective disorder?

A mix of schizophrenia and a mood disorder. Pscyhotic symptoms + prominent mood symptoms from
depressive/ manic disorder.

What does the diagnosis of schizophreniform disorder require?

Most of the criteria of schizophrenia are met, but the symptoms only for 1-6 months.

What is a brief psychotic disorder?

A sudden onset of delusions, hallucinations, disorganized speech, and/or disorganized behaviour –
only for 1 day – 1 month. The symptoms completely disappear after this.

What is a delusional disorder?

Delusions lasting atleast 2 month regarding situations that occur in real life, but not any other
psychotic symptoms.

What is a schizotypal personality disorder?

These people have a lifelong pattern of significant oddities in their self-concept, their ways of relating
to others, and their thinking and behaviour. They have no strong and independent sense of self and
may have trouble setting realistic or clear goals.
 Percieve others as hostile
 Believe that random events are related to them.

4 different biological theories of schizophrenia?

1. Evidence indicates genetic transmission, but this doesn’t fully explain who develops it.
2. Some people with schizophrenia show structural and functional abnormalities in specific
brain areas
3. Many schizophrenics have a history of birth complications or prenatal exposure to viruses,
which may affect brain development.
4. Neurotransmitter theories hold that excess level of dopamine contribute to schizophrenia,
but serotonin, GABA and glutamate may play a part as well.
What are found brain abnormalities in schizophrenia?
1. A gross reduction in gray matter in the cortex of people with schizophrenia.
2. Abnormal activity in prefrontal cortex.
3. Hipppocampus abnormal activity, and abnormal volume and shape.
4. Reduction and abnormality in white matter before overt symptoms
5. Elargement of ventricles  atrophy or deterioration in other brain tissue, long before the
core symptoms of schizophrenia.

What are the 3 causes for neuranatomical abnormalities in schizophrenia?

1. Birth complications
2. Prenatal viral infections
3. The gut microbiome: Bacteria, fungi and virusus in the gastrotestinal system.

what does the diathesis-stress model suggest about neurotransmitting in schizophrenia?

That the HPA-axis (hypofyse, bijnier, hypothalamus) may trigger a series of events resulting in neural
cicruit dysfunction, and alternations in dopamine production  Schizophrenia is caused by excess
levels of dopamine in the brain.

What are 3 facts that confirm the original dopamine theory?

1. Phenothiazines or neuroleptics reduce symptoms of schizophrenia, block the reuptake of
dopamine in the brain, reducing the functional level in the brain.
2. Drugs that increase the functional level of dopamine in the brain, such as amphetamines,
tend to increase the incidence of the positive symptoms of schizophrenia.
3. Neurimaging studies suggest the presence of more receptors for dopamine and higher levels
of dopamine in some brain ares in schizophrenics.

What fact goes against the original dopamine theory?

Not all schizophrenic persons have more dopamine receptors/ more dopamine.

What does the revised dopamine theory state?

Different types of dopamine receptors and different levels of dopamine in various areas of the brain
can account for the symptoms of schizophrenia. Other neurotransmitters may also play an important
role like serotonin, since it regulates dopamine in the meso system.
 Theres excess dopamine activity in the mesolimbic pathway (reward), that leads to delusions and
hallucinations.
 Theres low dopamine activity in prefrontal area, what may lead to negative symptoms of
schizophrenia

What does the social drift theory state?

Because schizophrenia symptoms interfere with a persons ability to complete an education and hold
a job, people with schizophrenia tend to drift downward in social class compared to the class of their
family of origin.

What is ‘’expressed emotion’’ in family setting?

Families high in expressed emotion: Low warmth, high critiscm. People in these families are more
prone for relapses and more likely to develop the full syndrome than low expressed emotion
families.

What are typical antipsychotig drugs (2 types) called and what do they do?
Neuroleptics.
Phenotiazines, like chorlpromazine. They calm agitation and reduce hallucination and delusion. They
block dopamine receptors. Positive symptoms are reduced, yet negative symptoms are worsened.
Thioxanthenes, butyrophenones: Halfened hospitalization due to schizophrenia.

What is a serious side effect of typical antipsychotic drugs?

Tardive dyskinesia: Involuntary movements of the tongue, face, mouth or jaw.

What can psychological treatments do that medication can’t?

Help with negative symptoms. These interventions can help individucals incerase their social skills
and social life.

What are cognitive treatments for schizophrenia based on?

They include helping people with schizophrenia recognize and change demoralizing attitudes they
may have toward their illness.

What are behavioural treatments for schizophrenia based on?

Based on the social learning theory, they include the use of operant conditioning and modelling to
teach them like conversational skills, asking for help or information and starting acitivities like
cooking, cleaning.

What are social interventions including?

Increasing contact between people with schizophrenia and tothers, through support group.

What are the two aims of family therapy in schizophrenia?

1. Increase the tolerance of the family for the uncontrollable symtoms of the disorder and
allowing them to monitor their family member’s use of medication and side effects.
2. Specific behavioural tecniques are used to encourage appropriate behaviour.
Family therapy is very culturally sensitive.

What are assertive community treatment programs?

They provide services for schozphrenics, relying on expertise of medical professionals, social workers
and psychologistst for patients needs 24/7. Help them reintegrate into society, maintain their
medications, gain needed skills and function as best as they can.
Lecture 7: Personality disorders

What is the five-factor model of personality?

A dimensional perspective that posits that everyone’s personality is organied within 5 personality
traits:
1. Openness
2. Conscientiousness
3. Extraversion
4. Agreeableness
5. Neurotisism.

Of what 2 models does the DSM-V consist of?

1. A categorical model that defines 10 different personality disorders in terms of criteria,
intended for clinical use.
2. A trait-specific, dimensonal model is included for further study, it’s a continuum model.

Wat is een persoonlijkheidsstoornis en wat zijn de algemene criteria?

Een onaangepast patroon van cognitie, emotie en gedrag.
 1. Het persoonlijkheidspatroon moet duidelijk afwijken van verwachtingen van diens cultuur,
zoals blijkt uit denkwijze over zichzelf, anderen of gebeurtenissen, emotionele ervaring en
expressie, interpersoonlijk functioneren en/ of impulscontrole.
2. Het moet in elke situatie zijn, stabiel zijn in de tijd, beginnen in de adolescentie of vroege
volwassenheid en leiden tot lijden of functionele beperkingen.

What is a cluster-A personality disorder?

Odd-eccentric personality disorder. Their behaviour is similar to schizophrenic behaviour, but cluster-
A people have a better grasp on reality.

What is a paranoid personality disorder?

A pattern of pervasive distrust and suspiciousness of others, seeing their motives as bad.
- They believe that other people are chronically trying to decieve or exploit them, concerned
about being victimized or mistreated by others.
- Very sensitive and angrily reactive to critisicm, holding grudges.
- They tend to misinterpret situations in line with their suspicions, yet they are somewhat
plausible in contrast to psychosis. Yet these people are also resistant to rational arguments
against their view.

For what clinical disorders are paranoids increased in risk?

Major depression, anxiety disorders, substance abuse, psychotic episodes and impaired vocational
functioning.

What is the biological theory, cognitive theory and social theory behind paranoia?
Biological: Paranoia is more common in families with schizophrenia than in healthy families.
Cognitive: It’s a result of an underlying belief that other people are malevolent and deceptive,
combined with a lack of self-confidence about being able to defend themselves.
Social: Differential exposure to discrimination, prejudice, childhood trauma, SES.

How does treatment in paranoid personality disorder look like?

 The aim is to gain a trustful relationship between therapist in client, so the client can learn to trust
others a bit more and can improve interpersonal relationship. This is done by being calm, respectful,
and being straightforward.

What is cognitive therapy for people with paranoid personality disorder based on?
On focusing on increasing their sense of self-efficacy in dealing with difficult situations, thuys
decreasing their fear and hostility toward others.

What is a schizoid personality disorder?

Een doordringend patroon van onthechting van sociale relaties en een beperkt scala aan emotionele
expressie in hun interacties met anderen. Zijn vaak onverschillig over hechte relaties, net zoals voor
kritiek, en beleven weinig plezier aan activiteiten.
 In few situations in which they may temporarily feel comforbale talking about themselves, they
may acknowledge having painful feelings, particularly related to social interactions.

What’s the theory behind schizoid personality disorder?

There’s a slight increased rate of SPD in the relatives of schizophrenics, and personality traits such as
low sociability and low warmth may be partially inherited  But its only indirect.

How is SPD treated?

If they even go to therapy, psychosocial treatment focu son increasing the person’s awareness for
their own feelings, and increasing their social skills.
what is a schizotypal personality disorder?
Symptoms similar to schizophrenia, but milder. The characteristics are cognitive and perceptual
distortions, and odd and eccentric behaviours. They have odd behaviours and have small range of
emotions.

In what 4 categories do the characteristics of schizotypical personality disorder fall?

1. Paranoia/ suspiciousness (cause for social anxiety).
2. Ideas of reference: Believing that random events have a particular meaning just for them.
3. Odd beliefs, magical thinking and preoccupation with bizarre fantasies.
4. Illusions (not hallucinations).

What did a US study find out about culture and schizotypal personality disorder?
They found ot that african americans are diagnosed with schizotypal personality disorder more
frequently probably because they are more likely to be exposed to conditions that enhance a
vulnerability, like urban living and low SES.

What is the biological theory of schizotypal?

Most likely genetically through a gene that regulates NMDA-receptors. Also dysregulation of
dopamine. This is just like in schizophrenia, only milder. They also have the same cognitive deficits as
schizophrenics, like verbal fluency, inhibiiting information, and memory.

What does treatment of schizotypal look like?

The same drugs as schizophrenia, but sometimes also antidepressants.

What is the aim in psychotherapy for schizotypal?

To increase social contacts and learn socially appropriate behaviour through social skills training.

What is the crucial component of cognitive therapy?

Teaching the schizotypals to look for objective evidence in the environment to support their thoughts
and to disregard bizarre thoughts.

what are cluster B personality disorders?

Dramatic-emotional personality disorders. They engage in behaviours that are dramatic and
impulsive, showing little regard for their own safety or the safetiy of others. May engage in suicidal
behaviour or self-damaging acts. A core feature is a lack of concern for others.

What is borderline personality disorder?

1. Out-of control emotions that cannot be smoothed
2. Hypersensitivity to abandonment
3. Tendency to cling too tightly to other people
4. History of selfharm.
5. Self-concept is unstable; periods of grandiose self-importance, feeling need for others to
support their self esteem.
6. Prone to transient dissociative states, feeling unreal, losing track of time and forgetting who
they are.
7. Unstable interpersonal relationships, going from idealizing to despising others.
8. Unstable mood, severe depression, anxiety and anger.
9. Strong tendency to engage in impulsive, self-damaging behaviours.

When is the greatest risk of suicide in BPD?

In the 1st/ 2st year after diagnosis, because people often are not diagnosed until a crisis brings them
to the attention of the mental health system.

What is the cognitive theory behind BPD?

People with BPD are hyperattentive to negative emotional stimuli in the environment, their
memories are more negative/ they make negatively biased interpretation of situations. Struggle to
emphatize/ are more negative towards others. They rely on others to help them cope with difficult
situations but do not have enough self-confidence to ask for this help in mature and effective ways so
they become manipulative and indirect.

What do psychoanalytic theorists suggest about people with BPD?

Thay they never learned to fully differentiate their view of themselves from their view of others,
making them extremely reactive to others opionions of them and to the possibility of abandonment.

What is splitting?
BPD persons tend to see themselves and others as either all good or all bad and to vacillate (aarzel,
weifel) between these two views. This is the cause of their unstable emotions, reflecting their
weifilingen between the all-good and the all-bad self and the all-good and the all-bad other.

What is brain difference seen in BPD?

A smaller volume in amygdala and hippocampus, greater activation of the amygdala. Prefrontal
cortex is also abnormal. The disorder runs in families.

How is BPD treated?

By dialectical behaviour therapy: focuses on helping clients gain a more realistic and positive sense of
self. Reduces depression, anxiety and self-mutilating behaviour while increasing interpersonal
functioning.

What is STEPPS?
Systems training for emotional predictability and problem solving, a group intervention for people
with BPD, combining cognitive techniques challenging irrational cognitions and behavioural
techniques addressing self-management and problem solving.
 Showed greater improvement in negative affect, impulsivity, and functioning than clients receiving
the usual therapy.

What does cognitive-bheavioural therapy in BPD focus on?

On challenging pateients maladaptive beliefs and teaching them more adaptive ways to function in
daily life
 Results in less hospitalizations/ suicide attempts, awa greater improvement in mood.

What are two psychodynamic oriented therapies?

1. Transference-focused: Uses the relationship between patient and therapist to help patients
develop a more realistic and healthier understanding of themselves and their interpersonal
relationships.
2. Mentalization-based: Providing patients with validation and suppport, because people with
bpd have a difficulty understanding the mental states of themselves and others because of
truamatic experiences in childhood.

What is a histrionic personality disorder?

Shares features with BPD, like shifting emotions and intense, unstable relationships. They want
attention and flattering nurturance, and ma be overly trusting of and influenced by ohters esp
authority figures. They tend to bhe dramatic and seductive. Tend to exaggerate medical problems
and have an increased rate of suicidal threats. Often seek treatment for depression or anxiety.
 Cause is unknown
What are 2 types of treatment for histrionic?
Psychodynamic: focus on uncovering repressed emotions and needs and helping people with the
disorder express these emotions and needs in more socially appropriate ways.
Cognitive: Focus on identifying clients’ assumptions that they cannot function on their own and
helping them formulate goals and plans for their life that do not rely on the approval of others.

What are the characteristics of narcissistic personality disorder?

Acting dramaticlly, seek admiration from others and are shallow in their emotional expressions/
relationships. They rely on their inflated self-evaluations and see dependency on others as weak and
threatening. See themselves as superior. Are arrogant, exploit others. They don’t experience fear of
abandonment.

what do psychodynamic oriented theoriest theorize abt narcisissm?

The symptoms are maladaptive strategies for managing emotions and self-views. Think that they did
not develop a realistically posiitive view of themselves or adaptive strategies for handling stress and
distress as children, so they rely on the praise and domination of others for their self-esteem.

What about cognitive theorists?

They argue that some people with narcissistic personality disorder develop unrealistically positive
assumptions about their self because of toegeeflijkheid en overawardering van SO’s during
childhood, or as a defense against rejection or unmet basic emotional needs.

What are the 2 types of narcisissm?

1. Grandiose narcisissm: Coping difficulties in self esteem by viewing oneself as superior and
unique and by engaging in grandiose fanatasies.
2. Vulnerable narcisissm: Coping difficulties in self esteem by engaging in grandiose fantasies to
quell shame.

How is narcisisstic personality disorder treated?

They tend not to seek treatment, except when they develop depression or other problems.

What are cluster C personality disorders?

Anxious-fearful personality disorders. Characterized by a chronic sense of anxiety or fearfulness and
behaviours intended to ward off feared situations.

What is an avoidant personality disorder?

Characterized by low self-esteem, being prone to shame, and being extremely anxious about being
criticized by others and thus avoid interactions in which there is any possibility of being crititcized.

What are the 2 pathological personality traits that characterize avoidant pd?
1. Negative affectivity
2. Detachment.

What are the theories behind avoidant pd?

1. Genetics: same genes are likely also involved in SAD.
2. They report higher rates of emotional neglect.
 3. Cognitive: People develop early in life dysfunctional beliefs about being worthless, as a result
of rejection by important others.

How is avoidant PD treated?

Cognitive and behavioural therapies include graduated exposure to social settings, social skills
training, and challenges to neagtive automatic thoughts about themselves and social situations.

What is dependent personality disorder?

Anxiety about interpersonal interaction, due to the deep need to be cared for by others, rather than
being concerned about criticism. Clinging to others, heavily relying on others for advice and
reassurance. Don’t initiate new activities except in an effort to please others. They fear the loss of
relationship support.

What is the biological theory behind dependent pd?

It runs in families, children and adolesscents with a history of seperation anxiety or chronic physical
illness appear to be more prone to developing a dependent personality disorder.

What is the cognitive theory behind dependent pd?

People with dependent pd have exaggerated and inflexible beliefs related to their depending needs,
which drives their dependent behaviours. There might also be an influence of overprotective and
autoritarian parenting.

What does treatment of dependant PD look like?

 They frequently seek treatment and show great insight and self-awareness  good relationship
with therapist.
Psychodynamic: focus on helping clients gain insight into dependant behaviour.
Nondirective/ humanistic: Fostering autonomy and self confidence in persons with the disorder.
Cognitive behavioural: Includes behavioural techniques designed to increase assertive behaviours
and decrease anxiety, as well as cognitive techniques designed to challenge clients’ assumptions
about the need to rely on others.

What is obsessive-compulsive personality disorder?

Basing self-esteem on productivity and on meeting unreasonably high goals. Compulsive:
Preoccupied with rules, details, and order; and perfectionistic.

What are the differences between OCD patients and OCD personality disorder?
- The pd involves a more general way of interacting with the world than OCD, which involves
only specififc obsessional thoughts and compulsive behaviours.
- Individuals view their concerns as part of their personality, OCD patients experience it as
unwanted.
- They tend to be workaholics who see little need for leisure activities or friendship.

What are the cognitive/ biological theories behind OCPD?

Cognitive theories suggest that people with this disorder believe that flaws and mistakes are
intolerable.
Biological: It appears to be related to genetic factors similar to those found in OCD. Abonroamlities in
the prefrontal cortex has been found. There’s al so spontaneous neural activity in multiple brain
regions which may account for cognitive inflexibility, excessive self-control, and lower levels of
empathy.

How is OCPD treated?

Supportive therapy: Assists people in overcoming the crises that bring them in for treatment.
Behavioural therapy: Decrease compulsive behaviour, aiming to replace maladaptive thoughts and
rigid expectations with more flexible beliefs and attitudes.

Why is there an alternative model for personality disorders, the continuum?

1. The 10 separate personality disorders have overlap, which makes it hard to distinguish them.
2. Symptoms vary over time in their severity and occurrence, causing people to go into and out
of the diagnosis.
3. People often seem as if they have a personality disorder, when they are actually suffering
from an acute disorder.
4. The DSM-V Criteria did not fit many people who seemingly had pathological personalities
5. The criterea didn’t reflect the extensive literature on fundamental personality traits that are
consistent across cultures.

What does the alternative DSM-V model characterize?

Personality disorders in terms of impairments in personality functioning and pathological personality
traits on a scale and with a model of five pathological traits.

What are the 4 pathological traits in the alternative DSM-V model?

1. Negative affectivity (is someone even-tempered/ ability to handle stress)
2. Detachment (outgoing and trusting)
3. Antagonism (honesty and concern)
4. Disinhibition (responsibility, organized, cautios)
5. Psychoticism (Personality traits that are relatively rare in general, but are important aspects
of certain types of dysfunction).

What are the criteria to diagnose an individual with a PD in the alternative DSM model?
- Show significant difficulties in identity and interpersonal functioning
- Significant pathological personality traits, which are unusual for the developmental state/
envoronment, not caused by a substance.

What 6 personality disorders are included in the alternative DSM model?

Antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal.

When is the diagnosis personality disorder-trait specified given?

When an individual doesn’t meet the criteria for any of the disoders but still has significant difficulties
in hois or her sense of self and relationships together with pathological personality traits. The clincian
then has to specify which traits the person has.

Why is the alternative model a hybrid mode?

Because it combines a dimensional or continuum approach with the categorical apporach.

Lecture 9- mood disorders

What 2 types of mood disorder are there?

Bipolar disorder: ‘manic depression’, characterized by mania and depression.
Depressive disorder: just depression.

What are the symptoms of depression?

1. Anhedonia: A loss of interest in everything in life.
2. Changes in appetite, sleep, and acitivity levels.
 3. Psychomotor retardation/ agitation: Retardation is characterized by walking and speaking
more slowly/ quietly, and prolonged reaction times. Agitation is not being able to sit still.
4. Thoughts are filled with themes of worthlessness, guilt, hopelessness, sometimes suicide.

When is a major depressive disorder diagnosed?

The depressive symptoms lasting 2 weeks or more. They must be severe enough to interfere with the
person’s everyday functioning. .

Major depressive disorder single episode versus mdd, recurrent episode?

1. Only one depressive episode
2. 2 or more episodes seperated by at least 2 consecutive months without symptoms.

8 features of subtypes of depression

1. Anxious distress: anxiety symptoms as well as depressive symptoms
2. Mixed features: meets criteria for major depressive disorder and 3 symptoms of mania.
3. Melancholic features: Physiological symptoms are particularly prominent.
4. Psychotic: experience delusions and hallucinations
5. Catatonic: Strange behaviors (lack of movement to excited agitation) know as catatonia.
6. Atypical: odd assortment of symptoms
7. SAD: seasonal affective disorder.
8. Peripartum onset: Pregnancy

Persistent depressive disorders

 Depressed mood for most of the day, for more days than not, for atl. 2 years.
Diagnosis requires: presence of 2 or more of the following symptoms:
a. Poor appetite
b. Insomnia/ hypersomnia
c. Low energy or fatigue
d. Low self-esteem
e. Poor concentration
f. Hopelessness.
 Show a higher risk for comorbid disorders than those with major depressive disorder alone.

Premenstrual dysphoric disorder:

Severe mood disorder char. By cognitive affective and physical symptoms, occuring before
menstruation. Symptoms are a mixture of depression, anxiety and tension, and irritability and anger;
also, physical symptoms.

What are the diagnostic criteria for PMDD?

- At least 5 physical, affective, and/ or behavioural symptoms
- At least 1 symptom of unstable emotion.
- Significant distress and/ or impairment must be present in the area of work, school, social
activities or interpersonal relationships.

What is disruptive mood dysregulation disorder?

A disorder in children, char. By immature and inappropriate temper outbursts that are grossly out of
proportion to a situation in intensity and duration. At least 3 times per week for atl. 12 months in atl.
2 settings.
 Big comorbidity with odd, cd, adhd, eg.

Why is diagnosing depression in older adults more complicated?

 1. Older people may be less willing than younger adults to report the symptoms of depression
because of the society they grew up in.
2. Symptoms often occur in the context of a serious illness, which can interfere with making an
appropriate diagnosis.
3. They are more likely to have MCI, and it is difficult to distinguish between this and a
depressive disorder.

What is mania and when can it be diagnosed?

A mood that is elated, but often mixed with irritation and agitation. They have unrealistically positive
and grandiose self-esteem. They experience racing delusional thoughts and impulsive behaviours.
They may speak rapidly. This mood must be shown for atl. 1 week.

What is bipolar 1 disorder?

Must expect full manic episodes alternating with full depressive episodes, severe or relatively mild.
 Can also be mixed; experienceing both mania and depression in 1 day.

What is bipolar 2 disorder?

Experience of hypomania, same as mania but milder episode. It doesn’t interfere with daily
functioning, doesn’t involve hallucinations or delusions. It lastst at least 4 days, followed by a major
depressive episode.

What is cyclothymic disorder?

Less severe but more chronic. Person alternates between periods of hypomanic symptoms and some
depressive symptoms. The periods of depressive symptoms significantly interfere with daily
functioning. The symptoms doesn’t meet the criteria for hypomania or major depressive episodes.

Genetic factors in depression are?

- First degree relatives of people with depression are 2/3 times more likely to also have
depression.
- Early life depression has a stronger genetic base than adulthood depression.
- There are many genetic components between psychiatric and behavioral disorders.

5 biological factors in depression:

1. Genetics
2. Neurotransmission
3. Brain abnormalities in structure
4. Neuroendocrine factors
5. Gut microbiome and inflammation.

What is the neurotransmitter theory behind depression?

Esp the monamines: Norepinephrine and Serotonin are important, and to a lesser extent also
Dopamine. They are found in large concentrations in the limbic system. The release process,
especially for serotonin may be abnormal in case of depression.

What is different in brain structures in depression?

4 athe prefrontal cortex, anterior cingulate, hippocampus, and the amygdala.
1. There’s reduced metabolic activity and a reduction in the volume of gray matter in the PFC.
2. The anterior cingulate also has different levels of activity, playing an important role in body’s
response to stress, emotional expression, and social behaviour.
 3. The hippocampus has smaller volume, and is linked to memory and fear-related learning.
4. The amygdala has abnormalities in structure and functioning. It helps direct attention to
stimuli that are emotionally salient and have major significance for the individual.

What is neuroendocrine and what is the part of it in depression?

It regulates important hormones which affect basic functions like sleep, appetite, sexual drive, and
the ability to experience pleasure.

What does the behavioural theory of depression state?

Suggests that life stress leads to depression because it reduces the positive reinforcers in a person’s
life. Depression arises as reaction to stressful negative events. The person begins to withdraw, which
results in further reduction in positive reinforcements  more withdrawal etc.

What does the learned helplessness theory suggest?

It suggests that the type of stressful event most likely to lead to depression is an uncontrollable
negative event. These events can lead people to believe they are helpless to control important
outcomes in their environment. This may lead to low motivation, passivity, and indecisiveness.

What does the cognitive theory behind depression state?

That people with depression look at the world through a negative cognitive traid: They have negative
views of themselves, the world, and the future.. they have thinking errors that support this, such as
ignoring positive events and exaggerating negative events.

What does the reformulated learned helplessness theory state?

It explains how cognitive factors might influence whether a person becomes helpless and depressed
following a negative event. People who explain negative events by causes that are internal, stable
and golbal tend to blame themselves, expect negative events, and expect them in many areas of
their lives.

What is the interpersonal theory of depression?

Focus on relationships, since interpersonal issues and losses are often a trigger for depression.
Depressed people are more likely than non-depressed people to have chronic conflict in their
relationships.

What is rejection sensitivity?

A heightened need for approval and expressions of support from others, but also easily perceiving
rejection by others.

What is a cohort effect?

This exisits when people’s difference in some psychological variable depends not on their age per se,
but instead on the era in which they live. Like: War, rapid change, pandemic.

Who in gender is more prone to depression and why?

Women about twice as likely. Because when faced with distress, men are more likely to turn to
alcohol and women are more likely to ruminate about their feelings and problems. Might be due to
social norms. Women are also more interpersonally oriented and experience depressive symptoms
when there is conflict.

What 3 biological factors are there in bipolar?

Genes: Strongest predictor.
Structural brain abnormalities: Amygdala and prefrontal cortex. Also smaller hippocampal volume.
Also the striatum is activated abnormally  hypersensitivity to rewarding cues.
Neurotransmitter factors: Dysregulation in the dopamine system may lead to excessive reward-
seeking during the manic phase and a laack of this in depressed phase.

What are psychosocial contributors to BPD?

Greater sensitivity to rewards, the greater this sensitivity the more likely to relapse into (hypo)manic
symptoms. In contrast, individuals with high sensitivity to punishment relapse into depressive
disorders sooner.

What are drug treatments in depression?

1. SSRI’s: not more effective than other treatments, but they have fewer side effects and are
safer.
2. SNRI’s: influence norepinephrine and serotonin. Slight advantage over SSRI’s in preventing
relapse, but also more side effects.
3. Bupropion: Works on norepinephrine and dopamine. Helps people with psychomotor
retardation, hypersomnia, cognitive slowing, inattention, and craving.
4. Tricyclic antidepressants: First drugs to show consisstently relieve depression, but arent used
that much these days because of the side effects and fatality in overdose.
5. Monoamine oxidase inhibitors: MAO-inhibitors. Not really used anymore. MAO is an enzyme
that causes the breakdown of monoamine neurotransm. In the synapse. This drug has
dangerous side effects like liver damage or low blood pressure.

What are mood stabilizers for mood disorders?

1. Lithium: Improves the abnormal functioning of intracellular processess, used in BPD. Quite
effective in reducing suicide risk. Problem: an effective dose and a toxic dose is small, toxicity
give awful side effects. A lot of people also get resistent after a while.
2. Anticonvulsant and Atypical Antipsychotic medications: they reduce seizures and stabilize
mood in BPD. Side effects include blurred vision, fatigue eg. Especially useful in treating
psychotic manic symptoms.

How does electroconvulsive therapy work?

A brain seizure is induced by passing an electrical current through one side of the patient’s head.
Consists of 6-12 sessions, it results in decreases in metabolic activity in several regions of the brain,
relieving depressive symptoms. It can lead to memory loss and difficulty learning new information.

What is repetitive transcraniel magnetic stimulation?

In rTMS, the patient is exposed to repeated, high intensity magnetic pulses focused on particular
brain structures. The left prefrontal cortex is targeted, since this shows abnormally low metabolic
activity in some people with depression.

What is vagus nerve stimulation?

A patient who undrgo this can remain awake, and there’s fewer side effects. The vagus nerve is
stimulated; part of the ANS, which carreis info to the hypothalamus and amygdala from the body,
which are involved in depression.

What is light therapy?

People with SAD are exposed to bright light for a few hours each day during winter months, which
can reduce someones symptoms. Resets circadian rhytms, thereby normalizing hormone- and
neurotransmitterproduction. It also decreases levels of melatonin, which then increases the levels of
norepinephrine and serotnonin, reducing the symptoms of depression.

What does behavioural therapy in depression look like?

Focusing on increasing positive reinforcers and decreasing aversive experiences by helping the
depressed person change their patterns of interaction with the environment. Includes teaching the
client how to change their negative circumstances, learning new skills for managing their moods (12
weeks).

What does CBT in depression look like? + 2 goals

1. Change the negative, hopeless patterns of thinking described by the cognitive models of
depression.
2. Aims to help people with depression solve concrete problems in their lives and develop skills
for being more effective in their world.
Setting goals in 6-12 weeks, includes helping the client to discover when their negative thoughts
occur, challenge those thoughts, and recognize the deeper, basic beliefs or assumptions they hold
that fuel their depression.

Of what 4 types of problems does interpersonal therapy for depression consist?

1. Grief from loss of a lost one: helping clients face such losses, explore their feelings and invest
in new relationships.
2. Interpersonal role disputes: arise when people do not agree on their roles in a relationship.
Help the client recognize the dispute and then guide him or her in making choices about
what concessions might be made to the other person in the relationship.
3. Role transitions: tpeople sometimes become depressed over the role they left behind. Help
develop more realistic perspectives toward roles that are lost and learn to regard positive
roles more positively.
4. Deficits in interpersonal skills: The therapist reveiws with clients their past relationships, esp.
during childhood, and helps them understand those relationships and how they affect them
right now.

What is interpersonal and social rhythm therapy?

It’s an enhancement of interpersonal therapy designed specifically for BPD. Combines interpersonal
techniques together with behavioural techniques to help patients maintain regular routines and
social stability.

What is family-focused therapy?

Designed to reduce interpersonal stress in BPD, the SO’s are trained in and educated about the
disorders.  Shown to work due to lower relapse rates.

What is suicide?
Death from injury, poisoning, or suffocation where there is evidence that the injury was self-inflicted,
and that the person intended to kill themselves.

3 types of suicide?
1. Completed suicides: death.
2. Suicide attempts: may or may not end in death
3. Suicidal ideation: thoughts of suicide.

What are gender differences in suicide?

2/3 times more women than men attempt suicide, men are 4 times more likely than women to
complete suicide.
What are ethnic and cross-cultural differences in suicide?
Suicide rates are highter amongs groups of poverty, lack of education and hope, discrimination,
substance abuse, limited access to care, and the easy availability of guns.

Why are LGBTQI a group identified as a high-risk population for suicidal ideations and behavior,
and depression?
1. Mental health problems are more prevalent among gender minorities
2. Often a subject of peer violence.
3. Questioning sexual orientation or gender identitiy gives more likelihood to experience
depression and suicidality.

What is Non-suicidal Self-Injury?

Repeatedly cutting, burning, puncturing or signficantly injuring their skin with no intent to die.
There’s an increased risk for suicide attempts and it occurs at an elevated rate across mood/anxiety
disorders.

What do theories of NSSI suggest?

It functions as a way of regulating emotion and/ or influencing the social environment.

3 types of suicide according to Durkheim’s theory?

1. Egoistic suicide: committed by people who feel alienated from others, empty of social
contacts, and a lone in an unsupportive world.
2. Anomic: people who experience severe disorientation because of a sudden change
3. Altruistic suicide: Feel as if taking their life will benefit society.

Lecture 10, 11: Developmental psychopathology

What are neurodevelopmental disorders?

They include ADHD, autism spectrum disorder, intellectual disability, and learning, communication
and motor disorders. They typically arise in childhood.

What are neurocognitive disorders?

Disorders that typically arise in older age.

What is ADHD?
Attention-deficit/hyperacitivity disorder. Characterized by termendous trouble learning skills like
paying attention, impulse control, and accomplishing long-term goals in children.

What are the 3 subtypes of ADHD and when are they diagnosed?
1. Combined presentation: requires 6 or more symptoms of inattention and 6 or more
symptoms of hyperactivity-impulsivity.
2. Predominantly inattentive presentation: 6 or more symptoms of inattention, but less than 6
hyperactivity-impulsivity symptoms.
3. Predominantly hyperactive/impulsive presentation: 6 or more symptoms of hyperactivity-
impulsivity, but less than 6 symptoms of inattention.
What are risks for a person who has ADHD?
1. Developing a conduct disorder: violating social and cultural norms
2. Higher risk for depression, anxiety, substance abuse

What is seen in ADHD brains?

1. Abnormal activity of dopamine and norepinephrine is seen in prefrontal cortex, striatum, and
cerebellum.
2. The cerebral cortex is smaller in volume, and there is less connectivity between the frontal
areas of the cortex and brain ares that influence motor behaviour, memory and attention,
and emotional reactions. .
3. The brains develop slower.

What does ritalin do?

It increases levels of dopamine in brain synapses, enhancing the release and inhibiting the reuptake.
It’s a stimulant.

Out of what 2 fundamental behaviour domains does autism exist?

1. Deficits in social interactions and communications.
2. Restricted, repetitive patterns of behaviours, interests and activities

How is autism spectrum disorder seen in toddlers?

Interaction with parents: hardly making eye contact, refusing cuddling. Delay in language
development. No interest in playing with other children and not much reaction to other people’s
emotions. Being preoccupied with one toy. Routines and rituals are extremely important and change
can be highly distressing.

What is echolalia?
Simply echoing what one just heard and not generating own words. When trying to generate own
words or sentences, language is one-sided and lacks reciprocity.

What are the diagnostic criteria of autism?

Symptoms must have their onset in early childhood, but there’s wide variety in the outcome, which is
why it’s a spectrum.

Neurological abnormabilities in autism spectrum disorder

- Seizures are commonly seen in adults with ASD
- The cerebellum, cerebrum, amygdala and hippocampus are abnormal.
- Also abnormal functioning in brain areas related to perception of facial expressions, joint
attention, empathy, and thinking about social situations.

What is Intellectual Disability?

It involves signficant deficits in intellectual abilities, such as abstract thinking, reasoning, learning,
problem-solving, and planning, and also in life functioning.

In what 3 domains of daily living is intellectual disability seen?

1. Conceptual: Cognitive skills
2. Social
3. Practical (personal care)

In what 4 levels of severity is intellectual disability classified?

 1. Mild level: Limitations in ability to acquire typical academic or job-related skills, may seem
immature in social interactions and overly concrete in their communication. Able to take care
for themselves reasonably well except in complex situations.
2. Moderate: Significant delays in language development, physically clumsy, trouble dressing
and feeding themselves and typically don’t achieve beyond the second-grade level in
academic skills
3. Severe: Very limited vocabulary and may speak in 2 or 3 word sentences. May have
significant deficits in motor development and play with toys inappropriately. Cannot shop or
cook for themselves and require support for all aspects of daily living.
4. Profound: fully dependent on others for all aspects of daily living in all 3 domains, as no
conceptual skills are developed

What is the cause of intellectual disability?

PKU and Tay-Sachs diseas. In PKU amino acid builds up in the body and causes brain damage. Tay-
Sachs causes progr. Degeneration of the nervous system, leading to deterioration

Where does social programs focus on?

On the integration of the child into the mainstream where possible, on placement in group homes
that provide comprehensive care, and on institutionalization when necessary.

What is a specific learning disorder?

Having deficits in one or more academic skills; reading, written expression, and/ or mathemetics.

What are communication disorders (4 types)

They involve persistent difficulties in the acquisition and use of language and other means of
communication.
1. Language disorders: Difficulties with spoken language, written language, and other language
modalities
2. Speech sound disorder: Persistent difficulties in producing speech.
3. CHildood-onset fluency disorder: Stuttering.
4. Social communication disorder: deficits in using verbal and nonverbal communication for
social purposes, such as greeting and sharing information, in a manner that is appropriate for
the social context  can be given only if the problems aren’t better explained by autism
spectrum disorder.

What are causes of learning and communication disorders?

Genetic factors are implicated in all.
Abnormalities in brain structure: Broca’s area.
Environmental factors: lead poisoning, birth defects, sensory deprivation, low SES.

What 4 motor disorders does the DSM-V specify?

1. Tourette’s
2. Persistent motor/ vocal tic disorder
3. Stereotypic movement disorder
4. Developmental coordination disorder.

What are tourette’s and persistent motor/ vocal tic disorder?

They both have tics: sudden, rapid, recurrent, nonrythmic motor movements or vocalizations. People
with tourettes have motoric and vocal tics, but PMVDT have only one of them. Tics get more
frequent when people are under stress or bored.
What is stereotypic movement disorder?
They engage in repetitive, seemingly driven, and apparantly purposeless behavior, like handshaking,
waving, hair twirling, body rocking, head banging, and self biting.
Differ from tics: The individual may continue to engage in them for an extended period of time. Seen
in autism and OCD.
 Associated with dysfunction dopamine systems in motoric parts of brain like cerebrum ,basal
ganglia and PFC.

What is developmental coordination disorder?

Motor disorder involving fundamental deficits or significant delays in the development of basic
motor skills, which are not due to a medical condition.

What is delirium?
A side issue of a neurcognitive disorder that is characterized by disorientation, recent memory loss,
and a clouding of attention. The signs become worse at night.
 Agitation, fear, and disrupted sleep-wake cycles, delusional, hallucinations.

What is the cause of delirium?

A neurocogntive disorder, and a wide range of medical disorders inc. stroke, fever, HIV infeaction.

Chapter 6: Somatic symptom and Dissociative Disorders

What happens in somatic symptom and dissociative disorders?

People develop multiple separate personalities or completely lose their memory of significant
portions of their lives. Patients cannot confront difficult emotions and stressful experiences, so they
unconsciously convert their emotions into physical and psychological symptoms.

What happens in somatic symptom disorder?

Signifcant physical symtpoms for which theres no apparent organic cause, but the result of
psychological fators. They have health concerns that are excessive given their actual health, that
persist even when they have evidence that they are well, and that interfere with their daily
functioning.
 difficulty in diagnosing: The possibility that an individual has a real physical disorder that is difficult
to detect or diagnose.

What is illness anxiety disorder?

Distinction between this and somatic symptom disorder is that they don’t actually experience
physical symptoms, but worry that they will develop or have a serious illness, without neccesarily
severe physical symptoms.

What is a conversion disorder?

Can’t move a body part duye to psychological reasons. Often, a traumatic event is converted into a
physical symptom.
 can often be cured by hypnosis

How did freud view conversion symptoms?

As the result of the transfer from the psychich energy of repressed emotions to physical symptoms.
 1. Primary gain: anxiety wordt minder
2. Secondary gain: receiving attention from others, daardoor minder verwachtingen.

What is a factitious disorder?

Mensen doen alsof ze een ziekte hebben voor aandacht
 Imposed on another: Moeder doet alsof kind heel ziek is

What is dissociaton?
A process where components of mental experience are split off from consciousness but remain
accessible through dreams and hypnosis.

What is DID?
Dissociative identity disorder. People have more personalities, everyone is different age,
characteristics, different gender, and specific functions.  Alters. Childhood trauma is often
associated with the development of DID.

What is the persecutor personality in DID?

The bad person; self harming and suicidal, leaving the host personality to experience the pain. They
believe they can harm the other personalities without harming themselves.

what does DID treatment look like?

The goal is to integrate all the alter personalities into one coherent personality and helping the
patient rebuild the capacity for coping with distress and trusting healthy relationships.
 can be achieved by helping the identities become aware of one another, determining the function
and helping each personality confront and work through the traumas.

What are 2 types of dissociative amnesia?

1. Organic amnesia: Caused by brain injury  involves anterograde amnesia and/ or retrograde
amnesia.
2. Psychogenic amnesia: absence in brain injury, thought to have psychological causes 
retrograde amnesia.

What is dissociative fugue?

Individu reist naar een nieuwe plek en kan zich niks herinneren van zn ‘oude leven’ en begint een
‘nieuw leven’. They may not find it odd that they cannot remember anything from their past and
suddenly return to their previous identity and home with no memory of what they did during the
fungue.

What is feigned amnesia?

Fake amnesia, common in individuals with financial, sexual or legal problems.

What is depersonalization/ derealization disorder?

Frequent and distressing episodes during which they feel detached from their own mental processes
or body, as if they are outside observers of themselves.
Slides!
Different ways to look at health and illness:
1. Categorical
2. Typological
3. Dimensional.

Fear versus anxiety:

Anxiety is a broader concept than fear
Fear has a clear focus
Anxiety is more fuzzy: worry, apprehension.

Pros and cons of classifcation:

Cons:
- Typologies can hide basic dimension
- Confusion description and explanation
- Losing info due to labels
- Stigmatising door labeling.
Pros
- Standardized communication
- Organized
- Efficent
- Explicit classification.