PSYCHOPATHOLOGY IN HISTORICAL

Hospital
CONCEPT Lifespan Developmental Psychopathology
Doctor of Philosophy - study of abnormal behaviors across the lifespan.
Abnormal Behavior ● More
- a psychological dysfunction within an Research/ Causation
individual that is associated with distress/ Less Clinical PhD Etiology- origin of the disease/ disorder
impairment, and a response that is atypical or Works - Includes BioPsychoSocial Model
● Works at the
socially or culturally unacceptable
Academe and
the Hospital Treatment
> Psychological Dysfunction - Drugs and Therapy
- a breakdown in cognitive, emotional, or
Studying Psychological Disorders
behavioral functioning > THE SUPERNATURAL TRADITION
Clinical Description
> Distress / Impairment ~ Demons and Witches
- represents the unique combination of behaviors,
- when an individual is upset or stressed - powers of demons and witches influence bizarre
thoughts, and feelings that make up a specific
> Atypical response / Not culturally acceptable behavior
disorder
- a behavior that deviates from what is known as
- the word clinical refers to both the types of ETIOLOGY DISORDER TREATMENT
average or normal (nag ccause ng pagkabahala
problem or disorders that can be found in both
sa iba) Demons and Demonic Exorcism
clinical and hospitals.
Dysfunction + Distress/Impairment + Atypical Witches Possession
Behavior= Psychological Disorder
Prevalence
- “how many people in the population as a whole ~ Stress and Melancholy
Psychopathology - Nicholas Oresme: disease of melancholy
have the disorder?” (laganap sa isang community)
- the scientific study of psychological disorders (Depression) source of some bizarre behavior
Incidence rather than demons
JOB EDUCATIONAL - “how many new cases occur during a given time ETIOLOGY DISORDER TREATMENT
ATTAINMENT period?” (apektado o bilang)
Mental & Depression Rest
Counseling Psych. Emotional and Anxiety Sleep
Clinical Psych. Prognosis
- the anticipated course of disorder (depende sa Stress Happy and healthy
Psychiatric Social environment
Workers MASTERAL DEGREE sakit)
Baths
Marriage and Family Ointment
Therapist Acute Onset: disorder begin suddenly Potions
Mental Health Insidious Onset: disorder develops gradually
Counselors - Although some symptoms (despair and lethargy)
are identified with the sin of acedia or sloth.
Doctor of Developmental Psychology
Psychology - study of changes and development over time
Treatment for Possession
● Clinical
- Sufferer is largely responsible for the disorder,
Work/Less PsyD Dev. Psychopathology
Research which might well be punished for the evil deeds.
- study of changes and development of abnormal
● Works at the - Exorcism have the virtue of being painless
behaviors over time
- If exorcism failed: A) make the body inhabitable - Hippocratic-Galen Approach: HUMORAL - Grey's position was that the causes of insanity
by demons B) Torture C) Hanging people over a THEORY OF DISORDERS were always physical. Therefore, the mentally ill
pit of poisonous snakes patient should be treated as physically ill.
Humoral Theory - invented the rotary fan to ventilate his large
Mass Hysteria - Hippocrates assumed that brain functioning was hospital.
- large scale outbreaks of bizarre behavior. (pang related to our 4 bodily fluids: BLOOD, BLACK - Grey's leadership, the conditions in hospitals
lahatan ang apektado) BILE, YELLOW BILE, PHLEGM greatly improved, and they became more humane,
livable institutions.
HUMOR (Body fluids) ORIGIN
Emotion Contagion
- if someone nearby becomes frightened or sad, Phlegm Brain ~ Development of Biological Tradition
chances are that you will become afraid and sad Manfred Sakel (1927)
as well (napapasa yung emotion mo sa ibang tao) Blood Heart - Used high dosage of insulin until the
patient convulsed and became temporally
Black Bile Spleen
Mob Psych comatose.
- if one person identifies a “cause” of the problem, Yellow Bile Liver - Due to convulsion patient recovered from
others will probably assume that their own mental disorder
- Too much black bile: depression (melancholy)
reactions have the same source - Insulin Shock Therapy
- Sanguine: ruddy in complexion, cheerful and
optimistic, Insomnia and Delirium
~ The Moon and Stars Benjamin Franklin
- Phlegmatic: apathetic, sluggishness, calm under
Paracelsus (1493-1541) - Mild modest electric shock to the head
pressure
- Swiss Physician and Alchemist produced a brief convulsion and memory
- Choleric: hot tempered
- rejected the notion of the possession of the devil loss (amnesia)
- movement of star and planets affects the - Could be used for treating depression
behavior of an individual ETIOLOGY DISEASE TREATMENT
Lunatic: bizarre behavior is caused by a full moon Joshua Von Meduna
Imbalances of Depression Regulation of - Induced brain seizure cures schizophrenia
> THE BIOLOGICAL TRADITION Bodily Fluids Choleric Environment
Phlegmatic Bloodletting
~ Hippocrates and Galen Electroconvulsive Therapy
Hippocrates (460-377 BC) - Bloodletting: carefully measured amount of - a treatment that involves sending an electric
- Greek, father of modern western medicine blood was removed by leeches. current through your brain. This causes a brief
- Hippocratic Corpus: psychological surge of electrical activity within your brain (also
disorders could be treated like any other Somatic Symptoms Disorder known as a seizure). The aim is to relieve severe
disease - a medical problem for which no physical symptoms of some mental health problems.
- did not limit their search for the cause of symptoms can be found.
psychopathology; believed that Opium: used as sedatives.
psychological disorders are caused by: a) John P. Grey Neuroleptics (Major Tranquilizers): cure for
Brain Pathology/Head Trauma B) Genetics - champion of the biological tradition in the United hallucination and delusional thought process
and Heredity States was the most influential American Benzodiazepines (Minor Tranquilizers): reduces
psychiatrist of the time anxiety and is the most prescribed in the world
Galen (129-198 AD)
- Roman, adapted the idea of Hippocrates > THE PSYCHOLOGICAL TRADITION
~ Brain pathology is the leading cause of
psychological disorders.
Dorothea Dix (1802-1887)
- campaigned endlessly for reform in the treatment
of insanity
- main proponent of Mental Hygiene Movement
- reformed asylums and treating the mentally ill.
~ Psychoanalytic Theory
Sigmund Freud (1856-1939)
- Breuer and Freud believed that they had
"discovered" the unconscious mind and its
apparent influence on the production of
psychological disorders
- Catharsis: release of emotional material
(pagsigaw)
- Insight: a fuller understanding of the relationship
between current emotions and earlier events
- Psychoanalytic model: most comprehensive
theory yet constructed on the development and
structure of our personalities
The Structures of the Mind
a. Id
- driven by pleasure principle, lies in unconscious
- Type of Thinking: Illogical, Emotional, Irrational
- source of our strong sexual, aggressive energies
( masama) puro yes
b. Ego
- driven by the reality principle
- Type of Thinking: logical, rational
- ensures that we act realistically (balance, mas
mataas sa id and ego)
c. Superego (puro no at ipapakita na mali ang
ginagawa mo)
- driven by moral principles, lies in preconscious
- Type of Thinking: Conscience
- counteracts the potentially dangerous aggressive
and sexual drives of the id, the basis for conflict is
readily apparent
Defense Mechanism (sigmund freud)
- common patterns of behavior, often adaptive
coping styles when they occur in moderation,
observed in response to particular situations
- in psychoanalysis, these arcs are thought to be
unconscious processes originating in the ego
( maiwasan ang anxiety)
~ Humanistic Theory
- Self-actualizing: all of us could reach our
highest potential, in all areas of functioning, if only
we had the freedom to grow
Abraham Maslow (1908-1970)
- was most systematic in describing the structure
of personality
- postulated a hierarchy of needs, beginning with
our most basic physical needs for food and sex
and ranging upward to our needs for self-
actualization, love, and self-esteem
- Maslow hypothesized that we cannot progress up
the hierarchy until we have satisfied the needs at
lower levels
Carl Rogers
- person-centered therapy; in this approach, the
therapist takes a passive role, making as few
interpretations as possible
- Humanist theorists have great faith in the ability
of human relations to foster this growth.
- Unconditional positive regard, the complete and
almost unqualified acceptance of most of the
client's feelings and actions, is critical to the
humanistic approach
- Empathy is the sympathetic understanding of the
individual's particular view of the world.
~ The Cognitive-Behavioral Model
Ivan Petrovich Pavlov (1849-1936)
- Classical Conditioning: a type of learning in
which a neutral stimulus is paired with a response
until it elicits that response
Edward Titchener ( 1867-1927)
- Introspection: subjects simply reported on their
inner thoughts and feelings after experiencing
certain stimuli, but the results of this "armchair"
psychology were inconsistent and discouraging to
many experimental psychologists
~ Behaviorism
John B. Watson (1878-1958)
- the founder of behaviorism
- "Psychology, as the behaviorist views it, is a
purely objective experimental branch of natural
science. Its theoretical goal is the prediction and
control of behavior. Introspection forms no
essential part of its methods".
The Beginnings of Behavior Therapy
Joseph Wolpe (1915-1997)
- Systematic Desensitization: individuals were
gradually introduced to the objects or situations
they feared so that their fear could decline; that is,
they could test reality and see that nothing bad
happened in the presence of the phobic object or
scene
AN INTEGRATIVE APPROACH TO
PSYCHOPATHOLOGY
One dimensional model
- explain behavior in terms of a single cause
- paradigm, school or conceptual approach
- ignore information in other areas.
Multidimensional model
- interdisciplinary, eclectic, and integrative.
- “system” of influences that cause and maintain
suffering; draw upon multiple sources
- any one component of the system inevitably
affects the other components, forming a complex
network.
Multidimensional Influences of Abnormal
Behavior
1. Behavioral Influences
- Conditioned response: similar situations—even
words—produce the same reactions
- Tendency to avoid escape and avoid situations
2. Biological Influences
- Inherited overactive sinoartic baroreflex arc
that compensates for sudden increase in blood
pressure by lowering it
- Vasovagal syncope: heart rate and blood
pressure increase, body overcompensates which
cause fainting
- Syncope means "sinking feeling" or "swoon"
caused by low blood pressure in the head.
3. Emotional and Cognitive Influences
- Fear of fainting, worrying about health
- Rapid increase in heart rate caused by emotions
may have triggered stronger and more intense
baroreflexes.
4. Social Influences
- Being supportive only when somebody is
experiencing symptoms is not always helpful
because the strong effects of social attention may
actually increase the frequency and intensity of the
reaction
5. Developmental influences
- As time passes, many things about ourselves
and our environments change in important ways,
causing us to react differently at different ages
- Developmental critical period: more or less
reactive to a given situation or influence than at
other times
Genetic Contributions to Psychopathology
Genes
- long molecules of deoxyribonucleic acid (DNA) at
various locations on chromosomes, within the cell
nucleus, 46 chromosomes, 23 pairs
- The DNA contains the complete set of genetic
instructions (genome)
> Dominant allele: strongly influence a particular
trait
> Recessive allele: must be paired with another
(recessive) allele to determine a trait
> Phenotype: outward appearance of the person.
> Genotype: a person’s genetic information.
> Autosomes: 22 pairs of chromosomes; provide
programs or directions for the development of the
body and brain
- The 23rd pair is the sex chromosome.
- The double helix of the DNA is composed of 4
nucleotides with their nucleobases – adenine,
cytosine, guanine, and thymine.
- Genetic coding: DNA sequence that defines a
gene. For a gene to be expressed, the DNA code
is first copied (or transcribed) into a strand of
ribonucleic acid (RNA).
- Genetic locus: specific location of chromosomes
that codes for a gene.
- Alleles: alternative forms of genes.
- Polygenetic: influenced by many genes, each
contributing only a tiny effect, all of which, in turn,
may be influenced by the environment.
- Genes account for less than 50% of variations in
psychopathology.
- Single nucleotide morphism: one nucleotide
replaces another.
The Interaction of Genes and the Environment
Eric Kandel
- speculated that the process of learning affects
more than behavior; genetic structure of cells may
change as a result of learning if genes that were
inactive or dormant interact with the environment
in such a way that they become active
- the brain and its functions are plastic, subject to
continual change in response to the environment,
even at the level of genetic structure
Diathesis-Stress Model
- individuals inherit tendencies to express certain
traits or behaviors, activated under conditions of
stress
- the greater the underlying vulnerability, the less
stress is needed to trigger a disorder
- Vulnerability: inherited tendency or diathesis (a
condition making someone susceptible to a
disorder) that would not become prominent until
certain environmental events occurred
- The smaller the vulnerability, the greater the life
stress required to produce the disorder;
conversely, with greater vulnerability, less life
stress is required.
5-HTT gene: a gene that produces a substance
called a chemical transporter that affects the
transmission of serotonin in the brain
- Individuals with: short allele (SS)/long allele (LL)
- SS/no maltreatment: vulnerable to depression
- SS/maltreatment: severely vulnerable to
depression
- LL/maltreatment: less vulnerable to depression
- More related to stress in the recent past than
childhood experiences.
Gene-Environment Correlation Model or
Reciprocal Gene- Environment Model
- Genetic endowment may increase the probability
that an individual will experience stressful life
events
- Outcomes are a result of interaction between
genetic vulnerabilities and experiences.
- Might have a genetically determined tendency to
create environmental risk factors that trigger gene
vulnerability.
Epigenetics
- environmental influences affect the experiences
of certain genes both for individuals and
descendants.
- Telomeres: certain structures that cap the ends
of chromosomes to protect the chromosome from
deteriorating or getting entangled with neighboring
chromosomes.
- Exposure to adverse stressors has been
associated with shortening of telomere length,
which is correlated with lifespan and aging.
- Cross-fostering: calm and supportive behavior
by the mothers could be passed down through
generations of rats independent of genetic
influences because rats born to easily stressed
mothers but reared by calm mothers grew up more
calm and supportive
- The maternal behavior had lastingly altered the
endocrine response to stress by affecting gene
expression.
- The environmental effects of early parenting
seem to override any genetic contribution to be
anxious, emotional, or reactive to stress.
- Methylation: silenced of transcription rate of
gene
- Hypomethylation: increase the transcription rate
of gene
- Evidence of genetic changes due to the
environment are mostly observed in early
parenting influences and other early experiences.
- Our genetic endowment does contribute to our
behavior, our emotions, and our cognitive
processes and constrains the influence of
environmental factors. Environmental events, in
turn, can determine whether some genes are
activated or not.
Neuroscience and Psychopathology
The Central Nervous System:
- processes all information received from our
sense organs and reacts as necessary. It sorts out
what is relevant (such as a certain taste or a new
sound) from what isn't (such as a familiar view or
ticking clock)
- The spinal cord is part of the central nervous
system, but its primary function is to facilitate the
sending of messages to and from the brain, which
is the other major component of the central
nervous system (CNS) and the most complex
organ in the body.
- Neurons: transmit information throughout the
nervous system; smallest building blocks of brain
- Dendrites: have numerous receptors that
receive messages in the form of chemical
impulses from other nerve cells, which are
converted into electrical impulses
- Axons: transmits these impulses to other
neurons. Any one nerve cell may have multiple
connections to other neurons. These connections
are called synapses.
- Action potentials: electrical/nerve impulses
- Terminal button: end of an axon
- Synaptic cleft: the space between the terminal
button of one neuron and the dendrite of another
- Neurotransmitters: biochemicals that are
released from the axon of one neuron; transmit the
impulse to the dendrite receptors of another
neuron
- Glia (or glial) cells: another type of cell that
comprises the nervous system
The Structure of the Brain
- Brain Stem: the lower and more ancient part of
the brain; found in most animals, this structure
handles most of the essential automatic functions,
such as breathing, sleeping, and moving around in
a coordinated
- Forebrain: more advanced and evolved more
recently, contains the cerebrum, the thalamus, the
hypothalamus, the pineal gland and the limbic
system, largest part of the brain that controls
cognition, perception, language & social functions
- Hindbrain: contains the medulla, the pons, and
the cerebellum; regulates many autonomic
activities (breathing, pumping action of the heart
(heartbeat), and digestion)
- Cerebellum: controls motor coordination, and
abnormalities in the cerebellum may be associated
with autism, although the connection with motor
coordination is not clear
- Midbrain: coordinates movement with sensory
input and contains parts of the reticular activating
system, which contributes to processes of arousal
and tension (whether we are awake or asleep)
- Thalamus and Hypothalamus: at the top of the
brain stem; involved broadly with regulating
behavior and emotion
- Limbic system: includes such structures as the
hippocampus (sea horse), cingulate gyrus (girdle),
septum (partition), and amygdala (almond); this
system helps regulate our emotional experiences
and expressions and, to some extent, our ability to
learn and to control our impulses; involved with the
basic drives of sex, aggression, hunger, and thirst
- Basal ganglia: also at the base of the forebrain,
including the caudate (tailed) nucleus. Because
damage to these structures is involved in changing
our posture or twitching or shaking, they are
believed to control motor activity.
- Cerebral cortex: largest part of the forebrain;
contains more than 80% of all neurons in the
central nervous system; this provides us with our
distinctly human qualities, allowing us to look to
the future and plan, to reason, and to create
- Left Hemisphere: chiefly responsible for verbal
and other cognitive processes
- Right Hemisphere: better at perceiving the
world around us and creating images
- Temporal lobe: associated with recognizing
various sights and sounds and with long-term
memory storage
- Parietal lobe: for recognizing various sensations
of touch and monitoring body positioning
- Occipital lobe: associated with integrating and
making sense of various visual inputs
- Frontal lobe: largest, most complex part of the
cerebral cortex, involved in memory, speech,
language, and personality
- Prefrontal cortex: responsible for higher
cognitive functions such as thinking and
reasoning, planning for the future, and long-term
memory
The Peripheral Nervous System
Somatic nervous system
- controls voluntary muscles; conveys sensory
information to the central nervous system
Autonomic nervous system
- controls involuntary muscles and includes the
sympathetic nervous system and parasympathetic
nervous system. The primary duties of the
autonomic nervous system are to regulate the
cardiovascular system and the endocrine
system, and to perform other functions like aiding
digestion and regulating body temperature
- Endocrine system: each endocrine gland
produces its own chemical messenger: hormone,
and releases it directly into the bloodstream
- Epinephrine (also called adrenaline): produced
by adrenal glands in response to stress, as well as
salt-regulating hormones
- Thyroid gland: produces thyroxine, which
facilitates energy metabolism and growth
- Pituitary gland: a master gland that produces a
variety of regulatory hormones; and the gonadal
glands produce sex hormones such as estrogen
and testosterone
- Psychoneuroendocrinology: interdisciplinary
field of research integrating psychology,
endocrinology, and neuroscience to study
interactions of mind, brain & hormonal function
- Sympathetic nervous system: primarily
responsible for mobilizing the body during times of
stress or danger by rapidly activating the organs
and glands under its control; expends energy
- Parasympathetic system: takes over after the
sympathetic nervous system has been active for a
while, normalizing our arousal and facilitating the
storage of energy by helping the digestive process;
conserves energy
- Hypothalamus: connects to the adjacent
pituitary gland, which is the master or coordinator
of the endocrine system. Pituitary gland in turn,
may stimulate the cortical part of the adrenal
glands on top of the kidneys.
- Hypothalamic-Pituitary-Adrenocortical axis,
or HPA axis: the cortical part of the adrenal
glands that produces the stress hormone cortisol
Neurotransmitters
~ Chemical substances:
- Agonists: increase the activity of a
neurotransmitter by mimicking its effects
- Antagonists: decrease or block neurotransmitter
- Inverse agonists: produce effects opposite to
those produced by the neurotransmitter
- Changes in neurotransmitter activity may make
people more or less likely to exhibit certain kinds of
behavior in certain situations without causing the
behavior directly.
~ Types of Neurotransmitters
a. Monoamines:
a.1. Serotonin (5-HT): influences information
processing, behavior, moods, and thoughts;
dysregulated serotonin may contribute to
depression (aggression, suicide, impulsive
overeating, and excessive sexual behavior).
- very low serotonin is linked to instability and
impulsivity; drugs that affect serotonin levels: St.
John’s wort, psychedelics, and hallucinogens
a.2. Norepinephrine (noradrenaline): involved in
alarm responses and bodily processes
- Beta-blockers: drugs that block beta-receptors
so the response to the surge of norepinephrine is
reduced, which keeps blood pressure and heart
rate down
a.3. Dopamine: implicated in depression & ADHD
- best described as a switch that turns on various
brain circuits possibly associated with certain types
of behavior
b. Amino acids:
b.1. Gamma-aminobutyric acid (GABA): inhibits
(or regulates) the transmission of information and
action potentials; reduce anxiety; the GABA
system seems to reduce levels of anger, hostility,
aggression, and perhaps even positive emotional
states such as eager anticipation and pleasure
b.2. Glutamate: excitatory transmitter that “turns
on” many different neurons, leading to action
- Precision medicine: tailoring the treatment to
the individual patient in order to optimize therapy
outcome.
- The reasons that a problem develops in the first
place (the initiating factors) are not necessarily the
same as the reasons that problem still persists (the
maintaining factors). In order to treat the problem
effectively, it is typically more important to know
and target the maintaining factors than the
initiating factors.
- Brain development neurotrophic factor
(BDNF): a protein that is involved in learning by
stimulating growth of new neurons
Brain-Gut Connection
- our emotional well-being is influenced by our gut
as some gut bacteria (microbiomes) seem to be
important for physical and mental health
- the gut microbiome mediates and coordinates the
effects of genetics on emotional health
Behavioral and Cognitive Neuroscience
- Robert Rescorla's experiment that showed
contiguity—pairing a neutral stimulus and an
unconditioned stimulus—does not result in the
same kind of conditioning. The dog in the
contiguity-only group experiences the usual
conditioning procedure: Pairing a tone and meat
causes the tone to take on properties of the meat.
For the dog in the contiguity-and-random group,
the meat appeared away from the tones, as well
as with it, making the tone less meaningful.
Learned Helplessness (Martin Seligman and
Steven Maier)
- encounter conditions over which they have no
control and people become depressed if they
“decide” or “think” they can do little about the
stress in their lives
- Learned optimism: if people faced with
considerable stress and difficulty in their lives
nevertheless display an optimistic, upbeat attitude,
they are likely to function better psychologically
and physically
Social Learning (Albert Bandura)
- Modeling: People can learn just as much by
observing what happens to someone else in a
given situation. Much of what we learn depends on
our interactions with other people around us.
- Respondent and Operant Learning
- Learn to repeat behaviors followed by desirable
consequences and decrease behaviors followed
by undesirable consequences.
- Prepared Learning
- We have become highly prepared for learning
about certain types of objects or situations over the
course of evolution because this knowledge
contributes to the survival of the species. People
learn fears and phobias selectively.
- People learn fears and phobias selectively.
- Fear may be adaptive for our ancestors; it is
easier to learn associations that would have been
helpful to our ancestors.
Cognitive Science and the Unconscious
- Blind sight or unconscious vision: some
people who are blind can still sense objects that
would be in their visual field even if they do not
experience sight
- Implicit memory: acting on the basis of
experiences that are not recalled; apparent when
someone clearly acts on the basis of things that
have happened in the past but can't remember the
events
- Stroop paradigm: participants are shown a
variety of words, each printed in a different color.
They are shown these words quickly and asked to
name the colors in which they are printed while
ignoring their meaning.
- Black box: unobservable feelings and cognitions
inferred from an individual’s self-report behaviors.
- Emotional Phenomena: any emotional
experience is associated with approach and
avoidance tendencies
- Emotions: usually short-lived, temporary states
lasting from several minutes to several hours,
occurring in response to an external event
- Mood: more persistent period of affect or
emotionality
- Affect: valence dimension (pleasant or positive
versus unpleasant or negative) of an emotion
- Circumplex Model of Emotions: suggests that
emotions are distributed in a two-dimensional
circular space, containing arousal and valence
dimensions
- Affective style: sometimes used to summarize
commonalities among emotional states
characteristic of an individual
- Cognitive Aspects of Emotion: appraisals,
attributions, and other ways of processing the
world around you that are fundamental to
emotional experience
The Principle of Equifinality
- used in developmental psychopathology to
indicate that we must consider a number of paths
to a given outcome
CLINICAL ASSESSMENT AND DIAGNOSIS
CLINICAL ASSESSMENT
- systematic evaluation and measurement of
psychological, biological, and social factors in
an individual presenting with a possible
psychological disorder
DIAGNOSIS
- process of determining whether the particular
problem afflicting the individual meets all criteria
for a psychological disorder set forth in DSM-5
Three basic concepts that help determine the
value of an assessments:
1. RELIABILITY
- measurement is consistent
> Interrater reliability: two or more raters will get
the same answers
> Test-retest reliability: assessment techniques
are stable across time
ex. If you go to a clinician on Tuesday and are told
you have an IQ of 110, you should expect a similar
result if you take the same test again on Thursday.
2. VALIDITY
- measures what it is designed to measure
> Concurrent or descriptive validity: comparing
the results of an assessment measure under
consideration with the results of others
ex. If the results from a standard, long IQ test were
essentially the same as the results from a new,
brief version, you could conclude that the brief
version had concurrent validity.
> Construct validity: the signs and symptoms
chosen as criteria for the diagnostic category are
consistently associated or "go together"
> Content validity: if you create criteria for a
diagnosis, it should reflect the way most experts in
the field think of it
> Criterion validity: when the outcome is the
criterion by which we judge the usefulness of the
diagnostic category
> Predictive validity: how well it will tell you what
will happen in the future
ex. Does it predict who will succeed in school and
who will not (which is one of the goals of an lQ
test)?
3. STANDARDIZATION
- certain set of standards or norms is determined
for a technique to make its use consistent across
different measurements
CLINICAL INTERVIEW
- core of most clinical worK; gathers information
on current and past behavior, attitudes, and
emotions, as well as a detailed history of the
individual's life in general and of the presenting
problem
MENTAL STATUS EXAM
- systematic observation of an individual's
behavior; occurs when any one person interacts
with another
a. Appearance and behavior: clinician notes any
overt physical behaviors (ex. Frank's leg twitch) as
well as the individual's dress, general appearance,
posture, and facial expressions.
- Psychomotor retardation: slow and effortful
motor behavior that may indicate severe
depression
b. Thought processes: when clinicians listen to a
patient talk, they're getting a good idea of that
person's thought processes
ex. What is the rate or flow of speech? Quickly or
slowly? What about continuity of speech?
- Loose association or Derailment: disorganized
speech pattern that some patients with
schizophrenia have
- Delusions of persecution: someone thinks
people are after him and out to get him all the time
- Delusions of grandeur: an individual thinks she
is all-powerful in some way
- Ideas of reference: everything everyone else
does somehow relates back to the individual
- Hallucinations: things a person sees or hears
when those things really aren't there
c. Mood and affect.
> Mood: predominant feeling state
> Affect: feeling state that accompanies what we
say at a given point
d. Intellectual functioning.
e. Sensorium.
- general awareness of our surroundings
SEMISTRUCTURED INTERVIEWS
- made up of questions that have been carefully
phrased and tested to elicit useful information in
a consistent manner
- clinicians may depart from set questions to
follow up on specific issue
PHYSICAL EXAMINATION
- is recommended because medical conditions is
sometimes associated with specific psychological
problem
BEHAVIORAL ASSESSMENT
- using direct observation to formally assess an
individual's thoughts, feelings, and behavior in
specific situations or contexts
ABCs of Observation:
1. Antecedent: what happened just before
the behavior
2. Behavior: immediate behavior
3. Consequences: what happened afterward
INFORMAL OBSERVATION
- it relies on the observer's recollection, as well
as interpretation, of the events
FORMAL OBSERVATION
- involves identifying specific behaviors that
are observable and measurable
SELF-MONITORING (Self-Observation)
- observing own behavior to find patterns
REACTIVITY
- any time you observe how people behave, the
mere fact of your presence may cause them to
change their behavior
PSYCHOLOGICAL TESTS
- has specific tools to determine cognitive,
emotional, or behavioral responses that might be
associated with a specific disorder and more
general tools that assess long-standing personality
features
PROJECTIVE TESTS
- include a variety of methods in which ambiguous
stimuli, such as pictures of people or things, are
presented to people who are asked to describe
what they see
> Rorschach inkblot test: includes 10 inkblot
pictures that serve as the ambiguous stimuli and
client will tell what they see
> Thematic Apperception Test: series of 31
cards (30 with pictures on them and 1 blank card);
ask the person to tell a dramatic story about the
picture
> Sentence-completion method: logical
extension of word-association methods
PERSONALITY INVENTORIES
- self-report questionnaires that assess personal
traits
> Minnesota Multiphasic Personality Inventory
(MMPI): current version has 567 items with true-
or-false questions
INTELLIGENCE TESTS
- mental ability of individual
> Intelligent quotient (IQ) score: estimate of how
much a child's performance in school will
deviate from the average performance of others
of the same age
NEUROPSYCHOLOGICAL TESTS
- measure abilities in receptive & expressive
language, attention & concentration, memory,
motor skills, perceptual abilities, and learning &
abstraction
For any assessment strategy, there will be times
when the test shows a problem when none exists
(false positive) and times when no problem is
found even though some difficulty is present (false
negative).
NEUROIMAGING
- ability to look inside the nervous system and take
increasingly accurate pictures of the structure
and function of the brain
- for brain structure:
> Computerized axial tomography scan or CT
scan: multiple X-ray (passed directly through the
head) exposures of the brain from different angles
> Magnetic resonance imaging (MRI): the
patient's head is placed in a high-strength
magnetic field through which radio frequency
signals are transmitted
- for brain functioning:
> Positron emission tomography (PET) scan:
an individual is injected with a tracer substance
attached to radioactive isotopes, or groups of
atoms that react distinctively; when parts of the
brain become active, blood, oxygen, or glucose
rushes to these areas of the brain, creating "hot
spots" picked up by detectors that identify the
location of the isotopes
> Single photon emission computed
tomography (SPECT): works like PET, but a
different tracer substance is used
> functional MRI: take pictures of the brain at
work, recording its changes from one second to
the next
PSYCHOPHYSIOLOGICAL ASSESSMENT
- measurable changes in the nervous system
that reflect emotional or psychological events
> Electroencephalogram (EEG): measure
electrical activity in the head related to the firing
of a specific group of neurons reveals brain wave
activity
BIOFEEDBACK
- levels of physiological responding, such as
blood pressure readings, are fed back to the
patient (provided on a continuous basis) by meters
or gauges so that the patient can try to regulate
these responses
IDIOGRAPHIC STRATEGY
- unique about an individual's personality,
cultural background, or circumstances
NOMOTHETIC STRATEGY
- attempting to name / classify problems
> Classification: any effort to construct groups
or categories and to assign objects or people to
these categories on the basis of their shared
attributes or relation
> Taxonomy: classification of entities for
scientific purpose
> Nosology: taxonomic system to psychological,
clinical, medical phenomena
> Nomenclature: names or labels of the
disorders that make up the nosology
CLASSICAL (OR PURE) CATEGORICAL
APPROACH
- by Emil Kraepelin; every diagnosis has a clear
underlying pathophysiological cause, such as a
bacterial infection or a malfunctioning
endocrine system, and that each disorder is
unique
DIMENSIONAL APPROACH
- we note the variety of cognitions, moods, and
behaviors with which the patient presents and
quantify them on a scale
PROTOTYPICAL APPROACH
- identifies essential characteristics of an entity
so that you can classify it, but it also allows certain
nonessential variations that do not necessarily
change the classification
DIAGNOSIS BEFORE 1980
> Dementia praecox: deterioration of the brain SOCIAL AND CULTURAL CONSIDERATIONS IN
that sometimes occurs with advancing age DSM-5
(dementia) and develops earlier than it is CULTURE
supposed to, or "prematurely" (praecox); later - refers to the values, knowledge, and practices
changed to schizophrenia that individuals derive from membership in
> Bipolar disorder was called manic depressive different ethnic groups, religious groups, or other
psychosis. social groups, as well as how membership in these
groups may affect the individual's perspective on
DIAGNOSTIC AND STATISTICAL MANUAL their psychological disorder experiences
(DSM-Ill)
- lead by Robert Spitzer CULTURAL FORMULATION
- take an a theoretical approach to diagnosis, - allow the disorder to be described from the
relying on precise descriptions of the disorders as perspective of the patient's personal
they presented to clinicians rather than on experience and in terms of their primary social
psychoanalytic or biological theories of etiology and cultural group
- specificity and detail with which the criteria for > ataques de nervios in Hispanic subculture is a
identifying a disorder were listed made it possible type of anxiety disorder close to panic disorder
to study reliability & validity
COMORBIDITY
DSM-IV and DSM-IV-TR - diagnosed with more than one psychological
- rely as little as possible on a consensus of disorder at the same time
experts; any changes were to be based on sound
scientific data LABELING
- we categorize people; has negative connotations
DSM-5 and DSM-5-TR and contributes to stigma - stereotypic negative
- general consensus is that DSM-5 (note the beliefs, prejudices, attitudes to a devalued group
switch from Roman to Arabic numbering) is
largely unchanged from DSM-IV, although some
new disorders are introduced and other disorders
have been reclassified
- manual is divided into three main sections:
first section: introduces the manual and
describes how best to use it
second section: presents the disorders
themselves
third section: descriptions of disorders or
conditions that need further research before they
can qualify as official diagnoses
- text revision was published in 2022 and includes
prolonged grief disorder
 RESEARCH METHODS - process of assigning people to different
research groups; each person has an equal
Basic Components of a Research Study chance of being placed in any group
HYPOTHESIS
- educated guess ANALOGUE MODELS
- Robert Kegan describes us as the "meaning- - create in the controlled conditions of the
making" organisms (constantly striving to make laboratory aspects that are comparable
sense of what is going on) (analogous) to phenomenon under study
ex. Bulimia researchers could ask volunteers to
DEPENDENT VARIABLE binge eat in the laboratory, questioning them
- you want to measure before they ate, while they were eating, and after
they finished to learn whether eating in this way
INDEPENDENT VARIABLE made them feel more or less anxious, guilty, and
- influences on the characteristics or behaviors, so on.
you manipulate
GENERALIZABILITY
INTERNAL VALIDITY - extent to which results apply to everyone in a
- extent to which you can be confident that the certain population
independent variable is causing the dependent
variable to change EFFECT SIZE
- statistical methods that address how large the
EXTERNAL VALIDITY differences are
- how well the results relate to things outside your
study STATISTICAL SIGNIFICANCE
- mathematical calculation about the difference
TESTABILITY between groups
- ability to support the hypothesis
CLINICAL SIGNIFICANCE
CONFOUND / CONFOUNDING VARIABLE - whether or not the difference was meaningful
- any factor occurring in a study that makes the for those affected
results uninterpretable because a variable (ex.
the type of population being studied) other than SOCIAL VALIDITY
the independent variable (treatments) may also - obtaining input from the person being treated,
affect the dependent variable (ex. scores on as well as from significant others, about the
anxiety scales) importance of the changes that have occurred
ex. We might ask the participants and family
CONTROL GROUP members if they thought the positive video clip led
- not exposed to the independent variable or to lasting changes in eating behavior (such as
treatment eating more over the week following the study). If
the effect of the treatment is large enough to
RANDOMIZATION
impress those who are directly involved, the
treatment effect is clinically significant.
PATIENT UNIFORMITY MYTH
- tendency to see all participants as one
homogeneous group
Types of Research Methods
CASE STUDY METHOD
- investigating intensively one or more individuals
who display the behavioral and physical
patterns
ex. Sigmund Freud & Josef Breuer's description of
Anna O.
CORRELATION
- statistical relationship between two variables
ex. Are people with depression more likely to have
negative attributions (negative explanations for
their own and others' behavior)?
- The correlation (or correlation coefficient) is
represented as +1.00. The plus sign means there
is a positive relationship, and the 1.00 means that
it is a "perfect" relationship.
- Correlation allows us to see whether a
relationship exists between two variables but not to
draw conclusions about whether either variable
causes the effects. This is a problem of
directionality.
> Positive correlation: great strength or quantity
in one variable (ex. a great deal of marital
distress) is associated with great strength or
quantity in the other variable (ex. more child
disruptive behavior)
> Negative correlation: when the direction of
both variables are opposite (ex. as people grow
older, they tend to have fewer sleep problem)
EPIDEMIOLOGY
- study of the incidence, distribution, and
consequences of a particular problem or set of
problems in one or more populations
> Prevalence: the number of people with a
disorder at any one time
> Incidence: the estimated number of new cases
during a specific period
EXPERIMENT
- involves manipulation of an independent
variable and the observation of its effects
CLINICAL TRIAL
- a group experimental design; used to determine
the effectiveness and safety of a treatment or
treatments:
> Randomized clinical trials: employ
randomization of participants
> Controlled clinical trials: rely on control
conditions to be used for comparison
> Randomized controlled trial: preferred
method of conducting a clinical trial, uses both
randomization and one or more control
conditions
PLACEBO EFFECT
- from the Latin, meaning "I shall please"
- behavior changes as a result of a person's
expectation of change rather than as a result of
any manipulation
> Placebo control groups: placebo is given to
members of the control group,make them believe
they are getting treatment
> Double-blind control: not only are the
participants in the study "blind" or unaware of
what treatment they are given (single blind), but so
are the researchers or therapists providing
treatment (double blind)
> Allegiance effect: if the treatment that wasn't
expected to work seemed to be failing, the
researcher might not push as hard to see it
succeed
COMPARATIVE TREATMENT RESEARCH
- the researcher gives different treatments to two
or more comparable groups of people with a
particular disorder and can then assess
how/whether each treatment helped the people
who received it
> Process research: focuses on the
mechanisms responsible for behavior change, or
"Why does it work?"
> Treatment process: involves finding out why or
how your treatment works
> Treatment outcome: involves finding out what
changes occur after treatment
SINGLE-CASE EXPERIMENTAL DESIGNS
- involves the systematic study of individuals under
variety of experimental conditions
REPEATED MEASUREMENT
- behavior is measured several times instead of
only once before you change the independent
variable and once afterward
> Level: degree of behavior change with different
interventions
> Variability: degree of change over time
> Trend: direction of change
WITHDRAWAL DESIGN
- researcher tries to determine whether the
independent variable is responsible for changes in
behavior
ex. First, a person's condition is evaluated before
treatment, to establish a baseline. Then comes the
change in the independent variable. Last,
treatment is withdrawn ("return to baseline"), and
the researcher assesses whether (ex. Wendy's
anxiety level) changes again as a function of this
last step.
> Drug holidays: periods when the medication is
withdrawn so that clinicians can determine
whether it is responsible for the treatment
effects
MULTIPLE BASELINE
- rather than stopping the intervention to see
whether it is effective, the researcher starts
treatment at different times across settings,
behaviors or people
> Functional communication training: taught
the children to communicate instead of
misbehave
Genetics and Behavior Across Time & Culture
PHENOTYPE
- observable characteristics or behavior
GENOTYPES
- unique genetic makeup of individuals
> Human genome project: using the latest
advances in molecular biology, scientists working
on this project completed a rough draft of the
mapping of the approximately 25,000 human
genes; this identified hundreds of genes that
contribute to inherited diseases
> Endophenotypes: genetic mechanisms that
ultimately contribute to the underlying problems
causing the symptoms and difficulties experienced
by people with psychological disorders
FAMILY STUDIES
- simply examine a behavioral pattern or emotional
trait in the context of the family
PROBAND
- the family member with the trait singled out for
study

ADOPTION STUDIES
- scientists identify adoptees who have a
particular behavioral pattern or psychological
disorder and attempt to locate first-degree
relatives who were raised in different family
settings
TWIN STUDIES
- whether identical twins share the same trait
more often than fraternal twins
GENETIC LINKAGE ANALYSIS
- when a family disorder is studied, other
inherited characteristics are assessed at the
same time. These other characteristics called
GENETIC MARKERS are selected because we
know their exact location.
ASSOCIATION STUDIES
- compare such people to people without the
disorder
UNIVERSAL PREVENTION STRATEGIES
- focus on entire populations and target certain
specific risk factors (ex. behavior problems in
classrooms in low-income communities) without
focusing on specific individuals
> Selective prevention: specifically targets whole
groups at risk (ex. children who have parents
who have died) and designs specific
interventions aimed at helping them avoid future
problems
> Indicated prevention: strategy for those
individuals who are beginning to show signs of
problems (ex. depressive symptoms) but do not
yet have a psychological disorder
CROSS-SECTIONAL DESIGN
- take a cross section of a population across the
different age groups and compare them on some
characteristic
COHORT EFFECT
- same age at the same time, have all been
exposed to similar experiences
> Retrospect information: looking back
LONGITUDINAL DESIGNS
- follow one group over time and assess change
in its members directly
> Cross-generational effect: involves trying to
generalize the findings to groups whose
experiences are different from those of the study
participants
> Sequential design: combine longitudinal and
cross-sectional designs which involves repeated
study of different cohorts over time
- Sakit gila: (in Malaysia) psychological disorders
are commonly believed to have supernatural
origins
INFORMED CONSENT
- research participant's formal agreement to
cooperate in a study following full disclosure of the
research's nature and participant's role
ANXIETY TRAUMA AND STRESSOR-RELATED,
AND OBSESSIVE-COMPULSIVE AND
RELATED DISORDERS
ANXIETY
- future-oriented negative mood state
characterized by bodily symptoms of physical
tension and by apprehension about the future
ANTHROPOMORPHISM
- attributing of human characteristics or
behaviors to an animal or object
FEAR
- immediate alarm reaction to danger;
characterized by strong escapist tendencies in
response to present danger or life-threatening
emergencies
- protects us by activating a massive response
from the autonomic nervous system, which,
along with our subjective sense of terror, motivates
us to escape (flee) or, possibly, to attack (fight) -
this emergency reaction is called the FLIGHT OR
FIGHT RESPONSE.
PANIC
- sudden overwhelming reaction
- from the Greek god Pan who terrified travelers
with blood curdling screams
PANIC ATTACK
- abrupt experience of intense fear or acute
discomfort, accompanied by physical symptoms
that usually include heart palpitations, chest pain,
shortness of breath, and, possibly, dizziness
EXPECTED (CUED) PANIC ATTACK
- (ex. you know that you are afraid of high places)
you might have a panic attack in such situations
but not anywhere else
UNEXPECTED (UNCUED) PANIC ATTACK
- you don't have a clue when or where the next
attack will occur
Biological Contributions
> contributions from collections of genes in
several areas on chromosomes make us
vulnerable when the right psychological and social
factors are in place
> depleted levels of gamma aminobutyric acid
(GABA) are associated with increased anxiety,
although the relationship is not quite so direct
> noradrenergic system has also been
implicated in anxiety, and evidence from basic
animal studies, as well as studies of normal
anxiety in humans, suggests the serotonergic
neurotransmitter system is also involved
> the role of the (CRF) CORTICOTROPIN-
RELEASING FACTOR SYSTEM as central to the
expression of anxiety (and depression) and the
groups of genes that increase the likelihood that
this system will be turned on
> CRF activates HYPOTHALAMIC-PITUITARY -
ADRENOCORTICAL AXIS
- area of the brain most often associated with
anxiety is the LIMBIC SYSTEM which acts as a
mediator between the brainstem and the cortex
JEFFREY GRAY
- British neuropsychologist, identified a brain
circuit in the limbic system of animals heavily
involved in anxiety: BEHAVIORAL INHIBITION
SYSTEM (BIS)
- BIS is activated by signals from the brain stem of
unexpected events; danger signals in response
to something we see that might be threatening
descend from the cortex to the septal–
hippocampal system
Psychological Contributions
- Freud: anxiety was a psychic reaction to danger
surrounding the reactivation of an infantile fearful
situation
- Behavioral theorists: anxiety was the product of
early classical conditioning, modeling, or other
forms of learning
- a general “sense of uncontrollability” may
develop early as a function of upbringing and other
disruptive or traumatic environmental factors
- parents who provide a “secure home base” but
allow their children to explore their world and
develop the necessary skills to cope with
unexpected occurrences enable their children to
develop a healthy sense of control
- Anxiety sensitivity: general tendency to
respond fearfully to anxiety symptoms
Social Contributions
TRIPLE VULNERABILITY THEORY
- theory of the development of anxiety
> Generalized biological vulnerability
- first vulnerability (or diathesis); tendency to be
uptight or high-strung might be inherited
> Generalized psychological vulnerability
- second vulnerability; believing the world is
dangerous and out of control, and you might not
be able to cope when things go wrong based on
your early experiences
> Specific psychological vulnerability
- third vulnerability; you learn from early
experience, such as being taught by your parents,
that some situations or objects are fraught with
danger
GENERALIZED ANXIETY DISORDER
- at least 6 months of excessive anxiety and
worry (apprehensive expectation) must be
ongoing more days than not
- characterized by muscle tension, mental
agitation, susceptibility, fatigue, irritability, and
difficulty sleeping
- at least 3/6 criteria were met (1 for child)
- focusing one’s attention is difficult, as the mind
quickly switches from crisis to crisis
- median age of onset is 31
- low cardiac vagal tone (the vagus nerve: largest
parasympathetic nerve innervating the heart and
decreasing its activity)
- Benzodiazepines: give short term relief
- use antidepressants: Paroxetine (Paxil) and
Venlafaxine (Effexor)
- Cognitive-behavioral treatment: patients evoke
the worry process during therapy sessions and
confront anxiety-provoking images and thoughts
head-on
- CBT and the antidepressant drug sertraline
(Zoloft) were equally effective
- patients feel a strong need to control the future
and hold maladaptive beliefs about worrying,
which has been referred to as metacognitions:
cognitions (beliefs) about cognitions (worrying)
PANIC DISORDER
- individuals experience severe, unexpected
panic attacks; they may think they are dying or
otherwise losing control
- must experience an unexpected panic attack
and develop substantial anxiety over the
possibility of having another attack or about the
implications of the attack or its consequences
- panic attacks occur more often between 1:30 AM
and 3:30 AM than any other time
> Nocturnal Panic Attack
- occur during delta wave or slow-wave sleep
(occurs several hours after we fall asleep and is
the deepest stage of sleep)
> Sleep apnea
- interruption of breathing during sleep; feel like
suffocation
> Sleep terrors
- children screams; imagining that something is
chasing them around the room
> Isolated sleep paralysis
- occur in transitional state between sleep and
waking; unable to move and experiences a surge
of terror that resembles a panic attack;
occasionally, there are also vivid hallucinations
AGORAPHOBIA
- fear and avoidance of situations in which a
person feels unsafe or unable to escape to get
home or to a hospital in the event of a developing
panic symptoms
- coined by Karl Westphal, refers to fear of the
marketplace
- some do not avoid agoraphobic situations but
endure them with “intense dread”
> Interoceptive avoidance: avoidance of internal
physical sensations; removing oneself from
situations or activities that might produce the
physiological arousal
(ex. avoid sauna baths or any rooms in which they
might perspire)
> Panic control treatment (PCT): exposing
patients with panic disorder to the cluster of
interoceptive (physical) sensations that remind
them of their panic attacks; therapist attempts to
create "mini" panic attacks
SPECIFIC PHOBIA
- irrational fear of a specific object or situation
that markedly interferes with an individual's
ability to function, 6 months +
1. Animal (ex. spiders, insect, dogs)
2. Natural environment (ex. heights, storms, and
water)
3. Blood-injection-injury (ex. needles, invasive
medical procedures)
4. Situational (ex. planes, elevators, or enclosed
places)
5. Other (ex. situations that may lead to choking or
vomiting; in children,ex. loud sounds or costumed
characters)
> Claustrophobia: small enclosed places
> Frigophobia: fear of the cold
SEPARATION ANXIETY DISORDER
- children's unrealistic and persistent worry that
something will happen to their parents or other
important people in their life or that something
will happen to the children themselves that will
separate them from their parents
SOCIAL ANXIETY DISORDER
(SOCIAL PHOBIA)
- marked fear or anxiety about one or more social
situations in which the individual is exposed to
possible scrutiny by others
- fear or anxiety is out of proportion to the actual
threat, lasting for 6 months or more
> shinkeishitsu: anxiety disorders are best
summarized under the label in Japan
- taijin kyofusho: resembles SAD
SELECTIVE MUTISM
- rare childhood disorder characterized by a lack
of speech in one or more settings in which
speaking is socially expected
- lack of speech must occur for more than one
month and cannot be limited to the first month of
school
POSTTRAUMATIC STRESS DISORDER
- setting event for PTSD as exposure to a
traumatic event during which an individual
experiences or witnesses death or threatened
death, actual or threatened serious injury or
sexual violation
- when memories occur suddenly, accompanied
by strong emotion, and the victims find
themselves reliving the event, they are having a
FLASHBACK
- diagnosis of PTSD cannot be made until at
least one month after the occurrence of the
traumatic event
- new to DSM-5: the addition of “reckless or self-
destructive behavior” - sign of increased arousal
and reactivity; and addition of a “dissociative”
subtype - do not necessarily react with the
reexperiencing or hyperarousal
- Depersonalization: persistent or recurrent
experiences of feeling detached from one's mental
processes or body
- Derealization: persistent or recurrent
experiences of unreality of surroundings
ACUTE STRESS DISORDER
- this is really PTSD, occurring within the first
month after the trauma, but the different name
emphasizes the severe reaction that some
people have immediately
- Serotonin transporter gene involving two short
alleles (SS) described as increasing the
probability of becoming depressed.
- Family instability is one factor that may instill a
sense that the world is an uncontrollable,
potentially dangerous place.
- Support from loved ones reduces cortisol
secretion and hypothalamic–
pituitary–adrenocortical axis activity.
> CATHARSIS: reliving emotional trauma to
relieve emotional suffering
> IMAGINAL EXPOSURE: content of the trauma
and the emotions associated with it are worked
through systematically
ADJUSTMENT DISORDERS
- anxious or depressive reactions to life stress
that are generally milder than acute stress
disorder or PTSD but impairing in performance or
relationships
- unable to cope with the demands of the
situation, some require interventions
- if the symptoms persist for more than 6 months
after the removal of the stress or its
consequences, the adjustment disorder would be
considered “CHRONIC”
ATTACHMENT DISORDERS
- emerging before five years of age, in which the
child is unable or unwilling to form normal
attachment relationships with caregiving adults or
inadequate/abusive child-rearing practices
- failure to meet the child’s basic emotional
needs for affection, comfort, or even providing
for the basic necessities
> REACTIVE ATTACHMENT DISORDER
- seldom seek out a caregiver for protection,
support, and nurturance and will seldom respond
to offers from caregivers to provide this kind of
care
- lack of responsiveness, limited positive affect,
and additional heightened emotionality
(fearfulness, intense sadness)
> DISINHIBITED SOCIAL ENGAGEMENT
DISORDER
- showing a willingness to immediately
accompany an unfamiliar adult figure
somewhere without first checking back with a
caregiver
OBSESSIVE-COMPULSIVE DISORDER
- among those who suffer from anxiety and related
disorders, a client who needs hospitalization is
likely to have OCD
- usually referred for psychosurgery
(neurosurgery for a psychological disorder)
- dangerous event is a thought, image, or
impulse that the client attempts to avoid
- OCD ratio of female to male = 1:1
> Obsessions: intrusive and mostly nonsensical
thoughts, images, or urges that individual tries to
resist or eliminate
> Compulsions: thoughts or actions used to
suppress the obsessions, provide relief
> Four major types of obsessions
- Symmetry (keeping things in perfect order or
doing something in a specific way) obsessions
(26.7%)
- forbidden thoughts or actions (21%)
- cleaning and contamination (15.9%)
- hoarding (15.4%)
TIC DISORDER
- involuntary movement (ex. sudden jerking of
limbs)
TOURETTE’S DISORDER
- involuntary vocalizations
> Thought–action fusion: clients with OCD
equate thoughts with the specific actions or activity
represented by the thoughts
> Exposure and ritual prevention (ERP)
- process whereby the rituals are actively
prevented and the patient is systematically and
gradually exposed to the feared thoughts or
situations
BODY DYSMORPHIC DISORDER
- preoccupation with some imagined defect in
appearance by someone who actually looks
normal, “imagined ugliness”
- equal in men and women; where:
- Men tend to focus on body build, genitals, and
thinning hair and tend to have more severe BDD
- Women focus on more varied body areas, more
likely to have eating disorders
HOARDING DISORDER
- characteristics: excessive acquisition of things,
difficulty discarding anything, and living with
excessive clutter under conditions best
characterized as gross disorganization
> Animal hoarders: characterized by the failure or
inability to care for the animals or provide suitable
living quarters, which results in threats to health
and safety due to unsanitary conditions associated
with accumulated animal waste

TRICHOTILLOMANIA
- urge to pull out one’s own hair from anywhere on
the body, including the scalp, eyebrows, and arms
- noticeable hair loss, distress, and significant
social impairments

EXCORIATION
- skin picking disorder, repetitive and compulsive
picking of the skin, leading to tissue damage
> Psychological treatments: “habit reversal
training”
SOMATIC SYMPTOM AND RELATED
DISORDERS AND DISSOCIATIVE DISORDERS
The defining feature of the DSM-5 group of
somatic symptoms and related disorders is that the
symptoms consume their lives, and their
thoughts, feelings, and behaviors related to
somatic symptoms are disproportionate, whether
or not they are related to a medically diagnosed
illness, they show a disproportionate response
lasting at least 6 months.
"somatization" - a common process in which a
mental disorder manifests itself in the form of
physical symptoms.
DISSOCIATION OR DISSOCIATIVE
EXPERIENCES
- mild sensations that most people experience
occasionally are slight alterations, or
detachments, in consciousness or identity
Somatic symptoms and related disorders and
dissociative disorders used to be categorized
under one general heading, "hysterical
neurosis".
> Hysteria according to Hippocrates: wandering
uterus
- Conversion hysteria: (Freud) unexplained
physical symptoms indicated the conversion of
unconscious emotional conflicts into a more
acceptable form
SOMATIC SYMPTOM DISORDER
- more than 6 months
- used to be called Briquet's syndrome
(from Pierre Briquet, French physician)
- do not always feel the urgency to take action
but continually feel weak and ill, and they avoid
exercising, thinking it will make them worse
- disproportionate and persistent thoughts about
the seriousness of one's symptoms
Specify if:
- With predominant pain (previously pain
disorder): individuals whose somatic complaints
predominantly involve pain
ILLNESS ANXIETY DISORDER
- formerly known as hypochondriasis
- physical symptoms are either not experienced
at the present time or are very mild, but severe
anxiety is focused on the possibility of having or
developing a serious disease; at least 6 months
- anxiety or fear that one has a serious disease;
the essential problem is anxiety, but its expression
is different from that of the other anxiety disorders
- the individual is preoccupied with bodily
symptoms, misinterpreting them as indicative of
illness or disease; almost any physical sensation
may become the basis for concern
- if one or more physical symptoms are
relatively severe and are associated with anxiety
and distress, the diagnosis would be somatic
symptom disorder
Culture specific syndromes:
> Koro: (China) disorder in which there is the
belief, accompanied by severe anxiety and
sometimes panic, that the genitals are retracting
into the abdomen
> Dhat: (India) an anxious concern about losing
semen; is associated with a vague mix of physical
symptoms, including dizziness, weakness, and
fatigue
Three other factors may contribute:
a. seem to develop in the context of a stressful
life event
b. tend to have had a disproportionate incidence
of disease in their family when they were young,
thus, even if they did not develop somatic
symptom until adulthood, they carry strong
memories of illness that could easily become the
focus of anxiety
c. an important social and interpersonal
influence may be involved; an ill person often gets
a lot of attention
> Secondary gain: positive consequences of a
sick role
> Explanatory therapy: clinician went over the
source and origins of their symptoms in some
detail; these patients were assessed immediately
after the therapy and again at a 6-month follow-up
> cognitive-behavioral treatment (CBT) -
focused on identifying and challenging illness-
related misinterpretations of physical sensations
and on showing patients how to create
"symptoms" by focusing attention on certain body
areas.
> Exposure therapy - repeatedly confronting the
patient to stimuli that are relevant for health
anxieties (such as documentaries about diseases)
without using any avoidance and safety behaviors
(such as reassurance by doctors or checking the
abdomen for cancer)
> Drugs - (antidepressants), paroxetine (Paxil) – a
selective-serotonin reuptake inhibitor (SSRI)
Psychological factors affecting
medical condition
- the presence of a diagnosed medical
condition (such as asthma, diabetes, or severe
pain) clearly caused by a known medical
condition (such as cancer) that is adversely
affected (increased in frequency or severity) by
one or more psychological or behavioral factors
ex. Anxiety severe enough to clearly worsen an
asthmatic condition
CONVERSION
- has been used off and on since the Middle Ages
but was popularized by Freud
- believed the anxiety resulting from unconscious
conflicts somehow was "converted" into
physical symptoms to find expression
- allowed the individual to discharge some
anxiety without actually experiencing it
> Functional: refers to a symptom without an
organic cause
FUNCTIONAL NEUROLOGICAL SYMPTOM
DISORDERS (CONVERSION DISORDER)
- generally have to do with physical
malfunctioning, ex. paralysis, blindness, or
difficulty speaking (aphonia), without any
physical or organic pathology to account for the
malfunction
> Psychogenic nonepileptic seizures: seizures
which may be psychological in origin because
no significant electroencephalogram (EEG)
changes can be documented
> Globus hystericus: the sensation of a lump in
the throat that makes it difficult to swallow, eat, or
sometimes talk
> La belle indifference: attitude of long thought
that patients with conversion reactions had the
same quality of indifference to the symptoms
thought to be present in some people with severe
somatic symptom disorder; considered a hallmark
of conversion reactions
> malingerers - good at faking symptoms, aware
of what they are doing and are clearly attempting
to manipulate others to gain a desired end.
FACTITIOUS DISORDER
- also known as Munchausen syndrome
- was named for a German nobleman called
Baron von Munchhausen, who was known as the
Lilgenbaron or Baron of Lies for exaggerating his
war stories
- this suggests that the person is faking an
illness, just as the original Munchhausen lied
about his adventures
- under voluntary control, as with malingering,
but there is no obvious reason for voluntarily
producing the symptoms except, possibly, to
assume the sick role and receive increased
attention
> Factitious disorder imposed on another: also
known previously as Munchausen syndrome by
proxy
- deliberately makes someone else sick,
atypical form of child abuse
> Catharsis: (purging, or releasing) therapeutic
reexperiencing of emotionally traumatic events
blind sight or unconscious vision - occurs when
people respond to visual stimuli without being
aware of it
Freud described four basic processes in the
development of conversion disorder:
a. experiences a traumatic event, unacceptable,
unconscious conflict
b. conflict and resulting anxiety are
unacceptable, the person represses the conflict,
making it unconscious
c. the anxiety continues to increase and
threatens to emerge into consciousness, and
the person "converts" it into physical
symptoms, thereby relieving the pressure of
having to deal directly with the conflict
> primary gain - reduction of anxiety
d. the individual receives greatly increased
attention and sympathy from loved ones and
may also be allowed to avoid a difficult situation
or task
>secondary gain - attention or avoidance
DISSOCIATIVE DISORDERS
> DEPERSONALIZATION
- your perception alters so that you temporarily
lose the sense of your own reality, as if you
were in a dream and you were watching yourself
- experiences of unreality, detachment, or being an
outside observer with respect to one's thoughts,
feelings, body or actions
(ex. perceptual alterations, distorted sense of time,
unreal or absent self, emotional and/or physical
numbing)
> DEREALIZATION
- your sense of the reality of the external world is
lost; things may seem to change shape or size;
people may seem dead or mechanical
- experiences of unreality or detachment with
respect to surroundings
(ex. individuals or objects are experienced as
unreal, dreamlike, foggy, lifeless, or visually
distorted)
DEPERSONALIZATION-DEREALIZATION
DISORDER
- feelings of unreality are so severe and
frightening that they dominate one’s life and
prevent normal functioning
- during the depersonalization or derealization
experience, reality testing remains intact
DISSOCIATIVE AMNESIA
- inability to recall important autobiographical
information, usually of a traumatic or stressful
nature, that is inconsistent with ordinary forgetting
- consists of localized or selective amnesia for a
specific event or events, generalized amnesia:
identity or life history
> Generalized amnesia: unable to remember
anything, including who they are
> Localized or selective amnesia: a failure to
recall specific events, usually traumatic, that occur
during a specific period
> "tunnel vision" (perceptual distortions) > >
"mind emptiness" (difficulty absorbing new
information)
> DISSOCIATIVE FUGUE
- fugue literally meaning "flight"
- memory loss revolves around a specific incident -
an unexpected trip(s)
- mostly, individuals just take off and later find
themselves in a new place, unable to remember
why or how they got there
> Amok (as in "running amok"): common with
men; individuals in this trancelike state often
brutally assault and sometimes kill people or
animals; if the person is not killed himself, he
probably will not remember the episode
- Pivloktoq in Artic
- Frenzy witchcraft in Navajo
- Vinvusa in India and Nigeria
- Phii pob in Thailand
> When the state is undesirable and considered
pathological by members of the culture,
particularly if the trance involves a perception of
being possessed by an evil spirit or another
person, the individual would be diagnosed with an
other specified dissociative disorder: Dissociative
trance
DISSOCIATIVE IDENTITY DISORDER
- discontinuity in sense of self; recurrent gaps in
the recall of everyday events
- one may adopt as many as 100 new identities,
all simultaneously coexisting, although the
average number is closer to 15
- identities are complete, each with its own
behavior, tone of voice, and physical gestures
- the identities are only partially independent, so
it is not true that there are "multiple" complete
personalities so it was changed DSM-IV, from
multiple personality disorder to DID
> Treatment: fundamental goal is to identify cues - When trauma becomes unbearable, the person’s
or triggers that provoke memories of trauma, very identity splits into multiple dissociated
dissociation, or both and to neutralize them; the identities
patient must confront and relive the early trauma - Dissociative disorders cause - repression
and gain control over the horrible events, at least > ABSENT-MINDEDNESS: fail to register info,
as they recur in the patient's mind thoughts are focusing on other things
> Déjà vu: strange sensation of recognizing a
> ALTERS: shorthand term for the different scene that happen upon for the first time
identities or personalities in DID > Jamais Vu: a situation that part of our daily
> HOST PERSONALITIES: the person who lives felt unfamiliar
becomes the patient and asks for treatment; > Tip-Of-The-Tongue: unable to recall info but
usually attempt to hold various fragments of we know we know it
identity together but end up being overwhelmed
> SWITCH: transition from one personality to
another
> Spanos (1996) to suggest that the symptoms of
DID would mostly be accounted for by therapists
who inadvertently suggested the existence of
alters to suggestible individuals, a model known
as the "SOCIOCOGNITIVE MODEL" because the
possibility of identity fragments and early trauma is
socially reinforced by a therapist
> The Three Faces of Eve (book and movie); Sybil
(TV miniseries)
> Anna O: real name Bertha Pappenheim
> SUGGESTIBILITY: personality trait
distributed normally across the population (like
weight and height) some people equate the terms
suggestibility and hypnotizability
> hypnotic trance - tend to be focused on one
aspect of the world, and become vulnerable to
suggestions by the hypnotist.
> self-hypnosis - individuals can dissociate from
most of the world around them and "suggest" to
themselves that, for example, they won't feel pain
in one of their hands.
> AUTOHYPNOTIC MODEL: people who are
suggestible may be able to use dissociation as a
defense against extreme trauma
 MOOD DISORDERS AND SUICIDE
MOOD DISORDERS
- gross deviations in mood
- fundamental experiences of depression and
mania contribute, either singly or together, to all
the mood disorders
- used to be categorized as “depressive
disorders”, “affective disorders”, or even
“depressive neuroses”
MAJOR DEPRESSIVE EPISODE
- most commonly diagnosed and most severe
depression; extremely depressed mood state
that lasts at least 2 weeks
- includes cognitive symptoms (such as feelings
of worthlessness and indecisiveness) and
disturbed physical functions (altered sleeping
patterns, significant changes in appetite and
weight, or a notable loss of energy) to the point
that even the slightest activity or movement
requires an overwhelming effort
- most central indicators of a full major depressive
episode are the physical changes (somatic /
vegetative symptoms)
> Show dysfunctional reward processing and
ANHEDONIA: loss of energy and inability to
engage in pleasurable activities
MANIA or MANIC EPISODE
- abnormally exaggerated elation, joy, or
euphoria lasting at least 1 week
- increased goal-directed activity
- hyperactive, require little sleep, may develop
grandiose plans, believing they can accomplish
anything
> FLIGHT OF IDEAS: speech is typically rapid
and may become incoherent, because the
individual is attempting to express so many
exciting ideas at once
> Two factors that most importantly describe mood
disorders: severity and chronicity
HYPOMANIC EPISODE
- less severe version of a manic episode that
does not cause marked impairment in social or
occupational functioning and needs to last only 4
days rather than a full week
- Hypo means "below"; thus the episode is below
the level of a manic episode
MAJOR DEPRESSIVE DISORDER
- presence of depression and absence of manic
or hypomanic episodes before or during the
disorder
- at least one major depressive episode
- Recurrent: if at least two or more major
depressive episodes occurred and were
separated by at least 2 months during which the
individual was not depressed
8 Depressive Disorder Specifiers:
> MIXED FEATURES: experience manic
symptoms but feel somewhat depressed at the
same time
> ANXIOUS DISTRESS: keyed up or tense,
unusually restless, difficulty concentrating, fear
that something awful will happen
> MELANCHOLIC FEATURES: near to complete
absence of capacity for pleasure; lack reactivity,
empty mood, early morning awakening,
psychomotor agitation, guilt
> ATYPICAL FEATURES: mood reactivity, weight
gain, hypersomnia, leaden paralysis, pattern of
interpersonal rejection sensitivity
> PSYCHOTIC FEATURES: delusions or
hallucinations
> CATATONIC FEATURES: absence of
movement of has a CATALEPSY, muscles are
waxy and semirigid; patient’s arms or legs
remain in any position in which they’re placed
> PERIPARTUM ONSET: occur during
pregnancy or 4 weeks following the delivery
> SEASONAL PATTERN: onset and remission of
major depressive episode at characteristic time
of the year
MOOD-CONGRUENT PSYCHOTIC FEATURES:
content is consistent with depressive themes
MOOD-INCONGRUENT PSYCHOTIC
FEATURES: content does not involve typical
depressive themes
PARTIAL REMISSION: symptoms of immediately
previous major depressive episodes are present
but full criteria is not met, period lasting less than
2 months
FULL REMISSION: during the past 2 months, no
significant sign or symptoms are present
PERSISTENT DEPRESSIVE DISORDER
(DYSTHYMIA)
- depressed mood that continues at least 2 years,
during which the patient cannot be symptom-free
for more than 2 months at a time though they may
experience all major depressive episodes’
symptoms
- PDD differs from MDD in the number of
symptoms, but mostly it is in chronicity
SEASONAL AFFECTIVE DISORDER
- at least 2 years with no evidence of nonseasonal
major depressive episodes occurring during that
period of time
- may be related to daily and seasonal changes
in the production of melatonin, a hormone
secreted by the pineal gland
DOUBLE DEPRESSION
- have both major depressive episode and
persistent depression w/ fewer symptoms
LIGHT THERAPY: promising treatment for
seasonal affective disorder, provide relief from
depressive symptoms in few days
PHOTOTHERAPY: current treatment, most
patients are exposed to 2 hours of bright light
(2,500 lux) immediately on awakening
PHASE SHIFT HYPOTHESIS: patient’s circadian
rhythm is misaligned with environmental day-
night cycle
ACUTE GRIEF
- natural grieving process (6 to 12 months)
INTEGRATED GRIEF
- finality of death and its consequences are
acknowledged, individual adjusts to loss
PREMENSTRUAL DYSPHORIC DISORDER
- in majority of menstrual cycles, at least 5
symptoms must be present a week before:
- marked affective lability (mood swings),
irritability, depressed mood, anxiety, tension,
decreased interest, subjective difficulty in
concentration, lethargy, change in appetite,
insomnia, overwhelmed, physical symptoms
DISRUPTIVE MOOD DYSREGULATION
DISORDER
- severe recurrent temper outburst (verbally or
behaviorally), present for 12 or more months at
school, home or with peers
- diagnosis should not be made for the first time
before 6 years or after the age of 18
BIPOLAR DISORDERS
- originally called manic-depressive illness,
introduced by Emil Kraepelin
- alternates between depression and mania;
traveling from one pole to another
BIPOLAR I
- has full major depression and full mania
BIPOLAR II
- has major depression and mild mania
- at least one hypomanic episode and at least
one major depressive episode
- minimum duration is 4 days
- change in functioning, not severe, no psychotic
features
> Taio: manic or hypomanic phases
CYCLOTHYMIC DISORDER
- milder but more chronic version of bipolar
- chronic alternation of mood elevation and
depression that does not reach severity of manic
or major depressive episode
- at least 2 years, there have been periods with
hypomanic and depressive symptoms
> subtype of cyclothymia: predominance of mild
depressive symptoms, hypomanic symptoms and
equal distribution of both
EQUIFINALITY
- same product resulting from possibly different
cause
Causes of Mood Disorders:
PROBAND
- prevalence of a given disorder in the first-
degree relatives
>SEROTONIN
- regulate our emotional reactions
> DOPAMINE AGONIST L-DOPA
- produce hypomania in bipolar patients
STRESS HYPOTHESIS
- overactivity in the hypothalamic-
pituitary-adrenocortical axis, which produces
stress hormones
DEXAMETHASONE
- a glucocorticoid that suppress cortisol
secretion in normal participant
DEXAMETHASONE SUPPRESSION TEST
- biological test for depression
HIPPOCAMPUS
- heightened levels of stress hormones over a
long period of time, individual undergoes some
shrinkage of this brain structure
LEARNED HELPLESSNESS THEORY OF
DEPRESSION
- by Martin Seligman, one assumes no control
over the stress in their lives
- the depressive attributional styles is:
> INTERNAL: attributes negative events to
personal failings (all my fault)
> STABLE: the “additional bad things will always
be my fault” remains
> GLOBAL: attributions extend across variety of
issues
Aaron T. Beck: depression may result from a
tendency to interpret everyday events in a
negative way
ARBITRARY INFERENCE
- depressed person emphasizes the negative
rather than the positive aspects of the situation
DEPRESSIVE COGNITIVE TRIAD
- most cognitive errors in thinking negatively > ATTEMPTERS: self-injuries with the intent to
about themselves, the immediate world and the COGNITIVE-BEHAVIORAL ANALYSIS SYSTEM die
future OF PSYCHOTHERAPY > GESTURERS: intended not to die
- uses cognitive, behavioral and interpersonal
SELF-BLAME SCHEMA strategies Suicide Types (Emile Durkheim):
- feel personally responsible for every bad a. ALTRUISTIC SUICIDE
things that happens ELECTROCONVULSIVE THERAPY - formalized type of suicide
- seem to produce neurogenesis in the > Hara-kiri: formalized suicide in Japan when
NEGATIVE SELF-EVALUATION SCHEMA hippocampus someone brought dishonor
- they believe that they can never do anything
correctly ECLECTIC THERAPY b. EGOISTIC SUICIDE
- borrows from different systems or therapy of - due to loss of social support
Treatment of Mood Disorders treatment
> 4 basic antidepressants: c. ANOMIC SUICIDE
a. Selective-Serotonin Reuptake Inhibitors: INTERPERSONAL PSYCHOTHERAPY - due to the loss of prestige job
block the presynaptic reuptake of serotonin; - resolving problems in existing relationship
temporarily increases levels of serotonin at the > Stages of role dispute: d. FATALISTIC SUICIDE
receptor sites (ex. Prozac, Celexa, Laxapron, a. NEGOTIATION: both are aware and are trying - due to loss of control on identity
Luvox, Zoloft) to renegotiate it
b. Tricyclic Antidepressants: blocking reuptake b. IMPASSE: low-level resentment but no PSYCHOLOGICAL AUTOPSY
of norepinephrine and serotonin attempts to resolve it - pioneered by Edward Shneidman; this is the
c. Mixed Reuptake Inhibitors: antidepressants c. RESOLUTION: taking some actions psychological profile of a person who
that seem to have somewhat different committed suicide
mechanisms of neurobiological action like INTERPERSONAL AND SOCIAL RHYTHM
Effexor THERAPY
d. Monoamine Oxidase Inhibitors: block the - to regulates circadian rhythm
enzyme MAO that breaks down norepinephrine
and serotonin SUICIDE
- 11th leading cause of death in US; an
> St. John’s Wort (Hypericum): natural herb overwhelming a white phenomenon
> Lithium carbonate: antidepressant, salt
> Valproate: commonly prescribed mood SUICIDAL IDEATION
stabilizer for bipolar disorder - thinking seriously about suicide

> Transcranial Magnetic Stimulation: placing SUICIDAL PLANS

magnetic coll over one’s head - specific method for killing oneself
> Vagus Nerve Stimulation: pacemaker-like
device that generates pulses
SUICIDAL ATTEMPTS
BECK’S COGNITIVE THERAPY - those who survives suicides
- errors in thinking that directly cause depression
 EATING AND SLEEP-WAKE DISORDERS
BINGE-EATING DISORDER
- may binge repeatedly and find it distressing,
but they do not attempt to purge the food;
frequently consume unusually large amounts of
food and feel unable to stop eating
(ex. Manny has been having episodes lately when
he eats prodigious amounts of food. He’s been
putting on a lot of weight because of it.)
AVOIDANT/RESTRICTIVE FOOD INTAKE
DISORDER (ARFID)
- limit their food intake not because they are
concerned about weight or body shape but
because they are simply not interested in eating
or food or because they avoid certain sensory
characteristics or consequences of food or
eating
- can lead to impaired growth in children and to
significant weight loss in adults
> Body Mass Index (BMI): Highly correlated with
body fats
- undernourishment (BMI less than 18.5)
- obesity (BMI 30 or greater)
- severe (morbidly) obese (BMI 40 above)
OBESITY
- having too much body fat
- the more overweight someone is at a given
height, the greater the risks to health
DIABESITY
- when obesity is comorbid with diabetes
BULIMIA NERVOSA
- out-of-control eating episodes, or binges, are
followed by self-induced vomiting, excessive use
of laxatives, or other attempts to purge (get rid)
the food
(ex. Elena eats a whole pie, a cake, and two bags
of potato chips. She ran to the bathroom when she
was finished and it sounded like she was vomiting.
This disorder can lead to an electrolyte imbalance,
resulting in serious medical problems.)
- hallmark of people with bulimia: eats large
amounts of food at one time, typically more junk
foods than fruits or vegetables, then try to get rid
of the food or weight gain by throwing up, taking
laxatives, fasting (not eating anything), or
exercising a lot more than normal
Purging techniques:
a. Self-induced vomiting
b. Laxatives (relieve constipation)
c. Diuretics (result in loss of fluids through
greatly increased frequency of urination)
> Purging type (ex. vomiting, laxatives, or
diuretics)
> Non-purging type (ex. exercise and/or fasting)
Medical Consequences
- Salivary gland enlargement caused by
repeated vomiting, which gives the face a chubby
appearance
- Repeated vomiting may erode the dental
enamel on the inner surface of the front teeth as
well as tear the esophagus
- ELECTROLYTE IMBALANCE: continued
vomiting may upset the chemical balance of
bodily fluids, including sodium and potassium
levels
- Intestinal problems resulting from laxative
abuse are also potentially serious; they can
include severe constipation or permanent colon
damage
- Some individuals with bulimia have marked
calluses on their fingers or the backs of their
hands caused by the friction of contact with the
teeth and throat when repeatedly sticking their
fingers down their throat to stimulate the gag
reflex
ANOREXIA NERVOSA (intense fear of weight
gain; calorie reduction can lead to starvation)
- eats only minimal amounts of food or
exercises vigorously to offset food intake so
body weight sometimes drops dangerously
(ex. Kirsten has lost several pounds and now
weighs less than 90 pounds. She eats only a small
portion of the food her father serves her and fears
that intake above her current 500 calories daily will
make her fat. Since losing the weight, Kirsten has
stopped having periods. She sees herself as fat.)
- literally means nervous loss of appetite
> Restricting type: individuals’ diet to limit calorie
intake
> Binge-eating-purging type: rely on purging
- intense fear of obesity and relentlessly pursue
thinness
- less common than bulimia, but there is a great
deal of overlap (ex. Many individuals with bulimia
have a history of anorexia; that is, they once used
fasting to reduce their body weight below desirable
levels.)
- marked disturbance in body image
Medical complication
- Cessation (lack) of menstruation
(AMENORRHEA)
- Other medical signs and symptoms of anorexia
include dry skin, brittle hair or nails, and
sensitivity to or intolerance of cold
temperatures. Also, it is relatively common to see;
lanugo, downy hair on the limbs and cheeks.
- Cardiovascular problems, such as chronically
low blood pressure and heart rate, can also
result. If vomiting is part of the anorexia, electrolyte
imbalance and resulting cardiac and kidney
problems.
Associated Psychological Disorders
- Anxiety disorders and mood disorders
- One anxiety disorder that seems to co-occur
often with anorexia is obsessive-compulsive
disorder (OCD)
- Substance abuse is also common with anorexia
nervosa patient and, in conjunction with anorexia,
is a strong predictor of mortality, particularly by
suicide
Causes of Eating Disorder
> Levine and Smolak (1996) referred to "the
glorification of slenderness" in magazines and
on television, where most females are thinner than
the average American woman
> Repeated cycles of "dieting" seems to
produce stress-related withdrawal symptoms in the
brain, much like other addictive substances,
resulting in more eating than would have occurred
without dieting.
> REVERSE ANOREXIA NERVOSA
- syndrome in men (particularly weight lifters),
extremely concerned about looking small, even
though they were muscular
- avoided beaches, locker rooms, and other places
where their bodies might be seen
- prone to using anabolic-androgenic steroids to
bulk up
> FAILURE TO THRIVE
- syndrome in which growth and development of a
child is severely stunted because of inadequate
nutrition
> EMOTIONAL EATING BEHAVIOR
- eating to relieve stress or anxiety and binge
eating frequency peaked in the postovulatory
phases of the menstrual cycle for all women
whether they binged or not during their phases of
their cycle
People with anorexia are proud of both their diets
and their extraordinary control. People with
bulimia are ashamed of both their eating issues
and their lack of control.
Drug Treatment
> Prozac: effective for eating disorders
> Selective serotonin reuptake inhibitors: can
be helpful in the treatment of bulimia
Psychological Treatment
> COGNITIVE BEHAVIORAL THERAPHY -
ENHANCED
- first stage is teaching the patient the physical
consequences of binge eating and purging, as
well as the ineffectiveness of vomiting and laxative
abuse
- focuses on altering dysfunctional thoughts
and attitudes about body shape, weight, and
eating
- coping strategies for resisting the impulse to
binge and/or purge are also developed, including
arranging activities so that the individual will not
spend time alone after eating during the early
stages of treatment
NIGHT EATING SYNDROME
- consume a third or more of their daily intake
after their evening meal and get out of the bed at
least once during the night to have a high calorie
snack
BARIATRIC SURGERY
- surgical approach to extreme obesity; stapling
the stomach pouch or bypassing the stomach
through gastric bypass surgery
 SLEEP WAKE DISORDERS
MORAL TREATMENT
- used in the 19th century for people with severe
mental illness, including encouraging patients to
get adequate amounts of sleep as part of therapy
RAPID EYE MOVEMENT SLEEP
- region of the brain is also involved with our
dream sleep
SOCIAL JETLAG
- switching your schedule because of social factors
is similar to changing time zones when you travel
Two major categories of sleep-wake:
DYSSOMNIA SLEEP-WAKE DISORDER
- difficulties getting enough sleep, problems with
sleeping when you want to and complaints about
the quality of sleep
PARASOMNIA SLEEP-WAKE DISORDER
- abnormal behavior or physiological events
that occur during sleep, such as nightmares and
sleepwalking
POLYSOMNOGRAPHIC EVALUATION
- clearest and most comprehensive picture of
your sleep habits
- patient spends one or more nights sleeping in a
sleep laboratory and being monitored on a number
of measures,
OXYGEN DESATURATION
- measures of airflow
ELECTROENCEPHALOGRAM
- leg movements, brain activity measured
ELECTROOCULOGRAM
- measures eye movements
ELECTROMYOGRAM
- measures muscle movement
ELECTROCARDIOGRAM
- measures heart activity
ACTIGRAPH
- wristwatch size device records the number of arm
movements, and the data can be downloaded into
a computer to determine the length and quality of
sleep
SLEEP EFFICIENCY
- calculated by the amount of time sleeping by the
amount of time in bed
INSOMNIA
- difficulty falling asleep at bedtime, problems
staying asleep throughout the night, or sleep that
doesn't result in the person feeling rested even
after normal amounts of sleep
- After being awake for one or two nights, a person
begins having microsleeps that last approximately
15 seconds or shorter
FATAL FAMILIAL INSOMNIA
- a degenerative brain disorder; total lack of sleep
eventually leads to death
> Primary Insomnia: sleep problems were not
related to other medical or psychiatric problems.
PERIODIC LIMB MOVEMENT DISORDER
- excessive jerky leg movements can cause
interrupted sleep, seem similar to insomnia
REBOUND INSOMNIA
- sleep problems reappear, sometimes worse, may
occur when the medication is withdrawn
HYPERSOMNOLENCE DISORDER
- sleeping too much; excessive sleepiness that is
displayed as either sleeping longer than is typical
or frequently falling asleep during the day
- sleep through the night (sometimes longer than is
typical) but still complain of being excessively tired
throughout the day
NARCOLEPSY
- episodes of irresistible attacks of refreshing sleep
occurring daily, accompanied by CATAPLEXY:
episodes of brief loss of muscle tone, occurs while
the person is awake and can range from slight
weakness in the facial muscles to complete
physical collapse
- people with narcolepsy progress right to REM
almost directly from being awake
Two characteristics distinguish people who
have narcolepsy:
a. SLEEP PARALYSIS
- brief period after awakening when they can’t
move or speak
b. HYPNAGOGIC HALLUCINATIONS
- vivid and often terrifying experiences that begin
at the start of sleep and are said to be
unbelievably realistic because they include not
only visual aspects but also touch, hearing, and
even sensation of body movement
- Narcolepsy is associated with a cluster of genes
on chromosome 6, and it may be an autosomal
recessive trait.
- It appears that there is a significant loss of a
certain type of nerve cell (hypocretin neurons) in
those with narcolepsy.
SLEEP APNEA
- obstructed nighttime breathing
- often snore loudly, pause between breaths, and
wake in the morning with a dry mouth and
headache
OBSTRUCTIVE SLEEP APNEA HYPOPNEA
SYNDROME
- occurs when airflow stops despite continued
activity by the respiratory system, reported snoring
at night
CENTRAL SLEEP APNEA
- involves the complete cessation of respiratory
activity for brief periods and is often associated
with certain central nervous system disorders,
such as; cerebral vascular disease, head trauma,
and degenerative disorders
SLEEP-RELATED HYPOVENTILATION
- decreased airflow without a complete pause
in breathing
- causes an increase in carbon dioxide (CO2)
levels because insufficient air is exchanged with
the environment
CIRCADIAN RHYTHM SLEEP-WAKE
DISORDER
- discrepancy between the sleep-wake schedule
required by a person to be rested and the
requirements of the person's environment that
leads to excessive sleepiness or insomnia
- difficulty for the brain to synchronize its sleep
patterns with the current patterns of day and night
- rhythms don't exactly match our 24-hour day,
they are called circadian (from circa meaning
"about" and dian meaning "day")
> Extreme night owls, people who stay up late and
sleep late, may have a problem known as
DELAYED SLEEP PHASE TYPE, where sleep is
delayed or there is a later than normal bedtime.
The other extreme, people with an ADVANCED
SLEEP PHASE TYPE of circadian rhythm disorder
are "early to bed and early to rise”; sleep is
advanced or earlier than normal bedtime.
> Irregular sleep-wake type (people who
experience highly varied sleep cycles)
> Non-24-hour sleep wake type (for example,
sleeping on a 25-or 26-hour cycle with later and
later bedtimes ultimately going throughout the day)
MELATONIN
- contributes to the setting of our biological clocks
that tell us when to sleep, this hormone is
produced by the pineal gland in the center of the
brain
- has been nicknamed the "Dracula hormone"
because its production is stimulated by darkness
and ceases in daylight
Medical Treatments
- Prescribed one of several benzodiazepine or
related medications which include:
> short-acting drugs such as:
Triazolam (Halcion), Zaleplon (Sonata), Zolpidem
(Ambien)
> long-acting drugs such as:
Flurazepam (Dalmane): because the long-acting
drugs sometimes do not stop working by morning
and people report more daytime sleepiness
To help people with hypersomnolence or
narcolepsy, physicians usually prescribe a
stimulant such as:
Methylphenidate (Ritalin), Modafinil
Cataplexy, or loss of muscle tone, can be treated
with antidepressant medication, not because
people with narcolepsy are depressed but
because antidepressants suppress REM (or
dream) sleep. Also, sodium oxybate is
recommended to treat cataplexy.
The gold standard for the treatment of obstructive
sleep apnea involves the use of a mechanical
device-called the CONTINUOUS POSITIVE AIR
PRESSURE machine-that improves breathing
One general principle for treating circadian
rhythm disorders is that phase delays (moving
bedtime later) are easier than phase advances
(moving bedtime earlier). In other words, it is
easier to stay up several hours later than usual
than to force yourself to go to sleep several hours
earlier.
Research indicates that bright light (also referred
to as phototherapy) may help people with
circadian rhythm problems readjust their sleep
patterns.
Research on the treatment of nightmares
suggests that both psychological intervention
(such as cognitive-behavioral therapy) and
pharmacological treatment (such as prazosin)
can help reduce these unpleasant sleep events.
DISORDER OF AROUSAL
- motor movements and behaviors that occur
during NREM sleep including incomplete
awakening (confusional arousals), sleep walking,
or sleep terrors (abrupt awakening from sleep that
begins with a panicky scream)
SLEEP TERRORS
- most commonly afflicted children, usually begin
with a piercing scream
- child is extremely upset, often sweating, and
frequently has a rapid heartbeat; appear to
resemble a nightmare
- an approach to reducing chronic sleep terrors is
use of scheduled awakenings
SLEEPWALKING (SOMNAMBULISM)
- occurs during NREM sleep, when people walk in
their sleep, they are probably not acting out a
dream
- this parasomnia typically occurs during the first
few hours while a person is in the deep stages of
sleep
NOCTURNAL EATING SYNDROME
- when individuals rise from their beds, raid
refrigerator and eat while they are still asleep or
unconscious
SEXXSOMNIA
- acting out sexual behaviors such as masturbation
and sexual intercourse with no memory of the
event
NIGHTMARE DISORDER
- frequently being awakened by extended and
extremely frightening dreams that cause
significant distress and impaired functioning
RAPID EYE MOVEMENT SLEEP BEHAVIOR
DISORDER
- episodes of arousal during REM sleep that result
in behaviors that can cause harm to the individual
or others
RESTLESS LEGS SYNDROME
- irresistible urges to move the legs as a result
of unpleasant sensations (sometimes labeled
"creepying", "tugging or "pulling" in the limbs)
(otherwise referred to as Willis-Ekbom disease)
SUBSTANCE-INDUCED SLEEP DISORDER
- severe sleep disturbance that is the result of
substance intoxication or withdrawal
SLEEP STRESS
- number of events that can negatively affect sleep
like having too much caffeine or alcohol, poor
sleep hygiene (daily activities that affect how we
sleep)
Sleep Treatment
Cognitive
This approach focuses on changing the sleepers'
unrealistic expectations and beliefs about
sleep ("I must have 8 hours of sleep each night";
"If I get less than 8 hours of sleep, it will make me
ill"). The therapist attempts to alter beliefs and
attitudes about sleeping by providing information
on topics such as normal amounts of sleep and a
person's ability to compensate for lost sleep.
GUIDED IMAGERY RELAXATION
- some people become anxious when they have
difficulty sleeping, this approach uses
meditation or imagery to help with relaxation at
bedtime or after a night waking
GRADUATED EXTINCTION
- used for children who have tantrums at bedtime
or wake up crying at night, this treatment
instructs the parent to check on the child after
progressively longer periods until the child falls
asleep on his or her own
PARADOXICAL INTENTION
- involves instructing individuals in the opposite
behavior from the desired outcome; telling poor
sleepers to lie in bed and try to stay awake as
long as they can is used to try to relieve the
performance anxiety surrounding efforts to try to
fall asleep
PROGRESSIVE RELAXATION
- relaxing the muscles of the body in an effort to
introduce drowsiness
SEXUAL DYSFUNCTIONS, PARAPHILIC
DISORDERS AND GENDER DYSPHORIA
Sexual Dysfunction
- difficult to function adequately while having sex
(ex. They may not become aroused or achieve
orgasm)
Paraphilic Disorders
- new term for sexual deviation, sexual arousal
occurs primarily in the context of inappropriate
objects or individuals
Philia: strong attraction or liking
Para: abnormal
Gender Dysphoria
- there is incongruence and psychological distress
and dissatisfaction with the gender one has been
assigned at birth
Nonbinary
- spectrum of gender identities that are neither
female or male
> Sexual behaviors are strongly influenced by
social, generational, cultural, regional,
religious, and economic factors.
> Much higher percentage of men than women
report that they masturbate (self-stimulate to
orgasm).
> Sambia in Papua New Guinea believe semen is
an essential substance for growth and
development in young boys of the tribe. All young
boys in the tribe, beginning at approximately age
7, become semen recipients by engaging
exclusively in oral sex with teenage boys.
> Munda of northeast India require adolescents
and children to live together. Both male and female
children live in the same setting, and the sexual
activity, consisting mostly of petting and mutual
masturbation, is all heterosexual in nature.
Desire phase
- sexual urges occur in response to sexual cues or
fantasies
Arousal stage
- subjective sense of sexual pleasure and
physiological signs of sexual arousal
- in males: penile tumescence (increased flow of
blood into the penis)
- in females: vasocongestion (blood pools in the
pelvic area) leading to vaginal lubrication and
breast tumescence (erect nipples)
Plateau phase
- brief period occurs before orgasm
Orgasm phase
- in males: feelings of the inevitability of
ejaculation, followed by ejaculation
- in females: contractions of the walls of the lower
third of the vagina
Resolution phase
- decrease in arousal occurs after orgasm
Lifelong
- chronic condition that is present during a
person's entire sexual life
Acquired
- begins after sexual activity has been relatively
normal
Generalized
- occurring every time the individual attempts sex
Situational
- occurring with some partners or at certain times
but not with other partners or at other times
Sexual dysfunction
> Sexual Desire Disorders
1. Male hypoactive sexual desire disorder
- little or no desire to have sex
- persistently or recurrently deficient (or absent)
sexual/erotic thoughts or fantasies and desire for
sexual activity for a minimum duration of
approximately 6 months
2. Female sexual interest/arousal disorder
- little or no desire to have sex with diminished
ability to become excited or aroused by erotic cues
or sexual activity for approximately 6 months
> Sexual Arousal Disorders
1. Erectile disorder
- difficulty attaining or maintaining erections
> Orgasm Disorders
1. Delayed ejaculation
- inability to achieve an orgasm despite adequate
sexual desire and arousal
2. Premature ejaculation
- ejaculation that occurs well before the man and
his partner wish it to approximately 1 minute after
penetration
~ Retrograde ejaculation: ejaculatory fluids travel
backward into the bladder rather than forward
3. Female orgasmic disorder
- inability to achieve an orgasm despite adequate
sexual desire and arousal
> Sexual Pain Disorder
1. Genito-pelvic pain/penetration disorder
- difficulties with penetration during attempted
intercourse or significant pain during intercourse
~ Vulvodynia: chronic pain in the area on the
outside of a woman's genitals (vulva); a sensation
of burning, rawness, or stinging
~ Vaginismus: pelvic muscles in the outer third of
the vagina undergo involuntary spasms when
intercourse is attempted
Three major aspects to the assessment of
sexual behavior:
1. Interviews
- usually supported by numerous questionnaires
because patients may provide more information on
paper than in a verbal interview
2. Medical examinations
- to rule out the variety of medical conditions that
can contribute to sexual problems
3. Psychophysiological assessment
- to directly measure the physiological aspects of
sexual arousal
~ Penile strain gauge: measure penile erection;
as the penis expands, the strain gauge picks up
the changes and records them on a polygraph
~ Vaginal photoplethysmograph: smaller than a
tampon and is inserted into her vagina
- light source at the tip of the instrument and two
light-sensitive photoreceptors on the sides of the
instrument measure the amount of light reflected
back from the vaginal walls; because blood flows
to the vaginal walls during arousal, the amount of
light passing through them decreases with
increasing arousal
Erotophobia
- many people learn early that sexuality can be
negative and somewhat threatening, and the
responses they develop reflect this belief; this is
presumably learned early in childhood from
families, religious authorities, or others
Script theory of sexual functioning
- we all operate by following "scripts" that reflect
social and cultural expectations and guide our
behavior
> Socially transmitted negative attitudes about sex
may interact with a person's relationship difficulties
and predispositions to develop performance
anxiety and, ultimately, lead to sexual dysfunction.
Viagra pill
- powerful "little blue pill" (originally was blue and
shaped as a diamond) led people to believe that
most sexual dysfunctions were primarily due to
physical rather than psychological causes
Squeeze technique
- penis is stimulated, usually by the partner, to
nearly full erection
Vacuum device therapy
- creating a vacuum in a cylinder placed over the
penis; the vacuum draws blood into the penis,
which is then trapped by a specially designed ring
placed around the base of the penis
Paraphilic disorders
- cause distress or impairment to the individual or
cause personal harm or the risk of harm to others
Frotteuristic Disorder
- over a period of at least 6 months, recurrent and
intense sexual arousal from touching or rubbing
against a nonconsenting person, as manifested by
fantasies, urges, or behaviors
Fetishistic disorder
- a person is sexually attracted to non living
objects (ex. women's undergarments and shoes)
for at least 6 months
- associated with two classes of objects or
activities: (1) an inanimate object or (2) a source of
specific tactile stimulation (ex. clothing made out of
rubber)
Voyeuristic disorder
- practice of observing, to become aroused, an
unsuspecting individual undressing or naked for at
least 6 months
Exhibitionistic disorder
- achieving sexual arousal and gratification by
exposing genitals to unsuspecting strangers for at
least 6 months
Transvestic disorder
- sexual arousal is strongly associated with the act
of (or fantasies of) dressing in clothes of the
opposite sex, or cross-dressing
~ Autogynephilia: specifier for transvestism,
pattern of sexual arousal for a man associated not
with clothing itself but rather with thoughts or
images of oneself as a woman
Sexual sadism
- pleasure in either inflicting pain or humiliation
Sexual masochism
- pleasure in suffering pain or humiliation
(masochism)
Pedophilia
- sexual attraction to children (young adolescents
generally aged 13 years or younger)
Incest
- sexual attraction to family member
Covert sensitization
- patients associate sexually arousing images in
their imagination with some reasons why the
behavior is harmful or dangerous
Orgasmic reconditioning
- patients are instructed to masturbate to their
usual fantasies but to substitute
more desirable ones just before ejaculation
Relapse prevention
- patients are taught to recognize the early signs of
temptation and to institute a variety of self-control
procedures before their urges become too strong
> Gender dysphoria can also occur among
individuals with disorders of sex development
(DSD), formerly known as INTERSEXUALITY or
HERMAPHRODITISM, who are born with
ambiguous genitalia associated with documented
hormonal or other physical abnormalities.
Gender nonconformity
- boys who behave in feminine ways and girls who
behave in masculine ways
Gender-affirming surgery
- nonreversible step is to alter anatomy physically
to be consistent with gender identity
PERSONALITY DISORDERS
Personality
- all the characteristic ways a person behaves and
thinks
Personality disorders
- when personality characteristics interfere with
relationships with others, cause the person
distress, or in general disrupt activities of daily
living
- a persistent pattern of emotions, cognitions, and
behavior that results in enduring emotional
distress for the person affected and/or for others
and may cause difficulties with work and
relationships
Countertransference
- emotions of therapists brought out by clients
which tend to be negative for those diagnosed with
personality disorders
> Most disorders we discuss in this book were in
Axis I of the DSM-IV-TR, which included the
traditional disorders. The personality disorders
were included in a separate axis, Asxis II,
because as a group they were seen as distinct. It
was thought that the characteristic traits were
more ingrained and inflexible in people who have
personality disorders, and the disorders
themselves were less likely to be successfully
modified.
> The distinction between problems of degree and
problems of kind is usually described in terms of
dimensions instead of categories. The issue that
continues to be debated in the field is whether
personality disorders are extreme versions of
otherwise typical personality variations
(dimensions) or ways of relating that are different
from psychologically healthy behavior (categories).
ex. Society tends to look at gender categorically.
> Many researchers and clinicians see personality
disorders as extremes on one or more personality
dimensions. Yet because of the way people are
diagnosed with the DSM, the personality disorders,
like most other disorders, end up being viewed in
categories. You have two choices, either you do
("yes") or you do not ("no") have a disorder.
> To begin to address the personality dimensions,
the DSM-5 Alternative Model of Personality
Disorders (AMPD) was created in a different
section of DSM (Section III, Emerging Measures
and Models).
> A similar decision was made for the international
version of the DSM: the World Health
Organization's International Statistical
Classification of Diseases and Related Health
Problems, 11th version (ICD-11).
> The DSM-5 and the ICD- 11 classification of
personality disorders (PD) are largely
commensurate, and, when combined, they
delineate six trait domains:
a. negative affectivity
b. detachment
c. antagonism/dissociality
d. disinhibition
e. anankastia
f. psychoticism
Five-factor model or the "Big Five"
- people can be rated on a series of personality
dimensions, and the combination of five
components describes why people are so different
a. extroversion (talkative, assertive, and active
versus silent, passive, and reserved)
b. agreeableness (kind, trusting, and warm
versus hostile, selfish, and mistrustful)
c. conscientiousness (organized, thorough, and
reliable versus careless, negligent, and unreliable)
d. neuroticism (even-tempered versus nervous,
moody, and temperamental)
e. openness to experience (imaginative, curious,
and creative versus shallow and imperceptive)
> DSM-5 divides the personality disorders into
three clusters based on resemblance:
a. Cluster A (odd or eccentric): P, S, S
b. Cluster B (dramatic, emotional, or erratic):
A,B,H,N
c. Cluster C (anxious or fearful): A, D, OC
> A person could receive a diagnosis of one
personality disorder at one point in time and then
years later no longer meet the criteria for their
original problem but now have characteristics of a
second (or third) personality disorder.
> Men tend to be more aggressive, structured,
self-assertive, and detached.
> Women tend to be more submissive,
emotional, and insecure.
> Kaplan points out, many of the features of
histrionic personality disorder (such as
overdramatization, vanity, seductiveness, and over
concern with physical appearance)are
characteristic of the Western “stereotypical
woman." This disorder may simply be the
embodiment of extremely "feminine" traits;
branding such an individual mentally ill which
reflects society's inherent bias against females.
> Criteria for the disorder may themselves be
biased (criterion gender bias), or the assessment
measures & the way they are used may be biased
(assessment gender bias).
> A major concern with personality disorders is
that people tend to be diagnosed with more than
one. The term comorbidity historically describes
the condition in which a person has multiple
diseases.
> Sadistic Personality Disorder
- includes people who receive pleasure by inflicting
pain on others
> Passive-aggressive Personality Disorder
- people who are defiant and refuse to cooperate
with requests like attempting to undermine
authority figures
~ Both are controversial so they were not included
in DSM-5.
> Cluster A (odd or eccentric)
1. Paranoid Personality Disorder
- Main belief: "I cannot trust people."
- pervasive unjustified distrust
- excessively mistrustful and suspicious of others,
without any justification
- assume other people are out to harm or trick
them, so they tend not to confide in others
- may be argumentative, may complain, or may be
quiet; yet sensitive to criticism and have an
excessive need for autonomy
- relatives of individuals with schizophrenia may be
more likely to have paranoid personality disorder
than people who do not have a relative with
schizophrenia; in general, there appears to be a
strong role for genetics in paranoid personality
disorder
> Retrospective research
- asking people with this disorder to recall events
from their childhood; this suggests that early
mistreatment or traumatic childhood experiences
may play a role in the development of paranoid
personality disorder
- some psychologists point directly to the thoughts
(also referred to as SCHEMAS) of people with
paranoid personality disorder as a way of
explaining their behavior
> Establishing a meaningful therapeutic alliance
between the client and the therapist therefore
becomes an important first step
- often use cognitive therapy to counter the
person's mistaken assumptions about others,
focusing on changing the person's beliefs that all
people are malevolent and cannot be trusted
2. Schizoid Personality Disorder
- Main belief: "It's better to be isolated from
others."
- shows a pattern of detachment from social
relationships and a limited range of emotions in
interpersonal situations
- seem neither to desire nor to enjoy closeness
with others like romantic or sexual relationships
- they appear cold and detached and do not seem
affected by praise or criticism
- at least some people with schizoid personality
disorder are sensitive to the opinions of others but
are unwilling/unable to express this emotion
- term schizoid is relatively old, used by Bleuler
(1924) to describe people who have a tendency to
turn inward and away from the outside world
- consider themselves to be observers rather than
participants in the world around them
- childhood shyness is reported as a precursor to
later adult schizoid personality disorder; it may be
that this personality trait is inherited and serves as
an important determinant in the development of
this disorder
- abuse and neglect in childhood are also
reported among individuals with this disorder
> It is rare for a person with this disorder to
request treatment except in response to a crisis
such as extreme depression or losing a job
- therapists begin treatment by pointing out the
value in social relationships; the person with the
disorder may even need to be taught the emotions
felt by others to learn empathy
- therapist takes the part of a friend or significant
other in a technique known as ROLE-PLAYING
and helps the patient practice establishing and
maintaining social relationships
3. Schizotypal Personality Disorder
- Main belief: "Relationships are messy,
undesirable."
- typically socially isolated
- have psychotic-like (but not psychotic) symptoms
(such as believing everything relates to them
personally), social deficits, and sometimes
cognitive impairments or paranoia
- considered by some to be on a continuum (that
is, on the same spectrum) with schizophrenia but
without some of the more debilitating symptoms,
such as hallucinations and delusions
- often considered odd or bizarre because of how
they relate to other people, how they think and
behave, and even how they dress
- report unusual perceptual experiences, including
such illusions as feeling the presence of another
person when they are alone
- they often have beliefs around religious or
spiritual themes so clinicians must be aware that
different cultural beliefs or practices may lead to a
mistaken diagnosis of this disorder
(ex. some people who practice certain religious
rituals such as speaking in tongues, practicing
voodoo, or mind reading, may do so with such
obsessiveness as to make them seem extremely
unusual, thus leading to a misdiagnosis)
- some people are thought to have
"schizophrenia genes"
- studies have shown an increased prevalence of
schizotypal personality disorder among relatives
of people with schizophrenia who do not also
have schizophrenia themselves
- schizotypal symptoms are strongly associated
with childhood maltreatment
- One study used a combination of approaches,
including antipsychotic medication,
COMMUNITY TREATMENT (a team of support
professionals providing therapeutic services), and
social skills training to treat the symptoms
experienced by individuals with this disorder.
Researchers found that this combination of
approaches either reduced their symptoms or
postponed the onset of later schizophrenia.
> Cluster B (dramatic, emotional, or erratic)
1. Antisocial Personality Disorder
- Main belief: "I am entitled to break rules."
- present more often in males
- among the most puzzling of the individuals a
clinician will see in a practice and are
characterized as having a history of failing to
comply with social norms
- perform actions most of us would find
unacceptable, such as stealing from friends and
family; and also tend to be irresponsible,
impulsive, and deceitful
- completely lacking in conscience and empathy,
they selfishly take what they want and do as they
please, violating social norms and expectations
without the slightest sense of guilt or regret
- substance use disorder is common in people with
antisocial personality disorder and appears to be a
lifelong pattern among these individual
> Underarousal hypothesis
- psychopaths have abnormally low levels of
cortical arousal
> Philippe Pinel: identified what he called manie
sans delire (mania without delirium) to describe
people with unusual emotional responses and
impulsive rages but no deficits in reasoning ability
- other names of labels for this disorder: moral
insanity, egopathy, sociopathy, psychopathy
> Hervey Cleckley: psychiatrist who spent much
of his career working with the "psychopathic
personality" identified a constellation of 16 major
characteristics, most of which are personality traits
and are sometimes referred to as the "CLECKLEY
CRITERIA"
Conduct disorder
- separate diagnosis for children who engage in
behaviors that violate society's norms; most often
diagnosed in boys. It also provides for the
designation of two subtypes:
a. Childhood-onset type
- the onset of at least one criterion characteristic of
CD prior to age 10 years
b. Adolescent-onset type
- the absence of any criteria characteristic of CD
prior to age 10 years
> An additional subtype, new to the DSM-5, is
called "with a callous-unemotional
presentation”: a young person presents in a way
that suggests personality characteristics similar to
an adult with psychopathy.
2. Borderline personality disorder
- Main belief: "I deserve to be punished."
- characterized by their volatile and unstable
relationships; they tend to have persistent
problems in early adulthood, with frequent
hospitalizations, unstable personal relationships,
severe depression, and suicidal gestures
- most common personality disorder where it is
observed in every culture, is seen in about 1% to
2% of the general population and constitutes 20%
to 25% of all psychiatric admissions
- individuals with this disorder die by suicide at a
rate about 50 times higher than the general
population, with most research suggesting that 8%
to 10% of patients with this illness have taken their
own lives
> Emotional reactivity
- central aspect of borderline personality disorder
has led researchers to look at this personality trait
for clues about inherited influences
(endophenotypes)
Dialectical behavior therapy (DBT)
- involves helping people cope with the stressors
that seem to trigger suicidal behaviors and other
maladaptive responses
3. Histrionic Personality Disorder
- Main belief: "People are there to serve or admire
me."
- overly dramatic and often seem almost to be
acting, which is why the term histrionic, which
means theatrical in manner
- characterized by excessive emotionality and
attention seeking and more often diagnosed in
females
4. Narcissistic Personality Disorder
- Main belief: "Since I am special, I deserve special
rules."
- unreasonable sense of self-importance and are
so preoccupied with themselves that they lack
sensitivity, lack empathy and compassion for other
people
- has exaggerated feelings and their fantasies of
greatness called GRANDIOSITY
- In Greek mythology, Narcissus spent his days
admiring his own image reflected in water.
- arises largely from failure by the parents in
modeling empathy in child's early development

> Cluster C (anxious or fearful)
1. Avoidant Personality Disorder
- Main belief: "If people knew the "real" me, they
would reject me."
- extremely sensitive to the opinions of others, and
although they desire social relationships, their
anxiety leads them to avoid such associations
- their extremely low self-esteem-coupled with a
fear of rejection causes them to be limited in their
friendships and dependent on those they feel
comfortable with
- Theodore Millon, who initially proposed this
diagnosis, notes that it is important to distinguish
between individuals who are asocial because they
are apathetic, affectively flat, and relatively
uninterested in interpersonal relationships
(comparable to what DSM-5 terms schizoid
personality disorder) and individuals who are
asocial because they are interpersonally anxious
and fearful of rejection. The latter fit the criteria of
avoidant personality disorder. These individuals
feel chronically rejected by others and are
pessimistic about their future.
- Millon suggests that these individuals may be
born with a difficult temperament or personality
characteristics. As a result, their parents may
reject them or at least not provide them with
enough early, uncritical love. This rejection, in turn,
may result in low self-esteem and social alienation,
conditions that persist into adulthood.
> Therapeutic alliance
- the collaborative connection between therapist
and client appears to be an important predictor for
treatment success in this group
2. Dependent Personality Disorder
- Main belief: "I need people to survive, be happy."
- present more on females
- rely on others to make ordinary decisions as well
as important ones, which results in an
unreasonable fear of abandonment
- they sometimes agree with other people when
their own opinion differs so as not to be rejected
- their desire to obtain and maintain supportive and
nurturing relationships may lead to their other
behavioral characteristics, including
submissiveness, timidity, and passivity
3. Obsessive-compulsive PD
- Main belief: "People should do better, try harder."
- characterized by a fixation on things being done
"the right way"
- pervasive pattern of preoccupation with
orderliness, perfectionism, and mental and
interpersonal control
- one of the most common personality disorders in
the general population
- An intriguing theory suggests that the
psychological profiles of many serial killers point to
the role of obsessive-compulsive personality
disorder.
> Therapists help the individual relax or use
cognitive reappraisal techniques to reframe
compulsive thoughts. This form of cognitive-
behavioral therapy-following along the lines of
treatment for obsessive-compulsive disorder.
SCHIZOPHRENIA SPECTRUM AND OTHER - he distinguished dementia praecox (an early age misrepresentation of reality, "the basic
PSYCHOTIC DISORDERS of onset and a poor outcome were characteristic) characteristic of madness"
from manic-depressive illness now called bipolar ~ Delusion of grandeur: a mistaken belief that
Schizophrenia disorder (patterns were not essential to manic the person is famous or powerful
- startling disorder characterized by a broad depression) ~ Delusions of persecution: common delusion in
spectrum of cognitive and emotional dysfunctions - noted the numerous symptoms in people with people with schizophrenia is that others are "out to
including delusions and hallucinations, dementia praecox: hallucinations, delusions, get them"; can be most disturbing
disorganized speech and behavior, and negativism, and stereotyped behavior ~ Capgras syndrome: believes someone they
inappropriate emotions know has been replaced by a double
> Full recovery from schizophrenia has a low base Eugen Bleuler ~ Cotard's syndrome: believes they are dead
rate of 1 in 7 patients. - Swiss psychiatrist who introduced the term
SCHIZOPHRENIA which comes from the Greek Motivational view of delusions
John Haslam words for "split" (skhizein) and "mind" (phren) - would look at these beliefs as attempts to deal
- superintendent of a British hospital, published - underlying all the unusual behaviors shown by with and relieve anxiety and stress that in a way
Observations on Madness and Melancholy, people with this disorder was an ASSOCIATIVE helps the person make sense out of uncontrollable
eloquently portrayed what he called "a form of SPLITTING of the basic functions of personality anxieties in a tumultuous world
insanity", outlined a description of the symptoms of ~ Erotomania: a person develops "stories" around
schizophrenia Psychotic Behavior some issue (ex. a famous person is in love with
- characterized many unusual behaviors, although her)
Philippe Pinel in its strictest sense, it usually involves delusions
- French who described cases of schizophrenia (irrational beliefs) and/or hallucinations (sensory Deficit view of delusion
experiences in the absence of external events) - sees these beliefs as resulting from brain
Benedict Morel and schizophrenia is one of the disorders that dysfunction that creates these disordered
- physician at a French institution who used the involve psychotic behavior cognitions or perceptions
French term DEMENCE (loss of mind) PRECOCE
(early, premature) because the onset of the Criteria for Schizophrenia Hallucination
disorder is often during adolescence to describe - requires that two or more positive, negative, - experience of sensory events without any input
schizophrenia and/or disorganized symptoms be present for at from the surrounding environment
least 1 month, with at least one of these symptoms ~ Auditory hallucination: hearing things that
Emil Kraepelin including delusions, hallucinations, or disorganized aren't there, also the most common form
- give us what stands today as the most enduring speech experienced by people with schizophrenia, with
description and categorization of schizophrenia 70% to 80% of those with the diagnosis endorsing
- he combined several symptoms of "insanity" that this type
had usually been viewed as reflecting separate > Positive symptoms
and distinct disorders: CATATONIA (alternating - more obvious signs of psychosis or symptoms Metacognition
immobility and excited agitation), HEBEPHRENIA around distorted reality - "thinking about thinking" or examining your own
(silly and immature emotionality), and PARANOIA thoughts
(delusions of grandeur or persecution) and thought Delusion ~ Meta-worry: worrying about worrying; has been
these symptoms shared similar underlying features - a disorder of thought content, belief that would be linked to increased anxiety and depression
and included them under the Latin term seen by most members of a society as a symptoms for those experiencing hallucinations
DEMENTIA PRAECOX
> Broca's area
- involved in speech production
> Wernicke's area
- involves language comprehension
Metacognition theory
- people who are hallucinating are not hearing the
voices of others but are listening to their own
thoughts or their own voices and cannot recognize
the difference
> Poor "emotional prosody comprehension"
- Prosody: an aspect of our spoken language that
communicates meaning and emotion through our
pitch, amplitude, pauses, and so on
- Emotional prosody is deficient in persons with
auditory verbal hallucinations, contributing to the
confusion both with others as well as when
interpreting "inner voices"
> Negative symptoms
- involve deficits in normal behavior in such areas
as speech, blunted affect (or lack of emotional
reactivity), and motivation
- include apathy, poverty of (that is, limited)
thought or speech, and emotional and social
withdrawal; approximately 60% of people with
schizophrenia display these symptoms
Avolition
- inability to initiate and persist in activities; show
little interest in performing even basic day-to-day
functions, including those associated with personal
hygiene
Alogia
- relative absence of speech; may respond to
questions with brief replies that have little content
and may appear uninterested in the conversation
Anhedonia
- presumed lack of pleasure; signals an
indifference to activities that would typically be
considered pleasurable, includingeating, social
interactions, and sexual relations
Asociality
- lack of interest in social interactions; this
symptom can also result from or be worsened by
limited opportunities to interact with others,
particularly for severely ill patients
Affective Flattening
- similar to people wearing masks because they do
not show emotions when you would normally
expect them to; they may stare at you vacantly,
speak in a flat and toneless manner, and seem
unaffected by things going on around them
- approximately one quarter of the people with
schizophrenia exhibit FLAT AFFECT
- although they do not react openly to emotional
situations, they may be responding on the inside
> Disorganized symptoms
- rambling speech, erratic behavior, and
inappropriate affect
> People with schizophrenia often LACK
INSIGHT, an awareness that they have a problem.
In addition, they experience "associative splitting"
(Bleuler) and "cognitive slippage" (Meehl).
Disorganized speech
- describe such communication problems
Tangentiality
- type of response that didn't really answer the
question being asked or going off on a tangent
instead of answering a specific question
Loose association or derailment
- abruptly changed the topic of conversation to
unrelated areas
Inappropriate affect
- ex. laughing or crying at improper times
Catatonia
- involves motor dysfunctions that range from wild
agitation to immobility
Catatonic immobility
- people hold unusual postures, as if they were
fearful of something terrible happening if they
moved
- This manifestation can also involve WAXY
FLEXIBILITY or the tendency to keep their bodies
and limbs in the position they are put in by
someone else
Catatonia specifier:
1. Stupor (ex. no psychomotor activity; not actively
relating to environment)
2. Cataplexy (ex. passive induction of a poscure
held against gravity)
3. Waxy flexibility (ex. slight, even resistance to
positioning by examiner)
4. Mutism (ex. no, or very little, verbal response
[exclude if known aphasia])
5. Negativism (ex. opposition or no response to
instructions or external stimuli)
6. Posturing (ex. spontaneous and active
maintenance of a posture against gravity)
7. Mannerism (ex. odd, circumstantial caricature
of normal actions)
8. Stereotypy (ex. repetitive, abnormally frequent,
non-goal-directed movements)
9. Agitation, not influenced by external stimuli
10. Grimacing
11. Echolalia (ex. mimicking another's speech)
12. Echopraxia (ex. mimicking another's
movements)

Dimensional assessment
- rates the severity of the individual's symptoms on
a 0 to 4 scale with 0 indicating a symptom is not
present, 1 indicating equivocal evidence (that is,
not sure), 2 indicating it is present but mild, 3 that it
is present and moderate, and 4 that it is present
and severe
Schizophreniform disorder
- onset of psychotic symptoms within 4 weeks of
the first noticeable change in usual behavior,
confusion at the height of the psychotic episode,
good premorbid (before the psychotic episode)
social and occupational functioning, and the
absence of blunted or flat affect
- an episode of the disorder lasts at least 1 month
but less than 6 months; when the diagnosis must
be made without waiting for recovery, it should be
qualified as "provisional"
Schizoaffective disorder
- uninterrupted period of illness during which there
is a major mood episode (major depressive or
manic) concurrent with Criterion A of
schizophrenia
- delusions or hallucinations for 2 or more weeks in
the absence of a major mood episode (depressive
or manic) during the lifetime duration of the illness.
Delusional disorder
- persistent belief that is contrary to reality, in the
absence of other characteristics of schizophrenia
for 1 month or longer
~ Erotomanic type: irrational belief that one is
loved by another person, usually of higher status
like celebrities
~ Grandiose type: believing in one's inflated
worth, power, knowledge, identity, or special
relationship to a deity or famous person
~ Jealous type: believes the sexual partner is
unfaithful
~ Persecutory type: believing oneself (or
someone close) is being malevolently treated in
some way
~ Somatic delusions: person feels afflicted by a
physical defect or general medical condition
> These delusions differ from the more bizarre
types often found in people with schizophrenia
because in delusional disorder the imagined
events could be happening but aren't.
Shared psychotic disorder (folie a deux)
- an individual develops delusions simply as a
result of a close relationship with a delusional
individual
Substance / Medication - Induced Psychotic
Disorder
- there is a presence of delusions and/or
hallucinations
- there is evidence from the history, physical
examination, or laboratory findings of both (1)
symptoms in Criterion A developed during, or soon
after, substance intoxication or withdrawal or after
exposure to a medication, and (2) involved
substance/medication is capable of producing the
symptoms in Criterion A
Psychotic disorder associated with another
medical condition
- there is a prominent hallucinations or delusions
- there is evidence from the history, physical
examination, or laboratory findings that the
disturbance is the direct pathophysiological
consequence of another medical condition
Brief psychotic disorder
- presence of one or more positive symptoms such
as delusions, hallucinations, or disorganized
speech or behavior, often precipitated by
extremely stressful situations
- duration of an episode of the disturbance is at
least 1 day but less than 1 month
Prodromal stage: early stage of the disorder, a 1-
to 2-year period before the serious symptoms
occur but when less severe yet unusual behaviors
start to show themselves
Attenuated psychosis syndrome
- may have some of the symptoms of
schizophrenia but are aware of the troubling and
bizarre nature of these symptoms
Schizotypal personality disorder
- characteristics are similar to those experienced
by people with schizophrenia but
are less severe
- have psychotic-like (but not psychotic) symptoms
(such as believing everything relates to them
personally), social deficits, and sometimes
cognitive impairments or paranoia
> Genes are responsible for making some
individuals vulnerable to schizophrenia. No one
gene is responsible for schizophrenia; rather,
multiple gene variances combine to produce
vulnerability.
De novo mutations
- genetic mutations that can occur as a result of a
mutation in a germ cell (egg/sperm) of one of the
parents in the fertilized egg after conception
> Three of the most reliable genetic influences that
make one susceptible to schizophrenia include
sections on
- chromosome 8 (Neuregulin1 or NRG 1)
- chromosome 6 (Dystrobrevin-binding protein 1
or DTNBPl)
- chromosome 22 (catecholamine 0-
methyltransferase or COMT)
Endophenotyping
- find basic processes that contribute to the
behaviors or symptoms of the disorder and then
find the gene or genes that cause these difficulties
> Antipsychotic drugs (neuroleptics) often
effective in treating people with schizophrenia are
dopamine antagonists, partially blocking the
brain's use of dopamine.
> These neuroleptic drugs can produce negative
side effects similar to those in Parkinson's disease,
a disorder known to be caused by insufficient
dopamine.
> The drug L-dopa, a dopamine agonist used to
treat people with Parkinson's disease, produces
schizophrenia-like symptoms in some people.
> Amphetamines, which also activate dopamine,
can make psychotic symptoms worse in some
people with schizophrenia.
> When drugs are administered that are known to
increase dopamine (AGONISTS), there is an
increase in schizophrenic behavior; when drugs
that are known to decrease dopamine activity
(ANTAGONISTS) are used, schizophrenic
symptoms tend to diminish.
Hypofrontality
- hypo means "less active" or "deficient"
- deficient activity in a particular area of the frontal
lobes, the dorsolateral prefrontal cortex (DLPFC),
may be implicated in schizophrenia
Schizophrenogenic mother
- was used for a time to describe a mother whose
cold, dominant, and rejecting nature was thought
to cause schizophrenia in her children
Double bind communication Token economy
- was used to portray a communication style that - residents could earn access to meals and small
produced conflicting messages, which, in turn, luxuries by behaving appropriately; incentive
caused schizophrenia to develop system was combined with a full schedule of daily
activities
Expressed emotion
- emotional communication style, researchers Cognitive remediation
found that former patients with episode of - aimed at improving cognitive processes, such as
schizophrenic symptoms who had limited contact attention, executive functioning, and memory, all of
with their relatives did better than the patients who which are associated with impairments over the
spent longer periods with their families course of schizophrenia
> During the 1930s, several novel biological Behavioral family therapy
treatments were tried. One approach was to inject - resembles classroom education where family
massive doses of insulin-the drug that given in members are informed about schizophrenia and its
smaller doses is used to treat diabetes-to induce treatment, relieved of the myth that they caused
comas in people suffering from schizophrenia. the disorder, and taught practical facts about
INSULIN COMA THERAPY was thought for a time antipsychotic medications and their side effects
to be helpful, but closer examination showed it
carried great risk of serious illness and death. Assertive community treatment (ACT)
During this time, PSYCHOSURGERY, including - involves using a multidisciplinary team of
PREFRONTAL LOBOTOMIES (also known as a professionals to provide broad-ranging treatment
leucotomy), was introduced, and in the late 1930s, across all domains, including medication
ELECTROCONVULSIVE THERAPY (ECT) was management, psychosocial treatment, and
advanced as a treatment for schizophrenia. vocational training and support
> EXTRAPYRAMIDAL SYMPTOMS are more
serious side effects of drugs affecting
neurotransmitter systems. These symptoms
include motor difficulties similar to those
experienced by people with Parkinson's disease,
sometimes called Parkinsonian symptoms.
> AKINESIA is one of the most common; it
includes an expressionless face, slow motor
activity, and monotonous speech.
> TARDIVE DYSKINESIA, involves involuntary
movements of the tongue, face, mouth, or jaw and
can include protrusions of the tongue, puffing of
the cheeks, puckering of the mouth, and chewing
movements.
SUBSTANCE-RELATED, ADDICTIVE, AND (1) Ingestion, (2) Stomach, (3) Small intestine,
IMPULSE-CONTROL DISORDERS Physiological dependence (4) Heart, and (5) Liver
~ Tolerance: use of increasingly greater amounts Withdrawal delirium (delirium tremens)
of the drug to experience the same effect - a condition that can produce frightening
Substance-related and addictive disorders
~ Withdrawal: negative physical response when hallucinations and body tremors
- misuse of drugs and other substances people
the substance is no longer ingested
take to alter the way they think, feel and behave
> Consequences of long-term alcohol use:
Alcohol withdrawal delirium - Liver disease, pancreatitis, cardiovascular
Impulse-control disorders
- withdrawal from alcohol that can cause a person disorders, and brain damage
- a number of related problems that involve the
to experience frightening hallucinations and body - DEMENTIA: general loss of intellectual abilities
inability to resist acting on a drive or temptation
tremors and can be a direct result of neurotoxicity or
"poisoning of the brain" by excessive amounts of
Substance
> Depressants alcohol
- chemical compounds that are ingested to alter
- decrease central nervous system activity - KORSAKOFF SYNDROME: confusion, loss of
mood or behavior
- reduce the body's levels of physiological arousal muscle coordination, and unintelligible speech;
and help people relax (ex. sedative, hypnotic, believed to be caused by a deficiency of thiamine,
Psychoactive substances
anxiolytic) a vitamin metabolized poorly by heavy drinkers
- alter mood, behavior, or both
- FETAL ALCOHOL SYNDROME: combination of
Alcohol problems that can occur in a child whose mother
Levels of involvement:
- produced when certain yeasts react with sugar drank while pregnant; problems include fetal
Substance use
and water and fermentation takes place growth retardation, cognitive deficits, behavior
- ingestion of psychoactive substances in
problems, and learning difficulties
moderate amounts that does not significantly
Gamma-aminobutyric acid (GABA) system
interfere with social, educational, or occupational
- seems to be particularly sensitive to alcohol, an Alcohol dehydrogenase (ADH)
functioning
inhibitory neurotransmitter - enzyme that metabolizes alcohol
Substance intoxication
Glutamate system Binge drinking
- physiological reaction to ingested substances like
- an excitatory, helping neurons fire (turns on) - defined as drinking five or more drinks on one
drunkenness or getting high
- suspected to involve learning and memory, and it occasion at least once per month, and heavy
may be the avenue through which alcohol affects alcohol use is defined as binge drinking for
Substance use disorders
our cognitive abilities five/more days in a month
- when a substance use significantly interferes with
- Blackouts, the loss of memory for what happens
the user's life in terms of disruption in their life or
during intoxication, may result from the interaction > Model of Alcohol Progression:
functioning
of alcohol with this system 1. Prealcoholic stage
- A user must have at least two symptoms to be
Alcohol Use Disorder - drinking occasionally with few serious
diagnosed with a mild disorder. Moderate if four or
- Apparent stimulation is the initial effect of alcohol, consequences
five symptoms, and severe substance use disorder
although it is a depressant; experience a feeling of 2. Prodromal stage
if six or more symptoms.
well-being, inhibitions are reduced, and a person - drinking heavily but with few outward signs of a
becomes more outgoing. problem
- Motor coordination is impaired (staggering, 3. Crucial stage
Substance use disorders
slurred speech), reaction time is slowed, we - loss of control, with occasional binges
- how significantly the use interferes with the user's
become confused, our ability to make judgments is
life; if substances disrupt your education, job, or
reduced, and even vision and hearing can be > Alcohol does not cause aggression, but it may
relationships with others and put you in physically
negatively affected. increase a person's likelihood of engaging in
dangerous situations
impulsive acts, and it may impair the ability to
The path traveled by alcohol throughout the body: consider the consequences of acting impulsively.

Sedative: calming
Hypnotic: (sleep-inducing)
Anxiolytic: (anxiety-reducing)
Rohypnol
- forget me pill, cause extreme drowsiness (or
"blackouts"), often used in date rapes
Barbiturates
- a family of sedative drugs, prescribed to help
people sleep and replaced such drugs as alcohol
and opium
Benzodiazepines
- primarily used to reduce anxiety
> Stimulants
- causes a person to be more active and alert and
can elevate mood (ex. Amphetamines, cocaine,
nicotine, and caffeine)
Ma-huang (Ephedra sinica)
- Chinese amphetamine compound prescribed for
illnesses such as headaches, asthma, and the
common cold
Amphetamines
- induce feelings of elation and vigor and can
reduce fatigue; after a period of elevation, you
come back down feeling depressed or tired
- prescribed for people with narcolepsy and
children with attention-deficit/hyperactivity disorder
Amphetamine use disorders
- contain symptoms of euphoria or affective
blunting (a lack of emotional expression), changes
in sociability, interpersonal sensitivity, anxiety,
tension, anger, stereotyped behaviors (repetitive
motor movements), impaired judgment, and
impaired social or occupational functioning
Forms of amphetamine:
- Methylene-dioxymethamphetamine (ecstasy
or MMDA)
- Methamphetamine
Cocaine
- increases alertness, produces euphoria,
increases blood pressure and pulse, and causes
insomnia and loss of appetite
- makes the heart beat more rapidly and
irregularly, and it can have fatal consequences,
depending on a person's physical condition and
the amount of the drug ingested
Cocaine-induced paranoia
- exaggerated fears brought by cocaine use
disorder
Tobacco-related disorders
- NICOTINE in tobacco is a psychoactive
substance that produces patterns of dependence,
tolerance, and withdrawal
- Withdrawal symptoms: depressed mood,
insomnia, irritability, anxiety, difficulty
concentrating, restlessness, and increased
appetite and weight gain
> Being depressed increases your risk of
becoming dependent on nicotine, and being
dependent on nicotine will increase your risk of
becoming depressed.
Caffeine-related disorders
Caffeine
- most common of the psychoactive substances
found in tea, coffee, many soda drinks, and cocoa
products; high levels of caffeine are added to the
"energy drinks"
- small doses can elevate mood and decrease
fatigue, larger doses can make one feel jittery and
can cause insomnia
Caffeine use disorder
- problematic caffeine use that causes significant
impairment and distress
- Withdrawal symptoms: headaches, drowsiness,
and a generally unpleasant mood when denied
morning coffee
Opioid-related disorders
> Opiates
- natural chemicals in the opium poppy that have a
narcotic effect that produce temporary analgesia
(reduce pain) and euphoria (ex. heroin, kratom,
opium, codeine,
and morphine)
- induce euphoria, drowsiness, and slowed
breathing
- high doses can lead to death if respiration is
completely depressed
- Withdrawal from opioids can be so unpleasant
that people may continue to use these drugs
despite a sincere desire to stop and the symptoms
may begin within 6 to 12 hours.
- Withdrawal symptoms: excessive yawning,
nausea and vomiting, chills, muscle aches,
diarrhea, and insomnia that can persist for 1 to 3
days.
Enkephalins and endorphin: brain opioids that
provide narcotic effect
Cannabis-related disorders
Cannabis (marijuana)
- dried parts of the cannabis or hemp plant that
produces experiences of altered perceptions of the
world
- reactions to cannabis usually include mood
swings, heightened sensory experiences, seeing
vivid colors, or appreciating the subtleties of music
- Cannabis-derived products are prescribed for
chemotherapy-induced nausea and vomiting, HIV-
associated anorexia, neuropathic pain in multiple
sclerosis, and cancer pain.
Hallucinogen-related disorders
> Hallucinogens
- alter sensory perception and can produce
delusions, paranoia, and hallucinations (ex.
cannabis and LCD)
- LSD (d-lysergic acid diethylamide): most
common hallucinogenic drug derivatives of this
grain fungus (ergot)
Ergotism
- illness that constricted the flow of blood to the
arms or legs and eventually resulted in gangrene
and the loss of limbs
Phencyclidine (PCP)
- hallucinogen that is snorted, smoked, or injected
intravenously, and it causes impulsivity and
aggressiveness
Hallucinogen Use Disorder Symptoms
- perceptual changes, depersonalization, and
hallucinations
- If taken repeatedly over a period of days,
hallucinogens lose their effectiveness. Sensitivity
returns after about a week of abstinence.
Bad trips
- sort of frightening episodes in which clouds turn
into threatening monsters or deep feelings of
paranoia take over
> Other commonly misused substances
Inhalants
- variety of substances found in volatile solvents,
making them available to breathe into the lungs
directly
- high associated with the use of inhalants
resembles that of alcohol intoxication and usually
includes dizziness, slurred speech, lack of
coordination, euphoria, and lethargy
Anabolic steroids
- derived from or are a synthesized form of the
hormone testosterone used for asthma,
anemia, and breast cancer and males with
inadequate sexual development
- Dependence on the substance therefore seems
to involve the desire to maintain the performance
gains obtained rather than a need to re-experience
an altered emotional or physical state.
Designer drugs (dissociative anesthetics)
- causes drowsiness, pain relief, and the feeling of
being out of one's body
- low doses can produce a state of relaxation and
increased tendency to verbalize but higher doses
or with alcohol or other drugs it can result in Irresistible impulse
seizures, severe respiratory depression, and coma - experience of increasing tension leading up to
the act and, sometimes, pleasurable
> Genetic factors may affect how people anticipation of acting on the impulse
experience and metabolize certain drugs, which in
turn may partly determine who will or will not Intermittent explosive disorder
become regular users. - episodes in which a person acts on aggressive
> The brain appears to have a natural "pleasure impulses that result in serious assaults or
pathway" that mediates our experience of reward destruction of property
and all psychoactive substances seem to affect
this internal reward center. Kleptomania
> Dopamine, serotonin, and norepinephrine are - a recurrent failure to resist urges to steal things
neurotransmitters that are involved in the brain's that are not needed for personal use or their
reward system. monetary value
Pyromania
> Treatment: - an irresistible urge to set fires; the person feels a
~ Agonist substitution: providing the person with tension or arousal before setting a fire and a sense
a safe drug that has a chemical makeup similar to of gratification or relief while the fire burns
the addictive drug
~ Nicotine patch
~ Inpatient Facilities
~ Alcoholics Anonymous
~ Controlled Use
~ Component Treatment
~ Covert sensitization: imagining unpleasant
scenes to make negative associations to the
substance
~ Contingency management: selecting behaviors
that needs to be changed and decide on the
reinforcers that will reward reaching certain goals
~ Community reinforcement approach
~ Motivational enhancement therapy (MET):
behavior change in adults is more likely with
empathetic and optimistic counseling and a focus
on a personal connection with the client's core
values
> Gambling disorder
- inability to resist the urge to gamble which, in
turn, may results in negative personal
consequences
- exhibit a combination of characteristics, including
denial of the problem, impulsivity, and continuing
optimism that interfere with effective treatment
Impulse-control disorders
NEURODEVELOPMENTAL DISORDERS
Neurodevelopmental disorders
- neurologically based disorders that are revealed
in a clinically significant way during a child’s
developing years
Attention-Deficit/Hyperactivity Disorder
- developmental disorder featuring maladaptive
levels of inattention, excessive activity, and
impulsiveness
(ex. People who flit from activity to activity, who
start many tasks but seldom finish one, who have
trouble concentrating, and who don’t seem
to pay attention when others speak)
> Two categories of symptoms:
1. Problems of inattention
- people may appear not to listen to others; they
may lose necessary school assignments, books, or
tools; and they may not pay enough attention to
details, making careless mistakes
2. Hyperactivity and impulsivity
> Hyperactivity
- fidgeting, having trouble sitting for any length of
time, always being on the go
> Impulsivity
- blurting out answers before questions have been
completed and having trouble waiting turns
> Subtype:
1. Inattentive subtype: what some may call ADD,
absence of hyperactivity
2. Hyperactive/impulsive subtype: frenetic
activity, lack of impulse control & constant talking
3. Combined subtype: individuals meet criteria
for both inattention and hyperactivity/ impulsivity
> ADHD is considered to be highly influenced by
genetics. Environmental influences play a
relatively small role in the cause of the disorder
when compared with many other disorders.
Copy number variants
- mutations occur that either create extra copies of
a gene on one chromosome or result in the
deletion of genes
> Some research indicates that poor “inhibitory
control” (the ability to stop responding to a task
when signaled) may be common among both
children with ADHD and their unaffected family
members (siblings and parents) and may be one
genetic marker (an endophenotype) for this
disorder.
> Association between ADHD and maternal
smoking is one of the more consistent findings in
this area.
> ADHD has been thought to involve brain
damage, and this notion is reflected in the previous
use of labels such as “minimal brain damage” or
“minimal brain dysfunction”.
Treatment of ADHD
1. Psychosocial interventions
> Reinforcement programs reward the child for
improvements and, at times, punish misbehavior
with loss of rewards.
> Parent education programs teach families how
to respond constructively to their child's behaviors
and how to structure the child's day.
> Social skills training includes teaching them
how to interact appropriately with their peers
2. Biological interventions
> Stimulants
- Methylphenidate (Ritalin, Adderall)
> Non-stimulants
- atomoxetine (Strattera), guanfacine (Tenex), and
clonidine
Psychopharmacogenetics
- study of how your genetic makeup influences
your response to certain drugs
> Common Communication and Motor
Disorders:
Childhood-Onset Fluency Disorder
- disturbance in speech fluency, such as repeating
syllables or words, prolonging certain sounds,
making obvious pauses, or substituting words to
replace ones that are difficult to articulate; makes
people socially anxious
> Treatment:
Regulated-breathing method
- promising behavioral treatment; person is
instructed to stop speaking when a stuttering
episode occurs and then to take a deep breath
Altered auditory feedback
- electronically changing speech feedback to
people who stutter
Social (Pragmatic) Communication Disorder
- difficulties with the social aspects of verbal and
nonverbal communication, including verbosity,
prosody, excessive switching of topics, and
dominating conversations. (interrupting, talking too
loud, not listening to others)
- does not have the restricted and repetitive
behaviors found in ASD
> Treatment: Individualized social skills
training (ex. modeling, role playing)
Tourette's Disorder
- involuntary motor movements (tics), such as
head twitching, or vocalizations, such as grunts,
that often occur in rapid succession, come on
suddenly, and happen in idiosyncratic or
stereotyped ways
- develops before the age of 14; comorbidity
between tics and ADHD, as well as OCD
> Treatment: Self-monitoring, relaxation
training, and habit reversal
Specific Learning DIsorder
- significant discrepancy between a person's
academic achievement (IQ) and what would be
expected for someone of the same age
- characterized by one or more difficulties in areas
such as reading and writing
- should not be caused by a sensory difficulty,
such as trouble with sight or hearing, and should
not be the result of poor or absent instruction
Specifiers:
1. disorders of reading
2. written expression
3. mathematics
Response to intervention identifying a child as
having a specific learning disorder when the
response to a known effective intervention (early
reading program) is significantly inferior to the
performance by peers.
Communication disorders can appear
deceptively benign, yet their presence early in life
can cause wide-ranging problems later
- childhood-onset fluency disorder (previously
called stuttering)
- language disorder
Dyslexia
- difficulty decoding single words
> Causes
1. Genetic
- Chromosomes 1, 2, 3, 6, 11, 12, 15, and 18
(learning disorders)
> 3 areas of the left hemisphere involved:
a. Broca's area
- affects articulation and word analysis
b. Left parietotemporal area
- affects word analysis
c. Left occipitotemporal area
- affects recognizing word form
Intraparietal sulcus
- critical for the development of a sense of
numbers and is implicated in mathematics disorder
2. Environmental factors
- home reading habits of families
> Treatment of Learning Disorders
1. Educational intervention
Direct Instruction
a. Systematic instruction: using highly scripted
lesson plans that place students together in small
groups based on their progress
b. Teaching for mastery: teaching students until
they understand all concepts
2. Drug treatment
a. Methylphenidate (Ritalin or Adderall)
Intellectual developmental disorder
(intellectual disability)
- involves considerable deficits in cognitive abilities
Autism spectrum disorder
- a more severe disability, in which the child shows
significant impairment in social communication and
has restricted patterns of behavior, interest, and
activities
> Two major characteristics of ASD:
1. Impairments in social communication and social
interaction
2. Restricted, repetitive patterns of behavior,
interests, or activities
> 3 levels of severity:
Level 1: “Requiring support”
Level 2: “Requiring substantial support”
Level 3: “Requiring very substantial support”
Pervasive Developmental Disorders
1. Autistic disorder
2. Asperger's disorder
3. Childhood disintegrative disorder
Rett disorder
- genetic condition that affects mostly females and
is characterized by hand wringing and poor
coordination; is now diagnosed as ASD with
qualifier "associated with Rett syndrome"
1. Impairment in Social Communication and
Social Interaction
- they do not develop age-appropriate social
relationships
Social communication and social interaction
(one symptom cluster)
- problems with: social reciprocity, nonverbal
communication, and initiating and maintaining
social relationships
- with more severe symptoms:
- inability to engage in joint attention
(ex. If a toddler without ASD sees a toy she likes,
she might look at her mother, smile, look at the
toy, and look at her mother again)
2. Restricted, Repetitive Patterns of Behavior,
Interests, or Activities
- maintenance of sameness appeared to like
things to stay the same
- stereotyped and ritualistic behaviors,
stereotyped movements as spinning around in
circles, waving their hands in front of their eyes
with their heads cocked to one side, or biting their
hands
- less severe ASD: much more interested in
esoteric facts (airline sheds)
> Causes: Biological Dimensions
Genetic Influences
- Families that have one child with ASD have
about a 20% chance of having another child with
the disorder.
- One area that is receiving attention involves the
genes responsible for the brain chemical oxytocin
- have a role in how we bond with others and in
our social memory.
- Increased risk of having a child with ASD among
older parents.
Neurobiological Influences
- ASD have fewer neurons in the amygdala young
children with ASD actually have a larger amygdala
(causing excessive anxiety and fear).
- Children with ASD found lower levels of
oxytocin.
- Mercury
Intellectual Development DIsorder (Intellectual
disability)
- mental retardation
- difficulties with daily activities to an extent that
reflects both the severity of their cognitive deficits
and the type and amount of assistance they
receive
> Difficulties in three domains:
1. Conceptual skill deficits in areas such as
language, reasoning, knowledge, and memory.
2. Social problems with social judgment and the
ability to make and retain friendships.
3. Practical difficulties managing personal care
or job responsibilities.
> 4 levels of IDD
1. Mild, IQ score between 50-55 and 70
2. Moderate, with a range of 35-40 to 50- 55
3. Severe, ranging from 20-25 to 35-40
4. Profound, people with IQ scores below 20-25
> Level of support
1. Intermittent
2. Limited
3. Extensive
4. Pervasive
> Causes:
a. Environmental: deprivation, physical or
emotional abuse, and neglect
b. Prenatal: ex. exposure to disease or drugs
while still in the womb
c. Perinatal: ex. difficulties during labor/delivery
d. Postnatal: ex. infections and head injury
Biological Dimensions
Chromosomal disorders
- having an extra 21st chromosome, as in Down
syndrome
Single-gene disorders
- dominant gene (which expresses itself when
paired with a typical gene)
- recessive gene (which expresses itself only
when paired with another copy of itself)
- X-linked gene (present on the X or sex
chromosome)
- De novo disorders genetic mutations occurring
in the sperm/egg or after fertilization.
Dominant gene disorder
Tuberous sclerosis complex (TSC)
- about 60% of the people with this disorder have
TDD, and most have seizures (uncontrolled
electrical discharges in the brain) and
characteristic bumps on the skin that during their
adolescence resemble acne
Recessive disorder
Phenylketonuria (PKU)
- inability to break down a chemical in our diets
called phenylalanine
X-linked disorder
Lesch-Nyhan syndrome
- characterized by IDD, signs of cerebral palsy
(spasticity or tightening of the muscles), and self-
injurious behavior, including finger and lip biting;
only men are affected
Chromosomal Influences
Down syndrome (mongoloidism)
- most common chromosomal form of IDD
- trisomy 21 - extra 21st chromosome
- facial features, including folds in the corners of
their upwardly slanting eyes, a flat nose, and a
small mouth with a flat roof that makes the tongue
protrude
Amniocentesis
- procedure that involves removing and testing a
sample of the fluid that surrounds the fetus in the
amniotic sac
Chorionic villus sampling (CVS)
- a small piece of placenta tissue is removed and
tested
Fragile X syndrome
- second common heritable cause of IDD
- this disorder is caused by a change on the X
chromosome, a mutation that makes the tip of the
chromosome look as though it were hanging from
a thread
Cultural-familial intellectual disability
- people with these characteristics are thought to
have cognitive impairments that result from a
combination of psychosocial and biological
influences

> Treatment
Augmentative communication strategies
- may use picture books, teaching the person to
make a request by pointing to a picture
NEUROCOGNITIVE DISORDERS
Neurocognitive disorders
- in early editions of the DSM, they were labeled
organic mental disorders, along with mood,
anxiety, personality, hallucinosis (an abnormal
mental state involving hallucinations) and
delusional disorders
- the word organic indicated that brain injury or
dysfunction was believed to be involved
> Two classes of cognitive disorders:
1. Delirium
- an often temporary condition displayed as
confusion and disorientation
- impaired consciousness and cognition during the
course of several hours or days
- one of the earliest recognized mental disorders
(more than 2,400 years ago)
- appear confused, disoriented, and out of touch
with their surroundings; cannot focus and sustain
their attention on even the simplest tasks, and are
marked impairments in memory and language
> Treatment:
- If delirium is brought on by withdrawal from
alcohol or other drugs is usually treated with
haloperidol or other antipsychotic medications,
which help calm the individual
- The recommended first line of treatment is
psychosocial intervention. The goal of nonmedical
treatment is to reassure the individual to help them
deal with the agitation, anxiety, and hallucinations
of delirium.
> Prevention:
- Proper medical care for illnesses and therapeutic
drug monitoring can play significant roles in
preventing delirium.
- Structured multidisciplinary interventions:
reorienting the patient, providing vision and
hearing aids as needed, increasing sleep and
physical activity, maintaining proper hydration and
nutrition, involving the patient in therapeutic
activities, and reducing doses of psychoactive
drugs
2. Mild or major neurocognitive disorder
- progressive condition marked by gradual
deterioration of a range of cognitive abilities
Major neurocognitive disorder
- previously labeled dementia; a gradual
deterioration of brain functioning that affects
memory, judgment, language, and other advanced
cognitive processes
- substantial impairment in cognitive performance
Mild neurocognitive disorder
- new and was created to focus attention on the
early stages of cognitive decline
- modest impairment in cognitive performance
Agnosia
- inability to recognize and name objects
Facial agnosia
- inability to recognize even familiar faces
> Classes of neurocognitive disorder based on
etiology:
1. Alzheimer's disease
- "atypical form of senile dementia"
- impairment of memory, orientation, judgment,
and reasoning
- inability to integrate new information results in
failure to learn new associations
- forget important events and lose objects and
interest in nonroutine activities narrows
- display one or more other cognitive disturbances:
aphasia (difficulty with language), apraxia
(impaired motor functioning), agnosia (failure to
recognize objects), or difficulty with activities such
as planning, organizing, sequencing, or abstracting
information
- average survival time is estimated to be about 4
to 8 years, although many individuals live
dependently for more than 20 years
Sundowner syndrome
- difficulties become more pronounced late in the
day, perhaps as a result of fatigue or a disturbance
in the brain's biological clock
Cognitive reserve hypothesis
- suggests that the more synapses a person
develops throughout life, the more neuronal death
must take place before the signs of dementia are
obvious
> A large and important study-the Women's Health
Initiative Memory Study-looked at hormone use
among women and its effect on Alzheimer's
disease. A type of combined estrogen plus
progestin: Prempro, and, contrary to the belief that
giving women estrogen
2. Vascular injury
Vascular neurocognitive disorder
- progressive brain disorder that is a common
cause of neurocognitive deficits
- vascular refers to blood vessels; when the blood
vessels in the brain are blocked or damaged and
no longer carry oxygen and other nutrients to
certain areas of brain tissue, damage results
> There is increasing recognition of neurocognitive
disorder among athletes who receive repeated
blows to the head. In the past, this type of
neurocognitive disorder was referred to as
DEMENTIA PUGILISTICA (which suggested that
it was restricted to boxers or pugilists), but it is
currently referred to as CHRONIC TRAUMATIC
ENCEPHALOPATHY (CTE). It is caused by
repetitive head trauma that can provoke distinctive
neurodegeneration.
3. Frontotemporal degeneration
Frontotemporal neurocognitive disorder
- an overarching term used to categorize a variety
of brain disorders that damage the frontal or
temporal regions of the brain-areas that affect
personality, language, and behavior
> Two variants of frontotemporal
neurocognitive disorder: (1) through declines in
appropriate behavior (ex. socially inappropriate
actions, apathy, making poor judgments) or (2)
language (ex. problems with speech, finding the
right word, naming objects)
Pick's disease
- a rare neurological condition, occurring in about
5% of those people with neurocognitive
impairment, produces symptoms similar to that of
Alzheimer's disease
- believed to last from 5 to 10 years and appears to
have a genetic component
4. Traumatic brain injury
Traumatic brain injury (TBT)
- severe trauma to the head causes the brain to
sustain lasting injuries
Neurocognitive disorder due to traumatic brain
injury
- includes symptoms that persist for at least a
week following the trauma, including executive
dysfunction (such as difficulty planning complex
activities) and impairments in learning and
memory
5. Lewy body disease
Neurocognitive disorder due to Lewy body
disease
- Lewy bodies are microscopic deposits of a
protein that damage brain cells over time.
- the signs of this disorder come on gradually and
include impairment in alertness and attention, vivid
visual hallucinations, and motor impairment as
seen in Parkinson's disease
6. Parkinson's disease
Neurocognitive disorder due to Parkinson's
disease
- Parkinson's disease is a degenerative brain
disorder
- motor problems are characteristic among people
with Parkinson's disease, who tend to have
stooped posture, slow body movements (called
BRADYKINESIA), tremors, and jerkiness in
walking, the voice is also affected; afflicted
individuals speak in a soft monotone
7. HIV infection
Neurocognitive disorder due to HIV infection
- Human immunodeficiency virus type I (HIV-I)
which causes AIDS can also cause this disorder;
HIV infection itself seems to be responsible for the
neurological impairment
- the early symptoms of neurocognitive disorder
resulting from HIV are cognitive slowness,
impaired attention, and forgetfulness, they also
tend to be clumsy, to show repetitive movements
such as tremors and leg weakness, and to become
apathetic and socially withdrawn
> Neurocognitive disorder resulting from HIV is
sometimes referred to as SUBCORTICAL
DEMENTIA because it affects primarily the inner
areas of the brain, below the outer layer called
cortex.
8. Substance use
Substance / medication - induced
neurocognitive disorder
- long-term misuse of a number of drugs can lead
to symptoms of neurocognitive disorder,
including alcohol, inhalants such as glue or
gasoline (which some people inhale for the
euphoric feeling they produce), and sedative,
hypnotic, and anxiolytic drugs
9. Huntington's disease
Neurocognitive disorder due to Huntington's
disease
Huntington's disease
- a genetic disorder that initially affects motor
movements, typically in the form of chorea,
involuntary limb movements
- people with Huntington's disease can live for 20
years after the first signs of the disease appear,
although skilled nursing care is often required
during the final stages
10. Prion disease
Neurocognitive disorder due to prion disease
- a rare progressive neurodegenerative disorder
caused by PRIONS: proteins that can reproduce
themselves and cause damage to brain cells,
leading to neurocognitive decline
Creutzfeldt-Jakob disease
- one type of prion disease, is believed to affect
only one in every million individuals
- an alarming development in this disease is the
finding of 10 cases of a new variant that may be
linked to BOVINE SPONGIFORM
ENCEPHALOPATHY, more commonly referred to
as "mad cow disease"
11. Another medical condition
> After the death of the patient he described as
having a "strange disease of the cerebral cortex"
ALOIS ALZHEIMER performed an autopsy. He
found that the brain contained large numbers of
tangled, strandlike filaments within the brain cells
(referred to as NEUROFIBRILLARY TANGLES).
This type of damage occurs in everyone with
Alzheimer's disease.

> A second type of degeneration results from

gummy protein deposits called AMYLOID
PLAQUES (also referred to as neuritic or senile
plaques) that accumulate between the neurons in
the brains of people with this disorder.

> DETERMINISTIC genes, such as the precursor

gene for small proteins called amyloid beta
peptides (also referred to as beta amyloid or Ab)
and the Presenilin I and Presenilin 2 genes-will
inevitably lead to Alzheimer's disease, but these
genes are also rare in the general population.

> Some genes-including the apolipoprotein E4

(apo E4) gene, are known as SUSCEPTIBILITY
genes. These genes only slightly increase the risk
of developing Alzheimer's disease, but in contrast
to the deterministic genes, these are more
common in the general population.

> Two mechanisms that may account for amyloid

protein buildup are being studied
1. The first involves Amyloid precursor protein
(APP), a large protein that is eventually broken
down into the amyloid protein found in the amyloid
plaques.
2. A second, more indirect way that amyloid
protein may build up in brain cells is through
apolipoprotein E (apo E), which normally helps
transport cholesterols, including amyloid protein,
through the bloodstream. There are at least three
forms of this transporter protein: apo E2, apo E3,
and apo E4.