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Key stuff 2 - schizo, EDs, kids, and addiction
Terms in this set (24)
DSM criteria for Schizophrenia (2/5symptoms, 1month/6months)
A. 2 or more, present most of the time for a month (if untreated)
B. functioning markedly impaired since onset
C. signs of the distubance have persisted for ____________ below threshold of A (or may only show negative symptoms)
D. not schizoaffective disorder, depressive or bipolar
E. Not substance induced
Strong genetic components. Between MDD and Bipolar in terms of genetic components.
About 1% prevalence
1.4:1 men to women ratio. (estrogen protective factor)
ado usual onset but also 20-24 and a peak for women later on, corresponding to estrogen decreases, 45-50, then at 60. Onset for men a bit later than women, in general.
> disorganised speech
> grossly disorganised or catatonic behaviour
> negative symptoms (AAAA)
Meets Schizophrenia criteria A (at least two 2/5 symptoms, present most of the time for a month (if untreated)
> disorganised speech
> grossly disorganised or catatonic behaviour
> negative symptoms (AAAA)
The mood episode must be present for at least ____ of the total schizoaffective episode (to make diagnosis clearer) - though clinicians still often don't agree when diagnosising schizoaffective
Has better long term outcomes than schizophrenia but worse than mood disorders.
CONCURRENT major mood episode of depressive OR manic
(exact same schizo just shorter)
2/5 symptons but must have 1 of 3 key symptoms, for a ____________
Must have 1 of:
3. disorganised speech
Symptoms persist for at least a month but _____________
More likely to recover than those with full schizo
month (same as full schizo)
B. LESS THAN 6 months
Brief psychotic disorder (1/4, just a few days normally)
All in the name.
A. ONE or more of the 4 POS symptoms, including at least 1 of key 3:
3. disorganised speech
(Can show full symptoms of schizophrenia)
Lasts __________________, and behaviour does return BACK TO NORMAL
Must be less than a MONTH.
(usually caused by ____ , eg. walking in on your wife and bestie)
a day to a month (usually all done in a 3-7 days)
Name of newly included disorder in DSM-5 that needs further study?
Reasons to include?
attenuated psychosis syndome - mild psychotic symptoms, not severe enough for full-blown psychotic diagnosis, but indicates later risk
key syptom of APS is being confused by reality, confusing dreams with reality. Also lots of other mild versions of schizo symptoms, mild paranoia, mild hallucinations
For: get early treatment and hope to reduce chance of developing into full psychosis
And increases liklihood of early start thus long use of antipsychotic drugs, that have bad side effects like tissue loss and the chance of perpetuating psychosis after long-term use
How is the brain affected in schizo?
When is the key cognitive decline?
1. widespread cognitive impairment (attention, language, memory) - attention problems begin with eye-tracking dysfunction, and extend to working memory. Problems with amydala for reading emotions, hippocampus for memory, and thalamus for sensory input.
2. Struggles with habituation, no 'sensory gating' where brain shuts down response to second click
3. lost brain volume (about 3% reduction total brain volume) which is indicated by enlarged brain ventricles (and predates illness, can be seen in ado)
4. Shows both hypofrontality and hyperfrontality in PFC
"psychosis and cortical thinning go hand in hand"
white matter matters - myelin sheaths affected, thus brain connectivity affected
sharp decline happens between premorbid phase and first full onset. Then the decline stabilises (though continues)
Key diagnostic factor in both BED and bulimia:
binging / binging+compensating at least once a week for 3 months
personality traits most associated with eating disorders?
anorexia - most commonly developed ages _____
bulima - most commonly developed _____
binge eating _______
Anorexia: 51% recovered
Binge eating: 60% recover
Bulimia: 70% recover
perfectionism and negative affectivity
4 Most common eating disorder comorbidities:
Don't eat SPODs
About 60% of those with eating disorders have ______
Though, starvation can cause irritabiilty and obsessionality, so we must be careful in diagnosing comorbidities
1. substance abuse disorders
2. personality disorders. (Esp. OCPD = perfectionism and being in control)
60% have PDs (esp. Cluster C, anxious/avoidant), though cluster B is closely associated with bulimics (dramatic and impulsive)
Reason eating disorders were renamed to "feeding and eaeting disorders": _________ which, as its name suggests, involves ______in normal weight people who have not eaten large amounts of food.
another one: ________________ characterized by a failure to eat an appropriate diet, leading to weight loss and nutritional deficiencies.
These changes were made because previously, 60% of diagnoses were the catch-all 'unspecified' type. There's still a catch-all but the new ones help with more specific diagnoses.
avoidant restrictive food intake disorder. Not caused by desire to be a certain body shape, but motivated by dislike of food smells or other sensory aspects of food. eg. 20 year old Brit who died because he only ate french fries and toast.
Anorexia is not culture-bound, because it appears in Islamic cultures around fasting and purity.
Bulimia does seem to be __________ to the West.
SSRIs work better on _________ than _________ however serotonin is defnitely involved in each. A key problem is that it can only be gotten through _______.
CBT works well on both and is the leading treatment for bulimia.
Maudsley model popular for AX - teaches family how to help teen refeed, improves family relations.
The newest treatment, made for all pathological eating, is ______ which targets eating beahviours, body issues, perfectionism, low self-esteem and relationship problems.
bulimics than anorexics (though it seems it should work better on anorexics because surely they're getting less food!! maybe the causes are different though - it's more a key cause in bulimia than anorexia)
CBT-E - enhanced CBT (yes, the E is backwards)
Families of anorexics are described as showing the following characteristics:
> limited tolerance of disharmonious affect or psychological tension
> emphasis on _______
> parental over-direction of the child or subtle discouragement of autonomous strivings
> poor skills in ___________
> preoccupation with thinness and looking good
Individual risk factors: internalising the thin ideal, body dissatisfaction, dieting, negative affect, negative body image, childhood __________ , and ________ all implicated.
> emphasis on following rules
> poor skills in conflict resolution
Oppositional defiant disorder (ODD) is characterized by a recurrent pattern of negativistic, defiant, disobedient,and hostile behavior toward authority figures that persists __________.
ODD is grouped into three subtypes:
This disorder usually begins by the age of 8 and has a lifetime prevalence of 10%, with a slightly higher rate among boys
at least 6 months.
> angry/irritable mood,
> argumentative/defiant behavior,
Conduct disorder: 3/15/12, 1/15/6
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria __________________ from any of the categories below, with at least ONE criterion present _________________:
Aggression to people and animals (including sexual assault, mugging, weapon use)
Destruction of property - firesetting, general deliberate destruction
Decietfulness, theft, cons
Serious violation of rules (running away, truancy)
CD has a median age of onset of ________ (meaning half of those who ever develop this disorder have it by age 12) and a lifetime preva-lence of ______. Like ODD, CD is more common among boys than girls (though a wider gap now)
The earlier they get it, the more likely it will become ASPD
Most frequent comorbidities:
3 for 12 months
1 for 6 months
MEDIAN onset age: 12 years
prevalence 10%. (same as ODD)
substance abuse disorders
DSM for ADHD 6/18/6
min ___ symptoms for at least __ months that are inconsistent with development level and negatively impacts them socially and at school:
(9 symptoms of inattentiveness)
> _____________ with: details, during tasks and play, instructions, organisational, or anything involving mental effort
> loses things, distractable, forgetful
(9 hyperactivity and impulsivity symptoms)
> fidgets, taps, squirms
> leaves seat when supposed to sit, or runs and climbs when not supposed to
> can't play quietly, always on the go, talks excessively, blurts out answers, interrupts others talking, can't wait their turn, intrudes on other games
B. Symptoms must be present ___________
C. Occur across two or more settings (eg. at school and at home, or at work and with friends)
6 of 18 symptoms for 6 months
ATTENTIONAL DIFFICULTIES (first major category of symtoms)
B. before age 12
Key factor in learning disorders?
How are they defined?
subtle central nervous system impairments
"learning disorders reflect developmental delays"
Ivar Lovaas developed the first effective (and most effective so far) ASD treatment. 40 hours, one-on-one per week for two years. Using _______________. Helped 47% of kids reach normal intellectual and educational funcionting.
Drugs can help reduce aggression but they don't help with other aspects.
reinforcement of behaviours and punishment
The reward pathway is called the ___________
Substance dependence (addiction) is characterised by three basic processes:
_____________________ —repeated exposure to a substance results in reduced effect.
_____________________ —withdrawal syndrome, whereby cessation of substance use leads to adverse psychological and physiological symptoms.
_____________________ —observable behaviour of frequently using drugs—reinforcement is thought to play a role.
The first step in treating any substance addiction:
mesocorticolimbic dopamine pathway (MCLP)
DETOX > which invovles treating the withdrawal symptoms
Why does it make sense to view addiction as a mental disorder?
the symptoms reflect beahviours that involve a pathological need for the substances
(pathological: related to physical or mental disease)
Best approach to treating alcohol abuse?
Best psychotherapies are:
CBT only shows modest efficacy. Group therapies are best.
multidisciplinary approach: because the problems are often complex, requiring flexibility and individualization of treatment procedures. Can include biological approach using Antabuse to break the drinking cycle, then therapy and environmental approaches.
2. aversion therapy
Several psychoses related to alcohol use disorder have been identified: (often called alcohol-induced psychotic disorders)
1. ________________: disorientation, vivid hallucinations, esp of small, fast animals, terror (of the animals changing form into monsters), extreme suggestibility, body tremors, sweating, heart racing, coated tongue, foul breath
2. ____________ the most severe - memory loss for recent events, often comes with confabulation - may appear delusional but this is just to fill the memory gaps. Comes from years of alcohol abuse, and comes with many other cognitive deficits (due to malnutrition)
1. withdrawal delirium: typically lasts 3-6 days, followed by long sleep (thankfully there are drugs that can help reduce these withdrawal symptoms)
2. alcohol amnesiac disorder (fomerly Korsakoffs syndrome)
alcohol-induced psychotic disorder,
dementia associated with alco-hol use disorder.
Despite cocaine's addictive potential, __________________________. A recent review of 34 studies testing psychological treatments for substance use disorders evaluated in randomized controlled trials reported that both CBT and contingency management (CM) approaches are effective treatments for substance use disorders
psychological interventions have proven to be quite effective in successfully treating cocaine dependence
Alcohol Use Disorder (2/12)
A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least ___ of the following, occurring within a 12-month period:
1. Drinking more and for longer than was intended.
2. Persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving it.
5. Still drinking while failing to fulfill major role obligations at work, school, or home.
6. Still drinking, despire persistent or recurrent social or interpersonal problems caused by drinking.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous
9. Still drinking, despite knowing it's a problem
10. having a tolerance
11. experiencing Withdrawal.
2 over 12 months
so half the world is alcholic
The _______________ suggests that addiction is the result of a dysfunction of the dopamine reward pathway.
But it appears to be much more complex than that, and the pleasure experienced in response to drug use is not simply the result of elevated levels of dopamine. It's not enough to explain why some get addicted and some don't. Hence:
The _______________ hypothesis suggests that addiction is much more likely to occur in individuals who have genetic deviations in components of the reward pathway, which leads them to be less satisfied by natural rewards (e.g., from food, sex, drugs, and other pleasurable activities), which in turn leads them to overuse drugs and related experiences as a way to adequately stimulate their reward pathway.
Significant evidence has emerged to support the __________ hypothesis during the past several decades; however, with this supportive evidence has come the further realization that understanding addiction does not come down to pin-pointing a specific, deficient gene, but in understanding how genetic, neural, and environmental factors interact to lead to addictive behavior
dopamine theory of addiction
reward deficiency syndrome
reward deficiency syndrome
Sets found in the same folder
PDs summary, for last min
Last min 4 - treatments and DID (weeks 6-7)
key last min AB 1
Week 8 - Schizophrenia
Other sets by this creator
Last min 6 - childhood
Last min 5 - Schizo
Last min 3 - unipolar and bipolar
AB last min 2 - ahem, just week 4
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