ABNORMAL PSYCHOLOGY

DR. JOSEPH C. FRANCISCO, RP, RPm

Etiology of Shared Psychotic Disorder

Shared psychotic disorder, or folie deux, involves two individuals
who have a close relationship and share the same delusion.
This occurrence is attributed to the strong influence of the more
dominant (primary case or inducer) person over the submissive
(secondary case) individual.

Other types of Thought Disorders

Schizoaffective

Previous episode of Major Depression or Manic Disorder, or both

This co-occurs with schizophrenic symptoms
At two weeks of either delusions or hallucinations without mood disorder
The mood symptoms are present for a substantial amount of time

Other types of Thought Disorders

Schizophreniform
Symptoms of schizophrenia
Duration of disorder is at least 1 month and no longer than 6 months

Delusional Disorder
Bizarre delusions for at least one month
No full blown schizophrenia
Apart from the delusions, the individuals functioning in not markedly impaired

Other types of Thought Disorders

Brief Psychotic Disorder
Presence of one or more of the following: delusions, hallucinations,
disorganized speech, or grossly disorganized or catatonic behavior
The episode lasts for at least one day but less than one month

Shared Delusional Disorder

A delusion develops in the context of a close relationship with another
person who already has an established delusion
The delusion is similar in content to that of the person who already has
the established delusion

Delusions - examples
I am the son of George W Bush
and a Somali woman. They were on holiday there and left
me behind.
grandeur

I have a microchip in my brain which transmits

control
my thoughts to MI5.
My family are poisoning my food it tastes funny

persecution

Theyre making a TV programme about me I keep

seeing my name in the newspaper.
reference

Form sound judgment about

abnormal behaviors
Trace the roots of abnormality in the
behavior of some individuals

What comes into your mind

when you hear the word
ABNORMAL in the context of
human behavior?

ABNORMAL PSYCHOLOGY
DESCRIBE DIAGNOSTIC CRITERIA
EXPLAIN - MODELS
TREATMENT MODALITIES

PREDICT - PROGNOSIS

Psychopathology

Pathos - suffering
Disease - impairment
Abnormal - deviation

Four Ds in ABNORMAL BEHAVIOR.

Distress
Dysfunctional or Maladaptive Behavior

Danger

Deviancy or Statistically unusual

How do we diagnose Psychological

Disorders?
ABCS of Psychological Disorders

Affective symptoms
Behavioral symptoms
Cognitive symptoms
Somatic symptoms

Mental Disorders Qualifying Terms

Comorbidity- two or more disorders
ADHD WITH SPECIFIC LEARNING DISABILITY
ASD WITH INTELLECTUAL DISABILITY

Acute- sudden onset

Chronic- long-standing
Mild/Moderate/Severe- order of severity
Episodic Disorder- abate and to recur

Figure 14.2 Normality and abnormality as a continuum

Psychopathology
Sources

Somatogenic
Psychogenic

SSS
SIGNS
SYMPTOMS
SYNDROME

M&M

Mania - States of abnormal

excitement
Melancholia - States of abnormal
depression

21

Figure 14.11 Episodic patterns in mood disorders

Etiology: Origin

Etiology of Anxiety Disorders

Biological factors
Genetic predisposition, anxiety sensitivity
GABA circuits in the brain

Conditioning and learning

Acquired through classical conditioning or observational learning
Maintained through operant conditioning

Cognitive factors
Judgments of perceived threat

Personality
Neuroticism

Stressa precipitator

MODELS

BIOMEDICAL
GENETICS
NERVOUS SYSTEM BRAIN
BODY CHEMICALS

DOPAMINE AND SEROTONIN:

Schizophrenia too much dopamine

Depression too less serotonin

Structural Causes of Abnormality

Cerebral Cortex
HPA Axis
Limbic system

PSYCHODYNAMIC VIEW

ANAL RETENTIVE
ANAL EXPULSIVE

BEHAVIORAL VIEW
MALADAPTIVE LEARNING
FAULTY HABITS

 DIATHESIS-STRESS MODEL

Cognitive Models:

Aaron Beck and Albert Ellis developed cognitive

therapies
Irrational Thoughts
Automatic Thoughts

Humanistic / Existential Models

Abnormality results from lack of
Caring and support (Humanistic)
Meaning in life and anxiety (Existential)

Important People:
Carl Rogers, Abraham Maslow (Humanistic)
Rollo May, Irving Yalom, Victor Frankl
(Existential)

Sociocultural Model
Abnormalities can be influenced by social experiences
and cultural values

Abnormalities a result of a dysfunctional system, not just an

individuals pathology

Important People:

Salvator Minuchin, Virginia Satir developed family system

therapies
Thomas Szasz challenged idea of mentally ill as being a
troubling social label

BIOPSYCHOSOCIAL MODEL

34

NONAXIAL ---- CPGPG

Axis I

Clinical disorders

Axis II

Personality disorders
and Mental retardation

Axis III

General medical
conditions

Axis IV

Psychosocial and
environmental
problems

Axis V

Global assessment of
functioning

PREDISPOSING VS.
PRECIPITATING
DETERMINANTS

1. Predisposing Factors (remote) are factors

that make the patient susceptible to a
particular disorder or that makes the patient
more prone to develop a particular disorder
genetic or hereditary, if one of the relative
has a disorder, there is tendency that some of
the relatives may also inherit that kind of
disorder, the development was prolonged, it
takes time to develop gradually

2. Precipitating Factors (immediate) a

factor that triggers the onset of mental
disorders the effect is immediate

1.Biological Determinants
a. Predisposing hereditary
*Factor (genes)
*Body Constitution
* Body chemicals

b.Precipitating
*Accident
*Virus/Bacteria (disease) or
Neurotoxins

2. Psychological Determinants

a.Predisposing psychological
factors

Examples:

A history of parental rejection

attention deficit to children
A faulty psychosexual development
- Over and under gratification leads to
conflicts in psychosexual development
(History of Oral and Anal Development)

b.Precipitating factors
FRUSTRATION
STRESS
DEFENSE MECHANISM

3. Socio-cultural Determinants

a. Precipitating factor
WAR
UNEMPLOYMENT
POVERTY
RESIDENTIAL MOBILITY
RURAL AND URBAN

DSM-IV-TR

DSM-5

Disorders of infancy, Neurodevelopmental

childhood, and
Disorders
adolescence
Mental Retardation

Intellectual
disability
(intellectual
developmental
disorder

INTELLECTUAL DISABILITY (INTELLECTUAL

DEVELOPMENTAL DISORDER)
DIMINISH
D Deficit in general mental abilities
IM Impairment
I interaction (communication)
N notion
I Independence
S social responsibility
H Home

SEVERITY BASED ON ADAPTIVE FUNCTIONING

NOT ON IQ SCORES
MILD

Limited understanding of
risk situations

MODERETE

Social judgment and decisionmaking abilities are limited

SEVERE

Limited vocabulary and

grammar

PROFOUND

Understands simple
instructions and gestures

COMMUNICATION DISORDERS
DILA CO

DIfficulties In LAnguage,
Communication (SPEECH)

Impulse Control Disorders

Impulse Control Disorder is

characterized by

inability to stop performing

harmful
acts that is destructive to oneself and others, a drug
free addiction
The individual has no control over taming their impulses
Anxiety is released when the harmful action is done

Why do people continue to hurt themselves even

though they know it is bad for them?

People with impulse control disorders tend to seek

small and temporary pleasure at the expense of a
long term loss.

Causes of Impulsive Control Disorders

Not fully known how it starts
Serious head injuries and those with epilepsy have a
higher risk of developing this
Suggested as a side effect of other medical conditions
Abnormal neurological development and brain chemistry

Several types of Impulse Control Disorders

Trichotillomania pulling out hair uncontrollably, leading to hair loss

Pathological gambling excessive gambling even

when losing tons of money

Intermittent explosive disorder

periodic violent and hostile outbursts that harms people or property

Pyromania
The impulse to set fires for no reason

Treatment

Varies depending on specific ICD

Cognitive-behavioral Therapy
Selective serotonin reuptake inhibitors (SSRIs) and medication
individual psychotherapy
Stress management

Case Study
Carol, a 16 year old, could not control pulling her hair, including her scalp,
eyebrows and eyelashes
Felt an itch in her hair and proceeded to pull it to get relief

While doing homework, watching T.V, and reading, Carol would

unconsciously play and pull her eyebrows/eyelashes

Cognitive Behaviorial Treatment Strategies

Avoid being alone at home,since environmental cues can
trigger it
Used gloves initially, then settled on a bracelet that
would make noise so that Carol will notice she was
pulling her hair
Replacing behavior by playing with a brush where small
bristles were present
Cognitive approach: Change her thinking
Since her reason to pull was that she felt an itch,
numbing cream was used on her eyebrows

Results
Achieved moderate success with cognitive behavioral
treatment in weeks 3-4
Used to pull hair 10-15 times a night, and now does it
only 5-6 times
In weeks 5-9, Carol used numbing topical cream (could
only apply to eyebrows). She stopped pulling her
eyebrows, and was pleased, but still continued to pull
her eyelashes 2-3 times a month
Four month follow-up Carol did not continue to pull her
eyebrows anymore, but still was pulling her eyelashes

Scientific Study
A study conducted by Marc N. Potenza, MD, PhD, of Yale
University and colleagues showed that pathological gamblers
have decreased activeness in brain areas
Two groups were used: Pathological gamblers (10) and
participants without PG (11)
They used functional magnetic resonance imaging on participants
while they viewed videos of happy, sad and gambling occasions

 Men with PG reported stronger urges to gambling after watching the

gambling video
Both groups did not differ much on terms on the happy and sad videos
Those with PG had a decreased activity level in regions of brains thought to
be involved in impulse control when the gambling video was shown

Case 2

Eating Disorders:

Eating Disorders:

Look in the mirror. What do you see? Is it the real you or just another
"me"?

What is an Eating Disorder?

Eating disorders are mental
illnesses that cause serious
disturbances in a persons
everyday diet. It can manifest as
eating extremely small amounts of
food or severely overeating. The
condition may begin as just eating
too little or too much but
obsession with eating and food
over takes over the life of a
person leading to severe changes.

Types of eating disorders

Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Not Otherwise Specified (NOS)

Anorexia Nervosa: What is it?

Anorexia Nervosa:

Anorexia nervosa happens

when one is obsessed with
becoming thin that they reach
extreme measures and this
leads to extreme weight loss.

Anorexia Nervosa: Warning Signs

Dramatic weight loss
Refusal to eat certain foods or food categories.
Consistent excuses to avoid situations involving food
Excessive and rigid exercise routine
Withdrawal from usual friends/relatives

Health Risks with Anorexia

Heart failure
Kidney failure
Low protein stores
Digestive problems

Bulimia Nervosa: What is it?

Bulimia Nervosa

Bulimia Nervosa is an
eating disorder in which
one starts to consume
large amounts of food at
once and then is followed
by purging, using laxatives,
or overexercising to rid
themselves of the food
they ate.

Bulimia Nervosa: Warning Signs

Wrappers/containers indicating consumption of large amounts of food
Frequent trips to bathroom after meals
Signs of vomiting e.g. staining of teeth, calluses on hands
Excessive and rigid exercise routine
Withdrawal from usual friends/relatives

Health Risks with Bulimia

Dental problems
Stomach rupture
Menstruation irregularities

Binge Eating Disorder: What is it?

Binge eating Disorder

Binge eating is disorder in
which someone eats a lot
amount of food at a time
but they don't vomit.

Binge Eating Disorder: Warning Signs

Wrappers/containers indicating consumption of large amounts of food
MAY be overweight for age and height
MAY have a long history of repeated efforts to diet-feel desperate about
their difficulty to control food intake
MAY eat throughout the day with no planned mealtimes

Health Risks with

Binge Eating Disorder
High blood pressure
High cholesterol

Gall bladder disease

Diabetes
Heart disease
Certain types of cancer

Why do people develop eating

disorders?
Behaviors are unhealthy coping mechanisms

Factors to consider
Psychological
Interpersonal
Social/Cultural
Biological

Psychological factors
Low self-esteem
Feelings of inadequacy or failure

Feeling out of control

Response to change (puberty)
Response to stress (sports, dance)
Personal illness

Interpersonal Factors
Troubled family and personal relationships
Difficulty expressing emotions and feelings
History of being teased or ridiculed based on size or weight
History of physical or sexual abuse

Social and Cultural Factors

Cultural pressures that glorify thinness and place
value on obtaining the perfect body
Narrow definitions of beauty that include only
women and men of specific body weights and
shapes
Cultural norms that value people on the basis of
physical appearance and not inner qualities and
strengths

Biological Factors
Eating disorders often run in families (learn coping skills and
attitudes in family)
Genetic componentresearch about brain and eating in
taking place (certain chemicals in the brain control hunger,
appetite and digestion have been found unbalanced).

LANGUAGE DISORDER

Vocabulary, comprehension,
sentence structure

SPEECH SOUND DISORDER

Speech intelligibility (articulation)

CHILDHOOD-ONSET FLUENCY
DISORDER (STUTTERING)

Sound and syllable repetitions,

prolongations, broken words

SOCIAL (PRAGMATIC)
COMMUNICATION DISORDER

Deficit in using communication for

social purposes (greeting, sharing
information)

ASD

Deficit in nonverbal
communication, conversation,
relationships

ASD

Autism is a neurodevelopmental
disorder characterized by
impaired communication, social
interaction, and repetitive
behaviors.

ADHD

Symptoms: Impulsiveness

Acting before thinking of

consequences,
Jumping from one activity to another,
Disorganization,
Tendency to interrupt other people
conversations

Symptoms: Hyperactivity
Restlessness,
Often characterized by an inability to sit
still,
Fidgeting,
Climbing on things,
Restless sleep

Symptoms: Inattention

Easily distracted,
Day-dreaming,
Not finishing work,
Difficulty listening
Motor clumsiness

Posttraumatic Stress Disorder (PSTD)

Consequences of experiencing extreme stressors
Diagnostic criteria of DSM-5 requires that individuals:

Directly experience or witness the traumatic

event
Learn that the event happened to someone
they are close to
Experience repeated or extreme exposure to
the details of a traumatic event
90

Symptoms of PTSD (RP NH)

Repeated, Persistent,
Negative and
Hypervigilant
91

Traumas Leading to PTSD

Natural disasters
Human-made disasters
Traumatic events

Sexual assault
92

PART 2

Vincent
van Gogh

TROUBLED GENIUS ?

Scary guy?

EXTREME
SUBCULTURE

Celebrity Excess:
Britney Spears

STRESS OVERLOAD?

Celebrity Excess:
Charlie Sheen

NARCISSISTIC

Osama Bin Laden?

RELIGIOUS EXTREMIST

Berkeleys naked guy?

DSM5 Disorders

All the Disorders

1 Neurodevelopmental disorders
2 Schizophrenia spectrum and other psychotic disorders
3 Bipolar and related disorders
4 Depressive disorders
5 Anxiety disorders
6 Obsessive-compulsive and related disorders
7 Trauma- and stressor-related disorders
8 Dissociative disorders
9 Somatic symptom and related disorders
10 Feeding and eating disorders
11 Elimination disorders

12 Sleepwake disorders
13 Sexual dysfunctions
14 Gender dysphoria
15 Disruptive, impulse-control, and conduct disorders
16 Substance-related and addictive disorders
17 Neurocognitive disorders
18 Personality disorders
19 Paraphilic disorders
20 Other Mental Disorders
21 Medication-Induced Movement Disorders and Other Adverse Effects of
Medication
22 Other Conditions That May Be a Focus of Clinical Attention

ANXIETY-BASED MENTAL CONDITIONS

GAD: Generalized anxiety disorder

Panic disorder
Phobias
OCD: Obsessive-compulsive disorder
PTSD: Post-traumatic stress disorder

GAD: Generalized Anxiety

Disorder
free-floating anxiety
Physical symptoms include
autonomic arousal,
trembling, sweating,
fidgeting, agitation, and
sleep disruption.

Panic Disorder: Im
Dying
A panic attack is not just an anxiety
attack. It may include:
many minutes of intense dread or
terror.
chest pains, choking, numbness, or
other frightening physical sensations.
Patients may feel certain that its a
heart attack.
a feeling of a need to escape.
Panic disorder refers to repeated and
unexpected panic attacks, as well as a
fear of the next attack, and a change in
behavior to avoid panic attacks.

Specific Phobia
A specific phobia is more than just a
strong fear or dislike. A specific phobia is
diagnosed when there is an
uncontrollable, irrational, intense
desire to avoid the some object or
situation. Even an image of the object
can trigger a reaction--GET IT AWAY
FROM ME!!!--the uncontrollable,
irrational, intense desire to avoid the
object of the phobia.

Specific Phobias
Unreasonable or irrational fears of specific objects or situations
Categories according to DSM-5

Animal type
Natural environment type
Situational type
Blood-injection-injury type

111

Some Fears and Phobias

What trends are evident here? Which varies

more, fear or phobias? What does this imply?

Some Other Phobias

Agoraphobia is the avoidance of
situations in which one will fear
having a panic attack, especially a
situation in which it is difficult to
get help, and from which it difficult
to escape.

Social phobia refers to an intense fear of

being watched and judged by others. It is
visible as a fear of public appearances in
which embarrassment or humiliation is
possible, such as public speaking, eating, or
performing.

Agoraphobia
People fear:
Places where they might have trouble escaping or getting help if they
become anxious
That they will embarrass themselves if others notice their symptoms or
efforts to escape

In extreme cases individuals do not leave their homes alone

113

Theories of Phobias
Behavioral
Negative reinforcement: Reduction of Anxiety reinforced by the avoidance
of the feared object
Prepared classical conditioning: Conditioning of fear to certain objects or
situations

Biological
Related people share phobias

114

Treatment of Phobias
Behavioral treatments
Use exposure to extinguish the persons fear of the object or situation
Systematic desensitization
Modeling
Flooding

Applied tension technique: Increases blood pressure and heart rate

keeping people from fainting when confronted with the feared object

Biological treatment - Benzodiazepines

115

Social Anxiety Disorder

People become anxious in social situations and are afraid being
rejected, judged, or humiliated in public and focused on avoiding
such events
More common in women
Develops in either the early preschool years or adolescence

116

Theories of Social Anxiety Disorder

Genetic basis
Runs in families

Cognitive perspective - People with social anxiety disorder have:

Have excessively high standards for their social performance
Focus on negative aspects of social interactions and evaluate their own
behavior harshly

117

Treatments for Social Anxiety Disorder

Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Cognitive-behavioral therapy
Identifying negative cognitions people have and learning how to dispute
these cognitions

Mindfulness-based interventions

118

Panic Disorder
Occurrences of panic attack become common without being
provoked
Panic attacks: Short but intense periods during which people experience
many symptoms of anxiety
People begin to worry about having these attacks and change behaviors as a
result of this worry

People fear that they have a life-threatening illness

119

Obsessive-Compulsive Disorder [OCD]

Obsessions - Thoughts
Compulsion Actions
When is it a disorder?
Distress: when you are deeply frustrated with not being
able to control the behaviors
or
Dysfunction: when the time and mental energy spent
on these thoughts and behaviors interfere with
everyday life

Common OCD Behaviors

Percentage of children and adolescents with OCD reporting these obsessions or
compulsions:

Common pattern: RECHECKING Although you know

that youve already made sure the door is locked,
you feel you must check again. And again.

Post-Traumatic Stress Disorder

[PTSD]
About 10 to 35 percent of people who
experience trauma not only have
burned-in memories, but also four
weeks to a lifetime of:

repeated intrusive recall of those

memories.
nightmares and other reexperiencing.
social withdrawal or phobic
avoidance.
jumpy anxiety or hypervigilance.
insomnia or sleep problems.

Which People get PTSD?

Those with less control in the situation
Those traumatized more frequently
Those with brain differences
Those who have less resiliency
Those who get re-traumatized

Resilience and PostTraumatic Growth

Resilience/recovery after
trauma may include:
some lingering, but not
overwhelming, stress.
finding strengths in
yourself.
finding connection with
others.
finding hope.
seeing the trauma as a
challenge that can be
overcome.
seeing yourself as a
survivor.

Understanding Anxiety Disorders: Explanations from

Different Perspectives

Psychodynamic/
Freudian: repressed
impulses

Observational
learning: worrying
like mom

Classical
conditioning:
overgeneralizing a
conditioned response

Cognitive appraisals:
uncertainty is danger

Operant conditioning:
rewarding avoidance

Evolutionary:
surviving by avoiding
danger

Understanding Anxiety Disorders:

Freudian/Psychodynamic Perspective
Sigmund Freud felt that anxiety
stems from repressed childhood
impulses, socially inappropriate
desires, and emotional conflicts.
We repress/bury these issues in
the unconscious mind, but they
still come up, as anxiety.

Mood Disorders
Major depressive disorder [MDD] is:
more than just feeling down.
more than just feeling sad about
something.

Bipolar disorder is:

more than mood swings.
depression plus the problematic overly up mood called
mania.

Bipolar Disorder: Key Facts

Used to be called Manicdepressive disorder

Two extremes: Mania
Depression
Affects 1-2% of the population
Equal in males and females

What is Mania?

High Self-Esteem
Euphoria
High Energy
No Sleep
Extravagant Plans
Optimism
Hyperactive
Rapid Talking

Impaired Judgment
Excessive Gambling
Excessive Spending
Sexually Reckless
Excessive Drug and Alcohol Use

Depression: LEWIS

Lethargic
Excessive (sleep/eat)
Withdrawn
Inability to think clearly
Suicidal thoughts

Which of the following is NOT characteristic of the

manic state of bipolar disorder?
1.
2.
3.
4.
5.

Inflated ego
Excessive talking
Shopping sprees
Fearlessness
Too much sleep

Interesting Side Note:

The majority of those suffering
from Bipolar Disorder at some
level enjoy their periods of
mania.
Why?
1. Traits are seen as attractive
2. Surges of productivity and
creativity

Causes of Bipolar Disorder:

Genetics
Neuro-chemical
Cognitive
Interpersonal

Genetics:
Strong evidence
There is a huge difference
between the concordance rates
between identical and fraternal
twins.
So.. There may be some
predisposition here with
environmental factors
precipitating the symptoms.

Neuro-chemical:

Abnormal levels of
norepinephrine and
serotonin. (low and high
levels)
This may be hereditary
Drug therapy is very effective

Bipolar Disorder
Bipolar disorder was once called manic-depressive
disorder.
Bipolar disorders two polar opposite moods are
depression and mania.

Mania refers to a period of hyperelevated mood that is euphoric,

giddy, easily irritated, hyperactive,
impulsive, overly optimistic, and even
grandiose.

Contrasting Symptoms
Depressed mood: stuck feeling down, Mania: euphoric, giddy, easily irritated,
with:
with:
exaggerated pessimism
exaggerated optimism
social withdrawal
hypersociality and sexuality
lack of felt pleasure
delight in everything
inactivity and no initiative
impulsivity and overactivity
difficulty focusing
racing thoughts; the mind wont settle
fatigue and excessive desire to sleep
down
little desire for sleep

Bipolar Disorder and Creative Success

Many famous and successful people have lived with the ups and downs
of bipolar disorder. Some speculate that the depressive periods gave
them ideas, and the manic episodes gave them creative energy. Any
evidence of mood swings here?

Bipolar Disorder in Children and Adolescents

Does bipolar disorder show
up before adulthood, and
even before puberty?
Many young people have
cycles from depression to
extended rage rather than
mania.
The DSM-V may have a new
diagnosis for these kids:
disruptive mood
dysregulation disorder.

1.
a.
b.
c.
d.

An anxiety disorder is:

An emotional state identified by panic attacks.
An emotional condition classified by excessive checking.
Disordered thinking.
An excessive or aroused state characterized by feelings of
apprehension, uncertainty and fear.

2. Specific phobias are defined as:

a. Excessive worry bouts triggered by a specific object or situation.
b. An abnormal sensitivity to light.
c. An excessive, unreasonable, persistent fear triggered by a
specific object or situation.
d. A persistent fear of social situations.

3. Generalized Anxiety Disorder (GAD) is a pervasive condition in

which the sufferer experiences:
a. Fear of fear.

b. Continual apprehension and anxiety about future events.

c. Continual flashbacks to past events.
d. A desire to check that the environment is safe.

4. In Obsessive Compulsive Disorder (OCD) compulsions are

generally thought to be which of the following:
a. Repetitive or ritualized behavior patterns that the individual
feels driven to perform in order to prevent some negative
outcome happening.
b. Repetitive thoughts about something harming or distressing
others.
c. Overwhelming desires to behave in an inappropriate fashion.
d. Ritualized worrying about negative outcome of events.

5. In Major Depression, which of the following is a significant

neurotransmitter?
a. Serotonin.

b. Dopamine.
c. Betacarotine.
d. Acetylcholine.

6. Which of the following neurotransmitters is associated

specifically with Bipolar Disorder:
a. Serotonin.

b. Norepinephrine.
c. Dopamine.
d. Acetylcholine.

7. The phenomenon in Schizophrenia, known as downward drift

means which of the following?
a. Falling to the bottom of the social ladder.

b. Become homeless.
c. Inability to hold down a job.
d. All of the above.

8. Historically, Dementia praecox was a disease first identified by?

a. Freud
b. Beck
c. Watson
d. Kraepelin

9. In Schizophrenia psychotic features such as hallucinations,

delusions, disorganized speech and grossly disorganized or catatonic
behaviors are known as:
a. Negative symptoms
b. Positive symptoms
c. Mediating symptoms
d. Catastrophic symptoms

10. Misinterpretation of perceptions or experience in Schizophrenia

are known as:
a. Hallucinations

b. Misperceptions
c. Delusions
d. Avolition.

11. In Schizophrenia when an individual believes they are in danger,

this is referred to as:
a. Delusions of grandeur.

b. Delusions of persecution.
c. Delusions of control.
d. Nihilistic delusions.

12. Which of the following refers to when an individual with

Schizophrenia believes they are someone with fame or power?
a. Delusions of grandeur

b. Delusions of control
c. Delusions of reference
d. Nihilistic delusions

13. In Schizophrenia, when an individual believes that messages are

being sent directly to him or her, this is referred to as:
a. Delusions of persecution.

b. Nihilistic delusions.
c. Delusions of reference.
d. Delusions of persecution.

14. Which of the following ways might hallucinations be

experienced in Schizophrenia?
a. Auditory

b. Olfactory
c. Gustatory
d. All of the above

Suicide and Self-Injury

Every year, 1 million people commit suicide, giving up on the
process of trying to cope and improve their emotional well-being.
This can happen when people feel frustrated, trapped, isolated,
ineffective, and see no end to these feelings.
Non-suicidal self-injury has other functions such as sending a
message, or self-punishment.

Understanding Mood Disorders

Biological aspects and
explanations

Social-cognitive aspects and

explanations

Evolutionary
Genetic
Brain /Body

Negative thoughts and negative

mood
Explanatory style
The vicious cycle

Interpersonal:
Misery
you insist that the weight of the
world
should be on your shoulders
Misery
there's much more to life than what
you see
my friend of misery

No one wants to hang out with

a Debbie Downer or a
Negative Nancy.
So.they may have a lack of
social support
Sothey may gravitate
towards other negative
people. (Misery loves
company)

Major Depressive Disorder / SAD

Major Depressive Disorder intense depressed
mood, reduced interest or pleasure in activities,
and loss of energy for a min. of 2 weeks.
Seasonal Affective Disorder seasonal depression
that recurs usually during the winter months
(usually in northern latitudes)
Treatment UV lamps

An Evolutionary Perspective on the Biology of Depression

Depression, in its milder, nondisordered form, may have had
survival value.
Under stress, depression is socialemotional hibernation. It allows
humans to:
conserve energy.
avoid conflicts and other risks.
let go of unattainable goals.

take time to contemplate.

Genetics
Evidence of genetic influence on depression:
1. DNA linkage analysis reveals depressed gene regions
2. twin/adoption heritability studies

Biology of Depression: The Brain

Brain activity is diminished in depression and increased in mania.
Brain structure: smaller frontal lobes in depression and fewer axons in
bipolar disorder
Brain cell communication (neurotransmitters):
more norepinephrine (arousing) in mania, less in depression
reduced serotonin in depression

Preventing or Reducing Depression:

Using Knowledge of the Biology of Depression
1. Adjust
neurotransmitters with
medication.
2. Increase serotonin
levels with exercise.
3. Reduce brain
inflammation with a
healthy diet (especially
olive and fish oils).
4. Prevent excessive
alcohol use .

Understanding Mood Disorders: The SocialCognitive Perspective

Low Self-Esteem

Discounting positive information and

assuming the worst about self, situation,
and the future
Self-defeating beliefs
such as assuming that
one (self) is unable to
cope, improve, achieve,
Learned
or be happy
Helplessness

Depression is
associated with:
Rumination

Depressive
Explanatory
Style
Stuck focusing on whats bad

Depressive Explanatory Style

How we analyze bad news predicts mood.
Problematic event:
Assumptions about the
problem
The problem is:

The problem is:

The problem is:

Mood/result that goes

along with these views:

Theories of Panic Disorder

Biological factors
Heritability is 43 to 48 percent
Triggered in sufferers if they:
Hyperventilate or inhale a small amount of carbon dioxide
Ingest caffeine or take infusions of sodium lactate,
Breathe into a paper bag

People show dysregulation of norepinephrine systems in the locus ceruleus

167

Theories of Panic Disorder: Cognitive Factors

People prone to panic attacks tend to:
Pay very close attention to their bodily sensations and
misinterpret them in a negative way
Engage in snowballing catastrophic thinking, exaggerating
symptoms and their consequences
Anxiety sensitivity
Unfounded belief that bodily symptoms have harmful
consequences
Interoceptive awareness
Heightened awareness of bodily cues that signal a coming panic
attack
Interoceptive conditioning
Bodily cues that occurred at the beginning of previous panic
attacks become conditioned stimuli signaling new attacks

168

Conditioned Avoidance Response

Occurs in certain specific situations which
are perceived as an aversive stimuli

Reduces panic symptoms by reinforcing

avoidance behavior

169

Treatments for Panic Disorder

Biological treatments

Medication affecting serotonin and norepinephrine systems

Benzodiazepines
Most people experience a relapse of symptoms when drug
therapies are discontinued
Cognitive-behavioral therapy
Relaxation and breathing exercises
Identifying the catastrophizing cognitions
Relaxation and breathing exercises while experiencing panic
symptoms during the session
Challenging catastrophizing thoughts
Systematic desensitization therapy

170

Generalized Anxiety Disorder (GAD)

Being anxious all the time
Worrying about life
Common in women than in
men
171

Theories of Generalized Anxiety Disorder

Emotional and cognitive factors

Experiencing intense negative emotions

Showing heightened reactivity to emotional stimuli in the amygdala
Making a number of maladaptive assumptions
Focusing on detecting possible threats in the environment in unconscious
cognitions

172

Theories of Generalized Anxiety Disorder

Biological factors
People with generalized anxiety disorder have a deficiency of gammaaminobutyric acid
Results in excessive firing of neurons through many areas of the brain
Results in a person experiences chronic, diffuse symptoms of anxiety

GAD has a modest heritability

173

Treatment of Generalized Anxiety Disorder

Cognitive-behavioral treatments - Focus on helping people with
GAD by:
Confronting the issues they worry about most
Challenging negative, catastrophizing thoughts
Developing coping strategies

Biological treatments
Benzodiazepine drugs
Tricyclic antidepressant imipramine and the selective serotonin reuptake
inhibitor paroxetine
174

Separation Anxiety Disorder

Becoming anxious and upset if separated from the primary
caregivers
Not diagnosed unless:
Symptoms persist for at least 4 weeks
Significantly impair the childs functioning

175

Theories of Separation Anxiety Disorder

Biological factors
Tendency toward anxiety is heritable
Behavioral inhibition: Causes children to be:
Shy, fearful, and irritable as toddlers
Cautious, quiet, and introverted as school-age children

Psychological and sociocultural factors

Children learn to be anxious from their parents as an understandable
response to their environment

176

Treatments for Separation Anxiety Disorder

Cognitive-behavioral therapies - Teach skills:
For coping and for challenging cognitions that feed anxiety
To learn relaxation exercises to practice when separated from parents
To challenge fears about separation and use self-talk to calm themselves

Drugs used are antidepressants, antianxiety drugs, stimulants and

antihistamines

177

Obsessive-Compulsive Disorder
Obsessions: Thoughts, images, ideas, or impulses that are
persistent
Uncontrollably intrude upon consciousness
Cause significant anxiety or distress

Compulsions: Repetitive behaviors or mental acts that an

individual feels he or she must perform
Different from other stress related diseases and begins at a young
age
Tends to be chronic if left untreated
178

Obsessive-Compulsive Disorder
Common type of obsession in OCD
Thoughts and images associated with aggression, sexuality, and/or religion
Symmetry and ordering
Contamination and a cleaning compulsion

Hoarding: Closely related to OCD but is classified as a separate

diagnosis in the DSM-5

179

Obsessive-Compulsive Disorder
Hair-pulling disorder
Recurrent pulling out of hair resulting in noticeable hair loss
Called trichotillomania
Skin-picking disorder

Recurrently picking scabs or places on the skin, creating

significant lesions that often become infected and cause scars
Body dysmorphic disorder
People are excessively preoccupied with a part of their body
that they believe is defective but that others see as normal or
only slightly unusual

180

Theories of OCD and Related

Disorders
Biological theories
Focus on a circuit in the brain involved in motor behavior, cognition, and
emotion
Response to drugs is good
Genes help determine who is vulnerable to OCD

181

Theories of OCD and Related

Disorders: Cognitive Theories
People who develop OCD:

Are depressed or generally anxious much of the time

Have a tendency toward rigid, moralistic thinking
Appear to believe that they should be able to control all their thoughts
Have trouble accepting that everyone has horrific notions from time to time

Compulsions develop largely through operant conditioning

182

Treatments for OCD and Related Disorders

Biological treatments - Antidepressant, serotonin-enhancing drugs
Have significant side effects

Cognitive-behavioral treatments
Exposure and response prevention: Exposes the client to the focus of the
obsession, preventing compulsive responses to the resulting anxiety
Challenges individuals moralistic thoughts, excessive sense of
responsibility, and maladaptive cognitions

183

Figure 5.9 - Vulnerability-Stress Models

184

Causes of Anxiety Disorders:

Behavioral Acquired through Classical conditioning,
maintained through operant conditioning. (what does
this mean?)
Cognitive misinterpretation of harmless situations as
threatening (may selectively recall the bad instead of
the good)
Biological Neurotransmitter imbalances too little
GABA ( Valium, Xanum) OCD is treated with antidepressants (Prozac, Xoloft) low levels of serotonin

3rd Day:
Topics:

Schizophrenia
Dissociative Disorders
Personality Disorders
Neurocognitive Disorders
Gender Dysphoria
Drills

Lets Recall

How do we experience disgust?

Anxiety Disorders: 4SPAG
Obsessive-Compulsive and Related Disorders:
BOTHER

Anxiety Disorders (4SPAG)

Separation Anxiety Disorder Fear of Losing you! (4 wks in
Children; 6 mos in adults)
Selective Mutism Cant Speak! (Children: 1 month)

Specific phobia Takot aketch! (Specific object or situation:

animal, natural environment, blood-injection, situational, others)
Social Phobia Dont Judge Me! (anxiety about social situations;
fear of being scrutinized by others)
Panic Disorder OMG! Feeling of going crazy

Anxiety Disorders
Agoraphobia Ayoko ng masikip! (thinking the escaping might be
difficult)
GAD Kahit Ano, Kahit Sino! free-floating anxiety (6 months
duration)

OCD:

BOTHER

Body Dysmorphic Disorder Ayoko ng panget! (Preoccupied with

perceived defects or flaws in physical appearance that are not
observable to others; excessive grooming; mirror checking;
reassurance seeking)
OCD Di Mapakale! (Obsessions: thoughts; Compulsions: Actions);
persistent thoughts; repetitive behaviors (hand washing, ordering,
rechecking)

OCD
Trichotillomania Buhok ko Yan! (recurrent pulling out of ones
hair)
Hoarding Disorder Ipon Ko To! (difficulty discarding with
possessions)
Excoriation Balat Ko Yan! (recurrent skin picking resulting to skin
lesions)
Related Disorder: Body Dysmorphic-like with actual flaws.

How do we deal with difficulties?

TRAUMA-AND STRESSOR-RELATED DISORDERS : PADAR

TRAUMA-AND STRESSOR-RELATED DISORDERS:

PADAR
PTSD STOP IT! (Directly experiencing, Witnessing, Learning) With
Depersonalization: unreal self; With Derealization: unreal
situation
Acute stress disorder Stress ako! 3 days to 1 month (directly
experiencing,witnessing, learning trauma except through
electronic media, television, movies, or pictures unless work
related)

TRAUMA-AND STRESSOR-RELATED DISORDERS

Disinhibited Social Engagement Disorder Over sya! (A child
actively approaches and interacts with unfamiliar adults) 9-12
months.
Adjustment Disorder : Di ko Carry! stressors occuring within 3
months (with depressed mood, with anxiety, with mixed anxiety
and depressed mood)

TRAUMA-AND STRESSOR-RELATED DISORDERS

Reactive Attachment Disorder I dont care (Children: minimally
seeks comfort when distressed; minimal social and emotional
responsiveness to others) (9 months age 5)

What do we do when we are so sad?

BIPOLAR AND RELATED DISORDERS
DEPRESSIVE DISORDERS

Bipolar and Related Disorders

BIPOLAR 1: Classic Manic-depressive Disorder
BIPOLAR 2

DEPRESSIVE DISORDERS
DISRUPTIVE MOOD DYSREGULATION DISORDER: Grrrr! Severe
recurrent temper outbursts manifested verbally.

Major Depressive Disorder: LEWIS

PREMENSTRUAL DYSPHORIC DISORDER (on menstrual cycles: mood

swings; increased sensitivity)

How do we experience our body?

FEEDING AND EATING DISORDERS
DISRUPTIVE, IMPULSE-CONTROL AND CONDUCT DISORDERS

FEEDING AND EATING DISORDERS

PICA kain lang! Persistent eating of nonfood substances
of at least 1 month.
REMUNITION DISORDER Nguya lang ng nguya!
Regurgitated food may be re-chewed, re-swallowed, or
spit out.
AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER Yoko
nyan! Conditioned negative resposne associated with
food intake.

Eating
Disorders
Anorexia nervosa
Bulimia nervosa
Binge-eating disorder
Definition

Anorexia Nervosa

Compulsion to lose weight, coupled with certainty

about being fat despite being 15 percent or more
underweight

Bulimia Nervosa

Compulsion to binge, eating large amounts fast, then

purge by losing the food through vomiting, laxatives,
and extreme exercise

Binge-Eating Disorder

Compulsion to binge, followed by guilt and depression

DISRUPTIVE, IMPULSE CONTROL & CONDUCT

DISORDER
Oppisitional Defient Disorder: Ako ang correct! frequent and
persistent pattern of anger/irritable mood, argumentative and
defiant behavior or often argues with authoritative figures.
Intermittent Explosive Disorder: Boom! aggressive outbursts that
may last for less than 30 minutes.
Conduct Disorder: Hayup! Aggression to People and animals (may
develop ASPD)

DISRUPTIVE, IMPULSE CONTROL & CONDUCT

DISORDER
Pyromania: Sunog-Sunugan lang! deliberate fire setting
Kleptomania: Kating Palad! failure to resist impulses to steal
objects

How do we experience change over time?

NEURODEVELOPMENTAL DISORDERS

Neurodevelopmental Disorders
Intellectual disability: Deficits in intellectual functions
Communication Disorders:

Language Disorder limited sentence structure.

Speech Sound Disorder difficulty with speech sound
production.
Childhood-Onset Flueny Disorder (Stuttering)
disturbance in the normal fluency and time patterning
of speech.

Neurodevelopmental Disorders
Communication Disorders:
Social (Pragmatic) Communication Disorder difficulty
understanding social cues.
Autism Spectrum Disorder repetitive patterns of behavior and
deficit in social interaction across multiple contexts.
ADHD persistent inattention and/or hyperactivity-impulsivity
that interferes with functioning and development.
Specific Learning Disorder- difficulties learning and using
academic skills

Neurodevelopmental Disorders
Communication Disorders:

Developmental Coordination Disorder clumsiness and

inaccuracy of performance.
Stereotypic Movement Disorder repetitive and
purposeless motor behavior (hand shaking, waving,
body rocking, head banging, self-biting, hitting own
body)
Tic Disorders sudden nonryhtmic motor movement

27. In Binge-Eating/Purging Type anorexia nervosa, self-starvation is

associated with:
a. Not eating to help control weight gain

b. Not being bothered about weight gain

c. Regularly engaging in purging activities to help control weight
gain
d. Eating only certain food types

28. In Bulimia nervosa, the nonpurging sub-type, a behavior which is

used to compensate for binging is___
a. Exercise

b. Controlling intake of certain food types

c. Withdrawing from social interaction
d. Controlling carbohydrate intake

29. Individuals with bulimia have a perceived lack of control over

their eating behavior, and often report which of the following?
a. High levels of self-disgust

b. Low self-esteem
c. High levels of depression
d. All of the above

30. In animal research, lesions to which part of the brain have been
shown to cause appetite loss, resulting in a self-starvation
syndrome?
a. Lateral hypothalamus
b. Cerebrum
c. Amygdala
d. Basal ganglia

31. Body dissatisfaction is associated with triggering bouts of:

a. Purging
b. Binging
c. Dieting
d. Shopping

32. Which of the following is a prominent characteristic of

individuals with eating disorders?
a. High self-esteem

b. Low self-esteem
c. High levels of responsibility
d. Narcissism

33. Which of the following characteristics has regularly been

implicated in the aetiology of eating disorders?
a. Perfectionism

b. Narcissism
c. Extraversion
d. Introversion

Schizophrenia:
Psychosis refers to a
mental split from
reality and rationality.

the mind is split from reality, e.g. a split

from ones own thoughts so that they
appear as hallucinations.

Introduction: SCHIZOPHRENIA

Schizophrenia translates to
split mind.
This is not to be confused
with split personality.

How Common is the Disorder?

1% of the population suffers from this
disorder.
Average onset 20-29 yrs. of age
It is a very costly illness to treat.
Often times, it will require extensive
hospital care.
Medications are also quite expensive

Schizophrenia

Is not one disorder but a group

of disorders.

History
Emil Kraepelin: Dementia praecox
Eugen Bleuler: He renamed Kraepelins
dementia praecox as schizophrenia (1911);
splitting of mind.

Kurt Schneider: He emphasized the role of

psychotic symptoms, as hallucinations,
delusions and gave them the privilege of
the first rank symptoms even in the
concept of the diagnosis of schizophrenia.

Schizophrenia
About 1% of people are diagnosed with
schizophrenia.
Symptoms of Schizophrenia:
1.Disorganized thinking.
2.Disturbed Perceptions.
3.Inappropriate Emotions and Actions.
4.Deterioration of Adaptive Behaviors.

1.) Disorganized Thinking

The thinking is
fragmented, bizarre,
and cannot filter out
information.

Delusions (false beliefs)

Delusions of Persecution (people Delusions of Grandeur (belief
that you are more important
are out to get you).
than you really are).

More about Delusions (cont.)

The persons train of thought
deteriorates.
Thinking becomes chaotic rather
than logical.
Might say wild things that have
nothing to do with each other.
word salad dinglehopper
Little Mermaid

2.) Disturbed Perceptions

Hallucinations (usually
auditory) is a false perception.

Distorted Perception:
Hallucinations are the most common.
seeing other people, smells
These voices often make rude comments or
can even be in the form of a running
commentary on their lives.

3.) Inappropriate Emotions and Actions

Laugh at inappropriate times.
Flat Effect (emotionless).
Senseless, compulsive acts.
Catatonia - motionless waxy flexibility.

Disturbed Emotions:
Some patients show a
flattening of emotions no
response
Others show inappropriate
emotional responses these
may not fit with the situation
or with what they are saying.
They may also become
emotionally volatile. (erratic
or unpredictable)

4: Deterioration of Adaptive Behavior:

Routines get thrown out the
window. (work, social
relationships, etc.)
The ability to get up for work,
shower, eat breakfast, etc.
would be difficult for a
schizophrenic.
Personal hygiene is also often
neglected.

A schizophrenic patient believes that they are the smartest

person in the world. This false belief would be considered a:

1.
2.
3.
4.

Hallucinations
Distortion of perception
Delusion
Illusion

Positive vs. Negative Symptoms

Positive Symptoms
Presence of inappropriate symptoms

Negative Symptoms
Absence of appropriate ones.

Positive and Negative Symptoms of Schizophrenia

Positive +
presence of
problematic
behaviors

Hallucinations (illusory perceptions),

especially auditory
Delusions (illusory beliefs), especially
persecutory
Disorganized thought and nonsensical
speech
Bizarre behaviors

Negative absence of
healthy
behaviors

Flat affect (no emotion showing in

the face)
Reduced social interaction
Anhedonia (no feeling of enjoyment)
Avolition (less motivation, initiative,
focus on tasks)
Alogia (speaking less)
Catatonia (moving less)

Why Positive and Negative?

A patient that has more positive symptoms before
treatment will usually respond to treatment better than
a patient with more negative symptoms.
Some researchers classify schizophrenics by positive and
negative rather than by type.

Which of the following is a negative symptom

of schizophrenia?
1.
2.

Delusional thinking
Incoherent speech

3.
4.
5.

Hyper-excitability
Hearing voices
Flat affect

Types of Schizophrenia

Paranoid Schizophrenia

Always paranoid and

preoccupied with delusions of
persecution or grandeur as
well as hallucinations.
Always looking over your
shoulder like somebody is out
to get you!

Paranoid Schizophrenia: Cont.

To make sense of this
persecution they often
develop delusions of grandeur.
They may see themselves as
great inventors, or great
religious or political leaders.
I am the President of the
USA! (Sylvia)

Paranoid Schizophrenia:
Believe they have many
enemies who will harass and
oppress them.
They become suspicious of
friends and family. (being
watched)

Catatonic Schizophrenia:
People with catatonic
schizophrenia display extreme
inactivity or activity that's
disconnected from their
environment or encounters with
other people (catatonic
behavior).
These episodes can last for only
minutes or up to hours.

Catatonic Schizophrenia

Flat emotion.
Waxy flexibility.
Little movement, activity
or speech.
Negativism (resistance to
instructions)
Mutism & Stupor (lack of
verbal and motor
responses)

Catatonic Schizophrenia

Excessive mobility
(excitement), Physical
immobility (stupor)
peculiar movements,
mimicking speech
/movements(echolalia,
and echopraxia)

Disorganized Schizophrenia
Disorganized speech or behavior, or flat or
inappropriate emotion.
Clang associations: speaking in rhyme.
Im the worst
systematic, sympathetic
quite pathetic, apologetic, paramedic.
Word salad: nonsense talk.
Its all over for a squab true tray and there aint
no music. Ive got to travel all the time to keep
my energy alive.

Disorganized Schizophrenia:
Describes a severe deterioration of
adaptive behavior.
Person may become emotionless social
withdrawal.

They may also exhibit excessive babbling

and giggling.
Delusions often center around bodily
functions My brain is melting out of my
ears.

Undifferentiated Schizophrenia
Many varied symptoms.
"Undifferentiated
schizophrenia" is used as a label
for cases of schizophrenia that
don't match any of the
established types of
schizophrenia.

Undifferentiated Schizophrenia:
This is very common because
many schizophrenics display
multiple types of
schizophrenia.

Residual Schizophrenia
This subtype is diagnosed when the
patient no longer displays prominent
positive symptoms (i.e. hallucinations).
The person does show some negative
symptoms like speaking little or being
apathetic.

F21 Schizotypal disorder

According to lCD-10 this disorder
is characterized by eccentric
behavior and by deviations of
thinking and affectivity, which
are similar to that occurring in
schizophrenia, but without
psychotic features and expressed
symptoms of schizophrenia of any
type.

F22.0 Delusional Disorder

A disorder characterized by the
development of one delusion or of the
group of similar related delusions,
which are persisting unusually long,
very often for the whole life.
It begins usually in the middle age.

F25 Schizoaffective Disorders

Episodic disorders in which both
affective and schizophrenic
symptoms are prominent (during
the same episode of the illness or
at least during few days) but which
do not justify a diagnosis of either
schizophrenia or depressive or
manic episodes.

Phases of Schizophrenia
Acute/Reactive Schizophrenia In reaction to stress, some people develop positive
symptoms such as hallucinations.
Recovery is likely.

Chronic/Process Schizophrenia develops slowly, with more negative symptoms such

as flat affect and social withdrawal.
With treatment and support, there may be periods of a normal life, but not a
cure.
Without treatment, this type of schizophrenia often leads to poverty and social
problems.

Predicting Schizophrenia:
Early Warning Signs
Social/psychological factors
which tend to appear before
the onset of schizophrenia:

early separation from parents

short attention span
disruptive OR withdrawn behavior
emotional unpredictability
poor peer relations and/or solitary
play

Biological factors which

tend to appear before the
onset of schizophrenia:

having a mother with severe

chronic schizophrenia
birth complications, including
oxygen deprivation and low birth
weight
poor muscle coordination

What Causes Schizophrenia?

The exact cause of schizophrenia is not yet known

It is not the result of bad parenting or personal weakness
The Big Three:
1. Genetics
2. Brain Chemistry
3. Environmental Factors

Genetics

Schizophrenia tends to run in families

Parents dont have schizophrenia =1% chance
1 parent has schizophrenia = 14%
Both parents have schizophrenia = 46%

Understanding Schizophrenia
Whats going on in the
brain in schizophrenia?

Abnormal brain structure

and activity
Too many dopamine/D4 receptors help to explain
paranoia and hallucinations; its like taking
amphetamine overdoses all the time.
Poor coordination of neural firing in the frontal
lobes impairs judgment and self-control.
The thalamus fires during hallucinations as if real
sensations were being received.
There is general shrinking of many brain areas and
connections between them.

Understanding Schizophrenia
Are there biological risk factors
affecting early development?

Biological Risk Factors

Schizophrenia is somewhat more likely to develop
when one or more of these factors is present:

low birth weight

maternal diabetes
older paternal age
famine
oxygen deprivation during delivery
maternal virus during mid-pregnancy impairing brain
development

Schizophrenia is more likely

to develop in babies born:
during and after flu
epidemics.
in densely populated
areas.
a few months after flu
season.
after mothers had the flu
during the second
trimester, or had
antibodies showing viral
infection.
The lesson is to:
get flu shots with
early fall
pregnancies.

Biological Causes of Schizophrenia

Possible causes:
Enlarged ventricles (fluid filled
spaces) in the brain.
Shrinkage of brain tissue in limbic
system.

Environmental Factors:
Stress can bring out schizophrenic symptoms such as
delusions and hallucinations
Schizophrenia more often surfaces when the body is
undergoing hormonal and physical changes, such as those
that occur during the teen and young adult years.

Psychological Causes of Schizophrenia

There is NO proof that any social
or psychological factors cause
schizophrenia.
We dont know what role stress or
disturbed family communications
play.
The just appear to be correlated.

Lets check your Mind!!!!!

Functional changes in brain

Functional changes in brain

Schizophrenics cant
shift attention to other
criterion

Lets recall schizophrenia!

Subtypes of Schizophrenia
Paranoid
Plagued by hallucinations, often with negative messages, and
delusions, both grandiose and persecutory
Disorganized
Primary symptoms are flat affect, incoherent speech, and random
behavior

Catatonic
Rarely initiating or controlling movement; copies others speech
and actions
Undifferentiated
Many varied symptoms
Residual
Withdrawal continues after positive symptoms have disappeared

 Early detection and treatment

has the best results/response to
treatment.
For patients, once you have
schizophrenia you have it for
life. The best you can hope for
is control.

15. In Schizophrenia in reality-monitoring deficit refers to which of

the following:
a. Problem distinguishing between thoughts and ideas they
generated themselves.
b. Problems with memory loss.
c. Problems with spatial ability.
d. Problems distinguishing between what actually occurred and
what did not.

16. In schizophrenia, when an individual has disorganized speech

the term clanging refers to:
a. Individuals only communicate with words that rhyme.

b. Answers to questions may not be relevant.

c. Individuals communicate without completing their sentences.
d. Speech may neither structured nor comprehensible.

17. poverty of content in Schizophrenia is when:

a. Speech appears to be detailed in terms of numbers of words, but
is grammatically incorrect.

b. A tendency to jump from one topic to another within a sentence.

c. Poor use of vocabulary.
d. Poor use of grammar.

18. In Schizophrenia, the term anhedonia refers to?

a. An inability to enjoy food
b. An inability to express empathy
c. An inability to react to enjoyable or pleasurable events.
d. An inability to react appropriately to social cues.

19. Paranoid schizophrenia is a sub-type of Schizophrenia which is

characterized by:
a. The presence of disorganized behavior and flat or inappropriate
affect.
b. The presence of delusions or auditory hallucinations.
c. The severe disturbance of motor behavior.
d. A lack of prominent positive symptoms with evidence of on-going
negative symptoms.

Other Disorders
Dissociative
Disorders

Personality
Disorders

Dissociative Disorders
Disorders in which the
sense of self has become
separated (dissociated)
from previous memories,
thoughts, or feelings.

What are Dissociative Disorders?

Dissociative Disorder Disorders in which conscious

awareness becomes separated
(dissociated) from previous
memories, thoughts and
feelings.

Dissociative
Disorders

Examples:
Dissociative
Amnesia:

Loss of memory with no known physical cause; inability to recall

selected memories or any memories

Dissociative
Fugue

Running away state; wandering away from ones life, memory, and
identity, with no memory of these

Dissociative
Identity
Disorder
(D.I.D.)

Development of separate personalities

 Dissociative Amnesia
Dissociative Fugue
Dissociative Identity Disorder

Localized Amnesia:
Localized amnesia is present in an individual
who has no memory of specific events that
took place, usually traumatic.
Example: a survivor of a car wreck who has
no memory of the experience until two days
later is experiencing localized amnesia.

Selective Amnesia:
Selective amnesia happens when a person
can recall only small parts of events that took
place in a defined period of time.
Example: An abuse victim may recall only
some parts of the series of events around the
abuse.

Generalized Amnesia:
Generalized amnesia is diagnosed when a
person's amnesia encompasses his or her
entire life.
Example: I dont know who I am.

Systematized amnesia
Systematized amnesia is
characterized by a loss of
memory for a specific
category of information.
Example: A person with this
disorder might be missing all
memories about one specific
family member.

Organic Amnesia
(not a dissociative disorder)
Results from other medical trauma (e.g. a blow to the head, stroke,
alcoholism).

Dissociative Fugue
A form of dissociative amnesia characterized by physical
relocation and the assumption of a new identity with amnesia
for the previous identity. (Traveling amnesia).

These journeys can last hours, even several days, months or years.

Dissociative Identity Disorder (D.I.D.) formerly

Multiple Personality Disorder
In the rare actual cases of D.I.D.,
the personalities:
are distinct, and not present in
consciousness at the same
time.
may or may not appear to be
aware of each other.

D.I.D., or DID Not?

Evidence that D.I.D. is Real
Different personalities have
involved:
different brain wave patterns.
different left-right handedness.
different visual acuity and eye
muscle balance patterns.
Patients with D.I.D. also show
heightened activity in areas of the
brain associated with managing and
inhibiting traumatic memories.

Dissociative Identity Disorder:

DID - A rare dissociative

disorder in which a person
exhibits two or more
distinct and alternating
personalities.

Dissociative Identity Disorder (D.I.D.)

Used to be known as Multiple Personality
Disorder.
Often confused with schizophrenia.
People with D.I.D. commonly have a history
of childhood abuse or trauma.
Unlike schizophrenics, they have 2 or more
distinct identities, are not psychotic, and
have severe memory lapses.

Conditions:
Four conditions for diagnosis:
Presence of two or more distinct
personalities
At least two take control of persons
behavior
Inability to recall important
personal information
Not related to drugs or medical
condition

More about DID:

Generally individuals who have
this disorder are identified
initially because they complained
of having lost periods of time
during which they apparently
were doing something but have no
recollection of what.
Long-term psychotherapy is the
treatment of choice.
Therapy consists in attempt to
uncover trauma.

Key Facts About DID:

This disorder is RARE
Each personality may have its own
name, memories, traits, and physical
mannerisms.
May also be different in age, race,
gender, and sexual orientation.
Alters are commonly quite different
from one another.
The alters can come on suddenly

Causes:
Little is known
Stress
Intentional role playing (stemming from
inferiority)
Media reinforcement (Before Sybil, 1973 (2
or 3 alters, now 15 or more)
Most common cause: Severe physical,
sexual, emotional abuse, or rejection
(usually during childhood)
More likely to occur in females

Controversy:
Controversy
Only 200 cases before 1970
Now may run as high as 5% of inpatient
hospital admissions
- Some Psychologists think this is becoming
a cultural phenomenon

More about somatization disorder:

The disorder usually begins before the age
of 30 and occurs more often in women than
in men.
Patients are often dismissed by their
physicians as having problems that are "all
in your head.
Doctors will often think these patients are
making up their symptoms.

Somatoform Disorders
Disorders in which symptoms take a bodily
form without apparent physical cause.
Two types

Hypochondriasis
Characterized by imagined
symptoms of illness.
They usually believe that
the minor issues
(headache, upset stomach)
are indicative of more
severe illnesses.

Hypochrondriasis:
Hypochrondriasis - Patient
unrealistically interprets physical
signs such as pain, lumps, and
irritations as evidence of
serious illness.
Headache = brain tumor
They show excessive anxiety
about one or two symptoms.

What causes hypochondriasis?

Factors that might be involved in the
development of the disorder include the
following:
1. A history of physical or sexual abuse
2. A poor ability to express emotions
3. A parent or close relative with the
disorder Children might learn this
behavior if a parent is overly concerned
about disease and/or overreacts to even
minor illnesses.

Conversion Disorder

Loss or impairment of
some motor or sensory
function due to a
psychological conflict
or stress.
Formerly known as
hysteria.

Sigmund Freud

Conversion Disorder:
Patient will lose control of bodily
functions such as: becoming blind,
deaf, or paralyzed.
Anxiety will bring on these
symptoms.

Outcomes for People with Psychological Disorders

There are risks to be watchful of, obstacles to be

overcome, and improvements to be made, often
with the help of with treatment.
Some people with psychological disorders do not
recover.
Some achieve greatness, even with a
psychological disorder.

THE FINALE!!!!!
PSYCHOPATHOLOGY
DR. JOSEPH C. FRANCISCO, RP, RPm

Personality Disorders

Personality
Disorders

Personality disorders are

enduring patterns of social and
other behavior that impair social
functioning.

Personality Disorders:
Personality disorder person has
longstanding, maladaptive thought and
behavior patterns that are troublesome to
others, harmful, or illegal.
Key Fact these patterns may impair a
persons social functioning BUT they usually
do not create anxiety, depression, or
delusions.

Main Features of PDs

Extreme patterns of thinking, feeling, and behaving that
deviate from a persons culture
Begin early in life
Inflexible and maladaptive
Cause significant functional impairment and subjective
distress
- ego-syntonic vs. ego-dystonic

CLUSTER A: Odd / Eccentric

Paranoid Unwarranted
suspiciousness and mistrust,
overly sensitive, often envious
Schizoid Shy, withdrawn
behavior, poor capacity for
forming social relationships
Schizotypal Odd thinking, often
suspicious and hostile

Paranoid Personality Disorder

suspicious of others motives
interprets actions of others as deliberately
demeaning/threatening
expectation of being exploited
easily insulted/ bears grudges
appear cold and serious

Schizoid Personality Disorder

indifferent to relationships
limited social range (some are hermits)
aloof, detached, called loners
no apparent need of friends, sex
solitary activities

Schizotypal Personality Disorder

peculiar patterns of thinking and behavior

perceptual and cognitive disturbances
magical thinking
not psychotic
perhaps a distant cousin of schizophrenia

CLUSTER B: Dramatic / Emotionally

Problematic
Histrionic Excessively dramatic; seeking attention and
tending to overreact, egocentric
Narcissistic Unrealistically self-important, expects
special treatment, cant take criticism
Borderline Emotionally unstable, impulsive,
unpredictable, irritable
Antisocial Used to be called sociopaths or psychopaths,
violate other peoples rights without guilt or remorse,
can commit many violent crimes

Histrionic Personality Disorder

excessive emotional displays/
dramatic behaviour
attention-seeking, victim stance
seek re-assurance, praise
shallow emotions, flamboyant, selfcentred
very seductive, life of the party

Narcissistic Personality Disorder

grandiose, sense of self-importance
lack of empathy
hyper-sensitive to criticism
exaggerate accomplishments/ abilities
special and unique
entitlement
below surface is fragile self-esteem

Borderline Personality Disorder

marked instability of mood, relationships, self-image

intense, unstable relationships
uncertainty about sexuality
everything is good or bad
chronic feeling of emptiness

recurrent threats of self-harm/ slashers

Antisocial Personality Disorder

pattern of irresponsibility, recklessness, impulsivity beginning
in childhood or adolescence (e.g., lying, truancy)

adulthood:

criminal behaviour
little adherence to societal norms,
little anxiety
conflicts with others
callous/exploitive

Psychopathy
Egocentric, deceitful, shallow, impulsive individuals who use and
manipulate others
Callous, lack of empathy

Little remorse
Thrill-seeking
human predators (Hare, 1993)
No conscience

Biosocial Roots of Crime: The Brain

People who commit
murder seem to
have less tissue
and activity in the
part of the brain
that suppresses
impulses.

Other differences include:

less amygdala response when viewing violence.
an overactive dopamine reward-seeking system.

Antisocial Personality Disorder [APD]

Antisocial personality disorder
refers to acting impulsively or
fearlessly without regard for
others needs and feelings.
The diagnostic criteria include
a pattern of violating the
rights of others since age 15,
including three of these:

Deceitfulness
Disregard for safety of self or others
Aggressiveness
Failure to conform to social norms
Lack of remorse
Impulsivity and failure to plan ahead
Irritability
Irresponsibility regarding jobs, family, and
money

Which Kids May Develop APD as Adults?

Which kids are at risk?
Psychological factors:
those who in preschool
were impulsive,
uninhibited,
unconcerned with
social rewards, and low
in anxiety.
those who endured
child abuse, and/or
inconsistent,
unavailable caretaking.

Biological APD Risk Factors

Antisocial or unemotional biological
relatives increases risk.
Some associated genes have been
identified.
Risk factors include body-based
fearlessness, lower levels of stress
hormones, and low physiological arousal in
stressful situations such as awaiting
receiving a shock.
Fear conditioning is impaired.
Reduced prefrontal cortex tissue leads to
impulsivity.
Substance dependence is more likely.

Antisocial PD Criminality

Criminals: people
who repeatedly
commit crimes

People with
antisocial
personality
disorder

CLUSTER C: Chronic Fearfulness / Avoidant

Avoidant Excessively sensitive
to potential rejection, desires
acceptance but is socially
withdrawn
Dependent excessively lacking
in self-confidence, allows others
to make all decisions
Obsessive-compulsive usually
preoccupied with rules,
schedules, and details

Avoidant Personality Disorder

over-riding sense of social discomfort
easily hurt by criticism
always need emotional support
occasionally try to socialize
so distressing they retreat into
loneliness

Dependent Personality Disorder

submissive, clingy behaviour

fear of separation
easily hurt by criticism

Obsessive-Compulsive
Personality Disorder
excessive control and perfectionism
inflexible
preoccupied with trivial details
judgmental/moralistic
workaholic/ignore family members
often humourless

20. A sub-type of Schizophrenia known as Catatonic schizophrenia is

characterized by:
a. The severe disturbance of motor behavior.

b. The presence of disorganized behavior and flat or inappropriate

affect.
c. The presence of delusions or auditory hallucinations.
d. A lack of prominent positive symptoms with evidenced of ongoing negative symptoms.

21. A sub-type of Schizophrenia known as Residual Type

schizophrenia is characterized by:
a. The presence of delusions or auditory hallucinations.

b. A lack of prominent positive symptoms with evidence of on-going

negative symptoms.
c. The presence of disorganized behavior and flat or inappropriate
affect.
d. The severe disturbances of motor behavior.

22. In Schizophrenia, the diathesis-stress perspective refers to

which combination?
a. Low self-esteem and environmental stress.

b. Genetically-inherited biological factors and environmental

stress.
c. Gender and environmental stress
d. Intelligence and life stress.

23. The biochemical theory of schizophrenia known as the Dopamine

hypothesis refers to:
a. Insufficient dopamine activity

b. Contaminated dopamine
c. Excess dopamine activity
d. Allergic sensitivity to dopamine

24. Antipsychotic drugs such as the phenothiazines are used to help

treat Schizophrenia, by:
a. Blocking the brains dopamine receptor sites and so reducing
dopamine activity
b. Increasing brain dopamine activity
c. Replacing dopamine with norepinephrine
d. Preventing re-uptake of Serotonin.

25. Individuals with Schizophrenia who cannot infer the beliefs,

attitudes and intentions of others are said to lack:
a. Theory of Mind

b. Intelligence
c. Self-esteem
d. Sense of self

34. Which of the following is NOT a criterion of Borderline

Personality Disorder?
a. Instability in personal relationships

b. Lack of well-defined and stable self-image

c. Excessive worries and poor judgment of reality.
d. Unpredictable changes in moods, and impulsive behavior

35. Which of the following is NOT a characteristic of individuals with

paranoid personality disorder?
a. Avoidance of close relationships

b. Avoidance of public places

c. Are often spontaneously aggressive to others
d. Often feel that they have been deeply and ineversibly betrayed
by others.

36. Which of the following is a subtype of Dramatic/Emotional

Personality Disorders (Cluster B)
a. Paranoid Personality Disorder

b. Schizotypal Personality Disorder

c. Histrionic Personality Disorder
d. Schizoid Personality Disorder

37. The term sociopath or psychopath is sometimes used to

describe which type of personality disorder
a. Histrionic PD

b. Antisocial PD
c. Paranoid PD
d. Schizotypal PD

38. An individual with narcissistic personality disorder will routinely

overestimate their abilities and inflate their accomplishments, and
this is characterized by which of the following?
a. A pervasive need for admiration
b. An inability to monitor reality
c. Impulsive behavior such as drug abuse
d. Unusual ideas of reference

39. The apparent lack of empathy and the tendency to exploit

others for self-benefit, has lead psychologists to compare
narcissistic personality disorder with which of the following?
a. Histrionic PD
b. Antisocial PD
c. Paranoid PD
d. Schizotypal PD

40. Which of the following are considered to be the main features

of avoidant personality disorder?
a. Persistent social inhibition

b. Feelings of inadequacy
c. Hypersensitivity to negative evaluation
d. All of the above

41. Which of the following is NOT considered to be a risk factor for

personality disorders?
a. Living in inner cities

b. Low socioeconomic class

c. Gender
d. Being a young adult

42. According to psychodynamic theory which of the following is

NOT deemed to be characteristic of the parents of an individual
with paranoid personality disorder?
a. Demanding
b. Absent
c. Distant
d. Over rigid

43. Personality disorders are an enduring patterns of behavior that

persist from childhood into adulthood and because of this fact, one
of the best predictors of APD in adulthood is a diagnosis of:
a. Conduct disorder
b. Attention deficit disorder
c. Attachment disorder
d. Childhood disorder

44. Behavior of individuals with antisocial personality disorder often

appears impulsive and unpredictable due to switching quickly and
unpredictably between:
a. Dysfunctional memories
b. Dysfunctional schemas
c. Dysfunctional hearing
d. Dysfunctional balance

45. More recent research has linked Borderline Personality Disorder

(BPD) with bipolar disorder, and the two are often comorbid. Some
individuals with BPD belong to a broader:
a. Bipolar disorder spectrum
b. Social anxiety spectrum
c. Social identity spectrum
d. Generalized anxiety spectrum

46. Evidence suggests that individuals with Borderline Personality

Disorder have a number of brain abnormalities that may give rise to
impulsive behavior. there is evidence for dysfunctional in brain:
a. Circuitry
b. Dopamine
c. Anatomy
d. Corpus callosum functioning

49. Narcissistic personality disorder is also closely associated with

antisocial personality disorder (APD). Which of the following is not a
way in narcissistic individuals will regularly act:
a. Self-motivated
b. Deceitful
c. Aggressive
d. Withdrawn

50. Which of the following is NOT usually associated with Avoidant

Personality Disorder?
a. Low self-esteem

b. Feelings of shame
c. Feelings of guilt
d. Feelings of superiority

NeuroCognitive Disorders
Neurocognitive disorders

Dementia:

Why Do They Do That?

How Can I Help?

When Do I Need Help?

REALIZE

It Takes TWO to Tango

or two to tangle

386

387
Being right doesnt necessarily translate into
a good outcome for both of you

388
Its the relationship that is MOST critical
NOT the outcome of any one encounter

389
As part of the disease people with dementia
tend to develop typical patterns of speech,
behavior, and routines.
These people will also have skills and abilities
that are lost while others are retained or
preserved.

What is it NOT
NOT Normal Aging
NORMAL Aging

Slower to think
Slower to do
Hesitates more
More likely to look before you leap
Know the person but not the name
Pause to find words
Reminded of the past

390

Cant think the same

Cant do like before
Cant get started
Cant seem to move on
Doesnt think it out at all
Cant place the person
Words wont come even later
Confused about past versus now

What Could It Be?

Another medical condition

Medication side-effect
Hearing loss or vision loss
Depression
Acute illness
Severe but unrecognized pain
Other things

391

DEMENTIA

Alzheimers
Disease
Early - Young Onset
Normal Onset

Vascular
Dementias
(Multi-infarct)

Lewy Body
Dementia

FrontoTemporal Lobe
Dementias

Other Dementias
Genetic syndromes
Metabolic pxs
ETOH related
Drugs/toxin exposure
White matter diseases
Mass effects
Depression(?) or Other Mental
conditions
Infections BBB cross
Parkinsons

Delirium
Disturbance in attention (hours to a few days)
Memory deficit, disorientation, language

Specify whether:
Substance intoxication delirium
Substance withdrawal delirium
Medication-induced delirium

Major Neurocognitive disorders

Significant cognitive decline (complex attention, executive
function, learning and memory, language, perceptual-motor, or
social cognition.
Specify whether due to:
Alzheimers disease
Traumatic brain injury
Substance/medication use
Parkinsons disease
Huntingtons disease

Minor Neurocognitive Disorder

The cognitive deficits do not

interfere with capacity for
independence in everyday
activities.

Alzheimers

New information lost

Recent memory worse
Problems finding words
Mis-speaks
More impulsive or indecisive
Gets lost
Notice changes over 6 months 1 year

396

Vascular Dementia

Sudden changes
Can have bounce back & bad days
Judgment and behavior not the same
Spotty losses
Emotional & energy shifts

397

Lewy Body Dementia

Movement problems - Falls

Visual Hallucinations
Fine motor problems hands & swallowing
Episodes of rigidity
Nightmares
Fluctuations in abilities
Drug responses can be extreme & strange

398

Fronto-Temporal Dementias
Many types
Frontal impulse and behavior control loss
Says unexpected, rude, mean, odd things to others
Dis-inhibited food, drink, sex, emotions, actions
Temporal language loss
Cant speak or get words out
Cant understand what is said, sound fluent nonsense words

399

What is Dementia?...
It is BOTH

a chemical change in the brain

AND
a structural change in the brain

So
Sometimes they can & sometimes they cant

400

PET and Aging

PET Scan of 20-Year-Old Brain

ADEAR, 2003

401

PET Scan of 80-Year-Old Brain

402

403
Learning & Memory
Center
Hippocampus
BIG CHANGE

404

Understanding Language BIG CHANGE

405

Hearing Sound Not Changed

Sensory Strip
Motor Strip
White Matter Connections
BIG CHANGES

Automatic Speech
Rhythm Music
Expletives
PRESERVED
Formal Speech & Language
Center
HUGE CHANGES

407
Executive Control
Center
Emotions Behavior
Judgment
Reasoning

408

Vision Center BIG CHANGES

Positron Emission Tomography (PET)

Alzheimers Disease Progression vs. Normal Brains
Normal

G. Small, UCLA School of Medicine.

Early
Alzheimers

Late
Alzheimers

Child

409

So What is Dementia?

It
It
It
It
It
It

changes everything over time

is NOT something the person can control
is NOT always the same for every person
is NOT a mental illness
is real
is hard at times

410

Four Key Building Blocks

Activities to Relax & Re-energize
Activities to Feel Productive & Valued
Activities for Fun & Just Because
Activities to Take Care of Yourself

415

Things that will HELP

Build activities
Get active
Socialize
De-Stress
Get enough sleep
Get sleep apnea & depression treated
Control blood pressure & diabetes
Take meds CAREFULLY

417

Care Partners

Be a partner, not a boss

Be an advocate, build a team
Do with me, not for me or to me
Learn the SO WHAT? philosophy
Learn to let go not give up
Learn what you are good at, & what not
These ideas are for you TOO!

419

Some Key Beliefs & Principles:

All people need to be needed nurturing is a critical part of
life worth living
Dementia Steals Away Roles and Responsibilities that Make Us
WHO We Are
Activities can make a critical difference in the health and
well-being of people with dementia
IF
Used Appropriately for the degree of involvement it will
make a difference.

420

Therapy Types: Group Therapy

Group Therapy Helps people
because they realize that
others have similar problems.
Get information from therapist
and other group members
Cheaper than individual
therapy

Therapy Types: Couples and Family Therapy

Couples and Family Therapy
Therapist acts as a mediator
between the couples
The focus is to improve their
relationships

Therapy Types: Self-Help Groups

Self-help groups groups
themselves lead the group, not
a therapist
Tend to have a spiritual focus
Alcoholics Anonymous acts
as a peer support and outlet

Deinstitutionalization:
Serious overcrowding became a problem in the 1950s (neglect)
With creation of better meds, less hostile patients were placed
back in regular communities.

Drawback people cant make it on their own they cant afford

meds or treatment

Treatment Approaches:
No approach is ideal
Psychoanalysis
Behavioral
Humanistic
Cognitive
Biological

Psychoanalysis Terms:
Old terms:
Free association, manifest content, latent content, Hypnosis
New terms:
Resistance Blocking of anxiety-provoking feelings, coming
late for sessions (problem)
Transference Client learns to see therapist as significant
person in their life (open up)
Catharsis The release of emotional tension after reliving an
emotionally charged experience from the past.

Behavioral Terms:
Old terms:
Behavioral therapy, systematic desensitization, flooding, token economy,
primary/secondary reinforcers, behavior modification, aversive
conditioning
New terms:
Anxiety hierarchy Create a hierarchy of fears from least feared to
most (start small and work up)
Social skills training Treat patients using modeling, rehearsal, and
shaping
Biofeedback Giving immediate physiological feedback when treating a
patient this can lesson arousal (heart rate, blood pressure)

Humanistic Terms: Client Chooses Direction

of Therapy
Old terms:
Unconditional positive regard, self-actualization, ideal
self, real self
New terms:
Active listening Involves echoing, restating, and
seeking clarification of what the client says and does
Gestalt therapy Allows client to decide whether they
will allow past conflicts to control their future or
whether they will control their destiny

Cognitive Approach:
New Terms:
Cognitive restructuring Turning the distorted thoughts
into more realistic thoughts
Rational emotive therapy aims at eliminating selfdefeating thoughts. (Albert Ellis)
Cognitive triad Looks at what a person thinks about his
self / world / future (Aaron Beck)

Biological Terms:
Old Terms:
Tolerance, stimulants
New Terms:
Psycho pharmacotherapy The use of psychotropic to treat
mental disorders
Electroconvulsive shock treatment is given to treat mental
disorders (shocks impaired region of the brain to get it to
work more or less efficiently)
Psychosurgery the removal of brain tissue

Gender Dysphoria

Gender Identity Disorder GID

Introduction..

What is Gender Dysphoria... ??

it is a psychiatric disorder, occurring when an

individual feels uncomfortable with their
biological sex and wishes to change it. Prejudice
and negative feelings of anxiety and distress can
be experienced, leading to depression, self harm
and even suicide.

Gender Dysphoria...

It affects more males than females (On average, men are

diagnosed with gender dysphoria five times more often than
women).
The role of hormones is used to alter their physical features of
the person i.e. give them a more masculine or feminine
appearance with the ultimate remedy being gender re-assignment
surgery.

Gender Dysphoria...

This is a complex condition. People who have it

believe that they were somehow born into the
wrong body, and they often prefer to live as a
member of the opposite sex.
There is confusion between their sex, their
gender identity and their gender role.

Remember these definitions ..

Sex
Gender
identity

Gender
role

Whether someone is biologically male or female. Males have the sex

chromosomes XY and females and the sex chromosomes XX.

Whether someone

feels male or female.

Whether someone behaves in a stereotypical or socially/ culturally

male or female way.

Research Evidence for Gender Dysphoria

Biological i.e. genes and hormones
(nature)

Environmental ..
Social learning theory (SLT) could also play
a part with an absence of or inappropriate
role models to imitate.
(nurture)

By the way ..

The term transsexual should not however be confused with

transvestism or cross-dressing, which involves dressing as the
opposite sex for emotional or sexual pleasure.

Transvestites are content with their gender identity but enjoy the fantasy
of pretending to be a member of the opposite sex.

Biological Explanations

The role of genetics

Attention has centred on gene variants of the androgen receptor

that influence the action of testosterone and is in the
masculinisation of the brain.
More research is needed, especially to identify what types of
environmental factors are required to elicit an influence and the
biological processes through which genetic effects may be
medicated.

The role of hormones

Many gender dysphorics take opposite sex hormones as part of

their treatment but little is known effects of this process.
What evidence there is does not indicate any substantial
differences in hormone levels in individuals with gender dysphoria.

Socio-Cultural Theories: Family, Social, Interpersonal

Theory on Trauma

Substance Related
Disorders
Substance Abuse & Substance Dependence

Diagnoses associated with class of substances

Alcohol
Amphetamines
Caffeine
Cannabis
Cocaine
Hallucinogens

Inhalants
Nicotine
Opioids
Phencyclidine
Sedatives, hypnotics, or
anxiolytics
Polysubstance

Features of Substance Dependence

The essential feature of Substance
Dependence is a cluster of cognitive,
behavioral, and physiological symptoms
indicating that the individual continues use of
the substance despite significant substancerelated problems.
Although not specifically listed as a criterion
item, craving is likely to be experienced by
most (if not all) individuals with Substance
Dependence.

Criteria for Substance Dependence

Tolerance, as defined by either of the
following: markedly diminished effect
with continued use of the same
amount of the substance.

Criteria for Substance Abuse

Recurrent substance use resulting in a failure to fulfill major role
obligations at work, school, or home (e.g., repeated absences or poor
work performance related to substance use; substance-related
absences, suspensions, or expulsions from school; neglect of children
or household)

Introduction
Two primary groups:
Substance-use disorders (primarily dependence
and abuse)
Substance-induced disorders (intoxication,
withdrawal, and mental health consequences
of abuse)

Clinical syndromes
Substance dependence: a maladaptive pattern
of substance use that has led to clinically
significant impairment or distress.
The diagnosis is based on having at least three
symptoms occurring at any time during the same
12 month period.

Clinical syndromes

Tolerance (physiological)
Withdrawal (physiological)
Loss of control (psychological)
Cravings
Time spent around substance activity
Preoccupation
Continuation of usage.

Clinical syndromes
Substance abuse includes at least one of the following
symptoms:

Failure to fulfill major role obligations

Recurrent use of substance despite physical hazards
Repeated substance related legal problems
Persistent use despite social or relational problems

Behavioral, Cognitive, and Emotional

Problems

Stress
Insomnia
Anxiety
Depression
Acute psychotic states
Impaired cognition
Violent behavior

Social Problems
Marital and family problems
Legal difficulties
Loss of employment
Financial deterioration
Suicide risk is frequently present in a substance abusing
client particularly as health and psychosocial deterioration is
present.
Careful screening for self-destructive thoughts and/or
impulses is imperative with this population.

CLUSTER C: Chronic Fearfulness / Avoidant

Avoidant Excessively sensitive
to potential rejection, desires
acceptance but is socially
withdrawn
Dependent excessively lacking
in self-confidence, allows others
to make all decisions
Obsessive-compulsive usually
preoccupied with rules,
schedules, and details

20. A sub-type of Schizophrenia known as Catatonic schizophrenia is

characterized by:
a. The severe disturbance of motor behavior.

b. The presence of disorganized behavior and flat or inappropriate

affect.
c. The presence of delusions or auditory hallucinations.
d. A lack of prominent positive symptoms with evidenced of ongoing negative symptoms.

21. A sub-type of Schizophrenia known as Residual Type

schizophrenia is characterized by:
a. The presence of delusions or auditory hallucinations.

b. A lack of prominent positive symptoms with evidence of on-going

negative symptoms.
c. The presence of disorganized behavior and flat or inappropriate
affect.
d. The severe disturbances of motor behavior.

22. In Schizophrenia, the diathesis-stress perspective refers to

which combination?
a. Low self-esteem and environmental stress.

b. Genetically-inherited biological factors and environmental

stress.
c. Gender and environmental stress
d. Intelligence and life stress.

23. The biochemical theory of schizophrenia known as the Dopamine

hypothesis refers to:
a. Insufficient dopamine activity

b. Contaminated dopamine
c. Excess dopamine activity
d. Allergic sensitivity to dopamine

24. Antipsychotic drugs such as the phenothiazines are used to help

treat Schizophrenia, by:
a. Blocking the brains dopamine receptor sites and so reducing
dopamine activity
b. Increasing brain dopamine activity
c. Replacing dopamine with norepinephrine
d. Preventing re-uptake of Serotonin.

25. Individuals with Schizophrenia who cannot infer the beliefs,

attitudes and intentions of others are said to lack:
a. Theory of Mind

b. Intelligence
c. Self-esteem
d. Sense of self

34. Which of the following is NOT a criterion of Borderline

Personality Disorder?
a. Instability in personal relationships

b. Lack of well-defined and stable self-image

c. Excessive worries and poor judgment of reality.
d. Unpredictable changes in moods, and impulsive behavior

35. Which of the following is NOT a characteristic of individuals with

paranoid personality disorder?
a. Avoidance of close relationships

b. Avoidance of public places

c. Are often spontaneously aggressive to others
d. Often feel that they have been deeply and ineversibly betrayed
by others.

36. Which of the following is a subtype of Dramatic/Emotional

Personality Disorders (Cluster B)
a. Paranoid Personality Disorder

b. Schizotypal Personality Disorder

c. Histrionic Personality Disorder
d. Schizoid Personality Disorder

37. The term sociopath or psychopath is sometimes used to

describe which type of personality disorder
a. Histrionic PD

b. Antisocial PD
c. Paranoid PD
d. Schizotypal PD

38. An individual with narcissistic personality disorder will routinely

overestimate their abilities and inflate their accomplishments, and
this is characterized by which of the following?
a. A pervasive need for admiration
b. An inability to monitor reality
c. Impulsive behavior such as drug abuse
d. Unusual ideas of reference

39. The apparent lack of empathy and the tendency to exploit

others for self-benefit, has lead psychologists to compare
narcissistic personality disorder with which of the following?
a. Histrionic PD
b. Antisocial PD
c. Paranoid PD
d. Schizotypal PD

40. Which of the following are considered to be the main features

of avoidant personality disorder?
a. Persistent social inhibition

b. Feelings of inadequacy
c. Hypersensitivity to negative evaluation
d. All of the above

42. According to psychodynamic theory which of the following is

NOT deemed to be characteristic of the parents of an individual
with paranoid personality disorder?
a. Demanding
b. Absent
c. Distant
d. Over rigid

43. Personality disorders are an enduring patterns of behavior that

persist from childhood into adulthood and because of this fact, one
of the best predictors of APD in adulthood is a diagnosis of:
a. Conduct disorder
b. Attention deficit disorder
c. Attachment disorder
d. Childhood disorder

44. Behavior of individuals with antisocial personality disorder often

appears impulsive and unpredictable due to switching quickly and
unpredictably between:
a. Dysfunctional memories
b. Dysfunctional schemas
c. Dysfunctional hearing
d. Dysfunctional balance

45. More recent research has linked Borderline Personality Disorder

(BPD) with bipolar disorder, and the two are often comorbid. Some
individuals with BPD belong to a broader:
a. Bipolar disorder spectrum
b. Social anxiety spectrum
c. Social identity spectrum
d. Generalized anxiety spectrum

46. Evidence suggests that individuals with Borderline Personality

Disorder have a number of brain abnormalities that may give rise to
impulsive behavior. there is evidence for dysfunctional in brain:
a. Circuitry
b. Dopamine
c. Anatomy
d. Corpus callosum functioning

49. Narcissistic personality disorder is also closely associated with

antisocial personality disorder (APD). Which of the following is not a
way in narcissistic individuals will regularly act:
a. Self-motivated
b. Deceitful
c. Aggressive
d. Withdrawn

50. Which of the following is NOT usually associated with Avoidant

Personality Disorder?
a. Low self-esteem

b. Feelings of shame
c. Feelings of guilt
d. Feelings of superiority

NeuroCognitive Disorders
Neurocognitive disorders

Dementia:

Why Do They Do That?

How Can I Help?

When Do I Need Help?

REALIZE

It Takes TWO to Tango

or two to tangle

497

498
Being right doesnt necessarily translate into
a good outcome for both of you

499
Its the relationship that is MOST critical
NOT the outcome of any one encounter

500
As part of the disease people with dementia
tend to develop typical patterns of speech,
behavior, and routines.
These people will also have skills and abilities
that are lost while others are retained or
preserved.

What is it NOT
NOT Normal Aging

NORMAL Aging
Slower to think
Slower to do
Pause to find words
Reminded of the past

501

Cant think the same

Cant get started
Cant seem to move on
Words wont come even later
Confused about past versus now

Delirium
Disturbance in attention (hours to a few days)
Memory deficit, disorientation, language

Specify whether:
Substance - induced delirium
Medication-induced delirium

Major Neurocognitive disorders

Alzheimers disease
Traumatic brain injury
Substance/medication use
Parkinsons disease
Huntingtons disease

Minor Neurocognitive Disorder

The cognitive deficits do not

interfere with capacity for
independence in everyday
activities.

Alzheimers
New information lost
Recent memory worse
Problems finding words
Mis-speaks
More impulsive or indecisive
Gets lost
Notice changes over 6 months 1 year

505

Vascular Dementia

Sudden changes in personality or behavior

Can have bounce back & bad days
Judgment and behavior not the same
Spotty losses
Emotional & energy shifts

506

Lewy Body Dementia

Movement problems - Falls

Visual Hallucinations
Fine motor problems hands & swallowing
Episodes of rigidity
Nightmares
Fluctuations in abilities

507

Fronto-Temporal Dementias
Many types
Frontal impulse and behavior control loss
Says unexpected, rude, mean, odd things to others
Temporal language loss
Cant speak or get words out
Cant understand what is said, sound fluent nonsense words

508

What is Dementia?...
It is BOTH

a chemical change in the brain

AND
a structural change in the brain

So
Sometimes they can & sometimes they cant

509

510

511
Learning & Memory
Center
Hippocampus
BIG CHANGE

512

Understanding Language BIG CHANGE

Sensory Strip
Motor Strip
White Matter Connections
BIG CHANGES

Automatic Speech
Rhythm Music
Expletives
PRESERVED
Formal Speech & Language
Center
HUGE CHANGES

514
Executive Control
Center
Emotions Behavior
Judgment
Reasoning

515

Vision Center BIG CHANGES

Care Partners

Be a partner, not a boss

Do with me, not for me or to me
Learn to let go not give up
Learn what you are good at, & what not
These ideas are for you TOO!

516

Some Key Beliefs & Principles:

All people need to be needed nurturing is a critical part of
life worth living
Dementia Steals Away Roles and Responsibilities that Make Us
WHO We Are
Activities can make a critical difference in the health and
well-being of people with dementia
IF
Used Appropriately for the degree of involvement it will
make a difference.

517

Substance Related and

Addictive Disorders
Substance Abuse & Substance Dependence

Features of Substance Dependence

The essential feature of Substance
Dependence is a cluster of cognitive,
behavioral, and physiological symptoms
indicating that the individual continues use of
the substance despite significant substancerelated problems.
Craving is likely to be experienced by most
(if not all) individuals with Substance
Dependence.

Criteria for Substance Dependence

Tolerance, as defined by
either of the following:
markedly diminished effect
with continued use of the
same amount of the
substance.

Criteria for Substance Abuse

Recurrent substance use resulting in a
failure to fulfill major role obligations at
work, school, or home (e.g., repeated
absences or poor work performance related
to substance use; substance-related
absences, suspensions, or expulsions from
school; neglect of children or household)

Introduction
Two primary groups:
Substance-use disorders (primarily dependence
and abuse)
Substance-induced disorders (intoxication,
withdrawal, and mental health consequences
of abuse)

Clinical syndromes

Substance dependence: a
maladaptive pattern of substance
use that has led to clinically
significant impairment or distress.

Clinical syndromes
Substance abuse includes at least one of the
following symptoms:
Failure to fulfill major role obligations
Recurrent use of substance despite physical hazards
Repeated substance related legal problems
Persistent use despite social or relational problems

Behavioral, Cognitive, and Emotional

Problems

Stress
Insomnia
Anxiety
Depression
Acute psychotic states
Impaired cognition
Violent behavior

Social Problems
Marital and family problems
Legal difficulties
Loss of employment
Financial deterioration
Suicide risk is frequently present in a substance abusing
client particularly as health and psychosocial deterioration is
present.
Careful screening for self-destructive thoughts and/or
impulses is imperative with this population.

NON-SUBSTANCE-RELATED DISORDERS
GAMBLING DISORDER PROBLEMATIC GAMBLING BEHAVIOR (12
month period) restless or irritable when attempting to cut down or
stop gambling, often gambles.

52. ______ schizophrenia usually involves delusions of persecution

and grandeur.
a. Catatonic

b. Disorganized
c. Paranoid
d. Undifferentiated

53. A disorder characterized by continuous tension and occasional

anxiety attacks in which persons think they are going insane or are
about to die is called a
a. Panic disorder
b. Phobia
c. Depressive psychosis
d. Hysterical reaction

54. Graces actions resemble movie stereotypes of crazy behavior.

Her personality disintegration is extreme. She engages in silly
laugher, bizarre mannerisms, and obscene behavior. her diagnosis is
most probably:
a. Paranoid schizophrenia
b. Borderline schizophrenia
c. Catatonic schizophrenia
d. Disorganized schizophrenia

55. The antisocial personality ____

a. Avoids other people as much as possible.
b. Is relatively easy to treat effectively by psychotherapy.
c. Tends to be selfish and lacking remorse
d. Usually gives a bad first impression

56. The distinction between obsessions and compulsions is the

distinction between:
a. Engaging in behaviors that are merely inconvenient and those
that are severely disruptive.
b. Having positive and negative feelings towards an object or
event.
c. Thoughts that are evidence of neurosis or those that are
evidence of psychosis.
d. Having repetitious thoughts or engaging in repetitious actions.

57. Hearing voices that are not really there would be called a(n)
a. Hallucinations
b. Delusions
c. Auditory regression
d. Depressive psychosis

58. Mutism, stupor, and a marked decrease in responsiveness to the

environment are often seen in
a. Catatonic episodes

b. Paranoid episodes
c. Manic episodes
d. Borderline episodes

59. Robert was found wandering naked in the campus parking lot,
proclaiming himself to be Father Time. He shows evidence of a(n)
___ disorder.
a. Anxiety
b. Psychotic
c. Personality
d. Affective

60. Delusional thinking is characteristic of ____

a. Psychosis
b. Obsessive-compulsive disorder
c. Conversion disorder
d. Fugue

61. John has a lack of interest in friends or lovers and experiences

very little emotion. He can be described as having which of the
following personality disorders?
a. Avoidant
b. Schizoid
c. Borderline
d. Paranoid

62. Bulimia is defined in the DSM-5 as

a. A medical problem
b. A psychological factor affecting physical condition
c. A subtype of anorexia
d. An eating disorder separate from anorexia

63. Dieting has been shown to:

a. Result in decreased health risk
b. Increase risk for eating disorder
c. Be a type of eating disorder
d. Rarely be successful

64. The fact that the prevalence of eating disorder has increased in
the last few decades most supports which of the following
etiological theories:
a. Biological
b. Cognitive
c. Family systems
d. Socio-cultural

65. Formal thought disorder refers to which symptoms of

schizophrenia?
a. Delusions

b. Anhedonia
c. Disorganized speech
d. Hallucinations

66. Regarding their delusions, most schizophrenics

a. Do not see their delusions as illogical or unusual.
b. Recognize that their beliefs are unusual, but still cannot stop
thinking about them.
c. Seek help in ridding themselves of their delusional beliefs.
d. Go to get lengths to convince themselves to give up their
delusions, usually without success.

67. In which of the following personality disorders is a mood

disorder most likely to be comorbid?
a. Avoidant

b. Borderline
c. Obsessive-compulsive
d. Paranoid

68. The chief distinguishing feature of psychotic disorders is

a. Confusion of fantasy and reality
b. Antisocial conduct
c. Overwhelming anxiety
d. Obsessive behavior.

69. A common form of mental disorder afflicting 10-20% of the

population is
a. Schizophrenia

b. Senile dementia
c. Depression
d. Delusional disorder

70. Bob has never met Madonna but he is convinced that she is
deeply in love with him. Bob is suffering from ___
a. Grandiose delusions

b. Jealous delusions
c. Obsessive-compulsive disorder
d. Erotomanic delusions

71. If your met an individual who appeared to be very charming at

first, but later you discovered that he or she manipulated people,
caused others hurt without a second thought, and could not be
depended upon, you might suspect him of being
a. Dependent
b. Narcissistic
c. Paranoid
d. Antisocial

72. A person who has an extreme lack of self-confidence and who

allows others to run his or her life is said to have a(n) ___
personality
a. Dependent
b. Narcissistic
c. Paranoid
d. Antisocial

73. The Freudian explanation of anxiety disorders emphasizes

a. The avoidance paradox
b. Learned habits of self-defeating behavior
c. Forbidden impulses that threaten a loss of control
d. The development of a faulty or inaccurate self-image and
distorted self-perceptions

74. The most severe psychological disorder is a(n)

a. Personality disorder
b. Psychosomatic illness
c. Anxiety disorders
d. Psychosis

75. Mood disorders are those in which the person may

a. Experience severe depression and threaten suicide
b. Exhibit symptoms suggesting physical disease or injury but for
which there is no identifiable cause.
c. Exhibit behavior that is the result of an organic brain pathology.
d. Experience delusions and hallucinations.

76. In most anxiety disorders, the persons distress is

a. Focused on a specific situation.
b. Related to ordinary life stresses.
c. Greatly out of proportion to the situation
d. Based on a physical cause.

77. An unusual state called waxy flexibility is sometimes observed

in ____ schizophrenia.
a. Borderline

b. Disorganized
c. Catatonic
d. Paranoid

78. Roger has been extremely anxious for much of the past year, but
cant explain why. There is a good chance that he is experiencing
a. A generalized anxiety disorder

b. Sociopathy
c. Psychosis
d. A nervous breakdown

SLEEP-WAKE DISORDERS

Ma. Tosca Cybil A. Torres, RN

SLEEP DISORDERS

Ma. Tosca Cybil A. Torres, RN

Key Terms
Apnea:The temporary absence of breathing. Sleep apnea consists of
repeated episodes of temporary suspension of breathing during sleep.
Cataplexy: Sudden loss of muscle tone (often causing a person to
fall), usually triggered by intense emotion. It is regarded as a
diagnostic sign of narcolepsy.
Circadian rhythm: Any body rhythm that recurs in 24-hour cycles.
The sleep-wake cycle is an example of a circadian rhythm.
Dyssomnia: A primary sleep disorder in which the patient suffers
from changes in the quantity, quality, or timing of sleep.
Electroencephalogram (EEG): The record obtained by a device that
measures electrical impulses in the brain.

 Hypersomnia: An abnormal increase of 25% or more in time spent

sleeping. Patients usually have excessive daytime sleepiness.
Hypnotic: A medication that makes a person sleep.
Hypopnea: Shallow or excessively slow breathing usually caused
by partial closure of the upper airway during sleep, leading to
disruption of sleep.

 Insomnia: Difficulty in falling asleep or

remaining asleep.
Jet lag: A temporary disruption of the
body's sleep-wake rhythm following highspeed air travel across several time zones.
Jet lag is most severe in people who have
crossed eight or more time zones in 24
hours.

 Narcolepsy: A life-long sleep disorder marked by four symptoms:

sudden brief sleep attacks, cataplexy, temporary paralysis, and
hallucinations. The hallucinations are associated with falling asleep or
the transition from sleeping to waking.

 Parasomnia: A primary sleep disorder in which the person's

physiology or behaviors are affected by sleep, the sleep stage, or
the transition from sleeping to waking.
Pavor nocturnus: Another term for sleep terror disorder.

What is Sleep?
Sleep is a physical and mental
resting state in which a person
becomes relatively inactive and
unaware of the environment.
In essence, sleep is a partial
detachment from the world,
where most external stimuli are
blocked from the senses.

Sleep Disorder Defined:

group of syndromes characterized by disturbance in the patient's
amount of sleep, quality or timing of sleep, or in behaviors or
physiological conditions associated with sleep.
There are about 70 different sleep disorders
The condition must be a persistent problem, cause the patient
significant emotional distress, and interfere with his or her social
or occupational functioning.

Primary Sleep Disorders

The two major categories of

primary sleep disorders are
dyssomnias and the
parasomnias.

Dyssomnias
primary sleep disorders in which the
patient suffers from changes in the
amount, restfulness, and timing of
sleep.

Types of dyssomnias

Primary Insomnia
Difficulty in falling asleep or remaining asleep
that lasts for at least one month.
can be caused by a traumatic event related to
sleep or bedtime, and it is often associated
with increased physical or psychological arousal
at night
People who experience primary insomnia are
often anxious about not being able to sleep
usually begins when the person is a young adult
or in middle age

Primary Hypersomnia

a condition marked by
excessive sleepiness during
normal waking hours.

Narcolepsy

Narcolepsy
3 major symptoms:
1. Cataplexy is the sudden loss of muscle tone and
stability ("drop attacks")
2. Hallucinations may occur just before falling
asleep (hypnagogic) or right after waking up
(hypnopompic)
3. Sleep paralysis occurs during the transition from
being asleep to waking up.

Breathing-related Sleep Disorders

syndromes in which the patient's sleep is interrupted by problems with his or
her breathing

Obstructive Sleep Apnea Hypopnea

Daytime sleepiness, fatigue, or unrefreshing sleep despite
sufficient opportunities to sleep (snoring/gasping, or breathing
pauses during sleep)

Circadian Rhythm Sleep Disorders

Results from a discrepancy between the person's
daily sleep/wake patterns and demands of social
activities, shift work, or travel which may lead to
excessive sleepiness or insomnia, or both.

Jet lag
sleepiness and alertness that occur at
an inappropriate time of day
relative to local time, occurring
after repeated travel across more
than one time zone

Shift work

insomnia during the major sleep period or excessive

sleepiness during the major awake period associated
with night shift work or frequently changing shift work

PARASOMNIAS
primary sleep disorders in which the patient's behavior is affected by specific
sleep stages or transitions between sleeping and waking. They are
sometimes described as disorders of physiological arousal during sleep.

Nightmare Disorder
a parasomnia in which the patient is
repeatedly awakened from sleep by
frightening dreams and is fully alert on
awakening.
The child is usually able to remember
the content of the nightmare and may be
afraid to go back to sleep.
Nightmare disorder is most likely to
occur in children or adults under severe
or traumatic stress.

 is a parasomnia in which the patient awakens

screaming or crying.
The patient also has physical signs of arousal,
like sweating, shaking, etc.
It is sometimes referred to as pavor nocturnus.
The patient may be confused or disoriented for
several minutes and cannot recall the content of
the dream.
He or she may fall asleep again and not
remember the episode the next morning.
Sleep terror disorder is most common in children
four to 12 years old and is outgrown in
adolescence.

Sleep Terror Disorder

Sleepwalking disorder
sometimes called somnambulism
occurs when the patient is capable of complex
movements during sleep, including walking.
If the patient is awakened during a sleepwalking
episode, he or she may be disoriented and have
no memory of the behavior.
In addition to walking around, patients with
sleepwalking disorder have been reported to
eat, use the bathroom, unlock doors, or talk to
others. It is estimated that 10-30% of children
have at least one episode of sleepwalking.
However, only 1-5% meet the criteria for
sleepwalking disorder.
The disorder is most common in children eight
to 12 years old.

SLEEP DISORDERS RELATED TO MENTAL DISORDERS

Many mental disorders, especially depression or one of the anxiety

disorders, can cause sleep disturbances. Psychiatric disorders are the most
common cause of chronic insomnia.

SLEEP DISORDERS DUE TO MEDICAL CONDITIONS

Some patients with chronic neurological conditions like Parkinson's disease or
Huntington's disease may develop sleep disorders. Sleep disorders have also
been associated with viral encephalitis, brain disease, and hypo- or
hyperthyroidism.

SUBSTANCE-INDUCED
The
use of drugs, SLEEP DISORDERS
alcohol, and caffeine
frequently produces
disturbances in sleep
patterns. Alcohol abuse
is associated with
insomnia.

ELIMINATION DISORDERS

 ENURESIS: Repeated voiding of urine into bed or clothes, whether

intentional or involuntary. (May last until 5 years old)

ENCOPRESIS: Repeated passage of feces into inappropriate places

(e.g. Clothing, foor), whether involuntary or intentional

Mike has always been a loner. He has never much cared for being
with other people. He does not form relationship easily. He appears
to be without emotion. Mike may be exhibiting the ____ personality
disorder.
a. Schizoid
b. Paranoid
c. Histrionic
d. narcissistic

Although those with paranoid personality disorder often are deeply

suspicious, their suspiciousness usually do not:
a. Threaten their interpersonal relationships

b. Become delusional
c. Result in anger
d. Involve those with whom they work

The term schizophrenia can be interpreted to mean:

a. A split between thought and emotion
b. Having more than one personality
c. The same thing as a dissociative reaction
d. That a person is insane

A person who experiences a long series of imagined physical

complaints suffer from
a. A conversion reaction

b. Somatization disorder
c. A traumatic disorder
d. An obsession

When Sara returned from combat in the Gulf War, she began
experiencing high anxiety that has persisted without any
improvement. This example illustrates which anxiety related
disorder?
a. Panic
b. Post-traumatic stress
c. Phobia
d. Obsessive-compulsive

Gregory has been homeless for the past 3 years. The stress of being
homeless seems to have contributed to the onset of psychosis. This
example illustrates what risk factor for mental disorders?
a. Social
b. Family
c. Psychological
d. Biological

A researcher seeking an organic basis for schizophrenia would be

well-advised to investigate the role of:
a. Amphetamines and amphetamine receptors

b. Adrenaline and noradrenaline

c. Histamine and antihisthamine
d. Dopamine and dopamine receptors

Which of the following is characteristic of a dissociative disorder?

a. Phobic disorder
b. Amnesia
c. Paranoia
d. Depression

_____ schizophrenia usually involves delusions of persecution and

grandeur.
a. Catatonic

b. Disorganized
c. Paranoid
d. undifferentiated

A psychosis arising from an advanced stage of syphilis, in which the

disease attacks brain cells, is called
a. Korsakoffs syndrome

b. Delirium tremens
c. Schizotypical psychosis
d. General paresis

The extreme reaction known as fugue refers to

a. Physical flight to escape conflict
b. Severe depression
c. Hallucinations
d. Obsessive behavior

Disorganized schizophrenia is characterized by

a. Attacks of fear or panic
b. Silliness, laughter, and bizarre behavior
c. Delusions of persecution
d. Severe depression

Graces actions resemble movie stereotypes of crazy behavior.

Her personality disintegration is extreme. She engages in silly
laughter, bizarre mannerisms, and obscene behavior. Her diagnosis
is probably:
a. Paranoid schizophrenia
b. Borderline schizophrenia
c. Catatonic schizophrenia
d. Disorganized schizophrenia

Which of the following is classified as a mood disorder?

a. Bipolar disorder
b. Multiple personality disorder
c. Delusional disorder
d. Dissociative disorder

Current research suggests that cause of Alzheimers disease is

a. Brain pathology
b. A traumatic childhood
c. Inconsistent and ineffective parenting
d. Persistent delusional thoughts

Dysthymic disorder and cyclothymic disorder are two varieties of

a. Mood disorder
b. Conversion disorder
c. Schizophrenia
d. Somatoform disorder

The antisocial personality

a. Avoids other people as much as possible
b. Is relatively easy to treat effectively by psychotherapy
c. Tends to be selfish and lacking remorse
d. Usually gives a bad first impression

Belief that ones body is rooting and ravaged by disease would be

classified as:
a. Somatic delusions

b. Delusions of grandeur
c. Delusions of influence
d. Delusions of persecution

The distinction between obsessions and compulsions is the

distinction between:
a. Engaging in behaviors that are merely inconvenient and those
that are severely disruptive.
b. Having positive and negative feelings toward an object or event.
c. Thoughts that are evidence of neurosis and those that are
evidence of psychosis.
d. Having repetitious thoughts and engaging in repetitious actions.

Hearing voices that are not really there would be called a(n)
a. Hallucinations
b. Delusions
c. Auditory regression
d. Depressive psychosis

Behavioral problems in which the person exhibits symptoms

suggesting physical disease or injury, but for which there is no
identifiable cause, are called
a. Mood disorders
b. Schizophrenia
c. Organic brain pathologies
d. Somatoform disorders

Mutism, stupor, and a marked decrease in responsiveness to the

environment are often seen in
a. Catatonic episodes

b. Paranoid schizophrenia
c. Manic episodes
d. Borderline schizophrenia

Robert was found wandering naked in the campus parking lot,

proclaiming himself to be Father Time. He shows evidence of a(n)
____ disorder
a. Anxiety
b. Psychotic
c. Personality
d. affective

A person who mistrusts others and is hypersensitive and guarded

may be classified as a(n) ____ personality
a. Dependent

b. Antisocial
c. Narcissistic
d. Paranoid

Delusional thinking is characteristic of

a. Psychosis
b. Obsessive-compulsive disorder
c. Conversion disorder
d. fugue

I believe Amandas anxiety and defensiveness are the result of an

unrealistic self-image and an inability to take responsibility for her
feelings. This statement would most likely have been made by a
a. Psychodynamic theorist
b. Freudian therapist
c. Humanistic psychologist
d. Behavioristic theorist

Sensory experiences that occur in the absence of a stimulus are

called
a. Illusions

b. Hallucinations
c. Delusions
d. Affect episodes

In general, schizophrenia is characterized by

a. Rapid and unpredictable changes in emotion
b. Delusions of persecution and somatic complaints
c. Blunted or inappropriate emotions and withdrawal
d. High levels of anxiety coupled with a lack of conscience

Sexual Disorders
Paraphilias, Gender Dysphoria, and Sexual Dysfunctions
DR. JOSEPH C. FRANCISCO

What is Abnormal Sexual Behavior?

It causes harm to other people, or;
It causes an individual to experience
persistent or recurrent distress or
important areas of functioning related to
their sexual life

Paraphilias
Para meaning abnormal and philia meaning
attraction, Literally, Abnormal Attraction

Paraphilia
These are disorders in which an individual
has recurrent, intense sexually arousing
fantasies, sexual urges or behaviors
involving (1) Non-human objects, (2)
Children or other non-consenting persons
and (3) suffering or humiliation of ones self
or partner

Characteristics of persons with a Paraphilia

Always thinking to carry out their unusual behavior.
Overly obsessed that if the individual cannot get to their
desired object, they get stressed.
The individual will lose sight of other goals and
concentrate of the fulfillment of their sexual desires if
worse.
It causes intense personal distress or impairment in
social, work and other areas of life functioning.
Almost all cases of Paraphilia Involve MEN.

Examples of Paraphilias
Telephone Scatologia- making obscene phone
calls, such as describing ones masturbatory
activity, threatening to rape the victim, or trying
to find out the victims sexual activities.
Necrophilia- deriving sexual gratification from
viewing or having sexual contact with a corpse.
Zoophilia- having sex with animals or having
recurrent fantasies of sex with animals.

Examples of Paraphilias
Coprophilia- deriving sexual pleasure from contact with
feces.
Urophilia- deriving sexual pleasure from contact with
urine.
Autagonistophilia- having sex in front of others.
Somnaphilia- having sex with a sleeping person.
Stigmatophilia- deriving sexual pleasure from skin
piercing or a tattoo.
Autonepiophilia- wearing diapers for sexual pleasure.

But Keep in Mind!!

Paraphilias are not daydreams about unusual

sexual practices but are conditions that last
at least 6 months.

Pedophilia
Pedophilia is where an adult has uncontrollable
sexual urges to sexually immature children (13
below)
Persists from months to even years.
Forms of sexual acts against children include
kidnapping, sexual abuse, fondling, and
penetration or intercourse.

Types of Pedophilia
Situational Molesters
Normal Sexual development and interest. But when stress calls for it, they
sometimes want to become sexual with a child

Preference Molesters
Pedophillic behavior is already ingrained in the individuals lifestyle, clear
preference for children, esp. Boys, and will do anything (even marry) to
hide his behavior, and clearly sees nothing wrong with his unusual behavior.

Child Rapist
A violent childabuser whose behavior is an expression of hostile sexual
drives.

Fetishism
Fetishism is where a person feels a strong recurrent
sexual attraction to a nonliving object.
People with this are always preoccupied with the object
of desire, and they become dependent to it as an object
for sexual gratification.
Objects include shoes, gloves, underwear, stockings,
swimsuits, etc.

Partialism
Another variant of Fetishism.

People with Partialism are soley interested

in the sexual gratification from a specific
body part, examples are feet, neck,
underarms, back, etc.

Characteristics of Fetishism
They do unusual actions to the desired object, like
sucking, smelling, fondling, rubbing, burning and cutting.
Have no desires to intercourse with the partner with the
desired object, rather, they would masturbate to the
desired object.

It involves compulsive rituals that are beyond the control

of the individual, which can cause distress and
interpersonal problems.

Frotteurism
Derived from the word Frotter meaning To rub
Refers to the masturbation that involves rubbing
against another person.
Frotteur has recurrent sexual desires on rubbing
into people. Targets of Frotteurs are not
consenting people, rather they target strangers.

Characteristics of a Frotteur
Obsessed with the rubbing of selves to
unsuspecting strangers, finding it sexually
pleasurable.
Often acts quickly, or undetected.
Fantasizes that they are in an intimate
relationship with the stranger.
Treatment includes extinction and covert
conditioning.

Sexual Masochism and Sexual Sadism

Sexual Masochism
A Masochist is someone who seeks
pleasure from being subjected to
pain.

Sexual Sadism
Is about obtaining sexual enjoyment
from inflicting cruelty.

Sexual Masochism
Disorder marked by an attraction to achieving
sexual gratification by having painful stimulation
applied to ones own body, either alone or with a
partner.

Men and women with this disorder achieve sexual

satisfaction by such means like binding, ropes,
whips, or injuries.

Sexual Sadism
The converse of Sexual Masochism. Seeing or imagining
anothers pain excites the sadist. In contrast to Sexual
Masochism, which does not require a partner, sexual
sadism clearly requires a partner to enact sadistic
fantasies.

Sadomasochist is the term where in a person does

both Sadist and Masochist roles, or inflicting and
receiving pain.

Transvestic Fetishism
A syndrome found only in males.
A disorder in which a man has an uncontrollable urge to
wear a womans clothing, as primary means of achieving
sexual gratification.
This sexual gratification has a compulsive quality, and
consumes a lot of emotional energy.
Sometimes accompanied by masturbation.

Voyeurism
The word comes from the term voir, meaning To
See
A sexual disorder where an individual
compulsively seeks sexual gratification from
observing nudity or sexual activity of others who
are unaware that they are being watched.
This disorder is more common in men.
The term Peeping Tom usually refers to voyeur.

Gender Dysphoria
Gender Identity refers to the individuals selfperception as a male and female.

Gender Identity
The term gender identity refers to the
individuals perception as a male or female.
Gender role refers to the persons behaviors
and attitude that are indicative of his
gender.

Gender Dysphoria
A condition which involves a discrepancy
between an individuals assigned sex and
the persons gender identity.

Characteristics of GD

Experience a strong and persistent cross-gender

identification, which causes a feeling of
discomfort.

Experience intense feeling of distress.

Transsexualism
Refers to this phenomenon in which a
person has an inner feeling of belonging to
other sex.
People involve in this situation wishes to
live as members of the other sex.

The term transsexual should not however be confused with

transvestism or cross-dressing, which involves dressing as the
opposite sex for emotional or sexual pleasure.

Transvestites are content with their gender identity but enjoy the fantasy
of pretending to be a member of the opposite sex.

Sexual Dysfunctions
Refers to an abnormality in an individuals
sexual responsiveness and reactions

Four phases of the Sexual Response cycle

Arousal
Plateau
Orgasm
Resolution

Hypoactive Sexual Desire Disorder

The Individual has an abnormally

low level of interest in sexual
activity.

Sexual Aversion Disorder

characterized by an active dislike and

avoidance of genital contact with a
sexual partner, which causes personal
distress or interpersonal problems.

Female Sexual Interest/Arousal Disorder

Lack of, or significantly reduced sexual interest/arousal
Absence of erotic thoughts or fantasies
No initiation of seuxal activity
Absence of sexual excitement
reduced genital or nongenital sensations

Male Erectile Disorder

recurrent partial or complete

failure to attain or maintain
erection

Female Orgasmic Disorder

inability to achieve orgasm, or

a distressing delay in the
achievement of orgasm.

Premature Ejaculation

The male individual reaches orgasm in a

sexual encounter long before he wishes
to, perhaps even prior to penetration,
and therefore feels little or no sexual
satisfaction.

Male Hypoactive Sexual Desire Disorder

Absence of sexual/erotic thoughts

Lack of desire for sex

Sexual Pain Disorders/PENETRATION

DISORDER (Genito-Pelvic Pain)

involves the experience of pain

associated with intercourse.
Diagnosed as dyspareunia or
vaginismus.

79. Irrational and very specific fears that persist even when there is
no real danger to a person are called ___
a. Anxieties

b. Dissociations
c. Phobias
d. Obsessions

80. In some countries, it is normal to defecate or urinate in public.

This makes it clear that judgments of the normality of behavior are
a. Culturally relative

b. Statistical
c. A matter of subjective discomfort
d. Related to conformity

81. Three year old Shawn ate lead paint which was chipping off the
walls in an older home. Consequently, he developed a psychosis
based on brain damage due to lead poisoning. Shawns psychosis
would be called a(n)
a. Functional psychosis
b. Organic psychosis
c. Neural psychosis
d. Neo-cortical psychosis

82. False beliefs that are held even when the facts contradict them
are called
a. Fantasies

b. Hallucinations
c. Illusions
d. Delusions

83. Mary believes that she is the Queen of England. She is having
a. Depressive delusions
b. Delusions of grandeur
c. Delusions of reference
d. Delusions of persecution

84. True paranoids are rarely treated or admitted to hospitals

because
a. They are potentially harmful and dangerous to others.

b. They resist the attempts of others to offer help

c. Their severe hallucinations make reasoning with them impossible
d. Psychiatric hospitals are primarily for psychotics.

85. Discomfort in social situations, fear of evaluations, and timidity

are characteristics of what personality disorder?
a. Histrionic

b. Obsessive-compulsive
c. Schizoid
d. Avoidant

86. Obsessive-compulsive disorders involve

a. Loss of contact with reality
b. Unresolved anger
c. Unresolved oedipal conflict
d. High levels of anxiety

87. The dopamine-psychosis link is based on the observation that

a. Low dopamine levels of activity in the brain seem to produce
psychotic symptoms

b. There are high levels of dopamine activity in the brains of

psychotic people
c. There are high levels of amphetamine in the brains of
schizophrenics
d. Dopamine interacts with serotonin creating psychosis

88. The antisocial personality is one who

a. Is irresponsible and seems to lack remorse.
b. Is frequently dangerous and out of contact with reality.
c. Is always a delinquent or criminal.
d. Benefits greatly from humanistic and psychotic therapies.

89. Which of the following personality disorders describes a person

who has extremely unstable self-image, is moody, and does not
develop stable realtionships?
a. Borderline
b. Histrionic
c. Narcissistic
d. Schizoid

90. Phobias differ from ordinary fears in that they frequently

involve
a. Specific objects or situations

b. Bugs and crawling things

c. Intense reactions like vomiting or fainting
d. Heights and unfamiliar places

91. Which of the following personality disorders describes a person

who has an exaggerated sense of self-importance and who needs
constant admiration?
a. Dependent
b. Histrionic
c. Narcissistic
d. Schizoid

92. Describing a disorder as acute means that

a. It causes very severe distress and impairment
b. It causes very mild distress and impairment
c. It is a very long-lasting disorder
d. It is a disorder that is short in duration

93. Unipolar depression is also called:

a. Manic depression
b. Major depression disorder
c. Double depression
d. Cyclothymic disorder

94. What is the milder form of depression?

a. Dysthymic
b. Cyclothymic
c. Bipolar
d. Borderline

95. Symptoms of schizophrenia are categorized into negative and

positive. What is an example of a positive symptom of
schizophrenia?
a. Hallucinations
b. Flat affect
c. Catatonia
d. All of the above

96. Obsessive-compulsive disorder belongs in the general category

of:
a. Panic disorders

b. Mood disorders
c. Anxiety disorders
d. Personality disorders

97. Low levels of serotonin and norepinephrine are believed to be

involved with:
a. Depression

b. Schizophrenia
c. Parkinsons
d. Personality Disorders

98. A group of symptoms that appear together and are assumed to

represent a specific type of disorder is referred to as a
a. Syndrome

b. Sign
c. Psychosis
d. Disease

99. The presence of more than one condition within the same time
period is known as
a. Twin diagnosis

b. Misdiagnosis
c. Comorbidity
d. Confounded morbidity

100. Which category of disorders is less likely affected by culture?

a. Anxiety
b. Neurotic
c. Psychotic
d. personality

REMINDERS:

XOX

(eXtreme-Overly-eXagerrated)
HELP
(Hiding, Evolving, Lying, Prolonged)
US
(U and Society)

TIPS:

Bipolar 1 vs. Bipolar 2

Dysthymia vs. Cyclothemia
Antisocial, Borderline, Paranoid, Histrionic, avoidant, OCPD
Cure rate, relapse, remission, residual
Flight of ideas, retardation of ideas, confabulation, amnesia
DID, ego syntonic vs ego dystonic, depersonalization vs
derealization

TIPS:
Anxiety Disorders, Eating Disorders, Somatoform disorders, Impulse
control disorders
Intermittent Explosive Disorder, Conduct disorder vs Oppositional
Disorder
Body dysmorphic, Conversion disorder, Acute stress disorder

Paranoid schizophrenia, brief psychotic disorder, schizotypal,

schizophreniform

 Acute stress disorder, adjustment disorder

Hypoactive sexual desire disorder, vaginismus, orgasmic disoder,
sexual aversion disorder
Trichotillomania, intermittent explosive disorder, pain disorder
Dissociative fugue, DID,

Apathy, inappropriate affect, ambivalence, obsession

 Bulimia nervosa, obesity, binge eating

Benzodiazepines, barbiturates, antipsychotics, amphetamines

A group of drugs specifically indicated for schizophrenia is ____

a. Benzodiazepines
B. Barbiturates
C. antipsychotics
D. amphetamines

 a. Benzodiazepines class of psychoactive drugs (alters brain

function resulting in temporary changes in perception, mood and
behavior) Examples: cocaine, ecstacy
B. Barbiturates act as depressants
C. antipsychotics class of psychiatric medication to manage
psychosis
D. amphetamines act as stimulants

 A symptom in which the patient fills amnestic gaps with imaginary

images is called ___
A. Flight of ideas

B. Retardation of ideas
C. confabulation
D. Amnesia

 A symptom in which the patient fills amnestic gaps with imaginary

images is called ___
A. Flight of ideas rapid shifting of ideas (a symptom in bipolar mania)
B. Retardation of ideas intellectual disability
C. confabulation memory disturbance, the patient is unaware that
their memories are inaccurate resulted from injury to the brain.
Deception of memory which create an image of memory out of nothing.

D. Amnesia loss of memories, such as facts, information, and

experiences

 A condition that is characterized by the occurrence of one or more

depressive episodes in the absence of a history of mania is ____
A. Major depressive episode

B. Bipolar 1
C. Bipolar II
D. Dysthymia

 A condition that is characterized by the occurrence of one or more

depressive episodes in the absence of a history of mania is ____
A. Major depressive episode characterized by one or more major
depressive episodes with no history of mania or hypomania; there
is discrete periods of severe depression that come and go.
B. Bipolar 1 severe mood episodes from mania to depresion
C. Bipolar II milder form of mood elevation that alternate with
periods of severe depression
D. Dysthymia persistent depressive disorder (chronic form of
low level of depression)

 It is a lessening of the symptom of a disease or their temporary

reduction of disapperance.
A. Cure rate

B. Relapse
C. remission
D. residual

 It is a lessening of the symptom of a disease or their temporary

reduction of disapperance.
A. Cure rate recovery from illness (prognosis)

B. Relapse the return of an illness after a period of

improvement.
C. remission disapperance of signs and symptoms; the patients
health improves.
D. residual something that remains

A symptom characterized by the existence of conflicting feelings is

A. Apathy
B. Inappropriate affect
C. ambivalence
D. obsession

 A symptom characterized by the existence of conflicting feelings is

A. Apathy lack of feeling and emotion
B. Inappropriate affect incongruency of emotional expressions
with a certain situation
C. ambivalence conflicting reations, beliefs, or feelings toward
some object
D. obsession persistent thoughts

Thank you so much for

Listening~