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CHAPTER # 6 Personality Disorders

Personality Disorders:
6-10% population
inflexible or maladaptive > significant personal distress or impair functioning
Dont think they need to change
Ego syntonic = feelings perceived as natural vs. Dystonic (personality disorder vs. depression)
3 types:
perceived as odd or eccentric
paranoid, schizoid, schizotypal
overly dramatic or emotional
antisocial, borderline, histrionic, narcissistic
appear anxious or fearful
avoidant, dependent, obsessive compulsive
Odd or Eccentric
persistant suspiciousness of motives of others
no clear cut delusions (characteristic of paranoid schizophrenia)
2 - 4.5% M > W
overly sensitive to criticism
take offence, anger, grudges, dont confide
cultural effects: e.g immigrants
persistant lack of interest in social relationships
flattened effect
social isolation is main feature
better contact with reality than schizophrenia
3% M > ~ W
dont express emotions, aloof
not as blunted as schizophrenia
indifferent to criticism; wrapped up in abstract
may harbour sensitivity, just cant express; sometimes deep feelings for animals
eccentricities or oddities of though and behaviour w/o psychotic features
cant form close relationships, odd mannerism but not disturbed enough to be schizophrenic
have unusual perceptions but realize that they shouldnt be happening
idea of reference = believe others are talking about them behind their back
magical thinking= believe they have 6th sense
speech is abstract but not incoherent
no self direction
social anxiety but linked to paranoid thinking, not fear of rejection
co-morbididty: MDD, anxiety, increased suicide
share common genetics with schizophrenia
few develop into full blow
antisocial and irresponsible behaviour and lack of remove
disregard social norms
impulsive, dont live up to commitments
M > Q 2 -4%
behaviour emerges as child in form of conduct disorder: running away, fighting, cruelty, etc.
behaviour associated tends to decline with age and disappear by 40 but personality traits remain
affective and interpersonal traits: shallow emotions, selfish, deceitful, irresponsible, lack empathy

affective and interpersonal traits: shallow emotions, selfish, deceitful, irresponsible, lack empathy
2 dimensions: personality (lack of empathy, remorseless) and behaviour (unstable and anti social
psychopaths have psychopathic personalities and maybe antisocial; not psychotic
few with psychopathic personality > psychopaths; 50% prisoners diagnosed with antisocial;
psychopathic killers more cold blooded
4 psychopathic traits: interpersonal (deceit, superficial), affective (lack of empathy and remorse),
lifestyle (impulsive and lack of goals), antisocial (poor behavioural control, antisocial behaviour)
many law abiding and successful in life
more common in lower status: downward drift, hard to hold jobs, survival strategies are antisocial
Dramatic or Emotional
pervasive pattern of instability, self image, mood, lack of control on impulse
central feature: difficulty regulating emotions
uncertain about values and goals
cant handle being alone
adultion = needs met vs. loathing = when feeling scorned
2% W > M
originally define between neuroses and psychoses
splitting= inability to reconcile positive and negative aspect of experiences
excessive need to be centre of attention and receive praise
dramatic and emotional
but emotions seem shallow and exaggerated
use physical appearance to draw attention, overly macho, overly feminine, glitter
lack self esteem
1. %
adoption of inflated self image and demand constant attention
grandiose sense of self
brag about accomplishment
share feature with histrionic but have more inflated view of themselves and less melodramatic than
better organize thoughts than borderline
narcissistic injuries= extremely sensitive to slightest hint of rejection
adopt game-playing style in romantic relationships not intimacy
Anxious or Fearful
Obsessive Compulsive
maxim = place for everything and everything in its place
rigid ways of relating to others; perfectionist; lack spontaneity
2 - 8%
ruminate about prioritizing and never seem to start working
avoidance of social relationships due to fear of rejection
few close relationships outside family
avoid group occupational and recreation
same social withdrawal as schizoid, have interest and feelings of warmth for others where schizoid
lack interest

lack interest
co morbid with social anxiety often
difficulties making independent decisions
need to be take care of
submissive and clingy
linked to mood, and social phobia + hypertension, heart problems, gastrointestinal like ulcer and colitis
W > M who fear abandonment and tolerate husbands
0.5 %
Problem with Classification
whats abnormal
sexist bias
circular reasoning
Theoretical Perspectives;
Hans Kohut:
self psychology = describe processes that normally lead to achievement of cohesive sense of self or
grandiosity in narcissism
what matters most is how self develops, cohesive and realistic vs. inflated
narcissistic mount facade to cover feelings of inadequacy
lack of parental support set stage for pathological narcissism
Therapy: opportunity to express grandiose self image; overtime explore childhood roots and points
out imperfection in both to encourage realism
Otto Kernberg:
borderline cant synthesize + and - to make stable complete whole
parents, invariable fail to meet needs, even best parents
Margaret Mahler
first year develop symbiotic attachment to mom (sense of being one)
individuation= develop separate psych and bio identity from mom (separation) and recognize
personal characteristics define self identity (individuation)
borderline tendency to react with ambivalence means earlier ambivalence in separation individuation
focus on acquisition of behaviour than notion of traits
childhood shapes pattern of maladaptive behaviour; discouraged to speak mind > dependent ,
excessive parental discipline > OCD, social reinforcers like parental attention > histrionic
personality linked to physical or sexual abuse or neglect in CH
splitting is a coping mechanism
disturbances in family
BPD: parents have more control and less caring
lack nurturing > antisocial
Cognitive Behavioural
Therapy: help develop more effective problem solving; help re-conceptualize conflict situations
role or reinforcement for origins of antisocial
Bandura: observational learning for aggressive behaviour
interpretation of social experiences also important
antisocial cant read people
antisocial, narcissistic, paranoid, BPD
developing personality traits in psychopathy, like impulsivity and irresponsibility
Twin studies
Lack of Emotional Responsiveness

Lack of Emotional Responsiveness

antisocial maintain composure in stressful situations
explain why no fear in face of punishment
antisocial have lower GSR levels when expecting pain
autonomic NS is under responsive
Craving for Stimulation
explain antisocial lack of emotional response; anti and psychopath have exaggerate craving for
higher than normal threshold maintain optimum state of arousal
bored easily, drugs
Brain Abnormalities
BPD and Anti social: regulating emotion and restraining impulsive behaviour
prefrontal cortex (control impulse, weigh consequence) and structures in limbic (emotion and
Antisocial: brain circuit amygdala (fear generating) with prefrontal is different
Reinforcement Sensitivity Theory
3 systems (neural pathways) underpin individual differences in personality
Behavioural Approach: motivates intentions to seek reward; crave excitement
Fight/Flight Approach: motivate behaviours intended to avoid aversive stimuli
Behavioural Inhibition: resolves conflict among competing goals; anxiety, avoidance in FF is
preferred to BA and become sensitive to punishment
low family income, dysfunction, teenage mom
children in poverty most likely to have deviant role models
more aware of CH root of behaviour
Narcissist and BPD present challenges to therapist
direct, confrontational
BPD: help understand own and others emotion
change behaviour not personality
modelling and reinforcement
Beck: identify and correct distorted thinking
Linehan: dialectical behaviour therapy treat BPD combine CBT with buddhism; understand feelings,
learn to regulate, encourage alternative ways of relating, way 2 sides of argument
residential and foster care: token economies often for antisocial
drug therapy doesnt work directly
anti depressant: depression and anxiety
no substantial results
NT activity implicated in aggression in BPD
SSRI increase serotonin and help temper anger and rage
Canadian Treatment Services
psychotherapy should focus on extremeness of trait
look at history to see how behaviour shaped
Impulse Control
compulsive stealing
1 % W >M
common feature with OCD (but OCD temporary relief vs pleasurable excitement)
defence against penis envy and castration
Intermittent Explosive
impulsive agression and breakout and destroy shit

impulsive agression and breakout and destroy shit

tention before outburst
irregularities in serotonin transmission and maybe prefrontal
compulsive fire setting
anger and revenge motive

CHAPTER #7 Substance Use Disorder

Substance Use and Dependence
doesnt matter if illegal
Substance Use disorder: maladaptive behaviour use of psychoactive substance; include abuse and
2 or more features in 1 year
Caffeine doesnt count
continue using drug despite knowledge that its contributing to problems
often have physiological dependence
Substance Induced disorder: disorder induced by use of psychoactive substance like intoxication,
withdrawal syndrome, mood, delirium
Intoxication = pattern of repeated episodes of intoxication like drunkenness or being high; depends on
amount, users biology, and expectation
Withdrawal = cluster of symptoms when abruptly stop following prolonged use
alcohol: sweating, rapid pulse, hallucinations, illusions, anxiety, seizure
caffeine: headache, drowsiness, depressed mood, flu like symptoms
repeated use alter physiology
LCD, PCP, inhalants, dont produce significant withdrawal
Delirium Tremens
some heavy alcohol users who suddenly limit
autonomic hyperactivity, profuse sweating
Delirium = mental confusion with incoherent speech, disorientation, restlessness
impaired control over use of chemical substance
Physiological Dependence
users body comes to depend on steady supply; =/= addiction
Psychological Dependence
not physically like needing to combat stress
Drugs of Abuse
top 3: tobacco (25%); alcohol (15%); marijuana (5%)
Pathway to dependence: Experimentation > Routine (structure life around, denial, value change) >
addiction or dependence (feel powerless)
curb activity of CNS
reduce tension, anxiety, slow movement, impair cognition
works like benzodiazepines and heighten NT, increase GABA > relaxation
linked to increase health concerns like liver disease, some cancers, coronary heart disease
alcohol hepatitis= inflammation of liver; liver cirrhosis = health cell replaced with scar tissue
alcohol induced persisting amnestic = chronic alcoholism and nutritional deficiencies > loss STM,
disturbance of attention
Korsakoff: vitamin B deficiency; confusion, disorientation, memory loss
moderate lowers heart attack
most abused by First Nations; Jews have low incidences b/c kids use wine rituals and restrain on

most abused by First Nations; Jews have low incidences b/c kids use wine rituals and restrain on
excessive drinking; Asians less because of biological and cultural
Risk Factors: Men, 20-40, antisocial, family history, lower income and education
ease anxiety, tension, dull pain, epilepsy, high BP
mild euphoria, high dose produce drowsiness slurred speech like alcohol
3- 6 hours
synergistic: barbiturate + alcohol => 4X fold
epileptic seizure from abrupt untreated withdrawal
narcotic = pain relieving and sleep inducing
natural: morphine, heroin, codeine, from poppy
synthetic: demerol, Vicodin
rush and intense pleasure, dull awareness of problems, stimulate pleasure circuits like sex
analgesia= pain relief
Brain has opiates = endorphins important for regulating natural and pleasure and pain; mimic
withdrawal: 4-6 afters last dose is when it begins; flu like, anxiety, restlessness, irritability, high BP,
cramp, tremor, flashes, fever, insomnia
Morphine: soldiers disease
Heroin: most widely used, eradiate thought of sex or food; injected below skin
immediate, from 5-15 mintue lasting; well being for 3-5 hours; positive drives satisfied, negative
feelings disappear
increase CNS activity, enhance alertness, euphoria
synthetic aka speed, uppers, bennies, dexies
euphoric; pill, smoke or ice/crystal meth as pure form
liquid methamphetamine injected into veins for intense and immediate (most potent)
physiological dependence > withdrawal: depression, fatigque, vivid dreams, hypersomnia and
insomnia, ^ appetite
can cause brain damage > learning defecit
impulse violence if smoked and injected
Amphetamine Psychosis
mimic paranoid schizophrenic hallucinations
amphetamines underlying cause of schizophrenia?
knockoff of amphetamine; milder hallucinations and euphoria
adverse psychological: depression, anxiety, paranoia, psychosis
brain damage: kill neurons that produce NT dopamine and serotonin for regulating mood
Coca Cola
tolerance effect and identifiable withdrawal: depressed mood, sleep and appetite disturbance; brief
in duration like crash and intense depression
snorted in powder or smoked as crack (hardened form of cocaine >75% pure) > prompt and
potent rush and wears off in few minutes
freebasing = intensify effect; heat with ether to free psychoactive chemical base and smoke
stimulate pleasure circuit
sudden ^ BP and heart rate
overdose: insomnia, headache, restless, convulsion, tremor, hallucination, death
regular snorting: nasal problems like ulcers
repeated > depression and anxiety
psychotic symptoms get worse with more use
W < M except Natives
increases alertness; clammy skin, nausea, vomit , fainting, diarrhoea

increases alertness; clammy skin, nausea, vomit , fainting, diarrhoea

release epinephrine, hormone to great rush of autonomic NS > rapid heart rate ,release sugar
store to blood
tolerance + withdrawal: lack of energy, depressed, frustration, bad [ ], cramp, low heart rate,
palpitations, ^ appetite, weight gain, tremor
5% who quit for 2 days show withdrawal
Prevalence: higher in aboriginals, regardless of location; increasingly concentrated in lower income
and less educated
aka psychedelics = produce sensory distortions
also relaxations and euphoria, sometimes panic
LSD: lysergic acid diethyl amide
synthetic; vivd colour and visual distortion; expand consciousness; effects unpredictable and
depend on amount expectation mood & surroundings; more experienced drug user better handle
flashbacks: re-experience at anytime after
likely form chemical changes in brain caused by prior use of the drug
may develop tolerance but no significant withdrawal
PCP= phenylcyclidine aka angel dust
similar to hallucinogens
originally anesthetic > hallucination > discontinued
^ heart rate and BP, cause sweating, flushing, numbness
deliriant drug = produce states of delirium
feel invisible barrier between user and environment
like LSD depends on expectation, amount, mood
overdose: drowsiness, blank stare, coma, paranoia, aggression
generally hallucinogen
TCH in branches and leaves but highly concentrated in resin of female plant
Hashish: also from resin but more potent
more popular than alcohol
much more among young adults
low doses: relaxing like drinking
higher dose: withdraw into yourself
some say increases self insight or creativity
increased awareness of bodily sensations, high intoxication: ^ sexual sensation
dependence more psychological and physiological
withdrawal symptoms present
regular use > impairment in learning and memory; loss of IQ
Gambling Disorders
classified with substance use disorders
commonalities in expression, aetiology, comorbidity
Theoretical Perspectives
many drugs produce pleasurable affects by ^ availability of NT dopamine in charge of pleasure
alcohol: just hearing words associated with alcohol can activate reward pathway
steady influx of dopamine form using drugs makes it difficult for them to focus on anything other than
attaining and using drugs
Reward Centres
habituated by opiates it may stop producing endorphins > dependence on opiate from comfort
from pain
alcohol, amphetamine, cocaine, heroin, tobacco
twins have higher concordance
adopted children raised in non alcoholic and alcoholic families

substance use behaviours largely learned and can be unlearned
operant and classical conditioning and observational learning
not seen as symptoms of disease but problem habits
habituation from producing pleasure (+ reinforcement) and temporary relief (- reinforcement)
Operant: initially use drug bc social influence or observation; social reinforces like approval of drug
abusing companions
tension-reduction theory: the more often you drink to reduce tension, the strong the habit (self
rather than learning to solve problems, use drugs to escape them
after physiological dependence > - reinforcer to maintain habit
conditioning model of cravings
classical conditioning to explain drug craving
craving = conditioned response to environmental cues from prior use
e.g. sight of needles = conditioned stimuli
stimulus smokers = reach for cigarette in presence of smoking stimuli
alcoholics salivate more around smell of alcohol
cue exposure training = alcoholic therapy
Observational learning
children with parent smokers have higher risk
evidence supported; esp. role of expectancy
positive expectancy ^ likelihood of substance use
outcome expectancies: in teens strongly influenced by friends and parents; one drink effect
chronic abusers binge after one drink (absolutist thinking)
boost self efficacy expectations; e.g. if you think you need 2 drinks to break out of your shell and
socialize > dependent
alcoholism = oral dependent personality ( depression), traces origin to fixation on oral stage in
psychosexual development
Alcoholism often shows dependence but not sure which comes first: e.g. alcoholics lose jobs >
depend on others
no single personality in alcoholics has ben found; contrary to suggestion
encourage or discourage
peer pressure
Children who start drinking before 15 have 5-6 higher fold risk of developing alcohol dependence
help through withdrawal
safe in hospital
anti anxiety like Valium and Librium may help block severe withdrawal symptoms like seizures and
delirium tremens
alcohol ~ 1 week
~ 50 % relapse within 1 year
+ behavioural counselling ^ change of LT success
discourage alcohol because combination causes headache, palpitations, vomit; extreme case
shock and death
toxic effect in people with liver disease
Anti depressants
reduce craving for cocaine
stimulate neural process that promote pleasure
efficacy is questionable

efficacy is questionable
Bupropin = blunt craving for nicotine
Varenicline = quitting smoking but effectiveness is modest
blunt pleasure effect of nicotine
increase depression and suicide risk
Nicotine Replacement Therapy
nicotine replacement
wean from replacements eventually
supported by evidence
men benefit more than women
only physiological
ineffective if not + behavioural in LT
Methadone Maintenance Program
Methadone = synthetic opiate that blunt craving for heroin and curb withdrawal unpleasant
doesnt produce high (normal dose) so they can get jobs and fix liver
highly addictive, but publicly funded so dont need to do sketchy stuff to support drug habit
buprenophrine = similar to morphine block craving without strong high
many prefer since less sedative and can be taken as a pill 3 x a week instead of liquid daily
levomethadyl = another opiate
Naloxene & Naltrexone
naltrexone= blcok feeling of pleasure from alcohol, opiates like heroin, amphetamies
doesnt prevent from taking but blunts cravings
evidence for effectiveness is mixed
Non Professional Support
disease not sin
never cured: recovering
spiritual, group support, cognitive
Al Anon = support families of alcoholics
Alateen = support children with alcoholic parents
Residential Approach
stay in hospital or therapeutic residence
recommended when cant exercise control themselves
most inpatient use 28 day detox
first days focus on withdrawal, then emphasis shifts to counselling about destructive effects and
combatting distorted ideas
view problem as symptoms of conflict rooted in CH
attempt to resolve underlying conflict
some success but lack of research
no intention to change > contemplation > preparation > action > adaptation/maintenance >
self control strategies:
help develop skill to change abusive behaviour
focus on antecedent cues that trigger, abusive behaviours, and reinforcing or punishing
consequences that discourage abuse
contingency management programs
believe behaviour shaped by reward and punishment
provide rewards (reinforcement) for desirable behaviour like producing drug free urine samples
longer period of abstinence than methadone
aversive conditioning
pair aversive stimuli with substance abuse and stimuli to condition negative response
often temporary and fail to generalize to real life settings
social skill training
develop effective interpersonal responses in social situations

develop effective interpersonal responses in social situations

Relapse Prevention Training
hep identify high risk situations and learn effective coping skills for handling situations without turning
to drugs
prevent lapses from turning to full blow relapses
taught not to overreact to a lapse
abstinence violation effect: guilt and perceived loss of control felt after feeling like returning to drug use
after extended period of abstinence

Chapter # 10: Schizophrenia

chronic, debilitating disorder; increasingly disengaged from society
typically develops in late adolescence, making away from family to outside world
acute episodes: delusions, hallucinations, incoherent speech, bizarre behaviour, break with reality
between episode may be unable to think clearly and lack emotional responses
40% of schizophrenia patients have long periods of remission (= no disturbing symptoms and able to
function) lasting a year or more
Historical Conceptions
Kraeplin: dementia Praecox:
Bleuler: associations relationships among thoughts distorted; affect: emotions flattened;
ambivalence (toward others); autism into private fantasy
Schneider: 1st rank: central to diagnosis, hallucinations and delusions; 2nd rank: symptoms
associated with schizophrenia that occur in other psychological conditions, disturbance of mood and
psychotic behaviour may emerge gradually over years
waning interest in social activities and increasing difficulty meeting responsibility and impaired
subtle symptoms with unusual thoughts or abnormal perceptions =/= delusions or hallucinations
Active: delusions, hallucinations
following acute; enter this stage
behaviour returns to prodromal phase
flagrant psychotic behaviours absent; but still impaired cognition, social and emotionally; harbour
unusual ideas like telepathy
Disturbances of Thought & Speech
+ symptoms; coherent, meaning ful speech
Disturbance in content of though: false beliefs with lack of evidence
Delusions of persecution/ paranoia: police out to get me
Delusions of reference: people on bust talking about me
Delusions of being controlled: belief you are being controlled by external forces
Delusions of grandeur: believe youre jesus
Other Common Forms of Delusions
thought broadcasting: belief that everyone can hear thoughts
thoughts of insertion: belief that thoughts were planted by someone else
thoughts of withdrawal: belief that thoughts removed from mind
Disturbances in Form of Thought
tend to think in disorganized illogical ways
structure and content of thoughts disturbed: thought disorder
+ symptom, looseness of association

+ symptom, looseness of association

Neologism: words make up by speaker with no meaning to other people
perseveration: inappropriate repetition of same word
clanging: stringing words based on rhyme
blocking: involuntary abrupt interruption of speech/thought
Attentional Deficiencies
hypervigilance: over sensitivity to external sounds, esp during early stages; difficulty filtering irrelevant
stimuli, hard to focus attention
Eye Movement Dysfunction
difficulty tracking slow moving target across field of vision; jerky
98% accuracy discriminating schizophrenia from healthy based on this
Event Related Potential (ERPs)
brain wave patterns in response to external stimuli
normally brain suppresses response to repeated stimuli; so you can disregard irrelevant stimuli;
doesnt work effectively in schizophrenics
Perceptual Disturbance
auditory hallucinations & self talk
auditory hallucinations 60% of cases; inside or outside head
auditory cortex processes auditory stimulation during hallucinations
command hallucination: voices instruct them to do something
causes of hallucinations:
dopamine; anti psychotic drugs that block activity of dopamine reduce hallucinations
Emotional Disturbance
- symptoms like loss of normal emotional expression: flat effect
not sure if its inability to express or actually inability to experience emotion
Other Impairment
confused about identities
disturbance of volition
loss of initiative to pursue goals
- ive
catatonic behaviour
severely impaired cognitive and motor functioning
unaware of environment and maintain rigid posture
may show high excitement about seemingly purposeless behaviour or slow down to a state of stupor
wavy flexibility: adopting fixed posture in which they have been positioned by others

Categorical Model
Type 1: Positive Symptoms
presence of abnormal behaviour, hallucinations, delusions
break with reality
Type 2: Negative Symptoms
absence of normal behaviour like social skills, flattened effect
affect ability to function in daily life
functioning before disease was worse than it would have been in type 1
Theoretical Perspectives
overwhelming ego by primitive sexual or aggressive drives from id
under threat person regresses to oral stage: primary narcissism
breakdown of ego accounts for detachment from reality
ego boundaries: fail to recognize themselves as unique individuals
Sullivan: emphasis on interpersonal rather than intrapsychic
mother- child: set stage for gradual withdrawal; anxious interactions > take refuge in fantasy world
Critics: schizophrenic and infantile behaviour are different; cant be explained by regression
doesnt offer complete explanation
learn to exhibit bizarre behaviour

learn to exhibit bizarre behaviour

social cognitive: modelling of schizophrenic behaviour in hospitals because they get more attention:
Ulmann & Krasner
children may grow up in non reinforcing environments and never learn to respond properly to social
1st degree relatives have 10 fold risk
Concordance: 2 times
Cross fostering studies: heritability trait by observing diff. in adoptive and biological parents
Dopamine: do not have more dopamine, more receptors in brain or more sensitive to dopamine
neurolpetics = effect of anti psychotic drugs; block dopamine receptors; inhibit excessive
transmission > schizophrenic behaviour
amphetamines: ^ dopamine, cause schizophrenic behaviour
Viral Infections
dont know yet!
flu during first three months ^ 7 fold risk; born in winter have greater risk too
Brain Abnormalities
abnormality in physical structure and functioning
loss of brain tissue ( gray matter)
enlarged ventricle
deep brain structures may cause brain to create own reality?
abnormal functioning and loss of tissue in prefrontal cortex for thinking, planning, and organizing
also hippocampus and amygdala
Schizophrenic Mother
bitchy and overprotective; strip child of self esteem
higher risk if dad was passive
double bind communication theory: result of fucked family communications
Communication Deviance
unclear, vague communication
hard to follow speech
high CD parents difficulty on focusing on what kid is saying > attack verbally
likely of schizophrenic
Expressed Emotion
responding to the schizophrenic family member in hostile way
more than 2 time risk of relapse in high EE families
Cause or Source of Stress?
no evidence
increase risk of disturbed communication and emotional interaction
antipsychotic (tranquilizers/neuroleptics) : block dopamine receptors; effective;
Phenothiazine:Tardive Dyskinesia: movement disorder, major risk of LT use of neuroleptics, W> and
older people; improves over years
Atypical Anti psychotics: as effect but fewer neurological side effects and risk of TD; clozapine,
risperidone; complications: stroke, weight gain, cardiac death; clozapine can cause body to carry too
many white blood cells
Sociocultural Factor
medication and dosage vary based on ethnicity
Freud didnt think traditional view would work to treat
withdrawal into fantasy prevents from forming meaningful relationship with psychoanalyst

withdrawal into fantasy prevents from forming meaningful relationship with psychoanalyst
Learning Based
few believe that faulty learning causes schizophrenia
learning intervention has been effective though
selective reinforcement: provide attention for appropriate behaviour
token economy
socka skills training
CBT: useful addition to drug therapy for controlling hallucinations
evidence backed to work for hallucination, delusion, lack of motivation, etc.
Psychosocial Rehabilitation
help find place in society
often make use of skills training
Family Intervention Program
help cope with burden of caring for schizophrenic
benefits modest; question about whether relapse is prevented or delayed
Early Intervention Program
reduce disruption of activities, relationships, likelihood of hospitalization, suicide, etc.
Other Schizophrenia Spectrum Disorders
Brief Psychotic = last days to months with 1 of delusions, hallucinations, disorganized speech, catatonic
linked to stress
Schizophreniform = abnormal behaviour exactly like schizophrenia for 1 month to 6. after 6, reasses
Delusional = persistent, delusions beliefs
other than delusion, no evidence of odd behaviour
Schizoaffective aka mixed bag of symptoms = psychotic behaviours associated with schizophrenia at
same time as MDD
genetic link?
responds to anti-psychotic

Chapter # 11: Abnormal Psychology Across Lifespan

40% have experienced diagnosable mental disorder
learning disorder most common (10%) in 6-17 years and ADHD (9%)
ethnicity minority have higher risk
pervasive deficit in ability to relate and communicate with others and restricted range of interests
rising prevalence, 2%; link autism and schizophrenia to old fathers
evident 18-30 months..good babies before
Aspergers: social awkwardness but without significant language or cognitive deficits
aloneness, communication problems, ritualistic problems
echolalia = parroting back what youve heard in high pitch
pronoun reversal, words with meaning to them, raise voice at end of sentence
twirling hands, rocking, mutilate themselves, bang heads, pull hair
laggin intellectual development
Theoretical Perspectives
Eisenberg: really cold detached parents emotional fridge
Bettlehelm: extreme self absorption is defence against parental rejection
Lovaas: perceptual deficits only lets them process 1 stimulus at a time
learn by classical conditioning
attached to caregiver from association to primary reinforcers like food but autistic children do not

attached to caregiver from association to primary reinforcers like food but autistic children do not
connect to parent
neurological basis in brain abnormalities
overgrowth of brain in early postnatal development followed by significant slowed growth > brain
volume smaller than average children 5- 16
smaller corpus collsum: lateralization (making each side of the brain responsible for something)
under-developed mirror neurons > social deficit
malfunctions in complex circuitry and loss of brain tissue
focus behavioural, educational, communication
intensive behavioural > significant improvement leaning and language skills
applied behaviour analysis
early intervention is very important
Biomedical: largely use of anti psychotic drugs to control tantrums, aggressions, self injury
Intellectual Disability
broad delay in development of cognitive and social functioning
assess: formal intelligence test, observation of adaptive functioning
problem solving, abstract thinking, judgement, school performance
3 criteria: IQ < 70, impaired functioning in adaptive behaviour, onset before 18
< 1%
severity depends on adaptive functioning and ability to meet expectable demands; 85% mild
Down Syndrome = extra chromosome in 21st pair
1 in 800 births , ^ likelihood with parent age
traced to mom egg 90% of time
physical features: round face, broad flat nose, slanted eyes, protruding tongue, small limbs, curved 5
nearly all MR and many have malformation to heart and respiratory
most di by 49
children: learning and development difficulty, uncoordinated (no muscle tone), memory deficit, cant
express thoughts
Klinefelters: only guys, extra X > XXY
cant develop 2nd sex characteristics > small testes, low sperm, enlarged breast, poor muscle; ID
common; often dont know until testing for fertility
Turners: only in girls, X or X with partial 2nd X
normal external genitals, but bad ovaries, too little estrogen; short, infertile, endocrine and
cardiovascular problems
Fragile X: mutated gene on X in area that appears to be fragile
MR in 1 / 100- -1500 guys and 1/2000 - 2500 girls and less severe; no treatment
Phenylketonuria (PKU): prevent metabolization of phenylaniline and phenylpyruvic acid; genetic; low
PKU diet; 1/ 1000
Tay Sachs: lipid metabolism; genetic; early death; chromosome 15 recessive only Jews of Easter
Europe and French Canadians; loss of muscle control, deafness, blindness,s MR,paralysis, death by 5
Prenatal Factors
Rubella: brain damage > ID; role in autism
Cytomegalovirus: maternal disease ~ herpes carries risk of MR
maternal smoking or drinking : FASD and linked to developing ADHD
complications: oxygen deprivation, head injury, premature, brain infection, trauma, toxin
Cultural Familial Causes
Cultural Familial Retardation: milder MR from impoverished environment
respond dramatically when put in enriched learning experiences
inclusion and integration
trend towards deinstitutionalization of ID, from outrage from public from bad conditions of institutions
high risk of other psychiatric disorders like anxiety

high risk of other psychiatric disorders like anxiety

behavioural approach
teach severe R basic hygiene
shape desired behaviour by verbal instruction, physical guidance, rewards
skills training and anger management
Learning Disorder
deficiency in specific learning; has average or above average intelligence
dyslexia: impaired ready, most common 80%, 4% school children, B>G
Mathematical Disorder: difficulty with basic math; apparent at 6 but generally recognized at 8
Disorder of Written Expression: Dysgraphia - 4-10%
error in spelling, grammar; apparent at 7 mild case not diagnosed till 10
Problem with Executive Function
difficulty organizing and coordinating activities
Speech Sound Disorder
formerly: phonological disorder
difficulty articulating sounds in baseness of defect in oral speech
Social Pragmatic Communication Disorder
children with difficulties communicating verbally and non verbally with others in natural context
cant carry conversation and can be silent in group
Childhood Onset Fluency Disorder
stuttering; 3x M > W
Reading Disorder
dyslexia; M = W; cerebral cortex responsible for decoding sounds of written letters and assembling to
words; after 100 hours of intensive remedial instruction > improvement
Theoretical Perspective
sensory processing dysfunction
defect in brain circuit for processing sensory info
if parent has dyslexia have greater risk
concordance 70% vs 40%
defect in neural circuit
focus on information processing style and academic strength, bolster self esteem and increase
individual education plan: contractual document; learning and behavioural outcomes for student,
description of how outcomes are to be achieved and evaluated
Attention Deficit and Disruptive Behaviour
excessive motor activity and inability to focus attention
impulsive, inattention, hyperactivity
Subtype: predominantly inattentive, predominantly hyperactive, impulsive, combination
5-10% IN 6-14 year olds; 2-3x B> G; 6-8 > 12-14
poorly in school; cant follow instruction; more likely to have LD, risk of mood and anxiety; problem
getting along; disruptive; fight; unpopular
problems with working memory > difficult to keep mind on a task at hand
Theoretical Perspective
regulating attention, motor inhibition and executive control implicated
important role of genetics
2.5 more likely to have prenatal exposure to tobacco smoke
lead exposure
Ritalin; Concerta

paradoxical effects: calm them down and increase attention span
activate pre-frontal cortex: control impulsive behaviour and regulate attention
3/4 children success
loss of appetite, insomnia, cardiac arrest, stroke, death
first non stimulant; generic atomoxetine
Selective norepinephrine re-uptake inhibitor: increase availability of norepinephrine by interfering reuptake
combine behaviour modification based on reinforcement and cognitive modification
learn to stop and think before angry impulse
evidence backed to be effective; not as effective as stimulant
Disruptive Behaviour
Conduct Disorder: disruptive, antisocial behaviour
3.5% B >G, features before 10
Boys: steal, fight, vandalism
Girls: lying, truancy, substance abuse, prostitution
ADHD literally incapable of controlling behaviour; CD purposefully engage in antisocial behaviour
dont experience guilt
Oppositional Defiant Disorder: excessive oppositional tendencies and refuse requests
one of most common 6-12%
B > G before 12
precursor and milder form of CD
more non delinquent forms of conduct disturbance whereas CD is outright delinquent like stealing,
negativistic, defiant of authority, ague, refuse to follow orders
begins at 8 and develops gradually
Theoretical Perspective
oppositionality is underlying temperament: difficult child type
Psychodynamic of ODD
fixation at anal stage > conflict between parent and child over toilet training
leftover conflict > rebelliousness
Learning of ODD
prenatal use of inappropriate reinforcement strategies
unassertive and ineffective parenting
Families oF CD
negative, coercive relationships pushing, spanking, hitting
children very demanding
parental modelling of antisocial behaviour
behaviour based help reduce aggressive, disruptive behaviour
help parent have more clear rules and better discipline, increase positive reinforcement
set explicit rules and clear rewards
teach aggressive children to rethink social provocations as problems to be solves not challenges
that need violence
self calming techniques
Separation Anxiety
most common affecting adolescent; co morbid with depressive
extreme fear of separation
usually after stressful event
more prone to develop problem behaviours like anxiety in later CH when they face negative events
follow family around; voice concern about death; someone stay till they sleep; anxiety symptoms when

follow family around; voice concern about death; someone stay till they sleep; anxiety symptoms when
separation anticipated; pleading not to leave; tantrums
4% children, more common disorder under 12; G > B; associated with school refusal
Theoretical Perspective
anxiety symbolize unconscious conflict
cognitive bias in processing information like interpreting ambiguous as threatening
generalized anxiety arise from fears of rejection or failures that carry across situations
same CBT as anxiety in adults
gradual exposure to stimuli and relaxation training
cognitive technique: identify anxiety generating thought and replace with adaptive thoughts
CBT: good results
Antidepressant: SSRIs and Prozac work well
Depression in Childhood
greater sense of hopelessness, more cognitive errors, lower self esteem
Features: refuse to go to school; fear parent death; clingy
not able to recognize internal feelings till 7 bored
may last a year or more
rarely occurs alone; higher risk of anxiety, CD, ODD, and eating
2%; no gender different; after 15 2xG>B
3/4 who were depressed from 8-13 became depressed later in life
Correlates and Treatment
family problems
Internal, stable, global attributional style
adolescent girls: greater; social challenges of pressure
CBT: evidence backed; social skill; problem solving; family therapy
Suicide Among Children
rare in early but more common in late adolescence
college: second leading cause
Factors Associated
Gils; less populated; 15-24; First Nations; depression + hopelessness+low self esteem; previous
suicidal behaviour; sexual abuse; family problems; stressful event; addiction in the family; social
Neurocognitive; deficit in cognitive functioning
Delirium= extreme mental confusion, difficulty focusing attentino, clear and coherent and orient to
Demential= generalized progressive deficit; memory, learning, communication, judgement, motor
aka major neurocognitive disorder
memory loss and disturbance of executive function 2 major losses
usually has 3.3 years then go see doctors;
after 80 years, < 65 is called early onset, >65 senile dementia
Amyloid plaques, neurofibrillary tangles, reduction in NT, brain inflammation
Cause: Huntington, Parkinson, head injury, oxygen deprivation, stroke, meningitis
fatal; 65% of cases
progressive and irreversible; memory loss, deterioration of function including judgement
mother with AD > greater risk
not given diagnosis until other causes ruled out
may become depressed, confused, delusional when they know ability is slipping

may become depressed, confused, delusional when they know ability is slipping
can start talking to themselves or have hallucinations
some forms associated with gene
no cure
slow down decline in memory, language, thinking by inhibiting breakdown of acetylcholine
Donepezil (Aricept) ^ NT ACh levels
small and modest improvement
Memantine (Axura) block NT glutamate, found in high [ ] in AD
engage in stimulating activity can help boost performance in mild and moderate cases
lifestyle factors can help prevent: low animal fat diet + physical fitness in middle adulthood

Psychotropic affect NT GABA, Norepinephrine, dopamine, serotonin receptors and manage
thoughts and behaviours
depression, BP, schizophrenia, anxiety, sleep
42% should I socialize?
55% wont date someone with illness or addiction
10% general population has expressed need for MH intervention in last year
Side effects
vary; not every time; usually minimal and short lived
brown bag biopsy
Classes of Psychotropic Meds:
Effexor, Cymbalta, Prestiq
depression, anxiety, malaise
sexual side effect: ED, decreased libido, cant reach climax; nausea, headache, ^ BP
prescribed with caution if have other health issue
Celexa, Cipralex, Prozac, Zoloft, Paxil
Atypical Antidepressant
different mechanism; mostly dopamine
fewer side effects, > in geriatric
Wllbutrin, Remeron, Trazodone
4-6 weeks to give effect therapeutic range; when reached side effects minimal and manageable
2 classes
Typical, 1st gen: Haldol, Largactil, Nozinan, Loxapine
Atypical, 2nd gen: Abilify, Zyprexa, Seroquel, Clozapine, Riseridone
do well on + and - ive symptom; decrease suicidal and depressive
easier to take, last longer, increased compliance
less side effects like muscle spasm; SE: hunger, weight gain, sedation, ^ diabetes
injection into muscle for 1-4 weeks
more quickly with severe psychosis
brain to ability to produce and absorb dopamine
too much: + ive like hearing voices, hypervigilance
too little: -ive lack of motivation, poor self care, flat effect
Mood stabilizer
bipolar, manic
moderate on depressive
mechanism not understood
2-4 weeks for therapeutic effects to kick in
blood tests to monitor levels kidney and thyroid function
lithium toxicity symptoms: unsteady gait, poor judgement, difficulty with memory, problem solving
Antiolytics (anti anxiety)
as needed basis to control acute episodes

as needed basis to control acute episodes

Benzodiazepines and Beta Blockers
Benzodizepines: slow down CNS, breath slow, heart rate reduced, fight or flight lessened
impair judgment and slow reaction
if it ends in pam its a benzo
Beta blockers
used for cardiac and BP management
reduce anxiety by blocking effect of norepinephrine > short acting and feeling of calm without
as much slowed reaction as benzo
useful for social phobia
work quickly and effectively; highly addictive
build tolerance
mixed with alcohol fatal CNS depressant effect
abruptly stopping benzo > seizure, taper
quickly stopping antidepressants and mood stabilizers > withdrawal: vomit, achiness,
cant stop and restart with same drug and same dose
stimulants: ritalin, concerta
Amphetamines (stimulant): dexedrine, adderall
Atomoxetine, strattera (non stimulants)
side effect: headache, weight loss, low appetite, insomnia
Eating disorder: manage depressive symptoms, Prozac
Personality disorder: mood stabilizers, anti depressants, anti psychotic to treat
Geriatric/ Paediatric
less drug needed to be effect
side effects more quick and severe
can impede cognitive function
start low, go slow