Clinical Psychology – Interim exam 2 [UNIVERSITY OF AMSTERDAM]
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PSYCHOTIC DISORDERS
Disorder | Schizophrenia |
Symptoms | Two OR MORE of the following and one should be either 1, 2 or 3: |
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| Negative symptoms SUCH AS: |
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Time | 6 months (MUST INCLUDE ONE MONTH OF ACUTE EPISODE OR ACTIVE PHASE) |
Prevalence | 0.7%-1% |
Comorbidity | High (substance abuse, PTSD |
Other |
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Disorder | Schizophreniform disorder |
Symptoms | Two OR MORE of the following and one should be either 1, 2 or 3: |
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| Negative symptoms SUCH AS: |
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Time | 1 – 6 months |
Prevalence | <1% |
Comorbidity | High (substance abuse, PTSD |
Other |
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Disorder | Schizoaffective disorder |
Symptoms |
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Time | Not specified |
Prevalence | <1% |
Comorbidity | High |
Other |
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Disorder | Brief psychotic disorder |
Symptoms | Two OR MORE of the following and one should be either 1, 2 or 3: |
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| Negative symptoms SUCH AS: |
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Time | 1 day – 1 month |
Prevalence | Not specified |
Comorbidity | High (PTSD) |
Other |
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Disorder | Delusional disorder |
Symptoms |
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Time | Not specified |
Prevalence | <1% |
Comorbidity | Not specified |
SUBSTANCE USE DISORDERS
Disorder | Substance use disorder |
Symptoms |
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| AT LEAST two symptoms that impairs functioning within a 1-year period: |
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Time | 1 year |
Prevalence | Depends on the specifier |
Comorbidity | High (other substance use disorders, personality disorder, mood disorders, schizophrenia and anxiety disorders) |
Other |
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NOTE: Addiction refers to a severe substance use disorder
NOTE: The disorder specifies the abused substance (e.g., alcohol)
NOTE: 2-3 symptoms: mild, 4-5 symptoms: moderate, 6-11: severe
EATING DISORDERS
Disorder | Anorexia Nervosa |
Symptoms |
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Time | Not specified |
Prevalence | <1% |
Comorbidity | High (depression, obsessive-compulsive disorder, specific phobias, panic disorder and personality disorders) |
Other |
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Disorder | Anorexia Nervosa: restricting type |
Symptoms | Symptoms of anorexia nervosa AND: |
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Time | Not specified |
Prevalence | <1% |
Comorbidity | High (depression, obsessive-compulsive disorder, specific phobias, panic disorder and personality disorders) |
Other |
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Disorder | Anorexia Nervosa: binge-eating/purging type |
Symptoms | Symptoms of anorexia nervosa AND: |
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Time | Not specified |
Prevalence | <1% |
Comorbidity | High (depression, obsessive-compulsive disorder, specific phobias, panic disorder and personality disorders) |
Other |
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Disorder | Bulimia nervosa |
Symptoms |
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Time | AT LEAST once a week for three months |
Prevalence | 1%-2% |
Comorbidity | High (depression, personality disorders, substance use disorders, anxiety disorders and conduct disorder) |
Other |
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Disorder | Binge-eating disorder |
Symptoms |
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| Binge eating episodes include AT LEAST three of the following: |
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Time | AT LEAST one time per week for AT LEAST three months |
Prevalence | 0.2%-4.7% |
Comorbidity | High (mood disorders, anxiety disorders, ADHD, conduct disorder and substance use disorder) |
Other |
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SEXUAL DYSFUNCTIONS
Disorder | Female sexual interest/arousal disorder |
Symptoms | Diminished, absent or reduced frequency of AT LEAST three of the following: |
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Time | AT LEAST six months |
Prevalence | Not specifeid |
Comorbidity | Not specified |
Other |
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Disorder | Male hypoactive sexual desire disorder |
Symptoms |
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Time | AT LEAST six months |
Prevalence | Not specified |
Comorbidity | Not specified |
Other |
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Disorder | Erectile disorder |
Symptoms | On AT LEAST 75% of the sexual occasions: |
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Time | AT LEAST six months |
Prevalence | 13%-28% |
Comorbidity | Not specified |
Other |
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Disorder | Female orgasmic disorder |
Symptoms | On AT LEAST 75% of the sexual occasions: |
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Time | AT LEAST six months |
Prevalence | Not specified |
Comorbidity | Not specified |
Other |
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Disorder | Delayed ejaculation |
Symptoms | On AT LEAST 75% of sexual occasions |
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Time | AT LEAST six months |
Prevalence | <1% |
Comorbidity | Not specified |
Other |
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Disorder | Premature ejaculation |
Symptoms | On AT LEAST 75% of sexual occasions |
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Time | AT LEAST six months |
Prevalence | <3% |
Comorbidity | Not specified |
Other |
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Disorder | Genito-pelvic pain/penetration disorder |
Symptoms | Persistent or recurrent difficulties with AT LEAST one of the following: |
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Time | AT LEAST six months |
Prevalence | Not specified |
Comorbidity | Not specified |
PARAPHILIC DISORDERS
Disorder | Fetishistic disorder |
Symptoms |
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Time | AT LEAST six months |
Prevalence | Not specified |
Comorbidity | High (mood disorders, anxiety disorders and substance use disorders) |
Other |
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Disorder | Pedophilic disorder |
Symptoms |
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Time | AT LEAST six months |
Prevalence | Not specified |
Comorbidity | High (mood disorders, anxiety disorders and substance use disorders) |
Other |
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Disorder | Voyeuristic disorder |
Symptoms |
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Time | AT LEAST six months |
Prevalence | Not specified |
Comorbidity | High (mood disorders, anxiety disorders and substance use disorders) |
Other |
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Disorder | Exhibitionistic disorder |
Symptoms |
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Time | AT LEAST six months |
Prevalence | Not specified |
Comorbidity | High (mood disorders, anxiety disorders and substance use disorders) |
Other |
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Disorder | Frotteuristic disorder |
Symptoms |
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Time | AT LEAST six months |
Prevalence | Not specified |
Comorbidity | High (mood disorders, anxiety disorders and substance use disorders) |
Other |
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Disorder | Sexual sadism disorder |
Symptoms |
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Time | AT LEAST six months |
Prevalence | Not specified |
Comorbidity | High (mood disorders, anxiety disorders and substance use disorders) |
Other |
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Disorder | Sexual masochism disorder |
Symptoms |
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Time | AT LEAST six months |
Prevalence | Not specified |
Comorbidity | High (mood disorders, anxiety disorders and substance use disorders) |
Other |
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CHILDHOOD DISORDERS
Disorder | Attentional-deficit/hyperactivity disorder (ADHD) |
Symptoms | Either A or B: |
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| B: |
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| AND: |
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| AT LEAST six months |
Prevalence | 8%-11% |
Comorbidity | High (conduct disorder, anxiety disorder, depressive disorders, substance use disorder, ODD, eating disorders) |
Other |
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Disorder | Conduct disorder |
Symptoms | Repetitive and persistent behaviour pattern that violates the basic rights of others or conventional social norms as shown by AT LEAST three of the following in the following or previous 12 months and AT LEAST one in the previous six months: |
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Time | AT LEAST six months and twelve months |
Prevalence | 6%-9.5% |
Comorbidity | High (substance use disorder and internalizing disorders) |
Other |
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Disorder | Separation anxiety disorder |
Symptoms | Excessive anxiety that is not developmentally appropriate about being away from people to whom one is attached shown by AT LEAST three symptoms: |
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Time | AT LEAST three weeks |
Prevalence | Not specified |
Comorbidity | High (anxiety disorders) |
Disorder | Specific learning disorder |
Symptoms |
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Time | AT LEAST six months |
Prevalence | 5%-15% |
Comorbidity | High (substance use disorder and internalizing disorders) |
Other |
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Disorder | Intellectual disability |
Symptoms |
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| Significant deficits in adaptive functioning relative to the person’s age and cultural group in one or more of the following areas |
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Time | Not specified |
Prevalence | Not specified |
Comorbidity | Not specified |
Disorder | Conduct disorder |
Symptoms | A: Deficits in social communication and social interactions as exhibited by the following: |
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| B: Restricted, repetitive behaviour patterns, interests or activities exhibited by AT LEAST two of the following: |
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| C: Onset in early childhood |
| D: Symptoms limit and impair functioning |
Time | Not specified |
Prevalence | 1.5% |
Comorbidity | High (specific learning disorder, separation anxiety, social anxiety, specific phobias and general anxiety disorder) |
Other |
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DISORDERS OF LATE LIFE
Disorder | Mild neurocognitive disorder |
Symptoms | Modest cognitive decline from previous levels in one or more domains based on BOTH of the following: |
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Time | AT LEAST six months and twelve months |
Prevalence | 0.4% (1-2% in people aged 60-69 and >20% in people aged 85 or older) |
Comorbidity | Not specified |
Disorder | Major neurocognitive disorder |
Symptoms | Significant cognitive decline from previous levels in one or more domains based on BOTH of the following |
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Time | Not specified |
Prevalence | 0.4% (1-2% in people aged 60-69 and >20% in people aged 85 or older) |
Comorbidity | Not specified |
Disorder | Frontotemporal dementia |
Symptoms | Deterioration in AT LEAST three of the following at a level that leads to functional impairment |
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Time | AT LEAST six months and twelve months |
Prevalence | 0.4% (1-2% in people aged 60-69 and >20% in people aged 85 or older) |
Comorbidity | Not specified |
Disorder | Delirium |
Symptoms |
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Time | Not specified |
Prevalence | Higher in children and older adults; unspecified |
Comorbidity | Not specified |
Other |
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PERSONALITY DISORDERS: ODD AND ECCENTRIC CLUSTER
Disorder | Paranoid personality disorder |
Symptoms | Presence of four OR MORE of the following from early adulthood: |
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Time | From early adulthood |
Prevalence | Not specified |
Comorbidity | High (schizotypal, borderline and avoidant personality disorder) |
Other |
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Disorder | Schizoid personality disorder |
Symptoms | Presence of four OR MORE of the following from early adulthood: |
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Time | From early adulthood |
Prevalence | Not specified |
Comorbidity | Not specified |
Disorder | Schizotypal personality disorder |
Symptoms | Presence of five OR MORE of the following from early adulthood: |
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Time | From early adulthood |
Prevalence | Not specified |
Comorbidity | Not specified |
Other |
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PERSONALITY DISORDERS: DRAMATIC/ERRATIC CLUSTER
Disorder | Antisocial personality disorder |
Symptoms |
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| Pervasive pattern of disregard for the rights of others since the age of 15 shown by AT LEAST three of the following: |
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Time | From early adulthood |
Prevalence | Not specified |
Comorbidity | High (substance abuse disorder) |
Other |
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Disorder | Borderline personality disorder |
Symptoms | Presence of five OR MORE of the following from early adulthood: |
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Time | From early adulthood |
Prevalence | Not specified |
Comorbidity | High (PTSD, stress-, mood-, substance-related and eating disorders) |
Disorder | Histrionic personality disorder |
Symptoms | Presence of five OR MORE of the following from early adulthood: |
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Time | From early adulthood |
Prevalence | Not specified |
Comorbidity | Not specified |
Disorder | Narcissistic personality disorder |
Symptoms | Presence of five OR MORE of the following from early adulthood: |
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Time | From early adulthood |
Prevalence | Not specified |
Comorbidity | Not specified |
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PERSONALITY DISORDERS: ANXIOUS/FEARFUL CLUSTER
Disorder | Avoidant personality disorder |
Symptoms | Presence of four OR MORE of the following from early adulthood: |
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Time | From early adulthood |
Prevalence | Not specified |
Comorbidity | Not specified |
Disorder | Dependent personality disorder |
Symptoms | Presence of five OR MORE of the following from early adulthood: |
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Time | From early adulthood |
Prevalence | Not specified |
Comorbidity | Not specified |
Disorder | Obsessive-compulsive personality disorder |
Symptoms | Presence of four OR MORE of the following from early adulthood: |
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Time | From early adulthood |
Prevalence | Not specified |
Comorbidity | Not specified |
TREATMENT OF PSYCHOTIC DISORDERS
Type of treatment | Treatment | How it works |
Psychological | Social skills training | Teach patients how to manage a wide variety of interpersonal situations. It involves role-playing. |
Psychological | Family therapy | Educate about psychotic disorders, inform about antipsychotic medication, blame reduction and avoidance, improve communication and problem-solving skills within the family, social network expansion and instil hope. |
Psychological | Cognitive behaviour therapy (CBT) | Encourage patients to test delusions and change cognitions about these delusions. |
Psychological | Cognitive remediation therapy / cognitive enhancement therapy | Try to enhance basic cognitive functions, such as verbal learning ability. It is especially effective for functional outcomes. |
Psychological | Psychoeducation | Educate patients about their illness. |
Psychological | Case management | Bring patients in contact with case managers. Case managers are people who connect people with psychotic disorders with providers of whatever services they require. They hold together and coordinate the range of medical and psychological services people with psychotic disorders need to keep functioning outside the hospital with independence and peace of mind. |
Psychological | Residential treatment | Protected living units for people with psychotic disorders. |
Psychological | EMDR | Treat the trauma in psychosis. |
Biological | Medication | The use of antipsychotic medications. |
NOTE: Antipsychotic drugs have strong side effects.
TREATMENT OF SUBSTANCE USE DISORDERS
Disorder | Type of treatment | Treatment | How it works |
Alcohol use disorder | Biological | Medications | Disulfiram or Antabuse causes vomiting and nausea if alcohol is used. |
Alcohol use disorder | Psychological | Inpatient hospital treatment | Detoxication in hospital. Works well for people with few sources of social support. |
Alcohol use disorder | Psychological | Couples therapy | Cognitive behavioural therapy with a focus on the couple’s relationship to deal with alcohol-related stressors |
Alcohol use disorder | Psychological | Alcoholics Anonymous | Self-help program that provides emotional support, understanding and close counselling. Takes away responsibility and views addiction as a disease. |
Alcohol use disorder | Psychological | Cognitive and behavioural treatments | Teach people to reinforce behaviour inconsistent with alcohol use (contingency management) and help people avoid relapse (relapse prevention). |
Alcohol use disorder | Psychological | Motivational interventions | Comprehensive assessment of the drinking and a brief motivational treatment that includes individualized feedback about a person’s drinking. |
Alcohol use disorder | Psychological | Moderation in drinking | Teach a person to drink with moderation. |
Smoking | Biological | Nicotine replacement | Supply nicotine in another way than through cigarettes to gradually reduce use in order to avoid withdrawal symptoms. |
Smoking | Psychological | Wake-up call | A physician tells a person to stop smoking |
Smoking | Psychological | Scheduled smoking | Reduce nicotine intake gradually by increasing time between cigarettes |
Smoking | Psychological | Project EX | Teaching young people about the harmful effects of smoking and teaching them coping skills. |
Drug use disorder | Biological | Drug replacement | Using substitutes for drugs that fulfil the body’s craving but take away the effects. |
Drug use disorder | Psychological | Cognitive behavioural therapy | Change cognitions and behaviours in order to reduce drug use and improve functioning. Includes learning how to avoid high-risk situations. |
Drug use disorder | Psychological | Contingency management | Teach people to reinforce behaviour inconsistent with drug use. |
Drug use disorder | Psychological | Motivational enhancement therapy | A combination of CBT techniques and techniques associated with helping clients generate solutions that work for themselves. |
Drug use disorder | Psychological | Self-help residential homes | Separate people from social contacts associated with drug use in an environment where drugs are not available and continuing support is offered. |
NOTE: Substitute drugs are addictive
TREATMENT OF EATING DISORDERS
Disorder | Type of treatment | Treatment | How it works |
Bulimia nervosa | Biological | Medication | Bulimia is highly comorbid with depression, so antidepressants can reduce purging and binge eating. |
Anorexia nervosa | Biological | Medication | Antidepressants. There is little success with using this treatment. |
Anorexia nervosa | Psychological | Operant conditioning behaviour therapy | Providing positive reinforcers with weight gain. |
Anorexia nervosa | Psychological | Cognitive behavioural therapy | Changing cognitions regarding weight, body image and food. |
Anorexia nervosa | Psychological | Family-based therapy (FBT) | Improve interactions among family members. |
Bulimia nervosa | Psychological | Cognitive behavioural therapy | Encourage people to question society’s standards for physical attractiveness. Also changes cognitions regarding food, weight and body image. |
Bulimia nervosa | Psychological | Exposure and response prevention | Discouraging a person to purge after eating foods that usually elicit an urge to vomit. |
Bulimia nervosa | Psychological | Guided self-help CBT | Patients receive self-help material and therapists help them through the material. |
TREATMENT OF SEXUAL DYSFUNCTIONS
Type of treatment | Treatment | How it works |
Psychological | Exposure | Gradual and systematic exposure to anxiety-provoking aspects of the sexual situation. |
Psychological | Psychoeducation | Education about sex and the body in order to reduce anxiety |
Psychological / biological | Sensate-focus exercises | Touch the partner without touching the genitals and be very clear when something becomes uncomfortable. This promotes contact. |
Psychological | Cognitive intervention | Challenge the self-demanding, perfectionistic thoughts that often cause sexual dysfunction. |
Psychological | Communication training | Encourage partners to communicate their likes and dislikes more clearly. It also has an exposure element. |
Psychological / biological | Directed masturbation | The women has to find out through directed masturbation what she likes and what she does not like. |
Psychological / biological | Sex position treatment | Couples are taught specific sexual positions that increase the amount of clitoral stimulation. |
Biological | Medication | Antidepressant drugs are helpful when depression contributes to diminished sex drive. Buproprion counteracts the libido problems caused by SSRIs. PDE-5 inhibitors (Viagra) can help with erectile dysfunctions. |
TREATMENT OF PARAPHILIC DISORDERS
Type of treatment | Treatment | How it works |
Psychological | Enhance motivation | Enhance motivation to change illegal behaviour and motivation to continue treatment. |
Psychological | Cognitive behavioural treatment | Change beliefs about inappropriate sexual desires. It also includes training in empathy. |
Biological | Hormonal treatment | Medication that reduces androgens. SSRIs are also use because they reduce arousal to deviant objects. |
TREATMENT OF CHILDHOOD DISORDERS
Disorder | Type of treatment | Treatment | How it works |
ADHD | Biological | Stimulant medications | Medication (e.g: Ritalin) reduce disruptive behaviour and impulsivity and improve the ability to focus. The drugs interact with the dopamine system in the brain. |
ADHD | Psychological | Parent training | Train parents to deal with a child with ADHD. |
ADHD | Psychological | Classroom management | Reinforce positive behaviour (e.g: point system). |
ADHD | Psychological | Behavioural therapy | Use of cognitive behavioural therapy in order to improve behaviour. |
Conduct disorder | Psychological | Family check-up | Three meetings, introduction, assessing and feedback to parenting practices |
Conduct disorder | Psychological | Parent management training (PMT) | Teach parents to modify responses to children so prosocial responses are reinforced. |
Conduct disorder | Psychological | Multisystemic treatment (MST) | Deliver intensive and comprehensive therapy services in the community, targeting the adolescent, the family, the school and the peer group. |
Conduct disorder | Psychological | Prevention program | Intervene early before conduct disorder develops by focussing on academic, social and behaviour areas. |
Separation anxiety disorder | Psychological | Coping cat | Confrontation of fears, development of new ways to think about fear, exposure to feared situation and relapse prevention. |
Separation anxiety disorder | Psychological | Bibliotherapy | Giving parents written materials and make them act as therapists with their own children |
Separation anxiety disorder | Biological | Medication | The use of medication (Zoloft). |
Intellectual disability | Psychological | Residential treatment | People with intellectual disability live in residences integrated into the community where medical care is provided. |
Intellectual disability | Psychological | Behavioural treatments | Behavioural objectives are defined and worked towards in order to improve functioning. |
Intellectual disability | Psychological | Applied behaviour analysis | Similar to the treatment above, but also used to reduce inappropriate and self-injurious behaviour by breaking behaviour down in small steps and using operant conditioning. |
Intellectual disability | Psychological | Self-instructional training | Teach children to guide their problem-solving efforts through speech |
Intellectual disability | Psychological | Computer-assisted instruction | Teach children with intellectual disabilities skills and routines through the computer. |
ASD | Psychological | Behavioural treatment | Intensive operant-conditioning treatment over a long time improves the conditions of people with ASD. |
ASD | Psychological | Joint attention intervention | Improve joint attention of people with ASD |
ASD | Psychological | Symbolic play intervention | Improve communication of people with ASD |
ASD | Biological | Medication | Medication (Haldol, an antipsychotic medication) to reduce social withdrawal, stereotyped motor behaviour and maladaptive behaviours. There are severe side-effects of this medication |
TREATMENT OF DISORDERS OF LATE LIFE
Type of treatment | Treatment | How it works |
Biological | Medication | Medications to slow memory decline (e.g: cholinesterase inhibitors). Medication can also be used to treat co-occurring disorders with dementia. |
Psychological | Psychotherapy | Help patients and family deal with the effects of the disease. |
Psychological | Exercise increase | Intervention that increases exercise. |
Psychological | Cognitive training programs | Training programs that focus on improving memory, reasoning or cognitive processing speed. |
TREATMENT OF PERSONALITY DISORDERS:
Disorder | Type of treatment | Treatment | How it works |
All | Psychological | Psychotherapy | Reconsider childhood experiences and become more aware of how those experiences drive current behaviour. |
All | Psychological | Cognitive behavioural therapy (CBT) | Change dysfunctional cognitions and change a disorder in a more adaptive way of living |
All | Psychological | Schema therapy | Change people’s schemas from maladaptive to adaptive |
All | Psychological | Mentalisation-based treatment | Foster mentalisation, includes modelling. |
Schizotypal personality disorder | Biological | Medication | Antipsychotic drugs, as the disorder is very similar to schizophrenia. |
Avoidant personality disorder | Biological | Medication | Antidepressant medications. |
Avoidant personality disorder | Psychological | Exposure | Exposure to the feared stimulus. |
Borderline personality disorder | Both | Hospitalization | Hospitalize the patient, as suicide is a big risk. |
Borderline personality disorder | Psychological | Dialectical behaviour therapy (DBT) | Help the patient adopt a dialectical view of the world (people can be bad and good). |
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The goal of exploratory research is to disprove hypotheses, generate hypotheses and getting rich descriptions. Qualitative research is primarily exploratory research. The limitations of qualitative research are generalizability (1), causality (2) and biases (3). The solution to the problem of generalizability is using correlational studies. The solution to the problem of causality is conducting experiments and longitudinal studies.
The case study involves recording detailed information about one person at a time. One major pitfall of case studies is the bias of the theoretical framework. Correlational studies are used to study prevalence, risk factors and incidence. Limitations of correlational studies are the representativeness of samples and that confidence intervals are rarely given. There is always the possibility of a third-variable mediator in correlational studies.
There are several correlational methods for behaviour and molecular genetics:
Experiments are used to test causality. Internal validity is important for experiments and there is relatively low external validity. In analogue studies, the researcher attempts to emulate the conditions hypothesised to lead to abnormalities. Randomized controlled trials are studies in which clients are randomly assigned to receive active treatment or a comparison. Treatment outcome research addresses the question of whether the treatment works. A single-case experimental design is an experiment involving one person responding to manipulations of the independent variable. The reversal design or the ABAB design is one form of single-case experimental design:
A) Initial period (baseline)
B) Treatment
A) Reinstatement of conditions of baseline
B) Reintroduction of treatment
Clinical significance is defined by whether a relationship between variables is large enough to matter. The efficacy of treatment refers to whether the treatment works in the purest of conditions. The effectiveness of treatment refers to whether the treatment works in the real world.
Psychosis is a disruption in the experience of reality or disruption of reality testing. Hallucinations are perception-like experiences which occur without an external stimulus and the most common hallucinations are auditory hallucinations. It is not uncommon, as children tend to experience audio-visual hallucinations but this tends to stop at the age of 12 or 13. Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence. They are deemed bizarre if they are implausible, not understandable from same-culture peers and do not derive from ordinary life. There are several types of delusions:
Schizophrenia includes positive, negative and disorganized symptoms. Positive symptoms consist of symptoms that make it difficult for a person to tell what is real and what is not. Negative symptoms consist of behavioural deficits in motivation, pleasure, social closeness and emotion expression. Disorganized symptoms refer to the lack of ability to organize behaviour and conform to community standards. Catatonic behaviour is extremely disorganized behaviour. There are several negative symptoms:
Other symptoms include jumping to conclusions (1), disrupted self-experience (2), neurocognitive difficulties (3) and anosognosia (4): reduced insight into the illness. The severity of symptoms can be assessed using the Positive and Negative Syndrome Scale (PANSS) and using the beads task. Neurocognitive deficits can be measured by measuring working memory.
There is a strong genetic component in schizophrenia. There are several risk factors for developing a psychosis: being a migrant (1), urbanization (2), social exclusion (3) and trauma (4). A psychosis can be traumatic. A sense of social exclusion can play an important role in developing psychosis.
The social defeat hypothesis states that social exclusion increases the risk of psychosis. The dopamine hypothesis states that schizophrenia is related to excess activity of dopamine. The dopamine neurons in the prefrontal cortex may be underactive, which leads to overactivity of dopamine in the rest of the brain.
The cognitive model of auditory hallucinations states that an intrusive thought occurs, which is misattributed to an external source.
.....read moreThe incentive sensitization theory states that drugs stimulate the dopamine system (reward system), which produces rewards in the form of pleasurable feelings. This leads to the dopamine system becoming sensitive to the drug, resulting in incentive salience. Cue sensitivity leads to wanting of the drug and a dissociation between wanting and liking the drug develops.
The general development process of a substance use disorder (SUD) follows the following pattern: a positive attitude towards the drug (1), experimentation with the drug (2), regular use of the drug (3), heavy use of the drug (4), dependence or abuse of the drug (5). After this, there is either maintenance of the disorder (6) or recovery with the chance of relapse (7).
Tolerance is indicated by larger doses of the substances being needed to produce the desired effects. Withdrawal refers to the negative physical and psychological effects that develop when a person stops taking the substance or reduces the amount of substance being taken. People with a substance use disorder value immediate rewards more than delayed rewards. It recruits different brain regions and it can be hypothesised that both brain regions compete with each other when trying to make a decision.
Drug | Effects |
Marijuana | Feeling relaxed and sociable, large shifts in emotion, dull attention, fragmented thoughts, impaired thought processes, the sense that time moves more slowly, bloodshot, itchy eyes, dry mouth, increased appetite, raised blood pressure |
Opiates | Euphoria, drowsiness, lack of coordination, increase in self-confidence, lack of worries and fear, relieve pain and induce sleep |
Stimulants | Increase alertness and motor activity, heightens wakefulness, inhibits intestinal functions, quickening of heart rate, increase in self-confidence, euphoria |
Hallucinogen | Alter a sense of time, hallucinations and anxiety |
Ecstasy | Enhances intimacy, improve |
Eating disorders are not very stable. There is a lot of movement between the disorders. People with anorexia nervosa choose a thin figure as their ideal and overestimate their own body size, but are fairly accurate at reporting their weight. Maintaining thinness is strongly linked to self-esteem in anorexia nervosa.
There are several biological consequences of anorexia nervosa: falling of blood pressure (1), slowing of heart rate (2), decline of bone mass (3), kidney and gastrointestinal problems (4), drying of the skin (5), brittle nails (6), change in hormone levels (7), alteration of electrolytes (e.g., potassium) (8), tiredness (9) and lanugo (10).
Lanugo is a fine, soft hair that develops on the body in people with anorexia nervosa. 50%-70% of the people with anorexia nervosa recover, but it takes ±6-7 years to recover. Severity ratings in anorexia nervosa are based on BMI.
Bulimia nervosa and binge-eating disorder include binge eating. A binge is most likely to occur after a negative social interaction. Maintaining normal weight is strongly linked to self-esteem in bulimia nervosa. Most people with bulimia nervosa were slightly overweight before the onset of the disorder and binge eating started during an episode of dieting.
There are several biological consequences of bulimia nervosa: potassium depletion (1), diarrhoea (2), irregularities in heartbeat (3), menstrual problems (4), ragged teeth (5), swollen salivary glands (6) and tearing of tissue in the stomach and throat (7). Close to 75% of the people with bulimia nervosa recover. There are several biological consequences of binge eating disorder, with most of them being a consequence of obesity: sleep problems (1), anxiety (2), depression (3), irritable bowel syndrome (4) and early onset of menstruation (5).
Eating disorders are highly heritable. The hypothalamus regulates the level of cortisol in the body and cortisol levels differ in people with anorexia nervosa, but these hormonal differences are most likely to occur because of self-starvation. Self-starvation and excessive exercise may also increase endogenous opioids, substances produced by the body that reduce pain sensations, enhance mood and suppress appetite. Endogenous opioids may positively reinforce the behaviour that maintains the disorder.
Serotonin promotes satiety and severe food intake restrictions could interfere with the serotonin system. Dopamine is linked to the pleasurable aspects of food that compel an animal to go after food. Restrained eaters may be more sensitive to food cues. People with anorexia nervosa and bulimia nervosa had a greater expression of the dopamine transporter gene DAT. Expression of DAT influences the release of a protein that regulates the reuptake of dopamine back into the synapse.
Perfectionism and a sense of personal inadequacy may lead a person to become especially concerned with appearance. Western culture emphasizes and reinforces the desirability of being thin more for women than for men. The objectification of women’s bodies exaggerates this effect. Body shame has a negative influence on eating disorders, as well as criticism
.....read moreSexual fantasies begin to qualify as abnormal when they begin to affect us or others in unwanted or harmful ways. Sexual dysfunctions are persistent disruptions in the ability to experience sexual arousal, desire, or orgasm, or as pain associated with intercourse. Paraphilic disorders are defined as persistent and troubling attractions to unusual sexual activities or objects. Sexual norms and behaviour change with time and culture. Gender dysphoria refers to the idea that one should be the opposite gender.
Men report thinking about sex, masturbating and desiring sex more often as well as desiring more sexual partners and having more partners. Women tend to be ashamed of any flaws in their appearance and this shame can interfere with sexual satisfaction. Sexuality is more closely tied to relationship status for women than for men. Men are more likely to think of their sexuality in terms of power.
Women are more likely to report symptoms of sexual dysfunction, but men are more likely to meet diagnostic criteria for paraphilic disorder. The sexual response cycle consists of four phases:
For women, there is a difference between biological arousal and subjective excitement.
SEXUAL DYSFUNCTIONS
There are three types of sexual dysfunctions. Sexual dysfunctions involving sexual desire, arousal and interest (1), orgasmic disorders (2) and a disorder involving sexual pain (3). All sexual dysfunction disorders must last at least 6 months. Sexual concerns that arise as a consequence of severe relationship distress (e.g: partner abuse) should not be diagnosed as sexual dysfunctions.
Clinical profile female sexual interest/arousal disorder:
Diminished, absent or reduced frequency of AT LEAST three of the following: |
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Whether the behaviour is seen as problematic depends on culture. Externalizing disorders are characterised by more outward-directed behaviours. Internalizing disorders are characterised by more inward-focused experiences and behaviours.
There are three sub-types of ADHD:
People with ADHD tend to have problems getting along with peers and establishing friendships. They show poor social skills (1), aggressive behaviour (2) and overestimate their social skills (3). The combined type is the most likely to develop conduct problems.
The heritability of ADHD is ±70-80%. They have smaller dopaminergic areas in the brain, there are differences in brain structure, connectivity and function and they exhibit less activation in frontal areas. Frontal areas are important for the inhibition of behaviour. Low birth-weight (1), maternal smoking (2), interaction with family (3) and family characteristics (parental psychopathology) (4) are factors that can impact the development and can maintain or exacerbate the symptoms of ADHD. Food additives may help maintain or exacerbate the symptoms.
There are two paths of conduct disorder:
The adolescence-limited conduct disorder could result from a difference in physical maturation and the opportunity to assume adult responsibilities. Deficits in brain regions that support emotion (empathy) (1), deficiency in moral awareness (2), social information processing deficits (3), autonomic nervous system abnormalities (4) and peer rejection (5) are risk factors for conduct disorder. Ambiguous cues are often misinterpreted as evidence of hostile intent. Neighbourhood and family factors play a role in whether children associate with deviant peers.
The prevalence of depression in school-age children under 13 is ±2-3% and rises to ±6-16% in adolescence. Genetics (1), significant interpersonal stressful live events (2)¸ rejection by parents, cognitive distortions and a negative attributional style are risk factors for depression in children. The attributional style becomes stable by adolescence. The benefits of CBT may not last long for children and the side-effects of medication may be extreme for children.
Separation anxiety disorder is characterized by constant worry that some harm will befall their parents or themselves when they are away from their parents. For children, in order to be diagnosed with anxiety disorders, the fear does not need to be considered irrational as children are unable to make this judgement.
The heritability of anxiety disorders is ±29-50%. Parental control (1), insecure attachment style in infancy (2), overprotectiveness of parents (3), emotion regulation problems (4) and high levels of behavioural inhibition (5) are risk factors for the development of anxiety disorders in children.
A specific learning disorder is a condition in which a person shows a problem in a specific area of academic, speech, language
.....read moreThe number of elderly in the society increases because of an increase in life expectancy due to improved medical care and prevention of disease and because of the baby boom from 1946 – 1970. Diagnosing mental disorders in the elderly is difficult, as mental health is tied to physical problems and it is thus difficult to distinguish between a normal age-related change in function and neurocognitive disorders.
There are differences in circadian rhythm (1), temperature levels (2), cortisol level (3), metabolism (4) and heart rate (5) over the course of the day in the elderly. There is a flattening of daily cycle (1), fewer hours of sleep (2), peak shifts to the morning (3) and increased need for naps (4) with normal ageing. This leads to a decrease in cognitive abilities, a shift in peak performance, decrease in memory consolidation and a higher risk of brain disorders.
A problem with medication for the elderly is that the elderly often experience multiple medical issues, they take a number of medications, their medication is not adjusted to their age, medications are often tested on the young and there is a lot of medication nonadherence.
Ageism is an irrational prejudice against old people and/or ageing. There are several biases about ageing or being old. This includes being lonely (1), focussing on poor health (2) and being unhappy (3). There is social selectivity in older people, a shift of attention from forming new social interactions to cultivating the few important social interactions and older people are better at emotion regulation.
Age effects are the consequences of being a certain chronological age. Cohort effects are the consequences of growing up during a particular time period. Time-of-measurement effects are the effects of testing people at a particular time in history (e.g: after a terror attack). Consequences of longitudinal studies include selective mortality.
The prevalence of mental disorders is lower in the elderly and this could be due to reporting bias, cohort effects and selective mortality in research, but it likely reflects better mental health due to growing out of symptoms and enhanced coping abilities.
Dementia is a descriptive term for the deterioration of cognitive abilities to the point that functioning becomes impaired. In frontotemporal dementia, there is rapid progression of the disease and memory is not severely impaired, but there is functional impairment of executive function (1), ability to inhibit behaviour (2), empathy (3) and there is hyperorality (4), compulsive or perseverative behaviour (5) and apathy (6). It is caused by a loss of neurons in the frontal and temporal regions of the brain.
In dementia with Lewy bodies (DLB), protein deposits called Lewy bodies form in the brain and cause cognitive decline. It often occurs in the context of Parkinson’s disease, but this is not necessary. It is likely to include visual hallucinations, fluctuating cognitive symptoms and intense dreams with movement and vocalizing. Vascular dementia is caused by cerebrovascular disease. The onset of dementia
.....read morePersonality refers to a combination of unique traits expressed in thoughts, behaviours, feelings and interpersonal functioning. It is relatively stable over time and over situations. Personality disorders are pervasive, persistent and pathological. It can be assessed using semi-structured interviews (1), file research (2), using observations (3) and using heteroanamnesis, asking someone close to the person. They are dimensional in nature and the prevalence of a personality disorder is ±10%. The prevalence of personality disorders in prisons is ±60-70%. There is high comorbidity between the personality clusters.
Psychopathic people have no shame, poverty of emotions and manipulate others for personal gain. They seem unable to learn from experience, are insensitive to threats and immune to anxiety that keeps most people from breaking the law. Boldness (1), meanness (2) and impulsivity (3) underly psychopathy.
Problems with dopamine systems are involved in cognitive problems. Problems with serotonin systems are involved in anger and impulse control. Problems with MAO systems are involved with aggression. A dysfunctional amygdala leads to either hyper-emotionality or hypo-emotionality. A lack of frontal cortical control leads to impulses.
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PSYCHOTIC DISORDERS
Disorder | Schizophrenia |
Symptoms | Two OR MORE of the following and one should be either 1, 2 or 3: |
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