Enduring pattern of behavior that is pervasive and inflexible, as well as stable and of long duration that causes significant distress or impairment in functioning.
Personality Disorders DSM
Why are Personality Disorders difficult to diagnose?
- Diagnostic criteria is not well defined
- Reliability and validity of diagnosis
Comorbidity in Personality Disorders
60-85% with one personality disorder have at least one more and 25% have two or more.
Why is it difficult to study the causes of Personality Disorders?
- Unclear etiological view
- Most studies are retrospective
Paranoid Personality Disorder
Suspiciousness and mistrust of others and a tendency to see themselves as blameless. Tend to be on guard for perceived attacks.
Schizoid Personality Disorder
Impaired social relationships and the inability and lack of desire to form attachments to others.
Schizotypal Personality Disorder
Peculiar though patterns, oddities of perception and speech that interfere with communication and social interaction. Genetically related to Schizophrenia.
Histrionic Personality Disorder
Emotional and dramatic (theatrical), over concern with attractiveness, and tendency to irritability and temper outbursts if attention seeking is frustrated.
Narcissistic Personality Disorder
Grandiosity, preoccupation with receiving attention, self promoting and lack of empathy.
Antisocial Personality Disorder
Lack or moral or ethical development, inability to follow approved models of behavior, deceitfulness, shameless manipulation of others and history of conduct problems as a child. About half meet the criteria for psychopathy, while about 80% with psychopathy meet the criteria for Antisocial Personality Disorder.
Borderline Personality Disorder
Impulsiveness, innaproriate anger, drastic mood shifts, chronic feelings of boredom and fears of abandonment and self injurious behaviors or suicide.
Fear Responding in Psychopathy
- Less susceptible to fear and anxiety
- Slow at learning to stop responding in order to avoid punishment
Avoidant Personality Disorder
Hypersensitivity to rejection or social derogation, shyness and insecurity in social interaction and initiating relationships. Genetically related to Social Phobia.
Dependent Personality Disorder
Difficulty in separating in relationships, discomfort at being alone, subordination of needs in order to keep others involved in a relationship and indecisiveness.
Obsessive Compulsive Personality Disorder
Obsessive concern with order, rules and trivial details, perfectionistic, lack of expressiveness and warmth, and difficulty in relaxing and having fun.
Why are Personality Disorders difficult to treat?
- High comorbidity
Personality Disorders Treatment
- Dialectical Behavior Therapy - Focuses on one's inability to tolerate strong states of negative affect (accept the negative affect instead of engaging in self destructive behaviors).
- Cognitive Behavioral Therapy
Substance Abuse vs. Substance Dependence
Substance abuse is the beginning of the problem when there are legal and family issues because of the abuse. Substance Dependence is the point of tolerance and inability to stop as well as possible withdrawal symptoms.
Need for markedly increases amounts of the substance in order to achieve the desired effects. Markedly diminished effect of with continued use of the same amount of the substance.
Characteristic withdrawal syndrome of the substance. The same or similar substance is taken to avoid or relieve withdrawal symptoms. Withdrawal occurs when the dependent person tries to suddenly stop taking the substance.
Effects of alcohol on the brain
- At lower levels, alcohol stimulates certain brain cells and activates the brains "pleasure areas".
- At higher levels, alcohol depresses brain functioning.
- BAC of .08 - Intoxicated
- BAC of .50 - Unconsciousness
Physical consequences of chronic alcohol use
- Cirrhosis of the liver
- Brain damage
- Cardiovascular disease
- Fetal Alcohol Syndrome
Alcohol Amnestic Disorder (Korsakoff’s Syndrome)
A neurological disorder characterized by the lack of Thiamine (Vitamin B1) in the brain.
Psychological consequences of chronic alcohol use
- Alcohol withdrawal delirium
- Alcohol amnestic disorder
Societal consequences of chronic alcohol use
- Chronic fatigue
- Loss of responsibility
- Loss of pride in appearance
- Family problems
Biological Causal Factors for Alcohol abuse
- Having an alcoholic parent increases the risk of alcoholism
- Genetics may play a role in developing sensitivity to the addictive power of alcohol or personality traits associated with substance misuse
- Mesocorticolimbic dopamine pathway - center of psychoactive drug activation in the brain.
Parenting Causal Factors for Alcohol abuse
- Lack of stable family relationships and parental guidance
- Lack of monitoring
- Chaotic environments
- Family involvement can serve as a protective factor even when other risk factors are present
Psychological Causal Factors for Alcohol abuse
- Possibility of an addictive personality - Impulsivity, sensation seeking, anxiety-sensitivity, introversion/hopelessness
Tension Reduction Hypothesis
Alcohol abusers tend to be unwilling or unable to tolerate tension and stress, and many people believe that alcohol use will lower tension and anxiety and increase sexual desires and pleasures in life. Adults with less intimate and supportive relationships tend to show greater drinking habits following sadness or hostility.
Medications to treat Alcohol dependence
- Antabuse - Causes vomiting upon drinking
- Naltrexone - Decreases alcohol craving
- Valium and Diazepam - Reduce the effects of acute withdrawal
Psychological Treatment for Alcohol dependence
- Group therapy
- Environmental intervention
- Behavioral and Cognitive-Behavior therapy
Self help group that provides counseling and emotional support. Spiritual development is a key factor in AA, and the group believes that alcoholism is a disease that cannot be cured.
Helps people develop the motivation to change.
All different types of therapy work equally well
Alcohol relapse prevention
Individuals recovering from a substance addiction need to learn to identify the warning signs that may lead to a relapse.
Classes of Drugs
Behavioral effects of Opiates
- Euphoric spasm
- High/Pleasant relaxation
Physical effects of Opiates
- Risk of overdose
- Secondary health risks, such as HIV or AIDS
Social effects of Opiates
- Functional impairment'
- Legal problems
- Affiliation with deviant peers (narcotics subculture)
Effects of Opiates on the Central Nervous System
- Drug binds to receptor cites in brain and causes changes in several neurotransmitter systems that regulate incentive and motivation.
- Chronic use of Opiates may lead to reduced endorphin activity, resulting in craving.
- Can have long term neurological effects
Legitimate uses of Opiates
Provide relief from pain, anxiety and tension.
Effects of Cocaine
- Euphoria, confidence, alertness and excitement
- Headache, dizziness and restlessness
- Secondary health risks, such as damage to nasal passages
- Chronic use can lead to psychosis
- Tolerance and withdrawal
Effects of Amphetamines
- Psychologically and physically addictive
- Pushes the person to a state of hazardous fatigue
Effects of Methamphetamines
One of the most dangerous illegal drugs
- Severe withdrawal
- Permanent damage to cognitive ability
- Psychotic behavior
Effects of Nicotine
- 400,000 deaths in the U.S. per year
- Highly addictive, people continue to use it despite serious medical problems such as emphysema.
Effects of Caffeine
- Possible withdrawal
They don't usually create sensory images but they distort them
- LSD (Lysergic Acid Diethylamide)
- Ecstasy (MDMA)
- Mushrooms (Psilocybin)
- Marijuana (Cannabis)
- PCP (Phencyclidine)
- Special K (Ketamine)
Effects of LSD
Most potent Hallucinogen
Results in 9 hours of:
- Change in sensory perception
- Mood swings
- Feelings of depersonalization and detachment
- "Bad trips" and flashbacks
Effect of Ecstasy
Has both hallucinogen and stimulant properties
Tablets vary in strength and often contain other drugs
- Rush, feeling of calm energy and well being, intensified colors, sounds and feelings
- Empathy, sensation of understanding and accepting others
- Nausea, sweating, clenching of teeth, muscle cramps and blurred vision
- Memory impairment and more severe organic brain problems are possible, although long term effects are unknown
Effects of Marijuana
Hallucinogenic effects are not as extreme
- Mild euphoria, sense of well being and pleasant relaxation
- Intensification of senses, distorted sense of time
- Short term memory deficits
- May magnify negative moods
- High doses can lead to talkativeness, hilarity or anxiety and depression
- Lethargy, passivity and functional impairment
Legitimate uses of Marijuana
- Sedatives (Barbiturates)
- Anxiolytics (Benzodiazepines)
Effects of Sedatives
-Powerful depressant of the Central Nervous System
- Induce relaxation and sleep
- Psychological and physical dependency
Effects of Anxiolytics
Anti-anxiety medications (Valium, Xanax)
- High abuse potential
Treatment for drug use disorders
- Detoxification (Starting point)
- Motivation building
- Cognitive Behavioral Therapy
- Relapse prevention
- Group therapy and support groups, such as NA
- Medications and replacement therapy, such as methadone or the nicotine patch
- Treatment drop-out and relapse rates are very high
Classical conditioning in Heroin overdose
1. Initial exposure to drug --> effects on brain --> compensatory reactions
2. Environmental stimuli --> increase drug dose to overcome the conditioned response --> conditioned compensatory reactions
3. Novel environmental stimuli --> take high drug dose to overcome conditioned response --> no conditioned compensatory response leads to overdose
Why is it difficult to estimate prevalence rates for drug abuse disorders?
Not all people who have a problem with drugs are known to have the problem.
MCLP system (reward pathway) in drug use
The pleasurable feelings from the drugs reinforce the behavior so that person wants to repeat it.
Characterized by disturbances in thoughts, emotions and/or behavior. Shares similarities with depression. Negative symptoms suggest poor prognosis.
Positive Schizophrenia Symptoms
Additions to the usual range of feelings
Negative Schizophrenia Symptoms
Subtractions from the usual range of feelings
- Flat affect
- Poverty of speech (Alogia)
Disorganized Schizophrenia Symptoms
- Disorganized speech
- Disorganized or catatonic behavior
Erroneous belief that is fixed and firmly held despite contradictory evidence.
Types of delusions:
- Thought broadcasting
- Thought insertion/withdrawal
Sensory experience that seems real but occurs in the absence of an real stimulus.
- Loose associations
- Clang associations
- Word salad
- Disruption in goal directed activity
- Cannot maintain hygiene
- Disregard for safety
- Unusual dress
- Absence of all movement and speech
- Rigidity, hold unusual postures without seeming discomfort
- Delusions and Hallucinations
- Little disorganization
- Higher functioning, best prognosis
- Disorganized speech and behavior
- Deterioration in cognition, affect and behavior
- Lower functioning, poorer prognosis
- Pronounce motor symptoms
- May include echolalia or echopraxia
- May involve catatonic stupor
- Less prevalent in western societies
Very little research or information
Persistence of negative symptoms after positive symptoms remit
Major depressive, Manic or Mixed episode that co-occurs with symptoms of schizophrenia.
Symptoms of Schizophrenia that last for at least 1 month but less than 6 months. Appropriate for those that have a Schizophrenic episode but have relatively quick and long lasting remission periods.
Non-bizarre delusions that last for at least 1 month with no evidence of full-blown schizophrenia. Apart from delusions, the persons functioning is not markedly impaired.
Brief Psychotic Disorder
Presence of one or more of the following that last for more than 1 day but less than 1 month:
- Disorganized speech
- Grossly disorganized or catatonic behavior
Shared Psychotic Disorder
A delusion develops in the context of a close relationship with another person who already has an established delusion.
Family History in Schizophrenia
- Offspring of well twin just as likely to develop schizophrenia as the offspring of a schizophrenic twin.
- Much higher rate of schizophrenia among biological parents than adoptive parents of adoptees.
Discrete, stable and measurable traits that are thought to be under genetic control.
Prenatal factors in Schizophrenia
Prenatal factors, such as malnutrition, viral infections during pregnancy, Rh incompatibility and oxygen deprivation may provide environmental triggers for genetic expression of Schizophrenia.
Medications for Schizophrenia
- First generation antipsychotics
- Dopamine antagonists
The earlier medication is given, the better the outcome.
Psychosocial treatment for Schizophrenia
- Family therapy
- Case management
- Social skills training - Cognitive remediation
- Cognitive behavioral therapy
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