337 final Flashcards

Question

cohort design

Answer 1

single large sample, some of whom have the disorder (to compare to many control groups, useful when the disorder is common)

Answer 2

- identify proband and assess their family members - rates of illness should be higher than in the general population - family tends to have subthreshold presentations (we inherit traits or predispositions, not disorders) - coaggregation: disorders run in families in a nonspecific way (depression and anxiety coaggregate in familires) - can suggest a genetic role but doesn't prove it (move to adoption studies)

Answer 3

- parent as proband: find the kids they gave up for adoption to see if they're ill - adoptee as proband: compare their adopted/biological families to disentangle environment/genetic contributions - cross-fostering: kids of parents without a disorder raised in families of people with disorders compare to kids of parents with disorders raised in families of people without disorders

Answer 4

- gives an additive genetic component (A) that is roughly the difference between the Mz concordance and Dz concordance - common environment: shared environment - unique environment: nonshared environment - heritability estimate is sample-specific and varies according to environment - tends to increase with age and is higher when there's less environmental variance

Answer 5

- intermediate between genotype and phenotype - must correlate with illness in the population - must not be state-dependent - must be heritable (more in Mz than Dz) - must see family similarities - must be more present in families than in the general population - must be specific to a particular illness (ideally) - able to be measured

Answer 6

response to a real/perceived threat (prep for action) that is current, response is immediate and not mediated by conscious thought)

Answer 7

physiologically similar to fear but evoked without an identifiable or current threat

Answer 8

future-oriented (feeling threatened by potential occurrences that have not yet happened)

Answer 9

- 2F:1M - tends to have childhood onsets, but kids usually outgrow them (except for agoraphobia which onsets in 30s) - high comorbidity with other anxiety disorders and depression - prevalence is 12.5% for specific and 1.5% for agoraphobia

Answer 10

- classical conditioning: averse learning experiences = acquired fears (doesn't explain all cases) - fears maintained through operant conditioning (avoidance is negatively reinforced and fear cannot be disconfirmed - two-factor model) - evolutionary preparedness: evolved sensitivity to certain stimuli - immunizing effect of prior experience (kids have very little experience with anything)

Answer 11

- physiological sensations becomes the CS that was paired with a full-blown panic attack (the CR) - leads to reinforcement through avoidance

Answer 12

- 2F:1M - 4-5% lifetime prevalence - onset is about 24 years and very abrupt (rare before adolescence and after middle age) - heritability estimate about 30-40% - very comorbid with other Axis I disorders (and personality disorders common too)

Answer 13

- catastrophic misinterpretation of bodily sensations = more arousal = vicious cycle (initial symptoms are usually internally-generated, but could be due to caffeine, cocaine, etc.)

Answer 14

- trait-like fear about sensations related to anxiety - belief that if you keep having the panic symptoms, your health will eventually decline - more likely to panic when you experience anxiety

Answer 15

- safety behaviours: maladaptive coping contributes to maintenance of PDP - interoceptive avoidance: avoidance of internal symptoms that reproduce high arousal (caffeine, having sex, saunas) - experiential avoidance: distraction from anxiety sx, thought suppression

Answer 16

- neuroticism, negative affectivity - fear of fear could lead to behaviours that exacerbate stress - related to anxiety sensitivity

Answer 17

- anxious attachment (unpredictable/unresponsive caregiver) = anxiety disorders - respiratory disease is common (could be a diathesis) - reduced amygdala volume - increased HPA reactivity to environmental cues (difficulty differentiating between threat and safety cues)

Answer 18

- CBT: panic control treatment uses cognitive aspects, conditioning, behavioural exposure (Clark's model is more focused on cognitions) - ACT useful if you use behavioural exposure - exposure + relaxation + breathing training - SSRIs most useful, benzos also effective (both have withdrawal effects that could prompt relapse)

Answer 19

- 2F:1M - 5-6% (lifetime) or 3.1% (6-month) - onset is around 30 years, but highly variable - gradual onset - very chronic (similar to personality disorders) - high comorbidities (controversial diagnosis because of this - could just be conceptualized as negative affectivity that predisposes generally to psychopathology) - trait anxiety runs in families, so does GAD

Answer 20

- GAD: attentional biases toward threat - MDD: more likely to have memory biases - MDD: low positive affect (people with GAD can experience joy, but both have tendencies toward high negative affect) - intolerance of uncertainty is the core feature of GAD - MDD: precipitating event is humiliation vs. GAD: precipitating event is danger events - MDD: emotion context insensitivity (ECI) - disengagement from the environment in lab stressors - GAD: hyperresponsivity to threat and normal responses to positive stimuli in lab stressors

Answer 21

- extreme goal-focus in GAD = burnout = motivational disengagement in MDD - uncertainty about future in GAD = certainty about negative future in MDD - beliefs of helplessness in GAD = hopelessness in MDD - Or MDD could be a stressor, so after recovery people worry to prevent another episode

Answer 22

- rather than feel fear, worry about what to do about fear

Answer 23

- worry = cognitive avoidance about low-probability events - when those events don't occur, they believe their worry was effective, so they keep worrying to keep preventing the bad outcomes - worry is a verbal/cognitive process that buffers form emotional arousal (no vivid imagery = cannot change fear structure) - thought suppression = more intrusive worry = increases sense of lack of control = more worry

Answer 24

- core feature of GAD - tendency to react negatively to ambiguous situations (preferring a negative outcome to an uncertain one) - causal role in exacerbation of worry - information-processing bias (more recall of ambiguous situations and more likely to interpret them negatively)

Answer 25

- Type I worry: about daily events - Type II worry: worry about worry - belief that worry is a positive coping strategy, so they use it, but when they feel they can't cope with a stressor = Type II worry = belief that worry is uncontrollable

Answer 26

- implementing an 'as many as you can' strategy to response generation + negative mood = more perseveration (so the cycle continues)

Answer 27

- CBT (most effective) - relaxation training, psychoeducation, identifying triggers of worry, imaginal/in vivo exposure - cognitive restructuring: targeting beliefs about worry, intolerance of uncertainty, negative problem-solving orientation, cognitive avoidance - client preference for meds or behavioural Tx (CBT is better for long-term outcomes, but otherwise they're similar) - SSRIs, benzos, SNRIs, psychotropics to boost GABA, second-generation antipsychotics

Answer 28

- 2F:1M (gender differences emerge in adolescence) - 12% prevalence (2nd most common anxiety disorder, 3rd most common overall) - high comorbidity with anxiety and depression (high self-criticism) - SAD may act as a risk factor - lower prevalence in East Asian countries and among Hispanic and non-white populations (could be due to measurement problems) - onset age around 16 (social re-orientation and importance of peer judgment in adolescence) - moderately heritable

Answer 29

- social situations activate negative beliefs about their social competency - negative schemas interfere with their interpretation of the situation = see more danger and threat = more anxious = rejection is viewed as even more likely = more anxious - internal self-focus during social interactions so they can't focus on others' judgments (which acts a safety/avoidance behaviour) and makes them less socially competent - biased memory toward negative experiences which reinforces a negative self-schema

Answer 30

biased rumination that confirms negative beliefs

Answer 31

- Stroop task: cannot disengage attention from social threat words - dot-probe paradigm: attending preferentially to threat stimulus - attentional biases could also be shifting away from threat (which can lead to missing positive cues from others)

Answer 32

- judgment: self-critical, overestimate the likelihood of negative outcomes - memory: especially when info is personally relevant, negative intrusive memories of social situations - imagery: in third person = negative view of the self = more anxiety (contributes to maintenance)

Answer 33

- parental anxiety - insecure attachment = negative peer relations, interpersonal difficulties - childhood maltreatment = negative, global, stable inferential style - controlling/critical parenting - accommodating parenting = behavioural inhibition is reinforced

Answer 34

- cognitive restructuring - in vivo exposure - Clark and Wells cognitive therapy: shifting attention externally, decreasing safety and avoidance behaviours

Answer 35

- SSRIs and SNRIs - benzos (as-needed adjunct) - MAOIs (last resort) - atypical antipsychotics, anticonvulsants

Answer 36

- intrusive and inappropriate (ego-dystonic) - recognized to be your own thoughts (not thought-insertion) - contamination, uncertainty, aggressive, symmetry/exactness, sexual (less common in kids), somatic - never act on obsessions, but still cause distress

Answer 37

- attempts to neutralize or suppress obsessions (to decrease anxiety) - washing/cleaning, checking, repeating, mental (prayers, voluntary thoughts)

Answer 38

- 1.5% lifetime prevalence - slightly more common in males in childhood, but slightly more common in females in adulthood - age of onset is about 19 years - usually with gradual onset (often childhood onset) - very chronic (full remission is rare)

Answer 39

- while intrusive thoughts are very common, people with OCD consider them to be very upsetting + feel responsible and self-blame for any possible negative outcomes (which makes the thought more upsetting until they must perform the ritual to decrease anxiety) - negative affectivity increases rates of intrusive thoughts - deficits in STM: constantly re-checking because they can't remember if they've already checked - poor reality testing: difficulty distinguishing between real and imagined events (convinced that thoughts are true)

Answer 40

- believe they lack sufficient coping mechanisms or problem-solving skills to deal with threats - compulsions are an attempt to increase certainty about outcomes

Answer 41

belief that unwanted disturbing thoughts are just as bad as the actions themselves

Answer 42

belief that having a thought will increase the chance that the outcome will occur (which makes disturbing thoughts even more upsetting)

Answer 43

- attempts to undo or prevent thoughts (checking, crossing out, lighting on fire) - neutralizing immediately = decrease in anxiety and decrease in desire to neutralizing - delayed neutralizing = desire to neutralize remains, but anxiety decreases naturally - neutralizing isn't just driven by anxiety, but by a sense of responsibility

Answer 44

- especially associated with contamination subtype, but also hoarding, ordering, other specific phobias - runs in families, also has a learning component (vicarious) - OCD more likely to believe there's a danger of contamination (false alarm) - difficult to extinguish the aversive conditioning, so can be difficult to treat

Answer 45

- maladaptive beliefs (inflated responsibility, need to control thoughts, intolerance of uncertainty) - intrusive thoughts appraised as significant - operant conditioning helps maintain the disorder

Answer 46

- exposure and response prevention shows 50-70% improvement - in vivo/imaginal exposure to provoke anxiety, but let anxiety subside naturally and don't engage in rituals (helps to facilitate extinction) - within-session habituation (anxiety decreases within one session) and between-session habituation (anxiety is initially lower with every session) - inhibitory learning: new safety associations are being created - SSRIs, tricyclics show 20-40% reductions (convenient but modest)

Answer 47

- 2F:1M (but rates of trauma are equivalent across genders) - 7-8% prevalence (but rates of trauma are 50-60%) - highest risk of PTSD is associated with assault and violence (but still PTSD only develops in 50% of people) - rates vary culturally (may be due to time of measurement effects), predominant/distressing symptoms vary culturally

Answer 48

- gender - familial psychopathology - history of psychopathology - internalizing sx in childhood (negative affectivity) - childhood or previous traumas - lower IQ - nature of trauma (proximity, duration, risk to life, intention, psychological factors during the experience, *dissociation most important) - level of social support following trauma (but PTSD tends to erode social networks)

Answer 49

- similar abnormalities in ExP+ and UxP+ that aren't present in the other pair of twins which suggests the vulnerability factor hypothesis - slight differences between ExP+ and UxP+ suggest the worsening course hypothesis - symptom severity was correlated with hippocampal volume in the same person and in their co-twin

Answer 50

(1) scar hypothesis: caused by trauma (2) risk factor for trauma exposure (selecting dangerous environments) (3) vulnerability factor for developing PTSD following a trauma (SUPPORTED, only found in ExP+ and UxP+) (4) consequence of exposure to trauma (NOT SUPPORTED, if only in Exp+ and Exp-) (5) manifestation/sign of PTSD (if only in Exp+) (6) product of a sequel or complication of PTSD (worsening course - SUPPORTED, predicting one twin's PTSD severity from the co-twin's volume)

Answer 51

- autobiographical memories (verbally-accessible VAM): info consciously attended-to before, during, after trauma - situationally-accessible memories (SAM): unconsious information not easily accessed

Answer 52

- trauma can modify important beliefs about personal invulnerability, the world as a meaningful and predictable place, and the self as positive/worthy - can affect agency, safety, trust, power/control, esteem, intimacy - individuals will engage in (1) assimilation, alter interpretation of event, (2) accommodation, alter original belief slightly, or (3) overaccommodation, alter belief drastically

Answer 53

- traumatic stress occurs when most important resources are threatened (well-being, sense of trust)

Answer 54

- CBT is best, includes prolonged exposure (PE) to habituate to anxety and block negative reinforcement from avoidance - cognitive processing therapy (CPT) targets unhelpful thoughts without a behavioural component - stress-inoculation therapy (SIT) and present-centered therapy (PCT) focus on non-trauma - biological: SSRI, SNRI, antiadrenergics, mood stabilizers, anticonvulsants (benzos aren't effective) - 40-80% remission with large drop out rates (avoidance)

Answer 55

- MDD: 2F: 1M - bipolar: F=M - MDD 10-20x more common than bipolar - bipolar has earlier onset, more episodes, poorer outcomes

Answer 56

- to explain overlap between MDD and anxiety disorders - depression-specific: anhedonia (few people with anxiety show this sx) - anxiety-specific: physiological hyperarousal (may be better applied to panic/phobias) - overlap: general distress/negative affectivity - cannot explain all cases (SAD)

Answer 57

- 2F:1M - MDD lifetime prevalence is 16-17% - PDD lifetime prevalence is 3-6% - rates tend to be lower in East Asian countries - PDD rates are higher in industrialized countries - presentation varies culturally: somatic complaints in Asian, Latin American, North African countries

Answer 58

- onset teens/mid-20s (can be preceded by low grade chronic depression) - episodes last 5-6 months on average - 20% of episodes are longer than 2 years - 50% of people who have one episode will have at least another - most people relapse (average of 5-6 episodes over lifetime)

Answer 59

- very chronic - high likelihood of remission with relapse - common to have PDD with intermittent episodes of MDD

Answer 60

- proband with MDD = family more likely to have MDD, not bipolar - proband with bipolar = family more likely to have bipolar and MDD - some disorders run more cleanly in families, there is some overlap

Answer 61

- Mz and Dz index twins with bipolar or MDD, then find their co-twins to see if they have mood disorders, MDD, or bipolar - Bipolar appears more heritable (suggests 70% heritability) - suggests 96% heritability of mood disorders in general (mood disorders have a genetic component) - suggests 52% heritability of MDD

Answer 62

- higher heritability estimates in female twins for depression which suggests more genetic factors in girls

Answer 63

- Dimension 1: care, nurturance - dimension 2: overprotection, control - low care frequently reported, overprotection less so - interaction between low care and high overprotection is especially important

Answer 64

- behavioural inhibition (cause) = receive less positive reinforcement from the environment = even less likely to engage in those behaviours (avoidance - negative reinforcement) - interpersonal deficits can also decrease the amount of positive reifnrocement - anhedonia = amotivation = avoidance because lack of energy and activities aren't rewarding anyway - cognitive factors: low self-esteem = high negative affect = high self-criticism = bad social performance (which confirms belief of low self-esteem)

Answer 65

- negative views about self = negative views about the world = negative views about the future (these schemas act as a diathesis, filter information) - schemas contribute to negative automatic thoughts containing cognitive distortions

Answer 66

- all-or-nothing - arbitrary inference (drawing negative conclusions without evidence) - overgeneralization - selective abstraction (not seeing the whole picture) - magnification/minimization - personalization (bad things happen because of you) - emotional reasoning (something is true because of the strength of the emotion)

Answer 67

- learn early on that our behaviour is useless to change a situation, so we should stop expending effort to try (doesn't explain why depressed people feel guilty for bad things happening) - revision: we make internal, global, stable attributions when we feel like we lack control over a situation

Answer 68

- lab study for memory biases seen in depression (preferential recall for negative words that they endorsed as describing them) - we don't see these memory biases in people with anxiety - sometimes also seen in at-risk populations

Answer 69

- faster at finding threat in a safe environment and slower at finding safety cues in a threatening environment - stroop task: difficulty disengaging from threatening or sad words - dot-probe task - dischotic listening: difficulty inhibiting distractor information when it's related to loss, sadness, threat - less evidence for attentional than more memory biases

Answer 70

- diathesis can be biological (genetic, neurochemical (monoamines), endocrine (stress response), immunology (inflammation response), neural connectivity) - can be behavioural (avoidance) - can be cognitive (distortions, schemas) - can be emotional (reactivity, regulation)

Answer 71

- behavioural: decreasing unpleasant and increasing pleasant events (behavioural activation) - CBT: identify and challenge automatic thoughts, cognitive errors, negative core beliefs - interpersonal therapy: identifying and correcting lapses in interpersonal functioning - somatic: ECT, transcranial stimulation, deep brain stimulation, MAOIs, TCAs, SSRIs, SNRIs - PDD especially can benefit from continued pharmacotherapy and psychotherapy

Answer 72

- mood congruent (delusions of grandeur for mania, guilt and sin for depression) - mood incongruent (thought insertion/mind control for mania, anything happy for depression) - psychotics sx should only occur during the episode to still be considered bipolar, otherwise it's schizoaffective

Answer 73

- lifetime prevalence is 2-4%, stable worldwide - cyclothymia prevalence is 4-5% - 5-10% with depression will convert to bipolar - episodes last about 2 months (but duration can decrease with tx) - poor prognosis if mixed states or rapid cycling - relapse rate: 7-9 times over lifetime

Answer 74

- bipolar: lithium as mood stabilizer with anticonvulsants (has a lot of noncompliance) - MDD: antidepressants (which can trigger mania in bipolar)

Answer 75

- stress in prior 6 months predictive of onset and relapse - goal-attainment events can also trigger mania: get really happy = get dysregulated = no productive bx = downward spiral - elevated reward sensitivity (NAcc activation, more reactive to successes - predictor of severe course)

Answer 76

- need a high-level stressor to provoke the first episode = brain changes to be more vulnerable = need less stress for the next episode until no stress is required to provoke mania

Answer 77

- high norepinephrine in mania, low in depressive - decreased sensitivity of serotonin system = increase variability in dopamine system - high glutamate levels in PFC

Answer 78

- hyperactive amygdala in mania - decreased connectivity between amygdala and PFC - lower PFC activation (inability to inhibit emotions, abnormal control of limbic structures) - impairments in emotional control circuits - hyperactive BG and striatal activation

Answer 79

- inability to maintain daily rhythms, increased variability in circadian rhythms - fluctuations in sleep quality can trigger negative moods - bright light can trigger mania (disrupting circadian rhythms)

Answer 80

- external demand that presents a challenge to homeostasis/ability to maintain equilibrium - can be negative or positive, real or perceived

Answer 81

- how the organism reacts physiologically/psychologically to the stressor - necessarily and sufficiently an interaction between the organism and its environment

Answer 82

- sympathetic adrenomedullary system - hypothalamus signals = medulla secretes adrenaline and noradrenaline = fight-or-flight = peripheral excitation - immediate response

Answer 83

- hypothalamus-pituitary-adrenal axis - hypothalamus release corticotropin releasing hormone/factor = pituitary gland releases adrenocorticotropic hormone = adrenal cortex releases glucocorticoids = fight-or-flight (inhibit immune system)

Answer 84

the amount of strain the stress system is under

Answer 85

- memory, stress regulation - strong reciprocal connections with the hypothalamus and many cortisol receptors - acute stress decreases hippocampal activation - chronic stress decreases hippocampal volumes (cell death, fewer connections) - altered function of the hippocampus = cortisol hypersecretion (cannot dampen the cortisol response like it should)

Answer 86

- slow to develop, so it's easier to inflict damage on it (vulnerable to effects of stress) - repeated stress = dendritic shortening - severe child abuse = decreased PFC volume (cell death, reduced connections)

Answer 87

1. common 2. increases risk of lifetime mental disorder 3. nonspecific risk factor 4. increases risk of psychopathology throughout life 5. explains 30% of disorder onsets - can disrupt brain development (maternal cortisol) - can lead to persistent dysregulation of stress response systems

Answer 88

- maternal stress passed to fetus via glucocorticoids (placenta), so infants develop hypersensitive stress response systems (increased baseline and reactive cortisol)

Answer 89

- men doing the TSST with their female partner (doesn't work for women unless the male partner is making physical contact) - pet ownership, doing the TSST with a dog - physical exercise can protect against hippocampal degeneration, can improve mood immediately - present-focused breath

Answer 90

- increases allostatic load (increases blood pressure, and night cortisol) - can affect hippocampal volumes, alter mood and cognitive control - bad sleep hygiene can decrease sleep quality and duration

Answer 91

- larger heart rate responses and greater cortisol reactivity = future adverse health risks - also hyporesponsiveness of cortisol associated with adverse outcomes - stress-related circadian dysregulation (flatter diurnal cortisol slope)

Answer 92

- effects of ELS differ depending on type of stress - doesn't account for co-occurring ELS

Answer 93

- doesn't account for type, severity, chronicity

Answer 94

- experience-driven plasticity has specific influences on learning and neurodevelopment through synaptic pruning and myelination - threat/harshness, deprivation, unpredictability - measuring degrees of experiences in early life and making predictions about affective, cognitive, neural development that are similarly/differentially affected by these experiences

Answer 95

nonfatal self-directed potentially injurious behaviour with an intent to die

Answer 96

- thinking about, considering, planning suicide - can be defined very broadly or specifically, not always conceptualized the same way which makes it hard to study

Answer 97

- both highly correlated, also with depression and suicidal ideation - NSSI more prevalent and frequent, different methods, less severe, performs different functions

Answer 98

- to relieve negative emotions/regulate affect - not with intent to die - interpersonal: autonomy (sense of independence), interpersonal boundaries (who I am vs. others) or influence (trend), peer bonding, revenge (rarely endorsed), sensation seeking, toughness - intrapersonal (frequently endorsed): affect regulation, anti-dissociation, anti-suicide, marking distress, self-punishment

Answer 99

- stigma - low base-rate phenomenon - cannot be studied retrospectively, so must be studied longitudinally which requires very large samples - studying proxies for suicide because we can't study suicide as an outcome which may not be representative - ethically researchers must intervene if an attempt is imminent - etiologically complex (difficult to get a good holistic picture) - not much replication work

Answer 100

- high-income countries have higher rates of suicide - men are 3x more likely to die from suicide (disparity even larger in high-income countries) - women make more attempts than men, deaths by suicide are increasing for women - sex and age patterns differ according to economic status of country and time - death by suicide is more common in kids and younger adults - sexual and gender minorities have higher rates - white and First Nations have highest rates - young children have much lower rates of suicide, except Black youth who have higher rates of death by suicide

Answer 101

- developed: PTSD, bipolar, MDD - developing: PTSD, conduct, SUDs

Answer 102

- depression, hopelessness, impulsivity - impulsivity hastens transition from through to action

Answer 103

- psychache (emotional pain) is the primary motivator (threshold has been surpassed)

Answer 104

- motivated by a need to reduce aversive self-awareness

Answer 105

- perceived burdensomeness and low belongingness as motivators & hopelessness about both these things create desire for suicide - capability to act on suicide desire requires overcoming fears of death and pain

Answer 106

- internal self-oriented: hopelessness, psychache, need to escape, etc. (associated with greater intent to die and more preparation) - communication other-oriented: desire to seek help, communicate, etc. (associated with lower suicidal intent because they represent a continued connection to people and desire to maintain connection)

Answer 107

- dialectical behaviour therapy (for BPD) - cognitive therapy for suicide prevention (CT-SP) based on Beck's theory - collaborative assessment and management of suicide risk (CAMS) - prevention: reduce access to means, school-based interventions,

Answer 108

- risk factors can predict ideation, but not attempts (difficult to study how one progresses from thought to action) - Joiner's interpersonal theory - integrated motivational-volitional theory (O'Connor) - mental disorders (depression), impulsivity, hopelessness are predictors of ideation - specific disorders (PTSD), poor premeditation, access to lethal means are predictors of attempts

Answer 109

- defeat and entrapment are predictors of suicide desire - acquired capability, access to lethal means, planning, impulsivity explain the progression to action

Answer 110

- first step: psychological pain (one's existence is being punished with pain) and hopelessness about the future - pain can be isolation, high burdensomeness and low belonging, defeat and entrapment, etc. - second step: pain exceeds connectedness (to other people, a sense of purpose, an interest, etc.) and then ideation will escalate - third step: ideation progresses to attempt through capacity (fear of death is difficult to overcome) - capacity can be dispositional (lower pain sensitivity) or acquired (habituation to pain, injury, death), or practical (knowledge or and access to lethal means

Answer 111

death resulting from intentional self-injurious behaviour, associated with an intent to die as a result of the behaviour

Answer 112

takes steps toward making a suicide attempt but is stopped by another person prior to any injury or potential injury

Answer 113

takes steps to injure self, but stops self prior to any injury or potential for injury

Answer 114

acts or preparation toward making a suicide attempt

Answer 115

- behaviour that self-directed and deliberately results in injury or the potential for injury to oneself WITHOUT the intent to die (destruction of tissue not for socially sanctioned purposes) - low-lethality methods, people often use more than one - people who endorse suicide attempts report using the same method but with higher lethality - may have addictive properties (increasing severity or frequency to achieve the same effect)

Answer 116

- agency: self-initiated behaviour (not necessarily self-directed) - intent: some desire for death - outcome: actual/perceived potential for death

Answer 117

- archival: looking at existing death records and how variables relate to each other - psychological autopsy: reconstruct what a person was like before suicide through interviews with friends, family, etc. (gets individual-level predictors, but not from the person themselves) - big data: passively collect data from individuals and mapping it onto known suicide attempts to reconstruct psychological variables - experimental: comparing performance on tasks for people with attempts or without attempts - treatment studies: randomly assign to treatments or controls and compare outcomes - meta-analysis: looking at real effect sizes and associations

Answer 118

- women have higher rates of disorders associated with suicide attempts - men tend to die by more lethal means (firearm), likely because they have more access to more lethal means - greater intent? access to means influences the results of studies about this - women seek treatment and receive services for suicidal ideation - cultural acceptance: suicide attempts are seen as a cry for help ('feminine'), so men not seeking help or reporting attempts - women receiving more support from family and friends, men unlikely to seek support

Answer 119

- highest rates of suicide in the world - not equally distributed in different communities - youth living in communities with greater knowledge of their language (proxy for connectedness) have lower rates of suicide - Durkheim's theory - in Indigenous reserves, higher rates of risk factors for suicide (poverty, alcohol use, family violence, access to lethal means)

Answer 120

- feeling of becoming disconnected from people around you (lack of belonging in the world) - this sense accounts for population-wide rates of attempts and deaths

Answer 121

1. Poisoning 2. Cutting 3. Stabbing

Answer 122

1. firearm 2. suffocation 3. poisoning 4. fall

Answer 123

1. hanging 2. suffocation 3. poisoning 4. firearm

Answer 124

- not warning signs - can be modifiable or not - include many disorders, alcohol/drug abuse, impulsivity, aggressivity, perfectionism, abuse, chronic and physical illness, family/friend history of suicide, stressful events, NSSI, past attempts, etc.

Answer 125

- intoxication (usually alcohol) - younger age - access to means

Answer 126

- psychosocial/pharmaceutical treatment - lithium for BP, clozapine for psychosis - reducing aggressive behaviours in younger people can delay or prevent onset in adulthood - culturally-influenced coping strategies (moral objections to suicide, high family support in Latinx communities = lower rates of suicide)

Answer 127

- rates of suicide influenced by frequency of media reporting, content of media reporting (explicit about methods), positive/negative reporting biases (attitude toward suicide, portrayal of attempters) - more likely to experience contagion if the person is characteristically or demographically similar - glamorizing the victim and attempt could increase risk (13 Reasons)

Answer 128

- genetically influenced - what is inherited is likely a predisposition toward impulsivity, fearlessness, disorders associated with suicide

Answer 129

- specific subdimensions of impulsivity (poor premeditation, sensation-seeking, poor perseverance, negative urgency) are more related to suicidal behaviour - poor premeditation more related to attempters, while more negative urgency is high in both ideators and attempters - sensation-seeking and perseverance not related to ideation or attempts - fearlessness and lower pain sensitivity

Answer 130

- capacity can arise through practice, habituation, experience (playing violent video games, exposure to euthanasia, treating injuries, surgery) - research is cross-sectional/correlational (could be an active rGE)

Answer 131

1. depression severity (suicide ideators vs. no ideation) 2. PTSD (suicide ideators vs. no ideation) 3. depressive disorder (suicide ideators vs. no ideation) 4. hopelessness 5. anxiety disorder 6. drug use disorder 7. alcohol use disorder 8. sexual abuse 9. marital status 10. race 11. gender 12. education - these are correlated with general suicidality, but none of these factors distinguished ideators vs. attempters

Answer 132

- peaks during adolescence/young adulthood - earlier age of onset (13) than attempts (16) - rates decrease in middle age - lifetime prevalence 13-28% (much higher in clinical samples) - prevalence is stable worldwide

Answer 133

- cutting - skin abrading - interfering with wound healing - banging/self-hitting - burning

Answer 134

- male-female rates are inconclusive (despite the conception that it's more common in females) - higher rates in LGBTQ+ and may peak during the coming out process - risk somewhat more pronounced for males than females

Answer 135

- ecological momentary assessment to see what variables in the real world predict NSSI - assessing frequency, duration, intensity of NSSI thoughts, the context of the impulse before, during, after - intense but brief thoughts about NSSI = more likely to engage (negative urgency) - thoughts about NSSI likely to arise when feeling overwhelmed or scared/anxious - engaging in NSSI likely to occur when feeling rejected, self-hatred, numbness - function was to decrease or distract from negative thoughts (regulating affect) - negative reinforcement because NSSI does reduce negative affect - hourse preceding, slow increase in NA and decrease in PA, peak during NSSI, then NA decreases and PA increases

Answer 136

- attempters likely to have a history of NSSI, but many people engaging in NSSI do not attempt suicide - repetitive/severe NSSI is a strong predictor of attempts - likelihood of ideation in people engaging in NSSI - NSSI as a means of increasing capacity (practice/experience) - but temporal ordering still unclear

Answer 137

- under disinhibited externalizing, then under substance-related

Answer 138

- beer consumption very normative (with breakfast) - until the temperance movement in the US (religious and feminist movements) - now alcohol becomes a moral issue; consuming alcohol as a character issue that alienates you from God and your community - many conflicting attitudes about alcohol (can be glamorized in certain contexts and considered a moral defect)

Answer 139

- DSM-I: symptom of sociopathic personality disorder - alcohol and drug dependence without specific criteria - DSM-II: still a personality disorder, but started classifying drugs, criteria are about cravings - DSM-III: separated from personality disorders, each drug is a separate disorder, distinguishes between abuse (pathological use, impairment, duration of 1 month) and dependence (physiological tolerance and withdrawal) - DSM-III-R, IV: removed the word addiction, minor tweaks - DSM-5: no distinction between abuse and dependence, single disorder for all substances, added a craving symptom

Answer 140

- maladaptive pattern of use leading to distress or impairment indicated by one or more of: - failure to fulfill role obligations - consumption in physically hazardous situations - legal problems - social problems

Answer 141

- next step up from abuse (if you have this, you probably meet criteria for abuse) - maladaptive pattern of use leading to distress or impairment indicated by 3+ of the following: - tolerance - withdrawal - drinking more than intended - failure to cut down - lots of time spent consuming - other activities given up - physical or psychological problems

Answer 142

- assumes that if you meet criteria for dependence, you also meet criteria for abuse (which isn't always the case) - 'legal problems' disproportionately affects minorities and certain ethnicities, legal criteria are different depending on where you are

Answer 143

1. depressants: behavioural sedation (alcohol, anxiolytics) 2. stimulants: increase alertness and improve mood (cocaine, caffeine) 3. opiates: analgesia and euphoria (heroin, morphine, codeine) 4. hallucinogenics: alter sensory experience/contact with reality (marijuana, LSD) 5. other: inhalants, steroids, drugs not used as prescribed

Answer 144

- addictive disorders now include (DSM-5) Gambling disorder - the only new entry in behavioural addiction - hypothesized to be similar in clinical expression, neural origins, comorbidity, physiology, treatment - but this opens the door to pathologizing any socially undesirable behaviours (like sex addiction, shoplifting)

Answer 145

- how difficult it would be for people to not engage in the behaviour (stop using the substance), inability to stop despite negative consequences - nicotine is most addictive - need state/craving overwhelms other impulses

Answer 146

1. impairment of control 2. social impairment 3. risky use 4. pharmacological dependence (tolerance, withdrawal)

Answer 147

- use of any illict drug gets common in 10th grade, then very common in college age - polysubstance use disorder: concurrent dependence is more common than not (alcohol + nicotine, cocaine + alcohol) which is a more dangerous pattern of use - alcohol use more prevalent in western Europe

Answer 148

- still according to DSM-IV criteria - abuse: 13.2% - dependence: 5% - men have typically had 2-5 times higher rates, but women catching up - rates higher in White and Native American/First Nation populations and lower in Black and Hispanic populations - East Asian and Jewish populations have very low rates because of a gene polymorphism that makes alcohol harder to metabolize (makes it less fun), but use of other substances is similar

Answer 149

- 35-40% meet criteria for another disorder - onset in later adolescence/early adulthood - women deteriorate more quickly than men (in clinical samples, which are more severe)

Answer 150

- alcohol and marijuana as 'gateway drugs' which increase the likelihood of use of other drugs - this theory doesn't rule out a general tendency towards substance abuse (marijuana and alcohol are more accessible)

Answer 151

- twins discordant for marijuana use (one was using, the other wasn't) - twin that used marijuana was more likely to still be using marijuana + using other substances at follow-up - effects could be because you're choosing social groups who also use drugs (nonshared environment) - could be gateway drugs because of their social correlates rather than their chemical properties

Answer 152

- heavy drinking associated with higher rates of vulnerability to injury, marital discord, intimate partner violence, illness, neurocognitive impairments (white matter decrease) - decreased lifespan, especially men - suicide (proximal predictor) - chronic course more likely than recovery - controlled drinking outcome is a possibility - after 5 years of abstinence, unlikely to relapse

Answer 153

- 3, 7, 9 years post-treatment outcomes (1) low-functioning frequent heavy drinkers (2) low-functioning infrequent heavy drinkers (3) high-functioning heavy drinkers (4) high-functioning infrequent drinkers (both abstinent and controlled drinking) - most people are high functioning - abstinence isn't necessarily the only positive outcome to be striving for

Answer 154

- early drinking (before 15) - family history of AUD (but also see higher rates of almost all disorders, slight tendency toward more externalizing disorders but internalizing are also present) - adoptees from biological parents with AUD = higher rates, so some biological predisposition - higher tolerance for alcohol = need to drink more, slower to recognize the effects of alcohol, builds up your tolerance even more (sons of fathers with AUD tend to have better balance and coordination, the better they perform on these tasks, the more likely they are to develop AUD later)

Answer 155

- Mz and Dz who are concordant (have disorder) or discordant (one does, the other doesn't) - looking at the offspring of the twins - group 1: offspring of fathers who have AUD (high genetic and environmental risk) - group 2: dad is a Mz twin without AUD, but his co-twin has AUD (high genetic, low environmental) **group of interest** - group 3: dad is a Dz twin without AUD but his co-twin has AUD (moderate genetic risk, low environmental) - group 4: offspring of fathers without AUD (low genetic, low environmental) - group 1 more likely than 4 to have AUD, neither 2 or 3 was more likely to have AUD than group 4 - indicates that genes aren't deterministic, the environment is important

Answer 156

- positive reinforcement: it feels good to drink - people feel confident and happier - some people may be higher on sensation-seeking, reward-seeking which be a vulnerability

Answer 157

- men report their bonding with friends occurs in the context of drinking - drinking may be more rewarding for men - both males and females show increased mood after drinking - men experienced an increase in reciprocal smiling + longer duration of smiles = contagion more likely (more positive reinforcement from friends) - we don't see this reciprocal smiling in men with women or women with women

Answer 158

- negative reinforcement: for many people, it feels bad not to drink - self-medication, decreases anxiety/sadness/self-consciousness - evidence that some people with more trait negative affectivity may be vulnerable to AUD

Answer 159

- reinforcement learning - ventral tegmental area, nucleus accumbens, PFC - dopamine: mood, motivation, learning, experience of pleasure - dopamine produced in VTA, goes to NAcc, amygdala, hippocampus, PFC (production increases in response to reward)

Answer 160

- when learning: at first dopamine only fires in response to reward, but after learning the cues that indicate reward, dopamine response shifts to the cue - if you get the cue (so predict the reward) but not the reward, dopamine activity decreases - dopamine response shifts to the cue, indicating craving state (and if you don't get it, dopamine crashes) - not just disregard for consequences, but a need you can't control - focus of treatment to regulate the need state - more intense cravings associated with chronicity and severity of AUD

Answer 161

- SUD part of a deviant pattern of behaviour that is attributable to deficient socialization in early childhood - SUD more common in people engaging in criminality or recklessness (causality difficult to follow)

Answer 162

- both a stimulant and a depressant - while drinking: stimulant (increases elation, excitement, extraversion and decreases fatigue, restlessness, depression, tension) - after drinking: depressant (decreases vigor and increases fatigue, relaxation, confusion, depression) - increases in norepinephrine which mobilizes the brain and body for action (arousal, also associated with impulsivity)

Answer 163

- limbic system responsible for motivation, PFC controls the energy and inhibits when necessary - PFC becomes less active with alcohol consumption - alcohol also affects the temporal lobe (reduced activity in the hippocampus can explain why people black out - also reduced activity in the cerebellum = difficulty walking straight, fine motor control

Answer 164

- GABA necessary for reducing neuronal excitability throughout the nervous system (inhibitory synapses) - alcohol mimics GABA and inhibits dopamine neurons found in PFC, cerebellum, hippocampus - over time, alcohol will affect those areas (decrease white matter) - certain people with polymorphisms concerning GABA activity might be at increased risk for AUD - GABA associated with disinhibition during drinking and depressant effects after drinking

Answer 165

- most widely used and abused category - amphetamines, cocaine, nicotine, caffeine increase alertness and energy - produce elation, vigor, pleasure, reduce fatigue (similar to effects of adrenaline) followed by a 'crash' - increase dopamine and NE in the brain - can cause psychotic symptoms (DDx) - high risk of dependency and withdrawal, must be discontinued carefully - methamphetamines are highly addictive and can re-wire/shape the brain with repeated use

Answer 166

- stimulant blocking re-uptake of dopamine = elation, vigor, less fatigue - highly addictive, but addiction develops slowly - withdrawal can be painful (boredom, paranoia, tolerance) - crack: crystallized form of cocaine that is more used by lower SES and is more pathologized/more legal consequences, could be more pleasurable and addictive - prevalence = 0.7%

Answer 167

natural chemical in opium poppy (narcotic effect)

Answer 168

- class of natural and synthetic substances with narcotic effects - activate endogenous opioid receptors which can produce euphoria - blocking pain receptors = inhibitory effect - first used morphine for severe injuries (too addictive) then heroin (still too addictive) then methodone - withdrawal: anxiety, nausea, vomiting (very difficult to stop taking) - in low doses: euphoria, drowsiness, slurred speech, memory impairment, slowed breathing - in high doses: can be fatal (high sedation = respiratory failure and heart arrest) - prescription opioids are more common than recreational use

Answer 169

- alcohol expectancies: information about the reinforcement value of alcohol is stored as a memory template that can affect behavioural patterns of alcohol use - positive expectancies predict more alcohol use

Answer 170

- alcohol's ability to reduce tension or dampen stress - certain moderators affect the stress-dampening effects - genetic predisposition to stress reactivity could mediate effects of alcohol

Answer 171

- type 1 alcoholics: early onset with antisocial traits - type 2: late onset and tendency toward negative affect

Answer 172

- type A: later onset, fewer childhood risk factors, less severe dependence, fewer alcohol‐related problems, and less psychopathological dysfunction (better prognosis) - type B: childhood risk factors, familial alcoholism, early onset of alcohol‐related problems, greater severity of dependence, polydrug use, a more chronic treatment history, greater psychopathological dysfunction, more life stress

Answer 173

- social-environmental variables: situational factors that become paired with alcohol use (triggers) - coping skills: ability to cope with stressors without reverting to alcohol - cognitive factors: self-efficacy (ability to enact a behaviour/obtain an outcome) and outcome expectancies (beliefs about consequences) - relapse occurs from lack of coping skills = low self-efficacy beliefs about coping = positive alcohol expectancy

Answer 174

- substances with high potential for abuse produce psychomotor stimulation which acts as a reinforcer - effects are produced by the mesocorticolimbic pathway (which also contributes to craving)

Answer 175

- mesolimbic DA activation attributes salience to alcohol cues = motivation

Answer 176

- dysregulated reward and stress circuits due to repeated exposure to alcohol - integration of positive and negative reinforcement effects of alcohol

Answer 177

teaching skills for coping with drinking urges, including identifying triggers and preventing relapses

Answer 178

- AA, most widely used - goal of long‐term complete abstinence and generally discourage the use of any psychiatric medications

Answer 179

- comparing CBT, MET, 12-step - 12-step patients more likely to remain abstinent - at 3-year follow-up, all Tx had similar outcomes - initial client level of anger was the best moderator of Tx outcome (higher anger = MET better, lower anger = CBT or 12-step)

Answer 180

- motivational enhancement therapy - CBT, 12-step - behavioural marital therapy - community reinforcement approach - contingency management - cue-exposure therapy - mindfulness-based therapies

Answer 181

- often used to manage withdrawal symptoms - Naltrexone: decreasing alcohol consumption and treating alcohol dependence - disulfiram

Answer 182

- show more abstention from alcohol, less frequent, less heavy drinking - but when they do engage in drinking, higher risk for alcohol-related problems (chronic health problems, legal and interpersonal problems) - alcohol use and intoxication have historically been negatively viewed - tend to have conservative norms and attitudes about maintaining control (drinking not assimilated into daily life) - parents have less positive perceptions of alcohol, socialize their kids to be wary of it because of severe legal consequences - higher levels of religiosity

Answer 183

- alcohol dehydrogenase (ADH) breaks down alcohol into acetaldehyde which is broken down by mitochondrial aldehyde dehydrogenase (ALDH2) into acetate - protective factors against AUD: ADH variant that metabolizes alcohol more quickly and ALDH2 variant that breaks it down slower - ADH variant found only in Afr.Am. - positive experiences with alcohol, more physiological effects which protects against heavy drinking but also makes intoxication more overt (and contributes to negative consequences with law and social groups) - ALDH2 variant found in Asian - sensitivity to positive and negative effects of alcohol = lower drinking rates

Answer 184

basic set of rewarding circumstances or experiences that persons strive for (housing, economic security, work opportunity, knowledge, relationships)

Answer 185

- choose one behaviour among alternatives because others are more costly, less available - choice to consume alcohol depends on access to it and availability of alternatives - Afr.Am. men have less access to alternatives and SLRs which reduces the disincentive to drink - Afr.Am women may have more access to SLRs through caregiving - limited access to SLRs doesn't improve with age, so older men drink more

Answer 186

- neuroticism (even-tempered vs. temperamental/moody) - extraversion (talkative, assertive, active vs. passive, reserved, quieter) - openness to experience (imaginative, curious, creative vs. hsllaow, imperceptive) - agreeableness (kind, trusting, warm vs. hostile, selfish, distrustful) - conscientiousness (organized, thorough, reliable vs. careless, negligent, unreliable)

Answer 187

- enduring pattern of perceiving, relating to the environment - the range of responses one can generate in a situation (behaviour, affect, cognitions), the expression of personality traits vary depending on the situation - temperament develops early and personality begins at 18 years old, both are relatively stable

Answer 188

- rigidity in responses - same traits, but people generate the same responses over and over without adapting to the situation

Answer 189

- introduced in DSM-III as longstanding maladaptive ways of relating to the world as opposed to more transient/phasic syndromes like MDD - largely ignored until 1980 Axis II - not conceptualized as diathesis-stress, but as part of your personality that happens gradually and interferes with how you operate in the world (range in severity)

Answer 190

- enduring pattern of inner experience and behaviour that: - deviates from cultural expectations (social value) - pervasive and inflexible - onset in adolescence or early adulthood - stable over time - leads to distress or impairment (can be to the individual or to others)

Answer 191

- odd/eccentric - people who seem odd with unusual behaviour that ranges from eccentric detachment to extreme paranoia and withdrawal - paranoid PD - schizotypal PD - schizoid PD - least well-studied

Answer 192

- dramatic/emotional/erratic - tendency to be dramatic and emotional, impulsive, antisocial behaviour, attract attention in social situations, often show up in treatment or referred legally - antisocial PD - borderline PD - histrionic PD - narcissistic PD

Answer 193

- anxious/fearful - present like anxiety disorders - avoidant PD - dependent PD - obsessive-compulsive PD - avoidant and dependent have fears and anxieties as primary features, OCPD has rules and orderliness (not as much anxiety)

Answer 194

- 4-15% in gen pop (lots of variability depending on population and study) - higher rates in inpatient settings - high rates of comorbidity with other PDs (the norm) and major disorders (mood, anxiety, substance use)

Answer 195

- is there a difference between Axis I and II disorders in terms of distress, phasic/stable patterns? - are personality disorders a difference in degree or in kind? - how can one be diagnosed with 2+ PDs if we only have one personality - suggests that are categories might not be appropriate

Answer 196

- insight: person lacks good insight, but how do you decide which informant to interview - informant reports tend to vary, which informant is best, use of informants still rare in clinical practice - current mood states can exacerbate PD symptoms (people come in for Tx when they're distressed) - using different instruments can result in different diagnoses - categorical inter-rater reliability is good, but test-retest is weak (perhaps not as stable as we think) - PDs can be successfully treated (again, not as stable as we think)

Answer 197

- PDs as an extreme constellation of traits that are each along a continuum - proposed as a revision in DSM-5 but rejected - Five Factor model = almost all disorders are high in neuroticism (may not be specific enough for PD functioning), designed for normal populations and may not translate to clinical - Five Factor model works well for some PDs like BPD, histrionic, dependent, OCPD but not for others like schizoid and schizotypal

Answer 198

- keep antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, schizotypal - eliminate dependent, histrionic, schizoid, paranoid because of a lack of research about them (correlates, prevalence)

Answer 199

- potential for misdiagnosis based on clinician's perspective (few behavioural indicators in symptoms, no discrete time period which makes behaviours very context-dependent) - clinicians reluctant to diagnose women with antisocial, men with histrionic (aggression in ASPD may be expressed differently in men and women based on culture, histrionic explicitly gendered) - BPD appears to manifest differently in men and women (more diagnosed in women) - more men have dx of psychopathy than women despite being in prison for the same crimes

Answer 200

- people with diagnoses for BPD are likely to also meet criteria for avoidant and histrionic - antisocial has symptom overlap with schizoid and narcissistic (cluster B disorders conceptualized very similarly to each other) - high comorbidity with major disorders (avoidant/dependent = anxiety and depression, BPD = unipolar and bipolar, PTSD, ASPD/BPD/NPD = SUD, avoidant = eating disorders, OCPD = anorexia, binge eating)

Answer 201

- different combinations can result in very different presentations - BPD: more affective profile (unstable relationships, impulsivity, suicidal bx, affective instability, anger problems) vs. avoiding abandonment, unstable relationships, identity disturbance, emptiness, paranoia

Answer 202

- problems seem to arise primarily from problems with interpersonal relationships - may have secondary anxiety, depression but these arise from problematic ways of interacting with the world - 'difficult patients' because their problematic interactions extend to how they engage with the therapist - people do have these longstanding problems, which makes PDs very clinically compelling

Answer 203

- pervasive suspiciousness - tendency to see self as blameless - on guard for perceived attacks by others - will have a lot of conflict with others, looking for others to blame - more commonly diagnosed in men - some genetic overlap with psychosis and schizophrenia; primary difference is severity (paranoia vs. delusion) - overlap with avoidant and BPD

Answer 204

- near total lack of interest in intimate involvement with others (no social skills, no desire to obtain them) - limited emotional responsiveness (rarely experience intense emotions and don't understand them in others) - perceived as cold, indifferent ('loners') - diagnostic overlap with schizotypal - related to asocial disorders (like autism, but in autism people have a desire for social contact)

Answer 205

- cognitive and perceptual distortions - eccentricity of thought or speech (odd beliefs, odd speech, magical thinking like clairvoyance or telepathy, ideas of reference) - contact with reality is maintained - has paranoid features and tendency toward social isolation (people perceive them as weird) - overlap with schizophrenia (difference in degree of severity - not delusional), similar lab testing (eye tracking, working memory, inhibiting attention), familial co-aggregation - could be prodromal schizophrenia (teens with schizotypal are at increased risk for schizophrenia)

Answer 206

- highly dramatic, lively, extraverted - high excitement seeking, low self-consciousness - preoccupation with appearance - irritability and temper outbursts if attention seeking is frustrated - almost exclusively women, but if using a checklist, you don't see the same sex differences - prevalence 2-3% - tend to be attractive to other people, but have difficulty maintaining stable relationships - tend to be sexually provocative (seeking closeness) - overlap with NPD (seeking to be the center of attention), but histrionic have greater capacity for building relationships - often comorbid with BP - predicts poorer course of BP

Answer 207

- grandiosity - preoccupation with receiving attention - self-promoting, lack empathy, easily offended - highly variable clinical presentation (there could be two subtypes) - vulnerable subtype (masking criticism and self-doubt, self-loathing, more withdrawn) and grandiose subtype (grandiose, extraverted) - lack of empathy and grandiosity unites all presentations - overlap with BPD, histrionic, ASPD - hypercritical and retaliatory if not validated - male students were more likely to engage in sexual aggression when rejected - prevalence less than 1%, could be more present in males (or diagnostic bias with histrionic for females) - grandiose subtype associated with parental overvaluation - vulnerable subtype associated with abuse, cold and controlling parents

Answer 208

- avoiding interpersonal contact (extreme sensitivity to criticism and disapproval) - avoiding intimacy even if they desire it - extreme loneliness, low self-esteem, excessive self-consciousness - view themselves as socially inept and inferior - contrast with schizoid: want interpersonal contact, more emotionally expressive - DDx with SAD (substantial overlap, but you can find SAD without avoidant but rare to find avoidant without SAD) - shared genetic vulnerability with SAD (fear of evaluation is heritable, distinct diagnoses may not be necessary)

Answer 209

- inability to function independently (fearful, clingy, submissive) - submissive role in relationships, passivity (allowing others to take control of many aspects of their lives like clothes, hair, etc.) - difficulty expressing disagreement - go to extreme lengths to please people - feel vulnerable and useless when alone - overlap with separation anxiety, also BPD - may be more likely to be involved in abusive relationships - see higher rates of depression in male relatives of proband with dependent PD, and higher rates of panic in female relatives - more prevalent in individualistic cultures (prizing independence)

Answer 210

- inflexibility and desire for perfection - preoccupation with rules and order - often moralistic and judgmental - viewed as rigid, stubborn, cold - reluctance to delegate, more cheap/reluctant to throw things out - one of the oldest disorder concepts, but very limited research since 1980 - very little overlap with OCD, about 20% (no obsessions or rituals, no distress, egosyntonic) - OCD more likely to be comorbid with avoidant or dependent PD - perfectionism, hoarding, preoccupation with details are common features with OCPD and OCD - OCPD more common in men than OCD

Answer 211

- personality generally thought of as stable and unchanging (and it is fairly stable after your 20s) - PD diagnostic change is larger when measuring categorically (but changes still seem to be due to decreasing pathology) - PD improvement is more likely to lead to improvement in comorbid major disorders, not the other way around - acute criteria (willingness to interact with people) are what make PD manifestations less stable because they respond to Tx and diminish with maturation or stress resolution - longer-term maladaptive characteristics are more stable (level of social inhibition) - persistent dysfunction in PDs may be because the traits are very extreme, so it naturally takes them longer to stabilize

Answer 212

- origins in psychoanalytics - Stern: hypersensitive, problems with reality testing, negative reactions in therapy (patients getting worse with Tx) - patients not clearly neurotic or psychotic = on the 'border' (very broad name for someone not responding to Tx) - Knight: pseudo-neurotic schizophrenia (both psychosis and neurosis) - DSM-III: intense affect, impulsivity, relationship problems, brief psychotic experiences - now stuck with the name despite it being not descriptive ("emotionally unstable disorder")

Answer 213

- emotions change rapidly and repeatedly (intense and unpredictable) - difficult to control - angry outbursts common - family members feel shifts to be unpredictable, don't understand triggers - people with BPD have increased amygdala activation for fearful and happy faces (below conscious awareness) - giving more resources for emotional content = hypervigilance and hypersensitivity to emotional fluctuations

Answer 214

- low 5-HT (serotonin: mood regulation) - treated with SSRIs = improvements in aggressive impulsivity (but not overall reduced symptoms, no effect on emotion instability) - some evidence of DA dysfunction (antipsychotic meds effective as Tx, inferred through behaviours like impulsivity, sensation-seeking, emotion dysregulation)

Answer 215

- emotional instability often triggered by loss, rejection, disappointment (perceived/real) - unstable representations of others (idealization to devaluation) - fear of rejection + fear of becoming too attached = 'testing' others to get them to prove that they care - don't trust that others will stay

Answer 216

- men who engage in spousal abuse are often high on BPD characteristics - they have unreasonable standards, idealization/devaluation, blame partner when things go wrong, poor impulse control = violence - could see the same pattern in women, but not studied

Answer 217

- difficult to conceptualize a coherent self, often tends to be negative - sense of 'emptiness' - feel as though they have no substance when alone and define themselves in relation to others - value relationships highly: threat to relationship = threat to self

Answer 218

- impulsive and self-damaging - alcohol/substance abuse, spending sprees, risky sexual behaviours, gambling, eating binges - NSSI conceptualized as unstable behaviour (suicide behaviours can also be conceptualized that way, though not impulsive)

Answer 219

- NSSI very common in BPD (partly because it's a criterion) - threat to relationship/loved one leaving is a common trigger for NSSI to regulate negative affect - suicidal ideation very common, attempts as well (1 in 10 die by suicide) - reasons for attempts: to escape, to punish self, revenge (rare), to make others better off (more common), assumption of manipulative intent but maybe just trying to communicate

Answer 220

- 75% experience paranoid ideas or episodes of dissociation - more common and more intense in people with BPD, and triggered by lower required levels of stress - endorse dissociation even more than people with PTSD - dissociation understood as misperception, paranoid beliefs aren't as firm as delusions

Answer 221

- prevalence = 1-2% (higher in clinical settings), more common in women - runs in families, also find higher rates of externalizing, SUDs, MDD - has a genetic component (twin studies) - psychosocial stress factors are very important (early trauma, abuse, neglect have strong associations but nonspecific) - wide heterogeneity in presentation (debate about what are the core features of the disorder, no criterion A)

Answer 222

- MDD 60% - PTSD 35% - BP 20% - EDs 17%

Answer 223

- as a variant of depression: more chronic form (but evidence of distinct neural signatures) - as a variant of PTSD (but you can have BPD without trauma, trauma not unique to BPD or PTSD)

Answer 224

- chronic - evidence that a large majority can be treated - more severe in younger populations - suicidal and impulsive bx can improve with Tx, mood reactivity often persists but people learn how to cope

Answer 225

- Marsha Linehan - form of cognitive therapy, practice both acceptance and change - need to accept the person for who they are AND try to change the way they live their lives to align with their values - recognize emotions and their triggers

Answer 226

- biological predisposition toward big emotional responses, sensitivity to environment, problems regulating emotions - paired with a chronically invalidating environment: parents minimizing, blaming, rejecting, attributing pejorative responses to kid's emotions = even more difficulty regulating - punished for your emotions = emotions become scary and threatening - "i'm sad" "no you're not" (met with erratic and out-of-touch responses) = teaching the kid that they're wrong about their emotions or stop communicating emotions, emotions threatening

Answer 227

- innate aggression interferes with normal development, cannot integrate positive and negative perspectives of the self and others - unresponsive family environment disrupts development of a stable sense of self + unable to self-soother because they can't remember positive images of nurturing

Answer 228

- affective instability may be inherited - serotonin linked with suicide and impulsivity - dopamine linked with novelty seeking, reward pathways - oxytocin interacting with family functioning (important in child-parent bonding) - limbic and prefrontal abnormalities - uncinate fasciculus, OFC in emotion control, amygdala disconnection from PFC

Answer 229

- being able to delay or terminate a given response (cognitive or motor) for the purpose of achieving another goal or reward that is less immediate - cognitive/behavioural/motivational inhibition, interference control - cognitive deficit in BPD

Answer 230

- executive neurocognition deficits - verbal/nonverbal memory deficits (autobiographical) - social cognition: attending to negative cues, biases in emotion recognition, less likely to rate strangers as trustworthy

Answer 231

- criticism and hostility not linked to poorer outcomes - people with BPD fare better in Tx with emotional overinvolvement (perhaps process it better because of fear of abandonment)

Answer 232

- antipsychotics and antidepressants, anticonvulsants, benzodiazepines, lithium - modest benefits, not much research

Answer 233

- DBT - mentalization-based therapy (psychodynamic) - transference-focused psychotherapy (psychodynamic; correcting distortions in social perceptions) - schema-focused therapy (cognitive, behavioural techniques to modify schemas)

Answer 234

- comprehensive early description including behavioural, affective, interpersonal features of psychopathy - behavioural: impulsivity, antisocial behaviour, sexual deviancy, irresponsibility - affective/interpersonal: egocentricity, superficial charm, lack of empathy - behaviourally, a psychopath might not be coming into conflict with society but could be masking a severe affective/interpersonal deficit (psychologically-focused definition which explains why psychopathy isn't equivalent to ASPD)

Answer 235

- strong emphasis on observable behavioural criteria (no affective/interpersonal traits) to improve diagnostic reliability - tendency to violate the rights of others (deceitful, aggressive, antisocial behaviours) - demonstrates the divide between antisocial PD (only behavioural) and psychopathy (which includes affective/interpersonal) - roots of ASPD lie in psychopathy conceptualization

Answer 236

1. superficial charm and good intelligence 2. no delusions or irrational thinking 3. no nervousness or psychoneurotic manifestations 4. unreliability 5. untruthfulness or insincerity (lying without purpose just to see what happens) 6. lack of remorse or shame 7. inadequately motivated antisocial behaviour (impulsivity, whimsical and poorly thought out) 8. poor judgment and failure to learn by experience 9. pathologic egocentricity and incapacity for love 10. general poverty in major affective reactions (but could mimic without feeling) 11. specific loss of insight 12. unresponsiveness in general interpersonal relations 13. fantastic and uninviting behaviour with drink and sometimes without 14. suicide rarely carried out 15. sex life impersonal, trivial, and poorly integrated 16. failure to follow any life plan

Answer 237

- Robert Hare, based on Cleckley's criteria - 20 items rated by interview and school/police records - widely used for parole decisions, to predict recidivism - emphasizes hostility and aggression, but not a lack of anxiety (which is still central) - Hare emphasized that psychopaths can be successful, not necessarily criminal or violent - average person scores about 4, score of 30+ indicates psychopathy - factor analysis shows two factors (emotional-interpersonal and behavioural deviance)

Answer 238

- charm, grandiosity - lying, manipulation - lack of remorse - lack of emotional depth - lack of empathy - could be split into affective & interpersonal

Answer 239

- child behaviour problems - juvenile delinquency - boredom, impulsivity - irresponsibility - violent behaviour

Answer 240

- most inmates qualify for ASPD diagnosis, but less for psychopathy - ASPD misses non-criminal psychopathy - qualify for both ASPD and psychopathy = worst offenders - individuals showing more affective/interpersonal features and fewer antisocial behaviours are rarely criminalized

Answer 241

- psychopathy is the best predictor of recidivism - up to 4x more likely to re-offend (violently) - still not a perfect predictor - is it good to be using PCL for parole decisions?

Answer 242

- 0.2-3% for males and females in the gen pop - possible diagnostic bias explaining gender differences - higher in criminal and hospital settings

Answer 243

- difficult to measure in the population, but best guess around 1% - over-represented in prison settings (esp. in max security) - female inmate samples range 9-31%

Answer 244

- low birth weight - malnutrition (severe) during pregnancy - lead poisoning - mother's use of substances/alcohol during pregnancy - no direct causal link, but robust correlations (smoking during pregnancy and conduct problems) - possible pathways: smoking could alter brain development, could affect NT systems, could affect birthweight which in turn affect conduct, moms who smoke could be somehow different in a way that predisposes to conduct problems

Answer 245

- familial aggregation - twin studies suggest genetic contributions - genes could = difficult temperament, impulsivity, tendency to seek reward, insensitivity to punishment (genes as a causal factor for antisocial bx in general, aggression, impulsivity) - genes could moderate susceptibility to environmental risk factors (genes as a moderator) - genes could increase likelihood for exposure to environmental risk factors like parental divorce or maltreatment (gene-environment correlation)

Answer 246

correlation: likelihood of exposure to environments interaction: susceptibility to environments

Answer 247

- MAOA degrade amine neurotransmitters (DA, NE, 5-HT) - more MAOA = more degradation = lower levels of NTs (associated with depression) - less MAOA = less degradation = higher levels of NTs (associated with impulsivity/aggression) - could be main effects or interactions

Answer 248

- childhood maltreatment is a robust risk factor for conduct problems (but still most kids don't go on to show criminal behaviours in adulthood) - MAOA gene altering susceptibility to maltreatment (GxE interaction) - no maltreatment = no effect of low or high MAOA - severe maltreatment = high MAOA still more likely to engage in criminal behaviour, but low MAOA show very high levels of antisocial bx (very susceptible to maltreatment) - suggests MAOA as a diathesis, but this would assume that genotype and environment are independent, which isn't likely

Answer 249

- retrospective and prospective evidence of more abuse in childhoods of people with higher PCL scores - rGE (correlation, increase risk of exposure to environments): parents of kids with high PCL scores more likely to have high PCL scores (parents behaving erratically and aggressively and passed on genes)

Answer 250

- maltreatment + GxE interaction (MAOA) and rGE (abuse and PCL scores) - parents often lacking psychological and physical resources to cope with difficult children = inconsistent discipline (difficult to learn behavioural contingencies) - seeking similar antisocial peers reinforces behaviour (active rGE) - kids engaging in criminality and drug use at a young age (genetic predisposition) can change future opportunities and life path

Answer 251

- biological parents with ASPD = more likely to develop antisocial traits - biological parents with ASPD + adopted into families with adverse environments = even higher likelihood of developing antisocial traits - genes moderating susceptibility to adverse environments

Answer 252

- poverty and neighbourhood crime related to delinquency - social selection hypothesis: psychopathology = drift down in society - social causation hypothesis: poverty = psychopathology (Costello study showing causal association with parental supervision as the mediator)

Answer 253

- socialization of kids toward aggression leads them to become more aggressive (brought into a military environment when very young = they become aggressive adults) - minority status associated with antisocial bx, likely driven by low SES

Answer 254

- without distress, little motivation to change = Tx is challenging

Answer 255

weak evidence that SSRIs reduce aggressive bx and increase interpersonal skills

Answer 256

- some treatments can reduce rates of re-offending in criminal offenders - but these treatments can also cause rates of re-offending to increase in psychopaths (emphasizing empathy and social skills = they get better at conning or manipulating)

Answer 257

- looking at poorly integrated ex-combatants (not psychopathy, but involved in drugs, crime, violence) who were conscripted very young and socialized to be violent - looking at antisocial tendencies as acquired skills instead of personality traits - randomly assigned to CBT only, cash only, CBT+cash, neither - 8-week group cognitive therapy (self-control, emotion management, conscientiousness and perseverance, less impulsive), to shift self-image from outcast to society member - cash only = no reduction in antisocial bx - therapy = only short-term change in antisociality - cash+therapy = persistent reduction in antisocial behaviour, values, self-control - mechanism: therapy pushes you to see yourself as someone who could be better, cash allows you to implement the skills you learn in therapy (you can become that better person) - found to be less costly (societal) than allowing crime to continue

Answer 258

- Kraeplin's morbid personality - Schneider's affectionless personality - Millon's aggressive personality - Pinel's manie sans delire - often synonymous with criminality, sociopathy, ASPD (but consistent desire to separate psychopathy from general criminality)

Answer 259

- an alternative to the factors in PCL - meanness, disinhibition, and boldness as the core of the syndrome

Answer 260

Machiavellianism, narcissism, psychopathy

Answer 261

- deficits in the Behavioural Inhibition System (BIS) - hypoactive BIS and normal BAS = psychopathic symptoms - poor punishment learning, weak behavioural inhibition

Answer 262

- low levels of neuroticism - hyporeaction BIS

Answer 263

- high trait anxiety/neuroticism - hyperresponsive BAS but no deficits in BIS

Answer 264

- fearlessness impedes normal socialization = psychopathic symptoms (no fear conditioning, reduced amygdala functioning)

Answer 265

- abnormalities in selective attention = inability to consider contextual information that should modulate goal-directed behaviour - once attention is directed to a goal, they can't divert attention to context

Answer 266

- Emile Kraeplin's conceptualization of schizophrenia (the first to propose groupings of psychotic syndromes) - early dementia: begins at an early age, then progressive deterioration of cognitive abilities - Kraeplin began the conceptualization of BP and schizophrenia as distinct forms of dysfunction (despite overlap in genes, etiology, symptoms)

Answer 267

- contemporary of Kraeplin; people with DP didn't always show linear deterioration over time and could emerge later in life - primary deficit was loose associations (disorganized thinking came first, but caused the other positive symptoms) - first to use the term 'schizophrenia' for split mind (shattered cognitive ability, not DID) - considered schizophrenia a group of disorders - led to a more broad definition which increased rates of prevalence as people in N. America preferred Bleuler's conceptualization over Kraeplin's more narrow one

Answer 268

- disturbances in perception - content of thought - form of thought - affect - motoric - relating

Answer 269

- hallucinations: no stimulus is present but a perception occurs (vs. illusion in which a stimulus is present but misperceived) - hallucinations can be 'positive' (seeing things that aren't there) or 'negative' (not seeing something that is there) - hallucinations occur in the same time and physical space as other (real) perceptions so makes them difficult to differentiate - can occur in all sensory modalities - hearing your own thoughts (but perceived as someone else), voices talking about you (poor prognosis), voices narrating your behaviour - somatic passivity experiences: bodily sensations imposed by external forces - voices could be misinterpreting your own thoughts

Answer 270

- Ps reading words into a microphone that immediately transmitted those words in a distorted voice into their headphones - people with schizophrenia with auditory hallucinations more likely to make misattributions about their own speech to someone else - also much more likely to make these misattributions if the words they were saying were derogatory

Answer 271

- delusions: false belief based on an incorrect inference, firmly believed despite contradictory evidence - mild end: over-valued ideas (false belief, but can entertain the possibility that it could be false; common in schizotypal PD and prodromal schz)

Answer 272

- controlled by an outside force: lost the ability to act volitionally in the world - grandiose: famous, important, royalty - jealousy: partner being unfaithful - nihilistic: belief that oneself or the world doesn't exist - persecutory: people scheming, plotting, out to get you - of reference: someone or some event is trying to signal something significant to you - somatic: something is wrong with a part of your body - often have multiple fragmented delusions - thought withdrawal: vacuum sucking out your thoughts - thought insertion: planted in your mind or they belong to someone else - thought diffusion/broadcasting: other people hearing their thoughts while they can't necessarily hear their own - made impulses: external force causing you to do things without intent, acts aren't always conscious - made feelings: external force giving you affective experiences - made volitional acts: attributing your motivation to do something to some external force

Answer 273

- formal thought/speech disorder - derailment: similar to loose associations (can't follow the logic) but no pressured speech - word salad (extreme): no logical or grammatical structure, words not even recognizable - alogia: poverty of speech or content of speech (not conveying information) - neologisms: making up new words or giving existing words new meaning - blocking: related to thought withdrawal, stops speaking abruptly - illogical thinking

Answer 274

- blunted/flat (anhedonia is common, can be difficult to distinguish profound anhedonia in MDD from flat affect): blunted expression of affect though they might still have rich inner experiences of emotion - inappropriate affect: laughing in the wrong situations - difficulty perceiving emotions: identifying or tracking others' emotional changes

Answer 275

- catatonia (much rarer now) - catalepsy/waxy flexibility: patients immobile but you can move them and they'll stay in that position - stupor: immobile and unresponsive to the environment (but no brain damage) - posturing: assuming strange positions on their own - mutism (still sometimes common) - catatonic excitement: looks like psychomotor agitation, but looks purposeless and avolitional - catatonic negativism: immobile and resisting attempts to be moved - echolalia: senseless and avolitional repetition of auditory input - echopraxia: avolitional repetition of movements

Answer 276

- very withdrawn - preoccupied with a fantasy world that only they can see, others don't interact with (when supplemented by hallucinations, can be terrifying) - disordered volition: aimless and purposeless (has overlap with MDD) - anhedonia

Answer 277

- positive: presence of symptoms that shouldn't be there (hallucinations, delusions, inappropriate affect) - negative: absence of things that should be there (blunted affect, alogia, avolition) - positive responds better to meds, negative hard to treat - very few people have only negative symptoms

Answer 278

- poor reliability, still controversial (thought of as a residual category) - not a very distinct diagnosis, but also not just an atypical form of mood disorder or schizophrenia - prognosis is better than schizophrenia, but worse than mood disorders

Answer 279

- 0.7-1% - 1.4:1 male to female ratio - women tend to present with more symptoms of depression (can explain gender prevalence differences) - female sex hormone (estrogen) may be protective - child-onset before age 13 is very rare - prevalence rates increase for boys and girls in teens (more for boys) - prevalence peaks again for women in late 40s (menopause, less estrogen)

Answer 280

- very rare, more common in boys - always insidious onset which makes it hard to tell where actual onset begins - usually early speech and language problems (noticeable differences in social, cognitive, motoric deficits) - delayed motor development, poor coordination (not reaching motor milestones like crawling, difficulty with smooth pursuit) - unlikely to remit - higher rates of schizotypal and Schz in relatives (higher genetic loading for child-onset)

Answer 281

- only 20-30% able to live independently - another 20-30% have persistent moderate impairment and Sx - the last 50% have lifelong severe impairment - minority have periods of recovery - Schz has poorer prognoses and more impairment than other psychotic and nonpsychotic disorders - more benign course in countries that are not yet industrialized (demands of industrialized countries may make it difficult to find somewhere to exist OR because babies with fetal/birth complications are less likely to survive) - tend to die younger (even 20 yrs younger) - death by suicide is most common, then cardiovascular disease (smoking very common bc it manages sx, antipsychotics can have health-related side effects)

Answer 282

- good premorbid adjustment (had friends) - acute onset (less than 1 month) - manic and depressive symptoms - confusion or disorientation during psychotic episodes) - family history of mood disorders - patients with 5 good indicators = 80% had more positive outcomes

Answer 283

- poor premorbid adjustment - insidious, gradula onset - negative symptoms (esp. blunted affect) - family history of Schz - lower IQ - patients with many bad indicators = 40% had positive outcomes

Answer 284

- substance abuse (alcohol and nicotine) - substances could trigger it (esp. ones that mimic symptoms, but also marijuana) - suicide risk (20% attempt, 5% complete) especially for young men (good premorbid functioning may have more pronounced risk)

Answer 285

- perception of dangerousness and violence that isn't founded - very slight increased risk population-wide (this could be driven by higher rates of substance use) - aggression more common in younger males with a history of violence (tendency to stop taking meds, toward impulsivity, substance abuse) - higher likelihood that people with Schz are likely to be victims of violence or will commit suicide

Answer 286

- risk gets more and more elevated as you increase genetic overlap with a proband who has schz (Mz, Dz, kids, siblings, parents) - higher concordance in Mz twins than any other family member (28% vs. 6% in Dz) but still not as heritable as bipolar - offspring of the discordant co-twin (no schizophrenia with a twin who has it) is still much higher (17.4) so genetics playing a role

Answer 287

- monochorionic twins (Mz) share placenta and circulation & more likely to be schz-concordant than dichorionic Mz twins - dichorionic twins (Mz or Dz) do not share this environment

Answer 288

- intermediate step between genotype and phenotype (closer to the genes than phenotype, but still linked to the phenotype) - needs to be present in the population of interest - must be heritable - must always be present (not just in the state of psychosis), not state-dependent - co-segregate with the illness within families - present at higher rates within affected families - amenable to reliable measurement - ideally specific to the illness of interest

Answer 289

- ability to track the overall shape of the wave, but lots of noise, herky-jerky patterns - most reliable lab correlate - also seen in unaffected siblings, stays stable over time (not due to having psychosis or treatment) - only 50% of people with schizophrenia display this pattern, but more specific to schizophrenia than any other endophenotype (only seen in schz or related disorders)

Answer 290

- schz tend to have lower social class (causation vs. selection hypothesis) - selection hypothesis: family of origin doesn't also have lower SES, only the person with schz (difficult to maintain a job, less education, more homelessness) - causation hypothesis: immigrants and their first generation descendents tend to have higher rates of schz but their countries of origin do not - selective immigration hypothesis: people with higher risk of schz are immigrating (goes against what we know abt immigration & their families of origin don't have more schz) - stress theory of immigration: becoming a minority, dealing with stigma, finding jobs (kids also have to do this) - diagnostic bias: black people diagnosed with schz, white people with BP

Answer 291

- advanced paternal age at conception associated with higher risk - unclear what the cause/mechanism is - could be due to mutations in sperm cells (repeated mitosis) - or men who are older and having kids could be different in some way (schizotypal PD more likely to have kids when older?)

Answer 292

- breech delivery, prolonged labour, umbilical cord around neck = anoxia/hypoxia - anoxia also associated with DA sensitivity later

Answer 293

- viral infections during 2nd trimester (mothers during an epidemic were more likely to have schizophrenic kids - ecological fallacy, not necessarily every mother came into contact with the flu) - antibodies during pregnancy (if you have the antibodies, you had the flu) = schizophrenia in kids - direct evidence

Answer 294

- kids born in late winter/early spring show a 5-15% increase in rates - true in both northern and southern hemisphere and their respective winters, and effect decreases as you approach the equator - viruses can cause fetal damage and these are more common in fall and early winter (2nd trimester)

Answer 295

- dutch hunger winter = rates are 2x normal - could be a general lack of nutrition or a specific lack of folate or iron which are essential for brain development - replicated effect

Answer 296

- important period for neural migration (cells moving out to form the cortex and develop cortical organization) - could be a final common pathway conferring risk for schz - important for cortical connectivity, could result in cell death or thinner grey matter if disrupted (like by viruses, stress, malutrition) - disorganization in how cells are positioned (scrambled/nonparallel cytoarchitecture) and thinner cortices - creating a latent vulnerability that can be triggered by a stressor or substance

Answer 297

- tends to be decreased even in recent-onset people (suggests it's not a result of treatment) - also see progressive loss of grey matter over time (progressive deterioration continues for many years into the illness) - consistent with Kraeplin's DP - beginning in parietal and spreading to temporal and frontal (language and EF areas) until it gets to almost every region - not explained by just being ill or by antipsychotics, just a part of the course - some genetic mechanisms: inappropriate pruning of cells

Answer 298

- antispychotics block DA D2 receptors - cocaine, amphetamines boost DA activity and result in paranoia, psychosis, break with reality - L-DOPA for Parkinson's increases DA and can cause hallucinations - hypoxia/anoxia = DA hypersensitivity - CSF studies haven't always found increased DA metabolites (could be a receptor problem which is difficult to test bc antipsychotics alter DA receptor activity) - excess DA transmission in the striatum, reduced transmission in frontal lobes - aberrant salience: more DA = more attention toward irrelevant stimuli = difficulty integrating your sense of reality with others - failure to respond to meaningful reward cues (anhedonia and negative symptoms)

Answer 299

- activity in dlPFC heavily regulated by DA activity - region that is very important for working memory - working memory deficits seen in schz (and unique to schz, not seen in BP who were actively psychotic or healthy) even when in non-psychotic states, in schizotypal PD, and 1st degree unaffected relatives - could be a premorbid risk factor

Answer 300

- abnormal orofacial movements and upper limb dyskinesia (also seen in childhood and can reliably distinguish kids who went on to develop schz) - DA strongly involved in motor systems - early premorbid indicator

Answer 301

- people with schizophrenia 2x more likely to smoke weed - but since there's often insidious onset: maybe people with schz self-medicating premorbid symptoms with cannabis - prospective relationship even when controlling for premorbidity (still not definitive proof of causality) - THC increases DA synthesis: more DA and DA hypersensitivity correlated with how schz manifests - psychosis + consuming cannabis will exacerbate psychotic and cognitive symptoms (working memory, cognitive disorganization) - also see greater decreases in grey matter in patients using cannabis than those not using cannabis (still not causal; severe schz = using more, smoking weed because of the loss of grey matter)

Answer 302

- families high on tendencies to express negative emotions - during deinstitutionalization, patients who went home had higher rates of relapse and worse symptoms (these families had more emotional overinvolvement and showing hostility) - well-replicated effect regardless of patient characteristics - when EE is lowered (family therapy), relapse rates decrease - EE could play a causal role (stress of being in this type of family, types of attributions people make about patients) - EE still nonspecific (worse outcomes for depression, BP, predicts better outcomes for BPD)

Answer 303

- criticism: disapproval or dislike of the patient - hostility - emotional overinvolvment: no emotional distance from others' emotional experiences, very intrusive

Answer 304

- the types of reactions patients are eliciting from high-EE families - patients expressing somatic concerns, anxiety or depression, irritability, anger/hostility, unusual thinking, bizarre comments - in high EE families, patients are more likely to exhibit odd or disruptive bx which elicits criticism from the family, which makes it even more likely that the patient will respond with something else that is odd (defending their reality) and so on

Answer 305

- no single etiological factor will explain the development of schz - example pathway: genetic factor + pre/perinatal factor = brain vulnerability + stressors + further disorganization of brain during maturation = psychosis

Answer 306

no experienced distress or other effects from auditory hallucinations (usually because their community experiences hallucinations as positive)

Answer 307

- voices at first seem neutral but they become ominous when you start to fight them and with others' negative reactions - starting to interact with the voices = engaging in strange bx and rituals (these are attempts to make your reality coherent again) - catastrophic interpretations of hallucinations, so therapy should focus on how people think about their thoughts

Answer 308

- neuroleptics - have extrapyramidal symptoms (EPS) bc they block all DA receptors: involuntary muscle movements, spasms - tardive dyskinesia (potentially permanent bc the brain adds more DA receptors in response to a lack of input): involuntary movements of lips, tongue, neck (which look bizarre and contribute to further alienation) - dramatic and rapid decrease in symptom severity (within 24hrs) - side-effects include drowsiness, dry mouth, extreme weight gain - the earlier you treat psychosis, the better it works (lasting effects if you treat first episode onset) - could contribute to loss of brain tissue

Answer 309

- drowsiness, dry mouth, extreme weight gain - no EPS side-effects - equally effective as 1st gen (except clozapine which is better) - more expensive than 1st gen = restricted access - can result in metabolic syndrome, downstream diabetes, loss of white blood cells - could contribute to progressive loss of brain tissue

Answer 310

- family therapy as an adjunct (esp. for high EE) - psychoeducation is a major element: explaining what schz is, what causes it, helping them make different attributions abt behaviour - improve coping and problem-solving: how to relate to each other and regulate emotions - improve communication: reduce aggression and anger

Answer 311

- may be helpful for positive symptoms, not so much for negative symptoms - goals: decrease intensity of positive sx, reduce relapse, decrease social disabilities - coping with hallucinations and delusions: changing the response you're having can help decrease their intensity - VR environments where patients can practice chit-chat to increase their likelihood of having low-stakes positive interactions with strangers (has downstream positive effects on symptom severity)

Answer 312

- activating event: voices or a real-life event - belief: what people think about the voice (usually these are negative) - consequence: emotions you're having bc of the belief, behaviours you perform bc of it - try to intervene around the belief to separate feelings from what is actually happening

Answer 313

- trying not to think about something means you're actively keeping the thought in mind and makes it come back stronger - main goals of CBT and ACT for schz is to stop fighting the thoughts, just to accept it and not let it affect your behaviour or feelings

Answer 314

- peer support group for anyone who hears voices (which isn't necessarily psychopathological in itself just because of statistical deviance, and the voices can be accommodated) - aims to reduce distress surrounding auditory hallucinations - evidence is anecdotal - evidence that they work better for people with lower social functioning: could just be providing social contact and an accepting environment to practice social skills - limited evidence for whether they reduce distress about the voices, but can reduce stress about voices, take away their power and control over your behaviour

Answer 315

- trying to increase ability to be assertive with your voices - develop a contract for when you can engage with the voices or when you ignore them - tips for how to deal with the hallucinations like pretending to talk on the phone while you shout at them - selective listening: only engage with the voices when they say something positive (reward) and ignore when they say something negative (extinguish)

Answer 316

- deficits in sensory gating (filtering out unnecessary stimuli) - deficits in verbal and spatial memory, EF, social cognition - enlarged brain ventricles (brain shrinking) - 'leaky' myelinated pathways indicating axonal damage (abnormal connectivity) - adolescence is a period of synaptic pruning, but it may go on too long and result in schz-prone brains

Answer 317

- premorbid: subtle and occur long before onset - prodromal: immediately precede onset (this is so common that there are criteria for identifying individuals who are at high risk for developing schz in the next two years

Answer 318

- acute: reduce sx severity using meds - stabilization: to consolidate gains and attain a stable living condition - maintenance: when sx are in remission, prevent relapse and improve functioning

337 final Flashcards

(342 cards)