Substance-use disorder

DSM 1 & 2 classified this as a symptom of sociopathic personality disorder

DSM 3 classified it as a substance-use disorder, & added classes of substances
DSM 4 classified two distinctions between dependance & abuse, where dependance was thought as more severe
DSM 5 no longer differentiated between abuse & dependance
Different levels of involvement include the use, intoxication, abuse (i.e., risk behaviors) & dependance (i.e., need & craving)
Substance-use disorder —> Problematic patterns of substance use leading to distress or impairment over 12 months
Alcohol use disorder lifetime prevalence 30%
Alcohol use disorder has higher rates in white & First Nation populations
- Alcohol dehydrogenase —> Common in Asian & Jewish populations where drinking makes you sick
Alcohol use disorder comorbidity is 35-40% —> May be due to the fact that many factors contribute to alcohol use disorder & other
disorders
Onset in late adolescence & early adulthood (i.e., around 21 age), more common in men but women worsen quicker
Study by Vaillant —> 25% got diagnosed with alcohol use disorder, but decrease of rate with age
Heavy drinking associated with social, physiological & psychological risk
- Chronic use of alcohol = 12 year decrease of life + suicide risk with alcohol use disorder
Living alone = risk associated to get alcohol use disorder
Gateway hypothesis —> Idea that certain drugs are gateway drugs (alcohol, marijuana, nicotine) where they increase the likelihood of use
of other illicit drugs
Childs risk increases with number of parents with alcohol use disorder, where lifetime prevalence of relatives with it = 30%
Alcohol use disorder tends to be externalizing (i.e., interaction with environment)
Alcohol use disorder study with twins —> Genetics didn’t play that much of a role in this disorder, environmental factor was stronger
When drinking, alcohol is a stimulant —> Increase of norepinephrine = Arousal + impulsivity
After drinking, alcohol is a depressant —> Decrease of activation in prefrontal cortex, hippocampus, cerebellum
Psychomotor stimulant theory of addiction —> Stimulants lead to addiction by influencing the brain rewards system & motor function
- A study showed that men with relatives with alcohol use disorder tend to have larger increase of heart rate
Positive affect regulation theory —> Proposes that drinking increases a positive feeling
Positive alcohol expectancies —> Expectancy that drinking will make social, physical & emotional experience better
Experiment by Fairbairn —> Men tends to have higher rates of alcohol use disorder, maybe because of male bonding trough alcohol,
where men can be free from male stereotype when drinking
- Men showed increase in smiling when drinking + duration of smile increased = More interpersonally rewarding
Negative reinforcement of drinking —> Feel bad not to drink = Drink to avoid withdrawal symptoms
Negatives affect regulation theory —> Drinking to remove negative affect
Behavioral disinhibition —> You have disinhibited behaviors, thus risky, correlated with severity of alcohol use disorder
Negative emotionality —> Negative emotion + Drinking = Negative reinforcement behavior —> associated with alcohol use disorder
Deviance proneness —> Deviant patterns of behaviors associated with alcohol use disorder
Addictive substances —> Craving for substances where one has an overwhelming desire of the substance
Use of illicit drugs increases in age & then decreases in age (i.e., from college student till senior)
Polysubstance use —> Use of more than one substance (i.e., 80% drinkers are smokers, 50% cocaine users are alcoholics)
The mesocorticolimbic pathway —> From Ventral tegmental area to nucleus acccumbens to prefrontal cortex, where increase of dopamine
in this pathway = reinforcement
Amphetamines are agonist of dopamine & norepinephrine
Toxic psychosis —> Repeated high dose of stimulants = psychotic symptoms
Stimulants, amphetamines (cheap version = methamphetamine), cocaine (cheap version = crack cocaine)
Ketamine used to treat treatment resistant depression, psilocybin used to treat cancer patient anxiety & existential distress
Safer injection site = Lower harm among users, increase of referral for psychological services, no increase in drug users & drug crimes
Aversive treatment —> Make a drug less unpleasant (i.e., antabuse [disulfiram] a pill makes you sick if you took substances)
Contingency management —> Cogntive-behavioral therapy, where you identify prior factors that make you drink
Relapse prevention —> Identify possible triggers that will make you drink again
Motivational interviewing —> Good for people whom have intrinsic motivation to change, it is brief, cheap, reduce functional impairment
- A study showed that motivational interviewing reduced drinking & lowered risky behaviors
Personality targeted interventions —> School based intervention to target hopelessness, anxiety sensitivity, impulsivity, sensation seeking

Eating disorders:
Pica —> Person only eats non-food substances
Rumination disorder —> Repeatedly swallow food & throw it out
Avoidant/restrictive food intake disorder —> Restricts the type of food to eat
Anorexia nervosa —> Restriction of eating leading to low body weight, intense fear of gaining weight, distortion in perception of body weight
- Severity is based on body mass index & there are two subtypes
- >15 body mass index = extreme where less than 17 = moderate
1) Restricting subtype —> Low weight achieved through dieting, fasting or a lot of exercise
2) Binge eating/purging subtype —> Restricts + Binge eats/purge , where purging can be self-induced vomiting, use of laxatives…
- Objective binge vs. Subjective bing = Difference in amount of food eating, coming thing is loss of control & distress
Self-worth for a person with anorexia nervosa is all based on shape & weight even though they have a very low body mass index
A lot of body checking behaviors such as looking at weight, measuring body parts, wearing baggy clothes
Anorexia nervosa is an ego-syntonic disorder, the eating disorder is highly valued, positively reinforced, low weight = proud
Bulimia nervosa —> Recurrent episodes of binge eating, inappropriate compensatory behaviour, 1 episode/week for 1 month, self-evaluation
- Unlike AN, they don’t check their weight often, & check themselves in the mirror
Bulimia nervosa is typically in the normal weight range, they restrict their food, binge with forbidden food, purge to relive fear of weight
Study by Zuncker 2012 —> Restriction increases rate of binge eating, support therapy model to reduce diet restriction
Behavioral restriction = Behaviors to restrict food intake, Cognitive restriction = Restriction of certain types of food
Orthorexia —> Cognitively restricts themselves from eating certain foods (i.e., only eating biological food)
Binge eating disorder —> Binge eating episodes (i.e., eating large quantity of food) & eating quickly, alone, disgust feeling after
- No compensatory behaviors, less restriction, often overweight
A lot of crossovers with eating disorder, person can be diagnosed with AN restrictive type then AN binge/purge type
- AN = Body mass index <17 BN = Body mass index >17
- No one’s goes from AN restrictive type to binge eating disorder, this represent that these two eating disorder are two end of spectrum
Prevalence of AN = >1%, Bulimia nervosa = 1%, Binge eating disorder = 2%
Higher prevalence in women with 3:1 ratio, this may be due to gender biases & sociocultural factors (i.e., media says thin = wow)
Eating disorders have high comorbidity with other disorder where;
- obsessive compulsive personality disorder = AN & borderline personality disorder = bulimia nervosa
Age of onset is earliest for AN (16-20), then bulimia nervosa (21-24), then binge eating disorder (30-50)
Bulimia nervosa most heritable (50-83), then AN (48-76), then binge eating disorder (41%)
People with AN & Bulimia nervosa have low serotonin, & serotonin is made from tryptophan which is found in food
Thin ideal in women is portrayed in media where it is 15% below average weight of woman
Fiji study —> Fiji had low prevalence of eating disorder in 1995’s, then introduction of television where 11.3% reported purge behaviors
- Almost 70% reported dieting, feeling fat, television being factor to influence body image
A study found that social media predicted negative body image, but not vice versa (i.e., negative body image ≠ prediction of social media usage)
Appearance related social comparisons —> Media shows the ideal body which is thin which is restrictive making you feel ur behind
Internalization of thin ideal may be causal factor that increases risk of eating disorder
Eating disorder a person will develop schemas about weight & self —> Thin = + Positive factors, Fat = + Negative factors
Implicit attitudes bias —> Pro thin & anti-fat bias, Attentional bias —> attend or avoid food, body types, socially threatening faces
Memory biases —> If presented with neutral vs. Body words, body words have more importance
Risk factors —> Negative body image, dieting, low self-esteem, identity problems, negative affect
Escape theory of binge eating —> From Heatherton and Baumeister Binge eating is a motivated attempt to escape from self-awareness
High standards —> Compare self with those standards —> Shortcomings —> Escape of self-awareness
Cognitive narrowing effect —> Focus away from high level meaning & focus towards positive sensation associated with eating
Study by Smyth —> EMA was used where increase in negative emotion preceded binge/purge followed by decrease of negative affect
Negative urgency —> Engage in rash action in response to negative affect, positively correlated with bulimia nervosa symptoms
- A study showed that negative urgency predicted increased risk of binge eating (i.e., transdiagnostic risk factor)
Body displacement hypothesis —> A person feels a negative emotion & place it on their body = negative cognitions associated with body
AN ≠ Psychopharmacology, Bulimia nervosa = Antidepressants, Binge eating disorder = Bupropion
Cogntive-behavioral therapy enhanced —> More successful with bulimia nervosa & binge eating disorder
= Psychoeducation of cogntive-behavioral therapy formulation, regular pattern of eating, target cognitions about food & weight
Risk factors of obesity —> Complex pathway biopsycosociocultral factors, body mass index =genetics, family attitude about food
No public policies address weight as a discrimination factor
Cyclic obesity/weight-based stigma (COWEBS) model —> +stigma —> +stress—> +eating —> +cortisol —> +weight —> +stigma

Personality disorders:
5 models of personality —> 1) Neuroticism, 2) extraversion, 3) openness to experience, 4) agreeableness, 5) conscientiousness
DSM 3 axis 2 was made for personality disorder —> Permanent, gradually developed, inflexible
Personality disorder (DSM5) —> Enduring pattern of inner experience & behavior, deviates from culture norms, inflexible, onset of
adolescence or early adulthood, stable , leads to distress & impairment
Obsessive compulsive disorder is ego dystonic, obsessive compulsive personality disorder is ego syntonic
Cluster A (Odd/eccentric) —> Paranoid, schizoid, schizotypal
Cluster B (Dramatic/emotional/erratic) —> Narcissistic, antisocial, borderline, histrionic
Cluster C (Anxious/fearful) —> Avoidant, dependant, obsessive compulsive
Prevalence 4-15%, every cluster has same prevalence, higher in inpatient settings, anti-social personality disorder higher in prison
Global prevalence 8%, higher in high-income countries (i.e., individualistic)
A lot of potential misdiagnosis based on clinician prespectives
Men usually are diagnosed with anti-social personality disorder & woman with borderline personality disorder & histrionic personality disorder
Study by Warner —> 80% of individuals diagnosed with borderline personality disorder & histrionic personality disorder were female
Study by Gunderson —> 160 patient with borderline personality disorder, 6 months later 18 no longer met diagnostic criteria with 0 treatm
Comorbidity with a lot of major disorder & other personality disorders
Diagnostic overlap —> Similarity of symptoms between two disorders e.g., anti-social personality disorder & borderline personality disorder
Diagnostic heterogeneity —> Two people with the same diagnosis have different presentations
Five factor model (FFM) —> Personality disorder might reflect extreme levels of personality traits
Dimensional models —> Personality is on a continuum & not categorical in nature, breaking into facets improve predictive validity
A1) Paranoid personality disorder —> Suspiciousness & distrust, common in families with schizophrenia, they don’t have psychotic
delusions like schizophrenia, a lot of overlap with borderline personality disorder & avoidant personality disorder
A2) Schizoid personality disorder —> Lack of interest with others, flat affect, cold, impairment with affiliative system
- Common to see a child with autism disorder if parents have schizoid personality disorder
A3) Schizotypal personality disorder —> Cognitive & perceptual distortions, odd beliefs, magical thinking, telepathy, ideas of reference
- Overlap with schizophrenia but eccentric & odd ways of thinking, not delusional, there is cognitive deficits as schizophrenia
B1) Histrionic personality disorder —> Attention seeking behaviors, provocative seductive & flirtatious, difficulty maintaining relationships
B2) Narcissistic personality disorder —> Inflated sense of grandiosity, preoccupied with receiving attention, show off, need of admiration,
sense of entitlement, lack of empathy, more common in male
-Subtype of grandiose where they think they above everyone else, subtype of vulnerable where they are better than others due to insecurity
- Etiology of grandiose comes from parents saying child is best, subtype of vulnerable comes from emotional physical abuse +parent style
Study by Twenge —> Meta analyses with NPI, increase of score by 2 points in the past 30 years, maybe due to self-esteem movement
Study by Trzesniewski —> No evidence of increase of NPI, did not find the narcissism epidemic
C1) Avoidant personality disorder —> Avoid interpersonal contact, sensitive to criticism, desire closeness & are emotionally expressive
unlike schizoid personality disorder, people with social anxiety disorder can be diagnosed with avoidant personality disorder but not inverse
C2) Dependent personality disorder —> Inability to function independently, extreme need to be cared for, submissive role, don’t disagree
- Has the fear of abandonment from borderline personality disorder, & need for attention from histrionic personality disorder
- Relatives of a person with this personality disorder that are male are at risk for depression, female are at risk for panic
C3) Obsessive compulsive personality disorder —> Inflexibility & desire for perfection, emphasis on rules & order, moralistic
- Don’t accept help from others, stable features are rigidity, stubbornness, perfectionism, reluctant to change
- Don’t have compulsive rituals or true obsessions, 20% of people with obsessive compulsive disorder have this personality disorder
Psychodynamic view —> Personality disorder arise from disturbance from child-parent relationship
Separation-individuation —> When you are an infant in order to go to next stage you must separate yourself from mother
- Difficulties result in inadequate sense of self (bpd, npd, hpd) & problems with others (apd, aspd)
Attachment theory —> Affectional tie binds people together in space & endures over time, you adopt depending on interaction with caregiv
- Primary strategy —> Security based, Secondary strategies —> Hyper activation or deactivation
- Three attachment styles —> Secure, anxious/ambivalent, avoidant
Two dimensional models of attachment —> X-axis is between negative-positive model of self, Y-axis is negative-positive model of sig oth
Insecure attachment styles result into personality disorder, there is almost never a secure attachment in personality disorder
Study by Battleet —> Of the childhood in people with personality disorder, 73% report abuse, 82% report neglect
Stern (1938) described patient between the boarder of the psychoses & neuroses, Kernberg (1976) described borderline personality organza
- Splitting —> Defense mechanism, unconscious processes where one shift from idealizing someone then hating
WHO’s ICD-10 uses the term emotionally unstable disorder instead of borderline personality disorder
DSM5 borderline personality disorder —> Instability of interpersonal relationships, self-image, affect, impulsivity, early adulthood
- 3 core clinical features of instability; emotional, relationships, sense of self & behavior
1) Emotional —> Very intense mood swings, prolonged duration, extra sensitive to environmental stressors
- Emotional switching is common, where there is switches from positive to negative affects & vice versa
- Emotion dysreglation —> Difficulty regulating negative emotions, increase in emotion dysregulation can predict severity of BPD
2) Relationship —> Triggers of BPD are interpersonal, tend to be in relationships with problems, unstable representations of others
- Afraid to be alone, they often test others to see if someone will stay with them & etc
- They use two strategies reassurance seeking & venting to serve as emotion regulation function, which have + effect short but - long term
- Long term consequences can create interpersonal & intrapersonal consequences, it relies on negative reinforcement
3) Sense of self —> Shift between sense of self vs. conflicting selves, are fragile & have - self concept, tend to feel empty (alone h24)
- Self-fragmentation —> Non continuous sense of self across time, fragmented across time & contexts
- Relationships are priority, thus threat to that = threat to self
4) Behaviors —> Very impulsive right here right now vibes, when negative em they tend to get rid of it quick, when positive they have drive
Non-suicidal self-injury is very common in borderline personality disorder (65-90%), functions as emotion regulation
Suicidal ideation very common where almost all report it, suicide attempts are as high as 70% with 3 attempts on average, 8-10% die
Suicidal threat —> Verbal statement or behavioral act that may indicate serious intent to kill oneself, often trigger by interpersonal
relationships, viewed by others as demanding & manipulating
Dr. Joel Paris statement —> Hospitalization of people with BPD positively reinforces suicidality, leads to;
Psychiatrization —> Feeling of distress = trip to hospital
Prevalence of 1-2%, gender biases on woman, pros & cons in diagnosis in adolescence
- Con can be personality still developing thus stigma, Pro can be early intervention = better outcome
Comorbidity very high with other personality disorders & with internalizing/externalizing disorders
75% of borderline personality disorder patient report psychotic like symptoms (e.g., hallucinations, paranoid ideas, dissociation)
Depersonalization —> Feeling old being detached from oneself & mental processes (i.e., observer of your life)
Derealization —> Feeling of being detached from your surroundings
Experiment by Stiglmayr —>EMA ratings of participants of stress & dissociation, all groups showed association with stress & dissociation
-Effect was stronger on borderline personality disorder patients, they have more dissociate experiences in intensity, frequency & low stress
Childhood trauma, abuse, neglect play large role in borderline personality disorder
Study by Briere & Zaidi —> Sexually abused childhood for females = x5 borderline personality disorder
Study by Bandelow —> Only 6.1% of people with borderline personality disorder did not have childhood trauma
Relationship between insecure attachment style & borderline personality disorder
Metallization (Bateman, Fonagy) —> We understand ourselves & others in terms of mental states (i.e., getting into someone’s mind)
- Ability acquired thought attachment with caregiver, people with borderline personality disorder don’t have that
3 non-mentalization modes —> Teolological (thinking someone did = he did it), Psychic equivalence (own thought = reality), Pretend
mode (mental world is decoupled from reality)
Biosocial theory —> Core problem with borderline personality disorder is emotion dysregulation, comes from vulnerable biology & social
environment
- Vulnerable biology —> High sensitivity, reactivity, slow return to baseline
- Invalidating social environment —> Caregiver fail to validate child emotional experience = Emotional dysregulation
Anti-social personality disorder (DSM5) —> Pattern of disregard of the rights of others, ≥ 18 age, doing things ground of arrest,
deceiving, impulsivity (i.e., don’t plan ahead), aggressive, reckless, irresponsible, lack of remorse
Conduct disorder —> Aggression to animal & people, destruction of property, deceiving, theft, violation of rules
- Boys 4x diagnosis, girls diagnosis later in age
Psychopathy —> Fake emotions, no empathy, remorseless, follow the rules (i.e., less in prison compared to sociopath)
Psychopathy checklist (PCL) —> Robert Hare, 20 item check list, used a lot in NA, does not assess lack of anxiety/fear
- First factor tends to be interpersonal/affective, the second factor tends to be social deviance
Anti-social personality disorder tends to be different than psychopathy due to the first factor, all people with psychopathy tend to be aspd
Anti-social personality disorder 2-3% prevalence, 3-5x in men, higher rate in criminal & hospital settings
Etiology of this can be low birth weight, malnutrition during pregnancy, lead poisoning, use substances during pregnancy
Family studies reveal aggregation of externalizing disorders
MAOA gene —> Responsible for degradation of dopamine, serotonin & norepinephrine
- More activity of MAOA gene = depression, Less activity MAOA gene = More agresivity
- Low MAOA with childhood maltreatment (gene x environment) = Anti-social personality disorder
Passive rGE —> Parent give antisocial gene + chaotic environment
Evocative rGE —> Parents lack resources to deal with difficult children
Active rGE —> Antisocial individual associate with similar others
Social cause hypothesis —> Living in poverty = Increases rates of delinquency = psychopathology
Social selection hypothesis —> Psychopathology = Living in poverty = Increase rates of delinquency
Fearlessness hypothesis —> Anti-social personality disorder & psychopaths = fearless
- People whom are antisocial have history of physical punishment, thus tend to adapt to be neutral
- People with anti-social personality disorder tend to have reduced startle reflex
Experiment by Patrick —> Participants presented with neutral, positive & negative images with eye response measured
- Results showed that psychopath blinked less when presented negative image (i.e., did not have usual response compared to others)
Psychotherapy can make psychopath even worse, since they use the social skills development in psychotherapy & use it to their advantage
Cogntive-behavioral therapy only has high internal validity, low external validity

Schizophrenia:
Dementia Praecox —> Kraepelin, redefined psychosis into dementia praecox & manic depression, this disorder was a dementia at early age
Mania & schizophrenia tend to be placed together in dimensional/hierarchical models
Bleuler stated schizophrenia was not dementia (deterioration) praecox (early onset), since they didn’t need to always deteriorate & emerge later
- Schizophrenia was characterized by loss of association between thought processes, emotions & behaviors (i.e., split of reality)
- Gives rise to other symptoms since you’ve splitted (e.g., hallucinations & delusions)
Schizophrenia (DSM5) —> Need one of delusion, hallucinations, disorganized speech & one of grossly disorganized/catatonic behavior
- There is functional impairment, symptoms need to be >6 months, not attributable to substance use
1) Delusions —> Disorder of thought content, false belief based on incorrect inferences, are in the extreme end of the continuum
- Over-valued ideas —> False beliefs but are willing to understand they are false, it is in the light end to the continuum
Thought broadcasting —> Ideas that thoughts are being broadcasted to others
Thought insertion —> Idea that thoughts are being inserted in you
Grandiose delusions —> Thinking you are someone extremely powerful contrary to the reality in which you are
Delusions of jealousy —> Obsessed with others in which you think you partner is cheating on you thus you follow her
Nihilistic delusions —> Yourself or the world around you is dead
Persecutory delusions —> Thinking someone is out to get you (e.g., people in the streets are undercover agents trying to get you)
Delusions of reference —> Objects around you have special meanings (e.g., someone dropping their pen means he wants to talk to you)
Religious delusions —> Thinking satan is trying to give messages to you from the television
Somatic delusions —> Thinking that your organs are trying to communicate something with you
2) Hallucinations —> Can occur in call senses, auditory hallucinations being the most common (i.e., hearing voices that can’t differentiate)
- Schizophrenics may misinterpret their own self-talk as auditory hallucinations
Study on auditory hallucinations —> Experimenter played back a script that record the voice of the schizophrenic, in which they tended to
state that this voice (i.e., their own) belonged to someone else, especially if the words were derogatory,
3) Disorganized speech —> Disorder of thought form, communicate words & sounds that don’t make sense
- Derailment —> Talking in a normal pace but the words & words combination don’t make sense (e.g., word salad, neologism)
- Alogia —> Saying nothing or very little concrete answer, Blocking —> Individual with schizophrenia continuously talks then stops
Disorganized or catatonic behaviors —> Psychomotor deficits from agitation to immobility, unpredictable movement
- Catatonia —> Complete lack of motion, Stupor —> Person is mobile, rigid position you cant move, Waxy flexibility —> Can move
1) Negative affect symptom —> Blunted/flat affect, showing a person with schizophrenia gross image will not change his facial expression
- It will change this heart rate, inappropriate affect is also present where one could be smiling in an inappropriate context
2) Negative motivation symptom —> Very socially withdrawn, anhedonia (no fun in typical activity), avolition (no sense of will)
Positive symptoms —> Presence of symptoms that shouldn’t be there (e.g., delusions, hallucinations), medication works on that
Negative symptoms —> Absence of something that should be there (e.g., blunted affect, alogia, avolition, anhedonia), medication ≠ work
Schizoaffective disorder —> Schizophrenia features & severe mood disorder (unipolar or bipolar), need to have positive symptoms for 2
weeks in the absence of mood episodes, long term prognosis is better than schizophrenia
Lifetime prevalence of 0.7-1%, ratio of 1.4 to 1 for men, men have worse symptoms, gender bias in diagnosis
Female sex hormones (estrogen) tend to be a protective factor, postmenapausal makes estrogen decrease & make late onset of schizophrenia
Age of onset in late adolescence to adulthood (18-30), men peak earlier & women later
Study by Bleuler —> Longitudinal study, 22% had bad outcomes, 52% intermediate outcomes (i.e., periods of psychotic & remission),
22% had improved
Schizophrenia outcomes are better in developing countries, may be due to poor countries having greater social network & dependence
Comorbidity with substance abuse, they tend to smoke 3x more, may be due to improving brain/cognitive functioning related to schizophrenia
Lifespan of schizophrenia is -20 years due to suicide, since 20% make one attempt, 5% die especially young men
- People that had an amazing life pre-schizophrenia & worse post-schizophrenia tend to be more prone to suicide
Schizophrenics tend to be more aggressive, aggression being linked to substance use
Schizophrenia risk increases with genetic similarity + Higher rates of schizotypal personality disorder in families with schizophrenia
Twin studies concordance rate for monozygotic twins = 28% & 6% for dizygotic twins
Environment plays a big role in schizophrenia, monozygotic twins studies shower higher rates due to similar environment
Schizophrenia concordance rates for monozygotic twins that are monochorionic are higher than monozygotic twins dichorionic
Finland epidemic study —> 1957 Finland has influenza outbreak, where pregnant woman that had developed antibodies = + schizophrenia
Season of birth —> 5-10% increase risk of schizophrenia in people born late winter/early spring, due to most infections start fall/early wint
Birth complications —> Hypoxia/anoxia is the lack of oxygen during delivery can result into brain changes = schizophrenia
Advanced paternal age —> Later paternal age = +schizophrenia , due to later age = schizotypal personality disorder
Social class —> Schizophrenics tend to have lower socioeconomic status, social causation —> low SES = mental disorder
- Social drift —> Having mental disorder = lower socioeconomic status
Frontal brain deficiency hypothesis —> Poor performance on neuropsychological test that rely on frontal lobe (i.e., attention, memory)
Wisconsin card sorting task —> People with schizophrenia tend to make more error in this task
Smooth control —> Ability to track something smoothly with eyes
Study by Callahan —> Smooth control is lacking in schizophrenic patients, seems to be stable over time, also present in first degree relative
Loss of brain volume —> 3% reduction in brain volume, progressive loss of grey matter, deterioration continues post diagnosis
Grey matter deficits —> Brain loss in discordant monozygotic twins of schizophrenia
The dopamine hypothesis —> Antipsychotics block the D2 dopamine receptors, stimulants boost dopamine activity which can results into
toxic psychosis
- Parkinson is caused by low dopamine, which is treated with L-DOPA in which this drug causes increases in psychotic symptoms
- PET scans show too much dopamine released into synapses, some evidence in D2 & D3 receptors
Revised dopamine hypothesis —> Too much dopamine in striatum (positive symptoms) , too little in frontal lobes (negative symptoms)
Aberrant salience —> Increased dopamine activity causes to attend to more irrelevant stimuli
Cannabis use —> People with schizophrenia x2 usage of cannabis, predicts onset of schizophrenia, THC = + dopamine
Schizophrenic mother —> Mother with schizophrenia = Child with schizophrenia
Expressed emotion —> Caregivers attitudes towards child with mental disorder, comprised with criticism, hostility, emotional overinvolvement
- People who come from high expressed emotion family = Relapse of schizophrenia positive symptoms, maybe due to + stress
Expressed emotion study —> Negative mood difference is not present between low & high EE, odd & eccentric ways of thinking high in
high EE, maybe due because of patient saying something strange & family criticize, this makes + stress, negative reinforcement
Equifinality —> People with schizophrenia can get this same disorder in many different ways
Antipsychotics —> Dopamine antagonists, useful for positive symptoms only
- First generation —> Chlorpromazine, haloperidol, some develop extrapyramidal effect (e.g., stooped posture) & prolonged used may
develop Tardive Dyskinesia —> Eye twitch, tongue thrust
- Second generation —> Risperidone, quetiapine, less extrapyramidal effects + have mood stabilizing property helpful for bipolar
Psychosocial interventions —> Family with high EE, social & living skill training
Cogntive-behavioral therapy —> Helpful for positive symptoms, not negative symptoms

Psychotherapy:
Psychotherapy —> Professional uses techniques derived from psychological principles to relive psychological distress
- Can be from psychodynamic, cogntive-behavioral therapy, humanistic/existential, integrative/electic —> Mix of school of thoughts
Psychotherapist —> Non restrictive tittle that anyone can have unlike psychologist
Evidence based treatment & efficacy —> Evidence of treatment effect in controlled study, with internal validity (i.e., works for A & B)
Randomized controlled trials (RCT’s) —> Assign someone in active condition or placebo condition
- Wait-list control —> Placed on a fake waitlist, where they won’t receive active treatment
- Patient are usually uncomplicated cases, the trials are very controlled & manualized, where anyone can follow the structure from A to Z
Effectiveness —> Evidence that treatment has external validity
Evidence based practice —> Integration of the best available research & clinical expertise within the context of patient characteristics,
culture, values & treatment preferences (APA & CPA require training in these programs)
Hans Eysenck —> Published an article that psychotherapy did not work, which lead to a lot of research in psychotherapy
First wave of CBT —> Classic behavior therapies, classical & operant conditioning, systematic desensitization, focus on behavior not thougt
- Second wave —> Incorporation of cognitions, rise of cogntive-behavioral therapy
- Third wave —> New ideas & approaches such as acceptance & commitment therapy (ACT), dialectical behavior therapy (DBT)
Behavioral therapy —> Making person confront anxiety stimuli which will peak anxiety & habituate, but it negatively reinforces
In vivo exposure —> Systematic desensitization with exposure of fear situations/stimuli to extinct fear response, can also be imaginable exp
Interoceptive exposure —> When feared stimulus is not external but internal, thus systematic exposure to bodily symptoms
Exposure & response prevention (ERP) —> Exposure to stimuli with blockage of compulsion, can be applied to other disorder like SAD
Cognitive triangle —> Thoughts, emotions & behaviors are all interconnected with each other all influencing each others
Cognitive distortions —> Internal mental filters/biases that increases misery or anxiety & make us feel bad about oneself
Cognitive restructuring —> Socratic questioning (open ended questions on their way of thinking), challenge/restructure dysfunctional
cognitions, identifying underlying schemas (A20 rule, a person extreme reaction is 80% schemas & 20% actual experience)
Cogntive-behavioral therapy thought record —> Patient writing a thought record of where were you, emotions, negative automatic thought
Depression disorder treated with behavioral activation
Anxiety disorder treated with exposure, panic disorder treated with Interoceptive exposure, obsessive compulsive disorder with ERP
Acceptance & commitment therapy (ACT) —> From Steven Hayes, fosters acceptance of unwanted thoughts, discourage experiental
avoidance, stimulate action that improves circumstances of living
- Gives rise to 6 things that cause psychological inflexibility, people engage in cognitive distortion where their thoughts fuse with self
Dialectical behavioral therapy —> From Marsha Linehan, originally for borderline personality disorder & suicidal behavior
- Targets core problem of emotion regulation there is a comprehensive treatment structure
- Core treatment strategies; behavioral change, validation & dialectical (i.e., therapist ‘going’ inside you to experience you thoughts)
1) Behavioral strategies —> Change orientation (need to feel & do different), use of DBT diary card (record skills used)
2) Validation strategies —> Acceptance oriented, empathy & communication
3) Dialectical strategies —> Balancing of opposites, of contradictory truths at the same time, accept the client & encourage change
Mindfulness, distress tolerance, interpersonal effectiveness, emotion regulation are DBT skills that people lack
Dodo bird verdict study by Wampold —> Meta-analysis of efficacy of psychotherapy, effect size of psychotherapy vs. no treatment 0.82
- Differences between psychotherapies effect size was 0-0.21, this shows that all psychotherapies work on common factors
Positive expectancies distress —> A common factor, is person expect change = positive expectancies
Development of alliance —> A common factor, relationship between therapist & client
Contextual model —> 3 pathways that psychotherapy can take to inside positive outcomes
1) The real relationship —> Allows client to feel accepted & cared for
2) Expectations —> Hopeful for change, belief that treatment will help
3) Specific factors —> Specified therapeutic goals, elicits healthy actions
Therapeutic alliance —> Collaborative relationship between therapist & client with agreement on goals & therapy, better alliance = better res
Alliance rupture —> Breakdown of relationships between therapist & patient, can result into withdrawal (bye therapist) or confrontation (arg)
Alliance rupture-repair hypothesis —> Presence of rupture is positively related with treatment
Psychopharmacologal treatment arises from serendipity
Serendipity —> Result of medication is a result of chance & error
- e.g., MAOI was for tuberculosis, TCA for schizophrenia, Lithium for excess uric acid, benzodiazepines for boost effect of penicillin
Anxiolytics —> Symptoms of anxiety & muscle tension, impede progress of psychotherapy, habit forming
Barbiturates —> Early class of anxiolytics, very sedating,used recreationally, tolerance built quick
Benzodiazepines —> Low dose for anxiety, high dose fro sedation, good for short term, habit long term (withdrawal difficult)
Antidepressants —> Imipramine is the first one, MAOI, TCA, SSRI, SNRI, stopping medication = relapse
SSRI —> Most used antidepressant (Prozac, Zoloft, Paxil, Luvox), has benefits in other disorders, less side effects, no fatal overdose
Study by Kirsch —> Meta analysis conclusion that all variation of drug effect size is due to placebo characteristics
Short term outcomes = Medication, Long term outcomes = Psychotherapy