Chapter 14 Psychosis PDF

 Chapter 14 PSYCHOSIS 1 Schizophrenia Schizophrenia is characterized by a broad spectrum of cognitive and emotional dysfunctions that include o delusions and hallucinations o disorganized speech and behaviour o inappropriate emotions....

 Chapter 14 PSYCHOSIS 1 Schizophrenia Schizophrenia is characterized by a broad spectrum of cognitive and emotional dysfunctions that include o delusions and hallucinations o disorganized speech and behaviour o inappropriate emotions. Copyright © 2024 by Cengage Learning 2 Perspectives on the Concept of Schizophrenia Early Figures in Diagnosing Schizophrenia Emil Kraepelin (1899): differentiated two groups of psychoses: ◦ Manic-depressive illness ◦ Dementia praecox Kraepelin believed that they shared a common core: an early onset (praecox) and a deteriorating course marked by a progressive intellectual deterioration (dementia). Copyright © 2024 by Cengage Learning 3 1  Chapter 12 SUBSTANCE USE AND IMPULSE CONTROL 1 1 Causes Biological Dimensions Familial and Genetic Influences Genetic vulnerability to drug abuse, alcoholism Twin and Adoption studies OPRM1 receptor gene Alcohol use - Genes on chromosomes 1, 2, 7 & 11 o A gene on chromosome 4 - may protect people from becoming dependent The variations in alcohol dehydrogenase (ADH) and Aldehyde dehydrogenase (ALDH) may affect alcohol consumption and the risk for Alcohol related disorder. Copyright © 2024 by Cengage Learning 2 Causes Biological Dimensions Neurobiological Influences ◦ Dopaminergic system and the opioid-releasing neurons known as Mu opioid receptors (MOP-r) implicated. ◦ VTA, NAc, Ventral Pallidum, Prefrontal cortex ◦ The role of DA- Sensitization: repeated exposure to stimulant drugs leads to increased dopamine release when taking the drug. Copyright © 2024 by Cengage Learning 3 1  Chapter 12 SUBSTANCE USE AND IMPULSE CONTROL 1 Treatment Biological Treatments Agonist Substitution Chemical makeup of drug similar to addictive drug ◦ Methadone: opioid agonist; may lead to dependence ◦ More effective when combined with counselling ◦ Cross-dependent- act on the same CNS receptors, become a substitute for the original dependency ◦ Buprenorphine: less risk of dependence ◦ Nicotine substitution: gum, patch, inhaler, nasal sprays Copyright © 2024 Cengage Learning 2 Treatment Biological Treatments Antagonist Treatments Block or counteract the effects of psychoactive drugs Naltrexone: opioid-antagonist drugs ◦ Produces immediate withdrawal symptoms ◦ More effective if part of a treatment package ◦ Also given for alcohol dependence – inhibits DA release in the Nucleus Accumbens ◦ Reduces cravings Copyright © 2024 Cengage Learning 3 1  Chapter 13 PERSONALITY 1 Personality People’s typical way of thinking, feeling, and behaving ◦ Stable tendencies within individuals that influence how they respond to their environments. Gordon Allport’s (1966) –relatively enduring predispositions that influence our behavior across many situations. Copyright © 2024 by Cengage Learning 2 An Overview A personality disorder is: A persistent pattern of emotions, cognitions, behaviour, deviates markedly from the expectations of the individual's culture  enduring emotional distress for affected person and others Causes difficulties with work and relationships The DSM-5 TR lists 10 specific personality disorders Copyright © 2024 by Cengage Learning 3 1  An Overview Criteria that distinguish ‘normal’ versus ‘disordered’ personality (Livesley and colleagues) Normal Personality is having adaptive solutions to life tasks. Three life tasks (Livesley, 1998) 1. To form stable, integrated and coherent representations of self and others 2. To develop capacity for intimacy 3. To engage in pro-social and cooperative Personality disorders occur when there is a failure to manage any one of these life tasks (Flett et al., 2017) Copyright © 2017 by John Wiley and Sons. 4 Normal Personality and Personality Disorders Criteria that distinguish ‘normal’ versus ‘disordered’ personality- Millon’s (1986) Perspective : Key criteria: ◦ Rigid and inflexible– the person has difficulty altering his/her behaviour according to changes in the situation ◦ Structural instability -- refers to a fragility to the self that ‘cracks’ under stress (Flett et al., 2017) Copyright © 2017 by John Wiley and Sons. 5 An Overview Category of personality disorders is controversial. Categorical and Dimensional Models Problems of kind vs. problems of degree Low Stability of personality disorders diagnoses - a major criticism of categorical approach ◦ (Cluster B disorders – highest stability over time) Copyright © 2024 by Cengage Learning 6 2  An Overview DSM- 5 Eliminated Axis II (DSM-IV-TR) Maintained same categories as DSM-IV-TR Considered dimensional approach, which is described as an ‘alternative model’ (AMPD) in DSM-5 Section III ◦ Dimensional perspective: disordered personality reflects extreme levels of tendencies (traits) that exist on a continuum. ◦ Not fully adopted in DSM-5, remains a proposal Copyright © 2024 by Cengage Learning 7 An Overview Assessing Personality Disorders 1. Clinical Interviews – the preferred method ◦ Family members- informants 2. The Minnesota Multiphasic Personality Inventory (MMPI-2) is a psychological test that assesses personality traits and psychopathology; 567 true-false questions MMPI- 2 RF (Restructured form) 338 (Flett et al., 2017) MMPI -3 (2020) 335 items Copyright © 2017 by John Wiley and Sons 8 An Overview Assessing Personality Disorders 3. Millon Clinical Multiaxial Inventory-IV: the most widely used measure of personality disorder symptoms ◦ 195 true-false statements (Flett et al., 2017) Copyright © 2017 by John Wiley and Sons 9 3  An Overview Five-factor model of personality to be used as a meaningful way of measuring personality traits ◦ Extraversion (talkative, assertive, & active vs. silent, passive, & and reserved); ◦ Agreeableness (kind, trusting, and warm versus hostile, selfish, and mistrustful); ◦ Conscientiousness (organized, thorough, and reliable versus careless, negligent, and unreliable); Copyright © 2024 by Cengage Learning 10 An Overview Five-factor model (contd.) ◦ Neuroticism (nervous, moody, and temperamental versus even-tempered); and ◦ Openness to experience (imaginative, curious, and creative versus shallow and imperceptive) Copyright © 2024 by Cengage Learning 11 An Overview Personality Disorder Clusters DSM-5 TR divides personality disorders into three clusters. Cluster A – Odd/Eccentric ◦ Paranoid, Schizoid, and Schizotypal Cluster B – Dramatic/Erratic ◦ Anti-social, Borderline, Histrionic, and Narcissistic Cluster C – Anxious/Fearful ◦ Avoidant, Dependent, and Obsessive-Compulsive Copyright © 2024 by Cengage Learning 12 4  Copyright © 2024 by Cengage Learning 13 An Overview Statistics  Worldwide prevalence 7.8% (2020) ◦ More in high-income countries  Men tend to be diagnosed more PDs more often as compared to women overall, sp. APD  BPD, HPD more common in women Copyright © 2024 by Cengage Learning 14 An Overview Statistics Gender Differences  Criterion gender bias -the likelihood that men and women may exhibit the disorder differently because PD criteria include gender-related symptomatology  Assessment gender bias ◦ Histrionic personality disorder biased against females & APD biased against males Copyright © 2024 by Cengage Learning 15 5  An Overview Statistics Comorbidity It is difficult to diagnose a single, specific personality disorder people exhibit a wide range of traits several possible diagnoses Copyright © 2024 by Cengage Learning 16 Cluster A Disorders Paranoid Personality Disorder - Suspicious, mistrustful of others without justification Clinical Description Argumentative, may complain or stay quiet, hostile toward others, suicidal Tend to blame others Can be extremely jealous Ideas of reference- mistaken beliefs that meaningless events relate just to them Copyright © 2024 by Cengage Learning 17 Cluster A Disorders Paranoid Personality Disorder Bears relationship to: ◦ Paranoid type of schizophrenia ◦ Delusional disorder ◦ Hallucinations and full-blown delusions are not present ◦ Less impairment in social and occupational functioning than paranoid schizophrenia Comorbid with schizotypal, avoidant, and paranoid personality disorders Copyright © 2024 by Cengage Learning 18 6  Cluster A Disorders Paranoid Personality Disorder Causes Biological contribution – limited evidence Genetics Slightly more common among the relatives of people with schizophrenia Mistreatment or traumatic childhood experiences (retrospective research) – memory bias Cognitive factors – Mistaken assumptions about people and the world Copyright © 2024 by Cengage Learning 19 Cluster A Disorders Paranoid Personality Disorder Treatment Difficulty in establishing relationship with therapist (mistrustful of everyone) Cognitive therapy to change mistaken assumptions about others (cognitive restructuring) Copyright © 2024 by Cengage Learning 20 Cluster A Disorders Schizoid Personality Disorder Clinical Description Detachment from social relationships, no desire to enjoy closeness with others, cold, aloof, constricted affect Absence of the unusual thought processes that characterize the other disorders in Cluster A ◦ e.g., ideas of reference Slightly more common in men Comorbid with schizotypal, avoidant, and paranoid personality disorders Copyright © 2024 by Cengage Learning 21 7  Cluster A Disorders Schizoid Personality Disorder Causes ◦ Very little research ◦ Childhood shyness (a precursor), abuse, neglect ◦ Low density of dopamine receptors Treatment ◦ Rare to seek treatment ◦ Therapy- Emphasis on the value in social relationships ◦ Social skills training Copyright © 2024 by Cengage Learning 22 Cluster A Disorders Schizotypal Personality Disorder Clinical Description Eccentric thinking, social deficits, psychotic-like symptoms Cognitive impairment/Paranoid ideation Ideas of reference “Magical thinking” - unusual or irrational beliefs that events or thoughts can influence the world in supernatural or extraordinary ways Copyright © 2024 by Cengage Learning 23 Cluster A Disorders Schizotypal Personality Disorder Clinical Description Odd speech Eccentric behaviour and appearance Hypersensitive to criticism as children Copyright © 2024 by Cengage Learning 24 8  Cluster A Disorders Schizotypal Personality Disorder ◦ Comorbid with borderline, avoidant and paranoid personality disorders ◦ May increase the risk of developing major depressive disorder Copyright © 2024 by Cengage Learning 25 Cluster A Disorders Schizotypal Personality Disorder Causes Genetics: Family, Twin, adoption studies (Norway 2017) - prevalence of disorder in relatives of people with schizophrenia Left hemisphere damage: mild to moderate impairment on memory and learning assessments Enlarged ventricles and less temporal lobe grey matter Copyright © 2024 by Cengage Learning 26 Cluster A Disorders Schizotypal Personality Disorder Treatment Limited data Antipsychotic medication, community treatment, social skills training, CBT ◦ Reduce symptoms or may postpone the onset of later schizophrenia Copyright © 2024 by Cengage Learning 27 9  Cluster B Disorders Histrionic Personality Disorder Clinical Description  Dramatic, theatrical, self-centred, vain, seek constant reassurance, impulsive ◦ View situations in global, black-and-white terms ◦ Speech is often vague, lacking in detail Copyright © 2024 by Cengage Learning 28 Cluster B Disorders Histrionic Personality Disorder  Higher in women: may be overdiagnosed ◦ Western “stereotypical female”; overdramatic, vain, seductive, overconcerned with physical appearance Copyright © 2024 by Cengage Learning 29 Cluster B Disorders Histrionic Personality Disorder Causes Often co-occurs with antisocial personality disorder Treatment Improving problematic interpersonal relationships Modification of interactional style Copyright © 2024 by Cengage Learning 30 10  Cluster B Disorders Narcissistic Personality Disorder Clinical Description Unreasonable sense of self- importance, grandiosity No compassion for others, envious, arrogant Frequently depressed Copyright © 2024 by Cengage Learning 31 Cluster B Disorders Narcissistic Personality Disorder Causes Failure of empathetic “mirroring” from parents Child remains fixated at self-centred, grandiose stage of development Treatment CBT, coping strategies (relaxation training, accepting criticism), empathizing, treatment for depression Copyright © 2024 by Cengage Learning 32 References Barlow, D.H., Durand, V.M., Hofmann, S.G., & Lalumière, M.L. (2021). Abnormal psychology: An integrative approach (6th Cdn. ed.). Cengage Learning. Flett, G. L., Nancy, L. K., Davidson, G. C., & Neale, J. M. (2017). Abnormal psychology. (6th Cdn. ed.). Wiley 33 11  Treatment Biological Treatments Other Biological Treatments Sedatives to minimize discomfort for people withdrawing from other drugs Sedatives dependency - gradually tapered off Desipramine: increases abstinence rates for cocaine Copyright © 2024 Cengage Learning 4 Treatment Inpatient Facilities Detoxification – Withdrawal from alcohol or other drugs For initial withdrawal period Tranquilizers are sometimes given to ease the anxiety and discomfort of withdrawal Expensive Copyright © 2024 Cengage Learning 5 Treatment Psychosocial Treatments Alcoholics Anonymous (1935) and Its Variations Independent from established medical community 12-step philosophy; see Table 12.2 Effective with motivated individuals Cocaine Anonymous, Narcotics Anonymous, Marijuana Anonymous Copyright © 2024 Cengage Learning 6 2  Treatment Psychosocial Treatments Cognitive and Behavioural Treatments Aversion Therapy Prescribed drugs make ingesting abused substances extremely unpleasant ◦ Disulfiram (Antabuse) used for alcohol disorder ◦ Problem of noncompliance ◦ For smoking aversion: silver nitrate in gum, spray Covert sensitization: imagining unpleasant scenes Copyright © 2024 Cengage Learning 7 Treatment Psychosocial Treatments Cognitive and Behavioural Treatments Contingency management The clinician and client together select the behaviours that the client needs to change decide on the reinforcers that will reward reaching certain goals. Copyright © 2024 Cengage Learning 8 Treatment Psychosocial Treatments Cognitive and Behavioural Treatments Behavioural Self-Control Training for problematic drinking Emphasizes client’s control and includes one or more of the following ◦ Stimulus control ◦ Modification of the topography of drinking ◦ Reinforcing Abstinence (Flett et al, 2017) Copyright © 2017 John Wiley & sons, Inc. 9 3  Treatment Psychosocial Treatments Cognitive and Behavioural Treatments Community reinforcement approach Teaching social skills How to identify antecedents and consequences of their substance use behaviour Assistance with employment, education, finances to reduce stress; teaching job hunting skills Replace substance use with new recreational options Copyright © 2024 Cengage Learning 10 Treatment Psychosocial Treatments Cognitive and Behavioural Treatments CBT Motivational enhancement therapy (MET)- increase motivation to change behaviour ◦ Building trust ◦ Exploring ambivalence ◦ Setting goals ◦ Developing a plan Copyright © 2024 Cengage Learning 11 Treatment Psychosocial Treatments Relapse Prevention Alan Marlatt - Relapse seen as failure of cognitive and behavioural coping skills Helping people remove any ambivalence about stopping their drug ◦ Examining their beliefs about the positive aspects of the drug Copyright © 2024 Cengage Learning 12 4  Treatment Harm Reduction (Alan Marlatt) alternative to an approach that focuses on complete abstinence e.g. AA Controlled use Controlled use of a substance instead of abstinence e.g., controlled drinking ◦ May be an alternative, is not a cure ◦ Not very effective over the long term Safe injection sites (SISs) Copyright © 2024 Cengage Learning 13 Treatment Prevention Education-based programs Harm reduction (Alan Marlatt) vs. “No drugs” messages Skills training to avoid or resist social pressures Community-based interventions ◦ Encouraging responsible beverage services ◦ Local enforcements of drinking and driving laws ◦ Cooperation of governmental, educational, and other social institutions determines success Copyright © 2024 Cengage Learning 14 Gambling Disorder Persistent and recurrent problematic gambling behaviour  significant distress or impairment Job loss, bankruptcy, arrests Similar to substance use disorders ; craving; Tolerance and withdrawal People with gambling disorder: in denial, impulsive, continually optimistic Gambler Anonymous ; CBT Internet gaming disorder (For further study) Copyright © 2024 Cengage Learning 15 5  Impulse-Control Disorders Intermittent Explosive Disorder: Aggressive impulses resulting in serious assaults, destruction of property ◦ Controversial ◦ SE, NE, and testosterone levels ◦ Dysfunction of orbitofrontal cortex in inhibiting amygdala activation Copyright © 2024 Cengage Learning 16 Impulse-Control Disorders Kleptomania: recurrent failure to resist urges to steal things; rare; stigma associated; illegal o Typically starts in adolescence o High comorbidity with mood disorders o “Antidepressant behaviour”- relieving unpleasant feelings with stealing behaviour Pyromania: having an irresistible urge to set fires o Preoccupied with fire and the associated equipment Treatment: Cognitive-behavioural – identify signals that initiate the urges – coping strategies to resist these urges Copyright © 2024 Cengage Learning 17 References Barlow, D.H., Durand, V.M., Hofmann, S.G., & Lalumière, M.L. (2021). Abnormal psychology: An integrative approach (6th Cdn. ed.). Cengage Learning. Flett, G. L., Nancy, L. K., Davidson, G. C., & Neale, J. M. (2017). Abnormal psychology. (6th Cdn. ed.). Wiley 18 6  Causes Psychological Dimensions Positive Reinforcement Psychoactive drugs provide a pleasurable experience Use increase leads to tolerance increase Sometimes drugs are combined to enhance pleasurable experience Copyright © 2024 by Cengage Learning 4 Causes Psychological Dimensions Negative Reinforcement Psychoactive drugs provide escape from physical pain, from stress, or from panic and anxiety. Self-medication theory of addiction – e.g., Drinking is done with the goal of reducing an aversive state. Copyright © 2024 by Cengage Learning 5 Causes Psychological Dimensions Opponent-process theory – an integration of positive and negative reinforcement processes an increase in positive feelings will be followed by an increase in negative feelings a short time later. an increase in negative feelings will be followed by a period of positive feelings. Copyright © 2024 by Cengage Learning 6 2  Causes Psychological Dimensions Cognitive Factors Expectancy effect: what people expect to experience when they use drugs influences their reaction Expectancies ◦ develop before people actually use drugs ◦ change as people have more experience with drugs ◦ positive expectations predict  use Copyright © 2024 by Cengage Learning 7 Causes Psychological Dimensions Cognitive Factors Cravings Alcohol myopia - a state of shortsightedness in which superficially understood, immediate aspects of experience have a disproportionate influence on behaviour and emotion Copyright © 2024 by Cengage Learning 8 Causes Psychological Dimensions Conditioning theory of tolerance (Shep Seigel) ◦ Based on notion that tolerance is a learned response ◦ Environmental cues present when addictive behaviours are developed influence behaviours because these cues come to be associated with substance use - signal the drug effect is coming Copyright © 2024 by Cengage Learning 9 3  Causes Psychological Dimensions Conditioning theory of tolerance Feed-forward mechanisms—regulatory responses made in anticipation of a drug ◦ We learn to anticipate drug effects even before they actually occur (Flett et al., 2017) Conditioned compensatory responses Copyright © 2017 by John Wiley and Sons 10 Causes Social Dimensions People are exposed to these substances through friends, media Parental monitoring Two views of substance-related disorders o Moral weakness view o Disease model of physiological dependence Copyright © 2024 by Cengage Learning 11 Causes Cultural Dimensions Cultural norms affect rates of substance use /abuse Drinking heavily on certain social occasions Social pressure for heavy and frequent use Copyright © 2024 by Cengage Learning 12 4  References Barlow, D.H., Durand, V.M., Hofmann, S.G., & Lalumière, M.L. (2024). Psychopathology: An integrative approach (7th Canadian ed.). Cengage Learning. Flett, G. L., Nancy, L. K., Davidson, G. C., & Neale, J. M. (2017). Abnormal psychology. (6th Canadian ed.). Wiley Liliendfeld, S. O., Lynn, S. J., Namy, L.L., Woolf, N. J., Cramer, K. M., & Schmaltz, R. (2020). Psychology: From inquiry to understanding (4th Canadian ed.). Pearson Canada. 13 5  Perspectives on the Concept of Schizophrenia Early Figures in Diagnosing Schizophrenia Eugen Bleuler (1908) Proposed the term—schizophrenia ◦ A term derived from the Greek words for split (skhizein) and mind (phren). ◦ Associative splitting of the basic functions of personality ◦ “Breaking of associative threads” Copyright © 2024 by Cengage Learning 4 Perspectives on the Concept of Schizophrenia Identifying Symptoms Several behaviours or symptoms not shared by all people given diagnosis of schizophrenia Clusters of symptoms identified, such as: ◦ Hallucinations: seeing or hearing things that others do not ◦ Delusions: having beliefs that are unrealistic, bizarre, and not shared by others in the same culture Copyright © 2024 by Cengage Learning 5 Clinical Description Psychosis characterizes many unusual behaviours: ◦ Delusions and hallucinations Schizophrenia involves psychosis ◦ There is loss of contact with reality ◦ Affects all the functions we rely on each day Copyright © 2024 by Cengage Learning 6 2  Clinical Description Schizophrenia spectrum disorder: a group of diagnoses recognized by those in the field of schizophrenia. o Positive symptoms o Negative symptoms o Disorganized symptoms Copyright © 2024 by Cengage Learning 7 Clinical Description Positive Symptoms Symptoms around distorted reality; an excess or distortion of normal behaviour e.g., delusions, hallucinations 50%–70% people with schizophrenia experience hallucinations, delusions, or both Copyright © 2024 by Cengage Learning 8 Clinical Description Positive Symptoms Delusions ◦ Delusion of grandeur: a mistaken belief that the person is famous or powerful ◦ Delusions of persecution: others are out to get them ◦ Cotard’s syndrome: the person believes parts of their body are missing, or that they are dying, dead, or don't exist. ◦ Capgras syndrome: the person believes someone he or she knows has been replaced by a double Copyright © 2024 by Cengage Learning 9 3  Clinical Description Positive Symptoms Hallucinations Auditory hallucinations: hearing things that aren’t there ◦ Associated with listening to own thoughts ◦ Abnormal activation of primary auditory cortex ◦ Increased metabolic activity in left auditory cortex Copyright © 2024 by Cengage Learning 10 Clinical Description Positive Symptoms Hallucinations Some people with schizophrenia report hearing their own thoughts spoken by another voice. Some people claim that they hear voices arguing. Some people hear voices commenting on their behaviour. (Flett et al., 2017) Copyright © 2017 BY JOHN WILEY AND SONS 11 Clinical Description Negative Symptoms Absence or insufficiency of normal behaviour in areas such as speech, affect, and motivation Seen in approximately 25% with schizophrenia ◦ Avolition: inability to initiate/persist in activities ◦ Alogia: absence of speech; brief replies ◦ Anhedonia: lack of pleasure experienced ◦ Asociality: lack of interest in social interactions ◦ Affective flattening: no open reaction to emotional situations Copyright © 2024 by Cengage Learning 12 4  Chapter 12 SUBSTANCE USE AND IMPULSE CONTROL 1 1 Psychoactive Drugs Psychoactive substances - alter mood, behaviour, or both; include: Levels of involvement: Substance use - moderate amounts - does not significantly interfere with everyday life functioning. Substance intoxication: Our physiological reaction to ingested substances—drunkenness or getting high - Substance use disorder – addiction Copyright © 2024 by Cengage Learning 2 Levels of Involvement Substance Use Disorder Physiological dependence: ◦ Tolerance: greater amounts of drug needed to experience same effect ◦ Withdrawal: negative physical response when the substance is no longer ingested Psychological dependence: behavioural reactions to substance dependence Polysubstance use - using multiple substances. Copyright © 2024 by Cengage Learning 3 1  Substance Use Disorder Diminished Control 1. Uses more substance, or for longer, than intended. 2. Tries unsuccessfully to regulate use of substance. At least 2 3. Spends much time acquiring, using, or recovering from effects of substance. symptoms in the 4. Craves the substance. 12-month period Diminished Social Functioning 5. Use disrupts commitments at work, school, or home. Mild: Two or 6. Continues use despite social problems. three symptoms 7. Causes reduced social, recreational, and work activities. Moderate: Four Hazardous Use or five symptoms 8. Continues use despite hazards. 9. Continues use despite worsening physical or psychological Severe: Six or problems. more symptoms Drug Action 10. Experiences tolerance (needing more substance for the desired effect). 11. Experiences withdrawal when attempting to end use. Copyright © 2024 by Cengage Learning 4 Categories of Psychoactive Drugs Five general categories of substances: ◦ Depressants ◦ Opioids ◦ Stimulants ◦ Hallucinogens ◦ Other drugs Copyright © 2024 by Cengage Learning 5 Depressants Alcohol-Related Disorders Alcohol use marked by tolerance, withdrawal, and a drive to continue problematic use ◦ People who are physically dependent on alcohol tend to have more severe symptoms of the disorder ◦ Reverse Tolerance Often part of polysubstance/polydrug use ◦ Effects of drugs can be synergistic ◦ Potentially fatal overdoses (Flett et al., 2017) Copyright © 2017 by John Wiley and Sons 6 2  Depressants Alcohol-Related Disorders Clinical Description Depressant, inhibitory centres in the brain are depressed, or slowed ◦ Low dose- reduces inhibition ◦ High dose- acts as a potent sedative Copyright © 2024 by Cengage Learning 7 Depressants Alcohol-Related Disorders Clinical Description Continued drinking depresses more areas of the brain ◦ Impaired motor coordination ◦ Vision and hearing affected ◦ Reduces self-awareness and self- control ◦ Slower reaction time ◦ Confused, poor judgments ◦ Memory blackouts Copyright © 2024 by Cengage Learning 8 Depressants Alcohol-Related Disorders Effects Influences several neuroreceptor systems GABA, inhibitory neurotransmitter Glutamate systems – memory blackouts DA systems- pleasurable feelings Serotonin system- alcohol cravings Releases natural analgesics Copyright © 2024 by Cengage Learning 9 3  Depressants Alcohol-Related Disorders Long term effect Chronic drinking causes severe biological damage and psychological deterioration Almost every tissue and organ is adversely affected: ◦ Malnutrition ◦ Cirrhosis of the liver ◦ Damage to the endocrine glands and pancreas ◦ Heart failure, hypertension, stroke, and capillary hemorrhages, which in turn can produce brain damage (Flett et al., 2017) Copyright © 2017 by John Wiley and Sons 10 Depressants Alcohol-Related Disorders Long term effect Two types of brain syndromes Dementia – general loss of intellectual abilities Wernicke-Korsakoff syndrome – confusion, loss of muscle coordination, and incomprehensible speech Copyright © 2024 by Cengage Learning 11 Depressants Alcohol-Related Disorders Fetal alcohol syndrome (FAS): affects child whose mother drank while she was pregnant Copyright © 2024 by Cengage Learning 12 4  Depressants Alcohol-Related Disorders Withdrawal Chronic use – hand tremors, nausea or vomiting, anxiety, hallucinations, agitation, insomnia Delirium Tremens (DTs): frightening hallucinations and body tremors Copyright © 2024 by Cengage Learning 13 Depressants Alcohol-Related Disorders Statistics on Use and Abuse Canada – alcohol use disorder; 2022 12-month prevalence 2.2% Binge consumption frequent among college students Binge drinking- Males; 18-29 years Copyright © 2024 by Cengage Learning 14 Depressants Alcohol-Related Disorders Statistics on Use and Abuse Men drink more than women Single males most likely to be heavy drinkers Women absorb and metabolize alcohol differently Copyright © 2024 by Cengage Learning 15 5  Depressants Alcohol-Related Disorders Statistics on Use and Abuse Cultural differences exist Highest rates in Europe and Americas regions Attitudes, availability, family norms, physiological reactions Copyright © 2024 by Cengage Learning 16 Depressants Alcohol-Related Disorders Progression Early consumption can predict dependence/abuse in later years Linked with violent behaviour; may reduce the fear of punishment Copyright © 2024 by Cengage Learning 17 Depressants Sedative-, Hypnotic-, and Anxiolytic-Related Disorders Sedative (calming) Hypnotic (sleep-inducing) Anxiolytic (anxiety-reducing) Include ◦ Barbiturates: synthesized sedatives ◦ Benzodiazepines: anxiety-reducing (Valium, Xanax) ◦ Act on GABA NT system Copyright © 2024 by Cengage Learning 18 6  Depressants Sedative-, Hypnotic-, and Anxiolytic-Related Disorders Clinical Description Barbiturates - relax muscles, induce sleep ◦ Low doses produce mild feeling of well-being ◦ Large doses- effects similar to heaving drinking ◦ Overdosing is common means of suicide Benzodiazepines: calming, induce sleep ◦ Tolerance and dependence with repeated use Copyright © 2024 by Cengage Learning 19 Depressants Sedative-, Hypnotic-, and Anxiolytic-Related Disorders Clinical Description DSM-5 TR Criteria Similar to alcohol-related disorders Maladaptive behaviours, variable moods, impaired judgement, impaired social or occupational functioning, impaired motor functioning, slurred speech. Copyright © 2024 by Cengage Learning 20 Depressants Sedative-, Hypnotic-, and Anxiolytic-Related Disorders Statistics Benzodiazepine use declined by 6% between 2016– 2017 (CIHI, 2018) CTADS, 2019: 12% of Canadians reported using sedatives in the past year ◦ 9% of men and 14% of women Copyright © 2024 by Cengage Learning 21 7  Opioids Opiate: natural chemicals in opium poppy having a narcotic effect (Heroin, morphine, oxycodone) ◦ Temporarily lessen pain and anxiety; high doses overwhelming sense of euphoria ◦ Slow breathing, and cause lethargy Copyright © 2024 by Cengage Learning 22 Opioids Sleep-inducing, pain-relieving (analgesic) ◦ Canada in grip of opioid crisis: prescription and illegal ◦ 21.3 million prescriptions for opioids were dispensed in 2017 ◦ Withdrawal is unpleasant (nausea and vomiting, chills, muscle aches, diarrhea, and insomnia) continued use ◦ Intravenously taken: risks of HIV ◦ High mortality rates Copyright © 2024 by Cengage Learning 23 Stimulants Stimulant-Related Disorders Amphetamines “Uppers” leading to a “down” and crash Reduce appetite, weight Reduce fatigue Initially used to control mild depression and appetite Today used to treat children with hyperactivity Enhance the activity of NE and DA (attention, impulse control) The high produced by these drugs is less intense but generally lasts longer. Copyright © 2024 by Cengage Learning 24 8  Stimulants Stimulant-Related Disorders Amphetamines ◦ Behavioural symptoms - euphoria or affective blunting anxiety, tension, anger, stereotyped behaviours, impaired judgment, and impaired social or occupational functioning. ◦ Physiological symptoms - heart rate or blood pressure changes, perspiration or chills, nausea or vomiting, weight loss, muscular weakness, respiratory depression, chest pain, seizures, or coma Copyright © 2024 by Cengage Learning 25 Stimulants Stimulant-Related Disorders Methamphetamine ◦ The most abused form of amphetamine ◦ Intense exhilaration  followed by euphoria that can lasts for 6-12 hours ◦ Powerfully addictive ◦ Carries a high risk of overdose and dependence ◦ Tolerance builds quickly; Withdrawal - prolonged periods of sleep, irritability, depression. 26 Stimulants Stimulant-Related Disorders Methylenedioxymethamphetamine (MDMA), “ecstasy”: recreational drug Stimulate central nervous system ◦ Synthetic stimulant and mild hallucinogen ◦ Produces euphoria ◦ Lead to hallucinations and delusions Copyright © 2024 by Cengage Learning 27 9  Stimulants Stimulant-Related Disorders Cocaine Derived from leaves of the coca plant Coca-Cola contained 60 milligrams of cocaine per 240 mL until 1903 Clinical Description: increases alertness, blood pressure; causes insomnia Produces a quick rush of euphoria, indifference to pain and sense of well-being A crash of agitated depression occurs within 15 to 30 minutes after neurotransmitter levels drop. Copyright © 2024 by Cengage Learning 28 Stimulants Tobacco-Related Disorders Single most preventable cause of premature death (1 in every 5 deaths) Nicotine in tobacco is a psychoactive substance ◦ Produces dependence, tolerance, withdrawal 12% of Canadians smoke (CCHS, 2022) Inhaled nicotine enters blood in 7–19 seconds ◦ Low doses  acetylcholine and glutamate improves attention and memory ◦ Elevates dopamine levels  feelings of pleasure and reward Copyright © 2024 by Cengage Learning 29 Stimulants Tobacco-Related Disorders Nicotine and depression interrelated Genetic vulnerability and life stresses combine to lead to vulnerability to nicotine use and depression Second hand smoke Copyright © 2024 by Cengage Learning 30 10  Stimulants Tobacco-Related Disorders Many people have turned to the use of battery- powered electronic cigarettes (e-cigarettes); e- cigarette: inhale vaporized liquid of varying flavours: o motivated by restrictions on public smoking in public o presumed to be a healthier alternative (Flett et al., 2017) Copyright © 20217 By John Wiley and Sons 31 Hallucinogens Hallucinogens alter perception, mood, and various cognitive processes, often resulting in visual and auditory hallucinations. Increase in 12-month prevalence rate from 3.5% in 2018-2019 to 4% in 2021-22 (CTADS). Copyright © 2024 by Cengage Learning 32 Hallucinogens LSD (acid; d-lysergic acid diethylamide) ◦ Psilocybin (mushrooms), lysergic acid amide, dimethyltryptamine (DMT), mescaline (peyote), phencyclidine (PCP) Perceptual changes: subjective intensification of perceptions, depersonalization, and hallucinations Physical symptoms: pupillary dilation, rapid heartbeat, sweating, blurred vision (American Psychiatric Association, 2022) Copyright © 2024 by Cengage Learning 33 11  Hallucinogen LSD Two long-term effects of LSD: o Persistent psychosis. o Hallucinogen persisting perception disorder (HPPD) or Flashbacks (Liliendfeld et al., 2020) Copyright © 2020 Pearson Canada Inc. 34 Hallucinogens Cannabis - dried and crushed leaves and flowering tops of Cannabis sativa Major active chemical is delta-9- tetrahydrocannabinol (THC) Cannabis (marijuana) most routinely used drug in Canada; 12-month prevalence of Cannabis use disorder 1.4% (2022) Reverse tolerance with repeated use Copyright © 2024 by Cengage Learning 35 Hallucinogens Psychological Effects of Marijuana ◦ Feel more relaxed and sociable ◦ Can dull attention, fragment thoughts, and impair memory ◦ Extremely heavy doses can induce hallucinations Somatic Effects ◦ Specific cannabinoid receptors in brain have been located in various brain regions Therapeutic Effects ◦ Reduce nausea and appetite loss that accompanies chemotherapy (Flett et al., 2017) Copyright © 20217 By John Wiley and Sons 36 12  Other Drugs Inhalants ◦ Inhalant use disorder - Key symptoms include recurrent use and constant craving of inhalants ◦ Spray paint, paint thinner, amyl nitrate Anabolic-androgenic steroids Designer drugs Copyright © 2024 by Cengage Learning 37 References Barlow, D.H., Durand, V.M., Hofmann, S.G., & Lalumière, M.L. (2024). Psychopathology: An integrative approach (7th Canadian ed.). Cengage Learning. Flett, G. L., Nancy, L. K., Davidson, G. C., & Neale, J. M. (2017). Abnormal psychology. (6th Canadian ed.). Wiley Liliendfeld, S. O., Lynn, S. J., Namy, L.L., Woolf, N. J., Cramer, K. M., & Schmaltz, R. (2020). Psychology: From inquiry to understanding (4th Canadian ed.). Pearson Canada. 38 13  Clinical Description Disorganized Symptoms Include variety of erratic behaviours affecting speech, motor behaviour, emotional reactions; prevalence unclear ◦ Disorganized speech - communication problems (incoherence, poverty of speech, poverty of speech content etc.) Copyright © 2024 by Cengage Learning 13 Clinical Description Disorganized Symptoms ◦ Inappropriate affect and disorganized behaviour: laughing or crying at inappropriate times ◦ Catatonia: motor dysfunctions ranging from wild agitation to complete immobility ◦ Waxy flexibility Copyright © 2024 by Cengage Learning 14 Clinical Description An alternative approach to symptom subtyping Subtypes of Schizophrenia: Based on performances on a battery of neuropsychological tests - the Wisconsin Card Sorting Test (a test of executive functioning), the WAIS, and measures of motor function and verbal memory. Five subtypes: 1. normative, intact cognition 2. executive subtype - distinguished by impairment on the WCST 3. executive-motor subtype- deficits in card sorting & motor functioning 4. motor subtype - deficits only in motor functioning 5. dementia subtype - pervasive and generalized cognitive impairment. (Flett et al., 2017) Copyright © 2017 BY JOHN WILEY AND SONS 15 5  Clinical Description DSM-5 includes a dimensional assessment of symptoms on a 0– 4 scale A diagnosis of schizophrenia requires that two or more positive, negative, or disorganized symptoms be present for significant portion of during a one month At least one of these symptoms include hallucination, delusion, or disorganized speech Copyright © 2024 by Cengage Learning 16 Other Psychotic Disorders Schizophreniform disorder - includes people who experience the symptoms of schizophrenia for fewer than six months Schizoaffective disorder - includes people who have symptoms of schizophrenia and who also exhibit the characteristics of mood disorders such as depression and bipolar affective disorder. Copyright © 2024 by Cengage Learning 17 Other Psychotic Disorders Delusional disorder - includes people with a persistent belief that is contrary to reality, in the absence of the other characteristics of schizophrenia. ◦ Specify if erotomaniac, grandiose, jealous, persecutory, somatic types Copyright © 2024 by Cengage Learning 18 6  Other Psychotic Disorders Brief psychotic disorder - includes people with one or more positive symptoms such as delusions, hallucinations, or disorganized speech or behaviour over the course of less than a month. Copyright © 2024 by Cengage Learning 19 Other Psychotic Disorders Attenuated psychosis syndrome – under other specified schizophrenia spectrum and other psychotic disorders and as a condition for further study Schizotypal personality disorder Copyright © 2024 by Cengage Learning 20 Prevalence of Schizophrenia Statistics Schizophrenia affects approximately 24 million people or 1 in 300 people (0.32%) worldwide The CCDSS has reported 1.1% and 0.9% as the annual prevalence rates for BC and Canada, respectively Men and women affected at same rate Onset of schizophrenia is greatest in early adulthood and declines with age for males, whereas the reverse is true for females Copyright © 2024 by Cengage Learning 21 7  Prevalence of Schizophrenia Mortality rates are high which reflects the seriousness of the diagnosis: ◦ People with schizophrenia have a life expectancy that is 10-15 years shorter than people from the general population. ◦ Factors predicting this risk of earlier death include: illicit drug use, lower family involvement, medication, longer time to the initial remission of symptoms; Suicide Copyright © 2024 by Cengage Learning 22 Prevalence of Schizophrenia Development Age of onset: symptoms can begin early – late adolescence or early adulthood ◦ Up to 85% of people who develop schizophrenia go through a Prodromal stage: unusual behaviours before serious symptoms occur ◦ Takes 2–10 years for person at high risk to meet full criteria Relapse possible even after early treatment Copyright © 2024 by Cengage Learning 23 Prevalence of Schizophrenia Development People with schizophrenia typically have a number of acute episodes of their symptoms. Between episodes, they often have less severe but still very debilitating symptoms. Most people with schizophrenia are treated in the community; however, hospitalization is sometimes necessary. (Flett et al., 2017) Copyright © 2017 JOHN WILEY AND SONS 24 8  Prevalence of Schizophrenia Cultural Factors Universal; occurs in all races and cultures Asian countries – lowest prevalence Cultural variations to treatment ◦ Treatment outcomes are better in poorer countries Copyright © 2024 by Cengage Learning 25 Causes of Schizophrenia Genetic Influences Multiple gene variances combine to produce vulnerability Family Studies Children of parents with schizophrenia likely to have it too Predisposition may be inherited Copyright © 2024 by Cengage Learning 26 Causes of Schizophrenia Genetic Influences Twin Studies Identical twins vs. fraternal twins ◦ Environmental influences can be same or different ◦ Differential treatment in same household possible Copyright © 2024 by Cengage Learning 27 9  Causes of Schizophrenia Genetic Influences Adoption Studies Gene–environment interaction observed A good environment reduces risk of schizophrenia Copyright © 2024 by Cengage Learning 28 Causes of Schizophrenia Genetic Influences Gene–Environment Interactions Genes may act as vulnerability factors Interact with specific environmental pathogens at crucial developmental stages ◦ Leading to development of schizophrenia Copyright © 2024 by Cengage Learning 29 Causes of Schizophrenia Genetic Influences Genetic risk may arise from a large number of common genes implicated in schizophrenia ◦ Regions of chromosomes 1, 2, 3, 5, 6, 8, 10, 13, 20, 22 o Three most reliable genetic influences – sections on Chromosome 8 (Neuregulin 1 – NRG1) Chromosome 6 (dystrobrevin- binding protein 1 – DTNBP1) Chromosome 22 (Catecholamine O-methyl transferase – COMT) Copyright © 2024 by Cengage Learning 30 10  References Barlow, D.H., Durand, V.M., Hofmann, S.G., & Lalumière, M.L. (2024). Psychopathology: An integrative approach (7th Canadian ed.). Cengage Learning. Flett, G. L., Nancy, L. K., Davidson, G. C., & Neale, J. M. (2017). Abnormal psychology. (6th Canadian ed.). Wiley 31 11  Chapter 14 PSYCHOSIS 1 Causes of Schizophrenia Genetic Influences The Search for Markers Eye-tracking deficit may be a marker for schizophrenia Smooth pursuit eye movement Evidence for Multiple Genes Schizophrenia involves more than one gene; located at different sites throughout chromosomes Copyright © 2024 by Cengage Learning 2 Causes of Schizophrenia Neurobiological Influences Neurotransmitters Dopamine theory - Clues to the role of dopamine in schizophrenia: Neuroleptics (dopamine antagonists) effective in treating Neuroleptics produce negative side effects similar to Parkinson’s disease which is caused in part by  dopamine L-dopa (agonist) produces schizophrenia-like symptoms Amphetamines, which activate dopamine, can worsen some symptoms in schizophrenia Copyright © 2024 by Cengage Learning 3 1  Chapter 13 PERSONALITY 1 Cluster B Disorders Borderline Personality Disorder Clinical Description Impulsivity and instability in relationships, mood, and self-image, fear abandonment, no control over emotions, self-mutilating and suicidal behaviours Argumentative, irritable, sarcastic, quick to take offence Often engage in suicidal or self-mutilating behaviours Copyright © 2024 by Cengage Learning 2 Cluster B Disorders Borderline Personality Disorder Early conception: borderline between neurosis and schizophrenia One of the most common PD in clinical settings More common in women than in men Typically begins in early adulthood Comorbid with mood disorder, substance abuse, PTSD, eating disorders, and Cluster A PDs Copyright © 2024 by Cengage Learning 3 1  Cluster B Disorders Borderline Personality Disorder Causes Still largely unknown Runs in families; Twin studies – Genetics Poor functions of frontal lobes – impulsive behaviour o Perform poor on neurological tests of frontal lobe functioning; low glucose metabolism in the frontal lobes Increased and prolonged activation in the amygdala Early trauma and biological predisposition Copyright © 2024 by Cengage Learning 4 Cluster B Disorders Borderline Personality Disorder Causes Linehan’s diathesis stress theory Marsha Linehan - Two important factors- dysregulation and invalidation When people with a biological diathesis for having difficulty controlling their emotions are raised in family environment that is invalidating, extreme form – abuse  BPD (Flett et al., 2017) Copyright © 2017 By John Wiley and Sons 5 Cluster B Disorders Borderline Personality Disorder Treatment Few studies on the effectiveness of therapies Antipsychotic and antidepressants, lithium Treatments similar to those with PTSD Couples therapy for some Dialectical behaviour therapy (DBT) ◦ Effective in reducing suicide attempts Copyright © 2024 by Cengage Learning 6 2  Cluster B Disorders Borderline Personality Disorder Treatment DBT - Dialectical– Reality is an outcome of a constant tension between opposites ◦ Therapist’s paradoxical stance –accepting each person as they are and yet helping them change ◦ Challenge dichotomous thinking ◦ Teach assertiveness and emotion regulation (Flett et al., 2017) Copyright © 2017 By John Wiley and Sons 7 Cluster B Disorders Antisocial Personality Disorder Clinical Description Aggressive, lying, cheating, no remorse, substance abuse, unnatural death in boys with this disorder mania without delirium, moral insanity, egopathy, sociopathy, and psychopathy 50% to 80% of male offenders diagnosed with ASPD Conduct disorder in children Copyright © 2024 by Cengage Learning 8 Cluster B Disorders Antisocial Personality Disorder Genetic Influences Twin and Adoption studies Gene–environment interaction Chronic stress in family Children (Conduct Disorder) - Stressors- Academic difficulty, peer problems, low family income, neglect and harsh discipline from parents Copyright © 2024 by Cengage Learning 9 3  Cluster B Disorders Antisocial Personality Disorder Biological Influences Reduced gray matter in the paralimbic system (integrating emotional experiences with cognitive functions) Copyright © 2024 by Cengage Learning 10 Cluster B Disorders Antisocial Personality Disorder Neurobiological Influences The Underarousal Hypothesis The Yerkes-Dodson Curve- people with either low or high levels of arousal tend to experience negative affect  poor performance in most situations Underarousal of cortex Seek stimulation to boost the low levels of arousal Copyright © 2024 by Cengage Learning 11 Cluster B Disorders Antisocial Personality Disorder Neurobiological Influences Psychopaths- Excessive theta waves when they are awake Hare’s Cortical Immaturity Hypothesis of Psychopathy (1970) Cerebral cortex at a primitive stage of development Alternative explanation? Lack of concern; boredom, apathy Copyright © 2024 by Cengage Learning 12 4  Cluster B Disorders Antisocial Personality Disorder Neurobiological Influences The Fearless Hypothesis Psychopaths possess a higher threshold for experiencing fear than most other individuals Antisocial and risk-taking behaviours Copyright © 2024 by Cengage Learning 13 Cluster B Disorders Antisocial Personality Disorder Psychological and Social Dimensions Failure to abandon an unattainable goal Role of the Family: o Aversive interactions with parents - coercive family process o Parents’ inept monitoring of child’s activities o Inconsistent parental discipline at home o Childhood trauma Copyright © 2024 by Cengage Learning 14 Cluster B Disorders Antisocial Personality Disorder An Integrative Model Genetic vulnerability to antisocial behaviours and personality traits ◦ Weak inhibition systems and overactive reward system ◦ Underarousal or fearlessness ◦ Family stressors  interaction style antisocial behaviour  dropping out of school or poor occupational history Copyright © 2024 by Cengage Learning 15 5  Cluster B Disorders Antisocial Personality Disorder Treatment Parent training for diagnosed children o Recognize behaviour problems o Use praise to prosocial behaviours and problem behaviours Multifaceted approach to treatment for juvenile offenders. Prevention Preschool program combining good parenting skills and family support Copyright © 2024 by Cengage Learning 16 Cluster C Disorders Avoidant Personality Disorder Clinical Description Interpersonally anxious, fear rejection, pessimistic about their future Causes Born with difficult temperament, parental rejection, uncritical love ◦ Low self-esteem, social alienation persisting into adulthood Overactive behavioural inhibition system Copyright © 2024 by Cengage Learning 17 Cluster C Disorders Avoidant Personality Disorder Treatment Social skills training CBT: graduated exposure to feared situations Systematic desensitization: relaxing in the presence of feared situations Behavioural rehearsal Copyright © 2024 by Cengage Learning 18 6  Cluster C Disorders Dependent Personality Disorder Clinical Description Interpersonally dependent, anxious Submissive, timid, and passive Feelings of inadequacy, sensitive to criticism, need reassurance Cling to relationships Copyright © 2024 by Cengage Learning 19 Cluster C Disorders Dependent Personality Disorder Causes Disruptions in early childhood lead to fears of abandonment High in sociotropic traits Low on individualistic achievement traits Treatment Developing confidence; ensuring patient does not overdepend on therapist Copyright © 2024 by Cengage Learning 20 Cluster C Disorders Obsessive-Compulsive Personality Disorder Clinical Description Rigidity, poor interpersonal relationships, quest for perfectionism Causes and Treatment Genetics Relaxation techniques, CBT to reframe compulsive thoughts Copyright © 2024 by Cengage Learning 21 7  Personality Disorders Under Study Sadistic personality disorder: receiving pleasure by inflicting pain on others Passive-aggressive personality disorder: characterized by a pattern of indirectly expressing negative feelings instead of openly addressing them ◦ people are defiant and refuse to cooperate with requests Existence of these disorders is still controversial; hence not included in DSM-5 Copyright © 2024 by Cengage Learning 22 References Barlow, D.H., Durand, V.M., Hofmann, S.G., & Lalumière, M.L. (2024). Psychopatholog: An integrative approach (7th Canadian ed.). Cengage Learning. Flett, G. L., Nancy, L. K., Davidson, G. C., & Neale, J. M. (2017). Abnormal psychology. (6th Canadian ed.). Wiley 23 8  Causes of Schizophrenia Neurobiological Influences Neurotransmitters Excessive stimulation of striatal dopamine D2 receptors o Most effective antipsychotic drugs– block the stimulation of the D2 receptors A deficiency in the stimulation of prefrontal D1 receptors o May account for negative symptoms Copyright © 2024 by Cengage Learning 4 Causes of Schizophrenia Neurobiological Influences Neurotransmitters Glutamate o The N-mthyl-D-aspartate (NMDA) receptors o NDMA antagonist—antipsychotic behaviour Newer drugs used in treating schizophrenia implicate neurotransmitters such as serotonin in the disorder. Copyright © 2024 by Cengage Learning 5 Causes of Schizophrenia Brain Structure Reduction in cortical grey matter in both the temporal and frontal regions and reduced volume in basal ganglia Abnormally large lateral and third ventricles in people with schizophrenia Hypofrontality (less active frontal lobe)- Associated with negative symptoms Copyright © 2024 by Cengage Learning 6 2  Causes of Schizophrenia Viral infection In utero events may be associated with schizophrenia ◦ Prenatal exposure to influenza ◦ A parasite, Toxoplasma gondii Copyright © 2024 by Cengage Learning 7 Causes of Schizophrenia Psychological and Social Influences Stress  rates of schizophrenia found in central city areas inhabited by people in the  socio-economic class o Sociogenic hypothesis: tendency for people with schizophrenia to be found in lower social classes o Social selection hypothesis: people with schizophrenia may experience a downward social drift into the lower social classes Copyright © 2024 by Cengage Learning 8 Causes of Schizophrenia Psychological and Social Influences Families Schizophrenogenic: mothers with cold, dominant, rejecting nature may cause schizophrenia in their children Double bind nature of the family situation: communicating conflicting messages Copyright © 2024 by Cengage Learning 9 3  Causes of Schizophrenia Psychological and Social Influences Families and Relapse Expressed emotion (EE): disapproval, animosity, intrusiveness ◦ Predictor of relapse Copyright © 2024 by Cengage Learning 10 Treatment Biological Interventions Insulin Coma Therapy In the early 1930s, the practice of inducing a coma with large dosages of insulin  up to three quarters of the schizophrenics treated showed significant improvement. Later findings were less encouraging, and insulin-coma therapy—which presented serious risks to health, including irreversible coma and death—was gradually abandoned. Electroconvulsive therapy (ECT) ECT was also used after its development in 1938; it, too, proved to be only minimally effective. Copyright © 2024 by Cengage Learning 11 Treatment Biological Interventions Psychosurgery Frontal lobotomy Egas Moniz (mid-1930s ) Copyright © 2024 by Cengage Learning 12 4  Treatment Biological Interventions Neuroleptics - dopamine antagonists Conventional antipsychotics (First generation) Chlorpromazine ◦ When effective, neuroleptics help people think more clearly ◦ Reduce or eliminate delusions and hallucinations Effective for 60%–70% of persons who try them Copyright © 2024 by Cengage Learning 13 Treatment Biological Interventions Neuroleptics (Conventional antipsychotics) Extrapyramidal side effects: dysfunctions of the nerve tracts that descend from the brain to spinal motor neurons - resemble the symptoms of Parkinson’s disease. People taking antipsychotics often develop : tremors of the fingers, a shuffling gait, drooling Copyright © 2024 by Cengage Learning 14 Treatment Biological Interventions Neuroleptics (Conventional antipsychotics) ◦ Tardive dyskinesia - The mouth muscles involuntarily make sucking, lip-smacking, and chin-wagging motions. Copyright © 2024 by Cengage Learning 15 5  Treatment Biological Interventions Newer antipsychotics - Second-generation antipsychotics (Chlozapine) ◦ Have fewer side effects (TD) ◦ Reduce positive and negative symptoms ◦ Help in improving cognitive functioning. ◦ A major impact on serotonergic neurotransmitters and 5HT receptors Transcranial magnetic stimulation (TMS) treatment for hallucinations ◦ TMS also improves auditory hallucinations: effect is brief Copyright © 2024 by Cengage Learning 16 Treatment Psychosocial Interventions Psychoanalytic approach: not beneficial; may be harmful Behavioural family therapy: must be ongoing if patients and families are to benefit from it Token economy: for independence of daily skills Treatment compliance Social Skills Training Early intervention CBT for symptoms of delusions and depression Copyright © 2024 by Cengage Learning 17 Treatment Treatment across Cultures Treatments vary from culture to culture: herbal medicines, acupuncture, oral treatments, imprisonment, ancestor worship, etc. Prevention Identify and treat children who may be at risk for developing schizophrenia Identify instability in early family-rearing environment Treat persons in prodromal stages of disorder Copyright © 2024 by Cengage Learning 18 6  Treatment Biological Interventions Newer antipsychotics - Second-generation antipsychotics (Chlozapine) ◦ Have fewer side effects (TD) ◦ Reduce positive and negative symptoms ◦ Help in improving cognitive functioning. ◦ A major impact on serotonergic neurotransmitters and 5HT receptors Transcranial magnetic stimulation (TMS) treatment for hallucinations ◦ TMS also improves auditory hallucinations: effect is brief Copyright © 2024 by Cengage Learning 16 Treatment Psychosocial Interventions Psychoanalytic approach: not beneficial; may be harmful Behavioural family therapy: must be ongoing if patients and families are to benefit from it Token economy: for independence of daily skills Treatment compliance Social Skills Training Early intervention CBT for symptoms of delusions and depression Copyright © 2024 by Cengage Learning 17 Treatment Treatment across Cultures Treatments vary from culture to culture: herbal medicines, acupuncture, oral treatments, imprisonment, ancestor worship, etc. Prevention Identify and treat children who may be at risk for developing schizophrenia Identify instability in early family-rearing environment Treat persons in prodromal stages of disorder Copyright © 2024 by Cengage Learning 18 6