Summary PCHP Chapter 7 + 9 + 16

Summary PCHP Chapter 7 + 9 + 16


Schizophrenia Spectrum

1.0  Schizophrenia Spectrum (Split mind). 2

2.0  Symptoms. 2

·       2.1 Positive Symptoms. 2

·       2.2 Negative Symptoms. 3

3.0  Cognitive Deficits. 4

4.0  Diagnosis. 4

5.0  Prognosis. 4

6.0  Other Psychotic Disorders. 5

7.0  Biological Theories: 5

·       7.1 Genetics: 5

·       7.2 Structural and Functional Brain Abnormalities: 5

·       7.3 Neurotransmitters: 5

8.0        Psychosocial Theories. 6

·       8.1 Social drift and urban birth: 6

·       8.2 Stress and Relapse: 6

·       8.3  Family: 6

·       8.4  Cognitive Perspective. 6

·       8.5 Cross-Cultural Perspective. 6

9.0         Treatment. 6

·       9.1 Biological Treatment. 6

·       9.2 Psychological and Social Treatment. 7














1.0  Schizophrenia Spectrum (Split mind)
                - 5 Domains of symptoms (4 positive , 1 negative)
                - Cognitive deficits (not criteria for diagnosis)
                - Anhedonia (but feel same amount of emotion and more physical arousal)
                - Recovery rate (40% employed, 37% functioning well)
                - Negative symptoms are the bigger problem (marker for low socioeconomic status)



 Psychosis: Being unable to differentiate between reality and illusion


2.0  Symptoms

  • 2.1    Positive Symptoms: Overt expression
    -  Delusions
    - Hallucinations
    - Disorganized thought + speech + behaviour

     - Delusions: Person believes things that are highly unlikely or untrue, that are not amenable to change
                                         ! Not self-deceptions !
                                         à because, not possible, actively behave in concordance with the belief, resist neg. evidence

                                 persecutory delusions:  being watched, tormented, spied after
                                 delusion of reference: random events are meant to tell them something, related to them
                                 grandiose delusion: believe that one is special or perceives superpower
                                 delusion of thought insertion: belief that thoughts are controlled from outside
                                 à can occur together in a story
                                 à difference in content from cultural difference, maybe not abnormal if culture holds this belief



- Hallucinations: Unreal perceptual experiences, sometimes entwined with delusions

                             auditory: hearing voices, music à often negative qualities
                             visual: seeing things à often entwined with auditory

                                             tactile: something is happening outside, but to the body
                                             somatic: something is happening inside the body
                             à can be culture specific

 - Disorganized speech:

                             formal thought disorder: - Switch topics wildly without coherent transition (loose association,
                                                                                - Can also be totally unrelated words or new words (neologisms)
                                                                                - Associations made not by meaning but by sound (clangs)
                             à women suffer less, cause speech in their brain works bilateral

- Disorganized behaviour / catatonic: Unpredictable untriggered agitation, shouting, swearing
                                                                             - Sometimes occur with delusions, hallucinations
                                                                             - Cant organize daily routines (dressing, eating, bathing)
                                                                             - Socially unacceptable behaviour

                             Catatonia: Behavior that is unresponsive to the environment
                                                   - Lack of response to instructions (negativism)
                                                   - Rigid, bizarre postures, total lack of response (mutism)
                                                   - Purposeless excessive motor activity (catatonic excitement)



  • 2.2    Negative Symptoms: Loss of qualities of the person
    - persistent
    - difficult to treat

     - Restricted affect: - Reduction or absence of emotional epression
                                           - No eyecontact, gestures, or emotional content
                                           - Voice is monoton, emphasis, intonation, rhythm, tempo

     - Avolition/Asociality: - Inability to initiate/persist on set goals (work, school, home)
                                                   - Slowed movement, unmotivated
                                                   - Lack desire to interact with other people

3.0  Cognitive Deficits

- Deficit in attention, memory, processing speed
- Cannot manipulated or hold memory good
- Unable to filter relevant or irrelevant information (or find source of information)
à Affects social functioning severely
à Eventually cause of delusions or hallucinations when they try to make sense of the information
à Can lead to further symptoms and perpetuate or make it worse

- Relatives show cognitive impairment as well
- Early marker is congnitive impairment during childhood


4.0  Diagnosis

- Disorder since 19 century ( earlier called dementia praecox)
- Links between aspects of the mind are not there
- Symptoms can be similar to autism spectrum (therefore psychosis symptoms must be present)

- 2+ symptoms of psychosis (delusion, hallucination, disorganized speech) acute minimum 1 month
à acute phase
- additionally other symptoms that impair functioning for minimum 6 months

prodromal symptoms: before acute phase
residual symptoms: after acute phase
à indicate start or diminishing of the active phase (symptoms are less worse)

5.0  Prognosis

- Mostly years of impairment
- 10 years less life-expectancy
- Suffer more from infections and other diseases
- 10-15% suicide rate
- Functioning improves with age (cause reduction in dopamine levels?)
- Women: - better prognosis
                    - better recovery rate, less hospitalization, social adjustment
                    - Less cognitive deficits, less brain abnormality
                    - Better prenatal development (less likelihood for disorder)
                     à Estrogen affects dopamine regulation in positive way
- Sociocultural factors: - Developing countries better recovery rate à collectivist culture, lower discrimi.


6.0  Other Psychotic Disorders


  • Schizoaffective disorder: Mix with Mood-Disorder (manic episode, MDD)
                                                       - Requires at least 2 weeks of psychotic symptoms
  • Schizophreniform disorder: Criteria A,D,E and symptoms last from 1-6 months, not more
                                                            - Quick onset of symptoms
                                                            - 66% will develop Schizophrenia
  • Brief psychotic disorder: Sudden onset of psychotic features, disorganized behaviour
                                                      - Episode lasts between 1 day and 1 month
                                                      - Usually excellent recovery
  • Delusional disorder: Delusions that last min 1 month, no other psychotic symptoms, lack in functioning !!
                                             - Females are more at risk
  • Schizotypal personality disorder: Lifelong pattern of oddities and bad self-concept, thinking, behaviour, relation
                                                                       - No sense of independent self and trouble setting realistic goals.
                                                                       - Restricted emotional expression or odd
                                                                       - can´t understand others and have few relationships
                                                                       - Perceive others as deceitful, hostile à socially anxious, isolated
                                                                       - Can´t hold up attention, bad memory, learning
                                                                       à have same genetic traits and neurological abnormalities


7.0  Biological Theories:


  • 7.1    Genetics:
    - polygenetic disease
    - genetic transmission
    - 50% genes shared = 10% chance of schizophrenia, 25% = 3%, normal population risk 1-2%
    - Twinstudies: 80% of variation in schizophrenia is determined by genetical factors 20% epigenetic/psychosocial

  • 7.2    Structural and Functional Brain Abnormalities:
    - reduction of gray matter in cortex (medial, temporal, superior, prefrontal)
    à prefrontal cortex (attention, planning, emotional expression) connects to limbic system (emotion + cognition)
         ,basal ganglia (motor movement) and other areas.
    - Affects volume and shape of hippocampus (memory formation) à abnormality also found in relatives
    - reduction of white matter (connects parts of brain) in parts of working memory
    - Enlarged ventricles (fluid filled spaces in brain)

    - Abnormalities can be tied to birth complications (perinatal hypoxia) à epigenetic factor
    - Influenza /herpes epidemics /famine, (especially 2nd trimester of pregnancy) à brain development stage


  • 7.3    Neurotransmitters:
    - Dopamine dysfunction in different areas (excess/lack)
    - 1. Theory: Dopamine alone, supported by evidence of dopamine regulating drugs
    - 2. Theory: Negative symptoms not controlled by dopamine à something else must be in play
    à more complicated theory proposes that mesolimbic system (subcortic, salience and reward) has excess activity
         of dopamine. Low dopamine activity in prefrontal cortex à leads to negative symptoms
    - Serotonin also plays important role (regulate dopamine activity
    - GABA (gamma-aminobutyric acid
    - Glutamate neurons (Major excitatory pathway in cortex, limbic system, thalamus  (lack leads to cognitive +
      emotional symptoms)






8.0 Psychosocial Theories


  • 8.1    Social drift and urban birth:
    - Social drift: symptoms interfere with functioning à person drifts downward in socioeconomic status
    - Urban birth: 5x times more likely to develop schizophrenia à exposed to viruses and co



  • 8.3    Family:
    - First theorists blamed mothers (double bind situations = conflicting messages to child)
    à develop distorted view of themselves and others

    expressed emotion: Conflicting messages, anger and hostility + sometimes support toward ill person.
                                             à Ill person is overwhelmed by ambiguous information à can´t cope with all the stress
                                             à symptoms of schizophrenia
     - Expressed emotion is not so much of a problem in developing countries


  • 8.4    Cognitive Perspective
    - Difficulty in attention, inhibition and communication skills lead them to reserve resources (withdraw)
    - Delusions – Person tries to make sense of perceptual experiences
    - Hallucinations – Perceptual hypersensitivity
    - Negative symptoms – Expectations about social interactions à withdraw in order not to stress out more
                 à cognitive therapy helps to identify and cope with stressful events and dispute psychotic symptoms,
                      create expectations of positive outcomes (against negative symptoms)




9.0    Treatment


  • 9.1    Biological Treatment
    - Medications (insulin coma therapy, 1930, not used anymore)
    - Brain surgery (not used anymore)
    - Electroconvulsive ECT
    - 1950 Antipsychotic drugs = Neuroleptics (eg. Chlorpromazine)

                 Typical Antipsychotics:

                 - Chlorpromazine: Calm agitation, antipsychotic, others (trifluoperazine, thioridazine, phenazine)
                                                      à Block dopamine receptors. Can control positive symptoms
                 - Butyrophenone: no explanation given
                 - Thioxanthenes: no explanation given

    à 25% of people do not respons to these, if they help, people still are dysfunctional, high relapse rate 78-98%
    à side effects: grogginess, dry motugh, blurred vision, drooling, sexual dysfunction, visual problems, weight gain/lo
         ss, constipation, menstrual problems, depression, akinesia: slowed motor movement, speech, expressionless face,
         Parkinson similar symptoms, akathesis: agitation leads to uncontrolled movements
         tardive dyskinesia: involuntary movement of facial features (tongue, mouth, face, jaw)

                 Atypical Antipsychotics:

                 - Clozapine: Binds to D4 dopamine receptor, reduces negative + positive symptoms
                 - Risperidone: na
                 - Olanazapine: na
                 - Ziprasidone: na

    à side effects: dizziness, nausea, sedation, seizues, hypersalivation, weight gain, tachycardia,
                                agranulocytosis: deficiency of granulocytes à higher infection rate
                                   concentration problems

  • 9.2    Psychological and Social Treatment
                 - Increase social skills à reduce isolation, apathy, stress, risk of relapse

                 9.2.1      Behavioral, Cognitive, Social Treatments
                                 - Cognitive Treatment:
    Recognize and change beliefs
                                 - Behavioral Treatment: Operant conditioning, modelling of right and socially desired behaviour
                                                                  à Token economies
                                 - Social interventions: Self-help support groups, roleplaying, discussion, relief

                 9.2.2      Family Therapy

                                 - Teach family about causes, symptoms, medications of schizophrenia – basic education
                                 - Teach them communication + problem solving skills + behavioural techniques to teach the ill person
                                 à highly decrease relapse rate combined with drugs
                                 !!!! Cultural background needs to be considered !!!!

                 9.2.3      Assertive Community Treatment programs
    Community mental health movement
                                 à Tries to deinstitutionalize care, reintegrate ill in society/family à fail cause no funding
                                 - Provide allround service, 24/7
                                 - Homebased treatment helps reduce relapse or need for institutional care.

                 9.2.4      Traditional Healers:

                                 - Spiritual rituals, herbes.
                                 - Explanations of affectiveness:
                                                 1. Structural model: Interrelated levels of experience, cognition, body, emotion
                                                                                         à Symptoms when these are disbalanced
                                                 2. Social support model: Conflicting social situations are reason
                                                                                                    à Tries to motivate social circle to carry
                                                 3. Persuasive model: Rituals can change the meaning of the illness for person
                                                 4. Clinical model: Placebo effect, faith in the healers ways


    Eating Disorders


    9.1 Anorexia Nervosa. 1

    9.2 Bulimia Nervosa. 1

    9.3 Binge-Eating Disorder. 1

    9.4 Other Specified Feeding or Eating Disorders. 1

    9.5 Obesity. 2

    9.6 Theorie of Eating Disorders. 2

    9.6.1 Biological factors. 2

    9.6.2 Sociocultural and Psychological Factors. 2

    9.7 Treatment for Eating Disorders. 2

    9.7.1 Psychotherapy. 2

    9.7.2 Biological Therapy. 3



    9.1 Anorexia Nervosa


  • Selfstarvation
  • Cognitions: Need lose more weight, Distorted bodyimage, fear of gaining weight
  • Chronically fatigued
  • Begins in adolescence, duration 7 years female, 3 years male
  • Comorbid (anxiety, depression, suicidal, impulsive) à more for binge/purge type than restricting
  • Consequences: Cardiovascular problems, bradycardia (slowing of heartrate), arrhythmia (irregular heart beat)
  • Heart failure, expansion of stomach, Bone weakness (due to lack of estrogen), immune. Sys. Probs)

  • Hypothalamus, Serotonie, Dopamine, + hormones mulfunctioning

    Restricting type: no purging behaviours or binge eating, weightloss only due to exercise/fasting

    Binge/purge type: involved in binge eating and purging (Defining feature to bulimia nervosa: below healthy weight


    Amenorrhea: Menstrual periods stop


    9.2 Bulimia Nervosa


  • Uncontrolled eating bingeing  followed by purging (to prevent weight gain)
  • Still kind of normal bodyweight or even too much
  • 114+ episodes per week
  • Amounts of food larger than circumstances require
  • Selfevaluation heavily influenced on body image
  • Begins in adolescence, is chronic à 15 years
  • Consequences: Electrolyte imbalance from fluid loss (from purging) à heart failures
  • Serotonin related





    9.3 Binge-Eating Disorder


  • Does not engage in purging behaviour very often to compensate
  • Significantly overweight
  • Cognitions: Disgusted by themselves, ashamed
  • Comorbid: Depression, anxiety, substance abuse, personality disorders
  • Duration from 814 years
  • 2 subtypes: dieting subtype (maintain strict diet besides bingeing)
  • Depressive subtype (eat to quell emotions, are depressed, low self-esteem)


    9.4 Other Specified Feeding or Eating Disorders


                    Partial Syndrome: Does not meet full criteria for anorexia or bulimia nervosa (e.g. fewer binges)

                                                         Highly concerned and judgemental about their weight

                                                         Show psychological problems at age 20 (90%)


                    Atypical anorexia nervosa: Meets all symptoms but bodyweight is normal or above


                    Bulimia nervosa of low frequency/or limited duration: less than once a week and/or less than 3 months


                    Night eating disorder: Cravings after dinner in the night, lack of control of eating, begins in adolescence + chronic

                                                                    Not sleep-eating, (unconscious eating during sleep)


    9.5 Obesity


  • Risk factor to development of mental disorders
  • Result of using of antipsychotic drugs (psychotropic drugs)
  • BMI over 30
  • Consequences: Coronary heart disease, hypertension, stroke, type 2 diabetes, cancer.
  • Caused by environment (toxic food, fast food, refined food) and lack of physical activity
  • Prevention: Eat nutrientdense food, 30 min sports per day, healthy environment, healthy mindset.

    Bariatric surgery: Used over BMI 40. Bypass, food intake is limited.












    9.6 Theorie of Eating Disorders


                9.6.1 Biological factors


  • Heritability ca 50%
  • Runs in families
  • Hormone changes during puberty
  • Hypothalamus (regulates eating, receives messages about food consumption and controls further intake)
  • Neurotransmitter malfunction (serotonin, dopamine, norepinephrine
  • Hormones (cortisol, insulin)

    9.6.2 Sociocultural and Psychological Factors


  • Media Pressure, peer pressure (worse than media pressure)
  • Some sports that are weightdependent or aesthetic

    Cognitive factors: Low-selfesteem, perfectionism, concerned with opinion of others, dichotomous thinking style


    Emotion Regulation Difficulties: Maladaptive way of coping with negative emotions à emotional eating to feel



    Family Dynamics: Parents are onvercontrolling, do not allow expression of negative emotions

  • low parental warmth, high demands
  •                                      Children cannot separate from their parents à food intake gives them control


    9.7 Treatment for Eating Disorders


                9.7.1 Psychotherapy



  • Difficult to engage them in therapy, cause they value their thinness
  • CBT: Confront overevalutation of thinness, rewards for weightgains, relaxation techniques
  • Family therapy: Parents take control of weight and child can get it back by eating healthy

    Bulimia + Bingeing

  • CBT: Confront cognitions about weight and shape of body, teach healthy food intake schedules (36 months)
  • Interpersonal Therapy: Adresses problems with relationships (nondirective)
  • Supportiveexpressive psychodynamic therapy: talk about problems (especially relationships)
  • Behavioural: reinforcement of food intake, monitor food intake, coping techniques to avoid bingeing

    9.7.2 Biological Therapy


  • SSRI (bulimia)
  • Antidepressants (anorexia)
  • Olanzapine (antipsychotic drug, sideeffect: Restore weight)



Stress, Coping, Adjustment and Health. 1

16.1 Models of the Personality and effect on Stress and Health. 1

7.1 The Concept of Stress. 2

7.1.4 Varieties of Stress. 3

7.1.1 Stress Response. 3

7.1.2 Major Life Events. 3

7.1.3 Daily Hassles. 3

7.2 Coping Strategies. 3

7.2.1 Attributional Style. 3

7.2.2 Role of Positive Emotions. 4

7.2.3 Management of Emotions. 4

7.2.4 Disclosure. 4

7.3 Type A and D Personality and Cardiovascular Disease. 4


Stress, Coping, Adjustment and Health


  • How can psychology change people´s risk behaviours?
  • Leading causes of death are not disease, but lifestylefactors (smoking, stress, sports, emotions)


Health Psychology: Study how stable behavioural and psychological factors (e.g. personality) affect health


  • Personalities that are unassertive, emotionally inhibited, aggressive, hostile are prone to disease


Stress: Subjective reaction produced by an event that feels uncontrollable or threatening (lack of resources)


16.1 Models of the Personality and effect on Stress and Health


  • Models are not mutually exclusive: They may overlap ect..
  • Personality traits of conscientiousness, positive emotionality, low hostility, low neuroticism, high competence (efficiency) = best predictors of health


                Interactional model: Personality influences relationship between stress and illness

                                                         Limitation: Coping responses are not consistently adaptive or maladapitve


                Transactional model:     Personality has 3 effects:              1. Influences exposure to certain events

                                                                                                                                2. Influences interpretation or appraisal of event


Called transactional because there is a transaction between persons influence on events and appraisal of this event.

Textfeld: Called transactional because there is a transaction between persons influence on events and appraisal of this event.
                                                                                                                                3. Influences coping. Interactional model




                Health behaviour model: Does not directly influence stress and illness, but indirectly by engaging in health-

                                                                    Promoting behaviours (e.g sports, visiting the doc)



                Predisposition model: Personality and illness are influenced by underlying causes (e.g. genes)


    Third variable (confound) influences the others (e.g. enhanced sympathetic nervous system activity might cause both.


Illness behaviour model: Focuses on the actions that people take when they think they have an illness.

  • E.g. Neuroticism personality tends to just complain instead of going to doc.

7.1 The Concept of Stress


                Stressors: Events that cause stress

  • 1. Produce feeling of being overwhelmed (intensity)

2. Outside of power of influence – uncontrollable

3. Produce opposing tendencies: wanting or not wanting an object or activity or (person)


                à defined by appraisal of person: (subjective cognitive response)

                Primary appraisal: This is a threat to my personal goals

                Secondary appraisal: I do not have the resources

7.1.4 Varieties of Stress


                Acute stress: sudden onset of demands (stress in the here and now)

                Episodic acute stress: recurrent episodes of acute stress that are expected

                Traumatic stress: High intensity acute stress, effects last for years or lifetime. Hardcore symptoms à PTSD

                Chronic stress: Stress does not end à leads to serious systematic illness (diabetes, cardiovascular, immune sys.)


            7.1.1 Stress Response


  • Pattern of emotional and physiological reactions (fight or flight + sympathetic nervous system increase)


General adaption syndrome (GAS): Caused by constant exposure to stressors

                                3 Stages:              1. Alarm stage: Fight or flight response + sympathetic NS activation (also peripheral NS)

                                                                2. Resistance stage: Stressor continues for a longer period. Body uses resources to cope                                                                                             on above average consumption

                                                                3. Exhaustion stage: Physiological resources depleted à illness

            7.1.2 Major Life Events


  • Highly stressfull events to which people have to adjust their way of life.
  • Researcher made a list of most stressful events.
  • Most stressful events score high on the 3 factors of stressors (intensity, conflict, uncontrollability)
  • Research: More stressors = higher likelihood of developing a cold



7.1.3 Daily Hassles


  • Chronic and repetitive stressors (weekendjob, studying psychology, deadlines)
  • Negative cognitions such as worry about weight, little things ect.
  • Do not evoke the GAS Syndrome

7.2 Coping Strategies


            7.2.1 Attributional Style


  • How do people explain the events happening to them?
  • 3 dimensions:            stable vs unstable

Internal vs external

Specific vs global


                CAVE technique: Analysing publications in terms of the 3 dimensions


                Dispositional optimism: Expectation that good events will happen in the future and bad events will be rare

  • Focus on expectation on explanation
  • Optimistic bias: Perceive to be at lower risk than the true risk actually is.
  • Higher likelihood for posttraumatic growth (reevaluation of life after serious event + more happiness and health after this event


Self-efficacy: Belief that one has the resources/ability to deal with the problem at hand and achieve the goals



7.2.2 Role of Positive Emotions


  • Positive emotions are beneficial to stress because:   1. Sustain coping efforts

2. provide break from stress

3. give time to restore resources and social relationship


  • Broaden and build model: Positive emotions broaden narrowed perspective and help to build social relationships and restore resources
  • Positive emotions after stress help regeneration
  • 3 positive emotion coping strategies:              1. Positive reappraisal: focus on the good things (opportunites)

2. Problem focused coping: Think and act to deal with the cause of the stressor. Or the things they can control

3. Creating positive events: Humour, watch youtube motivation

à research field of positive Psychology: focus on what influences us positively instead of negatively

            7.2.3 Management of Emotions


                Emotional inhibition: Hold anxiety and emotions inside. Psychoanalysts think this is major reason for illness

  • Inhibition causes increased physiological arousal due to effort
  • Worse interpersonal relationships, insecure, lower level of well-being
  • Brain area involved: Prefrontral cortex. Planning, executive control
  • Correlates with: low relationship satisfaction and low commitment, high conflict.

!!!! When chronic: chronic sympathetic NS arousal à increased likelihood of cardiovascular disease & other. !!!!


7.2.4 Disclosure


  • Sharing private aspects of ones life with someone. Like emotional inhibition: Takes effort to keep it inside.

à  Enclosure leads to depression, anxiety, disease, Social relationships withdraw (cause they feel rejected)

  • Works because: Relieves from tension of keeping it inside. Allows reinterpretation/understanding. Eventually also habituation (to the emotional response). Change representation of even in persons mind.


Writing paradigm: Writing is like talking. Just put it out somewhere and the stress goes away.

  • The more the better (also talking)
  • Associated with objective and subjective well-being


7.3 Type A and D Personality and Cardiovascular Disease


                Type A: Syndrome that consists of 3 traits:

  • Competitive achievement motivation: need competition
  • Time urgency: Sense of wasting time
  • Hostility: Become frustrated and aggressive when blocked from their goal (independent and most defining trait for cardiov. Dis. ) à leads to inflammation of arteries by elevating leukocytes (white blood cells)

Arteriosclerosis: Slow blocking of arteries, /through fat and cholesterol. May lead
                                 to heart attack, tear on the walls of the arteries.


                Type D: Distressed personality: 2 traits

  • Negative affectivity: tendency to experience frequent negative emotions
  • Social inhibition: not share emotions and thoughts or worry in social situations (evaluation fear)
  • Have exaggerated stress resonse (more cortisol, thus inflammation) à risk increases for disease