Psychopathology – Final Exam Study

Guide (SP 2025)

Instructor: Dr. Etherton

Chapter 1: Historical Context and Features of Psychological Disorders

Definition & Core Concepts

A psychological disorder is a psychological dysfunction associated with distress or impairment

that is not typical or culturally expected.

DSM-5-TR:

Used for diagnosing mental disorders; latest revision was in 2022.

Key Features of Disorders:

Distress: Emotional pain or suffering.

Impairment: Disruption in daily functioning.

Deviance: Behavior violating social norms.

Key Terminology:

Prevalence – proportion of a population with a disorder.

Incidence – rate of new cases in a time period.

Onset – Acute (sudden) vs. Insidious (gradual).

Course – Chronic, episodic, or time-limited.

Prognosis – Anticipated development of a disorder.

Psychoanalytical Theory
The principles of psychoanalytic theory, originally developed by Sigmund Freud, focus on

unconscious processes and their influence on behavior. Here are the core ideas:

Core Principles of Psychoanalytic Theory

1. Unconscious Mind

o Most mental processes occur outside of conscious awareness.

o Thoughts, memories, and desires buried in the unconscious influence behavior.

2. Psychic Determinism

o All thoughts and behaviors have meaning and are influenced by unconscious

factors (nothing is accidental).

3. Structure of Personality

o Id – Instinctual drives (pleasure principle).

o Ego – Rational mediator (reality principle).

o Superego – Internalized morals and societal rules.

4. Defense Mechanisms (used by the ego to manage anxiety)

o Examples: Repression, denial, projection, displacement, sublimation, etc.

5. Childhood Experiences

o Early life experiences, particularly with caregivers, shape adult personality and

psychopathology.

6. Stages of Psychosexual Development

o Oral → Anal → Phallic → Latency → Genital

o Fixation at a stage could result in adult dysfunctions.

7. Insight and Interpretation

o Psychological healing occurs when unconscious conflicts are brought into

conscious awareness (e.g., via therapy).

8. Therapeutic Techniques

o Free association, dream analysis, interpretation, and transference analysis.

Behaviorist Assumptions, Principles, and Treatments

Core Assumptions

• All behavior (normal and abnormal) is learned through interaction with the
environment.

• Focus is on observable behavior, not unconscious thoughts.

• Mental disorders result from maladaptive learning (e.g., fears, avoidance).

Main Principles

• Behavior is shaped by associations (classical) or consequences (operant).

• Internal thoughts and feelings are not needed to explain behavior.

Treatment Approach

Behavior Therapy: Replace maladaptive behaviors with adaptive ones.

Techniques include:

• Exposure therapy (to unlearn fear)

• Systematic desensitization
• Reinforcement-based training (e.g., token economies)

Classical Conditioning (Pavlov)

Definition: Learning through association between two stimuli.

 Term Definition Example (Dog & Bell)

UCS (Unconditioned
Automatically triggers a response Food
Stimulus)

UCR (Unconditioned
Natural, unlearned reaction Salivating to food
Response)

Previously neutral; now triggers

CS (Conditioned Stimulus) Bell
response

CR (Conditioned Response) Learned reaction to CS Salivating to bell

Real-life example:

A child bitten by a dog (UCS) feels pain (UCR). Later, the sight of any dog (CS) causes fear

(CR).

Operant Conditioning (Skinner)

Definition: Learning through consequences of actions (reinforcement or punishment).

Term Goal Example

Positive Increase behavior by adding Giving praise for studying = more

Reinforcement something pleasant studying

 Term Goal Example

Negative Increase behavior by removing Putting on seatbelt stops beeping =

Reinforcement something unpleasant more seatbelt use

Decrease behavior by adding

Positive Punishment Giving a ticket for speeding
something unpleasant

Negative Decrease behavior by removing Taking away video games for

Punishment something pleasant breaking curfew

Historical Approaches

• Supernatural Tradition: Demonic possession, witchcraft, exorcism.

• Biological Tradition: Hippocrates' humors, syphilis discovery, early surgeries.

• Psychological Tradition: Moral therapy, Freud’s psychoanalysis, and early behaviorism.

Chapter 2: Etiology and Theoretical Approaches

One-Dimensional vs. Multidimensional Models:

• One-dimensional focuses on a single cause (e.g., genetics only).

• Multidimensional integrates biological, psychological, social, and environmental factors.

Key Etiological Concepts:

• Necessary Cause – Required for disorder to occur.

• Sufficient Cause – Alone can cause disorder.

• Contributory Cause – Increases likelihood of disorder.

Gene-Environment Interaction:

• Reciprocal model: Genes influence which environments we seek.

• Epigenetics: Environment influences gene expression.

• Psychoanalytic: Unconscious conflicts, defense mechanisms.

• Behavioral: Classical/Operant Conditioning; Observational learning.

• Cognitive: Maladaptive thought patterns, attribution styles (e.g., internal, global, stable).

Main Branches of the Nervous System

1. Central Nervous System (CNS)

Includes: Brain and spinal cord

Function: Processes, interprets, and stores information; sends instructions to the

body

2. Peripheral Nervous System (PNS)

Includes: All nerves outside the CNS

Two branches:

a. Somatic Nervous System

Controls voluntary movements (e.g., moving your hand)

b. Autonomic Nervous System

Controls involuntary functions (e.g., heartbeat, digestion)

Has two divisions:

Sympathetic Nervous System ("Fight or Flight")

Activates body in response to stress (↑ heart rate, dilated pupils, sweating)

Parasympathetic Nervous System ("Rest and Digest")

Calms the body, conserves energy (↓ heart rate, ↑ digestion)

Key Brain Structures

Amygdala

• Involved in emotions, especially fear and aggression

• Overactive in anxiety and PTSD

Hippocampus

• Critical for forming new memories

• Often affected by chronic stress or trauma

What is Heritability?

• Definition: The proportion of variation in a trait explained by genetic factors in a

population.

• Expressed as a percentage (e.g., “ADHD has a heritability of 70%” → 70% of differences

in ADHD traits are due to genes).

• Important: Heritability is about populations—not individuals.

Diathesis-Stress Model

• Diathesis = vulnerability (often genetic)

• Stress = environmental trigger

Model in Action:

Someone with a genetic predisposition for depression (diathesis) might only develop it after a

major life stressor (e.g., breakup, loss).

Key Point:

The more vulnerability (diathesis) someone has, the less stress it takes to trigger a disorder.

Chapter 3: Clinical Assessment and Diagnosis

Types of Clinicians in Mental Health

Can Prescribe
Title Degree/Training What They Do
Medication?

Diagnoses mental illness,

Psychiatrist Medical school + Yes (medical
provides therapy, focuses on
(M.D. or D.O.) psychiatry residency doctor)
medication management

Diagnoses, conducts
Clinical No (except in
Doctorate in psychology + psychological testing,
Psychologist some states with
clinical internship provides therapy (CBT,
(Ph.D. or Psy.D.) extra training)
ERP, etc.), may do research

Master’s degree (M.A.,

Licensed Provides individual/group
M.S., or [Link]. in
Professional therapy for a wide range of No
Counseling) + supervised
Counselor (LPC) issues
clinical hours
 Can Prescribe
Title Degree/Training What They Do
Medication?

Offers therapy, case

Licensed Clinical Master’s in Social Work
management, connects
Social Worker (MSW) + supervised No
clients to community
(LCSW) experience
resources

Licensed
Master’s in psychology or
Marriage and Specializes in family and
counseling with focus on No
Family Therapist couples therapy
couples/families
(LMFT)

Psychiatric Nurse Advanced practice nursing

Can assess, diagnose, treat, Yes (in most
Practitioner degree (MSN or DNP) +
and prescribe meds states)
(PMHNP) psych specialization

Purpose of Clinical Assessment

Gather relevant data to understand the person, predict behavior, plan treatment, and evaluate

outcomes. Like a funnel: broad to specific.

Key Concepts:

• Reliability – Consistency of results (e.g., test-retest, inter-rater).

• Validity – Whether the test measures what it claims to (e.g., MMPI measures traits accurately).

• Standardization – Uniform procedures in test use. Example: same MMPI questions, scoring

across clients.

Assessment Methods

• Clinical Interview – Structured or semi-structured; includes mental status exam: appearance,

behavior, mood, cognition.

• Behavioral Observation – Look at ABCs: Antecedents, Behavior, Consequences. E.g., a child

throws tantrums after being denied a toy.

• Projective Tests – Ambiguous stimuli reveal unconscious content (e.g., Rorschach Inkblot

Test, TAT).

• Objective Tests – Standardized, quantitative (e.g., MMPI). Used to assess personality traits or

psychopathology.

Diagnosis and Classification

DSM-5: Diagnostic criteria based on symptoms and duration.

Benefits: Communication, research, treatment guidance.

Risks: Stigma, labeling, self-fulfilling prophecy.

Chapter 4: Research in Psychopathology

Purpose of Research

Identify causes (etiology), determine progression (course), and test treatments.

Design Types:

• Correlational – Relationship between variables (e.g., childhood trauma ↔ depression). Cannot

infer causation.

• Experimental – Manipulate one variable (IV) and measure effect on another (DV). Random

assignment critical.

• Quasi-Experimental – No true randomization. Used when ethical or practical limits exist.

• Analog Studies – Simulate real-life problems in lab settings.

• Single-Case Design – Intensive study of one individual (e.g., ABAB design for behavior

therapy).

Variables:
• IV (Independent Variable) – What the researcher manipulates (e.g., therapy type).

• DV (Dependent Variable) – What’s measured (e.g., symptom change).

• Expectancy Effect – Participant or researcher expectations influence outcomes.

Validity:

• Internal – Confidence that IV causes DV.

• External – Generalizability of findings to the real world.

Example: A study testing CBT for depression uses random assignment and double-blind

design. Results show improved mood – high internal validity.

Chapter 5: Anxiety, OCD, and PTSD

Understanding Emotions

• Anxiety – Future-focused tension (e.g., worrying about failing a test).

• Fear – Present-focused alarm (e.g., seeing a snake).

• Panic Attack – Sudden, intense fear response with physical symptoms.

Behavioral and Cognitive Views of Anxiety Disorders

Behavioral Perspective

Classical Conditioning

• Anxiety can be learned through association.

• A neutral stimulus (e.g., elevator) becomes associated with fear after a negative
experience (e.g., getting stuck).
• Over time, just seeing the elevator triggers anxiety.

Example: A person experiences a panic attack in a grocery store. Later, they feel anxious just

entering a store.

Operant Conditioning

• Avoidance of feared situations reduces anxiety, which acts as negative

reinforcement—strengthening the avoidance behavior.
 • This is why anxiety disorders persist over time.

Example: Avoiding public speaking prevents anxiety → feels like relief → more avoidance next

time = fear never improves.

Cognitive Perspective

Core Idea: Anxiety is maintained by distorted thinking patterns and biased interpretations of

events.

Common Cognitive Distortions in Anxiety:

• Catastrophic thinking: “If my heart races, I’ll die.”

• Overestimation of danger: “If I go out, I’ll have a panic attack and faint.”
• Intolerance of uncertainty: “If I don’t know what’s going to happen, I can’t handle it.”

Integrated Example: Panic Disorder

1. Classical Conditioning: Panic attack → mall = now mall triggers anxiety

2. Operant Conditioning: Avoid mall = anxiety goes down → avoidance reinforced
3. Cognitive: “What if I lose control in public?” → increases anticipatory anxiety

In Treatment (CBT):

• Exposure therapy breaks the avoidance cycle.

• Cognitive restructuring helps challenge and reframe anxious thoughts.

Biological and Psychological Vulnerabilities

• Triple Vulnerability Model – Biological (genetic), General psychological (sense of control),

Specific (learned fears).

• Behavioral Inhibition System (BIS) – Activated by threat cues, increases anxiety.

Disorders and Treatments

Generalized Anxiety Disorder (GAD):

Excessive, uncontrollable worry. Often includes sleep issues, restlessness.

Treatment: CBT, relaxation training, worry exposure, tolerating uncertainty.

Panic Disorder:
Recurrent unexpected panic attacks; worry about future attacks.

Treatment: CBT + Interoceptive Exposure (e.g., spin in a chair to mimic dizziness).

Agoraphobia:

Fear of being in places where escape is difficult. Avoids crowds, buses.

Treatment: Systematic exposure therapy.

Phobias:

Excessive fear of specific stimuli (e.g., heights, dogs).

Treatment: Exposure therapy, participant modeling.

Social Anxiety Disorder (SAD):

Fear of being judged in social situations (e.g., giving a speech).

Treatment: CBT with role-play, feedback, exposure. Example: practice job interviews.

Obsessive-Compulsive Disorder (OCD):

Obsessions (e.g., thoughts of contamination) and compulsions (e.g., handwashing).

Treatment: ERP (exposure with response prevention), SSRIs.

Post-Traumatic Stress Disorder (PTSD):

Symptoms: re-experiencing trauma, avoidance, negative mood, hyperarousal.

Treatment: Prolonged Exposure (PE), Cognitive Processing Therapy (CPT). Example: writing

about trauma repeatedly to reduce intensity.

CBT Focus Across Disorders:

• Break avoidance cycles (negative reinforcement).

• Promote fear extinction through repeated, safe exposure.

Chapter 6: Somatic and Dissociative Disorders

Somatic Symptom & Related Disorders

These involve physical symptoms that cause distress or impairment, not fully explained by

medical conditions.
1. Somatic Symptom Disorder

• One or more distressing physical symptoms (e.g., pain, fatigue) plus excessive
thoughts, feelings, or behaviors about them.
• Symptoms are real to the person—even if medically unexplained.
• Worry and time spent on symptoms are disproportionate.

Example: A woman has chronic stomach pain, visits many doctors, but no cause is found.

She continues to believe she is seriously ill and is constantly anxious about her health.

2. Illness Anxiety Disorder (formerly Hypochondriasis)

• No or very mild symptoms, but intense fear of having a serious illness.

• Person constantly checks for signs of illness or avoids doctors altogether.
• Often misinterprets normal sensations as dangerous.

Example: A man feels occasional dizziness and becomes convinced he has a brain tumor,

despite normal scans.

3. Conversion Disorder (Functional Neurological Symptom Disorder)

• One or more neurological-like symptoms (e.g., paralysis, blindness, seizures) that can’t
be explained medically.
• Symptoms often appear suddenly after stress or trauma.
• Person is not faking and often seems indifferent to serious symptoms (called la belle
indifference in some cases).

Example: A woman suddenly loses her ability to speak after witnessing a traumatic accident.

Doctors find no medical explanation.

Dissociative Disorders

These involve disruptions in memory, identity, consciousness, or perception—usually in

response to trauma.

1. Dissociative Amnesia

• Inability to recall important personal information, usually following trauma or stress.

• Not due to brain injury or drugs.
 • Localized (can’t recall a specific event) or generalized (forget entire identity/history).

Example: After a car accident, a man can't remember who he is or where he's from.

2. Dissociative Fugue (Specifier of Amnesia)

• Sudden travel or wandering combined with amnesia for identity or past.

• Person may start a new life and not realize anything is wrong.

Example: A teacher goes missing and is found weeks later working in another state, with no

memory of his former life.

3. Dissociative Identity Disorder (DID) (formerly Multiple Personality Disorder)

• Presence of two or more distinct identities or “alters”, with gaps in memory.

• Often linked to severe childhood trauma.
• Alters may have different names, traits, even handwriting or allergies.

Example: A woman under stress switches to a different personality who talks and acts like a

child, then later has no memory of the episode.

Chapter 7: Mood Disorders

Know the Symptoms

Major Depressive Episode (MDE)

• Must last at least 2 weeks and include 5 or more symptoms (one must be depressed
mood or anhedonia):
o Depressed mood most of the day
o Diminished interest/pleasure (anhedonia)
o Appetite/weight changes
o Sleep disturbance (insomnia or hypersomnia)
o Fatigue or loss of energy
o Feelings of worthlessness/guilt
o Trouble concentrating
o Psychomotor agitation or retardation
o Recurrent thoughts of death/suicide

Example: A student can’t get out of bed, has no appetite, and feels hopeless nearly every day for

3 weeks.
Manic Episode (Bipolar I)

• Elevated, expansive, or irritable mood AND increased activity/energy

• Lasts at least 1 week or requires hospitalization
• 3+ symptoms (4 if mood is irritable):
o Inflated self-esteem/grandiosity
o Decreased need for sleep
o Talkativeness (pressured speech)
o Racing thoughts
o Distractibility
o Goal-directed activity or psychomotor agitation
o Risky behaviors (e.g., spending sprees, unsafe sex)

Example: A man sleeps 2 hours a night, starts 10 business projects, and says he's destined to be

president.

Hypomanic Episode (Bipolar II)

• Similar to mania but less severe

• Lasts at least 4 consecutive days
• Does not cause marked impairment or require hospitalization

Example: A woman feels unusually energetic and confident for 5 days, talks more than usual, but

still functions at work.

Mood Disorder Diagnoses

Disorder Key Features

Major Depressive Disorder

One or more MDEs; no history of mania/hypomania
(MDD)

Persistent Depressive Disorder Chronic depression ≥2 years; symptoms may be less severe

(Dysthymia) but more enduring

At least one manic episode (MDE may or may not be

Bipolar I Disorder
present)
 Disorder Key Features

At least one hypomanic episode and one MDE; no full

Bipolar II Disorder
manic episodes

Cognitive and Behavioral Causes of Depression

Cognitive Factors

• Negative cognitive triad: negative views about self, world, and future
• Attributional Style:
o Internal (“It’s my fault”)
o Global (“Everything is bad”)
o Stable (“It will always be this way”)
→ Leads to helplessness and hopelessness

Example: After failing an exam, someone thinks, “I’m stupid, I’ll never succeed, everything I try

fails.”

Behavioral Factors

• Reduction in positively reinforcing activities (e.g., socializing, hobbies)

• Person withdraws → gets less pleasure → feels worse → continues to withdraw

Psychological Treatments for Depression

Cognitive Therapy (CT)

• Identify and challenge distorted thoughts and negative beliefs

• Replace them with realistic, adaptive thoughts

Behavioral Activation (BA)

• Increase engagement in rewarding activities

• Rebuild daily structure, routine, and purpose

Interpersonal Therapy (IPT)

• Focuses on resolving interpersonal issues (grief, role disputes, isolation)

 • Helps improve social skills and emotional support

Example: A patient feels worthless and isolated → CT challenges thoughts → BA increases

activity → IPT helps address strained family relationships.

Biological Treatments for Mood Disorders

Antidepressant Medications

• SSRIs (e.g., Prozac) – Increase serotonin levels

• SNRIs, Tricyclics, MAOIs – Affect multiple neurotransmitters
• Often take 2–4 weeks to show effect

Mood Stabilizers (for Bipolar)

• Lithium – Classic treatment, reduces manic episodes and suicide risk

• Anticonvulsants (e.g., Depakote) – Used if lithium is ineffective or not tolerated

Electroconvulsive Therapy (ECT)

• Used for severe, treatment-resistant depression or urgent suicidality

• Electric current induces brief seizure → changes brain chemistry
• Effective and fast-acting, though may cause short-term memory loss

When used: MDD with psychotic features, catatonia, or when meds fail

Chapter 8: Eating Disorders

Eating Disorders Overview

1. Anorexia Nervosa

• Core features:
o Restriction of food intake, leading to significantly low body weight
o Intense fear of gaining weight, even when underweight
o Distorted body image (e.g., seeing themselves as “fat” despite being
underweight)
• Two types:
o Restricting type – No bingeing/purging; only calorie restriction
o Binge-eating/purging type – Includes episodes of bingeing or purging
(vomiting, laxatives)
Example: A girl who eats fewer than 600 calories a day and still thinks she’s overweight, even at

a dangerously low BMI.

2. Bulimia Nervosa

Core features:

Recurrent binge eating episodes

▪ Eating an unusually large amount of food in a short period

▪ Feeling out of control while eating

Compensatory behaviors to prevent weight gain:

▪ Vomiting, laxatives, fasting, excessive exercise

o Occurs at least once a week for 3 months
o Usually within or above normal weight range

Example: A college student eats a whole pizza and gallon of ice cream, then makes herself

vomit, feeling ashamed but repeating the cycle weekly.

3. Binge Eating Disorder (BED)

Core features:

o Recurrent binge eating episodes (like bulimia)

o No compensatory behaviors
o Binges are often accompanied by guilt, distress, and loss of control
o Often leads to overweight or obesity

Example: A man eats large amounts of food late at night alone, feels ashamed, and continues the

behavior several times a week.

Compensatory Behaviors

• Behaviors meant to “undo” calories consumed during a binge

• Common in bulimia and anorexia (binge/purge subtype)
• Includes:
o Vomiting
o Laxatives
o Fasting
o Excessive exercise
Effective Treatments for Eating Disorders

Cognitive-Behavioral Therapy (CBT)

• Most effective for bulimia and BED

• Targets:
o Cognitive distortions about food, weight, and body image
o Breaks binge-purge cycle or binge-restriction cycle
o Introduces regular eating patterns and healthy coping

Interpersonal Therapy (IPT)

• Addresses interpersonal conflicts, role transitions, grief, and social isolation

• Shown effective for bulimia and BED

Medications

• SSRIs (e.g., fluoxetine/Prozac) can reduce binge/purge frequency in bulimia

• Limited effect for anorexia unless combined with other treatments

Special Note on Anorexia

• Medical stabilization may be needed before therapy due to life-threatening

malnutrition
• Weight restoration is a critical first step

Chapter 10: Paraphilias and Sexual Dysfunctions

Sexual Dysfunctions

These involve issues with the desire, arousal, or orgasm phases of the sexual response cycle,

causing distress.

Common Sexual Dysfunctions (by phase):

1. Desire Phase

• Male Hypoactive Sexual Desire Disorder: Low/no interest in sex.

• Female Sexual Interest/Arousal Disorder: Lack of interest or arousal; reduced
thoughts/fantasies, lubrication, etc.
2. Arousal Phase

• Erectile Disorder (ED): Difficulty achieving/maintaining erection during sexual activity.

3. Orgasm Phase

• Delayed Ejaculation: Persistent delay or absence of ejaculation.

• Premature (Early) Ejaculation: Ejaculation occurs within 1 minute of penetration.
• Female Orgasmic Disorder: Delay/infrequency/absence of orgasm, or reduced intensity.

4. Genito-Pelvic Pain/Penetration Disorder

• Pain, fear, or tensing of pelvic muscles during penetration (can involve vaginismus or
dyspareunia).

Example for exam: A woman experiences pain during penetration and tenses up involuntarily—

likely Genito-Pelvic Pain/Penetration Disorder.

Etiology of Sexual Dysfunctions

• Biological: Medical conditions (e.g., diabetes, heart disease), medications (SSRIs),

hormone levels, alcohol/drug use.
• Psychological: Performance anxiety, early negative sexual experiences, low self-esteem.
• Social/Cultural: Relationship issues, cultural taboos, trauma, religious beliefs.

Treatments for Sexual Dysfunctions

• Psychoeducation: Normalize sexual experiences, correct myths

• Sensate Focus: Gradual exercises focusing on non-genital touching to reduce
performance anxiety and increase comfort
• Cognitive Therapy: Identify and challenge negative beliefs about sex
• Medical options:
o Viagra, Cialis for erectile dysfunction
o SSRIs (to delay orgasm in premature ejaculation)

Paraphilic Disorders (8 Main Types)

These involve intense sexual arousal to unusual stimuli, causing distress or risk to others.
 Paraphilia Description

1. Fetishistic Disorder Sexual arousal from nonliving objects (e.g., shoes, leather)

2. Transvestic Disorder Sexual arousal from cross-dressing, usually in heterosexual males

3. Voyeuristic Disorder Arousal from watching unsuspecting people naked or undressing

4. Exhibitionistic
Arousal from exposing genitals to unsuspecting strangers
Disorder

5. Frotteuristic Disorder Arousal from touching/rubbing against a non-consenting person

6. Sexual Masochism
Arousal from being humiliated, beaten, bound, or made to suffer
Disorder

7. Sexual Sadism
Arousal from inflicting suffering or humiliation on others
Disorder

Arousal involving prepubescent children (person must be ≥16 and

8. Pedophilic Disorder
5 years older than the child)

Example: A man gets aroused by rubbing against strangers on the subway → Frotteuristic

Disorder.

Etiology of Paraphilic Disorders

• Early conditioning: Accidental pairing of arousal with inappropriate stimuli (e.g.,

arousal during punishment or childhood experience)
• Sexual arousal patterns become reinforced over time
• Often lack of consensual sexual relationships in adolescence
• Social skill deficits, fantasy reinforcement, or impulsivity play a role

Treatments for Paraphilias

• Behavioral therapy:
o Covert sensitization: Pairing deviant fantasy with negative imagery
o Orgasmic reconditioning: Shift arousal to more appropriate stimuli
• Cognitive therapy: Challenge distortions (e.g., “the child enjoyed it”)
• Relapse prevention training
 • Medications (antiandrogens/"chemical castration") to reduce libido in high-risk cases

Chapter 13

What Is Psychosis?

• Psychosis = A loss of contact with reality, involving:

o Delusions (false beliefs)
o Hallucinations (false sensory perceptions)
o Disorganized thoughts or behavior

It is a symptom, not a diagnosis—seen in disorders like schizophrenia, bipolar disorder, and

severe depression.

Delusions vs. Hallucinations

Delusions Hallucinations

False beliefs held despite evidence False sensory experiences

Cognitive in nature Perceptual in nature

Example: "The CIA implanted a chip in my Example: Hearing voices when no one is

brain" there

Positive vs. Negative Symptoms of Schizophrenia

Positive Symptoms (excesses/distortions)

• Delusions (e.g., persecution, grandeur, control)

• Hallucinations (most often auditory)
• Disorganized speech (e.g., word salad, tangents)
• Disorganized or catatonic behavior

“Positive” means added to normal functioning.

Negative Symptoms (deficits/losses)

• Flat affect (reduced emotional expression)

• Avolition (lack of motivation)
• Alogia (poverty of speech)
• Anhedonia (inability to feel pleasure)
• Social withdrawal

“Negative” means missing from normal functioning.

Brain Abnormalities in Schizophrenia

• Enlarged ventricles (fluid-filled spaces) → less brain tissue

• Reduced activity in prefrontal cortex → poor decision-making, planning
• Smaller hippocampus and amygdala
• Abnormalities in temporal and frontal lobes

The Dopamine Hypothesis

Basic Idea: Schizophrenia is linked to excess dopamine activity, particularly in the

mesolimbic pathway.

Supporting Evidence:

• Antipsychotic meds that block dopamine receptors reduce symptoms

• Amphetamines (increase dopamine) can cause psychotic symptoms in healthy people

Contradictory Evidence:

• Not all patients respond to dopamine-blocking meds

• Negative symptoms may be linked to low dopamine in prefrontal cortex
• Other neurotransmitters (glutamate, serotonin) are also involved

Updated view: Dopamine is part of a more complex network of neurotransmitter imbalances.

Prenatal Risk Factors for Schizophrenia

• Maternal infections (e.g., influenza in 2nd trimester)

• Prenatal malnutrition
• Hypoxia (oxygen deprivation during birth)
• Maternal stress
• Advanced paternal age
These events may affect brain development, increasing vulnerability.

Expressed Emotion (EE) and Relapse

• Expressed Emotion = Family members show:

o High criticism
o Hostility
o Overinvolvement

High EE = ↑ Relapse rates

→ Patients do worse in families high in EE.

Antipsychotic Medications

1. Typical (First-Generation) Antipsychotics

• Block dopamine receptors (e.g., Haloperidol)

• Effective for positive symptoms
• Risk of extrapyramidal symptoms (e.g., tremors, rigidity)

2. Atypical (Second-Generation) Antipsychotics

• Target dopamine and serotonin

• Treat both positive and some negative symptoms
• Fewer motor side effects, but weight gain, diabetes risk (e.g., Risperidone,
Olanzapine)

Chapter 15: Neurocognitive Disorders

Neurocognitive Disorders Overview

Neurocognitive disorders involve a decline in cognitive functioning (e.g., memory, attention,

language) due to brain dysfunction. These disorders are not developmental—they represent a loss

of previous abilities.

1. Delirium

• Acute, sudden onset (hours to days)

• Fluctuating level of consciousness
 • Disturbance in attention and awareness (e.g., easily distracted, disoriented)
• Often includes hallucinations, confusion, and agitation
• Caused by a medical condition, medication, or substance withdrawal

Example: An elderly patient suddenly becomes confused and agitated after surgery and doesn’t

recognize their hospital room.

Reversible if underlying cause is treated.

2. Major Neurocognitive Disorder (Dementia)

• Significant cognitive decline from previous functioning

• Impairs independence in daily activities (e.g., forgetting how to cook, pay bills)
• Can affect memory, language, decision-making, personality

Example: A woman forgets familiar routes home, confuses her grandchildren’s names, and can’t

manage money anymore.

3. Mild Neurocognitive Disorder

• Modest decline in one or more cognitive areas

• Person can still function independently, though may need extra effort or tools (e.g.,
notes, reminders)

Example: A man forgets appointments more often and has trouble recalling names but still drives

and lives independently.

Key Difference:

Feature Mild NCD Major NCD

Decline Modest Impaired

Independence Preserved
Alzheimer’s Disease (Most Common Cause of Major NCD)

Neuropathology (Brain Changes in Alzheimer’s):

1. Neurofibrillary Tangles
o Twisted strands of tau protein found inside neurons
o Disrupt transport systems within cells → cell death
2. Amyloid Plaques
o Clumps of beta-amyloid protein that build up between neurons
o Interfere with neuron communication
3. Brain Atrophy
o Loss of neurons → shrinkage in hippocampus and cortex
o Memory, reasoning, and language are affected
4. Acetylcholine Deficiency
o Important neurotransmitter for memory and learning is reduced

Progression is gradual and irreversible.

Chapter 16

When Can Confidentiality Be Broken?

Confidentiality is a core ethical duty—but therapists are legally required to break it in specific

situations:

Exceptions:

• Threat of harm to self or others

• Suspected child or elder abuse
• Court subpoena or legal order
• Patient files a malpractice lawsuit
• Involuntary hospitalization for danger to self/others

Note: In these cases, the therapist can disclose only the necessary information to the relevant

parties.

Tarasoff Case – Duty to Warn

• Tarasoff v. Regents of the University of California (1976):

o A therapist failed to warn a woman (Tatiana Tarasoff) about a patient’s threats to
kill her.
 o The patient later murdered her.

Legal outcome:

Therapists now have a “duty to warn” the intended victim and/or authorities if a client poses a

serious, identifiable threat to someone else.

Insanity Defense (Not Guilty by Reason of Insanity – NGRI)

How often is it used?

• <1% of felony cases involve the insanity plea

• Of those, only a small % are successful

Definition: The defendant lacked the ability to understand the wrongfulness of their actions due

to a severe mental illness at the time of the crime.

What Happens if Found NGRI?

• The person is not punished (not sent to prison)

• They are committed to a forensic psychiatric hospital for treatment
• May remain institutionalized longer than a prison sentence would have lasted

Competency to Stand Trial

A person must:

1. Understand the charges against them

2. Understand the courtroom proceedings
3. Be able to work with their attorney

Competency refers to current mental state, NOT their state at the time of the crime.

If Found Not Competent to Stand Trial:

• Court proceedings are paused

• The person is sent for restoration treatment (usually in a hospital)
 • If they regain competency → trial proceeds
• If never restored → charges may be dropped or civil commitment pursued

Civil vs. Criminal Commitment

Type Definition Who Decides Purpose

Civil Involuntary hospitalization due to Protect public or

Judge or court
Commitment danger to self/others or grave disability individual

Criminal Detainment after criminal offense (e.g., Court/criminal Public safety and

Commitment NGRI) trial treatment

Rights of Committed Patients

• Right to least restrictive environment

• Right to treatment
• Right to refuse treatment (unless legally overridden for safety)
• Right to informed consent

Even committed individuals retain basic civil liberties.